rigid fixation
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2022 ◽  
Vol 19 (1) ◽  
pp. 59-63
Author(s):  
Sabin Shrestha ◽  
Dinesh Kumar Shrestha

Introduction: Monteggia fracture dislocations are rare injuries (<5%) where missed treatment results into deformity and dysfunction of forearm and hand. For the better functional result early diagnosis, accurate reduction of radial head and rigid fixation of ulna and immobilization during post-operative period for ligamentous healing around radius is vital. So operative treatment has been the primary method of treatment to prevent deformity and disability in monteggia fracture dislocation. Aims: The aim of this study was to evaluate the time taken to unite fractures, complications encountered and assess the functional outcome on the basis of K-wire fixation in monteggia fracture dislocation in children. Methods: A cross-sectional observational study was conducted in Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke with monteggia fracture dislocation in children. Results: Thirty-two monteggia fracture dislocation in children between six to 14 years of age were treated with intramedullary K-wires after reduction of radial head. Seven cases had open reduction, and five needed trans-capitellar K-wire supplementation. Mean union time was 8.44±1.94 weeks ranging from seven to 12 weeks. The functional outcome on the basis of Anderson’s scoring system was excellent in 25(78.1%), good in three and optimal in four cases. Conclusion: Monteggia fracture dislocation is better treated early and early mobilization of elbow joint is needed for better functional results.


2022 ◽  
Vol 27 (1) ◽  
Author(s):  
Henrik C. Bäcker ◽  
Mark Heyland ◽  
Chia H. Wu ◽  
Carsten Perka ◽  
Ulrich Stöckle ◽  
...  

Abstract Introduction Intramedullary (IM) fixation is the dominant treatment for pertrochanteric and femoral shaft fractures. In comparison to plate osteosynthesis (PO), IM fixation offers greater biomechanical stability and reduced non-union rates. Due to the minimally invasive nature, IM fixations are less prone to approach-associated complications, such as soft-tissue damage, bleeding or postoperative infection, but they are more prone to fat embolism. A rare but serious complication, however, is implant failure. Thus, the aim of this study was to identify possible risk factors for intramedullary fixation (IMF) and plate osteosynthesis (PO) failure. Materials and methods We searched our trauma surgery database for implant failure, intramedullary and plate osteosynthesis, after proximal—pertrochanteric, subtrochanteric—or femoral shaft fractures between 2011 and 2019. Implant failures in both the IMF and PO groups were included. Demographic data, fracture type, quality of reduction, duration between initial implantation and nail or plate failure, the use of cerclages, intraoperative microbiological samples, sonication, and, if available, histology were collected. Results A total of 24 femoral implant failures were identified: 11 IMFs and 13 POs. The average age of patients in the IM group was 68.2 ± 13.5 years and in the PO group was 65.6 ± 15.0 years, with men being affected in 63.6% and 39.5% of cases, respectively. A proximal femoral nail (PFN) anti-rotation was used in 7 patients, a PFN in one and a gamma nail in two patients. A total of 6 patients required cerclage wires for additional stability. A combined plate and intramedullary fixation was chosen in one patient. Initially, all intramedullary nails were statically locked. Failures were observed 34.1 weeks after the initial surgery on average. Risk factors for implant failure included the application of cerclage wires at the level of the fracture (n = 5, 21%), infection (n = 2, 8%), and the use of an additional sliding screw alongside the femoral neck screw (n = 3, 13%). In all patients, non-union was diagnosed radiographically and clinically after 6 months (n = 24, 100%). In the event of PO failure, the placement of screws within all screw holes, and interprosthetic fixation were recognised as the major causes of failure. Conclusion Intramedullary or plate osteosynthesis remain safe and reliable procedures in the treatment of proximal femoral fractures (pertrochanteric, subtrochanteric and femoral shaft fractures). Nevertheless, the surgeon needs to be aware of several implant-related limitations causing implant breakage. These may include the application of tension band wiring which can lead to a too rigid fixation, or placement of cerclage wires at the fracture site.


2022 ◽  
pp. 219256822110638
Author(s):  
Colby Oitment ◽  
Patrick Thornley ◽  
Frank Koziarz ◽  
Thorsten Jentzsch ◽  
Kunal Bhanot

Study Design Systematic review. Objectives Review the surgical techniques and construct options aimed at improving the biomechanical strength of cervical constructs. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify all studies examining biomechanical strategies utilized in the osteoporotic cervical spine. Screening was performed in duplicate for all stages of the review process. Results An initial search returned 3887 articles. After deletion of duplications and review of abstracts and full text, 39 articles met inclusion criteria. Overall, the surgical techniques reviewed aimed at obtaining rigid fixation in the setting of poor bone quality, or dispersing the forces at the bone-implant interface. We identified 6 key techniques to improve biomechanical fixation. These include bicortical fixation, appropriate screw selection (size and trajectory), PMMA augmentation, load sharing techniques, consideration of ancillary fixation around the occipitocervical junction, and supplementing the construct with post-operative collar or halo. Conclusion The summation of the literature highlights a framework of modalities available to surgeons to improve biomechanical fixation in the cervical spine. While these may improve construct strength in the setting of osteoporosis, there is a paucity of evidence available to make recommendations in this patient population.


2022 ◽  
Vol 8 ◽  
Author(s):  
Peter Endre Eltes ◽  
Mate Turbucz ◽  
Jennifer Fayad ◽  
Ferenc Bereczki ◽  
György Szőke ◽  
...  

Introduction: En-bloc resection of a primary malignant sacral tumor with wide oncological margins impacts the biomechanics of the spinopelvic complex, deteriorating postoperative function. The closed-loop technique (CLT) for spinopelvic fixation (SPF) uses a single U-shaped rod to restore the spinopelvic biomechanical integrity. The CLT method was designed to provide a non-rigid fixation, however this hypothesis has not been previously tested. Here, we establish a computational method to measure the deformation of the implant and characterize the bony fusion process based on the 6-year follow-up (FU) data.Materials and Methods: Post-operative CT scans were collected of a male patient who underwent total sacrectomy at the age of 42 due to a chordoma. CLT was used to reconstruct the spinopelvic junction. We defined the 3D geometry of the implant construct. Using rigid registration algorithms, a common coordinate system was created for the CLT to measure and visualize the deformation of the construct during the FU. In order to demonstrate the cyclical loading of the construct, the patient underwent gait analysis at the 6th year FU. First, a region of interest (ROI) was selected at the proximal level of the construct, then the deformation was determined during the follow-up period. In order to investigate the fusion process, a single axial slice-based voxel finite element (FE) mesh was created. The Hounsfield values (HU) were determined, then using an empirical linear equation, bone mineral density (BMD) values were assigned for every mesh element, out of 10 color-coded categories (1st category = 0 g/cm3, 10th category 1.12 g/cm3).Results: Significant correlation was found between the number of days postoperatively and deformation in the sagittal plane, resulting in a forward bending tendency of the construct. Volume distributions were determined and visualized over time for the different BMD categories and it was found that the total volume of the elements in the highest BMD category in the first postoperative CT was 0.04 cm3, at the 2nd year, FU was 0.98 cm3, and after 6 years, it was 2.30 cm3.Conclusion: The CLT provides a non-rigid fixation. The quantification of implant deformation and bony fusion may help understate the complex lumbopelvic biomechanics after sacrectomy.


2021 ◽  
Vol 10 (24) ◽  
pp. 5782
Author(s):  
Byung-Kyu So ◽  
Kyeong-Soo Ko ◽  
Dong-Hyuck Kim ◽  
Hyon-Seok Jang ◽  
Eui-Seok Lee ◽  
...  

Occlusal displacement often occurs after surgery for condylar process fractures because it is difficult to reduce these fractures precisely. However, performing semi-rigid fixation using a sliding plate may overcome this limitation. A retrospective clinical comparison between semi-rigid and rigid fixations was performed. Among 34 patients who had unilateral condylar process fractures, 17 were treated with rigid fixation and the remaining with semi-rigid fixation using a sliding plate. For all patients, panoramic radiographs were collected 1 day and 6 months after surgery. In these radiographs, ramus height and condylar process inclination were measured, and the differences between the fractured and normal sides were assessed. Additionally, the radiographic density of the fracture area was measured. Differences in surgical outcomes and operative times between the two groups and changes in postoperative deviations within each group were analyzed. There was no statistically significant difference in ramus height and condylar process inclination between the two groups at postoperative day 1 and 6 months. Radio-density was observed to be higher in the rigid fixation group, and it increased with time in both groups. The semi-rigid fixation group had a significantly shorter operative time than the other group did. Semi-rigid and rigid fixations showed no differences in terms of effectiveness and outcomes of surgery. In terms of operative time, semi-rigid fixation was superior to rigid fixation.


Author(s):  
Sawai Singh ◽  
Raghuveer Meena

Background: To evaluate the functional outcome of locking compression  plate for fractures around knee joint (Distal 1/3rd femur or proximal 1/3rd tibia) Methods: This prospective functional out-come study has been conducted on This prospective study has been conducted on 50 patients with Distal 1/3rd femur and 50 patients with  proximal 1/3rd tibia Results: According to Modified Mehrotra’s Criteria, the excellent (44.00%) and fair (42.00%) and (14.00%) had poor result Conclusion: Locking compression plate is the optimal tool for many supracondylar fractures of femur and proximal tibia fractures. It provides rigid fixation, where a widening canal, thin cortices and frequently poor bone stock make fixation difficult. Keywords: Femur, Tibia, Locking plate, MIPO, Outcome.


Author(s):  
Sushma Gopalakrishnan ◽  
R. Priyadharshini ◽  
Palati Sinduja

Complications are a reality in healing fractures. Most can be stopped or reduced by being aware of their pathophysiology. Others, though, are inevitable, but their Early diagnosis and effective treatment can help recovery. Significant complications Are Osteomyelitis, delayed union, non-union, malunion, premature union, which were a result of fracture repair. Keeping these complications into consideration Presurgical patient assessment as well as postoperative treatment should be taken into account. The goal of fracture repair is to ascertain rigid fixation and perfect alignment of the bone to permit each timely and maximized come to perform in the affected space. The particular injury, species and breed conformation, age, general health, concomitant malady processes, nutrition, and medications all play a job in healing and, therefore, response to the repair. However, these factors don't seem to be the sole determinants of outcome. the strategy of repair and surgical technique each play a vital role within the outcome of fracture management. For this reason, it's vitally necessary that the practitioner be aware of potential complications of fracture repair and take steps to stop them. This review centers on how these complications can be prevented, understood and handled.


2021 ◽  
Vol 2 (20) ◽  
Author(s):  
Sushil Patkar

BACKGROUND Displaced odontoid fractures that are irreducible with traction and have cervicomedullary compression by the displaced distal fracture fragment or deformity caused by facetal malalignment require early realignment and stabilization. Realignment with ultimate solid fracture fusion and atlantoaxial joint fusion, in some situations, are the aims of surgery. Fifteen such patients were treated with direct anterior extrapharyngeal open reduction and realignment of displaced fracture fragments with realignment of the atlantoaxial facets, followed by a variable screw placement (VSP) plate in compression mode across the fracture or anterior atlantoaxial fixation (transarticular screws or atlantoaxial plate screw construct) or both. OBSERVATIONS Anatomical realignment with rigid fixation was achieved in all patients. Fracture fusion without implant failure was observed in 100% of the patients at 6 months, with 1 unrelated mortality. Minimum follow-up has been 6 months in 14 patients and a maximum of 3 years in 4 patients, with 1 unrelated mortality. LESSONS Most irreducible unstable odontoid fractures can be anatomically realigned by anterior extrapharyngeal approach by facet joint manipulation. Plate (VSP) and screws permit rigid fixation in compression mode with 100% fusion. Any associated atlantoaxial instability can be treated from the same exposure.


2021 ◽  
Vol 25 (5) ◽  
pp. 15-30
Author(s):  
P. S. Lomasko ◽  
A. L. Simonova ◽  
D. A. Barkhatova ◽  
L. B. Khegay

The purpose of the research is to determine the needs of teachers and concretize the structural, content, technological and ergonomic characteristics of the new regional platform for the implementation of additional subject training of schoolchildren in the Krasnoyarsk region, functioning in a digital society. Despite the fact that today online education resources are gaining more and more popularity, providing unlimited access to sources of knowledge for all segments of the population, their use in the real educational process, including additional subject training of schoolchildren, is not gaining such popularity as among the adult contingent of students. This fact is due to the characteristics of the younger generation, as well as such characteristics of existing platforms as rigid fixation of content and procedural components, mass character without the possibility of adjusting to the needs of a particular student, school, program or the author’s position of a real teacher. In this regard, there is a need to develop such a platform that will meet the needs of school teachers, and innovative teachers, interested in the development and productive use of digital educational resources in the multilevel training of schoolchildren in the context of distance education will participate in its development and filling. It seems that such an environment will increase the innovative potential of the Krasnoyarsk region in the field of general education, positively affect the image and competitiveness among other regions of the Russian Federation.Materials and methods. The paper analyzes psychological, pedagogical, methodological literature and scientific works devoted to the research topic. The results of a questionnaire survey conducted by the authors are analyzed in order to determine the attitude of teachers of the Krasnoyarsk region to the idea of developing a new regional platform for additional subject training of schoolchildren and identifying the requests of its potential users in the field of structure, design, functional and technological characteristics.Results. The empirical data obtained in the course of the study confirmed the fact that the search for new ways and means of effective organization and implementation of additional subject training of schoolchildren is today an urgent and significant task for both pedagogical theory and educational practice. As the main characteristics of the educational platform, requested by the respondents, such as the ability to transform content according to the needs of the teacher and the student, clustering of content according to didactic tasks and subject content, the use of cognitive visualization, activation of independent activity of students, visualization of learning progress and an intuitive interface, meeting the main focus and the needs of the target audience were identified.Conclusion. The results of the research made it possible to determine the needs of teachers and to concretize the structural, substantive, technological and ergonomic characteristics of the new regional platform for the implementation of additional subject training of schoolchildren of the Krasnoyarsk region, functioning in a digital society. The data obtained are the basis for the development of training courses-transformers with open access to informative units for innovative teachers.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fan Yongfei ◽  
Liu Chaoyu ◽  
Xu Wenqiang ◽  
Ma Xiulin ◽  
Xu Jian ◽  
...  

Abstract Background Purely ligamentous Lisfranc injuries are mainly caused by low energy damage and often require surgical treatment. There are several operative techniques for rigid fixation to solve this problem clinically. This study evaluated the effect of using the Tightrope system to reconstruct the Lisfranc ligament for elastic fixation. Methods We retrospectively analyzed 11 cases with purely ligamentous Lisfranc injuries treated with the Tightrope system from 2016 to 2019, including 8 male and 3 female. X-ray was performed regularly after operation to measure the distance between the first and second metatarsal joint and the visual analogue scale (VAS) score was used to evaluate pain relief. American orthopedic foot & ankle society (AOFAS) and Maryland foot score were recorded at the last follow-up. Results The average follow-up time was 20.5 months (range, 17–24). There was statistically significant difference in the distance between the first and second metatarsal joint and VAS score at 3 months, 6 months, and the last follow-up when compared with preoperative values (P < 0.05).Mean of postoperative AOFAS mid-foot scale and Maryland foot score were 92.4 ± 4.3, 94.1 ± 3.5, respectively. The Tightrope system was not removed and the foot obtained better biomechanical stability. No complications occurred during the operation. Conclusion Tightrope system in the treatment of purely ligamentous Lisfranc injuries can stabilize the tarsometatarsal joint and achieve satisfactory effect.


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