Archives of orthopaedic and trauma surgery
-
Inferior dislocation of the glenohumeral joint or luxatio erecta humeri is a rare form of injury, accounting for only 0.5% of all shoulder dislocations. Bilateral cases are even less frequent, with only eight cases reported in the literature. ⋯ Based on this case and the pertinent literature, the pathophysiology, diagnosis, and treatment of this rare injury are discussed.
-
Arch Orthop Trauma Surg · Jun 2003
Improving reliability in the classification of fractures of the acetabulum.
Plain radiographs of the pelvis are routinely used in the initial assessment of patients with suspected fractures of the acetabulum. It is necessary for orthopaedic resident trainees, emergency physicians as well as orthopaedic surgeons who infrequently treat trauma patients to be able to describe these fracture patterns reliably to traumatologist orthopaedic surgeons who ultimately take over the patient care. Our purpose was two-fold: (1) to determine the reliability of the component parts of the Letournel classification of acetabular fractures involving six anteroposterior (AP) radiographic lines, and (2) to examine whether the addition of oblique radiograph views (Judet views) would improve the reliability. ⋯ In this study we report the following: (1) the reliability of the Letournel classification improves with level of training, (2) physicians with less experience with acetabular fractures have significantly better agreement in identifying fractures using the six radiographic lines on the AP film than the Letournel classification, and (3) agreement among the reviewers for the AP pelvic radiograph is not improved with additional oblique (Judet) views.
-
Arch Orthop Trauma Surg · Jun 2003
Which one is at risk in intraoperative fluoroscopy? Assistant surgeon or orthopaedic surgeon?
Orthopaedic surgeons use intraoperative portable fluoroscopy and roentgenography. The present study was an attempt to find out if there is a difference between the occupational radiation exposure to the orthopaedic surgeon and assistant surgeon in the operating room while using intraoperative fluoroscopy or radiographic control and to measure it. ⋯ Our findings show that although the radiation exposure during orthopaedic operations is below the recommendations of the European Committee on Radiation Protection, there is a higher risk of exposure for the assistant surgeon. It has to be kept in mind that there could be morphological and functional damage in cells exposed to radiation. Therefore, we should continue to use appropriate shielding precautions in view of the unknown long-term risks.
-
Arch Orthop Trauma Surg · May 2003
Comparative StudyPrimary ACL reconstruction with fresh-frozen patellar versus Achilles tendon allografts.
In recent years, there has been an interest in the use of allografts as an alternative graft for anterior cruciate ligament (ACL) reconstruction to reduce potential donor-site morbidity resulting from the harvest of autogenous tissue. Nevertheless, in the literature, the use of allografts for primary ACL reconstruction is controversial due to a higher failure rate and the potential risk of disease transmission. ⋯ Satisfactory clinical results can be achieved with the use of allografts for primary ACL reconstruction. Comparing Achilles tendon and patellar BTB allografts, the Achilles tendon-bone allograft seems to be advantageous for ACL reconstruction as the failure rate was significantly lower. Nevertheless, the total failure rate appears to be much higher compared with autogenous ACL reconstruction, indicating that the use of an allograft for routine uncomplicated primary ACL reconstruction offers few advantages. Therefore, autograft tissue remains our graft of first choice for this procedure. We advise reserving allografts for revision procedures where suitable autogenous tissues have been previously compromised, where a contraindication for autogenous tissue harvest exists, or for multiple ligament surgery.
-
Arch Orthop Trauma Surg · May 2003
Randomized Controlled Trial Comparative Study Clinical TrialReconstruction of acute anterior cruciate ligament injuries: a prospective, randomised study of 40 patients with 7-year follow-up. No advantage of synthetic augmentation compared to a traditional patellar tendon graft.
In a prospective, randomised study, we compared the results of anterior cruciate ligament reconstruction using the conventional medial patellar tendon strip procedure with the Kennedy ligament augmentation device (LAD) over-the-top augmentation technique. The aim of the study was to see if the addition of this device, with its specific potential complications (infection, synovitis, mechanical failure) and increased costs, gave better functional stability and less donor site morbidity. ⋯ At last follow-up we found no statistical difference in stability tests, functional or activity scores; both groups showed stable improvement concerning scores and arthrometry compared with the preoperative values. No advantages were associated with the use of the Kennedy LAD, and we do not recommend it or a similar device for uncomplicated cases. New augmentation devices are simply launched onto the market, and we recommend caution and thorough evaluation in prospective, randomised studies before they are adopted into use.