Background: The modified Dunn procedure (MDP) has risen enthusiasm in treating slipped capital femoral epiphyses (SCFE) due to the anatomic reduction and high patients’ satisfaction rates at long-term follow-up. Main aim of this study is to compare clinical and radiographic outcomes of 2 cohorts with moderate to severe stable SCFE treated by MDP and in situ fixation. Methods: Medical records were analysed to collect demographic data, comorbidities and time from slip to surgery. The collected postoperative data were: avascular necrosis (AVN); complications; progression of osteoarthritis and subsequent procedures. Southwick angles (SA), alpha angles and Klein line were measured on the preoperative x-rays, on the immediate postoperative period and at the latest follow-up. Outcomes scores were recorded by the following questionnaires: the Harris Hip Score, the Hip disability and Osteoarthritis Outcome Score, the Merle d’Aubigné and Postel score and the Western Ontario and McMaster Universities Arthritis Index. Kaplan-Meier survivorship curve was calculated. Results: We compared 81 hips treated by MDP with 22 hips treated by in situ pinning (PS) for moderate/severe stable SCFE. No significant differences were found between the 2 groups in terms of age, BMI, comorbidities and preoperative slip angles. At the latest follow-up, postoperative anteroposterior mean slip angles were respectively 6.2 and 19.9° in MDP and PS group ( p = 0.3). Slip angles in frog lateral view were 11° in the MDP group and 39.7° in the PS group ( p = 0.2). MDP group achieved better correction angles on frog leg view (11° vs. 39.7°; p < 0.001). There was no statistically significant difference in the occurrence of AVN among both groups (19.7% MDP group vs. 31.8% PS group) ( p = 0.2). Conclusions: The MDP in treating severe stable SCFE showed the best deformities corrections in conjunction with the highest functional scores at long-term follow-up and similar rates of osteonecrosis compared to in situ fixation.
Prosthetic joint infection diagnosis is often difficult since biofilm-embedded microorganisms attach well to the prosthetic surfaces and resist their detection by conventional methods. DL-dithiothreitol has been described as a valid method for biofilm detachment on orthopedic devices. We report the case of an occasional detection of Listeria monocytogenes in a non immuno-compromised patient with a preoperative diagnosis of aseptic loosening. The infection diagnosis due to such rare bacteria was made postoperatively, thanks to a DL-dithiothreitol-based device. This may be considered a feasible approach for the microbiological analysis of prosthetic joint infection, considering that a prompt diagnosis of such biofilm-associated infections could bring some advantages, such as an early and appropriate antibiotic therapy administration and a reduction of undiagnosed infections.
Several mechanical factors have been related to slipped capital femoral epiphysis (SCFE). Main aim of this study is to investigate the acetabular coverage and acetabular version in unilateral SCFE hips in order to detect a potential pincer-type deformity as predisposing factor; second, we compared those measurements either to the contralateral, uninvolved hips either to a matched healthy control population. A total of 85 patients treated for unilateral SCFE were retrospectively reviewed. The lateral center-edge angle (LCEA) and the Tönnis angle were used to assess acetabular coverage, whereas acetabular retroversion was defined by positive prominent ischial spine (PIS), cross-over sign (COS) and posterior wall sign (PWS). Angles and signs of the affected hips were compared to the contralateral hips and to a matched cohort undergoing an abdominal/pelvic computed tomography for nonorthopedic-related diseases. Affected and unaffected hips of patients with unilateral SCFE had similar morphology in terms of LCEA 28.7° vs. 28° (P = 0.4), Tönnis angle 9º vs. 9° (P = 0.1) and retroversion signs with concomitant rate of PWS and COS 57.6% vs. 50.5% (P = 0.4), PIS 56.4% vs. 49.4% (P = 0.4). Matched healthy controls vs. the affected hips showed a lower LCEA (P < 0.001) and higher Tönnis angle (P < 0.001) in conjunction with a lower incidence of acetabular retroversion: PWS and COS 40% vs. 57.6% (P = 0.01), PIS 43% vs. 56.4% (P = 0.07). A significant retroversion and increased overcoverage were observed in SCFE patients compared to matched healthy controls. In unilateral SCFE, the involved and uninvolved hips showed a substantial symmetry.
Background: The effect of the double-incision technique on the supinator muscle is unclear. Purpose: The aim of this study was to quantify fatty atrophy of the supinator muscle and map the area of muscle damage. Study Design: Case series; Level of evidence, 4. Methods: A total of 19 male patients (median age, 43 years) who underwent distal biceps tendon repair were included in the analysis. Patients with a minimum of 12 months of follow-up were included. The following variables were analyzed: range of motion; shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) score; Summary Outcome Determination (SOD) score; and isokinetic peak force and endurance in supination. Quantitative analysis and mapping of fatty infiltration of the supinator muscle were based on the calculation of proton density fat fraction on magnetic resonance imaging scans of both elbows using the IDEAL (Iterative Decomposition of Echoes of Asymmetrical Length) sequence. Results: At an average follow-up of 24 months (range, 12-64 months), the median SOD score was 9.0 (95% CI, 7.8-9.4), and the mean QuickDASH score was 6.7 (95% CI, 0.0-14.1). A difference of 17% in peak torque was measured between repaired and nonrepaired elbows (repaired elbow: 9.7 N·m; nonrepaired elbow: 11.7 N·m; P = .11). Endurance was better in the repaired elbow than the nonrepaired elbow (8.4% vs 14.9% work fatigue, respectively; P = .02). The average fat fraction of the supinator muscle was 19% (95% CI, 16%-21%) in repaired elbows and 14% (95% CI, 13%-16%) in contralateral elbows ( P = .04). The increase in fat fraction was located in a limited area between the radius and ulna at the level of the bicipital tuberosity. Conclusion: The assessment of the supinator muscle showed a limited increase in fat fraction between the radius and ulna at the level of the bicipital tuberosity. No significant effect on supination strength was highlighted.
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