Unexpected Long Lower Limb in Patients with Unilateral Hip Dislocation
Full-length standing AP radiographs best for predicting lower-limb-length discrepancy (LLD) in DDH patients. https://goo.gl/qc7DoY #JBJS #JBJSInfographics
Tags: developmental dysplasia of the hip, leg length discrepancy
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My TweetsMasquelet technique for the treatment of critical bone defects.
In the June 5th issue of The Journal, you can find an excellent current concepts review article on Masquelet technique written by Dr. Masquelet and colleagues!
The article reviews the surgical technique in detail, the history and development of the technique by Masquelet, the basic science behind the induced membrane, bone-grafting options, and key tips for success.
The clinical outcomes and patient reported outcomes in the literature is reviewed as well.
Lastly, the article features an FAQ with Masquelet (Table III). Definitely a must-read for any orthopedic surgeon treating bone defects!
You can find this article on jbjs.org in the June 5th issue of The Journal.
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #trauma #orthopedictrauma #traumasurgery #bone #fracture #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
Patellar tendon, hamstring tendon, or double-bundle ACL reconstruction?
In the June 5th issue of The Journal, Mohtadi et al. present their findings from a randomized control trial evaluating the 5-year outcomes of patients who underwent ACL reconstruction with a patellar tendon, single-bundle quadruple-stranded hamstring, or double-bundle hamstring autografts. A total 315 patients were randomized and completed the 5-year follow up which included Anterior Cruciate Ligament-Quality of Line score, IKDC scores, clinical exam, and reinjury rates.
At 5 years post op, there were no significant differences found in the disease-specific outcome scores across the three treatment groups. Although, a trend towards higher IKDC scores was seen in the patellar tendon group compared to the hamstring and double-bundle groups, this did not reach statistical significance.
Interestingly, there were a higher number of traumatic graft reinjuries seen in the hamstring and double-bundle groups (15% and 16%) compared to the patellar tendon group (4%) and this was statistically significant!
This article can be found at jbjs.org in the June 5th issue of The Journal.
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #sportsmedicine #aclreconstruction #aclinjury #acl #knee #sports #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
Modified V-Y Turndown Flap Augmentation for Quadriceps Tendon Rupture in TKA.
In the June 5th issue of The Journal, Shi et al. present their experience with using a modfied V-Y turndown flap to augment quadriceps tendon repairs following total knee arthroplasy. Twenty-four tendon ruptures in patients who previously underwent TKA were repaired using this technique by the senior author. Prior to the repair, none of the patients were able to walk independently.
Following repair, 92% of patients reported good or excellent results and 83% of patients achieved the goal of 0-120 degrees of active ROM and returned to pre-rupture activity levels. All patients were able to walk without an assistive device at the time of last follow up.
There were 2 (8%) complications in this series. One patient developed a hematoma and delayed wound healing that resolved with local wound care. The second sustained a re-rupture from a fall at 2 years post-op necessitating revision surgery.
This technique appears to be a reliable and effective treatment option for repairing quadriceps tendon ruptures in TKA without the need for allograft or synthetic material for tendon defects ≤6 cm.
This article can be found at jbjs.org in the June 5th issue of The Journal.
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #jointreplacement #totalkneearthroplasty #TKA #kneereplacement #science #jointreconstruction #arthroplasty #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
JBJS Deputy Editor for Social Media Chad Krueger, MD, discusses operative vs. nonoperative treatment for distal radius fractures in the elderly.
This article may be found in the June 5th issue of The Journal on jbjs.org
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #handsurgery #wrist #fracture #distalradiusfracture #randomizedcontrolledtrial #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
Need an update on Neer Type-II distal clavicle fractures?
In the most recent edition of JBJS Reviews, Hohmann et al. present an excellent overview of Neer Type-II distal clavicle fractures. They review the anatomy and biomechanics, contemporary surgical techniques, and the relevant literature on outcomes of each technique.
Important take home points include:
- Plate fixation alone is typically not sufficient as it does not address the horizontal and vertical instability seen in this injury.
- Hook plate fixation has the highest complication rate (41-63%).
- Augmentation of the coracoclavicular ligament is typically necessary to neutralize the deforming forces and reliably achieve union.
This review article can be found at jbjs.org under JBJS Reviews.
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #trauma #orthotrauma #bone #fracture #traumasurgery #clavicle #shoulder #shouldersurgery #sports #sportsmedicine #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
The evidence for decellular nerve allograft for nerve reconstruction grows!
If you haven’t seen it yet, the May 15th issue of The Journal published an excellent animal study evaluating the outcomes of decellular nerve allografts. Tang et al. created 10 mm sciatic nerve defects in genetically identical male Lewis rats and repaired them with a reverse autograft, 4-5 sural nerve cable autografts, or a matched-diameter decelluar nerve allograft. Outcomes were then measured at 12, 16, and 20 weeks which included functional testing and histologic evaluations.
The results demonstrated no significant difference between the decellular nerve allograft versus the reverse autograft or cable autografts across all measured outcomes and at times points.
Functional outcomes included isometric tetanic force recovery in tibialis anterior, tibialis muscle weight recovery, and gastrocnemius CMAP latency. Statistically significant improvements were seen across the time intervals however no differences were seen between the three repair groups suggesting nerve recovery progressed in all groups equally.
Histomorphometeric analysis evaluated axon density, myelin thickness, and G-ratio. The type of repair nor the time from surgery had an effect on axon count or axon density. Myelin thickness did increase with time from surgery but there were no differences seen between the three treatment groups at any time point.
This article serves to highlight the feasibility of using allograft for nerve reconstruction for nerve defects which avoids the inherent disadvantages of using autograft: donor site morbidity, limited graft availability, increased surgical time, and diameter mismatch. Still, more investigation is required before mainstream utilization of this technique including evaluating efficacy in humans.
This article can be found at jbjs.org in the May 15th issue of The Journal.
#jbjs #orthopedics #orthopedicsurgery #ortho #orthosurgery #surgery #medicine #handsurgery #nerve #nerveinjury #plasticsurgery #basicscience #science #nerverepair #nervereconstruction #evidencebasedmedicine #orthopedicresidency #orthoresidency #medicalschool
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