Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Sep 2014
Comparative StudyMorbidity of early spine surgery in the multiply injured patient.
The optimal timing of surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed against the morbidity of surgery in the early post-injury period. The performance of spine surgery in the Afghanistan theater permits analysis of the morbidity of early surgery on military casualties. The objective is to compare surgical morbidity of early spinal surgery in multiply injured patients versus stable patients. ⋯ The results indicate that published criteria defining a borderline unstable patient may have a role in predicting increased morbidity of early spine surgery. The perceived benefits of early intervention should be weighed against the greater risks of performing extensive spinal surgeries on multiply injured patients in the early post-injury period, especially in the setting of combat trauma.
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Arch Orthop Trauma Surg · Sep 2014
Tibial tubercle osteotomy in septic revision total knee arthroplasty.
The incidence of revision knee arthroplasty for infection is increasing and the required surgical approach for the revision is a challenge for surgeons. Extensile approaches are frequently used when it is impossible to evert the extensor mechanism. The aim of this paper is to report our experience with tibial tubercle osteotomy (TTO) and the functional results in patients who underwent a two-stage revision due to prosthesis infection. ⋯ Retrospective case series, Level IV.
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Arch Orthop Trauma Surg · Sep 2014
High complication rate after total knee and hip replacement due to perioperative bridging of anticoagulant therapy based on the 2012 ACCP guideline.
An increasing amount of patients receiving total joint replacement require bridging of long-term anticoagulants. Guidelines, aimed at preventing complications, focus on thromboembolic events but not on bleeding complications. In this retrospective observational study, bleeding and thromboemoblic (TE) complications were evaluated in patients requiring perioperative heparin bridging of antithrombotic therapy during primary unilateral total hip or knee arthroplasty (THA and TKA). ⋯ This study shows an alarmingly high complication rate in patients receiving LMWH bridging during elective TKA or THA surgery. All complications seem to be caused by, or secondary to bleeding. Patients need to be consulted about the risk of bleeding complications, and the risk of bleeding needs to be balanced over the risk of TE complications.
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Arch Orthop Trauma Surg · Sep 2014
Comparative StudyComparison of outside-in and inside-out technique for tibial fixation of a soft-tissue graft in ACL reconstruction using the Shim technique.
The aim of this study was to compare the biomechanical properties of tibial fixation of a free tendon graft in ACL reconstruction using the Shim, a new wedge-shaped implant, in an outside-in technique to fixation by the Shim used in an inside-out technique and fixation by interference screw in a porcine model. ⋯ As no statistically significant difference could be seen concerning load to failure, stiffness and elongation between the inside-out and the outside-in techniques, the Shim can be used for tibial fixation in an outside-in or inside-out technique depending on the preference of the surgeon. To prevent slippage of the graft a hybrid fixation should be considered.
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Arch Orthop Trauma Surg · Sep 2014
Soft tissue laxity should be considered to achieve a constant polyethylene thickness during total knee arthroplasty.
In total knee arthroplasty (TKA), the gap expansion effect by soft tissue laxity and bone resection amount influence directly on the proper gap size and ideal polyethylene insert thickness. In this study, we hypothesized if bone resection level could be controlled lesser as gap expansion effect resulted in the effects on gap expansion of the collateral release and lax lateral structure, appropriate gap size would be attained without extensive medial soft tissue release even in severe varus deformed knee. The purpose of this study was to show the usefulness of preoperative calculation of soft tissue laxity for determining the appropriate gap size for the targeted PE thickness in TKA. ⋯ This study showed the usefulness of preoperative calculation of soft tissue laxity for appropriate gap size for targeted polyethylene thickness and possibility to attain constant extension gap regardless of preoperative varus deformity.