USE OF THE uCentrum SYSTEM IN THE SURGICAL TREATMENT OF DISEASES OF THE VERTEBRAL SPINE / UTILIZAÇÃO DO SISTEMA uCentrum NO TRATAMENTO CIRÚRGICO DAS DOENÇAS DA COLUNA VERTEBRAL / USO DEL SISTEMA uCentrum EN EL TRATAMIENTO QUIRÚRGICO DE ENFERMEDADES DE LA COLUMNA VERTEBRAL

ABSTRACT Objectives: Evaluate the treatment outcome and the performance of the uCentum spinal fixation system in treating traumatic, degenerative, and tumoral diseases of the spine. Methods: This is a therapeutic study to investigate treatment outcomes and level of evidence III, including twenty-three adult patients of both sexes undergoing surgical treatment of degenerative (13 patients), traumatic (04 patients), or tumor diseases (06 patients). Patients were prospectively evaluated using clinical parameters: pain (visual analog scale), clinical and functional assessment questionnaires (SF-36, Oswestry and Roland-Morris), and radiological criteria (arthrodesis consolidation, loosening, breakage or deformation of the implants). Results: Twenty patients were followed for a period of 01 month to 12 month (mean 6,5±7,77). Three patients died due to complications unrelated to the primary disease (traumatic brain injury, septicemia, and lung tumor). Improvements were observed in clinical parameters and scores of the evaluation questionnaires used. No implant-related complications (breakage, loosening, deformation) were observed. Conclusion: the uCentum fixation system showed great versatility for performing the surgical treatment, allowing the performance of open, percutaneous procedures, the introduction of acrylic cement inside the implants, and conversion of polyaxial screws into monoaxial screws intraoperatively. Level of Evidence III; Therapeutic Studies - Investigating the Results of Treatment.

Resumo: Objetivos: Avaliar o resultado do tratamento e o desempenho do sistema uCentum de fixação vertebral no tratamento de doenças traumáticas, degenerativas e tumorais da coluna vertebral. Métodos: Trata-se de um estudo terapêutico de investigação dos resultados do tratamento e nível de evidência III, incluindo vinte e três pacientes adultos de ambos os sexos submetidos ao tratamento cirúrgico de doenças degenerativas (13 pacientes), traumáticas (04 pacientes) ou tumorais (06 pacientes). Os pacientes foram prospectivamente avaliados por meio de parâmetros clínicos: dor (escala visual analógica), questionários de avaliação clínica e funcional (SF-36, Oswestry e Roland-Morris), e critérios radiológicos (consolidação da artrodese, soltura, quebra ou deformação dos implantes). Resultados: vinte pacientes foram seguidos por um período de 01 a 12 meses (média 6,5 ± 7,77). Três pacientes foram a óbito devido a complicações não relacionadas com a doença primária (trauma cranioencefálico, septicemia e tumor pulmonar). Foi observada melhora dos parâmetros clínicos e escores dos questionários de avaliação utilizados. Não foram observadas complicações relacionadas com os implantes (quebra, soltura, deformação). Conclusão: o sistema de fixação uCentum apresentou grande versatilidade para a realização do tratamento cirúrgico, permitindo a realização de procedimentos abertos, percutâneos, introdução de cimento acrílico no interior dos implantes e conversão dos parafusos poliaxiais em monoaxiais no intra-operatório. Nível de Evidencia III; Estudos terapêuticos - Investigação dos resultados do tratamento.

Resumen: Objetivos: Evaluar el resultado del tratamiento y el desempeño del sistema de fijación vertebral uCentum en el tratamiento de enfermedades traumáticas, degenerativas y tumorales de la columna vertebral. Métodos: Este es un estudio terapéutico para investigar los resultados del tratamiento y el nivel de evidencia III, que incluye veintitrés pacientes adultos de ambos sexos sometidos a tratamiento quirúrgico de enfermedades degenerativas (13 pacientes), traumáticas (04 pacientes) o tumorales (06 pacientes). Los pacientes fueron evaluados prospectivamente mediante parámetros clínicos: dolor (escala analógica visual), cuestionarios de evaluación clínica y funcional (SF-36, Oswestry y Roland-Morris) y criterios radiológicos (consolidación de artrodesis, aflojamiento, rotura o deformación de los implantes). Resultados: veinte pacientes fueron seguidos durante un período de 1 a 12 meses (media 6,5 + 7,77). Tres pacientes fallecieron por complicaciones no relacionadas con la enfermedad primaria (lesión cerebral traumática, septicemia y tumor pulmonar). Se observaron mejoras en los parámetros clínicos y puntuaciones de los cuestionarios de evaluación utilizados. No se observaron complicaciones relacionadas con el implante (rotura, aflojamiento, deformación). Conclusión: el sistema de fijación uCentum mostró una gran versatilidad para realizar el tratamiento quirúrgico, permitiendo la realización de procedimientos abiertos, percutáneos, introducción de cemento acrílico en el interior de los implantes y conversión de los tornillos poliaxiales en tornillos monoaxiales en el intraoperatorio. Nivel de Evidencia III; Estudios terapéuticos - Investigación de los resultados del tratamiento.

Efficacy of percutaneous pedicle screw fixation of ankylosing spondylitis combined with thoracolumbar fractures / 中华创伤杂志

Objective To investigate the feasibility and clinical effect of percutaneous pedicle screw fixation in the treatment of ankylosing spondylitis (AS) with thoracolumbar fractures.Methods A retrospective case-series study was performed on 12 AS patients with thoracolumbar fractures admitted from January 2013 to January 2016.There were 9 males and 3 females,aged (42.7 ± 13.0) years (range,24-63 years).All patients received percutaneous minimally invasive pedicle screw fixation.The operation duration,intraoperative blood loss,length of incision,ambulation time,and time to basic life were recorded.Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before and after operation.Postoperative complications and bone fracture union were observed during the followup period.Results All patients were followed up for average 22 months (range,14-36 months).All patients underwent successful surgery,with operation duration and intraoperative blood loss of (178.0 ± 60.2) min and (116.7 ± 44.2) ml respectively.No serious complications such as blood vessel or nerve injury occurred during the operation.The incision length was 1.2-1.5 cm.All the patients were able to do exercise with the help of brace 2-3 days after the operation and returned to basic life after (23.4 ± 7.3)days postoperatively.At 1,3,6 and 12 months after operation,VAS and ODI differed significantly from the preoperative detections (P ＜ 0.05).During the follow-up,bone fracture union was observed in all patients,with no nail breakage or nail loosening occurred after operation.Conclusion For AS combined with thoracolumbar fractures,minimally invasive fixation can attain satisfactory curative effect,with advantages of minor lesion,little bleeding,fast recovery and sound bone union.

Ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture / 中国修复重建外科杂志

Objective: To explore the effectiveness of ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture. Methods: Between May 2013 and August 2015, 15 patients with fresh nondisplaced carpal scaphoid fractures (Krimmer type A2) were treated with ultrasound-guided Herbert screw fixation. There were 12 males and 3 females with an average age of 33.4 years (range, 18-51 years). The causes of injury included 9 cases of falls, 3 cases of training injuries, and 3 cases of machine injuries. The interval from injury to surgery was 2-15 days (mean, 5 days). No other complication was found. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the fracture healing time were recorded. The wrist function was assessed by the modified Mayo wrist score standard. Results: The operation time was 28-53 minutes (mean, 33.9 minutes); the intraoperative blood loss was 5-30 mL (mean, 10.5 mL); the intraoperative fluoroscopy was 2-6 times (mean, 2.6 times). All 15 patients were followed up 6-18 months (mean, 10.5 months). One patient developed pain and soreness in the skin of the nail entrance, and gradually relieved after fumigation. No complication such as infection occurred. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 11.6 weeks). At last follow-up, the modified Mayo wrist score was 76-99 (mean, 92.5). Among them, 12 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 93.3%. Conclusion: Ultrasound-guided fixation with Herbert screw is a reliable treatment method for fresh nondisplaced carpal scaphoid fractures with small invasion, less bleeding, and small radiation damage.

The shor-term clinical outcomes and safety of extreme lateral interbody fusion combined with percutaneous pedicle screw fixation for the treatment of degenerative lumbar disease / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the early efficacy and safety of extreme lateral interbody fusion (XLIF) combined with percutaneous pedicle screw fixation for lumbar degenerative disease.</p><p><b>METHODS</b>From January 2013 to June 2014, 13 patients with degenerative lumbar disease were treated with XLIF combined with percutaneous pedicle screw fixation, including 8 cases of lumbar instability, 5 cases of mild to moderate lumbar spondylolisthesis;there were 5 males and 8 females, aged from 56 to 73 years with an average of 62.1 years. All patients were single segment fusion. Operation time, perioperative bleeding and perioperative complications were recorded. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy. Interbody fusion rate was observed and the intervertebral foramen area changes were compared preoperation and postoperation by X-rays and CT scanning.</p><p><b>RESULTS</b>The mean operation time and perioperative bleeding in the patients respectively was(62.8±5.2) min and(82.5±22.6) ml. One case occurred in the numbness of femoribus internus and 1 case occurred in the muscle weakness of hip flexion after operation, both of them recovered within 2 weeks. All the patients were followed up from 12 to 19 months with an average of 15.6 months. VAS was decreased from preoperative 7.31±0.75 to 2.31±0.75 at final follow-up(<0.05); ODI was decreased from preoperative (42.58±1.55)% to (12.55±0.84)% at final follow-up(<0.05). At final follow-up, CT scanning confirmed 8 cases completely fused and 5 cases partly fused;the intervertebral foramen area was increased from preoperative (94.86±2.44)mm2 to (150.70±7.02)mm2(<0.05).</p><p><b>CONCLUSIONS</b>Extreme lateral interbody fusion combined with percutaneous pedicle screw fixation is an ideal method and can obtain early good clinical effects in treating lumbar degenerative disease.</p>

Outcomes of Arthroscopic Assisted Reduction and Percutaneous Fixation for Tongue-Type Sanders Type II Calcaneal Fractures / 대한족부족관절학회지

PURPOSE: To assess the clinical and radiographic results and complications of arthroscopy-assisted reduction and percutaneous fixation for patients with tongue-type Sanders type II calcaneal fractures. MATERIALS AND METHODS: Between August 2014 and December 2015, 10 patients who underwent surgery using subtalar arthroscopic assisted reduction and percutaneous fixation for tongue-type Sanders type II calcaneal fractures were reviewed. The mean age was 50.8 years (36~62 years), and the mean follow-up period was 24 months (12~40 months). The clinical results were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at the regular follow-ups, and the foot function index (FFI) at the last follow-up. The subtalar range of motion (ROM) was evaluated and compared with the uninjured limb at the last follow-up. The radiographic results were assessed using the Böhler's angle from the plain radiographs and the reduction of the posterior calcaneal facet using computed tomography (CT). The postoperative complications were assessed by a chart review. RESULTS: The VAS and AOFAS ankle-hindfoot score improved until 12 months after surgery. The FFI was 15 (1.8~25.9) and subtalar ROM was 75.5% (60%~100%) compared to the uninjured limb at the last follow-up. The Böhler's angle was increased significantly from 2° (−14°~18°) preoperatively to 21.8° (20°~28°) at the last follow-up. The reduction of the posterior facet was graded as excellent in five feet (50.0%) and good in five (50.0%) on CT obtained at 12 months after surgery. One foot (10.0%) had subfibular pain due to a prominent screw head. One foot (10.0%) had pain due to a longitudinal tear of the peroneal tendon that occurred during screw insertion. CONCLUSION: Subtalar arthroscopic-assisted reduction of the posterior calcaneal facet of the subtalar joint and percutaneous fixation is a useful surgical method for tongue-type Sanders type II calcaneal fractures.

Scaphoid fracture treated by percutaneous fixation with arthroscope assistance / 中国内镜杂志

Objective To investigate the preliminary clinical results of treating scaphoid fracture by percutaneous fixation with arthroscope assistance. Methods From October 2009 to May 2015, a consecutive series of 12 patients with scaphoid fracture were treated by percutaneous fixation with arthroscope assistance. Meanwhile TFCC was man-aged if necessary. As followed, X-ray was adopted for assessment bone healing at 6-month postoperation, 12-month postoperation. Postoperative evaluations included clinical measurement (grip strength and motion range), radiograph-ic, and functional (modified Mayo wrist score) parameters, Herbert and Fisher scaphoid fracture parameters. Healthy wrist as control group. Results All the scaphoid fracture were healed with an average healing time of 24 weeks. All 12 cases were followed for an average of 18.5 months. The function was rated excellent in 7 cases, good in 5 cases according to the modified Mayo wrist score. There was no difference between the injuried wrist and control group. Conclusion For scaphoid fracture, percutaneous fixation with arthroscope assistance is a reliable and minimally in-vasive method to treat scaphoid fracture.

Study of operative management for complex fracture of upper end of Humerus.

Background: Proximal humerus fractures are very common fractures occurring in the skeleton. They account for approximately 4 – 5% of the fracture attendance at the hospital. It is the most common fracture of shoulder girdle. It is the 3rd most common fracture in elderly. Till date various methods are used including percutaneous and open reduction & fixation according to fracture type. Aims & Objective: To study the occurrence, mechanism of injury and displacement of various types of fractures and different modalities of the fixations in proximal humerus fractures. Come to conclusion about preferred modality of treatment of proximal humerus fractures according to the pattern of fracture. Material and Methods: In present study 44 patients of complex fracture of proximal humerus treated with either open reduction internal fixation or percutaneous fixation from 2009 to 2012. Follow up assessment was done by Constant score. Results: Radiological union occur at about 8 to 12 weeks. Closed reduction and percutaneous k wire or cancellous screws fixation showed excellent results in majority cases of 3 -part fracture. All 4 part fractures are treated with ORIF. Open reduction and internal fixation with locking compression plates showed good results among all implants used. Conclusion: Principle of fixation is reconstruction of the articular surface, including the restoration of the anatomy, stable fixation, with minimal injury to the soft tissues preserving the vascular supply, should be applied. Majority of poor results are due to poor surgical techniques and lack early physiotherapy.

Arthroscopic assisted percutaneous bone grafting and screw fixation for the treatment of lateral tibial plateau fractures：A 4-year follow-up / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.26.009

Fractures of the Proximal Fifth Metatarsal: Percutaneous Bicortical Fixation

BACKGROUND: Displaced intraarticular zone I and displaced zone II fractures of the proximal fifth metatarsal bone are frequently complicated by delayed nonunion due to a vascular watershed. Many complications have been reported with the commonly used intramedullary screw fixation for these fractures. The optimal surgical procedure for these fractures has not been determined. All these observations led us to evaluate the effectiveness of percutaneous bicortical screw fixation for treating these fractures. METHODS: Twenty-three fractures were operatively treated by bicortical screw fixation. All the fractures were evaluated both clinically and radiologically for the healing. All the patients were followed at 2 or 3 week intervals till fracture union. The patients were followed for an average of 22.5 months. RESULTS: Twenty-three fractures healed uneventfully following bicortical fixation, with a mean healing time of 6.3 weeks (range, 4 to 10 weeks). The average American Orthopaedic Foot & Ankle Society (AOFAS) score was 94 (range, 90 to 99). All the patients reported no pain at rest or during athletic activity. We removed the implant in all cases at a mean of 23.2 weeks (range, 18 to 32 weeks). There was no refracture in any of our cases. CONCLUSIONS: The current study shows the effectiveness of bicortical screw fixation for displaced intraarticular zone I fractures and displaced zone II fractures. We recommend it as one of the useful techniques for fixation of displaced zone I and II fractures.

Arthroscopy Assisted Percutaneous Reduction and Screw Fixation of a Displaced Intra-articular Glenoid Fracture: A Case Report

PURPOSE: The authors used arthroscopy-assisted percutaneous reduction and cannulated screw fixation rather? than conventional arthrotomy for displaced glenoid fracture. MATERIALS AND METHODS: We used arthroscopy assisted reduction and screw fixation for a 66 year old man who had a clavicle fracture, a displaced glenoid fracture and a scapula fracture. RESULTS: At 9 months postoperatively, the patient had recovered full range of motion and was not inconvenienced by the surgery. Removal of the implant was done 12 months post-operatively under general anesthesia. CONCLUSION: The advantages of arthroscopy-assisted percutaneous screw fixation are less pain and less bleeding, shorter hospital stay and earlier rehabilitation. Arthroscopic percutaneous screw fixation for a displaced glenoid fracture seems to be a good alternative treatment method.

Computed Tomographic Analysis of Screw Positions in Volar Percutaneous Screw Fixation of Scaphoid Fractures

PURPOSE: We analysed the position of screws whithin the scaphoid on computed tomographic images of patients treated by volar percutaneous screw fixation for scaphoid fractures. MATERIALS AND METHODS: We reviewed 16 patients treated by volar percutaneous screw fixations for scaphoid fractures. In three (proximal, middle, distal) portions of the scaphoid, the distance from the center of the screw to the edge of the cortex and the diameter of the scaphoid were measured on the sagittal and coronal reconstructive computed tomographic images. We divided into two groups: the risk group with cortical breakage or penetration by the screw and the safe group with no cortical breakage. The position of screws was analysed and compared between two groups. RESULTS: The position of screws in the proximal scaphoid was more central than the distal scaphoid (p<0.05). The central screw placement in the distal scaphoid correlated with that in the proximal scaphoid. The average distance from the volar surface of the scaphoid tuberoisity to the entry point was 7.0 mm(5.0~8.8 mm) in risk group and 4.7 mm(1.5~7.6 mm) in safe group. It was differed significantly between risk group and safe group(p<0.05). CONCLUSION: This study suggests that volar percutaneous screw fixation for scaphoid fractures can achieve central screw placement in the proximal scaphoid. For the safe placement of the screw, a surgeon should be careful not to locate the entry point too far posteriorly on the scaphotrapezial joint.

The Result of Closed Reduction and Percutaneous Screw Fixation for Intra-articular Calcaneal Fracture of Joint Depression Type / 대한족부족관절학회지

PURPOSE: To evaluate the results of treatments by percutaneous Acutrak screw fixation for intra-articular joint depression type fracture of calcaneus. MATERIALS AND METHODS: Thirteen cases with intra-articular joint depression type fracture of calcaneus, from September 2004 to March 2006, were reviewed. There were 9 males and 4 females with 52.5 years old mean age (range: 31~74 years old). The average follow-up period was 18 months (range: 8~32 months). Steinmann pins and Freers were used for closed reduction. After closed reduction, Acutrak screws and K-wires were inserted. The patients were evaluated with Creighton-Nebraska health foundation assessment sheet for calcaneal fracture, the extent of recovery of Bohler angle, fragment size, and state of subtalar joint. RESULTS: Clinical results according to Creighton-Nebraska health foundation assessment sheet for calcaneal fracture were excellent in 6 cases (46%), good in 4 cases (30%), fair in 2 cases (15%), and poor in 1 case (7%). Average preoperative Bohler angle was 7.6degrees (range: 2degrees~13degrees). Average postoperative Bohler angle was 24.4degrees (range: 4degrees~33degrees). There were no soft tissue complications. There were one mild subtalar arthritis and one moderate subtalar arthritis. CONCLUSION: We think that closed reduction and percutaneous Acutrak screw fixation with or without K-wire is a good option for joint depression type fracture of calcaneus.

Arthroscopic Reduction and Percutaneous Fixation of Scaphoid Fracture and Nonunion / 대한정형외과학회잡지

PURPOSE: To analyze the results of an arthroscopic reduction and percutaneous fixation of scaphoid fracture and nonunion. MATERIALS AND METHODS: Fourteen scaphoid fractures or nonunion patients were analyzed clinically. There were 13 men and 1 woman, with a mean age of 30 (14-45) years. The average follow-up time was 13 months (12-18). Three cases had delayed union, 5 cases had nonunion and 6 cases had a fracture. After fluoroscopic reduction and an arthroscopic examination, the scaphoid was fixed with an Acutrak screw or K-wire percutaneously. The serial radiographs were checked by 2 weeks to confirm the bony union. The Mayo wrist score and DASH were used to assess the functional result at the final follow up. RESULTS: Bony union was acquired in 13 cases in a mean time of 8 weeks. The mean Mayo wrist score was 86 points (60-100) with 7 excellent, 4 good, 2 fair and 1 poor case. The mean DASH was 11.1 points (0-63.3). CONCLUSION: In scaphoid fracture and delayed union, good results could be obtained by an arthroscopic reduction and percutaneous fixation. However, in scaphoid nonunion, this technique should only be used in selected cases.

Surgical Treatment of Type II Talar Neck Fractures / 대한족부족관절학회지

PURPOSE: To evaluate the clinical results and determine appropriate methods of surgical treatment about type II talar neck fracture. MATERIALS AND METHODS: Among nineteen patients who received surgical treatment for type II talar neck fracture from May 2000 to May 2005. Fourteen patients with a follow-up period of more than 1 year were divided into two groups. Six patients reduced by closed reduction (Group A) with screw fixation and eight patients reduced by open reduction with screw fixation. We analyzed preoperative, postoperative and follow-up simple radiographs and reviewed patient hospital records retrospectively. Clinical results were evaluated by Hawkins scoring system. We analyzed pain, limp, range of motion of ankle and subtalar joint. RESULTS: Five patients (83.3%) in group A and seven patients (87.7%) in group B had excellent and good clinical results. There were no complications including avascular necrosis, delayed union, nonunion. CONCLUSION: Closed reduction with screw fixation of talar neck fracture shows correct reduction and satisfactory results. But because of short term period of follow-up, we need long term results.

Closed reduction and trans-cuteneous screw and Kirschner's wire fixation to treat intercondylar fracture of humerus / 中国矫形外科杂志

[Objective]To explore the methods and effects of closed reduction and percutaneous internal fixation to treat intercondylar fractures of humerus.[Method]From 2001,3 to 2004,9 we selectively treated 6 cases(group A) of Rise-Borough Ⅱ,Ⅲ type of humeral intercondylar fractures with closed reduction and percutaneous internal fixation with hollow screw and Kirschner's wire.Others(group B) treated with opened reduction and internal fixation with plates and screws.[Result]Following up 6～12 months,the outcome were evaluated with Aitken and Rorabeek rating system.Group A:5 patients were graded as excellent,1 as good.Group B:7 patients were graded as excellent,7 as good,1 as fair,1 as poor.[Conclusion]To treat Rise-Borough Ⅱ,Ⅲ type of humeral intercondylar fractures with closed reduction and percutaneous internal fixation with hollow screw and Kirschner's wire,can decrease iatrogenic impairment,receive reliable fixation and early functional exercise.The fracture union quickly,and the patient has excellent joint function and less postoperative complication.

Treatment of tibial plateau fractures by arthroscopic reduction and percutaneous fixation / 中国微创外科杂志

Objective To investigate the effectiveness of arthroscopic reduction and percutaneous fixation (ARPF) for the treatment of tibial plateau fractures. Methods Seventeen cases of tibial plateau fractures from April 1999 to June 2002 were reviewed. The fractured tibial plateau was reconstructed by “drag-and-draw” reduction and iliac crest bone graft under arthroscope. And percutaneous cancellous bone screw fixation was conducted. Results Clinical bone union was achieved in all the patients at the third postoperative month. No infection or severe osteoarthritis occurred. Conclusions ARPF for tibial plateau fractures has advantages of reduction under direct view, reliable fixation and facilitation for early activities.