Acta orthopaedica Scandinavica最新文献

{"title":"Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review.","authors":"Martin Bitsch,&nbsp;Nicolai Foss,&nbsp;Billy Kristensen,&nbsp;Henrik Kehlet","doi":"10.1080/00016470410001123","DOIUrl":"https://doi.org/10.1080/00016470410001123","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium is a frequent and serious complication in elderly patients following operation for hip fracture, leading to an increased risk of complications. The pathophysiological mechanisms are unresolved, but probably multifactorial. The purpose of this review is to summarize current knowledge about the pathogenesis of postoperative delirium with a view to finding strategies for prevention and management.</p><p><strong>Method: </strong>We conducted an Internet search through the Medline database (1966-March 2003) and supplemented it with a manual search. We included 12 studies which specifically discussed pathogenic factors or interventions against postoperative delirium following operation for hip fracture.</p><p><strong>Results: </strong>1,823 patients were included with an average incidence of delirium of 35%. We concentrated on pre-, intra-, and postoperative risk factors. Only advanced age and dementia met our fixed criterion of \"strong evidence\" for a significant association. Hence, from the studies that we reviewed we were unable to find intraoperative or postoperative factors with \"strong evidence\" for a significant association with delirium.</p><p><strong>Interpretation: </strong>Postoperative delirium is a serious complication. The pathophysiology leading to delirium after hip fracture surgery still remains to be clarified and no single drug or surgical regimen has proven to be preventive. This calls for more detailed investigations of the differential role of different pathogenic mechanisms, as well as an aggressive multimodal approach to enhance recovery and reduce morbidity, as has proven to be successful in a variety of elective surgical procedures. Such multimodal interventional studies represent a major task for orthopedic departments in collaboration with anesthesiologists, geriatricians, physiotherapists and nursing staff.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"378-89"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685562","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 intramedullary nailing of lower extremity fracture and respiratory function in polytraumatized patients with a chest injury: a retrospective study of 61 patients.","authors":"Lauri Handolin,&nbsp;Jarkko Pajarinen,&nbsp;Jan Lassus,&nbsp;Ilkka Tulikoura","doi":"10.1080/00016470410001277-1","DOIUrl":"https://doi.org/10.1080/00016470410001277-1","url":null,"abstract":"<p><strong>Background: </strong>The optimal treatment of diaphyseal fractures of the lower extremities in patients who also have serious chest injuries is not known.</p><p><strong>Patients and methods: </strong>We retrospectively evaluated the effect of an early intramedullary nailing (IMN) of femur or tibia fractures on respiratory function in 61 consecutive polytraumatized patients with unilateral or bilateral pulmonary contusion (thoracic AIS=3) admitted to our trauma intensive care unit between January 2000 and June 2001. 27 patients had a diaphyseal fracture of at least one long bone of the lower extremity, which was treated with IMN within 24 hours of admission.</p><p><strong>Results: </strong>We found no difference between patients with or without a lower extremity fracture regarding the length of ventilator treatment, oxygenation ratio (PaO2/FiO2) or in the incidence of acute respiratory distress syndrome (ARDS), pneumonia, multi-organ failure or mortality.</p><p><strong>Interpretation: </strong>In this retrospective study, IMN of a long bone fracture in a patient with multiple injuries and with a coexisting pulmonary contusion did not impair pulmonary function or outcome.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"477-80"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001277-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685610","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":"Combined radiology and cytology in the diagnosis of bone lesions: a retrospective study of 370 cases.","authors":"V. Söderlund, L. Skoog, A. Kreicbergs","doi":"10.1080/759369197","DOIUrl":"https://doi.org/10.1080/759369197","url":null,"abstract":"BACKGROUND\u0000Some of the risks with open biopsy can be avoided by fine-needle aspiration biopsy. The diagnostic contribution of radiologic findings has not been systematically studied.\u0000\u0000\u0000PATIENTS AND METHODS\u0000We retrospectively analyzed the validity of combined radiology and fine-needle aspiration cytology for the diagnosis of bone lesions in a consecutive series of 370 patients. The treatment diagnosis was based solely on radiology and cytology in 234 cases, whereas in 136 cases histopathology was also applied.\u0000\u0000\u0000RESULTS\u0000Comparison of radiology and cytology showed diagnostic compliance in 256 cases (69%) and non-compliance in 101 (28%). 13 (3%) cases failed to yield diagnostic material for cytology. Among the 256 compliant cases, the diagnostic error rate was 1% (2 were falsely benign), whereas the corresponding rate was 17% among the 101 non-compliant cases. In the latter group, 36 cases yielded only normal cells at aspiration, out of which 20 proved to have a neoplastic lesion (8 metastases, 12 benign). The overall sensitivity of cytology alone in recognizing malignancy was 90%. The specificity was 95%. Given a malignant or benign diagnosis, the positive predictive value was 97% and the negative predictive value was 84%.\u0000\u0000\u0000INTERPRETATION\u0000Our study suggests that a simple approach based on conventional radiography and fine-needle aspiration cytology offers a valid means of diagnosing bone lesions. Provided there is compliance between radiology and cytology, the risk of false diagnosis is around 1%.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"29 1","pages":"492-9"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60614603","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":"Persistent infection associated with residual cement after resection arthroplasty of the hip.","authors":"Martin Buttaro,&nbsp;Roberto Valentini,&nbsp;Francisco Piccaluga","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The danger of residual bone cement after resection of infected prosthetic components is controversial.</p><p><strong>Patients and methods: </strong>We analyzed 10 patients with infected total hip prosthesis who had been treated previously with resection arthroplasty and antibiotics and who had persistent infection with residual cement. In 9 patients, surgical debridement with resection of all the PMMA was performed, and adequate intravenous antibiotics were administered. 1 patient refused surgical treatment, but accepted antibiotics.</p><p><strong>Results: </strong>At an average of 4 (1-18) years of follow-up, 8 patients had no signs or symptoms of recurrent infection. 1 severely immunodeficient patient died 2 years after the removal of residual cement, for reasons other than his hip. The patient who refused surgical treatment continues to have an active sinus 4 years after first consultation.</p><p><strong>Interpretation: </strong>Residual cement may be responsible for chronic infection. At resection arthroplasty, as part of the treatment of an infected hip arthroplasty, all devitalized or foreign material must be removed.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"427-9"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24684378","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":"Effects of autogenous bone graft impaction and tricalcium phosphate on anterior interbody fusion in the porcine lumbar spine.","authors":"Haisheng Li,&nbsp;Xuenong Zou,&nbsp;Qingyun Xue,&nbsp;Niels Egund,&nbsp;Martin Lind,&nbsp;Cody Bünger","doi":"10.1080/00016470410001240-1","DOIUrl":"https://doi.org/10.1080/00016470410001240-1","url":null,"abstract":"<p><p>Background Impaction grafting can be achieved inside the spinal fusion cages, but its effect on bone graft incorporation and spinal fusion has not been studied. Animals and methods We investigated the effect of impaction grafting on the bone graft healing and fusion potential of beta-tricalcium phosphate (beta-TCP) inside the carbon fiber reinforced spinal fusion device (Brantigan cage) in 10 Danish landrace pigs. Lumbar spine interbody fusion of L2/3, L4/5 and L6/7 using carbon fiber cages was performed on each pig. Cages filled with either loosely-packed autologous iliac bone graft, rod-impacted autologous bone graft or beta-TCP were randomly distributed to the three fusion levels. Half of the animals were followed for 8 weeks, and the other half for 16 weeks. Results Radiographs and CT evaluations showed that autograft levels had significantly better results than beta-TCP levels (p<0.001 Fisher's Exact Test). However, the difference between impacted and loosely-packed levels was not significant. Histomorphometric analysis showed no difference between the loosely-packed and impacted cages with regard to bone volume, bone marrow volume, cartilage and fibrous tissue volume, while both of the autograft levels differed from the beta-TCP levels in all of the aforementioned parameters. Fluorochrome studies demonstrated that bone mineral apposition rate was significantly higher in the impacted cages than in the loosely-packed cages at 16 weeks. Interpretation Manual impaction of autologous bone graft into the carbon fiber cages resulted in a faster mineral apposition rate by 16 weeks. Bone ingrowth and spinal fusion were not influenced by impaction grafting.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"456-63"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001240-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24684383","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":"Abbas Karladani,&nbsp;Georgias Digas,&nbsp;Lars Ekström,&nbsp;Janos Swanpalmer,&nbsp;Jorma Styf,&nbsp;Tommy Hansson","doi":"10.1080/00016470410001268-1","DOIUrl":"https://doi.org/10.1080/00016470410001268-1","url":null,"abstract":"<p><strong>Background: </strong>There are numerous techniques for ankle arthrodesis.</p><p><strong>Material and methods: </strong>We 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.</p><p><strong>Results: </strong>In 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.</p><p><strong>Interpretation: </strong>The placement of a dowel graft in the diagonal plane in comparison to the coronal plane significantly increased the initial stability of an ankle arthrodesis.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"471-6"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001268-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685609","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":"Histological evaluation of a mosaicplasty of the femoral condyle-retrieval specimens obtained after total knee arthroplasty--a case report.","authors":"Niels Kock,&nbsp;Job van Susante,&nbsp;Ate Wymenga,&nbsp;Pieter Buma","doi":"10.1080/00016470410001330-1","DOIUrl":"https://doi.org/10.1080/00016470410001330-1","url":null,"abstract":"Copyright © Taylor & Francis 2004. ISSN 0001–6470. Printed in Sweden – all rights reserved. A 43-year-old man presented with persistent pain on the medial side of his left knee, 1 year after a bone-patellar tendon-bone autograft ACL reconstruction. Besides a dysfunctional ACL, earlier arthroscopy had already revealed a focal full-thickness chondral lesion (25 × 12 mm) of the medial femoral condyle (Figure 1A) and mild degenerative changes in the lateral compartment of the knee. The patient was offered a mosaicplasty of the medial femoral condyle. After a medial arthrotomy of the knee, 3 cylindrical osteochondral plugs (8 mm diameter) were harvested from the lateral throchlea (donor site) and transplanted to the chondral defect in the medial femoral defect (recipient site), using the mosaicplasty technique (Hangody et al. 1998, Bobic 1999, Hangody and Fules 2003, Horas et al. 2003). The donor site defects were each fi lled with a press-fi tted cylindrical osteo-periosteal plug obtained from the proximal tibia. It was hypothesized that these plugs would enhance healing of the subchondral bone and that the covering periosteum would enhance resurfacing of the donor site defects with fi brocartilagenous tissue. Initially, the patient’s symptoms clearly improved and a postoperative MRI showed restoration of the joint surface at the original chondral lesion in the medial condyle 3 months after surgery (Figure 1B). The 3 transplanted osteochondral plugs were still clearly visible in the subchondral bone, with signs of osseous integration. One plug appeared to have been placed rather too deeply, as seen from the step-off in the subchondral bone (Figure 1B, 2A). At the lateral aspect of the trochlea, the 3 donor site defects were also still clearly visible (Figure 1C). The osteo-periosteal plugs from the proximal tibia appeared to have remained in situ and some resurfacing of the defects had occurred. After 3 years the knee became symptomatic again, with pain and swelling. Radiographic evaluation revealed mild degenerative changes (Figure 1D). Conservative treatment was not accepted and a total knee arthroplasty was performed. This procedure eventually provided good-quality retrieval specimens for histological evaluation of a mosaicplasty.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"505-8"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001330-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24685616","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":"Chronological changes of serum chromium levels after modern metal-on-metal total hip arthroplasty.","authors":"Katsuhiko Maezawa,&nbsp;Masahiko Nozawa,&nbsp;Keiji Matsuda,&nbsp;Motoo Yasuma,&nbsp;Kaoru Mori,&nbsp;Fumiyo Enomoto,&nbsp;Seiki Ogawa,&nbsp;Katsuo Shitoto,&nbsp;Hisashi Kurosawa","doi":"10.1080/00016470410001187-1","DOIUrl":"https://doi.org/10.1080/00016470410001187-1","url":null,"abstract":"<p><p>We determined changes in serum chromium concentration every 6 months up to 3 years after implantation in 44 patients (mean age 63 (49-79) years, 35 women) who underwent modern metal-on-metal total hip arthroplasty (Metasul). The serum chromium levels increased between the first and second year after implantation (1 year: 1.05 (SD 0.76) microg/L, 2 years: 1.46 (SD 0.91) microg/L). A small increase was observed during the third year (1.61 (SD 1.31) microg/L). The clinical relevance of this finding is uncertain and should be determined in long-term studies on a large scale.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4","pages":"422-6"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001187-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24684377","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":"The influence of head and neck geometry on stability of total hip replacement: a mechanical test study.","authors":"R. Bader, R. Scholz, E. Steinhauser, S. Zimmermann, R. Busch, W. Mittelmeier","doi":"10.1080/759369184","DOIUrl":"https://doi.org/10.1080/759369184","url":null,"abstract":"BACKGROUND\u0000Dislocation after replacement may be caused by poor implant design or positioning, or by the surgical approach taken. We evaluated the influence of head and neck design on range of motion and stability (with respect to risk of dislocation) in total hip endoprostheses.\u0000\u0000\u0000MATERIAL AND METHODS\u0000Using a test device, we determined the stability afforded by different head sizes and neck geometries for various implant positions.\u0000\u0000\u0000RESULTS\u0000Increasing head diameter led to an enhancement of range of motion as well as resistance against subluxation, and thus to improved stability in any movement combination and implant orientation. Smaller femoral heads were associated with increased risk of dislocation, especially in a poor implant position such as retroversion, and steep positioning of the cup. Skirted metal or mushroom-shaped ceramic heads had a reduced range of motion until impingement of approx. 20 degrees, as compared to spherical standard heads. Furthermore, after identical joint loading, skirted heads dislocated more readily than standard heads with corresponding diameters.\u0000\u0000\u0000INTERPRETATION\u0000To obtain sufficient joint mobility and stability, neck geometry and implant position should be considered when choosing the femoral head size.","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 4 1","pages":"415-21"},"PeriodicalIF":0.0,"publicationDate":"2004-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60614375","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":"Standing radiographs underestimate joint width: comparison before and after resection of the joint in 34 total knee arthroplasties.","authors":"Jonas Weidow,&nbsp;Ingvar Mars,&nbsp;Claes-Göran Cederlund,&nbsp;Johan Kärrholm","doi":"10.1080/00016470410001259","DOIUrl":"https://doi.org/10.1080/00016470410001259","url":null,"abstract":"<p><strong>Background: </strong>Measurement or estimation of joint width is routinely used in the preoperative evaluation of gonarthrosis. To our knowledge, the validity and reproducibility of this procedure has not been adequately studied.</p><p><strong>Patients and methods: </strong>We measured joint width in 34 knees (medial arthrosis: n = 22, lateral arthrosis: n = 12) on preoperative weight-bearing radiographs and on radiographs of the corresponding part of the joint after knee arthroplasty. The bone/cartilage pieces were placed in anatomical positions and loaded in a jig made of perspex. High-density film was used to obtain maximum resolution.</p><p><strong>Results: </strong>In medial and lateral arthrosis, the minimum joint widths were median 0.3 and 0.2 mm smaller on the radiographs of the specimens (p = 0.05, 0.04). In lateral arthrosis the differences were more scattered (95% CI: lateral: 0.1 to -1.2 mm; medial: 0 to -0.5 mm), suggesting less precise determination.</p><p><strong>Interpretation: </strong>In medial arthrosis, the degree of underestimation is usually small and acceptable. More pronounced discrepancies could be found in lateral arthrosis, calling for the use of further diagnostic measures.</p>","PeriodicalId":75403,"journal":{"name":"Acta orthopaedica Scandinavica","volume":"75 3","pages":"315-22"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/00016470410001259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24620581","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}