Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 471 | Issue 9 | Sep, 2013

CT Pulmonary Angiography After Total Joint Arthroplasty: Overdiagnosis and Iatrogenic Harm?

Michele R. D’Apuzzo MD, Thomas C. Keller MD, Wendy M. Novicoff PhD, James A. Browne MD

CT pulmonary angiography (CTPA) has become widely adopted to detect pulmonary embolism (PE) after total joint arthroplasty (TJA). CTPA is a sensitive tool, which has the ability to detect emboli that may be clinically insignificant. This may lead to iatrogenic harm from overtreatment.

Surgical Technique: Tscherne-Johnson Extensile Approach for Tibial Plateau Fractures

Eric E. Johnson MD, Stephen Timon MD, Chukwunenye Osuji MD

The standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band (IT) and anterior tibialis origin in continuity from Gerdy’s tubercle and metaphyseal flare. We describe an alternative approach to increase lateral plateau joint exposure and maintain iliotibial band insertion to Gerdy’s tubercle.

Which Implant Is Better for Treating Reverse Obliquity Fractures of the Proximal Femur: A Standard or Long Nail?

Güvenir Okcu MD, Nadir Ozkayin MD, Cemil Okta MD, Ismet Topcu MD, Kemal Aktuglu MD

Reverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws. Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants. However, it is unclear whether nail length influences healing.

Heterotopic Ossification Rates After Acetabular Fracture Surgery Are Unchanged Without Indomethacin Prophylaxis

Sean M. Griffin MD, Stephen H. Sims MD, Madhav A. Karunakar MD, Rachel Seymour PhD, Nikkole Haines MD

We previously found no reduction in heterotopic ossification (HO) rates after acetabular surgery with indomethacin compared with a placebo. We subsequently abandoned routine indomethacin therapy after acetabular surgery but questioned whether the incidence had changed using a posterior approach.

Minimally Invasive Percutaneous Plate Fixation of Tibia Fractures: Results in 80 Patients

Alexandre A. Sitnik MD, PhD, Alexander V. Beletsky MD

Minimally invasive percutaneous plate fixation (MIPPF) has gained wide acceptance for treating periarticular fractures of the tibia. Despite the theoretical biological advantages of MIPPF, it is unclear whether these are offset by wound complications, union rate, and malalignment.

Segmental Tibial Fractures: An Infrequent but Demanding Injury

Martin Teraa MD, Taco J. Blokhuis MD, PhD, Lisa Tang MS, Loek P. H. Leenen MD, PhD

Segmental tibial fractures are considered to be a special injury type associated with high complication rates. However, it is unclear whether healing of these fractures truly differs from that of nonsegmental fractures.

Submuscular Bridge Plating for Complex Pediatric Femur Fractures Is Reliable

Amr A. Abdelgawad MD, Ryan N. Sieg MD, Matthew D. Laughlin DO, Juan Shunia MD, Enes M. Kanlic MD

Complex, high-energy pediatric femur diaphyseal fractures cannot be treated reliably by conventional methods: casting is not suitable for polytrauma and large children, external fixation is associated with a high rate of malalignment and refractures, elastic nails are unsuitable for unstable fractures and metaphyseal areas, and lateral trochanteric entry rigid nails cannot address proximal and distal fragments and need relatively large medullary canals. A few centers have reported that submuscular bridge plating (SBP) is associated with minimal complications, but these findings require confirmation.

Implant Material and Design Alter Construct Stiffness in Distal Femur Locking Plate Fixation: A Pilot Study

Ulf Schmidt MD, Rainer Penzkofer PhD, Samuel Bachmaier MSc, Peter Augat PhD

Construct stiffness affects healing of bones fixed with locking plates. However, variable construct stiffness reported in the literature may be attributable to differing test configurations and direct comparisons may clarify these differences.

Cumulative Effects of Bone and Soft Tissue Injury on Systemic Inflammation: A Pilot Study

Roman Pfeifer MD, Sophie Darwiche MD, Lauryn Kohut MA, Timothy R. Billiar MD, FACS, Hans-Christoph Pape MD, FACS

In multiply injured patients, bilateral femur fractures invoke a substantial systemic inflammatory impact and remote organ dysfunction. However, it is unclear whether isolated bone or soft tissue injury contributes to the systemic inflammatory response and organ injury after fracture.

Are Pentraxin 3 and Transsignaling Early Markers for Immunologic Injury Severity in Polytrauma? A Pilot Study

Christian Kleber MD, Christopher A. Becker MD, Katharina Schmidt-Bleek DVM, PhD, Klaus D. Schaser MD, Norbert P. Haas MD

Inflammatory-related conditions and organ failure (OF) lead to late trauma mortality. Cytokine profiles can predict adverse events and mortality, potentially guiding treatment strategies (damage control surgery versus early total care). However, the specific cytokines to predict the clinical course in polytraumatized patients are not fully identified.

Unstable Intertrochanteric Femur Fractures: Is There a Consensus on Definition and Treatment in Germany?

Matthias Knobe MD, Gertraud Gradl MD, Andreas Ladenburger MD, Ivan S. Tarkin MD, Hans-Christoph Pape MD

Extramedullary and intramedullary implants have improved in recent years, although consensus is lacking concerning the definition and classification of unstable intertrochanteric fractures, with uncertainties regarding treatment.

What Are Predictors for Patients’ Quality of Life After Pelvic Ring Fractures?

Joerg H. Holstein MD, Antonius Pizanis MD, Daniel Köhler MD, Tim Pohlemann MD

Data from literature on predictors for patients’ quality of life after pelvic ring fractures are conflicting and based on small study populations.

Is There a Difference in Timing and Cause of Death After Fractures in the Elderly?

Inge S. Liem MD, Christian Kammerlander MD, Christoph Raas MD, Markus Gosch MD, Michael Blauth MD

Patients who sustain osteoporotic fractures have excessive mortality compared to age-matched controls, which is most pronounced within the first 6 months postfracture. However, the timing and cause of death in the first 3 months after sustaining a fracture are unclear.

Is the Transplant Quality at the Time of Surgery Adequate for Matrix-guided Autologous Cartilage Transplantation? A Pilot Study

Johannes Zellner MD, Peter Angele MD, Florian Zeman PhD, Richard Kujat PhD, Michael Nerlich MD

Matrix-guided autologous chondrocyte transplantation (MACT) has been proposed as an option for treating large full-thickness cartilage defects. However, little is known about the chondrogenic potential of transplants for MACT at the time of implantation, although cell quality and chondrogenic differentiation of the implants are crucial for restoration of function after MACT.

Can a Modified Anterior External Fixator Provide Posterior Compression of AP Compression Type III Pelvic Injuries?

Richard Martin Sellei MD, Peter Schandelmaier MD, Philipp Kobbe MD, Matthias Knobe MD, Hans-Christoph Pape MD, FACS

Current anterior fixators can close a disrupted anterior pelvic ring. However, these anterior constructs cannot create posterior compressive forces across the sacroiliac joint. We explored whether a modified fixator could create such forces.

Trauma Care in India and Germany

Hans-Joerg Oestern MD, Bhavuk Garg MD, Prakash Kotwal MD

Road traffic accidents are among the leading causes of death worldwide in individuals younger than 45 years. In both India and Germany, there has been an increase in registered motor vehicles over the last decades. However, while the number of traffic accident victims steadily dropped in Germany, there has been a sustained increase in India. We analyze this considering the sustained differences in rescue and trauma system status.

Do Parameters Used to Clear Noncritically Injured Polytrauma Patients for Extremity Surgery Predict Complications?

Thomas Dienstknecht MD, Dieter Rixen MD, Peter Giannoudis MD, Hans-Christoph Pape MD

In multiply injured patients, definitive stabilization of major fractures is performed whenever feasible, depending on the clinical condition.

Severity of Injury Predicts Subsequent Function in Surgically Treated Displaced Intraarticular Calcaneal Fractures

Stefan Rammelt MD, PhD, Hans Zwipp MD, PhD, Wolfgang Schneiders MD, PhD, Constanze Dürr MD

The treatment of displaced, intraarticular calcaneal fractures (DIACFs) remains challenging and the best treatment choices remain controversial. The majority of patients will have some lasting functional restrictions. However, it is unclear which patient- or surgeon-related factors predict long-term function.

Does Additional Head Trauma Affect the Long-term Outcome After Upper Extremity Trauma in Multiple Traumatized Patients: Is There an Additional Effect of Traumatic Brain Injury?

Hagen Andruszkow MD, Christian Probst MD, Orna Grün MD, Christian Krettek MD, Frank Hildebrand MD

Musculoskeletal injuries are common in patients with multiple trauma resulting in pain, functional deficits, and disability. Traumatic brain injuries (TBIs) are common in severely injured patients potentially resulting in neurological impairment and permanent disability that would add to that from the musculoskeletal injuries. However, it is unclear to what degree the combination affects impairment.

Acute Complications of Patients With Pelvic Fractures After Pelvic Angiographic Embolization

Amir Matityahu MD, Meir Marmor MD, Joshua Knute Elson MPH, Corey Lieber MD, Gregory Rogalski MD, Cindy Lin MPH, Tigist Belaye MS, Theodore Miclau MD, Utku Kandemir MD

Hemodynamically unstable patients with a pelvic fracture and arterial pelvic bleeding frequently are treated with pelvic angiographic embolization (PAE). PAE is reported to be a safe and effective method of controlling hemorrhage. However, the loss of blood supply and subsequent ischemia from embolization may lead to adverse consequences.

Trauma Care in Germany: An Inclusive System

Johannes A. Sturm MD, Hans-Christoph Pape MD, Thomas Dienstknecht MD

Development of trauma systems is a demanding process. The United States and Germany both have sophisticated trauma systems. This manuscript is a summary of political, economic, and medical changes that have led to the development of both trauma systems and the current high-quality standards.

Can Joint Contact Dynamics Be Restored by Anterior Cruciate Ligament Reconstruction?

Yuichi Hoshino MD, PhD, Freddie H. Fu MD, DSc, James J. Irrgang PT, PhD, ATC, FAPTA, Scott Tashman PhD

Rotational kinematics has become an important consideration after ACL reconstruction because of its possible influence on knee degeneration. However, it remains unknown whether ACL reconstruction can restore both rotational kinematics and normal joint contact patterns, especially during functional activities.

Is Premorbid Glenoid Anatomy Altered in Patients with Glenohumeral Osteoarthritis?

Eric T. Ricchetti MD, Michael D. Hendel MD, PhD, David N. Collins MD, Joseph P. Iannotti MD, PhD

Restoration of native, premorbid glenoid anatomy may be a goal in component placement during total shoulder arthroplasty. However, if patients with unilateral glenohumeral osteoarthritis are predisposed to the development of arthritis owing to abnormal native glenoid anatomy, this recommendation may be inappropriate.

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Jia-Guo Zhao MD, Jia Wang MD, PhD, Peng Zhang MD

Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique.

High Prevalence of Adverse Reactions to Metal Debris in Small-headed ASR™ Hips

Aleksi Reito MD, Timo Puolakka MD, PhD, Petra Elo MD, PhD, Jorma Pajamäki MD, PhD, Antti Eskelinen MD, PhD

There has been increasing concern of metal-on-metal (MOM) hip replacements regarding adverse reactions to metal debris. Information regarding prevalence and risk factors for these adverse reactions is scarce.

Do Ion Levels in Metal-on-metal Hip Resurfacing Differ From Those in Metal-on-metal THA at Long-term Followup?

Lucia Savarino BSc, Matteo Cadossi MD, Eugenio Chiarello MD, Nicola Baldini MD, Sandro Giannini MD

Metal-on-metal hip resurfacing arthroplasty (MOM HR) has become an established alternative to traditional metal-on-metal total hip arthroplasty (MOM THA) for younger, more active patients. Nevertheless, concerns remain regarding wear and corrosion of the bearing surfaces and the resulting systemic metal ion distribution.

Results of Total Hip Arthroplasty Differ in Subtypes of High Dislocation

George Hartofilakidis MD, George C. Babis MD, DSC, Kalliopi Lampropoulou-Adamidou MD, MSc, John Vlamis MD, DSC

In a previous study, we described two subtypes of high dislocation of the hip depending on the presence (C1) or absence (C2) of a false acetabulum, yet we have already presented the concise followup of total hip arthroplasty (THA) in these patients as a group at a minimum of 15 years.

Total Hip Arthroplasty for the Sequelae of Legg-Calvé-Perthes Disease

Yaser M. K. Baghdadi MD, A. Noelle Larson MD, Anthony A. Stans MD, Tad M. Mabry MD

The durability and risks associated with total hip arthroplasty (THA) for patients with a history of Legg-Calvé-Perthes disease (LCPD) are not well known.

Reliability and Validity of Measuring Acetabular Component Orientation by Plain Anteroposterior Radiographs

Ming Lu MD, Yi-Xin Zhou MD, PhD, Hui Du MD, Ji Zhang MD, Jian Liu MD

Inaccurate placement of an acetabular cup can cause impingement, dislocation, and accelerated wear. However, there is no universally agreed-on approach to measuring cup position using plain radiographs.

Posterior Condylar Offset Does Not Correlate With Knee Flexion After TKA

Yoshinori Ishii MD, Hideo Noguchi MD, Mitsuhiro Takeda MD, Junko Sato MD, Shin-ichi Toyabe MD

Studies of medial and lateral femoral posterior condylar offset have disagreed on whether posterior condylar offset affects maximum knee flexion angle after TKA.

What Is the Success of Treatment of Hip and Knee Candidal Periprosthetic Joint Infection?

Steve W. N. Ueng MD, Ching-Yu Lee MD, Chih-chien Hu MD, Pang-Hsin Hsieh MD, Yuhan Chang MD, PhD

Fungal infection at an arthroplasty site is rare and poses a therapeutic challenge. To the best of our knowledge, no reports have been published thus far on the success rate of prosthesis reimplantation after fungal prosthetic joint infections.

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

In Jun Koh MD, Chong Bum Chang MD, Jung Ha Lee MD, Young-Tae Jeon MD, Tae Kyun Kim MD

Dexamethasone is a potent analgesic and antiemetic. However, the benefit of dexamethasone after TKA is unclear, as is the efficacy in a current multimodal regime.

How Reliable Are Standard Radiographic Measures of the Foot and Ankle in Children With Achondroplasia?

Jia Xu MD, Kwang-Won Park MD, Qing-Lin Kang MD, PhD, Young-Jin Jung MD, Hae-Ryong Song MD, PhD

Radiographic measurements are typically used in achondroplasia (ACH) during correction of lower limb alignment. However, reliabilities for the measurements on weightbearing radiographs of the foot and ankle in patients with ACH have not been described, and the differences between the ACH population and subjects without ACH likewise have not been well characterized; these issues limit the use of studies on this subject.

Is There an Epidemic Vitamin D Deficiency in German Orthopaedic Patients?

Gerrit Steffen Maier MD, Philipp Jakobs, Klaus Edgar Roth MD, Andreas Alois Kurth MD, Uwe Maus MD

Vitamin D plays an essential role in bone health and muscle function. Some studies have shown a widespread rate of vitamin D deficiency in the general population, but few have reported on the vitamin D status of orthopaedic patients.

The Peripheral Neuronal Phenotype is Important in the Pathogenesis of Painful Human Tendinopathy: A Systematic Review

Benjamin John Floyd Dean MRCS (Ed), Sarah L. Franklin PhD, Andrew Jonathan Carr FRCS, FMedSci

The pathogenesis of tendinopathy is complex and incompletely understood. Although significant advances have been made in terms of understanding the pathological changes in both the extracellular matrix and the cells involved, relatively little is known about the role of neuronal regulation in tendinopathy. The frequent mismatch between tendon pathology and pain may be explained, in part, by differences in the peripheral neuronal phenotype of patients.

Veterans With Diabetes Receive Arthroplasty More Frequently and at a Younger Age

Karen B. King PhD, Thomas W. Findley MD, PhD, Allison E. Williams RN, ND, PhD, Allan L. Bucknell MD

A future increase in total joint arthroplasties in patients with diabetes seems likely considering the prevalence of osteoarthritis and diabetes mellitus are increasing. However, the rates of arthroplasty in the population of patients with diabetes are unclear.

Case Report: Thoracic Outlet Syndrome in an Elite Archer in Full-draw Position

Jin Young Park MD, PhD, Kyung Soo Oh MD, Hyun Yul Yoo MD, Jun Gyu Lee MD

One possible pathomechanism of thoracic outlet syndrome (TOS) is shoulder abduction and extension inducing backward motion of the clavicle which causes compression on the brachial plexus. This position occurs during the full-draw stage of archery, by drawing and holding the bowstring.

Erratum to: Risk Factors for Early Revision After Primary TKA in Medicare Patients

Kevin J. Bozic MD, MBA, Edmund Lau MS, Kevin Ong PhD, Vanessa Chan MPH, Steven Kurtz PhD, Thomas P. Vail MD, Harry E. Rubash MD, Daniel J. Berry MD

Chronic Knee Pain in an 80-year-old Woman

Mark R. Robbin MD, Peter G. Pavlidakey MD, Patrick Getty MD, Hooman Yarmohammadi MD
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