Pub Date : 2019-02-20DOI: 10.2174/1874325001913010053
H. Kan, A. McBride, A. Mclean, W. O’Callaghan, H. Khan, P. Gallie
Displaced intraarticular neck of femur fractures for low-demand patients are primarily managed with hemiarthroplasty. The optimal implant design for modularity is unclear. Globally and within Australia, the use of monoblock implants varies significantly by location; however, monoblock use is decreasing in Australia in favour of modular systems, with little evidence-based explanation. This study aimed to compare the radiological and clinical outcomes of monoblock and modular hemiarthroplasties. This retrospective cohort study involved patients who underwent hemiarthroplasty for neck-of-femur fractures between 2009 and 2013 at the Gold Coast University Hospital. Leg length and femoral offset were measured from post-operative pelvic radiographs. Revision and mortality rates were extracted from hospital medical records and Australian Joint Registry data. A total of 249 patients were evaluated (112 with modular and 147 with monoblock implants). Patient demographics were comparable between the treatment groups; however, the monoblock group comprised significantly older persons. No between-group differences in leg length discrepancies were identified. Femoral offset was under-restored on average by 5.86mm (p<0.05) compared to the uninjured side within the monoblock group. Mortality rates were significantly higher in the monoblock group (23% vs 12%, P=0.026) at the 1-year mark. No significant between-group differences were found in 30-day mortality, length of stay, or revision rates. Modular hemiarthroplasty was superior for restoring offset in our cohort, but no group differences were noted for leg length. While modular implants seemed better for restoring normal hip anatomy and were associated with a lower 1-year mortality rate, no other advantages were found.
对于低需求患者，移位的股骨关节内颈骨折主要采用半关节置换术。模块化的最佳植入物设计尚不清楚。在全球和澳大利亚境内，单块植入物的使用因地点而异;然而，在澳大利亚，模块化系统的使用正在减少，几乎没有证据支持的解释。本研究旨在比较单块半关节置换术和模块化半关节置换术的放射学和临床结果。这项回顾性队列研究涉及2009年至2013年间在黄金海岸大学医院接受股骨颈骨折半关节置换术的患者。术后骨盆x线片测量腿长和股骨偏移量。修正率和死亡率是从医院病历和澳大利亚联合登记处的数据中提取的。共有249名患者接受了评估(112名采用模块化种植体，147名采用单块种植体)。两组患者人口统计数据具有可比性;然而，单块组明显由老年人组成。未发现组间腿长差异。与未损伤侧相比，单块组股骨偏位平均缺损5.86mm (p<0.05)。1年后，单块组的死亡率明显更高(23% vs 12%， P=0.026)。在30天死亡率、住院时间或复查率方面，组间无显著差异。在我们的队列中，模块化半关节置换术在恢复偏位方面优于对照组，但在腿长方面没有组间差异。虽然模块化植入物似乎更好地恢复了正常的髋关节解剖结构，并且与较低的1年死亡率相关，但没有发现其他优势。
{"title":"Modular Versus Monoblock Hemiarthroplasty in Trauma: A 5-Year Retrospective Analysis of Radiographic and Clinical Outcomes","authors":"H. Kan, A. McBride, A. Mclean, W. O’Callaghan, H. Khan, P. Gallie","doi":"10.2174/1874325001913010053","DOIUrl":"https://doi.org/10.2174/1874325001913010053","url":null,"abstract":"\u0000 \u0000 Displaced intraarticular neck of femur fractures for low-demand patients are primarily managed with hemiarthroplasty. The optimal implant design for modularity is unclear. Globally and within Australia, the use of monoblock implants varies significantly by location; however, monoblock use is decreasing in Australia in favour of modular systems, with little evidence-based explanation. This study aimed to compare the radiological and clinical outcomes of monoblock and modular hemiarthroplasties.\u0000 \u0000 \u0000 \u0000 This retrospective cohort study involved patients who underwent hemiarthroplasty for neck-of-femur fractures between 2009 and 2013 at the Gold Coast University Hospital. Leg length and femoral offset were measured from post-operative pelvic radiographs. Revision and mortality rates were extracted from hospital medical records and Australian Joint Registry data.\u0000 \u0000 \u0000 \u0000 A total of 249 patients were evaluated (112 with modular and 147 with monoblock implants). Patient demographics were comparable between the treatment groups; however, the monoblock group comprised significantly older persons. No between-group differences in leg length discrepancies were identified. Femoral offset was under-restored on average by 5.86mm (p<0.05) compared to the uninjured side within the monoblock group. Mortality rates were significantly higher in the monoblock group (23% vs 12%, P=0.026) at the 1-year mark. No significant between-group differences were found in 30-day mortality, length of stay, or revision rates.\u0000 \u0000 \u0000 \u0000 Modular hemiarthroplasty was superior for restoring offset in our cohort, but no group differences were noted for leg length. While modular implants seemed better for restoring normal hip anatomy and were associated with a lower 1-year mortality rate, no other advantages were found.\u0000","PeriodicalId":23060,"journal":{"name":"The Open Orthopaedics Journal","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81527622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-20DOI: 10.2174/1874325001913010042
Amandeep Chopra, P. Hoogervorst, M. Marmor
It is commonly believed that delay in fracture fixation of more than two weeks results in increased Surgical Time (ST), due to scar and callus formation at the fracture site. Reducing ST can lower hospital costs and decrease radiation exposure. A retrospective chart review was conducted to investigate whether early fracture care (up to 2 days after injury) results in decreased ST and radiation exposure compared to delayed fracture care (> 14 days after injury) for distal radius and bimalleolar ankle fractures. A total of 581 radius and ankle fractures that underwent surgical fixation between 2014 and 2017 were identified from the OR registry. Cases with only a single volar locking plate for the distal radius and constructs consisting of 2 medial malleolar screws, third tubular plate, and up to 1 syndesmotic screw for the ankle were included. The mean ST for distal radius cases done up to 2 days after injury was significantly greater than ST for distal radius cases done > 14 days after injury (125.78±29.75 minutes versus 105.83±24.82 minutes respectively , p=0.06). The mean ST for ankle fracture cases done less than 2 days did not differ from ST for ankle fracture cases done > 14 days after injury (140.86±28.15 minutes versus 173.22±39.98 minutes respectively, p=0.06). There was no significant difference in radiation exposure. Delaying surgery for distal radius and bimalleolar ankle fractures > 14 days after injury does not seem to significantly affect the duration of surgery or radiation exposure.
{"title":"Delayed Internal Fixation of Distal Radius and Bimalleolar Ankle Fractures Does Not Increase Surgical Time","authors":"Amandeep Chopra, P. Hoogervorst, M. Marmor","doi":"10.2174/1874325001913010042","DOIUrl":"https://doi.org/10.2174/1874325001913010042","url":null,"abstract":"\u0000 \u0000 It is commonly believed that delay in fracture fixation of more than two weeks results in increased Surgical Time (ST), due to scar and callus formation at the fracture site. Reducing ST can lower hospital costs and decrease radiation exposure. \u0000 \u0000 \u0000 \u0000 A retrospective chart review was conducted to investigate whether early fracture care (up to 2 days after injury) results in decreased ST and radiation exposure compared to delayed fracture care (> 14 days after injury) for distal radius and bimalleolar ankle fractures. A total of 581 radius and ankle fractures that underwent surgical fixation between 2014 and 2017 were identified from the OR registry. Cases with only a single volar locking plate for the distal radius and constructs consisting of 2 medial malleolar screws, third tubular plate, and up to 1 syndesmotic screw for the ankle were included. The mean ST for distal radius cases done up to 2 days after injury was significantly greater than ST for distal radius cases done > 14 days after injury (125.78±29.75 minutes versus 105.83±24.82 minutes respectively , p=0.06). The mean ST for ankle fracture cases done less than 2 days did not differ from ST for ankle fracture cases done > 14 days after injury (140.86±28.15 minutes versus 173.22±39.98 minutes respectively, p=0.06).\u0000 \u0000 \u0000 \u0000 There was no significant difference in radiation exposure. Delaying surgery for distal radius and bimalleolar ankle fractures > 14 days after injury does not seem to significantly affect the duration of surgery or radiation exposure.\u0000","PeriodicalId":23060,"journal":{"name":"The Open Orthopaedics Journal","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89100079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-20DOI: 10.2174/1874325001913010060
G. Nazari, J. Howard, B. Lanting
Both physical and mental stress is present within the practice of healthcare professionals, which in turn negatively affects the quality of the services provided to the population and therefore, leading to mental exhaustion of the individuals involved. To track physiological and psychological responses to common hip and knee surgeries, and during clinic days, in a group of orthopaedic surgeons and their clinical fellows (trainees), and to compare the physiological and psychological results with baseline physiological stress tests. Heart Rate (HR), Breathing Rate (BR), and self-reported anxiety were recorded in 3 fellowship trained orthopaedic surgeons and 5 clinical fellows using a wearable Equivital EQO2 physiological monitor and the State-Trait Anxiety Inventory (STAI). Data was recorded for days in surgery as well as clinic for 6-8 hours/day. This data was compared to baseline physiological stress tests. Mean HR and percentage of heart rate maximum (%HR-max) were not significantly different between staff and fellows throughout the surgery days regardless of the role occupied during both primary Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). For Heart rate variability (HRV), there was no difference noted between staff and fellows at any moment around and during THA, however, fellows had significantly higher variability during TKA and maintained this increased variability in the postoperative period. In THA, staff failed to show any statistical difference between the HRV in the cases they were assuming the role of primary surgeon compared to the cases they were assisting and the clinic days. On the contrary, fellows showed significantly higher HRV when they were assisting during THA compared to when they were assuming the primary surgeon role or during their clinic days. Different stress patterns were noted in clinical fellows compared to the staff, especially showing a higher overall HRV during TKA.
{"title":"Variations in Physiological and Psychological Responses of Orthopaedic Surgeons and Clinical Fellows during Hip and Knee Arthroplasties","authors":"G. Nazari, J. Howard, B. Lanting","doi":"10.2174/1874325001913010060","DOIUrl":"https://doi.org/10.2174/1874325001913010060","url":null,"abstract":"\u0000 \u0000 Both physical and mental stress is present within the practice of healthcare professionals, which in turn negatively affects the quality of the services provided to the population and therefore, leading to mental exhaustion of the individuals involved.\u0000 \u0000 \u0000 \u0000 To track physiological and psychological responses to common hip and knee surgeries, and during clinic days, in a group of orthopaedic surgeons and their clinical fellows (trainees), and to compare the physiological and psychological results with baseline physiological stress tests.\u0000 \u0000 \u0000 \u0000 Heart Rate (HR), Breathing Rate (BR), and self-reported anxiety were recorded in 3 fellowship trained orthopaedic surgeons and 5 clinical fellows using a wearable Equivital EQO2 physiological monitor and the State-Trait Anxiety Inventory (STAI). Data was recorded for days in surgery as well as clinic for 6-8 hours/day. This data was compared to baseline physiological stress tests.\u0000 \u0000 \u0000 \u0000 Mean HR and percentage of heart rate maximum (%HR-max) were not significantly different between staff and fellows throughout the surgery days regardless of the role occupied during both primary Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). For Heart rate variability (HRV), there was no difference noted between staff and fellows at any moment around and during THA, however, fellows had significantly higher variability during TKA and maintained this increased variability in the postoperative period. In THA, staff failed to show any statistical difference between the HRV in the cases they were assuming the role of primary surgeon compared to the cases they were assisting and the clinic days. On the contrary, fellows showed significantly higher HRV when they were assisting during THA compared to when they were assuming the primary surgeon role or during their clinic days.\u0000 \u0000 \u0000 \u0000 Different stress patterns were noted in clinical fellows compared to the staff, especially showing a higher overall HRV during TKA.\u0000","PeriodicalId":23060,"journal":{"name":"The Open Orthopaedics Journal","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75570450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-31DOI: 10.2174/1874325001913010034
Kazuki Kanazawa, I. Yoshimura, Tomonobu Hagio, Takuaki Yamamoto
Minimally invasive distal linear metatarsal osteotomy is commonly performed to correct mild-to-moderate hallux valgus. The technique is easy to perform, fast, and has a low complication rate with satisfactory clinical results. However, it has so far not been applied to hallux valgus with concomitant hallux valgus interphalangeus deformity. We aimed to investigate the short-term clinical results of distal linear metatarsal osteotomy combined with Akin osteotomy in hallux valgus with concomitant hallux valgus interphalangeus deformity. We retrospectively reviewed 10 patients (10 feet) who underwent surgery for hallux valgus with hallux valgus interphalangeus between 2012 and 2016. Akin osteotomy was performed and fixated with a screw/K-wire, followed by distal linear metatarsal osteotomy and K-wire fixation. Clinical evaluations pre- and postoperatively used the Japan Society for Surgery of the Foot (JSSF) scale and the Visual Analog Scale (VAS). Radiography pre-and postoperatively assessed the hallux valgus, hallux valgus interphalangeus, and the intermetatarsal angle. The mean follow-up period was 20.2 months. Both the JSSF and VAS score improved significantly, from 64.5 to 90.0 and from 5.5 to 1.1, respectively. In all patients, bone healing was complete within four months with no osteonecrosis of the metatarsal head or malunion at the osteotomy site. The hallux valgus angle improved from 31.5° to 7.7°, the hallux valgus interphalangeus angle from 17.2° to 5.8°, and the intermetatarsal angle from 11.7° to 5.5°. Distal linear metatarsal osteotomy combined with Akin osteotomy safely and effectively corrects mild-to-moderate hallux valgus with hallux valgus interphalangeus deformity.
微创远端直线跖骨截骨术通常用于矫正轻度至中度拇外翻。该技术操作简单、快捷、并发症发生率低，临床效果满意。然而，迄今尚未应用于拇外翻合并拇外翻指间畸形。我们的目的是探讨远端跖骨直线截骨联合Akin截骨术治疗拇外翻合并拇外翻指间畸形的近期临床效果。我们回顾性分析了2012年至2016年期间接受拇外翻合并指间外翻手术的10例患者(10英尺)。行Akin截骨术并用螺钉/ k -钢丝固定，随后行远端跖骨直线截骨术和k -钢丝固定。术前和术后临床评估采用日本足部外科学会(JSSF)评分和视觉模拟评分(VAS)。术前和术后影像学评估拇外翻、拇外翻指间关节和跖间角。平均随访时间为20.2个月。JSSF和VAS评分均有显著改善，分别从64.5到90.0和从5.5到1.1。在所有患者中，骨愈合在4个月内完成，没有跖骨头骨坏死或截骨部位愈合不良。拇外翻角由31.5°提高到7.7°，拇外翻指间角由17.2°提高到5.8°，跖间角由11.7°提高到5.5°。远端跖骨直线截骨联合Akin截骨术安全有效地矫正轻、中度拇外翻伴拇外翻指间畸形。
{"title":"Distal Linear Metatarsal Osteotomy Combined with Akin Osteotomy for Hallux Valgus with Hallux Valgus Interphalangeus","authors":"Kazuki Kanazawa, I. Yoshimura, Tomonobu Hagio, Takuaki Yamamoto","doi":"10.2174/1874325001913010034","DOIUrl":"https://doi.org/10.2174/1874325001913010034","url":null,"abstract":"\u0000 \u0000 Minimally invasive distal linear metatarsal osteotomy is commonly performed to correct mild-to-moderate hallux valgus. The technique is easy to perform, fast, and has a low complication rate with satisfactory clinical results. However, it has so far not been applied to hallux valgus with concomitant hallux valgus interphalangeus deformity.\u0000 \u0000 \u0000 \u0000 We aimed to investigate the short-term clinical results of distal linear metatarsal osteotomy combined with Akin osteotomy in hallux valgus with concomitant hallux valgus interphalangeus deformity.\u0000 \u0000 \u0000 \u0000 We retrospectively reviewed 10 patients (10 feet) who underwent surgery for hallux valgus with hallux valgus interphalangeus between 2012 and 2016. Akin osteotomy was performed and fixated with a screw/K-wire, followed by distal linear metatarsal osteotomy and K-wire fixation. Clinical evaluations pre- and postoperatively used the Japan Society for Surgery of the Foot (JSSF) scale and the Visual Analog Scale (VAS). Radiography pre-and postoperatively assessed the hallux valgus, hallux valgus interphalangeus, and the intermetatarsal angle.\u0000 \u0000 \u0000 \u0000 The mean follow-up period was 20.2 months. Both the JSSF and VAS score improved significantly, from 64.5 to 90.0 and from 5.5 to 1.1, respectively. In all patients, bone healing was complete within four months with no osteonecrosis of the metatarsal head or malunion at the osteotomy site. The hallux valgus angle improved from 31.5° to 7.7°, the hallux valgus interphalangeus angle from 17.2° to 5.8°, and the intermetatarsal angle from 11.7° to 5.5°.\u0000 \u0000 \u0000 \u0000 Distal linear metatarsal osteotomy combined with Akin osteotomy safely and effectively corrects mild-to-moderate hallux valgus with hallux valgus interphalangeus deformity.\u0000","PeriodicalId":23060,"journal":{"name":"The Open Orthopaedics Journal","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74738608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-31DOI: 10.2174/1874325001913010020
Fred Rt Nelson
The authors give a comprehensive review of the wide range of bone and soft tissue disturbances resulting from both anterior and posterior shoulder dislocations wherein a defect in the humeral head often occurs [1]. They review the literature on physical examination and imaging techniques that help define the extent of the injury, acting as tools in both nonsurgical and surgical planning. In a few cases this is based on age and other demographics. There are several key concepts available for treatment planning. One is the glenoid tracking theory [2]. The theory is based on the shape and location of the humeral head defect relative to the glenoid bone and soft tissue lesions. This is supplemented by their review of the classification of Hill-Sachs lesion. This classification is based on the size and shape, but does not take into account the location of the posterior humeral head defect [3].
{"title":"Managing Bony Defects of the Shoulder Joint that Occur in Association with Dislocation","authors":"Fred Rt Nelson","doi":"10.2174/1874325001913010020","DOIUrl":"https://doi.org/10.2174/1874325001913010020","url":null,"abstract":"The authors give a comprehensive review of the wide range of bone and soft tissue disturbances resulting from both anterior and posterior shoulder dislocations wherein a defect in the humeral head often occurs [1]. They review the literature on physical examination and imaging techniques that help define the extent of the injury, acting as tools in both nonsurgical and surgical planning. In a few cases this is based on age and other demographics. There are several key concepts available for treatment planning. One is the glenoid tracking theory [2]. The theory is based on the shape and location of the humeral head defect relative to the glenoid bone and soft tissue lesions. This is supplemented by their review of the classification of Hill-Sachs lesion. This classification is based on the size and shape, but does not take into account the location of the posterior humeral head defect [3].","PeriodicalId":23060,"journal":{"name":"The Open Orthopaedics Journal","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79783518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-31DOI: 10.2174/1874325001913010022
A. Kurmis
The management of symptomatic bony digital lesions is by no means a simple task or an insignificant undertaking. While malignant lesions are routinely managed by proximal transverse resection [3] (often a relatively simple procedure) – intending to limit remote spread and mortality – management of symptomatic benign lesions can pose great clinical challenges. Specifically considering osteoid osteomas, given anatomic barriers, the inability to safely offer modern RF ablation to digital extremities steers treating clinicians towards either aggressive (and likely prolonged) symptomatic management or consideration for surgical treatment [4]. Poor tolerance and efficacy limit the former in many instances [1, 5]. While amputation can seem an ‘easy’ option, the loss of a hand digit or (especially) a border digit of the foot can have major functional ramifications [6]. Driven by ever-increasing societal expectations of enduring function [7], and a general reluctance to take up digital prosthetics [8], patients continually push us to consider local reconstructive options. These are often no mean feat. Equally, from a patient perspective, the cosmetic impact of surgical management weighs heavily [9].
{"title":"Hallux Osteoid Osteoma: A Case Report and Literature Review","authors":"A. Kurmis","doi":"10.2174/1874325001913010022","DOIUrl":"https://doi.org/10.2174/1874325001913010022","url":null,"abstract":"The management of symptomatic bony digital lesions is by no means a simple task or an insignificant undertaking. While malignant lesions are routinely managed by proximal transverse resection [3] (often a relatively simple procedure) – intending to limit remote spread and mortality – management of symptomatic benign lesions can pose great clinical challenges. Specifically considering osteoid osteomas, given anatomic barriers, the inability to safely offer modern RF ablation to digital extremities steers treating clinicians towards either aggressive (and likely prolonged) symptomatic management or consideration for surgical treatment [4]. Poor tolerance and efficacy limit the former in many instances [1, 5]. While amputation can seem an ‘easy’ option, the loss of a hand digit or (especially) a border digit of the foot can have major functional ramifications [6]. Driven by ever-increasing societal expectations of enduring function [7], and a general reluctance to take up digital prosthetics [8], patients continually push us to consider local reconstructive options. These are often no mean feat. Equally, from a patient perspective, the cosmetic impact of surgical management weighs heavily [9].","PeriodicalId":23060,"journal":{"name":"The Open Orthopaedics Journal","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86167462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-31DOI: 10.2174/1874325001913010013
M. Tyllianakis, A. Panagopoulos, K. Fokas, Argyri Eleni, P. Megas
Van Nes Rotationplasty (VNRP) is a biological reconstructive surgical method for pediatric sarcoma, complex trauma or severe lower limb deficiencies that often gets overlooked due to cosmetic reasons and psychological aspects. We report a unique case of knee stiffness and severe scarring from burns treated with this technique in a young patient who had also amputated contralateral femur. A 15-year-old boy was trapped in a fire 10 years ago and sustained extensive contractures on his left knee due to severe burns and also an above knee amputation on his right thigh. For 10 years the boy had never received rehabilitation or worn any prosthesis and he managed to move bearing mainly on his palms. On admission to our hospital Van Nes rotationplasty was preferred among other treatment options as the most suitable solution for him and was successfully performed without complications. The patient had severe stiffness on his right hip and decreased muscle power in the VNRP leg but after intensive physiotherapy he was able to stand upright and walk again using custom made bilateral prostheses and crutches. VNPR is a reasonable option in severe contractures and scarring of the knee joint.
Van Nes旋转成形术(VNRP)是一种用于儿童肉瘤、复杂创伤或严重下肢缺陷的生物重建手术方法，由于美观和心理方面的原因经常被忽视。我们报告一个独特的情况下，膝关节僵硬和严重的疤痕烧伤治疗与此技术在一个年轻的病人也切除了对侧股骨。一名15岁的男孩10年前被困在一场火灾中，由于严重烧伤，他的左膝持续严重挛缩，右大腿膝盖以上截肢。10年来，这个男孩从未接受过康复治疗，也没有戴过任何假体，他主要靠手掌来移动方位。入院时，Van Nes旋转成形术在其他治疗方案中被首选为最适合他的解决方案，手术成功，无并发症。患者右髋关节严重僵硬，VNRP腿肌肉力量下降，但经过强化物理治疗后，他使用定制的双侧假肢和拐杖能够站立并再次行走。VNPR是严重挛缩和膝关节瘢痕的合理选择。
{"title":"Rehabilitation and Prosthetic Design after Van Nes Rotationplasty of the Left Leg Due to Severe Burn Contractures in a Patient with Contralateral Amputated Right Femur: A Case Report","authors":"M. Tyllianakis, A. Panagopoulos, K. Fokas, Argyri Eleni, P. Megas","doi":"10.2174/1874325001913010013","DOIUrl":"https://doi.org/10.2174/1874325001913010013","url":null,"abstract":"\u0000 \u0000 Van Nes Rotationplasty (VNRP) is a biological reconstructive surgical method for pediatric sarcoma, complex trauma or severe lower limb deficiencies that often gets overlooked due to cosmetic reasons and psychological aspects. We report a unique case of knee stiffness and severe scarring from burns treated with this technique in a young patient who had also amputated contralateral femur.\u0000 \u0000 \u0000 \u0000 A 15-year-old boy was trapped in a fire 10 years ago and sustained extensive contractures on his left knee due to severe burns and also an above knee amputation on his right thigh. For 10 years the boy had never received rehabilitation or worn any prosthesis and he managed to move bearing mainly on his palms. On admission to our hospital Van Nes rotationplasty was preferred among other treatment options as the most suitable solution for him and was successfully performed without complications.\u0000 The patient had severe stiffness on his right hip and decreased muscle power in the VNRP leg but after intensive physiotherapy he was able to stand upright and walk again using custom made bilateral prostheses and crutches.\u0000 \u0000 \u0000 \u0000 VNPR is a reasonable option in severe contractures and scarring of the knee joint.\u0000","PeriodicalId":23060,"journal":{"name":"The Open Orthopaedics Journal","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76534782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-31DOI: 10.2174/1874325001913010008
H. Weiss, D. Turnbull
Congenital scoliosis is a three-dimensional deformity of the spine including a frontal plane deviation of the spine caused by malformations of vertebrae and ribs. Early surgery is suggested even in mild cases with formation failures in the first three years of life, although there are reports that, in this group of patients, a conservative approach might be beneficial. The purpose of this case report is to document the long-term outcomes of a patient with failures of formation and with a curve exceeding 50° over more than 20 years of his life.
{"title":"Conservative Treatment of Congenital Scoliosis – Case Report with a History of 22 Years","authors":"H. Weiss, D. Turnbull","doi":"10.2174/1874325001913010008","DOIUrl":"https://doi.org/10.2174/1874325001913010008","url":null,"abstract":"Congenital scoliosis is a three-dimensional deformity of the spine including a frontal plane deviation of the spine caused by malformations of vertebrae and ribs. Early surgery is suggested even in mild cases with formation failures in the first three years of life, although there are reports that, in this group of patients, a conservative approach might be beneficial. The purpose of this case report is to document the long-term outcomes of a patient with failures of formation and with a curve exceeding 50° over more than 20 years of his life.","PeriodicalId":23060,"journal":{"name":"The Open Orthopaedics Journal","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91365042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-31DOI: 10.2174/1874325001913010032
F. Nelson
The authors present a systematic review where 50 of 454 articles were selected on reconstruction for bone loss in both metastatic and primary proximal humerus tumors [1]. Described are a number of reconstruction options, the wide variation of patient demands for which options may be applied, and a number of neuromuscular variables. The review is not intended to be a procedural outline but is designed to show the options for post-tumor reconstruction surgery around the proximal humerus and glenoid. The undertaking of this review required members of a single center where many of these techniques are applied over time. Albeit the patient follow-up in the review is fairly long for some procedures, there is no discussion on specific management for treating more aggressive tumors or those with a high local recurrence rate. The authors do state that there are circumstances where it makes sense to pursue the simplest option with the least risk of complications. On the other hand, more complex procedures might be offered for specific anatomic scenarios along with consideration of the patient’s physical demands and tolerance for complications.
{"title":"What is the Optimal Reconstruction Option After the Resection of Proximal Humeral Tumors? A Systematic Review","authors":"F. Nelson","doi":"10.2174/1874325001913010032","DOIUrl":"https://doi.org/10.2174/1874325001913010032","url":null,"abstract":"The authors present a systematic review where 50 of 454 articles were selected on reconstruction for bone loss in both metastatic and primary proximal humerus tumors [1]. Described are a number of reconstruction options, the wide variation of patient demands for which options may be applied, and a number of neuromuscular variables. The review is not intended to be a procedural outline but is designed to show the options for post-tumor reconstruction surgery around the proximal humerus and glenoid. The undertaking of this review required members of a single center where many of these techniques are applied over time. Albeit the patient follow-up in the review is fairly long for some procedures, there is no discussion on specific management for treating more aggressive tumors or those with a high local recurrence rate. The authors do state that there are circumstances where it makes sense to pursue the simplest option with the least risk of complications. On the other hand, more complex procedures might be offered for specific anatomic scenarios along with consideration of the patient’s physical demands and tolerance for complications.","PeriodicalId":23060,"journal":{"name":"The Open Orthopaedics Journal","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82744566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-31DOI: 10.2174/1874325001913010024
E. Garcia-Rey, E. Garcia-Cimbrelo
Clinical diagnosis of infectious back and hip anatomical regions are challenging. Although the “classic” triad for iliopsoas muscle abscess was described more than a hundred years ago, it is certainly not very frequent. Despite being a rare condition, most references are cases reports in the literature, and it is not clinically suspected very often. Due to the increasing number of immunocompromised patients nowadays in most countries, like the one with malignancies, the diagnostic difficulties are increasing. Painful back and hip conditions should be considered with caution in these patients in order to prevent severe septic cases like the one presented here.
{"title":"A Devasting Course of an Iliopsoas Muscle Abscess Subsequently Leading to Septic Shock, Septic Hip Arthritis, and Extended Gluteal Soft Tissue Necroses in an Elderly Immunocompromised Patient with Multiple Carcinomas: A Case Report and Brief Review of Literature","authors":"E. Garcia-Rey, E. Garcia-Cimbrelo","doi":"10.2174/1874325001913010024","DOIUrl":"https://doi.org/10.2174/1874325001913010024","url":null,"abstract":"Clinical diagnosis of infectious back and hip anatomical regions are challenging. Although the “classic” triad for iliopsoas muscle abscess was described more than a hundred years ago, it is certainly not very frequent. Despite being a rare condition, most references are cases reports in the literature, and it is not clinically suspected very often. Due to the increasing number of immunocompromised patients nowadays in most countries, like the one with malignancies, the diagnostic difficulties are increasing. Painful back and hip conditions should be considered with caution in these patients in order to prevent severe septic cases like the one presented here.","PeriodicalId":23060,"journal":{"name":"The Open Orthopaedics Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83373675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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