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Rouhani A, Samankan S, Hamishehkar H, Parish M. Unintended consequences: Hypotonic serum-induced acute kidney injury in shoulder arthroscopy. Knee Surg Sports Traumatol Arthrosc 2024; 32:2342-2345. [PMID: 38819936 DOI: 10.1002/ksa.12285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/02/2024]
Abstract
Arthroscopic shoulder surgery is an orthopaedic technique that involves the use of normal saline or hyperosmolar serums as irrigation. The mentioned operation is commonly regarded as a safe medical intervention. Occasionally, it may have serious repercussions for the patient. Fluid extravasation into muscle tissues and tissue injury and instability are possible consequences. This can be affected by the type and amount of serum used and the length of the surgery. The objective of this study was to document four cases of shoulder arthroscopy in which sterile distilled water, wrongly labelled as irrigation fluid, was utilized during the surgical procedure. Patients were readmitted a week after discharge due to acute kidney injury symptoms like fatigue and lethargy. All four patients were released after haemodynamic stability and normalization after haemodialyses. Due to the incident, serums should be closely monitored and labeled for the safety of patients. Additionally, distilled water as an irrigation solution in arthroscopic surgeries can harm patients. Although normal saline and hyperosmolar serums are unavailable, this remains true. LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- Alireza Rouhani
- Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sama Samankan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Hamishehkar
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Parish
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
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Gao X, Liu F, Wang G, Gao Y, Suyalatu X. Serum caspase‑1 levels serve as a predictive biomarker for the prognosis of patients undergoing arthroscopic‑assisted locking plate internal fixation in the treatment of high‑energy pilon fractures. Exp Ther Med 2024; 27:77. [PMID: 38264430 PMCID: PMC10804377 DOI: 10.3892/etm.2023.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/24/2023] [Indexed: 01/25/2024] Open
Abstract
The present study aimed to investigate the serum levels of caspase-1 in patients with high-energy pilon fractures, and its correlation with prognosis and clinical results. In this prospective study, 136 patients with high-energy pilon fractures who were treated with a locking plate combined with ankle arthroscopy from July 2015 to July 2020 were included. The treatment efficacy was evaluated according to the Mazur ankle function score. Serum caspase-1, interleukin (IL)-6, IL-1β and C-reactive protein (CRP) levels were measured using enzyme-linked immunosorbent assay. Reverse transcription-quantitative PCR was used to measure the mRNA expression of caspase-1. Additionally, demographic data and clinical characteristics, such as sex, age, intraoperative blood loss, fracture healing time, fracture classification and complications were collected and analyzed. The study revealed that the intraoperative blood loss, proportion of Ruedi-Allgower III and the serum levels of caspase-1 in the poor prognosis group were significantly higher compared with those in the good prognosis group. Additionally, patients with high-energy pilon fractures in the poor prognosis group exhibited significantly higher levels of caspase-1 and IL-1β serum levels at all time points in contrast to those in the good prognosis group. Spearman's analysis revealed a significant association between caspase-1, IL-1β levels and Mazur scores. Furthermore, caspase-1 could serve as a potential diagnostic biomarker for poor prognosis of patients with high-energy pilon fractures. Caspase-1, IL-1β, intraoperative blood loss and Ruedi-Allgower grade were the risk factors for poor prognosis in patients with high-energy pilon fractures. In summary, this study demonstrated that serum caspase-1 levels were progressively reduced during the treatment of high-energy pilon fractures patients and prominently lowered in those with a favorable prognosis. These findings could provide novel targets and a comprehensive approach to protecting patients with high-energy pilon fractures.
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Affiliation(s)
- Xiaoyu Gao
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Feng Liu
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Gang Wang
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Yu Gao
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Xin Suyalatu
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
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Bhashyam AR, Chen N. Arthroscopic-Assisted Fracture Fixation About the Elbow. Hand Clin 2023; 39:587-595. [PMID: 37827611 DOI: 10.1016/j.hcl.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Arthroscopic-assisted fracture fixation can be used for some adult elbow fractures. In particular, for articular fractures of the anterior elbow (coronoid/capitellum), elbow arthroscopy can provide excellent visualization of fracture fragments using a less invasive surgical exposure. Meticulous adherence to safe techniques and utilization of specialized equipment can help maximize safety and facilitate reproducible surgical results.
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Affiliation(s)
- Abhiram R Bhashyam
- Department of Orthopaedic Surgery, Hand & Arm Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Neal Chen
- Department of Orthopaedic Surgery, Hand & Arm Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Hwang JM, Lee CW, Kim PS, Ha YC. Arthroscopic Reduction and Internal Fixation in Patients with Acetabular Posterior Wall Fractures. Clin Orthop Surg 2023; 15:718-724. [PMID: 37811503 PMCID: PMC10551686 DOI: 10.4055/cios22199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/03/2023] [Accepted: 02/28/2023] [Indexed: 10/10/2023] Open
Abstract
Background This study aimed to access the radiologic and clinical outcomes after arthroscopic reduction and internal fixation with screws in patients with posterior wall fractures of the acetabulum. Methods From May 2013 to December 2019, 13 patients (11 men and 2 women) with posterior wall fractures of the acetabulum were treated with arthroscopic reduction and internal fixation with screws at two medical centers. The mean age at the index operation was 39 years (range, 22-58 years). The mean duration of follow-up was 23 months (range, 12-46 months). Clinical assessment was performed using the modified Merle d'Aubigné and Postel functional scoring system. The maximum displacement of acetabular or femoral head fragments detected on radiographs was used as radiographic results. Secondary osteoarthritis, osteonecrosis, or heterotrophic ossification was assessed at the latest follow-up. Results Bony union was shown at 12 weeks of follow-up in all patients. The radiologic outcomes showed an anatomical reduction in 11 patients and a satisfactory reduction in 2 patients. The modified Merle d'Aubigné and Postel functional score was excellent in 7 patients, good in 5 patients, and fair in 1 patient. Two patients had transient pudendal nerve palsy after hip arthroscopy. However, no sciatic nerve palsy occurred. At the latest follow-up, there was no heterotopic ossification, osteonecrosis of the femoral head, or posttraumatic osteoarthritis. Conclusions Arthroscopic reduction and internal fixation with cannulated screws can be good alternative options with good radiographic and clinical outcomes, convenient removal of intra-articular loose body, and low complication rates.
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Affiliation(s)
- Jung-Mo Hwang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Cheol-Won Lee
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Pil-Sung Kim
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, Korea
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Oyama S, Niimi N, Mori M, Hirata H. Intra-Articular Ultrasonography Probe for Minimally Invasive Upper Extremity Arthroscopic Surgery: A Phantom Study. J Clin Med 2023; 12:5727. [PMID: 37685794 PMCID: PMC10488905 DOI: 10.3390/jcm12175727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Upper extremity arthroscopic surgery is a highly technique-dependent procedure that requires the surgeon to assess difficult cartilage conditions and manage the risk of iatrogenic damage to nerves and vessels adjacent to the joint capsule in a confined joint space, and a device that can safely assist in this procedure has been in demand. METHODS In this study, we developed a small intra-articular ultrasound (AUS) probe for upper extremity joint surgery, evaluated its safety using underwater sound field measurement, and tested its visualization with a phantom in which nerves and blood vessels were embedded. RESULTS Sound field measurement experiments confirmed the biological safety of the AUS probe's output, while confirming that sufficient output power level performance was obtained as an ultrasound measurement probe. In addition, images of blood vessels and nerves were reconstructed discriminatively using A-mode imaging of the agar phantom. CONCLUSIONS This study provides proof-of-concept of the AUS probe in upper extremity surgery. Further studies are needed to obtain approval for use in future medical devices.
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Affiliation(s)
- Shintaro Oyama
- Innovative Research Center for Preventive Medical Engineering, Institute of Innovation for Future Society, Nagoya University, Tokai National Higher Education and Research System, NIC#5, Furo-cho, Chikusa-ku, Nagoya 4648601, Aichi, Japan
- Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Aichi, Japan;
| | - Nobuo Niimi
- Planning and Product Development Department, Nippon Sigmax Co., Ltd., 1-24-1 Nishi-Shinjyuku, Shinjyuku-ku, Tokyo 1600023, Japan
| | - Masato Mori
- Planning and Product Development Department, Nippon Sigmax Co., Ltd., 1-24-1 Nishi-Shinjyuku, Shinjyuku-ku, Tokyo 1600023, Japan
| | - Hitoshi Hirata
- Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Aichi, Japan;
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Cheng YH, Yang CP, Chang SS, Weng CJ, Chiu CH, Chan YS. Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up. J Orthop Surg Res 2023; 18:448. [PMID: 37349746 DOI: 10.1186/s13018-023-03938-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND To investigate the radiologic and prognostic outcomes after using arthroscopic-assisted reduction and internal fixation (ARIF) in complex tibial plateau fractures with mid- to long-term follow-up. METHODS This retrospective study reviewed complex tibial plateau fractures that underwent ARIF from 1999 to 2019. Radiologic outcomes, including tibial plateau angle (TPA), posterior slope angle (PSA), Kellgren-Lawrence classification and Rasmussen radiologic assessment, were measured and evaluated. The prognosis and complications were assessed by the Rasmussen clinical assessment with a minimum follow-up of 2 years. RESULTS Ninety-two consecutive patients (mean age: 46.9 years) with a mean follow-up of 74.8 months (24-180) were included in our series. Using AO classification, there were 20 type C1 fractures, 21 type C2 fractures, and 51 type C3 fractures. All the fractures achieved solid union. TPA was maintained well on average at the last follow-up and showed no significant difference compared to postoperatively (p = 0.208). In the sagittal plane, the mean PSA increased from 9.3 ± 2.9° to 9.6 ± 3.1° (p = 0.092). A statistically significant increase in PSA was also noted in the C3 group (p = 0.044). Superficial or deep infection was noted in 4 cases (4.3%), and total knee arthroplasty (TKA) was performed in 2 cases (2.2%) due to grade 4 osteoarthritis (OA). Ninety (97.8%) and 89 (96.7%) patients had good or excellent results in the Rasmussen radiologic assessment and Rasmussen clinical assessment, respectively. CONCLUSIONS The complex tibial plateau fracture could be treated successfully using arthroscopy-assisted reduction and internal fixation. Most patients achieve excellent and good clinical outcomes with low complication rates. In our experience, a higher incidence of increased slope was noted, especially in type C3 fractures. Reduction of the posterior fragment should be done cautiously during the operation. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- You-Hung Cheng
- Department of Orthopedic Surgery, New Taipei Municipal Tu-Cheng Hospital, Chang Gung Memorial Hospital, New Taipei City, Taiwan, ROC
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC
| | - Shih-Sheng Chang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC
| | - Chun-Jui Weng
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC.
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, No.222, Maijin Rd., Anle Dist., Keelung City, 204, Taiwan, ROC.
- Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC.
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Colozza A, Menozzi M, Perna L, Cavaciocchi M, Martini I, Galavotti C, Padovani S. Results of arthroscopically assisted reduction and fixation of anteromedial facet coronoid fractures at short-term follow-up. J Shoulder Elbow Surg 2022; 31:1890-1897. [PMID: 35550430 DOI: 10.1016/j.jse.2022.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Varus posteromedial rotatory instability is a typical pattern of elbow injury that involves fracture of the anteromedial facet (AMF) of the coronoid, as well as injuries to the lateral ligament complex and the posterior bundle of the medial collateral ligament. Some authors support the idea that subtype II AMF coronoid fractures require fixation to restore elbow stability, but this topic is still an issue in the literature. The purpose of this study was to assess the clinical and radiologic outcomes of arthroscopically assisted reduction and internal fixation (ARIF) of AMF fractures. METHODS This retrospective single-center trial evaluated consecutive patients who underwent ARIF of isolated subtype II AMF coronoid fractures between 2014 and 2020. At the final follow-up, the patients were examined for elbow range of motion, stability, and pain. Injury and post-treatment radiographs were reviewed to assess fracture healing and heterotopic ossification. RESULTS A total of 32 patients (21 male and 11 female patients) with a median age of 47 ± 16 years were included. The average follow-up period was 28 ± 12.4 months. Coronoid process fractures were fixed by cannulated screws in 26 cases (81.25%); in 2 of these cases, additional Kirschner wires were used. Two Kirschner wires were used in 1 case (3.12%), and in the remaining 5 cases (15.62%), osteosuture was used. The lateral ulnar collateral ligament was injured in 27 cases (84.4%) and was always repaired. Other associated lesions were medial collateral ligament injury, osteochondral lesion, and radial head fracture. There were no surgical complications. At the final follow-up, the average Mayo Elbow Performance Score was 98.4 ± 2.7 and the mean Oxford Elbow Score was 47.3 ± 1.4. No cases of nonunion were detected on radiographic assessment. CONCLUSIONS Although technically demanding, ARIF has several potential advantages in comparison to open surgery: less scarring, a decreased risk of infection, and less postoperative pain.
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Affiliation(s)
- Alessandra Colozza
- Osteoarticular Department, Orthopaedic and Traumatology Unit, Azienda Ospedaliera of Faenza, Faenza, Italy.
| | - Margherita Menozzi
- Orthopaedic and Traumatology Unit, Civil Hospital of Guastalla, Guastalla, Italy
| | - Luigi Perna
- Osteoarticular Department, Orthopaedic and Traumatology Unit, Azienda Ospedaliera of Faenza, Faenza, Italy
| | - Michele Cavaciocchi
- Osteoarticular Department, Orthopaedic and Traumatology Unit, Azienda Ospedaliera of Faenza, Faenza, Italy
| | - Ilaria Martini
- Osteoarticular Department, Orthopaedic and Traumatology Unit, Azienda Ospedaliera of Faenza, Faenza, Italy
| | | | - Sara Padovani
- Osteoarticular Department, Orthopaedic and Traumatology Unit, Azienda Ospedaliera of Faenza, Faenza, Italy
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Lee HJ, Kim SJ, Park YU, Hyun J, Kim HN. Use of an aiming drill guide and ankle arthroscopy for reduction of depressed articular surface in posterior malleolar fractures. J Orthop Surg (Hong Kong) 2022; 29:23094990211055867. [PMID: 34873969 DOI: 10.1177/23094990211055867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We describe a novel technique that uses an aiming drill guide and ankle arthroscopy for direct visualization and reduction of the depressed articular surface located between the posterior tibia and the fractured posterior malleolus. This technique requires less soft tissue dissection to visualize and reduce the depressed articular surface. METHODS Between June 2014 and May 2019, 126 patients were surgically treated for trimalleolar fractures. Among them, 11 had depressed articular fragment between the posterior tibia and the fractured posterior malleolus reduced using our novel technique. The study included six men and five women, with a mean age of 46.5 (range: 23-62) years. RESULTS In eight (73%) cases, the articular surface was reduced, with the articular surface step-off being less than 2 mm, as noted on postoperative computed tomography (CT). Syndesmosis congruity within an anterior-to-posterior difference of less than 2 mm was confirmed in nine (82%) cases via postoperative CT. The mean 100-mm visual analog scale (VAS) and the mean Olerud-Molander ankle score at the final follow-up were 16.6 ± 14.5 and 87.7 ± 7.5, respectively. CONCLUSIONS The depressed articular fragment located between the posterior tibia and the fractured posterior malleolus can be treated using an aiming drill guide and ankle arthroscopy. Ankle arthroscopy is used for direct visualization of the depressed articular surface, and the aiming drill guide can guide the bone plunger precisely to the depressed articular surface for reduction. This technique requires less soft tissue dissection than conventional techniques to visualize and reduce the depressed articular surface.
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Affiliation(s)
- Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Jae Kim
- Department of Orthopedic Surgery, 366256Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Young Uk Park
- Department of Orthopedic Surgery, 65783Ajou University Hospital, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Jintak Hyun
- Department of Orthopedic Surgery, 65521Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, 65521Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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Özdemir A, Pulatkan A, Eravsar E, Acar MA. The role of arthroscopy in the diagnosis of concomitant soft tissue injuries in scaphoid fractures and the effect of concomitant soft tissue injuries and fracture comminution on outcomes: A case-control study. Jt Dis Relat Surg 2021; 32:729-735. [PMID: 34842106 PMCID: PMC8650654 DOI: 10.52312/jdrs.2021.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/01/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives
This study aims to evaluate the role of arthroscopy in the diagnosis of concomitant injuries, to investigate the relationship between comminution and concomitant injuries, and to analyze the effect of concomitant injuries on functional outcomes in acute and subacute scaphoid fracture. Patients and methods
Between January 2011 and September 2018. A total of 32 acute scaphoid fracture patients (29 males, 3 females; mean age: 30±12 years; range, 18 to 65 years) were retrospectively analyzed. None of them had an obvious ligament injury in the radiological assessment. Functional outcomes were compared between concomitant and non-concomitant injuries and between comminuted and non-comminuted injuries. The percentage of range of motion (ROM), grip, and pinch strength were recorded according to the contralateral extremity to detect the restriction rate. The Mayo Wrist Score (MWS), the Turkish version of the Quick Disability of the Arm, Shoulder, and Hand (Q-DASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires were used to evaluate the functional results. Subjective pain was assessed using the Visual Analog Scale (VAS). The relationship between concomitant injuries and comminution was investigated. Results
There were 13 patients with comminuted fractures. Concomitant injuries were diagnosed in 17 patients. The presence of concomitant injuries was higher in comminuted fractures than in non-comminuted fractures. There was no significant difference between the groups in ROMs. The final follow-up Q-DASH, PRWE, MWS, and VAS scores and the pinch strength of non-comminuted fractures were found to be statistically better than those of comminuted fractures. There were statistically worse Q-DASH, PRWE, MWS, and VAS scores in patients with concomitant injuries. Conclusion
Arthroscopic scaphoid fracture surgery allows the diagnosis and treatment of concomitant lesions. The functional outcomes of concomitant lesions and comminuted fractures seem to be worse than those of others, while the ROM is comparable.
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Affiliation(s)
- Ali Özdemir
- Gazi Yaşargil Eğitim ve Araştırma Hastanesi El Cerrahisi Bölümü, 21010 Kayapınar, Diyarbakır, Türkiye.
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Heyes GJ, Khashkhusha TR, Mason L. Posterolateral Approach to Posterior Malleolar Fractures: A Literature Review. Foot Ankle Spec 2021; 16:149-158. [PMID: 34353143 DOI: 10.1177/19386400211009366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study reviews the current evidence on the indications and outcomes of the posterolateral approach in the treatment of posterior malleolar fractures. PubMed and Google Scholar search engines were used to construct a review of the literature for all studies detailing the posterolateral approach for posterior malleolar fracture fixation. A total of 11 studies met our inclusion criteria. In total, 332 fractures were identified. Overall superficial infection occurred in 4.5%, skin necrosis in 4.5%, and nerve injury in 4.5%. Hardware irritation that required removal occurred in 13.6%. None of the hardware removals involved posterior malleolus fixation. A total of 51 (15.4%) cases of arthritis were reported, follow-up ranged from a mean of 5.3 months to a mean 7.9 years. Regardless the majority of patient reported outcomes were excellent/good at final follow-up. Thresholds for joint reduction were not uniformly described or even quantified at all in some of the included studies. Variable indications for fixation were reported without reference to posterior malleolus fracture morphology. The posterolateral approach provides a satisfactory approach for fracture reduction with similar complication rates to that reported for other ankle fracture approaches. Further research is required on posterior malleolus fracture morphology, optimal fracture fixation and longer term functional and radiological outcomes.Levels of Evidence: Level III: Systematic review of retrospective cohort studies.
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Affiliation(s)
- Gavin J Heyes
- Consultant Trauma and Orthopaedic Surgeon, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Trauma and Orthopaedics Department, Liverpool, UK
| | | | - Lyndon Mason
- Consultant Trauma and Orthopaedic Surgeon, Liverpool University Hospitals NHS Foundation Trust, Aintree University Hospital, Trauma and Orthopaedics Department, Liverpool, UK
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Ye M, Chen J, Hu F, Liu Y, Tan Y. Suture versus screw fixation technique for tibial eminence fracture: A meta-analysis of laboratory studies. J Orthop Surg (Hong Kong) 2020; 28:2309499020907977. [PMID: 32124674 DOI: 10.1177/2309499020907977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of this study was to compare the biomechanical properties between the suture fixation technique and the screw fixation technique for tibial eminence fracture (TEF). METHODS The current study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, and the Cochrane were searched from inception to January 2019 comparing the suture and the screw fixation technique for TEF. The results of the eligible studies were analyzed in terms of stiffness, ultimate failure load, and displacement after the cyclic testing. RESULTS Six laboratory studies were included with a total of 114 knees: 57 knees were in the FiberWire suture group and 57 knees were in the single-screw group. The suture group had higher stiffness than the screw group, but there was no statistical difference between these two groups. Ultimate failure load in the suture group was statistically higher than that in the screw group. No statistically significant difference existed in displacement after the cyclic testing between the suture group and the screw group. CONCLUSION The FiberWire suture fixation may be biomechanically superior to a single screw fixation in TEF treatment in mature knees regarding ultimate failure load, while no significant difference was found between the two fixations in terms of stiffness and displacement after the cyclic testing.
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Affiliation(s)
- Mao Ye
- Department of Orthopedic Surgery, Xianning Central Hospital, The First Affiliated Hospital Of Hubei University Of Science And Technology, Xianning, China
| | - Jun Chen
- Department of Orthopedic Surgery, Xianning Central Hospital, The First Affiliated Hospital Of Hubei University Of Science And Technology, Xianning, China
| | - Feng Hu
- Department of Orthopedic Surgery, Xianning Central Hospital, The First Affiliated Hospital Of Hubei University Of Science And Technology, Xianning, China
| | - Yanxi Liu
- Department of Orthopedic Surgery, Xianning Central Hospital, The First Affiliated Hospital Of Hubei University Of Science And Technology, Xianning, China
| | - Yang Tan
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Alvarez A, Youn GM, Remigio Van Gogh AM, Shin Yin SS, Chakrabarti MO, McGahan PJ, Chen JL. Tibial Plateau With Arthroscopic Reduction-Internal Fixation. Arthrosc Tech 2020; 9:e213-e216. [PMID: 32099774 PMCID: PMC7029054 DOI: 10.1016/j.eats.2019.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/29/2019] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic-assisted internal fixation is an ideal technique for visualizing chondral reduction during tibial open reduction-internal fixation. Typically, open reduction-internal fixation is performed using radiographic and Fluoroscan imaging (Hologic, Bedford, MA) for reduction of subchondral bone. However, reduction without visualization does not ensure chondral surface reduction. This Technical Note and supplemental video describe an arthroscopic-assisted technique involving the tibial plateau that gives complete visualization as tamping occurs to restore the cartilage surface of the subchondral bone and elevate the fracture.
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Affiliation(s)
- Alyssa Alvarez
- Address correspondence to Alyssa Alvarez, B.A., Advanced Orthopaedics and Sports Medicine, 450 Sutter St, Ste 400, San Francisco, CA 94108, U.S.A.
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Kastenberger T, Kaiser P, Schmidle G, Schwendinger P, Gabl M, Arora R. Arthroscopic assisted treatment of distal radius fractures and concomitant injuries. Arch Orthop Trauma Surg 2020; 140:623-638. [PMID: 32193675 PMCID: PMC7181439 DOI: 10.1007/s00402-020-03373-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/16/2022]
Abstract
Wrist arthroscopy is mainly used to assist fracture reduction and fixation and to diagnose and treat concomitant injuries mainly to the scapholunate (SL), lunotriquetral (LT) ligament and the triangular fibrocartilage complex (TFCC). Arthroscopy is beneficial in improving anatomical reduction of fracture steps and gaps in intra-articular distal radius fractures (DRFs). Yet, the literature that the functional outcome correlates with the use of arthroscopy, is limited. Non-surgical treatment and immobilization is recommended for Geissler grade I-III Sl-ligament injuries, while open reduction, ligament suture and/or K-wire pinning is mandatory for complete ligament tears according to Geissler grade IV. This manuscript describes the current literature and gives insight into the authors' opinions and practice.
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Affiliation(s)
- Tobias Kastenberger
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Peter Kaiser
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gernot Schmidle
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Peter Schwendinger
- Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
| | - Markus Gabl
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Rohit Arora
- Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Cole G, Beale B. Minimally Invasive Osteosynthesis Techniques for Articular Fractures. Vet Clin North Am Small Anim Pract 2019; 50:213-230. [PMID: 31635914 DOI: 10.1016/j.cvsm.2019.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Articular fractures are common injuries in veterinary medicine. The principles of articular fracture repair are anatomic reduction and rigid fixation in order to optimize joint function. Fluoroscopy and arthroscopy are tools commonly used to allow for anatomic reduction with a minimally invasive approach. Minimally invasive techniques can decrease morbidity and promote an early return to function. Different types of articular fractures and options for minimally invasive repair are reviewed in this article.
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Affiliation(s)
- Grayson Cole
- Department of Surgery, Gulf Coast Veterinary Specialists, 8042 Katy Freeway, Houston, TX 77055, USA.
| | - Brian Beale
- Beale Veterinary Specialist and Emergency, 3804 Houston Highway, Victoria, TX 77905, USA
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Shao J, Wang J, Chen Y, Mao N, Zhang Q, Ni H. Comparison of a minimally invasive surgical technique with open surgery for transverse patella fractures. Exp Ther Med 2019; 18:4203-4208. [PMID: 31772625 PMCID: PMC6862010 DOI: 10.3892/etm.2019.8078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 10/26/2018] [Indexed: 11/06/2022] Open
Abstract
The current study aimed to compare a minimally invasive surgical technique with open surgery for the treatment of transverse patella fractures. A total of 38 patients with displaced transverse fractures of the patella were included in the current prospective study. A total 21 of them were treated with a minimally invasive surgical (MIS) technique and the other 17 patients had open surgery (OS) when using the Cable Pin System. Postoperative comparisons were based on radiographs, the visual analog scale (VAS) of pain, their ranges of motion and the Bostman grading scale. Compared with the OS group, the VAS score for pain was significantly lower and the angle of active flexion was better in the MIS group at 4 and 8 weeks. The angle of active extension at 4 weeks and the Bostman score at 8 weeks after surgery were better in the MIS group, although the differences became non-significant at 8 weeks and 12 months. In conclusion, the MIS technique for transverse patella fractures provided better clinical results and the knees functioned with less pain when compared with the OS group in the early period following surgery. MIS could be an adequate alternative in the treatment of transverse patella fractures.
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Affiliation(s)
- Jie Shao
- Department of Orthopedics, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China
| | - Jiabao Wang
- Department of Orthopedics, Suzhou First People's Hospital, Suzhou, Anhui 234000, P.R. China
| | - Yu Chen
- Department of Orthopedics, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China
| | - Ningfang Mao
- Department of Orthopedics, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China
| | - Qiulin Zhang
- Department of Orthopedics, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China
| | - Haijian Ni
- Department of Orthopedics, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China
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16
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Cucchi D, Arrigoni P, Luceri F, Menon A, Guerra E, Müller LP, Burger C, Eygendaal D, Wegmann K. Modified anteromedial and anterolateral elbow arthroscopy portals show superiority to standard portals in guiding arthroscopic radial head screw fixation. Knee Surg Sports Traumatol Arthrosc 2019; 27:3276-3283. [PMID: 30863912 DOI: 10.1007/s00167-019-05411-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Arthroscopic fixation of radial head radial head fractures is an appealing alternative to open reduction and internal fixation, which presents the advantage of minimal surgical trauma. The aim of this study was to evaluate if modifications to the standard anteromedial (AM) and anterolateral (AL) portals could allow screw placement for radial head fracture osteosynthesis closer to the plane of the radial head articular surface. METHODS Eight fresh-frozen specimens were prepared to mimic arthroscopic setting. Standard AL (ALst) and AM (AMst) and distal AL (ALdi) and AM (AMdi) portals were established. Eleven independent examiners were asked to indicate the optimal trajectory, when aiming to place a cannulated screw parallel to the radial head surface for radial head osteosynthesis. A three-dimensional digital protractor was used to measure the angle between the indicated position and a Kirschner wire placed parallel to the radial head articular surface (α). The Shapiro-Wilk normality test was used to evaluate the normal distribution of the samples. Means, standard deviations, and 95% confidence intervals (95% CI) were calculated for each portal. A coefficient of variation (CoV) was calculated to determine agreement among observers and intra-observer variability. RESULTS Mean α angles were 25.1 ± 11.5° for AMst, 13.8 ± 4.8° for AMdi, 17.1 ± 13.4° for ALst, -2.6 ± 9.2° for ALdi. No overlapping in the 95% CI of ipsilateral standard and distal portals was observed, indicating that the difference between these means was statistically significant. The distal portals showed smaller inter-observer CoV as compared to the standard ones (AMst: 10.0%; AMdi: 4.6%; ALst: 12.5%; ALdi: 10.6%). Intra-observer CoV was similar for all portals (AMst: 5.5%; AMdi: 6.1%; ALst: 7.7%; ALdi: 7.1%). CONCLUSIONS The use of distal AM and AL portals permits to obtain α angles closer to the radial head articular surface than standard AM and AL portals. This is expected to allow screw placement in a flatter trajectory, which should correlate with a superior biomechanical performance of fixation. Good reproducibility of Kirschner wire placement from distal portals was observer among different examiners. Modifications to the standard AM and AL elbow arthroscopy portals allow to place screws for radial head fracture osteosynthesis in a position which should guarantee superior biomechanical performance of fixation.
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Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund- Freud-Str. 25, 53127, Bonn, Germany. .,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Paolo Arrigoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,U.O. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Francesco Luceri
- U.O. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.,Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Enrico Guerra
- Shoulder and Elbow Unit, Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Lars Peter Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center, Kerpenerstrasse 62, 50937, Cologne, Germany
| | - Christof Burger
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund- Freud-Str. 25, 53127, Bonn, Germany
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center, Kerpenerstrasse 62, 50937, Cologne, Germany
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Haasters F, Helfen T, Böcker W, Mayr HO, Prall WC, Lenich A. The value of elbow arthroscopy in diagnosing and treatment of radial head fractures. BMC Musculoskelet Disord 2019; 20:343. [PMID: 31351457 PMCID: PMC6661091 DOI: 10.1186/s12891-019-2726-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 07/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Surgical treatment of radial head fractures is increasingly performed arthroscopically. These fractures often feature concomitant injuries to the elbow joint, which may be under-diagnosed in the radiological examinations. Little is known about the diagnostic value of arthroscopy, the treatment options that arise from arthroscopically assisted fracture fixation and clinical results. We hypothesized that arthroscopy can detect additional concomitant injuries and simultaneously expands the therapeutic options. Therefore aim of this study was to compare arthroscopic and radiologic findings, to assess the distinct arthroscopic procedures and to follow up on the clinical outcomes. Methods Twenty patients with radial head fractures were retrospectively included in two study centers. All patients underwent elbow arthroscopy due to at least one of the following suspected concomitant injuries: osteochondral lesions of the humeral capitellum, injuries of the collateral ligaments or loose joint bodies. Preoperative radiological findings were compared to arthroscopic findings. Afterwards, arthroscopic treatment options and clinical outcomes were assessed. Results Arthroscopic findings led to revision of the classified fracture type in 70% (p = 0.001) when compared to preoperative conventional radiographs (CR) and in 9% (p = 0.598) when compared to computed tomography (CT) or magnetic resonance imaging (MRI). Diagnosis of loose bodies was missed in 60% (p < 0.001) of the CR and in 18% (p = 0.269) of the CT/MRI scans. Osteochondral lesions were not identified in 94% (p < 0.001) of the CR and in 27% (p = 0.17) of the CT/MRI scans. Percutaneous screw fixation was performed in 65% and partial radial head resection in 10%. Arthroscopy revealed elbow instability in 35%, leading to lateral collateral ligament reconstruction. After a mean follow up of 41.4 ± 3.4 months functional outcome was excellent in all cases (DASH-Score 0.6 ± 0.8; MEPI-Score 98.5 ± 2.4; OES-Score 47.3 ± 1.1). Conclusions Elbow arthroscopy has a significant diagnostic value in radial head fractures when compared to standard radiological imaging. Although statistically not significant, arthroscopy also revealed concomitant injuries in patients that presented with an uneventful MRI/CT. Furthermore, all intraarticular findings could be treated arthroscopically allowing for excellent functional outcomes. Trial registration Institutional Review Board University of Munich (LMU), Trial Number 507–14.
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Affiliation(s)
- Florian Haasters
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany. .,Department of Knee, Hip and Shoulder Surgery, Schön Klinik Munich-Harlaching, Academic Teaching Hospital of the Paracelsus Private Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria.
| | - Tobias Helfen
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany
| | - Wolfgang Böcker
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany
| | - Hermann O Mayr
- Department of Orthopaedics and Traumatology, Freiburg University Hospital, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg im Breisgau, Germany
| | - Wolf Christian Prall
- Hospital of General, Trauma and Reconstructive Surgery, University of Munich (LMU), Nussbaumstr. 20, 80336, Munich, Germany.,Department of Knee, Hip and Shoulder Surgery, Schön Klinik Munich-Harlaching, Academic Teaching Hospital of the Paracelsus Private Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria
| | - Andreas Lenich
- Department of Orthopedic Sports Medicine, University Hospital Rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Zhou Y, Pan Y, Wang Q, Hou Z, Chen W. Hoffa fracture of the femoral condyle: Injury mechanism, classification, diagnosis, and treatment. Medicine (Baltimore) 2019; 98:e14633. [PMID: 30813201 PMCID: PMC6408088 DOI: 10.1097/md.0000000000014633] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hoffa fractures are coronal-plane fractures of the femoral condyle, which are rarer than sagittal-plane condylar fractures. This study aimed to systematically review the clinical knowledge base of Hoffa fractures to facilitate the diagnosis and management of such injuries. METHODS We searched Medline, Embase, Cochrane Library, Google Scholar, China National Knowledge Infrastructure, and China Biology Medicine disc, using the terms "Hoffa fracture" and "coronal fracture of femoral condyle." RESULTS One hundred five articles on Hoffa fractures were reviewed, and the clinical knowledge base was summarized. High-energy trauma is a common cause of a Hoffa fracture, although low-energy trauma and iatrogenic injury can also lead to these fractures. Commonly used classifications include the Letenneur classification, a computed tomography (CT) classification, the AO classification, and modified AO classification. Radiography can reveal fracture lines. If radiographic findings are negative in questionable cases, CT and magnetic resonance imaging (MRI) should be performed. Nondisplaced fractures can be managed conservatively; however, they involve a high risk of redisplacement. Open reduction and internal fixation are preferred. For young patients with good compliance, simple medial or lateral condylar fractures can be treated via a medial or lateral parapatellar approach. After fracture exposure, headless compression screws can be inserted perpendicularly to the fracture line from posterior to anterior. For bicondylar fractures, a median parapatellar incision can be used. For complex fractures in patients with osteoporosis or a high body mass index, cannulated screws with antigliding plate fixation should be used. CONCLUSION Here, we summarized the injury mechanism, diagnosis, classification, and treatment options of Hoffa fractures.
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Affiliation(s)
- Yabin Zhou
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Orthopedic Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province
- Department of Orthopedic Surgery, Shijiazhuang The Third Hospital
| | - Ying Pan
- Department of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qingxian Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Orthopedic Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province
| | - Zhiyong Hou
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Orthopedic Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province
| | - Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Orthopedic Research Institution of Hebei Province, Key Laboratory of Biomechanics of Hebei Province
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19
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Chraim M, Alrabai HM, Krenn S, Bock P, Trnka HJ. Short-Term Results of Endoscopic Percutaneous Longitudinal Tenotomy for Noninsertional Achilles Tendinopathy and the Presentation of a Simplified Operative Method. Foot Ankle Spec 2019; 12:73-78. [PMID: 30047803 DOI: 10.1177/1938640018790070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE This study was aimed to review the short-term results of endoscopic percutaneous longitudinal tenotomy for noninsertional Achilles tendinopathy using the Centerline Endoscopic Carpal Tunnel Release instrument (Arthrex). This method simplifies the operation technique, allows a good endoscopic visualisation of the Achilles tendon with very promising results. METHODS We performed multiple percutaneous longitudinal tenotomies under local anesthesia in 24 patients (25 tendons) with Achilles tendinopathy or peritendinitis that had failed conservative treatment between January 2013 and September 2016. All ambulatory procedures consisted of paratenon release and longitudinal tenotomies. The results were reviewed in 22 patients (23 tendons) at an average follow-up period of 22.5 months (range 10-36 months). Patients' satisfaction and functional outcomes were evaluated using the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, the pain visual analog scale (VAS), and the functional foot index. RESULTS Initial results are very promising with excellent results in 12 patients, good results in 9 patients, and fair result in 1 patient. One patient developed a postoperative thrombosis of the operated limb. Another patient developed a hypertrophic painful scar of the incision wound. The VAS for pain decreased drastically after the index procedure and averaged to 0.2 (SD 0.447). The VISA-A questionnaire score had improved from 42 ± 7.2 points preoperatively to 96.8 ± 14.3 points postoperatively (P = .004). The functional foot index decreased from 84 (SD 30.517) to 33.4 (SD 6.452) on the follow-up examination. CONCLUSIONS The endoscopic-assisted longitudinal tenotomies procedure of the Achilles tendon is easily feasible and can be performed on an outpatient basis, produces minimal complications and shows excellent results. The described technique is recommended for all surgeons especially for those familiar with endoscopy of the Achilles tendon. LEVELS OF EVIDENCE Therapeutic, Level IV: Case Series.
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Affiliation(s)
- Michel Chraim
- Department of Paediatric Orthopaedics, Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria (MC, SK, PB).,Department of Orthopaedics, King Saud University, Riyadh, Saudi Arabia (HMA).,Fusszentrum Wein, Vienna, Austria (HT)
| | - Hamza M Alrabai
- Department of Paediatric Orthopaedics, Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria (MC, SK, PB).,Department of Orthopaedics, King Saud University, Riyadh, Saudi Arabia (HMA).,Fusszentrum Wein, Vienna, Austria (HT)
| | - Sabine Krenn
- Department of Paediatric Orthopaedics, Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria (MC, SK, PB).,Department of Orthopaedics, King Saud University, Riyadh, Saudi Arabia (HMA).,Fusszentrum Wein, Vienna, Austria (HT)
| | - Peter Bock
- Department of Paediatric Orthopaedics, Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria (MC, SK, PB).,Department of Orthopaedics, King Saud University, Riyadh, Saudi Arabia (HMA).,Fusszentrum Wein, Vienna, Austria (HT)
| | - Hans-Jörg Trnka
- Department of Paediatric Orthopaedics, Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Vienna, Austria (MC, SK, PB).,Department of Orthopaedics, King Saud University, Riyadh, Saudi Arabia (HMA).,Fusszentrum Wein, Vienna, Austria (HT)
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20
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A combination of an anteromedial, anterolateral and midlateral portals is sufficient for 360° exposure of the radial head for arthroscopic fracture fixation. Knee Surg Sports Traumatol Arthrosc 2019; 27:319-325. [PMID: 30069651 DOI: 10.1007/s00167-018-5077-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Arthroscopic fixation of radial head fractures is an alternative to open reduction and internal fixation; the latter, however, presents the advantage of minimal soft-tissue damage. The exposure of the radial head for adequate screw placement can be technically challenging. The aim of this study was to evaluate the inter-observer agreement on the effective contact arc in the axial plane of the radial head of three different elbow arthroscopy portals. METHODS A fresh-frozen cadaver specimen was obtained and prepared in an arthroscopic setting. Standard anterolateral (AL), anteromedial (AM), and midlateral (ML) portals were established and a circular reference system was marked on the radial head. Ten orthopaedic surgeons were then asked to move the forearm from maximal supination to maximal pronation and indicate with a Kirschner wire from each portal the extension in which they would feel confident in placing a cannulated screw passing through the centre of the articular plane of the radial head (axial contact arc). The Shapiro-Wilk normality test was used to evaluate the normal distribution of the sample. A coefficient of variation (CoV) was calculated to determine agreement among observers. RESULTS The average arc of axial contact arc that could be contacted from the AM portal measured 150 ± 14.1°, or 41.7% of the radial head circumference; the one from the AL portal measured 257 ± 29.5°, or 71.4% of the radial head circumference; that from the ML portal measured 212.5 ± 32.6°, or 59.0% of the radial head circumference. Considering all three portals, the whole radial head circumference could be contacted. The AM portal showed the smallest CoV (9.4%) as compared to the AL (11.5%), and the ML (15.3%) portals. CONCLUSIONS With an appropriate use of the standard AL, AM, and ML portals, the whole radial head circumference can be effectively exposed for adequate fixation of radial head fractures. The contact arc of the AM portal presents the smallest variability among different observers and the AL portal shows a superiority in axial contact arc. This information is important for pre-operative planning, and helps to define the limits of arthroscopic radial head fracture fixation.
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21
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Vendeuvre T, Grunberg M, Germaneau A, Maloubier F, Faure JP, Gayet LE, Rigoard P, Brèque C. Contribution of minimally invasive bone augmentation to primary stabilization of the osteosynthesis of Schatzker type II tibial plateau fractures: Balloon vs bone tamp. Clin Biomech (Bristol, Avon) 2018; 59:27-33. [PMID: 30142475 DOI: 10.1016/j.clinbiomech.2018.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/18/2018] [Accepted: 08/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Schatzker type II tibial plateau fractures necessitate the least invasive treatment possible. Arthroscopic reduction by bone tamp followed by osteosynthesis is the current gold standard for this type of tibial plateau fracture. The objective of this study was to compare this technique to anterior approach tuberoplasty with balloon reduction. The comparison criteria were residual articular step off, metaphyseal cavity volume formed during reduction, and mechanical strength to separation and to depression displacement. METHODS Fractures were created on 12 human cadaveric tibiae and reduced by a minimally invasive approach in six specimens by a balloon, and by bone tamp in the six others. Articular step off and metaphyseal-epiphyseal cavity volume were measured by TDM. Mechanical tests were performed up to assembly failure to characterize structural strength. Secondary displacements, fracture depression displacement and separation were measured by optical methods. FINDINGS There was no significant difference in step off measurement after balloon reduction or bone tamp (0.29 cm vs 0.37 cm; p = 0.06). The cavity volume formed by balloon reduction was significantly smaller than the volume created by bone tamp reduction (0.45 cm3 vs 5.12 cm; p = 0.002). The compressive load required for assembly failure was significantly greater in the balloon group than in the bone tamp group (1210.17 N vs 624.50 N; p = 0.015). INTERPRETATION There exists a correlation between load to failure of the assembly frame and the metaphyseal volume required for bone fracture reduction. The minimally invasive balloon technique has fewer negative effects on the osseous stock, thereby enabling better primary structural strength of the fracture.
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Affiliation(s)
- T Vendeuvre
- Department of Orthopaedic Surgery and Traumatology, CHU, Poitiers, France; Spine & Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France; Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | - M Grunberg
- Department of Orthopaedic Surgery and Traumatology, CHU, Poitiers, France
| | - A Germaneau
- Spine & Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France.
| | | | - J-P Faure
- ABS Lab, Université de Poitiers, France
| | - L-E Gayet
- Department of Orthopaedic Surgery and Traumatology, CHU, Poitiers, France
| | - P Rigoard
- Spine & Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France; Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | - C Brèque
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France; ABS Lab, Université de Poitiers, France
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22
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Michelitsch C, Sommer C. [Reduction techniques for osteosynthesis of intra-articular fractures]. Unfallchirurg 2018; 122:110-119. [PMID: 30357429 DOI: 10.1007/s00113-018-0570-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The cornerstones for treatment of articular fractures are gentle handling of soft tissues and anatomical reconstruction of the articular surface with stable fixation, which enables a functional aftercare. By respecting these principles, satisfactory functional and radiological results with low complication rates can be achieved even for complex fracture patterns. Fracture complexity varies with the energy load during the trauma mechanism. The personality of the fracture must be recognized and totally understood by the operating trauma surgeon. The soft tissue situation in particular is of decisive importance. The definition of a fracture as a soft tissue injury that happens to have a broken bone in it is generally accepted and the local soft tissue status is seen as extremely significant. The success or failure of the treatment correlates with the correct interpretation of the overall situation. Meticulous planning is therefore an indispensable prerequisite for operative fracture treatment. Successful fracture management depends on individualized decision making with respect to optimal timing of the operative intervention, reconstruction strategy of the articular surface, choice of surgical approach, reduction maneuver technique and choice of implant. This strategy must be adapted to individual-specific fracture patterns and the patient's general condition. The aim of this article is to provide an overview of the strategy and technique in management of articular fractures, with the main focus on reduction maneuver techniques.
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Affiliation(s)
- C Michelitsch
- Klinik für Unfallchirurgie, Departement Chirurgie, Kantonsspital Graubünden, Loëstr. 170, 7000, Chur, Schweiz.
| | - C Sommer
- Klinik für Unfallchirurgie, Departement Chirurgie, Kantonsspital Graubünden, Loëstr. 170, 7000, Chur, Schweiz
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Li J, Liu C, Li Z, Fu Y, Yang Y, Zhang Q. Arthroscopic Fixation for Tibial Eminence Fractures: Comparison of Double-Row and Transosseous Anchor Knot Fixation Techniques with Suture Anchors. Med Sci Monit 2018; 24:7348-7356. [PMID: 30318505 PMCID: PMC6198712 DOI: 10.12659/msm.912961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Tibial eminence fractures often occur during sports participation, but the optimum choice of technique for treatment is still controversial. The aim of the current work was to compare the clinical outcomes of 2 new arthroscopic anchor fixation techniques for tibial eminence fracture. Material/Methods We included 72 isolated tibial eminence fracture patients treated at our hospital from October 2010 to August 2015; 37 patients received the classic double-row (DR) suture anchor fixation technique and 35 received the transosseous anchor knot (TAK) fixation under arthroscopy. The clinical efficacies of the 2 techniques were assessed by radiographs, Lysholm score, and International Knee Documentation Committee (IKDC) score in follow-ups. Results Patients were followed for 37.6 months (range, 18–54 months). There was no significant difference of the operative time between groups (P=0.169). Postoperative radiographs of all patients showed accurate reduction and fracture healing within 3 months. Lysholm and IKDC scores improved significantly compared with preoperative scores (P<0.001). However, no significant difference in the knee range of motion or improvement of Lysholm and IKDC scores was found between groups (P>0.05). Conclusions The DR and TAK techniques provide precise reduction and stable fixation methods for treating tibial eminence fractures, and the clinical outcomes of the 2 arthroscopic techniques with suture anchors are satisfactory.
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Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
| | - Chuihui Liu
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
| | - Yangmu Fu
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
| | - Yimeng Yang
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
| | - Qiang Zhang
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
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Why do we use arthroscopy for distal radius fractures? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1505-1514. [DOI: 10.1007/s00590-018-2263-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/30/2018] [Indexed: 01/12/2023]
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Li J, Yu Y, Liu C, Su X, Liao W, Li Z. Arthroscopic Fixation of Tibial Eminence Fractures: A Biomechanical Comparative Study of Screw, Suture, and Suture Anchor. Arthroscopy 2018; 34:1608-1616. [PMID: 29397286 DOI: 10.1016/j.arthro.2017.12.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/09/2017] [Accepted: 12/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare biomechanical outcomes of 4 different arthroscopic techniques for fixation of tibial eminence fractures. METHODS Twenty-four skeletally mature, fresh-frozen cadaveric knees were divided into 4 comparison groups based on the fixation method: screw fixation (group A), traditional sutures fixation with 2 FiberWire sutures (group B), a modified suture technique with 2 FiberWire sutures that created neckwear knots to firmly trap the fracture fragment (group C), or suture anchors which was based on the suture bridge technique primarily used in the shoulder for repair of rotator cuff tears and greater tuberosity fractures (group D). A tibial eminence fracture was created in each knee for subsequent fixation. After fixation, each knee underwent cyclic loading of 100 N to assess the displacement change after 500 cycles of the fixation construct. Afterward, a single tensile failure test load was performed to assess the ultimate failure load, stiffness, and failure mode for each specimen. RESULTS All specimens survived cyclic testing and were subsequently loaded to failure. Group C had the highest ultimate failure load (P < .05) and group D had the lowest displacement compared with the other 3 groups (P < .05). Different failure modes were found among the 4 groups. CONCLUSIONS Suture fixation using the neckwear knots technique provides superior fixation with regard to higher ultimate failure load, and absorbable suture anchor fixation with the suture bridge technique provides less displacement under cyclic loading conditions. Both techniques exhibited superior biomechanical properties compared with traditional screw and suture fixation. CLINICAL RELEVANCE The new techniques showed satisfactory biomechanical properties and provided more choice for surgeons in the treatment of tibial eminence fractures.
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Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Yang Yu
- Department of Orthopedics, Chinese PLA 252 Hospital, Baoding, Hebei, China
| | - Chunhui Liu
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Xiangzheng Su
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Weixiong Liao
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China.
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Abstract
The indications for arthroscopy have expanded over the years. Arthroscopic-assisted open reduction internal fixation in the setting of acute trauma is gaining popularity with foot and ankle surgeons. It serves to facilitate direct visualization of fracture fragments and allows for precise articular reduction with minimal soft tissue insult. Current evidence reports a high incidence of chondral injury with ankle fractures. Arthroscopy performed at the time of open reduction internal fixation allows for joint inspection and potential treatment of these posttraumatic defects.
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Wang J, Qi W, Shen X, Tao S, Liu Y. Results of arthroscopic fixation of Mason type II radial head fractures using Kirschner wires. Medicine (Baltimore) 2018; 97:e0201. [PMID: 29561446 PMCID: PMC5895338 DOI: 10.1097/md.0000000000010201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The goals of this study are to report an arthroscopic technique for the treatment of Mason type II radial head fractures using Kirschner wires (K-wires), and investigate the feasibility and evaluate the results.We retrospectively review 18 cases of closed Mason type II radial head fractures treated in our institution from August 2010 to May 2015. There were 13 males and 5 females with an average age of 30.6 (17-45 years) years. Injuries were caused by falling in 8 cases, by traffic accidents in 5 cases, and by sports in 5 cases. The average time from injury to admission was 3.9 days (1-11 days). All radial head fractures were confirmed on x-ray and computed tomography. The fracture fragments were fixed with percutaneous K-wires under arthroscopy.All surgical wounds healed with primary closure, and no complication occurred, such as neurovascular injury, infection, or hardware failure. All patients were followed up for a mean period of 19 months (range: 14-29 months). Bone union was achieved for all patients with a mean time of 11 weeks. At final follow-up, range of motion of the elbow has no significant difference in comparison to the uninjured side. The mean Visual Analog Scale for these patients was 1.7 (range 0-3). According to the Broberg-Morrey score, there were 7 excellent, 9 good, 2 fair, and 0 poor results (with good or excellent results in 89%). Mayo elbow performance score and the disabilities of the arm, shoulder, and hand score were significantly improved postoperatively.The present study demonstrates that arthroscopic fixation of Mason type II radial head fractures using K-wires provided a stable fixation with good clinical outcomes and patient satisfaction.
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Hüftgelenkarthroskopie bei Frakturen und Frakturfolgen. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-017-0177-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Liu P, Guo Y, Wen Y, Wang W. Clinical application of arthroscopy-assisted minimally invasive therapy in Chinese elderly with type III Pilon fracture. Clin Interv Aging 2017; 12:2033-2038. [PMID: 29238178 PMCID: PMC5716396 DOI: 10.2147/cia.s140272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Pilon fracture is so complex that its therapy poses a great challenge to surgeons. Few studies have compared arthroscopy-assisted minimally invasive therapy and external fixation combined with limited internal fixation (EFLIF), and an optimal choice of surgical therapy remains unclear in patients with type III Pilon fracture. Moreover, to our knowledge, very few studies have specifically evaluated arthroscopy-assisted minimally invasive therapy in Chinese elderly with type III Pilon fracture. The current study was performed to observe the clinical application of arthroscopy-assisted minimally invasive therapy, compared with EFLIF, in Chinese elderly with type III Pilon fracture. Methods There were 230 Chinese elderly with type III Pilon fracture assigned to undergo EFLIF (group A, n=115) or arthroscopy-assisted minimally invasive therapy (group B, n=115), and followed up for 1 year after surgery. Results Age, sex, causes, sides and types of Pilon fractures were not different between the two groups (P>0.05 for all). Compared with EFLIF, arthroscopy-assisted minimally invasive therapy achieved a better reduction result, bone union and Mazur system (P<0.05 for all). Patient satisfaction, screw loosening and infection prevalence were not different between the two groups (P>0.05 for all). There was no skin necrosis in the two groups. Traumatic arthritis had a significantly lower prevalence in participants with arthroscopy-assisted minimally invasive therapy than EFLIF (P<0.05 for all). Conclusion Compared with EFLIF, arthroscopy-assisted minimally invasive therapy for type III Pilon fracture significantly improved reduction result, bone union and functional status, and decreased traumatic arthritis, demonstrating that arthroscopy-assisted minimally invasive therapy is an optimal choice for type III Pilon fracture in Chinese elderly.
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Affiliation(s)
- Peiming Liu
- The Eleventh Department of Orthopaedics, The Fifth Hospital of Harbin, Harbin, China
| | - Yong Guo
- The Eleventh Department of Orthopaedics, The Fifth Hospital of Harbin, Harbin, China
| | - Ying Wen
- The Eleventh Department of Orthopaedics, The Fifth Hospital of Harbin, Harbin, China
| | - Wei Wang
- The Eleventh Department of Orthopaedics, The Fifth Hospital of Harbin, Harbin, China
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Vega J, Dalmau-Pastor M, Malagelada F, Fargues-Polo B, Peña F. Ankle Arthroscopy: An Update. J Bone Joint Surg Am 2017; 99:1395-1407. [PMID: 28816902 DOI: 10.2106/jbjs.16.00046] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jordi Vega
- 1Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain 2Human Anatomy and Embriology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain 3Manresa Health Science School, University of Vic-Central University of Catalonia, Barcelona, Spain 4Foot and Ankle Unit, Department of Orthopaedic Surgery, Heatherwood and Wexham Park Hospitals, Frimley Health NHS Trust, Ascot, Berkshire, United Kingdom 5Foot and Ankle Unit, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
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Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2017; 1:325-331. [PMID: 28461964 PMCID: PMC5367527 DOI: 10.1302/2058-5241.1.160016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The management of articular fractures is always a matter of concern. Each articular fracture is different from the other, whatever the classification system used and the surgical or non-surgical indications employed by the surgeon. The main goals remain anatomical reduction, stable fixation, loose body removal and minimal invasiveness. Open procedures are a compromise. Unfortunately, it is not always possible to meet every treatment goal perfectly, since associated lesions can pass unnoticed or delay treatment, and even in a ‘best-case’ scenario there can be complications in the long term. In the last few decades, arthroscopic joint surgery has undergone an exponential evolution, expanding its application in the trauma field with the development of arthroscopic and arthroscopically-assisted reduction and internal fixation (ARIF) techniques. The main advantages are an accurate diagnosis of the fracture and associated soft-tissue involvement, the potential for concomitant treatments, anatomical reduction and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee and ankle. The purpose of this paper is to provide a review of the most recent literature concerning arthroscopic and arthroscopically-assisted reduction and internal fixation for articular and peri-articular fractures of the upper limb, to analyse the results and suggest the best clinical applications. ARIF is an approach with excellent results in treating upper-limb articular and peri-articular fractures; it can be used in every joint and allows treatment of both the bony structure and soft-tissues. Post-operative outcomes are generally good or excellent. While under some circumstances ARIF is better than a conventional approach, the results are still beneficial due to the consistent range of movement recovery and shorter rehabilitation time. The main limitation of this technique is the steep learning curve, but investing in ARIF reduces intra-operative morbidity, surgical errors, operative times and costs.
Cite this article: Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. EFORT Open Rev 2016;1:325-331. DOI: 10.1302/2058-5241.1.160016.
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Affiliation(s)
- Luca Dei Giudici
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Faini
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Garro
- II Orthopaedic Division, Istituto Chirurgico Ortopedico Traumatologico, ICOT, Latina, Italy
| | - Agostino Tucciarone
- II Orthopaedic Division, Istituto Chirurgico Ortopedico Traumatologico, ICOT, Latina, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science DISCLIMO, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
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Piétu G, Ehlinger M. Minimally invasive internal fixation of distal femur fractures. Orthop Traumatol Surg Res 2017; 103:S161-S169. [PMID: 27867137 DOI: 10.1016/j.otsr.2016.06.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 02/07/2023]
Abstract
Fractures of the distal femur remain a daunting challenge. Since 1970, operative treatment has been recommended. Unfortunately, it is fraught with complications, and techniques have been developed to limit incidence of non-union, infection and stiffness. A soft-tissue friendly approach is the key point, with minimally invasive surgery as the ultimate goal: its biological and anatomical advantages have been demonstrated, but clinical studies have been less convincing, being based on historical series. At present, retrograde nailing and minimally invasive percutaneous plate osteosynthesis (ideally by locking plate) are the two main techniques. Unfortunately, reports tend to compare implants rather than operative techniques, hindering solid conclusions. Lastly, the delineation of "distal femur fracture" is quite variable, sometimes situated well above the AO epiphyseal square. Meta-analyses find almost no difference between the two implants in minimally invasive procedures. The main advantage of the plate is its versatility, whereas nailing can be impossible in case of certain hip or knee prostheses, compound articular fracture or medullary canal obstruction by fixation material (nail, stem, screw, etc.). The role of arthroscopy is limited. Only a few case reports describe its use in reduction of epiphyseal fracture. In the last analysis, the surgeon's experience is more relevant to outcome than any particular implant.
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Affiliation(s)
- G Piétu
- Clinique chirurgicale orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - M Ehlinger
- Service de chirurgie orthopédique et traumatologique, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67089 Strasbourg cedex 1, France
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Livet V, Cachon T. Avulsion fracture of the femoral attachment of the caudal cruciate ligament treated by arthroscopy in a Bernese Mountain puppy. VETERINARY RECORD CASE REPORTS 2017. [DOI: 10.1136/vetreccr-2016-000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kim YS, Lee HJ, Kim JI, Yang H, Jin HK, Patel HK, Kim JH, Park I. Arthroscopic fixation of the clavicle shaft fracture. J Orthop Surg (Hong Kong) 2017; 25:2309499016684411. [PMID: 28142348 DOI: 10.1177/2309499016684411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article describes an arthroscopic technique for the fixation of clavicle shaft fractures. A viewing portal is made 2 cm anterior to the fracture site, and a working portal is made 2 cm lateral to the fracture site. The guide wire for a 4.0-mm cannulated screw is inserted through the fracture site to the medial fracture fragment under arthroscopic guidance. Through the medial fragment, the guide wire is delivered through the skin anteriorly. The fracture is reduced, and then, the guide wire is drilled back across the fracture site to the lateral fracture fragment. After confirming the reduction under arthroscopy, the appropriately sized cannulated screw is inserted after reaming. This arthroscopic technique would be useful for the precise reduction and minimal invasive fixation of clavicle shaft fractures. Preliminary results are encouraging, and further studies with long-term follow-up are needed to determine the precise indications and limitations of the procedure.
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Affiliation(s)
- Yang-Soo Kim
- 1 Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo-Jin Lee
- 1 Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Ick Kim
- 1 Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyo Yang
- 1 Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong-Ki Jin
- 1 Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hiren Kirtibhai Patel
- 1 Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Ho Kim
- 1 Department of Orthopedic Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Park
- 2 Department of Orthopedic Surgery, Armed Forces Capital Hospital, Bundang-gu, Gyeonggi-do, Korea
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Luo H, Chen L, Liu K, Peng S, Zhang J, Yi Y. Minimally invasive treatment of tibial pilon fractures through arthroscopy and external fixator-assisted reduction. SPRINGERPLUS 2016; 5:1923. [PMID: 27917329 PMCID: PMC5097778 DOI: 10.1186/s40064-016-3601-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 10/25/2016] [Indexed: 11/21/2022]
Abstract
Objective The aim of this study was to evaluate the clinical outcome of tibial pilon fractures treated with arthroscopy and assisted reduction with an external fixator. Methods Thirteen patients with tibial pilon fractures underwent assisted reduction for limited lower internal fixation with an external fixator under arthroscopic guidance. The weight-bearing time was decided on the basis of repeat radiography of the tibia 3 months after surgery. Postoperative ankle function was evaluated according to the Mazur scoring system. Results Healing of fractures was achieved in all cases, with no complications such as severe infection, skin necrosis, or an exposed plate. There were 9 excellent, 2 good, and 2 poor outcomes, scored according to the Mazur system. The acceptance rate was 85%. Conclusion Arthroscopy and external fixator-assisted reduction for the minimally invasive treatment of tibial pilon fractures not only produced less trauma but also protected the soft tissues and blood supply surrounding the fractures. External fixation could indirectly provide reduction and effective operative space for arthroscopic implantation, especially for AO type B fractures and partial AO type C1 fractures.
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Affiliation(s)
- Huasong Luo
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China ; Department of Orthopedics, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
| | - Liaobin Chen
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Kebin Liu
- Department of Orthopedics, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
| | - Songming Peng
- Department of Orthopedics, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
| | - Jien Zhang
- Department of Orthopedics, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
| | - Yang Yi
- Department of Orthopedics, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, 434000 China
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Arrigoni P, D'Ambrosi R, Cucchi D, Nicoletti S, Guerra E. Arthroscopic fixation of coronoid process fractures through coronoid tunnelling and capsular plication. JOINTS 2016; 4:153-158. [PMID: 27900307 DOI: 10.11138/jts/2016.4.3.153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE the purpose of this study is to describe a new arthroscopic technique for reduction and fixation of coronoid process fractures (CPFs) and report clinical and functional results in 4 patients after a 24-month follow-up. METHODS four patients underwent arthroscopic reduction and fixation of isolated CPFs (acute or non-unions, type I or type II according to the Regan-Morrey classification) performed using a new technique based on coronoid tunnelling and capsular plication. The patients were evaluated 6, 12 and 24 months after surgery, using the Disability of the Arm, Shoulder and Hand scale (DASH), the Mayo Elbow Performance Index (MEPI), and a visual analog scale (VAS); elbow range of motion (ROM) and joint stability were also evaluated and the rate of complications was reported. RESULTS all 4 patients completed the follow-up. At 6, 12 and 24 months, respectively, they recorded mean DASH scores of 22, 14 and 7, mean MEPI scores of 74, 82 and 94, and mean VAS scores of 4, 2 and 1. The mean ROM increased in all directions (at 6, 12 and 24 months, respectively: flexion: 112°, 125°, 144°; extension: 3°, 5°, 6°; pronation: 76°, 84°, 91°; supination: 78°, 82°, 86°). No signs of instability were observed and no complications were reported. CONCLUSIONS the new all-arthroscopic coronoid tunnelling and capsular plication technique here proposed can restore elbow function, ROM and stability and allows anatomical reconstruction of the joint after type I or type II CPFs. If performed by an experienced arthroscopist, it is a valid alternative to open reduction and external fixation. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Paolo Arrigoni
- Università degli Studi di Milano, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Riccardo D'Ambrosi
- Università degli Studi di Milano, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Davide Cucchi
- Università degli Studi di Milano, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Yoo JY, O'Malley MJ, Matsen Ko LJ, Cohen SB, Sharkey PF. Knee Arthroplasty After Subchondroplasty: Early Results, Complications, and Technical Challenges. J Arthroplasty 2016; 31:2188-92. [PMID: 27430180 DOI: 10.1016/j.arth.2015.12.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Calcium phosphate bone substitutes (CPBS) are commonly used to augment and repair bone voids and defects after fractures around the knee joint. The purpose of this study was to determine whether prior arthroscopic application of a CPBS, for repair of magnetic resonance imaging-identified subchondral fractures associated with osteoarthritis (procedure referred to as subchondroplasty) adversely affected the performance and/or outcome of subsequent knee arthroplasty. METHODS Twenty-two patients who had arthroscopic repair of a periarticular fracture combined with use of a CPBS who later had knee arthroplasty were identified. Average follow-up for study patients was 23.5 months (range 12-52 months). These patients were matched demographically and for follow-up duration in a 2:1 ratio to a group of control subjects undergoing arthroplasty who had not undergone prior surgery. RESULTS Technical challenges related to surgical performance, clinical outcomes, and complications were determined for both the groups. At most recent follow-up, study patients had an average Oxford score of 40.6 (range, 25-48) compared with control subjects with an average score of 40.1 (range, 12-48). There was no difference in complications or surgical complexity between groups, and only standard primary components were used. CONCLUSION The results of our study suggest that prior arthroscopic repair combined with CPBS of periarticular fractures around the knee does not compromise the early outcomes and surgical performance or increase complications related to subsequent arthroplasty. However, longer follow-up of these patients is warranted to confirm that implant durability remains uncompromised.
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Affiliation(s)
- Joanne Y Yoo
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael J O'Malley
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Laura J Matsen Ko
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Steven B Cohen
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Peter F Sharkey
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Park JY, Chung WC, Kim CK, Huh SH, Kim SJ, Jung BH. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note. Hip Pelvis 2016; 28:120-6. [PMID: 27536654 PMCID: PMC4972886 DOI: 10.5371/hp.2016.28.2.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/12/2016] [Accepted: 04/28/2016] [Indexed: 11/24/2022] Open
Abstract
Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note.
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Affiliation(s)
- Jin Young Park
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Woo Chull Chung
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Che Keun Kim
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Soon Ho Huh
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Se Jin Kim
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Bo Hyun Jung
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
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Balioğlu MB, Akman YE, Bahar H, Albayrak A. Treatment of malreduced pilon fracture: A case report and the result in the long-term follow-up. Int J Surg Case Rep 2015; 19:82-6. [PMID: 26724734 PMCID: PMC4756181 DOI: 10.1016/j.ijscr.2015.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/05/2015] [Accepted: 12/17/2015] [Indexed: 11/26/2022] Open
Abstract
Tibial plafond fractures carry a high risk for post-traumatic osteoarthritis. Tricortical iliac crest autologous bone grafting (TCG) avoided need for arthrodesis. TCG with internal fixation restored joint stability, congruency and alignment. TCG should be considered for whom biological restoration is feasible.
Introduction The risk for post-traumatic osteoarthritis (POA) following tibial plafond joint trauma has been reported to be as high as 70–75%. In the treatment of more severe joint pathologies, with incongruity and intra-articular defects, internal or external fixations techniques may be required. Presentation of case We report the orthopedic management of a pilon fracture in a 30-year-old male with malunion and implant failure after initial mal-reduction of the fracture 9-months earlier. Tricortical iliac crest autologous bone grafting (TCG) was used in combination with internal fixation to restore distal tibial articular. The procedure resulted in a pain free ankle, sufficient range of motion for function and patient satisfaction. Discussion Early surgical intervention and anatomical reduction with appropriate fixation are recommended for intra-articular tibial pilon fractures. Autogenous bone grafting is a reliable treatment option to augment structural stability, bone defects and bone-healing. Indications for bone grafting include delayed union or nonunion, malunion, arthrodesis, limb salvage, and reconstruction of bone voids or defects. The application of TCG in the management of a malreduced tibial plafond fracture has not been described before. Conclusion We performed TCG with internal fixation in order to restore stability, congruency and alignment in a young patient in whom a biological restoration was feasible due to good bone quality. In suitable cases, TCG might provide an alternative to arthrodesis or arthroplasty.
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Affiliation(s)
- Mehmet Bulent Balioğlu
- Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Baltalimani, Istanbul, Turkey.
| | - Yunus Emre Akman
- Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Baltalimani, Istanbul, Turkey.
| | - Hakan Bahar
- Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Baltalimani, Istanbul, Turkey.
| | - Akif Albayrak
- Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Baltalimani, Istanbul, Turkey.
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El-Mowafi H, El-Hawary A, Kandil Y. The management of tibial pilon fractures with the Ilizarov fixator: The role of ankle arthroscopy. Foot (Edinb) 2015; 25:238-43. [PMID: 26442442 DOI: 10.1016/j.foot.2015.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 07/11/2015] [Accepted: 08/06/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pilon fractures usually result from high energy trauma, and are commonly associated with extensive soft tissue damage which prevents the use of open reduction and internal fixation. PURPOSE This study was designed to evaluate the use of the Ilizarov external fixator in the treatment of pilon fractures of the ankle, and to determine whether arthroscopy of the ankle could improve the outcome. METHODS From February 2011 to May 2013 a total of 23 patients with unilateral closed pilon fractures were divided into two groups treated with and without arthroscopy during fixation with the Ilizarov external fixator. The fractures were classified according to the AO Rüdi and Allgőwer classification. Follow up ranged from 10 to 37 months with a mean of 18 months. RESULTS All cases were evaluated at follow up by the AOFAS and the Bone et al. grading system. According to Bone et al. there were 3 cases excellent, 4 cases good, 2 cases fair, and 2 cases poor in Group A (without arthroscopy), whereas there were 4 cases excellent, 6 cases good, 2 cases fair in Group B (with arthroscopy). The AOFAS score for Group A was 77.8±5.8, and for Group B was 78.4±6.9. CONCLUSION We concluded that the Ilizarov external fixator is an excellent method in treating pilon fractures as it minimizes the need for extensive surgery. We also conclude that the use of arthroscopy during pilon fracture fixation did not add statistically significant improvement to our results and it needs longer term investigation to assess its advantage - if any - to the final outcome. LEVEL OF EVIDENCE level 2.
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Affiliation(s)
- Hani El-Mowafi
- Mansoura University Hospital, Mansoura Faculty of Medicine, Elgomhoria Street, Mansoura 35516, Aldakhlia, Egypt.
| | - Ahmed El-Hawary
- Mansoura University Hospital, Mansoura Faculty of Medicine, Elgomhoria Street, Mansoura 35516, Aldakhlia, Egypt
| | - Yasser Kandil
- Mansoura University Hospital, Mansoura Faculty of Medicine, Elgomhoria Street, Mansoura 35516, Aldakhlia, Egypt
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Abstract
Several types of elbow fractures are amenable to arthroscopic or arthroscopic-assisted fracture fixation, including fractures of the coronoid, radial head, lateral condyle, and capitellum. Other posttraumatic conditions may be treated arthroscopically, such as arthrofibrosis or delayed radial head excision. Arthroscopy can be used for assessment of stability or intra-articular fracture displacement. The safest portals are the midlateral (soft spot portal), proximal anteromedial, and proximal anterolateral. Although circumstances may vary according to the injury pattern, a proximal anteromedial portal is usually established first. Arthroscopy enables a less invasive surgical exposure that facilitates visualization of the fracture fragments in select scenarios.
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Affiliation(s)
- Leslie A Fink Barnes
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA
| | - Bradford O Parsons
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
| | - Michael Hausman
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai Medical Center, 5 East 98th Street, Box 1188, New York, NY 10029, USA
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Huang W, Gong X, Rahul M, Priyanka S, Wang C, Liang X, Ding G, Hu N. Anterior arthroscopic-assisted fixation of posterior cruciate ligament avulsion fractures. Eur J Med Res 2015; 20:88. [PMID: 26514777 PMCID: PMC4625641 DOI: 10.1186/s40001-015-0177-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022] Open
Abstract
Background Avulsion fractures of the tibial insertion of the posterior cruciate ligament (PCL) have always been regarded as rare injuries. The tibial attachment of the PCL is located in an area, which is difficult to access. Hypothesis To verify the effects of anterior arthroscopic fixation of PCL avulsion fractures. Methods 18 patients with PCL avulsion fracture were included. The inclusion criteria were: (1) the fracture fragment size was greater than 20 mm; (2) surgery in the acute phase of fractures (<3 weeks). The intervention was anterior arthroscopic fixation of fractures. Outcome variables included posterior laxity assessment with KT2000 arthrometer, posterior sag sign, the quadriceps activation test, the reverse Lachman, posterior stress X-rays, range of motion, and the IKDC form assessment. Results Complete osseous union showed in all cases during the follow-up (24–49 months). The posterior laxity assessment demonstrated slight posterior tibia translation (<5 mm) on the femur in 1 patient at 89 N and in 2 at maximal testing. All were stable on the posterior sag sign, the quadriceps activation test, the reverse Lachman and posterior stress X-rays. Two had loss of flexion of about 10° (grade B). Others showed a full range of knee motion. According to the IKDC form assessment, 16 patients were classified as grade A and 2 were classified as grade B. 16 of 18 patients were absolutely pain free, and there was general satisfaction on pain questionnaire. All the patients returned to their pre-injury knee function. No revision surgery was performed. Conclusions The anterior arthroscopic-assisted fixation guided with a tibial PCL guide is a simple and feasible alternative for treating PCL avulsion fractures when the fragment size is larger than 20 mm. Level of evidence Case–control study, Level III.
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Affiliation(s)
- Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Xuan Gong
- Department of Outpatient, Chongqing Zhongshan Hospital, Chongqing, 400013, China.
| | - Mishra Rahul
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Shukla Priyanka
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Changdong Wang
- Department of Biochemistry and Molecular Biology, Molecular Medicine and Cancer Research Center, Chongqing Medical University, Chongqing, 400016, China.
| | - Xi Liang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Guoliang Ding
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, 014030, China.
| | - Ning Hu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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The role of arthroscopy in articular fracture management: the lower limb. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:807-13. [DOI: 10.1007/s00590-015-1601-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
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Say F, Kuyubaşı N. Arthroscopy-Assisted Fixation of an Intra-Articular Medial Femoral Condyle (Hoffa) Fracture of the Knee: A Case Report. JBJS Case Connect 2014; 4:e109. [PMID: 29252777 DOI: 10.2106/jbjs.cc.m.00298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A thirty-one-year-old woman was diagnosed with a minimally displaced medial femoral condyle (Hoffa) fracture. Reduction and retrograde percutaneous screw fixation were performed under arthroscopic visualization. At three months postoperatively, she was able to walk without support, had no pain, and had full range of movement of the knee. CONCLUSION In Hoffa fractures, arthroscopy-assisted fixation is an option for treatment. It is advantageous because it allows the ability to evaluate other intra-articular structures, decreases blood loss, shortens surgical time, decreases soft-tissue dissection, and facilitates a shorter postoperative rehabilitation period.
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Affiliation(s)
- Ferhat Say
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, 55139, Turkey. .
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Schoepp C, Rixen D. Arthroskopisch gestütztes Frakturmanagement des oberen und unteren Sprunggelenks. ARTHROSKOPIE 2014. [DOI: 10.1007/s00142-013-0802-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lonjon G, Delgrande D, Solignac N, Faivre B, Hardy P, Bauer T. Arthroscopic treatment in split depression-type tibial pilon fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:399-403. [PMID: 24898416 DOI: 10.1007/s00590-014-1492-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 05/22/2014] [Indexed: 11/26/2022]
Abstract
Treatment of tibial pilon fractures is complicated and often very invasive. Partial fractures with a depressed component raise the question of the choice of surgical technique. Minimally invasive surgical reduction under arthroscopic guidance appears to be a promising alternative in this type of fracture. We describe a technique for arthroscopically assisted treatment of a split depression tibial pilon fracture.
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Affiliation(s)
- Guillaume Lonjon
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Ambroise Paré, 9 Avenue Charles de Gaulle, 92100, Boulogne Billancourt, France,
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Arthroscopic reduction and internal fixation of acetabular fractures. Knee Surg Sports Traumatol Arthrosc 2014; 22:867-70. [PMID: 24306124 DOI: 10.1007/s00167-013-2799-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
Arthroscopic reduction and screw fixation of acetabular fractures have not been reported. In this case report, arthroscopic treatment for acetabular fracture is reported for two patients. A 49-year-old man diagnosed with acetabular posterior wall fracture was treated by arthroscopic reduction and fixation using two screws. A 20-year-old woman who diagnosed with anterior column fracture was fixed using a screw using the arthroscopic technique prior to open reduction and internal fixation in the iliac bone fracture. Arthroscopic reduction and fixation in some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal.
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Schenker ML, Mauck RL, Ahn J, Mehta S. Pathogenesis and prevention of posttraumatic osteoarthritis after intra-articular fracture. J Am Acad Orthop Surg 2014; 22:20-8. [PMID: 24382876 PMCID: PMC4425936 DOI: 10.5435/jaaos-22-01-20] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Posttraumatic osteoarthritis (PTOA) occurs after traumatic injury to the joint. It is most common following injuries that disrupt the articular surface or lead to joint instability. The reported risk of PTOA following significant joint trauma is as high as 75%; articular fractures can increase the risk more than 20-fold. Despite recent advances in surgical management, the incidence of PTOA following intra-articular fractures has remained relatively unchanged over the last few decades. Pathogenesis of PTOA after intra-articular fracture is likely multifactorial and may be associated with acute cartilage injury as well as chronic joint overload secondary to instability, incongruity, and malalignment. Additional studies are needed to better elucidate how these factors contribute to the development of PTOA and to develop advanced treatment algorithms that consist of both acute biologic interventions targeted to decrease inflammation and cellular death in response to injury and improved surgical methods to restore stability, congruity, and alignment.
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Cavallo M, Natali S, Ruffilli A, Buda R, Vannini F, Castagnini F, Ferranti E, Giannini S. Ankle surgery: focus on arthroscopy. Musculoskelet Surg 2013; 97:237-45. [PMID: 23912216 DOI: 10.1007/s12306-013-0297-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/18/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The ankle joint can be affected by several diseases, with clinical presentation varying from mild pain or swelling to inability, becoming in some cases a serious problem in daily life activities. Arthroscopy is a widely performed procedure in orthopedic surgery, due to the low invasivity compared to the more traditional open field surgery. The ankle joint presents anatomical specificities, like small space and tangential view that make arthroscopy more difficult. METHODS From 2000 more than 600 ankle arthroscopies were performed at our institution. The treated pathologies were mostly impingement syndrome and osteochondral lesions, and in lower percentage instabilities and ankle fractures. RESULTS In the impingement, the AOFAS scores at FU showed an increase compared to scores collected preoperatively, with improvement of symptoms in most of the cases, good or excellent results in 80 % of cases. In ligament injuries, AOFAS score significatively improved at the maximum follow-up. In fractures all patients had an excellent AOFAS score at maximum follow-up, with complete return to their pre-injury activities. In osteochondral injuries, the clinical results showed a progressive improvement over time with the different performed procedures. Control MRI and bioptic samples showed a good regeneration of the cartilage and bone tissue in the lesion site. CONCLUSIONS The encouraging obtained clinical results, in line with the literature, show how the arthroscopic technique, after an adequate learning curve, may represent a precious aid for the orthopedic surgeon and for the patient's outcome. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- M Cavallo
- Clinical Orthopaedic and Traumatology Unit I, Rizzoli Orthopaedic Institute, Bologna, Italy,
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