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Introduction: This study analysed the trend of publications on anterior cruciate ligament (ACL) in Italy. It was hypothesised that publications on this topic have quickly increased in recent years due to increased knowledge of both clinical and radiological pathology. Methods: PubMed and Scopus were accessed on 29/11/2023. This retrieved 838 articles from PubMed and 1050 from Scopus. We analysed the top 10 authors, and journals in publication numbers, citation numbers, and citations per year. We have also looked at the top 10 institutions publishing on anterior cruciate ligament from Scopus as PubMed does not give this information in the output. Data mining was performed using the Orange software, Mac version 3.32.0 (https://orangedatamining.com/) from the titles of all articles. A word cloud analysis of titles, authors, journals and universities was performed. Results: The peak of citations was in 2017 with 1529, whilst the peak of publications was in 2019 with 59 articles published. Analysing the number of publications and citations for the journal, the most impacted journal is Knee Surgery, Sports Traumatology, Arthroscopy with 5472 citations and 183 articles, followed by The American Journal of Sports Medicine, with 2722 citations and 56 articles and Arthroscopy with 1990 citations and 62 articles. Considering also international collaborations, the most cited author is Della Villa F. in 2020 with 43.67 citations per year. The Italian author with the major number of publications is Zaffagnini S. with 39 articles, whilst the author with the higher number of citations is Aglietti P. with 1612 citations. Conclusions: ACL reconstruction has gained growing interest amongst the scientific community. Publications and citations presented a rising trend, the majority of the highly cited papers were contributed by few centres, and clinical trials were the most cited study designs. The long-term outcomes of ACL lesions have attracted interest. The authors hypothesised that shortly there will be an increase in articles analysing the results of ACL revisions, the use of lateral extra-articular tenodesis, and meniscus transplants. Level of evidence IV: Cross-Sectional Study [ABSTRACT FROM AUTHOR]

An instructional review of the anatomy, investigation, and management of scapholunate ligament injuries. Aimed at the knowledge level required for the trauma and orthopaedic FRCS examination. [ABSTRACT FROM AUTHOR]

Thoracolumbar spine injuries are commonly seen in trauma settings and have a high risk of causing serious morbidity. There can be controversy when it comes to classifying thoracolumbar injuries within the spinal community, but there remains a need to classify, evaluate and manage thoracolumbar fractures. This article aims to provide a guide on classification of thoracolumbar spine injuries using the AO Spine Thoracolumbar Injury Classification System (AO TLICS). [ABSTRACT FROM AUTHOR]

Purpose: Undiagnosed and undertreated posterior malleolus fractures lead to early ankle instability and arthritis. A preoperative CT scan could improve the management of those fractures. This study assessed the benefits of a systematic ankle CT scanner to diagnose and manage posterior malleolus fracture. Methods: A monocentric retrospective cohort study was conducted. Sixty consecutive patients with bimalleolar fractures were operated and underwent a preoperative CT scan. The mean age was 50.0 years old (18.6 years old) with a mean body mass index of 20.3 (kg/m2) (11.4 kg/m2) and 71.7% (43/60) of women. The primary outcome was the rate of posterior malleolus fragment diagnosed on X-rays and on CT scan. Secondly, interobserver and interobserver's agreement were compared between conventional X-rays and CT scan. Results: Thirty-five (58.3%) posterior fragment fractures were observed on X-rays and 53 (88.3%) on the preoperative CT scan (p < 0.01). The intraobserver reproducibility for X-rays was low (0.02 [− 0.23; 0.27]) and moderate for CT scan (0.45 [0.0; 0.84]). The interobserver reproducibility for X-rays was moderate (0.39 [0.15; 0.60]) and excellent for CT scan (0.78 [0.0; 1.0]). Conclusion: A wide proportion of bimalleolar fractures are associated with posterior malleolus fractures and undiagnosed with standard X-rays. We advocate a systematic preoperative CT scan in the management of bimalleolar fractures. Level of evidence: Level IV, retrospective cohort study. Trial registration number: 2218999v0, date of registration: 11/08/2020 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to determine if the radiographic humerus union measurement (RHUM) is predictive of union in humeral shaft fractures treated nonoperatively. Methods: All patients with long bone fracture nonunion presenting to a single surgeon were enrolled in a prospective registry. This registry was queried to identify patients with humeral shaft fractures treated nonoperatively and developed nonunion. The nonunion cohort was matched to a three to one gender- and age-matched control group that were treated nonoperatively for a humeral shaft fracture and achieved union. Two fellowship-trained orthopedic traumatologists blinded to eventual union scored radiographs obtained 12 weeks after injury using the RHUM. A binomial logistic regression determined the effect of the RHUM on the likelihood of developing union. Results: Nine patients with humeral shaft fractures treated nonoperatively with radiographs 12 weeks after injury that developed nonunion were identified. These patients were matched to 27 controls. Logistic regression demonstrated the RHUM was a significant predictor of healing 12 weeks after humeral shaft fracture treated nonoperatively (p = 0.014, odds ratio 9.434, 95% CI for OR 1.586–56.098). All patients with RHUM below 7 went on to nonunion. All patients with RHUM above 8 healed. Three of seven patients (43%) with RHUM of 7 or 8 healed. Conclusion: The RHUM demonstrated an increased likelihood of achieving union 12 weeks after injury. Orthopedic surgeons can counsel patients that fractures with RHUM scores of 6 or below are in danger of developing nonunion and can target interventions appropriately. [ABSTRACT FROM AUTHOR]

European Journal of Orthopaedic Surgery and Traumatology (EJOST) was founded in 1991. It was initially named as Orthopédie-Traumatologie, and since then it is dedicated in sharing knowledge and new evidence in the field of orthopaedics. Within 28 volumes and 157 issues, it has published 3218 scientific articles. In the early years of its distribution, published articles were in French, while the last two decades EJOST only hosts English articles between its pages. By the very beginning of its launch, it has been publishing high-quality research articles in all orthopaedic subspecialties and has gradually become one of the leading journals in its specific subject area. The aim of this study was to identify, analyse and categorize the most frequently cited articles, published by EJOST since its launch. [ABSTRACT FROM AUTHOR]

Purpose: Preoperative screening in hip fracture patients is vital to minimize perioperative complications. Preoperative chest radiographs (POCR) are performed in many hip fracture patients. Earlier research showed that few POCR abnormalities influence perioperative policy. However, no studies in nonelective patient with a specific surgical conditions have been performed. With many hip fractures per year worldwide, a significant cost reduction could be made by performing selective POCR without compromising the quality of care. This study assessed the need for POCR in hip fracture patients. Method: Retrospective analysis of low-energy trauma patients was performed aged 18 years and older in the VU University Medical Center for a hip fracture in a 5-year period. All preoperative diagnostics were analyzed. All adjourned operations were evaluated. Results: A total of 642 patients were included, 70% female, matching current epidemiologic figures. The POCR showed abnormalities in 22.6%. In 0.6% the POCR lead to an adjournment of the operation (2.8% of abnormal POCR's). These patients suffered from pneumonia. The POCR in these cases acted as a confirmation of the clinical diagnosis. Conclusion: Many factors involving the treatment of hip fracture patients are of importance in minimizing the risk of complications and mortality during and after admission. In 0.6% of all performed POCR's an abnormality leads to the adjournment of the operation. In all four cases the POCR matched the clinical findings. Because the additional value of the POCR in hip fracture patients was limited, we think that its selective use in clinical abnormalities is safe and will reduce unnecessary costs. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis of the knee causes significant disability amongst the elderly, and total knee replacement remains the only effective intervention for pain relief and functional improvement. Using data from single military healthcare institutional records in India, we estimated the utilization rates of total knee replacement by age, gender and rank profile. Methods: All the data were retrieved manually from institutional records as the institutional databases are yet to be digitized. The information on the study subjects was retrospectively retrieved from the records of the Department of Orthopaedics from the year 1997 to 2012. Trends were estimated by using two 6-year periods separated by a decade, i.e. 1997-2002 and 2007-2012. We estimated age-, gender- and rank-specific rates of TKR utilization in these years. Results: From 1997 to 2002, 37 TKRs were performed as compared to 800 during 2007-2012, showing a more than 20 times increase. During 1997-2002, the mean age was 62.6 years (SD-9.224) compared to 65.8 years (SD-7.05). There was significant disparity in TKR utilization rates on the basis of rank with officers and their dependent, showing much higher utilization rates in both year groups which is possibly explained by the higher level of awareness about the procedure, higher education levels and higher acceptability of the procedure by the officers as compared to PBORs. The rate of TKR was marginally higher amongst women as compared to men. Conclusion: The TKR utilization rates have increased tremendously over a decade. In view of this huge increase, future planning is essential to enable optimal material and human resource allocation as well as training to meet future challenges. [ABSTRACT FROM AUTHOR]

Rapid destructive arthritis of the hip is a rare entity with unknown pathogenesis and outcome. First described by Forestier in 1957, it is characterized by a rapidly progressive hip disease resulting in rapid destruction of both the femoral and acetabular aspects of the hip joint, with almost complete disappearance of the femoral head within a few months. Since the original description, case reports and small series have been reported, and many names have been proposed to describe the rapid destruction of the femoral head and occasionally the acetabulum. Initial presentation includes acute hip pain with the lack of radiographic evidence of joint destruction, rapidly progressing to complete vanishing of the proximal femur within a few months. This article summarizes the related literature aiming to present the current concepts for the diagnosis and treatment of rapid destructive arthritis of the hip. [ABSTRACT FROM AUTHOR]

Bioresorbable devices are commonly used in traumatology. The biomechanical stability of these materials has improved in the past decade, and they have proven to be biologically non-hazardous, while their main advantage is that their use avoids reintervention for removal of the device. A prospective monocentric study was conducted: 24 patients presenting with a fracture that was amenable to osteosynthesis by small-diameter screws were included. These comprised ten tibial spine fractures, four osteochondritis dissecans of the distal femur, eight fractures of the medial epicondyle of the distal humerus, and two distal tibial apophyseal fractures. One or more screws were used that were made of a copolymer of poly- l-lactide-poly- d-lactide acid and trimethylene carbonate with a diameter of 2.8 mm. All patients were immobilized with a cast. Clinical and radiographic monitoring was conducted every month. The entire follow-up protocol had a duration of 24 months. One patient with osteochondritis dissecans presented with joint effusion. Joint stiffness at the time of cast removal resolved completely after 4 months, except for with three children (one epicondyle fracture, two tibial spine fractures). No subjective or objective instability could be detected by clinical examination. Radiographic follow-up revealed no secondary displacement, and all of the fractures had healed. No osteolysis was seen around the screws. No growth disturbances were noticed. Bioresorbable materials thus appear to be a suitable alternative approach for certain pediatric fractures. Their use resulted in outcomes similar to traditional techniques in terms of functional properties and bone healing. Although initial costs are presumably slightly higher, by avoiding a removal operation the total financial burden is most likely reduced. Level of evidence: III. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare in two randomized cohorts the outcome of the fixation of ulna fractures with either a 3.5-mm dynamic compression plate (DCP) or a one-third tubular plate (TP). A complete follow-up for at least 6 months after surgery included fourteen patients in the DPC cohort and fourteen patients in the TP cohort. All patients in the DCP cohort healed, while three patients in the TP cohort (21%) had implant failures ( P = 0.22). Although limited by low-grade statistic power, this clinical trial confirms that third tubular plates are inadequate for the internal fixation of diaphyseal ulna fracture. [ABSTRACT FROM AUTHOR]

A 70-year-old male patient presented to our emergency department with trauma left hip following a fall. Physical examination revealed external rotation, slight flexion, adduction, and shortening of the affected limb. There was a palpable fullness in the groin. Radiographic examination revealed fracture neck of femur with femoral head dislocated anteriorly and lying in the obturator foramen. There was an associated femoral head fracture with a fragment of it in the acetabulum. Although this sort of injury has been reported once, the difference in our case lies in the age of the patient; the injury complex was caused by a less severe trauma and a unique mechanism of injury. Also a modification of Brumback classification is proposed to include such fractures more specifically in order to allow comparative analysis in such rare injuries as more and more such case reports are added to literature. [ABSTRACT FROM AUTHOR]

The results of distraction histogenesis using Ilizarov techniques for 18 consecutive patients were evaluated. There were 13 male and 5 female patients. Their ages ranged from 11 to 74 years (average 36.8 years). All patients presented with established hypertrophic nonunion of the tibia, associated deformity ≥15° and leg shortening. There were no cases of active infection at the time of our treatment. The procedure included fibular osteotomy, application of a pre-constructed Ilizarov frame. Controlled distraction was done until complete deformity correction and equalization of leg length. Weight bearing was allowed during treatment. All patients (100%) had their nonunions consolidated with deformity correction and restoration of the normal mechanical axis of the limb. The leg length discrepancy was corrected in all cases. The follow up ranged from 29 to 50 months (average 37.2 month) after fixator removal. Distraction histogenesis, using Ilizarov techniques, is a reliable method for consolidation of hypertrophic nonunion, deformity correction and equalization of leg length all in one procedure through minimal surgical interference. [ABSTRACT FROM AUTHOR]

Ipsilateral proximal and distal radial fractures represent an injury spectrum following trauma due to axial loading of forearm. This spectrum may vary from a minimal (undisplaced fractures at either ends) to a severe insult (associated proximal and distal ulnar fracture, comminution, displaced fragments and probable interosseous membrane damage). Series of five cases on ipsilateral proximal and distal radial fractures and their results. Two of these cases occurred in paediatric age group. Both these injuries commonly result from a fall on outstretched hand. In older age group, especially osteoporotic elderly women, the fracture pattern can be a result of low energy trauma with minimal displacement of fractures. In younger age group, the injury complex mainly results from high-energy trauma with comminution, instability and significant soft tissue damage. The proximal fractures might be a part of a more severe elbow dislocation which may not be obvious at the time trauma radiographs are taken. The main sequellae in the series were related to involvement of radial head. In the paediatric group, the fracture pattern was complicated by avascular necrosis of radial epiphysis and premature physeal fusion. Ipsilateral proximal and distal radial fracture is an uncommon injury pattern. The series illustrates a number of problems associated with this combination. Firstly, one should be aware of this rare injury pattern and there should be greater emphasis on clinical examination of elbow in cases of wrist injuries and vice versa. Once diagnosed, one faces the dilemma of appropriate management in these cases. The appropriate management will depend on the injury characteristics including the age of the patient and the fracture pattern. One should try to preserve the radial head to prevent a possible proximal radial migration especially in younger patients. In children, these injuries are extremely prone to complications and forewarning the parents of a possible poor result while treating these injuries is important. [ABSTRACT FROM AUTHOR]

The objective of this invitro study is to test and describe a new method of obtaining accurate sagittal plane bony entry point after tibial nailing using lateral projection radiograph without having to standardise the radiographic technique. Radiopaque markers were fixed to the anterior oblique facet of the proximal tibial metaphysis of ten synthetic tibiae between the articular surface and the tibial tubercle to simulate the intramedullary nailing bony entry point. Controlled standardised lateral radiographs were obtained in three different axial rotations. The 30 resultant radiographs were scrutinised for precise bony entry points: ‘C’ which represents the percentage of ratio of the distance between articular surface and the radio opaque marker ‘A’, to the distance between the articular surface and the tibial tubercle ‘B’. The Mean deviation in ‘C’ values from the true lateral was −0.4% in 15 ° internal rotation, −0.6% in 15 ° external rotation. None was statistically significant. Axial rotation has no significant effect on accuracy of sagittal plane bony entry point measurement in lateral radiographs. Precise bony entry point can be obtained using the method described without having to standardise lateral projection radiographs. [ABSTRACT FROM AUTHOR]

Osteoporotic distal radius fractures are a public health problem that medical osteoporosis treatment is unable to check. We have described a bone substitute method to improve mechanical properties in bone. Our current study aims at improving the technique by maximising the filling of the distal radius. Cavities were created by curettage in the distal radius using a styloid process approach in ten randomly selected wrists from the sample population of ten cadavers. All radii were injected percutaneously with calcium phosphate cement. Cement quantities injected were calculated and corrected for observed cement leakage. Our results show that distal radius curettage before cementoplasty can double the amount of calcium phosphate cement injected. Prevention of osteoporotic distal radius fractures by cementoplasty seems a promising technique. Slowly absorbed micro-porous biomaterial use is preferable in long-term preventive treatment. Nevertheless, in the future, this technique should apply in specific cases, such as medical osteoporosis treatment failure with contra-lateral wrist fracture. [ABSTRACT FROM AUTHOR]

We report the results of partial wound closure of the Cincinnati incision after surgical correction of 31 clubfeet in 21 children. The mean length of follow-up was 36.9 months. All feet were evaluated for the appearance of the scar and correction of the deformities. The initial appearance of the wound was a major concern to the parents. The final appearance of the scar was cosmetically acceptable to both the surgeon and the parents. Equinus deformity was corrected in all patients, with three of the feet attaining a dorsiflexion of more than 20°. [ABSTRACT FROM AUTHOR]

Placement of the guide wire in the dynamic hip screw operation can be a challenging task to the trauma surgeon. Complications can arise related to incorrect guide wire entry point, making multiple wrong tracks or even accepting an unsatisfactory lag screw placement. Insisting to optimise the guide wire position can lead to increase in operation time and radiation exposure time. A new, non-invasive technique is described to assist precision placement of the guide wire in the dynamic hip screw fixation of femoral neck fractures using no more than a size A4 plain folded paper and a non-permanent marker pen. The new, non-invasive, “no-high-tech” method can help trauma surgeons shorten the operation time and reduce the radiation exposure time needed to place the guide wire in the dynamic hip screw fixation of femoral neck fractures. [ABSTRACT FROM AUTHOR]

Carpal tunnel decompression is a procedure commonly performed by many orthopaedic surgeons. Although there is no general consensus on the best technique in terms of acceptability to patients and operative outcome, some surgeons have a specific personal preference, in particular with regard to the use of a tourniquet and the timing of its release. A prospective randomised controlled trial was performed to determine whether or not deflation of the tourniquet and achieving haemostasis prior to wound closure influenced the outcome of carpal tunnel decompression under local anaesthesia. After division of the retinaculum, 26 wrists were randomised to tourniquet released prior to closure and haemostasis with bipolar diathermy and 24 after closure and dressing application. Immediately after surgery, all patients were asked to indicate the maximum level of pain at the operative and tourniquet sites experienced intra-operatively using a visual analogue score. Patients were assessed for wound healing and symptom relief at 2 and 6 weeks post-operatively. Results were analysed using the Wilcoxon 2-sample test. The use of local anaesthesia and tourniquet was well tolerated in both groups. There was no statistically significant difference between the two groups in pain at the operative or tourniquet site or in wound healing and symptom relief at 2 and 6 weeks post-operatively. Open carpal tunnel decompression under local anaesthesia with tourniquet control is a safe, effective and acceptable technique. The timing of tourniquet release does not affect patient satisfaction, wound healing or symptom relief. [ABSTRACT FROM AUTHOR]

The closed body-exhaust ventilated system plays an important role in reducing infection rate in total hip arthroplasty. This demands a secure body-exhaust air hose. The current method of securing the air hose by tying the necklace hose ribbons around the waist often fails to hold the hose in place. This will inevitably undermine the effectiveness of the body-exhaust system. A new and simple method is described to stop the body-exhaust hose from slipping and migrating up the surgeon’s body. The surgeon’s own buttocks are used to anchor the hose ribbons in place. The new method can improve the effectiveness of the body-exhaust system and raise its potential to the maximum without causing any discomfort to the surgeon or jeopardising the sterility of the surgeon’s clothing. [ABSTRACT FROM AUTHOR]

Presents literature and CD-Rom software about orthopedic surgery and traumatology. Jean-Marie Andre's book "Atlas pratique des orthe'ses de la main"; "Bioceramics in Joint Arthroplasty--Proceedings 7th International BIOLOX Symposium"; "La gonarthrose," edited by Michel Bonnin and Pierre Chambat; "Fractures of the Distal Radius: A Practical Approach to Management," 2nd ed., by Diego L. Fernandez and Jesse B. Jupiter.

Injuries to the tarsometatarsal (Lisfranc) joint are uncommon, and the results of treatment are often unsatisfactory. Open reduction and internal fixation has been recommended as the treatment of choice for most unstable injuries. In the present study, we reviewed 16 patients who underwent closed or open reduction and Kirschner-wire transfixation of a Lisfranc injury in an 11-year period. Mean follow-up was 44 (range, 12–108) months. Average American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score was 78 (range, 45–100) points. Eight patients (50%) developed posttraumatic arthritis of the tarsometatarsal joints. The major cause was nonanatomical reduction, whereas patients with purely ligamentous injury showed a trend toward poorer postoperative outcome. On the basis of our study, open anatomical reduction of fracture-dislocations of the Lisfranc joint and Kirschner-wire transfixation leads to the best long-term outcome. [ABSTRACT FROM AUTHOR]

Paget's disease of the femur and tibia causes severe morbidity and mortality in the elderly population. It weakens and deforms the bone, causing significant disability. Deformities have been corrected with various methods, mostly using external fixation. In this study, we have utilised locked intramedullary nails after osteotomy to rectify these bone deformities. A number of patients were studied and followed up using a standard method to document outcome. The aim of this investigation was to determine the clinical effectiveness of internal fixation with interlocking nails for the treatment of deformities of pagetoid bones. The safety and effectiveness in terms of function, pain relief, and cosmetic results were determined after using internal fixation to correct deformed tibiae and femora. The goal of treatment was to restore a normal axis in the limb and allow early weight bearing, preventing mineral loss and additional bone weakening. The operative procedures are described and the pre- and post-operative appearance of the lower limb bones shown. The advantages of the procedure as compared to other methods of fixation are discussed. [ABSTRACT FROM AUTHOR]

Odontoid-lateral mass asymmetry is a finding occasionally noted on properly centered, open-mouth anteroposterior (AP) radiographs obtained following trauma. Controversy exists as to the clinical significance of this finding in patients with few or no symptoms. We retrospectively evaluated 13 patients who presented with radiographic evidence of odontoid-lateral mass asymmetry following trauma. The mean age was 23.8 (range 16–50) years. Injury most commonly followed a road traffic accident (RTA). Of the 13 patients, 31% were asymptomatic, 69% had cervical pain, and 31% had diminished range of cervical motion. No patient had torticollis or neurological deficit. Odontoid processes were anatomically normal. In the neutral position, asymmetry varied from 2 to 4 (mean 2.4) mm. No patient had radiographic evidence of fixation. The atlantodental interval (ADI) was normal in all cases and no translation was noted on the dynamic lateral radiographs. No fractures were identified on CT scans, and the mean rotation of the atlas on the axis was 6° (range 4–10°). No patient had formal treatment. At their most recent follow-up, 12 patients were asymptomatic with a normal range of cervical motion. One patient had persisting cervical pain. We conclude that the radiographic finding of an asymmetric odontoid-lateral mass interspace following trauma may be a normal variant in the minimally symptomatic patient and require no formal treatment. [ABSTRACT FROM AUTHOR]

There are only four reports on unilateral occlusion of the common iliac artery following ipsilateral anterior retroperitoneal approach to the lumbar spine. To the authors' knowledge, there are no previous reports on delayed bilateral iliac artery occlusion following retroperitoneal approach. We report on a rare case of a 37-year-old paraplegic man who sought this department with bilateral iliac artery occlusion and simultaneous unilateral thromboembolism to the left popliteal artery. The problem occurred following retroperitoneal approach for instrumentation of an L2 fracture performed 2 years ago. The left leg was amputated above the knee because of gangrene, while a left-sided abdominal-to-femoral artery bypass was performed to salvage the right leg. Six months later, the right leg was amputated below the knee because the patient was admitted again with gangrene of his right foot. Following that, the loosened anterior hardware was removed via a right retroperitoneal approach. Revision surgery revealed an apposition of the common iliac vessels from the loosened hardware, while the vertebral bodies at the affected area were severely osteoporotic. Spine surgeons should be aware for the appearance of this disastrous complication following anterior retroperitoneal surgery in patients with loss of sensation in the lower extremities who do not present subjective symptoms of ischemia. The presence of hardware loosening and migration, loss of correction and pseudarthrosis are the warning signs for diagnosis of such a complication. [ABSTRACT FROM AUTHOR]

Introduction. As the analysis of scoliosis requires global and local three-dimensional (3D) examinations of the spine in standing position, stereoradiography appears as one of the most adequate 3D imaging tools for its diagnosis. However, the definition level of the 3D stereoradiographic model may still be too low for local analysis. Objectives. (1) To increase the geometric definition of the 3D stereoradiographic reconstruction to obtain morpho-realistic models, and (2) to validate the accuracy of this technique using radiographs providing by a low-dose digital X-ray device. Method. Detailed generic objects for each vertebral level (approximately 2,000 points) were obtained using average models (approximately 200 points), from an existing data base of direct measurements in association with CT scan 3D model (2,000 points). Validation of these models was performed by comparing detailed stereoradiographic reconstructions of 36 dry human vertebrae belonging to each spinal level with the corresponding CT-scan reconstructions. Results. Comparison protocol between the detailed stereoradiographic reconstructions and the CT-scan reconstructions indicated mean (RMS) reconstruction errors of 0.7 mm (0.9), 0.9 mm (1.2) and 0.9 mm (1.2) for lower cervical, thoracic and lumbar levels respectively. Results showed 3D personalised models of 2,000 points without any loss of accuracy in comparison to previous studies. Conclusion. This study yields morpho-realistic, personalised 3D geometric models (accuracy close to CT-scan reconstruction) with a low irradiation dose. [ABSTRACT FROM AUTHOR]

Controversy persists regarding the eventual bone mineral density (BMD) variations in the contralateral hip and lumbar spine after unilateral primary total hip arthroplasty. Bone loss may occur if the operation requires a period of bed rest. The purpose of this study was to characterize BMD changes at these two sites after unilateral total hip replacement (THR). In this study, 52 male patients who underwent total hip arthroplasty with a cemented modular straight stem were included. BMD was assessed at the lumbar spine and the contralateral, nonoperated hip using the dual energy X-ray absorptiometry (DEXA) method. Measurements were done 1 month before the operation and at days 8, 90, 180, 365, and 710 postoperatively. No statistically significant BMD changes were present between the different measurements either in L2–L4 vertebrae or at any of the seven Grüen zones of the contralateral, nonoperated hip. Our results suggest that immediate full weightbearing permitted by cemented implants avoids bone loss from the proximal nonoperated femur and the lumbar spine and hence may prevent transformation of osteopenia to osteoporosis in older patients. [ABSTRACT FROM AUTHOR]

In response to the creation and popularisation of the Internet as a convenient medium of communication, there has been an explosion of healthcare information readily available to many patients. However, this information is not screened or regulated, and claims may be unsubstantiated and misleading. The aim of this study was to evaluate the nature and quality of orthopaedic surgical information on the World Wide Web (WWW). Three of the most commonly used search engines were assessed for information on three orthopaedic operations: carpal tunnel decompression, lumbar discectomy and anterior cruciate ligament reconstruction. Websites were classified and evaluated for completeness, accuracy, accountability and reference to a reliable source of information. The top (first) 20 relevant websites listed by each search engine for the three search phrases entered were judged, giving a total of 180 addresses. There were 21 triplications and 56 duplications, leaving a residue of 103 addresses for analysis. Health websites totalled 33%; the majority targeted the lay population (67%). Teaching file was the most common type of site (57%). Although 82% contained accurate information, in 67%, this information was incomplete. Of all websites reviewed, 85% were accountable for the information presented, but only 21% made references to reliable sources. The WWW offers easily accessible, patient-orientated orthopaedic surgical information. However, until an organised approach to website control is established, it is important for orthopaedic surgeons to emphasise to their patients that not everything they read is complete or accurate. Publicising sites known to be of high quality will promote safe browsing of the WWW. [ABSTRACT FROM AUTHOR]

The treatment of unstable trochanteric femoral fractures is still challenging, and the proximal femoral nails are becoming more commonly used. The proximal femoral nailing is usually performed on a fracture table under traction which is associated with some possible complications. In our study, we tried to present the results of proximal nailing surgery performed in the lateral decubitus position and manual traction on a radiolucent table without the fracture table traction. [ABSTRACT FROM AUTHOR]

The frequency of posterior sternoclavicular dislocations represents 0.019% of the shoulder injuries in the Centre of Traumatology and Orthopedics of Dakar. The posterior form is 0.033% compared to the anterior form. The authors report the cases of posterior sternoclavicular dislocations, occurred with seven men and one woman. Seven of these dislocations were located on the left side, including one case of polytraumatism, one associated with a brachial plexus compression, and one case with a fracture of the kneecap. The authors show the interest of the incidence of Heinig in the diagnosis. The open treatment following the technique of burrows which uses the tendon of the subclavius gives satisfactory results in both functional and anatomical respects. They discuss the orthopaedic methods and insist on their disadvantages, especially in the event of vascular lesion with a risk of haemorrhage of a clogged breach or source of instability, and the difficulty of radiological control after reduction. [ABSTRACT FROM AUTHOR]

Fluoroquinolones are considered to be relatively safe and effective antibacterial agents. Treatment with fluoroquinolones has become increasingly popular because of excellent gastro-intestinal absorption, superior tissue penetration along with broad-spectrum activity. The association between tendon rupture and fluoroquinolones were well established with older quinolones but very rare with newer quinolones like levofloxacin. We report a very rare case of spontaneous bilateral Achilles tendon rupture in a 66 year old patient associated with levofloxacin. This patient was started on levofloxacin for a chest infection. Ultra sound scan and magnetic resonance imaging confirmed the diagnosis. Early surgical repair was performed. The patient recovered well with no sequel of tendon rupture. Emphasis is placed on the necessity of identifying this potential and probably unusual complication of these newer antimicrobials. [ABSTRACT FROM AUTHOR]

We present a case of wooden foreign bodies in the foot with delayed diagnosis. Unreliability of plain radiographs in these situations is emphasized. The comparative utility of computed tomography, magnetic resonance scans and ultrasonography is evaluated from a literature review. We utilized a sinogram which showed the splinters and also indicated their location and orientation in a region of complex anatomy, thus reducing surgical time and morbidity. Management of a suspected radiolucent foreign body is fraught with pitfalls and we provide a possible algorithm for management. [ABSTRACT FROM AUTHOR]

There has been an increase in the prevalence of pyomyositis in children living in temperate climates over recent years. Its presentation in the muscles surrounding the pelvis is similar to other diseases of the hip joint including septic arthritis and transient synovitis. This can lead to a delay in diagnosis and treatment. We present two cases of pyomyositis in children, at previously undescribed sites, highlight the importance of careful clinical examination and underline that MRI remains the gold standard for accurate diagnosis. Prompt treatment can prevent abscess formation and thus the need for surgical intervention. [ABSTRACT FROM AUTHOR]

Segmental bone loss associated with high-energy trauma is a challenging problem for the physician. In majority of the cases, autogenous bone graft can be used successfully; however, reimplantation of extruded fragments has the benefits of maintaining skeletal length and avoiding the morbidity of the autogenous bone harvest. We report the case of a 17-year-old boy that had an open fracture of his left arm with an extruded fragment of 8 cm, which was successfully reimplanted. [ABSTRACT FROM AUTHOR]

Inferior shoulder dislocation (luxatio erecta humeri) is a rare form of shoulder dislocation. Two cases of this rare condition are reported, a review of management is presented. It is emphasized that heightened awareness for this injury is necessary because lesion are rare and few physicians are familiar with the condition. [ABSTRACT FROM AUTHOR]

We describe the case of a patient who presented with an acute pre-patellar bursitis, which did not improve with antibiotics. Aspiration of the bursa when it became fluctuant revealed urate crystals. Diagnosis was a rare first manifestation of gout, the occurrence of which had not been reported previously in orthopaedic literature. We highlight the importance of aspiration in the management of bursitis and its importance when gout is suspected, especially in one in whom non-steroidal anti-inflammatory drugs (NSAIDs) has recently been stopped. It is important to appreciate that the presence of crystals does not exclude the presence of infection. Bursitis can be caused by gouty crystals, but an infective cause of bursitis can result in secondary gout. Uric acid levels are not useful for the management of the first presentation of gout. We propose a simple algorithm for the management of acute bursitis. [ABSTRACT FROM AUTHOR]

We present the case of a 59-year-old man with a 6-cm diameter tumor on his left hand of 40 years duration. After radiograph and MRI studies, the tumor was excised. The pathological study revealed an aponeurotic calcifying fibroma that was confirmed after electronic microscopy. The size of this tumor was exceptional. One year postoperatively, there were no signs of local recurrence. [ABSTRACT FROM AUTHOR]

A 55-year-old woman presented with a 1-month history of anterior pain of the right knee. Magnetic resonance imaging showed a well-defined soft tissue mass in the fat pad posteriorly to the patellar tendon. An excisional biopsy was performed. Histologic examination showed tendosynovial giant cell tumor of the patellar tendon sheath. At the latest follow-up, there was no local tumor recurrence. [ABSTRACT FROM AUTHOR]

We report a rare case of double fractures of the odontoid process combined with a fracture of the anterior arch of the atlas. Combined fractures of the odontoid process and the upper cervical spine are not unusual. The presence of two different patterns of odontoid process fractures combined with a fracture of the anterior arch of the atlas is not reported in the literature available to us. The authors report on a patient who sustained two fractures in the odontoid process of C2 and a fracture of the anterior arch of C1. As the initial plain films were not clear enough to detect suspected lesions in the upper cervical spine, the patient underwent full investigation with CT scan and MRI. Reconstructive images showed the fractures of the odontoid process and the one of the atlas. The patient was treated conservatively with the application of cranial traction. The patient died 10 days later of unrelated cardiopulmonary insufficiency. During this period, there was no particular problem from the cervical spine. We recommend a high level of alert and suspicion to every case of upper cervical spine injury since, due to the complexity of the anatomy of this transitional area, a different biomechanical behavior exists leading to a variety of combination of fractures. [ABSTRACT FROM AUTHOR]

A rare case of an infected chronic hematoma in a patient with immunodeficiency syndrome mimicking a soft tissue neoplasm is presented. There are few reported cases of hematogenous infection of chronic hematomas, which be difficult to differentiate from soft tissue neoplasms. [ABSTRACT FROM AUTHOR]

We present a retrospective review of six cases of distal biceps tendon repair with a mean follow-up of 1 year. All patients were men aged between 34 and 62 years. In all patients, the injury was sustained with application of an unanticipated large load to the flexed arm. All but one patient was operated within a week of the injury. All six cases were operated through a single anterior incision and the torn tendon ends fixed to the radial tuberosity with implantable suture anchors. All patients were reviewed subjectively and objectively. All but one returned to preinjury activity within 6 months. One patient developed superficial radial nerve neurapraxia, which recovered, and one developed a superficial wound infection, which required treatment with oral antibiotics and surgical excision of the sinus. We believe that operative repair of distal biceps tendon rupture using a single anterior incision and suture anchors is a safe and effective method of treating theses injuries. [ABSTRACT FROM AUTHOR]

Posterior fracture dislocation of shoulder is an uncommon injury and often missed initially. Fracture dislocation of shoulder is difficult to assess with plain radiographs, hence a CT scan should be sought early. A detailed pre-operative planning should be made before operating these patients, as this injury does not tend to do well, especially after hemiarthroplasty. We present a case of bilateral posterior fracture dislocation of the shoulder treated by bilateral hemiarthroplasty with excellent results. [ABSTRACT FROM AUTHOR]

Aneurysmal bone cysts (ABCs) are benign lesions that are uncommon in the spine. Both investigation and treatment of these lesions can present significant difficulties. We report an unusual presentation in an adolescent with a delayed diagnosis of ABC. This case emphasises the need for extra vigilance in young patients with significant symptoms. [ABSTRACT FROM AUTHOR]

This report describes a patient complaining of low back pain and presenting with neurological symptoms that proved to be due to epidural metastasis from retroorbital malignant fibrous histiocytoma (MFH). Because of its origin, primary or metastatic MFH can appear virtually anywhere. Both imaging studies and intraoperative findings of this patient clearly demonstrated tumor in the epidural space but no involvement of vertebra. Resection of the tumor was followed by adjuvant radiotherapy, but the patient died 6 months postoperatively. On the basis of histologic examination, the tumor was diagnosed as a histiocytoma. Orbital and epidural MFH are very rare. This is the first reported case of epidural metastasis from retroorbital MFH. MFH is a highly malignant neoplasm with guarded prognosis despite treatment. [ABSTRACT FROM AUTHOR]

The Grammont total shoulder prosthesis (Delta III) is an original reversed constrained prosthesis. Classical indication is glenohumeral osteoarthritis with massive and irreparable rotator cuff tears. The authors report a Delta III arthroplasty for a rare histological variant of proximal chondrosarcoma, by pointing out the technical and biomechanical principles of this arthroplasty. Clinical and radiological results are presented with a 9-year follow-up. To our mind, in case of malignant bony tumours of proximal humerus with carcinologic cuff resection, the Grammont total shoulder arthroplasty is of interest and its proposal must be discussed. [ABSTRACT FROM AUTHOR]