JBJS Essential Surgical Techniques最新文献

{"title":"Intramedullary Screw Fixation for Simple Olecranon Fractures.","authors":"Tyler Thorne, Makoa Mau, Willie Dong, Leonard Lisitano, Zarek DaSilva, David L Rothberg, Thomas F Higgins, Justin M Haller, Lucas S Marchand","doi":"10.2106/JBJS.ST.23.00077","DOIUrl":"https://doi.org/10.2106/JBJS.ST.23.00077","url":null,"abstract":"<p><strong>Background: </strong>Olecranon fractures are common injuries that often require surgical fixation to maintain elbow function. Nonoperative management of these injuries may be indicated in the elderly, as a recent randomized controlled trial found that 81% (9) of 11 operatively managed olecranon fractures in the elderly had complications<sup>1</sup>. While traditional techniques such as tension-band wiring and plate fixation produced satisfactory functional outcomes, they are associated with high rates of complications<sup>2</sup>. Intramedullary screw fixation has gained popularity as an alternative technique for transverse olecranon fractures. The goal of this procedure is to reduce complication rates associated with olecranon open reduction and internal fixation while maintaining optimal functional outcomes.</p><p><strong>Description: </strong>The patient is positioned in the lateral decubitus position with the arm placed over a padded Mayo stand. A direct posterior incision is made to the olecranon. Following irrigation and hematoma evacuation, the fracture is reduced. Pointed reduction clamps are used to reduce the fracture and hold a provisional reduction. A 2 to 2.5-cm longitudinal incision is made over the footprint of the triceps insertion. Next, a 3.5-mm drill is passed from the olecranon tip to the proximal ulnar diaphysis. The proximal ulna is then opened with a 4.5-mm drill, and a 6.5-mm calibrated tap is used to sound the ulna. Then a 6.5-mm, solid, partially threaded screw with a washer is placed across the fracture. Reduction aids are removed, and the surgical site is closed. The arm is splinted for 2 weeks to allow for soft-tissue healing, after which immediate full, active range of motion is allowed.</p><p><strong>Alternatives: </strong>Alternatives include nonoperative treatment such as immobilization with a posterior long-arm splint, operative treatment with tension-band wiring, and operative treatment with plate and screw fixation.</p><p><strong>Rationale: </strong>Because of the high rates of stiffness, contracture, and joint involvement associated with nonoperative treatment of olecranon fractures, operative treatment of these injuries is often recommended<sup>3</sup>. The most common types of surgical fixation include tension-band wiring or a plate-and-screw construct. Both techniques successfully lead to fracture healing and satisfactory functional outcomes; however, the main drawback of these procedures is their high rate of complications<sup>2</sup>. A prior study reported complications in 19 (63%) of 30 patients with tension-band wiring and in 12 (38%) of 32 patients with plate-and-screw constructs. Symptomatic hardware, skin breakdown, and subsequent infection made up most of these complications<sup>2</sup>. In contrast, intramedullary screw fixation utilizes low-profile hardware that is seated within the osseous cortex. This reduces soft-tissue irritation in a region that contains low proportions of subcuta","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 2","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soft-Tissue Contouring and Nerve Management During Lower-Limb Osseointegration Surgery.","authors":"Anna M Vaeth, Grant G Black, Nicholas A Vernice, Lucy Wei, Clara G Choate, Albert Y Truong, Jason S Hoellwarth, Taylor J Reif, S Robert Rozbruch, David M Otterburn","doi":"10.2106/JBJS.ST.22.00074","DOIUrl":"https://doi.org/10.2106/JBJS.ST.22.00074","url":null,"abstract":"<p><strong>Background: </strong>Osseointegration provides a direct prosthesis interface for lower-limb amputees, many of whom are poor candidates for traditional socket-suspended prostheses. These skeletally anchored implants eliminate the skin-prosthesis interface, reducing complications such as soft-tissue breakdown, ulceration, and pain<sup>1</sup>. Soft-tissue contouring and management of peripheral nerves are essential aspects of osseointegrated implantation surgery for both transfemoral and transtibial amputees. These techniques protect the bone-implant interface, prevent skin-implant friction, and reduce neuroma formation, thus mitigating complications and maximizing patient satisfaction<sup>2,3</sup>.</p><p><strong>Description: </strong>In the present video article, we describe a technique for soft-tissue contouring during single-stage limb osseointegration that involves mobilizing the anterior and posterior musculature to cover the bone-implant interface without excess<sup>4</sup>. Peripheral nerves (i.e., the sciatic and femoral nerves for transfemoral osseointegration and the common peroneal, sural, and posterior tibial nerves for transtibial osseointegration) are identified, and targeted muscle reinnervation (TMR) is performed on each nerve. A regenerative peripheral nerve interface (RPNI) may also be utilized if there is a large size discrepancy during nerve coaptation. We excise redundant soft tissue, performing medial thigh lifts as needed, and resect subscarpal fat to create a posterior skin flap that is advanced over the implant. Finally, a skin aperture is created in the skin flap, through which the implant can attach to the prosthesis. Appropriate tension on the skin aperture is needed to allow for drainage and to avoid necrosis while preventing bacterial ingress into the surgical site.</p><p><strong>Alternatives: </strong>Alternatives to osseointegration include maximizing the functionality and comfort of a socket prosthesis, either by refitting the prosthesis or by revising the soft tissue of the residual limb. However, both of these strategies have been shown to lead to lower health-related quality of life and are not cost-effective techniques when compared with osseointegration<sup>5,6</sup>.</p><p><strong>Rationale: </strong>Lower-limb osseointegration is particularly beneficial for patients who have the desire to walk and are unable to tolerate traditional socket prostheses because of issues related to poor fit, pain, high metabolic demand, and/or skin breakdown<sup>7</sup>. Osseointegration has been shown to increase quality of life and reduce health-care costs in these patients. The efficacy and outcomes of osseointegration are not impacted by amputation etiology or history of vascular disease, making it a sound option for patients of all backgrounds.</p><p><strong>Expected outcomes: </strong>Single-institution studies and systematic reviews have shown that lower-limb osseointegration is safe and effective, often result","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 2","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12011565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted Total Hip Arthroplasty Through the Posterior Approach.","authors":"Maria T Schwabe, Joseph T Gibian, Kimberly A Bartosiak, Ilya Bendich, Andrew M Schneider","doi":"10.2106/JBJS.ST.24.00010","DOIUrl":"10.2106/JBJS.ST.24.00010","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted total hip arthroplasty (THA) through the posterior approach is indicated in cases of symptomatic hip arthritis. The goal of the procedure is to relieve pain and restore function while minimizing postoperative complications such as dislocation. Dislocation often occurs despite traditionally well placed components<sup>1,2</sup>. The hip-spine relationship can be a causative factor in postoperative instability, particularly in patients with altered spinopelvic kinematics as a result of spinal fusions or degenerative spine disease, in whom component placement based on anatomic landmarks may lead to functional malpositioning<sup>3,4</sup>. Therefore, we present our technique for robotic-assisted THA through the posterior approach, which incorporates patient-specific spinopelvic kinematic data to maximize impingement-free range of motion and minimize the risk of dislocation.</p><p><strong>Description: </strong>Preoperative computed tomography (CT) scans are obtained in order to generate a 3D model of the patient's unique hip anatomy. Lateral lumbar radiographs with the patient in the sitting and standing positions are also obtained preoperatively. The sacral slope is measured in each position, imported into the robotic software, and utilized to aid in positioning the components for optimal leg length, offset, and stability of the hip replacement based on the patient's unique spino-kinematic profile. The procedure begins with 3 partially threaded pins being driven into the ipsilateral iliac crest about 2 cm posterior to the anterior superior iliac spine. The robotic pelvic array is fastened to the pins. A standard posterior approach to the hip is utilized. Skin and subcutaneous tissues are dissected down to the iliotibial band and gluteus maximus fascia. The fascia is longitudinally incised, and a small metallic pin is malleted into the distal aspect of the greater trochanter. Initial leg length and offset values are captured. The short external rotators and posterior hip capsule are elevated. The hip is dislocated, and a neck resection is made at a level determined preoperatively with use of the robotic software. The acetabulum is exposed, and osseous registration is carried out to establish a relationship between the 3D model built with use of the robotic software and the patient's anatomy in vivo. The acetabulum is single-reamed, and the final cup is impacted in the desired position. The proximal femur is broached with increasingly sized broaches until rotational and axial stability has been achieved. A trial femoral neck and head are attached to the final broach, and the hip is reduced. Posterior and anterior hip stability are assessed, and leg length and offset are rechecked via the robotic system. Once the surgeon is satisfied, the hip is dislocated, the broach is removed, and the final femoral stem and head are manually implanted. The hip is then reduced for the final time. Closure is performed acc","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopically Assisted Lower Trapezius Transfer Using Peroneus Longus Autograft for Irreparable Posterosuperior Rotator Cuff Tears.","authors":"Silvampatti Ramasamy Sundararajan, Rajagopalakrishnan Ramakanth, Bandlapally Sreenivasa Guptha Sujith, Terence Dsouza, Karthikeyan Pratheeban, Shanmuganathan Rajasekaran","doi":"10.2106/JBJS.ST.23.00047","DOIUrl":"10.2106/JBJS.ST.23.00047","url":null,"abstract":"<p><strong>Background: </strong>Massive retracted rotator cuff tears are disabling in physically active patients. In patients with persistent pain in whom nonoperative treatment has failed, multiple surgical treatment options are available. Lower trapezius tendon transfer is a promising surgical procedure that can decrease pain, improve external rotation strength, and recreate more normal glenohumeral kinematics. In the present video article, we describe the surgical technique for successful arthroscopic (\"scopy\")-assisted lower trapezius transfer (SALTT) with use of an easily accessible peroneus longus autograft.</p><p><strong>Description: </strong>The patient is positioned in a beach-chair position with the ipsilateral half of the posterior shoulder girdle included in the draping for surgical access. Joint was viewed through the standard posterior and posterolateral portals, while anterolateral and anterosuperior portals were utilized as the working portals. Subacromial and superior capsular adhesions are released, and a partial cuff repair is performed. A 3 to 4-cm vertical incision is made along the scapular spine. The superior and inferior borders of the lower trapezius are delineated and completely detached from where they insert at the scapular spine. A 3-cm vertical incision is made at the posterior border of the lateral malleolus. The fascia is incised. The peroneus longus is identified and detached with the foot in maximum dorsiflexion and eversion and is harvested with use of a closed tendon stripper. Whip stiches are placed at 1 end of the autograft. With use of a large grasping clamp, starting from the anterolateral portal and aiming toward the medial scapular incision, the autograft is shuttled and the stitched end of the autograft is fixed to the humeral head with a knotless anchor. With the shoulder in maximum external rotation and 0° of abduction, tenodesis of the autograft is performed to the lower trapezius tendon with a Pulvertaft technique. The shoulder is then immobilized in 40° to 60° of external rotation in a custom brace for 6 to 8 weeks. Passive and gradual active-assisted shoulder exercises should begin at 6 to 8 weeks postoperatively.</p><p><strong>Alternatives: </strong>Surgical alternatives for irreparable tears include partial rotator cuff repair with biceps superior capsular reconstruction, superior capsular reconstruction with fascia lata graft, subacromial balloon spacer, and reverse shoulder arthroplasty. Tendon transfers are preferred in younger patients.</p><p><strong>Rationale: </strong>The lower trapezius has adequate tension, a similar line of pull as the infraspinatus, and enough tension to replace the function of the infraspinatus<sup>1</sup>. Biomechanical studies have shown that the maximum external rotation moment arm generated with use of a lower trapezius transfer with the arm at the side is superior to that with either latissimus dorsi or teres major transfer<sup>2</sup>, and lower trapezius transfe","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Press-Fit Bone-Anchored Prosthesis for Individuals with Transtibial Amputation.","authors":"Jan Paul M Frölke, Robin Atallah, Ruud Leijendekkers","doi":"10.2106/JBJS.ST.ER.23.00006","DOIUrl":"10.2106/JBJS.ST.ER.23.00006","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.ST.23.00006.].</p>","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Regenerative Peripheral Nerve Interface (RPNI) Surgery for Mitigation of Neuroma and Postamputation Pain.","authors":"Christine S W Best, Paul S Cederna, Theodore A Kung","doi":"10.2106/JBJS.ST.ER.23.00009","DOIUrl":"10.2106/JBJS.ST.ER.23.00009","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.ST.23.00009.].</p>","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Press-Fit Bone-Anchored Prosthesis for Patients with Short Transfemoral Amputation.","authors":"Jan Paul Frölke, Robin Atallah, Ruud Leijendekkers","doi":"10.2106/JBJS.ST.23.00007","DOIUrl":"10.2106/JBJS.ST.23.00007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;This video article describes the use of a bone-anchored prosthesis in patients with high above-the-knee amputations resulting in short residual limbs, most typically from trauma, cancer, infections, or dysvascular disease. The use of a socket prosthesis is usually unsuccessful in patients with a high transfemoral amputation because such prostheses have an unstable connection and often require additional waist belts for better attachment to the short residual limb. In most cases, a bone-anchored prosthesis results in substantial improvements in wear time, mobility, and quality of life in these patients. These patients may also be excellent candidates for early osseointegration implant surgery, given the knowledge that socket prostheses are rarely successful.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;This procedure is preferably performed in a single stage. After the surgical procedure, most patients stay 1 or 2 nights in the hospital, depending on the magnitude of the surgery (e.g., bilateral implantation of an osseointegration implant) and their comorbidities. Procedure steps include (1) preoperative implant planning, (2) patient positioning and setup, (3) soft-tissue correction (optional) and exposure of residual bone, (4) revision osteotomy with guided shortening, (5) preparation of the medullary canal and perpendicular cutoff plane, (6) marking of the lag screw with a custom-made aiming device and dummy prosthesis, (7) insertion of the intramedullary component with optional bone augmentation, (8) insertion of the lag screw, (9) soft-tissue contouring and closure, and (10) stoma creation and dual cone assembly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alternatives: &lt;/strong&gt;Simultaneous major leg amputation and implantation of an osseointegration prosthesis is not advocated as treatment. First, a rehabilitation program with a socket-suspended prosthesis should be trialed before a patient can apply for a bone-anchored prosthesis. After rehabilitation, satisfaction with a socket prosthesis may be adequate, making a bone-anchored prosthesis unnecessary; however, patients with very short residual limbs and/or irregular soft-tissue conditions may be candidates for early implantation of a bone-anchored prosthesis. Contraindications for osseointegration implant surgery are severe diabetes (with complications), severe bone deformity, immature bone, bone diseases (chronic infection or metastasis), current chemotherapy, severe vascular diseases, pain without a clear cause, body mass index of &gt;30 kg/m&lt;sup&gt;2&lt;/sup&gt;, and smoking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;About half of patients with a major lower-limb amputation who use an artificial leg are able to function acceptably well with use of a socket-suspended prosthesis; however, in cases with a high transfemoral amputation level, severe limitations may be expected, resulting in reduced prosthesis use, mobility, and quality of life. In these cases, energy transfer from limb to prosthesis is poor because of","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11841842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prone Transpsoas Lumbar Interbody Fusion for Degenerative Disc Disease.","authors":"Daniel K Park, Philip Zakko, Matthew S Easthardt, Philip K Louie","doi":"10.2106/JBJS.ST.23.00090","DOIUrl":"10.2106/JBJS.ST.23.00090","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Prone transpsoas lumbar interbody fusion (PTP) is a newer technique to treat various spinal disc pathologies. PTP is a variation of lateral lumbar interbody fusion (LLIF) that is performed with the patient prone rather than in the lateral decubitus position. This approach offers similar benefits of lateral spinal surgery, which include less blood loss, shorter hospital stay, and quicker recovery compared with traditional open spine surgery. PTP offers additional benefits over traditional lateral positioning, with a more familiar patient position for spine surgeons, the ability to perform simultaneous posterior decompression and fusion without repositioning, and improved sagittal alignment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;PTP is performed with the patient under general anesthesia and with use of somatosensory evoked potentials (SSEP) and electromyography (EMG) neuromonitoring. The patient is positioned prone with the aid of specialized patient positioners. Once the patient is positioned and draped, the disc space of interest is marked with use of fluoroscopic guidance. An incision is made, and blunt dissection is performed through the external oblique, internal oblique, and transversalis muscles. The psoas muscle is palpated, and dilators are placed at the target disc level under fluoroscopic guidance, with care taken to protect the peritoneum and lumbar plexus. Specialized retractors are then positioned. Anulotomy and disc removal, disc space preparation, trialing, and final interbody placement are performed. The procedure ends with obtaining hemostasis and closure of the incision.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alternatives: &lt;/strong&gt;Before surgery is performed, nonoperative treatment should be attempted, including the use of nonsteroidal anti-inflammatory drugs, physical therapy, and spinal injections. Surgical alternatives include posterior lumbar laminectomy with or without fusion, as well as other procedures in the anterior column, such as LLIF, anterior lumbar interbody fusion, oblique lumbar interbody fusion, transforaminal lumbar interbody fusion, and posterior lumbar interbody fusion. These alternatives must be considered, especially when working at the L4-S1 disc spaces, because of potential limitations to lateral surgery, such as in cases of high-riding iliac crests, a rising psoas, and previous abdominal surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Lateral spinal surgery evolved as a means to approach the anterior column of the spine in order to treat various spine disorders, such as degenerative disc disease, tumors, infection, and spinal deformity. With the PTP procedure, the patient is in the prone rather than the lateral decubitus position, which allows the psoas muscle to retract more posteriorly because it is under tension, pulling the lumbar plexus away from the target point of the procedure. In addition, the prone position results in improved sagittal alignment compared with the lateral position. With respect ","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Surgical Technique Guide for Percutaneous Screw Fixation for Metastatic Pelvic Lesions.","authors":"Jayson Lian, Rui Yang, Noel O Akioyamen, Jichuan Wang, David H Ge, Milan K Sen, Bang Hoang, David S Geller","doi":"10.2106/JBJS.ST.22.00034","DOIUrl":"https://doi.org/10.2106/JBJS.ST.22.00034","url":null,"abstract":"<p><strong>Background: </strong>The pelvis is one of the most common areas for metastatic bone disease. We recently described the use of a minimally invasive percutaneous screw fixation of metastatic non-periacetabular pelvic lesions, with excellent results.</p><p><strong>Description: </strong>The procedure can be completed in a standard operating theater without the need for special instruments. In our video we describe the appropriate intraoperative patient positioning, surgical equipment, surgical approach, and obtainment of the necessary fluoroscopic views for placement of various pelvic percutaneous screws.</p><p><strong>Alternatives: </strong>Alternative treatments include surgical procedures such as curettage, cement packing, and modified Harrington total hip arthroplasty through extensive open approaches. Additionally, as an alternative to standard fluoroscopy, intraoperative navigation and an O-arm could be utilized for the placement of screws. In our experience, intraoperative navigation has been helpful for confirmation of final screw placement and length. Overreliance on intraoperative navigation in the setting of poor bone quality and an abandonment of tactile feedback and the various tips described in this video article can lead to inadvertent extraosseous screw placement and injury. Furthermore, as navigation involves only a virtually computed image, we have found it challenging to utilize in complex, curved bones, such as the superior pubic ramus.</p><p><strong>Rationale: </strong>Percutaneous screw fixation is safe and effective for the treatment of metastatic non-periacetabular pelvic lesions. Given the simplicity of the technique and instrumentation, and the tolerance of concomitant treatments, this approach is worthy of broader consideration.</p><p><strong>Expected outcomes: </strong>In our recent study, 22 consecutive patients with painful non-periacetabular pelvic metastatic cancer underwent percutaneous screw fixation. There were no surgical complications. Postoperatively, there was significant improvement in visual analog scale pain scores and functional Eastern Cooperative Oncology Group scores, as compared with baseline³.</p><p><strong>Important tips: </strong>Despite the simplicity of the intraoperative set-up and instrumentation, the procedure is technically demanding. Obtaining the correct fluoroscopic views and troubleshooting intraoperative hurdles can be challenging.</p><p><strong>Acronyms and abbreviations: </strong>CT = computed tomographyASIS = anterior superior iliac spineGT = greater trochanterAP = anteroposteriorAIIS = anterior inferior iliac spineSI = sacroiliacTSTI = transsacral-transiliacVAS = visual analog scaleECOG = Eastern Cooperative Oncology GroupDVT = deep vein thrombosis.</p>","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11692961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Flexor Hallucis Longus Tendon Transfer for the Treatment of Chronic Achilles Tendon Defects.","authors":"Andrew Rust, Logan Roebke, Kevin D Martin","doi":"10.2106/JBJS.ST.23.00075","DOIUrl":"https://doi.org/10.2106/JBJS.ST.23.00075","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;An all-inside endoscopic flexor hallucis longus (FHL) tendon transfer is indicated for the treatment of chronic, full-thickness Achilles tendon defects. The aim of this procedure is to restore function of the gastrocnemius-soleus complex while avoiding the wound complications associated with open procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;This procedure can be performed through 2 endoscopic portals, a posteromedial portal (the working portal) and a posterolateral portal (the visualization portal). The FHL tendon is identified, and the joint capsule is debrided to identify the subtalar joint. A shaver is utilized to circumferentially debride the FHL at the level of the subtalar joint, allowing for full visualization of the tendon. Care is taken to avoid the posteromedial neurovascular bundle by keeping the shaver against the tendon. An endoscopic suture-passing device is utilized to pierce the FHL tendon and shuttle a nonabsorbable suture through the tendon; this step is done 2 times. The tendon is then cut at its distal-most aspect (adjacent to the subtalar joint) with an endoscopic cutter. The tendon is then brought through the posteromedial portal and prepared for transosseous passage with nonabsorbable suture. Next, the anterior insertion of the Achilles tendon is endoscopically identified and debrided. With use of needle endoscopy-targeted pin placement, a Beath pin is placed at the anterior footprint of the Achilles via the posteromedial portal. The pin is advanced dorsal to plantar and out the bottom of the foot and is confirmed on fluoroscopy. With use of an appropriately sized reamer, the Beath pin is loaded with the 2 grasping sutures and shuttled plantarly. The needle endoscope is then placed in the posterolateral portal to visualize the FHL tendon, advancing into the tunnel with the foot held in 15° of plantar flexion. An appropriately sized interference screw is then placed in the tunnel, using direct endoscopic visualization to confirm placement and depth of the screw.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Alternatives: &lt;/strong&gt;Chronic Achilles tendon ruptures with symptomatic weakness often necessitate operative treatment; however, high-risk patients may be better managed nonoperatively with an ankle-foot orthosis. These patients often demonstrate improved gait and function with this orthosis&lt;sup&gt;1&lt;/sup&gt;. The choice of operative technique for the treatment of chronic Achilles tendon defects is primarily based on tendon gap length; options include end-to-end repair, fascial advancement, and turn-down procedures with or without transferring the FHL, peroneus brevis, or flexor digitorum longus tendons. These techniques require substantial incisions and violation of the posterior compartments and Achilles paratenon, creating substantial postoperative scarring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Chronic Achilles tendon ruptures with defects or gaps leave the patient with weakness and biomechanical loss of the gastrocnemius-s","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"15 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11692965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}