Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2020
Case ReportsBowing-head sign: rare but detectable in pre-catastrophic hip implant failure.
Recently, catastrophic failure (i.e., dissociation between the metal femoral head and stem due to stem neck deformation) after total hip arthroplasty (THA) has been reported. Early detection of this complication is very important, because it is accompanied by an increased cobalt concentration in the body, which might influence systemic conditions such as heart failure and immune system diseases. However, early detection of stem neck deformation is considered as difficult. ⋯ Laboratory data showed abnormal serum cobalt (6.3 μg/L, normal < 1 μg/L) and chromium (3.8 μg/L, normal < 5 μg/L) levels. Considering those radiographic findings, deformation of the stem neck due to trunnionosis was diagnosed, and elective revision surgery was performed without any complications. Plain radiographs after THA should be assessed with attention to this complication, 'Bowing-head sign' must not be overlooked.
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Arch Orthop Trauma Surg · Dec 2020
Case ReportsCan an acute high-grade acromioclavicular joint separation be reduced and stabilized without surgery? A surgeon's experience.
While the management of Rockwood type III injuries is still a topic of debate, high-grade Rockwood type V injuries are mostly treated surgically, to anatomically reduce the acromioclavicular (AC) joint and to restore functionality. In this case report, we present a method for non-operative reduction and stabilization of a high-grade AC joint injury. ⋯ Non-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option. A "closed reduction and external fixation" approach with the aid of a dedicated AC joint brace can reduce the AC joint and keep it in place until ligamentous consolidation occurs, thus improving AC joint stability and cosmetic appearance without surgical intervention.
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Arch Orthop Trauma Surg · Dec 2020
Higher doses of topical tranexamic acid safely improves immediate functional outcomes and reduces transfusion requirement in total knee arthroplasty.
Topical administration of tranexamic acid (TXA) in patients undergoing total knee arthroplasty (TKA) is increasingly popular as it avoids the risks related with systemic absorption of the medication. Previous studies have established the efficacy of TXA in TKA, however here are limited direct comparison studies available and the dosing regimens vary. Hence, there is no consensus on an optimal dose. Our objective is to compare blood loss, transfusion requirement and immediate post-operative function between high (2 g) and low (1 g) dose tranexamic acid in patients undergoing TKA. ⋯ Higher dose of topical TXA is safe, helps improve immediate post-operative functional outcomes and reduces transfusion requirements.
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Arch Orthop Trauma Surg · Dec 2020
A cadaveric morphometric analysis of coracoid process with reference to the Latarjet procedure using the "congruent arc technique".
Congruent arc Latarjet procedure involves rotating the coracoid process so that its inferior surface is flush with the glenoid face, owing to their matching radius of curvature (ROC). However, there has been no cadaveric study to actually measure and compare the ROC of coracoid with glenoid, especially in Indian population. ⋯ The available length as well as height of the transferred coracoid must be considered when deciding optimum diameter fixation screws in Latarjet procedure. Owing to smaller anatomic dimensions of coracoid in Indian population, 2.7-mm screws provide the safest fixation option. Also, the ROC of coracoid and glenoid does not match in substantial proportion of the cadavers. Pre-operative planning should include a CT-based assessment of glenoid and coracoid dimensions to decide the technique of Latarjet procedure and the optimum diameter fixation screws required.
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Arch Orthop Trauma Surg · Dec 2020
Preoperative patellofemoral anatomy affects failure rate after isolated patellofemoral inlay arthroplasty.
To analyze whether preoperative patellofemoral anatomy is associated with clinical improvement and failure rate after isolated patellofemoral arthroplasty (PFA) using a modern inlay-type trochlear implant. ⋯ Level III, retrospective analysis of prospectively collected data.