Bone density may affect primary stability of anterior cruciate ligament reconstruction when organic core bone plug fixation technique used

Purpose Core Bone Plug Fixation (CBPF) technique is an implant-less methodology for ACL reconstruction. This study investigates the effect of bone density on CBPF stability to identify the bone quality that is likely to benefit from this technique. Methods Artificial blocks with 160 (Group 1), 240 (Group 2), and 320 (Group 3) kg/m3 densities were used to simulate human bone with diverse qualities. These groups are representative of the elderly, middle age and young people, respectively. A tunnel was made in each test sample using a cannulated drill bit which enabled harvesting the core bone plug intact. Fresh animal tendon grafts were prepared and passed through the tunnel, so the core bone was pushed in to secure the tendon. The fixation stability was tested by applying a cyclic load following by a pullout load until the failure occurred. The selected group was compared with interference screw fixation technique as a gold standard method in ACL reconstruction. Results The Group 2 stiffness and yield strength were significantly larger than Group 1. The graft slippage of Group 1 was significantly less than Group 3. The ultimate strengths were 310 N and 363 N, in Groups 2 and 3, significantly larger than that of Group 1. The ultimate strength in fixation by interference screw was 693.18 N, significantly larger than the bone plug method. Conclusions The stability of CBPF was greatly affected by bone density. This technique is more suitable for young and middle-aged people. With further improvements, the CBPF might be an alternative ACL reconstruction technique for patients with good bone quality. Clinical relevance The CBPF technique offers an implant-less organic ACL reconstruction technique with numerous advantages and likely would speed up the healing process by using the patient’s own bones and tissues rather than any non-biologic fixations.

Preliminary experience using S1–alar iliac fixation with navigation: technical note

Traditional iliac screws and S2–alar iliac (S2-AI) screws are common methods used for pelvic fixation, and many surgeons advocate pelvic fixation for long-segment fixation to the sacrum. However, in patients without severe deformities and only degenerative conditions, many surgeons may choose S1 screws only. Moreover, even with S2-AI screws, there is more muscular dissection than with using S1 screws, and the rod connection can be cumbersome in both S2-AI fixation and placing iliac screws. Using a surgical video, artist’s illustration, and intraoperative photographs, the authors describe the S1-AI screw fixation technique that allows for single-screw sacral and iliac fixation, requires less distal dissection of the sacrum, allows for easier rod connection, and may be an option in degenerative conditions needing pelvic fixation. However, this is a preliminary feasibility study, and in long fusion constructs, this type of fixation has only been used in conjunction with L5–S1 anterior lumbar interbody fusion (ALIF), and there are no long-term data on the use of this screw fixation technique without ALIF. In short-segment revision fusions, this technique may be considered for salvage in cases of large halos in the sacrum from loosened S1 screw fixation.

Displaced Distal Radius Fracture in Children, Single vs Double K-Wire Fixation

Introduction: Distal radius fracture in pediatric population is the most common sustained injury1. Treatment often is guided by the amount of displacement, with un-displaced fractures requiring only full cast and displaced fractures requiring fixation following reduction with Kirchner Wire (K-wire). Use of a single or double K-wire fixation technique is mostly dependent on the stability of the fracture as well as surgeon preference. Our study aims to evaluate both the Single vs. double K-wire fixation technique for the fixation of Displaced distal radius fracture in children in terms of time of surgery, fracture re-displacement, functional outcome and rate of complications. Materials & Methods: This was a prospective study conducted at The Children Hospital and Institute of Child Health, Lahore between February 1st, 2020 and July 30th 2021. Following approval from the Institutional Ethical committee, 54 pediatric patients presenting to the Emergency and outpatient department with trauma to affected wrist with Displaced Fracture of Distal Radius were admitted and divided into two equal groups. Closed Surgical Fixation following manipulation under anesthesia (MUA) with single and double cross K-wires was performed in each group and Full Cast below elbow was applied for 4 to 6 weeks. Mean radial shortening, angulation and displacement was measured on radiograph pre-operatively, immediate post operatively and at the time of removal of k-wires. Functional outcome was measured post k-wire removal follow up in terms of normal, mildly reduced, moderately reduced and severely reduced. Results: A total of 54 patients were included in the study with the mean age of 9.61(6-14) years, mean time of surgery was 17.26±3.75 minutes for single k-wire and 23.22±3.48 minutes for double k-wire fixation which was significant (p ≤ 0.05). Mean Follow-up was 6.70±0.76 weeks for single k-wire and 6.19±0.48 weeks for double k-wire fixation. There was a statistically significant increase in mean dorsal angulation immediate post-operatively and at the time of k-wire removal (p ≤ 0.05). There was no statistical difference in mean dorsal angulation between the two groups at the time of k-wire removal (p= 0.55). Seven (29.12%) patients of single k-wire developed complications including 3 (11.11%) pin site infection, 1 (1.85%) loss of reduction and 2 (7.41%) wire migration. In contrast to single k-wire fixation, 13 (48.15%) patients developed complications in double k-wire fixation including 7 (29.12%) pin site infection, 1 (1.85%) loss of reduction, 2 (7.41%) neuropraxia and 2 (7.41%) wire migration. In the single k-wire group, 22 (81.48%) patients had normal, 5 (18.52%) had mildly reduced and none had moderately reduced outcome. In double k-wire group, 21 (77.78%) had normal, 5 (.52%) had mildly reduced and 1 (3.70%) had moderately reduced outcome. Conclusion: We concluded that although functional outcome is similar in both groups, single k wire fixation is superior to double k-wire fixation technique in terms of reduced time of surgery and less post-operative complications specially the pin site infection. Key words: Displaced, Distal radius Fracture, K-wire fixation

A Modified Intrascleral Intraocular Lens Fixation Technique Using 27-Gauge Blunted Needles with Fewer Intraocular Manipulations

A new method for intraocular lens (IOL) fixation in the scleral tunnel using two common 27G blunted needles and an ultrathin 30G needle with fewer intraocular manipulations was developed. Half-depth scleral flaps were prepared, and vertically angled sclerotomies were performed under each scleral flap, 2 mm from the limbs with a 20G microblade or a 26G needle. Two bent 27G blunted needles connected the sclerotomy and corneoscleral incisions. One haptic was inserted into this bent 27G blunted needle extraocularly and extruded through the sclerotomy site. Each haptic was inserted into the lumen of the preplaced ultrathin 30G needle and buried into the scleral tunnel. In this retrospective study, we reviewed the outcomes of this new technique in patients with at least 3 months’ follow-up data. Iris capture of the IOL was not observed in any case, and IOL repositioning was not performed either. Astigmatism induced by intraocular aberration was almost as same as that with other methods. Our technique can be performed in any operation room without any extra instruments. This trial is registered with UMIN000044350.