This investigation looked at functional outcomes, following a novel technique of surgical repair using table staples. Patients underwent surgery for proximal hamstring rupture with table staples used to hold the tendon reapproximated to the ischial tuberosity. Functional outcomes following surgery were assessed. We also used a combined outcome assessment measure: the Perth Hamstring Assessment Tool (PHAT). A total of 56 patients with a mean age of 51 (range 15&#x2013;71) underwent surgery. The mean follow-up duration was 26 months (range 8&#x2013;59 months). A large proportion of patients (21/56, 37.5&#x25;) required reoperation for removal of the staple. Patients that did not require removal of the table staple did well postoperatively, with low pain scores (0.8&#x2013;2 out of 10) and good levels of return to sport or running (75.8&#x25;). Those that required removal of the staple had a significantly lower PHAT score prior to removal, 47.8, but this improved markedly once the staple was removed, with a mean of 77.2 (<svg style="vertical-align:-0.1638pt;width:66.875px;" id="M1" height="11.375" version="1.1" viewBox="0 0 66.875 11.375" width="66.875" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
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</svg>). Although our patients achieved similar outcomes in terms of pain and function, we thought the reoperation rate was unacceptably high. We would not recommend proximal hamstring tendon repair using this technique.

William Blakeney

Simon Zilko

Wael Chiri

Peter Annear

A Novel Technique for Proximal Hamstring Tendon Repair: High Reoperation Rate in a Series of 56 Patients

Ceramic-on-ceramic articulations have become an attractive option for total hip arthroplasty in young patients. In this study, we retrospectively evaluated the short- to midterm clinical and radiographic results in 51 consecutive patients (61 hips) using the newest generation of ceramic implants. Results obtained in our study showed positive clinical and radiological outcomes. Both HHS and UCLA activity scores doubled after surgery and tended to increase over time. There was one infection requiring a two-stage revision and a case of squeaking that began 2 years postoperatively after a mechanical fall.  The overall survival rate of the implants was 98.4&#x25; at six years with revision for any reason as the end point. Based on these results, fourth generation ceramics offer a viable option for young and active patients.

Avishai Reuven

Grigorios N. Manoudis

Ahmed Aoude

Olga L. Huk

David Zukor

John Antoniou

Clinical and Radiological Outcome of the Newest Generation of Ceramic-on-Ceramic Hip Arthroplasty in Young Patients

Objective. Repair of injured Achilles tendon in neglected cases is one of the difficult and challenging procedures for surgeon. Here, we share our experience with the use of two innovative techniques for repair of chronic rupture of Achilles tendon. Design. Prospective Study. Setting. Tertiary care hospital. Patients. Twelve patients with chronic Tendo Achilles rupture were followed up over a period of three to five years. Intervention. Patients were divided in two groups, A and B. In Group A, the repair was done with Gastroc-soleus turndown flap and weaving with Plantaris tendon graft and in Group B, with modified Kessler&#x2019;s technique strengthened with the free plantaris tendon graft. Outcome Assessment. Clinically and by Modified Rupp Scoring system. Results. At an average follow-up of 4 years (Group A, 3.7 and Group B, 4.4 years), the majority of the patients had excellent to good results as assessed with Modified Rupp Scoring with few minor complications in both the groups. There was no significant difference in the baseline variables such as age and gender and also in the Rupp&#x2019;s score between the two groups. Conclusion. The two techniques are novel and simple and have been found to be useful for repair of chronically ruptured Achilles tendon.

Pradeep Jain

Parthapratim Dutta

Prabal Goswami

Amol Patel

Shammi Purwar

Vaibhav Jain

Management of Neglected Achilles Tendon Division: Assessment of Two Novel and Innovative Techniques

Background. External fixation is useful in the primary treatment of pelvic ring injuries. The present study compared the biomechanical stability of five different configurations of an external pelvic ring fixation system. Methods. Five configurations of an anterior external pelvic ring fixation system were tested using a universal testing machine. One single connecting rod was used in group &#x201c;SINGLE,&#x201d; two parallel connecting rods in group &#x201c;DOUBLE,&#x201d; two and four rods, respectively, in a tent-like configuration in groups &#x201c;SINGLE TENT&#x201d; and &#x201c;DOUBLE TENT,&#x201d; and a rhomboid-like configuration in group &#x201c;RHOMBOID.&#x201d; Each specimen was subjected to a total of 2000 consecutive cyclic loadings at 1&#x2009;Hz lateral compression/distraction (&#xb1;50&#x2009;N) and torque (&#xb1;0.5&#x2009;Nm) loading alternating every 200 cycles. Translational and rotational stiffness were determined at 100, 300, 500, 700, and 900 cycles. Results. The &#x201c;SINGLE TENT&#x201d; and &#x201c;RHOMBOID&#x201d; configurations already failed with a preloading of 50&#x2009;N compression force. The &#x201c;DOUBLE&#x201d; configuration had around twice the translational stability compared with the &#x201c;SINGLE&#x201d; and &#x201c;DOUBLE TENT&#x201d; configurations. Rotational stiffness observed for the &#x201c;DOUBLE&#x201d; and &#x201c;DOUBLE TENT&#x201d; configurations was about 50&#x25; higher compared to the SINGLE configuration. Conclusion. Using two parallel connecting rods provides the highest translational and rotational stability.

Simon Tiziani

Georg Osterhoff

Stephen J. Ferguson

Gregor Spreiter

Max J. Scheyerer

Gian-Leza Spinas

Guido A. Wanner

Hans-Peter Simmen

Clément M. L. Werner

Biomechanical Comparison of Different External Fixation Configurations for Posttraumatic Pelvic Ring Instability

Neglected hip dislocation in patients with cerebral palsy is a challenge for the pediatric orthopedic surgeon. Many patients experience pain, limitation of hip motion, and sitting and hygiene problems. Arthrodesis, proximal femoral head resection, and subtrochanteric valgus osteotomy are effective salvage procedures for patients with painful hip dislocation and restricted hip motion when reconstruction of the hip is not possible. Osteopenia is one of the problems that can complicate the postoperative course in these patients. Postoperative cast immobilization may further worsen the osteopenia and can predispose to fractures of the femur after cast removal. Standard plating of the proximal osteotomy may not always provide adequate stability of the fixation. In order to prevent postoperative osteoporotic fractures we use locking plates, without casting. Since 2003 until 2011, we operated on 9 patients (14 hips) with painful neglected hip dislocations. The first three patients (five hips) were operated on using standard nonlocking plates. All other patients (nine hips) were operated on using locking plates. During the followup, the hardware failed in one of these cases. All patients treated with locking plates had not been casted postoperatively, and none had loss of fixation or fractures during the followup.

Mark Eidelman

Alexander Katzman

Michael Zaidman

Yaniv Keren

McHale Operation in Patients with Neglected Hip Dislocations: The Importance of Locking Plates

This study evaluates the outcomes of 92 hip arthroplasties using a press fit, tapered, split tip, proximally porous ingrowth (CSTi) femoral stem (Zimmer Natural Hip) in consecutive hip arthroplasty patients followed for an average of ten years postoperatively (range 5&#x2013;16 years). Patients were functionally and radiographically evaluated using Harris Hip Scores and plain radiographs assessing postarthroplasty groin or thigh pain and radiographic signs of stem subsidence, proximal femoral fixation, stress shielding, and related calcar resorption. At followup of 5&#x2013;10 years, the incidence of groin pain and thigh pain was 9.1&#x25; and 3.6&#x25;, respectively. This incidence improved over time. Beyond 10 years of followup, groin pain was 2.7&#x25; and thigh pain zero. In 89&#x25; of cases, there was solid contact between the calcar and the undersurface of the stem collar. Five cases were revised for instability (5.4&#x25;). The Harris Hip Scores and the incidence of thigh or groin pain were very favorable compared to other reported press fit total hip arthroplasty stems and not significantly different across a broad age range. There were no cases of stem loosening of failure of bony ingrowth into the stem.

Thomas B. Pace

James C. Karegeannes

M. Jason Palmer

Stephanie L. Tanner

Rebecca G. Snider

Clinical and Radiographic Evaluation of a Commercially Pure Cancellous-Structured Titanium Press Fit Total Hip Prosthetic Stem: Ten-Year Followup of the &#x201C;Natural Hip&#x201D; Femoral Stem

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Advances in Orthopedic Surgery