Acta Orthopaedica Belgica
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extension casting for both-bone forearm fractures in children
No full textPaediatric forearm fractures are commonly treated with closed reduction and cast immobilization. Determining the best way to cast these fractures during the initial presentation may prevent the need for re-manipulationAn analysis of casting technique for all patients under eighteen years of age treated with closed reduction and cast immobilization for both-bone fractures of the forearm at a regional tertiary referral hospital over 7 years was undertaken.One-hundred and eighty-nine consecutive patients with 207 fractures were reviewed. No significant association was found between casting technique and failure rates (p=0.124). However, if manipulation and plaster was performed by a trainee, failure rates were significantly reduced when extension casting was utilized (p=0.029). Closed reduction and cast immobilization with the elbow in an extended position is an effective treatment option for both-bone forearm fractures in a paediatric population and is a safer option when performed by more junior staff-members
Vascularized fibular autograft as salvage technique in failure of allograft intercalary reconstructions after tumor resections
No full textIntercalary allografts after diaphyseal resections for bone tumors represent the most frequent option of reconstruction. Main complications are non-unions, fractures and infections. The purpose of the current study was to report our experience with the use of vascularized fibular autograft as rescue technique in failed previous reconstructions after intercalary bone tumor resection of the extremities. Twenty-eight patients were followed over time. Causes of failure were non-union, allograft fracture and infection. Vascularized fibular autograft was used with mechanical support of massive bone allograft in 13 cases. Functional results were excellent in 19 cases, good in 8 and fair in one patient. Among complications we reported 4 non-unions, 2 allograft fractures, 1 non-union with plate breakage, 1 plate breakage, 1 infection, 1 limb shortening and 1 knee varus deformity. The rationale of vascularized fibular autograft is to provide biologic support. The association with massive bone allograft provides mechanical strength and early stability
Femoral anteversion measurement: evaluation of inter- and intraobserver correlation
No full textThe aim of this study was to evaluate the inter- and intraobserver reliability of a CT-based femoral anteversion measurement.17 CT scans showing an abnormal anteversion on one side were presented to 6. Three measurements of all scans were obtained: two bilateral measurements and a third measurement with a flipped CT scan.Interobserver correlation results using the spearman test for left, right and anteversion difference had a mean of respectively: 0.918, 0.760 and 0.757. Intraobserver correlation had a maximum of respectively: 0,99, 0,89 and 0,94. Correlation coefficients were consistently higher for the second measurement. The lower correlation boarder of 0,8 was often exceeded. Intraobserver correlation was higher than interobserver correlation.As we evaluated a high variance in interobserver reliability, we recommend an accurate and objective measurement of the anteversion angle. A personal measurement and comparison to the radiological protocol is necessary.
Short-term outcome trapeziectomy with ligament reconstruction and tendon interposition versus trapeziometacarpal prosthesis: a literature review
No full textBackground: Trapeziectomy with ligament reconstruction and tendon interposition and trapeziometacarpal prosthesis are two commonly used procedures for first carpometacarpal joint osteoarthritis. The purpose of this study is to compare the short-term outcome of trapeziectomy with ligament reconstruction and tendon interposition to trapeziometacarpal prosthesis. Methods: Pubmed, Cochrane library and science direct database were searched with adequate search terms. Used parameters were force, pain, mobility, functionality and complication. All papers describing the short-term outcome of ligament reconstruction and tendon interposition or trapeziometacarpal prosthesis were included in this review.Results: Trapeziometacarpal prostheses showed faster pain relief compared with trapeziectomy and ligament reconstruction and tendon interposition. Overall, there was a better strength in the trapeziometacarpal prosthesis group. A lack of information was found about the short-term functionality. The mobility recovers faster in the prosthesis group, although different scoring scales were used for measurement.Conclusion: We could confirm the faster pain relief in the prosthesis group and generally a faster recovery of strength and mobility. In the prosthesis group were more short-term complications. More studies are required to evaluate the short-term recovery of strength, the mobility, functionality and satisfaction
Functional outcome following closed reduction and percutaneous osteosynthesis of distal tibia articular fractures in children
No full textIntroduction: An alternative for articular fractures of distal tibia to the open procedure is a closed reduction associated with percutaneous osteosynthesis.Material and Methods : 38 patients were retrospectively reviewed. The measured parameters were: the score of Gleizes and the discrepancies between preoperative radiographic and CT scan measurements and postoperative radiographs.Results: a significant correlation was found between the gap and the step-off in preoperative radiographic and CT scan. A significant decrease of the gap and step-off displacement was noticed after surgery. The Gleizes scoring showed 35 good results, 2 average results and 1 poor result.Conclusion: Percutaneous fixation of ankle articular fractures in children is a simple and effective treatment giving similar results to open techniques while minimizing the risk of joint stiffness and healing complications. Growth complications are comparable with both techniques
Alpha Defensin Accuracy and Pitfalls in Diagnosing Septic Arthritis in Native Joints
No full textPurposeThis study aimed to test the accuracy of the synovial fluid biomarker, α-defensin, in diagnosing septic arthritis in native joints and highlight the pitfalls of its utilization for primary joints. We also discuss the cases where false results were demonstrated.MethodsA retrospective review of 10 patient’s records, who underwent α-defensin testing for suspected primary joint infections prior to performing arthroplasty surgery, was performed.Results6 primary knee and 4 primary hip joints were evaluated for septic arthritis utilizing the α-defensin test after arthrotomy was performed, as the patient had turbid synovial fluid or atypical bony features suggestive of septic arthritis. 2 of the primary hip joints had previous cephalomedullary nail insertions that cut-out and 1 knee joint had previous distal femur fixation for peri-articular fracture. There were 2 false positive α-defensin results in native knee joints that were eventually attributed to inflammatory arthritis after extensive cultures and microbial sequencing results returned negative. All other patients had negative α-defensin results that correlated with anti-microbial testing.ConclusionThe utilisation of the α-defensin test in primary joints should be interpreted with caution. The elevated levels of α-defensin may be attributable to inflammatory arthritis and further studies of its levels in native joints are required.
Prosthetic joint infection due to Mycobacterium bovis 5-years after BCG-instillations
No full textThe Bacillus Calmette-Guerin (BCG) has been used as intravesical immunotherapy for superficial urothelial bladder carcinoma in preventing its recurrence. Prosthetic joint infections due to those instillations are very rare and few practitioners know this side effect.We report the case of a 77-year old male with a medical history of right hip replacement and superficial urothelial bladder carcinoma treated with BCG-instillations. He presented with a painful hip joint and extreme difficulty at walking. Because of high suspicion of prosthetic joint infection, a 2-stage arthroplasty was performed. Microbiological culture revealed Mycobacterium bovis so he was kept on antituberculous therapy for twelve months. Remarkable is the delay between the instillations and the acquisition of the prosthetic joint infection. A medical history of BCG instillations should warrant the practitioner for a possible joint infection. There are no current guidelines concerning the therapy
Mental-health, coping and support following adverse events on the work-floor: a cross-sectional study among Dutch orthopaedic surgeons
No full textPhysicians are frequently exposed to adverse events on the work-floor, putting them at risk for mental health disorders. To explore this, a questionnaire was emailed to all members of the Dutch Society of Orthopaedic Surgeons, which included the Hospital Anxiety and Depression Scale and the Trauma Screening Questionnaire Common events considered a high emotional impact stressor were: missing a diagnosis, when a patient becomes severely handicapped, or doubting whether one is making the right decision.Prevalence of depression and anxiety was higher compared to the general population with a high income. Fifty-seven participants experienced an adverse event as traumatic. Most common coping strategies after adverse events were support from colleagues, support from friends and family, or doing sports.Overall, this study illustrates that more awareness must be created for the mental health of physicians as well as the implementation of a well-organized support system
A Radical Innovative Change in the Practice of Hand Surgery Using Wide Awake Local Anesthesia
No full textWide-awake local anesthesia no tourniquet (WALANT) technique is characterized by using local anesthetic plus adrenaline administered into the operative field, enabling us to perform longer and complex hand procedures without the need of an anesthetist. We assessed the impact of integrating WALANT on the practice of hand surgery in our center. We retrospectively reviewed charts of all hand surgeries performed in the years 2011 and 2016. The number of trauma cases performed in the ambulatory OR increased from 56 cases in 2011 to 131 in 2016, and elective complex cases increased from 9 to 65. Number of elective procedures conducted in the main OR increased from 67 to 105, and trauma cases performed “off hours” decreased from 53 to 21. We conclude that WALANT enables us to better utilize our OR resources, to treat hand trauma patients on an outpatient basis, and to shorten the wait time for elective hand surgery.
Is Parathyroid Hormone a Viable Solution for Nonunion?
No full textWe conducted a systematic review of published studies to evaluate the clinical results of parathyroid hormone (PTH) in the treatment of nonunion and delayed union. Four electronic databases (PubMed, Web of Science, EMBASE, and Cochrane library) were searched.A total of 24 patients from 13 published studies were identified. The mean age of the patients was 57 years (range, 19–91 years). Mean duration of nonunion after initial treatment was 8.4 months. PTH was given to the patients for 1.5 months to 10 months (mean, 5.3 months) for various types of fractures. The union ratesafter using PTH was 96%. Mean time to union after PTH therapy was 7.3 months (range, 3-15 months). No patients reported any side effects during the entire period of PTH treatment.Our study has helped to further elucidate the outcomes of PTH therapy in the treatment of nonunion. We believe that PTH is a viable option that is a promising, safe, and effective anabolic treatment for delayed union and nonunion