Posterior Arthroscopic Reduction and Internal Fixation for Treatment of Posterior Malleolus Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 115-120
Author(s):  
Kevin D. Martin
Keyword(s):  
Internal Fixation ◽  
Fracture Fixation ◽  
Lateral Approach ◽  
Fixation Method ◽  
Percutaneous Fixation ◽  
Alternative Technique ◽  
Surgical Indications ◽  
Level Of Evidence ◽  
Posterior Malleolus ◽  
Anterior Posterior

Posterior malleolus fractures and pilon variants refer to a pattern of fractures involving the posterior weightbearing surface of the tibial plafond. The surgical indications for fixation of posterior malleolus fractures varies considerably throughout the literature, based on the size and/or displacement. There is controversy on how to best address fracture fixation, with the main workhorses being either the posterior-lateral approach or indirect anterior-posterior–directed screws. We present an alternative technique for posterior malleolus fracture fixation using a direct posterior arthroscopic-assisted reduction internal fixation method. With this method, posterior malleolus fractures are reduced arthroscopically and percutaneous fixation is placed through the arthroscopic portals. Level of Evidence: Level V, expert opinion

scholarly journals Internal Fixation Method Using EZ-Tcon for Transconjunctival Fat Repositioning: Clinical Outcomes and Efficacy

2020 ◽  
Vol 44 (5) ◽  
pp. 1-12
Author(s):  
Cheol Ho Chang ◽  
Juyoung Bae ◽  
Myung Kyu Cha ◽  
Sa Ik Bang ◽  
Kyeong-Tae Lee
Keyword(s):  
Internal Fixation ◽  
Fixation Method ◽  
Full Description ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Advantages And Disadvantages ◽  
Tear Trough ◽  
Tear Trough Deformity ◽  
If Technique ◽  
Fat Repositioning

Abstract Background Transconjunctival fat repositioning is the gold standard for the correction of tear trough deformity. For fixation of fat pedicle, the internal fixation (IF) and externalized percutaneous suture (EPS) techniques are used, which have their own advantages and disadvantages. The present study aimed to introduce a new IF technique using a devised needle (EZ-Tcon) and to compare its outcomes with those of the conventional EPS technique. Methods Patients with primary tear trough deformity who underwent transconjunctival fat repositioning were reviewed and categorized into two cohorts according to the fixation technique: cohort 1 consisted of patients treated using the conventional EPS technique and cohort 2 consisted of those in whom the new IF technique using EZ-Tcon was adopted. Post-operative complications and aesthetic outcomes were assessed using a four-scale grading system. Results A total of 545 patients, 211 from cohort 1 and 344 from cohort 2 were evaluated with a median follow-up of 70 days. Compared to cohort 1, cohort 2 showed significantly lower rates of long-standing conspicuous scars on lower eyelid, re-operation and overall complications. In the analysis of aesthetic outcomes, 88.9 percent of cohort 2 showed grade 0 (no deformity) or I (mild deformity) post-operatively. The rate of excellent outcomes (improvements of ≥ two grades) was significantly higher in cohort 2 than in cohort 1 (p-value < 0.001). Conclusion Our technique using EZ-Tcon could possess advantages of the conventional IF and EPS techniques, showing lower complication rates and aesthetically satisfactory outcomes, and could be a safe and reliable method of transconjunctival fat repositioning. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

scholarly journals Intramedullary Fixation of Distal Radius Fractures Using CAGE-DR Implant

2018 ◽  
Vol 07 (05) ◽  
pp. 358-365
Author(s):  
Schneider Rancy ◽  
Stephanie Malliaris ◽  
Eric Bogner ◽  
Scott Wolfe
Keyword(s):  
Internal Fixation ◽  
Grip Strength ◽  
Distal Radius ◽  
Fracture Fixation ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Promising Alternative ◽  
Pain Scores

Purpose CAGE-DR implant is a novel Food and Drug Administration approved intramedullary fracture fixation device used for distal radius fractures. We examine a series of 22 patients and report the outcomes with this device. Materials and Methods A total of 24 patients with distal radius fractures (8 articular AO type C1/C2; 16 extra-articular AO type A2/A3) underwent open reduction and internal fixation (ORIF) using CAGE-DR implant by a single surgeon. Data including fracture type, angle of displacement, radiographic consolidation, grip strength, wrist range of motion (ROM), patient-rated wrist evaluation (PRWE), and Visual Analog Scale (VAS) pain scores were recorded at time of surgery and at standard follow-up. Results All 24 patients underwent uneventful ORIF. At first follow-up visit (9 days), all patients had full digital ROM (measured as 0 cm tip-to-palm distance). Two patients were lost to follow-up. Eighteen of the remaining 22 patients had sufficient radiographic follow-up and all 18 demonstrated healing. At latest follow-up (mean 9.7 months, range, 3–20), VAS pain scores averaged 0.6 (range, 0–8) and PRWE averaged 12.1 (range, 0–53.5). Grip strength of the operated hand averaged 58 lbs (range, 20–130). ROM included: wrist flexion 73° (50–95), wrist extension 78° (60–110), pronation 77° (60–90), supination 79° (60–90), ulnar deviation 31° (5–45), and radial deviation 17° (10–30). Three patients underwent screw removal to prevent tendon irritation. One patient underwent hardware removal due to prominence on imaging but was asymptomatic. There were otherwise no major complications, including complex regional pain syndrome, in the series to date. Conclusion The CAGE-DR fracture fixation system is a promising alternative to established methods of distal radius internal fixation. This series has a low reported pain score starting immediately postoperatively and a low complication rate. This novel device is a promising option for internal fixation of displaced distal radius fractures with a low complication profile. Level of Evidence This is a level IV, therapeutic study.

Fat Repositioning With a Combination of Internal Fixation and External Fixation in Transconjunctival Lower Blepharoplasty

2021 ◽  
Author(s):  
Jianwu Chen ◽  
Tao Zhang ◽  
Xuanru Zhu ◽  
Wenhua Huang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Internal Fixation ◽  
External Fixation ◽  
Fixation Method ◽  
Resonance Imaging ◽  
Facial Soft Tissue ◽  
Level Of Evidence ◽  
Tear Trough ◽  
Fat Repositioning

Abstract Background Various methods on transconjunctival fat repositioning have been promoted to treat tear trough deformities in patients with eye bags. Objectives The authors present a modified approach based on the facial soft-tissue spaces with the combined fixation method. Methods A total 226 patients underwent this procedure. Through a preseptal approach, the premaxillary and prezygomatic spaces were sequentially separated. Orbital fat was repositioned into the spaces together with the septum. The proximal part of the septum-fat flap was sutured to orbital rim with internal fixation, and their distal stumps were fixed to the end of the soft spaces with externalized percutaneous sutures. Surgical outcome was assessed by surgeons based on Hirmand’s grading system. Patients’ satisfaction and quality of life were measured using FACE-Q scales. Magnetic resonance imaging was employed to assess the long-term fate of the transposed fat. Results Tear trough deformities were eliminated in 86.7% of cases. Scores of lower eyelid FACE-Q decreased significantly (P &lt; 0.05). Patients demonstrated enhanced social confidence (P &lt; 0.05) and high satisfaction (74.3 ± 17.2) and were satisfied with their decision to undergo blepharoplasty (78.2 ± 18.7). Undercorrection occurred in 1 patient. Additional complications included transient granulomas, dye eye, unexplained swelling, and numbness, which resolved in all patients. Magnetic resonance imaging confirmed viability of the transposed fat within 6 to 8 months follow-up. Conclusions Transconjunctival fat repositioning, utilizing a combination of internal fixation and external fixation, is an effective approach to treat eye bags and tear trough deformities with good patient and surgeon satisfaction. Level of Evidence: 4

scholarly journals PO 18204 - Posterior ankle arthroscopy for percutaneous fixation of a posterior malleolar fracture

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 44S
Author(s):  
Guilherme De Souza Fernandes ◽  
Claudio Velleca e Silva
Keyword(s):  
Internal Fixation ◽  
External Rotation ◽  
Fracture Dislocation ◽  
Osteochondral Lesions ◽  
Flexor Hallucis Longus ◽  
Percutaneous Fixation ◽  
Malleolar Fracture ◽  
Percutaneous Reduction ◽  
Posterior Malleolar Fracture ◽  
Posterior Malleolus

Introduction: The authors report the case of a 47-year-old patient who fell and experienced a sprained ankle that progressed to posterolateral fracture-dislocation of the ankle and Lauge-Hansen stage 4 supination-external rotation. Objective: To evaluate the use of posterior ankle endoscopy to facilitate the internal fixation of a posterior malleolar fracture.  Methods: Case report of a patient with posterolateral fracture-dislocation of the ankle and description of the use of endoscopy for treatment. Examinations performed in the emergency room showed evidence of posterior malleolar fracture with a typical Volkmann fragment and a Danis-Weber type-B lateral malleolar fracture with posterolateral dislocation of the ankle joint. After fracture immobilization, the patient underwent surgical treatment with posterior endoscopy of the ankle for visualization and for percutaneous fixation of the posterior malleolar fracture and open reduction, with internal fixation with a direct incision of the fibula (lateral malleolus). Results: The use of endoscopic and arthroscopic methods for the ankle has gained popularity, although there is still apprehension in using posterior endoscopy due to its limited visualization and less-comprehensive indication compared with anterior methods. Currently, posterior methods are indicated for osteochondral lesions of the subtalar joint, posterior malleolar and calcaneal fractures, tenosynovitis of the flexor hallucis longus and posterior synovitis. Despite the limited visualization, the use of endoscopy in this case enabled the percutaneous reduction and fixation of the posterior malleolus without requiring a classic posterior approach; consequently, the patient experienced less pain during the postoperative period and faster recovery than occurs with the classic incision. Conclusion: We expect that over time posterior endoscopy will be increasingly used among surgeons in cases of posterior malleolar fracture because it offers a shorter hospital stay and allows patients to resume their activities of daily living earlier. However, posterior endoscopy of the ankle is not without complications and has a steeper learning curve than anterior endoscopy. Therefore, knowledge of the anatomy, indications and technique is fundamental.

Arthroscopic Visualization of the Tibial Plafond During Posterior Malleolar Fracture Fixation

1994 ◽  
Vol 15 (4) ◽  
pp. 206-208 ◽  
Author(s):  
Edward S. Holt
Keyword(s):  
Internal Fixation ◽  
Fracture Fixation ◽  
Open Reduction ◽  
Articular Surface ◽  
Malleolar Fracture ◽  
Posterior Tibial ◽  
Tibial Plafond ◽  
Posterior Malleolus ◽  
Anatomic Reduction ◽  
Trimalleolar Fracture

Fracture of the tibial plafond, such as in a trimalleolar fracture, with a large posterior tibial (posterior malleolus) fragment may require open reduction and internal fixation. Anatomic reduction of the articular surface can be ensured by visualizing the articular surface using an arthroscope during reduction. Four cases wherein this technique has proven effective are described.

scholarly journals Allocation of Anchors During Labral Repair: A Multicenter Cohort Analysis of Labral Treatment in Hip Arthroscopy

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098198
Author(s):  
Ryan P. McGovern ◽  
John J. Christoforetti ◽  
Benjamin R. Kivlan ◽  
Shane J. Nho ◽  
Andrew B. Wolff ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Cohort Analysis ◽  
Arthroscopic Surgery ◽  
Labral Repair ◽  
Fixation Method ◽  
Entire Group ◽  
Acetabular Labrum ◽  
Level Of Evidence ◽  
Multicenter Cohort ◽  
Tear Size

Background: While previous studies have established several techniques for suture anchor repair of the acetabular labrum to bone during arthroscopic surgery, the current literature lacks evidence defining the appropriate number of suture anchors required to effectively restore the function of the labral tissue. Purpose/Hypothesis: To define the location and size of labral tears identified during hip arthroscopy for acetabular labral treatment in a large multicenter cohort. The secondary purpose was to differentiate the number of anchors used during arthroscopic labral repair. The hypothesis was that the location and size of the labral tear as well as the number of anchors identified would provide a range of fixation density per acetabular region and fixation method to be used as a guide in performing arthroscopic repair. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We used a multicenter registry of prospectively collected hip arthroscopy cases to find patients who underwent arthroscopic labral repair by 1 of 7 orthopaedic surgeons between January 2015 and January 2017. The tear location and number of anchors used during repair were described using the clockface method, where 3 o’clock denoted the anterior extent of the tear and 9 o’clock the posterior extent, regardless of sidedness (left or right). Tear size was denoted as the number of “hours” spanned per clockface arc. Chi-square and univariate analyses of variance were performed to evaluate the data for both the entire group and among surgical centers. Results: A total of 1978 hips underwent arthroscopic treatment of the acetabular labrum; the most common tear size had a 3-hour span (n = 820; 41.5%). Of these hips, 1645 received labral repair, with most common repair location at the 12- to 3-o’clock position (n = 537; 32.6%). The surgeons varied in number of anchors per repair according to labral size ( P < .001 for all), using 1 to 1.6 anchors for 1-hour tears, 1.7 to 2.4 anchors for 2-hour tears, 2.1 to 3.2 anchors for 3-hour tears, and 2.2 to 4.1 for 4-hour tears. Conclusion: Variation existed in the number of anchor implants per tear size. When labral repair involved a mean clockface arc >2 hours, at least 2 anchor points were fixated.

scholarly journals Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

2020 ◽  
Vol 09 (02) ◽  
pp. 141-149
Author(s):  
Pooja Prabhakar ◽  
Lauren Wessel ◽  
Joseph Nguyen ◽  
Jeffrey Stepan ◽  
Michelle Carlson ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Scaphoid Fracture ◽  
Receiver Operating Curve ◽  
Scaphoid Nonunion ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Time From Injury

Abstract Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case–control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.

Posterior Instability of the Talus: An Anatomic Evaluation

Foot & Ankle ◽  
1989 ◽  
Vol 10 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Marion C. Harper
Keyword(s):  
Internal Fixation ◽  
Cadaver Study ◽  
Lateral Radiograph ◽  
Medial Malleolus ◽  
Posterior Instability ◽  
Posterior Tibial ◽  
Malleolar Fractures ◽  
Posterior Malleolus ◽  
Supporting Structures

A cadaver study was conducted to evaluate the role of the posterior tibial margin or posterior malleolus, as well as medial and lateral supporting structures, in providing posterior stability for the talus. Posterior malleolar fractures consisting of approximately 30%, 40%, and 50% of the articular margin on the lateral radiograph were created in specimens that were then subjected to posterior stressing. No posterior talar subluxation was noted in any specimen. Repeat stressing following removal of the medial malleolus again revealed no subluxation in any specimen. The lateral supporting structures, primarily the posterior fibulotalar and fibulocalcaneal ligaments, appeared to be the key structures providing posterior talar stability. If the fibula is stable in an anatomic position, feared posterior instability of the talus would not appear to be an indication for internal fixation of posterior malleolar fractures.

Sign in / Sign up

Export Citation Format

Share Document