Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2015
Is the cortical thickness index a valid parameter to assess bone mineral density in geriatric patients with hip fractures?
Reduced bone quality is a common problem during surgical fixation of geriatric hip fractures. The cortical thickness index (CTI) was proposed to assess the bone mineral density (BMD) of the proximal femur on the basis of plain X-rays. The purpose of this study was to evaluate the inter- and intraobserver reliability of the CTI and to investigate correlation between CTI and BMD in geriatric patients. ⋯ The CTI has sufficient reliability for the use in daily practice. It showed significant correlation with BMD in patients without hip fractures. In patients with proximal femoral fractures, no correlation between CTI and BMD was found. We do not recommend the CTI as parameter to assess the BMD of the proximal femur in geriatric patients with hip fractures.
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Arch Orthop Trauma Surg · Jun 2015
Case ReportsConservative treatment after failure of internal fixation for periprosthetic femoral fractures: a report of two cases.
Osteosynthesis using compression or locking plate following indirect fracture reduction and using a minimally invasive technique has been recommended for the surgical treatment of Vancouver B1 and C periprosthetic femoral fractures. Recent advancements in fracture healing emphasize the significance of the type of mechanical stability depending on fracture patterns and the importance of the preservation of the blood supply around the fracture sites. ⋯ Bone healing was successfully achieved in both cases as a result of the preservation of the tissues and the biology around the fractures during the initial operations. We present our experiences of conservative management together with the preservation of the biology around the fracture site, as viable alternative options for difficult and traumatic revision surgery in cases of failed periprosthetic fracture fixation procedures.
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Posterior-stabilized (PS) and cruciate-retaining (CR) total knee arthroplasties (TKA) are both successfully used for treatment of end-stage osteoarthritis. The choice of constraint depends on knee deformity and stability as well as most importantly surgeon preference. The aim of this study was to compare the amount of blood loss and required transfusions following TKA with the two different designs. ⋯ The blood loss was significantly higher in the PS group. This may be due to the box preparation that exposes more cancellous femoral bone, which may add to postoperative bleeding. The differences remain, however, small, as they did not lead to a significantly higher transfusion rate with PS TKA.
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Arch Orthop Trauma Surg · Jun 2015
Case ReportsBilateral locked anterior shoulder dislocation in a bench-pressing athlete: case report.
Chronic bilateral anterior shoulder dislocation is a rare entity. Treatment options range from conservative to surgical reduction. ⋯ Upon presentation, the patient had no pain with functional range of motion so he refused surgery. Conservative treatment could be an acceptable alternative to surgical intervention if pain and functional status are satisfactory.
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Arch Orthop Trauma Surg · Jun 2015
Case ReportsEvaluation and analysis of graft hypertrophy by means of arthroscopy, biochemical MRI and osteochondral biopsies in a patient following autologous chondrocyte implantation for treatment of a full-thickness-cartilage defect of the knee.
Graft hypertrophy represents a characteristic complication following autologous chondrocyte implantation (ACI) for treatment of cartilage defects. Although some epidemiological data suggest that incidence is associated with first-generation ACI using autologous chondrocyte implantation, it has also been reported in other technical modifications of ACI using different biomaterials. Nevertheless, it has not been described in autologous, non-periosteum, implant-free associated ACI. ⋯ No expression of collagen type X (a sign of chondrocyte hypertrophy), only slight changes of the subchondral bone and a nearly normal cell-matrix ratio suggest that tissue within the hypertrophic area does not significantly differ from intact and high-quality repair tissue and therefore seems not to cause graft hypertrophy. This is in contrast to the assumption that histological hypertrophy might cause or contribute to an overwhelming growth of the repair tissue within the transplantation site. Data presented in this manuscript might contribute to further explain the etiology of graft hypertrophy following ACI.