Acta Orthopaedica Belgica
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Could the orthopaedic surgeon deployed in austere setting perform flaps on the leg?
No full textThe orthopaedic military surgeons deployed in operations are led to perform soft tissue coverage on the lower limb. The purpose of this study was to evaluate if flaps performed by surgeons’ non-specialist in reconstructive surgery are associated with good outcome. All patients operated for a flap on the leg in French Forward Surgical Team deployed in theatre of operations between 2003 and 2013 were retrospectively reviewed. Forty-nine patients were included, for a total of 54 flaps’ procedures. Indications were open fractures in 25 cases and osseous infections in 29 cases. No flap was performed on French soldiers. All the flaps were pedicle. Outcome was favourable for more than 90% of flaps with no statistical difference between muscular and fasciocutaneous flap and with regard to the indication. In conclusion, an orthopaedic surgeon deployed in austere setting with significant good outcome can perform reconstructive surgery with legs’ flaps
Is the pelvis stable during supine total hip arthroplasty?
No full textIntra- operative changes in pelvic position during total hip arthroplasty (THA) can affect acetabular orientation. We evaluated these changes during supine THA using a proprietary mobile application called PelvicTracker. Twenty- two patients undergoing THA using direct anterior approach were included in the study. In the sagittal plane, the pelvis was extended (anterior tilt) as compared to the start of surgery in 19/ 22 hips at the time of cup implantation (mean extension: 3.1°; range: 1°-6°). In the transverse plane, the pelvis was rolled to the opposite side of surgery in 12 hips (mean roll: 2.8°; range: 1°-5°), to the same side in 8 hips (mean roll: 3.9°, range: 1°-9°) and unchanged in 2 hips at the time of cup implantation. Predicted change in cup version of ≥5° due to changes in pelvic position was seen in 7/22 (32%) patients. Although minor, changes in pelvic position do occur during supine THA which may affect acetabular orientation
Percutaneous hardware free corrective osteotomy for bunionette deformity.
No full textWhen bunionette deformities are not responding to conservative treatment, several surgical procedures are available. Recently, minimal invasive techniques have been proposed with good results. We present a retrospective review on 20 percutaneous distal oblique 5th metatarsal osteotomies for correction of bunionette deformity. Aftercare consisted of 5-6 weeks of corrective taping with full weight bearing using a post-op shoe. At a mean follow-up of 27.8 months, the American Orthopaedic Foot &Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal scale improved from a mean of 51 points to 91.6 points. 90% of patients had good or excellent clinical result and a mean pain score on the visual analog scale was 0.7 out of 10. Radiographic evaluation showed a good correction of the intermetatarsal and metatarsophalangeal angle. We did not encounter any complications. The percutaneous hardware free corrective osteotomy is an effective, reliable and safe procedure concerning the treatment of bunionette deformity
Changes in pelvic orientation after total hip arthroplasty: a prospective study with EOS ™.
No full textChanges in pelvic orientation after THA could alter the relationship between the femoral stem and the acetabular component and may be responsible of dislocation and implant degeneration. EOS ™ technology allows three-dimensional analysis of the pelvis in functional position with low irradiation. The purpose of the study was to evaluate changes in pelvic orientation after THA in standing position with EOS ™. In a prospective study, EOS ™ was performed in standing position preoperatively and 3 months after computer assisted THA for primary hip osteoarthritis. Differences between pre- and postoperative pelvic parameters values were analyzed. 40 patients were included. Changes greater than 5° was noted in 12,5% of cases for pelvic incidence, 35% of cases for sacral slope and in 22,5% of cases for pelvic version. In conclusion, pelvic parameters could be modified after THA.
Management of greater trochanteric pain syndrome: a systematic review
No full textIntroduction: Greater trochanteric pain syndrome is characterized by pain at or around the greater trochanter. Numerous management modalities have been proposed, with varying success.Study selection: Cochrane and Pubmed database have been searched from 1990 for studies focusing on the management of this syndrome. We only selected studies with a validated outcome measure. 11 studies met our inclusion criteria.Results: Evidence points towards a pain reduction in the first months after a corticosteroid injection, but this effect does not persist with time. Low energy shock wave therapy also has a positive effect in the short term, the longer term results being more controversial. Although surgery is poorly documented, authors agree to reserve this option only for greater trochanteric pain syndrome failing to respond to conservative measures. The complication and re-intervention rate should not be underestimated.
Is Autologous Blood Transfusion cost effective in Adolescent Idiopathic Scoliosis?
No full textThe purpose was to evaluate the use of preoperative autologous blood donation (PABD) for surgical treatment of adolescent idiopathic scoliosis (AIS). The surgical records of 37 patients Lenke type 1 AIS were reviewed. Patients were divided according whether they enter on a PABD program (25 patients) or rejected to joint (12 patients non-donors). Both groups were comparable. All but one PADB patients (96%) and only 2 non-donors patients (16.7%) require post-operative transfusion. On addition 12 PABD patients (48%) did not require all the stored blood. At discharge both groups had similar haemoglobin levels. The risk for transfusion was much higher in PABD patients than in non-donors. PADB patients were transfused despite a high haemoglobin level (>8 g/dl). Additionally a 31,4% of patient’s collected blood was not used. In our experience PABD resulted in an increase in procedures costs and lead to unnecessary blood transfusions
Radiation Exposure from Computed Tomography of the Upper Limbs
No full textTo investigate exposure to radiation we identified a cohort of 312 patients who underwent standardized CT of an upper limb within a three years period. The effective dose per dose length product coefficient was used to calculate the effective doses of radiation. Mean effective doses were as follows: shoulder CT, 10.83 (SD 6.36) mSv; wrist CT, 0.15 (SD 0.07) mSv; elbow CT performed with the arm above the head, 0.21 (SD 0.11) mSv and with the arm adjacent to the torso, 13.1 (SD 10.8) mSv. For a 20-year-old woman, the estimated lifetime attributable risk of developing cancer was 1.78/1000 for shoulder CT and 2.15/1000 for elbow CT performed with the arm adjacent to the torso. The effective doses for shoulder CT and elbow CT performed with the arm adjacent to the torso were substantial. For elbow CT scans, elevating the arm above the head decreases the radiation doses
Difference between spinecor brace and rigid brace in deformity correction and quality of life in adolescent idiopathic scoliosis
No full textAlthough there are several conservative treatment options only bracing found effective in preventing curve progression and subsequent need for surgery. The objective of this study is to compare the results of SpineCor brace and rigid brace in adolescent idiopathic scoliosis radiologically and clinically.Sixty-four adolescent idiopathic scoliosis patients treated with brace included in this study. Height, T1-Coccygx distance, gibbosity was measured. Rib hump deformity was evaluated with scoliometer. SRS-22 questionnaire used to determine the quality of life of patients after the first year of brace treatment.Differences in Cobb angles and gibbosity were insignificant in both groups. SRS-22 questionnairre results showed significant difference in pain, self image and function/activity subgroups. Mental health and satisfaction scores of patients were insignificant.These braces has similar effect on deformity correction. Surgery rates and success rates braces are approximately equal. Major difference between SpineCor and rigid brace is health related quality of life
Survival of the Birmingham Hip Resurfacing in young men up to 13 years post-operatively
No full textThe aim of this study was to determine the medium to long term survivorship of the Birmingham Hip Resurfacing prosthesis in an independent series of young men. The medical records and radiographs of all men aged 55 and under who had undergone Birmingham hip resurfacing by the senior author were reviewed. Patients who had not attended recent follow-up or had been previously discharged were contacted by telephone. Between 1999 and 2011 a total of 147 hips were resurfaced in 155 patients (mean age 47 years (19 to 55)) with minimum 5 year follow-up (mean 8.2, range 5 to 13.9 years). Eleven hips were revised giving overall cumulative survival of 88.8% at 13 years. In conclusion, this independent, single surgeon series demonstrates acceptable survival of the Birmingham Hip resurfacing in young men. It remains a valid option in certain cases but we believe alternative bearings are more suitable for most patients
Results of one-stage surgical treatment in children with Tönnis grade 4 developmental dysplasia of the hip: is it worse when it is bilateral?
No full textThis retrospective study compared the results of one-stage surgery of unilateral and bilateral Tönnis grade 4 hips (high dislocation in developmental hip dysplasia, DDH): 41 hips, 30 patients. Mean follow-up was 56 months. Pelvic radiographs were evaluated at three time points. Acetabular inclination angle improved significantly in both groups. Results were satisfactory (Severin classes I-II) in 13 hips (68.5%) (unilateral group) and 21 hips (89.5%) (bilateral group). Functional evaluation (McKay classification) at final follow-up revealed satisfactory results in 94.8% (unilateral group) and 63.6% (bilateral group). One-stage surgery is a reliable method for treating children with unilateral or bilateral DDH