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Techniques in Orthopaedics
Journal Prestige (SJR): 0.215  Number of Followers: 6  Hybrid journal (It can contain Open Access articles)ISSN (Print) 0885-9698 - ISSN (Online) 2333-0600 Published by LWW Wolters Kluwer  [297 journals]
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- A Unified Platelet-rich Plasma Preparation Protocol Using a Customizable
Concentration System for Knee Osteoarthritis-
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Authors: Baria; Michael R.; Magnussen, Robert A.; Lau, Melissa; Miller, Meghan Maume; Vasileff, William Kelton; Borchers, James R.
Abstract:
Introduction: Platelet-rich plasma (PRP) is an autologous solution of platelets, concentrated over baseline, that delivers a high dose of anti-inflammatory and anabolic proteins. High-quality data support its use for pathology like knee osteoarthritis (OA), but vast heterogeneity among PRP processing methods and product content make synthesizing clinical data very challenging. Most processing techniques rely upon centrifugation and often involve manual processing steps, such as resuspension or extraction of platelets, which can introduce further heterogeneity in the final product. The Angel cPRP device is a fully automated device that uses both centrifugation and principles of flow cytometry in its PRP processing. However, the system has a wide range of preprocessing settings that alter PRP composition and there are no recommendations or standards on which settings should be used for OA. The aims of this manuscript are to (1) describe a unified PRP processing technique using this system and (2) report preliminary outcomes using that unified protocol when treating knee OA.Methods: For the processing of PRP, all patients had whole blood drawn under aseptic conditions (104 cc whole blood for unilateral OA, 156 cc whole blood for bilateral OA) that was then processed at the unified setting of 0% hematocrit, first spin performed at 4000 rpm for 11 minutes and the second spin at 3000 rpm for 2 minutes. The device automatically separated the resulting PRP that was then injected. For the second aim of this work, 90 knees (63 patients) met the criteria for inclusion. International Knee Documentation Committee (IKDC) subjective scores completed at baseline and 3 months were collected and analyzed.Results: Overall, IKDC score improved from 42.3±14.1 preinjection to 59.7±17.5 at 3 months postinjection (P
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- Arthrodesis of the Pubic Symphysis With Compression Plating and Femoral
Strut Allograft for Pubic Instability and Osteitis Pubis: A Novel Surgical
Technique-
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Authors: Catanzano; Anthony A. Jr; Kollmorgen, Robert; Olson, Steven A.
Abstract:
Introduction: Osteitis pubis and pubic instability represent an uncommon, yet a potentially debilitating problem for patients. While many cases are amendable to conservative measures, the few recalcitrant cases present a difficult challenge for surgical management with the risk of implant failure, nonunion, and potential complications.Materials and Methods: A retrospective review of 3 patients undergoing symphyseal arthrodesis with a strut allograft for osteitis pubis and/or pubic instability after failed conservative management was conducted at a single institution. Preoperative evaluation, surgical technique, and postoperative regimen are thoroughly described. Surgical complications, reoperation rate, pain, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores, as well as radiographic outcomes were reported.Results: Three patients undergoing our symphyseal arthrodesis technique after failed conservative management were identified. All patients had an improvement from preoperative pain levels and the 2 patients with>12-month follow-up were able to return to full activity, including 1 patient returning to full active duty in the United States Army.Discussion: The unique technique presented here utilizes both implant fixation, as well as allograft supplementation to improve fusion rates. Although a limited sample with limited follow-up, the early results of this novel technique are encouraging and may represent a more reliable surgical option for patients with chronic, recalcitrant pubic instability.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- Surgical Elbow Dislocation: Technique and Comparative Outcomes
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Authors: Hoyt; Benjamin W.; Clark, DesRaj M.; Walsh, Sarah A.; Pensy, Raymond A.
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Introduction: Surgical access to lateral column fractures of the distal humerus is difficult via traditional approaches due to limited anterior articular exposure for direct reduction and fixation. We have refined a surgical elbow dislocation approach to the articular surface of the distal humerus for fixation of lateral column injuries, which may permit improved access for operative fixation.Materials and Methods: We performed a retrospective review of lateral column fractures treated with open reduction internal fixation at our institution between 2009 and 2019. We divided patients into 3 cohorts based on surgical approach: surgical dislocation (n=10), lateral (n=17), and posterior (n=9). Surgical reports, radiographs, and patient records were reviewed for hardware positioning, tourniquet time, estimated blood loss, postoperative reduction quality, and patient outcomes including range of motion, neurovascular injury, development of heterotopic ossification, and pain on a visual analog scale.Results: With the numbers available, we were unable to detect a significant difference in outcomes including pain, range of motion, or blood loss. No patients treated with this approach experienced neurovascular injury, instability, or nonunion at follow-up.Conclusions: The surgical elbow dislocation is a powerful tool to aid reduction and osteosynthesis of intra-articular fractures of the lateral distal humerus. It may enable greater articular access for complex distal humerus patterns without deleterious effects on surgical or patient reported outcomes.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- Reconstruction of Complex Acromion Nonunions and Fractures With a Locking
Mesh Plate-
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Authors: Ogunleye; Temi D.; Dugarte, Anthony J.; Gilbertson, Jeffrey A.; Cole, Peter A.
Abstract:
Objectives: To assess surgical and functional outcomes in a cohort of patients having surgically reconstructed acromion nonunions or severely comminuted acute fracture patterns treated with a variable angle, locking mesh plate with a matrix of screw options.Design: Retrospective case series.Setting: Level I trauma center.Patients: Between 2012 and 2017, 10 patients, 4 patients with acromion nonunions and 6 patients with severely comminuted acromion fractures presented to a single institution and underwent surgical treatment.Intervention: Surgical repair of complex acromion fractures and nonunions utilizing a 2.4/2.7 locking mesh plate (Depuy-Synthes) with bone grafting (nonunions).Main Outcome Measurements: Primary outcome measures include range of motion; strength; Disabilities of the Arm, Shoulder, and Hand; and Short Form 36 Health Survey.Results: Seven of 10 patients (70%) achieved 1 year follow-up, mean 23.3 months (range, 12 to 46 mo). Nine of 10 patients achieved union following the index reconstruction procedure and 1 patient achieved union after revision of failed mesh plate fixation. At final follow-up, the mean Disabilities of the Arm, Shoulder, and Hand score was 20.0 (11.2 in fracture group and 31.6 in nonunion group) and mean mental and physical component Short Form 36 scores were 51.4 and 42.9, respectively.Conclusions: A variable angle, locking mesh plate may be a useful implant choice for complex nonunions and severely comminuted fracture patterns of the acromion process. In this series, union rate and perioperative complications were acceptable in extreme fracture variants.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- Structural Iliac Crest Autograft for Segmental Reconstruction After
Metastatic Renal Cell Tumor Resection of the Radial Shaft-
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Authors: Ola; David; Perez, Diandra; Damron, Timothy A.
Abstract:
Introduction: Metastatic bone lesions are sometimes managed with en bloc resection that creates defects often requiring reconstruction. Reconstructive options for intercalary segmental bone defects are dependent on defect site and size. The radius is a rare site of metastatic disease and even rarer to require resection. While vascularized or nonvascularized fibular autografts have been used in this setting, there is no prior report detailing the use of a large autogenous iliac crest bone graft. We report structural iliac crest autograft reconstruction in a surgically resected radial diaphyseal solitary renal cell carcinoma metastasis.Case Report: A 62-year-old man presented with a solitary osseous metastatic bone lesion to the radial shaft. After nephrectomy, resection of the bone lesion followed by reconstruction with autogenous iliac crest bone graft was accomplished. Postoperative plain radiographs a year later showed integration at both graft-host junctions without hardware failure. The Musculoskeletal Tumor Society (MSTS)/Enneking score at 1 year was 22/30 points.Discussion: This article presents a case illustrating unique use of structural iliac crest autograft in segmental diaphyseal reconstruction of the radial shaft following metastatic renal cell carcinoma bone resection. This technique has the advantage of potentially increasing rate and decreasing time of healing when compared with allograft techniques and avoids increased operative time and potential donor site morbidity of vascularized fibular grafts.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- Proximal Femur Endoprosthesis Augmentation With Polymethylmethacrylate and
Condylar Plate: Surgical Technique Description-
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Authors: Leal García; Efraim; Gaitán Lee, Hernando; Piñeros Rincón, Mariana
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Introduction: Aseptic loosening by mechanical failure is one of the main causes of proximal femur endoprosthesis failure with different clinical consequences such as pain, inflammation, progressive loosening of muscular volume, and strength with functional limitation.Materials and Methods: We present the surgical description of the case of a patient with aseptic loosening of proximal femur endoprosthesis that was treated with a novel technique that combines different methods to achieve primary stability.Discussion: Different surgical techniques have been described to treat aseptic loosening of femoral endoprosthesis, including bone allografts, and total femur prosthesis which provides good functional results but high rates of complications such as infection (13%), dislocation (6%), and material failure (3%).Results: Proximal femur endoprosthesis augmentation with polymethylmethacrylate and condylar plate is a novel surgical technique that allows primary stabilization of the construct, early rehabilitation, improvement of functionality, and no signs of new loosening in a follow-up period of 6 months.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- Clinical Evaluation of a Minimally Invasive Technique Using a Free
Semitendinosus Tendon Graft for Reconstruction of a Chronic Achilles
Tendon Tear With Wide Gap-
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Authors: Bansal; Nitish; Dev, Parik; Tiwari, Punit; Jain, Ayush
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Introduction: The conventional approach to treat a chronic Achilles tendon tear with a wide gap is associated with many problems, primarily difficulty in filling the gap and skin complications. We used a minimally invasive technique to circumvent the problems.Materials and Methods: The study included 10 patients with chronic Achilles tendon tears with a wide gap (>6 cm, Kuwada type 4), who underwent reconstruction using free semitendinosus tendon graft transfer by a minimally invasive technique. Patients were followed up for 12 months. Toe walking, loss of dorsiflexion, and the American Orthopedic Foot and Ankle Score were assessed. The technique was also evaluated for any complications.Results: The age of the patients ranged from 40 to 53 years. The time since injury varied from 18 to 33 weeks. Full weight-bearing was achieved by 8 weeks in all the patients. All patients were able to walk on toes without assistance at 6 months. The mean American Orthopedic Foot and Ankle Score increased from 40.8 to 80.4 after the operation. Only 1 patient developed a superficial skin infection, which resolved with treatment.Conclusions: Semitendinosus graft transfer is a reliable method to treat chronic Achilles tendon rupture with a wide gap, as this wide gap can be covered easily, has a low risk of donor-site morbidity, and can be used even in tears at the insertion site, with good results. With the minimally invasive technique, the intervening skin bridge is maintained, leading to fewer skin complications.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- Neglected Painful Chronic Achilles Tendon Rupture With No Palpable Gap: A
Report of 3 Cases-
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Authors: Tiwari; Punit; Kaur, Harmeet; Bansal, Nitish; Leonchuk, Sergey S.
Abstract:
Purpose: The purpose of this study was to bring to the attention of orthopedic surgeon community of our new technique of quadruple hamstrings graft in neglected Achilles tendon rupture.Materials and Methods: In this technique article we present results of treatment of 3 cases with neglected painful chronic Achilles tendon rupture with no palpable gap using our new surgical technique. Our method uses semitendinosus and gracilis tendon as autograft which are passes through 2 bone tunnels in calcaneum and tied over a button.Results: At least after 1 year each patient was satisfied with result of our treatment. Patients were able to stand on their forefoot without pain. There was no infection or other complications.Conclusions: Our results show that new surgical technique may be use in similar cases and should be evaluated with better analytical studies.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- Cable Tie Dynamic Wound Closure: Alternative Technique for Secondary Wound
Closure-
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Authors: Singh; Simmrat; Ch’ng Hwei, Choo; Haseeb, Amber; Chin Aun, Low; Draman, Mohd. Rusdi
Abstract:
Background: Wound closure by secondary intention has always been a norm in clinical practice for large infected wounds at our institution. The aim is to prevent recurrent infection while waiting for wound closure. This study investigates the use of cable tie for dynamic wound closure in infected wounds to accelerate healing process as an alternative technique.Materials and Methods: Ten patients with infected wounds were recruited. The time to wound closure, complications, length, and cost of treatment were evaluated over 4 to 6 weeks.Result: All infected wounds were closed within 9.9 days with no documented complications.Conclusion: Cable tie used for dynamic wound closure in infected wounds is cheap and an effective alternative to wound healing by secondary intention.Level of Evidence: Level IV.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- Staged Knee Arthrodesis Using Unilateral Locked Compression Plating: A
Treatment for Recurrent Chronic Knee Infection-
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Authors: Friedman; Lisa G.M.; Rothberg, David; Horwitz, Daniel S.
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Background: The treatment following massive infection of the knee remains a difficult problem with above knee amputation and knee fusion being available treatment options when revision arthroplasty is no longer possible. We present a series of 12 patients who underwent fusion using a staged protocol.Methods: The patients underwent a first stage involving removal of implants, debridement, and placement of an antibiotic space over a tibial nail. Stage II involved removal of the spacer and nail by fragmenting the cement, and re-debridement. A laterally based locked compression plate was used to achieve fusion.Results: There were no intraoperative complications. All patients achieved radiographic fusion. The average limb length discrepancy was 2.6 cm. Five patients required further surgery: 1 for drainage of a postoperative hematoma, 3 for persistent infectious symptoms, and 2 for implant irritation. At final follow-up 1 patient had persistent infection and was unable to ambulate. All other patients returned to ambulation with 4 utilizing assistive devices at final follow-up.Conclusion: Failed, infected total knee arthroplasty is a challenging problem without an easy solution. A variety of techniques for knee arthrodesis, including intramedullary nailing and external fixation have been described with a wide success rate ranging from 20% to 100%. Few studies have examined compression plating to achieve knee arthrodesis. The use a 2-stage, single locked compression plate technique to achieve arthrodesis for the treatment of chronic infection after failed revision total knee arthroplasty can be a highly successful approach to a very challenging problem.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- The Clinical Assessment of the Extensor Pollicis Longus of the Thumb
Revisited—A Useful Test-
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Authors: Al Hussainy; Haydar Atheer
Abstract:
The loss of extensor pollicis longus (EPL) muscle function can be tested clinically in isolation using thumb retropulsion and thumb tenodesis tests. But the assessment of EPL can be challenging in cases where EPL is intact but dysfunctional due to overly elongated tendon like in severe shortening maluninion of distal radius fracture. We describe a clinical test that is based on the exclusive appreciation of the anatomy of EPL and its unique hyperextension capability at the interphalangeal joint of the thumb. The described test is useful in advanced assessment of the integrity of EPL, and in reverse for that of flexor pollicis longus too.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- Improved Waterproofing With Duct Tape in Pediatric Hip Spica Casting
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Authors: Wiznia; Daniel H.; Sharfman, Zachary T.; Mackey, Catherine; Sharkey, Melinda S.
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While pediatric hip spica casting is an invaluable tool to treat hip and femur conditions, effectively waterproofing the cast has represented a persistent challenge for the orthopaedist. We describe a simple technique that uses duct tape to allow for better waterproofing in the hopes of limiting unnecessary cast changes and skin complications.
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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- 3D Printing Surgical Guide for Nonunion: Technique Tip
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Authors: Cuervas-Mons; Manuel; Espinosa, Jose M.; Pérez-Mañanes, Ruben; Calvo, Jose; Trapero, Diego; Parra, Guillermo
Abstract:
No abstract available
PubDate: Wed, 01 Jun 2022 00:00:00 GMT-
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