Acta Orthopaedica Belgica
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Rectus femoris transfer improves stiff knee gait in hemiplegic adults following stroke or traumatic brain injury
No full textAim: To provide quantitative evidence of the effect of rectus femoris (RF) transfer surgery on improving gait in adults suffering from stiff knee gait (SKG) following acquired brain injury. Design: Retrospective cohort study. Population: Hemiplegic patients with decreased peak knee flexion in swing, reduced total knee ROM and spasticity of the RF demonstrated by a positive Duncan-Ely test and a pathologic dynamic electromyography of the RF. Methods: 10 right hemiplegic patients had a distal RF transfer. Pre- and postoperative kinematic, kinetic, and spatiotemporal parameters derived from 3D gait analysis and parameters from clinical examinations were retrospectively compared. Results: All patients had improved gait. Statistically significant improvements were observed in walking velocity and peak knee flexion in swing (19.93°±11.80°), knee flexion velocity at toe-off (110.26°±65.74°) and total knee range of motion (20.78°±10.66°). Conclusion: RF transfer improves knee flexion in swing in adult patients suffering from SKG following stroke or TBI
Demographics, fracture patterns and treatment strategies following wrist trauma
No full textThe objective of this study was to determine the percentage of radiographs which showed a fracture of the wrist. Secondary, the fracture characteristics and the received treatment were determined. Additionally, the percentage of operatively treated patients with a distal radius fracture was compared between the hospitals. A retrospective cohort study was performed in three Dutch hospitals in all consecutive adult patients with wrist trauma who presented at the ED. A fracture of the wrist was defined as a fracture of the distal one-third part of the radius, the distal one-third part of the ulna or any carpal bone. Fracture classification according to the AO/OTA classification, the amount of displaced fractures, and the received treatment were recorded. Out of 1740 patients with wrist trauma, 49% sustained one or more fractures of the wrist. The distal radius was most frequently fractured (61%). Almost half of the distal radius fractures was extra-articular (AO/OTA type A2-3) and 61% of fractures was displaced. Of all patients who sustained a distal radius fracture, 14% was treated operatively. Significantly more patients were treated operatively in the academic hospital in comparison to the teaching and non-teaching hospital.
Long-term outcome of prosthetic joint infections treated with two-stage revision.
No full textPurpose. Long-term evaluation of prosthetic joint infection treated with two-stage revision.Methods. Retrospective analysis of 102 periprosthetic infections treated with two-stage revision from 2010 to 2012 in Albenga hospital, Italy. During the second stage, samples for microbiological tests were collected. Failure was defined as a persistence of infection during the second stage or as a relapse during follow-up.Results. 102 cases (55 hip, 47 knee) were analyzed. Patients were evaluated for a median of 44 months. 8/102 (8%) had positive cultures at replacement. These patients were treated with long-term antibiotic treatment and in 3/8 (38%) infection was cured. 9 patients were loss to follow-up or died, 6 patients (6%) had a relapse a median of 16,3 months from replanting. Risk factors significantly related to failures were diabetes and infection due to methicillin-resistant staphylococci.Conclusions: Two stage revision requires continued follow up. Screening for infection at replacement suggests prolonged antibiotic treatment
Radiohamate impingement after proximal row carpectomy
No full textRadiocarpal impingement after PRC is a well-known complication due to impingement of the radial styloid against the radial carpal bones. A less common impingement syndrome is that of the pisiforme. We describe a radiohamate impingement and its diagnosis and treatment. Based on a case we saw at our practice. Diagnosis is bases on standard radiographs and SPECT-CT. The treatment is initially conservative. Surgery is necessary when conservative treatment fails and consists of resectie of the proximal pole of the hamate
Single dose Intravenous Tranexamic acid may not be adequate to reduce blood loss and blood transfusion requirement in patients undergoing single stage bilateral total knee arthroplasty
No full textTranexamic acid (TXA) is commonly used to minimize blood loss and transfusion requirements. However, the optimal regimen of TXA in single stage bilateral TKA is still not defined.In this retrospective study, 35 patients who received TXA and 31 patients who did not receive TXA were evaluated for blood loss and transfusion requirement. Both the groups were comparable in terms of age, sex, body mass index and preoperative haemoglobin (Hb) and haematocrit (Hct). There was no significant difference in the change in Hb levels (2.42 ± 1.28 vs 2.44 ± 1.31;p=0.95) and Hct (1.37 ± 0.96 vs 1.62 ± 0.98, p=0.22) between the groups. There were no significant differences between the study and control groups in the intraoperative blood loss (163.71 vs 165.32 ml, p=0.92), drain output (621.71 vs 695.65 ml, p=0.65) and total blood loss (785.0 vs 860.97, p=0.40). There was no significant difference in allogeneic blood transfusion between the groups (62.85% received blood in the study group vs 58.06% in the control group, p>0.05).Single intraoperative dose of TXA may not be adequate to reduce blood loss and blood transfusion requirement in bilateral TKA.
The use of ultrasound in the diagnosis of adverse reaction to metallic debris following metal on metal hip replacement
No full textBackground and purpose:The role of imaging in the diagnosis of adverse reaction to metallic debris (ARMD) with metal on metal (MoM) hip replacements is still unclear. A comparative study was undertaken to evaluate the efficacy of ultrasound in diagnosis of ARMD. Patients and methods:The study group included 35 patients with a clinical and histological diagnosis of ARMD. The control group included 16 asymptomatic patients of MoM hip replacements with low blood metal ions levels. Various sonographic features around hip in patients diagnosed with ARMD were recorded. Results and Interpretation:Fluid collection around iliopsoas and gluteal tendons following a MoM hip replacement is highly suggestive of ARMD and should not be thought of as an uncomplicated tendonitis. This study shows ultrasound as a reliable investigation in the diagnosis of ARMD following MoM hip replacements
Plate Augmentation Combined with Bone Grafting For Asptic Non-union Of Femoral Shaft Fractures Following Interlocking Nails
No full textThe aim of this study was to evaluate plate augmentation over previously inserted interlocking nails, combined with iliac bone grafting in treating aseptic femoral shaft non-unions. The research was conducted prospectively on 34 patients. A narrow dynamic compression plate was placed while the nail was retained. All the screws were directed posterior to the nail. There were 25 males and 9 females with mean age of 36.6 years old. The mean operative time was 95 minutes with 320ml blood loss. 28 patients showed solid healing by 6 months postoperatively (82%). By 8 months, all patients showed solid union (mean 6.3 months). Full range was regained in both hips and knees and all patients could walk bearing full weight without supportive devices by 8 months. Where non-union occurs over an interlocking nail, augmenting it with a plate and bone grafting appears to be an effective treatment method to obtain solid union
Safe zones in volar portals for wrist arthroscopy, evaluation of central portal: a cadaveric study
No full textThe purpose of this cadaveric study is to determine safe zones utilizing volar portals for wrist arthroscopy, by quantitatively describing the neurovascular relationships of a volar radial and a volar ulnar wrist arthroscopy portals in comparison with those of a newly described volar central portal, considering the advantages in visualization of volar portals for wrist arthroscopy over the standard dorsal. The neurovascular structures and the tendons of nine frozen human cadaveric upper limbs were exposed, while the aforementioned volar portal sites were pointed out with pins. The horizontal distance between the portals and the closest neurovascular branch or tendon was measured with a digital caliper, followed by statistical analysis of the data. The median interquartile range distances from portals to structures at risk were measured and safe zones around each portal were established. This study provides a safe approach to the volar radial and ulnar aspects of the radiocarpal and midcarpal joints, while volar radial and ulnar portals should be considered for inclusion in the arthroscopic examination of any patient with radial and ulnar sided wrist pain respectively. Regarding the volar central portal, it is reproducible, safe and both the above joints can be inspected through one single incision
Interobserver agreement of foot bimalleolar angle in different Pirani scores for the treatment of congenital talipes equino varus by Ponseti method.
No full textIntroduction: Congenital talipes equino varus is one of the most common musculoskeletal deformity. A structured evaluation of CTEV foot is essential to quantify the severity of deformity accurately and consistently and to record progress with treatment. Foot bimalleolar (FBM) angle, an objective method of assessment of deformity, is correlated with severity of deformity of clubfoot. Materials and methods: A prospective study was carried out including 150 clubfoot classified in 3 groups according to Pirani scoring: Group I (6-4.5), Group II (4.0-2.5) and, Group III (2.0-0), Pirani scoring by one observer & FBM angle calculated by 3 observers. Results: mean FBM angle was 63.6o, 69.3o and, 80.95o in group I to III respectively. Intraclass correlation coefficients (ICCs) and their 95% CI were used (Null hypothesis ICC=0.6 with p<0.05 significant). ICC was 0.54 (p>0.05), 0.74 & 0.75 (p<0.05) i.e. fair, good and, excellent in Group I to III respectively. Conclusion: Our conclusion is that interobserver agreement improves from fair to excellent from Group I to III as foot improves with treatment by Ponseti method. Hence we can use foot bimalleolar angle as an objective method of assessment of severity and correction of deformity and for follow up.
Comparative analysis of different total hip replacement implants used in a single health region of the United Kingdom- minimum 15 years follow-up
No full textAimWe describe the functional and radiological results at minimum 15 years follow up of four groups of THR implants used in our health region.Materials and method876 THRs in 837 patients who were included in the study that used prospectively collected data. There were 387 Charnley THRs, 188 hips in the CPT group, 106 hips in the Aesculap group and for 195 hips in the hybrid Exeter group.ResultsThe most common complications were dislocation(3.88%) and superficial infection(3.76%). With revision surgery for any reason as the end point, the survivorship of at 15 years in our series was 98.45% in the Charnley group, 96.8% in the CPT group, 96.22% in the Aesculap group and 97.94% in the Exeter hybrid THR group. There was no statistically significant difference in the number of hips at risk of revision, Harris Hip Scores and complication rates at 15 years.ConclusionWe feel that the choice of implant is best based on individual templating and training of the surgeon. Prospective randomised controlled trials and joint registry data may make implant selection easier in the future.