Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jul 2011
Case ReportsIsolated fractures of the teardrop of the acetabulum.
Fractures of the teardrop are very rare. We would like to present two patients with a fracture of the teardrop. The teardrop is a radiological entity, also known as the U figure. It can be seen on the antero-posterior as well as on the obturator oblique radiographs of the pelvis. It is one of the six fundamental radiographic reference lines corresponding to anatomical landmarks, which Letournel introduced for the evaluation of acetabular fractures. Injuries of the hip joint may include pure hip dislocations, dislocations with fracture of the femoral head, dislocations with fracture of the acetabulum, or both. The position of the femoral head in relation to the acetabulum and the vector of the force at the time of impact determine the type of injury produced. Dislocation of the hip can be classified as posterior, anterior, obturator, or central. Anterior dislocations of the hip are uncommon and constitute 10-15% of traumatic hip dislocations. Anterior dislocations are classified according to the position assumed by the femoral head: pubic, obturator, or perineal. In obturator dislocations, the femoral head can cause a fracture of the infero-medial margin of the acetabulum-the teardrop. ⋯ An isolated fracture of the teardrop is very rare. The typical injury mechanism consists in an anterior subluxation or luxation of the femoral head needing hip reduction on an emergency basis. The fracture of the teardrop itself can be treated non-operatively with a perfect functional result, because the infero-medial localization of the fracture does not impair the containment or congruity of the hip joint. In case of a painful or displaced fragment of the teardrop interfering with hip joint mobility, fragment removal may be indicated. In case of an associated supero-lateral femoral head fracture, the fragment can either be internally fixed or debrided depending on its size and fragmentation.
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Arch Orthop Trauma Surg · Jul 2011
Review Comparative StudyTo retain or remove the syndesmotic screw: a review of literature.
Syndesmotic positioning screws are frequently placed in unstable ankle fractures. Many facets of adequate placement techniques have been the subject of various studies. Whether or not the syndesmosis screw should be removed prior to weight-bearing is still debated. In this study, the recent literature is reviewed concerning the need for removal of the syndesmotic screw. ⋯ There is paucity in randomized controlled trials on the absolute need for removal of the syndesmotic screw. However, current literature suggests that it might be reserved for intact screws that cause hardware irritation or reduced range of motion after 4-6 months.
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Arch Orthop Trauma Surg · Jul 2011
Comparative StudyRepeated percutaneous vertebroplasty for refracture of cemented vertebrae.
Percutaneous vertebroplasty is an efficient procedure to treat painful osteoporotic vertebral compression fractures. However, refracture of cemented vertebrae occurs rarely after percutaneous vertebroplasty. This study was undertaken to investigate the incidence, characteristics, predisposing factors, and mistakes in technique associated with refracture of the same vertebra after percutaneous vertebroplasty. ⋯ Our study suggests that larger height restoration and solid lump filling cement are risk factors of refracture of cemented vertebral bodies. Symmetric cement distribution and fluid aspiration would be the potential ways to avoid refracture of cemented vertebral bodies.
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Arch Orthop Trauma Surg · Jul 2011
Comparative StudyOutcome after operative treatment of Vancouver type B1 and C periprosthetic femoral fractures: open reduction and internal fixation versus revision arthroplasty.
The rate of periprosthetic femoral fractures after hip arthroplasty is rising and the estimated current lifetime incidence is 0.4-2.1%. While most authors recommend revision arthroplasty in patients with loose femoral shaft components, treatment options for patients with stable stem are not fully elucidated. ⋯ The use of angular stable implants, additional cable wires or bone enhancing means is recommended.
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Arch Orthop Trauma Surg · Jul 2011
Arthroscopically assisted percutaneous osteosynthesis of displaced transverse patellar fractures with figure-eight wiring through paired cannulated screws.
For treatment of displaced transverse patellar fractures, open reduction and internal fixation is the standard reconstructive method. The role of percutaneous osteosynthesis is still unclear and worth of further investigation. Our hypothesis is that satisfactory reduction and rigid fixation is possible for the treatment of displaced transverse patellar fractures with some percutaneous techniques. Here, we present and evaluate a minimally invasive technique for these patellar fractures. ⋯ Under the control of arthroscopy and fluoroscopy, we successfully treated 21 displaced transverse patellar fractures by percutaneously osteosynthesis. This is a safe and reproducible method for transverse patellar fractures. However, it is not indicated for severely comminuted fractures.