Acta Orthopaedica Belgica
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Etiology of knee pain in elite cyclists A 14-month consecutive case series
No full textOveruse injuries of the knee are a common cause of missed training and competition days in elite cyclists, however the underlying conditions causing this knee pain are not well defined. We conducted a diagnostic study, investigating a consecutive series of 53 high level cyclists with non-traumatic knee pain over a 14 month period. Demographic data on the participants’ cycling specialty and training level was noted. Clinical information concerning knee pain intensity, location and occurrence were collected using a questionnaire. Our results show 7 different overuse injuries were identified. The prepatellar friction syndrome accounted for the majority of these overuse injuries (46%), while medial plica syndrome (15%), biceps femoris tendinopathy (7.5%), patellar tendinopathy (9.4%), infrapatellar plica friction syndrome (7.5%), infrapatellar fat pad impingement (5.7%) and iliotibial band syndrome (3.7%) were other causes of knee pain in these athletes. In contrast to current belief, our results show that instead of patellofemoral cartilage overload, friction related overuse injuries are the most frequent and underestimated cause of knee pain in high level cyclists
Vitamin D, calcium and albumin bloodserum levels in Belgian orthopedic patients – is systematic screening justified?
No full textIntroduction: In the setting of fracture care, orthopedic surgeons are primarily focused on treating the fracture itself, but more and more attention is being paid to prevention of such fractures. Materials and methods: We collected postoperative vitamin D, calcium and albumin bloodserum levels from 163 patients who were admitted with a femur fracture and from 233 patients who were admitted for an elective hip arthroplasty during the period of 365 days. Results: 84.21% of the fracture population had a vitamin D deficiency (< 20 ng/mL) as well as 77.30% of the elective hip arthroplasty population. There were no significant seasonal differences in the fracture population. 80.27% of the fracture population had an albumin deficiency (< 29 g/L) and 38.75% of the reference population. There were no significant statistical differences in vitamin D and albumin bloodserum levels in the two age groups. Conclusion: We can make the tentative assumption that systematic screening for all hip fracture patients and all elective hip arthroplasty patients admitted to our orthopedic ward – independent of their age, season or pathology – is justified
A case series of total hip replacements for patients with Paget's disease
No full textThe aim of this case series is to determine rates of revision in patients with Paget's disease undergoing total hip. replacements. Patients presenting to a single with Paget's disease of the femur or acetabulum undergoing total hip arthroplasty. Retrospective case note and radiographic review was undertaken. 32 patients with a mean age 77.4 (range 68-88). 12 males and 20 females. There were 25 cemented total hip replacements, 1 hybrid and 6 uncemented total hip replacements performed. The mean drop in haemoglobin was 33.3g/L (8-59). 14 (43.8%) received a blood transfusion. There were no deaths in the first year following surgery. 1 (3.1%) revision procedure was performed in the first year. At 5 year follow-up there were no further revisions in the 27 patients with 5 year followup (96.3% survivorship). Total hip replacement in patients with Paget's disease has low complication rates and low risks of revision
Can infection be predicted after intramedullary nailing of tibial shaft fractures?
No full textDespite the progress in tibial fracture care, some patients contract infection following intramedullary nailing. We analyzed which risk factors could predict infection in 171 tibial fractures. The independent variables included age, gender, body mass index, and comorbidities, along with external factors of fracture pattern, nailing settings, and treatment processing time. A multiple logistic regression used to identify infection risk factors.The risk of infection significantly increased according to the open grading, the fractures’ classification, time until antibiotic administration, and time until nailing. Gustilo type I fractures presented a higher rate of infection than expected, explained by a longer delay before surgery. The probabilistic equation allows infection prediction with high sensitivity and specificity. In total, we showed that no antibiotics’ prescription in emergency service and a transverse fracture pattern were predictors of infection. An infection risk score can be computed, aiding surgeons in decision making. Keeping these observations in mind could improve outcomes
Latarjet reconstruction in patients with anterior shoulder instability and significant Hill-Sachs lesion
No full textManagement of glenohumeral instability with large Hill–Sachs lesions remains controversial either to address or just grafting the glenoid rim defects. This study was done to investigate if open Latarjet is sufficient to prevent recurrent instability in patients with significant Hill-Sachs defects without addressing these lesions.In the period between October 2009 and November 2014 twenty three patients with shoulder instability and significant bone loss were treated by open Latarjet. All patients were followed up for a period ranged from 17 to 58 months (median ± SD: 30 ± 13.9).The mean preoperative Rowe score was significantly increased from 45.4 to 91.5 (p value <0,001). At the final follow up there was 17 patients with excellent result, 5 patients with good result and 2 patients with fair result. In Conclusion, Latarjet provides a reliable and effective stabilization for anteroinferior glenohumeral instability with significant bone loss and engaging Hill-Sachs lesion.
Inter- and intraobserver reliability in the assessment of glenoid fracture classifications
No full textObjectivesThroughout literature a number of glenoid classification systems have been described but lack clear correlation with the fracture patterns found in clinical cases. This study aimed to evaluate the intra- and interobserver agreement for fracture classifications of the glenoid, using either plain radiographs, computed tomography (CT) scans.DesignThe study was retrospective, using images with a variety of fracture types. Six observers classified the fractures at two separate time points. Classifications of Ideberg, OTA-AO, Mayo and Euler/Ruedi were used. Patient data was blinded and were randomly presented for the different imaging techniques. Agreement was determined using kappa coefficients.Results: Currently used glenoid fracture classification systems have a fair to moderate intraobserver reliability. Combining plain radiographs and CT scans led to a better observer agreement. For interoberserver reliability, the system of Euler scored slightly better than other systems.Conclusion: Although Ideberg’s classification is the most widely used system, this study does not support superiority of it. Based on this study there is need for a more reliable glenoid classification system
THE PROPRIOCEPTION OF THE KNEE JOINT FOLLOWING TIBIA PLATEAU FRACTURES
No full textProprioception is a conscious and/or unconscious perception of position change in an extremity or joint in space. In our study our purpose was to evaluate whether the lower extremity proprioception in long term, is altered following tibia plateau fractures and to assess its relation with age and type of fracture.This retrospective study includes the evaluation of proprioception in 38 tibia plateau fracture patients (29 male, 9 female) of various types who were operated with open reduction and internal fixation (ORIF) technique in our clinic, by comparison of both operated knee and unaffected knee. The mean age of the patients were 38,8 (range, 20-60) and mean follow-up time was 56 months (range, 13-120 months). Proprioception measurements were assessed at 300 and 600 of knee flexion degrees both passively and actively.There were no significant difference between the operated knee and unaffected knee by mean absolute angular deviation values at passive (p=0,22) or active 600 (p=0,22). Accordingly passive (p=0,47) and active 300 (p=0,62) mean absolute angular deviation values showed no significant difference.Our study has indicated that proprioception at the operated extremity is not significantly different from the unaffected knee in tibia plateau fractures at long term follow-up.
iliac screws in multi-level degenerative spine treated via long constructs crossing the lumbosacral junction
No full textThe purpose of this study is to evaluate the effectiveness of iliac screws in multilevel degenerative spine where long segmental fusion crossing the lumbosacral junction is required. 33 patients performed decompression combined with long instrumented fusion extending distally to the sacrum. The distal anchor was augmented by iliac screws. The minimum follow up period was 2 years. Outcome was analyzed by VAS for back pain and ODI. Fusion across L5/S1 was assessed using plain radiographs. It was achieved in all patients at the final follow up. The mean preoperative VAS was 7.69 ± 0.91. This improved to 3.21 ± 1.02. Mean preoperative ODI was 62.06 ± 7.72 whereas it was 31.81 ± 13.2 at the last visit. The changes in both scores were statistically significant (p≤ 0.05). Iliac screws placement seems to be effective in providing distal support in long fusions. The functional outcome and the lumbosacral fusion rate were more than satisfactory.
Direct anterior total hip arthroplasty in supine position using standard OR table: case series and review of complication and reoperation rate
No full textDirect anterior total hip arthroplasty (DA-THR) has gained popularity in the last decades due to multiple advantages: reduced blood loss, muscle sparing, reduced pain, reduced dislocation rate, shorter hospital stay and faster recovery. However, initial studies report an unacceptable high intra-operative complication rate, especially during the learning curve. We believe these complications are related to the positioning on traction devices or orthopaedic table. We reviewed the complications and reoperations in a consecutive series of 356 DA-THR using a supine positioning on a regular OR table, without femoral hyperextension. We conclude that the previously reported high complication rate in DA-THR might be caused by traction devices apart from other earlier reported reasons such as learning curve and the low-volume hip surgeon. We also believe that femoral hyperextension can be omitted without increasing the complication risk
Management of severe knee extension stiffness in children : particularity in sub-Saharan Africa
No full textIntroduction: Knee extension stiffness due to fibrous retraction of the quadriceps is a relatively uncommon condition in children but not so rare in developing countries. It is the result of iatrogenic intra-muscular injection. It is responsible for major functional prejudices in the childPatients and methods: A retrospective study was carried out over a period of 4 years. Twenty children were treated surgically for knee extension stiffness. In 100% of cases it was a severe retraction of the knee. The quadriceps-plasty described by Judet was used in 16 cases and a V-Y quadriceps-plasty in 4 cases. Immediate post-operative physiotherapy was performed every 6 hours with positioning in splint (with every 6-hour alternation between extension and 100°-flexion splint).Results: The average knee flexion degree was 5° in preoperative period and improved to 103° after the surgery. The final result was considered excellent in 30% and good in 70% of the cases