Pub Date : 2022-08-30DOI: 10.1097/BCO.0000000000001162
Sean B. Sequeira, Casey Imbergamo, Heath P. Gould, Melissa A. Wright, A. Murthi
Background: The most common surgical option for acute triceps tendon tears is primary repair. There is no consensus as to which fixation construct is biomechanically superior. The purpose of this study was to evaluate the biomechanical properties of transosseous cruciate (TC) versus suture anchors (SA) for triceps tendon repair. Methods: A systematic review was performed by searching PubMed, the Cochrane library, and Embase using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify studies that analyzed the biomechanical properties of TC and SA techniques for triceps tendon repair. The search phrase implemented was “triceps tendon repair biomechanics.” Evaluated outcomes included medial displacement, lateral displacement, and ultimate load to failure. Results: Four studies met inclusion criteria, including 74 cadaveric specimens (TC: 37, SA: 37), for triceps tendon repair comparing a transosseous technique with TC to SA fixation. Pooled analysis from four studies reporting on medial and lateral displacement revealed a statistically significant difference between TC and SA (P=0.048 and 0.006). Pooled analysis from three studies reporting on ultimate load to failure revealed a statistically significant difference in favor of SA compared to TC (P=0.035). Conclusions: Biomechanical testing of SA for triceps tendon repair is associated with higher ultimate load to failure and lower medial and lateral displacement when under load following repair. The findings of this biomechanical meta-analyses should be considered along with clinical outcome data when surgeons make a decision regarding triceps tendon repair techniques. Level of Evidence: Level II
{"title":"A biomechanical comparison between transosseous cruciate sutures and suture anchors for triceps tendon repair: a systematic review and meta-analysis","authors":"Sean B. Sequeira, Casey Imbergamo, Heath P. Gould, Melissa A. Wright, A. Murthi","doi":"10.1097/BCO.0000000000001162","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001162","url":null,"abstract":"Background: The most common surgical option for acute triceps tendon tears is primary repair. There is no consensus as to which fixation construct is biomechanically superior. The purpose of this study was to evaluate the biomechanical properties of transosseous cruciate (TC) versus suture anchors (SA) for triceps tendon repair. Methods: A systematic review was performed by searching PubMed, the Cochrane library, and Embase using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify studies that analyzed the biomechanical properties of TC and SA techniques for triceps tendon repair. The search phrase implemented was “triceps tendon repair biomechanics.” Evaluated outcomes included medial displacement, lateral displacement, and ultimate load to failure. Results: Four studies met inclusion criteria, including 74 cadaveric specimens (TC: 37, SA: 37), for triceps tendon repair comparing a transosseous technique with TC to SA fixation. Pooled analysis from four studies reporting on medial and lateral displacement revealed a statistically significant difference between TC and SA (P=0.048 and 0.006). Pooled analysis from three studies reporting on ultimate load to failure revealed a statistically significant difference in favor of SA compared to TC (P=0.035). Conclusions: Biomechanical testing of SA for triceps tendon repair is associated with higher ultimate load to failure and lower medial and lateral displacement when under load following repair. The findings of this biomechanical meta-analyses should be considered along with clinical outcome data when surgeons make a decision regarding triceps tendon repair techniques. Level of Evidence: Level II","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"538 - 542"},"PeriodicalIF":0.3,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43602768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-30DOI: 10.1097/BCO.0000000000001157
Dimitrios Ntourantonis, Ilias D Iliopoulos, K. Pantazis, A. Baikousis, P. Korovessis
Background: The proximal interphalangeal joint (PIPJ) is a synovial joint prone to injury encompassing a wide spectrum of severity. In the setting of complicated injuries, dynamic external traction systems are considered to be the optimal treatment modality with numerous different Kirschner-wire configurations combined with rubber bands, springs, pulleys, or hinges being described. However, many of these pose significant technical challenges for the surgeon or are unwieldy to the patient emphasizing the need for simple, easy to construct, and well-tolerated modifications, which are equally effective in reducing the fracture and allowing early motion. Methods: The authors retrospectively analyzed prospectively collected data of 12 patients with open complex PIPJ fracture dislocations treated with a custom-made external fixator based on the one that was originally suggested by Suzuki et al. All patients were men with an average age of 55.1 yr (23 to 81). Injured digits involved four index, five middle, and three ring fingers. Results: The mean follow-up was 54.36 mo, and all patients healed without a second operation and returned to their jobs and preinjury level of activity. The average active range of motion of the PIPJ was 75.16±3.18 degrees, DIPJ was 69.33±14.7 degrees, and MCPJ was 88.75±1.97 degrees. Mean Quick Disabilities of Arm, Shoulder, and Hand (DASH)-Japan Society for Surgery of the Hand (JSSH) score at the final examination was 4.33±1.38 (range 2.3 to 6.8). The authors recorded five complications involving two rubber bands breaking, one pin-track infection, one rubber band-axial traction pin malposition, and one swan neck deformity, which were treated accordingly. Conclusions: One of the most crucial factors affecting outcome in this kind of injury is the appearance of the digit and functional results. None of the participants in this series had any complaint about the appearance of their fingers in the final examination, and 10 out of 12 judged the cosmetic result as very good. To the authors' knowledge, this report is one of the few that describes the functional outcome of pins and rubbers traction system (PRTS) application in complex fracture and fractures-dislocations with severe comminution of the middle phalanx and not only fractures related to the PIP joint. Level of Evidence: Level V.
{"title":"Pitfalls and suggestions for the treatment of open, comminuted fractures of the middle phalanx using custom-made dynamic external fixators: a retrospective case series","authors":"Dimitrios Ntourantonis, Ilias D Iliopoulos, K. Pantazis, A. Baikousis, P. Korovessis","doi":"10.1097/BCO.0000000000001157","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001157","url":null,"abstract":"Background: The proximal interphalangeal joint (PIPJ) is a synovial joint prone to injury encompassing a wide spectrum of severity. In the setting of complicated injuries, dynamic external traction systems are considered to be the optimal treatment modality with numerous different Kirschner-wire configurations combined with rubber bands, springs, pulleys, or hinges being described. However, many of these pose significant technical challenges for the surgeon or are unwieldy to the patient emphasizing the need for simple, easy to construct, and well-tolerated modifications, which are equally effective in reducing the fracture and allowing early motion. Methods: The authors retrospectively analyzed prospectively collected data of 12 patients with open complex PIPJ fracture dislocations treated with a custom-made external fixator based on the one that was originally suggested by Suzuki et al. All patients were men with an average age of 55.1 yr (23 to 81). Injured digits involved four index, five middle, and three ring fingers. Results: The mean follow-up was 54.36 mo, and all patients healed without a second operation and returned to their jobs and preinjury level of activity. The average active range of motion of the PIPJ was 75.16±3.18 degrees, DIPJ was 69.33±14.7 degrees, and MCPJ was 88.75±1.97 degrees. Mean Quick Disabilities of Arm, Shoulder, and Hand (DASH)-Japan Society for Surgery of the Hand (JSSH) score at the final examination was 4.33±1.38 (range 2.3 to 6.8). The authors recorded five complications involving two rubber bands breaking, one pin-track infection, one rubber band-axial traction pin malposition, and one swan neck deformity, which were treated accordingly. Conclusions: One of the most crucial factors affecting outcome in this kind of injury is the appearance of the digit and functional results. None of the participants in this series had any complaint about the appearance of their fingers in the final examination, and 10 out of 12 judged the cosmetic result as very good. To the authors' knowledge, this report is one of the few that describes the functional outcome of pins and rubbers traction system (PRTS) application in complex fracture and fractures-dislocations with severe comminution of the middle phalanx and not only fractures related to the PIP joint. Level of Evidence: Level V.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"585 - 595"},"PeriodicalIF":0.3,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48966193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-29DOI: 10.1097/BCO.0000000000001163
B. Crist, T. Surma, Ennio Rizzo Esposito, Julia R Matera, John R. Worley, Joseph M. Rund, J. Cook
Background: A prior study reported a 22% complication rate using the direct anterior (DA) approach for total hip arthroplasty (THA) in the displaced femoral neck fracture population. This seemed contrary to institutional experience; this study investigated outcomes and complication rates for DA THA used in the displaced femoral neck fracture population. Methods: This retrospective cohort study identified and analyzed patients undergoing DA THA for a femoral neck fracture over a 4-year period at a level 1 academic trauma center who were treated by an experienced senior surgeon. Results: Thirty-seven patients (21 women, 16 men) were included in the final analysis. The mean age was 70.9 (SD 11.30) years. All patients received cementless components. One (2.7%) intraoperative greater trochanteric fracture and one (2.7%) in-hospital mortality were recorded. Average follow-up was 10.46 mo (range 0 to 53 mo). There were no reported postoperative periprosthetic fractures, dislocations, or revision arthroplasties. No deep venous thromboses or pulmonary embolisms occurred within 90 days of surgery. There were two (5%) deep infections. The overall complication rate was 8.1%. Patient-reported outcomes were available for 32 patients. Visual Analog Scale pain was 2.59 at 6 wk average compared with 1.83 at 12 mo. Hip Disability and Osteoarthritis Outcome Score Quality of Life at 6 wk averaged 46.69 compared with 59.24 at 12 mo. Conclusions: The direct anterior approach for THA can be a safe option for experienced surgeons. Level of Evidence: Level III.
{"title":"Anterior total hip arthroplasty outcomes in the treatment of femoral neck fractures: a retrospective cohort study","authors":"B. Crist, T. Surma, Ennio Rizzo Esposito, Julia R Matera, John R. Worley, Joseph M. Rund, J. Cook","doi":"10.1097/BCO.0000000000001163","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001163","url":null,"abstract":"Background: A prior study reported a 22% complication rate using the direct anterior (DA) approach for total hip arthroplasty (THA) in the displaced femoral neck fracture population. This seemed contrary to institutional experience; this study investigated outcomes and complication rates for DA THA used in the displaced femoral neck fracture population. Methods: This retrospective cohort study identified and analyzed patients undergoing DA THA for a femoral neck fracture over a 4-year period at a level 1 academic trauma center who were treated by an experienced senior surgeon. Results: Thirty-seven patients (21 women, 16 men) were included in the final analysis. The mean age was 70.9 (SD 11.30) years. All patients received cementless components. One (2.7%) intraoperative greater trochanteric fracture and one (2.7%) in-hospital mortality were recorded. Average follow-up was 10.46 mo (range 0 to 53 mo). There were no reported postoperative periprosthetic fractures, dislocations, or revision arthroplasties. No deep venous thromboses or pulmonary embolisms occurred within 90 days of surgery. There were two (5%) deep infections. The overall complication rate was 8.1%. Patient-reported outcomes were available for 32 patients. Visual Analog Scale pain was 2.59 at 6 wk average compared with 1.83 at 12 mo. Hip Disability and Osteoarthritis Outcome Score Quality of Life at 6 wk averaged 46.69 compared with 59.24 at 12 mo. Conclusions: The direct anterior approach for THA can be a safe option for experienced surgeons. Level of Evidence: Level III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"519 - 524"},"PeriodicalIF":0.3,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42152439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-29DOI: 10.1097/BCO.0000000000001164
K. Credille, Tyler Compton, Alexander R. Graf, S. Shi, Demetrios Douros
INTRODUCTION I n 2018, over 1.7 million hip arthroscopies were performed, most often for treatment of femoracetabular impingement (FAI), labral tears, and chondral defects. With popularity of hip arthroscopy increasing, unique complications such as injury to the lateral femoral cutaneous nerve (LFCN) during portal placement are becoming more common. A recent systematic review of 36,761 hip arthroscopies showed LFCN injury was the second most common nerve injury with an incidence of 0.3%. Anatomic studies demonstrate the average distance of the LFCN to the direct anterior hip portal is 0.3 cm. Laceration or stretch injury of the LFCN during hip arthroscopy can lead to neuroma formation, which can lead to significant disability from chronic neuropathic pain. Treatment of painful neuromas is complex and controversial. Nonsurgical treatments such as gabapentinoid and neuromodulating medications have been described, along with serial lidocaine injections. Ablation and desensitization therapy have shown inconsistent results. Traditional surgical options include resecting the neuroma and capping the nerve end. More recently, targeted muscle reinnervation has emerged as feasible treatment for neuromas arising from amputations. This is borne out of the 1980s technique of neurotization in which painful neuromas are excised, and the remaining sensory nerve is transferred to an adjacent muscle motor endplate to give the nerve a new role and prevent neuroma recurrence. While previous studies have shown success of neurotization to be as high as 80% elsewhere in the body, no studies to date have examined the role of this technique for treatment of LFCN neuromas associated with hip arthroscopy. Therefore, the purpose of our study is to present a case of successful LFCN neuroma treatment with neurotization to highlight this technique as a durable treatment option for this challenging hip arthroscopy complication. The patient was informed data concerning the case would be submitted for publication and provided consent. Institutional review board approval was not required for this case report.
{"title":"Lateral femoral cutaneous nerve neuroma treatment after hip arthroscopy: a case report and review of the literature","authors":"K. Credille, Tyler Compton, Alexander R. Graf, S. Shi, Demetrios Douros","doi":"10.1097/BCO.0000000000001164","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001164","url":null,"abstract":"INTRODUCTION I n 2018, over 1.7 million hip arthroscopies were performed, most often for treatment of femoracetabular impingement (FAI), labral tears, and chondral defects. With popularity of hip arthroscopy increasing, unique complications such as injury to the lateral femoral cutaneous nerve (LFCN) during portal placement are becoming more common. A recent systematic review of 36,761 hip arthroscopies showed LFCN injury was the second most common nerve injury with an incidence of 0.3%. Anatomic studies demonstrate the average distance of the LFCN to the direct anterior hip portal is 0.3 cm. Laceration or stretch injury of the LFCN during hip arthroscopy can lead to neuroma formation, which can lead to significant disability from chronic neuropathic pain. Treatment of painful neuromas is complex and controversial. Nonsurgical treatments such as gabapentinoid and neuromodulating medications have been described, along with serial lidocaine injections. Ablation and desensitization therapy have shown inconsistent results. Traditional surgical options include resecting the neuroma and capping the nerve end. More recently, targeted muscle reinnervation has emerged as feasible treatment for neuromas arising from amputations. This is borne out of the 1980s technique of neurotization in which painful neuromas are excised, and the remaining sensory nerve is transferred to an adjacent muscle motor endplate to give the nerve a new role and prevent neuroma recurrence. While previous studies have shown success of neurotization to be as high as 80% elsewhere in the body, no studies to date have examined the role of this technique for treatment of LFCN neuromas associated with hip arthroscopy. Therefore, the purpose of our study is to present a case of successful LFCN neuroma treatment with neurotization to highlight this technique as a durable treatment option for this challenging hip arthroscopy complication. The patient was informed data concerning the case would be submitted for publication and provided consent. Institutional review board approval was not required for this case report.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"626 - 628"},"PeriodicalIF":0.3,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42403889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-29DOI: 10.1097/BCO.0000000000001166
A. Afshar, A. Tabrizi, H. Taleb, Nasrin Navaeifar
INTRODUCTION Enchondroma is a benign tumor that develops in the proximal part of the fingers and is one of the most frequent primary and destructive tumors of the hand. The metacarpals and middle phalanx are the other most affected parts. Because there are no distinct clinical symptoms, it is sometimes not identified until a pathological fracture occurs. Enchondroma begins as a nidus of cartilaginous cells in the physis, arises in the medullary cavity and grows outward into the cortex, eventually growing into an endogenous mass in the bone. One therapeutic obstacle is a pathological fracture and its consequences in the distal phalanx because the extensor mechanism in the distal half has failed concurrently. This study discusses a case of mallet finger that was caused by a pathological fracture due to enchondroma. This case report was approved by the Ethics Committee of Urmia University of Medical Sciences. Written informed consent was obtained from the patient for its publication.
{"title":"Pathological mallet finger due to distal phalanx enchondroma: a case report","authors":"A. Afshar, A. Tabrizi, H. Taleb, Nasrin Navaeifar","doi":"10.1097/BCO.0000000000001166","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001166","url":null,"abstract":"INTRODUCTION Enchondroma is a benign tumor that develops in the proximal part of the fingers and is one of the most frequent primary and destructive tumors of the hand. The metacarpals and middle phalanx are the other most affected parts. Because there are no distinct clinical symptoms, it is sometimes not identified until a pathological fracture occurs. Enchondroma begins as a nidus of cartilaginous cells in the physis, arises in the medullary cavity and grows outward into the cortex, eventually growing into an endogenous mass in the bone. One therapeutic obstacle is a pathological fracture and its consequences in the distal phalanx because the extensor mechanism in the distal half has failed concurrently. This study discusses a case of mallet finger that was caused by a pathological fracture due to enchondroma. This case report was approved by the Ethics Committee of Urmia University of Medical Sciences. Written informed consent was obtained from the patient for its publication.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"634 - 636"},"PeriodicalIF":0.3,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42190096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-02DOI: 10.1097/BCO.0000000000001153
M. Jabalameli, H. Yahyazadeh, A. Bagherifard, Alireza Askari, M. Mohammadpour, Masoud Hasanikhah
Background: Excessive distal femoral resection in patients with severe preoperative flexion contracture has been previously attributed to the joint line elevation after performing total knee arthroplasty (TKA). In this study, the authors investigated the effects of excessive distal femoral cut on the patellar height as well as the outcome of TKA. Methods: This retrospective study included patients with severe flexion contracture (>30 degrees) who underwent TKA. They were divided into two groups according to the size of distal femoral cut: group A (≤9 mm, n=27) and group B (>9 mm, n=22). The functional and radiographic outcomes as well as radiographic indices of patellar height, including adductor ratio, Insall-Salvati index, Blackburne-Peel index, Caton-Deschamps index, and fibular height, were compared between these two study groups. Results: The baseline characteristics of the participants were comparable. The mean femoral cut was 8.3±0.8 in group A and 12.6±0.9 in group B. The mean changes of the adductor ratio, Insall-Salvati index, Caton-Deschamps index, Blackburne-Peel index, and fibular height were not significantly different between the two study groups. As well, the functional and radiographic outcomes of TKA were comparable. No revision surgery was required during the mean follow-up of 51.7±32.4 mo. No genu recurvatum was recorded, and no patient complained of knee instability. Conclusions: An excessive distal femoral cut does not seem to change patellar height in TKA patients, so it could be used safely for patients with a severe preoperative flexion deformity. Level of Evidence: Level IV.
背景:术前严重屈曲挛缩患者的股骨远端过度切除先前归因于全膝关节置换术(TKA)后关节线升高。在这项研究中，作者研究了股骨远端切口过多对髌骨高度的影响以及TKA的结果。方法:本回顾性研究纳入了接受TKA的严重屈曲挛缩(bbb30度)患者。根据股骨远端切口大小分为A组(≤9 mm, n=27)和B组(≤9 mm, n=22)。比较两组患者的功能和影像学结果以及髌骨高度的影像学指标，包括内收肌比例、Insall-Salvati指数、blackburn - peel指数、Caton-Deschamps指数和腓骨高度。结果:受试者的基线特征具有可比性。A组股骨切面平均值为8.3±0.8,b组为12.6±0.9。内收肌比值、Insall-Salvati指数、Caton-Deschamps指数、blackburn - peel指数、腓骨高度的平均变化在两组间无显著差异。此外，TKA的功能和影像学结果也具有可比性。在平均51.7±32.4个月的随访中，没有需要翻修手术。没有膝反屈的记录，没有患者抱怨膝关节不稳定。结论:过度股骨远端切口似乎不会改变TKA患者的髌骨高度，因此可以安全地用于术前严重屈曲畸形的患者。证据等级:四级。
{"title":"Up to 4 millimeters excessive distal femoral resection in total knee arthroplasty has no significant effect on patellar height and functional score in patient with severe flexion contracture: a retrospective study","authors":"M. Jabalameli, H. Yahyazadeh, A. Bagherifard, Alireza Askari, M. Mohammadpour, Masoud Hasanikhah","doi":"10.1097/BCO.0000000000001153","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001153","url":null,"abstract":"Background: Excessive distal femoral resection in patients with severe preoperative flexion contracture has been previously attributed to the joint line elevation after performing total knee arthroplasty (TKA). In this study, the authors investigated the effects of excessive distal femoral cut on the patellar height as well as the outcome of TKA. Methods: This retrospective study included patients with severe flexion contracture (>30 degrees) who underwent TKA. They were divided into two groups according to the size of distal femoral cut: group A (≤9 mm, n=27) and group B (>9 mm, n=22). The functional and radiographic outcomes as well as radiographic indices of patellar height, including adductor ratio, Insall-Salvati index, Blackburne-Peel index, Caton-Deschamps index, and fibular height, were compared between these two study groups. Results: The baseline characteristics of the participants were comparable. The mean femoral cut was 8.3±0.8 in group A and 12.6±0.9 in group B. The mean changes of the adductor ratio, Insall-Salvati index, Caton-Deschamps index, Blackburne-Peel index, and fibular height were not significantly different between the two study groups. As well, the functional and radiographic outcomes of TKA were comparable. No revision surgery was required during the mean follow-up of 51.7±32.4 mo. No genu recurvatum was recorded, and no patient complained of knee instability. Conclusions: An excessive distal femoral cut does not seem to change patellar height in TKA patients, so it could be used safely for patients with a severe preoperative flexion deformity. Level of Evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"461 - 465"},"PeriodicalIF":0.3,"publicationDate":"2022-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43358255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-28DOI: 10.1097/BCO.0000000000001151
Timothy Ashworth, Paul M. Alvarez, J. Laux, Sarat Ganga, R. Ostrum
Background: Despite the high rate of complications associated with tibial pilon fractures, treatment often remains fairly algorithmic. This study highlights risk factors for poor outcomes to guide individualized treatment in an effort to minimize complications. Methods: One hundred and fifty-seven surgically treated pilon fractures in 151 patients over 6 yr were included. The following factors were studied: age, gender, presence of diabetes, smoking status, presence of an open fracture, Association for Osteosynthesis-Orthopaedic Trauma Association (AO/OTA) fracture classification, number of plates and incisions, time to external fixator placement, time to definitive treatment, and incisions used. The two primary outcomes were nonunion and infection/wound complications requiring re-operation. Univariate tests were used for each variable in isolation. Multiple regression models were used to control important covariates. Interactions between the number of incisions, patient history of smoking, the number of plates utilized, and patient history of diabetes were analyzed. Results: Male gender, open fracture, history of diabetes and increasing time to fixation were associated with infection/wound complications. Open fractures were strongly associated with the development of nonunion. The interaction model for diabetes and increasing number of plates showed that each additional plate used when treating patients with a history of diabetes was associated with 6.08 times higher odds of developing an infection, a marginally significant result (P=0.065). Conclusions: Increased caution may be warranted when treating tibial pilon fractures in patients with certain risk factors. In patients with a history of diabetes, the additional dissection needed to place more implants may contribute to higher rates of infection. Level of Evidence: Prognostic Level III.
{"title":"A multicenter retrospective analysis of risk factors for poor outcomes after tibial pilon fractures","authors":"Timothy Ashworth, Paul M. Alvarez, J. Laux, Sarat Ganga, R. Ostrum","doi":"10.1097/BCO.0000000000001151","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001151","url":null,"abstract":"Background: Despite the high rate of complications associated with tibial pilon fractures, treatment often remains fairly algorithmic. This study highlights risk factors for poor outcomes to guide individualized treatment in an effort to minimize complications. Methods: One hundred and fifty-seven surgically treated pilon fractures in 151 patients over 6 yr were included. The following factors were studied: age, gender, presence of diabetes, smoking status, presence of an open fracture, Association for Osteosynthesis-Orthopaedic Trauma Association (AO/OTA) fracture classification, number of plates and incisions, time to external fixator placement, time to definitive treatment, and incisions used. The two primary outcomes were nonunion and infection/wound complications requiring re-operation. Univariate tests were used for each variable in isolation. Multiple regression models were used to control important covariates. Interactions between the number of incisions, patient history of smoking, the number of plates utilized, and patient history of diabetes were analyzed. Results: Male gender, open fracture, history of diabetes and increasing time to fixation were associated with infection/wound complications. Open fractures were strongly associated with the development of nonunion. The interaction model for diabetes and increasing number of plates showed that each additional plate used when treating patients with a history of diabetes was associated with 6.08 times higher odds of developing an infection, a marginally significant result (P=0.065). Conclusions: Increased caution may be warranted when treating tibial pilon fractures in patients with certain risk factors. In patients with a history of diabetes, the additional dissection needed to place more implants may contribute to higher rates of infection. Level of Evidence: Prognostic Level III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"452 - 457"},"PeriodicalIF":0.3,"publicationDate":"2022-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48602094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-25DOI: 10.1097/BCO.0000000000001144
E. Todd, Melissa A. Wright, A. Murthi
Posterior glenohumeral fracture dislocations are rare with a prevalence of 0.6/100,000 and represent only 0.9% of all shoulder fracture dislocations. They are caused most often by high-energy trauma, seizure, or electrocution. Diagnosis is often missed or delayed due to the infrequency of this injury. Delayed diagnosis increases the patient’s risk of developing long-term sequelae such as chronic posterior instability and avascular necrosis of the humeral head. Patients typically present with shoulder pain and the inability to rotate externally. Radiographs may demonstrate the light bulb sign on an anteroposterior view, and an axillary view can confirm a posterior dislocation. A CT scan usually is obtained in these patients to further confirm the diagnosis and provide better fracture characterization. There is no consensus on the best way to treat a posterior glenohumeral fracture-dislocation. Depending on the injury pattern and patient characteristics, options include open reduction and internal fixation (ORIF); modified McLaughlin procedure; hemi-, total, or reverse shoulder arthroplasty; and allograft or autograft reconstruction. This case report describes successful treatment with ORIF and 13-year follow-up of a posterior glenohumeral fracture dislocation with an anatomic neck fracture. The patient was informed that data concerning the case would be submitted for publication, and he provided consent.
{"title":"Long-term follow-up of a posterior glenohumeral fracture-dislocation treated with open reduction and internal fixation: a case report","authors":"E. Todd, Melissa A. Wright, A. Murthi","doi":"10.1097/BCO.0000000000001144","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001144","url":null,"abstract":"Posterior glenohumeral fracture dislocations are rare with a prevalence of 0.6/100,000 and represent only 0.9% of all shoulder fracture dislocations. They are caused most often by high-energy trauma, seizure, or electrocution. Diagnosis is often missed or delayed due to the infrequency of this injury. Delayed diagnosis increases the patient’s risk of developing long-term sequelae such as chronic posterior instability and avascular necrosis of the humeral head. Patients typically present with shoulder pain and the inability to rotate externally. Radiographs may demonstrate the light bulb sign on an anteroposterior view, and an axillary view can confirm a posterior dislocation. A CT scan usually is obtained in these patients to further confirm the diagnosis and provide better fracture characterization. There is no consensus on the best way to treat a posterior glenohumeral fracture-dislocation. Depending on the injury pattern and patient characteristics, options include open reduction and internal fixation (ORIF); modified McLaughlin procedure; hemi-, total, or reverse shoulder arthroplasty; and allograft or autograft reconstruction. This case report describes successful treatment with ORIF and 13-year follow-up of a posterior glenohumeral fracture dislocation with an anatomic neck fracture. The patient was informed that data concerning the case would be submitted for publication, and he provided consent.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"491 - 493"},"PeriodicalIF":0.3,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42324352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-25DOI: 10.1097/BCO.0000000000001152
Parth A. Vaghani, R. Samade, A. Gordon, T. Scharschmidt, K. Goyal
Background: Heterogeneity of grading schema among medical schools complicates utility of core clerkship grades reported. The purpose of this study was to understand the variation in number and verbiage in grading schemes during third-year core clerkships for orthopaedic surgery residency applicants. Methods: Applications to a single institution’s orthopaedic surgery residency program during the 2017-2018 match cycle were reviewed. Data extracted from the Medical Student Performance Evaluation (MSPE) included medical school name, number of core clerkships, grade options/tiers, and % grade distribution in clerkships. Applicant data collected included Step 1 Score, Step 2 Clinical Knowledge (CK) Score, Alpha Omega Alpha (AOA) membership status, clerkship grades, and medical school rank. Results: A total of 858 applications from 211 medical schools were reviewed. Further analysis was performed on 142 schools, representing 721 students, that reported grading distributions. The number of grade tiers varied from two to 11, with three (26.1%), four (43.7%), and five (20.4%) tiered grading systems being the most common. One-hundred unique verbiages were identified to describe grading among all schools. Schools ranked in the top 25 distributed honors more often than schools ranked outside the top 25 (P<0.001). The median for the average percentage of honors distributed by a school was 32.3%, with a total range of 2.4% to 72.6%. A significant relationship between applicant match success and medical school grading practices could not be determined (P=0.054). Conclusions: Significant differences in assigned grades by medical schools for third-year core clerkships were found. Therefore, students’ core clerkship grades should be reviewed in the context of the grade distributions at their medical schools. Level of Evidence: Level IV.
{"title":"Variation in core clerkship grading reported on the Medical Student Performance Evaluation (MSPE) for orthopaedic surgery applicants: a retrospective review","authors":"Parth A. Vaghani, R. Samade, A. Gordon, T. Scharschmidt, K. Goyal","doi":"10.1097/BCO.0000000000001152","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001152","url":null,"abstract":"Background: Heterogeneity of grading schema among medical schools complicates utility of core clerkship grades reported. The purpose of this study was to understand the variation in number and verbiage in grading schemes during third-year core clerkships for orthopaedic surgery residency applicants. Methods: Applications to a single institution’s orthopaedic surgery residency program during the 2017-2018 match cycle were reviewed. Data extracted from the Medical Student Performance Evaluation (MSPE) included medical school name, number of core clerkships, grade options/tiers, and % grade distribution in clerkships. Applicant data collected included Step 1 Score, Step 2 Clinical Knowledge (CK) Score, Alpha Omega Alpha (AOA) membership status, clerkship grades, and medical school rank. Results: A total of 858 applications from 211 medical schools were reviewed. Further analysis was performed on 142 schools, representing 721 students, that reported grading distributions. The number of grade tiers varied from two to 11, with three (26.1%), four (43.7%), and five (20.4%) tiered grading systems being the most common. One-hundred unique verbiages were identified to describe grading among all schools. Schools ranked in the top 25 distributed honors more often than schools ranked outside the top 25 (P<0.001). The median for the average percentage of honors distributed by a school was 32.3%, with a total range of 2.4% to 72.6%. A significant relationship between applicant match success and medical school grading practices could not be determined (P=0.054). Conclusions: Significant differences in assigned grades by medical schools for third-year core clerkships were found. Therefore, students’ core clerkship grades should be reviewed in the context of the grade distributions at their medical schools. Level of Evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"434 - 441"},"PeriodicalIF":0.3,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49050159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-21DOI: 10.1097/BCO.0000000000001149
Ali Ghaznavi, M. Mohammadpour, Nima Taheri, Sahand Cheraghiloohesara, Masoud Aslani
Background: Few studies have assessed the efficacy of temporary hemiepiphysiodesis in the treatment of genu valgum in patients with cystinosis. In the present study, the authors aimed to assess the postsurgical outcome of temporary hemiepiphysiodesis for genu valgum in patients with cystinosis. Methods: In this case series study, the inclusion criterion was the occurrence of genu valgum due to definitive diagnosis of cystinosis that was treated with temporary hemiepiphysiodesis technique. The lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were measured before and 6 to 12 mo after the operation. Surgical complications also were assessed within the mean follow-up time of 40.21±19.86 mo. Results: Overall, 14 patients undergoing temporary hemiepiphysiodesis due to genu valgum after cystinosis were assessed. The mean age was 10.00±2.41 yr (male 35.7%, female 64.3%). Hemiepiphysiodesis led to significantly increased LDFA in both left side (from 79.64±3.89 to 88.28±1.26, P=0.001) and right side (from 79.42±2.59 to 89.57±1.69, P=0.001). The change in MPTA on the left side (from 88.21±1.36 to 86.07±1.32, P=0.001) and right side (from 88.35±2.49 to 86.42±1.74, P=0.016) also was significant. Conclusions: Temporary hemiepiphysiodesis is a reproducible, efficient, and safe approach for correction of genu valgum in patients with cystinosis with few complications in children. Level of Evidence: Level III.
{"title":"Temporary hemiepiphysiodesis for correction of genu valgum due to cystinosis: a preliminary interventional study in children","authors":"Ali Ghaznavi, M. Mohammadpour, Nima Taheri, Sahand Cheraghiloohesara, Masoud Aslani","doi":"10.1097/BCO.0000000000001149","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001149","url":null,"abstract":"Background: Few studies have assessed the efficacy of temporary hemiepiphysiodesis in the treatment of genu valgum in patients with cystinosis. In the present study, the authors aimed to assess the postsurgical outcome of temporary hemiepiphysiodesis for genu valgum in patients with cystinosis. Methods: In this case series study, the inclusion criterion was the occurrence of genu valgum due to definitive diagnosis of cystinosis that was treated with temporary hemiepiphysiodesis technique. The lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were measured before and 6 to 12 mo after the operation. Surgical complications also were assessed within the mean follow-up time of 40.21±19.86 mo. Results: Overall, 14 patients undergoing temporary hemiepiphysiodesis due to genu valgum after cystinosis were assessed. The mean age was 10.00±2.41 yr (male 35.7%, female 64.3%). Hemiepiphysiodesis led to significantly increased LDFA in both left side (from 79.64±3.89 to 88.28±1.26, P=0.001) and right side (from 79.42±2.59 to 89.57±1.69, P=0.001). The change in MPTA on the left side (from 88.21±1.36 to 86.07±1.32, P=0.001) and right side (from 88.35±2.49 to 86.42±1.74, P=0.016) also was significant. Conclusions: Temporary hemiepiphysiodesis is a reproducible, efficient, and safe approach for correction of genu valgum in patients with cystinosis with few complications in children. Level of Evidence: Level III.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"33 1","pages":"424 - 427"},"PeriodicalIF":0.3,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47808949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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