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Yingze Zhang - One of the best experts on this subject based on the ideXlab platform.

  • Posterior Column acetabular fracture fixation using a w shaped angular plate a biomechanical analysis
    PLOS ONE, 2017
    Co-Authors: Ke Su, Shilun Li, Ruipeng Zhang, Tao Wu, Yingze Zhang
    Abstract:

    Objective The purpose of this study was to compare the stability and feasibility of four fixation constructs in a Posterior Column acetabular fracture: one reconstruction plate, one reconstruction plate and lag screw, two reconstruction plates, and a W-shaped acetabular angular plate. Methods Twenty embalmed cadaveric pelvises with a Posterior Column acetabular fractures were allocated to one of four groups: 1) a reconstruction plate, 2) a reconstruction plate with a Posterior Column lag screw, 3) double reconstruction plates, and 4) a W-shaped acetabular angular plate. These constructs were mechanically loaded on a testing machine, and construct stiffness values were measured. Strain gauges were utilized to measure the mechanical behavior in the condition of compressive force. Results Final stiffness was not different between the two reconstruction plates (445.81±98.30 N/mm) and the W-shaped acetabular angular plate (447.43±98.45 N/mm, p = 0.524), both of which were superior to a single reconstruction plate (248.90±61.95 N/mm) and a combined plate and lag screw (326.41±94.34 N/mm). Following the fixation of the W-shaped acetabular angular plate, the strain distribution was similar to the intact condition around the acetabulum. The parameters of the W-shaped acetabular angular plate that were observed at the superior region of the acetabulum were less than those of a single reconstruction plate (p<0.05), a single reconstruction plate with lag screw (p<0.05), and two reconstruction plates (p<0.05). Conclusions The novel W-shaped acetabular angular plate fixation technique was able to provide the biomechanically stiffest construct for stabilization of a Posterior Column acetabular fracture; it also resulted in a partial restoration of joint loading parameters toward the intact state.

  • Posterior Column acetabular fracture fixation using a W-shaped angular plate: A biomechanical analysis.
    PLOS ONE, 2017
    Co-Authors: Song Liu, Ruipeng Zhang, Yingchao Yin, Yingze Zhang
    Abstract:

    Objective The purpose of this study was to compare the stability and feasibility of four fixation constructs in a Posterior Column acetabular fracture: one reconstruction plate, one reconstruction plate and lag screw, two reconstruction plates, and a W-shaped acetabular angular plate. Methods Twenty embalmed cadaveric pelvises with a Posterior Column acetabular fractures were allocated to one of four groups: 1) a reconstruction plate, 2) a reconstruction plate with a Posterior Column lag screw, 3) double reconstruction plates, and 4) a W-shaped acetabular angular plate. These constructs were mechanically loaded on a testing machine, and construct stiffness values were measured. Strain gauges were utilized to measure the mechanical behavior in the condition of compressive force. Results Final stiffness was not different between the two reconstruction plates (445.81±98.30 N/mm) and the W-shaped acetabular angular plate (447.43±98.45 N/mm, p = 0.524), both of which were superior to a single reconstruction plate (248.90±61.95 N/mm) and a combined plate and lag screw (326.41±94.34 N/mm). Following the fixation of the W-shaped acetabular angular plate, the strain distribution was similar to the intact condition around the acetabulum. The parameters of the W-shaped acetabular angular plate that were observed at the superior region of the acetabulum were less than those of a single reconstruction plate (p

  • Fluoroscopic views for safe insertion of lag screws into the Posterior Column of the acetabulum
    BMC Musculoskeletal Disorders, 2014
    Co-Authors: Wei Chen, Yingze Zhang, Zekun Zhang, Yong Shen
    Abstract:

    Percutaneous lag screw fixation is an alternative treatment for non-displaced or minimally displaced Posterior Column fractures. This study aims to explore new fluoroscopic views of the acetabulum for safe percutaneous insertion of Posterior Column lag screws. Axial computed tomography (CT) scans were taken of sixteen embalmed adult cadavers. The axial CT images at the level of the middle height of the acetabulum were selected. The angle (angle α) between the Posterior cortex of the Posterior Column (PCPC) and the line intersecting the axial plane and the coronal plane, and the angle (angle β) between the medial wall and the line intersecting the axial plane and the sagittal plane were identified and measured. Tangential views of the PCPC and medial wall were obtained by referencing the measured angles. A lag screw was inserted into the Posterior Columns of the sixteen pelvic specimens under fluoroscopic guidance using an iliac oblique view and the two tangential views. CT scans were performed to evaluate the lag screw position. Axial CT images of 52 volunteers were obtained and the angles α and β were measured following the same methods used for the cadaveric specimens. The angles α and β for the specimens were 29.3±2.8.1 and 8.1±1.4 degrees, respectively. On the tangential view of the PCPC, the Posterior cortex appears as a nearly straight line between the lesser and greater sciatic notches. On the tangential view of the medial wall, the medial wall appears as a distinct straight line. Using these radiographic images, the lag screws were inserted into the Posterior Columns of bony pelvic specimens. Screw placement was confirmed by CT, and found to be fully intraosseous in all cases without any cortical breaches. The angles α and β were 30.4±4.1 and 9.2±1.9 degrees for male volunteers and 28.5±3.7 and 7.7±1.8 degrees for female volunteers, significant difference in these angles between cadaveric specimens and human volunteers. The tangential views of both the PCPC and medial wall can be obtained following the aforementioned methods The oblique iliac view and the two tangential views enable safe insertion of Posterior Column lag screws.

  • Computer.assisted thermoplastic elustomer film localization system for screw insertion to fix Posterior Column of acetabulum
    Chinese Journal of Orthopaedic Trauma, 2008
    Co-Authors: Jin-she Pan, Yingze Zhang
    Abstract:

    Objective To assess accuracy and efficacy of the mini-invasive screw insertion for fix-ation of the Posterior Column of acetabulum by the computer-assisted thermoplastic elastomer film localization system. Methods In a simulated surgical setup, 20 cannulated screws were placed into the Posterior Column of acetabulum in 10 corpses under the guidance of the computer-assisted thermoplastic elastomer film localization system. The positions of the screws were checked with CR and CT. Results All the 20 screws were in the safe area. Radiation exposure was totally avoided. Conclusion The system can pro-vide precise, effective and safe navigation for screw insertion to fix the Posterior Column of acetabulum, and markedly prevent the patient and the staff from exposure to the radiation. Key words: Surgery, computer-assisted; Thermoplastic elastomer film localization system; Acetabulum; Screws

Harm Hoekstra - One of the best experts on this subject based on the ideXlab platform.

  • poor sporting abilities after tibial plateau fractures involving the Posterior Column how can we do better
    European Journal of Trauma and Emergency Surgery, 2019
    Co-Authors: Liselore Quintens, M Reul, Stefaan Nijs, Juriaan Van Den Berg, Esther M M Van Lieshout, Michiel Verhofstad, Harm Hoekstra
    Abstract:

    Tibial plateau fractures with the involvement of the Posterior Column are an important prognostic factor towards poor functional outcome. We aimed to assess the sporting abilities postoperatively with special emphasis on the type of sports and sport-specific movements, as well as time needed to resume sports, restricting factors in sports engagement, and patient satisfaction. We aimed to provide prognostic information on return to sports. Demographic, clinical and radiological variables were retrospectively collected from 82 multicentric patients between 2014 and 2016. Prospectively, sporting abilities before and after surgery were determined using questionnaires at a mean follow-up of 33 months postoperatively. Involvement in sports significantly decreased, with only 68.4% of patients resuming sports (p < 0.001). The mean time needed to partially or fully resume sports was 6–9 and 9–12 months, respectively. The ability to resume at the pre-injury level of effort and performance was 22% and 12%, respectively. Restricting factors were pain (66%), fear of re-injury (37%), limited range of motion (26%), and instability (21%). The majority (59%) of patients were unsatisfied with their physical abilities. Significantly worse outcomes were observed in patients playing high-impact sports, experiencing knee pain during physical activity, suffering from extension/valgus or flexion/varus trauma. Tibial plateau fractures with the involvement of the Posterior Column significantly hamper the patients’ sporting abilities, leaving the majority of patients unsatisfied. Preoperative counseling about prognosis, setting realistic expectations, optimizing rehabilitation and pain management postoperatively, and advising low-impact sports might improve engagement in physical activities and emotional impact on patients. 3.

  • Poor sporting abilities after tibial plateau fractures involving the Posterior Column: how can we do better?
    European Journal of Trauma and Emergency Surgery, 2019
    Co-Authors: Liselore Quintens, Juriaan Van Den Berg, Stefaan Nijs, Michiel Verhofstad, Maike Reul, Esther Lieshout, Harm Hoekstra
    Abstract:

    Purpose Tibial plateau fractures with the involvement of the Posterior Column are an important prognostic factor towards poor functional outcome. We aimed to assess the sporting abilities postoperatively with special emphasis on the type of sports and sport-specific movements, as well as time needed to resume sports, restricting factors in sports engagement, and patient satisfaction. We aimed to provide prognostic information on return to sports. Methods Demographic, clinical and radiological variables were retrospectively collected from 82 multicentric patients between 2014 and 2016. Prospectively, sporting abilities before and after surgery were determined using questionnaires at a mean follow-up of 33 months postoperatively. Results Involvement in sports significantly decreased, with only 68.4% of patients resuming sports ( p  

  • Limited value of the Column concept in the operative management of Posterior Column tibial plateau fractures.
    European Journal of Trauma and Emergency Surgery, 2019
    Co-Authors: Juriaan Van Den Berg, Stefaan Nijs, Harm Hoekstra
    Abstract:

    Introduction The three-Column concept has been proposed as tool in surgical decision-making for treating tibial plateau fractures. Recent studies have underscored the negative effect of Posterior Column tibial plateau fractures on clinical outcome. The purpose of this study was to assess the value of the three-Column concept and Posterior plating in Posterior Column fractures. We hypothesized that treating patients according to the three-Column concept improves functional outcome.

  • Limited value of the Column concept in the operative management of Posterior Column tibial plateau fractures
    European Journal of Trauma and Emergency Surgery, 2019
    Co-Authors: Juriaan Van Den Berg, Stefaan Nijs, Harm Hoekstra
    Abstract:

    Introduction The three-Column concept has been proposed as tool in surgical decision-making for treating tibial plateau fractures. Recent studies have underscored the negative effect of Posterior Column tibial plateau fractures on clinical outcome. The purpose of this study was to assess the value of the three-Column concept and Posterior plating in Posterior Column fractures. We hypothesized that treating patients according to the three-Column concept improves functional outcome. Methods 111 consecutive tibial plateau fractures, treated between January 2009 and December 2016, with at least a Posterior Column fracture were included. Relevant demographic and treatment variables were studied. Applied treatment was retrospectively evaluated according to the three-Column concept. Patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Results Median follow-up was 43.1 months (IQR 29.0–63.3) with a response rate of 80.2%. Outcome scores were markedly lower compared to the general population. 22.5% patients were treated according to the three-Column concept and 27% was treated with Posterior plating. Predominantly combined fractures of Posterior and lateral Columns were treated without fixation of the Posterior Column. Neither treatment according to the three-Column concept and/or with Posterior plating was found to significantly influence outcome. Conclusions The outcome of Posterior Column fractures was equal, regardless of whether these fractures were treated or not. This indicates that the three-Column concept seems insufficient and gives rise to further debate on surgical strategies of Posterior Column fractures. The implementation of trauma mechanism-based fracture morphology in the three-Column concept might be important to consummate the three-Column concept as guiding tool. Level of evidence 3.

  • functional outcome of intra articular tibial plateau fractures the impact of Posterior Column fractures
    International Orthopaedics, 2017
    Co-Authors: Juriaan Van Den Berg, M Reul, Menno Nunes Cardozo, Anastasiya Starovoyt, Eric Geusens, Stefaan Nijs, Harm Hoekstra
    Abstract:

    Although regularly ignored, there is growing evidence that Posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of Posterior Column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies. A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-Column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of Posterior Column fractures was 61.9%. Posterior Column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-Column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of Posterior Column fracture fixation, due to a limited patient size. Our data indicates that implementation of the updated three-Column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize Posterior Column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of Posterior Column fractures with restoration of the sagittal alignment.

Stefaan Nijs - One of the best experts on this subject based on the ideXlab platform.

  • poor sporting abilities after tibial plateau fractures involving the Posterior Column how can we do better
    European Journal of Trauma and Emergency Surgery, 2019
    Co-Authors: Liselore Quintens, M Reul, Stefaan Nijs, Juriaan Van Den Berg, Esther M M Van Lieshout, Michiel Verhofstad, Harm Hoekstra
    Abstract:

    Tibial plateau fractures with the involvement of the Posterior Column are an important prognostic factor towards poor functional outcome. We aimed to assess the sporting abilities postoperatively with special emphasis on the type of sports and sport-specific movements, as well as time needed to resume sports, restricting factors in sports engagement, and patient satisfaction. We aimed to provide prognostic information on return to sports. Demographic, clinical and radiological variables were retrospectively collected from 82 multicentric patients between 2014 and 2016. Prospectively, sporting abilities before and after surgery were determined using questionnaires at a mean follow-up of 33 months postoperatively. Involvement in sports significantly decreased, with only 68.4% of patients resuming sports (p < 0.001). The mean time needed to partially or fully resume sports was 6–9 and 9–12 months, respectively. The ability to resume at the pre-injury level of effort and performance was 22% and 12%, respectively. Restricting factors were pain (66%), fear of re-injury (37%), limited range of motion (26%), and instability (21%). The majority (59%) of patients were unsatisfied with their physical abilities. Significantly worse outcomes were observed in patients playing high-impact sports, experiencing knee pain during physical activity, suffering from extension/valgus or flexion/varus trauma. Tibial plateau fractures with the involvement of the Posterior Column significantly hamper the patients’ sporting abilities, leaving the majority of patients unsatisfied. Preoperative counseling about prognosis, setting realistic expectations, optimizing rehabilitation and pain management postoperatively, and advising low-impact sports might improve engagement in physical activities and emotional impact on patients. 3.

  • Poor sporting abilities after tibial plateau fractures involving the Posterior Column: how can we do better?
    European Journal of Trauma and Emergency Surgery, 2019
    Co-Authors: Liselore Quintens, Juriaan Van Den Berg, Stefaan Nijs, Michiel Verhofstad, Maike Reul, Esther Lieshout, Harm Hoekstra
    Abstract:

    Purpose Tibial plateau fractures with the involvement of the Posterior Column are an important prognostic factor towards poor functional outcome. We aimed to assess the sporting abilities postoperatively with special emphasis on the type of sports and sport-specific movements, as well as time needed to resume sports, restricting factors in sports engagement, and patient satisfaction. We aimed to provide prognostic information on return to sports. Methods Demographic, clinical and radiological variables were retrospectively collected from 82 multicentric patients between 2014 and 2016. Prospectively, sporting abilities before and after surgery were determined using questionnaires at a mean follow-up of 33 months postoperatively. Results Involvement in sports significantly decreased, with only 68.4% of patients resuming sports ( p  

  • Limited value of the Column concept in the operative management of Posterior Column tibial plateau fractures.
    European Journal of Trauma and Emergency Surgery, 2019
    Co-Authors: Juriaan Van Den Berg, Stefaan Nijs, Harm Hoekstra
    Abstract:

    Introduction The three-Column concept has been proposed as tool in surgical decision-making for treating tibial plateau fractures. Recent studies have underscored the negative effect of Posterior Column tibial plateau fractures on clinical outcome. The purpose of this study was to assess the value of the three-Column concept and Posterior plating in Posterior Column fractures. We hypothesized that treating patients according to the three-Column concept improves functional outcome.

  • Limited value of the Column concept in the operative management of Posterior Column tibial plateau fractures
    European Journal of Trauma and Emergency Surgery, 2019
    Co-Authors: Juriaan Van Den Berg, Stefaan Nijs, Harm Hoekstra
    Abstract:

    Introduction The three-Column concept has been proposed as tool in surgical decision-making for treating tibial plateau fractures. Recent studies have underscored the negative effect of Posterior Column tibial plateau fractures on clinical outcome. The purpose of this study was to assess the value of the three-Column concept and Posterior plating in Posterior Column fractures. We hypothesized that treating patients according to the three-Column concept improves functional outcome. Methods 111 consecutive tibial plateau fractures, treated between January 2009 and December 2016, with at least a Posterior Column fracture were included. Relevant demographic and treatment variables were studied. Applied treatment was retrospectively evaluated according to the three-Column concept. Patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Results Median follow-up was 43.1 months (IQR 29.0–63.3) with a response rate of 80.2%. Outcome scores were markedly lower compared to the general population. 22.5% patients were treated according to the three-Column concept and 27% was treated with Posterior plating. Predominantly combined fractures of Posterior and lateral Columns were treated without fixation of the Posterior Column. Neither treatment according to the three-Column concept and/or with Posterior plating was found to significantly influence outcome. Conclusions The outcome of Posterior Column fractures was equal, regardless of whether these fractures were treated or not. This indicates that the three-Column concept seems insufficient and gives rise to further debate on surgical strategies of Posterior Column fractures. The implementation of trauma mechanism-based fracture morphology in the three-Column concept might be important to consummate the three-Column concept as guiding tool. Level of evidence 3.

  • functional outcome of intra articular tibial plateau fractures the impact of Posterior Column fractures
    International Orthopaedics, 2017
    Co-Authors: Juriaan Van Den Berg, M Reul, Menno Nunes Cardozo, Anastasiya Starovoyt, Eric Geusens, Stefaan Nijs, Harm Hoekstra
    Abstract:

    Although regularly ignored, there is growing evidence that Posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of Posterior Column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies. A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-Column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of Posterior Column fractures was 61.9%. Posterior Column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-Column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of Posterior Column fracture fixation, due to a limited patient size. Our data indicates that implementation of the updated three-Column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize Posterior Column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of Posterior Column fractures with restoration of the sagittal alignment.

Mitsuru Kawamura - One of the best experts on this subject based on the ideXlab platform.

  • thumb localizing test for detecting a lesion in the Posterior Column medial lemniscal system
    Journal of the Neurological Sciences, 1999
    Co-Authors: Keizo Hirayama, Toshio Fukutake, Mitsuru Kawamura
    Abstract:

    A proprioception examination, called the 'thumb localizing test' (TLT), is described as a technique for testing 'limb localization'. With the patient's eyes closed, the examiner positions one of the patient's upper limbs (fixed limb) and asks him to pinch the thumb of that limb with the opposite thumb and index finger (reaching limb). The findings for 221 patients (423 limbs) show that: there were TLT deficits when the limb contralateral to the cerebral lesion or ipsilateral to the peripheral nerve lesion was the fixed limb, but not when the fixed limb became the reaching limb; that the deficits of limb localization found by the TLT were strongly correlated with deficits of deep or discriminative perceptions such as sense of joint position and movement and tactile cutaneous localization, but uncorrelated with sensory deficits of pain and temperature; that deficits of limb localization were apt to arise from lesions in the Posterior Column-medial lemniscal system at various levels in the peripheral nerves, cervical cord, brainstem, thalamus or parietal lobe; and that impairment of limb localization and other deep or discriminative sensations were occasionally dissociated. The TLT is easily done at the patient's bedside and can detect a lesion in the Posterior Column-medial lemniscal system. Moreover, it provides the means to examine the perceptual deficits using a motor task of the opposite limb.

  • ‘Thumb localizing test’ for detecting a lesion in the Posterior Column–medial lemniscal system
    Journal of the Neurological Sciences, 1999
    Co-Authors: Keizo Hirayama, Toshio Fukutake, Mitsuru Kawamura
    Abstract:

    A proprioception examination, called the 'thumb localizing test' (TLT), is described as a technique for testing 'limb localization'. With the patient's eyes closed, the examiner positions one of the patient's upper limbs (fixed limb) and asks him to pinch the thumb of that limb with the opposite thumb and index finger (reaching limb). The findings for 221 patients (423 limbs) show that: there were TLT deficits when the limb contralateral to the cerebral lesion or ipsilateral to the peripheral nerve lesion was the fixed limb, but not when the fixed limb became the reaching limb; that the deficits of limb localization found by the TLT were strongly correlated with deficits of deep or discriminative perceptions such as sense of joint position and movement and tactile cutaneous localization, but uncorrelated with sensory deficits of pain and temperature; that deficits of limb localization were apt to arise from lesions in the Posterior Column-medial lemniscal system at various levels in the peripheral nerves, cervical cord, brainstem, thalamus or parietal lobe; and that impairment of limb localization and other deep or discriminative sensations were occasionally dissociated. The TLT is easily done at the patient's bedside and can detect a lesion in the Posterior Column-medial lemniscal system. Moreover, it provides the means to examine the perceptual deficits using a motor task of the opposite limb.

Ke Su - One of the best experts on this subject based on the ideXlab platform.

  • Posterior Column acetabular fracture fixation using a w shaped angular plate a biomechanical analysis
    PLOS ONE, 2017
    Co-Authors: Ke Su, Shilun Li, Ruipeng Zhang, Tao Wu, Yingze Zhang
    Abstract:

    Objective The purpose of this study was to compare the stability and feasibility of four fixation constructs in a Posterior Column acetabular fracture: one reconstruction plate, one reconstruction plate and lag screw, two reconstruction plates, and a W-shaped acetabular angular plate. Methods Twenty embalmed cadaveric pelvises with a Posterior Column acetabular fractures were allocated to one of four groups: 1) a reconstruction plate, 2) a reconstruction plate with a Posterior Column lag screw, 3) double reconstruction plates, and 4) a W-shaped acetabular angular plate. These constructs were mechanically loaded on a testing machine, and construct stiffness values were measured. Strain gauges were utilized to measure the mechanical behavior in the condition of compressive force. Results Final stiffness was not different between the two reconstruction plates (445.81±98.30 N/mm) and the W-shaped acetabular angular plate (447.43±98.45 N/mm, p = 0.524), both of which were superior to a single reconstruction plate (248.90±61.95 N/mm) and a combined plate and lag screw (326.41±94.34 N/mm). Following the fixation of the W-shaped acetabular angular plate, the strain distribution was similar to the intact condition around the acetabulum. The parameters of the W-shaped acetabular angular plate that were observed at the superior region of the acetabulum were less than those of a single reconstruction plate (p<0.05), a single reconstruction plate with lag screw (p<0.05), and two reconstruction plates (p<0.05). Conclusions The novel W-shaped acetabular angular plate fixation technique was able to provide the biomechanically stiffest construct for stabilization of a Posterior Column acetabular fracture; it also resulted in a partial restoration of joint loading parameters toward the intact state.