PURPOSETo describe our clinical experience with a system named SureShot? Distal Targeting (Smith & Nephew, Memphis, USA) based on magnetic field presence and discuss our suggestions on this technique.

METHODSWe analysed prospectively 47 patients affected by humeral, tibial or femoral fractures, treated in our institution during a 3-year period of time (August 2010 to September 2013). We considered the following parameters: the time to set up, the time to position a single screw, the effectiveness of the system (drilling ad screwing), the irradiation exposure time during distal locking procedure and surgical complications.

RESULTSA total number of 96 screws were inserted. The mean preparation time of the device was 5.1 min ± 2 min (range 3-10 min). The mean time for single screw targeting was 5.8 min ± 2.3 min (range 4-18 min). No major complications occurred. Only a few locking procedures were needed to be practiced in order to obtain the required expertise with this targeting device.

CONCLUSIONAccording to our results, this device is reliable and valid whenever the correct technique is followed. It is also user friendly, exposes to lower radiation and needs less surgical time compared to relative data from the literature. However, the surgeon should always be aware of how to use the free hand technique in case of malfunctioning of the system.

Bone Screws ; Fracture Fixation, Intramedullary ; adverse effects ; instrumentation ; methods ; Humans ; Magnetic Fields ; Prospective Studies

Bone Screws ; adverse effects ; Humans ; Medical Errors ; prevention & control ; Models, Biological ; Scoliosis ; surgery ; Thorax

Polymethl methacrylate (PMMA) screw reinforcement is frequently used in osteoporotic bone as well as in damaged pilot holes. However, PMMA use can be dangerous, since the amount of applied cement is uncontrolled. A 47-year-old male with traumatic cervical spondylolisthesis at C6-7 underwent anterior cervical plate fixation. During repeated drilling and tapping for false trajectory correction, a pilot hole was damaged. Although it was an unconventional method, PMMA augmentation was tried. However, PMMA was accidentally injected to the cervical spinal cord owing to lack of fluoroscopic guidance. The PMMA was surgically removed after corpectomy and durotomy. The patient had left side hemiparesis (Grade 2/5) immediately post operation. The patient improved spontaneously (Grade 4/5) except for 4th and 5th digit extension. Here, we report a rare complication of PMMA extrusion in the spinal cord during a damaged pilot hole injection, which has not previously been described.
Bone Cements/*adverse effects/therapeutic use ; Bone Screws ; Cervical Vertebrae/*surgery ; Humans ; Male ; Middle Aged ; Polymethyl Methacrylate/adverse effects/therapeutic use

OBJECTIVETo explore the therapeutic effects of internal fixation with Herbert screws for the treatment of Pipkin type I and type II femoral head fractures.

METHODSFrom January 2008 to December 2012, 23 patients with Pipkin type I and type II femoral head fractures were treated with open reduction and internal fixation by Herbert screws through Kocher-Langenbeck approach. Twenty-three patients (aged 18 to 52 years with a mean of 35.5 years, including 18 males and 5 females patients, 8 left hips and 15 right hips) with femoral head fractures and posterior hip dislocation. The fracture was classified according to Pipkin classification based on the radiographic findings, 5 patients had type I and 18 had type II fractures. The duration time from admission to the operation ranged from 6 to 72 h (averaged 32 h). The clinical and radiographic outcomes of the patients were measured using Thompson-Epstein scoring scale. The Harris hip score(HHS) was used to evaluate and compare hip functions at the latest follow-up between affected and healthy sides.

RESULTSAll the patients were followed up, and the duration ranged from 20 to 48 months (averaged 30 months). According to Thompson-Epstein system, 12 patients got an excellent result, 6 good, 4 fair and 1 poor. The average HHS at the finial follow-up was 87.80 ± 8.46 (ranged from 66 to 95), which is similar to that in the healthy side 90.10 ± 6.35 (ranged from 72 to 98) (t = 1.044, P = 0.302). The complications such as deep infection, and deep vein thrombosis were not found. At the 3rd year during follow-up,4 patients had avascular necrosis of femoral head. At the 1st year of follow-up, 1 patient had hip pain after walking,screws loosening and shift after trauma,and serious complications of traumatic arthritis. All the 5 patients were treated with total hip arthroplasties.

CONCLUSIONThe treatment of internal fixation with Herbert screws through the Kocher-Langenbeck approach is effective for Pipkin type I and type II femoral head fracture. The method is reliable and valuable for recommendation. However, such fracture may have avascular necrosis of femoral head and complication of traumatic arthritis, which should be observed carefully in clinic with preparation of the prevention and treatment measures.

Adolescent ; Adult ; Bone Screws ; Female ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Male ; Middle Aged

Compared with the traditional anterior and posterior operation,anterior transpedicular screw fixation (ATPS) has many advantages of hiomechanics, relative safety. Both problems of decompression and reconstruction can be resolved only through an anterior approach. A rather peculiar anatomic channel was used in ATPS, but no special tools was used in system supporting for anterior pedicle screw to place,so the indications of ATPS of lower cervical vertebrae is relatively narrow,it cannot replace of traditional anterior and posterior surgery. Problems of accurately inserting screws and the development of internal fixation device about ATPS is a hot spot of current research and a future direction. In recent years,many scholars have systematically studied the technique, and applied it in clinic gradually and achieved good effects. In order to improve the level of application,recent articles were analyzed retrospectively in this paper,and the studies of anatomy,biomechanical and clinical application of ATPS were reviewed.
Biomechanical Phenomena ; Bone Screws ; Cervical Vertebrae ; anatomy & histology ; injuries ; surgery ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans

Bone Screws ; Cervical Vertebrae ; injuries ; surgery ; Fracture Fixation, Internal ; adverse effects ; Humans ; Male ; Middle Aged ; Spinal Fractures ; surgery

Humans ; Neck Injuries/surgery* ; Carotid Artery Injuries/surgery* ; Neck ; Bone Screws/adverse effects* ; Carotid Artery, Common/surgery*

BACKGROUNDThe peculiar and highly variable C2 anatomy can make screw fixation more challenging and prone to potential vertebral artery or neurologic injury. Conventional C-arm fluoroscopy has several drawbacks. The aim of this research was to evaluate the accuracy of posterior C2 screw fixation using intraoperative three-dimensional fluoroscopy-based navigation (ITFN) and assess the perioperative complication rate related to screw placement.

METHODSA retrospective review identified patients who underwent operative management with C2 instruments using ITFN at our hospital between January 2006 and December 2012. Clinical data were obtained from medical records and final screw positions were graded according to a modified classification of Gertzbein and Robbins. Grade A and B screws were considered well positioned.

RESULTSThe study included 99 patients (53 males and 46 females) who underwent posterior C2 screw fixation using ITFN. The mean Japan Orthopedic Association score improved from (6.7 ± 1.9) points before surgery to (12.5 ± 2.7) points at 6-month follow-up (z = +8.628, P < 0.01). The mean visual analogue scale improved from (4.1 ± 1.2) points before surgery to (0.7 ± 0.9) points at 6-month follow-up, with an improvement of 83.7% (z = 8.638, P < 0.01). Of the 196 screws analyzed using computed tomography and chart review, 126 transarticular, 64 pedicle, and 6 pars screws were placed with 82.5% (104/126), 89.1% (57/64), and 100% (6/6) accuracy (grade A), respectively; 98.5% (193/196) of screws were grade A or B (grade C, 1.5% (3/196)), and no neurologic injuries occurred. In normal C2 cases, 93 transarticulars and 47 pedicles were placed with high accuracy rates of 90.3% (84/93) and 93.6% (44/47) (grade A), respectively. However, in cases with C2 deformity, 33 transarticular, 17 pedicle, and 6 pars screws were placed with only 60.6% (20/33), 76.5% (13/17), and 100% (6/6) accuracy (grade A), respectively.

CONCLUSIONITFN is a safe, accurate, and effective tool for posterior C2 fixation.

Adolescent ; Adult ; Aged ; Bone Screws ; adverse effects ; Female ; Fluoroscopy ; Humans ; Internal Fixators ; adverse effects ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

With rapid advancement in surgical techniques and improvement in implant materials, rate of internal fixation for pubic symphyseal disruption in rotationally and vertically unstable pelvic ring injuries has increased. Among various modes of implant failure, screw/plate breakage and loosening are common complications following unstable fixation. Migration of loose screws into the urinary bladder has been reported as an extremely uncommon complication of pubic symphyseal plating. Here we present a case report of a 52-year-old female who presented with asymptomatic passage of screws in her urine following migration into the bladder, 2 years after symphyseal plating for pubic diastasis in an anteroposterior compression pelvic ring injury.
Accidents, Traffic ; Bone Plates ; Bone Screws ; adverse effects ; Female ; Foreign-Body Migration ; diagnosis ; Humans ; Metals ; Middle Aged ; Pubic Symphysis Diastasis ; etiology ; surgery ; Urination

OBJECTIVETo investigate the reasonable methods of treatment for aged intertrochanteric fractures through the comparison and analysis about the clinical data and follow-up results of three kinds of treatment method of elderly intertrochanteric fractures.

METHODSFrom June 2004 to June 2010,131 patients with intertrochanteric fractures were treated and reviewed retrospectively. Among them, 72 patients were treated with dynamic hip screw (DHS) included 20 males and 52 females with an average age of (72.5 +/- 5.5) years, 43 patients were treated with proximal femoral nail antirotation (PFNA) included 12 males and 31 females with an average age of (72.8 +/- 4.9) years and 16 patients were treated with hemiarthroplasty included 4 males and 12 females with an average age of (76.0 +/- 5.0) years. The three groups of patients were statistically analyzed and compared on surgical trauma including operation time, blood loss, incision length, X-ray exposure, and on postoperative recovery including non-weight-bearing walking time, the hospitalization time, the healing time, the recovery of joint function and complications.

RESULTSAll patients were followed-up from 6 months to 3 years (means 18.2 months). In surgical trauma: the results of length of incision,operation time and blood loss was DHS>hemiarthroplasty>PFNA. PFNA group had the most X-ray exposure, hemiarthroplasty group had the least. In postoperative recovery: the results of in non-weight-bearing walking time, hospitalization time and healing time was DHS>PFNA>hemiarthroplasty. Harris scores at 12 weeks after operation in hemiarthroplasty was higher than that of DHS and PFNA, but there was no statistical difference between DHS and PFNA. The incidence of postoperative complications in DHS group was more than that of PFNA group, but there were not significant differences among three groups.

CONCLUSIONPFNA is prepered in the treatment of senile intertrochanteric fractures. DHS fixation is more suitable for primary hospital and AI-type fracture and the fracture near the entry point of PFNA. The hemiarthroplasty is one of the best ways to treat unstable comminuted and/or severe osteoporosis of elderly intertrochanteric fracture. However,it isn't generally considered.

Aged ; Bone Nails ; Bone Screws ; Female ; Fracture Fixation, Internal ; adverse effects ; instrumentation ; methods ; Hip Fractures ; physiopathology ; surgery ; Humans ; Male ; Postoperative Complications ; etiology ; Recovery of Function ; Retrospective Studies ; Time Factors