A prospective comparative study between percutaneous cannulated screws and Kirschner wires in treatment of displaced intra-articular calcaneal fractures.

PURPOSE: Several minimally invasive procedures were used to treat displaced intra-articular calcaneal fractures (DIACFs). No agreement among different authors about either the ideal fixation method or which technique is minimally invasive. The aim of this study was to compare functional and radiographic outcomes of two minimally invasive techniques in treatment of Sanders type II and III DIACFs by using K-wires or cannulated screws without bone grafts. METHODS: A prospective randomized controlled study was conducted on 28 patients (34 feet) with Sanders type II or III DIACFs, treated by closed reduction and fixation using cannulated screws or K-wires, at the Orthopedics Department of Sohag University Hospital, between April 2020 and February 2022. Functional assessment was done by American Orthopedic Foot and Ankle Society (AOFAS) score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler's, and posterior facet inclination angles) and three calcaneal distances (height, length, and width of the calcaneus). RESULTS: Mean ages of patients at the time of operation were 34.8 years for the cannulated screw group and 36.6 years for the K-wire group. A vast majority of patients were males (78.6%). Involvement of the right side in the cannulated screw group was 57.1% and that in the K-wire group was 47.9%. Mean operative time was significantly shorter among the K-wire group (42 min) compared to the cannulated screw group (57 min). Mean AOFAS score was higher among the cannulated screw group (85.9 points) compared to the K-wire group (75.8 points). Final VAS was significantly better among the cannulated screw group compared to the K-wire group. Mean time of radiographic union in the cannulated screw group was 8.9 weeks and that in the K-wire group was 10.1 weeks. CONCLUSION: Both techniques avoided wound complications associated with ORIF with the advantage of a shorter hospital stay. Patients in the cannulated screw group had better functional and radiographic outcomes and a lower rate of subtalar arthritis than patients in the K-wire group. K-wires had advantages of reduced operative time, and easy removal as an outpatient procedure.

One sacroiliac screw for posterior ring fixation in unstable pelvic fractures.

Unstable pelvic injuries are considered uncommon and they are usually associated with high rate of morbidity and mortality. High energy blunt trauma and falling from height are usually the main mechanism of injury. It is a retrospective study that was performed in academic level I trauma center. From September 2015 to December 2019, a consecutive series of 26 patients (7 females), with average age of 32 years with unstable pelvic fracture were included in this study. All patients underwent reduction and percutaneous fixation with one sacroiliac screw posteriorly for each sacroiliac joint and anterior arch fixation of the pelvic ring with either platting or external fixator. The average duration of follow up was 36 months. Clinical results: at the final follow-up, all patients had complete radiological healing of the fractures. The subjective functional assessment yielded excellent for twenty-two patients, good for two patients and fair for two patients. Posterior arch fixation of the pelvic ring with one sacroiliac screw beside anterior arch fixation in unstable fracture pelvis is a sufficient fixation method to maintain the requiring stability to allow complete union of the fracture. Level of Evidence: Therapeutic Level III.

Repair of Traumatic Avulsed Achilles Tendon using Double Cerclage Trans-calcaneal Stainless Steel Sutures: Prospective Study and Review of Literature.

INTRODUCTION: Achilles sleeve avulsion results in a direct disruption of the triceps surae-calcaneal complex from its insertion. It represents a surgical challenge to all orthopedic surgeons as a little tissue is available for direct repair of the achilles tendon into its insertion. Methods of fixation include suturing of the avulsed bone fragment, screw fixation, tension band wiring and suture anchors. In this study, we will present a new technique for repairing of the achilles sleeve avulsion injury using double cerclage stainless steel sutures. PATIENTS AND METHODS: Seven patients with sleeve avulsion of the achilles tendon were included in this study. Only post traumatic cases were involved. Repair of the avulsed tendon using double cerclage stainless steel sutures had been done for all patients. Postoperatively all patients had below knee cast for 4 weeks. Physiotherapy started after cast removal. Patients were followed at 3, 6, 12, 24 months. Pain was measured using VAS score. The AOFAS score was measured at the last follow up. RESULTS: All patients were followed for at least 24 months. Six males and one female were included in this study. The mean time for returning to work was about 15 weeks. One complication (delayed wound healing) occurred in one patient and healing was well after treatment with antibiotics and continuous dressing. The AOFAS score was excellent for six patients and good for one patient. CONCLUSION: Double cerclage stainless steel sutures can be used safely to treat patients with achilles sleeve avulsion fracture with a satisfactory clinical outcome.

Transforaminal Lumbar Interbody Fusion With Local Bone Graft Alone for Single-Level Isthmic Spondylolisthesis.

BACKGROUND: A retrospective study of patients treated by transforaminal lumbar interbody fusion (TLIF) with local bone graft alone for single-level isthmic spondylolisthesis (IS) between April 2009 and July 2014 in a single facility. METHODS: Demographic and operative data, complications, preoperative and postoperative clinical records, and radiographs were revised. The Visual Analogue Scale (VAS) and Denis Work Scale were used for clinical and functional assessment. Modified Lee et al. classification was used for assessment of union. RESULTS: Twenty-three patients with mean age of 45.04 ± 7.19 years had single-level TLIF with local bone graft alone for symptomatic IS with mean follow-up period of 28.39 ± 4.01 months and mean operative time of 170.09 ± 11.22 minutes. The VAS and Denis Work Scale improved from 8.48 ± 0.58 and 4.67 ± 0.47 preoperative to 2.91 ± 1.25 and 1.33 ± 0.58 at the latest follow up, respectively. Anterior vertebral translation improved from 27.22 ± 9.54% preoperatively to 8.38 ± 3.63% postoperatively and 10.39 ± 3.49 at the latest follow up. Disc space height was 9.67 ± 5.55% preoperatively, 21.60 ± 4.11% postoperative, and 16.24 ± 4.02% at the latest follow up. Lumbar lordosis improved from 29.39 ± 10.33° to 45.13 ± 6.84° postoperatively and 39.96 ± 7.52° at the latest follow up. Eighteen patients had definitive union, 4 patients with possible union, 1 patient with possible pseudoarthrosis. CONCLUSIONS: Transforaminal lumbar interbody fusion with local bone graft alone is an appropriate option for single-level IS, yet we do not recommend it for higher grades of slippage with anterior vertebral translation more than 25%.