Posterior popliteal fossa S-shaped incision with double-window approach in treating posterior column of tibial plateau fractures / 中国修复重建外科杂志

Objective: To evaluate the effectiveness and safty of posterior popliteal fossa S-shaped incision with double-window approach for the treatment of posterior column of tibial plateau fractures. Methods: A retrospective analysis was made on the clinical data of 13 patients with complex tibial plateau fractures involving both posteromedial and posterolateral columns between May 2015 and July 2017. There were 9 males and 4 females, aged 33-64 years (mean, 46.5 years). The causes of injury included traffic accident in 5 cases, falling from height in 2 cases, falling from electric bicycle in 4 cases, and falling because of skiing in 2 cases. The preoperative range of motion of the affected knees was (35.1±9.2)°. The time from injury to surgery was 7-19 days (mean, 13.3 days). All patients underwent a posterior popliteal fossa S-shaped incision through the window of medial heads of gastrocnemius muscle (medial window) and the window between medial and lateral head of gastrocnemius muscle (popliteal fossa window) approaches. After a good visual control of fracture reduction, both posteromedial and posterolateral columns of tibial plateau fractures were fixed with buttress plate respectively. Bone union, limb alignment, articular surface, and range of motion were estimated after operation. The American Hospital for Special Surgery (HSS) score was used to evaluate functional outcomes of knees. Results: After operation, 1 patient had fat liquefaction and dehiscence of incision, which healed after expanding the wound; the other patients' incisions healed by first intention, and no vascular or nerve injury occurred during operation. All the 13 patients were followed up 12-18 months (mean, 16 months). The X-ray films showed that all patients obtained good fracture unions, the fracture healing time was 14-22 weeks (mean, 18 weeks). At 12 months after operation, the articular surface was smooth without collapse, and the knee range of motion was (109.5±13.6)°, showing significant difference when compared with preoperative value ( t=18.879, P=0.000). No complication of infection, re-displacement of fracture, or secondary varus/valgus deformity was observed during follow-up. The HSS score was 82-96 (mean, 89.6) at 12 months after operation, with the result of excellent in 10 cases and good in 3 cases. Conclusion: The posterior column fracture of tibial plateau involving both posteromedial and posterolateral columns treated by double-window approach through posterior popliteal fossa S-shaped incision is safe and effective, with satisfactory results and good recovery of knee joint function.

Application advantages and prospect of three-dimensional printing technology in the diagnosis and treatment of posterior column fracture of tibial plateau / 中国组织工程研究

BACKGROUND: Application of three-dimensional printing technology provides an effective supplementary means for minimally invasive and individualized surgery of posterior column fracture of tibial plateau. OBJECTIVE: To summarize the present situation of diagnosis and treatment of posterior column fracture of tibial plateau, and to look forward to the effect of three-dimensional printing technology in the diagnosis and treatment of posterior column fracture of tibial plateau. METHODS: A computer-based retrieval of CNKI, WanFang, and PubMed databases was conducted using the keywords of “the fracture of tibial plateau, posterior column, 3D printing technology” in Chinese and English, respectively. Totally 210 articles were retrieved, and 56 eligible articles were finally included for review based on inclusion and exclusion criteria. The detailed contents included classification of posterior column fracture of tibial plateau, surgical treatment, application status of three-dimensional printing technology and postoperative rehabilitation. RESULTS AND CONCLUSION: Posterior column fracture of tibial plateau is a special type of plateau fracture, so the traditional method may lead to misdiagnosis. However, the solid model based on three-dimensional printing can directly make diagnosis, and analyze the injury mechanism and classification. In the treatment of posterior column fracture of tibial plateau, there are various traditional surgical approaches to choose: The posterior approach (postmedial approach, posterolateral approach), backward medial inverted “L” into the approach, anterolateral/anterolateral approach, anterolateral posterolateral combined approach, arthroscopy minimally invasive treatment and so on, but have not been unified yet. The application of three-dimensional printing technology has further improved the diagnosis and classification of posterior column fracture of tibial plateau, and provides a reference for preoperative guidance of personalized surgical plan, surgical approach selection, estimation of intraoperative bone implant volume and postoperative rehabilitation.

Percutaneous Magic screw Fixation for acetabular posterior column fracture: An imaging anatomical study / 解剖学报

Objective To investigate the entry point, direction and fixation range of Magic screw for acetabular posterior column fracture. Methods The 3D models of 100 pelvis were reconstructed by Mimics 19. 0 software based on CT data, and the virtual magic screw were placed in acetabular posterior column, then the screw' s entry point were determined, and the direction, length, diameter and safe range were measured respectively. Acetabular posterior column with magic screw was osteotomy modeling by Mimics 19.0 and imported the Geomagic Wrap 2017 software, after that anatomical parameters of the screw path were measured. Results The entry point of Magic screw on bone surface was located at (33. 37±5. 53) mm of the anterior inferior iliac spine moving posteriorly, and ( 13. 40±3. 70) mm of the apex of the upper margin of acetabular moving celphalad in male, which were (33. 97±5. 46) mm and (9. 01±3. 86)mm in female. The posterior inclination angle, interior inclination angle of magic screw and the angle between screw and iliac wing were (57.40±6.57)°, (52. 09±5. 65)° and (15. 21 ±3.42)° in male, which were (55. 64±8. 01)°, ( 51. 55±5. 58)° and (9. 85±3. 68)°in female. The maximum diameter of male screw was (6. 97±0. 98) mm, which was (6. 39±0. 85) mm in female. The length of male screw was (76. 73±9. 20) mm, which was (63. 64±8. 37) mm in female. The safe range of posterior inclination and interior inclination of were ( 7. 19 ± 3. 30)° and (9. 41 ±3. 95)° in male screw with 5.5 mm diameter, which were (8. 37±2. 82)° and ( 10. 32±3. 93)° in female screw with 5. 2 mm diameter. In the direction of the screw, the length range of the posterior column which is fixed by screw was (56. 87±7. 60) mm, and the proportion of fractures fixed with screws which were located on the top of the acetabular was 20/50 in male, which were (41. 71±7. 97) mm and 8/50 in female. Conclusion Percutaneous Magic screw is a minimally invasive treatment for acetabular posterior column fracture, which is difficult to operate. The screw can fix the fracture which is located at the middle and upper part of the acetabular posterior column.

Image anatomy of percutaneous retrograde screw fixation of acetabular posterior column / 解剖学报

Objective To investigate the position, direction and fixation range of retrograde screw of the posterior column of acetabulum based on CT data. Methods Totally 100 cases (50 males, 50 females) of normal adult pelvic CT data were collected from the First Affilated Hospital of Chongqing Medical University. The pelvis was reconstructed by Mimics 17. 0 software and imported into Geomagic Studio 2015 software. The virtual screw was placed in the posterior column from the ischial tuberosity to the iliac fossa, the maximum diameter, the entrance point, the exit point, the direction, safe fixation inclination angles of the screw were measured. The range of the screw fixing, the best fluoroscopic views and the easy-to-penetrate site of the screw in the posterior column were assessed. Results The safe corridor the posterior column of the acetabulum was similar to the "triangular prism" shape. The entrance point was located on the midline of the medial edge and lateral edge of the ischial tuberosity, which were ( 12. 99±1. 99) mm in male and ( 13. 26±2. 58) mm in female from farthest end of the ischial tuberosity. There were no stitistical significant differences between male and female ( P > 0. 05). The exit points was located at the iliac fossa, which were (23. 65 ± 2.42) mm in male and ( 24. 94 ± 2. 39) mm in female to the ipsilateral anterior sacroiliac joint line,and ( 19. 33±2. 60) mm in male and (17.63±2.00) mm in female to the arcus marginalis. The maximum diameters of screw were ( 17. 21±1. 41) mm in male and ( 15. 54±1. 51) mm in female. The angles between screw and coronal plane were ( 15. 00±4. 92)° in male and ( 12. 94±4. 72)° in female; the angles between screw and sagittal plane were ( 10. 52 ± 3. 04)° in male and ( 7. 72 ± 2. 99)° in female. The abore data had statistially significant differences between male and female ( P < 0. 05). Percutaneous retrograde screw could fix the acetabular posterior column fracture that below the 4. 0 cm proximal the horizontal plane of the femoral head center. The easy-to-penetrate sites were the junction of the acetabular posterior wall and the sciatic branch ,the middle part of the acetabulum, and below I. 0 cm of the highest point of greater sciatic notch. The tangential position of three lateral faces of the "triangular prism" were ilium oblique position 10° , the ilium Oblique position 60° and obturator Oblique position 60°. Conclusion The entrance point of the retrograde screw is located on the midline of the ischial tuberosity, which is 1. 3 cm from farthest end of the ischial tuberosity and the direction is forward inclination about 15° , external inclination about 10°. The acetabular posterior column fracture that below 4. 0 cm proximal plane to the femoral head center can be fixed by the retrograde screw.

Placa infrapectínea para reparación con mínima invasión de fracturas de lámina cuadrilátera acetabular: descripción de un nuevo implante y acceso paramedial / Infrapectineal Plate for repair with minimal invasion of quadrilateral blade acetabular fractures: description new implant and paramedial access

Resumen: Introducción: Las fracturas de la lámina cuadrilátera del acetábulo son las más difíciles de reducir y fijar. Se han desarrollado diferentes técnicas para la osteosíntesis de la lámina cuadrilátera. El objetivo de este trabajo fue crear implantes y un nuevo acceso quirúrgico para simplificar y mejorar la osteosíntesis de fracturas del acetábulo. Material y métodos: Un total de 83 pacientes fueron estudiados mediante la tomografía axial computarizada de ambos acetábulos, siendo medidos a nivel de columna posterior alta y baja con el fin de determinar longitud y diámetro de los implantes, a través del análisis de normalidad de variables, dónde p es > 0.05, usando la prueba Kolmogorov-Smirnov (Lilliefors). Las características anatómicas del nuevo acceso quirúrgico también se describen. La incisión se practicó en espécimen cadavérico para determinar la seguridad de todo el acceso. Resultados: El par de tornillos macho-hembra midió 20 x 6 x 8 mm (longitud, diámetro interno y de la cabeza), mientras que las placas fueron de 10 mm de ancho y 3 mm de espesor, con longitud correspondiente al número de orificios. Se desarrollaron instrumentos apropiados para su aplicación. Discusión: Este método puede facilitar la osteosíntesis del acetábulo. Se requieren estudios cadavéricos y clínicos para corroborarlo. Puede ser que se mejoren los resultados de osteosíntesis del acetábulo, con menor riesgo.

Abstract: Introduction: Quadrilateral plate fractures are the most difficult to reduce and fix. Different techniques have been developed for quadrilateral plate osteosynthesis. The objective of this work was to create an implant and a novel approach to simplify and improve acetabular fracture osteosynthesis. Material and methods: A total of 83 patients were studied. Pelvic CT scan images of both acetabula were measured at the proximal and distal posterior column. Implant length, diameters and morphological characteristics were determined. The anatomical features of a novel surgical approach are described. The paramedian approach was performed on a cadaveric specimen to determine its anatomical safety. Results: The screws measured 20 × 6 × 8 mm (length × core diameter x head diameter), with internal threads of 4.5 mm. The Kolmogorov-Smirnov (Lilliefors) test was used, where p had to be > 0.05. Plates were previously determined to be 10 mm wide and 3 mm thick, of variable length. Instruments were developed to surmount difficulties. Discussion: This new procedure and implant could make the repair of acetabular fractures easier and offers several advantages. Clinical trials are needed to assess the benefits of this proposal. The newly described method can allow acetabular fracture osteosynthesis to be performed safely, avoid iatrogenic injury to anatomical structures and achieve better results.

Principios quirúrgicos en fracturas de platillos tibiales con compromiso de columna posterior / Surgical principles in posterior column tibial plateau fractures

Las fracturas de platillos tibiales son lesiones complejas que incluyen una variedad de patrones morfológicos cada vez mejor caracterizados en la literatura. Históricamente, los esquemas de clasificación se han basado en evaluar los rasgos de fractura en el plano frontal y las técnicas quirúrgicas en lograr la fijación de esos fragmentos, sin tomar en consideración el compromiso óseo que ocurre en la región posterior de los platillos tibiales. Con el advenimiento de la clasificación columnar basada en tomografía computada, se han logrado desarrollar estrategias de fijación optimizada, dando cada vez más relevancia a la columna posterior. Este artículo realiza una revisión extensa de la literatura, otorgando los fundamentos quirúrgicos que explican la importancia del tratamiento específico de la columna posterolateral y posteromedial, con el fin de restablecer la biomecánica normal de la rodilla y el razonamiento quirúrgico de las diversas vías de abordaje específicas para una reducción y osteosíntesis satisfactoria de esos fragmentos.

Tibial plateau fractures are complex injuries which include a variety of morphological patterns that have been increasingly better characterized in the literature. Historically, classifications have focused on description of fracture patterns in the frontal plane, while surgical techniques have focused on reduction of these fragments not considering the osseous defects that occur on the posterior region of the tibial plateau. With new CT scan column based classifications, strategies to optimize fixation have been developed, giving relevance to the posterior column. This article is an exhaustive review of the literature, providing the surgical foundations that explain the importance of specific treatment of the posterolateral and posteromedial column, aiming to restore normal knee biomechanics. Furthermore, this article provides the diverse specific surgical approaches rationale for a satisfactory open reduction and internal fixation of these fragments.

Effect of posterior column stability and decompression on the treatment of lumbar burst fracture with nerve injury and its influence on vertebral body and neurological function / 中国综合临床

Objective To explore the effect of posterior column stability and decompression on the treatment of lumbar burst fracture with nerve injury and its effect on vertebral body and neurological function.Methods Fifty-two cases patients of lumbar burst fracture with nerve injury from February 2005 to July 2014 in Affiliated Hospital of Youjiang Medical College For Nationalities were selected as the research objects and divided into retention group(28 cases) and non-retention group(24 cases) according to the choice of operation method.The surgical clinical efficacy,the changes of the vertebral body and nerve function were compared between two groups.Results At 3 months,6 months and 12 months after operation,the fusion rate,sagittal diameter and the height of the injured vertebral body,pre-vertebral body,and intervertebral space were all significantly increased,while the Cobb angle,the pressure area and the sagittal displacement rate were markedly decreased(F of inner grouP=10.492,8.858,7.432,16.311,19.491,10.329,21.587;P0.05).After operation,the ASIA grade gradually improved,neurological function of the retention group recovered at 6 months after surgery,while non-retention group presented this effect at 12 months after surgery,moreover,at 12 months after operation,the proportion of E grade in retention group was 64.29%,higher than that of non-retention group(45.83%,F=12.758,P<0.001).The levels of neuron-specific enolase(NSE),S100B protein and myelin basic protein(MBP) in retention group were significantly lower than those of the non-retention group at 3 months after surgery(P<0.05).The improvement of S100B and MBP in the reservation group at 6 months after surgery were better than those of non-retention group,while at 12 months after surgery,only the improvement of MBP in retention group showed the better effects than non-retention group.Conclusion Posterior column stability and decompression show a high clinical efficacy on the treatment of lumbar burst fracture with nerve injury and it can significantly improve the vertebral body and neurological function.

Treatment of posterior column fracture in tibial plateau injury / 中华创伤骨科杂志

Objective To describe the operative procedures.fracture patterns and clinical outcomes of treatment of posterior column tibial plateau fractures.Methods From February 2005 to August 2006,36 patients with posterior column tibial plateau fracture were operated on.Twenty patients were treated with open reduction and buttress plate fixation via a posterior approach.They were 13 males and 7 females,with a mean age of 38.5(ranging from 29 to 52)years.The other 16 patients were operated on via anterior plus posterior approaches.They were 11 males and 5 females,with a mean age of 37.3(ranging from 27 to 49) yeam. Results All were followed up for an average of 14.5(ranging from 12 to 15)months.All frac- tures got united with an average radiographic bone union time of 15.7(ranging from 11 to 16)weeks and an average full weight-bearing time of 17.6(range from 13 to 21)weeks.The mean HSS(The Hospital for special surgery)score of all these patients at 12 months postoperatively were 83.4(ranging from 68 to 92). There were 1 case of inferior medial genicular vessel injury during the operation,1 wound dehiscence and 1 partial incision necrosis postoperatively which were all eventually healed with conservative treatments.Three cases of numbness within the posterior lower part of the calf occurred postoperatively.No screw toggle,slide, dislodging or fixation failure was found during follow-up.There were no significant differences both between TPA and PA on radiographies and between immediately after operation and 12 months psstoperatively. Conclusion Open reduction and internal fixation with buttress plates via a posterior or anterior plus posterior approaches is appropriate for treatment of posterior column tibial plateau fractures.

Hepatic Myelopathy Involving the Posterior Column

Hepatic myelopathy is a rare neurological complication of chronic liver disease, and is characterized by a progressing spastic paraparesis without any sensory loss. However, a few recent reports suggest that involvement of the sensory system is also possible in hepatic myelopathy. We present a patient with hepatic myelopathy, who had impaired proprioception and a delayed cortical response of somatosensory evoked potentials. This supports the hypothesis that hepatic myelopathy may involve the sensory system as well as the motor system.

Distribution and Patterns of Posterior Column Injury in Flexion-Distraction Injuries of Thoracolumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of the distribution and patterns of posterior column injury in flexion-distraction injuries of the thoracolumbar spine. OBJECTIVES: To recognize the various types of posterior column injury in terms of the path of the distraction force in flexion-dis-traction injuries of the thoracolumbar spine. SUMMARY OF LITERATURE REVIEW: As posterior column injuries are associated with instability of the spine, many authors have described and classified posterior column injuries. However, there are no descriptions or classifications in terms of the path of the distraction force in the literature. MATERIALS AND METHOD: The preoperative plain X-rays, axial CT, MRI (in 5 patients) and operation records of 34 patients were reviewed in relation to the patterns of posterior column injury. RESULTS: Posterior column injuries can be classified into two main types. In Type I(30/34), the distraction failure started from the spinous process one level above the fractured body (Type IA) or the posterior ligament complex between the spinous processes of the fractured and the level above (Type IB). In Type II(4/34), the distraction failure started from the spinous process of the fractured vertebra and from the interspinous ligament between the fractured level and the level below. CONCLUSIONS: Posterior column injuries can be described according to their starting point and the extent of the distraction force. Of these, Type IB was the most common. Using this classification, the injury of the posterior column in injuries of the thora-columbar spine fracture can be predicted.

Burst Fracture with Distraction Injury in the Posterior Column of the Thoracolumbar Spine / 대한정형외과학회잡지

PURPOSE: To evaluate the characteristics of burst fracture with distraction injury of the posterior column and provide diagnostic information categorizing thoracolumbar fractures causing instability. MATERIALS AND METHODS: Twenty-one patients with a thoracolumbar burst fracture and posterior column injury, as confirmed by radiogram or MRI were included in this study. To evaluate clinical features, the characteristics of the injury mechanism and the physical findings were reviewed. The degree of kyphotic deformity, compression ratio and canal encroachment were measured. RESULTS: The group consisted of ten men and eleven women with a mean age of 39.3 years. The most common cause of injury was a fall from height in 14 cases. A superficial tenderness was noted in all cases. Of twenty-one patients, eleven had an associated spinal fracture. Kyphotic deformity, compression ratio and canal encroachment were 19.9o, 23% and 14% in an average, respectively. CONCLUSION: Our data demonstrated that burst fracture with distraction injury of the posterior column has no remarkable radiographic parameter despite the associated significant instability. This finding suggests that the index of suspicion for this type of injury is important, and physicians should be aware of the integrity of the posterior column.

Analysis of Danger Zone of the Posterior Column of Acetabulum and Morphological Data of the Isehial Tuberosity / 대한정형외과학회잡지

Ten emhalmed cadaveric adult bony hemipelvis specimens were ohtained to evaluate the configuration of the posterior column of acetabulum and to find a safe path for screw placement into it as well as to report on the morphological data of the ischial tuherosity and to determine the most optimaI technique for ischial tuberosity screw placement for open reduction and internal fixation of posterior acetabular fracture. Cadaveric studies were performed analyzing icm cross-sections through the acetabulum for the purpose of studying the anatomical configuration of the danger zone. The plane of the cross-section was perpendicular to the posterior column. Each cross-section had the medial boundary ot the acetabulum projected onto the posterior column. By analysing the projections on the posterior column, the exact configuration of the danger zone was determined. In this study, the average width of the posterior column at the mid-acetabular Ievel was 3.9cm. Computed tomography scan of the acetabulum yielded valuable int'ormation regarding screw placement in the posterior column. The average width, height and depth of the ischial tuberosity were 25.7 mm, 33. 1 mm and 31.7mm, respectively. The average angles hetween the posterior and medial aspects and hetween the posterior and lateral aspects of the ischial tuherosities were 79.5degreesand 111.5degrees, respectively. The entry point of the screw should be Smm or 10mm medial to the lateral margin of the ischial tuherosity and the screws should be directed 35-40degrees, 45-50degrees and 50-55degrees caudally at the level of the inferior acetahular margin and lcm and 2cm below it, respectively. to obtain the most favorable bony purchase.

THE OPTIMAL COMPUTER AIDED DESIGN FOR LAG SCREW INTERNAL FIXATION IN THE POSTERIOR COLUMN OF THE ACETABULUM / 解剖学报

Objective To investigate a special optimized technique for computer aided measure,and provide an anatomical basis for the placement of lag screw in the posterior column of the acetabulum. Methods Eighty accurate hemi-pelvis models were reconstructed from 40 CT data sets.The optimization objective function,for improving the placement of lag screw,was built by adaptively sampling the weighted distance of screws to the acetabulum boundary according to surgical requirements,and the two end points of the screw were modified iteratively to reduce the objective value under constraints.The statistical measure data were provided according to new anatomical reference landmarks for clinical use. Results The optimal entry point for lag screw fixation in the posterior column was located(18.90?1.19) mm above the line connecting the anterior borderline of the sacroiliac joint with the notch between the anterior superior iliac spine and the anterior inferior iliac spine,and the connecting line was divided by the perpendicular project point with a proportion of 2∶3.The mean inclination of the lag screw was(85.99?2.04)? for angle with the line connecting the entry point with the notch between the anterior superior iliac spine and the anterior inferior iliac spine,and(37.54?1.55)? for angle with the line connecting the entry point with the perpendicular project point;the mean length of the lag screws in the posterior column was(133.07?3.22)mm.Conclusion The automatic optimized technique for the computer aided measure is very efficient and has many advantages over the conventional manual dissection methods,and is convenient to design new anatomical reference landmark systems for clinical use.