Springer Science and Business Media LLC

The purpose of our study was to present the spectrum and prevalence of intraarticular lesions in patients with shoulder pain after a single non-dislocating shoulder trauma and to evaluate the clinical results according to pathology and workers’ compensation status. Sixty consecutive patients (61 shoulders) with shoulder pain following a single non-dislocating shoulder trauma had shoulder arthroscopy. The indication for surgery was either persistent pain for 3 months or longer after trauma and/or an intraarticular lesion on MRI. Patients with history of shoulder complaints, previous shoulder surgery, a complete rotator cuff tear or a fracture of the shoulder girdle were excluded. Intraarticular findings during shoulder arthroscopy were retrospectively analyzed. After a minimum follow-up of 1 year patients were contacted by telephone interview and ASES score, Simple Shoulder Test, Subjective Shoulder Value and residual pain were assessed for the entire population and for patients with and without workers’ compensation. The most common intraarticular findings were SLAP (44.3 %) and Pulley (19.7 %) lesions followed by lesions of the anterior or posterior labrum (14.8 %). The mean age of the 13 women and 47 men was 41.9 years (SD 10.9). Patients with workers’ compensation had significantly lower scores than patients without and had a significantly lower return to work rate than patients without. In patients with persistent shoulder pain after sprain or contusion arthroscopy revealed a broad spectrum of intraarticular findings. Patients with workers’ compensation claims had worse results than those without. Case series (Level IV).

The results in 90 patients with osteoarthritis of the hip, treated by intertrochanteric osteotomy fixed with an AO blade plate, were analyzed 1–5 years after operation. The operatiopn was performed without displacement of osteotomy, the aim being to produce bony union in the original position using the AO compression technique. With one exception, all osteotomies fused, but dislocation exceeding 0.5 cm resulted in four cases. The operation brought about relief from night pain in 88% of the patients and relief from weight-bearing pain in 41%. Abduction and adduction were the only movements that improved. The results were the same 1–2 and 4–5 years after the operation. Complications were rare, and the use of the compression method enabled the patients to get on by themselves the day after operation. This method is particularly well suited for young patients.

1. Es wurde regional bzw. örtlich gehäuftes Vorkommen der angeborenen Hüftverrenkung beobachtet und mitgeteilt. Bisher besteht noch keine Klarheit darüber, worauf die Erscheinung zurückzuführen ist. 2. Zur Erklärung dieser Erscheinung wurden als auslösende Momente angegeben: „rassisch bedingte Eigenart des Beckenbaues“, „an die Keimzellen gebundene, in der Rasse verankerte und somit genotypisch erbbedingte Merkmale“, „Völker- und Rassenmischung“ usw. 3. Auf Grund der Resultate seines Studiums über diese Luxation glaubt der Verfasser, daß bei gewissen Völkern, in denen die freie Bewegung des Hüftgelenkes von Neugeborenen mehr gehindert wird, Spontaneinrenkung post partum erschwert wird und die Zahl der Luxationskinder sich infolgedessen vermehrt, während bei anderen Völkern oder Rassen dagegen, bei denen die Bewegung der Oberschenkel von Neugeborenen nicht gesperrt wird, die Spontanheilung post partum erleichtert wird und die Häufigkeit der Luxationspatienten infolgedessen zurückgeht.

Kyphotic deformity plays a key role in our evaluation of patients with thoracolumbar burst fracture, and there are several variables available for kyphotic deformity assessment, including Cobb angle, Gardner angle, and sagittal index. However, it remains unknown about intra- and inter-observer variability of sagittal index. The purpose of this study is to determine the reliability of the measurement for thoracolumbar burst fracture kyphosis using Cobb angle, Gardner angle, and sagittal index. Thirty-five patients with thorocolumbar burst fractures treated in our institute were identified. The lateral spine radiographs and midsagittal CT images of the 35 patients were measured on two separate occasions, in random order, by five attending spine surgeons using Cobb angle, Gardner angle, and sagittal index. We statistically assessed the agreement, the intra-observer and the inter-observer reliability of the three methods. The intra-observer reliability is always better than the inter-observer reliability, regardless of the parameter being measured or the imaging modality. Intra-class correlation coefficients (ICC) were the most consistent for Cobb angle, followed by Gardner angle and sagittal index. Midsagittal CT images had better intra- and inter-observer reliabilities than lateral plain radiography. Also, agreement was better using midsagittal CT images as compared with lateral plain radiography. The results of our study suggest that Cobb angle is the most consistent in terms of intra- and inter-observer reliabilities in the assessment of thoracolumbar burst fracture kyphosis.

A fracture is a clinical manifestation of osteoporosis and is one of the main causes of functional limitations and chronic pain in patients with osteoporosis. Muscle and coordination training are recommended to the patients as general measures. We inquired whether sling training is better than traditional physiotherapy in relieving pain and improving abilities of daily living. Fifty patients with osteoporosis were divided into two groups. Group A performed conventional physiotherapy, while Group B performed sling training exercises. Data were collected before and after the intervention and after 3 months. The registered parameters were stamina, posture, and pain. Posture, torques, and the associated strength of spinal muscles were studied in a biomechanical model in order to estimate the forces acting on the spine. Furthermore, the factors that exerted a positive impact on the success of therapy were registered. Forty-four patients (88%) completed the study. Positive effects of the training were noted in both groups, but significantly better effects were observed in the group that performed sling training. A reduction of pain independent of the number of fractures, significantly reduced torques, and reduced muscle strength were registered. Specific training programs helped to increase muscle strength and straightening the back thereby reducing the force needed on a permanent basis and decreasing torque in the spine. Sling training was more effective in that than traditional physiotherapy.

This feasibility study investigated the accuracy of anterior pelvic reference plane (APP) registration and acetabular cup orientation in two cadavers with different BMIs. Five observers each registered the APP five times in the 2 cadavers (BMIs: 32 kg/m² and 25 kg/m²) using an ultrasound-based navigation system. By comparison against the CT-derived reference landmarks, the errors in determining the individual landmarks defining the APP, as well as the resulting errors in the orientation of the APP and the acetabular cup orientation were determined. Across all measurements obtained with the ultrasound navigation system, the errors in rotation and version in determining the APP were 0.5° ± 1.0° and −0.4° ± 2.0°, respectively. The cup abduction and anteversion errors determined from all measurements of the five investigators for both cadavers together were −0.1° ± 1.0° and −0.4° ± 2.7°, respectively. The data further demonstrated a high reproducibility of the measurements for the resulting cup adduction and anteversion angle. Our preliminary results confirm that ultrasound navigation is a highly accurate tool that allows a reproducible registration of the APP and thereby enables accurate and precise intraoperative determination of the acetabular cup orientation also in patients with increased BMI.

Bài nghiên cứu kéo dài 3 năm đã chọn lọc 43 bệnh nhân cao tuổi bị gãy xương hông trong bao khớp cho một thử nghiệm ngẫu nhiên có đối chứng, so sánh phương pháp ghép xương (DHS) với thay khớp bán phần (HA). Thời gian phẫu thuật và lượng mất máu trong phẫu thuật ở nhóm DHS ngắn hơn đáng kể, nhưng việc chỉnh sửa không đủ và/hoặc cố định dẫn đến những vấn đề nghiêm trọng trong nhóm này. Tỷ lệ bệnh lý lâm sàng ở nhóm DHS thấp hơn. Không có sự khác biệt nào được chứng minh về tỷ lệ tử vong, biến chứng liên quan đến gãy xương hoặc phẫu thuật, hay nhu cầu can thiệp thứ cấp. Việc tái can thiệp có thể thực hiện mà không có rủi ro bổ sung ở cả hai nhóm và không dẫn đến kết quả xấu. Kết quả tương tự đã được thu được với cả hai phương pháp lên tới 24 tháng. Tại lần theo dõi 36 tháng, tỷ lệ kết quả xấu hơn đáng kể đã được chứng minh ở nhóm HA. Chúng tôi kết luận rằng phương pháp ghép xương là hợp lý như là phương pháp điều trị chính cho các trường hợp gãy xương hông trong bao khớp lệch chỗ ở bệnh nhân lớn tuổi. Thay khớp có thể được sử dụng an toàn trong các trường hợp mà phương pháp ghép xương không thành công.

Distal radioulnar joint (DRUJ) instabilities are challenging and their optimal treatment is controversial. In special cases or when reconstruction of the stabilizing triangular fibrocartilage complex (TFCC) fails, K-wire transfixation can be performed. However, no consensus has been reached regarding the rotational position of the forearm in which this should be done. Therefore, it was investigated whether anatomical reduction would best be achieved by transfixation in neutral position or supination of the forearm. Twelve cadaveric upper limbs were examined before dissection of the DRUJ stabilizing ligaments and after closed transfixation in both positions by C-arm cone-beam CT. Whether this was first done in neutral position or in supination was randomized. The change in the radioulnar ratio (RR) in percentage points (%points) was analyzed using Student's t-test. RR was used since it is a common and sensitive method to evaluate DRUJ reduction, expressing the ulnar head's position in the sigmoid notch as a length ratio. The analysis showed an increased change in RR in neutral position with 5.4 ± 9.7%points compared to fixation in supination with 0.2 ± 16.1%points, yet this was not statistically significant (p = 0.404). Neither position leads to a superior reduction in general. However, the result was slightly closer to the anatomical position in supination. Thus, transfixation of the DRUJ should be performed in the position in which reduction could best be achieved and based on these data, that tends to be in supination. Further studies are necessary to validate these findings and to identify influential factors.