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neutrally aligned, matched controls. 23 The varus group had a mean post-operative mechanical axis deviation of 6.3° (3.9° to 10.7°). There was no difference in functional results using multiple validated measures, and no revisions in either group at a
University Emergency Hospital Bucharest, Romania
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University Emergency Hospital Bucharest, Romania
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excision of bone sarcoma is valid if the resection performed achieves oncologic safe margins, clear of any tumour tissue, and the functional results and survival rates expected are equal or better than after an amputation performed for the same case ( Fig
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of less than 10° of varus in more than 85% of the patients. The functional results following treatment with functional bracing appear to be equivalent to that of surgical treatment, thus can be used successfully to manage HSF. 16 , 20 , 27 , 28
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functional result with a maximum limb length in combination with optimal wound healing to avoid multiple reoperations and prolonged hospitalization. The preservation of the knee joint is essential for successful rehabilitation in the elderly and cannot be
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Postoperative tenth week CT scan showing callus formation. Clinical and functional results In our series which was published recently, bony fusion was achieved in 98% (63 out of 64 shoulders) of the cases in a mean follow-up of 71.2 months (range
Shoulder Unit, Department of Orthopaedics, Centro Hospitalar Universitário de Santo António, Hospital de Santo António, Porto, Portugal
Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto, Portugal
Department of Orthopaedics, Hospital Lusíadas, Porto, Portugal
Shoulder and Elbow Unit, Hospital Lusíadas, Porto, Portugal
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Department of Orthopaedics, Hospital Lusíadas, Porto, Portugal
Shoulder and Elbow Unit, Hospital Lusíadas, Porto, Portugal
Department of Orthopaedics, Hospital da Luz Arrábida, Portugal
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relief and good functional results ( 1 ). However, massive and irreparable RCTs (MIRCTs) are a significant challenge for patients and surgeons. Commonly defined as a full-thickness injury involving at least two tendons or measuring >5 cm in the coronal
Department of Surgery, Universidad de La Laguna, Tenerife, Spain
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University of Basel, Basel, Switzerland
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Department of Orthopedic and Rehabilitation, University of Iowa, Iowa, USA
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Department of Surgery, Universidad de La Laguna, Tenerife, Spain
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Department of Surgery, Universidad de Sevilla, Sevilla, Spain
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Ankle osteoarthritis (OA) is much less frequent than knee or hip OA, but it can be equally disabling, greatly affecting the quality of life of the patients.
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Approximately 80% of ankle OA is post-traumatic, mainly secondary to malleolar fractures, being another of the main causes untreated in chronic instability. The average age of the patient affected by ankle OA is around 50 years, being therefore active patients and in working age who seek to maintain mobility and remain active.
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The authors conducted a comprehensive review of the conservative, medical, and surgical treatment of ankle OA.
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Initial conservative treatment is effective and should be attempted in any stage of OA. From a pharmacological point of view, non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular infiltrations can produce temporary relief of symptoms.
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After the failure of conservative-medical treatment, two large groups of surgical treatment have been described: joint-preserving and joint-sacrificing procedures.
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In the early stages, only periarticular osteotomies have enough evidence to recommend in ankle OA with malalignment. Both ankle arthrodesis and ankle replacement can produce satisfactory functional results if correctly indicated in the final stages of the disease.
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Finally, the authors propose a global treatment algorithm that can aid in the decision-making process.
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Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
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Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
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Purpose
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To compare the two main surgical approaches to address proximal humerus fractures (PHFs) stratified for Neer fracture types, to demonstrate which approach gives the best result for each fracture type.
Methods
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A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in PubMed, Web of Science, and Cochrane databases up to 4 January 2022. Inclusion criteria were studies comparing open reduction and internal fixation (ORIF) with deltopectoral (DP) approach and minimally invasive plate osteosynthesis (MIPO) with deltosplit (DS) approach of PHFs. Patient’s demographic data, fracture type, Constant–Murley Score (CMS), operation time, blood loss, length of hospital stay, complications, fluoroscopy time, and radiological outcomes were extracted. Results were stratified for each type of Neer fracture.
Results
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Eleven studies (798 patients) were included in the meta-analysis. No functional difference was found in the CMS between the two groups for each type of Neer (P = n.s.): for PHFs Neer II, the mean CMS was 72.5 (s.e. 5.9) points in the ORIF group and 79.6 (s.e. 2.5) points in the MIPO group; for Neer III, 77.8 (s.e. 2.0) in the ORIF and 76.4 (se 3.0) in the MIPO; and for Neer IV, 70.6 (s.e. 2.7) in the ORIF and 60.9 (s.e. 6.3) in the MIPO. The operation time in the MIPO group was significantly lower than in the ORIF group for both Neer II (P = 0.0461) and Neer III (P = 0.0037) fractures.
Conclusion
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The MIPO with DS approach demonstrated no significant differences in the results to the ORIF with DP approach for the different Neer fractures in terms of functional results, with a similar outcome, especially for the Neer II and III fracture types. The MIPO technique proved to be as safe and effective as the ORIF approach.
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Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Primary osteoarthritis (OA) of the elbow can cause disabling symptoms of pain, locking, stiffness, and a limitation in the range of motion. There is no consensus regarding the role of open and arthroscopic debridement in the treatment of symptomatic primary elbow OA. The aim of this study is to systematically review the outcome of surgical debridement. A preoperative/postoperative comparison will be made between the two surgical procedures.
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All studies reporting on debridement as treatment for primary elbow OA with a minimum of one-year follow-up were included. Outcome parameters were functional results, complications, and performance scores.
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Data were extracted from 21 articles. The arthroscopic group consisted of 286 elbows with a weighted mean follow-up of 40 ± 17 months (range, 16–75). The open group consisted of 300 elbows with a weighted mean follow-up of 55 ± 20 months (range, 19–85). Both procedures showed improvement in Mayo Elbow Performance Score (MEPS), range of motion (ROM) flexion-extension, and ROM pronation-supination. Only in ROM flexion was a statistically significant difference in improvement seen between the groups in favour of the open group. The arthroscopic group showed improvement in pain visual analogue scale (VAS) scores. Nothing could be stated about pain VAS scores in the open group due to a lack of data. In the arthroscopic group 18 complications (6%) were described, in the open group 29 complications (12%).
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Surgical debridement is an effective treatment for the disabling symptoms of primary elbow OA with an acceptable complication rate.
Cite this article: EFORT Open Rev 2020;5:874-882. DOI: 10.1302/2058-5241.5.190095
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terms of functional results or implant wear rate. One of the great advances in knee surgery is the management of unicompartmental arthritic damage by use of UKA ( Table 1 ). 1 , 15 , 18 , 21 , 22 For UKA, wear rate is a major long-term issue and
