Acta Orthopaedica Belgica
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Intraoperative Rotation Control in Closed Intramedullary Nailing in Tibia Diaphyseal Fractures: A prospective, randomised study
No full textThe intraoperative determination of rotation in closed intramedullary nailing of tibial fractures is difficult. In this study, a more reliable method was used and it was a more practical means of checking rotation intra-operatively for tibial shaft fractures.42 patients who presented with a unilateral tibia diaphyseal fracture. were randomly divided into two groups. In Group 1, the Intraoperative Rotation Control Method (IRCM) was used and compared with Group 2 as the control group. The rotation differences obtained from the MRI measurements were recorded and the mean rotation difference (MRD) was obtained for each group separately. Malrotation was determined at a statistically significantly lower rate in Group 1. The MRD was statistically significantly lower in Group 1.This method does not require exposure to radiation like other radiological methods. Thus, the method used can be considered to be effective in the prevention of malrotation
THE ROLE OF EDMONTON FRAILTY SCALE AND ASA GRADE IN THE ASSESSMENT OF MORBIDITY AND MORTALITY AFTER FRACTURE NECK OF FEMUR IN ELDERLY
No full textFrailty is a complex syndrome which affects the energy, physical ability, cognition and general health. Hip fractures are associated with causes and consequences of frailty such as osteoporosis, frequent falls, low body mass index, multiple medications and cognitive impairment. The aim of our study is to assess the value of ASA grade and Edmonton frailty score in the outcome of treatment of fracture neck of femurs in elderly patients. 192 patients admitted with fracture neck of femur were included in the study. The mean age was 79.23 years .120 patients had ASA grade 3, 56 patients had ASA grade 2 and 16 patients had ASA grade 1.The frailty index was calculated using Edmonton scoring index. Ninety four patients (49%) had low frailty score and 88 patients (51%) had a high frailty score of more than 10.All patients were followed up 4 weeks and one year after the surgery. The patients with high frailty scores have got more chance of developing wound infection and lower respiratory tract infection. In conclusion patients with high frailty index and ASA grade has got higher incidence of mortality and morbidity following fracture neck of femur
An Evaluation of Treating Non-union of Femoral Neck Fractures with Valgus Angulation Osteotomy Using Sliding Hip Screws
No full textPurpose: This study presents the outcomes of patients treated with DHS, following valgisation osteotomy, who had non-union after treatment for femoral neck fractures.Methods: The study retrospectively evaluated 16 patients who, between 2007 and 2014, developed pseudarthrosis following treatment for a femoral neck fracture and who were treated with DHS-osteosynthesis, after a valgus subtrochanteric osteotomy. Postoperative clinical evaluation of the patients was made using the Harris Hip Scoring (HHS) system. Results: Union of both the fracture and the osteotomy site was achieved in 17.2 weeks (range: 14-24 weeks) in all patients. The average Pauwels angle decreased from 72o (range 62–80) preoperatively to 26o (range 20–50) postoperatively. All patient’s fractures were Pauwels type III preoperatively and 4 type II and 12 type I postoperatively. The average HHS increased from 26 (range 18–34) preoperatively to 85 (range 68–94) postoperatively. Of the patients who were followed up for a mean duration of 3.1 years (range: 1-5 years), four had 1-cm shortening. No patient developed postoperative AVN of the femoral neck.Conclusions: For patients with non-union after femoral neck fracture, DHS-osteosynthesis after valgus osteotomy is a method with a shorter learning curve, which can be successfully performed
How much does saving femoral head cost after acetabular fracture? Comparison between ORIF and THA
No full textBackground We performed a prospective study on patients with acetabular fractures treated either with internal fixation either with arthroplasty comparing clinical outcomes, quality of life, economic resources and cost efficacy in the first five years after surgery.MethodsDemographic data, diagnosis, index treatment, costs and subsequent surgeries were recorded. Patients were requested to fulfill Merle d’Aubigné and EQ-5D-5L questionnaires.ResultsClinical differences between treatments are significant only in discharge period. Comparing respectively group with fixation and arthroplasty, cost efficacy was 5483 and 10838 euros/quality-adjusted-life years, mean global costs 23965 and 16878 € and quality of life gained in five years 2.788 and 3.175. Group of arthroplasty showed better quality of life at discharge and at one year. If choice between fixation and arthroplasty should be based only on cost-efficacy, arthroplasty should be suggested but clinical outcomes suggest to consider fixation because results at five years are not different to arthroplasty
Pinnacle® modular metal-on-metal articulation in primary total hip arthroplasty: mid-term results of 195 cases
No full textStudies concerning Pinnacle® modular metal-on-metal (MoM) total hip arthroplasty (THA) show better results than for most other MoM THAs. The goal of this study was to report on the revision rate, clinical outcome and metal ion levels regarding this specific prosthesis.Retrospectively selected patients were evaluated clinically, and Visual Analogue Score for pain (VAS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) were determined. Blood metal ion levels were measured.195 patients were included (mean follow-up 6.4 years). MoM related revision was performed in 5.1%. Clinical outcome was good, with a mean VAS of 6.7 out of 100, HHS of 88.9 and HOOS of 80.7. Five year survival was 96.6%, eight year survival decreased to 90.0%. No correlation could be found between metal ion levels and outcome.Although clinical outcome was good, overall survival of the Pinnacle® MoM is unacceptably low compared to MoP survival
Results of ulnar shortening osteotomy
No full textThe aim of the study was to find out if ulnar shortening is effective to treat ulnar wrist pain and which factors influence outcome. Thirty-seven patients were evaluated with a mean follow-up of 4.5 years. Thirty patients (81%) would undergo the same operation again although 21 (57%) had residual ulnar wrist pain. Mean disabilities of arm, shoulder and hand (DASH) score was 22 and mean patient rated wrist evaluation score (PRWE) was 33. DASH and PRWE scores were better in smokers, in patients operated on the non-dominant side and when follow-up was longer. PRWE score was worse in posttraumatic cases. Age, gender and type of osteotomy did not influence outcome. Three patients (8%) needed an additional operation for nonunion and in 17 (46%) plate and screws had to be removed. It can be concluded that ulnar shortening can be proposed to treat ulnocarpal wrist pain, but complete pain relief cannot be guaranteed and additional surgery may be required.
Anterior-MCL portal: easily reaching the posteromedial horn tear of a medial menisci
No full textThe Posteromedial horn of a medial meniscus are more prone to get injured, and it is an especially challenging lesion to the arthroscopist. The purpose of this passage was to introduce a new technique for the posteromedial horn tear. We presented a previously undescribed technique that allows good management of the posterior horn of the medial meniscus in patients with tight medial compartments.This technique uses three portals to conduct menisectomy and uses a third portal as the workhorse portal to manage the posterior region so that the posterior horn tears can be removed easily. Versus the standard technique, three portals are in need, including anterolateral portal, anteromedial portal and a whole new portal. This new portal is named Anterior-MCL portal, and it is nearly next to the anterior rim of the medial collateral ligament(MCL).This technique is especially noteworthy in that it decreases the difficulties for management the posteriormedial region in some knees with tight medial compartments
Isolated iliac wing fractures: are they really that benign?
No full text Background: The aim of this study was to review the incidence, management and outcome of isolated iliac wing fractures and to compare them with other type A, B and C fractures. Methods: From 2004 to 2015, the data of 547 patient with a pelvic fracture regarding age, gender, RTS, ISS, treatment, complications and mortality were analyzed and a comparison was made between iliac wing fractures and the other pelvic fractures. Results: We encountered 30 isolated iliac wing fractures. The ISS, shock class, transfusion rate, complications and mortality were comparable to those of patients with an unstable pelvic fracture. Concomitant injuries were observed in 93% of the patients. None of the fractures were operatively stabilized. Conclusion: Isolated iliac wing fractures are rare, and operative stabilization of the fracture itself is often not necessary. However, these fractures are serious injuries with characteristics resembling those of patients with an unstable pelvic ring injur
Outcomes of carpal tunnel surgery in patients with and without medical comorbidities with special attention to quality of life
No full textThe objective of this study was to compare the outcomes of carpal tunnel surgery in patients with and without medical comorbidities typical in this age range, with particular attention to evaluation of their quality of life. The outcomes of carpal tunnel release at 6 months after operation in 128 patients, 70 (55%) with and 58 (45%) without comorbidities were compared. The measurements were performed preoperatively and at 6 months after the operation and included pain intensity, grip strength, sensation, hand dexterity with the Levine and quality of life with the RAND SF-36 questionnaires. Results. At baseline, the patients with comorbidities had significantly poorer hand function and reduced perception of light touch. Carpal tunnel release resulted in significant improvement for all patients, although outcomes at 6 months were less favorable for those with comorbidities in terms of quality of life and general health status. This however does not mean that the presence of the comorbidities is prejudicial to the outcome of CTS surgery
Combined anterior talofibular ligament (ATFL) Lesion and anterolateral Syndesmotic Impingement after Ankle Sprain Trauma in runners
No full textBackground: The proliferation of cicatricial tissue after anterior inferior tibiofibular ligament lesion (AITFL) was described before; concomitant insufficiency of the anterior talofibular ligament (ATFL) may cause anterolateral impingement in the ankle joint of runners.Methods: Twenty-two runners with suspected syndesmotic impingement after ankle sprain were included in the study. An MRI of the ankle joint was performed followed by arthroscopy.Results: Arthroscopy revealed an ATFL lesion in 20 patients (87%) and anterolateral syndesmotic impingement in 17 patients (77%). An ATFL lesion was detected in all patients with anterolateral syndesmotic impingement. The sensitivity of MRI was 24% (4 patients) on detecting anterolateral syndesmotic impingement, and 25% (5 patients) on ATFL lesion.Conclusion: A traumatic sprain of the ankle frequently results in a combined ATFL lesion and anterolateral syndesmotic impingement in runners. MRI does not possess sufficient sensitivity to detect this combined pathology. Arthroscopy of the ankle joint should be performed