Bone morphogenetic proteins are osteoinductive factors which have gained popularity in orthopaedicsurgery and especially in spine surgery. The use of recombinant human bone morphogenetic protein-2 has been officially ...Bone morphogenetic proteins are osteoinductive factors which have gained popularity in orthopaedicsurgery and especially in spine surgery. The use of recombinant human bone morphogenetic protein-2 has been officially approved by the United States Food and Drug Administration only for single level anterior lumbar interbody fusion, nevertheless it is widely used by many surgeons with off-label indications. Despite advantages in bone formation, its use still remains a controversial issue and several complications have been described by authors who oppose their wide use.展开更多
Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth m...Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth metatarsal. Four types of subtalar dislocation have been described according to the direction of the foot in relation to the talus: medial, lateral posterior and anterior. It has been shown that some of these dislocations may spontaneously reduce. A rare case of a 36-year-old male patient who sustained a closed medial subtalar dislocation without any associated fractures of the ankle is reported. The patient suffered a pure closed medial subtalar dislocation that is hardly reported in the literature. Six months after injury the patient did not report any pain, had a satisfactory range of motion, and no signs of residual instability or early posttraumatic osteoarthritis. The traumatic mechanism, the treatment options, and the importance of a stable and prompt closed reduction and early mobilization are discussed.展开更多
Tranexamic acid(TXA)has revolutionized modern blood management in orthopaedic surgery,especially in total joint arthroplasty,by significantly reducing blood loss and transfusion rates.It is an antifibrinolytic agent a...Tranexamic acid(TXA)has revolutionized modern blood management in orthopaedic surgery,especially in total joint arthroplasty,by significantly reducing blood loss and transfusion rates.It is an antifibrinolytic agent and a synthetic derivative of the amino acid lysine,which can inhibit the activation of plasminogen and the fibrin breakdown process.The administration of TXA can be intravenous(IV),topical,and oral.In patients where the IV administration is contraindicated,topical use is preferred.Topical administration of the drug theoretically increases concentration at the operative site with reduced systemic exposure,reduces cost,and gives the surgeon the control of the administration.According to recent studies,topical administration of TXA is not inferior compared to IV administration,in terms of safety and efficacy.However,there are concerns regarding the possible toxicity in the cartilage tissue with the topical use of TXA mainly in hemiarthroplasty operations of the hip,unilateral knee arthroplasties,total knee arthroplasties where the patella is not resurfaced,and other intraarticular procedures,like anterior cruciate ligament reconstruction.The purpose of the present review is to present all the recent updates on the use of TXA focusing on the toxicity on chondrocytes and the articular cartilage that may or may not be provoked by the topical use of TXA.展开更多
文摘Bone morphogenetic proteins are osteoinductive factors which have gained popularity in orthopaedicsurgery and especially in spine surgery. The use of recombinant human bone morphogenetic protein-2 has been officially approved by the United States Food and Drug Administration only for single level anterior lumbar interbody fusion, nevertheless it is widely used by many surgeons with off-label indications. Despite advantages in bone formation, its use still remains a controversial issue and several complications have been described by authors who oppose their wide use.
文摘Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth metatarsal. Four types of subtalar dislocation have been described according to the direction of the foot in relation to the talus: medial, lateral posterior and anterior. It has been shown that some of these dislocations may spontaneously reduce. A rare case of a 36-year-old male patient who sustained a closed medial subtalar dislocation without any associated fractures of the ankle is reported. The patient suffered a pure closed medial subtalar dislocation that is hardly reported in the literature. Six months after injury the patient did not report any pain, had a satisfactory range of motion, and no signs of residual instability or early posttraumatic osteoarthritis. The traumatic mechanism, the treatment options, and the importance of a stable and prompt closed reduction and early mobilization are discussed.
文摘Tranexamic acid(TXA)has revolutionized modern blood management in orthopaedic surgery,especially in total joint arthroplasty,by significantly reducing blood loss and transfusion rates.It is an antifibrinolytic agent and a synthetic derivative of the amino acid lysine,which can inhibit the activation of plasminogen and the fibrin breakdown process.The administration of TXA can be intravenous(IV),topical,and oral.In patients where the IV administration is contraindicated,topical use is preferred.Topical administration of the drug theoretically increases concentration at the operative site with reduced systemic exposure,reduces cost,and gives the surgeon the control of the administration.According to recent studies,topical administration of TXA is not inferior compared to IV administration,in terms of safety and efficacy.However,there are concerns regarding the possible toxicity in the cartilage tissue with the topical use of TXA mainly in hemiarthroplasty operations of the hip,unilateral knee arthroplasties,total knee arthroplasties where the patella is not resurfaced,and other intraarticular procedures,like anterior cruciate ligament reconstruction.The purpose of the present review is to present all the recent updates on the use of TXA focusing on the toxicity on chondrocytes and the articular cartilage that may or may not be provoked by the topical use of TXA.
