Issue 64


February/March 2004 64_front.jpg

In this issue:

 

  • Canadian Joint Replacement Registry Significantly Expands Coverage
  • Arthritis of the Knee: Is there a role for arthoscopic debridement?
  • Treatment Options for Displaced Femoral Neck Fractures

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Adieu - James F Allen PDF Print E-mail
Dr. James F. (Jimmy) Allen was one of the 10 people tragically killed on the Cessna plane that crashed into Lake Erie on Saturday, January 17, 2004, shortly after take off from Pellee Island. Dr. Allen, an Active COA member since 1989, was a long time supporter of The Canadian Orthopaedic Foundations fundraising walk, Hip Hip Hooray (Chatham site), and his loss will have a devastating impact on the orthopaedic and Chatham communities. We extend our sympathies to his family and to the families of the nine others lost in the crash.
Last Updated on Friday, 09 March 2007 13:57
 
Themes - Osteoporosis in Orthopaedics PDF Print E-mail
Overview of CORS/COA Symposium Osteoporosis in Orthopaedics
2003 Annual General Meeting, Winnipeg, MB

Beth Snowden, R.N.
OOA Osteoporosis Coordinator

On Saturday October 4th, 2003 at the COA AGM, a plenary symposium was held on the topic of Osteoporosis in Orthopaedics. Chaired by Dr. Earl R. Bogoch, of Toronto, Ontario, the topics presented at this symposium included presentations on: Bone Quality by Dr. Thomas Einhorn, Boston; Ian Macnab Lecture on the Economic Impact of Fractures by Dr. Laura Tosi, Washington, DC; Vertebroplasty and Kyphoplasty by Dr. Christopher Bono, Boston; Massachusetts, and a status report on Canadian Orthopaedic Osteoporosis initiatives by Dr. Bogoch. After the presentations, a session of interactive real-time polling captured the current opinions and practice patterns of the attendees. The following represents an overview of the symposium.

Last Updated on Friday, 09 March 2007 13:55
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Themes - The Unipolar Endoprosthesis for Hip Fractures is it the Best Solution PDF Print E-mail
The Unipolar Endoprosthesis for Hip Fractures: is it the Best Solution?

Pierre Guy, MDCM, MBA, FRCSC
Assistant Professor, University of British Columbia
Vancouver, BC

Few procedures in orthopaedics have endured the test of time longer than ORIF1,2 or hemiarthroplasty3,4 for femur neck fractures. This injury so commonly presents to the orthopaedic surgeon that one would think there be little variation in treatment. In contrast, many published surveys5,6 still demonstrate a wide spectrum of practise in caring for femur neck fractures.

The present and future volume of cases7 require orthopaedic surgeons to make clinically and economically sound decisions in the treatment choices offered to these patients. The optimal choices seven key attributes would be to: minimize mortality, pain, bleeding, length of stay, revision rates and costs, while maximizing function. The ability to change the habits of practitioners to evidence-based ones is impeded not only by the limited good science available on the topic, but also by the fact that most surgeons have likely already treated many of these patients and have preset ideas on the topic.

The following text will answer four clinically relevant questions based on the highest level of scientific evidence (randomized control trials or meta-analyses) when available, otherwise relying on well designed studies.
Last Updated on Friday, 09 March 2007 13:55
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Themes - Total Hip Replacement for Displaced Subcapital Hip Fractures PDF Print E-mail
Total Hip Replacement for Displaced Subcapital Hip Fractures

Richard W. McCalden, M.D., MPhil(Edin), FRCSC
Assistant Professor of Orthopaedic Surgery
University of Western Ontario
London Health Science Centre
London, ON

The treatment of displaced subcapital hip fractures is becoming increasingly common and has an enormous impact on our health care system. In North America, these fractures are treated by either some form of internal fixation (IF) or various forms of hemiarthroplasty (HA). There is considerable evidence demonstrating better functional outcome and less need for reoperation with HA compared to IF in the treatment of displaced subcapital hip fractures in the elderly1,2.

What is the role of total hip replacement (THR) in the treatment of displaced subcapital hip fractures? The potential advantage of using THR relates to its highly predictable results, with survivorship of greater than 90% at 10 years, and its unparalleled results in terms of pain relief and overall function. In addition, the use of THR avoids the potential need for revision secondary to acetabular pain from ongoing acetabular erosion. The potential disadvantages of THR include the increased cost, increased surgical time and blood loss (which may lead to increased morbidity or mortality) and the potential increased rate of dislocation compared to HA.
Last Updated on Friday, 09 March 2007 13:55
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Themes - The Role Of Pinning In Subcapital Fractures PDF Print E-mail

The Role Of Pinning In Subcapital Fractures

Edward J. Harvey M.D., MSc
Montreal, QC

Displaced subcapital hip fractures represent a consistent problem in orthopaedic surgery. Assorted reasons for choosing a modality of treatment include ease of surgery, cost, morbidity and mortality, risk of AVN, re-operation rates and functional disability.

The physiologically young patient has traditionally been treated with internal fixation. There is little evidence-based literature to change that treatment plan. Currently, open or closed reduction and internal fixation with three or four screws are accepted therapies. Capsulotomy does not seem to be clinically relevant. Historically, expedient surgery has been advocated to avoid osteonecrosis. However, there is probably a low rate of AVN. Also, only about 20% of patients with AVN require further surgery. However, AVN is not painless in the high-demand patient post internal fixation. Some data suggests that urgent reduction and fracture fixation within 12 hours after a displaced fracture may be associated with a reduced rate of radiographic signs of avascular necrosis1. Pinning in the physiologically young patient is always indicated and none of the criteria such as cost, morbidity and mortality, re-operation rates and functional disability suggest otherwise.

Last Updated on Friday, 09 March 2007 13:55
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