Acta Orthop Belg
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Ruptures of the patellar and quadriceps tendon are rare injuries requiring immediate repair to re-establish knee extensor continuity and allow early motion. Ultrasound is extensively used as a diagnostic tool before surgery on acute traumatic tears of the patellar tendon and quadriceps tendons. The aim of our study was to evaluate the role of sonography in diagnosing quadriceps and patellar tendon rupture and in differentiating partial from complete tears. ⋯ MRI was 100% accurate. We conclude that ultrasonography is not a reliable method in establishing the diagnosis of acute injuries to the extensor mechanism of the knee, particularly the quadriceps tendon ruptures in the obese and the very muscular patients. If there is clinical ambiguity, MRI scan is a better investigation tool before undertaking surgical treatment.
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A unilateral facet dislocation noted in a 17-year-old boy after an axial cervical trauma proved to be an incidentally encountered preexisting lesion, most likely originating from a forceps delivery at birth. The surgical treatment initially considered was converted to a conservative approach, with full clinical recovery.
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Comparative Study
Comparative study between patients with osteonecrosis and osteoarthritis after hip resurfacing arthroplasty.
The purpose of this study was to compare the clinical outcomes of osteonecrosis (ON) and osteoarthritis (OA) patients after metal-on-metal hip resurfacing arthroplasty (HRA). We retrospectively reviewed our database and identified a study group of 122 HRA cases with the primary diagnosis of ON. A control group of 122 OA cases were randomly selected by a computer program to match the surgical date, gender and the femoral component type and size with the study group. ⋯ Overall survivorship, using any revision as an endpoint, was 88% for ON, compared to 100% for OA at ten years. There were no femoral failures in 47 uncemented femoral cases. Our study suggests that HRA may not be suitable for everyone, such as ON patients.
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Total joint arthroplasty in nonagenarians--a retrospective review of complications and resource use.
Increased age brings with it the potential for increased surgical risk. Assessment of specific age cohorts is necessary to plan future service provision and this is the case in hip and knee arthroplasty as the demand for these procedures is anticipated to increase. We retrospectively reviewed the outcomes, including complications, length of stay and blood transfusion rate, in a cohort of 35 nonagenarians undergoing primary or revision total hip and knee arthroplasty. ⋯ In this appropriately selected group of nonagenarians, we found no evidence to suggest surgery be withheld on the basis of age alone. However, patients with multiple medical comorbidities warrant appropriate assessment and surgical intervention in an institution with appropriate support. Future planning needs to take into account the predicted increase in demand for arthroplasty surgery in this age group.
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Plate fixation of extraarticular distal humeral shaft fracture is often difficult. Traditional techniques do not allow for stable fixation. A single DCP plate may have inadequate purchase in the distal fragment. ⋯ The mean elbow flexion/extension are was 4 degrees to 138 degrees. Infection was reported in two cases and was managed successfully with conservative measures. Postoperative radial nerve contusion was reported in one case with complete resolution within 3 months.