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Paediatric Spondylolisthesis
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
Q: The patient returns to your clinic after 6 months of non-operative management complaining that the pain is worse, and she has developed right-sided pain radiating to the lateral aspect of her leg and dorsum of the foot. Upright XR demonstrates a Meyerding Grade I spondylolisthesis. How would you proceed with management? Although studies have suggested a benign course in low-grade spondylolisthesis, this patient has progressive pain symptoms and onset of neurology. Surgical options include bilateral pars repair with screws or tension band wiring. Alternatively, posterior instrumented fusion and decompression would successfully stabilise the slip and decompress the nerve root. Studies have demonstrated that in patients who fail non-operative management, surgical fusion results in a high success rate. Evidence is suggestive that high-grade spondylolisthesis may be treated with circumferential fusion, that is anterior fusion with an interbody device and posterior fusion in preference to posterior-only approaches.
Surgery of the Hand
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Norbert Kang, Ben Miranda, Dariush Nikkhah
The terminal extensor tendon is detached from the base of the distal phalanx, exposing the joint. The collateral ligaments are excised, and the volar plate detached from the base of the distal phalanx. This allows the joint to be disarticulated completely. The joint surfaces are removed with a saw or bone nibbler to expose the cancellous bone with the intention of creating two flat surfaces with the correct angulation (i.e. 0°–10°). For fixation, 90°–90° wiring is probably the easiest technique to understand and perform. Tension band wiring is also acceptable but technically more challenging (Figure 9.6). Other acceptable alternatives include the use of a Lister loop (although the K-wire then needs to be removed at 8 weeks), Herbert or cannulated screw fixation and plating.
Management of osteoporotic proximal humeral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Tension band wiring in combination with intramedullary Ender nails or K-wires has been considered the standard for a long time, and good results have been reported, but biomechanically these techniques are not stable (31–35).
Treatment of Bennett fractures with tension-band wiring through a small incision under loupes and a headlight
Published in The Physician and Sportsmedicine, 2019
Xu Zhang, Vikas Dhawan, Shuming Zhao, Yadong Yu, Xinzhong Shao, Guisheng Zhang
The tension-band wiring technique is a minimally invasive procedure. The incision is approximately of the same length as the total length of the incision required for three arthroscopic portals. Utilizing the advantage of extensive mobilization of the skin of the dorsal hand, the small incision can be moved back and forth to facilitate visualization and manoeuvrability. Loupes and headlights facilitate accurate reduction and fixation under direct visualization even in the deep operative field. The risk of fragmentation associated with fixation using K-wires is lower than that observed with screw fixation. Tension-band wiring generates pressure at the fracture site, which reduces fixation failure and improves bone healing. The rigid fixation achieved with this method enables early CMC joint motion and consequently reduces postoperative joint stiffness. No iatrogenic injuries occurred in this study because no neurovascular structures were encountered in the operative field. When removing the implants, the wire loop was removed initially followed by the K-wire so that the wire could be pulled out around the K-wire to avoid technical difficulties related to soft tissue ingrowth.
Interosseous wiring for fragmented proximal phalangeal fractures
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hidetoshi Teraura, Hideki Sakanaka, Hiroyuki Gotani
Five patients with proximal phalangeal fractures treated with IOW between October 2011 and June 2018 were included, with a postoperative observation period of ≥6 months. The surgery was performed by a single surgeon (level 3. Specialist – experienced [3]) under general anesthesia or supraclavicular block. Zig-zag incisions were made on the dorsal skin, depending on the extent of the fracture. After the extensor tendon was longitudinally split, the periosteum was carefully detached to expose the fracture site (Figure 1(A)). Bone fragments were then reduced one by one and fixed using 0.7 mm or 1.0 mm Kirschner wires and 26-gauge (0.405 mm diameter, American wire gauge) or 28-gauge (0.321 mm diameter) stainless steel wires. Tension band wiring and circular wiring were used according to the fracture type (Figure 1(B)). The periosteum was repaired using 5-0 nylon, avoiding direct contact of the implant and extensor tendon to prevent extensor tendon adhesions (Figure 1(C)). The split extensor tendon was carefully sutured and repaired using 5-0 nylon while the proximal interphalangeal (PIP) joint was held in a flexed position (Figure 1(D)). After the surgery, buddy taping was applied to the injured and adjacent fingers, and dorsal fixation was performed using Alfence splints (Alcare Co., Ltd., Tokyo, Japan), maintaining the metacarpophalangeal (MP) joint in a 70° flexion position (Burkhalter fixation). The PIP and distal interphalangeal (DIP) joints were left free to move without fixation, and ROM exercises began immediately after surgery. Flexion contractures can occur even when the PIP joints are left free; therefore, patients were instructed to perform exercises to extend the PIP joints regularly. Three weeks after surgery, the splint was removed, and ROM exercises for the MP joints were initiated.