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INTRODUCTION: Radiocapitellar joint arthroplasty is a commonly performed procedure, which often leads to early failure or instability. Few studies assess the effect of radiocapitellar joint arthroplasty on the ulnohumeral joint. We hypothesized that static forces of contact (compressing cartilage, or cartilage relaxation contact force) would reveal the effect of varying radial head implant size and elbow position on the ulnohumeral joint. METHODS: A minimally-invasive method of measuring cartilage relaxation contact force was utilized in 10 fresh-frozen human cadaveric specimens that did not require significant dissection or intraarticular sensor placement. Specimens were rigidly fixed in various positions of elbow flexion and forearm pronosupination with increasing radial head implant lengths. Uniaxial distracting forces were applied and displacement was repeatedly measured with resultant best-fit polynomial curves to determine inflections corresponding to the force required to overcome static cartilage relaxation as in previous work. FINDINGS: Baseline mean (intra-cadaver) cartilage relaxation contact force was 11.8 N (standard error of the mean = 0.3) at 90° of elbow flexion and neutral rotation. There was little variation within specimens (Intraclass correlation coefficient > 0.94). Cartilage relaxation contact force increased at the ulnohumeral joint with radial head implant overstuffing (> 4 mm, P < 0.05) and elbow flexion (120°, P < 0.001). Pronosupination altered cartilage relaxation contact force in an implant-length independent manner (P < 0.05). INTERPRETATION: Radiocapitellar joint arthroplasty implant length and elbow joint position independently contribute to increased cartilage relaxation contact force at the ulnohumeral joint. This further supports attempts at anatomic reconstruction of the radiocapitellar joint to prevent pathologic ulnohumeral joint loading.
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Articulación del Codo , Prótesis Articulares , Humanos , Articulación del Codo/cirugía , Radio (Anatomía)/cirugía , Antebrazo , Artroplastia , Cadáver , Fenómenos BiomecánicosRESUMEN
Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children.
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Clavos Ortopédicos , Fijación Intramedular de Fracturas , Fracturas del Radio/cirugía , Adolescente , Clavos Ortopédicos/efectos adversos , Niño , Preescolar , Codo/fisiopatología , Codo/cirugía , Articulación del Codo/fisiopatología , Articulación del Codo/cirugía , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/rehabilitación , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/rehabilitación , Humanos , Masculino , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/etiología , Periodo Posoperatorio , Radiografía , Radio (Anatomía)/diagnóstico por imagen , Radio (Anatomía)/lesiones , Radio (Anatomía)/fisiopatología , Radio (Anatomía)/cirugía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/epidemiología , Fracturas del Radio/rehabilitación , Rango del Movimiento Articular , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento , Túnez/epidemiología , Lesiones de CodoRESUMEN
INTRODUCTION: Syndesmotic injury alters joint mechanics, which may fail to be restored unless an anatomic reduction is obtained. METHODS: A minimally invasive method of measuring joint forces was utilized that does not require significant dissection or intraarticular placement of sensory instruments. Steinmann pins were placed in the tibia and talus of eight fresh-frozen human cadaveric lower extremities and a baseline joint reaction force was determined. A syndesmotic injury was created and reduction (anatomic and anterior malreduction) performed with one or two quadricortical screws and joint reaction forces were measured after the injury and subsequent repairs. FINDINGS: Baseline mean tibiotalar joint reaction force was 31.4 (SD 7.3â¯N) and syndesmotic injury resulted in a 35% decrease (mean 20.3, SD 8.4â¯N, pâ¯<â¯0.01). Fixation of the injury using one or two syndesmotic screws resulted in significant increase compared to the injury state (mean 28.7, SD3.9â¯N, and mean 28.3, SD 6.4â¯N, pâ¯<â¯0.05), however there was no significant difference between the two methods of fixation. Malreduction of the fibula also increased joint reaction force compared to the injury state (mean 31.5, SD 5.2â¯N, pâ¯<â¯0.01), however a significant difference was not detected between malreduction and anatomic reduction. INTERPRETATION: The present study demonstrates that syndesmotic injury decreases joint reaction force within the tibiotalar joint, suggesting ankle joint instability. Tibiotalar force was restored with anatomic reduction with either a 1 or 2 quadricortical syndesmotic screws. Furthermore, anterior malreduction restored joint reaction force to levels similar to those observed at baseline and with anatomic reduction. LEVEL OF EVIDENCE: Level V: biomechanical/cadaver study.
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Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Tornillos Óseos , Peroné/cirugía , Fijación Interna de Fracturas/métodos , Inestabilidad de la Articulación/cirugía , Procedimientos de Cirugía Plástica , Anciano , Clavos Ortopédicos , Cadáver , Humanos , Extremidad Inferior/cirugía , Astrágalo/cirugía , Tibia/cirugíaRESUMEN
AIM: This research aims to study arthroscopic anchors design parameters. Prototypes were manufactured by new parameters values. The the performance of the prototypes was also tested. METHODS: Five 3D arthroscopic anchor models were created to evaluate the role of some design aspects. Thread type, pitch and tip angle were tested as variable parameters. These models were produced on engineering CAD software then imported into ANSYS for finite element analysis. A tensile load of 300 N was applied to each model while the simplified bone base was fixed-in-place as a boundary condition. The finite element results were compared with prototypes tensile testing. RESULTS: The finite element analyses showed stresses within physiological limits on the bone with all tested models. Thread type and pitch affected stresses on bone and anchor body. From stress point of view, two critical zones appeared on anchor body, anchor cortical bone connection and eyelet zone, while thread geometry (depth) affect the cortical bone response only. Laboratory tests matched finite element results and literature. CONCLUSION: Increasing thread pitch of arthroscopic anchors decreases stress on the bone, while increases stress on anchor body. Arthroscopic anchors thread type has a negligible effect on bone, while it reduces stresses on anchor body if it placed more material around eyelet in internal drive mechanism and suture eyelet type of anchors. Anchor tip angle has a negligible effect on bone and anchor body.
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BACKGROUND: Spring ligament tear is often found in advanced adult acquired flatfoot deformity and its reconstruction in conjunction with the deltoid ligament has been proposed to restore the tibiotalar and talonavicular joint stability. The aim of the present study is to determine the effect of spring ligament injury and subsequent reconstruction on static joint reactive force using a non-invasive method of measurement. METHODS: Ten fresh-frozen human cadaveric lower legs were disarticulated at the knee joint. Static joint reactive force of the tibiotalar and talonavicular joint were measured at baseline, after spring ligament injury, and after ligament reconstruction. Reconstruction consisted of a forked semitendinosis allograft with dual limbs to reconstruct the tibionavicular and tibiocalcaneal ligaments. FINDINGS: The mean baseline joint reactive force of the tibiotalar and talonavicular joints were 37.2â¯Nâ¯+â¯8.1â¯N and 13.4â¯Nâ¯+â¯4.2â¯N, respectively. The spring ligament injury model resulted in a significant 29% decrease in tibiotalar joint reactive force. Reconstruction of the tibionavicular limb resulted in a significant increase in tibiotalar and talonavicular joint reactive force compared to those seen in the injury state. Furthermore, the addition of the tibiocalcaneal limb significantly increased tibiotalar joint reactive force compared to those results obtained from the injury state and the tibionavicular limb alone. INTERPRETATION: This is the first study to demonstrate diminished tibiotalar static joint reactive force in a spring ligament injury model with subsequent joint reactive force restoration using two-limbed reconstruction of the deltoid and spring ligament. LEVEL OF EVIDENCE: Biomechanical Study.
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Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Pie Plano/cirugía , Inestabilidad de la Articulación/diagnóstico , Ligamentos Articulares/lesiones , Ligamentos Articulares/cirugía , Cadáver , Pie/cirugía , Humanos , Laceraciones , Enfermedades Musculares , Presión , Procedimientos de Cirugía Plástica , Estrés Mecánico , Articulaciones Tarsianas/fisiopatología , Articulaciones Tarsianas/cirugíaRESUMEN
INTRODUCTION: Villonodular synovitis (SVN) is a rare benign pseudotumoral proliferation of the synovial joint, of unknown etiology. In general, it reaches the big joints, especially the knee. Localization at the subtalar level is extremely rare, with only a few cases published in the literature. CASE REPORT: We report the case of an SVN of the subtalar in a 60-year-old patient without particular histories, who consulted for a swelling of the external border of the right foot evolving for 2 years. Biology, as well as the standard radiographs, was without anomalies. The diagnosis was evoked on magnetic resonance imaging (MRI) and confirmed by surgical biopsy and excision. The operative follow-up was simple with no recurrence after 3 years. CONCLUSION: SVN of the subtalar is rare. Surgical treatment is based mainly on synovectomy, and the prognosis depends mainly on the osteocartilaginous lesion and the quality of excision.
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Femoral varus osteotomy is a conservative treatment for external single-compartment gonarthrosis. This surgical procedure is little used and outcomes are little studied.This study aimed to assess the clinical and radiological results of femoral varising osteotomy in subjects with external femorotibial gonarthrosis associated with idiopathic genu valgum whose data were recorded over a period of 21 years (1992- 2013) in the Department of Orthopedics at Sahloul University Hospital, Sousse. The clinical evaluation of patients was performed using the IKS score (International Knee Society). Radiological assessment was based on pre-operative work-up and final follow-up assessment. We here report a case series of 9 patients (and 10 knees) whose average age was 45.2 years, with a sex ratio of 0.5. Mean follow-up was 99-months. Average knee score ranged from 48.4 points preoperatively to 73.5 points at the final follow-up assessment, with a statistically significant improvement (p<10-3). Medium functional score significantly improved, with a preoperative value of 49.5 points and a value of 72 points at the final follow-up assessment. Final correction helped to reduce valgus condition with an average of 3.7° and a preoperative value of 14°. This study, as well as the analysis of literature, indicates that femoral varising osteotomy is the treatment of choice for invalidating genu valgum of femoral origin, without any rheumatoid arthritis, overweight, internal femorotibial nor severe femoropatellar arthritis.
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Genu Valgum/cirugía , Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Adulto , Femenino , Fémur/cirugía , Estudios de Seguimiento , Humanos , Rodilla , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/patología , Estudios Retrospectivos , Tibia/cirugía , Túnez , Adulto JovenRESUMEN
INTRODUCTION: Odontoideum bone or the mobile odontoid process is one of the rarest malformations of the cervico-occipital hinge. It exposes to the atlo-axial instability and to the risk of bulbo-medullary compression threatening then the vital and functional prognosis. We report the case of a 16-year-old patient who was the victim of a raod accident resulting in acervical spine injury. Radiological investigation found an odontoideum bone malformation associated with C1C2 dislocation. CASE REPORT: A 16-year-old patient with no medical history had a road accident. Clinical evaluation found an incomplete tetraplegia.The imaging has revealed an atlo-axoidal dislocation with aspinal cord compression. Furthermore, radiological exams relvealed an odentoideum bone. A transcranial traction by a Gardner stirrup was set for 15 days to obtain a progressive reduction of the displacement. A full neurological recovery (FB-FD) was obtained.The patient was then operated to stabilize the reduction. A C1-C2 posterior zygapophyseal arthrodesis was performed. An autograft harvested from the iliac crest was used. Complementary open reduction and fixation of the cervico-occipital hinge was made using lamellar hooks and compression rods. At the 18-month follow-up, the clinical examination found no neurological deficiency and the plain radiography showed a complete fusion of the arthrodesis. CONCLUSION: Odontoideum bone is a rare and potentially life-threatening malformation. It is most often asymptomatic but symptoms could occur any time after a benign trauma. The prognosis mainly depends on the precocity of the management. Preventive surgery is recommended byseveral authorsin case ofinstability.
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The management of high-energy pilon fractures is still controversial. Open reduction and internal fixation are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. The aim of this retrospective study was to analyze the clinical and radiographic outcome of the ILIZAROV technique in patients with high-energy pilon fractures. Thirty cases of distal tibia epiphysis fractures (pilon fractures) were managed from 1999 to 2012. The study group included 5 cases of open fractures. The mean age was 47 years. According to Rüedi and Algower classification; 11 fractures were type II, and 19 type III. All fractures were a consequence of high-energy trauma. Fractures of the lower fibula were present in 28 of the patients. An external Fixator was applied for open fractures. Closed injuries were operated on 3 to 13 days after injury, with an average of 8 days. The mean follow-up was 48 months. All fractures united. The external fixator was removed after a mean of 22 weeks (10 - 28 weeks). Two patients with a type III fracture had a delayed union and were treated with corticotomy and dynamisation of the ILIZAROV fixator. Only one secondary displacement of a type III fracture was noted after two months and was treated by adjuction of 2 olive wires. There were no cases of osteomyelitis or deep infections. Pin-tract infections occurred in ten patients. We had not any case of nervous injury due to introduction of the pins. Using radiological criteria for assessement of reduction of the articular fragments, there was excellent and good restoration of articular structure in 24 cases. The average American Orthopeadic Foot and Ankle Society ankle-hind foot score was excellent in 16, good in 6, fair in 6 and poor in 2. Soft tissue healing occurred without need for plastic surgery in all cases. The movements of the ankle ranged from 0 to 20° of dorsiflexion and 5° to 40° of plantar flexion. Twenty patients had gone back to their preinjury profession. The ILIZAROV technique is a safe and a very effective treatment for severe pilon fractures with minimum complications and good healing results.
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Articulación del Tobillo/fisiopatología , Fracturas Abiertas/cirugía , Técnica de Ilizarov , Fracturas de la Tibia/cirugía , Adulto , Anciano , Hilos Ortopédicos , Fijadores Externos , Femenino , Peroné/lesiones , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Septic arthritis of the pubis symphysis is rare and difficult to diagnose. The objective of our study was to describe the biological, clinical, radiological and therapeutic aspects of this disease. This is a retrospective study of 4 cases of septic arthritis of the pubic symphysis collected in the Department of Rheumatology and Orthopaedics in Sousse in Tunisia over a period of 16 years (2000-2016). Our population consists of 3 women and one men. The mean age was 47 years (18-83). Clinical signs of appeal were inflammatory groin pain, pubic pain and fever. Symptoms appeared after forceps delivery in 2 cases, after surgery on the pelvis in one case and in a context of sepsis in one case. Radiographs showed pubic disjunction with irregular shoreline in all cases. CT performed in all patients and MRI in 2 patients showed erosions of the banks of the pubic symphysis with infiltration of the soft parts in all cases. The causative organisms were isolated in 3 cases by biopsy of soft tissue abscess under CT in 2 cases and vaginal swab in one case. Identified germs were staphylococcus aureus Méti-S (n=1), proteus mirabilis (n=1) and varied flora (n=1). The treatment consisted of appropriate antibiotics in all cases and surgical drainage of soft tissue abscess resistant to medical treatment in 2 cases. The outcome was favorable in all cases. Diagnosis of septic arthritis of the pubic symphysis is based on clinic supported by microbiologic culture results, image methods, and proteins augment during acute phase.
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Antibacterianos/administración & dosificación , Artritis Infecciosa/diagnóstico , Sínfisis Pubiana/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artritis Infecciosa/microbiología , Artritis Infecciosa/terapia , Biopsia , Drenaje/métodos , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Sínfisis Pubiana/microbiología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Túnez , Adulto JovenRESUMEN
Osteopecilia is a benign and rare condensing osteopathy. Its association with inflammatory rheumatism is very rare. We here report the case of a 25-year old patient with skin psoriasis, presenting with groin pain of inflammatory origin. Physical examination showed limitation of hip motions, lower limb-length inequality and pain on right sacroiliac mobilization. Laboratory tests showed inflammatory syndrome and negative immunological assessment. The radiograph of the pelvis revealed osteopecilia associated with destructive coxitis. CT scan of the pelvis showed coxitis and osteopecilia associated with bilateral sacroiliitis. The diagnosis of psoriatic arthritis associated with osteopecilia was retained. The patient was treated with methotrexate and NSAIDS. Osteopecilia usually is unexpectedly detected. Diagnostic radiology is essential to avoid unnecessary explorations and treatments.
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Artritis Psoriásica/diagnóstico por imagen , Osteopoiquilosis/diagnóstico por imagen , Psoriasis/patología , Sacroileítis/diagnóstico por imagen , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Psoriásica/tratamiento farmacológico , Artritis Psoriásica/patología , Femenino , Humanos , Diferencia de Longitud de las Piernas , Metotrexato/uso terapéutico , Osteopoiquilosis/tratamiento farmacológico , Osteopoiquilosis/patología , Sacroileítis/tratamiento farmacológico , Sacroileítis/patología , Tomografía Computarizada por Rayos XRESUMEN
Giant cell tumors of the synovial tendon sheaths (GCTSTS) are a localized form of hemopigmented villonodular synovitis. They mainly affect the hands. This study aims to analyse the epidemiology, clinical and therapeutic characteristics of GCTSTS, to assess the results of surgical treatment and to identify risk factors for recurrences. We conducted a retrospective data collection from medical records of 50 patients with GCTSTS of the hand between 1992 and 2016 in the Department of Orthopaedics at the Hospital of Sahloul (Sousse-Tunisia). The clinical and epidemiological features of GCTSTS have been specified. The average age of patients was 33 years (9-69 years), the sex ratio was 0,6. Constant swelling (100%), joints inter-phalangeal mobilization trouble (6%) and digital pain (18%) were the most frequent reason for consultation. All tumors were located at the level of the digital region, especially at the level of the index (42%). It occurred on the palm of the hand in 66% of cases. All patients underwent surgery; macroscopically GCTTS appeared as an encapsulated polylobed and yellowish brown tumor, extending into the flexor tendons sheath(4 cases) and under the extensor tendon (2 cases). We noted a single case of recurrent cancer (2%) which was treated surgically. The functional results were good in all cases. The diagnosis of GCTTS should be evoked when there is evidence of digital swelling. Their management is based on surgery which is difficult and should be performed correctly to avoid recurrences.