scholarly journals CORRELATION BETWEEN THE SCHANZ SCREW INSERTION ANGLE AND THE LOSS OF KYPHOSIS CORRECTION IN THORACOLUMBAR FRACTURES

2020 ◽  
Vol 19 (3) ◽  
pp. 209-212
Author(s):  
FABIO ANTONIO VIEIRA ◽  
ANDRÉ SOUSA GARCIA ◽  
FERNANDO TADASHI SALVIONI UETA ◽  
DAVID DEL CURTO ◽  
RENATO HIROSHI SALVIONI UETA ◽  
...  
Keyword(s):  
Statistical Difference ◽  
Burst Fracture ◽  
Level Of Evidence ◽  
Thoracolumbar Burst Fractures ◽  
Screw Insertion ◽  
Insertion Angle ◽  
Kyphosis Correction ◽  
Screw Insertion Angle ◽  
Parallel Assembly

ABSTRACT Objective To compare the Schanz screw insertion angle and the loss of the regional kyphosis correction in thoracolumbar burst fractures following posterior short instrumentation surgery. Methods Patients with a thoracolumbar burst fracture between levels T11-L2 were divided into two groups (parallel and divergent) according to the angle formed between the Schanz screw and the vertebral plateau. Regional kyphosis was evaluated in preoperative, immediate postoperative and last follow-up radiographs. Results Of the 58 patients evaluated, 31 had a parallel assembly and 27 had a divergent assembly. When we analyzed the angle of kyphosis, no statistical difference was observed between the pre- and postoperative radiographs. However, a statistical difference in the last follow-up radiographs and in the final loss of the kyphosis correction was confirmed. Conclusion The insertion of Schanz screws with a divergent assembly presents better radiographic results with less loss of kyphosis correction angle when compared with the parallel assembly technique. Level of Evidence III; Retrospective cohort study.

scholarly journals Minimally Invasive Spine Surgery for Unstable Thoracolumbar Burst Fractures: A Case Series

2016 ◽  
Vol 02 (04) ◽  
pp. e131-e138 ◽  
Author(s):  
Nitin Agarwal ◽  
Phillip Choi ◽  
Raymond Sekula
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Burst Fracture ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Burst Fracture ◽  
Thoracolumbar Burst Fractures ◽  
Percutaneous Pedicle Screw ◽  
Percutaneous Pedicle Screw Fixation

Introduction Traumatic thoracolumbar burst fracture is a common pathology without a clear consensus on best treatment approach. Minimally invasive approaches are being investigated due to potential benefits in recovery time and morbidity. We examine long-term resolution of symptoms of traumatic thoracolumbar burst fractures treated with percutaneous posterior pedicle screw fixation. Methods Retrospective clinical review of seven patients with spinal trauma who presented with thoracolumbar burst fracture from July 2012 to April 2013 and were treated with percutaneous pedicle screw fixation. Electronic patient charts and radiographic imaging were reviewed for initial presentation, fracture characteristics, operative treatment, and postoperative course. Results The patients had a median age of 29 years (range 18 to 57), and 57% were men. The median Thoracolumbar Injury Classification and Severity Scale score was 4 (range 2 to 9). All patients had proper screw placement and uneventful postoperative courses given the severity of their individual traumas. Five of seven patients were reached for long-term follow-up of greater than 28 months. Six of seven patients had excellent pain control and stability at their last follow-up. One patient required revision surgery for noncatastrophic hardware failure. Conclusion Percutaneous pedicle screw fixation for the treatment of unstable thoracolumbar burst fracture may provide patients with durable benefits and warrants further investigation.

scholarly journals THORACOLUMBAR BURST FRACTURES, SHORT X LONG FIXATION: A META-ANALYSIS

2016 ◽  
Vol 15 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Carlos Alberto Assunção Filho ◽  
Filipe Cedro Simões ◽  
Gabriel Oliveira Prado
Keyword(s):  
Blood Loss ◽  
Clinical Outcomes ◽  
Postoperative Period ◽  
Operative Time ◽  
Meta Analysis ◽  
Thoracolumbar Burst Fractures ◽  
Kyphosis Correction ◽  
Burst Fractures ◽  
Significant Difference

ABSTRACT The number of fixed segments in the surgical treatment of thoracolumbar burst fractures remains controversial. This study aims to compare the results of short and long fixation in thoracolumbar burst fractures through a meta-analysis of studies published recently. MEDLINE and Cochrane databases were used. Randomized controlled trials and non-randomized comparative studies (prospective and retrospective) were selected. Data were analyzed with the software Review Manager. There was no statistically significant difference in the Cobb angle of preoperative kyphosis. Long fixation showed lower average measurements postoperatively (MD = 1.41; CI = 0.73-2.08; p<0.0001) and in the last follow-up (MD = 3.98; CI = 3.22-4.75; p<0.00001). The short fixation showed the highest failure rates (RD = 4.03; CI = 1.33-12.16; p=0.01) and increased loss of height of the vertebral body (MD = 1.24; CI = 0.49-1.98; p=0.001), with shorter operative time (MD = -24.54; CI = -30.16 - -18.91; p<0.00001). There was no significant difference in blood loss and clinical outcomes. The high rates of kyphosis correction loss with short fixation and the lower correction rate in the immediate postoperative period were validated. There was no significant difference in the blood loss rates because arthrodesis was performed in a short segment in the analyzed studies. The short fixation was performed in a shorter operative time, as expected. No study has shown superior clinical outcomes. The short fixation had worse rates of kyphosis correction in the immediate postoperative period, and increased loss of correction in long-term follow-up, making the long fixation an effective option in the management of this type of fracture.

scholarly journals Navigation-assisted anchor insertion in shoulder arthroscopy: a validity study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kyunghwa Jung ◽  
Hyojune Kim ◽  
Erica Kholinne ◽  
Dongjun Park ◽  
Hyunseok Choi ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Path Length ◽  
Shoulder Arthroscopy ◽  
Level Of Evidence ◽  
Surgical Performance ◽  
Screw Insertion ◽  
Insertion Angle ◽  
Phantom Model ◽  
Total Path Length ◽  
Repeatability And Reproducibility

Abstract Background This study aimed to compare conventional and navigation-assisted arthroscopic rotator cuff repair in terms of anchor screw insertion. Methods The surgical performance of five operators while using the conventional and proposed navigation-assisted systems in a phantom surgical model and cadaveric shoulders were compared. The participating operators were divided into two groups, the expert group (n = 3) and the novice group (n = 2). In the phantom model, the experimental tasks included anchor insertion in the rotator cuff footprint and sutures retrieval. A motion analysis camera system was used to track the surgeons’ hand movements. The surgical performance metric included the total path length, number of movements, and surgical duration. In cadaveric experiments, the repeatability and reproducibility of the anchor insertion angle were compared among the three experts, and the feasibility of the navigation-assisted anchor insertion was validated. Results No significant differences in the total path length, number of movements, and time taken were found between the conventional and proposed systems in the phantom model. In cadaveric experiments, however, the clustering of the anchor insertion angle indicated that the proposed system enabled both novice and expert operators to reproducibly insert the anchor with an angle close to the predetermined target angle, resulting in an angle error of < 2° (P = 0.0002). Conclusion The proposed navigation-assisted system improved the surgical performance from a novice level to an expert level. All the experts achieved high repeatability and reproducibility for anchor insertion. The navigation-assisted system may help surgeons, including those who are inexperienced, easily familiarize themselves to of suture anchors insertion in the right direction by providing better guidance for anchor orientation. Level of evidence A retrospective study (level 2).

scholarly journals Navigation-assisted anchor insertion in shoulder arthroscopy: a validity study

2020 ◽  
Author(s):  
Kyunghwa Jung ◽  
Hyojune Kim ◽  
Erica Kholinne ◽  
Dongjun Park ◽  
Hyunseok Choi ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Path Length ◽  
Shoulder Arthroscopy ◽  
Level Of Evidence ◽  
Surgical Performance ◽  
Screw Insertion ◽  
Insertion Angle ◽  
Phantom Model ◽  
Total Path Length ◽  
Repeatability And Reproducibility

Abstract Background This study aimed to compare conventional and navigation-assisted arthroscopic rotator cuff repair in terms of anchor screw insertion.Methods The surgical performance of five operators while using the conventional and proposed navigation-assisted systems in a phantom surgical model and cadaveric shoulders were compared. The participating operators were divided into two groups, the expert group (n = 3) and the novice group (n = 2). In the phantom model, the experimental tasks included anchor insertion in the rotator cuff footprint and sutures retrieval. A motion analysis camera system was used to track the surgeons’ hand movements. The surgical performance metric included the total path length, number of movements, and surgical duration. In cadaveric experiments, the repeatability and reproducibility of the anchor insertion angle were compared among the three experts, and the feasibility of the navigation-assisted anchor insertion was validated.Results No significant differences in the total path length, number of movements, and time taken were found between the conventional and proposed systems in the phantom model. In cadaveric experiments, however, the clustering of the anchor insertion angle indicated that the proposed system enabled both novice and expert operators to reproducibly insert the anchor with an angle close to the predetermined target angle, resulting in an angle error of <2° (P = 0.0002).Conclusion The proposed navigation-assisted system improved the surgical performance from a novice level to an expert level. All the experts achieved high repeatability and reproducibility for anchor insertion. The navigation-assisted system may help surgeons, including those who are inexperienced, easily familiarize themselves to of suture anchors insertion in the right direction by providing better guidance for anchor orientation.Level of Evidence A retrospective study (level 2)

scholarly journals Optimal ilio-sacral screw trajectory in paediatric patients : a computed tomography study

2021 ◽  
Vol 87 (2) ◽  
pp. 285-291
Author(s):  
Mathilde Gaume ◽  
Mohamed Amine Triki ◽  
Christophe Glorion ◽  
Sylvain Breton ◽  
Lofti Miladi
Keyword(s):  
Computed Tomography ◽  
Spinal Canal ◽  
Sagittal Plane ◽  
Optimal Angle ◽  
Pelvic Fixation ◽  
Screw Insertion ◽  
Insertion Angle ◽  
Paediatric Patients ◽  
Screw Length ◽  
Screw Insertion Angle

Pelvic fixation during procedures performed to treat spinal deformities in paediatric patients remains challenging. No computed tomography studies in paediatric have assessed the optimal trajectory of ilio- sacral screws to prevent screw malposition. We used pelvic computed tomography from 80 children divided into four groups : females <10 and ≥10 years and males <10 and ≥10 years. A secure triangular corridor parallel to the upper S1 endplate was delineated based on three fixed landmarks. The optimal screw insertion angle was subtended by the horizontal and the line bisecting the secure corridor. Student’s t test was applied to determine whether the optimal screw insertion angle and/or anatomical parameters were associated with age and/or sex. Mean optimal angle was 32.3°±3.6°, 33.8°±4.7°, 30.2°±5.0°, and 30.4°±4.7° in the younger females, younger males, older females, and older males, respectively. The mean optimal angle differed between the two age groups (p=0.004) but not between females and males (p=0.55). Optimal mean screw length was 73.4±9.9 mm. Anatomical spinal canal parameters in the transverse plane varied with age (p=0.02) and with sex in the older children (p=0.008), and those in the sagittal plane varied with sex (p=0.04). Age affected ilio-sacral screw positioning, whereas sex did not. Several anatomical spinal canal parameters varied with age and sex. These results should help to ensure safe and easy ilio-sacral screw placement within a secure corridor.

scholarly journals Drill and Fill Technique for the Treatment of Scaphoid Delayed Unions and Nonunions

2019 ◽  
Vol 09 (02) ◽  
pp. 116-123
Author(s):  
Dennis S. Lee ◽  
David T. Lee ◽  
Sasidhar Uppuganti ◽  
Daniel S. Perrien ◽  
Nicholas D. Pappas ◽  
...  
Keyword(s):  
Cancellous Bone ◽  
Repeated Measures ◽  
Histomorphometric Analysis ◽  
Proximal Pole ◽  
Compression Screw ◽  
Level Of Evidence ◽  
Cancellous Bone Grafting ◽  
Screw Insertion ◽  
Post Hoc

Abstract Background This article reviews the results of a surgical technique using three iterations of drilling, autologous cancellous bone grafting (filling), and use of an intraosseous compression screw for the treatment of nondisplaced or minimally displaced scaphoid delayed unions or nonunions. Methods Part 1—Cadaveric study: Three cadaveric scaphoids underwent stained cancellous bone graft packing and headless cannulated compression screw placement using a single iteration of drilling and graft packing. Three additional scaphoids were allocated to the triple “drill and fill” group, and underwent three iterations of drilling and graft packing before screw insertion. Graft particle distribution on mid-sagittal sections was assessed under fluorescence microscopy. Comparison of normalized areas between the single and triple “drill and fill” groups was performed using repeated measures ANOVA and Tukey's post hoc test.Part 2—Clinical study: Twelve patients with minimally displaced scaphoid delayed unions and nonunions treated between April 2007 and December 2013 with the triple “drill and fill” technique were included. The average follow-up was 60.4 weeks. Two fellowship-trained musculoskeletal radiologists independently reviewed images for fracture healing. Results By the histomorphometric analysis, there was improved autograft distribution along the screw tract, particularly within the proximal pole, with three iterations of drilling and filling. Clinically, 11 of 12 delayed unions and nonunions had healed. Conclusion Our results support the use of the “drill and fill” technique as an option for the treatment of select nondisplaced or minimally displaced scaphoid nonunions and delayed unions at the waist without avascular necrosis of the proximal pole. Level of Evidence This is a Level IV study.

scholarly journals Biomechanical Analysis of Plate Fixation Compared With Various Screw Configurations for Use in the Latarjet Procedure

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093139
Author(s):  
Rachel M. Frank ◽  
Martina Roth ◽  
Coen Abel Wijdicks ◽  
Nicole Fischer ◽  
Alberto Costantini ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Biomechanical Properties ◽  
Latarjet Procedure ◽  
Screw Insertion ◽  
Single Screw ◽  
Insertion Angle ◽  
Failure Loads ◽  
Cyclical Loading ◽  
Screw Insertion Angle ◽  
With Screws

Background: The biomechanical properties of coracoid fixation with a miniplate during the Latarjet procedure have not been described. Purpose: To determine the biomechanical properties of miniplate fixation for the Latarjet procedure compared with various screw fixation configurations. Study Design: Controlled laboratory study. Methods: A total of 8 groups (n = 5 specimens per group) were tested at a screw insertion angle of 0°: (1) 3.75-mm single screw, (2) 3.75-mm double screw, (3) 3.75-mm double screw with washers, (4) 3.75-mm double screw with a miniplate, (5) 4.00-mm single screw, (6) 4.00-mm double screw, (7) 4.00-mm double screw with washers, and (8) 4.00-mm double screw with a miniplate. In addition, similar to groups 1 to 3 and 5 to 7, there were 30 additional specimens (n = 5 per group) tested at a screw insertion angle of 15° (groups 9-14). To maintain specimen uniformity, rigid polyurethane foam blocks were used. Testing parameters included a preload of 214 N for 10 seconds, cyclical loading from 184 to 736 N at 1 Hz for 100 cycles, and failure loading at a rate of 15 mm/min until 10 mm of displacement or specimen failure occurred. Results: All single-screw constructs and 77% of 15° screw constructs failed before the completion of cyclical loading. Across all groups, group 8 (4.00-mm double screw with miniplate) demonstrated the highest maximum failure load ( P < .001). There were no differences in failure loads among specimens with single-screw fixation (groups 1, 5, 9, and 12; P > .05). All specimens in groups 9, 10, 11, 12, 13, and 14 (insertion angle of 15°) had significantly lower maximum failure loads compared with specimens in groups 2, 3, 4, 6, 7, and 8 (insertion angle of 0°) ( P < .001 for all). Conclusion: These results indicate significantly superior failure loads with the miniplate compared with all other constructs. Across all fixation techniques and screw sizes, constructs with screws inserted at 0° performed better than constructs with screws inserted at 15°. Clinical Relevance: The use of a miniplate for coracoid fixation during the Latarjet procedure may provide a more durable construct for the high-demand contact athlete.

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