Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Aug 2016
Atrophic, aseptic, tibial nonunion: how effective is modified Judet's osteoperiosteal decortication technique and buttress plating?
Tibial nonunion is the most common nonunion encountered by the orthopedic surgeon. Repeated surgeries, cost, increased duration of hospital stay, disability, pain all contribute to the increased morbidity. Many methods have been used to treat nonunion of tibia with variable results and none of them are 100 % successful. Our objective was to determine the effectiveness of modification of Judet's decortication technique and buttress plating, without bone graft, in the treatment of aseptic, atrophic tibial nonunion. Also, to find the correlation between time of achieving union and time since injury to decortication. ⋯ Level II.
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Arch Orthop Trauma Surg · Aug 2016
Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery.
Pedicle screw fixation is the standard technique for the stabilization of the spine, a clinically relevant complication of which is screw loosening. This retrospective study investigates whether preoperative CT scanning can offer a predictor of screw loosening. ⋯ The determination of bone density with preoperative CT scanning can predict the risk of screw loosening and inform the decision to use cement augmentation to reduce the incidence of screw loosening.
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Arch Orthop Trauma Surg · Aug 2016
The cortical irregularity in the transition zone of the radial head and neck: a reliable radiographic sign of an occult radial head fracture.
Exclusion or detection of non-displaced radial head fractures can be difficult in radiographs, because they might lack conclusive radiographic signs, such as fracture lines or distracted articular fragments. Based on the typical injury mechanism of a radial head fracture, causing the head to hit the capitulum and leading to a depression of the anterolateral border of the radial head, we hypothesized that even slight cortical irregularities in the transition zone of the radial neck and head result from that depression and may be a reliable radiographic sign of an underlying radial head fracture. Secondarily, we tested the null hypothesis that the lack of cortical irregularities is sufficient to exclude a fracture of the radial head. ⋯ A cortical irregularity in the transition zone of the radial neck and head seems to be a reliable radiographic sign of an underlying radial head fracture. The absence of the cortical irregularity can be used to correctly identify a non-fractured radial head.
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Arch Orthop Trauma Surg · Aug 2016
Overestimation of femoral tunnel length during anterior cruciate ligament reconstruction using the retrograde outside-in drilling technique.
When the femoral tunnel socket is reamed in an oblique direction from the wall of inter-condylar notch in anterior cruciate ligament (ACL) reconstruction, the tunnel length can be shorter at the periphery than at the centre. Because surgeons can manipulate the direction of tunnel in the outside-in femoral tunnel drilling technique, this length mismatch would vary depending on the direction of the tunnel. The purpose of this study was to investigate this length mismatch when reamed in various directions. ⋯ When the drilling entry point is set far away from the lateral epicondyle, a significant increase was observed in tunnel length mismatch between the centre of the tunnel and its shortest peripheral side. Because the tunnel length is measured with a guide pin introduced at the centre of the tunnel before reaming in retrograde outside-in technique, this length mismatch could cause an overestimation of the tunnel length. Surgeons should recognise this mismatch when preparing the length of graft and socket to optimise the graft insertion length into the socket.
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Arch Orthop Trauma Surg · Jul 2016
Randomized Controlled Trial Multicenter StudyEvaluating the potential synergistic benefit of a realignment brace on patients receiving exercise therapy for patellofemoral pain syndrome: a randomized clinical trial.
It has been previously shown that exercise programs for patellofemoral pain syndrome (PFPS) can be supported by medially directed taping. Evidence supporting the use of patellar braces is limited because previous studies have been low quality. The aim of this study is to compare the outcomes of patients with PFPS after treatment with a medially directed patellar realignment brace and supervised exercise. ⋯ The use of a medially directed realignment brace leads to better outcomes in patients with PFPS than exercise alone after 6 and 12 weeks of treatment. After 1 year of follow-up this positive effect diminished.