Acta Orthopaedica Belgica
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Neopterin, Interleukin-6, Procalcitonin, C-reactive Protein, and PET-CT Staining as Markers in Infected Total Knee Prosthesis
No full textDiagnosis in prosthetic joint infections is challenging. Currently most of the diagnostic tests are non-specific. As these tests have high sensitivity but low specificity. Thus, specific tests, as alpha defensin, are needed to distinguish bacterial infections from reactions to surgical trauma.Methods Between April 2010 and December 2011, we analyzed white blood cell count, erythrocyte sedimentation rate, C-reactive protein, neopterin, interleukin-6, and procalcitonin and PET-CT imaging in 45 patients with confirmed prosthetic infection. The suitability and diagnostic power of these tests were assessed by using Shapiro-Wilk test, Mann-Whitney U test, and ROC curve analysis, and by comparing to 40 age- and gender-matched volunteers who underwent unilateral total knee prosthesis with normal serum indices and without known diseases.Results Significant differences were observed between infected patients and control volunteers (p < 0.05) for all parameters examined. Highest sensitivity (99 %) and specificity (98 %) were achieved using a combination of interleukin-6 and C-reactive protein. However, PET-CT imaging had diagnostic accuracy 93.3 %.Conclusion A combination of interleukin-6 and C-reactive protein also enables accurate diagnosis. But, none of these markers found neither sensitive nor specific in the diagnosis of periprosthetic infection as alpha defensin
Incidence of hypothermia and factors affecting variation in core body temperature in patients undergoing arthroscopic surgery of the hip
No full textBackground: The aim of this study was to determine the incidence of post-operative hypothermia in hip arthroscopy patients and factors affecting perioperative body temperature variation.Material and Methods: The final sample size was 46. Core body temperature was measured with a nasopharyngeal temperature probe at the induction of anaesthesia and at the end of the procedure. Other recorded variables were type of warming blanket, ambient theatre temperature and duration of surgery. It was noted whether the patient was shivering immediately post-operatively..Results: The series included 30 female and 16 male patients aged 18 to 57 years (mean 35), with a mean BMI of 26.4 (standard deviation 4.2). Overall incidence of hypothermia below 36°C was 61%. Results of the conditional regression analysis suggested a positive association between post-operative body temperature and pre-operative body temperature (P< .001).Conclusions: Incidence of hypothermia in hip arthroscopy patients is high (61%). We recommend warming patients pre-operatively with forced air warming devices to reduce this incidence
Fusion-segment of High-grade Lumbar Spondylolisthesis: 2-Year Follow-Up
No full textPurpose: To describe our experience in treating pediatric patients with high-grade spondylolisthesis by reduction and fusion surgery, and to determine the most appropriate range of fusion-segment for high-grade spondylolisthesis.Methods: A total of 12 patients with high-grade spondylolisthesis who had undergone reduction and posterior instrumented fusion at our institution were retrospectively reviewed. Results: All 12 cases were followed up for 24~48 months with an average of 35 ± 8 months. A transient L5 nerve root paralysis was observed in 1 case of L5 spondylolisthesis after operation. But the symptoms released spontaneously at 4 weeks after operation. The clinical and radiographic parameters including VAS score of leg pain and low back pain, ODI, PI, SP and LSA were all statistically different compared with that of preoperative (P < 0.05). Conclusion: If the spondylolisthesis not combined with severe structural scoliosis deformity or only combined with lumbosacral deformity, the posterior ligament complex (PLC) should be protected in case of adjacent segmental instability or spondylolisthesis. If the spondylolisthesis combined with severe structural scoliosis deformity (Cobb ≥ 70 °), in principle, it should be treated according to the characteristics of the two diseases respectively, which depends on the specific circumstances
Management of Adolescent tibia vara using Taylor spatial frame.
No full text purpose: To investigate the outcomes of using the Taylor Spatial Frame for the correction of adolescent tibia vara .Materials and Methods eleven adolescent tibia vara were evaluated for deformity, the analysis was performed on full-length standing anteroposterior radiographs of both lower extremities and lateral radiographs of the involved tibia.Proximal tibial osteotomy was performed, correction was done gradually using T.S.F.Results Average follow-up of about 13 months, the mean post-operative mPTA was 87.18 degrees SD 3.97, range ( 81 to 93 degrees), where the mean preoperative mean mPTA was 67.91 degrees SD8.68 range( 50 to 78 degrees).The mean postoperative MAD was 12.18mm SD 11.36, range from -1 to 26 mm, where preoperative mean MAD was 75.73mm SD 14.7, range 60 to 107mm. The mean postoperative PPTA was 80.18 degrees, SD 1.83, range from 77 to 83 degrees while the preoperative mean PPTA was 72.45 degrees, SD 11.67, range 42 to 82 degrees.The mean duration of fixator application was 123.5 days SD 25.45, range (85 to 166 days).Conclusion this to highlight the versatility and effectiveness of the TSF in the treatment of complex and often obstinate adolescent tibia vara
How often absence of palmaris longus and functional deficiency of flexor digitorum superficialis occurs?
No full textThis study was designed to find a possible correlation between the presence of the palmaris longus and function of the fifth flexor digitorum superficialis. We examined 300 participants to assess the absence of palmaris longus and flexor digitorum superficialis function by several clinical tests. Overall absence of palmaris longus, was seen in 157 participants (52.3%). Overall deficiency of flexor digitorum superficialis was noted in 100 participants (33.3%). In 5% we noted bilateral absence of palmaris longus and flexor digitorum superficialis deficiency. Five participants (1.7%) had unilateral absence of palmaris longus and flexor digitorum superficialis deficiency on the same, left or right hand. Bilaterally presence of these muscles we noted in 95 participants (31.7%). We believe that there is no connection between absent palmaris longus and absent function of flexor digitorum superficialis. We found a much higher prevalence of muscles absence individually and jointly than in other studies
Comorbidity in Dupuytren
No full textIn this report, a possible association between Dupuytren’s disease (DD) and other health problems was investigated. The health problems included in this study are: cardiac ischemia, hypertension, hyperlipidemia, diabetes mellitus, epilepsy, gout, rheumatoid arthritis, malignancy, asthma and COPD. The data of 725 patients with DD were collected from Intego, a database including all morbidity presented to the General Practitioners (GPs) in Flanders. The control group of 2900 age and sex matched non-DD patients was selected from the same database. A possible influence of severity of DD was evaluated by comparing the data of 333 patients operated for DD with the group of Integopatients with DD. This study showed a significant association of every single studied health condition with DD. Comparison of the operated group with the group from Intego with DD, demonstrated only some significant associations, a difference which may be explained by the difference in data collection.
Titanium elastic nailing in femoral diaphyseal fractures in children of 6-14 years age.
No full textBackground: Traditionally conservative methods were used in managing paediatric femoral diaphyseal fractures. There has been a renewed interest for operative treatment with Titanium elastic nail system (TENS) in the age group of 6-14 years.Materials and Methods: This prospective study was done on 20 paediatric patients aged 6-14 years. Stabilization was done with two titanium elastic nails. We followed them for maximum of two years after surgery. The results were evaluated using Flynn’s scoring criteria.Results: All fractures united in an average of 9.0 weeks, full weight bearing in an average of 9.2 weeks, mean hospital stay was 8.6 days and return to school at an average of 10 weeks. The results were excellent in 14, good in 5 and poor in 1 patient.Conclusion:- Treatment of diaphyseal femoral fracture in selected pediatric patients by TENS is reasonably effective.Keywords: Pediatric femoral diaphyseal fractures, Titanium elastic nail system
Trapeziumectomy and Mini Tightrope stabilization of the first metacarpal for thumb carpometacarpal osteoarthritis: a prospective case series
No full textOur purpose was to investigate the short-term results of trapeziumectomy and stabilization of the first metacarpal by using the TightRope© device, at a maximum follow-up of 1 year post-op. This is a novel method in treating first carpometacarpal joint osteoarthritis and an alternative to the variety of other methods that have been previously reported. We recruited 21 patients and assessed them at regular intervals, comparing pre-operative and post-operative variables. We recorded all complications during the study period. There was a statistically significant improvement in pain, hand grip and tip pinch power and functional outcome scores. Patients were very satisfied at 12 months after surgery. No significant change in thumb opposition was noted. There was subsidence of the first metacarpal at 1 year after surgery. Despite the existence of a significant number of alternative procedures, we feel that the procedure described in this paper has promising short-term results and is safe.
A comparison of ketamine sedation and general anaesthesia for manipulation of paediatric forearm fractures
No full textThe purpose of the study was to compare the use of ketamine sedation and general anaesthesia for manipulation of paediatric wrist and forearm fractures. A retrospective analysis was performed of patients under 16 years treated at our centre between October 2014 and October 2015. Exclusion criteria were open fractures and fractures with complete displacement. Outcomes measured were fracture reduction, the quality of the cast, fracture redisplacement, further surgical intervention and use of theatre time. 66 children were manipulated over the study period; 31 received ketamine sedation and 35 general anaesthesia. No statistically significant difference was found in the rate of re-intervention (p=0.48), quality of reduction (p=0.39), quality of cast (p=0.14 and p=0.21), or redisplacement (p=0.87). Those undergoing general anaesthesia used on average 50 minutes of theatre time and one third required an overnight admission. We conclude that ketamine sedation achieves comparable treatment outcomes to general anaesthesia whilst using fewer resources
The outcome of surgical management of chronic pectoralis major ruptures in weightlifters
No full textIntroduction Pectoralis major repair is increasing in frequency due to the uptake of weight training. Chronic tendon injuries tend not to have as favourable outcomes.Objectives We report our outcome of chronic pectoralis major ruptures following surgical repair.Methods Retrospective analysis of 8 patients who were weightlifters, treated for primary pectoralis major repair by one surgeon. Surgical repair was direct via suture anchors and one additionally required fascia lata graft due to tendon retraction. Outcome was assessed by comparing strength to the contralateral pectoralis muscle and the Oxford Shoulder Score.Results All patients were male with mean age of 36 years. Mean delay to surgery was 25.6 months. Mean follow-up was 19.6 months and mean Oxford Shoulder Score was 43.7. Six out of eight patients had full strength compared to the contralateral side. Complications included visible skin tethering not associated with weakness, stiffness associated with weakness and a seroma at fascia lata donor site. Conclusions This is the largest documented study of Chronic Pectoralis Major repair showing excellent outcomes with repair, even if delayed.