Radial head replacement with the MoPyC pyrocarbon prosthesis.

BACKGROUND: Radial head fractures often pose therapeutic dilemmas. We present the early results of patients who underwent radial head replacement with the MoPyC prosthesis (Bioprofile, Tornier, Saint-Ismier, France). MATERIALS AND METHODS: We re-evaluated patients who underwent post-traumatic radial head resection and implantation of the MoPyC prosthesis due to pain and motion restriction. All patients underwent radiographic evaluation. Clinical evaluation was performed using the Broberg-Morrey and the Mayo Elbow Performance Score (MEPS) scales. RESULTS: Thirty-two patients (20 men, 12 women; mean age, 54 years; 22 dominant upper limbs) were evaluated. Twenty had a comminuted radial head fracture (Mason IV, 15; Mason III, 5), 2 from radial head fracture malunion, and 10 had complex elbow injuries (comminuted radial head fractures with ligamentous ruptures with or without coronoid process fractures). Mean follow-up was 27 months (range, 21-46 months). The mean results at the latest follow-up were flexion-extension, 130° (range, 105°-150°); pronation, 74° (range, 60°-80°); and supination, 72° (range, 60°-80°). No laxity was evident during valgus and varus stress tests. Mean grip strength was 96% of the contralateral side. Broberg-Morrey scores were excellent in 33%, good in 44%, and fair in 23%. MEPS results were excellent in 80%, good in 17%, and fair in 3%. There were 6 cases of periprosthetic lucencies or osteolysis of the radius without any clinical signs of loosening. CONCLUSIONS: Radial head replacement with the MoPyC pyrocarbon prosthesis (when performed in carefully selected patients) yields satisfactory results regarding range of motion and function of the elbow joint.

Lower limb deformity following proximal tibia physeal injury: long-term follow-up.

BACKGROUND: Proximal tibial physeal injuries are quite rare, but their complications can be of great importance. The purpose of this study was to evaluate the effect of this injury on the axis and length of a child's limb. MATERIALS AND METHODS: This study focused on 12 patients with proximal physeal injury of the tibia (8 boys and 4 girls; mean age at the time of injury: 8.9 years). Injuries were classified according to the Salter-Harris scheme into 5 types (type II--7 patients, type III--3 patients, type IV--1 patient, type V--1 patient). In 5 cases, a coexisting fracture of the injured limb was observed (fibular fracture--3 cases, intercondylar fracture--1 case, tibial tubercle fracture--1 case). Ten patients were treated conservatively and 2 patients underwent an operation. Seven of the 12 patients were available for long-term follow-up, with a mean duration of 14.4 years (11.2-22.0 years). RESULTS: Angular deformity was observed in 6 of the 7 patients, with a mean valgus deformity of 2.7°, within an average of 5.8 months after the injury. After 3 years of follow-up, complete remodeling was observed in all of those 6 cases (4 of the patients were treated conservatively and 2 underwent surgery). One patient developed 6 mm of tibial shortening. No functional limitation or pain was recorded in any of the patients during the follow-up. CONCLUSIONS: Injury to the proximal tibial epiphysis, while rare, may result in angular or length disturbance, regardless of the initial treatment (conservative or surgical). Parents should always be informed of this possibility, and long follow-up is indicated. Nevertheless, this type of injury rarely results in functional limitations.

The long-term effects of hip fusion on the adjacent joints.

Hip fusion has served well for many years as the surgical procedure of choice to treat painful joints with severe osteoarthritis or tuberculous arthritis. This retrospective study evaluates the long-term results of hip fusion, as far as its impact on the adjacent joints is concerned. Thirty-three patients that underwent hip arthrodesis 26-52 years previously were evaluated. All patients reported being satisfied with the fusion and being able to adequately work and perform everyday activities. Twenty-five reported episodes of low back-pain, 18 reported pain in the ipsilateral knee, four in the contralateral knee and five in the contralateral hip. Back pain started after an average time interval of 24 years, and pain in the ipsilateral knee appeared 24.6 years after the fusion. Hip fusion, a procedure which is now hardly ever performed, appears to offer a painless, strong and stable hip. However, the adjacent joints, mainly the lumbosacral spine and the ipsilateral knee, will probably develop secondary degenerative arthritis.

Bursal osteochondromatosis overlaying an osteochondroma in the immature skeleton.

A rare case of bursal osteochondromatosis overlying an osteochondroma located at the proximal third of the left tibia in a 10-year-old boy is described. The treatment was operative by marginal resection of the affected bursa and marginal en bloc resection of the osteochondroma. The patient remains symptom and complication free 8 years postoperatively with no sign of recurrence of both lesions. This is the first reported case of a bursal osteochondromatosis overlying an osteochondroma in a developing skeleton, thus rendering this type of lesion one among the possible differential diagnoses that should be considered when dealing with relative diagnostic dilemmas in immature patients.

Stress fractures of the lesser metatarsals after a Wilson osteotomy for correction of hallux valgus deformity.

This article describes a patient with lesser-metatarsal stress fractures resulting from an oblique Wilson displacement first metatarsal osteotomy. The shortening of the first metatarsal forces the lesser metatarsals to bear the weight previously borne by the first ray and increases the compression stress on the adjacent metatarsal heads. The proximal displacement of the osteotomy must be minimized in order to limit the risk of stress fracture of the lesser metatarsals.

Postoperative re-perfusion of drained blood in patients undergoing total knee arthroplasty: is it effective and cost-efficient?

The value of postoperative salvage and re-infusion of drained blood was assessed in 155 patients undergoing total knee arthroplasty for primary knee osteoarthritis. In group A (n = 77), standard vacuum drains were used. In group B (n = 78), an auto-transfusion system was used and the blood drained within 6 hours postoperatively was re-infused. Group B patients were further distributed into 2 subgroups, in one of which methylprednisolone was administered before blood re-perfusion. Patients who received autologous blood had higher levels of haemoglobin at 8 hours (p < 0.05) and 24 hours postoperatively (p < 0.01) and needed less allogeneic blood transfusion (p < 0.01). Methylprednisolone administration was found to attenuate the postoperative febrile reaction (p = 0.01).

Arthroscopic debridement of the osteoarthritic knee under local anaesthesia.

This prospective study compared the efficacy of arthroscopic debridement in osteoarthritic knees under local, general or peridural anaesthesia. Between 1997 and 2001, 201 arthroscopic debridements were performed in 197 patients (173 partial meniscectomies, 192 articular trimmings, 119 microfractures, 201 lavage procedures) in 197 patients. Patients were treated under local (Group "L", n = 67), general (Group "G", n = 65) or peridural anesthesia ( Group "P", n = 65). No tourniquet was used. The follow-up ranged from 24 to 72 months (mean: 32 months). No major complication was noted. Results were assessed according to the scale of Baumgaertner et al independently from the type of anaesthesia used (p = 0.71). Results were excellent in 85 cases (L: 30, G: 27, E: 28), good in 75 (L: 25, G: 24, E: 26), fair in 27 (L: 9, G: 8, E: 10), poor in 14 (L: 7, G: 4, E: 3). Arthroscopic debridement of the osteoarthritic knee under local anaesthesia appears as an efficient, simple, safe, painless and cost-effective method of treatment.

Serum intact-parathyroid hormone level following total knee arthroplasty.

PURPOSE: To evaluate short-term parathyroid hormone (PTH) secretion following total knee arthroplasty (TKA). METHODS: 119 Caucasian postmenopausal women aged 49 to 81 (mean, 69.8) years who underwent TKA for end-stage knee osteoarthritis were included. Serum levels of intact-PTH, calcium, phosphorus, and creatinine were evaluated pre- and post-operatively (on days -1 and 7). Creatinine clearance was also calculated. RESULTS: In 67 of the patients, serum intact-PTH levels decreased after TKA; this sample proportion was not significant (p=0.82). In 16 of the patients, such levels elevated abnormally (above normal range). In the remaining 36 patients, such levels elevated within the normal range. Therefore, the mean serum intact- PTH level of all patients increased slightly after TKA (45.4 vs. 45.3, p=0.162). The serum intact-PTH level did not correlate to body weight (r=-0.045, p=0.624), patient age (r=-0.061, p=0.508), serum creatinine level (r=0.084, p=0.366), and clearance of creatinine (r=-0.037, p=0.692). CONCLUSION: In most postmenopausal women, the serum intact-PTH level decreased moderately following TKA, but in some, the level was abnormally elevated. This may interfere the prosthesis incorporation process.

The role of pantalar arthrodesis in the treatment of paralytic foot deformities. Surgical technique.

BACKGROUND: Pantalar arthrodesis is considered by many to be the final operative option before amputation for the treatment of paralytic foot deformities. The aim of the present study was to evaluate the long-term results of pantalar arthrodesis with regard to its impact on the adjacent joints and the walking ability of patients with paralytic foot deformities. METHODS: Twenty-four patients (seventeen men and seven women) who underwent a one-stage pantalar arthrodesis between 1953 and 1973 for the treatment of sequelae of poliomyelitis were reevaluated. All patients underwent a physical and radiographic examination, and all completed the Short Form-36 questionnaire and a pantalar arthrodesis specific questionnaire. RESULTS: The average age of the patients was twenty years at the time of the operation and 57.2 years at the time of the latest evaluation. The average duration of follow-up was 37.2 years. Eleven patients had development of immediate postoperative complications, including wound-healing problems (nine) and infections (two). The long-term results,however, were good (mean Short Form-36 scores, 73 of 100 points [overall], 51.5 points [physical functioning], and >70 points [all other domains]). Sixteen patients experienced repeated episodes of ipsilateral knee pain; most (fifteen) of these patients experienced a gradual onset of this pain, starting at an average of 20.8 years (range, fifteen to thirty years) postoperatively. The position of the fused ankle did not appear to have a significant impact on the development of ipsilateral knee pain or the time interval between the pantalar arthrodesis and the onset of ipsilateral knee pain. CONCLUSIONS: Pantalar arthrodesis effectively stabilizes the ankle, hindfoot, and midfoot in patients with severe paralytic deformities. Even though most patients can be expected to have development of osteoarthritis of the ipsilateral knee, it seems that a successfully performed pantalar arthrodesis in carefully selected cases is a reliable operative option offering a strong and stable foot that will function well for many years.

The role of pantalar arthrodesis in the treatment of paralytic foot deformities. A long-term follow-up study.

BACKGROUND: Pantalar arthrodesis is considered by many to be the final operative option before amputation for the treatment of paralytic foot deformities. The aim of the present study was to evaluate the long-term results of pantalar arthrodesis with regard to its impact on the adjacent joints and the walking ability of patients with paralytic foot deformities. METHODS: Twenty-four patients (seventeen men and seven women) who underwent a one-stage pantalar arthrodesis between 1953 and 1973 for the treatment of sequelae of poliomyelitis were reevaluated. All patients underwent a physical and radiographic examination, and all completed the Short Form-36 questionnaire and a pantalar arthrodesis-specific questionnaire. RESULTS: The average age of the patients was twenty years at the time of the operation and 57.2 years at the time of the latest evaluation. The average duration of follow-up was 37.2 years. Eleven patients had development of immediate postoperative complications, including wound-healing problems (nine) and infections (two). The long-term results, however, were good (mean Short Form-36 scores, 73 of 100 points [overall], 51.5 points [physical functioning], and >70 points [all other domains]). Sixteen patients experienced repeated episodes of ipsilateral knee pain; most (fifteen) of these patients experienced a gradual onset of this pain, starting at an average of 20.8 years (range, fifteen to thirty years) postoperatively. The position of the fused ankle did not appear to have a significant impact on the development of ipsilateral knee pain or the time interval between the pantalar arthrodesis and the onset of ipsilateral knee pain. CONCLUSIONS: Pantalar arthrodesis effectively stabilizes the ankle, hindfoot, and midfoot in patients with severe paralytic deformities. Even though most patients can be expected to have development of osteoarthritis of the ipsilateral knee, it seems that a successfully performed pantalar arthrodesis in carefully selected cases is a reliable operative option offering a strong and stable foot that will function well for many years.

Multidirectional habitual bilateral hip dislocation in a patient with Down syndrome.

A multidirectional (anterior and posterior) bilateral habitual nontraumatic dislocation of the hip in a 3-year-old girl with Down syndrome is reported. The treatment was conservative with application of a spica cast for 12 weeks to shrink the capsule. During the first 6 weeks of treatment, the hips were immobilized in abduction and full external rotation. During the last 6 weeks, the hips were in abduction and slight internal rotation. After cast removal, the hips seemed to have been stabilized, and the child has remained asymptomatic for the last 12 months.