Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2020
ReviewPosterolateral corner of the knee: a systematic literature review of current concepts of arthroscopic reconstruction.
Injuries of the posterolateral corner (PLC) of the knee lead to chronic lateral and external rotational instability and are often associated with PCL injuries. Numerous surgical techniques for repair and reconstruction of the PLC are established. Recently, several arthroscopic techniques have been published in order to address different degrees of PLC injuries through reconstruction of one or more functional structures. The purpose of this systematic review is to give an overview about arthroscopic techniques of posterolateral corner reconstructions and to evaluate their safeness. ⋯ Different approaches to arthroscopic PLC reconstruction are presented, yet clinical results are scarce. Up to now good and excellent clinical results are reported. No major complications are reported in the literature so far.
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Arch Orthop Trauma Surg · Dec 2020
Comparative StudyComparing iatrogenic radial nerve lesions in humeral shaft fractures treated with helical or straight PHILOS plates: a 10-year retrospective cohort study of 62 cases.
Humerus shaft fractures are common and often treated surgically with a proximal humerus internal locking system like the long PHILOS® plate. Due to its close anatomical proximity to the humerus, the radial nerve is particularly susceptible to traumatic and iatrogenic damage. The iatrogenic radial nerve damage associated with internal locking systems is described in about 7% of the cases. In order to avoid this lesion, helical plates have been suggested since 1999. This technique continues to not being used as standard as there is still a clear lack of evidence. This study aimed to understand if twisting a long PHILOS plate can reduce the rate of iatrogenic radial nerve damage in humerus shaft fractures. ⋯ Level 3, retrospective cohort study.
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Proximal femoral nail antirotation (PFNA) cut-in is a unique phenomenon seen in pertrochanteric hip fractures treated with the PFNA. Cut-in refers to the superomedial migration of the proximal femoral blade into the femoral head and hip joint. We recognize that cut-in is a completely separate entity from the well-described cut-out failure. This study assesses relevant radiological and patient risks factors for cut-in. ⋯ We propose a standardized nomenclature of "cut-in" for the phenomenon of superomedial migration of the proximal femoral blade. An anatomical neck-shaft reduction, accurate blade placement and increased surveillance for patients with severe osteoporosis are required to reduce the incidence and morbidity of cut-in.
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Arch Orthop Trauma Surg · Dec 2020
Case ReportsCan an acute high-grade acromioclavicular joint separation be reduced and stabilized without surgery? A surgeon's experience.
While the management of Rockwood type III injuries is still a topic of debate, high-grade Rockwood type V injuries are mostly treated surgically, to anatomically reduce the acromioclavicular (AC) joint and to restore functionality. In this case report, we present a method for non-operative reduction and stabilization of a high-grade AC joint injury. ⋯ Non-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option. A "closed reduction and external fixation" approach with the aid of a dedicated AC joint brace can reduce the AC joint and keep it in place until ligamentous consolidation occurs, thus improving AC joint stability and cosmetic appearance without surgical intervention.
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Arch Orthop Trauma Surg · Dec 2020
Higher doses of topical tranexamic acid safely improves immediate functional outcomes and reduces transfusion requirement in total knee arthroplasty.
Topical administration of tranexamic acid (TXA) in patients undergoing total knee arthroplasty (TKA) is increasingly popular as it avoids the risks related with systemic absorption of the medication. Previous studies have established the efficacy of TXA in TKA, however here are limited direct comparison studies available and the dosing regimens vary. Hence, there is no consensus on an optimal dose. Our objective is to compare blood loss, transfusion requirement and immediate post-operative function between high (2 g) and low (1 g) dose tranexamic acid in patients undergoing TKA. ⋯ Higher dose of topical TXA is safe, helps improve immediate post-operative functional outcomes and reduces transfusion requirements.