Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2013
The utility of clinical features for distinguishing subchondral insufficiency fracture from osteonecrosis of the femoral head.
Subchondral insufficiency fractures of the femoral head (SIF) need to be differentiated from osteonecrosis of the femoral head (ON), since these two conditions have several overlapping characteristics especially in their radiological findings. The purpose of this study was to determine the useful clinical features for differentiating SIF from ON. ⋯ The results of this study indicate that osteoporotic elderly women without any history of corticosteroid intake or alcohol abuse need to first be considered to have subchondral insufficiency fracture when radiographs show a collapse of the femoral head.
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Arch Orthop Trauma Surg · Dec 2013
Case ReportsRemote cerebellar haemorrhage after lumbar spine surgery: case report.
Remote cerebellar haemorrhage (RCH) is a well-described complication of supratentorial surgical procedures with an incidence ranging between 0.2 and 4.9 %, but is a rare complication of spinal surgery. We report a case of RCH in a 65-year-old woman who showed sudden mental deterioration 48 h after lumbar spinal surgery, which was complicated by incidental dural tearing with minimal CSF loss. Brain CT scan revealed hypodense areas compatible with acute infarction involving mostly the left cerebellar hemisphere. ⋯ An external ventricular derivation was placed in a second procedure 24 h later due to the persistence of ventricular dilatation. At discharge the patient was only showing a slight dysmetria with the fine motor skills of hands and fingers. All cases of RCH after spinal surgery reported in the literature are invariably associated to iatrogenic dural tearing; although CSF loss seems to play the key role in the pathogenesis of this rare complication, the exact pathophysiology of this condition still remains undetermined.
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Arch Orthop Trauma Surg · Dec 2013
Case ReportsReconstruction using an autograft with near complete preservation of the extensor retinaculum for chronic tibialis anterior tendon disruption.
We present the case of a 42-year-old woman with chronic disruption of the tibialis anterior tendon who was treated by reconstructive surgery using autologous semitendinosus tendon grafting. Two incisional approaches, proximal and distal of the degenerative scar tissue between each ruptured stump, made it possible to preserve most of the extensor retinaculum, except for the inferior Y-shaped medial segment that was excised to prevent adhesion between the reconstructed tendon and the extensor retinaculum. ⋯ Although some types of tendon transfer technique or interpositional autologous tendon grafting have been reported to show good outcomes for chronic tibialis anterior tendon disruption with a large defect, the recent trend has been toward reconstructive surgery using autografts. The surgical technique presented seems applicable for achieving minimum surgical complications in this rare condition.
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Arch Orthop Trauma Surg · Dec 2013
In vivo evaluation of the kinematics of the long head of the biceps tendon within the pulley: a 3 T MRI motion analysis.
To evaluate the kinetic amplitude and direction of the long head of the biceps tendon (LHB) within the pulley and the proximal bicipital groove, we performed a 3T-magnetic resonance-throwing motion analysis. ⋯ 12 healthy volunteers (age 22–34 years) were enrolled. Adduction led to an anterior deviation of the LHB within the bicipital groove. Loading conditions in medium (110°) elevation/external rotation furthermore led to a significant anterior deviation of the LHB. Conclusion Our findings support the thesis that pulley lesions result from movements of the LHB especially in extreme positions during throwing/overhead activities. Load application in the medium (110°) elevation/external rotation position might enable a better evaluation of patients with dedicated pulley lesions. These results need further evaluation in larger study cohorts and in patients with dedicated rotator cuff lesions, which will be the focus of ongoing studies.
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Arch Orthop Trauma Surg · Dec 2013
Correlation of reduction and clinical outcome in patients with degenerative spondylolisthesis.
Prospective cohort study. ⋯ The current study indicates a modest advantage for the best possible reposition in respect of the clinical outcome.