Acta Orthop Belg
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The aim of this study was to analyze the bone remodeling around the Nanos stem (Smith & Nephew, Marl, Germany) after primary total hip arthroplasty for coxarthrosis. In 25 patients (15 male, 10 female, mean age 59.9 years) with the diagnosis of coxarthrosis, a DEXA scan was performed immediately after surgery, 97 days (SD 6.1 days) and 368 days (SD 6.2 days) after implantation of a Nanos prosthesis. Plain radiographs were analyzed digitally for radiolucent lines, varus-valgus femoral stem alignment, measurement of stem migration and changes in varus-valgus femoral stem alignment. ⋯ There was no significant difference between the position of the COR and the pre- and postoperative offset. The absence of stem migration, angulation, or relevant radiolucent lines is seen as evidence for an unimpaired osseointegration of the Nanos stem approximately 12 months after implantation. It is concluded that the Nanos prosthesis can reduce loss of BMD of the proximal femur composed with conventional stems or other short-stemmed implants.
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In paediatric patients with fractures of the distal radius, the consequences of associated ulnar styloid fractures are often underestimated. These may include persisting pain or functional deficits. The aim of the present study was to report the outcome of these fractures using a modified DASH-Score. ⋯ Fractures of the base of the styloid process were more likely to develop non-union compared to fractures of its tip. The presence of an ulnar styloid fracture negatively influences the outcome of distal radius fractures. Patients with lesions of the ulnar styloid should be followed until union is observed and/or they are asymptomatic.
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Retained intramedullary femoral nails can pose a problem for the implantation of the femoral component during total hip arthoplasty (THA) and they must often be removed. A patient with a retained Küntscher femoral nail implanted 47 years previously presented in our outpatient clinic for a THA. Since removal of the nail was impossible without severe damage to the femur, we chose to perform an extended trochanteric osteotomy, to cut the proximal part of the nail and to implant a cemented short stem with its tip in the hollow end of the nail.
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Parsonage-Turner syndrome (PTS) is a distinct clinical syndrome, characterized by acute and severe (mostly) unilateral shoulder pain, followed by paresis and atrophy of the shoulder girdle, while the pain decreases. Most authors consider it as an immune-mediated disorder. PTS is notoriously unrecognised and is usually diagnosed with delay. ⋯ Arguments for PTS are: a certain delay between surgery and symptoms, intolerable pain followed by weakness and improvement of pain complaints, divergent distribution of weakness, sensory deficit and pain, which may be confirmed by electrodiagnosis. Early recognition of postsurgical PTS may avoid unnecessary investigations or surgical exploration. It allows to treat the patient properly, leading to greater satisfaction of both surgeon and patient; pain management, physical therapy and reassurance are the cornerstones.
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Necrotising fasciitis of the extremities is a rapidly progressive, potentially life threatening soft tissue infection. Early diagnosis, aggressive surgical and critical care management is vital in preventing mortality. This series reports the clinical presentation, behaviour of inflammatory markers, histological, microbiological and radiological findings in seven cases, which presented to our orthopaedic unit over the last one year. ⋯ Treatment modalities included antibiotics, immunoglobulins and surgical debridement. Four of the patients showed full remission. However, three (one with pre-existing carcinoma) of them succumbed to the condition.