Techniques in Orthopaedics最新文献

{"title":"Anatomic Markers for Intraoperative Identification of the Heuter Interval in the Direct Anterior Approach to the Hip","authors":"Ross Condell, Martin Kelly, Paul Mckenna","doi":"10.1097/bto.0000000000000648","DOIUrl":"https://doi.org/10.1097/bto.0000000000000648","url":null,"abstract":"Direct anterior approach (DAA) has been shown to have many benefits for patients undergoing total hip replacement. These include less soft tissue damage, a low dislocation rate, and earlier postoperative recovery compared with other approaches.1,2 The accurate identification of the Smith-Peterson interval is vital to minimize unnecessary soft tissue dissection, as well as to avoid injury to nearby structures. It also allows for an internervous approach, between the sartorius muscle (femoral nerve) and the tensor fascia latae muscle (superior gluteal nerve). This has been shown to lead to improved postoperative pain control and decreased length of hospital stay.3 The interval is accessed by incising the fascia over the tensor fascia lata muscle. It is the identification of this muscle that is the key element in ensuring safe exposure of the hip. A comprehensive understanding of the anterior hip anatomy is essential when acquiring exposure to the joint. Anterior mobilization of the femur is necessary for exposure for reaming, broaching, and femoral implant positioning. Specific releases are described in detail by Rodriguez et al,4 which allow the proximal part of the femur and the greater trochanter to be elevated anteriorly in front of the acetabulum with minimal force applied to the femur. The senior author has used the DAA in over 2500 cases to date and has identified 4 constant markers that aid in identifying the Smith-Peterson interval. TECHNIQUE After incision through the skin and subcutaneous fat, the tensor fascia muscle can be identified using the following markers (Figs. 1–3): Lateral to a line drawn from the anterior superior iliac spine to the head of the fibula. Oblique orientation of the muscle fibers running from the anterior superior iliac spine proximally in an inferolateral direction distally. Presence of perforating vessels in the fascia of the tensor fascia lata. Fat streak between tensor and sartorius medially. FIGURE 1: Right hip direct anterior approach. Anatomic landmarks for identifying the Heuter interval. ASIS indictes anterior superior iliac spine; TFL, Tensor fascia lata.FIGURE 2: Once the plane is identified, the fascia overlying the bulk of the tensor fascia muscle is incised and retracted to allow for access to the Heuter Interval.FIGURE 3: Anatomical landmarks for identifying the Heuter interval. The patient consented to clinical photography, available on request. ASIS indictes anterior superior iliac spine; TFL, Tensor fascia lata.Expected Outcomes The Heuter interval can be difficult to identify. However, using these 4 markers can allow surgeons to be confident with their approach. Once identified, the fascia overlying the bulk of the tensor fascia muscle is incised and retracted to allow for access to the Heuter interval and the hip capsule with minimal soft tissue disruption. The steep learning curve to the DAA can be aided by the identification of these markers. COMPLICATIONS The lateral femoral cutaneous nerve","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135895463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Technique of Cemented Acetabulum Component Insertion Using Robot Arm-assisted Surgery","authors":"Sofia Marasco, Ross Crawford, Dirk van Bavel","doi":"10.1097/bto.0000000000000647","DOIUrl":"https://doi.org/10.1097/bto.0000000000000647","url":null,"abstract":"Robotic arm-assisted surgery is becoming more widely used in total hip arthroplasty (THA) to aid surgeons in accurate component positioning. Surgical techniques describe cementless and hybrid THA implantation using robot arm-assisted systems, there is no description of cemented acetabular cup positioning and its use is considered off-label. Cemented THA has undergone technical and component improvement since the 1980s when studies first indicated high rates of loosening.1 Since this time, improved cementing techniques and cross-linked polyethylene cup introduction have demonstrated excellent results and improved survivorship.2,3 The Australian Joint Registry (AOANJRR)4 demonstrated that cemented THA has no difference from hybrid THA and a lower revision rate compared with cementless implants in the short term but with no difference long term. These results are not echoed in all registries as the later introduction of cross-linked polyethylene for cemented acetabular components compared with cementless creates a “polyethylene bias” when trying to interpret results. Since 2017, the AOANJRR has published data excluding non–cross-linked polyethylene articulations. Cemented acetabular cups are indicated for most patients who undergo THA but are particularly relevant for patients with poor quality acetabular bone stock (ie, osteoporosis and inflammatory arthritis or deficiencies that would lead to inadequate cementless fixation and revision of cup arthroplasty). These outcomes are maintained when surgeons maintain technique proficiency. The use of cemented acetabular implants also carries health and economic benefits with cemented implants costing significantly less than cementless acetabular components. The benefits extend into the postoperative period with decreased costs associated with reduced revision rates.5 We describe the surgical technique of cemented acetabular cup placement using the robot arm-assisted MAKO system (Stryker Kalamazoo). This technique is not currently described on the label, but it may be useful for surgeons who would like the benefit of haptic-controlled reaming and navigation of cemented cup implantation, as well as the potential benefits of the virtual range of motion impingement tool. TECHNIQUE Informed consent was obtained from the patient and the institution's ethical approval was obtained. Preoperative planning using the robot arm-assisted system is performed as though an uncemented acetabular component is being used. When the patient is placed in a lateral decubitus position, side support is placed at the sacral promontory and pubic bone, as a support on the anterior superior iliac spine leaves little sterile space between the post and iliac crest pins. (Fig. 1)FIGURE 1: Pelvic post against ASIS and pubic body. Note increased surgical field with post placed at the pubic body (Iliac crest marked with a dotted line and lower border of rib cage with solid line). ASIS indicate Anterior Superior Iliac Spine.Acetabular bone ","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135584290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lose the Big Retractors: Retraction Sutures for Upper Extremity Surgery","authors":"Samantha L. Reiss, Peter Zeblisky, Lisa K. Cannada","doi":"10.1097/bto.0000000000000644","DOIUrl":"https://doi.org/10.1097/bto.0000000000000644","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85605219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective Kirschner Wire Fixation to Reduce the Effect of Lateral Hinge Fracture During the Medial Opening Wedge Low Tibial Osteotomy: A Technical Note","authors":"J. Choi, J. Suh, Tae Hun Song","doi":"10.1097/bto.0000000000000643","DOIUrl":"https://doi.org/10.1097/bto.0000000000000643","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83557496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hybrid Integrated Approach: Beginner’s Guide to the Balancing in Knee Arthroplasty","authors":"S. Deshpande","doi":"10.1097/bto.0000000000000641","DOIUrl":"https://doi.org/10.1097/bto.0000000000000641","url":null,"abstract":"Gap balancing and measured resection techniques form the basic guidance on soft tissue balancing in total knee arthroplasty teachings. The concepts around knee arthroplasty constantly evolving keeping the basics right. Surgeons across the globe are blending established known techniques with newer modifications. The anatomic, functional, and kinematic alignments of the prosthetic knee are frequently debated at conferences. Irrespective of the alignment principle one is following the aim is to achieve a balanced knee for better function. While balancing the knee arthroplasty the basic theme accepted worldwide is the combination of gap balancing and measured resection philosophy. The additional procedures that aid in are these soft tissue releases, lateralization of the prosthesis, reduction osteotomy, and downsizing of the implant which results into a modern current way of approaching the idea of balancing. The surgical workflow I have discussed here is actually the amalgamation of standard teachings and newer trends resulting into the Hybrid integrated technique (H) of balancing a prosthetic a total knee arthroplasty. From the orthopedic trainee point of view it is confusing to see the operating room execution is different than conventional books information. Hence, there is a need to create a beginner’s guide of the current workflow. The modern algorithm helps in balancing the soft tissue releases and bony releases to complement each other. The below-mentioned surgical workflow is not a novel approach but scientifically documenting the current practice implemented by many surgeons at various arthroplasty centers. Hence, it is not a presentation of a personal clinical case study series but an adaptation of various surgical steps to form a workflow.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80789915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of External Fixator Assistance in Tibial Rotation Osteotomy—Technique and Results","authors":"N. Bor, E. Dujovny, N. Rozen, G. Rubin","doi":"10.1097/bto.0000000000000638","DOIUrl":"https://doi.org/10.1097/bto.0000000000000638","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87086726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the Alvarado Knee Holder in Infrapatellar Tibial Nail Removal: A Technical Trick","authors":"Arunlal Nadar, Shikha Sachdeva, C. M. Granade, D. Seligson","doi":"10.1097/bto.0000000000000636","DOIUrl":"https://doi.org/10.1097/bto.0000000000000636","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76091705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Patellar Tendon Reconstruction Technique Using Semitendinosus Allograft","authors":"Christopher M. Shaw, Joshua Locker, Bryan Perkins, M. Held","doi":"10.1097/bto.0000000000000639","DOIUrl":"https://doi.org/10.1097/bto.0000000000000639","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89374818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-pin Posterior Tuberosity to Medial Wall Reduction Technique in Calcaneal Fracture Using Sinus Tarsi Approach","authors":"Navindravadhanam Sockalingam, Voon Chin Leow, T. Balakrishnan, Chun-Keat Eo, Tharumaraja Thiruselvam","doi":"10.1097/bto.0000000000000637","DOIUrl":"https://doi.org/10.1097/bto.0000000000000637","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83294518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Reduction Maneuver for Distal Radius Fracture Involving an Intra-articular Sagittal Split","authors":"Colin Pavano, Jake Silver, C. Rodner","doi":"10.1097/bto.0000000000000633","DOIUrl":"https://doi.org/10.1097/bto.0000000000000633","url":null,"abstract":"","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83772956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}