Extra articular and transcutaneous migration of the poly - l / D lactide interference screw after popliteal tendon reconstruction / Migração extra-articular e transcutânea de parafuso de interferência de poly L D - lactide após reconstrução do tendão poplíteo

ABSTRACT Knee ligament reconstructions are commonly performed orthopedic procedures. Graft fixation is generally performed with metallic or absorbable interference screws. In a recent study, only ten reports of screw migration were retrieved; of these, only one was not related to the anterior cruciate ligament, and the majority was related to the use of poly-l-lactic acid (PLLA) screws. Only one case retrieved in the literature reported screw migration in reconstructions of the posterolateral corner, and that was to the intra-articular region. In the present article, the authors report a case of extra-articular and transcutaneous migration of a poly-l/D-lactide (PDLLA) interference screw following popliteal tendon reconstruction. Besides being the first case of popliteal tendon migration with extra-articular screw migration, no reports of PDLLA screw migration were retrieved in the literature.

RESUMO As reconstruções ligamentares do joelho são procedimentos ortopédicos frequentes. As fixações dos enxertos são mais comumente feitas com parafusos de interferência, metálicos ou absorvíveis. Em estudo recente, somente dez relatos sobre migração de parafusos foram encontrados; somente um deles não estava relacionado ao ligamento cruzado anterior (LCA) e a maioria estava relacionada a parafusos de poly-L-lactic acid (PLLA). Apenas um caso da literatura reportou migração de parafuso em reconstruções do canto posterolateral, essa para a região intra-articular. Neste artigo, os autores relatam um caso de migração extra-articular e transcutânea de um parafuso de interferência de poly L,D-lactide (PDLLA) após a reconstrução do tendão poplíteo. Além de ser o primeiro caso de reconstrução do tendão do poplíteo com migração extra-articular do parafuso, não foram encontrados na literatura relatos de migração de parafusos de PDLLA.

Treatment of unstable Hangman's fractures with pedicle and lateral mass screw fixation / 中华创伤骨科杂志

Objective To investigate the technique and clinical effects of pedicle screw fixation in treatment of unstable Hangman' s fractures in comparison with the conservative managements. Methods From January 1999 to July 2005, 36 patients with unstable Hangman' s fractures were treated in our department. Based on Levine- Edwards classification, 15 of them were treated with skull traction, and others with internal fixation with posterior pedicle screws (C2,3 fusion in 10 cases and C2- 4 fusion in 11 cases). After a posterior midline incision and clear exposure of posterior structure, the C2 screw was inserted through the center of the posterior aspect of lateral mass, inclining usually 20? to 30? towards the head of the transverse plane and 25? to 35? inwards to the medial incline of the sagittal plane. For C3,C4 screw insertion, the drilling was parallel to the joint plane of the relevant vertebra and inclined 35? to 40? outwards to the medial incline of the sagittal plane. The whole procedure was performed under the monitoring of C- arm screen for safety and accuracy. Results A mean follow- up time was 18 months (5 to 28 months). 6 cases treated by skull traction lost their anatomic reduction. Of the 21 cases treated by the pedicle screw fixation, 2 had loosened internal fixation but 19 experienced no screw loosening and their fractures were cured entirely without limited function of the cervical vertebra. Conclusions In treatment of unstable Hangman' s fractures, C2,3 or C2- 4 pedicle screw fixation is an effective method to achieve rigid reduction and early rehabilitation. However, there is no remarkable difference between C2,3 fusion and C2- 4 fusion