1,720,980 research outputs found
Lower limb joint repair and replacement: an overview
No full textIn the last few years, much has been published concerning total joint arthroplasty, and debates and discussions to new questions and points of view started many years ago. In this commentary, we report the latest evidence of best practice in the field of lower limb arthroplasty; this evidence is based on a literature search conducted by using PubMed and Scopus databases with a time limit of five years. We found novel evidence regarding cemented and not cemented implant, implant design, anticoagulant use, tourniquets, and other aspects of joints replacement surgery that we consider a common part of modern orthopedic practice. We specifically focus on lower limb joint replacement
Autograft Reconstruction for Chronic Achilles Tendon Disorders
No full textSurgical management of chronic tendon Achilles ruptures usually requires tendon grafting procedures. Several techniques have been described. We describe the use of 3 different minimally invasive tendon transfer techniques in the management of patients with a chronic rupture of the tendon Achilles, undertaking a free transfer of the semitendinosus tendon, or a transfer of the peroneus brevis or flexor hallucis longus tendons. All 3 techniques produce marked functional improvement, and return to sports is possible in most patients. The advantages of one technique over the others need to be explored. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence
Prevalence of Hyponatremia in Elderly Patients with Hip Fractures: A Two-Year Study
No full textObjective: This study investigated the prevalence of hyponatremia in elderly patients (≥65 years old) with hip fractures. Subjects and Methods: All records containing clinical and laboratory data on the 334 elderly patients admitted to the San Giovanni di Dio e Ruggi d'Aragona Hospital of Salerno, Italy, with hip fractures during 2014 and 2015, were retrieved from the hospital database. Patients were divided into 4 groups, according to their sex and the type of hip fracture. Sodium serum concentrations were retrieved from the medical records. Hyponatremia was defined as the presence of at least 1 episode of hyponatremia during the hospital stay. Results: Of 334 elderly patients, hyponatremia was found in 64 (19%). The prevalence of hyponatremia was 18% (28/157) for female patients with extracapsular proximal femoral fracture, 22% (17/79) for female patients with intracapsular proximal femoral fracture, 20% (12/60) for male patients with extracapsular proximal femoral fracture, and 18% (7/38) for male patients with intracapsular proximal femoral fracture. Conclusion: There was a high prevalence of hyponatremia in the elderly patients with hip fractures. Hence, serum sodium concentrations should be regularly assessed to prevent occurrence of hyponatremia
Surgery in Tendinopathies
No full textTendinopathies are challenging. The term "tendinopathy" refers to clinical condition characterized by pain, swelling, and functional limitations of tendons and nearby structures. Tendinopathies give rise to significant morbidity, and, at present, only limited scientifically proven management modalities exist. Achilles and patellar tendons are among the most vulnerable tendons, and among the most frequent lower extremity overuse injuries. Achilles and patellar tendinopathies can be managed conservatively and surgically. Several surgical procedures have been described for both conditions, and, if performed well, they lead to a relatively higher rate of success with low complication
Combined reconstruction of the medial patellotibial and patellofemoral ligaments
No full textBackground. Patellofemoral instability is commonly associated with the rupture of the medial patellofemoral ligament (MPFL), and the role of the medial patellotibial ligament (MPTL) is slowly emerging. Soft tissue reconstructions are able to restore patellar stability. Methods. We present a surgical technique for the combined reconstruction of the MPFL and MPTL using gracilis or semitendinosus tendon (ST) autograft and two patellar tunnels, looping the free end of the tendon graft around the adductor magnus tendon. Results. In this surgical technique the femoral physeal plate is not affected, no femoral tunnel needs to be drilled, no hardware is needed to fix the graft to the bone. Conclusion. The technique described is simple, safe, inexpensive, reproducible and does not require intraoperative fluoroscopy
Defensive antibacterial coating (Dac®) for prevention of infection in acl reconstruction: A feasibility study
No full textDefensive Antibacterial Coating (DAC) is a hydrogel, Conformité Européene (CE)-marked medical device, intended to be used as a disposable, quickly bioresorb-able antibacterial coating for implants. The present feasibility study investigated the application of DAC on the grafts, in addition to IV prophylaxis, during anterior cruciate ligament (ACL) reconstruction
Cell therapies in tendon, ligament, and musculoskeletal system repair
No full textIn the last few decades, several techniques have been used to optimize tendon, ligament, and musculoskeletal healing. The evidence in favor of these techniques is still not proven, and level I studies are lacking. We performed an analysis of the therapeutic strategies and tissue engineering projects recently published in this field. Here, we try to give an insight into the current status of cell therapies and the latest techniques of bioengineering applied to the field of orthopedic surgery. The future areas for research in the management of musculoskeletal injuries are outlined. There are emerging technologies developing into substantial clinical treatment options that need to be critically evaluated. Mechanical stimulation of the constructs reproduces a more propitious environment for effective healing
Impact of an orthogeriatrician on length of stay of elderly patient with hip fracture
No full textSummary: Hip fracture patients are complex, and orthopaedic management is limited to the surgery phase. To provide better evaluation pre-operatively and an optimal level of post-operative care, an orthogeriatrician was introduced in the orthopaedic team. This ensured that time to surgery from admission consistently was below 48 h, decreasing hospitalization time after surgery and total length of stay. Introduction: Hip fractures are a major health issue in elderly and frail patient. The integration of orthogeriatric care within the orthopaedic team could be useful to optimize the clinical conditions of these patients in perioperative phases and stabilize them after surgery, reducing hospital length of stay. The present study evaluates the role of an orthogeriatrician in the management of patients with a hip fracture. Materials and methods: Data about patients admitted and operated from February to September 2018 and from February to September 2019 were collected from the San Giovanni di Dio e Ruggi d’Aragona Hospital of Salerno database. A total of 352 patients were identified and divided in two groups according to the year in which the orthogeriatrician was working in Orthopaedic Department. Records regarding age, sex, side and type of fracture, time of admission, day of surgery and discharge were collected and length of stay, days from the admission to surgery and days from surgery to discharge were calculated. Results: There were no statistically significant differences in the pre-surgery phases of both groups, and all patients were operated at a mean of 2.1 days ± 1.8 SD from admission (p > 0.05). No statistically significant difference between demographic data in both groups (p > 0.01) was observed. There was, however, statistically significant reduction of hospitalization time after surgery and total LOS from 2018 to 2019 (p < 0.01). Conclusion: An Orthogeriatric doctor in an Orthopaedic and Traumatology Department may lead a multidisciplinary approach to manage elderly patients with hip fractures, ensuring that the time to surgery from admission is less than 48 h, and reducing hospitalization time after surgery and total length of stay
Non-insertional achilles tendinopathy: State of the art
No full textThe Achilles tendon is formed by the confluence of the gastrocnemius and soleus muscles and inserts on the posterior surface of the calcaneus. Non-insertional Achilles tendinopathy is common. Recently the importance of inflammation has been re-evaluated. The major symptom in non-insertional Achilles tendinopathy is pain, commonly on first moving after a period of rest. The diagnosis is clinical on the basis of history and presentation, characterised by pain and swelling on the posterior aspect of the tendon insertion. Furthermore, some clinical tests have been described for non-insertional Achilles tendinopathy diagnosis. They can be divided into palpation tests (tendon thickening, crepitus, pain on palpation, the Royal London Hospital (RLH) test, the painful arc sign) and tendon loading tests (pain on passive dorsiflexion, pain on single heel raise and pain on hopping). Imaging techniques, including ultrasound (US) and magnetic resonance imaging (MRI) scans, can be useful to identify the nature, location and extent of a lesion. US may be particularly useful with the addition of power Doppler, because the pain seems to be related to areas of neovascularisation. The first line of management for Achilles tendinopathy is conservative, including nonsteroidal anti-inflammatory drugs, physical therapy, taping, cryotherapy, shock wave therapy, hyperthermia and various peritendinous injections. When conservative treatment fails, between one-quarter and one-third of patients may require surgery
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