ABSTRACT
INTRODUCTION: Difficulties encountered during removal of implants present a common technical challenge in orthopedic surgery, for which a number of factors have been implicated. A variety of techniques and instruments have been used to overcome this. However, some of these may prove to be time consuming, expensive, and inaccessible to many surgical setups. We describe a technique used for the removal of a jammed interlocking screw from an intramedullary nail that allows for minimal damage to the hardware, bone, and surrounding soft tissue, with the added advantage of being relatively quick and technically uncomplicated with the use of simple instruments. CASE REPORT: We describe the case of an 81-year-old female with a history of surgical fixation for a left femur intertrochanteric fracture, who presented with groin pain 13 months post-fixation. Radiographs were suggestive of avascular necrosis of the femoral head with resultant cut-in of the blade, and the patient was eventually taken up for the removal of implants and total hip replacement. Intraoperatively, difficulties were encountered in the removal of the distal interlocking screw, with failure of conventional techniques initially. A high-speed burr was then employed to shape the screw head so as to achieve better grip with extraction devices, which facilitated smooth removal. CONCLUSION: We describe a simple method for difficult screw removal involving the use of a high-speed burr and vise grip pliers. This technique provides a quick and inexpensive option with commonly available surgical tools and may be considered when encountering difficulties with screw extraction.
ABSTRACT
Obesity is associated with a greater prevalence of symptomatic knee osteoarthritis. Obese patients are thought to have worse outcomes following unicompartmental knee arthroplasty (UKA).The aim is to compare clinical and functional outcomes of UKA in obese to non-obese patients. A systematic review on six databases (PubMed, MEDLINE, Embase, Web of Science, Scopus, and CENTRAL) from inception through July 2020 was performed. We extracted data to determine revision risk (all-cause, septic, and aseptic), complication risk, and infection risk, functional outcome scores (Knee Society Score [KSS], Oxford Knee Score [OKS], and range of movement [ROM]) in patients with obesity (BMI >30kg/m2) to non-obese patients (BMI <30kg/m2). Meta-analysis was performed using a random effects model. The MINORS criteria was used for quality assessment. Twelve of 715 studies were eligible. Compared with non-obese patients, obese patients had a higher risk ratio for all-cause revision (RR 1.49; 95% CI 1.04 to 2.13; p = 0.03); aseptic revision (RR 1.36; 95% CI 1.01 to 1.81; p=0.04) and complications (RR 2.12; 95% CI 1.17 to 3.85; p=0.01). No significant differences were found in risk of septic revision and overall infection. Obese patients also had lower KSS scores (MD -3.21; 95% CI -5.52 to -0.89; p<0.01), OKS scores (MD -2.21; 95% CI -3.94 to -0.48; p=0.01), and ROM (MD -7.17; 95% CI -12.31 to -2.03; p<0.01). The average MINORS score was 14.2, indicating a moderate quality of evidence. In conclusion, the risk of revision, aseptic revision, and complications are higher in obese patients. The clinical significance of a lower functional score in obese may not be appreciable. Despite the greater risks, there is no conclusive evidence that obesity should be a contraindication to UKA. Further studies are required to corroborate the current conclusions with higher-quality study designs.
