Acta Orthopaedica Belgica
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Surgical treatment of lateral ankle instability. Does allograft tendon have a better functional result?
No full textIntroductionSurgical treatment of lateral ankle instability can be performed with or without allograft. We compared these two technical options referring to patients’ functional, radiological and ultrasound data.Material and methodsForty patients were surgically treated for lateral painful instability of the ankle. Twenty patients underwent ligamentoplasty using the Broström-Gould technique and twenty underwent a ligamentoplasty by allograft tendon. Patients were matched in age and gender. The assessment was done at 2.5 years postoperatively by functional scores (Olerud & Molander, and Foot & Ankle Outcome), dynamic x-rays (focused on varus and anterior drawer stress tests) and ultrasound examination (focused on anterior talo-fibular and calcaneo-fibular ligaments). ResultsNo significant difference was found between the two techniques for all scores. DiscussionFunctional scores were more than 75% and the complication rate was low (<10%). Regarding the surgical technique, the tendon allograft could not prove to be more beneficial
Valgus Stress Radiography Following Superficial Medial Collateral Ligament Reconstruction Using A Modified LaPrade Technique With Adjustable Loop Femoral Fixation
No full textPurpose of this study was to assess postoperative laxity of MCL reconstructions utilizing a modified LaPrade superficial MCL reconstruction. We retrospectively reviewed post-operative valgus stress radiographs in 23 multiligament injured patients who underwent concurrent sMCL and cruciate ligament reconstruction by a single surgeon. Post-operatively, 23 patients underwent valgus stress radiographs that were assessed at a mean of 8.7 months (range: 4-13 months), and mean SSD was 0.64mm ± 0.42mm. Eight patients underwent both pre- and post-operative valgus stress radiographs. Post-operative (0.09mm ± 0.63mm) SSD was found to be significantly reduced compared to pre-operative (2.07mm ± 0.44mm) SSD (mean diff. = 1.98mm, 95% CI = 0.72-3.24, P=0.007). Inter-observer reliability value for medial compartment gap measurement was 0.91 with a 95% confidence interval of 0.34-0.97. In conclusion, presented technique results in excellent static stability of the knee as measured by valgus stress radiography at a minimum of 6 months postoperative
Demineralized bone matrix versus autogenous bone graft for thoracolumbar anterior single-level interbody fusion
No full textPurpose: In thoracolumbar fracture treatment, autogenous iliac crest bone grafting (ICBG) is the standard procedure to achieve anterior single-level fusion. To avoid associated problems of graft harvesting, intervertebral cages are an alternative, but cannot provide biological fusion. Therefore, investigations on fusion-enhancing adjuncts to cages are performed to find biomaterials with biological features comparable to bone grafts. This study was initiated to compare the results of demineralized bone matrix (DBM putty) plus cage vs. ICBG in anterior fusion procedures for thoracolumbar fractures.Methods: Thirty patients underwent posterior bisegmental instrumentation and anterior stabilization by (I) titanium cage with DBM putty (n=15), or (II) autogenous ICBG (n=15).Results: After nine months, biological fusion occurred in 80% and 57% (p≈0.24), respectively. Extent of clinical recovery was 82.5%±17.3% vs. 80.4%±12.9% (p≈0.90). Loss of kyphosis correction amounted to -1.4°±2.1° vs. -1.6°±4.1° (p≈0.91).Conclusions: Fracture treatment with DBM plus titanium cage showed promising 9-months-results in this pilot study on 30 individuals
Good mid-term results after Birmingham hip resurfacing and total hip arthroplasty
No full textAimsThis study aimed to determine the functional outcome and mid-term survival rates of the Birmingham Hip Resurfacing (BHR) and BHR/total hip arthroplasty (THA).Patients and MethodsThis retrospective, observational, single-centre study had 150 operations (46 BHR procedures, mean age, 60.8 years; 104 BHR/THA procedures, mean age 66.7 years) performed in 127 patients from 2005 to 2012 with clinical (Harris Hip Score [HHS] and Hip Disability and Osteoarthritis Outcome Score [HOOS]) and radiological follow-up (mean follow-up, 8.2 years; range, 4 to 10 years). Cobalt and chromium levels were measured via whole blood samples. ResultsNo revisions were required in either study group. Femoral stem osteolysis was observed in three patients in the BHR/THA group. No osteolysis was observed in the BHR group. Significantly higher HHS and HOOS were observed in the BHR group (p=0.04 and p=0.04, respectively). The average level of chromium in the BHR and BHR/THA group were 9.4 µg/L and 4.8 µg/L, respectively (p = 0.12). Average cobalt levels were 7.7 µg/L and 6.7 µg/L (p = 0.72)
The effectiveness of blood metal ions in identifying bilateral metal-on-metal total hip arthroplasty patients at risk of adverse reactions to metal debris
No full textPurpose: We investigated whether blood metal ions could effectively identify bilateral metal-on-metal total hip arthroplasty (THA) patients at risk of adverse reactions to metal debris (ARMD).Methods: Whole blood metal ions were sampled in 50 patients with bilateral 36mm Corail-Pinnacle THAs. Patients were divided into ARMD (n=10) and non-ARMD groups (n=40), with optimal ion thresholds for identifying ARMD determined using receiver operating characteristic analysis.Results: Maximum cobalt or chromium produced the highest area under the curve (71.8%). The optimal ion threshold for distinguishing between patients with and without ARMD was 4.0µg/l (90.0%=sensitivity, 65.0%=specificity, 39.1%=positive predictive value, 96.3%=negative predictive value). Fixed regulatory authority thresholds missed more patients with ARMD (10%-12% missed) compared to our threshold (2% missed).Conclusions: Bilateral THA patients with blood metal ions below our threshold were at low-risk of ARMD. Compared to currently recommended fixed authority thresholds, our threshold appears preferable for managing patients with these particular implants.
Open Reduction and Internal Fixation Versus Primary Partial Arthrodesis for Lisfranc Injuries Accompanied by Comminution of the Second Metatarsal Base
No full textThe objective of this retrospective study was to compare open reduction and internal fixation (ORIF) with primary partial arthrodesis for the treatment of Lisfranc injuries accompanied by comminution of the second metatarsal base. Thirty-four patients were treated with ORIF or primary partial arthrodesis from 2007 to 2013. The patients were followed for an average of 28.5 months. Evaluation was performed with clinical examination, radiography, Visual Analogue Scale (VAS), the American Orthopedic Foot and Ankle Society (AOFAS) Midfoot Score, and the Short Form 36 (SF-36). Fifteen patients were treated with ORIF, and nineteen patients were treated with primary partial arthrodesis. Anatomical reduction was obtained in all patients. At two years postoperatively, the mean AOFAS Midfoot score was 84.33 points in the ORIF group and 85.05 points in the primary partial arthrodesis group (P＞0.05). Also, no significant differences were seen in the VAS for pain (1.20 vs 1.05 points), SF-36 physical component (79.60 vs 79.89 points), SF-36 mental component (77.07 vs 79.21 points). With longer and conservative postoperative management, ORIF as well as primary partial arthrodesis for Lisfranc injuries accompanied by comminution of the second metatarsal base led to equal good mediun-term outcome
Outcomes of the patients with cultured pathogens at the time of nonunion surgery
No full textBACKGROUND: The purpose of this study is to evaluate incidence, preoperative laboratory markers, and outcomes of patients who positively cultured pathogens (PCP) at the time of surgical treatment for long bone fracture nonunion. METHODS: Two-hundred and sixteen patients were cultured at the time of fracture nonunion surgery. Laboratory data were collected prior to intervention and infectious laboratory markers ordered on patients suspected for infection. Patients were followed for one year. Wound complications, antibiotic use, healing, function, and re-admission for further surgery were assessed.RESULTS: Cultures returned positive on 23.1% of patients. More PCP’s (47.5%) developed wound complications, with greater mean antibiotic duration and more frequent returns to the OR averaging 1.3 procedures per patient. Twelve-month follow-up was obtained on 249/288 (86.5%) and PCPs reported globally worse function.CONCLUSIONS: Positive OR culture at the time of operative management for long bone nonunion was a prognostic indicator of poorer long-term functional outcomes
Anatomically based classification of medial clavicle fractures
No full textMedial clavicle fractures represent less than 5% of all clavicle injuries. The purpose of this study was to evaluate reliability of a new anatomically based (AB) classification system compared to other classification systems and to evaluate the clinical outcome of nonoperative treated fractures. 55 acute medial clavicle fractures (55 patients) were 3D reconstructed and evaluated using the Edinburgh (ED), Throckmorton (TR) and new AB classification. The AB classification classified the fracture as medial (Type 1) or lateral (Type 2) to the costoclavicular ligament and no or minimal displaced (Type A) or displaced (Type B). Next, a consecutive retrospective clinical evaluation of 38 of these patients was performed using the Oxford Shoulder and Constant Score.An anatomically based classification shows the highest inter- and intra-observer reliability. In case the fracture line originate medial to the costoclavicular ligament and is displaced the Constant and Oxford scores are significantly less
LONG-TERM EFFICIENCY OF EXTRACORPOREAL SHOCKWAVE THERAPY ON LATERAL EPICONDYLITIS
No full textLateral epicondilytis is a frequent cause of elbow pain in the adult age population. The purpose of this study was to determine the effects of extracorporeal shock wave therapy (ESWT) effective on long term clinical and functional results in the treatment on patients with lateral epicondylitis. Forty-six patients suffering from lateral epicondylitis for at least 3 months were treated in this study. Clinical evaluation scoring system tests were used before an done year after the treatment for each patients. The VAS improved from 9,3 to 1.8, and the Nirschl values improved from 6,4 to 4.3. In the control group, VAS improved from 8,4 to 7, and the Nirschl values improved from 6,8 to 6,1. ESWT application to LE patients those are resistent to the theraphy, carries beneficial effects to the long term which was previously stated fort he short term, both clinically and functionally
A growing stake in orthopedic surgery and traumatology for the future management of obese patients
No full textAbstractBackground: The prevalence of obesity is increasing. In orthopedic surgery, the impact of obesity is felt. The aim is to take stock of the consequences of obesity for patients at each stage of management.Methods: With a mini-review, we identified the main pathophysiological factors, the specific orthopedic complications and consequences to consider at each stage of the management.Results: The obese patients are subjected to a chronic inflammatory state and biomechanical stress.This augment septic risk, musculoskeletal damage, traumatic risk , the frequency of organ failure, and thus morbidity and mortality.This results in a more complex and longer support.At each stage of care, you have to adapt to optimize care. Patient information are necessary.Conclusions: Being obese in orthopedics is a factor of bad prognosis. Treatments will be adapted. This requires a specific preparation on each ste