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EFORT Open Reviews Sep 2016The management of articular fractures is always a matter of concern. Each articular fracture is different from the other, whatever the classification system used and the... (Review)
Review
The management of articular fractures is always a matter of concern. Each articular fracture is different from the other, whatever the classification system used and the surgical or non-surgical indications employed by the surgeon. The main goals remain anatomical reduction, stable fixation, loose body removal and minimal invasiveness.Open procedures are a compromise. Unfortunately, it is not always possible to meet every treatment goal perfectly, since associated lesions can pass unnoticed or delay treatment, and even in a 'best-case' scenario there can be complications in the long term.In the last few decades, arthroscopic joint surgery has undergone an exponential evolution, expanding its application in the trauma field with the development of arthroscopic and arthroscopically-assisted reduction and internal fixation (ARIF) techniques. The main advantages are an accurate diagnosis of the fracture and associated soft-tissue involvement, the potential for concomitant treatments, anatomical reduction and minimal invasiveness. ARIF techniques have been applied to treat fractures affecting several joints: shoulder, elbow, wrist, hip, knee and ankle.The purpose of this paper is to provide a review of the most recent literature concerning arthroscopic and arthroscopically-assisted reduction and internal fixation for articular and peri-articular fractures of the upper limb, to analyse the results and suggest the best clinical applications.ARIF is an approach with excellent results in treating upper-limb articular and peri-articular fractures; it can be used in every joint and allows treatment of both the bony structure and soft-tissues.Post-operative outcomes are generally good or excellent. While under some circumstances ARIF is better than a conventional approach, the results are still beneficial due to the consistent range of movement recovery and shorter rehabilitation time.The main limitation of this technique is the steep learning curve, but investing in ARIF reduces intra-operative morbidity, surgical errors, operative times and costs. Cite this article: Dei Giudici L, Faini A, Garro L, Tucciarone A, Gigante A. Arthroscopic management of articular and peri-articular fractures of the upper limb. 2016;1:325-331. DOI: 10.1302/2058-5241.1.160016.
PubMed: 28461964
DOI: 10.1302/2058-5241.1.160016 -
Journal of Experimental Orthopaedics Dec 2023Fractures around the elbow are often challenging to treat and in most cases require an extensive approach. Since the development of elbow arthroscopy, most authors have... (Review)
Review
Fractures around the elbow are often challenging to treat and in most cases require an extensive approach. Since the development of elbow arthroscopy, most authors have pointed out the potential advantages of a less invasive technique that can be useful for visualization and reduction of the articular fragments with an eventual percutaneous fixation. Arthroscopic techniques provide a limited exposure that may lead to a faster wound healing, lower rate of complications and thus, better recovery of range of motion. However, elbow arthroscopy is also a demanding technique, especially in a swollen and fractured joint, and it is not exempt of risks. The overall rate of complications has been rated from 1.5% to 11% and nerve injury rates from 1.26-7.5%.The objective of this review is to present the arthroscopic setup and general surgical technique for the management of elbow trauma and to define some clear indications. Patient positioning and operating room display is key in order to obtain success. In addition to the arthroscopic equipment, fluoroscopy is almost always necessary for percutaneous fixation and precise preparation is mandatory. In the last decade, literature regarding new portals or surgical tips for arthroscopic treatment of elbow fractures have been published.The main indications for fracture arthroscopic-assisted fixation are those articular fractures involving the coronoid, distal humerus shear fractures in the coronal plane (trochlear and capitellum fractures) and, more controversially, those affecting the radial head. The treatment of these type of fractures all arthroscopically is exponentially demanding as it might also require ligament repair. For coronoid fractures, it can be useful in Morrey type II and III, and O´Driscoll anteromedial facet fractures associated to a posteromedial instability pattern that also require a repair of the LCL. Although excellent results have been published, comparative series are scarce. Radial head fractures can also be approached arthroscopically in simple non-comminute fractures that can be fixed percutaneously.In conclusion, arthroscopy of the elbow is an excellent tool to better understand and visualize articular fractures of the elbow. However, despite the advances in surgical technique, whether it improves clinical and radiological results is still to be proven.
PubMed: 38133719
DOI: 10.1186/s40634-023-00710-z -
Medicine Jun 2020The clinical effects and safety over the treatment of tibia intercondylar eminence fracture (TIEF) with cannulated screw and suture fixation were evaluated under...
The clinical effect and safety of the treatment of tibia intercondylar eminence fracture with cannulated screw and suture fixation under arthroscope: Protocol for a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
The clinical effects and safety over the treatment of tibia intercondylar eminence fracture (TIEF) with cannulated screw and suture fixation were evaluated under arthroscope systematically, providing evidence-based medical support for the selection of surgical methods in terms of minimally invasive arthroscopic treatment for TIEF.
METHODS
The English databases of PubMed, EMBASE, Cochrane Library, CNKI, SinoMed, VIP, and Wanfang databases were searched by computer. The randomized controlled trials were conducted to compare the clinical effects of TIEF with cannulated screw and suture fixation under arthroscope. The retrieval period is from the beginning of database building to January 2020. There is no language restriction. Chinese databases are searched by keywords, while English databases are searched by the combination of subject words and free words. According to the retrieval strategy, the two evaluators will lead the conforming documents into Note Express for repeated literature screening, and the two evaluators will extract and cross-check the conforming documents according to the pre-designed data extraction table. Two researchers adopted the modified Jadad scale independently to evaluate the quality of the literature. The RevMan 5.3 version software provided by the Cochrane Collaboration Network was adopted for statistical analysis.
RESULTS
The study will strictly review and extract the data included in the literature, and scientifically make statistical analysis for the pre-set outcome indicators. All the research processes will be conducted in strict accordance with the guidance of system evaluation. In this study, the differences between cannulated screw fixation and suture fixation under arthroscopy will be evaluated by comparing the relevant outcome indicators. All the results of this study will be published openly in a highly influential professional academic journal.
CONCLUSION
The paper adopted Cochrane system evaluation method to collect and sort out the published literature about the treatment of tibial eminence fracture between cannulated screw fixation and suture fixation under arthroscopy, and to compare the clinical efficacy and safety of the two fixation methods utilizing meta-analysis and comparison of related outcome indicators. Through this study, we will draw a positive conclusion, which will provide a basis for the better treatment of tibial eminence fracture.
PROSPERO REGISTRATION NUMBER
PROSPERO CRD42020168433.
Topics: Bone Screws; Fracture Fixation, Internal; Humans; Knee Injuries; Meta-Analysis as Topic; Randomized Controlled Trials as Topic; Sutures; Systematic Reviews as Topic; Tibial Fractures
PubMed: 32502035
DOI: 10.1097/MD.0000000000020609 -
JBJS Essential Surgical Techniques Dec 2018Iliopsoas fractional lengthening (IFL) is performed on patients with symptomatic internal snapping. This condition is defined as painful and sometimes audible snapping...
BACKGROUND
Iliopsoas fractional lengthening (IFL) is performed on patients with symptomatic internal snapping. This condition is defined as painful and sometimes audible snapping of the iliopsoas (IP) tendon over the femoral head or iliopectineal line. Arthroscopic IFL is performed if the snapping is unresponsive to conservative treatment.
DESCRIPTION
Hip arthroscopy is performed with the patient in the supine position on a traction table. The portals used to access the joint capsule include standard anterolateral, mid-anterior, and distal anterolateral accessory (DALA) portals. With a 70° arthroscope, diagnostic arthroscopy is conducted to assess the quality of labral tissue, acetabular and femoral cartilage surfaces, and the ligamentum teres. When indicated, supplementary procedures, such as acetabuloplasty, labral repair, or labral reconstruction, are performed prior to IFL. With traction still applied, IFL is then performed from the central compartment at the level of the joint line. Exposure of the IP tendon is achieved with the use of a curved blade to extend the capsulotomy medially over the 3 o'clock position (right hip). Once the tendon can be appropriately visualized, a progressive and complete transverse cut is made in the tendinous portion, taking care to avoid the muscular portion. During this process, the anterolateral and mid-anterior portals serve as visualization and working portals, respectively.
ALTERNATIVES
Prior to arthroscopic IFL for painful internal snapping, nonsurgical options may include (1) physical therapy programs, (2) activity modification, (3) nonsteroidal anti-inflammatory drugs (NSAIDs), or (4) ultrasound-guided cortisone injections.
PubMed: 30775135
DOI: 10.2106/JBJS.ST.18.00020 -
Arthroscopy Techniques Sep 2020Knee arthroscopy has evolved greatly from its inception in the 20th century. Arthroscopic synovectomy is performed in the case of infection or significant synovitis. We...
Knee arthroscopy has evolved greatly from its inception in the 20th century. Arthroscopic synovectomy is performed in the case of infection or significant synovitis. We continue to develop more minimally invasive procedures, and the NanoScope (Arthrex, Naples, FL) has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and using the GraftNet (Arthrex), we can harvest tissue with a standard shaver for further evaluation. This technique provides an option to perform a synovectomy and biopsy without the use of standard arthroscopy portals through an incisionless approach.
PubMed: 33024664
DOI: 10.1016/j.eats.2020.05.002 -
The Open Orthopaedics Journal 2017Anterior shoulder instability has been successfully managed arthroscopically over the past two decades with refined "anatomic" reconstruction procedures involving the... (Review)
Review
BACKGROUND
Anterior shoulder instability has been successfully managed arthroscopically over the past two decades with refined "anatomic" reconstruction procedures involving the use of anchors for the repositioning and re-tensioning of the antero-inferior capsuloligamentous complex, in an effort to recreate its "bumper effect".
METHODS
Research and online content related to arthroscopic treatment of shoulder instability was reviewed and their results compared.
RESULTS
The short- and mid-term results of this technique have been very satisfactory. The greatest number of recent reports suggests that long-term results (>5 years follow-up) remain rather satisfactory, especially in the absence of significant glenoid bone loss (>20-25%). In these studies recurrent instability, in the form of either dislocation or subluxation, ranges from 5.1 to over 20%, clinical scores, more than 5 years after the index procedure, remain good or excellent in >80% of patient population as do patient satisfaction and return to previous level of activities. As regards arthroscopic non-anatomic bony procedures (Latarjet or Bristow procedures) performed in revision cases or in the presence of >20-25% bone loss of the anteroinferior aspect of the glenoid, recent reports suggest that their long-term results are very satisfactory both in terms of re-dislocation rates and patient satisfaction.
CONCLUSION
It appears that even "lege artis" performance of arthroscopic reconstruction decelerates but does not obliterate the degenerative procedure of dislocation arthropathy. The presence and grade of arthritic changes correlate with the number of dislocations sustained prior to the arthroscopic intervention, the number of anchors used and the age at initial dislocation and surgery. However, the clinical significance of radiologically evident dislocation arthropathy is debatable.
PubMed: 28400881
DOI: 10.2174/1874325001711010133 -
American Journal of Translational... 2020Measurements of cartilage defect size under an arthroscope are essential for prognosis and treatment decisions. A new method called arthroscopic measurement by computer...
Measurements of cartilage defect size under an arthroscope are essential for prognosis and treatment decisions. A new method called arthroscopic measurement by computer graphics (ACG) was developed to accurately calculate the size of the cartilage under an arthroscope. This study aimed to validate the accuracy and utility of this method. In this controlled laboratory study, the ACG method was validated by measuring the sizes of three cartilage defects in a knee joint of a pig, using the following techniques: traditional arthroscopic measurement by ruler (TAR), ACG, incised measurement by computer graphics (ICG), and incised measurement by ruler (IR, control, gold standard). Measurements were conducted by two blinded trained observers. Intra- and inter-observer variabilities were determined by calculating the intra-class correlation coefficient (ICC). Consistency among TAR, ACG, ICG and IR was analyzed using the command "Concord" in Stata. For arthroscopic measurements using ACG and ICG, the overall ICC intra- and inter-observer values were 0.99 and 0.98, respectively, which showed excellent reproductivity. The concord value showed consistency of various approaches relative to the gold standard method. The average concord value for TAR was 0.813, and the average concord value for ACG and ICG was 0.886 and 0.917, respectively. ACG utilizes computer graphics for measuring the size of cartilage defects of any size under an arthroscope, without reconditioning the injured cartilage. ACG showed excellent intra- and inter-observer reproducibility and satisfactory accuracy. This method would make it possible to more accurately match the graft with the defect, thereby facilitating cartilage repair.
PubMed: 33437381
DOI: No ID Found -
Arthroscopy Techniques Nov 2018Popliteal cysts, often referred to as Baker's cysts, are a common occurrence in the adult knee. Although controversy exists as to the exact indications for treatment,...
Popliteal cysts, often referred to as Baker's cysts, are a common occurrence in the adult knee. Although controversy exists as to the exact indications for treatment, these structures can cause extreme discomfort and morbidity, including pain from rupture and symptoms from neurovascular compromise. Prior to the development of the arthroscope, open treatment of popliteal cysts was not uncommon. Complications such as poor wound healing, cyst recurrence, and knee flexion contractures were reported after such treatment. Owing to the presence of a valve-type structure, also called the , there is 1-way flow of synovial fluid into the cyst. Although seldom described, there is a reproducible and relatively straightforward arthroscopic treatment for this pathology. This technical report will describe the arthroscopic treatment of popliteal cysts and clarify the posterior knee anatomy that gives the surgeon the landmarks to perform safe and effective arthroscopic treatment of popliteal cysts.
PubMed: 30533356
DOI: 10.1016/j.eats.2018.07.006 -
Orthopaedics & Traumatology, Surgery &... Feb 2019Impingement of hip arthroplasty components on soft tissues may adversely affect outcomes. An example is impingement of the cup on the ilio-psoas tendon, which has been... (Review)
Review
Impingement of hip arthroplasty components on soft tissues may adversely affect outcomes. An example is impingement of the cup on the ilio-psoas tendon, which has been reported in 0.4% to 8.3% of patients. Contributors to ilio-psoas tendon impingement (IPTI) can be categorised as anatomic (hypoplastic anterior wall), technical (inadequate anteversion and/or lower inclination, oversized cup, cement in contact with the tendon, and intra-muscular screw), and prosthetic (e.g., aggressive cup design, large-diameter head, resurfacing, and collared femoral prosthesis). IPTI manifests as groin pain, raising diagnostic challenges since this symptom lacks specificity. Physical findings of value for the diagnosis include pain exacerbation during active hip flexion, groin pain upon straight-leg raise to 30°, and/or snapping hip syndrome. Confirmation is then provided by ultrasonography and, most importantly, computed tomography. Once the diagnosis is confirmed, non-operative treatment combining physical therapy and local corticosteroid injections is prescribed. When these measures fail, endoscopic or arthroscopic surgery is generally effective. In patients with major cup malposition, revision of the cup is the preferred option, despite the higher complication rate. When cup position is adequate, ilio-psoas tenotomy can be performed either extra-articularly at the lesser trochanter (by endoscopy) or intra-articularly (by arthroscopy). The arthroscopic technique is more demanding but useful when the diagnosis is in doubt, as it allows examination of the prosthetic bearing surfaces. Both techniques and the risks inherent in each are discussed in detail. Tenotomy, whether performed endoscopically or arthroscopically, promptly provides good outcomes in over 85% of patients, usually with full recovery of hip flexor strength over time. These minimally invasive techniques, while as effective as conventional surgery, are associated with lower morbidity rates.
Topics: Arthroplasty, Replacement, Hip; Arthroscopy; Hip Joint; Humans; Pain; Postoperative Care; Tendinopathy; Tenotomy; Tomography, X-Ray Computed
PubMed: 30555016
DOI: 10.1016/j.otsr.2018.05.017 -
Journal of Wrist Surgery Jun 2022Arthroscopically-assisted reduction and internal fixation (AARIF) for distal radius fractures (DRF) has been extensively described. Little information is available...
Arthroscopically-assisted reduction and internal fixation (AARIF) for distal radius fractures (DRF) has been extensively described. Little information is available about AARIF in AO "B3" and "C" DRF with displaced lunate facet volar rim fragment (VRF) and volar carpal subluxation. However, lunate volar rim fragment (LVRF) may be very difficult to reduce and fix under arthroscopic control using the flexor carpi radialis (FCR) or FCR extended approaches while traction is applied. The aims were to describe our surgical technique of AARIF of partial or complete DRF with VRF and provide information about how often this technique may be necessary, based on a large DRF database. The dual-window volar approach for complete articular AO C DRF with volar medial fragment was described in 2012 for performing open reduction internal fixation (ORIF). Since 2015, we have used the dual-window approach for AARIF of "B3" or "C" DRF with volar carpal subluxation. We analyzed our PAF database, searching for patients treated with AARIF in "B3" and "C" fractures. The dual-window volar approach is very useful when using AARIF for AO "B3" and "C" DRF with displaced VRF and volar carpal subluxation. The anteromedial part of the exposure allows a direct access to reduction and fixation of the LVRF under traction and arthroscopic control. Overall, 1% of all articular DRF in this series showed a displaced LVRF amenable to the dual-window volar approach. It is almost impossible to access and properly fix a VRF using traction and arthroscopic control through the FCR or FCR extended FCR approach because of the stretched flexor tendon mass. The use of the dual-window approach during AARIF of AO "B3" or "C" DRF has not previously been reported. Displaced VRF are rare whether they were part of "B3" or "C" fractures. If AARIF is chosen, we strongly recommend the use of the dual-window volar approach for AO "B3" and "C" fractures with VRF. A single anteromedial approach can also be used for isolated "B3" anteromedial DRF.
PubMed: 35837590
DOI: 10.1055/s-0041-1735980