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Biomechanical considerations for fixation of osteoporotic bone
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Peter Augat, Christian von Rüden
Whenever possible, ligamentotaxis should be employed to initiate the reduction of the fracture. If necessary, the reduction needs to be performed by open reduction of the fracture fragments. Prior to the application of the osteosynthesis, the alignment of the correct load axes and the correct rotation of the anatomical axes need to be verified. Care has to be taken to maintain these axes during the application of the osteosynthesis. Precontoured anatomical locked plates have the inherent risk to readjust fracture fragments if reduction is not maintained during their application. In contrast to conventional plates, locked plates cannot be employed for fracture reduction but need to be applied to an already reduced fracture. Angle variability of the locking screws may additionally impede reduction maintenance, as those screws may deflect at the end of the screw insertion process. Thus, for contoured locking plates, the correct and careful placement of the first screws in the joint block is paramount. In the shaft area, temporary conventional screws may assist the alignment of the plate by pulling the plate toward the prealigned fracture. Care has to be taken so as not to lose correct alignment by pulling the fracture fragments toward the plate. Depending on the fixation principle, the conventional screw should be removed or replaced by a locking screw in order to avoid a stress rising effect at the plate.
Pilon Fracture
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
IV – Die punch fragment. This is the central articular fragment which lacks soft tissue attachment and therefore cannot be reduced by ligamentotaxis. It can prevent reduction and must be addressed by direct visualisation. These fragments vary in size and number depending on the degree of comminution.
Principles of fracture fixation
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Stephen Tai, Panagiotis Gikas, David Marsh
Periarticular fractures – where the close proximity of the fracture to the articular surface would make other forms of operative fixation technically difficult. The use of bridging external fixation (i.e. crossing the affected joint) can allow fracture reduction by ligamentotaxis.
Spontaneous morphological remodelling of the O-C1 joint after posterior fusion for occipitocervical dislocation
Published in International Journal of Neuroscience, 2022
Chizuo Iwai, Kazunari Fushimi, Satoshi Nozawa, Naofumi Mitsuishi, Hiroyasu Ogawa, Masato Maeda, Norishige Kuramitsu, Haruhiko Akiyama
Postoperative course of the O-C1 joint is not fully understood. Some authors have described that bone fragments in the spinal canal (due to thoracolumbar burst fractures) spontaneously remodelled and indirectly decompressed the spinal canal after posterior correction and instrumentation with ligamentotaxis [10,11]. Thus, reduction and immobilisation of the spine may induce changes in bone morphology and spontaneous remodelling. We found some previous reports regarding remodelling of the spinal articular morphology in the upper cervical spine. Remodelling of the C1-2 joint after halo vest immobilisation for chronic atlantoaxial rotatory fixation (AARF) has been reported. Tauchi et al. reported seven children who suffered AARF with unsatisfied conservative treatment. They proposed that deformity of the superior articular process of the C2 could be treated by careful closed manipulative reduction, followed by stabilisation with a halo vest for two to three months. They observed spontaneous remodelling of articular morphology of the C1-2 [12]. Similar therapeutic strategy was also reported by Ishii et al. They treated patients by closed manipulation and stabilisation with a halo vest, the so-called ‘remodelling therapy’ for chronic AARF [13].
Pelvic Ring Fractures and Lower Urinary Tract Injuries
Published in Journal of Investigative Surgery, 2021
The pelvic ring is defined by the structural relationship between the ilium, ischium, pubis and sacrum [1]. Functionally, the structures of the pelvic ring act as a protective scaffold for the urinary bladder and urethra that are positioned within it. Therefore, with pelvic ring fractures (PRFs) these structures are injured in approximately 5% of patients [2]. lnjuries to the bladder and urethra are referred to as lower urinary tract injuries (LUTIs) and typically occur after high-energy trauma like road traffic accidents and after falls from a significant height [3, 4]. Associations between PRFs and LUTIs after high energy trauma are through direct mechanisms (e.g. contact with a bone spicule) and indirect mechanisms (e.g. ligamentotaxis injury) [1].
Association Between Stability and Urologic Lesions in Pelvic Ring Fractures. A Case Series Report
Published in Journal of Investigative Surgery, 2021
Sebastián Corró, Andrea Sallent, Aleix Pons, MD, Óscar Ares, David Barastegui, Roberto Seijas
Lower urinary tract injuries (LUTI) are part of the broad spectrum of lesions associated with PRF. It is estimated that at least 4.2% of patients with PRF present with an associated LUTI [3]. These injuries tend to occur concurrently after high-energy trauma, such as traffic accidents, high falls and industrial accidents. Traffic accidents are the most frequently reported cause [4]. LUTI can be produced both by direct, such as an injury produced by contact with a bone spicula, and indirect mechanisms, as those produced by ligamentotaxis [1,2].