Session 7: Technical / Cases
Onsdag den 25. oktober
17:30-18:30
Lokale: Copenhagen
Chairmen: Søren Kold og Vilhelm Engell
Line Kjeldgaard Pedersen, Jens Svendsson, Mindaugas Mizukis, Søren Harving
Børne ortopædkirurgisk afdeling, Aalborg Universitetshospital; Børne ortopædkirurgisk afdeling, Aalborg Universitetshospital; Børne ortopædkirurgisk afdeling, Aalborg Universitetshospital; Børne ortopædkirurgisk afdeling, Aalborg Universitetshospital
Background: Focal Fibrocartilaginous Dysplasia (FFCD) is an extremely rare disorder causing angular deformities of the long bones in children. The condition is defined by a diafyseal fibrous tether preventing the natural sliding of periosteum during growth resulting in a hemiepiphysiodesis effect causing angular deformities. The location of the lesions are predominantly in the proximal tibia, although distal femoral, humeral and ulnar cases have been reported. No definitive consensus has been proposed regarding treatment. Spontaneus resolution of the deformity is primarily reported for tibial cases. Operative management may include excision of the tether, periosteum and curettage as well as corrective osteotomies.
Purpose / Aim of Study: To report on a case of femoral FFCD with operative management.
Materials and Methods: Operative management of a confirmed case of FFCD is presented with preoperative radiographical and Magnetic Resonance Image (MRI) evaluation in addition to a thorough peroperatively illustration of the operative management. Furthermore the postoperative angular correction is documented.
Findings / Results: A 22 months old boy referred for specialist children’s orthopaedic evaluation presented with progressive unilateral genu vara. Clinical evaluation showed bowing of the distal femur and subsequent radiographical examination revealed a lesion on the distal medial femoral diaphysis with an angular medial deformity. An MRI was performed under general anesthesia revealing a fibrous tether confirming the diagnosis of FFCD. The tether was treated surgically by excision of both the tether and surrounding periosteum and curettage.
Conclusions: FFCD with a medial femoral location can be operatively managed by open excision of the tether and medial periosteal release with subsequent correction of the angular deformity.
Børne ortopædkirurgisk afdeling, Aalborg Universitetshospital; Børne ortopædkirurgisk afdeling, Aalborg Universitetshospital; Børne ortopædkirurgisk afdeling, Aalborg Universitetshospital; Børne ortopædkirurgisk afdeling, Aalborg Universitetshospital
Background: Focal Fibrocartilaginous Dysplasia (FFCD) is an extremely rare disorder causing angular deformities of the long bones in children. The condition is defined by a diafyseal fibrous tether preventing the natural sliding of periosteum during growth resulting in a hemiepiphysiodesis effect causing angular deformities. The location of the lesions are predominantly in the proximal tibia, although distal femoral, humeral and ulnar cases have been reported. No definitive consensus has been proposed regarding treatment. Spontaneus resolution of the deformity is primarily reported for tibial cases. Operative management may include excision of the tether, periosteum and curettage as well as corrective osteotomies.
Purpose / Aim of Study: To report on a case of femoral FFCD with operative management.
Materials and Methods: Operative management of a confirmed case of FFCD is presented with preoperative radiographical and Magnetic Resonance Image (MRI) evaluation in addition to a thorough peroperatively illustration of the operative management. Furthermore the postoperative angular correction is documented.
Findings / Results: A 22 months old boy referred for specialist children’s orthopaedic evaluation presented with progressive unilateral genu vara. Clinical evaluation showed bowing of the distal femur and subsequent radiographical examination revealed a lesion on the distal medial femoral diaphysis with an angular medial deformity. An MRI was performed under general anesthesia revealing a fibrous tether confirming the diagnosis of FFCD. The tether was treated surgically by excision of both the tether and surrounding periosteum and curettage.
Conclusions: FFCD with a medial femoral location can be operatively managed by open excision of the tether and medial periosteal release with subsequent correction of the angular deformity.
Rasmus Cleemann, Mathias Bünger, Martin Gottliebsen, Klaus Kjær Petersen
Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, DK; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, DK; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, DK; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, DK
Background: Staphylococcus aureus (SA) bacteremia can develop into a broad array of infections foci, which can be difficult to recognize initially. Obturator pyomyositis (OP) is a rare differential diagnosis in patients presenting with fever and complaints from the hip area.
Purpose / Aim of Study: We would like to bring attention to a rare but important cause to fever and hip pain.
Materials and Methods: Four patients with OP were identified from 2013 to 2017. Patient files, radiological examinations and microbiological etiology were reviewed.
Findings / Results: Patients included 3 children (age 6-12) and 1 adult (age 31). Patients presented with fever (38.5-40.5°C), pain from the hip/groin area, a limp and elevated CRP (21.7-236.2 mg/L). 4/4 hip ultrasound examinations at admission were without joint effusion. OP was diagnosed by MRI 3 days after admission in 3/4 patients and after 7 days in 1 patient. Diagnosis in the last patient was delayed 6 days by use of CT and PET CT as initial imaging. 4 patients had affection of the internal obturator muscle, 3 included the external obturator muscle and 2 patients developed ipsilateral hip joint effusions. 4/4 initial blood cultures were positive for SA and patients were started on empiric antibiotics prior to surgery. Drainage was performed 1 day after MRI. 2 patients received a hip arthrotomy, 2 patients obturator muscles were incised and 1 patient received an additional ultrasound guided drainage procedure. Initial abscess/joint fluid samples were positive for SA except for the patient with delayed MRI.
Conclusions: Although not common OP as a course of hip pain should be suspected in patients with fever, hip pain and SA bacteremia. OP caused by SA can be accompanied by ipsilateral septic coxitis. We advocate MRI as the best modality to diagnose OP and to distinguish it from septic coxitis.
Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, DK; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, DK; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, DK; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, DK
Background: Staphylococcus aureus (SA) bacteremia can develop into a broad array of infections foci, which can be difficult to recognize initially. Obturator pyomyositis (OP) is a rare differential diagnosis in patients presenting with fever and complaints from the hip area.
Purpose / Aim of Study: We would like to bring attention to a rare but important cause to fever and hip pain.
Materials and Methods: Four patients with OP were identified from 2013 to 2017. Patient files, radiological examinations and microbiological etiology were reviewed.
Findings / Results: Patients included 3 children (age 6-12) and 1 adult (age 31). Patients presented with fever (38.5-40.5°C), pain from the hip/groin area, a limp and elevated CRP (21.7-236.2 mg/L). 4/4 hip ultrasound examinations at admission were without joint effusion. OP was diagnosed by MRI 3 days after admission in 3/4 patients and after 7 days in 1 patient. Diagnosis in the last patient was delayed 6 days by use of CT and PET CT as initial imaging. 4 patients had affection of the internal obturator muscle, 3 included the external obturator muscle and 2 patients developed ipsilateral hip joint effusions. 4/4 initial blood cultures were positive for SA and patients were started on empiric antibiotics prior to surgery. Drainage was performed 1 day after MRI. 2 patients received a hip arthrotomy, 2 patients obturator muscles were incised and 1 patient received an additional ultrasound guided drainage procedure. Initial abscess/joint fluid samples were positive for SA except for the patient with delayed MRI.
Conclusions: Although not common OP as a course of hip pain should be suspected in patients with fever, hip pain and SA bacteremia. OP caused by SA can be accompanied by ipsilateral septic coxitis. We advocate MRI as the best modality to diagnose OP and to distinguish it from septic coxitis.
Marianne Christensen, Kathrine Skov Andersen, Inge Lunding Kjær
Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital; Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital; Department of Orthopaedic Surgery, Aalborg University Hospital
Background: The results of functional treatment of Achilles tendon ruptures (ATR) are dependent on validity on all aspects of the treatment including primary information of the patient. Due to presentation of several consecutive patients with DVT and severe edema in our clinic, we decided to investigate if primary information was sufficient.
Purpose / Aim of Study: To assess the quality of patient information after ATR.
Materials and Methods: Case series of 7 consecutive patients with ATR seen in the outpatient clinic 2-5 days after initial treatment. All patients follow a standardized protocol for functional rehabilitation, our department has been thoroughly informed and we have a very precise instruction regarding anti thrombotic treatment, edema prophylaxis and risk signs. The hand-out patient information is also very thorough and given to the patient at the first contact. Our questionnaire focus on the information given to the patient concerning DVT prophylaxis at first contact. Diagnosis were secured clinically and orthosis was checked.
Findings / Results: 7 patients, all male, age 22-82 yrs. Time from rupture to treatment 1-2 days (6) and 10 days (1). 4/7 did not receive the hand-out patient information, 1 did not receive Xarelto (severe edema and familiar disposition of DVT), 1 had pressuremark from the orthosis, 1 (age 82) were weightbearing. Additional treatment: 4 patients received the hand-out patient information, 2 orthosis were changed to a cast. 1 received extra padding in the orthosis, 4 received information on edema prophylaxis, 2 were instructed in use of crutches without weightbearing.
Conclusions: These preliminary results are discouraging and will lead to our continuous use of an early control in the outpatient clinic. Further investigation should reveal how we can improve the quality of patient information and treatment.
Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital; Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital; Department of Orthopaedic Surgery, Aalborg University Hospital
Background: The results of functional treatment of Achilles tendon ruptures (ATR) are dependent on validity on all aspects of the treatment including primary information of the patient. Due to presentation of several consecutive patients with DVT and severe edema in our clinic, we decided to investigate if primary information was sufficient.
Purpose / Aim of Study: To assess the quality of patient information after ATR.
Materials and Methods: Case series of 7 consecutive patients with ATR seen in the outpatient clinic 2-5 days after initial treatment. All patients follow a standardized protocol for functional rehabilitation, our department has been thoroughly informed and we have a very precise instruction regarding anti thrombotic treatment, edema prophylaxis and risk signs. The hand-out patient information is also very thorough and given to the patient at the first contact. Our questionnaire focus on the information given to the patient concerning DVT prophylaxis at first contact. Diagnosis were secured clinically and orthosis was checked.
Findings / Results: 7 patients, all male, age 22-82 yrs. Time from rupture to treatment 1-2 days (6) and 10 days (1). 4/7 did not receive the hand-out patient information, 1 did not receive Xarelto (severe edema and familiar disposition of DVT), 1 had pressuremark from the orthosis, 1 (age 82) were weightbearing. Additional treatment: 4 patients received the hand-out patient information, 2 orthosis were changed to a cast. 1 received extra padding in the orthosis, 4 received information on edema prophylaxis, 2 were instructed in use of crutches without weightbearing.
Conclusions: These preliminary results are discouraging and will lead to our continuous use of an early control in the outpatient clinic. Further investigation should reveal how we can improve the quality of patient information and treatment.
Khuram Bashir, Leif Broeng
Orthopedic, Koege Hospital; Orthopedic, Koege Hospital
Background: Correct placement of the un-cemented cup is important in terms of stability and longevity of the hip. The X-pander® measures both the geometry of the acetabulum and the bone quality. The current report is part of a multicenter trial.
Purpose / Aim of Study: The aim of this registrations study is to examine whether the use of X-pander in primary hip replacement improves cup fixation and adaptation among trainee doctors.
Materials and Methods: Immediately after the operation, the surgeon fills out an evaluation form.
Findings / Results: Among the 14 evaluation forms filled out, the use of X-pander led to change in cup size in 3 cases (21%) and further reaming in 2 cases (14%). The surgeons (n=2) felt more secure with cup placement (12 / 14) and did not find any drawbacks with X-pander (11 / 14).
Conclusions: The surgeons involved have in general expressed their satisfaction with the functionality and clinical value of X-pander®. The device has the potential improve cup-placement by trainee surgeons. A radiological evaluation is planned.
Orthopedic, Koege Hospital; Orthopedic, Koege Hospital
Background: Correct placement of the un-cemented cup is important in terms of stability and longevity of the hip. The X-pander® measures both the geometry of the acetabulum and the bone quality. The current report is part of a multicenter trial.
Purpose / Aim of Study: The aim of this registrations study is to examine whether the use of X-pander in primary hip replacement improves cup fixation and adaptation among trainee doctors.
Materials and Methods: Immediately after the operation, the surgeon fills out an evaluation form.
Findings / Results: Among the 14 evaluation forms filled out, the use of X-pander led to change in cup size in 3 cases (21%) and further reaming in 2 cases (14%). The surgeons (n=2) felt more secure with cup placement (12 / 14) and did not find any drawbacks with X-pander (11 / 14).
Conclusions: The surgeons involved have in general expressed their satisfaction with the functionality and clinical value of X-pander®. The device has the potential improve cup-placement by trainee surgeons. A radiological evaluation is planned.