Dépouillements

Hospital accreditation and patient care, a dilemma? / Yves Fortems in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 205-210 Titre : Hospital accreditation and patient care, a dilemma? Type de document : texte imprimé Auteurs : Yves Fortems ; Elke Van Eynde ; Charlotte Fortems Année de publication : 2021 Article en page(s) : p. 205-210 Note générale : https://doi.org/10.52628/87.2.01 Langues : Anglais (eng) Mots-clés : Hospital accreditation  patient knowledge  patient perspective  quality of care  hospital choice Résumé : Despite the massive financial and human efforts of hospitals in the Flemish part of Belgium to increase quality through the path of external accreditation, so far this has not convinced the end user, in casu the patient. In this study of 307 hospital patients we conclude that the knowledge about accreditation is very limited to none existent (2%) in a sample of Belgian patients not working in medical practice and that patients do not choose their hospital care in accordance to the accreditation status of the hospital. We remain convinced that improving quality is a continuous concern for medical professionals and hospital management. However, we believe that patients, medical professionals and hospital managers might define quality care in a somewhat different way and we question the methodology of imposing a 2 vast amount of strict protocols as a way to improve quality in patient care. There is no conclusive evidence to support that these uniformly imposed “quality programs” improve patient care, except on safety issues. Permalink : ./index.php?lvl=notice_display&id=96616 [article] Hospital accreditation and patient care, a dilemma? [texte imprimé] / Yves Fortems ; Elke Van Eynde ; Charlotte Fortems . - 2021 . - p. 205-210. https://doi.org/10.52628/87.2.01 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 205-210 Mots-clés : Hospital accreditation  patient knowledge  patient perspective  quality of care  hospital choice Résumé : Despite the massive financial and human efforts of hospitals in the Flemish part of Belgium to increase quality through the path of external accreditation, so far this has not convinced the end user, in casu the patient. In this study of 307 hospital patients we conclude that the knowledge about accreditation is very limited to none existent (2%) in a sample of Belgian patients not working in medical practice and that patients do not choose their hospital care in accordance to the accreditation status of the hospital. We remain convinced that improving quality is a continuous concern for medical professionals and hospital management. However, we believe that patients, medical professionals and hospital managers might define quality care in a somewhat different way and we question the methodology of imposing a 2 vast amount of strict protocols as a way to improve quality in patient care. There is no conclusive evidence to support that these uniformly imposed “quality programs” improve patient care, except on safety issues. Permalink : ./index.php?lvl=notice_display&id=96616

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Ambulatory hand emergency: 2 years-experience in an public university hospital center / Alice Carricaburu in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 211-217 Titre : Ambulatory hand emergency: 2 years-experience in an public university hospital center Type de document : texte imprimé Auteurs : Alice Carricaburu ; Jordane Mouton ; Iad Nseir ; Roberto Beccari ; Silvia Gandolfi ; Isabelle Auquit-Auckbur Année de publication : 2021 Article en page(s) : p. 211-217 Note générale : https://doi.org/10.52628/87.2.02 Langues : Anglais (eng) Mots-clés : hand emergency  public  outpatient  traumatology  hand surgery Résumé : Hand emergencies represent the most frequent traumatic injuries and outpatient surgery is still improving. It will achieve 70% of total surgeries by 2022. Our hand trauma center has been able to set up an emergency day surgery department in a university hospital center. With this article, we would like to report the ambula- tory care management and practice for hand emer- gencies in our university hospital center over 2 years. 892 patients suffering from hand traumas and managed in our day surgery department, were retro-spectively reviewed between January 2016 and December 2017. Patients’ demographic data, anesthe- tic data, trauma’s circumstances, medical care and surgical outcomes have been disclosed. A descriptive analysis and a statistical assessment was realized. Cut injury was the most recorded case, followed by impactions. Tendon injuries were the most frequent (32%), followed by fractures (26%), and exposed joints (18%). 13% of injuries were nil findings. Average patient care delay was 1.16 days. Mean of hospitalization was 7.5 hours. 16/892 patients needing intravenous antibiotics required hospitalization. 41 complications including 27 secondary surgeries were reported. Hospital facilities are forced to reassess their entire procedures to achieve efficiency and improvement for healthcare. Progress in outpatient surgery permits emergency management in hand surgery, improving patient cares both medically and economically. Permalink : ./index.php?lvl=notice_display&id=96619 [article] Ambulatory hand emergency: 2 years-experience in an public university hospital center [texte imprimé] / Alice Carricaburu ; Jordane Mouton ; Iad Nseir ; Roberto Beccari ; Silvia Gandolfi ; Isabelle Auquit-Auckbur . - 2021 . - p. 211-217. https://doi.org/10.52628/87.2.02 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 211-217 Mots-clés : hand emergency  public  outpatient  traumatology  hand surgery Résumé : Hand emergencies represent the most frequent traumatic injuries and outpatient surgery is still improving. It will achieve 70% of total surgeries by 2022. Our hand trauma center has been able to set up an emergency day surgery department in a university hospital center. With this article, we would like to report the ambula- tory care management and practice for hand emer- gencies in our university hospital center over 2 years. 892 patients suffering from hand traumas and managed in our day surgery department, were retro-spectively reviewed between January 2016 and December 2017. Patients’ demographic data, anesthe- tic data, trauma’s circumstances, medical care and surgical outcomes have been disclosed. A descriptive analysis and a statistical assessment was realized. Cut injury was the most recorded case, followed by impactions. Tendon injuries were the most frequent (32%), followed by fractures (26%), and exposed joints (18%). 13% of injuries were nil findings. Average patient care delay was 1.16 days. Mean of hospitalization was 7.5 hours. 16/892 patients needing intravenous antibiotics required hospitalization. 41 complications including 27 secondary surgeries were reported. Hospital facilities are forced to reassess their entire procedures to achieve efficiency and improvement for healthcare. Progress in outpatient surgery permits emergency management in hand surgery, improving patient cares both medically and economically. Permalink : ./index.php?lvl=notice_display&id=96619

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The demographics and outcomes in patients with bilateral distal radius fractures / Matthew Gonzalez in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 219-225 Titre : The demographics and outcomes in patients with bilateral distal radius fractures Type de document : texte imprimé Auteurs : Matthew Gonzalez ; Ayesha Rahman ; Philipp Leucht ; Tejwani Nirmal Année de publication : 2021 Article en page(s) : p. 219-225 Note générale : https://doi.org/10.52628/87.2.03 Langues : Anglais (eng) Mots-clés : distal radius  bilateral  fracture  wrist  demographics  outcomes Résumé : Although distal radius fractures are quite common, bilateral distal radius fractures seldomly occur. Due to this, treatment is primarily based on surgeon experience with unilateral fractures, however bi- lateral fractures add a level of complexity : loss of functional independence. The purpose of this study was to examine a cohort of patients with bilateral distal radius fractures to identify differences in demographics, mechanism of injury, and outcomes to further our understanding of these rare injuries. 23 patients were identified retrospectively over a 5-year period that met inclusion criteria. The medical records were reviewed with multiple demographic and clinical parameters recorded and analyzed. Males were more likely to sustain high-energy mechanisms (80% vs. 53%). Patients <50 years old were more likely to sustain high-energy mechanisms (90% vs. 46%) and were more likely to be treated operatively (80% vs. 62%). The most commonly associated injury was a head injury (30%). All patients treated non-operatively reported minimal/no pain upon final follow-up where 57% of patients treated operatively noted regular pain. 75% of patients with medical comorbidities had minimal/no pain upon final follow- up. Conclusions : Patients with bilateral fractures were more likely to be younger males who suffered from higher energy mechanisms. Age was a critical factor in determining treatment strategy. Rates of associated head injuries were elevated, which is an important factor for the clinician to keep in mind when treating this population. As we further our understanding of this unique population, we can improve our treatment approaches and subsequently attain better outcomes. Permalink : ./index.php?lvl=notice_display&id=96621 [article] The demographics and outcomes in patients with bilateral distal radius fractures [texte imprimé] / Matthew Gonzalez ; Ayesha Rahman ; Philipp Leucht ; Tejwani Nirmal . - 2021 . - p. 219-225. https://doi.org/10.52628/87.2.03 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 219-225 Mots-clés : distal radius  bilateral  fracture  wrist  demographics  outcomes Résumé : Although distal radius fractures are quite common, bilateral distal radius fractures seldomly occur. Due to this, treatment is primarily based on surgeon experience with unilateral fractures, however bi- lateral fractures add a level of complexity : loss of functional independence. The purpose of this study was to examine a cohort of patients with bilateral distal radius fractures to identify differences in demographics, mechanism of injury, and outcomes to further our understanding of these rare injuries. 23 patients were identified retrospectively over a 5-year period that met inclusion criteria. The medical records were reviewed with multiple demographic and clinical parameters recorded and analyzed. Males were more likely to sustain high-energy mechanisms (80% vs. 53%). Patients <50 years old were more likely to sustain high-energy mechanisms (90% vs. 46%) and were more likely to be treated operatively (80% vs. 62%). The most commonly associated injury was a head injury (30%). All patients treated non-operatively reported minimal/no pain upon final follow-up where 57% of patients treated operatively noted regular pain. 75% of patients with medical comorbidities had minimal/no pain upon final follow- up. Conclusions : Patients with bilateral fractures were more likely to be younger males who suffered from higher energy mechanisms. Age was a critical factor in determining treatment strategy. Rates of associated head injuries were elevated, which is an important factor for the clinician to keep in mind when treating this population. As we further our understanding of this unique population, we can improve our treatment approaches and subsequently attain better outcomes. Permalink : ./index.php?lvl=notice_display&id=96621

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Is it really safe to evaluate symptomatic extensor carpi ulnaris tendon instability by magnetic resonance imaging (MRI)? / Tahir Öztürk in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 227-234 Titre : Is it really safe to evaluate symptomatic extensor carpi ulnaris tendon instability by magnetic resonance imaging (MRI)? Type de document : texte imprimé Auteurs : Tahir Öztürk ; Mehmet Burtaç Eren Année de publication : 2021 Article en page(s) : p. 227-234 Note générale : https://doi.org/10.52628/87.2.04 Langues : Anglais (eng) Mots-clés : extensor carpi ulnaris tendon  ECU instability  wrist MRI  morphometric analysis Résumé : The extensor carpi ulnaris (ECU) tendon is in the sixth extensor compartment of the wrist and is isolated from other tendons by a different sheath. Extensor carpi ulnaris pathologies are characterized by pain locally localized to the wrist ulnar side. Outpatient records and wrist MRI (magnetic resonance imaging) tests were retrospectively scanned between January 2018 and July 2019. By examining the anamnesis and examination notes of the patients in the outpatient clinic records, patients with wrist ulnar side pain, pain or sensitivity on the ulnar styloid and provocation test (synergy) were assigned to the first study group (Group 1).The second study group was composed of patients who underwent wrist MR for the diagnosis or differential diagnosis of a synovial cyst around the wrist, without ulnar side pain (Group 2).While evaluating MR images in the axial plane, the depth and width of the ulnar groove, thickness of the ECU tendon were measured. The position of the ECU tendon relative to the ulnar groove and the forearm rotation during the shooting were recorded.105 cases evaluated, there were 41 cases in the symptomatic subgroup and 64 cases in the asymptomatic subgroup. Among all patients, the mean patient age was 38.05.In the evaluation according to whether cases were symptomatic or not, there was no significant relationship between being symptomatic and the degree of instability and MR withdrawal position. Our study suggests that ECU instability in MR is not a specific condition, and detection of MR in instability may not be associated with a patient’s symptoms. Permalink : ./index.php?lvl=notice_display&id=96622 [article] Is it really safe to evaluate symptomatic extensor carpi ulnaris tendon instability by magnetic resonance imaging (MRI)? [texte imprimé] / Tahir Öztürk ; Mehmet Burtaç Eren . - 2021 . - p. 227-234. https://doi.org/10.52628/87.2.04 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 227-234 Mots-clés : extensor carpi ulnaris tendon  ECU instability  wrist MRI  morphometric analysis Résumé : The extensor carpi ulnaris (ECU) tendon is in the sixth extensor compartment of the wrist and is isolated from other tendons by a different sheath. Extensor carpi ulnaris pathologies are characterized by pain locally localized to the wrist ulnar side. Outpatient records and wrist MRI (magnetic resonance imaging) tests were retrospectively scanned between January 2018 and July 2019. By examining the anamnesis and examination notes of the patients in the outpatient clinic records, patients with wrist ulnar side pain, pain or sensitivity on the ulnar styloid and provocation test (synergy) were assigned to the first study group (Group 1).The second study group was composed of patients who underwent wrist MR for the diagnosis or differential diagnosis of a synovial cyst around the wrist, without ulnar side pain (Group 2).While evaluating MR images in the axial plane, the depth and width of the ulnar groove, thickness of the ECU tendon were measured. The position of the ECU tendon relative to the ulnar groove and the forearm rotation during the shooting were recorded.105 cases evaluated, there were 41 cases in the symptomatic subgroup and 64 cases in the asymptomatic subgroup. Among all patients, the mean patient age was 38.05.In the evaluation according to whether cases were symptomatic or not, there was no significant relationship between being symptomatic and the degree of instability and MR withdrawal position. Our study suggests that ECU instability in MR is not a specific condition, and detection of MR in instability may not be associated with a patient’s symptoms. Permalink : ./index.php?lvl=notice_display&id=96622

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Radiological and functional outcomes of modified Metaizeau technique in displaced radial neck fractures / Ökkes Bilal in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 235-241 Titre : Radiological and functional outcomes of modified Metaizeau technique in displaced radial neck fractures Type de document : texte imprimé Auteurs : Ökkes Bilal ; Ali Murat Kalender ; Burçin Karsli ; Volkan Kilinçoglu ; Mustafa Kinas ; Nuh Dünar Année de publication : 2021 Article en page(s) : p. 235-241 Note générale : https://doi.org/10.52628/87.2.05 Langues : Anglais (eng) Mots-clés : Radius neck fracture  children  closed reduction  displaced fracture  intramedullary nailing Résumé : The management of displaced radial neck fractures in children is still a controversial topic. The objective of this study is to examine the outcomes of modified Metaizeau technique in the children with displaced radius neck fractures. The retrospective study included 15 children with displaced radial neck fracture with an angulation of more than 30° who were managed with the use of leverage technique by mosquito clamps and internal fixation with elastic stable intramedullary nailing (ESIN). Radiological and functional assessments were performed during follow-up. Additionally, the patients were evaluated using Mayo Elbow Per- formance Score (MEPS). All the children could be managed with clamp-assisted closed reduction. The average duration of follow up was 25.5 ± 6.1 months (15-36 months). An excellent elbow function was achieved in all but one patient. Based on Metaizeau classification, excellent, good, fair, and poor outcomes were achieved in 11, 1, 2, and 1 patients, respectively. The average postoperative MEPS score was 98.7 ± 5.1 (80-100). Clamp-assisted closed reduction and fixation with ESIN is a good choice in the children with displaced radial neck fractures. This technique is associated with good functional and radiologic outcomes in the medium-term. Further studies are warranted with larger sample sizes. Permalink : ./index.php?lvl=notice_display&id=96625 [article] Radiological and functional outcomes of modified Metaizeau technique in displaced radial neck fractures [texte imprimé] / Ökkes Bilal ; Ali Murat Kalender ; Burçin Karsli ; Volkan Kilinçoglu ; Mustafa Kinas ; Nuh Dünar . - 2021 . - p. 235-241. https://doi.org/10.52628/87.2.05 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 235-241 Mots-clés : Radius neck fracture  children  closed reduction  displaced fracture  intramedullary nailing Résumé : The management of displaced radial neck fractures in children is still a controversial topic. The objective of this study is to examine the outcomes of modified Metaizeau technique in the children with displaced radius neck fractures. The retrospective study included 15 children with displaced radial neck fracture with an angulation of more than 30° who were managed with the use of leverage technique by mosquito clamps and internal fixation with elastic stable intramedullary nailing (ESIN). Radiological and functional assessments were performed during follow-up. Additionally, the patients were evaluated using Mayo Elbow Per- formance Score (MEPS). All the children could be managed with clamp-assisted closed reduction. The average duration of follow up was 25.5 ± 6.1 months (15-36 months). An excellent elbow function was achieved in all but one patient. Based on Metaizeau classification, excellent, good, fair, and poor outcomes were achieved in 11, 1, 2, and 1 patients, respectively. The average postoperative MEPS score was 98.7 ± 5.1 (80-100). Clamp-assisted closed reduction and fixation with ESIN is a good choice in the children with displaced radial neck fractures. This technique is associated with good functional and radiologic outcomes in the medium-term. Further studies are warranted with larger sample sizes. Permalink : ./index.php?lvl=notice_display&id=96625

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Big and deep seated lipomatous tumours in children : results of surgical treatment / Emin Özkul in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p.243-246 Titre : Big and deep seated lipomatous tumours in children : results of surgical treatment Type de document : texte imprimé Auteurs : Emin Özkul ; Serhat Elçi ; Muhsin Elçi ; Celil Alemdar Année de publication : 2021 Article en page(s) : p.243-246 Note générale : https://doi.org/10.52628/87.2.06 Langues : Anglais (eng) Mots-clés : lipoma  child  surgery Résumé : The objective of the study is aimed to evaluate results of our pediatric patients with big and deep-seated lipomatous tumors Results of 32 children who underwent resection for 5 cm or larger and deep-seated lipomas were evaluated. The mean age of the patients was 9.1 years (range, 0-16 ; 11 female/21 male), and median follow-up period was 3.21 years (range, 1-10 years). The median size of the excised tumour was 11 cm (range, 6-28 cm) in maximal dimension. Big lipomas in children can be treated with marginal resection procedures without biopsy with lower complication and local recurrence ratio compared to adult patients with similar tumours in similar size and location. Permalink : ./index.php?lvl=notice_display&id=96626 [article] Big and deep seated lipomatous tumours in children : results of surgical treatment [texte imprimé] / Emin Özkul ; Serhat Elçi ; Muhsin Elçi ; Celil Alemdar . - 2021 . - p.243-246. https://doi.org/10.52628/87.2.06 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p.243-246 Mots-clés : lipoma  child  surgery Résumé : The objective of the study is aimed to evaluate results of our pediatric patients with big and deep-seated lipomatous tumors Results of 32 children who underwent resection for 5 cm or larger and deep-seated lipomas were evaluated. The mean age of the patients was 9.1 years (range, 0-16 ; 11 female/21 male), and median follow-up period was 3.21 years (range, 1-10 years). The median size of the excised tumour was 11 cm (range, 6-28 cm) in maximal dimension. Big lipomas in children can be treated with marginal resection procedures without biopsy with lower complication and local recurrence ratio compared to adult patients with similar tumours in similar size and location. Permalink : ./index.php?lvl=notice_display&id=96626

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Genu valgum deformity – correction by a wedgeless implantless femoral “V” osteotomy / Amrit Goyal in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 247-254 Titre : Genu valgum deformity – correction by a wedgeless implantless femoral “V” osteotomy Type de document : texte imprimé Auteurs : Amrit Goyal ; Vikas Gupta ; Meenakshi Goyal ; Rajesh Chandra ; Vinod K. Sharma Année de publication : 2021 Article en page(s) : p. 247-254 Note générale : https://doi.org/10.52628/87.2.07 Langues : Anglais (eng) Mots-clés : genu valgum  osteotomy  deformity  paediatric  knee Résumé : Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar “V” osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours. Permalink : ./index.php?lvl=notice_display&id=96627 [article] Genu valgum deformity – correction by a wedgeless implantless femoral “V” osteotomy [texte imprimé] / Amrit Goyal ; Vikas Gupta ; Meenakshi Goyal ; Rajesh Chandra ; Vinod K. Sharma . - 2021 . - p. 247-254. https://doi.org/10.52628/87.2.07 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 247-254 Mots-clés : genu valgum  osteotomy  deformity  paediatric  knee Résumé : Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar “V” osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours. Permalink : ./index.php?lvl=notice_display&id=96627

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Complication rate after scoliosis surgery in children with cerebral palsy / Elke Vandendriessche in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 255-261 Titre : Complication rate after scoliosis surgery in children with cerebral palsy Type de document : texte imprimé Auteurs : Elke Vandendriessche ; Marijke Proesmans ; Els Ortibus ; Pierre Moens Année de publication : 2021 Article en page(s) : p. 255-261 Note générale : https://doi.org/10.52628/87.2.08 Langues : Anglais (eng) Mots-clés : cerebral palsy  scoliosis surgery  complication rate Résumé : Scoliosis is an important problem in children with cerebral palsy (CP). However, the choice for a spinal fusion has to be weighed against the risks of major surgery in this vulnerable population. Paediatricians are frequently consulted preoperatively to assess the (respiratory) risk involved, but data on this question specific for CP are rare. Therefore, we investigated the complication rate after scoliosis surgery in children with CP, compared to idiopathic scoliosis (IS), and we searched for risk factors for the most common complications. In a retrospective monocenter study we analyzed the medical records from all children with CP and IS undergoing scoliosis surgery from 2010 until 2014. Duration of hospitalization and postoperative complications were compared within a 6-month follow-up. Univariate and multivariate logistic regression models were used to identify risk factors. The study included 44 patients with CP (mean age 15y0mo) and 78 patients with IS (mean age 14y6mo). Children with CP experience a higher rate of complications : respiratory and cardiovascular, as well as wound infections and decubitus ulcers (p<0.05). Postoperative pneumonia was the most frequent complication in both patient groups (43% and 18% in CP and IS respectively), with epilepsy being a significant risk factor (OR 3.85, p= 0.037) in children with CP. Intensive care unit and total hospital stay were longer in the CP group (p<0.001). These results may add information on perioperative care and surgical decision making. Permalink : ./index.php?lvl=notice_display&id=96628 [article] Complication rate after scoliosis surgery in children with cerebral palsy [texte imprimé] / Elke Vandendriessche ; Marijke Proesmans ; Els Ortibus ; Pierre Moens . - 2021 . - p. 255-261. https://doi.org/10.52628/87.2.08 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 255-261 Mots-clés : cerebral palsy  scoliosis surgery  complication rate Résumé : Scoliosis is an important problem in children with cerebral palsy (CP). However, the choice for a spinal fusion has to be weighed against the risks of major surgery in this vulnerable population. Paediatricians are frequently consulted preoperatively to assess the (respiratory) risk involved, but data on this question specific for CP are rare. Therefore, we investigated the complication rate after scoliosis surgery in children with CP, compared to idiopathic scoliosis (IS), and we searched for risk factors for the most common complications. In a retrospective monocenter study we analyzed the medical records from all children with CP and IS undergoing scoliosis surgery from 2010 until 2014. Duration of hospitalization and postoperative complications were compared within a 6-month follow-up. Univariate and multivariate logistic regression models were used to identify risk factors. The study included 44 patients with CP (mean age 15y0mo) and 78 patients with IS (mean age 14y6mo). Children with CP experience a higher rate of complications : respiratory and cardiovascular, as well as wound infections and decubitus ulcers (p<0.05). Postoperative pneumonia was the most frequent complication in both patient groups (43% and 18% in CP and IS respectively), with epilepsy being a significant risk factor (OR 3.85, p= 0.037) in children with CP. Intensive care unit and total hospital stay were longer in the CP group (p<0.001). These results may add information on perioperative care and surgical decision making. Permalink : ./index.php?lvl=notice_display&id=96628

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Transient synovitis of the hip : is systematic radiological screening necessary for the detection of Perthes disease? / Charles Edouard Heylen in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 263-268 Titre : Transient synovitis of the hip : is systematic radiological screening necessary for the detection of Perthes disease? Type de document : texte imprimé Auteurs : Charles Edouard Heylen ; Pierre-Louis Docquier ; Dana Dumitriu Année de publication : 2021 Article en page(s) : p. 263-268 Note générale : https://doi.org/10.52628/87.2.09 Langues : Anglais (eng) Mots-clés : transient synovitis  Perthes disease  X-ray  hip Résumé : Current imaging guidelines in Belgium advise a systematic X-ray screening of the hips after an episode of transient synovitis of the hip, in order to detect Perthes disease. The aim of this study was to analyze whether systematic radiological screening is necessary for all children or whether the X-ray indication could be guided by clinical symptoms. A retrospective single center study including all children with the diagnosis of transient synovitis of the hip between 2013 and 2018 was performed. 242 patients with the diagnosis of one or more transient synovitis episodes were included, 102 of whom underwent a follow up X-ray. Persistence or recurrence of symptoms were recorded for all patients, as well as the results of follow-up hip X-rays. 12 children did not remain symptom-free after the episode of transient synovitis. Of these patients 10 had a normal follow-up X-ray and 3 were diagnosed with Perthes disease. 1 patient of those 3 had a normal X-ray but was diagnosed with Perthes disease on MRI. Of the children which remained symptom-free after the episode of transient synovitis, none were diagnosed with Perthes disease afterwards. A follow-up X-ray to exclude Perthes disease after a diagnosis of transient hip synovitis appears to be necessary only in patients with persistent or recurrent symptomatology. Permalink : ./index.php?lvl=notice_display&id=96629 [article] Transient synovitis of the hip : is systematic radiological screening necessary for the detection of Perthes disease? [texte imprimé] / Charles Edouard Heylen ; Pierre-Louis Docquier ; Dana Dumitriu . - 2021 . - p. 263-268. https://doi.org/10.52628/87.2.09 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 263-268 Mots-clés : transient synovitis  Perthes disease  X-ray  hip Résumé : Current imaging guidelines in Belgium advise a systematic X-ray screening of the hips after an episode of transient synovitis of the hip, in order to detect Perthes disease. The aim of this study was to analyze whether systematic radiological screening is necessary for all children or whether the X-ray indication could be guided by clinical symptoms. A retrospective single center study including all children with the diagnosis of transient synovitis of the hip between 2013 and 2018 was performed. 242 patients with the diagnosis of one or more transient synovitis episodes were included, 102 of whom underwent a follow up X-ray. Persistence or recurrence of symptoms were recorded for all patients, as well as the results of follow-up hip X-rays. 12 children did not remain symptom-free after the episode of transient synovitis. Of these patients 10 had a normal follow-up X-ray and 3 were diagnosed with Perthes disease. 1 patient of those 3 had a normal X-ray but was diagnosed with Perthes disease on MRI. Of the children which remained symptom-free after the episode of transient synovitis, none were diagnosed with Perthes disease afterwards. A follow-up X-ray to exclude Perthes disease after a diagnosis of transient hip synovitis appears to be necessary only in patients with persistent or recurrent symptomatology. Permalink : ./index.php?lvl=notice_display&id=96629

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Acetabular distraction hip arthroplasty in neglected transverse and T-shape acetabular fractures : a different application / Ayman Abdelaziz Bassiony in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 269-274 Titre : Acetabular distraction hip arthroplasty in neglected transverse and T-shape acetabular fractures : a different application Type de document : texte imprimé Auteurs : Ayman Abdelaziz Bassiony ; Saleh Gameel ; Ahmed Nageeb Mahmoud Année de publication : 2021 Article en page(s) : p. 269-274 Note générale : https://doi.org/10.52628/87.2.10 Langues : Anglais (eng) Mots-clés : Acetabular fracture non-union  pelvic discontinuity  acetabular distraction  total hip arthroplasty Résumé : Neglected acetabular fractures are often challenging to treat. The aim of this study is to highlight the technique of acetabular distraction with porous metal cup as a viable technique to address such complex cases. This is a prospective study of seven patients who had neglected acetabular fracture or fracture non-union that were managed with total hip arthroplasty using acetabular distraction and porous metal cup with cemented liner. The average age of the patients was 51 years (range 36-58 years). Average time of follow up was 18 months (range 12-36 months). Radiological results at latest follow up and by comparing serial radiographs showed that all cases had a well-fixed implant construct without evidence of loosening or malorientation. Average Harris hip score pre-operatively was 46, which improved to an average of 84 post-operatively. Our study shows that total hip replacement using acetabular distraction with porous metal cup provide early good results in reconstruction of acetabular bony deficiencies due to neglected acetabular fracture. Permalink : ./index.php?lvl=notice_display&id=96630 [article] Acetabular distraction hip arthroplasty in neglected transverse and T-shape acetabular fractures : a different application [texte imprimé] / Ayman Abdelaziz Bassiony ; Saleh Gameel ; Ahmed Nageeb Mahmoud . - 2021 . - p. 269-274. https://doi.org/10.52628/87.2.10 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 269-274 Mots-clés : Acetabular fracture non-union  pelvic discontinuity  acetabular distraction  total hip arthroplasty Résumé : Neglected acetabular fractures are often challenging to treat. The aim of this study is to highlight the technique of acetabular distraction with porous metal cup as a viable technique to address such complex cases. This is a prospective study of seven patients who had neglected acetabular fracture or fracture non-union that were managed with total hip arthroplasty using acetabular distraction and porous metal cup with cemented liner. The average age of the patients was 51 years (range 36-58 years). Average time of follow up was 18 months (range 12-36 months). Radiological results at latest follow up and by comparing serial radiographs showed that all cases had a well-fixed implant construct without evidence of loosening or malorientation. Average Harris hip score pre-operatively was 46, which improved to an average of 84 post-operatively. Our study shows that total hip replacement using acetabular distraction with porous metal cup provide early good results in reconstruction of acetabular bony deficiencies due to neglected acetabular fracture. Permalink : ./index.php?lvl=notice_display&id=96630

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Analysis of morphological parameters in pelvic radiography and hip MRI : a practical reporting recommendation / Esin Derin Cicek in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 275-283 Titre : Analysis of morphological parameters in pelvic radiography and hip MRI : a practical reporting recommendation Type de document : texte imprimé Auteurs : Esin Derin Cicek ; Halime Cevik Année de publication : 2021 Article en page(s) : p. 275-283 Note générale : https://doi.org/10.52628/87.2.11 Langues : Anglais (eng) Mots-clés : hip morphology  magnetic resonance imaging (MRI)  pelvic radiography (PR)  femoro-acetabular impingement  Tönnis sign  reporting Résumé : Although numerous criteria have been proposed to define abnormal hip morphology, mostly used in the diagnosis of femoroacetabular impingement, it is not a practical approach to measure all of these parameters in all cases without clinical suspicion. In this study, our aim was to develop an evaluating and reporting standardization for routine hip exami- nations to define both hip morphology and impingement. A total of 108 patients with routine hip magnetic resonance imaging (MRI) and antero-posterior pelvic radiograph (PR) were included in this retrospective study. Alpha angle (AA), acetabular depth (AD), acetabular protrusion, acetabular anteversion, collo- diaphyseal angle (CDA), lateral center-edge angle (LCEA) and Tönnis angle (TA) were measured. The differences and associations between these parameters were evaluated according to imaging modality or plane, and sex. Although a significant difference has been found between the axial AA and the coronal AA mean values measured on MRI, there was also a strong correlation. Coronal measurements were significantly higher. AA values measured in PR and coronal MRI were comparable. Males had higher AA in both planes as compared to females. There were no significant differences between CDA values in MRI and PR. There was a significant difference and a moderate correlation between AD values in MRI and PR. We suggest that routine reports should include a measurement of AA in two planes, and measurement of CDA in PR or MRI. Due to the difference in AD between MRI and radiography, LCEA or TA may represent better alternatives. Checking for a negative Tönnis sign would represent a practical approach. Permalink : ./index.php?lvl=notice_display&id=96632 [article] Analysis of morphological parameters in pelvic radiography and hip MRI : a practical reporting recommendation [texte imprimé] / Esin Derin Cicek ; Halime Cevik . - 2021 . - p. 275-283. https://doi.org/10.52628/87.2.11 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 275-283 Mots-clés : hip morphology  magnetic resonance imaging (MRI)  pelvic radiography (PR)  femoro-acetabular impingement  Tönnis sign  reporting Résumé : Although numerous criteria have been proposed to define abnormal hip morphology, mostly used in the diagnosis of femoroacetabular impingement, it is not a practical approach to measure all of these parameters in all cases without clinical suspicion. In this study, our aim was to develop an evaluating and reporting standardization for routine hip exami- nations to define both hip morphology and impingement. A total of 108 patients with routine hip magnetic resonance imaging (MRI) and antero-posterior pelvic radiograph (PR) were included in this retrospective study. Alpha angle (AA), acetabular depth (AD), acetabular protrusion, acetabular anteversion, collo- diaphyseal angle (CDA), lateral center-edge angle (LCEA) and Tönnis angle (TA) were measured. The differences and associations between these parameters were evaluated according to imaging modality or plane, and sex. Although a significant difference has been found between the axial AA and the coronal AA mean values measured on MRI, there was also a strong correlation. Coronal measurements were significantly higher. AA values measured in PR and coronal MRI were comparable. Males had higher AA in both planes as compared to females. There were no significant differences between CDA values in MRI and PR. There was a significant difference and a moderate correlation between AD values in MRI and PR. We suggest that routine reports should include a measurement of AA in two planes, and measurement of CDA in PR or MRI. Due to the difference in AD between MRI and radiography, LCEA or TA may represent better alternatives. Checking for a negative Tönnis sign would represent a practical approach. Permalink : ./index.php?lvl=notice_display&id=96632

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Optimal ilio-sacral screw trajectory in paediatric patients : a computed tomography study / Mathilde Gaume in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 285-291 Titre : Optimal ilio-sacral screw trajectory in paediatric patients : a computed tomography study Type de document : texte imprimé Auteurs : Mathilde Gaume ; Mohamed Amine Triki ; C. Glorion ; Sylvain Breton ; L. Miladi Année de publication : 2021 Article en page(s) : p. 285-291 Note générale : https://doi.org/10.52628/87.2.12 Langues : Anglais (eng) Mots-clés : Ilio-sacral screws  pelvic fixation  computed tomography study  paediatric population Résumé : Pelvic fixation during procedures performed to treat spinal deformities in paediatric patients remains challenging. No computed tomography studies in paediatric have assessed the optimal trajectory of ilio- sacral screws to prevent screw malposition. We used pelvic computed tomography from 80 children divided into four groups : females <10 and ≥10 years and males <10 and ≥10 years. A secure triangular corridor parallel to the upper S1 endplate was delineated based on three fixed landmarks. The optimal screw insertion angle was subtended by the horizontal and the line bisecting the secure corridor. Student’s t test was applied to determine whether the optimal screw insertion angle and/or anatomical parameters were associated with age and/or sex. Mean optimal angle was 32.3°±3.6°, 33.8°±4.7°, 30.2°±5.0°, and 30.4°±4.7° in the younger females, younger males, older females, and older males, respectively. The mean optimal angle differed between the two age groups (p=0.004) but not between females and males (p=0.55). Optimal mean screw length was 73.4±9.9 mm. Anatomical spinal canal parameters in the transverse plane varied with age (p=0.02) and with sex in the older children (p=0.008), and those in the sagittal plane varied with sex (p=0.04). Age affected ilio-sacral screw positioning, whereas sex did not. Several anatomical spinal canal parameters varied with age and sex. These results should help to ensure safe and easy ilio-sacral screw placement within a secure corridor. Permalink : ./index.php?lvl=notice_display&id=96633 [article] Optimal ilio-sacral screw trajectory in paediatric patients : a computed tomography study [texte imprimé] / Mathilde Gaume ; Mohamed Amine Triki ; C. Glorion ; Sylvain Breton ; L. Miladi . - 2021 . - p. 285-291. https://doi.org/10.52628/87.2.12 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 285-291 Mots-clés : Ilio-sacral screws  pelvic fixation  computed tomography study  paediatric population Résumé : Pelvic fixation during procedures performed to treat spinal deformities in paediatric patients remains challenging. No computed tomography studies in paediatric have assessed the optimal trajectory of ilio- sacral screws to prevent screw malposition. We used pelvic computed tomography from 80 children divided into four groups : females <10 and ≥10 years and males <10 and ≥10 years. A secure triangular corridor parallel to the upper S1 endplate was delineated based on three fixed landmarks. The optimal screw insertion angle was subtended by the horizontal and the line bisecting the secure corridor. Student’s t test was applied to determine whether the optimal screw insertion angle and/or anatomical parameters were associated with age and/or sex. Mean optimal angle was 32.3°±3.6°, 33.8°±4.7°, 30.2°±5.0°, and 30.4°±4.7° in the younger females, younger males, older females, and older males, respectively. The mean optimal angle differed between the two age groups (p=0.004) but not between females and males (p=0.55). Optimal mean screw length was 73.4±9.9 mm. Anatomical spinal canal parameters in the transverse plane varied with age (p=0.02) and with sex in the older children (p=0.008), and those in the sagittal plane varied with sex (p=0.04). Age affected ilio-sacral screw positioning, whereas sex did not. Several anatomical spinal canal parameters varied with age and sex. These results should help to ensure safe and easy ilio-sacral screw placement within a secure corridor. Permalink : ./index.php?lvl=notice_display&id=96633

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Cementation of proximal femoral nails of the very elderly subject in per-trochanteric fractures / Sorya Plang in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 293-298 Titre : Cementation of proximal femoral nails of the very elderly subject in per-trochanteric fractures Type de document : texte imprimé Auteurs : Sorya Plang ; Romain Dayan ; Frédéric Khami ; Clément Preneau ; Olivier Barbier ; Camille Choufani Année de publication : 2021 Article en page(s) : p. 293-298 Note générale : https://doi.org/10.52628/87.2.13 Langues : Anglais (eng) Mots-clés : pertrochanteric fracture  osteosynthesis  surgery  elderly Résumé : The management of pertrochanteric fractures (PTF) in the very elderly relies on early verticalisation to limit complications of the decubitus and this requires stable osteosynthesis allowing immediate full support without risk of mechanical failure. The aim of the study was to analyse the value of cementing the cervicocephalic blade during osteosynthesis with a proximal femoral nail. A prospective bicentric comparative study was con- ducted. Patients over 90 years of age with PTF were included. Centre A used a PFNA (Proximal Femoral Nail Antirotation) nail without blade cementing and Centre B used the same nail with blade cementing. The primary endpoint was the occurrence of disassembly of the osteosynthesis requiring revision surgery. Secondary endpoints were functional out- come (resumption of walking), postoperative pain and duration of surgery. Sixty-four patients were included in Centre A and 23 patients were included in Centre B. Mean age, gender, functional abilities before fracture, fracture type and tip-apex distance were comparable between the groups. Postoperative pain and duration of surgery did not show significant differences between the groups. Four patients operated on with an uncemented PFNA (6.25%) and one patient operated on with a cemented PFNA nail (4.35%) showed early dismantling. The rate of patients returning to walking was significantly higher in the cemented group (p=0.00005). No significant differences in the rate of dismantling were observed between the two groups. However, the group operated on with a cemented PFNA showed better functional recovery with a significantly higher rate of walking recovery. Permalink : ./index.php?lvl=notice_display&id=96635 [article] Cementation of proximal femoral nails of the very elderly subject in per-trochanteric fractures [texte imprimé] / Sorya Plang ; Romain Dayan ; Frédéric Khami ; Clément Preneau ; Olivier Barbier ; Camille Choufani . - 2021 . - p. 293-298. https://doi.org/10.52628/87.2.13 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 293-298 Mots-clés : pertrochanteric fracture  osteosynthesis  surgery  elderly Résumé : The management of pertrochanteric fractures (PTF) in the very elderly relies on early verticalisation to limit complications of the decubitus and this requires stable osteosynthesis allowing immediate full support without risk of mechanical failure. The aim of the study was to analyse the value of cementing the cervicocephalic blade during osteosynthesis with a proximal femoral nail. A prospective bicentric comparative study was con- ducted. Patients over 90 years of age with PTF were included. Centre A used a PFNA (Proximal Femoral Nail Antirotation) nail without blade cementing and Centre B used the same nail with blade cementing. The primary endpoint was the occurrence of disassembly of the osteosynthesis requiring revision surgery. Secondary endpoints were functional out- come (resumption of walking), postoperative pain and duration of surgery. Sixty-four patients were included in Centre A and 23 patients were included in Centre B. Mean age, gender, functional abilities before fracture, fracture type and tip-apex distance were comparable between the groups. Postoperative pain and duration of surgery did not show significant differences between the groups. Four patients operated on with an uncemented PFNA (6.25%) and one patient operated on with a cemented PFNA nail (4.35%) showed early dismantling. The rate of patients returning to walking was significantly higher in the cemented group (p=0.00005). No significant differences in the rate of dismantling were observed between the two groups. However, the group operated on with a cemented PFNA showed better functional recovery with a significantly higher rate of walking recovery. Permalink : ./index.php?lvl=notice_display&id=96635

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Occult periprosthetic fractures of the acetabulum in THA using an elliptic cup design have no adverse impact on outcome / Thomas Häller in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 299-304 Titre : Occult periprosthetic fractures of the acetabulum in THA using an elliptic cup design have no adverse impact on outcome Type de document : texte imprimé Auteurs : Thomas Häller ; Claudio Dora ; Pascal Schenk ; Patrick Oliver Zingg Année de publication : 2021 Article en page(s) : p. 299-304 Note générale : https://doi.org/10.52628/87.2.14 Langues : Anglais (eng) Mots-clés : Periprosthetic fracture  acetabular fracture  periprosthetic acetabular fracture  total hip arthroplasty  clinical outcome Résumé : Occult periprosthetic fractures have been defined as a fracture only visible on postoperative CT scans but not on postoperative plain radiography after an uneventful surgery without intraoperative fracture. The fracture rate for hemispherical and peripheral self-locking cups has been described as 8.4%. We retrospectively analyzed postoperative CT scans after primary THA to clear the question whether such occult periprosthetic fractures of the acetabulum require particular treatment strategy. Between 2014 and 2018 we identified 115 CT scans of 114 patients after primary cementless THA with elliptical cups using a direct anterior approach. The CT scans were obtained as part of other investigations. Localization of the fracture, patients demographics, clinical (WOMAC, Harris Hip Score) and radiological outcome were analyzed. Fracture and non-Fracture group were compared with regard to demographics and short-term outcome after 1 year. Four occult fractures (3.5%) were identified. Three fractures involved the posterior wall. All patients had an uneventful routine postoperative rehabilitation. Patients with occult fractures showed similar post- operative HHS and WOMAC scores at 3 (HHS p = 0.576, WOMAC p = 0.128) and 12 (HHS p = 0.479, WOMAC p = 0.588) months. There were no cup loosening nor radiolucent lines at latest follow-up (mean FU 22 months, range 12-34 months). Clinical and radiological short-term outcome was not impaired by the occurrence of an occult periprosthetic fracture of the acetabulum. The incidental detection of an occult periprosthetic fracture of the acetabulum does not seem to oblige the surgeon to adapt the postoperative regime. Permalink : ./index.php?lvl=notice_display&id=96664 [article] Occult periprosthetic fractures of the acetabulum in THA using an elliptic cup design have no adverse impact on outcome [texte imprimé] / Thomas Häller ; Claudio Dora ; Pascal Schenk ; Patrick Oliver Zingg . - 2021 . - p. 299-304. https://doi.org/10.52628/87.2.14 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 299-304 Mots-clés : Periprosthetic fracture  acetabular fracture  periprosthetic acetabular fracture  total hip arthroplasty  clinical outcome Résumé : Occult periprosthetic fractures have been defined as a fracture only visible on postoperative CT scans but not on postoperative plain radiography after an uneventful surgery without intraoperative fracture. The fracture rate for hemispherical and peripheral self-locking cups has been described as 8.4%. We retrospectively analyzed postoperative CT scans after primary THA to clear the question whether such occult periprosthetic fractures of the acetabulum require particular treatment strategy. Between 2014 and 2018 we identified 115 CT scans of 114 patients after primary cementless THA with elliptical cups using a direct anterior approach. The CT scans were obtained as part of other investigations. Localization of the fracture, patients demographics, clinical (WOMAC, Harris Hip Score) and radiological outcome were analyzed. Fracture and non-Fracture group were compared with regard to demographics and short-term outcome after 1 year. Four occult fractures (3.5%) were identified. Three fractures involved the posterior wall. All patients had an uneventful routine postoperative rehabilitation. Patients with occult fractures showed similar post- operative HHS and WOMAC scores at 3 (HHS p = 0.576, WOMAC p = 0.128) and 12 (HHS p = 0.479, WOMAC p = 0.588) months. There were no cup loosening nor radiolucent lines at latest follow-up (mean FU 22 months, range 12-34 months). Clinical and radiological short-term outcome was not impaired by the occurrence of an occult periprosthetic fracture of the acetabulum. The incidental detection of an occult periprosthetic fracture of the acetabulum does not seem to oblige the surgeon to adapt the postoperative regime. Permalink : ./index.php?lvl=notice_display&id=96664

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Comparison of fluoroscopy time in short and long cephalomedullary nailing for 31A2 intertrochanteric hip fractures / Karthik Vishwanathan in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 305-311 Titre : Comparison of fluoroscopy time in short and long cephalomedullary nailing for 31A2 intertrochanteric hip fractures Type de document : texte imprimé Auteurs : Karthik Vishwanathan ; Keyur Akbari ; Amit Patel Année de publication : 2021 Article en page(s) : p. 305-311 Note générale : https://doi.org/10.52628/87.2.15 Langues : Anglais (eng) Mots-clés : radiation exposure  fluoroscopy  hip fractures  intertrochanteric fractures  intramedullary nailing  cephalomedullary nailing Résumé : There is no study that has compared the radiation exposure during short (Short PFN) and long proximal femoral nailing (Long PFN) for 31A2 intertrochanteric hip fractures. The objective of the present study was to compare the radiation exposure time in short and long proximal femoral nail during the treatment of 31A2 intertrochanteric hip fractures. This prospective cohort study was carried out in a University teaching hospital. Sixty one consecutive patients with 31A2 intertrochanteric femur fracture treated with pro- ximal femoral nail were included in the study. The distal locking in the short PFN was performed using the locking zig and distal locking in the long PFN was performed using the free hand perfect circle technique. The same mobile image intensifier (Multimobil 5E, Siemens, Erlangen, Germany) was used in the entire study. The outcome measure was the fluoroscopy exposure time (seconds) which was measured directly from the image intensifier. Thirty patients underwent fixation with short PFN and 31 patients underwent fixation using long PFN. The mean fluoroscopy exposure time in short PFN cohort was 189.5 seconds ± 26 (range : 150-250 seconds) and the mean fluoroscopy exposure time in long PFN cohort was 283.4 seconds ± 43.8 (range : 200-400 seconds). The mean fluoroscopy exposure time was 93.9 seconds shorter in the short PFN cohort and this difference was statistically significant (p < 0.0001 ; 95% CI : 75.4 to 112.3). The radiation exposure to the operating team is significantly less during treatment with short PFN in 31A2 intertrochanteric fractures. Permalink : ./index.php?lvl=notice_display&id=96665 [article] Comparison of fluoroscopy time in short and long cephalomedullary nailing for 31A2 intertrochanteric hip fractures [texte imprimé] / Karthik Vishwanathan ; Keyur Akbari ; Amit Patel . - 2021 . - p. 305-311. https://doi.org/10.52628/87.2.15 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 305-311 Mots-clés : radiation exposure  fluoroscopy  hip fractures  intertrochanteric fractures  intramedullary nailing  cephalomedullary nailing Résumé : There is no study that has compared the radiation exposure during short (Short PFN) and long proximal femoral nailing (Long PFN) for 31A2 intertrochanteric hip fractures. The objective of the present study was to compare the radiation exposure time in short and long proximal femoral nail during the treatment of 31A2 intertrochanteric hip fractures. This prospective cohort study was carried out in a University teaching hospital. Sixty one consecutive patients with 31A2 intertrochanteric femur fracture treated with pro- ximal femoral nail were included in the study. The distal locking in the short PFN was performed using the locking zig and distal locking in the long PFN was performed using the free hand perfect circle technique. The same mobile image intensifier (Multimobil 5E, Siemens, Erlangen, Germany) was used in the entire study. The outcome measure was the fluoroscopy exposure time (seconds) which was measured directly from the image intensifier. Thirty patients underwent fixation with short PFN and 31 patients underwent fixation using long PFN. The mean fluoroscopy exposure time in short PFN cohort was 189.5 seconds ± 26 (range : 150-250 seconds) and the mean fluoroscopy exposure time in long PFN cohort was 283.4 seconds ± 43.8 (range : 200-400 seconds). The mean fluoroscopy exposure time was 93.9 seconds shorter in the short PFN cohort and this difference was statistically significant (p < 0.0001 ; 95% CI : 75.4 to 112.3). The radiation exposure to the operating team is significantly less during treatment with short PFN in 31A2 intertrochanteric fractures. Permalink : ./index.php?lvl=notice_display&id=96665

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Outpatient total hip arthroplasty : the future? / Solange de Wouters in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 313-319 Titre : Outpatient total hip arthroplasty : the future? Type de document : texte imprimé Auteurs : Solange de Wouters ; Steven Petronilia ; Daniel Paulet ; Tom De Baere ; Etienne Willemart ; Olivier Cornu Année de publication : 2021 Article en page(s) : p. 313-319 Note générale : https://doi.org/10.52628/87.2.16 Langues : Anglais (eng) Mots-clés : total hip arthroplasty  outpatient  ambulatory  safety Résumé : With advancements in minimally invasive surgical technique, pain management and rehabilitation proto- cols, and prevention of post-operative complications, outpatient total hip arthroplasty became a realistic goal. This study reports our experience of performing outpatient total hip arthroplasty assessing its feasi- bility and safety. Between December 2015 and January 2018, 52 outpatient total hip arthroplasties were performed. We implemented a peri-operative management proto- col that included education, improved analgesia and rapid rehabilitation. Patients were asked about any complications they had experienced after surgery and about the perception of their experience as outpatient. Any early post-operative emergency department visits, acute office appointments or hospital re-ad- missions were registered. Fifty-one of 52 patients (98,1%) enrolled in the study met the discharge criteria and achieved their goal of going home on the day of surgery, and only one patient (1,9%) required an overnight stay. There were two visits to the emergency room, with one hospital re-admission (1,9%) on the night of the surgery. There were no major post-discharge complications in the short-term follow-up (minimum of three months). Only one patient (1,9%) reported a significantly negative experience. With this first Belgian experience reporting on out- patient primary total hip arthroplasty, our data demonstrate that early discharge does not result in excessive re-admissions or other post-discharge complications due to an early discharge. This study suggests that total hip arthroplasty can be performed safely and successfully in appropriately selected patients and that patients who experienced that ambulatory protocol declared themselves highly satisfied. Permalink : ./index.php?lvl=notice_display&id=96666 [article] Outpatient total hip arthroplasty : the future? [texte imprimé] / Solange de Wouters ; Steven Petronilia ; Daniel Paulet ; Tom De Baere ; Etienne Willemart ; Olivier Cornu . - 2021 . - p. 313-319. https://doi.org/10.52628/87.2.16 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 313-319 Mots-clés : total hip arthroplasty  outpatient  ambulatory  safety Résumé : With advancements in minimally invasive surgical technique, pain management and rehabilitation proto- cols, and prevention of post-operative complications, outpatient total hip arthroplasty became a realistic goal. This study reports our experience of performing outpatient total hip arthroplasty assessing its feasi- bility and safety. Between December 2015 and January 2018, 52 outpatient total hip arthroplasties were performed. We implemented a peri-operative management proto- col that included education, improved analgesia and rapid rehabilitation. Patients were asked about any complications they had experienced after surgery and about the perception of their experience as outpatient. Any early post-operative emergency department visits, acute office appointments or hospital re-ad- missions were registered. Fifty-one of 52 patients (98,1%) enrolled in the study met the discharge criteria and achieved their goal of going home on the day of surgery, and only one patient (1,9%) required an overnight stay. There were two visits to the emergency room, with one hospital re-admission (1,9%) on the night of the surgery. There were no major post-discharge complications in the short-term follow-up (minimum of three months). Only one patient (1,9%) reported a significantly negative experience. With this first Belgian experience reporting on out- patient primary total hip arthroplasty, our data demonstrate that early discharge does not result in excessive re-admissions or other post-discharge complications due to an early discharge. This study suggests that total hip arthroplasty can be performed safely and successfully in appropriately selected patients and that patients who experienced that ambulatory protocol declared themselves highly satisfied. Permalink : ./index.php?lvl=notice_display&id=96666

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The impact of direct oral anti-coagulants on hip fracture management : a systematic review and meta-analysis / Samuel Holmes in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 321-326 Titre : The impact of direct oral anti-coagulants on hip fracture management : a systematic review and meta-analysis Type de document : texte imprimé Auteurs : Samuel Holmes ; Sarmad Bahnam Année de publication : 2021 Article en page(s) : p. 321-326 Note générale : https://doi.org/10.52628/87.2.17 Langues : Anglais (eng) Mots-clés : anti-coagulation  DOAC  NOAC  hip  fracture  NOF  neck of femur Résumé : Hip fractures are a common presentation in the elderly, a group who commonly have co-morbidities requiring the use of anticoagulants. Recently, direct oral anti-coagulants (DOAC) have become a popular method of anticoagulating patients. The primary aim of this review is to determine if the use of DOAC in elderly patients with hip fractures results in delays to theatre and/or an increased mortality risk. Major databases including Pubmed, MEDLINE and Embase were searched for relevant studies and the included studies reference lists were screened for further studies. A total of 6 studies were included in meta-analysis which was undertaken using RevMan software with 95% confidence interval (CI). Compared to control groups, patients who were anticoagulated with DOAC and required operative management of a hip fracture experienced a statistically significant delay to treatment. However independent analysis showed these patients did not experience an increased mortality risk when compared to the control group. While data is limited, treating clinicians should be comforted by these findings as operative manage- ment can be safely delayed to reduce the risk of intraoperative bleeding. Permalink : ./index.php?lvl=notice_display&id=96667 [article] The impact of direct oral anti-coagulants on hip fracture management : a systematic review and meta-analysis [texte imprimé] / Samuel Holmes ; Sarmad Bahnam . - 2021 . - p. 321-326. https://doi.org/10.52628/87.2.17 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 321-326 Mots-clés : anti-coagulation  DOAC  NOAC  hip  fracture  NOF  neck of femur Résumé : Hip fractures are a common presentation in the elderly, a group who commonly have co-morbidities requiring the use of anticoagulants. Recently, direct oral anti-coagulants (DOAC) have become a popular method of anticoagulating patients. The primary aim of this review is to determine if the use of DOAC in elderly patients with hip fractures results in delays to theatre and/or an increased mortality risk. Major databases including Pubmed, MEDLINE and Embase were searched for relevant studies and the included studies reference lists were screened for further studies. A total of 6 studies were included in meta-analysis which was undertaken using RevMan software with 95% confidence interval (CI). Compared to control groups, patients who were anticoagulated with DOAC and required operative management of a hip fracture experienced a statistically significant delay to treatment. However independent analysis showed these patients did not experience an increased mortality risk when compared to the control group. While data is limited, treating clinicians should be comforted by these findings as operative manage- ment can be safely delayed to reduce the risk of intraoperative bleeding. Permalink : ./index.php?lvl=notice_display&id=96667

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Dynamic trial fitting of the cup in press-fit total hip arthroplasty, a feasibility study / Daniël Hoornenborg in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 327-331 Titre : Dynamic trial fitting of the cup in press-fit total hip arthroplasty, a feasibility study Type de document : texte imprimé Auteurs : Daniël Hoornenborg ; Justin Van Loon ; Sheryl De Waard ; Inger Sierevelt ; Kim T.M. Opdam ; Gino M.M.J. Kerkhoffs ; Daniël Haverkamp Année de publication : 2021 Article en page(s) : p. 327-331 Note générale : https://doi.org/10.52628/87.2.18 Langues : Anglais (eng) Mots-clés : press-fit  trial fitting  acetabular component  total hip arthroplasty Résumé : Trial fitting of the cup during total hip arthroplasty (THA) is done by trial cups, which do not resemble the real press-fit obtained by the definitive implant. Our goal is to judge feasibility of the X-pander® in clinical practice ; a device developed to mimic the real press-fit obtained by the definitive cup, to ensure satisfactory press-fit. In this feasibility study 45 experienced orthopaedic surgeons from 7 European countries filled in a structured survey after 78 primary THA and 31 revision surgeries, using the X-pander instead of traditional trial cups. Primary outcomes were decision change concerning cup size or further reaming and increased confidence regarding cup insertion and size. Additionally, potential association between the primary outcomes and procedure (primary or revi- sion), bone quality and experience of the surgeon were evaluated. In 33.3% of the primary and 32.2% of the revision cases the X-pander measurement changed the deci- sion and further reaming or change of cup size was decided. In 61.5% and 58.1% of respectively the primary and revision THAs the X-pander was judged to give fairly to much more reliable information than traditional trial cups. The X-pander could lead to less additional screw fixation, as stated in 37.2% of the primary and 25.8% of the revision cases and to better cup insertion in respectively 50.0% and 51.6%. This study validates that the X-pander may be a suitable option for accurate sizing and assessment of the reamed acetabulum and could replace traditional trial cups in THA. Permalink : ./index.php?lvl=notice_display&id=96668 [article] Dynamic trial fitting of the cup in press-fit total hip arthroplasty, a feasibility study [texte imprimé] / Daniël Hoornenborg ; Justin Van Loon ; Sheryl De Waard ; Inger Sierevelt ; Kim T.M. Opdam ; Gino M.M.J. Kerkhoffs ; Daniël Haverkamp . - 2021 . - p. 327-331. https://doi.org/10.52628/87.2.18 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 327-331 Mots-clés : press-fit  trial fitting  acetabular component  total hip arthroplasty Résumé : Trial fitting of the cup during total hip arthroplasty (THA) is done by trial cups, which do not resemble the real press-fit obtained by the definitive implant. Our goal is to judge feasibility of the X-pander® in clinical practice ; a device developed to mimic the real press-fit obtained by the definitive cup, to ensure satisfactory press-fit. In this feasibility study 45 experienced orthopaedic surgeons from 7 European countries filled in a structured survey after 78 primary THA and 31 revision surgeries, using the X-pander instead of traditional trial cups. Primary outcomes were decision change concerning cup size or further reaming and increased confidence regarding cup insertion and size. Additionally, potential association between the primary outcomes and procedure (primary or revi- sion), bone quality and experience of the surgeon were evaluated. In 33.3% of the primary and 32.2% of the revision cases the X-pander measurement changed the deci- sion and further reaming or change of cup size was decided. In 61.5% and 58.1% of respectively the primary and revision THAs the X-pander was judged to give fairly to much more reliable information than traditional trial cups. The X-pander could lead to less additional screw fixation, as stated in 37.2% of the primary and 25.8% of the revision cases and to better cup insertion in respectively 50.0% and 51.6%. This study validates that the X-pander may be a suitable option for accurate sizing and assessment of the reamed acetabulum and could replace traditional trial cups in THA. Permalink : ./index.php?lvl=notice_display&id=96668

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Acute femoral fracture does not compromise the outcome of total hip arthroplasty : 5 year results from a single center cohort study in 2,782 patients / Stefan B.T. Bolder in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 332-338 Titre : Acute femoral fracture does not compromise the outcome of total hip arthroplasty : 5 year results from a single center cohort study in 2,782 patients Type de document : texte imprimé Auteurs : Stefan B.T. Bolder ; Elsa A. Spaans ; Joost A.A.M. Van Den Hout ; Robert Wagenmakers ; Keon L.M. Koenraadt Année de publication : 2021 Article en page(s) : p. 332-338 Note générale : https://doi.org/10.52628/87.2.19 Langues : Anglais (eng) Mots-clés : hip  arthroplasty  femoral neck fracture  osteoarthritis Résumé : National arthroplasty registries reveal a higher risk of revision for periprosthetic fracture and dislocation after total hip arthroplasty (THA) in patients with a femoral neck fracture compared to those with osteoarthritis (OA). Since these registries may con- tain confounding factors, we conducted a single center cohort study comparing survival and reason for failure between THA for an acute femoral neck fracture and OA using the same hip prosthesis after a minimum follow-up of 2 years. We retrospectively analyzed 2782 patients who had undergone THA with an Accolade TMZF stem and a Trident cup between March 2009 and September 2014. Primary diagnosis before THA was osteoarthritis (OA group : n=2610) or acute femoral fracture (Fracture group : n=172). Patients in both groups were operated on by the same hip surgeons. Effect of diagnosis on THA survival was analyzed using Cox-regression analysis. Chi-square tests were used to illustrate the different reasons for revision between the groups. Mean follow-up was 4.6 years (2-7.6). A total of 100 revisions were performed. The revision risk was comparable between the OA and Fracture group (HR=1.04, 95% CI :0.46-2.39). No differences were found between the OA and Fracture group with respect to the occurrence of periprosthetic fractures (0.8% vs. 0.6%, p=0.71) and revisions for dislocation (0.6% vs. 1.2%, p=0.38). We found no difference in outcome or reason for revision between THA for OA or femoral neck frac- ture. Using an implant with a proven ODEP rating and having experienced hip surgeons carry out the procedures may be more important than the primary diagnosis. Permalink : ./index.php?lvl=notice_display&id=96669 [article] Acute femoral fracture does not compromise the outcome of total hip arthroplasty : 5 year results from a single center cohort study in 2,782 patients [texte imprimé] / Stefan B.T. Bolder ; Elsa A. Spaans ; Joost A.A.M. Van Den Hout ; Robert Wagenmakers ; Keon L.M. Koenraadt . - 2021 . - p. 332-338. https://doi.org/10.52628/87.2.19 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 332-338 Mots-clés : hip  arthroplasty  femoral neck fracture  osteoarthritis Résumé : National arthroplasty registries reveal a higher risk of revision for periprosthetic fracture and dislocation after total hip arthroplasty (THA) in patients with a femoral neck fracture compared to those with osteoarthritis (OA). Since these registries may con- tain confounding factors, we conducted a single center cohort study comparing survival and reason for failure between THA for an acute femoral neck fracture and OA using the same hip prosthesis after a minimum follow-up of 2 years. We retrospectively analyzed 2782 patients who had undergone THA with an Accolade TMZF stem and a Trident cup between March 2009 and September 2014. Primary diagnosis before THA was osteoarthritis (OA group : n=2610) or acute femoral fracture (Fracture group : n=172). Patients in both groups were operated on by the same hip surgeons. Effect of diagnosis on THA survival was analyzed using Cox-regression analysis. Chi-square tests were used to illustrate the different reasons for revision between the groups. Mean follow-up was 4.6 years (2-7.6). A total of 100 revisions were performed. The revision risk was comparable between the OA and Fracture group (HR=1.04, 95% CI :0.46-2.39). No differences were found between the OA and Fracture group with respect to the occurrence of periprosthetic fractures (0.8% vs. 0.6%, p=0.71) and revisions for dislocation (0.6% vs. 1.2%, p=0.38). We found no difference in outcome or reason for revision between THA for OA or femoral neck frac- ture. Using an implant with a proven ODEP rating and having experienced hip surgeons carry out the procedures may be more important than the primary diagnosis. Permalink : ./index.php?lvl=notice_display&id=96669

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Incidence of avascular necrosis following biceps tenodesis during proximal humerus open reduction and internal fixation / Kunal Mohan in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 339-346 Titre : Incidence of avascular necrosis following biceps tenodesis during proximal humerus open reduction and internal fixation Type de document : texte imprimé Auteurs : Kunal Mohan ; Justin Matthias Hintze ; David Morrissey ; Diarmuid Molony Année de publication : 2021 Article en page(s) : p. 339-346 Note générale : https://doi.org/10.52628/87.2.20 Langues : Anglais (eng) Mots-clés : proximal humerus  open reduction internal fixation  avascular necrosis  biceps  tenodesis  delto-pectoral Résumé : Avascular necrosis (AVN) may occur in up to 77% of proximal humeral fractures and can cause fixation failure. Risk factors include fracture position, calcar length and medial hinge integrity. We routinely perform intra-articular biceps tenotomy with tenodesis at the level of pectoralis major to facilitate fragment identification and potentially ameliorate post-operative pain relief. Concern exists that tenotomising the biceps damages the adjacent arcuate artery, potentially increasing the rate of AVN. The purpose of this study was to evaluate whether biceps tenodesis is associated with an increased risk of radiographically evident humeral head AVN. 61 fractures surgically treated over a 52-month period were retrospectively reviewed and radiographically assessed in accordance with Neer’s classification, calcar-length and medial hinge integrity. 40, 20 and 1 were four-, three- and two-part fractures respectively. 37 had a calcar-length less than 8mm and 26 suffered loss of the medial hinge. The median radiographic follow-up was 23 months. There was radiographic evidence of humeral head AVN in only one case, comparing favourably to rates quoted in current literature. In our experience, intra-articular biceps tenotomy with the deltopectoral approach was thus not associated with a significantly increased risk of humeral head AVN, even in complex four-part fractures. Permalink : ./index.php?lvl=notice_display&id=96670 [article] Incidence of avascular necrosis following biceps tenodesis during proximal humerus open reduction and internal fixation [texte imprimé] / Kunal Mohan ; Justin Matthias Hintze ; David Morrissey ; Diarmuid Molony . - 2021 . - p. 339-346. https://doi.org/10.52628/87.2.20 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 339-346 Mots-clés : proximal humerus  open reduction internal fixation  avascular necrosis  biceps  tenodesis  delto-pectoral Résumé : Avascular necrosis (AVN) may occur in up to 77% of proximal humeral fractures and can cause fixation failure. Risk factors include fracture position, calcar length and medial hinge integrity. We routinely perform intra-articular biceps tenotomy with tenodesis at the level of pectoralis major to facilitate fragment identification and potentially ameliorate post-operative pain relief. Concern exists that tenotomising the biceps damages the adjacent arcuate artery, potentially increasing the rate of AVN. The purpose of this study was to evaluate whether biceps tenodesis is associated with an increased risk of radiographically evident humeral head AVN. 61 fractures surgically treated over a 52-month period were retrospectively reviewed and radiographically assessed in accordance with Neer’s classification, calcar-length and medial hinge integrity. 40, 20 and 1 were four-, three- and two-part fractures respectively. 37 had a calcar-length less than 8mm and 26 suffered loss of the medial hinge. The median radiographic follow-up was 23 months. There was radiographic evidence of humeral head AVN in only one case, comparing favourably to rates quoted in current literature. In our experience, intra-articular biceps tenotomy with the deltopectoral approach was thus not associated with a significantly increased risk of humeral head AVN, even in complex four-part fractures. Permalink : ./index.php?lvl=notice_display&id=96670

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Knee mega-prosthesis in the management of complex knee fracture of the elderly : a case series and review of the literature / Gautier Beckers in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 347-351 Titre : Knee mega-prosthesis in the management of complex knee fracture of the elderly : a case series and review of the literature Type de document : texte imprimé Auteurs : Gautier Beckers ; David Mazy ; Philippe Tollet ; Olivier Van Nieuwenhove Année de publication : 2021 Article en page(s) : p. 347-351 Note générale : https://doi.org/10.52628/87.2.21 Langues : Anglais (eng) Mots-clés : distal femur fracture  knee mega-prosthesis  elderly  osteoporosis Résumé : The management of complicated distal femur fractures (DFF) of the elderly continues to pose a challenge. Knee mega-prosthesis are mostly used for Total knee arthroplasty revision and tumor resection surgery but they can be used for the treatment of complex knee fractures. The purpose of the present study is to examine the short- to mid- term outcomes of their use for complex DFF of the elderly. We retrospectively identified 4 patients with DFF AO33C3 on osteoporotic bone treated by total knee arthroplasty from September 2015 to October 2019. The average age at the time of the surgery was 79,5 years (range, 69 to 95 years). All patients were females and underwent a total knee replacement by one senior surgeon, with the OSS TM Orthopaedic Salvage System (Zimmer Biomet, Warsaw, Indiana, USA). Outcome measures included clinical outcome scores, radiological analyses, reoperation rate and complications. At an average follow-up of 2,3 years (range, 0,6 to 4,2 years), the average Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) was 17,25 (range, 7 to 37), the average Oxford knee score was 35,25 (range, 25 to 41) and the average pain Numerical Rating Scale (NRS) was 0,5 (range, 0 to 1). 3 Patients had postoperative anemia but no implant related complications has been reported. Complex DFF of the elderly treated with mega knee arthroplasty exhibit good clinical outcomes scores. The patients should be selected carefully as the complication rate found in the literature remains high. Permalink : ./index.php?lvl=notice_display&id=96671 [article] Knee mega-prosthesis in the management of complex knee fracture of the elderly : a case series and review of the literature [texte imprimé] / Gautier Beckers ; David Mazy ; Philippe Tollet ; Olivier Van Nieuwenhove . - 2021 . - p. 347-351. https://doi.org/10.52628/87.2.21 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 347-351 Mots-clés : distal femur fracture  knee mega-prosthesis  elderly  osteoporosis Résumé : The management of complicated distal femur fractures (DFF) of the elderly continues to pose a challenge. Knee mega-prosthesis are mostly used for Total knee arthroplasty revision and tumor resection surgery but they can be used for the treatment of complex knee fractures. The purpose of the present study is to examine the short- to mid- term outcomes of their use for complex DFF of the elderly. We retrospectively identified 4 patients with DFF AO33C3 on osteoporotic bone treated by total knee arthroplasty from September 2015 to October 2019. The average age at the time of the surgery was 79,5 years (range, 69 to 95 years). All patients were females and underwent a total knee replacement by one senior surgeon, with the OSS TM Orthopaedic Salvage System (Zimmer Biomet, Warsaw, Indiana, USA). Outcome measures included clinical outcome scores, radiological analyses, reoperation rate and complications. At an average follow-up of 2,3 years (range, 0,6 to 4,2 years), the average Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) was 17,25 (range, 7 to 37), the average Oxford knee score was 35,25 (range, 25 to 41) and the average pain Numerical Rating Scale (NRS) was 0,5 (range, 0 to 1). 3 Patients had postoperative anemia but no implant related complications has been reported. Complex DFF of the elderly treated with mega knee arthroplasty exhibit good clinical outcomes scores. The patients should be selected carefully as the complication rate found in the literature remains high. Permalink : ./index.php?lvl=notice_display&id=96671

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Investigation of the relationship between trochlear morphology and medial patellar cartilage defect using magnetic resonance imaging / Semra Duran in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 352-358 Titre : Investigation of the relationship between trochlear morphology and medial patellar cartilage defect using magnetic resonance imaging Type de document : texte imprimé Auteurs : Semra Duran ; Elif Gunaydin Année de publication : 2021 Article en page(s) : p. 352-358 Note générale : https://doi.org/10.52628/87.2.22 Langues : Anglais (eng) Mots-clés : chondromalacia patella  femoral trochlea  morphology  magnetic resonance imaging Résumé : The aim of this study was to evaluate trochlear morphology in patients with medial patellar cartilage defects via magnetic resonance imaging (MRI). Three hundred patients who were diagnosed with grade 2, 3 and 4 medial patellar cartilage defect using MRI according to the International Cartilage Repair Society Classification System and 100 control subjects were evaluated. Trochlear morphology was evaluated based on lateral trochlear inclination (LTI), medial trochlear inclination (MTI), sulcus angle( SA), femoral lateral and medial condyle symmetry, trochlear facet asymmetry, and trochlear width on the axial MR images. The mean SA was significantly higher in the medial patellar cartilage defect group compared to the control group (p<.05). The LTI and MTI of the cartilage defect group were significantly lower than those of the control group (p<.05). With the decreasing LTI and MTI, there was an increase in medial patellar cartilage loss. LTI (r=-0.46) and MTI (r=-0.53) were moderately correlated with SA. There was no significant differences in femoral lateral and medial condyle symmetry, trochlear facet asymmetry, and trochlear width between groups with and without medial patellar cartilge defect (p > .05). A flattened medial trochlea is a risk factor for cartilage structural damage of the medial patellofemoral joint, and it plays a role in the development of a defect in the medial patellar cartilage. The medial patellar cartilage defect is associated with the flattened lateral trochlea. Permalink : ./index.php?lvl=notice_display&id=96672 [article] Investigation of the relationship between trochlear morphology and medial patellar cartilage defect using magnetic resonance imaging [texte imprimé] / Semra Duran ; Elif Gunaydin . - 2021 . - p. 352-358. https://doi.org/10.52628/87.2.22 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 352-358 Mots-clés : chondromalacia patella  femoral trochlea  morphology  magnetic resonance imaging Résumé : The aim of this study was to evaluate trochlear morphology in patients with medial patellar cartilage defects via magnetic resonance imaging (MRI). Three hundred patients who were diagnosed with grade 2, 3 and 4 medial patellar cartilage defect using MRI according to the International Cartilage Repair Society Classification System and 100 control subjects were evaluated. Trochlear morphology was evaluated based on lateral trochlear inclination (LTI), medial trochlear inclination (MTI), sulcus angle( SA), femoral lateral and medial condyle symmetry, trochlear facet asymmetry, and trochlear width on the axial MR images. The mean SA was significantly higher in the medial patellar cartilage defect group compared to the control group (p<.05). The LTI and MTI of the cartilage defect group were significantly lower than those of the control group (p<.05). With the decreasing LTI and MTI, there was an increase in medial patellar cartilage loss. LTI (r=-0.46) and MTI (r=-0.53) were moderately correlated with SA. There was no significant differences in femoral lateral and medial condyle symmetry, trochlear facet asymmetry, and trochlear width between groups with and without medial patellar cartilge defect (p > .05). A flattened medial trochlea is a risk factor for cartilage structural damage of the medial patellofemoral joint, and it plays a role in the development of a defect in the medial patellar cartilage. The medial patellar cartilage defect is associated with the flattened lateral trochlea. Permalink : ./index.php?lvl=notice_display&id=96672

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Anatomic reconstruction of the medial collateral ligament in multi-ligaments knee injury using achilles allograft : a modification of Marx’s technique / Hamidreza Yazdi in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 359-365 Titre : Anatomic reconstruction of the medial collateral ligament in multi-ligaments knee injury using achilles allograft : a modification of Marx’s technique Type de document : texte imprimé Auteurs : Hamidreza Yazdi ; John Y. Kwon ; Mohammad Ghorbanhoseini ; Alireza Youssof Gomrokchi ; Paniz Motaghi Année de publication : 2021 Article en page(s) : p. 359-365 Note générale : https://doi.org/10.52628/87.2.23 Langues : Anglais (eng) Mots-clés : MCL repair  allograft  Marx’s technique  superficial MCL  anchor sutures  staged reconstruction Résumé : Medial Collateral Ligament (MCL) injury may require operative treatment. Marx et al. described the latest technique for reconstruction of MCL. While good results have been reported using the Marx technique, some issues have been observed. To address the mentioned issues, a modification to the Marx technique has been devised. Eleven patients were enrolled and their ligaments were repaired by the fixation of allograft on the proximal and distal attachment footprints of the superficial MCL. For preventing loss of knee ROM, MCL and other ligaments were reconstructed in 2 separate stages. At the last follow up the ROM, knee ligament laxity and functional outcome scores, subjective (IKDC) and Lysholm score were evaluated and recorded. Knee motion was maintained in all cases. Two cases demonstrated 1+ valgus instability at 30 degrees of knee flexion. Both were treated for combined MCL and PCL tear, the rest were stable. The average IKDC-subjective score was 93 ± 4 and the average Lysholm score was 92 ± 3. All patients were satisfied and returned to their previous level of activity. In this technique, the superficial MCL was recon- structed closer to its anatomical construct. Patients didn’t have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Patients didn’t have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Also reconstructing the ligaments in 2 stages helped to preserve the knee motion. Permalink : ./index.php?lvl=notice_display&id=96673 [article] Anatomic reconstruction of the medial collateral ligament in multi-ligaments knee injury using achilles allograft : a modification of Marx’s technique [texte imprimé] / Hamidreza Yazdi ; John Y. Kwon ; Mohammad Ghorbanhoseini ; Alireza Youssof Gomrokchi ; Paniz Motaghi . - 2021 . - p. 359-365. https://doi.org/10.52628/87.2.23 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 359-365 Mots-clés : MCL repair  allograft  Marx’s technique  superficial MCL  anchor sutures  staged reconstruction Résumé : Medial Collateral Ligament (MCL) injury may require operative treatment. Marx et al. described the latest technique for reconstruction of MCL. While good results have been reported using the Marx technique, some issues have been observed. To address the mentioned issues, a modification to the Marx technique has been devised. Eleven patients were enrolled and their ligaments were repaired by the fixation of allograft on the proximal and distal attachment footprints of the superficial MCL. For preventing loss of knee ROM, MCL and other ligaments were reconstructed in 2 separate stages. At the last follow up the ROM, knee ligament laxity and functional outcome scores, subjective (IKDC) and Lysholm score were evaluated and recorded. Knee motion was maintained in all cases. Two cases demonstrated 1+ valgus instability at 30 degrees of knee flexion. Both were treated for combined MCL and PCL tear, the rest were stable. The average IKDC-subjective score was 93 ± 4 and the average Lysholm score was 92 ± 3. All patients were satisfied and returned to their previous level of activity. In this technique, the superficial MCL was recon- structed closer to its anatomical construct. Patients didn’t have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Patients didn’t have any complaints of hardware under the skin and the need for a second surgery for hardware removal was avoided. Also reconstructing the ligaments in 2 stages helped to preserve the knee motion. Permalink : ./index.php?lvl=notice_display&id=96673

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Does anterolateral ligament injury change the treatment option in patients with partial ACL tears? / Burak Gunaydin in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 366-373 Titre : Does anterolateral ligament injury change the treatment option in patients with partial ACL tears? Type de document : texte imprimé Auteurs : Burak Gunaydin ; Tugba Ilkem Kurtoglu Ozcaglayan ; Mehmet Umit Cetin ; Abdulkadir Sari ; Yasar Mahsut Dincel ; Cagatay Tekin Année de publication : 2021 Article en page(s) : p. 366-373 Note générale : https://doi.org/10.52628/87.2.24 Langues : Anglais (eng) Mots-clés : anterior cruciate ligament  partial ACL tear  anterolateral ligament  arthroscopic reconstruction  MRI Résumé : Patients with ACL tears with ALL injury have more clinical complaints (instability, feeling of the pop on the knee or knee sliding). patients have ALL injury with partial ACL tears, It is unclear whether the choice of treatment will be conservative or surgical. This study aimed to determine the effect of anterolateral ligament (ALL) status, whether intact or ruptured, on the choice of conservative or surgical treatment in patients with partial anterior cruciate ligament (ACL) tears. Between 2015 and 2019, patients with suspected partial ACL tears were identified on both physical examination and MR imaging. 122 patients who had partial ACL tears and also status of patient’s ALL could be evaluated by radiologist were included in the study, retrospectively. Sixty-two patients who underwent ACL reconstruction were determined as group 1, and 60 patients who did not undergo ACL reconstruction were defined as group 2. In patients with partial ACL rupture with or without ACL reconstruction, it was evaluated whether a ruptured or non- ruptured ALL was effective in this decision of conservative or surgically. The MRIs of patients with partial ACL tears were evaluated by a radiologist and it was concluded that the ALLs of 50 patients were ruptured, and 72 were intact. The ALLs of 36 patients in group 1 were ruptured, and 26 patients were intact. Fourteen patients in group 2 had ruptured ALLs, 46 patient’s ALLs were intact. Seventy-two percent of the patients with partial ACL tears who had ruptured ALLs in MRI underwent ACL reconstruction. It was found that ACL reconstruction was performed more frequently in patients with partial ACL tears with ALL rupture. Therefore, we believe that preoperative evaluations of ALLs using MRI in patients with partial ACL tears are essential for surgical planning. Permalink : ./index.php?lvl=notice_display&id=96674 [article] Does anterolateral ligament injury change the treatment option in patients with partial ACL tears? [texte imprimé] / Burak Gunaydin ; Tugba Ilkem Kurtoglu Ozcaglayan ; Mehmet Umit Cetin ; Abdulkadir Sari ; Yasar Mahsut Dincel ; Cagatay Tekin . - 2021 . - p. 366-373. https://doi.org/10.52628/87.2.24 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 366-373 Mots-clés : anterior cruciate ligament  partial ACL tear  anterolateral ligament  arthroscopic reconstruction  MRI Résumé : Patients with ACL tears with ALL injury have more clinical complaints (instability, feeling of the pop on the knee or knee sliding). patients have ALL injury with partial ACL tears, It is unclear whether the choice of treatment will be conservative or surgical. This study aimed to determine the effect of anterolateral ligament (ALL) status, whether intact or ruptured, on the choice of conservative or surgical treatment in patients with partial anterior cruciate ligament (ACL) tears. Between 2015 and 2019, patients with suspected partial ACL tears were identified on both physical examination and MR imaging. 122 patients who had partial ACL tears and also status of patient’s ALL could be evaluated by radiologist were included in the study, retrospectively. Sixty-two patients who underwent ACL reconstruction were determined as group 1, and 60 patients who did not undergo ACL reconstruction were defined as group 2. In patients with partial ACL rupture with or without ACL reconstruction, it was evaluated whether a ruptured or non- ruptured ALL was effective in this decision of conservative or surgically. The MRIs of patients with partial ACL tears were evaluated by a radiologist and it was concluded that the ALLs of 50 patients were ruptured, and 72 were intact. The ALLs of 36 patients in group 1 were ruptured, and 26 patients were intact. Fourteen patients in group 2 had ruptured ALLs, 46 patient’s ALLs were intact. Seventy-two percent of the patients with partial ACL tears who had ruptured ALLs in MRI underwent ACL reconstruction. It was found that ACL reconstruction was performed more frequently in patients with partial ACL tears with ALL rupture. Therefore, we believe that preoperative evaluations of ALLs using MRI in patients with partial ACL tears are essential for surgical planning. Permalink : ./index.php?lvl=notice_display&id=96674

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Diagnostic value of routine pre-operative investigations used in combination in the diagnosis of periprosthetic joint infection / Lucy C. Walker in Acta Orthopaedica Belgica, Vol.87/2 (Juin 2021)

Public ISBD [article]  inActa Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 374-381 Titre : Diagnostic value of routine pre-operative investigations used in combination in the diagnosis of periprosthetic joint infection Type de document : texte imprimé Auteurs : Lucy C. Walker ; Nick D. Clement ; Munawar Ashmi ; Julie Samuel ; David J. Deehan Année de publication : 2021 Article en page(s) : p. 374-381 Note générale : https://doi.org/10.52628/87.2.25 Langues : Anglais (eng) Mots-clés : Periprosthetic joint infection  C-reactive protein (CRP)  Erythrocyte sedimentation rate (ESR)  joint aspiration  diagnostic algorithm Résumé : The primary aim of this study was to assess the diagnostic accuracy of joint aspiration culture, serum C-reactive protein (CRP) and serum erythrocyte sedimentation rate (ESR), individually, and in combination for the diagnosis of periprosthetic joint infection (PJI). A consecutive patient series with pre-operative inflammatory marker levels, an aspiration culture of either hip or knee arthroplasty and intra-operative culture samples from subsequent revision surgery was compiled. This retrospective patient cohort analysis included 128 aspiration. The data were analysed to compare pre-operative aspiration cultures, serum ESR and CRP levels to the chosen gold standard for PJI diagnosis of intra-operative culture samples. A diagnostic algorithm was created using the above tests combined with clinical suspicion index. The values that had the highest sensitivity and specificity of predicting PJI were >5 for CRP and >16 for ESR. CRP used individually had the highest sensitivity and negative predictive value (NPV) of any test (75.0% and 75.9%, respectively). ESR + aspirate had the highest specificity and positive predictive value (PPV), of 100% for both. Using all three tests together the specificity and PPV were higher than the test individual values (95.3% and 85.0% respectively). Based on subgroup analyses the combination of ESR or CRP plus joint aspiration has superior PPV compared to individual tests. ESR and CRP had the highest NPV when used in isolation. An algorithm has been developed to guide clinical diagnosis. Permalink : ./index.php?lvl=notice_display&id=96675 [article] Diagnostic value of routine pre-operative investigations used in combination in the diagnosis of periprosthetic joint infection [texte imprimé] / Lucy C. Walker ; Nick D. Clement ; Munawar Ashmi ; Julie Samuel ; David J. Deehan . - 2021 . - p. 374-381. https://doi.org/10.52628/87.2.25 Langues : Anglais (eng) in Acta Orthopaedica Belgica > Vol.87/2 (Juin 2021) . - p. 374-381 Mots-clés : Periprosthetic joint infection  C-reactive protein (CRP)  Erythrocyte sedimentation rate (ESR)  joint aspiration  diagnostic algorithm Résumé : The primary aim of this study was to assess the diagnostic accuracy of joint aspiration culture, serum C-reactive protein (CRP) and serum erythrocyte sedimentation rate (ESR), individually, and in combination for the diagnosis of periprosthetic joint infection (PJI). A consecutive patient series with pre-operative inflammatory marker levels, an aspiration culture of either hip or knee arthroplasty and intra-operative culture samples from subsequent revision surgery was compiled. This retrospective patient cohort analysis included 128 aspiration. The data were analysed to compare pre-operative aspiration cultures, serum ESR and CRP levels to the chosen gold standard for PJI diagnosis of intra-operative culture samples. A diagnostic algorithm was created using the above tests combined with clinical suspicion index. The values that had the highest sensitivity and specificity of predicting PJI were >5 for CRP and >16 for ESR. CRP used individually had the highest sensitivity and negative predictive value (NPV) of any test (75.0% and 75.9%, respectively). ESR + aspirate had the highest specificity and positive predictive value (PPV), of 100% for both. Using all three tests together the specificity and PPV were higher than the test individual values (95.3% and 85.0% respectively). Based on subgroup analyses the combination of ESR or CRP plus joint aspiration has superior PPV compared to individual tests. ESR and CRP had the highest NPV when used in isolation. An algorithm has been developed to guide clinical diagnosis. Permalink : ./index.php?lvl=notice_display&id=96675

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Revue	Revue	Centre de Documentation HELHa Campus Montignies	Armoires à volets	Document exclu du prêt - à consulter sur place Exclu du prêt