Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Mar 2018
Functional outcomes after removal of hardware in patellar fracture: are we helping our patients?
Functional outcomes after Open Reduction Internal Fixation (ORIF) of the patella are variable. Common complications of patella ORIF include persistent anterior knee pain, limited range of motion and symptomatic hardware. The purpose of this study was to evaluate if removal of hardware is beneficial to symptomatic patients after patellar fracture fixation. ⋯ Hardware removal after patella ORIF significantly improves patient reported pain and quality of life outcomes but not functional outcomes. Patients should be counseled regarding the expected outcome of hardware removal following patella ORIF and diabetic patients should be given special consideration before undergoing this procedure.
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Arch Orthop Trauma Surg · Mar 2018
Degenerative changes after posterior cruciate ligament reconstruction are irrespective of posterior knee stability: MRI-based long-term results.
Posterior cruciate ligament reconstruction (PCLR) is advocated to prevent an early onset of osteoarthritis. We hypothesized that posterior instability after PCLR correlates with degenerative changes. ⋯ Patients undergo degenerative changes after PCLR, which are significantly higher compared to the contralateral knee. These occur predominantly at PFJ/MFTJ and are irrespective of posterior stability. Concomitant meniscus/cartilage injuries and a high number of previous surgeries are further risk factors.
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Arch Orthop Trauma Surg · Mar 2018
Posterolateral overhang affects patient quality of life after total knee arthroplasty.
To investigate the appropriate mediolateral placement of symmetrical tibial components and the amount of overhang expected from the posterolateral of tibial components implanted to give ideal coverage and the subsequent incidence of residual knee pain and reduction in functional capacity. ⋯ This study demonstrated that overhang in the posterolateral region is surprisingly high and negatively affects the clinical results following TKA, thereby presenting a danger to the success of TKA. The risk of posterolateral oversizing can increase with placement of the tibial component in external rotation.
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Arch Orthop Trauma Surg · Mar 2018
The nail-shaft-axis of the of proximal femoral nail antirotation (PFNA) is an important prognostic factor in the operative treatment of intertrochanteric fractures.
Due to the world's aging population, intertrochanteric fractures are frequent. Considering age and comorbidities of most of these patients, it is indispensable to enable early postoperative mobilization of these patients. Intramedullary osteosynthesis with PFN-A is widely used and, in general, considered safe and reliable for the operative treatment of intertrochanteric fractures. However, implant -related complications are reported in 6-21% of all cases. In this study, we are analyzing complication rates and risk factors for implant-related complications. ⋯ When treating introchanteric fractures with PFNA reduction in neutral or even slight valgus, aiming for a TAD < 25 mm and a correct position of the blade within the femoral head reduced the risk for secondary varus displacement significantly. Furthermore, we suggest to aim for a central nail-shaft axis.
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Arch Orthop Trauma Surg · Mar 2018
The distance of the gluteal nerve in relation to anatomical landmarks: an anatomic study.
Gluteal insufficiency is of concern with lateral approaches to total hip arthroplasty. Damage to the branches of the superior gluteal nerve may cause degeneration of the innervated muscles. The direct anterior approach exploits the intermuscular and internerval interval between tensor fasciae latae laterally and sartorius and rectus femoris muscle medially. In this study, the distance of the superior gluteal nerve in relation to anatomical landmarks was determined. ⋯ The direct anterior approach for total hip arthroplasty minimizes the risk of injuring the superior gluteal nerve, which may result in a gluteal insufficiency. Special care should be paid on avoiding overstretching the tensor fasciae latea muscle using minimum force on retractors during surgery and by taking care of the entrance point of the superior gluteal nerve to the tensor fasciae latae.