Epoetin alfa reduces blood transfusion requirements in patients with intertrochanteric fracture

Purpose: The purpose of this study is to identify the potential benefits or complications from the use of epoetin alfa in patients with intertrochanteric fracture. Materials and Methods: Seventy-nine patients who sustained an intertrochanteric fracture were divided into 2 groups. One group received 10 daily doses of 20 000 IU of epoetin alfa beginning from the day of trauma, whereas the control group received placebo. Results: We found a statistically significant difference in the required units of allogenic blood used between the 2 groups (P = .034). The group that received epoetin alfa also showed an elevation of hematocrit and hemoglobin values, which was statistically significant at the seventh postoperative day (P = .019 and .015, respectively) compared to the control group. No complications were evident during our study. Conclusions: Patients with intertrochanteric fractures seem to benefit from the use of epoetin alfa because it is safe and reduces the need for blood transfusions. © 2010 Elsevier Inc

Truncal changes in patients suffering severe hip or knee osteoarthritis: A surface topography study

Backgroud: Osteoarthritis (OA) of the hip and knee is a degenerative disease with complications, including reduced range of motion and pain. Although OA of the hip and knee is common, there are few studies that investigated if patients with this condition had affected morphological truncal parameters. The objectives of this study were to compare the morphology of the spine and the pelvis of patients with hip or knee OA to that of a control group (CG) and to comment on the proposed mechanisms of these changes and the clinical effects on patients. Methods: This study included three groups of individuals. The first group consisted of 34 patients (15 men and 19 women with a mean age of 67.62 ± 8.28 years) suffering from hip OA. The second group consisted of 45 patients (11 men and 34 women with a mean age of 72.47 ± 7.0 years) suffering from knee OA. These patients were compared with a CG, which consisted of 25 individuals (13 men and 12 women with a mean age of 69.28 ± 10.11 years). The DIERS formetric 4D analysis system was used to calculate several truncal parameters in all planes. All analyses were accomplished using the SPSS ver. 17.0, and p < 0.05 was used to determine statistical significance. Results: Patients with hip OA presented with significantly increased values than those in the CG for sagittal imbalance, scoliosis angle, vertebral rotation, trunk torsion, and pelvic obliquity, and decreased values than those in the CG for fleche lombaire. Patients with knee OA presented with significantly increased values than those in the CG for sagittal imbalance, apical deviation, scoliosis angle, vertebral rotation, trunk torsion, and pelvic obliquity. Patients with hip or knee OA, compared to the CG, had greater forward inclination of the spine, greater scoliosis, greater vertebral rotation and trunk torsion, and greater obliquity of the pelvis at the frontal plane. Conclusions: Patients with severe hip or knee OA could have truncal morphology alterations, in addition to reduced hip or knee range of motion and pain. These alterations could cause significant negative effects, which may then seriously affect the patients' quality of life. © 2021 by The Korean Orthopaedic Association

Delayed foreign-body reaction to absorbable implants in metacarpal fracture treatment

Background: First-generation bioabsorbable implants have been associated with a high complication rate attributable to weak mechanical properties and rapid degradation. This has led to the development of stronger devices with improved durability. However, the modern implants have raised concerns about potential late-occurring adverse reactions. Questions/purposes: This retrospective study addressed the following questions: Can absorbable implants consisting of trimethylene carbonate, L-lactide, and D,L-lactide provide adequate fixation for healing of a metacarpal fracture? Will these implants obviate a second removal operation? What complications can occur in the reaction to implant breakdown? Patients and Methods: Twelve unstable, displaced, metacarpal fractures were studied in 10 consecutive patients (seven men, three women; mean age, 36.4 years; range, 18-75 years). The fractures were treated with absorbable plates and screws consisting of the aforementioned copolymers and designed to resorb in 2 to 4 years. Nine patients (10 fractures) were available for clinical and radiographic followups (mean, 45.7 months; range, 34-61 months). Results: Fracture healing was uneventful in all cases. Four patients experienced a foreign-body reaction during the second postoperative year and required surgical débridement to remove implant remnants. Histologic examination confirmed the diagnosis of a foreign-body reaction. Two other patients reported a transient local swelling that subsided without treatment. Conclusions: Our results indicate these absorbable implants for metacarpal fractures achieved adequate bone healing but simply postponed the problem of foreign-body reactions. Patients treated with bioabsorbable implants should be advised of potential late complications and should be followed for at least 2 years, possibly longer. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © 2010 The Association of Bone and Joint Surgeons®

Periprosthetic fractures in megaprostheses: Algorithmic approach to treatment

With increases in both life expectancy and the number of patients with endoprosthetic replacements, more periprosthetic fractures are expected to occur. Periprosthetic fractures related to megaprostheses present a treatment challenge, with a high incidence (one-third of affected patients) of secondary revision as a result of prosthetic loosening, infection, nonunion, refracture, or even amputation. Efforts to improve endoprosthetic reconstruction should focus on preventing postoperative complications. Understanding the causes of complications and strategies to avoid them could lead to significant improvements in implant survival, limb function, and patient outcomes. This article presents a concise review of the current literature and an algorithmic approach to reconstruction of these complex injuries. © SLACK Incorporated

Postoperative spine infections: A retrospective analysis of 21 patients

A retrospective analysis was performed to identify the risk factors, onset, clinical presentation, management and outcome of 21 patients with postoperative spinal infection. There were 9 men and 12 women with a mean age of 49 years (range 23-76 years). There were 19 early and 2 late spine infections: 14 superficial and 7 deep. Wound drainage occurred in 90.74% of the patients at an average of 19 days after surgery (range 7-102 days). Methicillin-resistant Staphylococcus aureus was the most common bacterial isolate. Eighteen patients were treated with open debridement, application of an irrigation-suction device for 5-7 days, primary or delayed wound closure and antibiotic administration. Removal of the instrumentation was necessary in three patients. Eighteen of the 21 patients had pain relief and all patients were infection free, 12 months after initiation of the treatment. One patient, who had instrumentation removal, required re-operation for spine instability and pseudarthrosis. © 2006 Springer-Verlag

Ulnar nerve injuries in guyon canal: A report of 32 cases

Purpose: In this study, the surgical outcomes of 32 patients with ulnar nerve injuries in the Guyon canal are presented. Outcomes were analyzed in relation to various factors such as age, surgical timing, zone of injury, and type of nerve reconstruction. Methods: Between 1990 and 2007, 32 patients with injury in Guyon canal were managed surgically. Twelve patients had ulnar nerve injury proximal to its bifurcation (zone I); 14 patients had isolated motor branch injury (zone II); and six patients had isolated sensory branch injury (zone III). End-to-end repair was achieved in 12 (38%) of 32 patients, while nerve grafting was performed in 20 (62%) cases. The mean follow-up period was 22 months. Results: Good and excellent motor function was restored in 25 (96%) of 26 cases with motor branch injury. Good and excellent sensory results were achieved in 15 (83%) of 18 cases with sensory branch injury. Outcomes were significantly better for those who had early repair (<4 weeks) when compared with those who had repair 4 weeks after injury (P < 0.05). There were no significant differences between outcomes after end-to-end repair or nerve grafting (P > 0.05) and between outcomes from repair of injuries in different zone (P > 0.05). Conclusions: Early diagnosis and surgical treatment with careful dissection of the ulnar nerve branches within the canal is very important. Adequate exposure is usually required to repair the nerve in the Guyon canal. Nerve grafting in this level could give analogous results as the end-to-end repair. © 2012 Wiley Periodicals, Inc

Insidious onset of tetraparesis due to cervical epidural abscess from Enterococcus faecalis

We report a case of cervical epidural abscess from Enterococcus faecalis, which caused an insidious onset of tetraparesis. This 53-year-old female with a history of diabetes mellitus and chronic renal failure under hemodialysis presented with pain and progressive weakness of upper and lower extremities without fever. Although a recent MRI she did at the beginning of symptoms showed no significant pathologies, except for a cervical disc herniation and adjacent spinal degeneration, and stenosis that confused the diagnostic procedure, newer imaging with CT and MRI, which was performed due to progression of tetraparesis, revealed the formation of a cervical epidural abscess. Surgical drainage was done after a complete infection workup. The patient showed immediate neurological improvement after surgery. She received antibiotics intravenously for 3 weeks and orally for another 6 weeks. The patient was free from complications 24 months after surgery. A high index of suspicion is most important in making a rapid and correct diagnosis of spinal epidural abscess. The classic clinical triad (fever, local pain, and neurologic deficits) is not sensitive enough for early detection. Continuous clinical, laboratory, and imaging monitoring are of paramount importance. Early diagnosis and surgical intervention could optimize the final functional outcome. © 2013 Konstantinos Chr. Soultanis et al