Indian Journal of Orthopaedics最新文献

Introduction: There is scarce data in literature on the demographics, treatment, and outcomes of subtrochanteric femur fracture patients. This study evaluated the effect of age on injury details, perioperative and hospital parameters, and outcomes following subtrochanteric fracture fixation.

Methods: An IRB-approved review of a consecutive series of subtrochanteric femoral fractures was performed. Patient charts and radiographs were examined to confirm patients were operatively treated for an AO/OTA Type 32A, B or C subtrochanteric femur fracture, as well as for demographics, injury information, perioperative details, radiographic parameters, hospital quality measures, and outcomes. Patients were divided into younger (Y) (< 65 years old) and older (O) (≥ 65 years old) cohorts. Comparative analyses were conducted between cohorts.

Results: Of 205 patients, 161 (78.5%) comprised the O cohort and 44 (21.5%) the Y cohort. The O cohort represented a sicker (higher CCI and ASA), less ambulatory population. Patients in the Y cohort sustained more high-energy injuries (p < 0.001). The most common fracture pattern was type 32A in both cohorts (p = 0.003). Older patients were treated more frequently with a 1-screw nail design (p = 0.005). The Y cohort had a shorter time to surgery (p = 0.002) and were more likely to be discharged home (p < 0.001). There were no differences in post-op complications, readmission or mortality rates, nonunion, fixation failure, or radiographic time to healing between cohorts.

Conclusion: Younger patients present with different subtrochanteric fracture patterns and discharge profiles than older patients and are treated with different implants. However, despite these differences, younger and older patients have similar radiographic and clinical outcomes.

Level of evidence: III.

Background: Obesity has been consistently proven to be associated with an increased risk of dislocation following total hip arthroplasty (THA). As the prevalence of obesity continues to rise globally, it is of vital importance to minimise risks, including dislocation rates, in these patients undergoing THA.

Methods: We describe a series of patients with obesity, morbid obesity (BMI ≥ 40) and super-obesity (BMI ≥ 50) undergoing THA at our institution over a 10-year period using a dual-mobility acetabular cup. The dislocation rate and all-cause revision rate were used as primary outcome measures. Patient-reported outcomes (PROMS) were assessed using the Oxford hip score (OHS) and VAS score. We assessed for differences in PROMS after grouping patients into BMI ranges of 30-34.9, 35-39.9, 40-49.9 and > 50.

Results: A total of 180 dual-mobility THAs in 162 patients were included of which 36 hips had BMI ≥ 40 and 8 hips had BMI ≥ 50. The mean age was 64.2 (29-88) years and the mean follow-up period was 52.1 months (13-122 months). The all-cause revision rate was 2.2% and no patient had a post-operative dislocation. The survivorship of the acetabular component was 100% with the maximum follow-up being 10.1 years. The mean OHS was 43.82 ± 3.29 (30-48) and the mean VAS for pain from the hip was 0.94 ± 1.34 (0-8). No significant difference in PROMS was found between the four BMI ranges.

Conclusion: Our results indicate excellent mid-term survivorship, and improvement over traditional dislocation rates in high BMI patients with a dual-mobility THA.

Background: The scaphoid is the most commonly fractured carpal bone, often going into non-union and secondary complications. Despite this, no explicit guidelines exist for the management of its non-union till date. This study quantitatively analyses the existent research on scaphoid nonunions from 2013 to 2024 using bibliometric methodology.

Materials and methods: The Web of Science database was used to search for and extract publications using the keywords 'scaphoid' AND 'nonunion'. Articles were then filtered based on their eligibility, and the metadata of the remaining articles was analysed using bibliometric methodology (R software and VOSviewer application). Performance analysis and science mapping were performed to obtain the metrics for past, present, and future trends in research on scaphoid nonunions.

Results: A total of 272 articles were included in the study for bibliometric analysis after screening the initial 501 articles. There has been a rise in the number of articles published yearly, but the overall growth rate still remains negative. Developed nations with economic stronghold dominate in research, with the United States of America (USA) having the most published and cited articles. International collaborations in research were also lead by the USA with majority of its ties with Canada. The Journal of Hand Surgery-American Volume clearly remains the most productive and cited journal on this subject. Keywords analysis shows a shift from arthrodesis and excision towards bone grafting, arthroscopy, and internal fixation, indicating a future research trend towards minimally invasive procedures and evaluating the need for grafting.

Conclusions: There is a continually increasing research interest in scaphoid non-unions with a trend towards minimally invasive definitive treatment methods. The research, however, lacks major contributions from the developing world which need to be strengthened. The need for vascularized and non-vascularized grafts is still under evaluation, with an emerging opinion in favour of even graft-less fixation.

[This corrects the article DOI: 10.1007/s43465-024-01256-7.].

Background: Bone regeneration following a fracture is dependent on multiple factors including skeletal stem cells (SSCs). Recruitment, proliferation, and differentiation of the SSCs is guided by the proteins and metabolites found within the fracture microenvironment. Understanding how intrinsic factors affect the fracture microenvironment has been a topic of ongoing investigation. This study sought to determine whether the levels of select proteins and metabolites within the fracture hematoma would be differentially expressed depending on the age of the patient. We hypothesized that a distinct set of proteins and metabolites found within the fracture hematoma microenvironment would be present at varying levels depending on patient age.

Methods: The research study was reviewed and approved by an Institutional Review Board. Hematomas were collected from subjects aged 18 years old or older undergoing surgical intervention for a fracture. Hematoma samples were selected from the biorepository and assigned to one of two fracture groups including young ankle/hindfoot and aged ankle/hindfoot. Protein and metabolite levels within each hematoma were analyzed by liquid chromatography-mass spectrometry.

Results: A total of seven hematomas were included in each the young ankle/hindfoot and aged ankle/hindfoot groups. From the global metabolomic analysis, creatine, 2-methylindoline, and acetyl-L-carnitine were identified as being differentially expressed between both groups. An untargeted metabolomic analysis of the two groups identified significant differences in the levels of an additional 66 metabolites. Proteomic analysis identified 34 proteins that were expressed at significantly different levels.

Conclusions: The level of metabolites and proteins found within the local fracture environment vary by patient age. Future investigations will focus on identifying a role for these proteins and metabolites in bone homeostasis and fracture healing.

Level of evidence: N/A, basic science investigation.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-024-01284-3.

Purpose: There is paucity of guidelines with inadequate data available about the extent and prevention of bone and joint disease in beta-thalassemic patients in Indian population. This study aims to determine bone and joint involvement in beta-thalassemic patients. It evaluates serum biochemical parameters of bone formation and resorption and correlates with the symptomatology in these patients. The study also determines their daily physical activity and find a correlation if any with bone mineral density.

Methods: The study was carried out on 40 regularly transfused beta thalassemic patients between 5 and 18 years of age under regular follow-up at our centre from June 2012 to June 2014. All patients were interviewed as per a well-structured proforma for symptoms relating to bone and joint disease as described by the patient/parents in past 1 year and physical activity by QAPACE questionnaire. Venous blood samples were drawn under aseptic conditions and used for estimation of biochemical parameters (calcium, phosphorus, alkaline phosphatase, vitamin D, parathyroid hormone and serum ferritin). Enrolled subjects were scanned for bone mineral density (BMD) at femur neck, trochanter and Ward's angle using dual-energy X-ray absorptiometry.

Results: A total of 40 patients were enrolled in the study (Male:Female = 80:20). Half the patients (n = 20) had symptoms pertaining to bone and joint disease. The most common symptom was leg pain (42.50%), followed by backache (22.50%). Asymptomatic patients had greater mean serum vitamin D as compared to the symptomatic patients (22.2 vs 15.08 ng/ml) (p = 0.225). Five patients were detected to have osteopenia, all above 10 years of age. The mean BMD in symptomatic patients at femur neck, trochanter and ward's angle was 0.781, 0.639 and 0.735 g/cm², respectively, as compared to 0.754, 0.635 and 0.722 g/cm² in asymptomatic patients. The difference was not statistically significant. Patients with low BMD had lower mean pre-transfusion Hb (< 9 g/dl) (p = 0.01). Eighty percent of osteopenic patients had sedentary lifestyle as compared to 44% of patients with normal BMD. Bone mineral density did not have any correlation with vitamin D levels, serum ferritin and type of chelation therapy.

Conclusion: Pre-transfusion hemoglobin of more than 9 gm/dL has a protective role in maintaining good bone health and bone mineral density. Engaging thalassemia patients in physical activity has a positive effect on bone mineral density. Low vitamin D levels contribute to symptoms of bone and joint involvement in thalassemia and the same needs to be determined and supplemented.

Objective: To present the clinical result of spinal fixation system made entirely of Carbon-Fiber-Reinforced (CFR)-Hybrid Polyaryl-Ether-Ether-Ketone (PEEK).

Summary of background data: Fusion surgery has been used to treat chronic low back pain caused by degenerative disk disease (DDD). The traditional pedicle screw system made of titanium, though biocompatible, can lead to complications, such as stress shielding and implant failure.

Methods: Fifty-two patients with one-level degenerative disc disease, with or without spinal stenosis, were treated with a stand-alone novel pedicular screw system (PSS) made entirely of CFR-PEEK composite biomaterial. Forty-six were followed for 24 months. Changes in pain and disability were evaluated using a 0-10-point visual analog scale (VAS) and a 0-90 (after omitting the question related to sex life) Oswestry Disability Index (ODI), respectively. Imaging evaluations of fusion were performed with standard and dynamic radiographs.

Results: Mean age was 58.4 ± 12.7 years. The mean operating time was 114.9 ± 22.7 min; X-ray exposure was 38.5 ± 18.1 s. No operative problems or complications were encountered. Three patients were lost to follow-up and three patients were re-operated. Forty-six patients completed follow-up of 24 months; the mean VAS was 6.49 points for lower back pain and 6.54 for leg pain, and the mean ODI by 41.6. No screw breakage or loosening was reported. Radiological consolidation was observed in all patients within 12 months. No clinical symptoms or radiological signs of adjacent degenerative disc disease were observed up to 24 months.

Conclusions: The all CFR-PEEK PSS is user friendly, safe, and compatible with modern imaging techniques. Its mechanical strength lessens the risk of implant failure, while its bone matching elastic modules seem to contribute in the short term to fusion, and in the long term to potential prevention of adjacent disk disease.

Background: Distal femur infected non-union management is very challenging especially when there is late presentation and after multiple intervention. Various methods have been described and studied in the literature for infected non-union of femur which includes bone transport by fixators (ring fixators/monolateral frames) and by Masquelet method.

Objectives: To study the clinical and radiological outcomes and study the effect on quality of life by patient-reported outcomes (EQ5D5L) and VAS (Visual Analog Scale) score in patients of infected non-union of distal femur managed with combination of Masquelet method and Ilizarov ring fixator.

Patients and methods: Eleven patients aged between 18 and 60 years, both sexes, presenting with infected non-union of distal femur were considered for the study. Average findings were: time of presentation-56 weeks post-injury, number of previous surgeries-2.1, bone loss after debridement-8.5 cm, pre-operative VAS score-8.4, pre-operative EQ5D5L score-21.4, ISS-55.6, NUSS-56.54. Surgery was performed in two stages. Stage one involved debridement, application of a knee-spanning ring fixator, a vancomycin-loaded poly methyl methacrylate cement spacer, and closure, with corticotomy performed in some patients during this or the second stage.

Results: The three patients (27.3%) had graft infection and underwent gradual docking after debridement. The results calculated for eight patients (without graft infection 72.7%) are as follows: Average ROM of knee 0 to 29.3degrees, external fixator duration was 48.1 weeks, union time was 27.5 weeks, VAS score was 1.9, immediate post-operative and 6 months frame removal EQ5D5L scores were 13.8 and 10.6, respectively. ASAMI bone score was excellent in five (62.5%), good in two (25%), and fair in one (12.5%). ASAMI functional score was excellent in one (12.5%), good in six (75%), and fair in one (12.5%).

Conclusion: Masquelet method with stabilization using Ilizarov ring fixator with or without lengthening can give promising results in patients with less infection severity score. Patients with high score should be managed by only fixators (ring/monolateral).

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-024-01279-0.