Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2024
Management of osteochondritis dissecans lesions of the elbow including return to sport remains variable among orthopaedic surgeons.
Management of osteochondritis dissecans (OCD) lesions of the capitellum is challenging. Historically, variability exists between surgeons in the evaluation, treatment, and return to sport criteria. The purpose of this study was to define the current trends regarding evaluation, nonoperative and surgical management, and return to sport criteria for capitellar OCD lesions among surgeons. ⋯ There is significant variability in the management of capitellar OCD in athletes. Small, centralized lesions are likely to be treated with debridement and microfracture with faster return to sport. Treatment of large, lateral lesions remains variable. Regarding OAT procedures, perceived morbidity, reimbursement, and limited evidence dissuade use. There is no consensus on return to sport, though lack of pain and time were most important; overhead athletes and gymnasts are restricted longer from returning to sport. Level of Evidence Level 5, diagnostic, cross-sectional survey.
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Arch Orthop Trauma Surg · Dec 2024
Enhancing treatment outcomes for Acute Periprosthetic Hip Joint infection: optimizing debridement, antibiotics, and Implant Retention through vacuum sealing drainage in the deep tissue.
Debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) is under debated since the reported success rate is inconsistent. This study aimed to explore the efficacy of vacuum sealing drainage (VSD) used as an adjunct to irrigation and debridement for acute PJI. ⋯ The incorporation of VSD in the deeper region enhances the outcomes of DAIR, achieving an 86.67% success rate in managing acute PJI. This approach offers a potentially safe and effective treatment, though patients with higher Charlson comorbidity index and elevated preoperative CRP levels face increased risks of failure.
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The scaphoid bone is essential for wrist stability, force transmission, and movement, being crucial for maintaining carpal kinematics. In cases where the scaphoid is non-reconstructable, a complete replacement can serve as a treatment option to preserve carpal alignment and motion. This approach has evolved since its first descriptions in 1945, benefiting significantly from advancements in patient-specific implant design, additive manufacturing/3D printing, and material use in recent years. We present a technique for scaphoid replacement using a patient-specific prosthesis and reconstruction of intrinsic and extrinsic ligaments to achieve optimal stability and mobility.
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Arch Orthop Trauma Surg · Dec 2024
The vascular anatomy and harvesting of the medial femoral condyle flap in pigs.
Clinically, there has been increasing employment of the medial femoral condyle flap. Pigs have been employed as a model of the medial femoral condyle flap. However, related anatomical studies from the perspective of comparative medicine are rare. The objective of this study was to explore the vascular anatomy of the medial femoral condyle in pigs, explore the surgical procedure of the medial femoral condyle flap in pigs, and compare the medial femoral condyle flap in pigs and humans. ⋯ The vascular anatomy of the medial femoral condyle in pigs and that of humans exhibited great similarities. The medial femoral condyle flap in pigs was as easily harvested as that in humans. Pigs could serve as a suitable animal model for the medial femoral condyle flap.
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Arch Orthop Trauma Surg · Dec 2024
Utility of routine X-ray surveillance following hip sonography for developmental dysplasia in children: a single-center study spanning a decade.
This study evaluates the necessity of routine X-ray follow-ups in children with developmental dysplasia of the hip (DDH), identified through Graf hip ultrasound, a standard component of screening in Germany. The purpose of this study was to investigate the occurrence of radiological deterioration in hips that were initially diagnosed and treated according to established guidelines within a university-based risk-enriched cohort and to identify associated risk factors. ⋯ The data demonstrate pathological findings even after successful conservative treatment of DDH. Worsening of X-ray findings appear less frequent in mild dysplasia. These insights support routine radiographic follow-up assessments after successful conservative therapy. However, further dedicated studies are needed to determine whether patients with initially normal radiographs require radiographic follow-up.