Showing papers in "European Journal of Orthopaedic Surgery and Traumatology in 2005"
TL;DR: The results of this study suggest that in daily practice the X-ray measurement of the incidence only may be considered as an accurate indicator of pelvis morphology for the study of relations between pelvis anatomy and spinal curves.
Abstract: Reliability and reproducibility of two radiological pelvic parameters are tested: thickness (length of the segment defined by the middle of the upper endplate of the sacrum to the middle of the bi-coxo-femoral axis) and pelvic incidence (angle defined by the perpendicular line to the centre of the upper endplate of the sacrum and the thickness line). These two parameters provide a pelvis description and assess the relation between pelvis and spinal curves. The anatomical reliability of these radiological parameters was not achieved. The values of these two parameters from X-ray versus direct measurement on 12 anatomical specimens are compared. The direct measurement was performed by means of an electromagnetic Fastrak system (Polhemus society) providing 3D position of anatomical landmarks and allowing to measure the incidence and the thickness. These parameters were also measured from sagittal X-ray. Their values were compared. Incidence: the paired t-test and the variance ratio test were not statistically significant and a highly significant positive correlation existed between anatomical and radiological values (r=0.98; P<0.001). Thickness: the paired t-test was significant (P<0.01). There was a negative correlation between anatomical values of incidence and thickness (r= −0.54; P<0.05) but not for radiological values. A strong correlation exists which validates the radiological measurement of an angle, i.e. incidence, although there is a lack of reliability of the X-ray measurement of a distance, i.e. thickness, which is due to technical conditions of the X-ray examination. The results of this study suggest that in daily practice the X-ray measurement of the incidence only may be considered as an accurate indicator of pelvis morphology for the study of relations between pelvis anatomy and spinal curves (e.g., lordosis, scoliosis, spondylolisthesis).
50 citations
TL;DR: No statistical difference was found between the bone specimens treated with supercritical CO2 and the fresh-frozen paired specimens when considering maximal compressive strength, Young’s modulus and work to failure.
Abstract: Bone allografts can be treated by various techniques before implantation. Recently, treatments based on supercritical carbon dioxide (CO2) were developed. The goal of this study was to evaluate the influence of such a treatment on the biomechanical properties of bone allografts. Thirteen human femoral heads obtained from patients who had undergone hip arthroplasty were cut along the frontal plane yielding to two slices with similar mechanical properties. For each femoral head, one of the two slices (randomly chosen) was fresh-frozen, whereas the other one underwent all steps of a supercritical CO2 based treatment in order to clean and secure bone tissue. Nine specimens (7 mm×9 mm×10 mm) per slice were then cut and loaded under compression in a physiologic saline solution maintained at 37°C. For the maximal compressive strength a mean value (SD) of 9.6 (2.4) MPa for fresh bone and 10.2 (5.2) MPa for treated one was found. Regarding the Young’s modulus a mean value of 417 (85) MPa was obtained for fresh specimens and 412 (149) MPa for the treated ones. No statistical difference was found between the bone specimens treated with supercritical CO2 and the fresh-frozen paired specimens when considering maximal compressive strength, Young’s modulus and work to failure.
27 citations
TL;DR: Although 5.5 years of average retreat remain a short follow-up in orthopaedic surgery, the outcomes without specific complications are satisfactory and allow one to go with this materials in total hip revision surgery.
Abstract: Management of bone loss in revision total hip replacement is a challenge. To eliminate any immunological or infectious problem and so to try to improve the long term results obtained with allografts the authors used synthetic ceramics as bone substitutes. Thirty-two hips with a mean follow-up of about 5.5 years (from 3 years to 8 years) were reviewed for this study. The bone defect was classified according to American Academy for Orthopaedic Surgery classification. Two ceramics, one in granules for cavities filling, another in different forms to reconstruct segmental deficiencies, were used; according to the local bone conditions and the age of the patient no cemented jumbo cups or screwed reconstruction rings with a hook and with a polyethylene cup were implanted. Clinical results were assessed according to Postel and Merle d’Aubigne scale. No specific complications were noted. Other complications as dislocations or infections were on a level with other series in this surgery. Radiological assessment affirmed a good integration without any border in all the cases except in one infection. No secondary displacement occurred except in one case after a fall with an acetabular fracture. A progressive invasion of the ceramics by bone can be seen on the X-ray in all cases. Although 5.5 years of average retreat remain a short follow-up in orthopaedic surgery, the outcomes without specific complications are satisfactory and allow one to go with this materials in total hip revision surgery.
21 citations
TL;DR: The results show that distal radius curettage before cementoplasty can double the amount of calcium phosphate cement injected, and slowly absorbed micro-porous biomaterial use is preferable in long-term preventive treatment.
Abstract: Osteoporotic distal radius fractures are a public health problem that medical osteoporosis treatment is unable to check. We have described a bone substitute method to improve mechanical properties in bone. Our current study aims at improving the technique by maximising the filling of the distal radius. Cavities were created by curettage in the distal radius using a styloid process approach in ten randomly selected wrists from the sample population of ten cadavers. All radii were injected percutaneously with calcium phosphate cement. Cement quantities injected were calculated and corrected for observed cement leakage. Our results show that distal radius curettage before cementoplasty can double the amount of calcium phosphate cement injected. Prevention of osteoporotic distal radius fractures by cementoplasty seems a promising technique. Slowly absorbed micro-porous biomaterial use is preferable in long-term preventive treatment. Nevertheless, in the future, this technique should apply in specific cases, such as medical osteoporosis treatment failure with contra-lateral wrist fracture.
19 citations
TL;DR: A reciprocal regulatory and autoregulatory process that couples the mutually dependent processes of angiogenesis and osteogenesis is described and it is demonstrated that the hypoxia characteristic of healing bone is an integral mediator of this complex phenomenon.
Abstract: Osteoblasts and endothelial cells are intimately located within the skeleton, and their interaction is an integral component of bone repair, a complex process which continues for weeks under conditions of low oxygen tension. This study investigated the paracrine factors that couple angiogenesis and osteogenesis and demonstrates that hypoxia is an integral mediator of this complex phenomenon. Hypoxia stimulates vascular endothelial growth factor (VEGF) and not basic fibroblast growth factor (bFGF) release from primary human osteoblasts and is directly angiogenic, enhancing human microvascular endothelial cell proliferation and vessel tube formation in vitro. Hypoxic endothelial cells release potent osteogenic mitogens, endothelin-1 (Et-1) and insulin-like growth factor-1 (IGF-1). The conditioned medium of hypoxic osteoblasts significantly enhance blood vessel formation (indirect angiogenesis), far in excess of hypoxia alone, via a primarily VEGF-dependent mechanism. Et-1 and IGF-1 from hypoxic endothelial cells cause osteoblasts to proliferate and differentiate and further enhance their angiogenic potential. In summary, this study describes a reciprocal regulatory and autoregulatory process that couples the mutually dependent processes of angiogenesis and osteogenesis and demonstrates that the hypoxia characteristic of healing bone is an integral mediator of this complex phenomenon.
16 citations
TL;DR: The case of a 74-year-old lady who had pain in the left knee due to an anteromedial fracture of her metal tibial tray post total knee arthroplasty with a kinematic (Howmedica) prosthesis is presented.
Abstract: The fracture of the tibial tray is a rare complication post total knee arthroplasty. We present the case of a 74-year-old lady who had pain in the left knee due to an anteromedial fracture of her metal tibial tray post total knee arthroplasty with a kinematic (Howmedica) prosthesis. There are 25 reported cases of fractures of the posterior-medial aspect of the tibial tray. This is the first case describing an anteromedial tibial tray fracture. We performed a retrieval analysis of the polyethylene component and the fractured tibial base plate and reviewed the literature to determine the predisposing factors contributing to tibial tray fractures. Tibial component malalignment, excessive polyethylene wear and subsequent bone lysis, inherent metallurgical weakness and certain design features of the tray have been identified as the possible contributing factors to failure in this case.
14 citations
TL;DR: Good and excellent results can be expected from either the mini-incision or the ordinary approach in hemiarthroplasty and this approach results in less dissection and facilitates rapid patient recovery and possibility earlier discharge from the hospital.
Abstract: Minimally invasive osteosynthesis is a well-recognized treatment; however, those of arthroplasty or hemiarthroplasty may rarely be performed. We reviewed the comparison of a mini-incision approach in hemiarthroplasty versus that of an ordinary approach in patients with femoral neck fractures. Two different operative procedures were compared. Thirty-two patients (group 1) had a mini-incision in hemiarthroplasty. Thirty-two patients (group 2) were treated with the conventional approach. The postoperative treatment course was the same for both groups. The mean length of follow-up was 25 months. The results were excellent or good in 86% of the patients (50 of 64) and were equally good for both procedures. However, the full weight bearing term was significantly shortened for patients treated by the mini-incision procedure. Good and excellent results can be expected from either the mini-incision or the ordinary approach in hemiarthroplasty. Only full weight bearing term was significantly short following the mini-incision. This approach results in less dissection and facilitates rapid patient recovery and possibility earlier discharge from the hospital.
13 citations
TL;DR: The case of a 17-year-old male who presented with quadriparesis following an acute neck injury from a tackle in a football match and MRI scans of cervical spine showed a Type-1 Chiari malformation.
Abstract: We present the case of a 17-year-old male who presented with quadriparesis following an acute neck injury from a tackle in a football match. MRI scans of cervical spine showed a Type-1 Chiari malformation. The quadriparesis resolved over 24 h. We also present an overview of the differing presenting features of this condition from the literature. Whether these patients have to be advised against returning to contact sports is debatable.
11 citations
TL;DR: The authors present seven cases of a teardrop fracture of the axis treated in the National Spinal Injuries unit at the Mater Miscericordiae University Hospital, Dublin from 1993 to 2003 and the mean follow-up time was 6 years.
Abstract: The teardrop fracture of the axis comprises a special entity, characterized by an avulsed fragment, of varying size, from the anterior inferior angle of the body of C2. It is extremely rare and differs in many respects from the teardrop fracture of the lower cervical spine, which was originally described by Schneider and Kahn in 1956. Indeed, much of what is written about teardrop fractures relates to lower cervical spine flexion type teardrop fractures. To date there are only 36 reported cases of teardrop fracture of the axis. We present seven cases of a teardrop fracture of the axis treated in the National Spinal Injuries unit at the Mater Miscericordiae University Hospital, Dublin from 1993 to 2003. The mean follow-up time was 6 years. The stability of this fracture has been questioned by certain authors, resulting in disagreement concerning the best choice of treatment to be followed. The radiological, clinical features and functional outcome of patients who have sustained a teardrop fracture of the axis will be described. The mechanism of injury and potential for instability will be compared with teardrop fractures of the lower cervical spine so as to emphasize the importance of recognizing this injury as a separate entity.
11 citations
TL;DR: It is concluded that delay in ORIF of ankle fractures is associated with increased complication, increased morbidity and increased hospital stay, and these fractures should be surgically fixed within 24 h.
Abstract: A retrospective review of closed ankle fractures treated using open reduction and internal fixation (ORIF) was undertaken. The aim was to investigate if the timing of surgery had any influence upon soft tissue complications and hospital stay. Sixty-two patients, 31 men and 31 women, were reviewed. Twenty-four (39%) underwent the surgery within 24 h (average 17.5 h) of injury, while the other 38 (61%) were operated at an average of 3.1 (2–9) days. The average length of stay (LOS) was 7.1 (range 2–15) days in patients who had the surgery within 24 h of injury as compared to 10.6 (range 4–64) days in those who had their surgery after 24 h of injury. The post-operative stay was 6.3 days as compared to 7.5 days in the two groups respectively. Fourteen complications were seen, including six infections all of which occurred in patients who underwent surgery after 24 h of injury. Three cases with delayed wound healing were also noted. A significantly higher complication rate was noted in patients aged 70 years or older (6/11). We conclude that delay in ORIF of ankle fractures is associated with increased complication, increased morbidity and increased hospital stay. These fractures should be surgically fixed within 24 h.
10 citations
TL;DR: It is concluded that bony entry point in the sagittal plane is not a significant prognostic indicator for anterior knee pain following intramedullary tibial nailing.
Abstract: Forty-four consecutive diaphyseal extra-articular tibial fractures (43 patients) were treated with intramedullary interlocking nail. There were 35 men and eight women with a mean age of 38 years. Average follow-up was 25 months. Cases were divided into two groups: anterior-knee-pain group, 20 knees; and no-pain group, 24 knees. The lateral projection radiographs of their tibiae were scrutinised for precise bony portal point. The distance between articular surface and tibial tubercle was divided into three equal zones. In the superior zone, six had pain and six did not. In the central zone, eight had pain and 15 did not. In the inferior zone, six had pain and three did not. There was no significant difference between anterior knee pain and the three zones of the bony entry, age, gender, mechanism of injury, dynamisation, nail protrusion, approach and union time. We conclude that bony entry point in the sagittal plane is not a significant prognostic indicator for anterior knee pain following intramedullary tibial nailing.
TL;DR: This research investigates in vitro experimental test bodies of four different ISO standardised, frequently used, artificial implant alloys subject to electrochemical corrosion independently of mechanical influences when in contact with body liquids and found that up to 80% of the entire dissolution of each ion occurred within the first 24 h of immersion.
Abstract: Metallic materials in orthopaedic implants must bear mechanical loads with resultant surface damage. In addition to mechanical load, the surface damage on the implants occurs due to electrochemical corrosion from the physiological environment in-vivo. This research investigates in vitro experimental test bodies (surface area: 4.71 cm2) of four different ISO (International Organization for Standardization) standardised, frequently used, artificial implant alloys (TiAl6V4, Ti, CoCr29Mo, FeCrNiMoMnNbN). The test materials were immersed in inert polystyrene test tubes filled with 1 ml of serum (pH 7.4) by avoidance of any friction and mechanical load. Here, they were subject to electrochemical corrosion independently of mechanical influences when in contact with body liquids. It was found that up to 80% of the entire dissolution of each ion occurred within the first 24 h of immersion. Additionally, the dissolution of the metal ions depended on the proportional mix of the individual elements in respective alloys. Therefore, the highest percent of ion concentration was found for Co (CoCr29Mo) followed by Fe (FeCrNiMoMnNbN) and Mo (FeCrNiMoMnNbN). The lowest percent of ion concentrations were evident for Ti (Ti), Cr (CoCr29Mo) and Cr (FeCrNiMoMnNbN).
TL;DR: This work describes a classic GCTTS that, at the time of presentation, had the uncharacteristic X-ray film appearance of a phalangeal lytic osseous lesion.
Abstract: Giant cell tumors of the tendon sheath (GCTTS) are common tumors that frequently involve soft tissue affecting the digits, but intraosseous extension into the medullary canal of the phalanges is a most uncommon finding. We describe a classic GCTTS that, at the time of presentation, had the uncharacteristic X-ray film appearance of a phalangeal lytic osseous lesion.
TL;DR: It was concluded that Chitra porous HAP was a safe and useful bone graft substitute for cancellous bone augmentation in fractures and remained radio-opaque even at 1 year.
Abstract: Synthetic bone-graft substitutes are increasingly being used in clinical orthopaedic practice. In India, Sree Chitra Tirunal Institute of Medical Sciences and Technology has pioneered the research and development of indigenous ceramic bone substitutes. The Chitra HAP is a synthetic porous Hydroxyapatite that has completed pre-market trials according to prescribed format and has also undergone limited clinical trials in humans. This study is a clinical trial to ascertain the use of the product in the treatment of cancellous impaction fractures. Twenty-eight tibial plateau fractures were treated by a standard surgical protocol using the HAP for cancellous bone augmentation. The results were evaluated by serial radiography at specified intervals up to 1 year. At 1 year the HAP appeared fully integrated with the host bone radiologically and the articular subsidence had ceased. The synthetic HAP remained radio-opaque even at 1 year. No adverse effects were noticed due to the synthetic material. It was concluded that Chitra porous HAP is a safe and useful bone graft substitute for cancellous bone augmentation in fractures.
TL;DR: Age more than 65 years, significant comminution (A3 or C3 in AO classification), and associated ulnar fracture were the variables found to have statistically significant correlation with poor radiological outcome in distal radial fractures stabilized with K wires.
Abstract: The aim of this retrospective study was to identify the variables associated with poor radiological outcome in distal radial fractures stabilized with K wires. Patients who underwent K-wire fixation for unstable fractures of the distal radius in the last 3 years were included. Fractures were classified according to AO classification. Immediate postfixation radiographs and radiographs taken just prior to removal of K wires were analyzed to study three radiological parameters: palmar or dorsal tilt, radial inclination, and ulnar variance. Changes in these parameters were used to grade the anatomical end result as excellent, good, fair, or poor according to the Stewart classification. The results were analyzed statistically against variables such as age, gender, AO classification, associated ulnar fracture, number of K wires used, delay in fixation, and duration of fixation. A total of 113 fractures were analyzed. Average age of patients was 56.2 years, with male-to-female ratio of 1:2. Average loss of radial tilt was 4.12°, loss of palmar tilt was 8.07°, and loss of ulnar variance was 3.12 mm. We found excellent results in 23.9%, good result in 56.6%, fair results in 15%, and poor results in 4.4% of patients. Age more than 65 years (P value 0.004), significant comminution (A3 or C3 in AO classification) (P value 0.007), and associated ulnar fracture (P value 0.015) were the variables found to have statistically significant correlation with poor radiological outcome.
TL;DR: The authors describe two patients with this disorder affecting the shoulder that initially presented a diagnostic dilemma until X-Rays revealed destruction of the shoulder joint with marked resorption of the humeral head, and magnetic resonance imaging revealed a syrinx in the central cord associated in one patient with Arnold-Chiari malformation.
Abstract: Neuropathic arthropathy of the shoulder is a relatively rare disorder and is mainly caused by tabes dorsalis and syringomyelia. Sensory deficit has been implicated as its causative factor. It is frequently misdiagnosed because its early symptoms may suggest a mild infection, minor fracture, tendon rupture, or a similar benign problem. The authors describe two patients with this disorder affecting the shoulder that initially presented a diagnostic dilemma. The two patients were initially misdiagnosed until X-Rays revealed destruction of the shoulder joint with marked resorption of the humeral head, and magnetic resonance imaging revealed a syrinx in the central cord associated in one patient with Arnold-Chiari malformation.
TL;DR: The authors present two cases of palm thorn injuries to the hand that developed late complications because of a missed diagnosis or a late treatment, and Surgery was finally necessary in both cases providing a satisfactory result.
Abstract: Palm thorn injuries to the hand are frequent lesions in our area. When they are promptly identified and treated, a good result can be expected without further complications. But they can present as a serious problem in cases of late diagnosis and/or late treatment. We present two cases of palm thorn injuries to the hand that developed late complications because of a missed diagnosis or a late treatment. The first patient developed an osteomyelitis and the second case a chronic synovitis. Surgery was finally necessary in both cases providing a satisfactory result. Six months after the definitive treatment, both patients are painless, with full motion and free of infection. Once these injuries are identified they must be treated to avoid late complications. Thorns have to be removed to decrease the swelling response and the formation of foreign body granuloma. If a infection develops, an immediate treatment with surgical debridement and antibiotic therapy has to be instaured.
TL;DR: A patient who sustained two fractures in the odontoid process of C2 and a fracture of the anterior arch of C1 and died 10 days later of unrelated cardiopulmonary insufficiency is reported on.
Abstract: We report a rare case of double fractures of the odontoid process combined with a fracture of the anterior arch of the atlas. Combined fractures of the odontoid process and the upper cervical spine are not unusual. The presence of two different patterns of odontoid process fractures combined with a fracture of the anterior arch of the atlas is not reported in the literature available to us. The authors report on a patient who sustained two fractures in the odontoid process of C2 and a fracture of the anterior arch of C1. As the initial plain films were not clear enough to detect suspected lesions in the upper cervical spine, the patient underwent full investigation with CT scan and MRI. Reconstructive images showed the fractures of the odontoid process and the one of the atlas. The patient was treated conservatively with the application of cranial traction. The patient died 10 days later of unrelated cardiopulmonary insufficiency. During this period, there was no particular problem from the cervical spine. We recommend a high level of alert and suspicion to every case of upper cervical spine injury since, due to the complexity of the anatomy of this transitional area, a different biomechanical behavior exists leading to a variety of combination of fractures.
TL;DR: There is sufficient justification for the use of this modular two-piece stem, which has fulfilled its purpose in the majority of patients, enabling the authors to extend with confidence indications for the cementless stem to all the anatomical types of femur encountered.
Abstract: The authors report on more than 10 years’ experience of using a cementless femoral stem, with a two-piece modular design, for indications of primary prosthetic replacement. One hundred and sixty-five prostheses, inserted between 06/11/1991 and 31/12/1994, were reviewed. No patient was lost to follow-up. The probability of 10-year survival of these hip prostheses was assessed using the actuarial Kaplan–Meier method (the endpoint was revision of the arthroplasty regardless of the reason: failure of the femoral or acetabular component, fracture of one piece of the implant etc.). The mean age of the 165 patients (84 women, 81 men) was 64 years. The clinical results were excellent or good in 87.2% of hips. There was no instance of post-operative thigh pain (apart from one case), because of the primary stability of the hydroxyapatite-coated metaphyseal part where stress transmission occurs, while the diaphyseal part, selected in accordance with requirements and smaller in diameter than the femoral canal, remained free in the diaphysis. No significant difference in the results was noted in accordance with the pattern of femoral anatomy encountered; however, the cylindrical femur yielded slightly inferior results (PMA score). Radiological follow-up showed that femoral fixation had been obtained, generally accompanied by obvious signs of bone fixation (endosteal ossification, radiolucencies indicating condensed bone in the smooth zone). A high number of cortical changes was not noted. Two stems were the cause of revision surgery, one because of thigh pain without sealing, the other because the stem fractured. Six acetabular implants were removed without interfering with the femoral stem, because of localised osteolysis around an expandable peg. Two other acetabular implants were replaced: one because poor positioning resulted in recurrent luxation and the other for premature wear of the polyethylene after 7 years. The grounds for revision were failure of the acetabular implant in 8 cases out of 10. Thus, there is sufficient justification for the use of this modular two-piece stem, which has fulfilled its purpose in the majority of patients, enabling us to extend with confidence indications for the cementless stem to all the anatomical types of femur encountered. Our series of patients included almost 78.7% of what are known as “normal” femurs, but in the remaining cases (21.3%) or in more than one in five instances, the modular stem made it possible to extend the indications for a cementless prosthesis to all the patterns of femur encountered, in particular to young adults, who often have femoral dysplasia or a cylindrical femur. The survival curve reflects the life of the implant: implant survival is 96.3%. If acetabular revisions are not included it is 98.8%. Conclusions: A modular system then, consisting of a metaphyseal and diaphyseal part, appears to be a first-rate component which optimises the indication for implantation of a cementless femoral prosthesis in order to obtain the correct performance of a medical service as the survival curve demonstrates.
TL;DR: The experience in the management of this complex injury pattern in adolescent females injured in separate accidents is reported and the pertinent literature on the subject is reviewed.
Abstract: Traumatic bilateral asymmetric hip dislocation is an extremely uncommon injury and rarely seen in children. We report two such cases in adolescent females injured in separate accidents. One of these patients also suffered a left femoral shaft fracture, ipsilateral labral avulsion and contra-lateral acetabular fracture. We report our experience in the management of this complex injury pattern and review the pertinent literature on the subject.
TL;DR: The results indicated that the PNT obtained the better bone integration and apposition compared to titanium cage, and the biocompatibilité of two implants seemed comparable.
Abstract: The aim of this research was to evaluate and compare the bone integration and apposition capacities of two metallic intervertebral fusion implants, porous nitinol (PNT: porous Nickel Titanium Naval Ordonance Laboratory) and titanium intervertebral cage, in the sheep lumbar spine. Sixteen sheep received two implants each at L2–L3 and L4–L5 lumbar levels so as to subject both the implants to the same mechanical loads. The sheep were then sacrificed at 3, 6 and 12 months post-implantation periods. Lumbar segments were then harvested. A qualitative (macroscopic and microscopic observation) and quantitative (histomorphometric) analysis of bone integration and apposition was carried out on histological slides. The results indicated that the PNT obtained the better bone integration and apposition compared to titanium cage. The osseo-integration of each implant seemed to be influenced by its structure and its hardness. However, the biocompatibility of two implants seemed comparable.
TL;DR: It is concluded that the number and site of loose bodies have no prognostic value in predicting the outcome and the scores of the Mayo Elbow Performance Score and the Derby Elbow Osteoarthritis Radiography Score improved.
Abstract: Twelve consecutive patients were reviewed after having Outerbridge-Kashiwagi procedure of the elbow to ascertain the effect of the site and number of loose bodies on the outcome. Patients were assessed using the Mayo Elbow Performance Score (MEPS) and the Derby Elbow Osteoarthritis Radiography Score (DEORS). Ten men and two women with a mean age of 47 years were followed up for a mean of 3.6 years. Seven patients had two or less loose bodies, and five had more than two loose bodies. Seven had anterior loose bodies alone and five had both anterior and posterior loose bodies. MEPS improved from a mean of 51 to 85 points. Visual analogue pain score improved from a mean of 7.4 to 2.6. DEORS improved from a preoperative mean of 6.5 to 5.3. Number of loose bodies had no significance on the functional outcome; neither had the site. We concluded that the number and site of loose bodies have no prognostic value in predicting the outcome.
TL;DR: This short-term follow-up of THA for DDH using uncemented implants is encouraging for arthrosis secondary to DDH.
Abstract: We present our experience over 6 years with the use of uncemented total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) with a mean follow-up of 3 years In a 6-year period, 26 THAs were performed in 19 patients with Hartofilakidis grades 2 and 3 dislocation of the hips Out of 19 patients, seven had bilateral dislocations Uncemented acetabular and femoral components were used in all patients Patients with a minimum follow-up of 1 year were included in the study The average age at the time of surgery was 38 (range 20–69) years Approaches used include trochanteric osteotomy in 14 (54%) patients and a lateral approach in 12 (46%) patients In addition, subtrochanteric osteotomy was performed in four (15%) patients A Mallory-head femoral stem was used in 15 (58%) patients; a DDH femoral stem was in nine (35%), and the S-ROM femoral prosthesis in two (8%) A Mallory head acetabular shell was used in all cases, a 222-mm chrome cobalt head was used in 18 (69%), and a 28-mm chrome cobalt head was used in eight (31%) The average follow-up was 3 (range 1–6) years The Harris hip score (HHS) improved in the cohort from a mean preoperative score of 51 to a mean postoperative score of 86 (p<005) The mean preoperative SF36v2 score was 42 compared to postoperatively of 67(p<005) The complication rate was 11% with nonunion of a subtrochanteric osteotomy in one patient, dislocation in one, and trochanteric bursitis due to fracture of Dall-Miles cables in one THA for DDH is a technically demanding procedure This short-term follow-up of THA for DDH using uncemented implants is encouraging for arthrosis secondary to DDH It provides better function compared to arthrodesis or excision arthroplasty, especially in young individuals A long-term follow-up is required in order to establish the role of this management strategy
TL;DR: This study shows that for patients referred with severe osteoarthritis of the knee, both the American Knee scores and Oxford Knee Scores deteriorate significantly prior to surgery, although most of this change is not during their time on the waiting list, and questions the current emphasis on surgical waiting times instead of patient symptoms and physical function in determining the timing of surgery.
Abstract: The disabling symptoms of osteoarthritis of the knee can be dramatically improved with joint replacement. The aim of this study was to examine the change in pain and physical function that occurs in patients with osteoarthritic knees awaiting total knee replacement. Data was collected prospectively from a cohort of 124 consecutively recruited patients at three stages of assessment over a mean of 24 months (range 9–32 months). The patients were assessed at the time of referral by the general practitioner, when first assessed by the orthopaedic consultant, and just before surgery. At each visit, the patients were examined and the American Knee Score and Oxford Knee Score completed by the patient. The function element of the American Knee Score deteriorated significantly from the time of referral till the time of first orthopaedic consultation (P=0.005) and also from the time of referral to the time of surgery (P=0.006). The pain element of the American Knee Score improved from the time of referral till the time of orthopaedic assessment (P=0.011). The change in Oxford knee scores between the time the patient was put on the waiting list and the time of surgery was not statistically significant (P=0.30). Our study shows that for patients referred with severe osteoarthritis of the knee, both the American Knee Scores and Oxford Knee Scores deteriorate significantly prior to surgery, although most of this change is not during their time on the waiting list. The time from referral by the general practitioner (GP) to orthopaedic assessment by the consultant was l.8–14.2 months (average 9.8 months) and from the time of orthopaedic assessment, i.e. when seen by the consultant and placed on the waiting list to the time of surgery was 9.1–22 months (average 13.3 months). We have shown that the pain and functional elements of the American Knee Score behave independently to the total score. This research therefore questions the current emphasis on surgical waiting times instead of patient symptoms and physical function in determining the timing of surgery.
TL;DR: The results suggest that reconstructive nailing using a long proximal femoral nail may be considered a useful strategy for the treatment of diaphyseal and metaphYseal femoral metastatic lesions.
Abstract: Femoral involvement is frequently observed in bone metastases. Intramedullary nailing is a common technique for prophilactic stabilisation of femur when diaphysis or metadiaphysis are involved. Reconstructive nailing is currently used in the treatment of subtrochanteric involvements. The aim of this study is to evaluate results of contemporary femoral shaft and subtrochanteric or femoral neck metastases treated with long proximal femoral nail. A consecutive series of 27 impending or complete femoral fractures due to metastastic localisation treated with reconstructive nailing was analysed in this study. Indication to prophilactic stabilisation was defined according to Mirel’s criteria; preoperative planning included MRI, which showed the contemporary involvement of subtrochanteric region or neck also in the cases of shaft localisations. A long titanium proximal femoral nail with one distal screw inserted in a static mode was used in all patients. Improvement of the quality of life, with no mechanical problems (screw breakage or implant failure), was observed in this series. These results suggest that reconstructive nailing using a long proximal femoral nail may be considered a useful strategy for the treatment of diaphyseal and metaphyseal femoral metastatic lesions.
TL;DR: The final appearance of the scar was cosmetically acceptable to both the surgeon and the parents, andEquinus deformity was corrected in all patients, with three of the feet attaining a dorsiflexion of more than 20°.
Abstract: We report the results of partial wound closure of the Cincinnati incision after surgical correction of 31 clubfeet in 21 children. The mean length of follow-up was 36.9 months. All feet were evaluated for the appearance of the scar and correction of the deformities. The initial appearance of the wound was a major concern to the parents. The final appearance of the scar was cosmetically acceptable to both the surgeon and the parents. Equinus deformity was corrected in all patients, with three of the feet attaining a dorsiflexion of more than 20°.
TL;DR: This work reports the first in the literature bilateral femoral neck insufficiency fracture in a young female, due to heroin and methadone use related osteoporosis, and suggests a high index of clinical suspicion and prompt imaging in the case of activity related hip pain could prevent missing such pathology in this cohort of patients.
Abstract: Stress fractures of the femoral neck are potentially disabling injuries if the diagnosis is missed or delayed and proper treatment is not provided. We report the first in the literature bilateral femoral neck insufficiency fracture in a young female, due to heroin and methadone use related osteoporosis. A high index of clinical suspicion and prompt imaging in the case of activity related hip pain could prevent missing such pathology in this cohort of patients, avoiding its devastating sequelae.
TL;DR: A 17-year-old man presented with MRSA osteomyelitis of the femoral shaft after treatment for a closed fracture by an external fixator after radical debridement and resection at the infected site, the cement beads containing antibiotics were removed; and cultures of the intraoperative specimens were negative.
Abstract: A 17-year-old man presented with MRSA osteomyelitis of the femoral shaft after treatment for a closed fracture by an external fixator. Six weeks after radical debridement and resection at the infected site, the cement beads containing antibiotics were removed; and cultures of the intraoperative specimens were negative. The defect remained with a gap of 5.0 cm in length. A small callus was observed on the medial side of the defect on a radiograph of anteroposterior view. However, the size of the defect and callus remained un-changed over a 6 week period, so low-intensity pulsed ultrasound therapy was applied to the defect site. After two months of ultrasound exposure, rapid bone growth with radiographic bridging of the bone defect was observed, and the external fixator was removed. The fracture was completely consolidated three months after the initiation of the ultrasound treatment.
TL;DR: The management of intra-articular calcaneal fractures during the past years has been ranged from the nihilistic approach of no active treatment to open reduction and internal fixation (ORIF) or even to early subtalar arthrodesis or in combination with minimal approach, demonstrated in this study.
Abstract: The management of intra-articular calcaneal fractures during the past years has been ranged from the nihilistic approach of no active treatment to open reduction and internal fixation (ORIF) or even to early subtalar arthrodesis. The management of such fractures with the use of circular external fixators in a closed fashion or in combination with minimal approach is demonstrated in our study. The midterm results of 36 intra-articular calcaneal fractures treated between 1996 and 2003 with the use of the Ilizarov apparatus according to our modified operative strategy are presented. In treating calcaneal fractures, the classic Essex-Lopresti classification into depression and tongue type has been proved very useful in our hands. While the depression-type fractures can be reduced through skeletal traction and the above-mentioned minimal approach, tongue-type fractures can cause difficulties in reducing and especially maintaining the reduction of the tongue fragment. Especially for these fractures, a combined technique was applied by reducing the fracture with Steinmann pins according to the Essex-Lopresti method and incorporating them into the Ilizarov apparatus. This technique appears to be a lot easier and more accurate than the alternative “bent-wire technique” for reducing and holding down a tongue fragment. The original Essex-Lopresti manipulation alone with plaster immobilization does not allow weight bearing and is associated with regional osteoporosis. Apart from the Essex-Lopresti classification, the material was also categorized by the widely accepted Sanders CT classification for comparison of our results to those of the literature. The SF-36 patient-oriented general health status questionnaire was utilized before, during, and after the treatment period to assess patients’ satisfaction levels. We propose this operative strategy as an option for the treatment of all calcaneal fractures.
TL;DR: A case of neonatal osteofibrous dysplasia that was diagnosed 3 days after birth that must be differentiated from adamantinoma due to their radiological appearance, predilection for tibia and fibula, clinical picture, and certain histological similarities is described.
Abstract: We describe a case of neonatal osteofibrous dysplasia that was diagnosed 3 days after birth. Osteofibrous dysplasia is a fibro-osseous lesion rarely seen in long bones. It is also known as congenital osteitis fibrosa or ossifying fibroma of bones. Although it occurs in children under 10 years of age, it is extremely rare in newborn babies. It must be differentiated from adamantinoma due to their radiological appearance, predilection for tibia and fibula, clinical picture, and certain histological similarities.