Screw Fixation of Os Acetabuli: An Arthroscopic Technique.
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ABSTRACT:
SUBMITTER: Cuellar A
PROVIDER: S-EPMC5495954 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Os acetabuli is thought to be the result of an unfused ossification center or an acetabular rim fracture in the setting of femoral-sided femoroacetabular impingement syndrome. Historically, patients with symptomatic hips have been treated with resection alone; however, in patients with large bone fragments or with reduced acetabular coverage prior to surgical intervention, iatrogenic dysplasia and structural instability may develop after resection. Therefore, for patients with an acetabular os, labral tearing, and cam-type femoroacetabular impingement, internal fixation of the os acetabuli, femoral osteochondroplasty, and labral repair have been described. We propose a "suture-on-screw" arthroscopic technique to simultaneously address both the labral tear and os acetabuli, thereby reducing the number of suture anchors required for labral fixation, leading to an efficient and cost-effective approach for the treatment of these patients.
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Project description:Transverse glenoid fractures with a cranial coracoglenoidal fragment (Ideberg type III) can lead to detrimental post-traumatic sequelae. Open surgery requires an extensive surgical approach. Arthroscopic procedures are highly challenging with respect to both fracture reduction and screw osteosynthesis. We present a reproducible arthroscopic technique for a dislocated transverse glenoid fracture using 5 standard portals. Grasping the coracoid with a small, serrated reduction clamp through the anterior portal allows simple and sufficient reduction. Safe screw osteosynthesis can then be performed from cranially without the need to create a Neviaser portal.
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Project description:The os acetabuli is thought to arise from unfused secondary ossification centers or as rim fractures in the setting of dysplastic hips or hips with femoroacetabular impingement. Resection of a large os acetabuli can lead to structural instability of the joint, and in these cases, osteoplasty of the impingement, reduction and internal fixation of the osseous fragment, and labral repair have been described in the literature. Anchor fixation for labral repair in the surrounding zone of the osteosynthesis might bring some technical problems. We aim to describe a technical modification improving labral lesion treatment while addressing the rim fracture. The addition of a suture to the screw addresses both lesions because it simultaneously has the function of a screw and an anchor. A suture-on-screw technique for os acetabuli fixation helps surgeons to gain versatility and is more cost-effective for the patients and health services.
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Project description:Acetabular rim fractures, or os acetabuli, are hypothesized to occur as a result of an unfused ossification center or a stress fracture from repetitive impingement of an abnormally shaped femoral neck against the acetabular rim. When treated surgically, these fragments are typically excised as part of the correction for femoroacetabular impingement. However, in some patients, removal of these fragments can create symptoms of gross instability or microinstability of the hip. In these cases, internal fixation of the fragment is necessary. The purpose of this technical note is to describe indications, the arthroscopic technique, and postoperative care for fixation of acetabular rim fractures.
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Project description:Several articles have described arthroscopic fixation of coronal shear fractures of the distal humerus. However, not all of them have used purely arthroscopic techniques. In this Technical Note we describe another technique for intra-articular distal humeral fracture fixation using arthroscopy alone. Standard proximal anteromedial, proximal anterolateral, and posterolateral viewing portals are established with soft spot portal for reduction. During intra-articular examination, the fragment involving the capitellum and the trochlea as 1 piece is detected. Closed manipulative reduction under anesthesia is conducted with distraction, varus force, and gradual elbow extension. After closed reduction, reduction of the fragment more precisely under arthroscopic visualization using probe and elevator is performed. The fragment is temporarily fixed using 2 Kirschner wires from posterior direction. Anatomic reduction is confirmed with an image intensifier. Screw guide pin is inserted posteroanteriorly under image intensification, and a headless compression screw is placed over each wire. We describe a safe, reproducible, and minimal invasive technique for the arthroscopic treatment of coronal shear fractures of the distal humerus.
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Project description:In the presence of bone loss, the Bristow or Latarjet procedure is used to alleviate anterior glenohumeral instability. The techniques have gradually improved under arthroscopy. However, such an arthroscopic procedure has a steep learning curve, lengthy operation time, and considerable risk of complications, inhibiting its rapid development. The current method of modified arthroscopic Bristow procedure with screw fixation without subscapularis split reduces surgical time, reduces the risk of nerve damage consequences, and is simple to apply. Technique Video Video 1 We present our modified arthroscopic Bristow procedure: screw fixation without subscapularis split. The patient is placed in the beach-chair position, and 5 portals are created. After performing a diagnostic arthroscopy examination, the coracoid process lower surface, tip, and base, and the conjoined tendon are identified. The soft tissue lateral to the conjoined tendon is released to a sufficient length to allow transferring the coracoid process. The coracoacromial ligament is excised at its coracoid insertion to expose its lateral and upper surfaces. Subsequently, the pectoralis minor muscle is released from the coracoid to ∼5 cm below the junctions between the pectoralis minor muscle and the conjoined tendon to ensure the transfer of the coracoid process will not be affected. A 1.2-mm K-wire is drilled into the coracoid under the guidance of a thin cannula. A PDS line is passed through the bone tunnel for traction and guidance. After ensuring an adequate length of the coracoid bone, it is osteotomized with a willow saw. Subsequently, the labrum and capsule are detached completely from the glenoid to the 6-o’clock position. The glenoid is refreshed by a burr. The upper edge of the subscapularis is pressed downwards by a switching stick until the 4-o’clock position of the anterior glenoid is exposed. A marking point is placed to assist in creating a tunnel at the 4-o’clock position. After drilling and measuring, a 1.2-mm K-wire is inserted into the tunnel to guide the screw. The coracoid is pulled out through portal D, its length is measured, and its osteotomy surface is trimmed to match the anterior glenoid surface. A hole is drilled from the center of the osteotomy surface to the tip of the coracoid with a 1.2-mm K-wire. The hole created by the 1.2-mm K-wire is drilled through with a 2.7-mm hollow drill. A cannulated screw with a diameter of 4 mm is implanted into the coracoid graft along the 1.2-mm K-wire, leaving 2 mm of the screw head above the osteotomy surface for the coracoid's final fixation. The lateral edge of the conjoined tendon is sutured with No. 2 ETHIBOND suture near the coracoid and kept sufficiently taut to prevent twisting during coracoid fixation. The coracoid with partial screw fixation is then inserted for the final fixation. The tip of the screw is positioned against the K-wire introduced through the glenoid tunnel in the previous phase. The K-wire is threaded through the screw, and the coracoid and screw are secured with a screwdriver. The final placement of the transferred coracoid is arthroscopically assessed through portal B. The postoperative anteroposterior radiograph shows that a single screw maintains the coracoid in place. The 3-dimensional computed tomography scan depicts the locations of the graft and screw. The transferred coracoid is seen at the 4-o’clock position, and the glenoid surface is well integrated with the coracoid graft’s surface. The scan also shows that the transferred coracoid is standing on the glenoid surface with a 90° rotation. (PDS, polydioxanone.).
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Project description:Arthroscopic repair of the long head of the biceps (LHB) is performed to treat various biceps pathologies yet the choice between tenotomy or tenodesis remains controversial. Although tenotomy is simpler and quicker, tenodesis results in fewer complications, and there are several techniques available using various fixation devices and sites. This Technical Note describes an all-arthroscopic, suprapectoral tenodesis technique using a bioresorbable interference screw, without motorized devices to create the humeral tunnel in the bicipital groove. The LHB tendon is detached from its glenoid insertion using an arthroscopic cutting instrument or electrocautery. Two portals are created 50 mm distal to the acromioclavicular joint and at 15 mm on either side of the bicipital groove. The arthroscope is introduced through the distal lateral portal till it makes contact with the humerus. The LHB is fastened within its groove using a grasper, reinforced, and then fixed in the humeral tunnel using an interference screw. The present technique is safe, simple, and reproducible. It requires 2 portals in addition to the standard posterior portal and the intra-articular working portal. It minimizes iatrogenic intra-articular damage and thereby limits possible complications. It also limits the intra-articular operative time compared with SLAP repairs.
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Project description:Adequate reduction of posterior malleolar fractures leads to better outcomes. Arthroscopic reduction and internal fixation presents an opportunity for excellent reduction with a minimally invasive approach. Herein, we present a technique with some discussion on outcomes.
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Project description:Acromioclavicular (AC) joint dislocation is a common injury, particularly among active young individuals. Numerous surgical procedures for treating acute, high-grade AC joint dislocation have been reported. However, no standard surgical procedure that restores the normal kinematics of the AC joint is available. Among the available coracoclavicular (CC) fixation techniques, cortical button fixation was recently introduced, and it has had successful outcomes. Moreover, it is advantageous because it can be used in arthroscopic procedures. However, because of the limited number of fixation tools, a fundamental problem in terms of horizontal instability and gradual subsidence of cortical buttons has been observed, eventually leading to a threat to vertical stability. Therefore, we developed a unique CC fixation technique with multiple small tunnels using all-suture anchors, which may overcome potential complications caused by cortical buttons that require bone tunnels with relatively large diameters. This arthroscopic CC fixation technique was designed to achieve the ideal horizontal and vertical stability that may restore native AC kinematics.
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