Acta Orthopaedica Belgica
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Modular bicompartmental knee arthroplasty: current technique, prosthetic design, short and long term results.
No full textThe shifting demographics of patients with localized knee arthritis, including younger, more active patients, is a chief motivation for mounting interest in tissue preserving surgical substitutes for total knee arthroplasty (TKA). Modular unlinked bicompartmental knee arthroplasty (MBKA) is an emerging knee-resurfacing approach that provides a conservative alternative to TKA. Arthritis involving both patellofemoral and medial or lateral tibiofemoral compartments, with no significant deformity or bone deficiency, preserved motion, and intact cruciate ligaments, can be effectively managed with MBKA. Combined patellofemoral arthroplasty + medial or lateral unicompartmental knee arthroplasty is tailored to treat the pathologic areas of such mid-stage arthritis with the benefit of improved function and tissue conservation. MBKA done in appropriate patients, using precise technique, with appropriate implants has shown to give good short and long term functional results compared to TKA.
Virtual 3D planning and patient specific surgical guides for corrective osteotomy of the clavicle: report of three cases.
No full textAlthough many clavicular malunions result in minimal functional deficit, in some symptomatic cases a corrective osteotomy might be necessary. Recently, computer-assisted surgical planning combined with patient-specific surgical guides was introduced as a powerful technology with the potential to improve the accuracy, efficiency, and consistency of corrective osteotomies, as shown for osteotomies in other anatomical regions. We describe the use of this technique in three cases of clavicular malunion
The effect of distraction-based growth friendly spinal instrumentation on growth in early-onset scoliosis
No full textThe benefits and drawbacks of growth friendly spinal instrumentation have been reported as a result of developments in the treatment of early-onset scoliosis. Seventeen patients who underwent growth friendly spinal instrumentation surgery with a minimum 2-year follow-up were included in the review. The mean number of lengthenings was 3, initial surgery age took place at 108.1 ± 30.2 months and follow-up at 40.6 ± 16.6 months. Spinal height (T1–S1 and T1–T12), space available for the lungs, major Cobb angle for scoliosis, maximum thoracic kyphosis, lumbar lordosis, shoulder and pelvic balance, and coronal and sagittal balance were assessed preoperatively and during the latest follow-up. Treatment with growth friendly spinal instrumentation provided an evident increase in spine height and space available for the lungs, and a significant decrease in scoliosis and thoracic kyphosis. In growth friendly spinal instrumentation treatment, the most commonly observed complications were proximal anchor problems (76.4%) and proximal junctional kyphosis (58.8%). In treatments using growing rods, excessive thoracic kyphosis correction should not be made to avoid proximal junctional kyphosis
THE USE OF SUTURE ANCHORS IN AKIN OSTEOTOMY: A NEW SURGICAL TECHNIQUE
No full textBackground: To perform an Akin osteotomy using suture anchors to achieve stability of the osteotomy line and avoid the need for a further operation to remove an implant.Patients and Methods: Akin osteotomy using suture anchors was performed on 35 feet of 30 patients diagnosed with hallux valgus. Preoperative and postoperative clinical evaluation of the patients was made using American Orthopaedic Foot and Ankle Society (AOFAS) scores.Results: Preoperative AOFAS values for pain, function and alignment were measured. Pain values were 8 patients 20 points, function values were, activity, 14 patients 4 points. Post-operative AOFAS values were measured and evaluated as follows. Pain values were 33 patients 40 points, function values were, activity, 30 patients 10 points. These results were found to be statisically highly significant (p<0.001).Conclusion: Rigid fixation was achieved with suture anchors and patients made an early return to normal activities. Postoperative shoes were used for early mobilisation
Risk factors for complications associated with bone lengthening by callotasis
No full textThe present study aims to assess the incidence of complications related to bone lengthening procedures and to identify the risk factors that may predict these complications. We retrospectively studied 71 lengthening procedures in 53 patients (mean age 14.6 years) from 2001 to 2015. A circular external fixator was used in 48 procedures, a monolateral fixator in 20 procedures and an intramedullary lengthening rod in 3 procedures. Duration of distraction, fixator’s time, days of treatment, lengthening percentage, bone healing index, distraction regenerate length, distraction index, risk factors and complications were evaluated. The mean follow-up was 5 years. Complications occurred in 80% of the procedures; 52 % were major complications and 48 % minor. Adult age, duration of distraction, fixator’s time and days of treatment were predictors of complications. Close follow-up is necessary during distraction and healing period and after implant removal.
Median nerve collagen wrapping in revision surgery: Clinical outcome of 10 patients
No full text Nerve wrap protectors are bioabsorbable synthetic materials made of collagen or extracellular matrix that provide a non-constricting encasement for injured peripheral nerves. They are designed to be used as an interface between the nerve and the surrounding tissue. After hydrated, they transform into a soft, pliable, nonfriable, easy to handle porous conduit. The wall of the nerve wrap has a longitudinal slit that allows to be placed around the injured nerve. Τhis article presents the surgical technique for median nerve neurolysis and nerve coverage using a collagen or an extracellular matrix nerve wrap protector in 10 patients with recurrent or persistent carpal tunnel syndrome. All patients had a mean of three previous open carpal tunnel operations, which were not successful. The mean follow-up was 3 years. Under axillary nerve block anaesthesia with the use of pneumatic tourniquet, a standard open carpal tunnel approach was done incorporating the previous incision. Scar tissue was excised in a healthy bed and the median nerve was thoroughly released with external neurolysis. An appropriate length of nerve wrap protector was cut longitudinally according to the length of nerve release. The nerve wrap was loosely sutured with separate polypropylene sutures No. 7-0. A dorsal splint was applied for a mean of 2 weeks followed by progressive passive and active range of motion rehabilitation exercises of the wrist and fingers. At the last follow-up, all patients showed improvement of clinical symptoms, static two-point discrimination test and median nerve conduction studies, and absence of Tinel sign. Differences in outcome and complications with respect to the nerve wrap materials used were not observed.
Eaton and Littler Ligament Reconstruction for the Painful first Carpometacarpal Joint: Patient satisfaction.
No full textThe ligamentous reconstruction according to Eaton and Littler, is designed to restore the stability of the carpometacarpal joint of the thumb. However we saw many patients with persisting pain and loss of thumb function. We evaluated the satisfaction after an Eaton and Littler-procedure as well as possible risk factors in the development of thumb basal joint instability. A retrospective chart review, clinical assessment and telephone survey was executed in 33 patients who had undergone this surgery, with a mean follow-up of 7 years. Only 45% of the patients were satisfied. Within the group of clinical assessed patients, there were significant differences in thumb function comparing operated with not operated side. Hypermobility in the joints can be a contributing factor for this thumb basal joint instability, but has no effect on the outcome after an Eaton-Littler procedure.Eaton and Littler-surgery does not alleviate pain and loss of thumb function in 55% of patients with instability of the basal joint of the thumb.
DHS for subtrochanteric fracture in a pediatric osteopetrotic fracture: a case report and literature analysis
No full textOsteopetrosis is a rare hereditary condition which may have autosomal recessive or autosomal dominant inheritance. Patients tend to present most commonly with fractures but involvement of cranial nerves and hematopoetic system is not uncommon. In fact, patients with infantile and intermediate type tend to present more often with problems other than orthopaedic problems. While diagnosis can be made on the basis of radiographs, management needs to be customized for every patient. Non operative and operative management both have their advantages and disadvantages. We are here reporting a case of subtrochanteric fracture in an eight-year-old child which was managed successfully with a dynamic hip screw (DHS) after closed reduction was unsuccessful. Surgery could be performed successfully by taking precautions during reduction, drilling and screw placement. At the latest follow up, which was after one and half years of surgery the fracture had united well and the child faced no limitations of activities. Thus, a DHS can be considered as effective mean of management of pediatric subtrochanteric fractures in osteopetrosis
Four-Corner Arthrodesis Using Two Headless Compression Screws
No full textWe present the outcome of four-corner wrist arthrodesis using two headless compression screws for fixation. The study group consisted of 27 patients who underwent arthrodesis from 1998 through 2007. Data on demographic parameters, diagnosis, range of motion, pain and complications were collected from the medical files. A total of 77 series of anteroposterior, oblique, and lateral x-rays were reviewed by three independent interpreters; consensus of at least two was required for the bones to be considered fused. Fusion was achieved in 24/27 wrists. Overall, inter-observer agreement in identifying radiographic bony fusion was fair (κ=0.41). At the critical timing, 86 (SD 68) days postoperatively, when the decision regarding fusion was made, inter-observer agreement was poor (κ=0.07). Our rates of fusion are consistent with reports in the literature. Radiographs performed at 3 months after four-corner arthrodesis are not reliable for the diagnosis of fusion
Hoverboards and upper limb fractures in children
No full textPurposeThe purpose of this study is to report our experience of fractures in children riding Hoverboards.MethodsWe undertook a prospective review of all children attending our hospital who sustained fractures whilst riding a Hoverboard. Data such as patient demographics, type of fracture sustained, treatment received, complications and outcome were collected.ResultsTwelve children, 5 males and 7 females with ages ranging from 5.5 to 15.3 years were included in this study. All patients sustained upper limb fractures and the distal radius was the commonest fracture site (30%). Surgery was required in 6 (50%) out of the 12 patients because the respective fractures were displaced. No patient had any ongoing complaints or disability at the last clinic review. ConclusionChildren riding Hoverboards are predisposed to upper limb fractures and parents who purchase Hoverboards should be warned about this.