Acta Orthopaedica Belgica
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External fixation for high energy paediatric diaphyseal tibial fractures: Taylor Spatial Frame versus Uniplanar Fixator
No full textPurpose: compare the outcomes of the Taylor Spatial Frame (TSF) versus the Unipolar External Fixator (UEF) (Hoffman) in children’s tibial diaphyseal fractures.Materials and methods: forty-two children with high-energy diaphyseal tibial fractures underwent surgical treatment from January 2006 to December 2013 were divided in 2 groups based on type of fixation. Paley's criteria were used to evaluate obstacles and complications from surgery until one year after frame removal. Statistical analysis was performed using Cohen's d test and Student T-test.Results: Mean follow-up for both groups was 2,4 years. No intraoperative complications, neuromuscular injury, re-fracture, leg length discrepancy, malrotation and post-operative complications according to Paley's criteria were recorded.Discussion: No statistical differences were observed regarding correction after treatment and time to union between open and close fractures in each group. However, statistically significant differences were observed regarding the incidence of problems, obstacles and time to union when TSF was applied
Interest of a compression screw for the arthrodesis of the first metatarsophalangeal joint of the foot: comparative study
No full textObjective: The purpose was to determine whether or not an additional compression screw to an arthrodesis of the first metatarsophalangeal joint (MTP1) by plate conferred any clinical and radiological benefits for the patient.Methods: 105 cases (95 patients) were prospectively enrolled and analysed in two groups: PLATE-only with 2 small plates fixation (n=51) and PLATE+compSCREW with an additional compression screw fixation (n=54). Both groups were followed up over 4-years and were compared using the AOFAS score and a radiologic assessment to determine the fusion rate.Results: PLATE-only reported 6 failures: 2 cases of clinical mobilisation of the joint and 4 cases of painless fibrous fusion. In the PLATE+compSCREW group, there were 3 cases of painless fibrous fusion. When considering the fusion rate, there was a significant statistical difference between the two groups.Conclusion: The use of an additional compression screw reduced the time to joint fusion and decreased the failure rate at last follow-up
Low handgrip strength is associated with a higher incidence of pressure ulcers in hip fractured patients.
No full textIntroduction. Pressure ulcers (PUs) are highly frequent in hip fractured elderly patients. Handgrip strength (HGS) is an efficient, method to measure functional capacity. The aim was to analyze if low HGS is associated with higher incidence of pressure ulcers within a population of elderly patients with hip fracture.Material and Methods. A cohort study, which included 462 patients admitted at the Hip and Pelvic Surgery Department of a tertiary hospital, in Monterrey, Mexico. HGS measurement was performed using a Jamar® Hydraulic Hand Dynamometer. Patients were grouped into tertiles according to their grip strength measurement by sex, and evaluated for presence or absence of PUs during hospital admission and followed until discharge. Results. The general incidence of PUs was 25.7%. The incidence was higher in the weaker subjects. After multivariate analysis, only HGS remained associated with PUs incidence.Conclusion. Low handgrip strength is associated with a higher incidence of pressure ulcers
Morphological abnormalities of the femur in the dysplastic hip, Relation between femur en acetabulum
No full textPurposeTo apply statistical shape modelling to perform an evaluation of femoral deformity in developmental hip dysplasia and to describe its relation to the amount of acetabular coverage.Methods An observational case-control study consisting of 40 right dysplastic cases compared to 43 normal hips, was designed. The femurs were scanned, followed by 3D reconstruction for statistical shape modelling. Inter-shape correspondences of the femoral shape were used to portray changes in femoral morphology to the amount of acetabular coverage. Partial least-squares regression was applied to establish a direct connection between acetabular coverage and the geometry of the femoral shape.ResultsAcetabular coverage accounted for 7.1% of variation in the overall femur shape. Significant changes in femoral morphology were observed with decreasing acetabular coverage. Conclusion Anatomic abnormalities inherent to the dysplastic hip are limited to the very proximal part of the femur and significantly increase when the acetabular coverage decreases. Flattening of the femur head is most pronounced at the peripheral part of the head
Management of stress fractures of the proximal tibia in patients with advance knee osteoarthritis. A case Series.
No full textPurpose: To evaluate the outcome of one stage long stem total knee replacement of patients with stress fracture of the proximal tibia of the knee joint.Materials and Methods: Record of 15 patients, 14 females and one male who underwent one stage long stem total knee replacement from the year January 2008 till December 2014 were reviewed retrospectively. Outcome variable was fracture healing which was seen clinically (pain free and postop ambulation) as well as radiologically (union of three out of four cortex).Results:Mean age of the patients were 65 years and the mean BMI was 31. Of the 15 knees 13 had varus malalignment and 2 had valgus malalignment. The mean duration of fracture healing was four and a half months and the mean duration of follow-up was 26 months. All the patients were ambulated full weight bearing with walker. One patient had non-union at fracture site which required bone grafting.ConclusionLong stem total knee replacement is an effective method of treating tibial stress fractures associated with advance osteoarthritis as it not only restores the normal mechanical alignment but also facilitates fracture healin
DHS AND ANTI-ROTATIONAL SCREW VS CANNULATED SCREWS IN FEMORAL NECK FRACTURES. THERE ARE DIFFERENCE IN CLINICAL OUTCOME AND INCIDENCE OF AVN?
No full textThe purpose of this study was to compare the period of union, functional outcomes and complications of patients with femoral neck fractures treated with percutaneous cannulated screws versus dynamic hip screw (DHS) and antirotational screwWe enrolled 160 consecutive patients with a fracture of the neck of the femur,according to Garden classification treated from 2010 to 2011. The average age was 67.8 years. The patients were referred for treatment with cannulated screws or to treatment with DHS plate and anti-rotational screw. All patients were followed up with a minimum follow-up of 1 year. The Harris Hip Score was used.In the two study groups the differences in consolidation and functional results were not statistically significant. The increased risk of avascular necrosis is realted with the degree of displacement rather than the surgical treatment. The blood loss was significantly lower in group I, due to the smaller incision (screws were applied percuataneously).The preliminary results of our study were a not superiority of one surgical technique over the other, by assessing the time to bone healing and the functional results.
What is the reason of the high fibular head in the Discoid Lateral Meniscus?
No full textThe purpose of this study was to assess the factors associated with high fibular head in symptomatic discoid lateral meniscus (DLM). Eighty-seven patients with complete DLM (discoid group) and 80 normal subjects (control group) were included prospectively. Plain X-rays and MRI were analyzed for level and angle of the fibular head and thickness and type of Wrisberg ligament. Multivariate regression analysis was performed to find the factors associated with levels of the fibular head and DLM. The angle of the fibular head was the only factor associated with level of the fibula in the discoid group (odds ratio: 3.0, p=0.007). The 13.6mm cut off value for fibular level had 70.5% sensitivity and 77.0% specificity for diagnosis of DLM. A high fibular head was associated with larger angle and type of fibular head.
Treatment of acute spondylolysis in elite athletes. Literature review and presentation of a new percutaneous grafting technique.
No full textIntroductionThe initial treatment of acute spondylolysis in young elite athletes is conservative.Excellent clinical results are seen when there is osseous healing of the defect. When there is no osseous healing, repetitive and maximal loading of the lumbar spine often remain painful. Osseous healing is more likely when lesions are diagnosed and treated early. When no signs of healing are present at computed tomography (CT-scan) after 4 months of conservative treatment and when pain persists, percutaneous surgical treatment can be considered in elite athletes.MethodsWe present a new percutaneous bone grafting technique for young elite athletes with acute spondylolysis.ResultsOsseous healing was achieved and the patient was able to resume competitive sport activities within 6 months after surgery.ConclusionThis technique can improve fracture biology without muscle damage and without affecting the normal mobility of the spine, eventually leading to osseous healing.
Evaluation of results of “Trochanteric Femoral Nailing (TFN) “ in comminuted unstable trochanteric fractures
No full textABSTRACT: Background: In recent years, intramedullary nails for the treatment of comminuted and unstable intertrochanteric hip fractures have gained prominence relative to conventional, sliding hip screws. The purpose of our study was to evaluate the result of Trochanteric femoral nailing in comminuted, unstable Trochanteric fracture femur in terms of anatomical restoration and functional outcome.Materials & Methods : It is a prospective and without control study. Trochanteric femoral nailing has been done in selected 25 patients and they are followed up postoperatively for at least 12 months. Pre-operative and post-operative clinical and radiological parameters are compared accordingly.Results: Union in all cases. Overall complication rate 12% including some implant related complications. Functional outcome on Harris Hip Score is comparable with standard literature.Conclusions: For treatment of intertrochanteric hip fractures, particularly with comminuted fracture fragments, an intramedullary devices offer beneficial features in comparison with the extramedullary devices. Further biomechanical and clinical studies are necessary to validate the efficacy of the trochanteric femoral nail, but in our experience this is an improvement over the currently available devices. Level of Evidence- Level 1 therapeutic study
Delayed total hip arthroplasty infection with Mycobacterium Tuberculosis complex
No full textTotal Hip Arthroplasty (THA) joint infection is an uncommon (0,3-1,7%) [20] but devastating complication after THA. While mostly caused by Gram-positive bacteria, with staphylococci and streptococci accounting for up to 76% of cases [21], orthopaedic surgeons are sometimes faced with atypical germs such as fungi or mycobacteria. We present a case of THA joint infection caused by Mycobacterium tuberculosis (MT) in a patient without a previous history of MT infection. A literature review was performed, and the treatment is discussed