RESUMO
LEVEL OF EVIDENCE: Level IV: Case report.
Assuntos
Tendão do Calcâneo , Traumatismos dos Tendões , Humanos , Tendão do Calcâneo/cirurgia , Ruptura/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Traditional Kirschner wire (K-wire) stabilization of first metatarsal distal chevron osteotomy involves 1 cortex of fixation; however, unicortical fixation is associated with a high complication rate, including pin migration. A method of K-wire fixation utilizing 3 cortices may be biomechanically superior and potentially equivalent to single-screw fixation. METHODS: Cadaveric specimens fixed with tricortical K-wires were tested in both the physiologic and cantilever conditions against specimens fixed with unicortical K-wires (N = 8) and single screws (N = 9) utilizing matched-pair comparison groups. Differences in physiologic and cantilever fixed/intact stiffness ratio and cantilever failure load were determined. RESULTS: The tricortical fixation specimens had a significantly higher stiffness ratio in cantilever loading than the unicortical fixation specimens (60.50% tricortical, 34.17% unicortical, P = .02) but not in physiologic load (15.34% tricortical, 25.75% unicortical, P = .23). In cantilever failure loading, the tricortical fixation specimens had a significantly higher load to failure than the unicortical fixation specimens (132.81 N tricortical, 58.58 N unicortical, P < .01). Stiffness ratio under physiologic load, cantilever load, and ultimate load to failure were not significantly different between tricortical K-wire and screw-fixation groups. CONCLUSION: Tricortical K-wire fixation for distal chevron osteotomies is biomechanically superior to traditional unicortical K-wire fixation, and equivalent to single-screw fixation. LEVELS OF EVIDENCE: Level V: Cadaver study.
Assuntos
Hallux Valgus , Ossos do Metatarso , Fenômenos Biomecânicos , Parafusos Ósseos , Fios Ortopédicos , Cadáver , Hallux Valgus/cirurgia , Humanos , Ossos do Metatarso/cirurgia , Osteotomia/métodosRESUMO
ABSTRACT: Orthopaedic hardware explantation is a multifaceted topic with complex legal, ethical, and scientific aspects that require thorough exploration. Issues of device ownership, explant-induced disease propagation, and potential device resale pose legal risks to providers and health-care institutions. Ethically, implant removal highlights the potential that performing procedures at the request of the patient will incentivize patient compliance and strengthen the patient-surgeon relationship. However, the return of explanted hardware to patients could hinder scientific study and innovation, ultimately limiting advancement in risk reduction and patient outcomes. Continued research into these topics remains paramount to ensure that clinicians and institutions deliver optimal patient care while abiding with legal and ethical imperatives. This article addresses the legal, ethical, and scientific issues that are pertinent to returning an explanted orthopaedic implant to the patient and the potential ramifications of such practice.
Assuntos
Ortopedia , Remoção de Dispositivo , Humanos , Princípios Morais , Equipamentos OrtopédicosRESUMO
Introduction: Chronic global pelvic instability can be due to many different etiologies with infection being an uncommon cause. We present a case of chronic global pelvis instability secondary to osteomyelitis involving both the anterior and posterior ring, a rare and challenging problem with no standard treatment. Case Presentation: A 57-year-old female with a history of intravenous drug use presented with global pelvis instability in the setting of pubic symphysis and posterior sacroiliac osteomyelitis with multiple-associated abscesses. She was managed with serial surgical debridement's X4 and combined anterior and posterior fixation/fusion, with resolution of her infection and instability. Conclusions: This is the first reported case of chronic pelvis instability secondary to anterior and posterior pelvic ring osteomyelitis that was successfully treated with serial debridement and combined anterior and posterior fixation/fusion.