scholarly journals Arthroscopically Assisted Cannulated Screw Fixation for Treating Type III Tibial Intercondylar Eminence Fractures: A Short-Term Retrospective Controlled Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Chao Zheng ◽  
Huanli Han ◽  
Yujiang Cao
Keyword(s):  
Pivot Shift ◽  
Screw Fixation ◽  
Cannulated Screw ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Type Iii ◽  
Intercondylar Eminence ◽  
Arthroscopically Assisted ◽  
Group A ◽  
Group B

Background: This study presents the clinical results from 22 children who underwent minimally invasive arthroscopically assisted screw fixation for the treatment of intercondylar eminence fractures.Methods: We retrospectively analyzed the clinical data of 22 children (aged 7.5 to 13.5 years) with type III tibial intercondylar eminence fractures who were treated in our department from March 2007 to September 2019. According to the type of operation, the patients were divided into two groups: group A (n = 12) received arthroscopically assisted cannulated screw fixation, and group B (n = 10) received open reduction and cannulated screw internal fixation. Radiography scans, Lysholm scores, International Knee Documentation Committee (IKDC) 2,000 subjective scores, Tegner scores, range of motion (ROM) of the knee, the anterior drawer test (ADT), the Lachman test, and the pivot-shift test were used to evaluate the clinical efficacy.Results: All 22 children were evaluated over a 12 to 58 month follow-up period (mean: 27.5 months). At the final exam, group A was significantly superior to group B in Lysholm scores (93.33 ± 3.55 vs. 86.20 ± 4.52), IKDC scores (92.06 ± 3.55 vs. 86.07 ± 5.81), and Tegner scores (7.75 ± 0.87 vs. 6.40 ± 0.52) and presented shorter operative times (25.42 ± 3.97 vs. 35.00 ± 5.27). The differences were statistically significant (P < 0.05). All the incisions healed primarily. No complications, such as fracture fragment displacement, delayed epiphyseal growth, or knee joint dysfunction, were observed. The drawer test, Lachman test, and pivot-shift test were negative for all patients.Conclusions: Arthroscopically assisted cannulated screw fixation is effective and safe for the treatment of tibial intercondylar eminence fractures, providing excellent stability and quick recovery of joint function.

scholarly journals Augmented cerclage wire improves the fixation strength of a two-screw construct for humerus split type greater tuberosity fracture: a biomechanical study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chao-Jui Chang ◽  
Wei-Ren Su ◽  
Kai-Lan Hsu ◽  
Chih-Kai Hong ◽  
Fa-Chuan Kuan ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Biomechanical Study ◽  
Fixation Strength ◽  
Myotendinous Junction ◽  
Steel Cable ◽  
Simple Modification ◽  
Greater Tuberosity ◽  
Cerclage Wire ◽  
Group A ◽  
Group B

Abstract Background Poor functional outcome can result from humeral greater tuberosity (GT) fracture if not treated appropriately. A two-screw construct is commonly used for the surgical treatment of such injury. However, loss of reduction is still a major concern after surgery. To improve the biomechanical strength of screw fixation in GT fractures, we made a simple modification of the two-screw construct by adding a cerclage wire to the two-screw construct. The purpose of this biomechanical study was to analyze the effect of this modification for the fixation of GT fractures. Materials and methods Sixteen fresh-frozen human cadaveric shoulders were used in this study. The fracture models were arbitrarily assigned to one of two fixation methods. Group A (n = 8) was fixed with two threaded cancellous screws with washers. In group B (n = 8), all screws were set using methods identical to group A, with the addition of a cerclage wire. Horizontal traction was applied via a stainless steel cable fixed directly to the myotendinous junction of the supraspinatus muscle. Displacement of the fracture fixation under a pulling force of 100 N/200 N and loading force to construct failure were measured. Results The mean displacements under 100 N and 200 N traction force were both significantly decreased in group B than in group A. (100 N: 1.06 ± 0.12 mm vs. 2.26 ± 0.24 mm, p < 0.001; 200 N: 2.21 ± 0.25 mm vs. 4.94 ± 0.30 mm, p < 0.001) Moreover, the failure load was significantly higher in group B compared with group A. (415 ± 52 N vs.335 ± 47 N, p = 0.01), Conclusions The current biomechanical cadaveric study demonstrated that the two-screw fixation construct augmented with a cerclage wire has higher mechanical performance than the conventional two-screw configuration for the fixation of humeral GT fractures. Trial registration Retrospectively registered.

scholarly journals Comparison Between With Kirschner-wires Only And Combined Screw Fixation in Proximal Reverse Chevron osteotomy(PCMO) For Hallux Valgus Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Hwa Jun Kang ◽  
Hong-Geun Jung ◽  
Jong-Soo Lee ◽  
Sungwook Kim ◽  
Mao Yuan Sun
Keyword(s):  
Hallux Valgus ◽  
Screw Fixation ◽  
Fixation Method ◽  
Kirschner Wires ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

A comparative study of laminoplasty with short segment transpedicular screw fixation versus laminoplasty with anterior fusion in treating extensional cervical spinal cord injury without radio graphic abnormality in adults

2019 ◽  
Author(s):  
Bi Zhang ◽  
Zhenhai Zhou ◽  
Honggui Yu ◽  
Zhimin Pan ◽  
Rongping Zhou ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Intraoperative Blood Loss ◽  
Short Segment ◽  
Transpedicular Screw ◽  
Cord Injury ◽  
Group A ◽  
Group B ◽  
Transpedicular Screw Fixation

Abstract Background: Cervical spinal cord injury(CSCI) without major fracture or dislocation is often described as cervical SCI without radiographic abnormality (SCIWORA). Majority of this injury could be without radiographic abnormality but with disrupted anterior longitudinal ligament or intervertebral disc unless examined by MRI. The optimal surgical management of this cervical spinal cord injury remains controversial. This study is to evaluate the clinical advantages of laminoplasty combined with short-segment transpedicular screw fixation for managing this issue. Methods: SCIWORA patients were collected into two groups according to different surgical methods. Patients in group A received laminoplasty combined with transpedicular screw fixation, and patients in group B received anterior cervical fusion combined with laminoplasty. All cervical spine were assessed by X-ray, CT, MRI preoperatively and postoperatively to evaluate the decompression range, bonegraft fusion and instruments location. ASIA grade and JOA score were recorded to assess the neurological function recovery. Complications, surgery time, intraoperative blood loss and hospital stay were compared between two groups. Mean follow-up was at least 2 years. Results: In this study, Forty eight patients were in group A and 54 ones were in group B. All cases were decompressed fully and obtained fusion 6-month postoperatively. The ASIA grade was improved postoperatively, but no significantly different between two groups (p=0.907). The JOA was 6.12±1.76 preoperatively and improved to 11.98±2.98 postoperatively with the 53.13% neurofunction recovery rate in group A, with no significantly different compared with group B(vs 6.63±2.45, p=0.235; vs 12.62±3.59, p=0.303; vs 57.76%, p=0.590)respectively. Total 18 complications occurred but the occurrence was significant lower in group A(p=0.020). The average surgery time was 2.2±0.32 hours, intraoperative blood loss was 304±56ml and hospital stay was 8.2±3.1 days, significantly decreased compared with group B(vs 3.1±0.29, p=0.000; vs 388±61ml, p=0.000; vs 12±2.8days, p=0.000)respectively. Conclusions: Cervical laminoplasty combined with short-segment transpedicular screw fixation is a reliable option to treat SCIWORA patients with CSS. The advantages include achieving sufficient cervical decompression, maintaining cervical stability and avoiding extra anterior cervical fusion which increases surgery time, intraoperative blood loss, postoperative complications and hospital stay.

scholarly journals The Anterolateral Structure of the Knee Does Not Affect Anterior and Dynamic Rotatory Stability in Anterior Cruciate Ligament Injury: Quantitative Evaluation With the Electromagnetic Measurement System

2019 ◽  
Vol 47 (14) ◽  
pp. 3381-3388 ◽  
Author(s):  
Daisuke Araki ◽  
Takehiko Matsushita ◽  
Yuichi Hoshino ◽  
Kanto Nagai ◽  
Kyohei Nishida ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Electromagnetic Measurement System ◽  
The Mean ◽  
Anterior Cruciate ◽  
Electromagnetic Measurement ◽  
Tibial Translation ◽  
Acl Deficient

Background: The biomechanical function of the anterolateral structure (ALS), which includes the anterolateral joint capsule and anterolateral ligament (ALL), remains a topic of debate. Hypothesis: The ALS contributes to knee joint stability during the Lachman test and the pivot-shift test in anterior cruciate ligament (ACL)–deficient knees. Study Design: Controlled laboratory study. Methods: Fourteen fresh-frozen hemipelvis lower limbs were used. For 7 specimens, the anterior one-third of the ALS and the residual ALS were cut intra-articularly with a radiofrequency device. Subsequently, the ACL was cut arthroscopically. For the other 7 specimens, the ACL was cut first, followed by the anterior one-third of the ALS and the residual ALS intra-articularly. During the procedures, the iliotibial band (ITB) was kept intact. At each condition, the anterior tibial translation (ATT) during the manual Lachman test and the acceleration of posterior tibial translation (APT) and the posterior tibial translation (PTT) during the manual pivot-shift test were measured quantitatively with an electromagnetic measurement system. The mean values of those parameters were compared among 6 groups (ACL intact, one-third ALS cut, all ALS cut, ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut). Results: The mean ATTs during the Lachman test and the mean APTs and PTTs in the ACL-cut conditions (ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut) were significantly larger than those under the ACL-intact conditions (ACL intact, one-third ALS cut, all ALS cut) ( P < .01). However, no statistically significant differences were observed among the intact, one-third ALS–cut, and all ALS–cut conditions, within the ACL-intact or ACL-cut conditions. Conclusion: Intra-articular dissection of the ALS did not increase the ATT during the Lachman test or the APT and PTT during the pivot-shift test under the intact condition of the ITB, regardless of the integrity of the ACL. When the ITB is intact, the ALS does not have a significant role in either anterior or dynamic rotatory knee stability, while the ACL does. Clinical Relevance: Recent growing interest about ALL reconstruction or ALS augmentation may not have a large role in controlling either anterior or dynamic rotatory knee instability in isolated ACL-deficient knees.

Surgery for Acromioclavicular Dislocation: Factors Affecting Functional Recovery

2017 ◽  
Vol 83 (12) ◽  
pp. 1427-1432
Author(s):  
Jun Zhang ◽  
Zhengran Ying ◽  
You Wang
Keyword(s):  
Functional Recovery ◽  
Constant Score ◽  
Hook Plate ◽  
Acromioclavicular Dislocation ◽  
Type Iii ◽  
Clavicular Hook Plate ◽  
Group A ◽  
Group B ◽  
Rockwood Type Iii ◽  
Shoulder Score

The objective of the study is to compare the clinical outcomes of two different interventions for Rockwood type III (or above) acromioclavicular dislocation and study the factors influencing postoperative functional recovery. A total of 60 patients with Rockwood type III (or above) acromioclavicular dislocation were included in the study. Patients were divided into two groups based on the surgical intervention: Clavicular Hook Plate Fixation (Group A) and EndoButton technique of Coracoclavicular Ligament Reconstruction (Group B). Constant shoulder score was employed for the assessment of functional recovery before and after the surgery. Statistical analysis was performed in terms of age, gender, obesity (body mass index), Constant shoulder score, compliance of rehabilitation guidance, and the amount of reduction loss. The Constant score was significantly improved after surgery (P < 0.05). The score was better in Group B compared with Group A in the sixth month after surgery (P < 0.05), but showed no significant difference in the fifteenth month. Compliance with rehabilitation guidance significantly affected the values of the Constant score after the surgery (P < 0.05). Clavicular Hook Plate and EndoButton technique both are effective ways to treat Rockwood type III (or above) acromioclavicular dislocation. However, EndoButton technique is more effective for early functional recovery. Patients’ compliance with rehabilitation guidance is critical for the functional recovery after surgery.

Modified cannulated screw fixation in the treatment of Pauwels type III femoral neck fractures: A biomechanical study

2020 ◽  
Vol 74 ◽  
pp. 103-110 ◽  
Author(s):  
Lin Zhou ◽  
Jiaming Lin ◽  
Anfei Huang ◽  
Weidong Gan ◽  
Xu Zhai ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Screw Fixation ◽  
Biomechanical Study ◽  
Femoral Neck Fractures ◽  
Cannulated Screw ◽  
Type Iii

scholarly journals Is cement-augmented sacroiliac screw fixation with partially threaded screws superior to that with fully threaded screws concerning compression and pull-out force in fragility fractures of the sacrum? – a biomechanical analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Juliana Hack ◽  
Maiwand Safi ◽  
Martin Bäumlein ◽  
Julia Lenz ◽  
Christopher Bliemel ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Fragility Fractures ◽  
Cement Augmentation ◽  
Osteoporotic Bone ◽  
Sacroiliac Screw ◽  
Pull Out ◽  
Sacroiliac Screw Fixation ◽  
Group A ◽  
Group B ◽  
Screw Group

Abstract Background Providing a stable osteosynthesis in fragility fractures of the pelvis can be challenging. Cement augmentation increases screw fixation in osteoporotic bone. Generating interfragmentary compression by using a lag screw also improves the stability. However, it is not known if interfragmentary compression can be achieved in osteoporotic sacral bone by cement augmentation of lag screws. The purpose of this study was to compare cement-augmented sacroiliac screw osteosynthesis using partially versus fully threaded screws in osteoporotic hemipelvises concerning compression of fracture gap and pull-out force. Methods Nine fresh-frozen human cadaveric pelvises with osteoporosis were used. In all specimens, one side was treated with an augmented fully threaded screw (group A), and the other side with an augmented partially threaded screw (group B) after generating a vertical osteotomy on both sides of each sacrum. Afterwards, first a compression test with fracture gap measurement after tightening of the screws was performed, followed by an axial pull-out test measuring the maximum pull-out force of the screws. Results The fracture gap was significantly wider in group A (mean: 1.90 mm; SD: 1.64) than in group B (mean: 0.91 mm; SD: 1.03; p = 0.028). Pull-out force was higher in group A (mean: 1696 N; SD: 1452) than in group B (mean: 1616 N; SD: 824), but this difference was not statistically significant (p = 0.767). Conclusions Cement augmentation of partially threaded screws in sacroiliac screw fixation allows narrowing of the fracture gap even in osteoporotic bone, while resistance against pull-out force is not significantly lower in partially threaded screws compared to fully threaded screws.

Modified Iliotibial Band Tenodesis Is Indicated to Correct Intraoperative Residual Pivot Shift After Anterior Cruciate Ligament Reconstruction Using an Autologous Hamstring Tendon Graft: A Prospective Randomized Controlled Trial

2020 ◽  
Vol 48 (5) ◽  
pp. 1069-1077 ◽  
Author(s):  
Mark Porter ◽  
Bruce Shadbolt
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Similar Rate ◽  
Iliotibial Band ◽  
Group A ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Group B

Background: The indications for the addition of anterolateral soft tissue augmentation to anterior cruciate ligament (ACL) reconstruction and its effectiveness remain uncertain. Purpose: To determine if modified iliotibial band tenodesis (MITBT) can improve clinical outcomes and reduce the recurrence of ACL ruptures when added to ACL reconstruction in patients with a residual pivot shift. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients with a primary ACL rupture satisfying the following inclusion criteria were enrolled: first ACL rupture, involved in pivoting sports, skeletally mature, no meniscal repair performed, and residual pivot shift relative to the contralateral uninjured knee immediately after ACL reconstruction. Patients were randomized to group A (no further surgery) or group B (MITBT added) and were followed up for 2 years. The patient-reported outcome (PRO) measures used were the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) subscale of sport/recreation (Sport/Rec), KOOS subscale of quality of life (QoL), Lysholm knee score (LKS), Tegner activity scale (TAS), recurrent ACL ruptures, or need for further surgery in either knee. Analysis of variance was used to compare PROs; the Wilcoxon test was used for the TAS; and the chi-square test was used for recurrence of ACL ruptures, meniscal injuries, and contralateral ACL ruptures ( P < .05). Results: A total of 55 patients were randomized: 27 to group A (female:male ratio = 15:12; mean age, 22.3 ± 3.7 years) and 28 to group B (female:male ratio = 17:11; mean age, 21.8 ± 4.1 years). At 2-year follow-up, group A had a similar IKDC score (90.9 ± 10.7 vs 94.2 ± 11.2; respectively; P = .21), lower KOOS Sport/Rec score (91.5 ± 6.4 vs 95.3 ± 4.4, respectively; P = .02), similar KOOS QoL score (92.0 ± 4.8 vs 95.1 ± 4.3, respectively; P = .14), lower LKS score (92.5 ± 4.8 vs 96.8 ± 8.0, respectively; P = .004), lower TAS score (median, 7 [range, 7-9] vs 8 [range, 8-10], respectively; P = .03), higher rate of recurrence (14.8% vs 0.0%, respectively; P < .001), similar rate of meniscal tears (14.8% vs 3.6%, respectively; P = .14), and similar rate of contralateral ACL ruptures (3.7% vs 3.6%, respectively; P = .99) relative to group B. Conclusion: The augmentation of ACL reconstruction with MITBT reduced the risk of recurrent ACL ruptures in knees with a residual pivot shift after ACL reconstruction and improved KOOS Sport/Rec, LKS, and TAS scores. Registration: ACTRN12618001043224 (Australian New Zealand Clinical Trials Registry)

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