Acta Orthopaedica Belgica
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“Turn laterally to the left!”. The need for uniform C-arm communication terminology during orthopaedic trauma surgery
No full textBackground:To avoid disturbed teamwork, unnecessary radiation exposure, and procedural delays, we designed and tested a uniform communication language for use in fluoroscopy-assisted surgical procedures.Methods:Input of surgeons and radiographers was used to create a set of commands. The potential benefit of this terminology was explored in an experimental setting.Results:There was a tremendous diversity in the currently used terminology. Use of the newly designed terminology showed a reduction of procedural time and amount of images needed.Conclusion:Our first standardized Dutch language terminology can reduce total fluoroscopy time, number of images acquired, and potentially radiation exposure. For Dutch speaking colleagues, the developed terminology is freely available for use in their OR.
Assessment of the Medial Longitudinal Arch in Children with Flexible Pes Planus by Plantar Pressure Mapping
No full textIntroduction Plantar Pressure mapping has been introduced as a new modality for assessment of the height of the medial longitudinal arch of the foot. Among the most commonly used methods for such assessment are the radiographic measurements and footprints.Patients and Methods The purpose of this study was to investigate the correlation between radiologically measured angles, Staheli index measurements on footprints (SI), and Arch Index Contact Force Ratio (AICFR) obtained from pressure mapping analysis in 28 children (56 feet) with flexible pes planus.Results A positive correlation of pressure mapping results was found with the talo-first metatarsal angle, the calcaneal pitch angle, as well as the footprint scans (P < 0.001).Conclusion This study demonstrated that plantar pressure mapping is a reliable and effective tool in screening, diagnosis, and follow up of children with flexible pes planus. Keywords Plantar Pressure Maping · Flexible Pes Planus· Medial Longitudinal Arch in Children
Influence of varus/valgus positioning of the Nanos® and Metha short-stemmed prostheses on stress shielding of metaphyseal bone
No full textThe aim of this study was to analyze bone remodeling around the Nanos® (Smith & Nephew) and Metha® (Aesculap AG) stems as a function of varus/ valgus stem positioning. In 75 patients with diagnosed coxarthrosis, either Nanos® (n= 51) or Metha® (n= 24) prostheses were implanted. Digital assessment of plain radiographs immediately, 97, and 381 days after THA showed no clinically relevant migration, angulation, or change in offset and center of rotation.The DEXA scans showed significant BMD changes in Gruen zones 1 (-12.3%), 2 (-4.3%), and 6 (+6%) (t-test). The pre/postoperative CCD for the Nanos® was 129°/ 135° and for the Metha® 131°/ 127°. No clinically relevant correlation between postoperative CCD and BMD was identified (Pearson-Correlation). In conclusion, there was no clinically relevant influence of varus/valgus placement on proximal femur BMD after implantation of the Nanos® or Metha® prostheses
Rare case of aneurymal bone cyst of cuboid bone in a 10 year old girl
No full textAneurysmal bone cysts (ABC) are rare and they represent 1- 1.4 % of all primary bone tumors. ABC of cuboid bone are extremely rare, especially in children a very few cases have been reported in literature since 1967. We present a case of pathological fracture of cuboid bone due to aneurysmal cyst in a 10 year old girl. Surgery was performed, which included open biopsy with aspiration and intralesional curettage . Bone defect was then filled in by fully synthetic cancellous bone graft substitute, consisting of pure β-tricalcium phosphate. Aneurysmal cyst of cuboid bone with pathological fracture could be successfuly treated with pure β-tricalcium phosphate as a bone graft substitute. This procedure is safe with excellent outcome.Follow up to nearly four years did not show any reccurence
Comparative study of autograft harvested from contra lateral proximal tibia versus the iliac crest for operative management of depressed tibial plateau fractures
No full textOur study evaluates differences in fracture healing, clinical outcome and donor site morbidity between iliac crest bone graft and contra lateral proximal tibial bone graft utilized for internal fixation of displaced tibial plateau fractures. In 34 patients requiring bone grafting, iliac crest was utilized in 16 and proximal tibia in the remaining 18. Fracture union was achieved in all patients in either group at a mean period of 14 weeks with no difference in the functional knee scores between the groups. The iliac crest group showed significantly higher visual analogue pain scores in the immediate post-operative period and greater donor site complications like superficial wound infection, incisional hernia and chronic pain compared to the proximal tibial group. Contra lateral proximal tibia offers a viable alternative to iliac crest as a donor site for bone graft with adequacy of graft quantity, ease of graft harvest and lesser donor site morbidity
Results of cosmetic lower limb lengthening by the lengthening over nail technique
No full textWe reviewed our results following cosmetic lengthening by the lengthening over nail technique (LON) in terms of the importance of patient selection process, bone and soft tissue complications, and functional and subjective clinical outcomes. The study was retrospective by reviewing data from medical records and radiographs. A total of 32 patients, 24 males and 8 females, with constitutional short stature underwent the lengthening over nail technique for cosmetic purposes between 2000 and 2013. Lengthening was performed in femora in 15 patients and in tibiae in 17 patients. All patients who were accepted for cosmetic lengthening underwent a careful selection process that included a psychiatric evaluation. The mean follow-up time was 73 months (range, 12 to 163 months). There were 34 complications.Cosmetic lengthening is not without complications. Patient selection is of paramount importance, as is a detailed preoperative discussion of the procedure and the possible complications. The LON technique is recommended for cosmetic lengthening because it is a minimally invasive technique that provides high patient comfort during lengthening and because it has documented reproducible results
Dynamic hip screw fixation of intertrochanteric fractures without using traction table.
No full textPurpose: To evaluate a new technique of Dynamic hip screw (DHS) fixation without using traction table.Materials and methods: from july 2006 to july 2012, 328 patients undergoing DHS fixation using manual traction technique were evaluated in terms of Tip apex distance(TAD), quality of fracture reduction, operation time, preoperative preparation timeResults: in 97% cases good to moderate reduction could be achieved. The mean TAD was 19.2 millimeters, mean operation time 37 minutes and screw cutout rate was only 0.91%.Conclusion: This technique is easy, reproducible, cheap do not sacrifice reduction alignment, screw position and is extremely beneficial in polytrauma patients where multiple surgeries are to be done.
Comparison of lumbar pedicular dynamic stabilization systems versus fusion for lumbar degenerative disc disease: a meta-analysis
No full textPurpose: The aim of this study was to systematically compare the safety , effectiveness and radiological change after lumbar pedicular dynamic stabilization systems (LPDSS) and fusion for treating lumbar degenerative disc disease(LDDD).Methods: All studies published up to April 30th 2015 comparing various LPDSS with any lumbar fusion for treating LDDD were acquired by a comprehensive search in various databases. After assessment of methodological quality of the trials and extraction of the date, a meta-analysis was performed.Results: A total of 16 trials included 881 patients were identified and reported with a short-term (within 2 years) and middle-term (2-year to 4-year) follow-up . The patients treated with LPDSS compared with lumbar fusion revealed significant advantages in operating time, intra-operative blood loss , complications and adjacent segment degeneration/disease(ASD). Meanwhile, no obvious clinical significance was found in the improvement of ODI, VAS scores, satisfaction rate of operation and the range of motion (ROM) of adjacent segments between the two groups.Conclusions: The results showed that LPDSS had superiority in some ways that part of which still could not be proved comparable to lumbar fusion. What’s more, there was no significant difference in symptoms relieved, functional recovered and motion preserved. In brief, LPDSS was recommended in consideration of the safety, but for the effectiveness and adjacent segment changes, a prudent attitude was necessary in choosing the two operation modes before a large scale and long-term follow-up study
Combination of transpedicular enucleation and Plate-Rod System for single-stage correction of progressive hemivertebral scoliosis
No full textThe purpose of this study is to report the effectiveness of transpedicular enucleation and Plate-Rod System for Scoliosis (PRSS) fixation for the treatment of hemivertebral (HV) scoliosis. 16 patients with progressive HV scoliosis underwent the combined procedure. The technique involves excision of cancellous bone to eliminate the blood supply of the cartilaginous endplate and destroy the superior and inferior vertebral end plates, followed by PRSS fixation to correct the main curve and compensatory curve. The mean age at operation was 8.125±1.82 years. The scoliosis curve was corrected from average 55.06±25.68° preoperatively to 21.25±15.51° postoperatively. At the latest follow-up, the Cobb angle was 24.38±16.44°, and compared with immediate postoperative angle there was no significant difference (P>0.05). No surgical complication of neurological deficits occurred in any patients. Combined use of transpedicular enucleation and PRSS fixation is a safe and effective single-stage method for the management of HV scoliosis in growing children
Long term self esteem assessment after height increase by lengthening and then nailing.
No full textPurpose: to assess the long term psychosocial functioning after height increase, using the external fixation then nailing method.Patients and methods: Rosenberg Self-esteem scale and a questionnaire to assess social functioning were completed by 28 patients both preoperatively and at a mean follow-up of 7 years.Results: The mean total score of RSE self-esteem for the 28 patients before lengthening was 21.5 (SD 1.03) (20-24). The mean total score of RSE for the patients 1 year after lengthening was 22 (SD 1.17) (20-24) with highly significant difference (p = 0.002).The mean total RSE self-esteem score after 7 years was 21.7 (SD 1.12) (21-25) with no significant difference (p = 0.11)Interpretation:improvement was an evident in the short term self esteem after 1 year of follow up of the patients with height increase. On the other hand, there was an evident deterioration in the long term psychosocial evaluation during follow up after 7 years of height increase, returning to near pre-operative levels of self esteem