Archives of orthopaedic and trauma surgery
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Shoulder pathologies are often accompanied by rotator interval synovitis. This phenomenon is poorly described in the literature so far. The aim of the study was to analyze the occurrence of macroscopically visible synovial reaction in the rotator interval in patients with chronic shoulder pathologies and to perform a histopathological evaluation. ⋯ Cohort study, level of evidence, 2b.
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Arch Orthop Trauma Surg · Aug 2019
Augmentation of plate osteosynthesis for proximal humeral fractures: a systematic review of current biomechanical and clinical studies.
Secondary dislocation due to loss of fixation is the most common complication after plate fixation of proximal humeral fractures. A wide range of different techniques for augmentation has been described to improve the primary and secondary stability. Nevertheless, comparative analyses on the specific advantages and limitations are missing. Therefore, the aim of the present article was to systematically review and evaluate the current biomechanical and clinical studies. ⋯ Augmentation of plate fixation for proximal humeral fractures seems to be a reliable and safe procedure. All common techniques mechanically increase the constructs' stability. Clinically evaluated procedures show reduced complication rates and improved patient outcomes. Augmentation techniques seem to have the highest significance in situations of reduced bone mineral density and in high-risk fractures, such as 4-part fractures. However, more high-quality and comparative clinical trials are needed to give evidence-based treatment recommendations.
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Arch Orthop Trauma Surg · Aug 2019
Acetabular revision arthroplasty using press-fitted jumbo cups: an average 10-year follow-up study.
Acetabular revision arthroplasty using jumbo cups for moderate-to-severe acetabular defects has varied outcomes. We evaluated the clinical and radiological outcomes of acetabular revision arthroplasty using a press-fitted jumbo cup and sought to identify factors that influence outcomes during intermediate follow-up. ⋯ Press-fitted jumbo cups for acetabular revision arthroplasty exhibited encouraging results during follow-up for an average of 10 years. Use of highly cross-linked polyethylene liners and proper placement of the acetabular component with an inclination angle < 50° may contribute to better clinical outcomes after acetabular revision arthroplasty with jumbo cups.
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Arch Orthop Trauma Surg · Aug 2019
Practicability of a locking plate for difficult pathologies of the scaphoid.
Headless compressions screws are the most implanted devices for scaphoid fractures and nonunions. For cases when screw osteosynthesis is not possible, a special locking plate for scaphoid reconstruction has been developed. The purpose of this study was to evaluate the safety and practicability of this device for difficult scaphoid pathologies. ⋯ This new locking device for scaphoid reconstruction seems to be a safe, useful and reliable tool in the treatment of difficult nonunions or multi-fragmentary scaphoid fractures. The practicability is convincing and satisfying fusion rates can be accomplished. However, most patients require hardware removal. We recommend using this plate as a rescue option when a stable osteosynthesis is necessary for the healing process and screw fixation has already failed or is not possible.
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Arch Orthop Trauma Surg · Aug 2019
Posterior condylar resections in total knee arthroplasty: current standard instruments do not restore femoral condylar anatomy.
Correct femoral rotational alignment in total knee arthroplasty (TKA) is important for femoropatellar knee kinematics as well as for the overall clinical success. The goal of the present study was to evaluate how accurately standard instruments of various manufacturers with specific rotational settings in posterior referencing restore the posterior femoral condylar anatomy and allow a rotational alignment which matches a particular anatomic rotational landmark on CT. ⋯ Femoral sizers using a posterior referencing technique increase, with rising external rotation, medial posterior condylar resection to an extent that may exceed the implant thickness in the majority of systems. Surgeons should be aware that current standard instruments do not restore the anatomy of the posterior medial and lateral condyle and do not align the femoral component parallel to the aTEA, which may result in internal rotation of a symmetric femoral component.