Radiographic accuracy in TKA with a CT-based patient-specific cutting block technique.

PURPOSE: Patient-specific instrumentation (PSI) technology for the implantation of total knee arthroplasty (TKA) has a rising interest in the orthopaedic community. Data of PSI are controversially discussed. The hypothesis of this paper is that the radiological accuracy of CT-based PSI is similar to the one of navigated TKA published in the literature. METHODS: Since 2010, all 301 consecutively performed PSI TKAs (GMK MyKnee©) were included in this study. The radiological assessment consisted in a preoperative and postoperative standard X-ray and long-standing X-ray. Changes from the planned to the definitively implanted component size were documented. Postoperative analysis included limb alignment and position of femoral and tibial components (for varus/valgus and flexion or tibial slope). RESULTS: The postoperative average hip-knee-ankle angle was 180.1° ± 2.0°. In the frontal plane a total of 12.4 % of outliers >3°, for the tibial components 4.1 % of outliers >3° and for the femoral components 4.8 % of outliers >3° were measured. A total of 12.3 % of outliers for posterior tibial slope and 9 % of outliers >3° for the femoral flexion were noted. 10.8 % of the 602 planned size components were adapted intraoperatively. CONCLUSION: Although it is still unknown which limb axis is the correct one for the best clinical result, a technology providing the aimed axis in a most precise way should be chosen. Comparing the outcome of the current study with the data from the literature, there does not seem to be any difference compared to computer-assisted surgery. LEVEL OF EVIDENCE: IV.

Cómo lograr la óptima colaboración del niño en el consultorio dental / How to achieve optimal child co-operation in the dental office

El propósito del presente estudio fue evaluar la conducta de un grupo de niños durante su tratamiento dental mediante la utilización de técnicas no farmacológicas, así como también medir el grado de satisfacción alcanzado por los niños respecto a su tratamiento. El grupo de estudio estuvo constituido por 25 niños de 3 a 9 años de edad que fueron atendidos en la Clínica de Odontología Pediátrica Postgrado de la Facultad de Estomatología de la Universidad Peruana Cayetano Heredia (Lima, Perú), todos ellos con diagnóstico de caries dental y pulpitis irreversible que recibieron tratamiento de operatoria o terapia pulpar. El estudio concluye que las técnicas no farmacológicas son apropiadas para reducir la ansiedad en niños y lograr una colaboración óptima durante su tratamiento, permitiendo una adecuada relación paciente-dentista. A través del test de satisfacción del tratamiento dental de Tarnowski y Simonia se determinó que la mayoría de los niños presentaron grados de satisfacción positivos respecto de la atención que recibieron

Cómo lograr la óptima colaboración del niño en el consultorio dental / How to achieve optimal child co-operation in the dental office

El propósito del presente estudio fue evaluar la conducta de un grupo de niños durante su tratamiento dental mediante la utilización de técnicas no farmacológicas, así como también medir el grado de satisfacción alcanzado por los niños respecto a su tratamiento. El grupo de estudio estuvo constituido por 25 niños de 3 a 9 años de edad que fueron atendidos en la Clínica de Odontología Pediátrica Postgrado de la Facultad de Estomatología de la Universidad Peruana Cayetano Heredia (Lima, Perú), todos ellos con diagnóstico de caries dental y pulpitis irreversible que recibieron tratamiento de operatoria o terapia pulpar. El estudio concluye que las técnicas no farmacológicas son apropiadas para reducir la ansiedad en niños y lograr una colaboración óptima durante su tratamiento, permitiendo una adecuada relación paciente-dentista. A través del test de satisfacción del tratamiento dental de Tarnowski y Simonia se determinó que la mayoría de los niños presentaron grados de satisfacción positivos respecto de la atención que recibieron (AU)

The value of preoperative planning for total hip arthroplasty.

To analyse the value and accuracy of preoperative planning for total hip replacement (THR) we digitised electronically and compared the hand-sketched preoperative plans with the pre- and postoperative radiographs of 100 consecutive primary THRs. The correct type of prosthesis was planned in 98%; the agreement between planned and actually used components was 92% on the femoral side and 90% on the acetabular side. The mean (+/- SD) absolute difference between the planned and actual position of the centre of rotation of the hip was 2.5 +/- 1.1 mm vertically and 4.4 +/- 2.1 mm horizontally. On average, the inclination of the acetabular component differed by 7 +/- 2 degrees and anteversion by 9 +/- 3 degrees from the preoperative plans. The mean postoperative leg-length difference was 0.3 +/- 0.1 cm clinically and 0.2 +/- 0.1 cm radiologically. More than 80% of intraoperative difficulties were anticipated. Preoperative planning is of significant value for the successful performance of THR.

Operative management of the stiff elbow: sequential arthrolysis based on a transhumeral approach.

Between December 1990 and September 1993, 26 consecutive patients (27 elbows) were treated for elbow contractures. We used a modified transhumeral approach supplemented by a limited lateral approach with or without a limited medial approach according to the correction gained after each step of the procedure. Eleven posttraumatic, 6 degenerative, and 10 miscellaneous contractures were evaluated. The mean follow-up was 30 months. Statistically significant improvement in the range of motion was obtained for all groups of patients; the mean flexion-extension arc of motion increased from 66 degrees to 100 degrees for the posttraumatic contractures, from 79 degrees to 102 degrees for the degenerative contractures, and from 85 degrees to 121 degrees for a miscellaneous group of contractures. Relief of pain was not an issue in the posttraumatic group; it was not significant for the degenerative group but was significant for the miscellaneous group. Flexion and extension force were maintained, and no joint was made unstable. Complications included three transient ulnar neuropathies and one tardy ulnar nerve palsy. The technique presented offers the advantage of virtually unlimited exposure of the joint in a stepwise manner, dictated by the intraoperative assessment of joint motion combined with preservation of the medial and lateral collateral ligament complexes and all relevant muscle insertions and origins. The concept is applicable to contractures of differing cause and can be adapted to the specific needs of the patient.

Plate osteosynthesis of diaphyseal fractures of the radius and ulna.

Between January 1980 and December 1989, 133 consecutive patients were treated for a fracture of the shaft of one or both forearm bones (134 forearms in total). All fractures were stabilized with AO/ASIF 3.5 mm stainless-steel dynamic compression plates. The 1 year follow-up rate was 99 per cent; the long-term follow-up rate was 92 per cent (the mean long-term follow-up was 10.2 years (range, 2.7-15.2)) so there were 96 men and 35 women, with an average age of 37.5 years (range, 16-63). Twenty-two per cent of the forearms had open fractures, 26 per cent of patients had sustained multiple injuries and 19 per cent had a head injury. One hundred and twenty-seven of 132 forearms (96.2 per cent) underwent problem-free consolidation before 6 months. Two delayed unions and two non-unions required reoperation. There was one superficial infection in a patient with a closed fracture. Plates were removed from 70 patients (53 per cent) at a mean of 33.1 months (range, 8-122) after the first operation. In this group, there were three refractures (4.3 per cent) occurring at a mean of 8.7 months (range, 0-14) after plate removal. This study confirms the safety and efficacy of plate osteosynthesis in forearm shaft fractures: a high union rate and low complication rate can be anticipated. The data presented form the most reliable information on this subject currently available with the longest and highest rate of follow up of a sufficient number of patients using a single implant system in a single institution.

Use of the ipsilateral vascularised fibula for tibial reconstruction.

Between 1989 and 1994 we used a vascularised ipsilateral fibular graft in 24 patients with segmental tibial defects. We report 12 patients with a minimum follow-up of two years. The graft was either transposed medially or inverted on its vascular pedicle. Full weight-bearing was achieved at between four and seven months. We had few complications and consider that the use of this method is a valuable option in reconstruction of the tibia.