International Orthopaedics最新文献

Purpose: Longus colli acute calcific tendinitis (LCCT) is a painful disease characterized by a triad of neck pain, neck stiffness and odynophagia. It is a relatively rare cause of neck pain, often unknown or underdiagnosed, but it is important to be aware of its existence as it can mimic other potentially more dangerous illnesses.

Methods: We present a short series of five cases in which we gathered demographic and clinical data including imaging studies and compared our findings to previous reports by other authors. The diagnosis of LCCT was made by the combination of a compatible clinical presentation and blood workup plus the identification of a calcific deposit in the proximal oblique fibers of the longus colli muscle and retropharyngeal edema via computed tomography.

Results: Five patients were analyzed. Mean age was 44 years, three female and two male. All patients initially presented neck pain and painful mobilization, while only 60% presented with odynophagia. There were no patients with radiculopathy nor fever. The mean values for ESR, CRP and White Blood Cell (WBC) were 23.2 mm/h, 2.97 mg/dl and 10.21 * 10^9/L respectively. On CT and/or MRI exploration all the patients presented a visible calcific deposit on the anteroinferior border of the anterior C1 arch and visible signs of retropharyngeal oedema.

Conclusions: LCCT is a self-limited pathology that is caused by a foreign-body type reaction in the retropharyngeal space secondary to the degradation and resorption of calcium hydroxyapatite deposits usually found at the anteroinferior border of the anterior C1 arch. It is necessary to create awareness of this pathology amongst physicians because it can mimic more serious illness like retropharyngeal abscess, meningitis and spondylodiscitis and this may lead to unnecessary expenditures and antibiotic usage.

Background: Femoroacetabular impingement affects 14%-17% of young adults; nonoperative physiotherapy has demonstrated outcomes comparable to surgery in selected cohorts. However, age-specific treatment responses remain poorly defined, impeding evidence-based management across age cohorts.

Methods: We conducted a prospective observational cohort study of 120 participants with femoroacetabular impingement at three specialized centres. Participants were stratified into adolescent (≤ 18 years; n = 60) and adult (19-45 years; n = 60) cohorts, each receiving standardized physiotherapy over six months. The primary outcome was a change in the International Hip Outcome Tool-33 score at six months. Secondary outcomes included Hip Outcome Score subscales, biomechanical measures, and return-to-sport rates assessed at six and 12 months. Statistical analysis employed two-sample t-tests and chi-square tests with a two-sided α = 0.025 for primary outcomes.

Results: At six months, adolescents achieved significantly higher International Hip Outcome Tool-33 scores (72.4 ± 18.3 vs. 61.8 ± 19.7; difference, 10.6 points (95% CI, 3.2-18.0); p = 0.006 and faster time to clinically meaningful improvement (8.2 ± 4.1 vs. 10.7 ± 5.3 weeks; p = 0.012). Adolescents demonstrated superior Hip Outcome Score Activities of Daily Living (88.3 ± 14.2 vs. 82.1 ± 16.8; p = 0.037), modified Harris Hip Scores (85.7 ± 12.8 vs. 79.3 ± 15.2; p = 0.007), and hip range of motion. Return-to-sport rates favored adolescents at 12 months (89.6% vs. 77.6%). Advantages persisted throughout the 12-month follow-up.

Conclusions: Adolescent femoroacetabular impingement patients demonstrate superior functional recovery trajectories compared to adults following nonoperative physiotherapy management. These findings support age-stratified treatment algorithms and suggest more favorable prognoses for younger patients pursuing conservative management.

Purpose: Lenke type 3 and 6 scoliosis present a significant challenge due to the presence of two structural curves. Traditional surgical approaches provide adequate correction for one curve but often leave the secondary curve undercorrected, leading to residual deformity. This study evaluates the efficacy of the novel Simultaneous Independent Rod Derotation (SIRD) technique in treating adolescent idiopathic scoliosis (AIS) with Lenke type 3 and 6 curves.

Materials and methods: A retrospective analysis was conducted on 24 AIS patients (Lenke type 3 and 6) treated between January 2020 and September 2022. Patients were divided into two groups: SIRD group (n = 9) and Standard Single Rod Derotation (SRD) group (n = 15). Preoperative and postoperative radiographs were analyzed to assess the correction of major and minor curves. Intraoperative parameters, including surgical time, blood loss, and postoperative recovery, were evaluated as well.

Results: The SIRD technique demonstrated significantly greater correction in both major and minor curves compared to SRD. The mean percentage reduction in major curves was 78.95% ± 7.09% in the SIRD group versus 68.79% ± 10.05% in the SRD group (p = 0.014). For minor curves, the reduction was 82.71% ± 8.87% in the SIRD group compared to 68.02% ± 13.44% in the SRD group (p = 0.0082). No significant differences were observed in surgical time, intraoperative blood loss, or hospital stay between groups.

Conclusion: The SIRD technique overcomes the limitations of conventional methods by effectively correcting both curves in Lenke type 3 and 6, offering a more balanced and comprehensive solution for scoliosis cases. Further studies are needed to confirm these findings.

Background: Essex-Lopresti injuries, defined by a combination of radial head fracture, interosseous membrane (IOM) rupture, and distal radioulnar joint (DRUJ) disruption, result in forearm longitudinal instability, ulnar-positive variance, pain, and loss of rotation. Although radial head replacement (RHR) is commonly performed, the biomechanical contribution of IOM reconstruction remains controversial. This study quantified the relationship between sequential disruption of forearm stabilizers and resultant longitudinal and rotational instability, and evaluated the extent to which RHR with IOM reconstruction restores forearm stability.

Methods: Ten fresh-frozen cadaveric forearms underwent sequential sectioning of the proximal radioulnar joint (PRUJ), DRUJ, partial and complete IOM, and radial head, followed by anatomic, overstuffed, and understuffed RHR with IOM reconstruction. Rotational motion was assessed using a custom jig and goniometer, while longitudinal displacement under axial load was measured using a materials testing machine. Data were analyzed with paired t-tests and repeated-measures ANOVA.

Results: Sequential sectioning significantly increased both rotation and longitudinal translation. Total forearm rotation expanded from 84° (intact) to 171° (complete injury; p < 0.001), primarily due to increased supination. Longitudinal displacement rose by ~ 30% after PRUJ/DRUJ injury, 100% after partial IOM sectioning, 200% after complete IOM disruption, and 435% following radial head removal (p < 0.001). RHR with IOM reconstruction restored near-normal rotation (90°, p = 0.518 vs. intact) and axial displacement (neutral, 4.37 mm; supination, 6.34 mm; p = 1.000 vs. intact). Overstuffed RHR restricted rotation, while understuffed RHR showed no significant difference from intact.

Conclusions: RHR combined with IOM reconstruction effectively restores forearm rotational and longitudinal stability in Essex-Lopresti injuries.

Aim: Our primary aim was to describe the microbiology of long-bone non-unions after open fracture. Then, we sought to determine the clinical and biological factors associated with the risk of positive intraoperative tissue cultures and the outcome after non-union surgery.

Methods: We retrospectively selected patients > 18 years, who had a primary planned surgical treatment of long-bone non-union after diaphyseal open fracture, with no previous history of infection. Infection was confirmed when growth of the same micro-organism was observed from at least two bone/tissue samples obtained at the time of non-union surgery.

Results: From 2005 to 2021, 85 patients (64 males, 21 females) were included, with a mean age of 38.5 ± 15 years (18-75 years) at the time of non-union surgery. Anatomic regions included the tibia (58 cases), femur (21 cases), and humerus (6 cases). Cultures were positive in 29 cases (34%), including nine polymicrobial infections (31%), with coagulase-negative Staphylococcus species (n = 10) and Staphylococcus aureus (n = 9) being the most prevalent bacteria, followed by Cutibacterium acnes (n = 5), and Pseudomonas aeruginosa (n = 2). The risk of infection correlated with diabetes mellitus (p = 0.0017), the presence of a fistula (p = 0.001), and the type of index wound according to Cauchoix-Duparc (p = 0.03). The risk of postoperative complications and the need for additional surgery, notably for persistent non-union, were higher in patients with an infected non-union.

Conclusions: An underlying low-grade indolent infection was found in a third of cases of presumed aseptic long-bone non-union following an open fracture. The risk of infection was associated with diabetes mellitus, the presence of a fistula, and greater severity of the initial wound. In these cases, the risk of septic failure was almost three times higher as compared to patients with negative cultures.

Level of evidence: Retrospective study, Level III.

Purpose: Periprosthetic joint infection (PJI) after shoulder arthroplasty remains a devastating complication, and the optimal surgical approach is still debated. This study aimed to compare the outcomes of single-stage versus two-stage revision and to identify clinical or demographic factors associated with treatment failure.

Methods: A retrospective observational study was conducted at a single tertiary hospital including 29 patients treated for shoulder PJI between 2010 and 2023. Patients underwent either one-stage (n = 15) or two-stage (n = 14) revision according to clinical and microbiological criteria, and the final choice of surgical strategy (one-stage vs. two-stage revision) was made at the discretion of the attending surgeon. The primary outcome was treatment success, defined as infection eradication without further surgery or suppressive antibiotics. Secondary outcomes were pain and functional results measured with the Constant-Murley Score (CMS), the Simple Shoulder Test (SST), and the Visual Analog Scale (VAS). A standard statistical analysis was performed comparing baseline data of both groups and finding factors related to the primary outcome.

Results: Baseline characteristics of both groups were comparable. Overall infection control was achieved in 83% of patients, nonetheless, the one-stage group showed a higher success rate compared with the two-stage group (93% vs. 71%), although this difference did not reach statistical significance (p = 0.169; OR:0.19(0.003,2.29)). Functional outcomes assessed by CMS and VAS did not differ significantly between groups, whereas SST scores were significantly better following one-stage revision (p = 0.006). Increased BMI and a higher number of previous surgeries tended to be associated with treatment failure.

Conclusion: Single-stage revision achieved comparable infection control and better functional outcomes than two-stage revision, supporting its role as a reliable surgical option for shoulder PJI in appropriately selected patients, although it could be influenced by bias selection.

Purpose: This study evaluated the accuracy of intraoperative leg length and femoral anteversion measurements obtained during total hip arthroplasty (THA) using the Mako robotic system with enhanced mode.

Methods: A total of 55 hips in four men and 51 women who underwent primary THA with the Mako system via an anterolateral approach were retrospectively evaluated. Intraoperative measurements of leg length and femoral anteversion displayed by the Mako enhanced mode were compared with postoperative CT-based measurements. Absolute errors and their distributions were calculated to assess the accuracy of intraoperative assessments.

Results: The mean absolute error was 2.3 ± 1.8 mm for postoperative leg length discrepancy and 2.9 ± 2.2° for stem anteversion. Of the 55 hips, 46 (83.6%) showed leg length errors within 3 mm and 51 (92.7%) within 5 mm. For stem anteversion, 48 hips (87.3%) were within 3° and all 55 hips (100%) were within 5°. Mako enhanced mode could not be completed in 10.7% of cases because of femoral array loosening or screw penetration into the medullary canal.

Conclusion: Mako enhanced mode demonstrated clinically acceptable accuracy for intraoperative measurement of leg length and femoral anteversion, contributing to precise femoral stem implantation in robotic-assisted THA.

Purpose: This study aims to describe and analyse pediatric cervical spine (C-spine) trauma over 32 years at a level 1 trauma centre.

Methods: A retrospective observational study was conducted, including patients younger than 16 years hospitalised after C-spine trauma from 1991 to 2022. Data on demographics, injury mechanisms, affected levels, associated injuries, neurological deficits (Frankel scale), treatments, and outcomes were analysed. Patients were divided into two age groups: < eight years (Group A) and nine to 16 years (Group B). Injuries were categorised as SCIWORA or skeletal, and by level-upper (C0 to C2) or lower (C3 to C7). Statistical analysis was performed using SPSS v29.0 (p < 0.05).

Results: A total of 102 patients were identified (67% male; 65% > 8 years). Younger children had more upper C-spine injuries (55.6%), lower injuries were more common in Group B (53%) (p = 0.006). mechanisms included motor vehicle accidents, pedestrian accidents, falls, and sports injuries. Associated injuries were present in 59% of cases, mainly head trauma. SCIWORA occurred in 14.7% of patients, with MRI-confirmed cord contusions in 60% of these. Most patients (74.7%) underwent conservative treatment. Neurological deficits were present in 38% of patients, and 51.2% showed improvement. The mortality rate was 16.5%, significantly higher among those with neurological impairment (p = 0.004).

Conclusion: Pediatric C-spine trauma is uncommon. MRI is essential for detecting spinal cord injury in SCIWORA. The high prevalence and impact of associated injuries on mortality highlight the need for thorough primary evaluation. Multicenter studies are necessary to improve management strategies and outcomes.