Clinical Effectiveness of the Plate Screw Internal Fixation Technique in the Treatment of Patients with Traumatic Fractures of Long Bones in the Lower Extremities

Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.

Pedicle Screw Fixation with Kyphoplasty Decreases the Fracture Risk of the Treated and Adjacent Non-treated Vertebral Bodies:a Finite Element Analysis

Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures（OVCFs） after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation（PSF） with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs.By simulating cement augmentation with or without short segment pedicle screw fixation（PSF）,two tridimensional,anatomically detailed finite element models of the T10–L2 functional spinal junction were developed.The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations.The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra.The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae.Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.

Comparison of Clinical Outcomes of Cortical Bone Trajectory and Traditional Pedicle Screw Fixation in Posterior Lumbar Interbody Fusion

Posterior lumbar interbody fusion (PLIF) is a common surgical procedure and widely used in the treatment of lumbar degenerative disc disorders. Traditionally, posterior lumbar interbody fusion is done by using the traditional pedicle screw (PS) which offers great advantages, but at the same time it has some disadvantages which include the risk of superior facet joint violation and muscle damage. Recently, an alternative method of screw insertion via cortical bone trajectory (CBT) has been invented which has less invasive process and can be placed without the drawbacks associated with the traditional pedicle screw. However, it has to remain an interest whether CBT will provide similar or greater clinical outcomes compared to PS in PLIF. So the main aim of this review is to compare the clinical outcomes of cortical bone trajectory and traditional pedicle screw fixation in posterior lumbar interbody fusion based on the articles published on this topic. Compared to the traditional pedicle screw fixation, PLIF with CBT has similar clinical outcome based on pain intensity, ODI status and JOA score, as well as similar fusion rate and radiological evaluated complication such as loosening of screw. In addition PLIF with CBT has advantages of less facet joint violation, less blood loss, less intraoperative muscle damage and perioperative pain. On the basis of this study, we can suggest that PLIF with CBT can be considered as a reasonable alternative to PS in PLIF.

Successful outcomes of unilateral vs bilateral pedicle screw fixation for lumbar interbody fusion:A meta-analysis with evidence grading

BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.

Investigation of optical reflectance from different animal vertebra along the fixation trajectory of pedicle screw in frequency domain

Accurate placement of pedicle screw(PS)is crucial in spinal surgery.Developing new real-time intra-operative monitoring and navigation methods is an important direction of clinical appli-cation research.In this paper,we studied the spectrum along the fixation trajectory of PS in frequency domain to tackle the accuracy problem.Fresh porcine vertebrae,bovine vertebrae and ovine vertebrae were measured with the near-infrared spectrum(NIR)device to obtain the reflected spectrum from the vertebrae.Along the fixation trajectory of PS,average energy from different groups was calculated and used for identifying different tissues and compared to achieve the optimal recognition factor.Compared with the time domain approach,the frequency domain method could divide the spectra measured at different tissue points into different groups more stably and accurately,which could serve as a new method to assist the PS insertion.The results gained from this study are significant to the development of hi-tech medical instruments with independent intellectual property rights.

Treatment of Anderson Type II Odontoid Fracture in Elderly Patients by Posterior Pedicle Screw Fixation Combined with Iliac Bone Grafting

Objectives: To explore the treatment and related prognosis of elderly patients with Anderson II odontoid fracture with posterior pedicle screw fixation combined with iliac bone grafting. Methods: Retrospective analysis of 17 cases of elderly patients with Anderson II odontoid fracture who underwent posterior pedicle screw fixation combined with iliac bone grafting from January 2013 to December 2016. 17 patients had a history of trauma before surgery, and they all have varying degrees of atlantoaxial instability or subluxation and varying degrees of neck occipital pain and limited mobility. Result: No spinal cord or vertebral artery injury occurred during surgery. Follow-up information is complete. The follow-up period was 6 to 48 months (mean 27.4 ± 12.4 months). Postoperative imaging review prompted a good reduction of cervical spine, stable sequence;no pedicle screw loosening, fracture, iliac bone graft at the location of the situation, odontoid fracture and bone healing at the good, the patient after cervical rotation are limited to varying degrees. Conclusion: Posterior pedicle screw fixation combined with iliac bone grafting in elderly patients with Anderson II odontoid fracture can achieve good stability, and the prognosis is good, but long-term cervical rotation function may be affected to varying degrees.

Learning curves of robot-assisted pedicle screw fixations based on the cumulative sum test

BACKGROUND In robot-assisted(RA)spine surgery,the relationship between the surgical outcome and the learning curve remains to be evaluated.AIM To analyze the learning curve of RA pedicle screw fixation(PSF)through fitting the operation time curve based on the cumulative summation method.METHODS RA PSFs that were initially completed by two surgeons at the Beijing Jishuitan Hospital from July 2016 to March 2019 were analyzed retrospectively.Based on the cumulative sum of the operation time,the learning curves of the two surgeons were drawn and fit to polynomial curves.The learning curve was divided into the early and late stages according to the shape of the fitted curve.The operation time and screw accuracy were compared between the stages.RESULTS The turning point of the learning curves from Surgeons A and B appeared in the 18th and 17th cases,respectively.The operation time[150(128,188)min vs 120(105,150)min,P=0.002]and the screw accuracy(87.50%vs 96.30%,P=0.026)of RA surgeries performed by Surgeon A were significantly improved after he completed 18 cases.In the case of Surgeon B,the operation time(177.35±28.18 min vs 150.00±34.64 min,P=0.024)was significantly reduced,and the screw accuracy(91.18%vs 96.15%,P=0.475)was slightly improved after the surgeon completed 17 RA surgeries.CONCLUSION After completing 17 to 18 cases of RA PSFs,surgeons can pass the learning phase of RA technology.The operation time is reduced afterward,and the screw accuracy shows a trend of improvement.

Evaluation of Percutaneous Pedicle Screw Fixation in Patients with Pyogenic Spondylitis of the Thoracolumbar Spine

Background: Basic principle for the treatment of pyogenic spondylitis (PS) is conservative care, but surgical intervention is often required when conservative treatment may fail. We have experienced many conservative cases of various complications due to long-term bed rest and poor pain control. Recently we have adopted percutaneous pedicle screw (PPS) fixation for the treatment of PS as a minimally invasive spine stabilization (MISt) fusion to reduce such morbidity of the conservative care. Objective: To evaluate the impact of PPS fixation in patients with PS. Study Design: A retrospective analysis of the medical records. Subjects, Methods: We reviewed 54 consecutive patients who underwent treatment in our hospital for PS during 2005-2018 and observed for more than 12 months. Of those we excluded cases showing effectiveness to initial treatment (it was defined fever relief or C-reactive protein (CRP) inversion in 3 weeks of antibiotics) so that this study is a retrospective study in cases showing initial treatment resistance. Finally, this study included 29 cases. Medical records of these 29 cases were reviewed for baseline, organism isolated and its detection rate, the clinical outcome in 12 months (Discharge, Transfer, Death), the period from the first visit to our hospital to fever relief, CRP inversion, ambulation, and Discharge or Transfer. Results: These cases were divided into two groups, the conservative group (C-group): 17 cases, and the PPS group (P-group): 12 cases. There is no statistically significant difference in fever relief (p = 0.051) and CRP inversion (p = 0.208). The period to ambulation and discharge or transfer was significantly shorter in group P (p = 0.020, p = 0.031). 1-Year survival rate was 92% in the P-group, and 71% in the C-group. There is no statistically significant difference (p = 0.354) between the two groups. The rate of Discharge to home and care facility is 58% in P-group, and 47% in C-group. And the rate of Transfer is 34% in P-group, and 35% in C-group. Conclusion: PPS fixation was effective to achieve shortening the period to ambulation and discharge or transfer. But it was not effective in infection control. This suggests that PPS fixation should be aggressively administered to patients who can expect pain relief and early ambulation by PPS fixation in the patient of PS showing resistance to initial treatment.

A novel technique for sacropelvic fixation using image-guided sacroiliac screws:a case series and biomechanical study

In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.

TREATMENT OF DISLOCATION OF THE FRESH ACROMIOCLAVICULAR JOINT USING INTERNAL FIXATION OF CLOSED REDUCTION AND CANNULATED LAG SCREW

Objective Introduce a new method to treat fresh acromioclavicular joint dtslocations-close reduction and percutaneous internal lixatlon using guide cannulated lag screw. Methods 12 cases of acute acromioclavicular joint dislocations were treated and followed. Results 11 cases succeeded and one failed with technical mistakes. Conclusion Because no important nerve or vessel passing between coracoid process and clavicle, close reduction and percutaneous coracoclavicular cannulated lag screw fixation treatment is safe, effective and affords early rehabilitation.

Three-dimensional finite element study of anterior transpedicular screw-artificial vertebral fixation in lower cervical spine

Objective Biomechanical properties of the anterior cervical pedicle screw artificial vertebral system and conventional anterior screw plate system were analyzed in lower cervical spine by finite element.Methods CT images were obtained from a 38-year-old female volunteer.Following models were established and analyzed by Mimics14.0,Geomagic Studio 2013,ANSYS 14.0 software:the intact cervical model(C3-C7),corpectomy of C5 model,the model of conventional anterior screw plate system fixation(AP),and the model of anterior transpedicular screw artificial vertebral body sys-

Outcome of Long Segment Transpedicular Screw Fixation in Unstable Thoracolumbar Spine Injury with Incomplete Neurological Deficit

Background: Long segment transpedicular screw fixation in thoracolumbar spine injury has gained popularity in the last decades as it provides immediate stability, prevents further risk of complications and allows early mobilization of patient. Objectives: Evaluation of clinical and functional outcome after long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit patients. Methods: This quasi experimental study was conducted at Dhaka Medical College and Hospital (DMCH), Dhaka, Bangladesh from January 2016 to December 2017. A total of twenty four (24) patients with traumatic unstable fracture of the thoracolumbar spine with incomplete neurological deficit underwent long segment transpedicular screw fixation were included in this study. Clinical and radiologic outcomes were assessed pre-operatively and post-operatively. Results: A total of 24 patients aged between 20 - 60 years of both sexes (Male-21, Female-03) were included in this study. Their mean (±SD) age was 33.12 (±8.57) years. Most of them were farmer [09 (37.5%)] and day labour [08 (33.33%)]. Motor vehicle accidents were the most common [16 (66.67%)] cause of injury and then fall from height [08 (33.33%)]. The most common level of injury involved was L1-10 (41.67%) patients, followed by L2-07 (29.17%), T12-05 (20.83%) and T11-02 (8.33%) of the study patients. Burst fracture was the commonest [22 (91.67%)] type of fracture followed by Chance fracture [02 (8.33%)]. Pre-operative mean (±SD) Cobb angle, Kyphotic deformation of vertebral body, Beck index and vertebral compression deformity were 21.83 ± 4.5 degrees, 22.09 ± 4.40 degrees, 0.78 ± 2.65 and 0.18 ± 0.93 mm respectively, after procedure which were significantly (p Conclusions: Long segment transpedicular screw fixation is an effective method of treatment in patients having thoracolumbar spine injury with incomplete neurological deficit.

Comparison of joint function and trauma severity after arthroscopic headless compression screw fixation and conventional open reduction and internal fixation treatment of patellar transverse fracture

Objective:To study the differences in joint function and trauma severity after arthroscopic headless compression screw fixation and conventional open reduction and internal fixation treatment of patellar transverse fracture.Methods: 58 patients with patellar transverse fracture who accepted operative treatment in our hospital between August 2012 and December 2015 were collected and divided into open surgery group (n=30) and arthroscopic surgery group (n=28) according to the surgical approach. Before operation and 3 months after operation, the knee joint function of two groups of patients was evaluated respectively;3 d after operation, enzyme-linked immunosorbent assay (ELISA) was used to detect serum pain mediators, stress hormones and other trauma-related indicators.Results:Differences in the knee joint function index levels were not statistically significant between two groups of patients before operation (P>0.05);3 months after operation, the maximal knee joint flexibility and maximal extension levels of arthroscopic surgery group were higher than those of open surgery group (P<0.05);3 d after operation, serum prostaglandin (PGI2), dopamine (DA), neuropeptide Y (NPY), substance P (SP), glucocorticoid (Cor), renin (R), angiotensin 1 (Ang1), angiotensin 2 (Ang2), epinephrine (E), norepinephrine (NE) and aldosterone (ALD) levels of arthroscopic surgery group were significantly lower than those of open surgery group (P<0.05).Conclusions:Arthroscopic headless compression screw fixation can optimize the knee joint function and reduce the surgical trauma in patients with patellar transverse fracture.

Unilateral pedicle screw fixation combined with lumbar interbody fusion for the treatment of lumbar degenerative diseases

Objective To explore the feasibility and efficiency of the treatment of lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion (PLF) procedures in which unilateral pedicle screw fixation was used.

Atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability

Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were

Safety factors for anterior pedicle screw fixation tunnel in axis

Objective To investigate feasibility and safety of anterior pedicle screw fixation tunnel in the axis so as to provide theoretic evidence for further clinical application.Methods Thirty-two dry axis specimens were used foranterior

Atlantoaxial pedicle screw fixation for old odontoid fracture combined with atlantoaxial instability

Objective To explore the clinical effect of the trans-atlantoaxial pedicle screw-rod internal fixation and fusion in treatment of old odontoid fracture combined with atlantoaxial instability. Methods The study involved 48 patients with

Free-hand cervical pedicle screw fixation for upper cervical fracture and instability

Objective To evaluate the clinical effect of the free-hand cervical pedicle screw fixation in treatment of the upper cervical fracture and instability. Methods A retrospective review was performed on 15 patients

Value of helical CT volume rendering technique in post-operative evaluation of screw in screw fixation of axis fractures

To explore the value of helical CT volume rendering technique (VRT) in post-operative evaluation of screw fixation of axis fractures.Methods There were 21 cases of screw fixation of axis fractures between February 2002 and May 2004 in the study including six cases with fractures on axis body,five on odontoid process and 10 on axis body and odontoid process.All cases received X-ray plain film,helical CT scanning,multi-planar reformatting(MPR) and VRT.Results Screw fixation through axis body and massa lateralis atlantis was performed in 10 cases and that through axis body and odontoid process in 11.VRT could clearly display full aperture of screw orbit,location of screw and angle of fixation and hence was superior to X-ray plain film and MPR.Multi-angle VRT displayed asymmetrical space of odontoid process and massa lateralis atlantis in four cases and medial deviation of 2～5 mm of half screw in screw fixation through axis body and massa lateralis atlantis in six.Conclusion VRT can eliminate false shadow of fixation screw,clearly display full aperture of screw orbit and hence supply improtant imaging evidence for post-operative evaluation of screw fixation of axis fractures.7 refs,1 fig,1 tab.