Acta Orthopaedica Belgica
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Pain in dupuytren disease: literature review
No full textTo investigate pain and the effect of treatment in patients with Dupuytren disease, we analyzed the literature on pre- and post-interventional pain and complex regional pain syndrome. The pre-interventional pain intensity score of primary Dupuytren ranged from 0.3/10 to 2.0/10. One year after surgery or needle fasciotomy, no significant change of pain could be found. Collagenase therapy significantly reduced the mean pain intensity score from 1.3/10 [SD 2.2] to 0.5/10 [1.5] (p<0.01) after one year. The prevalence of complex regional pain syndrome after fasciectomy ranged from 0% to 12.8%, after needle fasciotomy from 0% to 6.3%, and after collagenase therapy from 0% to 3.0%. We conclude that for most Dupuytren patients, pain is not an issue. A minority seems to suffer pain and collagenase treatment appears to reduce this complaint significantly. However, complex regional pain syndrome is a known complication of Dupuytren treatment, with a low incidence after minimal invasive treatment
Severe hypertrofic ossification after a shoulder arthroscopy: a rare clinical presentation
No full textPeriarticular ossification is a well-known complication after orthopedic surgical procedures, with a predilection of the hip and elbow, and an incidence around 30%-40%(6). Heterotopic ossification is a rare complication after shoulder arthroscopy and is rarely clinically significant. To our knowledge only one series of patients with heterotopic ossification starting from the acromion with comparable radiographic findings and symptoms after shoulder arthroscopy has been described.We report a case of a 65-year old caucasian man with a slow and painful revalidation after arthroscopic shoulder surgery encompassing rotator cuff repair, biceps tenotomy and acromioplasty, with recurrence of impingement symptoms unresponsive to conservative therapy, physiotherapy and one corticosteroid infiltratrion. He developed a severe heterotopic ossification starting from the insertion of the deltoid to the acromion and of the coraco-acromial ligament. This was succesfully treated by arthroscopic excision of the ossifying lesion of the acromion and postoperative prophylactic therapy with nonsteroidal anti-inflammatory drugs as secondairy prevention
Proximal femoral nail antirotation (PFNA) and Hemiarthroplasty in the treatment of elderly intertrochanteric fractures
No full textObjective: To investigate reasonable treatment of intertrochanteric fractures with proximal femoral nail antirotation (PFNA) or Hemiarthroplasty (HA) in elderly patients.Methods: In January 2009 to June 2013 367 patients were admitted in our hospital. Comparison between the two methods (PFNA and Hemiarthroplasty) was done with the time duration of the surgery, intra-operative blood loss, and postoperative weight bearing time, implant complications and The Harris hip score.Results: Results were analyzed after 50 months of follow up. In comparison of the surgical time duration between the PFNA group the Hemiarthroplasty group, Hemiarthroplasty had shorter duration of surgical time. The intra operative blood loss of PFNA was significantly less than Hemiarthroplasty. Post operative weight bearing time was significantly shorter in Hemiarthroplasty than PFNA. Conclusion: For elderly patients with unstable fractures, severe osteoporosis and preoperative mobility can be preferred to Hemiarthroplasty. The proximal femoral nail Antirotation (PFNA) for the treatment of intertrochanteric fractures has been increasingly accepted and widely used
Pelvic Height Planning versus Conventional Templating in preoperative planning of acetabulum cup size for THA
No full textThis study aimed to compare the accuracy of pelvic height planning vs. conventional templating for acetabulum cup. Total 200 consecutive patients underwent primary total hip arthroplasty (THA) were randomly grouped into: group A accepting conventional templating and group B accepting pelvic height planning. Preoperative measurement of acetabular cup was performed with conventional templating and pelvic height planning respectively. There were 57 cases in same size or with one type size discrepancy, 49 with two type size discrepancy, and 14 with three type size discrepancy in group A. There were 145 cases in same size or one type size discrepancy, 20 with two type size discrepancy, and 3 type size discrepancy in group B. The mean difference between the planned size and actual cup was 2.58 ± 0.89 mm vs. 1.38 ± 1.22 mm. The pelvic height planning is reliable to use for preoperative planning when compared with conventional templating
Sagittal Spinopelvic Parameters in Patients with Degenerative Lumbar Spondylolisthesis
No full textThe purpose of this study was to compare various sagittal spinopelvic parameters between patients with and without degenerative lumbar spondylolisthesis (DLS).A total of 165 patients who underwent surgery for low back and/or radicular pain were divided into two groups: those without DLS (non-DLS group; n = 85) and those with DLS (DLS group; n = 80).In all sagittal spinopelvic parameters, no significant difference was found between the non-DLS and DLS groups. The mean pelvic incidence (PI) value of the DLS group (56.4°) was almost similar to that of the non-DLS group (57.5°). The cross-sectional ratio of lumbar musculature was significantly smaller in the DLS group than in the non-DLS group (p = 0.046).Contrary to the results of previous studies, a high PI may not be a predisposing factor for DLS development. Atrophy of back extensor muscles may play a role in the pathogenesis of DLS
Outcomes of reverse total shoulder arthroplasty with postoperative scapular fracture
No full textThe aim of this study is to discuss the functional outcome, clinical outcome and pain scores of scapular fractures and to analyze these outcome results based on fracture location. A systematic review in accordance with the PRISMA guidelines was conducted. A total of 78 RTSA in 12 articles were retained for qualitative analysis. The average minimum follow-up was 33.3 ± 14.4 months (range 12-60 months) and the mean age was 74.4 ± 5.6 years (range 63-85 years) with a mean female percentage of 90.9%. Overall, the mean DASH score was 39.8 ± 9.4 points (range 29.5-48.0 points), ASES score 53.4 ± 23.3 points (range 13.3-95.0 points), SST 3.2 ± 2.2 points (range 0.0-5.1 points), the only OSS 28.0 points and Constant-Murley shoulder score 50.5 ± 20.0 points (range 31.5-69.0). The mean anterior elevation was 91.5° ± 30.7° (range 46.0°-160.0°), abduction 87.8° ± 21.8° (range 55.0°-125.0°), external rotation 33.2° ± 22.2° (range 9.0°-85°) and the only internal rotation was 60.0°. The VAS score averaged of 3.8 ± 2.8 points (range 0.8-9.0 points). A subgroup analysis of acromial and scapular spine fractures was performed. Acromial and scapular spine fractures have an undeniable effect on RTSA outcomes
Neutrophil-to-lymphocyte ratio (NLR) distribution shows an advantage compared to C-reactive protein (CRP) for the early inflammation monitoring after total hip arthroplasty.
No full textThis study aimed to verify whether Neutrophil to lymphocyte ratio (NLR) distribution has an advantage when compared to C-reactive protein (CRP) distribution for the inflammation monitoring after total hip arthroplasty (THA).116 THA patients were retrospectively selected over a 2 years period. They all had available blood tests preoperatively and at postoperative days 2, 4 and 42. Median peak values were compared between CRP and NLR. The effect of demographics on CRP and NLR was tested.At days 4 and 42, 100% and 16.3% of patients had not reached normal CRP (< 10mg/L) while 56.8% and 6.8% of patients had not reached normal NLR (<5) respectively. No effect of demographics on NLR except for age. Older patients had higher NLR (p 0.037).NLR showed a quicker return to normal than CRP. Our results show that NLR seems to be a better marker to follow inflammation after THA than CRP
Nocardia Farcinica infection of a reversed shoulder prosthesis: case report and review
No full textWe present a case of Nocardia farcinica after placement of reverse shoulder prosthesis in a 73-year-old woman. One month after surgery, the patient was admitted to the hospital with a spontaneous drainage of the wound and complaints of aggravating pain in the operated shoulder. There was no history of an immunosuppressive disease or therapy. After cultivation and empiric therapy with flucloxacillin, Nocardia farcinica was found and treated with a combination of intravenous amikacin and ceftriaxone. Eight days after drainage, a rinse and replacement of the polyethylene cup and glenosphere was executed. The treatment was proven to be successful whereas X-ray scans showed no complications nor any other consequences up until five years after therapy. To our knowledge, this is the first shoulder prosthetic Nocardia infection published in English literature. The aim of this report is to review/gather the knowledge about this particular infection and inform health care providers about this uncommon case
Frequency and risk factors of complications after surgical treatment of ankle fractures: a retrospective study of 433 patients.
No full textIntroduction: Ankle fractures are frequent and are associated with a high rate of postoperative complications. Can complications be anticipated and correlated to patient demographics, lifestyle, fracture or surgery related factors?Patients and Methods: we retrospectively reviewed all medical reports of 433 patients who underwent ankle fracture surgery between 2013 and 2017. Multivariate logistic regression was performed.Results: Complications were present in 26% of the cases. The most frequent was poor wound healing (10%) associated with surgical site infection in 6%. More severe fractures happened to be a risk factor for poor wound healing (p = 0,032) and malunion (p < 0,001). Open fractures had respectively 6 to 9 times more mal- (p = 0,012) and nonunion (p = 0,018). Overweight patients with alcohol abuse were doubling their chances of cutaneous (p = 0,030) and infectious (p = 0,040) complications, and tripling their risks of nonunion (p = 0,003). Discussion: Complications of ankle fracture treatment are frequent and their risks increases with complexity of fracture. This study brings new evidence concerning the combined effect of overweight and alcohol abuse on poor wound healing, surgical site infection and non-union
Results Following Surgical Intervention for Fracture Nonunions: Does Diabetes Predict Poor Outcomes?
No full textPurpose: The purpose of this study was to compare the functional outcomes of diabetic patients who were treated for a fracture nonunion against matched controls.Materials and Methods: Sixty-one diabetic patients (type 1 or type 2) were identified from a prospective database. This cohort was paired with matched controls and univariate analysis was performed to evaluate for differences in complication rates, time to bony union and functional outcomes at 3, 6, 12, and greater than 24 months post-operatively.Results: The diabetic group was composed of 29 females and 32 males, with an average age of 58 years, and 17 upper extremity nonunions and 43 lower extremity nonunions. Time to bony union, complication rate or functional outcomes at any follow-up time point did not significantly differ between groups.Conclusions: The comorbidity of diabetes mellitus does not lead to worse functional outcomes or increased complications following surgical treatment for a fracture nonunion