7,063 research outputs found
Accurate Determination of the Sites of the Distal Hole of the Humeral Interlocking Intramedullary Nail Using Monofilament Solid Core Optical Fiber
This prospective study was conducted in order to evaluate the results of using the monofilament solid core optical fiber for the accurate determination of the site of the distal hole of the humeral interlocking intramedullary nail. Seven patients with fresh humeral fractures treated with humeral interlocking intramedullary nailing from April 2005 to May 2007 were evaluated. The minimum follow-up period was 12 months. We analyzed type of humeral fracture, time of technique, length of the incision, and Radiation exposure. All cases were treated with one distal locking screw during interlocking intramedullary nailing. The technique is based on the semitransparency of the bone tissue. The system is composed of 2 parts: light source and monofilament solid core optical fiber. Description of the technique:- After reduction of the fracture and assembly of the nail, a mechanical measure is taken to determine the expected site of the distal locking holes of the interlocking nail and site of skin incision, then a longitudinal skin incision is made and the soft tissue is dissected until the bone is reached, then the optical fiber is introduced until its tip reaches the distal hole and adjusted to concentrate the light on the nail hole. At this time an illuminated ellipse appears on the anterior cortex of the bone. The drill bit is adjusted to the center of this ellipse then the drilling is started. After piercing of the nearby cortex a 3.5 mm suction handle is introduced in the bone hole to suck the blood then physical and mechanical checks are done after which the far cortex is drilled. The results show that the site of the distal hole of the humeral interlocking intramedullary nail could be detected successfully in all cases with no radiation exposure. As a conclusion; we can say that Monofilament solid core optical fiber can be used successfully for the accurate determination of the site of the distal hole of the humeral interlocking intramedullary nail. For satisfactory results, accurate technique and experience of the operator were required
Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking.
Background and Objectives: Freehand distal interlocking of intramedullary nails is technically demanding and prone to handling issues. It requires precise placement of a screw through the nail under fluoroscopy guidance and can result in a time consuming and radiation expensive procedure. Dedicated training could help overcome these problems. The aim of this study was to assess construct and face validity of new Digitally Enhanced Hands-On Surgical Training (DEHST) concept and device for training of distal interlocking of intramedullary nails. Materials and Methods: Twenty-nine novices and twenty-four expert surgeons performed interlocking on a DEHST device. Construct validity was evaluated by comparing captured performance metrics-number of X-rays, nail hole roundness, drill tip position and drill hole accuracy-between experts and novices. Face validity was evaluated with a questionnaire concerning training potential and quality of simulated reality using a 7-point Likert scale. Results: Face validity: mean realism of the training device was rated 6.3 (range 4-7). Training potential and need for distal interlocking training were both rated with a mean of 6.5 (range 5-7), with no significant differences between experts and novices, p ≥ 0.234. All participants (100%) stated that the device is useful for procedural training of distal nail interlocking, 96% wanted to have it at their institution and 98% would recommend it to colleagues. Construct validity: total number of X-rays was significantly higher for novices (20.9 ± 6.4 versus 15.5 ± 5.3, p = 0.003). Success rate (ratio of hit and miss attempts) was significantly higher for experts (novices hit: n = 15; 55.6%; experts hit: n = 19; 83%, p = 0.040). Conclusion: The evaluated training device for distal interlocking of intramedullary nails yielded high scores in terms of training capability and realism. Furthermore, construct validity was proven by reliably discriminating between experts and novices. Participants indicate high further training potential as the device may be easily adapted to other surgical tasks
Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking
Background and Objectives: Freehand distal interlocking of intramedullary nails is technically
demanding and prone to handling issues. It requires precise placement of a screw through the nail
under fluoroscopy guidance and can result in a time consuming and radiation expensive procedure.
Dedicated training could help overcome these problems. The aim of this study was to assess construct
and face validity of new Digitally Enhanced Hands-On Surgical Training (DEHST) concept and
device for training of distal interlocking of intramedullary nails. Materials and Methods: Twenty-nine
novices and twenty-four expert surgeons performed interlocking on a DEHST device. Construct
validity was evaluated by comparing captured performance metrics—number of X-rays, nail hole
roundness, drill tip position and drill hole accuracy—between experts and novices. Face validity was
evaluated with a questionnaire concerning training potential and quality of simulated reality using
a 7-point Likert scale. Results: Face validity: mean realism of the training device was rated 6.3 (range
4–7). Training potential and need for distal interlocking training were both rated with a mean of
6.5 (range 5–7), with no significant differences between experts and novices, p 0.234. All participants
(100%) stated that the device is useful for procedural training of distal nail interlocking, 96% wanted
to have it at their institution and 98% would recommend it to colleagues. Construct validity: total
number of X-rays was significantly higher for novices (20.9 6.4 versus 15.5 5.3, p = 0.003). Success
rate (ratio of hit and miss attempts) was significantly higher for experts (novices hit: n = 15; 55.6%;
experts hit: n = 19; 83%, p = 0.040). Conclusion: The evaluated training device for distal interlocking of
intramedullary nails yielded high scores in terms of training capability and realism. Furthermore,
construct validity was proven by reliably discriminating between experts and novices. Participants
indicate high further training potential as the device may be easily adapted to other surgical tasks
Fluoroscopic freehand and electromagnetic-guided targeting system for distal locking screws of humeral intramedullary nail
Purpose
The current techniques used to lock distal screws for the nailing of long bone fractures expose the surgeons, radiologists and patients to a hearty dose of ionizing radiation. The Sureshot™ Distal Targeting System is a new technique that, with the same results, allows for shorter surgery times and, consequently, less exposure to radiation.
Materials and methods
The study was performed on 59 patients (34 males and 25 females) with a simple humerus fracture diagnosis, type 1.2.A according to the AO classification, who were divided into two groups. Group 1 was treated with ante-grade intramedullary nailing with distal locking screws inserted with a freehand technique. Group 2 was treated with the intramedullary nail using the Sureshot™ Distal Targeting System. Two intra-operative time parameters were evaluated in both groups: the time needed for the positioning of the distal locking screws and the time of exposure to ionizing radiations during this procedure.
Results
Group 2 showed a lower average distal locking time compared to group 1 (645.48″ vs. 1023.57″) and also a lower average time of exposure to ionizing radiation than in group 1 (4.35″ vs. 28.96″).
Conclusion
The Sureshot™ Distal Targeting System has proven to be equally effective when compared to the traditional techniques, with the added benefits of a significant reduction in both surgical time and risk factors related to the exposure to ionizing radiation for all the operating room staff and the patient
Intramedullary Nailing of Periarticular Fractures
Plate fixation has historically been the preferred surgical treatment method for periarticular fractures of the lower extremity. This trend has stemmed from difficulties with fracture reduction and concerns of inadequate fixation with intramedullary implants. However, the body of literature on management of periarticular fractures of the lower extremities has expanded in recent years, indicating that intramedullary nailing of distal femur, proximal tibia, and distal tibia fractures may be the preferred method of treatment in some cases. Intramedullary nailing reliably leads to excellent outcomes when performed for appropriate indications and when potential difficulties are recognized and addressed
The Effects of Interlocking a Universal Hip Cementless Stem on Implant Subsidence and Mechanical Properties of Cadaveric Canine Femora.
ObjectiveTo determine if an interlocking bolt would limit subsidence of the biological fixation universal hip (BFX(®)) femoral stem under cyclic loading and enhance construct stiffness, yield, and failure properties.Study designEx vivo biomechanical study.AnimalsCadaveric canine femora (10 pairs).MethodsPaired femora implanted with a traditional stem or an interlocking stem (constructs) were cyclically loaded at walk, trot, and gallop loads while implant and bone motions were captured using kinematic markers and high-speed video. Constructs were then loaded to failure to evaluate failure mechanical properties.ResultsImplant subsidence was greater (P = .037) for the traditional implant (4.19 mm) than the interlocking implant (0.78 mm) only after gallop cyclic loading, and cumulatively after walk, trot, and gallop cyclic loads (5.20 mm vs. 1.28 mm, P = .038). Yield and failure loads were greater (P = .029 and .002, respectively) for the interlocking stem construct (1155 N and 2337 N) than the traditional stem construct (816 N and 1405 N). Version angle change after cyclic loading was greater (P = .020) for the traditional implant (3.89 degrees) than for the interlocking implant (0.16 degrees), whereas stem varus displacement at failure was greater (P = .008) for the interlocking implant (1.5 degrees) than the traditional implant (0.17 degrees).ConclusionAddition of a stabilizing bolt enhanced construct stability and limited subsidence of a BFX(®) femoral stem. Use of the interlocking implant may decrease postoperative subsidence. However, in vivo effects of the interlocking bolt on osseointegration, bone remodeling, and stress shielding are unknown
Novel use of Steinman pin in removal of broken interlocking screws
Broken screws after interlocking nailing of long bones are commonly seen in Orthopaedic practice. Removal of such screws can be difficult particularly the distal part which is often held within the bone. We describe a simple technique of using Steinman pin to aid removal of broken screws in a case of non-union fracture tibia with broken interlocking nail and screws. Steinman pin being easily available and the reproducible technique make it a useful aid for removal of broken interlocking screws
Design and analysis of a wire-driven flexible manipulator for bronchoscopic interventions
Bronchoscopic interventions are widely performed for the diagnosis and treatment of lung diseases. However, for most endobronchial devices, the lack of a bendable tip restricts their access ability to get into distal bronchi with complex bifurcations. This paper presents the design of a new wire-driven continuum manipulator to help guide these devices. The proposed manipulator is built by assembling miniaturized blocks that are featured with interlocking circular joints. It has the capability of maintaining its integrity when the lengths of actuation wires change due to the shaft flex. It allows the existence of a relatively large central cavity to pass through other instruments and enables two rotational degrees of freedom. All these features make it suitable for procedures where tubular anatomies are involved and the flexible shafts have to be considerably bent in usage, just like bronchoscopic interventions. A kinematic model is built to estimate the relationship between the translations of actuation wires and the manipulator tip position. A scale-up model is produced for evaluation experiments and the results validate the performance of the proposed mechanism
Functional outcome in distal third tibial fractures treated with interlocking nailing
Background: The purpose of this study was to evaluate the functional outcome in distal third tibial fractures not extending into the ankle joint treated with interlocking nailing.Methods: Twenty eight patients of distal tibial fractures were admitted in our orthopaedic department .5 patients were lost to follow up. Hence 23 patients were studied. After initial resuscitation and immobilization, they were taken up for internal fixation. Depending upon their general condition and associated injuries the time interval for surgery varied from one day to two weeks. They were periodically followed at 6 weeks, 3rd month, 4th month, 6th month and every eight weeks thereafter, till fracture union.Results: No patient in the study went in for non-union. All the fractures united well. However two patients had osteomyelitis which was settled after nail removal and appropriate antibiotics. One had ankle stiffness. The outcome was analysed with Johner and Wruh criteria.Conclusions: The outcome of treatment of distal tibial fractures is mostly affected by the severity of the injury and associated complications or injury. The study showed that interlocking nailing gives good results in distal third tibial fractures
A prospective randomized comparative study on fractures of lower third of both bones of the leg treated by interlock nailing of tibia with or without fixation of fibula
Background: In the treatment of fractures of the distal third of tibia and fibula treated by interlocking nail of tibia, the role of fixing the fibular fracture is not clearly defined. This study was conducted to assess the benefits of fixation of fibular fracture in distal third leg bones fractures.Methods: 95 patients were enrolled into study and divided randomly into two groups based on whether fibula fixed or not with interlock intramedullary nailing tibia. Patients were followed for an average period of 11 months both radiologically and clinically.Results: We observed that the average valgus angulation was significantly less (P =0.001) in the group where fibula was fixed. The outcome of the two groups for clinical ankle score, time of union and complication showed no difference (P ≥0.05). Conclusions: We concluded that fixation of fibula decrease the malalignment of tibia in distal third fractures of tibia and fibula treated with interlocking nail of tibia.
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