ABSTRACT
Background: The Lane plate was one of the first widely used bone plates, utilized in the first decades of the twentieth century. Here we present the results of a retrieval analysis on a Lane plate, and a review of the history of these plates. Our patient underwent plating of her femur with a Lane plate in 1938. She developed a sciatic nerve palsy, managed surgically later that year by Dr. Arthur Steindler at the University of Iowa. Her femur healed, her nerve recovered, and she did well until 2020, at age 94, when she presented to the University of Iowa with a draining sinus that appeared to communicate with the plate. She underwent irrigation and debridement with hardware removal. The plate was sectioned, and its composition and structure characterized. Methods: We retrieved hard copies of the patient's archived medical records from 1938, which document in detail the treatments performed by Dr. Steindler. The plate was analyzed using scanning electron microscopy (SEM) to characterize the surface of the plate. A cross section was taken from the plate, and the composition of the alloy was determined using energy dispersive x-ray spectroscopy (EDS). A review of the literature surrounding early plating techniques was conducted. Results: Our patient recovered from her surgery and soon returned to her baseline state of health. Intraoperative cultures grew C. acnes. Analysis of the surface of the plate demonstrated significant corrosion, and the crystal structure seen on SEM suggested a strong alloy that is prone to corrosion. Analysis of the cross section with EDS demonstrated an alloy containing 94.9% iron, 1.7% aluminum, 1.2% chromium, and 1.1% manganese. Conclusion: The Lane plate was introduced around 1907 by Sir William Arbuthnot Lane, a British surgeon, and was one of the first widely used devices for the plating of fractures. Given that this patient was likely one of the last to be treated with a Lane plate, this may be the final opportunity for such a retrieval analysis. Level of Evidence: IV.
Subject(s)
Bone Plates , Fractures, Bone , Humans , Female , Aged, 80 and over , Alloys , Femur , Fracture Fixation, InternalABSTRACT
BACKGROUND: Septic knee arthritis is considered an orthopedic emergency due to its significant morbidity and potential to be life-threatening. One important outcome in treatment of septic knee arthritis is whether return to the operating room for repeat irrigation and debridement is required. This complication presents extra burden to the patient, as well as to the health care system. This study aims to first isolate the incidence of repeat irrigation and debridement at the authors' home institution and then define risk factors for repeat washout for septic arthritis of the knee. METHODS: Records from all patients at a single academic institution with acute septic knee arthritis who had arthroscopic or open I&D of the knee joint from January 2005-December 2015 were collected retrospectively. Patients were initially identified on the basis of diagnosis coding in the institution's medical information system. Following collection/screening based on strict inclusion/exclusion criteria, a cohort of 63 patients was ultimately included. 18 patients were assigned to a "repeat washout" (RW) cohort and 45 patients were assigned to a "no repeat washout" (NRW) cohort. Univariate analyses and multivariable regression models were performed between the two washout cohorts to identify variables associated with repeat washout. RESULTS: Patients requiring a repeat washout (RW) had a statistically significant association with African American/Hispanic race, higher BUN levels, higher serum white blood cell (WBC) count on admission, concurrent infection, and isolated bacteremia when compared to those patients who did not require a repeat washout (NRW) (all respective P < 0.05). Multivariable regression analysis demonstrated concurrent infection and higher synovium WBC count to increase the risk for another repeat washout. Patients who had a concurrent infection were shown to have nearly 12-fold higher odds of needing a repeat washout than those without a concurrent infection (95% CI:2.40-56.88; P = 0.0023). For every 1000 unit increase in synovium WBC count, the odds of needing a repeat washout increased by 1% in patients with concurrent infection (95% CI:1-2%; P = 0.0168). CONCLUSION: This study retrospectively isolated risk factors associated with repeat surgical lavage. In the multivariable regression analysis, both concurrent infection and increased synovial WBC count were significantly associated with the need for repeat knee I&D. This finding is significant, as it may signify a potential for increased infectious resilience for acute septic arthritis of the knee secondary to seeding from systemic infection, thus requiring multiple I&Ds to meet resolution. This finding may carry clinical significance in the early stages of patient counseling regarding hospital course and prognosis. LEVEL OF EVIDENCE: IV.
ABSTRACT
PURPOSE: Augmented reality has potential to enhance surgical navigation and visualization. We determined whether head-mounted display augmented reality (HMD-AR) with superimposed computed tomography (CT) data could allow the wearer to percutaneously guide pedicle screw placement in an opaque lumbar model with no real-time fluoroscopic guidance. METHODS: CT imaging was obtained of a phantom composed of L1-L3 Sawbones vertebrae in opaque silicone. Preprocedural planning was performed by creating virtual trajectories of appropriate angle and depth for ideal approach into the pedicle, and these data were integrated into the Microsoft HoloLens using the Novarad OpenSight application allowing the user to view the virtual trajectory guides and CT images superimposed on the phantom in two and three dimensions. Spinal needles were inserted following the virtual trajectories to the point of contact with bone. Repeat CT revealed actual needle trajectory, allowing comparison with the ideal preprocedural paths. RESULTS: Registration of AR to phantom showed a roughly circular deviation with maximum average radius of 2.5 mm. Users took an average of 200 s to place a needle. Extrapolation of needle trajectory into the pedicle showed that of 36 needles placed, 35 (97%) would have remained within the pedicles. Needles placed approximated a mean distance of 4.69 mm in the mediolateral direction and 4.48 mm in the craniocaudal direction from pedicle bone edge. CONCLUSION: To our knowledge, this is the first peer-reviewed report and evaluation of HMD-AR with superimposed 3D guidance utilizing CT for spinal pedicle guide placement for the purpose of cannulation without the use of fluoroscopy.
