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Vascularized bone grafting and herbert screw fixation of scaphoid nonunions with avascular proximal poles.

Nonunion of the fractured scaphoid can present a difficult surgical problem, especially in fractures near the proximal pole. The incidence of nonunion is greater in this region, in which the vascularity of the proximal fracture segment is compromised and the proximal fragment is small and resists rigid fixation. Recent development of better vascularized bone grafting techniques has provided a tool with which to address this vexing problem. Because many authors had previously shown the advantage of rigid fixation in obtaining scaphoid union, it seemed advantageous to us to combine these two met

Autologous bone grafting without screw fixation for tibial defects in total knee arthroplasty.

We evaluated 30 knees with autologous bone grafts, performed without screw fixation, for tibial defects in total knee arthroplasty (TKA). The tibial defects were classified into three types: contained, flat peripheral, and slant peripheral. The resected femoral condyle was fixed with a combination of bone cement and the tibial component, without using screws. The patients were followed for an average of 6 years and 10 months. In all knees except 1, the grafted bone united and formed good continuity with the tibial floor. Autologous bone grafting without screw fixation is a simple and effective

The effect of infection and lag screw fixation on the union of membranous bone grafts in a rabbit model.

Infection complicating craniofacial procedures contributes significantly to patient morbidity and health care costs. The role of fixation materials in this setting remains unclear. As foreign material, does fixation hardware increase patients' susceptibility to developing postoperative infection? Furthermore, once infection is established, should fixation hardware be removed? To answer these questions, we performed an onlay membranous bone grafting procedure to the mandible in 94 New Zealand White rabbits, applied lag-screw fixation in half the animals, and inoculated the wounds with different

The operative treatment of craniosynostosis using bone plate and screw fixation (titanium micro system).

Two cases of craniosynostosis treated with the new titanium micro system for the skeletal fixation are described. Mechanical and physical characteristics of the system (biocompatibility, high strength, malleability, possibility of adequate stabilization) are discussed. Aesthetic and functional outcomes are evaluated.

[Treatment of fractures of the carpal scaphoid with Herbert's bone screw. Review of 21 clinical cases].

Twenty-one patients with scaphoid fractures treated by internal fixation with the Herbert screw are reviewed. Nine patients presented acute fractures and twelve had fractures with delayed or non-union. The results of these two kinds of lesions are analyzed following the criteria established by Herbert and Fisher in 1984. This type of internal fixation gives excellent results in isolated lesions of the scaphoid provided it is correctly executed.

Modifications of the distal metaphyseal osteotomy to better facilitate use of the Herbert bone screw for fixation.

The Herbert bone screw was initially developed for management of fractures of the carpal scaphoid. Due to its unique features, the applications of this rigid internal fixation device have been expanded. The most common use of the Herbert screw in podiatric surgery has been for fixation of the Austin osteotomy of the first metatarsal head, for correction of hallux abducto valgus. Technical difficulties encountered in this procedure may have discouraged its use or led to discontinuance. These problems are addressed, and modifications in technique are suggested. The most important modification in

[The place of osteosynthesis with screwed up metallic plates in the treatment of the shaft fractures of the forearm bones].

The modern findings regarding the biomechanics of the forearm call for an as perfect as possible reduction of the fractures at this level. That is why, especially in adults, the surgical treatment is gaining more and more ground. In this context the osteosynthesis with screwed up metallic plates, preferably with compression, any time the local situation allows, it, represents the method of choice. In the 333 cases operated upon during 1971-1980 it has offered us full satisfaction. The taping with Küntscher nail was indicated--especially in the past--only in some fractures of ulna, mainly in th

Comparative biomechanical analysis of equine accessory carpal bone fracture repair: Cortical screws in lag fashion versus X-plate technique.

OBJECTIVE: To compare the feasibility and biomechanical stability of two surgical techniques for fixation of vertical plane fractures of the accessory carpal bone (ACB). STUDY DESIGN: Randomized experimental ex vivo study. SAMPLE POPULATION: Eight equine accessory carpal bones were included in a control group. A total of 20 equine cadaveric forelimbs were randomly assigned into two groups (n = 10 per group). METHODS: Vertical plane fractures were created palmar to the extensor sulcus using an oscillating saw. In Group 1 (CS), fractures were stabilized with two 4.5 mm cortical screws in lag

Bisphosphonate-Conjugated Sitafloxacin for Treatment of Staphylococcus aureus Infection Associated with Cortical Bone Screws: Case Series in Sheep Model.

Background/Objectives: Hydroxybisphosphonate-conjugated sitafloxacin (HBCS) was developed to achieve higher antibiotic concentrations within infected bone. Small animal studies supported further development, but the feasibility of HBCS treatment in a more clinically relevant and larger animal model is unknown. Methods: In this study, we present case reports on four sheep, each receiving four MRSA-contaminated tibial screws treated with different regimens of intravenous antibiotics. The first two sheep received two screws contaminated with 103 CFU and two screws contaminated with 105 CFU. Sheep

Guided Bone Regeneration in the Posterior Mandible Using a Resorbable Metal Magnesium Membrane and Fixation Screws: A Case Report.

Background: Due to bone loss, implant placement in the posterior mandible is often impossible without prior augentative procedures. The reconstruction of bone defects with horizontal and vertical components using particulated bone grafts requires the placement of a mechanically stable structure for stabilization of the grafting material. Although titanium-reinforced membranes and titanium meshes have been shown to be effective in this indication, the necessity of their removal, often in a separate surgical procedure, is seen as a disadvantage. Since the introduction of a new resorbable magnesi

The treatment efficacy of cortical bone trajectory (CBT) pedicle screws for lumbar degenerative disease in the Chinese Han population.

PURPOSE: To provide reference data on CBT pedicle screws from CT measurements of L1 to L5 in the Chinese Han population and to assess the treatment efficacy of CBT pedicle screws in cases of lumbar degenerative disease. METHODS: In total, 100 patients were identified from the CT database for CBT morphometric measurement of the lumbar spine. According to sex and age, patients were divided into four groups. The diameter, length, and angle of the vertebral pedicle and trajectory were measured. Then, a total of 36 patients with lumbar degenerative disease were included in this study for clinical

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… Should we use cortical bone screws for cortical bone trajectory? J Neurosurg Spine. (2015) 22(4):416–21. 10.3171/2014.9.SPINE1484 15. Snyder LA, Martinez-Del-Campo E, Neal MT, Zaidi HA, Awad AW, Bina R, et al. …

Coracoid bone graft osteolysis after Latarjet procedure: A comparison study between two screws standard technique vs mini-plate fixation.

AIMS: One of the reason for Latarjet procedure failure may be coracoid graft osteolysis. In this study, we aimed to understand if a better compression between the coracoid process and the glenoid, using a mini-plate fixation during the Latarjet procedure, could reduce the amount of coracoid graft osteolysis. MATERIALS AND METHODS: A computed tomography scan analysis of 26 prospectively followed-up patients was conducted after modified Latarjet procedure using mini-plate fixation technique to determine both the location and the amount of coracoid graft osteolysis in them. We then compared our

Thickness of buccal bone in the mandible and its clinical significance in mono-cortical screws placement. A CBCT analysis.

The aim of this study was to determine the safest length of monocortical screws that can be inserted for the treatment of mandibular fractures following Champy's technique. Fifty cone-beam computed tomography (CBCT) scans of hemi-mandibles were studied. Linear measurements were taken from the buccal cortical plate to the tooth apex, from the canine to the second premolar, and from the buccal cortical plate to the tooth apex and the inferior alveolar canal in the molar area. The minimum values of the horizontal distances both at the level of the apex and the inferior alveolar canal at the secon

Dislocated femoral neck fractures. A follow-up study of 98 cases treated by multiple AO (ASIF) cancellous bone screws.

A series of 98 dislocated femoral neck fractures were treated by closed reduction and osteosynthesis with multiple AO (ASIF) cancellous bone screws. The patients were followed up for 2 years (or until death). The degree of dislocation did not have a statistically significant influence on the failure rate, which was, however, significantly correlated with poor reduction. Thirty-nine percent of the fractures were complicated by non-union or late segmental collapse. Forty-three of the patients participated in the 2 year follow-up examination. Of these patients, 38 had achieved excellent or good h…

Predicting osteosynthesis screw failure by peri-implant bone morphology in multiple loading conditions.

Osteosynthesis screws are critical in orthopaedic surgery for stabilizing and aligning bone fracture fragments. Despite their importance, screw failure remains a significant complication, often due to excessive movement at the implant-bone interface resulting from both physiological loading and external mechanical forces. This study aims to enhance understanding of screw failure mechanisms by investigating the relationship between peri-implant CT-based trabecular bone morphology and screw failure under axial-, shear-, and mixed loading conditions, including the effect of plate elevation. Using

Development of Polymer-Metal Screw System for Bone Fracture Repair: Combining Strength and Biocompatibility.

Bone screws and plates are either made of metals (such as titanium grade 5 alloy or magnesium alloy) or polymers (such as polylactide-co-glycolide, poly-l-lactide, or polyurethane) and are used for the treatment of bone fractures. However, these metallic/polymeric orthopedic products also exhibit several complications, including bone tissue damage, stress shielding, metallosis, and inadequate stability of polymers. We aimed to create a polymer-metal screw system to fix the problems associated with conventional screws in fracture surgery, and in this context, the polymer-metal screw system was …

Biomechanical analysis analyzing association between bone mineral density and lag screw migration.

A proximal femoral nail using a helical blade (HB) is commonly utilized to treat proximal femoral fracture but cut through failure of the lag screws is one of the devastating complications following the surgery. While controversial, one of the potential risk factors for cut through failure is poor bone strength which can be predicted by measuring bone mineral density (BMD). In this study, we performed a biomechanical test on the fractured femoral head to validate whether the indirectly measured BMD from the contralateral hip or that measured directly from the retrieved femoral head can elucida

Ex vivo biomechanical evaluation of a bone-screw-fastener for tibial plateau leveling osteotomy.

INTRODUCTION: The objective of this study was to investigate the effect of a novel screw type on stiffness and failure characteristics of a tibial plateau leveling osteotomy (TPLO) construct under cyclic loading conditions. The authors hypothesized that bone-screw-fasteners (BSF) would result in superior biomechanical stability compared with locking buttress screws (LBS). MATERIALS AND METHODS: Twelve pairs of canine cadaveric pelvic limbs were included in this ex vivo biomechanical study. A TPLO was performed using a 3.5mm locking TPLO plate and stabilized using either LBS or BSF. Cyclic loa

Quantification and visualization of anterior pelvis bone density to optimize screw fixation: A novel technique.

Plate fixation of anterior pelvic ring fractures is often a vital component when surgically treating unstable pelvis fractures. Certain plate and screw configurations can have premature implant loosening, potentially in part due to insufficient pullout strength in lower density bone. This study sought to define densities about the anterior pelvic ring using a novel computer-based technique. Thirty-three patients who received a computed tomography (CT) of the abdomen/pelvis for reasons other than pelvis fracture in a 1-month time period were included. Three statistically distinct density region

Abducens nerve palsy treated by tethering the globe to the lateral orbital rim with a bone screw.

We report the case of a 38-year-old man with abducens palsy following a traumatic skull injury who failed multiple strabismus surgeries. A suture-armed 5 mm micro bone screw was placed on the anterior face of the lateral orbital rim and used to tether and abduct the globe. The patient remained orthotropic in primary position 12 months postoperatively.