ABSTRACT
OBJECTIVES: The current biomechanical work compares the symphyseal and sacroiliac stability obtained with two systems of bone osteosynthesis. The two methods of fixation compared were the 6-hole suprapubic non-locked plate and pubic fixation with two cannulated screws, a novel technique that can be applied percutaneously in the clinical practice. The aim of this study was to examine the validity of the use of two-cannulated-screws osteosynthesis in order to minimize the secondary effects of open fixation, especially in patients in whom an open reduction is contraindicated. MATERIALS AND METHODS: A biomechanical study was designed in 9 fresh, human pelvis specimens, simulating an AO B1.1 type injury, using both fixation systems sequentially in each specimen. In both parts of the test, the specimens were subjected to an axial load of 300N. Displacements and rotations between the different pelvic elements were studied by means of a discrete set of points. The absence of differences between the two systems has been set as the null hypothesis. RESULTS: There were significant differences in favor of the cross-cannulated screws in most of the displacements measured at the pubic symphysis and sacroiliac joint. CONCLUSIONS: Fixation of the AO B1.1 type fractures with cross cannulated screws restores the biomechanical behavior of the pubic symphysis, obtaining better stability than fixation with the 6-hole non-locked plate. To date, no comparative, biomechanical studies have been conducted with these two systems of osteosynthesis. This study demonstrates that cross-cannulated screws fixation of the pubic symphysis in AO B1.1 pelvic fractures should be considered as an alternative to the conventional plating system.
Subject(s)
Fracture Fixation, Internal/instrumentation , Fractures, Bone/surgery , Pelvic Bones/pathology , Aged , Aged, 80 and over , Biomechanical Phenomena , Bone Plates , Bone Screws , Cadaver , Equipment Design , Female , Humans , Middle Aged , Stress, MechanicalABSTRACT
INTRODUCTION: Although the gold standard in open book pelvic fractures remains the pubic symphysis (PS) plate fixation, the clinical outcomes are not satisfactory, despite the excellent anatomical reduction assessed radiologically. Some authors suggest that residual instability of the posterior pelvic elements may be responsible for the chronic pain and the early osteoarthritic changes in the sacroiliac joint (SIJ). OBJECTIVE: To evaluate whether the isolated posterior fixation with one or two iliosacral screws (ISSs) is sufficient to provide adequate stability for the treatment of Burgess Young APC-II (YB APC-II) type of pelvic ring injuries. METHODS: Biomechanical experimental study using 7 fresh human pelvises, where an YB APC-II pelvic injury was previously implemented. The isolated posterior fixation of the pelvic ring with 1 or 2 ISSs directed in the S1 vertebra body was analysed in each specimen following an axial load of 300N. The different displacement of the SIJ and of the PS were analysed in all three spatial axes, using the validated optical measurement system 3D PONTOS 5M. A multivariate version of Friedman test (non-parametric ANOVA for repeated measures) was performed. RESULTS: The isolated fixation of the SIJ with 1 ISS did not show any differences with respect to the intact pelvis (p=0.851). Regarding the PS, both type of fixations (with 1 or 2 ISSs) confirmed an acceptable correction and adequate control of the PS even though with some differences compared to the intact pelvis (p=0.01). The presence of the second ISS found not to offer any significant additional benefit. The three-dimensional analysis of the behaviour of the pelvic elements, in these two different types of fixation, did not show any statistical significant differences (p=0.645). CONCLUSION: The posterior fixation with ISS can represent an alternative option for treatment of pelvic injuries associated with rotational instability. Further prospective clinical studies are necessary to determine, the influence of the residual pubic symphysis mobility in the every day life, when the above-mentioned technique is applied.
Subject(s)
Fracture Fixation, Internal/methods , Fractures, Bone/surgery , Pelvic Bones/surgery , Pubic Symphysis/surgery , Sacrum/surgery , Aged , Biomechanical Phenomena , Bone Plates , Bone Screws , Cadaver , Female , Fractures, Bone/pathology , Humans , Pelvic Bones/injuries , Pelvic Bones/pathology , Pubic Symphysis/pathology , Sacrum/injuries , Sacrum/pathologyABSTRACT
Objetivo: valorar causas y zonas de compresión del nervio cubital en el canal de Guyon. Material y método: se realizó un estudio retrospectivo de 12 pacientes intervenidos de síndrome del túnel cubital con un seguimiento medio de 9 meses. A todos se les practicó un estudio electrofisiológico y se observó si existe relación con la presencia de síndrome de túnel del carpo. Resultados: En solo 3 casos encontramos una etiología clara de la compresión nerviosa. Existe mayor presencia de síndrome de túnel del carpo en aquellos con compresión cubital idiopática pero sin significación estadística. Conclusiones: La mayoría de las compresiones cubitales en la muñeca, bajo nuestra experiencia, son de origen idiopático. Con la cirugía existe mejoría clínica de la sintomatología
Objective: To assess causes and areas of ulnar nerve compression in Guyon's canal Methods: A retrospective study of 12 patients undergoing cubital tunnel syndrome with a mean of 9 months was performed. All we performed an electrophysiological study and found the correlation with the presence of carpal tunnel syndrome. Results: In only 3 cases we found a clear etiology of nerve compression. There is an increased presence of carpal tunnel syndrome in those with idiopathic ulnar compression but without statistical significance. Conclusions: Most of the ulnar compression at the wrist, in our experience, are idiopathic. With surgery there is clinical improvement of symptoms
Subject(s)
Humans , Male , Female , Ulnar Nerve Compression Syndromes/diagnosis , Ulnar Nerve Compression Syndromes/therapy , Electrophysiology/methods , Electrophysiology/trends , Cubital Tunnel Syndrome/complications , Cubital Tunnel Syndrome/diagnosis , Cubital Tunnel Syndrome/therapy , Retrospective Studies , Carpal Tunnel Syndrome/complications , Cubital Tunnel Syndrome/physiopathology , Cubital Tunnel Syndrome , Postoperative Period , Microvascular Decompression Surgery/methodsABSTRACT
Objetivo: Determinar si existen diferencias entre los resultados obtenidos por cirujanos ortopedas infantiles (COI) y cirujanos ortopedas generales (COG) en el tratamiento de fracturas supracondíleas de húmero en la infancia. Material y método: Revisión retrospectiva de las fracturas supracondíleas de húmero tipo III de la clasificación de Gartland intervenidas en el hospital Virgen del Rocío entre los años 2007-2011. Se obtuvieron dos poblaciones dependiendo del tipo de cirujano que llevó a cabo la intervención (COG o COI) y se realizó un análisis comparativo entre ambos de los resultados funcionales, estéticos (según los criterios de Flynn) y radiológicos (ángulo de Baumann e intersección de la línea humeral anterior con el capitellum) tras un mínimo de 12 meses de evolución. Resultados: No se encontraron diferencias estadísticamente signifi cativas en resultados funcionales, estéticos ni en los parámetros radiológico postintervención. Conclusiones: Teniendo en cuenta los resultados del presente estudio ambos, COI y COG, presentan el suficiente nivel de entrenamiento y habilidades quirúrgicas para llevar a cabo el correcto tratamiento de este tipo de fracturas. Nivel de evidencia: III
Objective: To determine whether there are differences between the results obtained by Pediatric orthopedic surgeon and General orthopedic surgeons in the treatment of supracondylar humeral fractures in children. Material and Methods: A retrospective review of Gartland type III supracondylar humerus fractures treated in Virgen del Rocio Hospital between 2007- 2011 was performed. Two populations were obtained depending on the surgeon who performed the procedure and a comparative analysis between the functional and aesthetic results according to Flynn criteria was performed, as well as a radiological analysis (Baumann angle and intersection of the anterior humeral line with the capitellum) after aminimum of 12 months of follow-up. Results: No statistically significant differences in functional, aesthetic or radiological post-intervention parameters were found. Conclusions: Considering the results of this study both Pediatric orthopedic surgeons and General orthopedic surgeons, have a sufficient level of surgical training and skills to carry out the correct treatment of these fractures. Level of evidence: III
