Cigarette smoking has a negative impact on the skeletal system, causes a decrease in bone mass in both young and old patients, and is considered a risk factor for the development of osteoporosis. In addition, it disturbs the bone healing process and prolongs the healing time after fractures. The mechanisms by which cigarette smoking impairs fracture healing are not fully understood. There are few studies reporting the effects of cigarette smoking on new blood vessel formation during the early stage of fracture healing. We tested the hypothesis that cigarette smoke inhalation may suppress angiogenesis and delay fracture healing. We established a custom-made chamber with airflow for rats to inhale cigarette smoke continuously, and tested our hypothesis using a femoral osteotomy model, radiograph and microCT imaging, and various biomechanical and biological tests.Aims
Methods
Periprosthetic infection is the most challenging complication following total knee arthroplasty (TKA). Poor oral hygiene has been assumed as an important risk factor for TKA infection. We aimed to investigate whether the improvement of oral hygiene through dental scaling could reduce the risk of TKA infection. A nested case control study was conducted and enrollees in the National Health Insurance Research Database (NHIRD) aged above 40 years who had received total knee arthroplasty (TKA) between 1999–2002 were included as the TKA cohort. The cases were patients who underwent resection arthroplasty for infected TKA, and each case was matched by 4 controls from the TKA cohort by gender, using incidence density sampling method. The frequency of dental scaling before the index date was analyzed and compared between the case and the control groups. Multiple conditional logistic regression was used to assess the frequency of dental scaling and the risk of TKA infection.BACKGROUND
METHODS
We present a simple and useful geometrical equation system to carry out the pre-operative planning and intra-operative assessments for total knee arthroplasty. These methods are extremely helpful in severely deformed lower limbs. Total knee arthroplasty is a highly successful surgery for most of the patients with knee osteoarthritis. With commercial instruments and jigs, most surgeons can correct the deformity and provided satisfactory results. However, in cases with severe extra-articular deformity, the instruments may mislead surgeons in making judgment of the true mechanical axis. We developed a geometrical equation system for pre-operative planning and intra-operative measurement to perform correct bony cuts and achieve good post-operative axis.Summary Statement
Introduction
Although tourniquets are widely used in total knee arthroplasty (TKA), their influence on the postoperative course is still unclear. In addition, tourniquet-related soft tissue damage is a major concern in daily practice. We performed a prospective, randomized controlled trial to clarify the role of tourniquets in TKA. Seventy-two patients undergoing TKA were randomly allocated to a tourniquet or non-tourniquet group. Changes in C-reactive protein, creatine phosphokinase, and other indicators of soft tissue damage were monitored preoperatively and postoperatively on days 1, 2, and 4. Rehabilitation progress was also recorded for comparison.Background
Methods
Total knee arthroplasty (TKA) is associated with significant blood loss, for which blood transfusion might be necessary. The role of the tourniquet is controversial, though it is widely used by orthopedic surgeons. Its use was believed to be effective in decreasing intraoperative blood loss and creating a bloodless surgical field, which theoretically would facilitate the cementing technique and other surgical procedures. However, reactive blood flow reached its peak within five minutes after the tourniquet had been released. The tourniquet controls intraoperative blood loss, but cannot stop postoperative blood loss. Patients who were managed with a tourniquet during the operation often complained of thigh pain. This was possibly caused by the direct pressure of an inflated tourniquet on the nerves and local soft tissues. Limb swelling and increased soft tissue tension caused by reactive hyperperfusion after tourniquet deflation may also contribute to the wound pain. The aim of our study is to investigate the effect of tourniquet on blood loss and soft tissue damage in TKA. In this prospective, randomized study, 72 patients with primary cemented knee arthroplasty were randomly allocated to two groups (with and without tourniquet). The operation time, blood loss, post-operative hemoglobin, hematocrit, markers of soft tissue damage (myoglobin, Cretine Posphokinase(CK), LDH, GOT, Creatinine), status of rehabilitation, knee pain and thigh pain were monitored until discharge.Introduction
Materials & Methods
We evaluated the morphological changes to the ulnar nerve of both elbows in the cubital tunnel by sonography in a total of 237 children, of whom 117 were aged between six and seven years, 66 between eight and nine years, and 54 between ten and 11 years. We first scanned longitudinally in the extended elbow and then transversely at the medial epicondyle with the elbow extended to 0°. We repeated the scans with the elbow flexed at 45°, 90°, and 120°. There were no significant differences in the area of the ulnar nerve, but the diameter increased as the elbow moved from extension to flexion in all groups. More importantly, the ulnar nerve was subluxated anteriorly on to the medial epicondyle by 1.5% to 1.9% in extended elbows, by 5.9% to 7.9% in those flexed to 45°, by 40.0% to 44% in those flexed to 90°, and by 57.4% to 58.1% in those flexed to 120°, depending on the age group. Sonography clearly and accurately showed the ulnar nerve and was useful for localising the nerve before placing a medial pin. Because the ulnar nerve may translate anteriorly onto the medial epicondyle when the elbow is flexed to 90° or more, it should never be overlooked during percutaneous medial pinning.
