Current Issue : April - June Volume : 2019 Issue Number : 2 Articles : 8 Articles
The treatment methods used for Blauth type IIIB hypoplastic thumbs are controversial. We performed a nonvascularized,\nhemilongitudinal metatarsal bone transfer on a 5-year-old boy with a type IIIB hypoplastic thumb. Despite the childâ??s age, the\ngrowth of the thumb was confirmed and the thumb had stabilized. Moreover, growth disorder of the donor toe was not\nobserved. This method is relatively easy to perform. And donor toe deformation can be prevented, because of the preservation of\nmore than half of the metatarsal bone. In our case, the patient was 5 years of age; nevertheless, the epiphyseal line was opened\nand the grafted metatarsal bone grew. This method is useful in terms of its simplicity and prevention of postoperative complications...
Background. To date, there have been no published investigations on the cause of acetabular debonding, a rare failure phenomenon\nin metal-on-metal hip resurfacing where the acetabular porous coating delaminates fromthe implant while remaining well fixed to\nthe pelvic bone. Purposes. This study aims to summarize the current understanding of acetabular debonding and to investigate the\ndiscrepancy in rate of debonding between two implant systems. Patients and Methods. To elucidate potential causes of debonding,\nwe retrospectively analyzed a single-surgeon cohort of 839 hip resurfacing cases. Specifically, we compared rate of debonding and\nmanufacturing processes between two implant systems. Results. Group 1 experienced significantly more cases of debonding than\nGroup 2 cases (4.0% versus 0.0%, p value<0.0001). Implant manufacturing processes differed in surface coating, heat treatment,\npostmanufacturing treatment, and apex thickness. Debonded implants were more likely to havemissed RAIL guidelines (p=0.04).\nConclusions. We identified implant system, postoperative time, and acetabular component placement as variables contributing to\nrate of debonding. We recommend minimizing acetabular inclination angle according to RAIL guidelines. Further, we evaluated\nmanufacturing differences between the two implant systems but did not have access to proprietary data to identify the cause of\ndebonding. Both implants met ASTM standards, yet only the Group 1 implant debonded. This suggests the second implant had\ngreater fatigue shear strength. Because the Group 2 implant achieved a more durable interface that did not debond, we suggest\nthe ASTM F1160 standard for fatigue shear strength be increased to that achieved by its manufacturer. Level of Evidence II. A\nretrospective evaluation of prospectively collected data...
Gout is a form of inflammatory arthritis caused by hyperuricemia characterized\nby painful, hot and swollen joints. However, tophi involving carpal\ntunnel with concomitant presence of finger movement dysfunction as the\nfirst presentation of gout is rare. This suggests the involvement of flexor tendon\ninside the carpal tunnel. Here, we report a case of infiltration of tophi at\nthe flexor tendon of the hand presented as the first clinical manifestation of\ngout causing trigger finger like symptoms. Patient underwent surgery to confirm\nthe diagnosis and improve flexor tendon excursion. Our patientâ??s finger\nmovement improved dramatically after operation....
In the United States,more than 300,000 hip fractures occur annually in the elderly population with associated significant morbidity\nand mortality. Both intracapsular and extracapsular hip fractures have inherent treatment challenges and therefore are at risk\nof nonunion complications. A systematic assessment including radiographic, metabolic, and infectious evaluations should be\ncompleted for all patients suspected of nonunion. Failed internal fixation of intracapsular hip fractures is typically treated with\narthroplasty, while extracapsular proximal femur nonunions may be amenable to revision internal fixation or arthroplasty.While\nnot a classic hip fracture, bisphosphate associated subtrochanteric femur fractures affect a similar patient population and are\nhistorically difficult to treat. Atypical subtrochanteric femur fractures are at increased risk of nonunion given the altered biologic\nenvironment secondary to bisphosphonate use; therefore adjuvant therapies may be beneficial in setting of revision fixation.Having\na thorough understanding of nonunion risks, recognition, evaluation, and treatment is necessary for appropriate patient care....
Background: Osteoporotic fracture occurs mostly at the spine, in which the commonest one is vertebral compression\nfracture. Bone turnover markers (BTMs) can be applied to assess bone formation and resorption activity. Nevertheless,\nthere are few reports on BTMs changes after osteoporotic vertebral compression fracture. The aim of this study is\nto investigate the kinetics of bone turnover markers after osteoporotic vertebral compression fractures in postmenopausal\nfemale....
Objective: To demonstrate the efficacy and safety of a multimodal stratified\napproach for prevention of thromboembolism in patients undergoing primary\ntotal hip arthroplasty. Method: A longitudinal retrospective clinical study\nof a cohort of 341 individuals undergoing total hip arthroplasty between\nMarch 2008 and July 2016. Of these, 242 patients met the criteria for inclusion\nin the study. Individuals with a history of deep vein thrombosis or pulmonary\nthromboembolism, thrombophilia, hypercoagulation conditions, and\nchronic users of anticoagulants before surgery received enoxaparin at a dose\nof 40 mg/day for 21 days. For the other group, acetylsalicylic acid was prescribed\nat a dose of 200 mg/day for 30 days. All patients had surgical risk assessed\nby the American Anesthesiology Association classified as I or II, and\nunderwent regional anesthesia, effective hydration, the same protocol of early\npostoperative rehabilitation, and the use of compression stockings. Drug cost\nanalysis was performed based on the BrasÃndice . To date, there are no publications\nin PubMed and Scielo on this subject regarding the Brazilian population.\nResults: The need for blood transfusion in the enoxaparin group was\nhigher and the overall complication and hemorrhagic rates were also significantly\nhigher (p < 0.010) in this group. Aspirin prescription costs 39 times\nless than enoxaparin. Conclusion: In patients without predisposing factors to\nthromboembolism and undergoing primary total hip arthroplasty, the multimodal\napproach with acetylsalicylic acid seems to be effective, with low cost\nand a low rate of complications....
Nonunion is a relatively rare, yet challenging problem after fracture of the femoral neck. Risk factors include verticality of the\nfracture line and presence of comminution of the posteromedial calcar, as well as quality of reduction. Treatment options consist of\nvalgus intertrochanteric osteotomy versus arthroplasty. Treatment should be tailored to the individual patient, taking into account\npatient age and activity demands. This review outlines the principles and technical considerations for valgus osteotomy of the\nproximal femur in the setting of femoral neck nonunion....
Delirium is a common and serious syndrome in elderly patients.The hypoactive type of delirium is known to have\ndifferent characteristics, but further studies are needed to define the specificities of these characteristics.Our study aims at finding\nspecific risk factors, especially estimated blood loss during operations of hyper- and hypoactive delirium in orthopedic elderly\npatients. Methods. One hundred and seventy-five elderly patients were evaluated using the Confusion AssessmentMethod (CAM)\nand the 4\nth edition text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Trained psychiatrists\ninterviewed the subjects directly at pre- and postoperative time points. We reviewed medical records after the patients were\ndischarged. Results. Thirty-nine patients (22.3%) were diagnosed with multiple types of delirium, which included 17 hyperactive\ntypes (65.9%), 13 hypoactive types (33.3%), and 9 mixed types (23.1%). Although the mean estimated blood loss in patients with\neither hyper- or hypoactive symptoms was larger than in patients lacking these symptoms, the odds ratio was only significant in\npatients with hyperactive symptoms. In addition, age, preoperative daily function, and preoperative hyponatremia were found to be\nrisk factors for hyperactive but not hypoactive symptoms. Conclusion. Patients with hypoactive symptoms had different risk factors\nthan patients with hyperactive symptoms of delirium. The estimated blood loss, well-known risk factors for delirium,might be risk\nfactors for only hyperactive delirium.The acute precipitating factors seemed to show stronger correlation with the hyperactive type\nof delirium than with the hypoactive type....
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