PubMed · 9181515
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K Klaue. 1997. Titanium plate fixation.. https://doi.org/10.1097/00005131-199704000-00024
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PURPOSE: Reduction and plate osteosynthesis of condylar fractures often require a wide extraoral approach with the risk of aesthetic impairment and possible facial nerve palsy. To avoid complications, the purpose of this pilot study was to use an endoscopic device for the treatment of condylar fractures also allowing for endoscopically assisted plate application. PATIENTS AND METHODS: Seven condylar fractures were operated under endoscopic control. In three patients, a newly developed device for endoscopically controlled plate application was clinically tested. The new device and the application technique is described in detail. RESULTS: In two of three cases using this approach, fracture healing was achieved with the condyle in the anatomically correct position. In the third case the plate had to be removed early because of insufficient screw fixation. CONCLUSION: This technique may be helpful to further minimize surgical trauma in head and neck fracture treatment. The newly developed plate application device may also be used to approach other regions of the skull eg, the skull base, the zygoma, or the orbit.
STUDY DESIGN: This study introduces a useful plating technique for complex reconstructions of the anterior cervical spine. OBJECTIVE: To provide a short-segment-buttressing technique for the stabilization of long anterior fusion constructs in the cervical spine while avoiding the potential morbidity and risks associated with long-segment anterior cervical plating. SUMMARY OF BACKGROUND DATA: Anterior fibular or iliac crest strut grafts are at risk of dislodging when used after multisegment (> 3 vertebrae) corpectomy in various spinal disorders. Long-segment anterior cervical plates have been used to reduce the incidence of graft displacement and migration but have been shown to increase risk for early failure because of screw dislodgement. METHODS: Eleven patients with cervical myelopathy underwent a multilevel (average 3.36 levels) corpectomy followed by the placement of a fibular or iliac crest strut graft. An anterior short-segment locking or buttress plate was then placed in the vertebral body, either inferior or superior to the seated graft, depending on the ease of insertion and quality of the host bone. Posterior segmental fixation was performed in all patients during the same procedure. The average follow-up was 30.8 months (range, 25-36 months). RESULTS: No incidence of plate or graft migration (anteroposterior plane) or dislodgement was reported in this series. One graft fracture occurred secondary to the placement of a intragraft screw through an anterior junctional plate. No patients experienced clinical morbidity related to the junctional plate. Neurovascular complications and wound complications were not encountered in any of these patients. All had an improvement in their neurologic symptoms, and 10 of the 11 patients had fusion documented on plain radiographs. CONCLUSIONS: The use of a junctional plate anteriorly along with posterior segmental fixation and fusion may prevent or decrease the incidence of graft and internal fixation dislodgement after a long-segment cervical reconstruction procedure.
STUDY DESIGN: Investigation of the mean safe lateral-mass screw lengths in the Roy-Camille and Magerl screw techniques in cadaveric cervical specimens. OBJECTIVES: To report the mean screw path length and to evaluate the relation of the screw trajectory to the nerve root in the Roy-Camille and Magerl screw techniques. SUMMARY OF BACKGROUND DATA: Potential injury to the cervical nerve root caused by too long a screw remains a major concern. Few studies regarding proper screw length and its relation to the adjacent nerve root are available. METHODS: Fourteen cervical spines were used for this study. Each lateral mass from C3 to C7 was drilled according to the techniques described by Roy-Camille (right side) and Magerl (left side). The cervical spines were harvested from the cadavers, and the anterior aspect of the lateral mass and spinal nerve were exposed. The screw path length between the dorsal and ventral cortices of the lateral mass were measured. An additional measurement was taken from the ventral aspect of the lateral mass to the nerve root along the screw path. RESULTS: The mean screw path length in the Roy-Camille technique decreased consistently from C3 (15.7 +/- 1.7 mm) to C7 (11.3 +/- 0.8 mm). The mean distance from the ventral cortex to the nerve root ranged from 1.2 to 2.3 mm, and the smallest value was at C7. The mean screw path length in the Magerl technique also decreased from cephelad to caudal, with a range of 15-16 mm at C3-C6 and a mean value of 13.8 mm at C7. CONCLUSIONS: A safe screw length is 14-15 mm in the Roy-Camille technique and 15-16 mm in the Magerl technique at C3-C6. A short screw may be used at C7 if desired.