Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Apr 2012
ReviewSalvage of recurrence after failed surgical treatment of hallux valgus.
Recurrence of the deformity is unfortunately a common occurrence following surgical treatment of hallux valgus. The underlying reason for recurrence is multifactorial and includes surgeon's factor, patient's factor, and deformity components that were not addressed at the index procedure. ⋯ Successful treatment requires understanding the underlying reason for the failure of initial treatment and correcting bony alignment, restoring the joint congruity, and balancing soft tissues. We present an algorithmic approach to revision hallux valgus surgery.
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Arch Orthop Trauma Surg · Apr 2012
Clinical TrialPrecision of Ci-navigated extension and flexion gap balancing in total knee arthroplasty and analysis of potential predictive variables.
The aim of this study was to evaluate the accuracy of final limb alignment and flexion-extension and medial-lateral gap balancing in computer navigated total knee arthroplasty and to analyze various possible predictive variables that may affect the gaps in computer navigated knee arthroplasty. ⋯ Computer-assisted navigated total knee replacement allows for accurate gap balancing that is not dependent on the various pre- and intraoperative factors mentioned, including age, sex, Range of motion preoperative deformity and grade of osteoarthritis. The Ci-calculated and verified tibial, and femoral cuts are the only possible factors affecting the extension gap.
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Arch Orthop Trauma Surg · Apr 2012
Tibial tubercle advancement osteotomy with bone allograft for patellofemoral arthritis: a retrospective cohort study of 50 knees.
Forty consecutive patients (21 females and 19 males) in a single centre underwent 50 tibial tubercle advancement osteotomy procedures for patellofemoral arthritis between January 1993 and April 2007. Twenty knees with patellar maltracking also underwent medialisation of the tibial tubercle (6-12 mm) in addition to the standard 10-15 mm elevation. Femoral head bone allograft blocks were utilised in all cases, and all patients achieved bony union without further surgery. Forty-five knees had previously undergone arthroscopy, 18 with arthroscopic lateral releases. ⋯ Tibial tubercle advancement osteotomy can be an effective treatment for anterior knee pain and for patients with arthroscopic evidence of patellar chondral damage. It can provide excellent/good long-term functional results in the majority of patients, with very high satisfaction levels and sustained improvement in pain symptoms. The use of femoral head bone allograft is both effective in obtaining bony union and by definition avoids the donor-site morbidity. Knees with patellar malalignment may also undergo individualised medialisation of the tibial tubercle such that the patella lies in the centre of the femoral trochlea, and may benefit from lateral trochleaplasty surgery in the presence of trochlear dysplasia. However, the major operative complication rate is high at 12%, and fracture of the tibial tubercle is associated with a poorer outcome. One can expect 10% of operated knees to have had some clinical deterioration in the patellofemoral joint by a mean follow-up of 93 months.
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Arch Orthop Trauma Surg · Apr 2012
Virtual Bernese osteotomy using three-dimensional computed tomography in hip dysplasia.
Accurate assessment of acetabular morphology and its relationship to the femoral head is essential for planning a periacetabular osteotomy. We observed the acetabular coverage after virtual Bernese osteotomy using computer-aided technique. ⋯ Computer-aided virtual surgery technique based on three-dimensional computed tomography information enabled acetabular coverage to be quantified preoperatively in Bernese osteotomy. Lateral rotation of osteotomized acetabular fragments improved anterior and posterior coverage as well as lateral coverage.
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Arch Orthop Trauma Surg · Apr 2012
Influence of trabecular microstructure and cortical index on the complexity of proximal humeral fractures.
Poor bone quality increases the susceptibility to fractures of the proximal humerus. It is unclear whether local trabecular and cortical measures influence the severity of fracture patterns. The goal of this study was to assess parameters of trabecular and cortical bone properties and to compare these parameters with the severity of fractures and biomechanical testing. ⋯ In our study population local trabecular bone structure and cortical index could not predict the severity of proximal humeral fractures in the elderly. Complex fractures do not necessarily imply lower bone quality compared to simple fractures.