Internal Fixation
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2021 ◽  
Haopeng Luan ◽  
Kai Liu ◽  
Qiang Deng ◽  
Weibin Sheng ◽  
Maierdan Maimaiti ◽  

Abstract Background: To evaluate the efficacy of debridement and bone grafting using internal fixation in the treatment of kyphotic cervical tuberculosis, and analyze the changes of pre-operation and post-operation sagittal parameters, which related to the surgical indications.Methods: Clinical and radiographic data of patients with kyphotic cervical TB treated by debridement and BGIF at our hospital from January 2010 to December 2017 were analyzed retrospectively. The sagittal parameters of the cervical vertebra at the pre-operation, post-operation, and last follow-up were documented and were compared. Results: Eighteen patients of simple anterior approach debridement and fusion with internal fixation (group A), and 5 patients underwent anterior debridement and fusion, combined with posterior internal fixation (group AP). In the comparison of preoperative sagittal parameters, significant improvement after surgery was observed in both groups, included Cobb angle, SCA, C2-C7SVA, and CG-SVA (P < 0.05). There were no significant differences in T1 Slope, NT, and TIA (P > 0.05).Conclusions: In the treatment of kyphotic cervical TB, the characteristics of the lesion, the degree of kyphosis and spinal cord nerve compression damage can be presented clearly by the radiographic sagittal parameters, which does a favor to individualize the choice of surgical approach safely and effectively.

OrthoMedia ◽  
2021 ◽  

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Yohei Yanagisawa ◽  
Yusuke Eda ◽  
Shotaro Teruya ◽  
Hisanori Gamada ◽  
Masashi Yamazaki

Introduction. Sacroiliac rod fixation (SIRF) preserves the mobility of L5/S1 (lumber in the pelvis), as a surgical procedure for high-energy pelvic ring fractures. The concept of SIRF method without pedicle screws into L4 and L5 is called ‘within ring’ concept. Case Presentation. We report here the clinical results of ‘within ring’ concept treatment with sacroiliac rod fixation for a case of displaced H-shaped Rommens and Hofmann classification type IVb fragility fractures of the pelvis (FFP), which A 79-year-old woman had been difficult to walk due to pain that had been prolonged for more than one month since her injury. The patient was successfully treated with SIRF, no pain waking with a walking stick and returned to most social activities including living independently within 6 months of the operation. Conclusion. SIRF is useful because it can preserve the mobility in the lumbar pelvis; not including the lumbar spine in the fixation range like spino pelvic fixation is a simple, safe, and low-invasive internal fixation method for displaced H-shaped type IVb fragility fractures of the pelvis.

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Bo Liu ◽  
Yufei Wang ◽  
Yaning Zhang

Objective. To investigate the clinical effects of posterior laminectomy and decompression plus lateral mass screw-rod internal fixation for the treatment of multisegment cervical spinal canal stenosis and the improvement of cervical curvature and range of motion in patients. Methods. A total of 68 patients with multisegment cervical spinal stenosis who were treated in our hospital from January 2019 to June 2020 were selected and randomly divided into the control group and the observation group according to the random number table, with 34 patients in each group. The patients in the control group were treated with traditional posterior cervical open-door laminoplasty with silk suture fixation, while those in the observation group were treated with posterior cervical laminectomy and decompression plus lateral mass screw-rod internal fixation. The perioperative index of patients in the two groups was recorded, and the clinical efficacy of patients was evaluated. The patient’s JOA score, cervical physiological curvature, and cervical range of motion were evaluated. The occurrence of complications was recorded during follow-up. Results. The amount of intraoperative bleeding and postoperative rehabilitation training time in the observation group was less than that in the control group ( P < 0.05 ). There was no significant difference in operation time between the two groups ( P > 0.05 ). The total effective rate of the observation group was significantly higher than that of the control group ( P < 0.05 ). The JOA scores at 1 week, 6 months, and 12 months after operation in the observation group were higher than those in the control group ( P < 0.05 ). The physiological curvature of cervical spine in the observation group at 1 week, 6 months, and 12 months after operation was higher than that in the control group ( P < 0.05 ). The cervical range of motion at 12 months after operation in the observation group was significantly higher than that in the control group ( P < 0.05 ). The incidence of postoperative complications in patients of the observation group was significantly lower than that of the control group ( P < 0.05 ). Conclusion. Posterior laminectomy and decompression plus lateral mass screw-rod internal fixation can help patients to improve various clinical symptoms caused by nerve compression and obtain better improvement of cervical curvature and range of motion. It is an ideal surgical method for the treatment of multisegment cervical spinal canal stenosis, and it is conducive to improving the clinical efficacy of patients.

2021 ◽  
Vol 22 (1) ◽  
Ashraf N. Moharram ◽  
Mostafa Mahmoud ◽  
Ahmed Lymona ◽  
Ahmed Afifi ◽  
Mostafa Ezzat ◽  

Abstract Background Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. Methods Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. Results Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. Conclusion Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. Level of evidence Level IV, Therapeutic study


Treatment of unstable ankle fragility fractures: current concepts Displaced ankle fractures are frequently seen in the geriatric population. It is well known that diabetes, osteoporosis and peripheral vascular disease, which are common in the geriatric population, have a negative impact on the postoperative outcome of these fractures. Therefore, the management of these ankle fragility fractures poses specific challenges. The standard in the treatment of unstable ankle fractures, even in the elderly, is an open reduction and internal fixation (ORIF). Major complications (infections, malunion, implant failure), however, often occur. In recent years, new osteosynthesis techniques (intramedullary fibular nailing, fixation with an external fixator, hindfoot nailing) in combination with optimized perioperative care have reduced the risk of complications. In this study, the case report of an unusually severe complication after plate-and-screw fixation augmented with retrograde pinning in an 87-year-old male patient is presented, as well as a review of the literature concerning the optimal treatment of unstable ankle fractures in the elderly. This review can be used as a guideline for the general practitioner, geriatrician, emergency doctor and orthopaedic surgeon treating these difficult injuries.

2021 ◽  
Michael-Tobias Neuhaus ◽  
Nils-Claudius Gellrich ◽  
Alexander-Nicolai Zeller ◽  
Alexander Karl-Heinz Bartella ◽  
Anna Katharina Sander ◽  

Abstract Open treatment of condylar base and neck fractures is widely recommended, whereas treatment of condylar head fractures is still controversial and just is removal of osteosynthesis material. In this study, bone resorption and remodelling after open treatment of condylar head fractures were three-dimensionally (3D) assessed and correlated with clinical parameters in a medium follow-up. Of 18 patients with 25 condylar head fractures who underwent open reduction and internal fixation, clinical data and cone beam computed tomography (CBCT) datasets were analysed. Condylar processes were segmented in the postoperative and follow-up CBCT scans. Volumetric and linear changes were measured using a sophisticated 3D-algorithm. In the course after surgery, patients function and pain improved significantly. Low rates of postoperative complications were observed. All 3D measurements showed no significant bone resorption during the follow-up period. Open reduction of condylar head fractures leads to good patients outcomes and low rates of long-term complications. This study underlines the feasibility and importance of open treatment of condylar head fractures and may help to spread its acceptance as the preferred treatment option.

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Yen-Chang Lin ◽  
Wei-Chieh Chen ◽  
Chun-Yu Chen ◽  
Shyh-Ming Kuo

Abstract Background The WALANT (wide-awake local anesthesia with no tourniquet) technique was based on local infiltration of lidocaine and epinephrine. This technique has rapidly gained popularity in recent years and can perform most hand operations. This study aimed to investigate the time spent on anesthesia and operation and perform an economic analysis among general anesthesia, wrist block with a tourniquet, and the WALANT technique for the internal fixation of metacarpal fractures. Methods We retrospectively reviewed all the single metacarpal fractures managed with the same procedure, open reduction, and internal fixation with the plate between January 2015 and December 2019. They were divided into three groups according to the method of anesthesia: (1) general anesthesia (GA group), (2) wrist block with a tourniquet (WB group), and (3) WALANT technique (WALANT group). We collected and analyzed patient demographic data, perioperative or postoperative complications, number of hospital days, and postoperative functional recovery assessment. Results A total of 63 patients met the inclusion criteria, including 24 in the GA group, 28 in the wrist block group using a tourniquet, and 11 in the WALANT group. There were no complications during the operation and follow-up in each group. The GA group had an average of 32.8 min of anesthesia time, significantly longer than the other two groups. However, there is no significant difference regarding surgical time among the presenting three groups. The discomfort of vomiting and nausea after surgery occurred in 20 patients in the GA group (38.1%). Nevertheless, there was no postoperative vomiting and nausea present in both the WB and WALANT groups. Most patients achieved full recovery of pre-injury interphalangeal and metacarpophalangeal motion at the final assessment of functional recovery. Conclusions The patients undergoing metacarpal fixation surgery under WALANT or WB had significantly less anesthesia time and postoperative vomiting and nausea. Moreover, there was no difference in surgical time and intraoperative complications. The time-related reduction improved the utilization of the operation room for additional cases. The reduction of the preoperative examination, anesthesia fee, postoperative recovery room observation, and hospitalization can effectively reduce medical costs. Furthermore, the WALANT group is more acceptable because of no tourniquet, which commonly causes discomfort.

Markus Laubach ◽  
Felix M. Bläsius ◽  
Ruth Volland ◽  
Matthias Knobe ◽  
Christian D. Weber ◽  

Abstract Purpose To determine whether internal fixation (IF) or hip arthroplasty (HA) is associated with superior outcomes in geriatric nondisplaced femoral neck fracture (FNF) patients. Methods Data from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) were analyzed (IF Group 449 and HA Group 1278 patients). In-hospital care and a 120-day postoperative follow-up were conducted. Primary outcomes, including mobility, residential status, reoperation rate, and a generic health status measure (EQ-5D score), and the secondary outcome of mortality were compared between groups. Multivariable analyses were performed to assess independent treatment group associations (odds ratios, ORs) with the primary and secondary end points. Results Patients in the HA group were older (83 vs. 81 years, p < 0.001) and scored higher on the Identification of Seniors at Risk screening (3 vs. 2, p < 0.001). We observed no differences in residential status, reoperation rate, EQ-5D score, or mortality between groups. After adjusting for key covariates, including prefracture ambulatory capacity, the mobility of patients in the HA group was more frequently impaired at the 120-day follow-up (OR 2.28, 95% confidence interval = 1.11–4.74). Conclusion Treatment with HA compared to treatment with IF led to a more than twofold increase in the adjusted odds of impaired ambulation at the short-term follow-up, while no significant associations with residential status, reoperation rate, EQ-5D index score, or mortality were observed. Thus, IF for geriatric nondisplaced FNFs was associated with superior mobility 120 days after surgery. However, before definitive treatment recommendations can be made, prospective, randomized, long-term studies must be performed to confirm our findings.

2021 ◽  
Shangbo Niu ◽  
Dehong Yang ◽  
Yangyang Ma ◽  
Shengliang Lin ◽  
Xuhao Xu

Abstract BackgroundIntervertebral fusion and internal fixation are often applied to patients with lumbar spinal disease. Whether to remove the internal fixation after successful fusion remains uncertain, but such a question needs to be explored in light of concerns regarding patients’ quality of life and health insurance. We sought to probe if the removal of internal fixation after successful lumbar intervertebral fusion affects patients’ quality of life.MethodsThis was a real-world retrospective case–control study. Data of 102 patients who had undergone posterior lumbar fusion with cage and internal fixation to treat lumbar degenerative diseases were extracted from a single center from 2012 to 2020. Fifty-one patients had undergone internal fixation removal surgery, and 51 controls who retained internal fixations were matched according to demographic and medical characteristics. The quality of life of patients based on the Medical Outcomes Study Short Form 36 (SF-36) scale and their self-assessment were surveyed.ResultsThere was no statistical difference in the overall score of the SF-36 questionnaire between the two groups, but the general health (GH) subscore was lower in the case group than in the control group (P = 0.0284). Among those patients who underwent internal fixation removal, the quality of life was improved after instrument removal as indicated by an increased overall score (P = 0.0040), physical functioning (PF) (P = 0.0045), and bodily pain (BP) (P = 0.0008). Among patients with pre-surgery discomfort, instrument removal generated better outcomes in 25% and poor outcomes in 4.2%. Among patients without pre-surgery discomfort, instrument removal generated better outcomes in 7.4% and poor outcomes in 11.1%.ConclusionAmong patients who achieved successful posterior lumbar internal fixation, whether or not to remove the fixation instruments should be evaluated carefully. In patients experiencing discomfort, instrument removal could improve their quality of life, but the benefits and risks should be comprehensively explained to these patients. Instrument removal should not be routinely performed due to its limited or even negative effect in patients who do not report discomfort before surgery.

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