Zeev Feldbrin

Clinical outcomes following ankle fracture: a cross-sectional observational study.

BackgroundThe purpose of the current study was to examine objective and subjective differences between three severity groups of ankle fractures patients compared to healthy controls.MethodsThis was a case-controlled study. 92 patients with an ankle fracture injury of which 41 patients were eligible to participate in the study. 72 healthy people served as controls. All patients underwent a computerized gait test, completed self-assessment questionnaires (The Foot and Ankle Outcome Score (FAOS) and the SF-36), evaluated with the American Foot and Ankle Score (AOFAS) form and completed the 6-min walk test. The control group performed a computerized gait test and completed the SF-36 health survey.ResultsAll ankle fracture patients presented compromised gait patterns and limb symmetry compared to controls (p < 0.05). Ankle fracture patients also had lower SF-36 scores compared to controls (p < 0.05). Significant differences were found between the unimalleolar group compared to the bimalleolar and trimalleolar groups in most parameters, except for the FAOS scores. There were no significant differences between the bimalleolar fracture group and the trimalleolar fracture groups.ConclusionsAlthough all fracture severity classification groups presented a compromised gait pattern and worse clinical symptoms compared to controls, it seems that patients with a unimalleolar fracture is a different group compared to bimalleolar and trimalleolar fracture. Furthermore, it seems that bimalleolar fracture and trimalleolar fracture affect the gait pattern and clinical symptoms to an equal extent, at least in the short-term.Trial registrationNCT01127776.

The Use of 99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

The aim of this study was to assess the pattern of annexin V uptake in hip and knee prostheses suspected of being infected. Methods: A total of 7 patients undergoing revision surgery for hip or knee prostheses were studied; 5 patients had total hip replacements, and 2 had total knee replacements. Infection was confirmed by pathology, culture results, laboratory evaluation, and clinical follow-up. All patients also underwent a bone scan before surgery. Results: Annexin V scan findings were positive in 5 patients and negative in 2. Annexin V uptake was either focal (n = 4) or linear (n = 1). There were 4 true-positive, 2 true-negative, 1 false-positive, and no false-negative annexin V studies. Annexin V uptake was either more extensive or less extensive than, and usually was incongruent with, 99mTc-methylene diphosphonate uptake. Conclusion: Our findings suggest that annexin V imaging shows greater uptake with infection than with aseptic loosening and has a high negative predictive value for prosthetic infection.

Surgical treatment of posttraumatic radioulnar synostosis in children.

The authors describe two children who underwent surgical treatment of radioulnar synostosis. One case involved simple excision; the other, excision and interposition of Gore-Tex vascular graft material. In a review of the literature, no other report of the latter type of surgical treatment was found. A discussion of the literature concerning this rare complication in children and the current surgical treatment options are included.

Changes in the pattern of fractures of the hip in patients 60 years of age and older between 2001 and 2010: A radiological review

The purpose of this study was to identify changing trends in the pattern of distribution of the type and demographics of fractures of the hip in the elderly between 2001 and 2010. A retrospective cross-sectional comparison was conducted between 179 fractures of the hip treated in 2001, 357 treated in 2006 and 454 treated in 2010. Patients aged < 60 years and those with pathological and peri-prosthetic fractures were excluded. Fractures were classified as stable extracapsular, unstable extracapsular or intracapsular fractures. The mean age of the 179 patients (132 women (73.7%)) treated in 2001 was 80.8 years (60 to 96), 81.8 years (61 to 101) in the 357 patients (251 women (70.3%)) treated in 2006 and 82.0 years (61 to 102) in the 454 patients (321 women (70.1%)) treated in 2010 (p = 0.17). There was no difference in the gender distribution between the three study years (p = 0.68). The main finding was a steep rise in the proportion of unstable peritrochanteric fractures. The proportion of unstable extracapsular fractures was 32% (n = 57) in 2001, 35% (n = 125) in 2006 and 45% (n = 204) in 2010 (p < 0.001). This increase was not significant in patients aged between 60 and 69 years (p = 0.84), marginally significant in those aged between 70 and 79 years (p = 0.04) and very significant in those aged > 80 years (p < 0.001). The proportion of intracapsular fractures did not change (p = 0.94). At present, we face not only an increasing number of fractures of the hip, but more demanding and complex fractures in older patients than a decade ago. This study does not provide an explanation for this change.

Cincinnati Incision Approach for Posterior Ankle and Calcaneal Pathology: Technique Tip

Level of Evidence: V, Expert Opinion

Primary Closure of Elective Toe Amputations in the Diabetic Foot—Is it Safe?

BACKGROUND Toe amputation is the most common partial foot amputation. Controversy exists regarding whether to primarily close toe amputations or to leave them open for secondary healing. The purpose of this study was to evaluate the results of closed toe amputations in diabetic patients, with respect to wound healing, complications, and the need for further higher level amputation. METHODS We retrospectively reviewed the results of 40 elective or semi-elective toe amputations with primary closure performed in 35 patients treated in a specialized diabetic foot unit. Patients with abscesses or necrotizing fasciitis were treated emergently and were excluded. Patients in whom clean margins could not be achieved due to extensive cellulitis or tenosynovitis and patients requiring vascular intervention were excluded as well. Outcome endpoints included wound healing at 3 weeks, delayed wound healing, or subsequent higher level amputation. RESULTS Out of 40 amputations, 38 healed well. Thirty amputations healed by the time of stitch removal at 3 weeks and eight had delayed healing. In two patients the wounds did not heal and subsequent higher level amputation was eventually required. CONCLUSIONS In carefully selected diabetic foot patients, primary closure of toe amputations is a safe surgical option. We do not recommend primary closure when infection control is not achieved or in patients requiring vascular reconstruction. Careful patient selection, skillful assessment of debridement margins and meticulous technique are required and may be offered by experienced designated surgeons in a specialized diabetic foot unit.

Primary Closure of Toe Amputations in the Diabetic Foot - Is it Safe?

Abstract BACKGROUND: METHODS: RESULTS: CONCLUSIONS:

Unicompartmental arthroplasty of the knee with the cemented MOD3TM prosthesis

A consecutive prospective series of 19 knees had unicompartmental arthroplasty between 1991 and 1992 for gonarthrosis and AVN. The MOD3TM prosthesis was used in all cases. A total follow-up evaluation was undertaken after 6 to 7.5 years (mean 6.5 years) in 18 patients (1 patient has died during the observation period). Complications included 1 technical failure, 2 cases of thromboembolic phenomena and 1 case of a late deep infection. Knee score averaged 84.3 (pre-operative 54.7) and functional score averaged 68.9 (pre-operative 34.6).There were no cases with aseptic loosening of the prosthesis.It is concluded that with the appropriate indications, the unicompartmental arthroplasty of the knee is an effective and predictable procedure to achieve pain reduction and improved quality of life in patients with monocompartmental arthritis. Furthermore, the cemented MOD3TM prosthesis yields results that are comparable to other unicompartmental prostheses in current use.ZusammenfassungIn einer prospektiven Serie in den Jahren 1991 and 1992 wurden 19 unikompartimentelle Kniegelenkprothesen bei Gonarthrose und avaskulärer Knochennekrose durchgeführt. In allen Fällen wurde die MOD3TM-Prothese eingesetzt. Die Nachuntersuchung bei 18 Patienten (ein Patient verstarb his zur Nachuntersuchung) erfolgte nach durchschnittlich 6,5 Jahren (sechs bis 7,5 Jahre). Als Komplikationen wurden ein technischer Fehler, zwei Thromboembolien und eine späte tiefe Infektion beobachtet. Der Knie-Score hatte im Mittel 84,3 Punkte (präoperativ 54,7 Punkte), und der Funktionsscore betrug im Mittel 68,9 Punkte (präoperativ 34,6 Punkte). Aseptische Prothesenlockerungen wurden nicht beobachtet.Die Untersuchungsergebnisse legen nahe, daß bei regelrechter Indikation der unikompartimentelle Kniegelenkersatz ein effektives und vorhersehbares Verfahren zur Schmerzlinderung und Verbesserung der Lebensqualität darstellt. Darüber hinaus sind die Ergebnisse mit der zementierten MOD3TM-Prothese vergleichbar mit anderen derzeit verwendeten unikompartimentellen Prothesen.