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Adam J. Starr - One of the best experts on this subject based on the ideXlab platform.
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Vertical shear pelvic ring injuries: do transsacral screws prevent Fixation Failure?
OTA international : the open access journal of orthopaedic trauma, 2020Co-Authors: Breann K Tisano, Adam J. Starr, Drew Kelly, Ashoke K SathyAbstract:To determine the frequency of Fixation Failure after transsacral-transiliac (TS) screw Fixation of vertical shear (VS) pelvic ring injuries (OTA/AO 61C1) and to describe the mechanism of Failure of TS screws. Retrospective cohort study. Level 1 academic trauma center. Twenty skeletally mature patients with unilateral, displaced, unequivocal VS injuries were identified between May 1, 2009 and April 31, 2016. Mean age was 31 years and mean follow-up was 14 months. Twelve had sacroiliac dislocations (61C1.2) and eight had vertical sacral fractures (61C1.3). Operative treatment with at least one TS screw. Radiographic Failure, defined as a change of >1 cm of combined displacement of the posterior pelvis compared with the intraoperative position on inlet and outlet radiographs. Radiographic Failure occurred in 4 of 8 (50%) vertical sacral fractures. Posterior Fixation was comprised of a single TS screw in 3 of these 4 Failures. The dominant mechanism of screw Failure was bending. All of these Failures occurred early in the postoperative period. No Fixation Failures occurred among the sacroiliac dislocations. There were no deep infections or nonunions. This is the first study to describe the mechanism of Failure of TS screws in a clinical setting after VS pelvic injuries. We caution surgeons from relying on single TS screw Fixation for vertically unstable sacral fractures. Close radiographic monitoring in the first few weeks after surgery is advised. Level IV. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.
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vertical shear pelvic ring injuries do transsacral screws prevent Fixation Failure
OTA international : the open access journal of orthopaedic trauma, 2020Co-Authors: Breann K Tisano, Adam J. Starr, Drew P Kelly, Ashoke K SathyAbstract:Objectives To determine the frequency of Fixation Failure after transsacral-transiliac (TS) screw Fixation of vertical shear (VS) pelvic ring injuries (OTA/AO 61C1) and to describe the mechanism of Failure of TS screws. Design Retrospective cohort study. Setting Level 1 academic trauma center. Patients/Participants Twenty skeletally mature patients with unilateral, displaced, unequivocal VS injuries were identified between May 1, 2009 and April 31, 2016. Mean age was 31 years and mean follow-up was 14 months. Twelve had sacroiliac dislocations (61C1.2) and eight had vertical sacral fractures (61C1.3). Intervention Operative treatment with at least one TS screw. Main Outcome Measurements Radiographic Failure, defined as a change of >1 cm of combined displacement of the posterior pelvis compared with the intraoperative position on inlet and outlet radiographs. Results Radiographic Failure occurred in 4 of 8 (50%) vertical sacral fractures. Posterior Fixation was comprised of a single TS screw in 3 of these 4 Failures. The dominant mechanism of screw Failure was bending. All of these Failures occurred early in the postoperative period. No Fixation Failures occurred among the sacroiliac dislocations. There were no deep infections or nonunions. Conclusions This is the first study to describe the mechanism of Failure of TS screws in a clinical setting after VS pelvic injuries. We caution surgeons from relying on single TS screw Fixation for vertically unstable sacral fractures. Close radiographic monitoring in the first few weeks after surgery is advised. Level of Evidence Level IV.
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Superior pubic ramus fractures fixed with percutaneous screws: What predicts Fixation Failure?
Journal of orthopaedic trauma, 2008Co-Authors: Adam J. Starr, Tetsuya Nakatani, Charles M. Reinert, Kevin B CederbergAbstract:Objective The purpose of this study is to present the early complications of percutaneous screw Fixation of superior pubic ramus fractures and to present a new classification scheme for superior pubic ramus fractures. Design Retrospective. Setting Level 1 trauma center. Patients One hundred and twelve patients with pelvic fracture between the ages of 14 to 89 years underwent percutaneous screw Fixation of 145 pubic ramus fractures. Eighty-one patients with 107 surgically repaired fractures were followed to fracture union. Follow-up averaged 9 months (range 2-52 months). One additional patient who sustained Fixation Failure 4 days after surgery was included to yield a study group of 82 patients with 108 surgically repaired ramus fractures. Intervention Patients underwent percutaneous screw Fixation of a superior pubic ramus fracture. Main outcome measurements Superior pubic ramus fractures were classified according to a new scheme, the Nakatani system, which categorizes superior ramus fractures according to location with respect to the obturator foramen. Patient radiographs were examined for evidence of loss of reduction, defined as any motion at the ramus fracture site or hardware motion, after fracture surgery. Results Of the 82 patients followed to union or Fixation Failure, 12 (15%) had loss of reduction on follow-up radiographs. The average age of patients who lost reduction was 55 years. The most common mechanism of reduction loss was a collapse of the pubic ramus over the screw, with recurrence of an internal rotation deformity of the injured hemipelvis. Ten patients who lost reduction were women, and 11 had undergone ramus screw placement in retrograde fashion. No loss of reduction was seen in Zone III ramus fractures (those that involve the bone lateral to the obturator foramen). No patient sustained recognized neurologic, vascular, or urologic injury as a result of percutaneous screw Fixation of a superior pubic ramus fracture. Conclusions The prevalence of loss of reduction after percutaneous screw Fixation of pubic ramus fractures is 15%. Loss of reduction is more common in elderly and female patients and in patients whose ramus screws are placed in a retrograde fashion. Also, loss of reduction appears to be more common in fractures medial to the lateral border of the obturator foramen.
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Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict Fixation Failure?
Journal of orthopaedic trauma, 2006Co-Authors: Damian R Griffin, Adam J. Starr, Charles M. Reinert, Alan L Jones, Shelly WhitlockAbstract:To measure the Failure rate of percutaneous iliosacral screw Fixation of vertically unstable pelvic fractures and particularly to test the hypothesis that Fixations in which the posterior injury is a vertical fracture of the sacrum are more likely to fail than Fixations with dislocations or fracture-dislocations of the sacroiliac joint. Retrospective review. Level 1 trauma center. All patients with pelvic fractures admitted between January 1, 1993, and December 31, 1998, were identified from the trauma registry. Hospital records were used to identify patients treated with iliosacral screws. Radiologic studies were examined to identify patients who had unequivocally vertically unstable pelvic fractures. Immediate postoperative and follow- up anteroposterior, inlet, and outlet radiographs from a minimum of 12 months postinjury were examined. Position, length, and numbers of iliosacral screws and any evidence of screw Failure (eg, bending or breakage) were recorded. Residual postoperative displacement and late displacement of the posterior pelvis were measured. The main outcome measure was Failure, defined as at least 1cm of combined vertical displacement of the posterior pelvis compared with immediate postoperative position. The main analysis was for association between fracture pattern and Failure. Patient demographic data, iliosacral screw position, and anterior pelvic Fixation method also were studied. The study group comprised 62 patients with unequivocally vertically unstable pelvic fractures in whom the posterior injury was treated with closed reduction and percutaneous iliosacral screw Fixation. Of patients, 32 had dislocations or fracture-dislocations of the sacroiliac joint, and 30 had vertical fractures of the sacrum. Fixation failed in four patients, all with vertical sacral fractures and all within the first 3 weeks after surgery. These four patients required revision Fixation. In two further cases with vertical sacral fractures, there was evidence that the fracture had only barely been held by the Fixation, but these fractures healed, and followup radiographs did not meet the displacement criteria for Failure. A vertical sacral fracture pattern was associated significantly with Failure (Fisher exact test, P = 0.04); the excess risk of Failure compared with sacroiliac joint injury was 13% (95% confidence interval 1% to 25%). There was no significant association between Failure and anterior Fixation method, iliosacral screw arrangement or length, or any demographic or injury variable. Percutaneous iliosacral screw Fixation is a useful technique in the management of vertically unstable pelvic fractures, but a vertical sacral fracture should make the surgeon more wary of Fixation Failure and loss of reduction.
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vertically unstable pelvic fractures fixed with percutaneous iliosacral screws does posterior injury pattern predict Fixation Failure
Journal of Orthopaedic Trauma, 2003Co-Authors: Damian R Griffin, Adam J. Starr, Charles M. Reinert, Alan L Jones, Shelly WhitlockAbstract:Objective: To measure the Failure rate of percutaneous iliosacral screw Fixation of vertically unstable pelvic fractures and particularly to test the hypothesis that Fixations in which the posterior injury is a vertical fracture of the sacrum are more likely to fail than Fixations with dislocations or fracture-dislocations of the sacroiliac joint. Design: Retrospective review. Setting: Level 1 trauma center. Methods: All patients with pelvic fractures admitted between January 1, 1993, and December 31, 1998, were identified from the trauma registry. Hospital records were used to identify patients treated with iliosacral screws. Radiologic studies were examined to identify patients who had unequivocally vertically unstable pelvic fractures. Immediate postoperative and follow-up anteroposterior, inlet, and outlet radiographs from a minimum of 12 months postinjury were examined. Position, length, and numbers of iliosacral screws and any evidence of screw Failure (eg, bending or breakage) were recorded. Residual postoperative displacement and late displacement of the posterior pelvis were measured. The main outcome measure was Failure, defined as at least 1cm of combined vertical displacement of the posterior pelvis compared with immediate postoperative position. The main analysis was for association between fracture pattern and Failure. Patient demographic data, iliosacral screw position, and anterior pelvic Fixation method also were studied. Results: The study group comprised 62 patients with unequivocally vertically unstable pelvic fractures in whom the posterior injury was treated with closed reduction and percutaneous iliosacral screw Fixation. Of patients, 32 had dislocations or fracture-dislocations of the sacroiliac joint, and 30 had vertical fractures of the sacrum. Fixation failed in four patients, all with vertical sacral fractures and all within the first 3 weeks after surgery. These four patients required revision Fixation. In two further cases with vertical sacral fractures, there was evidence that the fracture had only barely been held by the Fixation, but these fractures healed, and follow-up radiographs did not meet the displacement criteria for Failure. A vertical sacral fracture pattern was associated significantly with Failure (Fisher exact test, P=0.04); the excess risk of Failure compared with sacroiliac joint injury was 13% (95% confidence interval 1% to 25%). There was no significant association between Failure and anterior Fixation method, iliosacral screw arrangement or length, or any demographic or injury variable. Conclusions: Percutaneous iliosacral screw Fixation is a useful technique in the management of vertically unstable pelvic fractures, but a vertical sacral fracture should make the surgeon more wary of Fixation Failure and loss of reduction.
Je-hyun Yoo - One of the best experts on this subject based on the ideXlab platform.
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Gamma3 nail with U-Blade (RC) lag screw is effective with better surgical outcomes in trochanteric hip fractures.
Scientific reports, 2020Co-Authors: Seung Beom Han, Jae-kyun Jung, Chul-young Jang, Dae-kyung Kwak, Jeong-woo Kim, Je-hyun YooAbstract:The objective of this retrospective study was to investigate the surgical outcomes of AO/OTA 31 A1-3 trochanteric fractures treated with the new-generation Gamma3 nail with U-Blade (RC) lag screw and to analyze the risk factors related to Fixation Failure. A total of 318 consecutive patients who underwent cephalomedullary nailing using Gamma3 nail with U-Blade lag screw for trochanteric hip fractures between September 2015 and June 2018 were enrolled. The average age was 80 years and most patients (69%) were women. The mean follow-up was 12.2 months with a minimum of 6 months. 309 (97.2%) showed bony union with a mean time to union of 13.5 ± 8.7 weeks. Cut-out occurred in 2 patients (0.6%) and 7 patients showed excessive collapse (≥15 mm) of the proximal fragment. These 9 patients were assigned to the Failure group. The presence of a basicervical fracture component and comminution of the anterior cortex on preoperative 3-D CT showed a significant association with Fixation Failure, including cut-out, although comminution of the anterior cortex was the only independent risk factor for Fixation Failure on multivariate logistic regression analysis. Gamma3 nail with U-Blade lag screw showed favorable results for trochanteric hip fractures, with low cut-out rate (0.6%). However, more caution is required in treating trochanteric fractures with a basicervical fracture component and anterior cortex comminution even with this nail.
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Risk Factors Associated with Failure of Cephalomedullary Nail Fixation in the Treatment of Trochanteric Hip Fractures
Clinics in orthopedic surgery, 2020Co-Authors: Je-hyun Yoo, Jun-dong Chang, Changwon Park, Jihyo HwangAbstract:Background Intramedullary (IM) nailing is widely performed in elderly patients with trochanteric fractures. Thus, it is important to identify causative factors associated with Fixation Failure. We investigated Fixation Failures after IM nailing in elderly patients with trochanteric fractures and compared the Failure group with nonFailure group to identify risk factors of Fixation Failure. Methods A total of 396 patients aged 65 years or older underwent IM nailing for trochanteric fractures between January 2012 and August 2016 at our institution. Of those, 194 patients who were followed up for more than 12 months were enrolled in this study; 202 patients were excluded due to death during follow-up, bedridden status before injury, and loss to follow-up. All patients underwent plain radiography and preoperative computed tomography (CT). Results Fixation Failure occurred in 11 patients (5.7%). Seven patients had stable fractures (AO/OTA); eight patients had basicervical fractures (confirmed by CT). Five patients had comminution in the greater trochanter (confirmed by CT). Regarding fracture reduction, eight patients showed discontinuity in the anterior cortex. The position of the lag screw on the lateral view was in the center in six patients and in a posterior area in the other five patients. On the basis of comparison with the 183 patients without Fixation Failure, risk factors of Fixation Failure were higher body mass index (BMI; p = 0.003), basicervical type of fracture (p = 0.037), posterior placement of the lag screw on the lateral view (p < 0.001), and inaccurate reduction of the anterior cortex (p = 0.011). Conclusions Among the risk factors of Fixation Failure after IM nailing in elderly patients with trochanteric fractures, discontinuity of the anterior cortex and posterior position of the lag screw are modifiable surgeon factors, whereas higher BMI and basicervical type of fracture are nonmodifiable patient factors. Therefore, care should be taken to avoid Fixation Failure in IM nailing for patients with a basicervical type of fracture or higher BMI or both.
Martyn J. Parker - One of the best experts on this subject based on the ideXlab platform.
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Prediction of Fixation Failure after sliding hip screw Fixation.
Injury, 2004Co-Authors: Humayon Pervez, Martyn J. Parker, Sarah L. VowlerAbstract:Cut-out of the lag screw is the commonest cause of Fixation Failure after sliding hip screw Fixation of extracapsular hip fracture. A number of technical aspects of surgery have been used to asses the risk of cut-out. This study was to determine which of these indicators was the most reliable predictor of cut-out. The anterior-posterior and lateral post-operative radiographs of 23 cases of cut-out were compared with those of 77 cases of uneventful fracture healing. The tip-apex distance with correction for magnification was found to show the most significant difference between patients with cut-out against those without (P = 0.001), followed by the lag screw position on the lateral radiographs (P = 0.0095 and 0.014), reduction of the fracture on the anterior-posterior radiograph (P = 0.011 and 0.016) and the uncorrected tip-apex distance (P = 0.019). We recommend that for audit and research purposes the corrected tip-apex distance, fracture reduction and implant positioning methods should be used. For routine clinical practice, the uncorrected tip to apex distance, which is sum of the distance from the tip of the lag screw to the apex of the femoral head on anterior-posterior and lateral radiograph, and fracture reduction angle on the anterior-posterior radiograph are recommended.
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The Cochrane Library - Extramedullary Fixation implants and external fixators for extracapsular hip fractures
The Cochrane database of systematic reviews, 2002Co-Authors: Martyn J. Parker, Helen HandollAbstract:Background Extramedullary Fixation of hip fractures involves the application of a plate and screws to the lateral side of the proximal femur. In external fixators, the stabilising component is held outside the thigh by pins or screws driven into the bone on either side of the fracture. Objectives To compare different types of extramedullary Fixation implants and external fixators for treating extracapsular hip fracture in adults. Search strategy We searched the Cochrane Musculoskeletal Injuries Group specialised register and reference lists of relevant articles up to July 2002. Selection criteria All randomised or quasi-randomised trials comparing these devices for the Fixation of extracapsular hip fracture in adults. Data collection and analysis Two reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from trialists when required. Wherever appropriate, data from comparable trials were pooled. Main results Two trials examining the Gotfried plate and one, an external fixator, are newly included in this update. All 13 included trials had methodological flaws, which may affect the validity of their results. The limited data available for three trials (355 patients) comparing a fixed nail plate (Jewett or McLaughlin) with the sliding hip screw (SHS) indicated an increased risk of Fixation Failure for fixed nail plates. The two trials (433 patients) comparing the RAB plate with the SHS had contrasting results, notably in terms of operative complications, Fixation Failure and anatomical restoration. One trial (100 patients) found no significant difference between the Pugh nail and the SHS. Two trials (292 patients) compared the Medoff plate with the SHS. One trial reported higher operative blood loss and longer operative times for the Medoff plate. There was a lower risk of Fixation Failure for unstable trochanteric fractures fixed with the Medoff plate. Two trials involving, respectively, unstable trochanteric fractures (569 patients) and subtrochanteric fractures (107 patients) compared the Medoff plate with three different screw-plate systems. There were no statistically significant differences in outcome for trochanteric fractures. For subtrochanteric fractures, there was a tendency to less Fixation Failure for the Medoff plate, but no evidence for differences in longer-term outcomes. Two trials (226 patients) compared the Gotfried percutaneous plate with a SHS. A higher intra-operative Fixation Failure rate of the Gotfried plate indicated some specific restriction to its use. The Gotfried plate appeared to involve lower operative blood losses. There were insufficient data on long term outcomes. One trial (100 patients) provided some evidence of less operative trauma and speedier recovery for external Fixation when compared with the SHS. Final outcomes appeared similar. Authors' conclusions The fixed nail plate has higher risks of implant breakage and Fixation Failure than the SHS. Though insufficient evidence on other outcomes is available from randomised trials, the increased Fixation Failure rate is a major consideration and thus the SHS appears preferable. Insufficient information is available to draw firm conclusions of significant differences between the SHS and either the RAB, the Pugh, the Medoff or the Gotfried plates, or an external fixator.
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Trochanteric hip fractures. Fixation Failure commoner with femoral medialization, a comparison of 101 cases.
Acta orthopaedica Scandinavica, 1996Co-Authors: Martyn J. ParkerAbstract:The radiographic characteristics of 27 patients with a trochanteric fracture treated with a sliding hip screw in which Fixation Failure occurred, were compared with 74 cases having uneventful fracture union. Femoral medialization was commoner in specific fracture types, particularly if there was comminution of the lateral femoral cortex at the site of in sertion of the lag screw. Femoral medialization was strongly associated with Fixation Failure, with a 7-fold increase in the risk of Failure if medialization at more than one third occurred. These observations indicate that the value of implants preventing femoral medialization in specific types of trochanteric fracture merit further evaluation.
Ashoke K Sathy - One of the best experts on this subject based on the ideXlab platform.
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vertical shear pelvic ring injuries do transsacral screws prevent Fixation Failure
OTA international : the open access journal of orthopaedic trauma, 2020Co-Authors: Breann K Tisano, Adam J. Starr, Drew P Kelly, Ashoke K SathyAbstract:Objectives To determine the frequency of Fixation Failure after transsacral-transiliac (TS) screw Fixation of vertical shear (VS) pelvic ring injuries (OTA/AO 61C1) and to describe the mechanism of Failure of TS screws. Design Retrospective cohort study. Setting Level 1 academic trauma center. Patients/Participants Twenty skeletally mature patients with unilateral, displaced, unequivocal VS injuries were identified between May 1, 2009 and April 31, 2016. Mean age was 31 years and mean follow-up was 14 months. Twelve had sacroiliac dislocations (61C1.2) and eight had vertical sacral fractures (61C1.3). Intervention Operative treatment with at least one TS screw. Main Outcome Measurements Radiographic Failure, defined as a change of >1 cm of combined displacement of the posterior pelvis compared with the intraoperative position on inlet and outlet radiographs. Results Radiographic Failure occurred in 4 of 8 (50%) vertical sacral fractures. Posterior Fixation was comprised of a single TS screw in 3 of these 4 Failures. The dominant mechanism of screw Failure was bending. All of these Failures occurred early in the postoperative period. No Fixation Failures occurred among the sacroiliac dislocations. There were no deep infections or nonunions. Conclusions This is the first study to describe the mechanism of Failure of TS screws in a clinical setting after VS pelvic injuries. We caution surgeons from relying on single TS screw Fixation for vertically unstable sacral fractures. Close radiographic monitoring in the first few weeks after surgery is advised. Level of Evidence Level IV.
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Vertical shear pelvic ring injuries: do transsacral screws prevent Fixation Failure?
OTA international : the open access journal of orthopaedic trauma, 2020Co-Authors: Breann K Tisano, Adam J. Starr, Drew Kelly, Ashoke K SathyAbstract:To determine the frequency of Fixation Failure after transsacral-transiliac (TS) screw Fixation of vertical shear (VS) pelvic ring injuries (OTA/AO 61C1) and to describe the mechanism of Failure of TS screws. Retrospective cohort study. Level 1 academic trauma center. Twenty skeletally mature patients with unilateral, displaced, unequivocal VS injuries were identified between May 1, 2009 and April 31, 2016. Mean age was 31 years and mean follow-up was 14 months. Twelve had sacroiliac dislocations (61C1.2) and eight had vertical sacral fractures (61C1.3). Operative treatment with at least one TS screw. Radiographic Failure, defined as a change of >1 cm of combined displacement of the posterior pelvis compared with the intraoperative position on inlet and outlet radiographs. Radiographic Failure occurred in 4 of 8 (50%) vertical sacral fractures. Posterior Fixation was comprised of a single TS screw in 3 of these 4 Failures. The dominant mechanism of screw Failure was bending. All of these Failures occurred early in the postoperative period. No Fixation Failures occurred among the sacroiliac dislocations. There were no deep infections or nonunions. This is the first study to describe the mechanism of Failure of TS screws in a clinical setting after VS pelvic injuries. We caution surgeons from relying on single TS screw Fixation for vertically unstable sacral fractures. Close radiographic monitoring in the first few weeks after surgery is advised. Level IV. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.
Tim Chesser - One of the best experts on this subject based on the ideXlab platform.
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is Fixation Failure after plate Fixation of the symphysis pubis clinically important
Clinical Orthopaedics and Related Research, 2012Co-Authors: Stephen A C Morris, D. Smart, Judith Loveridge, Tim ChesserAbstract:Background Plate Fixation is a recognized treatment for pelvic ring injuries involving disruption of the pubic symphysis. Although Fixation Failure is well known, it is unclear whether early or late Fixation Failure is clinically important.