Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Feb 2023
Salvage of limb salvage in oncological reconstructions of the lower limb with megaprosthesis: how much to push the boundaries?
Megaprosthesis represent the most commonly used limb salvage method after musculoskeletal tumor resections. Nevertheless, they are burdened by high complication rate, requiring several surgical revisions and eventually limb amputation. The aims of this study were to evaluate the effect of rescuing the limb with subsequent revisions on complication rates (a), incidence of amputations (b), and whether complications reduce functional outcome after the first surgical revision (c). ⋯ The number of further revision surgeries after limb salvage with megaprosthesis increases the incidence of complications. Repeated surgical revisions, in particular after infection, increase the amputation rate. The most frequent causes of failure were structural failures and infections. MSTS score was superior for patients undergoing limb salvage than amputees. However, MSTS progressively decreased with multiple revisions becoming inferior to the functional score of an amputated patient.
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Arch Orthop Trauma Surg · Feb 2023
A clinical decision support system in back pain helps to find the diagnosis: a prospective correlation study.
The aim of this study is to show the concordance of an app-based decision support system and the diagnosis given by spinal surgeons in cases of back pain. 86 patients took part within 2 months. They were seen by spine surgeons in the daily routine and then completed an app-based questionnaire that also led to a diagnosis independently. ⋯ An overestimation of the severity of the diagnosis occurred more often than underestimation (15.1% vs. 7%). The app-based tool is a safe tool to support healthcare professionals in back pain diagnosis.
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Arch Orthop Trauma Surg · Feb 2023
Does metatarsus primus elevatus really exist in hallux rigidus? A weightbearing CT case-control study.
Elevated first metatarsal, Metatarsus primus elevatus (MPE), has been a topic of controversy. Recent studies have supported a significantly elevated first metatarsal in hallux rigidus on weight-bearing radiographs (WBR). However, conventional radiographs have limitations for accurate measurement. Our objective was to comparatively assess MPE and other variables which can affect the spatial relationship of the forefoot in the HR group compared to controls using weight-bearing CT (WBCT). ⋯ The present study demonstrated significantly increased MPE in HR on WBCT and MPE greater than 4.19 mm on WBCT can be used as a diagnostic threshold for HR.
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Arch Orthop Trauma Surg · Feb 2023
Migration pattern of cemented Exeter short stem in Dorr type A femurs. A prospective radiostereometry study with 2-year follow-up.
The Exeter short stem (ESS) is 25 mm shorter than the standard length v40 Exeter stem (Stryker) and intended for a narrow femoral diaphysis. The purpose of the study was to evaluate the migration pattern of the cemented ESS. ⋯ The 2-year migration pattern of the cemented ESS was similar to reports for the cemented standard length Exeter stem. Low preoperative T-score and varus stem-position showed a tendency for higher stem migration and should be studied as risk factors for failure in larger studies of cemented polished stems.
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Arch Orthop Trauma Surg · Feb 2023
Long-term results of Bernese periacetabular osteotomy using a dual approach in hip dysplasia.
We report the long-term results of Bernese periacetabular osteotomy using a dual approach in hip dysplasia. Fifty-three hips (49 patients, mean age 39.9 years: 13-62 years; bilateral hips: four patients) that underwent periacetabular osteotomy using a dual approach (combined Smith-Peterson and Kocher-Langenbeck techniques) between May 1997 and December 2005 were analyzed in this study. The clinical and radiologic outcomes and complications were analyzed and the final survival rates of the operated hips were investigated with survival analysis curves. ⋯ One patient developed an avulsion fracture of the anterior superior iliac spine, and none of the cases had an infection or permanent neurologic damage. Kaplan-Meier analysis revealed that the 10-year survival rate was 93% (95% confidence interval [CI] 81-98%) with arthroplasty as the endpoint and 86% (95% CI 70-91%) with the progression of osteoarthritis based on Tönnis osteoarthritis rating as the endpoint. Based on the outcomes of a long-term follow-up of more than 10 years on average, Bernese periacetabular osteotomy via a dual approach was found to be a satisfactory method for lowering the incidence of complications while preserving hips.