Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2017
Patient-specific instrumentation development in TKA: 1st and 2nd generation designs in comparison with conventional instrumentation.
This study was conducted to determine if the difference in magnetic resonance imaging (MRI)-based 2nd generation patient-specific instrumentation (PSI) design affects post-operative restoration of neutral mechanical alignment in total knee arthroplasty (TKA) compared with the 1st generation PSI design and conventional surgical techniques. In addition, it is aimed at elucidating whether PSI improves surgical efficiency with respect to operating room time, estimated blood loss and the number of instrument trays used intra-operatively. ⋯ The 1st generation PSI design did not have a shorter surgical time or improved alignment compared with conventional instrumentation (CI). However, the use of the perfectly fitted 2nd generation PSI design was associated with improvements in both of these measurements. This study emphasizes the importance of PSI design in intra-operative and post-operative outcomes of TKA.
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Arch Orthop Trauma Surg · Jan 2017
Bacterial reduction and shift with NPWT after surgical debridements: a retrospective cohort study.
Surgical debridement, negative-pressure wound therapy (NPWT) and antibiotics are used for the treatment of open wounds. However, it remains unclear whether this treatment regimen is successful in the reduction and shift of the bacterial load. ⋯ The treatment regimen of combined use of repetitive debridement, irrigation and NPWT in an operating room with antibiotics significantly reduced the bacterial load and led to a shift away from Gram-positive bacteria, facultative anaerobic bacteria, and S. aureus, as well as questionably toward CoNS and Pseudomonas spp. in this patient cohort. High rates of wound closure were achieved in a relatively short time with low revision rates. Whether each modality played a role for these findings remains unknown.
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Arch Orthop Trauma Surg · Jan 2017
Patient-specific factors influencing the traction forces in hip arthroscopy.
The application of traction in hip arthroscopy is associated with peri-operative complications. Within a therapeutic case series, patient-related factors correlating with high-traction forces during hip arthroscopy and occurring complications should be identified. ⋯ The study revealed several patient-specific risk factors correlating with high-traction forces during hip arthroscopy. With view to potential complications, these patient groups require special attention during surgical treatment as well as in future studies.
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Arch Orthop Trauma Surg · Jan 2017
Clinical and radiologic outcomes of arthroscopic suture bridge repair for the greater tuberosity fractures of the proximal humerus.
To report the clinical and radiological outcomes of arthroscopic suture bridge repair for the GT fractures of the shoulder joint. ⋯ Arthroscopic suture bridge repair was useful for the treatment of displaced GT fractures with or without comminution and the management of the combined lesions. At the final follow-up, meaningful remodeling of the GT fracture and satisfactory clinical outcomes could be achieved.
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Arch Orthop Trauma Surg · Jan 2017
Nerve supply of the subscapularis during anterior shoulder surgery: definition of a potential risk area.
The purpose of the study was to evaluate the position of the subscapular nerves relative to surgical landmarks during exposure and to analyze the pattern of innervation of the subscapularis to avoid injury during anterior shoulder surgery. ⋯ The subscapularis has a variable nerve supply, which increases the risk of muscle denervation during open shoulder surgery. Dissection or release should be avoided at the anterior aspect of the subscapularis muscle more than 1 cm medial to the musculotendinous junction. In approaches with a horizontal incision of the subscapularis, splitting should be performed at a vertical distance of 3.2-3.6 cm to the coracoid base to avoid iatrogenic subscapular nerve injuries.