The authors describe a novel suture fixation technique that combines a doubled suture with a sliding knot. The knot can be tied in both open and arthroscopic surgery to fix torn tendons/ligaments and fractured/osteotomized bones. The advantages of the doubled-suture Nice knot include strength, adjustability, simplicity, and versatility. This technique, which has proven useful in the authors' practice for the past 10 years, has replaced metallic wires and cables for bone fixation. The doubled-suture Nice knot can also be tied over a double-button and has been used for ankle syndesmosis, acromioclavicular joint separation repair, and coracoid bone block fixation. [Orthopedics. 2017; 40(2):e382-e386.].
RSA is an effective form of treatment for patients with type 1 sequelae of a fracture of the proximal humerus associated with rotator cuff deficiency or stiffness of the shoulder, with high rates of satisfaction. Rotator cuff tears and stiffness of the shoulder had an adverse effect on the clinical outcome. Cite this article: Bone Joint J 2018;100-B:318-23.
In acetabular revisions, polyethylene (PE) liners are often cemented into metal shells on top of acetabular screw heads. This study investigates the possibility of using this technique to obtain fixed-angle acetabular screws Eth a concept that has not yet been reported in the literature. Two groups of screws (n=8) were inserted into Trabecular Metal revision shells (Zimmer), into which PE liners were then cemented. Screws in Group 1, inserted in the shell's pre-fabricated holes, were countersunk, whereas screws in Group 2 were inserted in custom-drilled holes that make their heads protrude into, and interdigitate with, the overlying cement mantle. Perpendicular loading was then applied to the screw shafts both statically to failure and cyclically. A greater stiffness was observed for the protruding screws upon static loading; and while the countersunk screws all failed at the screw-cement junction (53.44 + or - 8.33 N), the protruding screws all failed at the screw shaft (1049.79 + or - 32.12 N) a 20-fold difference (p< 0.05). Under cyclic loading, only the protruding screw head specimen did not fail, undergoing an overall displacement within the limits of osseointegration.These results support the hypothesis that the protrusion of an acetabular screw head into an overlying cement mantle significantly increases its angular stability. Provided other variables are favorable, this locking effect may increase the initial stability of the whole implant, thus improving the ultimate success of complex acetabular revisions.
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