Aims. Fracture-Related Infection (FRI) is a severe complication caused by microbial infection of bone. It is imperative to gain more insight into the potentials and limitations of Debridement, Antibiotics and Implant Retention (DAIR) to improve future FRI treatment. The aims of this study were to: 1) determine how time to surgery affects the success rate of DAIR procedures of the
Compartment pressures have not previously been studied in healthy children. We compared the pressures in the four
Reimplantation is a well-established procedure in reconstructive surgery. This is especially so after amputation of the upper limb since prostheses provide limited function. In unilateral amputation of the
Background and Objectives. There are various classifications to assess the degree of open fracture and each has it’s own advantages and disadvantages. We proposed a new system since we couldn’t find any which was simple, objective, reliable, reproducible and applicable in an emergency setting. We set five variables namely, skin break, bone damage, muscle injury, neurovascular impairment and the degree of contamination to make scoring. We needed to know if the proposed classification had a better reliability, was simple, objective and applicable. Design and Setting. A proposed diagnostic testing was set to better classifying the degree and severity open fractures. Every patient with open
Aim. Soft tissue defects of the
Introduction. Lower limb immobilisation with full casts is commonly used to manage fractures. There may be the need to split casts in an emergency, such as compartment syndrome, with no current consensus as to which technique is most effective in reducing pressure quickly. Our study aims to compare the reduction in pressure across
Aims: Our purpose was to evaluate þnal results of the fasciotomy of the
Aim. Since surgical site infections (SSIs) remain among the most common complications of orthopedic (trauma) surgery, there has been unwavering attention for potential predictors of a SSI. Specifically in surgical fields with a high complication rate, such as foot/ankle surgery, risk factor identification is of great importance. Recently, some studies have suggested environmental factors such as season to be of influence on the number of SSI. Specifically patients operated on in the summer are reported to have a higher incidence of SSIs, compared to other seasons. The aim of this study is to identify if “seasonality” is a significant predictor for SSI in a cohort of (trauma) surgical foot and ankle procedures. Method. This retrospective cohort study included all patients undergoing trauma related surgery (fracture fixation, arthrodesis, implant removal and tendon repair) of the
Ulceration of the
The aetiology of pain in the
Aims: Only gangrene of the entire foot and life-threatening sepsis with severe infection require a high amputation. Method: Between 1984 and 1999, 188 amputations in the area of the lower extremity were carried out at Bad Düben specialist hospital for orthopaedics. In 31 cases, partial amputation (so-called amputation of border zones) was required in the area of the foot owing to diabetic foot syndrome. The medical records were analysed and the patients who were still living underwent a follow-up examination; 8 patients had died. Results: Of the 31 patients, 20 were men and 11 were women. From 1982 to 1987 there were 4 partial amputations of the foot, from 1988 to 1993 there were 12 and from 1994 to 1999 there were 11. The average age was 69.1 years. In 11 cases, amputation of the
Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation. A total of 100 patients were included in this prospective, randomized, controlled monocentre study allocated to the three subgroups of dislocated ankle fracture (n = 40), pilon fracture (n = 20), and intra-articular calcaneal fracture (n = 40). Patients were randomized to the two study groups in a 1:1 ratio. The effectiveness of VIT (intervention) compared with elevation (control) was analyzed separately for the whole study population and for the three subgroups. The primary endpoint was the time from admission until operability (in days).Aims
Methods
The aim of this study was to evaluate the functional outcome in patients undergoing implant removal (IR) after fracture fixation below the level of the knee. All adult patients (18 to 75 years) undergoing IR after fracture fixation below the level of the knee between November 2014 and September 2016 were included as part of the WIFI (Wound Infections Following Implant Removal Below the Knee) trial, performed in 17 teaching hospitals and two university hospitals in The Netherlands. In this multicentre prospective cohort, the primary outcome was the difference in functional status before and after IR, measured by the Lower Extremity Functional Scale (LEFS), with a minimal clinically important difference of nine points.Aims
Patients and Methods
Vacuum orthoses are being applied in the care of patients with foot and
Introduction. Fully implantable distraction nails are frequently used for lengthening of the
Aim. Fracture-related infection (FRI) is a severe post-traumatic complication which can be accompanied with a soft-tissue defect or an avital soft-tissue envelope. In these cases, a thoroughly planned orthoplastic approach is imperative since a vital soft-tissue envelope is mandatory to achieve fracture union and infection eradication. The aim of our study was to analyse plastic surgical aspects in the management of FRIs, including the type and outcome of soft-tissue reconstruction (STR), and to investigate the long-term outcome of FRI after STR. Method. Patients with a
Aims. Understanding of open fracture management is skewed due to reliance on small-number lower limb, specialist unit reports and large, unfocused registry data collections. To address this, we carried out the Open Fracture Patient Evaluation Nationwide (OPEN) study, and report the demographic details and the initial steps of care for patients admitted with open fractures in the UK. Methods. Any patient admitted to hospital with an open fracture between 1 June 2021 and 30 September 2021 was included, excluding phalanges and isolated hand injuries. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture. Demographic details, injury, fracture classification, and patient dispersal were detailed. Results. In total, 1,175 patients (median age 47 years (interquartile range (IQR) 29 to 65), 61.0% male (n = 717)) were admitted across 51 sites. A total of 546 patients (47.1%) were employed, 5.4% (n = 63) were diabetic, and 28.8% (n = 335) were smokers. In total, 29.0% of patients (n = 341) had more than one injury and 4.8% (n = 56) had two or more open fractures, while 51.3% of fractures (n = 637) occurred in the
The aim of this study was to investigate the effect of different loading scenarios and foot positions on the configuration of the distal tibiofibular joint (DTFJ). Fourteen paired human cadaveric
Gait analysis is an indispensable tool for scientific assessment and treatment of individuals whose ability to walk is impaired. The high cost of installation and operation are a major limitation for wide-spread use in clinical routine. Advances in Artificial Intelligence (AI) could significantly reduce the required instrumentation. A mobile phone could be all equipment necessary for 3D gait analysis. MediaPipe Pose provided by Google Research is such a Machine Learning approach for human body tracking from monocular RGB video frames that is detecting 3D-landmarks of the human body. Aim of this study was to analyze the accuracy of gait phase detection based on the joint landmarks identified by the AI system. Motion data from 10 healthy volunteers walking on a treadmill with a fixed speed of 4.5km/h (Callis, Sprintex, Germany) was sampled with a mobile phone (iPhone SE 2nd Generation, Apple). The video was processed with Mediapipe Pose (Version 0.9.1.0) using custom python software. Gait phases (Initial Contact - IC and Toe Off - TO) were detected from the angular velocities of the
The quest for optimal treatment of acute distal tibiofibular syndesmotic disruptions is still in progress. Using suture-button repair devices is one of the dynamic stabilization options, however, they may not be always appropriate for stabilization of length-unstable syndesmotic injuries. Recently, a novel screw-suture repair system was developed to address such issues. The aim of this study was to investigate the performance of the novel screw-suture repair system in comparison to a suture-button stabilization of unstable syndesmotic injuries. Eight pairs of human cadaveric
The quest for optimal treatment of acute distal tibiofibular syndesmotic disruptions is still in full progress. Using suture-button repair devices is one of the dynamic stabilization options, however, they may not be always appropriate for stabilization of length-unstable syndesmotic injuries. Recently, a novel screw-suture repair system was developed to address such issues. The aim of this study was to investigate the performance of the novel screw-suture repair system in comparison to a suture-button stabilization of unstable syndesmotic injuries. Eight pairs of human cadaveric
INTRODUCTION. There is a growing interest in surgical variables that are controlled by the orthopaedic surgeon, including
Abstract. Background. Benign osteolytic lesions of bone represent a diverse group of pathological and clinical entities. The aim of this study is to highlight the importance of intraoperative endoscopic assessment of intramedullary osteolytic lesions in view of the rate of complications during the postoperative follow up period. Methods. 69 patients (median age 27 years) with benign osteolytic lesion had been prospectively followed up from December 2017 to December 2018 in a university hospital in Cairo, Egypt and in a level-1 trauma center in United Kingdom. All patients had been treated by curettage with the aid of endoscopy through a standard incision and 2 portals. Histological analysis was confirmed from intraoperative samples analysis. All patients had received bone allografts from different donor sites (iliac crest, fibula, olecranon, etc). None of them received chemo or radiotherapy. Results. Most of lesions were enchondroma (n=29), followed by Aneurysmal bone cyst (ABC) (n=16), Fibrodysplasia (n=13), Chondromyxoid fibroma (n=3), simple bone cyst (n= 3), non-ossifying fibroma (n= 3), giant cell tumour (n= 1) and chondromyxoid fibroma (n = 1). Site of lesion varied from metacarpals (n = 29), femur (n= 1),
Aim. The incidence of deep infections after internal fixation of ankle and
Background context: It is frequently stated that referred pain does not travel below the knee. However, for many years studies provoking referred pain have demonstrated pain radiating below the knee. Methods: Over a twelve month period, 643 patients with mechanical back pain and 185 patients with nerve root compressions were seen. For each patient two body map images (front and back) were obtained. Some patients attended for review, at a minimum of six weeks after their first visit. These images were also analysed. Composite images were created by combining all images from patients in one diagnosis group. Colour based overlays were used to analyse the body map images, to locate the locations of pain. Colour density was scaled so that the site with the most hits had a pure colour, reducing down to zero colour for sites with no hits. Results: There were 720 nerve root compression images. 216 (30%) showed no leg pain, 91 (12.6%) showed upper leg pain, 134 (18.6%) showed
Rembrandt’s etching of a beggar with a wooden leg is notable because the two lower limbs of the presumed beggar are present and not deformed. Using the facilities of four specialised Dutch art institutes, we carried out a systematic investigation to find other etchings and engravings of subjects with artificial legs supporting non-amputated limbs, from the period 1500 to 1700 AD. We discovered 28 prints produced by at least 18 artists. Several offered clues to a disorder of a knee, the
Background and purpose: Implantation of the femoral component at 10 to 15 degrees of anteversion is recommended in total hip arthroplasty. Surgical guidelines suggest that the
Introduction: Ankle sprains are among the most common injuries in sports and recreational activities. 10 to 40% of the acute ankle sprains lead to chronic ankle instability (CAI), which can be divided into its mechanical and its functional division. The clinical-orthopaedic diagnosis of mechanical ankle instability (MAI) has been well established, whereas the etiology of the functional ankle instability (FAI) is still not objectively allocatable. The aim of this study was to identify neuromuscular patterns in
Purpose: Ankle sprains are among the most common injuries in sports and recreational activities. 10 to 40% of the acute ankle sprains lead to chronic ankle instability (CAI), which can be divided into its mechanical and its functional division. The clinical-orthopaedic diagnosis of mechanical ankle instability (MAI) has been well established, whereas the etiology of the functional ankle instability (FAI) is still not objectively allocatable. The aim of this study was to identify neuromuscular patterns in
Treatment of comminuted intraarticular calcaneal fractures remains controversial and challenging. Anatomic reduction with stable fixation has demonstrated better outcomes than nonoperative treatment of displaced intraarticular fractures involving the posterior facet and anterior calcaneocuboid joint (CCJ) articulating surface of the calcaneus. The aim of this study was to investigate the biomechanical performance of three different methods for fixation of comminuted intraarticular calcaneal fractures. Comminuted calcaneal fractures, including Sanders III-AB fracture of the posterior facet and Kinner II-B fracture of the CCJ articulating calcaneal surface, were simulated in 18 fresh-frozen human cadaveric
Aims. Cone beam CT allows cross-sectional imaging of the tibiofibular syndesmosis while the patient bears weight. This may facilitate more accurate and reliable investigation of injuries to, and reconstruction of, the syndesmosis but normal ranges of measurements are required first. The purpose of this study was to establish: 1) the normal reference measurements of the syndesmosis; 2) if side-to-side variations exist in syndesmotic anatomy; 3) if age affects syndesmotic anatomy; and 4) if the syndesmotic anatomy differs between male and female patients in weight-bearing cone beam CT views. Patients and Methods. A retrospective analysis was undertaken of 50 male and 50 female patients (200 feet) aged 18 years or more, who underwent bilateral, simultaneous imaging of their
The position of the gastrocnemius tendon relative to the calcaneus and fibular head distance may be different in children with cerebral palsy (CP) when compared to normal children. However, no such data is available. Usually, palpation of the muscle bellies or previous experience of the operating surgeon is employed to place the surgical incision. Inaccurate localisation may cause incorrect incision and a risk of iatrogenic damage to the vital structures (i.e. sural nerve). The aim of our study is to compare gastrocnemius muscle length in-vivo between paretic and unaffected children and suggest a formula to localise muscle-tendon junction. Ten children with di/hemiplegia (seven females and three males; mean age 8y 7mo, range 2–14y) were recruited. None of them had received any conventional medical treatment. An equal number of age/sex matched, typically developing children (mean age 9y 1mo, range 4–14y) were recruited. Participants lay prone on an examination plinth with their feet hanging from its edge. Sagittal-plane ultrasound scanning of the gastrocnemius muscle at rest was performed to measure the length of gastrocnemius bellies. We also measured the heights,
Controversy still exists in the literature regarding efficacy and usefulness of CASN in knee arthroplasty. However, obsession with basic alignments and proper correction of mechanical axes fails to recognise the full future potential of CASN which seems to lie in enhanced dynamic assessment. Basic dynamics usually at least includes intraoperative assessment of limb alignments, flexion-extension gap balancing and simple testing through ranges of motion. However our upgraded CASN system (Brainlab) is also capable of enhanced assessment not only including the provision of data on initial to final alignments but also contact point observations. The system can also perform an enhanced ‘Range Of Motion’ (ROM) analysis including observation of epicondylar axis motion, valgus and varus, antero-posterior shifts as well as flexion and extension gaps. Tracking values for both tibiofemoral and patellofemoral motion have also been obtained after performing registration of the prosthetic trochlea. Observations were then made using a set of standardised dynamic tests. Firstly, the
CASN is generally good at bone morphing and sizing, assisting with component orientation, gap balancing and providing reasonably accurate alignments of limb and components alike. However, such routine navigation technique fails to use the full potential of the registered information. Current technique provides reasonable static stability information in the coronal plane, but with axial and sagittal planes less well considered. A more dynamic approach seems to be necessary to define ‘potential envelopes of motion’, seeming to be the best possible way in which CASN will finally show fundamental improvements over ‘conventional’ technique. Enhanced dynamic assessment using an upgraded CASN system (Brainlab) is now capable of improved ROM analysis and contact point observations. This consists of storing dynamic information including a) epicondylar axis motion, b) valgus and varus alignments, c) antero-posterior shifts, as well as d) flexion and extension gaps. Tracking values for both tibiofemoral and patellofemoral motion can also be obtained after performing registration of the prosthetic trochlea. Observations can be made using a set of standardised dynamic tests. Firstly, the
Introduction. In orthopaedics one of the most common complications is infection. The occurrence of a postoperative infection significantly increases the failure rate; both in the case of prosthetic and trauma surgery. Some patients despite a meticulous antiseptic procedures, a close monitoring of controls peri- and post-operative undergo the development of infection of the fixation devices with the risk of developing osteomyelitis. This risk is highly increased in the distal leg because of the known problems with blood supply and poor muscle coverage. The functionality of the affected segment is impaired, quoad fuctionem, with increased risk of amputation and sometimes with poor prognosis, quoad vitam. The therapeutic strategy proposed by our group is to treat an osteomyelitic site as a pseudo-tumor with a megaimplant following a ladder strategy driven by the NUSS classification. This work shows our experience with a developing system by Waldemar-LINK highlighting critical issues and preliminary results. Objectives. The purpose of this study is to evaluate retrospectively the early outcome after the implantation of this megaprosthesis of the
Purpose. Implant positioning is one of the critical factors influencing the postoperative outcome in total hip arthroplasty (THA). Conventional (manual) intraoperative stem adjustment may result in variability and inaccuracy of stem antetorsion (AT). Since March 2013, we have measured stem antetorsion with CT free Navigation system (OrthoPilot Navigation System THA Pro Ver4.2, B/Braun Aesculap Germany: Navi). We have developed a simple instrument, the Gravity-guide (G-guide), for intraoperative assessment and adjustment of stem AT. We evaluated the accuracy and effectiveness of G-guide and navigation software as referenced to postoperative CT evaluation with 3D template system (Zed hip, LEXI, Japan). Method. Between March 2013 and December 2014, 50 patients underwent primary THA were evaluated. Surgeries were performed with routine techniques with a modified Hardinge approach with the patient at a lateral decubitus position in all cases. The G-guide consists of two parts: one attached to the
Objectives. Electromagnetic fields (EMF) are widely used in musculoskeletal
disorders. There are indications that EMF might also be effective
in the treatment of osteoporosis. To justify clinical follow-up
experiments, we examined the effects of EMF on bone micro-architectural
changes in osteoporotic and healthy rats. Moreover, we tested the
effects of EMF on fracture healing. Methods. EMF (20 Gauss) was examined in rats (aged 20 weeks), which underwent
an ovariectomy (OVX; n = 8) or sham-ovariectomy (sham-OVX; n = 8).
As a putative positive control, all rats received bilateral fibular
osteotomies to examine the effects on fracture healing. Treatment
was applied to one proximal
Purpose: Previous gait studies in community ambulatory older adults show reduced walking velocity, shorter steps, ankle stiffness, and increased duration of double-limb support. A description of gait in very active older adults is needed. Methods: Subjects: 13 senior athletes (age 65±4 years) and 13 young athletes (age 24±3 years). Inclusion criteria: running plus other activity, body mass index <
26, no systemic disease, no
INTRODUCTION. Medial and lateral unicompartmental knee arthroplasty (UKA) are both reliable treatment options for isolated osteoarthritis. Postoperative
Anatomical referencing, component positioning, limb alignments and correction of mechanical axes are essential first steps in successful computer assisted navigation. However, apart from basic gap balancing and quantification of ranges of motion, routine navigation technique usually fails to use the full potential of the registered information. Enhanced dynamic assessment using an upgraded navigation system (Brainlab V. 2.2) is now capable of producing enhanced ‘range of motion’ analysis, ‘tracking curves’ and ‘contact point observations’. ‘Range of motion analysis’ was performed simultaneously for both tibio-femoral and patella-femoral joints. Other dynamic information including epicondylar axis motion, valgus and varus alignments, antero-posterior tibio-femoral shifts, as well as flexion and extension gaps were simultaneously stored as a series of ‘tracking curves’ throughout a full range of motion. Simultaneous tracking values for both tibiofemoral and patellofemoral motion was also obtained after performing registration of the prosthetic trochlea. However, there seems to be little point in carrying out such observations without fully assessing joint stability by applying controlled force to the prosthetic joint. Therefore, in order to fully assess ‘potential envelopes of motion’, observations have been made using a set of standardised simple dynamic tests during insertion and after final positioning of trial components. Also, such tests have been carried out before and after any necessary ligament balancing. Firstly, the
Summary. The mathematical model has proven to be highly accurate in measuring leg length before and after surgery to determine how leg length effects hip joint mechanics. Introduction. Leg length discrepancy (LLD) has been proven to be one of the most concerning problems associated with total hip arthroplasty (THA). Long-term follow-up studies have documented the presence of LLD having direct correlation with patient dissatisfaction, dislocation, back pain, and early complications. Several researchers sought to minimize limb length discrepancy based on pre-operative radiological templating or intra-operative measurements. While often being a common occurrence in clinical practice to compensate for LLD intra-operatively, the center of rotation of the hip joint has often changes unintentionally due to excessive reaming. Therefore, the clinical importance of LLD is still difficult to solve and remains a concern for clinicians. Objective. The objective of this study is two-fold: (1) use a validated forward-solution hip model to theoretically analyze the effects of LLD, gaining better understanding of mechanisms leading to early complication of THA and poor patient satisfaction and (2) to investigate the effect of the altered center of rotation of the hip joint regardless LLD compensation. Methods. The theoretical mathematical model used in this study has been previously validated using fluoroscopic results from existing implant designs and telemetric devices. The model can be used to theoretically investigate various surgical alignments, approaches, and procedures. In this study, we analyzed LLD and the effects of the altered center of rotation regardless of LLD compensation surgeons made. The simulations were conducted in both swing and stance phase of gait. Results. During swing phase, leg shortening lead to loosening of the hip capsular ligaments and subsequently, variable kinematic patterns. The momentum of the
Local infiltration analgesia is a relatively novel technique developed for effective pain control following total knee replacement, reducing requirements of epidural or parenteral post-operative analgesia. The study aimed to investigate the anatomical spread of Local Infiltration Analgesia (LIA) used intra-operatively in total knee arthroplasty (TKA) and identify the nerve structures reached by the injected fluid. Six fresh-frozen cadaveric lower limbs were injected with 180ml of a solution of latex and India ink to enable visualisation. Injections were done according to our standardised LIA technique. Wounds were closed and limbs were placed flat in a freezer at −20°C for two weeks. Limbs were then either sliced or dissected to identify solution locations. Injected solution was found from the proximal thigh to the middle of the
Objectives: (1) To establish whether the acute phase of Perthes’ disease is associated with abnormalities of growth or bone/collagen turnover. (2) To investigate subsequent changes during treatment and healing. Methods: In a longitudinal study of 9 children (7 boys), mean age 6.5years (range 3.0 -9.8 years), we serially monitored insulin-like growth factor (IGF)-I, IGF binding protein (BP)-3, bone alkaline phosphatase (ALP, osteoblast activity), C-terminal propeptide of type I collagen (PICP, bone collagen synthesis), C-terminal telopeptide of type I collagen (ICTP, bone collagen degradation), and N-terminal propeptide of type III collagen (P3NP, soft tissue collagen synthesis) in weeks 1,2 and 12 following acute presentation with a limp and again (in 7/9 patients) 1-2 years after presentation. We measured lengths of both
Aims. Meningococcal septicaemia can result in growth arrest and angular deformities. The aim of this case series was to review the pattern of involvement in the
This study aimed to investigate the incidence of ≥ 5 mm asymmetry in lower and whole leg lengths (LLs) in patients with unilateral osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH-OA) and primary hip osteoarthritis (PHOA), and the relationship between lower and whole LL asymmetries and femoral length asymmetry. In total, 116 patients who underwent unilateral total hip arthroplasty were included in this study. Of these, 93 had DDH-OA and 23 had PHOA. Patients with DDH-OA were categorized into three groups: Crowe grade I, II/III, and IV. Anatomical femoral length, femoral length greater trochanter (GT), femoral length lesser trochanter (LT), tibial length, foot height, lower LL, and whole LL were evaluated using preoperative CT data of the whole leg in the supine position. Asymmetry was evaluated in the Crowe I, II/III, IV, and PHOA groups.Aims
Methods
We re-examined clinically and radiologically 88 patients with a fracture of the
Introduction. Knowledge of knee kinetics and kinematics contributes to our understanding of the patho-mechanics of knee pathology and rehabilitation and a mobile system for use in the clinic is desirable. We set out to assess validity and reliability of ambulatory Inertial Motion Unit (IMU) Sensors (Pegasus¯) against an established optoelectronic system (CODA¯). Pegasus¯ uses inertial sensors placed on subjects' thighs and
This observational cross-sectional study aimed to answer the following questions: 1) how has nonunion incidence developed from 2009 to 2019 in a nationwide cohort; 2) what is the age and sex distribution of nonunions for distinct anatomical nonunion localizations; and 3) how high were the costs for surgical nonunion treatment in a level 1 trauma centre in Germany? Data consisting of annual International Classification of Diseases (ICD)-10 diagnosis codes from German medical institutions from 2009 to 2019, provided by the Federal Statistical Office of Germany (Destatis), were analyzed. Nonunion incidence was calculated for anatomical localization, sex, and age groups. Incidence rate ratios (IRRs) were determined and compared with a two-sample z-test. Diagnosis-related group (DRG)-reimbursement and length of hospital stay were retrospectively retrieved for each anatomical localization, considering 210 patients.Aims
Methods
During the preoperative examination, surgeons determine whether a patient, with a degenerative hip, is a candidate for total hip arthroplasty (THA). Although research studies have been conducted to investigate in vivo kinematics of degenerative hips using fluoroscopy, surgeons do not have assessment tools they can use in their practice to further understand patient assessment. Ideally, if a surgeon could have a theoretical tool that efficiently allows for predictive post-operative assessment after virtual surgery and implantation, they would have a better understanding of joint conditions before surgery. The objectives of this study were (1) to use a validated forward solution hip model to theoretically predict the in vivo kinematics of degenerative hip joints, gaining a better understanding joint conditions leading to THA and (2) compare the predicted kinematic patterns with those derived using fluoroscopy for each subject. A theoretical model, previously evaluated using THA kinematics and telemetry, was used for this study, incorporating numerous muscles and ligaments, including the quadriceps, hamstring, gluteus, iliopsoas, tensor fasciae latae, an adductor muscle groups, and hip capsular ligaments. Ten subjects having a pre-operative degenerative hip were asked to perform gait while under surveillance using a mobile fluoroscopy unit. The hip joint kinematics for ten subjects were initially assessed using in vivo fluoroscopy, and then compared to the predicted kinematics determined using the model. Further evaluations were then conducted varying implanted component position to assess variability. The fluoroscopic evaluation revealed that 33% of the degenerative hips experienced abnormal hip kinematics known as “hip separation” where the femoral head slides within the acetabulum, resulting in a decrease in contact area. Interestingly, the mathematical model produced similar kinematic profiles, where the femoral head was sliding within the acetabulum (Figure 1). During swing phase, it was determined that this femoral head sliding (FHS) is caused by hip capsular laxity resulting in reducing joint tension. At the point of maximum velocity of the foot, the momentum of the
We have been operating TKA for the deformity of OA and RA knee using OrthoPilot kinematic navigation system manufactured by Aesculap (Germany, Tutulingen) since 2005. It has the technology of ligament balance check capability, of which intra-operative registration is not so troublesome and also has the guidance system to achieve the correct bony cutting to the mechanical axis. Although we only have short-term results so far, we have evaluated our results and made some observations. We have 151 cases at our institution composed of 114 OAs and 37 RAs, with 29 males and 122 females. Among them, 95 cases were able to follow-up over one year. Limited only to three cases, we had to discontinue the usage of this system due to the loosening of the rigid body during surgery, which we had to change the maneuver to use manual instrument. The average age at the time of surgery was 73.8 years (range, 38 to 90), and the average BMI was 24.5 (range, 15.6 to 37.7). The average femoral axis, which is the angle between the femoral mechanical axis and the femoral joint surface in the coronal plane, was 2.06 degrees (range, −9 to 10). The average pre-bone-cutting tibiofemoral axis was −8.04 degrees (range, −31 to 15), which after implantation became −0.18 degrees (range, −6 to 6). Tibial proximal cutting has to be perpendicular to the mechanical axis of the
Rotational defects of the lower limb are frequently encountered and often underestimated. In fact, many symptoms in the lower joint can be related to rotational alteration in the
Background: The experimental use of maggots (sterile larvae of Lucilia sericata) can prevent the amputation of an extremity in case of severe infection after trauma injury. Maggots destroy bacteria by secreting enzymes such as tryptase, peptidase and lipase. An alkaline environment is created by the secretion of allantoin, ammonia and calcium carbonate, which reduces bacterial growth and stimulates new formation of granulation tissue. Material and Methods: In the period 4.1999–12.2003 42 patients (mean age 54 yrs (25–83), were included in cur prospective study for maggot treatment of severe infections after trauma (Osteomyelitis n=26,
To evaluate mid-to long-term patient-reported outcome measures (PROMs) of endoprosthetic reconstruction after resection of malignant tumours arising around the knee, and to investigate the risk factors for unfavourable PROMs. The medical records of 75 patients who underwent surgery between 2000 and 2020 were retrospectively reviewed, and 44 patients who were alive and available for follow-up (at a mean of 9.7 years postoperatively) were included in the study. Leg length discrepancy was measured on whole-leg radiographs, and functional assessment was performed with PROMs (Toronto Extremity Salvage Score (TESS) and Comprehensive Outcome Measure for Musculoskeletal Oncology Lower Extremity (COMMON-LE)) with two different aspects. The thresholds for unfavourable PROMs were determined using anchor questions regarding satisfaction, and the risk factors for unfavourable PROMs were investigated.Aims
Methods
Surgical treatment of complex wounds of the lower extremities has greatly evolved in the last years, leading to a higher percentage of limb salvage and good functional recovery. Microsurgery surely is a good weapon when facing extensive tissue losses and infections. From 1994 to 2004, 25 patients have been treated in our department for complex traumas of the lower limb. These cases include 4 acute complex injuries with extensive soft tissue loss (Gustilo III open fractures) which were treated with 3 Latissimus Dorsi and 1 Gracilis Muscle Flaps; 10 delayed referrals with exposed bone or bony/soft tissue loss (1 Fibula Flap for the distal femur, 1 Fibula Flap for the
As an alternative to external fixators, intramedullary lengthening nails (ILNs) can be employed for distraction osteogenesis. While previous studies have demonstrated that typical complications of external devices, such as soft-tissue tethering, and pin site infection can be avoided with ILNs, there is a lack of studies that exclusively investigated tibial distraction osteogenesis with motorized ILNs inserted via an antegrade approach. A total of 58 patients (median age 17 years (interquartile range (IQR) 15 to 21)) treated by unilateral tibial distraction osteogenesis for a median leg length discrepancy of 41 mm (IQR 34 to 53), and nine patients with disproportionate short stature treated by bilateral simultaneous tibial distraction osteogenesis, with magnetically controlled motorized ILNs inserted via an antegrade approach, were retrospectively analyzed. The median follow-up was 37 months (IQR 30 to 51). Outcome measurements were accuracy, precision, reliability, bone healing, complications, and patient-reported outcome assessed by the Limb Deformity-Scoliosis Research Society Score (LD-SRS-30).Aims
Methods
The Open-Fracture Patient Evaluation Nationwide (OPEN) study was performed to provide clarity in open fracture management previously skewed by small, specialist centre studies and large, unfocused registry investigations. We report the current management metrics of open fractures across the UK. Patients admitted to hospital with an open fracture (excluding phalanges or isolated hand injuries) between 1 June 2021 and 30 September 2021 were included. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture software. All domains of the British Orthopaedic Association Standard for Open Fracture Management were recorded.Aims
Method
The August 2012 Trauma Roundup. 360. looks at: pelvic fractures, thromboembolism and the Japanese; venous thromboembolism risk after pelvic and acetabular fractures; the displaced clavicular fracture; whether to use a nail or plate for the displaced fracture of the distal tibia; the dangers of snowboarding; how to predict the outcome of
In vitro experiments have shown, that stabilisation of the fibula in complete fractures of the
Low energy hip dislocation in children is an uncommon injury (0.335% of injuries ) which represents a true orthopaedic emergency. Case 1 ; A 6 year old girl attended hospital non-weightbearing with right thigh pain after slipping whilst attempting to kick a football. The leg was shortened and internally rotated with no neurovascular deficit. Radiographs revealed a posterior dislocation of the right hip. A closed reduction was undertaken in theatre within four hours. She was immobilised in a hip spica for 6 weeks. At six month review she was pain free and back to full activities. Radiographs showed no abnormality. Case 2 ; A 5 year old boy attended A+E non-weight-bearing with right
It has been suggested that a supramalleolar osteotomy can return the load distribution in the ankle joint to normal. However, due to the lack of biomechanical data, this supposition remains empirical. The purpose of this biomechanical study was to determine the effect of simulated supramalleolar varus and valgus alignment on the tibiotalar joint pressure, in order to investigate its relationship to the development of osteoarthritis. We also wished to establish the rationale behind corrective osteotomy of the distal tibia. We studied 17 cadaveric
Aims: Prior research has demonstrated that currently available total ankle implants fail to restore physiologic joint mobility. Most of the modern mobile-bearing designs that feature a flat tibial component and a talar component with anatomic curvature in the sagittal plane function non physiologically with the natural ligament apparatus. The aims of this investigation were a) to elucidate the natural relationship between ligaments and articular surfaces at the intact human ankle joint and b) to develop a new design of total ankle replacement able to replicate this relationship between the retained ligaments and the implanted prosthetic components. Methods: Motion during passive flexion was analyzed in ten skeleto-ligamentous
Background. In vivo fluoroscopic studies have proven that femoral head sliding and separation from within the acetabular cup during gait frequently occur for subjects implanted with a total hip arthroplasty. It is hypothesized that these atypical kinematic patterns are due to component malalignments that yield uncharacteristically higher forces on the hip joint that are not present in the native hip. This in vivo joint instability can lead to edge loading, increased stresses, and premature wear on the acetabular component. Objective. The objective of this study was to use forward solution mathematical modeling to theoretically analyze the causes and effects of hip joint instability and edge loading during both swing and stance phase of gait. Methods. The model used for this study simulates the quadriceps muscles, hamstring muscles, gluteus muscles, iliopsoas group, tensor fasciae latae, and an adductor muscle group. Other soft tissues include the patellar ligament and the ischiofemoral, iliofemoral, and pubofemoral hip capsular ligaments. The model was previously validated using telemetric implants and fluoroscopic results from existing implant designs. The model was used to simulate theoretical surgeries where various surgical alignments were implemented and to determine the hip joint stability. Parameters of interest in this study are joint instability and femoral head sliding within the acetabular cup, along with contact area, contact forces, contact stresses, and ligament tension. Results. During swing phase, it was determined that femoral head pistoning is caused by hip capsule laxity resulting from improperly positioned components and reduced joint tension. At the point of maximum velocity of the foot (approximately halfway through), the momentum of the
The Chopart joint complex is a joint between the midfoot and hindfoot. The static and dynamic support system of the joint is critical for maintaining the medial longitudinal arch of the foot. Any dysfunction leads to progressive collapsing flatfoot deformity (PCFD). Often, the tibialis posterior is the primary cause; however, contrary views have also been expressed. The present investigation intends to explore the comprehensive anatomy of the support system of the Chopart joint complex to gain insight into the cause of PCFD. The study was conducted on 40 adult embalmed cadaveric lower limbs. Chopart joint complexes were dissected, and the structures supporting the joint inferiorly were observed and noted.Aims
Methods
Robotic-assisted total knee arthroplasty (TKA) has proven higher accuracy, fewer alignment outliers, and improved short-term clinical outcomes when compared to conventional TKA. However, evidence of cost-effectiveness and individual superiority of one system over another is the subject of further research. Despite its growing adoption rate, published results are still limited and comparative studies are scarce. This review compares characteristics and performance of five currently available systems, focusing on the information and feedback each system provides to the surgeon, what the systems allow the surgeon to modify during the operation, and how each system then aids execution of the surgical plan. Cite this article: Abstract
Introduction: Open
To evaluate whether low-intensity pulsed ultrasound (LIPUS) accelerates bone healing at osteotomy sites and promotes functional recovery after open-wedge high tibial osteotomy (OWHTO). Overall, 90 patients who underwent OWHTO without bone grafting were enrolled in this nonrandomized retrospective study, and 45 patients treated with LIPUS were compared with 45 patients without LIPUS treatment in terms of bone healing and functional recovery postoperatively. Clinical evaluations, including the pain visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score, were performed preoperatively as well as six weeks and three, six, and 12 months postoperatively. The progression rate of gap filling was evaluated using anteroposterior radiographs at six weeks and three, six, and 12 months postoperatively.Aims
Methods
The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption. Adolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications.Aims
Methods
Posterior malleolar (PM) fractures are commonly associated with ankle fractures, pilon fractures, and to a lesser extent tibial shaft fractures. The tibialis posterior (TP) tendon entrapment is a rare complication associated with PM fractures. If undiagnosed, TP entrapment is associated with complications, ranging from reduced range of ankle movement to instability and pes planus deformities, which require further surgeries including radical treatments such as arthrodesis. The inclusion criteria applied in PubMed, Scopus, and Medline database searches were: all adult studies published between 2012 and 2022; and studies written in English. Outcome of TP entrapment in patients with ankle injuries was assessed by two reviewers independently.Aims
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It is known that patients who are undergoing major orthopaedic operations of the
This study aimed to develop and validate a fully automated system that quantifies proximal femoral bone mineral density (BMD) from CT images. The study analyzed 978 pairs of hip CT and dual-energy X-ray absorptiometry (DXA) measurements of the proximal femur (DXA-BMD) collected from three institutions. From the CT images, the femur and a calibration phantom were automatically segmented using previously trained deep-learning models. The Hounsfield units of each voxel were converted into density (mg/cm3). Then, a deep-learning model trained by manual landmark selection of 315 cases was developed to select the landmarks at the proximal femur to rotate the CT volume to the neutral position. Finally, the CT volume of the femur was projected onto the coronal plane, and the areal BMD of the proximal femur (CT-aBMD) was quantified. CT-aBMD correlated to DXA-BMD, and a receiver operating characteristic (ROC) analysis quantified the accuracy in diagnosing osteoporosis.Aims
Methods
Introduction: Open
In cases of severe periprosthetic joint infection (PJI) of the knee, salvage procedures such as knee arthrodesis (KA) or above-knee amputation (AKA) must be considered. As both treatments result in limitations in quality of life (QoL), we aimed to compare outcomes and factors influencing complication rates, mortality, and mobility. Patients with PJI of the knee and subsequent KA or AKA between June 2011 and May 2021 were included. Demographic data, comorbidities, and patient history were analyzed. Functional outcomes and QoL were prospectively assessed in both groups with additional treatment-specific scores after AKA. Outcomes, complications, and mortality were evaluated.Aims
Methods
Chronic osteomyelitis (COM) of the lower limb in adults can be surgically managed by either limb reconstruction or amputation. This scoping review aims to map the outcomes used in studies surgically managing COM in order to aid future development of a core outcome set. A total of 11 databases were searched. A subset of studies published between 1 October 2020 and 1 January 2011 from a larger review mapping research on limb reconstruction and limb amputation for the management of lower limb COM were eligible. All outcomes were extracted and recorded verbatim. Outcomes were grouped and categorized as per the revised Williamson and Clarke taxonomy.Aims
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This study aimed to determine the expression and clinical significance of a cartilage protein, cartilage oligomeric matrix protein (COMP), in knee osteoarthritis (OA) patients. A total of 270 knee OA patients and 93 healthy controls were recruited. COMP messenger RNA (mRNA) and protein levels in serum, synovial fluid, synovial tissue, and fibroblast-like synoviocytes (FLSs) of knee OA patients were determined using enzyme-linked immunosorbent assay, real-time polymerase chain reaction, and immunohistochemistry.Aims
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Several studies have reported that patients presenting during the evening or weekend have poorer quality healthcare. Our objective was to examine how timely surgery for patients with severe open tibial fracture varies by day and time of presentation and by type of hospital. This cohort study included patients with severe open tibial fractures from the Trauma Audit and Research Network (TARN). Provision of prompt surgery (debridement within 12 hours and soft-tissue coverage in 72 hours) was examined, using multivariate logistic regression to derive adjusted risk ratios (RRs). Time was categorized into three eight-hour intervals for each day of the week. The models were adjusted for treatment in a major trauma centre (MTC), sex, age, year of presentation, injury severity score, injury mechanism, and number of operations each patient received.Aims
Methods
Using a rat model the characteristics of the sensory neurones of the dorsal-root ganglia (DRG) innervating the hip were investigated by retrograde neurotransport and immunohistochemistry. Fluoro-Gold solution (FG) was injected into the left hip of ten rats. Seven days later the DRG from both sides between T12 and L6 were harvested. The number of FG-labelled calcitonin gene-related peptide-immunoreactive or isolectin B4-binding neurones were counted. The FG-labelled neurones were distributed throughout the left DRGs between T13 and L5, primarily at L2, L3, and L4. Few FG-labelled isolectin B4-binding neurones were present in the DRGs of either side between T13 and L5, but calcitonin gene-related peptide-immunoreactive neurones made up 30% of all FG-labelled neurones. Our findings may explain the referral of pain from the hip to the thigh or
Ankle fracture is one of the most common musculoskeletal injuries sustained in the UK. Many patients experience pain and physical impairment, with the consequences of the fracture and its management lasting for several months or even years. The broad aim of ankle fracture treatment is to maintain the alignment of the joint while the fracture heals, and to reduce the risks of problems, such as stiffness. More severe injuries to the ankle are routinely treated surgically. However, even with advances in surgery, there remains a risk of complications; for patients experiencing these, the associated loss of function and quality of life (Qol) is considerable. Non-surgical treatment is an alternative to surgery and involves applying a cast carefully shaped to the patient’s ankle to correct and maintain alignment of the joint with the key benefit being a reduction in the frequency of common complications of surgery. The main potential risk of non-surgical treatment is a loss of alignment with a consequent reduction in ankle function. This study aims to determine whether ankle function, four months after treatment, in patients with unstable ankle fractures treated with close contact casting is not worse than in those treated with surgical intervention, which is the current standard of care. This trial is a pragmatic, multicentre, randomized non-inferiority clinical trial with an embedded pilot, and with 12 months clinical follow-up and parallel economic analysis. A surveillance study using routinely collected data will be performed annually to five years post-treatment. Adult patients, aged 60 years and younger, with unstable ankle fractures will be identified in daily trauma meetings and fracture clinics and approached for recruitment prior to their treatment. Treatments will be performed in trauma units across the UK by a wide range of surgeons. Details of the surgical treatment, including how the operation is done, implant choice, and the recovery programme afterwards, will be at the discretion of the treating surgeon. The non-surgical treatment will be close-contact casting performed under anaesthetic, a technique which has gained in popularity since the publication of the Ankle Injury Management (AIM) trial. In all, 890 participants (445 per group) will be randomly allocated to surgical or non-surgical treatment. Data regarding ankle function, QoL, complications, and healthcare-related costs will be collected at eight weeks, four and 12 months, and then annually for five years following treatment. The primary outcome measure is patient-reported ankle function at four months from treatment.Aims
Methods
Introduction. In revision TKA, the management of bone loss depends on location, type, and extent of bony deficiency. Treatment strategies involve cement filling, bone grafting and augments. On the market several solutions are currently available, differing for their shape, thickness and material. While the choice of the shape and the thickness is mainly dictated by the bone defect, no explicit guideline is currently available to describe the best choice of material to be selected for a specific clinical situation. However, the use of different materials could induce different response in term of bone stress and thus changes in implant stability that could worsen long-term implant performance. For these reasons, an investigation about the changes in bone stress in the femur and in the tibia when augments, with different materials and thicknesses was performed. Methods. Different configurations have been separately considered including proximal tibial, distal or/and posterior femoral augments with a thickness of 5, 10 and 15 mm. Apart the control, in which no augments were used, but only the TKA is considered, the augment in all the other configurations were considered made by three different materials: bone cement, to simulate cement filling, tantalum trabecular metal and conventional metal (titanium for the tibia and CoCr for the femoral augments). Each configuration was inserted on a
Periprosthetic joint infections (PJIs) and fracture-related infections (FRIs) are associated with a significant risk of adverse events. However, there is a paucity of data on cardiac complications following revision surgery for PJI and FRI and how they impact overall mortality. Therefore, this study aimed to investigate the risk of perioperative myocardial injury (PMI) and mortality in this patient cohort. We prospectively included consecutive patients at high cardiovascular risk (defined as age ≥ 45 years with pre-existing coronary, peripheral, or cerebrovascular artery disease, or any patient aged ≥ 65 years, plus a postoperative hospital stay of > 24 hours) undergoing septic or aseptic major orthopaedic surgery between July 2014 and October 2016. All patients received a systematic screening to reliably detect PMI, using serial measurements of high-sensitivity cardiac troponin T. All-cause mortality was assessed at one year. Multivariable logistic regression models were applied to compare incidence of PMI and mortality between patients undergoing septic revision surgery for PJI or FRI, and patients receiving aseptic major bone and joint surgery.Aims
Methods
The incidence of rupture of an Achilles tendon constitutes 0,01–0,02%. The infection of the Achilles tendon after operativ repair is a very rare but severe complication. In this study we examined the functional outcome after radical debridement of the Achilles tendon. From 2009 to 2014 we treated 26 patients (22 male, 4 female) with an infection oft he Achilles tendon. In 24 cases the infection was caused after suture of the tendon, in 2 cases the infection was caused by an open injury. The average age was 46,8 (21 to 75). The number of operations the patient had to undergo before admitted to our hospital was 23, in average (with an range from 0 to 9 operations). We performed a radical debridement and the insertion of a local antibiotic carrier. In all cases an at least subtotal resection of the Achilles tendon was necessary. In 10 cases we found Staphylococcus aureus, in 4 cases atleast 2 different types of bacteria. In 2 cases we detected E.coli, in 1 case Enterococcus faecalis and 1 case Bacteroides fragiles. In 6 cases we didn´t succeed in identifying a bacteria despite of a hisological report describing a severe infection. In all cases we achieved a long-lasting stop of the infection. We succeed in 22 cases with just one operation. In 2 cases we had to perform several surgeries(3 Operations and 7 operations) due to extended soft tissue damage of the
This study aims to answer the following questions in patients with hip osteoarthritis (OA) who underwent total hip arthroplasty (THA): are patient-reported outcome measures (PROMs) affected by the location of the maximum severity of pain?; are PROMs affected by the presence of non-groin pain?; are PROMs affected by the severity of pain?; and are PROMs affected by the number of pain locations? We reviewed 336 hips (305 patients) treated with THA for hip OA from December 2016 to November 2019 using pain location/severity questionnaires, modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), international Hip Outcome Tool (iHOT-12) score, and radiological analysis. Descriptive statistics, analysis of covariance (ANCOVA), and Spearman partial correlation coefficients were used.Aims
Methods
(Case) 79-year-old woman. Past history, in 1989, right femur valgus osteotomy. in 1991, THA at left side. Follow-up thereafter. Hyaluronic acid injection for both knee osteoarthritis. (Clinical course)Her right hip pain getting worse and crawling indoors from the beginning of July 2013. We did right hybrid THA at August 2013(posterior approach, TridentHA cup, Exeter stem, Biolox Forte femoral head 28mm). But immediately, she dislocated twice than the third day after surgery because she became a delirium. It has been left by nurse for about 6 hours because of the midnight after the second dislocation. Next morning, check the dislocation limb position, closed reduction wasdone under intravenous anesthesia. As a result of waking up from the anesthesia, and complained of paralysis and violent pain in the right leg backward. A right lower extremity nerve findings, there is pain in the
Purpose. Use of theguide angle method using intramedullary guide angle for distal femoral cutting in total knee arthroplasty may cause error when rotation of the femur occurs or the insertion point of the intramedullary guide is incorrectly positioned in preoperative radiography. On the other hand, use of the measured cutting method, in which resection of distal femoral condyles is performed according to predicted measured thickness in a preoperative radiograph can allow for correction of these errors intraoperatively. Therefore, we compared these two distal femoral bone cutting methods for restoration of accurate coronal alignment. Methods. Between 2010 and 2012, 47 patients (70 knees) underwent total knee arthroplasty for treatment of osteoarthritis with varus deformity and flexion contracture less than 10 degrees. Bone resection depending on distal femur resection thickness measured before the operation was performed in 38 cases (Group I). Distal femoral cutting using the guide angle was performed in 32 cases (Group II). Radiographic evaluation, including mean value of
The segmental bone transport allows the reconstruction of large scale bone defects resulting after a redical debridement due to an infection or after trauma. We use the Ilizarov fixator for the segmental transport. The part of the bone that has to be moved through the defect is pulled by a lateral and a medial towing rope. To determine continuously the forces of tension in the wires and to detect early complications of the bone transport we implanted in each wire a load cell with a resistance strain gauge. The knowledge of the resulting forces leads to the development of an automatic forced controlled bone transport. Since 09/2004 we have measured the forces of tension in the wires in 77 patients undergoing a segmental bone transport due to a long-extending osteomyelitis. The average age was 47,2 (6 to 68). In 12 patients we had to treat a bone defect of the thigh (average size of the defect 12,5 cm), in 55 patients 56 large scale bone defects of the
There have been a large number of studies reporting the knee joint force during level walking, however, the data of during deep knee flexion are scarce, and especially the data about patellofemoral joint force are lacking. Deep knee flexion is a important motion in Japan and some regions of Asia and Arab, because there are the lifestyle of sitting down and lying on the floor directly. Such data is necessary for designing and evaluating the new type of knee prosthesis which can flex deeply. Therefore we estimated the patellofemoral and tibiofemoral forces in deep knee flexion by using the masculoskeltal model of the lower limb. The model for the calculation was constructed by open chain of three bar link mechanism, and each link stood for thigh,
Background. Ankle arthroplasty is increasingly used to reduce pain and improve or maintain joint mobility in end-stage ankle arthritis. Both treatments show similar results with regard to functional outcome scores and sport related activities. However, the rates of complications and reoperations were higher after ankle replacement. Particularly for the first implant designs, with more promising results for newer designs. One of these newer designs is the Mobility Total Ankle System. Short term results in recent literature describe an improvement of functional outcomes; however complication rates vary widely, ranging from 9 to 37% and the 4-year survival rates ranging between 84 and 98 percent. Therefore, the aim of this study was to assess the clinical and radiographic short term results of the Mobility prosthesis. Methods. Between March 2008 and September 2013, 67 primary total ankle arthroplasties with the Mobility prosthesis were performed, in 64 patients, by one experienced foot and ankle surgeon. Complications, reoperations, failures and the survival rate were retrospectively examined. Patient reported outcomes were assessed with the use of the FFI score and visual analogue scale (VAS) for pain. Prosthesis alignment was measured on the first weightbearing radiographs of the ankle according to the procedure described by Rippstein et al.1 (Fig. 1). Results. The mean follow-up period was 40 months (range 12–78 months). There were two intraoperative and 13 postoperative complications, requiring seven reoperations. The reason for reoperation was painful impingement of the medial and/or lateral gutter (n=4), a deep infection (n=1), subsidence of the talus component (n=1) and a cyst located in the tibiofibular joint (n=1). Failure occurred in three of the 67 cases, with one early deep infection with a loose tibia component, one case of aseptic loosening and one case of chronic ankle pain without an assignable cause. A two-stage revision, ankle arthrodesis and amputation of the
Soft tissue balancing in total knee replacement may well be the determining factor in raising the fair patient satisfaction. The development of intelligent implants allows quantification of reactive loads to applied pressures. This can be tested in dynamic mode such as heel push test at surgery, or in static mode such as when testing for varus/valgus (VV) laxity of the collateral ligaments of the knee. We postulate that a well-balanced knee will have comparable if not equal load distribution across compartments in dynamic loading. When tested for laxity, we anticipate an equal or comparable response to VV applied loads under physiologic load range of 10–50N. This study sought to analyze the relationship between the kinematic (joint motion) and kinetic (force) effects to VV testing in the 0–15 degrees range of flexion. One goal was to demonstrate that testing the knee in locked extension (Screw Home effect) is unreliable and should be abandoned in favor of the more reliable VV testing at 10–15 degrees of flexion. This is a preliminary cadaveric study utilizing data from two hemibodies. The pelvis was fixed in a custom test rig with open or closed chain
Introduction. Patients undergoing total knee arthroplasty (TKA) are at high risk of post operative venous thromboembolism (VTE). Edoxaban, the oral direct and selective factor Xa inhibitor, is available for preventing VTE after TKA. Recently, patients often take antiplatelet drugs including aspirin for their past illness. In our hospital, patients, in general, undergoing TKA receive edoxaban, but patients with aspirin for past illness receive only aspirin for preventing VTE. The aim of this study was to compare edoxaban and aspirin for preventing VTE in patients undergoing TKA. Materials and methods. From April 2012 to March 2014, 137 patients underwent primary TKA under general anesthesia with epidural anesthesia or femoral/ sciatic nerve block. Patients were excluded following; (1) renal dysfunction, (2) have taken anticoagulants such as warfarin for past illness. Finally, a total of 120 patients were enrolled. At the surgery, tourniquet was inflated and mid-vastus approach was used. After prosthesis implantation, tourniquet was deflated and drain tube was inserted. Intra and after operation, an intermittent pneumatic compression device was used. At postoperative day 2, edoxaban or aspirin started after removal of epidural anesthesia or drainage tube. Ninety-seven patients were assigned to receive edoxaban once daily (group E), and the rest of 23 received aspirin again same as before (group A). Edoxaban were scheduled to continue for 10 days. DVT diagnosis. At postoperative day 7, compression and colored Doppler imaging was taken for bilateral common femoral veins, superficial veins, popliteal veins and calf veins by skilled clinical technologist. Augmentation by calf squeezing and by dropped
Introduction. Over the past decade, the use of negative pressure wound therapy (NPWT) devices has increased and expanded to include a wide variety of patients. However, the safety and efficacy of NPWT over skin in open fractures is still unknown. The purpose of this study was to evaluate the complication rate and outcome of open fractures treated by NPWT over closed wounds or flaps. Materials and methods. We performed a retrospective review of prospectively collected data of 10 patients, with an average age of 37.9 years old, who underwent NPWT over surgically closed wounds or random pattern cutaneous flaps in open fractures. All wounds were debrided and closed, and NPWT was applied over the skin sequentially in emergency operations. Results. The open fracture sites were
We present the results of 13 patients who suffered severe injuries to the
Evidence-based orthopaedic surgery emphasizes the need to properly design and perform high-quality randomized controlled trials to minimize bias and to truly ensure the effectiveness of orthopaedic interventions. The currently available best evidence suggests to load and move the Achilles tendon after an open or percutaneous repair for an acute rupture. Following repair of the torn AT, patients are immobilized with their ankle in gravity equines. They are encouraged to bear weight on the operated limb as soon as possible to full weightbearing, and discharged home on the day of the procedure. All patients are given an appointment for review 2 weeks postoperatively, when they receive a single cast change, with the ankle accommodated in a removable anterior splint in a plantigrade position, secured to the
This study aims to ascertain the value of CT in assessing union of complex tibial fractures in patients treated with internal or external fixation. Twenty patients who fit the above criteria were selected from a list of those sent for CT
Treatment of syndesmotic injuries is a subject of ongoing controversy. Locking plates have been shown to provide both angular and axial stability and therefore could potentially control both shear forces and resist widening of the syndesmosis. The aim of this study is to determine whether a two-hole locking plate has biomechanical advantages over conventional screw stabilisation of the syndesmosis in this pattern of injury. Six pairs of fresh-frozen human cadaver
1. The intraosseous and extraosseous circulation of the talus was examined in thirty necropsy specimens. 2. The blood supply to the talus is quite diffuse and arises from the three major arteries of the
We report four patients with unilateral bowing of the
Full-thickness burns around the knee can involve the extensor mechanism. The gastrocnemius flap is well described for soft tissue reconstruction around the knee. We describe a method where a Whichita Fusion Nail¯ knee arthrodesis, combined with a medial gastrocnemius muscle flap was used to salvage the knee and preserve the
To identify the prevalence of neuropathic pain after lower limb fracture surgery, assess associations with pain severity, quality of life and disability, and determine baseline predictors of chronic neuropathic pain at three and at six months post-injury. Secondary analysis of a UK multicentre randomized controlled trial (Wound Healing in Surgery for Trauma; WHiST) dataset including adults aged 16 years or over following surgery for lower limb major trauma. The trial recruited 1,547 participants from 24 trauma centres. Neuropathic pain was measured at three and six months using the Doleur Neuropathique Questionnaire (DN4); 701 participants provided a DN4 score at three months and 781 at six months. Overall, 933 participants provided DN4 for at least one time point. Physical disability (Disability Rating Index (DRI) 0 to 100) and health-related quality-of-life (EuroQol five-dimension five-level; EQ-5D-5L) were measured. Candidate predictors of neuropathic pain included sex, age, BMI, injury mechanism, concurrent injury, diabetes, smoking, alcohol, analgaesia use pre-injury, index surgery location, fixation type, Injury Severity Score, open injury, and wound care.Aims
Methods