SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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THINK surgical TSolution-One
No full textTHINK Surgical TSolution-One® is an active-autonomous, image-based, robotic milling system which enables the surgeon to attain a consistently accurate implant component positioning. The TSolution-One® system is capable of achieving this through an image-based preoperative planning system which allows the surgeon to create, view and analyse the surgical outcome in 3D. The accuracy and precision of component positioning have been attributed to the following factors: customized distal femoral resection, accurate determination of the femoral rotational alignment, minimization of errors and maintenance of bone temperature with robotic milling. Despite all these advantages, there is still a paucity of long-term, high-quality data that demonstrates the efficacy of robotic-assisted total knee arthroplasty (TKA). Questions regarding radiation risks, prolonged surgical duration and cost-effectiveness remain unanswered. This paper aims to describe: (1) TSolution-One® surgical technique; (2) limitations and complications; (3) clinical and radiological outcomes
Slipped capital femoral epiphysis: a review of management in the hip impingement era
No full textSlipped capital femoral epiphysis (SCFE) remains the most common adolescent hip disorder. Most cases present with stable slips, and in situ fixation is the most commonly adopted treatment worldwide. The introduction of the concept of femoroacetabular impingement and subsequent studies have revealed SCFE-related hip impingement to be a significant pre-arthritic condition, and the previously suggested remodeling of the proximal femur after in situ fixation has been called into question. Complex proximal femoral osteotomies and more recently intra-articular procedures via surgical hip dislocation have been employed. The literature is still lacking a strong evidence to undertake such aggressive procedures. Moreover, the application of a particular procedure regarding the nature of the slip, being stable or unstable, the degree of the slip, and the condition of the physis has not been extensively described in the literature. The purpose of this article is to outline the SCFE-related hip impingement, to review the best evidence for the current treatment options for both stable and unstable slips, and to develop an algorithm for decision making
The Paley ulnarization of the carpus with ulnar shortening osteotomy for treatment of radial club hand
No full textRecurrent deformity from centralization and radialization led to the development in 1999 of a new technique by the author called ulnarization. This method is performed through a volar approach in a vascular and physeal sparing fashion. It biomechanically balances the muscle forces on the wrist by dorsally transferring the flexor carpi ulnaris (FCU) from a deforming to a corrective force. The previous problems of a prominent bump from the ulnar head and ulnar deviation instability were solved by acutely shortening the diaphysis and by temporarily fixing the station of the carpus to the ulnar head at the level of the scaphoid. This is the first report of this modified Paley ulnarization method, which the author considers a significant improvement over his original procedure
Total hip arthroplasty via the direct anterior approach with a dual mobility cup for displaced femoral neck fracture in patients with a high risk of dislocation
No full textIntroduction: Although total hip arthroplasty (THA) is superior to bipolar hemiarthroplasty (BHA) for displaced femoral neck fracture in terms of hip pain, function and reoperation rate, THA has a higher rate of dislocation. The direct anterior approach (DAA) and a dual mobility cup (DMC) are associated with lower rates of dislocation. The aim of this study was to investigate the outcomes of THA compared with BHA, and in those patients who had a THA we investigated those with a DMC (DMC-THA) and compared them with those had a single conventional cup (Single cup-THA).
Materials: A total of 89 patients living independently were included between 2009 and 2015. We assessed patient characteristics, peri- and post-operative outcomes, walking ability and one-year mortality. Adjusted odds ratios (Adjusted ORs) were estimated for decrease of walking ability and one-year mortality using a logistic regression model with adjustment for potential confounders such as age, neuromuscular diseases with weakness, duration of surgery, perioperative blood loss and preoperative walking ability.
Results: BHA (20 patients) versus THA (69 patients): There was no significant difference in the walking ability in either group. Multivariable logistic regression analysis demonstrated a significant association with one-year mortality in both groups [THA Adjusted ORs 0.088 (95% CI 0.0007–0.69); p = 0.020]. Single cup-THA (36 patients) versus DMC-THA (33 patients): The DMC-THA group had significantly greater age and more patients with neuromuscular diseases with weakness compared with the Single cup-THA group. Multivariable logistic regression analysis demonstrated no significant difference in the decrease of walking ability and in the one-year mortality between the groups. There were no post operative dislocations in any group.
Discussion: THA via the DAA is one of the best treatments for displaced femoral neck fracture with a low risk of dislocation. THA via the DAA with a DMC is a safe and effective treatment for the patients with a high risk of dislocation
Arthroscopic-assisted retrograde mosaicplasty for an osteochondral defect of the femoral head without performing surgical hip dislocation
No full textOsteochondral autograft transplantation (mosaicplasty) for the osteochondral defects of the femoral head is generally performed with safe dislocation of the hip joint. Here, we present a 27-year-old male patient who had a symptomatic osteochondral defect of the femoral head and underwent mosaicplasty applied by hip arthroscopy without surgical hip dislocation. The preoperative radiological evaluation showed a focal osteochondral defect on the weight-bearing surface of the femoral head. With the assistance of hip arthroscopy, the defect area was reconstructed with osteochondral plug, which was taken from the ipsilateral knee, inserted in a retrograde fashion, and positioned with the spherical surface of the femoral head cartilage under fluoroscopic and arthroscopic control. At the final follow-up (26 months postoperatively), he had full range of motion (ROM) without pain and radiographic evaluation showed near complete incorporation of the graft with preservation of the native joint space. Mosaicplasty can be applied in a retrograde fashion with the assistance of hip arthroscopy without using surgical hip dislocation and may be an alternative treatment option for the osteochondral defects of the femoral head in young patients
Pediatric cervical spine injuries with neurological deficits, treatment options, and potential for recovery
No full textPurpose: The purpose of the present study was to highlight the challenges in managing cervical spine injuries in children with neurological deficits.
Introduction: Cervical spine injuries in children are relatively rare. Pattern, severity, and level of these injuries are age dependent. Neurological deficits in young children are uncommon and usually have a good potential for recovery.
Patients and methods: This report includes four cases with pediatric cervical spine injuries with variable degrees of spinal cord injuries and neurological deficits. All the four patients were five years old or younger at the time of injury. Those patients were presented with different patterns of injuries and the treatment was customized for every patient. Marked neurological improvement occurred in all patients at the last follow-up.
Conclusion: The treatment of pediatric cervical spine injuries should be individualized. Children with stable injuries should do well with non-operative treatment while operative treatment is recommended when the indication is appropriate and the expertise is available. Neurological deficits due to spinal cord injuries in pediatric patients have a high potential for recovery, provided that adequate management is considered
Combined three-part humeral anterior fracture-dislocation and humeral shaft fracture treated with one-stage long stem shoulder hemiarthroplasty in an active elderly patient
No full textIntroduction: Injuries combining a humeral head fracture-dislocation and a shaft fracture of the ipsilateral humerus are very rare. They should be separated from extended fractures of the humeral head to the shaft [
Kerboull-type plate in a direct anterior approach for severe bone defects at primary total hip arthroplasty: technical note
No full textIntroduction: For cases with extensive acetabular bone defects, we perform surgery combining the Kerboull-type (KT) plate and bone graft through direct anterior approach (DAA) in primary total hip arthroplasty (THA) requiring acetabular reconstruction as minimally invasive surgery. This paper provides the details of the surgical procedure.
Methods: The basic structure of the Kerboull-type plate is a cruciform plate. Since the hook of the Kerboull-type plate has to be applied to the tear drop, a space for it was exposed. The tear drop is located in the anterior lower region in surgery through DAA in supine position. It was also confirmed by fluoroscopy as needed. The bone grafting was performed using an auto- or allogeneic femoral head for bone defects in the weight-bearing region of the hip joint.
Results: Of 563 patients who underwent primary THA between 2012 and 2014, THA using the KT plate through DAA was performed in 21 patients (3.7%). The mean duration of postoperative follow-up was 31.8 months. The mean operative time was 188.4 min, and the mean blood loss was 770 g. The patients became able to walk independently after 2.4 days on average (1–4 days). On clinical evaluation, the modified Harris Hip Score was 45.6 ± 12.4 before surgery, and it was significantly improved to 85.3 ± 8.97 on the final follow-up.
Discussion: DAA is a true intermuscular approach capable of conserving soft tissue. Since it is applied in a supine position, fluoroscopy can be readily used, and it was very useful to accurately place the plate
Extraskeletal osteochondroma within the iliopsoas muscle: case report
No full textOsteochondromas, occurring usually in the metaphyses of long bones, are among the most frequent benign musculoskeletal neoplasms and both their sporadic and hereditary variants have been studied extensively. Extraskeletal osteochondromas, however, are much less common. They have been shown to arise near joints or synovial spaces of feet, hands, or bursae. Herein, we present a very rare case of an extraskeletal osteochondroma within the iliopsoas muscle
Arthroscopic osteochondral autologous transplantation for the treatment of osteochondritis dissecans of the femoral head
No full textOsteochondritis dissecans (OCD) of the femoral head is an unusual cause of hip pain. It can be associated with other intra-articular pathologies including: acetabular labral tears or bone deformities such as Legg-Calve-Perthes Disease (LCPD). In this article, we propose a modern surgical technique using an arthroscopic antegrade and retrograde osteochondral autologous transplantation (OAT) procedure for assessing and treating OCD lesions of the femoral head