Acta Orthopaedica Belgica
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Mucoid degeneration of the anterior cruciate ligament; complete resection as equivalent treatment to partial resection.
No full textPurpose: Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. Methods: Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006 - 2016. Symptoms included limited range of motion (ROM) and posterior knee pain.Results: Preoperative and postoperative results of eleven patient were compared. Postoperative recovery was four weeks on average. All patients (100%, n=11) reported an improvement in pain. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Eight patients (72.7%, n=8) reported an improvement of knee instability, while three patients (27.3%, n=3) experienced an unchanged knee stability. All patients (100%, n=11) reported a good to very good surgery satisfaction. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. Conclusions: Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL
Experience of Surgical Treatment via Posterior Approaches for Herniated Thoracic Disc
No full textThe incidence of symptomatic herniated thoracic disc (HTD) is very low. There are still no established priority in surgical approaches and guidelines for additional instrumentation with fusion.From 2007 through 2014, 38 patients (22 males and 16 females) who underwent an operation for HTD were enrolled. Thoracolumbar region was a most common site for HTD (31/38, 81.6%). The clinical characteristics of HTD based on size, location, and calcification; the factors for applying instrumentation with fusion were analyzed retrospectively.All patients were undergone surgical treatment via various posterior approaches. The additional instrumentation with fusion was performed in 14 patients (36.8%). The larger amount of facet joint resection (more than 50%) was only statistical significant factor for instrumentation (p=0.023). There were four surgical complications (10.5%). Surgical treatment via posterior approach was a reliable modality for HTD. The significant factor for applying additional instrumentation with fusion was the amount of facet joint resection
Minimally invasive procedure of acute acromioclavicular joint dislocation: one suture-button device versus two suture-button devices
No full textThe purpose of this study was to assess the clinical results of patients treated with either one suture-button device or two suture-button devices for acute acromioclavicular (AC) joint dislocations. Eighty patients were randomized to operative stabilization either by one suture-button device (OSB, 40) or by two suture-button devices (TSB, 40). Postoperative complications, the Constant, VAS and SST scores, patient subjective satisfaction result were reviewed. The total incidence of complications was similar in both groups (16/40 vs. 17/40, P=0.820). There were no significant differences in the length of hospitalization, the Constant, VAS and SST scores, and the ability to return to previous work between the two groups. However, the patients of TSB group had longer incision length, more blood loss, more operative and radiation time and more hospitalization costs (P<0.01). The radiological evaluation showed no significant difference in the CC distance between the two groups (P=0.557).Our results indicated that one suture-button device could achieve the same good radiological and clinical results as two suture-button devices did.
Porous titanium revision shells permit early weight-bearing and rapid rehabilitation in revision hip surgery
No full textAn aging population and younger primary arthroplasty candidates have led to increased demand for acetabular bone deficient revision hip surgery. Seventy consecutive revision arthroplasty porous titanium shells prior to December 2011 were reviewed. We sought to determine evidence of implant instability in this cohort. Radiological data were analysed for stability. Primary endpoint was revision of implant. Mean age at surgery was 69.9 (±10) years. Median time since primary surgery was 13 years (range: 0.3 – 37). Forty-nine per cent had Paprosky Type 2b or greater acetabular deficiency. Bone graft and augments were not used. One shell was revised for ingrowth failure. Mean acetabular inclination was 35.4˚ (±7.3) post-operatively and 36.9˚ (±7.28) at latest follow up. There were no screw fractures. Porous titanium shells in revision arthroplasty are stable and permit rapid rehabilitation.
Reconstruction of chronic Achilles tendon ruptures in elderly patients, with vascularized Flexor Hallucis Longus (FHL) tendon transfer using single incision technique.
No full text Purpose: To report the outcome following reconstruction of neglected Achilles tendon ruptures in elderly patients with Flexor hallucis longus tendon (FHL) biotenodesis.Method: Seventeen cases (mean age 65.7 years), of Achilles tendon reconstruction with FHL biotenodesis for chronic ruptures were reviewed. Outcomes evaluated with American orthopaedic foot and ankle score (AOFAS), calf girth atrophy, range of ankle movement, ability to perform single leg heel raise and patient satisfaction.Results: The mean follow up was 27 months (range 17-52). The mean AOFAS score improved from 57.47 (+/-5.98) to 96.71(+/-3.57). Mean calf girth atrophy was 1.53 (+/- 0.43 cm) on the operated side. There was no significant difference in the range of ankle movement. All except one patient were able to perform single leg heel raise. We observed an inverse relation for patient age and chronicity of tear to the endurance strength of Achilles tendon. All the patients were satisfied with the outcome. We had one complication of superficial wound infection.Conclusion: Single incision FHL biotenodesis is a safe and effective procedure for this complex condition. It mitigates the need for extensive soft tissue procedures like turn down flaps or V-Y plasty.
Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) vs. Open Plating in Superior Plating of Midshaft Clavicle Fractures
No full textIntroduction: Plate osteosynthesis is the choice of treatment in displaced midshaft fractures of adulthood. In this retrospective-multicenter study we aimed to compare the outcomes of minimal invasive percutaneous plate osteosynthesis (MIPPO) with conventional open plating of midshaft clavicular fractures with superior plating.Material-Method: Between April 2011 and January 2015, surgically treated 52 adult patients (age 18-55), having AO type 15-B2.1-3 and 15-B3.1-3 fractures with more than 20 mm. shortening either with MIPPO (n=22, mean age: 32.32±8.22) or conventional plating (n=30, mean age: 34.70±9.37) were extracted from the hospital records. Baseline characteristics and operative data were collected. Functional and radiological evaluation was performed and statistically analyzed.Results: Demographic properties were similar between groups. Both operative time and fluoroscopy time was significantly longer in MIPPO group (approx. 6.5 minutes longer operation and 12 seconds longer fluoroscopy time). Time for radiographic union was significantly shorter in MIPPO group (13.64±2.98 weeks), compared to conventional plating group (16.50±4.52 weeks, p=0.01).Conclusion: Despite prolonged operative and fluoroscopy time, MIPPO technique for midshaft fractures of clavicle allows for a shorter recovery compared to conventional open plating.
Retrograde intramedullary nailing for humeral midshaft fractures: a retrospective cohort study
No full textAim: This study evaluates the patient-reported functional outcome, clinical functional outcome and frequency of complications of simple oblique and transverse humeral midshaft fractures treated with a retrograde expert humeral nail.Methods: A retrospective cohort study of humeral midshaft fractures (AO 12-A2, 12-A3) treated with retrograde nailing between January 2010 and February 2018 in a level II trauma center was performed. Patients’ perception of functional outcome was measured using the Disabilities of the Arm, Shoulder and Hand (DASH) scores.Results: Thirteen patients with a median age of 20-years were treated with a retrograde nail. The median DASH score, administered 29 months (IQR 74) after surgery, was 7.9 (IQR 15.9). There were no perioperative fractures and the frequency of complications was 8%, being one nonunion.Conclusions: Retrograde nailing for humeral midshaft fractures is a safe technique, with excellent patient reported and clinical functional outcome. No iatrogenic perioperative fractures occurred, and had a low complication frequency. We recommend the retrograde technique, if surgical fixation of humeral midshaft fractures is needed, especially in younger patients for who rotator cuff associated injuries will have a major impact on quality of life
WHICH UNICONDYLAR PROSTHESIS IS BETTER IN THE MID- TERM IN OBESE PATIENTS: FIXED OR MOBILE?
No full textIntroduction: There is not any study in the literature comparing the outcomes of fixed and mobile unicompartmental prostheses which are applied in the obese patients. Objective of this study was to compare outcomes of ourcations and revision are higher in the obese compared to non-obese patients, Patients and Methods:Of 293 patients in whom we performed unicompartmental knee prosthesis due to medial gonarthrosis between 2003 and 2014, The study included 57 patients having BMI >30 kg/ m2 who were regularly followed-up. Results:In the final controls; mean flexion was found as 107° (100-128°)(p<0.05), mean extension as 3° (0-5°) and mean tibiofemoral angle as 4° (1-5°) (p<0.05) valgus. Postoperative mean WOMAC value was found as 91.23 ± 3.02 (92-96) (p<0.05) and mean KSS score as 88.3 ± 3.94 (85-100) (p<0.05). Discussion:Unicompartmental knee prosthesis is a good treatment option which can be applied also in obese patients and has high survival rates. No significant difference was found between the prostheses with fixed and mobile insert in terms of function and knee scores. However, fixed unicompartmental prosthesis should primarily be preferred in obese patients because of the challenging surgical technique, difficult learning curve and insert dislocation that we encounter with mobile prosthese
Anterior cervical discectomy and fusion with Scarlet AC-T cervical secured cage Safety evaluation and 6 months radiological Follow Up Original Article
No full textAlthough fusion rates are higher with ACDF if supplemented with a plate, plates are associated with higher morbidity and dysphagia. We studied a stand-alone cage with integrated fixation for zero-profile segmental stabilization.We performed a retrospective analysis of prospectively collected data on 32 ACDF patients using titanium screw-secured cages, 13 males, 19 females, aged between 36 and 76 years, (mean 56,5 y). 25 had one-level surgery, 7 two-levels. The most frequently operated levels were C5C6 (22) and C6C7 (13). All patients presented with neck and arm pain, 17 with myelopathy. Nine had predominant soft disc herniation, 22 had more disco-osteophytic compression and one had pseudarthrosis. The patients were evaluated for early post-operative complications, subsidence, screw loosening, migration and fusion by ROM assessment on dynamic lateral Xrays after 6 months.We observed two cases of minimal subsidence, two mild transient dysphagias, one superficial infection, no screw loosening, and no migration. Bridging bone was observed in 27 levels (93%). 77,3% of the patients showed solid fusion, 18,2% ongoing fusion, and 4,5% had signs of failed fusionPerforming ACDF with the Scarlet AC-T cervical secured, we observed no implant related complication. Solid or ongoing fusion was observed in 95,5 % of the operated levels after 6 months.
The challenge of the infected pilon tibial non-union: treatment with radical resection, bone transport and ankle arthrodesis
No full textA significant number of patients with pilon tibial fractures develop complications, the most devastating being a combination of infection and non-union with bone loss.The results of the Ilizarov bone transport technique were retrospectively evaluated in ten patients. All underwent an extensive resection and reconstruction aiming at an ankle arthrodesis. The outcome was registered by clinical and radiographic examination as proposed by Paley’s functional and bone results classification.A good healing at the level of the docking site could be obtained in all patients but with a re- intervention in 8 of the 10. In 5 of these patients, re-intervention with a transcalcaneal nailing leaded to the final healing. Other options are debridement of the docking site (2 patients) and a new Ilizarov (1 patient).If patients are prepared to participate in a long-term treatment with the risk of multiple interventions a reconstruction can be performed, resulting in a limb with an acceptable function, allowing all activities of daily life and even a professional occupation. To obtain this final result with a definite union at the docking site a secondary retrograde intramedullary nailing is considered a valuable and safe procedure