Acta Orthopaedica Belgica
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Headless compression screw fixation for type 2 and 3 articular surface fractures of the distal humerus using transolecranon approach
No full textThe objectives of this study were to determine the clinical and radiologic outcome after headless compression screw fixation through the transolecranon approach in patients who had sustained Dubberley type 2 and 3 articular surface fractures of the distal humerus. Twenty-seven patients were included in the study. There were 23 Dubberley type 2 and 4 type 3 fractures. All patients were available for a minimum of 24 months of follow-up. The evaluation was performed using the VAS, the DASH score, and the MEPS. The outcome was excellent in 18 patients, and 9 patients had a good result by the MEPS. The average range of flexion was 132° (range 110°–140°). The mean extensor lag was 7.9° (range 0°–30°). The main advantages of the transolecranon approach are direct fracture visualization, ease of joint inspection, help in reduction, and ease of correct perpendicular fracture fixation
Joint Space Width, but not Osteophyte Thickness, is a Reliable Indicator of Degeneration of Lateral Knee Joint Cartilage
No full textIn this histologically controlled in vitro study, we evaluated the validity of plain radiography for the assessment of lateral knee joint cartilage degeneration (25 specimens). We examined the correlation between histological grade and radiography findings along with patient demographics. Our study indicated that the Mankin score had a significant inverse correlation with middle joint space width (JSW;r=−0.19,P=0.02), but not with inner and outer JSW (inner:r=−0.11,P=0.10, outer:r=−0.14,P=0.06) under a non-weight bearing condition. The Mankin score had a significant inverse correlation with middle and outer JSW (middle:r=−0.17,P=0.04, outer:r=−0.14,P=0.04), but not with inner JSW (inner:r=−0.15,P=0.06) under valgus stress. There was no significant correlation between the Mankin score and osteophyte thickness (r=0.004,P=0.76). We also examined the correlation with patient demographics. We found that only the preoperative femorotibial angle had a significant inverse correlation with the Mankin score. These results indicate that JSW, but not osteophyte thickness, is reliable for evaluating lateral femoral cartilage degeneration
Factors Associated with Degeneration of Rotator Cuff Tendon: A Histological Study in Patients with Rotator Cuff Tear
No full textFactors associated with tendon degeneration have not been fully investigated. The purpose of this study was to identify factors associated with tendon degeneration in patients with rotator cuff tear. A total of 93 patients with a full-thickness rotator cuff tear (fRCT) were included in the study. A full-thickness supraspinatus tendon sample was harvested from the middle portion between the lateral edge and the musculotendinous junction, and assessed histologically. Association between the degree of tendon degeneration and factors in demographic, clinical, radiologic, and arthroscopic categories were investigated. The mean of the total degeneration score was significantly lower in patients with symptom duration of 6 months or less than longer than 6 months (13.1 ± 2.6 vs 14.4 ± 2.3, p = 0.010). This study showed that tendon degeneration significantly progressed 6 months after the onset of symptoms, and suggested early intervention to avoid further deterioration of tendon degeneration.
Salvage revision arthroplasty after failed TMC joint prosthesis.
No full textThe purpose of this retrospective study was to describe our experience with failed TMC joint prostheses and to report the results of 7 cases that were treated by a salvage revision arthroplasty. We only performed this salvage arthroplasty when partial (cup replacement) or total change of TMC prosthesis was not possible. We performed a resection arthroplasty with (partial) trapezial excision and spacer insertion to prevent scaphometacarpal collaps. We used the proximal part of the Ascencion® MCP implant (Integra) as spacer. Among our 7 patients, 3 were satisfied with a VAS satisfaction of 8 or more. Four patients had pain levels less than or equal to 3. Our mean DASH score was 32.7. Our patients had good opposition and retropulsion scores and the mean TMC joint flexion and abduction values were both 40°. But tip and key pinch ipsilateral was insufficient (mean tip pinch of 2kg and key pinch of 1kg).We believe that the salvage revision arthroplasty with (partial) trapezial excision and spacer insertion is a valuable treatment option for failed TMC joint replacement. But further research needs to compare all the different revision options after TMC joint replacement in a multicenter randomized controlled trial
The impact of upright radiographs of midshaft clavicle fractures on treatment recommendations.
No full textIntroduction: Clavicle fractures’ treatment recommendations are based on displacement. The goal of this paper is to determine upright clavicle radiographs at initial presentation changes timing and method of treatmentMethods: Retrospective study in a level 1 trauma center. 356 patients with clavicle fractures were reviewed. Patients with only supine radiographs (Group 1, 285 patients) were compared to patients with supine and upright radiographs (Group 2, 71 patients).Results: Higher proportion of fractures in the upright vs supine radiographs were displaced 100% or more of the clavicle width, (52.1% vs. 33.5%, p =0.004). Treatment assignment changed from nonoperative to operative treatment more commonly in the Group 2 compared to Group 1 (43.7% vs 21.9%, p =0.019). The most common reason for surgery in Group 1 was presence of continued pain or failure to develop radiographic evidence of callus on serial radiographs(17, 53.1%) as compared to Group 2 (2, 14.2%, p =0.014). In Group 2 the most common cause for treatment change was displacement (12, 85.7%) as compared to Group 1 (15, 46.9%, p =0.014).Discussion:Patients with upright x-rays are more likely to have a change in treatment because of displacement while patients that had supine x-rays have more delayed/nonunion
C-reactive protein kinetics and its predictive value in orthopedic (trauma) surgery: A systematic review
No full textIn Orthopedic Trauma Surgery (OTS), C-reactive-protein (CRP) is a widely used marker for the diagnosis of postoperative wound infections (POWI’s) and other complications. The aim of this systematic review was to describe specific CRP kinetics and to evaluate the diagnostic value of CRP for te detection of post-operative complications in OTS. The same pattern is reported consistently, where the highest levels of CRP are found at post-operative-day two or three, returning to normal in three weeks. Amplitude varies per procedure. Persistently high CRP levels or secondary increases may indicate complications. A low CRP may be used to rule out complications
The contribution of the medial retinaculum as a restraining factor to the patella dislocation
No full textThe objective was to evaluate the contribution of the medial retinaculum to the stability of the patella for the knee, for several angles of flexionFor six cadaveric knees, the patella and patella retinaculum were exposed and the force required to dislocate the patella laterally 5mm was measured, in 0, 45 and 90 degrees of knee flexion, preserving and dissecting the medial retinaculum. Wilcoxon singed rank test (SPSS, version 23, Chicago, USA) was used for data analysis. A p value <0.05 was considered as statistical significant.The force required to displace the patella laterally is smaller with the medial retinaculum dissected than intact, in 0, 45 and 90 degrees (p=0.028, p=0.046, p=0.027 respectively). The lateral displacement force is greater as the flexion angle increases (p=0.028), with medial retinaculum intact and dissected.So an intact medial retinaculum provides more stability against lateral displacement forces to the patella, especially in lower flexion angles. Thus surgical methods reinforcing the medial retinaculum combined or not with lateral retinaculum release, are of great importance in the plan of the orthopedic surgeons. The engagement of the bones during flexion of the knee contributes significantly to the stability of the patella
Radiologic and Clinical Outcome of the Cement Augmented Pedicle Screws After a Minimum 2-year Follow-up
No full text55 patients with cement-augmented pedicle screw were retrospectively analyzed. All patients underwent computed tomography at a minimum of 2 years after index operation. Computed tomography scans were analyzed to determine pedicle screw loosening, cement leakage, and fusion rates at augmented levels. The purpose of this study was to analyze the efficacy and complications of cement augmentation in elderly patients. Screw loosening occurred at fused levels in all patients, except one patient with pseudoarthrosis. All cases of screw loosening occurred at levels without interbody fusion. Extravasation of cement was performed in 7 (12.7%) patients and three (5.4%) patients had asymptomatic pulmonary cement emboli. Three (5.4%) patients had deep wound infection, and they were treated successfully with debridement and antibiotic therapy without need for instrument removal. Cement augmentation of PSs in elderly osteoporotic patients prevents screw pull-out. However, a very low rate of screw loosening may be seen at the levels without interbody fusion
Leg power, pelvic movement and physical activity after periacetabular osteotomy. A prospective cohort study.
No full textPurpose To investigate changes in leg power, pelvic movement and patient-reported outcome in patients with hip dysplasia one year after periacetabular osteotomy. Methods Forty-one patients (7 males) with a mean age of 28.8 years scheduled for periacetabular osteotomy were tested before surgery, and 4 and 12 months after. Leg power, pelvic range of motion and the Hip and Groin Outcome Score (HAGOS) was collected.Results One year after surgery, power in the operated leg had improved (p=0.004) and there was no significant difference between power in the operated leg and contralateral leg (p=0.22). In the frontal plane, pelvic range of motion decreased significant during stair-climbing and stepping down. The same pattern was seen in the sagittal plane but the changes were non-significant. All subscales on the HAGOS improved significantly over time (p<0.001).Conclusion Leg power and pelvic range of motion in patients with symptomatic hip dysplasia improved 12 months after periacetabular
the influence of weather conditions on osteoarthritis and joint pain after prosthetic surgery
No full textThe purpose of this narrative review was to highlight the research on the influence of weather conditions on patients with osteoarthritis, the pathophysiological mechanisms and the therapeutic consequences. A search was conducted using the Pubmed, Medline and Web of Science databases. Barometric pressure, temperature and humidity are the weather conditions that are found to be correlated most to the worsening of pain complaints. But, due to the difficulty of measuring the impact of these variables and the great diversity in study protocols, an analysis of studies regarding this topic shows conflicting results. Central sensitization mechanisms and the function of a Transient Receptor Potential channel might explain the pain hypersensitivity to cold weather. Joint pain, caused by central sensitization mechanisms, cannot always be treated with joint arthroplasty. When pain remains present after joint arthroplasty, centrally mediated pain constitutes an important role