The American journal of orthopedics
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Comparative Study
Transsacral versus modified pelvic landmarks for percutaneous iliosacral screw placement--a computed tomographic analysis and cadaveric study.
The alar roots of the first sacral body are the usual confines for iliosacral screw (IS) placement when stabilizing a sacroiliac joint injury or sacral fracture. The traditional transsacral method of IS placement aligns the screw horizontally through the sacral ala on both the inlet and outlet views of the sacrum. A modified oblique method of IS placement aligns the screw in an oblique fashion, directed inferiorly to superiorly and posteriorly to anteriorly. ⋯ All 5 screws were located within the confines of the S-1 segment by means of the modified oblique technique. Thus, the modified oblique placement technique allowed greater accuracy and reliability over transsacral landmarks in placing percutaneous ISs. The use of the modified oblique pelvic landmarks is warranted during percutaneous iliosacral screw stabilization of the posterior pelvis.
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Comparative Study
Evaluation of tendon-to-bone reattachment: a rabbit model.
Two different tendon-to-bone reattachment methods were compared to assess tensile strength and histologic repair. After sharp dissection, rabbit Achilles tendons were reattached to the calcaneus by one of two methods: to abraded cortical bone (group 1) or into a cancellous bone tunnel (group 2). After surgery, each rabbit had its long-leg hip spica-cast in plantar flexion for 3 weeks. ⋯ Blinded pathologic evaluation reported similar healing with both methods over time. With both methods, healing occurred with Sharpey fibers attached to the superficial cortex, with tendon resorption occurring in the bone tunnel. The simple method of cortical reattachment was shown to be equal to the more complex bone-tunnel reattachment.
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Randomized Controlled Trial Clinical Trial
Bupivacaine for postoperative pain relief at the iliac crest bone graft harvest site.
An inevitable side effect of iliac crest bone graft harvesting is postoperative pain at the donor site. Bupivacaine hydrochloride is a long-acting local anesthetic that is clinically effective for approximately 8 hours. The present study was undertaken to assess postoperative pain relief with locally injected bupivacaine at the iliac crest bone graft harvest site. ⋯ The single diabetic patient who had a triple arthrodesis developed a wound infection at the catheter placement site. The number of patients was too small to draw conclusions about the differences in pain-medication requirements between patients undergoing single versus multiple diskectomies and fusions. In view of the lack of improvement in pain relief and the risk of infection, local administration of bupivacaine at the iliac bone harvest site is not recommended in its present form for postoperative analgesia.
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One complication of the Chrisman-Snook ankle reconstruction is persistent postoperative pain. The incidence of this complication ranges from 7% to 60%. We report 10 cases of surgical exploration for persistent pain after Chrisman-Snook reconstructions. ⋯ Surgical exploration should be considered for any of the following findings: persistent point tenderness (especially at the graft tunnel sites), localized swelling, a painful mass, recurrent instability/laxity, a symptomatic neuroma, or painful inversion and dorsiflexion. To prevent the complication of persistent postoperative pain after the Chrisman-Snook ankle reconstruction, we recommend the following: 1) avoid forced eversion when tensioning the graft, excessive posterior placement of the calcaneal tunnel, casting in eversion, and the use of nonabsorbable suture; 2) resect the distal muscle belly of the peroneus brevis muscle distal to the superior peroneal retinaculum; 3) check for tears in the peroneus brevis; 4) respect the sural nerve; and 5) obtain a watertight closure of the joint capsule. Although the Chrisman-Snook ankle reconstruction is an excellent technique, numerous pitfalls in surgical technique must be avoided.