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Search for other papers by Michael Beverly in
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This review of bone perfusion introduces a new field of joint physiology, important in understanding osteoarthritis.
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Intraosseous pressure (IOP) reflects conditions at the needle tip rather than being a constant for the whole bone. Measurements of IOP in vitro and in vivo, with and without proximal vascular occlusion confirm that cancellous bone is perfused at normal physiological pressures.
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Alternate proximal vascular occlusion may be used to give a perfusion range or bandwidth at the needle tip more useful than a single IOP measure.
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Bone fat is essentially liquid at body temperature. Subchondral tissues are relatively delicate but are micro-flexible. They tolerate huge pressures with loading.
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Collectively, the subchondral tissues transmit load mainly by hydraulic pressure to the trabeculae and cortical shaft.
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Normal MRI scans demonstrate subchondral vascular marks which are lost in early osteoarthritis.
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Histological studies confirm the presence of those marks and possible subcortical choke valves which support hydraulic pressure load transmission.
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Osteoarthritis appears to be at least partly a vasculo-mechanical disease. Understanding subchondral vascular physiology will be key to better MRI classification and prevention, control, prognosis and treatment of osteoarthritis and other bone diseases.
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Search for other papers by Pietro Ruggieri in
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Satisfactory results in terms of functional and oncological outcomes can be obtained in sacral and pelvic malignant bone tumors.
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Preoperative planning, adequate imaging, and a multidisciplinary approach are needed.
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3D-printed prostheses have to fulfill several requirements: (i) mechanical stability, (ii) biocompatibility, (iii) implantability, and (iv) diagnostic compatibility.
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In this review, we highlight current standards in the use of 3D-printed technology for sacropelvic reconstruction.
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Despite the general success of anterior cruciate ligament reconstructions (ACL-R), there are still studies reporting a high failure rate. Orthopedic surgeons are therefore increasingly confronted with the treatment of ACL retears, which are often accompanied by other lesions, such as meniscus tears and cartilage damage and which, if overlooked, can lead to poor postoperative clinical outcomes.
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The literature shows a wide variety of causes for ACL-R failure. Main causes are further trauma and possible technical errors during surgery, among which the position of the femoral tunnel is thought to be one of the most important.
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A successful postoperative outcome after ACL-revision surgery requires good preoperative planning, including a thorough evaluation of patient's medical history, e.g. instability during daily or sports activity, increased general joint laxity, and hints for a low-grade infection. A careful clinical examination should be performed. Additionally, comprehensive imaging is necessary. Besides a magnetic resonance imaging, a CT scan is helpful to determine location of tunnel apertures and to analyze for tunnel enlargement. A lateral knee radiograph is helpful to determine the tibial slope.
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The range of surgical options for the treatment of ACL-R failure is broad today. Orthopedic surgeons and experts in Sports Medicine must deal with various possible associated injuries of the knee or unfavorable anatomical conditions for ACL-R.
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The aim of this review was to highlight predictors and reasons of failures of ACL-R as well as describe diagnostic procedures to individualize treatment strategies for improved outcome after revision ACL-R.
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Search for other papers by Alexander Milstrey in
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The relevance of geriatric ankle fractures is continuously increasing.
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Treatment of these patients remains challenging and requires adapted diagnostic and therapeutic strategies, as compliance to partial weight bearing is difficult to maintain compared to younger patients.
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In addition, in the elderly even low impact injuries may lead to severe soft tissue trauma, influencing timing and operative strategies.
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Recently, the direct posterolateral approach and plate fixation techniques, angular stable implants as well as intramedullary nailing of the distal fibula have been found to improve stategical concepts.
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This article aims to provide a comprehensive overview of the diagnostic and recent aspects with respect to how this difficult entity of injuries should be approached.
ICATKnee, Institut Catalá de Traumatologia i Medicina de l’Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain
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ICATKnee, Institut Catalá de Traumatologia i Medicina de l’Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain
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Search for other papers by Giuseppe Gianluca Costa in
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Anterior cruciate ligament (ACL) reconstruction failure can be defined as abnormal knee function due to graft insufficiency with abnormal laxity or failure to recreate a functional knee according to the expected outcome.
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Traumatic ruptures have been reported as the most common reason for failure. They are followed by technical errors, missed concomitant knee injuries, and biological failures.
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An in-depth preoperative examination that includes a medical history, clinical examinations, advanced imaging, and other appropriate methods is of utmost importance.
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There is still no consensus as to the ideal graft, but autografts are the favorite choice even in ACL revision.
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Concomitant meniscal treatment, ligamentous reconstruction, and osteotomies can be performed in the same surgical session to remove anatomical or biomechanical risk factors for the failure.
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Patient expectations should be managed since outcomes after ACL revision are not as good as those following primary ACL reconstruction.
Search for other papers by Agnieszka Halm-Pozniak in
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Search for other papers by Bernd Grimm in
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Digitization in orthopaedics and traumatology is an enormously fast-evolving field with numerous players and stakeholders. It will be of utmost importance that the different groups of technologists, users, patients, and actors in the healthcare systems learn to communicate in a language with a common basis.
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Understanding the requirements of technologies, the potentials of digital application, their interplay, and the combined aim to improve health of patients, would lead to an extraordinary chance to improve health care.
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Patients' expectations and surgeons’ capacities to use digital technologies must be transparent and accepted by both sides.
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The management of big data needs tremendous care as well as concepts for the ethics in handling data and technologies have to be established while also considering the impact of withholding or delaying benefits thereof.
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This review focuses on the available technologies such as Apps, wearables, robotics, artificial intelligence, virtual and augmented reality, smart implants, and telemedicine.
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It will be necessary to closely follow the future developments and carefully pay attention to ethical aspects and transparency.
Search for other papers by Paul L Rodham in
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Search for other papers by Vasileios P Giannoudis in
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Department of Trauma & Orthopaedics, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland
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Search for other papers by Peter V Giannoudis in
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The ability to enhance fracture healing is paramount in modern orthopaedic trauma, particularly in the management of challenging cases including peri-prosthetic fractures, non-union and acute bone loss.
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Materials utilised in enhancing fracture healing should ideally be osteogenic, osteoinductive, osteoconductive, and facilitate vascular in-growth.
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Autologous bone graft remains the gold standard, providing all of these qualities. Limitations to this technique include low graft volume and donor site morbidity, with alternative techniques including the use of allograft or xenograft.
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Artificial scaffolds can provide an osteoconductive construct, however fail to provide an osteoinductive stimulus, and frequently have poor mechanical properties.
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Recombinant bone morphogenetic proteins can provide an osteoinductive stimulus; however, their licencing is limited and larger studies are required to clarify their role.
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For recalcitricant non-unions or high-risk cases, the use of composite graft combining the above techniques provides the highest chances of successfully achieving bony union.
Search for other papers by Martin McNally in
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Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Austria
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Search for other papers by Ricardo Sousa in
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Prosthetic joint infections (PJI) can be difficult to diagnose.
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Studies have shown that we are missing many infections, possibly due to poor diagnostic workup and the presence of culture-negative infection.
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PJI diagnosis requires a methodical approach and a standardised set of criteria.
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Multiple PJI definitions have been published with improved accuracy in recent years.
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The new European Bone and Joint Infection Society definition offers some advantages in clinical practice. It identifies more clinically important infections and accurately defines those with the highest risk of treatment failure. It reduces the number of patients with uncertain diagnoses.
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Classification of PJIs may offer a better understanding of treatment outcomes and risk factors for failure.
Search for other papers by Mark F Siemensma in
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Search for other papers by Anna E van der Windt in
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Search for other papers by Denise Eygendaal in
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The elbow is prone to stiffness due to its unique anatomy and profound capsular reaction to inflammation. The resulting movement impairment may significantly interfere with a patient’s activities of daily living.
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Trauma (including surgery for trauma), posttraumatic arthritis, and heterotopic ossification (HO) are the most common causes of elbow stiffness.
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In stiffness caused by soft tissue contractures, initial conservative treatment with physiotherapy (PT) and splinting is advised. In cases in which osseous deformities limit range of motion (e.g. malunion, osseous impingement, or HO), early surgical intervention is recommended.
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Open and arthroscopic arthrolysis are the primary surgical options. Arthroscopic arthrolysis has a lower complication and revision rate but has narrower indications.
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Early active mobilization using PT after surgery is recommended in postoperative rehabilitation and may be complemented by splinting or continuous passive motion therapy. Most results are gained within the first few months but can continue to improve until 12 months.
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This paper reviews the current literature and provides state-of-the-art guidance on the management regarding prevention, evaluation, and treatment of elbow stiffness.
Search for other papers by Ilse Degreef in
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Search for other papers by Maarten Van Nuffel in
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In the long term, limited fasciectomy is currently the most reliable treatment for Dupuytren’s contracture.
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The risk for complications is significant, certainly in recurrent disease and in the presence of abundant scar tissue.
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Meticulous surgical technique is mandatory.
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Microsurgery increases magnification from four times (with surgical loupes) up to 40 times.
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Using the microscope in Dupuytren’s surgery, a technique named microfasciectomy is likely to increase both safety and efficiency by preventing instead of treating surgical complications.
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Increased experience with microsurgery will benefit Dupuytren’s treatment and hand surgery in general.
