Indian Journal of Orthopaedics最新文献

Introduction: Non-union fractures represent a significant challenge in orthopedic practice, contributing to considerable morbidity and socioeconomic burden. Traditional treatments, such as autologous bone grafting, are effective but have limitations, including donor-site morbidity and limited tissue availability. Autologous peripheral blood-derived orthobiologics, including growth factor-rich concentrate (GFC), have emerged as a minimally invasive alternative, leveraging the body's natural healing mechanisms by concentrating and applying growth factors directly to the fracture site. This study evaluates the safety and efficacy of GFC injections in the treatment of non-union fractures.

Materials and methods: This quasi-experimental study included 17 patients with non-union fractures of various long bones, treated under fluoroscopic guidance with three doses of 5 mL GFC injections, administered 2 weeks apart at the non-union site. Demographic data, injury characteristics, and comorbid conditions were recorded. Growth factor levels were quantified via enzyme-linked immunosorbent assay (ELISA), and statistical analyses were conducted to explore associations between the amount of growth factors and treatment outcomes. Radiographic assessments and bony callus appearance were evaluated at the baseline and at 1-, 3-, and 6-month follow-up post-last injection.

Results: No adverse effects were reported throughout the duration of the study. The majority of patients (82.4%) showed significant improvement, evidenced by enhanced bony callus formation and reduced non-union signs. No significant correlation was found between the specific growth factor levels and the clinical outcomes of non-union of fractures. However, the presence of comorbid conditions significantly influenced treatment efficacy, underscoring the importance of patient selection in clinical practice.

Conclusion: Administration of GFC injection is safe and potentially efficacious for the treatment of non-union fractures, offering an alternative to traditional surgical interventions. These results laid the foundation for prospective, adequately powered, randomized and non-randomized clinical studies with longer follow-up to further establish the efficacy of GFC in patients with non-union fractures. Moreover, formulation protocols need to be optimized while considering patient-specific variables, to ensure reproducibility and repeatability of outcomes from these studies.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-024-01278-1.

Purpose: Transforaminal lumbar interbody fusion (TLIF) and oblique lumbar interbody fusion (OLIF) are the most commonly conducted operations for interbody fusions. In addition to fusion, the restoration of proper spinal alignment has become crucial for achieving favorable functional outcomes. There is a lack of agreement on which lumbar interbody fusion technique provides the most effective correction for sagittal spinopelvic parameters (SSPs). This study aims to investigate the functional outcome in terms of SSPs in patients undergoing single level OLIF and TLIF for lumbar degenerative disc disease.

Methodology: Retrospective analysis of single level OLIF or TLIF was done. The patients' index and follow-up data until 6 months of surgery were collected. Radiographic parameters analysis included disc height (DH), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), pelvic index, lumbar lordosis (LL), segmental lordosis (SL). Clinical outcomes were recorded using visual analogue scale (VAS) and Oswestry Disability Index (ODI).

Results: In a total of 38 patients (19 in each group) mean age was 51.52 ± 12.67 years in OLIF and 52.17 ± 9.73 years in TLIF. Improvement in DH was more in OLIF but not statistically significant (p = 0.075). Significant improvements were seen in PT, and SL post-TLIF. Change in SSPs among groups shown no significant differences. Both VAS and ODI shown improvements in both the groups but no significant difference was noted while comparing the two groups.

Conclusion: The study showed better restoration of SSPs by TLIF in terms of PT and SL although functional outcomes appear similar in both procedures. Increase in DH is the important determinant for resulting good outcome. Patients with maintained spinopelvic balance can be treated satisfactorily with less-invasive OLIF.

[This corrects the article DOI: 10.1007/s43465-024-01232-1.].

Understanding the etiology of nonunion is crucial to its effective management. Nonunion arises from a complex interplay of biological and mechanical factors. High-velocity injuries, which are becoming more prevalent, often involve extensive soft-tissue damage and stripping compromises the vascularity of bone fragments. The lack of adequate blood supply hampers the healing process and contributes to persistence of nonunion. Such injuries often result in high levels of contamination and persistent infections, making fractures particularly difficult to manage and leading to nonunion. Despite recent advances in medical techniques and interventions, managing the problem of nonunion still remains a formidable challenge. Much effort has gone into the understanding of the problem. With this review, we have made an attempt to correlate some of the known factors and looked at the future including the possible role of genetics in predicting the problem and modifying the outcome of nonunion.

Background

The quadrant method is widely used to determine the femoral footprint center (FFC) on radiographs or computed tomography (CT) and can also describe the tibial footprint center (TFC). However, its application on three-dimensional (3D) magnetic resonance imaging (MRI) has been limited. This study aims to describe the ACL footprint center position on 3D MRI of healthy knees using the quadrant method.

Methods

Proton density (PD) sequence 3D MRI was conducted on 45 intact knees, aged 18 to 45 years. The centers of the ACL footprints were determined, and 2D simulated radiographic images were generated from the 3D MRI data. The quadrant method was then applied to calculate the positions of the footprint centers.

Results

The FFC was located at 31.6% in the deep–shallow (DS) direction and 31.3% in the high–low (HL) direction. The TFC was positioned at 45.1% in the mediolateral (ML) direction and 39.9% in the anteroposterior (AP) direction.

Conclusions

The ACL footprint centers identified in this study were positioned similarly to previous studies, with the exception of the TFC in the ML direction, which was found to be more medial. This approach has the potential to enhance preoperative planning and intra-operative navigation in ACL reconstruction surgeries.

Background

Hip surgery is often necessary for children with severe neuromuscular disabilities to avoid chronic pain resulting from hip migration. This study correlated the Surgical Vulnerability Score (SVS), a novel measure of physiological reserve, with reconstructive hip surgery outcomes to improve shared surgical decision-making.

Materials and methods

Sixty-eight cases performed by a single surgeon were retrospectively evaluated. Cases were graded according to physiological vulnerability using the SVS, which was then correlated with two outcomes: length of hospital stay (LOS) and severity of postoperative complications. The Gross Motor Function Classification System (GMFCS) level was used as a baseline comparison. Sub-analysis compared results for patients who underwent only a femoral varus derotation osteotomy (VDRO) (n = 48) with those who underwent a combined VDRO and Dega Pelvic Osteotomy (Dega PO) (n = 20).

Results

Results showed that a higher SVS was associated with increased LOS (p = 0.001) and severity of postoperative complications (p = 0.0008). A greater GMFCS level was not associated with either LOS (p = 0.246) or the severity of postoperative complications (p = 0.282). For patients who underwent only a VDRO, an increase in SVS had no association with LOS (p = 0.483) or severity of complications (p = 0.981). However, for patients who underwent both a VDRO and Dega PO, a higher SVS was associated with increased LOS (p = 0.0002) and severity of complications (p = 0.0001).

Conclusions

The SVS can aid surgical decision-making and prepare the child’s family for surgery. Early intervention and fixation using only a VDRO may lead to better outcomes, underscoring the importance of hip surveillance programs in the early identification of migrating hips.

Introduction

Multiligament knee injuries (MLKI) are rare and complex, significantly impacting long-term outcomes, with risks of osteoarthritis, joint stiffness, and reduced activity levels.

Objective

To explore the evolution of MLKI treatment protocols, comparing historical and modern approaches, and to present a patient-tailored, preservation-first algorithm.

Methods

This article reviews the literature on MLKI management, focusing on surgical timing, techniques, and rehabilitation protocols. The proposed algorithm categorizes MLKIs based on tear location and tissue quality, incorporating options, such as primary ligament repair, augmentation, and reconstruction.

Results

The modern preservation-first algorithm provides a tailored approach to MLKI treatment, addressing the complexity and heterogeneity of these injuries, and aims to mitigate risks like postoperative arthrofibrosis.

Conclusion

MLKI management remains complex and controversial. The presented algorithm offers a structured, individualized treatment strategy that integrates modern surgical and rehabilitation advancements.

Lateral extra-articular tenodesis (LET) has shown an upswing in popularity since the role of antero-lateral rotatory instability (ALRI) in ACL tears has become better understood. Its primary aim is to restore antero-lateral rotatory stability and hence reduce stresses placed on the ACL graft in high-risk individuals which should reduce graft failure rates. Many techniques have been described for LET using a variety of fixation methods (screws, anchors, etc.). Most of these techniques rely on a large incision laterally. We describe a novel technique (‘mini-LET’) which uses a 3–4 cm incision, to improve cosmesis.