Acta Orthop Belg
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We investigate the anatomy of the lumbosacral anterior great vessels using computer tomography (CT) angiography before L5/S1 anterior interbody surgery. Sixty-two adult patients were selected. The location of the abdominal aortic bifurcation and common iliac venous confluence in the lumbar vertebrae and the anatomic parameters of the iliac vascular space (e.g., distances from the included angle vertex of the iliac vascular space to the median sagittal plane and to the inferior boundary of L5 and distances between the left and right iliac vessels on the inferior boundary of L5 and on the superior boundary of S1) were analysed. ⋯ The calculated L5/S1 intervertebral space exposure percentages of types A, B and C were 32.21%, 82.58% and 54.68%, respectively. During L5/S1 anterior interbody surgery, type B intervertebral discs can be exposed conveniently, preventing injury of the iliac vessels, which was also observed in 54.68% and 32.21% of the type C and type A discs, respectively. Because the type A intervertebral disc has minimal exposure, the risk of iliac vascular injury is relatively high in these patients.
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This study was designed to evaluate the effectiveness of the treatment of infected tibial nonunion by bone transport using the Ilizarov external fixator. We retrospectively reviewed 66 patients with infected tibial nonunion treated by bone transport using the Ilizarov external fixator. Our study included 62 males and 4 females with a mean of age 37.06 years. The average length of the bone defects after radical debridement was 6.27 cm (range 3-13 cm). The mean follow-up after removal of the apparatus was 25.91 months (18-46 months). 6 patients were lost to follow-up. All the patients achieved bone union and no recurrence of infection was observed. The mean external fixation index was 1.38 months/cm (range 1.15-1.58 months/cm). According to Association for the Study and Application of the Method of Ilizarov (ASAMI) classification, bone results were excellent in 44, good in 15, fair in 5 and poor in 2; functional results were excellent in 24, good in 26, fair in 10 and no poor. ⋯ Our study and the current evidence suggested that Ilizarov methods in the treatment of infected tibial nonunion acquired satisfied effects in bone results and functional results. Radical debridement is the key step to control bone infection.
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Comparative Study
Treatment of distal femur fractures with locking plates: Comparison of periprosthetic fractures above total knee arthroplasty and non-periprosthetic fractures.
The purpose of the present study was to compare the results and plate fit of periprosthetic and non-periprosthetic distal femur fractures fixed with locking plates. Twenty-one periprosthetic fractures above a TKA and 27 non-periprosthetic fractures were retrospectively reviewed. The primary healing rate, bone union time, clinical and radiographic results, complications, and additional surgeries were compared between the two groups. ⋯ The incidence of overall complication and additional surgeries did not differ (3/21 vs. 5/27, 1/21 vs. 4/27). Plate fit trouble was observed more frequently in periprosthetic fractures (10/21 vs. 1/27, p = 0.004). Fixation of distal femur fractures with locking plates provided satisfactory results with a low risk of complications and additional surgeries in both periprosthetic and non-periprosthetic fractures.
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Comparative Study Observational Study
Comparison of intra-operative regimes of tranexamic acid administration in primary total hip replacement.
The administration of tranexamic acid to decrease blood loss in primary total hip replacement is established. In this observational study three different regimes of tranexamic acid were used to investigate the effects of combined intravenous and topical administration of tranexamic acid to a single intravenous bolus given at induction or closure. Group 1 (n = 50) received 1 g tranexamic acid intravenously at induction and 500 mg tranexamic acid topically during closure. ⋯ The mean haemoglobin loss was 2.83 g/dL (95% Confidence interval [CI] 2.51 to 3.15 g/dL) in Group 1, 2.92 g/dL (95% CI 2.65 to 3.19 g/dL) in Group 2 and 3.36 g/dL (95% CI 2.94 to 3.77 g/dL) in Group 3. No significant difference in mean haemoglobin loss was found (p = 0.123). In this observational, non-randomised study we found no additional advantage to giving topical tranexamic acid at closure in addition to intravenous tranexamic acid given at induction.
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Comparative Study
Three metal-on-metal hip replacement devices from the same manufacturer--a short- to mid-term survival.
The aim of this retrospective study was to evaluate short- to mid-term results of three different metal-on-metal hip devices from the same manufacturer. A total of 329 hip operations were performed in a single academic unit between 2004 and 2010 using either Birmingham hip resurfacing or Synergy--Birmingham and Synergy--R3 total hip arthroplasty. The overall survival rate at the end of the follow-up time for Birmingham hip resurfacing was 88%, for Synergy--Birmingham total hip arthroplasty 95%, and for Synergy--R3 total hip arthroplasty 81% (p = 0.036). ⋯ Head sizes > 50 mm had lower revision rates compared to smaller ones. Synergy--R3 had a poor survival already at short-term. The mid-term survival of Birmingham hip resurfacing arthroplasty was inferior compared to previous studies.