Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Feb 2023
ReviewRib fractures in the elderly population: a systematic review.
Multiple rib fractures are associated with significant morbidity and mortality, especially in elderly patients. There is growing interest in surgical stabilization in this subgroup of patients. This systematic review compares conservative treatment to surgical fixation in elderly patients (older than 60 years) with multiple rib fractures. The primary outcome is mortality. Secondary outcomes include hospital and intensive care length of stay (HLOS and ILOS), duration of mechanical ventilation (DMV) and pneumonia rates. ⋯ It remains unknown to what extent conservative and operative treatment contribute individually to reducing morbidity and mortality in the elderly with multiple rib fractures. To date, the quality of evidence is rather low, thus well-performed comparative observational studies or randomised controlled trials considering all confounders are needed to determine whether operative treatment can improve a patient's outcome.
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Arch Orthop Trauma Surg · Feb 2023
Review Meta AnalysisTendon transfer in foot drop: a systematic review.
Foot drop is a disorder that impairs walking and leads to tripping and falling. Tendon transfer (e.g., tibialis posterior tendon) is a typical secondary procedure in foot drop treatment. The purpose of this systematic review was to identify the most common tendon transfer techniques for treating foot drop and to analyze the reported functional outcomes. Furthermore, it was of interest if the type of surgical technique affects the functional outcome. ⋯ Due to various outcome measures and lack of preoperative assessment in the included studies, a meta-analysis of the pooled results was not possible. Nevertheless, the findings of this study show that tendon transfer increases mobility and self-independency leading to patient satisfaction. The choice of the surgical technique does not affect the outcome. A prospective collection of patient data and standardized outcome measures will be important to further analyze the efficacy of tendon transfer techniques.
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Arch Orthop Trauma Surg · Feb 2023
Diagnostic utility of open biopsy in patients with two culture-negative aspirations in the diagnostic work-up of periprosthetic joint infection.
Different approaches have been proposed for bacterial identification in patients with a suspected periprosthetic joint infection (PJI). If a one-stage procedure is considered, a higher rate of preoperative bacterial identification can be achieved if biopsy is included in the diagnostic work-up. The performance of open biopsy (OB) in the context of PJI has not been clearly determined yet. The purpose of this study was to determine the value of an OB added to two consecutive culture-negative joint aspirations during PJI workup. ⋯ The OB is a valuable resource if preoperative synovial fluid cultures are negative, a high suspicion of infection persists and a one-stage procedure is preferred. It intends bacteria identification and allows surgeons to evaluate prosthetic complications for further surgical procedures.
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Arch Orthop Trauma Surg · Feb 2023
A windows technique for sustentaculum tali screw fixation using the sinus tarsi approach for calcaneal fractures: a cadaveric study.
The minimally invasive approach for displaced intra-articular calcaneal fractures is significantly reducing postoperative wound complications. One minimally invasive method, the sinus tarsi approach (STA) has been increasingly widely used. STA is, however, challenging due to its technical demands and the risk of injury to the sural nerve (SN). The purpose of this study was to identify the SN and its branches including their anatomical relationship to the STA as well as to describe an anatomical windows technique for STA including determination of the safe angle for screw insertion into the sustentaculum tali fragment. ⋯ The distal window is the safest for surgical approach and for calcaneal surgery screw fixation in terms of avoiding sural nerve injury. In addition, that window provides a wide working angle for screw fixation.
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Arch Orthop Trauma Surg · Feb 2023
Long-term results of Bernese periacetabular osteotomy using a dual approach in hip dysplasia.
We report the long-term results of Bernese periacetabular osteotomy using a dual approach in hip dysplasia. Fifty-three hips (49 patients, mean age 39.9 years: 13-62 years; bilateral hips: four patients) that underwent periacetabular osteotomy using a dual approach (combined Smith-Peterson and Kocher-Langenbeck techniques) between May 1997 and December 2005 were analyzed in this study. The clinical and radiologic outcomes and complications were analyzed and the final survival rates of the operated hips were investigated with survival analysis curves. ⋯ One patient developed an avulsion fracture of the anterior superior iliac spine, and none of the cases had an infection or permanent neurologic damage. Kaplan-Meier analysis revealed that the 10-year survival rate was 93% (95% confidence interval [CI] 81-98%) with arthroplasty as the endpoint and 86% (95% CI 70-91%) with the progression of osteoarthritis based on Tönnis osteoarthritis rating as the endpoint. Based on the outcomes of a long-term follow-up of more than 10 years on average, Bernese periacetabular osteotomy via a dual approach was found to be a satisfactory method for lowering the incidence of complications while preserving hips.