scholarly journals Surgical Drill Guide for Insertion of an Infra-Acetabular Screw Based on an Anatomically Precontoured Plate System: A Cadaveric Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Viola Freigang ◽  
Maximilian Gottsauner ◽  
Markus Rupp ◽  
Christian Pfeifer ◽  
Stephan Grechenig ◽  
...  
Keyword(s):  
Cadaveric Study ◽  
Joint Surface ◽  
Acetabular Fractures ◽  
Pelvic Brim ◽  
Anatomic Structure ◽  
System A ◽  
Drill Guide ◽  
Fracture Management ◽  
Distal Fixation ◽  
Fine Adjustment

Purpose. Due to the anatomic structure of the pelvis, free-hand placement of screws in the acetabular fracture management can be difficult. Infra-acetabular screw fixation increases acetabular stability by distal fixation of the cup. Aim of this cadaveric study is to investigate if a plate-referenced drill guide can provide save placement of an infra-acetabular screw over a precontoured suprapectineal quadrilateral buttress plate (SQBP). Methods. We constructed a drill guide for an infra-acetabular screw based on the surface of an anatomically precontoured SQBP. A total of 12 adult cadaveric acetabular specimens were used for drill guide-assisted placement of the infra-acetabular screw. The drill guide contains a radiopaque spiral to allow longitudinal fine adjustment of the SQBP along the pelvic brim to assure correct position of the plate-drill-guide construct in relation to the Koehler’s teardrop. After screw placement, we conducted a computed tomography (CT) scan of all specimens to assess the actual position of the screw in relation of the infra-acetabular corridor and the acetabular joint surface. Results. The position of the screw was within the infra-acetabular corridor in all cases. We did not see any intra-articular or intrapelvic screw penetration. The mean distance of the centerline of the screw to the medial border of the infra-acetabular corridor was 3.35 mm. The secure distance to the virtual surface of the femoral head to was 7.3 mm. Conclusions. A plate-referenced drill guide can provide safe placement of an infra-acetabular screw for treatment of acetabular fractures. Radiographic fine adjustment is necessary to access the optimal entry point.

scholarly journals Subtalar Joint Preparation Using 2 Portal Posterior Arthroscopic Technique vs Sinus Tarsi Open Approach: A Cadaveric Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Karthikeyan Chinnakannu ◽  
Eildar Abyar ◽  
Haley M. McKissack ◽  
Martim Pinto ◽  
Aaradhana J. Jha ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Cadaveric Study ◽  
Joint Surface ◽  
Open Approach ◽  
Open Technique ◽  
Arthroscopic Technique ◽  
Joint Preparation ◽  
Sinus Tarsi ◽  
Subtalar Fusion ◽  
Significant Difference

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: Subtalar fusion is the treatment of choice for subtalar arthritis when conservative management fails. Subtalar fusion can be done through open approach or arthroscopic technique. Arthroscopic technique is associated with rapid recovery; however, it requires adequate training and skill. Arthroscopic technique can be done through lateral or posterior portals. Sometimes it may be necessary to use accessory portal to open or distract the joint for adequate joint preparation. Use of accessory portal may result in injury to the neurovascular structure. Whatever the technique, one of the most important aspects of fusion is adequate preparation of the joint. Aim of our study is to compare the preparation of subtalar joint using sinus tarsi open approach and posterior subtalar scopy using 2 portal technique in cadaveric specimens. Methods: We used 20 below knee fresh-frozen cadaver legs for this cadaveric study. Subtalar joints of ten specimens were prepared through the lateral approach, while the remaining ten joints were prepared using sinus tarsi incisions. After the completion of preparation, all ankles were dissected open, photographic images of calcaneal and talar articular were taken. (Image)Surface areas of each articular facet and prepared area of the talus, distal tibia, and distal fibula were measured and analyzed. Results: Open technique results in better preparation of joint surface in calcaneus and overall. While open technique results in preparation of 92% joint surface (combined talus and calcaneus), arthroscopic technique results in in 80% of joint surface. Open technique results in better preparation of calcaneus (79vs 94%). The anterolateral corner of calcaneus was difficult to be reached using the scope and unprepared in most cases. There was no significant difference in the preparation of talar articular surface. (Table 1) Conclusion: Open sinus tarsi results in more joint preparation compared to 2 portal posterior arthroscopic technique. The less amount of joint preparation in arthroscopic technique is mostly due to less preparation of AL corner. Of calcaneus. When using posterior arthroscopic technique, it is advisable to use accessory portal to distract the joint to aid in adequate preparation.

Safety of Hip Anchor Insertion From the Midanterior and Distal Anterolateral Portals With a Straight Drill Guide: A Cadaveric Study

2016 ◽  
Vol 45 (3) ◽  
pp. 627-635 ◽  
Author(s):  
Ryan M. Degen ◽  
Lazaros Poultsides ◽  
Stephanie W. Mayer ◽  
Angela E. Li ◽  
Struan H. Coleman ◽  
...  
Keyword(s):  
Cadaveric Study ◽  
Drill Guide

Accuracy of anterior cruciate ligament tunnel placement with an active robotic system: A cadaveric study

2002 ◽  
Vol 18 (9) ◽  
pp. 968-973 ◽  
Author(s):  
Volker Musahl ◽  
Andreas Burkart ◽  
Richard E. Debski ◽  
Andrew Van Scyoc ◽  
Freddie H. Fu ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Robotic System ◽  
Cadaveric Study ◽  
Tunnel Placement ◽  
System A ◽  
Anterior Cruciate

Difficulties in Treating Complex Knee Injuries with Fracture of Posterior Tibial Plateau

2018 ◽  
Vol 20 (4) ◽  
pp. 293-300
Author(s):  
Kamil Kołodziejczyk ◽  
Krzysztof Kuliński ◽  
Krzysztof Fedorowicz ◽  
Maciej Langner ◽  
Jarosław Czubak ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Tibial Plateau ◽  
Knee Injuries ◽  
Tibial Plateau Fractures ◽  
Knee Joints ◽  
Joint Surface ◽  
X Rays ◽  
Posterior Tibial ◽  
Fracture Management ◽  
Operative Planning

Background. The aim of the study was to assess the outcomes of surgical treatment of complex knee injuries with a posterior inverted-L approach to the knee joint. Material and methods. The study retrospectively enrolled 13 patients who underwent surgical treatment due to knee injuries with posterior tibial plateau fractures in 2015-2017. Pre-operative planning was based on antero­po­sterior and lateral X-rays and CT images. The fracture was assessed according to Luo’s three-column classification. Radiographic postoperative assessment was based on lower limb (standing) X-rays and measurements of the MPTA, aPPTA, JLCA, and aFaT angles in the operated and healthy limbs. Clinical assessment was based on the IKDC, KOOS, and Tegner-Lysholm Knee Scoring Scale. Results. Mean follow-up duration was 11.5 months (4-25 months). Anatomical joint surface reduction was achiev­ed in 12 patients and bone union was present in all patients. A posterior inverted-L approach was used in 9 pa­tients and combined approaches in 8 patients. According to the three-column classification, single-column fractures were found in 3 patients, two-column fractures in 4, and three-column fractures in 6 patients. The KOOS was 82%, the IKDC score was 80%, and the Tegner-Lysholm score was 82 points. Radiographic assessments of the operated knee joints showed an MPTA of 88.64 degrees, aPPTA of 79.78 degrees, JLCA of 0.8 degrees, and aFaT of 7.9 degrees. Conclusions. 1. Anatomical reduction and stable fixation of posterior plateau fractures of the proximal tibia are crucial in fracture management. 2. A posterior inverted-L approach is very useful when treating posterior tibial plateau fractures.

Biomechanical assessment of a novel bone lengthening plate system — A cadaveric study

2013 ◽  
Vol 28 (2) ◽  
pp. 232-238 ◽  
Author(s):  
Tae Gon Jung ◽  
Seung Woo Suh ◽  
Sung Jae Lee ◽  
Bongju Kim ◽  
Dong-Wook Han ◽  
...  
Keyword(s):  
Cadaveric Study ◽  
Bone Lengthening ◽  
Biomechanical Assessment ◽  
System A ◽  
Plate System

scholarly journals Functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum

2021 ◽  
Vol 7 (6) ◽  
pp. 1139
Author(s):  
K. Nageswara Rao ◽  
Ronak Dinesh Soni ◽  
C. Nagesh ◽  
P. A. Shravan Kumar ◽  
B. Arvind Kumar
Keyword(s):  
Functional Outcome ◽  
Weight Bearing ◽  
Posterior Wall ◽  
Joint Surface ◽  
Acetabular Fractures ◽  
P Value ◽  
Radiological Outcome ◽  
Anatomic Reduction ◽  
Joint Reduction

<p class="abstract"><strong>Background:</strong> The incidence of acetabular fractures has increased following road traffic accidents. The aim of the study is to evaluate functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done at Nizam’s Institute of Medical Sciences, Hyderabad between May 2018 and May 2020. The sample size is 20 patients between the age group 18-60 years who presented to the hospital with closed posterior wall and/or column fractures of acetabulum with or without posterior dislocation of hip joint. Functional outcome is assessed by using the modified Merle D’ Aubigne Postel clinical grading system, radiological outcome by Matta et al and perioperative complication are assessed by retrospectively analyzing medical records and radiographics examination.<strong></strong></p><p class="abstract"><strong>Results:</strong> Functional outcome according to Merle D’ Aubigne and Postel score 16 patients (75%) showed good, 3 patients (20%) showed fair, 1 patient (5%) showed poor outcome. Radiological outcome according to Matta criteria, 16 patients (75%) showed excellent quality of joint reduction, 4 patients (25%) showed good quality of reduction of joint. There was significant correlation between anatomic reduction of the joint surface and functional outcome of the patient in our study (p value &lt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> Accurate joint reduction is of utmost importance in reduction of posterior wall or column fractures of acetabulum as posterior wall is the weight bearing zone. Functional outcome depends on fracture type, associated injuries, selection of patient, time between injury and surgery and postoperative rehabilitation.</p>

scholarly journals 1065 Exposing the Incidence of Ileus in Pelvic and Acetabular Fractures: A Retrospective Case Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Ward ◽  
R Ahmed ◽  
J Adedeji ◽  
J McGregor-Riley
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
High Energy ◽  
Trauma Centre ◽  
Acetabular Fractures ◽  
Retrospective Case ◽  
Visceral Injury ◽  
Bowel Surgery ◽  
Major Trauma Centre ◽  
Fracture Management

Abstract Background Paralytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury. This is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures. Method All patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data included patient demographics, injury pattern, fracture management and presence of ileus. Previous studies identified patients as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay. Results An incidence of ileus of 40.35% was observed in the 57 included patients. Ileus was three times more common in patients with a diagnosis of diabetes mellitus (p = 0.56) and 2.5 times more common in the presence of an open pelvic/acetabular fracture (p = 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p = 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors. Conclusions The authors have identified the essentiality of early risk factor identification and hope to encourage further research to create a prognostic tool.

Analysis of the Mechanisms for Compensation in Clock B

2020 ◽  
pp. 149-174
Author(s):  
David Harrison
Keyword(s):  
Quality Factor ◽  
Large Mass ◽  
High Quality ◽  
Suspension Spring ◽  
High Q ◽  
System A ◽  
Before And After ◽  
Design Requirements ◽  
Fine Adjustment ◽  
Pendulum Clock

This chapter assesses the design requirements of the grasshopper escapement, the pendulum and suspension spring to provide compensation for changing density and viscosity of the air surrounding the pendulum and changing escapement torque. It assesses the key components of the Harrison system: a pendulum bob of modest mass; a pendulum operating at a large running arc; and the grasshopper escapement’s increased torque delivery, ability to run without lubrication, its composers that allow fine adjustment to the torques delivered before and after the escaping arcs are reached and the importance of the thickness of the suspension spring that runs within circular cheeks. It also compares the system to the traditional pendulum clock design that traditionally employs a pendulum with a large mass and high-quality factor—high Q. Furthermore, it discusses Harrison’s stipulation that the pendulum needed to slightly reduce its length when warm.

Propensity for Hip Dislocation in Gait Loading Versus Sit-to-Stand Maneuvers: Implications for Surgical Management of Acetabular Fractures

2010 ◽  
Author(s):  
Erik McDonald ◽  
Meir Marmor ◽  
Jenni M. Buckley ◽  
Amir Matityahu
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Hip Dislocation ◽  
Acetabular Fractures ◽  
Loading Conditions ◽  
Joint Contact Force ◽  
Sit To Stand ◽  
Hip Stability ◽  
Fracture Management ◽  
Joint Contact

Acetabular fractures present a clinical challenge due to the complicated anatomy and difficulty of exposure, reduction, and fixation. There are several indications for surgery including any fracture which is displaced more than 2mm, failure to maintain reduction by closed means, or, for transverse fractures, a roof-arc angle less than 45 degrees (1,2). The last indication was determined by a cadaver model that only evaluated hip stability in the single leg stance phase of the gait cycle (3). Kinesiological models have well established that the magnitude and direction of the joint contact force can deviate substantially from the mechanics of gait loading, particularly for such activities of daily living as sit-to-stand maneuvers and climbing stairs (4,5). Thus, the criteria for fracture stability established using gait-only loading conditions may be inadequate for other activities of daily living. Basic engineering principles would dictate that the most conservative estimate of dislocation potential be used in managing these cases clinically; and it is therefore important to re-evaluate fracture management criteria in alternative loading conditions that have a high potential for dislocation.

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