Acta Orthopaedica Belgica
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Is there any correlation between short-term MRI and mid-term clinical results in patients undergoing an Osteochondral Autograft in the knee?
No full textObjective: To evaluate Magnetic Resonance Imaging (MRI) in patients who underwent an Osteochondal Autograft (OA) and correlate them with their clinical results. Methods: 33 patients (mean age 32 years) undergoing OA were retrospectively evaluated. All patients had MRI at mean 6.6 months. Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores evaluated at mean follow-up of 28 months (12 – 88). Results: Tegner Pre-operatively: 6.6, Post-operative: 7.4 (p<0.001). Mean Lysholm: 87, mean IKDC: 86. MRI: complete filling of the lesion in 25 (75.7%) patients, complete integration of the graft in 5 (15.1%) and intact repair tissue in 22 (66.6%) Positive correlation between the degree of repair and filling of the defect and higher Lysholm and IKDC (p<0.05) Conclusions: There is a minor association between short-term MRI and mid-term clinical results after an OA being the degree of repair and filling of the chondral defect the only parameters correlated with patient´s evolution
Does the implant make the difference ? – Prospective comparison of two different proximal femur nails
No full textThe aim of this study was to compare two proximal femur nails with regard to the complication rate and midterm clinical outcome: the InterTAN nail (ITN) versus the third generation gamma nail (GN).78 patients older than 60 years with an unstable intertrochanteric femoral fracture (AO/OTA 31 A2/A3) were randomised over a 20 month period into either ITN (n=39) or GN (n=39). The outcomes of interest were the perioperative implant-related complications and the functional status (Harris Hip Score) at 6 months postoperatively.In 14 of the ITN and in two of the GN procedures the surgeons rated the implant as cumbersome (p=0.002). Functional outcome and complication rate did not differ between both groups. The mechanical failure correlated with the positioning of the lag screw independent on the used implant.The surgeon´s technique (closed reduction, positioning of lag screw) and not implant configuration, is of crucial importance in achieving successful outcome
Do the patients with acute isolated pubic ramus fractures have to be hospitalized?
No full textObjectives: To evaluate the characteristics of acute isolated pubis ramus fractures including hemoglobin level changes.Patients and Methods: 129 patients were included in the study. Hemoglobin levels on admission and at 24th hours were evaluated. Radiographs and computed tomography of pelvis were also evaluated. The patients were divided into subgroups; according to accompanying occult posterior pelvic injuries, receiving anticoagulant-antiaggregant treatment, number of pubic rami fractures (single or multiple), level of the energy (low or high) and zone of the fracture (s). Student t test and Chi-square test were used for statistical analysis.Results: Mean hemoglobin decrease was 1.21 gr/dL. 46 of the patients were under anticoagulant or antiaggregant treatment. 51 of the fractures had occurred with low energy trauma. Posterior ring injuries were observed in 75 of the patients. Hemoglobin level decrease was statistically significant in; high trauma energy etiology, antiaggregant or anticoagulant usage and fractures which was in the lateral half of the superior pubic ramus.Conclusion: It is important to follow all pubic rami fractures closely, because even in low energy trauma hemoglobin levels could decrease significantly. We recommend to hospitalize for monitoring these group of patients
ANGULAR DEFORMITY DEVELOPMENT AFTER THE DISTAL TIBIAL PHYSEAL FRACTURES
No full textSeveral clinical and radiological factors can be prognostic in the development of angular deformity following physeal injuries of the distal tibia. One of the radiological parameters, premature physeal closure (PPC), can be detected during postoperative follow-ups. Aim of our study was to identify the prognostic factors in development of angular deformity and its relationship with PPC.One hundred and four patients treated due to physeal injuries of the distal tibia were included in our study. Patients were divided into three groups based on Salter-Harris (SH) classification. The intergroup relationships between sex, age, the amount of energy sustained during injury, premature physeal closure, the amount of residual gap, and deformity were analyzed.Angular deformity developed in 25% (3/12) of SH Type 2, in 60% (9/15) of Type 3 and 30% (3/10) of Type 4 patients with PPC. A residual displacement of more than 2 mm, age and premature physeal closure were specified as significant risk factors for development of angular deformity.2 mm limit for residual displacement and findings of premature physeal closure in the radiological evaluations during follow-ups are prognostic factors in avoiding malalignment of the distal tibia
5 Year Patient Reported Outcomes and Survivorship of the Triathlon Total Knee Replacement: A Cohort Study
No full textThe aim of this study was to determine outcomes and survivorship of the Triathlon knee replacement up to 5 years post-operation. A cohort of 266 patients receiving a Triathlon knee replacement were assessed before surgery and at 3 months, 1 year, 2 years, 3 years and 5 years post-operation. Assessments included patient-reported outcome measures, American Knee Society Score, complications and survivorship. The largest improvements in pain, function, stiffness and knee-related quality of life occurred in the first 3 months post-operation. Further smaller improvements were reported between 3 and 12 months post-operation, and then a plateauing of outcomes was observed up to 5 years. A high percentage of patients (86%) were satisfied with their outcome at 5 years. Survivorship with revision as the endpoint was 96.6% (95% CI 93.2-98.1%) at 5 years post-operation. In conclusion, this study observed good mid-term patient outcomes and survivorship of the Triathlon knee replacement
Surgical treatment of the Anterior Cruciate Ligament Rupture: where do we stand today?
No full textThe rupture of the anterior cruciate ligament is one of the most common orthopaedic injuries. This review gives an overview of the surgical treatment of the ACL rupture. A correct knowledge of the anatomy of the ACL is crucial in treating this injury. Recent studies describe the ACl as flat rather than divided in distinct structural bundles. Reconstructive and primary repair techniques can be used to approach this native anatomy. Reconstructive surgery of the ACL still is the golden standard in ACL surgery. An individualized approach is key and should be used. However, ACL reconstruction is not always a success. Return to preinjury of sports only reaches 65% and ACL-reconstructed knees are prone to osteoarthritis. Previous attempts at the primary repair of the ACL were archaic and had disappointing results. Modern diagnostics, operative and biological techniques and strict patient selection could initiate a revival of this technique
A meta-analysis of external fixation and flexible intramedullary nails for femoral fractures in children
No full textBackground: The present meta-analysis aims at comparing results of external fixation and flexible intramedullary nails for femoral fractures in children between 5 and 15 years of age.Material and Methods: We searched potential studies in the following database: Cochrane library, PubMed and EMABASE up to May 2014. All randomized controlled trials, Clinical controlled trials and retrospective controlled studies comparing external fixation and flexible intramedullary nails in femoral fractures of children were included. Data was extracted independently for meta-analysis.Results: Seven trials altogether involving 338 cases of femoral fractures of children treated by external fixation (128 cases) and flexible intramedullary nails (210 cases) were included in the meta-analysis. Results showed that flexible intramedullary nails was superior to external fixation in less time to union (p=0.043), lower postoperative infection rate (p=0.001) and refracture rate (p=0.008). It may not increase delayed union, Limb-length discrepancy (LLD), pain and bursitis (p=0.471). Both fixations obtained a similar patient satisfaction.Conclusion: Flexible intramedullary nail had greater advantages for the treatment of femoral fractures in children aged 5-15 years, compared to external fixation based on current meta-analysis. The outcomes will ultimately require a rigorous and adequately powered randomized controlled trials to prove
pre-discharge postoperative radiographs after primary total knee replacement: tradition or science?
No full textABSTRACTBackground and purpose: There is mounting evidence questioning the utility of immediate postoperative radiographs after total knee replacement (TKR). We hypothesized that eliminating the pre-discharge film would not have any effect on the postoperative patient outcomes. Materials and Methods: Retrospective analysis of prospectively collected data was performed on 220 knees from January 2013 to July 2015. Group1- Surgeon A, 112 knees with pre-discharge radiographs and group2- Surgeon B, 108 knees with weight bearing radiographs 6 weeks postoperatively. Results: Greater knee pain was seen in Group 1 (p = 0.01). A cost reduction of approximately $220 per patient was observed with the exclusion of the pre-discharge film. Eliminating routine inpatient pre-discharge radiographs after simple primary TKR does not alter the rehabilitation protocol, identify any of the standard complication or have any medico-legal implications. On the contrary, these films seem to increase postoperative pain and costs
Excision of painful dorsal wrist ganglion by open or arthroscopic approach : A comparison study
No full textPurpose: Dorsal wrist ganglion can be removed through open or arthroscopic excision. The better method for relieving pain remains unknown. In this study, we addressed the following questions: (1) does open excision provide better pain relief than arthroscopic? (2) is there any difference in patient satisfaction, functional outcome, and re-operation rate? Methods: Forty-five patients with painful dorsal wrist ganglions underwent open or arthroscopic excision. Posterior interosseous neurectomy was performed during open excision. Clinical outcomes were assessed with a focus on pain relief. Patient satisfaction, recurrence, and reoperation due to residual pain were also assessed. Results: The average pain scores improved significantly after both, open and arthroscopic excision. However, five patients who underwent arthroscopic excision reported the same or worse pain, whereas all patients who underwent open excision reported postoperative alleviation of pain. The recurrence rate was comparable. Patient satisfaction was better in those who underwent open excision. Reoperation was performed in four patients who had residual pain after arthroscopic excision. Conclusion: Both, open and arthroscopic methods can alleviate pain in patients with painful dorsal wrist ganglion. However, 20% of the patients who underwent arthroscopic excision reported residual or persistent pain
Difficult to treat osteoarticulars infections : Focus on Mycobacterial and Fungal infections
No full textBone and joint infections are rare but often devastating. While bacteria are most commonly encountered organisms, mycobacteria and fungi are less frequent. Management of the latter is often more complex, especially in the presence of foreign material. We will increasingly be faced with mycobacterial and fungal bone infections, as medical conditions and newer therapeutics lead to more immunosuppression. In this article, we will review osteomyelitis, septic arthritis and peri-prosthetic joint infections related to mycobacteria and fungi