Indian Journal of Orthopaedics最新文献

Purpose

Non-union is a significant complication following open diaphyseal tibia fractures. Management can be complex and unpredictable. Several principles must be addressed often in combination to achieve union. The aim of this study is to report on the characteristics, management and eventual outcome of non-united open tibial fractures over a 12-year period from a level I trauma centre.

Methods

This is a retrospective observational study of all adults (age 18 years and older) presenting to a level 1 trauma centre with a diaphyseal tibia fracture. Non-union was diagnosed using the standard FDA definition of incomplete union by 9 months or no progress to union in the preceding 3 months. Injury and patient demographics in addition to all interventions and complications were recorded for each patient.

Results

Forty three cases of diaphyseal non-union were identified from 2008 to 2019. Only the presence of peripheral vascular disease demonstrated a statistically significant association with the development of non-union. In 44% of cases, more than one additional operation was required to achieve union. Successful union was achieved in 90% of cases with 74% of patients returning to full pre-injury function without complication.

Conclusion

Management of non-union is a complex problem which requires a multifaceted and bespoke approach. We have included an algorithm to help guide decision making based on our institutional experience. A satisfactory result is achievable in the majority of patients.

Background

There is a broad consensus among orthopedic surgeons in the treatment of Gartland type I supracondylar humerus fractures (conservative) and Gartland type III (surgical) fractures, but there is controversy regarding the treatment of choice for Gartland type II fractures. The aim was to analyze the existing current evidence on the choice of surgical or conservative treatment of Gartland type II supracondylar humerus fractures.

Methods

A systematic review was carried out following the PRISMA guidelines. The search was conducted on May 24, 2023, in PubMed and Cochrane Central, introducing the terms (“humerus” AND “supracondylar”) AND (“Gartland II” OR “Gartland 2”). The selected studies were evaluated with the JBI checklist for quasi-experimental studies.

Results

5 retrospective comparative studies were included (evidence level III). Radiological and functional results were good with both treatments. Only one study obtained a better result with surgical treatment (with n = 4 in the conservative group); the other four studies did not find significant differences between the two types of treatment. There are risks of bias in all studies.

Conclusions

Both types of treatment (conservative and surgical) are valid for type II Gartland supracondylar humerus fractures, and provide good results, both functional and radiological. There is not enough scientific evidence to be able to affirm that one of the two treatments (surgical or conservative) is superior to the other for the treatment of these fractures. Findings on the initial radiograph, such as rotational deformity, coronal malalignment, or a severely angulated distal humeral fragment, can assist in the decision-making process.

Purpose

This study investigates the radiological outcomes of robotic-assisted total hip arthroplasty (RATHA) compared to manual total hip arthroplasty (mTHA), addressing the ongoing debate on the effectiveness of RATHA in achieving superior implant positioning accuracy.

Methods

A prospective cohort of 212 patients (103 robotic, 109 manual) underwent THA and were evaluated for postoperative radiological outcomes, focusing on the inclination and anteversion angles of the acetabular cup. Outlier prevalence was assessed based on angles outside the defined Lewinnek safe zones. All post-operative measurements were made using the BoneNinja application.

Results

High inter-observer and intra-observer reliabilities were observed, validating the measurement accuracy. The mean anteversion and inclination angles in the RATHA cohort were 40.5 ± 1.5 and 24.5 ± 3.1° respectively; and the mTHA cohort were 42.1 ± 4.9 and 24.9 ± 4.5°. There was a statistically significant difference in inclination angles between the two cohorts whereas the anteversion angles showed no difference. Majority of the conventional THRs (N = 72, 55.4%) were placed outside the safe zone for anteversion. The inclination angles revealed a highly significant difference between the cohorts (p < 0.0001), with all the robotic THRs (N = 121, 100%) being placed within the safe zone for inclination, whereas only 70% (N = 91) of the conventional THRs were within the safe zone. 97.5% of RA-THRs were within 3° of the proposed plan, demonstrating high accuracy.

Conclusion

RATHA significantly outperforms MTHA in radiological accuracy, achieving precise acetabular cup positioning with minimal outliers. These results advocate for RATHA's adoption in THA to enhance outcome predictability and affirm its reliability and safety over manual methods.

Introduction

Rehabilitation after Total Knee Arthroplasty (TKA) often includes proprioceptive exercises to prevent falls, but studies on proprioceptive training have yielded conflicting findings. This study aims to explore impact of proprioceptive training on functional performance after TKA.

Methods

Eighty patients who underwent unilateral TKA were randomly assigned to a proprioceptive exercise (PE) group or a routine exercises (RE) group. The PE group received proprioceptive exercises in addition to routine physiotherapy. Osteoarthritis Research Society Internal (OARSI) recommended tests and Oxford Knee Score (OKS) were used to assess performance and outcome at 3 and 6 months.

Results

In the 30-s chair sits test, the PE group outperformed the RE group at 3 months (13.69 vs. 9.17) and 6 months (21.07 vs. 18.63) (p < 0.001 and p = 0.030). Stair climbing favoured PE group at 3 months (8.86 vs. 16.66, p = 0.037) and 6 months (0.556 vs. 1.133, p = 0.001). At 6 months in the 40-m fast-paced walk test, the PE group had a significantly shorter time (0.308 min vs. 0.557 min, p < 0.001). Timed up and go test at 6 months favoured PE group (0.204 min vs. 0.377 min). In the 6-min walk test, the PE group covered significantly greater distances than the RE group at 3 months (589.59 vs. 346.53 m, p < 0.001) and 6 months (649.60 vs. 448.32 m, p < 0.001). OKS at 3 months was 38 ± 2.0 for PE group and 38 ± 4 for RE group (p = 1). OKS at 6 months was 42 ± 4 for PE group and 40 ± 2 for RE group (p = 0.94).

Conclusion

This study highlights the importance of proprioception-based rehabilitation in improving functional performance for TKA patients, surpassing traditional rehabilitation programmes.

Background

Humeral lateral condyle fracture is the most common elbow fracture in children after supracondylar fractures. Non-union of these fractures may cause ulnar nerve deficit, deformity and loss of joint motion, which are difficult to manage. Treatment of lateral condyle non-union can be done in two stages or one stage. However, despite all types of treatment, the chance of success is very variable. Many complications such as avascular necrosis, loss of motion, non-union, chronic pain, and heterotopic ossification have been reported as a result of surgeries performed for lateral condyle pseudoarthrosis.

Objective

In this article, we applied two-stage surgical treatment to a pediatric patient who developed ulnar neuropathy and elbow valgus deformity as a result of lateral condyle non-union.

Case report

A 8-year-old boy with lateral condyle nonunion presented to our clinic with pain and deformity. After initial examination, two-stage surgical treatment was planned to achieve union and deformity correction. In the first stage, we performed pseudoarthrosis surgery and ulnar nerve anterior transposition, and in the second stage, we performed elbow valgus deformity correction surgery. In three year follow-up, the range of elbow was 130/5/0 flexion/extension, with full supnation and pronation. Carrying angle was same with the opposite side.

Conclusion

Pediatric humeral lateral condyle nonunions cause deformity, pain, loss of motion, instability and neuropathy. Surgical treatment of nonunions with a careful planning provide excellent clinical and functional results.

Background and Aims

Multi-ligament knee injuries (MLKI) are serious and challenging to manage. This study aimed to elucidate the impact of surgical timing on both early and long-term outcomes following an MLKI.

Methods

A comprehensive search strategy was employed across PubMed, Scopus, Web of Science, and the Cochrane Library. Studies were identified using a combination of relevant keywords encompassing “multi-ligament knee injury,” “knee dislocation,” “reconstruction,” “repair,” “surgery,” and “timing,” and their synonyms, along with appropriate Boolean operators. Selection of articles (systematic reviews and meta-analyses) adhered to predefined inclusion and exclusion criteria. Furthermore, a meta-analysis was conducted utilizing data extracted from primary studies.

Results

Early surgery for MLKI demonstrated a significant advantage over delayed surgery, reflected by significantly higher Lysholm scores (Mean Difference [MD] 3.51; 95% Confidence Interval [CI] 1.79, 5.22), IKDC objective scores (Mantel–Haenszel Odds Ratio [MH-OR] 2.95; 95% CI 1.30, 6.69), Tegner activity scores (MD 0.38; 95% CI 0.08, 0.69), and Mayer’s ratings (MH-OR 5.47; 95% CI 1.27, 23.56). In addition, we found a significantly reduced risk of secondary chondral lesions (MH-OR 0.33; 95% CI 0.23, 0.48), lower instrumented anterior tibial translation in the early surgery group (MD −0.92; 95% CI −1.83, −0.01), but no significant difference was observed in the secondary meniscal tears, between the two groups. However, the early surgery group also exhibited a significantly increased risk of knee stiffness (MH-OR 2.47; 95% CI 1.22, 5.01) and a greater likelihood of requiring manipulation under anaesthesia (MH-OR 3.91; 95% CI 1.10, 13.87).

Conclusion

Early surgery for MLKI improves function, and stability, and reduces further articular cartilage damage, but increases the risk of stiffness.

Level of Evidence

IV.

Objective

The study aimed to assess Sirt6 levels in serum of knee osteoarthritis (OA) patients compared to healthy individuals to evaluate its correlation with OA and to understand how Sirt6 is linked with the change in IL-6 levels.

Methods

The cross-sectional study involved 50 knee OA patients clinically diagnosed as per the American College of Rheumatology guidelines and 50 healthy controls. Radiological examination as per Kellgren–Lawrence (KL) criteria was done to determine the disease severity. Peripheral blood samples were collected from each participant, and serum Sirt6 and IL-6 levels were measured using ELISA.

Results

The serum Sirt6 levels in knee OA patients were significantly lower as compared to healthy controls (p = 0.023). Patients with knee OA of KL grade 4 had significantly lower Sirt6 levels as compared to those with KL grade 2 OA (p = 0.031). Individuals of younger age group had higher Sirt6 levels compared to older age group. IL-6 levels in knee OA patients were significantly higher as compared to controls (p = 0.007). A negative correlation was observed between serum Sirt6 and IL-6 levels (r = − 0.407; p = 0.035).

Conclusion

The study concludes that serum Sirt6 levels are inversely associated with knee OA and may serve as a potential biomarker for the disease. Moreover, a negative correlation between Sirt6 and IL-6 levels was observed in this study. Further investigations are necessary to confirm these findings and to explore the mechanisms by which Sirt6 and IL-6 are involved in OA.