Radiographic results on acetabular cup placement with the SuperPath technique: a retrospective study of 756 cases.

BACKGROUND: The Supercapsular percutaneously assisted total hip (SuperPath) technique is a relatively new minimally invasive approach for total hip arthroplasty (THA). Good clinical outcomes related to its use are reported in the literature. Nonetheless, there are still uncertainties about its validity in terms of radiographic outcomes. Main purpose of the study is to evaluate the effectiveness of the SuperPath in acetabular cup positioning through radiographic evaluation of acetabular inclination angle (IA) and acetabular anteversion (AA) angle within the safe zone described by Lewinnek. The leg length discrepancy (LLD), femoral offset (FO), and acetabular offset (AO) were also measured to ascertain the radiographic effectiveness of SuperPath in the acetabular cup placement. METHODS: Between January 2016 and December 2019, all SuperPath cases eligible for the study were included. They were operated by three orthopaedic surgeons with long-standing experience in THA via conventional posterolateral approach and who have performed SuperPath training fellowship. The Mann-Whitney U test was used for statistical assessments (p-value < 0.05). Means ± standard deviation (SD) of the radiographic IA and AA were calculated for each year. RESULTS: A retrospective analysis of 756 THAs was performed. The average percentage of IA within the Lewinnek's safe zone was from 80 to 85%, while the average percentage of AA was from 76 to 79%. Both IA and AA showed no statistically significant difference between two consecutive years. Good results, in the ranges of normal values, were also obtained for LLD, FO and AO, with homogeneous outcomes between 1 year and the following one. CONCLUSION: It is possible to achieve good radiographic values of acetabular cup orientation through the SuperPath within the Lewinnek's safe zone. These results are similar to those reported in the literature by authors using SuperPath. Low rate (0,3%) of hip dislocations were reported. Therefore, the SuperPath technique represents a good alternative THA approach. Nevertheless, there is not a statistically significant improvement in these radiographic parameters over a four-year time. LEVEL OF EVIDENCE: Level IV, retrospective study.

Fragment specific fixation with APTUS wrist system for volar rim fractures of the distal radius: a multicentric study.

PURPOSE: Volar rim fractures of the distal radius are a spectrum of pathology that must be well identified and treated to achieve good outcomes and avoid surgical failures. New devices of fragment specific fixation have been developed during the last decades to fix this fragment. The purpose of this retrospective study was to evaluate the ability of APTUS® wrist distal radius system to securely fix different types of volar rim fractures. METHODS: Patients with at least 1 year of follow-up and a preoperative CT-scan evaluation of the fracture pattern were included in the study. Clinical, radiological and functional outcomes were assessed. RESULTS: Sixty-eight patients with an average follow-up of 34, 1 months (12-61) were included in the study. There were no clinical and radiological complications, including loss of reduction, device failure and tendon ruptures. No patients required hardware removal. Wrist range of motion in flexion-extension averaged 96°, while in pronation-supination 144°. At final follow-up mean visual analogue scale pain was 1,8. Questionnaires, as dissabilities of the arm, shouldder and hand (DASH) score and patient-related wrist evolution (PRWE) score were 6,6 and 3 respectively. Grip strenght measured 86% compared to the normal side. CONCLUSION: APTUS® wrist presents a versatile set of fragment specific fixation plates able to easily and securely fix all types of volar rim fracture. The system can be used with other devices without any kind of interference between them. When correctly placed and used with the right indications, no late complications can be recorded.

Dorsally and volarly angulated extra-articular malunions of the distal radius treated with volar corrective osteotomy and volar locking plate fixation. A case series of 19 patients with a long-term follow-up.

BACKGROUND AND AIM: To date, different technique of corrective osteotomy for the treatment of distal radius extra-articular malunions are described. With this study, we present a case series of corrective osteotomy using volar plate fixation to treat volar and dorsal extra-articular malunions aiming to evaluate the effectiveness of corrective osteotomies through volar plate stabilization in these two types of extra-articular malunions. METHODS: Between August 2008 and May 2017 all patients diagnosed with extra-articular malunion were included in the study. An extended volar Orbay approach and two types of dedicated volar locking plate (Medartis AG, Switzerland and Acumed, Hillsboro,OR) were used. Clinical and radiological parameters were evaluated. The DASH and PRWE scores and the VAS scale questionnaires were administered. The results were analyzed through statistical evaluations. RESULTS: A retrospective analysis of 19 patients diagnosed with extra-articular malunion was carried out. Nine had a volar type deformity (group A), while the other 10 had a dorsal type deformity (group B). The active range of motion (aROM), radiographic parameters, grip strength and pinches in both groups were statistically improved, except for radial deviation in both groups, ulnar deviation in group A, and radial inclination in group B.  The grip strength and pinches values were slightly better in group A. DASH, PRWE scores and VAS scale showed a significant improvement. CONCLUSION: Corrective osteotomy through volar fixation is an effective technique to treat both extra-articular dorsally and volarly angulated malunions. Statistically significant benefits are present in both types of deformities, with better outcomes in the group of volar deformities.

Avoiding unconscious injection of vial-derived rubber particles during intra-articular drug administration.

Objective: Vial coring describes the occurrence of small rubber particles, which are formed by needles when perforating vial stoppers. These particles may be aspirated along with the drug. Unconscious injection of rubber particles may increase the risks associated with intra-articular injections. This study aimed to analyze the frequency of this phenomenon and possibilities to avoid its occurrence. Method: 800 vials of 2 â€‹mL, filled with sodium chloride, were divided into 4 groups (n â€‹= â€‹200 each). Aspiration through the rubber stopper was performed with a 18-Gauge needle and the fluid was ejected onto a 10 â€‹µm filter paper through a 18-Gauge needle (group one) and a 23-Gauge needle (group two). In group three a 23-Gauge needle was used for aspiration and ejection. In group four, aspiration was performed using 18-Gauge needles with implemented 5 â€‹µm filters. Subsequently, a microscopic analysis of the filter papers was performed. Results: In none of the 800 specimen, a rubber particle was detected by naked eye. Microscopically, 20 (10%) rubber particles were detected in group one, 21 (11%) in group two and 65 (33%) in group three. In group four, no particles were visualized. Conclusion: This study shows the occurrence of rubber particles in 10-33% of the cases, when standard needles are used for the aspiration of drugs. We therefore recommend using industrially prefilled syringes, filter needles or removing the rubber stopper before withdrawing drugs from vials for intra-articular injections.