Asymptomatic and Unnoticed Intra-articular Screw Over 18 Years after Fracture of the Posterior Wall of the Acetabulum – a Question of Stability?

2020 ◽  
Author(s):  
Christof K. Audretsch ◽  
Florian Schmidutz ◽  
Markus Alexander Küper
Keyword(s):  
Hip Joint ◽  
External Rotation ◽  
Weight Bearing ◽  
Posterior Wall ◽  
Acetabular Labrum ◽  
The Stability ◽  
The Right ◽  
Weight Bearing Area ◽  
Acetabular Wall

AbstractFractures of the posterior wall of the acetabulum occur in a frequency of 25 – 30%. Multifragmentary fractures involving 40 – 50% of the acetabular surface, the quality of reduction as well as involvement of cartilage and acetabular labrum are considered to have an impact on the development of a reduced posterior stability of the hip joint. This results in a shift of the main weight bearing area with development of a posttraumatic osteoarthritis. In the presented case, a 42-year old male patient was operated on 18 years ago due to a posterior acetabular wall fracture. Retrospectively, one of the screws was located partially intraarticular. However, the patient was asymptomatic over the 18-year period. The first consultation was due to unspecific symptoms of osteoarthritis of the right hip joint especially during flexion and external rotation. Due to only mild radiological signs of osteoarthritis, we indicated only the removal of the intraarticular screw. The symptoms postoperatively switched to a feeling of instability, so a total hip arthroplasty was performed. Since the operation, the patient is asymptomatic regarding the hip joint. The intraarticular screw seemed to stabilize the hip joint. This case demonstrates the importance of a good posterior guidance for the stability of the hip joint on one hand. On the other hand, it demonstrates the minor stress load of the posterior acetabular region, especially after fracture of the posterior wall. Therefore, a good posterior guidance should be one major aim of treatment of posterior acetabular wall fractures.

scholarly journals Ligamentum teres reconstruction with labrum and capsule repair after posterior acetabular wall fracture: a case report

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. i41-i45
Author(s):  
Jacek Mazek ◽  
Maciej Gnatowski ◽  
Antonio Porthos Salas ◽  
Marcin Domżalski ◽  
Rafał Wójcicki ◽  
...  
Keyword(s):  
Hip Joint ◽  
Hip Dislocation ◽  
Ligamentum Teres ◽  
Hip Instability ◽  
Post Traumatic ◽  
The Right ◽  
Capsule Repair ◽  
Acetabular Wall

Abstract The aim of this case study is to present arthroscopic treatment of recurrent hip instability after acute post-traumatic posterior hip dislocation with a fracture of the posterior acetabular wall. A male patient aged 35 suffered a dislocation of the right hip joint with a fracture of the posterior acetabular wall due to an accident. The fracture was stabilized during emergency surgery with a locking compression plate, and the patient was released home in a hip brace. Multiple dislocations of the hip joint followed with the implant being confirmed as stable. Decision was made to qualify the patient for a right hip arthroscopy. During the surgery, ligamentum teres was reconstructed using gracilis and semitendinous muscle grafts, followed by the labrum and joint capsule repair, where the surgery that stabilized the acetabular wall fracture had damaged them. There were no complications following the procedure. Short-term follow-up of 3 months demonstrates the patient has a stable hip, reduced pain and has returned to pre-injury activities.

scholarly journals Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0052
Author(s):  
Sohail Yousaf ◽  
Daniel Hay
Keyword(s):  
Systematic Review ◽  
External Rotation ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Controlled Trials ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Stress Radiographs ◽  
The Stability ◽  
Supination External Rotation

Category: Trauma Introduction/Purpose: Differentiating stable isolated fibula fractures consistent with supination external rotation (SER) II ankle fractures from unstable SER IV fractures is essential in determining the need for surgical stabilisation. Stress radiographs are usually required to assess stability including gravity stress views (GSV) and external rotation views (ER). There is no clear consensus as to which modality is most useful to determine stability in a fracture clinic or emergency setting. In last, few years clinical uncertainty about the reliability has led researcher to focus on weight bearing radiographs (WB) .We aim to review recent literature regarding reliability of WB radiographs to estimate the stability of supination external rotation ankle fractures. Methods: A systematic review of the literature relating to radiological assessment of stability of supination external rotation ankle fractures was conducted according to PRISMA guidelines. The systematic review was prospectively registered with PROSPERO. It involved the following steps: Researching the question-Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture? Setting inclusion and exclusion criteria-All English language articles published in the including any Randomised controlled trials (RCT’s) and cohort studies. Data collection)– A literature search of Medline (PubMed), the Cochrane Bone, Joint, and Muscle Trauma Group trial register, the Cochrane central register of controlled trials, Embase and CINAHL was undertaken. The grey literature was searched. Key terms ‘supination external rotation fracture’, ‘stability’. Other variations to the key words were ‘weight bearing’, “axial load”, ‘stress x-rays’, ‘systematic reviews’ and ‘meta-analysis’. Results: A total of six studies met the inclusion criteria including 601 patients. No previous systematic review on stress radiographs including weight bearing was published. All studies concluded weight bearing radiographs is an easy, pain-free, safe and reliable method to estimate stability of isolated distal fibula fractures. No serious concerns or complications were reported. Conclusion: The evidence base contained many methodological limitations and most of the evidence was either level III or IV, and so any conclusion drawn from the research must be done so with caution. The studies suggest that GSV overestimates the instability which should be assessed with studies should focus on randomized controlled trials with narrow range of clinically useful outcome measures.

scholarly journals Can the Open Stance Forehand Increase the Risk of Hip Injuries in Tennis Players?

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096629
Author(s):  
Caroline Martin ◽  
Anthony Sorel ◽  
Pierre Touzard ◽  
Benoit Bideau ◽  
Ronan Gaborit ◽  
...  
Keyword(s):  
Hip Joint ◽  
Inverse Dynamics ◽  
External Rotation ◽  
Tennis Players ◽  
Flexion Extension ◽  
Hip Injuries ◽  
Hip Motion ◽  
Hip Kinematics ◽  
The Right ◽  
Hip Flexion

Background: The open stance forehand has been hypothesized by tennis experts (coaches, scientists, and clinicians) to be more traumatic than the neutral stance forehand as regards hip injuries in tennis. However, the influence of the forehand stance (open or neutral) on hip kinematics and loading has not been assessed. Purpose: To compare the kinematics and kinetics at the hip joint during 3 common forehand stances (attacking neutral stance [ANS], attacking open stance [AOS], defensive open stance [DOS]) in advanced tennis players to determine whether the open stance forehand induces higher hip loading. Study Design: Descriptive laboratory study. Methods: The ANS, AOS, and DOS forehand strokes of 8 advanced right-handed tennis players were recorded with an optoelectronic motion capture system. The flexion-extension, abduction-adduction, and external-internal rotation angles as well as intersegmental forces and torques of the right hip were calculated using inverse dynamics. Results: The DOS demonstrated significantly higher values than both the ANS and AOS for anterior ( P < .001), medial ( P < .001), and distractive ( P < .001) forces as well as extension ( P = .004), abduction ( P < .001), and external rotation ( P < .001) torques. The AOS showed higher distractive forces than the ANS ( P = .048). The DOS showed more extreme angles of hip flexion ( P < .001), abduction ( P < .001), and external rotation ( P = .010). Conclusion: The findings of this study imply that the DOS increased hip joint angles and loading, thus potentially increasing the risk of hip overuse injuries. The DOS-induced hip motion could put players at a higher risk of posterior-superior hip impingement compared with the ANS and AOS. Clinical Relevance: Coaches and clinicians with players who have experienced hip pain or sustained injuries should encourage them to use a more neutral stance and develop a more aggressive playing style to avoid the DOS, during which hip motion and loading are more extreme.

Activity and Quality of Life after Total Hip Arthroplasty

2017 ◽  
Vol 19 (5) ◽  
pp. 0-0 ◽  
Author(s):  
Anna Świtoń ◽  
Ewa Wodka-Natkaniec ◽  
Łukasz Niedźwiedzki ◽  
Tadeusz Gaździk ◽  
Tadeusz Niedźwiedzki
Keyword(s):  
Quality Of Life ◽  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
External Rotation ◽  
Harris Hip Score ◽  
Joint Analysis ◽  
Total Hip

Background. Coxarthrosis is a chronic musculoskeletal condition that causes severe pain and considerable limi­tation of the patient’s motor performance. Total hip arthroplasty is one of the most common and effective methods used in the treatment of advanced degenerative changes. The aim of the present study was to evaluate the activity and quality of life of patients after unilateral total hip arthroplasty. Material and methods. The study was conducted in a group of 189 patients who had undergone unilateral total hip arthroplasty. Goniometry was used to determine the range of motion of both hip joints. Patients’ physical ability and pain severity were assessed based on the Harris Hip Score (HHS) questionnaire. Results. The examination of the range of motion in the lower extremities revealed statistically significant diffe­rences in flexion (p<0.01), abduction (p=<0.01), adduction (p<0.01) and external rotation (p<0.01) between the operated and the healthy extremity. The greatest limitation of motion was demonstrated for external rotation (<14°). Approximately 14% of the patients were not able to perform this motion in their healthy hip joint, while 17.5% of them could not do so in the affected hip joint. Analysis of HHS results (mean = 79 pts) revealed that more than 50% of the patients described their functional ability and quality of life as good and excellent. It was demonstrated that 54% of patients did not suffer from pain, whereas minor or mild pain was noted in 35%. Conclusions: 1. A subjective clinical assessment of patients after total hip arthroplasty showed that their quality of life had improved. 2. It is necessary to perform physiotherapy after total hip arthroplasty, on both the operated and healthy side. 3. Exacerbation of pain and impaired activity in patients after total hip arthroplasty were associated with the female sex to a considerable extent.

Influence of exogenous and endogenous factors on the quality of the preanalytical stage of laboratory tests (review of literature)

2020 ◽  
Vol 65 (12) ◽  
pp. 778-784
Author(s):  
D. P. Piskunov ◽  
L. A. Danilova ◽  
A. S. Pushkin ◽  
S. A. Rukavishnikova
Keyword(s):  
Laboratory Testing ◽  
Cell Metabolism ◽  
Endogenous Factors ◽  
Preanalytical Phase ◽  
Exogenous Factors ◽  
The Stability ◽  
The Right ◽  
Needle Diameter ◽  
And Storage

A literature review in the article presents an analysis of the influence of endogenous and exogenous factors on quality of preanalytical phase of laboratory testing. The review shows significance of external and internal factors influencing blood samples at preanalytical phase of laboratory testing. Among the exogenous factors considered: phlebotomy, test tubes for samples, transportation and storage. A number of factors exist at this phase that significantly affect test results. We examined these aspects of phlebotomy process: staff training, disinfectant contamination, needle diameter, needle material contamination. The review considers possible contamination with tube components and the importance of choosing the right anticoagulants and excipients. Transportation and storage of biological samples can be a source of errors at the preanalytical phase of laboratory testing. We analyzed the problem of determining the stability of analytes during storage and aspects of transportation samples by modern means. Among the endogenous factors considered: hemolysis, lipemia, icterricity, cell metabolism.. Hemolysis is one of the most frequent consequences of errors at the preanalytical phase. We analyzed importance of choosing a method for identifying hemolized tubes and the heterogeneity of bias results on different analytical systems. The review shows contribution of various classes of lipoproteins to turbidity of sample, possible preanalytical errors and impact on analytical tests. We examined possible effects of high bilirubin concentrations on analyte measurements. In the review, we also examined metabolism of some cells and its effect on samples.

scholarly journals To the problem of choosing a hip implant

2019 ◽  
Author(s):  
V. N. Turchin ◽  
O. A. Loskutov ◽  
A. S. Drozhin ◽  
E. V. Volkova
Keyword(s):  
Hip Joint ◽  
Average Distance ◽  
Quantitative Characteristic ◽  
Posterior Wall ◽  
Correct Choice ◽  
Lateral Projection ◽  
Direct Projection ◽  
Quantitative Characteristics ◽  
The Difference

Endoprosthetics is often the only way out for a patient with severe hip joint pathology. An important step, in many ways ensuring successful replacement, is the correct choice of implant. When installing the hip joint implant, one of its parts - the leg - is placed in the marrow canal of the femur. Moreover, the installation must be done in a way that ensures, that on one hand, the leg fits tightly against the walls of the channel and on the other hand, no critical stress appears in the channel. Otherwise, serious postoperative complications are possible. Proper fit of the prosthesis is ensured by the correct choice from a given standard set of implants. To date the choice of the implant is realized using x-ray images of the canal in the direct and lateral projections. The implant images on a transparent film are sequentially applied to the hip and thighbone images in a straight and lateral projection, and thus a suitable implant is selected. In this regard, the problem of constructing an al-gorithm for choosing an implant based on quantitative characteristics arises. The method of optimal implant selection based on the quantitative characteristics of the implant and of the difference between the width of the channel in the direct projection and the width of the implant in a direct projection is a possible solution. The best for this channel in a direct projection is the implant for which the average distance between the upper wall of the canal and the implant is the smallest. The quantitative characteristic of the placement quality of the implant in the lateral projection is introduced in a similar way. The implants that fit in the channel are considered. It also must be taken into account that the implant should have contact with the channel in at least three points in the lateral projection. “The best for a given channel on the lateral projection is the implant for which the difference between the minimum distance from the anterior wall of the canal to the posterior wall of the implant and the width of the implant in this section is minimal. In best case, the best implant is the one that fits best in both projections. However, this does not always happen. Finally, for a given channel the choice of an implant from a given set of implants, generally speaking, is ambiguous. In addition to the characteristics and quality of an implant placement proposed here, other methods are possible

scholarly journals Functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum

2021 ◽  
Vol 7 (6) ◽  
pp. 1139
Author(s):  
K. Nageswara Rao ◽  
Ronak Dinesh Soni ◽  
C. Nagesh ◽  
P. A. Shravan Kumar ◽  
B. Arvind Kumar
Keyword(s):  
Functional Outcome ◽  
Weight Bearing ◽  
Posterior Wall ◽  
Joint Surface ◽  
Acetabular Fractures ◽  
P Value ◽  
Radiological Outcome ◽  
Anatomic Reduction ◽  
Joint Reduction

<p class="abstract"><strong>Background:</strong> The incidence of acetabular fractures has increased following road traffic accidents. The aim of the study is to evaluate functional and radiological outcome in surgically managed posterior wall and column fractures of acetabulum.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done at Nizam’s Institute of Medical Sciences, Hyderabad between May 2018 and May 2020. The sample size is 20 patients between the age group 18-60 years who presented to the hospital with closed posterior wall and/or column fractures of acetabulum with or without posterior dislocation of hip joint. Functional outcome is assessed by using the modified Merle D’ Aubigne Postel clinical grading system, radiological outcome by Matta et al and perioperative complication are assessed by retrospectively analyzing medical records and radiographics examination.<strong></strong></p><p class="abstract"><strong>Results:</strong> Functional outcome according to Merle D’ Aubigne and Postel score 16 patients (75%) showed good, 3 patients (20%) showed fair, 1 patient (5%) showed poor outcome. Radiological outcome according to Matta criteria, 16 patients (75%) showed excellent quality of joint reduction, 4 patients (25%) showed good quality of reduction of joint. There was significant correlation between anatomic reduction of the joint surface and functional outcome of the patient in our study (p value &lt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> Accurate joint reduction is of utmost importance in reduction of posterior wall or column fractures of acetabulum as posterior wall is the weight bearing zone. Functional outcome depends on fracture type, associated injuries, selection of patient, time between injury and surgery and postoperative rehabilitation.</p>

scholarly journals STABILITY ANALYSIS FOR EMBANKMENTS WITH GEOELECTRICITY

2020 ◽  
Vol 15 (2) ◽  
pp. 114-122
Author(s):  
Teddy Wartono Sudinda
Keyword(s):  
Stability Analysis ◽  
Groundwater Flow ◽  
Water Level ◽  
Human Activities ◽  
Soil Layer ◽  
Flow Patterns ◽  
Soil Density ◽  
The Stability ◽  
The Right

Abstract The collapse of the embankment is a problem that needs attention to find the right solution, so that the risk can be minimized. The condition of the embankment is influenced by the strength of the soil layer of the embankment, groundwater flow in the embankment, the condition of the water level of the embankment and human activities around the embankment. Changes in the quality of soil density in the embankment can form cavity zones within the embankment which cause changes in groundwater flow patterns in the embankment. The degradation of the soil layer of the embankment can cause piping, overtopping which is the cause of erosion of the embankment body and disturbs the stability of the embankment. Therefore, to determine the condition of the embankment soil layer, research on the stability of the embankment has been carried out using the geoelectric method at the location of the embankment in the Cipancuh and Penjalin reservoirs, so that an image of the embankment soil layer is obtained to determine the cavity zones in the embankment, the flow pattern in the embankment soil layer. Keywords:  cavity zones, flow patterns, geoelectric methods, the stability of the embankment.

scholarly journals Strategi Pemasaran Cabai Merah Pada Sub Terminal Agribisnis Manik Mekar Nadi

2017 ◽  
Author(s):  
NI NYOMAN TISNA DEWI ◽  
I NYOMAN GEDE USTRIYANA ◽  
A.A.A. WULANDIRA SAWITRI DJELANTIK
Keyword(s):  
Technological Development ◽  
Product Distribution ◽  
Marketing Strategies ◽  
External Factors ◽  
Business Networks ◽  
Market Demand ◽  
The Government ◽  
The Stability ◽  
The Right

The Marketing Strategies of Red Chili at Sub Terminal AgribusinessManik Mekar NadiRed chili is one type of commercial vegetable that has long been cultivated in Indonesia. STA Manik Mekar Nadi has implemented marketing strategies to market its agricultural production, especially red chili. The purpose of the study was to analyze the internal and external factors, as well as the right strategies to be carried out by STA Manik Mekar Nadi in the marketing of red chili. The choice of location was done purposively and the number of the key informants was seven peoples. Results of research of marketing strategies of red chili showed that the internal factors include: the strength factors, namely, its strategic location, complete facilities, regular customers, and the guaranteed quality of red chili, while the weakness factors, namely, lack of capital, perishable products, unable to meet the demand, not using the services / advertising in the mass media. External factors include: opportunity factors, namely increasing purchasing power of consumers, government supports, increased domestic market demand, and technological development support, while the threat factors, namely, the emergence of new similar competition, consumers ‘sensitivity to price changes, fluctuations in the price of red chili at the local farmers, and the stronger bargaining power of consumers. The strategies adopted by STA Manik Mekar Nadi in marketing the red chili are to maintain the quality of red chili, to expand markets and product distribution, to increase the production of red chili, to have capital loans, promotion of technology, product standardization, standardization of prices, to expand business networks, to increase operational facilities, to maintain the stability of prices at the consumer level, and to increase the stock of red chili. The STA Manik Mekar Nadi is recommended to apply for financial assistance to the government, to add transportation and to enlarge the warehouse, as well as to conduct promotion.

Arthroscopic removal of osteoid osteoma with gamma probe assistance in the hip joint

2018 ◽  
Vol 29 (3) ◽  
pp. 328-335
Author(s):  
Klemen Stražar ◽  
Ivan Slodnjak ◽  
Oskar Zupanc ◽  
Matej Drobnič
Keyword(s):  
Osteoid Osteoma ◽  
Hip Joint ◽  
Weight Bearing ◽  
Gamma Probe ◽  
Case Series ◽  
Life Questionnaire ◽  
Post Surgery ◽  
Arthroscopic Removal ◽  
Patient Reported ◽  
Weight Bearing Area

Aim: The aim was to present the surgical technique and clinical outcome in a series of patients treated with gamma-probe-assisted arthroscopic removal of osteoid osteoma in the hip joint. Methods: The case series consisted of 10 patients diagnosed with osteoid osteoma of the hip, who were treated by arthroscopic nidus removal. An endoscopic gamma probe was used intraoperatively to locate the nidus and to control the extent of its removal. Residual osteoma cavities were additionally treated with an arthroscopic radiofrequency ablator. Microfracturing was performed when the osteochondral defect was in the weight-bearing area and osteochondroplasty was done in cases of concomitant cam deformity. Nonarthritic Hip Score (NAHS), Tegner activity score, quality of life questionnaire (EQ-5D) and postoperative magnetic resonance imaging (MRI) were used for evaluation before and post-surgery, with a minimum follow-up of 2 years. Results: The relative reduction of the gamma irradiation count immediately after removal of the nidus was 44.9% (range 33.3–54.5%). Postoperatively, all patients experienced prompt pain relief and a significant improvement according to all patient reported outcomes. Control MRI revealed fibro-cartilaginous tissue repair of post-osteoma osteochondral defects in the weight-bearing area; 1 patient showed signs of early degeneration. Conclusions: The results of this case series demonstrated the safety and high efficacy of gamma-probe-assisted arthroscopic removal of the osteoid osteoma from the hip joint. Endoscopic gamma probe was recognised as a very useful device for locating the nidus of the osteoid osteoma exactly and preventing incomplete or excessive removal of the bone.

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