Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jun 2008
Comparative StudyValue of 3D fluoroscopic imaging of acetabular fractures comparison to 2D fluoroscopy and CT imaging.
Intraoperative two-dimensional (2D) fluoroscopy of acetabular fractures is difficult due to the complex three-dimensional (3D) anatomy. Intraoperative 3D fluoroscopy may have particular utility in the evaluation of acetabular fractures. We compared the accuracy of 3D fluoroscopic imaging in evaluating acetabular fracture displacement and implant placement with fluoroscopy and computed tomography (CT) scans. ⋯ 3D-fluoroscopic imaging appears to be extremely accurate in evaluating acetabular fracture constructs. Its sensitivity and specificity for evaluating intraoperative hardware was greater than with 2D fluoroscopy and equivalent to CT scan. Volumetric impactions were also reliably demonstrated on both of the 3D modalities, which were both superior to 2D fluoroscopy. Overall, Iso-C3D multiplanar imaging yields information regarding implant placement and articular reduction that is more detailed and accurate than standard fluoroscopy and is comparable to CT.
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Arch Orthop Trauma Surg · Jun 2008
Quantification of bone strength by intraoperative torque measurement: a technical note.
Bone strength describes the resistance of bone against mechanical failure. Bone strength depends on both the amount of bone and the bone's quality, and the bone strength may be looked upon as a relevant parameter to judge an osteosynthesis' stability. Information about bone strength was barely available intraoperatively in the past. The previous work of our group reported on development and laboratory evaluation of mechanical torque measurement as a method for the intraoperative quantification of bone strength. With the clinical series presented here we intend to verify that the im gesamten Text DensiProbe instrumentation for intraoperative torque measurement and the related measurement method are eligible for intraoperative use based on the following criteria: application of the method may not create complications, the measurement can be performed by the surgeon himself and may only cause a limited increase in the procedure time. ⋯ The data presented clearly indicate that the DensiProbe instrumentation and measurement principle are eligible for routine intraoperative use by trained surgeons. Interpretation of possible correlations between BMD values measured by means of DEXA and the Peak Torque values assessed by DensiProbe has to be considered very carefully, because BMD and Peak Torque analyse bone at a different scale. Only within the framework of a multicenter study it will be possible to include a sufficient number of patients for calculation of the methods' predictive value towards implant failure and to verify acceptance of the method by the surgeons.
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Subtalar dislocation (SD) is an uncommon injury accounting for 1-2% of all dislocations. It involves simultaneous disruption of the talocalcaneal and talonavicular joints, without involvement of the calcaneocuboid or tibiotalar joints or talar neck fracture. We present a retrospective study of pure medial and lateral SDs treated conservatively and discuss the pathogenesis, classification, prognostics and therapeutic aspects of SD. ⋯ Various factors adversely affect outcome, including type of dislocation (lateral/medial, open/closed), severity of the injury, associated fractures, length of immobilization. Management of closed isolated SD is by immediate conservative treatment in order to avoid or reduce the incidence of early soft-tissue and vascular complications and poor long-term outcomes due to post-traumatic arthritis, talus necrosis and subtalar joint stiffness. However, complications may still arise despite correct treatment.
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Arch Orthop Trauma Surg · Jun 2008
Jumbo cups for revision of acetabular defects after total hip arthroplasty: a retrospective review of a case series.
The treatment of acetabular bone defects presents a great challenge in revision total hip arthroplasty (THA). The purpose of this study was to evaluate the clinical and radiological outcome of revision THA using jumbo cups for acetabular reconstruction after applying the bone-grafting technique. We studied 17 patients with acetabular defects ranging from Type 2A to Type 3A according to Paprosky's classification. ⋯ Two acetabular components failed, one due to aseptic loosening and another one due to septic loosening. There was a trend of displacement of the femoral head centre towards the infero-lateral position after using jumbo cups that approached statistical significance (p = 0.065). Closure of acetabular defects of Types 2A to 3A according to Paprosky's classification and type II to III according to the AAOS-score respectively can be satisfactorily accomplished using jumbo cups after applying the bone-grafting technique.
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Arch Orthop Trauma Surg · May 2008
Randomized Controlled TrialEffect of compaction drilling during ACL reconstruction with hamstrings on postoperative tunnel widening.
This study investigates whether the amount of tibial and femoral bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction with hamstrings can be reduced by compaction bone tunnel drilling. ⋯ Level 4.