OBJECTIVETo compare the biomechanical performances of different wires and cable fixation devices in posterior instrumentation for atlantoaxial instability, and test the effect of different fixation strengths and fixation approaches on the surgical outcomes.

METHODSSix specimens of the atlantoaxial complex (C0-C3) were used to establish models of the normal complex, unstable complex (type II odontoid fracture) and fixed complex. On the wd-5 mechanical testing machine, the parameters including the strength and rigidity of anti-rotation, change and strength of stress, and stability were measured for the normal complex, atlantoaxial instability complex, the new type titanium cable fixation system, Atlas titanium cable, Songer titanium cable, and stainless wire.

RESULTSThe strength and rigidity of anti-rotation, change and strength of stress, stability of flexion, extension and lateral bending of the unstable atlantoaxial complex fixed by the new double locking titanium cable fixation system were superior to those of the Songer or Atlas titanium cable (P<0.05) and medical stainless wire (P<0.05). Simultaneous cable fastening on both sides resulted in better fixation effect than successive cable fastening (P<0.05). Better fixation effect was achieved by fastening the specimen following a rest (P<0.05).

CONCLUSIONSThe fixation effects can be enhanced by increased fastening strengths. The new type double locking titanium cable fixation system has better biomechanical performance than the conventional Songer and Atlas titanium cables. Fastening the unstable specimens after a rest following simultaneous fastening of the specimen on both sides produces better fixation effect.

Atlanto-Axial Joint ; physiopathology ; surgery ; Biomechanical Phenomena ; Bone Wires ; Cadaver ; Humans ; Internal Fixators ; Joint Instability ; physiopathology ; surgery ; Orthopedic Fixation Devices

OBJECTIVETo investigate the therapeutic effects of closed reduction and external fixation (plaster or splint) for the treatment of displaced humeral supracondylar fractures in children.

METHODSFrom March 2007 to September 2009,33 children (15 female and 18 male) with humeral supracondylar fractures treated in our hospital, ranging from 3 to 12 years old with an average of 6.4 years old. All the fractures were extension-type injuries, the flexion injures were excluded in our study. The humeral supracondylar fractures were classified according to Gartland classification. There were 21 Type H and 12 type III. In the initial treatment, all the patients were treated with closed reduction and external immobilization. The blood supply of the damaged upper extremity was evaluated before and after treatment. Clinical assessment was obtained at final follow-up using Flynn criteria, and radiologic assessment was obtained using Baumann and lateral humerocapitellar angles.

RESULTSAll the children were treated successfully with closed reduction in the initial time; 24 children maintained limb alignment by external immobilization. Nine patients lost position due to the swelling around the elbow which affected unstable external fixation during the follow-up, 5 of which were treated with a repeated closed reduction and internal fixation with Kirschner wires, 4 of which were treated with traction. Thirty-one patients had a satisfactory outcome and 2 patients had an unsatisfactory outcome according to the Flynn criteria at the latest follows-up.

CONCLUSIONClosed reduction and external stabilization is an important method for the treatment of displaced humeral supracondylar fractures in children. Making regular follow-up visits after closed reduction and casting is important for patients to maintain acceptable alignment, avoid complications and diagnose any loss of reduction.

Casts, Surgical ; Child ; Child, Preschool ; External Fixators ; Female ; Fracture Fixation, Internal ; Humans ; Humeral Fractures ; surgery ; Male ; Splints

OBJECTIVETo approach the clinical curative effect of treatment of the disease of vertebral column by the arc-track private lock pedicle orthopedics fixation system (ALPF II).

METHODSEighty-six cases were treated by useing ALPF II. The average age of the cases was 36.8 years (range from 18 to 69 years),the male was 39 cases and the female was 37 cases. The results were evaluated and all the cases were followed-up.

RESULTSAll the patients were followed-up for 9 to 30 months. The amelioration of patients nerve function,spinal motion, low back pain and leg pain was 94.1%, 65.9%, 92.1% and 87.4% respectively. The height of anterior and posterior border after operation were improved greatly than that before operation (P < 0.01, P < 0.05). The X-ray films showed that the angle of kyphosis was also improved significantly (P < 0.01).

CONCLUSIONTo treat spinal column disease, ALPF II is a kind of operation safety simple, easy control, reset good, curative effect credibility, the complications little of treatment method.

Adolescent ; Adult ; Aged ; Female ; Humans ; Internal Fixators ; Male ; Middle Aged ; Orthopedic Fixation Devices ; Spinal Diseases ; surgery

Bone Plates ; Bone Screws ; Humans ; Internal Fixators ; Mandible ; surgery

OBJECTIVETo study therapeutic effects of internal fixation with Kirschner wires and biodegradable tension band through double small incisions for the treatment of humeral supracondylar fracture in children.

METHODSFrom 2006 to 2010,82 children with humeral supracondylar fractures were treated with internal fixation using crossed Kirschner wires combined with biodegradable tension bands. Among the patients, 53 patients were male and 29 patients were female, ranging from 5 to 12,with an mean of 7 years old. The elbow joint function and Carrying angle were observed before and after treatment. The Flynn criteria was used to evaluate therapeutic effects.

RESULTSAll the patients were followed up, and the duration was six months. The average limitation angle of elbow joint was (2.8 +/- 3.7) degrees,and the Carrying angle was (12.7 +/- 2.2) degrees. According to Flynn clinical evaluation, 80 patients got an excellent result, 2 good.

CONCLUSIONTreatment of child humeral supracondylar fracture with internal fixation using Kirschner wires and biodegradable tension bands through double small incisions is believed to be a good method, which has advantages of minimal trauma, reliable fixation, early exercises and rapid recovery.

Bone Wires ; Child ; Child, Preschool ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; surgery ; Male ; Orthopedic Fixation Devices

The lumbosacral fusion has some problems because of it's biomechanical characteristics especially in the unstable spine of various causes and results considerable cases of pseudoarthrosis even with long immobilization. The conventional internal fixators for the spine are not adequate for the lumbosacral fixation with difficulty of sacral fixation maintaining lumbosacral lordosis and risk of the sacral nerves. Recently the pedicle screws and sacral screws connected to the plates or rods are known to be very effective and safe for the lumbosacral fixation permiting early mobilization and decreasing the incidence of pseudoarthrosis. Authors reviewed 10 cases of lumbosacral fusion with internal fixation using the long bone plates and screws which were managed since June 1986 at the department of orthopaedic surgery, Daegu Fatima Hospital and the followings were obtained. 1. The cases were 5 isthmic and 5 degenerative spondylolisthesis with enough spinal stenosis and instability before surgery or after decompression procedures having ages from 39 to 62 years old. 2. All cases had adequate decompression and bilateral intertransverse fusion combined with the internal fixation from 4th lumbar spine to sacrum. 3. Post-operative complications noted in 3 cases such as superficial infection, marginal skin necrosis, paralytic ileus, urinary difficulty and loosening of screws which were all improved without additional procedures. 4. There was no pseudoarthrosis at follow-up examination of 6 months to 1 year and 9 months in spite of a case of loosening of screws. 5. Ambulation was allowed in 2 weeks after surgery wearing lumbosacral corset and all satisfied the results having complete or significant improvement of the symptoms. 6. The internal fixation using long bone plates and screws for the lumbosacral fusion was considered to be effective with very low cost and good mobility.
Animals ; Bone Plates ; Daegu ; Decompression ; Early Ambulation ; Follow-Up Studies ; Immobilization ; Incidence ; Internal Fixators ; Intestinal Pseudo-Obstruction ; Lordosis ; Necrosis ; Pedicle Screws ; Pseudarthrosis ; Sacrum ; Skin ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Walking

OBJECTIVETo investigate the features and causes of complications of unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion in treating lower lumbar diseases.

METHODSThe clinical data of 166 patients with lower lumbar diseases who underwent unilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion with intervertebral cages from January 2008 to December 2013 were retrospectively analyzed. There were 64 males and 102 females, aged from 24 to 74 years with a mean of 51.9 years old, suffered from lower lumbar lesions for 47.5 months on average (ranged, 8 months to 30 years). Among these patients, lumbar intervertebral disc degeneration was found in 49 patients, recurred lumbar intervertebral disc protrusion in 17 patients, massive lumbar intervertebral disc protrusion in 23 patients, lumbar intervertebral disc protrusion accompany with spinal canal stenosis in 27 patients, lumbar degenerative spondylolisthesis with degree I (Meyerding grade) in 21 patients, far lateral lumbar intervertebral disc protrusion in 5 patients. Single segmental diseases occurred in 124 patients and two segmental diseases in 42 patients. The diseases occurred at L(3,4) segment in 6 patients, at L(4,5) segment in 97 patients, at L5S1 segment in 21 patients, at L(2,3), and L(3,4) segments in 1 patient, at L(3,4) and L4,5) segments in 26 patients, and at L(4,5), and L5S1 segments in 15 patients.

RESULTSThere was no abnormal bleeding in the patients and no patient received blood transfusion. During the surgery, spinal dura mater injury with cerebrospinal fluid leakage complicated in 1 patient, a fracture of vertebral pedicle in 4 patients, and end plate injury in 2 patients. No postoperative cerebrospinal fluid, incision infection and skin necrosis were found after operation. Nerve root injury was found in 1 patient. According to the position of pedicles crew, 371 screws of 163 patients were in degree I and 3 screws of 3 patients were in degree II; position of translaminar facet screw, 199 screws of 157 patients were type I, 8 screws of 8 patients were type II, 1 screw of 1 patient was III. Translaminar facet screw was slightly short in 2 patients. Five patients were lost to follow-up, two patients were died. The remaining patients were followed up for 35.4 months on average (ranged, 12 to 60 months). During the follow-up period , end plate was cut off and intervertebral cages were embedded in 14 segments of 14 patients. Abnormal pain of both lower extremities was found in 1 patient. With the exception of 11 unidentified segments in 11 patients, 189 segments of 148 patients obtained intervertebral fusion. No loosening, displacement, breakage of pedicle screw or translaminar facet screw, displacement of intervertebral cages or obvious degeneration of adjacent segments were found. The coronal and sagittal planes balance of lumbar vertebra were obviously improved. Postoperative JOA score was significantly increased than that of preoperative.

CONCLUSIONUnilateral pedicle screw fixation combined with contralateral percutaneous translaminar facet screw fixation and lumbar interbody fusion with intervertebral cages is a good choice for the treatment of lower lumbar diseases, but it has a risk of complications. Abundant surgeon's surgical experience, careful operation, and rational use of imaging technique can effectively reduce the incidence of complications.

Adult ; Aged ; Bone Plates ; Female ; Humans ; Internal Fixators ; Intervertebral Disc Degeneration ; surgery ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Spondylolisthesis ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo probe the accuracy and safety of using an aiming device in the transpedicular fixation of cervical spine.

METHODSEight cervical specimens were obtained. We used the computed tomography (CT) to scan C3 to C7, measured the medial angle of the pedicle, and determined the location of the pedicle projecting on the articular process. Then we took the oblique X-ray film, measured the cephalic/caudal angle of the pedicle, and determined the location of the pedicle projecting on the articular process. All the specimens were equally divided into two groups. Screws of 2.8 mm x 30 mm, were used. Specimens in one group were inserted with the transpedicular screw manually, while specimens in the other one inserted with the transpedicular screw using a self-designed aiming device that can be modulate at the three dimensions according to the angles of the pedicles.

RESULTSThe first group totally had 40 screws from C3 to C7. There were 13 screws in the pedicle, 9 violated the walls of the pedicle but not involved the adjunct structure, and 18 injured the important structure such as spinal cord, verteberal artery, or nerve root. In the other group, only 4 screws violated the walls of the pedicle but not involved the adjunct structure, and the others all in the pedicles. The difference was of statistical significance (P < 0.01).

CONCLUSIONIn the cervical spine, transpedicular fixation using an aiming device can improve the accuracy and safety during operation.

Adult ; Bone Screws ; Cervical Vertebrae ; diagnostic imaging ; surgery ; Female ; Humans ; Internal Fixators ; Male ; Orthopedic Fixation Devices ; Spinal Fusion ; instrumentation ; methods ; standards ; Stereotaxic Techniques ; Therapy, Computer-Assisted ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the clinical effect of PCB (a new anterior cervical instrumental system combining an intradiscal cage with an integrated plate) in treating traumatic cervical intervertebral disc herniation.

METHODSAnterior decompression and PCB internal fixation were used in 22 patients with traumatic cervical intervertebral disc herniation. They were followed up from 3 to 16 months and analyzed by symptom and image data. Among them, 16 patients underwent fixation at one level and 6 patients at two levels.

RESULTSThis technique did not cause intraoperative complications. After surgery no screw backout or device failure was found. Based on the JOA grade, 20 patients improved clinically and 2 gently because of serious cervical stenosis. The general excellent rate was 90.9%.

CONCLUSIONSPCB internal fixation is stable. Morbidity of donor and acceptor sites is less. No collars are needed after surgery.

Adult ; Bone Plates ; Cervical Vertebrae ; Equipment Design ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Male ; Middle Aged ; Orthopedic Fixation Devices ; Orthopedic Procedures

OBJECTIVETo compare the anti-rotation biomechanical performances of wire and various cable fixation devices currently used in the posterior Brooks instrumentation for atlantoaxial instability.

METHODSIn this experiment,six specimens of the atlantoaxial complex (Occipital-C3) were used. The models of the normal complex,unstable complex (type II odontoid fracture) and fixed complex were established. On the WD-5 mechanics experimental machine,the parameters including the strength and rigidity of anti-rotation were quantified for the normal complex (group N),the atlantoaxial instability complex (group M), the new type Titanium cable (group A), Atlas titanium cable (group B), Songer Titanium cable (group C), stainless wire(group D).

RESULTSThe max strength of A, B, C, D groups was 12.5, 11.3, 11.52, 11.55 N x m respectively, the max rigidity was 58.81, 53.17, 54.11, 54.35 N x cm/deg respectively. The strength and rigidity of anti-rotation, compare to the unstable atlantoaxial complex which were fixed by the new double locking Titanium cable fixation system were superior to those of normal complex, instability complex, Songer or Atlas Titanium cable (P < 0.05).

CONCLUSIONHaving been changed the locking method, the anti-rotation biomechanical characteristics of the new type double locking Titanium cable fixation system are superior or similar to the traditional Songer or Atlas Titanium cable.

Atlanto-Axial Joint ; physiopathology ; surgery ; Biomechanical Phenomena ; Bone Wires ; Humans ; Joint Instability ; physiopathology ; surgery ; Orthopedic Fixation Devices ; Rotation