SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Biomechanical properties of osteoporotic rat femurs after different hormonal treatments: genistein, estradiol, and estradiol/progesterone
No full textIntroduction: The purpose of the study is to compare the effects of genistein, estradiol, estradiol/progesterone combination on the bone mineral density and biomechanical properties of ovariectomized rats’ bone.
Methods: 50 female adult Sprague-Dawley rats were divided into five groups. Bilaterally ovaeriectomy were performed in all groups except the sham-operated group. Groups were a sham-operated group and a control group (water was given), estradiol treated group (17-β estradiol 0.015 mg/kg per day), genistein treated group (genistein 10 mg/kg per day), and an estradiol/progesterone combination group (17-β estradiol 0.015 mg/kg plus drosperinone 0.028 mg/kg per day). The water or hormones were implemented in relevant groups for eight weeks by orogasthric catheter. The bone mineral density and biomechanical properties of the femur were analyzed.
Results: Genistein, estradiol, and estradiol/progesterone groups increased bone mineral density significantly compared to the control group. In diaphysis and metaphysis bending test, all groups had higher peak load values than the control group. There were statistically significant differences between the estrogen/progesterone group and control group in diaphysis bending with regard to peak load. There were statistically significant differences between the estradiol and control groups in metaphysis bending with regard to peak load. In axial rotation test, all groups had higher peak torque values than the control groups.
Conclusions: Genistein, estradiol and estrogen/progesterone combination improved the biomechanical properties of the ovariectomized rat bone. Genistein which has less side effects may be considered as an alternative in the treatment of postmenopausal osteoporosis
CT scan evaluation of glenoid bone and pectoralis major tendon: interest in shoulder prosthesis
No full textIntroduction: The shoulder arthroplasty brings satisfaction to patients in terms of quality of life and indolence. However whether anatomic implant or reverse, it does not escape from the loosening of the glenoid component. Moreover, optimal implantation is required to ensure the functional outcome without shortening of the arm. The purpose of this study is obtain CT scan evaluation of the glenoid bone stock in order to optimize glenoid component implantation and obtain a reference to determine optimal humeral component placement in case of humeral proximal fracture.
Materials and methods: Between 2010 and 2011 we have analyzed 200 intact shoulder’s CT. We measured maximal and minimal width in the transverse plane of the glenoid, the distance from the pectoralis major (PM) tendon to the humeral head, the greater tubercle, change of curvature and the anatomical neck.
Results: Mean maximum width was 27.4 ± 3.4 mm and mean minimum width was 15.5 ± 2.8 mm. Distances between upper edge of PM tendon to: humeral head, greater tubercle, change of curvature and anatomical neck were respectively: 67.6 ± 9.98 mm, 57.8 ± 10.3 mm, 28.7 ± 9 mm, and 34.2 ± 9.7 mm.
Conclusion: Our study has produced an assessment of glenoid bone stock for optimal positioning of the glenoid implant but also to obtain a reference to determine the ideal location of the humeral component in the case of proximal humerus fracture
Lesion of the hip abductor mechanism
No full textIntroduction: The disruption of the abductor muscles of the hip after hip revision surgery often causes limping, pain, and instability of the implant. The purpose of our paper is to describe a mesh technique to repair hip abductor mechanism injuries after hip revision.
Patients and methods: Forty-six patients with hip abductor damage after prosthetic revision were treated. Inclusion criteria were: patients presenting with prosthetic loosening, complaint of pain, and with a positive Trendelenburg sign due to deficient abductor muscle mechanisms. Thirty-one were women (67.39%) with an average age of 64 years (34–82 years). The number of previous revision surgeries was three (two to seven). The Merle d’Aubigné score and variants before and after treatment were also reported.
Results: In the postoperative follow-up after hip revision with the mesh technique, the Merle d’Aubigné score improved and the Trendelenburg sign was negative in 78.3% of the patients (p < 0.001). Also, the Trendelenburg test with the knee flexed was negative in 60.9% (p < 0.001) and the stair-climbing test was negative in 60.9% of cases (p < 0.001). The gluteus medius test in the lateral position was negative in 52.2% of patients, and in the lateral position with the knee flexed it was negative in 47.8% of patients (p < 0.001).
Discussion: Repair of the abductor mechanism with the mesh technique has proven effective for both partial and total lesions
Assessment of outcome after hip fracture: development of a universal assessment system for hip fractures
No full textBackground: The aim of the study was to refine current evaluation systems used to assess outcome after a hip fracture and to devise a simple and practical system to assess all hip fracture patients.
Methods: Three continuous scales were defined for pain, mobility and functional independence. These were all found to have an acceptable degree of inter-observer agreement. The pre-fracture mobility and independence scores were related to the one-year mortality for a consecutive series of 381 patients.
Results: Scores for mobility and functional independence were highly predictive of mortality (p < 0.0001).
Conclusions: It is recommended that the outcome after hip fracture should be standardised to these principle outcomes of pain, regain of mobility and independence and mortality. These scores can be use to assess progress and identify those who may require additional assessment or intervention
Lengthening over nails using the double plate system ONAS-DPS
No full textStable insertion of large Schanz screws behind an intramedullary (IM) nail when lengthening over nails (LON) may be difficult due to the limited bone stock. Additionally, the highly probable contact between the screws and IM nail (which is difficult to avoid) increases the likelihood of infection spreading from the skin via Schanz screws directly to the IM nail. A new device for LON has been developed. Instead of inserting Schanz screws from the external fixator beside the IM nail (as in standard LON), a system of two overlaying plates was constructed. Schanz screws can be fixed to the plates without entering the bone. The plates are fixed to the bone using four angle stability screws. The holes in the plates offer stabile fixation for a chosen angle under which the screw is positioned through the cortical bone. Using the new system there is no need to place Schanz screws behind the IM nail. Instead, Schanz screws pass to the plate and not through the bone. The new system for elongation over IM nail is called “Over Nail Angle Stability-Double Plate System” (ONAS-DPS) [Antolič V (2013) Modular side device with an intramedullary nail for guiding a bone during its lengthening. World Intellectual Property Organization. International Publication number: WO 2013/176632 A1]
When should the external approach be resorted to in the arthroscopic treatment of perimeniscal cyst?
No full textIntroduction: Meniscal cysts very often cause meniscal tears and especially when it is peripheral, some of the healthy parts of meniscus might be needlessly sacrificed. In particular conditions, extraarticular approaches might save some menisci. In the present study, we evaluated the conditions which required using the extraarticular approach in addition to the arthroscopic procedure, to maximally preserve the meniscus.
Methods: Eight patients with perimeniscal cysts were evaluated retrospectively. One cyst was localized within the medial meniscus and seven in the lateral meniscus. The mean age was 36.13 (range; 19–63) years, mean follow-up time, 27.3 (range; 12–47) months. Patients were evaluated by using a Visual Analogue Score (VAS) to measure pain relief and “Lysholm score” to measure functional improvement. In all patients except one, in which the cystic cavity was connected with the joint at the periphery of the meniscus, the cyst was drained from the intraarticular opening. When the cyst was too large (three cases) and in one case where a large amount of meniscus was preserved for reasons mentioned above, additional extraarticular drainage was carried out.
Results: The mean preoperative and postoperative VAS were 6 (range; 2–8) and 1.55 (range; 0–3) (p = 0.00058) and Lysholm scores were 64.75 (range; 48–86) and 93.11 (range; 80–100) (p = 0.0014), respectively.
Discussion: In cysts, which have very limited or no connection with the joint on the most peripheral region of the meniscus and/or are larger than the meniscus height, extraarticular drainage of the cyst might produce unnecessary meniscal loss and function. In the extraarticular drainage, scrapping the walls of the cyst, while inspecting with an arthroscope, reduces recurrence of the cyst
Cementless anatomical prosthesis for the treatment of 3-part and 4-part proximal humerus fractures: cadaver study and prospective clinical study with minimum 2 years followup
No full textIntroduction: The purpose of this study was to evaluate the functional and radiological outcomes of a cementless, trauma-specific locked stem for 3- and 4-part proximal humeral fractures.
Materials and methods: This study consisted of two parts: a cadaver study with 22 shoulders and a multicenter prospective clinical study of 23 fracture patients evaluated at least 2 years after treatment. In the cadaver study, the locked stem (HumelockTM, FX Solutions) and its instrumentation were evaluated. In the clinical study, five senior surgeons at four different hospitals performed the surgical procedures. An independent surgeon evaluated the patients using clinical (Constant score, QuickDASH) and radiological (X-rays, CT scans) outcome measures.
Results: The cadaver study allowed us to validate the height landmarks relative to the pectoralis major tendon. In the clinical study, at the review, abduction was 95° (60–160), forward flexion was 108° (70–160), external rotation (elbow at body) was 34° (0–55), the QuickDASH was 31 (4.5–59), the overall Constant score was 54 (27–75), and the weighted Constant score was 76 (31.5–109).
Discussion: This preliminary study of hemiarthroplasty (HA) with a locked stem found results that were at least equivalent to published series. As all patients had at least a 2-year follow-up, integration of the locked stem did not cause any specific complications. These results suggest that it is possible to avoid using cement when hemiarthroplasty is performed for the humeral stem. This implant makes height adjustment and transosseous suturing of the tuberosities more reproducible
Patellar instability in Indian population: relevance of tibial tuberosity and trochlear groove distance
No full textIntroduction: The tibial tuberosity to trochlear groove (TTTG) distance in the western population is extensively studied through various modalities such as X-rays, computerised tomography and magnetic resonance imaging. However, to our knowledge there is very little or no literature support to indicate that TTTG distance has been studied in the Indian population.
Methods: We therefore undertook a study to measure the TTTG distance in 100 MRI scans of normal Indian knees. Patients with the following co-morbidities were excluded from the study; ligamentous laxity, patellofemoral instability, mal-alignment and osteoarthritis. We measured TTTG distance on the axial MRI slices using OsiriX software.
Results: The mean value for females was found to be 14.07 mm and that for male was found to be 13.34 mm. Our study indicates that the TTTG distance, using MRI scans as measurement modality, in the Indian population is significantly different when compared to the published western data.
Discussion: We believe that this study can form the basis for future studies on the relationship between TTTG distance and patellar instability in Indian population
Meniscus delivery: a maneuver for easy arthroscopic access to the posterior horn of the medial meniscus
No full textPathology of posterior horn of medial meniscus is common and often presents a difficult approach during arthroscopy for various reasons. We describe an easy maneuver to facilitate “delivery of the medial meniscus” during arthroscopy