Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2024
Review Meta AnalysisCollagenase clostridium histolyticum injection versus limited fasciectomy for the treatment of Dupuytren's disease: a systematic review and meta-analysis of comparative studies.
The aim of the present study is to systematically review the literature on well-selected comparative studies for meta-analysis on outcome differences between collagenase clostridium histolyticum (CCH) injection and limited fasciectomy (LF) for Dupuytren's disease. ⋯ Evidence of the present study confirms that CCH injection has a higher rate of disease recurrence whereas LF carries a higher risk for severe complications. It's imperative that the trade-off between these aspects is considered, keeping in mind that CCH injections may be repeated in case of disease recurrence without increasing procedure related risks, especially in complex cases.
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Arch Orthop Trauma Surg · Jan 2024
ReviewKey aspects of soft tissue management in fracture-related infection: recommendations from an international expert group.
A judicious, well-planned bone and soft tissue debridement remains one of the cornerstones of state-of-the-art treatment of fracture-related infection (FRI). Meticulous surgical excision of all non-viable tissue can, however, lead to the creation of large soft tissue defects. The management of these defects is complex and numerous factors need to be considered when selecting the most appropriate approach. ⋯ Specifically we discuss the optimal timing for tissue closure following debridement in cases of FRI, the need for negative microbiological culture results from the surgical site as a prerequisite for definitive wound closure, the optimal type of flap in case of large soft tissue defects caused by FRI and the role of negative pressure wound therapy (NPWT) in FRI. Finally, recommendations are made with regard to soft tissue management in FRI that should be useful for clinicians in daily clinical practice. Level of evidence Level V.
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Arch Orthop Trauma Surg · Jan 2024
ReviewThe 'Holy Grail' of shoulder dislocations: a systematic review on traumatic bilateral luxatio erecta; is it in reality a once-in-a-lifetime experience for an orthopaedic surgeon?
Even though shoulder dislocation is thought to be the most common dislocation treated in the Emergency Department, inferior ones, known as Luxatio Erecta, comprise only 0.5% of them. Taking into consideration the rareness of unilateral Luxatio Erecta, bilateral cases should be even fewer. The purpose of this paper is to identify the reported number of cases of Traumatic Bilateral Luxatio Erecta in the literature over the last 100 years and to summarize the mechanism of injury, the initial management, and the complications of these patients. ⋯ The presence of this injury is extremely rare with only 51 cases in the literature. The incidence of concomitant injuries and complications seems to be extremely high and neurological deficits were detected on 42.8% of patients with Bilateral Luxatio Erecta. To our knowledge, this is the first systematic review of the literature regarding Traumatic Bilateral Luxatio Erecta that includes articles not only in English, a fact that provides more reliability on the estimation of the real number of cases of this rare injury compared to any other review on this subject to date.
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Arch Orthop Trauma Surg · Jan 2024
ReviewChopart dislocations: a review of diagnosis, treatment and outcomes.
Chopart injuries can be allocated into 4 broad groups, ligamentous injury with or without dislocation and fracture with or without dislocation, which must occur at the talonavicular joint (TNJ) and/or calcaneocuboid joint (CCJ). Chopart dislocations are comprised of pure-dislocations and fracture-dislocations. We aim to review the literature, to enable evidence-based recommendations. ⋯ Chopart dislocations are a complex heterogenous midfoot injury with historically poor outcomes. There is a relative paucity of research discussing these injuries. We have offered evidence-based recommendations related to the clinical and surgical management of these rare pathologies.
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Arch Orthop Trauma Surg · Jan 2024
Randomized Controlled TrialAvoiding screw overlength using dorsal horizon view in palmar plate osteosynthesis of distal radius fractures: a prospective randomized trial.
Distal radius fractures are the most commonly reported fractures in adults. Treatment has changed in recent years to open reduction and palmar plate fixation. Penetration of the dorsal screw, however, is a well-known complication. Intraoperative anteroposterior and lateral radiographs lack the exact assessment of dorsal screw length and intraoperative measurement is therefore very likely to be inaccurate in a comminuted dorsal radial cortex. Secondary extensor tendon ruptures are reported in up to 6% following palmar plate fixation of distal radius fracture. ⋯ Based on the results of this study, the dorsal horizon view improves the assessment of the correct screw length and should routinely be used in palmar plate osteosynthesis of distal radius fractures. Since screw protrusion cannot be absolutely ruled out using the dorsal horizon view, monocortical drilling or screw downsizing is still mandatory.