Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2022
Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect.
Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. ⋯ A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.
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Arch Orthop Trauma Surg · Dec 2022
All-polyethylene unicompartmental knee arthroplasty is associated with increased risks of poorer knee society knee score and lower satisfaction in obese patients.
Although metal-backed tibial component (MB) is biomechanically superior to all-polyethylene (AP) implants in fixed-bearing unicompartmental knee arthroplasty (UKA), recent studies have shown comparable functional outcomes between the two. However, no study has examined this comparison in obese patients (BMI ≥ 30 kg/m2). We investigated whether functional outcomes between the two implants differ among obese patients, and whether the extent of obesity influences these outcomes. ⋯ We found no differences in functional and quality-of-life outcomes between fixed-bearing AP and MB tibial components among obese patients who underwent UKA. However, among higher obesity patients (BMI ≥ 35 kg/m2), patients with AP tibial component were associated with lower KSKS score and a lower proportion of attaining satisfaction fulfillment 2 years postoperatively.
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Arch Orthop Trauma Surg · Dec 2022
Fully hydroxyapatite-coated compaction broached and triple-tapered stem may reduce the risk of stress shielding after primary total hip arthroplasty.
Changes in bone mineral density (BMD) around the fully hydroxyapatite (HA)-coated compaction broached and triple-tapered stem, namely, Polarstem, after total hip arthroplasty (THA) are currently unknown. Therefore, the aims of this study were to investigate clinical outcomes of Polarstem, mainly postoperative temporal changes in BMD around the stem for 2 years, and to compare them with those of HA-coated and non-HA-coated tapered-wedge stems. ⋯ Polarstem, a fully HA-coated compaction broached and triple-tapered stem, maintained BMD around the femoral calcar until 2 years postoperatively and could reduce the risk of stress shielding compared with tapered-wedge stems.
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Arch Orthop Trauma Surg · Dec 2022
Slight cartilage damage in weight-bearing area of lateral femoral condyle do not compromise short-term outcomes of medial unicompartmental knee arthroplasty.
Medial unicompartmental knee arthroplasty (mUKA) requires full-thickness cartilage in the lateral compartment, but slight damage of the cartilage surface can be ignored. However, as this statement lacks literature support, we investigated whether slight cartilage damages in the weight-bearing area of the lateral femoral condyle would affect the outcome of mUKAs. ⋯ Cartilage damage of Outerbridge grade 1 and grade 2 in the weight-bearing area of the lateral femoral condyle will not compromise the short-term outcome of medial mobile-bearing UKA.
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Arch Orthop Trauma Surg · Dec 2022
Computed tomography-based classifications of posterior malleolar fractures and their inter- and intraobserver reliability: a comparison of the Haraguchi, Bartoníček/Rammelt, and Mason classifications.
Complex ankle fractures often include fractures of the posterior malleolus. The most clinically relevant posterior malleolus fracture classifications are computed tomography (CT) based. These classifications aim to enable clear communication and help develop treatment strategies. This study investigates the inter- and intraobserver reliability of the Haraguchi, Bartoníček/Rammelt and Mason posterior malleolar fracture classifications. ⋯ All classifications show substantial, if not perfect inter- and intraobserver reliabilities independent of observer level of expertise.