Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2023
Full endoscopic anterior intrapelvic plate osteosynthesis: a cadaveric feasibility study.
In this investigation, it was assumed that it must be possible to visualize the intrapelvic aspect as accustomed by pelvic surgeons using the anterior intrapelvic (modified Stoppa) approach. Moreover, it was hypothesized, that plate mountings will not only be possible for the symphysis but also at the supra- and infrapectineal aspect as well as to the posterior column. Ten anonymized cadaveric specimens were included in this study. ⋯ This investigation demonstrated, that endoscopic anterior intrapelvic plate osteosynthesis was feasible in the majority of the cases in a series of ten cadaveric models. New instruments will be needed such as extra-long rasp elevators, ball-spikes as well as devices to hold and position plates and extra-long self-holding screwdrivers. With these, endoscopic pelvic surgery will likely be a realistic option for selected pelvic trauma cases in the future.
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Arch Orthop Trauma Surg · Jan 2023
Blood management in direct anterior versus posterior primary total hip arthroplasty using tranexamic acid: a matched cohort study.
Proponents of the direct anterior approach (DAA) for THA claim patients recover faster compared to primary THA through the posterior approach (PA). Blood loss and transfusion have substantially declined with the use of tranexamic acid (TXA). However, it is still controversial if hemoglobin drops and transfusion rates are affected by the surgical approach when TXA is routinely used. ⋯ In this large matched cohort study, there was no difference in the perioperative hemoglobin drop, the transfusion rate and the transfusion amount between DAA and PA THA.
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Arch Orthop Trauma Surg · Jan 2023
Accelerate postoperative management after scoliosis surgery in healthy and impaired children: intravenous opioid therapy versus epidural therapy.
Postoperative pain is a major concern following scoliosis surgery. CEA (continuous epidural analgesia) is established in postoperative pain therapy as well as intravenous patient-controlled analgesia (IV-PCA). The purpose of this study was to compare the clinical outcomes of both methods. ⋯ CEA provides appropriate pain management after scoliosis surgery, regardless of the patient's mental status. It allows earlier postoperative defecation for all patients , as well as shorter hospitalization and an earlier mobilization for healthy patients.
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Arch Orthop Trauma Surg · Jan 2023
Less soft tissue release in total knee arthroplasty for anteromedial compared to posteromedial knee osteoarthritis.
In total knee arthroplasty (TKA), the aim of achieving a mechanically straight leg axis as well as symmetrical and equally wide gaps has become established as the gold standard in terms of surgical technique. In contrast to TKA unicompartmental knee arthroplasty (UKA) is performed in anteromedial osteoarthritis (AMOA) and does not normally require releases. This raises the hypothesis whether the type of osteoarthritis (AMOA vs. posteromedial osteoarthritis (PMOA)) determines the requirement for soft tissue releases in TKA. ⋯ To achieve a neutral mechanical alignment, a release has to be performed due to asymmetry of the extension gap more often if PMOA is present than in AMOA. Surgeons should be prepared to perform more frequent and extensive medial releases in PMOA. Higher constrained implants should be available in case of unintended over release in PMOA.
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Arch Orthop Trauma Surg · Jan 2023
Distal ulna fractures in adults-subcapitular, transverse fractures did not benefit from surgical treatment.
Fractures of the distal ulna, excluding the styloid, are rare. The cause of injury is often a fall on an outstretched hand with an extended wrist, and in most cases there is a concomitant distal radius fracture. The aims of this retrospective study were to investigate the results of the current treatment of distal ulna fractures in adults, with or without a concomitant distal radius fracture, and if a recently presented fracture classification could predict outcome. ⋯ Distal ulna fractures almost always unite and the result is comparable to that of isolated distal radius fractures when measured by PRWE. Based on the opinions of the radiologists and how often a consensus discussion was needed for classification, we found the updated AO classification system difficult to use, if dependent only on standard radiographic views. In the present study, transverse extra-articular ulna fractures did not benefit from internal fixation regardless if associated with a distal radius fracture or isolated.