Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Apr 2020
Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture.
Geriatricians have been increasingly involved in the pre-operative process in frail elderly patients with a hip fracture which can benefit re-hospitalization, post-operative functional performance, and mortality. The objective of this study was to compare the number of older patients with hip fractures who opted for non-surgical management after the addition of pre-operative comprehensive geriatric assessment (CGA) with shared decision making by a geriatrician to usual care. Secondary objectives were: reasons for non-surgical management, duration of life, and location of death. ⋯ The geriatrician can have an important role in decisions for non-surgical management by shared decision making in the pre-operative period in patients ≥ 70 years with a hip fracture in the emergency room.
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Arch Orthop Trauma Surg · Apr 2020
Comparative StudyComparison of various tendon repair techniques in extansor zone 3 injuries: an experimental biomechanical cadaver study.
To compare five different repair techniques for extensor tendon zone III modified Kessler (MK), double-modified Kessler (DMK), modified Kessler epitendinous (MKE), double-modified Kessler epitendinous (DMKE), and running-interlocking horizontal mattress (RIHM) in terms of shortening, stiffness, gap formation, and ultimate load to failure. ⋯ RIHM was found to be stronger and more durable for extensor tendon zone III than the other techniques in terms of ultimate load to failure and stiffness.
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Arch Orthop Trauma Surg · Apr 2020
Tactile techniques are associated with a high variability of tunnel positions in lateral extra-articular tenodesis procedures.
The purpose of this study was to determine the variability of femoral tunnel positions applying two different lateral extra-articular tenodesis (LET) techniques, guiding on the tactile identification (1) of the lateral epicondyle (Lemaire procedure) and (2) of the Kaplan fibre attachments on the distal femur (MacIntosh procedure) and to analyse whether one of these procedures is more suitable for reliable femoral tunnel positioning in LET procedures. ⋯ Femoral tunnel positions in LET procedures have a high degree of variability and inaccuracy. Palpating anatomic landmarks appears to be insufficient to generate reproducible tunnel positions. Radiographic landmarks may enable more reproducible identification of isometric femoral tunnel positions and reduce malpositioning.
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Arch Orthop Trauma Surg · Apr 2020
Pre-operative templating in THA. Part II: a CT-based strategy to correct architectural hip deformities.
Pre-operative templating for total hip arthroplasty (THA) remains inaccurate due to improper magnification and alignment. We aimed to describe an improved templating strategy using computed tomography (CT) to predict component sizes and offsets with greater accuracy. ⋯ We described a strategy for pre-operative templating in THA. Despite the accuracy of CT, the authors found significant variations between planned and post-operative reconstructions, which suggest that pre-operative templating should only be used as an approximate guide.
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Arch Orthop Trauma Surg · Apr 2020
Dual-energy CT as an innovative method for diagnosing fragility fractures of the pelvic ring: a retrospective comparison with MRI as the gold standard.
As the average age of society increases, so does the number of cases of fragility fractures of the pelvis (FFP). Magnetic resonance imaging (MRI) can visualise associated oedema and is thus the gold standard for diagnosing such fractures. MRI, however, is costly, not always available, and involves certain exclusion criteria. Dual-energy computed tomography (DECT) appears to be a promising alternative. It is unclear, however, whether it could be used for diagnosing FFP with similar sensitivity/specificity. The aim of our study was thus to compare conventional CT and DECT with MRI in cases of suspected FFP. ⋯ Our study shows DECT to be reliable and superior to conventional CT in terms of oedema detection and specific fracture classification in FFP. DECT thus combines the advantages of conventional CT (good visualisation of bone matter) and MRI (medullary cavity and visualisation of occult fractures).