International Orthopaedics最新文献

Purpose: Proximal femur megaprostheses (PFMPs) are used to manage large bone defects in both non-oncological indications (NOI) and oncological indications (OI). However, little is known about the comparative risks of reoperation and functional outcomes between these groups. This study aimed to evaluate the cumulative incidences of reoperation and functional results of PFMPs between NOI and OI.

Methods: This retrospective, monocentric cohort study included 109 implants between 2005 and 2020 (NOI, n = 42; OI, n = 67). Competing risk analysis was used to estimate and compare cumulative incidence of reoperation and complications, with death as a competing event. The Musculoskeletal Tumour Society Score (MSTS) was retrospectively assessed to compare functional outcomes.

Results: The estimated cumulative incidence of reoperation at ten years did not statistically differ: 33.5% for NOI vs. 32.7% for OI (HR = 0.90, 95% CI (0.42-0.95), p = 0.791). The estimated cumulative incidence of complications at ten years did not statistically differ (HR = 1.50, 95%CI (0.80-2.80), p = 0.204). The MSTS score at ten years was significantly higher in the OI group (78.2% ± 19.5) compared to the NOI group (48.3% ± 10.9) (p = 0.012).

Conclusion: PFMPs for NOI demonstrate a comparable risk of reoperation to OI, but with lower long-term functional outcomes.

Purpose: The present study aims to provide normative values for Hand Grip Strength (HGS) and Hand Pinch Strength of healthcare staff and evaluate key body anthropometric predictors of these strengths.

Methods: This cross sectional study was conducted on 2,337 healthcare staff. HGS and pinch strength were assessed for both hands using a hydraulic hand dynamometer and pinch gauge. Descriptive data were reported for dominant and non-dominant HGS and pinch strength, after stratification by gender, age, and height. Multivariatelinear regression analysis was performed to assess predictor variables.

Results: The maximum HGS values were identified in men aged 35 to 40, measuring 38.00 ± 7.81 kg, and in women aged 50 to 55, measuring 22.20 ± 4.13 kg. The highest pinch strength values were recorded in men aged 45 to 50, with measurements of 7.16 ± 1.48 kg, and in women aged 35 to 40, with measurements of 4.24 ± 1.15 kg. The predictor variables for dominant HGS and pinch strength exhibited 59% and 51% prediction for variations in dominant HGS and pinch strength, respectively, using gender, height, and wrist circumference as predictors. Height (for grip: dominant hand: β = 0.33, CI [0.28, 0.37]; for pinch: dominant hand: β = 0.04, CI [0.02, 0.05]) was the most effectively correlated anthropometric variable.

Conclusion: The findings demonstrate differences in HGS and pinch strength among different gender and age groups. Multiple linear regression analysis highlights the crucial role of anthropometric variables in evaluating hand strength. These results can provide guidance for future research and clinical assessments.

Trial registry number: Not applicable.

Level of evidence: Level III (analytical cross-sectional study on big sample size).

Purpose: High Fascial Compartment Pressure (HCP) is one of the most common complications in ankle fractures. This study aimed to investigate the incidence of HCP in pilon fracture and analyze the risk factors of HCP in order to closely monitor its further development into Acute Compartment Syndrome. A nomogram is constructed and validated to predict HCP in patients with pilon fracture.

Methods: We collected information on 1,863 patients with pilon fracture in the 3rd Hospital of Hebei Medical University Hospital from January 2019 to March 2024. Patients with HCP were assigned to the HCP group and those without HCP to the non-HCP group. The inpatient medical record system was inquired for data collection, including demographics, comorbidities, injury types, and laboratory biomarkers. Variables with a significance level of P < 0.05 in the univariate analysis were included in the multivariate logistic regression analysis. The backward stepwise regression method was applied to identify independent risk factors associated with HCP. The selected predictors were then entered into R software for further analysis, and Nomogram construction.

Results: The rate of HCP was 11.57%. Several predictors of HCP were found, including Body Mass Index (BMI) (p<0.001), Deep Vein Thrombosis (p < 0.001), occurrence of Fracture Blister (FB) (p < 0.001), use of Dehydrating Agent (p < 0.001), duration of limb immobilization (p < 0.001),and Systemic Immune-inflammation Index (SII) (p < 0.001). In addition, BMI (p < 0.001, OR 1.52, 95% CI 1.35 to 1.71), DVT (p < 0.001, OR 4.35, 95% CI 2.51 to 7.52), duration of limb immobilization (p < 0.01, OR 1.66, 95%CI 1.25 to 2.20) and SII (p < 0.01, OR 1.00, 95%CI 1.00 to 1.00) were correlated with increased HCP risk. Meanwhile, FB (p < 0.001, OR 0.23, 95% CI 0.13 to 0.39) and Dehydrating Agent (p < 0.001, OR 0.10, 95% CI 0.06 to 0.19) were associated with decreased HCP risk. The nomogram was established based on six predictors independently related to HCP.

Conclusions: Our investigation has shown that, compared with tibial diaphyseal fractures, pilon fractures are more prone to HCP because of their high energy injury characteristics. This research also shows BMI, DVT, occurrence of FB, use of Dehydrating Agent, duration of limb immobilization, and SII are independent risk factors for HCP in patients with pilon fracture. We have also devised a nomogram grounded in these identified predictors. In particular, this study found for the first time that SII is an independent risk factor for HCP, which provides a basis for clinical and basic science research on fascial immunology in the future.

Purpose: Accurate identification of radiographic landmarks is fundamental to characterizing glenohumeral relationships before and sequentially after shoulder arthroplasty, but manual annotation of these radiographs is laborious. We report on the use of artificial intelligence, specifically computer vision and deep learning models (DLMs), in determining the accuracy of DLM-identified and surgeon identified (SI) landmarks before and after anatomic shoulder arthroplasty.

Materials & methods: 240 true anteroposterior radiographs were annotated using 11 standard osseous landmarks to train a deep learning model. Radiographs were modified to allow for a training model consisting of 2,260 images. The accuracy of DLM landmarks was compared to manually annotated radiographs using 60 radiographs not used in the training model. In addition, we also performed 14 different measurements of component positioning and compared these to measurements made based on DLM landmarks.

Results: The mean deviation between DLM vs. SI cortical landmarks was 1.9 ± 1.9 mm. Scapular landmarks had slightly lower deviations compared to humeral landmarks (1.5 ± 1.8 mm vs. 2.1 ± 2.0 mm, p < 0.001). The DLM was also found to be accurate with respect to 14 measures of scapular, humeral, and glenohumeral measurements with a mean deviation of 2.9 ± 2.7 mm.

Conclusions: An accelerated deep learning model using a base of only 240 annotated images was able to achieve low levels of deviation in identifying common humeral and scapular landmarks on preoperative and postoperative radiographs. The reliability and efficiency of this deep learning model represents a powerful tool to analyze preoperative and postoperative radiographs while avoiding human observer bias.

Level of evidence: IV.

Purpose: Subclinical peroneal neuropathy without overt foot drop has been linked to increased fall risk in adults, yet remains under reported due to subtle symptoms and lack of awareness. Patients with carpal tunnel syndrome (CTS) often experience other nerve entrapments, prompting this study to evaluate CTS (a proxy for peroneal nerve entrapment) as a significant predictor of time to first fall.

Methods: Data from the Merative MarketScan Research Databases (2007-2021) were used to identify adult patients using ICD-9/10 codes. Patients were stratified by CTS diagnosis and fall occurrences, with relevant comorbidities recorded. A survival analysis employing the Cox proportional hazards model assessed relationships between CTS, comorbidities, and future fall risk, accounting for changes in health status over time. Age was the time scale with CTS as a time-varying predictor. This approach isolated CTS-associated risk, while considering the natural increase in fall risk with age.

Results: Among 63,187,681 subjects (mean age = 52.82 years ± 7.61), 1,411,695 had a diagnosis of CTS. Of those with CTS, 45,479 patients had a future fall. Univariate analysis showed significant associations between CTS and higher rates of arthritis and diabetes, while heart disease was less prevalent. CTS increased fall risk by 25% (HR 1.25, p < .005). Heart disease was associated with a 10% increase in fall risk (HR 1.10, p < .005), while arthritis and diabetes increased fall risk by 2% (both HR 1.02, p < .005). Kaplan-Meier curve illustrated a steeper decline in survival probability for the CTS group, indicating they experienced falls at younger ages and at a higher rate than those without CTS (χ² = 4386.4, p < .001).

Conclusion: Prior diagnosis of CTS is associated with an increased fall risk. Providers should screen CTS patients for fall risk and implement appropriate monitoring strategies. Further investigation on the role of peroneal nerve entrapment in this increased fall risk is warranted. This study identifies a treatable cause of falls, with potential to enhance patient safety and reduce fall-related morbidity.

Purpose: Trauma and orthopaedic (T&O) surgery relies on medical implants and materials, often resulting in metalwork wastage (prosthesis, screws, nails, and plates). This places an economic strain on healthcare services and the environment. Our primary outcome is to quantify the implant wastage across the literature, and secondarily investigate the associated costs in this specialty.

Methods: A literature search of three databases (Scopus, PubMed and Embase) was performed using MeSH terms relating to "implant waste" and "trauma and orthopaedic surgery", from January 1980 to November 2023. We included any observational studies that reported patients undergoing T&O surgery, where the wastage or associated costs was reported.

Results: Our search returned 2,145 articles, of which 15 met the final inclusion criteria, encompassing 26,832 procedures. Nine studies reported the extent and cost of waste, six reported the weight of waste and ten concurrently reported the cost. Implant waste events occurred in up to 30% of all T&O procedures, being the most likely to occur in fracture fixation, and cost hospitals between $4,130 and $189,628.41 annually. Screws were the most wasted material, followed by plates and nails. Up to 95% of waste events were caused by human factors.

Conclusion: Despite the limited number of studies, there is an economic burden and environmental footprint in T&O surgery services. The main factors contributing to the waste was human error, and contamination. Further research is required to determine methods of mitigating and limiting implant waste in T&O Surgery.

Introduction: During 280 years of studies of the anatomy of the distal tibiofibular articulation, there have arisen many unclear issues regarding the description of individual structures and their terminology. These historical inaccuracies were subsequently reflected in the clinical practice.

Materials and methods: A literature search of original publications and historical sources was performed.

Results: The distal tibiofibular articulation is a synovial joint, rather than a syndesmosis, as it is an integral part of the ankle joint. The interosseous tibiofibular ligament (ITFL), described for the first time by a French anatomist Bichat in 1801, is the strongest ligament of the tibiofibular mortise. Unfortunately, this clinically important ligament is not recognized by the current international anatomical nomenclature. The terms anterior inferior (AITFL) and posterior inferior tibiofibular ligaments (PITFL) are historical remnants "reimported" from the American/British literature and should not be used, because the analogous superior ligaments do not exist. The intermalleolar ligament, first described by Weitbrecht in 1742, is a variable, but constant, structure reinforcing the posterior capsule of the ankle joint. The term inferior transverse ligament (IFT) denoting in the English literature the inferior part of the posterior tibiofibular ligament was originally used for the intermalleolar ligament. The IFT ligament is a part of the posterior tibiofibular ligament and there is no reason to stress its importance.

Conclusion: The chaos in the anatomy, terminology and depiction of the articulation of the distal tibia and fibula, unparalleled in any other joint of the human body, is the result of historical development. A certain negative role was, in this respect, played also by Basiliensia Nomina Anatomica (1895), that eradicated ITFL and called the distal tibiofibular joint a syndesmosis.