Antibiotic-loaded bone cement in total joint arthroplasty.

Periprosthetic joint infection is a devastating complication after total joint replacement. Prevention is mandatory and systemic antibiotic prophylaxis is nowadays a recognized cornerstone. Further addition of local antibiotics eluting from bone cement is a real possibility but its routine use is controversial. Pros and cons of its routine use in primary and revision total joint arthroplasty will be discussed. Cement spacers carrying high doses of antibiotic(s) are currently accepted during two-stage treatment of infected prosthetic joints. Several issues such as alternatives to classic antibiotics, optimal dosages and others will also be explored.

Scapholunate ligament reconstruction using a flexor carpi radialis tendon graft.

PURPOSE: To review the results of scapholunate ligament reconstruction using a flexor carpi radialis tendon graft. METHODS: We performed a retrospective review of 22 patients with post-traumatic scapholunate instability who were treated with a modification of the Brunelli, a flexor carpi radialis tendon graft. RESULTS: The mean follow-up was 61 months. The average age was 40 years. The average loss of flexion was 23° and of extension was 22° compared with the contralateral side. Grip strength averaged 67% of the nonoperated side. All patients except 2 returned to work. Degenerative changes were seen in 3 patients at the time of revision. Complications occurred in 2 patients and included avascular necrosis of the scaphoid. CONCLUSIONS: Perfect biomechanical reconstruction might not be possible for scapholunate dissociation. Our results show, however, that ligament reconstruction led to satisfactory results from the patient's point of view. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Long Biceps Subpectoral Tenodesis With Suspensory Button and Bicortical Fixation.

Tenodesis of the long head of the biceps (LHB) tendon has long been recognized as a valid alternative to address pathologic conditions of this tendon. However, the location and type of fixation is still a matter of discussion, because common complications associated with this procedure include failure of the repair, persistent pain, reaction to the fixation device, cosmetic deformity, and fracture. The authors describe a method of subpectoral LHB tenodesis that aims to preserve bone stock and allows a strong, easy, and reproducible type of fixation with a minimal approach. LHB tenotomy is performed arthroscopically in a standard fashion, and the tenodesis is completed with bicortical fixation in the humerus using a knotless suspensory button with an appropriate pusher originally developed for another purpose. Magnetic resonance imaging showed a safe distance between the implant and important vasculonervous structures. In the cases where subpectoral fixation is chosen, this method seems to offer additional safety as a result of the minimal amount of bone removed and the very small size of the implant.

Cubital compressive neuropathy in the elbow: in situ neurolysis versus anterior transposition - comparative study.

OBJECTIVE: To compare the results from two of the most commonly used surgical techniques: in situ decompression and subcutaneous transposition. The processes of patients treated surgically in a public university hospital between January 2004 and December 2011 were reviewed. Cases of proximal compression of the nerve, angular deformity of the elbow and systemic diseases associated with non-compressive neuropathy were excluded. METHODS: Ninety-seven cases were included (96 patients). According to the modified McGowan score, 14.4% of the patients presented grade Ia, 27.8% grade II, 26.8% grade IIb and 30.9% grade III. In situ neurolysis of the cubital was performed in 64 cases and subcutaneous anterior transposition in 33. RESULTS: According to the modified Wilson and Knout score, the results were excellent in 49.5%, good in 18.6%, only satisfactory in 17.5% and poor in 14.4%. In comparing the two techniques, we observed similar numbers of excellent and good results. Grades IIb and III were associated with more results that were less satisfactory or poor, independent of the surgical technique. CONCLUSION: Both techniques were shown to be efficient and safe for treating cubital tunnel syndrome.

OBJETIVO: Comparar os resultados de duas das técnicas cirúrgicas mais usadas, a descompressão in situ e a transposição subcutânea. Foram revistos os processos dos doentes tratados cirurgicamente num hospital universitário público entre janeiro de 2004 e dezembro de 2011. Foram excluídas compressões proximais do nervo, deformidades angulares do cotovelo e doenças sistêmicas associadas a neuropatia não compressiva. METODOS: Foram incluídos 97 casos (96 doentes). Segundo o escore modificado de McGowan, 14,4% dos pacientes encontravam-se no Grau Ia, 27,8% no II, 26,8% no IIb e 30,9% no III. A neurólise in situ do cubital foi feita em 64 casos e a transposição anterior subcutânea em 33. RESULTADOS: Segundo o escore modificado de Wilson e Knout, os resultados foram excelentes em 49,5%, bons em 18,6%, apenas satisfatórios em 17,5% e pobres em 14,4%. Na comparação das duas técnicas observamos valores similares de resultados excelentes ou bons. Os graus IIb e III estão associados a mais resultados menos satisfatórios ou maus independentemente da técnica cirúrgica. CONCLUSÃO: As duas técnicas se revelam eficientes e seguras no tratamento do síndrome do túnel cubital.

Carpal tunnel syndrome due to a plexiform neurofibroma of the median nerve in a neurofibromatosis type 1 patient: clinical approach.

The authors report the case of a 56-year-old male patient with neurofibromatosis type 1 (NF1) diagnosed during adolescence and with an insidious clinical evolution, characterised by an exuberant cutaneous involvement, referred to the orthopaedics outpatient clinic presenting with carpal tunnel syndrome secondary to a plexiform neurofibroma of the median nerve. A comprehensive clinical approach is discussed, considering the natural history of the disease and its potential complications, as well as the lack of consensus regarding standard therapeutic options for the compressive peripheral neuropathies in the NF1 disease.

Cubital compressive neuropathy in the elbow: in situ neurolysis versus anterior transposition – comparative study / Neuropatia compressiva cubital no cotovelo: neurólise in situ versus transposição anterior–Estudo comparativo

Objective: To compare the results from two of the most commonly used surgical techniques: in situ decompression and subcutaneous transposition. The processes of patients treated surgically in a public university hospital between January 2004 and December 2011 were reviewed. Cases of proximal compression of the nerve, angular deformity of the elbow and systemic diseases associated with non-compressive neuropathy were excluded. Methods: Ninety-seven cases were included (96 patients). According to the modified McGowan score, 14.4% of the patients presented grade Ia, 27.8% grade II, 26.8% grade IIb and 30.9% grade III. In situ neurolysis of the cubital was performed in 64 cases and subcutaneous anterior transposition in 33. Results: According to the modified Wilson and Knout score, the results were excellent in 49.5%, good in 18.6%, only satisfactory in 17.5% and poor in 14.4%. In comparing the two techniques, we observed similar numbers of excellent and good results. Grades IIb and III were associated with more results that were less satisfactory or poor, independent of the surgical technique. Conclusion: Both techniques were shown to be efficient and safe for treating cubital tunnel syndrome...

Objetivo: Comparar os resultados de duas das técnicas cirúrgicas mais usadas, a descompressão in situ e a transposição subcutânea. Foram revistos os processos dos doentes tratados cirurgicamente num hospital universitário público entre janeiro de 2004 e dezembro de 2011. Foram excluídas compressões proximais do nervo, deformidades angulares do cotovelo e doenças sistêmicas associadas a neuropatia não compressiva. Metodos: Foram incluídos 97 casos (96 doentes). Segundo o escore modificado de McGowan, 14,4% dos pacientes encontravam-se no Grau Ia, 27,8% no II, 26,8% no IIb e 30,9% no III. A neurólise in situ do cubital foi feita em 64 casos e a transposição anterior subcutânea em 33. Resultados: Segundo o escore modificado de Wilson e Knout, os resultados foram excelentes em 49,5%, bons em 18,6%, apenas satisfatórios em 17,5% e pobres em 14,4%. Na comparação das duas técnicas observamos valores similares de resultados excelentes ou bons. Os graus IIb e III estão associados a mais resultados menos satisfatórios ou maus independentemente da técnica cirúrgica. Conclusão: As duas técnicas se revelam eficientes e seguras no tratamento do síndrome do túnel cubital...