外固定支架结合经皮交叉穿针固定治疗不稳定型桡骨远端骨折

目的探讨外固定支架结合经皮交叉穿针固定治疗不稳定型桡骨远端骨折的临床疗效。方法采用外固定支架结合经皮交叉穿针固定治疗34例不稳定型桡骨远端骨折患者。结果患者均获得随访,时间6~14个月。X线检查显示,骨折端解剖复位,固定牢靠,骨性愈合。按Green-O'brien腕关节评分标准评估:优26例,良6例,一般2例,优良率为94.1%。无钉道感染、骨髓炎、医源性神经肌腱伤和交感神经反射性骨营养不良等并发症。2例发生关节僵硬,经积极功能锻炼后症状好转。结论外固定支架结合经皮交叉穿针固定治疗不稳定型桡骨远端骨折能达到解剖复位,固定可靠,且有效减轻术后腕关节功能障碍。     

Skeletal pinning and external fixation; pros and cons

Arguments for and against the use of skeletal pinning and external fixation are discussed. Its use in certain selected cases is advocated. Illustrative case reports are presented.     

Distal medial tibial locking plate for fixation of extraarticular distal humeral fractures; an alternative choice for fixation

Objective

The aim of this study was to describe an alternative fixation method for distal humeral extra-articular fractures through posterior approach using distal tibia anatomic locking plate; and to evaluate the patient's functional outcome and union condition.

Mapping the columns of the acetabulum—Implications for percutaneous fixation

Knowledge of the bony thickness of the acetabular columns is one requisite for safe execution of percutaneous fixation of acetabular fractures. We performed a cadaveric study to determine anatomical dimensions of the columns of acetabulum with reference to percutaneous screw fixation. Twenty-two hemipelves (11 pairs) from 6 male and 5 female cadavers were measured and statistically analysed.In the anterior column, the psoas groove displayed the least vertical thickness of 15.1 mm (range, 12.1-18.2 mm), followed by the obturator canal with 15.9 mm (range, 12.2-20.6 mm). The mean thickness of the posterior column wall of the acetabulum along the screw path displayed 21.3 mm (range, 16.5-30.3 mm). This study provides a clinical map for safe passage of both antegrade and retrograde percutaneous screws. Anatomic data suggests that 7.3 mm cannulated screws can be safely accommodated by the anterior and posterior columns of the acetabulum.     

Additive manufactured push‐fit implant fixation with screw‐strength pull out

Additive manufacturing offers exciting new possibilities for improving long‐term metallic implant fixation in bone through enabling open porous structures for bony ingrowth. The aim of this research was to investigate how the technology could also improve initial fixation, a precursor to successful long‐term fixation. A new barbed fixation mechanism, relying on flexible struts was proposed and manufactured as a push‐fit peg. The technology was optimized using a synthetic bone model and compared with conventional press‐fit peg controls tested over a range of interference fits. Optimum designs, achieving maximum pull‐out force, were subsequently tested in a cadaveric femoral condyle model. The barbed fixation surface provided more than double the pull‐out force for less than a third of the insertion force compared to the best performing conventional press‐fit peg (p < 0.001). Indeed, it provided screw‐strength pull out from a push‐fit device (1,124 ± 146 N). This step change in implant fixation potential offers new capabilities for low profile, minimally invasive implant design, while providing new options to simplify surgery, allowing for one‐piece push‐fit components with high levels of initial stability. © 2017 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 36:1508–1518, 2018.     

Transpedicular screw fixation of the lumbar spine: “How I Do It”

The technique of lumbar vertebral body screw insertion is described in detail. The exposure, starting point determination, and direction of insertion are all discussed. The specifics of the use of the joystick or gear shift followed by the nuances of the insertion of the screw itself are detailed.     

Biologic fixation

One of the major problems of implant surgery is the failure of the bone-cement interface. Because of such failures, observed with increasing frequency with the passage of time, biologic fixation of total joint implants by means of bone ingrowth has become the focus of considerable interest among orthopedic surgeons. Actual bone ingrowth has been demonstrated into porous metals, resulting in a strong interface between metal and bone. Many clinical trials of biologic fixation, including endoprostheses and total hip, shoulder, and knee prostheses, are being conducted. The brief experience of such fixation in humans supports the hypothesis that bone ingrowth will provide stable fixation for load-bearing prostheses. Many questions remain to be answered about biologic fixation and the burden that falls upon the clinical scientist to identify the proper niche for this process in the care of the musculoskeletal patient.     

Biological fixation of subtrochanteric fractures by external fixation

Fifty-one subtrochanteric fractures have been stabilized by external fixation over the last 9 years. Union occurred in all types of fractures, usually within 6 months. Soft tissue interposition led to non-union in three patients. Refracture in one patient and significant limb-length discrepancy in two patients was seen. The technique is versatile, easily reproducible and ‘biological’. Protected weight-bearing is not necessary after removal.