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  • Paediatric infected femoral nonunion; mid-term results of a rare problem with a single-stage treatment and up to eleven and half years follow-up
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-16
    Gamal Ahmed Hosny, Abdel-Salam Abdel-Aleem Ahmed

    Nonunion of femur fractures is a devastating disabling complication which is rare in children. The purpose of this study was to report the outcomes of treating infected femur nonunions in children by the Ilizarov fixator in one stage.

    更新日期:2020-01-16
  • While home chlorhexidine washes prior to shoulder surgery lower skin loads of most bacteria, they are not effective against Cutibacterium ( Propionibacterium )
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-14
    Frederick A. Matsen, Anastasia J. Whitson, Jason E. Hsu

    Abstract Purpose Chlorhexidine showers prior to shoulder arthroplasty are commonly recommended by surgeons to lower the risk of periprosthetic infection; however, the effectiveness of these washes in eliminating bacteria from the skin of the shoulder has not been thoroughly evaluated. The objective of this study was to determine the degree to which pre-operative chlorhexidine washes effectively eliminate bacteria from the epidermal skin surface and from the dermis freshly incised during shoulder arthroplasty. Methods Around 66 patients undergoing primary shoulder arthroplasty were instructed to shower with chlorhexidine before surgery. Each patient had three skin swabs: (1) the epidermis at a pre-operative clinic appointment, (2) the epidermis at surgery after home chlorhexidine showers but prior to skin preparation, and (3) the dermis after incision of the prepared skin. The bacterial loads of Cutibacterium and other bacterial types from each swab were compared to determine whether the showers were effective in altering the bacterial loads. Results Chlorhexidine washes were effective in reducing the skin load of other bacterial species (p < 0.005), but they did not decrease the skin load of Cutibacterium (p = 0.585). Conclusions Pre-operative skin showers with chlorhexidine were not effective in reducing the load of Cutibacterium on the skin of patients having shoulder arthroplasty. Since Cutibacterium is responsible for the highest percentage of shoulder periprosthetic infections, research is needed to identify more effective means of removing these bacteria from the surgical field.

    更新日期:2020-01-14
  • Traditional and bionic dynamic hip screw fixation for the treatment of intertrochanteric fracture: a finite element analysis
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-11
    Yunwei Cun, Chenhou Dou, Siyu Tian, Ming Li, Yanbin Zhu, Xiaodong Cheng, Wei Chen

    The dynamic hip screw (DHS) is widely used for fixing intertrochanteric femur fractures. A porous bionic DHS was developed recently to avoid the stress concentration and risk of post-operative complications associated with titanium alloy DHSs. The purpose of this study was to compare the effects of traditional titanium alloy, bionic titanium alloy, and bionic magnesium alloy DHS fixation for treatment of intertrochanteric fractures using finite element analysis.

    更新日期:2020-01-13
  • Supramalleolar osteotomy in post-traumatic valgus ankle osteoarthritis
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-10
    Nicola Krähenbühl, Roman Susdorf, Alexej Barg, Beat Hintermann

    To assess how the level of the deformity, the stage of the osteoarthritic process, and the role of additional surgeries impact radiographic and clinical outcomes following an extra-articular medial closing supramalleolar osteotomy for treatment of post-traumatic valgus ankle osteoarthritis.

    更新日期:2020-01-11
  • Computerized navigation for total hip arthroplasty is associated with lower complications and ninety-day readmissions: a nationwide linked analysis
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-09
    Elizabeth B. Gausden, Joseph E. Popper, Peter K. Sculco, Barret Rush

    Abstract Introduction The objective was to evaluate if the use of CA-THA was associated with lower complications in the first 90 days following THA compared with conventional THA. Methods The Nationwide Readmission Database (NRD) was queried to identify patients who underwent THA between 2012 and 2014. The primary outcome was arthroplasty-related complications within the first 90 days following THA. Multivariate models predicting the risk of complications, readmission, and revision-related readmission within 90 days of discharge were created. Results A total of 309,252 patients with a minimum 90-day follow-up following elective primary THA were identified. After controlling for age, sex, comorbidities, indication, income, and type of insurance, the use of CA during THA resulted in a 12% reduced odds of 90-day complications (OR 0.88, 95% CI 0.77–0.99, p = 0.04). Discussion The use of CA-THA resulted in lower 90-day complication rates and readmission rates compared with traditional THA after controlling for confounding variables. There was no significant difference in the rates of revision surgery between the groups within the first 90 days.

    更新日期:2020-01-09
  • Epidemiology of Achilles tendon injuries in collegiate level athletes in the United States
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-06
    Jimmy J. Chan, Kevin K. Chen, Salman Sarker, Rohit Hasija, Hsin-Hui Huang, Javier Z. Guzman, Ettore Vulcano

    Achilles injuries are devastating injuries, especially for competitive athletes. No studies have examined the outcomes of Achilles injuries in NCAA athletes. Therefore, a better characterization and understanding of the epidemiology is crucial.

    更新日期:2020-01-06
  • Management of neglected distal femur epiphyseal fracture-separation
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-06
    Malick Diallo, Massadiami Soulama, Alexander E. Hema, Adama Sidibé, Emile Bandré, Patrick W. H. Dakouré

    Neglected epiphyseal fracture-separations of the distal femur are rare. Still reported in developing countries, they lead to therapeutic issues. The objective of the study is to describe their characteristics and to propose treatment options.

    更新日期:2020-01-06
  • Gross trunnion failure in metal on polyethylene total hip arthroplasty—a systematic review of literature
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-04
    Tungish Bansal, Sameer Aggarwal, Mandeep Singh Dhillon, Sandeep Patel

    Multiple cases of dissociation of the head from the neck termed as gross trunnion failure (GTF) in total hip replacement have been described. Very little quantitative data is available for patient and implant factors associated and predisposing to this complication.

    更新日期:2020-01-04
  • Partial implant retention in two-stage exchange for chronic infected total hip arthroplasty
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-04
    Xiaojun Shi, Jing Yang, Zongke Zhou, Bin Shen, Pengde Kang, Fuxing Pei

    Abstract Background The efficacy of partial retention of well-fixed components during two-stage exchange for chronic total hip arthroplasty (THA) infection has remained unknown. Methods A total of 14 patients with chronic infected THA were treated with damage control two-stage revision, including selective retention of the well-fixed femoral or acetabular component, aggressive debridement, antibiotic-laden cement spacer, antibiotic therapy, and delayed reimplantation. Indications for this treatment included chronic infected THAs with ingrown femoral or acetabular component and positive microbial growth with sensitive antibiotics. We excluded patients with acute infection; negative microbial growth; positive pathogen with high-virulence bacterial infections and multiple drug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, fungi, and Mycobacterium tuberculosis; sinus formation; a prior failure for periprosthetic joint infection (PJI) treatment; and obvious bone resorption in both femoral and acetabulum side. During the study period, this represented 3.3% (14/425) of the patients treated for infected THA. Minimum follow-up was three years. None of the 14 patients in this series were lost to follow-up. Successful treatment was defined according to a modified Delphi-based international multidisciplinary consensus. Results No repeated debridement and recurrence of infection occurred during the study period; no patient need chronic antibiotic suppression. Successful treatment of chronic PJI was achieved in all patients. Despite the high peri-operative complication rate, no severe consequences were observed. The mean Harris Hip Score was 86 (range, 82–92; SD, 3.3). Conclusions The selective partial implant retention two-stage revision for chronic PJI may be a treatment option in properly selected patients with low virulence bugs.

    更新日期:2020-01-04
  • Effect of humeral stem and glenosphere designs on range of motion and muscle length in reverse shoulder arthroplasty
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-03
    Alexandre Lädermann, Patrick J. Denard, Philippe Collin, Olivia Zbinden, Joe Chih-Hao Chiu, Pascal Boileau, Flora Olivier, Gilles Walch

    Abstract Purpose To determine how different combinations of humeral stem and glenosphere designs for reverse shoulder arthroplasty (RSA) influence range of motion (ROM) and muscle elongation. Methods A computed tomography scan of a non-pathologic shoulder was used to simulate all shoulder motions, and thereby compare the ROM and rotator cuff muscle lengths of the native shoulder versus 30 combinations of humeral components (1 inlay straight stem with 155° inclination and five onlay curved stems with 135°, 145° or 155° inclinations, using concentric, medialized or lateralized trays) and glenospheres (standard, large, lateralized, inferior eccentric and bony increased-offset (BIO-RSA)). Results Only five of the 30 combinations restored ≥ 50% of the native ROM in all directions: the 145° onlay stem (concentric tray) combined with lateralized or inferior eccentric glenospheres and the 145° stem (lateralized tray) combined with either a large, lateralized or inferior eccentric glenosphere. Lengthening of the supraspinatus and infraspinatus, observed for all configurations, was greatest using onlay stems (7–30%) and BIO-RSA glenospheres (13–31%). Subscapularis lengthening was observed for onlay stems combined with BIO-RSA glenospheres (5–9%), while excessive subscapularis shortening was observed for the inlay stem combined with all glenospheres except the BIO-RSA design (> 15%). Conclusions The authors suggest implanting 145° onlay stems, with concentric or lateralized trays, together with lateralized or inferior eccentric glenospheres.

    更新日期:2020-01-04
  • Direct anterior approach in lateral position achieves superior cup orientation in total hip arthroplasty: a radiological comparative study of two consecutive series
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-03
    Fei Hu, Xifu Shang, Xianzuo Zhang, Min Chen

    Abstract Introduction Although the advantages of total hip arthroplasty (THA) using the direct anterior approach (DAA) have been well documented, DAA in the supine position is limited by the difficulty in exposing the acetabulum and femur, which may result in implant malpositioning and intra-operative complications. Recent studies have reported that DAA-THA in the lateral position can achieve satisfactory clinical and radiographic outcomes. The aim of this study was to investigate the difference in implant alignment between two patient cohorts that underwent primary THA by DAA and the traditional posterolateral approach (PLA) in the lateral position. Methods A total of 208 THAs (110 using DAA and 98 using PLA) were retrospectively analyzed. Results The cup anteversion angle was closer to the target anteversion angle, and the accuracy of cup orientation was superior in the DAA group. A total of 82 (74.5%) DAA-THA and 56 (57.1%) PLA-THA cases showed successful inclination and anteversion angles (p = 0.008) of the implant. In addition, 90 (81.8%) DAA-THA and 67 (68.4%) PLA-THA cases had successful anteversion angle (p = 0.024). There was no significant difference between the two groups in terms of successful inclination angle (98 vs. 81, p = 0.181), as well as in the stem alignment in both coronal and sagittal planes. Conclusion THA using DAA in the lateral position can achieve superior cup orientation compared to PLA while maintaining the stem alignment.

    更新日期:2020-01-04
  • The impact of intramedullary nailing on the characteristics of the pulmonary neutrophil pool in rodents
    Int. Orthop. (IF 2.384) Pub Date : 2020-01-03
    Michel Paul Johan Teuben, Martijn Hofman, Alba Shehu, Johannes Greven, Zhi Qiao, Kai Oliver Jensen, Frank Hildebrand, Roman Pfeifer, Hans-Christoph Pape

    Dysregulation of polymorphonuclear neutrophil (PMN) biology is associated with the development of inflammatory complications after trauma, such as acute respiratory distress syndrome (ARDS). It has been demonstrated that intramedullary nailing is both associated with altered pulmonary neutrophil deposition and the occurrence of ARDS. This standardized study aimed to characterize the long-term remote neutrophil response in the lungs in case of a femur fracture and intramedullary nailing.

    更新日期:2020-01-04
  • Correction to: Sleep improvement after hip arthroplasty: a study on short-stem prosthesis
    Int. Orthop. (IF 2.384) Pub Date : 2019-08-20
    Josef Hochreiter, Harald Kindermann, Georg Mattiassich, Reinhold Ortmaier, Marian Mitterer

    Authors first and last names have been interchanged. The correct presentation is given above.

    更新日期:2020-01-04
  • Unaddressed arterial injuries in revision total hip arthroplasty: mortality outcomes of a low-prevalence complication
    Int. Orthop. (IF 2.384) Pub Date : 2019-06-20
    Pablo Ariel Slullitel, Lionel Llano, Christian García-Ávila, Fernando Diaz-Dilernia, Francisco Piccaluga, Martin Buttaro, Gerardo Zanotti, Fernando Comba

    Abstract Purpose Peri-operative major arterial haemorrhage after revision total hip arthroplasty (RTHA) is an odd but limb- and life-threatening complication. In this retrospective analysis, we sought to determine the prevalence of such injuries requiring selective catheter embolization or bypass after RTHA and to evaluate the associated mortality rate. Methods Between 1995 and 2016, 2524 RTHAs were performed at a high-volume centre (1031 one-stage revisions, 1370 two-stage revisions and 123 resection arthroplasties). Throughout this period, nine patients presented with signs of persistent bleeding unaddressed during index surgery (9/2524; 0.35%), causing haemodynamic instability. All patients underwent angiographic exploration within the first 24 post-operative hours. Angiography evidenced four cases of bleeding pseudoaneurysms (three of them related to the common femoral artery and one to the medial circumflex femoral artery) and five cases of direct lacerations (one case in the inferior epigastric artery, one in the hypogastric artery, one in the external iliac artery, one in the popliteal artery and another in the superior gluteal artery). Results Six cases underwent selective percutaneous angiographic embolization with gelatin microspheres, obtaining immediate haemodynamic stabilization; whereas three cases required a further bypass surgery with synthetic graft. Of the former group, four patients had an uneventful evolution, while two died at a mean of 49 days after surgery due to multi-organ failure (MOF). Two cases of the bypass group died because of MOF at a mean of 22 days. Overall mortality rate was 44%. Conclusions The overall risk of arterial injury associated with RTHA was low. However, recognition of such a complication is imperative since it was associated with a high mortality rate.

    更新日期:2020-01-04
  • Twenty common errors in the diagnosis and treatment of periprosthetic joint infection
    Int. Orthop. (IF 2.384) Pub Date : 2019-10-22
    Cheng Li, Nora Renz, Andrej Trampuz, Cristina Ojeda-Thies

    Misconceptions and errors in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The goal of this paper is to systematically describe twenty common mistakes in the diagnosis and management of PJI, to help surgeons avoid these pitfalls.

    更新日期:2020-01-04
  • Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis
    Int. Orthop. (IF 2.384) Pub Date : 2019-09-13
    Luxme Mahendira, Caroline Jones, Angelo Papachristos, James Waddell, Laurence Rubin

    To evaluate the management and costs of osteoarthritis of the knee (OAK), a progressive joint disease due to bone and cartilage degeneration, with significant personal and societal impact.

    更新日期:2020-01-04
  • Initial displacement as a risk factor for avascular necrosis of the femoral head in pediatric femoral neck fractures: a review of one hundred eight cases
    Int. Orthop. (IF 2.384) Pub Date : 2019-10-26
    Wentao Wang, Yiqiang Li, Yueming Guo, Ming Li, Haibo Mei, Jingfan Shao, Zhu Xiong, Jin Li, Federico Canavese, Shunyou Chen, Chinese Multicenter Pediatric Orthopedic Study Group (CMPOS)

    To evaluate the correlation between avascular necrosis (AVN) and the amount (severity) and direction (translation and angulation) of initial displacement of pediatric femoral neck fractures.

    更新日期:2020-01-04
  • Sleep improvement after hip arthroplasty: a study on short-stem prosthesis
    Int. Orthop. (IF 2.384) Pub Date : 2019-07-27
    Josef Hochreiter, Harald Kindermann, Mattiassich Georg, Reinhold Ortmaier, Marian Mitterer

    The purpose of this study was to evaluate sleep disturbance prospectively before and after short-stem hip arthroplasty.

    更新日期:2020-01-04
  • Methods of intra- and post-operative determination of the position of the tibial component during total knee replacement
    Int. Orthop. (IF 2.384) Pub Date : 2019-10-27
    Roman Popescu, Emil G. Haritinian, Stefan Cristea

    To identify the most reliable anatomical landmarks and imaging techniques for assessing the rotation of the tibial component in total knee arthroplasty (TKA).

    更新日期:2020-01-04
  • Modified split tendon transfer of posterior tibialis muscle in the treatment of spastic equinovarus foot deformity: long-term results and comparison with the standard procedure
    Int. Orthop. (IF 2.384) Pub Date : 2019-11-19
    Marko Aleksić, Zoran Baščarevic, Vladan Stevanović, Jelena Rakočević, Andreja Baljozović, Goran Čobeljić

    Abstract Introduction Split tendon transfer of tibialis posterior (SPOTT) is a treatment option for the hindfoot varus deformity in patients with cerebral palsy (CP). The purpose of this study was to present the long-term results of the newly modified SPOTT procedure developed by our senior author and compare it with the standard SPOTT technique in equinovarus foot deformity due to CP. Method Our retrospective cohort study included patients with spastic foot deformity due to CP treated with the standard or modified SPOTT technique. Patients’ age at the time of the surgery was ≥ five years with follow-up period of at least four years. Surgical outcomes were evaluated using Kling’s criteria during the patient’s last follow-up visit. Results The analysis included 124 patients (146 feet), where 105 feet were treated by the standard SPOTT technique and 41 feet by the modified SPOTT technique. Patients’ median age at the time of the surgery was 11 years. Patients were followed-up for a median period of eight years during which the modified SPOTT technique showed significantly better surgical outcomes compared with the standard group (excellent/good results in 38 feet, 92.7%, vs. 79 feet, 75.2%, p = 0.02). Two groups of patients did not significantly differ in GMFCS level, age at the time of the surgery, or patient gender. There was similar distribution in CP patterns in the standard and modified groups; spastic hemiplegia was the most prevalent form, followed by spastic diplegia and spastic paraplegia. Overall, better surgical success was achieved in patients with GMFCS levels I–III (100%, 94.8%, and 69.8%, respectively). SPOTT procedure failure was frequently noticed in patients with GMFCS level IV (90.9%). Conclusion The modified SPOTT procedure demonstrated efficiency and safety in patients with equinovarus foot deformity due to CP during the long-term follow-up. Compared with the standard procedure, the newly modified SPOTT technique showed significantly better surgical outcome, irrespective of the patients’ gender, age, initial GMFCS level, and CP type.

    更新日期:2020-01-04
  • Knee joint replacement as primary treatment for proximal tibial fractures: analysis of clinical results of twenty-two patients with mean follow-up of nineteen months
    Int. Orthop. (IF 2.384) Pub Date : 2019-10-23
    Valtteri Tapper, Alar Toom, Maija Pesola, Konsta Pamilo, Juha Paloneva

    Proximal tibial fractures are typically treated with osteosynthesis. In older patients, this method has been reported to be associated with a high complication rate, risk of post-traumatic osteoarthritis, and long partial or non-weight bearing during the recovery phase. To avoid these problems, primary total knee replacement (TKR) has become an increasingly common treatment option.

    更新日期:2020-01-04
  • Outcomes of knee arthroplasty for primary treatment of pathologic peri-articular fractures of the distal femur and proximal tibia
    Int. Orthop. (IF 2.384) Pub Date : 2019-09-04
    Joshua D. Johnson, Cody C. Wyles, Kevin I. Perry, Brandon J. Yuan, Peter S. Rose, Matthew T. Houdek

    Abstract Background Treatment goals for pathologic fractures about the knee include pain relief and unrestricted weight bearing. In cases of condylar destruction, these fractures may not be amenable to internal fixation, and arthroplasty may be considered. The purpose of this study was to analyze the outcomes of knee arthroplasty for primary treatment of impending or pathologic fractures of the distal femur or proximal tibia. Methods Fifteen (8 males and 7 females) patients, mean age 62 ± nine years, undergoing arthroplasty for management of a pathologic peri-articular distal femur (n = 11) or proximal tibia (n = 4) fracture between 2001 and 2017 were reviewed. Implants included tumour endoprostheses (n = 11) and rotating hinged total knees (n = 4). Pathology included metastatic disease (n = 14) and lymphoma (n = 1). Eight (53%) patients presented with a fracture while the remainder had large impending lesions. Results Mean follow-up was 19 months. At final follow-up, 11 patients had died with overall five year survival of 33%. Two (13%) patients required re-operation; including wound irrigation and debridement (n = 1) and above knee amputation for local recurrence (n = 1). An additional two (13%) patients developed post-operative VTE. MSTS, KSS, and KSS-F scores improved from a mean 12 ± 16%, 30 ± 11, and 14 ± 24 pre-operatively to 69 ± 26%, 75 ± 16, and 67 ± 25 at final follow-up, respectively (P < 0.001). Thirteen (87%) patients had severe pain prior to surgery with no patients (0%, P < 0.001) reporting severe pain at last follow-up. Conclusion Knee arthroplasty provided improved function and full weight-bearing making it an effective treatment for pathologic periarticular fractures of the distal femur and proximal tibia.

    更新日期:2020-01-04
  • Diagnosis and treatment of mycoplasmal septic arthritis: a systematic review.
    Int. Orthop. (IF 2.384) Pub Date : null
    Y Chen,Z Huang,X Fang,W Li,B Yang,W Zhang

    PURPOSE Septic arthritis caused by Mycoplasma is rare. The diagnosis and effective treatment of mycoplasmal septic arthritis remains a serious problem for clinicians. The aim of this systematic review was to document the available evidence on the diagnosis and treatment methods for mycoplasmal septic arthritis and to provide guidance for clinicians. METHODS The PubMed, EMBASE, and Cochrane Library databases were searched in December 2018.The searches were limited to the English language. Article screening and data extraction and compilation were conducted by two independent reviewers. All the included studies were assessed using the Methodological Index for Non-randomized Studies (MINORS) tool. RESULTS There was a total of 33 articles including 34 cases of mycoplasmal septic arthritis and eight of them were periprosthetic joint infection (PJI). Twenty-four patients (70.6%) were immunocompromised, and the synovial fluid white blood cell (WBC) count was significantly lower in the immunocompromised group than in the immunocompetent group (48,527 × 106/L vs. 100,640 × 106/L; P = 0.009). The traditional culture method took longer, and the positivity rate was lower than that of nucleic acid testing (50% vs. 100%; P = 0.016). Only 19.2% (5/26) of patients treated with empiric antibiotics were relieved of symptoms, while 82.4% (28/34) of patients achieved satisfactory results after being treated with antibiotics against Mycoplasma. CONCLUSION The possibility of mycoplasmal septic arthritis should be considered if patients with joint infections have a history of immunocompromised, repeated negative cultures, and poor empiric antibiotic treatment results. The rational use of nucleic acid testing technologies can help in the clinical diagnosis and treatment of mycoplasmal septic arthritis.

    更新日期:2019-11-01
  • Outcome of primary deltoid ligament repair in acute ankle fractures: a meta-analysis of comparative studies.
    Int. Orthop. (IF 2.384) Pub Date : null
    Motasem Salameh,Abduljabbar Alhammoud,Nedal Alkhatib,Ahmed K Attia,Mohamed M Mekhaimar,Pieter D'Hooghe,Karim Mahmoud

    PURPOSE The indications of deltoid ligament repair in ankle injuries with widened medial clear space in the absence of medial malleolus fracture remain controversial. Many authors reported no difference in long-term functional outcomes, while others stated that persistent medial clear space widening and malreduction are higher when deltoid ligaments went without repair. This meta-analysis aims to report the current published evidence about the outcomes of deltoid ligament repair in ankle fractures. METHODS Several databases were searched through May 2018 for comparative studies. The primary outcome was the medial clear space correction, while secondary outcomes included maintenance of medial clear space reduction, pain scores, functional outcome, and total complications if any. Three comparative studies met the inclusion criteria for the meta-analysis. The analysis included a total of 192 patients, 81 in the deltoid ligament repair group and 111 in the non-repair group. RESULTS The medial clear space correction and maintenance of the said correction on final follow-up radiographs were superior in the deltoid ligament repair group. Although the pain scores were better in the repair group at the final follow-up, this did not result in a better functional outcome, with similar total complication rates. CONCLUSION In conclusion, those who had their deltoid ligament repaired had superior early and late radiological correction of the medial clear space, an indicator of the quality of ankle reduction with better pain scores. However, no differences in the functional outcome and complications rate were reported.

    更新日期:2019-11-01
  • Learning curve and clinical outcomes of percutaneous endoscopic transforaminal decompression for lumbar spinal stenosis.
    Int. Orthop. (IF 2.384) Pub Date : null
    Jin Yang,Chuan Guo,Qingquan Kong,Bin Zhang,Yu Wang,Lifeng Zhang,Hao Wu,Zhiyu Peng,Yuqing Yan,Dongfeng Zhang

    PURPOSE To define and analyze the learning curve of percutaneous endoscopic transforaminal decompression (PETD) for lumbar spinal stenosis (LSS). METHODS From July 2015 to September 2016, 78 patients underwent PETD; one of whom was converted to open surgery, two were lost, and 75 were included in this study. Clinical results were assessed by using the Oswestry Disability Index (ODI) and visual analog scale (VAS). The learning curve was assessed by a logarithmic curve-fitting regression analysis. Of these 75 patients, 35 were defined as the "early" group, and 40 were defined as the "late" group for comparison. RESULTS The mean follow-up was 25.37 ± 4.71 months. The median operative time gradually decreased from 95 (interquartile range, IQR, 85-110) minutes for the early group to 70 (IQR, 60-80) minutes for the late group (P < .000), and an asymptote was reached after approximately 35 cases. After surgery, the VAS for leg pain (LP) and ODI decreased significantly and remained constant during the follow-up. However, the VAS of low back pain (LBP) increased mildly. The total complication rate was 6.6%. ODI, VAS of LP and of LBP, and complication rate did not significantly differ between two groups. Early ambulation and short hospital stay after surgery were achieved. CONCLUSION The learning curve of PETD for LSS was assessed and good clinical results were achieved. The surgeon's experience with this technique correlated with reduced operation time. Proper patient selection, familiarity with pathological anatomy, and manipulation under endoscopic view may shorten the learning curve and decrease complications.

    更新日期:2019-11-01
  • The Iron Man of the Renaissance: the contribution of Girolamo Fabrizi d'Acquapendente.
    Int. Orthop. (IF 2.384) Pub Date : null
    F Vandenbulcke,K Ashmore,S Cialdella,A Giuffrida,E Kon,M Marcacci,B Di Matteo

    PURPOSE To highlight the most relevant contributions of the Italian Renaissance surgeon Girolamo Fabrizi d'Acquapendente in the field of orthopaedics and traumatology. METHODS An extensive research on the life and achievements of Girolamo Fabrizi was conducted on University Libraries as well as on electronic databases like PubMed. RESULTS Girolamo Fabrizi d'Acquapendente is known for his embryology and physiology studies, particularly on sensory organs and blood circulation. He founded the world's first permanent anatomical theater established at the University of Padua and inaugurated in 1595. His most notable publications include surgical and definitely orthopedics works such as "De fracturis" (On fractures) and "De luxationibus" (On joint displacement). He outlined some principles of treatment that are still valid nowadays such as anatomical reduction and stabilization of the fracture, that were applied using the equipment available at that time. He described and illustrated maneuvers and instruments, such as pulleys, winches, splint, and bandages. He further depicted the famous "Oplomochlion" ("the armored man"), which is actually a collection of all of the braces used at the time to correct congenital and post-traumatic deformities. CONCLUSION Bracing and prosthetic replacements have accompanied medical history throughout the centuries, from Ancient Egypt to the present, but it was the ingenuity of Renaissance surgeons that pushed biomedical technology to new heights: Girolamo Fabrizi d'Acquapendente was one of the most illustrious contributors to these great achievements.

    更新日期:2019-11-01
  • Correction to: The optimization of the length of the lower limbs after hip arthroplasty.
    Int. Orthop. (IF 2.384) Pub Date : 2019-10-08
    Viktor Shilnikov,Alexey Denisov,Khadizhat Masueva

    Authors first and last names for the first and third authors have been interchanged. The correct presentation is given above.

    更新日期:2019-11-01
  • Correction to: Congenital orthopaedic limb deformities in Corpus Hippocraticum.
    Int. Orthop. (IF 2.384) Pub Date : 2019-09-04
    Maria-Triantafyllia Revelou,Anna Eleftheriou,Georgia Fezoulidi,Panayiotis Hatzikyriakou,Vasileios Raoulis,Gregory Tsoucalas

    The word "limb" in the article title was misspelled with a "p" at the end. The correct title is: Congenital orthopaedic limb deformities in Corpus Hippocraticum which is also given above.

    更新日期:2019-11-01
  • Diagnosing acute compartment syndrome-where have we got to?
    Int. Orthop. (IF 2.384) Pub Date : 2019-08-31
    Tristan E McMillan,William Timothy Gardner,Andrew H Schmidt,Alan J Johnstone

    PURPOSE Acute compartment syndrome is a condition whereby tissue ischaemia occurs due to increased pressure in a closed myofascial compartment. It is a surgical emergency, with rapid recognition and treatment-the keys to good outcomes. METHODS The available literature on diagnostic aids was reviewed by one of the senior authors 15 years ago. Now, we have further reviewed the literature, to aim to ascertain what progress has been made. RESULTS In this review, we present the evidence around a variety of available diagnostic options when investigating a potential case of acute compartment syndrome, including those looking at pressure changes, localised oxygenation, perfusion, metabolic changes and available blood serum biomarkers. CONCLUSIONS A significant amount of work has been put into developing modalities of diagnosis for acute compartment syndrome in the last 15 years. There is a lot of promising outcomes being reported; however, there is yet to be any conclusive evidence to suggest that they should be used over intracompartmental pressure measurement, which remains the gold standard. However, clinicians should be cognizant that compartment pressure monitoring lacks diagnostic specificity, and could lead to unnecessary fasciotomy when used as the sole criterion for diagnosis. Therefore, pressure monitoring is ideally used in situations where clinical suspicion is raised.

    更新日期:2019-11-01
  • Resurfacing versus not-resurfacing the patella in one-stage bilateral total knee arthroplasty: a prospective randomized clinical trial.
    Int. Orthop. (IF 2.384) Pub Date : 2019-06-23
    Chengzhi Ha,Baoxin Wang,Wei Li,Kang Sun,Dawei Wang,Qicai Li

    PURPOSE Resurfacing the patella in one-stage bilateral total knee arthroplasty (TKA) remains debatable. This study aimed to assess the mid-term outcomes of patients after one-stage bilateral TKA performed with and without patellar resurfacing, respectively, with at least five years of follow-up. METHODS Sixty-six patients (132 knees) scheduled for first-ever one-stage bilateral TKA due to osteoarthritis received patellar resurfacing and retention, respectively, on one knee and the other, randomly selected. All patients received Scorpio NRG knee prostheses and were evaluated by radiology (anteroposterior, lateral, and axial views) pre-operatively and yearly post-operatively, for at least five years. Knee Society Score and Feller Score values were measured. Anterior knee pain, patellar clunk, and patient satisfaction were assessed. RESULTS One patient died within five years of operation and four were lost to follow-up. One patient developed severe dementia and could not be constructively questioned. Therefore, 60 patients (120 knees) were finally analyzed. There were significantly improved Knee Society and Feller scores (P < 0.001) in the resurfacing group compared with the non-resurfacing group post-operatively. Anterior knee pain and patellar clunk rates were lower on the resurfaced side compared with the non-resurfaced side (P < 0.001). Meanwhile, 47% and only 7% patients preferred the resurfaced and non-resurfaced sides, respectively, at final follow-up. No revision was performed for patellofemoral complications, and no significant differences were found between the two groups in radiographic outcomes. CONCLUSIONS Using the Scorpio NRG knee prosthesis, patellar resurfacing is superior to non-resurfacing in patients with osteoarthritis observed for ≥ five years. REGISTRATION TRIALS NUMBER NCT03600922 KEY POINTS: • Findings Patellar resurfacing is superior to non-resurfacing in osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) with the Scorpio NRG knee prosthesis. • Implications Patellar resurfacing should be performed in OA patients during TKA. • Caution Several prosthesis types should be assessed in the same study setting, and multicenter studies are required before generalizability of the present findings.

    更新日期:2019-11-01
  • Dual mobility constructs in revision total hip arthroplasty: survivorship analysis in recurrent dislocation versus other indications at three to twelve-year follow-up.
    Int. Orthop. (IF 2.384) Pub Date : null
    Nicolas de l'Escalopier,Valérie Dumaine,Guillaume Auberger,Antoine Babinet,Jean-Pierre Courpied,Philippe Anract,Moussa Hamadouche

    BACKGROUND The aim of this retrospective study was to evaluate the clinical, radiologic, and survival results of dual mobility (DM) sockets in revision total hip arthroplasty (THA) performed for instability versus revision THAs performed for other reasons. METHODS From a computerized database, we identified 84 revision THAs using a modern DM socket performed in 81 patients with a mean age of 71 years. Indication for revision was recurrent dislocation in 47 hips, and other reasons in the remaining 37 hips. A survivorship analysis according to the actuarial method was carried out on the entire series using revision for any cause, revision for dislocation, and radiological cup loosening revised or not, as the end points. RESULTS Of the 81 patients, twelve died, six were lost to follow-up, eight had been revised, and 55 patients (58 hips) were unrevised and alive at a mean follow-up of 6.4 years. Dislocation occurred in four of the 47 (8.5%) hips for which indication for revision was dislocation versus one of the remaining 37 (2.7%) hips [odds ratio = 3.4 (0.4-31.3), p = 0.07]. According to our criteria, three acetabular components of which one was revised were considered as loosened. When using revision for dislocation as the end-point, the survival rate at seven years was 90.4 ± 5.3% (IC95%, 79.9-100) in the 47 hips for which the indication for revision was dislocation versus 100% in the remaining 37 hips (log-rank, p = 0.5). CONCLUSIONS The current study indicated that DM sockets represent an interesting solution to prevent dislocation in revision THAs at mid-term follow-up.

    更新日期:2019-11-01
  • Is there scientific evidence to support antibiotic prophylaxis in patients with periodontal disease as a means to decrease the risk of prosthetic joint infections? A systematic review.
    Int. Orthop. (IF 2.384) Pub Date : null
    Ana Isabel Moreira,Luzia Mendes,José António Pereira

    PURPOSE To re-assess the scientific literature to ascertain if there is scientific evidence to support antibiotic prophylaxis in patients with periodontal disease as a means to decrease the risk of prosthetic joint infections. INTRODUCTION Prosthetic joint infections occur in approximately 0.3-2% of patients and, of these, around 6-13% are thought to be caused by oral bacteria. Antibiotic prophylaxis prior to dental procedures as a means to prevent a prosthetic joint infection has been controversial throughout the years. However, it remains unclear to what extent it has a beneficial effect. We do know that bacteraemia of oral origin is directly proportional to any ongoing inflammation or infection, and that a diseased periodontium may act as an entry for bacteria to spread to distant locations, through the bloodstream, and potentially be the cause of distant site infections. MATERIALS AND METHODS Updated literature search using the PubMed (Medline), and the Clarivate Analytics databases, to identify eligible articles since the previous searches up to April 2019 (last 5 years). RESULTS No studies that relate periodontal disease to the development of a prosthetic joint infection were found. CONCLUSION Currently, there is no evidence to support or exclude the need of antibiotic prophylaxis as a means to decrease the risk of prosthetic joint infections in patients with periodontal disease.

    更新日期:2019-11-01
  • Reconstruction of composite leg defects post-war injury.
    Int. Orthop. (IF 2.384) Pub Date : 2019-10-20
    Reem A Karami,Fadi M Ghieh,Rawad S Chalhoub,Said S Saghieh,Suhail A Lakkis,Amir E Ibrahim

    BACKGROUND In a high conflict region, war injuries to the distal lower extremity are a major source of large composite defects involving bone and soft tissues. These defects are at the edge between using a single free flap [osteo-(+/-myo) cutaneous] vs double free flap reconstruction (bone and soft tissue). In this paper, we present our experience and outcomes in treating patients with leg war injury reconstructed using a single free fibula flap. METHODS Fifteen patients with distal leg composite defects secondary to war injuries were treated between January 2015 and March 2016. All patients were reconstructed using single barrel free fibula osteo-(+/-myo)cutaneous flap where single or double skin paddles were used according to the soft tissue defect requiring coverage. RESULTS There were no cases of total or partial flap loss. Complications were limited to three cases including traumatic fibula fracture, venous congestion with negative findings, and residual soft tissue defect requiring coverage. There were no cases of wound dehiscence or infection. Mean follow-up time was 418.8 days. Mean bone healing time was nine months after which patients were allowed full weight bearing. CONCLUSION A single barrel free fibula osteo-(+/-myo)cutaneous flap is a valid and reliable tool for reconstruction composite lower extremity defects post-war injury. Adequate planning of fibula flap soft tissue components (skin, muscle) rearrangement is essential for success in such challenging reconstructions.

    更新日期:2019-11-01
  • The patient results and satisfaction of knee arthroplasty in a validated grading system.
    Int. Orthop. (IF 2.384) Pub Date : 2019-09-14
    Christiaan Rudolf Oosthuizen,Catherine Van Der Straeten,Innocent Maposa,Christian Hugo Snyckers,Duwayne Peter Vermaak,Sebastian Magobotha

    INTRODUCTION The validated Knee Osteoarthritis Grading System (KOGS) was implemented and clinical results were compared with patient satisfaction data and implant survivorship in a multi-centre study with surgeons familiar with unicompartmental knee arthroplasty (UKA), patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA). This is also the first study to evaluate the prevalence of UKA and TKA in consecutive osteoarthritis (OA) knee arthroplasties assessed by this system.. METHOD A consecutive cohort of knees was gathered at three different institutions as categorized by KOGS and surgically treated with the recommended implant unless clinical reasons or patient preference precluded such an option. One thousand one hundred seventy-seven consecutive knees were evaluated including 311 TKA (26%), 695 medial UKA (59%), 154 lateral UKA (13%) and 17 PFA (2%) and the results of the categories evaluated with the Oxford Knee Score (OKS) and the complications reflected in the different categories. RESULTS The failure rate of the UKA (3.5%) or TKA (1.6%) is not higher than accepted results in the literature and the difference in complications is negligible between the UKA (72%) and TKA (26%) cohorts. Revision of a UKA to a TKA as an endpoint was 0.58% with ipsilateral progression at 0.8% over a period of five to 84 months (mean follow-up of 36 months) despite the 'excessive' proportion of UKA in this cohort. The Oxford Score improvement is significant in TKA and UKA and contributes to the acceptable outcomes (The OKS for TKA improved from 20 pre-operatively to 36 post-operatively and the UKA improved from 22 pre-operatively to 39 post-operatively). CONCLUSION KOGS achieves acceptable early survival and functional results when implemented and is a suitable tool for identifying the preferred implant as was validated.

    更新日期:2019-11-01
  • Clinical experience with combined reconstruction of the anterior cruciate and anterolateral ligaments of the knee in sportsmen.
    Int. Orthop. (IF 2.384) Pub Date : 2019-09-13
    Evgeniy Nikolaevich Goncharov,Oleg Aleksandrovich Koval,Vadim Erikovich Dubrov,Eduard Nikolaevich Bezuglov,Anastasiya Mikhaylovna Filimonova,Nikolay Gavriilovich Goncharov

    BACKGROUND Rupture of the anterior cruciate ligament (ACL) is one of the most common sports injuries of the knee joint. Today, we have a large number of approaches to arthroscopic reconstruction of the anterior cruciate ligament that lead to successful outcomes and allow the patients to return to a significant level of activity post-operatively. Nevertheless, the return to competitions rate stays relatively low. The functional state is thought to be dependent on rotational and anteroposterior stability of the knee. These data encourage search for methods of additional stabilization of the knee joint, one of them being extra-articular tenodesis, or reconstruction of anterolateral ligament of the knee. THE AIM OF THE STUDY To evaluate medium-term results of combined simultaneous arthroscopic reconstruction of anterior cruciate ligament and anterolateral ligament of the knee joint in sportsmen and to access the probability of return to competitions. MATERIALS AND METHODS The surgeries were performed in 2014-2015 in 50 patients who fulfilled the entry criteria: 20 patients (including 10 professional sportsmen) underwent arthroscopic ACL reconstruction together with reconstruction of anterolateral ligament-group 1 (main group), and 30 patients (including 10 professional sportsmen) underwent arthroscopic ACL reconstruction-group 2 (control group). RESULTS Group 1: All patients of group 1 were able to return to the pre-operative sports level in two years after the surgery. The mean Tegner Lysholm score was 72.6 ± 6.45 (hereinafter, SE-standard error) before the surgery and 97.4 ± 1.18 after the surgery. The mean IKDC score was 63.1 ± 4.8% before the surgery and 96.3 ± 1.8% after the surgery. Group 2: 20 of 30 patients (66.7%) returned to the pre-operative level of activity and returned to competitions (if they were professional sportsmen) in a year after the surgery. Five of ten patients (50%) (professional sportsmen) returned to competitions. Fifteen of 20 patients (75%) (amateur sportsmen) also returned to competitions. The mean pre-operative Tegner Lysholm score was 69.6 ± 3.5, and the mean post-operative score was 92.1 ± 3.9. The mean pre-operative IKDC score was 73.4 ± 3.2%, and the mean post-operative score was 90.3 ± 3.7%. CONCLUSION The results of the study show that more patients with higher functional demands and more professional sportsmen returned to sports. Despite the results of our and other foreign studies, a need remains for studies that will compare outcomes of ALL reconstruction with the same surgical technique in homogenous groups of patients.

    更新日期:2019-11-01
  • Clinical and radiological outcomes in thoracolumbar fractures using the SpineJack device. A prospective study of seventy-four patients with a two point three year mean of follow-up.
    Int. Orthop. (IF 2.384) Pub Date : 2019-08-17
    Gael Kerschbaumer,Benoit Gaulin,Sébastien Ruatti,Jérôme Tonetti,Mehdi Boudissa

    PURPOSE The aim of this study was to assess clinical and radiological results of SpineJack on the treatment of vertebral body fractures in a continuous prospective series of patients. MATERIAL AND METHODS Between May 2012 and April 2015, all patients operated using the SpineJack device were prospectively included in this monocentric study. Demographic data, clinical, and radiological results were recorded. Complications and surgical managements were recorded. RESULTS At a mean follow-up of 2.3 years, 74 patients with 77 fractured vertebrae were included. The stand-alone SpineJack group comprised 60 patients with 63 fractured vertebrae (group 1) and the group with additional posterior fixation 14 patients with 14 fractured vertebrae (group 2). The average initial vertebral wedge angle was 13.3 ± 6.1 degrees for group 1 and 15.3 ± 5.7 degrees for group 2 (p = 0.25). Post-operative values were 6.5 ± 4.6 degrees for group 1 and 5.1 ± 3.9 degrees for group 2 (p = 0.31). The differences within the same group were highly significant (p < 0.0005). The loss of reduction at last follow-up was 0.8 ± 1.6 degrees in group 1 and 0.6 ± 2.0 degrees in group 2 (p = 0.77). Subjective results were considered as very good or good for 57 patients (95%) in group 1 and for 11 patients (79%) in group 2, p = 0.07. CONCLUSION The SpineJack seems to be a promising tool in the treatment of traumatic vertebral fractures with a correction in the sagittal plane comparable with what can be found in the literature.

    更新日期:2019-11-01
  • Early surgical treatment of first-time anterior glenohumeral dislocation in a young, active population is superior to conservative management at long-term follow-up.
    Int. Orthop. (IF 2.384) Pub Date : 2019-08-09
    Angelo De Carli,Antonio Pasquale Vadalà,Riccardo Lanzetti,Domenico Lupariello,Edoardo Gaj,Guglielmo Ottaviani,Bhavik H Patel,Yining Lu,Andrea Ferretti

    PURPOSE To compare the long-term effectiveness of non-operative treatment with immediate arthroscopic surgical stabilization in young, active patients after first-time anterior glenohumeral dislocation. MATERIALS AND METHODS Consecutive patients aged 15-25 years who suffered primary traumatic anterior glenohumeral dislocation were enrolled in this prospective, non-randomized investigation. In total, 160 patients were enrolled-64 opted for surgical stabilization (group A), while 96 opted for conservative treatment (group B). At final follow-up of over 6.5 years, 60 patients in group A (96.7% males, age 22.8 ± 3.2) and 70 patients in group B (90.0% males, age 20.8 ± 2.9) were evaluated with physical examination, patient-reported outcome measures (PROMs), and radiological studies. Recurrence and return to sport (RTS) data were collected, and variables were compared between groups. RESULTS Recurrence rate in group A was 13.3% at mean latency of 3.3 ± 1.9 years, compared to 71.4% at mean latency of 2.1 ± 1.5 years in group B (P < 0.001 for both recurrence rate and latency). In group A, 70.0% of patients RTS at the pre-injury level, versus 41.4% of patients in group B (P < 0.001). Patients in group A scored significantly higher on all PROMs (all P < 0.001) and had significantly less osteoarthritis (P = 0.004), when compared to group B. CONCLUSION Acute surgical stabilization of first-time anterior shoulder dislocation in young, active patients is more effective than conservative treatment at long-term follow up, based on lower recurrence rate, better RTS, and higher patient-perceived improvement.

    更新日期:2019-11-01
  • Prophylactic inferior vena cava filters for operative pelvic fractures: a twelve year experience.
    Int. Orthop. (IF 2.384) Pub Date : 2019-08-09
    Wayne B Cohen-Levy,Jin Liu,Milan Sen,Sheldon H Teperman,Melvin E Stone

    INTRODUCTION Conflicting evidence exists regarding the role of inferior vena cava filters (IVCFs) in the prevention of pulmonary embolism. The aim of this study was to review an institutional policy of prophylactic IVCF placement in all operative pelvic and acetabular fractures as a means of preventing PE by comparing it to a historical prepolicy period of significantly less aggressive IVCF placement. METHODS The trauma registry of a single level 1 trauma center was retrospectively queried for all pelvic or acetabular fractures for the prepolicy and intervention periods as defined as January 2003-December 2008 and January 2009-December 2014, respectively-yielding 231 patients for analysis. The primary and secondary outcomes measured were the incidence of PE and deep vein thrombosis. RESULTS The rate of prophylactic IVCF insertion significantly increased during the study period (p < 0.001). The incidence of pulmonary embolism (1.8% vs. 5.1%, p = 0.351) and DVT (19.3% vs. 10.3%, p = 0.231) were not significantly different when comparing the prepolicy and intervention cohorts. In patients with operative fractures, a nonsignificant trend of increasing incidence of DVTs was appreciated in patients with a prophylactic IVCF versus those without prophylactic IVCF (13 vs. 2, p = 0.222). DISCUSSION A policy of increased use of prophylactic IVCFs in patients with operative pelvic and acetabular fractures failed to reduce the incidence of PE or DVT. In contrast, several case reports and institutional series have published several risks associated with IVCF placement including failure to retrieve temporary IVCF. CONCLUSION The benefit of prophylactic IVCF in this patient population is unclear.

    更新日期:2019-11-01
  • Three-dimensional computed tomography analysis and functional results of calcaneal fractures treated by an intramedullary nail.
    Int. Orthop. (IF 2.384) Pub Date : 2019-08-03
    Antoine Fourgeaux,John Estens,Thierry Fabre,Olivier Laffenetre,Julien Lucas Y Hernandez

    BACKGROUND Intramedullary calcaneal nailing is used to treat displaced intra-articular calcaneal fractures. The main goal of the study was to assess the reduction of tomography and secondary goals were patient functional scores and complication rates. METHODS The functional outcome and restoration of the radiographic parameters were evaluated post-operatively, at three months, at one year, and at the last follow-up. The morphology of the posterior facet was evaluated post-operatively, at one year and at the last follow-up by CTs. RESULTS Twenty-six patients were included. The mean follow-up was 2.8 years. The mean AOFAS-AHS was 79 at the last follow-up. The mean calcaneal height index and length rose respectively from 0.44 to 0.86 and 83 to 87 mm, and the width decreased from 50 to 46 mm. CONCLUSION The radiographic parameters were restored. The AOFAS-AHS was comparable with other series. This study confirms the efficiency of this procedure with lower rate of complications.

    更新日期:2019-11-01
  • Extra-articular proximal femur fractures in children and adolescents treated by elastic stable intramedullary nailing.
    Int. Orthop. (IF 2.384) Pub Date : 2019-07-29
    Flavia Alberghina,Antonio Andreacchio,Mattia Cravino,Matteo Paonessa,Federico Canavese

    PURPOSE Extra-articular proximal femur fractures (EPFF) remain challenging for their intrinsic instability. The aim of this study is to evaluate the results of elastic stable intramedullary nailing (ESIN) of extra-articular proximal femur fractures in children and adolescents. METHODS A retrospective monocentric study of children treated by ESIN for EPFF between 2012 and 2018 was conducted. We included all patients sustaining a fracture within 10% of the femur length below the lesser trochanter. Studied data were age, sex, femur length, fracture distance below the lesser trochanter, number of days of hospitalization, time to nail removal, and complications. Beaty's criteria and the titanium elastic nailing (TEN) outcome measure scale were used to evaluate radiologic outcome and assess clinical recovery, respectively. RESULTS A total of 24 cases were reviewed (18 males, 6 females). Mean age was 8.23 years (range 5-13). Mean duration of hospitalization was 3.7 days (range 2-12). Mean time to nail removal was 28 weeks (range 12-53). Malalignment was observed in five patients, but in all cases, angulation did not exceed 10°. No limb length discrepancy was observed. Twenty out of 24 patients had excellent Beaty's radiological and TEN clinical outcome scores. No poor results were observed. CONCLUSIONS The results of our study show that good outcomes following surgical treatment by ESIN should be expected in children younger than 14 years of age with displaced EPFF. Excellent radiological and clinical outcomes were observed in 83.7% of the cases, with a low rate of complications and short hospital stay.

    更新日期:2019-11-01
  • Social determinants associated to chronic pain after total knee arthroplasty.
    Int. Orthop. (IF 2.384) Pub Date : 2019-07-20
    Rodrigo Núñez-Cortés,Claudio Chamorro,Maritza Ortega-Palavecinos,Gustavo Mattar,Orlando Paredes,Álvaro Besoaín-Saldaña,Carlos Cruz-Montecinos

    AIM OF THE STUDY Analyze the association between social health determinants (SHD) and chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA). METHOD A cross-sectional study was performed in 58 TKA patients. The subjects were classified in two groups: with (n = 22) or without (n = 36) CPSP. SHD considered were gender, age, educational level, economic income, and labour conditions. RESULTS Significant differences were found concerning educational level when comparing subjects with or without CPSP, with a low educational level of 22.4% and 19%, respectively. 15.5% of patients with persistent pain had a high educational level compared with 43.1% of the patients without persistent pain (p = 0.032). No significant differences were found for the other categories (p > 0.05). The odds ratio (95% confidence interval) was 3.28 (1.09-9.93) for lower educational level compared with high educational level. DISCUSSION CPSP must be considered a severe health problem. In addition to SDH, there are multiple factors associated with chronic pain after TKA that must be considered for an effective treatment. CONCLUSIONS Patients with lower educational level showed a three-time higher association to develop CPSP. Considering SHD could be of relevance when elaborating new interventions or health strategies and more specialized counseling for patients with persistent pain after TKA.

    更新日期:2019-11-01
  • Patient-specific cutting guides for open-wedge high tibial osteotomy: safety and accuracy analysis of a hundred patients continuous cohort.
    Int. Orthop. (IF 2.384) Pub Date : 2019-07-06
    Samir Chaouche,Christophe Jacquet,Maxime Fabre-Aubrespy,Akash Sharma,Jean-Noël Argenson,Sebastien Parratte,Matthieu Ollivier

    INTRODUCTION Several recent studies have reported accurate and reliable use of patient-specific cutting guides (PSCG) for medial opening-wedge high tibial osteotomy (OW-HTO); however, a majority of these are small cases series or ex-vivo reports. The hypothesis of this study was that performing an OW-HTO with PSCG results in a reliable and accurate correction with good or satisfactory patient-reported functional outcomes at a mean of two years. We also hypothesized that the use of PSCG would not increase the rate of specific or non-specific complications. METHODS In this single-centre, observational study, a prospective cohort of a hundred patients (age < 60 years with isolated medial knee osteoarthritis and significant metaphyseal tibial vara) were included between February 2014 and November 2017 to investigate the safety and accuracy of OW-HTO using PSCG. The accuracy of post-operative alignment was defined by the difference between the desired correction defined pre-operatively and the correction obtained post-operatively measured on CT scan (ΔHKA, ΔMPTA, ΔPPTA). Functional outcomes were evaluated by the difference between the value obtained in the pre-operative questionnaire and that obtained at the last follow-up (mean 2 years) using the KOOS and UCLA activity scale. Intra-operative and post-operative complications were recorded. RESULTS The mean patient age was 44.17 ± 6.77 years; no patient was lost to follow-up at a mean of two years. The mean ΔHKA was 1 ± 0.95°, the mean ΔMPTA was 0.54 ± 0.63°, and the mean ΔPPTA was 0.43 ± 0.8°. No significant differences (all p values > 0.05) were observed between the desired correction defined pre-operatively and the correction obtained post-operatively (ΔHKA, ΔMPTA, ΔPPTA). An improvement of 27 ± 25 for the KOOS Pain, 28 ± 26 for the KOOS symptoms, 27 ± 28 for the KOOS ADL, 26 ± 33 for the KOOS sport/rec, 28 ± 38 for the KOOS QOL, and 2.6 ± 2.4 for the UCLA was obtained as compared with the pre-operative values (all p < 0.0001). No procedures observed were abandoned, and the PSCG was well positioned in all cases. The overall complication rate was 32% up to two years post-operatively, most of them being classed as minor events (28%). CONCLUSION Performing an OW-HTO with PSCG produces an accurate correction with good functional outcomes at a mean of two years. Furthermore, there is no increase in the rate of specific or non-specific complications. A study to assess the reproducibility of this technique, regardless of the surgical level, is needed.

    更新日期:2019-11-01
  • Altered seric levels of albumin, sodium and parathyroid hormone may predict early mortality following hip fracture surgery in elderly.
    Int. Orthop. (IF 2.384) Pub Date : 2019-07-01
    Alejandro Lizaur-Utrilla,Blanca Gonzalez-Navarro,Maria F Vizcaya-Moreno,Fernando A Lopez-Prats

    PURPOSE To analyse a wide set of routine laboratory parameters at admission to predict mortality within 30 post-operative days in elderly patients with hip fracture, as well as calculate the critical values of those biomarkers. METHOD Data of 994 patients older than 65 years with hip fracture were analysed of which 89 (8.2%) died within 30 post-operative days. Variables described in the literature with potential influence on early mortality were collected, including demographics, fracture type, American Society of Anesthesiologists score, Charlson's comorbidity index and pre-operative Hodkinson's mental test and the Katz index for activities of daily living. In addition, an exhaustive collection of biomarkers from routine blood testing at admission was performed. Critical levels of biomarkers were calculated by the method of area under ROC curve. RESULTS At admission, early mortality group had significantly higher Charlson's index (p = 0.001) and lower the Katz index (p = 0.001). The surgical delay also was significantly longer in that group (p = 0.001). In univariate analyses, serum concentration at admission of total protein (p = 0.004), albumin (p = 0.001), sodium (p = 0.001), and parathyroid hormone (PTH) (p = 0.001) were significantly different between both groups. In multivariate analysis, serum albumin < 2.9 g/dL (p = 0.013), sodium < 127 mEq/L (p = 0.035) and PTH > 65 pg/mL (p = 0.005) were predictors of early mortality. The three biomarkers together accounted for 67% of the variability in early mortality. CONCLUSION The association of altered levels at admission of serum concentration of albumin, sodium and PTH was predictor of early mortality following hip fracture surgery in elderly patients.

    更新日期:2019-11-01
  • Exposure of the brachial plexus in complex revisions to reverse total shoulder arthroplasty.
    Int. Orthop. (IF 2.384) Pub Date : 2019-06-17
    Jorge Rojas,Filippo Familiari,Amrut U Borade,Jacob Joseph,E Gene Deune,Jack V Ingari,Edward G McFarland

    BACKGROUND Excision of extensive scar tissue (EEST) may be required in certain cases of revision reverse total shoulder arthroplasty (RTSA). Neurovascular structures are at a higher risk of iatrogenic direct injury in these cases. We describe a technique to expose and protect the musculocutaneous and axillary nerves in a series of revision RTSA cases that required EEST. METHODS Between 2004 and 2013, 83 revision RTSA procedures were identified in our database. Of these, 18 cases (22%) who underwent concomitant nerve exploration for EEST preventing glenoid exposure, preventing reduction of the humeral component, or causing instability of the implanted RTSA, were included. All patients were observed for a minimum of two years or until reoperation. Patient-reported outcome scores (PROMs), range of motion (ROM), and complication rates were analyzed. RESULTS Patients had significant pain relief and improvement in PROMs post-operatively. Two patients (11%) required another revision surgery because of infection (one patient with glenoid loosening; one patient with stem loosening). Two patients (11%) had instability successfully managed with closed reduction. Two patients (11%) had a clinically evident post-operative nerve injury. Both cases were neurapraxias (1 partial brachial plexopathy and 1 partial isolated axillary nerve injury) and experienced complete neurologic recovery at last follow-up. CONCLUSIONS Complete permanent nerve injuries resulting from direct surgical trauma during revision RTSA requiring EEST can be avoided using the technique presented here. Despite proper exposition of the nerves, partial temporary neurapraxic injuries may occur. Patients who underwent this procedure experienced significant improvements in shoulder pain and function with complication rates consistent to those previously reported in revision RTSA.

    更新日期:2019-11-01
  • Good outcome using anatomically pre-formed buttress plates for anteromedial facet fractures of the coronoid-a retrospective study of twenty-four patients.
    Int. Orthop. (IF 2.384) Pub Date : 2019-06-09
    Alexander Klug,Stefan Buschbeck,Yves Gramlich,Johannes Buckup,Reinhard Hoffmann,Kay Schmidt-Horlohé

    PURPOSE The aims of this retrospective study were to describe the characteristics of anteromedial facet fracture of the coronoid (AMFF) and to determine the outcome following surgery using anatomically pre-formed coronoid buttress plates. METHODS Twenty-four patients underwent surgery for AMFF, using a pre-formed buttress plate, between 2011 and 2017 (20 men, four women), with a mean age of 47.7 years (range, 19-78 years) and a mean post-operative follow-up of 3.7 years (range, 12-86 months). Fracture classification, injury pattern, accompanying injuries, post-operative range of motion, and revision rate were noted. Post-operative radiographs assessed union, arthritic change, and joint articulation. Joint function was quantified using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS Eleven cases with subtype 2 and 13 cases with a subtype 3 AMFF could be included, of which 15 had an associated rupture of the lateral collateral ligament (LCL) and nine of the medial collateral ligament (MCL). Post-operatively, all cases went to bone union without secondary elbow instability. The mean post-operative range of motion was 125° (range, 90-140°), mean MEPS was 98, mean OES was 43, and mean DASH score was 7. Five patients required repeat surgery within two years due to a limited range of motion; 90% of patients regained their pre-trauma levels of physical activity. CONCLUSIONS AMFF are challenging injuries, frequently associated with lesions to the collateral ligament complex. Using anatomically pre-formed coronoid plates, excellent functional outcomes can be achieved.

    更新日期:2019-11-01
  • The forgotten joint score in total and unicompartmental knee arthroplasty: a prospective cohort study.
    Int. Orthop. (IF 2.384) Pub Date : 2019-05-23
    Geert Peersman,Jeroen Verhaegen,Barbara Favier

    PURPOSE The purpose of this study was to assess whether unicompartmental knee arthroplasty (UKA) results in better patient-reported and clinical outcome than total knee arthroplasty (TKA). The study hypothesis was UKA yields better patient-reported and clinical outcomes than TKA. METHODS Our prospective cohort study compared patients who underwent medial UKA or TKA from February 2014 through June 2015. Forgotten Joint Score (FJS), the short form of the Knee Injury and Osteoarthritis Outcome Score (KOOS PS), EuroQOL Five Dimensions Questionnaire (EQ-5D), and the Knee Society Score (KSS) were completed at two weeks, six weeks, three months, six months, and one year post-operatively. The KOOS PS, EQ-5D, and the KSS were also documented pre-operatively. RESULTS Fifty-seven patients (57 knees) were allocated to the UKA group and 62 patients (62 knees) to the TKA group. At baseline, no statistically significant differences were observed between groups regarding patient demographics and pre-operative scores. Except for FJS at 2 weeks (p = 0.326), all postoperative scores revealed significant differences as early as two weeks and up to 12 months (p < 0.05). CONCLUSIONS Our findings suggest UKA patients are less aware of their joint replacements than TKA patients for medial osteoarthritis of the knee. UKA conserves more soft tissue and bone than TKA, which may be the reason for the differences observed.

    更新日期:2019-11-01
  • Anterior cruciate ligament reconstruction in association with medial unicompartmental knee replacement: a retrospective study comparing clinical and radiological outcomes of two different implant design.
    Int. Orthop. (IF 2.384) Pub Date : 2019-05-13
    Andrea Tecame,Roberto Savica,Michele Attilio Rosa,Paolo Adravanti

    PURPOSE Unicompartmental knee arthroplasty (UKA) combined with anterior cruciate ligament (ACL) reconstruction has recently been suggested as a feasible treatment option for young and active patients with medial compartment osteoarthritis (OA) and ACL deficiency. The aim of this study is to evaluate retrospectively the outcomes of two different implant designs in patients with medial OA secondary to traumatic ACL rupture, who underwent combined ACL reconstruction and unicompartmental knee replacement. METHODS From January 2007, to December 2013, 24 patients with medial OA secondary to ACL rupture underwent medial unicompartmental knee arthroplasty (UKA) and ACL reconstruction. Nine patients received a mobile bearing UKA (Group 1) and fifteen a fixed-bearing one (Group 2). The mean follow-up was 53 ± 8.3 months for Group 1 and 42 ± 6.7 months for Group 2. Knee Society Score (KSS), Western Ontario and McMaster Index of Osteoarthritis (WOMAC) index and radiological evaluation used to assess the implant loosening alignment of the knee joint and tibial slope were recorded pre-operatively and at the last follow-up. RESULTS At the final follow-up, all patients showed statistically significant clinical improvements with respect to the pre-operative values (p < 0.05). No significant difference was observed in WOMAC index and KSS both objective and functional between groups at the last follow-up (KSS obj. 73.4 ± 9.3 vs 77.3 ± 10.5; KSS funct. 86.2 ± 6.2 vs 84.7 ± 5.9; WOMAC 79.3 ± 7.3 vs 81.3 ± 7.6 for Group 1 and 2, respectively). No differences in radiolucent lines were found between the groups. CONCLUSION The use of different prosthesis design (fixed- or mobile-bearing) during a combined procedure of ACL reconstruction and medial unicompartmental arthroplasty does not affect the middle-term clinical and radiological outcomes.

    更新日期:2019-11-01
  • Outcomes after locked plating of displaced patella fractures: a prospective case series.
    Int. Orthop. (IF 2.384) Pub Date : 2019-05-02
    Alexander Ellwein,Helmut Lill,Rony-Orijit DeyHazra,Tomas Smith,Jan Christoph Katthagen

    PURPOSE Tension band wiring remains a common treatment for patella fractures, but complication rates are high, with unsatisfactory results. The purpose of this observation study was to evaluate clinical results and complication rates of a novel patella locking plate fixation. METHODS Twenty patients (mean age, 59.2 ± 18 years) with displaced patella fractures were prospectively enrolled. Range of motion, knee scores (Tegner, Lysholm, Kujala), complications, and revision surgeries were assessed six weeks, six months, 12 months, and 24 months after surgery. Results were compared to the situation before trauma in regards to the time of follow-up using a paired sample t test. RESULTS According to the OTA classification, the fractures were classified as follows: one A1, four C1, six C2, and nine C3. Range of motion improved from 121° after six weeks to 140°, 141°, and 143° within the follow-up period. While the Tegner, Lysholm, and Kujala scores were 4.1/97/97, respectively, before trauma, they improved from 2.6/80/89 to 3.6/94/89, 3.7/95/94, and 4.1/97/97 within the follow-up period. Three patients had a complication (15%): one fracture dislocation, one reactive bursitis, and one renewed fracture. Four patients reported discomfort or anterior knee pain especially when kneeling on the implant. CONCLUSIONS The patella locking plate is a safe and effective treatment for patella fractures, including comminuted fractures. Function can be restored within six months after surgery, and the complication rate is low. Nonetheless, the implant can cause discomfort or anterior knee pain especially when kneeling, which can necessitate an implant removal.

    更新日期:2019-11-01
  • Risk factors and failures in the management of limb injuries in combat casualties.
    Int. Orthop. (IF 2.384) Pub Date : 2019-04-12
    Antoine Grosset,Georges Pfister,Nicolas de l'Escalopier,Soryapong Plang,Anne-Pauline Russo,James-Charles Murison,Laurent Mathieu,Sylvain Rigal

    INTRODUCTION Treatment of war wounds is based on a sequential surgical strategy, which frequently faces therapeutic failures, which then burden the final functional result. The aim of this study was to identify risk factors of failure of the different treatments to prevent the therapeutic failure. METHODS A monocentric case-control study was done on French war-wounded soldiers treated for an open fracture caused by an invasive war weapon. The primary end point was the treatment failure three months after the injury. The risk factors of failure studied were the traumatic mechanism, the general and local lesional assessment, and the surgery performed. RESULTS Between January 1, 2004 and December 31, 2016, 57 soldiers were included, with an average follow-up of 3.42 years. On 81 limb segments studied, the most injured segment was the leg (37.0%). A vital or urgent surgery requirement (OR = 1.56; p = 0.02) and bone loss substance (OR = 5.45; CI95% = 1.54-20.09) were risk factors of failure for limb salvage treatment. Improvised explosive device traumatic mechanism (OR = 1.56; p = 0.02) and the persistence of surgical site contamination after two debridement procedures (OR = 1.20; p = 0.04) were risk factors of failure for amputation procedures. CONCLUSIONS Two main risk factors of treatment failure are highlighted: those in relation to traumatic mechanisms and general lesional assessment and those in relation to surgical site conditions. There is no over risk of failure in relation to surgical procedure and treatment.

    更新日期:2019-11-01
  • External fixation for primary and definitive management of open long bone fractures: the Syrian war experience.
    Int. Orthop. (IF 2.384) Pub Date : 2019-03-25
    Abduljabbar Alhammoud,Bakry Maaz,Ghalib Ahmed Alhaneedi,Mason Alnouri

    AIMS To report on the experience of one field hospital in using external fixation as a primary and definitive treatment for open long bone fractures during the Syrian war. METHODS A total of 955 patients with open long bone fractures (femur, tibia, humerus) who were operated and followed up at a field hospital in Aleppo, Syria, from 2011 to 2016, were retrospectively reviewed. Different types of uniplanar and some multiplanar external fixators were used solely as a primary and definitive tool until bone union was achieved. Union rate and infection rate were reported in association with age, gender, Gustilo/Anderson classification, type of fixator, and presence of neurovascular injuries. RESULTS Out of 955 patients, 404 (42.3%) continued to follow up until bone union or until removal of the external fixator. The average age was 27.5 ± 11 years, with 91.6% males and 8.2% females. The overall union rate was 68.3% (276/404), with 60.9% (95/156) in open femur, 70.3% (137/195) in open tibia, and 83% (44/53) in open humerus fractures. The overall infection rate was 16.7% (67/401), with 18.6% in open femur, 18.1% in open tibia, and 5.8% in open humerus fractures. CONCLUSION The use of external fixation for definitive treatment of open long bone shaft fractures caused by high energy trauma during times of wars or conflicts is reliable and should be used in early frontline intervention and in areas with limited access to resources.

    更新日期:2019-11-01
  • Decision-making algorithm for sequential treatment of diaphyseal bone gaps in war-wounded patients in the Middle East.
    Int. Orthop. (IF 2.384) Pub Date : 2019-02-25
    Rasheed M Fakhri,Patrick Herard,Mohammed I Liswi,Anne L Boulart,Ali M K Al Ani

    INTRODUCTION Tibial bone gaps after war injuries are common and can be managed by different types of surgery, including compression, bone graft, tibialisation of fibula, bone transport, and free flaps. Here, we present an algorithm developed at a humanitarian surgical hospital to manage tibial bone gaps. We also identify some key factors affecting patient outcomes and describe some clinical considerations for choosing treatment strategy. METHOD We performed retrospective data analysis on war-wounded adult patients with tibial injuries treated at our project according to the described algorithm. Patient outcomes were followed for at least four years. Outcomes assessed were length of stay, complication rate, re-admission (late complications), and final discharge. RESULTS Among the 200 included patients, 103 (51.5%) had bone gaps. Univariate analysis showed that the presence of a bone gap, but not its size, was associated with significantly increased risk of early complications, while type of surgery was significantly correlated with re-admission. Presence of a bone gap and type of surgery were each significantly associated with length of stay. Bone gap size showed no correlation with outcomes, an unexpected finding. DISCUSSION Soft tissue damage with compromised vascularity may explain the lack of association between bone gap size and outcomes. Specialised centres using standardised approaches to complex surgical reconstruction can play an important role in expanding the evidence base needed to improve case management. CONCLUSIONS Less invasive procedures may lead to better patient outcomes, although unfortunately may not always be possible given the nature of the injury and/or injury site.

    更新日期:2019-11-01
  • Perceived skills for sports performance after primary hip arthroplasty: a cross-sectional study.
    Int. Orthop. (IF 2.384) Pub Date : 2019-02-21
    James Madrid,Maria Bautista,Juan F Guio,Guillermo Bonilla,Akillefs Betancourt,Adolfo Llinas

    PURPOSE Recommendations arising from existing literature regarding restrictions and benefits of sporting activities after joint replacement surgery vary widely. As hip arthroplasty patients are becoming increasingly active, their expectations about post-operative function are constantly evolving. The aim of this study is to identify the perception of patients regarding their performance in sports activities after hip arthroplasty. METHODS This cross-sectional study included all patients undergoing primary hip arthroplasty, for any diagnosis, between January 2009 and January 2016. By applying a telephone survey, practice of sports before surgery, resumption after surgery, level of performance, and causes of non-resumption of sports activities were assessed. RESULTS Data of 531 patients were obtained. Of these, 13% were engaged in sports before surgery. The most frequently practiced sports were golf (27.5%) and tennis (22%). Of the 72 patients that practiced sports, only 44.4% (30 patients) returned to this activity after surgery. Nonetheless, 71% of these patients reported to have an equal or better athletic performance than before surgery. The main causes reported by patients not to return to sports were the fear of injury and recommendation of the surgeon. CONCLUSIONS A significant number of patients return to sports after hip arthroplasty and most of them perceive a good athletic performance after surgery. These findings should enrich the pre-operative assessment of patient's expectations, particularly for those who wish to resume physical activity.

    更新日期:2019-11-01
  • Randomised clinical trial assessing migration of uncemented primary total hip replacement stems, with and without autologous impaction bone grafting.
    Int. Orthop. (IF 2.384) Pub Date : 2019-02-02
    Michael Rutherford,Riaz J K Khan,Daniel P Fick,Samantha Haebich,Oscar Nivbrant,Thomas Kozak

    PURPOSE Uncemented stems in primary total hip replacement (THR) are concerning in the elderly due to ectatic femoral canals and cortical thinning resulting in higher incidence of fracture and subsidence in this population. To obviate this concern, the authors developed a technique using autologous impaction bone grafting to achieve a better fitting femoral stem. The aim of this randomised clinical trial was to assess the efficacy of the technique. METHODS From 2013 to 2015, a total of 98 consecutive participants (100 primary THR procedures) were inducted into a single-institution, single-blinded, randomised clinical trial assessing, with radiostereometric analysis (RSA), the efficacy of autologous impaction bone grafting in uncemented primary THR compared with traditional uncemented primary THR technique. The primary outcome measure was femoral component migration using RSA. Secondary outcomes were post-operative proximal femoral bone density (using DEXA), hip function and quality of life using Oxford Hip Score (OHS) and Short Form-12 Health Survey (SF-12), hip pain and patient satisfaction. RESULTS There was no difference in femoral component stability (p > 0.5) or calcar resorption between the Graft and No Graft Groups at two years. There was also no difference in OHS, SF-12, pain or satisfaction between the Graft and No Graft Groups at two years (p > 0.39). CONCLUSIONS Autologous impaction bone grafting in uncemented primary THR has shown its short-term post-operative outcomes to be equivalent to standard uncemented technique, whilst offering a better fit in patients who are between femoral stem sizes. AUSTRALIAN CLINICAL TRIAL REGISTRATION NUMBER ACTRN12618000652279.

    更新日期:2019-11-01
  • Use of a fibrin sealant within a blood-saving protocol in patients undergoing revision hip arthroplasty: effects on post-operative blood transfusion and healthcare-related cost analysis.
    Int. Orthop. (IF 2.384) Pub Date : 2019-01-24
    Marco Scardino,Federica Martorelli,Tiziana D'Amato,Giorgia Fenocchio,Vincenzo Simili,Guido Grappiolo,Berardo Di Matteo,Elizaveta Kon,Michele Lagioia

    PURPOSE Blood transfusion and blood management are important aspects in orthopaedic surgery. Strategies include intra-operative and post-operative blood salvage and even the use of fibrin sealant in selected case. Objectives of the study were (1) to compare the total number of transfusions and the length of hospital stay in patients undergoing complete revision hip arthroplasty (RHA) with and without the use of a fibrin sealant (EVICEL®) and (2) to evaluate the possible role in cost savings of EVICEL® in association with the blood-saving protocol. METHODS Retrospective observational study evaluating patients undergoing complete RHA (stem + cup) with a blood-saving protocol with (n = 50) and without EVICEL® (n = 60). The outcome measures were: number of patients transfused (allogeneic red blood cells-RBC-and plasma), amount of blood/plasma transfusions, quantity of re-infused recycled blood, and length of hospital stay. An economic model was developed to assess the differences in costs between the two groups. RESULTS EVICEL® reduced the number of transfused red blood cells and plasma (p < 0.001), and the hospital stay (p = 0.01) compared to control group. EVICEL® can induce a reduction in resource consumption with an average cost-savings of €1.676 per patient. CONCLUSION EVICEL® may be effective in reducing red blood cells and plasma transfusion as well as hospital stay. The inclusion of EVICEL® in a blood-saving protocol seems to produce clinical efficacy and cost savings.

    更新日期:2019-11-01
  • The Ganz acetabular reinforcement ring shows excellent long-term results when used as a primary implant: a retrospective analysis of two hundred and forty primary total hip arthroplasties with a minimum follow-up of twenty years.
    Int. Orthop. (IF 2.384) Pub Date : 2019-01-22
    Marc C Attinger,Pascal C Haefeli,Henrik C Bäcker,Remy Flueckiger,Peter M Ballmer,Klaus A Siebenrock,Frank M Klenke

    PURPOSE The acetabular reinforcement ring with a hook (ARRH) has been designed for acetabular total hip arthroplasty (THA) revision. Additionally, the ARRH offers several advantages when used as a primary implant especially in cases with altered acetabular morphology. The implant facilitates anatomic positioning by placing the hook around the teardrop and provides a homogenous base for cementing the polyethylene cup. Therefore, the implant has been widely used in primary total hip arthroplasty at our institution. The present study reports the long-term outcome of the ARRH after a minimum follow-up of 20 years. METHODS Two hundred and ten patients with 240 primary THAs performed between April 1987 and December 1991 using the ARRH were retrospectively reviewed after a minimum follow-up of 20 years. Twenty-three of 240 hips were lost to follow-up, 110 patients with 124 THAs had deceased without having a revision surgery performed. This left 93 hips for final evaluation. Of those, 75 hips were assessed clinically and radiographically after a mean follow-up of 23.1 years (range 21.1-26.1 years). In 18 cases, clinical and radiographic assessment was omitted because implant revision had been performed prior to the follow-up investigation. The primary endpoint was defined as revision for aseptic loosening. RESULTS Out of the 93 hips available for final evaluation, 14 hips were revised for aseptic loosening; another four were revised for other reasons (deep infection n = 2, recurrent dislocation n = 2). The survival probability of the cup was 0.96 (95% confidence interval 0.93-0.99) after 20 years with aseptic loosening as endpoint. Radiographic analysis of the surviving 75 hips showed at least one sign of radiographic loosening in 24 hips. The mean Merle d'Aubigne score increased from 8 points pre-operatively to 15 points at final follow-up (7.5 ± 1.8 vs 15.0 ± 2.3, p < 0.001). The mean HHS was 85 ± 14 at final follow-up. Radiographic loosening did not correlate with the clinical outcome. CONCLUSIONS The long-term results of the ARRH in primary THA are comparable to results with standard cemented cups and modern cementless cups. We believe that the ARRH is a versatile implant for primary THA, especially in cases with limited acetabular coverage and altered acetabular bone stock where the ARRH provides sufficient structural support for a cemented cup.

    更新日期:2019-11-01
  • A comparative study about the incidence of dislocation and peri-prosthetic fracture between dual mobility versus standard cups after primary total hip arthroplasty.
    Int. Orthop. (IF 2.384) Pub Date : 2019-01-07
    Elliot Sappey-Marinier,Anthony Viste,Yoann Blangero,Romain Desmarchelier,Michel-Henri Fessy

    PURPOSE Dislocation and peri-prosthetic fracture (PPF) are major reasons for revision THA (total hip arthroplasty). The main advantage of dual mobility (DM) cups is to minimize the incidence of dislocation compared to single mobility (SM) cups. We hypothesized that the use of DM would lead to an increased risk of PPF because of its greater stability. In contrast, standard cups would be at higher risk of dislocation. METHODS A retrospective comparative study was performed in our institution including 126 revision THAs between January 2013 and December 2017. Collected data included gender, age, BMI, Parker score, ASA score, the etiology for primary THA, type of cup (SM or DM), cortical index, Noble index, and the stem fixation. RESULTS Overall, 53 standard and 73 DM cups were included for study. In the dislocation group, 29 had standard cups (83%) and 6 had DM cups (17%). Dislocation was 12-fold higher in SM cups (p < 0.001). In the PPF group, 24 had standard cups (26%) and 67 had DM cups (74%). PFF was 12-fold higher for DM cups (p < 0.001). A higher Parker score and a higher cortical index had a protective effect on the risk of PPF (OR = 0.76 (p = 0.03), OR = 0.57 (p = 0.048)). CONCLUSION The use of DM increased hip stability but led to a higher rate of PPF by load transfer on the femur. Further studies with larger cohort and follow-up are needed to confirm these findings and measure the incidence of these complications.

    更新日期:2019-11-01
  • 更新日期:2019-11-01
  • About Orthopaedic awards, drains, patients safety and outcomes.
    Int. Orthop. (IF 2.384) Pub Date : 2019-08-10
    Marius M Scarlat

    更新日期:2019-11-01
  • Abulcasis (936-1013): his work and contribution to orthopaedics.
    Int. Orthop. (IF 2.384) Pub Date : 2019-07-01
    Konstantinos Markatos,Andreas Mavrogenis,Emmanouil Brilakis,Demetrios Korres,Marianna Karamanou,Efstathios Chronopoulos

    AIM OF THE STUDY The purpose of this historic review is to summarize the life and work of Abulcasis (936-1013) and his contribution to surgery and orthopaedics. METHOD We conducted an extensive search in libraries as well as online in PubMed and Google Scholar. RESULTS Abulcasis in his work combines the knowledge of ancient Greek and Roman physicians and surgeons with the extensive knowledge of Arabic medicine and pharmacology. He also pioneered surgical technique with the invention of numerous surgical instruments and with several revolutionary surgical techniques. CONCLUSION Abulcasis made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and innovations in his work remained a work of reference in the West and East for many centuries to come.

    更新日期:2019-11-01
  • A comparison of the use and non-use of closed suction wound drainage in open reduction and internal fixation of femoral shaft fractures.
    Int. Orthop. (IF 2.384) Pub Date : 2019-06-30
    Obiora N Muoghalu,Gabriel O Eyichukwu,Emmanuel Iyidobi,Udo E Anyaehie,Kenechi A Madu,Ikechukwu C Okwesili

    PURPOSE The aim of this study was to determine if the routine use of closed suction wound drainage is justified following open reduction and internal fixation (ORIF) of femoral shaft fractures. METHOD This was a prospective comparative study of two study groups: those with post-operative closed suction drainage (WCSD) and those not with closed suction drainage (NWCSD). RESULTS Fifty-six patients, twenty-eight each for the two cohorts, were recruited for this study. Five patients (17.9%) in the WCSD group and only one patient (3.6%) in NWCSD group had surgical site infection (p = 0.20). Four patients (14.3%) in the WCSD group and nine (32.1%) in NWCSD group had wound dressing reinforcements (p = 0.21). CONCLUSION There was generally no statistically significant difference in the incidence of wound infections, strike through bloodstain with wound dressing reinforcement and duration of hospital stay in patients with and without closed suction wound drainage after ORIF of femoral shaft fractures. The duration of the injury may however influence the decision to use or not use wound drain after surgery.

    更新日期:2019-11-01
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