Needle 'double reverse' traction reset and fixation with MiPPO for tibial plateau fractures / 局解手术学杂志

Objective To analyze the indications and evaluate the efficacy of the needle to 'double reverse' traction reset,inside and outside double column locking plate internal fixation with MiPPO for tibial plateau fractures.Methods From August 2015 to March 2017,a total of 31 patients with tibial plateau fractures in our hospital were divided into treatment group and control group.The treatment group with 12 cases were treated with the needle to be 'double reverse' traction reset,inside and outside double column locking plate MiPPO fixation.The control group with 19 cases received open reduction and internal fixation with locking plate.Results In treatment group,the operation time was (51.3±6.5)minutes,the intraoperative bleeding was (60±8.7)mL.In the control group,the operation time was (68.5±6.6)minutes,the intraoperative bleeding was (230±7.8)mL.The operation time and blood loss of treatment group were less than those of control group,the differences were statistically significant(P<0.05).The postoperative X ray film of fracture showed that the bone plate and screw position were ideal compared with those before operation,no complication occurred.Conclusion The needle 'double inverse' traction and locking plate MiPPO fixation treatment have good clinical effect for patients of Schatzker Ⅴ,Ⅵ tibia platform fracture,with less complication.

Usefulness of Treatment with 6.5 mm Cancellous Screw and Steinmann Pin Fixation for Calcaneal Joint Depression Fracture / 대한족부족관절학회지

PURPOSE: To report the radiographic and clinical results of 6.5 mm cancellous full threaded buttress screw or Steinmann pin fixation to maintain a reduction of calcaneal posterior facet depression fracture. MATERIALS AND METHODS: From June 2009 to June 2012, 50 consecutive cases with calcaneal joint depression fracture that underwent open reduction and screw or pin fixation were enrolled in this study. A 6.5 mm cancellous full threaded screw was inserted from the posteroinferior aspect of the calcaneal tuberosity to the posterior facet (group A) or Steinman pin was inserted from the posterosuperior aspect of the calcaneal tuberosity to the calcaneocuboidal joint (group B). Both preoperative and postoperative Bohler and Gissane angles were measured radiographically, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale on the final follow-up were assessed. RESULTS: The mean age of patients was 44.1 years, and the mean follow-up period was 27.2 months. According to the Sanders classification, 28 cases were type II and 22 cases were type III. In Sanders type II, Bohler and Gissane angles improved significantly from 10.1degrees and 126.2degrees preoperatively to 27.2degrees and 117.1degrees, respectively, in the immediate postoperative radiograph, and at the final follow-up, 26.6degrees and 118.6degrees, respectively. In Sanders type III, Bohler and Gissane angles improved significantly from 5.0degrees and 129.8degrees to 29.9degrees and 119.3degrees, respectively, in the immediate postoperative radiograph, and 26.9degrees and 120.2degrees at the final follow-up. All cases achieved bony union, and the average period until complete union was 13.3 weeks. AOFAS ankle-hindfoot scale was 82.6 in Sanders type II and 77.3 in Sanders type III at the final follow-up. CONCLUSION: A 6.5 mm cancellous full threaded buttress screw or Steinman pin fixation is a noninvasive treatment method with a merit of being able to maintain the bearing capacity of the posterior facet comparable to plate fixation.

Steinmann Pin Assisted Reduction of Subtrochanteric Femoral Fracture

PURPOSE: Nail insertion is the treatment of choice for subtrochanteric femoral fracture, but displacement of proximal bone fragment makes it difficult to find an ideal entry point. Therefore, in this study we aimed to determine the usefulness of treatment of subtrochanteric femoral fracture using Steinmann pin assisted reduction, internal fixation, and insertion of intramedullary nails. MATERIALS AND METHODS: We evaluated 33 patients who were followed-up more than a year with a displaced subtrochanteric femoral fracture treated with closed reduction and intramedullary nail fixation between January 2008 and March 2013. In addition, we studied postoperative bone union time, postoperative reduction status, change of the femur neck shaft angle, evaluation of hip joint function, return to daily life, and complications. RESULTS: All fractures with Steinmann pin assisted reduction were united but they included three cases of delayed union. In Fogagnolo classification, all cases were up to acceptable states and the varus change of femur neck shaft angle was 0.94degrees+/-3.1degrees; no significant difference in Harris hip score was observed between preoperative and last follow-up (p>0.05). CONCLUSION: There were satisfactory results in bone union and reduction state with Steinmann pin assisted reduction. Therefore, Steinmann pin assisted reduction is a useful surgical technique for subtrochanteric femoral fracture.

Treatment with Modified Steinmann Pins and Tension Band Wiring Technique in Proximal Humeral Comminuted Fractures with Osteoporosis

PURPOSE: To evaluate the usefulness of internal fixation with modified Steinmann pins and tension band wiring technique in comminuted proximal humeral fracture with osteoporosis and the correlations among bone mineral density, age, Neer's score and period of union. MATERIALS AND METHODS: Twelve cases of comminuted proximal humeral fracture with osteoporosis were surgically treated with modified Steinmann pins and tension band technique, and followed up for an average 20.8 months (range, 6~39 months). Average age was 73.6 years old (range, 59~85 years old). Results were assessed using Neer's evaluation criteria. RESULTS: Excellent results were noted in eight cases and satisfactory results in four cases. Radiological union was obtained in all cases. Two cases showed impingement syndrome of the proximal portions of Steinmann pins, which were managed by early removal of the metal. One case developed operative wound infection, which were managed by antibiotics therapy, irrigation and secondary closure. CONCLUSION: Internal fixation using modified Steinmann pins and tension band wiring technique for proximal humeral fracture, with osteoporosis, makes complete union of fracture, minimizes risk of complications, and enables early rehabilitation by rendering relatively rigid fixation.

Comparison of Results in Two Operative Treatments for Clavicle Shaft Fractures in Adult: Comparison of Results between Open Reduction and Internal Fixation with the Plate and Percutaneous Reduction by Towel Clip and Intramedullary Fixation with Steinmann

PURPOSE: To evaluate the results between open reduction and internal fixation with the plate and percutaneous reduction by towel clip and intramedullary fixation with Steinmann pin for clavicle shaft fractures in adult. MATERIALS AND METHODS: We have studied the results in 33 cases with the plate, 35 cases with the Steinmann pin among total 68 cases of clavicle shaft fracture. The patients were followed up over a period of at least 12 months. The final postoperative outcome was analyzed with the clinical outcomes using Kang's criteria, radiological union time and operation time. RESULTS: The clinical outcome that was good or excellent according to the Kang's criteria showed a distribution of 88% in the group using the plate with 29 cases out of total 33 cases, 91% in the group using the Steinmann pin with 32 cases out of total 35 cases. The mean radiological union time was 8.9 weeks in the group using the plate, 9.1 weeks in the group using Steinmann pin. The mean operation time was 72 minutes in the group using the plate, whereas was 18 minutes in the group using Steinmann pin. CONCLUSION: In the treatment of adult clavicle shaft fracture, two groups did not show a significant statistical difference in clinical and radiological outcomes. However, the operation time and postoperative functional recovery was significantly shorter and faster in the group using Steinmann pin. Additionally economic and cosmetic aspect was more satisfactory in the group using Steinmann pin.

The Operative Treatment of Mid-Shaft Clavicular Nonunions: Intramedullary Fixation with Threaded Steinmann Pin and Bone Grafting

PURPOSE: To evaluate the clinical and radiological results of the treatment of mid-shaft clavicular nonunions using intramedullary fixation with threaded Steinmann pin and bone grafting. MATERIAL AND METHODS: In 16 patients treated with intramedullary fixation of threaded Steinmann pin and autogenous iliac bone grafting for the mid-shaft clavicular nonunions, 10 patients with follow-up over 1 year were investigated. All patients (10 clavicle fractures) underwent conservative treatment initially. The average age of patients was 56 years old (range, 18~70 years old). Eight cases were atrophic nonunions, two hypertrophic. A clinical assessment was evaluated postoperatively after 5 months according to the evaluation method of Kona et al. RESULTS: According to the evaluation method of Kona et al, four cases achieved excellent results, five cases good, and one case achieved a fair result. The average period until bony union was 9 weeks (range, 7~12.5 weeks) without infection, pin migration or breakage. One case showed skin irritation by lateral margin of Steinmann pin, which was subsided by pin removal after bony union. CONCLUSION: We obtained satisfactory results and have concluded that intramedullary fixation with threaded Steinmann pin and bone grafting could appropriately treat nonunions of the mid-clavicular fracture occurred after conservative treatment, because it minimizes soft tissue injury, gets relatively stable fixation and early ROM, predicts early bone union, facilitates pin removal under local anesthesia.

Treatment of Proximal Humeral Fractures using Modified Steinmann Pins and Tension Band Wiring / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evalulate the usefulness of internal fixation with two modified Steinmann pins and tension band wiring in displaced proximal humeral fracture. MATERIALS AND METHODS: Thirteen cases of displaced proximal humeral fracture were surgically treated with modified Steinmann pins and tension band wiring and followed for an average 24.9 (6-39) months. Male to female ratio was 6 to 7. Average age was 58.1 (39-81) years. Results were assessed using Neer's evaluation criteria. RESULTS: Excellent results were noted in 9 cases and satisfactory results in 4 cases. All cases obtained radiological union. There was no complication such as avascular necrosis of humeral head or metal failure. Two cases showed impingement syndrome of the proximal portions of Steinmann pins, which were managed by early removal of the metal after union. CONCLUSIONS: Internal fixation using modified Steinmann pins and tension band wiring for proximal humeral fracture minimizes perioperative soft tissue damage, has a low risk of complications, and enables early rehabilitation by rendering relatively rigid fixation.

Atlantoaxial Dislocation in Down Syndrome Treated by Occipitocervical Fusion Using Threaded Steinmann Pin: A Case Report

Atlantoaxial dislocation is common in patients with Down syndrome, and an increased incidence was first noted by Tishler and Martel in 1965. Laxity of the transverse atlantal ligament is thought to be responsible for atlantoaxial dislocation, and surgical stabilization has been recommended for pateints who have instability, with or without myelopathy. Various surgical techniques and hardwares have been developed for occipitcervical fusion with varying degrees of results. The authors presents a case of Down syndrome with cervical myelopathy treated by occipitocervical fusion with an anatomically contoured threaded Steinmann-pin, which was secured to the occiput via small burr holes and to the vertebrae by sublaminar wiring, and supplemental autograft. This technique has the advantage over bone grafting, in that it affords rigid stabilization, allows early mobilization and may contribute to eventual bony fusion.

Removal of Broken Screws of Interlocking Nail: technical note / 대한정형외과학회잡지

Concerns have been raised about the potential for hardware failure in interlocking nails and screws especially with small diameter nail. Existing techniques for removing broken interlocking screws can involve trephine over-cutting of the screws, which requires wide bone exposure and creates larger stress risers by enlarging the original screw hole. We present this new technique for removal of broken screws of 2 femoral interlocking nails and 6 tibia interlocking nails. This Steinmann pin ""punch"" technique is to drive the screws through the opposite cortex and soft tissue for removal through a small stab wound. The rationale of this technique is based on the less holding power of the interlocking screw which is not only a machinary screw but also placed on the metaphyseal portion.