Acta Orthop Belg
-
The reconstruction of large bone defects in the infectious environment is still a big challenge for limb salvage because of disturbance in bacterial flora, bacterial resistance and limitation of blood supply at scarred tissue. This retrospective study was to evaluate long-term outcomes in patients who were performed vascularized fibular transfers for treatment of large bone defects in the infectious environment. The review included 26 patients with an average age of 27 years old. ⋯ Three patients had partial necrosis of skin paddle. Three patients, who were stabilized by screw and external fixator, had an infection at the distal part of the fibular graft and pin tracts. 25 fibular grafts (96%) showed complete bone union. This review has showed that the vascularized fibular transfer can be effective for management of large segmental bone defects in the infectious environment.
-
Randomized Controlled Trial Comparative Study
Randomized controlled trial comparing stabilization of fresh close femoral shaft fractures in children with titanium elastic nail system versus stainless steel elastic nail system.
In vitro mechanical studies have demonstrated equal or superior fixation of pediatric femoral fractures with use of titanium elastic nails (TENS) as compared with stainless steel elastic nails (SSEN). SSEN are less expensive as compared to TENS. However, there are only two studies in the English literature which have compared the results of TENS and SSEN in paediatric femoral shaft fracture. ⋯ Both groups showed a similar rate of complication, most common being prominent hardware. TENS and SSENS are equally effective treatment modalities for paediatric femoral shaft fracture with similar rate of complications. However, SSENS is less costly as compared to TENS and can be considered as an alternative in a resource constrained setup.
-
Heterotopic ossification (HO), the ectopic formation of bone in soft tissues, is a relevant musculoskeletal disorder that, by reduction of range of motion, may lead to significant impairment of quality of live. HO can either be acquired or hereditary. Acquired HO is seen most often after hip prosthetic surgery and pelvic trauma. ⋯ Hence, selection of the appropriate animal model for the study of HO is exceedingly important. The present paper reviews the history and major features of the different animal models of acquired HO, and reveals some of the insights gained through the study of animal models; important biochemical and pathophysiological key features are highlighted. Clinical studies have proved indometacine, celecoxib and radiation therapy to be effective in reducing the occurrence of HO, but not always be able to prevent it.
-
Surgically accessible aneurysmal bone cysts (ABC) have traditionally been treated with curettage. Selective arterial embolization was initially proposed as a preoperative adjuvant to reduce peroperative bleeding. Currently, the role of embolization has been extended to the definitive treatment of aneurysmal bone cyst of the spine in children, as well as to other locations in the skeleton. ⋯ Selective arterial embolization (SAE) is a minimally invasive, safe and effective procedure for the permanent occlusion of the pathological feeding vessels of spinal ABC. It should be considered as the treatment of choice for lesions difficult to access with surgery, especially in young patients. Careful pre-embolization vascular mapping of the lesion, operator's experience and use of NBCA are the keys to success.
-
The Disability of the Arm, Shoulder and Hand (DASH) and the Patient-Rated Wrist Evaluation (PRWE) scores appear most frequently in the literature when assessing functional outcome after distal radius fracture. We aimed to evaluate if the two questionnaires correlate. We reviewed 258 cases of adults who sustained a distal radius fracture over a one year period. ⋯ The results of both questionnaires correlated strongly (Spearman's coefficient = 0.90). As the DASH score is potentially influenced by concomitant upper limb problems we suggest that the specific patient rated wrist evaluation (PRWE) be the sole instrument for assessing the functional outcome of distal radius fractures. This will reduce questionnaire fatigue and standardise the literature.