Staged management of knee dislocation in polytrauma injured patients.

Introduction: Knee dislocation in the polytrauma setting is rare. The optimal method that this injury should be managed remains controversial. We therefore undertook a study to evaluate the incidence and outcomes of knee dislocation in polytrauma patients treated in our institution.

Diagnostic value of US, MR and MR arthrography in shoulder instability.

Introduction: The aim of our study was to compare US, conventional MRI and MR arthrography findings in patients with anterior shoulder instability and with a clinical diagnosis of labral capsular ligamentous complex lesion. At the same time we evaluated the accuracy of MR arthrography in the diagnosis of this lesion.

Methods: After approval of the local Ethics Committee, our department's Trauma Registry from July 2008 up to February 2012 was retrospectively reviewed to identify all eligible patients.

Provocative discography screening improves surgical outcome.

Objective: The objective of this study was to compare the surgical outcomes of patients operated on, with or without discography prior to operation.

Methods: The study was designed as a randomized controlled trial, using power analysis with McNemar's test on two correlated proportions. The study comprised of 310 patients divided into trial (207) and control (103) groups.

Quality of pain in herpes zoster patients.

Pain typically accompanies acute herpes zoster and persists well beyond rash healing. Different types of pain are reported by patients with herpes zoster. Current studies show that these types of pain vary with respect to their presence, location, duration, intensity and quality, hence pain needs to be analyzed more thoroughly.

Isolated capitellum humeri fractures in adults.

From 2003 through 2009 we treated 35 patients who suffered from an isolated capitellum humerus fracture whom we treated with osteosynthesis. Patients who presented with concomitant fractures were not included. Thirty-four patients were categorized as Type I (Hahn-Steinthal) while one patient was Type IV (McKee).

Acromioclavicular and coracoclavicular PDS augmentation for complete AC joint dislocation showed insufficient properties in a cadaver model.

Purpose: Optimal surgical treatment of high-grade acromioclavicular joint dislocations is still controversially discussed. The purpose of the present controlled laboratory study was to evaluate whether a polydioxansulfate (PDS(®)) cord augmentation with separate reconstruction of the coracoclavicular (CC) ligaments and the acromioclavicular (AC) complex provides sufficient vertical stability in a biomechanical cadaver model.

Methods: Twenty-four shoulders of fresh-frozen cadaveric specimen were tested.

History and factors of survival of total hip arthroplasty.

Since the 1960s total hip arthroplasty (THA) has represented one of the greatest accomplishments in orthopedic surgery. It improves the functionality, working ability and quality of life of patients with non-functional hip joint due to various reasons. This article reviews general and regional history of THA, current knowledge and concepts regarding the long-term outcomes of the procedure and emphasizes the need for establishing national (and international) THA registries as an essential way of gathering data critical for decision making in daily practice as well as in defining national healthcare policies in respect to arthroplasty procedures.

Nail position has an influence on anterior knee pain after tibial intramedullary nailing.

Our aim was to determine the possible relationship between anterior knee pain (AKP) and nail position marked as a distance from tip of nail to tibial plateau (NP) and to the tuberositas tibiae (NT). Nail position has an influence on anterior knee pain after tibial intramedullary nailing. We evaluated postoperative outcome results of 50 patients in the last 3 years with healed fractures initially treated with intramedullary (IM) reamed nails with 2 or 3 interlocking screws on both parts of the nail and with the use of medial paratendinous incision for nail entry portal.

Intraarticular application of autologous conditioned serum (ACS) reduces bone tunnel widening after ACL reconstructive surgery in a randomized controlled trial.

Purpose: Pro-inflammatory cytokines play a pivotal role in osteoarthritis, as well as in bone tunnel widening after ACL reconstructive surgery. A new treatment option is to administer autologous conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and growth factors (IGF-1, PDGF, and TGF-β1, among others) in the liquid blood phase. The purpose of this trial was to establish whether the postoperative outcome could be affected by intraarticular application of ACS.

Shotgun injury to the arm: a staged protocol for upper limb salvage.

Low-energy shotgun fractures involving the arm are complex injuries. Previously published reports have emphasized various problems associated with these injuries. This case report describes a low-energy shotgun wound managed by a staged treatment protocol involving: (1) a spanning external fixator and immediate soft tissue management, followed by (2) osteosynthesis and autogenous bone grafting and (3) epineural suturing of injured radial nerve, with a successful outcome.

Clinical and radiological evaluation of minimally displaced proximal humeral fractures.

Introduction: The purpose of this prospective study was to assess the Constant score and radiographic outcome in 66 patients (mean age 58.7 years/mean follow-up 51 months) with a minimally displaced and/or impacted fracture of the proximal humerus treated with early mobilization.

Method: Special attention was paid to analyze the specific intrinsic parameters (age, gender, ASA grade and length of physiotherapy), injury-related parameters (classification, osteoporosis) and therapy-related parameters (initial fracture displacement, residual bony-deformity after healing, secondary fracture displacement during healing period, non-union, humeral head necrosis and omarthrosis) that may influence the final score.

Physiotherapy after volar plating of wrist fractures is effective using a home exercise program.

Objective: To determine the effect of 2 different postoperative therapy approaches after operative stabilization of the wrist fractures: treatment by a physical therapist with 12 sessions and an unassisted home exercise program.

Design: Randomized controlled cohort study.

Setting: Hospital-based care, primary center of orthopedic surgery.

The Dynamic Martin Screw: an Alternative for Intracapsular Femoral Neck Fractures?

Objectives: The aim of this study was to determine whether the fixation device known as the dynamic Martin screw (DMS) offers a reasonable alternative for stabilizing intracapsular femoral neck fractures.

Materials And Methods: A total of 63 patients with intracapsular femoral neck fractures, stabilized between 1993 and 1997 with the DMS, were followed up in this retrospective study in both 1999 and 2002. The patients were on average 64 years of age, with 30 younger and 33 older than 65.

Biomechanical comparison of two side plate fixation techniques in an unstable intertrochanteric osteotomy model: Sliding Hip Screw and Percutaneous Compression Plate.

Background: Our objective was to determine the biomechanical primary stability of two different side plate fixation devices in an unstable intertrochanteric cadaver model: the Sliding Hip Screw with an additional derotation screw was compared with the Percutaneous Compression Plate.

Methods: Eight pairs of human cadaver femurs were tested for comparison of the primary stability of the two implants in two modes: (a) cyclic loading up to 200 N, 400 N, 600 N, 800 N, and 1000 N, respectively. In vitro combined axial and bending loads were applied.

The non-steroidal anti-inflammatory drug diclofenac reduces appearance of osteoblasts in bone defect healing in rats.

Introduction: Non-steroidal anti-inflammatory drug (NSAID) is well known to significantly delay fracture healing. Results from in vitro studies implicate an impairment of osteoblast proliferation due to NSAIDs during the initial stages of healing. We studied whether diclofenac, a non-selective NSAID, also impairs appearance of osteoblasts in vivo during the early phase of healing (at 10 days).

Implant-associated posttraumatic osteomyelitis: collateral damage by local host defense?

Infections following osteosynthesis or total joint replacement, also known as ''implant-associated posttraumatic osteomyelitis'', represent a major complication in orthopedic and trauma surgery. While the formation of bacterial biofilms on the implanted osteosynthesis materials is generally accepted as cause of the persistent infection, the molecular mechanisms leading to the progressive and destructive local inflammatory process and eventually to bone degradation, the osteolysis, have not been delineated. Here we provide evidence supporting the hypothesis that it is not the infection per se that causes tissue degradation and osteolysis, but rather the cytotoxic, proteolytic, and proinflammatory effector functions of cells of the host defense, particularly of the infiltrating polymorphonuclear neutrophils.

Primary stability of various forms of osteosynthesis in the treatment of fractures of the proximal tibia.

The treatment of fractures of the proximal tibia is complex and makes great demands on the implants used. Our study aimed to identify what levels of primary stability could be achieved with various forms of osteosynthesis in the treatment of diaphyseal fractures of the proximal tibia. Pairs of human tibiae were investigated.

The unreamed intramedullary tibial nail in tibial shaft fractures of soccer players: a prospective study.

Lower leg fractures are common and complex injuries in soccer players. Twenty-five mainly recreational soccer players who sustained a tibial shaft fracture were treated with the AO-UTN (Unreamed Tibial Nail). This prospective series included 25 males with a mean age of 28.

Intramedullary pressure increase and increase in cortical temperature during reaming of the femoral medullary cavity: the effect of draining the medullary contents before reaming.

Background: Reaming is regarded as the most adverse aspect of the intramedullary nailing procedure since it leads not only to impairment of the vessels but also to an increase in intramedullary pressure and cortical temperatures which may in turn lead to aseptic cortical necroses and pulmonary dysfunction. Intramedullary pressure increase is considered to be the most detrimental of these factors.

Methods: The aim of this study was to investigate the effect on intramedullary pressure and cortical temperature of removing the medullary fat before reaming.

Reduction of severe wrist injuries in snowboarding by an optimized wrist protection device: a prospective randomized trial.

Background: The benefits of sport are well recognized, but many activities carry a sport-specific injury risk. Snowboarding has become an increasingly popular winter sport in Austria in recent years, with an estimated 900,000 participants annually. Roughly 6,000 of these suffer from injury and up to 2,000 sustain moderate or severe wrist injuries (mainly fractures of the distal radius and epiphysiolyses).

A method for all-inside arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears.

There have been different descriptions of arthroscopic repair of the Palmer 1B tear of the triangular fibrocartilage complex (TFCC). Both outside-in and inside-out techniques are in common use, but both have the disadvantage of an extra incision to tie the knots and they are time consuming. We present a technique for all-inside repair of Palmer 1B TFCC tears using a technique known from meniscal repair in the knee joint.

Small free vascularized iliac crest bone grafts in reconstruction of the scaphoid bone: a retrospective study in 60 cases.

Carpal instability may result in progressive degenerative arthritis of the wrist. The surgical goal of the reconstruction of scaphoid nonunion is to achieve bone union and to restore the scaphoid. Many procedures are described to treat scaphoid nonunion for different indications.

Carpal tunnel topography during endoscopic decompression.

The safety of the endoscopic technique for carpal tunnel release remains a major concern. Serious complications such as division nerves, tendons or vessels may occur. In this study the topography of the carpal tunnel was studied in fresh cadaver hands after the introduction of the blade assembly of a one portal system.

Acetabular fractures: operative management and long term results.

Introduction: While the undisplaced acetabular fractures have a good prognosis after conservative treatment, the management of the displaced fractures has been a controversial issue over the last decades with variable results in their treatment and prognosis. Anatomical reduction can be only achieved operatively. The long term outcome of 209 patients with displaced acetabular fractures treated by open reduction and internal fixation was presented.

Denervation of the radiocarpal joint. A follow-up study in 22 patients.

Denervation surgery has been a mainstay of our management of chronic pain in the wrist. If there is useful movement at the wrist we prefer denervation to arthrodesis. We have reviewed 22 patients at a mean of 50 months after such denervation surgery at the wrist.