Comparison of time-efficiency of individually wrapped screws and sterile screw racks in distal radius fracture treatment.

INTRODUCTION: Time-efficiency of individually wrapped screws versus screws in a screw rack is not well established. MATERIALS AND METHODS: We performed a prospective single-center clinical study timing the interval between the surgeon asking and receiving a screw during plate and screw osteosynthesis of distal radius fractures. Patients were randomized for individually wrapped screws or screws in a screw rack. The study was conducted in a Level 1 Trauma Center and surgeries were performed between March and June 2023. RESULTS: Average handling time for screws from a screw rack was 9 s (SD 5.5; range 3-28) and 22 s for individually wrapped screws (SD 6.1; range 6-38). This average difference of 13 s is significant (p < 0.0001). CONCLUSION: There is a significant increase in handling time using individually wrapped screws over using a screw rack. LEVEL OF EVIDENCE: Level I (therapeutic, randomized controlled trial).

Cup oversizing as a risk factor for postoperative groin pain in Total Hip Arthroplasty : a retrospective analysis of 437 hips.

The majority of patients are pain free after total hip replacement, but some experience anterior hip pain due to iliopsoas impingement. There is evidence that a prominent or malpositioned cup may cause iliopsoas tendonitis. The purpose of this study was to determine whether oversizing the cup is a risk factor for postoperative groin pain. We retrospectively investigated 437 total hip replacements in which the femoral head diameter had been measured for other research purposes. Data regarding the cup size and positioning was collected from implant identification labels and pelvis x-rays. Clinical data were recovered from the medical files. Native femoral head size, cup size, anteversion, inclination and DS (difference between native femoral head size and cup size) and type of pain (anterior hip pain or non-anterior hip pain) were analyzed and correlations were sought. There was a strong and significant correlation between native femoral head size and cup size. Mean DS was 5.5 mm in the no pain group, 6.9 mm in the anterior hip pain group and 5.9 mm in the non-anterior hip pain group. The difference in mean DS was significant (P=0.046) in patients experiencing anterior hip pain vs. those with no pain or non-anterior hip pain. As patients with anterior hip pain had a significant larger DS of 6.9 mm, it seems that a cup size of more than 6 mm above the native femoral head size should be avoided. We therefore recommend a systematic intraoperative head size measurement prior to definite cup choice.

The Direct Anterior Approach for Complex Primary Total Hip Arthroplasty: The Extensile Acetabular Approach on a Regular Operating Room Table.

BACKGROUND: The direct anterior approach on a regular operating room table has been reported with low dislocation rates. This might be beneficial for complex primary total hip arthroplasty (THA) such as in patients with cerebral palsy or following femoral or pelvic osteotomies. Extending the approach is often required to overcome problems such as acetabular deformities or severe contractures. METHODS: We retrospectively evaluated the results and complications of 29 patients with 37 complex primary THA in which an extensile approach was used. The extensile approach is described. Functional scores were collected in case the patient was ambulatory independently (n = 17). RESULTS: The average age was 35 years (range 15-85) with a mean follow-up of 39 months (range 12-60). There were 3 (8%) intra-operative and 4 (11%) early post-operative complications (<3 months), of which 3 (8%) were anterior dislocations. Late complications (>3 months) consisted of a fibrous ingrown stem, a socket loosening following a pelvic fracture, and a late hematogenous infection (8%). Seventy-one percent of the complications occurred in the first 18 cases (49%) indicating a learning curve. The mean post-operative Harris Hip Score was 79 (range 56-97). CONCLUSION: Complex THA can be safely conducted through the extensile anterior approach on a regular operating room table with the use of conventional implants, even in cases with a high risk of dislocation.

Percutaneous hardware free corrective osteotomy for bunionnette deformity.

When bunionette deformities are not responding to conservative treatment, several surgical procedures are available. Recently, minimal invasive techniques have been proposed with good results. We present our results of a strictly percutaneous 5th metatarsal osteotomy to correct the deformity with bandage after care. We present a retrospective review on 20 percutaneous distal oblique 5th metatarsal osteotomies for correction of bunionette deformity. Aftercare consisted of 5-6 weeks of corrective taping with full weight bearing using a post-op shoe. Patients were evaluated radiographically and clinically by the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Inter-phalangeal scale, Visual Analogue scale (VAS) and Coughlin classification. At a mean follow-up of 27.05 months, the AOFAS improved from a mean of 51 points to 91.6 points (max 100). 90% of patients had good or excellent clinical result and a mean pain score on the visual analog scale was 0.7 out of 10. Radiographic evaluation showed a good correction of the intermetatarsal and metatarsophalangeal angle. We did not encounter any complications such as infections, wound breakdown, neurovascular problems, non-union or recurrence. The percutaneous hardware free corrective osteotomy is an effective, reliable and safe procedure concerning the treatment of bunionette deformity. The results are comparable with previously published outcomes of open and minimal invasive procedures with considerable less soft tissue damage, shorter operating time and the lack of internal fixation.

Complex total knee arthroplasty using resection prostheses at mid-term follow-up.

Complex primary or revision TKA may require the use of a resection type prosthesis to address major bone loss and soft tissue deficiencies. The aim of this retrospective study is to evaluate the clinical and radiographic outcomes of salvage knee reconstructions in a larger cohort and longer follow-up than previously reported. We therefore present the results of 66 cases treated with the Finn/OSS knee system with an average follow-up of 5 years (range 2-12). Indications included 63 revision cases and three primary interventions with either massive bone loss and/or soft tissue deficiency. At final follow-up the average knee society score had significantly improved from 46 preoperatively to 73, and the function score improved from 27 to 47 points. Four cases needed to be revised: one for recurrent infection, two for aseptic loosening and one for implant breakage. Nine patients underwent minor reinterventions; including five cases with irrigation and debridement for prolonged wound drainage, two patellar realignment procedures and two extensor mechanism repairs. Two patients developed a peroneal nerve palsy. Overall implant survivorship with revision as the endpoint was 92% at 5 and 10 years. We conclude that the use of a resection prosthesis in the complex primary and revision TKA leads to acceptable results, but the complication rate is relatively high.