Avulsion fracture of the ischial tuberosity: A surgical dilemma.

The clinician should make the treatment choice considering the patient's requirements. Thus, surgical treatment can successfully achieve long-lasting satisfactory results and provide the best chance for a rapid return to sports.

Caudal Epidural Injections in Lumbar Spinal Stenosis: Comparison of Nonimage, Ultrasonography-, and Fluoroscopy-Guided Techniques. A Randomized Clinical Trial.

INTRODUCTION: Caudal epidural injections (CEIs) are widely used in the treatment of lumbar spinal stenosis (LSS). Imaging modalities, such as fluoroscopy and ultrasonography, are frequently employed to confirm proper needle placement and to prevent possible complications. This is a prospective, randomized, study aiming to compare the efficacy of nonimage, ultrasonography-, and fluoroscopy-guided CEIs for the management of LSS. METHODS: A total of 45 patients were included based on their clinical symptoms and their magnetic resonance images indicative of LSS. Patients were randomized and allocated into 3 equal groups, the nonimage, the ultrasonography-guided, and the fluoroscopy-guided group. All patients received 12 mg betamethasone and 4 mg ropivacaine dissolved in 20 mL normal saline. The injections were administered twice, with a 30-day interval. Visual Analogue Scale (VAS) and Oswestry Disability Index were recorded before the injections and 1 month after the second injection. The procedure times for each group were also compared. RESULTS: Visual Analogue Scale scores and Oswestry Disability Index values were improved in all the groups compared to the baseline values (p < 0.001). The intergroup difference in Visual Analogue Scale scores and Oswestry Disability Index values before and after CEIs was not statistically significant (p = 0.836 and p = 0.438, respectively). The mean procedure time was higher for the fluoroscopy-guided group, followed by ultrasonography-guided, but the differences were not statistically significant (p = 0.067). CONCLUSION: CEIs are an effective analgesic method for patients suffering from LSS. Nonimage, ultrasonography-, and fluoroscopy-guided CEIs are similarly effective in terms of pain relief and functional improvement.

Flexible intramedullary nailing in the treatment of forearm fractures in children and adolescents, a systematic review.

BACKGROUND: Forearm fractures are common injuries among children and adolescents. Traditionally, they were managed conservatively with closed reduction and cast immobilization. The last decade there is an increasing trend towards operative treatment. The treatment modalities available include plate and screws, flexible intramedullary nailing and external fixation devices - rarely used nowadays. The aim of this systematic review is to investigate the indications of flexible intramedullary nailing in the childhood population, to compare its results with plating and to provide detailed information considering technical pitfalls and complications that may be encountered. MATERIALS AND METHODS: An extensive search was performed in the electronic databases (PubMed, EMBASE) from their inception up to June 2019 in order articles relevant to this review to be retrieved. The search terms used were the following: forearm fracture, both-bone fracture, pediatric, nailing, fixation. 56 articles were considered suitable for inclusion. RESULTS: The indications for surgery are unstable and irreducible fractures, open and fractures with neurovascular compromise. As far as the fracture site is concerned, radius and ulna shaft fractures, radial head and Monteggia fractures are suitable for nailing.Although plates and nailing have comparable clinical outcomes and complication rates, flexible intramedullary nailing has the advantage of smaller incisions, less tissue disruption, shorter operative and hospital times and an ease in hardware removal.Controversy exists over the need of single or double nailing in both-bone fractures of the forearm. In addition, there is no consensus as to which is the preferred nail diameter. Yet, all the authors agree that open reduction must be considered after certain failed closed reductions in order compartment syndrome to be avoided.Flexible intramedullary nailing is not complication-free. Skin irritation, Extensor Pollicis Longus rupture, superficial radial nerve injury, delayed union or even nonunion, malunion and refractures are some of the complications that may be encountered. DISCUSSION: Flexible nails are excellent implants combining stability and elasticity. The procedure of passing the nails across radius and ulna is relatively simple, requiring a small learning curve. Flexible intramedullary nailing is an excellent treatment modality for the treatment of forearm fractures in children and adolescents.

Cruciate-retaining total knee arthroplasty: How much of the PCL is really retained?

PURPOSE: It is questionable how much of the PCL is really preserved following a complete transverse tibial cut during a cruciate-retaining (CR) total knee arthroplasty (TKA). It is hypothesized that a complete transverse tibial cut jeopardizes the PCL tibial insertion during a common CR TKA. Thus, the aim of the present study was to assess intraoperatively the amount of PCL tibial attachment damage following a standard complete tibial cut technique. METHODS: Thirty consecutive female patients suffering from degenerative knee osteoarthritis were included. Two measurements were performed on preoperative MRI images. On sagittal plane, the PCL facet of tibia and the PCL tibial attachment were measured. All 30 patients underwent a TKA using a common CR prosthesis. Postoperatively, the amount of PCL facet resection was measured on the resected tibial plateau using a digital sliding caliper. RESULTS: In preoperative MRI images, the length of the PCL facet of tibia was found 25.5 ± 2.1 mm and the length of the PCL tibial attachment was 14.5 ± 1.3 mm. The amount of PCL facet resection following TKA was 20.6 ± 2.2 mm on average. This result corresponds to an average resection of 65.1 ± 15.9 % of the PCL tibial attachment following TKA. CONCLUSION: The hypothesis that a complete transverse tibial cut during a conventional CR TKA jeopardizes the PCL tibial insertion was confirmed. According to measurements performed on preoperative knee MRI scans and surgical specimens of resected tibial plateaus, a significant amount of the PCL insertion on the tibia is actually removed in the majority of cases. Surgeons should be aware that when resecting the tibial plateau without using a technique that spares the PCL tibial attachment, there is a high risk of considerable damage to the PCL that may, in turn, increase the likelihood of potential complications due to PCL deficiency. LEVEL OF EVIDENCE: IV.

The Rotaglide mobile-bearing total knee arthroplasty: no difference between cemented and hybrid implantation.

PURPOSE: The optimal fixation of the Rotaglide total knee arthroplasty's (TKA) components is controversial. It is hypothesized that the hybrid fixation (cementless femoral component) in a mobile-bearing TKA system might cause increased rate of loosening--especially in the femoral part--and finally failure of the arthroplasty. Consequently, the aim of this study was to compare the survival and revision rates and also the clinical and radiological outcomes of the cemented and hybrid fixation of the Rotaglide TKA. METHODS: One hundred patients, who underwent TKA with the Rotaglide prosthesis, were randomly placed in two groups. In the first group, the prosthesis was cemented, and in the second group, the hybrid technique was used. Revision and mortality rates were compared after 8-12 years of follow-up. Knee and Osteoarthritis Outcome Score (KOOS) questionnaire and the Knee Society Roentgenographic Evaluation and Scoring System were used to demonstrate clinical and radiographic differences. RESULTS: There were no statistically significant differences in revision (n.s.) or mortality (n.s.) rates between the two treatment arms. The clinical outcome at the time of last follow-up (mean 9.5 years, SD ± 1.4) ranged from very good to excellent (77.8 ± 17.5 for the cemented group and 77.2 ± 20.4 for the hybrid group). No statistically significant differences in all KOOS subscales. Radiographs showed no significant difference in prosthesis alignment and no evidence of loosening between groups. CONCLUSION: The hypothesis that the hybrid fixation in a mobile-bearing TKA system might cause increased rate of loosening and finally failure of the arthroplasty was not confirmed. The fixation technique (cemented or hybrid) had no influence on the prosthesis's survivorship, and also on mortality rates, clinical and radiographic outcomes in a mean follow-up time of 9.5 ± 1.4 years. The Rotaglide TKA is a safe and reliable prosthesis regardless the fixation technique.