International Orthopaedics最新文献

Purpose: Early onset scoliosis (EOS) surgery with growth rods has complications. While casting is an alternative, special frames and training are often unavailable. Our study evaluates a simple, reproducible casting technique for EOS using universally available equipment without a special casting table.

Methods: 27 children with EOS underwent serial casting with a simple technique using two standing stools, a Cervical Sayre traction kit, and a metal plate. Casts were changed every three to four months. Pre, post, and follow-up Cobb angles and complications were recorded. Patients were grouped into congenital (CS) and non-congenital (NCS) EOS and compared.

Results: 27 children (mean age 4.15 years) with EOS underwent 116 casting procedures (mean 4.29 casts/patient). Significant curve correction (63.85° to 33.8°) was noted (p < 0.05). NCS had better correction than CS post-first cast (p < 0.05). Complications included three dermatitis and one mild respiratory distress.

Conclusion: The technique yielded results similar to those of traditional casting tables/frames and is ideal for resource-limited settings.

Purpose: To evaluate the efficacy of tibiotalocalcaneal arthrodesis using retrograde nailing (TTCAN) in post-traumatic conditions with high septic risk. We hypothesized that this minimally invasive technique would achieve bone union and satisfactory functional recovery without increasing septic risk.

Methods: A prospective single-centre observational study included 20 patients who underwent TTCAN between January 2020 and December 2023. The primary outcome was the complete joint fusion rate at six months. Secondary outcomes included pain assessment, complications, functional evaluation using the modified AOFAS score, and quality of life assessment using the SF-12 questionnaire.

Results: Complete tibiotalocalcaneal fusion was achieved in 55% of patients at six months. Diabetes was significantly associated with fusion failure (p = 0.026). For nonunion cases (n = 14), the consolidation rate reached 78.6% at six months and 92.9% at final follow-up. The mean modified AOFAS score was 48.4 ± 17.5 at six months, improving to 51.2 ± 19.3 at final follow-up (mean 15.6 months). Quality of life assessment showed greater impact on physical (PCS-12: 32.0 ± 6.9) than mental (MCS-12: 47.0 ± 12.7) components. Complications included delayed healing (25%) and one superficial infection.

Conclusion: TTCAN proves to be a reliable salvage solution for complex ankle and hindfoot trauma in high-risk septic contexts, enabling limb preservation with acceptable functional outcomes and minimal complications.

Purpose: Rotator cuff (RC) tears are common in older adults, often leading to muscle atrophy. Standard arthroscopic repair has high re-tear rates, prompting the use of biological patches for augmentation. This study assessed differences in range of motion, strength, and tendon healing using ultrasound in primary and revision RC repairs using acellular dermal allograft augmentation.

Methods: Forty-eight patients undergoing arthroscopic RC repair with dermal allograft augmentation were assessed, with 42 completing a median follow-up of 32.4 months. Twenty patients had primary repairs and 22 had revision procedures. A control group of 26 patients, matched for age, sex, BMI, and RC injury type, underwent RC repair without patch augmentation. Active range of motion, Constant-Murley socre (CS), Simple Shoulder Test (SST), Subjective Shoulder value (SSV) and isometric strength were measured. Tendon healing was assessed via dynamic US.

Results: Both primary and revision groups showed significant improvements in clinical scores and shoulder mobility. However, the primary group had significantly higher postoperative CS, SST and SSV scores. Strength tests indicated lower values in the revision group compared to primary and control groups. Ultrasound outcomes showed reduced tendon thickness in 23 patients, with similar repair integrity across groups. Five cases of RC re-tears were noted, with higher but not significantly different re-tear rates in the revision group.

Conclusion: Dermal allograft augmentation in RC repair leads to significant clinical improvement in both primary and revision cases, but strength recovery is less pronounced in revision repairs. Long-term follow-up is necessary to validate these findings and assess the durability of tendon healing.

Level of evidence: Level III, Retrospective cohort design, Treatment study.

Nerve injury primarily leads to neuropathic pain but may also have overlapping elements of nociplastic pain or ongoing nociceptive pain. Electrical stimulation is particularly effective in the treatment of neuropathic pain and may be effective for nociplastic and nociceptive pain. While multiple mechanisms contribute to the analgesic effect of electrical stimulation, the most widely accepted theory for the predominant effect is that of Melzack and Wall's gate control theory. According to this theory, non-painful sensory input carried by low-threshold large-diameter Aβ fibres disrupt the transmission of pain signals in small pain fibers (Aδ and C fibres). This occurs through the activation of inhibitory interneurons in the dorsal horn, which ultimately blocks pain signal transmission.This theory has been employed for different forms of stimulation, including transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS), and peripheral nerve stimulation (PNS). Each of these methods offers a different approach to localized stimulation and neuromodulation for the treatment of pain. TENS is a non-invasive technique, that delivers electrical currents via surface electrodes placed on the skin. PENS, in contrast, is a minimally invasive method that applies electrical currents through small needles inserted near a target muscle or neural structure. PNS involves the implantation of temporary or permanent electrodes to deliver electrical stimulation directly to peripheral nerves. These modalities are widely used to manage various pain conditions including non-malignant, chronic musculoskeletal and neuropathic pain, such as chronic low back pain, neck pain, neuropathic pain, myofascial pain, and post-operative pain. TENS is particularly notable as a non-invasive device that is affordable, over-the-counter, self-administered, and nonpharmacological option that does not pose the risk of toxicity or overdose. PENS stands out for its ability to integrate electrical stimulation therapy with electroacupuncture through a minimally invasive technique. PNS, on the other hand, is unique in its capacity to precisely target specific nerves and provide a range of stimulation options for extended treatment durations.This article provides a narrative overview of TENS, PENS and PNS with a particular focus on their application for neuropathic pain management and for athletes. We will review mechanisms of action, indications, diagnostic and treatment algorithms, as well as complications and limitations. The overview concludes with a complex case study demonstrating the use of various electrical stimulation therapies, ultimately to successful pain resolution for the patient.

Purpose: Tendon lengthening is a common lower limb surgical procedure in paediatric orthopaedics and deformity correction. Healing of a lengthened tendon is typically supported by casting and unloading of the operated limb. Although tendon rupture or overcorrection may adversely affect surgical outcomes, few studies have examined surgical means of improving post-operative stability of the tendon. We aim to evaluate a novel method for augmenting Z-Plasty tendon lengthening as a first step to clinical translation.

Methods: In this experimental ex vivo study, we employed a bovine flexor tendon model (n = 18) to examine a novel mechanical augmentation method after tendon lengthening by Z-plasty. Conventional surgical suturing of the imposed Z-plasty (n = 6) and an experimental group (n = 6), in which additional augmentation was performed by interlocking fibres of a biomaterial scaffold to the underlying tendon using a novel micro-needling technique, were compared to native tendons (n = 6).

Results: The needle interlocked scaffold successfully augmented the suture repair, showing more than doubled ultimate failure force compared to controls (482 ± 107 N vs. 206 ± 37 N, p < 0.01), and more than 1.5-fold repair stiffness (41 ± 7 N/mm vs. 26 ± 9 N/mm, p < 0.01).

Conclusion: We conclude that the use of an interpenetrating biomaterial scaffold represents a promising new approach for improving biomechanical tendon properties, which may have an implication on the stability of tendon suture, lengthening and tendon transfer procedures as well as on post-operative management and earlier mobilization.

Purpose: This study seeks to explore whether intra-wound vancomycin powder (IVP) is a cost-effective adjunct to standard of care (SOC) in patients undergoing total joint arthroplasty (TJA) from a US payor perspective.

Methods: A decision-analytic model in the form of a decision tree was developed to compare the cost and outcomes of IVP with those of SOC in preventing periprosthetic joint infections (PJI) in TJA patients. The base case analysis assumes a hypothetical practice with an equal volume (50/50) of THA and TKA procedures in both the IVP + SOC and the SOC arm. Cost and clinical effectiveness data were obtained from published literature. Sensitivity and threshold analyses were used to estimate how changing inputs would impact the cost-effectiveness of IVP.

Results: Deterministic results found that in the base case model, IVP as an adjunct to SOC generates a cost saving of $260.38/patient. In scenario analysis, where THA and TKA procedures were separated, the estimated cost saving was $241.50/patient and $279.27/patient, respectively. Break-even analysis showed that the cost of IVP per patient would need to be $244.82-$282.59, or the PJI relative risk (RR) be approximately 0.99. Probabilistic analysis found IVP + SOC was cost-saving in 99.26% of the 10,000 iterations in the base case model.

Conclusion: Applying local vancomycin as an adjunct to SOC in primary TJA is not just cost effective, but cost-saving in reducing PJIs, saving an average of $260.38/patient. Depending on individual institution/practice infection rates and revision surgery costs, local vancomycin administration for primary TJA should be considered.

Purpose: The purpose of this scoping review is to analyze the application of artificial intelligence (AI) in ultrasound (US) imaging for diagnosing carpal tunnel syndrome (CTS), with an aim to explore the potential of AI in enhancing diagnostic accuracy, efficiency, and patient outcomes by automating tasks, providing objective measurements, and facilitating earlier detection of CTS.

Methods: We systematically searched multiple electronic databases, including Embase, PubMed, IEEE Xplore, and Scopus, to identify relevant studies published up to January 1, 2025. Studies were included if they focused on the application of AI in US imaging for CTS diagnosis. Editorials, expert opinions, conference papers, dataset publications, and studies that did not have a clear clinical application of the AI algorithm were excluded.

Results: 345 articles were identified, following abstract and full-text review by two independent reviewers, 18 manuscripts were included. Of these, thirteen studies were experimental studies, three were comparative studies, and one was a feasibility study. All eighteen studies shared the common objective of improving CTS diagnosis and/or initial assessment using AI, with shared aims ranging from median nerve segmentation (n = 12) to automated diagnosis (n = 9) and severity classification (n = 2). The majority of studies utilized deep learning approaches, particularly CNNs (n = 15), and some focused on radiomics features (n = 5) and traditional machine learning techniques.

Conclusion: The integration of AI in US imaging for CTS diagnosis holds significant promise for transforming clinical practice. AI has the potential to improve diagnostic accuracy, streamline the diagnostic process, reduce variability, and ultimately lead to better patient outcomes. Further research is needed to address challenges related to dataset limitations, variability in US imaging, and ethical considerations.

Purpose: International Medical Graduates (IMGs) have lower match rates than their United States (U.S.)-trained Doctor of Allopathic Medicine (MD) and Doctor of Osteopathic Medicine (DO) peers. This study aims to more completely elucidate the research accomplishments required for IMGs to match into orthopaedic residency and to compare their academic productivity during residency to that of U.S. MD and DO graduates.

Methods: Data from orthopaedic-related journals and ACGME-accredited residency programs were extracted in July of 2024 using Python. Variables included: residency year, publications, first-author publications, citations, journals, h-index, medical school type, and the medical school and residency program locations.

Results: Prior to residency, the 56 matched IMGs had a mean of 32.8 publications, 9.8 first-author publications, and 517.1 citations. Matched U.S. MDs had an average of 3.7 publications, 1.1 first-author publications, and 61.0 citations while DO matched applicants had an average of 3.7 publications, 1.0 first-author publications, and 5.6 citations. During residency, IMG orthopaedic residents averaged 5.2 publications per year and 16.6 citations per year. U.S. MD residents averaged 1.3 publications per year and 3.6 citations per year, while DO residents averaged 0.55 publications per year and 1.1 citations per year. The h-index averaged 9.8 for IMGs, 2.2 for U.S. MDs and 0.7 for DOs. All comparisons for IMGs vs. U.S. MDs and IMGs vs. DOs yielded P < 0.0001.

Conclusion: These findings highlight the significant differences in research output between IMGs and their U.S.-trained counterparts in orthopaedic surgery, and show that these differences continue throughout residency.

Background: understanding the concept of multiple compression neuropathy syndrome has recently evolved, leading to better clinical assessment and evaluation. However, decompression of the involved nerves might require multiple incisions. Concomitant compression neuropathy, such as Lacertus Syndrome (LS) and cubital tunnel syndrome, is not uncommon. The traditional approach for releasing both nerves encompasses two separate surgical incisions. Minimazing surgical incisions is essential for postoperative scar management and nerve gliding. In this paper we describe a single surgical incision for releasing both compressions.

Surgical technique: To release the Lacertus Fibrosis using the classical surgical incision for cubital tunnel syndrome, an incision is made between the medial epicondyle and olecranon. After reaching the brachial fascia, the skin and subcutaneous tissue are raised as a one flap off the fascia. The lacertus fibrosis, identified as a thick rectangular or trapezoid stracture attached to the brachial fascia, is then incised to expose the median nerve beneath it.

Conclusion: As we advance towards the concept of multiple compression neuropathy, it is crucial to minimize surgical incisions to reduce pain, wound breakdown, scar formation, traction neuropathy, neuroma formation, and unsatisfactory aesthetic outcomes.