Acta orthopaedica Scandinavica最新文献

{"title":"Pressure ulcer risk in hip fracture patients.","authors":"Ronald Houwing,&nbsp;Marja Rozendaal,&nbsp;Wendeline Wouters-Wesseling,&nbsp;Erik Buskens,&nbsp;Paul Keller,&nbsp;Jeen Haalboom","doi":"10.1080/00016470410001132-1","DOIUrl":"https://doi.org/10.1080/00016470410001132-1","url":null,"abstract":"<p><p>Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU were high age and the length of time on the operating table. The risk assessment tool had a low predictive value, however. It is thus hard to predict which patients will develop PU and which will not. Accordingly, we propose maximum preventive measures against PU for all patients presenting with hip fractures.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"390-3"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001132-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early revision after hemiarthroplasty and osteosynthesis of cervical hip fracture: short-term function mortality unchanged in 102 patients.","authors":"Jaakko Sipilä, P. Hyvönen, J. Partanen, J. Ristiniemi, P. Jalovaara","doi":"10.1080/759369182","DOIUrl":"https://doi.org/10.1080/759369182","url":null,"abstract":"BACKGROUND\u0000There is no consensus on whether osteosynthesis or hemiarthroplasty is preferable in the treatment of cervical hip fractures. Osteosynthesis is associated with more reoperations than hemiarthroplasty but there is little information available on the consequences of these reoperations.\u0000\u0000\u0000PATIENTS AND METHODS\u0000We studied the effect on mortality, hospital stay and functional outcome of revision performed within 4 months of primary surgery with hemiarthroplasty or osteosynthesis for cervical hip fracture. 50 (6%) of 792 patients treated with uncemented Austin-Moore hemiarthroplasty and 52 (13%) of 411 patients with osteosynthesis (86 with two hook pins and 325 with three cannulated screws) had had revision surgery. Control groups matched for age, sex, residential status, walking ability at fracture, type of primary operation and fracture type consisted of patients who had not had a reoperation.\u0000\u0000\u0000RESULTS\u0000Reoperation impaired walking ability and was associated with increased use of walking aids at 4 months in the hemiarthroplasty group and the osteosynthesis group as compared to controls, but did not have any statistically significant effect on residential status. In the hemiarthroplasty group, 4-month mortality was 12% among the reoperated patients and 18% among the controls, while mortality at 1 year was 24% in both groups. The corresponding figures in the osteosynthesis group and controls were 6% and 6% at 4 months, respectively, and 17% and 13% at 1 year.\u0000\u0000\u0000INTERPRETATION\u0000To some extent, reoperation impairs early functional outcome after cervical hip fracture treated by either osteosynthesis or hemiarthroplasty, but does not increase mortality to any significant degree.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4 1","pages":"402-7"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60614270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ankle arthrodesis using dowel bone graft and cancellous-bone screws: a mechanical study in cadavers.","authors":"A. Karladani, Georgias Digas, L. Ekström, J. Swanpalmer, J. Styf, T. Hansson","doi":"10.1080/759369193","DOIUrl":"https://doi.org/10.1080/759369193","url":null,"abstract":"BACKGROUND\u0000There are numerous techniques for ankle arthrodesis.\u0000\u0000\u0000MATERIAL AND METHODS\u0000We studied the stability of an ankle arthrodesis with the use of two cross-screws combined with dowel graft technique in 14 fresh-frozen ankles from amputees. The arthrodesis was performed by a dowel graft technique, in the coronal plane in 7 specimens (group 1) and in the diagonal plane in the remaining 7 (group 2). Allocation into the two groups took place after normalization according to the bone mineral content of the specimens. All ankles were fixed with two 6.5-mm diameter cancellous-bone screws, with the ankle in neutral position. Tibiotalar motion was measured during 5 Nm torque loading in plantar flexion-dorsiflexion, abduction-adduction and eversion-inversion planes of the ankle joint. Two testing sequences were performed and the mean value of both tests in each direction was used for the analysis.\u0000\u0000\u0000RESULTS\u0000In all 3 planes, the torque applied caused more motion with the dowel graft in the coronal plane (group 1) than with the graft in the diagonal plane (group 2). The differences between the two groups were significant for abduction-adduction and eversion-inversion planes. Statistical analysis of differences between the first and second test showed significantly greater stiffness in group 2 than in group 1 in plantar flexion-dorsiflexion torque.\u0000\u0000\u0000INTERPRETATION\u0000The placement of a dowel graft in the diagonal plane in comparison to the coronal plane significantly increased the initial stability of an ankle arthrodesis.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4 1","pages":"471-6"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60614361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary intramedullary nailing after distraction osteogenesis: 30 patients followed for 2-12 years.","authors":"Elias Lambiris,&nbsp;Andreas Papadopoulos,&nbsp;Aggeliki Karabasi,&nbsp;Athanasios Karageorgos","doi":"10.1080/00016470410001286-1","DOIUrl":"https://doi.org/10.1080/00016470410001286-1","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus about replacement of an external fixator by reamed intramedullary nailing in fracture cases.</p><p><strong>Patients and methods: </strong>We evaluated the outcome in 30 patients (33 segments) of secondary intramedullary nailing during the consolidation phase after callus distraction using an external device. The main reasons for nailing were docking site nonunion (17 patients), angular deformity or fracture of the lengthened area (8 patients) or intolerance of the external device (5 patients), in 11 patients combined with a delayed distracted callus maturation. The average follow-up time was 4 (2-12) years.</p><p><strong>Results: </strong>Intramedullary infection after nailing occurred in 1 case, and slight loss in callus length in 5 cases. Failure of union at the docking site with nail breakage occurred in 1 case. In the other patients, consolidation in the lengthened callus area and also union at the docking site were achieved on average 6 months after nailing.</p><p><strong>Interpretation: </strong>We believe that intramedullary nailing during the consolidation phase after bone lengthening or bone transport is a treatment option for delayed callus maturation or docking site nonunion, reducing prolonged use of the external fixator.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"481-6"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001286-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of MMP-9 and its tissue inhibitor TIMP-1 in human osteosarcoma: findings in 42 patients followed for 1-16 years.","authors":"Cristina Ferrari,&nbsp;Serena Benassi,&nbsp;Francesca Ponticelli,&nbsp;Gabriella Gamberi,&nbsp;Paola Ragazzini,&nbsp;Laura Pazzaglia,&nbsp;Alba Balladelli,&nbsp;Franco Bertoni,&nbsp;Piero Picci","doi":"10.1080/00016470410001295-1","DOIUrl":"https://doi.org/10.1080/00016470410001295-1","url":null,"abstract":"<p><strong>Background: </strong>The activity of matrix metalloproteinases (MMPs) in degrading extracellular matrix is controlled by activation of proenzymes and inhibition of MMP tissue inhibitors (TIMPs).</p><p><strong>Patients and methods: </strong>To assess the proteolytic cascade imbalance in malignancy progression, tissue expression and serum levels of MMP-2, MMP-9 and of their inhibitors TIMP-2 and TIMP-1 respectively were evaluated in 42 selected patients with high-grade osteosarcoma (OS). MMP-2, MMP-9, TIMP-2 and TIMP-1 were studied in biopsies by immunohistochemistry and in serum by ELISA test. Patients were subdivided into 3 groups according to their follow up: continuously disease-free, diagnosis of metastasis during follow-up, and metastasis at diagnosis.</p><p><strong>Results: </strong>Immunohistochemistry demonstrated an imbalance between MMPs and TIMPs, with a more evident role for MMP-9 than for MMP-2 in tumor progression. TIMP-1 inhibitor in plasma was higher in patients with osteosarcoma than in a control group. This high value of TIMP-1 was particularly evident in the group of patients who later developed metastases and/or local recurrences, and in those with metastases at diagnosis.</p><p><strong>Interpretation: </strong>Our findings confirm the protective action of TIMP-1, as MMP inhibitor, but also show its activity as a growth factor underlining its multifunctional role in OS.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"487-91"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001295-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure of ceramic THR with liner dislocation--a case report.","authors":"Kengo Yamamoto,&nbsp;Takaaki Shishido,&nbsp;Toshiyuki Tateiwa,&nbsp;Yoichi Katori,&nbsp;Toshinori Masaoka,&nbsp;Atsuhiro Imakiire,&nbsp;Ian Clarke","doi":"10.1080/00016470410001312-1","DOIUrl":"https://doi.org/10.1080/00016470410001312-1","url":null,"abstract":"In September 1998, an all-alumina total hip replacement was performed in a 57-year-old woman using an ABS Cup System THR (Kyocera Ltd. Kyoto, Japan) (ABS HA Shell (CH 46)/ABS Liner (28-46)/Ball Head (28N: -4)/Perfi x Stem #12-M) for left traumatic femoral head necrosis (Figure 1a). The liner had an alumina inlay packed with polyethylene.In May 2002 discomfort appeared in the hip, with crepitation when walking. 3 weeks later, dis-location of the liner was confi rmed on radiographs. The liner had rotated about 90° in the metal shell and the ball head had been displaced in superolat-eral direction (Figure 1b). At the revision opera-tion, we observed pale gray color contamination in the synovia surrounding the neck and pseudocap-sule. The inlay had been dislocated in the liner and the stem neck had been impinged against the rim of the inlay. The ball head was in contact with the metal shell in the superolateral area. We found no distraction of ceramic parts. The liner, metal shell and alumina ball were revised into a polyethylene liner, metal shell and metal ball (Figure 1c).For the revised implant, we confi rmed the lesion and degree of injury of the implants by the naked eye and light microscopy, and observed the wear pattern of the ball head and the inlay. We used scanning electron microscopy (SEM) to examine the microstructure of the bearing surface. Based on macroscopic observation, about two-thirds of the circumference of the marginal part of the liner polyethylene had suffered a loss around the notch, to lock the liner between the shell. Metal contamination was observed on the rim of the alu-mina inlay, which had been dislocated in the liner (Figure 2).The SEM fi ndings in the normal load-bearing area suggested a very low wear rate, because the machine marks had just been smoothed out (grade II) (Shishido et al. 2002). On the other hand, in the rim of the bearing surface of the inlay and in the peripheral area of the ball head, the grain of the surface had been pulled out (grade V), so the wear was considered to be more severe (Figure 3).","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"500-2"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001312-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical correction of kyphosis: posterior total wedge resection osteotomy in 32 patients.","authors":"Unsal Domanic,&nbsp;Ufuk Talu,&nbsp;Fatih Dikici,&nbsp;Azmi Hamzaoglu","doi":"10.1080/00016470410001231-1","DOIUrl":"https://doi.org/10.1080/00016470410001231-1","url":null,"abstract":"Background Many surgical procedures have been developed for the treatment of kyphoscoliosis. We present our experience of one technique for posterior total wedge resection osteotomy, with clinical and radiographic results. This is a one-stage solution which results in a shortened posterior column and reduced tension on the spinal cord in rigid angular kyphosis. Patients and methods Between 1990 and 2000, we treated 32 patients with rigid local kyphosis by posterior wedge osteotomy and instrumentation. The etiology was congenital malformation in 17 cases, infection in 11 and previous laminectomy in 4 cases. The osteotomy is performed at the apex of the kyphotic deformity and covers two vertebrae. The upper and lower borders of the osteotomy are right inferior to the transverse processes of the upper and lower vertebrae respectively. The apex of the posteriorly based triangular osteotomy is either at the anterior vertebral body or anterior longitudinal ligament. Results The mean preoperative angle of local kyphosis was 72 (25–112) degrees mainly at the thoracolumbar region, and it improved to a mean of 23 (0–48) degrees after an average follow-up of 57 (24–108) months. The mean preoperative sagittal plumbline imbalance of 5.5 (2–12) cm was improved to 1.2 (−2–3.5) cm postoperatively. The mean loss of correction since operation was 3.4 (0–11) degrees. Radiographically, solid anterior and posterior fusion was achieved in all patients by 6 months. 1 patient had irreversible paraplegia and 2 others had transient nerve root injury postoperatively. Interpretation Posterior total wedge resection osteotomy eliminates the need for anterior procedure and does not cause tractional force on the spinal cord, since the posterior column is shortened. This is an effective one-stage procedure, especially for the treatment of sharp and rigid kyphosis.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"449-55"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001231-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24684382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative delirium--a challenge for the orthopedic team.","authors":"Yngve Gustafson","doi":"10.1080/00016470410001114","DOIUrl":"https://doi.org/10.1080/00016470410001114","url":null,"abstract":"","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"375-7"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual strength testing in 14 upper limb muscles: a study of inter-rater reliability.","authors":"J. Jepsen, L. Laursen, Anders I Larsen, C. Hagert","doi":"10.1080/759369189","DOIUrl":"https://doi.org/10.1080/759369189","url":null,"abstract":"BACKGROUND\u0000Manual muscle testing has been termed a \"lost art\" and is often considered to be of minor value. The aim of this investigation was to study the inter-rater reliability of manual examination of the maximal voluntary strength in a sample of upper limb muscles.\u0000\u0000\u0000PATIENTS AND METHODS\u0000The material consisted of a series of 41 consecutive patients (82 limbs) who had been referred to a clinic of occupational medicine for various reasons. Two examiners who were blinded as to patient-related information classified 14 muscles in terms of normal or reduced strength. In order to optimize the evaluation, the individual strength was assessed simultaneously on the right and left sides with the limbs in standardized positions that were specific for each muscle. Information on upper limb complaints (pain, weakness and/or numbness/tingling) collected by two other examiners resulted in 38 limbs being classified as symptomatic and 44 as asymptomatic. For each muscle the inter-rater reliability of the assessment of strength into normal or reduced was estimated by kappa-statistics. In addition, the odds ratio for the relation to symptoms of the definition in agreement of strength was calculated.\u0000\u0000\u0000RESULTS\u0000The median kappa-value for strength in the muscles examined was 0.54 (0.25-0.72). With a median odds ratio of 4.0 (2.5-7.7), reduced strength was significantly associated with the presence of symptoms.\u0000\u0000\u0000INTERPRETATION\u0000This study suggests that manual muscle testing in upper limb disorders has diagnostic potential.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4 1","pages":"442-8"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60614142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthrodesis for tuberculous coxarthritis: good outcome in 32 adolescents.","authors":"H Mustafa OZdemir,&nbsp;Ugur Yensel,&nbsp;Tunç Cevat Ogün,&nbsp;Hakan Senaran,&nbsp;Abdurrahman Kutlu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on best treatment of advanced tuberculous coxarthritis in young patients.</p><p><strong>Patients and methods: </strong>We report our results concerning hip arthrodesis for advanced tuberculous arthritis of the hip in 32 adolescents. The operation was preceded by standard antituberculous chemotherapy for 4 weeks, which was continued for 12 months after surgery. At the last follow-up, clinical and radiographic examinations of the ipsilateral knee, contralateral hip and lower back were done. We evaluated function, limitations, and presence of pain with our usual questions.</p><p><strong>Results: </strong>Their average age at the time of operation was 16 (12-18) years and the average duration of followup 12 (10-18) years. Solid bony fusion occurred in all patients after mean 5 months and no complications developed in the postoperative period. 28 patients were satisfied with the fused hip. No patients had reactivation of tuberculosis in any part of their body. The results were comparable to those of arthrodesis performed for other causes.</p><p><strong>Interpretation: </strong>Hip arthrodesis is an alternative method of treatment for advanced stages of tuberculous coxarthritis in the adolescent.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"430-3"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24684379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}