Tuesday, August 18, 2009

THE HANSSON TWIN HOOK


Hansson Twin Hook
Introduction
The Hansson Twin Hook is a new concept for the treatment of trochanteric hip fractures. Its development is based on the long and successful experience with the Hansson Pin System®. The Hansson Twin Hook offers a STRONG, STABLE FIXATION with MINIMAL SURGICAL TRAUMA.
Indications
The Hansson Twin Hook consists of two parts, an inner sliding tongue and an outer pin. The outer pin is 8.9 mm in diameter. Fixation in the femoral head is achieved by pushing the inner sliding tongue out through the proximal windows. The hooks are 4.6 mm in width and extend outward in a gentle curve 11 mm on each side of the outer pin.

The Hansson Twin Hook is used in combination with the Swemac Hip Plate or the Medoff Sliding Plate®.
Key Features and Benefits
Loading and deformation tests using cadaver femoral heads have shown that the Hansson Twin Hook behaves differently, compared to the Compression Hip Screw. In case of impaired sliding between the Twin Hook and the plate/barrel, the compressive forces are ­transmitted to the fixation of the Hansson Twin Hook in the femoral head rather than to the fracture.
If the compression screw moves, the bone is stripped. With the Hansson Twin Hook, instead of stripping the bone, the hooks will gradually bend, making this a more forgiving and durable fixation.

The Hansson Twin Hook gives 2-3 times better rotational resistance in cadaver femoral heads than a compression hip screw. Rotational stability of the Hansson Twin Hook in the plate barrel is ensured through bilateral flattening of the shaft to match the inside of the hip plate barrel.

Two hooks are positioned anterior and posterior with a total hook span of 31 mm. The hooks will be in contact with both cancellous and subchondral bone in the femoral head, providing a very good support against displacement.

Thursday, March 5, 2009

PLATING OR NAILING



23 years male fracture femur ..fixed with LCDCP ... xray film taken after 2 month
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Wednesday, March 4, 2009

LCP OR LOCKING NAIL??


she is 55 years old female with oblique fracture in lower third of femur with communition of posteromedial cortex. i fixed it with LCP with lag screw.

Tuesday, March 3, 2009

RADIAL HEAD PROSTHESIS

Regardless of whether the fracture is an isolated injury or associated with other lesions, internal fixation is the preferred option, providing that stable anatomical reduction can be achieved, so as to enable an exercise regime to be instituted immediately
If internal fixation is not possible, or if a successful outcome is uncertain, it should not be considered. The patient is not helped by IF that does not restore the anatomical pattern or which requires protective immobilization.

Sunday, March 1, 2009

Hydrogel as a Repair Device for Torn Cartilages


Researchers at the University of Bradford's School of Engineering and the university's spinoff called AGT Sciences have been working on a new hydrogel with potential applications in orthopedics, wound care, and other clinical disciplines in which connective tissue matters.Here's what AGT says about its product, promoted as "cartilage repair gel":Our hydrogel is made up almost entirely of water, yet can thicken to produce a substance 100-1000 times stronger than any other gel of its kind.This is because it is composed of two very long elastic-like molecules that form strong covalent bonds with each other to form a 3D network, like a cage, that holds the water. By adjusting the number of bonds, the physico-chemical properties of the gel can be manipulated to make it thick, thin or sticky. The gel also has the capability to hold molecules of other substances, whether water soluble or water insoluble (e.g. oil).Much of the company’s development has been undertaken using polyvinyl alcohol (PVOH) as the co-polymer. Our innovation, derived from research undertaken by our scientists at the University of Bradford, is a unique cross-linker, "PD2000", that is capable of bonding with a range of co­polymers to form materials with a unique combination of useful properties.A summary of the features of this technology includes:# Physical and Chemical Properties Able to form a wide range of hydrogels with different physico-chemical properties# Able to vary the physical form ranging from liquid to a solid# Solid can be formed with very high water content (90%+)# Cross-linking reaction can complete unaffected by the presence of other substances# Very high mechanical strength maintained even with high (90%+) water content# Can be extruded into films# Temperature and radiation resistant# Cross-linking reaction is reversible when desiredRelease and Absorption Properties# Can be used for sustained release of incorporated substances by virtue of zero order kinetics# Can be used to generate microemulsions – with the added capability of being able to ‘burst’ and release# Hygrostatic – maintains level of hydrationToxicity and Cell Biology# Non-toxic and meets current safety regulations# Intrinsically bacterostatic# Can be used as a medium for tissue growth

MAKO Introduces RIO Robotic Arm for Orthopedic Surgeries




MAKO Surgical has announced the release of its RIO Robotic Arm Interactive Orthopedic System. On display at this week's American Academy of Orthopaedic Surgeons annual meeting in Las Vegas, the device is designed to assist surgeons during knee resurfacing operation, a minimally invasive type of surgery thought to be useful for younger, active patients with early osteoarthritis. Since the knee resurfacing is a notoriously difficult operation to perform, the hope is that such a robot will introduce stability and precision.




From MAKO'S press release


The RIO™ Robotic Arm Interactive Orthopedic System and the RESTORIS® MCK MultiCompartmental Knee System make bone and tissue sparing MAKOplasty® partial knee resurfacing available to a larger population of patients. Previously, it was only possible to perform this precision resurfacing surgery on the medial (inner) portion of the knee. Now it can be performed on the medial, patellofemoral (top) or both components of the knee, offering a large and growing population of patients with early to mid-stage osteoarthritis (OA) of the knee a less invasive treatment option than total knee replacement.
“The field of medical robotics is coming of age, and MAKO is committed to leading the way in orthopedic surgery,” said Dr. Maurice R. Ferré, President, Chief Executive Officer and Chairman of the MAKO Board of Directors. “The advancement of our technology with RIO™ and RESTORIS® MCK allows a greater number of patients with osteoarthritis to benefit from the precision and improved outcomes of MAKOplasty®. ”
MAKO’s robotic arm system is the first FDA-cleared robotic arm system for orthopedic surgery. It provides patient-specific, three-dimensional modeling for pre-surgical planning. As surgeons use the robotic arm to resurface the knee for placement of the implants, RIO™ provides real-time inter-operative visual, tactile and auditory feedback, enabling a high level of precision and optimal positioning of the implants.
MAKOplasty® provides the potential for improved surgical outcomes, with a less invasive partial knee resurfacing procedure that spares healthy bone and tissue, preserves ligaments and allows for a more rapid recovery and a more natural feeling knee.

Friday, February 20, 2009


a 65 years old lady with supracondylar with intercondylar fracture humrus , fracture fixed with locking reconstruction plate with interfragmentary lag screw and two k wires.

TWO WEEK OLD SUPRACONDYLAR FRACTURE HUMRUS




25 yrs male, with supracondylar humrus fracture, treated with reconstruction plate and lag screw

Wednesday, February 18, 2009

EXCHANGE NAILING OR PLATE FIXATION?????

Exchange nailing or plate fixation
orthopedic Trauma Directions 2007; 03; 11-21

Summary

Evidence from nine case series suggests rates of solid union may be lower and the complication frequency higher for exchange nailing of femoral shaft nonunions than with plate fixation. However, no comparative study was found to evaluate the efficacy and safety of these procedures and there were more series describing exchange nailing than plate fixation. Methodologically rigorous comparative studies with larger populations are necessary to establish the long term safety and efficacy of these two operative treatments and to evaluate the superiority of one treatment over another.

Studies for this case

Study 1
Banaszkiewicz PA, Sabboubeh A, McLeod I, et al (2003)Femoral exchange nailing for aseptic non-union: not the end to all problemsInjury; 34(5):349–356.
Study 2
Choi YS, Kim KS (2005)Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures.Int Orthop; 29(5):287–290.
Study 3
Finkemeier CG, Chapman MW (2002)Treatment of femoral diaphyseal nonunions.Clin Orthop Relat Res; (398):223–234.
Study 4
Wu CC, Chen WJ (2002)Exchange nailing for aseptic nonunion of the femoral shaft.Int Orthop; 26(2):80–84.
Study 5
Bellabarba C, Ricci WM, Bolhofner BR (2001)Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing.Journal of Orthopaedic Trauma; 15(4):254–263.
Study 6
Hak DJ, Lee SS, Goulet JA, et al (2000)Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union.J Orthop Trauma; 14(3):178–182.
Study 7
Ueng SW, Chao EK, Lee SS, et al (1997)Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing.J Trauma; 43(4):640–644.
Study 8
Weresh MJ, Hakanson R, Stover MD, et al (2000)Failure of exchange reamed intramedullary nails for ununited femoral shaft fracturesJ Orthop Trauma; 14(5):335–338.
Study 9
Wu CC, Chen WJ (1997)Treatment of femoral shaft aseptic nonunions: comparison between closed and open bone-grafting techniquesJ Trauma; 43(1):112–116.

Sampling
A MEDLINE search was conducted for studies published between 1997 and 2006 comparing exchange nailing and plate fixation for treatment of femoral shaft nonunions. No comparative studies were found. Studies were excluded if there were fewer than five patients in any treatment group, if femoral nailing was not the initial treatment for the fracture or if outcomes for nonunion treatment were not separable. Studies were also excluded if there was loss of length of >1.5 cm or 1-stage femoral lengthening was done as part of the treatment. If multiple reports of the same study were found, the primary study report was included. Of 16 case-series identified, 9 remained after these exclusions and are summarized.

Objective
To critically summarize the outcomes and complications for exchange nailing and plating with bone graft for treatment of femoral shaft nonunions.

Common outcome measures

Solid union (radiographic or clinical)
Time to union
Complications (including reoperation for nonunion, malrotation, limited flexion, infection, broken nails, deep venous thrombosis, pulmonary embolism)
Operative time

Interventions
Exchange nailing:
Removal of prior intramedullary nail, over-reaming of intramedullary canal and insertion of exchange nail [Banaszkiewicz, Finkemeier, Wu 02, Hak, Weresh, Wu 97].
Plate fixation:
Plate fixation with and without autologous bone grafting leaving intramedullary nail in situ [Choi, Ueng] Removal of intramedullary nail, plate fixation with and without autologous bone grafting [Bellabarba].

Results
Solid union
Solid union (radiographic or clinical) was achieved in a smaller percentage of patients treated with exchange nailing (75%, range 56%–100%) compared with plate fixation (96%, range 91 –100%) based on pooled estimates.
There were more patients (N = 154) treated by exchange nailing [Banasziewicz, Finkemeier, Wu 02, Hak, Weresh, Wu 97] than those treated with plating (n = 55) [Choi, Bellabarba, Ueng].

Time to union
Pooled estimates of the mean time to achieve union were similar for both treatments: 5.2 months (4–9) when exchange nailing was used, and time to union 5.9 (4.2–7.2) months when plate fixation was used. [Banasziewicz, Wu 02, Wu 97, Choi, Bellabarba, Ueng].

Complications
The frequency of complications appears somewhat higher for nailing than for plate fixation. Since patients may have experienced more than one complication, the total number of complications divided by the total number of patients is reported.
The pooled estimate for the frequency of complications was 27% (0%–67%) with exchange nailing [Banasziewicz, Finkemeier, Wu 02, Weresh, Wu 97] and 18% (0%–30%) with plate fixation [Bellabarba, Ueng].
Complications described included nonunion, malrotation, limited flexion, infection, broken nails, deep venous thrombosis and pulmonary embolism.

Operative time
Pooled estimates for mean operative time were 96 minutes (36–150 minutes) for exchange nailing [Banasziewicz, Wu 97] and 125 minutes (66–164 minutes) for plate fi xation [Choi, Bellabarba].
Mike Bemelman > NetherlandsChristian van der Werken > Netherlands

IM nailing is currently the treatment of choice for the great majority of femoral shaft fractures. Surgery is really minimally invasive, the biomechanics are almost optimal, and the healing rates are very high, especially after reaming of the medullary canal. These benefits are also valid for the treatment of femoral shaft nonunions.

To our surprise the presented analysis revealed some evidence that suggests that the rates of solid union may be lower and the complication frequency higher for exchangenailing of femoral shaft nonunion than with plate fixation in combination with cancellous bone grafting on broad indication.

This evidence is only level IV—based on case series— and possibly even weaker because the presented data is extracted from a small number of mainly retrospective (8/9) clinical studies, in a heterogeneous group of patients who were treated by many different doctors and with a variety of materials and methods.

In our experience, exchange nailing with reaming of the medullary canal has several distinct advantages over plate fixation and bone grafting. Surgery is in general rather simple and elegant with a shorter operation time. Access is through an existing scar while no comorbidity (pain, physical and cosmetic) is added for surgical exposure of the nonunion area and bone graft harvesting. After nailing full weight bearing is generally the rule.

Nevertheless there are still rational indications for plate fixation, eg, nonunions in combination with a deformity, in cases in which the nail and/or locking bolds are broken (especially if the nail is solid) and in situations where the nail is inserted too deeply or through a joint.