Acta Orthop Belg
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Randomized Controlled Trial
No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients.
We performed a prospective, randomised controlled trial to assess the differences in the use of a conventional suction drain, an Autologous Blood Transfusion (ABT) drain and no drain, in 168 patients. There was no significant difference between the drainage from ABT drains ( mean : 345 ml) and the suction drain (314 ml). ⋯ Patients that did not have a drain inserted stayed in hospital a significantly shorter period of time, compared with drains. We feel the benefits of quicker drying wounds, shorter hospital stays and the economic savings justify the conclusion that no drain is required after hip replacement.
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Case Reports
Epidural abscess T5T8 due to methicillin-resistent staphylococcus aureus in an immunocompetent patient.
A 28-year-old man was admitted with severe thoracic pain, a body temperature of 37.20, paraplegia and sphincter disturbances. MRI revealed an epidural abscess T5T8. A decompressive laminectomy T5T8 was performed and the abscess was removed. ⋯ MRI is the first choice diagnostic tool. Laminectomy, drainage and intravenous antibiotics constitute the basic treatment. Antibiotics alone can be sufficient in case of whole spine involvement, lumbosacral localization without neurological symptoms, fixed neurological deficit, complete paralysis for more than 72 hours, or severe concomitant medical problems.
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An ageing population and greater number of hip and knee replacements performed have led to an increasing number of patients with ipsilateral hip and knee replacements in situ. This often physiologically suboptimal population is at risk for periprosthetic fracture. An interprosthetic femoral fracture represents a unique challenge to the surgeon and requires a detailed multidisciplinary management strategy involving both fracture fixation and often complex revision. ⋯ We believe this fracture pattern presents to the general orthopaedic surgeon a unique challenge, which bridges the expertise of the trauma and revision surgical spectrum. It is obvious that this will become an increasing issue with the median age of the population increasing. This case series highlights the need for ready availability of biological, arthroplasty and trauma systems to address such.
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The aim of this study was to determine the functional outcome and radiological results after open and arthroscopic stabilization of the acromioclavicular joint using a double-button fixation system. We reviewed 16 patients that were surgically treated for acromioclavicular dislocation using a double-button fixation system. An arthroscopic technique was used in 9 patients for acute injuries and an open technique in 7 patients for subacute or chronic lesions. ⋯ Only one patient experienced a redislocation after new trauma and needed revision surgery. Operative treatment of grade 3 and 4 acromioclavicular dislocations, using a double button coracoclavicular fixation system, yielded good functional results with full return to work and recreational activities. Arthroscopic coracoclavicular fixation without CA ligament transfer should be reserved for acute injuries within 2 weeks after the trauma.
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The objective of this prospective consecutive cohort study was to investigate the effect of sagittal cervical profile, gender and age on the thoracic kyphosis in 228 subjects, mainly adults, free of spinal complaints and with a thoracic kyphosis of less than 500. The subjects, who were actually treated for lower extremity problems, were divided into two groups: the 68 subjects in group 1 (30%) had loss of cervical lordosis, while the 160 subjects in group 2 (70%) had a physiological cervical lordosis. In group 1 (loss of cervical lordosis) the mean angles of the upper (T1T6), lower (T7T12), and whole (T1T12) thoracic kyphosis were 8 degrees +/- 2 (range: 3-28 degrees), 15 degrees +/- 4 (range: 6-400), and 24 degrees +/- 6 (range: 10-46 degrees), respectively. ⋯ Also age had no influence, neither in group 1 nor in group 2 as a whole, but in group 2 advanced age (> 50 years) was correlated with a significant increase in the lower (T7T12) (p = 0.009) and whole (T1T12) thoracic kyphosis (p = 0.007). This study yields standards for reference for the normal curvatures of the spine in the sagittal plane. The literature is quite controversial on this matter.