15 research outputs found
The bridging infix : a modified, minimally invasive subcutaneous anterior pelvic fixation technique
Various methods for anterior pelvic ring fixation have been described in the literature, each
with specific advantages and disadvantages. We describe a modified minimally invasive
subcutaneous technique for anterior fixation: the Bridging Infix.
It combines the benefits of internal plate fixation with external fixator principles. We merged and
modified features of the existing INFIX and Pelvic Bridge techniques during the design. Similar
to these techniques, we use plate-rods typically used during occipitocervical fusions. The design
changes allow for less discomfort due to prominent hardware in thin patients and eliminate the
need for an intact medial pubic rami for fixation. There is also no risk of bladder injury due to
accidental screw perforation through the pubic rami.
The Bridging Infix is ideal for patients who are physiologically too frail for extensive open
reduction and plate osteosynthesis, such as elderly patients with pelvic fragility fractures who are
failing to mobilise due to pain. It can also be used for patients in whom external fixators may be
impractical or poorly tolerated, such as obese patients or those with increased nursing demands.
This technique does not provide adequate posterior pelvic ring stability, thus it requires an intact
posterior tension band or the addition of separate posterior fixation.
Patients can commence in-bed mobilisation the same day as the procedure, with weight-bearing
as tolerated allowed for most cases, and toe-touching reserved for highly unstable injury patterns
only. The implants are not routinely removed unless requested by the patient, especially in the
elderly to avoid additional anaesthetic exposure. Potential complaints include lateral thigh pain,
due to lateral femoral nerve compression, and mechanical discomfort during exercise activities.https://www.saoj.org.za/index.php/saoj%20am2024Orthopaedic SurgerySDG-03:Good heatlh and well-bein
Establishing the safety of the lateral femoral cutaneous nerve when using the bridging infix for anterior pelvic fixation
BACKGROUND
Established subcutaneous internal fixation techniques have shown a better quality of life with
reduced pain. However, complications still arise, with the most significant being injury of the
lateral femoral cutaneous nerve (LFCN). A novel minimally invasive modified technique, the
Bridging Infix, has been proposed; however, the safety of the LFCN during the procedure is
currently unknown. The aim of the study, therefore, was to determine the relationship between
the Bridging Infix and the LFCN.
METHOD
Fifty formalin-fixed cadaveric specimens and two fresh frozen cadaver specimens were utilised
in the study. The Bridging Infix was inserted as per the technique guide. Superficial dissection of
the surgical site was subsequently conducted. Bilateral measurements of the distance between
the LFCN and the implant as well as palpable bony landmarks were taken to determine safe
zones for implant placement.
RESULTS
Overall the LFCN was identified coursing deep to the inguinal ligament. The minimum distance
from the LFCN to the most proximal cortical screw was 18.00 mm. The mean distance from the
most proximal screw to the LFCN was 37.97 ± 12.20 mm.
CONCLUSION
The LFCN was not injured or impinged by the Bridging Infix in any of the cadaver specimens used
in this study. Thus, the surgical procedure can be considered safe if layer by layer dissection is
employed and the screws are directly inserted on the iliac crest, with no pressure being applied
within three finger breadths medial to the anterior superior iliac spine.The National Research Foundation (NRF) of South Africa.http://journal.saoa.org.zaam2024AnatomyStatisticsSDG-03:Good heatlh and well-bein
The Knee Osteoarthritis Grading System for Arthroplasty
Background: The aim of this study is to validate the Knee Osteoarthritis Grading System (KOGS) of progressive osteoarthritic degeneration for the tri-compartmental knee. This system defines the site and severity of osteoarthritis to determine a specific knee arthroplasty.
Methods: The radiographic sequence for KOGS includes standing coronal (anteroposterior), lateral, 30° skyline patella, 15° and 45° Rosenberg and stress views in 20° of flexion. Cohen's kappa and related agreement statistical methods were used to assess the level of concordance of the 7 evaluators between A and B cohorts for each evaluator and also against the actual arthroplasty used. Sensitivity and specificity was also assessed for the KOGS in identifying true partial knee arthroplasties (PKAs) and total knee arthroplasties (TKAs) as decided from the cohort A evaluations.
Results: From a cohort of 330 patients who were included in the study, 71 (22.5%) underwent a TKA procedure, 258 (78.2%) a PKA, and 1 (0.3%) was neither a TKA nor PKA. KOGS was able to identify true PKAs (sensitivity) in the range of 92.2%-98.5% across all the different evaluators. The KOGS method was able to identify a PKA or a TKA with an accuracy ranging from 92% to 98.8% across all different evaluators. The surgical results after 20 months are at least comparable with the expected average in the academic literature.
Conclusion: The KOGS classification provides a reliable and accurate tool to assess suitability of an individual patient for undergoing PKA or TKA
Minimally invasive subcutaneous anterior fixation of pelvic fractures in the elderly : case report and literature review
BACKGROUND:
As our population ages, the incidence of pelvic fragility fractures will rise accordingly. Despite
these fractures having similar mortality rates to proximal femur fractures, there exist discrepancies
between the management of these injuries. Although a number of pelvic fragility fractures can be
treated successfully with conservative means, early treatment with appropriate surgical means
should be considered in those failing conservative treatment or with unstable fracture patterns.
CASE REPORT:
We present an 84-year-old female who sustained a pelvic fragility fracture after a low-energy
fall. Despite adequate conservative treatment, she was unable to mobilise. She was taken for
anterior and posterior fixation, using our modified minimally invasive subcutaneous technique (the
Bridging Infix) for anterior fixation. At the six-week follow-up she had regained full independent
mobility. She had three syncope-related falls during this period, but radiographs revealed no
sign of implant displacement. One year after her surgery she had complete union of her fracture,
good function and no desire to have the implant removed.
DISCUSSION:
With the expected increase in pelvic fragility fractures due to the growing elderly population, our
understanding of these injuries has begun to change. Occult posterior ring injuries have been
described in up to 80% of cases, while fracture progression to unstable patterns can occur in
up to 15% of stable patterns. Despite conservative management being the primary treatment
of choice, these patients suffer morbidity and mortality rates comparable to proximal femur
fractures. Early appropriate surgical management should be considered in patients failing to
mobilise. Various surgical techniques have been described, each with their own advantages and
disadvantages. Newer minimally invasive techniques are gaining favour, especially for use in
elderly patients. These constructs combine the low profile benefits of internal plate fixation with
ex-fix principles.
CONCLUSION:
The Bridging Infix is a modified technique for minimally invasive subcutaneous anterior pelvic
fixation. Its use can strongly be considered by even the general orthopaedic surgeon in cases
where patients are too frail for extensive or invasive surgeries, such as open reduction and
internal fixation with plate and screws.https://www.saoj.org.zaOrthopaedic Surger
The Knee Osteoarthritis Grading System for arthroplasty
BACKGROUND : The aim of this study is to validate the Knee Osteoarthritis Grading System (KOGS) of
progressive osteoarthritic degeneration for the tri-compartmental knee. This system defines the site and
severity of osteoarthritis to determine a specific knee arthroplasty.
METHODS : The radiographic sequence for KOGS includes standing coronal (anteroposterior), lateral, 30
skyline patella, 15 and 45 Rosenberg and stress views in 20 of flexion. Cohen’s kappa and related
agreement statistical methods were used to assess the level of concordance of the 7 evaluators between
A and B cohorts for each evaluator and also against the actual arthroplasty used. Sensitivity and specificity
was also assessed for the KOGS in identifying true partial knee arthroplasties (PKAs) and total knee
arthroplasties (TKAs) as decided from the cohort A evaluations.
RESULTS : From a cohort of 330 patients who were included in the study, 71 (22.5%) underwent a TKA procedure,
258 (78.2%) a PKA, and 1 (0.3%) was neither a TKA nor PKA. KOGS was able to identify true PKAs
(sensitivity) in the range of 92.2%-98.5% across all the different evaluators. The KOGS method was able to
identify a PKA or a TKAwith an accuracy ranging from92% to 98.8% across all different evaluators. The surgical
results after 20 months are at least comparable with the expected average in the academic literature.
CONCLUSION : The KOGS classification provides a reliable and accurate tool to assess suitability of an individual
patient for undergoing PKA or TKA.http://www.arthroplastyjournal.orgOrthopaedic Surger
The Knee Osteoarthritis Grading System (KOGS) for arthroplasty
Background The aim of this study is to validate the Knee Osteoarthritis Grading system (KOGS) of progressive osteoarthritic (OA) degeneration for the Tri-compartmental knee. This system defines the site and severity of OA to determine a specific knee replacement. Methods The radiographic sequence for KOGS includes standing coronal (antero-posterior), lateral, 30° skyline patella, 15° and 45° Rosenberg and stress views in 20° of flexion. Cohen’s Kappa and related agreement statistical methods were used to assess the level of concordance of the seven evaluators between A and B cohorts for each evaluator and also against the actual arthroplasty used. Sensitivity and specificity was also assessed for the KOGS in identifying true partial knee replacements (PKR) and total knee replacements (TKR) as decided from the cohort A evaluations. Results From a cohort of 330 patients who were included in the study, 71 (22.5%) underwent a TKR procedure, 258 (78.2%) a PKR and 1 (0.3%) was neither a TKR nor PKR. KOGS was able to identify true PKRs (sensitivity) in the range of 92.2% to 98.5% across all the different evaluators. The KOGS method was able to identify a PKR or a TKR with an accuracy ranging from 92% to 98.8% across all different evaluators. The surgical results after 20 months are at least comparable with the expected average in the academic literature. Conclusion The KOGS classification provides a reliable and accurate tool to assess suitability of an individual patient for undergoing partial or total knee replacement