Medical Apparatus: Imaging Guide to Orthopedic Devices
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Gallery of Orthopedic Medical Devices

Introduction

Neck & Spine Gallery

Fracture Fixation Gallery

Joint Arthroplasty Gallery 

 

Complications of Orthopedic Apparatus 

Gallery References

 

 

Gallery of Orthopedic Medical Devices - Complications


By Tim B. Hunter, MD and Mihra S. Taljanovic, MD, PhD

 

Complications of fracture fixation apparatus

Plate loosening and screw displacement Displaced suture anchors Left femur intramedullary rod (nail) fracture proximally
Humerus fixation plate loosening and screw displacement Humerus plate loosening and screw displacement Displaced suture anchors Left femur IM rod fracture
39 year-old woman with poorly healing complex proximal and distal humerus fractures. The bicondylar distal humerus fixation plates have become loosened with displacement of multiple screws into the soft tissues of the right arm and forearm.    
Retained drill guide Migration of fracture fixation pin (K-wire)
 
Retained drill guide Retained drill guide Pins in plaster Extrusion of K-wire
Frontal and lateral views of the right wrist after placement of a volar T-plate and screws for a comminuted distal radius fracture. On the lateral view there is a retained drill guide (arrow) that was inadvertently left in place. It should have been removed at the end of the surgical procedure. It is not evident on the AP view and was initially overlooked by both an MSK radiologist and the patient's orthopedic surgeon. Elderly woman with distal radius fracture stabilized by multiple fixation pins (K- wires) Three weeks later one of the K-wires has become displaced extending through the radius and skin.
Failed low contact dynamic compression (LCD) plate Zickel nail
Left ulna LCD plate postoperative view Left ulna LCD plate failure Left LCD plate revision

Zickle nail

48 year-old man with left comminuted mid-shaft radius and ulna fractures. An immediate postoperative radiograph (left) shows placement of LCD plates in both the radius and ulna. Follow-up radiograph (middle) two weeks later shows mild angulation at the ulnar plate (arrow). At revision surgery the ulnar plate had failed and come loose from the ulna. The radial plate was intact. A long revision LCD plate was placed in the ulna (right). Skin staples are visible next to the revised ulnar plate. The Zickel (aka Zickle) nail system is designed to treat pathologic fractures in the femur as well as acute subtrochanteric hip fractures and acute supracondylar femoral fractures. The sharp bend in the nail (arrow) often results in re-fracturing if the nail is later removed. From Hunter, 1994.

Right femur retrograde intramedullary rod (nail) extrusion with fracture of distal locking screw Right femoral neck helical screw displacement with penetration of the right acetabulum
Retrograde femoral IM rod extrusion Retrograde femoral IM rod extrusion Right femoral neck helical screw displacement Right femoral neck helical screw displacement
46 year-old man with healing distal femoral fracture
 
There are bilateral short femoral nails with helical femoral neck screws. The screw on the right has penetrated the right acetabulum.
Settling of right hip dynamic compression screw Fixation screw projecting into right hip joint
Right hip dynamic compression screw Right hip dynamic compression screw settling Fixation screw projecting into right hip joint Fixation screw projecting into right hip joint
65 year-old man with basicervical femur fracture treated with dynamic compression screw and sideplate. The fracture had delayed healing, and ten months after screw placement settling of the fracture significantly displaced the compression screw. 60 year-old woman treated for right femur intertrochanteric fracture with lateral stabilizing trochanter plate, dynamic compression screw, and separate cannulated fixation screw which extends into the right hip joint.

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Fixation screw projecting into right hip joint Left first metatarsophalangeal joint arthrodesis screw fractures Left tibia stress fracture after fibular fracture fixation
Screw in right hip joint Left MTP joint fusion screw fracture Left ankle stress fracture AP view Left ankle stress fracture oblique view
The compression screw has slid distally in the barrel as it was designed to do when the femoral neck fracture site becomes compressed. This did not prevent the screw from cutting out of the femoral head (curved arrow). From Hunter, 1994 52 year-old man with chronic wound on plantar surface of the left foot and poliomyelitis of the left 2nd metatarsal head (arrow). There is incidental fracturing of two fixation screws from past large toe MTP joint arthrodesis. A short one-third tubular plate and screws plus interfragmentary screw stabilize a healing distal fibular fracture. An associated stress fracture (arrow) is in the distal tibial metaphysis from altered weight-bearing from the fibular fracture.
Right femur periarticular plate breakage and chronic fracture nonunion Iatrogenic fracture fixation failure
Right femur periarticular plate breakage Right femur periarticular plate breakage Left hip jatrogenic fracture fixation failure Left hip jatrogenic fracture fixation failure
36 year-old man with bullet wound in 2003 complicated by femur fracture infected non-union treated by multiple attempts with external fixation and open reduction and internal fixation (ORIF). Radiography 12 years later shows chronic fracture hypertrophic nonunion, multiple shrapnel fragments, and breakage of a periarticular fixation plate. Intraoperative fixation of an intertrochanteric fracture demonstrates a cephalomedullary device with the tip of the cephalic screw positioned too short and very inferior in the neck (very large tip-apex distance). Subsequent fracture fixation failure observed as the head and neck segment of the femur flexed 90 degrees with cut-out of the screw approaching the hip joint.
Failure of fracture fixation due to ambulating against advice
Fracture fixation with IM nail and supplementary plate and screws. AP view Tibia fracture fixation with IM nail and supplemental plate and screws.  Lateral view Follow-up tibia fracture.  Patient ambulating against advice. Follow-up tibia fracture.  Patient ambulating against advice.
Male patient with proximal tibia and fibula fractures treated by intramedullary nail and supplemental one-third tubular plate. Initial intraoperative fluoroscopic AP and lateral images (left two images) show the plate (arrow on lateral image). The patient ambulated against advice and was lost to follow-up. Two months later he again presented (right two images) to the clinic. There is now tibia fracture migration, and the proximal medial to lateral interlocking screw has backed out (AP view). The lateral view demonstrates fracture displacement with flexion deformity. The nail has troughed outside the proximal anterior tibia and is sitting within the soft tissues. The supplementary plate is broken, there is a broken interlocking screw, and abundant fracture callus is present.
Left hip cannulated screw fracture Left knee antegrade intramedullary rod displacement into knee joint Left ankle syndesmotic screw fracturing
Left hip cannulated screw fracture Left knee antegrade intramedullary rod displacement into knee joint Left knee antegrade intramedullary rod displacement into knee joint Left ankle syndesmotic screw fracturing
41 year-old man with chronic left femoral neck fracture and fracture of superior cannulated fixation screw. The partially visualized intramedullary nail is for an old femoral shaft fracture.     22 year-old man with syndesmotic screw placement for medial avulsive ankle injury. The screws fractured and loosened and were later removed.

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Complications of neck and spine apparatus

Complications of joint arthroplasty

 

 

 

 


Author contact information

Tim Hunter
Email: hunter@radiology.arizona.edu


COPYRIGHT 2013: TBH
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