Τετάρτη, 21 Αυγούστου 2019

About Orthopaedic awards, drains, patients safety and outcomes

Risk factors for refracture of the forearm in children treated with elastic stable intramedullary nailing

Abstract

Purpose

This study aims to investigate risk factors for refracture of the forearm in children treated with elastic stable intramedullary nailing (ESIN).

Methods

Clinical data of 267 patients who had been treated for forearm fractures by ESIN in our hospital from January 2010 to December 2014 were retrospectively reviewed. Risk factors for forearm refractures were determined using logistic regression analysis.

Results

Forearm refractures occurred in 11 children. Univariate analysis revealed that age, body weight, number of fractures, open fracture, nail diameter, and immobilization time were not associated with refractures. However, gender (male, P = 0.042) and fracture location (lower third, P = 0.007) were significantly associated with refractures. Multivariate analysis revealed that fracture location was an independent risk factor for forearm refractures (P = 0.031).

Conclusion

Forearm refracture is uncommon in children treated with ESIN. Fracture location is an independent risk factor for forearm refractures in these patients.

Subcutaneous internal anterior fixation of pelvis fractures—which configuration of the InFix is clinically optimal?—a retrospective study

Abstract

Introduction

Subcutaneous internal fixation (InFix) has become a valid alternative for anterior fixation of pelvic ring injuries. Complications associated with this technique are lateral femoral cutaneous nerve (LFCN) irritation and anterior thigh pain due to prominent implants. The aim of this study was to identify a configuration of the InFix that causes the least adverse side effects.

Methods

Nineteen patients (6 females, mean age 61 years) with 38 hemipelves were included. Rod-to-bone distance and symphysis-rod distance were measured on AP- and outlet- radiographs. These distances were analyzed in relation to the primary outcomes: early removal of the InFix, post-operative complications and damage of the LFCN.

Results

Regarding rod-to-bone distance, a distance of 20 to 25 mm causes less complications, LFCN damage and no early removals of the InFix. Symphysis-to-rod distance analysis showed the best results regarding LFCN damage and other complications when the rod had a distance of less than 40 mm to the symphysis. A distance more than 40 mm was associated with fewer early removal of the InFix.

Conclusions

Planned optimized configuration of the InFix with a rod-to-bone distance between 20 and 25 mm may reduce postoperative complications. Regarding LFCN damage, the rod-to-symphysis distance should not be more than 40 mm.

Abulcasis (936–1013): his work and contribution to orthopaedics

Abstract

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.

Is distal locking screw necessary for intramedullary nailing in the treatment of humeral shaft fractures? A comparative cohort study

Abstract

Purpose

The gold standard for intramedullary nailing (IMN) in humeral shaft fracture treatment is bipolar interlocking. The aim of this study was to compare clinical and radiographic outcomes in two cohorts of patients treated with IMN with or without distal interlocking. We hypothesized that there was no significant difference between isolated proximal interlocking and bipolar interlocking in terms of consolidation and clinical results.

Methods

One hundred twenty-one acute humeral shaft fractures were retrospectively included in group WDI (without distal interlocking screw, n = 74) or in group DI (with distal interlocking screw, n = 47). One hundred six patients (87.60%) could be verified by an X-ray, and 63 (52.07%) could be examined clinically. Fracture union at 6 months was the primary outcome, and the second was the final clinical outcome for shoulder and elbow after at least 6 months of follow-up. Pain, operating time, and radiation time were also analyzed.

Results

The two groups were not significantly different for population, fractures, or immobilization duration. No significant difference was found for bone union (WDI 89.06% vs DI 83.33%, p = 0.51), shoulder or elbow functional outcomes, or pain. However, there were significant differences in advantage to the WDI group for operating time (WDI 63.09 ± 21.30 min vs DI 87.96 ± 30.11 min, p < 0.01) and fluoroscopy time (WDI 59.06 ± 30.30 s vs DI 100.36 ± 48.98 s, p < 0.01).

Conclusions

Thus, it seems that there were no significant differences between proximal unipolar and bipolar interlocking for humeral shaft fractures in terms of consolidation and clinical outcomes. WDI avoided the additional operating time and fluoroscopy time and risks linked to DI.

Comparison of sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fractures Sanders type IV

Abstract

Purpose

Displaced intra-articular calcaneus fractures Sanders type IV(DIACFS IV) can result in an unsatisfactory prognosis and a high complication rate. Our investigation intends to compare the outcomes of DIACFS IV treated by open reduction and internal fixation (ORIF) via sinus tarsi approach (STA) with these via extensile lateral approach (ELA).

Methods

Sixty-nine patients (82 ft) with DIACFS IV who were treated with ORIF (29 in STA group and 40 in ELA group) were retrospectively assessed. Median follow-up was 50 months in two groups. Radiographic results were reviewed pre-operatively and post-operatively, and relative complications were collected. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale (VAS).

Results

The wound-healing complication rate was 14.28% in STA group and 34.04% in ELA group (p = .043), and overall complication rate was 54% and 77% (p = .056), respectively. Seven cases of sural nerve injury only occurred in ELA group. The post-operative radiographs of the calcaneus (Böhler’s angle, height, width, and length) were significantly different from those measured pre-operatively in each group. And these data were parallel between the two groups. In STA and ELA groups, the average AOFAS was 75.45 versus 72.44 (p = .496), and the mean VAS was 23.95 versus 30.93 (p = .088), respectively.

Conclusion

Similar clinical and radiographic outcomes are achieved between STA and ELA. And STA has a lower incidence of wound healing complication and sural nerve injury. Therefore, ORIF via STA can be a considerable management for DIACFS IV.

Development of periprosthetic bone mass density around the cementless Metha® short hip stem during three year follow up—a prospective radiological and clinical study

Abstract

Purpose

The purpose of this study was to check the concept of the cementless Metha® short hip stem in order to find out whether proximal physiological load transfer can be achieved.

Methods

Fourty-three patients were included. Epidemiological factors were established. The Harris Hip Score was determined and measurement of bone mass density as well as osteodensitometric and radiological measurements was carried out pre-operatively, post-operatively, and after six, 12, 24, and 36 months.

Results

Harris Hip Score improved from 55.9 ± 12.4 pre-operatively to 94.8 ± 8.2 after 36 months (p < 0.001). After initial reduction of bone density in zones 1 and 7 up to six months post-operatively, there was a steady approximation of bone density to the initial values (p < 0.05).

Conclusion

The Metha® short hip stem shows good clinical results. Furthermore, there is an increase of bone density in the proximal zones 1 and 7 between six and 36 months serving as a sign of physiological load transfer.

Does high hip centre affect dislocation after total hip arthroplasty for developmental dysplasia of the hip?

Abstract

Background

To achieve sufficient socket coverage by the native bone, high placement of cementless acetabular cup is often required. We previously reported, using computer simulation, that higher hip centre improved the bone coverage but decreased the range of motion in total hip arthroplasty (THA) for patients with hip dysplasia. However, in a clinical setting, the correlation between the hip centre height and dislocation after primary THA is still unclear. We examined whether a high hip centre affects dislocation after THA.

Methods

A total of 910 patients, with 1079 dysplastic hips, who underwent primary THA were retrospectively reviewed. The age at THA averaged 63.0 years and mean follow-up was 74.3 months. Vertical centre of rotation (V-COR) was defined as the distance from the head centre to the interteardrop line. Uni- and multivariate logistic regression models were applied to identify significant factors affecting dislocation.

Results

Ten hips in nine patients (0.9%) had dislocation after THA. In univariate analysis, age at surgery and V-COR were significant risk factors for dislocation. Multivariate analysis identified advanced age at operation (odds ratio [OR] 1.8/5 years), Crowe classification (OR 15.6), V-COR (OR 3.1/5 mm), and femoral head size (OR 11.6) as independent risk factors for dislocation. Receiver operating characteristic curve analysis revealed the cutoff value of the V-COR for dislocation as 23.9 mm.

Conclusions

A higher hip centre with the V-COR > 23.9 mm affected dislocation after THA for DDH. Our results would be useful for reconstruction of the hip centre, particularly with cementless acetabular cups.

The effect of post-operative limb positioning on blood loss and early outcomes after primary total knee arthroplasty: a randomized controlled trial

Abstract

Introduction

The purpose of this study was to investigate the benefits of three different post-operative limb positions in primary total knee arthroplasty (TKA).

Methods

The trial was a single-surgeon, randomized, controlled trial, and 135 patients following primary TKA were randomized into three groups: group A (45 patients who were treated with the hip fixed at 50° and knee flexed at 90° for 6 hours post-operatively), group B (45 patients who were treated with the hip elevated at 30° and knee flexed at 45° for 6 hours  post-operatively), and group C (45 patients in whom the affected knee was fully extended after surgery). Tranexamic acid was used in all patients.

Results

The total blood loss and hidden blood loss in group A (921 ± 209 mL, 597 ± 213 mL) were significantly less than in groups B (1125 ± 222 mL, 784 ± 229 mL) and C (1326 ± 291 mL, 915 ± 301 mL) and less in group B compared with group C. The drain volume in groups A (158 ± 35 mL) and B (174 ± 45 mL) was significantly lower than in group C (249 ± 31 mL). The maximum haemoglobin drop in group A (3.1 ± 0.5 g/dL) was statistically significantly less than in groups B (3.6 ± 0.7 g/dL) and C (4.3 ± 0.4 g/dL). The range of motion (ROM) in groups A (102 ± 3°, 105 ± 2°) and B (100 ± 3°, 104 ± 2°) was significantly better than in group C (98 ± 3°, 102 ± 2°) at the time of discharge and one  month after surgery; it was also significantly less for group A (104.9 ± 2.1%, 108.0 ± 2.4%) compared with groups B (106.7 ± 3.1%, 108.3 ± 2.7%) and C (108.4 ± 3.2%, 110.6 ± 3.0%) with post-operative knee swelling. No differences in transfusion requirements and complications were observed among the three groups.

Conclusions

The affected knee flexion position was superior to the use of a fully extended position for blood management, but it only contributed to better early functional recovery up to three  months post-operatively in TKA. In addition, by fixing the affected knee at a high flexion position of 90°, patients could achieve less blood loss, lower knee swelling, and better early results for ROM and patient satisfaction than the other two groups.

Dual offset metaphyseal-filling stems in primary total hip arthroplasty in dysplastic hips after a minimum follow-up of ten years

Abstract

Purpose

The aim of this study was to assess the long-term performance of tapered one-third proximally coated stems in dysplastic hips.

Methods

This study included 135 dysplasia patients (150 hips) who underwent a total hip arthroplasty and had a minimum follow-up of ten years. Single design tapered stems were used in all patients. There were 112 women (83%) and 23 men (17%) with a mean age of 45 years (23 to 72) at the time of surgery. The mean follow-up was 14.7 years (10 to 16.8). For clinical evaluation, the Harris Hip Score and Merle D’Aubigne scale were used pre-operatively and at the final follow-up. Implant survival was calculated using Kaplan-Meier survivorship analysis, with failure defined as a component revision for any reason.

Results

Overall, one stem was revised for a deep infection. There were no other femoral stem revisions secondary to loosening, wear, periprosthetic fracture, or instability. Radiographic evaluation showed excellent stem osteointegration in all cases. Kaplan-Meier survivorship, with stem revision for any reason as the end point, was 98% at 14 years (95% confidence interval 92.5 to 99.8).

Conclusion

This study demonstrates that a dual offset tapered stem achieved excellent survivorship and stability, as well as good clinical outcome scores with minimal thigh pain and stress shielding in patients with arthritis and developmental dysplasia of the hip; a dual offset tapered stem may be a suitable option for primary total hip arthroplasty in this group.

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