Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jul 2013
Case ReportsClosed rupture of flexor tendon by hyperextension mechanism in wrist level (zone V): a report of three cases.
Closed flexor tendon ruptures due to trauma without external wound are rare. When the flexor tendon has excessive loading, failure occurs at the tendon insertion or its origin from the bone. It is likely to result in avulsion fracture rather than rupture of the proper portion of the tendon by forceful grasping with hyperextension. ⋯ On physical examination, these patients could not flex interphalangeal joint of thumb or distal interphalangeal joint of the fifth finger. All patients underwent MRI or ultrasonography to find out the location of loss in continuity of the flexor tendons before the operation. After identifying the location, flexor tendon repair or tendon graft using palmaris longus were performed.
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Arch Orthop Trauma Surg · Jul 2013
Computed tomography assessment of lateral pedicle wall perforation by free-hand subaxial cervical pedicle screw placement.
To present the technique of free-hand subaxial cervical pedicle screw (CPS) placement without using intra-operative navigating devices, and to investigate the crucial factors for safe placement and avoidance of lateral pedicle wall perforation, by measuring and classifying perforations with postoperative computed tomography (CT) scan. The placement of CPS has generally been considered as technically demanding and associated with considerable lateral wall perforation rate. For surgeons without access to navigation systems, experience of safe free-hand technique for subaxial CPS placement is especially valuable. ⋯ Placement of screw through a correct trajectory may lead to grade 1 perforation, which suggests transversal expansion and breakage of the thinner lateral cortex, probably caused by mismatching of the diameter of 3.5 mm screws and the tiny cancellous bone cavity of pedicle. Grade 1 perforation is deemed as relatively safe to the vertebral artery. Grade 2 perforation means obvious deviation of the trajectory angle of hand drill, which directly penetrates into the transverse foramen, and the risk of vertebral artery injury (VAI) or development of thrombi caused by the irregular blood flow would be much greater compared to grade 1 perforation. Moreover, there are two crucial maneuvers for increasing accuracy of screw placement: identifying the precise entry point using a curette or hand drill to touch the true entrance of the canal after decortication, and guiding CPS trajectory on axial plane by the resistant of thick medial wall.
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Arch Orthop Trauma Surg · Jul 2013
Case ReportsHeterotopic ossification in portal sites following hip arthroscopy.
Heterotopic ossification (HO) is a well-known condition that usually occurs after head trauma, burns and open surgical procedures, most commonly around the hip and elbow joints. It is a well-documented complication occurring after open hip surgery; however, there exists limited information regarding its prevalence and clinical importance following hip arthroscopy. We report a case of symptomatic HO formation in portal sites following arthroscopic rim decompression, femoroplasty and labral debridement that was successfully treated with arthroscopic removal.
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Arch Orthop Trauma Surg · Jul 2013
Return to play following ACL reconstruction: survey among experienced arthroscopic surgeons (AGA instructors).
There is a lack of consensus regarding appropriate criteria attesting patient's unrestricted sports activities after ACL reconstruction. The purpose of this study was to perform a survey among experienced arthroscopic surgeons regarding their return to play guidelines in these patients. ⋯ In conclusion, the majority of surgeons do not consider muscle function, jump tests, alignment tests, and proprioception as relevant return to sports criterion. However, these are two crucial parameters for return to sports.
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Arch Orthop Trauma Surg · Jul 2013
Comparative StudyFixation of supracondylar femoral fractures following total knee arthroplasty: is there any difference comparing angular stable plate fixation versus rigid interlocking nail fixation?
Literature does not provide any reliable comparison between angular stable plate fixation and rigid nail fixation for stabilization of supracondylar periprosthetic femoral fractures. Thus, the purpose of this study was to compare these two implants in clinical practice relating to fracture healing, functional results and treatment-related complications. ⋯ Sixty-four (76 %) patients returned to their pre-injury activity level and were satisfied with their clinical outcome. We had an overall Oxford outcome score of 2.21, with patients following angular stable plate fixation of 2.22, and patients after rigid nail fixation of 2.20. Successful fracture healing within 6 months was achieved in 74 (88 %) patients. Comparing between plate fixation and nail fixation, statistical analysis did not reveal any significant differences. Overall, we had a relatively high rate of fracture healing and a satisfactory functional outcome with both implants. Both methods of fixation showed similar results relating to the functional outcome and individual satisfaction of the patients. However, with regards to fracture healing and treatment-related complications, intramedullary nail fixation showed slight advantages.