The purpose of this paper was to evaluate the necesity of associating a lateral extraarticular tenodesis in patients that will undergo an anterior cruciate ligament reconstruction or revision and to briefly describe the surgical procedure. Multiple lateral extraarticular tenodesis techniques were described and also graft selection and fixation types are also important. In conclusion acute ACL tears with grade 3+ pivot shift can be succesfully treated by combined ACL reconstruction and LEAT association.
Bone defects are a challenge to any and in fact every orthopedic surgeon, be they as a consequence of trauma, peri-implant bone loss as is the case in revision surgery or, more often than not, in tumors of the bone. These defects are in most cases difficult to reconstruct, but even more so in the case when they are located around the major joints of the lower limb, i.e. the hip and the knee. We focus in this article on acetabular bone defects as well as on defects around the knee (distal femur and proximal tibia). We present implant possibilities and modern means of reconstructing the bone defect using augments. We also present three representative cases from our Clinic, to further exemplify the discussed concepts. We present our opinions on reconstructing bone defects after tumor and revision surgery in the hip and knee and we draw conclusions.
The use of osteosynthesis materials in orthopedics is fundamental in the surgical management of patients presenting with various pathologies of the locomotor system, in most cases trauma, but also malign and benign tumors. The risk that these materials could have in inducing malignant transformation of benign tumors or in the onset of primary malignant tumors, was rarely studied. On the one hand, primary malignant tumors of the locomotor system are much less frequent than other kind of neoplasms (for example Ewing sarcoma has an incidence of 1-3 cases / 1.000.000 people / year, ostosarcoma has an incidence of 2 cases / 1.000.000 people / year). On the other hand, usually there is a time window of several years, different from one case to another, from the moment of action of the etiopathogenic factor to the moment of revealing the presence of a neoplastic disease. Based on our clinical practice on a few clinical cases, we intend to study more thoroughly the etiology of primary bone malignant tumors in general and the role of the osteosynthesys materials in this matter especially.
Bone changes occurring in people with rheumatoid arthritis increase the incidence of fractures in these patients. In the complex fractures of the 3-part proximal humerus, the treatment of choice is represented by open reduction and osteosynthesis. Because of the important role of the distal portion of the humerus in the elbow joint, fi rm osteosynthesis with angularly blocked implants provides a superior biomechanics and stability in the treatment of complex fractures even in the elderly with a diminished bone stock due to osteoporosis. The preliminary diagnosis was established following simple radiographs. Establishing the diagnosis required computerized tomography and three-dimensional elbow reconstruction. Surgery was performed following the analysis of the imaging data, practicing the fi rst step of reduction and osteosynthesis by the MIPO technique of the proximal humerus fracture, subsequent reduction and osteosynthesis of the distal humerus fracture, the defective bone was fi lled with artifi cial bone graft, and the osteosynthesis of the osteotomized olecan. Reduced soft tissue damage, reduced postoperative pain, reduced functional impairment, and axillary nerve protection confer superiority to osteosynthesis through the mini-invasive approach (MIPO) versus the transdeltoid approach. RezumatModifi cările ososase ce apar la persoanele cu poliartrită reumatoidă cresc incidenţa fracturilor la acești pacienţi. În fracturile complexe ale humerusului proximal cu 3 fragmente, tratamentul de elecţie este reprezentat de reducerea deschisă și osteosinteză. Datorită rolului important al porţiunii distale a humerusului, în cadrul articulaţiei cotului, osteosinteza fermă prin plăci blocate premulate, angular stabile, oferă o biomecanică și o stabilitate superioară în tratamentul fracturilor complexe chiar și la persoanele în vârstă, cu un stoc osos diminuat din cauza osteoporozei. Diagnosticul preliminar a fost stabilit în urma efectuării radiografi ilor simple. Stabilirea diagnosticului a impus efectuarea unei tomografi i computerizate și o reconstrucţie tridimensională a cotului. Intervenţia chirurgicală a fost efectuată în urma analizei datelor imagistice, practicându-se în primă etapă reducere și osteosinteză prin tehnica MIPO a fracturii de humerus proximal, ulterior reducerea și osteosinteza fracturii de humerus distal, plombajul defectului osos cu substituent și hobanajul olecranului osteotomizat. Lezarea redusă a ţesuturilor moi, reducerea durerii postoperator, diminuarea gradului de insufi cienţă funcţională și protejarea nervului axilar conferă superioritate osteosintezei prin abordul miniminvaziv (MIPO) faţă de abordul transdeltoidian. Cuvinte cheie: MIPO, reconstrucţie 3D tomografi e computerizată, poliartrită reumatoidă, fractura humerus proximal, fractură humerus distal CASE REPORT
A key component of a successful external myoprosthesis is not a part of the prosthesis, but an area: the interface between the prosthesis and the amputation stump. This is because in this area takes place a critical exchange of information, in the form of a myoelectrical signal being transferred from the muscles, through the fascia, fat and skin, to the surface EMG sensors, that in turn transfer this information to a part of the prosthesis that is responsible with the analysis, augmentation and use of this signal in order to control the movements of the electromechanical parts of the prosthesis. Any condition that leads to an impaired transmission of information from the skin to the EMG sensors inevitably leads to an underperformance of what may otherwise be a highly developed model of exoprosthesis, thus potentially rendering it no more useful than a basic mechanical model. We aim to review the possible difficulties that may arise in this area, and that may lead to a faulty transfer of signal, with a loss in quantity or quality. For this purpose, we will review the current literature for this subject, including reference books and articles, and complete this information with our personal experience. In doing this, we hope to provide a guide to practitioners, bioengineers and patients alike, in order to be able to anticipate and correct any potential problem as they may arise.
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