- Volume:3 Issue:1, 2016
- تاریخ انتشار: 1394/12/25
- تعداد عناوین: 8
Page 1Context: This article wants to give a current concept for the challenging decision for conservative or operative treatment strategies of non-unions according to the principles of diamond concept and aspects that have to be attended.
Evidence Acquisition: Between February 2010 and March 2014, 424 patients with non-unions were treated at Heidelberg university hospital. This database has been analyzed at least one year after the treatment. The analysis and the experience in surgery and treatment of non-unions as well as present literature were prepared for this review as a current concept.ResultsIf an atrophic non-union is suggested, reosteosynthesis and biological stimulation is required. A revision surgery of autologous transplantation of cancellous bone from the iliac crest is often enough. Alternatively, reamer-irrigator-aspirator (RIA) can be taken out of the femur with lower complications and pain in the extraction area and be combined with growth factors like bone morphogenetic proteins (BMPs), if consolidation after cancellous bone is still absent. In complex cases, consequential and radical removal of the infection often improved circulation through interventional angiography and use of the two-step procedure (the Masquelet technique) as well as a tissue covering are required.ConclusionsBy using the diamond concept as a complex concept, non-unions can be treated in different stages in a targeted manner.Keywords: Diamond Concept, Reamer, Irrigator, Aspirator, Non, Union, Masquelet Technique
Large/Massive Tears, Fatty Infiltration, and Rotator Cuff Muscle Atrophy: A Review Article With Management Options Specific to These Types of Cuff DeficienciesPage 2Context: There are many studies in the literature looking into factors affecting outcomes in rotator cuff surgery. The aetiology of rotator cuff deficiency is often multi-factorial and there are many facets towards successful management in this often debilitating condition.
Evidence Acquisition: We performed a literature search of MEDLINE and Embase databases using the terms large rotator cuff tears, fatty infiltration rotator cuff, rotator cuff atrophy, rotator cuff augmentation, rotator cuff tendon transfers, allografts rotator cuff repair, xenograft rotator cuff repair and synthetic grafts rotator cuff repair.ResultsIn this article, we focus particularly on the aetiology, pathology and prognosis of large tears, fatty infiltration and muscle atrophy of the rotator cuff. An overview of the various treatment strategies and current/future concepts are also discussed in managing patients with these types of rotator cuff deficiencies.ConclusionsLarge tears, fatty infiltration and muscle atrophy of the cuff are challenging. An in-depth understanding of these elements may prove vital for the practising orthopedician in determining the right course of management. Techniques in strengthening the repair construct using augmentation play an important role in the treatment of this condition.Keywords: Rotator Cuff, Large Tears, Massive Tears
A Comparative Evaluation of Primary Total Hip Arthroplasty via Lateral and Posterolateral ApproachesPage 3BackgroundTotal hip arthroplasty (THA) is regarded as the most successful and common surgical approach in orthopedic surgeries. Several surgical approaches have been described for THA to introduce minimally invasive surgical exposures. Posterolateral and lateral approaches are traditional and still most commonly used approaches for primary THA. In deciding which approach to use¡ consideration of complications¡ and clinical and radiological outcomes¡ using one approach or another should be evaluated.ObjectivesThe purpose of this study was to compare the early postoperative outcomes of posterolateral and lateral surgical approaches.
Patients andMethodsThe current study was conducted on a group of 134 primary hip arthroplasty of 120 patients who had undergone THA surgery at Shafa Orthopedic Hospital in Tehran¡ Iran¡ from March 2011 to October 2014. The lateral approach was used in 79 hips and¡ posterolateral approach was used in 55 hip based on surgeons preference. Two groups were assessed considering the following outcomes: clinical evaluation including Harris hip score (HHS)¡ blood loss¡ blood transfusion¡ hemoglobin level¡ infections¡ deep vein thrombosis (DVT) and dislocation¡ as well as radiological evaluation including the proximal femur fracture¡ limb length discrepancy and cup inclination angle. The follow-up for both groups was at 6¡ 12¡ 24¡ 36 and 48 weeks after the surgery.ResultsThere was no significant difference between the two approaches regarding demographic characteristics¡ HHS¡ blood loss¡ transfusion¡ hemoglobin level¡ dislocation and cup inclination angle. However¡ there was a significant difference in the incidences of infections¡ DVT¡ proximal femur fracture and discrepancy of limb length between the two approaches.ConclusionsThe results of this study indicate that both lateral and posterolateral approaches offer similar early clinical outcomes and some different radiological outcomes.Keywords: Primary Total Hip Arthroplasty, Lateral Approach, Posterolateral Approach, Clinical Outcome, Radiological Outcome
Optimal Timing and Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): Literature Review and World Consensus (Part Five)Page 4Context: There is a need to find the optimal doses and any need for weight adjustment in patients who have higher than standard BMI. There is also a need to determine if repeating doses of antibiotics is necessary when the surgery takes longer than usual.
Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. 28 of 221 articles were relevant to the 2 following questions regarding perioperative antibiotic prophylaxis to prevent PJI.ResultsPreoperative antibiotics have different pharmacokinetics based on patient weight and should be weight-adjusted. An additional dose of antibiotic should be administered intraoperatively after two half-lives of the prophylactic agent. The general guidelines for frequency of intraoperative antibiotic administration are provided. We recommend that re-dosing of antibiotics be considered in cases of large blood volume loss (> 2000 cc) and fluid resuscitation (> 2000 cc). As these are independent variables¡ re-dosing should be considered as soon as the first of these parameters are met.ConclusionsRecommendations for need for weight adjustment doses and repeat of doses in longer duration surgeries in terms of perioperative antibiotic prophylaxis in hip and knee arthroplasty were provided based on evidences in the literature and consensus of expert delegates from consensus meeting.Keywords: Infection, Joints, Periprosthetic, Arthroplasty
Spinal Osteoid Osteoma Associated With Soft Tissue Changes as a Challenging Diagnosis: A Review of the LiteraturePage 5Context: Spinal osteoid osteoma (OO) is an infrequent tumor and due to both its smallness and complex anatomy of the spine diagnosis is challenging. In addition¡ associated undefined soft tissue changes on magnetic resonance imaging (MRI) frequently cause misdiagnosis.
Evidence Acquisition: PubMed database was searched for spinal osteoid osteoma and larger clinical series related to clinical pictures¡ diagnosis or treatment modalities¡ and also case reports with especially soft tissue changes and related to special treatment modalities were introduced to the study. It was aimed at to make conscious practitioners of clinical and diagnostic characteristics of spinal OOs.ResultsSpinal OOs constitute about 10% of OOs and the most of the tumors are seen in adolescents or young adults. The most frequent clinical picture is painful scoliosis or torticollis according to the level of the tumor. On MRI that is the most frequently performed imaging modality in the patients with painful scoliosis¡ undefined extensive bone and soft tissue changes is quite frequent. Clinicians must be aware from these findings and they must suspect and investigate the patients with bone scintigraphy and thin sectioned computerized tomography that both of them together can show presence of the lesion and provide to determine exact location of the lesion. Despite the increasing number of the studies using percutaneous ablation techniques¡ standard treatment of spinal OOs is still intralesional excision. Surgical excision usually provides immediate pain relief¡ and recurrence is not frequent.ConclusionsDiffuse paravertebral muscle and soft tissue involvement having resemblance to myositis is not quite rare in the patients with spinal OO. This may be the sole finding on MRI and it must be alert for the clinicians to look for small OO nidus by bone scintigraphy or thin sectioned CT scan.Keywords: Osteoid Osteoma, Spinal Tumor, Soft Tissue
Page 6IntroductionTransient osteoporosis of the hip (TOH) is a relatively rare disorder characterized by the loss of bone tissue in the proximal femur. Hip joint is the most common location of the disease, although it may also involve the knee, ankle or foot bones. Self-limited nature of the disease is characteristic with complete relief of symptoms occurring after 6 - 12 months.Case PresentationAuthors report a case with transient osteoporosis of the hip and a clear migratory pattern of osteoporosis from the hip to talus bone in the ipsilateral foot. Spontaneous resolution of symptoms occurred in the patient and he was asymptomatic in the last follow-up.ConclusionsIt is important to consider TOH in the differential diagnosis of middle-aged males and young females with hip pain. It should be included in the differential diagnosis of patients with acute foot and ankle pain. The importance of recognizing this condition lies in its self-limiting nature, with spontaneous resolution in less than a year in the majority of cases. Consequently, invasive investigations may often be avoided in these patients.Keywords: Regional Migratory Osteoporosis, Recurrence, Hip, Talus
Page 7IntroductionAlkaptonuria (AKU) is a very rare disease and occurs due to the deficiency of the enzyme homogentisate1¡ 2-dioxygenase (HGD) which results in ochronosis¡ a term used to describe the dark pigmentation of the tissues. AKU affects mostly the knee joint followed by the hip as major weight bearing joints¡ where the life quality of such patients is severely affected.Case PresentationWe present a case of Caucasian male who was suffering from severe osteoarthritis of the knee. Initially he underwent in a nearby hospital an arthroscopic partial meniscectomy. Fourteen months later we performed a total knee replacement using the Journey II CR prosthesis. We found a dark pigmentation of the inside of the knee (synovial tissue and cartilage). A positive urine test and a pathological specimen examination revealed the diagnosis of AKU. The patient had no complications after the surgery and underwent a standard rehabilitation program.ConclusionsOsteoarthritis could be the first manifestation of patients with AKU and the onset of the joint disease could be late and rapid.Keywords: Alkaptonuria, Ochronosis, Knee Arthroplasty, Journey II CR
Page 8IntroductionHumeral nonunion is a condition resulting from lack of healing at the fracture site often associated with alteration of the local biological potential.Case PresentationA 38-year-old male patient, who had a fracture in the left humerus caused by a fall 8 months earlier was presented. He was treated non-operatively with Sarmiento brace.ConclusionsThe present study introduced a new minimally invasive bridge-plate technique for treatment of humeral shaft nonunion that avoids wide dissection, radial nerve isolation and periosteum stripping. It is a safe procedure, which led to bone healing and good results in a patient with atrophic humeral shaft nonunion.Keywords: Humerus, Nonunion, Minimally, Invasive Surgery