Association of Kirschner wires and shape-memory staple in four-corner arthrodesis

Background. Wrist arthrosis is a painful disease that is responsible for a reduced wrist function and upper limb dysfunction. Proposed by Watson in 1984, scaphoidectomy and four-corner arthrodesis has good results in scapho-lunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) treatment. Objectives. The purpose of this study was to analyze the results of four-corner arthrodesis using Kirschner wire and shape-memory staples. Methods. 12 patients (12 wrists) were operated by scaphoidectomy and four-corner arthrodesis according to Watson technique, using Kirschner wires fixation for capito-luno-hamato fusion and shape-memory staples for hamato-triquetral fusion. The mean age of the patients was 64.7 years, and the period of follow-up was 2.1 years. Results. The results were evaluated using preoperative data, surgery protocols and clinical postoperative data obtained at follow-up: pain, patient’s satisfaction, force, range of motion, X-ray imaging. The fusion was achieved in all cases in a mean time of 2.4 months for all involved articulations. The mean postoperative range of motion was 26.25⁰ of extension, 24.16⁰ of flexion, 16.11⁰ of radial inclination and 18.89⁰ of cubital inclination. After surgery, compared to the unaffected contralateral side, grip strength was 62.8%. Conclusions. Combination of K-wires and shape-memory staple for four-corner arthrodesis is very efficient in treating SLAC and SNAC lesions

Surgical Approaches for Total Knee Arthroplasty

Total knee arthroplasty surgery is a current practice in orthopedic surgery. The success of this intervention consists in part in the realignment of the lower extremity’s anatomical axis, adequate implant orientation and design, good implant fixation, proper soft tissue balancing, and stability. A good exposure also allows optimal placement of the components. Our preferred approach is the median parapatellar approach in most cases. However, the orthopedic surgeon may face anatomical variants associated with knee types that may complicate the classic approach. We are reviewing multiple surgical approaches also used by us in our clinic in total knee arthroplasty, as well as additional techniques in these surgical approaches. The MIS approach can be used in many cases to reduce pain and speed the healing process. All of the total knee arthroplasty approaches are detailed with anatomical illustrations along with advantages and disadvantages of each. The ultimate goal is to restore knee function as quickly as possible and to preserve the anatomical integrity of the joint

Study on the arthroscopic repair of the rotator cuff tear

Rotator cuff tear (RCT) is common shoulder pathology. The majority of the patients do not require surgical treatment, their evolution being favorable under conservative treatment. In other cases, the symptomatology does not improve without surgery. This can be open or less invasive, i.e. arthroscopic. Material and Methods: We evaluated 30 cases of rotator cuff (supraspinatus) tear, operated on arthroscopically between 2015 and 2017. All surgeries were done arthroscopically, by the same surgeon. The data were collected using the Constant score and the SST score, calculated preoperatively and postoperatively at 12 months. The average age was 52.6 for female patients and 53.2 for male patients. Results: they improved after treatment. The constant score increased from 44 to 84 and SST from 25% to 83.3%. All patients were treated closing the defect, using one or more anchors, with a simple or a double-row technique. Conclusions: The evolution was good with significant improvement in terms of pain and strength

Residual plaque burden in patients with acute coronary syndromes after successful percutaneous coronary intervention

Objectives: The aim of this study was to characterize and evaluate the clinical impact of untreated atherosclerotic disease after percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). Background: Residual atherosclerotic disease after successful PCI may predispose future major adverse cardiovascular events (MACE). Compared with intravascular ultrasound (IVUS), angiography underestimates the presence and severity of coronary artery disease. Methods: Following successful PCI of all clinically significant lesions in 697 patients with ACS, 3-vessel grayscale and radiofrequency IVUS was performed. Lesions were prospectively characterized, and patients were followed for a median of 3.4 years. A total of 3,229 untreated lesions (4.89 ± 1.98 lesions/patient) were identified by IVUS, with mean plaque burden (PB) of 49.6 ± 4.2%. Results: By angiography these nonculprit lesions were mild, with mean diameter stenosis of 38.9 ± 15.3%. At least 1 lesion with a PB <70% (PB70 lesion) was found in 220 (33%) patients. By multivariable analysis, a history of prior PCI and angiographic 3-vessel disease were independent predictors of PB70 lesions. Patients with PB70 lesions had greater total percent plaque volume, normalized PB, fibroatheromas, thin-cap fibroatheromas, and normalized volumes of necrotic core and dense calcium. Patients with PB70 lesions had greater 3-year rates of MACE due to untreated nonculprit lesions (20.8% vs. 7.7%, p < 0.0001). Among imaged nonculprit lesions, the proportion of PB70 lesions causing MACE was significantly greater than non-PB70 lesions (8.7% vs. 1.0%, p < 0.0001). Conclusions: After successful PCI of all angiographically significant lesions, overall untreated atherosclerotic burden remains high, and PB70 lesions are frequently present in the proximal and mid-coronary tree. Patients with PB70 lesions have greater atherosclerosis throughout the coronary tree, have more thin-cap fibroatheromas, and are at increased risk for future cardiovascular events. (PROSPECT: An Imaging Study in Patients With Unstable Atherosclerotic Lesions; NCT00180466