Acta Orthopaedica Belgica
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Biomechanical Comparison of Fracture Site Stability of Femoral Nails after Fracture Site Resorption
No full textAfter fracture site resorption, instability increases. We aimed to compare fracture site stability of different femoral nails after fracture site resorption. Thirty composite femurs, divided into three groups of tens for interlocking nails, compression nails and newly designed compressive anti-rotation (CAROT) nails. Using axial compression-distraction and custom made torsion machines, fracture site rotational and axial stabilities after 1 mm fracture site resorption were determined. Between 6 Nm external and 6 Nm internal rotation torques, means of maximum fracture site rotation arc of motion were 5.94 mm in compression, 5.9 mm in interlocking nails and 3.5 mm in CAROT nails. Between 2300 N compression and 150 N distraction forces, means of fracture site axial motion were 3.15 mm for interlocking nail and 1.26 mm for both CAROT nails and compressions nails. CAROT nails are superior to compression nails and interlocking nails regarding fracture site rotational and axial stability after 1 mm fracture site resorption.
interbody fusion versus posterolateral fusion in treatment of low grade lytic spondylolisthesis
No full textObjectives. A prospective randomized study to compare the outcome of two widely used fusion methods; posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in treatment of adult low grade lytic spondylolisthesis to know which is ideal.Methods. 40 consecutive patients with single level lytic spondylolisthesis were randomly divided into two treatment groups when undergoing surgery. Blood loss and operative time were recorded. Patients were postoperatively assessed using JOA score. Union rate was assessed. They were followed up for a minimum of 2 years.Results. No differences were found between both groups as regards operative time, blood loss. At 2 years follow up, statistically significant improvement in JOA scores were found in both fusion groups. However, no difference could be found between the groups. Both groups showed solid fusion with no evidence of non-union in all cases.Conclusion. Both methods appear to be equally effective in treatment of the condition
Femur can be lengthened over nail, along its mechanical axis: a modified lengthening over nail technique
No full textThe theoretical risk of medialisation of the knee joint and the lateral shift of the lower extremity mechanical axis is present, due to lengthening of the femur along its anatomical axis. With this new technique described in this study we aimed to prove that lengthening over nail can be performed along the mechanical axis of the femur.Six lower-limb models were used to perform three different lengthening techniques. In group 1, lengthening was achieved along the anatomical axis with an external fixator. In group 2, the clamps of the external fixator were adjusted at 6° to achieve lengthening along the mechanical axis. In group 3, eight different sized nails were applied with an external fixator (angle adjustable clamps were at 6°) to achieve lengthening along the mechanical axis by LON technique.The modified LON technique described in this study provided lengthening along the mechanical axis. One of the main advantages of the procedure is the chance for reconsideration and revision of unforeseen malalignments, via the help of the distal angular adjustable clamps; during the time of the surgery for external fixator removal before application of the poller screws
The Surgical Management for Isolated Scaphotrapeziotrapezoid (STT) Osteoarthritis: A Systematic Review of the Literature
No full textWe performed a systematic review to find out the safety and efficacy of various procedures for isolated scaphotrapeziotrapezoid osteoarthritis. Eleven articles were included. The most common procedure was arthroplasty with pyrocarbon implant (28%), followed by resection of distal pole of scaphoid with proximal trapezium and trapezoid resection (18%). The other procedures included trapeziectomy with ligament reconstruction and tendon interposition (LRTI) (14%), arthroscopic resection of distal scaphoid (11%), trapezium and trapezoid resection with LRTI (10%) and arthrodesis (10%).Complications were noted in 18 (15%) patients. The most common complication (7.5%) was asymptomatic dorsal intercalated segmental instability (DISI) followed by dislocation of the pyrocarbon implant (3%). Fusion resulted in decreased range of motion and grip strength. The distal scaphoid resection was related to high rate of DISI. The dislocation of pyrocarbon implant is avoidable with good surgical technique. Arthroplasty with pyrocarbon implant may be the first choice in younger patients.
Radiolucent Lines around Knee Arthroplasty Components: A narrative review
No full textAseptic loosening of total knee arthroplasty (TKA) components is one of the frequent reasons for early revision together with infection and instability. Aseptic loosening is usually preceded by the observation of radiolucent lines (RLL) on radiographs. Radiolucent lines have conventionally been considered a sign of osteolysis due to particles disease of either polyethylene or cement wear. However, RLL can be observed quite early after TKA, way before wear and osteolysis can even occur. Immediate postoperative RLL are secondary to surgical technique. Early development of RLL, on an initially satisfying radiograph, is secondary to changes to the cement-bone interface
Irrigation and Debridement for Periprosthetic Hip Infections
No full textWe performed a systematic review of the literature regarding outcomes of early infection after total hip arthroplasty (THA). We searched multiple databases (PubMed, Web of Science, EMBASE, and Cochrane library) for articles in the area published from 1950 to 2016. A total of 212 patients from 8 published studies were identified. The minimum follow-up was 4 months (range, 4–132 months). The most frequently isolated organisms were Staphylococcus aureus and coagulase-negative staphylococci. 153 of 212 (72%) patients were successfully treated, with no signs of infection or continued antibiotic treatment at the latest follow-up.In 48 of the 59 patients for whom treatment failed, infection was successfully treated with 1-stage or 2-stage reimplantation or resection arthroplasty. Overall mortality attributable to the infection of the hip was 2 % (four patients).Our study has helped to further elucidate the clinical and functional outcome of early periprosthetic hip infections treated with DAIR. We believe DAIR is a reasonable treatment option in early infection after primary THA in selected patients.
Dual-Mobility Socket in Challenging Total Hip Arthroplasty: 2-6 Years Follow-up
No full textThe success of dual-mobility sockets in achieving implant stability in primary hip replacement is already well established. However, stability cannot always be achieved, especially when dealing with more difficult indications.At our department, 104 dual-mobility sockets (92 uncemented and 12 cemented) were implanted for primary total hip arthroplasty in 97 patients between 2009 and 2013. Indications for hip arthroplasty included primary and secondary coxarthrosis, acetabular and subcapital fractures, avascular necrosis, tumor surgery and metastatic fractures. Although no loosenings were observed, 2 dislocations and 1 infection occurred shortly after surgery. In this challenging group of patients no fixation problems or intraprosthetic dislocations have been observed. The design therefore seems to be a valid alternative to constrained implants, especially in high-risk cases, although dislocation cannot be prevented at all times. Although the findings are very promising, long-term survival studies are mandatory to evaluate intraprosthetic stability and fixation longevity of dual-mobility sockets.
Minimally Invasive Plate Osteosynthesis (MIPO) Technique for Complex Tibial shaft Fracture
No full textIntroduction: To evaluate the clinical and radiological results of the treatment of complex tibial shaft fracture (AO/OTA type 42-C) with minimally invasive plate osteosynthesis(MIPO).Materials and Methods: Twenty patients diagnosed with complex tibial shaft fracture without extension to the articular surface and treated with MIPO, including 9 cases of AO/OTA type 42-C2 and 11 cases of AO/OTA type 42-C3, 6 of which were open fractures. External fixation was used for open fractures until the soft tissue damage had healed; then, 2nd stage operation with MIPO was performed to stabilize the fracture. Each patient was followed up for a minimum of 12 months.Results: The mean time to union was 20.1 weeks. Delayed union was observed in 4 cases. Angular deformity, length shortening and non-union were not observed.Conclusion: Severely comminuted and open fractures of the tibial shaft may benefit from temporary external fixation prior to performing MIPO
Central band reconstruction for the treatment of Essex-Lopresti injury: A novel technique using brachioradialis tendon
No full textLongitudinal stability of the forearm is mainly provided by three structures: the radiocapitellar contact, which acts as the primary stabilizer, the central band of the interosseous ligamentous complex (IOLC) and the intact triangular fibrocartilage complex (TFCC). In an Essex-Lopresti lesion the forearm becomes fully destabilized, since all of these three components are injured. Fixation or replacement of the radial head with a metallic prosthesis along with repair of the TFCC and stabilization of the distal radioulnar joint (DRUJ) are well-established treatment goals. However the reconstruction of the central band of the IOLC remains to some extent controversial. The authors believe that the reconstruction of the central band , particularly in active patients, is crucial in order to restore normal load distribution through the forearm, thus ensuring both transverse and longitudinal stability. In this article, we present a case with an Essex-Lopresti lesion, which was effectively treated acutely with restoration of all three components of the injury (radial head prosthesis, DRUJ repair and reconstruction of the central band of the IOLC). A novel technique by rerouting the brachioradialis tendon is described in detail
Comparison of Acetabulum posterior wall fractures and fracture dislocations, dislocation does not affect clinical and radiological outcomes
No full textIntroduction: To compare radiological and clinical outcomes of posterior wallacetabulum fractures and posterior wall fracture dislocations.Materials and methods: Data were retrospectively gathered from one universityhospital including 52 acetabulum fractures and fracture dislocations. 26 patients (%50)were posterior acetabulum fractures and fracture dislocatiions who operativelytreated.Radiographic evaluations performed before and after the operation and at thelast follow up. Clinical outcome evaluation performed at the last follow up. Clinical andradiological outcomes evaluated including Merle D'aubigne clinical assessment scoreand Matta's radiologic measurement score. Brooker classification used to measureheterotopic ossification.Results: Both Merle D'aubigne score and Matta score were higher in the posterior wallacetabulum fracture group than fracture dislocation group. But there wasn't significantlydifference between two groups' clinical and radiologic outcomes. (p ˃ 0,05) Reductionquality and Matta radiologic scores were correlated significantly in 2 groups.Conclusions: Posterior dislocation may not negatively affect clinical and radiologicoutcomes. Reduction quality is important predictive factor of outcomes in both posteriorwall acetabulum fractures and fracture dislocations