Acta Orthopaedica Belgica
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Intramedullary nailing of displaced midshaft clavicle fractures using a TEN with end cap: issues encountered
No full textThis study describes our experience with a possible solution for implant-related irritation after intramedullary nailing of clavicle fractures: the end cap.Ten patients with a displaced midshaft clavicle fracture were treated with intramedullary nailing and an end cap in 2013. Patients were followed in the outpatient clinic until fracture union and contacted again in 2015.Prospectively collected data included shoulder function and complications.The median follow-up was 28.5 months (between 27 and 30 months). QuickDASH scores were 18.2,9.1 and 2.3 after 6 weeks,3 months and latest follow-up respectively. No patients were lost to follow-up. Nine patients (90%) had some type of complication. Three patients required implant removal. One implant failure occurred which required major revision surgery. In conclusion, because in 70% of the patients the implant-related irritation was directly caused by the end cap, we believe end caps should not be used after intramedullary nailing for displaced midshaft clavicle fractures.
Total Knee Arthroplasty in Patients with Prior Adjacent Multi-Organism Osteomyelitis
No full textJoint degeneration may make a total knee replacement a requirement for pain relief and function, however the presence of adjacent osteomyelitis makes management extremely challenging. We describe a series of four patients with a mean age of 50 with multi-organism osteomyelitis who underwent single-stage total knee replacements at an average of 63 months following eradication. Three patients did well but had complications associated with poor skin and soft tissues, and abnormal bone anatomy. One patient developed an infection and following a re-revision had an arthrodesis. The final mean Knee Society Score and Oxford Knee Score was 62 (54-66) and 34 (29-38) respectively. We have highlighted that these are a difficult cohort of patients to manage and their care is optimised through a multi-disciplinary approach by a high volume surgeon
Comparison of Two Temporary Fixation Techniques for the Treatment of Type Ⅱ Odontoid Fracture
No full textTo evaluate and compare the clinical and radiographic results between temporary C1-C2 pedicle screw fixation and cable-dragged reduction and cantilever beam internal fixation. Between 2010 and 2013, temporary C1-C2 pedicle screw fixation (Group P, 28 patients) and cable-dragged reduction following cantilever beam internal fixation (Group C, 33 patients) were performed on type Ⅱ odontoid fracture cases. Implants were removed after fracture union. All of the 61 surgeries were performed successfully with no iatrogenic neurological worsen. One patient in Group P detected intra-operative vertebral artery injury. All patients gained fracture union. Among the observed indexes, only blood loss in Group P (128.9±73.9ml) is statistically higher than in Group C (97.3±54.2ml). Pedicle screw fixation carries the risk of vertebral artery injury, especially in patients with high-riding vertebral artery. Cable-dragged reduction following cantilever beam internal fixation could avoid the potential risk of vertebral injury, but it prolonged the fixed segments. We thought cable-dragged reduction following cantilever beam internal fixation could be an alternative method for treating type Ⅱ odontoid fracture
Title: A Systematic Review Of Three Dimensional (3-D) Printing Applications In Hip and Knee Arthroplasty
No full textPurpose: Three dimensional (3D) printing, a form of rapid prototyping (RP) which is based on computer aided design (CAD) has been around for decades. The aim of this paper is to review the literature on the clinical application of 3D printing in orthopaedic surgery. Methods: A literature search was carried out on MEDLINE using search terms ‘three dimensional printing”, “rapid prototyping”, AND “hip surgery” and “knee surgery”. The database search was conducted in December 2016. Sixteen papers (547 patients) were reviewed and these described the clinical application of RP in hip and knee surgery, particularly used in revision surgery and malignant conditions where bone structure had been severely deformed. Results: Eight studies reported reduced surgical time during hip and knee elective surgery. There was reduced intraoperative blood loss during hip arthroplasty in two studies and the post-operative alignment of the lower limb was reported as significantly more accurate in five studies compared to the conventional surgery. Conclusion: Current literature suggests good outcomes to date based on the small number of clinical studies on 3D printing in orthopaedic hip and knee arthroplasty.
Temporary screw epiphysiodesis for ankle valgus in children
No full textAim: The aim of this case series was to assess clinical outcomes and achievable correction grades following temporary percutaneous medial malleolar screw epiphysiodesis. Methods: A retrospective chart review of 16 consecutive children with ankle valgus (23 ankles) treated with medial malleolar screw epiphysiodesis in one single institution was performed. Tibiotalar angle, fibular station, and the lateral distal tibial angle were measured before screw epiphysiodesis, and before and after hardware removal. Results: Mean mechanical and anatomical lateral distal tibial angles were significantly improved by epiphysiodesis (75.6° to 85.2° and 75.7° to 85.3°, respectively, p < 0.005). Similarly, mean tibiotalar angle was significantly improved by screw epiphysiodesis when comparing to the last follow-up before screw removal (5.8° to 14.2°, p < 0.005). We observed a slight rebound following screw removal. Conclusion: Temporary medial malleolar screw epiphysiodesis is an effective method to treat ankle valgus in children
Polyaxial locking plate fixation in periprosthetic, peri-implant and distal shaft fractures of the femur: a comparison of open and less invasive surgical approaches
No full text Introduction Polyaxial locking plate fixation is a widely performed treatment for femoral shaft, periprosthetic, and peri-implant fractures in elderly patients. This study’s purpose was to compare patient outcomes following the open technique (OT) and less invasive techniques (LIT). Material and Methods Data were gathered from 44 patients with 46 fractures treated with polyaxial locking plate between 2010-2015. Twenty fractures underwent the OT and 26 had a LIT. Long-term assessments for 83% of the fractures were done at a median of 23 months postoperatively. Results Bone healing rates were 82% in the OT and 100% in the LIT group (p=0.0688). The difference in the median duration of the surgery (OT 120 minutes, LIT 73 minutes) (p< 0.001) was the main statistically significant finding. DiscussionBoth surgical techniques resulted in similarly favourable outcomes. The LIT would be the preferred operating technique, especially when treating patients more susceptible to intra- and/or postoperative morbidity.
Evaluation of cerclage wiring in the treatment of subtrochanteric fractures
No full textTreatment of subtrochanteric fractures is challenging because of their typical displacement pattern. Use of circumferential cerclage wires can be added to intramedullary nailing to facilitate better anatomical reduction. Concerns exist regarding additional soft tissue damage and ischemia of the periosteum. The aim of this study was to assess the effect of cerclage on union and infection rates. The postoperative results of 115 patients over 11 years were retrospectively viewed. Twenty-three patients were treated with cerclage. The primary outcome measure was ‘return to theatre for fixation failure’. There was no difference in reoperation rate or in infection rate. Average displacement of the lateral wall was larger (9mm vs 1,3mm) in the no-cerclage group (p=0,003). The mean duration of surgery in the cerclage group was 28 minutes longer (p=0.003). Cerclage wiring does not lead to higher re-operation, nor higher infection rates. The use of cerclage wire in open reduction is advocated when closed reduction is not satisfactory.
Is there a place for conservative treatment of a Vancouver B2 fracture around a cemented polished tapered stem?
No full textBackgroundRevision of the unstable stem of a total hip replacement following a peri-prosthetic fracture of the femur is a complex procedure with a high complication rate. With this study we aim to describe the radiologic findings of a specific fracture around polished tapered stems.MethodsEight male patients presented with a painful hip replacement after a fall. Standard radiographs did not show any signs of a fracture. CT scans showed a complex burst fracture in all cases. Conservative treatment was initiated for at least 6 weeks. A cement-in-cement revision was conducted at 3 months in case the patient was not pain free.ResultsAfter 3 months none of the fractures had displaced, neither had the stem subsided. Five patients were pain free and did not require surgical intervention. One patient underwent a cement-in-cement stem revision because of persistent pain.ConclusionNormal radiographs of a post-traumatic and painful polished tapered stem do not exclude a Vancouver type B2 fracture and should be followed by a CT-scan. Cement cracks, eccentric gaps and subsidence are highly suspicious signs for a non-displaced fracture pattern. Conservative treatment remains an option for these fractures and can be followed by a cement-in-cement stem revision after fracture healing, if this is still required
Evaluation of intra-operative imaging during scarf osteotomy – an unnecessary cost or an essential prerequisite?
No full textBackground: Scarf osteotomy is an effective surgical treatment option for hallux valgus. It can manipulate alignment in three planes, allowing accurate anatomical correction. The potential benefit of intra-operative image intensification (II) to gauge deformity correction during surgery however, has not been quantitatively reported. This study aims to compare the correction of hallux valgus by scarf osteotomy with and without intra-operative imaging.Methods: Retrospective analysis of a consecutive series of scarf osteotomy in 2 groups. Group A had intra-operative radiographic assessment and group B did not. Patient and surgical data was collected with a mean follow-up of 14 months. Results: Of 99 scarf osteotomies there was no significant difference in age, gender or pre-operative deformity between the groups (p<0.05). No statistical difference was found between the radiographic corrections of the two groups (p<0.05), although operating time was less in group B.Conclusions: This series shows that intra-operative imaging does not improve accuracy of deformity correction, or implant position in scarf osteotomy. We suggest it is not required routinely during scarf osteotomy
Achievement of Primary stability using 3D- CT guided custom design femoral stems in patients with proximal femoral deformity: EBRA-FCA analysis
No full textPurpose: Hip replacement in patients with proximal femoral deformity and end stage arthrosis is technically challenging. The purpose of this study was to measure the subsidence rate of custom femoral stems using EBRA-Femoral Component Analysis (FCA) software, as an indicator of achievement of primary stability.Methods: We retrospectively reviewed 14 hips in 12 consecutive patients who underwent this procedure between June 2008 and Feb 2011. There were 7 males and 5 females with a mean age 41 years (22—60). The primary diagnosis in the majority of the cases was Perthes and DDH with secondary osteoarthritis.Results: The average follow up period was 36 ± 10 months (19-51 months). Average subsidence was the 0.96 mm ± 0.95mm (0-2.9 mm). All patients had signs of osteointegration at the metaphyseal level.Conclusion: We conclude that the 3D-CT guided custom made femoral stem produces reliable proximal ‘fit and fill’ and osteointegration without the need of a corrective osteotomy in patients with proximal femoral deformity but long term studies are needed to assess the performance of this femoral stem. Key words: Custom design femoral stem, EBRA-FCA, primary stabilit