Determination of the best point of entry of percutaneous insertion of sacroiliac screws depending on patient positioning for surgery: A cadaveric study.

BACKGROUND: The standard starting point for percutaneous sacroiliac screw insertion was initially determined at the intersection of the line posterior to the anterior superior iliac spine and the line continuing the anatomical axis of the femur. The technique was pioneered in patients lying prone in surgery, although it has been used with patients in the supine position. The optimal starting point for patients in both prone and supine positions remains uncertain. OBJECTIVES: This cadaveric study aimed to determine the best entry point for the percutaneous insertion of sacroiliac screws depending on the patient's positioning for surgery. MATERIAL AND METHODS: Kirschner wires (K-wires) were percutaneously inserted into the sacral body of 8th human cadavers. In addition to the so-called standard sacroiliac screw entry point (point A), points located consecutively 1 cm (point B) and 2 cm (point C) cranially from the point along the line, prolonging the femoral axis were also studied. The K-wires were inserted into the studied entry points on the right side in a supine position and on the left side of the same cadaver in a prone position. The placement of the K-wires was assessed using radiographic imaging and cadaver dissection. RESULTS: An analysis of the K-wire placement in the supine position revealed incorrect positioning of 100% of the K-wires inserted at entry point A and 87% at entry point B. All the K-wires inserted in the supine position at entry point C were correctly placed. All K-wires inserted in the prone position were correctly positioned. CONCLUSIONS: All 3 studied entry points enabled the correct placement of orthopedic implants for prone position surgery. The best entry point for surgery performed in the supine position was located 2 cm cranially from the standard entry point, along the line prolonging the femoral axis.

Comparison of the effect of combined usage of povidone-iodine irrigation and topical vancomycin powder to the use of povidone-iodine irrigation alone on the periprosthetic joint infection incidence rate in patients undergoing primary total hip and knee arthroplasty: a protocol for multicenter prospective randomized clinical trial.

BACKGROUND: With the increasing number of joint replacement surgeries, periprosthetic joint infection (PJI) has become a significant concern in orthopedic practice, making research on PJI prevention paramount. Therefore, the study will aim to compare the effect of combined usage of povidone-iodine and topical vancomycin powder to the use of povidone-iodine alone on the PJI incidence rate in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA). METHODS: The prospective randomized clinical trial will be conducted in two independent voivodeship hospitals with extensive experience in lower limb arthroplasties. The studied material will comprise 840 patients referred to hospitals for primary THA or TKA. The patients will be randomly allocated to two equal groups, receiving two different interventions during joint replacement. In group I, povidone-iodine irrigation and consecutively topical vancomycin powder will be used before wound closure. In group II, only povidone-iodine lavage irrigation will be used before wound closure. The primary outcome will be the incidence rate of PJI based on the number of patients with PJI occurrence within 90 days after arthroplasty. The occurrence will be determined using a combined approach, including reviewing hospital records for readmissions and follow-up phone interviews with patients. The infection will be diagnosed based on Musculoskeletal Infection Society criteria. The chi-square test will be used to compare the infection rates between the two studied groups. Risk and odds ratios for the between-groups comparison purposes will also be estimated. Medical cost analysis will also be performed. DISCUSSION: A randomized clinical trial comparing the effect of combined usage of povidone-iodine irrigation and vancomycin powder to the use of povidone-iodine irrigation alone in preventing PJIs after primary arthroplasty is crucial to advancing knowledge in orthopedic surgery, improving patient outcomes, and guiding evidence-based clinical practices. TRIAL REGISTRATION: ClinicalTrials.gov NCT05972603 . Registered on 2 August 2023.

The Association between the Extent of the Osteoarthritic Meniscus Degeneration and Cigarette Smoking-A Pilot Study.

Background and Objectives: The negative effects of smoking on the musculoskeletal system were presented by many authors, although the relationship between smoking and osteoarthritis remains unclear. The aim of this paper was to investigate the negative effects of smoking on meniscal tissue in osteoarthritic knees by microscopic examination, by adapting the Bonar scoring system and its modifications. Materials and Methods: The study involved 34 patients with varus knees, from whom 65 samples of knee menisci were obtained. The mean age in the studied group was 65.385 years. The smoking status of the patients concluded that there were 13 smokers and 21 nonsmokers. Results: Among smokers, the mean classical Bonar score was 8.42 and the mean modified Bonar score was 6.65, while nonsmokers were characterized by scores of 8.51 and 7.35, respectively. There was a statistically significant negative correlation between the number of cigarettes and the collagen in the medial meniscus (p = 0.0197). Moreover, in the medial meniscus, the modified Bonar score correlated negatively with the number of cigarettes (p = 0.0180). Similarly, such a correlation was observed between the number of cigarettes and the modified Bonar score in the lateral meniscus (p = 0.04571). Furthermore, no correlation was identified between the number of cigarettes and the classical Bonar score in the lateral meniscus. There was a statistically significant difference in the collagen variable value between the smokers and nonsmokers groups (p = 0.04525). Conclusions: The microscopic investigation showed no differences in the menisci of smokers and nonsmokers, except for the collagen, which was more organized in smokers. Moreover, the modified Bonar score was correlated negatively with the number of cigarettes, which supports the role of neovascularization in meniscus pathology under the influence of tobacco smoking.

Anatomy of the sacroiliac joint with relation to the lumbosacral trunk: Is there sufficient space for a two-hole plate?

Dislocations of the sacroiliac joint (SIJ) are treated with iliosacral screws or anterior plating. The study aimed to investigate the course of the lumbosacral trunk with reference to SIJ and determine whether is there sufficient space for two screws through the sacrum while performing anterior plating. Sixty patients, who underwent an MRI of the lumbar spine were included in our study. The three transverse LT-SIJ distances were measured at the three points (A, B, and C). We also analyzed 60 CT pelvic scans at points A, B, and C in order to measure: the vertebral canal-to-SIJ distance, the sacrum's pelvic-to-dorsal surface sagittal distance, and the median plane-to-SIJ angle. The mean transverse LT-SIJ distances at points A, B, and C were 20.0 ± 3.05 mm, 17.9 ± 3.20 mm, and 12.3 ± 2.49 mm, respectively. Based on CT analyses, the vertebral canal-to-SIJ distances were 30.5 ± 7.65 mm at point A, 21.4 ± 5.05 mm at point B and 15.7 ± 6.05 mm at point C. The sacrum's pelvic-to-dorsal surface sagittal distances reached values: 35.1 ± 11.62 mm at point A, 52.5 ± 10.58 mm at point B, and 57.5 ± 7.79 mm at point C. The median plane-to-SIJ angles measured 31.4 ± 4.82 degrees at point A, 26.6 ± 3.77 degrees at point B and 21.3 ± 3.25 mm at point C. Proximally, the safe zone for applying an anterior plate of SIJ is 20.0 mm. Since both the safe zone and safe corridor taper distally, surgeons may securely use one screw of gradually increased length towards the distal direction of SIJ, with inclination of 30 degrees in relation to the median plane of the lesser pelvis.

Safety and efficacy of two ilioiliac tension band plates osteosynthesis of fragility fractures of the pelvis.

The study retrospectively determined the efficacy and safety of fixation of the pelvis (FFP) fragility fractures type IV using two tension band ilioiliac locking compression plates. Forty-one patients with FFP were treated in 2017-2020. 16 patients with FFP type IV, unable to walk weight-bearing, were treated by fixation using two tension band ilioiliac locking compression plates without fixing the anterior ring. Preoperatively and one year postoperatively, the functional outcome and performance were assessed using Pelvic Discomfort Index (PDI) and Timed Up and Go (TUG) test. Pre- and postoperative hemoglobin level was evaluated. Operation time and intra-and postoperative complications were documented. One year postoperatively, an X-ray was taken. The arithmetic mean (x) and standard deviations (±) of quantitative variables were calculated. T-test for dependent samples was used for pre-and postoperative results comparison. The PDI improved (p < 0.001) from x = 81.42 ± 4.04 to x = 36.19 ± 15.58. Preoperatively none of the patients was able to perform the TUG test. Postoperatively, the result exceeded x = 13.13 ± 3.99 s. The operation lasted x = 42.80 ± 8.90 min. Hemoglobin decreased (p < 0.001) from 11.63 ± 1.11 to 9.07 ± 1.21 g/dL. No complications nor fixation loosening were noted. The study support fixation using two tension band ilioiliac locking compression plates as an efficient and safe treatment of the FFP type IV.

Differences in Accuracy and Radiation Dose in Placement of Iliosacral Screws: Comparison between 3D and 2D Fluoroscopy.

Percutaneous iliosacral screw fixation is a widely accepted method of stabilizing the posterior pelvic ring. Recently developed tools such as 3D-navigated fluoroscopy and computed navigation seem to prevent a surgeon from conducting screw misplacement. The study aimed to comparatively assess the introduction of sacroiliac screw placement using 2D and 3D fluoroscopy in terms of accuracy and radiation exposure. Iliosacral screws were introduced in 37 patients using 2D (group N1) and in 36 patients using 3D fluoroscopy (group N2) techniques. Overall, 61 and 56 screws were introduced in groups N1 and N2, respectively. Screw placement accuracy was assessed using postoperative computed tomography and Smith's scale. Intraoperative radiation exposure was also assessed. No differences were noted between groups in terms of screw positioning accuracy and radiation dose. Both 2D and 3D fluoroscopy provide good visualization for safely placing percutaneous iliosacral joint screws. Using 3D fluoroscopy-based navigation in comparison with 2D fluoroscopy is not advantageous.