Pub Date : 2022-08-25DOI: 10.1097/BTO.0000000000000600
D. Morrow, Connor R. Read, Charles Powell, B. Dunlap, F. Colon, Joseph Miller, Bryce A. Cunningham
Background: An iliopsoas abscess is a type of deep pelvic infection that presents as an uncommon cause of back pain. Patients generally present with vague and ambiguous symptoms that pose diagnostic difficulty. This case report describes a 19-year-old female who initially presented with low back pain and lower extremity lumbar radiculopathy secondary to complex iliacus deep pelvic infection. This is the second documented case of lumbar radiculopathy as the presenting symptom for iliopsoas abscess. The patient underwent surgical drainage and debridement and was prescribed intravenous culture-tailored antibiotic therapy for 6 weeks.
{"title":"Lumbar Radiculopathy due to Iliacus Abscess: Diagnosis, Treatment, and Review of the Literature","authors":"D. Morrow, Connor R. Read, Charles Powell, B. Dunlap, F. Colon, Joseph Miller, Bryce A. Cunningham","doi":"10.1097/BTO.0000000000000600","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000600","url":null,"abstract":"Background: An iliopsoas abscess is a type of deep pelvic infection that presents as an uncommon cause of back pain. Patients generally present with vague and ambiguous symptoms that pose diagnostic difficulty. This case report describes a 19-year-old female who initially presented with low back pain and lower extremity lumbar radiculopathy secondary to complex iliacus deep pelvic infection. This is the second documented case of lumbar radiculopathy as the presenting symptom for iliopsoas abscess. The patient underwent surgical drainage and debridement and was prescribed intravenous culture-tailored antibiotic therapy for 6 weeks.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"64 1","pages":"34 - 38"},"PeriodicalIF":0.3,"publicationDate":"2022-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89187435","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 : 2022-08-09DOI: 10.1097/bto.0000000000000599
Luigi Zanna, Gregorio Secci, R. Civinini, F. Matassi
{"title":"Pearls and Pitfalls of Arthroscopic Posteromedial Portal for Posterior Knee Chondromatosis Surgical Treatment","authors":"Luigi Zanna, Gregorio Secci, R. Civinini, F. Matassi","doi":"10.1097/bto.0000000000000599","DOIUrl":"https://doi.org/10.1097/bto.0000000000000599","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"51 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73910966","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 : 2022-08-09DOI: 10.1097/BTO.0000000000000596
Baylor Blickenstaff, LeeAnne Torres, C. Giangarra
Objectives: Osteochondritis dissecans (OCD) is a condition affecting the capitellum in adolescent overhead athletes causing separation of articular cartilage from the subchondral bone. Multiple treatment strategies addressing these lesions have been described. The purpose of this study was to report a novel technique using BioCartilage® (Arthrex, Naples, FL) to augment microfracture of OCD lesions of the capitellum in adolescent athletes with the prediction that this would lead to favorable clinical outcomes. Methods: A retrospective review was performed of 5 patients with OCD lesions of the capitellum who underwent open surgical intervention with BioCartilage implantation through a lateral approach to the elbow. There were 4 female patients and 1 male patient. The mean age was 13 years. The average follow-up was 55.8 months. Results: Each patient returned to their original sport at 6 months with a painless range of motion and full strength. American Shoulder and Elbow Scores and Mayo Elbow Performance Scales postoperatively were 100, and Visual Analog Scales were 0/10 for each patient. There were no complications or reoperations. Radiographs obtained at 6 to 8 months postoperatively showed healing of the lesions with no further evidence of an osseous defect. Conclusion: Our technique shows promising mid-term results. A safe and timely return to play was achieved in each case. This technique offers advantages by providing an excellent range of motion and return to sport using a familiar open approach.
{"title":"Treatment of Osteochondritis Dissecans of the Capitellum Using BioCartilage in Adolescent Athletes Results in Safe and Timely Return to Play","authors":"Baylor Blickenstaff, LeeAnne Torres, C. Giangarra","doi":"10.1097/BTO.0000000000000596","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000596","url":null,"abstract":"Objectives: Osteochondritis dissecans (OCD) is a condition affecting the capitellum in adolescent overhead athletes causing separation of articular cartilage from the subchondral bone. Multiple treatment strategies addressing these lesions have been described. The purpose of this study was to report a novel technique using BioCartilage® (Arthrex, Naples, FL) to augment microfracture of OCD lesions of the capitellum in adolescent athletes with the prediction that this would lead to favorable clinical outcomes. Methods: A retrospective review was performed of 5 patients with OCD lesions of the capitellum who underwent open surgical intervention with BioCartilage implantation through a lateral approach to the elbow. There were 4 female patients and 1 male patient. The mean age was 13 years. The average follow-up was 55.8 months. Results: Each patient returned to their original sport at 6 months with a painless range of motion and full strength. American Shoulder and Elbow Scores and Mayo Elbow Performance Scales postoperatively were 100, and Visual Analog Scales were 0/10 for each patient. There were no complications or reoperations. Radiographs obtained at 6 to 8 months postoperatively showed healing of the lesions with no further evidence of an osseous defect. Conclusion: Our technique shows promising mid-term results. A safe and timely return to play was achieved in each case. This technique offers advantages by providing an excellent range of motion and return to sport using a familiar open approach.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"15 1","pages":"15 - 20"},"PeriodicalIF":0.3,"publicationDate":"2022-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89536179","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 : 2022-08-03DOI: 10.1097/BTO.0000000000000598
Nikki A. Doerr, A. Kellish, M. Kleiner, C. Gutowski
Introduction: Tumor excision of the subchondral bone of the distal femur epiphysis is technically challenging particularly in skeletally immature patients due to the open physis above and articular surface below. Preservation of the physis, maintenance of structural support to, and integrity of, the cartilage, and conservation of joint kinematics must all be considered and are often threatened by current percutaneous or open surgical treatment options. Materials and Methods: We present a case of a 16-year-old male athlete with a distal femur epiphyseal bone lesion. He underwent transarticular en bloc excision and autograft reconstruction using osteoarticular transfer system (OATS) technique. Results: Final pathology revealed complete excision of an osteoid osteoma. The patient had regained full strength and range of motion at 3 months postoperatively, and at 22 months postoperatively was free of disease and back to full level of athletic participation. Conclusions: This article describes a technique for excision of subchondral epiphyseal bone lesions in the distal femur in skeletally immature patients which mitigates the risk of complications associated with physeal injury, incomplete tumor resection, and iatrogenic injury to the overlying cartilage.
{"title":"The Utilization of Osteoarticular Transfer System in the Treatment of Distal Femur Osteoid Osteoma: A Case Report","authors":"Nikki A. Doerr, A. Kellish, M. Kleiner, C. Gutowski","doi":"10.1097/BTO.0000000000000598","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000598","url":null,"abstract":"Introduction: Tumor excision of the subchondral bone of the distal femur epiphysis is technically challenging particularly in skeletally immature patients due to the open physis above and articular surface below. Preservation of the physis, maintenance of structural support to, and integrity of, the cartilage, and conservation of joint kinematics must all be considered and are often threatened by current percutaneous or open surgical treatment options. Materials and Methods: We present a case of a 16-year-old male athlete with a distal femur epiphyseal bone lesion. He underwent transarticular en bloc excision and autograft reconstruction using osteoarticular transfer system (OATS) technique. Results: Final pathology revealed complete excision of an osteoid osteoma. The patient had regained full strength and range of motion at 3 months postoperatively, and at 22 months postoperatively was free of disease and back to full level of athletic participation. Conclusions: This article describes a technique for excision of subchondral epiphyseal bone lesions in the distal femur in skeletally immature patients which mitigates the risk of complications associated with physeal injury, incomplete tumor resection, and iatrogenic injury to the overlying cartilage.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"84 1","pages":"28 - 33"},"PeriodicalIF":0.3,"publicationDate":"2022-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88071094","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 : 2022-07-15DOI: 10.1097/BTO.0000000000000597
Daniel T. Miles, Mila Scheinberg, Robert S. Quigley
Introduction: Tibial shaft fractures are common injuries in the pediatric population that can reliably be treated with conservative treatment. However, unstable tibial shaft fractures in the pediatric population have limited operative treatment options because the skeletal immaturity of these patients makes rigid intramedullary devices contraindicated in this population, and external fixation strategies are associated with a high complication rates. Elastic nailing with cerclage is a minimally invasive, and relatively soft tissue sparing technique that can decrease wide dissection and periosteal stripping associated with plating. However, treating long oblique length unstable femur fractures with elastic nails has been shown yield good result; EIN in length unstable tibia shaft fractures with elastic nails has not been explored. Materials and Methods: Review of 2 patients receiving novel cerclage augmented elastic nailing technique. Results: Patients included had complete follow-up to fracture union, had no surgical complications postoperatively, and no failure of fixation. Patients achieved full range of motion and strength compared with the contralateral uninjured limb. Both patients returned to preinjury activity levels with no limitations. Discussion: We present a novel technique using elastic nails in unstable long oblique tibia fractures with a cerclage augment. This can expand EIN indications to provide a load-sharing construct with relative stability to length unstable tibia fractures that EIN use would typically be contraindicated. This in turn affords the benefits of EIN such as reliable fracture healing, excellent functional and cosmetic results with a safe and reproducible surgical technique.
{"title":"Length Unstable Pediatric Tibial Shaft Fracture Treated With Cerclage Augmented Elastic Intramedullary Nails: A Novel Technique","authors":"Daniel T. Miles, Mila Scheinberg, Robert S. Quigley","doi":"10.1097/BTO.0000000000000597","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000597","url":null,"abstract":"Introduction: Tibial shaft fractures are common injuries in the pediatric population that can reliably be treated with conservative treatment. However, unstable tibial shaft fractures in the pediatric population have limited operative treatment options because the skeletal immaturity of these patients makes rigid intramedullary devices contraindicated in this population, and external fixation strategies are associated with a high complication rates. Elastic nailing with cerclage is a minimally invasive, and relatively soft tissue sparing technique that can decrease wide dissection and periosteal stripping associated with plating. However, treating long oblique length unstable femur fractures with elastic nails has been shown yield good result; EIN in length unstable tibia shaft fractures with elastic nails has not been explored. Materials and Methods: Review of 2 patients receiving novel cerclage augmented elastic nailing technique. Results: Patients included had complete follow-up to fracture union, had no surgical complications postoperatively, and no failure of fixation. Patients achieved full range of motion and strength compared with the contralateral uninjured limb. Both patients returned to preinjury activity levels with no limitations. Discussion: We present a novel technique using elastic nails in unstable long oblique tibia fractures with a cerclage augment. This can expand EIN indications to provide a load-sharing construct with relative stability to length unstable tibia fractures that EIN use would typically be contraindicated. This in turn affords the benefits of EIN such as reliable fracture healing, excellent functional and cosmetic results with a safe and reproducible surgical technique.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"5 1","pages":"21 - 27"},"PeriodicalIF":0.3,"publicationDate":"2022-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90149690","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 : 2022-06-30DOI: 10.1097/BTO.0000000000000587
Gustavo de Mello Ribeiro Pinto, Rodrigo Chauke Rezende, Cristiano Nabuco Dantas, Marcelo Costa de Oliveira Campos, Leandro Albuquerque Lemgruber Kropf
Introduction: The surgical treatment of the proximal humerus fractures is challenging because of various presentations, especially in osteoporotic bones. The use of fixed-angle locked plates combined with grafts increases the fixation stability and healing rate. This study aims to describe a novel option of autogenous bone graft from the distal clavicle in the treatment of the proximal humerus fracture. Materials and Methods: This is a descriptive study of a novel technique including patients undergoing surgical treatment of the proximal humerus fracture with locked plates and autograft from the distal clavicle. Results: A total of 3 female patients underwent treatment in the last year, and there are no complications reported. All fractures remained stable without varus collapse of the humeral head. Conclusion: We are the first to describe the use of the distal clavicle as an option of autograft for the treatment of the proximal humerus fractures. This technique has low morbidity and complexity, easy reproduction and low cost and can be harvested in the same donor region as the operative site.
{"title":"Distal Clavicle Autograft in Fractures of the Proximal Humerus: Surgical Technique","authors":"Gustavo de Mello Ribeiro Pinto, Rodrigo Chauke Rezende, Cristiano Nabuco Dantas, Marcelo Costa de Oliveira Campos, Leandro Albuquerque Lemgruber Kropf","doi":"10.1097/BTO.0000000000000587","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000587","url":null,"abstract":"Introduction: The surgical treatment of the proximal humerus fractures is challenging because of various presentations, especially in osteoporotic bones. The use of fixed-angle locked plates combined with grafts increases the fixation stability and healing rate. This study aims to describe a novel option of autogenous bone graft from the distal clavicle in the treatment of the proximal humerus fracture. Materials and Methods: This is a descriptive study of a novel technique including patients undergoing surgical treatment of the proximal humerus fracture with locked plates and autograft from the distal clavicle. Results: A total of 3 female patients underwent treatment in the last year, and there are no complications reported. All fractures remained stable without varus collapse of the humeral head. Conclusion: We are the first to describe the use of the distal clavicle as an option of autograft for the treatment of the proximal humerus fractures. This technique has low morbidity and complexity, easy reproduction and low cost and can be harvested in the same donor region as the operative site.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"38 1","pages":"245 - 248"},"PeriodicalIF":0.3,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87569709","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 : 2022-06-28DOI: 10.1097/BTO.0000000000000595
S. Keyhani, M. Movahedinia, Farzad Amouzadeh, Naser Ghanbari
Objectives: A patellar tendon rupture is an extremely disabling extensor mechanism injury. This follow-up study describes the clinical and radiologic outcomes of a new modified technique for reconstructing chronic patellar tendon ruptures. Materials and Methods: From 2014 to 2018, we reconstructed 15 chronic patellar tendon ruptures using Achilles tendon-bone allograft. Clinical and radiologic outcomes were evaluated preoperatively and during the final follow-up, 2 to 7 years after reconstruction. Assessments involved the International Knee Documentation Committee (IKDC), Lysholm, and Kujala scores, as well as quadriceps muscle strength and extension lag. Radiologic results were evaluated using the Insall-Salvati index on plain radiography and allograft integration through magnetic resonance imaging. Results: At the final follow-up, the Lysholm, IKDC, and Kujala scores improved by 57, 58, and 54 points, respectively (P<0.001). The average quadriceps muscle strength improved from 2.6 (2 to 3) before the operation to 4.6 (4 to 5) at the final follow-up (P<0.001). The extension lag also improved significantly from 31.7 degrees (25 to 40) to 0.6 degrees (0 to 10). The preoperative Insall-Salvati index was 1.6 (1.5 to 1.9), which improved significantly to 1.2 (1 to 1.3) postoperatively (P<0.001). Two years after the operation, magnetic resonance imaging showed good allograft integration in all pateints. Conclusion: Combining an Achilles tendon-bone allograft with a robust fixation method led to favorable clinical and radiologic outcomes. Level of Evidence: Level IV.
{"title":"Achilles Tendon-Bone Allograft is Advantageous for Chronic Patellar Tendon Ruptures Using a Modified Fixation Technique","authors":"S. Keyhani, M. Movahedinia, Farzad Amouzadeh, Naser Ghanbari","doi":"10.1097/BTO.0000000000000595","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000595","url":null,"abstract":"Objectives: A patellar tendon rupture is an extremely disabling extensor mechanism injury. This follow-up study describes the clinical and radiologic outcomes of a new modified technique for reconstructing chronic patellar tendon ruptures. Materials and Methods: From 2014 to 2018, we reconstructed 15 chronic patellar tendon ruptures using Achilles tendon-bone allograft. Clinical and radiologic outcomes were evaluated preoperatively and during the final follow-up, 2 to 7 years after reconstruction. Assessments involved the International Knee Documentation Committee (IKDC), Lysholm, and Kujala scores, as well as quadriceps muscle strength and extension lag. Radiologic results were evaluated using the Insall-Salvati index on plain radiography and allograft integration through magnetic resonance imaging. Results: At the final follow-up, the Lysholm, IKDC, and Kujala scores improved by 57, 58, and 54 points, respectively (P<0.001). The average quadriceps muscle strength improved from 2.6 (2 to 3) before the operation to 4.6 (4 to 5) at the final follow-up (P<0.001). The extension lag also improved significantly from 31.7 degrees (25 to 40) to 0.6 degrees (0 to 10). The preoperative Insall-Salvati index was 1.6 (1.5 to 1.9), which improved significantly to 1.2 (1 to 1.3) postoperatively (P<0.001). Two years after the operation, magnetic resonance imaging showed good allograft integration in all pateints. Conclusion: Combining an Achilles tendon-bone allograft with a robust fixation method led to favorable clinical and radiologic outcomes. Level of Evidence: Level IV.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"36 1","pages":"10 - 14"},"PeriodicalIF":0.3,"publicationDate":"2022-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79812149","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 : 2022-06-03DOI: 10.1097/BTO.0000000000000594
Samuel J Mease, Hallie R. Bradley, D. R. Thota, A. Starr, Drew T. Sanders
Purpose: Tibia fractures with soft tissue compromise present are challenging to manage. For fractures with significant swelling or open injury not amenable to internal stabilization, external fixators provide sufficient stability for bony healing. Ring fixators and hybrid constructs provide adequate stability for healing but are costly, and challenging to apply and maintain. We present the “T-bar” external fixator, a novel construct that can be maintained until bony union and allows for range of motion of adjacent joints. We also report the demographics, clinical, and radiographic outcomes of 34 patients treated definitively with this construct. Materials and Methods: The T-bar external fixator uses standard pins and bars in a novel arrangement. It can be applied for Arbeitsgemeinshaft fur Osteosynthesefragen/Orthopaedic Trauma Association-type 41/42/43 type injuries, with or without supplemental fixation for intra-articular patterns. Results: Between 2008 and 2015, 34 patients were treated for tibia fracture with T-bar external fixation, with intention to treat in a definitive manner. Twenty-nine were male, and average age was 44.3 years. Thirty-one sustained high energy mechanisms of injury. Twenty were Gustilo-type 2 or 3 fractures. Of 14 closed fractures, 12 were Tscherne-type 2 or 3. Conclusions: The T-bar external fixator offers an alternative to ring and hybrid external fixator constructs in treatment of tibia fractures with significant soft tissue compromise. Of 28 patients with complete follow up, only 1 case of osteomyelitis was reported. All patients were managed without amputation. Three required revision for nonunion, all Arbeitsgemeinshaft fur Osteosynthesefragen/Orthopaedic Trauma Association-type 43.
{"title":"Technical Trick: T-Bar External Fixator for Definitive Management of Periarticular and Metadiaphyseal Tibial Fractures","authors":"Samuel J Mease, Hallie R. Bradley, D. R. Thota, A. Starr, Drew T. Sanders","doi":"10.1097/BTO.0000000000000594","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000594","url":null,"abstract":"Purpose: Tibia fractures with soft tissue compromise present are challenging to manage. For fractures with significant swelling or open injury not amenable to internal stabilization, external fixators provide sufficient stability for bony healing. Ring fixators and hybrid constructs provide adequate stability for healing but are costly, and challenging to apply and maintain. We present the “T-bar” external fixator, a novel construct that can be maintained until bony union and allows for range of motion of adjacent joints. We also report the demographics, clinical, and radiographic outcomes of 34 patients treated definitively with this construct. Materials and Methods: The T-bar external fixator uses standard pins and bars in a novel arrangement. It can be applied for Arbeitsgemeinshaft fur Osteosynthesefragen/Orthopaedic Trauma Association-type 41/42/43 type injuries, with or without supplemental fixation for intra-articular patterns. Results: Between 2008 and 2015, 34 patients were treated for tibia fracture with T-bar external fixation, with intention to treat in a definitive manner. Twenty-nine were male, and average age was 44.3 years. Thirty-one sustained high energy mechanisms of injury. Twenty were Gustilo-type 2 or 3 fractures. Of 14 closed fractures, 12 were Tscherne-type 2 or 3. Conclusions: The T-bar external fixator offers an alternative to ring and hybrid external fixator constructs in treatment of tibia fractures with significant soft tissue compromise. Of 28 patients with complete follow up, only 1 case of osteomyelitis was reported. All patients were managed without amputation. Three required revision for nonunion, all Arbeitsgemeinshaft fur Osteosynthesefragen/Orthopaedic Trauma Association-type 43.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"1 1","pages":"5 - 9"},"PeriodicalIF":0.3,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88001114","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 : 2022-05-26DOI: 10.1097/BTO.0000000000000593
S. Mittal, Tanya Trikha, A. Karpe, Pulak Vatsya, V. Trikha
Introduction: Interlocking nailing for femoral shaft fractures is one of the most common surgeries by orthopedic traumatologists. With the advent of cephalon-medullary nailing, a center-center position of the head screw has become mandatory. With retroversion or reduced anteversion of neck, a center placement needs internal rotation of the nail. This makes distal locking problematic, as now making a perfect circle is difficult due to the physical constraints of C-arm rotation. Objective: To describe a novel technique to overcome the anatomic constraints and get a perfect circle for quick distal locking. Material and Methods: We used a novel technique in our routine femur nailing cases. Here, in cases with reduced anteversion of the neck, distal locking was tenuous due to difficulty in making a perfect circle. Thus, we have used a new technique called “Turning the table” where we externally rotate the table, which allows us to get a perfect circle for locking in almost a single exposure. Results: This is a useful technique in cases where getting a perfect circle is difficult due to anatomic constraints and variations and can help in getting a perfect circle with limited radiation exposure.
{"title":"“Turning The Tables”: A Technical Tip to Overcome Anatomic Constraints While Distal Locking During Femur Intramedullary Nailing","authors":"S. Mittal, Tanya Trikha, A. Karpe, Pulak Vatsya, V. Trikha","doi":"10.1097/BTO.0000000000000593","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000593","url":null,"abstract":"Introduction: Interlocking nailing for femoral shaft fractures is one of the most common surgeries by orthopedic traumatologists. With the advent of cephalon-medullary nailing, a center-center position of the head screw has become mandatory. With retroversion or reduced anteversion of neck, a center placement needs internal rotation of the nail. This makes distal locking problematic, as now making a perfect circle is difficult due to the physical constraints of C-arm rotation. Objective: To describe a novel technique to overcome the anatomic constraints and get a perfect circle for quick distal locking. Material and Methods: We used a novel technique in our routine femur nailing cases. Here, in cases with reduced anteversion of the neck, distal locking was tenuous due to difficulty in making a perfect circle. Thus, we have used a new technique called “Turning the table” where we externally rotate the table, which allows us to get a perfect circle for locking in almost a single exposure. Results: This is a useful technique in cases where getting a perfect circle is difficult due to anatomic constraints and variations and can help in getting a perfect circle with limited radiation exposure.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"79 1","pages":"253 - 257"},"PeriodicalIF":0.3,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91241598","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 : 2022-05-23DOI: 10.1097/BTO.0000000000000592
Erik Y. Tye, J. Bryman, R. Kay, Adam J. Taylor, J. Andrawis, L. Kwong
Introduction: Contemporary differences exist with regards to revision total knee arthroplasty (TKA) fixation philosophy. The use of an all-cementless constrained condylar knee (CCK) design for revision TKA with porous tantalum has not been described in the recent peer-reviewed literature. Our rationale for using an all-cementless design in the revision setting includes the theoretical decrease in aseptic loosening and enhanced preservation of bone stock. Methods: We report the surgical technique and clinical results of 28 patients who underwent revision TKA utilizing an all-cementless CCK design and review the complications, rerevisions, and survivorship free of aseptic loosening. All subjects were included in the survivorship analysis. Results: The mean age of patients was 62.8 years. The average length of follow-up was 3.6 years (range: 2 to 6 y). Seventeen patients underwent revision TKA for periprosthetic joint infection as the second stage of a 2-stage reconstruction, 7 for aseptic loosening, and 4 for instability. There were 6 failures defined as the removal of any components for any reason; 5 of the 6 failures were due to recurrent periprosthetic joint infection. There were no failures that were revised for aseptic loosening. Discussion: If we consider those patients lost to follow-up to represent a failure (5/28), our series would have an 82.1% survivorship free from aseptic loosening and a failure rate 17.9% at an average of 3.6 years. Early results suggest the use of an all-cementless CCK design with porous tantalum for revision TKA may provide an acceptable alternative to cemented and hybrid techniques in selected patients.
{"title":"All-cementless Revision Total Knee Arthroplasty Using a Constrained Condylar Design With Porous Tantalum: Technique and Clinical Results","authors":"Erik Y. Tye, J. Bryman, R. Kay, Adam J. Taylor, J. Andrawis, L. Kwong","doi":"10.1097/BTO.0000000000000592","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000592","url":null,"abstract":"Introduction: Contemporary differences exist with regards to revision total knee arthroplasty (TKA) fixation philosophy. The use of an all-cementless constrained condylar knee (CCK) design for revision TKA with porous tantalum has not been described in the recent peer-reviewed literature. Our rationale for using an all-cementless design in the revision setting includes the theoretical decrease in aseptic loosening and enhanced preservation of bone stock. Methods: We report the surgical technique and clinical results of 28 patients who underwent revision TKA utilizing an all-cementless CCK design and review the complications, rerevisions, and survivorship free of aseptic loosening. All subjects were included in the survivorship analysis. Results: The mean age of patients was 62.8 years. The average length of follow-up was 3.6 years (range: 2 to 6 y). Seventeen patients underwent revision TKA for periprosthetic joint infection as the second stage of a 2-stage reconstruction, 7 for aseptic loosening, and 4 for instability. There were 6 failures defined as the removal of any components for any reason; 5 of the 6 failures were due to recurrent periprosthetic joint infection. There were no failures that were revised for aseptic loosening. Discussion: If we consider those patients lost to follow-up to represent a failure (5/28), our series would have an 82.1% survivorship free from aseptic loosening and a failure rate 17.9% at an average of 3.6 years. Early results suggest the use of an all-cementless CCK design with porous tantalum for revision TKA may provide an acceptable alternative to cemented and hybrid techniques in selected patients.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"10 1","pages":"207 - 213"},"PeriodicalIF":0.3,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81102160","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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