European Instructional Lectures (eBook)

Foreword 6
Preface 7
Contents 8
Contributors 10
Part I General Orthopaedics 13
Current Status of Arthroplasty Registers in Europe 14
Introduction 14
Historical Review and Methods 14
Basic Requirements for the Development and Activities of a National Arthroplasty Register 15
Registers in Orthopaedics 17
Basic Principles in Interpreting Register Data of Other Countries 17
Benefits the Individual Surgeon Can Derive from Registers 18
Discussion 19
Acknowledgements 20
References 20
National Registration of Hip Fractures in Sweden 22
Development of the National Registration RIKSHÖFT 22
Hip Fracture Demographics 23
National Data 2007 23
Motivation 28
Performance 28
Computing and Feed Back 28
Funding 28
References 28
Current Status of Articular Cartilage Repair 30
Introduction 30
Arthroscopic Debridement 30
Reparative Techniques 31
Restorative Techniques 31
Treatment Selection 33
Future Developments 34
Conclusions 34
References 35
Thromboprophylaxis After Major Orthopaedic Surgery: State of the Art 39
Introduction 39
Venous Thromboembolism After Major Orthopaedic Surgery 39
Guideline Recommendations 40
Current Options for Thromboprophylaxis 40
New Developments in Prophylaxis: Targeted Anticoagulants 41
References 45
Part II Paediatrics 49
DDH: Diagnosis and Treatment Strategies 50
Introduction 50
Method 50
Results 52
Conclusion and Recommendation 54
Acknowledgments 55
References 55
Slipped Capital Femoral Epiphysis 56
Introduction 56
Classi. cation 56
Clinical Signs and Symptoms 57
Complications 61
After-Treatment 62
Prognosis 62
Summary 65
References 66
Major Joint Contractures in Children 70
Make the Diagnosis 70
Planning Treatment 71
Physiotherapy 71
Splints and Orthotics 71
Tone-Reducing Medication 72
Soft Tissue Releases 72
Correction of Limb Alignment 72
Arthrodesis 73
Arthroplasty 73
Decision Making 73
Part III Trauma 74
Damage-Control Orthopaedic Surgery in Polytrauma: In. uence on the Clinical Course and Its Pathogenetic Background 75
Decision Making for the Treatment of Major Fractures: Evidence for the Bene. ts of Tapered Treatment Evidence for the Bene. ts of Tapered Treatment 75
Pathogenesis of Organ Failure Following Trauma Induced by Multiple Fractures, Soft-Tissue Damage and Acute Haemorrhage 77
Interaction Between Acute Surgery After Trauma and the Pathophysiological Responses Induced by Trauma 78
Factors for Grading Patient Assessment 79
Summary 80
References 81
Fractures and Non-Unions of the Clavicle 83
Surgical Anatomy and Classi. cation 83
Up-Date on Conservative Treatment for Mid-Clavicular Fractures 84
Modalities of Plate Fixation of Mid-Clavicular Fractures 85
Intra-Medullary Fixation 85
Results of Operative Treatment 85
Indications for Surgery in Mid-Clavicular Fractures 85
Mal-Union of Midshaft Clavicle Fractures 86
Non-Union of Mid-Clavicle Fractures 86
Fractures of the Lateral Third of the Clavicule 86
Conclusions 87
References 87
Proximal Humeral Fractures 89
Introduction 89
Epidemiology 89
Imaging Studies 89
Classi. cations Systems 91
Current Trends of Treatment 92
Conclusions 95
References 96
Fixation of Intertrochanteric Femoral Fractures 98
Introduction 98
Treatment Methods 98
Discussion 99
Conclusions 102
References 102
Surgical Management of Distal Tibial Fractures in Adults 104
Introduction 104
Classification 104
Soft Tissue Injuries 106
Initial Management 107
De. nitive Management 108
Surgical Techniques 109
Intra-Articular Fractures, AO 43-B 112
Intra-Articular Fractures, AO 43-C 115
Conclusion 117
References 117
Part IV Upper Limb and Hand 120
The Distal Radio-Ulnar Joint: Functional Anatomy, Biomechanics, Instability and Management 121
Functional Anatomy 121
Biomechanics 122
Injuries of the DRUJ: Pathophysiology 123
Treatment Options 125
References 128
Distal Radius Fractures: Evolution in the Treatment Standard of Care 2009 131
Introduction 131
Epidemiology 131
Results and How to Measure Them 132
Treatment Alternatives 134
Open Surgery 135
Bone Grafts and Bone Cements 135
The Future 137
A Treatment Protocol 139
Conclusions 139
References 139
Dupuytren’s Contracture 143
Introduction 143
Structures, Properties and Function of the Palmar Aponeurosis and Related Tissues 143
How Does the Palmar Aponeurosis Function in Non-Human Primates? 145
Considerations Concerning the Plantar Aponeurosis 146
The Mechanical Properties of the Palmar Aponeurosis 146
The Clinical and Natural Course of Dupuytren’s Disease 147
Plantar Duypuytren’s Disease 148
Complications 156
Part V Spine 159
Low Back Pain 160
Strategies and Management 160
Diagnostic Strategies History 160
Physical Examination 160
Imaging 161
Natural History 161
Therapy 161
Surgical Treatment 163
Conclusion and Future Perspectives 163
Reference 163
Part VI Hip 165
Total Hip Arthroplasty: A Comparison of Current Approaches 166
Introduction 166
Differences 166
Non-Union 168
Nerve Palsy and Neuralgia 168
Trendelenburg Sign and Gait 170
Gait and Limp 170
Trochanteric Pain 171
Dislocation 171
Infection 173
Outcome 173
Leg Length 173
Heterotopic Ossification 173
Patient Preference 173
Minimally-Invasive Modifications 174
Comparison Between Normal and Minimally-Invasive Technique in the Same Approach 174
Comparison Between Normal and Minimally-Invasive Technique in Different Approaches 175
Discussion 175
Conclusions 176
References 176
Chapter How to Do a Cemented Total Hip Arthroplasty 179
Introduction 179
Clinical Outcome 182
The Current Cementing Technique 186
Conclusions 188
References 188
How to Do a Cementless Hip Arthroplasty 191
Introduction 191
Implant Selection 191
Implant Survival 203
References 204
Part VII Knee 205
How to Treat a Meniscal Lesion? 206
Biomechanics of the Menisci and the Sequelae of Meniscectomies 206
Meniscal Repair 207
Meniscal Replacement 208
The In. uence of Associated Lesions on the Treatment of Meniscal Tear 209
Conclusion 210
Acknowledgements 211
References 211
Soft-Tissue Balance in Total Knee Arthroplasty 213
Biomechanics of Total Knee Arthroplasty 213
Aims of Total Knee Arthroplasty 214
Genu Recurvatum 214
Fixed Flexion and Restoration of Joint-Line 214
Soft-Tissue Balance in the Varus Knee with or without Fixed Flexion 215
Tibial Defect in a Varus Knee 217
Soft-Tissue Balance in the Valgus Knee with or without Fixed Flexion 217
Summary 218
References 218
Revision Total Knee Arthroplasty with Bone Loss 219
Introduction 219
Classification 219
Mobile-Bearing Revisions 220
Treatment Options for Bone Loss 220
Conclusion 222
References 222
Part VIII Foot and Ankle 224
Ankle Arthritis 225
Definition 225
Epidemiology and Aetiology 225
Pathophysiology 225
Clinical Presentation and Functional Limitation 226
Radiological Presentation 227
Conservative Treatment 228
Surgical Treatment 228
Conclusion and Perspectives 233
References 233
Hallux Rigidus: Arthroplasty or Not? 236
Introduction 236
Arthrodesis 236
Arthroplasty 237
Discussion 240
Reference 241