Orthopedics RSS : Gourt

Malunion of the distal radius

Abstract Fractures of the distal radius are extremely common injuries, which are steadily becoming a public health issue. One of the most common complications following distal radius fractures is still malunion of the distal radius. This review of the literature surrounding distal radius malunion covers the biomechanics of distal radial malunion, treatment options, indications for surgery, surgical techniques, and results. Content Type Journal ArticleCategory HandsurgeryPages 1-10DOI 10.1007/s00402-012-1466-yAuthors Karl-Josef Prommersberger, Klinik für Handchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97615 Bad Neustadt, GermanyThomas Pillukat, Klinik für Handchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97615 Bad Neustadt, GermanyMarion Mühldorfer, Klinik für Handchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97615 Bad Neustadt, GermanyJörg van Schoonhoven, Klinik für Handchirurgie, Rhön-Klinikum, Salzburger Leite 1, 97615 Bad Neustadt, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

The direct lateral approach: impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach

Abstract Introduction Minimally invasive total hip arthroplasty has been successfully introduced in the past decade. Nevertheless, standard approaches such as the direct lateral approach are still commonly used in orthopaedic surgery due to easy handling, good intra-operative overview and low complication rates. However, a frequent occurrence of fatty atrophy within the anterior third of the gluteus medius muscle has been demonstrated when using the modified direct-lateral approach (mDL), which may be associated with a reduction in function, limitation of internal leg rotation, gait disorders and pain. The question addressed in this study is whether mDL-approach leads to unfavourable changes in foot progression angle (FPA), gait and to more postoperative pain compared with a minimally invasive anterolateral approach (ALMI). Methods Thirty patients with primary osteoarthritis of the hip were recruited for this study. All subjects received an uncemented THA (Alloclassic®-Zweymüller stem, Allofit® Cup, FA Zimmer®), 15 through an ALMI-approach and 15 via the mDL-approach. Gait analyses were performed both preoperatively and 3 months after surgery to measure FPA, step length, stance duration, cadence and walking speed. Additionally, the Harris-Hip Score, pain according to the visual analogue scale and the Trendelenburg sign were evaluated. Results No influence of the surgical approach could be observed on the gait patterns or FPA. Furthermore, neither increased external rotation of the limb nor restriction of internal rotation during walking could be established. Pain and Harris-Hip Score did not differ significantly between the two groups. Conclusion In comparison with an ALMI approach, the mDL approach did not lead to a change in FPA postoperatively. No detrimental effect could be found on the gait pattern or pain after surgery. Based on these measurements, the minimally invasive anterolateral approach did not appear to provide functional benefits in outcome over the mDL approach. Consequently, both surgical approaches seem to be equally applicable approaches with good to very good functional results. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-7DOI 10.1007/s00402-012-1467-xAuthors Michael Müller, Department of Orthopedics, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, GermanyVerena Schwachmeyer, Julius Wolf Institute and Center for Sports Science and Sports Medicine Berlin (CSSB), Charité-Universitätsmedizin Berlin, Berlin, GermanyStephan Tohtz, Department of Orthopedics, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, GermanyWilliam R. Taylor, Julius Wolf Institute and Center for Sports Science and Sports Medicine Berlin (CSSB), Charité-Universitätsmedizin Berlin, Berlin, GermanyGeorg N. Duda, Julius Wolf Institute and Center for Sports Science and Sports Medicine Berlin (CSSB), Charité-Universitätsmedizin Berlin, Berlin, GermanyCarsten Perka, Department of Orthopedics, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, GermanyMarkus O. Heller, Julius Wolf Institute and Center for Sports Science and Sports Medicine Berlin (CSSB), Charité-Universitätsmedizin Berlin, Berlin, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Evaluation of femoral head coverage following Chiari pelvic osteotomy in adolescents by three-dimensional computed tomography and conventional radiography

Abstract Introduction Currently, the cover of the femoral head was mainly assessed using conventional plain films after Chiari pelvic osteotomy in most studies. The purpose of the current study was to observe whether the femoral head coverage measured by three-dimensional computed tomography (3D-CT) was consistent with the radiographic findings. Patients and methods A total of 24 patients (24 hips) with an average age of 11.5 years, underwent Chiari osteotomy due to acetabular dysplasia, and 15 subjects (30 hips) of normal control with a mean age of 12 years were involved in the study. The pre- and postoperative coverage of femoral head was measured by using conventional plain film and 3D-CT on the anterior 1/4, middle 1/2, and posterior 1/4 coronal plane. The anterolateral, mediolateral and posterolateral coverage measured by 3D-CT were compared with the coverage measured by plain radiograph, and which were also compared with the normal control individuals. Results The postoperative anterolateral, mediolateral coverage measured by 3D-CT was significantly smaller than that measured by radiography (P < 0.01). No significant difference was found between the 3D-CT measurements on the posterolateral coverage and the radiographic results. The anterolateral femoral head coverage in the patients following Chiari pelvic osteotomy was also smaller than that in the normal control individuals (P = 0.026). In contrast, the postoperative posterolateral coverage in the patients was more excessive than that in the normal control individuals (P = 0.001). Conclusion Conventional radiographs may show sufficient cover of the femoral head after Chiari osteotomy, whereas in fact, the cover may be not perfect, especially on the anterolateral part. Therefore, the postoperative 3D-CT is beneficial for evaluating the outcome of Chiari osteotomy, especially when the anterolateral coverage of femoral head is significantly insufficient preoperatively. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-7DOI 10.1007/s00402-012-1464-0Authors LianYong Li, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, ChinaJingYu Jia, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, ChinaQun Zhao, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, ChinaLiJun Zhang, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, ChinaShiJun Ji, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, ChinaEnBo Wang, Department of Paediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, 110004 Liaoning, China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Predictive factors of cervical spondylotic myelopathy in patients with lumbar spinal stenosis

Abstract Objective To analyze cervical spondylotic myelopathy (CSM) predictive factors in patients with lumbar spinal stenosis (LSS). Methods Two hundred thirty-seven patients who visited for low back pain, lower limb pain and/or lower limb numbness and who were diagnosed with LSS were enrolled in this study. The ratio of males to females was 117–120, and the mean age was 68.8 years (range 45–87 years). LSS and CSM were diagnosed by characteristic symptoms, physical findings and MRI. We examined gender, age, Torg-Pavlov ratio (TPR), spondylolisthesis or spondylosis, LSS symptom types and number of stenosis segments with LSS to clarify predictive factors for CSM. Results There were 21 (8.86%) patients with coexistent CSM among 237 LSS patients. CSM morbidity was significantly more common among males compared with females. TPR was 0.71 ± 0.09 in the CSM patients and 0.81 ± 0.10 in the non-CSM patients. TPR of the CSM patients was significantly smaller than that of the non-CSM patients. We analyzed to determine the predictive factors of CSM and TPR was identified. The predictive value of TPR for CSM was 0.78. Conclusion Torg-Pavlov ratio was the most important predictive factor of CSM in patients with LSS. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-5DOI 10.1007/s00402-012-1465-zAuthors Hideki Iizuka, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, JapanKeisuke Takahashi, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, JapanShinya Tanaka, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, JapanKohei Kawamura, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, JapanYoshitomo Okano, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, JapanHiromi Oda, Department of Orthopaedic and Spinal Surgery, Saitama Mediclal University, Morohongo 38, Moroyama, Iruma, Saitama 350-0495, Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Computational measurement of joint space width and structural parameters in normal hips

Abstract Introduction Joint space width (JSW) of hip joints on radiographs in normal population may vary by related factors, but previous investigations were insufficient due to limitations of sources of radiographs, inclusion of subjects with osteoarthritis, and manual measurement techniques. We investigated influential factors on JSW using semiautomatic computational software on pelvic radiographs in asymptomatic subjects without radiological osteoarthritic findings. Methods Global and local JSW at the medial, middle, and lateral compartments, and the hip structural parameters were measured in asymptomatic, normal 150 cases (300 hips), using a customized computational software. Results Reliability of measurement in global and local JSWs was high with intraobserver reproducibility (intraclass correlation coefficient) ranging from 0.957 to 0.993 and interobserver reproducibility ranging from 0.925 to 0.985. There were significant differences among three local JSWs, with the largest JSW at the lateral compartment. Global and medial local JSWs were significantly larger in the right hip, and global, medial and middle local JSWs were significantly smaller in women. Global and local JSWs were inversely correlated with CE angle and positively correlated with horizontal distance of the head center, but not correlated with body mass index in men and women. They were positively correlated with age and inversely correlated with vertical distance of the head center only in men. Conclusions There were interindividual variations of JSW in normal population, depending on sites of the weight-bearing area, side, gender, age, and hip structural parameters. For accurate diagnosis and assessment of hip osteoarthritis, consideration of those influential factors other than degenerative change is important. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-8DOI 10.1007/s00402-012-1463-1Authors Takashi Nishii, Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, JapanToshiyuki Shiomi, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, JapanTakashi Sakai, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, JapanMasaki Takao, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, JapanHideki Yoshikawa, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, JapanNobuhiko Sugano, Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years

Abstract Background This study aims to compare radiographic and clinical outcomes of Dynesys and posterior lumbar interbody fusion (PLIF) for the treatment of multisegment disease. Methods Thirty-five consecutive patients who received Dynesys implantation at three levels from L1 to S1 from November 2006 to July 2007 were studied. A retrospective analysis of the medical records of 25 patients with the same indications who received 3-level PLIF (L1–S1) was also conducted. Radiographic and clinical outcomes between the groups were compared. All patients included in the analysis completed 3-year follow-up. Dynesys stabilization resulted in higher preservation of motion at the operative levels, as well as total range of motion from L1 to S1. A decrease of anterior disc height was seen in the Dynesys group and an increase was seen in the PLIF group. An increase in posterior disc height was noted in both groups; however, was greater in the PLIF group at 3 years. Results The Dynesys group showed a greater improvement in Oswestry Disability Index and visual analogue scale back pain scores at 3 years postoperatively. There were no differences in complications between the two groups. Conclusion In conclusion, Dynesys is an acceptable alternative to PLIF for the treatment of multisegment lumbar disease. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-7DOI 10.1007/s00402-012-1460-4Authors Shang-Won Yu, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of ChinaCheng-Yo Yen, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of ChinaChin-Hsien Wu, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of ChinaFeng-Chen Kao, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of ChinaYu-Hsien Kao, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of ChinaYuan-Kun Tu, Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung County, Taiwan, Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Temporary cement tectoplasty: a technique to improve prefabricated hip spacer stability in two-stage surgery for infected hip arthroplasty

Abstract This technical note describes an intraoperatively custom-made, antibiotic-loaded bone cement roof, used in conjunction with a prefabricated hip spacer to improve component stability, as part of the first stage of a two-stage procedure for an infected hip implant. This technique was successfully used in seven cases who presented with extensive superior and/or posterio-superior acetabular defect, which created a risk of spacer dislocation. With this technique we were able to avoid any further dislocation in these seven cases. We believe that the technique may reduce postoperative spacer dislocation in cases with extensive acetabular defects, while improving clinical outcomes. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-6DOI 10.1007/s00402-012-1461-3Authors X. Flores, Reconstruction and Septic Division, Department of Orthopedic Surgery, Hospital Universitario Vall d′Hebron, Barcelona, 08035 SpainP. S. Corona, Reconstruction and Septic Division, Department of Orthopedic Surgery, Hospital Universitario Vall d′Hebron, Barcelona, 08035 SpainJ. Cortina, Reconstruction and Septic Division, Department of Orthopedic Surgery, Hospital Universitario Vall d′Hebron, Barcelona, 08035 SpainE. Guerra, Reconstruction and Septic Division, Department of Orthopedic Surgery, Hospital Universitario Vall d′Hebron, Barcelona, 08035 SpainC. Amat, Reconstruction and Septic Division, Department of Orthopedic Surgery, Hospital Universitario Vall d′Hebron, Barcelona, 08035 Spain Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Arthroscopic stabilization for Neer type 2 fracture of the distal clavicle fracture

Abstract The distal clavicle fractures are divided into three types according to Neer’s classification. Types 1 and 3 fractures are treated with a sling to immobilize the upper extremity. However, the treatment of type 2 fractures is controversial. We paid attention to the anatomic basis of type 2 fractures that the disruptions of the conoid ligament lead to the distraction between the two bony fragments. In this study, we describe the arthroscopic procedure to reconstruct the disrupted ligament and stabilize the fracture as a minimally invasive method. The subjects were seven patients with the distal clavicle fractures. According to Neer’s or Rockwood’s classification on plain radiographs, all seven patients were evaluated as type 2 or 2B, respectively. Our surgical procedure was performed with the patient in the beach chair position. We have used the artificial ligament with an EndoButton (Smith & Nephew Endoscopy, Andover, MA) as the substitute ligament to reconstruct the disrupted conoid ligament. The mean duration of postoperative follow-up was 2 years and 5 months. The bony union was achieved in all patients at a final follow-up. When concerning the range of motion at final examinations, mean forward flexion was 171°, mean abduction was 165°, mean internal rotation was Th11, and mean horizontal adduction was 132°. It is possible to treat the distal clavicle fractures by a minimally invasive arthroscopic procedure without opening the fracture site of clavicle. Content Type Journal ArticleCategory Arthroscopy and Sports MedicinePages 1-5DOI 10.1007/s00402-011-1455-6Authors Katsumi Takase, Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku Shinjuku-ku, Tokyo, 160-0023 JapanRyohei Kono, Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku Shinjuku-ku, Tokyo, 160-0023 JapanKengo Yamamoto, Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku Shinjuku-ku, Tokyo, 160-0023 Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

All-pedicle-screw versus hybrid hook-screw instrumentation for posterior spinal correction surgery in adolescent idiopathic scoliosis: a curve flexibility matched-pair study

Abstract Introduction Comparisons of all-pedicle-screw (PS) and hybrid hook-screw (HS) instrumentation for the treatment of adolescent idiopathic scoliosis (AIS) have produced conflicting results. The aim of this study was to compare all-pedicle-screw and hybrid hook-screw instrumentation for the treatment of AIS using a matched-pair study design in which preoperative flexibility was matched. Methods In this retrospective study conducted at one medical center, 21 all-pedicle-screw/hybrid hook-screw pairs of Lenke type I AIS patients matched for age, height, weight, body mass index, sex, and preoperative curve flexibility who had been treated at our institution from January 2000 to October 2006 were selected. Postoperative and 2-year postoperative coronal curve correction, postoperative kyphosis, blood transfusion needs, operation time, and hospital cost were measured and analyzed statistically. Results The PS group compared with the HS group had better postoperative correction (P = 0.0231) and 2-year coronal curve correction (P = 0.016). While statistically significant (P = 0.0073), the postoperative Cobb angle was only 3° less in the PS group, Maintenance of correction after 2 years was better in the PS group (P = 0.0016). The PS group had less blood loss (P < 0.0001) and shorter operation time (P < 0.0001), but the hospital cost for the PS group was higher (P < 0.0001). Conclusions All-pedicle-screw and hybrid hook-screw instrumentations are comparable with regard to curve correction, but all-pedicle screw instrumentation reduces blood loss during surgery and shortens the operation time, which may help shorten healing time. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentPages 1-7DOI 10.1007/s00402-011-1454-7Authors Changwei Yang, Department of Orthopedics, Changhai Hospital, Shanghai, 200433 People’s Republic of ChinaXianzhao Wei, Department of Orthopedics, Changhai Hospital, Shanghai, 200433 People’s Republic of ChinaJiahao Zhang, Foreign Guest Hospital Ward, Huashan Hospital, Shanghai, People’s Republic of ChinaDajiang Wu, Department of Orthopedics, Changhai Hospital, Shanghai, 200433 People’s Republic of ChinaYingchuan Zhao, Department of Orthopedics, Changhai Hospital, Shanghai, 200433 People’s Republic of ChinaChuanfeng Wang, Department of Orthopedics, Changhai Hospital, Shanghai, 200433 People’s Republic of ChinaXiaodong Zhu, Department of Orthopedics, Changhai Hospital, Shanghai, 200433 People’s Republic of ChinaShisheng He, Department of Orthopedics, Changhai Hospital, Shanghai, 200433 People’s Republic of ChinaMing Li, Department of Orthopedics, Changhai Hospital, Shanghai, 200433 People’s Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Single-stage anterior debridement and fusion with autografting and internal fixation for pyogenic lumbar spondylodiscitis

Abstract Introduction Patients with pyogenic lumbar spondylodiscitis can be successfully treated by non-operative methods. However, the typical operation for this condition includes debridement of the infected site, bone grafting and internal fixation to stabilize the spine. Single-stage anterior debridement and fusion with autografting and internal fixation of one spinal segment were performed on nine patients with pyogenic lumbar spondylodiscitis. This operative procedure is rarely documented for pyogenic lumbar spondylodiscitis. Aim To evaluate the safety and effectiveness of single-stage anterior debridement, autografting and internal fixation of one spinal segment for pyogenic lumbar spondylodiscitis. Results At the final follow-up, seven out of the nine patients were pain free. Two patients had mild, intermittent back pain (Visual Analogue Scale rating of 1–2), which represented an improvement from their preoperative pain. All nine patients had no clinical, laboratory or radiological evidence of recurrence of infection. Moreover, all the patients showed solid bony fusion. Conclusion Based on the limited population studied, it suggested that this technique may be a safe and effective operative procedure for appropriate pyogenic lumbar spondylodiscitis in patients. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-7DOI 10.1007/s00402-011-1451-xAuthors Xiang Wang, Department of Orthopaedics, The First Affiliated Hospital of Medical School of Zhejiang University, 79 Qingchun Road, Hangzhou, ChinaJianshen Zhou, Department of Orthopaedic Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 ChangHuai Road, Bengbu, Anhui, ChinaChangchun Zhang, Department of Orthopaedic Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 ChangHuai Road, Bengbu, Anhui, ChinaZhenhua Liu, Department of Orthopaedic Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 ChangHuai Road, Bengbu, Anhui, China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Online oxygen measurements in ex vivo perfused muscle tissue in a porcine model using dynamic quenching methods

Abstract Introduction Transplantation of autologous free tissue flaps is the best applicable technique for treating large and complex tissue defects and still has one major failure criterion. Tissue—and in particular muscle tissue—is strongly sensitive to ischemia, thus after a critical period of oxygen depletion the risk of a partial or total flap loss is high. Materials and methods For that reason a miniaturized ex vivo perfusion system has been developed, that supplies the tissue during operational delays. The purpose of this study was to determine the oxygenation levels during such a perfusion using different perfusates and therefore to objectify if a complementary oxygenation unit is required to improve perfusion quality. The oxygen levels of the tissue, as well of the perfusate, were measured by using minimal invasive optical oxygen sensors that are based on dynamic quenching. The ex vivo perfused tissue was the porcine rectus abdominis muscle. Results Results show, that during perfusion with heparinized crystalloid fluid (Jonosteril®) and heparinized autologous whole blood, additional oxygenation of the perfusion reactor led to different ex vivo oxygen tissue saturations, which can be detected by dynamic quenching. Conclusion Dynamic quenching methods are a promising and valuable technique to perform online oxygen measurements in ex vivo perfused muscle tissue in a porcine model. Content Type Journal ArticleCategory Basic SciencePages 1-7DOI 10.1007/s00402-011-1458-3Authors Adrian Dragu, Department of Plastic and Hand Surgery, Friedrich-Alexander-University of Erlangen-Nürnberg, University Hospital, Krankenhausstrasse 12, 91054 Erlangen, GermanyChristian D. Taeger, Department of Plastic and Hand Surgery, Friedrich-Alexander-University of Erlangen-Nürnberg, University Hospital, Krankenhausstrasse 12, 91054 Erlangen, GermanyRainer Buchholz, Institute of Bioprocess Engineering, Friedrich-Alexander-University of Erlangen-Nürnberg, 91052 Erlangen, GermanyBjörn Sommerfeld, Institute of Bioprocess Engineering, Friedrich-Alexander-University of Erlangen-Nürnberg, 91052 Erlangen, GermanyHolger Hübner, Institute of Bioprocess Engineering, Friedrich-Alexander-University of Erlangen-Nürnberg, 91052 Erlangen, GermanyTorsten Birkholz, Department of Anaesthesiology, Friedrich-Alexander-University of Erlangen-Nürnberg, University Hospital, Erlangen, GermanyJudith Amélie Kleinmann, Department of Plastic and Hand Surgery, Friedrich-Alexander-University of Erlangen-Nürnberg, University Hospital, Krankenhausstrasse 12, 91054 Erlangen, GermanyFrank Münch, Department of Heart Surgery, Friedrich-Alexander-University of Erlangen-Nürnberg, University Hospital, Erlangen, GermanyRaymund E. Horch, Department of Plastic and Hand Surgery, Friedrich-Alexander-University of Erlangen-Nürnberg, University Hospital, Krankenhausstrasse 12, 91054 Erlangen, GermanyKonstantin Präbst, Institute of Bioprocess Engineering, Friedrich-Alexander-University of Erlangen-Nürnberg, 91052 Erlangen, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Systematic review of the complications of plate fixation of clavicle fractures

Abstract Background The number of displaced midshaft clavicle fractures treated surgically is increasing and plate fixation is often the treatment modality of choice. The study quality and scientific levels of evidence at which possible complications of this treatment are presented vary greatly in literature. Purposes The purpose of this systematic review is to assess the prevalence of complications concerning plate fixation of dislocated midshaft clavicle fractures. Methods A computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Studies included for review reported complications after plate fixation alone or in comparison to either treatment with intramedullary pin fixation and/or nonoperative treatment. Two quality assessment tools were used to assess the methodological quality of the studies. Included studies were ranked according to their levels of evidence. Results After study selection and reading of the full texts, 11 studies were eligible for final quality assessment. Nonunion and malunion rates were less than 10% in all analysed studies but one. The vast majority of complications seem to be implant related, with irritation or failure of the plate being consistently reported on in almost every study, on average ranging from 9 to 64%. Conclusion The quantity of relevant high evidence studies is low. With low nonunion and malunion rates, plate fixation can be a safe treatment option for acute dislocated midshaft clavicle fractures, but complications related to the implant material requiring a second operation are frequent. Future prospective trials are needed to analyse the influence of various plate types and plate position on implant-related complications. Content Type Journal ArticleCategory Trauma SurgeryPages 1-9DOI 10.1007/s00402-011-1456-5Authors Frans-Jasper G. Wijdicks, Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, The NetherlandsOlivier A. J. Van der Meijden, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO 81657, USAPeter J. Millett, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO 81657, USAEgbert J. M. M. Verleisdonk, Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, The NetherlandsR. Marijn Houwert, Department of Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

The posterolateral approach for plating tibial plateau fractures: problems in secondary hardware removal

The posterolateral approach for plating tibial plateau fractures: problems in secondary hardware removal Content Type Journal ArticleCategory Letter to the EditorPages 1-2DOI 10.1007/s00402-012-1459-xAuthors Yi-Gang Huang, Department of Orthopedic Surgery, Tongji Hospital, Tongji University, 389 Xin Cun Road, Shanghai, 200065 People’s Republic of ChinaShi-Min Chang, Department of Orthopedic Surgery, Tongji Hospital, Tongji University, 389 Xin Cun Road, Shanghai, 200065 People’s Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Extracorporeal shock wave therapy in early osteonecrosis of the femoral head: prospective clinical study with long-term follow-up

Abstract Introduction Extracorporeal shock wave therapy (ESWT) may exert beneficial effects in avascular necrosis of femoral head (AVNFH). Patients The current study evaluated the effectiveness of ESWT in reducing pain and in slowing down the progression of bone damage in 36 patients with unilateral AVNFH of stage Association Research Circulation Osseous (ARCO) I, II and III. At the beginning of the study, 10 hips were classified as stage I, 11 as stage II and 15 as stage III. Each treatment cycle included four sessions, with 2,400 impulses each administered at 0.50 mJ/mm2, at 48–72 h intervals. Follow-up examinations were scheduled at 3, 6, 12 and then 24 months. Method Clinical assessments included assessment of pain scores, Harris Hip Scores and Roles and Maudsley score. Plain radiographs and magnetic resonances of the hip were used to evaluate the size of the lesion, the extent of collapse of subchondral bone, and degenerative changes of the hip joint. Results Patients from ARCO stage I group and stage II group achieved significantly better results than patients from ARCO stage III group at all follow-up time points (p < 0.005). During the follow-up period, 10 of the 15 stage III ARCO patients received an arthroplasty. ARCO stages I and II lesions were unchanged on radiographs and on magnetic resonance images. Conclusion ESWT in ARCO stages I and II may help to prevent progression of the area of avascular necrosis and manage pain. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentPages 1-10DOI 10.1007/s00402-011-1444-9Authors Maria Chiara Vulpiani, Physical Medicine and Rehabilitation Unit, Sapienza University School of Medicine, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, ItalyMario Vetrano, Physical Medicine and Rehabilitation Unit, Sapienza University School of Medicine, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, ItalyDonatella Trischitta, Physical Medicine and Rehabilitation Unit, Sapienza University School of Medicine, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, ItalyLaura Scarcello, Physical Medicine and Rehabilitation Unit, Sapienza University School of Medicine, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, ItalyFederica Chizzi, Physical Medicine and Rehabilitation Unit, Sapienza University School of Medicine, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, ItalyGiuseppe Argento, Department of Radiology, Sapienza University School of Medicine, Sant’Andrea Hospital, Rome, ItalyVincenzo Maria Saraceni, Physical Medicine and Rehabilitation Unit, Sapienza University School of Medicine, Sant’Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, ItalyNicola Maffulli, Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UKAndrea Ferretti, Orthopaedic Unit and Kirk Kilgour Sports Injury Center, University School of Medicine, Sant’Andrea Hospital, Rome, Italy Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Diagnosis of discogenic low back pain in patients with probable symptoms but negative discography

Abstract Objective The purpose of the current study was to determine, whenever the patients complained of probable symptoms of discogenic low back pain and had obvious disc pathological changes on magnetic resonance imaging (MRI) but showed negative in discography, whether we could absolutely exclude the diagnosis of discogenic pain or not. Methods The patients we selected in our study had only one segmental disc pathology on MRI for the purpose of minimizing the interference and all patients complained of probable discogenic pain symptoms. Some special lumbar diseases were excluded by physical examination and CT or MRI scan. Finally, 45 isolated patients with negative discography were enrolled in our study from January 2006 to June 2008. Twenty-three patients were randomly distributed in experimental group, who underwent provocative discography plus intradiscal injection of dexamethasone (5 mg in each patient), while the other 22 patients in the control group received intradiscal injection of saline as a placebo. Visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the changes of pain and function after discography. Results The mean age of the 16 male and 29 female patients was 44.9 years, whose main clinical manifestations included axial back pain (100%), pain in the region of Groin (33.3%), pain in the anterior or posterior region of thigh (42.2%), buttock pain (24.4%) and lower extremity pain (11.1%), and among them L3–L4 pathological disc was found in three patient, L4–L5 pathological disc in 28 patients and L5–S1 pathological disc in 14 patients. Discography and CT scans of the 45 patients revealed that there were grade 5 in 38 discs and grade 4 in seven discs by means of Modified Dallas classification. After about 6-month follow-up, the results showed that VAS scores and ODI scores were greatly improved during the first 3-month follow-up in the experimental group compared with pre-discography and between groups (p < 0.05), but no statistically significant difference after 24-week follow-up (p > 0.05). The probable symptoms of discogenic low back pain were significantly improved in the experimental group in the short term. Conclusion The study indicated that negative discography in patients with probable symptoms of discogenic low back pain cannot absolutely exclude the diagnosis of discogenic pain. Patients of this kind may suffer from other diseases, but we cannot ignore the existence of discogenic pain. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentPages 1-6DOI 10.1007/s00402-011-1448-5Authors Yang Yu, Department of Orthopedics, The Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Huangpu District, Shanghai, 200003 P. R. ChinaWei Liu, Department of Orthopedics, The Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Huangpu District, Shanghai, 200003 P. R. ChinaDianwen Song, Department of Orthopedics, The Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Huangpu District, Shanghai, 200003 P. R. ChinaQunfeng Guo, Department of Orthopedics, The Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Huangpu District, Shanghai, 200003 P. R. ChinaLianshun Jia, Department of Orthopedics, The Second Military Medical University, Changzheng Hospital, 415 Fengyang Road, Huangpu District, Shanghai, 200003 P. R. China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Trochanteric osteotomy in primary and revision total hip arthroplasty: risk factors for non-union

Abstract Background Trochanteric osteotomies (TO) facilitate exposure and “true hip reconstruction” in complex primary and revision total hip arthroplasty (THA). However, non-union represents a clinically relevant complication. The purpose of the present study was to identify risk factors for trochanteric non-union. Methods All cases of THA approached by TO during the past 10 years were analyzed with respect to potential risk factors for non-union. Results In 298 cases complete data were available for analysis. Trochanteric union occurred in 80.5%, fibrous union in 5.4% and non-union 14.1%. Risk factor analysis revealed a four times higher risk for non-union in anterior trochanteric slide osteotomies compared to extended trochanteric osteotomies and a three times higher risk in cemented versus non-cemented stems. Multiple logistic regression analysis revealed patient’s age and use of cement to be independent risk factors for non-union. Conclusions Femoral cementation and increasing age negatively influence the union of trochanteric osteotomies. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-7DOI 10.1007/s00402-011-1457-4Authors Karl Wieser, Department of Orthopaedics, University of Zurich, Balgrist Hospital, Forchstrasse 340, CH 8008 Zurich, SwitzerlandPatrick Zingg, Department of Orthopaedics, University of Zurich, Balgrist Hospital, Forchstrasse 340, CH 8008 Zurich, SwitzerlandClaudio Dora, Department of Orthopaedics, University of Zurich, Balgrist Hospital, Forchstrasse 340, CH 8008 Zurich, Switzerland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Periarticular infiltration in total hip replacement: effect on heterotopic ossification, analgesic requirements and outcome

Abstract Background Up to 80% of patients develop heterotopic ossification (HO) following total hip replacement (THR) and high grades may adversely affect outcome. This study investigated the influence of local infiltration of a NSAID (Ketorolac) and local anaesthetic on the incidence and grade of HO following THR, the effect on post-operative opiate analgesic requirement and on patient reported outcome score. Methods A retrospective study was performed on 118 THRs performed without periarticular infiltration from 2003 to 2005, and on 211 performed with infiltration from 2005 to 2008. Pre-operative and 12-month radiographs were examined and HO graded according to the Brooker classification. Peri-operative analgesic requirements and NSAID use were noted and outcome was measured at 1 year with the Oxford Hip Score. Results Univariate and multivariate analysis indicated that single-dose periarticular NSAID infiltration did not reduce the incidence or grade of HO. Preoperative HO (p = 0.005) and enthesopathy (p = 0.027) were significant predictors of post-operative HO. The use of post-operative oral NSAID (except aspirin) significantly reduced HO (p = 0.001). Periarticular infiltration significantly reduced opiate analgesia use in the first 24 h (p < 0.001) and length of inpatient stay (p < 0.001). There was no difference in Oxford Hip Score at 1 year. Conclusion Preoperative enthesopathies are a risk factor for postoperative HO. Periarticular infiltration of NSAID and local anaesthetic does not reduce HO incidence or grade in THR, but does reduce perioperative opiate requirements and length of hospital stay. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-7DOI 10.1007/s00402-011-1453-8Authors Chloe E. H. Scott, Orthopaedic Department, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA UKJulia Streit, Orthopaedic Department, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA UKLeela C. Biant, Orthopaedic Department, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA UKSteffen J. Breusch, Orthopaedic Department, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA UK Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Salvage of recurrence after failed surgical treatment of hallux valgus

Abstract Recurrence of the deformity is unfortunately a common occurrence following surgical treatment of hallux valgus. The underlying reason for recurrence is multifactorial and includes surgeon’s factor, patient’s factor, and deformity components that were not addressed at the index procedure. Salvage of recurrence can be challenging for both the patient and the surgeon. Successful treatment requires understanding the underlying reason for the failure of initial treatment and correcting bony alignment, restoring the joint congruity, and balancing soft tissues. We present an algorithmic approach to revision hallux valgus surgery. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-9DOI 10.1007/s00402-011-1447-6Authors Xiaojun Duan, Center for Joint Surgery, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Chongqing, 400038 ChinaAnish R. Kadakia, Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Michigan, 2098 South Main Street, Ann Arbor, MI 48103, USA Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Surgical outcomes and prognostic factors of cervical spondylotic myelopathy in diabetic patients

Abstract Background There have been a few reports on the surgical outcomes of cervical myelopathy in diabetic patients; however, those studies included ossification of the posterior longitudinal ligament. This study investigated whether surgical outcome of expansive laminoplasty (ELAP) for diabetic patients with cervical spondylotic myelopathy (CSM) differs from that for non-diabetic patients and determined prognostic factors in diabetic patients. Methods We retrospectively reviewed 78 patients with CSM after excluding the cases with other medical conditions, which could affect surgical outcome from 222 consecutive patients who had undergone ELAP between 2000 and 2008 in our hospital. The patients were divided into two groups: diabetic patients (Group 1) and non-diabetic patients (Group 2). We evaluated differences in age, gender, pre- and postoperative Japanese Orthopaedic Association (JOA) score, recovery rate (RR), symptom duration, and postoperative complications between the two groups. In Group 1, the correlation between RR and factors indicating the severity of diabetes mellitus was assessed. Results There were 13 patients in Group 1 and 65 in Group 2. There was no significant difference in age, gender, JOA score before or after surgery, or symptom duration between the two groups. Group 1 showed poorer recovery of sensory and motor function in the lower extremities. A negative correlation was observed between RR and the preoperative hemoglobin A1c (HbA1c) level in Group 1. Conclusions Diabetic patients experienced benefits from ELAP similar to non-diabetic patients. A negative correlation between RR and preoperative HbA1c level suggests that strict blood sugar control is recommended before surgery. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-6DOI 10.1007/s00402-011-1449-4Authors Toshiyuki Dokai, Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, JapanHideki Nagashima, Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, JapanYoshiro Nanjo, Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, JapanAtsushi Tanida, Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, JapanRyota Teshima, Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Comparison of three suture techniques and three suture materials on gap formation and failure load in ruptured tendons: a human cadaveric study

Abstract Introduction There is a large variety of ruptures of tendons and ligaments in trauma surgery. Reliable data about the most appropriate suture technique and suture material for ruptured tendons are sparse. This human cadaveric study compares the biomechanical properties of three suture materials and three suture techniques for semitendinosus tendon repair. Method Sixty-three human cadaver hamstring tendons underwent tenotomy and repair with either Baseball suture, Kessler suture, or a novel “Hannover” suture, using either PDS™ 2-0, Ethibond™ 2-0, or Fiberwire™ 2-0. Biomechanical analysis included pretensioning the constructs with 2 N for 50 s, then cyclic loading of 500 cycles between 2 and 15 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. After this, ultimate failure load and failure mode analysis was performed. Results Ruptures repaired by Fiberwire™ as suture material and the Baseball suture technique were able to withstand significantly higher maximum failure loads (72.8 ± 22.0 N, p < 0.001) than the Kessler suture and the Hannover suture, while ruptures repaired by Fiberwire™ and the Kessler suture technique showed the lowest elongation after cyclic loading (14.6 ± 3.8 mm, p = 0.15). Conclusion These findings may be of relevance for the future clinical treatment of tendon ruptures. Further in vivo clinical application studies are desirable for the future. Content Type Journal ArticleCategory Basic SciencePages 1-6DOI 10.1007/s00402-011-1452-9Authors M. Petri, Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, GermanyM. Ettinger, Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, 30625 Hannover, GermanyA. Dratzidis, Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, GermanyE. Liodakis, Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, GermanyS. Brand, Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, GermanyU. V. Albrecht, Institute for Legal Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, GermanyC. Hurschler, Laboratory for Biomaterials and Biomechanics (LBB), Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, 30625 Hannover, GermanyC. Krettek, Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, GermanyM. Jagodzinski, Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Accuracy of measurement of femoral anteversion in femoral shaft fractures using a computer imaging software: a cadaveric study

Abstract Introduction Rotational malalignment after intramedullary nailing of femoral fractures remains an unresolved problem. Various techniques have been described to address this problem, with limited success. In this cadaveric study, we describe the determination of the femoral anteversion (FAV) angle utilizing a new imaging software program which allows us to generate and manipulate reformatted virtual images from standard DICOM (Digital Imaging and Communications in Medicine) images. Materials and methods Eleven intact femoral specimens were scanned by CT before and after fracture induction in standardized fashion. The obtained DICOM image datasets were uploaded to the new software tool. From this, we obtained reformatted virtual fracture fragment images, which enabled us to reconstruct the femoral anatomy and determine FAV measurements. We then compared FAV measurements before and after fracture induction to determine if there were any statistically significant differences. Results Fracture induction generated 5 AO type A and 6 AO type B fractures. In the specimens prior to fracture induction, we were able to determine the mean FAV to be 17.94° ± 4.48°. Additionally, analysis of the fractured femoral specimens revealed the new mean FAV to be 16.26° ± 4.83°. Statistical analysis of these two measurement groups did not demonstrate statistical significance. When a sub-analysis was performed of the FAV measurements between the two different AO fracture types, there also were no statistically significant differences. Discussion Through new imaging software that allows us to reformat standard DICOM images and generate virtual fracture fragments, we were able to determine the appropriate FAV. We feel that this technique can potentially be integrated into the imaging algorithm for femoral shaft fractures in the future, and can potentially optimize clinical outcomes by allowing the orthopaedic surgeon to determine precisely the appropriate native FAV. Content Type Journal ArticleCategory Trauma SurgeryPages 1-4DOI 10.1007/s00402-011-1450-yAuthors Timo Stübig, Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30655 Hannover, GermanyWilliam Min, Division of Orthopaedic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USAMussa Arvani, Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30655 Hannover, GermanyNael Hawi, Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30655 Hannover, GermanyChristian Krettek, Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30655 Hannover, GermanyMusa Citak, Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, 30655 Hannover, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Influence of trabecular microstructure and cortical index on the complexity of proximal humeral fractures

Abstract Objectives Poor bone quality increases the susceptibility to fractures of the proximal humerus. It is unclear whether local trabecular and cortical measures influence the severity of fracture patterns. The goal of this study was to assess parameters of trabecular and cortical bone properties and to compare these parameters with the severity of fractures and biomechanical testing. Methods Twenty patients with displaced proximal humeral fractures planned for osteosynthesis were included. Fractures were classified as either 2-part fractures or complex fractures. Bone after core drilling was harvested during surgery from the humeral head in each patient. Twenty bone cores obtained from nonpaired cadaver humeral heads served as nonfractured controls. Micro-CT (μCT) was performed and bone volume/total volume (BV/TV), connectivity density (CD), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular spacing (Tb.Sp), and bone mineral density (BMD) were assessed. The cortical index (CI) was determined from AP plain films. Biomechanical testing was done after μCT scanning by axially loading until failure, and ultimate strength and E modulus were recorded. Results BV/TV, BMD and CD showed moderate to strong correlations with biomechanical testing (r = 0.45–0.76, all p < 0.05). No significant differences were detected between the 2-part and complex fracture groups and controls regarding μCT and biomechanical parameters. CI was not significantly different between the 2-part and complex fracture groups. Conclusions In our study population local trabecular bone structure and cortical index could not predict the severity of proximal humeral fractures in the elderly. Complex fractures do not necessarily imply lower bone quality compared to simple fractures. Content Type Journal ArticleCategory Basic SciencePages 1-7DOI 10.1007/s00402-011-1446-7Authors Georg Osterhoff, Department of Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, GermanyGerd Diederichs, Department of Radiology, Charité Campus Mitte, Berlin, GermanyAndrea Tami, AO Research Institute, Davos, SwitzerlandJan Theopold, Department of Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, GermanyChristoph Josten, Department of Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, GermanyPierre Hepp, Department of Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Key outcomes are usually not reported in published fracture secondary prevention programs: results of a systematic review

Abstract Objective A secondary analysis of a systematic review on interventions to improve osteoporosis (OP) investigation and treatment was conducted to examine reported key outcomes: (1) the cost of the intervention; (2) the proportion of patients taking OP medication beyond 6 months of the intervention; and (3) the proportion of patients who re-fractured. Methods Fifty-seven articles reporting on 54 studies (64 interventions) from 11 countries were included. Intervention studies to improve OP management were eligible if they were conducted in an orthopedic setting and included primary data on ≥20 patients presenting with a hip fracture or any fragility fracture. To compare outcome data across all interventions regardless of study design, an equated proportion (EP) using a denominator based on the intention-to-treat principle was derived. Whether a cost analysis had been conducted, the EP of patients who were taking medication beyond 6 months of the intervention, and the EP of patients who re-fractured during the study period were documented. Results Of the 54 studies, 2 reported a cost analysis and demonstrated that the interventions were at least cost-effective. The EP for medication use beyond 6 months of the intervention ranged from 17 to 56% for four studies. The EP for re-fracture ranged from 0 to 5% for four studies. Conclusion Most interventions did not report key outcomes. In addition, authors used varying time frames for re-fracture and medication use, making direct comparisons impossible. Authors should consider including intervention costs, medication use beyond 6 months of the intervention, and re-fracture data in future fracture secondary prevention programs. Content Type Journal ArticleCategory Osteoporotic Fracture ManagementPages 1-7DOI 10.1007/s00402-011-1442-yAuthors Joanna E. M. Sale, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, CanadaDorcas Beaton, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, CanadaJosh Posen, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, CanadaVictoria Elliot-Gibson, Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, CanadaEarl Bogoch, Mobility Program, St. Michael’s Hospital, Toronto, ON, Canada Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients

Abstract The purpose of this review was to assess the effectiveness and safety of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients. We searched the Cochrane Library, MEDLINE and EMBASE for published randomized clinical trials comparing cemented with uncemented hemiarthroplasty for femoral neck fractures. Eight trials assessing 1,175 hips were eligible for meta-analysis. The pooled results showed that there was no significant difference between cemented and uncemented group with regard to the mortality, reoperation rates and postoperational complications. The overall incidence of residual pain at 1 year after operation was 23.6% in the cemented prosthesis and 34.4% in the uncemented, with significant difference (relative risk 0.69, 95% CI 0.53–0.90; P = 0.007; fixed-effect models).The available evidence suggested that compared with uncemented hemiarthroplasty, cemented hemiarthroplasty in treating the elderly with displaced femoral neck fractures was not associated with a higher risk of mortality, reoperation and complications but can reduce the risk of residual pain and provide better functional results. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-9DOI 10.1007/s00402-011-1436-9Authors Xiangping Luo, Department of Orthopedic Surgery, The People’s Hospital of Leiyang, Leiyang, Hunan, ChinaShunqing He, Department of Orthopedic Surgery, The People’s Hospital of Leiyang, Leiyang, Hunan, ChinaZhian Li, Department of Orthopedic Surgery, The People’s Hospital of Leiyang, Leiyang, Hunan, ChinaDeijia Huang, The First Affiliated Hospital of Guangxi Traditional Chinese Medical College, Nanning, China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Follow-up investigation of open trigger digit release

Abstract Purpose The purpose of this retrospective study was to identify the postoperative complications and disorders associated with open trigger finger release. Factors that were investigated by this study included demographic details, the number of digits affected, BMI, level of manual strain, trauma, received systemic medication, hand dominance, pre-treatment with steroid injection, and concomitant diseases. Methods One hundred and three patients, who underwent open release surgery for 117 trigger fingers and thumbs, were followed up until complete resolution of all complaints. Patients’ age, BMI, hand dominance, occupational manual strain, and previous medical history regarding trigger finger or thumb were obtained. Associated conditions and medical treatment, trauma, and previous hand surgical interventions were included as well. Details regarding duration of complaints, ROM, visual analogue pain scale, swelling, recurrence of the disease following previous surgical release, and persistence of complaints following corticosteroid injection were examined. Results The dominant hand was not significantly more frequently affected than the non-dominant hand. Occupation also did not influence the incidence of trigger digit. Patients with systemic steroid therapy had a significantly shorter duration of postoperative symptoms with a mean duration of 29.3 days (range, 28–31 days ± 1.3). Significantly less postoperative swelling was noticed in patients with a pre-surgical steroid injection. The mean duration of symptoms before and after surgery was significantly shorter for a trigger thumb than for trigger finger. Discussion Open trigger digit release constitutes an adequate low-risk surgical procedure for treatment of trigger digit. In this study, we could show that the incidence of this disease is not significantly correlated with the manual strain, trauma, BMI, hand dominance or concomitant diseases like diabetes mellitus, rheumatoid arthritis, renal insufficiency, and hypothyroidism. Additionally, this study illustrates the importance of a careful postoperative follow-up treatment to avoid potential persistent functional limitations. Content Type Journal ArticleCategory HandsurgeryPages 1-7DOI 10.1007/s00402-011-1440-0Authors Fedaye Cakmak, Department of Hand Surgery, Vulpiusklinik, Bad Rappenau, GermanyMaya B. Wolf, Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, GermanyThomas Bruckner, Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, GermanyPeter Hahn, Department of Hand Surgery, Vulpiusklinik, Bad Rappenau, GermanyFrank Unglaub, Department of Hand Surgery, Vulpiusklinik, Bad Rappenau, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Prospective evaluation of patients with anterior cruciate ligament reconstruction using a patient-based health-related survey: comparison of single-bundle and anatomical double-bundle techniques

Abstract Purpose To compare the treatment outcomes of single-bundle and anatomical double-bundle anterior cruciate ligament (ACL) reconstructions, we used the patient-based health-related QOL questionnaire SF-36 to evaluate patients with ACL injury who underwent surgical reconstruction using the two techniques. Patients and methods A prospective study was performed on patients who were diagnosed with ACL injury and underwent ACL reconstruction. Eighty-four male patients who were followed for at least 2 years were analyzed in this study. Forty-four patients were operated by single-bundle technique, and 40 by double-bundle technique. SF-36, Lysholm score, anterior tibial translation, and pivot shift were assessed before surgery and 6, 12 and 24 months after surgery. Results In the preoperative SF-36 survey, the scores of almost all the subscales were lower than the national standard scores in both groups. After operation, the scores of all the subscales improved to the national standard values in all patients, but no difference was observed between two groups. Lysholm score, distance of anterior tibial translation and pivot shift positive rate improved significantly after operation in all patients, but there were no significant differences between two groups. Discussion Although good clinical results have been reported for double-bundle ACL reconstruction, some studies reported no clear difference compared to the conventional single-bundle technique. In the present study, significant improvements were achieved after operation in both groups, confirming the usefulness of both techniques. No clear merit of one method over the other was found, not only from the conventional objective assessments but also from the patient-based subjective evaluation. Content Type Journal ArticleCategory Arthroscopy and Sports MedicinePages 1-6DOI 10.1007/s00402-011-1443-xAuthors Satoshi Ochiai, The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533 JapanTetsuo Hagino, The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533 JapanShinya Senga, The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533 JapanMasanori Saito, The Sports Medicine and Knee Center, National Hospital Organization, Kofu National Hospital, 11-35 Tenjin-cho, Kofu, Yamanashi, 400-8533 JapanHirotaka Haro, Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Adrenaline infiltration in proximal tibial osteotomy: is there evidence for safety?

Adrenaline infiltration in proximal tibial osteotomy: is there evidence for safety? Content Type Journal ArticleCategory Letter to the EditorPages 1-2DOI 10.1007/s00402-011-1437-8Authors Pierre Pasquier, Department of Anesthesiology, Instruction Military Hospital Val-de-Grâce, HIA Val-de-Grâce, Boulevard de Port Royal, 75005 Paris, FranceMathieu Boutonnet, Department of Anesthesiology, Instruction Military Hospital Val-de-Grâce, HIA Val-de-Grâce, Boulevard de Port Royal, 75005 Paris, FranceCyprien Bourrilhon, Institute of Military Medical Research, Brétigny-sur-Orge, FranceGuillaume de Saint Maurice, Department of Anesthesiology, Instruction Military Hospital Val-de-Grâce, HIA Val-de-Grâce, Boulevard de Port Royal, 75005 Paris, FranceJean Pierre Tourtier, Department of Anesthesiology, Instruction Military Hospital Val-de-Grâce, HIA Val-de-Grâce, Boulevard de Port Royal, 75005 Paris, France Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws

Abstract Introduction The aim of this study is to compare the rate of screw loosening and clinical outcomes of expandable pedicle screws (EPS) with those of conventional pedicle screws (CPS) in patients treated for spinal stenosis (SS) combined with osteoporosis. Methods One hundred and fifty-seven consecutive patients with SS received either EPS fixation (n = 80) or CPS fixation (n = 77) to obtain lumbosacral stabilization. Patients were observed for a minimum of 24 months. Outcome measures included screw loosening, fusion rate, Japanese Orthopaedic Association (JOA) scores and Oswestry disability index (ODI) scoring system, and complications. Results In the EPS group, 20 screws became loose (4.1%) in 6 patients (7.5%), and two screws (0.4%) had broken. In the CPS group, 48 screws became loose (12.9%) in 15 patients (19.5%), but no screws were broken. The fusion rate in the EPS group (92.5%) was significantly higher than that of the CPS group (80.5%). The rate of screw loosening in the EPS group (4.1%) was significantly lower than that of the CPS group (12.9%). Six EPS (1.8%) screws were removed. In the EPS group, two screws had broken but without neural complications. Twelve months after surgeries, JOA and ODI scores in the EPS group were significantly improved. There were four cases of dural tears, which healed after corresponding treatment. Conclusions EPS can decrease the risk of screw loosening and achieve better fixation strength and clinical results in osteoporotic lumbar spine fusion. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-6DOI 10.1007/s00402-011-1439-6Authors Zi-xiang Wu, Institute of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 Shaanxi Province, People’s Republic of ChinaFu-tai Gong, Department of Orthopedics, Xi’an Hospital of Traditional Chinese Medicine, Dongdai Street 183, Xi’an, 710001 Shaanxi Province, People’s Republic of ChinaLi Liu, Department of Orthopedics, Baoji Central Hospital, Jiangtan Street 8, Baoji, 721000 Shaanxi Province, People’s Republic of ChinaZhen-sheng Ma, Institute of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 Shaanxi Province, People’s Republic of ChinaYang Zhang, Institute of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 Shaanxi Province, People’s Republic of ChinaXiong Zhao, Institute of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 Shaanxi Province, People’s Republic of ChinaMin Yang, Institute of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 Shaanxi Province, People’s Republic of ChinaWei Lei, Institute of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 Shaanxi Province, People’s Republic of ChinaHong-xun Sang, Institute of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 Shaanxi Province, People’s Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Surgical treatment and management of hip fracture patients

Abstract Introduction Osteoporosis-related hip fractures are associated with high mortality and costs. The optimum type of treatment for such fractures is controversial. To shed some light on this issue, the surgical treatment and management of osteoporotic hip fractures were discussed during a hip fracture surgical working group at the 2009 International Society For Fracture Repair Annual Meeting comprising leading experts in the field. Materials and methods The working group consisted of eight orthopaedic surgeons, six industry representatives and one research scientist. Eleven participants were from Europe and four were from the USA and Canada. Two chairmen posed 12 questions relating to the surgical treatment and management of osteoporotic hip fractures. Each question was discussed and key points were noted. Results Surgery should commence within 24–48 h but the patient should be optimized if presenting with ≥3 comorbidities. Specialized centres integrating orthopaedics, geriatricians and rheumatologists could be a solution for the lack of specialist care post-surgery. Surgical technique is important in fracture fixation, as is the implant, but there has been no improvement in implant design in the past 50 years. As a consequence, malunion has become unjustifiably accepted. Fracture healing can be accelerated using pharmaceuticals which are also important in secondary prophylaxis. All displaced femoral neck fractures in geriatric patients should be treated with hip replacement, the choice between using cemented or uncemented fixation being at the surgeon’s discretion. Discussion and conclusion This working group discussion highlighted several important issues which could be of interest to the orthopaedic community. Content Type Journal ArticleCategory Osteoporotic Fracture ManagementPages 1-5DOI 10.1007/s00402-011-1441-zAuthors Antonio Moroni, School of Sports Science, University of Bologna, Via G. C. Pupilli 1, 40136 Bologna, ItalyMartha Hoque, University of Bologna, Via G. C. Pupilli 1, 40136 Bologna, ItalyJames P. Waddell, St. Michael’s Hospital, Toronto, ON, CanadaThomas A. Russell, University of Tennessee, Memphis, TN, USABurkhard Wippermann, Klinikum Hildesheim GmbH, Hildesheim, GermanyGary DiGiovanni, Synthes Inc, West Chester, PA, USA Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Clinical characteristics and surgical outcome of the symptomatic ossification of ligamentum flavum at the thoracic level with combined lumbar spinal stenosis

Abstract Study design Retrospective study. Objective To identify the clinical significance of coexistence of lumbar spinal stenosis (LSS) with thoracic ossification of ligamentum flavum (OLF), and to study the surgical outcome of the thoracic OLF patients with or without LSS. Summary of background data The OLF at the thoracic level (thoracic OLF) is a rare disease that causes acquired thoracic spinal canal stenosis. Thoracic OLF is frequently combined with other spinal disorders, such as LSS, and it is not uncommon for thoracic OLF to be misdiagnosed as LSS, resulting in delayed diagnosis. However, clinical impacts of the coexistence of LSS with thoracic OLF remain unknown. Methods In the present study, 36 patients who underwent posterior decompression for OLF-induced thoracic myelopathy were retrospectively reviewed, and the adverse influence of the copresence of LSS with thoracic OLF was studied with regard to clinical features such as clinical symptoms and surgical outcome. Results Out of 36 patients, 18 patients had LSS (combined group: C-group), and the remaining 18 patients had thoracic OLF only (thoracic group: T-group). No significant inter-group differences were found in terms of gender, age, follow-up period, and preoperative duration of symptoms. Regarding the etiology of LSS in the C-group, 12 cases had degenerative LSS, two cases had lumbar OLF, one case had degenerative LSS with lumbar OLF, one case had had degenerative LSS with lumbar OPLL, and two cases had traumatic LSS due to lumbar kyphosis after vertebral fracture. Clinical examination revealed that the T-group was significantly more likely to demonstrate Achilles hyper-reflexia, while the C-group was significantly more likely to demonstrate Achilles hypo-reflexia. The mean preoperative and postoperative JOA scores were not statistically different between the two groups. However, the mean recovery rate of the JOA score was 17.3% in the C-group, and 30.4% in the T-group. Statistical analysis revealed that the recovery rate of the C-group was significantly lower than that of the T-group. Conclusion Thoracic OLF with LSS will show a more severe clinical manifestation than that without LSS. In this study, we clearly indicated that the coexisting LSS in thoracic OLF will have adverse effects on the surgical results in thoracic OLF. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-6DOI 10.1007/s00402-011-1438-7Authors Yoshihiro Matsumoto, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanKatsumi Harimaya, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanToshio Doi, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanKenichi Kawaguchi, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanSeiji Okada, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JapanAkihiko Inoguchi, Department of Orthopaedic Surgery, Sada Hospital, Fukuoka, JapanMasami Fujiwara, Department of Orthopaedic Surgery, Sada Hospital, Fukuoka, JapanYukihide Iwamoto, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Total hip arthroplasty: to cement or not to cement the acetabular socket? A critical review of the literature

Abstract The optimal method for acetabular socket fixation remains controversial. We present a critical analysis of the current evidence from a systemic literature review of comparative studies, long-term case series, prior literature reviews, meta-analysis, and national arthroplasty registry data for cemented and uncemented acetabular components to determine the respective survivorship rates, overall risk of re-operation, dislocation rates, and wear-related complications. Using contemporary techniques, both cemented and uncemented sockets can yield good long-term results, but our evaluation suggests that the overall/all cause re-operation risk is lower for cemented fixation. Until and unless crosslinked polyethylene (PE) liners or alternative bearings can prove to yield superior outcome in the future, the cemented PE cup remains the gold standard, in all age groups, by which every acetabular component should be compared. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-17DOI 10.1007/s00402-011-1422-2Authors N. D. Clement, Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA UKL. C. Biant, Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA UKS. J. Breusch, Department of Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA UK Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Clinical and radiographical results of 179 thrust plate hip prostheses: 5–14 years follow-up study

Abstract Introduction The thrust plate hip prosthesis (TPP) is a bone-reserving prosthesis for cementless fixation at the metaphysis of the proximal femur. We retrospectively evaluated the results of 162 patients (179 hips) who underwent hip arthroplasty using TPP. Patients and methods Eighty-three patients (87 hips) suffered from osteoarthritis of the hip joint (OA group), 79 patients (92 hips) from osteonecrosis of the femoral head (ON group). The mean age at surgery was 55 years in the OA group and 47.4 years in the ON group. The mean follow-up period was 97 months in the OA group and 104 months in the ON group. For these patients, we evaluated the results clinically and radiographically. Results The mean Merle d’Aubigne’s score improved from 8.2 to 16.9 in the OA group and from 9.1 to 16.6 in the ON group at the final follow-up. Early mechanical loosening of TPP was observed in two hips of OA and one hip of ON. In one patient of ON, bilateral TPPs had to be removed 5 years postoperatively because of infection. Two female patients with ON suffered from a spontaneous femoral fracture below the tip of the lateral plate. Kaplan–Meier survivorship using TPP removed for any reason as the end point was 97.7% in the OA group and 90.3% in the ON group after 13 years. Conclusion The middle-term results of the TPP were satisfactory if the indication for the TPP and the operative procedure were appropriate. The TPP is a useful and safe prosthesis for relatively young patients with not only osteoarthritis of the hip but also osteonecrosis of the femoral head. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-8DOI 10.1007/s00402-011-1434-yAuthors Yuji Yasunaga, Department of Artificial Joints and Biomaterials, Hiroshima University, Graduate School of Biomedical Sciences, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551 JapanTakuma Yamasaki, Department of Orthopedic Surgery, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, JapanToshihiko Matsuo, Department of Artificial Joints and Biomaterials, Hiroshima University, Graduate School of Biomedical Sciences, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551 JapanTomokazu Yoshida, Department of Orthopedic Surgery, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, JapanSeigo Oshima, Department of Orthopedic Surgery, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, JapanJunji Hori, Department of Orthopedic Surgery, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, JapanKeiichiro Yamasaki, Department of Orthopedic Surgery, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, JapanMitsuo Ochi, Department of Orthopedic Surgery, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Virtual Bernese osteotomy using three-dimensional computed tomography in hip dysplasia

Abstract Background Accurate assessment of acetabular morphology and its relationship to the femoral head is essential for planning a periacetabular osteotomy. We observed the acetabular coverage after virtual Bernese osteotomy using computer-aided technique. Methods Three-dimensional computed tomography of 18 normal hips and 3 symptomatic dysplastic hips were analyzed. Through the center of the femoral head, vertical images were obtained at 10° intervals from 0° to 180° of rotation, using multiplanar reformation technique. Subsequently we measured 19 center–edge angles (CEAs) from each acetabulum. Four types of virtual osteotomy were performed on the three dysplastic hips. The adequacy of acetabular coverage after osteotomy was determined by comparing CEAs after correction with normal CEAs. Results Pearson correlation coefficients between the CEAs measured from normal cases and postoperative cases after lateral rotation of osteotomized fragments were 0.906 in case 1, 0.975 in case 2, 0.976 in case 3. Additional anterior rotation increased anterior acetabular coverage and simultaneously decreased posterior coverage in all three cases. Conclusion Computer-aided virtual surgery technique based on three-dimensional computed tomography information enabled acetabular coverage to be quantified preoperatively in Bernese osteotomy. Lateral rotation of osteotomized acetabular fragments improved anterior and posterior coverage as well as lateral coverage. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-8DOI 10.1007/s00402-011-1435-xAuthors Dong Hun Suh, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, KoreaDae Hee Lee, Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul, 136-705 KoreaWoong Kyo Jeong, Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul, 136-705 KoreaSang Won Park, Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul, 136-705 KoreaChang Ho Kang, Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, KoreaSoon Hyuck Lee, Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul, 136-705 Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Tibial tubercle advancement osteotomy with bone allograft for patellofemoral arthritis: a retrospective cohort study of 50 knees

Abstract Patients and methods Forty consecutive patients (21 females and 19 males) in a single centre underwent 50 tibial tubercle advancement osteotomy procedures for patellofemoral arthritis between January 1993 and April 2007. Twenty knees with patellar maltracking also underwent medialisation of the tibial tubercle (6–12 mm) in addition to the standard 10–15 mm elevation. Femoral head bone allograft blocks were utilised in all cases, and all patients achieved bony union without further surgery. Forty-five knees had previously undergone arthroscopy, 18 with arthroscopic lateral releases. Results Ninety-four percentage of knees had sustained improvement in visual analogue pain scores (mean improvement of 37.4, P < 0.05) at a mean follow-up of 81 months (range 26–195 months), with 96% of patients still satisfied; and 92% of knees had sustained improvement in Shelbourne and Trumper anterior knee function scores (mean improvement of 39.8, P < 0.05). Overall clinical outcomes were rated excellent/good in 77%, fair in 35% and poor in 8% of knees. Two knees required arthroplasty surgery over the follow-up period (at 18 months and 8 years), and their anterior knee pain and function scores were not included in the analyses. Six knees (12%) suffered major complications: 1 temporary common peroneal neuropraxia; 2 intraoperative tibial metaphyseal fractures; and 3 tibial tuberosity fractures (at 8 days, 3 weeks and 3 months). Four knees (8%) suffered superficial wound infections, 31 knees had some numbness around the midline scar, 7 knees had scar pain lasting up to 12 months, and 22 knees (44%) experienced some discomfort relating to the metalwork, which was removed in all these cases. Conclusions Tibial tubercle advancement osteotomy can be an effective treatment for anterior knee pain and for patients with arthroscopic evidence of patellar chondral damage. It can provide excellent/good long-term functional results in the majority of patients, with very high satisfaction levels and sustained improvement in pain symptoms. The use of femoral head bone allograft is both effective in obtaining bony union and by definition avoids the donor-site morbidity. Knees with patellar malalignment may also undergo individualised medialisation of the tibial tubercle such that the patella lies in the centre of the femoral trochlea, and may benefit from lateral trochleaplasty surgery in the presence of trochlear dysplasia. However, the major operative complication rate is high at 12%, and fracture of the tibial tubercle is associated with a poorer outcome. One can expect 10% of operated knees to have had some clinical deterioration in the patellofemoral joint by a mean follow-up of 93 months. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-9DOI 10.1007/s00402-011-1433-zAuthors Henry Dushan Atkinson, Sportsmed SA, 32 Payneham Road, Stepney, 5069 Adelaide, SA, AustraliaChristopher A. Bailey, Sportsmed SA, 32 Payneham Road, Stepney, 5069 Adelaide, SA, AustraliaSanjeev Anand, Sportsmed SA, 32 Payneham Road, Stepney, 5069 Adelaide, SA, AustraliaParminder Johal, Sportsmed SA, 32 Payneham Road, Stepney, 5069 Adelaide, SA, AustraliaRoger D. Oakeshott, Sportsmed SA, 32 Payneham Road, Stepney, 5069 Adelaide, SA, Australia Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Cementless total hip arthroplasty in rheumatoid arthritis: a systematic review of the literature

Abstract Background Compromised rheumatic bone is a potential risk factor for mechanical complications in cementless total hip arthroplasty (THA) in cases of rheumatoid arthritis (RA). Increased rates of intra-operative fractures, component migration and (early) aseptic loosening are to be expected. Despite this, cementless THA is performed in cases of RA. Methods A literature search on cementless THA in RA was performed in EMBASE (1993–2011), Medline (1966–2011) and the Cochrane Library. A systematic review was conducted with a special emphasis on mechanical complications. Results Twenty-three case series and five studies of implant registries were included. Acetabular fractures and/or migration of the cup were reported in 9 out of 22 studies of the cup. Proximal femoral fractures and/or subsidence of the stem were reported in 14 out of 20 studies of the stem. Six studies compared failure rates of uncemented and cemented components due to aseptic loosening. The overall failure rate ratio (uncemented/cemented) for the cup was 0.6 (95% CI: 0.14–2.60) and for the stem 0.71 (95% CI: 0.06–8.55), both favoring uncemented fixation. The failure rates in case series without a control group were compared to the NICE criteria (failure rate/1). The overall failure rate for the cup was 0.97 (95% CI: 0.50–1.88) and for the stem 0.79 (95% CI: 0.44–1.41). Failure rates of aseptic loosening of higher than 1 (favoring cemented fixation) were reported in 6 out of 26 studies of the cup and in 2 out of 25 studies of the stem. In all these studies, the inferior implant designs were blamed, and not the type of fixation or the quality of the bone. Conclusions Despite substantial rates of mechanical stem complications, no evidence was found to establish that cementless components perform less well than cemented components. The results justify the use of cementless THA in RA patients. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-12DOI 10.1007/s00402-011-1432-0Authors Rob E. Zwartelé, Department of Orthopedic Surgery, Kennemer Gasthuis, Haarlem, The NetherlandsSuzanne Witjes, Department of Orthopedic Surgery, Slotervaartziekenhuis, Amsterdam, The NetherlandsH. Cornelis Doets, Department of Orthopedic Surgery, Slotervaartziekenhuis, Amsterdam, The NetherlandsTheo Stijnen, Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The NetherlandsRudolf G. Pöll, Department of Orthopedic Surgery, Slotervaartziekenhuis, Amsterdam, The Netherlands Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

All-arthroscopic intramedullary nailing of 2- and 3-part proximal humeral fractures: a new arthroscopic technique and preliminary results

Abstract Purpose The most criticism of antegrade humeral nailing is the potentially deleterious effect on the shoulder function, which is caused by the trauma to the M. supraspinatus (SSP) at the nail insertion site. We describe a new technique of all-arthroscopical intramedullary nailing, which preserves the rotator cuff, and compare it with the conventional open procedure. Methods From 11/2009 to 12/2010 82 patients with unstable, displaced proximal humeral fractures were treated surgically. Twenty-one of these patients received an intramedullary nailing. Sixteen of 21 met the inclusion criteria. Based on the surgeon’s arthroscopic experience, patients were assigned to the arthroscopic (group I, n = 8) or open group (group II, n = 8). Both groups were compared due to the replacement results, complications, time of surgery and fluoroscopy. Concomitant intraarticular pathologies were assessed (group I). First clinical results after a median follow-up of 13 months (group I) and 14 months (group II) were reported. Results Between group I and II, no significant differences were seen in patients age [77 years (range 45–90 years) vs. 76 years (range 65–92 years)], gender (6 female/2 male vs. 5 female/3 male) and fracture pattern (six 2-/two 3-part fractures vs. five 2-/three 3-part fractures). The reduction was evaluated by the caput-diaphysis-angle, which was median 137° (range 120–147°) in group I and 132° (range 120–158°) in group II (p = 0.959). Postoperatively, group I showed one varus-, group II two varus- and valgus deformities. Median time of surgery was 75 min (range 45–182 min) versus 70 min (range 40–146 min) (p = 0.442), fluoroscopy time 1.5 min (range, 0.6–3.7 min) versus 1.2 min (range 0.3–2.2 min) in group I and II (p = 0.336). Concomitant pathologies like one traumatic bicipital tendon-lesion and three partial lesions of the SSP were observed and treated in group I. Constant Scores and Visual Analogue Scale did not differ significantly between both groups at the time of follow-up. Conclusions All-arthroscopical humeral nailing is possible, preserves the rotator cuff and provides equal replacement and functional results like the open technique. An arthroscopically visualized optimal nail insertion point provides less frequent head deformities. Level of evidence Level III. Content Type Journal ArticleCategory Osteoporotic Fracture ManagementPages 1-7DOI 10.1007/s00402-011-1430-2Authors Helmut Lill, Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstraße 5, 30169 Hannover, GermanyChristoph Katthagen, Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstraße 5, 30169 Hannover, GermanyAlexandra Hertel, Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstraße 5, 30169 Hannover, GermanyJustus Gille, Department of Orthopaedics and Trauma, University Hospital Schleswig–Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, GermanyChristine Voigt, Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Humboldtstraße 5, 30169 Hannover, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Survivorship of second-generation metal-on-metal primary total hip replacement

Abstract Background Second generation metal-on-metal total hip replacements (THR) were introduced in the late 1980s and various studies reported conflicting data on their outcome. Methods Implant survival of 1,270 second-generation 28 mm metal-on-metal primary THR in 1,121 patients followed prospectively at a mean of 6.8 years postoperatively was evaluated retrospectively. The probability of survival at 10 years was estimated using the method of Kaplan and Meier, and relative risk factors including age, gender, BMI, type of implant fixation and component size were calculated using the Cox proportional-hazards model. Results Sixty-three (5%) THRs were revised, these being 28 hips for aseptic loosening and 35 for reasons other than aseptic loosening. The probability of survival at 10 years, with revision for any reason as the endpoint, was 0.90 (95% confidence interval (CI) 0.86–0.94) for the THR as a whole, 0.91 (95% CI 0.87–0.95) for the cup, and 0.96 (95% CI 0.94–0.98) for the stem. No demographic factors or covariates were found to significantly affect the implant survivorship. Discussion As there was no superior probability of survival, and there have been concerns on putative local and systemic toxicity of metal debris, the use of second-generation metal-on-metal articulations for primary THR remains moot. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-7DOI 10.1007/s00402-011-1427-xAuthors C. Neuerburg, Schulthess Clinic, Lengghalde 2, 8008 Zurich, SwitzerlandF. Impellizzeri, Schulthess Clinic, Lengghalde 2, 8008 Zurich, SwitzerlandJ. Goldhahn, Schulthess Clinic, Lengghalde 2, 8008 Zurich, SwitzerlandPh. Frey, Schulthess Clinic, Lengghalde 2, 8008 Zurich, SwitzerlandF. D. Naal, Schulthess Clinic, Lengghalde 2, 8008 Zurich, SwitzerlandM. von Knoch, Department of Orthopedic Surgery, General Hospital Bremerhaven, Bremerhaven, GermanyM. Leunig, Schulthess Clinic, Lengghalde 2, 8008 Zurich, SwitzerlandF. von Knoch, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Fall incidence and risk factors in patients after total knee arthroplasty

Abstract Purpose To prospectively investigate the relationship between physical function and falls among elderly patients who underwent total knee arthroplasty (TKA) and to determine the incidence of falls as well as their risk factors. Methods A total of 108 patients (17 male, 91 female) over 60 years of age who underwent TKA were enrolled and who were living independently in community. 75 patients fulfilled our inclusion criteria and 74 (8 male, 66 female) of them agreed to participate. Baseline assessment (physical examination, physical performance tests, and self-administered questionnaire) were conducted between 6 and 12 months after the last arthroplasty and the follow-up assessment was performed 6 months after the baseline assessment. Monthly pre-stamped postcards were sent to assess the incidence of falls. Results Of the 74 patients enrolled, 70 (94.6%) completed a 6-month prospective observation. 23 of 70 patients (32.9%) fell during the observational period. Postoperative range of knee flexion, ranges of knee flexion and extension and ankle plantar flexion were significantly lower in fallers than in non-fallers (P = 0.016, P = 0.037, P = 0.014, respectively). In the multivariate analysis, postoperative range of knee flexion (OR 0.277, 95%CI 0.088–0.869, P = 0.028) and ankle plantar flexion (OR 0.594, 95%CI 0.374–0.945, P = 0.028) were determined to be significant risk factors. Conclusion Elderly people who underwent TKA are considered more likely to fall compared with healthy elderly people. For patients with limited knee flexion and ankle plantar flexion, improvement of ROM by exercise therapy and patient education regarding the prevention of falls and fractures are considered necessary. Content Type Journal ArticleCategory Knee ArthroplastyPages 1-9DOI 10.1007/s00402-011-1418-yAuthors Hiromi Matsumoto, Rehabilitation Division, Hakuai Hospital, Ryomitsuyanagi 1880, Yonago, Tottori 683-0853, JapanMakoto Okuno, Department of Orthopedic Surgery, Hakuai Hospital, Yonago, JapanTatsuhiko Nakamura, Department of Orthopedic Surgery, Hakuai Hospital, Yonago, JapanKichizo Yamamoto, Department of Orthopedic Surgery, Hakuai Hospital, Yonago, JapanHiroshi Hagino, School of Health Science, Faculty of Medicine, Tottori University, Yonago, Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Unexpected injury of the orthopaedic surgeon: a case report of a hammer splinter

Abstract Sharps injuries have become one of the most important occupational injuries and they are common during surgery, with rates between 1.7 and 6.9% of all surgical procedures. This case report, however, revealed an extremely rare and unexpected condition, which could not be prevented by the reasonable safety precautions against injury. Closed reduction and closed intramedullary fixation was planned for the patient with humeral shaft fracture. While advancing the nail by hammering a piece of metal detached. A short time following the commencement of the procedure, the surgeon who was performing the operation felt a sudden severe pain in the neck. A radio-opaque intensity in the cervical region was detected on X-rays. There was a piece of metal from the hammer. The risk encountered in the present case comprises a condition, the prevention of which is probably impossible with the frequently utilized preventive measures against injuries. For this reason, the operating room team and in particular, the surgeon, should be careful about possible expected injuries, as well as the unexpected ones. Sharps injuries continue to be a serious concern for all healthcare workers. In some studies however, reporting of sharps injuries by healthcare workers remains a problem with reporting levels cited as low as 15% and as high as 90% (Kerr H-L, Stewart N Ann R Coll Surg Engl 91:430–432, [6]). Guo et al. pointed out the most recent sharps injuries at work, and syringe needles was by far the most important items causing injuries, followed by glass products, suture needles, and intravenous catheters. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentPages 1-4DOI 10.1007/s00402-011-1431-1Authors Ahmet Ozgur Yildirim, First Clinics of Ortopedics and Traumatology, Ankara Numune Education and Research Hospital, Ankara, Republic of TurkeyYusuf Alper Katı, First Clinics of Ortopedics and Traumatology, Ankara Numune Education and Research Hospital, Ankara, Republic of TurkeyOzdamar Fuad Oken, First Clinics of Ortopedics and Traumatology, Ankara Numune Education and Research Hospital, Ankara, Republic of TurkeyAhmet Ucaner, First Clinics of Ortopedics and Traumatology, Ankara Numune Education and Research Hospital, Ankara, Republic of Turkey Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Biomechanical investigation of the stabilization principle of the Latarjet procedure

Abstract Purpose The purpose of the study was to determine the biomechanical status of the different components of the Latarjet procedure. The anterior capsule reconstruction with the transferred coracoacromial ligament (CAL) and the necessity of an intact subscapularis tendon were of particular interest. We hypothesized that the anterior capsule reconstruction will have a significant effect and that the Latarjet procedure will lose its stabilizing effect if the subscapularis tendon is torn. Methods Stability testing of 12 human shoulder specimens was performed. After testing of the intact joint, a combined anterior glenoid and capsule defect was set arthroscopically. Then the Latarjet procedure was performed using an open approach and tested with and without loading of the conjoint tendons (10 N). Afterwards, the specimens were distributed into two groups and the Latarjet technique was reduced stepwise: dissection of the CAL, dissection of the conjoint tendons (group A); reduction of the coracoid segment, dissection of the subscapularis tendon (group B). Biomechanical testing was performed for each condition in two positions: 60° of glenohumeral abduction with neutral rotation and with 60° of external rotation; each with a passive humerus load of 30 N in the anterior, inferior and anteroinferior direction. Results The Latarjet technique with load applied to the conjoint tendons significantly reduced translation compared with the defect condition for all tested positions in all directions. In group A, the CAL-dissection led to a significant increase of anterior translation (+5.0 mm, p = 0.003) and inferior translation (+7.3 mm, p = 0.025) in neutral rotation and of anterior translation in 60° of external rotation (+4.4 mm, p = 0.034). In group B, the reduction of the coracoid bone down to the coracoid tip resulted in a significant increase of only the anterior translation in abduction and 60° of external rotation (+4.5 mm, p = 0.05). In contrast, the detachment of the subscapularis tendon led to a significant increase of translation in all testing positions except the inferior direction in the neutral rotation. Conclusions We found the anterior capsule reconstruction to represent a significant contribution to the stabilizing effect of the Latarjet procedure, whereas a deficiency of the subscapularis tendon eliminates its effect. Clinical relevance We recommend to perform the Latarjet technique with an anterior capsule reconstruction (e.g. CAL transfer) and with a transfer of the coracoid bone block rather than a transposition of the coracoid tip. Furthermore, we were able to show that an intact subscapularis tendon is a necessary prerequisite for a reliable stabilization. Content Type Journal ArticleCategory Arthroscopy and Sports MedicinePages 1-10DOI 10.1007/s00402-011-1425-zAuthors M. Wellmann, Department of Orthopaedic Surgery, Hannover Medical School, Anna von Borries Str. 1-6, 30625 Hannover, GermanyH. de Ferrari, Department of Orthopaedic Surgery, Hannover Medical School, Anna von Borries Str. 1-6, 30625 Hannover, GermanyT. Smith, Department of Orthopaedic Surgery, Hannover Medical School, Anna von Borries Str. 1-6, 30625 Hannover, GermanyW. Petersen, Department of Orthopaedic Surgery, Hannover Medical School, Anna von Borries Str. 1-6, 30625 Hannover, GermanyC. H. Siebert, Department of Orthopaedic Surgery, Hannover Medical School, Anna von Borries Str. 1-6, 30625 Hannover, GermanyJ. D. Agneskirchner, Department of Orthopaedic Surgery, Hannover Medical School, Anna von Borries Str. 1-6, 30625 Hannover, GermanyC. Hurschler, Department of Orthopaedic Surgery, Hannover Medical School, Anna von Borries Str. 1-6, 30625 Hannover, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Effects of microendoscopy-assisted reduction and screw fixation through a single mini-incision on posterior cruciate ligament tibial avulsion fracture

Abstract Introduction There are various surgical approaches for the treatment of posterior cruciate ligament (PCL) injury-associated tibial fracture avulsion, including arthroscopy-assisted surgery and open posterior surgery. However, none of these treatments are perfect. We have established a simple procedure with microendoscopy-assisted reduction and cannulated screw fixation for the treatment of this disease through a single mini-incision. In this study, we delineated the effects of this surgical approach for patients with PCL tibial avulsion fracture. Patients and methods We retrospectively reviewed 24 patients with acute PCL tibial avulsion fracture treated via this method from 2004 to 2008. All the patients were implanted with cannulated screws (AO/ASIF, 3.5, 4.0 or 4.5 mm in diameter, 3–4 mm in length) for fixation by microendoscopy. The posterior drawer test (PDT) and KT-2000 arthrometer examination were performed to evaluate knee stability. The Lysholm knee scoring scale and the International Knee Documentation Committee (IKDC) scoring scale were used to assess knee function. Types and rates of complications and radiographic follow-up were reviewed for all cases. Results 23 of 24 cases achieved knee stability by PDT and KT-2000 examination. The Lysholm’s score was improved from 43.8 ± 4.6 to 95.3 ± 3.8. The IKDC evaluation demonstrated an improved function in 17 cases with grade A, 6 with grade B, and 1 with grade C. No relevant complications were experienced by any patient. Conclusions Increased stability, functional improvement, and few complications were observed in patients of PCL injury-associated tibial fracture avulsion treated with the microendoscopy-assisted reduction and cannulated screw fixation through a single mini-incision. Content Type Journal ArticleCategory Orthopaedic SurgeryPages 1-7DOI 10.1007/s00402-011-1426-yAuthors Wei Chen, Department of Orthopaedics, Southeast Hospital of Xiamen University, Zhangzhou, 363000 Fujian, ChinaDezhi Tang, Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032 ChinaLiangqi Kang, Department of Orthopaedics, Southeast Hospital of Xiamen University, Zhangzhou, 363000 Fujian, ChinaZhenqi Ding, Department of Orthopaedics, Southeast Hospital of Xiamen University, Zhangzhou, 363000 Fujian, ChinaMo Sha, Department of Orthopaedics, Southeast Hospital of Xiamen University, Zhangzhou, 363000 Fujian, ChinaJiayuan Hong, Department of Orthopaedics, Southeast Hospital of Xiamen University, Zhangzhou, 363000 Fujian, China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel

Abstract According to our observation in ACL reconstruction, we find root tears of the posterior horn of the lateral meniscus as a common concomitant injury in ACL-deficient knees. This might be a consequence of initial trauma or of the increased anterior–posterior translation of the tibia and an overload impact on the posterior meniscus root in ACL-deficient knees. A tear of the posterior horn of the medial meniscus causes a 25% increase in peak pressure in the medial compartment compared with that found in the intact condition. The repair restores the peak contact pressure to normal (Allaire et al. in J Bone Joint Surg Am 90(9):1922–1931, [2008]). A tear of the posterior horn of the lateral meniscus might have similar consequences. We hypothesize the surgical anatomical reattachment of the root at the tibia helping to restore knee joint kinematics and helping to advance ACL-graft function. This article presents an arthroscopical technique to reattach the posterior meniscus root in combination with ACL double-bundle reconstruction. The procedure uses the tibial PL tunnel to fix the meniscus suture. Content Type Journal ArticleCategory Arthroscopy and Sports MedicinePages 1-5DOI 10.1007/s00402-011-1429-8Authors Philipp Forkel, Clinic for Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar-Theyß-Str. 27-31, 14193 Berlin, GermanyWolf Petersen, Clinic for Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar-Theyß-Str. 27-31, 14193 Berlin, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Persistent ulnar-sided wrist pain after treatment of triquetral dorsal chip fracture: six cases related to triangular fibrocartilage complex injury

Abstract Introduction Persistent ulnar-sided wrist pain after treatment of triquetral dorsal chip fracture even after union is a matter of concern. There could be various reasons for this persistent pain like arthritis, instability, fractures and non-union. We correlate our findings of physical examination and wrist arthroscopy as triangular fibrocartilage complex injury to be one of the causes of this persistent pain. Patients Six subjects who had persistent ulnocarpal joint pain and tenderness after triquetral dorsal chip fracture, despite 2 months of conservative treatment, were subjected to physical tests. If the physical examination yields positive results, then magnetic resonance imaging followed by arthroscopic treatment was performed. The six patients were then evaluated using the visual analogue scale, the Mayo modified wrist score, and the grip strength test. Results Triangular fibrocartilage complex (TFCC) injury was observed in all six cases and partial TFCC resection and synovectomy were performed. Analysis of the visual analogue scale, Mayo modified wrist score, and grip strength test data revealed statistically significant improvements (P < 0.05). Conclusion In addition to several causes reported in the published literature, TFCC injury can be a cause of persistent ulnar pain after treatment of triquetral dorsal chip fracture. Arthroscopic partial TFCC resection can be considered to be a suitable treatment for such cases. Content Type Journal ArticleCategory HandsurgeryPages 1-6DOI 10.1007/s00402-011-1416-0Authors Seoung-joon Lee, Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, KoreaChasanal Mohan Rathod, Department of Orthopaedic Surgery, Yonsei University College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul, 120-752 KoreaKwang-Won Park, Department of Orthopaedic Surgery, Yonsei University College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul, 120-752 KoreaJin-Ho Hwang, Department of Orthopaedic Surgery, Yonsei University College of Medicine, 250 Seongsanno (134 Sinchon-dong), Seodaemun-gu, Seoul, 120-752 Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Precision of Ci-navigated extension and flexion gap balancing in total knee arthroplasty and analysis of potential predictive variables

Abstract Introduction The aim of this study was to evaluate the accuracy of final limb alignment and flexion–extension and medial–lateral gap balancing in computer navigated total knee arthroplasty and to analyze various possible predictive variables that may affect the gaps in computer navigated knee arthroplasty. Materials and methods The DePuy Ci system, a nonimage-based passive optical computer navigation system, was used in 225 patients with knee osteoarthritis to assist for the total knee arthroplasty. From the raw data the Ci-verified pre- and postoperative leg axis in extension, angle of tibia and femur resection, the flexion and extension angle, the medial and lateral extension and flexion gaps were extracted; and differences in gaps were calculated and subjected to statistical analysis. Leg alignment and implant position were determined only by the navigation system. Preoperative variables were evaluated for their impact on the final flexion/extension and medial/lateral gaps achieved. Results Though the preoperative femoro-tibial coronal alignment had a large variance, postoperatively 98.22% of the knee was found to be between −3° and +3° in the coronal limb alignment axis. The Ci-verified femoral and tibial cuts in the coronal plane showed a good accuracy. The sagittal alignment of the femoral cut ranged from 8.20° flexion to 3.20° of extension. Rectangular extension and flexion gaps were achieved with ≤3 mm of difference in gaps on medial and lateral sides in 98 and 93% of knees, respectively. Difference between extension and flexion gaps on the medial side was ≤3 mm in 83% and on the lateral side in 84% of the knees. Of all the possible predictive variables analyzed, Pearson correlation and multiple regression analysis showed significant correlation only between the medial–lateral gap difference in extension and the Ci-verified femoral cut, tibial cut and limb axis, all in the coronal plane. Conclusion Computer-assisted navigated total knee replacement allows for accurate gap balancing that is not dependent on the various pre- and intraoperative factors mentioned, including age, sex, Range of motion preoperative deformity and grade of osteoarthritis. The Ci-calculated and verified tibial, and femoral cuts are the only possible factors affecting the extension gap. Content Type Journal ArticleCategory Knee ArthroplastyPages 1-10DOI 10.1007/s00402-011-1419-xAuthors S. Fickert, Orthopedic and Trauma Surgery Center, University Medical Center Mannheim, Theodor Kutzer Ufer 1–3, 68167 Mannheim, GermanyA. Jawhar, Orthopedic and Trauma Surgery Center, University Medical Center Mannheim, Theodor Kutzer Ufer 1–3, 68167 Mannheim, GermanyP. Sunil, Apollo Hospital, Hyderabad, IndiaH.-P Scharf, Orthopedic and Trauma Surgery Center, University Medical Center Mannheim, Theodor Kutzer Ufer 1–3, 68167 Mannheim, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Value of magnetic resonance arthrography in post-traumatic anterior shoulder instability prior to arthroscopy: a prospective evaluation of MRA versus arthroscopy

Abstract Purpose This prospective study was designed to evaluate the value of magnetic resonance arthrography (MRA) after traumatic anterior shoulder instability prior to arthroscopy. Methods Patients included had two or more shoulder dislocations, at least the first being traumatic. MRA images were scored for Hill Sachs lesions, superior labral anterior posterior (SLAP) lesions, rotator cuff tears, glenohumeral ligament (GHL) lesions and Bankart lesions. Consequently, a standardized shoulder arthroscopy was performed. Five surgeons were involved in the study, initially blinded to the MRA results. MRA and arthroscopic findings were compared. Interobserver agreement was calculated by using Cohen’s Kappa coefficients (κ). Results Eighteen patients (13 male, 5 female) were included (mean age 26.1 years). Hill Sachs lesions demonstrated fair agreement (κ = 0.33) whereas for SLAP lesions moderate agreement was calculated (κ = 0.43). On MRA, four partial thickness rotator cuff lesions were seen, not being stated by arthroscopy. GHL lesions were described on MRA in 15 patients; only two patients turned out to have GHL lesions at arthroscopy. Two arthroscopically diagnosed Bankart lesions which needed surgical treatment were not detected by MRA (moderate agreement, κ = 0.47). Conclusions In patients with post-traumatic anterior glenohumeral instability MRA shows many lesions that can not be confirmed by arthroscopy and therefore do not have therapeutical consequences. On the other hand some labral lesions which do need surgical treatment are not detected on MRA. At least from this study, it can be concluded that MRA has limited value prior to the arthroscopic treatment of post-traumatic shoulder instability. Content Type Journal ArticleCategory Arthroscopy and Sports MedicinePages 1-5DOI 10.1007/s00402-011-1423-1Authors Hugo C. van der Veen, Department of Orthopaedic Surgery, Medical Center Leeuwarden, P.O. Box 888, 8901 BR Leeuwarden, The NetherlandsJames P. M. Collins, Department of Radiology, Medical Center Leeuwarden, Leeuwarden, The NetherlandsPaul C. Rijk, Department of Orthopaedic Surgery, Medical Center Leeuwarden, P.O. Box 888, 8901 BR Leeuwarden, The Netherlands Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Primary results of Kienböck’s disease treated using balloon kyphoplasty system

Abstract Objective Kienböck’s disease is difficult to treat and optimal treatments for stages II to III continue to elude investigators. We hypothesized that impacting the ischemic cancellous trabeculae and increasing the strength and rigidity of the lunate with balloon kyphoplasty can prevent lunate collapse, relieve the symptoms, and increase wrist range of motion. The purpose of this study was to demonstrate the feasibility of percutaneous balloon kyphoplasty for treatment of stage II to III Kienböck’s disease. Methods The study group comprised five patients (two in stage II, three in stage III). All were treated with balloon kyphoplasty. Pain, strength, and wrist flexion/extension range of motion were evaluated preoperatively and postoperatively. The Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand (DASH) Score were used to evaluate outcomes. Patient satisfaction was also assessed. Comparisons between preoperative and postoperative data were made with SPSS software. Results Clinical data were collected at a mean of 26.6 months (range 24–28 months) postoperatively. Pain was significantly reduced from 6.8 ± 0.8 in the visual analog scale preoperatively to 0.6 ± 0.9 at the 24-month follow-up. Strength and range of motion were improved postoperatively in all patients. The mean DASH score was 11.3 (range 6.7–18.3), and the mean Mayo Wrist Score was 78 (range 75–80). All five patients returned to their previous occupations. Conclusions Balloon kyphoplasty can prevent lunate collapse, reduce pain, and improve wrist function of patients with stage II to III Kienböck’s disease. Further studies regarding the feasibility of this new approach are warranted. Content Type Journal ArticleCategory HandsurgeryPages 1-7DOI 10.1007/s00402-011-1428-9Authors Wei Chen, Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 People’s Republic of ChinaJuan Wang, Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 People’s Republic of ChinaJinshe Pan, Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 People’s Republic of ChinaQi Zhang, Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 People’s Republic of ChinaXinzhong Shao, Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 People’s Republic of ChinaYingze Zhang, Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 People’s Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Isolated AL bundle reconstruction of the PCL

Abstract Introduction The purpose of this study was to evaluate the clinical and radiologic results after isolated reconstruction of the posterior cruciate ligament (PCL) using the semitendinosus (ST) and gracilis (GR) tendons with the arthroscopic single-bundle technique. Methods All patients upon whom we had performed a single-bundle PCL reconstruction between 2002 and 2005 prospectively underwent a standardized follow-up examination after 2 years. Isolated PCL reconstruction was carried out on 41 patients during the observation period. Pre- and postoperative stress radiographs were taken using the Telos stress device in order to evaluate the dorsal translation. Knee joint function and degree of activity were recorded using the Tegner activity score, the subjective International Knee Documentation Committee (IKDC) score, and the overall IKDC score. Results 33 of 41 patients (80.4%, 17 men, 16 women) completed the study. The posterior tibial translation of −10.1 ± 1.8 mm had an overall average improvement to a postoperative value of −5.0 ± 2.5 mm (p < 0.001). The patients showed a significant improvement in the Tegner activity score from an average 2.8 ± 0.8 points to 5.9 ± 1.2 points (p < 0.001). Evaluation of the subjective IKDC showed a significant improvement from a preoperative score of 41.86 ± 11.49 points to a postoperative score of 69.54 ± 11.39 points (p < 0.001). In total, 24 patients (72.8%) exhibited a normal or nearly normal outcome. Conclusion The abovementioned reconstruction technique can achieve a stable knee function in patients with isolated PCL insufficiency. The isolated single-bundle PCL reconstruction offers an improvement regarding the activity level and stability of the knee joint. Level of evidence Level IV. Content Type Journal ArticleCategory Arthroscopy and Sports MedicinePages 1-8DOI 10.1007/s00402-011-1403-5Authors Matthias Lahner, Department of Orthopedic Surgery, Ruhr-University Bochum, St. Josef-Hospital, Gudrunstr. 56, 44791 Bochum, GermanyTobias Vogel, Department of Orthopedic Surgery, Ruhr-University Bochum, St. Josef-Hospital, Gudrunstr. 56, 44791 Bochum, GermanyLars Victor von Engelhardt, Department of Orthopedic Surgery, Ruhr-University Bochum, St. Josef-Hospital, Gudrunstr. 56, 44791 Bochum, GermanyMartin S. Schulz, Orthopedic Clinic Markgröningen, Markgröningen, GermanyMichael J. Strobel, Sporthopaedicum Straubing, Straubing, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Ultrasound-based computer navigation of the acetabular component: a feasibility study

Abstract Introduction This feasibility study investigated the accuracy of anterior pelvic reference plane (APP) registration and acetabular cup orientation in two cadavers with different BMIs. Method Five observers each registered the APP five times in the 2 cadavers (BMIs: 32 kg/m² and 25 kg/m²) using an ultrasound-based navigation system. By comparison against the CT-derived reference landmarks, the errors in determining the individual landmarks defining the APP, as well as the resulting errors in the orientation of the APP and the acetabular cup orientation were determined. Results Across all measurements obtained with the ultrasound navigation system, the errors in rotation and version in determining the APP were 0.5° ± 1.0° and −0.4° ± 2.0°, respectively. The cup abduction and anteversion errors determined from all measurements of the five investigators for both cadavers together were −0.1° ± 1.0° and −0.4° ± 2.7°, respectively. The data further demonstrated a high reproducibility of the measurements for the resulting cup adduction and anteversion angle. Conclusion Our preliminary results confirm that ultrasound navigation is a highly accurate tool that allows a reproducible registration of the APP and thereby enables accurate and precise intraoperative determination of the acetabular cup orientation also in patients with increased BMI. Content Type Journal ArticleCategory Hip ArthroplastyPages 1-9DOI 10.1007/s00402-011-1412-4Authors Georgi I. Wassilew, Department of Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, GermanyMarkus O. Heller, Julius Wolff Institute and Center for Musculoskeletal Surgery, Center for Sports Science and Sports Medicine Berlin (CSSB), Charité–Universitätsmedizin Berlin, Berlin, GermanyOlaf Hasart, Department of Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, GermanyCarsten Perka, Department of Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, GermanyIngrid Südhoff, Aesculap AG, Tuttlingen, GermanyViktor Janz, Department of Orthopedics, Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, GermanyGeorg N. Duda, Julius Wolff Institute and Center for Musculoskeletal Surgery, Center for Sports Science and Sports Medicine Berlin (CSSB), Charité–Universitätsmedizin Berlin, Berlin, GermanyChristian König, Julius Wolff Institute and Center for Musculoskeletal Surgery, Center for Sports Science and Sports Medicine Berlin (CSSB), Charité–Universitätsmedizin Berlin, Berlin, Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses

Abstract Introduction We performed radiologic measurement of the distal and middle phalanges in volunteers to determine the size of a headless compression screw suitable for distal interphalangeal (DIP) joint arthrodesis in Korean subjects and report on clinical results using an acutrak fusion screw. Materials and methods Radiologic measurements on the distal and middle phalanx were performed to determine the optimal size of screw. Five hundred fingers from 50 adult Koreans without any abnormality on plain radiographs were selected and anteroposterior and lateral radiographs were obtained for measurements. For the distal phalanx, the narrowest diameter of the cortical bone was measured to determine the minimal diameter of the screw that would not penetrate the cortex. For the middle phalanx, the narrowest diameter of the medullary canal was measured to determine the appropriate size of the screw for fixation. Between May 2004 and December 2007, there were 23 fingers in 22 patients (6 male, 16 female) that had finger DIP joint or thumb IP joint arthrodesis performed with the acutrak fusion screws. At the final follow up, time to union, complications, clinical fusion angle, pinch power, visual analogue score (VAS) for pain and the Korean version of the disabilities of the arm, shoulder and hand (DASH) questionnaire were assessed. Results In the distal phalanx, the narrowest diameter of the cortex was 2.64 ± 0.51 mm for the little finger. In the middle phalanx, the narrowest diameter of the medullary canal was 1.83 ± 0.50 mm for the little finger and 4.17 ± 0.68 for the thumb. The mean time to union was 10 weeks (range 8–12). The mean clinical fusion angle of the DIP joint was 11.9° (range 0–20). The VAS pain score was 0.4 (range 0–3). Pinch power was 75% of the normal side. The average Korean DASH score was 5 points (range 0–8). We experienced one intraoperative fixation failure for thumb IP joint arthrodesis caused by a wide medullary canal of the proximal phalanx. Conclusion The acutrak fusion screw was a feasible and adequate tool for DIP arthrodesis, particularly in Koreans. However, meticulous attention to technique was important to avoid complications in some little fingers. If preoperative radiographs suggest the thumb has a wide medullary canal, alternate methods of fixation should be considered. Content Type Journal ArticleCategory HandsurgeryPages 1-7DOI 10.1007/s00402-011-1413-3Authors Joo-Hyoun Song, Department of Orthopedic Surgery, St. Vincent’ Hospital, The Catholic University of Korea, 93 Ji-dong, Paldal-gu, Suwon, 442-723 KoreaJoo-Yup Lee, Department of Orthopedic Surgery, St. Vincent’ Hospital, The Catholic University of Korea, 93 Ji-dong, Paldal-gu, Suwon, 442-723 KoreaYang-Guk Chung, Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, KoreaIl-Jung Park, Department of Orthopedic Surgery, Bucheon St. Mary’s Hospital, The Catholic University of Korea, 2 Sosa-dong, Wonmi-gu, Bucheon, 420-717 Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Meniscal tear repaired with Fast-Fix sutures: clinical results in stable versus ACL-deficient knees

Abstract Aim The aim of this prospective study was to analyze the results of meniscal tears repaired with Fast-Fix All-inside suture in stable versus anterior cruciate ligament (ACL)-deficient knees. Patients Forty patients, everybody professional players, all underwent arthroscopic surgery, were divided into two groups and followed-up for at least 24 months. Group A (stable knee affected with isolated meniscal tears) consisted of 20 patients treated exclusively with Fast-Fix suture. Group B (ACL-deficient knees affected with meniscal tears) consisted of 20 patients in which we performed a Fast-Fix suture with concurrent ACL reconstruction (hamstring duplicated). Comparing both Groups together, we have noticed that the good clinical result of meniscal sutures with ACL reconstruction associated has occurred faster than isolated meniscal suture, regardless of the meniscus, the knee, and age of the patient. In fact 6 months after surgery, in Group A, there was a success by 65% against 85% for the Group B with 8.3 points International Knee Documentation Committee (IKDC) difference in favor of the latter. Whereas 24 months after surgery, the percentage was increased achieving 90% in Group A and 95% in Group B with 12.6 points IKDC difference in favor of the Group B. A statistical analysis of variable, both after 6 and 24 months, showed a significant improvement of knee conditions for patients with ACL reconstruction. Conclusion In conclusion, other than observing the better results in meniscal tears with ACL-deficient knee, we observed that among all cases the best healing occurred in patients affected by meniscal longitudinal vertical tears located in Red–Red zone of external meniscus with an extension of 10 mm in ACL-deficient knee, treated with Fast-Fix suture and ACL reconstruction associated. Content Type Journal ArticleCategory Arthroscopy and Sports MedicinePages 1-8DOI 10.1007/s00402-011-1391-5Authors A. Tucciarone, Istituto Chirurgico Ortopedico Traumatologico, 04100 Latina, ItalyL. Godente, Istituto Chirurgico Ortopedico Traumatologico, 04100 Latina, ItalyR. Fabbrini, Istituto Chirurgico Ortopedico Traumatologico, 04100 Latina, ItalyL. Garro, Istituto Chirurgico Ortopedico Traumatologico, 04100 Latina, ItalyF. Salate Santone, Istituto Guglielmo Tagliacarne, Rome, ItalyClaudio Chillemi, Istituto Chirurgico Ortopedico Traumatologico, 04100 Latina, Italy Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

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110811-1643 Orthopedics/Upper Extremity - Minnesota MN Seeking BC/BE orthopedic surgeon to join 2 other orthopedic surgeons in a busy practice affiliated with highly reputable and well known health

Orthopedics jobs in "General Orthopedic Surgeon - Indiana" - IN

110726-1621 General Orthopedic Surgeon - Indiana IN Outstanding opportunity for BC/BE orthopaedic surgeon to practice with well established group at 232-bed facility No visa sponsorship available

Orthopedics jobs in "Orthopedic Surgeon - South Carolina" - SC

120125-1879 Orthopedic Surgeon - South Carolina SC Seeking BC/BE general Orthopedic Surgeon to join private practice with two experienced orthopedists in coastal South Carolina Ideal candidate will

Orthopedics jobs in "Orthopedic Hand Surgeon - Florida" - FL

101110-1432 Orthopedic Hand Surgeon - Florida FL Seeking BC/BE orthopedic hand surgeon for well established six member physician-owned practice Fellowship training in orthopedic hand surgery required

Orthopedics jobs in "Orthopedic Surgeon - Pennsylvania" - PA

101015-1366 Orthopedic Surgeon - Pennsylvania PA Seeking a BE/BC physician to join a well established group of two practicing general orthopedics Fellowship training desired Good referral stream

Orthopedics jobs in "Orthopedic Surgeon - Pennsylvania" - PA

100218-933 Orthopedic Surgeon - Pennsylvania PA Orthopedic surgeon for a well-established three-person private group Ideal candidate will be trained and proficient with either upper extremity,

Orthopedics jobs in "Orthopedic Surgeon - North Dakota" - ND

090520-694 Orthopedic Surgeon - North Dakota ND Seeking BC/BE Orthopaedic Surgeon for existing multi-specialty practice Training required in foot and ankle, pediatrics, spine, sports medicine, total

Orthopedics jobs in "Orthopedic Surgeon - Minnesota" - MN

110120-1522 Orthopedic Surgeon - Minnesota MN Multi-specialty group seeking BC/BE orthopedic surgeon J1/H1B sponsorship Full partnership offered after two years Competitive compensation with

Orthopedics jobs in "Orthopedic Surgeon - Minnesota" - MN

101109-1421 Orthopedic Surgeon - Minnesota MN Seeking BC/BE orthopaedic surgeon to join multi-specialty group Sub-specialty training or interests beneficial Competitive compensation with 2 year

Orthopedics jobs in "Welcome" - MN

100104-876 Orthopedic Surgeon - Minnesota MN Seeking a BC/BE orthopaedic surgeon to step into an existing practice J1 and H1B visas welcome Unique resort community surrounded by 412 Minnesota

Orthopedics jobs in "Orthopedic Surgeon - Minnesota" - MN

090520-685 Orthopedic Surgeon - Minnesota MN Seeking a BC/BE orthopaedic surgeon for expanding multi-specialty group Currently have seven orthopaedic surgeons J1/H1B approved In addition, the

Orthopedics jobs in "Orthopedic Surgeon - Kentucky" - KY

100707-1173 Orthopedic Surgeon - Kentucky KY Practice seeking orthopedic surgeon due to the need in the community Partnership opportunity You will be busy from day one Income guarantee plus

Orthopedics jobs in "Orthopedic Surgery - Georgia" - GA

120113-1847 Orthopedic Surgery - Georgia GA Seeking BC/BE Orthopedic surgeon to join established group Practice has been in the community for over 30 years and is devoted to the diagnosis, treatment,

Orthopedics jobs in "Orthopedics - North Carolina" - NC

091201-836 Orthopedics - North Carolina NC General surgery Hospital employed position created due to expansion. Third physician needed to join two others Great payor/mix Call - 1:3 Call is

Orthopedics jobs in "Las Vegas deisrable suburb" - NV

Opportunity Join established/highly respected Orthopedic Surgery group. Sr. partner may be retiring this year, so general orthopedic Surgeon is needed. Hand fellowship would be a plus since those

Orthopedics jobs in "Call For More Information" - OH

Looking to develop a large hospital employed Orthopedic group. Excellent Base Salary. Production and Performance Bonuses. Medical school loan repayment up to $200,000. State of the Art facility with

Orthopedics jobs in "Hills" - IA

090512-676 Orthopedic Surgeon - Iowa IA Need Orthopedic surgeon to join hospital team Visa sponsorship offered Hospital employed position Competitive salary Generous benefits Low cost of

Orthopedics jobs in "Wilkes-Barre/Poconos" - PA

A well-established facility in the Wilkes-Barre/Poconos area of PA is in need of a BC/BE Orthopedic Surgeon. Its highly-skilled team of healthcare professionals is dedicated

Orthopedics jobs in "Inquire for details" - TN

BC/BE Orthopedic Surgeon is needed to join an established practice in the Beautiful Mountains of Northeast Tennessee. Competitive Salary plus WRVU bonus structure. Large referral base. This area offers

Orthopedics jobs in "Inquire for details" - WI

BC/BE General Orthopedic Surgeon needed for multi-specialty group. Ability to develop a Sports Medicine practice, if desired. Part-time (3-day workweek) or Full-time (4-day workweek). Proposed call schedule

Orthopedics jobs in "Inquire for details" - MN

BC/BE Orthopedic Surgeon needed to join two other Orthopedic Surgeons in a busy practice. Fellowship training preferred, but not required in upper extremity. Call consists of general orthopedics call,

Orthopedics jobs in "Inquire for details" - WI

BC/BE Orthopedic Surgeon needed for growing department in multi-specialty group. Fellowship training in sports medicine or total joints is welcome. The normal work schedule will consist of a total of

Orthopedics jobs in "Inquire for details" - TN

BC/BE Orthopedic Surgeon to step into a ready-made practice. Great opportunity to lead with the potential to recruit into your practice once established. Choice of hospital employment + production bonus

Orthopedics jobs in "Inquire for details" - ND

Two (2) BC/BE ORTHOPEDIC SURGEONS wanted to join four orthopedic surgeons at Orthopedics Clinic. Part of physician multi-specialty group and 1:6 call anticipated. Offers 500+ miles of trails, 400

Orthopedics jobs in "Inquire for details" - NC

To Join busy private practice. Three orthopedists, one who does sports medicine knees, another who does joint replacement, the head orthopedist general work seeking a spine physician to help them expand

Orthopedics jobs in "Greater Sacramento" - CA

An excellent opportunity for a BC/BE Internal Medicine Physician exists in the Greater Sacramento area of CA. Board Certified is preferred but Board Eligible will be accepted.

Orthopedics jobs in "Greater Fort Wayne" - IN

Our client in the Greater Fort Wayne, IN area is looking to recruit 2 BC/BE Orthopedic surgeon for their new practice. Board Certified is preferred but Board Eligible

Orthopedics jobs in "Greater Pittsburgh" - PA

We have an outstanding opportunity for a BC/BE Orthopedic Surgeon in the Greater Pittsburgh area of PA to join a well-established facility. Board Certified is preferred but Board

Orthopedics jobs in "Call for location" - AR

Arkansas Hospital seed Locum Tenen to Permanent Orthopedic Surgeon to start as soon as possible for fulltime ongoing coverage. Would consider any availabilty for the working interview process. This is

Orthopedics jobs in "Call for location" - KS

Client needs an orthopedic surgeon to provide locums coverage until a contract or agreement can be reached for perm. It is a great way to get th know the area and practice before signing a long term commitment

Orthopedics jobs in "Greater Alleghany" - NY

A regional medical center in the beautiful area of Greater Alleghany is seeking a Permanent BE/BC Orthopedic Surgeon to start immediately. Monday - Friday work week with

Orthopedics jobs in "Great Location" - CA

Locums Orthopaedic Surgeon needed in Central CA for Clinic and Call work 3/5-3/12. Bread and Butter scope with about 20 patients per day in clinic and very light call. Wonderful location with loads

Orthopedics jobs in North Carolina

All Orthopedics jobs in North Carolina for Sun Feb 5 2012

Orthopedics jobs in "Great Location" - VA

A community hospital located in western Virginia is currently searching for an orthopaedic surgeon to provide ongoing, long term locum tenens coverage until a permanent replacement can be found. The

Orthopedics jobs in "Great Location" - NM

Orthopaedic Surgeon needed full time, clinic and call in NM. Starting in May 2012 - August 2012. Total joints (Hips & Knees) are a must. Competitive pay and wonderful area. Lots of outdoor activities

Orthopedics jobs in "NW of Phoenix" - AZ

Our client located NW of Phoenix, AR is seeking a BC/BE Orthopedic Surgeon to be employed in hospital-owned clinic. Board Certified is preferred but Board Eligible will be accepted.

Orthopedics jobs in "Not Disclosed" - ND

A healthcare facility in East Central North Dakota seeks to add a permanent Board Certified or Board Eligible Orthopedic Surgeon to their staff. The ideal candidate will be available to work Monday through

Orthopedics jobs in "Not Disclosed" - VA

Our client located in Southwest VA seeks a permanent BC or BE (within 3 years)Orthopedic Surgeon to begin as soon as possible. Expected shifts are Tues/Wed/Fri 9 a.m.-5 p.m which are clinic days. Monday

Orthopedics jobs in "Metro/Central" - TN

A well-established facility located in the Metro/Central area of TN is seeking a BC/BE General Orthopedic Surgeon to bring on board. Board Certified is Preferred but

Orthopedics jobs in "Not Disclosed" - KS

A practice in the Topeka, KS area seeks to hire a permanent Orthopedic Surgeon. Doctors must be Board Certified or Board Eligible. If BE, the physician must be less than three years out of residency.

Orthopedics jobs in "Not Disclosed" - VA

A permanent (or locum to perm) Orthopedic Surgeon is needed in NW Virginia. A group of Orthopedic Surgeons is looking to expand their group through the incorporation of several new surgeons ranging from

Orthopedics jobs in "Williamsport" - PA

Susquehanna Health is seeking a BC/BE fellowship trained Orthopedic Surgeon (Foot & Ankle or Shoulder/Upper Extremity) to join two (2) others in a busy group practice here in Williamsport, Pennsylvania.

Orthopedics jobs in "West/Central" - PA

Our client in the West/Central area of PA is currently looking to bring on a BC/BE Orthopedic Surgeon. Board Certified is preferred but Board Eligible will be accepted. Out-patient

Orthopedics jobs in "West/Central" - PA

Our client in the West/Central area of PA is currently looking to bring on a BC/BE Orthopedic Surgeon. Board Certified is preferred but Board Eligible will be accepted. Out-patient

Orthopedics jobs in "Eastern Iowa" - IA

This is an excellent opportunity for a BE/BC Orthopedic Surgeon to either join 1 other or establish a new solo practice in a very comfortable eastern Iowa city. The practice will be general orthopedics

Orthopedics jobs in "Southwestern" - IN

We have an outstanding opportunity for a BC/BE Orthopedic Surgeon to practice in top physician-friendly state for a well-established practice in southwestern Indiana. This practice offers advanced

Orthopedics jobs in "Portsmouth" - VA

Do you have a passion to care for our nation's heroes and have an Orthopedic Fellowship ? Then consider this dream job in a cutting edge, professional, fast-paced naval medical facility! As a Physician

Orthopedics jobs in "Portsmouth" - VA

Do you have a passion to care for our nation's heroes and enjoy Orthopedics? Then consider this dream job in a cutting edge, professional, fast-paced naval medical facility! As a Physician Assistant

Orthopedics jobs in "Whitesburg" - KY

Whitesburg ARH Hospital BC/BE Orthopedic Surgeon Whitesburg ARH Hospital is seeking a BC/BE Orthopedic Surgeon to join its medical staff. Our 90-bed community hospital prides itself with a high tech-high

Orthopedics jobs in "Whitesburg" - KY

Orthopedics jobs in "Williamson" - KY

Williamson ARH Hospital BC/BE Orthopedic Surgeon Williamson ARH Hospital is seeking a BC/BE Orthopedic Surgeon to join its medical staff. Our 163-bed community hospital prides itself with a high

Orthopedics jobs in "Santa Rosa" - CA

Orthopaedic Surgeon – Minimally Invasive Need California Wine and Lake Country Salary + WRVU = $700,000 - $900,000+ Potential High Volume General - Sports & Total Joints Genuine

Orthopedics jobs in "ORS 166750" - CA

CALIFORNIA ORTHOPEDIC SURGERY ACADEMIC APPOINTMENT IMMEDIATE NEED FOR AN ORTHOPEDIC SURGEON TRULY MAKE AN IMPACT IN THIS COMMUNITY Exciting opportunity to step into collaborative, highly

Orthopedics jobs in "Gulf Coast" - TX

A thriving community located in the Gulf Coast area of Texas is currently looking to bring on a BC/BE Orthopedic Surgeon to join their group. Board Certified is preferred but

Orthopedics jobs in "ORS 166749" - CA

CALIFORNIA ORTHOPEDIC SURGERY ACADEMIC APPOINTMENT IMMEDIATE NEED FOR AN ORTHOPEDIC SURGEON TRULY MAKE AN IMPACT IN THIS COMMUNITY Exciting opportunity to step into collaborative, highly trained

Orthopedics jobs in "ORS143659" - CA

SACRAMENTO, CALIFORNIA ORTHOPEDIC SURGERY COVER 1 HOSPITAL AND NO TRAUMA IMMEDIATE NEED EXISTING PRACTICE EMPLOYMENT OPPORTUNITY WITH A QUICK PARTNERSHIP TRACT Join an established and respected

Orthopedics jobs in "ORS132609" - CA

ORTHOPEDIC SURGERY SPORTS MEDICINE NORTHERN CALIFORNIA IMMEDIATE NEEDBE AS BUSY AS YOU WANT TO BE

Orthopedics jobs in "Northern" - MI

Seeking a board certified/eligible Orthopedic Surgeon for general Orthopedics to join a multi-specialty hospital medical group. Prefer candidate with a Reconstructive Fellowship/interests or major joint

Orthopedics jobs in "Delaware" - DE

Great client in Delaware seeks Orthopedic surgeons for permanent positions for several of it's locations. Please contact me if you are interested: Clay Hagblom Medical Search International 1-877-706-4949