Pub Date : 2023-04-21DOI: 10.1097/bto.0000000000000632
Dana A. Perim, Tyra Swanson, Ernest N. Chisena
{"title":"Open Reduction of Pediatric Femur Fracture: A Technical Trick","authors":"Dana A. Perim, Tyra Swanson, Ernest N. Chisena","doi":"10.1097/bto.0000000000000632","DOIUrl":"https://doi.org/10.1097/bto.0000000000000632","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89796033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-11DOI: 10.1097/bto.0000000000000627
V. Shur, S. Yacovelli
{"title":"Intramedullary Fibular Strut Allograft and a Small Fragment Nonlocking T-plate for Periprosthetic Lateral Femoral Condyle Fracture: A Case Report","authors":"V. Shur, S. Yacovelli","doi":"10.1097/bto.0000000000000627","DOIUrl":"https://doi.org/10.1097/bto.0000000000000627","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"16 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80272439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1097/BTO.0000000000000629
R. Schwartz, P. Kotlarsky, M. Eidelman
Background: Varus deformity of the distal tibia secondary to epiphyseal fracture and partial growth arrest is relatively common. Growth arrest of the medial part of the epiphysis leads to varus deformity of the distal tibia and fibular overgrowth. If the deformity is left untreated, the malalignment may lead to irreversible damage and early ankle joint osteoarthritis in the long term. Several surgical techniques have been described in the literature to achieve correction and prevent late complications. These include the closure of the remaining epiphysis and various osteotomies around the ankle, using internal and external fixation. Materials and Methods: We report a technique that includes medial open wedge supramalleolar osteotomy, insertion of a structural cortical allograft and fixation with an anatomically contoured locking plate, completion of closure of the distal tibial physis, and distal fibular epiphysiodesis to prevent tibiofibular relations distortion. Part of this protocol is osteotomy of the distal fibula to prevent excessive pressure on the talus, and at the end of the operation, fibular fixation should be performed as well. In children with open physis and potential for significant leg length discrepancy, we recommend closure of the contralateral physis of the distal tibia and fibula. To the best of our knowledge, precise details of this protocol have not been described. Conclusion: We believe that this protocol is a reliable, accurate, and relatively simple method that provides not only anatomic correction and restoration of the ankle joint to prevent early ankle and subtalar arthritis but also addresses late complications, such as ipsilateral fibular overgrowth and limb length discrepancy.
{"title":"Surgical Correction of Posttraumatic Varus Deformity of the Distal Tibia Due to Medial Growth Arrest in Children and Adolescents: Surgical Technique","authors":"R. Schwartz, P. Kotlarsky, M. Eidelman","doi":"10.1097/BTO.0000000000000629","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000629","url":null,"abstract":"Background: Varus deformity of the distal tibia secondary to epiphyseal fracture and partial growth arrest is relatively common. Growth arrest of the medial part of the epiphysis leads to varus deformity of the distal tibia and fibular overgrowth. If the deformity is left untreated, the malalignment may lead to irreversible damage and early ankle joint osteoarthritis in the long term. Several surgical techniques have been described in the literature to achieve correction and prevent late complications. These include the closure of the remaining epiphysis and various osteotomies around the ankle, using internal and external fixation. Materials and Methods: We report a technique that includes medial open wedge supramalleolar osteotomy, insertion of a structural cortical allograft and fixation with an anatomically contoured locking plate, completion of closure of the distal tibial physis, and distal fibular epiphysiodesis to prevent tibiofibular relations distortion. Part of this protocol is osteotomy of the distal fibula to prevent excessive pressure on the talus, and at the end of the operation, fibular fixation should be performed as well. In children with open physis and potential for significant leg length discrepancy, we recommend closure of the contralateral physis of the distal tibia and fibula. To the best of our knowledge, precise details of this protocol have not been described. Conclusion: We believe that this protocol is a reliable, accurate, and relatively simple method that provides not only anatomic correction and restoration of the ankle joint to prevent early ankle and subtalar arthritis but also addresses late complications, such as ipsilateral fibular overgrowth and limb length discrepancy.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"36 1","pages":"135 - 140"},"PeriodicalIF":0.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90548814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-27DOI: 10.1097/BTO.0000000000000628
M. M. Michael R. Baria, M. M. Alex C. DiBartola, MD Karen Woods, MD Lok Valentas, MD W. Kelton Vasileff, BVSc Sushmitha Durgam
Introduction: Platelet-rich plasma (PRP) is effective for knee osteoarthritis (OA) and certain tendinopathies. Current recommendations support the use of leukocyte-poor PRP for OA and leukocyte-rich PRP for tendinopathy. If a patient presents with both OA and tendinopathy, very few systems can create multiple PRP products in the same treatment session. The Angel device processes multiple cycles to produce different PRP products. Methods: Ten healthy volunteers donated 156 mL whole blood (WB) that was mixed with 24 mL of anticoagulant citrate dextrose solution, solution A. The first PRP was produced by processing 120 mL at the 0% hematocrit setting and the second PRP was created by processing the remaining 60 mL at the 15% hematocrit setting. WB and PRP underwent complete blood counts and growth-factor analysis. Results: Ten patients donated WB for processing. The 0% setting yielded 3.7 ± 0.15 mL PRP, whereas the 15% setting produced 4.7 ± 0.33 mL. The 0% and 15% settings both concentrated platelets significantly more than WB (1101.5 ± 281.7 K/uL and 1357.8 ± 363.7 vs 184.3 ± 39.1 K/uL, P = 0.000). The 0% setting reduced total leukocytes, but this was not statistically significant. The 15% setting concentrated total leukocytes to 24 ± 8.72 K/uL, which was significantly higher than WB (P = 0.000). Neutrophil concentration was significantly reduced in the 0% PRP compared with 15% (0.032 ± .02 vs 6.75 ± 5.76 K/uL, P = 0.000). Discussion: Two unique PRP products were created from the same batch of WB using a single commercial kit by processing aliquots at different settings.
富血小板血浆(PRP)对膝关节骨关节炎(OA)和某些肌腱病变有效。目前的建议支持使用白细胞含量低的PRP治疗OA，而白细胞含量高的PRP治疗肌腱病变。如果患者同时患有骨性关节炎和肌腱病变，很少有系统可以在同一疗程中产生多种PRP产品。Angel设备处理多个循环以生产不同的PRP产品。方法:10名健康志愿者捐献156 mL全血(WB)，与24 mL抗凝柠檬酸葡萄糖溶液a溶液混合，在0%血细胞比容下处理120 mL产生第一次PRP，在15%血细胞比容下处理其余60 mL产生第二次PRP。WB和PRP进行全血细胞计数和生长因子分析。结果:10例患者捐献WB用于处理。0%的PRP浓度为3.7±0.15 mL，而15%的PRP浓度为4.7±0.33 mL。0%和15%的PRP浓度均显著高于WB浓度(1101.5±281.7 K/uL和1357.8±363.7 vs 184.3±39.1 K/uL, P = 0.000)。0%的设置减少了白细胞总数，但这没有统计学意义。15%组总白细胞浓度为24±8.72 K/uL，显著高于对照组(P = 0.000)。中性粒细胞浓度在0% PRP组显著低于15% PRP组(0.032±0.02 vs 6.75±5.76 K/uL, P = 0.000)。讨论:两种独特的PRP产品是通过在不同的设置下处理相同的配额，使用单一的商业试剂盒从同一批WB中创建的。
{"title":"Creating 2 Unique Platelet-rich Plasma Products From a Single Batch of Whole Blood With a Single Processing Kit","authors":"M. M. Michael R. Baria, M. M. Alex C. DiBartola, MD Karen Woods, MD Lok Valentas, MD W. Kelton Vasileff, BVSc Sushmitha Durgam","doi":"10.1097/BTO.0000000000000628","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000628","url":null,"abstract":"Introduction: Platelet-rich plasma (PRP) is effective for knee osteoarthritis (OA) and certain tendinopathies. Current recommendations support the use of leukocyte-poor PRP for OA and leukocyte-rich PRP for tendinopathy. If a patient presents with both OA and tendinopathy, very few systems can create multiple PRP products in the same treatment session. The Angel device processes multiple cycles to produce different PRP products. Methods: Ten healthy volunteers donated 156 mL whole blood (WB) that was mixed with 24 mL of anticoagulant citrate dextrose solution, solution A. The first PRP was produced by processing 120 mL at the 0% hematocrit setting and the second PRP was created by processing the remaining 60 mL at the 15% hematocrit setting. WB and PRP underwent complete blood counts and growth-factor analysis. Results: Ten patients donated WB for processing. The 0% setting yielded 3.7 ± 0.15 mL PRP, whereas the 15% setting produced 4.7 ± 0.33 mL. The 0% and 15% settings both concentrated platelets significantly more than WB (1101.5 ± 281.7 K/uL and 1357.8 ± 363.7 vs 184.3 ± 39.1 K/uL, P = 0.000). The 0% setting reduced total leukocytes, but this was not statistically significant. The 15% setting concentrated total leukocytes to 24 ± 8.72 K/uL, which was significantly higher than WB (P = 0.000). Neutrophil concentration was significantly reduced in the 0% PRP compared with 15% (0.032 ± .02 vs 6.75 ± 5.76 K/uL, P = 0.000). Discussion: Two unique PRP products were created from the same batch of WB using a single commercial kit by processing aliquots at different settings.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"15 1","pages":"144 - 148"},"PeriodicalIF":0.3,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74256880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-28DOI: 10.1097/BTO.0000000000000623
V. Zanardi, J. A. M. Guimarães, João Victor Silveira Möller, C. Roesler
Introduction: Vertical femoral neck fractures in young adults are usually caused by high-energy trauma. These injuries are difficult to stabilize due to significant shear forces acting on the fracture site. Their treatment is challenging and with high risks of complications, such as fixation failure, malunion, nonunion, and avascular necrosis of the femoral head. Material and Methods: It compared the biomechanical stability provided by 3 different fixation methods: (1) dynamic hip screw with derotation screw, (2) cannulated screws with a conventional medial bone plate, and (3) cannulated screws with a locked medial bone plate. These fixation structures were applied on fourth-generation medium-sized synthetic bones, with a 17 pound per cubic foot cellular foam core and cervico-diaphyseal angle of 120 degrees were used. The comparison was performed through biomechanical tests under cyclic loading followed by an ultimate load. The interfragmentary movement at the fracture site was the main variable for the cyclical phase. Results: The biomechanical comparison showed no statistical differences (P > 0.05) in stiffness, micromovement level, and mechanical resistance among the fixation techniques evaluated. Discussion: To stabilize the vertical femoral neck fracture in young patients, the use of a medial bone plate associated with cannulated screws on a “tie-rod” assembly is an option that supports the mechanical demand until the fracture healing. The locked medial plate did not provide an advantage compared with the conventional bone plate.
{"title":"Medial Locking Plate Can Increase the Fixation Stability of Vertical Femoral Neck Fracture in Young Adults?","authors":"V. Zanardi, J. A. M. Guimarães, João Victor Silveira Möller, C. Roesler","doi":"10.1097/BTO.0000000000000623","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000623","url":null,"abstract":"Introduction: Vertical femoral neck fractures in young adults are usually caused by high-energy trauma. These injuries are difficult to stabilize due to significant shear forces acting on the fracture site. Their treatment is challenging and with high risks of complications, such as fixation failure, malunion, nonunion, and avascular necrosis of the femoral head. Material and Methods: It compared the biomechanical stability provided by 3 different fixation methods: (1) dynamic hip screw with derotation screw, (2) cannulated screws with a conventional medial bone plate, and (3) cannulated screws with a locked medial bone plate. These fixation structures were applied on fourth-generation medium-sized synthetic bones, with a 17 pound per cubic foot cellular foam core and cervico-diaphyseal angle of 120 degrees were used. The comparison was performed through biomechanical tests under cyclic loading followed by an ultimate load. The interfragmentary movement at the fracture site was the main variable for the cyclical phase. Results: The biomechanical comparison showed no statistical differences (P > 0.05) in stiffness, micromovement level, and mechanical resistance among the fixation techniques evaluated. Discussion: To stabilize the vertical femoral neck fracture in young patients, the use of a medial bone plate associated with cannulated screws on a “tie-rod” assembly is an option that supports the mechanical demand until the fracture healing. The locked medial plate did not provide an advantage compared with the conventional bone plate.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"4 1","pages":"126 - 130"},"PeriodicalIF":0.3,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72907798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-23DOI: 10.1097/BTO.0000000000000626
J. Cross, Michael Rasmussen, Phillip J. Stokey, Jason C. Tank
Introduction: Skeletal traction is an integral technique in orthopedic fracture management, used primarily in the acute preoperative setting, but in many parts of the world, is still considered for definitive management. Maintenance of skeletal traction during imaging procedures can be a large burden on providers, and releasing traction even for a short period of time can have significant adverse outcomes for patients. There is currently no practical technique for accomplishing this in the literature. Materials and Methods: We describe here a novel and easily reproducible setup that allows for the maintenance of traction during computed tomography scans. Results: The described technique is versatile as it can be used with different computed tomography scanners, easily assembled in a few minutes, and accommodates up to 25 lbs. Conclusions: This technical design offers a safe and quickly reproducible setup for skeletal traction in unique situations where traction is required during imaging. The apparatus has implications for advanced diagnostic and research-based imaging as well, and all materials should be readily available at any institution frequently performing skeletal traction.
{"title":"Maintaining Skeletal Traction During CT Scans: A Novel and Reproducible Setup","authors":"J. Cross, Michael Rasmussen, Phillip J. Stokey, Jason C. Tank","doi":"10.1097/BTO.0000000000000626","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000626","url":null,"abstract":"Introduction: Skeletal traction is an integral technique in orthopedic fracture management, used primarily in the acute preoperative setting, but in many parts of the world, is still considered for definitive management. Maintenance of skeletal traction during imaging procedures can be a large burden on providers, and releasing traction even for a short period of time can have significant adverse outcomes for patients. There is currently no practical technique for accomplishing this in the literature. Materials and Methods: We describe here a novel and easily reproducible setup that allows for the maintenance of traction during computed tomography scans. Results: The described technique is versatile as it can be used with different computed tomography scanners, easily assembled in a few minutes, and accommodates up to 25 lbs. Conclusions: This technical design offers a safe and quickly reproducible setup for skeletal traction in unique situations where traction is required during imaging. The apparatus has implications for advanced diagnostic and research-based imaging as well, and all materials should be readily available at any institution frequently performing skeletal traction.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"25 1","pages":"131 - 134"},"PeriodicalIF":0.3,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80164073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-20DOI: 10.1097/bto.0000000000000625
R. Rajfer
{"title":"Letter to Editor Regarding Intramedullary Delivery of Autologous Bone Graft to Long Bone Defects Using Reamer Irrigator Aspirator 2 System: Technical Trick","authors":"R. Rajfer","doi":"10.1097/bto.0000000000000625","DOIUrl":"https://doi.org/10.1097/bto.0000000000000625","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"8 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85648413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-20DOI: 10.1097/BTO.0000000000000624
Ryan T. Voskuil, Eric Welder, Steven A. Schulz, J. Mayerson, T. Scharschmidt
Background: Treatment options for distal femoral bone loss resulting from malignancy, infection, or trauma can be grouped into limb salvage techniques versus amputation. A vascularized osteomyocutaneous flap using the ipsilateral tibia—a tibial turn-up procedure—can be used to restore femoral length for high above-knee amputations in both the primary and revision setting. We report 3 patients treated with this procedure. Purpose: To describe the treatment algorithm and functional outcomes of patients who have undergone a tibial turn-up procedure and to highlight its viability when considering surgical options for the treatment of distal femoral primary bone and soft tissue malignancy and in cases of severe trauma, infection, or implant failure. Patients and Methods: Three patients ages 21 to 56 years old treated with tibial turn-up as a salvage procedure for failed limb sparing techniques were followed for 1.5 to 3.5 years postoperatively. One was treated for recalcitrant chronic distal femur osteomyelitis, 1 for aseptic loosening of distal femoral replacement, and 1 for infected distal femoral replacement. Radiographic and functional outcomes including prosthetic use, ambulatory status, and current activity level were reported. Results: At a minimum 1.5-year follow-up, all 3 patients achieved bony union and were ambulatory with prosthetics without the use of additional gait aids. Conclusions: Tibial turn-up is an effective treatment option in the setting of distal femoral bone loss and/or limb salvage complications, providing good functional outcomes with a single durable surgery.
{"title":"Indications and Outcomes of a Tibial Turn-up Procedure: A Case Series and Review of the Literature","authors":"Ryan T. Voskuil, Eric Welder, Steven A. Schulz, J. Mayerson, T. Scharschmidt","doi":"10.1097/BTO.0000000000000624","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000624","url":null,"abstract":"Background: Treatment options for distal femoral bone loss resulting from malignancy, infection, or trauma can be grouped into limb salvage techniques versus amputation. A vascularized osteomyocutaneous flap using the ipsilateral tibia—a tibial turn-up procedure—can be used to restore femoral length for high above-knee amputations in both the primary and revision setting. We report 3 patients treated with this procedure. Purpose: To describe the treatment algorithm and functional outcomes of patients who have undergone a tibial turn-up procedure and to highlight its viability when considering surgical options for the treatment of distal femoral primary bone and soft tissue malignancy and in cases of severe trauma, infection, or implant failure. Patients and Methods: Three patients ages 21 to 56 years old treated with tibial turn-up as a salvage procedure for failed limb sparing techniques were followed for 1.5 to 3.5 years postoperatively. One was treated for recalcitrant chronic distal femur osteomyelitis, 1 for aseptic loosening of distal femoral replacement, and 1 for infected distal femoral replacement. Radiographic and functional outcomes including prosthetic use, ambulatory status, and current activity level were reported. Results: At a minimum 1.5-year follow-up, all 3 patients achieved bony union and were ambulatory with prosthetics without the use of additional gait aids. Conclusions: Tibial turn-up is an effective treatment option in the setting of distal femoral bone loss and/or limb salvage complications, providing good functional outcomes with a single durable surgery.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"35 1","pages":"120 - 125"},"PeriodicalIF":0.3,"publicationDate":"2023-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84933670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-07DOI: 10.1097/BTO.0000000000000621
C. Iobst, A. Bafor
Background: A reverse planning method is an option for distal femur deformity correction. However, the accuracy of the technique hinges on the precision of the initial guidewire placement. This study describes a modification to the reverse planning method designed to simplify the surgical procedure for retrograde femoral nailing to correct valgus deformities. The steps of the surgical technique and the early results are presented. Materials and Methods: After IRB approval, patients with distal femoral valgus deformity treated with retrograde nails using the modified reverse planning method were identified. Data obtained retrospectively included basic demographics, pre and postsurgery mechanical lateral distal femoral angle, the magnitude of limb length discrepancy if present, the duration of surgery, and the occurrence of any complications. Results: We analyzed 17 limbs in 15 patients (10 females). The mean age at surgery was 18 years. Four patients had an additional limb length discrepancy (mean value of 2.8 ± 0.9 cm). The mean pre and postoperative mechanical lateral distal femoral angle was 83 degrees and 90 degrees, respectively (P < 0.0001). The mean duration of surgery was 90 minutes. Conclusions: This study demonstrates that the modified reverse planning concept can be applied successfully to achieve accurate correction and healing of distal femoral valgus deformities. Furthermore, by adjusting the level of the osteotomy, this modified approach simplifies the surgical technique in several ways: (1) it creates a reproducible visual cue for the surgeon, (2) it decreases the surgical time by eliminating the need for fixator assistance, and (3) it reduces the need for multiple coronal planes blocking screws.
{"title":"A Modified Reverse Planning Method for Correction of Distal Femoral Valgus Deformity: Surgical Technique and Early Results","authors":"C. Iobst, A. Bafor","doi":"10.1097/BTO.0000000000000621","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000621","url":null,"abstract":"Background: A reverse planning method is an option for distal femur deformity correction. However, the accuracy of the technique hinges on the precision of the initial guidewire placement. This study describes a modification to the reverse planning method designed to simplify the surgical procedure for retrograde femoral nailing to correct valgus deformities. The steps of the surgical technique and the early results are presented. Materials and Methods: After IRB approval, patients with distal femoral valgus deformity treated with retrograde nails using the modified reverse planning method were identified. Data obtained retrospectively included basic demographics, pre and postsurgery mechanical lateral distal femoral angle, the magnitude of limb length discrepancy if present, the duration of surgery, and the occurrence of any complications. Results: We analyzed 17 limbs in 15 patients (10 females). The mean age at surgery was 18 years. Four patients had an additional limb length discrepancy (mean value of 2.8 ± 0.9 cm). The mean pre and postoperative mechanical lateral distal femoral angle was 83 degrees and 90 degrees, respectively (P < 0.0001). The mean duration of surgery was 90 minutes. Conclusions: This study demonstrates that the modified reverse planning concept can be applied successfully to achieve accurate correction and healing of distal femoral valgus deformities. Furthermore, by adjusting the level of the osteotomy, this modified approach simplifies the surgical technique in several ways: (1) it creates a reproducible visual cue for the surgeon, (2) it decreases the surgical time by eliminating the need for fixator assistance, and (3) it reduces the need for multiple coronal planes blocking screws.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"10 1","pages":"149 - 155"},"PeriodicalIF":0.3,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84020203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-07DOI: 10.1097/bto.0000000000000622
José George, C. M. Hoshino, S. Shymon
Introduction: At our institution, the laparoscopic irrigator aspirator (LIA) is used as the primary means of irrigation in open fractures, as it allows for quicker and more efficient irrigation. The purpose of this technical trick is to evaluate the cost and time savings between gravity tubing, pulse lavage, and LIA methods. Materials and Methods: The 3 different methods of irrigation, gravity tubing, pulse lavage, and LIA, were set up, and the time to use one 3 L bag of normal saline was recorded for each. The list prices for each method of irrigation were obtained, and the time and cost saved per 3 L bag was multiplied by 3 for the total time and cost 9 L of irrigation. Results: The LIA was the most efficient irrigation method and saved 303 seconds over gravity and 534 seconds saved over pulse lavage over 9 L. For cost, the laparoscopic resulted in $156.15 saved over gravity and $332.80 saved over pulse lavage over 9 L when accounting for cost of operating room time and cost of implant. At our institution, 34 open tibia fractures were treated in 2019, which results in 2.86 hours and $5309.10 saved over gravity and 5.04 hours and $11,315.2 saved over pulse lavage by using the LIA. Conclusions: Lap irrigation is a viable alternative to gravity tubing and pulse lavage for open fracture irrigation and results in both time and cost savings.
{"title":"The Laparoscopic Irrigator Aspirator: A Time and Cost Saving Alternative Irrigation Method for Open Fractures","authors":"José George, C. M. Hoshino, S. Shymon","doi":"10.1097/bto.0000000000000622","DOIUrl":"https://doi.org/10.1097/bto.0000000000000622","url":null,"abstract":"Introduction: At our institution, the laparoscopic irrigator aspirator (LIA) is used as the primary means of irrigation in open fractures, as it allows for quicker and more efficient irrigation. The purpose of this technical trick is to evaluate the cost and time savings between gravity tubing, pulse lavage, and LIA methods. Materials and Methods: The 3 different methods of irrigation, gravity tubing, pulse lavage, and LIA, were set up, and the time to use one 3 L bag of normal saline was recorded for each. The list prices for each method of irrigation were obtained, and the time and cost saved per 3 L bag was multiplied by 3 for the total time and cost 9 L of irrigation. Results: The LIA was the most efficient irrigation method and saved 303 seconds over gravity and 534 seconds saved over pulse lavage over 9 L. For cost, the laparoscopic resulted in $156.15 saved over gravity and $332.80 saved over pulse lavage over 9 L when accounting for cost of operating room time and cost of implant. At our institution, 34 open tibia fractures were treated in 2019, which results in 2.86 hours and $5309.10 saved over gravity and 5.04 hours and $11,315.2 saved over pulse lavage by using the LIA. Conclusions: Lap irrigation is a viable alternative to gravity tubing and pulse lavage for open fracture irrigation and results in both time and cost savings.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"2001 1","pages":"141 - 143"},"PeriodicalIF":0.3,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91314644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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