Acta Orthopaedica Belgica
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Metastasis from lung carcinoma to the finger: A case report
No full textSkeletal metastasis in the hand is exceedingly rare. In approximately 10% of the reported cases, it occurs as the primary manifestation of an occult malignancy. The early, correct diagnosis is warranted given the patient’s poor prognosis. Conventional radiographs and MRI are helpful in diagnosis, but histology is needed for confirmation. Due to the usual wide spread malignancy, palliation is the primary goal of treatment. Disarticulation and resection of the affected ray is the most common approach. We present a case of a skeletal metastasis from a lung carcinoma in the fourth digit of the hand and performed a curettage of the metastatic tumor, followed by a stabilization of the middle phalanx with a bone cement spacer and postoperative local radiation. The postoperative pain relief was acceptable and the functional outcome was relatively good, and therefore indicates that this treatment option could be considered in the palliative care setting of acrometastatis
Current knowledge in orthopaedic surgery on recommending sport activities after total hip and knee replacement
No full textThe increasing number of younger patients with total hip arthroplasty and total knee arthroplasty sets higher demands on the postoperative quality of life. When it comes to athletic activity, recommendations and guidelines for sports remain unclear.We have reviewed published literature to determine the extent to which patients resume their athletic activities postoperatively, and what would be the best choice. Golf and double tennis remain the most recommended activities. No-impact, low power sports like swimming and bicycling are generally allowed. Jogging is not considered as a factor for short-term implant failure, but a long-term analysis is needed. Contact and high-impact sports like football or basketball are not recommended. There are no recommendations regarding alpinism and field hockey
Conservative treatment for clavicle stress fractures following the clavicular hook plate fixation
No full textWe investigated the outcome of conservative treatment and potential causes for clavicle stress fractures following the clavicular hook plate fixation. Six cases of clavicle stress fractures were retrospectively reviewed. All the stress fractures occurred near the medial end of the hook plates. The average interval between the hook plate fixation and the clavicle stress fractures was 28.3 days (range, 18 to 60 days). The mean follow-up was 27 months (range, 15 to 42 months). Fracture union was achieved in all 6 cases. The most proximal screws in the hook plates were found to be eccentric in the clavicular midshaft in 5 cases. At the final follow-up, the average Constant and Murley scores of the operated shoulders were 91.7 (range, 83 to 96). Clavicle stress fractures could be treated conservatively with satisfactory results. Attention should be paid to the position of the most proximal screws in the hook plates
10-year results of the Nesovic procedure combined with adductor release for groin pain in 33 competitive athletes.
No full textPurpose:The aim of this study is to evaluate a surgical treatment for groin pain in athletes.Methods:We present 10 years results of 33 patients operated on between April 2002 and May 2006 diagnosed with a “sports hernia”. The injury was treated with a bilateral abdominal procedure according to Nesovic combined with a bilateral adductor release after unsuccessful conservative treatment. There were 32 male patients between 18 and 43 years and one female patient aged 25 years with a mean age of 28.8 at time of surgery. All procedures were bilateral. Patients were seen in the postoperative clinic and a questionnaire was collected after 2 years and 10 years.Results:Within 16 weeks, 30 patients (90,9 %) returned to the same or a higher level of sports activities. 10 years after surgery 31 patients (93,9%) remained free of pain. 1 patient has minor pain after training (VAS 0-1) and only 1 patient still experiences pain (VAS ≥5) after heavy work. 19 of 20 patients (95%, 57% of total cohort) were pain free to the end of their sporting careers.
Fibromatosis: A Review of the Risk Factors for Recurrence & Outcomes
No full textIntroduction: Aggressive fibromatosis is a rare condition. These benign fibrous tumours can develop in connective tissue. Wide-margin resection is the favoured method of treatment, however, radiotherapy and chemotherapy can also be used, to reduce the rate of recurrence.Method: We undertook a retrospective analysis of case notes of patients who had been diagnosed with aggressive fibromatosis. Data regarding treatments received and whether the tumours had recurred was collected. We also evaluated any other factors that may have influenced the risk of recurrence in these patients.Results: The recurrence rate was 47% overall, with the main risk factors being a younger age (below 30 years), being female and larger size of tumour. Patients were also more likely to have a recurrence if their original tumour was in the lower limb.Conclusion: We conclude that high recurrence rate, may be reduced in future with patient-specific treatments based on patient characteristics, tumour histology and limb targeted therapies when a wider evidence base is achieved
Modified stoppa approach combined with iliac fossa approach for treating compound acetabular fractures by using an anterior ilioischial plate
No full textMost compound acetabular fractures involving both anterior and posterior columns are caused by high-energy injuries. Patients with compound acetabular fractures often have poor conditions and hardly tolerate major surgery. This study aims to investigate effectiveness of an ilioischial plate in treatment of compound acetabular fractures.A consecutive series of 40 patient with complex acetabular fractures, treated operatively were retrospectively reviewed. A modified Stoppa approach combined with an iliac fossa approach was used. Anterior column was stabilized with reconstruction plates for iliac wing and along iliopectineal line to pubis in all cases. Psterior column was fixed with newly developed ilioischial plate running from ilium to ischial ramus or conventional posterior column screws or quadrilateral plate fixation. Patients were divided into experimental group(ilioischial plate for posterior column fixation)and control group(standard fixation techniques).In both groups, 90% of all reductions were good to excellent. According to modified Merle Aubigne and Postel scoring system, percentage of good to excellent was 85% in experimental group as compared to 80% in control group. Compared with control group, physical function (PF), role physical (RP) and social function (SF) were significantly better in experimental group (P<0.05). Fracture healing was achieved in all patients.
Treatment of posterolateral tibial plateau fractures through fibular osteotomy approach
No full textThe best approach for treating posterolateral tibial plateau fractures remains controversial. Between January 2009 and July 2012, twelve patients with posterolateral tibial plateau fracture were treated using the fibular osteotomy approach with a proximal tibia locking compression plate. Clinical outcomes during 25.6 ± 2.1 months (range 22-38 months) follow-up were retrospectively collected and analyzed. The average surgical duration was 92.5 ± 14.5 min (range 83–107 min). An anatomic reduction rate of 91.7 % (11/12) was observed although one patient with a lateral comminuted fracture and dislocation presented a 2-mm joint surface depression postoperatively. The average fracture healing time was 11.6 ± 3.1 weeks (range 8-15 weeks), with an average hospital for special surgery knee score of 94.1 ± 3.2 points (range 80-100 points), an average knee flexion of 118.6° ± 18.1° (range 96°-138°) and an average knee extension of 1.9° ± 2.2° (range 0°-6.3°). No complications were found. The fibular osteotomy approach with a proximal tibial compression plate can attain a satisfactory clinical outcome for patients with posterolateral tibial plateau fractures.
Biomechanical and clinical comparison of unilateral and bilateral plating of comminuted distal femoral fractures
No full textThis study was to compare the relative strength of fixation and clinical outcomes of unilateral and bilateral plating of comminuted distal femoral fractures. Eight matched pairs of embalmed cadaveric femurs were selected. A gap osteotomy was created to stimulate an AO/OTA A3 fracture. One femur of each pair was fixed with a locking plate; the other, with a locking plate and a medial plate. Nondestructive axial compression and maximum load to failure test were performed. Significantly greater axial displacement occurred with the UPG than with the BPG. In load-to-failure testing, the peak load was 2568± 452 N, and 3822± 567 N, respectively. A total of 52 patients were divided into unilateral plating group (UPG) and bilateral plating group (BPG). There was no significant difference between UPG and BPG in terms of blood loss, time to union, complication rate, Visual analog score, range of motion and Neer knee score. Bilateral plating proved stronger than unilateral plating in biomechanical testing; however, bilateral plating was not superior to unilateral plating in clinical outcomes. Therefore, we do not recommend bilateral plating as a routine fixation of comminuted distal femoral fractures
Acute acromioclavicular joint dislocation treated with tightrope: Mini-open versus percutaneous stabilization
No full textThe purpose of this study was to compare prospectively the radiographic and clinical results of patients treated with tightrope through either mini-open or percutaneous stabilization for acute AC joint injuries.Eighty patients were included in this study and were randomly divided into two groups. Group A included 40 injuries treated with mini-open repair. Group B consisted of 40 injuries treated with percutaneous stabilization. Demographic and clinical data were comparable between the two groups before surgery (P>0.05). The average follow-up time of Group A, was 26.5±4.3 months and Group B, was 25.2±5.6 months (P>0.05). The mean operative time was 63.2±9.6 minutes and 45.6±7.1 minutes, and the mean incision length was 6.0±1.5 cm and 4.0±0.8 cm, respectively. The operative time and incision length were significantly longer in Group A (both P<0.05). However, the radiological assessment revealed no significant difference in the coracoclavicular (CC) distance between the two groups (P>0.05). The rate of loss of reduction in the Group A was similar to that in Group B (6/40 vs. 5/40, P>0.05).Both two methods were efficient methods for acute AC joint dislocation. However, percutaneous fixation had the advantages of a shorter surgical time and smaller incision length
What have animals taught us about total joint arthroplasty?: A review of the literature
No full textAnimal models for total joint arthroplasty (TJA) have been reported on extensively in the literature. This work seeks to objectively review the most relevant and recent studies performed using these models, and to provide insight into the strengths and weaknesses of each. The terms joint arthroplasty and animal model were searched on Pubmed on March 1, 2015. Animal models included bovine, canine, ovine, goat, rat, and rabbit. Much of the work in animal models for TJA has focused on the biologic response to novel materials, biologics, and surgical techniques; as interest grows the use of animal models may increase