scholarly journals TOMOGRAPHIC STUDY OF THE S2-ALAR-ILIAC SCREW TECHNIQUE IN BRAZILIAN WOMEN

2018 ◽  
Vol 17 (4) ◽  
pp. 313-316 ◽  
Author(s):  
Thiego Pedro Freitas Araújo ◽  
João Paz Vaz de Souza ◽  
Diego Ubrig Munhoz ◽  
Mauro Costa Morais Tavares ◽  
Raphael Martus Marcon ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Diagnostic Test ◽  
Adult Female ◽  
Ct Scans ◽  
Level Of Evidence ◽  
Bone Length ◽  
Iliac Screws ◽  
Iliac Screw ◽  
The Mean ◽  
Lumbosacral Fixation

ABSTRACT Objective: Lumbosacral fixation presents problems in its arthrodesis, mainly due to pseudoarthrosis. Iliac screws minimize this problem, however, they show problems in the operative wound. The S2-Alar-iliac (S2AI) screw presents a lower rate of these complications. The anatomical differences between the populations and the sexes analyzed in the literature justify the study of the S2AI screw technique in Brazilian women. Methods: A total of 14 adult female CT scans were analyzed by 4 evaluators. Results: The mean bone length was 131.8 mm, the largest bone diameter was 22.6 mm, and the smallest bone diameter was 22.6 mm. Conclusions: The data presented are compatible with the literature and may assist spine surgeons in choosing the best implant and surgical technique. Level of Evidence I; Diagnostic Studies — Investigating a Diagnostic Test (anatomical investigation).

scholarly journals TOMOGRAPHIC STUDY OF THE S2-ALAR-ILIAC SCREW TECHNIQUE IN BRAZILIAN MEN

2019 ◽  
Vol 18 (3) ◽  
pp. 226-230
Author(s):  
LUIS PIMENTEL SOMBRA ◽  
RICARDO TEIXEIRA E SILVA ◽  
THIEGO PEDRO FREITAS ARAÚJO ◽  
OLAVO LETAIF BIRAGHI ◽  
RAPHAEL MARTUS MARCON ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Adult Males ◽  
Anthropometric Parameters ◽  
Level Of Evidence ◽  
Bone Length ◽  
Iliac Screws ◽  
Pulling Forces ◽  
Iliac Screw ◽  
The Mean ◽  
The Right

ABSTRACT Objective The use of pedicle screws was a milestone for modern spinal surgery. This type of fixation, due to its superior biomechanics, gave greater fixation power, greater capacity to withstand the pulling forces and, therefore, greater stability and lower rates of pseudoarthrosis. Fixation of the lumbosacral junction, even with the development of these new implants, remains a challenge mainly because the considerable rates of pseudoarthrosis. The use of iliac screws solves the biomechanical difficulties. However, its use shows high rates of surgical wound problems. The S2-Alar-Iliac screw (S2AI) came as a solution to these complications. The lack of studies about anatomical and anthropometric parameters in the Brazilian population justifies the study. Methods Eleven hip tomographies of Brazilian adult males were analyzed by four evaluators. The right and left sides were considered. In each patient, measurements were made of greater and shorter bone length, greater and smaller bone diameter, distance from the entry point to the skin, sagittal and axial angles related to the hypothetical insertion of an S2AI screw and compared to the same measurements obtained with the iliac screw. Results The mean bone length was 136.7 mm, the greatest bone diameter was 24.8 mm, the smallest bone diameter was 19.7 mm and the distance from the screw to the skin was 42.1 mm for the S2AI screw. Conclusions The obtained data present an average of the sample that can be useful in the decision of the surgical technique in the studied group. Level of evidence I; Diagnostic Studies (Anatomical Investigation).

scholarly journals USE OF ALAR-ILIAC S2 SCREW TECHNIQUE IN SCOLIOSIS SECONDARY TO MYELOMENINGOCELE

2019 ◽  
Vol 18 (2) ◽  
pp. 110-112
Author(s):  
Coracy Gonçalves Brasil Neto ◽  
Luiz Müller Ávila ◽  
Dulce Helena Grimm ◽  
Carlos Abreu de Aguiar ◽  
Luis Eduardo Munhoz da Rocha
Keyword(s):  
Material Failure ◽  
Preoperative Period ◽  
Level Of Evidence ◽  
Radiographic Images ◽  
Pelvic Fixation ◽  
Iliac Screws ◽  
Iliac Screw ◽  
The Mean ◽  
Clinical Records

ABSTRACT Objective: To evaluate retrospectively the results related to the use of pelvic fixation with alar-iliac S2 screw in individuals with myelomeningocele. Methods: Retrospective study of cases surgically treated with this technique, between January 2015 and March 2018 at the Pequeno Principe Children's Hospital. Radiographic images and clinical records were analyzed in search of complications. Results: Twelve patients with mean age of 13.3 years were treated at the time of surgery. The mean follow-up was 11.5 months. The mean of the highest magnitude curve measured by the Cobb angle in the preoperative period was 83.8°; while in the last postoperative follow-up was 29.5° (correction of 65%). The mean pelvic obliquity was 23.1° in the preoperative period and in the postoperative was 7.1° (correction of 69%). Only 2 cases (17%) with complications associated with material failure at the level of sacroiliac fixation, due to the unilateral release of the head of the polyaxial S2 iliac screw. Conclusions: The technique of pelvic fixation in the scoliosis secondary to myelomeningocele with the use of S2 alar-iliac screws has shown satisfactory results, with only two complications (17%) directly related to pelvic fixation in the operated cases. Level of Evidence IV; Series of Cases.

Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries

2016 ◽  
Vol 37 (12) ◽  
pp. 1317-1325 ◽  
Author(s):  
Onur Kocadal ◽  
Mehmet Yucel ◽  
Murad Pepe ◽  
Ertugrul Aksahin ◽  
Cem Nuri Aktekin
Keyword(s):  
Screw Fixation ◽  
Ct Scans ◽  
Functional Evaluation ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Suture Button ◽  
Fixation Group ◽  
Significant Difference ◽  
The Mean

Background: Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans. Methods: Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2. Results: There was a statistically significant decrease in the degree of fibular rotation ( P = .03) and an increase in the upper syndesmotic area ( P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area ( P = .02) and distal tibiofibular volumes ( P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups. Conclusion: Although the functional outcomes were similar, the restoration of the fibular rotation in the treatment of syndesmotic injuries by screw fixation was troublesome and the volume of the distal tibiofibular space increased with the suture-button fixation technique. Level of Evidence: Level III, retrospective comparative study.

Role of Rotation in Total Ankle Replacement

2019 ◽  
Vol 40 (12) ◽  
pp. 1358-1367 ◽  
Author(s):  
Ali-Asgar Najefi ◽  
Yaser Ghani ◽  
Andy Goldberg
Keyword(s):  
Pearson Correlation ◽  
Axial Rotation ◽  
Total Ankle Replacement ◽  
Ct Scans ◽  
Tibial Torsion ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Preoperative Ct ◽  
The Mean ◽  
Foot Position

Background: The importance of total ankle replacement (TAR) implant orientation in the axial plane is poorly understood with major variation in surgical technique of implants on the market. Our aim was to better understand the axial rotational profile of patients undergoing TAR. Methods: In 157 standardized computed tomography (CT) scans of patients with end-stage ankle arthritis planning to undergo primary TAR surgery, we measured the relationship between the knee posterior condylar axis, the tibial tuberosity, the transmalleolar axis (TMA), and the tibiotalar angle. The foot position was measured in relation to the TMA with the foot plantigrade. The variation between the medial gutter line and the line bisecting both gutters was assessed. Results: The mean external tibial torsion was 34.5 ± 10.3 degrees (11.8-62 degrees). When plantigrade, the mean foot position relative to the TMA was 21 ± 10.6 degrees (0.7-38.4 degrees) internally rotated. As external tibial torsion increased, the foot position became more internally rotated relative to the TMA (Pearson correlation, 0.6; P < .0001). As the tibiotalar angle became more valgus, the foot became more externally rotated relative to the TMA (Pearson correlation, −0.4; P < .01). The mean difference between the medial gutter line and a line bisecting both gutters was 4.9 ± 2.8 degrees (1.7-9.4 degrees). More than 51% of patients had a difference greater than 5 degrees. The mean angle between the medial gutter line and a line perpendicular to the TMA was 7.5 ± 2.6 degrees (2.8-13.7 degrees). Conclusion: There was a large variation in rotational profile of patients undergoing TAR, particularly between the medial gutter line and the TMA. Surgeon designers and implant manufacturers should develop consistent methods to guide surgeons toward judging the appropriate axial rotation of their implant on an individual basis. We recommend careful clinical assessment and preoperative CT scans to enable the correct rotation to be determined. Level of Evidence: Level IIc, outcomes research.

scholarly journals Unilateral versus bilateral iliac screws for spinopelvic fixation: are two screws better than one?

2014 ◽  
Vol 36 (5) ◽  
pp. E10 ◽  
Author(s):  
Rajiv Saigal ◽  
Darryl Lau ◽  
Rishi Wadhwa ◽  
Hai Le ◽  
Morsi Khashan ◽  
...  
Keyword(s):  
Postoperative Infection ◽  
Screw Fixation ◽  
Insufficiency Fractures ◽  
Single Institution ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Iliac Screw ◽  
Sacral Insufficiency Fractures ◽  
The Mean

Object Long-segment spinal instrumentation ending at the sacrum places substantial biomechanical stress on sacral screws. Iliac (pelvic) screws relieve some of this stress by supplementing the caudal fixation. It remains an open question whether there is any clinically significant difference in sacropelvic fixation with bilateral versus unilateral iliac screws. The primary purpose of this study was to compare clinical and radiographic complications in the use of bilateral versus unilateral iliac screw fixation. Methods The authors retrospectively reviewed 102 consecutive spinal fixation cases that extended to the pelvis at a single institution (University of California, San Francisco) in the period from 2005 to 2012 performed by the senior authors. Charts were reviewed for the following complications: reoperation, L5–S1 pseudarthrosis, sacral insufficiency fracture, hardware prominence, iliac screw loosening, and infection. The t-test, Pearson chi-square test, and Fisher exact test were used to determine statistical significance. Results The mean follow-up was 31 months. Thirty cases were excluded: 12 for inadequate follow-up, 15 for lack of L5–S1 interbody fusion, and 3 for preoperative osteomyelitis. The mean age among the 72 remaining cases was 62 years (range 39–79 years). Forty-six patients underwent unilateral and 26 bilateral iliac screw fixation. Forty-one percent (n = 19) of the unilateral cases and 50% (n = 13) of the bilateral cases were treated with reoperation (p = 0.48). In addition, 13% (n = 6) of the unilateral and 19% (n = 5) of the bilateral cases developed L5–S1 pseudarthrosis (p = 0.51). There were no sacral insufficiency fractures. Thirteen percent (n = 6) of the unilateral and 7.7% (n = 2) of the bilateral cases developed postoperative infection (p = 0.70). Conclusions In a retrospective single-institution study, single versus dual pelvic screws led to comparable rates of reoperation, iliac screw removal, postoperative infection, pseudarthrosis, and sacral insufficiency fractures. For spinopelvic fixation, placing bilateral (vs unilateral) pelvic screws produced no added clinical benefit in most cases.

Deep Cheek Fat Volumes and Midfacial Aging

2019 ◽  
Vol 40 (5) ◽  
pp. 467-475 ◽  
Author(s):  
Jacob I Tower ◽  
Neil A Gordon ◽  
Boris Paskhover
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Longitudinal Analysis ◽  
Linear Regression Analysis ◽  
Ct Scans ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
The Mean ◽  
The Cross ◽  
Fat Volume

Abstract Background Midfacial volumizing procedures are increasingly common in facial rejuvenation. However, the changes that occur in midfacial fat with aging are poorly understood. Objectives The aim of this study was to determine how deep cheek fat volume is predicted by age. Methods We conducted retrospective cross-sectional and longitudinal studies of patients based on facial computed tomography (CT) scans. In the cross-sectional cohort, multiple linear regression analysis was performed to model the relations between age and deep cheek fat volumes. In the longitudinal analysis, changes to deep cheek fat volumes were tracked among subjects who underwent multiple facial CT scans. Results The cross-sectional cohort comprised 109 patients. The mean (SD) age of the subjects was 59.7 (15.0) years (range, 21.7-91.1 years). A linear regression analysis showed that increasing age was associated with increasing deep cheek fat volume (β = 0.015, P &lt; 0.001). Additional regression analyses showed that the gain of fat with aging was more pronounced in the caudal aspect of the cheek (β = 0.007, P &lt; 0.001) than in the cephalad (β = 0.005, P &lt; 0.001). Twenty-three subjects were identified for longitudinal analysis. The mean (SD) ages at initial and final imaging time points were 50.0 (5.8) and 60.3 (5.2) years. In the deep fat compartment, there was an average gain of 0.23 mL over 10.3 years (P = 0.03). Conclusions Age is an important predictor of midfacial deep cheek fat volume. In this study, there is no evidence of adipose volume loss in the deep cheek compartment. Rather, aging was associated with an increase in deep cheek fat, possibly reflecting pseudoherniation of buccal fat. Level of Evidence 2

scholarly journals Arthroscopic lift, drill, fill and fix (LDFF) is an effective treatment option for primary talar osteochondral defects

2019 ◽  
Vol 28 (1) ◽  
pp. 141-147 ◽  
Author(s):  
Kaj T. A. Lambers ◽  
Jari Dahmen ◽  
Mikel L. Reilingh ◽  
Christiaan J. A. van Bergen ◽  
Sjoerd A. S. Stufkens ◽  
...  
Keyword(s):  
Rating Scale ◽  
Short Form ◽  
Case Series ◽  
Ct Scans ◽  
Osteochondral Defects ◽  
Effective Treatment Option ◽  
Level Of Evidence ◽  
Sf 36 ◽  
The Mean

Abstract Purpose The purpose of this study was to describe the mid-term clinical and radiological results of a novel arthroscopic fixation technique for primary osteochondral defects (OCD) of the talus, named the lift, drill, fill and fix (LDFF) technique. Methods Twenty-seven ankles (25 patients) underwent an arthroscopic LDFF procedure for primary fixable talar OCDs. The mean follow-up was 27 months (SD 5). Pre- and post-operative clinical assessments were prospectively performed by measuring the Numeric Rating Scale (NRS) of pain in/at rest, walking and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) and the Short Form-36 (SF-36) were used to assess clinical outcome. The patients were radiologically assessed by means of computed tomography (CT) scans pre-operatively and 1 year post-operatively. Results The mean NRS during running significantly improved from 7.8 pre-operatively to 2.9 post-operatively (p = 0.006), the NRS during walking from 5.7 to 2.0 (p < 0.001) and the NRS in rest from 2.3 to 1.2 (p = 0.015). The median FAOS at final follow-up was 86 for pain, 63 for other symptoms, 95 for activities of daily living, 70 for sport and 53 for quality of life. A pre- and post-operative score comparison was available for 16 patients, and improved significantly in most subscores. The SF-36 physical component scale significantly improved from 42.9 to 50.1. Of the CT scans at 1 year after surgery, 81% showed a flush subchondral bone plate and 92% of OCDs showed union. Conclusion Arthroscopic LDFF of a fixable primary talar OCD results in excellent improvement of clinical outcomes. The radiological follow-up confirms that fusion of the fragment is feasible in 92%. This technique could be regarded as the new gold standard for the orthopedic surgeon comfortable with arthroscopic procedures. Level of evidence Prospective case series, therapeutic level IV.

scholarly journals A Multicenter, Prospective, Randomized, Contralateral Study of Tissue Liquefaction Liposuction vs Suction-Assisted Liposuction

2018 ◽  
Vol 38 (9) ◽  
pp. 980-989 ◽  
Author(s):  
Joseph P Hunstad ◽  
Christopher P Godek ◽  
Bruce W Van Natta ◽  
Bill G Kortesis ◽  
Gaurav Bharti ◽  
...  
Keyword(s):  
Energy Source ◽  
Study Design ◽  
Adult Female ◽  
Arm Movements ◽  
Extraction Rate ◽  
Stroke Rate ◽  
Fat Tissue ◽  
Level Of Evidence ◽  
Fat Extraction ◽  
The Mean

AbstractBackgroundTissue liquefaction liposuction (TLL) deploys a novel energy source utilizing a stream of warmed, low-pressurized, and pulsed saline to extract fat tissue.ObjectivesCompare TLL to suction-assisted liposuction (SAL) to determine which device is more efficient for surgeons and provides better recovery for patients.MethodsThirty-one adult female patients were followed prospectively in a contralateral study design comparing differences in bruising, swelling, tenderness, and incision appearance ratings between TLL and SAL procedures. Surgical efficiency and appearance of the lipoaspirate were also compared.ResultsAll 31 patients successfully completed the study. For TLL and SAL procedures, the average volumes of infusion (1.242 vs 1.276 L) and aspirated supernatant fat (704 vs 649 mL) were statistically similar. TLL median fat extraction rate was faster than SAL (35.6 vs 25 mL/min; P &lt; 0.0001), and stroke rate was reduced in TLL vs SAL procedures (48 vs 120 strokes/min; P &lt; 0.0001), and both were statistically significant. The mean total scores for bruising, swelling, treatment site tenderness, and incision appearance were lower, indicating improved patient recovery on the TLL side.ConclusionsTLL and SAL techniques produced comparable volume of fat aspirate. TLL demonstrated a 42% faster fat extraction rate and a 68% reduction in arm movements needed to complete the procedure compared to SAL, both of these differences are statistically significant. The TLL side was noted to have reduced bruising and swelling and improved incision site appearance with less tenderness compared to the SAL side.Level of Evidence: 2

Revisiting the Natural History of Chronic Scaphoid Nonunions: A Retrospective Study of 20 Cases

2021 ◽  
Author(s):  
J. Terrence Jose Jerome
Keyword(s):  
Retrospective Study ◽  
Natural History ◽  
Functional Outcome ◽  
Grip Strength ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Degenerative Arthritis ◽  
Level Of Evidence ◽  
History Of ◽  
The Mean

Abstract Background The natural history of scaphoid nonunion is the development of degenerative arthritis. A lot of information is still unclear about this progression. The purpose of this study is to analyze patients with scaphoid nonunions who had not received any kind of treatment and to assess the functional outcome. Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions between 2009 and 2019. None of the patients received any treatment. The age at the time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms, and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate angles were recorded. Pain score, modified mayo wrist score, grip strength, range of movement, and the functional outcome of these scaphoid nonunions were analyzed. A statistical correlation between the scaphoid nonunion presentations and the functional outcome was assessed. Results The mean age of the patients was 62 years (range: 35–82 years.). There were 17 male and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions. The mean duration of scaphoid nonunion was 34 years (range: 10–62 years). None of the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination, gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement ≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no significant impact on the functional outcome. Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis over a period of years, which is still unpredictable. Most of the patients become aware of the nonunion following a precedent injury or other reasons. Most of the patients have fair/good functional outcome despite reduced range of movements and grip strength. Many do not favor surgical intervention in the course of nonunion. Chronic nonunions open a lot of unanswered questions. Clinical relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with little knowledge about certain people with nonunion who did not have any kind of treatment. The demographics, clinical findings, and radiological parameters do confirm the progression of these nonunion to arthritis, but most of them had fair-to-good outcome throughout their life. It opens our thinking about the real need of treatment in such nonunions and raises numerous questions about the disease. Level of evidence This is a Level IV study.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

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