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Cao H, Zheng T, Jin Z. Validation for the effect of intra-exposure patient motion on the assessment of radiostereometric implant migration in a tibial component phantom study. Orthop Traumatol Surg Res 2024; 110:103776. [PMID: 38016580 DOI: 10.1016/j.otsr.2023.103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND An increasing number of radiostereometry (RSA) research studies have long-term follow-up implant migration outcomes, which show ascending curves of implant migration with occasionally decreasing migration. After scrutinizing images and RSA scenes related to the alternating curves, we suppose that intra-exposure patient motion may contribute to that. The main purposes of this in vitro study were 1) to identify whether the patient motion in different directions could result in the inaccurate assessment of implant migration, and 2) to figure out which direction(s) accounted for the alternating curves. HYPOTHESIS It was hypothesized that the assessments of implant migration would be less precise and accurate than they could be when patient motion occurred, and such motion would contribute to the alternating curves of radiostereometric implant migration. MATERIALS AND METHODS A customized phantom, assembled with a tibial component, was designed for simulating intra-exposure patient motion during follow-up RSA examinations. Two different Roentgen tubes were used as the current standard of radiology departments. Radiographs were acquired in a uniplanar technical arrangement. Two defined protocols were conducted: one is to simulate implant migration outcomes at post-op, the early stage (6months), and the later stage (2 to 10years) ; during the later stage, the other is to mimic patient motion by phantom motion in the medial-lateral (x), distal-proximal (y), and anterior-posterior (z) axes. RESULTS Phantom motion could result in the inaccurate assessment of implant migration, and translations along the medial-lateral (x) axis were the most influenced by patient motion. Motion along the medial-lateral (x) axis could account for the curves with decreasing migration. DISCUSSION Our assessments of implant migration may be less precise and accurate than they could be when intra-exposure patient motion occurs. We probably neglect the importance of 100% simultaneous exposures, and the influence of patient motion on RSA accuracy and data reliability, due to the difficulty in detecting patient (micro)motion. Electronically synchronized exposures of two paired Roentgen tubes are 100% simultaneous for image acquisition, and they are thus highly recommended for the assessment of implant migration in RSA. TYPE OF STUDY AND LEVEL OF PROOF not applicable.
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Affiliation(s)
- Han Cao
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; Department of Orthopaedic Surgery, Taizhou Second People's Hospital, 225599 Taizhou, PR China.
| | - Tiansheng Zheng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Gannan Medical University, 341000 Ganzhou, PR China
| | - Zhengshuai Jin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanjing Medical University, 210029 Nanjing, PR China; Department of Orthopaedic Surgery, Jiangsu Shengze Hospital, 215228 Suzhou, PR China
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Oh HS, Ryu CH, Kim SK, Kim WJ. Oral extrusion of implant after cervical disc arthroplasty: A case report. J Orthop Sci 2024; 29:418-422. [PMID: 35879208 DOI: 10.1016/j.jos.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/14/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Ho-Seok Oh
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Chang-Hyun Ryu
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Sung-Kyu Kim
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea.
| | - Woo-Jong Kim
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
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Jørgensen PB, Krag-Nielsen N, Lindgren L, Mørup RMS, Kaptein B, Stilling M. Radiostereometric analysis: comparison of radiation dose and precision in digital and computed radiography. Arch Orthop Trauma Surg 2023; 143:5919-5926. [PMID: 36422666 DOI: 10.1007/s00402-022-04674-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Radiostereometric Analysis (RSA) is used to measure fixation of joint prosthesis. This study compared radiation dose and image quality of a digital radiography (DR) RSA system and a computed radiography (CR) RSA system in a clinical setting. METHODS RSA recordings of 24 hips and shoulders were analyzed. We compared two systems: (1) Arcoma T0 with ST-VI image plates and Profect CR-IR 363 reader to (2) AdoraRSA with CXDI-70C wireless DR detectors in a clinical uniplanar RSA set-up with a ± 20 degrees tube angulation and 35 cm × 43 cm detectors. Effective dose was calculated using dedicated software. Image quality was evaluated using calibration errors as calculated by the RSA software. RESULTS The mean dose for hips was 0.14 (SD 0.04) mSv in the CR system and 0.05 (SD 0.02) mSv in the DR system. The mean dose for shoulders was 0.16 (SD 0.07) mSv in the CR system and 0.09 (SD 0.03) mSv in the DR system. Radiation dose was 64% (p < 0.001) and 43% (p = 0.03) lower in the DR system compared with the CR system for hip and shoulder RSA, respectively. Image quality was better for the DR system with 60-80% less calibration errors compared to the CR system. CONCLUSION Owing to highly efficient detectors and added filtration at the x-ray tubes, the DR system considerably reduced radiation dose compared with the CR system without compromising image quality. Based on the findings in this study, we recommend replacing CR RSA systems with DR RSA systems. REGISTRATION Patients were selected from clinical studies performed on the two systems and approved by the local ethics committee [20060165, M-20100112, M-20070082, M-20110224, and 20070258] and registered with ClinicalTrials.gov [NCT00408096, NCT01289834, NCT00913679, NCT02311179, and NCT00679120].
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Affiliation(s)
- Peter Bo Jørgensen
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark.
| | | | - Lars Lindgren
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Margrethe Staghøj Mørup
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
| | - Bart Kaptein
- Biomechanics and Imaging Group (BIG), Leiden University Medical Center, Leiden, The Netherlands
| | - Maiken Stilling
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
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Yao SH, Lin SF, Lin CH, Chen CH. Loop Anchor Tension Band Technique for Patella Fractures Lowers the Rate of Kirschner Migration. Injury 2021; 52:1556-1562. [PMID: 33243524 DOI: 10.1016/j.injury.2020.11.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/17/2020] [Accepted: 11/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the complications of patella fracture after open reduction and internal fixation using our innovative, loop-based modification of the tension band wiring technique and the traditional tension band wiring technique. METHODS Fifty-eight patients with patella fracture (AO/OTA: 34-C) were enrolled in this retrospective case-control study during the study period. We treated 36 patients with the traditional tension band wiring and 22 patients with our loop anchor tension band technique. Lysholm knee scoring scale, sex, numbers of wire dislodge, number of implants removal between two groups were compared. RESULTS The number of cases of wire dislodgement was zero in the loop anchor tension band group and seven in the traditional tension band group. There was statistically significant difference (P = 0.037). Lysholm knee score (P = 0.685) and operation time (P = 0.395) were not significantly different between the two groups CONCLUSIONS: The loop anchor tension band technique is safe and effective for treating patella fractures. The rates of implant loosening and wire pull-out were significantly lower in the loop anchor tension band group than those in the traditional technique group.
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Affiliation(s)
- Shu-Hsin Yao
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Shu-Fan Lin
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Chang-Hao Lin
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Chun-Ho Chen
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan;; School of Medicine, National Taiwan University, Taipei, Taiwan..
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Fili S, Seddig S, Vastardis I, Perdikakis G, Wölfelschneider P, Kohlhaas M. [Explantation of the CyPass implant in a case series of patients with corneal decompensation]. Ophthalmologe 2021; 118:42-49. [PMID: 32350610 DOI: 10.1007/s00347-020-01106-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In microinvasive glaucoma surgery (MIGS) the CyPass microstent (Alcon Inc.) was implanted in the suprachoroidal space to increase the uveoscleral outflow, thereby lowering the intraocular pressure. Due to the excessive loss of corneal endothelial cells, the implant was withdrawn from the global market in August 2018. METHODS A loss of corneal endothelial cells was observed in 6 patients (8 eyes in total) with early to moderate primary open-angle glaucoma 3 years after CyPass implantation. One eye developed a bullous keratopathy. In all patients an implant migration in the anterior chamber compared to the original postoperative position was detected, with more than one ring of the CyPass implant being visible in the anterior chamber. RESULTS In all eight cases the CyPass implant was removed. The local therapy with cortisone eye drops in combination with a 5% sodium chloride solution did not improve chronic corneal edema in one patient. Therefore, a Descemet membrane endothelial keratoplasty (DMEK) was performed with postoperative improvement of visual acuity. CONCLUSION In patients with more than one visible ring of the CyPass implant in the anterior chamber and subsequent localized loss of corneal endothelial cells, CyPass trimming or removal is recommended to avoid the progression of generalized corneal endothelial cell reduction and the onset of refractory, chronic corneal edema.
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Affiliation(s)
- Sofia Fili
- Klinik für Augenheilkunde, St.-Johannes-Hospital, Johannesstr. 9-17, 44137, Dortmund, Deutschland.
| | - Sabine Seddig
- Klinik für Augenheilkunde, St.-Johannes-Hospital, Johannesstr. 9-17, 44137, Dortmund, Deutschland
| | - Iraklis Vastardis
- Klinik für Augenheilkunde, St.-Johannes-Hospital, Johannesstr. 9-17, 44137, Dortmund, Deutschland
| | - Georgios Perdikakis
- Klinik für Augenheilkunde, St.-Johannes-Hospital, Johannesstr. 9-17, 44137, Dortmund, Deutschland
| | - Peter Wölfelschneider
- Klinik für Augenheilkunde, St.-Johannes-Hospital, Johannesstr. 9-17, 44137, Dortmund, Deutschland
| | - Markus Kohlhaas
- Klinik für Augenheilkunde, St.-Johannes-Hospital, Johannesstr. 9-17, 44137, Dortmund, Deutschland
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Wang XF, Meng Y, Liu H, Hong Y, Wang BY. Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery: Four case reports. World J Clin Cases 2020; 8:3890-3902. [PMID: 32953869 PMCID: PMC7479569 DOI: 10.12998/wjcc.v8.i17.3890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease. Surgical techniques are important for resolving patients’ symptoms and maintaining the normal functioning of cervical implants. However, the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit. In this paper, we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.
CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations. All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery. The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression. The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery. The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement. The symptoms of all patients were significantly relieved after surgery.
CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.
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Affiliation(s)
- Xiao-Fei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ying Hong
- Department of Operation Room, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bei-Yu Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Lefebvre R, Hom M, Leland H, Stevanovic M. Peripheral nerve injury with Nexplanon removal: case report and review of the literature. Contracept Reprod Med 2018; 3:15. [PMID: 30377538 PMCID: PMC6196439 DOI: 10.1186/s40834-018-0070-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/29/2018] [Indexed: 01/19/2023] Open
Abstract
Background Implantable devices offer convenient, long-acting, and reversible contraception. Injury to the peripheral nerves and blood vessels have been reported as rare complications of implantation and extraction. Case presentation We present a case of ulnar nerve injury in a 21-year-old woman from attempted in-office removal of a deeply implanted Nexplanon® device. The injury resulted in an ulnar nerve palsy requiring surgical exploration, neuroma excision, and sural nerve cable grafting. Conclusions In-office attempts to remove contraceptive implants that are deep or have migrated can cause iatrogenic nerve injury. Devices that are non-palpable, deep, or migrated should be imaged before formal surgical exploration and removal. Any patient with neurologic symptoms after placement or after attempted removal requires prompt diagnosis and referral to a peripheral nerve surgeon.
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Affiliation(s)
- Rachel Lefebvre
- 1Department of Orthopaedic Surgery, Division of Hand Surgery, University of Southern California, 1200 N State Street A7-CT, Los Angeles, CA 90033 USA
| | - Marianne Hom
- 2Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Ave., IRD Room 512, Los Angeles, CA 90033 USA
| | - Hyuma Leland
- 3Department of Plastic and Reconstructive Surgery, University of Southern California, 1510 San Pablo St., Suite 415, Los Angeles, CA 90033 USA
| | - Milan Stevanovic
- 1Department of Orthopaedic Surgery, Division of Hand Surgery, University of Southern California, 1200 N State Street A7-CT, Los Angeles, CA 90033 USA
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Abstract
The literature within the last 10 years on MRI use in patients with orthopedic implants is reviewed. A literature search returned 15 relevant articles. Only 2 discussed pediatric patients. Overall, significant displacement of implants was infrequent. Radiofrequency-induced heating of implants differed among the studies, but most reported increases of less than 1°C. The authors conclude MRI is safe in patients with orthopedic implants because implant displacement and heating pose little risk to patients. A risk-to-benefit ratio is warranted, however, to assess the clinical utility and necessity of the study. Further research and individual assessment of implant properties and MRI-related interactions are warranted.
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Jacobsen A, Seehaus F, Hong Y, Cao H, Schuh A, Forst R, Sesselmann S. Model-based roentgen stereophotogrammetric analysis using elementary geometrical shape models: 10 years results of an uncemented acetabular cup component. BMC Musculoskelet Disord 2018; 19:335. [PMID: 30223820 PMCID: PMC6142331 DOI: 10.1186/s12891-018-2259-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background Non-cemented acetabular cup components demonstrated different clinical performance depending on their surface texture or bearing couple. However, clinical osseointegration needs to be proved for each total joint arthroplasty (TJA) design. Aim of this study was to detect the in vivo migration pattern of a non-cemented cup design, using model-based roentgen stereophotogrammetric analysis with elementary geometrical shape models (EGS-RSA) to calculate early cup migration. Methods Interchangeable applicability of the model-based EGS-RSA method next to gold standard marker-based RSA method was assessed by clinical radiographs. Afterwards, in vivo acetabular cup migration for 39 patients in a maximum follow up of 120 months (10 years) was calculated using model-based EGS-RSA. Results For the axes with the best predictive capability for acetabular cup loosening, mean (±SD) values were calculated for migration and rotation of the cup. The cup migrated 0.16 (±0.22) mm along the cranio-caudal axis after 24 months and 0.36 (±0.72) mm after 120 months, respectively. It rotated − 0.61 (±0.57) deg. about the medio-lateral axis after 24 months and − 0.53 (±0.67) deg. after 120 months, respectively. Conclusions Interchangeable applicability of model-based EGS-RSA next to gold standard marker-based RSA method could be shown. Model-based EGS-RSA enables an in vivo migration measurement without the necessity of TJA specific surface models. Migration of the investigated acetabular cup component indicates significant migration values along all the three axes. However, migration values after the second postoperative year were within the thresholds reported in literature, indicating no risk for later aseptic component loosening of this TJA design.
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Affiliation(s)
- Anne Jacobsen
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Frank Seehaus
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Yutong Hong
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Han Cao
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Alexander Schuh
- Muskuloskelettales Zentrum, Klinikum Neumarkt, Nürnberger Str. 12, 92318, Neumarkt i. d. OPf, Germany
| | - Raimund Forst
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany
| | - Stefan Sesselmann
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Rathsberger Str. 57, 91054, Erlangen, Germany. .,Institute for Medical Technology, Ostbayerische Technische Hochschule Amberg-Weiden, Hetzenrichter Weg 15, 92637, Weiden, Germany.
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Abduljabbar FH, Waly F, Nooh A, Ouellet J. Growing rod erosion through the lamina causing spinal cord compression in an 8-year-old girl with early-onset scoliosis. Spine J 2016; 16:e641-6. [PMID: 27163968 DOI: 10.1016/j.spinee.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/29/2016] [Accepted: 05/04/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Early-onset scoliosis often occurs by the age of 5 years and is attributed to many structural abnormalities. Syndromic early-onset scoliosis is considered one of the most aggressive types of early-onset scoliosis. Treatment starts with serial casting and bracing, but eventually most of these patients undergo growth-sparing procedures, such as a single growing rod, dual growing rods, or a vertical expandable titanium prosthetic rib. PURPOSE This case report aimed to describe an unusual complication of erosion of a growing rod through the lamina that caused spinal cord compression in an 8-year-old girl with early-onset scoliosis. STUDY DESIGN This is a case report. METHODS A retrospective chart review was used to describe the clinical course and radiographic findings of this case after rod erosion into the spinal canal. RESULTS The patient underwent successful revision surgery removing the rod without neurologic complications. CONCLUSIONS Patients with syndromic early-onset scoliosis are more prone to progressive curves and severe rotational deformity. We believe that the severe kyphotic deformity in addition to the dysplastic nature of the deformity in this population may predispose them to this unusual complication.
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Affiliation(s)
- Fahad H Abduljabbar
- Division of Orthopedic Surgery, McGill Scoliosis and Spine Centre, McGill University Health Centre, 1650 Cedar Ave, T8-200, Montreal, QC H3G 1A4, Canada; Department of Orthopedic Surgery, King Abdulaziz University, Abdullah Sulayman St, P.O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Feras Waly
- Division of Orthopedic Surgery, McGill Scoliosis and Spine Centre, McGill University Health Centre, 1650 Cedar Ave, T8-200, Montreal, QC H3G 1A4, Canada; Division of Orthopedic Surgery, University of Tabuk, Khalid Elsedery St, P.O. Box 741, Tabuk, 71491, Saudi Arabia
| | - Anas Nooh
- Division of Orthopedic Surgery, McGill Scoliosis and Spine Centre, McGill University Health Centre, 1650 Cedar Ave, T8-200, Montreal, QC H3G 1A4, Canada; Department of Orthopedic Surgery, King Abdulaziz University, Abdullah Sulayman St, P.O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Jean Ouellet
- Division of Orthopedic Surgery, McGill Scoliosis and Spine Centre, McGill University Health Centre, 1650 Cedar Ave, T8-200, Montreal, QC H3G 1A4, Canada.
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Huang TW, Huang KC, Lin SJ, Chuang PY, Shih HN, Lee MS, Hsu RWW, Shen WJ. Effects of teriparatide on cementless bipolar hemiarthroplasty in patients with osteoporotic femoral neck fractures. BMC Musculoskelet Disord 2016; 17:300. [PMID: 27435235 PMCID: PMC4952237 DOI: 10.1186/s12891-016-1149-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/23/2016] [Indexed: 01/02/2023] Open
Abstract
Background For osteoporotic femoral neck fractures, suitable bone-implant stability is critical for pain relief, early return to daily activities and reduction of complications. Teriparatide (parathyroid hormone [PTH1-34]) can improve bone-implant stability in some basic studies. However it’s use in osteoporotic femoral neck fractures treated by cementless hemiarthroplasties for the beneficial effects on bone-implant stability is sparse in the literature. The aim of this study was to determine if post-operative teriparatide administration can reduce femoral stem migration and improve early functional recovery and health-related quality of life (HRQoL). Methods Between 2010 and 2014, patients with osteoporotic femoral neck fracture who underwent cementless bipolar hemiarthroplasty were included into this retrospective cohort study. Group A included patients treated with cementless bipolar hemiarthroplasty only; Group B patients had additional teriparatide. Demographic data, complications, radiographic and functional outcomes as well as health-related quality of life (HRQoL) were compared. Results There were 52 hips in group A (no teriparatide) and 40 hips in group B (patient who received teriparatide). The subsidence of the femoral stem tended to be significantly decreased in the teriparatide group at 6 and 12 weeks post-operatively (p = 0.003 and p = 0.008, respectively). The Harris Hip Score (HHS) increased significantly from pre-operation to 6 weeks post-operatively and thereafter up to one year in both groups. However, there were no significant differences in terms of subsequent fracture, mortality, HHS, and HRQoL between two groups during the entire study period. Conclusions Teriparatide significantly reduces the subsidence of the cementless femoral stem in elderly patients in the early post-operative period, but this benefit does not reflect better functional outcomes and HRQoL. Further prospective randomized large-scale cohort study is warranted for evidence-based recommendations.
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Affiliation(s)
- Tsan-Wen Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan No. 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan.,Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Huang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan No. 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan.,Chang Gung University, Taoyuan, Taiwan
| | - Shih-Jie Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan No. 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan
| | - Po-Yao Chuang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan No. 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan
| | - Hsin-Nung Shih
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University, Taoyuan, Taiwan
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Road, Niaosong Dist., Kaohsiung City, 83301, Taiwan. .,Chang Gung University, Taoyuan, Taiwan.
| | - Robert Wen-Wei Hsu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan No. 6, West Section, Chia-Pu Road, Pu-Tz City, Chia-Yi Hsien, 613, Taiwan. .,Chang Gung University, Taoyuan, Taiwan.
| | - Wun-Jer Shen
- PO CHENG Orthopedic Institute, 100 Bo-ai 2nd Road Zuoying District, Kaohsiung, Taiwan
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Mankowski B, Polchlopek T, Strojny M, Grala P, Slowinski K. Intraspinal migration of a Kirschner wire as a late complication of acromioclavicular joint repair: a case report. J Med Case Rep 2016; 10:66. [PMID: 27012827 PMCID: PMC4807587 DOI: 10.1186/s13256-016-0844-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 02/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Penetrating neck trauma involving foreign bodies is a rare event in European countries. Due to its relatively high mortality rate, the correct management strategy must be initiated from the beginning to prevent fatal complications. In the medical literature, there are only a few cases describing foreign bodies penetrating the cervical spine. Because of its rareness, many trauma centers lack the proper routine to adequately manage such injuries. CASE PRESENTATION This case report describes a 34-year-old white man of Central European descent with Kirschner wire migration and perforation of his vertebral foramen. He underwent acromioclavicular joint repair surgery 7 years ago, presented with a painful sensation around the area of his left clavicle and left side of his neck after a motorcycle accident. No neurological deficit was detected. CONCLUSIONS In such cases, a thorough radiological evaluation of the spinal cord and the surrounding vasculature is mandatory for a complete understanding of the extent of the injury and determining the proper surgical management. In cases of vertebral artery trauma both an endovascular and an open approach can be contemplated.
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Affiliation(s)
- Bartosz Mankowski
- Department of Trauma, Burns and Plastic Surgery, Poznan University of Medical Sciences, Poznań, Poland.
| | - Tadeusz Polchlopek
- Department of Trauma, Burns and Plastic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Marcin Strojny
- Department of Trauma, Burns and Plastic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Pawel Grala
- Department of Trauma, Burns and Plastic Surgery, Poznan University of Medical Sciences, Poznań, Poland
| | - Krzysztof Slowinski
- Department of Trauma, Burns and Plastic Surgery, Poznan University of Medical Sciences, Poznań, Poland
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Mechlenburg I, Klebe TM, Døssing KV, Amstrup A, Søballe K, Stilling M. Evaluation of periprosthetic bone mineral density and postoperative migration of humeral head resurfacing implants: two-year results of a randomized controlled clinical trial. J Shoulder Elbow Surg 2014; 23:1427-36. [PMID: 25220196 DOI: 10.1016/j.jse.2014.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/05/2014] [Accepted: 05/15/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Implant migration, bone mineral density (BMD), length of glenohumeral offset (LGHO), and clinical results were compared for the Copeland (Biomet Inc, Warsaw, IN, USA) and the Global C.A.P. (DePuy Int, Warsaw, IN, USA) humeral head resurfacing implants (HHRIs). METHODS The study randomly allocated 32 patients (13 women), mean age 63 years (range, 39-82 years), with shoulder osteoarthritis to a Copeland (n = 14) or Global C.A.P. (n = 18) HHRI. Patients were monitored for 2 years with radiostereometry, dual-energy X-ray absorptiometry, Constant Shoulder Score (CSS), and the Western Ontario Osteoarthritis of the Shoulder Index (WOOS). LGHO was measured preoperatively and 6 months postoperatively. RESULTS At 2 years, total translation (TT) was 0.48 mm (standard deviation [SD], 0.21 mm) for the Copeland and 0.82 mm (SD, 0.46 mm) for the Global C.A.P. (P = .06). Five HHRI were revised, and in the interval before the last follow-up (revision or 2 years), TT of 0.58 mm (SD, 0.61 mm) for revised HHRI was higher (P = .02) than TT of 0.22 mm (SD, 0.17 mm) in nonrevised HHRI. A comparison of TT at the last follow-up (revision or 2 years) found no difference between the HHRIs (P = .12). Periprosthetic BMD decreased initially but increased continuously after 6 months for both HHRIs. At 2 years, BMD was 48% higher around the Copeland HHRI (P = .005). The mean difference in LGHO was significantly higher for the Copeland than for the Global C.A.P. HHRI (P = .02). Clinical results evaluated with CSS and WOOS improved over time for both implant groups (P < .01), with no differences between the groups. CONCLUSION Both implants had only little migration and good clinical results. Periprosthetic BMD and LGHO both increased for the Copeland HHRI more than for the Global C.A.P HHRI.
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