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Part Time Orthopedics Job in Statewide Texas with MES Peer Review

Independent Peer Review ORTHOPAEDIC PHYSICIANS - EXCELLENT PART TIME OPPORTUNITY! Texas Licensed Retired or Active Practicing PERFORM PEER REVIEWS AT HOME OR ANYWHERE YOU HAVE INTERNET

Permanent Orthopedics Job in Springdale Arkansas with Community Health Systems

General Orthopaedic surgeon needed for a solo opportunity with the hospital. Employment or an Income Guarantee based on the MGMA standard rate is offered and a productivity bonus is negotiable. Physician

Permanent Orthopedics Job in South Central Kansas with Rural Health Education & Services

KRC.0507.1309.06C Orthopedist for progressive multi-specialty group practice. There are currently 11 specialties and 23 physicians and 5 mid-levels on staff. Salary is $350,000 (first year guarantee),

Permanent Orthopedics Job in Manchester Connecticut with Advanced Orthopaedic & Sports Medicine

Opportunity for fellowship-trained orthopaedic surgeon to join successful and busy orthopedic practice of 35 years. Practice offers comprehensive treatment for upper extremity, knees and total joint

Permanent Orthopedics Job in Yuma Arizona with Yuma Regional Medical Center

BC/BE Orthopaedic Surgeon to establish a solo independent practice in the community of Yuma, Arizona. The right candidate will be the 7th full time Orthopaedic Surgeon in the community and the medical

Permanent Orthopedics Job in WV statewide West Virginia with Medical Doctor Associates, Inc.

A leading healthcare provider in southern West Virginia is actively seeking a BC/BE Orthopedic Surgeon for their facility. This facility insists on hiring the finest talent to meet the growing needs

Permanent Orthopedics Job in AL statewide Alabama with Medical Doctor Associates, Inc.

Outstanding opportunity for BC/BE Orthopedic Surgeon with subspecialty to join existing practice. Tremendous growth within the community requires recruitment. Excellent financial package with Sign On

Locum Tenens Orthopedics Job in Not Disclosed Louisiana with

A locum-to-permanent Orthopedic Surgeon is needed for northern Louisiana. This is a one of a kind opportunity to join a well established multispecialty group with partnership available after two years.

Permanent Orthopedics Job in Not Disclosed North Dakota with Locum Medical Group

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

Permanent Orthopedics Job in south east Missouri with 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

Permanent Orthopedics Job in Boston north shore Massachusetts with 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

Permanent Orthopedics Job in Northern Michigan with 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

Permanent Orthopedics Job in Delaware Delaware with 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

Locum Tenens Orthopedics Job in Southwestern Oregon with 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

Locum Tenens Orthopedics Job in Southern Missouri with Medical Search International

Great Orthopedic Surgery job in Missouri, 2 weeks on 2 weeks off long term! We need someone to cover a clinic and take call M-F, surgery is scheduled for Thursday. Non acute call on weekends possible.

Permanent Orthopedics Job in southeast Missouri with 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

Permanent Orthopedics Job in Harrisburg Area Pennsylvania with Medical Search International

Hospital is seeking an Orthopaedic Surgeon to join (1) one other here in central, Pennsylvania with a call rotation of 1:7. This new practice is located on the hospital campus adjacent to an 8000 sqft.,

Locum to Permanent Orthopedics Job in Florham Park New Jersey with Medical Search International

A busy Southern Michigan medical center is seeking a BC/BE Orthopedic Surgeon to join their group. The hospital offers a very competitive salary and benefits package. Recent grads and fellows are welcomed!!

Locum to Permanent Orthopedics Job in Northeastern New York with Medical Search International

How would you like to spend your summer and fall in beautiful scenic Northeastern New York? We have a great client that is looking for some locums coverage starting in August and this will continue until

Permanent Orthopedics Job in Northeastern New York with Medical Search International

We have a great opportunity in North Eastern NY. This is an employed position with the Hospital based practice. This opportunity is located in a beautiful part of the country and is only a short flight

Permanent Orthopedic Foot and Ankle Job in Miami Florida with 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.

Permanent Orthopedic Foot and Ankle Job in Not Disclosed Florida with 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

Permanent Orthopedic Foot and Ankle Job in Dallas Texas with Executec Recruiters

To join a 2-physician single specialty ORS group.For more information, email CV in Word format to sales@executecrecruiters.com

Permanent Orthopedic Foot and Ankle Job in Call for More Information Massachusetts with 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

Permanent Orthopedic Foot and Ankle Job in Ft. Lauderdale Florida with Execu-Search

BC/BE Orthopedic Surgeon with fellowship training in Foot/Ankle to join well established and growing Orthopedic practice. Excellent compensation, full benefits package and a great opportunity to grow

Permanent Orthopedic Foot and Ankle Job in Orthopedic (Hand, Foot & Ankle) Physician Jobs in Coastal North Carolina North Carolina with 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

Permanent Orthopedic Foot and Ankle Job in Referrals from 1000+ Physicians in Major Metro, ‘Most Recession-Proof City’ in 2008, #5211 Oklahoma with 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

Permanent Orthopedic Foot and Ankle Job in Dallas area Texas with 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

Permanent Orthopedic Foot and Ankle Job in Mooresville North Carolina with Job Job Recruiting

Orthopedic Foot and Ankle Surgeon We are actively recruiting a BC/BE Orthopedic Foot and Ankle Surgeon to join a local, multi-specialty physician group. The practice will be located in the beautiful

Permanent Orthopedic Foot and Ankle Job in Brockport New York with 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

Permanent Orthopedic Foot and Ankle Job in Call for Information Kansas with 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

Three-dimensional measurement of femoral antetorsion: comparison to a conventional radiological method

Abstract Purpose The aim of our study was to produce a 3-D reconstruction of a CT dataset and compare it to the conventional method, with that same dataset, in terms of precision and the influence of femoral positioning. Methods A mechanical support was developed to rigidly fix the femur in a designated position. After measuring the real AT, a CT scan with different femur positions was performed. Eight cadaveric specimens were utilized for this study. Each examination was performed twice and the mean value was recorded. The Jend method was chosen as the conventional mode for femoral antertorsion measurement. In the 3-D reconstruction, the angle between the femoral neck and trailing edge of the femoral condyles was measured. Results Measurement of the AT by 3-D reconstruction (0.8°) was significantly better than the conventional method after (3.0°; P = 0.016). The positioning of the femur influences measurement of the femoral AT angle by conventional method measurement whereas evaluation using the 3-D reconstruction was more independent of femoral positioning. Conclusion 3-D reconstruction enables precise determination of the femoral AT angle, and is independent of femoral positioning as conventional methods seem to be. In clinical practice, 3-D reconstruction may allow a greater understanding of the femoral AT angle post fracture reduction and internal fixation. However, we believe the 3-D method of measuring the AT-angle can potentially optimize the patient’s treatment outcome by allowing the orthopaedic surgeon to measure the femoral AT-angle more precisely after femoral fracture reduction. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0923-8Authors Musa Citak, Hannover Medical School Trauma Department Hannover GermanyMarkus Oszwald, Hannover Medical School Trauma Department Hannover GermanyPadhraig F. O’Loughlin, Hospital for Special Surgery Department of Orthopaedic Surgery 535 East 70th Street New York NY 10021 USAMustafa Citak, Hannover Medical School Trauma Department Hannover GermanyDaniel Kendoff, Hospital for Special Surgery Department of Orthopaedic Surgery 535 East 70th Street New York NY 10021 USATobias Hüfner, Hannover Medical School Trauma Department Hannover GermanyChristian Krettek, Hannover Medical School Trauma Department Hannover Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Transforaminal lumbar interbody fusion with one cage and excised local bone

Abstract Introduction The effect of transforaminal lumbar interbody fusion (TLIF) with one cage and excised local bone were investigated in 52 patients with a mean follow-up of 18.2 months. Method The clinical outcomes including the modified Prolo scale and a visual analog scale (VAS), and radiological assessments including the ratio of interbody graft area, fusion rate, posterior disk height (PH), and the lordosis angle (LA) of the motion segment were studied. Results According to a modified Prolo scale, 90.4% of the patients obtained either excellent or good results. The VAS significantly decreased postoperatively. There was significant postoperative improvement of the PH and LA, and no significant loss of the PH and LA was found at final follow-up. The fusion rate in this series was 96.6%. Conclusion In conclusion, TLIF with one cage and excised local bone grafting can provide satisfactory treatment outcomes and solid interbody fusion without harvesting and grafting autologous iliac bone. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0917-6Authors Yuxiang Xiao, The Second Affiliated Hospital of Medical College, Zhejiang University Department of Orthopaedics No.88, Jefang Road 310009 Hangzhou City Zhejiang Province ChinaFangcai Li, The Second Affiliated Hospital of Medical College, Zhejiang University Department of Orthopaedics No.88, Jefang Road 310009 Hangzhou City Zhejiang Province ChinaQixin Chen, The Second Affiliated Hospital of Medical College, Zhejiang University Department of Orthopaedics No.88, Jefang Road 310009 Hangzhou City Zhejiang Province China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine; evaluation of a new MRI staging classification and imaging findings as indicators of surgical management: a retrospective study of 37 patients

Abstract Introduction The aim of this study was to review the patients with lumbar epidural abscess in terms of neurological morbidity, therapeutic outcome, and prognosis, while assessing the usefulness of a new MRI staging classification and specific imaging findings as indicators for surgical management. Materials and methods We reviewed 37 patients who sustained epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine. Ten patients were treated conservatively, while 27 required urgent or elective surgical drainage. We studied patients with respect to symptomatology, Frankel-American Spinal Injury Association (ASIA) scale evaluation and a new proposed system of MRI staging of pyogenic spondylodiscitis (stages I–V). Results Of the 37 patients with stage IV and V MRI lesions, 13 (35%) had septicemia and 8 (22%) presented with Frankel-ASIA scale C-D neurological status. All cases with ringlike enhancement on gadolinium-enhanced MRI in the epidural abscess lesions were treated surgically. Progression of local kyphosis and loss of intervertebral disk height were significantly prevented in the surgical group (P < 0.05). Improvements of neurological status and laboratory data were better in the surgical group than the conservative group (P < 0.05), with significantly short hospital stay (P < 0.05). Discussion Epidural abscess associated with pyogenic spondylodiscitis presents with various neurological symptoms. In addition to assessment of progression by clinical symptomatology, modified neurological Frankel-ASIA scaling and the currently proposed MRI staging regimen may help to consider the timing of surgical intervention. In the acute, subacute or acute-on-chronic phase and the ringlike enhancement pattern of epidural abscess on gadolinium-enhanced MRI may be an indicator for surgery. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-009-0928-3Authors Kenzo Uchida, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji Fukui 910-1193 JapanHideaki Nakajima, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji Fukui 910-1193 JapanTakafumi Yayama, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji Fukui 910-1193 JapanRyuichiro Sato, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji Fukui 910-1193 JapanShigeru Kobayashi, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji Fukui 910-1193 JapanKe-Bing Chen, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji Fukui 910-1193 JapanErisa S. Mwaka, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji Fukui 910-1193 JapanHisatoshi Baba, Fukui University Faculty of Medical Sciences Department of Orthopaedics and Rehabilitation Medicine Matsuoka Shimoaizuki 23 Eiheiji Fukui 910-1193 Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Rivaroxaban and dabigatran etexilate: two new oral anticoagulants for extended postoperative prevention of venous thromboembolism after elective total hip arthroplasty

Abstract Extended thromboprophylaxis is vital in patients undergoing total hip arthroplasty (THA) because of the prolonged risk of venous thromboembolism (VTE). Despite evidence that extended prophylaxis can reduce the incidence of symptomatic VTE in this high-risk patient population and the evidence-based guideline recommendations, a large proportion of patients still do not receive an adequate duration of thromboprophylaxis. This is partly due to the limitations of conventional anticoagulants, such as the subcutaneous route of administration or the requirement for routine coagulation monitoring and dose adjustment. New oral anticoagulants (such as the direct thrombin inhibitor dabigatran etexilate and the Factor Xa inhibitor rivaroxaban) could address the current unmet need. Phase III clinical studies in VTE prevention in patients undergoing THA and total knee arthroplasty (TKA) showed that dabigatran etexilate was non-inferior to the EU regimen of enoxaparin, but did not achieve non-inferiority to the US regimen of enoxaparin. In contrast, rivaroxaban demonstrated superiority to both enoxaparin regimens for the prevention of VTE after THA and TKA, without a significant increase in major bleeding rates. Their convenient, once-daily, fixed dosing, with no need for routine coagulation monitoring, could facilitate adherence to evidence-based guideline recommendations of extended thromboprophylaxis after THA. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0930-9Authors Lars C. Borris, Århus University Hospital Department of Orthopaedics Nørrebrogade 44 Århus C Denmark Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Spondylodiscitis of the lumbar spine in a non-immunocompromised host caused by Yersinia enterocolitica O:9

Abstract Here presented is an extremely rare case of a spinal osteomyelitis (L5–S1) with epidural empyema in a non-immunocompromised 62-year-old man caused by Yersinia enterocolitica O:9. The infection occurred acutely and required immediate surgical treatment. Y. enterocolitica was cultured from the empyema fluid, wound swabs of the intervertebral disc L5–S1 and stool cultures. Following the surgical decompression and antibiotic treatment, the patient recovered completely, without neurological deficits. A review of the literature revealed only sparse cases of spondylodiscitis due to other Y. enterocolitica serogroups. To our knowledge, we report here the first case of a spondylodiscitis of the lumbar spine caused by Y. enterocolitica serovar O:9 in a non-immunocompromised patient. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0921-xAuthors Martin Ellenrieder, University of Rostock Department of Orthopaedics Doberaner Straße 142 18057 Rostock GermanyAndreas E. Zautner, University of Rostock Department of Microbiology, Virology and Hygiene Schillingallee 70 18055 Rostock GermanyAndreas Podbielski, University of Rostock Department of Microbiology, Virology and Hygiene Schillingallee 70 18055 Rostock GermanyRainer Bader, University of Rostock Department of Orthopaedics Doberaner Straße 142 18057 Rostock GermanyWolfram Mittelmeier, University of Rostock Department of Orthopaedics Doberaner Straße 142 18057 Rostock Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Early results in the treatment of proximal humeral fractures with a polyaxial locking plate

Abstract Objectives We report early results using a second generation locking plate, non-contact bridging plate (NCB PH®, Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH® combines conventional plating technique with polyaxial screw placement and angular stability. Design Prospective case series. Setting A single level-1 trauma center. Patients A total of 50 patients with proximal humeral fractures were treated from May 2004 to December 2005. Intervention Surgery was performed in open technique in all cases. Main outcome measures Implant-related complications, clinical parameters (duration of surgery, range of motion, Constant–Murley Score, subjective patient satisfaction, complications) and radiographic evaluation [union, implant loosening, implant-related complications and avascular necrosis (AVN) of the humeral head] at 6, 12 and 24 weeks. Results All fractures available to follow-up (48 of 50) went to union within the follow-up period of 6 months. One patient was lost to follow-up, one patient died of a cause unrelated to the trauma, four patients developed AVN with cutout, one patient had implant loosening, three patients experienced cutout and one patient had an axillary nerve lesion (onset unknown). The average age- and gender-related Constant Score (n = 35) was 76. Conclusions The NCB PH® combines conventional plating technique with polyaxial screw placement and angular stability. Although the complication rate was 19%, with a reoperation rate of 12%, the early results show that the NCB PH® is a safe implant for the treatment of proximal humeral fractures. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0924-7Authors Johannes B. Erhardt, Klinik für Orthopädische Chirurgie, Kantonsspital St. Gallen 9007 St. Gallen SwitzerlandG. Roderer, Universitätsklinik Ulm Abteilung für Unfallchirurgie Ulm GermanyK. Grob, Klinik für Orthopädische Chirurgie, Kantonsspital St. Gallen 9007 St. Gallen SwitzerlandT. N. Forster, Klinik für Orthopädische Chirurgie, Kantonsspital St. Gallen 9007 St. Gallen SwitzerlandK. Stoffel, The University of Western Australia Fremantle Orthopaedic Unit Perth WA AustraliaM. S. Kuster, Klinik für Orthopädische Chirurgie, Kantonsspital St. Gallen 9007 St. Gallen Switzerland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Cocktail therapy for femoral head necrosis of the hip

Abstract Introduction Cocktail therapy consists of extracorporeal shock wave treatment (ESWT), hyperbaric oxygen therapy (HBO) and alendronate. We hypothesized that this combined therapy may produce better results than ESWT alone when treating hip necrosis. Methods This prospective, randomized study evaluated the effectiveness of cocktail therapy in early hip necrosis, and then compared it to shock wave treatment alone. Sixty-three patients (98 hips) were randomly divided into two groups. Group A consisted of 28 patients (50 hips) who received cocktail therapy, and group B consisted of 35 patients (48 hips) who received only ESWT. Each affected hip was treated with 6,000 shocks of ESWT at 28 kV (equivalent to 0.62 mJ/mm2) in a single session. Cocktail patients also received HBO therapy performed in a multi-place chamber daily for 20 treatments, and they were administered 70 mg of alendronate orally per week for 1 year. The evaluations included clinical assessment, radiograph and MRI. Results After a minimum of 2-years of follow-up, the overall results showed 74% improved, 16% unchanged and 10% worsened in group A; and 79.2% improved, 10.4% unchanged and 10.4% worsened in group B (P = 0.717). Total hip replacement (THR) was performed for 10% of group A and 10.4% of group B (P = 0.946). MRI showed significant reduction in bone marrow edema and a trend of decrease in the size of the lesions in both groups, however, no difference was noted between the two groups. Cocktail therapy is effective for early hip necrosis, but the results are comparable to ESWT in short-term follow up. The joint effects of HBO and alendronate over EWST were not observed. Conclusion Long-term results are needed to determine whether or not the synergistic effects of ESWT, HBO and alendronate over ESWT alone exist in early hip necrosis. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0918-5Authors Shan-Ling Hsu, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan Department of Orthopedic Surgery 123 Ta-Pei Road, Niao-Sung Hsiang Kaohsiung 833 TaiwanChing-Jen Wang, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan Department of Orthopedic Surgery 123 Ta-Pei Road, Niao-Sung Hsiang Kaohsiung 833 TaiwanMel Shiuann-Sheng Lee, Chang Gung Memorial Hospital-Taoyuan Medicine Center, Chang Gung University College of Medicine, Taiwan Department of Orthopedic Surgery Taipei TaiwanYi-Sheng Chan, Chang Gung Memorial Hospital-Taoyuan Medicine Center, Chang Gung University College of Medicine, Taiwan Department of Orthopedic Surgery Taipei TaiwanChung-Cheng Huang, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan Department of Radiology Kaohsiung TaiwanKuender D. Yang, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan Department of Medical Research Kaohsiung Taiwan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Screw fixation of the radial head: radiological assessment of the proximal radio-ulnar joint and average radial head diameter—an anatomic study

Abstract Introduction Anatomical study of 11 radii heads was done. Method A screw which is 2 mm longer than radial head diameter was used. Five views (AP with the forearm in supination, neutral rotation, pronation and LAT view the arm in supination and neutral rotation) were taken. In all cases the screw penetration was detected in one or two of the anteroposterior views. The lateral views were not sensitive to detect the screw penetration. For intraoperative assessment of screw length, the anteroposterior views in different position of rotation is sensitive method to detect penetration of the open reduction of head radius. Anteroposterior and lateral view with the arm in same position can miss some case of screw penetration. The diameter of the radial head was assessed. Result A difference in the radial head diameter between males and females was noticed. This can be reflected on the screw diameter. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0922-9Authors Amr Atef Abdelgawad, University of Toledo Medical Center Orthopedic Department 3065 Arlington Ave Toledo OH 43614 USAAdeel Hussain, University of Toledo Medical Center Orthopedic Department 3065 Arlington Ave Toledo OH 43614 USANabil A. Ebraheim, University of Toledo Medical Center Orthopedic Department 3065 Arlington Ave Toledo OH 43614 USA Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Geographical variation in incidence of primary total hip arthroplasty: a population-based analysis of 34,642 replacements

Abstract Background Considerable variation in total hip arthroplasty (THA) incidence between regions has been described. The aim of this study was to evaluate geographical variation in the incidence of primary THA for OA in Finland and to analyze variables associated with this variation. Methods Using Hospital Discharge Register, 34,642 THAs performed for primary OA over the 1998 and 2005 period were identified. Incidence indices for 21 hospital administrative regions were determined. Logistic regression analysis and generalized linear models were used for studying the association of potential explanatory factors for the variation in the incidence of THA. Results Incidence indices of THA varied from 1.9- to 3.0-fold during the study period. A high ratio of primary THA for primary OA to primary THA for any reason was associated with a high absolute incidence of primary THA (P < 0.001). Neither average incomes nor morbidity were associated with the incidence of THA. Interpretation When hip surgery was performed on a larger scale, threshold for performing THAs due to primary OA was higher. Socio-economic status had no apparent effect on THA rate. Surgeon decision-making related factors influence THA rates when there are only a few surgeons responsible for performing THAs in a region. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0919-4Authors Keijo T. Mäkelä, Turku University Central Hospital Department of Orthopaedics and Traumatology Rauhankatu 24 D 32 20100 Turku FinlandMikko Peltola, The National Institute for Health and Welfare Lintulahdenkuja 4 00271 Helsinki FinlandUnto Häkkinen, The National Institute for Health and Welfare Lintulahdenkuja 4 00271 Helsinki FinlandVille Remes, Peijas Hospital, Helsinki University Central Hospital Department of Orthopaedics and Traumatology Töölönkatu 31 a 13 00260 Helsinki Finland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Use of hydroxyapatite ceramics for treatment of nonunited osseous defect after open fracture of lower limbs

Abstract Introduction Osseous defects in nonunited open fracture of the lower limbs are difficult to treat. Autogenous bone grafting is a promising treatment options, but a finite amount of autogenous bone graft is available from each individual and donor site morbidity remains a problem. These limitations have prompted the development and use of synthetic biomaterials such as hydroxyapatite (HA) ceramics. However, little information is available regarding the challenging cases such as nonunited open fractures The purpose of the present study is to evaluate the outcomes associated with the treatment of osseous defects in nonunited open fracture using novel HA ceramics. Methods Twelve bones (4 femora and 8 tibias) in 11 patients (10 men and 1 woman), with an average age of 49.1 (range 19–71) years, with nonunited osseous defects after open fracture were treated by the grafting of HA ceramics alone or with autogenous iliac bone followed by internal or external fixation. Results The patients were followed for an average of 25.2 months in average (range 10.3 –58.1 months). Finally, 11 of 12 fractures united clinically and radiographically, while one fracture required a second procedure for additional autogenous iliac bone grafting. The average time to union from the index surgery was 5.6 months (median 5.3 months, range 2.3–11 months.). Radiographs showed good incorporation of grafted HA into the host bone in most of the united cases. As a complication, transient wound drainage was found in two cases. Conclusion The current protocol using the HA ceramics appears to be safe and efficacious for the treatment of osseous defects after the open fractures. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0914-9Authors Takanobu Nakase, Hoshigaokakouseinenkin Hospital Department of Orthopaedic Surgery 4-8-1, Hoshioka, Hirakata-city Osaka 573-8511 JapanMasakazu Fujii, Garashia Hospital Department of Orthopaedic Surgery Minoh JapanAkira Myoui, Osaka University Medical School Department of Orthopaedic Surgery Suita JapanNoriyuki Tamai, Osaka University Medical School Department of Orthopaedic Surgery Suita JapanYasuhisa Hayaishi, Garashia Hospital Department of Orthopaedic Surgery Minoh JapanTakafumi Ueda, Osaka National Hospital Department of Orthopaedic Surgery Osaka JapanMasayuki Hamada, Hoshigaokakouseinenkin Hospital Department of Orthopaedic Surgery 4-8-1, Hoshioka, Hirakata-city Osaka 573-8511 JapanHideo Kawai, Hoshigaokakouseinenkin Hospital Department of Orthopaedic Surgery 4-8-1, Hoshioka, Hirakata-city Osaka 573-8511 JapanHideki Yoshikawa, Osaka University Medical School Department of Orthopaedic Surgery Suita Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts’ review

Abstract Introduction A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares the different percutaneous distractional approaches for intra-articular calcaneal fractures. The history, technique, anatomical and fracture considerations, limitations and the results of different distractional approaches reported in the literature are reviewed. Method Literature review on different percutaneous distractional approaches for displaced intra-articular calcaneal fractures. Results Eight studies in which application of a distraction technique was used for the treatment of calcaneal fractures were identified. Because of the use of different classification, techniques, and outcome scoring systems, a meta-analysis was not possible. A literature review reveals overall fair to poor result in 10–29% of patients. Ten up to 26% of patients are unable to return to work after percutaneous treatment of their fracture. A secondary arthrodesis has to be performed in 2–15% of the cases. Infectious complications occur in 2–15%. Some loss of reduction is reported in 4–67%. Conclusion Percutaneous distractional reduction and fixation appears to be a safe technique with overall good results and an acceptable complication rate, compared with other treatment modalities for displaced intra-articular calcaneal fractures. A meta-analysis, based on Cochrane Library criteria is not possible, because of a lack of level 1 and 2 trials on this subject. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0915-8Authors T. Schepers, Erasmus MC, University Medical Center Rotterdam Department of Surgery, Traumatology P.O. Box 2040 Room H822-k 3000 CA Rotterdam The NetherlandsP. Patka, Erasmus MC, University Medical Center Rotterdam Department of Surgery, Traumatology P.O. Box 2040 Room H822-k 3000 CA Rotterdam The Netherlands Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Superior gluteal artery injury presenting as delayed onset shock

Abstract Injury to the superior gluteal artery (SGA) is usually associated with acetabular fractures or posterior pelvic ring injuries. The diagnosis is suspected in cases of initial hemodynamic instability which is refractory to resuscitation. The initial presentation is often dramatic and is caused by direct injury to the artery at the time of traumatic impact. In these cases, patient management at most trauma centers follows a pre-arranged algorithm which decreases the likelihood of a missed diagnosis. Delayed arterial bleeding, however, is rare and potentially catastrophic since most algorithms are not designed to detect these infrequent occurrences. We present two such cases due to initial blunt buttock trauma combined with an anterior pelvic ring fracture and a L2 spine fracture which resulted in delayed massive bleeding from the SGA. Delayed arterial bleeding should be considered in late onset shock associated with pelvic or lumbar vertebrae body fractures or direct buttock injury. If active bleeding is suspected, urgent arteriography with embolization is the treatment of choice. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0916-7Authors Qi Zhang, Hebei Medical University Department of Orthopaedics, 3rd Hospital 050051 Shijiazhuang Hebei People’s Republic of ChinaWei Chen, Hebei Medical University Department of Orthopaedics, 3rd Hospital 050051 Shijiazhuang Hebei People’s Republic of ChinaWade R. Smith, Denver Health Medical Center Department of Orthopaedics Denver CO 80204 USAJinshe Pan, Hebei Medical University Department of Orthopaedics, 3rd Hospital 050051 Shijiazhuang Hebei People’s Republic of ChinaHuaijun Liu, Hebei Medical University Department of Radiology, 2nd Hospital 050051 Shijiazhuang Hebei People’s Republic of ChinaYingze Zhang, Hebei Medical University Department of Orthopaedics, 3rd Hospital 050051 Shijiazhuang Hebei People’s Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

In vitro testing of the osteoinductive potential of different bony allograft preparations

Abstract Introduction Bony allografts are used frequently in the clinic for bone defect filling, however, less comparative data concerning their osteoinductive potential are available. Aim The purpose of the present study was the comparative analysis of different allograft preparations. From five donors, we investigated fresh-frozen cancellous bone (native), peracetic acid–ethanol sterilized (PES) cancellous bone, cortical bone and demineralised bone matrix (DBM). In addition, two commercially available DBM products from five different donors were analyzed: Allomatrix® (Wright Medical Technology Inc.) and DBX putty® (Synthes GmbH). For positive control and as a clinically used growth factor, BMP-2 was chosen. Method To investigate the osteoinductivity C2C12 cells were cultured with the different materials and the effect on cell proliferation and alkaline phosphatase activity were measured. Result Proliferation was significantly enhanced by the native cancellous bone, Allomatrix, and BMP-2 and decreased by the PES-processed cancellous bone. The osteogenic differentiation was significantly enhanced by BMP-2 and the two commercial DBM products and decreased by PES-sterilized cancellous bone. All tested materials revealed a high donor-dependent variability. This is the first comparative study on the osteoinductivity of bony allografts frequently used in clinic. Content Type Journal ArticleCategory Basic ScienceDOI 10.1007/s00402-009-0908-7Authors N. Bormann, Julius Wolff Institut, Center for Musculoskeletal Surgery, Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin Augustenburger Platz 1 13353 Berlin GermanyA. Pruss, Charité-Universitätsmedizin Berlin Institut für Transfusionsmedizin Augustenburger Platz 1 13353 Berlin GermanyG. Schmidmaier, Julius Wolff Institut, Center for Musculoskeletal Surgery, Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin Augustenburger Platz 1 13353 Berlin GermanyBritt Wildemann, Julius Wolff Institut, Center for Musculoskeletal Surgery, Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin Augustenburger Platz 1 13353 Berlin Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Lack of radiographic loosening signs in a hip resurfacing that failed by stem fracture

Abstract Fracture of the femoral stem is a rare manifestation of femoral component loosening in hip resurfacing. The patient had undergone successful hip resurfacing 3 years prior to presentation, presenting with complaints of groin pain, but without radiographic evidence of loosening. At 6 years post-operatively, the patient again presented with groin pain. Radiographs demonstrated a mid-stem fracture. Analysis of the retrieved implant and resected femoral head following conversion to total hip arthroplasty indicated that component failure and fracture appeared to be secondary to failed fixation and implant loosening not related to osteonecrosis or acute femoral neck fracture. The case report highlights the difficulty in diagnosing femoral component loosening in hip resurfacing in the absence of gross implant subsidence or stem radiolucency. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0913-xAuthors Tyler Steven Watters, Duke University Medical Center Division of Orthopaedic Surgery 200 Trent Drive Durham NC 27710 USARhett K. Hallows, Duke University Medical Center Division of Orthopaedic Surgery 200 Trent Drive Durham NC 27710 USAPat Campbell, University of California J. Vernon Luck Research Center, Orthopaedic Hospital Los Angeles CA USADiane B. Covington, Duke University Medical Center Division of Orthopaedic Surgery 200 Trent Drive Durham NC 27710 USAThomas Parker Vail, University of California Department of Orthopaedic Surgery San Francisco CA USAMichael P. Bolognesi, Duke University Medical Center Division of Orthopaedic Surgery 200 Trent Drive Durham NC 27710 USA Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Dutch orthopedic blood management surveys 2002 and 2007: an increasing use of blood-saving measures

Abstract Background Hip and knee arthroplasties are frequently complicated by the need for allogeneic blood transfusions. The surveys were developed to assess the use of blood-saving measures in orthopedic surgery in the Netherlands in 2002 and 2007. Study design and methods In 2002 and 2007, a questionnaire on blood management measures after several orthopedic procedures was sent to all Dutch orthopedic departments (110 and 96, respectively). Results The response was 79% in 2002 and 84% in 2007. The use of preoperative autologous blood donation remained virtually unchanged in 2002 versus 2007 for both hip (10.9 and 10.5%) and knee (5.7 and 8.2%) arthroplasty. In 2007, there was a substantial increase in departments using erythropoietine for hip (31.6–66.1%) as well as knee (24.0–55.5%) arthroplasty. There was an increase of the use of autologous retransfusion of intraoperatively suctioned washed blood in hip (20.3–28.4%) as well as knee arthroplasty (8.9–16.1%) over the 5-year period, but it was predominantly used in revision hip arthroplasty (54.3%). The use of postoperative autologous retransfusion of filtered drained wound blood increased dramatically in 5 years time in hip (11.5–51.0%) and knee arthroplasty (15.9–59.3%). Conclusion There is an evident increase in the preoperative use of erythropoietin and the postoperative use of autologous retransfusion of drained blood among Dutch orthopedic departments. There appears to be an increasing awareness and positive attitude among Dutch orthopedic surgeons to implement perioperative blood-saving measures. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0910-0Authors Wieger Geert Horstmann, Kennemer Gasthuis Haarlem Department of Orthopedic Surgery Boerhaavelaan 22 2035 RC Haarlem The NetherlandsHarmen B. Ettema, Isala Clinics Department of Orthopedic Surgery and Traumatology Zwolle The NetherlandsCees C. P. M. Verheyen, Isala Clinics Department of Orthopedic Surgery and Traumatology Zwolle The Netherlands Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Cementless total hip replacement: a prospective clinical study of the early functional and radiological outcomes of three different hip stems

Abstract Introduction Optimal fixation of cementless total hip stems is essential for long-term survival rates. Aim The purpose of this prospective study was to evaluate the early clinical and radiological outcomes of two new total hip stems with metaphyseal (Symax®) and predominantly diaphyseal (Hipstar®) anchoring principles in comparison to the well-established straight Zweymueller (SL-Plus®) stem. Method Clinical and radiological evaluations of 74 patients were undertaken preoperatively as well as at 6 and 12 months postoperatively using the Harris Hip Score (HHS) and Western Ontario and McMaster Universities-Score. Results During follow-up no stem had to be revised. The mean preoperative HHS of the three study groups amounted to 54.6 ± 15.7 points. At the 12 months follow-up the mean HHS in the SL-Plus group (n = 22) was 88.3 ± 10.5 points, in the Hipstar group (n = 25) 83.3 ± 15.0 and the in Symax group (n = 27) 83.6 ± 15.1. Due to stress shielding the straight Hipstar stem revealed radiolucent lines in the proximal Gruen zones of about 60%, whereas the SL-Plus stem showed significantly more radiolucent lines (87%). However, subsequent long-term studies must be carried out in order to clarify if the progression of radiolucent lines may influence the clinical result and implant longevity. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-009-0907-8Authors Philipp Bergschmidt, University of Rostock Department of Orthopaedics Doberaner Strasse 142 18057 Rostock GermanyRainer Bader, University of Rostock Department of Orthopaedics Doberaner Strasse 142 18057 Rostock GermanySusanne Finze, University of Rostock Department of Orthopaedics Doberaner Strasse 142 18057 Rostock GermanyAlexander Gankovych, University of Rostock Department of Orthopaedics Doberaner Strasse 142 18057 Rostock GermanyGuenther Kundt, University of Rostock Department of Medical Informatics and Biometry Rembrandtstrasse 16/17 18057 Rostock GermanyWolfram Mittelmeier, University of Rostock Department of Orthopaedics Doberaner Strasse 142 18057 Rostock Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Anatomic stem design reduces risk of thin cement mantles in primary hip replacement

Abstract Purpose To analyse the influence of femoral stem design in the lateral plane (anatomic vs. straight) on the cement mantle quality. Method In this consecutive multi-surgeon radiographic study we determined, Dorr grading, cement mantle quality (Barrack) and mantle thickness using Gruen zones 1–14 in 280 primary cemented total hip replacements, divided into two groups (140 anatomic Biomet Olympia, 140 straight Exeter Universal Series). Results Twenty-three per cent of the straight Exeter Universal stems had a cement mantle of <2 mm thickness in Gruen zone 8 and 25% in Gruen zone 9, compared to 0.7% of the anatomical Olympia stems in Gruen zone 8 and 1.4% in Gruen zone 9. The difference between the two groups was statistically significant (P < 0.001). In all other zones no significant differences were found. Conclusion This radiological study confirms that femoral stems with an anatomical curve in the lateral plane carry a lower risk of thin cement mantles (especially in Gruen zones 8 and 9) than straight stems. Cement mantle analysis in one radiographic plane only is insufficient. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0903-zAuthors Christian Hank, University of Edinburgh Department of Orthopaedic Surgery, New Royal Infirmary at Little France Old Dalkeith Road Edinburgh EH16 4SU ScotlandMichael Schneider, University of Edinburgh Department of Orthopaedic Surgery, New Royal Infirmary at Little France Old Dalkeith Road Edinburgh EH16 4SU ScotlandCheryl S. Achary, University of Edinburgh Department of Orthopaedic Surgery, New Royal Infirmary at Little France Old Dalkeith Road Edinburgh EH16 4SU ScotlandLeslie Smith, University of Edinburgh Department of Orthopaedic Surgery, New Royal Infirmary at Little France Old Dalkeith Road Edinburgh EH16 4SU ScotlandSteffen J. Breusch, University of Edinburgh Department of Orthopaedic Surgery, New Royal Infirmary at Little France Old Dalkeith Road Edinburgh EH16 4SU Scotland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Are sinus-track cultures reliable for identifying the causative agent in chronic osteomyelitis?

Abstract Purpose The infection of bone that contains bone marrow called osteomyelitis, and is caused by different microorganisms. In this study, we aimed to determine the diagnostic value and accuracy of cultures of material from a sinus track compared with those of cultures of bone specimens that have been controversial. Materials and method Prospective study was conducted at Hospital University of Dicle, a 1,090-bed university-based hospital located in Diyarbakır, Turkey. Between May 2005 and September 2006, sinus-track cultures were compared with those of bone cultures from 43 patients with chronic osteomyelitis. Results The patients’ mean age was 30.6 ± 3.6 years, and 29 (67%) male and 14 (33%) female. Organisms isolated from bone cultures were Staphylococcus 69% (29/42), Escherichia coli 9.5% (4/42), Pseudomonas aeruginosa 9.5% (4/42), Proteus mirabilis 7% (3/42), respectively. Cultures of sinus track and bone specimens gave identical results in 38% of patients. Conclusion The value of bone culture in the therapy of osteomyelitis must be emphasized; it is the only reliable means of determining the responsible agent, up on which the antibiotic therapy is based. The correlation between sinus track and bone cultures was 38%, i.e., failure in the treatment for 6 patients out of 10. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-009-0909-6Authors Mehmet Ulug, BSK Anadolu Hospital Department of Infectious Diseases and Clinic Microbiology 43100 Kutahya TurkeyCelal Ayaz, Dicle University Medical School Department of Infectious Diseases and Clinic Microbiology 21280 Diyarbakir TurkeyMustafa Kemal Celen, Dicle University Medical School Department of Infectious Diseases and Clinic Microbiology 21280 Diyarbakir TurkeyMehmet Faruk Geyik, Duzce University Medical School Department of Infectious Diseases and Clinic Microbiology 81100 Düzce TurkeySalih Hosoglu, Dicle University Medical School Department of Infectious Diseases and Clinic Microbiology 21280 Diyarbakir TurkeySerdar Necmioglu, Dicle University Medical School Department of Orthopedics and Traumatology 21280 Diyarbakir Turkey Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Tartrate-resistant acid phosphatase 5b and C-terminal telopeptides of type I collagen as markers for diagnosis of aseptic loosening after total hip replacement

Abstract Introduction Plain radiography, bone scintigraphy, digital subtraction arthrography and various other techniques can be used to evaluate loosening of hip replacements. These methods are associated with radiation exposure and some of them have an increased morbidity. Furthermore, in some cases the results are not conclusive. Method The osteoclast biomarkers tartrate-resistant acid phosphatase 5b (TRAP 5b) and C-terminal telopeptides of type I collagen (CTX) in serum taken from 12 patients with aseptic loosening were measured. Serum samples from 24 other patients, 12 with an intact arthroplasty and 12 without any kind of joint replacement, served as control groups. Results The serum level of CTX was increased in comparison to the control groups, but the differences were not significant. In contrast, the increase in TRAP 5b in patients with aseptic loosening was highly significant (P < 0.001). A TRAP 5b value of 3.365 U/L was determined as a cut-off value, giving a sensitivity of 83.3% and specificity of 91.7% to differentiate the patients with aseptic loosening from those with an intact arthroplasty. Measurement of serum TRAP 5b may be a clinically relevant assay for monitoring patients after arthroplasty. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-0905-xAuthors Stefan Landgraeber, University of Duisburg-Essen Department of Orthopaedics Pattbergstrasse 1-3 45239 Essen GermanyFranz Löer, University of Duisburg-Essen Department of Orthopaedics Pattbergstrasse 1-3 45239 Essen GermanyHansjörg Heep, University of Duisburg-Essen Department of Orthopaedics Pattbergstrasse 1-3 45239 Essen GermanyTim Classen, University of Duisburg-Essen Department of Orthopaedics Pattbergstrasse 1-3 45239 Essen GermanyFlorian Grabellus, University of Duisburg-Essen Institute of Pathology and Neuropathology Hufelandstrasse 55 45122 Essen GermanyMartin Totsch, University of Duisburg-Essen Institute of Pathology and Neuropathology Hufelandstrasse 55 45122 Essen GermanyMarius von Knoch, University of Duisburg-Essen Department of Orthopaedics Pattbergstrasse 1-3 45239 Essen Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Long-term outcome after joint reconstruction or medial resection arthroplasty for anterior SCJ instability

Abstract Introduction In the present study, the long-term results of 11 patients with anterior sternoclavicular joint (SCJ) instability are reported. All included patients had an anterior SCJ instability and due to delayed diagnosis, operative treatment was not done immediately. Method The patients had a mean age of 29.2 years (range 16–63 years). One patient sustained concomitant injuries. Six patients had resection arthroplasty. Five patients had reconstruction of the SCJ with transosseous tension band PDS fixation or ligament reconstruction with additional wire cerclage. The results of treatment were evaluated after a mean follow-up period of 9.9 years (range 1–27 years) using the ASES, DASH and power-, age and gender adjusted Constant–Murley Score. Results In general, the mean values of the different scores (ASES 79.8; DASH 11.8; Constant–Murley 81%) demonstrated good outcome. The outcome evaluation of the patients who had SCJ reconstruction did not differ significantly from the patients who had medial resection arthroplasty. The rate of postoperative pain or instability was low using visual analog scale and did not differ significantly between the groups. The outcome results of the reconstruction group were equal to the results of the resection group when SCJ-reconstruction was performed soon after SCJ injury. One patient in the resection group (6 patients) demonstrated poor results due to continued instability of the remaining clavicle. Conclusion We concluded that patient selection and a specific clinical indication for operative treatment are crucial. Resection of the medial clavicle results in good functional outcome when the costoclavicular ligament is preserved or reconstructed. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-0911-zAuthors Martin Panzica, Hannover Medical School Department of Trauma Surgery Carl-Neuberg-Str. 1 30625 Hannover GermanyJ. Zeichen, Hannover Medical School Department of Trauma Surgery Carl-Neuberg-Str. 1 30625 Hannover GermanyS. Hankemeier, Hannover Medical School Department of Trauma Surgery Carl-Neuberg-Str. 1 30625 Hannover GermanyR. Gaulke, Hannover Medical School Department of Trauma Surgery Carl-Neuberg-Str. 1 30625 Hannover GermanyC. Krettek, Hannover Medical School Department of Trauma Surgery Carl-Neuberg-Str. 1 30625 Hannover GermanyM. Jagodzinski, Hannover Medical School Department of Trauma Surgery Carl-Neuberg-Str. 1 30625 Hannover Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051