Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Sep 2013
Case ReportsAutologous double-barrel vascularized fibula bone graft for arthrodesis of the shoulder after tumor resection.
Arthrodesis of the shoulder is a straightforward and established alternative to reconstruct the shoulder function after tumor resection of the proximal humerus. In most cases, some kind of intercalary bone graft is used to bridge the bony defect. However, due to low stability of a single fibula autograft and disadvantages of exogenous graft material when performing combined allo- and autograft reconstruction, efforts to develop new surgical techniques, with the intention to lower the complication rates, are ongoing. ⋯ The fibula's unique dual endosteal and periosteal blood supply makes it effective as a double-barrel bone graft for major long bone defects, which requires extra bone volume to prevent fractures until bone hypertrophy occurs. Additional bone and scar formation between the two struts are believed to provide a stable and long lasting construct, as seen in our patients.
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Osteomyelitis is a challenging diagnosis for every patient because of its protracted treatment process. Very experienced orthopaedic surgeons are needed to diagnose and treat this bacteria-related severe disorder in a right and proper way. ⋯ The treatment of osteomyelitis should be done in centres with expertise in the treatment of this challenging disease. Different methods should be offered by surgeons and individual treatment concepts acquired together with the patient. The treatment of complications like soft tissue defects should be provided in the same centre and performed in short time lag to the prior surgery. The cooperation of the patient and surgeons of different specialities is mandatory in these cases.
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Arch Orthop Trauma Surg · Sep 2013
Evidence of an autoregulatory mechanism of regional bone blood flow at hypotension.
Blood flow in various organs is determined by an autoregulatory mechanism that guarantees constant organ perfusion over a wide range of arterial blood pressure changes. This physiological principle has been proven for the kidney, brain and intestinal tract, but so far not for bone. This study was carried out to determine whether there is an autoregulatory mechanism of bone or not. ⋯ The correlation between arterial pressure and organ perfusion in the bone is similar to blood flow within the kidney, indicating the presence of an autoregulated blood flow mechanism within the bone tissue.
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Arch Orthop Trauma Surg · Sep 2013
Impact of tendon suturing on the interference fixation strength of quadrupled hamstring tendon grafts.
Interference screw fixation of soft tissue grafts has been a widely used fixation technique for cruciate ligament reconstruction. Suturing of the graft construct prior to graft fixation has been proposed to increase fixation strength; however, the effect on mechanical properties has not been well characterized. The goal of this study was to determine whether uniform suturing of the tendon graft affects (1) ultimate fixation strength of the hamstring tendon graft and (2) motion of the tendon in the bone tunnel during cyclic loading when comparing sutured grafts vs. unsutured grafts. ⋯ This study confirms that suturing of the graft construct before interference screw fixation may increase ultimate failure load. However, an improvement of structural properties in response to cyclic loading with sub-maximal loads could not be confirmed. Clinicians using interference screw fixation may suture the graft to improve fixation strength; however, suturing does not appear to allow a more aggressive rehabilitation after surgery.
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Arch Orthop Trauma Surg · Aug 2013
Comparative StudyComparison of tunnel locations of double bundle ACL reconstruction using the conventional transtibial technique with anatomic tunnel locations using a 3D CT model.
The purposes of this study were: (1) to compare tunnel locations using the conventional transtibial technique with reference data, and (2) to identify factors that make it difficult to position the femoral tunnel correctly or contribute to breakage of the bone bridge between the two tibial tunnels. ⋯ It seems that conventional transtibial drilling technique used during double bundle ACL reconstruction does not reproduce correct tunnel locations compared with reference data. This problem was found to be related to the bony geometry of the medial wall of the lateral femoral condyle or the bone bridge between the two tibial tunnels. Our results indicate that RBL should be determined by pre-operative CT or plain lateral radiography, and that transtibial single bundle reconstruction or double bundle reconstruction using other methods should be attempted when the RBL exceeds 1.14.