Surgical technique description : Transosseous 'over the top' reconstruction of capsule and tendons in primary total hip arthroplasty using a posterior approach.

Dislocation after total hip arthroplasty (THA) remains a devastating complication and a primary cause for revision arthroplasty. Historical data indicate that a posterior approach is associated with a higher dislocation rate. In this study, we present a highly reliable and anatomical reconstruction, based on the biomechanical findings of a previous cadaveric experiment. The posterior soft tissues were repaired in 2 layers. First a reattachment of the posterior orbicular ligament is performed at the anterior capsule. Subsequently a transosseous 'over the top' reinsertion of both capsule and tendons is performed close to there anatomical insertion. We prospectively collected data of 408 THAs from January 2004 until December 2013, through a posterior approach and with a capsule and tendon reconstruction based on a previous cadaveric study. There was a low early dislocation rate in primary THA (one of 408 THAs, 0,2%) and no complications related to the technique. This anatomical reconstruction of both capsule and tendons is associated with a low dislocation rate without complications at the level of the greater trochanter.

Intramedullary fixation of forearm fractures in adults.

The authors present a retrospective study of acute fractures of the diaphysis of the radius or ulna, or both, in adults treated by intramedullary nailing. Seventy diaphyseal fractures in 38 patients (30 men and 8 women) were treated by intramedullary fixation. The mean age of the patients was 31.5 years. Union occurred in 66 fractures (94%). The average union-time was 73 days. Compared with the results published by other authors, using the same evaluation criteria, union-time with the intramedullary technique was shorter than with other techniques. Union-rates and functional results were similar to those in comparable studies. Closed nailing does have many advantages, including early union, low incidence of infection, small scars, less blood loss, and short operating time with minimal surgical trauma.

Transcutaneous electrical stimulation (TCES) for the treatment of adolescent idiopathic scoliosis: preliminary results.

The authors report on the results of a preliminary study on the treatment of progressive idiopathic scoliosis by electrical surface stimulation. The study, involving 30 spinal curvatures, showed stabilization of the median primary curvature (30 degrees) in the course of treatment, the median duration of which was 12 months. Overall, 73.2% of the curvatures treated, responded favorably (stabilization or regression of the curve); however, 26.8% of the curvatures progressed in spite of the transcutaneous electrical stimulation treatment. The only complication noted was contact eczema in 20% of the cases. The authors feel that surface electrical stimulation treatment can be regarded as an acceptable alternative to a brace in the treatment of idiopathic scoliosis, and at this stage it deserves a place in the conservative therapeutic approach to idiopathic scoliosis.