scholarly journals Blocking Pins Instead of Blocking Screws in the Treatment of Distal Tibial Fractures with Intramedullary Nail

2020 ◽  
Author(s):  
Xiaodong Bai ◽  
Zhaohui Song ◽  
Shuangquan Yao ◽  
Song Liu ◽  
Lijie Ma ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Healing Process ◽  
Operating Time ◽  
Tibial Fractures ◽  
Controlled Study ◽  
Intramedullary Nails ◽  
Distal Tibial Fractures ◽  
Radiographic Outcomes ◽  
Average Change

Abstract Background: Distal tibial fractures have a high risk of malalignment when treated with intramedullary nails. The use of blocking screws can aid in achieving satisfactory alignment. The aim of this study was to compare the clinical and radiographic outcomes of temporary blocking pins with those of blocking screws for distal tibial fractures. Methods: From June 2011 through November 2018, a total of 90 patients with distal tibial fractures were enrolled in this prospective randomized controlled study. The patients were randomly received either blocking pins or blocking screws reduction during nailing. After reduction, 5 points at the distal fragment were effectively fixed. Results: The operating time in the BP group was 73.77±6.25 min, which was significantly shorter than 80.05±8.51 min in the BS group (P<0.001). The time to healing in the BP group was shorter than that in the BS group (18.52±4.57 vs. 21.51±3.17 weeks; P=0.001). The coronal and sagittal plane deformities at any time points were comparable (all P＞0.05). During the 12-month follow-up period, patients had an average change in the coronal plane of 1.34 degrees in the BP group and 1.00 degrees in the BS group (P=0.120), as well as an average change in the sagittal plane of 1.09 degrees and 0.81 degrees (P=0.110), respectively. Malunion was seen in two patients (5%) in the BP group and one patient (2%) in the BS group ( P＞0.05). Conclusion: The blocking pins can help achieve satisfactory alignment for distal tibial fractures during nailing. Intramedullary nails without blocking screws can afford adequate stability to maintain the reduction during the healing process when an effective five-point anchoring fixation is achieved.

scholarly journals Locking versus Non-locking Neutralization Plates with Limited Excision and Internal Fixation for Treatment of Extra-articular Type a Distal Tibial Fractures

2017 ◽  
Vol 11 (1) ◽  
pp. 57-63
Author(s):  
Kai-hua Zhou ◽  
Nong Chen
Keyword(s):  
Locking Plate ◽  
Type A ◽  
Tibial Fractures ◽  
Locking Plates ◽  
Superficial Infection ◽  
Distal Tibial Fractures ◽  
Radiographic Outcomes ◽  
Plate Group ◽  
The Cost

Purpose: This study aimed to compare the clinical, radiologic, and cost-effectiveness results between locking and non-locking plates for the treatment of extra-articular type A distal tibial fractures. Methods: We performed a retrospective review of AO/OTA 42-A1, A2 distal tibial fractures treated by plates from January 2011 to June 2013. Patients were divided to the locking plate group or the non-locking plate group. Clinical outcomes, radiographic outcomes, and hospitalization fee were compared between the two plates groups. Results: 28 patients were treated with a locking plate and 23 patients were treated with a non-locking plate. The mean follow-up was 18.8 months (12-23 months). There were no significant differences between the groups in surgical time, bleeding, bone union time, or AOFAS scores. The cost of the locking plate was ¥24,648.41 ± 6,812.95 and the cost of the non-locking plate was ¥11,642 ± 3,162.57, p < 0.001. Each group had one patient that experienced superficial infection these wounds were readily healed by oral antibiotics and dressing changes. To date, five patients in the locking group and ten patients in the non-locking group had sensations of metal stimulation or other discomfort (X2 = 3.99, p < 0.05) Until the last follow-up, 14 patients in the locking plate group and 18 patients in the non-locking plate group had their plates removed or wanted to remove their plates (X2 = 4.31, p < 0.05). Conclusion: The use of locking or non-locking plates provides a similar outcome in the treatment of distal fractures. However the locking plate is much more expensive than the non-locking plate.

scholarly journals Rheumatoid forefoot reconstruction in the non-rheumatoid patient

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Devon Nixon ◽  
Richard McKean ◽  
Sandra Klein ◽  
Jeffrey Johnson ◽  
Jeremy J. McCormick
Keyword(s):  
Rheumatoid Arthritis ◽  
Sagittal Plane ◽  
Deformity Correction ◽  
Metatarsal Head ◽  
Rheumatoid Patient ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Forefoot Surgery ◽  
Forefoot Reconstruction

Category: Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Residual pain and recurrent deformity following forefoot surgery can cause significant disability. In patients with rheumatoid arthritis, first metatarsophalangeal (MTP) joint arthrodesis with lesser metatarsal head resection – often referred to as a rheumatoid forefoot reconstruction – has been shown to be a reliable operation for pain relief and deformity correction. Limited data, however, has been published on outcomes of the same forefoot reconstruction operation in the non- rheumatoid patient. Here, we review our experience with this procedure in patients without rheumatoid disease, hypothesizing improved clinical and radiographic outcomes following surgery. Methods: Following chart review and surveying billing codes, we retrospectively identified patients from 2007-2015 without a diagnosis of rheumatoid arthritis who underwent first MTP arthrodesis with lesser metatarsal head resection (rheumatoid forefoot reconstruction). Phone surveys were then conducted to assess clinical outcomes including pain and satisfaction scores. Preoperative and postoperative radiographs were reviewed for 1, 2 intermetatarsal angle (IMA), hallux valgus angle (HVA), 2nd MTP angle (MTP-2), and lesser MTP alignment (in both sagittal and axial planes). Postoperative radiographs were also assessed for radiographic union. Results: We identified 14 non-rheumatoid patients (16 feet) who underwent forefoot reconstruction – of those, 13 patients (15 feet) were successfully contacted via follow-up phone survey. Mean postoperative follow up was 42.3 (range: 12-76) months from surgery to phone interview. Mean postoperative satisfaction scores were 9.1 (out of 10), and no patients required further surgery after forefoot reconstruction. Pain scores significantly decreased from 6.2 preoperatively to 2.0 postoperatively (P<.001). Radiographic parameters (IMA, HVA, MTP-2, and lesser MTP alignment in the sagittal plane) all improved with surgery (P<.05). All 16 feet achieved union of the first MTP arthrodesis. Conclusion: With decreased pain, high satisfaction rates, and improved radiographic parameters, first MTP arthrodesis coupled with metatarsal head resection (rheumatoid forefoot reconstruction) is a viable surgical option for non-rheumatoid patients who have failed prior attempts at forefoot reconstruction or have chronic forefoot pain with deformity.

Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

2017 ◽  
Vol 5 (10) ◽  
pp. 4355
Author(s):  
Siddharth Goel ◽  
Abhay Elhence
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixation ◽  
External Fixator ◽  
Tibial Fractures ◽  
Fixation Method ◽  
Ankle Pain ◽  
Distal Tibial Fractures ◽  
Tract Infections

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

Stifle arthrodesis using a locking plate system in six dogs

2015 ◽  
Vol 28 (04) ◽  
pp. 288-293 ◽  
Author(s):  
T. Nicetto ◽  
M. Petazzoni
Keyword(s):  
Body Weight ◽  
Medical Records ◽  
Tibial Fracture ◽  
Locking Plate ◽  
Sagittal Plane ◽  
Inclusion Criteria ◽  
Radiographic Outcomes ◽  
Locking Plate System ◽  
Plate System

SummaryObjectives: To describe the use of the Fixin locking plate system for stifle arthrodesis in dogs and to retrospectively report the clinical and radiographic outcomes in six cases.[uni2028]Materials and methods: Medical records of dogs that had arthrodesis with the Fixin locking plate system were reviewed. For each patient, data pertaining to signalment and implant used were recorded. Plate series and thickness, number of screws placed, number of cortices engaged, and screw diameters were also recorded. The outcome was determined from clinical and radiographic followups. Radiographic outcomes assessed included the measurement of the postoperative femoral-tibial angle in the sagittal plane.Results: Six dogs met the inclusion criteria for the study. Mean body weight was 13 kg (range: 3 - 34 kg). Radiographic follow-up (mean: 32 weeks, range: 3 - 52 weeks) was available for all dogs. In one case, an intra-operative complication occurred. In another case, a tibial fracture occurred 20 days after surgery. All arthrodeses healed and no implant complication was detected although all cases had mechanical lameness.Clinical significance: Stifle arthrodesis can be performed successfully using a Fixin locking plate system.

Treatment for distal tibial fractures with intramedullary nails and blocking screws

2011 ◽  
Vol 22 (5) ◽  
pp. 395-401
Author(s):  
Mustafa Seyhan ◽  
Baris Kocaoglu ◽  
Arel Gereli ◽  
Ufuk Nalbantoglu ◽  
Metin Turkmen
Keyword(s):  
Tibial Fractures ◽  
Intramedullary Nails ◽  
Distal Tibial Fractures

scholarly journals The Results of Hemivertebra Resection by the Posterior Approach in Children with a Mean Follow-Up of Five Years

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ramazan Erden Erturer ◽  
Bekir Eray Kilinc ◽  
Bahadir Gokcen ◽  
Sinan Erdogan ◽  
Kursat Kara ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Sagittal Plane ◽  
Operating Time ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Early Postoperative Period ◽  
X Rays ◽  
Hemivertebra Resection ◽  
The Mean

Aim. To evaluate the radiologic and clinical results of patients who underwent deformity correction and stabilization for congenital spinal deformities using pedicle screws after hemivertebra resection. Material and Method. Nine patients, mean age 9.2, who underwent posterior hemivertebrectomy and transpedicular fixation for congenital spinal deformity and had longer than five years of follow-up were evaluated retrospectively. The hemivertebrae were located in the thoracic region in 4 patients and thoracolumbar transition region in 5 patients. The patients were evaluated radiologically and clinically in the postoperative period. Results. Mean length of follow-up was 64.2 months. The mean operating time was 292 minutes. The mean blood loss was 236 mL. The average hospitalization time was 7 days. The amount of correction on the coronal planes was measured as 31%. The mean segmental kyphosis angle was 45.7 degrees preoperatively and it was measured 2.7 degrees in the follow-up period. There were no statistically significant differences between the early postoperative period and final follow-up X-rays with respect to coronal and sagittal plane deformities. Conclusion. The ability to obtain a sufficient and balanced correction in the cases accompanied by long compensator curvatures that have a structural character in hemivertebra may require longer fusion levels.

Percutaneous Plating of Distal Tibial Fractures

2002 ◽  
Vol 23 (9) ◽  
pp. 818-824 ◽  
Author(s):  
Amal Khoury ◽  
Meir Liebergall ◽  
Eli London ◽  
Rami Mosheiff
Keyword(s):  
Sagittal Plane ◽  
Dynamic Compression ◽  
Plate Fixation ◽  
Varus Deformity ◽  
Valgus Deformity ◽  
Tibial Fractures ◽  
Superficial Infection ◽  
Distal Tibial Fractures ◽  
Type Fracture ◽  
Anatomical Fixation

This article presents our experience with 24 patients who had distal tibial fractures and were treated by percutaneous plate fixation. Distribution of the fractures according to the AO/OTA classification was as follows: five patients suffered from a 43 A type fracture, six from a 43 B type fracture, and 13 from a 43 C type fractures. Four of the fractures were open. Exclusion criteria included 43 C3 fractures and Gustilo III open fractures. All fractures showed radiographic signs of union enough to enable full weightbearing within an average time of 12.3 weeks. All patients showed a good range of motion (average dorsiflexion 12° and average plantiflexion 18°). Two fractures united with mal-union: one with an 8° valgus deformity and another with a 7° varus deformity. Both cases, which had a metaphyseal component, were treated by means of a “soft” (flexible and manually adjustable) AO 3.5 mm reconstruction plate. Except for one case of superficial infection, no infections were detected in any of the patients. The biological percutaneous plate fixation of distal tibial fractures with no extensive intra-articular involvement is a good soft tissue preserving technique. It provides a rigid and anatomical fixation in most cases. We conclude that type B fractures with one intact column can be fixed with either “soft” or “rigid” plates, and type A and C fractures with a metaphyseal component should be fixed with “rigid” plates (AO 4.5 mm Dynamic Compression Plate). In these fractures the reduction should be performed cautiously due to the tendency of sagittal plane mal-reduction.

An up to 7-Year Retrospective Analysis of Biologic and Technical Complication With the All-on-4 Concept

2016 ◽  
Vol 42 (3) ◽  
pp. 265-271 ◽  
Author(s):  
Marco Tallarico ◽  
Luigi Canullo ◽  
Milena Pisano ◽  
David Peñarrocha-Oltra ◽  
Miguel Peñarrocha-Diago ◽  
...  
Keyword(s):  
Healing Process ◽  
Success Rates ◽  
Marginal Bone Loss ◽  
Prospective Data ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Technical Complication ◽  
Edentulous Jaws

The aim of this study was to evaluate retrospectively biologic and technical complications as well as clinical and radiographic outcomes of patients treated with 4 implants according to the All-on-4 protocol and followed up to 7 years of function. Data from 56 consecutive patients presenting complete edentulous jaw, aged 18 years or older, treated between January 2008 and December 2013, were evaluated. The outcomes were implant and prosthetic survival and success rates, any complications, and marginal bone loss (MBL). Two-hundred twenty-four implants were placed in 56 patients. During the entire follow-up, 1 maxillary implant but no prosthesis failed during the healing process. Fourteen patients experienced 1 complication each (10 technical, 4 biologic). The overall implant and prosthetic success rate was 98.2% and 82.1%, respectively. All complications were considered as minor and successfully resolved chairside. A mean MBL of 1.30 ± 0.63 mm was observed at the last follow-up. Statistically significant difference was found for postextractive implants (0.79 ± 0.26) vs implants placed in healed sites (1.03 ± 0.46; P = 0.024). Within the limits of the present study, the All-on-4 concept may be a valuable surgical and prosthetic option for the treatment of complete edentulous jaws. However, minor technical and biologic complications can occur. Further long-term prospective data with primary outcomes focused on success rates are needed.

scholarly journals Endoscopic Transcorporeal Approach and Channel Repair for Cervical Disc Herniation: 2-Year Follow-Up Study

2021 ◽  
Author(s):  
Qian Du ◽  
Wei-Jun Kong ◽  
Guang-Ru Cao ◽  
Zhi-Jun Xin ◽  
Jun Ao ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Japanese Orthopaedic Association ◽  
Operating Time ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
Intervertebral Disc Herniation ◽  
X Rays ◽  
Radiographic Outcomes ◽  
Bone Plug

Abstract Objective To investigate the 2-year follow-up outcomes of patients with cervical intervertebral disc herniation (CIVDH) after percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair. Methods From Oct. 2016 to Mar. 2017, 24 patients with central/mediolateral CIVDH was treated with PEATCD and channel repair. Of the 24 cases, five interventions were performed at C3-C4 level, 11 were performed at C4-C5 level, and 8 were performed at C5-C6 level. Clinical outcomes were evaluated by Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA), and Visual Analog Scale (VAS). Radiographic outcomes were measured with X-rays, computed tomography (CT) and magnetic resonance imaging.Results All the 24 procedures were completed successfully with an average operating time of 86.40±8.19min. Neck collar was advised for 3 weeks for all patients. No procedure-related complications were observed except for the swollen neck in 5 patients, which rehabilitated within 2 hours without sequela. The final scores of NDI, JOA, and VAS were improved significantly compared to those of preoperative assessments, 7.74±7.31 VS. 52.11±22.10, 16.04±0.68 VS. 9.08±1.31, and 0.52±0.65 VS. 6.73±1.45, respectively, P<0.05. Mean disc height was decreased from preoperative 5.43±0.52 mm to final 5.05±0.43 mm, without related-symptoms. No bone plug migration or channel collapse was measured during postoperative periods. All the channels were absent 12 months postoperative. Conclusion The most outstanding advantages of PEATCD with channel repair were “functional preservation” and “anatomical protection” for cervical spine, and which is a safe, feasible, effective, and minimally invasive surgery that offers an alternative for patients with CIVDH.

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