Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Bone Nails”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources
PubMed1987

An analysis of factors influencing stability of surgical advancement of the maxilla by the Le Fort I osteotomy.

Skeletal stability after maxillary surgical advancement was studied in 30 patients. Postoperative movement of all measured skeletal and dental points were on the average negligible. Equal stability was seen in maxillary advancement alone and with concomitant mandibular surgery. Eight cases examined individually showed larger than desired postoperative movements. In six of these cases the undesirable postoperative changes were secondary to undesirable preoperative orthodontic flaring of the incisors. The Begg orthodontic technique, because of its tendency to axially rotate teeth, was shown to produce more variability in tooth position than edgewise orthodontics. This study confirms that no preoperative flaring of the maxillary incisors should be attempted; instead, the teeth should be retracted and placed over basal bone with a normal axial inclination. Occlusal correction should then be accomplished by surgery. Suspension wires and bone grafting are sufficient to obtain skeletal stability in cases of maxillary advancement up to 11 mm. In cases where the surgery is more complex, rigid fixation is recommended.

Bone Nails↗
PubMed1989

Composite wiring of metacarpal and phalangeal fractures.

Composite wiring techniques using various configurations of Kirschner pins and stainless steel wire sutures have been applied to the treatment of 63 fractures of the long bones of the hand. The secure fixation achieved allowed active motion within 1 week of operation. Thirty-three metacarpal fractures achieved a final mean total active motion of 256 degrees (standard deviation 13.4) (normal total active motion -260 degrees). Twenty-one phalangeal fractures achieved a mean total active motion of 215 degrees (standard deviation, 46 degrees). There were no instances of infection, malunion, nonunion, loss of reduction, or tendon rupture in the 63 fractures that were treated.

Adolescent↗
PubMed1990

Scapho-trapezio-trapezoid arthrodesis for treatment of chronic static and dynamic scapho-lunate instability: a 10-year perspective on pitfalls and complications.

Goals of reducing wrist pain, allowing a stable active wrist range of motion, and retarding degenerative changes make arthrodesis of the scapho-trapezio-trapezoid joint a popular treatment for chronic static and dynamic scapho-lunate instability; however, pitfalls and complications have not been well studied. Forty-seven wrists in 46 patients over a 10-year period revealed a complication rate of 52%. Failure to attain perfect scaphoid reduction consistently resulted in persistent incapacitating pain. Radial styloid-scaphoid impingement, observed after "successful" limited wrist fusion, was effectively treated by simple styloidectomy. Carpal osteomyelitis, lunate avascular necrosis, pin-tract infection, progressive medial carpal translation, and intractable pain without arthrosis complete the spectrum of complications managed in this series. Careful preoperative patient screening and attention to detailed recommendations will assist surgeons in avoiding the many potential problems associated with this procedure.

Arthrodesis↗
PubMed1991

Treatment of displaced articular fractures of the radius.

Forty patients with articular fractures of the distal radius in which anatomic reduction of the joint surface could not be obtained by closed manipulation or by ligamentotaxis with external fixators had a combination of percutaneous and/or open reduction techniques to restore articular congruity. X-ray films taken after treatment with an average follow-up of 4 years showed satisfactory extraarticular alignment in 85% of the cases, and 37 (92.5%) patients demonstrated an articular step-off of 1 mm or less at late follow-up examination. Radiographic evidence of radiocarpal arthritis was present in 5% of the cases at follow-up examination.

Adolescent↗
PubMed1993

Tension band arthrodesis of small joints in the hand.

Two-hundred three patients underwent 290 tension band arthrodeses of the metacarpophalangeal and proximal interphalangeal joints of the hand. Nine patients (3%) failed to achieve bony union, four had painless pseudarthroses, and one patient had a small finger amputation. Twenty-five fusions (9%) required hardware removal. There were 10 superficial infections (all responded to oral antibiotic therapy), and three fusions were malrotated. Tension band arthrodesis is our choice for fusion of the metacarpophalangeal and proximal interphalangeal joints. It is reliable and provides stable fixation, pins do not protrude, and external splinting is unnecessary in the cooperative patient.

Adolescent↗
PubMed1993

Low-velocity gunshot wounds of the metacarpal: treatment by early stable fixation and bone grafting.

The results of early stable fixation of 64 metacarpal fractures due to low-velocity gunshot wounds in 49 patients were reviewed retrospectively. These reconstructive procedures were performed between 1 and 7 days after injury and involved stable internal fixation supplemented with primary iliac crest bone graft in 40 fractures with bone loss or comminution. Postoperatively, the hands were splinted with 90 degrees of metacorpophalangeal flexion while early interphalangeal motion was emphasized. Follow-up averaged 12 months, with a range of 4 months to 7 years. Primary bone union was achieved in all metacarpals. The average range of motion was 65 degrees for the metacarpophalangeal joint, 72 degrees for the proximal interphalangeal joint, and 60 degrees for the distal interphalangeal joint. Complications included two superficial infections. There were no cases of deep infections or persistent draining wounds. Early, stable fracture fixation of these injuries achieved union, alignment, and early rehabilitation with no appreciable increase in morbidity.

Adolescent↗
PubMed1994

Wrist arthrodesis: a combined intramedullary pin and autogenous iliac crest bone graft technique.

Forty-six wrist arthrodeses in 36 patients were reviewed. The technique used provided a reliable fusion method for a variety of wrist disorders. The arthrodeses were performed using an autogenous iliac crest bone graft, with an intramedullary Steinman pin placed within the distal radial and third metacarpal shafts, and an obliquely-placed Kirschner wire across the second metacarpal base into the radius. The distal ulna, instead of the radius, was used in patients with radial agenesis. Three patient populations were identified: group 1, connective tissue wrist disorders; group 2, congenital wrist disorders; and group 3, acquired wrist disorders. A residual flexion, radial deviation deformity was noted with the congenital disorders. All patients had low demand requirements for this fused wrists. The average time of fusion for each group as 14, 15, and 12 weeks, respectively.

Adult↗
PubMed1988

Irradiating with a prosthesis or metal pin in the radiation treatment field.

This is a case study of a patient who had a liposarcoma of the tibia and also had a titanium pin directly in the treatment field. A total midline dose of 63 Gy was prescribed. The effects of the pin in the treated area was examined. Four different methods were used to examine and verify the delivered dose: (1) Treatment planning computerized isodose curves, (2) A parallel plate ion chamber and polystyrene phantom, (3) TLD, and (4) Film dosimetry. The results from all four methods of dose examination are compiled and are used to make a decision on what to do about the dose non-uniformity due to the dense titanium pin. If a prosthesis or metal pin is in the treatment area, one must determine the composition of the pin. Then one should verify or examine the results of the dose perturbations produced. One may or may not want to change the original dose prescription but the dose throughout the irradiated volume will be changed due to the metal pin. It is important to evaluate these effects, as discussed in this article, to accurately deliver a prescribed dose.

Bone Nails↗
PubMed1994

The response of bone to external loading regimens.

The results of Hert et al. have been re-examined using an external pin fixation technique involving New Zealand White rabbits. New bone formation was assessed with tetracycline epifluorescence in 49 animals. The animals were operated upon using inhalational anaesthesia, and pins were placed at opposite ends of the tibia of both hind limbs. Following recovery, oxytetracycline was given at a dosage of 25 mg kg-1 body weight intraperitoneally on the day of loading and on the fourteenth day of the loading regimen. The bones were loaded for 45 min per 24 h. Undemineralized specimens were sectioned and standardized photographs produced. The area of new bone was determined by a planimeter and by digitization. In dynamic loading the shape of the force/time curve is of little significance; the response is frequency dependent and for higher frequencies the response is greater than that from continuous loading; there was no statistical significance between the rapid relief loading regimens. For continuous loading the response is a function of the load value. In all cases more bone is laid down in immature subjects than in adults. With regard to osteoclastic activity, all loading increased the areas of resorption irrespective of character, in all adult animals intermittent loads produced a greater area of ostoeclastic resorption than static loads and produced a greater change as the number of load cycles per minute increased. The adult control animals had more resorptive activity than the immature animals although there was no statistical significance. Loading, irrespective of its character, led to a net increase of bone, the osteoblastic effects thus outweighing the osteoclastic effects.

Aging↗
PubMed2003

Hamstring insertion site healing after anterior cruciate ligament reconstruction in patients with symptomatic hardware or repeat rupture: a histologic study in 12 patients.

PURPOSE: Our goal was to characterize the type of biologic anchor of hamstring tendons to the femoral tunnel in cases of transfixion fixation for the anterior cruciate ligament (ACL) reconstruction. The histologic bone-hamstring tendon anchorage is not yet clearly understood despite many experimental and some clinical studies. It constitutes the weak point of the ACL reconstruction. The type of fixation, either distant from the joint such as transfixion fixation or at the tunnel entrance such as aperture fixation will determine a specific tendon-bone healing process. TYPE OF STUDY: Histological study. METHODS: We performed ACL reconstruction with 4 strands of semitendinosus and gracilis tendons fastened by a transfixion fixation. Femoral fixation was secured by transfixion (Transfix; Arthrex, Naples, CA) and tibia fixation by a biodegradable interference screw and 2 staples. Between 3 and 20 months after surgery, we performed 12 hamstring tendon biopsies (in 9 men and 3 women; mean age, 29 years). Biopsies were performed 2 cm from the femoral outlet in 10 patients undergoing hardware removal or by coring the femoral tunnel in 2 cases of repeat rupture. In 8 cases, the femoral device was removed for persistent lateral pain, in 2 cases for instability of the hardware, and in 2 cases a repeat rupture of the graft occurred. The samples were taken by coring a tunnel 5 mm in diameter, with a tubular harvester, along the femoral Transfix axis. Each fragment was stained with H&E, Solochrome cyanine, or Masson-trichrome, and microscopical examination was performed, including polarized light. RESULTS: At 3 months (in 1 case), a fibrovascular interface was seen between the tendon and uncalcified osteoid with very few collagen fibers. At 5 and 6 months (in 2 cases), some Sharpey-like fibers and less immature woven bone was seen. Maturity of the secondary insertion was seen after at least 10 months in 5 cases. In 2 cases, no contact was seen at the biopsy site despite good clinical stability. The 2 remaining cases underwent repeat rupture at the midsubstance of the graft at 12 and 17 months after surgery. In the first case, the tendon-bone fixation was limited at the outlet of the femoral tunnel with no fixation inside the tunnel. In the second case, the fixation was continuous with Sharpey fibers along the tunnel. CONCLUSIONS: According to our histologic results in patients, the time to obtain a mature indirect anchorage at the top of the tunnel was 10 to 12 months, which is much longer than in reported animal models (6 to 24 weeks). To our knowledge, this is the first clinical study reporting the histologic type of femoral ligament insertion 2 cm from the outlet of the tunnel with hamstring autograft for ACL reconstruction.

Adult↗
PubMed2003

Primary stability of bone-patellar tendon-bone graft fixation with biodegradable pins.

PURPOSE: We evaluated the initial bone-patellar tendon-bone (BPTB) graft fixation strength of biodegradable pins compared with interference screws in anterior cruciate ligament reconstruction using bovine knees. TYPE OF STUDY: Biomechanical in vitro study. METHODS: Ten BPTB grafts from human donors fixed with 2 biodegradable 2.7-mm pins (Rigid Fix; Ethicon, Mitek Division, Norderstedt, Germany) crossing the bone block perpendicular and 10 BPTB grafts fixed with conventional biodegradable interference screws (Absolute Absorbable Interference Screw; Innovasive Devices, Marlborough, MA) underwent ultimate single-cycle failure loading at a rate of 200 mm/min. The grafts were fixed to bovine tibia to simulate young human femoral bone density. Failure mode, displacement before failure, and ultimate failure load were tested with a testing machine. The pullout force was in line with the bone tunnel to simulate a worst case scenario. RESULTS: The failure mode for cross pins was either fracture of the bone block (5 specimens) or fracture of the articular pin (5 specimens). The failure mode for interference screws was slippage past the screw in all specimens. In the single cycle loading test, the mean yield load for the biodegradable pins was 400.2 (+/- 122.4) N, maximum load, 524.6 (+/- 136.6) N, with a mean stiffness of 155.2 (+/- 32.4) N/mm. The yield load at failure for the interference screw was 402.7 (+/- 143.9) N, maximum load 515.7 (+/- 168.5) N with a mean stiffness of 168 (+/- 42) N/mm. CONCLUSIONS: Fixation of a BPTB graft with 2 biodegradable 2.7-mm pins (Rigid Fix) leads to primary stability that is comparable to fixation with biodegradable interference screws.

Absorbable Implants↗
PubMed2005

Cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction with hamstring tendons: results of a controlled prospective randomized study with 2-year follow-up.

PURPOSE: To determine if there is a different clinical outcome after cross-pin versus interference screw fixation in anterior cruciate ligament (ACL) reconstruction with hamstring tendons. TYPE OF STUDY: Prospective randomized clinical follow-up study. METHODS: Sixty-two patients were randomized into either TransFix cross-pin (Arthrex, Naples, FL) (TransFix group, n = 31) or metal interference screw femoral fixation (screw group, n = 31) in ACL reconstruction with hamstring tendons. The distal fixations were an AO screw with spiked washer post and metal interference screw. The evaluation methods were clinical examination, CA 4000 laxity (OSI, Hayward, CA), and Lido isokinetic muscle torque measurements (Lido MultiJoint II; Loredon, West Sacramento, CA) as well as International Knee Documentation Committee (IKDC), Tegner activity level, Lysholm knee, and Kujala patellofemoral scores. RESULTS: There were no differences between the study groups preoperatively. For the 2-year follow-up, 26 patients of the TransFix group and 30 patients of the screw group were available (90%). The evaluation methods disclosed no statistical differences between the groups at the 1- or 2-year follow-up examinations. At the 2-year follow-up, 22 (85%) of the TransFix and 22 (73%) of the screw group patients were in the IKDC A or B categories. There were significantly more additional procedures postoperatively in the TransFix group owing to the removal of the tibial fixation post hardware in 15 (48%) cases. CONCLUSIONS: There were no statistically or clinically relevant differences in the results 1 or 2 years postoperatively and both techniques seemed to improve patients' performance. LEVEL OF EVIDENCE: Level I.

Adolescent↗
PubMed2005

Mechanical strength of four different biceps tenodesis techniques.

PURPOSE: The aim of this study was to compare the biomechanical properties of 4 different biceps tenodesis techniques. TYPE OF STUDY: Biomechanical experiment. METHODS: Four groups of fresh sheep shoulders (28 total) with similar shape characteristics were used. Biceps tenodesis was performed using the following techniques: group 1 (n = 7), tunnel technique; group 2 (n = 7), interference screw technique; group 3 (n = 7), anchor technique; and group 4 (n = 7), keyhole technique. Each construct was loaded to failure and the groups were compared with respect to maximum load in Newtons and deflection at maximum load in millimeters. The results were statistically analyzed with 1-way analysis of variance, the Bonferroni post hoc test and the Student t test or the nonparametric Mann-Whitney U test. RESULTS: The calculated average maximum loads were 229.2 +/- 44.1 N for the tunnel technique, 243.3 +/- 72.4 N for the interference screw, 129.0 +/- 16.6 N for the anchor technique, and 101.7 +/- 27.9 N for the keyhole technique. Statistical testing showed no statistically significant differences between groups 1 and 2, groups 3 and 4, or groups 2 and 3 with respect to maximum load and deflection at maximum load (P = .09/P = .49, P = .41/P = .79, and P = .06/P = .82 for load/deflection in the 3 comparisons, respectively). However, all other group comparisons revealed significant differences for both parameters (group 1 v group 4 [P < .01/P < .01]; group 1 v group 3[P < .01/P = .01]; and group 2 v group 4 [P = .007/P = .003]). CONCLUSIONS: The strongest construct was made with the interference screw technique, followed by the tunnel, anchor, and keyhole techniques. There were no statistically significant differences between the interference screw and tunnel techniques with respect to maximum load or deflection at maximum load. CLINICAL RELEVANCE: Although it is difficult to extrapolate in vitro data to the clinical situation, the interference screw technique has better initial biomechanical properties and may produce improved clinical outcomes.

Alloys↗
PubMed2005

Cyclic loading comparison between biodegradable interference screw fixation and biodegradable double cross-pin fixation of human bone-patellar tendon-bone grafts.

PURPOSE: The aim of this study was to compare ultimate load, yield load, stiffness, and displacement after cyclic loading of a cross-pin technique and an interference screw technique for the fixation of bone-patellar tendon-bone (BPTB) grafts in anterior cruciate ligament (ACL) reconstruction. TYPE OF STUDY: Biomechanical in vitro study. METHODS: The devices tested were 2 2.7-mm biodegradable pins (RigidFix; Ethicon, Mitek Division, Norderstedt, Germany) and biodegradable interference screws (Absolute; Innovasive Devices, Marlborough, MA). Each device was used for the fixation of 10 8-mm, 9-mm, or 10-mm sized human BPTB grafts in tunnels drilled in bovine knees. Ultimate load, yield load, stiffness, and displacement after cyclic loading (1,000 cycles between 50 and 250 N) were then evaluated. RESULTS: All 8-mm grafts that were fixed with cross-pins failed after a mean of 124 cycles of load. The 9-mm and 10-mm grafts survived the cyclic loading protocol. Yield load and maximum load of the 10-mm groups (cross-pin and interference screw) were significantly higher than that of the 9-mm groups. There was no significant difference in maximum load, yield load, and stiffness between the cross-pin and interference screw fixation technique for 1 graft size. CONCLUSIONS: The biomechanical data suggest that femoral fixation of 9-mm and 10-mm BPTB grafts using 2.7-mm biodegradable cross-pins leads to primary stability that is comparable to that of biodegradable interference screws. Fixation of 8-mm BPTB grafts using 2.7-mm biodegradable cross-pins had poor results. CLINICAL RELEVANCE: The diameter of the bone block is the limiting factor for the final fixation strength and the cyclical survival when using cross-pins. We strongly recommend not using this technique for bone blocks smaller than 9 mm in diameter.

Absorbable Implants↗
PubMed2005

Anatomically oriented anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft via rectangular socket and tunnel: a snug-fit and impingement-free grafting technique.

An anterior cruciate ligament (ACL) reconstruction technique is described to place bone-patellar tendon-bone (BPTB) graft in an anatomically oriented fashion to mimic the 2 bundles of the normal ACL, based on the concept of twin tunnel ACL reconstruction, to maximize the graft-tunnel interface. In this technique, the attached bone plug is introduced into a rectangular femoral socket via a halfway rectangular tibial tunnel for the anterior portion of the graft to function as the anteromedial bundle and for its posterior portion to behave as the posterolateral bundle. A snug fitting of the graft is achieved not only at the femoral socket, but also in the tibial tunnel.

Anterior Cruciate Ligament↗
PubMed2005

Posterolateral corner reconstruction of the knee: surgical technique utilizing a bifid Achilles tendon allograft and a double femoral tunnel.

Reconstruction of the posterolateral corner of the knee has received increased attention in the recent literature. Basic science studies have helped us determine the 3 critical structures of the posterolateral corner: the lateral collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament. We have developed an anatomic posterolateral corner reconstruction that most closely resembles these 3 key structures and is based on the work of previous authors. Our technique is performed using a single Achilles allograft. The bone plug is secured in a femoral tunnel at the anatomic attachment of the popliteus tendon with an interference screw. The Achilles tendon is then split approximately 1 to 2 cm distal to the bone plug into 2 segments: (1) the popliteofibular ligament portion that is passed through a fibular tunnel starting at the anatomic attachment of popliteofibular ligament and fixed with a biointerference screw and (2) the static portion of the popliteus tendon securing this through a tibial tunnel passed from posterior to anterior right at the musculotendinous junction of the popliteus. The anterior limb of the Achilles tendon exiting the fibula is then brought back around, secured to the fibular attachment of the LCL with a suture anchor, and is then passed through a separate femoral tunnel placed at the anatomic attachment of the LCL.

Achilles Tendon↗
PubMed2006

Comparison of initial mechanical properties of 4 hamstring graft femoral fixation systems using nonpermanent hardware for anterior cruciate ligament reconstruction: an in vitro animal study.

PURPOSE: To compare the initial mechanical characteristics of 4 systems used to fix tendons to the femur during anterior cruciate ligament reconstruction. METHODS: A total of 32 porcine femurs were used to study the following fixation systems: Bioabsorbable interference screw (Stryker, Kalamazoo, MI), Bio-Transfix Cross-pin (Arthrex, Naples, FL), Biosteon Cross-pin (Stryker), and a fixation technique based on wrapping the graft around the femoral condyle itself, thus allowing it to be fixed in place without the use of any hardware. The mechanical characteristics of each system were obtained by a preconditioned failure tensile test. RESULTS: The yield load values (990.9 +/- 242.6 N for Bio-Transfix, 905.1 +/- 158.8 N for Biosteon Cross-pin, 684.4 +/- 119.7 N for the without-hardware system (WHS), and 369.4 +/- 120.1 N for the interference screw) revealed significant differences between the techniques that used cross-pins and the other 2 techniques (P < .006) on the one hand, and between the without hardware technique and the interference screw (P < .004) on the other. The stiffness of the 2 cross-pin fixation systems (117.6 +/- 22.5 N for Bio-Transfix and 112.6 +/- 22.5 N for Biosteon) was greater (P < .01) than those of the other systems (79.4 +/- 15.2 N for the WHS and 68.5 +/- 13 N for the interference screw). CONCLUSIONS: The initial biomechanical properties of the 2 cross-pin fixation systems proved to be superior to those of the other 2 systems studied. The WHS fixation system exhibited better mechanical properties than its interference screw counterpart. CLINICAL RELEVANCE: The better initial mechanical characteristics encountered using the Bio-Transfix and Biosteon Cross-pin systems indicate that these systems are better equipped to bear the loads generated by aggressive rehabilitation. The WHS fixation system provides an alternative to interference screw fixation.

Absorbable Implants↗