Gorham–Stout Disease - Andreas F. Mavrogenis, MD, Constantinos P. Zambirinis, MD, Panayiotis A. Dimitriadis, MD, Athanasios Tsakanikas, MD, and Panayiotis J.
Gorham–Stout disease is a rare disease of unknown etiology. It is characterized by spontaneous excessive replacement of bone by proliferative non-neoplastic thin-walled lymphatic and/or blood vessels. Histology shows positive stain for the lymphatic endothelial marker LYVE-1 (lymphatic vascular endothelial hyaluronan receptor-1) and many lymphatic growth factors (PDGF-BB, VEGF-C, VEGFR- 3). Patients may present with localized pain and/or weakness and radiographic evidence of massive osteolysis involving contiguous bone structures. The disease usually progresses and complications may occur with significant morbidity and mortality. Close monitoring of these patients is recommended. Treatment remains challenging. Surgical treatment has been combined with pre- and postoperative radiation therapy. Drug regimes including bisphosphonates and vitamin D have been used with various results. Currently, the most effective agent is INF-˛ due to its anti-angiogenic effect. The effect of the newer immunomodulatory agents such as the OK-432 remains to be proved. (Journal of Surgical Orthopaedic Advances 19(2):85–90, 2010) Key words: bisphosphonates, Gorham–Stout disease, IFN-˛, massive idiopathic or progressive telangiectatic osteolysis, OK-432, phantom bone disease, primary bone lymphagioma or hemangiomatosis, radiotherapy, vanishing or disappearing bone disease
The Effect of Incisional Negative Pressure Therapy on Wound Complications After Acetabular Fracture Surgery - Robert N. Reddix, Jr., MD, Xiaoyan ‘‘Iris’’ Leng
The purpose of the study was to determine if the use of incisional negative pressure therapy affected the rate of wound complications after acetabular fracture surgery. Between August 1996 to April 2005, 301 patients were found to have had an operatively treated acetabular fracture. There were 235 patients who had placement of incisional vacuum-assisted closure (VAC) who had three (1.27%) deep wound infections and one (0.426%) wound dehiscence. There were 66 consecutive patients who were available in the 5 years preceding the usage of the incisional VAC who had four (6.06%) deep wound infections and two (3.03%) wound dehiscences. This is less than the published infection rate of 4% for patients undergoing operative treatment of acetabular fractures and less than the authors’ rate of 6.15% in the time period before the use of the incisional negative pressure wound therapy (p D .0414). The use of incisional negative pressure wound therapy significantly decreases perioperative wound complications after acetabular fracture surgery. (Journal of Surgical Orthopaedic Advances 19(2):91–97, 2010) Key words: acetabular fracture, incisional vacuum-assisted wound closure, negative pressure wound therapy, surgical incisions, surgical wound infection
Prosthetic Treatment of Hip Fractures in the Elderly Patient - Jonathan D. York, BS, Pamela G. Allen, MD, Beth P. Smith, PhD, and Riyaz H. Jinnah, MD, FRCS
As the elderly population in our society significantly increases, the incidence of displaced femoral neck fractures will increase proportionally. Three surgical procedures are available to treat such fractures: internal fixation, hemiarthroplasty (unipolar or bipolar), and total hip arthroplasty. Long-term costs and efficacy of these three procedures vary, primarily due to postoperative complications. Thus, it is imperative that all surgeons conduct a proper preoperative evaluation of each patient before choosing the optimal treatment plan. Internal fixation has been shown to bemore beneficial for physiologically younger patients who sustain displaced femoral neck fractures. However, the choice between hemiarthroplasty and total hip arthroplasty in the geriatric patient remains difficult. This article aims to provide a practical algorithm for the treatment of these patients. (Journal of Surgical Orthopaedic Advances 19(2):98–103, 2010) Key words: displaced, fracture, hemiarthroplasty, intracapsular, total hip arthroplasty
Early Motion Protocol for Select Galeazzi Fractures After Radial Shaft Fixation - David E. Gwinn, MD, Robert V. O’Toole, MD, and W. Andrew Eglseder, MD
Galeazzi fractures traditionally are treated in long arm casts with the wrist fully supinated for 6 weeks after open reduction and internal fixation. Recent literature suggests that early motion can be permitted for a subset of Galeazzi fractures. Defining a safe postoperative protocol that allows immediate elbow motion, immediate platform weight bearing, and early wrist motion might decrease elbow morbidity, increase range of motion, and improve outcomes. A retrospective review of a prospectively collected database of 26 patients at a level I trauma center was conducted. Early motion protocol was assigned to patients who were radiographically and clinically stable after plate and screw fixation. Elbow flexion and platform weight bearing were allowed immediately; increased wrist rotation was allowed at 2-week intervals. Early motion of elbow and wrist seems to be safe during postoperative rehabilitation of repaired Galeazzi fractures. The postoperative protocol might maximize elbow and wrist range ofmotion. (Journal of Surgical Orthopaedic Advances 19(2):104–108, 2010) Key words: distal radioulnar joint, early motion protocol, Galeazzi fracture, radial shaft fracture
Torsional Stiffness of an Intramedullary Nail Versus Blade Plate Fixation for Tibiotalocalcaneal Arthrodesis: A Biomechanical Study - John Froelich, MD
The purpose of this investigation is to compare the rotational stability of intramedullary rod fixation with blade plate and screw fixation in tibiotalocalcaneal arthrodesis. Five matched pairs of cadaver ankles were randomly fixated with a lateral blade plate and screws or a retrograde intramedullary nail. The bone mineral density (BMD) for each sample was ascertained. These samples were tested through internal and external rotation of 0.5°/s until 7 N-m was achieved. The torsional stiffness of each specimen was determined from the linear slope of the torque-rotation curve. No statistical difference in internal (p D .11) or external (p D .36) rotation for the matched pairs was noted. Data were excluded from one intramedullary sample secondary to early failure of the tibia. A trend toward increased rotational stability in the intramedullary group versus plate fixation in specimens with lower BMD was observed. These findings suggest no rotational biomechanical advantage of intramedullary nail compared to blade plate fixation in a cadaveric tibiotalocalcaneal arthrodesis model. (Journal of Surgical Orthopaedic Advances 19(2):109–113, 2010) Key words: ankle fusion, blade plate, intramedullary, nail, tibiotalocalcaneal fusion
Outcome of Percutaneous Screw Fixation of Scaphoid Fractures - Dominic P. Patillo, MD, Michael Khazzam, MD, Michael W. Robertson, MD, and Barry J. Gainor, MD
The optimal treatment of minimally displaced or nondisplaced fractures of the scaphoid is unclear. Traditionally, management of these fractures has been unpredictable with a significant risk of nonunion when treated conservatively. This study examined the results from 32 patients who underwent percutaneous screw fixation using a 3.0-mm AO/ASIF cannulated screw for a nondisplaced or minimally displaced fracture of the scaphoid waist. Eighteen patients were available for final follow up (average 3.2 years) including administration of the DASH questionnaire, a physical examination, and final radiographs. Sixteen (89%) healed successfully after the index procedure. There were two complications consisting of nonunions, both of which required revision open reduction and internal fixation for fracture union. These also went on to heal, resulting in an ultimate union rate of 100%. No significant differences were found between operative and nonoperative extremities with regard to radial–ulnar deviation arc of motion, grip, or pinch strength. The average DASH score was 7.4, indicating no disability. Percutaneous fixation of acute, nondisplaced scaphoid fractures with 3.0- mm AO/ASIF cannulated screw is a safe, effective technique that minimizes the need for long-term wrist immobilization, allows an expeditious return to vocational activity, and results in reliable rates of union. (Journal of Surgical Orthopaedic Advances 19(2):114–120, 2010) Key words: DASH, fracture management, open reduction and internal fixation, scaphoid fracture
CALAXO Osteoconductive Interference Screw: The Value of Postmarket Surveillance - Charles L. Cox, MD, Kelly C. Homlar, MD, PGY-3, James L. Carey, MD, and Kurt P.
The CALAXO osteoconductive interference screw was recalled in August 2007 due to reports of increased numbers of postoperative complications associated with screw swelling and prominence leading to the need for surgical debridement. This study reviews complications associated with CALAXO screw use in a consecutive cohort of patients undergoing anterior cruciate ligament reconstruction surgery by the senior author at the authors’ institution. Over a 12-month period, 226 CALAXO interference screws, either of 20 mm length or 25 mm length, were implanted in 112 patients, and postoperative complications were noted. The 25-mm tibial screw was over 5 times (RR 5.2, 95% CI 1.8 to 15.3) more likely to be prominent than the 20-mm screw (p value D .002). Four surgical debridements were required in the 25-mm tibial screw group; none were required in the 20-mm group. The authors hypothesize that the inability to bury the longer screw length into the bone tunnel is associated with postoperative complications associated with the CALAXO screw. (Journal of Surgical Orthopaedic Advances 19(2):121–124, 2010)
Streptococcus bovis Infection of Total Hip Arthroplasty in Association With Carcinoma of Colon - Ajay Srivastava, MD, Norman Walter, MD, and Patrick Atkinson, P.
Streptococcus bovis is normally found in the gastrointestinal tract of the human population. The association between Streptococcus bovis and bowel neoplasia has been frequently reported. This report presents two cases of total hip arthroplasty with Streptococcus Bovis infection at 18 and 11 years after arthroplasty. The diagnosis was made with the help of clinical findings, standard radiographs, and laboratory tests (complete blood count, C-reactive protein, sedimentation rate, and the hip aspiration). Infections were treated by implant removal and antibiotic spacer implantation. Intravenous antibiotics were administered for 12 weeks. Revision arthroplasty was performed when laboratory tests (complete blood count, C-reactive protein, sedimentation rate) were within normal limits. Streptococcus bovis infection prompted the authors to investigate for any bowel malignancy. Colonoscopy and transrectal biopsy revealed adenocarcinoma in case 1, while case 2 had prior diagnosis of flat polyps in the colon. There are a limited number of reports in the literature reporting the presence of Streptococcus bovis infection concurrent with arthroplasty and bowel malignancy. These two case reports highlight the possibility of hematogenous seeding of arthroplasty components by Streptococcus bovis in patients with colonic neoplasia. Streptococcus bovis infection of hip arthroplasty may provide an opportunity for diagnosis of colonic neoplasia. Acute hip pain in patients with hip endoprostheses and simultaneous bowel malignancy should be evaluated promptly for hematogenous infection by standard radiograph, complete blood count, C-reactive protein, sedimentation rate, and hip aspiration. (Journal of Surgical Orthopaedic Advances 19(2):125–128, 2010) Key words: colonic neoplasia, Streptococcus bovis, total hip arthroplasty
Primary Monophasic Synovial Sarcoma Presenting as a Benign Neurogenic Tumor: Case Review and Review of the Literature - Kameron R. Shahid, MD, Kimberly K. Amram
This report describes two cases of monophasic synovial sarcoma which were initially diagnosed as benign nerve sheath tumors based on imaging features. Retrospective review of the first case and re-review of the second case after initial diagnosis showed imaging features which distinguished the lesions from classical, benign neurogenic tumors. Accurate prospective diagnosis of soft tissue masses in locations in or around nerves and with morphology similar to nerve sheath tumors represent a clinical challenge. Careful review of imaging features and absence of the typical, reproducible findings should allow the benign lesion to be excluded from the diagnostic possibilities in most cases and allow for improved preoperative planning. (Journal of Surgical Orthopaedic Advances 19(2):129–133, 2010) Key words: MRI, prospective diagnosis, schwannoma, synovial sarcoma