Acta Orthopaedica Belgica
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Pisiform excision for refractory flexor carpi ulnaris tendinopathy of the wrist
No full textPurposeTo report the long-term clinical results after pisiform excision in patients with refractory flexor carpi ulnaris (FCU) tendinopathy. MethodsWe performed pisiform excision in 14 patients with recalcitrant FCU tendinopathy, who had failed conservative treatment. Nine patients were followed-up for more than 2 years. Pre-operative pain visual analog scale (VAS) was extracted from the electronic medical records. Post-operative symptoms and function were assessed with pain VAS, quick disabilities of arm, shoulder and hand (DASH) score, patient rated wrist evaluation (PRWE) score, and satisfaction VAS for surgery at the final follow-up. ResultsAfter the mean follow-up period of 6 years, all patients showed improvement in pain VAS (from 5.9 to 1.2). The post-operative scores of quick DASH and PRWE were 3.5 and 13.1, respectively. Satisfaction VAS score was 8.8 and all patients returned to their work. ConclusionExcision of the pisiform bone improved symptoms in patients with refractory FCU tendinopathy
Cozen’s Phenomenon: State of the ‘Art Management Taking the Advantages of Recent Advances in Growth Modulation with Critical Review
No full textCozen’s phenomenon is an uncommon condition with unclear protocol for management. The purpose of this study was to emphasize a reliable plan for treatment of these cases. Case series of 14 patients fulfilling the determined inclusion criteria were treated using 8-plate hemiepiphyseodesis. Their mean age at the time of the operation was (4 y & 7m). The mean preoperative anatomical femoro-tibial valgus angle was 22°. Overcorrection (~ 5°) was obtained in all the cases at the end of treatment after a mean period of 15 months. Although two cases showed early rebound at the 8th month of follow up, it was temporary and all the cases fortunately after a mean follow up period of 28 months showed complete resolution. 8-plate is a simple, effective, and safe technique that works successfully when used properly in selected cases of Cozen’s phenomenon
Reduced joint awareness after total knee arthroplasty with a cruciate retaining design
No full textA range of different total knee arthroplasty (TKA) designs have been developed, each specifically designed to relieve pain and restore knee function with the greatest possible patient satisfaction. The purpose of this study was to compare a posterior stabilized design and a cruciate-retaining design. We hypothesized that a cruciate-retaining design would have a higher Forgotten Joint Score (FJS) than a posterior stabilized design. Ninety-two patients were used in our analysis (46 patients in each group) involving TKA (Attune, Depuy-Synthes) between January 2014 and March 2015. We excluded patients with valgus alignment, post-traumatic arthritis, rheumatoid arthritis and major previous surgery on the knee. We compared the FJS, the Oxford Knee Score (OKS) and their ceiling effects. FJS was significantly higher in the fixed-bearing cruciate-retaining group (P=0.043). The mean ( SD) FJS for the cruciate-retaining group was 78,4 25.1 compared to 67.6 27.6 for the posterior stabilized group. No significant difference in OKS was detected. The total ceiling effect for FJS and OKS was 32.2% and 45.5%, respectively. In conclusion, patients with cruciate-retaining TKA showed a better FJS in comparison to posterior stabilized TKA. FJS has a higher discriminatory power compared to OKS
The effect of intramedullary signal intensity in MRI on the therapeutic efficacy of posterior cervical decompression laminectomy with internal fixation and fusion for multi-level cervical spondylotic myelopathy: A retrospective cohort study
No full textBackground:We aimed to investigate the effect of intramedullary signal intensity in MRI on the therapeutic efficacy of posterior cervical decompression laminectomy with fixation for multi-level cervical spondylotic myelopathy. Methods: Fifty-six patients were retrospectively analyzed in two experimental groups: signal (-) group (n=41) and signal (+) group (n=15). JOA scores, Borden values, Cobb angles, disc space heights, and adjacent disc space heights of the cervical spine were measured to evaluate the neurological functional recovery rate. Results:The effective rate in the spinal cord signal (-)/(+) group was 95.1%/86.7% and the excellent (or good) rate was 85.4% (or 20.0%). A rank-sum test revealed a significant difference between the JOA score improvement rates of the signal (+) and signal (-) groups. Analyses of variance showed that the Borden values and Cobb angles, but not the disc space heights and inter-vertebral space heights, collected at these four time points were statistically different. Conclusion:The signal (-) group improvement rate was higher than that of the signal (+) group despite the fact that posterior cervical decompression laminectomy with fixation effectively improved the overall neurological functions in all MCSM patients. Furthermore, the surgery provided good cervical stability throughout the whole observation period. Keywords: cervical spondylotic myelopathy; posterior decompression; internal fixation; signal change in MRI; cervical stabilit
Surgical options in the management of landmine blast injuries of lower Limb: a randomised prospective study
No full textLandmine blast injuries are high velocity shattering injuries that produce ghastly and gory wounds, presenting a dilemma to the treating surgeon, especially when the literature on this subject is limited. The aim of the present study is to enlist various surgical procedures that can be explored to treat such complex injuries. 60 cases having varied degrees of involvement of the lower limb from mine blasts were managed. Surgical treatment was tailored to the individual requirement depending on the extent and severity of injury. Serial surgical wound debridement was an integral part of all these procedures. Limb salvage was possible in 70% cases. A combination of surgical approaches and procedures from fixation to different types of amputations can be employed for treating mine blast injuries to maximise residual limb function.
Principal component analysis as a tool for determining optimal tibial baseplate geometry in modern TKA design.
No full textOptimal tibial component fixation in total knee arthroplasty (TKA) requires maximal tibial bone coverage, optimized mediolateral cortical fit as well as component rotation. Failure to achieve an optimal fit may result in component subsidence and loosening in case of undersizing, or overhang with subsequent soft tissue impingement in case of overhang.To date there is no consensus on optimal tibial component shape, and significant variability exists among different design manufacturers. In this study "principal component analysis" was used as a statistical tool in order to determine the ideal tibia baseplate shape, based upon anthropometric CT-scan data defining an average proximal tibial shape and variations. Gender specificity was evaluated and differences in geometry depending on anatomic constitution (varus, neutral, valgus) were analyzed.The results from our study indicate that in the arthritic knee differences in proximal tibial morphology at the resection level were mainly attributed to size and not shape. This is true for both Caucasian men and women, and is independent from the anatomical constitution
Excellent functional recovery after Kirschner-wire extension blocking technique for displaced closed bony mallet finger injuries; results of 36 cases
No full textPurposeBony mallet finger injuries comprise 30% of all mallet injuries. Operative treatment of bony mallet fingers injuries still remains controversial. The aim of this study was to describe the k-wire extension blocking technique and the functional results using the PRWHE questionnaire.MethodsA single center retrospective observational cohort of 36 patients was defined between January 2010 and December 2015. Inclusion criteria for this study were acute fractures with 1) persistent displacement of more than 3 mm in extension splint, 2) palmar subluxation of the distal phalanx or 3) fracture fragments consisting of more than one third of the joint surface.ResultsAccording to the PRWHE questionnaire, excellent results were observed with a mean follow up period of 32 months of all patients. Two patients developed a clinically relevant superficial wound infection and one patient developed a nail deformity .ConclusionIn conclusion, the k-wire extension blocking technique is safe and results in excellent mid-term functional outcome.(Level of evidence IV according to the Oxford Centre for Evidence Based Medicine 2011 Levels of Evidence
Surgical treatment of displaced clavicle fractures with a novel intramedullary device; comparison of less-invasive versus standard technique.
No full textObjectives: This study compared the standard technique with a less invasive technique for implantation of Sonoma Crx device in patients with displaced clavicle fractures.Methods: Patients were randomly allocated into two treatment groups based on the planned surgical method; Group 1 patients (n=36) received the standard method whereas group 2 patients (n=35) received the less invasive method originally developed by our team. Follow-up information included radiographic data, quick-DASH scoring, range of motion measurement and Constant shoulder score.Results: Mean time of operation (p<0.001) and mean time of fluoroscopy were significantly shorter (p<0.001) in Group 1 vs. to Group 2. Mean time of hospital stay was significantly longer in Group 1 vs. Group 2 (p=0.01). Time until bony union was slightly longer in Group 1 compared to Group 2 (p=0.01).Conclusion: Sonoma Crx device can safely be implanted through a medial single incision with closed reduction.
Investigation of the changing etiology and risk factors of prosthetic joint infections: A university hospital surveillance study from 2011-2017
No full textWe sought to characterize the causative pathogens of prosthetic joint infections (PJIs), evaluate the trends in microbial etiologies, and identify potential risk factors for PJI. This was a retrospective study analyzing 70 patients with PJI following 3,253 total joint arthroplasties between 2011 and 2017. Staphylococci were the most common cause of infection (52.9%). There was a significant trend in the percentage of carbapenem-resistant gram-negative bacilli (GNB) (increased to 66.7% in 2016 from 0.0% in 2011) (p=0.021). GNB and polymicrobial etiology were found at significantly high levels in cases involving early PJIs (p=0.005 and p=0.048, respectively). While staphylococci were significantly higher in PJIs after total knee arthroplasty (75%), GNB were significantly higher in PJIs after total hip arthroplasty (49.1%) (p<0.001 and p=0.001, respectively). Binary logistic regression analysis showed that the risk of PJI was significantly higher in cases with fracture and diabetes mellitus (odds ratio [OR], 4.3, 95% confidence interval [CI], 1.78-10.5; OR, 4.1, 95% CI, 1.66-10.5, respectively). These results suggest that the empirical and targeted antimicrobial treatment of PJIs may become more difficult in the future
Efficacy of IV tranexamic acid versus autologous blood salvage systems in controlling blood loss following knee arthroplasty.
No full textThe purpose of this study is evaluate and compare efficacy of tranexamic acid (TXA) versus autologous blood salvage systems in blood loss management following primary total knee arthroplasty (TKA). Observational, prospective, randomized study performed between April 2016 and June 2017. 120 consecutive patients who underwent TKA were divided into three groups: Group A, with one drain and a blood salvage system; Group B, with two drains and a blood salvage system; and Group C, with IV TXA and one drain without a blood salvage system. Principal outcomes included hemoglobin (Hb) and hematocrit (Htc) decreases 24 hours after surgery and need for transfusion. We found statistically-significant differences between Group C versus A and B (P=0.002, P=0.004) and among the groups individually: C vs A (P=0.012) and C vs B (P=0.003) in hemoglobin levels; C vs A (P=0.022) and C vs B (P=0.007) in hematocrit levels. There were no significant differences between A and B. Three patients in A (50%) and 3 in B (50%) needed transfusions. No patients in C required transfusion, but this was not statistically significant (P=0.206). TXA significantly reduces decreases in hemoglobin and hematocrit levels following TKA compared to blood salvage drains