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Surgery of the Knee
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Alexander D Liddle, Lee A David, Timothy WR Briggs
Femoral preparation is undertaken with the knee flexed and the patella everted. A large drill bit is used to create an entry point in the distal femoral canal at a point approximately 1 cm anterior to the insertion of the PCL within the trochlear notch. The intramedullary rod should be inserted into the canal with care, especially if a previous total hip replacement has been performed. The distal femoral cutting jig is positioned over the rod and adjusted so that the distal cut is set at a 5°–9° valgus angle to the appropriate side of the knee to be replaced (Figure 11.3). Ideally, this should be chosen to match the anatomical axis of the contralateral limb, if normal.
Animal Models for Testing Bioabsorbable Materials
Published in Yuehuei H. An, Richard J. Friedman, Animal Models in Orthopaedic Research, 2020
Yuehuei H. An, Richard J. Friedman
Very few diaphyseal models are available (Table 4). The first diaphyseal model was reported by Vainionpää et al.,59 in which a tibial osteotomy was fixed with a T-shaped PGA/PLA copolymer implant (Figure 5A). Oblique fractures of metacarpal bones in calves were also fixed with PLA tension screws (Figure 5 B).61 Models of femoral osteotomy fixed with PLA, SR-PLA, or SR-PGA intramedullary rods have been reported in the dog, rabbit, and cat (Figure 5C,D).57,58,60The intramedullary rod can be inserted through the greater trochanter or the intercondylar notch. The studies showed that the bioabsorbable rods were strong enough to be used in intramedullary nailing of femoral diaphyseal osteotomies in the three animal species. In the authors’ laboratory, healing of a trephined femoral diaphyseal osteotomy in the dog has been used to observe the effect of fixation using a PGA/PLA (80/20 ratio) screw (Figure 4).53 In most of the reports, bone consolidation normally occurred in 6-8 weeks.
Microsurgical Procedures in Research on the Lymphatic System
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
Waldemar L. Olszewski, Thomas Ryffa
Bone fixation is achieved first with an intramedullary rod made from a 22-gauge needle. The femoral vein and then the artery are anastomosed with a 10/0 Dermalon® suture under the operating microscope. The sciatic nerve can be repaired if necessary with epineural 10/0 Dermalon® sutures. The muscles are approximated with 4/0 sutures. If patency of the anastomosed vessels can be demonstrated after 10 to 15 min, the wound is closed. A cylindrical metal splint can be applied to the skin around the limb, or an adjustable yoke placed around the rat’s neck, to prevent carnivorous autoamputation of the anesthetic limb.
Remote-controlled internal lengthening plate for distraction osteogenesis in pediatric patients
Published in Expert Review of Medical Devices, 2019
Jérémie Gaudreau, Mina Mekhail, Reggie Hamdy, Isabelle Villemure
Most prominent in the implantable limb-lengthening field, the PRECICE nail is a telescopic intramedullary rod powered by a rotating magnet. The PRECICE has been successful in treating adult cases of limb length discrepancy and congenital deformities. However, as with all intramedullary devices, its implantation in the medullary canal through the bone epiphyses renders it inaccessible to the pediatric population, because it would damage the growth plates, which are responsible for longitudinal bone growth. This nail is currently the only implantable limb-lengthening solution to be approved by the FDA since the ISKD’s removal from the market [12–14]. The Fitbone, powered by an electric motor and an RF transmitter, is another commercially-available intramedullary lengthening nail. Though it is not FDA-approved, it can achieve adequate lengthening with the advantages of a fully internal device but retains the shortfalls of the nail’s design principles, which necessarily entail the implantation through the patient’s growth plates [15].