Orthopedics RSS : Gourt

Great Location :: Illinois :: Intelligent Placement Solutions, Inc

Existing single specialty group seeking a general orthopedist to join our sports medicine specialst at our clinic. Call will be one in four, some trauma will be required. Salaried position for the first

Great Location :: Florida :: Intelligent Placement Solutions, Inc

Who could ask for more? A proven business model that allows the right orthopedic surgeon the opportunity to share in multiple ancillary revenues. You'll be on Florida's beautiful gulf coast, less than

Not Disclosed :: New York :: Locum Medical Group

A client located in southern New York is seeking a permanent Orthopedic Surgeon. This area of New York offers its residents and visitors small-city charm, abundant industry, affordable housing, ample

Not Disclosed :: Texas :: Locum Medical Group

A hospital sponsored private practice in southern Texas is seeking a permanent Orthopedic Surgeon to serve the city's growing patient population. This position will allow you to enjoy the autonomy of

Not Disclosed :: Kansas :: Locum Medical Group

A hospital about 70 miles southwest of Kansas City, Kansas seeks to hire an Orthopedic Surgeon. Candidates must be Board Certified and the hospital will license if needed. You will need to be qualified

Not Disclosed :: Ohio :: Locum Medical Group

A health system that operates three clinics in Cleveland suburbs is seeking a part-time orthopedic surgeon. Ultimately, the organization seeks a permanent employee that is interested in working 1-2 days

Not Disclosed :: Michigan :: Locum Medical Group

A practice located approximately one hour north of Lansing, Michigan seeks to hire a Board Certified or Board Eligible Orthopedic Surgeon. You will be joining an existing thriving practice owned by the

Not Disclosed :: Texas :: Locum Medical Group

A practice located between Austin and Houston, Texas seeks to hire an Orthopedic Surgeon. Candidates must have an active Texas medical license with a DPS and be either Board Certified or Board Eligible

Not Disclosed :: Virginia :: Locum Medical Group

A permanent Orthopedic Surgeon is needed for an opportunity in northern Virginia, west of the Washington D.C. suburbs. A group of Orthopedic Surgeons is looking to expand their group through the incorporation

SouthWest :: Montana :: Intelligent Placement Solutions, Inc

BC/BE Orthopedic Hand Surgeon. Practice full-scope, state-of-the-art medicine in a collegial environment. We partners with our talented and well trained medical staff to guide strategic decisions so that

SouthEast :: Texas :: Intelligent Placement Solutions, Inc

Practice in a very nice community with miles of shorelines boating fishing and nice amenities as well. There is a need for a new orthopedic surgeon due to continuing growth. Excellent starting salary

NorthEast :: Ohio :: Intelligent Placement Solutions, Inc

ORTHOPEDIC SURGEON At the present time, only one full time surgeon at multi specialty clinic. Need two Ortho Surgeons to accommodate the high volume. Department does employ a PA. First Year Salary Guarantee

NorthWest :: Pennsylvania :: Intelligent Placement Solutions, Inc

Orthopedics*** PRIORITY *** Private practice or employed position options exist to join a renowned orthopedic center of excellence. Seeking a board certified/eligible orthopedic surgeon, preferably with

SouthWest :: Virginia :: Intelligent Placement Solutions, Inc

Employed position, could also go private if you wanted. 2 Orthos in the practice now. Need someone to practice a long time. Want someone who is surgically aggressive. On Money - 350+. Maybe higher

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

Orthopedic Group seeking a BE/BC Orthopaedic Surgeon. Join a well-established group (one physician, two midlevels) in an area with a high demand for orthopedic services. Experienced or a new Grad, this

Central :: Illinois :: Intelligent Placement Solutions, Inc

General orthopedist sought to join two others in a hospital owned practice. Plenty of work, great compensation scheme. Established referral base.Within reach of Chicago but with none of the hassles traffic

Central :: Oklahoma :: Intelligent Placement Solutions, Inc

ORTHOPEDIC SURGEON Oklahoma ($400 $450,000). Popular and growing suburb ofMetro area. 5 year old hospital with new emergency department. Strong support from Primary Care Physicians. Low Managed Care.

North :: New York :: Intelligent Placement Solutions, Inc

Step into an existing hospital employed practice with modern updated operating rooms. Excellent starting salary with incentives built on top of a very generous base, great place to live. Rolling hills,

East :: Texas :: Intelligent Placement Solutions, Inc

If youve ever wanted to be a part of an outstanding and well run practice, providing a tremendous income, this is the financially and professionally rewarding opportunity for you: Salary- $650K, Signing-

East :: Georgia :: Intelligent Placement Solutions, Inc

A modern well equipped community hospital is seeking a third orthopedist to join their team. Very busy due to the geographic location. Most of the doctors who work here have a house at the beach. Hospital

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

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.

Design and finite-element evaluation of a versatile assembled lumbar interbody fusion cage

Abstract Introduction When an interbody cage is inserted into a human being’s lumbar spine, not only the design, but also the material used is considerably crucial, particularly when minimally invasive lumbar fusion (MILIF) approaches are considered. The purpose of this study was to design a multi-function cage (either for MILIF or open lumbar interbody fusion) and also to evaluate the strength of the design based on a finite-element model analysis. Method Three-dimensional finite-element models that were instrumental in the reproduction of post-operative conditions under which different cages, such as assembled lumbar interbody fusion cages (ALIFC) and the separated ones, could be examined and traced after implantation were developed. Simulations were run to realize various loading conditions including axial compression, flexion, extension, lateral bending and rotation under a constant compressive preload. Meanwhile, the evaluation results derived from FEMs data focused on endplate stress distribution, peak stress of von Mises and stress of cage. Stress distributions on the bone surface were evaluated and discussed as well. Results The consequences of cage insertion, high strains and stresses, were concentrated in the areas where the cage and endplate were in contact with each other. Simultaneously, contact stresses around the implants seemed to be concentrated around the periphery of the device. After implantation of ALIFC, the stiffness of the new cages was similar to that of traditional cages in an assemble condition, according to the biomechanical data dealing with FEM. Once a separated cage was in the place of an assembled cage, the stresses would get symmetrically distributed in the lateral areas of the endplate and decrease significantly at the center where the separated cage was not in contact with the endplate. The stress of the cage was going to be high once being rotating; most significant difference of stresses distribution due to the alternative choice has been found in the state of rotation. On comparison of peak von Mises stresses on the endplates in the new cage, the stresses were symmetrically distributed in the lateral areas of the endplate when a separated cage was used in place of an assembled cage. Conclusion The new cage was more advantages with regard to endplate stress distribution, peak stress of von Mises and stress of cage than the assembled state. ALIFC can provide sufficient primary stability for lumbar intervertebral fusion and the new cage may be regarded as a suitable device for load-bearing implantation. Content Type Journal ArticleCategory Basic ScienceDOI 10.1007/s00402-010-1055-xAuthors Jin-Yong Ding, The Third Military Medical University Department of Orthopaedics, Xinqiao Hospital Xinquiao Street No. 2, Shapingba Di 400037 Chongqing People’s Republic of ChinaShen Qian, Guangdong General Hospital of Chinese People Armed Force Guangzhou Guangdong 510517 People’s Republic of ChinaLei Wan, General Hospital of Guangzhou Military Area Command of Chinese PLA Department of Orthopaedics 510507 Guangzhou Guangdong People’s Republic of ChinaBo Huang, The Third Military Medical University Department of Orthopaedics, Xinqiao Hospital Xinquiao Street No. 2, Shapingba Di 400037 Chongqing People’s Republic of ChinaLi-Gen Wang, Guangdong General Hospital of Chinese People Armed Force Guangzhou Guangdong 510517 People’s Republic of ChinaYue Zhou, The Third Military Medical University Department of Orthopaedics, Xinqiao Hospital Xinquiao Street No. 2, Shapingba Di 400037 Chongqing People’s Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Initial increased wear debris of XLPE-Al2O3 bearing in total hip arthroplasties

Abstract Introduction Aseptic implant loosening caused by wear debris is a common reason for early implant failure after total hip replacement (THR). Materials and methods We prospectively studied 96 patients (110 hips), 48 men and 48 women (mean age 46.8 years, mean body mass index 26.1) who had undergone cementless THR (titanium stem, press-fit cup, Al2O3 ball, XLPE liner) at a mean of 17.4 months (SD 13.4). Results The semi-computerized evaluation of wear rate showed wear of 0.25 mm (SD 0.3) corresponding to a volume of 97.6 mm3 (SD 121.1) during the first year. It was remarkable that the annual rate of wear was significantly lower in the second year: 0.14 mm (SD 0.1), 60.0 mm3 (SD 78.7). The implant survival rate was 100%. However, two patients underwent revision surgery. Interpretation Good, early functionality can be achieved by a cementless THR including a modular stem and a XLPE-Al2O3 bearing system. The rate of wear debris for XLPE-Al3O2 was much higher than expected within the first year after THR. However, after the initial running-in period a significant decrease of wear was documented, suggesting a biphasic abrasion [0.38 mm (SD 0.2) within the first year vs. 0.14 mm (SD 0.1)] after the running-in-period 1 year following surgery. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-010-1061-zAuthors Marcus Jäger, Heinrich-Heine University Medical School Department of Orthopaedics Moorenstr. 5 40225 Duesseldorf GermanyMichael Behringer, Heinrich-Heine University Medical School Department of Orthopaedics Moorenstr. 5 40225 Duesseldorf GermanyChristoph Zilkens, Heinrich-Heine University Medical School Department of Orthopaedics Moorenstr. 5 40225 Duesseldorf GermanyTravis Matheney, Harvard Medical School Orthopaedic Department, Children’s Hosptial Boston 300 Longwood Avenue Boston MA 02115 USARüdiger Krauspe, Heinrich-Heine University Medical School Department of Orthopaedics Moorenstr. 5 40225 Duesseldorf Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Metrenperone enhances collagen turnover and remodeling in the early stages of healing of tendon injury in rabbit

Abstract Introduction This study evaluated the effects of metrenperone on healing of unilateral, collagenase-induced lesions in the Superficial Digital Flexor Tendons (SDFT) of rabbits. Methods After controlled injury of the left SDFT, nine rabbits received daily treatment with metrenperone for 28 days. Another nine were untreated controls; in both groups the contra-lateral tendons served as uninjured controls. Histological and ultrastructural changes, mechanical properties, dry weight, collagen content, and amount of DNA in healing and control tendons were assessed 28 days after injury. Results Restoration of structural hierarchy was more organized in treated than in untreated tendons while cellularity was greater in the latter. At the ultrastructural level, collagen in treated lesions was predominantly in the form of small-diameter, new fibrils, with few large, old fibrils; in untreated lesions there was a high proportion of large, old fibrils but relatively few small, new ones. The amount of DNA in untreated injuries was much greater than in normal tendons, while in treated lesions it was not significantly different from that of uninjured controls. There were no significant differences in total collagen, stiffness and ultimate strength of injured, treated, and untreated tendons 28 days after injury. Both were significantly weaker than their corresponding contralaterals. Conclusions The findings suggest that metrenperone had positive effects on collagen turnover, remodelling, and organization during acute inflammation and fibroplasia. Provided that the new fibrils subsequently matured in a normal manner, mechanical characteristics of the organized scar should be better than those of an untreated lesion. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-010-1057-8Authors Ahmad Oryan, Shiraz University Department of Pathobiology, School of Veterinary Medicine Shiraz IranIan A. Silver, Bristol University Department of Anatomy Bristol UKAllen E. Goodship, The Royal Veterinary College Institute of Orthopaedic and Musculoskeletal Science London UK Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

A customized modular reference array clamp for navigated spine surgery

Abstract Introduction The current authors have developed a modular system of reference array fixation which is tailored specifically to the spinal level being operated upon. They believe that this system may further increase the precision and accuracy of pedicle screw placement. Materials and methods Two formalin-fixed whole body cadavers were used for this study. For cervical spine evaluation of the reference clamp, four odontoid screws (two per cadaver) for C1/C2-fusion and four lateral mass screws (two per cadaver) were implanted. Following navigated screw placement with 2D and 3D fluoroscopic verification, insertion of two lateral mass screws was performed. In the same way, lumbar and thoracic pedicle screws were implanted. Two pedicle screws were placed at two levels of the lumbar and two levels of the thoracic areas giving an overall of 16 screws implanted (8 cervical, 4 thoracic, and 4 lumbar). Postoperative evaluation involved comparison of postoperative 3D scans and preoperative planning images. A simple classification system was used for evaluation of any deviation from the planned trajectory. Results All pedicle screw placements were performed as planned without any technical problems. The reference array clamps remained in position at all the spinal levels at which they were employed with no loosening or displacement and no secondary damage to any of the spinous processes. Manual manipulation was performed but no displacement or slippage was observed. Image artefacts caused by the reference clamp were not significant as to obscure the area of interest. Both imaging modalities (Iso-C 3D and Vario 3D) generated sufficiently precise 3D images. There was no substantial difference in quality when those two systems were compared. Discussion Insufficient fixation of the reference clamp can lead to failure and complications. To date, no reference clamp systems have been developed specifically for navigated spine surgery. Conclusions Stable reference array fixation is a critical step in navigated surgery. To date, the same reference clamps have been applied to the spinal anatomy as have been developed originally for the appendicular skeleton. The current investigators have developed a novel modular clamp and have demonstrated its efficacy in a cadaveric model. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-010-1060-0Authors Padhraig F. O’Loughlin, Computer Assisted Surgery Center Department of Orthopaedic Surgery, Hospital for Special Surgery 535 East 70th Street New York NY 10021 USADorothea Daentzer, Hannover Medical School Orthopedic Department Hannover GermanyTobias Hüfner, Computer Assisted Surgery Center Department of Orthopaedic Surgery, Hospital for Special Surgery 535 East 70th Street New York NY 10021 USANesrin Uksul, Hannover Medical School Trauma Department Hannover GermanyMustafa Citak, Computer Assisted Surgery Center Department of Orthopaedic Surgery, Hospital for Special Surgery 535 East 70th Street New York NY 10021 USAJonas Haentjes, Hannover Medical School Trauma Department Hannover GermanyChristian Krettek, Hannover Medical School Trauma Department Hannover GermanyMusa Citak, Computer Assisted Surgery Center Department of Orthopaedic Surgery, Hospital for Special Surgery 535 East 70th Street New York NY 10021 USA Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Soft tissue metastasis of thyroid carcinoma in the knee region mimicking a paraarticular inflammatory lesion

Abstract We report a case of a 57-year-old male patient presenting with a painful mass in the popliteal fossa of the left knee, while the X-ray being unremarkable, MRI suggested a paraarticular lesion such as an inflamed paraarticular ganglion. A biopsy showed a poorly differentiated metastasis of a papillary thyroid carcinoma, the patient had been operated on 8 years ago. This case emphasizes that in patients with malignancies such as papillary thyroid carcinomas long-term courses (over years) with several phases of tumor spread occur finally leading to filiae in any location. Thus, in such patients, a metastatic lesion even in unusual places such as the periarticular soft tissue should be included in the differential diagnosis. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1043-1Authors Torsten Prietzel, University of Leipzig Orthopedic Hospital Leipzig GermanyAnna Macher, University of Leipzig Institute of Pathology Liebigstr. 26 04103 Leipzig GermanyIrina Haferkorn, University of Leipzig Institute of Pathology Liebigstr. 26 04103 Leipzig GermanyNicole Schmitz, University of Leipzig Institute of Pathology Liebigstr. 26 04103 Leipzig GermanyFrank Schmidt, University of Leipzig Institute of Radiology Leipzig GermanyThomas Aigner, Medical Center Coburg Institute of Pathology Ketschendorferstr. 33 96450 Coburg Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Serum metal ion levels after second-generation metal-on-metal total hip arthroplasty

Abstract Introduction Metal-on-metal bearings for total hip arthroplasty are increasing in popularity. However, metal ion toxicity, metal hypersensitivity, and metal carcinogenicity are the causes concern for patients with metal-on-metal hip replacement. We investigated serum levels of cobalt and chromium ions in patients with successfully implanted second-generation metal-on-metal total hip arthroplasty (THA) using PINNACLE-A (DePuy, Warsaw, IN, USA). Materials and methods Thirty-three patients underwent primary cementless THA with the use of a 36-mm femoral head PINNACLE-A with a metal-on-metal articulation. Blood samples were taken preoperatively, at 3 months, and at 1 year, and levels of cobalt and chromium were determined. Results At 3 months, levels of both cobalt and chromium had increased significantly compared with preoperative levels. There were no significant differences between levels of either metal at 3 months and 1 year. Conclusion Patients with metal-on-metal THA had higher circulating levels of metal ions than before arthroplasty at 3 months, with no additional significant increases at 1 year in this study. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-010-1056-9Authors Takao Imanishi, Mie University Graduate School of Medicine Department of Orthopaedic Surgery 2-174 Edobashi Tsu Mie 514-8507 JapanMasahiro Hasegawa, Mie University Graduate School of Medicine Department of Orthopaedic Surgery 2-174 Edobashi Tsu Mie 514-8507 JapanAkihiro Sudo, Mie University Graduate School of Medicine Department of Orthopaedic Surgery 2-174 Edobashi Tsu Mie 514-8507 Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Spinal osteochondroma: a report on six patients and a review of the literature

Abstract Introduction Osteochondromas are the most common benign tumour of the bone. They occur in two forms as solitary and hereditary multiple form. Osteochondromas are generally located on the metaphysis of the long bones. From 1 to 4% of osteochondromas occur in the spine. Spinal osteochondromas can cause cord and root compression and also be asymptomatic. In the diagnosis of osteochondromas, radiological methods are very important. Purpose of study Because spinal osteochondroma is very rare, other benign and malign tumours should be kept in mind during differential diagnosis. In this paper, six patients with spinal osteochondral lesions were evaluated at our orthopaedic oncology department. Patients Between 1986 and 2009, six patients, four males, two females with an average age of 31.2 (9–65) were diagnosed with spinal osteochondroma at our clinic. Although one patient was diagnosed following another complaint, five patients were suffering from pain. In addition, four patients had swelling and one patient had neurological symptoms. Five patients were treated surgically, and the sixth one was followed conservatively. Discussion The patients with spinal osteochondral lesions applied with mostly pain and swelling at the dorsal of the vertebrae. Because neurological symptoms are rarely seen, radiological examination is of great importance in diagnosis. Conclusions Patients suffering from spinal osteochondroma, due to the risk of secondary chondrosarcoma, must be closely evaluated both clinically and radiologically. If necessary, the patient must be treated surgically following histopathological diagnosis. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-010-1058-7Authors Cuneyd Gunay, Ankara Numune Research and Training Hospital 5th Clinic, Department of Orthopaedic Surgery and Traumatology 06100 Sihhiye/Ankara TurkeyHakan Atalar, Fatih University Department of Orthopaedic Surgery and Traumatology Alparslan Turkes Caddesi No: 57 06510 Emek/Ankara TurkeyYusuf Yildiz, Ankara University Department of Orthopaedic Surgery and Traumatology 06100 Sihhiye/Ankara TurkeyYener Saglik, Ankara University Department of Orthopaedic Surgery and Traumatology 06100 Sihhiye/Ankara Turkey Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Opponensplasty using palmaris longus tendon and flexor retinaculum pulley in patients with severe carpal tunnel syndrome

Abstract Introduction Thenar muscle atrophy is a common finding in long-standing severe carpal tunnel syndrome (CTS). Combination of carpal tunnel release and Camitz opponensplasty has been used to treat severe CTS with thenar muscle atrophy. Camitz opponensplasty is beneficial for abduction, but provides little benefit to thumb flexion and pronation. This problem could be overcome by the use of a pulley. Materials and methods Twelve cases of long-standing CTS with severe thenar muscle atrophy in 11 patients were investigated. They were treated with the modified Camitz opponensplasty using a pulley at the ulnar side remnant of the flexor retinaculum at the time of carpal tunnel release. Outcome was assessed by clinical grade of thenar muscle atrophy, degree of thumb opposition and the patient’s satisfaction. Results The average grade of thenar muscle atrophy improved from grade 3 pre-operatively to grade 0.83 at the last follow-up. Mean maximal palmar abduction improved from 3.6 to 6.8 cm, and spatial rotation improved from 54° to 83°. Kapandji tip opposition changed from 65 to 85% symmetry at the last follow-up. All 11 patients were ‘very satisfied’ or ‘satisfied’ with the outcome. Conclusion Modified Camitz opponensplasty is a simple procedure that provides immediate improvement of thenar function. Palmar flexion and pronation can be further improved by addition of a pulley. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-010-1053-zAuthors Il-Jung Park, Catholic University of Korea Department of Orthopaedic Surgery, Bucheon St. Mary’s Hospital 2 Sosa-dong, Wonmi-gu Bucheon 420-717 KoreaHyoung-Min Kim, Catholic University of Korea Department of Orthopaedic Surgery, Bucheon St. Mary’s Hospital 2 Sosa-dong, Wonmi-gu Bucheon 420-717 KoreaSang-Uk Lee, Catholic University of Korea Department of Orthopaedic Surgery, Bucheon St. Mary’s Hospital 2 Sosa-dong, Wonmi-gu Bucheon 420-717 KoreaJoo-Yup Lee, Catholic University of Korea Department of Orthopaedic Surgery, Bucheon St. Mary’s Hospital 2 Sosa-dong, Wonmi-gu Bucheon 420-717 KoreaChanghoon Jeong, Catholic University of Korea Department of Orthopaedic Surgery, Bucheon St. Mary’s Hospital 2 Sosa-dong, Wonmi-gu Bucheon 420-717 Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Implant-free press-fit fixation for bone–patellar tendon–bone ACL reconstruction: 10-year results

Abstract Objective The aim of this study is to determine the outcome of anterior cruciate ligament (ACL) reconstruction without foreign material with patellar tendon bone graft in the fixation with bone dowels near the native insertion. Materials and methods Between 1998 and 1999, 189 patients were operated with ACL reconstruction with BTB patellar tendon graft. In a prospective study, 148 (78%) (91M, 57F) patients could be seen for a mean follow-up of 10.3 years. All had foreign material-free press-fit and a bottom-to-top (BTT) fixation in 120° knee flexion. All patients were evaluated with detailed history, clinical examinations, radiographic examination with weight bearing which could be compared to the time of surgery in 64 (43%) patients. Laxity testing was performed in Lachman position with the Rolimeter and pivot shift. All patients were graded according to the IKDC and Tegner activity score. Results 87% of the patients achieved an IKDC score of A/B. The subjective IKDC score was A/B in 94.6% of the subjects. The average side-to-side difference was 1.42 ± 0.88 mm for the Lachman test, 97% of the patients were rated between 0 and 2 mm. The pivot-shift test was negative in 90% and was observed with a glide in 7% of the patients. Radiological joint space narrowing was found in the medial compartment in 8 (12.4%) cases, and laterally in 9 (14.1%) cases. All these patients had partial or total meniscus resections. The patello-femoral joint space was reduced in 21 (23%) cases. The Tegner activity score changed from 6.9 pre-injury to 5.0 at the 10-year follow-up. Conclusion The implant-free fixation of the graft with bone dowels and BTT implantation has good and excellent results after 10 years in more than 80% of the patients. Loss of the meniscus is a main factor contributing to osteoarthritis. Advantages of patellar tendon bone press-fit fixation include anatomical positioning and fast bone-to-bone healing, ease for revision surgery and cost effectiveness. Content Type Journal ArticleCategory Arthroscopy and Sports MedicineDOI 10.1007/s00402-010-1050-2Authors Gernot Felmet, Clinic for Orthopedics and Sports Traumatology Orthopädische Praxis, ARTICO Sportklinik Hirschbergstr. 25 78054 Villingen-Schwenningen Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Autologous matrix-induced chondrogenesis aided reconstruction of a large focal osteochondral lesion of the talus

Abstract The aim of this case report is to describe a novel technique for treatment of large osteochondral lesions of the talus using autologous matrix-induced chondrogenesis with a collagen I/III membrane. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-010-1048-9Authors Martin Wiewiorski, University Hospital Basel Orthopaedic Department Spitalstrasse 21 4031 Basel SwitzerlandAndré Leumann, University Hospital Basel Orthopaedic Department Spitalstrasse 21 4031 Basel SwitzerlandOlaf Buettner, University Hospital Basel Orthopaedic Department Spitalstrasse 21 4031 Basel SwitzerlandGeert Pagenstert, University Hospital Bonn Orthopaedic Department Bonn GermanyMonika Horisberger, University Hospital Basel Orthopaedic Department Spitalstrasse 21 4031 Basel SwitzerlandVictor Valderrabano, University Hospital Basel Orthopaedic Department Spitalstrasse 21 4031 Basel Switzerland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Palmar multidirectional fixed-angle plate fixation in distal radius fractures: do intraarticular fractures have a worse outcome than extraarticular fractures?

Abstract Introduction The results and complications using a palmar plate system with the possibility of multidirectional fixed-angle screw fixation (Aptus® Radius 2.5 mm by Medartis®) for the treatment of unstable distal radius fractures were evaluated in a single cohort study including 62 patients. Patients Patients with extra- and intraarticular fractures were evaluated separately. The mean follow-up was 14.7 months. Active wrist motion averaged 60.1° extension, 52.0° flexion, 86.3° pronation, and 84.6° supination. Grip strength averaged 89% of the contralateral wrist. Results There was no loss of the initial reduction with bony union in all cases. The mean DASH-score was 12.6 points. Postoperative complications included two extensor pollicis longus tendon ruptures, two median nerve compression syndromes, one complex regional pain syndrome, and one postoperative haematoma. In our series the results of the intraarticular fracture group were similar to the extraarticular fracture group. The complication rate, however, was substantially higher in the intraarticular fracture group. Conclusion We conclude that palmar plating with multidirectional fixed-angle screw insertion is an effective and useful treatment option, especially for complex intraarticular distal radius fractures. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-010-1045-zAuthors Juerg Sonderegger, Kantonsspital Department of Hand, Plastic and Reconstructive Surgery St. Gallen SwitzerlandS. Schindele, Hand Center, Schulthess Clinic Zurich SwitzerlandM. Rau, Kantonsspital Hand Unit, Department of Surgery Schaffhausen SwitzerlandJ. G. Gruenert, Kantonsspital Department of Hand, Plastic and Reconstructive Surgery St. Gallen Switzerland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Cartilage repair approach and treatment characteristics across the knee joint: a European survey

Abstract Introduction To describe indication, approach and treatment modalities for the management of knee cartilage lesions among a selected European population. Methods An electronic questionnaire covering general and specific items concerning cartilage repair at the knee joint was designed and disposed to survey cartilage treatment characteristics among a defined population of trained and accredited musculoskeletal surgeons. Results A total of 242 (80.13%) interviewees returned the questionnaire. Two-thirds of the respondents considered patient age to not limit (33.1%) or considered the age of 50 as the upper limit (32.2%) for interventional cartilage surgery. There was no consensus on when to correct mechanical axis deformation. Irrespective of lesion size, surgical debridement and microfracture are the techniques most frequently used. Surgical approach to full-thickness cartilage defects is commenced when the lesion size exceeds 1 cm2 in 75.6% of respondents; mainly utilizing microfracture or debridement for defects smaller than 1, 2 and 3 cm2. Controversy exists for treatment of lesions exceeding 3 cm2, where autologous chondrocyte transplantation is utilized in the majority of cases (33.5%), while as well microfracture (19.0%) and with lesser frequency osteochondral plug (9.5%) transplantation are recommended. Debridement was indicated to be used in combination with other techniques, while microfracture, chondrocyte or osteochondral plug transplantation are applied as individual techniques. Conclusions Microfracture with debridement are the two most frequently used operations in lesions up to 3 cm2 . There remains disagreement when indicating cartilage repair when age, mechanical axis deviation or treatment of lesions over 3 cm2 are concerned. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-010-1047-xAuthors Gian M. Salzmann, University Medical Centre, Albert-Ludwigs University Freiburg Department of Orthopaedic and Trauma Surgery Freiburg GermanyP. Niemeyer, University Medical Centre, Albert-Ludwigs University Freiburg Department of Orthopaedic and Trauma Surgery Freiburg GermanyM. Steinwachs, Schulthess Clinic Orthobiologics Zurich SwitzerlandP. C. Kreuz, Technische Universitaet Muenchen Department of Orthopedics, Klinikum Rechts Der Isar Munich GermanyN. P. Südkamp, University Medical Centre, Albert-Ludwigs University Freiburg Department of Orthopaedic and Trauma Surgery Freiburg GermanyH. O. Mayr, OCM Munich Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle

Abstract Background Isolated lateral malleolar fractures usually result from a supination-external rotation (SER) injury and may include a deltoid ligament rupture. The necessity of operative treatment is based on the recognition of a relevant medial soft-tissue disruption. Currently used tests to assess ankle stability include manual stress radiographs and gravity stress radiographs, but seem to overestimate the need for fracture fixation. Methods We investigated the use of weightbearing radiographs to distinguish stable and unstable isolated lateral malleolar fractures induced by the SER mechanism in 57 patients. Patients with stable fractures (SER type II according to the Lauge-Hansen classification) were treated non-operatively with varying external support. Forty-seven patients were evaluated by questionnaire and AOFAS ankle-hindfoot score. Follow-up was 18–120 months (mean 62). Results Fifty-one of fifty-seven (90%) patients were found to have stable fractures (SER type II) and were treated non-operatively. The AOFAS score was 96.1 points on average (range 85–100) at latest follow-up. Four patients reported minor complaints. A “moderate” correlation of risk factors (i.e. smoking) to delayed bone healing was found while the correlation of varying external support (i.e. bandage, cast) to the AOFAS score and delayed bone healing was “poor”. Conclusion The use of weightbearing radiographs is an easy, pain-free, safe and reliable method to exclude the need for operative treatment, with excellent clinical outcome in the majority of the patients seen at latest follow-up. The delay of 3–10 days until the decision about surgical treatment is well accepted by the patients. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-010-1051-1Authors Martin Weber, University of Bern, Inselspital Department of Orthopaedic Surgery 3010 Bern SwitzerlandHelge Burmeister, Kantonsspital Department of Orthopaedic Surgery Schwyz SwitzerlandGerhard Flueckiger, Zieglerspital Department of Orthopaedic Surgery Berne SwitzerlandFabian G. Krause, University of Bern, Inselspital Department of Orthopaedic Surgery 3010 Bern Switzerland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Presence of subchondral bone marrow edema at the time of treatment represents a negative prognostic factor for early outcome after autologous chondrocyte implantation

Abstract Introduction Since introduction of autologous chondrocyte implantation (ACI), various factors have been described that influence the clinical outcome. The present paper investigates the influence of bone marrow edema at time of treatment on clinical function before and in the early clinical course after ACI. Methods 67 patients treated with ACI for cartilage defects of the knee joint were included. Presence of subchondral bone marrow edema was graded as absent (1), mild (2), moderate (3) or severe (4) using magnetic resonance (MR) imaging before surgery. All patients were assessed in terms of clinical function before surgery and 6 as well as 12 months after ACI using IKDC and Lysholm scores. Presence of subchondral edema was correlated with functional outcome. Results In 18 patients edema on initial MRI was graded as “absent”, while 17 patients had grade 2 edema, 19 patients had grade 3 edema and 13 patients had grade 4 edema. IKDC score increased significantly from 49.8 points (SD ± 14.9) to 72.3 points (SD ± 17.5) at 12 months (p < 0.01). At all time points investigated, patients of group “4” showed inferior results to all other groups (p < 0.05). In addition, in patients without any edema, better clinical function was detected compared to all other groups before surgery (p < 0.05) and compared to group 3 at 6 months following ACI (p < 0.05). Conclusions Presence of severe subchondral bone marrow edema seems to correlate with knee function in patients with cartilage defects and may be a reliable prognostic factor for the early clinical course after ACI. Content Type Journal ArticleCategory Arthroscopy and Sports MedicineDOI 10.1007/s00402-010-1049-8Authors Philipp Niemeyer, Freiburg University Hospital Department of Orthopedic Surgery and Traumatology Hugstetter Str. 55 79095 Freiburg GermanyGian Salzmann, Freiburg University Hospital Department of Orthopedic Surgery and Traumatology Hugstetter Str. 55 79095 Freiburg GermanyMatthias Steinwachs, Schulthess Clinic Department of Cartilage Regeneration and Orthobiologics Zurich SwitzerlandNorbert P. Südkamp, Freiburg University Hospital Department of Orthopedic Surgery and Traumatology Hugstetter Str. 55 79095 Freiburg GermanyHagen Schmal, Freiburg University Hospital Department of Orthopedic Surgery and Traumatology Hugstetter Str. 55 79095 Freiburg GermanyPhilipp Lenz, Freiburg University Hospital Department of Orthopedic Surgery and Traumatology Hugstetter Str. 55 79095 Freiburg GermanyWolfgang Köstler, Freiburg University Hospital Department of Orthopedic Surgery and Traumatology Hugstetter Str. 55 79095 Freiburg Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Navigated scaphoid screw placement using customized scaphoid splint: an anatomical study

Abstract Introduction Accuracy in navigated surgery depends on placement and registration of stable reference markers close to the anatomic region of interest. Navigation in small and complex anatomic regions, such as the scaphoid, is challenging due to difficulties in placing a stable reference marker. In the current paper, we describe the use of a customized wrist-positioning device “Scaph-splint” with a built-in reference marker that facilitates navigated scaphoid screw insertion in combination with a 3D imaging device. Materials and methods Initial cadaveric feasibility study Five fresh-frozen cadaveric upper extremity specimens were utilized. Each specimen was secured onto the “Scaph-splint” with the wrist in about 90° of extension. Using a 3D fluoroscope, a series of images were taken of the carpal bones and reconstructed in axial, sagittal, and coronal planes. Navigated planning and guidance of scaphoid drilling and screw placement was performed. Next, a repeat 3D scan was taken to analyze the drill canal. The accuracy of navigated scaphoid drilling, drilling trials, and any penetration of the scaphoid outside of the planned drill trajectory were evaluated. A grading scheme was used to assess the drilling accuracy: Grade 1 <1 mm deviation, Grade 2 <2 mm deviation, Grade 3 <3 mm. Results Scaphoid drilling was confirmed to be completely accurate (Grade 1) in two specimens, highly accurate (Grade 2) in two specimens, and accurate (Grade 3) in one specimen. No specimen required a repeat drilling of the scaphoid. In one specimen, the proximal scaphoid pole was perforated by the drill. No registration failures or loosening of the reference marker occurred. Conclusion The use of the “Scaph-splint” enabled stabilization of the hand and wrist, thus adequately fixing the reference marker in relation to scaphoid for optimal navigation and screw placement without the need to directly penetrate the scaphoid with a reference marker. The use of 3D fluoroscopy further increased the accuracy and precision of scaphoid screw placement. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-010-1044-0Authors Musa Citak, 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 USADaniel Kendoff, Hospital for Special Surgery Department of Orthopaedic Surgery 535 East 70th Street New York NY 10021 USAEduardo M. Suero, Hannover Medical School Trauma Department Hannover GermanyRalph Gaulke, Hannover Medical School Trauma Department Hannover GermanyLucien C. Olivier, St. Josefs-Hospital Cloppenburg Department of Traumatology, Hand and Reconstructive Surgery Cloppenburg GermanyChristian Krettek, Hannover Medical School Trauma Department Hannover GermanyTobias Hüfner, Hannover Medical School Trauma Department Hannover Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Preoperative planning of total hip replacement using the TraumaCad™ system

Abstract Introduction Templating is now the standard approach for preoperative planning of total joint replacement and fracture fixation. The aim of this study was to assess the accuracy of new software, TraumaCad™, for preoperative planning for total hip replacement. Methods This software enables the import and export of all picture archiving communication system (PACS) files from local working stations. It can integrate with all PACS systems. We retrospectively reviewed TraumaCad™-generated templates of digitalized preoperative radiographs of 73 consecutive patients. Results The acetabular component, measured within ±1 size, was accurate in 65 patients (89%), and the femoral stem design component was accurate in 70 patients (97%). The accuracy of the femoral size was predicted in 57 patients within 1 size (87%) and in 65 patients within 2 sizes (96%) out of 68 patients in the Corail femoral component group. TraumaCad™ successfully predicts the sizes of femoral and acetabular component and easily integrates with all PACS files. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-010-1046-yAuthors Ely Liviu Steinberg, Tel-Aviv University Department of Orthopedic Surgery “B”, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine 6 Weizmann St. Tel-Aviv 64239 IsraelNadav Shasha, Tel-Aviv University Department of Orthopedic Surgery “B”, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine 6 Weizmann St. Tel-Aviv 64239 IsraelAharon Menahem, Tel-Aviv University Department of Orthopedic Surgery “B”, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine 6 Weizmann St. Tel-Aviv 64239 IsraelShmuel Dekel, Tel-Aviv University Department of Orthopedic Surgery “B”, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine 6 Weizmann St. Tel-Aviv 64239 Israel Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Minimally invasive primary THA: anterolateral intermuscular approach versus lateral transmuscular approach

Abstract Introduction Currently, several potential advantages lead to minimally invasive total hip arthroplasty which become popular with orthopaedic community. However, there is little comparative study on minimally invasive techniques especially through anterior approach. This investigation aimed to evaluate the efficacy of minimally invasive modified Watson–Jones approach and to compare short-term clinical results with minimally invasive modified Hardinge approach. Methods A consecutive series of 92 patients managed with minimally invasive total hip arthroplasty (47 with use of a modified Watson–Jones approach and 45 with use of a modified Hardinge approach) by one surgeon at one hospital were studied. All patients received the same design of cementless acetabular cup and femoral component. Data analysis included patient demographics, pre-operative diagnosis, surgical duration, intra-operative blood loss, type of anesthesia and length of hospital stay. Radiographic analysis included cup inclination angle, femoral stem alignment and leg length discrepancy. Results No significant differences were noticed with regard to the average surgical time, intra-operative blood loss and length of hospital stay in both groups. The average femoral component alignment and the average post-operative abduction angle of the acetabular cup were in acceptable ranges in both groups. However, the prevalence of femoral stem varus outlier was significantly high in minimally invasive modified Watson–Jones approach group. Conclusions The higher prevalence of varus stem outlier in minimally invasive modified Watson–Jones approach must be considered to minimize femoral stem malalignment. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1035-1Authors Thomas L. Bernasek, Florida Orthopaedic Institute 13020 Telecom Parkway North Tampa FL 33637 USAWoo-Suk Lee, Konyang University Hospital Department of Orthopedic Surgery 685 Gasuwon-dong, Seo-gu Daejeon KoreaHan-Jun Lee, Chung-Ang University Department of Orthopaedics, College of Medicine Seoul 156-755 South KoreaJae-Sung Lee, Chung-Ang University Department of Orthopaedics, College of Medicine Seoul 156-755 South KoreaKi-Hwan Kim, KonKuk University Department of Orthopaedic Surgery, Chungju Hospital Chungju KoreaJae-Jun Yang, Chung-Ang University Department of Orthopaedics, College of Medicine Seoul 156-755 South Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Comparison between bovine bone and titanium interference screws for implant fixation in ACL reconstruction: a biomechanical study

Abstract Introduction The application of interference screws for the fixation of bone-patellar tendon-bone (BPTB) grafts is a well-established technique in anterior-cruciate ligament reconstruction. Interference screws derived from bovine compact bone are a biological alternative to metallic or biodegradable polymer interference screws. Materials and methods In 60 porcine specimens, the tibial part of an anterior-cruciate ligament reconstruction was performed using a BPTB graft. To secure the graft, either an 8-mm titanium interference screw or a self-made bovine interference screw (BC), or a commercial bovine compact bone screw (Tutofix®) was used. The maximum failure load was determined by means of a universal testing machine with computer interface at a testing speed of 50 mm/min. In a second test series, cyclic sub-maximal load was applied to the test specimen from 40 to 400 N with a number of 1,000 load cycles and a frequency of 1 Hz. Subsequently, the maximum failure load was determined. The stiffness of the test specimen was investigated in both test series. Each type of interference screw was tested 10 times. Results A secure fixation of the grafts was achieved with all interference screws. In the experiments on the maximum load to failures, the titanium screws showed significantly higher failure loads than the Tutofix® screws (P = 0.005). The stiffness of the grafts fixed with BC screws was significantly higher as compared to the fixation with Tutofix® screws (P = 0.005). After cyclic sub-maximal loading, the maximum failure load of the titanium screws was significantly higher than that of the Tutofix® screws (P = 0.033). The fixation of the BC screws showed a significantly higher failure load (P = 0.021) and stiffness (P = 0.032) than the Tutofix® screw fixation. Except for two screw head fractures and two intra-tendinous graft ruptures, the failure mode was slippage in the interface between interference screw and bone plug. Conclusion Interference screws derived from bovine compact bone show similar good results as the titanium interference screws. Therefore, the safety and in vivo performance of products derived from xenogenic bone should be the focus of further investigations. Content Type Journal ArticleCategory Arthroscopy and Sports MedicineDOI 10.1007/s00402-010-1052-0Authors Turgay Efe, University Hospital Marburg Department of Orthopaedics and Rheumatology Baldingerstraße 35043 Marburg GermanyJoscha Bauer, University Hospital Marburg Department of Orthopaedics and Rheumatology Baldingerstraße 35043 Marburg GermanySilke Herdrich, Department of Orthopaedics Gotenstraße 1-6 65929 Frankfurt/Main GermanyLeo Gotzen, Esculapclinic Nordanlage 19 35390 Giessen GermanyBilal Farouk El-Zayat, University Hospital Marburg Department of Orthopaedics and Rheumatology Baldingerstraße 35043 Marburg GermanyJan Schmitt, University Hospital Marburg Department of Orthopaedics and Rheumatology Baldingerstraße 35043 Marburg GermanyMarkus Dietmar Schofer, University Hospital Marburg Department of Orthopaedics and Rheumatology Baldingerstraße 35043 Marburg Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Evaluation of the ankle function following reconstruction of the donor defect with a split fibular bone after a vascularized fibular flap transfer

Abstract Introduction To validate the hypothesis that the reconstruction of the missing segment of the fibula using a redundant split fibular graft after a vascularized fibular flap transfer may have a better effect on ankle function. Materials and methods Of the 24 head and neck cancer patients who received a free fibula flap for mandible reconstruction, 14 patients underwent the conventional method of donor site closure, in which the redundant fibular bone was discarded (Group I). Ten patients underwent longitudinal osteotomy of the redundant non-vascularized fibular portion to bridge the donor site defect (Group II). Postoperative subjective satisfaction level was evaluated with a self-constructed questionnaire in 10 parameters (ambulation with assistance, ankle instability, ankle stiffness, muscle weakness, leg edema, foot numbness, ankle pain, other sites of pain besides the ankle, and restriction to run) and the 4 voluntary motions (dorsiflexion, plantar flexion, eversion, and inversion) of both ankles were measured using a CYBEX II dynamometer. Results The muscle peak torque of the donor leg was significantly lower at ankle plantar flexion (P = 0.002), eversion (P = 0.002), and inversion (P = 0.0002) in Group I as well as at dorsiflexion (P = 0.031), plantar flexion (P = 0.016), and inversion (P = 0.002) in Group II against the contralateral non-operated leg. The muscle power was significantly greater when performing ankle eversion (P = 0.049) in those who underwent split fibular bone reconstruction. There was no difference in the subjective satisfaction score between these two groups. Conclusion The reconstruction of the donor site with a split fibular bone graft led only a slight improvement in ankle eversion. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-009-1042-2Authors Ching-Hua Hsieh, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine Department of Plastic and Reconstructive Surgery Kaohsiung TaiwanShun-Man Cheung, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine Department of Physical Medicine and Rehabilitation Kaohsiung TaiwanCheuk-Kwan Sun, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine Department of General Surgery Kaohsiung TaiwanYu-Chi Huang, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine Department of Physical Medicine and Rehabilitation Kaohsiung TaiwanGuang-Shyh Lan, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine Department of Physical Medicine and Rehabilitation Kaohsiung TaiwanHsueh-Wen Chang, National Sun-Yat-Sen University Department of Biological Sciences Kaohsiung TaiwanSeng-Feng Jeng, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine Department of Plastic and Reconstructive Surgery Kaohsiung Taiwan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation

Abstract Background There were no studies in literature to compare the clinical outcomes of percutaneous nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation. Methods A retrospective of patients with symptomatic contained cervical disc herniated were operated on with PCN and PCD from June 2003 to July 2005. Two-hundred and four patients initially fulfilled the study criteria, and 28 patients were lost in follow-up. The patients were categorized into different groups depending on the procedure by PCN (81 cases) or PCD (95 cases). Results The clinical outcomes, pain reduction, and segment stability were recorded during this study. Puncture of the needle into the disc space was accurately performed under C-arm fluoroscopy guidance in all cases and no intraoperative deaths were reported in our study. At the end, 176 cases had follow-up and 28 cases were lost, and the follow-up rate was 88.0% (81/92) in the PCN group and 84.8% (95/112) in the PCD group. The follow-up time ranged from 16 to 48 months (average 29 months), and on an average of 28.86 ± 4.52 months on PCN and 8.42 ± 3.21 months on PCD (t = −0.24, P = 0.81, >0.05). The operation time averages of PCN and PCD are 4.67 ± 1.16 and 11.95 ± 1.80, respectively (P < 0.01). The pain index improved from 7.12 ± 1.13 to 2.74 ± 0.89 (t = 27.03, P = 0.0000, <0.001) in PCN patients and from 7.18 ± 1.09 to 2.71 ± 0.91 (t = 29.57, P = 0.0000, <0.001) in PCD patients. Clinical results of PCN were excellent in 31 cases, good 32 cases, fair 13 cases, and poor 5 cases; for PCD, the results were 33, 42, 12, and 7 cases, respectively, and 1 in discitis. Good and excellent was 78.4% (77.8% in PCN and 79.5% in PCD, P > 0.05). There was one case of PCN that had the partial Perc-D SpineWand broken in the disc space, cannot be moved by the percutaneous cervical discectomy, and remained there itself. One of the cases had discitis in this study after PCD. Patient presented with neck pain and associated radicular pain and numbness in the left upper-limb after 8 days of PCD. There were no instable cases after procedures of PCN and PCD. There were no significant difference in stability of preoperatively and postoperatively between PCN and PCD (P > 0.05). Conclusions PCN and PCD treatments of contained cervical disc herniation show good outcomes and there was no difference in the stability of cervical spine. PCN and PCD are safe, minimally invasive, and no differences were observed between the methods in clinical outcome. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1041-3Authors Denglu Yan, Third Hospital of Guangzhou Medical College Orthopedic Department 63 Duobao Road Guangzhou 510150 People’s Republic of ChinaJian Li, Third Hospital of Guangzhou Medical College Orthopedic Department 63 Duobao Road Guangzhou 510150 People’s Republic of ChinaHaodong Zhu, Third Hospital of Guangzhou Medical College Orthopedic Department 63 Duobao Road Guangzhou 510150 People’s Republic of ChinaZhi Zhang, Third Hospital of Guangzhou Medical College Orthopedic Department 63 Duobao Road Guangzhou 510150 People’s Republic of ChinaLijun Duan, Sichuan University Second University of West China Hospital Chengdu People’s Republic of China Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Arthrodesis of the subtalar and talonavicular joints through a medial surgical approach: a series of 15 cases

Abstract Introduction We report a series of 15 double-hindfoot (subtalar and talonavicular joint) arthrodeses through a single medial approach on 14 patients. Mean age at surgery was 59.3 years. The chosen surgical technique was always identical using a medial approach and performed by a single surgeon. The average follow-up was 20.6 months. Method The mean Kitaoka score increased from 44 to 75, axis of the hindfoot decreased from 21° to 11° in valgus, arch foot angle decreased from 142° to 134.4°. Two failures have led to a secondary complementary arthrodesis of the talocrural joint. Results Throughout our study, subtalar and talonavicular arthrodesis in the treatment of painful valgus deformities of the hindfoot reveals to be a valuable and safe alternative. The chosen fixation method combined with a good articular surface avivement through medial approach guarantee a long-term fusion. Moreover, resort to a medial approach significantly reduces wound complications. Conclusion This medial approach procedure permits the fusion without developing non-union and provides a significant correction of the fixed deformities. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1029-zAuthors Rémi Philippot, Centre Hospitalier et universitaire de Saint Etienne Laboratoire de Physiologie de l’Exercice, EA 4338 Saint Etienne Cedex 2 FranceJulien Wegrzyn, Centre Hospitalier Edouard Herriot Service de chirurgie orthopédique 5 pl Arsonval 69437 Lyon Cedex 03 FranceJean Luc Besse, Centre Hospitalier Lyon Sud chemin Grand Revoyet Service de chirurgie orthopédique 69310 Pierre Bénite France Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Soft stabilization with interspinous artificial ligament for mildly unstable lumbar spinal stenosis: a multicenter comparison

Abstract Introduction In an attempt to fill a gap between simple decompression alone and fusion in the spectrum of surgical treatment for degenerative lumbar spinal stenosis (DLSS), the authors sought to demonstrate the efficacy and reproducibility of soft stabilization with interspinous artificial ligament after microsurgical fenestration to prevent post-decompression segmental instability for mildly unstable DLSS. Materials and methods Clinical outcomes from 556 patients treated with soft stabilization with artificial ligament following microdecompression for mildly unstable DLSS from March 1998 to June 2006 were retrospectively obtained from three institutions in three countries. Outcomes were measured at a mean of 48.9 months after surgery using MacNab criteria. Peri- and postoperative complications and revision surgery cases were also analyzed. Results Follow-up was achieved in 391 (70.3%) of the 556 patients. Clinical outcomes were excellent in 43.7%, good in 36.7%, fair in 12.2%, and poor in 7.4% of the patients. The overall clinical success rate was 80.4%. No major complications except postoperative hematoma and wound infection (6/391 cases, 1.5%) were observed, and few revision surgeries (2.3%) were done during follow-up. Conclusion We found favorable and reproducible results with soft stabilization with artificial ligament after microdecompression for mildly unstable DLSS from three institutions in three countries. Soft stabilization with artificial ligament may be concluded to represent an effective prevention of increased post-decompression instability with reliable reproducibility for mildly unstable DLSS in carefully selected patients. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1031-5Authors Sang-Ho Lee, Wooridul Spine Hospital Department of Neurosurgery Seoul KoreaManuel Enes, Centro De Cirurgia Discal Doutor Manuel Enes Porto PortugalThomas Hoogland, Dr. T. Hoogland Spine Center Department of Spine Surgery Munich Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Treatment of fractures of the fifth metatarsal with the XS-nail retrospective study and comparison with tension-band wiring

Abstract Introduction Many different surgical methods and implants for the treatment of fifth metatarsal fractures have been established yet. A high rate of complications, such as nonunion, fragment dislocation, refracture, implant deformation and irritation are widely occurring due to the insufficient ability of the implants to compensate the tension applied to the proximal fragment through the peroneal tendon combined with an impaired blood supply at the fracture zone. Therefore, the search for improved surgical solutions is thoroughly understandable. Thus, we have introduced the XS-nail as an intramedullary nail system that bears the ability to provide a compression to the fracture zone through a grub screw. In this work, we have analyzed the position of the XS-nail in relationship to other methods with special regard to the tension-band wiring. Method In a retrospective analysis, we examined 77 cases, where a proximal fifth metatarsal fracture has been treated with the XS-nail. As a comparison group, we collected data from 47 patients who had been treated with tension-band wiring for the same indication in our hospital. Altogether, we included 124 patients, representing the largest study population of surgically treated cases of proximal fifth metatarsal fractures as compared to the actual literature. Results When compared with the tension-band wiring group, we found in mean a shorter duration of the surgery, a lower necessity of an open reduction (18 vs. 100%), fewer postsurgical weight-bearing restrictions (54 vs. 100%) and a shorter duration of rehabilitation (48 vs. 71 days). Especially, the fracture compression was distinctively higher in the XS-nail group (postsurgical lateral dislocation was 0–59%). The advantages of the tension-band wiring were found in the fixation of small fragments and an easier implant removal. Generally, nonunion and refracture were not seen in both methods. When compared with the results from literature, we found positive results regarding the hospitalization duration, the weight-bearing ability, the rehabilitation course and the patients’ satisfaction. Conclusion Thus, the XS-nail proved to be an effective and technical optimized implant for the treatment of proximal fifth metatarsal fractures that provides a rapid full-weight-bearing mobilization and shows good long-term results. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-1025-3Authors Christian Renner, Klinikum Aschaffenburg Department of Trauma Surgery and Orthopedics Am Hasenkopf 1 63739 Aschaffenburg GermanyJ. Whyte, Klinikum Aschaffenburg Department of Trauma Surgery and Orthopedics Am Hasenkopf 1 63739 Aschaffenburg GermanyS. Singh, Klinikum Aschaffenburg Department of Trauma Surgery and Orthopedics Am Hasenkopf 1 63739 Aschaffenburg GermanyW. Friedl, Klinikum Aschaffenburg Department of Trauma Surgery and Orthopedics Am Hasenkopf 1 63739 Aschaffenburg Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Initial load-to-failure and failure analysis in single- and double-row repair techniques for rotator cuff repair

Abstract Aim This experimental study aimed to compare the load-to-failure rate and stiffness of single- versus double-row suture techniques for repairing rotator cuff lesions using two different suture materials. Additionally, the mode of failure of each repair was evaluated. Method In 32 sheep shoulders, a standardized tear of the infraspinatus tendon was created. Then, n = 8 specimen were randomized to four repair methods: (1) Double-row Anchor Ethibond® coupled with polyester sutures, USP No. 2; (2) Double-Row Anchor HiFi® with polyblend polyethylene sutures, USP No. 2; (3) Single-Row Anchor Ethibond® coupled with braided polyester sutures, USP No. 2; and (4) Single-Row Anchor HiFi® with braided polyblend polyethylene sutures, USP No. 2. Arthroscopic Mason–Allen stitches were placed (single-row) and combined with medial horizontal mattress stitches (double-row). All specimens were loaded to failure at a constant displacement rate on a material testing machine. Results Group 4 showed lowest load-to-failure result with 155.7 ± 31.1 N compared to group 1 (293.4 ± 16.1 N) and group 2 (397.7 ± 7.4 N) (P < 0.001). Stiffness was highest in group 2 (162 ± 7.3 N/mm) and lowest in group 4 (84.4 ± 19.9 mm) (P < 0.001). In group 4, the main cause of failure was due to the suture cutting through the tendon (n = 6), a failure case observed in only n = 1 specimen in group 2 (P < 0.001). Conclusions A double-row technique combined with arthroscopic Mason-Allen/horizontal mattress stitches provides high initial failure strength and may minimize the risk of the polyethylene sutures cutting through the tendon in rotator cuff repair when a single load force is used. Content Type Journal ArticleCategory Basic ScienceDOI 10.1007/s00402-009-1036-0Authors M. H. Baums, University of Göttingen Medical Centre (UMG), Georg-August-University Department of Orthopaedic Surgery Robert-Koch-Street 40 37075 Göttingen GermanyG. H. Buchhorn, University of Göttingen Medical Centre (UMG), Georg-August-University Department of Orthopaedic Surgery Robert-Koch-Street 40 37075 Göttingen GermanyF. Gilbert, University of Göttingen Medical Centre (UMG), Georg-August-University Department of Orthopaedic Surgery Robert-Koch-Street 40 37075 Göttingen GermanyG. Spahn, Clinic of Orthopaedic Surgery and Traumatology Eisenach Eisenach GermanyW. Schultz, University of Göttingen Medical Centre (UMG), Georg-August-University Department of Orthopaedic Surgery Robert-Koch-Street 40 37075 Göttingen GermanyH.-M. Klinger, University of Göttingen Medical Centre (UMG), Georg-August-University Department of Orthopaedic Surgery Robert-Koch-Street 40 37075 Göttingen Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Bone remodeling in proximal HA-coated versus uncoated cementless SL-Plus® femoral components: a 5-year follow-up study

Abstract Background and purpose Bone resorption at the femoral stem due to stress shielding has been particularly observed secondary to cementless hip replacement. This prospective study of 126 total-hip replacements was performed to examine clinical outcomes and changes in peri-prosthetic bone density after implantation of a double-tapered cementless femoral component manufactured with versus without hydroxyapatite (HA) coating. Methods Sixty-seven femoral components with and 59 femoral components without proximal HA coating were implanted and examined after a mean follow-up of 5.8 (SD 1.1, 2.8–7.8) years. The Harris hip score (HHS) and plain radiographs were used for clinical and radiological follow-up evaluations. Possible changes in peri-prosthetic bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry (DEXA). Results Clinical outcome, measured by HHS, was similar in both groups. On plain radiographs, significantly less radiolucent lines were observed for the coated implants. DEXA revealed a significant increase in BMD at the proximal zones, along the medial side, and at the stem tips in the coated compared with the non-coated implants. Interpretation Hydroxyapatite-coated implants yield favorable radiographic characteristics, but no greater clinical benefit after 5 years’ implantation. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-009-1040-4Authors W. Steens, Paracelsus Klinik Lipper Weg 11 45770 Marl GermanyA. G. Schneeberger, Shoulder and Elbow Surgery Seefeldstr. 27 8008 Zurich SwitzerlandR. Skripitz, University of Rostock Department of Orthopaedics Rostock GermanyP. Fennema, Smith and Nephew Orthopaedics AG 6343 Rotkreuz SwitzerlandC. Goetze, Auguste-Viktoria-Klinik 32545 Bad Oeynhausen Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Fixation of Akin osteotomy for hallux abductus with absorbable suture

Abstract Background The Akin osteotomy is a widely used procedure where various fixation methods are available, predominantly with the use of metallic component (wire, screw, staple etc.). The aim of this study is to demonstrate the results of our modified Akin procedures, where the fixation of the phalangeal osteotomy is achieved by absorbable suture, without metallic component. Materials and methods Between July 2004 and October 2008, authors performed their first 22 consecutive Akin procedures with the above technique. Mean age of patients was 49 [standard deviiation (SD) 17, range 19–69] years. Mean follow-up time was 26 (SD 13, range 8–57) months. Results Mean correction of the distal articular set angle (DASA) was 9.4 (SD 7.1, range 5–28) degrees. Mean shortening of the proximal phalanx was 1.8 (SD 1.0, range 0.3–4.1) mm. Among the 22 osteotomies, there was no evidence of non-union, delayed union, excessive bone callus, or loss of correction. 100% of the patients would undergo the procedure again, 91% (20/22) were completely satisfied; and 9% (2/22) were satisfied, including the one complication case. Conclusion The method presented in this study for fixation of the akin osteotomy showed results identical to the ones using conventional (metal) fixation techniques concerning radiological (correction of DASA, shortening of the proximal phalanx), and clinical (complication rate, subjective satisfaction rate) findings, without the risk of complication due to hardware irritation. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1024-4Authors Kálmán Tóth, University of Szeged Department of Orthopaedics 6. Semmelweis str 6725 Szeged HungaryPéter Kellermann, University of Szeged Department of Orthopaedics 6. Semmelweis str 6725 Szeged HungaryKároly Wellinger, University of Szeged Department of Orthopaedics 6. Semmelweis str 6725 Szeged Hungary Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Intraoperative three-dimensional fluoroscopy assessment of iliosacral screws and lumbopelvic implants stabilizing fractures of the os sacrum

Abstract Introduction Percutaneous iliosacral screw fixation of unstable sacrum fractures has gained popularity since its introduction in the 1990s. The combination with lumbopelvic implants allows the application even in situations of higher instability. Both manual and navigated screw insertion in the sacrum and vertebra bodies shows unchanged relevant malpositions. The current standard to control the screw position is postoperative computed tomography. The study presents the results of assessment of these implants by intraoperative three-dimensional fluoroscopy. Methods From January 2008 through March 2009, 14 patients had stabilization of the dorsal pelvic ring with iliosacral screws alone or in combination with lumbopelvic implants. Intraoperative 3D fluoroscopy was performed to evaluate the position of the implants stabilizing the posterior pelvic ring. Results Fourteen iliosacral screws and eight pedicle screws were depicted. In all patients, we were able to adequately evaluate the placement of iliosacral screws, lumbar pedicle screws and iliacal screws. As a consequence of intraoperative 3D scan a lumbar pedicle screw was corrected. The entire scanning procedure required 5 min. The time for analyzing the 3D scan took 3 min. Conclusions Intraoperative 3D fluoroscopy is a valuable tool for intraoperative assessment of iliosacral screws and lumbopelvic implants. The technique should help us to detect intraoperative malplacement of the screws more reliably than conventional fluoroscopy and allows an immediate correction of malplaced implants. Therefore, a postoperative computed tomography to control the position of implants is dispensable. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1039-xAuthors Markus Beck, University of Rostock Department of Trauma and Reconstructive Surgery Schillingallee 35 18057 Rostock GermanyMarkus Kröber, Department of Orthopedic Surgery Kantonspital St. Gallen 9700 St. Gallen SwitzerlandThomas Mittlmeier, University of Rostock Department of Trauma and Reconstructive Surgery Schillingallee 35 18057 Rostock Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Medical problems in hip fracture patients

Abstract Increasing number of older patients are admitted to hospital with hip fractures. This review evaluates the common medical problems that arise as a consequence of having a hip fracture. Older patients with fractures commonly have co-morbidities that require evaluation prior to and after surgery. Joint acute orthopaedic–geriatric units have been established to provide comprehensive orthopaedic and medical care with some studies showing a reduction in postoperative complications and mortality. Recommendations surrounding the care of the older orthopaedic patient include early surgical fixation, the use of prophylactic antibiotics and thromboembolic prophylaxis, good perioperative pain control to improve ambulation, delirium detection and management to decrease the risk complications, such as institutionalisation, the avoidance of malnutrition, urinary tract management, osteoporosis management and the promotion of early mobilisation to improve functional recovery. Physicians are well placed to manage these patients with orthopaedic surgeons during the perioperative period. Sufficient evidence exists for most recommendations for fracture patients, but further research is needed in most areas. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1038-yAuthors Carol Pei Wei Chong, The University of Melbourne Department of Medicine, Austin and Northern Health Melbourne VIC AustraliaJudith A. Savige, The University of Melbourne Department of Medicine, Austin and Northern Health Melbourne VIC AustraliaWen Kwang Lim, The University of Melbourne Department of Medicine, Austin and Northern Health Melbourne VIC Australia Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Two-dimensional fluoroscopic navigation in posterior cruciate ligament reconstruction: a preclinical cadaver study

Abstract Objectives To assess the feasibility and accuracy of frameless stereotactic two-dimensional fluoroscopy-assisted guide pin (GP) placement in posterior cruciate ligament (PCL) reconstruction in human cadavers. Materials and methods A total of 13 pins were placed in 7 cadaver specimens, using a fluoroscopic-based navigation technique. The knees were fixed noninvasively on a carbon baseplate. Interventions were planned on intraoperatively acquired perpendicular fluoroscopic images. A stereotactic aiming device was mounted to the carbon baseplate and adjusted according to the planned trajectories. GPs were advanced through the aiming device to the precalculated depth. GP positions were verified by image fusion of the fluoroscopic planning and control data, respectively. Measurements were scored on three occasions by one independent observer. In order to assess interobserver reliability, measurements were scored by two further independent observers on one occasion. Results The femoral cohort included seven GP placements in seven cadavers. Mean GP placement accuracy according to plan was 1.3 mm (SD 0.9 mm, range 0.3–3.8 mm) at the target point. The recorded femoral angular misalignment of GPs was 1.1° (SD 0.9°, range 0.2°–3.3°). The tibial cohort included six GP placements in six cadavers. Mean GP placement accuracy according to the plan was 1.8 mm (SD 2.1 mm, range 0.3–9.5 mm). The recorded tibial angular misalignment of GPs was 1.4° (SD 1.1°, range 0.1°–5°). Navigated GP implantation, as planned, was optimal in six out of seven cases in the femoral cohort and in four out of six cases in the tibial cohort. Conclusion Our preliminary cadaver study suggests that the use of fluoroscopic-based navigation combined with a stereotactic targeting device may be a helpful tool to improve PCL reconstruction. In addition, this method may also be used for other minimal invasive skeletal interventions. Content Type Journal ArticleCategory Arthroscopy and Sports MedicineDOI 10.1007/s00402-009-1037-zAuthors Ralf E. Rosenberger, Medical University Innsbruck Department of Trauma Surgery and Sports Medicine Innsbruck AustriaReto J. Bale, Medical University Innsbruck Department of Radiology Innsbruck AustriaCornelia Kneisl, Medical University Innsbruck Department of Trauma Surgery and Sports Medicine Innsbruck AustriaDietmar Krappinger, Medical University Innsbruck Department of Trauma Surgery and Sports Medicine Innsbruck AustriaMartin Knoflach, Medical University Innsbruck Department of Radiology Innsbruck AustriaRene Attal, Medical University Innsbruck Department of Trauma Surgery and Sports Medicine Innsbruck Austria Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Adductor tenotomy: its role in the management of sports-related chronic groin pain

Abstract Patients and methods Chronic adductor-related groin pain in athletes is debilitating and is often challenging to treat. Little is published on the surgical treatment when conservative measures fail. This single center study reviews the outcomes of 48 patients (68 groins) who underwent percutaneous adductor tenotomy for sports-related chronic groin pain. Questionnaire assessments were made preoperatively and at a minimum follow-up of 25 months. Results Mean pre-injury Tegner activity scores of 8.8 reduced to 6.1 post-injury and these improved to 7.7 following surgery (p < 0.001). Sixty percent of patients regained or bettered their pre-injury Tegner activity scores after the adductor surgery; however, mean post-surgical Tegner scores still remained lower than pre-injury scores (p < 0.001). No patient had been able to engage in their chosen sport at their full ability pre-operatively, and 40% had been unable to participate in any sporting activity. The mean return to sports was at 18.5 weeks postoperatively, with 54% returning to their pre-injury activity levels, and only 8% still unable to perform athletic activities at latest follow-up. Seventy-three percent patients rated the outcome of their surgery as excellent or very satisfactory, and only three patients would not have wished to undergo the procedure again if symptoms recurred or developed on the opposite side. No patients reported their outcome as worse. A 78.1% mean improvement in function and an 86.5% mean improvement in pain were reported, and these two measures showed statistically significant correlation (p = 0.01). Groin disability scores improved from a mean of 11.8 to 3.9, post-operatively (p < 0.001). Bruising was seen in 37% of procedures, 3 patients developed a scrotal hematoma and 1 patient had a superficial wound infection. One patient developed recurrent symptoms following re-injury 26 months post-surgery, and fully recovered following a further adductor tenotomy. Conclusions Adductor tenotomy provides good symptomatic and functional improvement in chronic adductor-related groin pain refractory to conservative treatment. Content Type Journal ArticleCategory Arthroscopy and Sports MedicineDOI 10.1007/s00402-009-1032-4Authors Henry Dushan E. Atkinson, North Middlesex University Hospital Department of Trauma and Orthopaedics, University College London Medical School Sterling Way London N18 1QX UKParminder Johal, Sportsmed SA 32 Payneham Road, Stepney Adelaide SA 5069 AustraliaMark S. Falworth, Sportsmed SA 32 Payneham Road, Stepney Adelaide SA 5069 AustraliaVijai S. Ranawat, Sportsmed SA 32 Payneham Road, Stepney Adelaide SA 5069 AustraliaBenan Dala-Ali, North Middlesex University Hospital Department of Trauma and Orthopaedics, University College London Medical School Sterling Way London N18 1QX UKDavid K. Martin, Sportsmed SA 32 Payneham Road, Stepney Adelaide SA 5069 Australia Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

CT-guided needle biopsy for musculoskeletal lesions

Abstract Introduction We determined the diagnostic accuracy rate of 207 cases that underwent CT-guided needle biopsy for musculoskeletal lesions during the past 10 years, and describe the efficacy and indications of this method. Materials and methods We retrospectively analyzed a consecutive series of 207 cases that presented to our oncology group and underwent CT-guided needle biopsy during the 10-year period between April 1998 and March 2008. Diagnostic accuracy was assessed statistically by anatomical location and final diagnosis. The biopsy site was the spine/sacrum in 70 cases, pelvis in 53, extremities in 51, rib/scapula in 20, and retroperitoneum in 13. Bone lesions were detected in 176 cases and soft tissue lesions in 31. The final diagnosis was metastatic tumor in 63 cases, primary bone tumor in 63, primary soft tissue tumor in 23, infection in 18, and hematopoietic malignancy in 16 and non-tumorous lesions in 24. Results The diagnostic accuracy rate for all cases was 90%. No serious complications were seen. No statistically significant difference was found by anatomical site. According to the final diagnosis, benign tumors/malignant tumors (p < 0.005), primary bone tumor (p < 0.01), and infectious conditions (p < 0.001) showed significantly low diagnostic accuracy rates. Discussion CT-guided needle biopsy is a safe method with high diagnostic accuracy for musculoskeletal lesions. However, in patients with a primary bone tumor, it should be indicated for the initial diagnosis. If a comprehensive assessment based on the imaging conflicts with the pathological findings, an open biopsy should be considered. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-009-1030-6Authors Satoshi Tsukushi, Nagoya University Graduate School of Medicine Department of Orthopaedic Surgery 65 Tsurumai-cho, Showa-ku Nagoya 466-8550 JapanYoshihiro Nishida, Nagoya University Graduate School of Medicine Department of Orthopaedic Surgery 65 Tsurumai-cho, Showa-ku Nagoya 466-8550 JapanYoshihisa Yamada, Nagoya Memorial Hospital Department of Orthopaedic Surgery Nagoya JapanMasahiro Yoshida, Aichi Cancer Center Aichi Hospital Department of Orthopaedic Surgery Okazaki JapanNaoki Ishiguro, Nagoya University Graduate School of Medicine Department of Orthopaedic Surgery 65 Tsurumai-cho, Showa-ku Nagoya 466-8550 Japan Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Cross-cultural adaptation and validation of the German version of the Western Ontario shoulder instability index

Abstract Background The Western Ontario shoulder instability index (WOSI) is a disease-specific quality of life measurement tool with 21 items for patients with shoulder instability. Here, we report on translation and validation of the German version of the WOSI according to international guidelines. Patients and methods A total of 86 patients in three groups were included in this study. In group I, 24 patients underwent surgical stabilization of the shoulder. Preoperatively and at 12 months post-operatively the WOSI, Rowe score, UCLA, Constant score, and the SF-36 were evaluated. In group II, 25 patients were evaluated 2.6 ± 1.2 years after sustaining a primary traumatic shoulder dislocation. Group III consisted of 37 healthy men and women with normal, healthy shoulders. Evaluation of Pearson’s correlation coefficient between WOSI and Rowe score, UCLA, SF-36 and Constant score and for test–retest reliability was made. Moreover, Cronbach’s alpha and floor, and ceiling effects were analyzed. Results Internal consistency was high (Cronbach’s alpha 0.92).Test–retest reliability (Pearson correlation coefficient) was excellent (r = 0.92). The construct validity showed a significant correlation between the WOSI and the scores investigated. There were no floor or ceiling effects for the German WOSI score. Conclusion The German translation of the WOSI is a valid and reliable tool, applicable to outcome studies on patients with shoulder instability. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-009-1033-3Authors Jochen G. Hofstaetter, Medical University of Vienna Department of Orthopaedic Surgery, Vienna General Hospital Waehringer Guertel 18-20 1090 Vienna AustriaBeatrice Hanslik-Schnabel, Medical University of Vienna Department of Orthopaedic Surgery, Vienna General Hospital Waehringer Guertel 18-20 1090 Vienna AustriaStefan G. Hofstaetter, Klinikum Wels Department of Orthopaedics Wels AustriaChristian Wurnig, Medical University of Vienna Department of Orthopaedic Surgery, Vienna General Hospital Waehringer Guertel 18-20 1090 Vienna AustriaWolfgang Huber, Medical University of Vienna Department of Orthopaedic Surgery, Vienna General Hospital Waehringer Guertel 18-20 1090 Vienna Austria Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis

Abstract Background Planter fasciitis is a common cause of heel pain in adults. Many treatment options exist. Most of patients resolve with conservative management. Approximately 10% of patients develop persistent and often disabling symptoms. Patients and methods This prospective study includes 37 patients with an established diagnosis of chronic plantar fasciitis, aiming to compare two different techniques of treatment. First group includes 17 patients with a mean age of 42 years treated by endoscopic plantar fasciotomy (EPF); the mean follow-up was 11 months. Second group includes 20 patients with a mean age of 45 years treated by extracorporeal shock Wave Therapy (ESWT); the mean follow-up was 7.6 months. Results In the first group (EPF), using the visual analog scale the average post-operative pain was improved from 9.1 to 1.6. Post-operatively, 58.8% had no limitation of functional activities, 35.3% had minimal limitation of activities and 5.9% had moderate limitation of activities. Concerning patient satisfaction, 82.3% of patients were completely satisfied, 11.8% of patients were satisfied with reservation and 5.9% of patients were unsatisfied. For the second group (ESWT), using the visual analog scale the average post-operative pain was improved from 9 to 2.1. Post-operatively, 50% had no functional limitation of activities, 35% had minimal limitation of activities, 10% had moderate limitation of activities, and 5% had severe limitation of activities. Concerning patient satisfaction, 75% of patients were completely satisfied and 25% were satisfied with reservation or unsatisfied. Conclusion Because of better results with endoscopic release versus the benefits of no complications, no immobilization, and early resumption of full activities with ESWT, we conclude that ESWT is a reasonable earlier line of treatment of chronic plantar fasciitis before EPF. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1034-2Authors Ahmed Mohamed Ahmed Othman, El-Minia University Faculty of Medicine El-Minia EgyptEhab Mohamed Ragab, Al-Azhar University, Assuit Branch Faculty of Medicine Assuit Egypt Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Minimal invasive fixation of proximal humeral fractures with an intramedullary nail: good results in elderly patients

Abstract Objective To report on the results of a minimally invasive technique for the fixation of displaced proximal humeral fractures with a locked intramedullary nail. Patients and methods All consecutive patients treated with a T2™ intramedullary nail between 2004 and 2007 were evaluated. Thirty-three patients were included [mean age 78, m:f ratio (1:4)]. Fracture characteristics were classified according to AO and Neer (eighteen 2-part, eleven 3-part, five 4-part fractures). Results Functional outcome (Constant Score) was excellent in nine, satisfactory in eight and poor in three patients. Subjective outcome was satisfactory to good for patients with 2-part and 3-part fractures but poor for 4-part fractures. Major complications comprised four fixation failures, two cases of impingement and one deep infection. Conclusions Minimally invasive fixation of displaced 2-part and 3-part humeral fractures in an elderly population shows satisfactory to excellent results in 80% of patients. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1027-1Authors Nico Sosef, Medical Center Haaglanden Department of Surgery The Hague The NetherlandsRoderick van Leerdam, Medical Center Haaglanden Department of Surgery The Hague The NetherlandsPieter Ott, Medical Center Haaglanden Department of Radiology The Hague The NetherlandsSven Meylaerts, Medical Center Haaglanden Department of Surgery The Hague The NetherlandsSteven Rhemrev, Medical Center Haaglanden Department of Surgery The Hague The Netherlands Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Giant cell tumor of the femoral head and neck: result of intralesional curettage

Abstract Background There have been not much reports on the result of intralesional excision for giant cell tumors (GCTs) of the femoral head and neck because of its rarity. The purpose of this study is to review the results of patients managed with intralesional curettage for GCT of the femoral head and neck. Methods We retrospectively reviewed 12 patients with a GCT of the femoral head and/or neck. All of them were treated with curettage and followed up to monitor local recurrence and pulmonary metastasis. Mean duration of follow-up was 58.3 months. Results Although recurrence rate of the present study was rather high (41.7%, 5 of 12 hips), 9 of 12 hips (75%) were preserved at last follow-up including 2 hips that underwent repeat curettage, and functional outcomes of the preserved hips were satisfactory. Conclusion It may be that curettage should be considered as a primary treatment of choice for GCTs of the femoral head and neck. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1026-2Authors Hwan Seong Cho, Kyungpook National University College of Medicine, Kyungpook National University Hospital Department of Orthopaedic Surgery Daegu KoreaIl-Hyung Park, Kyungpook National University College of Medicine, Kyungpook National University Hospital Department of Orthopaedic Surgery Daegu KoreaIlkyu Han, Seoul National University Hospital Department of Orthopaedic Surgery, Seoul National University College of Medicine Seoul KoreaSeung Chul Kang, Seoul National University Hospital Department of Orthopaedic Surgery, Seoul National University College of Medicine Seoul KoreaHan-Soo Kim, Seoul National University Hospital Department of Orthopaedic Surgery, Seoul National University College of Medicine Seoul Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Cervical spondylolysis in a judo player: a case report and biomechanical analysis

Cervical spondylolysis in a judo player: a case report and biomechanical analysis Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00402-009-1023-5Authors Nam Chull Paik, Arumdaun Wooldul Spine Hospital Department of Radiology 647-4 Sinjeong 2-dong, Nam-gu Ulsan 680-828 Republic of Korea Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

The Fixion expandable stem hemiarthroplasty for displaced femoral neck fracture: technical features and pilot study

Abstract Background Management of displaced femoral neck fracture in elderly patients is challenging due to the patient’s high risk profile, poor quality bone stock and muscle weakness. Materials and methods Fifty-one patients with displaced (Garden 3–4) intracapsular femoral neck fractures were treated with a newly designed Fixion expandable stem hemiarthroplasty implant and followed thereafter for a minimum of 6 months. Results Thirty patients (58.8%) had concomitant diseases graded 3–4 by the ASA scoring system. Two patients (4.8%) incurred deep wound infections that necessitated hardware removal. One case (2.6%) of dislocation was treated by closed reduction. Forty-two patients (82.4%) survived >6 months and cooperated with the study protocol. Mild groin/thigh pain was reported by 11 patients (26.2%). Twenty-six (61.9%) had lost 1–2 out of 4 grades of mobility. Conclusions Fixion implant may be considered a further step in the evolution of femoral joint hemiarthroplasty. In the short term, it has proven to be as effective as cemented implant and to be user-friendly for the surgeon. It is also anticipated to be feasible whenever revision is required. Content Type Journal ArticleCategory Osteoporotic Fracture ManagementDOI 10.1007/s00402-009-1022-6Authors Yoram Folman, Hillel Jaffe MC Department of Orthopaedics Hadera 38100 IsraelNimrod Ron, Hillel Jaffe MC Department of Orthopaedics Hadera 38100 IsraelShay Shabat, Hillel Jaffe MC Department of Orthopaedics Hadera 38100 IsraelGaetano Romano, Cardarelli MC Department of Orthopaedic Surgery Naples ItalyOlimpio Galasso, University “Magna Graecia” Division of Orthpaedic Surgery Catanzaro Italy Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Biological osteosynthesis of complex proximal humerus fractures: surgical technique and results from a prospective single center trial

Abstract Introduction Locked plating for complex proximal humerus fractures through a deltopectoral incision can be difficult due to the fracture morphology and need for fixed angle screws. Although good results have been reported with the deltopectoral approach; technical difficulties, excessive soft tissue stripping and fears of avascular necrosis have lead to the use of minimal access techniques. Method Fifteen patients with three or four part fractures were treated by locked plating through a mini-invasive lateral trans-deltoid approach. All patients were relatively young with good bone quality and had sustained a high-velocity injury. Initial closed reduction was attempted in all patients, but majority of the patients (9/15) required open reduction to achieve a satisfactory reduction. Results Union was achieved in all patients. All fractures united with an acceptable alignment. There were no incidences of axillary nerve palsy. There were no incidences of hardware failure or loss of reduction. There were no incidences of avascular necrosis at 1-year follow-up. The mean normalized constant score at last follow-up was 85.24. Conclusion Locked plating through lateral trans-deltoid incision may offer a better alternative to the deltopectoral approach in these complex fractures where locked plating is contemplated. It respects the fracture biology, allows ease in placement of the locking plate and angle stable screws and offers a stable construct with less surgical morbidity. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-1028-0Authors Ashok S. Gavaskar, Parvathy Ortho Hospital No: 8, Sakthi Villa Apartments, Gandhi Road, Gill Nagar, Choolaimedu Chennai 600094 Tamilnadu IndiaS. Muthukumar, Parvathy Ortho Hospital No: 8, Sakthi Villa Apartments, Gandhi Road, Gill Nagar, Choolaimedu Chennai 600094 Tamilnadu IndiaNaveen Chowdary, Saveetha Medical College and Research Institute Chennai India Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Do we need femoral derotation osteotomy in DDH of early walking age group? A clinico-radiological correlation study

Abstract Introduction The occurrence of exaggerated femoral anteversion and the role of femoral derotation osteotomy in developmental dysplasia of hip, especially early walking age group are controversial. Method We evaluated femoral anteversion, acetabular anteversion, acetabular index in 15 dislocated hips and 11 normal hips in cases of unilateral dislocation of hip in DDH of age group 12–48 months. We correlated this femoral anteversion with the intra operative “test of stability” which is described by Zadeh et al. We found that there was no statistically significant difference in femoral anteversion between dislocated and normal hips. In all the 15 cases we did open reduction by anterior approach (Somerville approach) and evaluated the position for maximum stability. In 3 cases we were unable to perform test of stability as they needed femoral shortening for reduction of joint. Results In the rest 12 hips, 10 were stable in flexion and abduction while 2 were stable in flexion. None of the hips required internal rotation for stability. Hence we did salters osteotomy in all the hips and femoral shortening through lateral approach in 3 cases. At a minimum follow up of 18 months all the hips were clinically stable and none of them dislocated till final follow up. The mean correction of acetabular index was 15.4° and the outcome was excellent in 8 hips and good in 7 hips as per modified McKay’s criteria. Hence we recommend that femoral derotation osteotomy is not needed in DDH of early walking age group. Conclusion As the surgical treatment of DDH involves complex osteotomies around the hip and these surgeries have effect on long term outcome, MRI evaluation of femoral anteversion as a part of pre operative evaluation is advised. Also, as the intra operative evaluation needs enough clinical experience and it can not be performed in cases requiring femoral shortening for reduction, we consider pre operative evaluation of femoral anteversion by MRI as essential rather than adjunctive. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1020-8Authors Aditya Krishna Mootha, Postgraduate Institute of Medical Education and Research Department of Orthopaedics Sector 12, Room No: 323, P-Block, New Doctors Hostel Chandigarh 160012 IndiaRaghav Saini, Postgraduate Institute of Medical Education and Research Department of Orthopaedics Sector 12, Room No: 323, P-Block, New Doctors Hostel Chandigarh 160012 IndiaMandeep Dhillon, Postgraduate Institute of Medical Education and Research Department of Orthopaedics Sector 12, Room No: 323, P-Block, New Doctors Hostel Chandigarh 160012 IndiaSameer Aggarwal, Postgraduate Institute of Medical Education and Research Department of Orthopaedics Sector 12, Room No: 323, P-Block, New Doctors Hostel Chandigarh 160012 IndiaEmal Wardak, Wazir Akbar Khan Government Hospital Kabul 10010 AfghanistanVishal Kumar, Postgraduate Institute of Medical Education and Research Department of Orthopaedics Sector 12, Room No: 323, P-Block, New Doctors Hostel Chandigarh 160012 India Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Partial versus unrestricted weight bearing after an uncemented femoral stem in total hip arthroplasty: recommendation of a concise rehabilitation protocol from a systematic review of the literature

Abstract The aim of this systematic review was to find evidence-based support in the literature to allow immediate unrestricted weight bearing after primary uncemented total hip arthroplasty (THA). Accelerated rehabilitation programs for THA are becoming increasingly popular to shorten hospital stay and to facilitate rapid restoration of function. The goals of these rehabilitation programs could be more easily achieved if immediate unrestricted weight bearing (UWB) could be allowed after a THA. So far, however, immediate weight bearing is frequently contraindicated in widely accepted protocols for uncemented THA due to fear for subsidence and absence of osseous integration of the femoral stem. Thus, frequently protected weight bearing and restricted activities are still advocated for at least 6 weeks after surgery. In addition, we analyzed the literature to come to a recommendation on gait pattern and walking aid. From a systematic search in several electronic databases 13 studies met the inclusion criteria. These studies were reviewed according to the Cochrane methodology. We found moderate to strong evidence that no adverse effects on subsidence and osseous integration of the femoral stem after uncemented THA occur after immediate UWB. Based on this literature review, we recommend early rehabilitation after uncemented THA with a reciprocally gait pattern using crutches, one cane for independency in ADL in case patients walk limp-free and walking without crutches as soon as possible. During the first weeks after surgery only stair climbing should be performed with protected weight bearing because of high torsion loads on the hip. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-009-1017-3Authors A. M. Hol, Rijnstate Hospital Department of Physiotherapy Wagnerlaan 55 6800 TA Arnhem The NetherlandsS. van Grinsven, Rijnstate Hospital Department of Physiotherapy Wagnerlaan 55 6800 TA Arnhem The NetherlandsC. Lucas, Academic Medical Centrum Department of Clinical Epidemiology and Biostatistics Amsterdam The NetherlandsJ. L. C. van Susante, Rijnstate Hospital Department of Orthopedics Arnhem The NetherlandsC. J. M. van Loon, Rijnstate Hospital Department of Orthopedics Arnhem The Netherlands Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Infected nonunions of diaphyseal fractures of the forearm

Abstract Background There are no reported series that specifically deal with repair of infected nonunions of the diaphysis of the forearm bones. We sought to determine whether a standardized treatment protocol we have utilized for 15 patients from 1989 to 2005 results in a high union rate, resolution of infection, and a good functional outcome. Methods The study cohort included nine male and six female patients who presented to a University hospital setting with an infected nonunion of the diaphysis of the radius or ulna. Every patient had a minimum of 2-year follow-up. The average patient age was 45 years (range 17–79). Eight of the patients had fractures involving their dominant arm. Thirteen patients had initially fractured both the radius and ulna, but two of these patients had subsequently healed one of the bones. One patient had an isolated radius fractures, and one patient fractured the ulna alone. All patients underwent a protocol that combines aggressive surgical debridements as necessary, definitive fixation after 7–14 days, tricortical iliac crest bone grafting for segmental defects, leaving wounds open to heal by secondary intention, 6 weeks of culture-specific intravenous antibiotics, and early active range of motion (ROM) exercises. We sought to report our success rate of nonunion repair, number of re-interventions, complication rate, final ROM, and the ability to eradicate the infection using this treatment regimen. Results At most recent follow-up (average 5 years, range 2–15 years), all patients had united and resolved their infections. One case was considered a failure, although he did go on to unite a one-bone forearm and was free of infection at most recent follow-up. All but three patients, including the one failure, had at least 50° of supination/pronation and 30–130° of flexion/extension arc. Excluding the one failure that united his one-bone forearm at 46 months, the average time to union was 13.2 weeks (range 10–15 weeks). Conclusions The results of this study indicate that our standard protocol for treatment of infected nonunion of the shafts of the radius and ulna is reliable at obtaining fracture union with a good functional result, while also resolving the infection. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1016-4Authors Mark L. Prasarn, University of Rochester Orthopaedic Trauma Attending Rochester NY USAE. Anne Ouellette, University of Miami Investigation from the Department of Orthopaedics and Rehabilitation, Jackson Memorial Hospital Miami FL USADavid R. Miller, University of Miami Investigation from the Department of Orthopaedics and Rehabilitation, Jackson Memorial Hospital Miami FL USA Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Digit and hand replantation

Abstract For the past 45 years, the advent of microsurgery has led to replantation of almost every amputated part such as distal phalanx, finger tip, etc. Replantation of digits and hand can restore not only circulation, but also function and cosmetic of the amputated part. The goals of replantation are to restore circulation and regain sufficient function and sensation of the amputated part. Strict selection criteria are necessary to optimize the functional result. The management of this type of injuries includes meticulous preoperative management, microsurgical experience and continuous postoperative care. Among various factors influencing the outcome, the most important are the type and the level of injury, ischemia time, history of diabetes, age, sex, and smoking history. During the replantation procedure, bone stabilization, tendon repair, arterial anastomoses, venous anastomoses, nerve coaptation, and skin coverage should be performed. All structures should be repaired primarily, unless a large nerve gap or a flexor tendon avulsion injury is present. Adequate postoperative evaluation is mandatory to avoid early or late complications. To improve functional results, many replantation patients may need further reconstructive surgery. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-1021-7Authors Alexandros E. Beris, University of Ioannina, School of Medicine Department of Orthopaedic Surgery 45110 Ioannina GreeceMarios G. Lykissas, University of Ioannina, School of Medicine Department of Orthopaedic Surgery 45110 Ioannina GreeceAnastasios V. Korompilias, University of Ioannina, School of Medicine Department of Orthopaedic Surgery 45110 Ioannina GreeceGregory I. Mitsionis, University of Ioannina, School of Medicine Department of Orthopaedic Surgery 45110 Ioannina GreeceMarios D. Vekris, University of Ioannina, School of Medicine Department of Orthopaedic Surgery 45110 Ioannina GreeceIoannis P. Kostas-Agnantis, University of Ioannina, School of Medicine Department of Orthopaedic Surgery 45110 Ioannina Greece Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Effect of partial medial meniscectomy on the proprioceptive function of the knee

Abstract Introduction The aim of this study was to assess the proprioception of the partial meniscectomized knee and to assess if there is an effect on the knee proprioception. Materials and methods We performed a case–control study involving patients with meniscus tear at the posterior horn of medial meniscus. Group 1 composed of 19 patients, with an average age of 26.3 years, who were enrolled after sustaining an injury to the medial meniscus. Twenty healthy individuals, with an average age of 25.1, without history of knee injury, constituted Group 2. In order to document the proprioceptive capabilities of the knee, angle reproduction tests were performed. Results At a mean of 2 years after the surgery, there was no difference between the meniscectomized and healthy knee regarding the angle deviations in the lower flexion angles (15°, 30°, 45°). However, mean knee joint position sense (KJPS) at 60° reproduction in Group 1 and 2 was 64.3 (SD 5.3) and 69.2 (SD 4.9), respectively. Concomitantly, mean KJPS at 75° reproduction in Group 1 and 2 were 80.1 (SD 6.59) and 74.4 (SD 5.6), respectively. Paired t test showed a statistically significant difference between Group 1 and 2 when compared to control angle deviations at 60° and 75° reproductions (P < 0.05). Conclusion KJPS of the patients in meniscectomized group was poorer than the patients in healthy knee group at 60° and 75° knee flexion degrees. Those results indicated that even a partial absence of menisci causes a deterioration of proprioceptive functions of the knee. Content Type Journal ArticleCategory Arthroscopy and Sports MedicineDOI 10.1007/s00402-009-1018-2Authors Mustafa Karahan, Marmara University Department of Orthopedics and Traumatology, Faculty of Medicine Istanbul TurkeyBaris Kocaoglu, Acibadem University Department of Orthopedic Surgery, Acibadem Kadikoy Hospital, Faculty of Medicine Istanbul TurkeyCengiz Cabukoglu, Pendik Sifa Hospital Department of Orthopedic Surgery Istanbul TurkeyUmut Akgun, Acibadem University Department of Orthopedic Surgery, Acibadem Kozyatagi Hospital, Faculty of Medicine Istanbul TurkeyRustu Nuran, Acibadem University Department of Orthopedic Surgery, Acibadem Kozyatagi Hospital, Faculty of Medicine Istanbul Turkey Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051 Journal Volume Volume 130 Journal Issue Volume 130, Number 3 / March, 2010

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

Erratum to: Reduction of radiation dose during radiofrequency denervation of the lumbar facet joints using the new targeting system SabreSource™: a prospective study in 20 patients Content Type Journal ArticleCategory ErratumDOI 10.1007/s00402-009-1019-1Authors Dirk Proschek, University of Frankfurt Department of Spine Surgery, Hospital for Trauma and Orthopaedic Surgery Friedrichsheim Marienburgstraße 2 60528 Frankfurt am Main GermanyKonstantinos Kafchitsas, University of Frankfurt Department of Spine Surgery, Hospital for Trauma and Orthopaedic Surgery Friedrichsheim Marienburgstraße 2 60528 Frankfurt am Main GermanyMichael Rauschmann, University of Frankfurt Department of Spine Surgery, Hospital for Trauma and Orthopaedic Surgery Friedrichsheim Marienburgstraße 2 60528 Frankfurt am Main GermanyAndreas Kurth, University of Frankfurt Department of Spine Surgery, Hospital for Trauma and Orthopaedic Surgery Friedrichsheim Marienburgstraße 2 60528 Frankfurt am Main GermanyThomas Vogl, University of Frankfurt Department of Diagnostic and Interventional Radiology Frankfurt am Main GermanyFlorian Geiger, University of Frankfurt Department of Spine Surgery, Hospital for Trauma and Orthopaedic Surgery Friedrichsheim Marienburgstraße 2 60528 Frankfurt am Main Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases

Abstract Background Elbow instability is a common feature after medial epicondyle fractures, displaced or not, even in the absence of dislocation. Undisplaced or minimally displaced fractures often have an underestimated degree of instability secondary to unrecognised capsuloligamentous and muscular injuries. The purpose of this retrospective study was to analyze and to assess objectively the results of the surgical treatment of these acute injuries. Methods One hundred and thirty-nine displaced medial epicondyle fractures were surgically treated and reviewed. A valgus stress test was performed on each child under general anesthesia or sedation. Functional outcome was assessed using a scoring system based on a series of clinical and radiographic criteria. The mean age of patients at the time of accident was 11.9 years. Mean follow-up was 3.9 years. All fractures had associated with instability of the elbow. A posterolateral elbow dislocation was associated in 80 fractures. The medial epicondylar fragment was anatomically reduced and fixed in all cases. Results The final result was excellent in 130 cases and good in 9 cases. Elbow were stable and pain free in all patients. Normal elbow range of motion was reported in 133 cases. Union was achieved in all cases. Among these cases, nine had presented a «fibrous» union with no change on valgus stress views. No cases of cubitus valgus ≥10° were observed. Anatomical abnormalities of the elbow were present in 28 cases: periarticular calcification in 18 cases, medial condyle groove formation in 4 cases, moderate hypertrophy and fragmentation of the medial epicondyle, respectively, in 3 cases. The positive valgus stress test performed at the time of surgery for all epicondyle fractures without associated dislocation regardless of there degree of displacement justified our operative approach. Conclusion Operative intervention is a good management of these fractures and results in an anatomic reduction, a solid bone union and prevents valgus instability. Even with postoperative immobilization of the elbow (mean of 4 weeks), stiffness is rare. Damage to the medial stabilizing structure of the elbow rather than the extent of medial epicondyle displacement has a far greater influence on joint stability and outcome. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-1009-3Authors Djamel M. Louahem, Lapeyronie Hospital Orthopaedic Pediatric Surgery Department Montpellier FranceSophie Bourelle, North Hospital Pediatric Surgery Department Saint-Etienne FranceFlorent Buscayret, Lapeyronie Hospital Orthopaedic Pediatric Surgery Department Montpellier FrancePhilippe Mazeau, Lapeyronie Hospital Orthopaedic Pediatric Surgery Department Montpellier FrancePaula Kelly, Lapeyronie Hospital Orthopaedic Pediatric Surgery Department Montpellier FranceAlain Dimeglio, Lapeyronie Hospital Orthopaedic Pediatric Surgery Department Montpellier FranceJérôme Cottalorda, North Hospital Pediatric Surgery Department Saint-Etienne France Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

In vitro evaluation of the influence of the wave length and height in the wave-plate osteosynthesis

Abstract Objective The aim of this study is to compare the mechanical characteristics of four different moldings of the wave-plate, with and without a polyamide block under the plate simulating the corticocancellous bone graft. Materials and methods Four different wave-plates were analyzed: (1) short-low (SL): wave length of four holes and 10 mm height; (2) short-high (SH): four holes length and 20 mm height; (3) long-low (LL): six holes length and 10 mm height; and (4) long-high (LH): six holes length and 20 mm height. The plate was assembled in a polyamide cylinder simulating a type B diaphyseal fracture, with the contact of one-third of the diameter, with and without a polyamide block under the plate, submitted to an application of an eccentric axial load (100 N/min). Results Without the polyamide block under the plate there were no statistical differences between the different wave-plates: SL 64.8 ± 3.5 N; SH 62.4 ± 3.4 N; LL 60.3 ± 3.9 N; LH 52.1 ± 5.9 N. There were no differences in the stiffness as well. All four different moldings of the wave-plates tested with the polyamide block showed higher maximum strength compared with the plates without the block. The configuration with higher maximum strength was the LH-B (2,195.3 ± 252.2 N). The plate with highest stiffness was the LL-B (90.5 ± 7.5 N/mm). Conclusions We concluded that without the usage of the polyamide block under the plate neither the length nor the height changed the maximum strength and the stiffness. With the polyamide block, the maximum strength and the stiffness were significantly higher. The long and high wave-plate with the block showed higher maximum strength while the long and low the highest stiffness. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-1013-7Authors Kodi E. Kojima, Santa Casa Medical School Department of Orthopaedic and Traumatology São Paulo BrazilJose Soares Hungria Neto, Santa Casa Medical School Department of Orthopaedic and Traumatology São Paulo BrazilPatricia M. M. B. Fucs, Santa Casa Medical School Department of Orthopaedic and Traumatology São Paulo Brazil Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Influence of platelet-rich plasma on the anterior fusion in spinal injuries: a qualitative and quantitative analysis using computer tomography

Abstract Introduction The effects of platelet-rich plasma (PRP) were monitored by performing a controlled cohort study of patients undergoing an anterior spinal fusion. One group was treated with the addition of PRP. The growth factors contained within the blood platelets are known to play an important role in the new formation of bone following fractures or the implantation of bone grafts. But the results following the use of PRP in spinal fusion are not yet published. Method The study involved a group of 15 patients, who had suffered an injury of the thoracic or lumbar spine and had undergone an anterior fusion using cages. They had received an additional posterior stabilisation and/or anterior implants as well as bone graft combined with PRP. A control group made up of 20 patients received a similar treatment, but without the addition of PRP. A CT scan was performed of all patients during follow-up examinations. The area on the left side of the cage, where the bone graft with or without PRP had been applied, was analysed and the patients were divided into three classes, depending upon the rate of fusion: complete fusion, incomplete fusion and no/minimal ossification. In cases which were classified as complete or incomplete ossification, an additional CT volumetry and densitometry was performed. The patient-referred outcome was documented using the VAS spinal score. Results In both groups, 40% of the patients had reached a complete fusion in the CT scans. No or minimal fusion was documented in 20% of the PRP group and 30% of the control group. When measuring the density within the newly formed bone mass, both groups showed nearly identical percentages with a density of over 100 Hounsfield units (HU). The share of bone with a density of over +500 HU was 29.33% in the PRP group and 23.57% in the control group. Within the partition of over +100 HU, the absolute density was significantly higher in the PRP group (639.7 vs. 514.2 HU). Similar results could be shown within the partition of over +500 HU (930.7 vs. 846 HU). The VAS scores showed no significant differences between the two groups. Conclusion The additional application of autologous PRP involves very little risk for the patients. The study implies that the use of PRP provides a faster fusion and higher density values within the fusion mass. A clear advancement in spinal fusion in terms of a clinical benefit remains questionable. Content Type Journal ArticleCategory Trauma SurgeryDOI 10.1007/s00402-009-1015-5Authors Erik K. Hartmann, University Hospital Wuerzburg Department of Trauma and Reconstructive Surgery Oberduerrbacher Strasse 6 97080 Wuerzburg GermanyTimo Heintel, University Hospital Wuerzburg Department of Trauma and Reconstructive Surgery Oberduerrbacher Strasse 6 97080 Wuerzburg GermanyRobert H. Morrison, University Hospital Wuerzburg Department of Trauma and Reconstructive Surgery Oberduerrbacher Strasse 6 97080 Wuerzburg GermanyArnulf Weckbach, University Hospital Wuerzburg Department of Trauma and Reconstructive Surgery Oberduerrbacher Strasse 6 97080 Wuerzburg Germany Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

Histopathological, radiological and clinical aspects of the temporal assignment of scaphoid non-union

Abstract Objective The aim of this study was to evaluate the correlation between clinical, radiological and histopathological signs of scaphoid non-unions (SNU) with regard to the age of the fracture, primarily because this is relevant for therapy and compensation claims. Materials and methods Thirty-eight patients with SNU underwent clinical and radiological examination of the wrist prior to surgery. Preoperative X-rays of the wrist were analysed using the scores of Herbert and Fisher, Filan and Herbert, Trojan and Jahna, Gupta as well as scaphoid non-union advanced collapse. Sclerotic bone of the SNU was resected during surgery. Resected material was evaluated histologically after staining with hematoxylin–eosin and periodic acid-Schiff reaction. Radiological and histological examinations were performed by independent investigators in a blinded fashion. Results The preoperative range of motion of the injured compared to the contralateral wrist was significantly reduced for the dorsi- and palmar flexion and for the radial and ulnar deviation; however, this reduction was not time dependent. There was no significant correlation between the radiological results and the age of the SNU, while fibrous tissue or fibrocartilage in the fracture gap was present in all cases. Significantly less fibrous or fibrocartilage bone cysts (p = 0.041) and bone remodelling (p = 0.031) were seen in older SNU (at 45 months). Definitive sclerotic bone covering of the fracture edges was significantly more common in older SNU (p = 0.035). Conclusion Radiological and most of the conventional histological findings do not correlate with time after initial injury. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1010-xAuthors Susanne Rein, University Hospital “Carl Gustav Carus” Department of Trauma and Reconstructive Surgery Fetscherstr. 74 01307 Dresden GermanyUwe Hanisch, Hospital “Carl Thiem” Institute of Pathology Thiemstr. 111 03048 Cottbus GermanyStefan Rammelt, University Hospital “Carl Gustav Carus” Department of Trauma and Reconstructive Surgery Fetscherstr. 74 01307 Dresden GermanyGünter Schmidt, Hospital of Ingolstadt Surgical Department Krumenauer Str. 25 85049 Ingolstadt GermanyHans-Eberhardt Schaller, University of Tuebingen Department of Plastic, Hand, Reconstructive and Burn Surgery, Trauma Centre Schnarrenbergstr. 95 72076 Tübingen GermanyHans Zwipp, University Hospital “Carl Gustav Carus” Department of Trauma and Reconstructive Surgery Fetscherstr. 74 01307 Dresden GermanyMatthias Oehmke, Medical University of Vienna Department of Special Anaesthesia and Pain Control Vienna AustriaStefan Weindel, Hospital of Linth Department of Hand, Aesthetic and Plastic Surgery Gasterstr. 25 8730 Uznach Switzerland Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051

The threat of misdiagnosis of primary osteosarcoma over the age of 60: a series of seven cases and review of the literature

Abstract Background Osteosarcoma is the most common, non-haematopoietic, primary malignant bone tumour with an incidence of 0.3–0.5 per 100,000. There is some discrepancy in literature concerning the peaks of incidence of osteosarcoma. Some describe only one peak which arises in adolescence, whilst others report a bimodal age distribution with a second peak over the age of 60. In this retrospective study, we evaluated osteosarcoma patients over age 60 treated at our department and reviewed previous studies from the literature. Patients and methods Sixty-four patients (40 male, 24 female) with a mean age of 29 years (from 7 to 82) were treated for primary osteosarcomas. At the time of diagnosis, seven patients (two male and five female) were over 60 years of age with a mean follow-up of 46 months after definite diagnosis. Results Three out of seven osteosarcomas were primarily radiologically or histologically misdiagnosed, but only one was mistreated with intramedullary nailing at a trauma centre. At last follow-up, two patients had died from the disease, three were alive with disease, and two had no evidence of osteosarcoma. Conclusions We did not find an increased incidence of primary osteosarcoma in the elderly; yet, older patients had a higher rate of misdiagnosis due to untypical radiological findings in combination with longer times from the onset of first symptoms to definite diagnosis. In cases of pathological fracture, it is essential to assess whether it is caused by mechanical stress or a primary or secondary tumour before leading into mistreatment, especially in older patients. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-009-1011-9Authors Patrick Sadoghi, Medical University of Graz University Clinic of Orthopaedic Surgery Auenbruggerplatz 5-7 8036 Graz AustriaAndreas Leithner, Medical University of Graz University Clinic of Orthopaedic Surgery Auenbruggerplatz 5-7 8036 Graz AustriaHeimo Clar, Medical University of Graz University Clinic of Orthopaedic Surgery Auenbruggerplatz 5-7 8036 Graz AustriaMathias Glehr, Medical University of Graz University Clinic of Orthopaedic Surgery Auenbruggerplatz 5-7 8036 Graz AustriaChristine Wibmer, Medical University of Graz University Clinic of Orthopaedic Surgery Auenbruggerplatz 5-7 8036 Graz AustriaKoppany Bodo, Medical University of Graz Institute of Pathology Auenbruggerplatz 25 8036 Graz AustriaFranz Quehenberger, Medical University of Graz Institute of Medical Statistics, Informatics and Documentation Auenbruggerplatz 12 8036 Graz AustriaReinhard Windhager, Medical University of Graz University Clinic of Orthopaedic Surgery Auenbruggerplatz 5-7 8036 Graz Austria Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051