Midterm Results of Consecutive Periprosthetic Femoral Fractures Vancouver Type A and B

Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2 ± 8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n = 5) or type B (n = 29) were followed-up after 43.2 months, none of the patients were lost to follow- up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications

An Indication-Based Concept for Stepwise Spinal Orthosis in Low Back Pain According to the Current Literature

Background: The current literature is not conclusive for spinal orthosis treatment in low back pain. Therefore, two questions have to be answered: Does the current literature support the indication of spinal orthosis treatment in low back pain? Which treatment concept can be derived from the result? Method: The 30 highest-rated literature citations (PubMed: best match, 30 December 2021) dealing with low back pain and spine orthosis were included in the study. Excluded were all articles related to Kinesio Taping, scoliosis, physical exercise, or dealing with side effects and unrelated to treatment effect. Thus, the literature list refers only to “low back pain and spine orthoses”. These articles were analyzed according to the PRISMA criteria and divided according to “specific diagnosis”, when the cause of pain was explained (group A), or when “specific diagnosis is not given” (group B). The articles were also distinguished by the information about the orthosis. Articles with biomechanical information about the function of the orthoses were called “diagnosis-based orthosis” (group C). All other articles were part of the group “unspecific orthotic treatment” (group D). The results were compared to each other in terms of effectiveness. According to anatomical causes, a concept of orthosis selection depending on diagnosis of low back pain for clinical practice was developed. The risk of bias lies in the choice of the MESH terms. The synthesis of the results was a clinical treatment concept based on findings from the current literature. Results: The literature citations with 1749 patients and 2160 citations of literature were processed; 21 prospective clinical or biomechanical studies and 9 review articles were included. The combination of literature citations according to “specific diagnosis” (group A) and “diagnosis based orthosis” (group C) was very likely to lead to a therapeutic effect (seven articles). No positive effect could be found in four articles, all dealing with postoperative treatment. When “specific diagnosis is not given” (group B) and combined with “unspecific orthotic treatment” (group D), therapy remained without measurable effect (15 articles). An effect was described in four articles (three biomechanical studies and one postoperative study). In review articles, according to specific diagnosis, only one article dealt with fractures and another with stenosis. In all review articles where specific diagnosis was not given, no effect with spine orthoses could be found. Using this knowledge, we created a clinical treatment concept. The structure was based on diagnosis and standardized orthoses. According to pain location and pathology (muscle, intervertebral disc, bone, statics, postoperative) the orthoses were classified to anatomical extent and the mechanical limitation (bandage, bodice, corset, orthosis with shoulder straps and erecting orthosis). Conclusion: The effectiveness of spinal orthoses could not be deduced from the current literature. The most serious limitation was the inconsistency of the complaint and the imprecise designation of the orthoses. Interpretation: Articles with a precise allocation of the complaint and a description of the orthosis showed a positive effect. The treatment concept presented here is intended to provide a basis for answering the question concerning the effectiveness of spinal orthoses as an accompanying treatment option in low back pain

Diagnostic Limitations and Aspects of the Lumbosacral Transitional Vertebrae (LSTV)

The regeneration of an intervertebral disc can only be successful if the cause of the degeneration is known and eliminated. The lumbosacral transitional vertebrae (LSTV) offer itself as a model for IVD (intervertebral disc) regeneration. The aim of this work is to support this statement. In our scoliosis outpatient clinic, 1482 patients were radiologically examined, and ambiguous lumbosacral junction underwent MRI examination. Patients with Castellvi classification type II–IV were included and the results are compared with the current literature in PubMed (12 October 2022). The LSTV are discussed as a possible IVD model. A total of 115 patients were diagnosed with LSTV Castellvi type II–IV. A Castellvi distribution type IIA (n-55), IIB (n-24), IIIA (n-20), IIIB (n-10) and IV (n-6) can be found. In all, 64 patients (55.7%) reported recurrent low-back pain (LBP). Scoliosis (Cobb angle >10°) was also confirmed in 72 patients (58 female and 14 male) and 56 (75.7%) had unilateral pathology. The wide variation in the literature regarding the prevalence of the LSTV (4.6–35.6%) is reasoned by the doubtful diagnosis of Castellvi type I. The LSTV present segments with reduced to absent mobility and at the same time leads to overload of the adjacent segments. This possibility of differentiation is seen as the potential for a spinal model

Diagnostic Limitations and Aspects of the Lumbosacral Transitional Vertebrae (LSTV)

The regeneration of an intervertebral disc can only be successful if the cause of the degeneration is known and eliminated. The lumbosacral transitional vertebrae (LSTV) offer itself as a model for IVD (intervertebral disc) regeneration. The aim of this work is to support this statement. In our scoliosis outpatient clinic, 1482 patients were radiologically examined, and ambiguous lumbosacral junction underwent MRI examination. Patients with Castellvi classification type II–IV were included and the results are compared with the current literature in PubMed (12 October 2022). The LSTV are discussed as a possible IVD model. A total of 115 patients were diagnosed with LSTV Castellvi type II–IV. A Castellvi distribution type IIA (n-55), IIB (n-24), IIIA (n-20), IIIB (n-10) and IV (n-6) can be found. In all, 64 patients (55.7%) reported recurrent low-back pain (LBP). Scoliosis (Cobb angle >10°) was also confirmed in 72 patients (58 female and 14 male) and 56 (75.7%) had unilateral pathology. The wide variation in the literature regarding the prevalence of the LSTV (4.6–35.6%) is reasoned by the doubtful diagnosis of Castellvi type I. The LSTV present segments with reduced to absent mobility and at the same time leads to overload of the adjacent segments. This possibility of differentiation is seen as the potential for a spinal model

Management of a failed metatarso-phalangeal joint fusion utilizing a hemicup prosthesis

We report a case of a 65-year-old man with a painful nonunion of the first metatarsophalangeal joint (MTPJ). It is one of the main severe complications of this surgery. Its prevalence is described between 5% and 10% across different operative techniques. The implantation of hemicup-prosthesis has been successfully used for the hallux rigidus treatment with very promising results. In our case report, we introduce a treatment method of converting a pseudoarthrosis of the first MTPJ, made of two crossing screws into a hemicup-prosthesis as a salvage procedure. This is to our best knowledge the first report using this device for treatment of pseudoarthrosis of the first MTPJ

Midterm results of consecutive periprosthetic femoral fractures Vancouver type A and B

Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2+/-8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n=5) or type B (n=29) were followed-up after 43.2 months, none of the patients were lost to follow- up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications

A recurrent giant cell tumor of bone treated with denosumab

Although the giant cell tumor of bone is generally classified as a benign tumor it can rarely metastasize and has a potential risk of local recurrence. We want to report about a female patient who suffered from a recurrence of a giant cell tumor of bone after the implantation of a total endoprosthesis of the knee joint. We have treated her with denosumab, which is a receptor activator of nuclear factor kappa-B ligand inhibitor. In this case report we want to present a new option to treat this kind of neoplasm

Immunological and morphological analysis of heterotopic ossification differs to healthy controls

Abstract Background Formation of lamellar bone in non-osseus tissue is a pathological process called heterotopic ossification. It is the aim of this study to analyse the morphology and immunological status of patients with heterotopic ossification compared to individual healthy persons. Methods Human bone marrow and blood samples were obtained from 6 systemically healthy individuals and 4 patients during resection of heterotopic ossification from bone at hip arthroplasty. Bone was fragmented and treated with purified collagenase. Immunofluorescence surface staining was performed and analyzed with flow cytometry. Microcomputed tomography scanning was done performed at a resolution of 11 and 35 μm isometric voxel size respectively using a two different cone beam X-computer tomography systems and a microfocus X-ray tube. Subsequently the volume data was morphometrically analysed. Results The monocytes, stem cells, stroma cells and granulocytes progenitor cells were strongly reduced in the heterotopic ossification patient. Additionally a significant reduction of stromal stem cells cells and CD34 positive stem cells was observed. The frequency of NK-cells, B cells and T cells were not altered in the patients with heterotopic ossification compared to a healthy person. Micromorphometric parameters showed a lower content of mineralized bone tissue compared to normal bone. Mean trabecular thickness showed a high standard deviation, indicating a high variation in trabecular thickness, anisotropy and reducing bone strength. Conclusions This work shows altered immunological distribution that is accompanied by a low decrease in bone volume fraction and tissue mineral density in the heterotopic ossification sample compared to normal bone. Compared to healthy subjects, this might reflect an immunological participation in the development of this entity

Minimally Invasive AC Joint Reconstruction System (MINAR®) in Modified Triple-Button Technique for the Treatment of Acute AC Joint Dislocation

Acute acromioclavicular (AC) joint dislocation is a frequent sports injury with more than 100 different operation methods described. A total of 65 patients with an acute AC joint dislocation were treated with the modified MINAR® system between 2009 and 2013. Clinical outcome, horizontal and vertical instability, as well as concomitant intraarticular injuries were assessed. We used Zanca, stress and axial X-rays for radiological assessment. A Constant score of 95 (±8.8), University of California Los Angeles Shoulder score (UCLA) of 31 (±4.9), Disabilities of Arm, Shoulder and Hand (DASH) of 9.1 (±14.3), and Visual Analogue Scale (VAS) of 0.9 (±0.126) was found. A total of 30 patients (59%) had no signs of reduction loss, nine patients (18%) a slight loss, 11 patients (22%) a partial loss, and one patient (2%) a total loss. No significant influence on the clinical scores could be shown. The postoperative coracoclavicular (CC) distance negatively affected the Constant (p = 0.007) and UCLA scores (p = 0.035). A longer time interval to surgery had a negative influence on all scores (p ≤ 0.001). We could not find any signs of persistent horizontal instability or intraarticular injuries at follow-up. The MINAR® system promises satisfactory functional and radiological results. When setting the correct indication, patients benefit from an early operation. No persisting horizontal instability was observed following suturing of the AC capsule and the delta fascia