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BACKGROUND: We evaluated the mid-term results of previously cemented hip arthroplasties revised with uncemented modular femoral components. METHODS: The study included 40 patients (36 females (90 %) and 4 males (10 %), mean age 67.6 years, range 39-87 years) who underwent revision of a previously cemented hip prosthesis with an uncemented modular femoral stem between 2005 and 2009. The indications for revision were femoral aseptic loosening in 38 (95 %) cases and acetabular protrusion in 2 (5 %). According to the Paprosky classification, the femoral defect was type 1 in 10 (25 %) patients, type 2 in 16 (40 %), type 3a in 11 (27.5 %), type 3b in 2 (5 %) and type 4 in 1 (2.5 %). The Harris hip score was used for the clinical evaluation. Femoral vertical subsidence, the cortical index and femoral stem stability were assessed radiologically. The mean follow-up period was 84 months (range 61-95 months). RESULTS: The mean Harris hip score was 41.4 (range 35.4-44.4) preoperatively and 80.9 (range 65.6-98.3) at the final follow-up examination (p < 0.05). Mean vertical subsidence was 5.7 mm (range 2.5-10.5 mm) in seven (17.5 %) patients. Stable bone fixation was observed in 38 (95 %) patients, fibrous stable fixation in 2 (5 %) and no instability in any patient. Radiographs taken during the early postoperative period revealed that the cortical index was a mean of 1.34 (range 1.11-1.73) and a mean of 1.55 on the final follow-up radiographic examinations (range 1.16-1.91) (p < 0.01). CONCLUSIONS: Satisfactory results were achieved using uncemented modular femoral components during revision of previously cemented femoral components. Many modular femoral stems provide primary stability by filling femoral bone losses and help determine stem length, offset and anteversion.
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Artroplastia de Reemplazo de Cadera/métodos , Cementos para Huesos , Fémur/diagnóstico por imagen , Fémur/cirugía , Prótesis de Cadera , Diseño de Prótesis/métodos , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/instrumentación , Femenino , Estudios de Seguimiento , Prótesis de Cadera/normas , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis/normas , Falla de Prótesis/efectos adversos , Radiografía , Reoperación/instrumentación , Reoperación/métodos , Estudios RetrospectivosRESUMEN
PURPOSE: The purpose of this study was to evaluate our experience to clarify the suggestion that there should be a significant disease-free interval before total knee arthroplasty (TKA) and to determine the correct timing of surgery for reconstruction of the joint destruction in patients suffering from tuberculous arthritis. METHODS: Twelve patients with advanced joint destruction and tuberculous arthritis of the knee with recent onset were reviewed in this study. The time interval from our diagnosis of active infection to arthroplasty averaged 4 ± 1.5 months. Histopathology of the biopsy specimens revealing granulomatous lesions, including epithelioid histiocytes surrounded by lymphocytes, confirmed the diagnosis of each patient. A primary knee prosthesis was performed in seven knees. In five knees, there was severe bone loss after the extensive debridement of the entire joint, and thereafter, revision prosthesis was preferred to preserve the joint line. Patients were given post-operative antituberculous treatment for a total of 1 year, whereas for three patients, whose erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values remained above normal by the sixth month, the chemotherapy was continued for up to 18 months. The Knee Society TKA roentgenographic evaluation and scoring system was used for radiological evaluation of the knees. Clinical evaluation of the knees was done preoperatively and at the time of the most recent follow-up using the American Knee Society Scoring System. RESULTS: Within the average follow-up period of 6.1 ± 1.8 years, no reactivation of tuberculous infection was found in any of the patients. ESR was normal, less than 20 mm/h, after a mean time of 5.5 ± 2.0 months. The CRP was normal, less than 0.8 mg/dl, after a mean time of 4.6 ± 1.3 months. At the most recent follow-up, the average knee score improved from 32.4 ± 19.4 to 83.4 ± 14.0 points (p < 0.05), and the average function score improved from 33.3 ± 11.9 to 86.6 ± 7.7 points (p < 0.05). Ten knees showed good integrity, and no radiolucent lines were found in the bone-prosthesis interface in relation to any component. Radiolucent lines were apparent on the tibial side in two knees. They were less than 1 mm thick and non-progressive, and clinically, there was no evidence of loosening of the component. Culture specimens were positive for five patients. CONCLUSIONS: TKA is a safe procedure for tuberculous arthritis with recent onset providing symptomatic relief, functional improvement and early return to activity when performed in correct time. A long disease-free interval should not be a prerequisite for arthroplasty. Wide surgical debridement is the mainstay to eradicate the disease, and post-operative antituberculous chemotherapy controls the residual foci. LEVEL OF EVIDENCE: IV.
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Artroplastia de Reemplazo de Rodilla , Articulación de la Rodilla/cirugía , Tuberculosis Osteoarticular/cirugía , Anciano , Femenino , Humanos , Prótesis de la Rodilla , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
OBJECTIVE: The aim of this study was to evaluate the long-term results of porous-coated, cementless total knee arthroplasty with screw fixation. METHODS: This study included 68 knees of 54 patients (43 female, 11 male; mean age: 56.9 years, range 46 to 70 years). Cruciate-retaining cementless total knee prostheses were implanted in all patients diagnosed with primary osteoarthritis. Clinical, functional and radiological evaluations were performed according to the Knee Society's Knee Scoring System (KSS). Prosthesis survival was analyzed using Kaplan-Meier curves. Mean follow-up time was 9.2 (range: 8 to 12) years. RESULTS: Preoperative mean knee and function scores were 42.3 (range: 32 to 61) and 39.1 (range: 35 to 66), respectively, while they were 88.6 (range: 54 to 96) and 82.8 (range: 50 to 100), respectively at the final follow-up (p<0.05). Mean preoperative knee flexion was 98° (range: 80° to 110°) and 112° (range: 85° to 130°) at the final follow-up (p<0.05). Preoperative and postoperative mean alignments were 9.2° varus and 5.4° valgus, respectively. Revisions were performed due to aseptic loosening of the tibial component in one patient, periprosthetic fracture in one and dislocation of the patella in one. Two superficial infections (3%) were observed. There was no osteolysis around the screws during the follow-up period. The overall rate of implant survival was 95.6% (range: 91.56% to 99.60%; 95% CI) at 12 years. CONCLUSION: Long-term outcomes of porous-coated, cementless total knee arthroplasty with screw fixation were successful in terms of clinical and radiological evaluation and yielded a high survival rate.
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Artroplastia de Reemplazo de Rodilla/métodos , Tornillos Óseos , Articulación de la Rodilla/cirugía , Prótesis de la Rodilla , Osteoartritis de la Rodilla/cirugía , Anciano , Cementos para Huesos , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/fisiopatología , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Diseño de Prótesis , Rango del Movimiento Articular , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to investigate the effects of growing rod treatment on the clinical and radiographic outcome and respiratory function of young children with scoliosis. METHODS: Data from 25 patients (24 females, 1 male) who underwent surgical treatment with growing rods for scoliosis between 1997 and 2007 were evaluated retrospectively. Dual growing rods were used in 16 patients and single growing rods in 9. Patients' average age was 7.38 ± 3.8 years at the initial surgery. Cobb angle, T1-S1 length, and instrumentation length were measured radiographically. Respiratory functions were evaluated at the final follow-up. RESULTS: Patients received an average of 4.2 lengthening treatments over an average period of 44.9 months. Cobb angles improved from 56.7° to 25.1° after final fusion. T1-S1 length increased from 27.2 ± 3.4 to 34.9 ± 3.6 cm after the initial surgery and 38.6 ± 3.7 cm post final fusion. Average growth was 1 ± 0.4 cm per year. Mean values of respiratory parameters at the last follow-up were FVC: 83.5 ± 3.5, FEV: 84.8 ± 5.3, and FVC/FEV1: 1 ± 0.046. Twelve patients experienced complications, of which eight were instrument-related and four medical. CONCLUSION: The growing rod technique is effective in the treatment of spinal deformity in young scoliosis patients and appropriate for improving both spinal column height and pulmonary function.
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Dispositivos de Fijación Ortopédica , Procedimientos Ortopédicos/instrumentación , Escoliosis/diagnóstico por imagen , Escoliosis/terapia , Columna Vertebral/crecimiento & desarrollo , Factores de Edad , Niño , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Mediciones del Volumen Pulmonar , Masculino , Procedimientos Ortopédicos/métodos , Diseño de Prótesis , Radiografía , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Columna Vertebral/cirugía , Factores de Tiempo , Resultado del TratamientoRESUMEN
The purpose of this study was to evaluate the effect of the AperFix device (Cayenne Medical, Inc, Scottsdale, Arizona), composed of polyetheretherketone (PEEK) polymer, on tunnel widening after hamstring anterior cruciate ligament (ACL) reconstruction as compared with 2 other fixation devices: the TransFix (Arthrex, Inc, Naples, Florida) and the EndoButton (Smith & Nephew Endoscopy, Mansfield, Massachusetts). Sixty-seven patients with isolated total ACL ruptures who underwent arthroscopically assisted reconstruction using hamstring autografts at the authors' institution were included in the study. Patients were assigned into 1 of 3 groups in a nonrandomized fashion: AperFix (n=18), TransFix (n=29), and EndoButton (n=20). Mean follow-up was 30 months. Tunnel widening measurements were performed on anteroposterior and lateral digital plain radiographs taken in postoperative week 1 and at final follow-up. Laxity testing, Lysholm scoring, and arthrometric evaluation were performed.All 3 graft fixation devices resulted in significant tunnel widening in both tibial and femoral tunnels at final follow-up when compared with the immediate postoperative period. Tunnel widening between groups was not significantly different in terms of coronal and sagittal femoral tunnel diameters. Tibial tunnel diameter increase in the sagittal plane in the EndoButton group was significantly smaller than that in the TransFix and AperFix groups. No correlation was found between the amount of tunnel enlargement and clinical outcomes of ACL surgery. This study's findings suggest that tunnel enlargement after ACL reconstruction is influenced by the type of graft fixation on the tibial side irrespective of clinical outcome, and PEEK polymer does not have an effect on tunnel widening after hamstring ACL reconstruction.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Materiales Biocompatibles/administración & dosificación , Cetonas/administración & dosificación , Polietilenglicoles/administración & dosificación , Complicaciones Posoperatorias/prevención & control , Tendones/trasplante , Adulto , Ligamento Cruzado Anterior/cirugía , Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Artroscopía , Benzofenonas , Femenino , Fémur/efectos de los fármacos , Fémur/patología , Fémur/cirugía , Humanos , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/efectos de los fármacos , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Masculino , Polímeros , Estudios Retrospectivos , Rotura , Tibia/efectos de los fármacos , Tibia/patología , Tibia/cirugíaRESUMEN
BACKGROUND: An accepted comprehensive clinical approach to the deformed spine with tuberculous infection is still lacking. We aimed to determine the usage of a staged algorithm in the treatment of kyphotic spine with tuberculous infection and to present the clinical results of the patients treated with the help of this protocol. MATERIALS AND METHODS: 54 patients (28 females, 26 males) with a mean age of 39.2 (22-76) years. Preoperative, early postoperative, and followup clinical and radiologic results were evaluated retrospectively. The patients were classified into Kaplan A (kyphotic deformity <30°), Kaplan B (kyphotic deformity 30°-60°) and Kaplan C (kyphotic deformity >60°). They were operated by posterior instrument with anterior debridment (Kaplan A), debridment with anterior bone grafting (Kaplan B) and anterior column resection and bone grafting in Kaplan C. RESULTS: Tuberculous involvement were seen at more than one level in 40 patients and paraspinal abscess were detected in 31. Preoperative focal kyphotic deformity was reconstructed with an average of 19 (9-38) degrees. Twenty-six patients had neurologic compromise with different severities and 12 of them improved after the surgical intervention. Improvement in work ability and pain status was detected in 52% and 61% of the patients, respectively. Wound complications responding to medical care were detected in nine patients. Initial kyphotic deformity was found as an important parameter in selecting the surgical procedure. CONCLUSION: Regarding resected amount of infected osseous material, as planned preoperatively, have resulted with better concordance between anterior and posterior column heights and better sagittal alignment. We could correct kyphosis and improve sagittal balance with staged algorithm as used by us.
RESUMEN
STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To compare the single and dual growing rod techniques with an emphasis on shoulder balance in the surgical treatment of early-onset scoliosis. SUMMARY OF BACKGROUND DATA: In the literature, there exist not much data about shoulder balance through growing rod intervention using either single or dual rods for progressive scoliosis in patients of young age. METHODS: A total of 20 patients with early-onset scoliosis who were treated surgically using growing rod techniques (11 patients: single rod group, 9 patients: dual rod group) were analyzed radiographically. Radiographical measures of shoulder balance (difference of coracoid process height, clavicula-tilt angle, and clavicula-rib cage intersection point) and scoliosis of both groups that were obtained in the preoperative, postoperative, and final follow-up period underwent statistical analysis in comparison with each other. RESULTS: Both single and dual growing rod techniques improved the deformity correction, maintained the correction and allowed spinal growth in the surgical treatment of early-onset scoliosis. Single rod technique had a higher incidence of rod breakage. Both techniques effected the shoulder levels similarly. CONCLUSIONS: When evaluated separately, single rod technique does improve shoulder balance significantly. For a more definitive evaluation, a comparison study having more patients in both groups is essential.
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Escoliosis/diagnóstico por imagen , Hombro/diagnóstico por imagen , Columna Vertebral/crecimiento & desarrollo , Niño , Femenino , Humanos , Masculino , Radiografía , Estudios Retrospectivos , Escoliosis/cirugía , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/cirugía , Resultado del TratamientoRESUMEN
Subtrochanteric fractures of the femur below an arthritic hip are uncommon and challenging to orthopedic surgeons. Most of these fractures occur in elderly patients with advanced osteoporosis. The treatment choices consist of treatment of the fracture and the above hip joint versus treatment of the fracture alone. This study evaluates the clinical and radiological outcomes of arthroplasties performed to treat both conditions in a single surgery with the use of a cementless modular revision stem. Twelve subtrochanteric femoral fractures of 12 patients (9 women, 3 men) with a mean age of 76.4 years (range, 62-88 years) were treated with cementless modular revision stems. Total hip arthroplasty was performed with cementless femoral and acetabular component fixation. All hips received the same femoral and acetabular implants. All patients had comorbidities and the average American Society of Anesthesiologists score was 2.3 (range, 1-3). Ten of the 12 hips (83%) required an assistance device for ambulation before the trauma. There were 2 Dorr Type A (17%), 3 Dorr type B (25%), and 7 Dorr type C (58%) femora. The mean postoperative Harris Hip Score was 83 (range, 72-92) with a mean follow-up of 4.3 years (range, 2-7 years). At final follow-up, 9 hips (75%) were ambulatory without support (P=.016). Ten hips (83%) were able to both ambulate and walk up and down stairs. Two hips (17%) were able to ambulate but could not climb and descend stairs. Union was achieved in all femora at an average of 22.3 weeks (range, 16-32 weeks). Radiographic findings demonstrated stable ingrowth of the femoral prosthesis with no evidence of subsidence in 11 hips (92%). The average Engh score for all femora was 20.2 (range, 10-26). There was no relationship between the bone morphology (Dorr type) of the femoral medullary canal and the bone ingrowth scores of Engh (P=.639).
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Artroplastia de Reemplazo de Cadera/métodos , Fijación Interna de Fracturas/instrumentación , Fracturas de Cadera/cirugía , Prótesis de Cadera , Osteoartritis de la Cadera/cirugía , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/efectos adversos , Cementos para Huesos , Femenino , Fijación Interna de Fracturas/métodos , Indicadores de Salud , Fracturas de Cadera/complicaciones , Articulación de la Cadera/fisiopatología , Articulación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Oseointegración , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/fisiopatología , Diseño de Prótesis , Rango del Movimiento Articular , Recuperación de la Función , Resultado del Tratamiento , Caminata/fisiologíaRESUMEN
The aim of this retrospective clinical study was to evaluate and compare the results of the technique so called 'two above one below approach' with intermediate screws at the fracture site with long-segment posterior fusion in the surgical treatment of thoracolumbar burst fractures. For this purpose neurologically intact 27 patients having isolated one level thoracolumbar burst fracture underwent posterior instrumentation and fusion in our clinic via 'two above-one below approach' with intermediate screws at the fracture site. A control group consisting of 15 patients having one level thoracolumbar burst fracture treated with long segment posterior spinal fusion in our institute was formed. At the preoperative, postoperative and final follow up period, anterior body height loss, local kyphosis and sagittal index values of both groups were noted. At the final follow up Visual Analogue Pain Scale and Oswestry disability scores were noted. Retrospective data from both groups underwent statistical analysis. In both groups anterior body height loss, local kyphosis and sagittal index measurements improved at the final follow-up, but there was no significance between two groups in terms of radiological and clinical follow-up data. The loss of correction in local kyphosis of short-segment group in the interval between postoperative and follow-up period was also significant. No implant failure was noted. As a conclusion 'two above one below approach' with intermediate screws at the fracture site is associated with loss of correction radiographically, but favorable clinical outcomes in the presence of any implant failure can be achieved in the treatment of thoracolumbar burst fractures.
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Fracturas de la Columna Vertebral/cirugía , Adolescente , Adulto , Anciano , Tornillos Óseos , Femenino , Humanos , Fijadores Internos , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía , Adulto JovenRESUMEN
The aim of this retrospective study was to compare clinical outcomes of the TransFix (Arthrex Inc., Naples, FL) fixation method and the brand-new AperFix (Cayenne Medical, Scottsdale, AZ) device in arthroscopic reconstruction of anterior cruciate ligament. A total of 38 patients with isolated complete anterior cruciate ligament rupture underwent arthroscopic reconstruction via two different fixation methods using hamstring autografts. Patients were evaluated in terms of range of motion values, Lysholm scores, laxity testing, and complications. Average flexion was 136.53 +/- 6.9 degrees in the TransFix group and 126.32 +/- 4.9 degrees in the AperFix group (p < 0.001). Mean Lysholm score was 82.42 +/- 8.5 in the TransFix group and 88.68 +/- 9.4 in the AperFix group (p < 0.022). There was no significance between the two groups in terms of laxity testing and complication rates. In the early postoperative period, satisfactory and comparable clinical results were achieved with the AperFix system when compared with cross-pin fixation in arthroscopic anterior cruciate ligament reconstruction.
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Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Dispositivos de Fijación Ortopédica , Adolescente , Adulto , Artroscopía , Benzofenonas , Materiales Biocompatibles , Femenino , Estudios de Seguimiento , Humanos , Cetonas , Articulación de la Rodilla/cirugía , Masculino , Polietilenglicoles , Polímeros , Rango del Movimiento Articular , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: Tuberculosis arthritis of the hip is a crippling disease and there is need for an effective and acceptable treatment for the hips with bone destruction. The aim of this report was to evaluate the efficacy of the diagnostic method for hip tuberculosis and clinical results of the patients to clarify the question of whether a total hip arthroplasty (THA) should be attempted on a patient with a current or previous infection. MATERIALS AND METHODS: Nine patients with active tuberculosis of the hip, treated by cementless THA, were analyzed retrospectively. The mean age of the patients at diagnosis was 43.4 years (range 22-72 years). Laboratory tests of all the patients revealed high erthrocyte sedimentation rates (ESR) and C-reactive proteins. Plain radiographs showed bone destruction with joint space narrowing in all patients. Magnetic resonance imaging (MRI) scans showed fluid within the joint in five patients. Two patients had associated pulmonary tuberculosis. To confirm the clinico-radiological diagnosis, an open biopsy was performed for histopathological examinations of all the hips. Tuberculosis of the hips was treated with primary cementless THA, followed by postoperative antituberculous medication for 1 year. The inflamed soft tissues and the destroyed bones were completely resected and curetted out at the time of operation. RESULTS: At the final evaluation, the mean Harris Hip Score improved to 94.8 (range 90-98; P = 0.003). ESR became normal, less than 15 mm/h, with a mean time of 4 months (range 2-9 months). The C-reactive protein was normal, less than 0.8 mg/dl, after a mean time of 3 months (range 1-7 months). With an average follow-up of 5.6 years (range 2-8 years), no reactivation of tuberculosis infection was found in each patient. All of the femoral stems and acetabular cups were radiologically stable and demonstrated signs of bone ingrowth at the final follow-up. All histopathologic examinations showed granulomatous lesions including epitheloid histiocytes surrounded by lymphocytes. CONCLUSIONS: Cementless THA can be safely performed in advanced tuberculosis of the hip for providing symptomatic relief and functional improvement of the hips. Complete curettage and resection of the infected tissue and postoperative antituberculous chemotherapy with a minimum of 1-year duration are very important in preventing reactivations.
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Artroplastia de Reemplazo de Cadera , Articulación de la Cadera , Tuberculosis Osteoarticular/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis Osteoarticular/diagnóstico , Adulto JovenRESUMEN
OBJECTIVES: We aimed to evaluate the clinical and radiological outcomes of open reduction and internal fixation augmented with calcium phosphate cement (CPC) in the treatment of depressed tibial plateau fractures. METHODS: Twenty-eight knees of 28 patients [19 males and 9 females; mean age, 41.2 years (range 22-72 years)] who had open reduction and internal fixation combined with CPC augmentation were included in this study. Seventeen fractures were Schatzker type II, 5 were type III, 3 were type IV, 2 were type V, and 1 was type VI. CPC was used to fill the subchondral bone defects in all knees. Fixation of the fragments was done with screws in 3 knees (10%). Standard proximal tibial plates or buttress plates were used in 25 knees (90%) with an additional split fragment extending distally to achieve internal fixation. Full weight-bearing was allowed in 6.4 weeks (range 6-12 weeks) after surgery. Resorption of CPC granules was defined as the decrease in the size and density of grafting material on radiographs. Rasmussen's radiological and clinical scores were determined postoperatively. Functionality was assessed with Lysholm knee scoring system. Activity was graded with Tegner's activity scale. RESULTS: Union was achieved in all patients with a mean follow-up of 22.2 months (range 6-36 months). There were no intraoperative complications. At the latest follow-up radiographs, resorption of the graft was observed in 25 knees (89%). Rasmussen's radiologic score was excellent in 17 patients (61%), good in 9 patients (32%), and fair in 2 patients (7%). Rasmussen's clinical score was excellent in 9 patients (32%), good in 18 patients (64%), and fair in 1 patient (4%). According to the Lysholm knee score, functional results were excellent in 16 patients (57%), good in 8 patients (29%), and fair in 4 patients (14%). Twenty-two patients (78%) achieved the preoperative activity level after surgery, and there was no significant difference between the mean preoperative and postoperative Tegner scores (4.11±0.68 and 4.04±0.64, respectively, p=0.161). CONCLUSION: CPC is a safe biomaterial with many advantages in augmenting the open reduction and internal fixation of depressed tibial plateau fractures, including elimination of morbidity associated with bone graft harvesting, the unlimited supply of bone substitute, the optimum filling of irregular bone defects, and shortening of the postoperative full weight-bearing time.
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Cementos para Huesos , Fosfatos de Calcio , Fijación Interna de Fracturas , Rodilla , Tibia/cirugía , Fracturas de la Tibia/cirugía , Adulto , Anciano , Cementos para Huesos/normas , Cementos para Huesos/uso terapéutico , Tornillos Óseos , Sustitutos de Huesos/normas , Sustitutos de Huesos/uso terapéutico , Trasplante Óseo , Fosfatos de Calcio/uso terapéutico , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/rehabilitación , Curación de Fractura , Humanos , Rodilla/fisiopatología , Rodilla/cirugía , Masculino , Persona de Mediana Edad , Radiografía , Recuperación de la Función , Tibia/diagnóstico por imagen , Tibia/fisiopatología , Fracturas de la Tibia/diagnóstico , Fracturas de la Tibia/fisiopatología , Factores de Tiempo , Soporte de PesoRESUMEN
OBJECTIVES: We evaluated the results of acute application of the Ilizarov external fixator for segmental tibial fractures and also examined the experience with these special type fractures. METHODS: Twenty-four patients (19 males, 5 females) with a mean age of 37.8 years (range 22-66) with segmental tibial fractures were treated with the use of an Ilizarov type circular fixator. According to the categorisation of Melis et al., the fractures were types I, II, III and IV in seven, nine, five and three patients, respectively. Seven fractures were closed and 17 were open (9 grade IIIa, 5 grade IIIb, 2 grade II, 1 grade I according to the Gustilo classification). The mean time from the injury to surgery was 14 h (range 4-36). Eight patients with partial-thickness soft-tissue defects with no bone exposure were managed by split thickness skin grafting. Flap procedures were performed in four patients. All patients had good lower leg viability with a MESS score 6 and below. No patients had bone defects of 3 cm or more at the fracture level. Functional and bone results were made using the criteria proposed by ASAMI. The mean follow-up 28 months (range 12-70). RESULTS: We obtained excellent results in 20 and good results in 4 patients in terms of bone assessment. Functional results were excellent in 19 and good in 5 patients. All radiological evaluations showed normal alignment except in two patients. Both united with a residual procurvatum deformity. No rotational deformity was seen. Bone grafting was performed in one patient with a distal fracture. Complete union was achieved in all patients. None of the patients required amputation. There were no refractures after frame removal. Pin-tract infection occurred in 13 of the 24 patients. There were no incidents of chronic osteomyelitis secondary to pin-tract infection. The mean time for proximal fracture union was 36.4 weeks (range 10-78) and 39.8 weeks (range 12-80) for the distal fractures (p>0.05). Callus and consolidation occurred earlier posterolaterally. There were no implant failures. CONCLUSION: Ilizarov external fixator is a successful method in the acute management of segmental tibial fractures. This method is particularly effective in the treatment of distal segmental fractures of the tibia when the distal segment is short. This method allows for control of complications by decreasing the need for new operations even in the presence of infection.
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Fracturas Cerradas/cirugía , Técnica de Ilizarov , Fracturas de la Tibia/cirugía , Adulto , Anciano , Fenómenos Biomecánicos , Fijadores Externos , Femenino , Curación de Fractura/fisiología , Fracturas Cerradas/diagnóstico por imagen , Fracturas Cerradas/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Índice de Severidad de la Enfermedad , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
STUDY DESIGN: Retrospective case analysis. OBJECTIVE: Tuberculosis spondylitis is a cause of sagittal imbalance and neurologic impairment. In this study, the result of decompression and closing wedge osteotomy with instrumented fusion performed in patients with tuberculous spondylitis were analyzed retrospectively. SUMMARY OF BACKGROUND DATA: Twelve patients with angular kyphotic deformity underwent decompression and closing wedge osteotomy with instrumented fusion between 2000 and 2004. Clinical and radiologic assessment was based on pain, functional and neurologic status, and radiologic measurements. METHODS: There were 7 men and 5 women with median age of 52 years (range, 24 to 76 y). The average follow-up period was 62 months (range, 48 to 70 mo). The radiologic involvement included the angle of kyphosis on the anteroposterior and lateral radiographs. The preoperative and postoperative clinical assessments were performed by the using Oswestry Disability Index. All patients were asked to rate their preoperative and postoperative pain measurement using a pain visual analog scale. RESULTS: Visual analog scale scores improved from 5.8 in average (range, 4 to 8) to 2.2 in average (range, 1 to 4) and in the mean and Oswestry Disability Index from 54.2 (46 to 60) preoperatively to 15.2 (8 to 22) at the latest follow-up. Four patients presented neurologic findings. Three patients had improvement in their neurologic status, 1 patient did not improve and remained as American Spinal Injury Association (ASIA) grade C. Kyphotic deformity of the patients has improved from 51.1 to 23.2 degrees postoperatively. One of them has to be revised and instrumentation was extended to upper levels. Fusion was achieved at the last follow-up. CONCLUSIONS: Despite developing pseudarthrosis secondary to implant failure in 1 case, we recommend debridement, closing wedge osteotomy, and posterior instrumented fusion to correct sagittal balance in tuberculous spondylitis.
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Descompresión Quirúrgica/métodos , Cifosis/etiología , Cifosis/cirugía , Laminectomía/métodos , Osteotomía/métodos , Tuberculosis de la Columna Vertebral/complicaciones , Tuberculosis de la Columna Vertebral/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: The use of cement is associated with increased morbidity and mortality rate in elderly patients, hence cementless hemiarthroplasty is suggested. We evaluated the results of cementless hemiarthroplasty for femoral neck fractures in elderly patients with high-risk clinical problems. MATERIALS AND METHODS: Forty-eight patients (29 females, 19 males) with a mean age of 88 years (range: 78 to 102 years). having femoral neck fractures were treated with the use of cementless hemiarthroplasty. Porous-coated femoral stems were used in 30 patients (62%) and modular type femoral revision stems in 18 patients (38%). Bipolar femoral heads were used in all patients. Radiological follow-up after operation was done at the one, three, six months and annually. RESULTS: The mean follow-up period was 4.2 years (range: 18 months to eight years). None of the patients died during hospitalization. Medical complications occurred in six patients (12%) within the follow-up period and four patients (8%) died within this period. Only two hips were converted to total hip arthroplasty due to acetabular erosion. Femoral revision was planned for one patient with a subsidence of > 3 mm. None of the patients had acetabular protrusion or heterotopic ossification. The mean Harris-hip score was 84 (range: 52 to 92). Dislocation occurred in one patient (2%). CONCLUSION: Cementless hemiarthroplasty is a suitable method of treatment for femoral neck fractures in elderly patients with high-risk clinical problems especially of a cardiopulmonary nature. This method decreases the risk of hypotension and fat embolism associated with cemented hemiarthroplasty.
RESUMEN
OBJECTIVES: We evaluated the results of Fulkerson osteotomy in patients with chronic patellofemoral malalignment. METHODS: Fulkerson osteotomy (anteromedial tibial tubercle transfer) was performed in 21 knees of 18 patients (10 females, 8 males; mean age 28.6 years; range 21 to 42 years). The patellofemoral congruence angle, lateral patellofemoral angle, and patellofemoral index were measured pre- and postoperatively on tangential radiograms obtained at 45 degrees knee flexion. Malalignment patterns were determined by computed tomography as lateral tilt (n=12), lateral patellar subluxation (n=4), and both (n=5). All the patients underwent arthroscopic examination preoperatively and all had severe osteoarthrosis in the patellar articular surfaces (Outerbridge type III-IV). The mean anteriorization was 10.5 mm (range 7 to 15 mm). The vastus medialis oblique muscle was advanced in seven knees. The patients were assessed according to the criteria of Fulkerson et al. pre- and postoperatively. The mean follow-up was 28 months (range 20 to 60 months). RESULTS: According to the criteria of Fulkerson et al., the results were excellent, very good, or good in 18 knees (85.7%), fair in two knees (9.5%), and poor in one knee (4.8%). Pain and instability scores showed significant improvement (p<0.05). On final radiographic assessment, the mean patellofemoral congruence angle and patellofemoral index were -6.8 degrees (range -26 degrees to 10 degrees ) and 1.4 (range 0.8 to 1.6), respectively (p<0.05). The lateral patellofemoral angle had a lateral orientation in all the knees. Complications included tibial tubercle avulsion (n=1), deep vein thrombosis (n=1), and slight knee flexion contractures (n=4). Wound-related problems, compartment syndrome, peroneal nerve palsy, or proximal tibial fracture were not encountered. CONCLUSION: Successful results are obtained by Fulkerson osteotomy in the treatment of chronic patellofemoral malalignment with severe articular degeneration (Outerbridge type III-IV) particularly in the lateral and distal regions of the patella.
Asunto(s)
Desviación Ósea/cirugía , Luxación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Transferencia Tendinosa/métodos , Adulto , Desviación Ósea/diagnóstico por imagen , Desviación Ósea/patología , Femenino , Fémur/cirugía , Humanos , Luxación de la Rodilla/diagnóstico por imagen , Luxación de la Rodilla/patología , Masculino , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/patología , Rótula/cirugía , Complicaciones Posoperatorias , Radiografía , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
OBJECTIVES: We compared the results of primary total hip arthroplasty (THA) with those of early salvage THA following failure of internal fixation for acute displaced femoral neck fractures in elderly patients. METHODS: Patients with displaced femoral neck fractures (Garden type III, IV) were treated with either early salvage arthroplasty following failure of internal fixation (n=34; mean age 68 years) or THA (n=34; mean age 67.5 years). Both groups consisted of 8 men and 26 women with the same age range (60 to 75 years). Uncemented THA was performed in both groups. All patients were physiologically and socially active before the initial trauma. The hips were evaluated with the use of the Merle D'Aubigne scoring system. Prognostic risk factors were determined on radiographs obtained before or shortly after internal fixation. The mean follow-up was 5.2 years in the secondary and 5 years in the primary THA groups. RESULTS: During the first year of THA, there were 21 complications in 16 patients and nine complications in six patients in the secondary and primary THA groups, respectively (p<0.05). The results with respect to pain were worse and reoperation rate was higher in the revision group (p<0.05). The mean Merle D'Aubigne hip scores for pain, mobility, and walking were higher in the primary THA group. Radiographs taken before or after internal fixation showed prognostic risk factors in 32 patients (94.1%). CONCLUSION: Primary THA is a good choice of treatment for femoral neck fractures in physiologically and socially active elderly patients with a high life expectancy and cognition level.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Fracturas del Cuello Femoral/cirugía , Fijación Interna de Fracturas/métodos , Anciano , Femenino , Fracturas del Cuello Femoral/diagnóstico por imagen , Fracturas del Cuello Femoral/epidemiología , Fracturas del Cuello Femoral/patología , Servicios de Salud para Ancianos , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Radiografía , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Terapia Recuperativa , Resultado del Tratamiento , Turquía/epidemiologíaRESUMEN
OBJECTIVES: We evaluated the results of open reduction and internal fixation with the use of dynamic compression plating in patients with pseudarthrosis of the humeral shaft. METHODS: Eighteen patients (12 males, 6 females; mean age 41 years; range 22 to 68 years) with aseptic pseudarthrosis of the humeral shaft were treated by open reduction and internal fixation with the use of a dynamic compression plate following unsuccessful treatment with conservative (n=7) or surgical (n=11) methods. The mean interval between the initial and final treatments was 12.2 months (range 5 t 46 months). Exploration of the radial nerve and autogenous corticocancellous grafting were simultaneously performed in all the cases. Functional results were evaluated according to the Stewart-Hundley's criteria. The mean follow-up was 38.8 months (range 12 to 78 months). RESULTS: Union was achieved in all (94.4%) but one patient within a mean duration of 5.5 months (range 3 to 8 months). Functional results were good in fourteen patients (77.8%), fair in three patients (16.7%), and poor in one patient (5.6%). Radial nerve palsy that occurred in two patients during the early postoperative period underwent spontaneous recovery within three and five months, respectively. Mild reflex sympathetic dystrophy developed in two patients. CONCLUSION: In selected patients with pseudarthrosis of the humeral shaft, the results of open reduction and internal fixation with the use of dynamic compression plating are excellent, provided that an appropriate surgical technique is employed.