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  • ISSN: 2373-9290
    Volume 3, Issue 4
    Research Article
    Werner Maurer-Ertl, Joerg Friesenbichler*, Martin Svehlik, Lukas Holzer, Patrick Sadoghi, Kathrin Ogris, Andreas Leithner and Reinhard Windhager
    Introduction: Minimally invasive total hip arthroplasty (THA) is advertised to allow improved and faster rehabilitation due to reduced soft-tissue damage compared to THA performed with a standard transmuscular approach. The aim of this prospective Level II study was to analyze gait function after THA using 3 different approaches and 2 different types of prostheses.
    Patients and Methods: Ten patients underwent THA through a minimally invasive anterior (n=5) or antero-lateral (n=5) approach using conventional ceramic-on-ceramic prostheses. In comparison, 8 metal-on-metal resurfacing arthroplasties were implanted through a posterior approach. An instrumented three-dimensional gait analysis was performed to evaluate gait function preoperatively, 6-weeks and 6-months postoperatively after implantation. The Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to evaluate the functional clinical outcome.
    Results: The pre- and postoperative gait analyses showed constantly all but one no differences between the three groups for gait parameters. Only the step length was significantly longer in case of anterior and posterior approach compared to the antero-lateral approach (p=0,025). The scoring systems (HHS, WOMAC) resulted in nearly identical pre- and postoperative scores with excellent functional outcome in all groups.
    Conclusions: The current study indicates that there are no functional differences at 6-months follow-up for THAs performed through different approaches. The only difference at gait analysis performed 6-months following hip arthroplasty showed to be longer stride length for the anterior and posterior approach in comparison to the THA group performed through an antero-lateral approach.
    Jefferson Brand, Richard Hardy*, Engin Sungur, Jefferson Brand III, Ray Bowman and Paul Dale
    Introduction: Immediately following total knee arthroplasty, Continuous Femoral Nerve Catheter (CFNC) and single-Injection Femoral Nerve Blocks (FNB) provide extended pain relief and improve functional outcomes. This study aimed to determine if immediate post-surgical outcomes are affected by the type of nerve block utilized.
    Materials and Methods: A retrospective comparison study of 154 primary unilateral total knee replacement procedures was performed. Postoperative outcomes of patients who received a CFNC (NaropinĀ®, APP Pharmaceuticals, and Schaumberg, IL) versus a FNB (Marcaine or Ropivacaine) were evaluated. The CFNC was removed the evening of postoperative day 1 (POD1).
    Data comparison included information from postoperative day 1 (POD1) and postoperative day 3 (POD3): Narcotic usage, Visual Analog Scale (VAS) pain scores upon ambulation, surgical knee extension and flexion, longest distance walked, and hospital length of stay (LOS). Data analysis included ANOVA, ANCOVA, logistic regression, and chi-square goodness-of-fit test. Diagnostic techniques ensured validity of the results.
    Results: 154 total patients (93 CFNC, 61 FNB) were evaluated. ANCOVA model fitted to the data indicated CFNC and FNB was a significant factor (p-value 0.02) on the pain improvement from POD1 to POD3, controlling for medication use, with logistic regression. VAS scores in the FNB group were significantly improved from POD1 to POD3 (p= 0.02). There is statistically significant evidence that pain improvement for FNB is greater than CFNC after controlling for narcotic use. No other significant differences were found.
    Conclusion: Single-Injection Femoral Nerve Blocks may be more effective than CFNC Blocks in controlling postoperative pain following unilateral total knee replacement.
    Case Report
    Jeremy D Podolnick* and Jeffrey V Dermksian
    Introduction: The combination of tibia plateau and shaft fractures, previously reported as type of "bifocal" tibia fracture, is a rare injury.1 The majority of tibia plateau fractures and bifocal tibia fractures occur after high-energy trauma.1,2 The treatment of these injuries varies depending on type, mechanism of injury, and patient characteristics.
    Case Presentation: We report the case of one patient who sustained a Schatzker VI tibial plateau fracture with extension through the tibial diaphysis after a low-energy injury, likely due to her history of Rheumatoid Arthritis (RA) treated with Methotrexate (MTX) and Prednisone. The patient was initially managed with external fixation to allow for soft tissue resuscitation followed by open reduction and internal fixation. The fracture went on to fully unite.
    Conclusion: Bifocal tibia fractures are a challenging entity. There is sparse literature regarding the treatment of this type of injury. We have found only one review of bifocal tibia fractures and one paper reporting on the treatment of noncontiguous ipsilateral tibia plateau and shaft fractures. To our knowledge, no prior case reports have been published regarding this injury.
    Philippa A Rust* and S-A Philips
    We describe an unusual case of a triangular fibrocartilage tear after a wrist-lock manoeuvre in a police officer. The case highlights the possibility of injury with this wrist position and the importance of wrist arthroscopy in a patient with an unusual history.
    Stephanie Hili*, Anna Allan and Maxim Horwitz
    Swellings of the hand are commonly caused by ganglion cysts, giant cell tumours or epidermoid inclusion cysts. We present an unusual case of a swelling in the digit of a 15 year old male resulting from a fibroma of the tendon sheath. The case was not only unusual in terms of the histological nature of the swelling, but also in the position of the tumour. The mass was located deep to the flexor tendons. Careful dissection and partial sacrifice of the digital pulley system was necessary to ensure complete excision and consequently reduce the risk of recurrence.
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