International Orthopaedics最新文献

Purpose: To investigate the effects of adding immediate weight-bearing to tolerance into a post-operative rehabilitation program for surgically treated Tibial Plateau (TP) fractures on clinical and radiological outcomes.

Methods: A randomized control trial. 106 Patients were recruited following open reduction internal fixation (ORIF) TP fracture, with 54 patients meeting the criteria for inclusion. Patients were assigned randomly into one of two groups: (1) the traditional group (TG) and (2) the weight-bearing group (WG). The TG was given the non-weight-bearing (NWB) rehabilitation protocol for six weeks. The WG was allowed immediate weight-bearing, and the same therapeutic exercise program was given to both groups. The dependent variables, including clinical and radiological measurements, were recorded six weeks, three months, and six months after the surgery.

Results: A total of 45 patients (11 women and 34 men), with a mean age of 43 ± 14 years, completed the study. There were significant differences between groups in favor of the WG at 6-months for the total clinical Rasmussen score (p =.002) as well as for the pain (p =.005), walking capacity (p =.002), and knee ROM (p =.047). We found neither difference between groups regarding radiological CT- Scan and X-ray measures nor Rasmussen's radiological scores (p =.854). Fracture type (Schatzker I-IV) did not affect any radiological measures between the groups. Four of 45 patients had intra-articular collapse, three in TG and one in WG (p =.571).

Conclusion: Immediate weight-bearing as tolerated after ORIF of TP fractures (Schatzker I-IV) resulted in better clinical outcomes with no significant differences in the radiological measures.

Purpose of review: The purpose of this narrative review is to highlight upper extremity nerve compression syndromes and peripheral neuropathies reported in throwing and overhead athletes.

Recent findings: The overhead-throwing athlete may experience unique patterns of injuries and pathology related to the biomechanics and demands of the throwing motion, a demanding manoeuvre that places a significant amount of stress across the upper limb. Nerve injuries that may appear in high-level throwers include suprascapular and long thoracic neuropathy, quadrilateral space syndrome, and thoracic outlet syndrome. Nerve compression syndromes around the shoulder may appear with pain, paresthesia, and upper limb weakness. Overlapping features may be common among these compression neuropathies or mimic other common shoulder pathologies. Prompt differential diagnosis and successful treatment should be based on knowledge of key anatomical features, pathophysiology, clinical examination, and appropriate paraclinical studies.

Purpose: The aim of this study was to assess functional and radiological outcomes of radial head arthroplasty (RHA) compared to open reduction and internal fixation (ORIF) in isolated Mason type-III fractures with a minimum of five years follow-up.

Methods: This was a retrospective single-center study of closed isolated Mason type-III radial head fractures operated between January 2008 and December 2017. Nineteen patients were included in group RHA and 35 patients in group ORIF. The mean age was 51 years old in group RHA and 41 years old in group ORIF (p = 0.02). Functional and radiological outcomes were evaluated.

Results: Mean follow up was eight years (range, 5-14). Clinical results and functional scores showed no significant differences, except a better pronation in group RHA (p = 0.04). Two secondary radial head resection or implant removal were performed in each group (p = 0.56) with poor functional outcomes in group ORIF. There was less heterotopic ossification in group RHA (15.8% vs. 42.8%; p = 0.03). Capitulum wear was found in 63% in group RHA against 25.7% in group ORIF (p < 0.05).

Conclusion: Functional results of RHA and ORIF were comparable for isolated Mason type-III fractures at a mean follow-up of eight years. We recommend to perform RHA for isolated Mason type-III fracture if articular reduction or stability of the fixation is not satisfying.

Level of evidence: III.

Purpose: To examine the effectiveness of a novel bone graft reduction technique with a bone tamp impactor instrument in minimally invasive treatment of tibial plateau collapse fractures through arthroscopic and imaging evaluation.

Methods: This is a retrospective analysis of prospectively collected data on patients with tibial plateau collapse fracture who received the novel bone graft reduction procedure with a bone tamp impactor instrument for minimally invasive treatment of tibial plateau collapse fractures in a tertiary referral university hospital from February 2021 to March 2023. Patients were classified according to a classification combined with Schatzker classification, AO classification and three-column classification. Arthroscopy evaluation and radiographs were used to measure the reduction effect.

Results: A total of 196 patients were eligible and included. Compared to the preoperative values, post-ADD(c) showed a significant reduction improvement (P = 0.000-0.007), ranging from 87.9 to 96.6% for different classifications. The post-ADD (s) have decreased by 87-96.8% (P = 0.000-0.039), the post-FFG and post-TPW reduced by 87.5-100% (P = 0.000-0.026) and 34.2-63.5% (P = 0.000-0.075) respectively. Additionally, the lower limb alignment have been significantly corrected, with notable changes in post-MPTA (P = 0.000-0.081), post-PTSA (P = 0.000-0.178) and post-FTA (P = 0.000-0.069) for different types of fracture, measured one day after surgery. Arthroscopic evaluation indicated that the average articular surface depression depth was less than 4 mm, and over 60% achieved a depression depth of less than 2 mm. All patient achieved a less than 2 mm of postoperative fracture fragment gap, with over 50% achieving a gap of less than 1 mm. None of patients experienced neurovascular injury or wound infection.

Conclusion: The novel bone graft reduction technique utilizing a bone tamp impactor instrument can achieve effective reduction in all types of tibial plateau collapse fractures. This method may prove to be a useful option for minimally invasive treatment of tibial plateau fractures.

Purpose: The goal of this study was to report the duration of pain relief and need for subsequent surgical intervention following intra-articular steroid injection of the elbow in the setting of arthritis.

Methods: The authors' institutional database was accessed to identify patients who underwent a corticosteroid injection of the elbow for arthritis. For included patients, demographic information, steroid dosage, duration of symptoms relief, complications, and progression to surgical management were recorded. A chi-squared or Fisher exact test was utilized for categorical variables while a two-way Analysis of Variance (ANOVA) or Wilcoxon ranked sum test was utilized for continuous variables as appropriate. Statistical significance was defined as p < 0.05.

Results: There were 67 patients included in the study who underwent between one and 14 injections. Patients experienced some degree of pain relief 80% of the time for an average of 12.5 (range 0-64) weeks after their first injections. There was only one documented complication following steroid injection. Twenty-one (7.9%) patients ultimately underwent surgical intervention for their elbow arthritis. Younger age was associated with progression to surgical intervention (p = 0.01).

Conclusion: Corticosteroid injections to the elbow are an effective method of pain control in patients with elbow arthritis.

Level of evidence: IV.

Purpose: Symphyseal diastasis accounts for 13-16% of pelvic ring injuries. Symphyseal plating via a Pfannenstiel approach was the standard method of fixation for symphysis diastasis. Recently, percutaneous reduction and fixation of pelvic fractures have been employed to treat various pelvic ring and acetabulum injuries. The current study aims to compare the clinical and radiological results of treatment of symphysis pubis diastasis using symphyseal plating and percutaneous symphyseal screws.

Methods: It is a retrospective study conducted at a trauma centre at academic level I. One hundred and ten patients were identified in our records. Sixty patients were excluded according to our exclusion criteria. Fifty patients were included in this study. Among which were 26 patients treated with anterior symphyseal plating (Group A) and 24 patients treated with percutaneous symphyseal screws (Group B). Posterior pelvic injury was fixated according to the existing pathology. In both groups, we recorded operation time, intraoperative blood loss, length of the incision, number of x-ray shots, changes in symphysis distance (preoperative, immediate postoperative, and in the last follow-up), and time for union. At the last follow-up, the clinical evaluation was conducted using the Visual Analogue Scale (VAS), and the functional evaluation was conducted using the Majeed scoring method for both groups.

Results: All patients have followed up for at least two years. According to the Majeed Score, group A's functional classification was excellent for fourteen patients, good for seven, fair for two, and poor for three cases. Group B's functional classification was excellent for seventeen patients, good for six, and poor for one. The operative time and intraoperative time were significantly different between both groups, while the symphysis diastasis at the last follow-up was insignificant. Five patients in group A showed metal failure in the form of plate breakage, screw loosening, and screw backing out. In Group B, one case showed implant failure and loss of reduction in the form of screw backing out and widening of the symphysis pubis. Two patients in group A had infections at the incision site, which were treated with antibiotics and daily dressings and resolved adequately. No recorded cases of infection in group B.

Conclusion: Both techniques showed favourable results. The group with symphyseal plating showed a higher failure rate than the group with percutaneous screw fixation. The symphyseal screw group had shorter operative time, smaller incision, and less intraoperative blood loss than the symphyseal plating group but more radiation exposure. The symphyseal screw technique is a technically demanding technique and requires a high learning curve. It involves more radiation exposure, especially in inexperienced surgeons.

Purpose: Post-operative LLD is a major concern after THA. The anterior approach on a standard table allows surgeons for a direct control of the leg length. Intra-operative radiography (IR) helps in assessment of hip biomechanics and anatomic parameters. The aim of this study is to evaluate the LLD after THA through anterior approach with or without a position table and with or without the use of intra-operative radiographs. The hypothesis is that leg length may be better control when IR and a standard table are used.

Methods: This is a single-centre retrospective comparative cohort study of three matched groups of 80 patients receiving anterior approach THA with three different techniques (Group A: positioning table with IR; Group B: standard table with IR; Group C: standard table without IR). Pre-operative and post-operative LLD was calculated. Age, sex, BMI, acetabular cup and femoral stem size, operative time, and blood loss were recorded.

Results: In Group A, 15 patients (19%) had a LLD greater than 5 mm, and two patients (2,5%) had a LLD greater than 10 mm. In Group B, 20 patients (25%) had a LLD greater than 5 mm, and two patients (2,5%) had a LLD greater than 10 mm. In Group C, 16 patients (20%) had a LLD greater than 5 mm, and three patients (3,7%) had a LLD greater than 10 mm. No statistically significant differences were found for LLD > 5 mm, for LLD > 10 mm, nor for the mean LLD between the three groups (p  > 0.05). Mean operative time was statistically longer in Group B (p  < 0.05).

Conclusion: Neither the use of a standard/positioning table neither the use of IR seemed to be superior in restoring leg length after anterior approach THA. Together with the contradictory results in literature, findings of the current study indicate that no technique is clearly superior to one other and surgeons' experience may play the most relevant role.

Purpose: Debridement, Antibiotic Treatment, and Implant Retention (DAIR) is considered the first-line treatment for early acute Prosthetic Joint Infection (PJI). This study aims to evaluate the five year success rates of early acute PJI managed with DAIR taking into consideration the time from the index surgery.

Materials and methods: A retrospective analysis of medical charts for 291 consecutive patients with acute PJI occurring within the first three months after primary or revision arthroplasty was conducted. Patients were stratified into two groups based on DAIR timing: Group (A) patients who underwent DAIR within the first four weeks post-arthroplasty; Group (B) patients who underwent DAIR between five and 12 weeks post- arthroplasty. Success rate was defined as implant in place, without signs of infection and not under suppressive antibiotic treatment.

Results: The overall five year success rate for the entire cohort at five years was 62.2%. The mortality rate during the study period was 8.2%. The five year success rate was 64.4% (141 of 219) for Group A and 55.6% (40 of 72) for Group B (p = 0.21). Including deceased patients without signs of infection and retained implants as successful cases, the five year success rates increased to 69.9% for Group A (153 out of 219) and 69.4% for Group B (50 out of 72). The implant survival rate at five years was 73% for Group A and 71% for Group B.

Conclusion: Our findings indicate that there are no significant differences between patients who undergo a DAIR procedure within four weeks from those performed between week five and 12. Importantly, the overall success rate decreased from 75.6 to 62.2% in the last three years of follow-up.

Purpose: Wide Awake Local Anesthesia No Tourniquet (WALANT) has gained significant attention since its introduction in 2005. Over 343 publications since 2013 highlight its increasing use in nerve decompression surgeries. WALANT is known for its safety benefits, cost-effectivenes and improved patient experience compared to traditional sedation and tourniquet-based methods. This review examines the advantages of WALANT in nerve decompression surgery, emphasizing its growing adoption and benefits.

Methods: A comprehensive review of the WALANT technique is provided, focusing on injection strategies, including buffered lidocaine with epinephrine, proper needle placement and generous volume of tumescent anesthesia. Specific injection protocols and surgical approaches are discussed for various nerve decompression procedures such as carpal tunnel, lacertus, cubital tunnel, radial tunnel and lateral intermuscular septum releases.

Results: WALANT eliminates sedation-related risks such as nausea, aspiration pneumonia and thromboembolism, making it suitable for high-risk patients (ASA 4). It reduces healthcare costs by decreasing the need for post-anesthesia care units and operating in minor procedure rooms. The technique fosters greater surgeon-patient interaction, reduces hospital stays and avoids preoperative fasting and testing. WALANT has demonstrated positive outcomes across multiple nerve decompression procedures.

Conclusion: WALANT provides a transformative approach in nerve decompression surgery, offering enhanced safety, cost-effectiveness and improved patient-centered care. It significantly contributes to positive surgical outcomes, making it a valuable technique for both patients and healthcare providers.

Purpose: The aim of the present study was to describe our experience with French Elbow Connection (FEC) (i.e. elbow reduction and triple ligamentoplasty) for patients with chronic elbow dislocation (CED).

Materials and methods: We performed a retrospective review of 12 patients in two departments of orthopaedic surgery undergoing the FEC procedure for CED between 2019 and 2024. The median follow-up was 1.80 years (IQR 1.00; 1.97). Range of motion, mean Mayo Elbow Performance score (MEPS), visual analog scale (VAS), elbow stability, and radiographic outcome were recorded.

Results: Median MEPS and VAS were 90.00 points (IQR 75.60; 100.00) and 0 (IQR 0; 1.50), respectively. Eight (66%) patients reported no pain. The median active flexion-extension and prono-supination arcs were 145°(IQR 102.60; 150.00), and 170°(IQR 155.03; 170.00) respectively. Persistent valgus or varus instability was identified in 2 (17%), and 1 (8%) patient respectively. Size patients (50%) were diagnosed with osteoarthritis (OA) and 1 patient experienced worsening postop OA (from grade 1(preop) to 3(postop)).

Conclusion: CED is a complex condition that presents elbow surgeons with unique challenges. The FEC procedure allows for immediate active ROM and yielded satisfactory short-term outcomes in our hands. Larger, longer-term studies will be necessary to assess reproducibility and confirm results can be maintained over time.

Level of evidence: level IV; therapeutic study (case series [no, or historical, control group]).