Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2009
The anterior center edge angle in Lequesne's false profile view: interrater correlation, dependence on pelvic tilt and correlation to anterior acetabular coverage in the sagital plane. A cadaver study.
Lequesne's vertical-center-anterior margin (VCA) angle measured on the false profile view of the pelvis aims at quantifying the anterior acetabular coverage of the femoral head. The anterior delimitation of the acetabular roof is often defined on the false profile view but there are no data on its interrater reliability. Additionally, it is not known how pelvic tilt may influence this angle. Finally, the plane in which this angle is measured lies at an angle of 65 degrees to the sagittal plane and we wondered if this angle would be transposable to the anterior acetabular coverage measured in the sagittal plane. ⋯ Lequesne's VCA angle has an excellent interrater reliability and represents a reliable measure of acetabular dysplasia for comparisons with published data. Lequesne's VCA angle is influenced by pelvic tilt in a linear manner. Performing the false profile view in a standing position may reduce the clinical relevance of this dependency on pelvic tilt. The correlation of Lequesne's VCA angle to anterior acetabular coverage in the sagittal plane is low and therefore unsuitable to be transposed into the sagittal plane.
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Arch Orthop Trauma Surg · Jun 2009
Closing lateral wedge valgus osteotomy with dynamic hip screw for the treatment of varus nonunion of pertrochanteric fracture: can restoration of biomechanics and stabilization alone heal?
Nonunion of pertrochanteric fracture is rare and its occurrence especially without prior surgical intervention has been hardly ever reported. Hence there is not much literature describing the best way to treat them. Nonunion of pertrochanteric fracture collapses in to varus by virtue of deforming action of muscles and thus deranging the biomechanics of the hip and indirectly preventing fracture union further. Hence it is very important to re-orient the abductor lever arm to biomechanically advantageous normal configuration favoring fracture healing. In general, principles of treatment of nonunion like open reduction of the fracture with freshening of fracture fragments, stabilization and bone grafting are very difficult to the surgeon and the patient. ⋯ All fractures and osteotomies had healed uneventfully at the last follow-up with good functional outcome. Harris Hip score had improved from 34 +/- 6 (range 22-47) to 89 +/- 4 (range 83-95) at an average of 11 months (range 7-13 months) follow-up. Valgus osteotomy converts shear forces across the fracture site into compressive forces thus achieving union.
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Arch Orthop Trauma Surg · Jun 2009
Mid to long-term results of open acromioclavicular-joint reconstruction using polydioxansulfate cerclage augmentation.
There is still controversy about the optimal operative treatment of acromioclavicular (AC)-joint dislocations. However, in the current literature, only few studies are available on mid- to long-term results of different stabilization methods. This retrospective study presents the clinical and radiographical results after open reduction and stabilization of AC-joint dislocations using polydioxanesulfate (PDS) cerclage augmentation. ⋯ Treatment of AC-joint dislocation using PDS cerclage augmentation leads to good to excellent clinical results. However, mid- to long-term follow-up reveals a high incidence of radiographic signs of osteoarthritis of the AC-joint. Whether this is due to the surgical technique and could be reduced using other, more anatomical fixation techniques or whether the injury itself leads to these changes, need to be shown.
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Arch Orthop Trauma Surg · Jun 2009
Stability changes after cryosurgery in long tubular bones in correlation to histological results: an animal trial.
Pathologic bone fractures in cryosurgery of bone tumors have been described in literature. This study utilizing a sheep model should prove the possible reduction of potential fracture while using a new miniature cryoprobe minimizing tissue damage and providing accurate control of the ablation process. Furthermore, postoperative histological changes should be investigated and the results correlated with the stability trials. ⋯ A thorough control of the freezing process and the low iatrogenous weakening of the bone due to placing the probe when modern miniature cryoprobes are used can minimize the risk of pathological postoperative fractures. However, at least 2 months after operation there is histological proof of bone healing with appropriate reduction of bone stability, which should be considered for the clinical application of this new technique.
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We reviewed four patients diagnosed with a cortical desmoid lesion at the distal posterior medial femur. Each case reflects a clinical scenario that can be present. ⋯ Here, we present the specific imaging features in association with patients history and clinical findings facilitating establishment of correct diagnosis. Exact diagnosis is important in order to avoid unnecessary biopsy and complicated therapeutic strategies.