Volume 3, Issue 1
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Balloon Kyphoplasty: Cement Augmentation in Acute Osteoporotic Thoraco-Lumbar Fractures
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Article in press
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Angulation and Translation Capabilities of a Minimized Orthopedic Hexapod Ortho-SUV Frame: An Experimental Study
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Abstract [+]
Introduction
Orthopedic hexapods demonstrated effectiveness and accuracy in deformity correction of limbs in both adults and children. Previous studies demonstrated the best reduction capabilities of the orthopedic hexapod Ortho-SUV Frame (OSF) versus other models of this group of external fixation devices. Minimized version of this hexapod (minimized Ortho-SUV Frame (OSFm)) was created to reduce common for this group disadvantages: large bulkiness and weight and limitation on working with “short segments”. However, the reduction capabilities of the OSFm have not yet been studied.
Aim
To evaluate translation and angulation capabilities of OSFm with standard struts size and to compare results to OSF with short struts size.
Materials and Methods
The experimental study was performed using plastic models of the tibia with osteotomy at the middle third of the shaft. Proximal and distal bone fragments were fixed with one-ring modules. The reduction capabilities of OSFm in the first series and OSF in the second series of the experiment were studied. According to the method of fixing the struts to the rings, experiments were divided into three groups: directly to the ring, using straight plates, and using Z-shaped plates. Translation and angulation capabilities were evaluated by the maximum displacement of the distal bone fragment relative to the proximal one until any of the struts reached its minimum or maximum possible length.
Results
In translation OSFm outperforms OSF by 2.8-9.5% fixed the struts directly to the rings, by 4.8-9.7% using straight plates, and by 27.3-29.3% using Z-plates. In angulation OSFm with struts fixed directly to the rings outperforms OSF by 33.9-55.4%, by 36.9-47.3% using straight plates, and by 29.6-36% using Z-plates.
Conclusion
OSFm exceeds OSF in translation and angulation capabilities in all series of experiment. Distraction and rotation capabilities and the bone fragments fixation rigidity should be evaluated as further research to prove application of OSFm as a possible better candidate for deformity correction of limbs in children and foot deformity correction.
Keywords
External fixation; Deformity correction; Orthopedic hexapod; Reduction capabilities.
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Current Issue
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Giant Iatrogenic Lumbar Pseudomeningocele: A Case Report and Literature Review
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Abstract [+]
Post-discectomy iatrogenic lumbar pseudomeningoceles are an uncommon complication. This pathology is an extradural, encapsulated, cerebrospinal fluid collection which develops at the site of previous surgery as the consequence of an unnoticed or unrepairable dural tear. A pseudomeningocele is defined as giant if it grows beyond 8 cm in length. Giant iatrogenic pseudomeningoceles with detailed information are quite rare in the literature with only 21 reported cases including the current case. Herein, we present a middle age woman with a giant pseudomeningocele which had developed subsequent to L4-L5 discectomy.
Keywords
Iatrogenic lumbar pseudomeningocele; Pathology; Discectomy.
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Adipofascial Turnover Forearm Flap for a Large Defect in Hand after Squamous Cell Tumor Extirpation. A Case Report
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Squamous cell carcinoma is a cancer that is rare in the hand. The extirpation of this cancer can leave an important cutaneous defect in many cases. The cutaneous covering at the back of the hand is a challenge for any surgeon, especially when there are large skin defects with exposure of tendons, bones or neurovascular structures. Here, we describe a clinical case where an adipofascial turnover forearm flap and full thickness skin graft were performed, after the extensive extirpation of the well-differentiated squamous cell carcinoma has been made.
Keywords
Flap; Adipofascial; Forearm; Hand; Skin defect; Carcinoma; Tumor; Squamous cell.
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Characteristics of Effective and Safe Methods of Treatment for Fresh Fracture-Dislocations of the Proximal Humerus
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Pre-Debridement and Post-Debridement Culture in Open Fractures of the Extremities: A Comparative Study
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Lateral Tibial Plateau with Peroneal Nerve Entrapment is Unique Fracture in Diagnosis and Management
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Magnet Expandable Rods a Promising Technology which can Lead to Catastrophic Failure
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Previous Issue
Characteristics of Effective and Safe Methods of Treatment for Fresh Fracture-Dislocations of the Proximal Humerus
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Aim
The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics.
Patients and Methods
This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis.
Results
Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed.
Conclusion
The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation.
Keywords
Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.
Pre-Debridement and Post-Debridement Culture in Open Fractures of the Extremities: A Comparative Study
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Background
Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites.
Methods
Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data.
Results
Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the six-hour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for post-debridement.
Conclusion
The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate.
Keywords
Open fractures; Debridement; Pre-debridement; Post-debridement; Meta- analysis; Systematic review.
Lateral Tibial Plateau with Peroneal Nerve Entrapment is Unique Fracture in Diagnosis and Management
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A majority of tibial plateau fractures involve the lateral plateau. Posterolateral tibial plateau fractures are caused by a valgus force that impacts the posterolateral plateau against the lateral femoral condyle. We describe a unique case of a patient who sustained a lateral plateau fracture with posterior displacement behind a fractured fibular head, with entrapment of the peroneal nerve. This unusual fracture pattern required dual anterolateral and lateral approach for reduction and fixation.
Keywords
Tibial plateau; High energy; Fracture; Peroneal nerve entrapment.
Magnet Expandable Rods a Promising Technology which can Lead to Catastrophic Failure
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Abstract [+]
In recent years, there has been a paradigm shift in the treatment of early-onset scoliosis. This change is manifested by a propensity to avoiding or delaying fusion surgeries due to their many potential shortcomings. Many surgeons gravitate towards conservative measures and growth-friendly implants such as magnetic expandable growing rods. Still, such interventions are not impeccable. This case report discusses 8-year-old girl with early-onset scoliosis managed with magnetic expandable rods after failing conservative management. The results were promising at first. However, catastrophic failure was diagnosed after multiple successful elongations necessitating discarding the system and changing the construct to conventional growing rods.
Keywords
Magnet rods; Growing rods; Growth friendly procedures; Catastrophic failure; Early-onset scoliosis; Juvenile scoliosis; Scoliosis complications.
