Prevention of Proximal Junctional Kyphosis or Failure: Soft Landings and Tension Band Augmentation
As adult spinal deformity surgery becomes more prevalent, the rates of proximal junctional kyphosis (PJK) will rise proportionally. The exact mechanism of PJK is unknown. However, it is thought to be multifactorial and includes violation of the facets and disruption of the posterior ligamentous complex. There are multiple techniques that are aimed at reducing the pathologic forces at the interface of the proximal aspect of the construct and normal anatomy. In this review, the authors shall discuss the causes of PJK and new techniques such as spinous process hooks, transitional rods, and tethering that have been developed t...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Symposium Source Type: research
Prevention of Proximal Junctional Kyphosis or Failure: Cement Augmentation
Vertebral cement augmentation (vertebroplasty) has recently garnered increasing attention as a possible prophylactic treatment for the prevention of proximal junctional kyphosis and proximal junctional failure in osteoporotic patients undergoing long spinal fusions. The supporting data mostly comes from small retrospective case series, but indicates a modest benefit, particularly in the prevention of proximal junctional failure. Common risks include possible cement extravasation leading to embolization events, and a theoretical increased risk of adjacent segment fracture. Deformity surgeons should familiarize themselves wi...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Symposium Source Type: research
Recurrent Proximal Junctional Kyphosis
Proximal junctional kyphosis (PJK) is one of the most common radiographic forms of adjacent segment degeneration with an incidence as high as 50% in adult spinal deformity surgery. It is a multifactorial problem with much still to be learned about the etiology and the most efficacious prevention methods. The challenge of addressing PJK can certainly be amplified in patients that develop recurrent proximal junctional kyphosis (rePJK) after revision surgery for PJK, which occurs in up to 45% of revision PJK cases. Patients found to be at the greatest risk for rePJK are those that have a pelvic tilt change>5 degrees, sagittal...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Symposium Source Type: research
Proximal Junctional Kyphosis Symposium: Patient Factors That Can Contribute to Development of Proximal Junctional Kyphosis
The development of proximal junctional kyphosis is complex and cannot be attributed to any single factor. The following paragraphs discuss some patient-related factors that have been linked to the development of this condition. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Symposium Source Type: research
Economic Impact of Proximal Junctional Kyphosis
Proximal junctional kyphosis (PJK) is a common occurrence after posterior thoracolumbar instrumented spinal fusions for adult spinal deformity (ASD). Despite its relative frequency, PJK’s economic impact has only recently gained appreciation and attention. On the basis of the available literature, direct costs associated with revision surgery for PJK range from ∼$20,000 to $120,000. The average direct costs for revision operations for PJK in the lower thoracic spine are similar to the costs for revision operations for PJK in the upper thoracic spine. Variability in costs may be attributable to variations in surgical st...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Symposium Source Type: research
Proximal Junctional Kyphosis Following Adolescent Idiopathic Scoliosis Correction
Proximal junctional kyphosis (PJK) following surgical correction of adolescent idiopathic scoliosis (AIS) is a postoperative radiographic finding observed in the sagittal plane. Development of PJK has not been shown to lead to a negative clinical outcome following spinal fusion for AIS. Long-term satisfactory outcome following spinal deformity surgery is related to the status of the sagittal plane. Proper understanding and prevention of PJK in AIS surgery is needed to preserve the best sagittal plane following surgical correction of AIS. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Symposium Source Type: research
Proximal Junctional Kyphosis and Proximal Junctional Failure in the Treatment for Adult Spinal Deformity: Definitions and Epidemiology
Proximal junctional failure (PJF) is considered to be one of the most serious complications after correction surgery with a long construct for adult spinal deformity. Proximal junctional kyphosis (PJK) was first defined as an angle between the lower endplate of the uppermost instrumented vertebra (UIV) and the upper endplate of UIV+2 of 10 degrees or greater, and at least 10 degrees greater than the preoperative measurement. Although PJK has been found to cause no significant clinical symptoms, PJF is regarded as a pathology associated with a fracture of UIV or UIV+1, posterior osseoligamentous disruption, or a pullout of ...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Symposium Source Type: research
Proximal Junctional Kyphosis and Proximal Junctional Failure Following Spinal Deformity Surgery
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Preface Source Type: research
Biomechanical Comparison of Pronator Quadratus Repair Techniques in the Modified Henry Approach for Distal Radius Fracture
Conclusions:
This cadaveric study shows that if deemed necessary for soft tissue coverage or for biological aid in fracture healing, suture anchor is the strongest repair choice for pronator quadratus. This conclusion must be weighed against the fact that no in vivo tensile strength value sustained by the pronator quadratus is known in the literature and that simple suture could be sufficient to hold the repaired muscle while the wrist is immobilized postoperatively. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 29, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
Hydrodissection and Hydrodelineation of Hamstring Tendons: Novel Technique for Graft Harvesting
Hamstring graft harvest is an important step in modern day arthroscopic anterior cruciate ligament reconstruction surgery. Various techniques of hamstring graft harvest has been reported. We have described a novel method of graft harvesting which eases the identification of the desired tendons and offers protection to saphenous nerve and superficial medial collateral ligament, which could be damaged. Our method is easy to perform after some training and does not require any additional equipment. It is also reproducible as the structures over the medial side of the tibia have a consistent anatomic pattern. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 29, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
A Useful Tip for Removal of a Well-fixed Trabecular Metal Tibial Cone
We present a technique for removal of a well-fixed porous tantalum tibial cone in the setting of a revision total knee arthroplasty. The following case is of a 56-year-old man who required a repeat 2-stage revision of an infected total knee implant that included a porous tantalum tibial cone (Trabecular Metal). The patient had previously undergone a 2-stage revision and achieved excellent fixation with a stemmed, posterior stabilized, rotating platform revision implant, and a well-ingrown porous tantalum tibial cone. To potentiate a successful outcome and avoid further bone loss, this technique was implemented for tibial c...
Source: Techniques in Orthopaedics - November 29, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
Femoral Derotation for the Acutely Malrotated Femur Following Intramedullary Nail Fixation
Clinically significant malrotation is one of the common complications following intramedullary treatment of femoral shaft fractures. We provide our experience revising an acutely malrotated femoral shaft fracture treated by intramedullary nail fixation. Following clinical examination, radiographic evaluation must include computed tomography scan for evaluation of femoral torsion. Derotation should be pursued after discussion of risks and benefits with the patient, if the malrotation exceeds 15 degrees in comparison with the uninjured limb. Revision surgery must include careful intraoperative clinical examination, as well a...
Source: Techniques in Orthopaedics - November 29, 2020 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
Efficiency of Power Versus Hand Screwdriver for Cortical Lag Screw Insertion
Conclusions:
The difference in time between the actual techniques of using power or manual tools is marginal as accuracy is the most important factor for screw insertion efficiency. We propose that surgeons utilize the modality they are more accurate with to prevent misdirected screws and increase efficiency in the operating room. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 29, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
A New Joystick Technique for the Reduction of Unstable Trochanteric Hip Fractures: Especially With Rotational Deformity
We are performing surgical treatment of trochanteric hip fractures using an intramedullary nail. There are irreducible fractures in which the correct reduction cannot be performed with the usual traction and internal rotation. In particular, the rotational deformity is difficult to reduce. One of the causes of this is the instability and uncontrollability of the proximal bone fragment. To address this problem, we devised a new joystick technique. From the same skin incision as used for inserting the intramedullary nail, a 3.0 mm Kirschner wire (K-wire) is inserted into the femoral neck perpendicularly. A K-wire is insert...
Source: Techniques in Orthopaedics - November 29, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Technical Tip: Talar Neck Fixation Strategy Based on Fracture Variants
We present a reliable observation of the morphology of talar neck fractures and demonstrate how this can be used to justify a pragmatic fixation method. The “anatomic” versus the “surgical” neck can be determined from the routine preoperative imaging. Appreciation of which fracture variant is present guides the fixation strategy as outlined. Our department has adopted this fixation principle over a 5-year period for a consecutive series of 8 talar neck fractures. Over our series we have not observed any loss in reduction or avascular necrosis. We would propose that talar neck fixation should be based on the locatio...
Source: Techniques in Orthopaedics - November 29, 2020 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
