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Clinical and radiological outcome of Thoracolumbar fractures treated by Transpedicular Fixation

January 10, 2017/in Volume 3 | Issue 1 | Jan-April 2017

Vol 3 | Issue 1 | Jan – Apr 2017 | page: 38-45 | Suresh Babu Surapaneni, Venkata Suresh Babu Tummala, Ravikanth Makkena Author: Suresh Babu Surapaneni [1], Venkata Suresh Babu Tummala [1], Ravikanth Makkena [2] [1] Department of Orthopaedics, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India. [2] […]

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

May 10, 2016/in Volume 2 | Issue 2 | May-Aug 2016

Vol 2 | Issue 2 | May – Aug 2016 | page:53-55 | Wasudeo Gadegone, Vijayanad Lokhande, Yogesh Salphale Author: Wasudeo Gadegone [1], Vijayanad Lokhande [1], Yogesh Salphale [1] [1] GMC Chandrapur, Maharashtra, India. [2] Shushrusha Multispecialty hospital, Chandrapur, India. [3] Smt. Kashibai Navale Medical College and General Hospital, Pune Address of Correspondence Dr. W.M. […]

Clinical and radiological outcome of Thoracolumbar fractures treated by Transpedicular Fixation

January 10, 2017/in Volume 3 | Issue 1 | Jan-April 2017

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

May 10, 2016/in Volume 2 | Issue 2 | May-Aug 2016

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Clinical and radiological outcome of Thoracolumbar fractures treated by Transpedicular Fixation

January 10, 2017/in Volume 3 | Issue 1 | Jan-April 2017

Vol 3 | Issue 1 | Jan – Apr 2017 | page: 38-45 | Suresh Babu Surapaneni, Venkata Suresh Babu Tummala, Ravikanth Makkena

Author: Suresh Babu Surapaneni [1], Venkata Suresh Babu Tummala [1], Ravikanth Makkena [2]

[1] Department of Orthopaedics, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India.
[2] Department of Orthopaedics, ASM Medical College, Eluru, West Godavari, Andhra Pradesh, India.

Address of Correspondence:
Dr. Suresh Babu Surapaneneni,
Suresh Ortho & Multispeciality Clinic, 56-2-18, Koneru Satyanarayana Street,
Canara Bank Road, Patamata, Vijayawada – 520 010, Andhra Pradesh, India.
Phone: +91-9440219597. Tel.: +0866-2474797.
E-mail: drssureshbabu@yahoo.com

Abstract

Background: The injuries involving the spinal cord are generally challenging to manage. The aim of this study was to analyze and compare the clinical including neurological and radiological outcome of thoracolumbar burst fractures treated by short segment and long segment transpedicular instrumentation and posterolateral fusion.
Methods: 34 patients with or without neurological deficit were studied. Gaines scoring, American Spinal Cord Injury Association impairment scale was used for study.
Results: The mean intra-operative correction of K-angle in the short segment group was 14.68° and the loss of correction observed at the last follow-up evaluation was 6.62° with a final gain of 8.06°. The mean intra-operative correction in the long segment group was 19.76° and the loss of correction observed at the last follow-up evaluation was 6.61°. Final gain was 13.15°. On radiological evaluation of wedge angle, mean correction loss of 3.87 degrees and 3.4% implant failure was noted in the short segment group while the long segment group had 1.53 degrees of mean correction loss and no implant failure. There was no positive correlation found between Gaines score with progression of deformity. Neurological Outcome in the short segment group four grades of improvement was found in 1 patient, three grades in 1 patient, two grades in 2 patients and one grade in 6 patients. In the long segment group, three grades of improvement were found in 3 patients, two grades in 2 patients and one grade in 2 patients. 1 of the grade D patient showed improvement within the grade and 3 patients did not show any improvement. Average ASIA motor score improved with treatment from 28.31 to 39.56 points (11.25 points) in short segment group and from 19.91 to 28.46 points (8.55 points) in long segment group.
Conclusion: Transpedicular fixation is a stable, reliable and less surgically extensive construct for addressing thoracolumbar burst fractures. About 6-8° loss of correction was observed with both short and long segment stabilizations in our study. Long segment has better results in terms of maintenance of reduction and final gain. The length of instrumentation does not seem to have any effect on the neurological outcome.

Key Words: Thoracolumbar fractures, Clinical, Radiological outcome.

References

1. Instructional Course Lecture AAOS: Diagnosis and management of thoracolumbar spine fractures. JBJS Vol. 85A: Number 12: Dec. 2003.
2. Harrington PR, Tullos HS. Reduction of severe spondylolisthesis in children. South Med J 1969; 62-1-7.
3. Steffee AD, Biscup RS, Sitowski DJ. Segmental spine plates with pedicle screw fixation- a new internal fixation device for disorders of the lumbar and thoracolumbar spine. Clin orthop 1986; 203: 45-53.
4. Mirjanli et al: Comparison of Transpedicular fixation configurations in Burst fractures of thoracolumbar vertebra. Turkish Spine Journal. Vol. 6, No. 3 Year 1995.
5. Louis et al: Posterior approach with Louis plates for fractures of the thoracolumbar and lumbar spine with and without Neurological deficits. Spine 1998;23(18):2030-2039. .
6. Parker et al: Successful short segment instrumentation and fusion for thoracolumbar spine fractures. A consecutive 4 1/2 year series. Spine volume 25, Number 9, Pg 1157-1169.
7. Gertzbein SD, Brown CMC et al: The neurological outcome following surgery for spinal fractures. Spine 13: 641-644, 1988.

How to Cite this article: Surapaneni SB, Tummala VSB, Makkena R. Clinical and Radiological Outcome of Thoracolumbar Fractures Treated by Transpedicular Fixation. Trauma International Jan-Apr 2017; 3(1): 38-45.

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The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

May 10, 2016/in Volume 2 | Issue 2 | May-Aug 2016

Vol 2 | Issue 2 | May – Aug 2016 | page:53-55 | Wasudeo Gadegone, Vijayanad Lokhande, Yogesh Salphale

Author: Wasudeo Gadegone [1], Vijayanad Lokhande [1], Yogesh Salphale [1]

[1] GMC Chandrapur, Maharashtra, India.
[2] Shushrusha Multispecialty hospital, Chandrapur, India.
[3] Smt. Kashibai Navale Medical College and General Hospital, Pune

Address of Correspondence
Dr. W.M. Gadegone.
VivekNagar Mul-Road Chandrapur 442402, Maharashtra, India.
Email: gadegone123@yahoo.co.in

Abstract

Conservative treatment remains the gold standard in treatment of simple undisplaced midshaft clavicle fractures, but for displaced and comminuted fractures surgical intervention is appropriate especially in young active adults. Surgical stabilisation can be achieved using either a plate or an intramedullary device. One of dreaded complication of intramedullary device in migration of the implant. We have used a screw intramedullary device with screw mechanism at one end which can get hold in the medial cancellous bone, thus preventing chances of migration. This report describes the technique of using the screw intramedullary nail for displace clavicle fracture.
Keywords: clavicle fracture, intramedullary nailing.

Introduction

Although conservative treatment is the gold standard for clavicle fractures, there may be some issues like shoulder impairement, a bump at the fracture site that is cosmetically unacceptable or nonunions which happen when grossly displaced fractures are treated conservatively. Surgical stabilisation may be additionally indicated in cases with completely displaced fractures (gap of > 20mm), potential skin perforation, shortening of clavicle by more than 20 mm, neurovascular injury, and floating shoulder injury. Plating is an option which is used commonly, but leads to scarring and may need repeat surgery of implant removal. Intrameduallry nailing has been successfully used by few authors but has a complications like nail migration. We are using a screw intrameduallry device (Fig. 1) which anchors to the metaphyseal bone by the wide screw head at the end of the nail. This technicaal note simply describes the technique.

Implant

Screw elastic intramedullary nail is available in diameter of 2, 2.5, and 3 mm. The nails are 5-6 cm in length , with screw portion of 10mm length and 4.5mm in diameter. The screw head is of 3.5 mm size where the appropriate screw driver fits (Fig. 1). The nail is made of either steel of titanium and is sufficiently elastic to bend as it traversed the canal from the point of insertion and resilient enough to spring back in the curvature when finally seated. However it is still rigid enough to withstand the torsional, rotational, and angulatory forces.]Nail has a bevelled tip at one end and a threaded head positioned at other. This design allows the self-cutting thread to be advanced and screwed in with a 3.5 mm screw driver. The distal beveled end of the nail aids in fracture reduction and helps in engaging in the subchondral area of the bone, thereby imparting stability. The inserter should firmly grasp the nail in order to control rotation, insertion and nail withdrawal. It is best to mount the nail on a T handle while inserting but other devices can also be used (Fig. 2)

Surgical Technique:

Operative procedure is carried out under interscalanae block or general anaesthesia. Affected shoulder is elevated by a bolster so that clavicle becomes more prominent. This position also helps to restore length and increase exposure of the clavicle (Fig. 3). The procedure is performed under fluoroscopic guidance. A one centimeter skin incision is made over medial end of clavicle and a hole is drilled in the anterior cortex with a 3.2 mm drill bit and guide. The insertion point is made approximately 1 cm lateral to the sternoclavicular joint. The entry portal is then enlarged with an awl (Fig.3).

The reaming of canal is done with sequential reamer and then an elastic nail of appropriate diameter and length is inserted in the medullary canal of clavicle with a universal chuck and T-handle (Fig. 4).

With oscillating movements the nail is advanced until it reaches the fracture site. With the help of percutaneously placed towel clips fracture fragments are approximated (Fig. 5). The reduction is checked in image-intensifier and then the nail is advanced through the fracture site till it reaches distal end of clavicle. Generally nail can be negotiated one cm short of acromioclavicular joint. If closed reduction is unsuccessful, an additional skin incision is made at fracture site for open reduction of the fragments (Fig. 5).

Although clavicle is S shaped, tip of the nail is curved which helps the surgeon to pass the elastic nail into distal fragment. After adequate engagement of the distal fragment, the medial end of screw nail is screwed in the metaphyseal region of the medial end of clavicle and skin closed over it (Fig. 6).

Postoperatively arm pouch sling is given for three weeks. Gentle pendulum exercises of the shoulder are allowed as per pain tolerance immediately after surgery. We tend to limit extreme overhead activities for 3-6 weeks. At four to six weeks, active assisted range of motion in all planes was allowed. When fracture union (defined as radiographic union with no pain or motion with manual stressing of the fracture) was evident, muscle strengthening exercises were also allowed. At eight to twelve weeks, Isometric and isotonic exercises were prescribed for shoulder girdle muscles with return to full activities (including sports) at three months (Fig. 7).

Conclusions

Percutaneous elastic screw intramedullary nailing of the clavicle is a safe, reliable method for fixation of displaced midshaft clavicle fractures. It is less invasive and allows rapid healing by callus formation. Complication rates are low, with better functional and cosmetic results.

How to Cite this article: Gadegone W, Lokhande V, Salphale Y. The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note. Trauma International May – Aug 2016;2(2):53-55.

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

Clinical and radiological outcome of Thoracolumbar fractures treated by Transpedicular Fixation

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

Clinical and radiological outcome of Thoracolumbar fractures treated by Transpedicular Fixation

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

Full Sized Blog Element (Big Preview Pic)

Clinical and radiological outcome of Thoracolumbar fractures treated by Transpedicular Fixation

Author: Suresh Babu Surapaneni [1], Venkata Suresh Babu Tummala [1], Ravikanth Makkena [2]

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

The Screw Intra-medullary Elastic Nail Fixation in fresh Displaced Mid Shaft Clavicle Fractures – Technical note

Author: Wasudeo Gadegone [1], Vijayanad Lokhande [1], Yogesh Salphale [1]

Abstract

Introduction

Implant

Conclusions

(Abstract) (Full Text HTML) (Download PDF)

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