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Journal articles on the topic 'Orthopaedic surgery; Joint geometry; Movement'
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1
Eric Buckley, Richard, and Daniel Vern Hunt. "Reliability of Clinical Measurement of Subtalar Joint Movement." Foot & Ankle International 18, no. 4 (April 1997): 229–32. http://dx.doi.org/10.1177/107110079701800408.
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This study was designed to evaluate the intra- and inter-examiner reliability during repeated clinical measurements of subtalar movement. The study was a blinded experimental model in which 11 Royal College certified orthopaedic surgeons measured the subtalar movement of the 10 lower extremities of five normal subjects. The measurements were performed in accordance with previously published recommendations. Measurements of both inversion and eversion were recorded in degrees. Employing a variance component analysis, a coefficient of agreement between examiner measures was established. The coefficient of agreements were 0.107 for right lower extremities and 0.0656 for left lower extremities. An evaluation of means and ranges of individual examiner measures demonstrated a potential average loss of range of motion of 20% simply because of variability in measurement. It was also determined that a learning curve did not exist within examiners in this study. The reliability of clinical estimates of subtalar movement by this method is extremely poor. Both inter- and intraex-aminer reliability are so poor as to suggest that this method of examination no longer be used to determine or document the measurement of subtalar movement.
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Kapur, RA, PA McCann, and PP Sarangi. "Reverse geometry shoulder replacement for proximal humeral metastases." Annals of The Royal College of Surgeons of England 96, no. 7 (October 2014): e32-e35. http://dx.doi.org/10.1308/003588414x13946184903964.
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The management of skeletal metastases can be challenging for the orthopaedic surgeon. They represent a significant source of pain and disability for cancer patients, adding to the morbidity of their condition. Treatment is directed at the alleviation of symptoms and the restoration of function. Metastatic involvement of the proximal humerus can be especially debilitating, having the potential to cause severe pain and loss of function. We present a report of three such cases where reverse geometry proximal shoulder replacement was used to provide a pain free functional range of movement in patients with concomitant rotator cuff disease. In all cases, significant symptomatic relief was achieved postoperatively with preservation of upper limb function. No surgical complications were noted. It is our belief that this novel surgical strategy provides a valuable and effective option for the management of proximal humeral metastatic disease in the rotator cuff deficient patient.
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Leonard, L., D. M. Sirkett, I. J. Langdon, G. Mullineux, D. G. Tilley, P. S. Keogh, J. L. Cunningham, et al. "Engineering a new wrist joint replacement prosthesis—a multidisciplinary approach." Proceedings of the Institution of Mechanical Engineers, Part B: Journal of Engineering Manufacture 216, no. 9 (September 1, 2002): 1297–302. http://dx.doi.org/10.1243/095440502760291844.
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The wrist joint is highly complex and there remain unresolved problems to be overcome in designing a successful wrist joint prosthesis. Consequently, the results of total wrist joint replacements have been poor compared to those for hip and knee joint replacements. A multidisciplinary team of orthopaedic surgeons and engineers is working at Bath to tackle some of the key issues in the engineering of a new wrist joint prosthesis. Following a brief background to the work being undertaken by the group, this paper describes two ongoing research activities. Firstly, an assessment is being made of the optimum geometry for a wrist replacement through the use of a geometric constraint modeller. The second activity is the development of a mechanical simulator to assess wrist prosthesis function and loading. A computer algorithm controls articulation of the wrist using cables that mimic normal wrist tendons. This system allows for full movement of the hand and can also simulate external loading. The forces transmitted at the prosthesis/bone interfaces can be monitored using sensors attached adjacent to the prosthesis.
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Pijls, B. G., I. M. J. G. Sanders, E. J. Kuijper, and R. G. H. H. Nelissen. "Segmental induction heating of orthopaedic metal implants." Bone & Joint Research 7, no. 11 (November 2018): 609–19. http://dx.doi.org/10.1302/2046-3758.711.bjr-2018-0080.r1.
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Objectives Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty. Non-contact induction heating of metal implants is a new and emerging treatment for PJI. However, there may be concerns for potential tissue necrosis. It is thought that segmental induction heating can be used to control the thermal dose and to limit collateral thermal injury to the bone and surrounding tissues. The purpose of this study was to determine the thermal dose, for commonly used metal implants in orthopaedic surgery, at various distances from the heating centre (HC). Methods Commonly used metal orthopaedic implants (hip stem, intramedullary nail, and locking compression plate (LCP)) were heated segmentally using an induction heater. The thermal dose was expressed in cumulative equivalent minutes at 43°C (CEM43) and measured with a thermal camera at several different distances from the HC. A value of 16 CEM43 was used as the threshold for thermal damage in bone. Results Despite high thermal doses at the HC (7161 CEM43 to 66 640 CEM43), the thermal dose at various distances from the HC was lower than 16 CEM43 for the hip stem and nail. For the fracture plate without corresponding metal screws, doses higher than 16 CEM43 were measured up to 5 mm from the HC. Conclusion Segmental induction heating concentrates the thermal dose at the targeted metal implant areas and minimizes collateral thermal injury by using the non-heated metal as a heat sink. Implant type and geometry are important factors to consider, as they influence dissipation of heat and associated collateral thermal injury. Cite this article: B. G. Pijls, I. M. J. G. Sanders, E. J. Kuijper, R. G. H. H. Nelissen. Segmental induction heating of orthopaedic metal implants. Bone Joint Res 2018;7:609–619. DOI: 10.1302/2046-3758.711.BJR-2018-0080.R1.
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Hay-David, AGC, T. Stacey, and I. Pallister. "Motorcyclists and pillion passengers with open lower-limb fractures: a study using TARN data 2007–2014." Annals of The Royal College of Surgeons of England 100, no. 3 (March 2018): 203–8. http://dx.doi.org/10.1308/rcsann.2017.0222.
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Introduction We aimed to identify population demographics of motorcyclists and pillion passengers with isolated open lower-limb fractures, to ascertain the impact of the revised 2009 British Orthopaedic Association/British Association of Plastic Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4), in terms of time to skeletal stabilisation and soft-tissue coverage, and to observe any impact on patient movement. Methods Retrospective cohort data was collected by the Trauma Audit and Research Network (TARN). A longitudinal analysis was performed between two timeframes in England (pre-and post-BOAST 4 revision): 2007–2009 and 2010–2014. Results A total of 1564 motorcyclists and 64 pillion passengers were identified. Of these, 93% (1521/1628) were male. The median age for males was 30.5 years and 36.7 years for females. There was a statistically significant difference in the number of patients who underwent skeletal stabilisation (49% vs 65%, P < 0.0001), the time from injury to skeletal stabilisation (7.33 hours vs 14.3 hours, P < 0.0001) and the proportion receiving soft-tissue coverage (26% vs 43%, P < 0.0001). There was no difference in the time from injury to soft-tissue coverage (62.3 hours vs 63.7 hours, P = 0.726). The number of patients taken directly to a major trauma centre (or its equivalent) increased between the two timeframes (12.5% vs, 41%, P < 0.001). Conclusions Since the 2009 BOAST 4 revision, there has been no difference in the time taken from injury to soft-tissue coverage but the time from injury to skeletal stabilisation is longer. There has also been an increase in patient movement to centres offering joint orthopaedic and plastic care.
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Su, Chenxian, Yangbo Liu, Peng Wu, Jiandong Yuan, Junzhe Lang, Congcong Wu, Yiou Zhang, Li Chen, and Lei Chen. "Ipsilateral femoral neck and intertrochanteric fractures with posterior dislocation of the hip: A report of two cases." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949901990044. http://dx.doi.org/10.1177/2309499019900449.
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Traumatic hip dislocation usually occurs in young patients, with the increasing number of high-energy injuries, and 62–93% of reported adult traumatic hip dislocations were caused by high-speed motor vehicle crashes. However, ipsilateral femoral neck fractures and intertrochanteric fractures with posterior dislocation of the hip are extremely rare, and this injury poses a challenge to orthopaedic surgeons. Here, we report two cases of simultaneous ipsilateral femoral neck fracture, intertrochanteric fracture and posterior dislocation of the hip joint in young patients who were treated with proximal femoral locking compression plate (PFLCP). The long-term follow-up (one patient was followed up for 3 years and the other for 7 years) showed that these patients had excellent functional outcomes with near-normal ranges of hip movement. The authors believe that using smaller plates with the lateral PFLCP is an acceptable method to treat this injury in young patients.
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Radovanovic, Tatjana, Vladimir Vukov, Marko Bumbasirevic, Zoran Raznatovic, Aleksandar Lesic, and Ljubomir Djurasic. "Rehabilitation of a patient after operationally treated idiopathic recurrent, posterior shoulder subluxation." Acta chirurgica Iugoslavica 59, no. 1 (2012): 95–99. http://dx.doi.org/10.2298/aci1201095r.
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Introduction: involuntary, idiopathic, recurrent posterior shoulder subluxation is a rare entity. Subluxation of the shoulder joint occurs with every elevation movement of the hand with a certain level of pain. Active abduction and anteflexion are possible only to 90o. Only surgical treatment produces results. Goal: The goal is to show that timely commenced, continuously conducted rehabilitation of the shoulder after surgically repaired involuntary, idiopathic, recurrent posterior subluxation of the shoulder, leads to restitution of function. Case outline R.M. patient 24 years old, was admitted to the Institute for Orthopaedic Surgery and Traumatology, Clinical Center in Belgrade, for surgical treatment. Previously was treated conservatively. ROM (anteflexion 700 abduction 60o) with persistant pain in shoulder. Rehabilitation started first postoperative day. Result: - 2.5 months post surgery - ROM (active movement) anteflexion 165o, abduction 140o, without pain and no tendency of posterior subluxation. - 3.5 months post surgery, full active movements were achieved, except external rotation of -20o - 5 months post surgery, the patient had full range of motion in all directions. The last control was performed one year after surgery. The patient has no symptoms, lives normal life and is engaged with sports.
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Rajesh, G., WY Ip, SP Chow, and BKK Fung. "Dynamic Treatment for Proximal Phalangeal Fracture of the Hand." Journal of Orthopaedic Surgery 15, no. 2 (August 2007): 211–15. http://dx.doi.org/10.1177/230949900701500218.
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Purpose. To assess a protected mobilisation programme (dynamic treatment) for proximal phalangeal fracture of the hand, irrespective of the geometry. Methods. Clinical and radiological results of 32 consecutive patients with proximal phalangeal fracture of the hand treated from January 2001 to February 2007 were evaluated. Our supervised rehabilitation programme was strictly followed to gain full range of movement of the proximal interphalangeal joint and to prevent the development of an extension lag contracture. Patients were followed up for a mean period of 15 (range, 13–16) months. Results were evaluated using the Belsky classification. Results. The results were excellent in 72% of the patients, good in 22%, and poor in 6%. Some patients defaulted follow-up, which made long-term assessment difficult. The poor results may have been related to patient non-compliance or default from rehabilitation. Many good results upgraded to excellent following further rehabilitation. Conclusion. Skeletal stability, not rigidity, is necessary for functional movements of the hand. Proximal phalangeal fractures can be effectively treated by closed methods, using the stabilising effect of soft tissues (zancolli complex–metacarpophalangeal retention apparatus) and external devices (metacarpophalangeal block splint), thus enabling bone healing and movement recovery at the same time.
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Carr, Renee, Simon MacLean, John Slavotinek, and Gregory Bain. "Four-Dimensional Computed Tomography Scanning for Dynamic Wrist Disorders: Prospective Analysis and Recommendations for Clinical Utility." Journal of Wrist Surgery 08, no. 02 (November 14, 2018): 161–67. http://dx.doi.org/10.1055/s-0038-1675564.
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Background Four-dimensional computed tomography (4D CT) is a rapidly developing diagnostic tool in the assessment of dynamic upper limb disorders. Functional wrist anatomy is incompletely understood, and traditional imaging methods are often insufficient in the diagnosis of dynamic disorders. Technique This study has developed a protocol for 4D CT of the wrist, with the aim of reviewing the clinical utility of this technology in surgical assessment. A Toshiba Aquilion One Vision scanner was used in the protocol, in which two- and three-dimensional “static” images, as well as 4D “dynamic” images were produced and assessed in the clinical context of each patient. These consisted of a series of multiple 7-second movement clips exploring the nature and range of joint motion. Patients and Methods Nineteen patients with symptoms of dynamic instability were included in the study. Patients were assessed clinically by two orthopaedic surgeons, and qualitative data were obtained from radiological interpretation. Results The study demonstrated varied abnormalities of joint movement attributed to a range of wrist pathology, including degenerative arthritis, ligamentous injuries, Kienbock's disease, and pain following previous surgical reconstructive procedures. Interpretation of the 4D CT scan changed the clinical diagnosis in 13 cases (68.4%), including the primary (15.8%) or secondary diagnosis (52.6%). In all cases, the assessment of the dynamic wrist motion assisted in understanding the clinical problem and led to a change in management in 11 cases (57.9%). The mean effective radiation dose for the scan was calculated at 0.26 mSv. Conclusion We have found that the clinical utility of 4D CT lies in its ability to provide detailed information about dynamic joint pathology not seen in traditional imaging, targeting surgical treatment. Limitations to the use of 4D CT scan include lack of availability of the technology, potential radiation dose, and radiographer training requirements, as well as limited understanding of the nature of normal motion.
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Oppelt, Konrad, Aidan Hogan, Felix Stief, Paul Alfred Grützner, and Ursula Trinler. "Movement Analysis in Orthopedics and Trauma Surgery – Measurement Systems and Clinical Applications." Zeitschrift für Orthopädie und Unfallchirurgie 158, no. 03 (July 10, 2019): 304–17. http://dx.doi.org/10.1055/a-0873-1557.
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Abstract Background Technical development lead to an enhancement of clinical movement analysis in the last few decades and expanded its research and clinical applications. Since the mid 20th century, human movement analysis has made its way into clinical practice, e.g. in treating poliomyelitis and infantile cerebral palsy. Today, it has a wide range of applications in various clinical areas. The aim of this narrative review is to illustrate the variety of camera-based systems for human movement analysis and their clinical applications, specifically in the field of orthopaedics and trauma surgery (O/U). Benefits and limitations of each system are shown. Future development and necessary improvements are discussed. Material and Methods A selective literature review was undertaken with the databases PubMed and Google Scholar using keywords related to clinical human movement analysis in the field of orthopaedics and trauma surgery. Furthermore standard book references were included. Results Common video camera systems (VS) are used for basic visual movement analysis. Instrumented movement analysis systems include marker-based systems (MBS), markerless optical systems (MLS) and rasterstereographic analysis systems (VRS). VS, MBS and MLS have clinical use for dynamic examination of patients with various disorders in movement and gait. Among such are e.g. neuro-orthopaedic disorders, muscular insufficiencies, degenerative and post-trauma deficiencies with e.g. resultant pathologic leg axis. Besides the measurement of kinematic data by MBS and MLS, the combination with kinetic measurements to detect abnormal loading patterns as well as the combination with electromyography (EMG) to detect abnormal muscle function is a great advantage. Validity and reliability of kinematic measurements depend on the camera systems (MBS, MLS), the applied marker models, the joints of interest and the observed movement plane. Movements in the sagittal plane of the hip and knee joint, pelvic rotation and tilt as well as hip abduction are generally measured with high reliability. In the frontal and transverse planes of the knee and ankle joint substantial angular variabilities were noted due to the small range of motion of the joints in these planes. Soft tissue artefacts and marker placement are the biggest sources of errors. So far MLS did not improve these limitations. MBS are most accurate and remain the gold-standard in clinical and scientific movement analysis. VRS is used clinically for static 3D-analysis of the trunk posture and spine deformities. Current systems allow the dynamic measurement and visualisation of trunk and spine movement in 3D during gait and running. Planar x-ray-imaging (Cobbʼs angle) and to some extent cross sectional imaging with CT-scan or MRI are commonly used for the evaluation of patients with spinal deformities. VRS offers functional 3D data of trunk and spine deformities without radiation exposure, thus allowing safer clinical monitoring of the mainly infantile and adolescent patients. The accuracy, validity and reliability of measurements of different VRS-systems for the clinical use has been proven by several studies. Conclusion The instrumented movement analysis is an additional tool that aids clinical practitioners of O/U in the dynamic assessment of pathologic movement and loading patterns. In conjunction with common radiologic imaging it aids in the planning of type and extent of corrective surgical interventions. In the field of orthopaedics and trauma surgery movement analysis can help as an additional diagnostic tool to develop therapeutic strategies and evaluate clinical outcomes.
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Greeley, Nansee, and Theresa Reardon Offerman. "Now & Then: Measuring Angles in Physical Therapy: A New Angle on the History of Movement." Mathematics Teaching in the Middle School 2, no. 5 (March 1997): 338–46. http://dx.doi.org/10.5951/mtms.2.5.0338.
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Now… What do geometry and physical therapy have in common? “Angles!” according to Robin Nicholson. Robin is a physical therapist, often called a PT, in Saint Paul, Minnesota. She works at the HealthEast OPTimum Rehabilitation Center-Maplewood and sees about twelve patients a day for half-hour sessions. Patients come to her after they have recovered from surgery or from an injury to a muscle, ligament, or joint. She has worked with patients as young as five and as old as ninety. “In general,” she said, “the younger the patient, the quicker the recovery process.” Robin believes that the most important facet of recovery is the attitude of the patient.
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Darwood, A., R. Secoli, S. A. Bowyer, A. Leibinger, R. Richards, P. Reilly, A. Dawood, A. Tambe, R. Emery, and F. Rodriguez y. Baena. "Intraoperative Manufacturing of Patient-Specific Instrumentation for Shoulder Arthroplasty: A Novel Mechatronic Approach." Journal of Medical Robotics Research 01, no. 04 (November 30, 2016): 1650005. http://dx.doi.org/10.1142/s2424905x16500057.
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Optimal orthopaedic implant placement is a major contributing factor to the long term success of all common joint arthroplasty procedures. Devices such as three-dimensional (3D) printed, bespoke guides and orthopaedic robots are extensively described in the literature and have been shown to enhance prosthesis placement accuracy. These technologies, however, have significant drawbacks, such as logistical and temporal inefficiency, high cost, cumbersome nature and difficult theatre integration. A new technology for the rapid intraoperative production of patient-specific instrumentation, which overcomes many of the disadvantages of existing technologies, is presented here. The technology comprises a reusable table side machine, bespoke software and a disposable element comprising a region of standard geometry and a body of moldable material. Anatomical data from computed tomography (CT) scans of 10 human scapulae was collected and, in each case, the optimal glenoid guidewire position was digitally planned and recorded. The achieved accuracy compared to the pre-operative bespoke plan was measured in all glenoids, from both a conventional group and a guided group (GG). The technology was successfully able to intraoperatively produce sterile, patient-specific guides according to a pre-operative plan in 5[Formula: see text]min, with no additional manufacturing required prior to surgery. Additionally, the average guidewire placement accuracy was [Formula: see text][Formula: see text]mm and 6.82[Formula: see text] in the manual group, and [Formula: see text][Formula: see text]mm and [Formula: see text] in the guided group, also demonstrating a statistically significant improvement.
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Li, W., S. Wayte, D. Griffin, D. Chetwynd, D. Karampela, E. Torabi, and K. Mao. "An Initial Investigation of Hip Joint Contact Behaviour Using Advanced Non-Linear Finite Element Methods." Applied Mechanics and Materials 668-669 (October 2014): 1557–60. http://dx.doi.org/10.4028/www.scientific.net/amm.668-669.1557.
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The hip implant is a very successful treatment for serious osteoarthritis, especially in older patients, but less desirbale for earlier interventions. There is a growing consensus that most hip arthritis is due to shape abnormalities that cause impingement at the ball and socket, collectively called femoroacetabular impingement (FAI). The ball does not fit accurately into the socket, leading to premature wear, and then destructive arthritis. It is not then necessary to replace the whole hip joint; newly developed surgical techniques that accurately reshape the bones to relieve impingement and reduce wear have been shown to be effective. This surgery can be performed with a conventional open approach, or be arthroscopic (keyhole) surgery. It would be better to reshape bones to suit each individual patient. Finite element methods (FEM) have been widely used for biomechanical studies of hip implants and periacetabular osteotomy, but hardly at all in hip reshaping. Non-linear FEM is employed in the current study to perform biomechanical evaluations of differences in contact pressure between normal and arthritic hip joints to help basic understanding and lead to more accurate surgery. The hip joint bone structure is obtained through a medical CT scan and then the CT images have been converted into a format readable by FEM solvers. A sophisticated non-linear contact model of the hip joint bringing together the interactions of true geometry, natural movement and contact forces has been established using this advanced FEM.
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Hozumi, Akira, Kennichi Kidera, Ko Chiba, Takayuki Shida, and Makoto Osaki. "Clinical Outcomes Evaluation of Combined Valgus and Chiari Osteotomy Inconsistent with Patient Satisfaction." BioMed Research International 2018 (2018): 1–5. http://dx.doi.org/10.1155/2018/2409656.
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The Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire, which is tailored to Japanese lifestyles, has recently been developed in Japan as a patient-reported outcome measure. In this study, combined valgus and Chiari osteotomy were evaluated using the JHEQ and JOA scores. The subjects were 42 hips of 39 patients with a mean age at surgery of 45.3 years. The mean follow-up period was 95.3 months. Radiological osteoarthritis stage, preoperative and postoperative JOA scores, JHEQ score at final follow-up, and patient dissatisfaction with hip joint status rated on a visual analog scale were evaluated. The factors that affected patient dissatisfaction were also identified using multiple regression analysis. Radiological osteoarthritis stage at final follow-up was either maintained or improved in 85.7%. The mean JOA score improved from 57.2 preoperatively to 78.7 at final follow-up. The JHEQ score at final follow-up, however, was low, at 43.3 points. Patients who were comparatively satisfied accounted for 47.6%. Of the JHEQ subscales, movement had the lowest scores, and this was the subscale that had the greatest effect on patient dissatisfaction. The present results suggest that the results of JOA score are inconsistent for postoperative patients’ satisfaction after CVCO, and patient-based evaluation tool must also be used.
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Yunus, Mohammed, and Mohammad S. Alsoufi. "Experimental Investigations into the Mechanical, Tribological, and Corrosion Properties of Hybrid Polymer Matrix Composites Comprising Ceramic Reinforcement for Biomedical Applications." International Journal of Biomaterials 2018 (August 23, 2018): 1–8. http://dx.doi.org/10.1155/2018/9283291.
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Hybrid polymer matrix composites (HPMC) are prominent material for the formation of biomaterial and offer various advantages such as low cost, high strength, and the fact that they are easy to manufacture. However, they are associated with low mechanical (low hardness) and tribological properties (high wear rate). The average hip joint load fluctuates between three to five times of the body weight during jumping and jogging and depends on various actions relating to body positions. Alternate bone and prosthesis material plays a critical role in attaining strength as it determines the method of load transferred to the system. The material property called modulus of elasticity is an important design variable during the selection of the geometry and design methodology. The present work is demonstrated on how to improve the properties of high-density polyethylene (HDPE) substantially by the addition of bioceramic fillers such as titanium oxide (TiO2) and alumina (Al2O3). The volume fractions of Al2O3 and TiO2 are limited to 20% and 10%, respectively. Samples were fabricated as per ASTM standards using an injection moulding machine and various properties such as mechanical (tensile, flexural, and impact), tribological (hardness, wear), and corrosion including SEM, density, and fractography analysis studied. Experimental results revealed that an injection moulding process is suitable for producing defect-free mould HPMC. HPMC comprising 70% HDPE/20% Al2O3/10% TiO2 has proved biocompatible and a substitute for biomaterial. A substantial increase in the mechanical and tribological properties and full resistance to corrosion makes HPMC suitable for use in orthopaedic applications such as human bone replacement, bone fixation plates, hip joint replacement, bone cement, and bone graft in bone surgery.
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Nishino, Tomofumi, Hajime Mishima, Haruo Kawamura, Tomohiro Yoshizawa, Shumpei Miyakawa, and Masashi Yamazaki. "Ten-year results of 55 dysplasia hips of hip offset and leg length reconstruction in total hip arthroplasty with cementless tapered stems having a high offset option designed for dysplastic femur." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949902090949. http://dx.doi.org/10.1177/2309499020909499.
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Purpose: In developmental dysplasia of the hip (DDH), the centers of hip rotation move in the superior and lateral direction. In total hip arthroplasty for such cases, movement of the center of hip rotation is in the inferior and medial direction. It causes an increase in leg length and a decrease in acetabular offset. We therefore evaluated the change of hip offset and leg length before and after surgery with two stems having a high offset option. Patients and Methods: The preoperative diagnosis was secondary osteoarthritis due to DDH excluded Crowe IV. A stem selection was decided based on preoperative two-dimensional templating. Total 55 hips in 50 patients were followed up for minimum 10 years. Pre- and postoperative clinical evaluations were performed using a hip joint function scoring system. Radiographic evaluations were used for offset and leg length measurements and other associated factors. Results: Both stems showed excellent clinical results. A high offset option was used in 60% of all cases. No postoperative dislocations were observed. The biological fixation was stable in all cases. The hip offset was restored without excessive leg lengthening in most cases. Conclusion: Anatomical consistency could be maintained by using a stem which matched geometry of the proximal part and had offset option. These cementless tapered stems having a high offset option are suitable for Crowe I to III hip dysplasia if two-dimensional X-ray templates fit the shape of the proximal femurs. They were associated with excellent clinical results and biological fixation. The offset option may be useful to adjust leg length and offset in DDH patients.
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Gray, Julia, Matthew Welck, Nicholas P. Cullen, and Dishan Singh. "Functional dystonia in the foot and ankle." Bone & Joint Journal 103-B, no. 6 (June 1, 2021): 1127–32. http://dx.doi.org/10.1302/0301-620x.103b6.bjj-2020-2187.r2.
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Aims To assess the characteristic clinical features, management, and outcome of patients who present to orthopaedic surgeons with functional dystonia affecting the foot and ankle. Methods We carried out a retrospective search of our records from 2000 to 2019 of patients seen in our adult tertiary referral foot and ankle unit with a diagnosis of functional dystonia. Results A total of 29 patients were seen. A majority were female (n = 25) and the mean age of onset of symptoms was 35.3 years (13 to 71). The mean delay between onset and diagnosis was 7.1 years (0.5 to 25.0). Onset was acute in 25 patients and insidious in four. Of the 29 patients, 26 had a fixed dystonia and three had a spasmodic dystonia. Pain was a major symptom in all patients, with a coexisting diagnosis of chronic regional pain syndrome (CRPS) made in nine patients. Of 20 patients treated with Botox, only one had a good response. None of the 12 patients who underwent a surgical intervention at our unit or elsewhere reported a subjective overall improvement. After a mean follow-up of 3.2 years (1 to 12), four patients had improved, 17 had remained the same, and eight reported a deterioration in their condition. Conclusion Patients with functional dystonia typically presented with a rapid onset of fixed deformity after a minor injury/event and pain out of proportion to the deformity. Referral to a neurologist to rule out neurological pathology is advocated, and further management should be carried out in a movement disorder clinic. Response to treatment (including Botulinum toxin (Botox) injections) is generally poor. Surgery in this group of patients is not recommended and may worsen the condition. The overall prognosis remains poor. Cite this article: Bone Joint J 2021;103-B(6):1127–1132.
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Suleman, Imam, and Aswedi Putra. "DISTRIBUTION OF KNEE OSTEOARTHRITIS CASES IN PERTAMINA BINTANG AMIN HOSPITAL, BANDAR LAMPUNG." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl5 (May 1, 2020): 2325967120S0005. http://dx.doi.org/10.1177/2325967120s00058.
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Osteoarthritis is a degenarative joint disease which affects joint cartilage. Almost 80% patients movement are limited and 25 % of them can not evev perform daily activities. Due to its chronic and progressive nature, socio-economic impacts in many developed and developing countries are enormous. This study aimed to determine the distribution of patient with knee osteoarthritis in Pertamina Bintang Amin Hospital Bandar Lampung. Methods: This study is a decriptive cross sectional approach with secondary data taken from medical record. Thirty eight cases were evaluated in this study from January 2019 – Mei 2019. The variables observed include age, sex, body mass index (BMI) and occupations. Results: The result show that 36,8 % of the samples were aged 50-59 years,78,9 % of the samples were female, 71,1 % of the samples had BMI obesity, 60,5 % and 43,2 % were work as housewife. A total of 23 of 38 knee samples had grade III, and 3 of 38 knee samples alsohad grade I, and as many as 7 of the 38 knee samples had a” very severe” clinical gradation. These result may be due to patients who have low grade gradation clinics and have received medical attention at the level I health facility or II. Conclusion: Form the result of this study, it can be concluded that age, sex, BMI, occupations and Kellgren-Lawrence scoring system at Pertamina Bintang Amin Bandar Lampung is in comformity with research that has been done in many places and theories that exist. Reference: Apley, Ag., & Louis Solomon, (2017). Osteoarthritis. In David Warwick (ED). System of Orthopaedics and Trauma (10th Ed., pp. 91-105). London, UK: CRC Press. Fransen M.Bridgett L. March L.Hoy D. Penserga E. Brooks P.The Epidemiolgy os Osteoarthritis in Asia. International Journal of Rheumatic Diseases 2011;14;113-212. Zhang Fu – Quang,Wu Ming – Xia, Liu Xian – Xiang, Gender and Sex distribution of middle and old aged people with osteoarthritis in Fuzhou, Vol II, May 2009. American of Orthopaedic Surgeon, Relatioship of Osteoarthritis and Biochemical Reactions, Journal of Bone and Joint Surgery, 2004 volume II.
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Wagener, J., C. Schweizer, L. Zwicky, T. Horn Lang, and B. Hintermann. "Arthroscopically assisted fixation of Hawkins type II talar neck fractures." Bone & Joint Journal 100-B, no. 4 (April 2018): 461–67. http://dx.doi.org/10.1302/0301-620x.100b4.bjj-2017-0772.r3.
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Aims Arthroscopically controlled fracture reduction in combination with percutaneous screw fixation may be an alternative approach to open surgery to treat talar neck fractures. The purpose of this study was thus to present preliminary results on arthroscopically reduced talar neck fractures. Patients and Methods A total of seven consecutive patients (four women and three men, mean age 39 years (19 to 61)) underwent attempted surgical treatment of a closed Hawkins type II talar neck fracture using arthroscopically assisted reduction and percutaneous screw fixation. Functional and radiological outcome were assessed using plain radiographs, as well as weight-bearing and non-weight-bearing CT scans as tolerated. Patient satisfaction and pain sensation were also recorded. Results Primary reduction was obtained arthroscopically in all but one patient, for whom an interposed fracture fragment had to be removed through a small arthrotomy to permit anatomical reduction. The quality of arthroscopic reduction and restoration of the talar geometry was excellent in the remaining six patients. There were no signs of talar avascular necrosis or subtalar degeneration in any of the patients. In the whole series, the functional outcome was excellent in five patients but restricted ankle movement was observed in two patients. All patients had a reduction in subtalar movement. At final follow-up, all patients were satisfied and all but one patient were pain free. Conclusion Arthroscopically assisted reduction and fixation of talar neck fractures was found to be a feasible treatment option and allowed early functional rehabilitation. Cite this article: Bone Joint J 2018;100-B:461–7.
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Grant, Sabrina, A. W. Blom, Michael R. Whitehouse, Ian Craddock, Andrew Judge, Emma L. Tonkin, and Rachael Gooberman-Hill. "Using home sensing technology to assess outcome and recovery after hip and knee replacement in the UK: the HEmiSPHERE study protocol." BMJ Open 8, no. 7 (July 2018): e021862. http://dx.doi.org/10.1136/bmjopen-2018-021862.
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IntroductionOver 160 000 people with severe hip or knee pain caused by osteoarthritis undergo total hip (THR) or knee replacement (TKR) surgery each year in the UK within the National Health Service (NHS), and this number is expected to increase. Innovative approaches to evaluating surgical outcomes will be needed to respond to the increasing burden of joint replacement surgery. The Sensor Platform for Healthcare in a Residential Environment, Interdisciplinary Research Collaboration (SPHERE-IRC) have developed a system of sensors that can monitor the health-related behaviours of people living at home. The system includes sensors for the home environment (measuring temperature, humidity, room occupancy, water and electricity usage), a wristband body-worn activity monitor and silhouette (body outline) sensors. The aim of HEmiSPHERE (Hip and knEe study of a Sensor Platform of HEalthcare in a Residential Environment) is to (1) determine the accuracy and feasibility of the sensory data as it compares with conventional assessment of health outcomes after surgery using patient self-reported questionnaires, and (2) to explore how the SPHERE system is useful for everyday clinical decision-making.Methods and analysisA feasibility study recruiting and installing the SPHERE system in the homes of up to 30 NHS adult patients as they undergo a THR or TKR. Through a mixed-methods design, the SPHERE system will monitor and record continuous measurements of daily behaviour. Main outcomes will assess the relationships between environmental, behavioural and movement data and the parameters of interest from the standard clinical assessments measuring patient outcomes over time. Patient interviews and focus groups with consultant orthopaedic surgeons will provide in-depth understanding of the acceptability, feasibility and accuracy of the data.Ethics and disseminationWe aim to disseminate the findings through regional talks and seminars, international conferences and peer-reviewed journals and social media.
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Starring, Hunter, William H. Waddell, William Steward, Stuart Schexnayder, Jack McKay, Claudia Leonardi, Amy Bronstone, and Vinod Dasa. "Total Knee Arthroplasty Outcomes in Patients with Medicare, Medicare Advantage, and Commercial Insurance." Journal of Knee Surgery 33, no. 09 (May 23, 2019): 919–26. http://dx.doi.org/10.1055/s-0039-1688785.
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AbstractAs more commercial insurance companies adopt a bundled reimbursement model, similar to the Comprehensive Care for Joint Replacement (CJR) algorithm for Medicare beneficiaries, accurate risk adjustment of patient-reported outcomes (PROs) is critical to ensure success. With this movement toward bundled reimbursement, it is unknown if a formula adjusting for similar risks in the Medicare population could be applied to PROs in commercially insured and Medicare Advantage populations undergoing total knee arthroplasty (TKA). This study was performed to compare PROs after TKA in these insurance groups after adjusting for proposed risks. Demographics and clinical data were abstracted from medical records of 302 patients who underwent TKA performed by a single surgeon at a university-based orthopaedic practice during 2013 to 2017. Differences in PROs between commercially insured, Medicare Advantage, and Medicare patients during the 6 months following surgery were evaluated while controlling for demographics, clinical data, and baseline PRO scores. Medicare and Medicare Advantage patients were older (p < 0.001) and had more comorbidities (p = 0.001) than commercial patients. During the first 3 months following TKA, patients in all three groups experienced similar rates of recovery. At 6 months after surgery, outcomes began to diverge by insurance group. Medicare patients reported significantly less ability to perform activities of daily living (78.6 vs. 63.2; p = 0.001), worse physical function (39.6 vs. 44.9; p = 0.003), and more pain interference (57.9 vs. 52.4; p = 0.018) at day 180 than commercially insured patients. There were no statistically significant differences between Medicare Advantage patients and either commercially insured or Medicare patients. Therefore, commercial insurance companies that intend to apply a risk-adjusted equation similar to the CJR algorithm to commercial populations should be cautioned since the postoperative outcomes in this investigation differed after adjusting for the same risk factors that have been proposed for inclusion in the CJR algorithm. Nonetheless, further studies should be performed to ensure that companies participating in bundled reimbursement models have a positive influence on comprehensive health care for patients and providers. This is a level III, retrospective prognostic study
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Gonzalez, L. J., K. Hildebrandt, K. Carlock, S. R. Konda, and K. A. Egol. "Patient function continues to improve over the first five years following tibial plateau fracture managed by open reduction and internal fixation." Bone & Joint Journal 102-B, no. 5 (May 2020): 632–37. http://dx.doi.org/10.1302/0301-620x.102b5.bjj-2019-1385.r1.
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Aims Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients’ long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. Methods In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired t-test. Results Patient-reported functional outcomes as assessed by overall SMFA were statistically significantly improved at five years (p < 0.001) compared with one-year data from the same patients. Patients additionally reported an improvement in the Standardized Mobility Index (p < 0.001), Standardized Emotional Index (p < 0.001), as well as improvement in Standardized Bothersome Index (p = 0.003) between the first year and latest follow-up. Patient-reported pain and knee ROM were similar at five years to their one-year follow-up. In total, 15 of the patients had undergone subsequent orthopaedic surgery for their knees at the time of most recent follow-up. Of note, only one patient had undergone knee arthroplasty following plateau fixation related to post-traumatic osteoarthritis (OA). Conclusion Knee pain following tibial plateau fracture stabilizes at one year. However, PROs continue to improve beyond one year following tibial plateau fracture, at least in a statistical sense, if not also clinically. Patients displayed statistical improvement across nearly all SMFA index scores at their minimum five-year follow-up compared with their one-year follow-up. Cite this article: Bone Joint J 2020;102-B(5):632–637.
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Ræder, Benedikte W., Wender Figved, Jan E. Madsen, Frede Frihagen, Silje B. Jacobsen, and Mette Renate Andersen. "Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial." Bone & Joint Journal 102-B, no. 2 (February 2020): 212–19. http://dx.doi.org/10.1302/0301-620x.102b2.bjj-2019-0692.r2.
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Aims In a randomized controlled trial with two-year follow-up, patients treated with suture button (SB) for acute syndesmotic injury had better outcomes than patients treated with syndesmotic screw (SS). The aim of this study was to compare clinical and radiological outcomes for these treatment groups after five years. Methods A total of 97 patients with acute syndesmotic injury were randomized to SS or SB. The five-year follow-up rate was 81 patients (84%). The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. Secondary outcome measures included Olerud-Molander Ankle (OMA) score, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of movement, complications, reoperations, and radiological results. CT scans of both ankles were obtained after surgery, and after one, two, and five years. Results The SB group had higher median AOFAS score (100 (interquartile range (IQR) 92 to 100) vs 90 (IQR 85 to 100); p = 0.006) and higher median OMA score (100 (IQR 95 to 100) vs 95 (IQR 75 to 100); p = 0.006). The SS group had a higher incidence of ankle osteoarthritis (OA) (24 (65%) vs 14 (35%), odds ratio (OR) 3.4 (95% confidence interval (CI) 1.3 to 8.8); p = 0.009). On axial CT we measured a significantly smaller mean difference in the anterior tibiofibular distance between injured and non-injured ankles in the SB group (–0.1 mm vs 1.2 mm; p = 0.016). Conclusion Five years after syndesmotic injury treated with either SB or SS, we found better AOFAS and OMA scores, and lower incidence of ankle OA, in the SB group. These long-term results favour the use of SB when treating an acute syndesmotic injury. Cite this article: Bone Joint J 2020;102-B(2):212–219.
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Pinheiro, Ana Costa, Carolina Oliveira, Margarida Areias, Bruno Pombo, Filomena Ferreira, Cristina Sousa, and Miguel Leal. "Avulsion Fractures In Sports." Orthopaedic Journal of Sports Medicine 6, no. 6_suppl3 (June 1, 2018): 2325967118S0004. http://dx.doi.org/10.1177/2325967118s00042.
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INTRODUCTION: Fractures-detached is an injury in the place where the tendon or the ligament is inserted in the bear, in the plates of growth. Thus, in the offspring, or tendons or proximal ligaments of a growth plate, may provide sufficient force to cause a growth plate fracture. Single fractures of the apophysis are rare and rarely known lesions. In this article we present 3 clinical cases of patients with indirect trauma, such as the anterior fracture of the anterior tibial tuberosity, the anterior superior iliac spine fracture, and the small fracture of the femoral trochanter. METHOD: Retrospective descriptive of 3 clinical cases based on patients’ electronic clinical processes. CASE 1: Male of 16 years old, victim of fracture-avulsion of the anterior tuberosity of the tibia (ATT). The injury occurred during football practice, immediately feeling intense knee pain associated with functional impairment of the left lower limb. The Emergency Service was used, with pain in the palpation of the left knee, edema, joint effusion, high patella and incapacity of active extension of the affected limb. The left knee radiograph showed a fracture of the ATT. Computed tomography (CT) revealed an extensive metaphyseal-epiphyseal vein, corresponding to a fracture-avulsion type IIIC in a context of previous Osgood-Schlatter disease. It was subjected to open reduction and internal fixation of the fracture with two cannulated screws, without complications. After surgery, the affected lower limb was immobilized for about 1 month, after which the patient started physiotherapy. After 3 months, the patient initiated complaints of contralateral knee pain related to ATT, with improvement after 3 months of conservative treatment. The patient restarted the sport activity at 6 months postoperatively, without complaints or limitations. After 2 years of follow-up, the patient did not present complaints or limitations of mobility bilaterally and resumed the activity level before the injury. CASE 2: The adolescent male, an occasional physical exercise student at school, turned to the US for pain on the right side of the basin, 4 days after a jump during a basketball game. The objective test revealed gait claudication, palpation of the right anterior superior iliac spine (ASIS) and limitation of right movements. The radiograph and CT of the basin, to diagnose a fracture-avulsion of right ASIS, with deviation less than 3 cm. Treatment of pain, relative rest and taking oral anti-inflammatories and discharge of the affected member for 4 weeks. X-ray and CT, at 6 weeks, did not show fracture healing. However, the patient recovers from physical activity after 8 weeks, remains asymptomatic and unrestricted in the practice of physical exercise. CASE 3: An 11-year-old male, he used the Urgency Service with pain at the level of the anterior inner side of the right thigh and functional impotence of the ipsilateral lower limb, after indirect trauma with hyperextension movement in soccer game. The radiographic examination revealed a fracture of the isolated aversion of the small trochanter of the right femur with deviation of less than 2 cm. However, the patient recovers from physical activity after 8 weeks, remains asymptomatic and unrestricted in the practice of physical exercise. DISCUSSION: Or diagnosis of clinical substrate, treatment of low energy trauma rarely caused by trauma. In general, conservative treatment with conventional analgesics and restoration of the load is opted for. According to the degree of deviation (> 3 cm), it can opt for surgical treatment, or it prevents functional deficits and deformities, more frequently in the anterior tibial tuberosity fracture. CONCLUSIONS: After a harvest of the clinical history, a careful analysis of the imaging, were identified as 3 different single fractures, tended in 2 of the cases, non-surgical treatment with analgesia and load restriction (single fracture of the anterior iliac spine And the single fracture of the small trochanter of the femur). In the fracture of the anterior tuberosity of the tibia, after the fracture classification, an open reduction and osteosynthesis were performed with 2 cannulated screws. These case reports are important for the determination of vulnerability to low energy trauma, as well as guiding treatment and preventing functional deficits and deformities. REFERENCES: McKinney B, Nelson C, Carrion W. Apophyseal Avulsion Fractures of the Hip and Pelvis. Orthopedics. 2009; 32(1):42. Kameyama O, Ogawa R. Avulsion fracture of the iliac spine during sporting activity: Report of 30 fractures and their outcome. Journal of Orthopaedic Science .1996; 1(6): 356-362. Rosenberg N, Noiman M, Edelson G. Avulsion fractures of the anterior superior iliac spine in adolescents. J Orthop Trauma. 1996; 10:440–3. Veselko M, Smrkolj V. Avulsion of the anterior superior iliac spine in athletes: case reports. J Trauma. 1994; 36:444–6. T. Pesl, P. Havran. Acute tibial tubercle avulsion fractures in children: selective use of the closed reduction and internal fixation method.J Child Orthop., 2 (5) (2008), pp. 353–356. R.P. Albuquerque, V. Giordano, A.C.P. Carvalho, T. Puell, M.I.P. Albuquerque, N.P. Amaral. Fratura avulsão bilateral e simultânea da tuberosidade tibial em uma adolescente: relato de caso e terapêutica adotada.Rev Bras Ortop., 47 (3) (2012), pp. 56–60. L.H. Carvalho Júnior, W.A. Benevides, F.C.S. Nogueira, W.V. Fonseca, R.P. Andrade. Fraturas da tuberosidade tibial anterior em adolescentes. Relato de casos e revisão da literatura. Rev Bras Ortop., 30 (1) (1995), pp. 70–73. Avulsões apofisárias da bacia e do fémur proximal no jovem desportista. Revista de Medicina Desportiva Informa,2011.2(2), pp 13-15.
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Mercader, Alexandra, Heinz Roettinger, Amir Bigdeli, and Tim C. Lueth. "Visualization of patient’s knee movement and joint contact area during knee flexion for orthopaedic surgery planing validation." Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization, December 28, 2020, 1–8. http://dx.doi.org/10.1080/21681163.2020.1835551.
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ZS, Kundu, Vandana, Verma Vishal, and Verma Bhawna. "Prevention of Quadriceps Inhibition is The Key to Achieve Movement of The Knee Joint After Total Knee Replacement and Lower End of Femur Surgery." International Journal Of Scientific Advances SP, no. 1 (2021). http://dx.doi.org/10.51542/ijscia.spi1.08.
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Background: Knee stiffness and weakness of quadriceps is common after surgeries around knee and even after total knee replacement. Swelling and inflammation in the early phases after surgery may contribute to stiffness and arthrogenic muscle inhibition. Aggressive physiotherapy to regain range of motion and early isometric and isotonic exercises are indicated for prevention of complications. Material and method: This were a descriptive, cross-sectional study which included hundred patients (without any limit of age range) attending the orthopaedic physical therapy outpatient department of Positron Hospital were selected for this study. The subjects were assessed for quadriceps inhibition and knee range of motion. The patients were assessed one week, six weeks and 12 weeks post surgery. The patients underwent supervised physiotherapy till 6 weeks and were put on home exercise program for next 6 weeks. Results: The quadriceps inhibition in initial phase was about 25% and quadriceps inhibition in recovery phase remained only 5%. There was zero flexion deficit in 30%, 59% and 76% of patients in first week, sixth week and twelfth week respectively. Mean of flexion deficit in hundred patients were 15% in first week, 6.5% flexion deficit remained in sixth week and only 2.9%flexion deficit left in twelfth week. Conclusion: Quadriceps inhibition was seen in 25% patients. Quadriceps inhibition was not associated with gender or age. There was moderate to strong correlation between flexion deficit and quadriceps inhibition
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Ostetto, Federico, Debora Lana, Gianmarco Tuzzato, Eric Staals, Davide M. Donati, and Giuseppe Bianchi. "Total hip arthroplasty in hereditary multiple exostosis patients: literature review and evaluation of 10 cases." HIP International, June 16, 2021, 112070002110250. http://dx.doi.org/10.1177/11207000211025051.
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Background: Acquired hip deformities in patients affected by hereditary multiple exostosis (HME) may incur in early hip osteoarthritis and functional limitation requiring primary total hip arthroplasty (THA). Characteristic coxo-femoral joint dysmorphisms in HME may pose a challenge for the orthopaedic surgeon. Here we report our experience in a series of patients with HME treated in our hospital with THA. Methods: With a mean follow-up of 5 years, 10 primary THAs were reviewed; proximal femur deformities, acetabular dysplasia and joint osteoarthritis has been assessed through x-rays and CT-scan evaluation. In all cases hemispheric press-fit cups were used; 4 stem had metaphyseal engagement, 5 had proximal diaphyseal engagement and 1, with anatomical geometry, had metaphyseal fixation. 2 cases required stem cementation, 3 modular neck and 1 lateralised. The clinical data, complications and clinical outcomes, were recorded and analysed. Results: The mean Harris Hip Score (HHS) increased from 34 preoperative to 86 postoperative; preoperative mean neck shaft angle (NSA) was 150°, head/neck ratio 0.6, offset 31 mm; Wiberg angle 28°, Sharp angle 38°, 1 patient had subluxation grade 4 according to Crowe, 8 hips showed osteoarthritis (Tönnis grade ⩾2 ); 5 femurs were classified as Dorr type C, 2 as type B and 3 as type A. Perioperative complications were not observed. Conclusions: Primary THA in HME significantly improved clinical and functional outcomes. Press-fit cup fixation together with metaphyseal and proximal diaphyseal stem engagement on reliable bone quality femur, represents a valid option in HME patients with normal acetabular morphology, wide broaden neck and valgus NSA.
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Park, Chul Hyun, Hongfei Yan, and Jeongjin Park. "Randomized comparative study between extensile lateral and sinus tarsi approaches for the treatment of Sanders type 2 calcaneal fracture." Bone & Joint Journal, January 3, 2021, 1–8. http://dx.doi.org/10.1302/0301-620x.103b.bjj-2020-1313.r1.
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Aims No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. Methods Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of movement (ROM), Böhler’s angle and calcaneal width, and posterior facet reduction. Results Although four patients (12.5%) in the ELA groups and none in the STA group experienced complications, the difference was not statistically significant (p = 0.113). VAS and AOFAS score were significantly better in the STA group than in the ELA group at six months (p = 0.017 and p = 0.021), but not at 12 months (p = 0.096 and p = 0.200) after surgery. The operation time was significantly shorter in the STA group than in the ELA group (p < 0.001). The subtalar joint ROM was significantly better in the STA group (p = 0.015). Assessment of the amount of postoperative reduction compared with the uninjured limb showed significant restoration of calcaneal width in the ELA group compared with that in the STA group (p < 0.001). Conclusion The ELA group showed higher frequency of wound complications than the STA group for Sanders type 2 calcaneal fractures even though this was not statistically significant.
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Hoelscher-Doht, Stefanie, A. M. Kladny, M. M. Paul, L. Eden, M. Buesse, and R. H. Meffert. "Low-profile double plating versus dorsal LCP in stabilization of the olecranon fractures." Archives of Orthopaedic and Trauma Surgery, May 16, 2020. http://dx.doi.org/10.1007/s00402-020-03473-9.
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Abstract Introduction Proximal ulna fractures are common in orthopaedic surgery. Comminuted fractures require a high primary stability by the osteosynthesis, to allow an early functional rehabilitation as fast as possible, to reduce long-term limitations of range of motion. Classical dorsal plating is related to wound healing problems due to the prominence of the implant. New low-profile double plates are available addressing the soft tissue problems by positioning the plates at the medial and lateral side. This study analysed whether, under high loading conditions, these new double plates provide an equivalent stability as compared to the rigid olecranon locking compression plate (LCP). Materials and methods In Sawbones, Mayo Type IIB fractures were simulated and stabilized by plate osteosyntheses: In group one, two low-profile plates were placed. In group two, a single dorsal plate (LCP) was used. The bones was than cyclically loaded simulating flexion grades of 0°, 30°, 60° and 90° of the elbow joint with increasing tension forces (150 , 150 , 300 and 500 N). The displacement and fracture gap movement were recorded. In the end, in load-to-failure tests, load at failure and mode of failure were determined. Results No significant differences were found for the displacement and fracture gap widening during cyclic loading. Under maximum loading, the double plates revealed a comparable load at failure like the single dorsal plate (LCP). The double plates failed with a proximal screw pull-out of the plate, whereas in the LCP group, in 10 out of 12 specimens the mode of failure was a diaphyseal shaft fracture at the distal plate peak. Conclusion Biomechanically, the double plates are a good alternative to the dorsal LCP providing a high stability under high loading conditions and, at the same, time reducing the soft tissue irritation by a lateral plate position.