scholarly journals Comparative Biomechanical Study of Screw Fixation Techniques in Periacetabular Osteotomy

Biomechanics ◽  
2021 ◽  
Vol 1 (1) ◽  
pp. 131-144
Author(s):  
Mahsan Bakhtiarinejad ◽  
Amirhossein Farvardin ◽  
Ryan J. Murphy ◽  
Robert B. Grupp ◽  
John E. Tis ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Periacetabular Osteotomy ◽  
Developmental Dysplasia ◽  
Biomechanical Study ◽  
Pelvic Bone ◽  
Optimal Method ◽  
Yield Load ◽  
Acetabular Fragment ◽  
Significant Difference ◽  
Fixation Techniques

Periacetabular osteotomy (PAO) is a common surgical treatment for developmental dysplasia of the hip. To obtain the optimal method of fixation during PAO, different screw fixation techniques have been proposed for stabilizing the acetabular fragment. This study assesses the biomechanical performance of two popular 3-screw fixation techniques: iliac (IS) and transverse (IT) configurations, through finite element simulations. Additionally, different 2-screw combinations are simulated to investigate the biomechanical significance of each screw of the fixation configurations. The study findings show that yield load of the pelvic bone subject to gait loading for IT configuration is on average 7% higher compared to that of the IS. Although the yield load of the IT is predicted to be slightly higher, no significant difference in bone stiffness and displacement of the acetabular fragment are found between two configurations. Simulation results, therefore, do not demonstrate a significant biomechanical advantage of the IT configuration over the IS. Furthermore, the biomechanical comparison between the 2-screw combinations of IS and IT fixations demonstrates that the most anterior screw in IS, located at the iliac crest, and the most medial screw in the IT are the most critical elements in providing sufficient stability and support for acetabular fragment.

scholarly journals Is transverse screw fixation really necessary in PAO?—A comparative in vivo study

2021 ◽  
Author(s):  
Vincent J Leopold ◽  
Juana Conrad ◽  
Christian Hipfl ◽  
Maximilian Müllner ◽  
Thilo Khakzad ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Periacetabular Osteotomy ◽  
Fixation Technique ◽  
Acetabular Fragment ◽  
Center Edge ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract The optimal fixation technique in periacetabular osteotomy (PAO) remains controversial. This study aims to assess the in vivo stability of fixation in PAO with and without the use of a transverse screw. We performed a retrospective study to analyse consecutive patients who underwent PAO between January 2015 and June 2017. Eighty four patients (93 hips) of which 79% were female were included. In 54 cases, no transverse screw was used (group 1) compared with 39 with transverse screw (group 2). Mean age was 26.5 (15–44) in group 1 and 28.4 (16–45) in group 2. Radiological parameters relevant for DDH including lateral center edge angle of Wiberg (LCEA), Tönnis angle (TA) and femoral head extrusion index (FHEI) were measured preoperatively, post-operatively and at 3-months follow-up. All patients were mobilized with the same mobilization regimen. Post-operative LCEA, TA and FHEI were improved significantly in both groups for all parameters (P ≤ 0.0001). Mean initial correction for LCEA (P = 0.753), TA (P = 0.083) and FHEI (P = 0.616) showed no significant difference between the groups. Final correction at follow-up of the respective parameters was also not significantly different between both groups for LCEA (P = 0.447), TA (P = 0.100) and FHEI (P = 0.270). There was no significant difference between initial and final correction for the respective parameters. Accordingly, only minimal loss of correction was measured, showing no difference between the two groups for LCEA (P = 0.227), TA (P = 0.153) and FHEI (P = 0.324). Transverse screw fixation is not associated with increased fragment stability in PAO. This can be taken into account by surgeons when deciding on the fixation technique of the acetabular fragment in PAO.

scholarly journals Fixation stability and implant-associated complications in periacetabular osteotomy: a comparison of screw and K-wire fixation

2021 ◽  
Author(s):  
Vincent Justus Leopold ◽  
Juana Conrad ◽  
Robert Karl Zahn ◽  
Christian Hipfl ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Screw Fixation ◽  
Periacetabular Osteotomy ◽  
Implant Migration ◽  
Major Complications ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Wire Fixation ◽  
Fixation Stability ◽  
Screw Group

Abstract Aims The aim of this study was to compare the fixation stability and complications in patients undergoing periacetabular osteotomy (PAO) with either K-wire or screw fixation. Patients and methods We performed a retrospective study to analyze a consecutive series of patients who underwent PAO with either screw or K-wire fixation. Patients who were treated for acetabular retroversion or had previous surgery on the ipsilateral hip joint were excluded. 172 patients (191 hips: 99 K-wire/92 screw fixation) were included. The mean age at the time of PAO was 29.3 years (16–48) in the K-wire group and 27.3 (15–45) in the screw group and 83.9% were female. Clinical parameters including duration of surgery, minor complications (soft tissue irritation and implant migration) and major complications (implant failure and non-union) were evaluated. Radiological parameters including LCE, TA and FHEI were measured preoperatively, postoperatively and at 3-months follow-up. Results Duration of surgery was significantly reduced in the K-wire group with 88.2 min (53–202) compared to the screw group with 119.7 min (50–261) (p < 0.001). Soft tissue irritation occurred significantly more often in the K-wire group (72/99) than in the screw group (36/92) (p < 0.001). No group showed significantly more implant migration than the other. No major complications were observed in either group. Postoperative LCE, TA and FHEI were improved significantly in both groups for all parameters (p = < 0.0001). There was no significant difference for initial or final correction for the respective parameters between the two groups. Furthermore, no significant difference in loss of correction was observed between the two groups for the respective parameters. Conclusion K-wire fixation is a viable and safe option for fragment fixation in PAO with similar stability and complication rates as screw fixation. An advantage of the method is the significantly reduced operative time. A disadvantage is the significantly higher rate of implant-associated soft tissue irritation, necessitating implant removal. Level of evidence III, retrospective trial.

scholarly journals Periacetabular Osteotomy Performed with Imageless Computer-Assisted Navigation: Case Report

2019 ◽  
Vol 2 (1-3) ◽  
pp. 33-39
Author(s):  
Atul F. Kamath ◽  
Rachel R. Mays
Keyword(s):  
Surgical Navigation ◽  
Periacetabular Osteotomy ◽  
Computer Navigation ◽  
Developmental Dysplasia ◽  
Computer Assisted ◽  
Developmental Hip Dysplasia ◽  
Assisted Navigation ◽  
First Case ◽  
Acetabular Fragment ◽  
Pao Surgery

Periacetabular osteotomy (PAO) is an effective surgical treatment for developmental hip dysplasia. The goal of PAO is to reorient the acetabulum to increase acetabular coverage of the femoral head, as well as to reduce contact pressures within the hip joint. The primary challenge of PAO is to accurately achieve the desired acetabular fragment orientation, while maximizing containment and congruency. As key parts of the procedure are performed out of direct field of view of the surgeon, combined with this challenge of precise spatial orientation, there is a potential role for technologies such as surgical navigation. Adjunctive technology may provide information on the orientation of repositioned acetabulum and may offer a useful assist in performing PAO. Here, we present a case of developmental dysplasia of the hip treated via PAO with the addition of an imageless computer navigation device. Surgery was successful, and, at 3 months after procedure, the patient was progressing well. To our best knowledge, this is the first case using imageless computer-assisted navigation in PAO surgery.

Headless Compression Screw Fixation for Proximal Phalanx Fractures: A Biomechanical Study

Hand ◽  
2020 ◽  
pp. 155894472092664
Author(s):  
Lauren Fader ◽  
Luke Robinson ◽  
Michael Voor
Keyword(s):  
Screw Fixation ◽  
Proximal Phalanx ◽  
Biomechanical Study ◽  
Materials Testing ◽  
Compression Screw ◽  
Headless Compression Screw ◽  
Screw Length ◽  
Significant Difference ◽  
Flexion Extension ◽  
Bending Load

Background: Proximal phalanx fractures are common injuries of the hand with multiple treatment options. Intramedullary (IM) screw fixation has become more widely used, and early outcomes are promising. However, biomechanical data regarding this type of fixation are sparse. Methods: Two methods of IM screw fixation of proximal phalanx fractures were tested in cadaver specimens. All specimens were treated with a single antegrade headless compression screw, with half getting the addition of a blocking screw. To test the most common deforming force of flexion-extension, each phalanx was subjected to apex volar 3-point bending using the Materials Testing System test frame. Results: There was no significant difference in the stiffness of 3-point bending with single antegrade screws alone and with a blocking screw (mean, 63.1 vs 52.2 N/mm; P = .27). When comparing smaller with larger specimens, stiffness of the small group was significantly greater than that of the large group when both fixation methods were included (85.3 vs 30.1 N/mm; P < .0002). When comparing stiffness with percent fill of the screw within bone, there was a moderately positive correlation (0.51). Conclusions: Addition of a blocking screw did not increase the stability of the IM screw fixation construct for proximal phalanx fractures. When comparing specimen size, the smaller bones were stiffer under 3-point bending load, regardless of the type of fixation. In addition, those specimens that had a larger longitudinal screw length to bone length ratio were stiffer. These findings provide valuable information as techniques for IM screw fixation of proximal phalanx fractures continue to evolve.

Bicortical versus unicortical fixation of plated clavicular fractures: A biomechanical study

2020 ◽  
pp. 175857322091421
Author(s):  
Ezequiel E Zaidenberg ◽  
Michael Voor ◽  
Enrique Pereira ◽  
Luciano A Rossi ◽  
Carlos R Zaidenberg
Keyword(s):  
Screw Fixation ◽  
Plate Fixation ◽  
Clavicle Fracture ◽  
Axial Loading ◽  
Biomechanical Study ◽  
Combined Loading ◽  
Torsional Stiffness ◽  
Fourth Generation ◽  
Reconstruction Plate ◽  
Significant Difference

Purpose To compare the biomechanical properties of three plate stabilization techniques for midshaft clavicle fractures: anatomical bicortical locking construct, anatomical unicortical locking construct, and reconstruction bicortical locking construct. Methods We analyzed superior plating of the clavicle using an anatomical clavicle plate (Acumed) with both bicortical or unicortical screw fixation and a locking reconstruction plate (DePuy-Synthes). Twenty-one fourth generation composite clavicles were used for non-destructive stiffness testing in axial loading, bending, and torsion. Fifteen composite clavicles and 17 foam clavicles were used for cyclic failure testing using a combined loading method that included all three loading modes. Results No significant differences were found between the three constructs in torsional stiffness nor in vertical bending loading. In axial loading, the anatomical bicortical locking construct was significantly stiffer than either anatomical unicortical locking construct or the reconstruction bicortical locking construct. The unicortical fixation was also significantly stiffer than the reconstruction bicortical locking construct. Regarding failure testing, there was not a significant difference between the bicortical and unicortical anatomical locking constructs; however, both were significantly stronger than bicortical screw fixation in the reconstruction plate. Conclusion Based on the biomechanical performance of these constructs, unicortical locked plate fixation may be a reasonable option in the treatment of displaced midshaft clavicle fracture fixation.

scholarly journals Biomechanical Evaluation of Sagittal Split Ramus Osteotomy Fixation Techniques in Mandibular Setback

2020 ◽  
Vol 10 (9) ◽  
pp. 3031
Author(s):  
Michael Y. C. Chen ◽  
Yi-Fan Wu ◽  
Heng-Li Huang ◽  
Jui-Ting Hsu
Keyword(s):  
Screw Fixation ◽  
Resistance Force ◽  
Sagittal Split Ramus Osteotomy ◽  
Mandibular Setback ◽  
Significant Difference ◽  
Fixation Techniques ◽  
Group 3 ◽  
Group 2 ◽  
Bicortical Screw ◽  
Group 1

The objective of this study was to evaluate and compare the biomechanical behavior of internal fixation techniques in bilateral sagittal split ramus osteotomies (BSSROs) for mandibular setback. Artificial polyurethane mandibles were used in this study. The distal segment of the mandible was repositioned in an 8-mm setback position. All mandibles were divided into three groups: Group 1 had a straight plate with a four-hole monocortical fixation, Group 2 had a curved plate with a four-hole monocortical fixation, and Group 3 had a three–inverted L-type bicortical screw fixation. Vertical loads were applied on the incisal edge by a material testing system. The resistance force at 1, 3, 5, and 10 mm of displacement was analyzed. From the experimental results, Group 1 showed significantly lower results than Groups 2 and 3. No significant difference was observed between Groups 2 and 3 at 1, 3, and 5 mm of displacement. However, at 10 mm of displacement, the resistance force of Group 3 was greater than that of Group 2. For BSSROs, this study concluded that curved plate fixation exhibited the same rigidity as the inverted-L bicortical screw fixation did at ≤5 mm displacement.

scholarly journals Comparison of the stability of three fixation techniques between porous metal acetabular components and augments

2018 ◽  
Vol 7 (4) ◽  
pp. 282-288 ◽  
Author(s):  
N. A. Beckmann ◽  
R. G. Bitsch ◽  
M. Gondan ◽  
M. Schonhoff ◽  
S. Jaeger
Keyword(s):  
Acetabular Component ◽  
Screw Fixation ◽  
Porous Metal ◽  
Porous Titanium ◽  
Relative Movement ◽  
Fixation Methods ◽  
Significant Difference ◽  
Fixation Techniques ◽  
The Stability ◽  
Acetabular Components

Objectives In order to address acetabular defects, porous metal revision acetabular components and augments have been developed, which require fixation to each other. The fixation technique that results in the smallest relative movement between the components, as well as its influence on the primary stability with the host bone, have not previously been determined. Methods A total of 18 composite hemipelvises with a Paprosky IIB defect were implanted using a porous titanium 56 mm multihole acetabular component and 1 cm augment. Each acetabular component and augment was affixed to the bone using two screws, while the method of fixation between the acetabular component and augment varied for the three groups of six hemipelvises: group S, screw fixation only; group SC, screw plus cement fixation; group C, cement fixation only. The implanted hemipelvises were cyclically loaded to three different loading maxima (0.5 kN, 0.9 kN, and 1.8 kN). Results Screw fixation alone resulted in up to three times more movement (p = 0.006), especially when load was increased to 100% (p < 0.001), than with the other two fixation methods (C and SC). No significant difference was noted when a screw was added to the cement fixation. Increased load resulted in increased relative movement between the interfaces in all fixation methods (p < 0.001). Conclusion Cement fixation between a porous titanium acetabular component and augment is associated with less relative movement than screw fixation alone for all implant interfaces, particularly with increasing loads. Adding a screw to the cement fixation did not offer any significant advantage. These results also show that the stability of the tested acetabular component/augment interface affects the stability of the construct that is affixed to the bone. Cite this article: N. A. Beckmann, R. G. Bitsch, M. Gondan, M. Schonhoff, S. Jaeger. Comparison of the stability of three fixation techniques between porous metal acetabular components and augments. Bone Joint Res 2018;7:282–288. DOI: 10.1302/2046-3758.74.BJR-2017-0198.R1.

scholarly journals Comparison of the modified Smith-Petersen (S-P) and ilioinguinal (I-I) approaches for periacetabular osteotomy in adult developmental dysplasia of the hip: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rui Luo ◽  
Guomin Li ◽  
Bo Li ◽  
Ruyin Hu ◽  
Yankun Li
Keyword(s):  
Blood Loss ◽  
Statistical Significance ◽  
Periacetabular Osteotomy ◽  
Operation Time ◽  
Developmental Dysplasia ◽  
Postoperative Function ◽  
Group I ◽  
Significant Difference ◽  
Operation Stage ◽  
Dysplasia Of The Hip

Abstract Background Adult developmental dysplasia of the hip is an untreated congenital hip dysplasia that results in adult hip pain. One of the usual and effective methods for the treatment of this condition is periacetabular osteotomy. However, which approach is better between the modified S-P and the I-I approaches is still unclear and controversial. Method and materials We retrospectively assessed our experience with the modified S-P and the I-I approaches by inquiring and evaluating intraoperative blood loss, postoperative radiographic material, postoperative function of the hip, and related complications from July 2014 to January 2019. Results A total of 61 patients with adult developmental dysplasia of the hip were enrolled, and 33 patients were divided into a modified S-P group and 28 patients were divided into I-I group. The operation time and blood loss of group I-I were higher than that of group modified S-P. Other clinical and radiographic indexes showed no statistical significance between group the modified S-P and I-I groups. Conclusion There is no significant difference in the improvement of the function of the hip at the post-operation stage, but group I-I may require more operation time and blood loss at the intra-operation stage.

scholarly journals Costs of open, arthroscopic and combined surgery for developmental dysplasia of the hip

2020 ◽  
Author(s):  
Jeffrey D Hassebrock ◽  
Cody C Wyles ◽  
Mario Hevesi ◽  
Hilal Maradit-Kremers ◽  
Austin L Christensen ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Periacetabular Osteotomy ◽  
Hospital Costs ◽  
Developmental Dysplasia ◽  
Treatment Groups ◽  
Unit Costs ◽  
Significant Difference ◽  
Optimal Value ◽  
Nationally Representative ◽  
Dysplasia Of The Hip

Abstract A variety of options exist for management of patients with developmental dysplasia of the hip (DDH). Most studies to date have focused on clinical outcomes; however, there are currently no data on comparative cost of these techniques. The purpose of this study was to evaluate in-hospital costs between patients managed with periacetabular osteotomy, hip arthroscopy or a combination for DDH. One hundred and nine patients were included: 35 PAO + HA, 32 PAO and 42 HA. There were no significant differences in the demographic parameters. Operative times were significantly different between groups with a mean of 52 min for PAO, 100 min for HA and 155 min for PAO + HA, (P &lt; 0.001). Total direct medical costs were calculated and adjusted to nationally representative unit costs in 2017 inflation-adjusted dollars. Total in-hospital costs were significantly different between each of the three treatment groups. PAO + HA was the most expensive with a median of $21 852, followed by PAO with a median of $15 124, followed by HA with a median of $11 582 (P &lt; 0.001). There was a significant difference between outpatient median costs of $11 385 compared with $24 320 for inpatients (P &lt; 0.001). Procedures with greater complexity were more expensive. However, a change from outpatient to inpatient status with HA moved that group from the least expensive to similar to PAO and PAO + HA. These data provide an important complement to clinical outcomes reports as surgeons and policymakers aim to provide optimal value.

scholarly journals Comparison of the modified Smith-Petersen (S-P) and ilioinguinal (I-I) approaches for periacetabular osteotomy in adult developmental dysplasia of the hip: a retrospective study

2019 ◽  
Author(s):  
Rui Luo ◽  
Li Guomin ◽  
Bing Li ◽  
Bo Li ◽  
Ruyin Hu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Statistical Significance ◽  
Periacetabular Osteotomy ◽  
Operation Time ◽  
Developmental Dysplasia ◽  
Postoperative Function ◽  
Group I ◽  
Significant Difference ◽  
Operation Stage ◽  
Dysplasia Of The Hip

Abstract Background Adult developmental dysplasia of the hip is an untreated congenital hip dysplasia that results in adult hip pain in adults. One of the usual and effective methods for the treatment of this condition is periacetabular osteotomy. However, controversy on which approach is better between the modified S-P and the I-I approaches is still unclear and ununified. Method and materials we retrospectively assessed our experience with the modified S-P and the I-I approaches by inquiring and evaluating of intraoperative blood loss, postoperative radiographic material, postoperative function of hip and related complications from July 2014 to January 2019. Results A total of 61 patients with adult developmental dysplasia of the hip were enrolled, and 33 patients were divided into group modified S-P and 28 patients were divided into group I-I. The operation time and blood loss of group I-I were higher than that of group modified S-P. other clinical and radiographic indexes showed no statistical significance between group modified S-P and group I-I. Conclusion There is no significant difference improving the function of the hip at the post-operation stage, but group I-I may require more operation time and blood loss at the intra-operation stage.

Sign in / Sign up

Export Citation Format

Share Document