SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Advances in deformity correction, limb lengthening and reconstruction
No full textThis article summarizes the content of this special issue of the journal about: deformity correction, limb lengthening and reconstruction
Single stage en bloc resection of a recurrent metastatic osteosarcoma of the pediatric lumbar spine through multiple exposures – a novel approach
No full textTo obtain a wide resection and safe margins in recurrent spine osteosarcoma, the surgical approach can include – posterior only, combined posterior and anterior, and combined posterior and anterior with a return to posterior in multiple stages. In our case, we used a novel approach of multiple extensile exposures circumferentially in a single stage with a single surgical prep. We present the case of a 9-year-old female with a history of metastatic osteosarcoma, who previously underwent an attempted en bloc resection with an L3 corpectomy and left below knee amputation. At 1 year follow-up, she developed a recurrent solitary spine lesion at the previous surgical resection site. An additional attempt at complete surgical resection was performed with a complex en bloc L2, L3, L4 corpectomy with removal of deep spinal implants and anterior and posterior spinal fusion with instrumentation and revision decompressive laminectomy. The patient had a good functional outcome without neurological deficits, except those resulting from resection of involved lumbar nerve roots. At last follow-up of 5 months, there was no local recurrence or distant metastasis. This approach for revision resection of recurrent spinal osteosarcoma can be performed successfully with clean margins in a safe manner
Motion preservation surgery: excision of juxta C5–C6 intervertebral disc osteoid osteoma using 3D C-arm based navigation: technical report
No full textIntroduction: Precise targeted excision of the C5–C6 osteoid osteoma with placement of reference array on clavicle with minimal disturbance of anatomy and motion.
Methods: A 20-year-old male presented with an osteoid osteoma in the superior end plate of the C6 vertebra abutting the spinal canal causing intractable pain. The authors curetted the nidus using a 3D C-arm-based intraoperative scan integrated with an optical navigation system through a minimal access anterior cervical exposure. The patient reference array was affixed to the left clavicle using a threaded pin.
Results: The postoperative CT-scan revealed complete excision. Follow-up MRI and CT after 12 months revealed C5–C6 intervertebral disc to be intact without evidence of any tumor recurrence. VAS for neck pain improved from 8/10 to 2/10 immediately postoperatively and 0/10 at 1 year follow-up with no limitation of cervical movement. A motion segment was preserved with this technique.
Conclusions: Navigation allowed safe curettage of the nidus with minimal disturbance to the anatomy and motion. The site of attachment of patient reference array on clavicle can be recommended as stable, meeting all the criteria for optimal accuracy and stability
Accuracy of bone resection in total knee arthroplasty using CT assisted-3D printed patient specific cutting guides
No full textIntroduction: We conducted this study to determine if the pre-surgical patient specific instrumented planning based on Computed Tomography (CT) scans can accurately predict each of the femoral and tibial resections performed through 3D printed cutting guides. The technique helps in optimization of component positioning determined by accurate bone resection and hence overall alignment thereby reducing errors.
Methods: Prophecy evolution medial pivot patient specific instrumented knee replacement systems were used for end stage arthrosis in all consecutive cases over a period of 20 months by a single surgeon. All resections (4 femoral and 2 tibial) were measured using a vernier callipers intraoperatively. These respective measurements were then compared with the preoperative CT predicted bone resection surgical plan to determine margins of errors that were categorized into 7 groups (0 mm to ≥2.6 mm).
Results: A total of 3618 measurements (averaged to 1206) were performed in 201 knees (105 right and 96 left) in 188 patients (112 females and 76 males) with an average age of 67.72 years (44 to 90 years) and average BMI of 32.3 (25.1 to 42.3). 94% of all collected resection readings were below the error margin of ≤1.5 mm of which 90% showed resection error of ≤1 mm. Mean error of different resections were ≤0.60 mm (P ≤ 0.0001). In 24% of measurements there were no errors or deviations from the templated resection (0.0 mm).
Conclusion: The 3D printed cutting blocks with slots for jigs accurately predict bone resections in patient specific instrumentation total knee arthroplasty which would directly affect component positioning
Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for closed distal tibial fractures: a meta-analysis of the clinical outcomes
No full textIntroduction: Minimally invasive percutaneous plate osteosynthesis (MIPPO) has emerged as a viable alternative for the treatment of distal tibial fractures. However, the clinical outcomes of this procedure compared to intramedullary (IM) nail fixation have yet to be established. The present meta-analysis aims to compare the clinical outcomes following MIPPO and IM nail fixation for closed distal tibial fractures.
Methods: MEDLINE and EMBASE databases were searched from date of inception to 10th April 2017. Randomized controlled trials (RCTs) comparing MIPPO with IM nail fixation for closed and Gustilo Grade I distal tibial fractures were included. Outcomes assessed included time to union, complications and functional outcomes. Quality and risk of bias of the RCTs were assessed using the Cochrane Collaboration Tool.
Results: Five RCTs comprising 497 patients were included. MIPPO was associated with a longer time to union (MD: 1.08, 95% CI: 0.26, 1.90, p = 0.010, I
2 = 84%) and increased risk of wound complications (RR: 1.58, 95% CI: 1.01, 2.46, p = 0.04, I
2 = 0%). Both MIPPO and IM nail fixation had comparable risks of malunion, delayed union, non-union and deep infections, with similar functional outcomes.
Discussion: Compared to IM nail fixation, a MIPPO fixation technique for distal tibial fractures is associated with a longer time to fracture union and an increased risk of wound complications. Neither technique demonstrates a clear advantage with regard to risk of malunion/non-union, or functional outcome. Assuming equivalent surgical expertise with both techniques, the results suggest that IM nail fixation is the treatment modality of choice for these challenging fractures
Early results of surgery for femoroacetabular impingement in patients with osteonecrosis of femoral head
No full textPurpose: Femoroacetabular impingement and its surgical treatment have not been described before in osteonecrosis of femoral head. We present here outcomes of 15 patients with femoroacetabular impingement secondary to osteonecrosis of femoral head. This results from partial collapse of femoral head, particularly in the anterosuperior region, secondary to osteonecrosis. With subsequent remodelling, periphery of the femoral head flattens and osteophytes form in this area. All these patients were managed with open/arthroscopic osteochondroplasty of femoral head.
Methods: These patients were symptomatic for hip impingement. Cam deformity was studied using computed tomography and magnetic resonance imaging. In six patients open osteochondroplasty was carried out using surgical hip dislocation. In nine patients arthroscopic femoral head osteochondroplasty was done. All the patients were followed up for hip pain (VAS), Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and hip range of motion.
Results: A statistically significant improvement in the VAS for pain, HHS, and WOMAC score was noted. Average HHS improved from 71.3 (SD, 13) to 89.7 (SD, 14.5), p-value 0.0079. Average WOMAC improved from 73.6 (SD, 15.4) to 92.4 (SD, 16), p-value 0.0154. Impingement test became negative in all the patients. A significant improvement in hip ROM was noted. There was no conversion to total hip arthroplasty. All patients could sit on the floor cross-legged and squat.
Conclusion: Some patients with partial collapse of femoral head due to osteonecrosis present chiefly with symptoms of femoroacetabular impingement. They should be identified as osteochondroplasty gives successful results in these patients.
Level of evidence − I
Correction notice to: Early results of total hip arthroplasty using dual-mobility cup in patients with osteonecrosis of the femoral head
No full textArthroscopic excision of intra-articular sub-periosteal osteoid osteoma of elbow: a case report
No full textWe are presenting a unique case of a sub-periosteal osteoid osteoma involving coronoid fossa in a 25-year-old male. He was symptomatic for 2 years and his presentation mimicked mono-articular inflammatory arthritis. His plain radiographs were normal and the computed tomogram confirmed features of a sub-periosteal osteoid osteoma. He was treated with arthroscopic excision of the lesion. Pain relief was noticed immediately after the surgery and maintained at latest follow up of 1 year
Use of the HemiCAP partial hip resurfacing technique for traumatic femoral head osteochondral defects following obturator hip dislocations
No full textFracture of the femoral head (OTA 31-C1.3) following anterior obturator dislocations are a challenging problem as the fractures are often communited, impacted and with loose osteochondral fragments, making surgical fixation difficult. This can result in residual articular defects if the fragments cannot be internally fixed and need be excised, predisposing to secondary osteoarthritis. Treatment options for these defects are limited, have variable results and with limited literature to guide us on outcomes due to the rarity of these injuries. Here, we describe the first use of the technique of partial femoral head resurfacing in two patients with such fractures and report on their long term outcomes
Two cases of combined patellar tendon avulsion from the tibia and patella
No full textAvulsion fractures of the inferior pole of the patella and proximal tibial apophysis are independently rare injuries. They occur in children due to the relative weakness of the apophyseal cartilage compared to the ligaments and tendons. The combination of these two fractures, is exceedingly rare, with only a few previously described cases in the literature. Due to the infrequent presentation of this injury, careful examination and consideration of advanced imaging is important for diagnosis and preoperative planning. Here we present two cases of combined sleeve fractures of the inferior pole of the patella and tibial apophysis, with discussion of the pathophysiology, classification, identification and management of the injury