Techniques in Orthopaedics : TIO

Scientist and technologist have long sought to advance limb prostheses that connect directly to the peripheral nervous system, enabling a person with amputation to volitionally control synthetic actuators that move, stiffen and power the prosthesis, as well as to experience natural afferent sensations from the prosthesis. Recently, the agonist-antagonist myoneural interface (AMI) was developed, a mechanoneural transduction architecture and neural interface system designed to provide persons with amputation improved muscle-tendon proprioception and neuroprosthetic control...

Despite evidence that malnutrition is associated with significant complications in orthopedic surgery1 , unrecognized malnutrition continues to be a "silent epidemic", effecting up to 50% of hospitalized patients. Specifically, pre-surgical malnutrition is associated with increased risk for surgical site infections, increased length of hospital stay, and increased health care costs in patients following total joint arthroplasty. Serologic markers (i.e. serum albumin and total lymphocyte count), anthropometric measurements, (i...

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In spine surgery, pedicle screw instrumentation is being used very commonly. However, putting pedicle screws in the right place and direction needs the use of image intensifier in 2 orthogonal planes. This consumes valuable time while moving the image intensifier and operating table multiple times during the surgery and also excess radiation exposure. Here, we present a simple technique to apply surgical pearl to angulate the pedicle screws in cephalocaudal direction using simple instrument available on table...

There are various techniques of cement applications in total knee arthroplasty with a lack of clear consensus on best practice. The use of a bladder syringe as a reservoir and applicator of cement allows for minimal handling of the cement along with greater control and cost savings as compared with the manufacturer cement guns.

Fractures of the supercondylar humerus are the most common elbow fracture in pediatrics. Management of this injury would be aided if surgeons could reliably test fracture stability intraoperatively after pinning. A transverse supracondylar humerus fracture model was created using 3 adult cadaver upper-extremity specimens with an intact soft tissue envelope. Using the lateral entry technique, three 2.0 mm pins were then drilled using lateral entry technique to create an "A" pinning. Pins were checked in anteroposterior and lateral views with the C-arm to confirm accurate placement in both planes...

Instability of the knee joint after total knee replacement (TKR) is one of the most important reasons for revision TKR. Inadequate release or tightening of the collateral ligaments in the knee joint may cause instability and early failure. This study presents a case series study of a new technique for ligament balancing wherein the collateral ligament is detached from its origin and rotated (twisted) around its longitudinal axis to tighten the ligament before the origin is reattached to its original position...

Background: Fractures and dislocations of the base of the fifth metacarpal can lead to arthritis of the fifth carpometacarpal (CMC) joint. For patients who are symptomatic and fail conservative management, arthrodesis of the fifth CMC joint can be offered. The fusion can be performed using Kirschner wires (K-wires), but can lead to complications such as pin tract infection and pin migration. A low-profile locking plate may represent an attractive alternative. The purpose of this study was to compare the biomechanical stability of these 2 fusion techniques...

When persistent rotation of the femur remains into adolescence, it can cause functional limitations such as fatigue, anterior knee pain, and frequent tripping. In these cases, derotation of the femur via osteotomy is often performed. We report preliminary results of bilateral derotational osteotomy for excessive femoral anteversion or retroversion using the modified intramedullary nail technique. A retrospective review of 8 patients was performed. Patients were excluded if additional procedures were performed or if the femoral osteotomy included any deformity correction other than rotation...

Accurate acetabular cup placement is a crucial step for a successful total hip replacement. Transverse acetabular ligament is an important and reliable landmark that helps in determining the version during the placement of acetabular cups. However, the visualization of transverse acetabular ligament may not be easy as the view may be blocked by the implants and the instruments. We have devised a simple technique to aid in achieving patient-specific ante-version during implantation of uncemented acetabular cups by using "channel lines...

Introduction: All available patient-specific instruments or patient-specific templates (PSTs) are controlled by implant companies. Most of these companies outsource some of the steps of the PST such as imaging, preoperative planning, manufacturing of PST, and packing/sterilization. This is a proof of concept clinical study on the hospital-based PST system for total knee arthroplasty (TKA). Methods: A total number of 257 TKA procedures were performed on the basis of a new concept of hospital-based PSTs...

The loss of bone mineral density caused by Chronic Kidney Disease can make the delineation of a patient's bony anatomy impossible during intra-operative fluoroscopy. This has the potential to increase the failure rate of implants used in the surgical treatment of neck of femur fractures due to sub-optimal placements. Intra-operative arthrograms add to the techniques available to a surgeon to achieve optimal implant placement without compromising the patient's renal function nor increasing the radiation dose exposure to the surgical team...

Surgical repair of the Achilles tendon is a common procedure for acute Achilles tendon ruptures. Variations in surgical technique and patient positioning exist, with the ultimate goal of achieving a durable repair while minimizing complications. Recently the use of a mini-open approach has been demonstrated to provide a durable repair that is comparable to using a larger traditional open approach. In this paper we describe a mini-open approach for surgical repair of the Achilles tendon while the patient is in the supine position...

The cortical bone trajectory (CBT) screw technique yields effective mechanical and clinical results, improving the holding screw strength with a less invasive exposure. Accurate and safe screw placement is crucial. A patient-specific drill template with a preplanned trajectory was considered a promising solution; however, it is critical to assess the efficacy and safety of this technique. This study aims to evaluate the accuracy of patient-specific computed tomography (CT)-based rapid prototype drill guide templates for the CBT technique...

Anterolateral rotational laxity of the knee is a persistent problem following anterior cruciate ligament reconstruction (ACLR) that can lead to increased rates of graft failure. Renewed interest in the anterolateral complex of the knee has led to a resurgence in the use of adjunctive techniques such as lateral extra-articular tenodesis and anterolateral ligament reconstruction. Use of these techniques can restore normal knee kinematics and potentially thereby reduce the rate of graft failure. Historically, experience with modified ACLR techniques such as the double-bundle ACLR have shown that improved biomechanics is not always reflected in clinical outcome trials...

In the anterior cruciate ligament (ACL) deficient knee, excellent outcomes are achieved in many patients with an isolated, intra-articular ACL reconstruction. Some patients, however, have ongoing instability or suffer graft rupture. Failure after ACL reconstruction is multifactorial, but residual anterolateral rotatory laxity is 1 potential contributing factor. Lateral extra-articular procedures are a heterogenous group of operations that were initially described as isolated treatments for the ACL deficient knee, and subsequently used in combination with intra-articular reconstructions...

Background: Graft rupture rate, return to sport and persistent rotational instability remain a concern postoperatively following anterior cruciate ligament (ACL) reconstruction. The anterolateral ligament (ALL) has recently been shown to act as a lateral knee stabilizer that helps improve rotational stability. To improve functional and clinical outcomes, a combined ACL reconstruction with an associated ALL reconstruction has been proposed. Purpose: The main purpose of this study was to evaluate the clinical outcomes of the combined ACL and ALL reconstruction...

The heterogeneity of available cadaveric, histologic, and radiographic results related to the anterolateral ligament (ALL) does not support its existence as a discrete anatomic structure. Moreover, focusing narrowly on the ALL in isolation, what has previously been referred to as "ALL myopia," obscures a thorough appreciation for the stability contributions of both capsular and extracapsular structures. We consider injury to the soft tissues of the anterolateral knee-the anterolateral complex-just one component of what is frequently found to be a spectrum of pathology observed in the rotationally unstable, anterior cruciate ligament (ACL)-deficient knee...

Residual anterolateral rotatory laxity following injury and reconstruction of the anterior cruciate ligament (ACL) has become a popular topic and has generated interest in characterizing the relative contribution from the anterolateral structures of the knee. Studies have reported on the anatomic and biomechanical features of the anterolateral ligament (ALL), revealing a role in restraining internal tibial rotation in both ACL-intact and ACL-deficient knees. The Kaplan fibers of the iliotibial band have also been reported to provide significant restraint to internal tibial rotation...

Despite several previous articles in the literature, never before have so many studies with regard to anterolateral knee structures been performed. The anterolateral knee complex consists briefly of the iliotibial band, with its proximal and distal attachments, the joint capsule, and the anterolateral ligament (ALL). The recently introduced ALL has several different descriptions, making it difficult to build a consensus with regard to its anatomy. An extensive description of these structures, particularly the iliotibial band and the ALL, with regard to anatomy and imaging, will be provided in this article...