International orthopaedics
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Observational Study
Haemodynamic assessment in simulated operative positions before knee arthroplasty can be useful in deep vein thrombosis prediction.
During knee arthroplasty, the leg is placed in several forced positions, which are mainly uncomfortable for all tissue structures in the region, including the vascular structures. Veins have a weaker quality of the wall structure than arteries, so during the forced position morphological and haemodynamic consequences are expected mainly in the venous system. Conditions of safe aseptic environment for the arthroplasty are in collision with routine intra-operative analysis of local haemodynamics in real time. This is the reason why we have no insight into the haemodynamic and morphological changes at the time in which the initiation of deep vein thrombosis (DVT) occurs. For this reason we created the hypothesis that the monitoring of the occurrence and detection of potential DVT risks can be achieved pre-operatively using echosonograms in simulated operative positions, and then compare them with the cases of postoperative DVT. ⋯ We believe that preoperative ultrasound analysis performed during the simulation of operative positions is a useful pre-operative test that can identify patients at risk of developing postoperative DVT. We would recommend that during surgery procedure to minimise forced position of knee flexion.
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The number of patients having hip and knee arthroplasties on the ipsilateral leg is going to rise. In this regard, the prevalence of interprosthetic femoral fractures is going to increase further. The treatment of these fractures is difficult and sometimes it is impossible to perform an osteosynthesis because of worse bone quality. The goal of this study was to investigate the use of an interposition sleeve as an alternative treatment option for interprosthetic fractures with major bone loss. ⋯ The interposition sleeve is a valuable treatment option for interprosthetic fractures in situations in which osteosynthesis is impossible or insecure due to major bone defects. However, fracture healing should be preferred whenever possible.
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The Vancouver Classification System (VCS) for assessing periprosthetic femoral fractures has become universally accepted. The Unified Classification System (UCS) has expanded upon and updated the VCS and applied treatment principles to all periprosthetic fractures. However, periprosthetic femoral fractures accompanied by stem fracture after hip arthroplasty were not classifiable under the original VCS or the UCS. ⋯ We believe that our new fracture pattern, a supplement to the VCS and UCS, is useful in the establishment of a therapeutic strategy for periprosthetic femoral fractures.
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The purpose of this study is to report on the cumulative incidence and the outcome of surgically-treated postoperative PPFs in patients with femoral neck fractures treated with a THA or HA using an Exeter stem. ⋯ The cumulative incidence of surgically treated PPFs was considerable among patients with Exeter stems operated due to a femoral neck fracture. The re-operation rate due to fracture-related complications was highest among patients with B2 fractures.
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The aim of this study was to determine the biomechanical properties of four fixation options for periprosthetic supracondylar femoral fractures. ⋯ The intramedullary fibular strut allograft with polyaxial locking plate did not prove to be significantly better to the polyaxial locking plate only in a periprosthetic distal femur fracture model.