Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Mar 2018
ReviewTibial tubercle osteotomy (TTO) in total knee arthroplasty, is it worth it? A review of the literature.
Tibial tubercle osteotomy (TTO) is a well-established extensile approach to improve joint visualization and implant removal. Despite this, TTO is a challenging technique with a long learning curve and potential pitfalls. Complications are not infrequent, even if performing the correct surgical steps. Aim of this paper is to review the current literature about TTO, its safeness and reliability, and finally the complications rate. ⋯ TTO may be necessary to correct pathological tuberosity position or patella tracking. However, TTO is a challenging technique to improve the surgical approach during total knee arthroplasty. A strict surgical technique can lead to better results and to minimize complications. However, it is not clear if the improved outcome can outweigh the longer surgery and the higher risk of pitfalls.
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Arch Orthop Trauma Surg · Mar 2018
A lateral retinacular release during total knee arthroplasty changes femorotibial kinematics: an in vitro study.
Lateral retinacular release (LRR) is a common procedure during total knee arthroplasty (TKA), especially if patellar maltracking is observed intraoperatively. The impact of LRR on patellofemoral kinematics is well-examined, but the influence on femorotibial kinematics requires more elucidation. Therefore, the aim of this study was to evaluate the effects of LRR on femorotibial kinematics in vitro. ⋯ The results suggest that LRR significantly decreases lateral femoral rollback as well as internal rotation of the tibia, probably by changing the tension of the iliotibial band. When performing a LRR in clinical routine, surgeons should be aware of altering not only patellofemoral kinematics but also the femorotibial kinematics.
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Arch Orthop Trauma Surg · Mar 2018
Predictors of cut-out after cephalomedullary nail fixation of pertrochanteric fractures: a retrospective study of 813 patients.
Cut-out is the most common mechanical complication of the osteosynthesis of pertrochanteric fractures. This complication determines a significant increase in morbidity in elderly patient. Cut-out is defined as the varus collapse of the femoral head-neck fragment with the extrusion of the cephalic screw. Surgical treatment of cut-out might lead to further complications, longer rehabilitation, increased social burden and healthcare system costs. The aim of the study is to identify the predictors of cut-out to prevent its occurrence. ⋯ The results of the present study demonstrate that good quality of reduction and correct position of the lag screw are likely to decrease the risk of cut-out complication. A nomogram for cut-out prediction is proposed for clinical validation.
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Arch Orthop Trauma Surg · Mar 2018
New angle measurement device to control the posterior tibial slope angle in medial opening wedge high tibial osteotomy.
Medial opening wedge high tibial osteotomy has been associated with an unintentional increase in the posterior tibial slope angle. We aimed to evaluate the effectiveness of a novel bone spreader angle rod to maintain the native posterior tibial slope angle in medial opening wedge high tibial osteotomy. ⋯ IV.
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Arch Orthop Trauma Surg · Mar 2018
Observational StudyIs treatment of geriatric hip fracture patients cost-covering? Results of a prospective study conducted at a German University Hospital.
Hip fractures have increased medical and socio-economic importance due to demographic transition. Information concerning direct treatment costs and their reimbursement in Germany is lacking. ⋯ Treatment of geriatric hip fracture patients in a university hospital in Germany does not seem to be cost-covering. Adjustment of the reimbursement for treatment of complex hip fracture patients should be considered.