Introduction

One of the disadvantages of lateral decubitus position during arthroscopic rotator cuff repair is the difficulty to control arm rotation intraoperatively making it necessary to create additional portals for anchor placement or an additional scrubbed assistant to control arm rotation.

Accurate implant size estimation for internal fixation of long bone fractures can reduce intra-operative errors, operative time and radiation exposure. With the advent of pre-packed sterile implants, the exponential increase in the number of internal fixation devices and the lack of standard templates for them on PACS systems, templating has become increasingly difficult. This often results in the opening up of wrong implants leading to increased costs both in terms of increased operative time and additional implants. We describe a technique to determine implant size preoperatively using sterile implant boxes. Post anaesthesia and positioning, the pre packed implant box of approximate size is placed over the limb across the fracture site. An X-ray is then taken using the C-arm. In case of a plate, the number of holes desired on either side of the fracture, the shape of the implant and planned placement of screws are seen. Different implant boxes with the contained implant are placed and once the most appropriate implant for the particular fracture is reached, the box is opened and implant is kept ready for insertion. This technique has been found to be accurate, easy, reproducible and effective for estimating the implant size thereby decreasing the chances of opening wrong implants and saving the intra operative time substantially.

Introduction

It is not uncommon to encounter patients with atypical hip or lower extremity pain, ill-defined clinico-radiological features and concomitant hip and lumbar spine arthritis. It has been hypothesized that an anaesthetic hip arthrogram can help identify the source of pain in these cases. The purpose of this study is to analyze our experience with this technique in order to verify its accuracy.

Purpose: The current gold-standard for atlanto-axial fixation is C1-C2 Transarticular Screw (TS) fixation. In certain cases, the complicated nature of vertebral artery injury could make the application of bilateral transar-ticular screws impossible. This study biomechanically compares three atlantoaxial transarticular salvaging fixation techniques.

Method: Nine Fresh ligamentous human cervical spine specimens (C0-C4) were thawed and the tissue surrounding the spine, except the ligaments and discs, was carefully removed. Pure moments were applied to skull in increments of 0.5 Nm from 0 Nm to 2.0 Nm with the help of loading arms, nylon strings and pulleys. The specimens were tested in extension (EXT), flexion (FLEX), left lateral bending (LB), right lateral bending (RB), left axial rotation (LR) and right axial rotation (RR) for all the cases. The positions of the LEDs were recorded using an Optotrak Motion Measurement System (Northern Digital, Waterloo, Ontario, Canada) and was converted into three rotations (flexion/extension, lateral bending and axial rotation) using rigid body kinematic principles in relation to the fixed base. The specimens were tested intact and after type II odontoid fracture, were instrumented and tested with three fixation constructs:

C1-C2 TS on right side and C1LMS-C2PS on contralateral side

Results: All of the three instrumented cases significantly reduced motion across C1-C2 segment in all the modes when compared to intact (P< 0.005, two-tailed unpaired t-test at confidence interval of ninety-five percent) except in extension. TS+C1lM+C2PS is significantly stiffer than TS+ Wire only in axial rotation (P< 0.05) and equivalent in flexion/extension (P=0.75/P=0.51) and left/right bending (P=0.22/P=0.58). TS+C1LM +C2PS is equivalent to TS+C1LM+C2IL in all the loading modes (P> 0.05). TS+C1LM+C2IL is significantly stiffer than TS+Wire in axial rotation (P < 0.05) and equivalent in flexion/extension (P=0.93) and left/right bending (P=0.69/P=0.84).

Conclusion: This study showed that TS+C1LMS+C2PS fixation is equivalent to TS+C1LMS+C2ILS fixation in all the rotation modes and superior to TS+Wire fixation in axial rotation averaged over all ranges of motion. Also, TS+C1LMS+C2ILS fixation is superior to TS+Wire fixation in axial rotation averaged over all ranges of motion.

Introduction: Failure of internal fixation of intertrochanteric fractures may be associated with delayed union or malunion resulting in persistent pain and diminished function. The purpose of this study is to evaluate results of the use of a tapered, fluted, modular, distally fixing cementless stem in the management of failed treatment of intertrochanteric hip fractures in elderly patients.

Methods: 837 patients had internal fixation of intertrochanteric fractures over a seven year period (2000–2007) at our institution. Of these, 15 patients with mean age of 80.6 years (69.8–92.3), underwent hip arthroplasty for failure of internal fixation. Clinical and radiographic records of these patients were evaluated.

Results: At an average follow up of 2.86 (2–4.5) years, all patients showed marked functional improvement with change in mean Harris hip score from 35.90 to 83.01 (P < 0.01). Fourteen stems had stable bony ingrowth and one stem was loose and subsided by 5 mm. Three patients used a walker for ambulation, ten patients used a cane and two could ambulate without aids.

Conclusion: Use of a tapered fluted modular cementless stem allows stable distal fixation in a reproducible fashion with good functional outcome in this challenging cohort of patients. All patients were ambulatory, however majority used walking aids.

Statement: To present the early results of using new implants in the fixation of the hamstrings tendons for ACL reconstruction.

Background and Aim of the study: PINN-ACL system (Conmed UK, Linvatec UK ltd.), is a recently developed implant designed for transverse femoral fixation of hamstrings grafts in ACL reconstruction, allowing for increased pull out strength. It consists of a Graft Harness composed of Poly L-Lactic Acid with a high strength polyethylene fibre loop and a Cross pin composed of Self-Reinforced PLLA. Tibial fixation is achieved by a bioabsorbable Matryx Interference Screw; composed of Self-Reinforced 96L/4D PLA and beta-Tri-Calcium Phosphate(Linvatec Biomaterials ltd.)

We describe our early experience with this new system, the technique of fixation, short-term clinical results, functional outcome and MRI features of these implants.

Materials and Methods: A prospective data collection was undertaken over the past 12 months. The operative steps:, four strand hamstring preparation, tensioning, femoral fixation of graft with graft harness and cross pin, tensioning the graft and tibial fixation with bio- absorbable interference screw. More than 80% of the cases were performed without tourniquet. The follow up were made at 2,12,24,36 weeks and further evaluation as needed for the purpose of the study. Outcomes were assessed with Lysholm, Tegner and IKDC scores.

Results: 24 cases were performed in 23 cases. The mean age, gender and laterality were 34(17–51), 1.7M: 1F, 14L:10 R. The injury pattern: sports (77%) and RTA (11%)

Tunnel view of the harness was excellent in 79%. Linvatec Tensioner was used in 60%. Graft was not detached in 20%. The mean follow up period was 7 months (2 –12). At last follow up Lachman and pivot shift were negative in 85% and grade 1 in 15%, The mean postoperative scores were Tegner-7 (5–10), Lysholm-7 (5–10) and IKDC-71 (57–93) respectively.

1 wound problem required washout. The tibial screw twisted off at final turn in 1 patient. The cross pin drill missed the guide in 1 patient.

At 32 weeks MRI scan: the implants were still evident, However apart form 1 patient, there was no surrounding bone reaction and none showed tunnel widening.

Conclusion: Early results are encouraging, both operative technique and fixation. However, harness size is limited to 8 and 9 mm only and the implants were still evident at a mean period of 32 weeks against the manufactures claim of 24 weeks.