Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Apr 2023
Repeat two-stage exchange arthroplasty for recurrent periprosthetic hip or knee infection: what are the chances for success?
Two-stage revision is a frequently chosen approach to treat chronic periprosthetic joint infection (PJI). However, management of recurrent infection after a two-stage exchange remains debated and the outcome of a repeat two-stage procedure is unclear. This study investigates the success rates of repeat two-stage exchange arthroplasty and analyzes possible risk factors for failure. ⋯ The success rates after repeat two-stage exchange arthroplasty are low. Patients must be counseled accordingly and different modes of treatment should be considered.
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Arch Orthop Trauma Surg · Apr 2023
Approach-related anatomical differences in patients with lumbo-sacral transitional vertebrae undergoing lumbar fusion surgery at level L4/5.
Lumbo-sacral transitional vertebrae (LSTV) are accompanied by changes in soft tissue anatomy. The aim of our retrospective study was to evaluate the effects of LSTV as well as the number of free lumbar vertebrae on surgical approaches of ALIF, OLIF and LLIF at level L4/5. ⋯ For patients with LSTV and five or four free lumbar vertebrae, the LLIF approach at L4/5 may be hindered due to a high riding iliac crest as well as anterior shift of the psoas muscle. Whereas less mobilization and retraction of the iliac veins may reduce the risk of vascular injury at this segment by ALIF and OLIF. For patients with 6LV, a lower relative height of the iliac crest facilitates lateral approach during LLIF. For ALIF and OLIF, a stronger vessel retraction due to the deeper-seated vascular bifurcation is necessary during ALIF and is therefore potentially at higher risk for vascular injury.
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Arch Orthop Trauma Surg · Apr 2023
Reverse rhino sign as a radiological sign of low-grade infected reverse shoulder arthroplasty.
Low-grade infections following shoulder surgery are difficult to diagnose. Recently, curved-shaped bony spurs, further mentioned "reverse rhino signs" because of its shape, growing inferior on the glenoid were noticed on X-rays of patients with a reverse shoulder arthroplasty (RSA) and a Cutibacterium acnes (C. acnes) infection. This study aimed to determine the sensitivity and specificity of the reverse rhino sign as a radiological marker for detecting low-grade shoulder infections in RSA. ⋯ Diagnostic level IV.
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Arch Orthop Trauma Surg · Apr 2023
Medial femoral condyle free flap for carpo-metacarpal instability following hamate comminute fracture.
Complete reconstruction of the hamate bone has been reported in the literature mostly following cancer excision or avascular necrosis. For the exiguity of the tissue deficit, bone grafting has usually been used as treatment option for its rapidity and easiness to perform, even if a variable amount of bone resorption may occur. In traumatic cases, microbial contamination may jeopardize the success of a well performed bone graft and vascularised bone grafts may represent a better reconstructive option. Here we describe the first case reported in the literature of a patient underwent complete hamate reconstruction following trauma with an osseous medial femoral condyle free flap as vascularized arthrodesis between the capitate and the 4th MTC base, in order to stabilize the 4th and 5th finger and the ulnar carpo-metacarpal joint.
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Arch Orthop Trauma Surg · Apr 2023
Nonunion of conservatively treated humeral shaft fractures is not associated with anatomic location and fracture pattern.
Humeral shaft fractures make up 1-3% of all fractures and are most often treated nonoperatively; rates of union have been suggested to be greater than 85%. It has been postulated that proximal third fractures are more susceptible to nonunion development; however, current evidence is conflicting and presented in small cohorts. It is our hypothesis that anatomic site of fracture and fracture pattern are not associated with development of nonunion. ⋯ Fracture pattern and anatomic location of nonoperatively treated humeral shaft fractures were not related to development of fracture nonunion.