Acta Orthopaedica Belgica
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The addition of an anti-rotation screw to the dynamic hip screw
No full textObjectivesThe aim of this study is to assess if there is a difference in outcomes between a dynamic hip screw with or without an anti-rotation screw in the treatment of hip fractures. MethodsAll patients with an intracapsular hip fracture who underwent dynamic hip screw osteosynthesis between January 2010 and December 2013 in three Dutch hospitals were reviewed. Minimal follow-up was one year. ResultsThe study included a total of 364 patients. 24 patients were lost to follow-up and excluded. 297 (87.4%) were in the dynamic hip screw group and 43 (12.6%) in the dynamic hip with anti-rotation screw group. Direct comparison of patient characteristics of the two groups showed significant differences in age, sex, Garden classification and Pauwels classification. Conclusion Patients operated with a dynamic hip screw and anti-rotation screw are significantly younger and their fractures are significantly more dislocated and steeper. To draw conclusions about differences in outcome, a randomised clinical trial should be performed
A DEMOGRAPHIC STUDY OF ACUTE INJURIES IN BASKETBALL PLAYERS
No full textAbstract Studies that analyse the epidemiology of acute injuries in basketball players in European countries are limited. Objective The purpose is to present an overview of the incidence of injuries and injury patterns in Flanders and to correlate them to possible intrinsic and extrinsic risk factors.DesignAll acute injuries that occurred in Flanders during 2009-2013, collected by the insurance, were analysed. The incidence and parameters such as date of birth, date of occurrence of the injury, gender and diagnosis were evaluated. ResultsInjury incidence varied from 7.40% up to 8.45%. Females and players at age 16-17, 14-15 and older than 30 are at higher risk. The ankle/foot region is most frequently injured. There is a higher risk of injury after season-and Christmas break. ConclusionAge, gender and chronometry are risk factors to get injured. Sprains are the most frequent, while the ankle/foot region is the most susceptible to injury.
Coracoid process transfer for anterior shoulder instability: a pectoralis minor sparing method.
No full textBackground: The Latarjet procedure alters scapulothoracic motion by releasing the pectoralis minor insertion to the coracoid. The purpose of this study is to evaluate the feasibility of retaining the pectoralis minor insertion and a part of the conjoint tendon on to the remainder of the coracoid, and to evaluate the efficiency of the procedure in avoiding scapular dyskinesis, without concessions to glenohumeral stability.Methods: We retrospectively reviewed the first 9 patients with a minimum of 6 months of follow up and recorded scapulothoracic position and scapulothoracic motion, patient satisfaction, Oxford score, and Short Form (SF)-36.Results: No scapular dyskinesis was observed at final follow-up. Radiographies consistently showed a bony spur at the original osteotomy site, suggesting a functional attachment of the pectoralis minor tendon to the scapula.Conclusions: Harvesting only the lateral part of the coracoid is technically feasible, efficient in treating anterior shoulder instability and avoids scapular dyskinesis
Outcome following total knee replacement in patients with a previous patellectomy.
No full textAlthough patellectomy is a rarely performed surgical procedure, patients may still progress to develop osteoarthritis of the tibiofemoral compartments leading to total knee replacement surgery. Due to the mechanical disadvantage of a previous patellectomy, it has previously been suggested that a prosthesis with more constraint should be used, however, there are conflicting reports in the literature. We aimed to assess the effects of stability following total knee replacement in patellectomised knee with revision as a primary endpoint. We reviewed the outcome of 25 total knee replacements in our institution in patients with a previous patellectomy. Ten were posterior stabilised and 15 minimally stabilised (including those with a ‘deep dish’). Five of the patients in the minimally stabilised group underwent revision surgery, and 3 of these were early revision due to instability. None of the patients in the posterior stabilised group underwent revision. We conclude that when a total knee replacement is performed in a patient with a previous patellectomy a posterior stabilised implant should be used
Prevention of Complex Regional Pain Syndrome type 1 after conservative treatment of a distal radius fracture with a home exercise program: A proof-of-concept study.
No full textPurpose: Prevention of CRPS-1, a post-traumatic pain syndrome, after a distal radius fracture is important as this syndrome might lead to chronic pain and serious disabilities. In several studies, it was shown that CRPS-1 can be cured with exercise and graded activities.Method: In a prospective cohort study, a home exercise program with progressive loading exercises was applied immediately after cast removal in patients with a distal radius fracture. After three months, patients were interviewed by telephone using the subjective Budapest diagnostic criteria for CRPS-1.Results: In our study, 56 patients were included and 9 patients (16%) scored positive on the subjective diagnostic criteria. None of the 9 patients was diagnosed with CRPS-1.Conclusion: This study indicates that a home exercise program after conservative treatment of distal radius fracture is a safe and effective option to prevent CRPS-1. A larger study is needed to prove the preventive power of this home exercise program.Level of evidence:
Importance of Assistant Intra-operative Medial Distraction Technique for Intraarticular Calcaneus Fractures
No full textPurpose To report the clinical efficacy of open reduction and internal fixation (ORIF) assisted by medial distraction for intra-articular calcaneus fractures. Methods From September 2010 to November 2013, 151 patients with intra-articular calcaneus fractures were treated at our department by ORIF. Medial distraction was used in 27 cases but not in 124 ones. The 2 groups were compatible, without significant differences in preoperative general data (p>0.05). Results The mean duration of surgery in the distraction group (71.6±18.3 minutes) was significantly shorter than that in the non-distraction group (80.4±20.7 minutes), and the varus angle in the distraction group (5.3°±4.4°) was significantly smaller than that in the non-distraction group (10.6°±6.5°) (p<0.05). There were no significant differences in bone union time, American Orthopaedic Foot & Ankle Society score, Böhler angle, Gissane angle, calcaneal axis (p>0.05). Conclusion ORIF assisted by medial distraction technique is effective for intra-articular calcaneal fractures, especially in correcting calcaneal axis
A systematic review of management of scapular fractures
No full textThere is no agreement within literature regarding management of scapula fractures. Our aim was to carry out a systematic review of literature on management of the scapular fractures.Our search across multiple medical databases for studies on the scapular fractures until February 2014 yielded 32 studies. We have excluded case series <7 patients, case reports, review articles, articles without abstract, observational studies and articles on fractures following shoulder arthroplasty.There were 8 prospective case series and one cohort study, however, majority of the included studies were retrospective studies. There were 1237 patients, follow up data were available for 941 patients who underwent either conservative (629) or operative management (512).Non-operative management scapular body fractures had satisfactory results. The scapular neck fractures displaced <10mm have satisfactory outcome following non-operative management. Operative management of displaced glenoid fossa fractures and scapular neck fractures displaced >10mm lead to a better functional outcome
A comparison of outcomes of K-wire vs plate fixation for distal radial fractures with regard to patients’ quality of life
No full textThe objective of the study was a comparison of outcomes of K-wire vs plate fixation for distal radial fractures with regard to patients’ quality of life. One hundred and two patients, 79 women and 23 men with displaced distal radial fractures, were non-randomly allocated for either K-wire (n=72) or palmar plate (n=30) fixation. In general, simpler fractures were fixed by pins, while plates were used for those that were more severe. No statistically significant differences were seen at 3- and 6-month follow-up assessment in any of the analyzed variables: wrist range of motion, total grip and key-pinch strength, and the DASH and SF-36 scores. We conclude that being guided by the postulated algorithm in treatment-choice of distal radial fractures is a reasonable balance between clinical- and cost-effectiveness. We also failed to find any advantage in health-related quality of life as an outcome measure in distal radial fractures compared to standard measures
LISS plate for treatment of distal femoral fracture. Clinical and functional outcomes
No full textIntroduction: The aim of this study is to relate the complexity of the distal femoral fracture and the length of the LISS plate usedMaterial and Methods: A retrospective study of 30 patients with a distal femoral fracture, who underwent distal femur LISS plate (Synthes). Average age of 71 years (20-101). According AO 16 fractures type A, 5 type B, type C and 9. We study the consolidation index, and clinical outcomes by KSS test (Knee Society Score).Results: fracture consolidation on average 16 weeks (14-20 w). KSS value of 77,3 (50-97) at 2 years post-surgical , better results on type C fractures (84,25). According to score only 2 cases with bad functional results (6%).Conclusions: LISS plate let us achieve 94% good-acceptable results. Unlike the literature, the best results were obtained in AO type C fractures, maybe associated to the lower age (53 years) and better functional recovery capacity of this group
Symptomatic venous thromboembolism after trauma surgery – a study on 56.884 procedures
No full textIntroduction: Patients undergoing trauma surgery are at significant risk for developing thromboembolism. Venous thromboembolism rates, especially after less common surgical procedures are unknown. The purpose of this study is to establish data on the incidence of venous thromboembolism in trauma practice following a surgical procedure.
Methods: All surgical trauma procedures between 2006 and 2011 were identified within the Achmea Health Database. This database records medical care to persons insured at the Achmea health insurance company. This is the largest health insurance company in the Netherlands. In the year following the surgical procedure we analyzed if a claim was filed concerning a deep venous thrombosis or pulmonary embolism.
Results: 56.884 surgical trauma procedures were included in the analysis and followed for one year thereafter. Venous thromboembolism development was raised most markedly until 100 days after the surgical procedure. Relatively high incidences of venous thromboembolism were found after surgical lower extremity and pelvic procedures.
Conclusions: The present large database study provides a comprehensive view on the epidemiology of venous thromboembolism after different traumatic injuries requiring a surgical procedure