Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Mar 2017
Comparative StudyThe Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?
The definition of osseous instability in radiographic borderline dysplastic hips is difficult. A reliable radiographic tool that aids decision-making-specifically, a tool that might be associated with instability-therefore would be very helpful for this group of patients. ⋯ Level III, diagnostic study.
-
Clin. Orthop. Relat. Res. · Mar 2017
Comparative StudyIs There Asymmetry Between the Concave and Convex Pedicles in Adolescent Idiopathic Scoliosis? A CT Investigation.
Adolescent idiopathic scoliosis is a complex three-dimensional deformity of the spine characterized by deformities in the sagittal, coronal, and axial planes. Spinal fusion using pedicle screw instrumentation is a widely used method for surgical correction in severe (coronal deformity, Cobb angle > 45°) adolescent idiopathic scoliosis curves. Understanding the anatomic difference in the pedicles of patients with adolescent idiopathic scoliosis is essential to reduce the risk of neurovascular or visceral injury through pedicle screw misplacement. ⋯ There is clinically important asymmetry in the morphologic features of pedicles in individuals with adolescent idiopathic scoliosis. The concave side of the curve compared with the convex side is smaller in height and width periapically. Furthermore, the trajectory of the pedicle is more acute on the convex side of the curve compared with the concave side around the apex of the curve. Knowledge of these anatomic variations is essential when performing scoliosis correction surgery to assist with selecting the correct pedicle screw size and trajectory of insertion to reduce the risk of pedicle wall perforation and neurovascular injury.
-
Clin. Orthop. Relat. Res. · Mar 2017
Comparative StudyIs Needle Biopsy Clinically Useful in Preoperative Grading of Central Chondrosarcoma of the Pelvis and Long Bones?
Central chondrosarcoma of bone is graded on a scale of 1 to 3 according to histological criteria. Clinically, these tumors can be divided into low-grade (Grade 1) and high-grade (Grade 2, Grade 3, and dedifferentiated) chondrosarcomas. Although en bloc resection has been the most widely used treatment, it has become generally accepted that in selected patients with low-grade chondrosarcomas of long bones, curettage is safe and effective. This approach requires an accurate preoperative estimation of grade to avoid under- or overtreatment, but prior reports have indicated that both imaging and biopsy do not always give an accurate prediction of grade. ⋯ Level III, diagnostic study.
-
Clin. Orthop. Relat. Res. · Mar 2017
A Novel System for the Surgical Staging of Primary High-grade Osteosarcoma: The Birmingham Classification.
Chemotherapy response and surgical margins have been shown to be associated with the risk of local recurrence in patients with osteosarcoma. However, existing surgical staging systems fail to reflect the response to chemotherapy or define an appropriate safe metric distance from the tumor that will allow complete excision and closely predict the chance of disease recurrence. We therefore sought to review a group of patients with primary high-grade osteosarcoma treated with neoadjuvant chemotherapy and surgical resection and analyzed margins and chemotherapy response in terms of local recurrence. ⋯ Level IV, prognostic study.
-
Clin. Orthop. Relat. Res. · Mar 2017
What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?
Traditional treatments for pathological fractures of the proximal femur resulting from metastatic bone disease include fixation with intramedullary nailing supplemented with polymethylmethacrylate, osteosynthesis with a plate-screw construct and polymethylmethacrylate, or endoprosthetic reconstruction. Despite the frequent practice of these treatments, treatment outcomes have not been rigorously compared. In addition, very few studies examine specific approaches to endoprosthetic reconstruction such as long stem hemiarthroplasty. ⋯ Level IV, therapeutic study.