Acta orthopaedica Belgica最新文献

Compartment syndrome of the thigh and a pseudoaneurysm of the arteria profunda femoris are rare entities that usually occur independently. Untreated, both can lead to life-threatening complications making prompt diagnosis and management mandatory. The diagnosis of an acute compartment syndrome can be suspected clinically, and subsequently needs to be confirmed by intra-compartmental pressure measurement. Treatment should be done by urgent fasciotomy within 6 hours. A pseudoaneurysm can also be suspected clinically. Various imaging modalities exist to confirm the diagnosis, with duplex ultrasound being the diagnostic test of choice. Treatment is depending on the importance of clinical symptoms and on the size of the pseudoaneurysm. We present the first case in which an acute compartment syndrome of the thigh was complicated by a pseudoaneurysm of the arteria profunda femoris. The pseudoaneurysm was subsequently complicated by hemorrhage and infection.

Liner dissociations are rare but catastrophic complications after THA, requiring revision surgery. Although this complication has been well documented in THA with modular components, it has been rarely described in preassembled designs. In this report we present a rare case of liner dissociation in a ceramic-on-ceramic pre-assembled cup design. A 41-year-old man who received THA seven years ago, presented with sudden pain in the hip. Radiographic examination confirmed a small dissociation of the liner component in the acetabular shell, as well as radiolucency between the acetabular shell and the ceramic liner, and pneumarthrosis. Revision surgery was carried out six weeks following the liner dissociation. To make an accurate diagnosis, orthopaedic surgeons must be aware of the symptoms of liner dissociation.

The aim of the study was to evaluate a modified direct lateral approach for total hip arthroplasty in terms of clinical and functional outcomes, rate of complications and hospitalization. We retrospectively reviewed the data of 526 patients with THA operated in our department between January 2017 and December 2021. Clinical examination, functional outcome and radiographic evaluation were performed during follow-up. Patients were evaluated at the following time points: preoperatively and postoperatively at 3 days, 6 weeks, 12 weeks and 1 year and we registered surgery related data, complications, Visual Analogue Scale pain score, Harris Hip Score, the Western Ontario McMaster Osteoarthritis Index. Low intraoperative blood loss, short operation time, short hospitalization, early mobilization of the patient and good range of motion imposed the modified direct lateral approach as a valuable procedure for the patients with THA. VAS score evaluated at 3 days and 6 weeks indicated a very good overall postoperative experience. The HHS and Womac scores were evaluated at 6 weeks, 12 weeks and 1 year and showed excellent results. Trendelenburg gait and abductor weakness, traditionally related with direct lateral approach, were not significant statistically and complete reversible. We registered a very low complication rates with good functional outcome. The modified direct lateral approach can lead to superior outcomes, improved quality of life, with reduced intra and postoperative complications rate.

Peri-prosthetic infection (PJI) represents one of the most devastating complications of total hip arthroplasty (THA). The aim of this study is to assess the reliability of different PJI risk assessment scales between two matched pairs of THA groups. This study included 37 patients with PJI following THA performed between 2012 and 2020 (Group A). Each patient in this group was matched, based on sex, age, and follow-up duration, with a control patient who underwent the same surgical procedure without any septic complications (Group B) during the same period. Each patient's assessment included the American Society of Anesthesiologists (ASA) score and a retrospective evaluation using three different preoperative, specific PJI risk assessment scales: the International Consensus Meeting (ICM) Preoperative Risk Calculator for PJI, the Mayo PJI Risk Score, and the KLIC-score. The two groups were statistically compared using descriptive analyses, both for binomial data and numerical variables. Statistically significant higher values were observed in the preoperative ASA score and surgical time in Group A. Statistically different higher scores were determined only with the ICM risk calculator score in Group A. No significant differences were found using the KLIC score and Mayo score between the two groups. We emphasize the reliability of the ASA score as a nonspecific preoperative assessment scale for PJI. The ICM risk calculator was confirmed as a reliable, specific preoperative assessment scale for PJI, suggesting its routine adoption in THA clinical practice.

This study aimed to describe a surgical procedure for the management of corticosteroid-induced osteonecrosis of the femoral head (ONFH) and report its clinical results. The technique included harvesting a bone plug from the lateral femoral neck, core decompression, and bone marrow aspirate concentrate (BMAC) application; the procedure was completed by press-fit insertion of the autologous bone plug in the debrided area. Autologous bone plug-sliding with core decompression and bone marrow concentrate aspirate application provides good clinical outcomes in the management of ONFH. A retrospective review was performed using records of patients operated on between October 2019 and June 2021. Only patients with Ficat-Arlet stage-2 ONFH, who underwent the procedure described, were included. Twenty- nine hips (18 patients) were included and evaluated clinically and radiologically. Clinical evaluation included the Harris hip score (HHS) and Visual analogue scale (VAS) for pain, while radiological evaluation included direct radiographs. The average age was 39.8 years (± 11.7, range: 24-65 years). The average follow-up was 13.5 months (± 3.4, range: 8-19 months). There were improvements in the VAS pain and Harris hip scores in all patients. Average HHS increased from 61.90 to 87.45 (p < 0.001), while the average VAS pain score decreased from 7.14 to 3.27 (p < 0.001). No complications were encountered in any of the patients during the follow-up. None of the patients had femoral head collapse on the latest radiograph or required total hip replacement. The combination of the novel autologous bone plug-sliding method with conventional regenerative methods is a successful treatment choice for ONFH.

The use of personal protective equipment (PPE) can significantly reduce staff exposure to harmful radiation and infection. Fluoroscopic procedures in orthopaedic theatre can generate high levels of radiation and good adherence to PPE use is essential to reduce long term cancer risk, including thyroid cancer. To assess baseline compliance with PPE, availability of PPE in theatre and carry out an intervention to promote greater use of PPE. This was a closed-loop interventional study set in a level 1 trauma centre and an elective/rehabilitation unit. Data were collected in 40 cases pre and post-intervention from 26th May-7th July 2017. All health care practitioners present at fluoroscopic screening were observed. PPE availability was audited daily. A questionnaire was used to assess surgical and nursing knowledge/practices regarding radiation/infection safety. An educational presentation was delivered to the groups at highest risk of exposure. 39/41 questionnaires were completed (29 surgeons, 10 nurses). 41% of respondents had taken a radiation training course or felt they had adequate training. There was a significant increase in the use of thyroid guards by surgeons 13/115 (11.3%) pre-intervention to 54/117 (46.2%) post-intervention (p<0.001) and radiographers (p=0.019) post-intervention. Logistic regression showed an 89.7% increased likelihood of thyroid guard use post-intervention and a 12.7% increased chance of thyroid guard use for each extra guard available. A short educational, easily replicated session, significantly improved compliance with thyroid guards by orthopaedic surgeons.

Female underrepresentation in Orthopedic Surgery and Traumatology is a well-known issue worldwide, including in Belgium. Most of the literature comes from northern America. This two-part study aims to quantify the female workforce in orthopedic surgery in Belgium and assess the presence of unconscious biases among active orthopedic surgeons. Epidemiological data from national registries, orthopedic societies and universities in Belgium were analyzed. This included data on medical students, residents, active orthopedic surgeons and awards given by a Belgian orthopedic society. Additionally, a questionnaire was administered to Belgian orthopedic surgeons, assessing their perceptions of gender stereotypes and potential unconscious biases. 90 participants responded with 70% of men and mean age was 36 years old. The data revealed that 12% of active orthopedic surgeons in Belgium were women in 2020. However, the representation f women was higher among residents, with a thirty percent distribution. In one university, women had a slightly higher chance of getting accepted in the orthopedic training then men. The questionnaire results indicated the presence of unconscious bias regarding subspecialties, which aligned with the actual distribution. Women tend to specialize more in upper limb surgery and pediatrics while men focus more frequently on lower limb surgery. The findings highlight the need for addressing the underrepresentation of women in orthopedic surgery and traumatology in Belgium. If the current rate of progress continues, it is projected that 30% of active orthopedic surgeons will be female by the year 2074. Identifying and addressing factors contributing to the underrepresentation, such as lack of mentorship, unconscious biases, visibility issues, and discrimination, is crucial for empowering future female orthopedic surgeons and fostering diversity in the field. Collaboration among European universities and orthopedic societies can play a vital role in reducing barriers and promoting gender equality in orthopedic surgery and traumatology.

The study aimed to evaluate the outcomes of osteonecrosis of the femoral head (ONFH) in adults after surgical treatment including invasive electromagnetic osteostimulation (E-Stim). Further, the influence of disease stage and several comorbidities on the joint preservation rate should be examined. Sixty patients (66 hip joints) with ONFH were included in this retrospective cross-sectional analysis (mean follow-up: 58 months, 19-110 months). Potential ONFH risk factors and comorbidities (ONFH stage, age, sex, alcohol, smoking, cortisone medication, chemotherapy) were recorded. The influence of specific parameters on the joint preservation rates was evaluated by a multivariate logistic regression analysis. Finally, patients with preserved hip joints underwent an assessment of their last available X-rays. The joint preservation rate depended on the initial ONFH Steinberg stage (I+II: 82.8%, III: 70.8%, ≥ IVa: 38.5%). Initially collapsed ONFH (p ≤ 0.001) and cortisone therapy (p = 0.004) significantly decreased the joint preservation rates. In case of progressed ONFH, the presence of ≥ 2 risk factors resulted in higher THA conversion rates (stage III: OR 18.8; stage ≥IVa: OR 12). In 94% of the available X-rays, the ONFH stage improved or did not progress. No complications could be attributed to the E-Stim device or procedure. The present surgical protocol including minimally invasive E-Stim revealed high joint preservation rates for non-collapsed ONFH after mid-term postoperative follow-up. Especially in progressed ONFH, the-risk profile seems to be crucial and hence, for joint preserving surgery, careful patient selection is recommended.

The purpose of this study is to assess the clinical significance of the radiologic safe zone based on computed tomography and to compare the outcomes of three different implants for fixation of isolated radial head fractures. We retrospectively reviewed 367 patients who underwent internal fixation for isolated radial head fractures. We newly defined two subtypes of Mason type II fractures associated with the radiographic safe zone (IIA, two-part fracture allowing for safe fixation of plate; IIB, two-part fracture not allowing for safe fixation). 170 patients (CCS group, n = 82; HCS group, n = 31; plate group, n = 57) were investigated with no significant differences in demographics. The range of pronation and supination at 1 month postoperatively (P = 0.04 and P = 0.04) and the range of supination at 6 and 12 months postoperatively (P = 0.03 and P = 0.03) were significantly smaller in the plate group. In Mason type IIB fractures, the average MEPS was higher in the CCS and HSC groups than in the plate group (P = 0.01 and P = 0.02). And the average DASH score was lower in the CCS and HCS groups (P < 0.01 and P < 0.01). Evaluation of the radiologic safe zone is potentially helpful in selecting better surgical fixation option. For type III fractures, 2.3-mm cortical screws would be a better option than Acutrak screws. Plates would not be suitable for type IIB radial head fractures.

Treatment of fibular fractures associated with extra-articular distal tibia fractures is technically challenging and the purpose of this study was to evaluate the use of intramedullary nail fixation of fibular fractures when associated with this fracture. Between January 2018 and December 2021, 33 patients presenting extra-articular distal tibia fractures and fibular fractures (AO/OTA 43A) were treated. Clinical and radiological data were collected during routine postoperative follow-ups. Thirty-one patients were monitored for a period of time ranging from 12 to 23 months, with an average follow-up of 17.5 ± 3.3 months. Fibular bone union took an average of 3.6 ± 0.9 months. At the last follow-up, the average fibular alignment and postoperative ankle talocrural angles were 1.8° and 9.1°, respectively. No detectable radiographic rotational malalignment and serious complications related to the fibular incision was observed. The average AOFAS and OMAS scores at the most recent follow-up were 88.3 ± 6.2 and 87.4 ± 6.0, respectively. Intramedullary nail fixation worked well to keep the fibula in place in fibular fractures connected to extra-articular distal tibia fractures.