Orthopedics Research and Traumatology – Open Journal (e-ISSN 2473-0963) is an online peer-reviewed open access journal that deals with all the topics of orthopedics and traumatology.
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Introduction
Orthopedic hexapods demonstrated effectiveness and accuracy in deformity correction... more Introduction Orthopedic hexapods demonstrated effectiveness and accuracy in deformity correction of limbs in both adults and children. Previous studies demonstrated the best reduction capabilities of the orthopedic hexapod Ortho-SUV Frame (OSF) versus other models of this group of external fixation devices. Minimized version of this hexapod (minimized Ortho-SUV Frame (OSFm)) was created to reduce common for this group disadvantages: large bulkiness and weight and limitation on working with “short segments”. However, the reduction capabilities of the OSFm have not yet been studied. Aim To evaluate translation and angulation capabilities of OSFm with standard struts size and to compare results to OSF with short struts size. Materials and Methods The experimental study was performed using plastic models of the tibia with osteotomy at the middle third of the shaft. Proximal and distal bone fragments were fixed with one-ring modules. The reduction capabilities of OSFm in the first series and OSF in the second series of the experiment were studied. According to the method of fixing the struts to the rings, experiments were divided into three groups: directly to the ring, using straight plates, and using Z-shaped plates. Translation and angulation capabilities were evaluated by the maximum displacement of the distal bone fragment relative to the proximal one until any of the struts reached its minimum or maximum possible length. Results In translation OSFm outperforms OSF by 2.8-9.5% fixed the struts directly to the rings, by 4.8-9.7% using straight plates, and by 27.3-29.3% using Z-plates. In angulation OSFm with struts fixed directly to the rings outperforms OSF by 33.9-55.4%, by 36.9- 47.3% using straight plates, and by 29.6-36% using Z-plates. Conclusion OSFm exceeds OSF in translation and angulation capabilities in all series of experiment. Distraction and rotation capabilities and the bone fragments fixation rigidity should be evaluated as further research to prove application of OSFm as a possible better candidate for deformity correction of limbs in children and foot deformity correction.
Squamous cell carcinoma is a cancer that is rare in the hand. The extirpation of this cancer can ... more Squamous cell carcinoma is a cancer that is rare in the hand. The extirpation of this cancer can leave an important cutaneous defect in many cases. The cutaneous covering at the back of the hand is a challenge for any surgeon, especially when there are large skin defects with exposure of tendons, bones or neurovascular structures. Here, we describe a clinical case where an adipofascial turnover forearm flap and full thickness skin graft were performed, after the extensive extirpation of the well-differentiated squamous cell carcinoma has been made.
Post-discectomy iatrogenic lumbar pseudomeningoceles are an uncommon complication. This pathology... more Post-discectomy iatrogenic lumbar pseudomeningoceles are an uncommon complication. This pathology is an extradural, encapsulated, cerebrospinal fluid collection which develops at the site of previous surgery as the consequence of an unnoticed or unrepairable dural tear. A pseudomeningocele is defined as giant if it grows beyond 8 cm in length. Giant iatrogenic pseudomeningoceles with detailed information are quite rare in the literature with only 21 reported cases including the current case. Herein, we present a middle age woman with a giant pseudomeningocele which had developed subsequent to L4-L5 discectomy.
In recent years, there has been a paradigm shift in the treatment of early-onset scoliosis. This ... more In recent years, there has been a paradigm shift in the treatment of early-onset scoliosis. This change is manifested by a propensity to avoiding or delaying fusion surgeries due to their many potential shortcomings. Many surgeons gravitate towards conservative measures and growth-friendly implants such as magnetic expandable growing rods. Still, such interventions are not impeccable. This case report discusses 8-year-old girl with early-onset scoliosis managed with magnetic expandable rods after failing conservative management. The results were promising at first. However, catastrophic failure was diagnosed after multiple successful elongations necessitating discarding the system and changing the construct to conventional growing rods.
A majority of tibial plateau fractures involve the lateral plateau. Posterolateral tibial plateau... more A majority of tibial plateau fractures involve the lateral plateau. Posterolateral tibial plateau fractures are caused by a valgus force that impacts the posterolateral plateau against the lateral femoral condyle. We describe a unique case of a patient who sustained a lateral plateau fracture with posterior displacement behind a fractured fibular head, with entrapment of the peroneal nerve. This unusual fracture pattern required dual anterolateral and lateral approach for reduction and fixation
Background
Due to contamination, open fractures are considered to be dangerous and thereby requir... more Background Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites. Methods Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data. Results Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the sixhour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for postdebridement. Conclusion The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate.
Aim
The study was aimed to assess the results of treatment for fracture-dislocations of the proxi... more Aim The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics. Patients and Methods This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis. Results Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed. Conclusion The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation. Keywords Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.
Necrotizing fasciitis (NF) is a life-threatening soft tissue infection characterized by a rapidly... more Necrotizing fasciitis (NF) is a life-threatening soft tissue infection characterized by a rapidly spreading infection of the subcutaneous tissue and in particular the fascia. Early diagnosis and radical surgical debridement are required. Surgery is indicated if NF is clinically suspected and must not be delayed by diagnosis in order to reduce mortality. We report a case of NF following surgery of an acral melanoma.1,2
There are different processes via which a muscle cell can utilize oxygen to make energy that will... more There are different processes via which a muscle cell can utilize oxygen to make energy that will sustain activity. The type of activity and duration of activity will determine what energy system is used to sustain the activity being done. Aerobic metabolism uses oxygen to sustain the energy demand. Oxygen is obtained from the air we breathe, and then transported to the cells though the myoglobin. Although ambient air only contains 21% oxygen, it is enough to sustain life and energy needs. But what if the muscle cell could instead receive 100% oxygen? The delivery method would be via hyperbaric oxygen therapy (HBO) which supplies oxygen at 100% concentration under a minimum of 1 atmospheric pressure. Atmospheric pressure will affect the outcomes of consuming 100% oxygen. Research supports positive findings on oxygen therapy under pressure and muscle cell recovery but much research still needs to be investigated. One research study revealed detrimental effects of 100% oxygen breathed in consistently for days resulting in comorbidities that did not exist prior to experiment. HBO can pose some risks but if it is applied in a controlled manner, HBO can be a safe option to enhance cellular recovery and cell function.
Background: The available literature on the reported patient satisfaction following bilateral sta... more Background: The available literature on the reported patient satisfaction following bilateral staged primary total knee arthroplasty (TKA) is limited. The purpose of our study is to compare patient-reported satisfaction following bilateral non-simultaneous TKA performed in a single unit. Methods: We retrospectively analyzed our regional database, the Trent and Wales Arthroplasty Audit Group (TWAAG). Patients who had bilateral staged TKA in the University Hospitals of Leicester, UK, between 1990 and 2007 and had completed a 12-month post-operative questionnaire were included in the study. Results: One thousand one patients were included in the study. 824 patients (82.3%) reported being satisfied with both of their primary TKAs. 91% and 88% reported being satisfied with their TKA respectively for the first and second sides. A chi-squared test revealed that the difference in satisfaction rates between the first and second side TKA was statistically significant. 86 patients were pleased with their first side but not pleased/unsure with the second side. On the other hand, 55 patients were pleased with their second side but not pleased/unsure with the first side. This difference was also statistically significant. Conclusion: In our study, more patients were pleased following their first side compared to their second side TKA.
Upper cervical spine injuries are the most common form of spinal cord trauma that occur in presch... more Upper cervical spine injuries are the most common form of spinal cord trauma that occur in preschool children. Among such injuries, odontoid synchondrosis fractures are the most frequently observed, though relatively few cases have been reported in the medical literature. The most appropriate approach to describe such cases is physeal injuries of the basilar synchondrosis plate between the odontoid process and the body of the axis. Acute odontoid synchondrosis fractures are further classified into 3 subtypes based on the amount of dense displacement and the degree of fracture angulation. Type Ic, the most severe subtype, will require a posterior atlantoaxial fixation for an associated atlantoaxial subluxation. The majority of Type Ia and type Ib odontoid synchondrosis fractures that display only mild to moderate dense displacement and angulation, can be adequately addressed through proper fusion. Complete fusion may be achieved through external immobilization after careful alignment is reached by either Minerva Orthosis or the use of a Halo-vest. Regardless of the technique applied, prior to immobilization, acute synchondrosis fractures should be brought together through either neck hyperextension or by using the skull traction procedure. While Minerva orthosis has been effective in the treatment for two case series and a few case reports, the use of Halo-vesting in young children presents challenges due to decreased skull thickness and the presence of a certain amount of soft osseous tissue. For these reasons, a certain level of controversy exists in the medical literature as to whether the use of such a device is warranted. According to the opponents of this practice, Halo-vesting is often a frustrating and anxiety-provoking experience for young patients. They likewise draw attention to the concerns and hospitality anticipated from the caregivers of such children who have been vested. Furthermore, these authors document that Halo orthosis is associated with a higher percentage of complications such as pin site infections, pin loosening or dislodgement, the breakdown of skin, dysphagia, dural tears and even brain abscesses. Conversely, proponents believe that Halo-vesting is a well-tolerated procedure in a majority of children as well as in toddlers. In accordance with this belief, existing evidence demonstrates that with a modification in the pin number, pin design, location of insertion, and insertion torque, the incidence of pin dislodgement and pin loosening may be reduced. Moreover, pin-site infections can be prevented through periodic medical supervision of the child patient as well as educating caregivers on how to properly clean and monitor pin sites. Overall, the number of the children with odontoid synchondrosis fractures, who have been treated with Halo-vesting accounts for roughly 40 cases with a mean percentage of complication rate recorded at 40%. Herein, 3 young children with acute odontoid synchondrosis fractures are reported in whom solid fusion at the synchondrosis plate was achieved through the application of Halo orthosis. These children were placed in a Halo-vest for 8 to 10 weeks without demonstrating any noted complications.
Background: Cervical ossification of posterior longitudinal ligament (OPLL) is a common disease a... more Background: Cervical ossification of posterior longitudinal ligament (OPLL) is a common disease among the elderly population of East Asian countries. Cervical OPLL is often misdiagnosed in lateral radiography or magnetic resonance imaging (MRI). The present study analyzes the diagnostic accuracy of cervical OPLL in lateral radiography and MRI compared to computed tomography (CT). Methods and Materials: A total of 60 Japanese patients who were clinically diagnosed with cervical OPLL by CT imagining were considered in this study. Firstly, a lateral radiograph was checked identifying a high-density structure along the posterior aspect of vertebral bodies as OPLL. Secondly, a T2 weighted MRI sagittal image was obtained which delineated a thick low-signal posterior longitudinal ligament as OPLL. Thirdly, a cervical CT investigated vertebral bodies in which OPLL was present. Subsequently, lateral radiographs and MRIs were compared to the CT scans. The diagnostic accuracy in lateral radiograph and MRI were evaluated and causes of misdiagnosis were postulated. Results: Diagnostic accuracy utilizing lateral radiograph and MRI were 20% (12/60) and 25% (15/60), respectively. Only 5 out of the 60 cases displayed evidence of OPLL in all three modalities. Regarding each vertebral level, accuracy using lateral radiograph and MRI of each C2-C7 was C2 (88.8% and 100%), C3 (88.8% and 100%), C4 (79.5% and 97.9%), C5 (95.5% and 110.6%), C6 (42.5% and 70.2%) and C7 (23.8% and 66.6%). Conclusions: Diagnosing cervical OPLL using lateral radiograph is prone to underestimation; whereas, diagnosis via MRI is prone to overestimation. If severe spondylosis, facet joints, and pedicle shadows occur, they can hinder the detection of OPLL in the lateral radiograph. Regarding the MRI-based diagnosis, it would be difficult to distinguish ossifications from ligament hypertrophy. However, the use of X-ray and MRI present an accurate diagnostic tool for cervical OPLL at the levels of C2, C3, C4 and C5.
Aims: To assess the effectiveness of muscle pedicle graft in avascular necrosis (AVN) head femur ... more Aims: To assess the effectiveness of muscle pedicle graft in avascular necrosis (AVN) head femur in Grade 1 and Grade 2 AVN of femoral head grade 1 and grade 2 as head sparing procedure. Method: The pixel count in Tc-99 bone scan single photon emission computed tomography (SPECT) was used as perfusion analysis through a standardized procedure of assessment at six monthly intervals. Comparisons of the scan and the counts at each interval was used to determine whether the procedure was producing a beneficial effect and to what extent. The cases were followed-up for a minimum period of two years. Result: It was discovered that the comparative ratios had a bearing on the clinical improvement and could be used as a predictor variable for the outcome. They also had a significant prognostic value. Conclusions: Muscle pedicle graft in Grade 1 and Grade 2 AVN femoral head does benefit the patient. The SPECT analysis of the Tc-99 bone scan can be used as a monitor and reasonably predict the outcome and adverse end results.
Os odontoideum (OO) is defined as an ossicle with circumferential smooth margins and no osseous c... more Os odontoideum (OO) is defined as an ossicle with circumferential smooth margins and no osseous continuity with the body of axis. While the size of the ossicle is variable, it has a smooth surface, therefore, the cause of this condition has been presumed to be both congenital and traumatic. The possible cause of this condition has been implicated in its underlying etiology. However, patients with this condition may be asymptomatic or may be symptomatic of a variety of neurological deficits and vascular dysfunctions. The treatment of both the symptomatic and symptomatic characteristics of this condition has undergone changes over the past few decades. The most challenging issue encountered is the management of OO with irreducible atlantoaxial dislocation. This outlines the objective of our discussion to examine the aforementioned subject extensively and review the appropriate potential strategies for the treatment of this condition.
Vertebral body compression fractures due to osteoporosis is the most common fracture in patients ... more Vertebral body compression fractures due to osteoporosis is the most common fracture in patients with osteoporosis.1 It affects significantly the quality of life (QoL) and is associated with pain interfering with activities of daily living. The management of osteoporotic vertebral body fracture could be surgical or non-surgical. Medical treatment is focused on better mineralization of bone to stop osteoporosis or to improve the quality of bone. Any underlying metabolic abnormalities and provision of supplemental calcium/vitamin D in conjunction with bisphosphonates or calcitonin, or both. Routine hormone replacement therapy has fallen out of favor because of concerns regarding adverse effects identified in long-term follow-up studies. In many cases, the vertebral body fracture is significant and requires surgical intervention. This can be achieved by sagittal alignment correction and vertebral body height restoration utilizing pedicle screw instrumentation or by using cement augmentation. This article will focus on cement augmentation options.
Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among the elderly. It is a w... more Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among the elderly. It is a well-defined syndrome with axial and peripheral skeletal manifestations including hyperostosis at the tendon insertions site around the joint capsules as well as the ossification of the anterior longitudinal ligament (ALL) of the spine. The bridged ossified anterior longitudinal ligament may infrequently cause swallowing difficulties and respiratory distress. The initial complication is due to excessively enlarged cervical osteophytes at the cervical-subaxial level and at or below C4 with a compression of esophagus. The subsequent complications are usually secondary to enlarged spurs above C4. In this paper we discuss two cases where the patients have experienced progressive dysphagia for one year and in which radiological findings were compatible with DISH from C2-C7 with the largest existing at C4. Surgical excision of the prominent osteophytes resulted in improvement of the dysphagia in both cases.
Aim
The Extracortical Clamp Device (ECD) is a novel external fixation component which unlike conv... more Aim The Extracortical Clamp Device (ECD) is a novel external fixation component which unlike conventional implants does not perforate long bone cortices. Therefore, it simplifies methods of combined and consecutive internal and external fixation, periprosthetic fracture osteosynthesis and deformity correction. This study compared the incidence of complications with the use of the ECD in combined external fixation of the femur. Methods A prospective controlled study was designed with one group including 66 frames assembled using the ECD. These were compared with the second group of 29 frames utilising a combination of external and internal fixation, the latter comprising conventional wires and pins only. Results In the ECD group, pin tract infection was identified in 14.8% of cases. In these patients, infection occurred in 45.5% of all fixation elements; of these, 18.2% occurred around the ECD. In the WP (only wired and pins) group pin tract infection occurred in 29.2% cases. ECD fracture occurred in one case (3.7%). In the WP group, transosseous element breakage occurred in 3 cases (13.6%). In the treatment of periprosthetic fractures and deformities using the ECD, pin tract infection was seen in 16.7%. In the treatment of similar fractures and deformities not associated with an endoprosthesis, pin tract infections were seen in 21.5% of cases. Conclusion In this study we have demonstrated that the ECD does not increase the number of complications specific to external fixation. All resultant complications applicable to the ECD were addressed by conservative measures, and did not affect the outcome. The use of the ECD eliminates complications and concerns in combined osteosynthesis such as obstruction and jamming of an intramedullary device; fretting wear due to contact with half pins or wires and endoprosthesis; loss of torsional control as seen not uncommonly with half pins; the reduction in frame stability due to the use of smaller pins; and the risk of pin or wire cut-out due to eccentric placement.
When I graduated in 1973 and registered with the Rajasthan
state branch of the Medical Council of... more When I graduated in 1973 and registered with the Rajasthan state branch of the Medical Council of India, I was given a copy of the Hippocratic Oath. That it is no longer the practice speaks volumes for what it is worth. Taking the Hippocratic Oath is probably no longer in practice, even though it can be of great worth and value for medical practitioners today.
Background
Several techniques have been developed for simpler and safer procedures during the las... more Background Several techniques have been developed for simpler and safer procedures during the last 2 decades. Techniques of vertebral body augmentation have been developed in an effort to treat these refractory cases. The injection of low-viscosity poly-methylemethacrylate (PMMA) under high pressure poses a potential risk for neural compromise and pulmonary embolism by uncontrolled leakage. Therefore, balloon kyphoplasty and vertebroplasty using a large cannula low pressure injection of PMMA in a high-viscosity state has been introduced. Percutaneous kyphoplasty (PKP) is a recently developed, minimally invasive surgical approach for the treatment of osteoporotic vertebral compression fractures (OVCF). Objective Our objective is directed towards the study of the role of kyphoplasty in the management of osteoporotic thoracolumbar fractures, following the analysis of clinical and radiographic outcomes. Our objective is to evaluate the efficacy and safety of kyphoplasty in the treatment of acute vertebral osteoporotic compression fractures and to validate the hypothesis that kyphoplasty will help diminish pain, disability and improve the quality of life (QoL). The goal of this study was to determine the safety and effectiveness of kyphoplasty in improving vertebral body height, decreasing pain, and improving affected functions. Patients and Methods A prospective analysis of 30 patients (10 males and 20 females), being treated with kyphoplasty, was performed at our institution, after a clinical follow-up of 6 months. The patients had vertebral compression fractures (VCFs) at levels T7 to L4 due to osteoporosis arising from primary and secondary etiological factors. There were 41 VCFs in these 30 patients. The median age was 69 years (range 53-87 years). Subjects were excluded if they had associated spinal stenosis, neurologic deficit, an active infection, and severe comorbidities, such as uncorrected coagulopathy. Results According to the pain scores, 26 (87%) patients showed a drastic post-operative improvement whereas, in 2 cases, significant improvement was noted after a follow-up in 3 months. On the other hand, 2 (7%) patients showed a deteriorated pain score. 24 (80%) patients showed constant improvement over a period of 6 months. 7 patients (23%) showed further improvement after the 6 months clinical follow-up. Conclusion All PMMA extravasations were asymptomatic; the cement was observed at a close vicinity to the treated vertebrae. We treated 41 fractures with balloon kyphoplasty (BKP); however, the failure of balloon distension occurred in 6 fractures (14%), which were managed with conventional vertebroplasty; Therefore, the exact cause behind the failure of the procedure is still unclear.
Background: Total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are ... more Background: Total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are effective treatments for glenohumeral arthritis and rotator cuff arthropathy. Purpose: To determine if the use of a post operative closed-suction drain following TSA and RTSA affects hemoglobin levels, clinical outcomes, and complications. Hypothesis: Patients who did not receive a drain will have less hemoglobin loss, better clinical outcome scores, and lower complication rates following TSA/RTSA. Methods: All patients who underwent TSA or RTSA by one of two surgeons between January 1, 2011 and May 15, 2013 were recorded. Patient demographic information was recorded. Patients were grouped based on use of a post-operative deep drain. Pre and post-operative hemoglobin, length of hospital stay, clinical outcome scores, and complications were recorded and analyzed. Results: Sixty-four patients (average age 58.9±9.9 years, 55% male) underwent RTSA (13) or TSA (51) without the use of a post-operative closed-suction drain; 304 patients (average age 66.7±9.6 years, 55% female) underwent RTSA (179) or TSA (125) with the use of a post-operative closed-suction drain. Average follow up was similar in both groups: 14.95±7.22 months in the drain group and 14.55±6.74 months in the no drain group (p=.723). Using multivariate analysis to control for confounding variables and differences between the two groups, drain usage was correlated with significantly lower postoperative hemoglobin (p=0.0002), longer length of stay (p≤0.0001), and lower postoperative SST (p=0.003). Conclusion: Closed-suction drain usage following RTSA and TSA leads to greater loss of hemoglobin and longer length of stay. No clinically significant differences in transfusion rate and clinical outcome scores were seen with or without drain usage.
Introduction
Orthopedic hexapods demonstrated effectiveness and accuracy in deformity correction... more Introduction Orthopedic hexapods demonstrated effectiveness and accuracy in deformity correction of limbs in both adults and children. Previous studies demonstrated the best reduction capabilities of the orthopedic hexapod Ortho-SUV Frame (OSF) versus other models of this group of external fixation devices. Minimized version of this hexapod (minimized Ortho-SUV Frame (OSFm)) was created to reduce common for this group disadvantages: large bulkiness and weight and limitation on working with “short segments”. However, the reduction capabilities of the OSFm have not yet been studied. Aim To evaluate translation and angulation capabilities of OSFm with standard struts size and to compare results to OSF with short struts size. Materials and Methods The experimental study was performed using plastic models of the tibia with osteotomy at the middle third of the shaft. Proximal and distal bone fragments were fixed with one-ring modules. The reduction capabilities of OSFm in the first series and OSF in the second series of the experiment were studied. According to the method of fixing the struts to the rings, experiments were divided into three groups: directly to the ring, using straight plates, and using Z-shaped plates. Translation and angulation capabilities were evaluated by the maximum displacement of the distal bone fragment relative to the proximal one until any of the struts reached its minimum or maximum possible length. Results In translation OSFm outperforms OSF by 2.8-9.5% fixed the struts directly to the rings, by 4.8-9.7% using straight plates, and by 27.3-29.3% using Z-plates. In angulation OSFm with struts fixed directly to the rings outperforms OSF by 33.9-55.4%, by 36.9- 47.3% using straight plates, and by 29.6-36% using Z-plates. Conclusion OSFm exceeds OSF in translation and angulation capabilities in all series of experiment. Distraction and rotation capabilities and the bone fragments fixation rigidity should be evaluated as further research to prove application of OSFm as a possible better candidate for deformity correction of limbs in children and foot deformity correction.
Squamous cell carcinoma is a cancer that is rare in the hand. The extirpation of this cancer can ... more Squamous cell carcinoma is a cancer that is rare in the hand. The extirpation of this cancer can leave an important cutaneous defect in many cases. The cutaneous covering at the back of the hand is a challenge for any surgeon, especially when there are large skin defects with exposure of tendons, bones or neurovascular structures. Here, we describe a clinical case where an adipofascial turnover forearm flap and full thickness skin graft were performed, after the extensive extirpation of the well-differentiated squamous cell carcinoma has been made.
Post-discectomy iatrogenic lumbar pseudomeningoceles are an uncommon complication. This pathology... more Post-discectomy iatrogenic lumbar pseudomeningoceles are an uncommon complication. This pathology is an extradural, encapsulated, cerebrospinal fluid collection which develops at the site of previous surgery as the consequence of an unnoticed or unrepairable dural tear. A pseudomeningocele is defined as giant if it grows beyond 8 cm in length. Giant iatrogenic pseudomeningoceles with detailed information are quite rare in the literature with only 21 reported cases including the current case. Herein, we present a middle age woman with a giant pseudomeningocele which had developed subsequent to L4-L5 discectomy.
In recent years, there has been a paradigm shift in the treatment of early-onset scoliosis. This ... more In recent years, there has been a paradigm shift in the treatment of early-onset scoliosis. This change is manifested by a propensity to avoiding or delaying fusion surgeries due to their many potential shortcomings. Many surgeons gravitate towards conservative measures and growth-friendly implants such as magnetic expandable growing rods. Still, such interventions are not impeccable. This case report discusses 8-year-old girl with early-onset scoliosis managed with magnetic expandable rods after failing conservative management. The results were promising at first. However, catastrophic failure was diagnosed after multiple successful elongations necessitating discarding the system and changing the construct to conventional growing rods.
A majority of tibial plateau fractures involve the lateral plateau. Posterolateral tibial plateau... more A majority of tibial plateau fractures involve the lateral plateau. Posterolateral tibial plateau fractures are caused by a valgus force that impacts the posterolateral plateau against the lateral femoral condyle. We describe a unique case of a patient who sustained a lateral plateau fracture with posterior displacement behind a fractured fibular head, with entrapment of the peroneal nerve. This unusual fracture pattern required dual anterolateral and lateral approach for reduction and fixation
Background
Due to contamination, open fractures are considered to be dangerous and thereby requir... more Background Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites. Methods Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data. Results Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the sixhour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for postdebridement. Conclusion The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate.
Aim
The study was aimed to assess the results of treatment for fracture-dislocations of the proxi... more Aim The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics. Patients and Methods This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis. Results Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed. Conclusion The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation. Keywords Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.
Necrotizing fasciitis (NF) is a life-threatening soft tissue infection characterized by a rapidly... more Necrotizing fasciitis (NF) is a life-threatening soft tissue infection characterized by a rapidly spreading infection of the subcutaneous tissue and in particular the fascia. Early diagnosis and radical surgical debridement are required. Surgery is indicated if NF is clinically suspected and must not be delayed by diagnosis in order to reduce mortality. We report a case of NF following surgery of an acral melanoma.1,2
There are different processes via which a muscle cell can utilize oxygen to make energy that will... more There are different processes via which a muscle cell can utilize oxygen to make energy that will sustain activity. The type of activity and duration of activity will determine what energy system is used to sustain the activity being done. Aerobic metabolism uses oxygen to sustain the energy demand. Oxygen is obtained from the air we breathe, and then transported to the cells though the myoglobin. Although ambient air only contains 21% oxygen, it is enough to sustain life and energy needs. But what if the muscle cell could instead receive 100% oxygen? The delivery method would be via hyperbaric oxygen therapy (HBO) which supplies oxygen at 100% concentration under a minimum of 1 atmospheric pressure. Atmospheric pressure will affect the outcomes of consuming 100% oxygen. Research supports positive findings on oxygen therapy under pressure and muscle cell recovery but much research still needs to be investigated. One research study revealed detrimental effects of 100% oxygen breathed in consistently for days resulting in comorbidities that did not exist prior to experiment. HBO can pose some risks but if it is applied in a controlled manner, HBO can be a safe option to enhance cellular recovery and cell function.
Background: The available literature on the reported patient satisfaction following bilateral sta... more Background: The available literature on the reported patient satisfaction following bilateral staged primary total knee arthroplasty (TKA) is limited. The purpose of our study is to compare patient-reported satisfaction following bilateral non-simultaneous TKA performed in a single unit. Methods: We retrospectively analyzed our regional database, the Trent and Wales Arthroplasty Audit Group (TWAAG). Patients who had bilateral staged TKA in the University Hospitals of Leicester, UK, between 1990 and 2007 and had completed a 12-month post-operative questionnaire were included in the study. Results: One thousand one patients were included in the study. 824 patients (82.3%) reported being satisfied with both of their primary TKAs. 91% and 88% reported being satisfied with their TKA respectively for the first and second sides. A chi-squared test revealed that the difference in satisfaction rates between the first and second side TKA was statistically significant. 86 patients were pleased with their first side but not pleased/unsure with the second side. On the other hand, 55 patients were pleased with their second side but not pleased/unsure with the first side. This difference was also statistically significant. Conclusion: In our study, more patients were pleased following their first side compared to their second side TKA.
Upper cervical spine injuries are the most common form of spinal cord trauma that occur in presch... more Upper cervical spine injuries are the most common form of spinal cord trauma that occur in preschool children. Among such injuries, odontoid synchondrosis fractures are the most frequently observed, though relatively few cases have been reported in the medical literature. The most appropriate approach to describe such cases is physeal injuries of the basilar synchondrosis plate between the odontoid process and the body of the axis. Acute odontoid synchondrosis fractures are further classified into 3 subtypes based on the amount of dense displacement and the degree of fracture angulation. Type Ic, the most severe subtype, will require a posterior atlantoaxial fixation for an associated atlantoaxial subluxation. The majority of Type Ia and type Ib odontoid synchondrosis fractures that display only mild to moderate dense displacement and angulation, can be adequately addressed through proper fusion. Complete fusion may be achieved through external immobilization after careful alignment is reached by either Minerva Orthosis or the use of a Halo-vest. Regardless of the technique applied, prior to immobilization, acute synchondrosis fractures should be brought together through either neck hyperextension or by using the skull traction procedure. While Minerva orthosis has been effective in the treatment for two case series and a few case reports, the use of Halo-vesting in young children presents challenges due to decreased skull thickness and the presence of a certain amount of soft osseous tissue. For these reasons, a certain level of controversy exists in the medical literature as to whether the use of such a device is warranted. According to the opponents of this practice, Halo-vesting is often a frustrating and anxiety-provoking experience for young patients. They likewise draw attention to the concerns and hospitality anticipated from the caregivers of such children who have been vested. Furthermore, these authors document that Halo orthosis is associated with a higher percentage of complications such as pin site infections, pin loosening or dislodgement, the breakdown of skin, dysphagia, dural tears and even brain abscesses. Conversely, proponents believe that Halo-vesting is a well-tolerated procedure in a majority of children as well as in toddlers. In accordance with this belief, existing evidence demonstrates that with a modification in the pin number, pin design, location of insertion, and insertion torque, the incidence of pin dislodgement and pin loosening may be reduced. Moreover, pin-site infections can be prevented through periodic medical supervision of the child patient as well as educating caregivers on how to properly clean and monitor pin sites. Overall, the number of the children with odontoid synchondrosis fractures, who have been treated with Halo-vesting accounts for roughly 40 cases with a mean percentage of complication rate recorded at 40%. Herein, 3 young children with acute odontoid synchondrosis fractures are reported in whom solid fusion at the synchondrosis plate was achieved through the application of Halo orthosis. These children were placed in a Halo-vest for 8 to 10 weeks without demonstrating any noted complications.
Background: Cervical ossification of posterior longitudinal ligament (OPLL) is a common disease a... more Background: Cervical ossification of posterior longitudinal ligament (OPLL) is a common disease among the elderly population of East Asian countries. Cervical OPLL is often misdiagnosed in lateral radiography or magnetic resonance imaging (MRI). The present study analyzes the diagnostic accuracy of cervical OPLL in lateral radiography and MRI compared to computed tomography (CT). Methods and Materials: A total of 60 Japanese patients who were clinically diagnosed with cervical OPLL by CT imagining were considered in this study. Firstly, a lateral radiograph was checked identifying a high-density structure along the posterior aspect of vertebral bodies as OPLL. Secondly, a T2 weighted MRI sagittal image was obtained which delineated a thick low-signal posterior longitudinal ligament as OPLL. Thirdly, a cervical CT investigated vertebral bodies in which OPLL was present. Subsequently, lateral radiographs and MRIs were compared to the CT scans. The diagnostic accuracy in lateral radiograph and MRI were evaluated and causes of misdiagnosis were postulated. Results: Diagnostic accuracy utilizing lateral radiograph and MRI were 20% (12/60) and 25% (15/60), respectively. Only 5 out of the 60 cases displayed evidence of OPLL in all three modalities. Regarding each vertebral level, accuracy using lateral radiograph and MRI of each C2-C7 was C2 (88.8% and 100%), C3 (88.8% and 100%), C4 (79.5% and 97.9%), C5 (95.5% and 110.6%), C6 (42.5% and 70.2%) and C7 (23.8% and 66.6%). Conclusions: Diagnosing cervical OPLL using lateral radiograph is prone to underestimation; whereas, diagnosis via MRI is prone to overestimation. If severe spondylosis, facet joints, and pedicle shadows occur, they can hinder the detection of OPLL in the lateral radiograph. Regarding the MRI-based diagnosis, it would be difficult to distinguish ossifications from ligament hypertrophy. However, the use of X-ray and MRI present an accurate diagnostic tool for cervical OPLL at the levels of C2, C3, C4 and C5.
Aims: To assess the effectiveness of muscle pedicle graft in avascular necrosis (AVN) head femur ... more Aims: To assess the effectiveness of muscle pedicle graft in avascular necrosis (AVN) head femur in Grade 1 and Grade 2 AVN of femoral head grade 1 and grade 2 as head sparing procedure. Method: The pixel count in Tc-99 bone scan single photon emission computed tomography (SPECT) was used as perfusion analysis through a standardized procedure of assessment at six monthly intervals. Comparisons of the scan and the counts at each interval was used to determine whether the procedure was producing a beneficial effect and to what extent. The cases were followed-up for a minimum period of two years. Result: It was discovered that the comparative ratios had a bearing on the clinical improvement and could be used as a predictor variable for the outcome. They also had a significant prognostic value. Conclusions: Muscle pedicle graft in Grade 1 and Grade 2 AVN femoral head does benefit the patient. The SPECT analysis of the Tc-99 bone scan can be used as a monitor and reasonably predict the outcome and adverse end results.
Os odontoideum (OO) is defined as an ossicle with circumferential smooth margins and no osseous c... more Os odontoideum (OO) is defined as an ossicle with circumferential smooth margins and no osseous continuity with the body of axis. While the size of the ossicle is variable, it has a smooth surface, therefore, the cause of this condition has been presumed to be both congenital and traumatic. The possible cause of this condition has been implicated in its underlying etiology. However, patients with this condition may be asymptomatic or may be symptomatic of a variety of neurological deficits and vascular dysfunctions. The treatment of both the symptomatic and symptomatic characteristics of this condition has undergone changes over the past few decades. The most challenging issue encountered is the management of OO with irreducible atlantoaxial dislocation. This outlines the objective of our discussion to examine the aforementioned subject extensively and review the appropriate potential strategies for the treatment of this condition.
Vertebral body compression fractures due to osteoporosis is the most common fracture in patients ... more Vertebral body compression fractures due to osteoporosis is the most common fracture in patients with osteoporosis.1 It affects significantly the quality of life (QoL) and is associated with pain interfering with activities of daily living. The management of osteoporotic vertebral body fracture could be surgical or non-surgical. Medical treatment is focused on better mineralization of bone to stop osteoporosis or to improve the quality of bone. Any underlying metabolic abnormalities and provision of supplemental calcium/vitamin D in conjunction with bisphosphonates or calcitonin, or both. Routine hormone replacement therapy has fallen out of favor because of concerns regarding adverse effects identified in long-term follow-up studies. In many cases, the vertebral body fracture is significant and requires surgical intervention. This can be achieved by sagittal alignment correction and vertebral body height restoration utilizing pedicle screw instrumentation or by using cement augmentation. This article will focus on cement augmentation options.
Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among the elderly. It is a w... more Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among the elderly. It is a well-defined syndrome with axial and peripheral skeletal manifestations including hyperostosis at the tendon insertions site around the joint capsules as well as the ossification of the anterior longitudinal ligament (ALL) of the spine. The bridged ossified anterior longitudinal ligament may infrequently cause swallowing difficulties and respiratory distress. The initial complication is due to excessively enlarged cervical osteophytes at the cervical-subaxial level and at or below C4 with a compression of esophagus. The subsequent complications are usually secondary to enlarged spurs above C4. In this paper we discuss two cases where the patients have experienced progressive dysphagia for one year and in which radiological findings were compatible with DISH from C2-C7 with the largest existing at C4. Surgical excision of the prominent osteophytes resulted in improvement of the dysphagia in both cases.
Aim
The Extracortical Clamp Device (ECD) is a novel external fixation component which unlike conv... more Aim The Extracortical Clamp Device (ECD) is a novel external fixation component which unlike conventional implants does not perforate long bone cortices. Therefore, it simplifies methods of combined and consecutive internal and external fixation, periprosthetic fracture osteosynthesis and deformity correction. This study compared the incidence of complications with the use of the ECD in combined external fixation of the femur. Methods A prospective controlled study was designed with one group including 66 frames assembled using the ECD. These were compared with the second group of 29 frames utilising a combination of external and internal fixation, the latter comprising conventional wires and pins only. Results In the ECD group, pin tract infection was identified in 14.8% of cases. In these patients, infection occurred in 45.5% of all fixation elements; of these, 18.2% occurred around the ECD. In the WP (only wired and pins) group pin tract infection occurred in 29.2% cases. ECD fracture occurred in one case (3.7%). In the WP group, transosseous element breakage occurred in 3 cases (13.6%). In the treatment of periprosthetic fractures and deformities using the ECD, pin tract infection was seen in 16.7%. In the treatment of similar fractures and deformities not associated with an endoprosthesis, pin tract infections were seen in 21.5% of cases. Conclusion In this study we have demonstrated that the ECD does not increase the number of complications specific to external fixation. All resultant complications applicable to the ECD were addressed by conservative measures, and did not affect the outcome. The use of the ECD eliminates complications and concerns in combined osteosynthesis such as obstruction and jamming of an intramedullary device; fretting wear due to contact with half pins or wires and endoprosthesis; loss of torsional control as seen not uncommonly with half pins; the reduction in frame stability due to the use of smaller pins; and the risk of pin or wire cut-out due to eccentric placement.
When I graduated in 1973 and registered with the Rajasthan
state branch of the Medical Council of... more When I graduated in 1973 and registered with the Rajasthan state branch of the Medical Council of India, I was given a copy of the Hippocratic Oath. That it is no longer the practice speaks volumes for what it is worth. Taking the Hippocratic Oath is probably no longer in practice, even though it can be of great worth and value for medical practitioners today.
Background
Several techniques have been developed for simpler and safer procedures during the las... more Background Several techniques have been developed for simpler and safer procedures during the last 2 decades. Techniques of vertebral body augmentation have been developed in an effort to treat these refractory cases. The injection of low-viscosity poly-methylemethacrylate (PMMA) under high pressure poses a potential risk for neural compromise and pulmonary embolism by uncontrolled leakage. Therefore, balloon kyphoplasty and vertebroplasty using a large cannula low pressure injection of PMMA in a high-viscosity state has been introduced. Percutaneous kyphoplasty (PKP) is a recently developed, minimally invasive surgical approach for the treatment of osteoporotic vertebral compression fractures (OVCF). Objective Our objective is directed towards the study of the role of kyphoplasty in the management of osteoporotic thoracolumbar fractures, following the analysis of clinical and radiographic outcomes. Our objective is to evaluate the efficacy and safety of kyphoplasty in the treatment of acute vertebral osteoporotic compression fractures and to validate the hypothesis that kyphoplasty will help diminish pain, disability and improve the quality of life (QoL). The goal of this study was to determine the safety and effectiveness of kyphoplasty in improving vertebral body height, decreasing pain, and improving affected functions. Patients and Methods A prospective analysis of 30 patients (10 males and 20 females), being treated with kyphoplasty, was performed at our institution, after a clinical follow-up of 6 months. The patients had vertebral compression fractures (VCFs) at levels T7 to L4 due to osteoporosis arising from primary and secondary etiological factors. There were 41 VCFs in these 30 patients. The median age was 69 years (range 53-87 years). Subjects were excluded if they had associated spinal stenosis, neurologic deficit, an active infection, and severe comorbidities, such as uncorrected coagulopathy. Results According to the pain scores, 26 (87%) patients showed a drastic post-operative improvement whereas, in 2 cases, significant improvement was noted after a follow-up in 3 months. On the other hand, 2 (7%) patients showed a deteriorated pain score. 24 (80%) patients showed constant improvement over a period of 6 months. 7 patients (23%) showed further improvement after the 6 months clinical follow-up. Conclusion All PMMA extravasations were asymptomatic; the cement was observed at a close vicinity to the treated vertebrae. We treated 41 fractures with balloon kyphoplasty (BKP); however, the failure of balloon distension occurred in 6 fractures (14%), which were managed with conventional vertebroplasty; Therefore, the exact cause behind the failure of the procedure is still unclear.
Background: Total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are ... more Background: Total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) are effective treatments for glenohumeral arthritis and rotator cuff arthropathy. Purpose: To determine if the use of a post operative closed-suction drain following TSA and RTSA affects hemoglobin levels, clinical outcomes, and complications. Hypothesis: Patients who did not receive a drain will have less hemoglobin loss, better clinical outcome scores, and lower complication rates following TSA/RTSA. Methods: All patients who underwent TSA or RTSA by one of two surgeons between January 1, 2011 and May 15, 2013 were recorded. Patient demographic information was recorded. Patients were grouped based on use of a post-operative deep drain. Pre and post-operative hemoglobin, length of hospital stay, clinical outcome scores, and complications were recorded and analyzed. Results: Sixty-four patients (average age 58.9±9.9 years, 55% male) underwent RTSA (13) or TSA (51) without the use of a post-operative closed-suction drain; 304 patients (average age 66.7±9.6 years, 55% female) underwent RTSA (179) or TSA (125) with the use of a post-operative closed-suction drain. Average follow up was similar in both groups: 14.95±7.22 months in the drain group and 14.55±6.74 months in the no drain group (p=.723). Using multivariate analysis to control for confounding variables and differences between the two groups, drain usage was correlated with significantly lower postoperative hemoglobin (p=0.0002), longer length of stay (p≤0.0001), and lower postoperative SST (p=0.003). Conclusion: Closed-suction drain usage following RTSA and TSA leads to greater loss of hemoglobin and longer length of stay. No clinically significant differences in transfusion rate and clinical outcome scores were seen with or without drain usage.
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Papers by Orthopedics Research and Traumatology – Open Journal
Orthopedic hexapods demonstrated effectiveness and accuracy in deformity correction of limbs in both adults and children. Previous studies demonstrated the best reduction capabilities of the orthopedic hexapod Ortho-SUV Frame (OSF) versus other models of this group of external fixation devices. Minimized version of this hexapod (minimized Ortho-SUV Frame (OSFm)) was created to reduce common for this group disadvantages: large bulkiness and weight and limitation on working with “short segments”. However, the reduction capabilities of the OSFm have not yet been studied.
Aim
To evaluate translation and angulation capabilities of OSFm with standard struts size and to compare results to OSF with short struts size.
Materials and Methods
The experimental study was performed using plastic models of the tibia with osteotomy at the middle third of the shaft. Proximal and distal bone fragments were fixed with one-ring modules. The reduction capabilities of OSFm in the first series and OSF in the second series of the experiment were studied. According to the method of fixing the struts to the rings, experiments were divided into three groups: directly to the ring, using straight plates, and using Z-shaped plates. Translation and angulation capabilities were evaluated by the maximum displacement of the distal bone fragment relative to the proximal one until any of the struts reached its minimum or maximum possible length.
Results
In translation OSFm outperforms OSF by 2.8-9.5% fixed the struts directly to the rings, by 4.8-9.7% using straight plates, and by 27.3-29.3% using Z-plates. In angulation OSFm with struts fixed directly to the rings outperforms OSF by 33.9-55.4%, by 36.9- 47.3% using straight plates, and by 29.6-36% using Z-plates.
Conclusion
OSFm exceeds OSF in translation and angulation capabilities in all series of experiment. Distraction and rotation capabilities and the bone fragments fixation rigidity should be evaluated as further research to prove application of OSFm as a possible better candidate for deformity correction of limbs in children and foot deformity correction.
Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites.
Methods
Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data.
Results
Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the sixhour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for postdebridement.
Conclusion
The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate.
The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics.
Patients and Methods
This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis.
Results
Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed.
Conclusion
The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation. Keywords Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.
in a single unit.
Methods: We retrospectively analyzed our regional database, the Trent and Wales Arthroplasty Audit Group (TWAAG). Patients who had bilateral staged TKA in the University Hospitals of Leicester, UK, between 1990 and 2007 and had completed a 12-month post-operative questionnaire were included in the study.
Results: One thousand one patients were included in the study. 824 patients (82.3%) reported being satisfied with both of their primary
TKAs. 91% and 88% reported being satisfied with their TKA respectively for the first and second sides. A chi-squared test revealed that the difference in satisfaction rates between the first and second side TKA was statistically significant. 86 patients were pleased with their first side but not pleased/unsure with the second side. On the other hand, 55 patients were pleased with their second side but not pleased/unsure with the first side. This difference was also statistically significant.
Conclusion: In our study, more patients were pleased following their first side compared to their second side TKA.
acute synchondrosis fractures should be brought together through either neck hyperextension or by using the skull traction procedure. While Minerva orthosis has been effective in the treatment for two case series and a few case reports, the use of Halo-vesting in young children presents challenges due to decreased skull thickness and the presence of a certain amount of soft osseous tissue. For these reasons, a certain level of controversy exists in the medical literature as to whether the use of such a device is warranted. According to the opponents of this practice, Halo-vesting is often a frustrating and anxiety-provoking experience for young patients. They likewise draw attention to the concerns and hospitality anticipated from the caregivers of such
children who have been vested. Furthermore, these authors document that Halo orthosis is associated with a higher percentage of complications such as pin site infections, pin loosening or dislodgement, the breakdown of skin, dysphagia, dural tears and even brain abscesses. Conversely, proponents believe that Halo-vesting is a well-tolerated procedure in a majority of children as well as in toddlers. In accordance with this belief, existing evidence demonstrates that with a modification in the pin number, pin design, location of insertion, and insertion torque,
the incidence of pin dislodgement and pin loosening may be reduced. Moreover, pin-site infections can be prevented through periodic medical supervision of the child patient as well as educating caregivers on how to properly clean and monitor pin sites. Overall, the number of the children with odontoid synchondrosis fractures, who have been treated with Halo-vesting accounts for roughly 40 cases with a mean percentage of complication rate recorded at 40%. Herein, 3 young children with acute odontoid synchondrosis fractures are reported in whom solid fusion at the synchondrosis plate was achieved through the application of Halo orthosis. These children were placed in a Halo-vest for 8 to 10 weeks without demonstrating any noted complications.
Methods and Materials: A total of 60 Japanese patients who were clinically diagnosed with cervical OPLL by CT imagining were considered in this study. Firstly, a lateral radiograph was checked identifying a high-density structure along the posterior aspect of vertebral bodies
as OPLL. Secondly, a T2 weighted MRI sagittal image was obtained which delineated a thick low-signal posterior longitudinal ligament as OPLL. Thirdly, a cervical CT investigated vertebral bodies in which OPLL was present. Subsequently, lateral radiographs and MRIs were
compared to the CT scans. The diagnostic accuracy in lateral radiograph and MRI were evaluated and causes of misdiagnosis were postulated.
Results: Diagnostic accuracy utilizing lateral radiograph and MRI were 20% (12/60) and 25% (15/60), respectively. Only 5 out of the 60 cases displayed evidence of OPLL in all three modalities. Regarding each vertebral level, accuracy using lateral radiograph and MRI of each
C2-C7 was C2 (88.8% and 100%), C3 (88.8% and 100%), C4 (79.5% and 97.9%), C5 (95.5% and 110.6%), C6 (42.5% and 70.2%) and C7 (23.8% and 66.6%).
Conclusions: Diagnosing cervical OPLL using lateral radiograph is prone to underestimation; whereas, diagnosis via MRI is prone to overestimation. If severe spondylosis, facet joints, and pedicle shadows occur, they can hinder the detection of OPLL in the lateral radiograph. Regarding the MRI-based diagnosis, it would be difficult to distinguish ossifications from ligament hypertrophy. However, the use of X-ray and MRI present an accurate diagnostic tool for cervical OPLL at the levels of C2, C3, C4 and C5.
Method: The pixel count in Tc-99 bone scan single photon emission computed tomography (SPECT) was used as perfusion analysis through a standardized procedure of assessment at six monthly intervals. Comparisons of the scan and the counts at each interval was used to determine whether the procedure was producing a beneficial effect and to what extent. The cases were followed-up for a minimum period of two years.
Result: It was discovered that the comparative ratios had a bearing on the clinical improvement and could be used as a predictor variable for the outcome. They also had a significant prognostic value.
Conclusions: Muscle pedicle graft in Grade 1 and Grade 2 AVN femoral head does benefit the patient. The SPECT analysis of the Tc-99 bone scan can be used as a monitor and reasonably predict the outcome and adverse end results.
fracture could be surgical or non-surgical. Medical treatment is focused on better mineralization of bone to stop osteoporosis or to improve the quality of bone. Any underlying metabolic abnormalities and provision of supplemental calcium/vitamin D in conjunction with bisphosphonates
or calcitonin, or both. Routine hormone replacement therapy has fallen out of favor because of concerns regarding adverse effects identified in long-term follow-up studies. In many cases, the vertebral body fracture is significant and requires surgical intervention. This can be achieved by sagittal alignment correction and vertebral body height restoration utilizing pedicle screw instrumentation or by using cement augmentation. This article will focus on cement augmentation options.
and peripheral skeletal manifestations including hyperostosis at the tendon insertions site around the joint capsules as well as the
ossification of the anterior longitudinal ligament (ALL) of the spine. The bridged ossified anterior longitudinal ligament may
infrequently cause swallowing difficulties and respiratory distress. The initial complication is due to excessively enlarged cervical
osteophytes at the cervical-subaxial level and at or below C4 with a compression of esophagus. The subsequent complications are
usually secondary to enlarged spurs above C4. In this paper we discuss two cases where the patients have experienced progressive
dysphagia for one year and in which radiological findings were compatible with DISH from C2-C7 with the largest existing at C4.
Surgical excision of the prominent osteophytes resulted in improvement of the dysphagia in both cases.
The Extracortical Clamp Device (ECD) is a novel external fixation component which unlike conventional implants does not
perforate long bone cortices. Therefore, it simplifies methods of combined and consecutive internal and external fixation, periprosthetic
fracture osteosynthesis and deformity correction. This study compared the incidence of complications with the use of
the ECD in combined external fixation of the femur.
Methods
A prospective controlled study was designed with one group including 66 frames assembled using the ECD. These were compared
with the second group of 29 frames utilising a combination of external and internal fixation, the latter comprising conventional
wires and pins only.
Results
In the ECD group, pin tract infection was identified in 14.8% of cases. In these patients, infection occurred in 45.5% of all fixation
elements; of these, 18.2% occurred around the ECD. In the WP (only wired and pins) group pin tract infection occurred
in 29.2% cases. ECD fracture occurred in one case (3.7%). In the WP group, transosseous element breakage occurred in 3 cases
(13.6%). In the treatment of periprosthetic fractures and deformities using the ECD, pin tract infection was seen in 16.7%. In
the treatment of similar fractures and deformities not associated with an endoprosthesis, pin tract infections were seen in 21.5%
of cases.
Conclusion
In this study we have demonstrated that the ECD does not increase the number of complications specific to external fixation.
All resultant complications applicable to the ECD were addressed by conservative measures, and did not affect the outcome.
The use of the ECD eliminates complications and concerns in combined osteosynthesis such as obstruction and jamming of an
intramedullary device; fretting wear due to contact with half pins or wires and endoprosthesis; loss of torsional control as seen
not uncommonly with half pins; the reduction in frame stability due to the use of smaller pins; and the risk of pin or wire cut-out
due to eccentric placement.
state branch of the Medical Council of India, I was given a
copy of the Hippocratic Oath.
That it is no longer the practice speaks volumes for what
it is worth. Taking the Hippocratic Oath is probably no longer in
practice, even though it can be of great worth and value for medical
practitioners today.
Several techniques have been developed for simpler and safer procedures during the last 2 decades. Techniques of vertebral body augmentation
have been developed in an effort to treat these refractory cases. The injection of low-viscosity poly-methylemethacrylate (PMMA) under high
pressure poses a potential risk for neural compromise and pulmonary embolism by uncontrolled leakage. Therefore, balloon kyphoplasty and
vertebroplasty using a large cannula low pressure injection of PMMA in a high-viscosity state has been introduced. Percutaneous kyphoplasty
(PKP) is a recently developed, minimally invasive surgical approach for the treatment of osteoporotic vertebral compression fractures (OVCF).
Objective
Our objective is directed towards the study of the role of kyphoplasty in the management of osteoporotic thoracolumbar fractures, following
the analysis of clinical and radiographic outcomes. Our objective is to evaluate the efficacy and safety of kyphoplasty in the treatment of acute
vertebral osteoporotic compression fractures and to validate the hypothesis that kyphoplasty will help diminish pain, disability and improve the
quality of life (QoL). The goal of this study was to determine the safety and effectiveness of kyphoplasty in improving vertebral body height,
decreasing pain, and improving affected functions.
Patients and Methods
A prospective analysis of 30 patients (10 males and 20 females), being treated with kyphoplasty, was performed at our institution, after a clinical
follow-up of 6 months. The patients had vertebral compression fractures (VCFs) at levels T7 to L4 due to osteoporosis arising from primary and
secondary etiological factors. There were 41 VCFs in these 30 patients. The median age was 69 years (range 53-87 years). Subjects were excluded
if they had associated spinal stenosis, neurologic deficit, an active infection, and severe comorbidities, such as uncorrected coagulopathy.
Results
According to the pain scores, 26 (87%) patients showed a drastic post-operative improvement whereas, in 2 cases, significant improvement was
noted after a follow-up in 3 months. On the other hand, 2 (7%) patients showed a deteriorated pain score. 24 (80%) patients showed constant
improvement over a period of 6 months. 7 patients (23%) showed further improvement after the 6 months clinical follow-up.
Conclusion
All PMMA extravasations were asymptomatic; the cement was observed at a close vicinity to the treated vertebrae. We treated 41 fractures with
balloon kyphoplasty (BKP); however, the failure of balloon distension occurred in 6 fractures (14%), which were managed with conventional
vertebroplasty; Therefore, the exact cause behind the failure of the procedure is still unclear.
Purpose: To determine if the use of a post operative closed-suction drain following TSA and RTSA affects hemoglobin levels, clinical outcomes, and complications.
Hypothesis: Patients who did not receive a drain will have less hemoglobin loss, better clinical outcome scores, and lower complication rates following TSA/RTSA.
Methods: All patients who underwent TSA or RTSA by one of two surgeons between January 1, 2011 and May 15, 2013 were recorded. Patient demographic information was recorded. Patients were grouped based on use of a post-operative deep drain. Pre and post-operative
hemoglobin, length of hospital stay, clinical outcome scores, and complications were recorded and analyzed.
Results: Sixty-four patients (average age 58.9±9.9 years, 55% male) underwent RTSA (13) or TSA (51) without the use of a post-operative closed-suction drain; 304 patients (average age 66.7±9.6 years, 55% female) underwent RTSA (179) or TSA (125) with the use of a post-operative closed-suction drain. Average follow up was similar in both groups: 14.95±7.22 months in the drain group and 14.55±6.74 months in the no drain group (p=.723). Using multivariate analysis to control for confounding variables and differences between the two groups, drain
usage was correlated with significantly lower postoperative hemoglobin (p=0.0002), longer length of stay (p≤0.0001), and lower postoperative SST (p=0.003).
Conclusion: Closed-suction drain usage following RTSA and TSA leads to greater loss of hemoglobin and longer length of stay. No clinically significant differences in transfusion rate and clinical outcome scores were seen with or without drain usage.
Orthopedic hexapods demonstrated effectiveness and accuracy in deformity correction of limbs in both adults and children. Previous studies demonstrated the best reduction capabilities of the orthopedic hexapod Ortho-SUV Frame (OSF) versus other models of this group of external fixation devices. Minimized version of this hexapod (minimized Ortho-SUV Frame (OSFm)) was created to reduce common for this group disadvantages: large bulkiness and weight and limitation on working with “short segments”. However, the reduction capabilities of the OSFm have not yet been studied.
Aim
To evaluate translation and angulation capabilities of OSFm with standard struts size and to compare results to OSF with short struts size.
Materials and Methods
The experimental study was performed using plastic models of the tibia with osteotomy at the middle third of the shaft. Proximal and distal bone fragments were fixed with one-ring modules. The reduction capabilities of OSFm in the first series and OSF in the second series of the experiment were studied. According to the method of fixing the struts to the rings, experiments were divided into three groups: directly to the ring, using straight plates, and using Z-shaped plates. Translation and angulation capabilities were evaluated by the maximum displacement of the distal bone fragment relative to the proximal one until any of the struts reached its minimum or maximum possible length.
Results
In translation OSFm outperforms OSF by 2.8-9.5% fixed the struts directly to the rings, by 4.8-9.7% using straight plates, and by 27.3-29.3% using Z-plates. In angulation OSFm with struts fixed directly to the rings outperforms OSF by 33.9-55.4%, by 36.9- 47.3% using straight plates, and by 29.6-36% using Z-plates.
Conclusion
OSFm exceeds OSF in translation and angulation capabilities in all series of experiment. Distraction and rotation capabilities and the bone fragments fixation rigidity should be evaluated as further research to prove application of OSFm as a possible better candidate for deformity correction of limbs in children and foot deformity correction.
Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites.
Methods
Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data.
Results
Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the sixhour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for postdebridement.
Conclusion
The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate.
The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics.
Patients and Methods
This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis.
Results
Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed.
Conclusion
The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation. Keywords Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.
in a single unit.
Methods: We retrospectively analyzed our regional database, the Trent and Wales Arthroplasty Audit Group (TWAAG). Patients who had bilateral staged TKA in the University Hospitals of Leicester, UK, between 1990 and 2007 and had completed a 12-month post-operative questionnaire were included in the study.
Results: One thousand one patients were included in the study. 824 patients (82.3%) reported being satisfied with both of their primary
TKAs. 91% and 88% reported being satisfied with their TKA respectively for the first and second sides. A chi-squared test revealed that the difference in satisfaction rates between the first and second side TKA was statistically significant. 86 patients were pleased with their first side but not pleased/unsure with the second side. On the other hand, 55 patients were pleased with their second side but not pleased/unsure with the first side. This difference was also statistically significant.
Conclusion: In our study, more patients were pleased following their first side compared to their second side TKA.
acute synchondrosis fractures should be brought together through either neck hyperextension or by using the skull traction procedure. While Minerva orthosis has been effective in the treatment for two case series and a few case reports, the use of Halo-vesting in young children presents challenges due to decreased skull thickness and the presence of a certain amount of soft osseous tissue. For these reasons, a certain level of controversy exists in the medical literature as to whether the use of such a device is warranted. According to the opponents of this practice, Halo-vesting is often a frustrating and anxiety-provoking experience for young patients. They likewise draw attention to the concerns and hospitality anticipated from the caregivers of such
children who have been vested. Furthermore, these authors document that Halo orthosis is associated with a higher percentage of complications such as pin site infections, pin loosening or dislodgement, the breakdown of skin, dysphagia, dural tears and even brain abscesses. Conversely, proponents believe that Halo-vesting is a well-tolerated procedure in a majority of children as well as in toddlers. In accordance with this belief, existing evidence demonstrates that with a modification in the pin number, pin design, location of insertion, and insertion torque,
the incidence of pin dislodgement and pin loosening may be reduced. Moreover, pin-site infections can be prevented through periodic medical supervision of the child patient as well as educating caregivers on how to properly clean and monitor pin sites. Overall, the number of the children with odontoid synchondrosis fractures, who have been treated with Halo-vesting accounts for roughly 40 cases with a mean percentage of complication rate recorded at 40%. Herein, 3 young children with acute odontoid synchondrosis fractures are reported in whom solid fusion at the synchondrosis plate was achieved through the application of Halo orthosis. These children were placed in a Halo-vest for 8 to 10 weeks without demonstrating any noted complications.
Methods and Materials: A total of 60 Japanese patients who were clinically diagnosed with cervical OPLL by CT imagining were considered in this study. Firstly, a lateral radiograph was checked identifying a high-density structure along the posterior aspect of vertebral bodies
as OPLL. Secondly, a T2 weighted MRI sagittal image was obtained which delineated a thick low-signal posterior longitudinal ligament as OPLL. Thirdly, a cervical CT investigated vertebral bodies in which OPLL was present. Subsequently, lateral radiographs and MRIs were
compared to the CT scans. The diagnostic accuracy in lateral radiograph and MRI were evaluated and causes of misdiagnosis were postulated.
Results: Diagnostic accuracy utilizing lateral radiograph and MRI were 20% (12/60) and 25% (15/60), respectively. Only 5 out of the 60 cases displayed evidence of OPLL in all three modalities. Regarding each vertebral level, accuracy using lateral radiograph and MRI of each
C2-C7 was C2 (88.8% and 100%), C3 (88.8% and 100%), C4 (79.5% and 97.9%), C5 (95.5% and 110.6%), C6 (42.5% and 70.2%) and C7 (23.8% and 66.6%).
Conclusions: Diagnosing cervical OPLL using lateral radiograph is prone to underestimation; whereas, diagnosis via MRI is prone to overestimation. If severe spondylosis, facet joints, and pedicle shadows occur, they can hinder the detection of OPLL in the lateral radiograph. Regarding the MRI-based diagnosis, it would be difficult to distinguish ossifications from ligament hypertrophy. However, the use of X-ray and MRI present an accurate diagnostic tool for cervical OPLL at the levels of C2, C3, C4 and C5.
Method: The pixel count in Tc-99 bone scan single photon emission computed tomography (SPECT) was used as perfusion analysis through a standardized procedure of assessment at six monthly intervals. Comparisons of the scan and the counts at each interval was used to determine whether the procedure was producing a beneficial effect and to what extent. The cases were followed-up for a minimum period of two years.
Result: It was discovered that the comparative ratios had a bearing on the clinical improvement and could be used as a predictor variable for the outcome. They also had a significant prognostic value.
Conclusions: Muscle pedicle graft in Grade 1 and Grade 2 AVN femoral head does benefit the patient. The SPECT analysis of the Tc-99 bone scan can be used as a monitor and reasonably predict the outcome and adverse end results.
fracture could be surgical or non-surgical. Medical treatment is focused on better mineralization of bone to stop osteoporosis or to improve the quality of bone. Any underlying metabolic abnormalities and provision of supplemental calcium/vitamin D in conjunction with bisphosphonates
or calcitonin, or both. Routine hormone replacement therapy has fallen out of favor because of concerns regarding adverse effects identified in long-term follow-up studies. In many cases, the vertebral body fracture is significant and requires surgical intervention. This can be achieved by sagittal alignment correction and vertebral body height restoration utilizing pedicle screw instrumentation or by using cement augmentation. This article will focus on cement augmentation options.
and peripheral skeletal manifestations including hyperostosis at the tendon insertions site around the joint capsules as well as the
ossification of the anterior longitudinal ligament (ALL) of the spine. The bridged ossified anterior longitudinal ligament may
infrequently cause swallowing difficulties and respiratory distress. The initial complication is due to excessively enlarged cervical
osteophytes at the cervical-subaxial level and at or below C4 with a compression of esophagus. The subsequent complications are
usually secondary to enlarged spurs above C4. In this paper we discuss two cases where the patients have experienced progressive
dysphagia for one year and in which radiological findings were compatible with DISH from C2-C7 with the largest existing at C4.
Surgical excision of the prominent osteophytes resulted in improvement of the dysphagia in both cases.
The Extracortical Clamp Device (ECD) is a novel external fixation component which unlike conventional implants does not
perforate long bone cortices. Therefore, it simplifies methods of combined and consecutive internal and external fixation, periprosthetic
fracture osteosynthesis and deformity correction. This study compared the incidence of complications with the use of
the ECD in combined external fixation of the femur.
Methods
A prospective controlled study was designed with one group including 66 frames assembled using the ECD. These were compared
with the second group of 29 frames utilising a combination of external and internal fixation, the latter comprising conventional
wires and pins only.
Results
In the ECD group, pin tract infection was identified in 14.8% of cases. In these patients, infection occurred in 45.5% of all fixation
elements; of these, 18.2% occurred around the ECD. In the WP (only wired and pins) group pin tract infection occurred
in 29.2% cases. ECD fracture occurred in one case (3.7%). In the WP group, transosseous element breakage occurred in 3 cases
(13.6%). In the treatment of periprosthetic fractures and deformities using the ECD, pin tract infection was seen in 16.7%. In
the treatment of similar fractures and deformities not associated with an endoprosthesis, pin tract infections were seen in 21.5%
of cases.
Conclusion
In this study we have demonstrated that the ECD does not increase the number of complications specific to external fixation.
All resultant complications applicable to the ECD were addressed by conservative measures, and did not affect the outcome.
The use of the ECD eliminates complications and concerns in combined osteosynthesis such as obstruction and jamming of an
intramedullary device; fretting wear due to contact with half pins or wires and endoprosthesis; loss of torsional control as seen
not uncommonly with half pins; the reduction in frame stability due to the use of smaller pins; and the risk of pin or wire cut-out
due to eccentric placement.
state branch of the Medical Council of India, I was given a
copy of the Hippocratic Oath.
That it is no longer the practice speaks volumes for what
it is worth. Taking the Hippocratic Oath is probably no longer in
practice, even though it can be of great worth and value for medical
practitioners today.
Several techniques have been developed for simpler and safer procedures during the last 2 decades. Techniques of vertebral body augmentation
have been developed in an effort to treat these refractory cases. The injection of low-viscosity poly-methylemethacrylate (PMMA) under high
pressure poses a potential risk for neural compromise and pulmonary embolism by uncontrolled leakage. Therefore, balloon kyphoplasty and
vertebroplasty using a large cannula low pressure injection of PMMA in a high-viscosity state has been introduced. Percutaneous kyphoplasty
(PKP) is a recently developed, minimally invasive surgical approach for the treatment of osteoporotic vertebral compression fractures (OVCF).
Objective
Our objective is directed towards the study of the role of kyphoplasty in the management of osteoporotic thoracolumbar fractures, following
the analysis of clinical and radiographic outcomes. Our objective is to evaluate the efficacy and safety of kyphoplasty in the treatment of acute
vertebral osteoporotic compression fractures and to validate the hypothesis that kyphoplasty will help diminish pain, disability and improve the
quality of life (QoL). The goal of this study was to determine the safety and effectiveness of kyphoplasty in improving vertebral body height,
decreasing pain, and improving affected functions.
Patients and Methods
A prospective analysis of 30 patients (10 males and 20 females), being treated with kyphoplasty, was performed at our institution, after a clinical
follow-up of 6 months. The patients had vertebral compression fractures (VCFs) at levels T7 to L4 due to osteoporosis arising from primary and
secondary etiological factors. There were 41 VCFs in these 30 patients. The median age was 69 years (range 53-87 years). Subjects were excluded
if they had associated spinal stenosis, neurologic deficit, an active infection, and severe comorbidities, such as uncorrected coagulopathy.
Results
According to the pain scores, 26 (87%) patients showed a drastic post-operative improvement whereas, in 2 cases, significant improvement was
noted after a follow-up in 3 months. On the other hand, 2 (7%) patients showed a deteriorated pain score. 24 (80%) patients showed constant
improvement over a period of 6 months. 7 patients (23%) showed further improvement after the 6 months clinical follow-up.
Conclusion
All PMMA extravasations were asymptomatic; the cement was observed at a close vicinity to the treated vertebrae. We treated 41 fractures with
balloon kyphoplasty (BKP); however, the failure of balloon distension occurred in 6 fractures (14%), which were managed with conventional
vertebroplasty; Therefore, the exact cause behind the failure of the procedure is still unclear.
Purpose: To determine if the use of a post operative closed-suction drain following TSA and RTSA affects hemoglobin levels, clinical outcomes, and complications.
Hypothesis: Patients who did not receive a drain will have less hemoglobin loss, better clinical outcome scores, and lower complication rates following TSA/RTSA.
Methods: All patients who underwent TSA or RTSA by one of two surgeons between January 1, 2011 and May 15, 2013 were recorded. Patient demographic information was recorded. Patients were grouped based on use of a post-operative deep drain. Pre and post-operative
hemoglobin, length of hospital stay, clinical outcome scores, and complications were recorded and analyzed.
Results: Sixty-four patients (average age 58.9±9.9 years, 55% male) underwent RTSA (13) or TSA (51) without the use of a post-operative closed-suction drain; 304 patients (average age 66.7±9.6 years, 55% female) underwent RTSA (179) or TSA (125) with the use of a post-operative closed-suction drain. Average follow up was similar in both groups: 14.95±7.22 months in the drain group and 14.55±6.74 months in the no drain group (p=.723). Using multivariate analysis to control for confounding variables and differences between the two groups, drain
usage was correlated with significantly lower postoperative hemoglobin (p=0.0002), longer length of stay (p≤0.0001), and lower postoperative SST (p=0.003).
Conclusion: Closed-suction drain usage following RTSA and TSA leads to greater loss of hemoglobin and longer length of stay. No clinically significant differences in transfusion rate and clinical outcome scores were seen with or without drain usage.