Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jul 2013
Computed tomography assessment of lateral pedicle wall perforation by free-hand subaxial cervical pedicle screw placement.
To present the technique of free-hand subaxial cervical pedicle screw (CPS) placement without using intra-operative navigating devices, and to investigate the crucial factors for safe placement and avoidance of lateral pedicle wall perforation, by measuring and classifying perforations with postoperative computed tomography (CT) scan. The placement of CPS has generally been considered as technically demanding and associated with considerable lateral wall perforation rate. For surgeons without access to navigation systems, experience of safe free-hand technique for subaxial CPS placement is especially valuable. ⋯ Placement of screw through a correct trajectory may lead to grade 1 perforation, which suggests transversal expansion and breakage of the thinner lateral cortex, probably caused by mismatching of the diameter of 3.5 mm screws and the tiny cancellous bone cavity of pedicle. Grade 1 perforation is deemed as relatively safe to the vertebral artery. Grade 2 perforation means obvious deviation of the trajectory angle of hand drill, which directly penetrates into the transverse foramen, and the risk of vertebral artery injury (VAI) or development of thrombi caused by the irregular blood flow would be much greater compared to grade 1 perforation. Moreover, there are two crucial maneuvers for increasing accuracy of screw placement: identifying the precise entry point using a curette or hand drill to touch the true entrance of the canal after decortication, and guiding CPS trajectory on axial plane by the resistant of thick medial wall.
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Arch Orthop Trauma Surg · Jul 2013
The use of a dual-mobility concept in total hip arthroplasty patients with spastic disorders: no dislocations in a series of ten cases at midterm follow-up.
Total hip arthroplasty (THA) is one of the treatment options in patients with cerebral palsy (CP) with painful osteoarthritis of the hip. However, the risk of dislocation of the prosthesis is higher in patients with CP when compared with physically normal patients. In this retrospective study of ten consecutive cases, we hypothesized that the use of a dual-mobility cup could reduce this risk of dislocation combined with good functional results. ⋯ The use of a dual-mobility cup in THA in patients with CP can lead to favourable results with respect to dislocation and clinical outcome.
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Arch Orthop Trauma Surg · Jul 2013
Influence of fracture type and surgeon experience on the emission of radiation in distal radius fractures.
Ionising radiation is a potential risk for potentially exposed personnel. Only a few studies have examined the factors contributing to the emission of radiation in orthopaedic trauma procedures. We hypothesize that the experience of the surgeon and the fracture type influence the emission of radiation intraoperatively. ⋯ The emission of radiation during this procedure depends on the fracture type and the experience of the surgical team. Operating theatre personnel should be aware of the higher emission rates during the treatment of type C fractures and in teaching hospitals with inexperienced team members.
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Arch Orthop Trauma Surg · Jul 2013
Intraoperative panoramic image using alignment grid, is it accurate?
Minimally invasive orthopedic trauma surgery relies heavily on intraoperative fluoroscopic images to evaluate the quality of fracture reduction and fixation. However, fluoroscopic images have a narrow field of view and often cannot visualize the entire long bone axis. ⋯ Panoramic images produced by stitching fluoroscopic images together with help of an alignment grid demonstrated the same accuracy at evaluating the coronal plane alignment of femur fractures as conventional X-rays.
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Arch Orthop Trauma Surg · Jul 2013
Case ReportsHeterotopic ossification in portal sites following hip arthroscopy.
Heterotopic ossification (HO) is a well-known condition that usually occurs after head trauma, burns and open surgical procedures, most commonly around the hip and elbow joints. It is a well-documented complication occurring after open hip surgery; however, there exists limited information regarding its prevalence and clinical importance following hip arthroscopy. We report a case of symptomatic HO formation in portal sites following arthroscopic rim decompression, femoroplasty and labral debridement that was successfully treated with arthroscopic removal.