Acta Orthop Belg
-
The aim of this study was to assess the results of percutaneous injection of autologous bone marrow in the treatment of fractures presenting with delayed union or non union after internal fixation. Twenty consecutive patients presenting to our outpatient clinic with internally fixed fractures with delayed union or non union were included in the study. ⋯ Nineteen out of the twenty fractures achieved clinical and radiological union, on average after 2.95 months. In this series, percutaneous bone marrow injection appeared as a simple and effective method to accelerate fracture healing in patients with delayed union and nonunion of fractures.
-
Assessment and treatment of osteoporosis are recommended following hip fracture. Osteoporosis treatment assumes an adequate calcium intake and a normal vitamin D plasma level. The authors conducted a study in three phases. Phase I: circulating 25-hydroxyvitamin D levels were retrospectively recorded from in the case records of 381 consecutive patients with 387 hip fractures, between March 2010 and September 2011. Only 27 patients had sufficient (> 75 nmol/L) circulating vitamin D, and of these 22 were taking vitamin D supplements. The remainder, 354 patients, had abnormally low vitamin D levels, with a mean value of 26.4 nmol/L. These findings confirmed literature data, and gave rise to the prospective Phase II (October 2011): 14 consecutive patients with a hip fracture received rapid substitution therapy with 50,000 IU cholecalciferol (vitamin D3) daily for 3 days. Patients with corrected calcium level (calcium level based on the serum albumin level) > 2.60 mmol/L were excluded from phase II (and phase III), in order to avoid hypercalcemia. Substitution resulted in an increase in vitamin D plasma levels from +/- 29.6 nmol/L to +/- 81.4 nmol/L (p < 0.0001), after +/- 14 days. However, vitamin D level remained below the desired threshold of 75 nmol/L in 29%. Therefore it was decided to increase the treatment period from 3 days to 7 days in the next 54 patients with a hip fracture in a prospective phase III (October 2011-January 2012). This time rapid substitution resulted in an increase from +/-31.4 nmol/L to +/-131.1 nmol/L (p < 0.0001), after +/- 16 days, and 100% of treated patients achieved plasma levels above the desired threshold of 75 nmol/L. ⋯ virtually all patients with a hip fracture have low vitamin D plasma levels; substitution with 50,000 IU oral cholecalciferol daily for 7 days increases vitamin D plasma levels rapidly, safely and consistently.
-
Large head modular metal-on-metal total hip replacement (MoMTHR) has been shown to have increased revision rates in the National joint registry and in literature. We reviewed 41 consecutive patients with 44 hips who had large head MoM THR using a Birmingham Hip Resurfacing (BHR) cup/Synergy stem combination between June 2005 and Nov 2009 with a mean followup of 59.5 months. ⋯ Kaplan-Meier analysis showed a mean cumulative survival rate of 79.2% (95% CI: 75.5%-82.9%) In addition there is a subset of 5/44 patients (113%) with mild grade groin pain who may need revision in the future. Based on these findings, we do not recommend performance of large head MoMTHR in the future.
-
The aim of this study was to better quantify the role of delayed MRI scans in acute wrist injuries, and to assess the prevalence and distribution of multiple occult injuries of the wrist. A retrospective study was made of all patients who had been referred to the orthopaedic trauma clinic for a possible scaphoid fracture and with normal radiographs over a two year period. There were 110 patients. ⋯ The MRI scan is a useful tool in obtaining a definite diagnosis in acute wrist injuries. Among other findings, an occult scaphoid fracture was diagnosed on MRI in 2.7% of cases in this study. To conclude, in the majority of patients with persisting symptoms after two weeks following a wrist trauma, the cause of symptoms was pathology in other tissues in the wrist including soft tissues, other carpal bones and distal forearm.
-
The Thrust Plate Prosthesis is a femoral implant designed for total hip arthroplasty, based on the principles of physiologic loading of the metaphysis of the proximal femur, and preserving the bone stock. This study presents the long-term clinical and radiological results of 34 patients with 36 Thrust Plate Prostheses. In a retrospective analysis, we investigated the reoperation-free survival as well as the clinical and radiological results. ⋯ The major complaint was pain at the lateral side of the hip (44%). Radiolucencies did not exceed 1 mm, but 35% of the hips showed resorption of the cortex directly under the thrust plate, together with cancellous bone hypertrophy at the calcar, noted in 97%. Because of the relatively high reoperation-free survival and favourable radiological results, the Thrust Plate Prosthesis appears as a possible alternative to stemmed total hip arthroplasty, especially in relatively young patients.