International Orthopaedics最新文献

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.

Purpose: Study of the sagittal accuracy of the 'Robotic Surgical Assistant' (ROSA^®), compared to conventional surgery, regarding the application of the tibial slope (TS). Study of the impact of TS on the range of motion (ROM) and patient-reported outcome measures (PROMS).

Methods: Inclusion of patients who underwent primary Total Knee Arthroplasty (TKA) between 1/1/2021 and 15/4/2024. Divided into robotic-assisted TKA (RA-TKA) and manual TKA (M-TKA). Measurement of pre- and post-operative TS, using the posterior tibial cortex, on profile knee X-rays. 3° TS applied arbitrarily for both groups. ROM was measured pre-operatively and at three, six and 12 months post-operatively. Patient satisfaction assessed via Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS).

Results: 266 patients were included in the study. The M-TKA (110) had a post-operative TS of 3.11° (± 2.12°). 81.21% were within 2° of the target and 92.87% within 3°. The RA-TKA (82) had a post-operative TS of -0.11° ± (1.93°). 36.83% were within 2° of the target and 56.63% within 3°. RA-TKA had a KOOS of 64.43 ± 12.87 and OKS of 33.05 ± 6.01. M-TKA had a KOOS of 64.18 ± 13.11 and OKS of 32.31 ± 5.97. Maximum flexion at 12 months was 118.74° ± 8.19° for M-TKA and 121.88° ± 7.43° for RA-TKA (p = 0.002).

Conclusion: The application of TS using ROSA^® was less precise than the conventional method in achieving post-operative TS values as measured on X-rays. However, there were no clinical differences in ROM or PROMS.

Objective: This study aims to evaluate the clinical efficacy of endoscopic plantar fascia release through the modified dual medial deep fascia approach for the treatment of refractory plantar fasciitis.

Methods: A retrospective study was conducted involving 34 patients with refractory plantar fasciitis treated by endoscopic plantar fascia release through the modified dual medial deep fascia approach. Among them, 25 patients had concurrent calcaneal spurs. All patients were followed for a minimum of 12 months. Functional outcomes were assessed using the Visual Analogue Scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score, while structural evaluations included the Medial Longitudinal Arch Angle (MLAA), navicular tuberosity height-to-foot length ratio (NH/FL), and the Arch Index (AI). Differences between patients with and without calcaneal spurs were also analyzed.

Results: All patients completed at least 12 months of follow-up, with primary wound healing in all cases. Two patients experienced transient plantar skin numbness and small toe abduction difficulty, which resolved within three months. The VAS score decreased significantly from 6.53 ± 1.19 preoperatively to 1.18 ± 0.76 postoperatively, and the AOFAS score improved from 52.41 ± 5.23 to 93.29 ± 3.91 (both P < 0.05), indicating statistical significance. However, changes in the MLAA, NH/FL and AI were not statistically significant. Apart from age differences (49.04 ± 4.41 vs. 34.56 ± 3.13), no significant differences in other scores were observed between the calcaneal spur group and the non-calcaneal spur group at the final follow-up. Moreover, compared to the methods reported in other studies, our study demonstrated a shorter operative time and superior pain and functional outcomes.

Conclusion: The dual medial deep fascia approach for endoscopic plantar fascia release is a safe, quick, effective, and minimally invasive technique that yields favourable clinical outcomes. It has certain advantages compared to other techniques. The presence of calcaneal spurs does not impact postoperative outcomes.

Background: The suprascapular and axillary nerves can be subject to entrapment due to both their anatomical courses and their anatomical relationships with surrounding anatomical structures around shoulder. These entrapments were previously considered as a diagnosis of exclusion. However, today these pathologies can be diagnosed as primary. The most common complaints of patients are pain and sometimes weakness. The clinician's suspicion is very important in making diagnosis. The patient's history, duration of symptoms, and information such as the movements in which the complaints increase should be questioned carefully and in detail. In physical examination, symmetrical evaluation of both shoulders can provide important information. In addition, cervical and brachial plexus pathologies should be kept in mind. According to the suprascapular and axillary nerve innervations, muscle atrophy should be evaluated during inspection. Range of motion and neurological examination around shoulder should be performed. Since these entrapments can be seen together with rotator cuff tears and labrum pathologies etc., these additional pathologies should also be targeted during evaluation. The evaluation should be expanded with imaging methods such as plain radiographs, ultrasonography, computed tomography, magnetic resonance imaging, electrodiagnostic studies and local anaesthetic injections to the entrapment area. There is no definitive method to diagnose these pathologies. As a result of all these evaluations, a diagnosis can be made. There is no consensus on treatment. In isolated entrapment cases where there are no additional surgical pathologies such as space-occupying lesions, non-operative treatment is primarily recommended. It is generally recommended to try non-operative treatment for at least six months. Surgical treatment is recommended in cases where non-operative treatment fails or in cases where there are additional pathologies requiring surgery or in cases where there is extrinsic compression such as sapce-occupying lesions. In the decision and choice of surgical treatment, it is very important to determine the aetiology precisely. Surgical treatment can be performed open and arthroscopically. Various additional arthroscopic portals and techniques have been described. However, there is no clear consensus on the superiority of these treatments over each other. Although physical therapy is recommended after surgical treatment, there is no consensus on this issue in the literature.

Aim: This review aims to summarize the diagnosis and management of suprascapular and axillary nerve entrapments in athletes, focusing on clinical presentation, diagnostic methods, treatment options, and current controversies.

Background: The role of lacertus fibrosis as the primary perpetrator behind the illusive pronator teres syndrome is becoming increasingly recognized in recent literature. The aim of this systematic review is to explore the outcomes of lacertus fibrosis release in patients complaining of proximal median nerve entrapment signs and symptoms.

Methodology: In this systematic review, Pubmed, Cochrane Library, Scopus, Ovid databases were reviewed. Studies in which structures, other than the lacertus fibrosus, in the proximal forearm had been concomitantly released were deemed illegible. Various outcome assessment tools were utilized; those were pain, numbness, and satisfaction visual analog scales, return of function and muscle strength, quick DASH, work DASH, and activity DASH scores. Adherence to PRISMA guidelines was maintained.

Results: A total of seven studies, three interventional and 4 retrospective observational studies, were included in this review out of 118 articles. These included 446 participants who underwent lacertus fibrosis release with a mean age of 45 years old across a mean duration of postoperative follow-up of 16.1 months. A significant proportion of the patients had a history of unsuccessful conservative or surgical management (prior carpal tunnel release in 10.5%). Minimal access surgery under WALANT was performed in 95%, US-guided release under WALANT in 3.3%, and open exploration was done in 1.5%. A horizontal incision hidden in the elbow flexion creese was done in 74.2%, oblique incision 2 cm distal and 2 cm radial to the medial epicondyle in 20.8%, and open exploration through a Z-shaped incision over the antecubital fossa in 1.5%. Immediate pain relief and return of function and strength was reported in 99.6%. A significant improvement was reported in postoperative quick DASH (mean = 24 points), work DASH (mean = 28.8 points), and activity DASH (mean = 44.8 points). Further, a significantly lower VAS score was obtained on pain, numbness, and paraesthesia scales. There were two complications, a case of postoperative haematoma and another case of surgical site infection. Seven patients complained of residual symptoms by the end of the follow up duration; carpal tunnel release was done in three and release of superficialis arcade was necessitated in four other cases.

Conclusion: Lacertus syndrome can be optimally managed by surgically releasing the lacertus fibrosus. This can be done as a minimally invasive procedure under WALANT. A high index of suspicion is required when encountering patients with signs and symptoms of median nerve entrapment, specifically those who were treated unsuccessfully with the presumption of carpal tunnel syndrome.

Purpose: Total knee arthroplasty (TKA) is a highly effective treatment for osteoarthritis patients unresponsive to conservative therapies. Chronic postsurgical pain (CPSP) following TKA is understudied, with approximately 20% of patients reporting chronic pain. This cross-sectional study conducted in Jordan aims to (1) determine the prevalence of chronic knee pain after TKA in the Jordanian population and (2) identify associations between demographics and rehabilitation factors with chronic pain.

Methods: Data were collected from 90 Jordanian patients post-TKA. Demographics (age, gender, BMI, and smoking) and rehabilitation factors (pre-operative sessions, post-operative sessions, and duration) were recorded. Statistical analyses included descriptive statistics and 95% confidence intervals. Independent t-tests and Chi-square analyses were used to determine the differences between those with and without chronic pain. Pearson correlations were used to determine the association between demographic and rehabilitation factors with the prevalence of chronic pain.

Results: Ninety patients were included in the study with an average age of 60.3 ± 10.1 years. The prevalence of chronic post-TKA pain in Jordan was 57.8% (52/90), (95% CI: 46.9-68%). No significant differences were found in demographics and pre-operative rehabilitation. Chronic pain was significantly associated with post-operative rehabilitation sessions and duration (r =.349, p =.001) (r =.342, p =.001, respectively. Patients with chronic pain received fewer post-operative rehabilitation sessions (P <.001) and had shorter rehabilitation durations (P <.001) compared to patients without chronic pain.

Conclusion: Chronic pain after TKA is highly prevalent in Jordan (57.8%), with reduced rehabilitation engagement strongly linked to its occurrence. Optimizing post-operative rehabilitation protocols may mitigate CPSP risk among Jordanian TKA patients.

Purpose: The full spectrum of diseases caused by S. infantarius remains poorly understood, particularly its role in musculoskeletal infections.

Methods: A retrospective study was conducted from January 2008 to May 2024. Patients with bacterial infections and detection of S. infantarius in at least one tissue sample, fluid sample, or blood cultures were included. Follow-up controls in patients with musculoskeletal infection were performed.

Results: S. infantarius could be identified in at least one sample (blood cultures, wound fluid, wound swab, bile, tissue or urine sample) of 72 patients. 33 were considered clinically relevant with symptomatic infections (63.4 ± 21.1 years; positive samples: 1.39 ± 0.86; total number of samples: 2.7 ± 1.76). Non-muskuloskeletal infections (n = 29; 61.1 ± 21.5 years; positive samples: 1.28 ± 0.59) included a variety of different infections (sepsis (n = 11), abdominal/gastrointestinal/urogenital infections (n = 16), soft tissue infections (n = 2)). Four patients with musculoskeletal S. infantarius infection (positive samples: 2.25 ± 1.89; diagnosis: acute PJI, spondylodiscitis, chronic PJI and postoperative spinal wound infection) required surgical and/or antimicrobial treatment. Follow-up after musculoskeletal infection varied between 10 and 60 months. Antibiotic susceptibility testing displayed a sensitivity to Penicillin in all isolates. No patient had a recurrent positive sample/infection with S. infantarius.

Conclusions: This study describes musculoskeletal infections caused by S. infantarius, highlighting its possible relevance as pathogen in orthopedic infections. The findings underscore the importance of recognizing and appropriately treating S. infantarius. In case of penicillin allergy, clindamycin shows to be an effective alternative treatment.

Purpose: The prevalence of carpal tunnel syndrome (CTS) as the foremost upper extremity entrapment neuropathy is well-documented. The present study aimed to evaluate the prevalence of anatomical variations in the carpal tunnel and their potential role as risk factors for CTS.

Methods: Data from 447 CTS patients who underwent median nerve decompression between 2018 and 2019 were retrospectively analyzed. As a control group, 200 hands from 103 age- and sex-matched asymptomatic volunteers were further investigated.

Results: Anatomical variations identified through ultrasound in 19.7% of CTS hands and 16.0% of controls. Specifically, 10.3% of CTS hands had persistent median arteries, while 14.3% had bifid median nerves. Both variations occurred in 4.9% of CTS patients. In the control group, 13.0% had persistent median arteries and 11.0% had bifid median nerves, with both found in 8.0%.

Conclusions: Anatomical variations were found in both, CTS patients and controls, but their prevalence did not differ significantly between groups, suggesting they are not independent risk factors for CTS.