Small joint arthrodesis technique using a dowel bone graft in a rabbit model.
ABSTRACT: The dowel bone graft fusion technique for the ankle is a well-known and useful method. However, clinical results of dowel bone graft for small joint fusion are unknown. The objective of the present study is to evaluate the effects of dowel bone graft technique for small joint arthrodesis in an in vivo arthrodesis of rabbit elbow model compared with the conventional arthrodesis technique (open, joint surface debridement, and internal fixation method). We assigned 28 young adult New Zealand white rabbits to one of two groups: Group 1, the conventional fusion technique group; Group 2, the dowel bone graft fusion technique group. We performed arthrodesis surgery in two different ways for each group. Eight weeks after the operation, specimens were harvested, radiographed, mechanically tested for torque to failure and stiffness, and evaluated for histology. Fusion rates were 77% (10/13) in Group 1 and 93% (13/14) in Group 2 (p = 0.326). Torque to failure showed a mean of 0.86 Nm in Group 1 and 0.77 Nm in Group 2 (p = 0.464). The mean value of stiffness was 0.11 Nm/deg in Group 1 and 0.11 Nm/deg in Group 2 (p = 0.832). In Group 2, histological examination showed residual cartilage absorption and inflammatory response in all cases. In this model, we have been unable to show a difference in either the union rate or strength of fusion between the two methods. However, the dowel bone graft technique is an easy and less invasive method and has some advantages over the conventional method.
Project description:STUDY DESIGN: Retrospective case series. OBJECTIVE: To assess fusion rates in patients with sacroiliac joint (SIJ) pain following a minimally invasive technique using fibular dowel allograft. METHODS: Thirty-seven consecutive patients (mean age: 42.5 years [range, 23-63 years]) with SIJ pain treated with 38 minimally invasive elective SIJ arthrodeses were retrospectively reviewed using chart and x-ray data. The fusion procedure consisted of minimal muscle stripping over the posterior SIJ and insertion of a cranial and caudal fibular dowel graft across the joint following placement of Steinmann pins. Fusion was deemed to be present when bone bridging trabeculae could be seen crossing the SIJ on either oblique x-rays or by computed tomographic scan. Patients were followed-up for a mean of 52 months (range, 24-62 months). Visual Analog Scale (VAS) was used to monitor clinical pain improvement. RESULTS: Thirty-four patients with SIJ arthrodeses (89.5%) healed and led to substantial improvement in VAS pain scores (preoperative 9.1, postoperative 3.4) (P < .001). This improvement in VAS occurred over a 6-month period and was sustained through subsequent follow-up. Nonunion occurred in four patients with SIJ (10.5%). Each SIJ nonunion was successfully treated by secondary autogenous bone grafting and compression screw fixation. CONCLUSIONS: In patients with primary low back pain attributable to the SIJ, a minimally invasive, dual fibular dowel graft provided high rates of fusion and improved pain scores. [Table: see text].
Project description:Tibiotalocalcaneal arthrodesis is most common and effective surgical treatment for severe hindfoot pathology, but the fusion rate is often lower than the ordinary tibiotalar arthrodesis because of the more serious joint disease associated with obvious deformity and osteoporosis. Recent literature describe tibiotalocalcaneal arthrodesis with reverse PHILOS plate with good clinical outcome result, though some patients non-union, due to eccentric force of the plate may be hidden. The purpose of this study was to evaluate clinical outcome of the lateral approach for tibiotalocalcaneal (TTC) arthrodesis with reverse PHILOS Plate and medial cannulated screw.Between Jun, 2013 to April, 2015 12 patient with hindfoot pathology had TTC arthrodesis with a reverse PHILOS plate with medial cannulated screw through a lateral approach with resection of the distal fibula and bone graft. Perioperatively observe for wound and neurovascular status. Patients were follow-up from post-operative 1, 3, 6 and12 months, to observation of wound healing, ankle pain, subtalar Joint Fusion, internal fixation and ankle function. Ankle function were scored according to the American Orthopaedic Foot and Ankle Society(AOFAS) Ankle-Hindfoot Scale system.Twelve ankle fusion all patient follow-up, with mean time to surgery 18.6 months (12-36 month). No cases infection and issue necrosis; one patient complaint of lateral foot numbness we observe and follow-up was spontaneously recovery after 3 months. After 3 months of operation, no obvious pain of ankle joint and internal fixations loose were found. Almost fusion and good axial alignment of TTC joint also were found by X-ray and CT examination. After final fellow-up of each case, no case complain of pain of ankle joint, good fusion and axial alignment of TTC joint were also all found through Terminology. The mean American Orthopaedic Foot and Ankle society (AOFAS) score average was 77.5.TTC arthrodesis with reverse PHILOS Plate and medial cannulated screw have advantages of clear incision, effective bone orthopaedic and graft fully secure, stable internal fixation, high fusion rate and less complications, can effectively correct deformities, alleviate hindfoot pain and improve function, and is an effective method of treatment of after severe hindfoot disease.This trial is registered on ClinicalTrials.gov with reference number: ID: NCT02977910 . Registered 26 Nov 2016, retrospectively registered.
Project description:OBJECTIVE:Conventional techniques for atlantoaxial fixation and fusion typically pass cables or wires underneath C1 lamina to secure the bone graft between the posterior elements of C1-2, which leads to complications such as cerebrospinal fluid (CSF) leak and neurological injury. With the evolution of fixation hardware, we propose a novel C1-2 fixation technique that avoids the morbidity and complications associated with sublaminar cables and wires. METHODS:This technique entails wedging and anchoring a structural iliac crest graft between C1 and C2 for interlaminar arthrodesis and securing it using a 0-Prolene suture at the time of C1 lateral mass and C2 pars interarticularis screw fixation. RESULTS:We identified 32 patients who underwent surgery for atlantoaxial with our technique. A 60% improvement in pain-related disability from preoperative baseline was demonstrated by Neck Disability Index (p < 0.001). There were no neurologic deficits. Complications included 2 patients CSF leaks related to presenting trauma, 1 patient with surgical site infection, and 1 patient with transient dysphagia. The rate of radiographic atlantoaxial fusion was 96.8% at 6 months, with no evidence of instrumentation failure, graft dislodgement, or graft related complications. CONCLUSION:We demonstrate a novel technique for C1-2 arthrodesis that is a safe and effective option for atlantoaxial fusion.
Project description:Surgical techniques for anterior cruciate ligament reconstruction are evolving, becoming less invasive, with fewer and smaller incisions, preservation of knee bone stock and tendons at the donor site, and better graft positioning and fixation. We describe an anterior cruciate ligament reconstruction technique that aims to preserve bone stock and spares the gracilis. The semitendinosus graft construct is prepared in a quadruple way and fixed with a cortical button in both tunnels, with increased stiffness and resistance of the graft construct. The tibial tunnel is filled at the end of the operation with a bone dowel, keeping the bone stock intact. This technique is safe, with a short learning curve; preserves the gracilis; saves bone; and increases the stiffness and resistance of the tibial fixation.
Project description:Ankle arthrodesis has been widely reported as an effective solution in treating tibiotalar joint osteoarthritis. The arthroscopic tibiotalar approach for arthrodesis has also been proven to give excellent results in terms of bone fusion rates and reduction of wound-related pain and complications. Historically, ankle malalignment has represented one of the main contraindications for the arthroscopic procedure, but interestingly some investigators have shown that the coronal joint deformity may be addressed arthroscopically as well. Other investigators have also demonstrated that part of the valgus/varus is due to malrotation of the talus within the mortise; therefore, controlling the talar position becomes crucial for correcting more severe deformities. We present here a technique for correcting tibiotalar malalignment during arthroscopic arthrodesis in varus or valgus ankles, performed through a K-wire used as a joystick to manage the talar position on both the coronal and axial planes.
Project description:To our knowledge, proximal tibiofibular joint instability has never been reported in a patient with a total knee arthroplasty (TKA). We present the case of a patient with anterolateral proximal tibiofibular joint instability associated with a complex primary TKA. In 2010, a male patient of 47 years was referred for TKA after posttraumatic osteoarthritis. The patient's history includes a fracture of the left lateral tibial plateau in 2008 and removal of osteosynthesis material in 2009. TKA with a lateral metal augment and intramedullary stem was performed in 2010. After TKA, instability of the left proximal tibiofibular joint (PTFJ) was diagnosed. The patient underwent PTFJ arthrodesis and, at 5 years' follow-up, had no residual pain, with full range of motion. In this case, arthrodesis was the only possible surgical option because reconstruction surgeries require the establishment of bone tunnels in the tibia and fibula for the passage of a graft. Low bone quality and the use of an intramedullary stem with a metal augment in the tibia made any reconstruction technique unfeasible because the proximal tibia was obliterated. Although several PTFJ reconstruction techniques are available, they are difficult to apply to patients with a complex TKA.
Project description:The purpose of this study was to compare the clinical outcome, union rate, and complications of a consecutive series of Scaphoid excision and limited wrist arthrodesis performed by a single surgeon using distal radius bone graft and K-wires or circular plate fixation. A sequential series of ten patients(11 wrists) who were stabilized with temporary K-wires were compared to 11 patients (11 wrists) who were stabilized with a circular plate. Minimum follow-up was 1 year. One patient in the K-wire group was converted to a wrist fusion. Six of the remaining ten patients in the K-wire fixation group and 8 of the 11 patients in the circular plate fixation group returned for the following blinded evaluations: Quick DASH, analog pain scale, range of motion, grip and pinch strength, plain x-ray, and multi-detector computed tomography evaluation. One non-union occurred in the K-wire group. There were no non-unions in the circular plate fixation group. There was no difference in any of remaining measures or rate of complications. This study shows that equivalent results can be obtained using circular plate fixation compared to K-wires when equivalent bone graft source and fusion technique are used. If K-wire removal requires a return to the OR, circular plate fixation is more cost-effective.
Project description:The effectiveness of subtalar arthrodesis has been well documented in treating degenerative subtalar joint disease. The arthroscopic subtalar approach for arthrodesis has also been proved to give excellent results in terms of bone fusion rates and reduction of wound-related pain and complications. To date, the main concerns about arthroscopy have regarded incision-related neurologic complications such as lesions of the tibial, fibular, and sural nerves. In this context, we present a 2-portal lateral (anterior and middle) approach to arthroscopic subtalar arthrodesis, recently documented in the literature, that provides similar excellent access to the joint with a lower risk of nerve damage.
Project description:Instabilities of the subtalar joint are commonly overlooked or mismanaged, and chronic instability is a debilitating condition leading to premature joint degeneration. Several methods of treatment have been described, mainly screw fixation, arthrodesis, or ligament reconstruction. Most studies describe open methods for ligament reconstruction. We describe an original technique for "all-inside" arthroscopic graft reconstruction of the interosseous talocalcaneal ligament for subtalar instability.
Project description:Background:Sacroiliac joint (SIJ) degeneration is a common source of low back pain (LBP). Minimally invasive (MI) SIJ fusion procedures have demonstrated meaningful clinical improvement. A recently developed MI SIJ fusion system incorporates decortication, placement of bone graft and fixation with threaded implants (DC/BG/TF). Patients and Methods:Nineteen patients who had MI SIJ fusion with DC/BG/TF were enrolled at three centers. Fusion was assessed in CT images obtained 12 and 24 months postoperatively by an independent radiographic core laboratory. LBP was assessed using a 0-10 numerical pain scale (NPS) preoperatively and at 12 and 24 months postoperatively. Results:At 12 months, 15/19 patients (79%) had bridging bone across the SIJ, and at 24 months 17/18 patients (94%) available for follow-up had SIJ fusion. Of the patients with bridging bone 88% had fusion within the decorticated area, with solid fusion in 83%. A significant reduction in NPS scores was demonstrated, representing a 73% reduction in average low back pain. Conclusion:The patients in this series demonstrated significant improvement in LBP. Fusion rates at 24 months demonstrate promise for this system, which utilizes the established orthopedic principles of DC/BG/TF to achieve arthrodesis. Further study is warranted to demonstrate comparative fusion rates for different implant systems.