Clavicular osteotomy to assess subclavian vein injury during internal fixation of midshaft clavicle fractures

Midshaft clavicle fractures are commonly fixed with locking plates. The subclavian vein risks injury during this procedure and the consequences can be fatal. The purpose of this present study is to describe a clavicular osteotomy technique in order to equip orthopaedic surgeons with a means of rapidly accessing a subclavian vein injury. The osteotomy should only be performed following an urgent intraoperative vascular surgery assessment. There must be shared consensus from both orthopaedic and vascular surgery that direct repair of the subclavian vein is necessary, and further exposure is required. The results of the technique performed on thirteen embalmed cadaveric specimens are also included. The osteotomy was able to expose 3.16 cm (SD = 0.60) of the subclavian vein and both the fracture and osteotomy site of all clavicles (100%) were able to be reduced and fixed using a single pre-contoured fifteen-hole lateral plate intended for use on the contralateral shoulder. This surgical technique study confirms that in the rare circumstance that the osteotomy is utilized, adequate exposure of the subclavian vein is achieved.

Can the design of the instruments used for undersized osteotomies influence the initial stability of implants installed in low-density bone? An in vitro pilot study

Objectives The aims of this study were to compare the initial implant stability obtained using four different osteotomy techniques in low-density synthetic bone, to evaluate the instrument design in comparison to the implant design, and to determinate a possible correlation between the insertion torque and initial stability quotient (ISQ). Materials and methods Four groups were identified in accordance with the osteotomy technique used (n = 10 implants per group): group G1, osteotomy using the recommended drilling sequence; group G2, osteotomy using an undersized compactor drill; group G3, osteotomy using an undersized drill; and group G4, osteotomy using universal osseodensification drills. Two polyurethane blocks were used: block 1, with a medullary portion of 10 pounds per cubic foot (PCF 10) and with a 1 mm cortical portion of PCF 40, and block 2, with a medullary of PCF 15 and with a 2 mm cortical portion of PCF 40. Tapered implants of 4 mm in diameter and 11 mm in length were used. The insertion torque (IT) and ISQ were measured. The dimensions of the final instrument used in each group and the dimensions of the implant were used to calculate the total area of each part, and these data were compared. Results Differences between the four groups were found for IT and ISQ values depending on the technique used for the osteotomy in the two synthetic bone models (p < 0.0001). All groups showed lower values of initial stability in block 1 than in block 2. Conclusions Undersized osteotomies with instruments designed according to the implant body significantly increased the initial stability values compared to beds prepared with universal drills and using the drilling sequence standardized by the manufacturer.

A Novel Technique of Transpedicular Opening-wedge Osteotomy for Treatmtent of Rigid Kyphosis in Patients With Ankylosing Spondylitis

BackgroundTo investigate the effectiveness and feasibility of a novel vertebral osteotomy technique, transpedicular opening-wedge osteotomy (TOWO) for correcting rigid thoracolumbar kyphotic deformity in patients with ankylosing spondylitis (AS).Methods18 AS patients underwent TOWO for correcting rigid thoracolumbar kyphosis. Radiographic parameters were compared before surgery, 1 week after surgery and at last follow-up. SRS-22 questionnaire was assessed before surgery and at last follow-up to evaluate clinical improvement. The operating time, estimated blood loss and complications were analyzed. ResultsThe mean operating time and estimated blood loss were 236 minutes and 595 ml, respectively. Sagittal parameters improved significantly after surgery. The height of anterior column of osteotomized vertebrae was increased significantly at 1 week after surgery and last follow-up when compared to preoperative, but the height of middle column did not changed significantly. SRS-22 scores were improved significantly at last follow-up than preoperative. Solid fusion was achieved in all patients after 12 months follow-up, no screw loosening, screw pull out or rod breakage was noticed at last follow-up. ConclusionsTOWO could achieve a satisfactory kyphosis correction by opening anterior column instead of vertebral body decancellation and posterior column closing, which simplified the osteotomy procedure and improved the surgical efficacy.

Functional and Aesthetic Outcome Following Simultaneous Temporomandibular Joint Ankylosis Release and Correction of Chin Discrepancy by Lower Border Osteotomy-A Case Report

This is a case report of a 19 year old adult female with facial asymmetry secondary to right Temporomandibular Joint (TMJ) ankylosis with a history of previous surgery at the age of 10 years with gap arthroplasty for tmj ankylosis which was unsuccessful and lead to relapse .Because of decreased mouth opening and facial disfigurement patient was not able to have a quality life. She reported to our department where she got operated simultaneously for tmj ankylosis with interpositional arthroplasty using temporalis myofascial flap and novel osteotomy technique for correction of chin asymmetry. After surgery there is a significant improvement in patient both functionally and aesthetically.

Use of a Locking Plate and Drill Sleeves to Guide Dome-Shaped Supramalleolar Osteotomy: Technique Tip

Level of Evidence: Level V, expert opinion.