Acta Orthopaedica Belgica
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A revisited technique for combined anterior cruciate ligament and anterolateral ligament reconstructions
No full textA new technique for combined anterior cruciate ligament and anterolateral ligament reconstructions is described. An iliotibial band strip is used as an ALL graft , leaving the distal insertion intact and fix it with a knotless anchor on the femoral origin, after tunneling it under the lateral collateral ligament
Role of ilizarov external fixator in treatment of humeral non-union.
No full text Abstract:Introduction:Treatment of non-union of the bone is a challenge, especially when fracture complicated with infection, angulation and translation, which is difficult to be managed by conventional methods.Here, we discussed the technique and the results of treatment of humeral non- union by ilizarov .Methodology:20 patients with 20 humeral shafts nonunion were treated by Ilizarov and debridement, the mean age of the patients was 35.05±11.48 years, there were 13 males and 7 femalesResults: The mean follow up period was 16.2 months. The mean frame-keeping period was 8.1 months. Bony union was achieved in all patients.According to A.S.A.M.I. scale it was excellent in 13 patients (65%), good result in 4 patients (20%), fair in 3 patients (15%) and no poor results.Conclusion: illizarov is effective in various types of humeral non-union, provided that good understanding of the fracture requirements.Level of evidence: IV.Key words: ilizarov, humerus, non-union.
Bi-unicompartmental versus total knee arthroplasty: long term results
No full textObjectives. The hypothesis of the current study is that Bi-Unicompartmental knee arthroplasty (Bi-Uni) could have long term outcomes equivalent to totl knee arthroplasty (TKA).Methods. A total of 19 patients treated from January 1999 to March 2003 with the simultaneous implantation of 2 Unicompartmental knee arthroplasties (UKA) were matched with 18 patients who had undergone a computer-assisted TKA for bicompartmental tibio-femoral osteoarthritis of the knee between August 1999 and September 2002.Results. At the last follow-up no statistical significant differences were seen for KSS, Function score and WOMAC Arthritis Index (pain score), while statistical differences were reported for the function (p<0.05) and stiffness (p<0.01) WOMAC indexes, respectively, in favor of the Bi-Uni group.Conclusion. The results of this study indicate that Bi-Uni is a valid alternative to address medial and lateral tibio-femoral osteoarthritis of the knee in selected cases at least as well as TKA
BILATERAL POSTERIOR FRACTURE DISLOCATION OF THE SHOULDERS: REVIEW OF CASE REPORTS AND TREATMENT
No full textBilateral Posterior Fracture Dislocation (BPFD) of the shoulder is an uncommon but not rare presentation. We describe etiology, diagnostics, treatments and outcome and give a historic review and with a current approach of this pathology. We reviewed 55 cases (110 shoulders), mostly men (49/55) , with a mean age of 49.2 years, mean follow up 21.9 months, mean delay until diagnose of 12.7 days (0-112 days), with a seizure as the cause in 80.0% . Other causes are electrocution, trauma or other. If the mechanism is not clear an epileptic insult should be considered the cause until proven otherwise. Closed reduction or mini open reduction is common in the more dated literature, but gives a overall good outcome. Arthroplasty is the prefered method in the more recent literature. Autografts from the shoulder treated with arthroplasty can be used to reconstruct the articular surface of the contralateral shoulder. High index of suspicion is important and a CT is most important diagnostic tool
Spina bifida neuropathic foot osteomyelitis; results of using ilizarov technique in 46 cases
No full textAbstract:Neuropatheic foot osteomyelitis is a challenging condition for both surgeon and patient, we retrospectively reviewed patients with spina bifida who had chronic foot osteomyelitis presented to our centre from 1995 to 2016. The study yielded 46 patients with chronically infected and deformed feet with a mean age of 31.26 years (range: 18–70 years; SD: 9.61) and Mean follow-up of 5.76 years (range 1- 21years; SD: 3.9). Our technique included a staged debridement IV antibiotics and ilizarov fixation followed by arthrodesis in 44 cases and calcanisation in two cases. American Orthopedic foot and ankle association (AOFAS) score was used to assess the results with a Pre-operative mean of (72.73 ± SD 10.11) and (82.32 ± SD 7.5) at final follow-up respectively, P-value was 0.29. Laboratory, x-ray, CT scans and foot prints were used to assess pre and postoperative results. Overall 76% had good outcome with a plantigrade stable and infection free feet. Those with recurrence were treated with the same technique and achieved the final goal of treatment. Using ilizarov technique in the treatment of neuropatheic spina bifida foot osteomyelitis present a reliable and more suitable option for infected and deformed feet
Conservative treatment of knee osteoarthritis
No full textPurpose: Osteoarthritis of the knee causes chronic knee pain, loss of function and disability in the ageing population. When no treatment is applied, a guaranteed onset of symptoms and/or structural damage can be observed in the diseased knee. This work reviewed the different published guidelines, proposing combinations of weight reduction, physical therapy and rehabilitation, self-management education programs and pharmacological treatment.Methods: Randomized clinical trials, systematic reviews and guidelines were identified using the databases PubMed and Web of Science. Specific journals and reference lists were investigated. Sixty high quality articles were included concerning the conservative treatment of knee osteoarthritis.Results: Weight loss when BMI > 28kg/m2; aerobic, proprioception and strengthening training; NSAIDs (ibuprofen, diclofenac, aceclofenac), IA corticosteroid and IA hyaluronic acid has the highest evidence. The importance of a combined therapy using several treatments is emphasized to assure the greatest positive clinical and structural outcome.Conclusion: To achieve the greatest positive clinical and structural outcome, a combined conservative therapy is recommended
Reintervention rates following hallux valgus correction with the original and a modified Kramer osteotomy
No full text Numerous surgical techniques to correct hallux valgus deformities are performed worldwide, some of which were developed to address problems associated with existing techniques. This retrospective study investigated patient’s outcomes and reintervention rates following the original Kramer osteotomy (KO) and a modified version of the KO (MKO). Results of radiological and clinical were gathered from medical records and long-term follow-up visits. Angular measurements significantly improved and only three minor postoperative complications occurred after both procedures. No significant loss of correction was detected at long-term follow-up. The reintervention rate in the MKO group was 53% and the malalignment rate in the KO group was 18%.Despite promising angular results, both techniques had important weaknesses. MKO had a high reintervention rate, which was even more clinically problematic than malalignment after KO. Given the vast array of surgical techniques to treat this condition, we conclude that better performing options should be considered.
Volar retinacular ganglions (flexor tendon sheath ganglions) - the results of surgical treatment
No full textVolar retinacular ganglions are the third most common group of all ganglions located in the hand and wrist region. The purpose of this work is to present our experience in management and the results of operative treatment of volar retinacular ganglions. One-hundred-and-seven patients were operated-on for volar retinacular ganglions between 2000 and 2014. One-hundred-and-eight ganglions were resected. Complications observed in five patients postoperatively (digital nerve irritation, restricted range of motion of digital joints) resolved within several weeks. At final follow-up, no ganglion recurrence, impairment of finger mobility, innervation or blood supply were observed in any of the patients.Conclusions: Volar retinacular ganglions are solitary, unilocular tumours, with markedly higher incidence in women and equal distribution between body sides. They are most common in the palmodigital crease of the middle and index fingers. Operative treatment of volar retinacular ganglions is associated with a very small risk of permanent complications and recurrence
Efficacy and safety of Aspirin plus intermittent pneumatic compression device as thromboprophylaxis after total hip arthroplasty: prospective randomized control trial
No full textPatients who had total hip arthroplasty (unilateral/bilateral) were randomized to receive prophylaxis with aspirin plus intermittent pneumatic compression device or low molecular weight heparin. After four to six days, all patients underwent bilateral lower-extremity color doppler ultrasonography to screen for deep venous thrombi in the calf, thigh, and pelvic veins. 180 patients (224) joints) were randomized into 2 groups. Prevalence of deep vein thrombosis and pulmonary embolism in Indian patients who underwent total hip arthroplasty was 1.11% and 0.55% respectively. The rates of deep venous thrombosis were 2.22%, in the aspirin plus compression group compared 0% in the low molecular weight heparin group. The rates of pulmonary embolism were 1.11% in the Aspirin plus compression group and 0% in the heparin group, and there were no fatal pulmonary emboli. Within the six weeks and three months follow-up, no thromboembolic events occurred. The rate of major bleeding events was 1.11% in the aspirin and compression group and 10% in the low-molecular-weight heparin group.
Operative Treatment Algorithm for Intra-articular Calcaneal Fractures
No full textDisplaced calcaneus fracture often results in severe permanent sequelae and considerably limits the activities of daily living. In this prospective cohort study we present the outcomes of surgical treatment of 137 displaced intra-articular calcaneal fractures, over 8y period. Follow-up data were obtained up to 3 years post-operatively. Post-operative function was assessed by scoring systems - Creighton-Nebraska Health Foundation Assessment Scale (C-N score) and Ankle-Hindfoot Scale AOFAS (A-H score) and radiographic assessment revealed the accuracy of the position. According to our experience we could advocate percutaneous reduction and screw fixation as the method of choice for Sanders type IIC tongue-type fractures and modified Palmer approach with screw alone, C-nail, K-wires or alternatively an open plate osteosynthesis in Sanders type IIAB depression fractures. For Sanders Type III fractures, we find ORIF with a plate as the most suitable method and an external fixation supplemented with K-wires for Sanders Type IV