Acta Orthopaedica Belgica
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Flexible memory-alloy instrumentation for unilateral traspedicular kyphoplasty and guided cement augmentation of the Thoracic spine.
No full textThe purpose of this novel study was to investigate the feasibility of unilateral transpedicular balloon kyphoplasty particularly of the upper thoracic vertebrae using an 11- gauge balloon and cement inserter, and to study the morphological parameters of the thoracic spine pedicles. We usedour fresh frozen cadaveric thoracic spines with intact rib cages and skin for kyphoplasty from T1 to T12 vertebrae under C-arm fluoroscopy.The most limiting width 2.46+/-0.32mm was in the middle levels (T5-T8). The absolute minimum height was at T1 (3.80-3.87mm). All regions of the vertebral body were effectively targeted for cement augmentation.Using the kyphoplasty technique in combination with the pre-bent 11mm memory-alloy cement inserter allowed targeting of the desired position of the vertebral body for effective vertebral body cement augmentation.
level of patient education and proximal humerus fractures: a predictor and screening method
No full textAbstractPurpose:To identify risk factors of functional outcome following proximal humerus open reduction and internal fixation.Methods: Patients treated for proximal humerus fractures with open reduction and internal fixation were enrolled in a prospective data registry. Patients were evaluated for function using the Disability of the Arm, Shoulder and Hand score for 12 months and as available beyond 12 months. Univariate analyses were conducted to identify variables associated with functional outcome. Significant variables were included in a multivariate regression predicting functional outcome.Results: Demographics and minimum of 12 month follow-up were available for 129 patients (75%). Multiple regression demonstrated postoperative complication (B=8.515 p=0.045), education level (B=-6.269,p<0.0005), age (B=0.241,p=0.049) and Charlson Comorbidity Index (B=6.578, p=0.001) were all significant predictors of functional outcome.Conclusion:Orthopaedic surgeons can use education level, comorbidities, age, and postoperative complication information to screen patients for worse outcomes, establish expectations, and guide care
Arthroscopic treatment of the young degenerative
No full textPurpose: We evaluate our experience with arthroscopic interpositioning arthroplasty as a treatment of the young degenerative shoulder joint.Material and Methods: Between 2007 and 2009 ten patients were treated with either a dermal allograft or a meniscal allograft.Results: In seven patients the graft failed and within 13 months these were revised to a total shoulder arthroplasty. Three patients are still satisfied after 7 to 8 years follow-up.Conclusions: Biologic resurfacing of the glenoid may have a role in the management of glenohumeral arthritis in the young and active patient, but the optimal graft and pathology still need to be defined
The Effect of Local and Systemic Application of Tranexamic Acid on The Amount of Blood Loss and Allogeneic Blood Transfusion After Total Knee Replacement: A Prospective Randomized Controlled Study
No full textThe effect of local and systemic Tranexamic Acid on blood loss and need for transfusion after total knee replacement was compared prospectively. Between 2012-2013, 90 patients with unilateral TKR were included. They were randomly divided into 3 and 15 mg/kg TXA was infused before and 10 mg/kg 1 hour after surgery in Group 1, 2 gr TXA was used topically in 2 and no TXA was applied in 3. Total blood loss and transfusion rate were used as outcome. Mean amounts of blood loss were 898.03±151.7, 823.64±126.49 and 898.03±249.46 ml in Groups 1, 2 and 3 respectively. There was a decrease in blood loss in TXA groups (p<0,001). No difference was found between local and systemic groups (p=0,385). Transfusion wasnot required in TXA groups but it was 8 in control group. No thromboembolic problem was seen in any patient. Since TXA decreased blood loss and lessen the need for transfusion significantly without increasing thromboembolic events in TKR, we suggested its usage in TKR either systemically or topically whenever possible.
Management of Osteoporotic Compression Vertebral Fractures
No full textIntroduction: Pathological vertebral fractures including osteoporotic compression fractures are common problems with an incidence which increases as the age of the population increases.The aim of this study is to evaluate the clinical outcome of percutaneous vertebroplasty in patients with refractory pathological fractures.Material and Methods: It is a clinical prospective study conducted on 56 patients. .The patients were assessed pre- and postoperatively with (VAS) with a 0 to 10 scaling . Local anasthesia was used in 51 patients and general anaesthesia was used in 5 patients. Biplanar fluoroscopy was used. Unipedicular approach was used .Results: 87.5% of patients experienced partial or complete pain relief within the first 24 hrs after the procedure. The mean preoperative VAS was 8.4±1.6, which improved to 2.5±0.3 at four weeks after surgery.Conclusion: This mini-invasive procedure can immediately and significantly reduce pain and improve the quality of life of these patients
Investigation of knee pain in the osteoarthritis and neuropathic pain awareness
No full textWe aimed to investigate the awareness of both types of chronic pain among patients and doctors.This prospective study was planned and coordinated by orthopedic and internal medicine clinics and included 100 patients with a diagnosis of knee OA. Patients with an OA diagnosis included those with NP linked to diabetes and those without NP, and these groups were compared using the visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritic Index (WOMAC). Data analysis of both groups focused on descriptive statistics of demographic and clinical characteristics.The average WOMAC pain score for patients with NP was 4.33±1.2 while the score for VAS was 8.25±0.8. Patients without NP had a WOMAC pain score of 2.49±0.6 and a VAS of 6.28±1.8. It was observed that in these two knee OA patient groups, NP had a statistically significant enhancing effect on the WOMAC pain score and the VAS (p<0.001).Currently, when the source of pain that is not relieved after the frequently-performed arthroplasty is considered, the awareness level of NP among orthopedists should be increased and we believe multidisciplinary studies are required on this topic
Tendon balancing in hallux valgus surgery
No full textRecurrent valgus of the hallux after hallux valgus surgery is an unpleasant complication. A possible cause is the imbalance and maltracking of particularly the extensor hallucis longus (EHL) and less frequently the flexor hallucis longus (FHL) or extensor hallucis brevis (EHB) tendon of the hallux. In patients with a tight achilles tendon, the EHL tendon can be recruited to aid dorsiflexion of the foot, creating imbalance. The literature on this subject is very scarce.Materials: In 10 patients with severe hallux valgus, a perioperative evaluation after performing the osteotomies and capsular closure showed tight extensor or flexor tendons of the hallux with residual valgus maltracking. A balancing of the tendons was performed with a realignment -lengthening procedure.Results: A good clinical result was obtained in all patients. No adverse effects were seen after tendon balancing. Strength in all tendons was at least 3+, except in one patient with multiple sclerosis. No weaknesses or difficulties during walking were reported.Discussion: Tendon balancing could play a role in prevention of hallux valgus recurrences and can be performed without loss of strength or compromising of walking ability
The Indirect Cost of Patient Specific Instruments
No full textPurpose To calculate the indirect costs of Patient Specific Instruments (PSI) based on an opportunity cost, cost of efforts and a supply chain cost model to compare PSI for value with conventional total knee arthroplasty (TKA).Methods In 81 patients the total (direct + indirect) cost of PSI-assisted TKA was compared with conventional TKA. Surgical times and coronal mechanical alignment were measured to evaluate the effectiveness of the PSI system.Results Indirect costs (459 euro) make up 40% of the total cost that can run up to 1142 euro for a patient operated with PSI guides. No difference in surgical times or coronal alignment was observed in between both groups.Conclusion Considering the total cost of PSI no value was found for the use of PSI in primary TKA as measured by surgical times or for obtaining a neutral mechanical axis in the coronal plane.
Complications resulting from tracker pin-sites in computer navigated knee replacement surgery
No full textInterosseous pin sites used in Computer Navigated knee Arthroplasty are known to cause complications including infection neurovascular injury, thermal necrosis and peri-prosthetic fracture. Many studies have looked at ways of reducing these risks to improve results in computer-navigated surgery. We present our complication rates and techniques used to reduce complications in a retrospective study of 321 patients performed by a single surgeon in between 2009 and 2013. One patient was identified with a superficial pin site infection. No major complications were recorded during a mean follow up period of 31 months. Attention to detail in every aspect of pin insertion reduces the rates of both minor and major complications. In particular rates of peri-prosthetic fracture were shown to be lower when using a uni-cortical drilling technique compared with the use of bicortical drilling in other studies
unilateral lumbar interbody fusion (ULIF)
No full text Abstract: Results and clinical outcome of a prospective multicenter clinical study involving 100 patients undergoing a lumbar interbody fusion procedure using an unilateral approach to the spine to introduce a new surgical technique as a viable and less invasive alternative to standard posterior (PLIF) or transforaminal (TLIF) lumbar interbody fusion techniques: For certain indications clinical data show that unilateral lumbar interbody fusion (ULIF) offers the surgeon a considerable time advantage compared to standard lumbar interbody fusion techniques