Archives of orthopaedic and trauma surgery
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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
Treatment options for proximal humeral fractures in the older adults and their implication on personal independence.
No consensus exists on the optimal treatment of proximal humeral fractures (PHFx). Uncertainty about surgical treatment in the older adults using locking plates (e.g., PHILOS) has emerged, due to a high number of complications. This study aimed to assess the impact of non-operative versus operative treatment of a PHFx on the level of self-dependence in our older population. ⋯ In our study population, non-operatively treated older adults with an AO type A2, A3, B1 fracture of the proximal humerus tended to have a high chance to return to their premorbid level of independence, compared to patients treated with a locking plate. A change in the treatment algorithm for these PHFx may be carefully considered and further investigated in clinical practice.
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Arch Orthop Trauma Surg · Dec 2020
Varying development of femoral and tibial subchondral bone tissue and their interaction with articular cartilage during progressing osteoarthritis.
Differences between tibial and femoral joint surfaces and knee compartments concerning coupled bone and cartilage turnover or bone-cartilage cross talk have not been previously examined, although the mechanical and biological interaction of the mineralized subchondral tissues with articular cartilage is of great importance for advancing osteoarthritis. ⋯ Structural bone and cartilage parameter changes showed varying developments and correlations among each other in the different compartments of the knee. As a clinical conclusion, therapies to postpone or prevent cartilage degeneration by influencing the loss of mineralized bone could be site dependent.
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Excessive femoral internal torsion is an important risk factor for patellar dislocation. The aim of the present study was to estimate the effect of derotational osteotomy of the femur on the tibial tubercle trochlear groove (TTTG) distance or patellar tilt angle (PTA) and to report our clinical outcomes of recurrent patellar dislocation after femoral derotation osteotomy. ⋯ Derotational osteotomy of the femur for the treatment of recurrent patellar dislocation can achieve good clinical results, including improved TTTG distance and PTA and improved knee function.
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Arch Orthop Trauma Surg · Dec 2020
A detaching, V-shaped tibial tubercle osteotomy is a safe procedure with a low complication rate.
In patients with recurrent patellar dislocations, a tibial tubercle osteotomy (TTO) can be indicated to correct patella alta or an increased trochlear groove-tibial tubercle distance. Several surgical techniques are described. Previous studies emphasize that detaching osteotomies results in devascularisation, which can lead to non-union and tibial shaft fractures. The aim of this study was to report the complication rates directly related to the surgical technique of a V-shaped TTO, where the tubercle is completely released from its periosteum using a step-cut osteotomy. ⋯ A V-shaped TTO is a safe procedure. The presumed higher risk for tibial fractures or pseudo-arthrosis could not be confirmed.