Acta Orthop Belg
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Review Case Reports
Pelvic girdle sepsis in childhood. An illustrative case of the difficulty in diagnosis.
The child who presents with fever, limp and hip pain will often undergo multiple diagnostic procedures before a definitive diagnosis is made. We describe a diagnostically challenging case of a 14-year-old boy presenting with an atraumatic painful limp and pyrexia. Eventually the diagnosis of obturator internus muscle abscess with associated ischial osteomyelitis was made. ⋯ Symptomatology varies, clinical examination is non-specific and the diagnosis can be difficult. Haematological indices are more predictive than in cases of classical osteomyelitis or septic arthritis. Subtle features on conventional radiography and isotope bone scanning should not be overlooked while CT and MRI may be complementary in diagnosis.
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Review Comparative Study
Review of methods to quantify lag screw placement in hip fracture fixation.
This review considers methods used to quantify lag screw placement within the femoral head following proximal femoral fracture. Implants used for fixation of femoral neck fractures can lead to unwanted outcomes in some patients. ⋯ These are the concepts of 'Tip Apex Distance' and Parker's ratio method of lag screw placement. We shall discuss each one in turn and their implications in terms of fracture fixation failure.
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Fourteen patients, all female, who underwent coccygectomy for coccygodynia resistant to conservative treatment, were reviewed after a mean follow-up period of 30 months; 5 had a very good result and 7 had a good result. No re-operations were performed. Coccygodynia can be a real problem in women and total coccygectomy is an acceptable operation for coccygodynia not responding to conservative treatment.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of regional nerve block to epidural anaesthesia in day care arthroscopic surgery of the knee.
Day care minimally invasive surgery demands minimal complications with anaesthesia. Nerve blocks are increasingly being employed for surgical procedures on the lower limb, and we attempted to evaluate their benefits and drawbacks in a prospective randomised study in patients undergoing knee arthroscopy. We compared the effectiveness, onset time, duration of analgesia, patient acceptance, failure rate and post-operative comfort of epidural anaesthesia (with 20 ml of 2% lidocaine with adrenaline 1 in 200000) and peripheral nerve blocks (combined 3-in-1 and sciatic nerve block, with 50 ml of 1% lignocaine with adrenaline 1 in 200000, using nerve stimulator). ⋯ However 52.2% of patients in group-I required rescue analgesia postoperatively, as compared to only 18.7% in group-II (p < 0.05). We concluded that even though combined 3-in-1 and sciatic nerve block technique has longer anaesthesia induction time, the lesser need for postoperative rescue analgesia, and lesser potential complications like inadvertent spinal puncture, retention of urine and late onset of back pain, make this an attractive option for day care arthroscopy. The use of a nerve stimulator ensures accuracy, patient counselling allows good cooperation, and advance planning can include potential skin incision delays.
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Comparative Study Clinical Trial
Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with a minimum follow-up of 6 years.
Posterolateral fusion has long been considered the "gold standard" technique for surgical treatment of adult spondylolisthesis. Superior results have subsequently been reported with interbody fusion with cages and posterior instrumentation. The goal of this prospective study was to compare the two techniques regarding their clinical outcomes and fusion rates. ⋯ The fusion rate was 93% with PLIF and 68% with PLF, but without any significant incidence on the functional outcome. Based on these findings, we now use posterior interbody fusion for high grade spondylolisthesis which requires reduction or if the disc space is still high. When the slip grade is low, or the disc space is narrow, we prefer posterolateral fusion.