Minimally invasive lag screw fixation of sacroiliac luxation/fracture using a dedicated novel instrument system: Apparatus and technique description.

OBJECTIVE: To describe a novel Sacroiliac Luxation Instrument System (SILIS™) and its application in minimally invasive osteosynthesis (MIO) of sacroiliac luxations/fractures (SIL/F). The SILIS was designed to provide stable SIL/F reduction and accurate sacral screw placement while reducing personnel exposure to ionizing radiation during intraoperative fluoroscopy. STUDY DESIGN: Descriptive, proof of concept cadaveric study. METHODS: A right SIL and a left SIL/F were created on a Labrador Retriever that had died of natural causes. Bilateral sacroiliac lag screw fixation was performed under fluoroscopic guidance with the SILIS, which consists of dedicated reduction and fixation instruments rigidly linked to table-bound 6-axis arms. RESULTS: Throughout surgery, the SILIS facilitated and maintained stable reduction and allowed accurate placement of a custom designed drill guide over the sacral body without the surgeon's manual holding of any reduction or fixation instruments. The surgical team was therefore able to step away from the C-arm when acquiring fluoroscopic images, thus reducing exposure to radiation. Dorsoventral and craniocaudal screw deviation from an ideal trajectory ranged from 0.9° to 3.8°. Both screws were fully located within the sacral body. CONCLUSION: The SILIS addresses limitations associated with MIO of SIL/F, including maintenance of reduction throughout surgery along with reliable and accurate sacral screw placement. Distance from the X-ray source is the most effective protection against radiation. Use of the SILIS allows the surgical team to move away from the C-arm during fluoroscopy, thereby reducing personnel exposure to dangerous direct and back-scattered ionizing radiation.

Surgical stabilization of concomitant canine medial patellar luxation and cranial cruciate ligament disease. Effect of fixation method on postoperative complication rate and clinical outcome.

OBJECTIVES: To compare complication rates and outcomes between cases of concomitant cranial cruciate ligament (CrCL) disease and medial patellar luxation (MPL) treated using extracapsular stabilization and tibial tuberosity transposition (ECS+TTT) and tibial tuberosity transposition and advancement (TTTA). METHODS: In a multicentre retrospective study, records from four referral hospitals were reviewed for dogs with concomitant CrCL pathology and MPL treated using ECS+TTT or TTTA. Data retrieved included signalment, partial/complete CrCL tear, MPL grade, treatment performed, occurrence of postoperative complications, and postoperative outcome grade. Associations between surgical procedure and risk of complication and surgical procedure and outcome were investigated using univariable logistic regression and proportional odds logistic regression respectively. Multiple logistic regression was used to explore confounding factors. RESULTS: A total of 72 stifles were evaluated in 66 dogs; 32 stifles were stabilized using ECS+TTT and 40 using TTTA. Overall complications were 2.7 times more frequent in the ECS+TTT group and major complications occurred only in this group. The TTTA group was less likely to suffer complications (17.5%) compared to the ECS+TTT group (46.9%) (p = 0.009) and TTTA cases had lower odds of a poorer clinical outcome (p = 0.047). CLINICAL SIGNIFICANCE: Stifles stabilized using ECS+TTT are more likely to suffer from postoperative complications and a poorer clinical outcome when compared to TTTA.