Pub Date : 2021-11-02DOI: 10.1097/bto.0000000000000576
P. J. Tawney
{"title":"Advanced Adjunctive Techniques in Amputation and Limb Restoration","authors":"P. J. Tawney","doi":"10.1097/bto.0000000000000576","DOIUrl":"https://doi.org/10.1097/bto.0000000000000576","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"31 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86741393","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 : 2021-10-21DOI: 10.1097/BTO.0000000000000573
Brooke Hayashi, J. Shahbazian, Kerry Loveland, J. Gerardi
Introduction: Flexible intramedullary nail fixation (FIN) has become the preferred mode of treatment for femur fractures in elementary school aged children. One clear limitation of FIN is the inability to control length unstable femur fractures. This case series evaluates radiographic union rates, fracture alignment, and postoperative complications for a novel technique of FIN and adjunct external fixation in length unstable femur fractures. Materials and Methods: A retrospective chart review was performed using current procedural terminology coding to identify 10 pediatric femur fractures utilizing flexible nail fixation with supplemental external fixation in length unstable femur fractures. Electronic medical records were used to obtain demographic information and length of operative time. A picture archiving and communication system was utilized to review radiographs. Results: Combined FIN fixation and supplemental external fixation were used in ten pediatric patients with length unstable femur fractures. The average age at time of injury was 6.4 years (range: 3 to 8 years). The average duration of external fixation was 30 days with no pin site complications including infection or refracture. Average time to union was 54 days with no radiographic loss of reduction. There were no documented intraoperative or postoperative complications. Conclusions: The cases reviewed in this study support that in addition to FIN fixation for unstable pediatric femur fractures, a supplemental external fixator provides a viable option with all fractures obtaining union, acceptable alignment, no loss of reduction, and no postoperative complications. This technique may provide another tool in the orthopedist armamentarium and possibly as an alternative to submuscular plating.
{"title":"Flexible Intramedullary Nail Fixation With Supplemental External Fixator for Unstable Pediatric Femur Fractures: A Case Series","authors":"Brooke Hayashi, J. Shahbazian, Kerry Loveland, J. Gerardi","doi":"10.1097/BTO.0000000000000573","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000573","url":null,"abstract":"Introduction: Flexible intramedullary nail fixation (FIN) has become the preferred mode of treatment for femur fractures in elementary school aged children. One clear limitation of FIN is the inability to control length unstable femur fractures. This case series evaluates radiographic union rates, fracture alignment, and postoperative complications for a novel technique of FIN and adjunct external fixation in length unstable femur fractures. Materials and Methods: A retrospective chart review was performed using current procedural terminology coding to identify 10 pediatric femur fractures utilizing flexible nail fixation with supplemental external fixation in length unstable femur fractures. Electronic medical records were used to obtain demographic information and length of operative time. A picture archiving and communication system was utilized to review radiographs. Results: Combined FIN fixation and supplemental external fixation were used in ten pediatric patients with length unstable femur fractures. The average age at time of injury was 6.4 years (range: 3 to 8 years). The average duration of external fixation was 30 days with no pin site complications including infection or refracture. Average time to union was 54 days with no radiographic loss of reduction. There were no documented intraoperative or postoperative complications. Conclusions: The cases reviewed in this study support that in addition to FIN fixation for unstable pediatric femur fractures, a supplemental external fixator provides a viable option with all fractures obtaining union, acceptable alignment, no loss of reduction, and no postoperative complications. This technique may provide another tool in the orthopedist armamentarium and possibly as an alternative to submuscular plating.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"43 1","pages":"214 - 217"},"PeriodicalIF":0.3,"publicationDate":"2021-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77425613","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 : 2021-10-21DOI: 10.1097/BTO.0000000000000575
D. Cohen, Jil A. Wood, S. MacDessi
Background: Intraoperative pressure sensors provide the ability to quantify soft tissue balance (STB) and guide balancing interventions in total knee arthroplasty (TKA). The purpose of this study was to validate a sensor-guided knee balancing algorithm for posterior-stabilized TKA and then report medium-term patient-reported outcome measures from a consecutive series of surgeries using this algorithm. Materials and Methods: An algorithm is described for sensor-guided soft tissue releases and bone recuts aiming for quantitative knee balance. The coprimary endpoints were the proportion of TKAs in which quantitative STB was achieved using the sensor-guided balancing algorithm and the number of balancing interventions required. Secondary outcomes included change in Knee injury and Osteoarthritis Outcome Score (KOOS) components, rates of manipulations for stiffness, and revision surgery. Results: In a consecutive series of 210 knees, quantitative STB was achieved in 91.9% of cases. Balancing procedures were required in 57.2% (n=120), with 84.3% (n=177) requiring up to 2 balancing interventions to achieve balance. Angular bone recuts were required in 22.9% (n=48) of TKAs. At a minimum of 2 years, there was a statistically significant, clinically meaningful increase in mean KOOS4 of 40.8 (SD=17.5). All ΔKOOS subscales improved. The incidence of manipulation for stiffness and revision surgery at up to 4 years were 3.3% (7/210) and 1.4% (3/210), respectively. Conclusions: Quantitative sensor-guided assessment allows precise attainment of STB using a balancing algorithm of both bone recuts and soft tissue releases. Excellent medium-term improvement in patient-reported outcome measures was achieved with posterior-stabilized TKA using intraoperative sensor-guided balancing interventions.
{"title":"Sensor-guided Knee Balancing in Posterior-stabilized Total Knee Arthroplasty: A Surgical Description and Report of Medium-term Patient Outcomes","authors":"D. Cohen, Jil A. Wood, S. MacDessi","doi":"10.1097/BTO.0000000000000575","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000575","url":null,"abstract":"Background: Intraoperative pressure sensors provide the ability to quantify soft tissue balance (STB) and guide balancing interventions in total knee arthroplasty (TKA). The purpose of this study was to validate a sensor-guided knee balancing algorithm for posterior-stabilized TKA and then report medium-term patient-reported outcome measures from a consecutive series of surgeries using this algorithm. Materials and Methods: An algorithm is described for sensor-guided soft tissue releases and bone recuts aiming for quantitative knee balance. The coprimary endpoints were the proportion of TKAs in which quantitative STB was achieved using the sensor-guided balancing algorithm and the number of balancing interventions required. Secondary outcomes included change in Knee injury and Osteoarthritis Outcome Score (KOOS) components, rates of manipulations for stiffness, and revision surgery. Results: In a consecutive series of 210 knees, quantitative STB was achieved in 91.9% of cases. Balancing procedures were required in 57.2% (n=120), with 84.3% (n=177) requiring up to 2 balancing interventions to achieve balance. Angular bone recuts were required in 22.9% (n=48) of TKAs. At a minimum of 2 years, there was a statistically significant, clinically meaningful increase in mean KOOS4 of 40.8 (SD=17.5). All ΔKOOS subscales improved. The incidence of manipulation for stiffness and revision surgery at up to 4 years were 3.3% (7/210) and 1.4% (3/210), respectively. Conclusions: Quantitative sensor-guided assessment allows precise attainment of STB using a balancing algorithm of both bone recuts and soft tissue releases. Excellent medium-term improvement in patient-reported outcome measures was achieved with posterior-stabilized TKA using intraoperative sensor-guided balancing interventions.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"56 1","pages":"232 - 237"},"PeriodicalIF":0.3,"publicationDate":"2021-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80672895","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 : 2021-09-16DOI: 10.1097/BTO.0000000000000571
B. L. Davison
Background: Cephalomedullary nailing is used to treat pertrochanteric fractures of the femur. A fracture or traction table is generally used to obtain and maintain fracture reduction. Some patients because of body habitus or ipsilateral foot or ankle pathology are not well suited for standard fracture table use. This study describes a technique and the results of using the large distractor on a standard radiolucent table to treat pertrochanteric femur fractures with a cephalomedullary implant. Methods: The described technique was used to reduce and stabilize pertrochanteric femur fractures with a cephalomedullary implant. All fractures were reduced on a radiolucent table using the large bone distractor with 5 or 6 mm threaded pin in supra-acetabular area of the pelvis and a 5 mm threaded pin in the distal femur. Results for the first 36 patients treated with this technique are reviewed. Results: All fractures were able to be reduced and stabilized using the technique. The average total operative time was 89 minutes and the average time from incision to wound closure was 53 minutes. Thirty patients were followed until fracture union and healed without further surgical intervention. One patient developed a nonunion with implant failure, 4 patients died, and 1 was lost to follow up. Conclusions: Pertrochanteric femur fractures can be reduced and stabilized using this technique if the surgeon feels the fracture table is not a good option.
{"title":"Cephalomedullary Nailing of Pertrochanteric Femur Fractures using a Large Distractor and Standard Radiolucent Table","authors":"B. L. Davison","doi":"10.1097/BTO.0000000000000571","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000571","url":null,"abstract":"Background: Cephalomedullary nailing is used to treat pertrochanteric fractures of the femur. A fracture or traction table is generally used to obtain and maintain fracture reduction. Some patients because of body habitus or ipsilateral foot or ankle pathology are not well suited for standard fracture table use. This study describes a technique and the results of using the large distractor on a standard radiolucent table to treat pertrochanteric femur fractures with a cephalomedullary implant. Methods: The described technique was used to reduce and stabilize pertrochanteric femur fractures with a cephalomedullary implant. All fractures were reduced on a radiolucent table using the large bone distractor with 5 or 6 mm threaded pin in supra-acetabular area of the pelvis and a 5 mm threaded pin in the distal femur. Results for the first 36 patients treated with this technique are reviewed. Results: All fractures were able to be reduced and stabilized using the technique. The average total operative time was 89 minutes and the average time from incision to wound closure was 53 minutes. Thirty patients were followed until fracture union and healed without further surgical intervention. One patient developed a nonunion with implant failure, 4 patients died, and 1 was lost to follow up. Conclusions: Pertrochanteric femur fractures can be reduced and stabilized using this technique if the surgeon feels the fracture table is not a good option.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"9 1","pages":"181 - 184"},"PeriodicalIF":0.3,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84293369","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 : 2021-09-13DOI: 10.1097/BTO.0000000000000572
Cao Thi, Nguyen Dang Ha
Introduction: The quadriceps tendon (QT) is a common autologous graft for anterior cruciate ligament reconstruction. However, the best way to harvest it is still undefined. This study aims to determine the QT’s anatomical structures as a graft for anterior cruciate ligament reconstruction and the ideal harvest site. Methods: Thirty fresh frozen knees from 15 cadavers were dissected, and the QT was analyzed. The length, depth, and width of the QT were measured in a standardized manner for each cadaver. Results: The QT superficial morphology showed 2 distinct peaks, with the maximum length correlating with the real lateral peak. The full length of the tendon was located at 64.3%±5.4% of the width from the medial border of the insertion. The maximum length of the QT was 79.4±4.5 mm. The mean width at its insertion onto the patella was 36.0±4.3 mm. The thickness at its maximum length on patella insertion was 7.2±0.4 mm. The mean diameter of the QT graft was 8.5±0.5 mm, with a mean cross-sectional area of 64.7±4.1 mm2. Conclusion: QT graft harvest should begin by locating the apex (maximum length) of the tendon (64.3% of the distance from the patella’s medial edge). The surgeon should then harvest a 10 mm wide graft medially to the maximum length, harvesting 70 mm long and full-thickness tendon.
{"title":"Applied Anatomy of the Quadriceps Tendon Related to the Technique of Harvesting the Quadriceps Tendon Graft","authors":"Cao Thi, Nguyen Dang Ha","doi":"10.1097/BTO.0000000000000572","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000572","url":null,"abstract":"Introduction: The quadriceps tendon (QT) is a common autologous graft for anterior cruciate ligament reconstruction. However, the best way to harvest it is still undefined. This study aims to determine the QT’s anatomical structures as a graft for anterior cruciate ligament reconstruction and the ideal harvest site. Methods: Thirty fresh frozen knees from 15 cadavers were dissected, and the QT was analyzed. The length, depth, and width of the QT were measured in a standardized manner for each cadaver. Results: The QT superficial morphology showed 2 distinct peaks, with the maximum length correlating with the real lateral peak. The full length of the tendon was located at 64.3%±5.4% of the width from the medial border of the insertion. The maximum length of the QT was 79.4±4.5 mm. The mean width at its insertion onto the patella was 36.0±4.3 mm. The thickness at its maximum length on patella insertion was 7.2±0.4 mm. The mean diameter of the QT graft was 8.5±0.5 mm, with a mean cross-sectional area of 64.7±4.1 mm2. Conclusion: QT graft harvest should begin by locating the apex (maximum length) of the tendon (64.3% of the distance from the patella’s medial edge). The surgeon should then harvest a 10 mm wide graft medially to the maximum length, harvesting 70 mm long and full-thickness tendon.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"18 1","pages":"192 - 195"},"PeriodicalIF":0.3,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86449021","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 : 2021-07-22DOI: 10.1097/BTO.0000000000000566
R. Samade, Nikhil Adapa, A. Roebke, Hisham M. Awan
Introduction: We describe the treatment of rheumatoid radiocarpal joint and distal radioulnar joint (DRUJ) arthritis with radioscapholunate (RSL) arthrodesis and DRUJ arthroplasty in 2 patients with 2 years follow-up. The RSL arthrodesis utilizes nitinol staples and local distal radius autograft to fuse the scaphoid and lunate to the distal radius. Materials and Methods: One patient was treated in their nondominant extremity, and the other patient had bilateral procedures. A constrained endoprosthesis was used for the DRUJ arthroplasty portion, using the same dorsal approach to the wrist as the RSL arthrodesis. Results: Before his procedures, this first patient-reported a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score of 66, which improved to 16 at 2 years postoperatively. He also reported a Visual Analog Scale score of 6/10 at rest in both wrists preoperatively. Following his procedures, Visual Analog Scale scores improved to 3/10 in the right wrist and 0/10 in the left wrist. Active wrist range of motion was measured to be a 60-degree arc on the right and a 47-degree arc on the left. Our second patient reported an improved QuickDASH score from 97 preoperatively to 68 at 2 years postoperatively and had a 70-degree arc of left wrist range of motion. No postoperative complications or reoperations were encountered in the cases. Discussion: The benefit of this technique is to allow simultaneous treatment of radiocarpal joint arthritis with RSL arthrodesis, permitting wrist flexion and extension through the midcarpal joints, and DRUJ arthritis with DRUJ arthroplasty, preserving pronation and supination.
{"title":"Radioscapholunate Arthrodesis and Distal Radioulnar Joint Arthroplasty for Rheumatoid Wrist Arthritis: A Surgical Technique","authors":"R. Samade, Nikhil Adapa, A. Roebke, Hisham M. Awan","doi":"10.1097/BTO.0000000000000566","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000566","url":null,"abstract":"Introduction: We describe the treatment of rheumatoid radiocarpal joint and distal radioulnar joint (DRUJ) arthritis with radioscapholunate (RSL) arthrodesis and DRUJ arthroplasty in 2 patients with 2 years follow-up. The RSL arthrodesis utilizes nitinol staples and local distal radius autograft to fuse the scaphoid and lunate to the distal radius. Materials and Methods: One patient was treated in their nondominant extremity, and the other patient had bilateral procedures. A constrained endoprosthesis was used for the DRUJ arthroplasty portion, using the same dorsal approach to the wrist as the RSL arthrodesis. Results: Before his procedures, this first patient-reported a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score of 66, which improved to 16 at 2 years postoperatively. He also reported a Visual Analog Scale score of 6/10 at rest in both wrists preoperatively. Following his procedures, Visual Analog Scale scores improved to 3/10 in the right wrist and 0/10 in the left wrist. Active wrist range of motion was measured to be a 60-degree arc on the right and a 47-degree arc on the left. Our second patient reported an improved QuickDASH score from 97 preoperatively to 68 at 2 years postoperatively and had a 70-degree arc of left wrist range of motion. No postoperative complications or reoperations were encountered in the cases. Discussion: The benefit of this technique is to allow simultaneous treatment of radiocarpal joint arthritis with RSL arthrodesis, permitting wrist flexion and extension through the midcarpal joints, and DRUJ arthritis with DRUJ arthroplasty, preserving pronation and supination.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"9 1","pages":"159 - 165"},"PeriodicalIF":0.3,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81523110","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 : 2021-07-22DOI: 10.1097/BTO.0000000000000565
M. Muttha, K. Das, H. Chhabra, Bibhudendu Mohapatra, V. Tandon
{"title":"Dual Syringe Technique for Aspiration in Percutaneous Transpedicular Biopsy of Spinal Lesions","authors":"M. Muttha, K. Das, H. Chhabra, Bibhudendu Mohapatra, V. Tandon","doi":"10.1097/BTO.0000000000000565","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000565","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"48 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77150463","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 : 2021-07-22DOI: 10.1097/BTO.0000000000000547
Megan Fracol, L. Janes, Sumanas W Jordan, G. Dumanian, J. Ko
Supplemental Digital Content is available in the text. Targeted muscle reinnervation (TMR) is a surgical technique that was initially developed for amputees to improve prosthetic control. TMR reroutes the ends of amputated nerves into more proximal motor nerves supplying residual redundant muscle groups. In doing so, it restores motor signals from the brain that would otherwise be lost by the amputation and allows the redundant muscle to communicate this lost function to a prosthetic device. Although initially developed for functional purposes, TMR has subsequently been shown to treat neuropathic and phantom limb pain. As such, indications for its use have significantly expanded. TMR is now widely performed for both upper and lower extremity amputees, at various amputee levels. While technical roadmaps have been published for many amputation levels, the goal of this paper is to update and summarize all these techniques in one place.
{"title":"Targeted Muscle Reinnervation in Amputees: A Review of Current Techniques","authors":"Megan Fracol, L. Janes, Sumanas W Jordan, G. Dumanian, J. Ko","doi":"10.1097/BTO.0000000000000547","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000547","url":null,"abstract":"Supplemental Digital Content is available in the text. Targeted muscle reinnervation (TMR) is a surgical technique that was initially developed for amputees to improve prosthetic control. TMR reroutes the ends of amputated nerves into more proximal motor nerves supplying residual redundant muscle groups. In doing so, it restores motor signals from the brain that would otherwise be lost by the amputation and allows the redundant muscle to communicate this lost function to a prosthetic device. Although initially developed for functional purposes, TMR has subsequently been shown to treat neuropathic and phantom limb pain. As such, indications for its use have significantly expanded. TMR is now widely performed for both upper and lower extremity amputees, at various amputee levels. While technical roadmaps have been published for many amputation levels, the goal of this paper is to update and summarize all these techniques in one place.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"88 1","pages":"329 - 336"},"PeriodicalIF":0.3,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79134712","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 : 2021-07-22DOI: 10.1097/BTO.0000000000000561
J. Stoneback, N. Donaldson, Ashley Ignatiuk, M. Iorio
{"title":"Multidisciplinary Team-based Amputee Care","authors":"J. Stoneback, N. Donaldson, Ashley Ignatiuk, M. Iorio","doi":"10.1097/BTO.0000000000000561","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000561","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"84 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73939100","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 : 2021-07-14DOI: 10.1097/BTO.0000000000000564
N. Uvaraj, Aju Bosco
Introduction: With increase in the number of thoracolumbar spine surgeries using pedicle screw instrumentation, there is a proportionate increase in the number of revision surgeries requiring implant removal. Lack of standardization in manufacturing spinal pedicle screws has led to diverse variations in their design and dimensions. Removal of polyaxial pedicle screws becomes extremely difficult when there is a mismatch between their tulip-head and the screwdriver. With the rapidly changing concepts and designs of spinal pedicle screws this problem may arise when the appropriate pedicle screw instrumentation is out of production. There may be a need for special instruments or an array of screwdrivers of various dimensions/designs to overcome this problem. We describe a simple yet versatile technique to remove polyaxial tulip-head pedicle screws using commonly available instruments in the spinal instrumentation set. Materials and Methods: Polyaxial screws were removed after converting them into monoblock screws using the appropriate set-screw screwdriver, a 25-mm long 5.5 mm rod, and a counter torque wrench. Results: Using this technique we have successfully removed 167 screws in 53 revision surgeries [instrumented fusions for lumbar degenerative diseases (n=21), thoracolumbar fractures (n=15), and scoliosis (n=17)]. No failed retrievals or complications like pedicle breach or neurological deficit were observed. Discussion: The described technique is simple to execute, effective, quick, and safe. It is versatile and can be used to remove polyaxial pedicle screws of any design in the thoracic and lumbar spine using the commonly available instruments in the routine spinal instrumentation set (appropriate set-screw screwdriver, a 25-mm long 5.5 mm rod, a counter torque wrench).
{"title":"A Simple Versatile Technique to Retrieve Polyaxial Tulip-head Spinal Pedicle Screws Following Failed Pedicle Screw Removal: A Technical Note With Analysis of Efficacy and Outcomes","authors":"N. Uvaraj, Aju Bosco","doi":"10.1097/BTO.0000000000000564","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000564","url":null,"abstract":"Introduction: With increase in the number of thoracolumbar spine surgeries using pedicle screw instrumentation, there is a proportionate increase in the number of revision surgeries requiring implant removal. Lack of standardization in manufacturing spinal pedicle screws has led to diverse variations in their design and dimensions. Removal of polyaxial pedicle screws becomes extremely difficult when there is a mismatch between their tulip-head and the screwdriver. With the rapidly changing concepts and designs of spinal pedicle screws this problem may arise when the appropriate pedicle screw instrumentation is out of production. There may be a need for special instruments or an array of screwdrivers of various dimensions/designs to overcome this problem. We describe a simple yet versatile technique to remove polyaxial tulip-head pedicle screws using commonly available instruments in the spinal instrumentation set. Materials and Methods: Polyaxial screws were removed after converting them into monoblock screws using the appropriate set-screw screwdriver, a 25-mm long 5.5 mm rod, and a counter torque wrench. Results: Using this technique we have successfully removed 167 screws in 53 revision surgeries [instrumented fusions for lumbar degenerative diseases (n=21), thoracolumbar fractures (n=15), and scoliosis (n=17)]. No failed retrievals or complications like pedicle breach or neurological deficit were observed. Discussion: The described technique is simple to execute, effective, quick, and safe. It is versatile and can be used to remove polyaxial pedicle screws of any design in the thoracic and lumbar spine using the commonly available instruments in the routine spinal instrumentation set (appropriate set-screw screwdriver, a 25-mm long 5.5 mm rod, a counter torque wrench).","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":"3 1","pages":"171 - 174"},"PeriodicalIF":0.3,"publicationDate":"2021-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91285323","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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