Archives of orthopaedic and trauma surgery
-
Arch Orthop Trauma Surg · Dec 2014
Removal of forearm plate leads to a high risk of refracture: decision regarding implant removal after fixation of the forearm and analysis of risk factors of refracture.
Plate fixation is the gold standard for the treatment of forearm fractures at present, and whether or not to remove the implant after bone union remains controversial. This study demonstrated some cases of refracture in adult forearm fractures after bone union and discussed the risk factors for decision-making regarding implant removal. ⋯ The incidence of refracture was significantly lower in the group that retained the implant. Routine implant removal after bone union in adult forearm fractures is not recommended due to the higher refracture rate.
-
Arch Orthop Trauma Surg · Dec 2014
Anatomical transosseous fixation of the deep and superficial fibers of the radioulnar ligaments.
The triangular fibrocartilage complex is in conjunction with the interosseous membrane the most important stabilizer of the distal radioulnar joint. Lesions of the triangular fibrocartilage complex may cause instability of the distal radioulnar joint with serious consequences. Therefore, the goal is to reconstruct and provide stability to prevent further harm. ⋯ This technique is quite simple and addresses the anatomical configuration of the radioulnar ligaments.
-
Arch Orthop Trauma Surg · Dec 2014
The "lateral gutter drive-through" sign revisited: a cadaveric study exploring its real mechanism based on the individual posterolateral structure of knee joints.
Although the validity of the "lateral gutter drive-through" (LGDT) test has been proved to offer high sensitivity and specificity in diagnosing the posterolateral rotational instability of knee joints, the real mechanism on how the injury pattern of individual posterolateral knee structure triggers the positive LGDT sign still remains unknown. ⋯ Accuracy of the LGDT test in diagnosing acute or chronic posterolateral corner (PLC) injuries will improve with the information in this study. It was the combined POP-T and PFL injuries that finally led to a positive LGDT sign. However, one should be cautious to use the LGDT test in diagnosing the PLC injuries when posteromedial structures and cruciate ligaments were all involved.
-
Arch Orthop Trauma Surg · Dec 2014
Reconstruction of a chronic patellar tendon rupture with semitendinosus autograft.
Successful outcome following patellar tendon rupture requires robust restoration of the extensor mechanism continuity. Rupture of the patellar tendon occurs most commonly in patients younger than 40 years and is the result of an indirect large force generated by contraction of the quadriceps, which is estimated to be at least 17.5 times of body weight. ⋯ We suggest that the hamstring tendon autograft is a safe, effective, and acceptable choice for patellar tendon reconstruction, and that it affords good ligament reconstruction.
-
Arch Orthop Trauma Surg · Dec 2014
Think twice before re-manipulating distal metaphyseal forearm fractures in children.
Treatment of displaced paediatric distal forearm fractures is not always successful. Re-occurrence of angular deformity is a frequent complication. No consensus exists when to perform secondary manipulations. The purpose of this study was to analyse the long-term outcome of re-angulated paediatric forearm fractures to determine if re-manipulations can be avoided. ⋯ Re-manipulation of distal forearm fractures in children <12 years did not improve outcomes, deeming re-manipulations unnecessary. Children ≥12 years in the conservative group achieved satisfactory outcomes despite re-angulations exceeding current guidelines. Based on observed remodelling, we now accept up to 30° angulation in children <9 years; 25° angulation in children aged 9-<12; 20° angulation in children ≥12 years, when re-angulation occurs. We conclude that clinicians should be more reluctant to perform re-manipulations.