Acta Orthopaedica Belgica
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Locked rigid antegrade intramedullary nailing of adolescent femoral fractures using a lateral trochanteric entry point
No full textAbstractThe purpose of this study is to present our experience of treating adolescent femoral fractures using a locked intramedullary nail with a lateral trochanteric entry point. We retrospectively reviewed 15 femoral fractures in 13 adolescents who were treated in our unit between 2011 and 2014. Data collected included patient demographics, mechanism of injury, type of fracture, associated injuries, time to union and complications. A radiographic review was also undertaken.The mean time to radiological union in 14 out of the 15 fractures was 13 weeks (range, 10-20 weeks). One patient had a delayed union that required bone grafting and united finally at 30 weeks post injury. The mean difference in the neck shaft angle between the operated and non-operated side was 1.5 degrees (range: -10 to 10 degrees). No patients had infection or avascular necrosis. Five nails were removed after the fractures had healed without complications.Locked rigid intramedullary nailing of adolescent femoral fractures is a safe and effective treatment option when the lateral aspect of the greater trochanter is used as an entry point.
Surgical treatment for developmental dysplasia of the hip- a single surgeon series of 47 hips with a 7 year mean follow up
No full textThe treatment of developmental dysplasia of the hip (DDH) in children remains controversial, we describe the clinical and radiological outcomes of 47 hips in 43 children treated with open surgery by one surgeon between 2004 and 2008 for DDH.The mean age at operation was 25 months (5 to 113) with a mean follow up of 89 months (22 to 169).At the latest follow up 40 of the 45 hips where Severin grades were recordable (89%) were graded as excellent or good, Severin class I or II. Clinically significant AVN (grade II to III according to the Kalamchi and MacEwen classification) was seen in 5 (11%) of the hips.We found a pelvic osteotomy to be a risk factor for AVN (p 0.02) and age at operation to be a risk factor for poor morphology at final follow up (p 0.03).Over 18 months old a pelvic osteotomy should be performed in selective cases depending on intra-operative stability, but we will now consider doing this as a staged procedure and delaying the osteotomy for a period of time after open reduction to reduce the risk of AVN.
Tibial component in total knee replacement: the effect of overhang and sizing on outcome
No full textAIM: The aim of this study was to find a relationship between tibial overhang, malpositioning and oversizing, and the functional outcome. 188 patients were included in this retrospective study. METHODS: All patients completed an Oxford knee score questionnaire at mean follow-up of 5 years. Anteroposterior radiographs of the total knee replacements were reviewed for medial and lateral overhang and oversizing. RESULTS: Lateral overhang was seen in 32.9% of patients with a mean Oxford knee score of 24.7. However lateral overhang proved no significant correlation with the functional outcome. Oversizing was seen in 31.9% of patients and, with a mean of 25.6, oversizing did have a correlation with Oxford Knee score. CONCLUSION: This study confirms that neither medial or lateral overhang of the tibial component influences functional outcome, independent of the severity of overhang. Oversizing the tibial component however, does show worse functional outcome scores at a 5 year review
An analysis of the course of carpal tunnel syndrome before operation
No full textThis work reports the results of an analysis into the course of carpal tunnel syndrome before operation in 479 patients, predominantly women, aged a mean of 58 years, who were scheduled for carpal tunnel operation. The patients were asked to characterise in detail the course of the disease and what determined the decision to undergo surgery. Results. We identified two specific patterns of CTS course: progressive and preservative/mild. Patients with short-lasting disease suffer first of all from symptoms, but the longer the duration, the more pronounced the functional impairment. In a proportion of patients with longer-lasting disease, spontaneous resolution may occur, for up to a year or more. Bilateral involvement is more common than unilateral and the interval between involvement of the other hand is a mean of 10 months. For most patients the primary motivation to undergo surgery is troublesome symptoms (pain and paraesthesia). Functional impairment is of secondary importance, however, its prominence increases in older patients and in those with longer-lasting diseas
A comparison of two minimally invasive procedures for intra-articular displaced calcaneal fractures in older children
No full textThe purpose was to compare the outcomes of displaced intra-articular calcaneal fractures in older children treated with poking reduction and cannulated screws fixation or with plates fixation using a sinus tarsi approach. 50 patients were randomised to operative stabilisation either by poking reduction and cannulated screws fixation (Group A, 28) or by plates fixation using a sinus tarsi approach (Group B, 22). No significant difference between these two groups in radiation time, average length of hospitalization, union time, full weight-bearing time, full physical activity time and the average AOFAS score. However, the patients of Group B had longer operation time (38.0±10.6 min vs. 66.5±9.4 min, P<0.05) and more hospital costs (6200±800 RMB vs. 15000±2000 RMB, P<0.05). Bohler’s angle and Gissane’s angle were significantly restored after surgery (P<0.05)on both groups. Postoperative incision pain was more frequent in Group B than in Group A (P<0.05).Both cannulated screws and plates were efficient methods for intra-articular calcaneal fractures in older children. However, poking reduction and cannulated screws fixation had the shorter operative time, fewer hospital costs and less incision pain.
Bicondylar tibial plateau fractures involving the posteromedial fragment: morphology based fixation
No full textThe aim of this study is to describe the morphology of the posteromedial fragment in the setting of bicondylar tibial plateau fractures and to use it as a base for selection of the method of fixation. Twenty two patients with bicondylar tibial plateau fractures involving the posteromedial fragment were included in this study. Plain X- ray and computed tomogram (CT) were performed in all patients. Thirteen patients were treated by dual plating while nine were treated by single lateral plate. The mean posteromedial fragment height was 39 mm. The cephalad surface area percentage of the posteromedial fragment relative to the entire tibial plateau ranged from 10% to 43%. with an average of 28%. The average knee motion at the final follow up was 110°. Two cases were complicated by implant failure. Morphological study of the osteromedial fragment could help in selection of the proper method of fixation
Lower limb equalization with percutaneus epiphysiodesis of the knee joint area.
No full textIntroductionEpiphysiodesis has become one of the most popular methods in the treatment of leg length discrepancy (LLD) due to its surgical simplicity, short hospitalization time, and a low risk of complications.Patients and MethodsA retrospective analysis was performed on 34 patients treated for LDD with percutaneus epiphisiodesis of the distal femur and/or the proximal tibia. The mean discrepancy was 2.8 cm. The outcome evaluation method was based on Kemnitz et al.ResultsBased on the Kemnitz criteria, 23 (67.6%) patients experienced good results, while 2 (5.9%) satisfactory and 9 (26.5%) poor results. In 47% of patients, swellings of the knee joint were observed in the postoperative period. One serious complication - varus deformity of 10 degrees in femur occurred in the follow-up period.ConclusionsPercutaneous epiphysiodesis is a simple method of the LLD correction, with a low rate of complications and applicable in cases of late LDD diagnosis
Patient restrictions following total hip arthroplasty: a national survey
No full textIn this prospective nation-wide web based survey we describe the current practice regarding patient restrictions following total hip arthroplasty.A web-based survey involving 20 items was developed and tested prior to administration. The questionnaire included general information, type of restrictions, specification and duration of restrictions. The target population consisted of all orthopaedic surgeons registered with the Dutch Orthopaedic Association working at one of the 94 orthopaedic departments in the Netherlands. The response rate of the orthopaedic departments was 78% (n=74). The majority of orthopaedic departments use patient restrictions following THA. Restrictions were used with different rates per type of surgical approach: anterior (69%), anterolateral (100%), straight lateral (94%) and posterolateral (93%). The duration of these restrictions is generally six weeks.Patient restrictions following THA are current practice, regardless of the surgical approach.
Fixation of clavicle alone in floating shoulder injury; functional and radiological outcome.
No full textBackground : The aim of this study was to evaluate the clinical and radiological results of fixation of clavicle alone in floating shoulder injury.From 2007to 2011 thirteen patients with floating shoulder injury (ipsilateral clavicle and scapular neck fracture ) were treated by isolated fixation of the clavicle by plate osteosynthesis . Assessment of the shoulder function was performed using the university of California at Los Angelos (UCLA) shoulder rating scale .The mean duration of follow up period was 24.3 months .All the fractures were united , fractures of the clavicle united from 11to 16 weeks after surgery and that of scapula from 12to16 weeks . The overall UCLA shoulder rating scale was 32.3 (range from 30-34) .Conclusion: Isolated plate fixation of clavicle fracture in floating shoulder injuries results in high rates of both clavicular and scapular fracture healing provided the integrity of coracoclavicular ligament and involvement of the coracoids process with the distal scapular fragment . Key wards ; floating shoulder , fracture clavicle , glenopolar angle , coracoclavicular ligament .
Acute and Chronic Effects of Early Progressive Resistance Training on Knee Pain and Knee Joint Effusion After Unicompartmental Knee Arthroplasty
No full textPurpose: To investigate if progressive resistance training initiated one week after unicompartment knee arthroplasty affect knee pain and knee joint effusion. Methods: Data from a previous randomized control trail was analysed.Knee pain was measured using a visual analogue scale, and knee circumference was used as an indication of knee joint effusion. Comparisons were made between the early (session 1+2) and late (session 15+16) phase of the 8-week intervention (chronic) and between the pre and post levels of single training sessions (acute). Results: Chronic effects: A significant decrease in pre- (55% SD 44%; p=0.004) and post-training (47% SD 53%; p=0.002) pain was observed. Also, a significant decrease in pre- (4.1% SD 3.3%; p=0.0001) and post-training (2.9% SD 2.7%; p=0.0004) circumference was observed. Acute effects: A significant increase in pain was observed in session 5, while a significant increase in circumference was observed in session 6-8, 10 and 13-16. Conclusion: Progressive resistance training initiated in the early post-operative phase following unicompartment knee arthroplasty does not increase the pain level immediately after a training session, despite frequent increases in joint effusion. Furthermore, pre- and post levels of pain and joint effusion dropped significantly following the intervention period.