Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Nov 2020
Regional differences in the three-dimensional bone microstructure of the radial head: implications for observed fracture patterns.
A characterization of the internal bone microstructure of the radial head could provide a better understanding of commonly occurring fracture patterns frequently involving the (antero)lateral quadrant, for which a clear explanation is still lacking. The aim of this study is to describe the radial head bone microstructure using micro-computed tomography (micro-CT) and to relate it to gross morphology, function and possible fracture patterns. ⋯ Our microstructural results suggest that the lateral side is the "weaker side", exhibiting lower bone volume faction, less trabeculae and higher trabecular separation, compared to the medial side. As the forearm is pronated during most falls, the underlying bone microstructure could explain commonly observed fracture patterns of the radial head, particularly more often involving the AL quadrant. If screw fixation in radial head fractures is considered, surgeons should take advantage of the "stronger" bone microstructure of the medial side of the radial head, should the fracture line allow this.
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New generation cephalomedullary nails are, currently, widely used for the treatment of trochanteric proximal femoral fractures. This study aims to compare the midterm outcomes and complication rates in patients with unstable 31A2 fractures treated with two different lengths of nails. ⋯ The present study comparing two lengths of the Gamma3 Nail in 31A2 fractures showed no overall differences in clinical and radiological outcomes, and complication rates. However, the use of LGN was associated with a statistically significant higher blood loss and operative time, and a tendency for increased need for transfusion, and anterior knee pain and reoperation rate. Therefore, we recommend the use of locked SGN in the treatment of 31A2 fractures.
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Arch Orthop Trauma Surg · Nov 2020
Clinical outcome and failure analysis of medial meniscus bucket-handle tear repair: a series of 96 patients with a minimum 2 year follow-up.
The failure rate of meniscal repair remains significant, especially for bucket-handle tears. This study aimed to evaluate the clinical outcomes, failure rate and risk factors for failure of bucket-handle medial meniscal tear repairs performed during ACL reconstruction. ⋯ Despite the fact that failure rate remains high for medial meniscus bucket-handle tears, suture repair of bucket-handle tears should be encouraged taking into account the long-term consequences of menisectomy.
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Arch Orthop Trauma Surg · Nov 2020
Partial resection of the infrapatellar fat pad during anterior cruciate ligament reconstruction has no effect on clinical outcomes including anterior knee pain.
Anterior knee pain (AKP) is a major complication that occurs after anterior cruciate ligament reconstruction (ACLR), even when hamstring tendon (HT) grafts are used. Damage to the infrapatellar fat pad (IPFP) during arthroscopy can cause AKP. The purpose of this study was to evaluate the influence of IPFP preservation on clinical outcomes, including AKP, in patients who underwent ACLR with HT autografts using the inside-out technique. ⋯ Level II.
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Arch Orthop Trauma Surg · Nov 2020
Observational StudyComplications of implant removal after healed hip fractures.
Osteosynthesis of pertrochanteric fractures is one of the most frequently performed procedures in orthopaedic trauma care. Auto-dynamization during fracture healing can lead to lateralization of the screw or blade. This can cause debilitating complaints, which sometimes necessitate the removal of the screw or blade. After removal of the implant, we observed spontaneous femoral neck fractures in five patients. This article presents an evaluation of these cases with reference to literature. ⋯ The clinical indications for implant removal in healed pertrochanteric fractures are not well established and should be restricted to specific cases. After removal of these implants without replacement partial weight-bearing should be advised strictly. Based on our findings it is recommended to replace the cephalomedullary nail with a shorter one, ideally combined with implant augmentation.