Current Issue : January - March Volume : 2016 Issue Number : 1 Articles : 10 Articles
Here, we describe an arthroscopic method specifically developed to augment rotator cuff repair using a flexible acellular dermal\npatch (ADP). In this method, an apparently complex technique is simplified by utilizing specific steps to augment a rotator cuff\nrepair. In this method, using a revised arthroscopic technique, rotator cuff repair was performed. This technique allowed easy\npassage of the graft, excellent visualization, minimal soft tissue trauma, and full four-corner fixation of an ADP. Twelve patients\nunderwent rotator cuff repair with augmentation using the combination of this method and ADP. Due to the technique and\nbiomechanical characteristics of the material, the repairs have been stable and with high patient satisfaction....
Fracture of the patella after total knee arthroplasty is an infrequent complication. In the presence\nof poor remaining bone stock, avascular necrosis, removal of the implant with partial or complete\npatellectomy is recommended. Arthroscopic removal of a loose body or cement extrusion has been\nrecently attempted successfully in very few cases, where loose and mobile cement fragments were\ninvolved and were often removed piecemeal. The authors experienced an unusual case of a patient\na 69-year-old woman who, after having fallen down, presented a comminuted patellar fracture.\nWe recommended an external orthosis and a temporary limitation of activity. Four months later,\nthe patient complained. An X-ray revealed a necrosis of the proximal fragment and a lowering of\nthe patellar button with the distal bone fragment. The removal of the patellar button was performed\nby arthroscopy. Conservative treatment can be successful for this patients and the removal\nof the patellar button loosening via arthroscopy appears to be an attractive technique to be used\nin similar cases....
The antibiotic elution profiles from calcium phosphate cement (CPC) used for treating infection sites after total joint arthroplasty\nvary depending on the type and number of impregnated antibiotics.The purpose of this study was to develop a method for efficiently\neluting vancomycin hydrochloride (VCM) and gentamicin sulfate (GM) from CPC. Examination of the antibiotic elution profiles\nof CPC impregnated with either VCM (CPC/V) or GM (CPC/G) or both (CPC/VG) revealed that the early elution of VCM from\nCPC/VG was impaired compared to CPC/V.However, the elution of GM from CPC/VG was similar or higher compared to CPC/G.\nScanning electron microscopy showed that the pore structure of CPC markedly differed depending on the type and number of\nantibiotics present. The pore size of CPC/VG was smaller compared to CPC/V but was larger compared to CPC/G. Thus, the\ninhibition of the early elution of VCM, which is a larger molecule than GM, was attributed to the decreased pore size of CPC/VG.\nThese findings suggest that when dual treatment with VCM and GM is required for infection following total joint arthroplasty, each\nantibiotic should be individually impregnated into CPC to maximize the elution efficiency of VCM....
Medical research often defines a person as elderly when they are 65 years of age or above, however defining elderly\nage by chronology alone has its limitations. Moreover, potential variability in definitions of elderly age can make\ninterpretation of the collective body of evidence within a particular field of research confusing. Our research goals\nwere to (1) evaluate published orthopaedic research and determine whether there is variability in proposed definitions\nof an elderly person, and (2) to determine whether variability exists within the important research sub-group of\nhip fractures. A defined search protocol was used within PubMed, EMBASE and the Cochrane Library that identified\northopaedic research articles published in 2012 that stated within their objective, intent to examine an intervention\nin an elderly population. 80 studies that included 271,470 patients were identified and subject to analysis. Four (5 %)\nstudies failed to define their elderly population. The remaining 76 (95 %) studies all defined elderly age by chronology\nalone. Definitions of an elderly person ranged from 50 to 80 years and above. The most commonly used age to\ndefine an elderly person was 65, however this accounted for only 38 (47.5 %) of studies. Orthopedic research appears\nto favor defining elderly age by chronology alone, and there is considerable heterogeneity amongst these definitions.\nThis may confuse interpretation of the evidence base in areas of orthopaedic research that focus on elderly patients.\nThe findings of this study underline the importance of future research in orthopaedics adopting validated frailty index\nmeasures so that population descriptions in older patients are more uniform and clinically relevant....
Background: Posterior laminectomy with instrumented fusion is a standard procedure for treating degenerative\ncervical kyphosis with stenosis (DCKS). Two major disadvantages of the surgery are adhesion of the dural membrane\nwith significant disfiguring of cervical spine and a small fusion bed around the lateral mass. One of the advantages\nof laminoplasty over laminectomy is the protection of the dural membrane from adhesion through preservation of\nposterior bony elements. This study presents the surgical outcomes of laminoplasty, instead of laminectomy, as a\ndecompression method applied in posterior instrumented fusion for DCKS.\nMethods: A consecutive single center series of twenty cases between 2008 and 2011 were retrospectively reviewed.\nThey were diagnosed as DCKS and received anterior cervical fusion followed by expansive open door laminoplasty and\nlateral mass or pedicle screw instrumented fusion. We collected the functional scores and changes of cervical curvature\non the basis of dynamic lateral films preoperatively and postoperatively. We used computed tomography scans and\nmagnetic resonance imaging (MRI) to evaluate the status of fusion and decompression.\nResults: The mean age at the time of surgery was 67.6 �± 15.2 years. Half of the patients were older than 75 years. All\nfunctional scores and cervical lordotic curvatures markedly improved. No recurrence of spinal cord compression was\ncaused by closure of opened laminae, according to MRI study that was conducted 12 months postoperatively. No\npseudarthrosis or hardware loosening was observed 24 months postoperatively.\nConclusion: The surgical aims for DCKS are adequate decompression, correction of kyphosis, and solid instrumented\nfusion. Laminoplasty applied in cervical fusion as a decompression method seems to lead to a favorable functional\nrecovery and reduces the complications of perineural adhesion that typically occur after laminectomy. In addition,\nlaminoplasty affords an additional fusion bed at the hinge side and this advantage benefits solid fusion mass formation\nfor the patients who suffered from DCKS....
Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent\nassociation with other traumatic injuries and, seldom found. Its main complication remains\nfemoral head avascular necrosis. We report on four cases of obturator dislocation of the hip. The\nmean age of patients was 30 years, and all their injuries followed a road traffic accident. Associated\nlesions were a contralateral femur fracture in two cases and an osteochondral fracture in one case.\nReduction of dislocations was achieved orthopedically under general anaesthesia and the average\nwaiting time before reduction was 20 hours. One patient had an intra-articular incarcerated fragment\nvisible on X-ray, and another patient showed signs of early coxarthrosis 15 months later. The\naverage follow-up time was 24 months....
Obesity is becoming a critical problem in the developed world and is associated with an increased incidence of osteoarthritis of\nthe hip.The Oxford Hip Score was used to determine if Body Mass Index (BMI) is an independent factor in determining patient\noutcome following primary total hip arthroplasty (THA). Using data from 353 operations we found that patients with BMI ââ?°Â¥ 30 had\nan absolute score that was lower preoperatively and postoperatively compared to those with a BMI < 30.There was no difference\nin pre- and postoperative point score change within each group; Kendallââ?¬â?¢s rank correlation was 0.00047 (95% CI, âË?â??0.073 to 0.074\n(...
Background A single iliosacral screw placed into the S1\nvertebral body has been shown to be clinically unreliable\nfor certain type C pelvic ring injuries. Insertion of a second\nsupplemental iliosacral screw into the S1 or S2 vertebral\nbody has been widely used. However, clinical fixation\nfailures have been reported using this technique, and a\nsupplemental long iliosacral or transsacral screw has been\nused. The purpose of this study was to compare the\nbiomechanical effect of a supplemental S1 long iliosacral\nscrew versus a transsacral screw in an unstable type C\nvertically oriented sacral fracture model.\nMaterials and methods A type C pelvic ring injury was\ncreated in ten osteopenic/osteoporotic cadaver pelves by\nperforming vertical osteotomies through zone 2 of the\nsacrum and the ipsilateral pubic rami. The sacrum was\nreduced maintaining a 2-mm fracture gap to simulate a\nclosed-reduction model. All specimens were fixed using\none 7.0-mm iliosacral screw into the S1 body. A supplemental\nlong iliosacral screw was placed into the S1 body in\nfive specimens. A supplemental transsacral S1 screw was\nplaced in the other five. Each pelvis underwent 100,000\ncycles at 250 N, followed by loading to failure. Vertical\ndisplacements at 25,000, 50,000, 75,000, and 100,000 cycles\nand failure force were recorded.\nResults Vertical displacement increased significantly\n(p\\0.05) within each group with each increase in the\nnumber of cycles. However, there was no statistically\nsignificant difference between groups in displacement or\nload to failure.\nConclusions Although intuitively a transsacral screw may\nseem to be better than a long iliosacral screw in conveying\nadditional stability to an unstable sacral fracture fixation\nconstruct, we were not able to identify any biomechanical\nadvantage of one method over the other.\nLevel of evidence Does not applyââ?¬â?biomechanical study....
Background: The aim of this study was to evaluate the accuracy of initial bone cutting of the distal\nfemur and the proximal tibia in TKA using an image-free navigation system. Methods: From February\n2006 to March 2013, we evaluated 60 knees in 50 patients using an image-free navigation\nsystem (Navigation: Stryker Navigation Cart System; Software: Stryker Knee Navigation; Ver2.0:\nStryker Orthopaedics US NJ Mahwah). First, we measured the angle shown by the navigation system\nbefore cutting, at the time we set the jig. Second, we measured the angles shown by navigation\nafter the bone was cut using the jig. Then, we compared these two angles for each patient to determine\nthe bone cutting error. Results: In the distal femur, 37 of 60 knees were cut in an extended\nposition in the sagittal plane, and 26 of 60 knees were cut in a varus in the coronal plane. In the\nproximal tibia, 29 of 60 knees were cut with decreased posterior slope in the sagittal plane, and 26\nof 60 knees were cut in a valgus. Conclusions: In this study, the distal femur tended to be cut in an\nextended and a varus position and the proximal tibia did with decreased posterior slope and in a\nvalgus position after initial bone cutting. It is necessary to note the initial cutting error in TKA.\nSince cutting errors affect postoperative outcome, we should cut bones several times. And as the\nreasons of the cause of the error, we propose new reason that cutting bone is not parallel with accuracy\nto AP axis....
The pneumococcal septic arthritis is uncommon in healthy adults. In most cases, it occurs in patients\nwith immune deficiency. Its exceptional location at the wrist can maintain doubt with\nrheumatic causes which are more frequent. IgG4 deficiency found in this patient was the only\ncause that could be impugned. We report the case of a young woman of 46 years without any\nevident cause of immunodeficiency and any particular risk factor, managed for septic arthritis of\nthe wrist due to Streptococcus pneumoniae. This case without any apparent risk factors demonstrates\nthat pneumococcal infection in a more distant articulation of the ENT is still possible. Scan\nhas been a very significant contribution in confirming the positive diagnosis that leads to surgical\ndrainage. The approach of the systematic search for the gateway must be done. In the study of the\npatient�s immune status, the realization of the protein profile could be interesting and then guide\nthe practitioner in the decision to vaccinate the patient against Streptococcus pneumoniae if he\nwas not. We recommend looking always for a cause of immunodeficiency including primary Ig\ndefiencies even among adult....
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