Acta Orthopaedica Belgica
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MANAGEMENT OF BIRTH-ASSOCIATED SUBTROCHANTERIC FEMUR FRACTURESMANAGEMENT OF BIRTH-ASSOCIATED SUBTROCHANTERIC FEMUR FRACTURES
No full textAbstractIn daily clinical practice most orthopedic surgeon suffer doubt about treatment of rare injuries. This study aims enlighten management of birth related femoral subtrochanteric fractures of neonates and remark difficult caesarian breech deliveries as a risk factor.Four birth-related femoral subtrochanteric fractures of neonates treated and followed up. All patients treated with Pavlik harness and union achieved by the fourth week. None of the patients suffer any angulation or limb length discrepancy. Proper management of this type fractures are achieves good results
External fixation versus hemiartroplasty in unstable intertrochanteric hip fractures of the elderly
No full text Purpose: To compare two alternative methods: external fixation (EF) and hemiarthroplasty (HA) in elderly patients with unstable intertrochanteric hip fractures Patients and methods: Forty-two patients with Orthopaedic Trauma Association type 31A2-2 or 31A2-3 fractures treated between January 2007 and December 2010 were included. Twenty-two patients underwent hemiarthroplasty and twenty patients underwent external fixation.Results: The mean length of stay in the operation room was 45 minutes and 108 minutes in the EF and HA groups, respectively (p < 0.05). The mean postoperative length of hospital stay was 2.7 days in the EF group and 4.9 days in the HA group (p <0.05). Functional scores and mortality rates were not different.Conclusions: Since operation time and post operative length of stay in hospital were shorter in the EF group and there were no difference in terms of other comparisons, external fixation which is a method known to be not only less aggressive but also cheaper can be preferred to arthroplasty in the treatment of unstable intertrochanteric fractures of the elderly
Epidemiology of scapular fractures
No full textThe aim of the study has been to acquire basic epidemiological data based on a representative group of patients with scapular fractures treated in one centre.The study analyses group of 250 patients. Diagnostics was based on CT examinations, in 227 cases with 3D reconstructions, in 97 cases compared with operative findings.The most common fracture in the group was that of the scapular body (52%), followed by fractures of the glenoid fossa (29%), fractures of the processes (11%) and fractures of the scapular neck (8%). 61% patients were treated non-operatively and 39 % patients were operated on. The most frequent associated injuries to the ipsilateral shoulder girdle were clavicular fractures (19%).Scapular fractures occur primarily in men, predominantly in 4th – 6th decades. After 60 years of age, there is an apparent increase in the share of women. The exact diagnostics should be based on 3D CT reconstructions
Operative techniques for treatment of chronic massive rotator cuff lesions: Deltoid flap transfer versus arthroscopic debridement.
No full textTreatment of chronic massive RCLs remains challenging. Expensive reconstruction techniques as deltoid flap transfer as well as low invasive arthroscopic debridement techniques were established and showed good results. In present study 106 patients with chronic, massive RCLs were treated by deltoid flap transfer (n=47 group I) and by arthroscopic debridement (n=59 group II). Postoperative outcome was determined by amount of pain, range of motion, shoulder functionality and radiological assessment of acromiohumeral distance (AHD). Statistically analysis was done by the T-Test and Mann-Whitney-U-Test. Both groups showed significant improvement of range of motion compared to preoperative situation, but statistical analysis revealed no significant difference between both groups either in flexion or abduction. Overall shoulder functionality increased significantly in group I (30,2 points) and group II (20,6 points) postoperative, however group I improved significantly more in overall functionality compared to group II (p < 0,01). Therefore, present study showed that surgical treatment with arthroscopic debridement or deltoid flap transfer can improve shoulder function in patients with chronic massive RCLs. Deltoid flap transfer showed significantly better results in overall shoulder function and seems superior regarding clinical outcome. However, a detailed risk-benefit analysis should be done before a deltoid-flap transfer is performed
Lateral pinning versus others procedures in the treatment of supracondylar humerus fractures in children
No full textWe compared results of lateral pinning procedure with crossed pinning, closed reduction, and open reduction. A retrospective review of 184 patients with displaced supracondylar humeral fractures. All patients had a minimum of 2 years follow-up (range 36-90 months). Patients were separated into 4 groups. Success was estimated by Flynn’s criteria. We compared success of the lateral pinning to others procedures. Incidence of nerve palsy was recorded and compared. Esthetic effect of lateral pinning is significantly better than closed reduction (p=0.0007), but no significant difference was found comparing with cross pinning and open reduction. Elbow function was similar. Cross pinning procedure was followed with ulnar nerve palsy in ten patients (20.8%). There was 1 case (5%) of combined nerve palsy including ulnar, median and radial nerve after open reduction procedure. Lateral pinning is safe and effective method of therapy for Gartland type II and III supracondylar humeral fractures.
The Current Role of Coronal Plane Alignment in Total Knee Arthroplasty in a Preoperative Varus Aligned Population: an Evidence Based Review
No full text• BackgroundBased on historical data, the current standard of care in Total Knee Artrhroplasty (TKA) is to restore the overall alignment to a neutral mechanical axis of 0° ± 3° or even slight valgus. However, there is significant controversy in literature regarding intentionally placing the TKA in the patient’s physiologic, rather than neutral (0 ± 3°), mechanical alignment.• Questions/purposesThe goal of this review is to provide a concise update on the present knowledge of frontal plane alignment TKA in a varus population• MethodsA systematic overview of the present literature was undertaken to determine basic science and clinical results in frontal plane alignment in primary TKA.• ResultsResults of studies based on laboratory research, retrieval analysis, cadaver research, finite models, survival scores, clinical outcome, gait analysis and radiographic outcome upon today are provided.• ConclusionsCurrently placement of a TKA in neutral alignment of 0°±3° of frontal plane alignment is the standard of care. However, frontal plane alignment in neutral may not be as strongly correlated to survivorship as previously thought. Caution needs to be exercised before changing the standard of care, and more research needs to be done.
Osteochondral fractures of the knee in skeletally immature patients: Short term results of operative fixation using Omnitech screws.
No full textPurpose:Osteochondral fractures in skeletally immature patients are rare. A retrospective case series is reported looking at the use of Omnitech compression screws for these injuries. Method:Nine patients with a mean age of 14 were included in the study with a mean follow up of 26 months. Results:The average KOOS, IKDC and Tegner Lysholm Scores were 86.7, 90.34 and 96.1 respectively. Conclusion:The use of Omnitech screws in the acute setting for skeletally immature patients shows excellent short-term outcomes.
A comparative study of three approaches for the treatment of lumbosacral tuberculosis
No full textThe posterior (P), antero-posterior (AP), and anterior approaches (A) were performed on 64 patients with lumbosacral tuberculosis respectively and the efficacies of the three approaches were compared in our study. Related data were then collected and compared with an average of 27.0 months follow up. The lumbosacral angles, VAS, ODI, ESR, and Frankel Grade were significantly improved at the post-operation or final follow-up when compared to preoperative scores. The average surgical time, blood loss, and hospital stay following anterior and posterior approaches were markedly less than those following antero-posterior approach. Moreover, there was no tuberculosis recurrence in AP and A group. However, P group had a recurrence rate of 11.1% (2/18). None of the patients in P and A group developed intraoperative or postoperative complications, while two cases were found in AP group. Taken together, anterior approach with the D-rod system is an appropriate method for lumbosacral tuberculosis treatment
Primary epiphyseal and metaepiphyseal tubercular osteomyelitis in children - A series of 8 cases.
No full textAbstractBackgroundThe purpose of our study was to retrospectively review the presentation, healing response and functional results of 8 such cases in children.Material and methodsThe patients were evaluated for pain, deformity, range of motion, limb length discrepancy (if any) and recurrence. Serial radiographs of the region were studied to see remineralization, obliteration of radiological lesions, status of physis and remodeling of the growth plate.Results The mean patient age was 7.1 years. Average follow up was 3.7 years. Knee region was involved in 4, distal radius in 2, shoulder and distal fibula in 1 patient each. The lesions were either localized or diffuse depending upon physeal involvement and osseous destruction. At the last follow up, the involved joints were painfree and had useful range of motion. Limb length lengthening was seen in all knee patients. The diffuse variety resulted in premature physeal closure. The residual lucencies persisted for several years without any clinical manifestations.ConclusionsPrimary epiphyseal and metaepiphyseal tuberculosis was relatively uncommon. The clinical outcome was good following curettage and multidrug antitubercular therapy. The epiphyseal and metaphyseal lucencies persisted for several months even after successful treatment. The diffuse variety lead to premature physeal closure
Aneurysmal bone cystic lesions: value of genomic studies
No full textAneurysmal bone cystic (ABC) lesions can be primary or secondary (to a trauma or a pre-existing benign or malignant tumour). Specific translocations of the USP6 gene are reported in about 70% of primary but never in secondary ABC lesions.We report two cases of ABC lesions in which imbalanced genomic aberrations were detected at initial presentation and showed complex clonal evolution.These demonstrative observations strengthen the guidelines regarding the diagnostic approach when an ABC is suggested by imaging. Biopsy is mandatory including genomic analysis. When a primary ABC is not clearly proven by the initial biopsy, an extensive curettage should be performed, with pathological examination of all removed tissue in order to exclude a secondary ABC. It also illustrates the added value of genomic analyses in the setting of an ABC lesion: complex clonal aberrations argues for a lesion secondary to a malignant proliferation whereas USP6 rearrangement allows the diagnosis of primary ABC