Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Feb 2016
Review Case ReportsRemoval of a bent intramedullary nail in lower extremity: report of two cases and review of removal techniques.
Removal of a bent intramedullary nail (IMN) is a rare but challenging orthopedic problem. Several removal techniques have been described up to date; however, there is no extensive review and no algorithm to manage these cases in current literature. The purpose of this paper is to present two cases that presented with bent IMN and provide an algorithm for management of this rare complication.
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Arch Orthop Trauma Surg · Feb 2016
Randomized Controlled TrialEffect of preemptive intra-articular morphine and ketamine on pain after arthroscopic rotator cuff repair: a prospective, double-blind, randomized controlled study.
Rotator cuff tear is a leading etiology of shoulder pain and disability. Surgical treatment is indicated in patients with persistent pain who fail a trial of non-surgical treatment. Pain reduction following rotator cuff repair, particularly within the first 24-48 h, is a major concern to both doctors and patients. This study aimed to compare the postoperative antinociceptive additive effects of pre-incisional intra-articular (IA) ketamine when combined with morphine with two times the dose of morphine or saline. ⋯ Pre-incisional intra-articular morphine reduced pain in the first 2 weeks after arthroscopic rotator cuff repair. Further research is warranted to elucidate the optimal timing and dosing of IA ketamine and morphine for postoperative analgesic effects.
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The treatment of adult non-traumatic avascular necrosis of the femoral head (AVN; N-ANFH) within an estimated incidence of 5000-7000 cases per annum in Germany remains a challenge. Risk factors include steroids, alcohol abuse, chemotherapy and immunosuppressive medication, but a genetic predisposition has been suggested. Early diagnosis of this often bilateral disease process is essential for successful conservative or joint preserving surgical management. In this review, we present the update German consensus S3 guideline "diagnosis and management for N-ANFH" as a concise summary. ⋯ Clinical suspicion of N-ANFH mandates radiographic evaluation. If radiographs are normal MRI scans are recommended, which should be evaluated according to the ARCO-classification. Differential diagnoses include transient osteoporosis, bone bruise, insufficiency fracture and destructive arthropathy. Untreated, subchondral fractures commonly occur within 2 years, during which the risk for contralateral involvement is high-thereafter unlikely. Conservative management with Ilomedin and Alendronat can be tried, but other pharmacological or physical treatments are inappropriate. No specific joint preserving procedure can be recommended, but core decompression should be considered in early stages if necrosis is <30 %. In ARCO stages IIIc or IV total hip arthroplasty (THA) should be contemplated, which offers similar outcome compared to osteoarthritis. Young age is the main risk factor for higher revision rates after THA for N-ANFH.
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Arch Orthop Trauma Surg · Feb 2016
Comparative StudyComparison of different femoral fixation implants and fit techniques for tunnel widening and clinical outcome in ACL reconstruction using hamstring autograft.
The purpose of the current study is to investigate in different femoral fixation devices whether tight (undersize drilled) fit technique decreases the tunnel widening and improves the clinical outcome compared to conventional technique in ACL reconstruction using hamstring tendon autograft. ⋯ Therapeutic case series, Level IV.
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Arch Orthop Trauma Surg · Feb 2016
Early clinical and radiological results of total knee arthroplasty using patient-specific guides in obese patients.
Total knee arthroplasty (TKA) is a challenging procedure in patients with a high body mass index (BMI). The aim of our study was to assess the outcome and accuracy of restoration of mechanical alignment in TKA using patient-specific guides (PSG) involving patients with high BMI. ⋯ Patient-specific guides technology restores the coronal mechanical axis reliably in obese patients without adversely affecting outcomes. Our short-term follow-up has shown favorable outcomes. Surgeons should use these customized jigs as a guide and adjust the size of components, alignment and rotation according to normal surgical principles.