A case of an atraumatic implant failure after primary rotating-hinge total knee arthroplasty

Rotating-hinge knee implants are fully constrained knee prostheses commonly used for revision total knee arthroplasty. Nevertheless, rotating-hinge devices have been increasingly utilized in primary setting. Complications are inevitable in orthopedic surgery, however, implant breakage after RHK arthroplasty has been rarely described in medical literature. We present a rare case of 70-year-old Caucasian, male patient who suffered an atraumatic femoral stem breakage in a primary NexGen ® Rotating Hinge Knee (Zimmer-Biomet ® , Warsaw, IN, USA).

Thrombosis of persistent median artery as a cause of carpal tunnel syndrome : case report

Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, caused by compression of the median nerve. Symptoms usually are present for months and aggravate over time. Acute onset of complaints and symptoms, like coldness of the hand, should raise awareness of a possible vascular cause of CTS.Persistent median artery (PMA) is a very rare anatomical variant of the blood supply of the upper limb. The presence of a thrombosed PMA is an extremely rare cause of CTS. In this article a case is presented in which the patient has carpal tunnel syndrome of his left hand, caused by a thrombosed persistent median artery. Conservative treatment, consisting of rest, ice applica- tion and non-steroidal anti-inflammatory drugs, failed. Surgical excision of the thrombosis and open exploration of the carpal tunnel was performed, with complete relief of symptoms. In literature different treatment options, like conservative treatment with antiplatelet therapy or surgical excision of the throm- bosis and decompression of the nerve, are described with good results. However up until now, no consensus exists about the golden standard in treatment of a thrombosed persistent median artery.

Secondary radial neuropathy after closed intramedullary nailing of humeral shaft fractures. Results over a 10-year period

Background. Retrospective study to examine secondary radial nerve palsy after humeral shaft fixation with closed locked intramedullary nailing. Materials and methods. Patients were identified from the hospitals’ registration systems for humeral shaft fractures, nerve lesions, plating, nailing and external fixation during a 10-year period from January 2007 to December 2016. All radial nerve lesions were registered and followed-up in patient files. Results. 89 patients with locked intramedullary nailing were available for an outpatient follow-up. Mean age was 67 years at the time of injury. 72 fractures were non-pathological. Of these, 31 were nonunions. 28, 61 and zero were identified in the proximal, middle and distal thirds of the humeral shaft respectively. 76 procedures were closed and 13 were with open reduction. Six radial nerves had nerve exploration. Eight patients developed immediate postoperative radial nerve palsies. Of these, six developed after closed surgery, two after nerve exploration. Of seven available patients with a radial nerve palsy, six of these remitted. Two patients were later surgically explored. One patient out of 89 sustained a verifiable permanent radial nerve paralysis. Conclusions. In this study, the risk of a radial nerve palsy was 7.9 % with closed locked intramedullary nailing. This study suggests that exploration of the radial nerve is not necessary routinely in order to prevent radial nerve lesions when performing closed intramedullary nailing for humeral shaft fractures in adults with a preoperative normal radial nerve function. Level of Evidence : Level IV.

Outcomes of total knee replacement with the use of a NexGen MIS Tibial Component (Mini-keel) : a systematic review

NexGen MIS Tibial Component (Mini-keel) is a tibial component specially developed for minimally invasive surgery in total knee replacement (TKR), and the size limitations of its design and the modular system could affect tibial fixation strength, however, this has not been precisely evaluated thus far. This study aimed to systematically review the literature describing the outcome following TKR with the use of a Mini-keel. Electronic searches of databases were undertaken in July 2019 by two experienced orthopaedic surgeons according to the PRISMA guidelines for literature describing the outcomes of TKR with the use of a Mini-keel. Quality of studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The initial search found a total of 623 studies from all the databases. Seven studies met all the inclusion criteria and were eligible for critical appraisal and quality assessment. In total, 2,198 cases were included in the systematic review. Thirty-five revision cases due to aseptic loosening were found from the systematic review. Two studies were negative about using a Mini-keel and three studies were positive about it, while the other two studies did not judge the quality of a Mini-keel. There have been conflicting conclusions among studies for the use of a Mini-keel. There remains a paucity of prospective cohort studies between TKRs with the use of a Mini-keel and those with the use of a conventional implant, which makes it difficult to determine the usefulness and reliability of this implant.

Evolution of head-shaft angle and neck-shaft angle in childhood

The current retrospective study investigates the natural evolution of head-shaft angle (HSA) and neck-shaft angle (NSA) in childhood. It is not known if a high HSA in early childhood leads to a high HSA in adulthood. This study aims to characterize the evolution of HSA and compares it with the more commonly known NSA in healthy children. We measured radiographs of 84 different healthy hips of children between 3 and 14.5 years old who underwent at least 2 radiographs of the pelvis, corresponding to 286 measurements. We used a linear mixed model to determine the covariance between random intercept and slope while allowing each individual hip to change over time. The covariance for HSA between random intercept and random slope was -4.262 (p < 0.001), corresponding to a high negative correlation of -0.717, for NSA -2.754 (p = 0.031) or a high negative correlation of -0.779. HSA and NSA were strongly correlated, a value of 0.736 (p < 0.001) was measured. The high negative correlation for random intercept and random slope means that the higher the initial value (intercept), the steeper the decline (slope). Therefore HSA decreases faster in hips with high HSA at an early age. Hips with high HSA in early childhood do not necessarily lead to hips with high HSA in adulthood. Our results may aid in future clinical decision making in patients with developmental dysplasia of the hip (DDH) with high HSA in particular.

Impact of the COVID-19 pandemic on the trauma and orthopaedic department at level one Major Trauma Centre in the republic of Ireland

The Coronavirus Disease (COVID-19) has been identified as the cause of a rapidly spreading respira- tory illness in Wuhan, Hubei Province, China in early December 2019. Since then, the free movement of people has decreased. The trauma-related injuries and the demand on the trauma and orthopaedic service would be expected to fall. The aim of this study to examine the impact of the COVID-19 pandemic on a level 1 Trauma Centre in the Republic of Ireland (ROI). Patients admitted to the Trauma & Orthopaedic (T&O) Department at Cork University Hospital (CUH) and the South Infirmary Victoria University Hospital (SIVUH), and their associated fracture patterns and management, between 01/03/20 and the 15/04/20 were documented and compared to the patient admissions from the same time period one year earlier in 2019. The total number of T&O operations performed decreased by 10.15% (P= 0.03)between the two time periods. The number of paediatric procedures fell by 40.32% (P= 0.15). Adult Distal radius and paediatric elbow fractures (excluding supracondylar fracture) increased by 88% and 13% (P= 0.19), (P= 0.04) respectively. Hip fractures remained the most common fracture-type admitted for surgery. The COVID-19 crisis has to lead to a decrease in the total numbers of trauma surgeries in a major trauma centre in the ROI. This decline is most evident in the number of paediatric and male adult patients presenting with fractures requiring operative management. Interestingly, fractures directly related to solo outdoor activities, such as running or cycling, as well as simple mechanical falls like ankle, distal radius, elbow, and hand fractures all increased. Irish males were more compliant with outdoors restrictions than females.

Concomitant ipsilateral acetabular and femoral fractures – an appraisal of outcomes and complications in 34 patients

Concomitant ipsilateral femoral and acetabular fractures are complex injuries which result from high-velocity trauma. Surgical treatment is the accepted management of such injuries. The objectives of this study were to evaluate the outcomes and study the complications in patients treated for concomitant ipsilateral acetabular and femoral fractures (type ‘B’ floating hip injuries). This retrospective study was conducted at a tertiary care teaching hospital on patients operated for type B floating hip injuries, who had completed a minimum of one-year follow-up after the surgery and whose complete records were available. Those with floating hip injuries with pelvic fractures were excluded. All patients were operated on the femoral side first, followed by the acetabular side. 34 patients were included ; most of them were young males. A road traffic accident was the most common mode, with a dashboard injury being the most common mechanism of injury. No association between the type of acetabular and femoral fractures was found. The clinical (measured with Harris hip score) and radiological (Matta’s method) outcomes at the latest follow-up were excellent or good in >60% cases and had a significant association with the quality of reduction on the post-operative radiographs. Com- plications were seen in 12 out of the 34 patients. Type B floating hips injuries can be managed well with acceptable short-term results by following a femur first strategy. However, patients must be informed of the possible complications and the probabilities of poorer outcomes when compared to isolated acetabular or femoral fractures.

Digital templating in total hip arthroplasty using contralateral healthy hip results in decreased accuracy

The accuracy of pre-operative digital templating for total hip arthroplasty (THA) using the diseased versus unaffected contralateral joint remains unclear. As such, we devised a study to compare templating precision between the operated hip joint versus the healthy side for patients with osteoarthritis (OA). The study hypothesis was that preoperative templating accuracy of THA on the ipsilateral diseased hip joint would be higher compared to the contralateral healthy hip in patients with OA. We retrospectively reviewed 100 patients who underwent THA for unilateral OA at our center from January 2018 to January 2020. Retrospective preoperative digital templating was performed separately on both the operated hip joint and the healthy contralateral hip joint by a single surgeon who was blinded by the in-situ components sizes. Accuracy of each group was compared to the implanted components. Assessment of the 100 included cases demonstrated superior acetabular component size prediction when templating was performed using the diseased hip compared to the healthy contralateral side (68.0% versus 51.0%, p<0.001). No differences between the cohorts were found regarding templating accuracy of femoral stem sizes (72.0% and 69.0%, p=0.375) or neck offset (73.0% and 69.0%, p=0.289). Templating acetabular cup size using the ipsilateral diseased hip is more accurate than using the contralateral healthy hip in patients with unilateral OA.

Total hip replacements following acetabular fractures. 7 to 15 years clinical and radiological results

This study is reporting the long term clinical and radiographic results of a group of 45 patients who underwent total hip arthroplasty following acetabular fractures. The study included 39 males and 6 females. The age of the patients ranged from 32 to 61 with a mean of 46.4 years. The indication for surgery was secondary osteoarthritis in 35 patients and avascular necrosis of the femoral head in the remaining ten. The follow up period ranged from 7 to 15 years with a median of 10.3 years. Uncemented total hip prostheses were used in 37 cases while 8 cases had hybrid prostheses with cemented cups and uncemented stems. Thirty patients (66.7%) needed autogenous acetabular bone grafting. There has been a statistically significant improvement from a preoperative mean Oxford hip score of 16 to a postoperative mean score of 39.8 (p < 0.001). At the end of follow up, two cases had revision for cup loosening. The complications included one case of transient sciatic nerve palsy, and two cases of heterotopic ossification. Currently, total hip replacement remains the best option for end stage post traumatic arthritis. There are technical challenges associated with this replacement surgery which the surgeon should be aware of.

One sacroiliac screw for posterior ring fixation in unstable pelvic fractures

Unstable pelvic injuries are considered uncommon and they are usually associated with high rate of morbidity and mortality. High energy blunt trauma and falling from height are usually the main mechanism of injury. It is a retrospective study that was performed in academic level I trauma center. From September 2015 to December 2019, a consecutive series of 26 patients (7 females), with average age of 32 years with unstable pelvic fracture were included in this study. All patients underwent reduction and percutaneous fixation with one sacroiliac screw posteriorly for each sacroiliac joint and anterior arch fixation of the pelvic ring with either platting or external fixator. The average duration of follow up was 36 months. Clinical results: at the final follow-up, all patients had complete radiological healing of the fractures. The subjective functional assessment yielded excellent for twenty-two patients, good for two patients and fair for two patients. Posterior arch fixation of the pelvic ring with one sacroiliac screw beside anterior arch fixation in unstable fracture pelvis is a sufficient fixation method to maintain the requiring stability to allow complete union of the fracture. Level of Evidence: Therapeutic Level III.