Fibrous tissue armoring increases the mechanical strength of an impacted bone graft

Impacted, morselized bone allografts are used with good clinical results in revision of hip prostheses with loosening and osteolysis. The impacted bone graft appears radiographically to remodel, but histological analyses have shown a heterogeneous picture with a mixture of living and dead bone. Thus, complete remodeling of the graft may be neither a prerequisite nor a cause of the good clinical results. The present study concerns the mechanical effect of the mere armoring of the bone graft by ingrowing fibrous tissue. We compared the compression strength of freshly-impacted grafts to grafts that had been inserted into a bone chamber and thus were penetrated by fibrous tissue growing in between the graft trabeculae. The compressive strength was doubled after 4 weeks of fibrous ingrowth. We conclude that the mechanical properties of an impacted graft are enhanced by armoring with ingrowing fibrous tissue. Strengthening of the parts of the impacted grafts which have not yet remodeled, would be clinically relevant for the outcome of the operation, since these parts are at high stress during the whole remodeling period. Complete osseous remodeling may not be necessary to obtain a good clinical result with a morselized impacted graft.     

手术结合早期功能锻炼治疗复杂型胫骨平台骨折的临床疗效评价

目的：探讨手术结合早期功能锻炼治疗复杂型胫骨平台骨折的临床效果。方法：回顾性分析手术治疗并获得随访的胫骨平台骨折患者38例,术后24 h后开始行CPM膝关节功能训练。Schatzker分型,Ⅳ型15例,Ⅴ型11例,Ⅵ型12例。结果：所有患者随访时间平均27.2个月（6～50个月）,骨折愈合时间9～17周,平均13.2周,无严重并发症出现。术后2周膝关节屈曲平均100.0°（75°～130°）;最后随访时膝关节屈曲平均118.5°（85°～130°）,膝关节HSS评分平均88.5分（80～100分）。结论：复杂型胫骨平台骨折手术复位内固定结合早期功能锻炼可获得良好的功能恢复。     

Innovative treatment for pes cavovarus: a pilot study of 13 children

Background and purpose — Pes cavovarus (PCV) is a complex deformity, frequently related to neurological conditions and associated with foot pain, callosities, and walking instability. The deformity has the tendency to increase during growth. Orthotic treatment is ineffective and surgery may be troublesome. We present the preliminary results of a new mini-invasive surgical technique for correction of this foot deformity.

Patients and methods — We operated on 13 children (24 feet), age 7–13 years. In 7 children the deformity was neurological in origin. The surgical technique included a dorsal hemiepiphysiodesis of the 1st metatarsal, and a plantar fascia release. The clinical deformity, hindfoot flexibility, and foot callosities, together with a radiological assessment (Meary angle, calcaneal pitch, and talo-calcaneal angle), was done pre- and postoperatively. At final check-up, after a median of 28 months (12–40), the Oxford Ankle Foot Questionnaire for children (OXAFQ-C) was used to assess patient satisfaction. The primary outcome was the hindfoot varus correction.

Results — All the operated feet improved clinically and radiologically. Heel varus improved from a mean 6° preoperatively to 5° valgus postoperatively. In those children where treatment was initiated at a younger age, full correction was achieved. Footwear always improved.

Interpretation — This treatment may offer a less aggressive alternative in the treatment of PCV in young children and may eventually reduce the amount of surgery needed in the future.     

Modified lateral approach for knee arthroplasty in a fixed valgus knee--the medial quadriceps snip

Background The evaluation of a total hip prosthesis would be most complete if the opinion of the patient, surgeon and the radiographs are combined. Disease specific patient outcome questionnaires are scarce, especially in Dutch.

Methods The disease-specific 12-item questionnaire on the perception of patients with total hip replacement was translated into Dutch. We also investigated the extra value of two specific hip items, “the need for walking aids” and “sexual problems because of the hip”, four general items on overall satisfaction and one question about patient classification. The 14 hip-specific items were each scored from 1 (least difficulties) to 5 (most difficulties). The Dutch translation, the “Oxford Heup Score” (OHS) was tested on psychometric quality in a multicenter prospective study.

Results The psychometric results of the OHS proved to be adequate. In the first postoperative year the score was very sensitive to changes, whereas in the second year it did not change significantly. The two added hip-specific questions were both filled out positively by more than 50% of the patients and thus fit perfectly into a hip-specific patient outcome questionnaire such as the OHS.

Interpretation The OHS proves to be an appropriate instrument for assessment of the outcome of total hip replacement from the patient's perspective. Together with the judgement of the surgeon, it provides useful insights into the question of whether this operation has been a success or not.     

Cost implications of the physiotherapy management of complex tibial fractures treated with circular frames

Seventy-three consecutive patients with complex tibial fractures treated with an Ilizarov frame or Taylor Spatial Frame received physiotherapy between April 2008 and April 2010. Data were collected prospectively, and physiotherapy input was recorded (in minutes) for the patients identified. This included treatment received as an inpatient as well as an outpatient. The data were categorized for proximal, middle and distal third tibial fractures for analysis. The average cost of physiotherapy for an inpatient with an Ilizarov frame is £121.82 per case, whereas that for an outpatient receiving treatment for trauma was calculated as £404.60. The combined average cost of physiotherapy to support treatment of a complex tibial fracture with a fine wire fixator is £546.27. Treatment involving circular frames is complex and expensive, and the high physiotherapy cost is not reflected in Healthcare Resource Group codes. This cost calculation will help service units, and NHS Trusts develop realistic costing plans to support treatment. Cost implications of the physiotherapy management of complex tibial fractures using the Ilizarov technique.     

High Tibial Osteotomy with Overcorrection of Varus Malalignment in Medial Gonarthrosis

Seventy-eight knee joints with varus malalignment were examined pre-operatively using three-point measurement. Operation was performed with or without 5° overcorrection of the varus deformity using random selection. the overcorrection group showed significantly better results than the normal-correction group.     

带锁髓内钉加植骨治疗胫骨骨不连21例

胫骨骨折术后骨不连的发生率较高。2003年1月～2011年1月,我院采用带锁髓内钉固定加植骨术治疗胫骨骨不连21例,疗效满意,报道如下。1材料与方法1.1病例资料本组21例,男15例,女8例,年龄23～61岁。初次治疗方     

手术治疗累及后髁的复杂性胫骨平台骨折的疗效分析

目的探讨手术治疗累及后髁的复杂性胫骨平台骨折的临床疗效。方法2005年10月～2011年10月，对31例累及后髁的复杂性胫骨平台骨折行切开复位内固定。结果应用王亦璁膝关节功能评定标准，分为优、良、可、差四级。结果本组31例均获得随访，时间6～22个月，平均12.4±2.6个月，骨折全部愈合，愈合时间6～11周，平均6.4±1.6周。依王亦璁膝关节功能评定标准，优16例，良12例，可2例，差1例，优良率为90.32%。结论手术入路治疗累及后髁的复杂性胫骨平台骨折疗效令人满意。