SP9.1.10 Penthrox for management of fractures, dislocations and more: Orthopaedics in the Emergency Department during the COVID-19 pandemic

Aim Methoxyflurane has undergone a renaissance using a smaller dose in a handheld ‘Penthrox’ device. There is minimal literature regarding its use in common orthopaedic management. Our Minor Injury Unit (MIU) was created due to COVID19 pandemic. The aim of this study was to investigate whether a Penthrox device could improve fracture/joint dislocation management and decreased the need for theatre resources at our MIU. Methods We reviewed all cases where Penthrox was used to facilitate minor procedures within a two month period. We recorded patient demographics, injury, time of admission, discharge and management. Success was defined as fracture manipulation into an adequate position, joint congruence achieved or completion of a planned procedure. Results 101 Penthrox doses were given to 89 patients over 97 episodes between 24/3/2020 and 26/5/2020. No complications were recorded. There was 100% success rate on fracture manipulation. For joint dislocation: 65% on native shoulder reduction; 30% on prosthetic total hip arthroplasty reduction; 100% on native elbow reduction. Penthrox was also used for other procedures such as wound reviews, removing external fixators, and applying braces with 100% success rate. Conclusion We have shown that Penthrox is safe and can be used for common emergency Orthopaedic procedures, particularly fracture manipulation. This helped keep operating theatres and other anaesthetic resources free which were especially vital and scarce during the COVID19 pandemic.

OSTEOSÍNTESIS DE FRACTURA DE ESPINA TIBIAL ASISTIDA CON ARTROSCOPÍA Y TORNILLO DE COMPRESIÓN TIPO HERBERT, REPORTE DE UN CASO Y REVISIÓN DE LITERATURA.

Introduction Tibial spine fractures have a prevalence of 3 per 100,000 people annually. High-energy trauma is the leading cause, followed by low-energy trauma and 40% by multiple trauma. Imaging studies play a crucial role in establishing the diagnosis. It is important to understand that radiography alone does not allow a correct identification of the fracture, so it is necessary to complement it with a CT or MRI scan. The Meyers-McKeever classification divides fractures by their degree of displacement and comminution into 4 types and guides us in the therapeutic decision. The management of these fractures depends on the morphology, soft tissue involvement and the general condition of the patient. Surgical treatment is primarily considered for displaced fractures. Within this approach, the arthroscopy-assisted technique has reported excellent results. with a low complication rate, compared to open techniques, despite the few studies to define the standard Gold treatment. Case description A clinical case of a 32-year-old patient with a posterior tibial spine fracture is reported, who underwent surgery with arthroscopic-assisted osteosynthesis and a 4.5 x 4.0 Herbert-type compression screw with intraoperative arthroscopic images that demonstrated the restoration of joint congruence, without menisci or ligament injury, assessing intraoperative arches of motion from 0 to 90 degrees. In his mediate postsurgical has been started isometric physiotherapy with flexion and extension of the knee from 0 to 90 degrees plus strengthening of the iliac psoas and quadriceps and resume his activities in 2 months after his surgery. Conclusion At present, there is no consensus on the optimal surgical technique due to the lack of clinical trials. More studies of higher quality and sample size are necessary to establish the Gold Standard in the treatment of tibial spine fractures. However, we found that by using Herbert-type compression screws, timely compression of the fracture fragment is achieved in the anatomical reduction. An updated review of the subject and its therapeutic management is carried out.

Iliofemoral technique modification using an anchor screw as treatment of canine traumatic hip luxation - case report

ABSTRACT Twelve dogs with traumatic hip luxation were selected for surgical intervention with a modified iliofemoral suture technique using an anchor screw to substitute the passage of suture material through a perforated tunnel in the ilium. Six procedures were performed with non-absorbable suture and other six with absorbable suture materials. These cases were evaluated at 15, 30, 60, and 90 days after surgery by performing an ambulation analysis and palpation of the joint. In all cases, there was a return of partial and total limb support in an average of 3 and 19 postoperative, respectively. The fixation strategy of the suture material in the ilium using an anchor screw proved to be efficient with a smaller surgical approach and lesser surgical difficulty, maintaining joint congruence in acute as chronic luxation cases. The use of absorbable and non-absorbable sutures had excellent clinical results, but there was a subjective superiority of the first ones, once 4 dogs of the non-absorbable group presented some discomfort during the postoperative palpation of the joint, 90 days after surgery.

Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment

Osteonecrosis of the femoral head is a disabling pathology affecting a young population (average age at treatment, 33 to 38 years) and is the most important cause of total hip arthroplasty in this population. It reflects the endpoint of various disease processes that result in a decrease of the femoral head blood flow. The physiopathology reflects an alteration of the vascularization of the fine blood vessels irrigating the anterior and superior part of the femoral head. This zone of necrosis is the source of the loss of joint congruence that leads to premature wear of the hip. Several different types of medication have been developed to reverse the process of ischemia and/or restore the vascularization of the femoral head. There is no consensus yet on a particular treatment. The surgical treatments aim to preserve the joint as far as the diagnosis could be made before the appearance of a zone of necrosis and the loss of joint congruence. They consist of bone marrow decompressions, osteotomies around the hip, vascular or non-vascular grafts. Future therapies include the use of biologically active molecules as well as implants impregnated with biologically active tissue. Cite this article: EFORT Open Rev 2019;4:85-97. DOI: 10.1302/2058-5241.4.180036

Percutaneous fixation of acetabular fractures

The objective of surgery for acetabular fractures is to achieve precise reduction to restore joint congruence, fix internal bone fragments, avoid displacement of the fracture and allow rapid rehabilitation. Open reduction and internal fixation is the benchmark method for displaced acetabular fractures, but open reductions can increase morbidity, causing neurovascular injury, blood loss, heterotopic bone formation, infection and poor wound healing. An anatomical reduction with a gap of 2 mm or less is a predictor of good joint function and reduced risk of post-traumatic osteoarthritis. The percutaneous approach is associated with fewer complications than open techniques, but acetabular geometry makes percutaneous screw insertion a challenging procedure. The percutaneous technique is recommended for non-displaced or slightly displaced fractures, and in obese, osteoporotic and elderly patients who cannot receive total joint arthroplasty. We recommend the use of intramedullary cannulated screws. Fracture reductions are achieved by manual traction of the affected bones. If some fracture displacement remains, accessory windows can be used to introduce a ball spike pusher, a hook or a Steinmann pin which can be used as a joystick to rotate the fracture. In this paper, we describe the accessory windows for the anterior column, the quadrilateral plate and the posterior column. We detail the position, direction and kind of screws used to stabilize the anterior and posterior columns. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170054

MODIFIED DEGA OSTEOTOMY IN TREATING DEVELOPMENTAL DYSPLASIA OF THE HIP

ABSTRACT Objective: To retrospectively evaluate the preliminary postoperative results of modified Dega-type acetabular osteotomy to treat developmental dysplasia of the hip, confirming the efficacy and reproducibility of this technique. Methods: This retrospective study included patients older than 18 months. A total of 19 hips underwent modified Dega osteotomy. Results: Satisfactory results were obtained, with an average decrease of the acetabular index from 39.2 to 20.6 degrees. The final average center edge angle was 29.6 degrees. Hip joint congruence was reestablished in all cases, and as of this writing, only one case developed necrosis in the femoral head during follow-up. Conclusion: Modified Dega osteotomy demonstrated good initial results, as well as the potential for use in treating developmental dysplasia of the hip. Level of Evidence IV; Case series.

Modern aspects on etiopathogenesis of canine osteoarthritis

Extracellular matrix and chondrocytes are the main structure components of the articular cartilage. The extracellular matrix is largely comprised of collagen fibers, proteoglycans and water, whereas the metabolically active chondrocytes are responsible for its production and maintenance. An interaction of the physical and biochemical characteristics of the articular cartilage is necessary for normal joint function by providing nearly frictionless motion, wear resistance, joint congruence and loading transmission to subchondral bone. The vicious cycle of osteoarthritis sets forth when structural and homeostatic aberrations, secondary to congenital or acquired joint diseases, occur in the articular cartilage. Although the pathological and biochemical changes of the articular cartilage in the osteoarthritic joint have been studied extensively, the exact mechanism pertaining its pathogenesis is still unknown.