Acta Orthopaedica Belgica
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breakage of volar locking plate system for distal radius fractures
No full textThe purpose of this study was to elucidate the cause of implant breakage of the volar locking plate system for distal radius fractures and as well as measures for its prevention. Medical data of patients without and with implant breakage were retrospectively compared. Postoperative reduction loss significantly affected implant breakage. Moreover, the absence of a distal locking screw aiming at the radial styloid and plate fixation with a gap formation of 2 mm or greater from the volar surface of the distal radius were significantly associated with breakage of distal locking screws. Plate fixation with sufficient contact of plate with the volar cortical surface of the distal radius and distal locking screws directed at the radial styloid may prevent the breakage of the distal locking screws. Additionally, patients with postoperative reduction loss should be closely monitored for the possibility of implant breakage during the postoperative period
Evaluation of ninety-six periprosthetic hip joint infections seen within five consecutive years
No full textBackground and purposePeriprosthetic hip joint infections (PHJI) are severe complications.In 2003 Zimmerli published a well-noted treatment algorithm for PHJI. The aim of this study is to evaluate outcome, analyze the applied treatment regimen and compare it to the proposed algorithm.MethodsWe evaluated the outcome of 96 PHJI treated at our institution 2008-2012 and analysed adherence to the algorithm and outcome in coherence with the algorithm.ResultsThe operations performed were irrigation and debridement with exchange of mobile parts (45%), two-stage exchange (36%), one-stage exchange (12%) and permanent explantation (7%). 47% were early infections, 53% delayed. Staphylococcus aureus was the most common pathogen. The overall success rate was 88%. In 12% of the cases the chosen operation didn’t follow the algorithm. Of these only 10% was successfully treated with the primary operation.InterpretationWe find that the algorithm proposed by Zimmerli is a useful tool and easy to translate into clinical practice. When followed it yields a high success rate
Retrograde dynamic locked intramedullary nailing for distal femoral aseptic nonunion associated with broken antegrade locked nail
No full textTechniques for treating distal femoral aseptic nonunions associated with antegrade locked nail breakage are controversial. Twelve patients with the described disorders were treated with retrograde dynamic traditional femoral locked nails. The proximal segment of the broken nail was removed from the hip area with the patient in the lateral decubitus position. Consequently, the patient was changed to the supine position. The distal segment of the broken nail was removed from the intercondylar inlet and a dynamic locked nail was inserted in a retrograde fashion. Two staples were used for reinforcing rotational stability whenever necessary. Early ambulation with protected weight bearing was encouraged. All 12 patients with 12 nonunions were followed for an average of 2.9 years (range, 1.1-4.7 years). All nonunions healed with a union rate of 100%, and the average time to union was 4.2 months (range, 3.0-5.5 months). There were no complications of nonunions, malunions or deep infection. Satisfactory knee function among 12 patients improved from 42% pre-operatively to 100% at the latest follow-up (p = 0.002). All 12 patients could walk without aids.The described technique may be an excellent alternative for treating a distal femoral aseptic nonunion associated with antegrade locked nail breakage.
A comparison of the InterTan Nail and Proximal Femoral Nail Antirotation in the Treatment of Reverse Intertrochanteric Femoral Fractures
No full textThe aim of this study was to compare the clinical and radiological results of InterTan nail and proximal femoral nail antirotation (PFNA) in the treatment of reverse intertrochanteric fractures (AO/OTA 31-A3). The study included a total of consecutive patients who presented at trauma centre with a reverse intertrochanteric fracture between in the last 7 years. Treatment was applied with PFNA in 33 patients and with InterTan nail in 36. Evaluation was made from the radiographs taken on postoperative day 1 and at the final follow-up examination of changes in the femoral neck and shaft angulation, measurement of telescoping of blade and lag screws and reduction quality. The mean telescoping was measured as 7.21±7.13mm in the PFNA group and 4.18±4.32 mm in the InterTan group (p=0.039). Mechanical failure was seen in 8 (24.2%) cases in the PFNA group and in one case of the InterTan group. Cut-out was observed in 4 cases of the PFNA group and in none of the InterTan group.The use of InterTan nailing in the fixation of reverse intertrochanteric fractures provided better clinical and radiological results compared to PFNA in terms of less telescoping, less change in the neck shaft angle and lower complication rates
Intramedullary nailing of dislocated midshaft clavicle fractures with the Rockwood Clavicle Pin, a retrospective study
No full textPurpose: This retrospective study evaluated the outcome after intramedullary nailing with the Rockwood Clavicle Pin (RCP) for acute displaced middle third clavicle fractures in adults.Methods: Of 84 included patients treated for this fracture 2003–2009, 66 (79%) were evaluated. Of these, 52 (79%) were re-examined, including fluoroscopy, while 14 patients (21%) were evaluated by mailed questionnaire. Primary outcome was Constant score (CS), secondary outcomes included: Subjective Shoulder Value (SSV), healing rate at follow up, complications, and cosmetic appearance. Results: Patients were re-evaluated with a mean follow-up of 39 months (range 13-96). Mean CS at follow up was 90 (range 55-100) and mean shoulder function measured with the SSV was 93 (range 36-100). Three (6%) of the re-examined patients had a non-union at follow up. Twelve (18%) had wound problems, with exposure of the lateral part of the pin in five patients (8%). There were no deep infections but seven patients (11%) were treated for superficial wound infections. Breakage of the implant occurred in one case (2%).Conclusions: Treatment of displaced midshaft clavicle fractures with the RCP results in good clinical outcome and a high patient satisfaction with a high healing rate. However, the technique is associated with postoperative complications
Comparison of local infiltration analgesia with single injection femoral nerve block in total knee arthroplasty
No full textAbstractThe purpose of this study was to compare the analgesic and hemostatic effects of Local Infiltration Analgesia (LIA) with single injection femoral nerve block (SFNB). A database of patients undergoing knee arthroplasty between 2008 and 2013 was analyzed. A group of patients who underwent minimally invasive TKA either with SFNB (n = 112) or with LIA (n = 112) were matched.In the early postoperative period, the LIA group had a significantly lower VAS score, a lower drop in Hb and a lower length of hospital stay.Both the SFNB and LIA techniques provide excellent pain relief following TKA. Nevertheless, LIA reduces pain better in the very early postoperative period by a more complete nerve blockade allowing immediate postoperative mobilization and ambulation leading to a shorter hospital stay. Furthermore, LIA decreases perioperative blood loss by its local hemostatic effect
The Acromion Index – reliability in radiographic and magnetic resonance imaging
No full textIntroduction:The present study evaluates the inter-rater reliability (IRR) of the Acromion Index (AI) in x-ray and MRI, the correlation between both types of imaging and the reliability of the AI as a predictor of rotator cuff tears (RCT).Patients and methods:116 patients who were surgical treated in our clinic.Results:The IRR in x-ray and MRI is excellent No significant correlation of the AI and patients without and with arthroscopic evidence of a RCT could be found. An AI ≥ 0.76 leads to a 76% presence and an AI < 0.75 only leads to a 54.9% presence of a RCT. With further decreasing AI there is another increase in the probability of RCT.Conclusion:The correlation of the AI and RCT is more parable rather than linear indicating that there is a possible ideal force vector of the deltoid muscle and a change of the AI in either direction leads to harm of the rotator cuff tendons.
Factors associated with the prevalence of incidental disease in the upper extremity
No full textPurpose: To learn more about the benefits of resiliency to upper limb health, we studied the null hypothesis that there is no difference in the prevalence of incidental disease between patients who seek care for an injury compared to those with a nontraumatic condition. Our secondary aim was to look for factors associated with incidental disease.Methods: One hundred and sixty five patients provided their demographics and completed measures of psychological factors and upper extremity-specific symptoms and disability. A hand surgeon examined subjects for objective signs of incidental disease.Results: Incidental disease was more common in patients with an injury. The only factor independently associated with incidental disease was older age.Conclusions: The finding that incidental disease is more common in injured patients and more common with age supports the concept that common upper limb diseases are often undiagnosed and adequately adapted.
Two-year results of stemless total shoulder arthroplasty in patients with primary osteoarthritis
No full textAbstractThis study presents functional and radiological results of a single surgeon series of consecutive patients who underwent stemless total shoulder arthroplasty (Eclipse, Arthrex, Naples, FL, USA) for primary osteoarthritis at a mean follow-up of 24 months. From January 2010 to December 2014, 18 patients underwent 20 stemless shoulder arthroplasties. In all cases, we implanted the Eclipse prosthesis (Arthrex, Naples, FL, USA) and a cemented polyethylene glenoid with keeled design. Patients were followed at 3, 12 and 24 months. The main outcomes were functional results. The Constant–Murley score improved from 35 to 68 points (p<0.05, Wilcoxon test), which represents an increase of 41 to80% (p<0.05, Wilcoxon test) for the age- and sex-adjusted scores within twelve months. The DASH improved from 57 to 28 points. This study shows that the Eclipse prosthesis provides consistent functional and radiological results compared to other stemless prostheses, as well as stemmed shoulder arthroplasty for primary osteoarthritis. Subject to further investigations, stemless prostheses can be considered as an alternative to modern stemmed prostheses in patients with osteoarthritis
Hamstring injury prevention in Belgian and English elite football teams
No full textHamstring injury is the most common injury in European professional football. The purpose of this study was to provide insight into the content of hamstring injury prevention programmes in English and Belgian elite football teams.Fifteen premier league teams (10 from Belgium and 5 from England) completed a questionnaire on hamstring injury prevention.Most football teams (93%) screened for hamstring injury risk factors. Less than 60% screened for risk factors including gluteus muscle strength, neural tension and body posture during running. While 80% of the teams had a hamstring injury prevention programme during preseason and official season; only 47% had a prevention programme during mid-season break. Hamstring muscle strength exercises were mainly performed before (77%) instead of after warming-up.In conclusion, while most investigated football teams perform hamstring injury prevention, the content and implementation of the prevention programmes is suboptimal in many Belgian and English elite football teams.