Acta Orthopaedica Belgica
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Spinal canal and dural sac dimensions in relation to treatment of lumbar disc herniation
No full textThis retrospective study was set up to investigate the predictive value of spinal canal and dural sac dimensions for treatment decisions and clinical outcome of lumbar disc herniation by quantitative MRI measurements in 182 patients.78 nonsurgical and 50 surgical patients were enrolled at final follow-up. The initial JOA score in nonsurgical patients was significantly superior than surgical patients (t-test: p＜0.001),whereas the final JOA score and the rate of improvement had no significant differences (t-test: p＞0.05). 88.46% of nonsurgical nonsurgical and 90.00% of surgical patients had a good or excellent outcome (chi-square test : p＞0.05). However, if the 16 recurrent cases were included, the percent dropped to 75.82% and 84.90%. Comparing with nonsurgical patients, the quantitative parameters such as midsagittal diameter and available diameter of canal, lateral recess width and cross-sectional area of spinal canal and dural sac were significantly smaller in surgical patients (t-test: p ＜0.001). And the initial JOA score was closely related to them (128 cases; Spearman rank correlation coefficient: r 0.01 = 0.486, 0.499, 0.493, 0.507, 0.484; p ＜0.001). In the study population, the patients whose initial MRI images showed smaller dimensions of spinal canal and dural sac tended to surgery for satisfactory outcomes
Surgical treatment of the adult acquired flexible flatfoot
No full textIn this review article, the authors give an overview of the currently available soft tissue and bony procedures in the treatment of the adult acquired flexible flatfoot. Instead of starting from the classification for posterior tibial tendon dysfunction, described by Johnson and Storm, the authors address the flatfoot from a more anatomical point of view. Based on this, they will try to define a treatment algorithm
Short-term results of surgical treatment with cephalomedullary nails for basicervical proximal femoral fractures
No full textThe treatment of basicervical femoral fractures remains controversial. The aim of this study was to examine the efficacy of intramedullary nail use in the surgical treatment of basicervical fractures. In total, 28 patients with basicervical fractures treated with proximal femoral nails were examined retrospectively. Fracture healing was observed in all patients, who were followed at least for 6 months. While the average radiological fracture healing timing was ~10.5 (8-14) weeks, clinical fracture healing occurred in 6 (5-9) weeks on average. Screw cut‑out, avascular necrosis, femur fracture, and surgical wound infections did not occur in any patient. Severe collapse (> 10%) was not noted in any patient. The postoperative mean Harris hip score was 81.2±21.3. Osteosynthesis application with a proximal femoral nail in basicervical proximal femur fractures is a surgical treatment that can be performed with minimally invasive techniques without open surgery. This is a rapid, sound, and simple treatment method with low morbidit
Evaluation of Results of Conservative Therapy in Patients with Transient Osteoporosis of Hip
No full text The aim of this study to evaluate general characteristics of 18 cases with transient osteoporosis of the hip(TOH) in our hospital within 3-year and to present their follow-up results after conservative treatment. Physical examination and laboratory findings, hip graphs and magnetic resonance imaging(MRI), Harris hip scores(HHSs), and treatment and follow-up results of cases were retrospectively evaluated. The mean duration of complaints of 6 females and 12 males was 6.1±2.7 weeks before the treatment. Only hyperbaric oxygen (HBO) therapy and a pair of Canadian crutches, but no medical therapy, were recommended for three female patients since they were on breastfeeding. As a standard management, other patients were protected from weight-bearing with Canadian crutches and underwent medical therapy with diclofenac sodium, acetylsalicylic acid, risedronate sodium and an additional HBO therapy. HHS increased from 55.6±7.8 to 88.8±5.8 on the 3rd month and to 96.0±1.8 on the 6th month after the treatment. Change in score with time was found significant.
Operative management of humeral nonunions. Factors that influence the outcome
No full textAim: The purpose of this study is to present the outcome of surgically treated humeral nonunions and find factors that affect the outcome.Patients and Methods: 45 patients with humeral nonunions (33 shaft, 7 proximal and 5 distal) were reviewed in a prospective manner. Treatment was based on a specific algorithm. Demographics, time to union, range of motion, functional outcome and complications were recorded and analysed.Results: Mean follow-up was 79.3 months and mean time to union was 4.3 months. Infection was associated with delayed union of the pseudarthrosis, while range of motion was negatively affected by the location (proximal) and the AO type of the initial fracture. Complication rate was 16%.Conclusion: The surgical management of humeral nonunions yields a favourable outcome with reduced rate of complications. Infection prolonged healing time, while proximal location of the nonunion and the type B or C fracture according to AO/OTA classification adversely affected range of motion
Treatment of Mallet Fracture using a Percutaneous Fixation Technique with an 18-Gauge Needle
No full textThe purpose of this paper is to introduce a simple and intuitive treatment method using an 18-gauge needle for mallet fractures that involve more than one-third of the articular surface. We performed a retrospective review of 17 patients who underwent closed reduction using an 18-gauge needle with transfixation of Kirschner wire between March 2007 and October 2013. According to the Wehbe and Schneider classification, 15 cases were type IB, 1 was type IIB, and 1 was type IIC. The mean size of bony fragments at the time of injury was 53 percent of the articular surface of the distal phalanx. According to Crawford’s criteria, 6 of 17 patients had an excellent result, 9 had a good result and 2 had fair results. Our method of percutaneous reduction using an 18-gauge needle with transfixation of Kirschner wire is minimally invasive and is useful for the fixation of mallet fractures
Hand disorders associated with diabetes: a review
No full textThe diabetes may cause damage many structures and organs of a human body and predispose to secondary disorders, including involvement of the hand. Carpal tunnel syndrome, trigger finger or Dupuytren’s disease occur more frequently in diabetic patients as well as other, poorer recognized conditions such as limited joint mobility, or hand weakness. The paper presents these disorders, emphasizes differences in clinical presentation, methods and outcomes of treatment, comparing to the non-diabetic patients. Although there are not call complications, some evidence suggests that they may be, as their prevalence is related to the duration of the diabetes, poor metabolic control and occurrence of other disorders such as retino- and nephropathy
Passive mobilization after arthroscopic rotator cuff repair is not detrimental in the early postoperative period
No full textThis prospective randomized study compares the clinical results of immediate passive mobilization versus delayed mobilization in the rehabilitation of rotator cuff repair during the early postoperative period.The mobilization group (79 patients) received immediate daily passive mobilization. The immobilization group (51 patients) was immobilized for 4 weeks until physiotherapy was started. Passive range of motion was noted preoperatively, at 6 weeks and 4 months. Strength was measured preoperatively and at 4 months. Constant-Murley, Simple Shoulder Test, SPADI and UCLA scores were noted at baseline and at 4 months. Ultrasonography was performed at 6 weeks to exclude early failures of repair. We noted no significant difference between the two groups regarding range of motion at 6 weeks and range of motion, strength and functional outcome scores at 4 months. Ultrasound didn’t show a difference in healing at 6 w in either of both groups.Both rehabilitation protocols seem applicable as well as safe in the early post-operative phase