Hip flexion strength remains decreased in anterior cruciate ligament reconstructed patients at one-year follow up compared to healthy controls.

PURPOSE: The aim of this study was to evaluate hip muscle flexion strength in patients who underwent anterior cruciate ligament (ACL) reconstruction with patellar or hamstrings tendon graft and compare them with healthy controls. METHODS: Sixty-eight male ACL deficient patients who underwent reconstruction (36 patients with hamstrings tendon graft and 32 patients with patellar tendon graft; randomized selection of type of graft) in our department, between July 2011 and July 2012, were enrolled in this randomised prospective study. Also 64 healthy male weekend athletes participated in the study as a control group. Hip flexor strength was measured by isokinetic dynamometer (Biodex), pre-operatively and one year after reconstruction. The statistical packet STATA 8.0 was used and statistical significance was set at p < 0.05. RESULTS: Hip flexion strength in ACL reconstructed patients either with patellar tendon or hamstrings grafts, one year after reconstruction is significantly decreased compared to healthy controls (p < 0.0001). Patients reconstructed with patellar tendon have stronger hip flexors than those reconstructed with hamstrings graft (p < 0.0001). CONCLUSION: Hip flexion strength remains decreased one year after ACL surgery compared to healthy controls. Patellar tendon could be the graft of choice for ACL reconstruction in athletes who must preserve stronger hip flexors.

Peroneus longus acute calcific tendinitis: a case report.

Calcific tendinitis of the peroneus longus tendon is extremely rare, with only two cases described previously in the literature. Herein we discuss the diagnosis and management of a case with an acute calcific tendonitis of peroneus longus tendon.

Complications associated with clavicular fracture.

The objective of our literature review was to inform orthopaedic nurses about the complications of clavicular fracture, which are easily misdiagnosed. For this purpose, we searched MEDLINE (1965-2005) using the key words clavicle, fracture, and complications. Fractures of the clavicle are usually thought to be easily managed by symptomatic treatment in a broad arm sling. However, it is well recognized that not all clavicular fractures have a good outcome. Displaced or comminuted clavicle fractures are associated with complications such as subclavian vessels injury, hemopneumothorax, brachial plexus paresis, nonunion, malunion, posttraumatic arthritis, refracture, and other complications related to osteosynthesis. Herein, we describe what the orthopaedic nurse should know about the complications of clavicular fractures.

Unusual cervical spine injury by fishing harpoon.

Modern fishing and hunting weapons are powerful and capable of causing severe tissue damage, similarly to gunshot wounds. The principles of management after fish harpoon penetrating injuries include primary basic life support, followed by trajectory surgical removal and wound care. Clinicians should know about the structures and the mechanisms of fishing harpoons and how to manage these injuries to avoid fatal complications. Lesions to the neck produced by underwater fishing harpoon, are extremely rare. Herein we describe a case of an unusual injury of cervical spine by fishing harpoon, and we discuss the appropriate management.

Massive haemorrhage due to minimally displaced pubic ramus fracture.

Fractures of the pubic ramus are commonly seen in the emergency room, but they are thought to be minor injuries. Occasionally, these fractures might be associated with massive haemorrhage. Here we report a case of bilateral obturator artery damage due to minimal displaced pubic ramus fracture.

Septic knee arthritis following ACL reconstruction: a systematic review.

Although postoperative septic arthritis is rare after ACL reconstruction, it carries a high morbidity that results in poor clinical outcome. Despite low incidence, it is important to recognize that infection and treat it without delay because of devastating consequences, such as loss of hyaline cartilage and arthrofibrosis, in order to avoid osteoarthritis development and near full range of motion achieved. Herein we discuss the pathogenesis, risk factors, clinical presentation, diagnostic evaluation, treatment protocols and complications of septic knee arthritis after ACL reconstruction.

Removal of broken distal intramedullary nail with a simple method: a case report.

Breakage of the intramedullary nail has long been recognized as an uncommon complication of intamedullary nailing of long bones. Retrieval of the distal fragment of a broken nail is a challenging problem. The surgeon needs to be familiar with as many methods of distal fragment extraction as possible. Herein we report a case of broken intramedullay nail, which was removed with a small reamer, wedged into the distal segment of the nail.

Intra-articular knee haemangioma originating from the anterior cruciate ligament: a case report.

INTRODUCTION: Synovial haemangioma is a rare intra-articular benign tumour, which may arise from any synovium-lined surface, but particularly in the knee joint. Synovial haemangioma originating from the anterior cruciate ligament has not been reported previously. CASE PRESENTATION: A 34-year-old man presented with a history of intermittent knee pain, locking and swelling. CONCLUSION: Knee intra-articular haemangioma, a very rare benign tumour, is often misdiagnosed. Magnetic resonance imaging is effective in detecting this lesion and should be performed in cases of persistent knee swelling and pain.

Occult acetabulum fracture. A case report.

Acetabular fractures that are radiographically occult are associated with insufficiency fractures, stress fractures, and fractures secondary to steroid-induced osteoporosis, usually affecting older patients after low-energy trauma. Occult acetabulum fractures in young patients are extremely rare. We discuss herein a case of an occult acetabulum fracture after high-energy trauma, in a young patient. This case illustrates the need for further diagnostic studies such as computed tomography, magnetic resonance imaging, or bone scanning when, despite negative radiographic findings, groin pain is persistent.

Complications of clavicle fracture and acromioclavicular joint rupture. What the general surgeon should know.

Fractures of the clavicle and acute dislocations of the acromioclavicular joint are common seen in the emergency room. Displaced or comminuted clavicle fractures and acromioclavicular joint ruptures (types III-VI) are associated with complications, such as subclavian vessels injury, hemopneumothorax, scapula-thoracic dissociation or brachial plexus paresis. Herein we discuss the usually complications seen after these injuries and underline whatever a trauma surgeon should know in order to avoid fatal situations.

The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options.

According to the literature, hip function after hip fracture is affected by the type of surgery. Our aim was to determine the correlation between surgical treatment of hip fracture and postoperative function in the elderly. Inclusion criteria were displaced hip fracture and age over 70 years. One hundred and twenty-nine participants were randomly divided into three groups according to the type of the surgical operation they underwent (hemi-arthroplasty [Merete, Berlin, Germany], total arthroplasty [Plus; De Puy, Warsaw, IN, USA] and internal fixation [Richards plate screw; Smith & Nephew, Memphis, TN, USA]). The function of the patients was estimated using the following parameters: the Barthel Index and Harris Hip Score, the range of passive hip motion, the gait speed of individuals, after 1 and 4 years of follow-up. The Barthel Index scores after 4 years of follow-up were 85.3, 82.6, 80.1 after total arthroplasty, hemi-arthroplasty and internal fixation respectively. Similarly, the Harris Hip Scores after 4 years of follow-up were 83.7, 79.5 and 73.6. The range of passive hip motion in the three groups of patients did not differ significantly (p>0.05). Also, patients of the total arthroplasty and hemi-arthroplasty groups walked faster than the patients of the internal fixation group 4 years after discharge (p<0.05). In conclusion, we believe that total hip arthroplasty is the treatment of choice for displaced subcapital hip fractures in patients over 70 years old.

Perioperative creatine phosphokinase (CPK) and troponin I trends after elective hip surgery.

BACKGROUND: Perioperative myocardial infarction (MI) is an important risk factor for cardiac morbidity and mortality after hip surgery. On the basis of the limitations of creatine kinase cardiac muscle isoenzyme (CK-MB) in the perioperative setting, and the high specificity of troponin I, we hypothesized that troponin I would be effective at detecting perioperative MI more frequently than CK-MB would be, after hip surgery. METHODS: A prospective study of the serum levels of creatine phosphokinase (CPK), its isoenzyme CK-MB, and troponin I, in 90 patients with risk factors for coronary artery disease, undergoing hip surgery is reported. We measured these cardiac markers in the postoperative period for 5 days, after hemiarthroplasty, total hip arthroplasty, and hip intramedullary nailing. RESULTS: We found increased levels of creatine phosphokinase and CK-MB, after all the types of operation, with maximum levels reached on the first postoperative day and the levels were more pronounced after total hip arthroplasty. False-elevated CK-MB index >6% without MI was evidenced in 43.3% of patients. Troponin I levels were elevated >3.1 ng/mL only in the patients who suffered MI postoperatively. All the patients who suffered MI had both CK-MB index and troponin I levels elevated. Also, we found high correlation between maximum CK-MB levels and size of implants, which means that reaming and its heating effect may be responsible for false-elevated CK-MB levels, except direct muscle damage caused by surgical incision. CONCLUSION: CK-MB index and troponin I have the same sensitivity, but troponin I is more specific than CK-MB index in detecting MI after hip surgery.