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1.
Seung Yeol Lee Chin Youb Chung Kyoung Min Lee Soon-Sun Kwon Kyu-Jung Cho Moon Seok Park 《European spine journal》2016,25(3):679-686
Purpose
We estimated the annual changes in radiographic indices of the spine in cerebral palsy (CP) patients and analyzed the factors that influence its progression rate.Methods
We included CP patients who had undergone whole-spine radiography more than twice and were followed for at least 1 year. The scoliosis Cobb angle, coronal balance, apical vertebral translation, apical rotation, and pelvic obliquity were measured on anteroposterior (AP) radiographs; thoracic kyphosis and lumbar lordosis angles, and sagittal balance was measured on lateral radiographs; and migration percentage was measured on AP hip radiographs to determine hip instability. For each gross motor function classification system (GMFCS) level, the Cobb angles, apical vertebral translation, coronal and sagittal balance, and pelvic obliquity were adjusted by multiple factors with a linear mixed model.Results
A total of 184 patients (774 radiographs) were included in this study. There was no significant annual change in scoliosis Cobb, thoracic kyphosis, and lumbar lordosis angles in the GMFCS level I–II and III groups. In the GMFCS level IV–V group, there was an annual increase of 3.4° in the scoliosis Cobb angle (p = 0.020). The thoracic kyphosis angle increased by 2.2° (p = 0.018) annually in the GMFCS level IV–V group. Apical vertebral translation increased by 5.4 mm (p = 0.029) annually in the GMFCS level IV–V group. Progression of coronal and sagittal balance and pelvic obliquity with aging were not statistically significant. Sex, hip instability, hip surgery, and triradiate cartilage did not affect the progression of scoliosis and the balance of the spine and pelvis.Conclusions
The scoliosis Cobb angle, thoracic kyphosis angle, and apical vertebral translation in the GMFCS level IV–V CP patients progressed with age. These findings can predict radiographic progression of scoliosis in CP patients.2.
Kerstin Reidy Christoph Heidt Stefan Dierauer Hanspeter Huber 《Journal of children's orthopaedics》2016,10(4):281-288
Background
Hip reconstructive surgery in cerebral palsy (CP) patients necessitates either femoral varus derotational osteotomy (VDRO) or pelvic osteotomy, or both. The purpose of this study is to review the results of a moderate varisation [planned neck shaft angle (NSA) of 130°] in combination with pelvic osteotomy for a consecutive series of patients.Methods
Patients with CP who had been treated at our institution for hip dysplasia, subluxation or dislocation with VDRO in combination with pelvic osteotomy between 2005 and 2010 were reviewed.Results
Forty patients with a mean follow-up of 5.4 years were included. The mean age at the time of operation was 8.9 years. The majority were non-ambulant children [GMFCS I–III: n = 11 (27.5 %); GMFCS IV–V: n = 29 (72.5 %)]. In total, 57 hips were treated with both femoral and pelvic osteotomy. The mean pre-operative NSA angle of 152.3° was reduced to 132.6° post-operatively. Additional adductor tenotomy was performed in nine hips (16 %) at initial operation. Reimers’ migration percentage (MP) was improved from 63.6 % pre-operatively to 2.7 % post-operatively and showed a mean of 9.7 % at the final review. The results were good in 96.5 % (n = 55) with centred, stable hips (MP <33 %), fair in one with a subluxated hip (MP 42 %) and poor in one requiring revision pelvic osteotomy for ventral instability.Conclusions
This approach maintains good hip abduction and reduces soft-tissue surgery. Moderate varisation in VDRO in combination with pelvic osteotomy leads to good mid-term results with stable, pain-free hips, even in patients with severe spastic quadriplegia.3.
Merete A. Malt Ånen Aarli Bård Bogen Jonas M. Fevang 《Journal of children's orthopaedics》2016,10(3):261-266
Aim
The Gait Deviation Index (GDI) is a score derived from three-dimensional gait analysis (3DGA). The GDI provides a numerical value that expresses overall gait pathology (ranging from 0 to 100, where 100 indicates the absence of gait pathology). The aim of this study was to investigate the association between the GDI and different levels of gross motor function [defined as the Gross Motor Function Classification System (GMFCS)] and to explore if age, height, weight, gender and cerebral palsy (CP) subclass (bilateral and unilateral CP) exert any influence on the GDI in children with unilateral and bilateral spastic CP.Methods
We calculated the GDI of 109 children [73 % boys, mean age 9.7 years (standard deviation, SD 3.5)] with spastic CP, classified at GMFCS levels I, II and III. Twenty-three normally developing children were used as controls [61 % boys, mean age 9.9 years (SD 2.6)]. Multiple linear regression analysis was performed.Results
The mean GDI in the control group was 100 (SD 7.5). The mean GDI in the GMFCS level I group was 81 (SD 11), in the GMFCS level II group 71 (SD 11) and in the GMFCS level III group 60 (SD 9). Multiple linear regression analysis showed that gender, age and CP subclass had no significant correlation with the GDI, whereas height and weight had a slight impact.Conclusion
This study showed a strong correlation between the GDI and GMFCS levels. The present data indicate that calculation of the GDI is a useful tool to characterise walking difficulties in children with spastic CP.4.
Purpose
To evaluate the short- and long-term outcomes of the Frey procedure for chronic pancreatitis (CP).Methods
The subjects of this study were 12 patients who underwent the Frey procedure for CP between January, 2000 and December, 2016. We assessed pain relief, weight gain, and exocrine/endocrine insufficiency during follow-up.Results
The study population comprised 11 men and 1 woman (91.7% vs. 8.3%; mean age, 50.3 ± 6.8 years; range 39–61 years). Pancreatitis was caused by alcohol in 9 (75%) patients and was idiopathic in 3 (25%) patients. The mean follow-up period was 82.5 ± 46.5 months (range 16.9–152.1 months). There was no operative mortality, but three patients (25%) suffered postoperative morbidity. All patients were pain-free at the time of discharge. There was no case of new-onset diabetes mellitus after surgery, although one patient (8.3%) suffered exocrine insufficiency. The body weight and body mass index of all patients improved during follow-up. Only one patient continued to suffer pain in the long term.Conclusion
The findings of this long-term follow-up of patients who underwent the Frey procedure suggest that it offers effective pain relief and is a safe technique for the management of CP.5.
Lisa C. Drefus Siobhan Clarke Karen Resnik Jayme Koltsov Emily R. Dodwell David M. Scher 《HSS journal》2018,14(2):143-147
Background
Stiff-knee gait is a common gait deviation in individuals with cerebral palsy (CP) due to rectus femoris (RF) muscle spasticity. The Duncan-Ely test is a velocity-dependent measurement of spasticity that is recorded as positive or negative. At our institution, we use a modification of the Duncan-Ely test, a 5-point ordinal rating scale, which delineates where the catch occurs within the rapid arc of knee flexion. It has been named the Root-Ely test.Questions/Purposes
We sought to determine the intra- and inter-rater reliability of the Duncan-Ely and Root-Ely tests in pediatric patients with CP.Methods
A convenience sample of 20 ambulatory subjects was recruited; mean age was 10.5?±?4.5 years, and the Gross Motor Function Classification System (GMFCS) levels were I–III. Five clinicians measured each individual’s RF spasticity using the Root-Ely protocol during a single visit. Simple κ statistics with 95% confidence intervals (CI) were utilized for intra-rater reliability and weighted κ statistics with 95% CI for inter-rater reliability.Results
The Root-Ely scale intra-rater reliability was 0.77 to 0.90 and inter-rater reliability was 0.32 to 0.87. Inter-rater reliability was good to excellent among experienced clinicians and fair to moderate in new clinicians.Conclusion
The Root-Ely 5-point scale has acceptable intra- and inter-rater reliability in pediatric individuals with CP among experienced clinicians. The Root-Ely test allows experienced clinicians to reliably quantify severity of RF spasticity and may give orthopaedic surgeons a clinical tool to better predict ideal candidates for RF transfers in individuals with CP in order to improve stiff-knee gait.6.
T. Pillukat R. A. Fuhrmann J. Windolf J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2016,28(4):233-250
Objective
Refixation of the triangular fibrocartilage complex (TFCC) to the ulnar capsule of the wrist.Indications
Distal TFCC tears without instability, proximal TFCC intact. Loose ulnar TFCC attachment without tear or instability.Contraindications
Peripheral TFCC tears with instability of the distal radioulnar joint (DRUJ). Complex or proximal tears of the TFCC. Isolated, central degenerative tears without healing potential.Surgical technique
Arthroscopically guided, minimally invasive suture of the TFCC to the base of the sixth extensor compartment.Postoperative management
Above elbow plaster splint, 70° flexion of the elbow joint, 45° supination for 6 weeks. Skin suture removal after 2 weeks. No physiotherapy to extend pronation and supination during the first 3 months.Results
In an ongoing long-term study, 7 of 31 patients who underwent transcapsular refixation of the TFCC between 1 January 2003 and 31 December 2010 were evaluated after an average follow-up interval of 116 ± 34 months (range 68–152 months). All patients demonstrated an almost nearly unrestricted range of wrist motion and grip strength compared to the unaffected side. All distal radioulnar joints were stable. On the visual analogue scale (VAS 0–10), pain at rest was 1 ± 1 (range 0–2) and pain during exercise 2 ± 2 (range 0–5); the DASH score averaged 10 ± 14 points (range 0–39 points). All patients were satisfied. The modified Mayo wrist score showed four excellent, two good, and one fair result. These results correspond to the results of other series.Conclusion
Transcapsular refixation is a reliable, technically simple procedure in cases with ulnar-sided TFCC tears without instability leading to good results.7.
Purpose
The aim of surgical intervention for chronic pancreatitis (CP) is to relieve symptoms and improve quality of life. However, the precise effect of surgery on the nutritional status of CP patients, which is often impaired by exocrine and endocrine pancreatic dysfunction, has not been elucidated. We conducted this study to evaluate whether Frey’s procedure improves the nutritional status of CP patients.Methods
The nutritional status of 35 patients who underwent Frey’s procedure for CP at our institute between April 2005 and December 2014, was assessed by the controlling nutritional status (CONUT) scoring before and 1 year after the surgery, and compared with that of seven CP patients who underwent pancreatoduodenectomy. The occurrence of postoperative hepatic steatosis was also monitored.Results
The nutritional status improved after Frey’s procedure, but not after pancreatoduodenectomy. The median postoperative CONUT score after Frey’s procedure was significantly lower than the preoperative score (1.0 ± 0.5 vs. 4.0 ± 2.5; p < 0.001).Conclusion
Frey’s procedure is superior to pancreatoduodenectomy for improving the nutritional status of CP patients.8.
Background
Operative management of scapular body fractures, when indicated, typically involves extensive exposure through a posterior approach. We present our experience with a deltoid preserving approach that allows excellent exposure of the fracture lines for reduction and fixation while minimizing muscle detachment and overall tissue trauma.Technique
Exposure of the scapula was obtained through a posterior incision. The posterior deltoid was exposed and retracted superiorly while the arm was abducted in accordance with Brodsky et al. The scapula was exposed in the interval between infraspinatus and teres minor.Patients and methods
Six patients were treated using this approach and were retrospectively reviewed. All were men with a mean age of 34 years (range 24–45 ± 6.7 years). The injuries involved two 14-A3.1 and four 14-A3.2 AO/OTA types of fractures. The mean follow-up after surgery was 28 months (range 21–36 ± 4.93 months).Results
All fractures could be anatomically reduced and healed without compromise. The mean Constant score was 93.8 (range 91–97 ± 2.13), while range of motion and strength returned to levels equal to the uninjured shoulder. All patients returned to their previous level of activity. We did not observe atrophy of the posterior muscles or hardware complications, and none required hardware removal.Conclusion
The deltoid and external rotators preserving posterior approach permitted good visualization of the fractures while allowing reduction and fixation without extensive muscular dissection and provided excellent functional outcomes. We consider that it offers obvious advantages over more aggressive muscle detaching approaches.Level of evidence
Therapeutic study, IV.9.
E. Crespo Romero R. Peñuela Candel S. Gómez Gómez A. Arias Arias A. Arcas Ordoño J. Gálvez González R. Crespo Romero 《Musculoskeletal surgery》2017,101(2):167-172
Background
This study aims to illustrate the results of percutaneous forefoot surgery (PFS) for correction of hallux valgus.Materials and methods
A prospective study of 108 patients, with hallux valgus deformity, who underwent PFS was conducted. The minimum clinical and radiological follow-up was two years (mean 57.3 months, range 22–112).Results
Preoperative mean visual analog scale was 6.3 ± 1.5 points, and AOFAS scores were 50.6 ± 11 points. At the last follow-up, both scores improved to 1.9 ± 2.4 points and 85.9 ± 1.83 points, respectively. Mean hallux valgus angle changed from 34.3° ± 9.3° preoperatively to 22.5° ± 11.1° at follow-up. At follow-up, 76.5% of the subjects were satisfied or very satisfied. Recurrence of medial 1st MT head pain happened in 22 cases (16.7%).Conclusions
PFS, in our study, does not improve the radiological and patient satisfaction rate results compared with conventional procedures. The main advantage is a low postoperative pain level, but with an insufficient HVA correction.Level of evidence
II, prospective study.10.
Catarina N. Damas Joana Silva Márcia C. Sá João Torres 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(2):127-132
Background
Healthy shoulder morphology is still unclear. Since bone morphology influences prosthetic features, this is relevant for glenohumeral joint reconstruction. The objective of this study was to assess the normal values of glenoid version, maximum width, base width and vault depth on computed tomography scans.Methods
Axial cut CT scans of 1072 healthy glenoids were retrospectively reviewed. Values of glenoid version, maximum glenoid width, glenoid base width and glenoid vault depth were measured by two different observers. Differences were determined between genders, and reproducibility and interrater reliability assessed.Results
Glenoid version was 37.71° ± 10.75°, range ?6.20° to 71.30°; maximum glenoid width was 26.06 ± 3.27 mm, range 15.40–36.90 mm; glenoid base width was 16.59 ± 2.61 mm, range 8.90–25.40 mm; glenoid vault depth was 9.72 ± 1.62 mm, range 4.70–15.90 mm. All measurements except for glenoid version were significantly higher in males than in females. Reproducibility was good for every measurement, except glenoid vault depth.Conclusion
We found differences in maximum glenoid width, base width and vault depth by gender in a large sample. Glenoid components’ maximum width was defined, as was reaming extension and orientation, the space available for implantation of the glenoid component, placement of pegs or keels in anatomic prostheses and the target for glenoid screws in inverted prostheses.Level of evidence
II.11.
T. Pillukat R. Fuhrmann J. Windolf J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2016,28(1):47-64
Objective
Bony healing of dislocated distal radius fractures after open reduction and internal stabilization by locking screws/pins using palmar approach.Indications
Extraarticular distal radius fractures type A2/A3, simple extra- and intraarticular fractures type C1 according to the AO classification, provided a palmar approach is possible.Contraindications
Forearm soft tissue lesions/infections. As a single procedure if a volar approach not possible.Surgical technique
Palmar approach to the distal radius and fracture. Open reduction. Palmar fixation of the plate to radial shaft with single screw. After fluoroscopy, distal fragments fixed using locking screws.Postoperative management
Below-the-elbow cast for 2 weeks. Early exercise of thumb and fingers, wrist mobilization after cast removal. Complete healing after 6–8 weeks.Results
Ten patients averaged 100?% range of motion of the unaffected side after 43±21 months. No complications observed. DASH score averaged 12±16 points; Krimmer wrist score was excellent in 7, good in 2, and fair in one.12.
Lawrence Camarda Alessandra La Gattuta Marcello Butera Francesco Siragusa Michele D’Arienzo 《Journal of orthopaedics and traumatology》2016,17(1):75-80
Background
Symptomatic hardware represents the most frequent complication reported following surgical treatment of patellar fracture. For this reason, some authors suggested using nonabsorbable sutures to fix the fracture with various techniques. The aim of this study was to evaluate clinical and radiological results of patients treated following a modified Pyriford technique using a FiberWire suture (Arthrex, Naples, FL, USA).Materials and methods
We retrospectively evaluated a case series of seventeen patients with displaced patellar fractures treated by open reduction and internal fixation with a modified tension band using FiberWire sutures. Clinical and radiological outcome were evaluated. Union time, complications, and reoperation rate were observed and recorded.Results
All fractures healed (time to union 9.2 ± 2 weeks), and no fixation failure was observed. Slight losses of reduction (<4 mm) were noted in two patients at 4 weeks postoperatively. The average Lysholm and Bostman scores at the final follow-up were 91 ± 5.7 (range 83–100) and 28.3 ± 1.6 (range 26–30), respectively.Conclusion
Modified tension band using FiberWire sutures showed satisfactory clinical results, with a low incidence of complications and reoperations. FiberWire tension bands could be used in place of metal-wire tension bands to treat patellar fracture, reducing the rate of symptomatic hardware.Level of evidence
413.
Purpose
To evaluate the radiographic, functional outcomes, complications and surgical specificities of L5 pedicle subtraction osteotomy for fixed sagittal and coronal malalignment.Methods
A retrospective cohort of consecutive patients with prospectively collected data. Ten patients who underwent PSO at L5 were eligible for a 2-year minimum follow-up (average, 4.0 years). Patients were evaluated by standardized upright radiographs. Preoperative and postoperative radiographies, surgical data and complications were collected.Results
All surgeries were revision surgeries. The mean lumbar lordosis before surgery was ? 22.5° (range, 8° to ? 33°) and improved to ? 58.5° (range, ? 40° to ? 79°). The sagittal vertical axis demonstrated a preoperative mean sagittal malalignment of 13.7 cm (range 3.5 to 20 cm), with correction to 4.6 cm postoperatively. Three patients required additional surgery at the latest follow-up for rod breakage.Conclusions
PSO of L5 can be a safe and effective technique to treat and correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio of such a major surgery. Most patients are satisfied, particularly when sagittal balance is achieved.14.
K.-H. Frosch R. Akoto T. Drenck M. Heitmann C. Pahl A. Preiss 《Operative Orthopadie und Traumatologie》2016,28(3):193-203
Objective
An arthroscopic technique for the reconstruction of the posterolateral corner combined with posterior cruciate ligament (PCL) reconstruction was developed.Indications
Posterolateral rotational instabilities of the knee. Combined lesions of the PCL, the popliteus complex (PLT) and the posterolateral corner. Isolated PLT lesions lacking static stabilizing function.Contraindications
Neuromuscular disorders; knee deformities or fractures; severe posterolateral soft tissue damage.Surgical technique
Six arthroscopic portals are necessary. Using the posteromedial portal, resect dorsal septum with a shaver. Visualize the PCL, the lateral femoral condyle and the posterolateral recessus with the PLT. Dissect the popliteomeniscal fibers; retract PLT until sulcus popliteus is visualized. Drill a 6-mm tunnel anteriorly into the distal third of the sulcus popliteus. Visualize femoral footprint of the PLT and place an anatomical drill tunnel. Pull the popliteus bypass graft into the knee and fix with bioscrews. Fix the reconstructed PCL. In cases of additional LCL injury, reconstruct LCL with autologous graft.Postoperative management
Partial weight-bearing for 6 weeks, range of motion exercises, quadriceps-strengthening exercises on postoperative day 1. Full extension allowed immediately with flexion limited to 20° for 2 weeks, to 45° for up to week 4, and to 60° up to week 6. Use a PCL brace for 3 months, running and squatting exercises allowed after 3 months.Results
In the 35 patients treated, no technique-related complications. After 1 year, 12 patients had a mean Lysholm Score of 88.6 (± 8.7) points and a side-to-side difference in the posterior drawer test of 2.9 (± 2.2) mm (preoperative 13.3 [± 1.9] mm).Conclusion
Low complication risk and good and excellent clinical results after arthroscopic posterolateral corner reconstruction.15.
Joon-Hyop Lee Young Jun Chai Tae-Hyung Kim June Young Choi Kyu Eun Lee Hyun-Young Kim Yoo-Seok Yoon Hyeon Hoe Kim 《World journal of surgery》2016,40(12):2970-2975
Background
Ganglioneuromas are benign tumors that rarely develop from adrenal glands. In this study, we present our clinical experience of patients with adrenal ganglioneuroma (AGN).Methods
Demographic, diagnostic, surgical, and pathologic findings of patients who were adrenalectomized as a result of AGN were retrospectively reviewed from the database of a tertiary referral hospital.Results
Among 1784 patients who underwent an adrenalectomy between 2002 and 2015, 35 (1.9 %; 14 males, 21 females) were diagnosed with AGN. Mean age was 33.4 ± 18.7 years (0–84). Twenty-nine (82.9 %) were asymptomatic, four (11.4 %) complained of abdominal discomfort, and two (5.7 %) had abdominal distension. Preoperative computed tomography (CT) reported AGN in 22 (62.9 %) cases. Precontrast Hounsfield units, increased postcontrast phase attenuation, and well-defined borders were characteristic CT features of AGN. Mean tumor size was 6.3 ± 3.3 cm (range, 1.5–16.0). No recurrence occurred during a median follow-up period of 19 months (range, 1–120).Conclusion
AGN was asymptomatic in most cases and diagnosis may be challenging. Adrenalectomy is a safe treatment modality for AGN and ensures favorable outcomes when diagnosed.16.
Paolo Paladini Rohit Singla Giovanni Merolla Giuseppe Porcellini 《International orthopaedics》2016,40(8):1675-1681
Purpose
The aim of this study was to establish whether anterior glenoid bone loss in patients with large glenoid rim defects can be restored with a coracoid graft (Latarjet procedure).Methods
A total of 143 consecutive patients with chronic anterior shoulder instability and glenoid bone deficiency were treated in 2013. A pre-operative computed tomography (CT) scan using the PICO method was obtained to estimate anterior glenoid rim erosion. The 23 patients with anterior glenoid deficiency exceeding 20 % were included in the study. A post-operative CT scan was obtained to establish whether coracoid transfer had fully restored the glenoid surface.Results
Mean bone loss was 26?±?3.9 % of the glenoid surface (range 20–34 %) compared with the contralateral glenoid. Mean coracoid dimensions were 26.3?±?2.9 mm?×?7.6?±?0.65 mm. The graft successfully restored the glenoid surface in all patients (mean filling, 102.4?±?0.8 %).Discussion
The Latarjet procedure is a valuable approach to treat patients with chronic shoulder instability and glenoid deficiency.Conclusion
Coracoid transfer restored the glenoid surface even in patients with large defects. The Eden-Hybinette technique seems to be more appropriate for revision surgery and for patients with a failed Latarjet procedure.17.
Kálmán Tóth Péter Kellermann Károly Wellinger 《Archives of orthopaedic and trauma surgery》2010,130(10):1257-1261
Background
The Akin osteotomy is a widely used procedure where various fixation methods are available, predominantly with the use of metallic component (wire, screw, staple etc.). The aim of this study is to demonstrate the results of our modified Akin procedures, where the fixation of the phalangeal osteotomy is achieved by absorbable suture, without metallic component.Materials and methods
Between July 2004 and October 2008, authors performed their first 22 consecutive Akin procedures with the above technique. Mean age of patients was 49 [standard deviiation (SD) 17, range 19–69] years. Mean follow-up time was 26 (SD 13, range 8–57) months.Results
Mean correction of the distal articular set angle (DASA) was 9.4 (SD 7.1, range 5–28) degrees. Mean shortening of the proximal phalanx was 1.8 (SD 1.0, range 0.3–4.1) mm. Among the 22 osteotomies, there was no evidence of non-union, delayed union, excessive bone callus, or loss of correction. 100% of the patients would undergo the procedure again, 91% (20/22) were completely satisfied; and 9% (2/22) were satisfied, including the one complication case.Conclusion
The method presented in this study for fixation of the akin osteotomy showed results identical to the ones using conventional (metal) fixation techniques concerning radiological (correction of DASA, shortening of the proximal phalanx), and clinical (complication rate, subjective satisfaction rate) findings, without the risk of complication due to hardware irritation.18.
Frank Braatz Daniel Staude Matthias C. Klotz Sebastian I. Wolf Thomas Dreher Stefan Lakemeier 《International orthopaedics》2016,40(8):1663-1668
Introduction
Neurogenic hip dislocation is quite common in children with cerebral palsy (CP). The purpose of this study was to evaluate the long-term outcome of single-event multilevel surgery (SEMLS) in combination with hip reconstruction by using a periacetabular osteotomy as described by Dega concerning post-operative remodeling and plasticity of the femoral head post-operatively.Methods
A total of 72 patients with CP as the primary disease and in whom a complex surgical hip reconstruction was performed during SEMLS between 1998 and 2004 were included in the study. There were 45 men and 27 women, with a median age of 7.6 (4.7–16.3) years at the time SEMLS was performed. The mean follow-up time was 7.7 years (4.9–11.8). X-rays were taken before and after surgery, and Rippstein 1 and 2 were used for follow-up. As the most reliable value for decentration, migration percentage (MP) as described by Reimers was used. To measure hip-joint cover at follow-up, the centre-edge angle was used. The hip was divided into four different categories according to sphericity and congruity. Using this approach, we could evaluate joint remodeling.Results
Pre-operatively, the mean MP measured by X-ray was 68 %. Directly after surgery, this value decreased on average by 12 % and at the long-term follow-up was 16.0 % on average. A high rate of incongruence was observed on X-rays taken directly after surgery: 66 hip joints were classified as incongruent. The number of aspherical and incongruent joints decreased to 54 at the follow-up examination.Conclusion
Data of our study with high plasticity of the hip joint suggest that even if the femoral head is deformed and a persistent incongruency after surgery is expected, hip reconstruction can be recommended.19.
M. Beirer L. Willinger L. Laccheta A. Buchholz A. Lenich A. B. Imhoff S. Siebenlist 《Obere Extremit?t》2018,13(3):197-203
Background
Conservative treatment of simple elbow dislocations is promoted; however, the importance of primary surgical treatment for these injuries has not been evaluated.Objectives
The objective of this study was to assess the results of the surgical and nonsurgical treatment of simple elbow dislocations regarding subjective patient satisfaction and joint stability.Materials and methods
Patients with surgically and nonsurgically treated simple elbow dislocations were included into this study. The elbow function was assessed by the Elbow Self-Assessment Score (ESAS). For objective evaluation, an ultrasound evaluation of the affected and the contralateral healthy elbow was performed.Results
A total of 20 patients with an average age of 47?±?13.1 years were clinically and sonographically assessed. The mean follow-up was 44?±?18.5 months (range 15–84 months); 10 patients were treated nonsurgically and 10 surgically. The ESAS was not significantly different between the nonsurgical (91.8?±?18.5 points) and the surgical treatment group (91.6?±?15.5 points; n.?s.). In addition, the ultrasound evaluation showed no instability in either treatment group.Conclusions
Both nonsurgical and surgical treatment can lead to high patient satisfaction and sonographic stability in simple elbow dislocations. Regarding the joint stability, the subjective perception does not necessarily correlate with the ultrasound findings.20.