Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Sep 2017
High non-anatomic tunnel position rates in ACL reconstruction failure using both transtibial and anteromedial tunnel drilling techniques.
Although it is well known from cadaveric and biomechanical studies that transtibial femoral tunnel (TT) positioning techniques are associated with non-anatomic tunnel positions, controversial data exist as so far no clinical differences could have been found, comparing transtibial with anteromedial techniques (AM). The purpose of the study was to analyze if graft failure following TT ACL reconstruction was more commonly associated with non-anatomic tunnel position in comparison with the AM technique. We hypothesized that, compared to AM techniques, non-anatomic tunnel positions correlate with TT tunnel positioning techniques. ⋯ Considerable rates of non-anatomic femoral and tibial tunnel positions were found in ACL revisions with both transtibial and anteromedial femoral drilling techniques. Despite the potential of placing tunnels more anatomically using an additional AM portal, this technique does not ensure anatomic tunnel positioning. Consequently, the data highlight the importance of anatomic tunnel positioning in primary ACL reconstruction, regardless of the applied drilling technique.
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Arch Orthop Trauma Surg · Sep 2017
Effects of initial graft tension on femoral tunnel widening after anatomic anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft.
The effects of initial graft tension upon tunnel widening (TW) following anatomic anterior cruciate ligament (ACL) reconstruction have not been elucidated. The purpose of this study was to retrospectively investigate the effect of two different graft-tensioning protocols upon femoral TW following anatomic ACL reconstruction using a bone-patellar tendon-bone (BPTB) graft and a three-dimensional (3D) computed tomography (CT) model. ⋯ High levels of initial graft tension resulted in greater TW of the femoral tunnel aperture following anatomical ACL reconstruction using BPTB grafts. However, such levels of graft tension did not affect clinical outcome.
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Arch Orthop Trauma Surg · Sep 2017
Posterior locked lateral compression injury of the pelvis in geriatric patients: an infrequent and specific variant of the fragility fracture of pelvis.
Posterior locked lateral compression injury (PLLCI) of the pelvic ring is an infrequent variant of lateral compression injury, a condition described in only eight reported cases since 2000. Lateral compression injury usually results from high-energy trauma and is characterized by locking between the medially translated fractured ilium and the anterior border of the sacrum, regardless of whether the fractured ilium involves the sacroiliac joint. However, in our experience, lateral compression injury can also result from low-energy trauma as a manifestation of pelvic fragility fracture. The aim of the present study was to describe this rare form of PLLCI in a case series of geriatric patients. ⋯ Geriatric patients can experience PLCCIs of the pelvis due to low-energy trauma. These fractures have different characteristics from those associated with severe injuries due to high-energy trauma, and they comprise an infrequent form of Rommens fragility fracture of the pelvis (type IIIa). In these cases, appropriate surgical management that includes sacroiliac plating combined with anterior external fixation can yield good outcomes.
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Arch Orthop Trauma Surg · Sep 2017
Randomized Controlled TrialDelayed union of humeral shaft fractures: comparison of autograft with and without platelet-rich plasma treatment: a randomized, single blinded clinical trial.
Despite an adequate orthopedic treatment with functional bracing, some patients develop a delayed union in humeral shaft fractures. The objective of the present study was to determine the bone consolidation time among patients with delayed union of diaphyseal humeral fractures who were managed with locking compression plate (LCP) fixation combined with an iliac crest autograft using platelet-rich plasma (PRP) as a co-adjuvant. ⋯ The use of PRP promotes earlier bone consolidation in patients with delayed union of the humeral shaft.