Accuracy of fluoroscopic examination in the treatment of Bennett’s fracture

Abstract Background Restoration of joint congruity is an important factor for the prevention of subsequent arthritis in patients with Bennett’s fracture. Surgical treatment of Bennett’s fracture is thus generally recommended for displaced intra-articular fractures to the proximal aspect of the thumb metacarpal. Fluoroscopic examination is used to evaluate the adequacy of closed reduction after pinning of Bennett’s fracture. The purpose of this study was to determine the accuracy of fluoroscopy to determine the reduction of Bennett’s fractures. Methods A model was created, to mimic a Bennett’s fracture utilizing ten fresh-frozen cadaveric hands. An oblique cut was made in the proximal aspect of the thumb metacarpal using an oscillating saw. The small oblique fragment involved 1/4–1/3 of the joint surface was then shifted in position creating a step-off or gap at the fracture site. An anatomical reduction model, gap models (1 mm, 2 mm, 3 mm), and step-off models (1 mm, 2 mm, 3 mm) were created using percutaneous fixation with two 1.0 mm Kirschner wires for each cadaveric hand. Fluoroscopic assessment then took place and was reviewed by 2 attending hand surgeons blinded to the actual position. Their estimated fluoroscopic position was then compared to the actual displacement. Results The step-off and gap on fluoroscopic examination showed a significant difference compared to the step-off and gap from direct visualization. The frequency of underestimation for the 3 mm displacement models from the fluoroscopic examination was 60%. The frequency for overestimated was 9% for the models in which displacement was within 2 mm (0, 1, 2 mm). Conclusions The assessment of articular gap and step-off using PA (postero-anterior), AP (antero-posterior), and lateral view of fluoroscopic examination is not accurate as compared to the examination by direct visualization. Surgeons need to be aware that PA, AP and lateral view of fluoroscopic examination alone may not be sufficient to judge the final position of a reduced Bennett’s fracture. Other methods such as live fluoroscopy in multiple different planes, 3-dimensional fluoroscopy or arthroscopic examination should be considered.

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Effectiveness of the Saline Load Test in Diagnosis of Traumatic Ankle Arthrotomies in Varying Arthrotomy Locations

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00326 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0032

Author(s):

Erin Ohliger ◽

Sara Lyn Miniaci-Coxhead

Keyword(s):

Methylene Blue ◽

Cadaveric Study ◽

Load Test ◽

Blue Staining ◽

Direct Visualization ◽

Anteromedial Portal ◽

Significant Difference ◽

Anterolateral Portal ◽

Fresh Frozen ◽

Ankle Trauma

Category: Ankle, Trauma Introduction/Purpose: The purpose of this study was to investigate the amount of fluid required and the sensitivity of the saline load test to identify an intra-articular arthrotomy of the ankle. Limited prior studies have been conducted in arthroscopic models with proposed volumes ranging from 30 ml to 60 ml. Due to this range it was inferred that volume needed to detect arthrotomy would vary based on site of arthrotomy. Using cadavers without prior ankle trauma or surgeries we aim to assess volume needed to detect ankle arthrotomies at varying arthrotomy locations. Methods: A cadaveric study was conducted using 20 thawed, fresh-frozen below knee amputations. Cadavers were randomly divided into four groups of five and an ankle arthrotomy was made using a 4 mm trochar at standard ankle portal sites; anteromedial, anterolateral, posteromedial, and posterolateral. To confirm intra-articular location, a scope was inserted for direct visualization. A 18-gauge needle was then inserted into the anteromedial portal, except for the anteromedial arthrotomy where the needle was inserted into the anterolateral portal, and saline mixed with methylene blue was loaded into joint. During the injection, the known arthrotomy site was viewed for extravasation. Amount of saline required to diagnose arthrotomy was recorded. All injections were confirmed as intra-articular by demonstrating methylene blue staining of the anterior joint by open exploration. Results: The saline volume required to achieve extravasation ranged from 3 mL to 11 mL. The median saline volume required to achieve extravasation was 5.3 mL. A total of 8 mL was required to achieve 90% sensitivity, 10 mL for 95% sensitivity and 11 mL for 99% sensitivity. For the anterolateral, anteromedial, posteromedial, and posterolateral arthrotomy sites the median saline volume needed to detect a traumatic arthrotomy was 5.2 ml, 6.2 ml, 5 ml, and 4.8 ml respectively. There was no statistically significant difference in volume needed to detect arthrotomies across all four locations. Conclusion: A minimum injection of 10 mL is recommended to identify 95% of traumatic arthrotomies approximately 4 mm in size. Prior studies performed in arthroscopic models with prior ankle pathology may overestimate volume needed to detect arthrotomies. No difference in volume needed to detect extravasation was found across all four arthrotomy locations.

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Abstract WP304: Prothrombin Complex Concentrate Rapidly Reverses Coagulopathy but does not Alter Mortality in Warfarin Intracerebral Hemorrhage

Stroke ◽

10.1161/str.44.suppl_1.awp304 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Xuemei Cai ◽

Susannah Orzell ◽

Sarah Suh ◽

Linda Bresette ◽

Farzaneh Sorond ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Vitamin K ◽

Conventional Therapy ◽

Prothrombin Complex Concentrate ◽

International Normalized Ratio ◽

Fresh Frozen Plasma ◽

Thromboembolic Complication ◽

Complication Rates ◽

Significant Difference ◽

Fresh Frozen

INTRODUCTION: Warfarin-associated intracerebral hemorrhage (wICH) remains the most lethal form of iatrogenic stroke. Conventional therapy with fresh frozen plasma (FFP) and intravenous vitamin K takes up to 30 hrs to normalize the international normalized ratio (INR). Prothrombin complex concentrate (PCC) does not require cross-match and is fast acting. We hypothesized that PCC can rapidly reverse coagulopathy and reduce mortality in wICH. Methods: We identified 130 consecutive adult wICH patients over five years from a prospectively collected database. 33 patients were excluded for death or withdrawal of care within 48 hours of admission and 8 patients were excluded for antecedent head trauma, leaving 89 patients for analysis. Forty patients received FFP and vitamin K (conventional therapy) and 49 received PCC in addition to conventional therapy. We compared 6-month mortality, time to INR normalization, quantity of FFP transfused, and thromboembolic complication rates between the two groups. We used logistic regression to adjust for important confounders. Results: PCC-treated and conventional therapy patients had similar distributions of age, sex, co-morbidities, ICH location, initial blood pressure and INR. PCC-treated patients had a higher incidence of intraventicular hemorrhage (IVH) (67% vs 33%). PCC-treated patients required less FFP (mean 6.8 units vs 3.3 units, p<0.0001) and had faster time to INR normalization (mean 3.8 hrs vs 9.8 hrs, p<0.0001). Incidence of ICH expansion was low in both groups. There was no difference in the incidence of deep venous thrombosis and pulmonary embolism (p=0.236) or troponin elevation (p=0.573). There was no significant difference in 6-month mortality (p=0.437) after adjusting for age, ICH location, ICH volume, and presence of IVH. Conclusions: PCC use in wICH was associated with shorter time to INR normalization and reduced FFP transfusion but was not associated with 6-month mortality in this cohort. There was no difference in thromboembolic complication rates between PCC-treated and FFP and vitamin K treated patients. Prospective trials of PCC are necessary to determine if its use can improve morbidity and mortality in wICH and to identify potential subgroups of wICH patients who may benefit from PCC.

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Clinical evaluation of two adult oxygenator systems in terms of mortality and major adverse events

Perfusion ◽

10.1177/02676591211063830 ◽

2021 ◽

pp. 026765912110638

Author(s):

Hüsnü Kamil Limandal ◽

Mehmet Ali Kayğın ◽

Servet Ergün ◽

Taha Özkara ◽

Mevriye Serpil Diler ◽

...

Keyword(s):

Adverse Events ◽

Hospital Stay ◽

Artery Bypass ◽

Length Of Hospital Stay ◽

Fresh Frozen Plasma ◽

Wound Complications ◽

Significant Difference ◽

Delayed Sternal Closure ◽

Fresh Frozen ◽

Major Adverse Events

Purpose The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality. Methods A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used. Results Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age ( p = .112), weight ( p = .465), body surface area ( p = .956), or gender ( p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day ( p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell ( p = .468), fresh frozen plasma ( p = .116), or platelet concentrate transfusion ( p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M ( p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S ( p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M ( p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M ( p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay ( p = .451). Conclusion The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.

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Sources of variation in myofibre number within and between litters of pigs

Animal Science ◽

10.1017/s0003356100013106 ◽

1991 ◽

Vol 52 (3) ◽

pp. 527-533 ◽

Cited By ~ 25

Author(s):

C. M. Dwyer ◽

N. C. Stickland

Keyword(s):

Muscle Fibre ◽

Significant Contribution ◽

Large White ◽

Significant Difference ◽

Fresh Frozen ◽

Sources Of Variation ◽

Fibre Number ◽

Acid Stable ◽

Total Muscle ◽

Secondary Fibre

ABSTRACTA study of the determinants of inter- and intra-litter variation in muscle fibre number was carried out on five litters of Large White piglets. Fresh frozen, whole mid-belly sections of m. semitendinosus were stained to demonstrate acid-stable myosin adenosine triphosphatase activity. From these sections it was possible to identify which fibres had developed as primary and which as secondary fibres. Estimations of total muscle fibre number, total primary fibre number and ratio of secondary fibres to primary fibres were made for each animal. Results demonstrated that primary fibre number varied between litters (P<0·01) and was responsible for the variation in total muscle fibre number (P < 005) between litters since there was no significant variation in secondary: primary ratio. Within-litter differences in total fibre number could be attributed to both the secondary: primary ratio and primary fibre number, in almost equal contributions. However, when only the largest and smallest extremes of the litters were compared, variation in fibre number was due to the significant difference in the secondary: primary ratio (P<0·01). Taken as a whole, the results appear to show that primary fibre number is responsible for all the variation in muscle fibre number between litters, and also makes a significant contribution, with secondary: primary fibre ratio, to the variation present within a litter. The factors responsible for variations in primary and secondary fibre numbers are discussed.

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Re-Recognition of Garden Index as a Criterion for Evaluating the Quality of Femoral Neck Fracture Reduction: An Imaging Study Based on Cadaver Specimens

10.21203/rs.3.rs-150244/v1 ◽

2021 ◽

Author(s):

Leyi Cai ◽

Wenjie Li ◽

Wenhao Zheng ◽

Jianshun Wang ◽

Xiaoshan Guo ◽

...

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Kirschner Wire ◽

Imaging Study ◽

Lateral View ◽

Healthy Human ◽

Rotational Displacement ◽

Significant Difference ◽

Neck Fracture

Abstract ObjectiveTo investigate whether the Garden index can determine the rotational displacement of femoral neck fracture. MethodsTen healthy human femoral specimens were obtained. A 2.0 mm diameter Kirschner-wire was placed in the center of the femoral head. The osteotomy was perpendicular in the middle of the femoral neck. The distal osteotomy surface was indicated the angle of rotation (pronation and supination to 90°, every 10° was an interval). The X-ray of anterior-posterior and lateral view was taken at different angles according to the mark. The Garden index and other relevant data were analyzed with the PCAS system. Meanwhile, the change of the area of the femoral head fovea at different rotation angles was observed. ResultsThere was no significant difference in the Garden index in 0~30° at pronation and supination position (P>0.05). In range of 40°~90°, there was a statistical difference in the Garden index (P<0.05). With the increase of the pronation angle, the area of the femoral head fovea is gradually reduced; as the angle of the supination increases, the area of the femoral head fovea is gradually increased. ConclusionThe Garden Index cannot accurately determine the rotational displacement of the femoral neck fracture during the pronation or supination range of 0~30°. Changes in the area of the femoral head fovea can help determine the rotational displacement of the femoral neck fracture.Level of EvidenceLevel V.

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COMPARISON OF HEMOSTASIS WITH TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY

Acta Ortopédica Brasileira ◽

10.1590/1413-785220212904235714 ◽

2021 ◽

Vol 29 (4) ◽

pp. 184-188

Author(s):

OTÁVIO MONTOVANELLI MONTEIRO ◽

RODRIGO TURRA PERRONE ◽

FABRÍCIO NASCIMENTO ALMEIDA ◽

CID PEREIRA DE MOURA JUNIOR ◽

SAULO GOMES DE OLIVEIRA ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Statistical Significance ◽

Primary Total Knee Arthroplasty ◽

Joint Surface ◽

Thromboembolic Events ◽

Significant Difference ◽

Total Knee ◽

Group 3

ABSTRACT Objective: To compare the use of intravenous and topical tranexamic acid (TXA) in unilateral primary total knee arthroplasty (TKA) in relation to blood loss and complications inherent to the medication. Method: Three groups with 14 patients each were constituted, and all of them were operated using the same surgical technique. In Group 1, usual measures for bleeding control were performed. Group 2 patients received TXA topically on the joint surface. In Group 3, intravenous TXA was used. Hemoglobin (HB), hematocrit (HTC), platelets (PLAT), prothrombin time, activated partial thromboplastin time and volume of blood drained observed 24 hours after arthroplasty were compared to the values of tests found before surgery. Results: There was a decrease in the concentration of HB, HTC and PLAT in all groups in relation to the preoperative, however without significant difference. Group 3 had a lower mean volume of drained blood than the other groups, with statistical significance. No adverse effects or thromboembolic events were observed in the groups that received TXA. Conclusion: This study showed superiority in the use of intravenous TXA in decreasing the volume of bleeding, without increasing the risk of thromboembolic events. Level of Evidence I, High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals.

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Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy

Foot & Ankle International ◽

10.1177/1071100718770365 ◽

2018 ◽

Vol 39 (8) ◽

pp. 978-983

Author(s):

Michael Hull ◽

John T. Campbell ◽

Clifford L. Jeng ◽

R. Frank Henn ◽

Rebecca A. Cerrato

Keyword(s):

Clinical Practice ◽

Clinical Relevance ◽

Articular Surface ◽

Proximal Phalanx ◽

Metatarsophalangeal Joint ◽

Metatarsal Head ◽

Lateral View ◽

Joint Surface ◽

Foot And Ankle ◽

Kirschner Wires

Background: Arthroscopy has been increasingly used to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized during joint arthroscopy. Methods: Ten fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The visualized surface area was measured using ImageJ® software. Results: On the distal 2-dimensional projection of the joint surface, an average 57.5% (range, 49.6%-65.3%) of the metatarsal head and 100% (range, 100%-100%) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72 degrees (range, 65-80 degrees) was visualized out of an average total articular arc of 199 degrees (range, 192-206 degrees), for an average 36.5% (range, 32.2%-40.8%) of the articular arc. Conclusion: Complete visualization of the proximal phalanx base was obtained. Incomplete metatarsal head visualization was obtained, but this is limited by technique limitations that may not reflect clinical practice. Clinical Relevance: This information helps to validate the utility of arthrosocpy at the hallux metatarsophalangeal joint.

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The Peroneal Groove Deepening Procedure: A Biomechanical Study of Pressure Reduction

Foot & Ankle International ◽

10.1177/107110070502600603 ◽

2005 ◽

Vol 26 (6) ◽

pp. 442-448 ◽

Cited By ~ 32

Author(s):

Craig I. Title ◽

Hung-Geun Jung ◽

Brent G. Parks ◽

Lew C. Schon

Keyword(s):

Biomechanical Study ◽

Posterior Tibial Tendon ◽

Peroneal Tendon ◽

Foot And Ankle ◽

Calcaneofibular Ligament ◽

Significant Difference ◽

Mean Pressure ◽

Fresh Frozen ◽

The Mean ◽

Pressure Changes

Background: The goal of this study was to identify pressure changes throughout the peroneal groove after a groove deepening procedure. We hypothesized that pressures would decrease. Methods: Twelve fresh-frozen foot and ankle specimens were used. A thin pressure strip containing four sensor pads was secured within the peroneal groove with pads 1 through 4 positioned at the calcaneofibular ligament (CFL) and at the distal, middle, and proximal groove, respectively. The midstance phase of gait was simulated with loads applied to the plantar foot and posterior tibial tendon and to the peroneus longus and brevis tendons. Pressures were recorded with the ankle in neutral, plantarflexion, dorsiflexion, inversion, and eversion. Groove deepening was done by osteotomizing the posterior fibular wall. Pressure readings were then recorded. Average pressures for each of the four sensor pads after the procedure were compared to those obtained before the procedure. Results: The mean pressure overlying the CFL increased at all five ankle positions; however, these changes were not significant. Significant decreases in pressure were noted within the distal and middle groove at all ankle positions after the peroneal groove deepening procedure. Pressure within the proximal groove increased at all but one position, with a significant difference noted in neutral and plantarflexion. Conclusion: Pressures within the middle and distal peroneal groove significantly decreased after a groove deepening procedure. Combining this technique with peroneal tendon debridement may be advantageous for treatment of partial peroneal tendon tears or recalcitrant peroneal tendinitis.

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The effect of intramedullary pin size and plate working length on plate strain in locking compression plate-rod constructs under axial load

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-16-01-0008 ◽

2016 ◽

Vol 29 (06) ◽

pp. 451-458 ◽

Cited By ~ 7

Author(s):

Mark Glyde ◽

Robert Day ◽

Giselle Hosgood ◽

Tim Pearson

Keyword(s):

Large Diameter ◽

Three Dimensional ◽

Fracture Site ◽

Locking Compression Plate ◽

Image Correlation ◽

Lower Strain ◽

Working Length ◽

Significant Difference ◽

Compression Plate ◽

Short Working

SummaryObjective: To investigate the effect of intramedullary pin size and plate working length on plate strain in locking compression plate-rod constructs.Methods: A synthetic bone model with a 40 mm fracture gap was used. Locking compression plates with monocortical locking screws were tested with no pin (LCP-Mono) and intramedullary pins of 20% (LCPR-20), 30% (LCPR-30) and 40% (LCPR-40) of intramedullary diameter. Two screws per fragment modelled a long (8-hole) and short (4-hole) plate working length. Strain responses to axial compression were recorded at six regions of the plate via three-dimensional digital image correlation.Results: The addition of a pin of any size provided a significant decrease in plate strain. For the long working length, LCPR-30 and LCPR-40 had significantly lower strain than the LCPR-20, and plate strain was significantly higher adjacent to the screw closest to the fracture site. For the short working length, there was no significant difference in strain across any LCPR constructs or at any region of the plate. Plate strain was significantly lower for the short working length compared to the long working length for the LCP-Mono and LCPR-20 constructs, but not for the LCPR-30 and LCPR-40 constructs.Clinical significance: The increase in plate strain encountered with a long working length can be overcome by the use of a pin of 30–40% intramedullary diameter. Where placement of a large diameter pin is not possible, screws should be placed as close to the fracture gap as possible to minimize plate strain and distribute it more evenly over the plate.

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Hematoma block for distal radius fractures – prospective, randomized comparison of two different volumes of lidocaine

Journal of International Medical Research ◽

10.1177/0300060518799883 ◽

2018 ◽

Vol 46 (11) ◽

pp. 4535-4538 ◽

Cited By ~ 1

Author(s):

Hagay Orbach ◽

Nimrod Rozen ◽

Barak Rinat ◽

Guy Rubin

Keyword(s):

Distal Radius ◽

Analgesic Efficacy ◽

Fracture Site ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Vas Score ◽

Significant Difference ◽

Group A ◽

Vas Scores ◽

Group B

Objective This study aimed to compare analgesic efficacy and safety of different volumes of lidocaine injected into a fracture hematoma (hematoma block [HB]) for reducing distal radius fractures. Methods Patients were randomly divided into two groups. Group A included patients in whom 10 mL of 2% lidocaine was injected into the fracture site and group B included patients in whom 20 mL of 1% lidocaine was injected. The fracture was manipulated after 15 minutes and the Visual Analogue Scale (VAS) score was recorded during manipulation. Patients were followed up for approximately 1 hour and complications were recorded. Results Twenty patients were enrolled in the study (12 women and eight men), with a mean age of 57 years (range, 32–87 years). Demographic findings were similar between the groups. The mean VAS score of group A was 5.50 ± 3.57 and that in group B was 3.09 ± 2.33, with no significant difference between the groups. Conclusion VAS scores between HB with 20 mL of 1% lidocaine and HB with 10 mL of 2% lidocaine are not significantly different. However, our study suggests that HB with 20 mL of 1% lidocaine has a better analgesic effect than HB with 10 mL of 2% lidocaine.

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