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At least 631 records · Page 35Linked to original sources
PubMed2006

A special instrument: the LISS tractor.

OBJECTIVE: Facilitation of reduction and retention in LISS (Less Invasive Stabilizing System) plate osteosynthesis of fractures of the distal femur by application of the large AO distractor. INDICATIONS: Any distal femoral fracture suited to LISS plate osteosynthesis. CONTRAINDICATIONS: Distraction can lead to a pullout of the Schanz screws in patients with pronounced osteoporosis. SURGICAL TECHNIQUE: Supine. Normal LISS osteosynthesis with lateral or parapatellar approaches. Insertion of one Schanz screw proximal to the end of the plate through a stab incision. Introduction of the LISS plate in the usual fashion and insertion of a second Schanz screw into plate hole "A", parallel to the joint. Assembly of the distractor onto the Schanz screws, distraction of the femur to the correct length and correction of varus/valgus alignment with the aid of the cable method, as well as correction of ante- and retrocurvature by insertion of an additional Schanz screw at the anterior aspect. At least two locking head screws should be inserted into the plate holes both proximally and distally. Removal of the AO distractor. Assembly of aiming guide and insertion of further screws into additional plate holes using the guide sleeve. RESULTS: Between May 1998 and September 2001, a total of 42 patients had their distal femoral fractures stabilized by LISS. The AO distractor was used from the 18th case onward. A time saving of approximately 13% was estimated, taking the learning curve of the LISS system into consideration. Three of 42 fractures showed relevant postoperative varus or valgus malalignment. No rotational malalignment was found. An effect of the LISS tractor on the incidence of malalignment could not be found with the limited number of cases examined; however, malalignment was correlated well with the rates found in literature for distal femoral fractures.

Bone Plates↗
PubMed1983

Alignment in total knee arthroplasty. Correlated biomechanical and clinical observations.

The initial experience with the Freeman-Swanson (ICLH) total knee arthroplasty (1971-1975) led to changes of tibial component size, alignment, instruments, and surgical technique in 1975. Certain patients in this initial series, however, have shown excellent long-term (5 1/2-9 years) results. In patients with overall alignment between 1 degrees and 13 degrees valgus, the success rate was 89%. In patients with knees aligned between neutral and 8 degrees varus, the success rate was only 14%. This startling difference in long-term results was investigated by using eccentric loading tests to simulate varus and valgus malalignment. Knee arthroplasties failed in eccentric loading at very low loads. Failure by lift-off of the unloaded side occurred at 9%-18% and failure of bone due to compression on the loaded side occurred at 34%-51% of the load at failure under ideal uniform loading conditions. Thus, both the long-term clinical study and the laboratory analysis demonstrate the importance of proper overall alignment in total knee arthroplasty.

Biomechanical Phenomena↗
PubMed2004

[Posterior occipitocervical fixation using C2 pedicle screws and occipitocervical plate systems].

OBJECTIVE: To observe the clinical effect of a occipitocervical fixation systems using C(2) pedicle screws and plates. METHODS: An occipitocervical fixation system was designed. Since June 2001 to March 2003, 38 patients with instability of atlantoaxial joint underwent reconstructive surgery using this systems. Twenty-four patients were associated with congenital occipitalization. The pedicle screws were inserted into C(2) pedicles in the direction as its axis. The occipitocervical plate was slightly bent to fit the occipital contour and fixed onto the occiput. Hyperflexion alignment of the occipitoatlantoaxial complex was corrected by application of extensional force created by tightening of the nut on the pedicle screws. The autogenous cancellous bones were grafted between the occiput and the axis. RESULTS: In this series, neither vertebral artery nor spinal cord was injured. 36 of 38 cases were followed up for an average of 18 months, all cases achieved solid bony fusion. No implant failure was found. CONCLUSIONS: Occipitocervical reconstruction by the combination of C(2) pedicle screws and occipitocervical plate systems can provide sufficient correction of malalignment in the occipitoatlantoaxial region and achieve high fusion rate.

Adolescent↗
PubMed2005

[Arthroscopic in situ arthrodesis of the upper ankle].

Fusion of the ankle is an established option for end-stage degenerative joint disease. The purpose of this paper is to present the surgical technique as well as our own results. AAA starts with removal of all the remaining cartilage and joint detritus. For this we routinely use a posterolateral portal. When opening the subchondral plate one must be careful not to remove too much bone. In our hands a small chisel is very helpful for this step. Fixation is performed with two screws. In 31 out of 35 patients, we were able to obtain a solid bony fusion. AAA of the ankle can be performed in patients without significant malalignment or bony defect. It is an "in-situ" fixation of the destroyed painful joint, which is not suitable for patients with neuropathic joints. Patients with secondary joint destruction due to rheumatoid arthritis can also be treated with AAA.

Adult↗
PubMed1995

Correction of dorsi-flexed intercalated segment instability after restoration of scaphoid height in a cadaver model of scaphoid non-union.

Models of scaphoid non-union with static dorsi-flexed intercalated segment instability were produced in five frozen arms from cadavers or subjects following accidents by repetitive mechanical loading of the wrist joints longitudinally after a bone defect has been made at the mid-portion of the scaphoid. We designed four models of reduction: anatomical reduction; reduction with a shortened scaphoid; anatomical reduction but with the radio-lunate ligament sectioned, and a shortened scaphoid with the radio-lunate ligament sectioned. Results suggested that anatomical reduction with rigid fixation with a Herbert screw was most effective for correction of malalignment with DISI. Preservation of the radio-lunate ligament during the palmar approach to the scaphoid seemed to be important to prevent ligamentous carpal instability.

Bone Screws↗
PubMed1990

[CD instrumentation in pelvic tilt].

Our realistic definition of pelvic obliquity is: any fixed malalignment existing between the spinal and pelvic structure in the frontal, sagittal and horizontal plane. The pelvic unit--with rare exceptions--must be considered one unique vertebra, an intercalary bone between the trunk and lower limbs. Like a structural vertebra in a scoliotic spine, the pelvic unit can be distorted in structure. The etiologies of pelvic obliquity can be divided into three major levels: below, inside and above the pelvis. Preoperative surgical planning must consider the position of the pelvis in the three dimensions. The technical options of pelvic fixation are described: alar staples, sacral screws, the cannulated iliosacral screw and finally the Galveston technique. The surgical technique is described. The results are presented in about 80 cases of CD instrumentation with pelvic fixation. For preoperative hyperlordosis a mean correction of 40 degree was achieved and for preoperative hyperkyphosis a mean correction of 66 degree.

Adolescent↗
PubMed2005

Percutaneous plate stabilization of proximal tibial fractures.

BACKGROUND: Despite various treatment methods, proximal tibial fractures are common injuries associated with poor outcomes and high rates of complications. To improve this, a percutaneous plating technique was performed to treat proximal tibial fractures. METHODS: Twenty-four proximal tibial fractures (17 proximal fractures [AO 41] and 7 proximal shaft fractures [AO 42]) were treated using percutaneous plating with either or both sides without bone graft. One was an open fracture. RESULTS: All fractures healed. The average time for fracture healing was 16.5 weeks (range, 8-24 weeks). Complications included one case of shortening (1 cm) and two cases of malalignments; one valgus of 6 degrees and one varus of 5 degrees. There was one case of superficial infection that was healed after removal, but no patient showed deep infection. Results were evaluated by the modified Rasmussen scoring system. Most patients had excellent or good results; only one patient had fair results. CONCLUSION: Minimally invasive percutaneous plating can provide favorable results in the treatment of proximal tibial fractures.

Adult↗
PubMed1986

RMC total knee replacement. A review of 166 cases.

This article describes a retrospective analysis of 166 total knee replacements using Richard's Maximum Contact prosthesis. Implant insertion was facilitated by instrumentation to guide the accuracy of the bony cuts; the bony surfaces were prepared using pulsatile lavage, and cement was inserted in a low viscous state. Ninety-four percent of all of the reconstructed knees were within 2 degrees of normal anatomic alignment, and more than 96% of both femoral and tibial components were within 2 degrees of optimal orientation to their respective bones. The radiographic appearance of bone cement radiolucency was 9.5% at 3 years. This was a dramatic improvement, compared with a previous series in which instrumentation and low-viscosity cement were not routinely used (P less than .01). In those cases, however, in which the implant was malaligned, the radiolucency rate was significantly increased (P less than .01). When evaluated with a modified British Orthopaedic Association rating system, decrease in pain was found in almost all patients, regardless of the etiology of their arthritis or of their preoperative score. Correction of deformity and achievement of knee stability were achieved in more than 90% of the knees.

Bone Cements↗
PubMed1989

Nonresurfaced patella in total knee arthroplasty.

Problems attributable to the patellofemoral joint are still the major cause of disability in contemporary knee arthroplasty. Patellar resurfacing does lead to further complications, such as loosening, wear, and malalignment. Two studies have been performed specifically to review experience with the nonresurfaced patella in total knee arthroplasty. The first study determined that patellofemoral symptoms occurred in 8% of the total group and the majority of these were due to patellar malalignment. The postoperative skyline views at 60 degrees and 90 degrees of flexion obtained routinely identified dynamic patellar maltracking responsible for anterior knee pain. The second study addressed long-term durability of the nonresurfaced patella. The tracking of the patella was maintained with only small shifts of patella position and the tendency to stabilize with time. Stress-induced bone remodelling, particularly of the lateral facet, occurred in 85% of patellae. No preoperative or postoperative radiologic variable was associated with anterior knee pain. The authors strongly recommend that accurate patellofemoral tracking be obtained at the time of knee arthroplasty by staged procedures, with removal of peripheral osteophytes, then proximal iliotibial tract release followed by lateral debulking to a marked degree to obtain neutral tracking. Only then will intracapsular lateral release be performed. The results presented support the use of the nonresurfaced patella, and patellar malalignment remains a major source of disability attributable to the patellofemoral joint following total knee arthroplasty.

Arthroplasty↗
PubMed2001

[LISS tractor. Combination of the "less invasive stabilization system" (LISS) with the AO distractor for distal femur and proximal tibial fractures].

Minimally invasive plate osteosynthesis (MIPO) in conjunction with the less invasive stabilization system (LISS) first requires reduction and retention of the fracture using such aids as external fixation, distractors, and percutaneous reduction clamps before the plate can be applied. Based on the open indirect "biological" technique of osteosynthesis, the LISS was combined with an AO distractor (LISS tractor) integrated into the LISS plate. This made reduction possible against the plate before final fixation of the LISS plate. The LISS tractor concept was validated in three patients and we present the technique here. No malalignments > 5 degrees occurred. Fluoroscopy lasted 3.0 min (range: 2.1-4.5) and the operation 125 min (range: 90-150). Modification of the well-known LISS technique by integrating the distractor into the LISS plate to simplify reduction and to provide temporary retention of the fracture has the potential to reduce the fluoroscopy time, the operation time, the rate of malalignments, and the learning curve for this MIPO technique.

Aged↗
PubMedDate not supplied

A critical analysis of the eccentric starting point for trochanteric intramedullary femoral nailing.

OBJECTIVES: Antegrade femoral intramedullary nailing through a greater trochanteric insertion site has been proposed for the treatment of subtrochanteric fractures. The currently available trochanteric nails have dissimilar characteristics, and the most appropriate insertion site for satisfactory subtrochanteric fracture alignment has not been determined. This study is an analysis of 5 different trochanteric femoral nails and 3 different insertion sites using a cadaveric model of a reverse obliquity subtrochanteric femur fracture to determine the optimal trochanteric entry site. SETTING: OSHA-approved cadaveric laboratory with an OEC 9800 (General Electric Company, Fairfield, CT) fluoroscopic C-arm. METHODS: Twenty-one embalmed human cadaveric femurs were stripped of soft tissues. Three different starting points on the anteroposterior radiograph were used: at the tip of the greater trochanter, and 2 to 3 mm medial and lateral to the tip. A reverse obliquity subtrochanteric fracture was created. The Trochanteric Antegrade Nail (TAN), Gamma nail (2nd and 3rd generations), Trochanteric Fixation Nail (TFN), and the Holland Nail were then inserted. The proximal bend and radius of curvature were calculated for each nail. Varus and valgus angulation as well as lateral gapping were measured on radiographs; also calculated were the mean, range, and standard deviation. Statistical analysis was performed on angulation and gapping at the fracture site by using Fisher least significant differences analysis, based on a 2-way ANOVA test. RESULTS: The Holland nail had a proximal bend of 10 degrees and a radius of 300 cm. TAN was 5 degrees and 350 cm, TFN was 6 degrees and 150 cm, Gamma 2 was 4 degrees and 300 cm, and Gamma 3 was 4 degrees and 200 cm. The tip starting point led to the most neutral alignment regardless of nail. The lateral starting point led to varus with all nails. The medial starting point led to valgus of >6 degrees with the Holland and TFN; Gamma and TAN had better alignment with <4 degrees of valgus. Gapping of the lateral cortex was greatest with a lateral starting point. CONCLUSIONS: An analysis of 5 trochanteric intramedullary nails with different proximal bends and 3 different starting points in the greater trochanter showed that the tip of the trochanter is close to the "universal" starting point. In this cadaveric subtrochanteric fracture model, the tip starting point led to the most neutral alignment regardless of nail used. The lateral starting point led to varus and gapping of the lateral cortex with all nails. CLINICAL RELEVANCE: Subtrochanteric fractures treated with a trochanteric antegrade nail should have an acceptable reduction before nail insertion. The tip of the trochanter, or even slightly medial, on anteroposterior fluoroscopy is recommended as the universal starting point for these nails. However, slight deviations from this point and nail geometry can cause fracture site malalignment. A lateral starting point led to varus alignment and should be avoided.

Bone Nails↗
PubMed2004

Comparison of intramedullary nailing of distal third tibial shaft fractures: before and after traumatologists.

We hypothesized that less malalignment and complications occur with intramedullary nailing of distal third tibia fractures (42A, B, C) after the implementation of orthopedic trauma surgeons to this level II community hospital. We also hypothesized that patients with < or =5 degrees of malalignment have poorer function as measured by the MODEMS functional outcome scale. Two cohorts of distal third tibia fractures were identified by discharge diagnosis or by the Orthopaedic Trauma Association database. Group I (n = 39) patients were stabilized with an intramedullary nail by community orthopedic surgeons. Group II (n = 18) patients were treated by orthopedic trauma surgeons. In Group I (community), 9 (23%) patients treated by the community surgeons exhibited >5 degrees of angulation in at least one direction. Five (13%) of these patients displayed angulation in more than one direction, and 3 of these patients exhibited >10 degrees of angulation. In Group II (trauma) 1 (5%) patient had >5 degrees angulation in any plane (P < .05). No differences were noted in time to union, nonunion, delayed union, hardware failure or infections between the two groups. Functional outcomes were assessed using the MODEMS lower limb module. In comparison of the patients with and without significant angulation, the P value for bodily pain was 0.042. Patients treated by the community orthopedic surgeons had a higher incidence of malalignment, as compared to those treated by orthopedic trauma specialists.

Adolescent↗
PubMed2004

Retrograde tibial nail for femoral shaft fracture with severe degloving injury.

We report an unusual case involving a motorcycle-vehicle collision, in which a 21-year-old woman sustained severe bilateral lower extremity degloving injuries and an associated right femoral shaft fracture. The trauma team was consulted to treat this disastrous event. Due to extensive contamination of the open wound around the entry site, retrograde intramedullary nailing was chosen to fix the fractured femoral shaft in preference to antegrade intramedullary nailing. A tibial interlocking nail was used as a substitute for immediate bony stabilization to facilitate soft tissue debridement and subsequent reconstruction. The excellent range of motion achieved in the right knee joint, without infection, limb-length discrepancy, rotational instability or angular malalignment, was encouraging.

Adult↗
PubMed1979

Plate fixation versus conservative treatment of tibial shaft fractures. A randomized trial.

One hundred consecutive patients with displaced fractures of the tibial shaft were randomly assigned to two groups, one treated with AO-plate fixation and the other with conservative methods. Strictly conservative treatment failed in two patients because of the interposition of muscles. Comparison of the groups showed that a longer duration of hospital stay was needed in the AO-plate group, and there were also more complications in that group. However, the median healing time was shorter and the anatomical end results were better than in the conservatively treated patients. Closed longitudinal fractures were found to be suitable and open fractures, unsuitable for AO-plate fixation. In the group that was treated conservatively most fractures that healed in malalignment were located in the distal third of the tibial shaft.

Adolescent↗
PubMed2005

Three-dimensional computer analysis of the modified Ludloff osteotomy.

BACKGROUND: The Ludloff first metatarsal osteotomy is used to correct the increased 1-2 intermetatarsal angle associated with hallux valgus deformity. We studied the spatial geometry of this osteotomy to determine the ideal parameters of the osteotomy saw cut and its rotation to give an optimal correction. METHODS: Three-dimensional computer modeling software was used to perform a virtual Ludloff osteotomy of the first metatarsal. Different geometric parameters of the osteotomy were studied. The osteotomy was rotated in virtual space and the geometric changes occurring in the virtual bone were then measured by the software. RESULTS: The optimal Ludloff osteotomy started at the dorsum of the first metatarsal base at the first tarsometatarsal joint and extended distally and plantarly to a point just proximal to the sesamoid articulation. A tilt of 10 degrees in the coronal plane of the osteotomy was necessary to limit first metatarsal head elevation. The best axis of rotation was within 5 mm of the proximal end of the osteotomy. CONCLUSIONS: The optimal geometric parameters of a modified Ludloff osteotomy limited first metatarsal shortening, elevation, and sagittal plane rotational malalignment that may occur with the use of this osteotomy.

Computer Simulation↗
PubMed2006

Two-strand posterior cruciate ligament reconstruction with a quadriceps tendon-patellar bone autograft: technical considerations and clinical results.

In patients with complete posterior cruciate ligament (PCL) ruptures in which 10 mm or more of increased posterior tibial translation is detected, associated knee disorders must be treated at the same time as the PCL injury. Varus malalignment and any abnormal medial or lateral ligament deficiency must be corrected before or with PCL reconstruction to avoid the risk of failure of the PCL graft. Gait retraining is recommended for patients with abnormal knee hyperextension patterns before ligament reconstruction is performed. Advances in PCL reconstruction include the use of a two-strand graft that may be placed using either a tibial inlay or an all-arthroscopic tibial tunnel technique. Biomechanical studies have shown a reduction in graft tension and improved load sharing in these constructs compared with single-strand reconstructions. The tibial inlay method can be used in athletic patients, and it also is required in PCL revisions in which a prior tibial tunnel must be avoided to achieve graft fixation. The tibial tunnel technique is used to treat dislocated knees for which reconstruction of multiple knee ligaments is required or when prior arterial injury or posterior skin or muscle damage limits the indications for a posterior open approach. Postoperative rehabilitation should protect the PCL graft from high forces and repetitive cyclic knee motions during the first 4 weeks postoperatively.

Humans↗
PubMedDate not supplied

Overuse injuries in sports. A review.

Because knowledge of overuse syndromes is limited, the diagnosis and treatment of these conditions are a challenge to sports medicine physicians. Trial and error methods of treatment and too little attention to basic research have resulted in less than optimum solutions. We do know that these maladies most frequently result from overload or repetitive microtrauma stemming from extrinsic factors such as training errors, poor performance, poor techniques and inappropriate surfaces or intrinsic factors including malalignment and muscle imbalance. Overuse injuries involving the muscles include compartment syndromes and muscle soreness; while those involving the tendons result from a variety of degenerative and inflammatory processes. Overstress of bone results in stress fractures, apophysitis and periostitis. Bursitis and joint overstress problems are also discussed briefly. General guidelines for establishing the appropriate diagnosis are: the initial stages of therapy require rest, often a modification or scaled down exposure to the athlete's usual performance rather than complete abstinence; in acutely symptomatic cases pain medications and various measures to control inflammation may be necessary; an exercise programme should start early with range of motion exercises and isometric muscle contractions; when pain allows, dynamic muscle and flexibility exercises can resume together with a conditioning programme; if possible, eccentric exercises should be performed. The treatment may also include other conservative treatment modalities and surgery in special cases. Overuse injuries constitute a great diagnostic and therapeutic problem because the symptoms are often diffuse and uncharacteristic. An appropriate diagnosis followed by adequate treatment can improve or eliminate most of these conditions, but perhaps even more importantly a proper understanding of overuse syndromes should allow physicians to assist athletes, trainers, and coaches in preventing them.

Achilles Tendon↗