Acta Orthop Belg
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Case Reports
Isolated synovial cyst of the acromio-clavicular joint associated with joint degeneration and an intact rotator cuff.
The majority of acromioclavicular joint cysts are the manifestation of underlying pathology of the rotator cuff. A chronic rotator cuff tear should be the first option in differential diagnosis, when facing such a condition, although this is not always the case. A case of a 67-year-old male patient, who abruptly developed a painless lump over his right acromioclavicular joint, is presented. ⋯ Surgical treatment, with cyst removal and resection of the distal end of the clavicle, was performed. The lesion was proved to be a synovial cyst. Eighteen months postoperatively, the patient was asymptomatic and no recurrence of the cyst was evident.
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Comparative Study
Comparison of autologous transfusion drains versus no drain in total knee arthroplasty.
Primary total knee arthroplasty is associated with blood loss both during surgery and in the immediate postoperative period, that may require allogenic blood transfusion. In view of the risks and financial implications of using allogenic blood, an accepted solution has been to utilise autotransfusion drains in the postoperative period thus allowing re-infusion of a patient's own blood. A number of studies have compared retransfusion techniques with standard drain use, but few report comparison with no drain use at all. ⋯ This difference was not statistically significant either. This study showed a low rate of allogenic blood use postoperatively (< 5%) where either a retransfusion drain or no drain was used at all. However because there was no measurable difference between the two, we conclude that using a retransfusion technique does not appear to be of significant financial or clinical benefit with regards to allogenic blood transfusions compared with using no drain.
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Spondylotic degeneration can manifest as tandem (concurrent) cervical and lumbar spinal stenosis. The primary manifestations include neurogenic claudication, gait disturbance and a mixture of findings of myelopathy and polyradiculopathy in both the upper and lower extremities. The purpose of this retrospective study was to report the existence and management of tandem (concurrent) cervical and lumbar spinal stenosis. ⋯ All the patients had excellent or good results and none deteriorated neurologically. Although tandem spinal stenosis occurred relatively infrequently, we concluded that its possible presence should not be overlooked. The treatment plan must be designed according to the chief complaints and symptoms of the patient.
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Case Reports
Osteonecrosis of the femoral head following medullary nailing of the femur in an adult.
The femoral head receives the majority of its blood supply via branches of the medial femoral circumflex artery, whose course runs across the piriformis fossa and along the superior aspect of the femoral neck. Cadaveric studies have demonstrated damage to the medial femoral circumflex artery in cases where the piriformis fossa was the entry point for intramedullary nailing. Although well recognised in children, osteonecrosis of the femoral head after intramedullary nailing has exceptionally been reported in adults. We present a case of osteonecrosis of the femoral head post-epiphyseal closure following IM nailing for a femoral fracture in a 22-year-old Caucasian adult.
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Comparative Study
Autologous chondrocyte implantation: a comparison between an open periosteal-covered and an arthroscopic matrix-guided technique.
In this prospective study, the authors compared the Carticel method of autologous chondrocyte implantation with the Hyalograft C technique. The aim of the study was to compare the clinical outcomes of the two methods, to identify any complications and to analyse MRI images of the repair process. Seventeen patients who had received autologous chondrocyte implantation with the Carticel technique and ten treated with Hyalograft C were assessed. ⋯ Molecular analysis was performed to assess mRNA levels of the various collagen molecules and proliferation and differentiation factors: the results showed that the implanted material undergoes progressive remodelling to regenerate hyaline cartilage. Both Carticel and Hyalograft C implantation techniques seem to lead to comparable short- and medium-term results. Moreover, this study confirmed that MRI is a valid tool in the follow-up evaluation of autologous chondrocyte implantation.