The Open Capsular Shift-Latarjet Procedure for Recurrent Anterior Shoulder Instability

Background: Capsular management is having an increasingly important place during the open Latarjet procedure especially in preventing postoperative glenohumeral arthritis. The open capsular shift-Latarjet procedure consists of the classic Latarjet procedure associated with a glenoid T-based capsular shift to treat patients with high risk of recurrent anterior shoulder instability. Indications: Patients presenting with humeral and/or glenoid bone loss, patients practicing professional activities or sports at risk of recurrence and without any previous capsular surgery, or major capsular deficiency. Technique Description: After a classic deltopectoral approach and the osteotomy of the coracoid process, a horizontal split of the subscapularis is performed. Then a glenoid T-based capsulotomy is performed, and 2 passing wire suture threads are passed through the inferior flap of the capsule to prepare the capsular shift. A first, soft, all-sutured anchor is inserted at the inferior part of the glenoid medially to the articular surface. The coracoid graft is then positioned with a first inferior cancellous screw to be flush with the articular surface and fixed using a second cancellous screw. A second anchor is placed laterally and superiorly to the coracoid at the anterior scapular neck. The capsular shift is performed using a passing wire technique to suture the capsular flap to both anchors and to ensure the extraarticular positioning of the coracoid. Results: Bouju et al found a low rate of recurrence with no revision surgeries and a significative lower incidence of osteoarthritis (8.6%) at 10-year follow-up compared with the current literature when suturing the capsule to the coracoid process. Itoigawa et al concluded that suturing the capsule on the coracoid may increase the risk of osteoarthritis due to a direct contact between the humeral head and the transferred coracoid, thus we suggest attaching the capsule over the glenoid. Discussion/Conclusion: With appropriate patient selection, this technique is safe and reliable to treat patients with anterior instability without any specific risk related to the surgery. The association of the capsular repair is an appropriate solution to better restore the anatomy and to prevent the long-term risk of glenohumeral arthritis.

Dynamic Hip Screw versus Cannulated Cancellous Screw in Pauwels Type II or Type III Femoral Neck Fracture: A Systematic Review and Meta-Analysis

Vertically oriented femoral neck fractures (FNFs) are known to be especially unstable FNFs, and they have a higher associated risk of failure. The dynamic hip screw (DHS) technique and the cannulated cancellous screw (CCS) technique are the two main fixation techniques used in the treatment of FNFs. However, no large clinical study has compared the DHS and CCS techniques in patients with high-shear-angle FNFs. MEDLINE, Embase, Cochrane Library, and Web of Science were systematically searched for studies that compared the DHS and CCS techniques for the treatment of Pauwels type II or type III FNF. Pooled analysis was performed to identify differences between the DHS and CCS techniques in Pauwels type II or type III FNF, with a focus on postoperative complications such as fracture nonunion and osteonecrosis of the femoral head (ONFH). We included five studies with a total of 252 patients. The DHS technique was used in 96 patients (DHS group), and the CCS technique was used in 156 patients (CCS group). The pooled analysis revealed that the nonunion rate in the CCS group was significantly higher than that in the DHS group (OR = 0.32; 95% CI, 0.11–0.96; p = 0.04, I2 = 0%), but there was no difference in the incidence of ONFH between the groups (OR = 0.98; 95% CI, 0.20–4.73; p = 0.98, I2 = 53%). For vertically oriented FNFs, the DHS technique is more favorable and has a lower risk of fracture nonunion than the CCS technique.

CUSTOMIZATION BASED ON CAD AUTOMATION IN PRODUCTION OF MEDICAL SCREWS BY 3D PRINTING

The paper presents a proposal of a complete CAD Automation solution enabling customization of the production of medical screws to individual patient requirements. The proposed approach using OLE technology enables the introduction of customization at the CAD project stage. The assembly of the surgical screw in the PLM system is generated by means of a specially developed application. The application communicates with the SolidEdge system using an API, taking into account 10 different input parameters. Three different types of medical screws have been developed in the application: the Herbert Screw, Cancellous Screw, and Malleolar Screw with three different thread types: rectangular, isosceles, and trapezoidal. The screws designed in this way can be manufactured using 3D printing techniques or CNC machining, and can be used for both humans and animals.

A Comparative Study of Functional Outcome of Olecranon Fractures Managed with Tension band Wiring Using K Wires with Tension Band Wiring Using Cancellous Screws Fixation

Introduction: Olecranon fracture are some of the common injuries seen in emergency with commonest mode of trauma being fall on outstretched hand and road traffic accident. Methods: This prospective comparative study was carried out from May 2020 to May 2021 within a study period of 1 year in Datta Meghe Medical College. 20 patients of olecranon fractures were enrolled randomly. Results: According to the Mayo classification, the majority of the cases in our study were type II A fractures. The Mayo elbow performance score. In the K wire category, 5 patients (50%) had excellent results, 3 patients (30%) had decent results, and 2 patients (20%) had fair results. In both categories, there were no negative repercussions. In the cancellous screw category, excellent results were found in 8 patients (80%), nice in 1 patient (10%), and fair in 1 patient (10%). Conclusions: From this study, we came to the conclusion that for displaced olecranon fractures as per Mayo’s II A classification fixed by using cancellous screw with tension band wiring gives better clinical outcome When compared to tension band wiring, K-wire fixation keeps costs down, time, and the chance of implant removal complications.

Surgical fixation of posterior cruciate ligament avulsion fracture from tibial attachment using cannulated cancellous screw: a clinical, radiological and functional outcome evaluation

<p class="abstract"><strong>Background:</strong> PCL (posterior cruciate ligament) is the main posterior stabilizer of the knee and plays a role in central axis controlling and imparting rotational stability to the knee. Injury to PCL presents commonly with avulsion fractures from its tibial attachment. An avulsion fracture of the PCL, if not surgically fixed, may lead to secondary changes in the knee joint. The aim of the study was to evaluate the clinical and functional results in patients with PCL tibial avulsion fractures treated by CC (cannulated cancellous) screw fixation.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study conducted at a tertiary care government hospital in Kolkata, between December 2018 to July 2020 on patients who underwent CC screw fixation for post-traumatic PCL avulsion fracture from tibial site. All patients were followed up for 9 months. Lysholm knee score was used to assess the functional outcomes of the patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> In a total of 10 patients, 9 (90%) patients showed excellent and 1 (10%) patient had good result during the final follow-up. 80% patients did not develop any complications. At the end of 9 months, the mean Lysholm score was 95.6. 8 (80%) patients achieved almost full knee ROM post-operatively by the end of final follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Surgical fixation using CC screws is a simple, easy, safe and reproducible method without requiring significant expertise for achieving good stability in PCL tibial site avulsion fractures, where early intervention prevents significant late disability as it provides an excellent clinical, functional and radiographic outcome along with good joint function.</p><p> </p>

WITH REGARDS TO THE CLINICO-FUNCTIONAL OUTCOMES, IN BETWEEN FQPP OR BDSF TECHNIQUE, WHICH IS SUPERIOR, AS A CANCELLOUS SCREW FIXATION OPTION, FOR FRACTURE NECK OF FEMUR.

Fracture Neck of Femur are common and one among the most challenging Orthopaedic trauma cases. Many a factors like age, time elapsed after occurrence of injury, presence of other musculo-skeletal trauma and presence of other co-morbid conditions, are all to be taken into account, before embarking on any surgical intervention. Given the precarious blood supply of the femoral head, AVN of the femoral head is a signicant complication in the displaced fractures. Among the various classication systems available, the Garden classication is still in vogue, as highlighted by Guyton J.L et al; (1). The purpose of this prospective study, is to establish the superiority or otherwise of the 'Four Quadrant Peripheral Parallel (FQPP) Screw Fixation” technique, over the “Biplanar Double Support Screw Fixation (BDSF)” technique, when opting for multiple percutaneous cancellous screw xation, for fracture neck of femur. The age group in our study included patients from 26 years to 55 years and had a total of 18 patients, who were recruited in between March 2018 to February 2020. Of these 18 patients, 9 patients were treated by the FQPP technique and another 9 patients by the BDSF technique. All cases were followed-up for at least 1 year (range: 12 to 35 months, mean 18 months). Evaluation was done by Harris Hip Score (HHS) (2). In the FQPP group, 55.56% (n=5) patients had good to excellent results, 22.22% (n=2) patients had fair and 22.22% (n=2) patients had poor outcomes. In the BDSF group 66.67% (n=6) patients had good to excellent results, 22.22% (n=2) patients had fair and 11.11% (n=1) patient had poor outcome. Thus, the results were only just marginally better for the BDSF group, in comparison to the FQPP group and hence, no substantial deductions could be made favoring the superiority of one xation type over the other.