Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2012
Evaluation of long-term outcomes of pasteurized autografts in limb salvage surgeries for bone and soft tissue sarcomas.
Pasteurized autografts used in limb salvage operations for malignant musculoskeletal tumors have several advantages, including reduced disease transmission, economic efficiency, accessibility, and anatomical conformation. However, their use has been associated with bone absorption, fracture, and pseudarthrosis. Few studies exist which have assessed the long-term outcomes of pasteurized autografts. The purpose of this study was to investigate the clinical outcomes of patients treated with pasteurized autografts and to compare these outcomes across various graft types. ⋯ Our findings show that pasteurized bone grafts in combination with vascularized fibular grafts have improved outcomes and potential clinical indications.
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Arch Orthop Trauma Surg · Nov 2012
Comparative StudyRelative role changing of lateral collateral ligament on the posterolateral rotatory instability according to the knee flexion angles: a biomechanical comparative study of role of lateral collateral ligament and popliteofibular ligament.
This cadaveric study assessed the relative role of the lateral collateral ligament (LCL) and popliteofibular ligament (PFL) in limiting tibia external rotation. ⋯ The PFL and LCL play equally important roles in limiting external rotation at the knee extended position (0°, 30°) but the LCL contribution becomes smaller than PFL at the flexed position (60°, 90°).
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Tears of the abductor mechanism of the hip are well recognized, but poorly understood. Little is known of the effect of demographics and pathology on prevalence of abductor mechanism tears or the impact on clinical outcome. ⋯ Tears are increasingly prevalent in women of advancing years and lower socioeconomic status which should be considered when planning operative approach in this demographic. When recognised and repaired there is no difference in the clinical outcome for those with abductor mechanism tears of the hip.
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Arch Orthop Trauma Surg · Nov 2012
Case ReportsIs augmentation a possible salvage procedure after lateral migration of the proximal femur nail antirotation?
Failed fracture fixation of proximal femur fractures in the elderly usually results in prosthetic replacement. In case of the proximal femur nail antirotation (PFNA), during lateral blade migration or periimplant fracture at the femoral shaft, the femoral head remains intact and therefore a joint preserving procedure might be performed. However, implant anchorage in the femoral head after the second blade implantation generally results in reduced anchorage in the remaining cancellous bone. Therefore, we hypothesize that in the above mentioned cases augmentation of the PFNA blade could be a treatment option before prosthetic surgery has to be performed. ⋯ Augmentation of simulated blade exchange after lateral blade migration demonstrated a good anchorage. There was superior rotational stability in the revised case and no inferiority during pull out for the investigated specimens. Furthermore, augmentation could compensate for destroyed trabeculae and poor bone stock. It could furthermore be an option when a failed implant has to be replaced by a long PFNA in case of shaft fracture at the tip of the implant to increase anchorage in the femoral head. From a biomechanical point of view, reosteosynthesis and augmentation in selected cases of PFNA revision could be an alternative to initial prosthetic replacement. In the case of cut-out or medial implant protrusion, the suggested salvage technique is not feasible.
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Arch Orthop Trauma Surg · Nov 2012
Anatomical evaluation of the rectus femoris tendon and its related structures.
The purpose of this study was to evaluate the anatomical structure of the quadriceps tendon in detail for use as an anterior cruciate ligament (ACL) graft tendon. ⋯ If the RF tendon only is used as an ACL graft, surgeons should be cautious of the fact that the narrowest point of the RF tendon is located close to the patella. The entire quadriceps tendon is big enough to be used as an ACL graft. However, since the direction of the VL and VI tendons is different, the suitability of the quadriceps tendon as an ACL graft is questionable.