Journal of surgical orthopaedic advances
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Comparative Study
Biomechanical comparison of two headless compression screws for scaphoid fixation.
This study compared compression generation between two headless compression screws: the Synthes 3.0-mm and the Acutrak standard. Twenty scaphoids were harvested from 10 pairs of fresh cadaveric forearms. A washer-shaped load cell was inserted between the halves of each scaphoid created by a simulated fracture via osteotomy. ⋯ Differences in parameters of interest were checked for significance (p < .05) with paired t tests. No significant differences were shown in mean (+/- standard deviation) peak torque (57 +/- 28 Ncm vs. 55 +/- 32 Ncm; p < .84), compression immediately after insertion (119 +/- 54 N vs. 91 +/- 37 N; p < .15), or compression 5 min after insertion (32 +/- 30 N vs. 38 +/- 24 N; p < .61) between the Synthes and Acutrak screw fixations, respectively. The choice between these two screws to stabilize scaphoid waist fractures should be based on parameters other than compression generation, such as size, availability, cost, and ease of use of the implant.
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Patients with spastic quadriplegia secondary to cerebral palsy manifest with severe spasticity and often with neuromuscular scoliosis. In order to optimize treatment and minimize morbidity in selected cases, the authors present a surgical option concurrently addressing these problems. This study reviews one case and describes the surgical technique in detail where intrathecal baclofen pump implantation and posterior spinal fusion are concomitantly performed to manage spasticity and scoliosis, respectively.
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A retrospective review was performed to analyze the radiographic and functional outcomes of two different surgeries to repair a pseudarthrosis following a transforaminal lumbar interbody fusion (TLIF) procedure. Although there are several published reports on the results of the TLIF procedure, there are no reports on how to salvage a failed TLIF. A total of 38 consecutive patients with failed TLIF procedures (at 50 levels) were repaired by either a direct anterior approach only (21 patients) or by a combined direct anterior approach coupled with a posterior exploration and pseudarthrosis repair (17 patients). ⋯ The authors' center's satisfaction questionnaire also showed similar results. The outcomes, both radiologic and functional, were equal in both groups. There was very little improvement in functional outcomes comparing prerepair to postrepair based on the authors' questionnaire.
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Although its use has fallen out of favor, the Halifax interlaminar clamp was used for many years to treat cervical instability through a posterior approach. Numerous complications, the majority of which are related to hardware failure, have been reported with the use of the interlaminar clamps and have led to the development of alternative techniques for posterior fusion, such as transarticular screw fixation. ⋯ To the authors' knowledge, this is the first case report of symmetric fractures through the posterior C1 ring lateral to the site of the Halifax clamps, resulting in recurrent atlantoaxial instability. This report focuses on the surgical management of this complication and provides a review of the literature that pertains to complications following the use of the Halifax clamp to treat atlantoaxial instability.
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Achilles tendon ruptures commonly affect middle-aged athletes and can result in considerable functional impairment. While the cause is multifactorial, the greatest risk is present for athletes involved in sports that involve sudden acceleration and deceleration. A thorough history and physical examination can accurately yield a diagnosis, but when question remains, magnetic resonance imaging is superior to ultrasound-guided evaluation. ⋯ Percutaneous methods of fixation have lower complication rates without an increase in the rate of rerupture when compared with open methods. Augmentation of an Achilles tendon repair has demonstrated no clinical benefit. Rehabilitation with early mobilization leads to improved patient-reported outcomes.