We conducted a randomised, controlled trial to determine whether changing gloves at specified intervals can reduce the incidence of glove
Pedicle screw (PS) insertion has been critised for its risk of serious injury to neurovascular structures. Although computed tomography (CT)-based navigation has been developed to avoid such complications,
The spread of viral diseases such as HIV has highlighted the importance of protecting medical personnel against contamination from blood. We have assessed the frequency of the
In orthopedic surgeries, it is critical to reduce the risks of drilling complications during bone fracture fixation, especially around critical organs such as in acetabula-pelvic procedures. Either over-drilling or x-ray overuse shall be avoided to reduce potential complications to the surrounding critical organs or tissues. Toward recognising
Objectives. Despite promising results have shown by osteogenic cell-based demineralized bone matrix composites, they need to be optimized for grafts that act as structural frameworks in load-bearing defects. The aims of this study is attempt to assess the effects of laser
Long femoral nails for neck of femur fractures and prophylactic fixation have a risk of anterior cortex
Aim. There is limited data on the frequency and impact of untoward events such as glove
To assess the current literature on suture anchor placement for the purpose of identifying factors that lead to suture anchor
This paper presents an ongoing review of the use of a wedge-shaped porous metal augments in the shoulder to address glenoid retroversion as part of anatomical total shoulder arthroplasty (aTSA). Seventy-five shoulders in 66 patients (23 women and 43 men, aged 42 to 85 years) with Walch grade B2 or C glenoids underwent porous metal glenoid augment (PMGA) insertion as part of aTSA. Patients received either a 15º or 30º PMGA wedge (secured by screws to the native glenoid) to correct excessive glenoid retroversion before a standard glenoid component was implanted using bone cement. Neither patient-specific guides nor navigation were used. Patients were prospectively assessed using shoulder functional assessments (Oxford Shoulder Score [OSS], American Shoulder and Elbow Standardized Shoulder Assessment Form [ASES], visual analogue scale [VAS] pain scores and forward elevation [FE]) preoperatively, at three, six, and 12 months, and yearly thereafter, with similar radiological surveillance. Forty-nine consecutive series shoulders had a follow-up of greater than 24 months, with a median follow-up of 48 months (range: 24–87 months). Median outcome scores improved for OSS (21 to 44), ASES (24 to 92), VAS (7 to 0), and FE (90º to 140º). Four patients died, but no others were lost to follow-up. Apart from one infection at 18 months postoperatively and one minor peg
Minimally invasive placement of iliosacral screws (SI-screw) is becoming the standard surgical procedure for sacrum fractures. Computer navigation seems to increase screw accuracy and reduce intraoperative radiation compared to conventional radiographic placement. In 2012 an interdisciplinary hybrid operating theatre was installed at the University of Ulm. A floor-based robotic flat panel 3D c-arm (Artis zeego, Siemens, Germany) is linked to a navigation system (BrainLab Curve, BrainLab, Germany). With a single intraoperative 3D scan the whole pelvis can be visualised in CT-like quality. The aim of this study was to analyse the accuracy of SI-screws using this hybrid operating theater. 32 SI-screws (30 patients) were included in this study. Indications ranged from bone tumour resection with consecutive stabilisation to pelvic ring fractures. All screws were implanted using the hybrid operating theatre at the University of Ulm. We analysed the intraoperative 3D scan or postoperative computed tomography and classified the grade of
Aim. ”There is not a lot of data of the frequency and impact of unwanted events including glove
The well-fixed cemented femoral stem and surrounding cement can be challenging to remove. Success requires evaluation of the quality of the cement mantle (interface lucency), position of the stem, extent of cement below the tip of the stem and skill with the specialised instruments and techniques needed to remove the stem and cement without perforating the femur. Smooth surfaced stems can usually be easily removed from the surrounding cement mantle with a variety of stem extractors that attach to the trunnion or an extraction hole on the implant. Roughened stems can be freed from the surrounding cement mantle with osteotomes or a narrow high speed burr and then extracted with the above instruments. Following this, the well-fixed cement mantle needs to be removed. Adequate exposure and visualization of the cement column is essential to remove the well-fixed cement without damage to the bone in the femur. This is important since fixation of a revision femoral component typically requires at least 4 cm of contact with supportive cortical bone, which can be difficult to obtain if the femur is perforated or if the isthmus damaged. Proximally, cement in the metaphyseal region can be thinned with a high speed burr, then split radially and removed piecemeal. It is essential to remember that both osteotomes and high speed burrs will cut thru bone easier than cement and use of these instruments poses a substantial risk of unintended bone removal and
INTRODUCTION. Isolated injuries of the sacral bone are rare. The pathomechanism of these injuries are usually high velocity accidents or falls from large heights. The computer-assisted implantation of iliosacral screws (SI-screw) becomes more important in the treatment of dorsal pelvic ring fractures. The advantage of the minimal-invasive screw placement is the reduction of the non-union and deep wound infection rate. Another advantage of computer-navigated SI-screw placement is the reduction of intraoperative radiation for the patient and the surgical staff. The purpose of this study was to analyse the position of navigated iliosacral screws. METHODS. In the study group 74 screws (49 patients) were included and radiologically analysed. All screws were implanted using 3D-navigation (BrainLAB Vector Vision, Brainlab, Germany). Navigation was always executed with the same 3D c-arm (ARCADIS Orbic 3D, Siemens, Germany) and navigation system. We determined the grade of
Background. A challenge to obtaining proper glenoid placement in total shoulder arthroplasty is eccentric posterior bone loss and associated glenoid retroversion. This bone loss can lead to poor stability and
Traditional medial soft tissue release for balancing of the varus knee in total knee arthroplasty can lead to an inconsistent reduction in medial tension. The purpose of this study is to establish whether sequential needle puncturing of the medial collateral ligament (MCL) can be a safe and predictable method for medial release. Total knee prostheses were implanted in 14 cadaveric specimens by a single surgeon. Medial tension was measured in flexion and extension by a pressure sensor with implants in place, and calipers after removal of implants and gap distraction under constant tension. Measurements were performed after each of 5 sets of 5 punctures of the MCL with an 18-gauge needle and following 5 transverse
The well-fixed cemented femoral stem and surrounding cement can be challenging to remove. Success requires evaluation of the quality of the cement mantle (interface lucency), position of the stem, extent of cement below the tip of the stem and skill with the specialised instruments and techniques needed to remove the stem and cement without perforating the femur. Smooth surfaced stems can usually be easily removed from the surrounding cement mantle with a variety of stem extractors that attach to the trunnion or an extraction hole on the implant. Roughened stems can be freed from the surrounding cement mantle with osteotomes or a narrow high speed burr and then extracted with the above instruments. Following this, the well fixed cement mantle needs to be removed. Adequate exposure and visualization of the cement column is essential to remove the well-fixed cement without damage to the bone in the femur. This is important since fixation of a revision femoral component typically requires at least 4cm of contact with supportive cortical bone, which can be difficult to obtain if the femur is perforated or if the isthmus damaged. Proximally, cement in the metaphyseal region can be thinned with a high speed burr, then split radially and removed piecemeal. It is essential to remember that both osteotomes and high speed burrs will cut thru bone easier than cement and use of these instruments poses a substantial risk of unintended bone removal and
Peri-prosthetic fractures around implants in the proximal humerus can present substantial challenges. Most individuals who undergo upper limb arthroplasty tend to be osteopenic to begin with, and the anatomy of the proximal humerus does not provide an excess of bone to work with. Therefore, peri-prosthetic fractures pose difficulties to rotator cuff function and implant stability. There are multiple classification systems, but series are small and the classification does not always lead to treatment algorithms. Risk factors for humeral fractures after shoulder arthroplasty include endosteal notching, cortical
The well-fixed femoral stem can be challenging to remove. Removal of an extensively osteointegrated cementless stem requires disruption of the entire implant-bone interface while a well-fixed cemented stem requires complete removal of all adherent cement from the underlying cortical bone in both the metaphysis and diaphysis of the femur. In these situations, access to those areas of the femur distal to the metaphyseal flare that are beyond the reach of osteotomes and high speed burrs is necessary. This typically requires use of an extended femoral osteotomy (ETO). The ETO should be carefully planned so that it extends distal enough to allow for access to the end of the stem or cement column and still allow for stable fixation of a new implant. Too short of an ETO increases the risk of femoral
Introduction. Bone marrow stimulation has been a successful treatment option in cartilage repair and microfracture was the procedure of choice since the late 1980s. Despite its success in young and active patients, microfracture has inherent shortcomings such as shallow channels, wall compression, and non-standardized depth and diameter. This in vitro study assessed bone marrow access comparing microfracture, 1 and 2mm K-Wires, 1mm drill, and a recently introduced standardized subchondral bone needling procedure (Nanofracture) that creates 9mm deep and 1mm wide channels. Methods. An adult ovine model was used to assess access to bone the marrow spaces as well as effects on bone following microfracture, nanofracture, K-wire, and drilling following ethical clearance. All bone marrow stimulation techniques were conducted on a full thickness articular cartilage defect on the medial femoral condyles by the same surgeon. The same groups were repeated in vitro in 4 paired ovine distal femurs. MicroCT (Inveon Scanner, Siemens, Germany) was performed using 3D reconstruction and 25 micron slice analysis (MIMICS, Materialise, Belgium). Results. Microfracture elicited shallow depth with bone compression surrounding the channels. Trabecular channel access was limited; the channel depth and diameter were non-standardized and highly user and instrument dependent. Nanofracture demonstrated deep cancellous bone
Introduction. Bisphosphonates (BP) are the first-line therapy for preventing osteoporotic fragility fractures. However, concern regarding their efficacy is growing because bisphosphonate use is associated with over-suppression of remodeling. Animal studies have reported that BP therapy is associated with accumulation of micro-cracks (Fig. 1) and a reduction in bone mechanical properties, but the effect on humans has not been investigated. Therefore, our aim was to quantify the mechanical strength of bone treated with BP, and correlate this with the microarchitecture and density of micro-damage in comparison with untreated osteoporotic hip-fractured and non-fractured elderly controls. Methods. Trabecular bone cores from patients treated with BP were compared with patients who had not received any treatment for bone osteoporotic disease. Non-fractured cadaveric femora from individuals with no history of bone metabolic disease were also used as controls. Cores were imaged in high resolution (∼1.3µm) using Synchrotron X-ray tomography (Diamond Light Source Ltd.) The scans were used for structural and material analysis, then the cores were mechanically tested in compression. A novel classification system was devised to characterise features of micro-damage in the Synchrotron images: micro-cracks, diffuse damage and