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Subtrochanteric fractures after retrograde femoral nailing

World Journal of orthopedics 2015年第9期6卷 738-743页

作者： Varatharaj Mounasamy Sathya Mallu Vishesh Khanna Senthil Sambandam department of ortho-pedics Virginia Common wealth University Health System department of orthopedics KG Hospital

Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis.

关键词： Peri-implant fracture Retrograde femoral nail Antegrade femoral nailing Interlocking screw Subtrochanteric fractures

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Posterolateral dislocation of the knee:Recognizing an uncommon entity

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World Journal of orthopedics 2016年第6期7卷 401-405页

作者： Colin YL Woon Mark R Hutchinson department of ortho-paedic Surgery University of Illinois at Chicago

Posterolateral dislocations of the knee are rare *** recognition and emergent open reduction is crucial.A 48-year-old Caucasian male presented with right knee pain and limb swelling 3 d after sustaining a twisting injury in the *** revealed the pathognomonic anteromedial "pucker" *** indices were greater than 1.0 and *** showed a posterolateral dislocation of the right *** underwent emergency open reduction without an attempt at closed *** at closed reduction of posterolateral dislocations of the knee are usually impossible because of incarceration of medial soft tissue in the intercondylar notch and may only to delay surgical management and increase the risk of skin *** resonance imaging is not crucial in the preoperative period and can lead to delays of up to 24 ***,open reduction should be performed once vascular compromise is excluded.

关键词： Knee dislocation Irreducible dislocation Medial patellofemoral ligament Vastus medialis Medial collateral ligament

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Interleukin-6 and ratio of plasma interleukin-6/interleukin-10 as risk factors of symptomatic lumbar osteoarthritis

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World Journal of orthopedics 2017年第2期8卷 149-155页

作者： I Ketut Suyasa I Ketut Siki Kawiyana I Made Bakta I Gde Raka Widiana department of ortho-paedic and Traumatology Faculty of MedicineUdayana Uni-versity Sanglah General Hospital department of Internal Medicine Faculty of MedicineUdayana University Sanglah General Hospital

AIM To determine the role of cartilage oligomeric matrix protein(COMP), interleukin(IL)-6, IL-10 and ratio of IL-6/IL-10 as risk factors of symptomatic lumbar osteoarthritis(OA) in postmenopausal women with estrogen *** Case-control study had been conducted in Sanglah General Hospital from October 2015 until March 2016. The blood samples were obtained and analyzed by enzyme-linked immunosorbent assay(ELISA).RESULTS From 44 pairs of samples which divided into 44 samples as case group and 44 samples as control group showed that high level of COMP in estrogen deficiency postmenopausal women were not at risk(OR = 0.7; 95%CI: 0.261-1.751; P = 0.393) for symptomatic lumbar OA(cut-off point 0.946). Estrogen deficiency in postmenopausal women with the high level of IL-6 had 2.7 times risk(OR = 2.7; 95%CI: 0.991-8.320; P = 0.033) for symptomatic lumbar OA from the low level of IL-6(cut-off point 2.264). At lower level of IL-10, there was no risk for symptomatic lumbar OA(OR = 0.6; 95%CI: 0.209-1.798; P = 0.345) than with the higher level of IL-10(cut-off point 6.049). While the high ratio of IL-6/IL-10 level in estrogen deficiency postmenopausal women gave 3.4 times risk(OR = 3.4; 95%CI: 1.204-11.787; P = 0.011)for symptomatic lumbar OA than the low ratio of IL-6/IL-10 level(cut-off point 0.364).CONCLUSION High ratio of IL-6/IL-10 plasma level was the highest risk factor for causing symptomatic lumbar OA in postmenopausal women with estrogen deficiency.

关键词： Symptomatic lumbar osteoarthritis Ratio of interleukin-6/interleukin-10 Interleukin-6 Interleukin-10 Cartilage oligomeric matrix protein

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Total joint replacement in inhibitor-positive haemophilia:Long-term outcome analysis in fifteen patients

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World Journal of orthopedics 2017年第10期8卷 777-784页

作者： Heidi Danielson Riitta Lassila Pekka Ylinen Timo Yrj?nen Orton ortho-paedic Hospital Invalid Foundation Helsinki University and Coagulation Disorders unit Department of Haematology and Comprehensive Cancer CentreHelsinki University Hospital

AIM To collect data from joint replacement in inhibitor patients, evaluate haemostatic and patient outcomes, and analyse the *** We report our 21-year, single-centre cumulative experience of 15 joint arthroplasties in six inhibitor *** Two low responder inhibitor patients were in the early days treated with FVIII, whereas bypassing agents were used in the rest of the high responder patients. The primary haemostatic outcome was good in 8/15, fair in 4/15 and poor in 3/15 operations. The overall patient outcome, including joint health and patient satisfaction, was good in 10/15, fair 4/15 and poor in 1/15. No deep infections were observed. Cost analysis was most beneficial in low responders and in two immune-tolerized, high responder patients. In all cases, factor replacement comprised the main treatment *** Our experience supports the initial use of bypassing agents as well as preoperative immune-tolerance induction when possible. Despite the challenges of haemostasis and severe joint disease, total joint arthroplasty can reach a good outcome, even in inhibitor patients. The risk for deep infection might be smaller than previously reported. Individual planning, intense multidisciplinary teamworkand execution of operations should be centralised in a professional unit.

关键词： Haemophilia Joint replacement Inhibitor Cost analysis Arthroplasty

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Modified porous tantalum rod technique for the treatment of femoral head osteonecrosis

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World Journal of orthopedics 2015年第10期6卷 829-837页

作者： Emilios E Pakos Panayiotis Megas Nikolaos K Paschos Spyridon A Syggelos Antonios Kouzelis Georgios Georgiadis Theodoros A Xenakis department of orthopaedics and Biomechanics University of IoanninaMedical School department of ortho-paedic Surgery University Hospital of PatrasUniversity of PatrasMedical School department of Anatomy HistologyEmbryologyUniversity of PatrasMedical School

AIM: To study a modified porous tantalum technique for the treatment of osteonecrosis of the femoral ***: The porous tantalum rod was combined with endoscopy,curettage,autologous bone grafting and use of bone marrow aspirates from iliac crest aspiration in 49 patients(58 hips) with a mean age of 38 *** majority of the patients had idiopathic osteonecrosis,followed by corticosteroid-induced *** hips were of Steinberg stage Ⅱ disease and 20 hips were of stage Ⅲ *** were followed for 5 years and were evaluated clinically with the Merle D'Aubigne and Postel score and *** primary outcome of the study was survival based on the conversion to total hip arthroplasty(THA).Secondary outcomes included deterioration of the osteonecrosis to a higher disease stage at 5 years compared to the preoperative period and identification of factors that were associated with *** Kaplan-Meier survival analysis was performed to evaluate the survivorship ofthe prosthesis,and the Fisher exact test was performed to test associations between various parameters with ***: No patient developed any serious intraoperative or postoperative complication including implant loosening or migration and donor site *** the 5-year follow up,1 patient died,7 patients had disease progression and 4 hips were converted to *** 5-year survival based on conversion to THA was 93.1% and the respective rate based on disease progression was 87.9%.Stage Ⅱ disease was associated with statistically significant better survival rates compared to stage Ⅲ disease(P = 0.04).The comparison between idiopathic and non-idiopathic osteonecrosis and between steroid-induced and non-steroid-induced osteonecrosis did not showed any statistically significant difference in survival *** clinical evaluation revealed statistically significantly improved Merle d'Aubigne scores at 12 mo postoperatively compared to the preoperative period

关键词： Avascular necrosis Femoral head Tantalum rod Survival Bone grafting

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Sonoelastography in the musculoskeletal system:Current role and future directions

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World Journal of Radiology 2016年第11期8卷 868-879页

作者： Naomi Winn Radhesh Lalam Victor Cassar-Pullicino department of Radiology Robert Jones and Agnes Hunt Ortho-paedic Hospital NHS Foundation Trust

Ultrasound is an essential modality within musculoskeletal imaging, with the recent addition of elastography. The elastic properties of tissues are different from the acoustic impedance used to create B mode imaging and the flow properties used within Doppler imaging, hence elastography provides a different form of tissue assessment. The current role of ultrasound elastography in the musculoskeletal system will be reviewed, in particular with reference to muscles, tendons, ligaments, joints and soft tissue tumours. The different ultrasound elastography methods currently available will be described, in particular strain elastography and shear wave elastography. Future directions of ultrasound elastography in the musculoskeletal system will also be discussed.

关键词： Ultrasound Elastography Musculoskeletal system

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Retrospective Case Series of Porous Titanium Cages in Oblique Lumbar Interbody Fusion Surgery Assessing Subsidence, Fusion and Functional Outcomes

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Open Journal of orthopedics 2023年第4期13卷 147-156页

作者： Joseph Maalouly Raghad Barri John Choi department of orthopedic Surgery and Spine Surgery Spine Ortho Clinic The Bays Hospital Melbourne Australia

Purpose: Implant subsidence is a possible complication of spinal interbody fusion. We aim to evaluate porous titanium cages subsidence, fusion and functional outcomes in patients subjected to oblique lumbar interbody fusion (OLIF) with these novel devices. Methods: Our institutional review board approved a single-center experience which included 60 patients who underwent OLIF from June 2018 to June 2020 utilizing the porous titanium implants. Data was collected in accordance with the Declaration of Helsinki, and written informed consent was obtained. Imaging studies including radiographs 1, 3, 6 and 12 months and computed tomography (CT) scan at 6 months obtained during routine postoperative follow-up visits, were studied for signs of implant subsidence, fusion and clinical parameters to determine the effectiveness of surgery such as Oswestry disability index (ODI). Results: Radiographic subsidence occurred in 1 out of 89 porous titanium interbody cages (1.1%). No subsidence was observed in the posterior screws and rods fixation group (N = 57). However, one case of subsidence occurred in the lateral plate fixation group (N = 3). The subsidence occurred in an osteoporotic elderly patient operated for adjacent segment disease, and she was later revised with posterior instrumentation using cemented screws and rods. She had an uneventful recovery. Fusion rates were evaluated under CT scan at 6 months with a rate of 88%. In terms of clinical outcomes, ODI decreased significantly from 20.3 preop to 10.7 postop with a P-value Conclusions: In our study, the subsidence rate was lower than previously reported in the literature. Also, we had good fusion rates at 6 months likely due to the porous titanium cages use. We had no subsidence in the posterior instrumented group and one case in the lateral fixation group with improved clinical outcomes.

关键词： Degenerative Diseases Osteoarthritis Lumbar Spine Anterior-to-Psoas Oblique Lumbar Interbody Fusion

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Rotator cuff tears: An evidence based approach

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World Journal of orthopedics 2015年第11期6卷 902-918页

作者： Senthil Nathan Sambandam Vishesh Khanna Arif Gul Varatharaj Mounasamy Joint Reconstruction Center Department of OrthopaedicsK.G. Hospital and Postgraduate Medical Institute DNB orthopaedics Department of Ortho- paedicsK.G. Hospital and Postgraduate Medical Institute Princess Alexandra Hospital VCU Medical Center Ambulatory Care Center

Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears(PTT) can be bursalsided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears(FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations- cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, antiinflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being costeffective, this helps in providing a functional shoulder witha stable cuff. An easily reproducible technique of maximal strength and sturdiness

关键词： Rotator cuff tears Partial thickness tears Full thickness tear Natural history Ultrasonography Magnetic resonance imaging Single row repair Double row repair Healing

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Long-term results of an anatomically implanted hip arthroplasty with a short stem prosthesis (MiniHip^(TM))

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World Journal of orthopedics 2018年第10期9卷 210-219页

作者： Lars V von Engelhardt Andreas Breil-Wirth Christian Kothny Jorn Bengt Seeger Christian Grasselli Joerg Jerosch Faculty of Health University of Witten/Herdecke department of Trauma Surgery orthopedics and Sports Medicine Katholisches Karl-Leisner Klinikum department of orthopedics Trauma Surgery and Sports MedicineJohanna Etienne Hospital Munich ortho Center department of orthopaedics and orthopaedic Surgery University Hospital Giessen and Marburg department of orthopaedics and Traumatology Waldburg-Zeil Clinic Tettnang

AIM To evaluate the clinical and radiological outcome nineand ten years after short-stemmed, bone preserving and anatomical hip arthroplasty with the MiniHip^(TM) system. METHODS In a prospective study, 186 patients underwent hip arthroplasty with a partial neck preserving short stem(MiniHip^(TM), Corin). Elderly patients were not excluded from this study, thus the mean age at the time of surgery was 59.3 years(range 32 to 82 years). Surgery and the follow-up assessments were performed at two Centers. Up until now, the mean follow-up was 112.5 ± 8.2 mo. The Oxford Hip Score(OHS) and the Hip Dysfunction Osteoarthritis and Outcome Score(HOOS) was assessed pre-and each year after surgery. The clinical follow-up was accompanied by standardized a.p. and axial radiological examinations. Periprosthetic lucencies, hypertrophies within the Gruen zones one to fourteen were assessed. A subsidence of the stem was investigated according to Morray and heterotopic ossifications were assessed according to *** The OHS and HOOS improved from 18 ± 3.3 to 46 ± 2.0 and from 30 ± 8.3 to 95 ± 4.6 points, P 0.05). Two stems were revised due to a symptomatic subsidence four and twelve months postoperatively. Thus, the survivorship for aseptic loosening at nine to ten years was 98.66%. Including one stem revision due to a symptomatic exostosis, bursitis and thigh pain as well as one revision because of a septic stem loosening, the overall survival for the stem with revision for any reason was 97.32%. Besides one asymptomatic patient, radiological signs of a proximal stress-shielding, such as bone resorptions within the proximal Gruen zones, were not noticed. Findings suggesting a distal loading, e.g., bony hypertrophies or bone appositions of more than 2 mm, were also not detected. CONCLUSION Regarding these first long-term results on the MiniHip^(TM), the implant performed excee

关键词： Primary hip arthroplasty Long-term results Short stem endoprothesis Prospective follow-up study Stress-shielding

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Complex ankle arthrodesis: Review of the literature

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World Journal of orthopedics 2015年第8期6卷 602-613页

作者： Remy V Rabinovich Amgad M Haleem S Robert Rozbruch department of orthopaedic Surgery Lenox Hill Hospital department of ortho-paedic Surgery Limb Lengthening and Complex Reconstruction Service Hospital for Special Surgery

Complex ankle arthrodesis is defined as an ankle fusion that is at high risk of delayed and nonunion secondary to patient comorbidities and/or local ankle/hindfoot factors. Risk factors that contribute to defining this group of patients can be divided into systemic factors and local factors pertaining to co-existing ankle or hindfoot pathology. orthopaedic surgeons should be aware of these risk factors and their association with patients' outcomes after complex ankle fusions. Both external and internal fixations have demonstrated positive outcomes with regards to achieving stable fixation and minimizing infection. Recent innovations in the application of biophysical agents and devices have shown promising results as adjuncts for healing. Both osteoconductive and osteoinductive agents have been effectively utilized as biological adjuncts for bone healing with low complication rates. Devices such as pulsed electromagnetic field bone stimulators, internal direct current stimulators and low-intensity pulsed ultrasound bone stimulators have been associated with faster bone healing and improved outcomes scores when compared with controls. The aim of this review article is to present a comprehensive approach to the management of complex ankle fusions, including the use of biophysical adjuncts for healing and a proposed algorithm for their treatment.

关键词： Ankle Arthrodesis Ilizarov Reconstruction Salvage

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