Primary bone and soft tissue tumours: Epidemiological data from a non-referral teaching department in Belgium.

Primary bone and soft tissue tumours are rare in a non-referral teaching department. The incidence varies greatly among the different subtypes and every Orthopaedic surgeon will encounter one or more benign or malignant lesions during their careers. History, clinical examination and technical investigations are of great importance, but basic knowledge and basic principles are necessary for a correct clinical practice. It was the purpose of this study to raise awareness towards such pathology by exemplifying our cases from a two-year period in our community-based hospital and if necessary, to refer patients to specialised sarcoma centres

Three-Dimensional Correction of Fibular Hemimelia using Computer-Assisted Planning: Case Report and Literature Review

The purpose of this study is to investigate a stepwise approach to translate the principles of deformity correction from 2D plain radiographs to a 3D computer assisted pre-operative planning (CAP), when treating a complex case of fibular hemimelia. Computed tomography slices were used to perform a 3D reconstruction of the deformity. CAP determined the different axes and apex of deformity based on geometrical functions of the software. The obtuse angle was computed and used to determine the concomitant osteotomy angle. An additional review of the literature was performed, allowing comparison towards the current treatment approaches.The pre- and post-operative clinical and radiographic follow up is reported. The computer assisted planning was applicable in a complex fibular hemimelia deformity.  The literature review demonstrated no previous use of a 3D computer assisted planning.This case report provides a feasible and effective method to convert the principles of deformity planning from a 2D to a 3D setting. The added value of this technique for clinical practice should be confirmed in further prospective studies

The pathogenesis of heterotopic ossification after traumatic brain injury. A review of current literature.

Introduction: Neurogenic heterotopic ossification (NHO), mostly defined as a benign process of formation of bone outside the skeletal system, after traumatic brain injury (TBI) is a musculoskeletal disorder that causes pain and reduces the range of motion, often leading to marked impairment of quality of life. The pathogenic factors that link the brain and bone and cause the formation of heterotopic bone are largely unknown. This article will try to summarize the current literature on the pathogenesis of NHO and accelerated fracture healing after TBI.Pathogenesis: The heterotopic formation of bone after TBI seems to be inducted by a complex interplay between local and systemic factors. For all different forms of HO, the same three conditions are required for the formation of ectopic bone: The presence of osteoprogenitor cells, a permissive environment, and a stimulating factor. The osteoprogenitor cells are thought to be of mesenchymal origin, however recent research suggests a possible neural origin. The permissive environment is created mainly by reactions to hypoxia and both local and sensory nerve inflammation. Many possible inducing factors have been described; the endogenic route is thought to be the most dominant in the stimulation of HO formation after TBI

Radiographic assessment of calcifying tendinitis of the rotator cuff: an inter- and intraobserver study

The radiographic appearance of calcific tendinitis of the rotator cuff varies according to the stage of the disease. We compared currently used classification systems in a large group of observers to identify the most reliable classification system. Thirty-seven orthopaedic surgeons evaluated shoulder radiographs of 25 patients to classify the stage of the calcific tendinitis according to the classifications by (1) Gärtner and (2) Molé on a Web-based study platform. Inter and intraobserver agreement among observers was measured using the Siegel and Castellan multirater κ. Both classification systems had fair interobserver agreement: κ was 0.25 for the Molé classification and 0.34 for the Gärtner classification. The Gärtner classification was significantly more reliable than the Molé classification. Currently there is no radiographic classification that can serve the purpose of guiding the treatment in a reliable way. The Gärtner classification is the most reliable, although far from perfect, radiographic classification there is

Orthopaedic support with 3D printing in children: marketing effect or solution of the future?

INTRODUCTION. In pediatric orthopaedics, the immobilization of a limb is traditionally done by a cast. The emergence of 3D technologies allows us to produce restraints specific to the anatomical characteristics of the patient. This paper aims to determine the feasibility of the process of developing these restraints.MATERIAL AND METHOD. Descriptive study of the creation process involving 19 patients aged 2 to 14 years for whom a restraint was placed between April 2018 and November 2018. This was mainly post-traumatic pathology (12) and children having a clubfoot (7). RESULTS.This type of restraint has the following characteristics: use of recyclable material; lightness; ventilation; visibility of the underlying skin tissue and its hydro-compatibility. The major limitations remaining are production time and printing errors.DISCUSSION. The emergence of 3D printing, allows us to extend its application to the medical world. When the therapeutic effectiveness of a restraint is achieved, quality of life becomes the main selection criterion. Based on observations already made in the past, we were able to develop a model that combines the advantages of the different approaches.CONCLUSION.New 3D printing technologies allow the creation of restraint devices with many advantages and customized adaptation possibilities

The effect of anti-gravity training after meniscal or chondral injury in the knee. A Systematic Review.

Reduced impact loading or anti-gravity training has recently been introduced as a new tool in the rehabilitation of orthopaedic conditions that require restricted weight bearing. The purpose of this strategy is to speed up the functional rehabilitation while at the same time protect the healing structures from harmful effects associated with impact loading. Anti-gravity treadmills (AlterG ®) and harness suspension devices seem to be the two most promising techniques. It is however today unclear how effective these devices are.The purpose of our study was therefore to perform a systematic literature review on the actual technology available and its effect on impact load reduction, as well as its effectiveness in accelerating functional recovery after meniscal and chondral injury to the knee.The results from our work demonstrate that only a limited number of studies are available, usually of moderate quality. The data suggest a variable effect on cartilage regeneration, and a potential for accelerated functional recovery in gait and running dynamics both with anti-gravity treadmill as well as suspension harness systems

Dutch translation and validation of the Norwich Patellar Instability score and Banff Patella Instability Instrument in patients after surgery for patellar instability

PurposeRecently, two new English specific patient reported outcome measures (PROMs) to evaluate treatment of patients with patellofemoral complaints have been developed: the Banff Patella Instability Instrument (BPII) and the Norwich Patellar Instability (NPI) score.  This study was designed to translate and validate the BPII and NPI in Dutch patients after surgical treatment for patellar instability.MethodsForward and backward translation of the outcome measures was performed. Patients who had been surgically treated for patellar instability filled out the NPI and BPII together with the Kujala Knee Score, numeric rating scales, Knee disability and Osteoarthritis Outcome Score (KOOS) and SF-36.  We assessed internal consistency and construct validity. We evaluated the presence of ceiling and floor effects.ResultsNinety-seven patients completed the online questionnaires. The internal consistency of the NPI and BPII score was excellent for both outcome measures. The BPII and NPI had good correlations with other PROMs. For the BPII we found no floor nor ceiling effect. For the NPI we found a floor effect but no ceiling effect. ConclusionOur results indicate that the Dutch version of the BPII and the NPI can be used for patients with patellar instability. Both PROMs have specific (dis)advantages.

A case series of total hip replacements for patients with Paget's disease

The aim of this case series is to determine rates of revision in patients with Paget's disease undergoing total hip. replacements. Patients presenting to a single with Paget's disease of the femur or acetabulum undergoing total hip arthroplasty. Retrospective case note and radiographic review was undertaken. 32 patients with a mean age 77.4 (range 68-88). 12 males and 20 females. There were 25 cemented total hip replacements, 1 hybrid and 6 uncemented total hip replacements performed. The mean drop in haemoglobin was 33.3g/L (8-59). 14 (43.8%) received a blood transfusion. There were no deaths in the first year following surgery. 1 (3.1%) revision procedure was performed in the first year. At 5 year follow-up there were no further revisions in the 27 patients with 5 year followup (96.3% survivorship). Total hip replacement in patients with Paget's disease has low complication rates and low risks of revision

A revisited technique for combined anterior cruciate ligament and anterolateral ligament reconstructions

A new technique for combined anterior cruciate ligament and anterolateral ligament reconstructions is described. An iliotibial band strip is used as an ALL graft , leaving the distal insertion intact and fix it with a knotless anchor on the femoral origin, after tunneling it under the lateral collateral ligament

Mucoid degeneration of the anterior cruciate ligament; complete resection as equivalent treatment to partial resection.

Purpose: Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) is a benign knee pathology, which is often indicated for surgical treatment if symptomatic. Most authors believe that partial ACL resection is the treatment of choice in symptomatic MD of the ACL. This study concerns complete ACL resection as a treatment of mucoid degenerated ACL. Methods: Thirteen patients were treated with complete ACL resection for symptomatic MD of the ACL from 2006 - 2016. Symptoms included limited range of motion (ROM) and posterior knee pain.Results: Preoperative and postoperative results of eleven patient were compared. Postoperative recovery was four weeks on average.  All patients (100%, n=11) reported an improvement in pain. All patients with a preoperative limited ROM (100%, n=9) reported a return to a normal (subjective) ROM. Eight patients (72.7%, n=8) reported an improvement of knee instability, while three patients (27.3%, n=3) experienced an unchanged knee stability. All patients (100%, n=11) reported a good to very good surgery satisfaction. Preoperative and postoperative KOOS questionnaires were compared and showed improvement in all categories. Conclusions: Complete resection of the ACL without ACL reconstruction is a reliable treatment for symptomatic cases of mucoid degenerated ACL