Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Mar 2018
New angle measurement device to control the posterior tibial slope angle in medial opening wedge high tibial osteotomy.
Medial opening wedge high tibial osteotomy has been associated with an unintentional increase in the posterior tibial slope angle. We aimed to evaluate the effectiveness of a novel bone spreader angle rod to maintain the native posterior tibial slope angle in medial opening wedge high tibial osteotomy. ⋯ IV.
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Arch Orthop Trauma Surg · Mar 2018
Observational StudyIs treatment of geriatric hip fracture patients cost-covering? Results of a prospective study conducted at a German University Hospital.
Hip fractures have increased medical and socio-economic importance due to demographic transition. Information concerning direct treatment costs and their reimbursement in Germany is lacking. ⋯ Treatment of geriatric hip fracture patients in a university hospital in Germany does not seem to be cost-covering. Adjustment of the reimbursement for treatment of complex hip fracture patients should be considered.
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Arch Orthop Trauma Surg · Mar 2018
The distance of the gluteal nerve in relation to anatomical landmarks: an anatomic study.
Gluteal insufficiency is of concern with lateral approaches to total hip arthroplasty. Damage to the branches of the superior gluteal nerve may cause degeneration of the innervated muscles. The direct anterior approach exploits the intermuscular and internerval interval between tensor fasciae latae laterally and sartorius and rectus femoris muscle medially. In this study, the distance of the superior gluteal nerve in relation to anatomical landmarks was determined. ⋯ The direct anterior approach for total hip arthroplasty minimizes the risk of injuring the superior gluteal nerve, which may result in a gluteal insufficiency. Special care should be paid on avoiding overstretching the tensor fasciae latea muscle using minimum force on retractors during surgery and by taking care of the entrance point of the superior gluteal nerve to the tensor fasciae latae.
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Arch Orthop Trauma Surg · Mar 2018
The nail-shaft-axis of the of proximal femoral nail antirotation (PFNA) is an important prognostic factor in the operative treatment of intertrochanteric fractures.
Due to the world's aging population, intertrochanteric fractures are frequent. Considering age and comorbidities of most of these patients, it is indispensable to enable early postoperative mobilization of these patients. Intramedullary osteosynthesis with PFN-A is widely used and, in general, considered safe and reliable for the operative treatment of intertrochanteric fractures. However, implant -related complications are reported in 6-21% of all cases. In this study, we are analyzing complication rates and risk factors for implant-related complications. ⋯ When treating introchanteric fractures with PFNA reduction in neutral or even slight valgus, aiming for a TAD < 25 mm and a correct position of the blade within the femoral head reduced the risk for secondary varus displacement significantly. Furthermore, we suggest to aim for a central nail-shaft axis.
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Arch Orthop Trauma Surg · Mar 2018
Medial meniscus grafting restores normal tibiofemoral contact pressures.
Tissue excision in the setting of a meniscal tear has been shown to dramatically increase peak contact stresses in the affected tibiofemoral joint compartment, leading to the development of degenerative changes and osteoarthritis. ⋯ From a static, time zero biomechanical perspective, segmental medial meniscus grafting of a partially meniscectomized knee restored mean pressure, peak pressure, and mean peak contact pressure areas of the medial tibiofemoral joint compartment back to levels observed in the intact medial meniscus at different knee flexion angles. In-vivo analysis under dynamic conditions is necessary to verify the healing efficacy and ability of the healed segmental medial meniscal allograft to provide long-term knee joint homeostasis when confronted with dynamic shear, rotatory, and combined, higher magnitude physiologic loading forces.