Modified tension band wiring technique by safely inserting K-wires in olecranon fracture osteosynthesis.

AIM: The present study presents the results of a modified tension band technique by surgically inserting K-wires to treat olecranon fractures. MATERIALS AND METHODS: The modification includes inserting the K-wires from the olecranon's upper tip and directing them to the ulna's dorsal surface. Twelve patients (three males and nine females) from 35 to 87 years of age were operated for olecranon fracture. After the standard approach, the olecranon was reduced and fixed with two K-wires from the tip to the dorsal ulnar cortex. Then the standard tension band technique was carried out. RESULTS: The average operating time was 17.25±3.08 min. No image intensifier was used since the wires' discharge was either visible, penetrating the dorsal cortex, or palpable through this area's skin. The time needed for the bone union was six weeks. In one female patient, the wires were cut out. This patient showed a satisfactory painless range of motion (ROM) of the elbow but did not achieve full ROM. However, this particular patient had a previous removal of the radial head, and she spent some time in the ICU intubated. The modified technique used here is as stable as the classic operation, and it is safe since there is no risk of injuring the nerves and vessels of the olecranon fossa. There is less or no need for an image intensifier. CONCLUSION: The outcomes of the present study are entirely satisfactory. However, many patients and randomized studies are needed to establish this modified tension band wiring technique.

Biomechanical testing of a shape memory alloy suture in a meniscal suture model.

PURPOSE: The purpose of this study was to evaluate the biomechanical results of meniscal repair in vitro by a nitinol suture and compare them with Ethibond (Ethicon, Somerville, NJ) and nylon. METHODS: The 6 testing groups consisted of nitinol, Ethibond, and nylon sutures (No. 2-0 and No. 3-0). Sixty bovine menisci with a vertical longitudinal tear were repaired with 1 horizontal mattress suture and were fully immersed into a water bath, adjusted to a tensile testing machine. All specimens were subjected to tensile testing, and force/displacement curves were obtained. Load to 5-mm gap, load to failure, tensile strength, stiffness, and mode of failure for each suture group were recorded. Statistical analysis included analysis of variance with Bonferroni correction for the post hoc multiple comparisons. RESULTS: Nylon sutures achieved the lowest scores in all measurements. Nitinol achieved better scores, but not significantly better scores, than Ethibond in load to 5-mm gap and stiffness. The No. 2-0 and No. 3-0 nitinol suture repair showed the highest mean tensile strength and load to failure, with significant differences, being 36% and 45% stronger, respectively, than Ethibond. Modes of failure included pulling through the inner segment of meniscus and rupture of the suture at the knot. CONCLUSIONS: This study shows the superior load-to-failure and tensile strength characteristics of nitinol. However, in terms of stiffness and gap resistance force, the results were equivalent to those of Ethibond. Nitinol is an interesting and promising suture. CLINICAL RELEVANCE: Nitinol can be elongated and become soft and flexible for proper suturing at low temperature. At body temperature, it can contract to its original length, providing stronger knots. This may result in more efficient primary stability of meniscal repair, minimizing the chances of loosening during healing and allowing earlier rehabilitation.

Repair of achilles tendon rupture under endoscopic control.

PURPOSE: To evaluate the functional outcomes and complications after endoscopically assisted percutaneous repair of Achilles tendon rupture. METHODS: An arthroscopically assisted percutaneous repair was performed in 20 patients between the ages of 28 and 47 years. Two patients were suffering from a long-standing rupture. Follow-up was 2.5 years. Evaluation entailed Merkel's scale for pain, functional load (weight) bearing capacity, and the heel raise test. For statistical analysis, a random effects Poisson regression model was used. RESULTS: All patients achieved good to excellent outcomes. The median score on Merkel's scale was 600. All patients were able to stand on the tiptoe of the operated leg and none had limitations placed on their daily activities. A 12% decrease in maximum torque and 16.5% decrease in work performance of the injured side were noted. There was no statistical significant difference in the heel raise test between the operated and non-operated leg. No wound problems, re-ruptures, or infections were reported. Two patients (10%) had sural neuralgia; in 1 case, it subsided without further treatment. CONCLUSIONS: Endoscopy in percutaneous Achilles tendon repair is useful in determining the initial gap and providing adequate apposition of the tendon ends. It is a safe technique with good outcomes and minimal complications. Despite its promising results, potential problems include sural neuralgia and some decrease in strength.

Rejection reaction to stabilizing bolts after ACL reconstruction: a case report.

A case of an adverse reaction to the stabilizing bolts after an ACL reconstruction is presented. A 21-year-old patient had an ACL reconstruction using the Mark II system. Six months post op, he presented to clinic having formed a pretibial swelling with serous discharge. There was mild tenderness over the femoral scar. Successive cultures of the tibial cyst effluent showed no microorganism growth and laboratory tests were normal. One year post op, symptoms and swelling persisted. X-rays showed periosteal reaction around the femoral bolt and resorption with widening of the distal tibial tunnel. An adverse reaction to the bolts was suggested as the possible cause. Surgical exploration was then performed. During the operation, free fluid evacuated from the femoral site and the tibial cyst was completely excised. All specimens were sent for culture, which were proven negative. Tibial and femoral bolts were both removed and no communication of the osseous tunnels to the joint was found. An arthroscopy was performed at the same time which showed degeneration of the ACL autograft, but an otherwise normal joint. Eighteen months later, the patient was symptom free and all inflammation indices still within the normal range.