scholarly journals Internal fixation of S1-S3 iliosacral screws and pubic screw as the best configuration for unstable pelvic fracture with unilateral vertical sacral fracture (AO type C1.3)

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769098 ◽  
Author(s):  
Ismail Hadisoebroto Dilogo ◽  
Oryza Satria ◽  
Jessica Fiolin
Keyword(s):  
Internal Fixation ◽  
Symphysis Pubis ◽  
Definitive Treatment ◽  
Posterior Fixation ◽  
Iliosacral Screw ◽  
Treatment Groups ◽  
Fixation Treatment ◽  
Load To Failure ◽  
Tension Band Plate ◽  
Type Of Fracture

Background: Although internal fixation is the definitive treatment in unstable pelvic fractures with disruption of the anterior arch and a vertical fracture of the sacrum (AO type C1.3), there have been no agreement of the best technique of internal fixation yet. We aimed to derive comparable objective data on stiffness and load to failure in this type of fracture fixations. Methods: Synbone was modified into AO type C1.3 fracture model, while treatments were divided into six internal fixation treatment groups using tension band plate (TBP), symphysis pubis plate (SP) with iliosacral screw at S1 and S2 (IS S1-S2), pubic screw (PS) with iliosacral TBP, PS and IS S1-S2, SP and IS S1-S3, PS and S1-S3 and finally PS and IS S1-S3. Sensor was applied to detect the shifting and rotation of fracture fragments. Mechanical strength test conducted with the application of axial force on the sacrum vertebra (S1). Results: The highest translational stiffness was observed in the group IS S1-S3 + PS (830.36 N/mm, p = 0.031) and there was no difference on the rigidity of the rotation between the groups posterior fixation using IS S1-S2 and IS S1-S3 ( p = 0.51). Meanwhile the highest load to failure was found in group IS S1-S3 + PS (1522.20 N). PS provided advantages compared to the use of plate. Conclusions: Group of PS and S1-S3 IS is the configuration of internal fixation with best translational and rotational stiffness and the largest load to failure compared to other techniques in AO type C1.3 fracture.

Implant retention and removal after internal fixation of the symphysis pubis

Injury ◽  
2005 ◽  
Vol 36 (7) ◽  
pp. 827-831 ◽  
Author(s):  
Raghu Raman ◽  
Craig S. Roberts ◽  
Hans-Christoph Pape ◽  
Peter V. Giannoudis
Keyword(s):  
Internal Fixation ◽  
Symphysis Pubis ◽  
Implant Retention

Association Between Minimum Inhibitory Concentration, Beta-lactamase Genes and Mortality for Patients Treated With Piperacillin/Tazobactam or Meropenem From the MERINO Study

2020 ◽  
Author(s):  
A Henderson ◽  
D L Paterson ◽  
M D Chatfield ◽  
P A Tambyah ◽  
D C Lye ◽  
...  
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Inhibitory Concentration ◽  
Absolute Risk ◽  
Definitive Treatment ◽  
Beta Lactam ◽  
Primary Analysis ◽  
Treatment Groups ◽  
Risk Increase ◽  
Mortality Difference ◽  
Post Hoc

Abstract Introduction This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial. Methods Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations. Results In total, 320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam nonsusceptible breakpoint (MIC >16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% confidence interval [CI] 2.8–87.2). The absolute risk increase for 30-day mortality for patients treated with piperacillin/tazobactam compared with meropenem was 9% (95% CI 3%–15%) and 8% (95% CI 2%–15%) for the original PA population and the post hoc MA populations, which reduced to 5% (95% CI −1% to 10%) after excluding strains with piperacillin/tazobactam MIC values >16 mg/L. Isolates coharboring extended spectrum β-lactamase (ESBL) and OXA-1 genes were associated with elevated piperacillin/tazobactam MICs and the highest risk increase in 30-day mortality of 14% (95% CI 2%–28%). Conclusions After excluding nonsusceptible strains, the 30-day mortality difference from the MERINO trial was less pronounced for piperacillin/tazobactam. Poor reliability in susceptibility testing performance for piperacillin/tazobactam and the high prevalence of OXA coharboring ESBLs suggests that meropenem remains the preferred choice for definitive treatment of ceftriaxone nonsusceptible Escherichia coli and Klebsiella.

An Isolated Chronic Osteochondral Fracture of the Third Metatarsal Head Treated With Bioabsorbable Pins

2016 ◽  
Vol 9 (6) ◽  
pp. 555-559 ◽  
Author(s):  
Toshinori Kurashige ◽  
Seiichi Suzuki
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Case Reports ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Osteochondral Fracture ◽  
The Third ◽  
Freiberg’S Disease ◽  
Type Of Fracture

An osteochondral fracture of the metatarsal head is generally the result of direct trauma and is associated with additional proximal fractures of the medially adjacent metatarsals. An isolated osteochondral fracture of the metatarsal head is extremely rare, with only 10 published case reports. Open reduction and internal fixation was performed in 6 of 10 cases and in 2 of 4 chronic cases, each with different implants previously. The mechanism of injury was considered to be shear force in 5 of the reported cases. It is difficult to achieve and maintain reduction in these cases, and the best method for treatment of this type of fracture is unclear. We report a case of an isolated chronic osteochondral fracture of the third metatarsal head in a 14-year-old boy. The boy reported pain in his third metatarsophalangeal joint on dismounting from a bicycle 2 months prior to presentation. He could play soccer at first; however, the pain worsened after running long distances. Therefore, he was referred to our department. Magnetic resonance imaging revealed an osteochondral fracture of the metatarsal head without Freiberg’s disease. We achieved a good result 12 months postoperatively by using open reduction and internal fixation with 2 bioabsorbable thread pins. Levels of Evidence: Therapeutic, Level IV: Case study

Evaluation of New Plate Designs for Symphysis Pubis Internal Fixation

1996 ◽  
Vol 41 (3) ◽  
pp. 498-502 ◽  
Author(s):  
Peter T. Simonian ◽  
John R. Schwappach ◽  
M. L. Chip Routt ◽  
Samuel G. Agnew ◽  
Richard M. Harrington ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Symphysis Pubis

Clinical Analysis of Internal Fixation Treatment of Intra-articular Calcaneal Fractures with Titanium Plate

2015 ◽  
Vol 72 (1) ◽  
pp. 153-156 ◽  
Author(s):  
Xiao-dong Chen ◽  
Chang-chun Zhang ◽  
Zhao-cheng Li ◽  
Heng Zhang ◽  
Xin-she Zhou ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Clinical Analysis ◽  
Titanium Plate ◽  
Calcaneal Fractures ◽  
Fixation Treatment

scholarly journals Percutaneous iliosacral screw fixation for posterior pelvic ring injuries: the first experience, complicatons

2013 ◽  
Vol 12 (4) ◽  
pp. 233-237
Author(s):  
Valentinas Uvarovas ◽  
Andrius Vaitiekus ◽  
Igoris Šatkauskas ◽  
Donatas Ulevičius
Keyword(s):  
Screw Fixation ◽  
Pelvic Ring ◽  
Operation Time ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Iliosacral Screw ◽  
Early Results ◽  
First Results ◽  
Group B ◽  
Iliosacral Screw Fixation

BackgroundPercutaneous iliosacral screw fixation is a minimally invasive technique for the treatment of unstable pelvic injuries involving the posterior ring. Nevertheless, screw malposition may result in dangerous complications involving injury to adjacent neurological structures. This study was conducted in order to evaluate the first results of using the percutaneous iliosacral screw technique at the Republican Vilnius University Hospital.ObjectiveTo report the early results and possible complications of percutaneous iliosacral screw fixation in the management of unstable pelvic ring injuries.MethodsThe data for the period 2011–2013 were collected retrospectively. Fifty-five patients who suffered from injury to the pelvic ring requiring surgical treatment were included in this study. Twenty-two operations were done using canulated screws(group A, 20 operations using 7.3 mm and 2 operations 8.3 mm screws), and 33 (group B) operations were done using noncanulated 6.5 mm screws. We compared our first results of using canulated and non-canulated screws. The data were analysedusing MS Exel.ResultsFrom the analysed 55 patients, 20 (36.4%) were men and 35 (63.6%) women; the average age of the patients was 51 (range, 21–98) years. According to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification, there were 49 patients withtype B and 6 patients with type C. The mean operation time was 36 min (range, 10–115). Three patients from group B required reoperation because of a neurological injury. Two of these patients suffered from L5 neuropathy and one from S1 radiculalgy.The complication rate was 9.1 per cent in group B, and they were now complicationa in group B. Twelve patients underwent percutaneous iliosacral screw fixation and anterior fixation, one patient underwent percutaneous iliosacral conversion to open posterior SI fixation osteosynthesis because of neurological complications, while the other 43 patients underwent percutaneous screw fixation only.ConclusionsPercutaneous iliosacral screw fixation is a rapid, safe and definitive treatment for unstable pelvic ring injury. The technique using standard C-arm fluoroscopy may allow accurate location of the screw placed in S1 and result in fewer complications when using percutaneous canulated screws. Key words: percutaneous iliosacral fixation, canulated iliosacral screws, three-dimensional fluoroscopyPerkutaninė kryžkaulio klubikaulio sąnario fiksacija esant užpakalinio dubens žiedo sužalojimams: pirmoji patirtis, komplikacijos  Įvadas / tikslasPerkutaninė kryžkaulio klubakaulio sąnario fiksacija sraigtais yra minimaliai invazinis operacinio gydymo metodas nestabiliems užpakalinio dubens žiedo sužalojimams gydyti. Vis dėlto gretimos nervinės struktūros gali būti pažeistos dėl blogossraigto padėties. Mūsų darbo tikslas – įvertinti Respublikinės Vilniaus universitetinės ligoninės pirmuosius kryžkaulio klubikaulio sąnario operacinio gydymo perkutaninės fiksacijos būdu rezultatus ir nustatyti nestabilių dubens žiedo sužalojimųgydymo komplikacijų dažnį.MetodaiRetrospektyviai išanalizuoti 2011–2013 metais gydytų 55 pacientų duomenys. Atliktos 22 operacijos naudojant kaniuliuotus (A grupė, 20 operacijų naudojant 7,3 mm ir 2 operacijos 8,3 mm sraigtus) ir 33 (B grupė) – nekaniuliuotus 6,5 mm sraigtus.Palyginome pirmuosius operacinio gydymo kaniuliuotais ir nekaniuliuotais sraigtais rezultatus. Duomenys analizavome MS Exel programa.RezultataiOperuoti 55 pacientai, iš jų 20 (36,4 %) vyrų ir 35 (63,6 %) moterys. Tiriamųjų amžiaus vidurkis – 51 (21–98) metai. Pagal AO (Arbeitsgemeinschaft für Osteosynthesefragen) klasifikaciją buvo 49 pacientai. Trys B grupės (9,1 %) pacientai buvo peroperuoti dėl neurologinių komplikacijų (du pacientai dėl L5 neuropatijos ir vienas dėl S1 radikulialgijos). A grupės pacientams komplikacijų nebuvo. Dvylikai pacientų atlikta perkutaninė kryžkaulio klubakaulio sąnario fiksacija ir kartu priekinė fiksacija ir 43 pacientams – tik užpakalinė kryžkaulio klubakaulio sąnario fiksacija sraigtu.IšvadosPerkutaninė kryžkaulio klubakaulio sąnario fiksacija yra greitas, saugus ir galutinis nestabilių užpakalinio dubens žiedo sužalojimų operacinio gydymo metodas. Naudojant standartinį rentgeno C-lanką galima tiksliai lokalizuoti sraigto padėtį S1slankstelio lygyje. Naudojant kaniuliuotus sraigtus komplikacijų nepasitaikė, o naudojant nekaniuliuotus sraigtus galimos neurologinės komplikacijos.Reikšminiai žodžiai: perkutaninė kryžkaulio klubakaulio sąnario fiksacija, kaniuliuoti kryžkaulio klubakaulio sraigtai, trijų dimensijų fluoroskopija.

scholarly journals Biomechanical Study on the Treatment of Acromioclavicular Joint Dislocation by Coracoclavicular Ligament Reconstruction With a Novel EndoButton Plate Combined With Suture Anchor

2021 ◽  
Author(s):  
Zhe Song ◽  
Chen Wang ◽  
Na Yang ◽  
Yangjun Zhu ◽  
Kun Zhang ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Acromioclavicular Joint ◽  
Suture Anchor ◽  
Acromioclavicular Joint Dislocation ◽  
Coracoclavicular Ligament ◽  
Joint Dislocation ◽  
Average Load ◽  
Load To Failure ◽  
Group A ◽  
Group B

Abstract Purpose This study aimed to assess the biomechanical stability of a novel internal fixation system of EndoButton plate combined with suture anchor in treating acromioclavicular joint dislocation in the cadaveric specimens. In addition, it provides a new method for the clinical treatment of acromioclavicular joint dislocation. Methods Twelve complete shoulder joint specimens were randomly divided into groups A, B, C, and D (n = 3). Firstly, a quasi-static non-destructive circulation experiment was carried out of coracoclavicular ligament until its function failed. Four different internal fixation materials were used to reduce and fix the acromioclavicular joint. Group A was treated with 3.5 mm clavicular hook locking compression plates, Group B with 5 mm suture anchor Group C with 10 mm Endo-button plate, and Group D with a novel combination of 5 mm suture anchor and 10 mm Endo-button plate. Fluoroscopy was performed to undertake the X-ray of the restored acromioclavicular joint, to evaluate the internal fixation position and acromioclavicular joint reduction. Finally, the shoulder joint was fixed firmly on an electronic universal testing machine (100KN) with a self-made stationary fixture, to conduct a destructive static tensile mechanical test of each specimen vertically at a 100 mm/min load speed. The stress-deformation curve was recorded using a computer connected with the universal mechanical testing machine, and the failure strength and reasons for internal fixation were also recorded. Results The average load-to-failure of the coracoclavicular ligament in groups A, B, C, and D was 373.4 ±0.57 N, 373.6 ±0.62 N, 374.4 ±0.68 N, and 373.9 ±0.15 N, respectively (P>0.05). After internal fixation failure, Group A showed two specimens with clavicular fracture, and one with acromial fracture, with an average load-to-failure of 409.8 ±2.92 N. Group B and D showed three specimens with prolapse of anchor, with average load-to-failure of 293.5 ±4.10 N and 374.2 ±0.40 N, respectively. Group C showed three specimens with basilar coracoid fracture, with average load-to-failure of 373.2 ±2.35 N. Statistical differences existed in the biomechanical load of internal fixation failure among the four groups. Group D was statistically different from Group A and Group B, but not Group C. Conclusion The newly designed EndoButton plate combined with suture anchor for coracoclavicular ligament reconstruction was found to boast simple operation and has high feasibility. Thus it was found effective in the reduction of acromioclavicular joint and treatment of acromioclavicular joint dislocation and fitted the biomechanical characteristics of the acromioclavicular joint.

Management of Subdural Hematohygromas in Abusive Head Trauma

Neurosurgery ◽  
2019 ◽  
Author(s):  
Vincent N Nguyen ◽  
David Wallace ◽  
Sonia Ajmera ◽  
Oluwatomi Akinduro ◽  
Lydia J Smith ◽  
...  
Keyword(s):  
Head Trauma ◽  
Abusive Head Trauma ◽  
Needle Aspiration ◽  
Hospital Charge ◽  
Definitive Treatment ◽  
Average Hospital ◽  
Entire Cohort ◽  
Treatment Groups ◽  
Fluid Collections ◽  
Burr Holes

Abstract BACKGROUND The optimal management of nonacute subdural fluid collections in infantile abusive head trauma (AHT) remains controversial. OBJECTIVE To review the outcomes and costs of the various treatments for symptomatic subdural fluid collections in children with AHT at a single center. METHODS Our AHT database was queried to identify children requiring any intervention for hematohygromas. Demographic, hospital course, radiologic, cost, readmission, and follow-up information were collected. RESULTS From January 2009 to March 2018, the authors identified 318 children with AHT, of whom 210 (66%) had a subdural collection of any type (blood or cerebrospinal fluid). A total of 50 required some form of intervention specifically for chronic hematohygromas. The initial management consisted of transfontanelle percutaneous aspiration (n = 31), burr holes with (n = 12) or without (n = 3) external subdural drainage, and mini-craniotomy (n = 4). Of those who were initially managed with 1 or more needle aspiration, 23 (74%) required further intervention—12 subduroperitoneal shunts and 11 nonshunt procedures. No patient who underwent burr holes/external drainage required further intervention (n = 16). Overall, the average number of interventions needed in these 50 children for definitive treatment was 1.8 (range, 1-4). A total of 15 children ultimately required a subduroperitoneal shunt. Complications (infectious, hemorrhagic, and thrombotic) were significant and occurred in all treatment groups except burr holes without drainage (n = 3). The average hospital charge for the entire cohort was $166 300.25 (range, $19 126-$739 248). CONCLUSION Based on our experience to date, burr hole with controlled external subdural drainage is an effective and preferred treatment for traumatic hematohygromas; complications and need for additional intervention is low.

scholarly journals Acromioclavicular Joint Stabilization: A Biomechanical Study of Bidirectional Stability and Strength

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983675 ◽  
Author(s):  
Patrick Hislop ◽  
Kentaro Sakata ◽  
David C. Ackland ◽  
Robert Gotmaker ◽  
Matthew C. Evans
Keyword(s):  
Cyclic Loading ◽  
Laboratory Study ◽  
Vertical Plane ◽  
Joint Capsule ◽  
Ac Joint ◽  
Treatment Groups ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Horizontal Stability ◽  
Group A

Background: It is important to restore horizontal and vertical stability to the acromioclavicular (AC) joint when treating dislocations of this joint. Most surgical stabilization techniques of the AC joint have primarily addressed the coracoclavicular ligament complex; however, these techniques may not satisfactorily restore horizontal stability to the AC joint. Purpose: To evaluate the strength and bidirectional stability of 3 AC joint stabilizing techniques in a cadaveric model. Study Design: Controlled laboratory study. Methods: A total of 24 cadaveric shoulders were randomly allocated to 3 treatment groups. For each group, a standardized AC joint stabilizing procedure was performed, and the specimens were potted for mechanical testing. The following reconstruction techniques were used: a single clavicular tunnel for group A, a double clavicular tunnel for group B, and a double clavicular tunnel plus suture fixation across the AC joint for group C. The specimens underwent cyclic loading in the horizontal and vertical planes and then load to failure. Eight control specimens also underwent cyclic loading in both planes. Construct stiffness during cyclic loading, change in displacement after cyclic loading in both planes, load to failure in the vertical plane, and mode of failure were evaluated, and stiffness was compared among the treatment groups as well as with a control group. Results: There was a decrease in joint stiffness for all groups, including controls, during the cyclic loading. Compared with controls, all 3 treatment groups demonstrated equivalent stiffness and displacement in the vertical plane. In the horizontal plane, all 3 treatment groups demonstrated decreased stiffness, increased displacement, or both when compared with controls. When groups were compared, no treatment arm proved superior regarding stiffness or displacement in either plane. Load-to-failure testing of the 3 treatment groups in the vertical plane demonstrated construct strength and stiffness comparable with reports for the native AC joint. The mode of failure was predominantly fracture at the point of fixation to the testing apparatus. Conclusion: There was no difference in bidirectional strength and stability between the single– and double–clavicular tunnel techniques of coracoclavicular reconstruction. The addition of a stabilizing suture across the AC joint does not improve horizontal stability in the absence of repair of the AC joint capsule and deltotrapezial fascia. Clinical Relevance: This laboratory study provides further evidence of the importance of the AC joint capsule and associated soft tissues in affording horizontal stability to that joint. Information from this and subsequent studies utilizing a bidirectional model can influence the choice of surgical procedure in the clinical treatment of AC joint dislocations.

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