PERCUTANEOUS INSTRUMENTATION WITHOUT ARTHRODESIS FOR THORACOLUMBAR BURST FRACTURES (A3/A4, B): A RETROSPECTIVE STUDY

ABSTRACT Objective: There is still no consensus as to the treatment options for thoracolumbar burst fractures, although these fractures are widely described in the literature. The aim of this study was to evaluate the clinical and radiological outcomes of percutaneous instrumentation without arthrodesis as a method of fixation of these lesions. Methods: This retrospective, cross-sectional study evaluated 16 patients by measuring regional kyphosis using the Cobb method and the scores for quality of life and return to work (Oswestry Disability Index, VAS, SF-36 and Denis). Results: Six months after surgical treatment, 62.5% of all patients showed minimal disability according to the Oswestry Disability Index, maintenance of regional kyphosis correction and no synthesis failure. Conclusions: The clinical and radiological outcomes of the study suggest that minimally invasive fixation is indicated for the treatment of thoracolumbar burst fractures. Level of evidence IV; Observational study: retrospective cohort.

Mathematical Modelling of Destabilization Stress Factors of Stable-Elastic Fixation of Distal Trans- and Suprasyndesmotic Fibular Fractures

Introduction. Specification of possible stress factors destabilizing the fibula stable osteosynthesis by the intramedullary nail with distal blocking and elastic fixation of distal syndesmosis by the thread with endobuttons by mathematical modelling of distal unstable ankle injuries. Material and Methods. We studied the thread tension during the combined stable-elastic fixation of unstable injuries of the ankle joint in cross-syndesmosis fractures of the fibula (B, C Danis–Weber classification), which includes a one-time stable minimally invasive fixation with the intramedullary nail and elastic fixation by the thread with endobuttons. We used a titanium alloy for the intramedullary nail and polyester for the thread. The deformed state was studied using the methods of mechanics. Results. A model of a fractured fibula blocked with the intramedullary nail and fixed with the elastic thread was developed. A formulation to specify the rational tension forces of the elastic thread depending on the parameters of the fibula and intramedullary blocking nail and on the location of the bone injury was obtained. The effect of foot rotation on the thread tension was investigated. The results of theoretical research should be implemented in medical practice. Conclusions. A mathematical model of the damaged fibula blocked by the intramedullary nail and fixed with the elastic thread was developed. Dependences for calculation of tension of the fixing thread were obtained. A slight increase in thread tension during foot rotation was found.

Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases

Purpose Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. Methods In this retrospective cohort study, OS and MIS groups were investigated. The bisegmental Cobb angles and dislocation angles were measured using pre- and postoperative CT images, and the initial malalignment and achieved reduction were calculated. Cut-seam time, calculated blood loss, transfusion number, fluoroscopy time, pedicle screw placement accuracy, duration of ICU stay, in-patient stay, and complications (bleeding, postoperative thrombosis and embolism, and postoperative mortality) were recorded. Results Seventy-five ASD patients with spine fractures (Ø 75 ± 11 years, male: 52, female: 23) (MIS: 48; OS: 27) were included in this study. The extent of reduction did not differ in the OS and MIS groups (p = 0.465; MIS:− 1 ± 3°, OS:−2 ± 6°). The residual postoperative malalignment angle was not significantly different (p = 0.283). Seventy-eight of the implanted screws (11%) showed malpositioning. No difference was found between OS and MIS (MIS, 37 [7%]; OS, 41 [16%]; p = 0.095). MIS was associated with less blood loss (OS: 1.28 ± 0.78 l, MIS: 0.71 ± 0.57 l, p = 0.001), cut-seam time (MIS: 98 ± 44 min, OS: 166 ± 69 min, p < 0.001), and hospital stay (MIS: Ø14 ± 16 d, OS: Ø38 ± 49 d, p = 0.02) than OS. Conclusion OS and MIS show equally limited performance in terms of the fracture reduction achieved. The MIS technique was superior to OS based on the perioperative outcome. Therefore, MIS should be preferred over OS for unstable spinal injuries, excluding C-type fractures, in ASD patients without neurological impairment.

EVALUATION OF FUNCTIONAL OUTCOME OF CALCANEUM FRACTURES TREATED BY MINIMALLY INVASIVE FIXATION TECHNIQUES

Purpose: To assess the functional outcome of calcaneum fracture treated by minimally invasive xation technique. Methods: 30 patients of displaced intraarticular calcaneum fractures were treated with minimally invasive xation techniques in this prospective study after obtaining informed consent regarding the same and satisfying inclusion and exclusion criteria. They were then followed up at 3 weeks, 6 weeks, 3 months, and 6 months. Functional outcomes were assessed using American association of foot and ankle score system (AOFAS) and Radiographs were also obtained on follow up and Bohler and Gissane angles were measured. Results: Out of 30 patients treated with minimally invasive xation techniques bony union occurred in all patients, functional outcome by American association of ankle and foot score (AOFAS) were 24 good, and 6 fair result. Radiographs showed restoration and maintainence of Bohler angle and Gissane angle in 28 patients at 6 months follow up. Conclusion: Minimally invasive technique for the treatment of intra articular fractures gives good to fair clinical outcome on short term follow up with very few complications. Restoration of Bohler and Gissane angle is correlated to good functional outcomes.

Comparison of percutaneous cross screw fixation versus open reduction and internal fixation for pelvic Day type II crescent fracture-dislocation: case-control study

Objective To investigate the clinical outcomes of percutaneous cross screws internal fixation for pelvic Day type II crescent fracture-dislocation. Methods We reviewed 66 consecutive patients undergoing surgical treatment for Day type II crescent fracture-dislocation from June 2005 to December 2017. Percutaneous cross screws internal fixation was performed in 40 patients, and open reduction and internal fixation was performed in 26 patients. The patient characteristics, surgical complications, radiographic and clinical outcomes and were compared. Results There was no statistically difference on the mean time from injury to surgery between the two groups. The time of operation, the amount of blood loss, the length of incision, and the hospital stay were significantly shorter in the percutaneous cross screws internal fixation group. No significant difference on Matta scores and Majeed scores between the two groups. The open reduction and internal fixation group resulted in a higher rate of intraoperative hemorrhage, nerve injury, discomfort, and pain. Conclusion Percutaneous cross screws internal fixation for Day II type pelvic crescent fracture-dislocation was safe and effective. Minimally invasive fixation had the advantages of short operation and hospitalization time, less intraoperative bleeding, and surgical trauma.

Comparison of percutaneous cross screw fixation versus open reduction and internal fixation for pelvic Day type II crescent fracture-dislocation: Case-control study

Objective: To investigate the clinical outcomes of percutaneous cross screws internal fixation for pelvic Day type II crescent fracture-dislocation.Methods: We reviewed 66 consecutive patients undergoing surgical treatment for Day type II crescent fracture-dislocation from June 2005 to December 2017. Percutaneous cross screws internal fixation was performed in 40 patients, and open reduction and internal fixation was performed in 26 patients. The patient characteristics, surgical complications, radiographic and clinical outcomes and were compared.Results: There was no statistically difference on the mean time from injury to surgery between the two groups. The time of operation, the amount of blood loss, the length of incision and the hospital stay were significantly shorter in the percutaneous cross screws internal fixation Group. No significant difference on Matta scores and Majeed scores between the two groups. The open reduction and internal fixation Group resulted in a higher rate of intraoperative hemorrhage, nerve injury, discomfort and pain.Conclusion: Percutaneous cross screws internal fixation for Day Ⅱ type pelvic crescent fracture-dislocation was safe and effective. Minimally invasive fixation had the advantages of short operation and hospitalization time, less intraoperative bleeding and surgical trauma.