We seek to investigate the relationship between vitamin D deficiency and outcomes after lumbar spinal fusions. Three types of hip prostheses exist: unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty (Figures 10-1 and 10-2). Use a child code to capture more detail. Lateral view of the TKA illustrating loosening of the anterior aspect of femoral component at the site of the bone–metal interface (arrow), as evidenced by the lucency between the femoral cortex and prosthesis. Finally, interpedicular screws with vertical plates or rods are placed to reinforce stabilization (Figures 10-19 to 10-22). There are no clear indications in management, and in most cases management often trends toward partial or total arthrodesis of the wrist and the hand. As a result, internal fixation is undesirable due to both increased damage to surrounding soft tissues and increased risk of infection with the use of internal plates and screws. Fracture of cerclage wires and misplacement of screw at fracture site. The postoperative radiograph evaluation includes at least two radiographic views of the prosthesis at right angles to one another (e.g., orthogonal views) in addition to any specific views particular for the joint imaged. Orthopedic surgeons routinely deploy specialized surgical hardware such as pins, rods, nails, screws, and anchors. Figure 10-32. Next, iodinated contrast is injected into the joint. Original Research. Total hip replacement. Prior to the advent of joint replacement, surgical management of a painful or nonfunctional joint included joint arthrodesis (e.g., joint fusion), osteotomy, nerve division, and joint debridement. CASE. They are made of titanium or radiolucent material such as polyether ether ketone (PEEK). The interfragmentary screw is a screw that crosses the fracture line (Figure 10-29), ideally perpendicular to the fracture line. A shoulder hemiarthroplasty is used in cases such as severe proximal humeral fractures and severe rotator cuff tear where the patient still possesses a normal glenoid. Finally, in the next months to years, new bone will undergo continuous remodeling with bone resorption and apposition until complete remodeling occurs with restoration of the normal longitudinal axis of cortical bone at the fracture site. One day in mid-December, orthopedic surgeon Dr. Bruno Gobbato walked into an operating room in Jaraguá do Sul, Brazil, put on a HoloLens 2 mixed-reality headset and prepared for surgery. Polymethylmethacrylate is the most commonly used cement to secure the prosthesis into the medullary cavity of the bone. Facet arthritis and degenerative disk and facet disease are common above and below the level of the fusion (Figure 10-22).8 Furthermore, fused bones are less mobile, making the adjacent vertebral bodies more prone to fracture in cases of trauma. Figure 10-6. ICD Code T84.8 is a non-billable code. The Haversian system is the functional unit of cortical bone. Common complications …   •  Privacy Policy The AP film is used to measure the angle of inclination that is optimal at 30–55° (Figure 10-2), and the lateral film is used to measure the angle of anteversion that is optimal around 15°.1,2 The femoral component should be either parallel to the femoral shaft or in slight valgus. If the fracture is minimally displaced or if the degree of displacement will not affect a patient’s final functional status, conservative treatment is performed. Unfortunately, there is a relatively high complication rate when dealing with mandible fractures. Relative contraindications include obesity, remote infection, unrepaired ligamentous injuries, and neurologic impairment. Contrast accumulation around in the region of periprosthetic lucency is suggestive of loosening (Figure 10-3B) or infection. Any gap widening or fracture of the plate is a symptom of instability (Figures 10-30 and 10-31). Figure 10-28. AP (A) and lateral (B) views of the lumbar spine, demonstrating posterior interbody fusion of L4-L5 with intervertebral disk spacer bone graft. Additional foci of endosteal scalloping may also be seen. Figure 10-25. Standing AP (Figure 10-4A), lateral (Figure 10-4B), and patellar views (Figure 10-4C) are obtained when evaluating the postoperative knee. Progressive lucency around a screw on follow-up radiographs is indicative of loosening. In this case, the ball-shaped glenoid component aligns with the cup of the humeral component. kenjirou-ohashi@uiowa.edu PURPOSE: To retrospectively evaluate multi-detector row computed tomography (CT) for the depiction … Interpretation of postoperative orthopedic radiographs comprises a significant portion of the practice of not only subspecialized musculoskeletal radiologists but also general radiologists. This section will discuss the procedures and range of hardware devices used in spinal fixation. Figure 10-22. Though it is impossible for the radiologist to become familiar with all the different devices in the market, the structural material and complications are shared among the variety of different prostheses. Mortise view of the right ankle depicting breakage of syndesmotic screws. T84. Initially a side plate is affixed to the distal femur and attached with multiple cortical screws. Recent advances in bio-materials and joint replacement technology have led to marked improvements in the longevity of joint prostheses. MRI, nuclear medicine scintigraphy with WBC scan, and possibly CT-guided aspiration may be needed for further characterization of the infection.6 One other complication of spinal fusion must be noted: although fusion may be successful, it will eventually cause increased stress at levels above and below the level of surgical fixation. These surgeries are usually performed with minimal tissue exposure and may be performed in retrograde or anterograde fashion. External fixators are made of a combination of pins and rods that are placed percutaneously into the bone above and below the fracture site (Figure 10-34). Three screws are typically used to achieve fixation, with two screws placed inferiorly and one placed superiorly.11,12. Shoulder hemiarthroplasty. Absolute contraindications for joint replacement include active local or systemic infection. Harrington rods help provide distraction along the concavity and compression forces across the convexity in the treatment of scoliosis. They are designed to anchor into cortical bone. Alternatively, anteriorly placed screws may penetrate the posterior cortex and cause impingement on the cord. Recent advances in biomaterials and joint replacement technology have led to marked improvements in the longevity of joint prostheses. Femoral cephalomedullary nail. Patients were afforded significant improvement in quality of life with the development of joint replacement techniques; however, older joint replacement components often suffered from premature wear. A constrained prosthesis has two components that are directly linked together. Finally, radial head prostheses may be performed in cases of comminuted radial head fractures (Figure 10-10). Figure 10-31. In this method, the fracture fragments are manipulated through the soft tissues and restored to as near as normal anatomical position as possible. Potential complications of intramedullary nail placement are violation of the joint space and damage to the internal cortical blood supply that can subsequently increase the rate of infection. This is a greater problem in semiconstrained or nonconstrained arthroplasties such as the shoulder or the elbow if the surrounding muscles, tendons, and ligaments do not have the adequate strength to prevent subluxation and dislocation. Aggressive granulomatosis (particle disease) in total hip arthroplasty (THA). Again, the native acetabular surface is unaltered. TKAs may involve simple patellar resurfacing (B) or placement of a patellar button (C). The most common complications and risks of orthopedic surgery include bleeding, infections, blood coagulation, nerve damage, lack of full range of motion, reaction to anesthesia, development of arthritis, scar formation, or re-injury of the joint or soft tissue. Please consult the latest official manual style if you have any questions regarding the format accuracy. Additional clinical information, including laboratory analysis, is needed to assess the likelihood of infection. Three types of surgeries exist for shoulder replacement: hemiarthroplasty (Figure 10-6), total shoulder arthroplasty (Figure 10-7), and reverse shoulder arthroplasty (Figure 10-8). (A) The femorotibial component should be aligned in 4–7)° of valgus, and the articular surface of the tibial component should be aligned parallel to the ground. Orthopedic hardware; Osteolysis; Postoperative complications; ASJC Scopus subject areas. Complications have been related to the size of implants removed in forearm fractures, and in inexperienced surgeons performing hardware removal. Bone fractures typically occur within the early postoperative period in patients with poor bone stock such as osteoporotic patients. External immobilization comes in the form of external slings, splints, or casts. There is screw breakage and rupture of proximal cerclage wires with resultant plate separation from cortical bone. AP (A) and lateral (B) views of the right ankle joint, exhibiting bridge plate fixation of oblique fibular fracture with malleolar screw fixation of medial malleolus fracture. Carver College of Medicine, IA 52242, USA. As a result, surgical pinning or wiring is performed, such as pinning the distal femur with attachment to a traction device in order to counteract the weight of the pull of the muscles and subsequent sustained traction on the distal fracture fragment. Screws are the most common orthopedic devices used in fracture fixation. For example, a complete examination of a total knee arthroplasty would include an AP view, a lateral view, and possibly a sunrise view for adequate visualization of the patella. ICD-10-CM Codes › S00-T88 Injury, poisoning and certain other consequences of external causes ; T80-T88 Complications of surgical and medical care, not elsewhere classified ; T84-Complications of internal orthopedic prosthetic devices, implants and grafts Mechanical complication of internal fixation device of other bones T84.2 The healing process with callus formation can be divided into four stages. Loose pedicular screws. It is usually a response to the radiolucent polyethylene liner or methylmethacrylate. As with joint replacement, and spinal fixation, many similar complications apply including infection, loosening, and hardware fracture. In this method, cerclage wires are used to fixate the two fracture fragments and are stabilized by additional Kirschner wires or screws. AP radiograph shows shoulder hemiarthroplasty. AP (A) and lateral (B) radiographs of UKA. Finally, tension band placement is commonly used in the fixation of olecranon and patellar fractures. Loosening is a common delayed complication shared by all prostheses (Figures 10-3A,B, 10-5A, and 10-11). The cup of the humeral component is connected to the stem portion of the prosthesis. In open fractures, there is usually significant surrounding soft tissue injury, possible vascular compromise, and increased risk of infection. The indications for external fixation include open fractures, periarticular fractures, and pediatric factures in which the growth plate is to be avoided. The osteoclasts function to resorb the end of the fracture, while osteoblasts form new bone behind the osteoclasts, thus creating numerous microscopic bony bridges across the fracture site. Hardware terminology and classifications are described, 2) An Atlas of Orthopedic Hardware arranges hardware into general and specific categories. Although second-generation ankle prostheses have had better outcomes than first-generation prostheses, ankle arthrodesis remains the treatment of choice in managing the painful ankle joint. In the MIR subgroup, wound infection with or without revision surgery represented the most common cause for IR. Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Fracture of the femoral contoured plate. It is the preferred method due to the risk of cord manipulation from a posterior approach, as well as the risk to vital structures such as the trachea, the esophagus, the lungs, and the carotid artery.8 First, the herniated portion of the disk or the entire disk is removed. These screws have a hollow core, which allows them to be inserted percutaneously over a guide wire, with less risk to the blood supply of the femoral head. Additional flexion and extension views aid with assessment of spinal stability. These include temporary metal devices only intended to be in the body for a short time, loose metal, or metal that may need to be removed to allow for additional sur… In these cases, a single femoral condyle and its tibial articulating surfaces are resurfaced. The entire prosthesis and surrounding bone need to be imaged on the examination. They are commonly used for reinforcement in revision arthroplasties due to periprosthetic fractures in order to provide additional support. In a total hip arthroplasty, the articular surface of both the femur and the acetabulum is replaced. Multiple thin-diameter Kirschner wires (also known as K-wires) are sometimes used in stabilizing comminuted intra-articular distal radial fractures (Figure 10-34) as well as many types of phalangeal and metacarpal fractures. 156.96.62.13 AP (A) and lateral (B) radiographs of the cervical fusion instrumentation show posterior cervical fusion of C2-T1 with pedicle screws and rods. Initially, the joint is aspirated for laboratory analysis. The type of fracture, anatomical site age, and comorbidities of the patient will dictate what approach the surgeon will have in treatment of the fracture. However, when a fracture is surgically reduced by plates and screws, fractures heal without callus formation. Postoperative Evaluation and Complications. Lateral radiograph of the lumbar spine shows L3-S1 posterior fusion via rods and pedicle screws, with large anterior marginal osteophyte seen at L2-L3 (arrow) with marked endplate subchondral sclerosis indicative of vertebral body degenerative changes and discogenic sclerosis as a result of abnormal stress at the site of the fused and unfused segments. (A) Both the femoral and tibial components of the TKA exhibit irregular periprosthetic lucency (arrows), suggestive of infection. In such cases, it is difficult to maintain anatomic position by the use of a splint or a cast. Loose femoral component of total knee arthroplasty (TKA). The lack of success is likely due to inability to duplicate the normal mechanics of the ankle joint and inability to restore the stabilizing effect of the ligaments. Two generalized categories exist. Figure 10-20. Figure 10-12. BLOG: Hardware complications in revision ACL reconstruction take careful consideration. Lumbar fusion with adjacent degenerative disc stress and disease. Unicompartmental knee prostheses have been used in younger patients with isolated medial or lateral compartment arthritis (Figure 10-5). Link to publication in Scopus. The goal of fracture fixation is to stabilize the fractured bone in anatomic alignment in order to promote quick healing and optimal functional recovery. Infection is a serious delayed complication of any joint replacement. AP (A) and lateral (B) radiographs of cervical fusion instrumentation show anterior cervical fusion of C4-5 and C5-7 via plates and vertebral body screws. Figure 10-8. Generalized indications for joint replacement include severe osteoarthritis, avascular necrosis, trauma, and inflammatory arthropathies such as rheumatoid arthritis. Patients were afforded significant improvement in quality of life with the development of joint replacement techniques; however, older joint replacement components often suffered from premature wear. There is linear soft tissue calcification incidentally noted near the medial tibial condyle. Posterior cervical fusion. The superior and inferior disks are also removed, and bone graft is placed in place of the removed vertebral body, which results in fusion of the adjacent vertebral bodies. Fracture of contoured lateral femoral plate with associated subtrochanteric fracture through fracture callus with associated varus malalignment and nonunion. Disk spacers are inserted into the intervertebral disk space after the diseased disk is removed (Figures 10-17A,B and 10-19A,B). The anchor was apparently deformed during surgical insertion, but the surgeon proceeded utilizing the same anchor. Heterotopic ossification in this region predictably results in significant deficits of hip flexion and abduction. Bone graft material is also used within the posterior elements in posterior spinal fusion to provide additional stability. Figure 10-26. Elbow prostheses can be categorized by design, either as linked or nonlinked. Ankle fracture with plate and screw fixations. Interpedicular screws are connected either by rods or plates that span single or multiple vertebral body segments (Figures 10-17 to 10-22). The scope can be general, such as pre-operative risk stratification or management of chronic medical problems. The devices used for external fixation fall under several categories, which will be discussed in turn. Additionally, on the AP view (A), note the periprosthetic lucency (arrows) that represents hardware loosening. Orthopedic complications seen in vitamin D deficiency include nonunion, pseudarthrosis, and hardware failure. Intervertebral spacers and bone grafts can also herniate anteriorly or posteriorly and cause neurologic compromise. They are combinations of different metals such as chromium–cobalt, chromium–cobalt–titanium, or chromium–cobalt–molybdenum.1 These different alloys have individual biomechanical properties based on their metal composition, and differ in terms of their resistance to stress, strain, and tension. AP view of the right wrist, demonstrating K-wire fixation of distal radius fracture with spanning external fixator in place. After about 2-3 weeks, you’ll meet again with your surgeon to ensure the foot is healing as expected now that the hardware has been removed. Rods can be attached to the spine by pedicle screws, wires, or cables. Dislocation or subluxation may occur in either the early or late postoperative period. Infected total knee arthroplasty (TKA) with antibiotic cement spacer. Joint aspiration is the most definitive technique to diagnose septic arthritis. This chapter reviews the basic concepts of joint replacement, spinal fusion, and fracture fixation, which are some of the most common procedures performed by orthopedic surgeons. “Complications of internal orthopedic prosth dev/grft” for short Non-Billable Code. This site uses cookies to provide, maintain and improve your experience.
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