Acta Orthopaedica Belgica
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Morbidity and mortality following femoral fractures in the elderly – is the 48 hours limit obligatory?
No full textPurpose: To study the influence of a national quality program for early surgical treatment for fragility hip fractures on patients' outcomes.Methods: A retrospective study comparing consecutive patients, 65 years and older, who were operated for proximal femoral fractures in the two years preceding and succeeding the initiation of the national quality program in 2013. Primary outcome was 1-year survival. Secondary outcomes were surgery within 48 hours, in-hospital complications and mortality, recurrent hospitalizations and orthopedic complications in the post-operative year.Results: 267 patients were treated in 2011-2012, and 328 patients in 2013-2014 were included. Patients' baseline characteristics were comparable. There was an 8% rise in the percentage of patients undergoing surgery within 48 hours. Other outcomes, including 1-year survival did not differ between groups.Conclusion: While the national quality program increased the percentage of patients treated within 48 hours, this was not found to correlate with a beneficial effect, either in the immediate or delayed period
CASE REPORT: Spontaneous swelling of the ankle in a child: a difficult diagnosis
No full textIntroduction: The authors present a case of monoarticular localized pigmented villonodular synovitis (PVNS) in a 7-year old girl. PVNS is a rare benign disease of the synovial tissue. It is especially rare in ankles of children, with only 15 cases reported in literature.Clinical procedure: The girl presented with swelling and pain in the left ankle since 4 weeks. The tentative diagnosis was made after a joint puncture and a MRI scan. A synovial mass with a brown-yellowish appearance was seen during the excisional biopsy. After removing the entire mass and without adjuvant therapy, no recurrence was detected after 12 months.Conclusions: As it is very rare in children, PVNS is easily misdiagnosed. Early diagnosis is important to prevent bone and cartilage damage. A review of the clinical, radiological and therapeutical features of PVNS are presented.
Clinical and Radiologic Outcomes after Arthroscopic Rotator Cuff Repair : Single-row versus Speed-Bridge Technique
No full textPurpose We compared clinical outcome between the Speed-Bridge technique and single-row techniques in patients with full-thickness rotator cuff tears and figured out the patterns of retear by computed tomography (CT) arthrogram and ultrasonography follow-up. Methods 209 patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair and were followed up for at least 2-year were enrolled retrospectively (group 1: single-row repair, group 2: Speed-Bridge repair). Pre- and postoperative data were reviewed to assess clinical and radiologic outcomes. Results There were no significant differences in clinical outcome between the 2 groups. The retear rates of medium and large-sized rotator cuff tear groups were higher in group 1 than in group 2 (p<0.05). There was no significant difference in the medial row failure rate between the 2 groups. Conclusions Present study showed that the knotless suture Bridge technique may be a considerable alternative method for treating full-thickness rotator cuff-tears
Considerable variety in usual care rehabilitation after knee arthroplasty: a survey amongst physiotherapists
No full textKnee arthroplasty (KA) is increasingly performed, but rehabilitation and the possibility of returning to sports after KA are understudied areas. A web-based survey amongst physiotherapists was conducted to obtain insight in current rehabilitation methods and their return to sports advice after KA. 82 physiotherapists (62%) completed the survey. Broad agreement existed concerning important goals of rehabilitation, including the improvement of ROM, muscle strength, coordination and gait pattern. However, physiotherapists use a wide variety of treatment strategies to achieve these goals. Return to low-impact sports is mostly recommended, while return to intermediate- and high-impact sports is either advised against or considered impossible. The development of new evidence-based guidelines on physiotherapy after KA could lead to a more uniform approach in the rehabilitation for KA patients. Furthermore, investigating effects of individualization in the rehabilitation may prove valuable in optimising both patient outcomes and cost-effectiveness of this worldwide increasingly performed intervention
The Threat of Longitudinal Cracking after Distal Radius Fracture Treatment with Volar Locking Plate
No full textThe purpose of this study was to examine the occurrence rate of longitudinal cracks and associated characteristics following volar locking plate fixation of the distal radius. Using case records from Shizuoka Saiseikai General Hospital dated between March 2008 and March 2015, a total of 419 eligible adult patients were identified. Standard anteroposterior postoperative radiographs were evaluated to classify longitudinal crack occurrence. Documented variables were compared between patients with longitudinal cracking and those without. Univariate analyses were conducted among each plate group. There were 38 confirmed cases of cracking (Acu-Loc: n=25, Acu-Loc 2: n=11, VA-TCP: n=2). All cracks healed within 4 to 6 weeks after the operation. Plate type, along with patient age and sex were significantly associated with the occurrence of a longitudinal crack (p<0.05). Although no severe complications related to longitudinal cracking were observed, associated risks for specific patient groups should be considered
Combined Open Reduction and Dega Transiliac Osteotomy for Developmental Dysplasia of the Hip in walking children
No full textThe aim of this work is to analyze a group of patients with DDH treated by combined open reduction and Dega transiliac osteotomy, evaluate the results and determine the advantages, disadvantages, assess the factors affecting the final outcome of such procedure. Prospective study was conducted during the period, November 2010- October 2014, 39 hips, in 29 children, with neglected DDH after walking age, diagnosed late or after failure to respond to previous non operative treatment. Mean age at time of surgery, 27.6 months (18-48 months). Mean follow up period 33.6 months (18-48 months). At the end of follow up, satisfactory final clinical results were obtained in 34 hips (87.2%) and unsatisfactory in 5 (12.8%) according to the McKay's criteria. Radiologically, satisfactory results were obtained in 32 hips (82.1%) and unsatisfactory in seven (17.9%), according to Severin's criteria. In conclusion, the results of our series show open reduction combined with Dega transiliac osteotomy to be a safe and efficient method for the surgical treatment of DDH in selected patients, and can easily and safely be combined with associated procedures for single stage correction of acetabular dysplasia
Late function and complications of hook plate implantation for distal-third clavicle fractures: a retrospective study
No full textIn this study, we examined data for 61 patients with Neer type II clavicle fractures treated with hook plate implantation between January 2008 and February 2011. The patients were divided into three groups depending on when the plates were removed after the fractures had healed: early removal (<3 months, n=20), delayed removal (3–6 months, n=35), and retained plate (>6 months, n=6). All patients underwent clinical and radiographic follow-up. Shoulder function was evaluated using the Constant shoulder score. All 61 patients were followed in the outpatient department for a median of 18 months. All fractures had healed. The mean Constant shoulder score was greater, indicating better function, in the early than delayed removal and retained plate groups (96 [range 89–100] vs. 77 [65–89] and 61 [57–78], respectively; p=0.000). The complication rate was 10, 22.9, and 50% in the early and delayed removal and retained plate groups, respectively (p=0.043). In summary, the timing of the removal of the hook plate for distal clavicle fractures plays an important role in subsequent shoulder function and complications
Management of spinal trauma patients: A national survey in The Netherlands.
No full textLack of consensus in spinal trauma management and differences in the practical organization between trauma regions can have significant consequences on the fate of patients with spine trauma. For this reason a national survery was conducted among the 11 trauma regions in the Netherlands. Representative surgeons were sent a survey on seven areas of spinal trauma management: (1) treatment protocol, (2) referral, (3) advisory committee, (4) classification used, (5) responsible medical specialist, (6) timing of surgical intervention, and (7) the current view on spinal trauma care. All 11 centers completed the survey yielding a response rate of 100%. The results of this study shows that in a relative small country, a tremendous variability in all seven areas differs substantially and can be of use to show the possible areas of discrepancies between trauma centers in comparable European countries
Long-term functional and radiological outcome after AC Tightrope® fixation in patients with acute Rockwood type III-VI acromioclavicular joint dislocation
No full textPurpose: The purpose of our study was to evaluate the clinical and radiological outcome after a single AC TightRope® fixation in patients with an acute Rockwood type III-VI AC joint dislocation.Methods: We performed a retrospective cohort study of patients who underwent AC TightRope® fixation for an acute Rockwood type III-VI AC joint dislocation. During follow up functional outcome was assessed using the Constant Shoulder Score (SSC) and the UCLA Shoulder Rating Scale. A standard anteroposterior x-ray of both the operated and the contralateral shoulder was performed. The coracoclavicular (CC) distance was measured and compared with the day 1 postoperative x-ray.Results. Twenty-nine patients participated the study. Mean follow up time after surgery was 43,4 months. Clinically the results were excellent: The mean Constant Shoulder score was 91, the mean UCLA score was 33. Radiologically some secondary loss of reduction was seen. Following radiological findings were seen: Clavicular tunnel widening, coracoclavicular calcifications, and osteolysis at the clavicular button site.Conclusion: Patients treated with a mini-open single AC TightRope® fixation had excellent long-term functional outcomes
Dislocation of modern design rotating hinge total knee arthroplasty: case series and narrative review
No full textThe aims of the study were to describe our experience with dislocations after rotating hinge total knee arthroplasty (RHTKA) in a consecutive prospective large series, its occurrence rate, causative mechanisms and to perform a literature review. In total, six dislocations were observed in 303 RHTKA procedures (2 primary and 4 revision) at a mean of 10 months after surgery. This resulted in a 2% dislocation rate, which is lower than the 3.1% cumulative rate reported in literature. Men and women were distributed equally, most of them (83%) were severely obese (BMI 34-52).The main mechanism of hinge dislocation was forced knee flexion with concomitant extensor mechanism insufficiency (four cases, 66.6%). The second cause was unscrewing of the locking pin (two cases, 33.3%).Improvements in the hinge design, as to better secure the locking pin to prevent unscrewing, seem advisable. A fixed hinge implant may be more optimal than RHTKA when extensor mechanism is deficient and its reconstruction is not possible or has failed.