1,720,978 research outputs found
Magnetically controlled growing rods for early scoliosis treatment in coffin-siris syndrome. Case report and literature review
No full textCoffin-Siris Syndrome (CSS) is a rare, genetic syndrome characterized by multiple anomalies, including scoliosis. However, there are only a few reports about the management of scoliosis in these patients. We present the case of an 8-year-old female with CSS presenting with a progressive, rigid thoracolumbar kyphoscoliosis. She was successfully treated with a magnetically controlled growing rod, demonstrating improved ambulatory capacity and performance of activities of daily living. In pediatric patients with Coffin-Siris syndrome, magnetic expandable rods can be considered as an option for the management of progressive early-onset scoliosis. Level of Evidence: V
Efficacy of the assisted self-reduction technique for acute anterior shoulder dislocation.
No full textIntroduction: The "original" traction-free Kocher's method to perform the reduction of shoulder dislocation has been recently reviewed and some authors speculated that it can be self performed by patients under the guide of the physician. In this way, as an "assisted self-reduction" technique, it is also effective and simple to perform. The aim is to study the effectiveness of the assisted self-reduction technique, in comparison to the well known and largely used traction-countertraction method.
Materials and methods: From a consecutive series of 237 uncomplicated anterior shoulder dislocations, a total of 61 were managed by the residents of our institution under the supervision of the senior authors using the assisted self-reduction method and 176 were managed by other orthopaedic consultants on duty in the Emergency Department using the traction-countertraction technique. Only the senior authors used the assisted self-reduction technique, whereas the other orthopaedic consultants used the traction-countertraction method. The need for intravenous sedation or general anaesthesia to perform the assisted self-reduction was considered a failure. Recorded variables were demographic data, previous dislocation, traumatic mechanism and medication use during shoulder reduction, time to perform the reduction.
Results: Ninety-eight percent of the acute dislocation treated with the assisted self-reduction technique and 81 % treated with the traction-countertraction method were reducible without recourse to intravenous sedation.
Conclusions: The assisted self-reduction technique is simple, effective and gentle. Physicians on duty in the Emergency Departments should therefore be encouraged to use it
Clinical and radiological outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction
No full textBackground: Septic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction is a rare complication. In the literature, several treatments have been proposed. The aim of the study was to report our results using ambulatory irrigation of the knee and parenteral and oral antibiotics. Methods: From January 2001 to December 2008, a total of 12 patients were treated for postoperative septic arthritis of the knee after ACL reconstruction in our hospital. The average age at trauma was 24 years (range 16-43 years). The treatment protocol included irrigation of the knee (for 2 days) and parenteral antibiotics and oral antibiotics subsequently. Repetitive irrigation was performed if necessary. The average duration of follow-up for our series was 38 months (range 6-54 months). Follow-up included International Knee Documentation Committee (IKDC) forms, radiography, Tegner and Lysholm scores, and KT-1000 arthrometric evaluation. Results: In all cases treatment of infection was successful. Neither graft nor hardware removal was needed in any of the cases. At final examination, the pivot shift was negative in 10 of 12 patients, and it was 1+ in the other 2 patients; the Lachman was negative in all cases. The mean postoperative Tegner score was 7.2, and the mean Lysholm score was 98.3. In all, 10 of the 12 patients were graded as group A and the other 2 as group B using the IKDC form. The mean postoperative manual maximum KT-1000 side-to-side difference was 2.3. No significant bone tunnel enlargement was found at radiographic evaluation. Conclusions: The described treatment regimen gives reliable results for this complication. There were no recurrences of septic arthritis or bone infection. No further surgeries were required, and the graft was retained during the treatment of septic arthritis
Double-Bundle Anterior Cruciate Ligament Reconstruction A Comprehensive Kinematic Study Using Navigation
No full textBackground: Single-bundle anterior cruciate ligament reconstruction seems to be insufficient to control a combined rotatory load of internal and valgus torque, whereas anatomical double-bundle reconstruction might produce a better biomechanical outcome, especially during rotatory loads. Hypothesis: The addition of the posterolateral bundle to the anteromedial bundle, in an in vivo double-bundle computer-assisted anterior cruciate ligament reconstruction, is able to reduce the internal rotation of the tibia at different degrees of flexion. Study Design: Controlled laboratory study. Methods: Ten consecutive anterior cruciate ligament reconstruction procedures were performed in male patients using double-bundle gracilis and semitendinosus tendon graft with the 2.0 OrthoPilot anterior cruciate ligament navigation system. Anteroposterior displacement at 30 degrees, 60 degrees, and 90 degrees as well as internal and external rotation at 0,degrees 15 degrees, 30 degrees, 45 degrees, 60 degrees, and 90 degrees of knee flexion were evaluated before reconstruction, after fixation of the anteromedial bundle, and then after fixation of the posterolateral bundle. Results: Fixation of the anteromedial bundle significantly (P .05). Conclusion: The hypothesis that the addition of the posterolateral bundle to the anteromedial bundle is able to reduce internal rotation of the tibia, minimizing the pivot-shift phenomenon, was not confirmed. Clinical Relevance: The effective role of the anatomical double-bundle procedure in better restoring knee kinematics and allowing better clinical outcomes should be questioned in an in vivo model of anterior cruciate ligament reconstruction using doubled semitendinosus and gracilis graft
The failure mode of two reabsorbable fixation systems: Swivelock with Fibertape versus Bio-Corkscrew with Fiberwire in bovine rotator cuff
No full textEffect of cyclic loading on new polyblend suture coupled with different anchors
No full textBackground: Secure tendon-to-bone fixation is essential for successful rotator cuff repair. Biomechanical properties of devices used in rotator cuff repair should be better understood. Purpose: To evaluate the response to incremental cyclic loading of 6 different anchor-suture complexes commonly used in rotator cuff repair. Study Design: Controlled laboratory study. Methods: Two absorbable anchors 5 mm and 6.5 mm in diameter and 1 metallic anchor, coupled with Ethibond or FiberWire, were tested on 5 pairs of fresh-frozen human cadaveric shoulders. An incremental cyclic load was applied until failure using a Zwich-Roell Z010 electromechanical testing machine. The ultimate failure load and mode of failure were recorded. An analysis of variance model was used for statistical analysis. Results: The FiberWire suture coupled with both absorbable and metallic anchors provided statistically significantly stronger fixation. However, although the metallic anchors in most cases failed because of slippage of the anchor, absorbable anchors failed because of rupture of the eyelet. Conclusions: The FiberWire seems to increase the strength of fixation devices under cyclic load using both absorbable and metallic anchors, with relevant differences in failure mode (slippage of the metallic anchor and eyelet failure in the absorbable anchor). Clinical Relevance: Use of the FiberWire suture might change the mode of failure of the suture-anchor complexes
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