Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Oct 2020
Outcomes after implementation of an open fracture clinical pathway.
Open fractures are associated with high rates of complication, morbidity and high economic costs. To improve outcomes, an open extremity fracture clinical pathway that protocolized surgical management and encouraged multidisciplinary collaboration was implemented in our institution. This study evaluates the clinical outcomes before and after the implementation of the pathway. ⋯ This study demonstrates that the implementation of an open extremity fracture clinical pathway significantly reduces the proportion of external fixation surgeries, length of hospital stay, and number of operations in patients with open tibial and femur fractures, without compromising complication rates.
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Arch Orthop Trauma Surg · Oct 2020
Randomized Controlled TrialQuadriceps tendon vs. patellar tendon autograft for ACL reconstruction using a hardware-free press-fit fixation technique: comparable stability, function and return-to-sport level but less donor site morbidity in athletes after 10 years.
The use of quadriceps tendon-patellar bone (QTB) autograft for anterior cruciate ligament (ACL) reconstruction is gaining momentum. Yet, long-term results that compare this procedure with established methods are lacking. The aim of this study was to report and compare long-term results of ACL reconstruction using QTB autografts versus bone-patellar tendon-bone (BPTB) autografts, both anchored using a hardware-free press-fit fixation technique. ⋯ Prospective and randomized, level of evidence 2.
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Arch Orthop Trauma Surg · Oct 2020
ReviewUse of allograft to reconstruct anterior bony glenoid defect in chronic glenohumeral instability: a systematic review.
Bone-block procedures are well-established in anterior chronic shoulder instability treatment. Autograft with the coracoid process (Bristow-Latarjet procedures) and iliac crest (Eden-Hybbinette) are the most frequent source of bone but the use of allograft is also possible. The objective of this review is to assess clinical and radiographic outcomes after bony allograft reconstruction in anterior glenohumeral instability. ⋯ This systematic review data suggest that allograft reconstructions in anterior glenohumeral instability could be a viable alternative to similar reconstructions with autografts and provide close clinical/radiological outcomes, at short and mid-term follow-up. Prospective randomized studies are needed to confirm these results.
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Arch Orthop Trauma Surg · Oct 2020
Review Case ReportsPrimary aneurysmal bone cyst of the scapula in adult patient: two case reports and a review of the literature.
Aneurysmal bone cyst (ABC) is a rare, benign but locally aggresive bone tumor of unknown origin tumor. It commonly affects children and usually occurs at the metaphysis of long bones. Scapula is a very rare location and ABCs of the scapula have been sparsely described in the literature. ⋯ The degree of diagnostic difficulty increases even more when an unusual tumor site has to be taken into account. Here, we describe rare and challenging cases of a primary ABC located at the scapula that was surgically treated. This is the first case report of ABC involving the scapula in adult patient.
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Arch Orthop Trauma Surg · Oct 2020
ReviewFracture fixation versus revision arthroplasty in Vancouver type B2 and B3 periprosthetic femoral fractures: a systematic review.
Hip arthroplasty (HA) is commonly performed to treat various hip pathologies. Its volume is expected to rise further due to the increasing age of the population. Complication rates are low; however, periprosthetic femoral fractures (PFF) are a rare, albeit serious, complication with substantial economic impact. While current guidelines propose revision with long-stemmed prostheses for all Vancouver B2 and B3 PFF, some recent research papers suggest that open reduction with internal fixation (ORIF) could lead to an equivalent outcome. Our aim was to summarize the evidence, elucidating under which circumstances ORIF leads to a favorable outcome after B2 and B3 PFF compared with revision surgery. ⋯ The choice of treatment modality for PFF depends on fracture, implant, and bone characteristics. Recent data show that successful outcome can be achieved without revising loose stems. ORIF may be a viable option if bone stock is adequate around uncemented or tapered polished stems with an intact cement mantle and the fracture geometry allows stable anatomic reconstruction. Conceptional considerations support this idea, but more data are needed to identify outcome predictors.