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Fulltext Surgical treatment of acromio-clavicular dislocation

Leow HK, Hyzan Y, Gan EC, Hassan S

Med J Malaysia, 1998 Sep;53 Suppl A:71-6.
PMID: 10968185

Acromio-clavicular joint (ACJ) dislocation usually occurs in young adults following trauma or sports injury. Fourteen patients underwent surgical treatment for symptomatic total ACJ dislocation (Rockwood and Matsen Type III-VI) in our unit between January 1996 and June 1997. Eight patients were operated within three weeks of injury and six in the chronic period (after three weeks). In the acute group, two patients had Botsworth procedure and six had Weaver-Dunn operations. All six in the chronic group had Rockwood procedure. Nine patients achieved excellent outcome with full range of shoulder movement, pain free and return to work within three months of surgery. Two patients had good outcome. Three other patients had satisfactory outcome with tolerable pain and light duty at three months. Two patients developed chronic shoulder pain and one had painful hypertrophic surgical scar. Two patients had screw breakage requiring revision surgery. In conclusion, surgical treatment for ACJ dislocation produces good results. We suggest that surgical treatment be the treatment of choice for young patients requiring early recovery and good shoulder function.

Matched MeSH terms: Bone Screws/adverse effects
Fulltext Screw osteosynthesis in the treatment of fracture lateral humeral condyle in children

Baharuddin M, Sharaf I

Med J Malaysia, 2001 Dec;56 Suppl D:45-7.
PMID: 14569766

We reviewed the results of screw osteosynthesis for the treatment of fracture lateral condylar physis in twenty children whose average age was six years old (range, two to ten years) at the time of operation from January 1998 till December 2000. The average interval between the injury and the operation was three and half days (range, one day to two weeks). The average duration of follow up was one year (range, one year to two years). Osteosynthesis was revised in two patients due to anterior placement of screw and rotated distal fracture fragment. Osseous union was achieved in all twenty patients. The result was rated excellent in nineteen patients and good in one patient.

Matched MeSH terms: Bone Screws/adverse effects*
Fulltext Case report: migration of a broken screw to the knee joint after hardware failure following closing wedge distal femoral osteotomy

Lee YS, Lee SH, Lee ES, Fong TS

BMC Musculoskelet Disord, 2019 Mar 20;20(1):118.
PMID: 30894158 DOI: 10.1186/s12891-019-2505-4

BACKGROUND: We report a case of hardware failure after distal femoral osteotomy (DFO) with a broken screw pulled out from the locking hole and positioned within the knee joint.
CASE PRESENTATION: A 57-year-old man presented to our orthopedic outpatient department with 3-months history of an unusual painful swelling at the operated area following DFO. The leakage of joint fluid from the penetrated suprapatellar pouch was assumed to be the reason for this complication.
CONCLUSIONS: The overall aim of this case report is to provide a lesson to budding surgeons who might experience a similar situation that cannot be easily explained, like the unexpected complication in the present case.

Matched MeSH terms: Bone Screws/adverse effects*
Use of Computed Tomography in Determining the Occurrence of Dorsal and Intra-articular Screw Penetration in Volar Locking Plate Osteosynthesis of Distal Radius Fracture

Diong TW, Haflah NHM, Kassim AYM, Habshi SMIA, Shukur MH

J Hand Surg Asian Pac Vol, 2018 Mar;23(1):26-32.
PMID: 29409409 DOI: 10.1142/S2424835518500030

BACKGROUND: The use of volar locking plate in distal radius fracture can lead to extensor tendon rupture due to dorsal screw penetration. The aim of our study was to investigate the occurrence of dorsal and intra-articular screw penetration using CT scan after volar distal radius osteosynthesis for distal radius fractures.
METHODS: Thirty patients who underwent distal volar locking plate for distal radius fracture were included in a retrospective study. In all 30 patients no dorsal and intra-articular screw penetration were detected on standard AP and lateral views of a plain radiograph. CT scan of the operated wrist was performed to determine the number of intra-articular and dorsal screw penetrations. Clinical examination was performed to determine the wrist functions in comparison to the normal wrist.
RESULTS: Nineteen wrists were noted to have screw penetration either dorsally or intraarticularly. The highest incidence is in the 2nd extensor compartment where 13 screws had penetrated with a mean of 2.46 mm. Six screws penetrated into the distal radial ulnar joint and five screws into the wrist joint with a mean of 2.83 mm and 2.6 mm, respectively. However, there was no incidence of tendon irritation or rupture.
CONCLUSIONS: This study demonstrated a high incidence of dorsal and intra-articular screw penetration detected by CT scan which was not apparent in plain radiograph. We recommend that surgeons adhere to the principle of only near cortex fixation and downsizing the locking screw length by 2 mm.

Matched MeSH terms: Bone Screws/adverse effects*
The effect of excision of the posterior arch of C1 on C1/C2 fusion using transarticular screws

Chang KC, Samartzis D, Fuego SM, Dhatt SS, Wong YW, Cheung WY, et al.

Bone Joint J, 2013 Jul;95-B(7):972-6.
PMID: 23814252 DOI: 10.1302/0301-620X.95B7.30598

Transarticular screw fixation with autograft is an established procedure for the surgical treatment of atlantoaxial instability. Removal of the posterior arch of C1 may affect the rate of fusion. This study assessed the rate of atlantoaxial fusion using transarticular screws with or without removal of the posterior arch of C1. We reviewed 30 consecutive patients who underwent atlantoaxial fusion with a minimum follow-up of two years. In 25 patients (group A) the posterior arch of C1 was not excised (group A) and in five it was (group B). Fusion was assessed on static and dynamic radiographs. In selected patients CT imaging was also used to assess fusion and the position of the screws. There were 15 men and 15 women with a mean age of 51.2 years (23 to 77) and a mean follow-up of 7.7 years (2 to 11.6). Stable union with a solid fusion or a stable fibrous union was achieved in 29 patients (97%). In Group A, 20 patients (80%) achieved a solid fusion, four (16%) a stable fibrous union and one (4%) a nonunion. In Group B, stable union was achieved in all patients, three having a solid fusion and two a stable fibrous union. There was no statistically significant difference between the status of fusion in the two groups. Complications were noted in 12 patients (40%); these were mainly related to the screws, and included malpositioning and breakage. The presence of an intact or removed posterior arch of C1 did not affect the rate of fusion in patients with atlantoaxial instability undergoing C1/C2 fusion using transarticular screws and autograft.

Matched MeSH terms: Bone Screws/adverse effects*
Fulltext Mechanical failure of Dynamic Hip Screw (DHS) fixation in intertrochanteric fracture of the femur

Nordin S, Zulkifli O, Faisham WI

Med J Malaysia, 2001 Dec;56 Suppl D:12-7.
PMID: 14569760

We studied 60 intertrochanteric fractures of the femur fixed with Dynamic Hip Screw (DHS). There were 10 cases (16.7%) with cutting-out of device through femoral head and neck. Stable fracture pattern, postero-inferior and central position of screw in the femoral neck and head produced high percentage of good result, whereas anterior or superior position of screw produced higher incidence of cut-out. We found osteoporosis and distance of screw tip to subchondral bone to have no influence on the final outcome.

Matched MeSH terms: Bone Screws/adverse effects*
Fulltext Osteomyelitis post acromioclavicular joint reconstruction

Yeak RD, Daud H, Nizlan NM

Chin J Traumatol, 2019 Jun;22(3):182-185.
PMID: 31060897 DOI: 10.1016/j.cjtee.2019.03.004

Acromioclavicular joint (ACJ) injury is a common shoulder injury. There are various techniques of ACJ reconstruction. Superficial infection after ACJ reconstruction is not an uncommon complication. However, osteomyelitis post ACJ reconstruction has never been highlighted as a possible complication. Our patient is a 31-year-old male who sustained a Rockwood 5 ACJ dislocation and had anatomical ACJ reconstruction with autogenous gracilis and semitendinosus graft. Our technique involved the anatomical reconstruction of the ACJ and the coracoclavicular ligament with the usage of two bioscrews and the temporary stabilisation of the ACJ with two k-wires. As in any orthopaedic surgery, infection is often disastrous especially when the surgery involves implants. It can be disastrous with high morbidity to the patient as well as a costly complication to treat. Therefore, we wish to highlight this case as despite its rarity, osteomyelitis can be devastating to the patient and should be prevented if possible.

Matched MeSH terms: Bone Screws/adverse effects
Fulltext Safety of thoracic pedicle screw application using the funnel technique in Asians: a cadaveric evaluation

Chan CY, Kwan MK, Saw LB

Eur Spine J, 2010 Jan;19(1):78-84.
PMID: 19763636 DOI: 10.1007/s00586-009-1157-8

The objective of this cadaveric study is to determine the safety and outcome of thoracic pedicle screw placement in Asians using the funnel technique. Pedicle screws have superior biomechanical as well as clinical data when compared to other methods of instrumentation. However, misplacement in the thoracic spine can result in major neurological implications. There is great variability of the thoracic pedicle morphometry between the Western and the Asian population. The feasibility of thoracic pedicle screw insertion in Asians has not been fully elucidated yet. A pre-insertion radiograph was performed and surgeons were blinded to the morphometry of the thoracic pedicles. 240 pedicle screws were inserted in ten Asian cadavers from T1 to T12 using the funnel technique. 5.0 mm screws were used from T1 to T6 while 6.0 mm screws were used from T7 to T12. Perforations were detected by direct visualization via a wide laminectomy. The narrowest pedicles are found between T3 and T6. T5 pedicle width is smallest measuring 4.1 +/- 1.3 mm. There were 24 (10.0%) Grade 1 perforations and only 1 (0.4%) Grade 2 perforation. Grade 2 or worse perforation is considered significant perforation which would threaten the neural structures. There were twice as many lateral and inferior perforations compared to medial perforations. 48.0% of the perforations occurred at T1, T2 and T3 pedicles. Pedicle fracture occurred in 10.4% of pedicles. Intra-operatively, the absence of funnel was found in 24.5% of pedicles. In conclusion, thoracic pedicle screws using 5.0 mm at T1-T6 and 6.0 mm at T7-T12 can be inserted safely in Asian cadavers using the funnel technique despite having smaller thoracic pedicle morphometry.

Matched MeSH terms: Bone Screws/adverse effects