Archives of orthopaedic and trauma surgery
-
Arch Orthop Trauma Surg · Jun 2019
ReviewPartial two-stage exchange at the site of periprosthetic hip joint infections.
In the past 10 years an increasing number of studies about partial two-stage exchange arthroplasty in the management of periprosthetic hip infections have been published. The aim of the present work was to systematically review the current knowledge about this procedure, and critically verify the success as well as the complications of this treatment option. ⋯ The partial two-stage exchange arthroplasty appears to be a possible option in the management of PJI when one prosthetic component is well-fixed so that their removal might result in significant bone loss and compromise of fixation at the time of the later prosthesis reimplantation, and the causative organisms are not multiresistant. The small numbers published about this protocol does not allow for a generalization of application and should be only applied in highly selected patients. Future studies with larger collectives and longer follow-ups are welcome to evaluate the clinical success of this option and its possible role in the management of PJI.
-
Arch Orthop Trauma Surg · Jun 2019
Risk factors for nonunion after intramedullary nailing of subtrochanteric femoral fractures.
Nonunion is a common complication after intramedullary nailing of subtrochanteric femoral fractures. A more detailed knowledge, particularly of avoidable risk factors for subtrochanteric fracture nonunion, is thus desired to develop strategies for reducing nonunion rates. The aim of the present study therefore was to analyse a wide range of parameters as potential risk factors for nonunion after intramedullary nailing of subtrochanteric fractures. ⋯ Our study indicates that intraoperative correction of varus malalignment and restoration of the medial cortical support are the most critical factors to prevent nonunion after intramedullary nailing of subtrochanteric femoral fractures. In addition, autodynamisation of the nail within the first 3 months post-surgery is a strong predictor for failure and should result in revision surgery.
-
Arch Orthop Trauma Surg · Jun 2019
Comparative StudyBiomechanical comparison of two biplanar and one monoplanar reconstruction techniques of the acromioclavicular joint.
The purpose of this proof-of-concept study was to investigate the biomechanical performance of two surgical techniques, namely (1) the double Tight-Rope fixation with an additional acromioclavicular FiberTape fixation (DTRC) and (2) the fixation of the clavicle to the acromion and coracoid in a bipodal manner (Bipod) using a Poly-Tape and FiberTape. Both techniques intend to address vertical and horizontal instability after acromioclavicular dislocation. They were compared with the commonly used (3) double Tight-Rope (DTR) technique, which only stabilizes the clavicle to the coracoid. ⋯ The DTRC and the DTR group resulted in similar low elongation, while the elongation in the Bipod technique was slightly higher. Even though this difference of 0.7 mm shows statistical significance, it most likely has no clinical relevance. When testing in posterosuperior direction, which is the clinically relevant load vector, an additional fixation of the clavicle to the acromion did not reduce elongation in this study. It is, furthermore, questionable if the benefit of an increased load-to-failure in combination with no improvement in elongation and stiffness as seen in the DTRC group outweighs the possible risks and increased costs coming with the DTRC refixation.
-
Arch Orthop Trauma Surg · Jun 2019
Anterior inferior tibiofibular ligament avulsion fractures in operatively treated ankle fractures: a retrospective analysis.
There is no consensus about the optimal treatment of anterior inferior ligament avulsion fractures of the ankle. The aim of this study is to provide insights regarding the incidence of anterior inferior ligament avulsion fractures, the association with fracture type, and correlation with treatment. ⋯ Level IV.
-
Arch Orthop Trauma Surg · Jun 2019
The relationship between global spinal alignment and pelvic orientation from standing to sitting following pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis.
To investigate the relationship between the spinal sagittal alignment and arc of pelvic motion from standing to sitting in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis following pedicle subtraction osteotomy (PSO). ⋯ In AS patients, pelvic orientation was adjusted by the global spinal alignment. When planning total hip arthroplasty for AS patients, global spinal alignment should be considered to improve the joint stability.