RESUMEN
BACKGROUND: Total elbow arthroplasty (TEA) has a higher rate of revision and complications than other total joint arthroplasties. Salvage options for failed TEAs are limited, especially when patients have poor ulna bone stock. The purpose of this study is to describe a surgical technique and report outcomes of patients who underwent revision TEA with implantation of the ulnar component into the radius to address ulna bony defects. METHODS: A retrospective review of 5 patients at a single institution from 2014 to 2019 in which the ulnar component was implanted into the radius to address large bony defects in the setting of revision TEA was performed. RESULTS: At follow-up of 2.1 ± 1.9 years, patients experienced an increase in total arc of motion from 86 ± 17° to 112 ± 8°, with infection eradication and no instances of distal component loosening. CONCLUSION: This salvage technique was effective at providing a stable elbow in patients with large ulna bony defects as a result of prosthetic joint infection or periprosthetic fracture.
Asunto(s)
Artroplastia de Reemplazo de Codo , Articulación del Codo , Codo , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Estudios de Seguimiento , Humanos , Falla de Prótesis , Radio (Anatomía)/cirugía , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento , Cúbito/diagnóstico por imagen , Cúbito/cirugíaRESUMEN
OBJECTIVE: To compare the volar Henry and dorsal Thompson approaches with respect to outcomes and complications for proximal third radial shaft fractures. DESIGN: Multicenter retrospective cohort study. PATIENTS/PARTICIPANTS: Patients with proximal third radial shaft fractures ± associated ulna fractures (OTA/AO 2R1 ± 2U1) treated operatively at 11 trauma centers were included. INTERVENTION: Patient demographics and injury, fracture, and surgical data were recorded. Final range of motion and complications of infection, neurologic injury, compartment syndrome, and malunion/nonunion were compared for volar versus dorsal approaches. MAIN OUTCOME: The main outcome was difference in complications between patients treated with volar versus dorsal approach. RESULTS: At an average follow-up of 292 days, 202 patients (range, 18-84 years) with proximal third radial shaft fractures were followed through union or nonunion. One hundred fifty-five patients were fixed via volar and 47 via dorsal approach. Patients treated via dorsal approach had fractures that were on average 16 mm more proximal than those approached volarly, which did not translate to more screw fixation proximal to the fracture. Complications occurred in 11% of volar and 21% of dorsal approaches with no statistical difference. CONCLUSIONS: There was no statistical difference in complication rates between volar and dorsal approaches. Specifically, fixation to the level of the tuberosity is safely accomplished via the volar approach. This series demonstrates the safety of the volar Henry approach for proximal third radial shaft fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Placas Óseas , Fracturas del Radio , Fijación Interna de Fracturas , Humanos , Radio (Anatomía) , Fracturas del Radio/cirugía , Rango del Movimiento Articular , Estudios RetrospectivosRESUMEN
PURPOSE: The Aptis total distal radioulnar joint (DRUJ) prosthesis is a semiconstrained implant designed for treatment of DRUJ arthritis and instability. The purpose of this study was to analyze short-term complications of this device. METHODS: We performed a retrospective chart review of patients undergoing semiconstrained DRUJ arthroplasty from 2007 to 2015 at a single institution. Records were analyzed for complications and the need for subsequent surgical procedures. RESULTS: Two senior hand surgeons at one institution performed 52 semiconstrained DRUJ arthroplasties over 8 years. Nineteen complications necessitating operative management occurred in 15 patients (29%). A total of 26 procedures were undertaken to address these complications. Complications included 4 periprosthetic fractures, 3 infections, 2 instances of aseptic loosening, 2 implant component failures, 1 instance of screw loosening, 3 neuromas requiring neurectomy, 2 instances of finger stiffness necessitating extensor tenolysis, and 2 cases of heterotopic ossification at the DRUJ. Three of the 52 implants were revised (6%) and 2 were explanted (4%); 3 of these (6%) were caused by deep infection. CONCLUSIONS: There is limited literature on outcomes of the semiconstrained DRUJ prosthesis. Prior studies reported low complication rates, with 0% to 5% revisions. In the current clinical series, 29% of patients required further surgery for complications, the most common reasons for which were periprosthetic fracture and infection. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Asunto(s)
Artritis/cirugía , Artroplastia de Reemplazo/efectos adversos , Inestabilidad de la Articulación/cirugía , Prótesis Articulares , Articulación de la Muñeca/cirugía , Adolescente , Adulto , Anciano , Artroplastia de Reemplazo/instrumentación , Remoción de Dispositivos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Articulación de la Muñeca/diagnóstico por imagen , Adulto JovenRESUMEN
OBJECTIVES: The objectives of this study were to determine (1) if patients undergoing reconstruction of an isolated anterior cruciate ligament (ACL) tear had different characteristics (age, gender, body mass index [BMI]) than patients undergoing ACL reconstruction (ACLR) with multiple knee ligament (MKL) tears and (2) whether there was a difference in prevalence of articular cartilage injury and meniscus tears between these two groups. METHODS: Patients undergoing primary ACLR between February 2005 and June 2013 were identified through an ACLR registry. Patients were grouped by whether they had an isolated ACL tear or an ACL tear associated with another knee ligament tear. The study cohort was analyzed to identify differences in patient characteristics and cartilage/meniscus injury patterns between the groups. RESULTS: Of the 21,377 ACLR cases enrolled in the registry during the study period, 2.5% (n = 549) had MKL tears. The MKL group had more males (73.2% vs. 62.8%, p < 0.001) than the isolated ACL group. The MKL group also had a higher percentage of patients with a BMI greater than 30 (31.1% vs. 22.7%, p = 0.0002). When adjusting for these variables, any articular cartilage injury was equal in the two groups (OR = 1.01, CI 0.82-1.25, p = 0.922), while medial femoral condyle injury was less common in the MKL group (OR = 0.73, CI = 0.56-0.07, p = 0.28). The likelihood of any meniscus tear was lower in the MKL group (OR = 0.56, CI = 0.47-0.67, p < 0.001) as was the likelihood of medial meniscus tears (OR = 0.53, CI = 0.44-0.65, p < 0.001). CONCLUSIONS: When comparing patients with MKL tears versus isolated ACL tears at ACLR, there was a higher percentage of males and patients with BMI over 30 in the MKL group. Medial femoral condyle articular cartilage injury, any meniscus tear, and medial meniscus tears were less common in patients with MKL injury compared to patients with isolated ACL tears.
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Lesiones del Ligamento Cruzado Anterior/epidemiología , Lesiones del Ligamento Cruzado Anterior/cirugía , Ligamentos Articulares/lesiones , Lesiones de Menisco Tibial/epidemiología , Adolescente , Adulto , Factores de Edad , Reconstrucción del Ligamento Cruzado Anterior , Índice de Masa Corporal , California/epidemiología , Estudios de Cohortes , Comorbilidad , Femenino , Fémur/lesiones , Humanos , Masculino , Prevalencia , Probabilidad , Sistema de Registros , Factores de Riesgo , Rotura/epidemiología , Rotura/cirugía , Factores Sexuales , Lesiones de Menisco Tibial/cirugía , Adulto JovenRESUMEN
PURPOSE: Deformities of the cervical spine are uncommon in the coronal plane. In this report, a unique case of a 31-year-old male with a fixed, 30° left coronal deformity due to heterotopic ossification 3 years status post poly-trauma was treated with an asymmetric C7 pedicle subtraction osteotomy (PSO). METHODS: Case report. RESULTS: Pre-operatively, the patient had a fixed 45-degree left tilt of his neck and radiographs demonstrated a rigid 30° scoliosis, 7 cm coronal imbalance, and 4 cm negative sagittal balance, diffuse bridging bone between the spinous processes and the facet joints of C5 to T1 bilaterally. An asymmetric C7 PSO with C2-T3 posterior spinal fusion was completed without complication. There was residual 9° coronal deformity, 2.9 cm left coronal imbalance, and 2.3 cm sagittal imbalance. He had a marked improvement in his function, as assessed by the SF-36 physical component score (pre-op 31.1; post-op 44.7) and mental component score (pre-op 46.0; post-op 66.8). Post-operatively, neck disability index scores also improved (pre-op 38; post-op 16). Although the patient passed away from a drug overdose 14 months post-operatively, he did not report neck pain, he had not sought evaluation from another physician for his neck, and he had not undergone a subsequent neck operation before his passing. CONCLUSION: In this one patient, an asymmetric C7 PSO was performed safely. While it was effective in addressing a fixed cervical coronal imbalance, its efficacy and safety profile should be confirmed in larger cohorts.