Orthopaedics

Durham, NC, United States

Orthopaedics

Durham, NC, United States
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Tatting L.,Orthopaedics; | Sandberg O.,Orthopaedics; | Bernhardsson M.,Orthopaedics; | Ernerudh J.,Linköping University | Aspenberg P.,Orthopaedics;
Acta Orthopaedica | Year: 2016

Background and purpose — Fracture healing involves different inflammatory cells, some of which are not part of the traditional bone field, such as B-cells and cytotoxic T-cells. We wanted to characterize bone healing by flow cytometry using 15 different inflammatory cell markers in a mouse model of metaphyseal injury, and incidentally discovered a previously unknown general skeletal reaction to trauma. Material and methods — A bent needle was inserted and twisted to traumatize the cancellous bone in the proximal tibia of C57/Bl6 female mice. This is known to induce vivid bone formation locally in the marrow compartment. Cells were harvested from the injured region, the uninjured contralateral tibia, and the humerus. The compositions of the immune cell populations were compared to those in untraumatized control animals. Results — Tibial metaphyseal injury led to substantial changes in the cell populations over time. Unexpectedly, similar changes were also seen in the contralateral tibia and in the humerus, despite the lack of local trauma. Most leukocyte subsets were affected by this generalized reaction. Interpretation — A relatively small degree of injury to the proximal tibia led to systemic changes in the immune cell populations in the marrow of unrelated bones, and probably in the entire skeleton. The few changes that were specific for the injury site appeared to relate to modulatory functions. © 2016 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation.


Trojian T.H.,Orthopaedics | Trojian T.H.,University of Connecticut
Clinics in Sports Medicine | Year: 2013

Thigh contusions are common injuries in sports, and the thigh is a very common location for sports-related muscle contusions. Treatment starts with placement of the knee in 120 of flexion for 24 hours. Nonsteroidal anti-inflammatory drugs can be detrimental to the healing if used for more than 48 to 72 hours, and glucocorticosteroids should be avoided. Early treatment with knee flexion to 120 degrees is very important, and is followed by range-of-motion exercises and advancement of activity. Early proper treatment is the key to success. Complications of myositis ossificans and compartment syndrome need to be considered. © 2013 Elsevier Inc.


Kurd M.F.,Thomas Jefferson University | Lurie J.D.,Dartmouth College | Zhao W.,Orthopaedics | Tosteson T.,Dartmouth College | And 4 more authors.
Spine | Year: 2012

STUDY DESIGN.: A retrospective cohort study. OBJECTIVE.: In this article, we examined the Spine Patient Outcomes Research Trial lumbar stenosis observational cohort to determine baseline patient characteristics that are predictive of the treatment patients chose. We also evaluated cutoff points on validated patient questionnaires that differentiate patients who chose surgery from those who chose nonsurgical management. SUMMARY OF BACKGROUND DATA.: Although the evidence from current studies suggests that surgical intervention is effective for lumbar spinal stenosis, the same studies show that nonoperative patients also improve. Thus, the reasons for patients choosing surgery versus nonoperative care are of continuing interest. METHODS.: Baseline patient and clinical characteristics between those who received operative intervention and those who received nonoperative care were compared to determine baseline predictors of lumbar spinal stenosis management. Also, an evaluation of responses to the 36-Item Short Form Health Survey Bodily Pain (BP), 36-Item Short Form Health Survey Physical Function (PF), and the modified Oswestry Disability Index (ODI) questionnaires was performed to determine the percentage of patients choosing surgical versus nonoperative care relative to their initial questionnaire values. RESULTS.: This analysis looked at the 356 patients in the observational spinal stenosis cohort of Spine Patient Outcomes Research Trial who completed at least 1 follow-up visit. Patients choosing surgery were younger (P = 0.022), had worse BP (P < 0.001), worse PF (P < 0.001), worse ODI (P < 0.001), worse Stenosis Bothersomeness Index (P < 0.001), were dissatisfied with their symptoms (P = 0.001), and had a worse self-assessed health trend (P < 0.001). Patients tended to choose surgery if they had lateral recess stenosis (P = 0.022). Kaplan-Meier curves demonstrate that patients with a BP score of 32 or less, PF score of 30 or less, and ODI greater than 29 chose surgery 75% of the time. CONCLUSION.: A greater understanding of baseline characteristics that influence patient choices in the treatment of lumbar spinal stenosis can aid the patient and the surgeon during the shared decision-making process. © 2012, Lippincott Williams & Wilkins.


Smith T.O.,Orthopaedics | Smith T.O.,Norwich University | Sexton D.,Musculoskeletal Disorders | Mann C.,Musculoskeletal Disorders | Donell S.,Musculoskeletal Disorders
BMJ (Online) | Year: 2010

Objective To compare the clinical outcomes of staples versus sutures in wound closure after orthopaedic surgery. Design Meta-analysis. Data sources Medline, CINAHL, AMED, Embase, Scopus, and the Cochrane Library databases were searched, in addition to the grey literature, in all languages from 1950 to September 2009. Additional studies were identified from cited references. Selection criteria Two authors independently assessed papers for eligibility. Included studies were randomised and non-randomised controlled trials that compared the use of staples with suture material forwound closure after orthopaedic surgery procedures. All studies were included, and publications were not excluded because of poor methodological quality. Review methods Two authors independently reviewed studies for methodological quality and extracted data from each paper. Final data for analysis were collated through consensus. The primary outcome measure was the assessment of superficial wound infection after wound closure with staples compared with sutures. Relative risk and mean difference with 95% confidence intervals were calculated and pooled with a random effects model. Heterogeneity was assessed with I2 and X 2 statistical test Results Six papers, which included 683 wounds, were identified; 332 patients underwent suture closure and 351 staple closure. The risk of developing a superficial wound infection after orthopaedic procedures was over three times greater after staple closure than suture closure (relative risk 3.83,95% confidence interval 1.38 to 10.68; P=0.01). On subgroup analysis of hip surgery alone, the risk of developing a wound infection was four times greater after staple closure than suture closure (4.79,1.24 to 18.47; P=0.02). There was no significant difference between sutures and staples in the development of inflammation, discharge, dehiscence, necrosis, and allergic reaction. The included studies had several major methodological limitations, including the recruitment of small, underpowered cohorts, poorly randomising patients, and not blinding assessors to the allocated methods of wound closure. Only one study had acceptable methodological quality. Conclusions After orthopaedic surgery, there is a significantly higher risk of developing a wound infection when the wound is closed with staples rather than sutures. This risk is specifically greater in patients who undergo hip surgery. The use of staples for closing hip or knee surgery wounds after orthopaedic procedures cannot be recommended, though the evidence comes from studies with substantial methodological limitations. Though we advise orthopaedic surgeons to reconsider their use of staples for wound closure, definitive randomised trials are still needed to assess this research question.


Gupta R.K.,Orthopaedics | Rohilla R.K.,Orthopaedics | Sangwan K.,Orthopaedics | Singh V.,Orthopaedics | Walia S.,Orthopaedics
International Orthopaedics | Year: 2010

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified. © 2009 Springer-Verlag.


Tuberculosis (TB) is a chronic granulomatous infection caused by acid-fast mycobacterium tuberculosis bacilli. Spinal involvement occurs in less than one percent of TB. Spinal TB (Potts disease) accounts for 50% of skeletal TB. Though it most commonly affects the thoracolumbar junction, it can occur at any level of the spine. Early diagnosis and treatment is mandatory in order to avoid neurological complications and spinal deformity.We report a case of a young female with tuberculosis of D12-L1 who was treated with posterior decompression using a modified transpedicular approachand posterior instrumentationwith a successful outcome.


PubMed | Orthopaedics
Type: Journal Article | Journal: Cureus | Year: 2016

Pigmented villonodular synovitis (PVNS) is a rare, benign, but potentially locally aggressive and recurrent condition characterized by synovial proliferation and hemosiderin deposition inside the joints, tendon sheaths, and bursae. It usually affects the large joints such as hip, knee, and ankle. We report a case of PVNS of the knee joint in a young female which was treated by subtotal synovectomy alone without the use of adjuvants. At the 14-month follow-up, the patient was pain free and had no signs of disease recurrence.


PubMed | Orthopaedics and Indraprastha Apollo Hospitals
Type: Journal Article | Journal: Cureus | Year: 2016

Ganglion cysts are benign soft tissue swellings commonly found in the wrist. The presence of these cysts in the elbow is uncommon, and few case reports have been reported for this condition at this location. These lesions can compress on the neighbouring structures or cause restriction of the joint movement. The awareness of this entity is a must, to arrive at an early diagnosis.We report a patient with swelling in the anterolateral aspect of the elbow which had been causing intermittent pain for the last 13 months. The MRI revealed a fluid-filled cystic swelling which was communicating with the radio-capitellar joint.The lesion was excised in toto, using anterolateral approach for the elbow, and sent for histopathological examination which confirmed the diagnosis of a ganglion cyst.Thus, due to the infrequent presentation, an awareness of this condition is necessary to prevent a delay in diagnosis and its subsequent management.


PubMed | Orthopaedics and Indraprastha Apollo Hospitals
Type: Journal Article | Journal: Cureus | Year: 2016

Giant Cell Tumour(GCT) of the distal fibula is extremely rare and poses challenges in the surgical management. Wide excision or intralesional curettage, along with adjuvant chemical cauterisation can prevent the recurrence of GCT. The excised bone gap needs reconstruction using tricortical iliac autograft and supportive plate fixation. In addition to wide excision, preservation of ankle mortise is advisable in locally aggressive and large lesions of the distal fibula. We report a GCT of the distal fibula in a young female patient. As part of the treatment, en bloc resection, chemical cauterisation with phenol, and distal fibula reconstruction with a tricortical iliac crest bone graft was done. Eighteen months after the treatment, thepatient has no recurrence and her ankle is stable with full range of movement. We suggest this method to be worthwhile for the treatment of this uncommon lesion in quantifying recurrence and functional outcome.


Tuberculosis (TB) is an emerging disease which affects about one-third of the worlds population, especially in developing countries. TB of the spine is the most common type of skeletal TB. Cervical spine TB is rare, constituting 2-3% of all cases of spinal TB. We would like to presentan unusual case of tuberculosis of the C1, C2, and C3 vertebrae with neurological deficit and its difficult management. A new method of treatment was done for this patient, which included reconstruction of the odontoid process using a tricortical iliac crest graft that was fixed with an anterior cervical plate. On follow-up, there was good incorporation of the graft. The neurological condition of the patient improved and was normal with partial restriction of neck movements. We suggest this technique to be worthwhile for treatment of this disease at this location.

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