Acta Orthopaedica Belgica
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Indications for primary rotating-hinge total knee arthroplasty. Is there consensus?
No full textThe use of rotating-hinge systems in total knee arthroplasty is most often seen in revision setting where excessive bone loss, ligamentous instability and/or extensor mechanism dysfunction may necessitate an increased level of component constraint. However, this implant type is also being increasingly used in the primary setting. The aim of this study is to review literature concerning the use of third generation rotating-hinge devices focusing on the indications for primary cases.Literature was searched for following search terms: total knee arthroplasty, primary indication, constraint, rotating hinge knee, knee prosthesis, hinged knee, total knee replacement. Additional papers were identified by screening references and similar articles. All papers dealing with first or second generation rotating-hinge implants and revision cases were discarded.After conducting a large literature search, we concluded that third generation rotating-hinge implants should be considered in limited indications in which ligamentous tibiofemoral instability is the core indication
Treatment of chronic osteomyelitis with antibiotic-loaded bone void filler systems: an experience with hydroxyapatites calcium-sulfate biomaterials
No full text This is a retrospective study that aims to quantify the problem of chronic osteomyelitis in one of the largest Italian orthopedic centers. Furthermore this study is focused on evaluation of efficacy of bone void filler systems with particular attention to a subgroup of patients treated with PerOssal®. Ninety-seven patients were included in this study between 2008 and 2013 with a minimum follow up of 24 months. A subgroup of 52 patients was treated with curettage plus PerOssal®, another group was treated with curettage only or curettage with other bone void filler systems.Overall we obtained a cure rate of 80,4%, whereas 19,6% had recurrent infection. Looking at the subgroup treated with PerOssal® we found a healing rate of 86,5%, which was significantly higher compared to the other groups. Of the patients with recurrence of infection, those treated with PerOssal® recurred 106 days later than the other patients
Dual plate for comminuted proximal humerus fractures
No full textThe purpose of this study is to evaluate radiological, clinical results and complication rates of dual plate fixation for severe metaphyseal comminuted fracture of proximal humerus. 21 patients who have proximal humerus fractures with impaired posteromedial buttress were enrolled. Fractures were treated with dual plate technique using proximal humeral locking plate and variable angle plate. Radiographic results were analyzed based on duration of union. For evaluation of the degree of anatomical reduction, neck shaft angle on the anteroposterior view was measured by simple plain radiography using the Paavolainen method, while anterior-posterior angulation was measured on the axial view. Degree of anatomic reduction was good in 17 patients (81.0%), fair in 3 patients (14.3%), and poor in 1 patient (4.8%). One case of impingement, and one case of avascular necrosis were noted. The dual plate technique provides stable fixation and satisfactory clinical and radiological results for severely comminuted proximal humerus fractures
operative treatment of unstable distal radius fractures: the dorsal plate revisited
No full textPurpose: To determine the functional outcome and complications following dorsal plating for unstable fractures of the distal radius.Methods: We searched our IRB-approved Distal Radius Fracture Databases and identified all patients who were treated with a dorsally applied plate. Thirty-four distal radius fractures in 33 patients with a mean age of 50 years and average follow-up of 14 months were treated with a dorsal locking plate from 2007 to 2015.Results: Fifteen and six patients had dorsal shearing fracture pattern and delayed presentation, respectively. There were no loss of reduction, malunion, or nonunion. Average VAS pain score was 2.1/10. Eight patients (23%) required hardware removal, one of which was due to extensor tendon rupture (3%) and five due to extensor tendon irritation (15%).Conclusions: Dorsal locked plating of distal radius fractures with newer low-profile implants is a viable option for particular fractures types, such as the dorsal rim shear type fractures.
Health care and productivity costs for isolated tibia shaft fracture admissions in The Netherlands
No full textThe aim of this study was to provide a detailed overview of age and gender specific health care costs and costs due to lost productivity for hospital admitted patients with an isolated tibia shaft fracture in The Netherlands between 2008 and 2012. Injury cases and length of hospital stay were extracted from the National Medical Registration. Information on extramural health care and work absence were retrieved from a patient follow-up survey on health care use. Medical costs included ambulance care, in-hospital care, general practitioner care, home care, physical therapy, and rehabilitation/nursing care. An incidence-based cost model was applied to calculate direct health care costs and lost productivity in 2012. Total direct health care costs for all patients admitted with a tibia shaft fracture (n = 1,635) were €13.6 million. Costs for productivity loss were €23.0 million. Total costs (direct health care and lost productivity) per patient were highest for men aged 40-49 years mainly due to lost productivity, and for women aged > 80 years, due to high direct medical costs
A Comparative Study of Three Different Surgical Methods
No full textThe purpose of this study was to evaluate and compare the results of plate osteosynthesis, intramedullary nailing (IMN), and hybrid fixation (plate osteosynthesis for the radius and intramedullary nail for the ulna) for the treatment of both-forearm-bone shaft fractures in adults. One-hundred-one cases of both-forearm-bone shaft fractures were retrospectively reviewed. In the ORIF, IMN, and HYBRID groups, the average union time was 10.8, 14.9, and 11.5 weeks, respectively. The ORIF and HYBRID groups had a significantly better radial bow ratio on the contralateral side compared to the IMN group. Pronation and supination of the forearm showed significant differences in the ORIF group (161°), IMN group (156°), and HYBRID group (160°). The IMN and hybrid fixation show radiologic and clinical outcomes similar to plate osteosynthesis. Thus, if the indication is properly selected, our results suggest that IMN and hybrid fixation would be acceptable treatment options for both-forearm-bone fractures in adults
A New 3D Reconstruction Method to Assess Anatomical Restoration in Vertebral Compression Fractures
No full textAbstract Background:Deformation of the spine following vertebral compression fracture (VCF) can be associated with severe spinal dysfunction. Anatomical restoration is described as the complete reduction and stable fixation of the fracture with the goal to restore the pre-fracture local and global spine properties. A new 3D-imaging technique is described.Methods:A new assessment method based on CT scans 3D reconstructions was developed. This method was used to assess the anatomical restoration of the fractured vertebrae. A procedure consisted in placing two titanium expandable implants for fracture reduction and stabilized with a high viscosity PMMA cement was used to demonstrate the method.Results:The cases presented here are demonstrating that this 3D-mapping software is a tool which can address the lack of valid, reproducible and user-friendly method to evaluate the anatomical restoration in VCF.Conclusion:The evaluation of the anatomical restoration of the fractured vertebrae raises some issues in terms of interpretation because of a lack of consensus in the existing reporting methods. A 3D-reconstruction method using CT scan and a newly-developed software is proposed to evaluate anatomical restoration in a clear, valid, reproducible and user-friendly method.
Is there a difference in outcome between two types of valgus unloading braces? A randomized controlled trial
No full textPurpose The short-term clinical and radiographic outcomes of two different valgus unloading braces were compared in patients with medial knee osteoarthritis (OA) and a varus leg alignment.Methods A RCT was performed in 100 patients (50 Bledsoe Thruster brace, 50 SofTec OA brace) with symptomatic medial knee OA and a varus leg alignment. Outcomes were the visual analogue scale pain and satisfaction, Dutch Western Ontario and McMaster Universities Osteoarthritis Index, SF-12, 6-Minutes Walking Test, hip-knee-ankle alignment, analgesic use, complications and compliance after a follow-up of 2 and 12 weeks.Results The clinical and radiographic outcomes were not significant different between both groups. Almost all clinical outcomes improved in both groups at follow-up compared to baseline. 24% of the patients discontinued using the brace.Conclusions No significant differences in clinical and radiographic outcomes were found between both groups after 2 and 12 weeks follow-up. Both braces were effective in the treatment of varus medial knee OA. Complications and compliance remains a problem
Reverse Shoulder Arthroplasty for Patients with Glenohumeral Osteoarthritis Secondary to Glenoid Dysplasia
No full text The purpose is to report the clinical and radiographic outcomes, complications and reoperations of reverse shoulder arthroplasty (RSA) for glenoid dysplasia. All patients who had undergone RSA for osteoarthritis secondary to underlying glenoid dysplasia were retrospectively identified. The study included twelve shoulders(11 patients), with a mean(SD) patient age of 62.2(13.2) years and median (range) clinical follow-up of 28(24-34) months. RSA resulted in substantial improvements in pain and function. At most recent follow-up, there was a significant improvement in forward flexion ROM, a non-significant improvement in internal rotation ROM, and no changes in external rotation ROM. The mean(SD) SST and ASES scores were 7.8(3.7) and 73.5(20.4), respectively. There were no reoperations or radiographic loosening. The results were excellent in 1 case, satisfactory in 8, and unsatisfactory in 3. RSA provides acceptable function and good pain relief, though patients should be advised that shoulder rotation may be somewhat limited.
Sonography-guided arthroscopic excision is more effective for treating volar wrist ganglion than dorsal wrist ganglion
No full textPurpose: The purpose of this study was to compare the treatment results of sonography-guided arthroscopic excision for volar and dorsal wrist ganglions.Methods: A total of 42 patients with wrist ganglions underwent sonography-guided arthroscopic resection. Clinical outcome measures included wrist range of motion, grip strength, patient-rated questionnaire Hand20, and numerical pain rating scale. All patients were assessed for recurrence throughout the follow-up period.Results: Ganglions were located at the dorsal wrist in 26 cases and at the volar wrist in 16 cases. The mean Hand20 and pain scores were significantly improved after sonography-guided arthroscopic ganglion resection in both volar and dorsal wrist ganglions. Ganglion recurrence was seen in six cases (23%) of dorsal wrist ganglion but no cases of volar wrist ganglion (P < .05).Conclusion: The use of sonography-guided arthroscopic ganglion excision is better for treating volar wrist ganglion than dorsal wrist ganglion