Acta Orthopaedica Belgica
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Comparison of Three Posterior Malleolar Fixation Methods in Trimalleolar Ankle Fractures
No full textBackground: This study aimed to compare the results of AP screws, PA screws and posterior buttress plate used in posterior malleolar fixation of trimalleolar fractures.Methods: 103 trimalleolar fracture cases treated surgically between October 2011 and January 2014 were extracted from hospital records. Patient’s demographics, presence of syndesmotic injury, fracture type, size of posterior malleolar fragment were recorded. Patients were invited for functional and radiological outcome evaluation at least one year postoperatively.Results: A total of 67 patients; 20 cases in the AP screw, 13 cases in the PA screw and 34 cases in the plate group. Better AOFAS scores and reduction quality were determined in the PA and plate groups compared to the AP screw group (p<0.001).Conclusion: PA screw and posterior buttress plate fixation with direct reduction via posterolateral approach demonstrated better radiological and functional outcomes than AP screw fixation
Fixation of Tibial Pilon Fractures based on Column Concept – A prospective study
No full textPurpose: Distal tibia fractures are complex injuries with high complication rates. Limited soft tissue, poor vascularity and complexity of fracture pattern impose limitations for traditional plating techniques. Better understanding of fracture patterns using 3D-CT reconstruction, optimum pre-op planning and availability of anatomical locking plates have certainly improved the outcome in these fractures. The outcome of the tibial pilon fixation by column concept was studied in Tibial Pilon AO C3 intra-articular fractures.Methods: Closed distal tibia intra articular fractures were managed by open reduction and internal fixation using distal tibial locking plates. The Tibial Pilon was stabilized using 4-column concept, in a minimally invasive technique.Results: We report the functional and radiological outcome in 12 patients of complex tibial pilon fractures, who were treated on the basis of the novel column concept.Conclusion: . Column-based stabilization of Pilon with associated fibular osteosynthesis and adequate rehabilitation protocol provide good outcome of AO Pilon C3 fractures.Keywords : Tibial pilon fractures; Column concept; ORIF; Distal tibia LC
Internal fixation with Kirschner wires is as efficient as rigid screw fixation in scaphoid fracture: long-term functional outcome
No full textThis study aimed to compare the long-term efficacy of Kirschner wires and Herbert screw internal fixation in scaphoid fracture. A retrospective chart with radiographic review and functional follow-up was conducted for patients with the scaphoid fracture. 65 patients (40 for K-wire fixation and 25 for Herbert screw) were enrolled. The nonunion rate for K-wire fixation and screw method were indifferent comprehensively and for iliac graft subgroup. Less bone necrosis was found with K-wire fixation (2.5% vs 16%, P=0.049). There’s no difference between groups in Mayo scores, post-operation pain and grid strength. Patients with K-wire fixation have larger range of motion on radial/ulnar deviation (35.25±11.32 vs 28.00±8.66, P=0.007). The results support the use of Kirschner wires in the treatment of scaphoid fractures. Advantages such as high union rates and good function recovery of wrist could be expected from minimal invasion, multi-axial stable fixation
Comparison of minimally invasive plate versus intramedullary nailing in the treatment of distal tibial metaphyseal fractures
No full textBackground: Comparison of minimally invasive plate versus intramedullary nailing in the treatment of distal tibial metaphyseal fractureMethods: Treatment was made by locked anatomic tibial plate with MIPO technique on 17 patients (Group1), closed intramedullary nailing on 18 patients (Group2). The cases were evaluated with the AFAS score.Results: The median operation duration was 90(59-139)mins in Group1, 77.5(59-145)mins in Group2. The median union time was 15(11-20)weeks in Group1, 18(12-22)weeks in Group2. The median AFAS score was 84(47-90) in Group1, 82(65-90) in Group2. The most common complication was infection in Group1 and malunion in Group2. Only the difference in operation time was found to be statistically significant between the two groupsConclusions: The clinical and functional results of both treatment methods were similar and effective. Malalignment should be kept in mind when treating with intramedullary nail; infection when treating with MIPO.Key words: Fracture; distal tibia; intramedullary nailing; minimally invasive plate osteosynthesi
A comparative study of four methods in treatment of pin tract infection in children supracondylar humerus fractures
No full textFrom April 2004 to February 2014, one hundred and eighty supracondylar humerus fractures in children were randomized to postoperative pin care by no pin tracts cleaning (Group A, 45 cases) or cleaning pin tracts daily (Group B, 45 cases) or cleaning every other day (Group C, 45 cases) or cleaning weekly (Group D, 45 cases). There was no significant difference in union time and pin retention time between the four groups. 72 cases (40%) had pin tract infection. Among them, the rate of grade 1 infection occurred about 20% and grade 2 about 11.1% and grade 3 about 5.6%. No significant difference was found between four groups in frequency and severity of pin tract infection (both P>0.05). However, complain of pain was more frequent in Group B than other three groups (P<0.05). Our results indicated that the four methods were effective in treatment of pin tract infection of children supracondylar humerus fractures. However, excessive frequent care caused more fear and anxiety in the mood of children and parents
The Latarjet procedure for anterior shoulder instability: A consecutive prospective series of 50 cases
No full textBackground The Latarjet is a successful primary and revision option for anterior shoulder instability. However, recent reports have highlighted varying complication rates. Our study prospectively collected clinical, functional and radiological outcomes of patients undergoing the procedure. Methods Forty-eight consecutive patients (fifty shoulders) underwent the Latarjet procedure in a single UK centre. Clinical, radiological and functional follow-up was performed. Results Mean clinical follow-up was 32 months and radiological follow-up 20 months. 95% shoulders were subjectively graded “excellent” or “good” and 5% “fair”. Mean Rowe, Oxford Shoulder Instability Score, American Shoulder and Elbow self-assessment Score and Subjective Shoulder Value Score all improved post-operatively (p<0.001). No infections, dislocations, revisions or metalwork-related complications occurred. There was one intra-operative coracoid fracture and five transient neurological injuries, resolving within three months. The long-term complication rate was 2%. Discussion The Latarjet procedure is safe and reliable for treating anterior shoulder instability with a very low long-term complication rate providing excellent clinical and functional outcomes
Diagnostic pitfalls in the differentiation between pyoderma gangrenosum and necrotizing fasciitis
No full textPyoderma gangrenosum and necrotizing fasciitis are two rare pathologic entities with a similar clinical image, but a who require a very different management. In general physicians, orthopedics, dermatologists, plastic surgeons will hardly ever see it, but when they do it is very important to distinguish between both. In this paper with the focus on the practical approach ,we expose the diagnostic pitfalls in the differential diagnosis, explain how to prevent them and summarize the evidence on therapeutic management. To achieve this we use a case where the diagnosis was rather difficult and utilize reviews where the clinical features, early diagnostic tools and treatment options are explained
Vitamin D deficiency is associated with longer hospital stay and lower functional outcome after total knee arthroplasty.
No full textHigh vitamin D deficiency prevalence has been found in hip and knee osteoarthritis, and a correlation between low vitamin D levels and worse functional outcome after hip arthroplasty was published before. Our goal was to examine the relation between vitamin D levels and outcome after knee arthroplasty on short and long term. In 138 patients with knee replacements preoperative vitamin D levels were recorded. 33 patients were vitamin D deficient (median 32 nmol/l, range 6-40 nmol/l) and 105 patients were vitamin D sufficient (median 65 nmol/l, range 41-177 nmol/l). After correction for confounders, vitamin D deficient patients had significant (p=0.03) longer hospital stay (+1.0 day, range 0.2-1.6 day), and significant (p=0.04) worse functional outcome also at long term follow up after eight years (WOMAC: +5.0, range 0.2-9.8). More research is needed to evaluate if rehabilitation and postoperative outcome can be improved by preoperative vitamin D suppletion
Vertebroplasty (PVP) is effective in the treatment of painful vertebral hemangiomas
No full textPurpose: We assessed the results of percutaneous vertebroplasty treatment of painful vertebral hemangiomas in 110 patients, with a three years follow-up.Patients and methods: 110 patients with painful vertebral hemangiomas were treated by percutaneous vertebroplasty. The patients were diagnosed by MRI and observed for 3 years after surgery. Visual Analog Scale was used to assess the level of pain. Results: Pain significantly diminished in all patients, 90% were free of pain for three years after augmentation. In 10% some pain appeared after 1 year, but less intensive than before surgery. 3 years after vertebroplasty 90% of patients were free of pain. No complications of PVP were observed. In 3 patients extravertebral leakage was noted with no clinical symptoms.Conclusions: PVP is highly effective in the treatment of painful vertebral hemangiomas. The method is safe, produce minimal complications and eliminates, or highly reduces pain for a long time period
Chemoprophylaxis in lower limb immobilization: A systematic review and meta-analysis
No full textBackground: The aim of this systematic review and meta-analysis is to review the effectiveness of low molecular weight heparin (LMWH) and novel oral anticoagulants (NOACs) for thromboprophylaxis in trauma patients treated with lower limb immobilisation.Methods: All randomized controlled trials (RCTs) comparing thromboprophylaxis to no prophylaxis or standard for prevention of venous throboembolism (VTE( in patients with lower limb trauma treated with immobilisation were included.Results: Eight studies totaling 3190 patients were included. The overall incidence of thromboembolic events in the control group ranged from 2.3% to 40% (137/871) and from 0% to 37% (77/884) in the LMWH group (RR 0.57; 95% CI = 0.45 to 0.73), P < 0.00001. One cohort study demonstrated equivalence of NOACs in VTE rate to LMWH with another demonstrating a significant reduction in VTE rates.Conclusions: Our results demonstrate that LWMH is an effective agent in reducing VTE in these patients with an acceptable safety profile