Acta Orthop Belg
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Arthroscopic treatment of septic arthritis of the hip is still not an established technique despite its minimally invasive nature and low morbidity. The goal of this study is to present the results of arthroscopic drainage and lavage for the treatment of septic arthritis of the hip in children over the age of six years. A three portal arthroscopic technique was used for drainage and irrigation in six children with septic coxitis. ⋯ No complications occurred in this group of children. Three directional arthroscopic surgery combined with large volume irrigation appeared as an effective treatment modality in cases of septic arthritis of the hip. It is less invasive than arthrotomy, and offers low post surgical morbidity.
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In intramedullary tibial nailing, multi-planar locking makes stabilization of proximal and distal metaphyseal fractures possible. A known complication in intramedullary nailing of the tibia is iatrogenic injury to neuro-vascular structures caused by the insertion of locking screws. As shown in previous studies, the distal positioning of the nail is important, as it determines the course of the locking bolts. ⋯ Human cadaveric legs were plastinated according to the sequential plastination technique after intramedullary nailing of the tibia and were then cut transversely. The tibial nails were placed centrally or posteriorly. Macroscopic analysis showed a distinct drawback of posterior nail positioning, with diminished options for the placement of the locking screws and thereby a risk of damaging the anterior and posterior neuro-vascular bundles by distal medio-lateral locking screws.
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Case Reports
Intraspinal metalloma causing lumbar stenosis after interbody fusion with cylindrical titanium cages.
Intraspinal metallomas are rare. The authors present a case after implantation of two titanium threaded interbody cages at the L4L5 level, without posterior instrumentation. ⋯ Subsequently, friction generated wear debris, which led to the formation of a granuloma, responsible for compression of the dural sac. Intraspinal metallosis should be kept in mind as an infrequent cause of delayed neurological symptoms after spinal surgery with metallic instrumentation.
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Interlocking intramedullary nailing is currently the preferred treatment for most tibial fractures requiring operative treatment, with good results and a relatively low complication rate as reported in large clinical series. However, vascular and neurological complications caused by interlocking screws have been reported. In addition, insertion of distal interlocking screws can be technically demanding and may entail substantial exposure. ⋯ Complications were those usually seen in diaphysis nailing and no complication was noted during nail expansion. Interlocking screws are not necessary, which reduces the risk of iatrogenic lesions. The expandable nail allows effective management of AO type A and B diaphyseal fractures of the tibia, a lower radiation exposure and shorter operative time.