Orthopedics RSS : Gourt

Western Florida group is seeking immediate Orthopedic Surgery coverage. :: Florida :: Weatherby Locums

Job 9544148-0018 This medical group practice is currently looking for an Orthopedic Surgeon to help provide on-going coverage, ASAP. Cases include. Non-Surgical; Surgical; Arthroscopy; Sports Rehab:

North Carolina facility seeks Orthopedic Surgeon for holiday coverage. :: North Carolina :: Weatherby Locums

Job 9501792-0059 This established facility in currently in need of a general orthopedic surgery physician for locum tenens coverage. Cases include Surgical & Non-Surgical, Arthoscopy, TTL Joint Replacement-hip,

Orthopedic Surgeon needed to provide call coverage in Texas :: Texas :: Weatherby Locums

Job 9506033-0013 Group practice seeks Orthopedic Surgery physician to provide temporary coverage. Dates of coverage needed are in October, November and December. Assistance with hospital privileges

Growing suburb east of Atlanta :: Georgia :: Nationwide Physician Recruitment

Due to growth in this great, growing suburb east of Atlanta (downtown Atlanta is less than an hour), a need has been created for an Orthopedic surgeon to establish a solo practice. You will have an

Boston north shore :: Massachusetts :: Nationwide Physician Recruitment

Outstanding opportunity for a BC Orthopedic Surgeon with sub-specialty in Foot/Ankle, Sports Medicine, Hand or Spine to join a group of 5. The call will be 1 in 6. Practice is midway between Boston

Southwestern :: Oregon :: Medical Search International

I have a great new opportunity in Southwestern, OR for an Orthopedic Surgeon. This opportunity is at a level III trauma center at a hospital that is around 200 beds. Coverage will be for office based

Dallas area :: Texas :: TX Client of South West Health Care Recruiters

On behalf of a client located in the Dallas area of Texas, we are seeking a BE/BC ORTHOPEDIC SURGEON with additional fellowship training in either Hand or Foot/Ankle (BC preferred, BE considered with

South east :: Missouri :: Nationwide Physician Recruitment

BE or BC Orthopedic Surgeon needed who can handle a busy practice, relate to people well and can use laymans terms with patients. This position involved general Orthopedic Surgery, and you can also

Southeast :: Missouri :: Nationwide Physician Recruitment

Very desirable area in SE Missouri at foothills of the Ozarks is looking for a general Orthopedic Surgeon to join their medical staff. The service area is 180,000 and the hospital is 423 beds. Your

Northeast :: Oregon :: Phyllis Vajda & Associates, LLC

Opportunity Beautiful northeast Oregon community seeks hospital employed general Orthopedic Surgeon. Qualifications Board Certified, preferred, with excellent clinical and communications skills.

Lancaster :: Pennsylvania :: Execu-Search

Position available in established practice with offices adjacent to two hospitals. Position is employed with paid CME, malpractice and vacation. Medical and dental benefits are available. Requirements

Southern :: California :: Southern CA-Cover 1 Hospital-Signing Bonus

SOUTHERN CALIFORNIAORTHOPEDIC SURGERY IMMEDIATE SURGICAL REFFERRALS PRIVATE PRACTICE /SHARED CALL RELOCATION & SIGNING BONUS COVER 1 HOSPITAL NO TRAUMA Heres your chance to develop your niche in a suburban

New York :: New York :: Winston Staffing

Orthopedics & Sports Medicine - Prestigious Multi-Specialty practice on Long Island is seeking a specialty trained physician to join their expanding practice. Come work alongside other highly skilled

New York :: New York :: Winston Staffing

Great opportunity in the beautiful Hudson Valley! Just one hour north of New York City. A Hospital, has all that "big city" medicine has to offer. This is a great opportunity to join dedicated and professional

New York :: New York :: Winston Staffing

Seeking a General Orthopedic Surgeon to help support our busy and growing off-site practice. Our hospital is dedicated to serving the health care needs of those in the Hudson Valley. We are an integrated

Staunton :: Virginia :: DayStar Medicine & Laser Aesthetics

Wonderful Family Medicine practice is becoming a Multi-Specialty group in cozy Augusta County in the center of the wine country in the incredible Shenandoah Valley of Virginia! Practice in a beautiful

Northern :: Michigan :: Medical Search International

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

Delaware :: Delaware :: Medical Search International

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

Augusta :: Georgia :: Nationwide Physician Recruitment

This is an exceptional opportunity to join a group of 6 in one of Georgia's most desirable locations. The population is 200,000 and the medical service area is 550,000. This opening was created due

North :: California :: Fidelis Partners

ORTHOPEDIC HOSPITALIST NORTHERN CALIFORNIA EXCELLENT CALL SCHEDULE $450K - $500K TOTAL FIRST YEAR A full practice awaits you * One weekend p/ month with no weekday night call * Orthopedic Hospitalist

Referrals from 1000+ Physicians in Major Metro, ‘Most Recession-Proof City’ in 2008, #5211 :: Oklahoma :: Timeline Recruiting

Come work for one of the most prestigious groups in the state. With about 20 Orthopaedic Surgeons in the group, you will have adequate support from day one. With the current share of the market, any

Orthopedic (Hand, Foot & Ankle) Physician Jobs in Coastal North Carolina :: North Carolina :: MedPro Search - Recruiting For Physician Jobs

A North Carolina Orthopedic Group is looking for a hand, and a foot and ankle orthopedic surgeon that wants to practice very close to the coast of North Carolina. You will be practicing with 8 orthopedic

Call for More Information :: Massachusetts :: Medical Search International

Busy Medical Center with all sub specialties of Orthopedics is seeking a BC/BE Orthopedic Surgeon with Foot and Ankle training. Metropolitan area! Fellows are welcomed!! Great compensation including

Call for Information :: Kansas :: Inhouse Physician Recruiters Network

The In-House Physician Recruiter Network, composed of over 500 hospital recruiters, represents over 10,000 hospitals and clinics. Our Network's special feature is to showcase outstanding physicians (who

Not Disclosed :: Montana :: Locum Medical Group

A permanent Foot and Ankle Orthopedist is needed to join a multispecialty surgery group located in Montana. The group is partnering with the local health system to open a brand new surgery center which

Not Disclosed :: Florida :: Locum Medical Group

A well established orthopedic practice in southern Florida is seeking an Orthopedic Surgeon. The ideal candidate will be Board Certified or Board Eligible in Orthopedic Surgery with fellowship training

Williamsport :: Pennsylvania :: Execu-Tech

Looking for a BC Orthopedic Surgeon with Fellowship in Foot & Ankle or Shoulder/Upper Extremity.

Brockport :: New York :: Execu-Tech

We are looking for a solid Orthopedic Surgeon BC is a must for a outstanding opportunity in the Upstate NY area. Relocation, excellent salary and bonus avialable. Contact Execu-Search asap Bob Calamita

Miami :: Florida :: Mercy Hospital

Orthopaedic Institute Expanding BC/BE Orthopaedic Surgeons with Fellowship training in Foot & Ankle, Spine Surgery, Total Joint Replacement & Reconstruction. Group practice with physical therapy component.

West :: North Carolina :: Intelligent Placement Solutions, Inc

We are actively recruiting a BC/BE Orthopedic Foot and Ankle Surgeon to join a local, multi-specialty physician group. The practice is located near Charlotte, NC. Requirements: Board certified or board

Repair of a large osteochondral defect in the knee joint using autologous and artificial bone graft combined with motion preserving distraction arthroplasty: a case report

Abstract The biological reconstruction of a large osteochondral defect in the weight-bearing area of the knee joint has long been a challenge to orthopedic surgeons. We present a case of a large posttraumatic defect in the weight-bearing area of knee joint treated with a novel distraction arthroplasty device after reconstruction of the joint surface using combined autologous and artificial bone graft. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0998-2Authors Mohamed Mahmoud Abouheif, Alexandria University Department of Orthopedic Surgery and Traumatology Alexandria EgyptMitsuhiro Nakamura, Hiroshima University Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences 1-2-3 Kasumi, Minami-ku Hiroshima 734-8551 JapanMasataka Deie, Hiroshima University Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences 1-2-3 Kasumi, Minami-ku Hiroshima 734-8551 JapanNobuo Adachi, Hiroshima University Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences 1-2-3 Kasumi, Minami-ku Hiroshima 734-8551 JapanMakoto Nishimori, Hiroshima University Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences 1-2-3 Kasumi, Minami-ku Hiroshima 734-8551 JapanSatoshi Sera, Hiroshima University Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences 1-2-3 Kasumi, Minami-ku Hiroshima 734-8551 JapanWirat Kongcharoensombat, Hiroshima University Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences 1-2-3 Kasumi, Minami-ku Hiroshima 734-8551 JapanMitsuo Ochi, Hiroshima University Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences 1-2-3 Kasumi, Minami-ku Hiroshima 734-8551 Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Use of 18F-FDG-PET in the diagnosis of endoprosthetic loosening of knee and hip implants

Abstract Introduction To diagnose septic and aseptic loosening 18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has been described with good results for hip arthroplasties. The purpose of the present study was to examine whether there is a difference of feasibility in detecting loosening of hip versus knee prostheses by use of 18F-FDG-PET. Patients Thirty-two patients with lower limb arthroplasty complaints (74 components) were studied preoperatively with 18F-FDG-PET. The interpretation of 18F-FDG-PET was done according to evaluated criteria. The final diagnosis based on intraoperative findings in all cases including microbiological examinations. Results For hip arthroplasty sensitivity/specificity of 18F-FDG-PET towards implant loosening was 80%/87%. For infectious loosening of hip endoprostheses sensitivity/specificity was 67%/83%. In knee endoprostheses sensitivity/specificity for loosening was 56%/82% and 14%/89% for infection. The sensitivity of the results for knee and hip joints in regard to infectious versus aseptic loosening was significantly different. Conclusion We confirm that 18F-FDG-PET is an appropriate tool to diagnose hip arthroplasty loosening. Differing from that 18F-FDG-PET showed a significant lower sensitivity/specificity in detecting septic loosening of knee endoprostheses. It may therefore be necessary to use different methods to diagnose loosening of endoprostheses depending on the type of implant which is examined. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1000-zAuthors Susanne Mayer-Wagner, Ludwig-Maximilians-University Munich Department of Orthopaedic Surgery, Klinikum Großhadern Marchioninistr. 15 81377 Munich GermanyWolfgang Mayer, Praxisgemeinschaft Heimeranplatz Heimeranplatz 2 80339 Munich GermanySonja Maegerlein, Berufsgenossenschaftliches Unfallkrankenhaus Hamburg Bergedorferstr. 10 21033 Hamburg GermanyRainer Linke, Friedrich-Alexander University of Erlangen Nuremberg Department of Nuclear Medicine, Klinikum Erlangen Krankenhausstr. 12 91054 Erlangen GermanyVolkmar Jansson, Ludwig-Maximilians-University Munich Department of Orthopaedic Surgery, Klinikum Großhadern Marchioninistr. 15 81377 Munich GermanyPeter E. Müller, Ludwig-Maximilians-University Munich Department of Orthopaedic Surgery, Klinikum Großhadern Marchioninistr. 15 81377 Munich Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

UKA in combination with PFR at average 12-year follow-up

Abstract Introduction Safety and efficacy of unicompartmental knee arthroplasty (UKA) has been shown in large patient series. Patellofemoral replacement (PFR) is known to be a viable solution to end-stage patellofemoral arthritis. Bicompartmental osteoarthritis (OA) affecting the medial tibio-femoral and the patello-femoral compartment (medio-patellofemoral OA) is often treated with total knee arthroplasty (TKA). It was hypothesized that medio-patellofemoral OA can successfully be treated with bicompartmental arthroplasty. Method In a retrospective approach nine patients who had received UKA in combination with PFR were included into the study. Intact ACL and lateral compartment were conditions for the indication. Patients were clinically examined including clinical scores (KSS and WOMAC) and radiographies were evaluated. Satisfaction of patients was recorded under four categories. Results Average follow-up after bicompartmental arthroplasty was 11.8 ± 5.4 years (4–17 years). Among the nine patients there were eight females and one male at an average age at operation of 64 ± 5 years. No surgical revisions were required following bicompartmental arthroplasty. The KSS score increased from a preoperative 68.8 ± 26.2 to 175.5 ± 22.9 at latest follow-up (p = 0.002). WOMAC was 18.3 ± 8.6 at latest follow-up. All patients included were satisfied (n = 3) or very satisfied (n = 6) with the outcome of this surgical procedure. Conclusion This small case series shows that a bicompartmental arthroplasty can be a successful approach to prevent or postpone TKA. However, this intervention is technically demanding and requires experience in both UKA and PFR. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0997-3Authors Thomas Jan Heyse, University Hospital Marburg Department of Orthopedics and Rheumatology Baldingerstrasse 35043 Marburg GermanyAhmed Khefacha, Institut du Genou, Clinique Hartmann Neuilly sur Seine Paris FrancePhilippe Cartier, Institut du Genou, Clinique Hartmann Neuilly sur Seine Paris France Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Three-dimensional analysis of the intramedullary canal axis of tibia: clinical relevance to tibia intramedullary nailing

Abstract Introduction The aim of this study was to evaluate the appropriate insertion point for a tibial intramedullary nail by measuring the intramedullary canal axis of the tibia in three dimensions. Methods Forty-three pairs (14 males and 29 females) of cadaveric low extremities (mean age 51 years, range 21–60 years) were analyzed to evaluate the appropriate insertion point for a tibial intramedullary nail by measuring the intramedullary canal axis of the tibia in three dimensions. Computed tomography was performed on 86 lower extremities from the hip to the ankle on cadavers. The location of the intramedullary canal axis of the tibia passing through the tibial plateau, the canal axis center (CAC), was measured. The correlations between the lateral tibial spine (LTS) and the mediolateral coordinates of the CAC were analyzed. Results The CAC was located at 56.5% distance from the medial cortex. On average, the CAC was located 1.1 mm medial from the LTS. The mean length from the surface center to the CAC was lateral 4.5 mm. Conclusion The appropriate insertion point for a tibial nail was the slightly medial aspect of the LTS. However, it led to the point with a broad range, increasing the necessity to take individual variations into consideration. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0992-8Authors Sang Jun Song, Kyung Hee University Department of Orthopaedic Surgery, College of Medicine 1 Hoegi-dong, Dongdaemun-gu Seoul 130-702 KoreaBi O Jeong, Kyung Hee University Department of Orthopaedic Surgery, College of Medicine 1 Hoegi-dong, Dongdaemun-gu Seoul 130-702 Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Management of osteoporosis-related bone fractures: an integrated concept of care

Abstract Introduction Multidisciplinary medical management of osteoporosis and osteoporosis-related fractures is still an important treatment issue today. In view of ethiopathology of osteoporosis and the future demographic development an increasing socioeconomic burden has to be estimated. A prerequisite for an effective secondary prophylaxis of osteoporotic fractures is the implementation of a treatment network, with inclusion of all partners involved in patient’s care. Therefore, special attention should be paid to formation and establishment of centres with multidisciplinary and integrated treatment concepts. This paper outlines the concept of a clinical centre for diagnosis and therapy of osteoporosis established 4 years ago. Furthermore, a concept of integrated care of osteoporosis-related fractures is introduced and the obtained data of a 2-year follow-up analysis will be presented. Methods The establishment of an osteoporosis centre at a university teaching hospital as well as certification according to the Dachverband Osteologie (DVO) guidelines were necessary. Recruitment of contract partners on both sides, health insurances and outpatient general practitioners as well as specialist doctors, was also essential. The implementation of an osteoporosis coordinator was a step to put the treatment concept into practice. Results and discussion Based on the recommendations of DVO guidelines, all diagnostic and therapeutic requirements of osteoporosis can be met by the team of consultant specialists at a clinical osteoporosis centre. In the described treatment concept of integrated care, 44 patients suffering of osteoporosis with a consecutive fracture could be included. Mean age was 77. Inclusion criteria were spinal fractures (61%), proximal femoral fractures (27%) and peripheral fractures (12%). Fifty percent of patients included into the contract had not received previous osteoporosis medication. Sixty-eight patients who met the inclusion criteria could not be included due to the lack of compliance (42%), patients’ disapproval (34%) or incomplete treatment and documentation algorithm (24%). Special attention should focus on the completion of standardised diagnosis and documentation. The high amount of time and personnel required has proven the importance of the introduction of an osteoporosis coordinator to be essential. Content Type Journal ArticleCategory Osteoporotic Fracture ManagementDOI 10.1007/s00402-009-0989-3Authors Carsten Strassberger, Hospital Dresden-Friedrichstadt Department of Trauma, Reconstructive and Hand-Surgery Friedrichstrasse 41 01067 Dresden GermanyLeonore Unger, Hospital Dresden-Friedrichstadt 1st Medical Clinic Friedrichstrasse 41 01067 Dresden GermanyAndreas T. Weber, Hospital Dresden-Friedrichstadt Department of Orthopaedics and Orthopaedic Surgery Friedrichstrasse 41 01067 Dresden GermanyAlexander Defer, Grossenhainer Strasse 129 01129 Dresden GermanyFelix A. Bonnaire, Hospital Dresden-Friedrichstadt Department of Trauma, Reconstructive and Hand-Surgery Friedrichstrasse 41 01067 Dresden Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Corrective osteotomy in symptomatic midshaft clavicular malunion using elastic stable intramedullary nails

Abstract Introduction It is our goal to present an alternative, less invasive surgical technique for corrective osteotomy in symptomatic midshaft clavicular malunion using elastic stable intramedullary nails (ESIN) and to present our results in a consecutive patients series. Method and patients Between January 2003 and December 2006, five patients aged between 23 and 44 years presented with a symptomatic malunion after nonoperative treatment of displaced midshaft clavicular fractures. Corrective osteotomy was performed without bone grafting. Results The osteotomy sites united in all patients after a mean of 4.4 months. The nails were removed in all patients after 7 months. At final follow-up, DASH and Constant Scores were significantly improved compared to preoperative values. Patients were significantly more satisfied with cosmetical appearance and overall outcome. Clavicular shortening was also significantly improved. Elastic stable intramedullary nailing leads to favourable results in corrective osteotomy of malunited midshaft clavicular fractures. Conclusion We therefore recommend this technique for corrective osteotomy of symptomatic midshaft clavicular malunions. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0994-6Authors Vinzenz Smekal, Innsbruck Medical University Department of Trauma Surgery and Sports Medicine Anichstraße 35 6020 Innsbruck AustriaChristian Deml, Innsbruck Medical University Department of Trauma Surgery and Sports Medicine Anichstraße 35 6020 Innsbruck AustriaFlorian Kamelger, Innsbruck Medical University Department of Trauma Surgery and Sports Medicine Anichstraße 35 6020 Innsbruck AustriaChristian Dallapozza, Innsbruck Medical University Department of Trauma Surgery and Sports Medicine Anichstraße 35 6020 Innsbruck AustriaDietmar Krappinger, Innsbruck Medical University Department of Trauma Surgery and Sports Medicine Anichstraße 35 6020 Innsbruck Austria Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Clinical application of BMP 7 in long bone non-unions

Abstract Background Non-unions of long bone fractures are a therapeutic and economic problem of increasing frequency. Aside from conservative treatment options such as ultrasound, impulse waves, and casts, the basic surgical options are autogenous cancellous bone grafting, rod dynamization, reamed nailing, plate fixation, and bone transport techniques. If these methods fail to work, there is a need for alternative treatment options. Methods Since May 2001, treatment with recombinant human bone morphogenic protein 7 (BMP 7 or osteogenic protein 1) in combination with a type-one collagen carrier has been the subject of increasing interest. BMP 7 induces the formation of new bone by stem cell differentiation, thereby initiating the reaction cascade of osteogenesis. Non-unions over 9 months and unsuccessful bone grafting constitute the indication for this treatment. Results We report our experience with 54 patients who had atrophic non-union of long bone fractures. Between May 2002 and May 2006, 57 units of BMP 7 were used. The localization of the non-unions included 21 in the femur, 26 in the tibia, 3 in the humerus and 7 in the forearm. In 36 cases, BMP 7 was used in combination with osteosynthesis revision and bone grafting; in 9 additional patients, BMP 7 was used with bone grafting alone. In 12 patients, BMP 7 was applied as a single procedure without any bone grafting or any change in osteosynthesis. Conclusions There were no perioperative or postoperative complications. Follow-up was obtained for a minimum of 6 months. 47 of the 57 (82%) implantations were successful, with bony healing confirmed by clinical and radiological evaluation. In summary, our results support BMP 7 as an additional innovative therapy for long bone non-unions. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0982-xAuthors Arash Moghaddam, University of Heidelberg BG Trauma Center Ludwigshafen, Unfallchirurgische Klinik Ludwig, Guttmann, Str. 13 67071 Ludwigshafen GermanyCharlotte Elleser, University of Heidelberg BG Trauma Center Ludwigshafen, Unfallchirurgische Klinik Ludwig, Guttmann, Str. 13 67071 Ludwigshafen GermanyBahram Biglari, University of Heidelberg BG Trauma Center Ludwigshafen, Unfallchirurgische Klinik Ludwig, Guttmann, Str. 13 67071 Ludwigshafen GermanyAndreas Wentzensen, University of Heidelberg BG Trauma Center Ludwigshafen, Unfallchirurgische Klinik Ludwig, Guttmann, Str. 13 67071 Ludwigshafen GermanyGerald Zimmermann, University of Heidelberg BG Trauma Center Ludwigshafen, Unfallchirurgische Klinik Ludwig, Guttmann, Str. 13 67071 Ludwigshafen Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Two-stage revision surgery for hip prosthesis infection using antibiotic-loaded porous hydroxyapatite blocks

Abstract Background Infection of a hip prosthesis is one of the most severe complications encountered in orthopedic practice. Two-stage reconstruction using an antibiotic-impregnated cement spacer has become a popular procedure for the treatment of this condition. However, there are some disadvantages with the use of antibiotic-loaded cement, including low biocompatibility, a very low release ratio, and the possibility of thermal damage to the antibiotic. We have developed an effective drug delivery system for osteomyelitis in which porous hydroxyapatite (HA) blocks are loaded with an antibiotic by the vacuum method. We report here a modification of this delivery system applied for the first stage of two-stage reconstruction surgery against infected hip prosthesis. Patients and methods Eight consecutive patients who developed hip prosthesis infection underwent two-stage revision total hip arthroplasty (THA) using antibiotic-loaded porous HA blocks prepared by the vacuum method. Thorough debridement and insertion of antibiotic-loaded HA blocks was performed in the first stage, followed by conversion to THA after eradication of infection in the second stage. Results The mean interval between the stages was 16.8 weeks. There were no complications related to the use of the antibiotic-loaded HA blocks. The patients were followed up for an average of 49 months with no evidence of recurrent infection. The mean Japanese Orthopedic Association hip score improved from 45.1 before surgery to 79.6 at the latest follow-up. Interpretation This simple approach utilizing antibiotic-impregnated HA blocks prepared by the vacuum method is considered to be effective for treatment of hip prosthesis infection. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0991-9Authors Iori Takigami, Gifu University Graduate School of Medicine Department of Orthopaedic Surgery 1-1 Yanagido Gifu 501-1194 JapanYoshiki Ito, Gifu University Graduate School of Medicine Department of Orthopaedic Surgery 1-1 Yanagido Gifu 501-1194 JapanDaichi Ishimaru, Gifu University Graduate School of Medicine Department of Orthopaedic Surgery 1-1 Yanagido Gifu 501-1194 JapanHiroyasu Ogawa, Gifu University Graduate School of Medicine Department of Orthopaedic Surgery 1-1 Yanagido Gifu 501-1194 JapanNobuyuki Mori, Gifu University Graduate School of Medicine Department of Orthopaedic Surgery 1-1 Yanagido Gifu 501-1194 JapanTakashi Shimizu, Gifu University Graduate School of Medicine Department of Orthopaedic Surgery 1-1 Yanagido Gifu 501-1194 JapanNobuo Terabayashi, Gifu University Graduate School of Medicine Department of Orthopaedic Surgery 1-1 Yanagido Gifu 501-1194 JapanKatsuji Shimizu, Gifu University Graduate School of Medicine Department of Orthopaedic Surgery 1-1 Yanagido Gifu 501-1194 Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Reduction of radiation dose during radiofrequency denervation of the lumbar facet joints using the new targeting system SabreSource™: a prospective study in 20 patients

Abstract Background and aims Facet joint denervation is a frequently performed technique to treat facet joint syndrome. Most often this technique is used under fluoroscopic guidance implicating high radiation doses for both patients and surgeons. This prospective study was performed to evaluate the effectiveness in reducing radiation dose during radiofrequency ablation therapy of the lumbar facet joints and to evaluate the feasibility and possibilities of the new real time image guidance system SabreSource™. Materials and methods As much as 20 consecutive patients with radiofrequency ablation therapy of the facet joints L4 to S1 were included. Ten patients were treated by fluoroscopic control alone; the following 10 patients were treated with the SabreSource™ image guidance system. A total of 40 thermal ablations to the facet joints were performed. Each patient was given one thermal ablation on both sides of the vertebral segment, either to the facet joints of L4–L5 or of L5–S1. Pain, according to the visual analogue scale (VAS), was documented before and 6 h after the intervention. Radiation dose, time of radiation and the number of shots needed to place the radiofrequency cannula were recorded. Results No complications occurred. Before therapy, the mean VAS in all patients was 7.6 (range 6–10). After therapy the mean VAS in all patients was 3.4 (range 0–5). Compared to the fluoroscopy-guided thermal ablation therapy the SabreSource™ system significantly reduced the number of fluoroscopy exposures (reduction 23.53%, p = 0.02), the time of radiation exposure (reduction 21.2%, p = 0.03) and the mean entrance surface dose (reduction 30.46%, p = 0.01). Conclusion The SabreSource System reduces radiation exposure and radiation dose in the radiofrequency denervation therapy of the lumbar facet joints and can be applied for other minimally invasive techniques. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0983-9Authors Dirk Proschek, University of Mainz Department of Trauma and Orthopaedic Surgery, University Hospital Langenbeckstraße 1 55131 Mainz GermanyKonstantinos Kafchitsas, University of Mainz Department of Trauma and Orthopaedic Surgery, University Hospital Langenbeckstraße 1 55131 Mainz GermanyMichael Rauschmann, University of Frankfurt Department of Orthopaedic Surgery, University Hospital Frankfurt GermanyAndreas Kurth, University of Mainz Department of Trauma and Orthopaedic Surgery, University Hospital Langenbeckstraße 1 55131 Mainz GermanyThomas Vogl, University of Frankfurt Department of Diagnostic and Interventional Radiology Frankfurt GermanyFlorian Geiger, University of Frankfurt Department of Orthopaedic Surgery, University Hospital Frankfurt Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Second-generation uncemented stems: excellent 5–13-year results

Abstract Introduction The purpose of this study was to prospectively evaluate the 5–13-year results of a cementless total hip arthroplasty with a special focus on the survivorship, occurrence of osteolysis, incidence of intraoperative femoral fractures, thigh pain, and cortical hypertrophy of the femoral stem. The femoral component used in this study was titanium fluted, slotted, symmetrical component that was prepared with intraoperative machining. The proximal third of the stem had hydroxyl-apatite coating and horizontal steps. Methods The clinical and radiographical results of a consecutive series of 157 total hip arthroplasties (124 patients) with this stem were investigated. Minimum follow-up was 5 years. The average age of the patients at the time of surgery was 47 years. Three patients died and ten patients were lost to follow-up, leaving 142 hips for evaluation. The clinical result was evaluated on the basis of the Merle d’Aubigné score, complications and thigh pain. A detailed radiographic analysis was performed at each follow-up visit. Kaplan–Meier survivorship analysis was performed to evaluate stem, cup, and bearing survivorship. Results The mean follow-up was 8.5 years (range 5–13 years). The average Merle d’Aubigné score improved from 10.5 points preoperatively to 17.4 points postoperatively. The cumulative 10-year survival rate was 99% for the femoral component, 99% for the acetabular component, and 69% for the bearing. Thigh pain was identified in three patients (2%). There was no distal femoral osteolysis. Seventy-nine percent of all the hips had endosteal spot welds around the coated, proximal one-third of the prosthesis. 51% had radiodense lines around the distal tip of the prosthesis, and 3% had cortical hypertrophy. One undersized stem and one cup were revised for aseptic loosening, and 25 bearings were exchanged. Conclusions Uncemented, machined, fluted titanium canal-filling femoral components achieve reliable fixation in this young patient population. They have a decreased incidence of activity-related thigh pain, lower rate of intraoperative femur fractures and cortical hypertrophy with comparable bone-ingrowth in comparison to other second-generation uncemented femoral components described in literature. Bearing wear and the need for bearing exchange was the only limitation of these constructs. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-009-0977-7Authors Moritz Tannast, Tufts University School of Medicine Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital Boston MA USATimo M. Ecker, Tufts University School of Medicine Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital Boston MA USAStephen B. Murphy, Tufts University School of Medicine Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital Boston MA USA Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051 Journal Volume Volume 129 Journal Issue Volume 129, Number 12 / December, 2009

Interscalene brachial plexus block for open-shoulder surgery: a randomized, double-blind, placebo-controlled trial between single-shot anesthesia and patient-controlled catheter system

Abstract Introduction Interscalene brachial plexus block (ISB) is widely used as an adjuvant regional pain therapy in patients undergoing major shoulder surgery and has proved its effectiveness on postoperative pain reduction and opioid-sparing effect. Method This single-center, prospective, double-blind, randomized and placebo-controlled study was to compare the effectiveness of a single-shot and a patient-controlled catheter insertion ISB system after major open-shoulder surgeries. Seventy patients were entered to receive an ISB and a patient-controlled interscalene catheter. The catheter was inserted under ultrasound guidance. Patients were then assigned to receive one of two different postoperative infusions, either 0.2% ropivacaine (catheter group) or normal saline solution (single-shot group) via a disposable patient-controlled infusion pump. Results The study variables were amount of rescue medication, pain at rest and during physiotherapy, patient satisfaction and incidence of unwanted side effects. The ropivacaine group revealed significantly less consumption of rescue medication within the first 24 h after surgery. Incidence of side effects did not differ between the two groups. Conclusion Based on our results, we recommend the use of interscalene plexus block in combination with a patient-controlled catheter system under ultrasound guidance only for the first 24 h after major open-shoulder surgery. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-009-0985-7Authors Sascha Goebel, Julius-Maximilians University Wuerzburg Department of Orthopaedic Surgery Wuerzburg GermanyJens Stehle, Julius-Maximilians University Wuerzburg Department of Orthopaedic Surgery Wuerzburg GermanyUlrich Schwemmer, Julius-Maximilians University Wuerzburg Department of Anaesthesiology Wuerzburg GermanyStephan Reppenhagen, Julius-Maximilians University Wuerzburg Department of Orthopaedic Surgery Wuerzburg GermanyBeatrice Rath, Julius-Maximilians University Wuerzburg Department of Orthopaedic Surgery Wuerzburg GermanyFrank Gohlke, Julius-Maximilians University Wuerzburg Department of Orthopaedic Surgery Wuerzburg Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Six-year follow-up of a preformed spacer for the management of chronically infected total hip arthroplasty

Abstract Antibiotic-loaded cement spacers are currently used in two-stage revision of septic total hip arthroplasty as temporary devices. Prolonged spacer implantation in infected shoulder has been described occasionally in poor candidates for reconstruction surgery (medically compromised and/or low-physical demand patients, deficient bone stock). Few papers previously reported the use of spacers in infected hip prosthesis as a permanent solution, but limited information is available on the medium-term behaviour. We detail medium-term clinical and radiographic follow-up of a preformed spacer in the management of a chronically infected hip arthroplasty in a 50-year-old female patient who did not undergo a second-stage surgery. Normalization of inflammatory markers was detected 3 weeks after surgery and persisted over time. Six years after surgery, the patient recovered a good range of motion and was able to walk pain free with assisted weightbearing. Remarkable radiological changes of the bone stock around the spacer stem have been assessed. New bone formation developed rapidly in the femur, leading to the consolidation of transfemoral osteotomy 6 months postoperatively. Two years after implantation, spontaneous and asymptomatic fatigue fracture in the mid-part of the stem occurred. Radiographs at 6 years showed a sufficient preservation of bone stock, though a slowly progressive resorption of the cortical femur around the stem was evident in the last year. In conclusion, prolonged spacer implantation seems to be not appropriate in septic hip arthroplasty as a permanent solution. In patients not undergoing a second-stage surgery, a careful and periodic monitoring is required to rule out possible and severe complications. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0984-8Authors Dario Regis, Verona University School of Medicine Department of Orthopaedic Surgery Verona ItalyAndrea Sandri, Verona University School of Medicine Department of Orthopaedic Surgery Verona ItalyBruno Magnan, Verona University School of Medicine Department of Orthopaedic Surgery Verona ItalyPietro Bartolozzi, Verona University School of Medicine Department of Orthopaedic Surgery Verona Italy Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Changes in content and synthesis of collagen types and proteoglycans in osteoarthritis of the knee joint and comparison of quantitative analysis with Photoshop-based image analysis

Abstract Introduction The different cartilage layers vary in synthesis of proteoglycan and of the distinct types of collagen with the predominant collagen Type II with its associated collagens, e.g. types IX and XI, produced by normal chondrocytes. It was demonstrated that proteoglycan decreases in degenerative tissue and a switch from collagen type II to type I occurs. The aim of this study was to evaluate the correlation of real-time (RT)-PCR and Photoshop-based image analysis in detecting such lesions and find new aspects about their distribution. Patients We performed immunohistochemistry and histology with cartilage tissue samples from 20 patients suffering from osteoarthritis compared with 20 healthy biopsies. Furthermore, we quantified our results on the gene expression of collagen type I and II and aggrecan with the help of real-time (RT)-PCR. Proteoglycan content was measured colorimetrically. Using Adobe Photoshop the digitized images of histology and immunohistochemistry stains of collagen type I and II were stored on an external data storage device. The area occupied by any specific colour range can be specified and compared in a relative manner directly from the histogram using the “magic wand tool” in the select similar menu. In the image grow menu gray levels or luminosity (colour) of all pixels within the selected area, including mean, median and standard deviation, etc. are depicted. Statistical Analysis was performed using the t test. Method With the help of immunohistochemistry, RT-PCR and quantitative RT- PCR we found that not only collagen type II, but also collagen type I is synthesized by the cells of the diseased cartilage tissue, shown by increasing amounts of collagen type I mRNA especially in the later stages of osteoarthritis. Results A decrease of collagen type II is visible especially in the upper fibrillated area of the advanced osteoarthritic samples, which leads to an overall decrease. Analysis of proteoglycan showed a loss of the overall content and a quite uniform staining in the different zones compared to the healthy cartilage with a classical zonal formation. Correlation analysis of the proteoglycan Photoshop measurements with the RT-PCR using Spearman correlation analysis revealed strong correlation for Safranin O and collagen type I, medium for collagen type II and glycoprotein but weak correlation between PCR aggrecan results. Conclusion Photoshop-based image analysis might become a valuable supplement for well known histopathological grading systems of lesioned articular cartilage. Content Type Journal ArticleCategory Basic ScienceDOI 10.1007/s00402-009-0981-yAuthors Andreas Lahm, University Hospital of the Ernst-Moritz-Arndt University Greifswald Section of Orthopaedic Research and Cell Biology, Department of Orthopaedics and Orthopaedic Surgery F.-v.-Sauerbruch Strasse 17475 Greifswald GermanyEike Mrosek, Mayo Clinic College of Medicine Cartilage and Connective Tissue Research Laboratory, Department of Orthopedic Surgery 200 1st Street SW Rochester MN 55905 USAHeiko Spank, University Hospital of the Ernst-Moritz-Arndt University Greifswald Section of Orthopaedic Research and Cell Biology, Department of Orthopaedics and Orthopaedic Surgery F.-v.-Sauerbruch Strasse 17475 Greifswald GermanyChristoph Erggelet, Arthrose Clinic Zürich Kraftstrasse 29 8044 Zürich GermanyRichard Kasch, University Hospital of the Ernst-Moritz-Arndt University Greifswald Section of Orthopaedic Research and Cell Biology, Department of Orthopaedics and Orthopaedic Surgery F.-v.-Sauerbruch Strasse 17475 Greifswald GermanyJan Esser, University Hospital of the Ernst-Moritz-Arndt University Greifswald Section of Orthopaedic Research and Cell Biology, Department of Orthopaedics and Orthopaedic Surgery F.-v.-Sauerbruch Strasse 17475 Greifswald GermanyHarry Merk, University Hospital of the Ernst-Moritz-Arndt University Greifswald Section of Orthopaedic Research and Cell Biology, Department of Orthopaedics and Orthopaedic Surgery F.-v.-Sauerbruch Strasse 17475 Greifswald Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Extremity soft tissue sarcomas presented as hematomas

Abstract Introduction Soft tissue sarcoma (STS) with extensive intra-tumoral hemorrhage is an infrequently described entity, usually misdiagnosed as intra-muscular hematoma. The outcomes in this group of patients have not been previously described. Materials and methods We retrospectively identified 15 patients, with initial clinical or imaging diagnosis of hematoma, or hematoma versus hemorrhagic sarcoma, although final diagnosis of high-grade STS was established in all cases. Results The most common location was the thigh. Three patients had a bleeding predisposition. Ten patients were referred for further evaluation with the initial diagnosis of muscle strain/hematoma, hematoma versus abscess in one, whereas four were referred for soft tissue mass evaluation. Final diagnosis was made by one biopsy in only 53% of patients. Mean time to diagnosis for patients with two biopsies was 7 months from initial presentation. Histologic diagnosis was malignant fibrous histiocytoma in ten patients. Surgical treatment included tumor resection in eleven and amputation in three patients. One patient had lung metastatic disease at presentation and eight developed lung metastases within a median time of 7 months. Conclusion We suggest that an STS masquerading as hematoma should be suspected when the mechanism and the energy of the trauma do not justify the clinically detected severity of the injury, or the lesion does not follow the expected clinical course of resolution after initial conservative management. Bleeding predisposition does not exclude malignancy. The evacuation of hematomas should include pathologic examination of tissue. Prognosis is dismal due to early metastatic disease. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0987-5Authors Vasileios A. Kontogeorgakos, Duke University, DUMC 3312 Section of Orthopaedic Oncology, Department of Orthopaedic Surgery Durham NC USASalutario Martinez, Duke University, DUMC 3312 Section of Orthopaedic Oncology, Department of Orthopaedic Surgery Durham NC USALeslie Dodd, Duke University, DUMC 3312 Section of Orthopaedic Oncology, Department of Orthopaedic Surgery Durham NC USABrian E. Brigman, Duke University, DUMC 3312 Section of Orthopaedic Oncology, Department of Orthopaedic Surgery Durham NC USA Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Transosseous capsuloplasty improves the outcomes of Lindgren–Turan distal metatarsal osteotomy in moderate to severe hallux valgus deformity

Abstract Introduction Lindgren–Turan osteotomy used in hallux valgus deformity is a subcapital, transverse displacement osteotomy of the first metatarsal without any additional capsular repair. The aims of this study are to describe a transosseous capsuloplasty technique in this procedure and evaluate whether capsuloplasty would improve the clinical and radiological outcomes in patients with moderate to severe hallux valgus deformity. Methods Twenty-three feet operated by Lindgren–Turan osteotomy (Group B) and 25 feet operated by the same osteotomy combined with transosseous capsuloplasty (Group A) were evaluated retrospectively for the correction of the hallux valgus, intermetatarsal and distal metatarsal articular angles, sesamoid reduction, American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating Scale as well as patient satisfaction. The mean postoperative follow-up was 14 (range 12–28) months. Results All radiological parameters improved considerably as a result of both groups. However, postoperative improvements in intermetatarsal and distal metatarsal articular angles were greater in Group A. Complete reduction of medial sesamoid was achieved in 52% of patients in Group A, whereas 17.4% of patients in Group B had complete reduction. AOFAS scores and number of patients with complete satisfaction in Group A were significantly greater than that in Group B. Conclusion Better clinical and radiological outcomes can be achieved in patients with moderate to severe hallux valgus deformity operated by Lindgren–Turan distal metatarsal osteotomy, when it combines with transosseous capsuloplasty. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0986-6Authors Namık Kemal Özkan, Göztepe Training and Research Hospital Orthopaedics and Traumatology Clinic Göztepe, Istanbul TurkeyMelih Güven, The Hospital of University of Abant Izzet Baysal Department of Orthopaedics and Traumatology Bolu TurkeyBudak Akman, Gülhane Military Medical Faculty Hospital Department of Orthopaedics and Traumatology Istanbul TurkeyMurat Çakar, Bağcılar Training and Research Hospital Orthopaedics and Traumatology Clinic Istanbul TurkeyAdnan Konal, Kartal Yavuz Selim Hospital Orthopaedics and Traumatology Clinic Istanbul TurkeyYalçın Turhan, Göztepe Training and Research Hospital Orthopaedics and Traumatology Clinic Göztepe, Istanbul Turkey Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating

Abstract Introduction New concepts in plate fixation have led to an evolution in plate design for olecranon fractures. The purpose of this study was to compare the stiffness and strength of locking compression plate (LCP) fixation to one-third tubular plate fixation in a cadaveric comminuted olecranon fracture model with a standardised osteotomy. Materials and methods Five matched pairs of cadaveric elbows were randomly assigned for fixation by either a contoured LCP combined with an intramedullary screw and unicortical locking screws or a one-third tubular plate combined with bicortical screws. Construct stiffness was measured by subjecting the specimens to cyclic loading while measuring gapping at the osteotomy site. Construct strength was measured by subjecting specimens to ramp load until failure. Results There was no significant difference in fixation stiffness and strength between the two fixation methods. All failures consisted of failure of the bone and not of the hardware. Conclusion Contoured LCP and intramedullary screw fixation can be used as an alternative treatment method for comminuted olecranon fractures as its stiffness and strength were not significantly different from a conventional plating technique. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0980-zAuthors Geert A. Buijze, Academic Medical Center Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery Meibergdreef 9 1100 DD Amsterdam The NetherlandsLeendert Blankevoort, Academic Medical Center Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery Meibergdreef 9 1100 DD Amsterdam The NetherlandsGabriëlle J. M. Tuijthof, Academic Medical Center Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery Meibergdreef 9 1100 DD Amsterdam The NetherlandsInger N. Sierevelt, Academic Medical Center Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery Meibergdreef 9 1100 DD Amsterdam The NetherlandsPeter Kloen, Academic Medical Center Department of Orthopaedic Surgery Meibergdreef 9 1100 DD Amsterdam The Netherlands Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Minimally invasive technique versus conventional technique of dynamic hip screws for intertrochanteric femoral fractures

Abstract Introduction Intertrochanteric fractures of femur are common in elderly patients. The compression hip screw has become the predominant method for osteosynthesis of intertrochanteric fractures. However, the conventional dynamic hip screws (CDHS) technique has some disadvantages. Recently, we have used a minimally invasive dynamic hip screws (MIDHS) technique to reduce these disadvantages. This prospective study is to compare curative effect of MIDHS with that of CDHS with open reduction on Evans type 1 intertrochanteric fractures. Materials and methods All 97 fractures were classified according to the Evans systems. The MIDHS group included 47 patients with an average age of 68.7 years, and the CDHS group included 50 patients with an average age of 68.7 years. The Singh index was used as a measure of osteoporosis. Results Both groups were similar in injury mechanism, fracture types, mean Singh index and medical diseases (all P > 0.50). All fractures were healed within 4 months in both groups except three cases who were implant failure and nonunion in the CDHS group. The MIDHS group had significantly smaller wound size, shorter surgery time, less blood loss, lower blood transfusion rate, earlier active mobilization of fractured hip joint, shorter hospital stay, lower serious complication rate and higher Harris hip score than the CDHS group (all P < 0.05). The satisfactory reduction, adequate screw position, healing time and union rate was not significantly difference between two groups (all P > 0.05). Conclusion When the fractures are treated adequately, either the MIDHS or the CDHS with open reduction is an effective and safe method, but the MIDHS is superior to the CDHS with open reduction for the treatment of Evans type 1 intertrochanteric fractures of femur. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0978-6Authors Jin-Ping Wang, West China Hospital, Sichuan University Department of Orthopedic Surgery 610041 Chengdu People’s Republic of ChinaTian-Fu Yang, West China Hospital, Sichuan University Department of Orthopedic Surgery 610041 Chengdu People’s Republic of ChinaQing-Quan Kong, West China Hospital, Sichuan University Department of Orthopedic Surgery 610041 Chengdu People’s Republic of ChinaShao-Jiang Liu, Central Hospital of Panzhihua Department of Orthopedic Surgery 617067 Panzhihua Sichuan People’s Republic of ChinaHeng Xiao, Central Hospital of Panzhihua Department of Orthopedic Surgery 617067 Panzhihua Sichuan People’s Republic of ChinaYang Liu, West China Hospital, Sichuan University Department of Orthopedic Surgery 610041 Chengdu People’s Republic of ChinaHui Zhang, West China Hospital, Sichuan University Department of Orthopedic Surgery 610041 Chengdu People’s Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Thigh mass associated with polyethylene wear-induced osteolysis after cementless total hip arthroplasty

Abstract Polyethylene wear-induced osteolysis is a common complication of total hip arthroplasty. We report a case of a patient who had an extensile osteolytic lesion that presented as a tumor-like thigh mass associated with a polyethylene wear debris-induced granuloma 18 years after cementless total hip arthroplasty. The patient received a proximally porous-coated stem that had not fully circumferentially coated surface, and, therefore, polyethylene wear particles could be transported to the distal stem tip area by fluid pressure generated from the hip joint during activity. Biologic reaction to polyethylene wear particles had then produced the extensile osteolytic lesion extending to the extramedullary diaphysis of the femur that presented as a solitary thigh mass mimicking a soft tissue tumor. To the authors’ knowledge, no case of a thigh mass and osteolytic femoral lesion associated with polyethylene wear after total hip arthroplasty has previously been reported. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0979-5Authors Youn-Soo Park, Sungkyunkwan University School of Medicine, Samsung Medical Center Department of Orthopedic Surgery 50 Ilwon-Dong Kangnam-Ku Seoul 135-710 South KoreaSeung-Jae Lim, Sungkyunkwan University School of Medicine, Samsung Medical Center Department of Orthopedic Surgery 50 Ilwon-Dong Kangnam-Ku Seoul 135-710 South KoreaJin-Hong Kim, Sungkyunkwan University School of Medicine, Samsung Medical Center Department of Orthopedic Surgery 50 Ilwon-Dong Kangnam-Ku Seoul 135-710 South KoreaAjay Wala, Sungkyunkwan University School of Medicine, Samsung Medical Center Department of Orthopedic Surgery 50 Ilwon-Dong Kangnam-Ku Seoul 135-710 South Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Clinical and radiological evaluation of minimally displaced proximal humeral fractures

Abstract Introduction The purpose of this prospective study was to assess the Constant score and radiographic outcome in 66 patients (mean age 58.7 years/mean follow-up 51 months) with a minimally displaced and/or impacted fracture of the proximal humerus treated with early mobilization. Method Special attention was paid to analyze the specific intrinsic parameters (age, gender, ASA grade and length of physiotherapy), injury-related parameters (classification, osteoporosis) and therapy-related parameters (initial fracture displacement, residual bony-deformity after healing, secondary fracture displacement during healing period, non-union, humeral head necrosis and omarthrosis) that may influence the final score. Patients There were 31 A (47%), 22 B (33%) and 13 C-fractures (19%). The median Constant score for the fractured shoulder was 89 points. Results All fractures healed without non-union. The radiological assessment showed in 80% a fracture-displacement with <15° angulation and/or <5-mm displacement of the greater tuberosity. At time of follow-up, the residual bony-deformity was perfect and good in 88% of cases. There was a significant association between the final Constant score and the age, ASA classification, AO (ABC) classification and initial fracture displacement. Conclusion Early physiotherapy, with a short period of immobilization is a sufficient therapy for management of minimally displaced and/or impacted fractures of the proximal humerus. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0975-9Authors Christian Bahrs, Eberhard-Karls University Tübingen Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen Schnarrenbergstr. 95 72076 Tubingen GermanyBernd Rolauffs, Eberhard-Karls University Tübingen Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen Schnarrenbergstr. 95 72076 Tubingen GermanyKlaus Dietz, Eberhard-Karls University Department of Medical Biometry Westbahnhofstr. 55 72070 Tubingen GermanyChristoph Eingartner, Caritas-Hospital Bad Mergentheim Clinic for Traumatology and Reconstructive Surgery Uhlandstr. 7 97980 Bad Mergentheim GermanyKuno Weise, Eberhard-Karls University Tübingen Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen Schnarrenbergstr. 95 72076 Tubingen Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Intraoperative complications using the Bio-Transfix femoral fixation implant in anterior cruciate ligament reconstruction

Abstract The use of biodegradable Transfix femoral fixation technique is a safe and well-accepted method when performing anterior cruciate ligament reconstruction. We report on three cases of deformation and back out of the Bio-Transfix implant over the lateral, distal femoral cortex, with failure of the passing wire when advancing the graft into the femoral tunnel in one of these patients. Two of the patients presented with symptoms of iliotibial band friction syndrome, while the third patient was asymptomatic. The graft had clinically integrated demonstrating AP and rotational stability. The symptoms relieved after removal of the failed Bio-Transfix implants in the symptomatic patients. The aetiology of the implant failure and the alternative methods to avoid such complications are discussed. Content Type Journal ArticleCategory Arthroscopy and Sports MedicineDOI 10.1007/s00402-009-0976-8Authors Michail Kokkinakis, Stoke Mandeville Hospital 43 Aston House, Mandeville Road Aylesbury Buckinghamshire HP21 8AL UKAlexander Ashmore, Stoke Mandeville Hospital 43 Aston House, Mandeville Road Aylesbury Buckinghamshire HP21 8AL UKMagdi El-Guindi, Stoke Mandeville Hospital 43 Aston House, Mandeville Road Aylesbury Buckinghamshire HP21 8AL UK Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051