Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Aug 2023
Correlation of head screw lengths in proximal humerus nailing: a CT-based study on 289 cases.
Nailing of the proximal humerus is an established method for the treatment of proximal humerus fractures. Choice of the correct length for potentially four proximal locking screws is essential for postoperative outcome. Due to positioning of the patient, intraoperative determination of the correct length of the anteroposterior (AP) screw with the x-ray beam is particularly challenging even for experienced surgeons. We hypothesized that there would be a correlation between the projected lengths of the different proximal locking screws and therefore the length of the AP-screw could be determined based on the three lateromedial (LM) screws. ⋯ This study was able to show that the length of the AP-screw could be determined from the intraoperatively measured lengths of the LM-screws. As our findings base on measurements performed in CT scans, clinical studies are needed to support our data.
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Arch Orthop Trauma Surg · Aug 2023
Smokers have increased risk of soft-tissue complications following primary elective TKA.
Smoking has been associated with numerous adverse outcomes following surgical procedures. The purpose of this study was to investigate, whether smoking status at time of surgery influences the outcome of primary TKA. ⋯ Current smoking increases risk of soft-tissue complications and revision after primary TKA, especially due to hematoma and restricted movement. Smoking cessation programs could reduce the risk of revision surgery.
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Arch Orthop Trauma Surg · Aug 2023
The optimal diagnostic cut-off of WBC and PMN counts for joint aspiration in periprosthetic joint infection is 2479/µL and 67%, respectively: ICM criteria thresholds are too high.
Various organizations have published definitions for periprosthetic joint infection (PJI) with significant differences in the cut-offs of white blood cell (WBC) count and polymorphonuclear (PMN) leukocyte cells. Herein, we aim to analyze optimal cut-offs in patients which are planned to undergo a prosthesis revision and compare them with the actual published thresholds of the International Consensus Meeting (ICM) and European Bone and Joint Infection Society (EBJIS). ⋯ II.
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Arch Orthop Trauma Surg · Aug 2023
The effects of hypoalbuminemia in obese patients undergoing total joint arthroplasty.
Total joint arthroplasty (TJA) is a highly effective surgery. However, poor nutritional status has been associated with worse outcomes. In orthopedics, nutrition status is commonly evaluated using serum albumin. When albumin levels fall below 3.0 g/dL, wound healing ability becomes impaired. Typically, malnutrition is associated with low BMI, but malnourished patients can also be obese. The goals of this study were to investigate the relationship between malnourishment represented through albumin levels of obese patients and likelihood of postoperative complications. ⋯ Our results demonstrated the prevalence of malnutrition increases as a patient's BMI increases. Further, hypoalbuminemia was associated with increased resource utilization and increased complication rates in all obese patients. We suggest screening albumin levels in obese patients preoperatively to give surgeons the best opportunity to optimize patient nutrition before undergoing surgery.
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Arch Orthop Trauma Surg · Aug 2023
Complications and revisions in anatomic and reverse short stem shoulder arthroplasty.
One current trend in the field of shoulder arthroplasty is a design shift to shorter and metaphyseal fixed humeral stem components. The aim of this investigation is to analyze complications resulting in revision surgery after anatomic (ASA) and reverse (RSA) short stem arthroplasty. We hypothesize that complications are influenced by the type of prosthesis and indication for arthroplasty. ⋯ Primary reverse shoulder arthroplasty had a significantly higher rate of complications and revisions than primary and secondary anatomic shoulder arthroplasty, respectively. Therefore, indications for reverse shoulder arthroplasty should be critically questioned in each individual case.