Acta Orthopaedica Belgica
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FRACTURE AND DISLOCATIONS OF THE LISFRANC TARSO-METATARSAL ARTICULATION: OUTCOME RELATED TO TIMING AND CHOICE OF TREATMENT
No full textLisfranc injuries refers to an injury where one or more of the metatarsals are displaced from the tarsus. The term is more commonly used to describe an injury to the midfoot centred on the 2nd tarsometatarsal joint. These fractures are sometimes easily missed, especially if they present in a politrauma. They are often difficult to diagnose and treat, but if not detected and appropriately managed they can cause long-term disability and have a high potential for chronic disability. A cohort of 71 patients with a Lisfranc fracture dislocation was reviewed. The lesions were classified according to the classification of Meyerson. All the patients were re-evaluated with a 3 year post-op follow up, with a clinical examination the Ankle-Hindfoot Scale AOFAS questionnaire, X-rays and baropodometric analysis. This review outlines the outcome on treatment of this injury with timing of diagnosis
Conventional versus direct magnetic resonance imaging in detecting labral lesions in femoroacetabular impingment - a retrospective multicenter study
No full textThe purpose of this study was to assess the reliability of Direct Magnetic Resonance Arthography (MRA) and Conventional Magnetic Resonance Imaging (MRI) in diagnosing labral lesions in patients with symptoms of femoroacetabular impingement (FAI).Materials and methods: Imaging and surgical data (n=490) were retrospectively collected from 5 high-volume centres providing arthroscopic treatment of FAI patients. Preoperative magnetic resonance imaging findings were compared with the actual surgical findings regarding labral condition in order to assess the effectiveness of MRI and MRA in identifying the presence of labral tears in patients with FAI.The results of this study indicate that MRI and MRA may both be useful for the diagnosis of acetabular labral lesions. The accuracy is slightly higher for MRI (71,4 %) compared to MRA (68,2 %), although MRA has higher sensitivity (74.4%,) as compared to MRI (66,9%).Conclusions: In a clinically suspected labral tear MRA has higher sensitivity than MRI. Further studies on asymptomatic patients may be needed to determine the specificity of different MRI techniques
Tranexamic acid in total knee replacement Which protocol? Which application form? :A prospective randomised study
No full textThe aim of this study was to prospectively compare different doses and application forms of TXA for the reduction of blood loss in patients with TKR and evaluate the results. This study included patients who were unresponsive to conservative management and 168 patients met the inclusion criteria. They were divided into 5 groups randomly as, Control (1), Local (2), Systemic+short infusion (3), Systemic+long infusion (4) and Systemic+oral (5). When compared with the Control group, blood loss was significantly reduced in Groups 2, 3 and 4 (p=0.001,0.001,0.003) but when the TXA protocols were compared, no statistically significant difference was observed. It was determined that in comparison with the control group, all the protocols for the use of TXA reduced blood loss and the need for transfusion without any increase in the complication rate. TXA is considered to be more effective and reliable than systemic use
Reconstruction of complex radial head fractures using fine-threaded K-wires: clinical outcome and remaining instability
No full textPURPOSE: Radial head replacement or ORIF are established treatment options for Mason type-III and type-IV fractures. The aim of this study was to provide results for reconstruction of these complex fractures using fine-threaded K-wires.METHODS: We present results after reconstruction of 15 Mason type-III and 8 Mason type-IV fractures. Parameters used to describe the functional outcome were pain level, range of motion, and clinical scores. To estimate the elbow stability we performed ultrasound examinations under valgus/varus stress.RESULTS: All radial heads could be reconstructed. The average resting pain level was 0.9 of 10. The average ROM for extension/flexion was 134°, average forearm rotation was 159°. For the whole patient collective the mean MEPS was 86.5 points and the mean QuickDASH was 16.8 points with no significant difference for both groups.CONCLUSION: We can recommend ORIF with fine-threaded K-wires for Mason type-III and type-IV fractures of the radial head. Ligamentous injuries can be addressed successfully with external fixation
Blade expandable intramedullary nails for fixation of tibial shaft fractures
No full textThis study is aimed to compare the clinical and radiological differences between classic locked intramedullary nailing ( LIN) and blade expandable intramedullary nailing (BEIN) at tibia shaft fractures. Operation time, exposing of radiation time and fracture healing times were recorded. Visual anolog scale (VAS) , shortening of tibia , angulation at fracture line were compared. As a results all the patients healed successfully. In LIN group operation time, exposing of radiation time was longer (statistically significant). Because of shorter operation time and lower radiation exposure we recommend the BEIN technique as a preferable technique in tibia intramedullary nailing
Correlation between Shoulder radiographic parameters and Supraspinatus tendon tear: Acromio-tuberosity index(ATI) and Acromio-tuberosity difference (ATD)
No full textThe purpose of this study was to find the correlation between supraspinatus tendon (SSP) tear, ATI and ATD. A case-control study design was conducted. The patients were selected from individuals presenting with shoulder pain. ATI and ATD were measured on neutral anteroposterior position of conventional radiographs. SSP integrity was evaluated on MRI. The study consisted of 143 patients with SSP tear and 39 patients with no SSP tears. The median ATI of SSP tear group and no SSP tear group were 1.08 ± 0.08 and 1.15 ± 0.06 respectively. The median ATD of SSP tear group and no SSP tear group were 2.25 ± 2.22 mm and 4.27 ± 1.55 mm respectively. The result showed that ATI and ATD had high correlation for SSP tear on MRI in patient with shoulder pain(Area Under Curve=0.748 and 0.746 for ATI and ATD respectively). Bursal side tear group also had lowest ATI and ATD compare to other tear pattern groups. Although results are statistically significant such a small difference, these emphasized their usefulness and concordance to rotator cuff pathogenesis described in previous studies
Evaluation of reduction quality with MRI after closed or open reduction of the hip in the treatment of developmental dysplasia of the hip
No full textBackground: Study analyses the usefulness of Magnetic resonance imaging (MRI) after closed or open reduction in this indication.Material and Methods: We prospectively reviewed 20 consecutive MRI studies performed without sedation after spica cast placement in 16 developmental hip dysplasia patients. MRI evaluation was carried out within 24 hours after cast application. Both coronal and axial sequences are used to determine wheter the femoral head is concentrically reduced, subluxed or frankly dislocated.Results: In two cases, the quality of radiographs was noted as being poor and responsible for difficulties in assessing the concentric reduction of the hip. MRI examination confirmed subluxation of the hip on coronal and axial images in this patients. Conclusions: Especially in the hips that the femoral head unossified and there is a suspicion of reduction quality, MRI is a safe and reliable imaging modality.Keyword:Hip dysplasia,Spica MRI,Open reduction,Closed reductio
Latissimus dorsi transfer using bone block technique to restore active external rotation in reversed total shoulder arthroplasty
No full textThe aim was to compare the outcome of a reversed shoulder arthroplasty with a latissiumus dorsi transfer without (LD-BB) or with bone block (LD+BB) in patients with rotator cuff-deficient shoulders and combined loss of active elevation and external rotation. Postoperative patients with LD+BB were not immobilized compared to 6 weeks of immobilization in patients with LD-BB. Clinical outcome was evaluated using the Constant Score, ADLER score and satisfaction rate. Also radiological follow-up of the bone-block was performed. In total 29 patients (21 LD+BB, 8 LD-BB) were evaluated. There was no significant difference between both groups at 3 months, 6 months and 1 year in clinical outcome. The radiological evaluation revealed remodellation and ingrowth of the bone block in all but one patient. We conclude that the bone block procedure is a safe technique to perform a LD transfer with good clinical outcome. It also allows early mobilisation and radiological evaluation
Clinical study of the novel FlexitSystem implant for high tibial open wedge osteotomy
No full textBackground: The FlexitSystem implant is a novel implant used in open wedge high tibial osteotomy.Methods: A clinical safety study was performed. Retrospective 50 patients were analyzed who were treated with an open wedge high tibial osteotomy and the new FlexitSystem implant, with a minimal follow-up of one year. Complication rate, radiographic outcomes and implant removal were investigated.Results: One patient underwent a revision surgery because of loss of correction and non-union. The complication rate was 10.0%. No other radiographic complications (screw breakage, implant failure) were found. In 24 patients (48%) the FlexitSystem implant was removed at a mean follow-up of 12.6 months (range 2.6 till 24.0 months). The mean reason was irritation of the implant.Conclusions: The FlexitSystem implant is a clinical safe and stable implant for an open wedge high tibial osteotomy, with a low complication rate. Unfortunately, the rate of implant irritation requiring removal remained high. Trial registration number: ID-number BC/1603-15
Does computerized tomography change the treatment decision in pediatric medial epicondyle fractures?
No full textThe amount of displacement in medial epicondylar fracture is one of the most important criteria for treatment decision. The displacement of medial epicondyle fractures of the humerus may be underestimated by standard AP and lateral views of elbow. The aim of the current study is to show the clinical relavance of computerized tomography (CT) for medial epicondyle fractures.A retrospective analysis; on patients with medial epicondyle fracture; was performed.Measurement was made from 9 reviewer, for 12 case,on both radiographs and CT. The difference between measurement of AP Xray and frontal and axial CT scans was found statistically significant for both 1st and 2nd assessments(p=0.001). Treatment decision for operative treatment was found statistically higher after evaluation with CT for both first and second assessment.(p=0,0001). CT had great relavance on treatment decision for pediatric medial epicondylar fractures. There is also much better interobserver agreement for axial CT scans for treatment decision.