SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Does bone debris in anterior cruciate ligament reconstruction really matter? A cohort study of a protocol for bone debris debridement
No full textBackground: The purpose of the current study was to determine whether a systematic five-step protocol for debridement and evacuation of bone debris during anterior cruciate ligament reconstruction (ACLR) reduces the presence of such debris on post-operative radiographs.
Methods: A five-step protocol for removal of bone debris during arthroscopic assisted ACLR was designed. It was applied to 60 patients undergoing ACLR (Group 1), and high-quality digital radiographs were taken post-operatively in each case to assess for the presence of intra-articular bone debris. A control group of 60 consecutive patients in whom no specific bone debris protocol was applied (Group 2) and their post-operative radiographs were also checked for the presence of intra-articular bone debris.
Results: In Group 1, only 15% of post-operative radiographs showed residual bone debris, compared to 69% in Group 2 (p < 0.001).
Conclusion: A five-step systematic protocol for bone debris removal during arthroscopic assisted ACLR resulted in a significant decrease in residual bone debris seen on high-quality post-operative radiographs
Groin pain in athletes: a novel diagnostic approach
No full textGroin pain in a performing athlete can be very challenging to diagnose and treat. The differential diagnosis includes intra-articular causes, extra-articular causes and non-musculoskeletal causes. A detailed clinical and radiological assessment of groin pain in this group is critical and can identify the underlying pathology. Diagnostic hip block is a valuable tool to differentiate intra-articular causes from extra-articular causes. Hip arthroscopy can help in identifying some of the elusive intra-articular conditions, which were once undiagnosed and therefore, left untreated, resulting in premature ending of competitive careers. This article attempts to explore current thinking on evaluation of groin pain, particularly in young individuals, and to establish a simple protocol for a clinical and diagnostic approach to this difficult problem
Infantile osteoarticular tuberculosis misdiagnosed as Bacillus Calmette-Guerin related osteomyelitis
No full textTuberculosis, a re-emerging public health problem, is uncommon in infancy. Two healthy completely immunized infants presenting with manifestations compatible with osteoarticular infection required surgical debridement. The cultures of the specimens were positive for M. tuberculosis (MTB) complex comprised multiple subspecies. One case was misdiagnosed as a Bacillus Calmette-Guerin (BCG) related osteomyelitis by a polymerase chain reaction (PCR) based on detection of genes at the region of difference 1. Genome extraction and PCR using the rimM gene and sequences analysis against MTB and BCG control samples confirmed that both specimens were infected by M. tuberculosis. The lesions were successfully healed within one year. Surgical debridement of suspected lesions is warranted in infants as a definitive treatment and to obtain tissues for further evaluation. Microbiological cultures only confirm nonspecific MTB complex infection. PCR kits may yield a false positive result. Identification of the pathogen by DNA extraction and sequence analysis should be recommended
Odontoid process fractures: the role of the ligaments in maintaining stability. A biomechanical, cadaveric study
No full textAims: We wished to investigate the role of the cervical ligaments in maintaining atlantoaxial stability after fracture of the odontoid process.
Methods: We dissected eight fresh-frozen cadaveric cervical spines to prepare the C1 and C2 vertebrae for biomechanical analysis. The C1 and C2 blocks were mounted and biomechanical analysis was performed to test the stability of the C1-C2 complex after cutting the odontoid process to create an Anderson and D’Alonzo type II fracture then successive division of the atlantoaxial ligaments. Biomechanical analysis of stiffness, expressed as Young’s modulus, was performed under right rotation, left rotation and anterior displacement.
Results: The mean Young’s modulus in anterior displacement decreased by 37% when the odontoid process was fractured (p = 0.038, 95% confidence interval 0.04–1.07). The mean Young’s modulus in anterior displacement decreased proportionally (compared to the previous dissection) by the following percentages when the structures were divided: facet joint capsules (bilateral) 16%, ligamentum flavum 27%, anterior longitudinal ligament 10%. These differences did not reach statistical significance (p > 0.05).
Discussion: We have found that the odontoid process itself may account for up to 37% of the stiffness of the C1-C2 complex and that soft tissue structures account for further resistance to movement. We suggest magnetic resonance imaging (MRI) of the soft tissues in the acute setting of a minimally displaced odontoid process fracture to plan management of the injury. If the MRI determines that there is associated ligament injury it is likely that the fracture is unstable and we would suggest operative management
Effects of sex differences on scapular motion during arm elevation
No full textIntroduction: Scapular motion during arm elevation is frequently evaluated in patients with shoulder disorders because it provides clinically useful information. With the development of measurement devices and improvement in accuracy, comparisons under various conditions have recently been reported. However, in most of these reports, the subjects examined were limited to males, or a mixed population of males and females. Only a few reports have described sex differences. In the current study, we performed three-dimensional dynamic analysis of arm elevation and investigated whether there is a sex difference in scapular motion.
Methods: Subjects included 18 healthy adult males (18 shoulders) and 19 healthy adult females (19 shoulders). Thirty-seven shoulders were on the dominant side. The age range was 20.5 ± 0.03 years. Subjects performed scapular plane arm elevation, and kinematic data were recorded using an electromagnetic tracking device. Scapular upward rotation and internal rotation angles and the posterior tilt angle accompanying arm elevation were calculated from recorded data. Changes in each angle during scapular motion were recorded according to sex.
Results: There were sex differences in scapular upward rotation and internal rotation angles. The upward rotation angle was significantly greater in males, whereas the internal rotation angle was significantly greater in females. No sex differences were noted in the scapular posterior tilt angle.
Discussion: Findings of this study may serve as basic data for scapular motion during scapular plane elevation in healthy males and females. In addition, it is necessary to evaluate and treat the shoulder while taking sex differences in scapular movement into consideration
Total ureteral avulsion leading to early nephrectomy as a rare complication of simple lumbar discectomy; a case report
No full textIntroduction: Lumbar discectomy constitutes the most common and probably easiest spine surgery but it is not without complications. The aim of this work is to report a case with total ureteral avulsion during lumbar discectomy due to careless advancement of the pituitary rongeur.
Methods: A 59-year-old male presented with refractory left L5-S1 lumbar disc herniation. During the surgery, left sided total ureteral avulsion occurred. Early postoperative progressive abdominal pain was the main clue for further investigation and diagnostic work-up.
Results: Abdominal ultrasonography, intravenous pyelography, and abdominal contrast-enhanced computed tomography (CT) detected a left ureteral injury. Although the injury was detected early, ureteral repair or renal autotransplantation was not possible and nephrectomy was finally indicated, due to a significant ureteral loss.
Discussion: Careful use of discectomy instruments, avoidance of excessive advancement of pituitary rongeurs (more than 3 cm), and thorough knowledge of the relevant anatomy are critical in preventing ureteral injury
Distal radius anatomy applied to the treatment of wrist fractures by plate: a review of recent literature
No full textFew studies on the anatomy of the radial epiphysis have been published in the past 10 years. However, with the availability of new intra- and extra-medullary implants and the recent rash of avoidable iatrogenic injuries, now is the time for a more detailed description of the metaphyseal-epiphyseal regions in the distal radius. Published studies on distal radius anatomy in recent years have focused on three aspects: distal limit and watershed line, dorsal tubercle, and wrist columns. Furthermore, a fresh look at distal radius biomechanics shows that the loads experienced by the distal radius vary greatly. This information should be taken into account during volar plating of distal radius fractures
Community nurse resource implications for a change in heparin prophylaxis policy
No full textIntroduction: A review was undertaken for a consecutive series of hip fracture patients for the year before and then after a change in low dose heparin prophylaxis policy.
Patients and methods: For the first year heparin was administered in hospital for a maximum of 14 days only. Patients sent home before this time were not discharged taking heparin. For the second year heparin was administered as recommended by NICE guidelines for 28 days from admission regardless of whether the patient was discharged.
Results: For the first year 486 patients were treated with a mean of 10.4 doses of heparin per patient. For the second year 465 patients were treated with a mean of 24.3 doses per patient. In total an extra 6,464 doses of heparin were administered. 33.8% of patients were unable to administer their heparin at home therefore a district nurse administered 2,284 of these doses of subcutaneous heparin at the patient’s home. The increased cost associated with the change in policy was estimated to be £161 per patient, with over 90% of this increase being incurred by the district nurse expense. If applied nationally for the England, using extended heparin prophylaxis for hip fracture patients would cost in excess of 12 million pounds each year.
Conclusion: Whilst the necessity for and duration of thromboembolic prophylaxis for these patients remains undetermined, there is a need to re-evaluate the cost effectiveness of the current recommendations for hip fracture patients