International Orthopaedics最新文献

Purpose: Hip deformity is frequent after childhood osteonecrosis in patients with sickle cell disease (SCD). When they are adults, they present a challenge as candidates for total hip arthroplasty (THA) because of abnormal bone development, their relative youth, and also because of their disease. Performing subtrochanteric osteotomy associated with THA is technically challenging, and healing of osteotomies has never been reported in this population with frequent osteonecrotic bone, whether using cemented or uncemented arthroplasties.

Methods: We retrospectively analyzed 59 cemented THA with femoral corrective osteotomies (subtrochanteric shortening and transverse derotational osteotomy) performed on hip deformities between 1984 and 2018 in 59 sickle cell adult patients. The patient's age at the onset of osteonecrosis was an average of 8.4 years (6 to 10 years), and at the time of the THA was 28.6 years (19 to 41 years). All the patients had a minimum followup period of six years. Endocrinopathy was frequently associated to SCD Data and consequences were evaluated on bone union. The mechanical variables, such as the length of the resected femur, limb lengthening, the location of the osteotomy site, the size of the stem bridging the osteotomy, and any complications, were also analyzed.

Results: The average length of the resected femoral segment was 38.4 mm. The length of the femoral stem (bridging the osteotomy) was average 13 cm. The mean osteotomy union time was 10.6 months. Twenty-four osteotomies healed in six months, six in nine months, and 29 in twelve months, while five required bone grafts at nine months. The union time of the osteotomy was average 10.6 months. Complications included four cases of transient nerve palsy, and five intraoperative femur perforations. No statistically significant relationship was found between osteotomy union time and mechanical variables. The severity of endocrinopathy associated with sickle cell disease prolonged the healing time. In three cases, cement leakage into the osteotomy gap occurred without resulting in non-healing.

Conclusion: Cemented THA, combined with a subtrochanteric femoral shortening with transverse derotational osteotomy, has a long union time but is effective for adult hip deformities of patients with sickle cell patients.

Purpose: This study aimed to evaluate the outcomes of three-dimensional (3D) Printing-Assisted Osteotomy in treating varus knee deformity from old tibial plateau fractures.

Methods: The study retrospectively analyzed patients with varus deformity induced by old-tibial plateau fractures between January 2019 and June 2023. All patients utilized 3D printed models for surgical planning. The Lysholm Knee Score (LKS), Visual Analog Scale (VAS) and Knee Society Score (KSS) were measured for functional outcomes. Medial Proximal Tibial Angle (MPTA), Joint Line Convergence Angle (JLCA), Mechanical Axis (%MA), Medial Tibial Plateau Depression (MTPD), and Femorotibial Angle (FTA) were measured for radiological outcomes.

Results: 15 patients (12 males and 3 females) were included in this study and followed up for 21.9 ± 8.6 (range, 12 to 28) months. Healing of the osteotomy sites were achieved in all patients at 15.8 ± 1.5 (range, 13 to 18) weeks. The knee varus deformities were significantly corrected as reflected by %MA (2.13 ± 13.1°(range, -20 to 22) versus 57.06 ± 9.8°(range, 41 to 70), p < 0.01), FTA (186.7 ± 3.2°(range, 181 to 193) versus 172.3 ± 2.1°(range, 169 to 175), p < 0.01), JLCA (5.8 ± 1.7°(range, 3 to 8) versus 1.3 ± 0.8°(range, 0 to 3), p < 0.01), and MPTA (5.6 ± 1.2°(range, 3 to 8) versus 1.2 ± 1.1°(range, -1 to 3), p < 0.01). Postoperative knee function showed dramatic improvements as reflected by VAS (4.6 ± 1.6 (range, 1 to 7) versus 0.7 ± 0.9 (range, 0 to 2), p < 0.01), KSS (50.1 ± 16.5 (range, 27 to 88) versus 88.5 ± 5.2 (range, 80 to 95), p < 0.01), and LKS (49.5 ± 10.2 (range, 37 to 69) versus 89.2 ± 2.5 (range, 87 to 94), p < 0.01).

Conclusions: 3D printing technology provides a valuable tool for understanding deformities and optimizing osteotomy strategies, thereby improving surgical efficacy and treatment outcomes. Its clinical application is highly recommended.

Purpose: We tested whether residents would improve in fluoroscopy knowledge and ability after using an inexpensive novel pelvis model and educational website.

Methods: Twenty-four orthopaedic residents were recruited from three United States residency programs and randomised into two groups with equal numbers of juniors and seniors. The OrthoAcademy group received educational materials from a website ( www.theorthoacademy.com ), whereas the control group did not. Survey scores, radiograph scores, number of fluoroscopic images taken, and overall radiation exposure were compared (1) between control and OrthoAcademy groups and (2) between junior and senior residents.

Results: Both groups had higher radiograph scores at the second round of testing than at the first (P =.004). The OrthoAcademy group had higher post-test than pre-test knowledge survey scores (P =.045), whereas the control group did not (P =.54). However, the OrthoAcademy group did not have higher radiograph scores between tests (P =.15), whereas the control group did (P =.01). Junior residents had higher second-round than first-round radiograph scores (P =.005) and survey scores (P =.006), whereas senior residents did not (P =.24 radiograph scores) (P =.30 survey scores).

Conclusions: Testing residents with this novel pelvis model improved the quality of the fluoroscopic images obtained by the residents, especially juniors. This study highlighted the need for more accessible resources for residents to learn about obtaining these images.

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.

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.

Objective: To evaluate the safety, reliability, and effectiveness of bioceramic rods (BR) in treating osteonecrosis of the femoral head (ONFH), compared with other treatments such as core decompression and autologous bone grafting.

Design: Systematic review and meta-analysis.

Data sources: Pubmed, Embase, and CNKI databases from January 2011 to July 2023.

Eligibility criteria for study selection: Included studies involved patients treated with bioceramic rods. Studies were required to have a follow-up time of more than six months and no statistically significant differences in baseline information between groups in controlled studies. Exclusions included literature reviews, case reports, conference abstracts, animal experiments, and studies without defined success criteria or lacking analysis on factors influencing efficacy.

Main outcome measures: The primary outcome measure was the Harris Hip Score (HHS) improvement rate. Secondary outcomes included the femoral head stability and survival rate, alongside the hip replacement rate.

Results: The systematic review revealed significant improvements in symptom relief and functional recovery using BR for the treatment of ONFH. An average follow-up of 20.44 months showed an overall HHS improvement rate of 33.93%. Hip preservation efficacy with BR was superior to core decompression and autologous bone grafting. The overall femoral head survival rate was 84.42%, with results sustained for three years. The success rate of hip preservation was notably higher with early intervention, which showed better outcomes when the overall HHS improvement exceeded 27%, and rates of excellent and good outcomes approached 90%.

Conclusions: Bioceramic rods offer a safe, minimally invasive, reliable, and effective treatment option for ONFH, ensuring substantial symptom relief and functional recovery. The technique's success in early disease stages suggests a strong potential for broader clinical adoption. Although additional benefits from combining BR with stem cells, platelet-rich plasma, and traditional Chinese medicine are noted, definitive conclusions on enhanced therapeutic effects remain inconclusive.

Purpose: Polytrauma presents a devastating event with great impact on the patient's life. While we are taking great care of improving our treatment algorithms, the rehabilitation often takes place outside of our direct field of vision. Yet, adequate rehabilitation is crucial for the patients to regain their former lives. The aim of this study, on the behalf of SICOT Trauma & Rehabilitation Research Group, was to identify rehabilitation strategies and standards in existing scientific literature.

Methods: A systematic literature search of MEDLINE and Embase from 2000 to 2023 was conducted. Inclusion criteria was the description of polytrauma rehabilitation strategies in the acute, post-acute or long-term stage. Reported treatment aims, conducted therapies and challenges were extracted and stratified to either of the stages.

Results: A total of 5212 studies were identified and 6 reviews and one original study were included according to our criteria. Overall, no article of higher evidence on how to perform polytrauma rehabilitation could be identified. From the available literature, disciplines involved in the rehabilitation could be described such as major challenges along the rehabilitation process.

Conclusion: This study highlights the need for standardized polytrauma rehabilitation algorithms. Whereas we could identify important information about each rehabilitation stage, we did not encounter specific evidence for prioritization of different therapies or algorithms of treatment. Polytrauma rehabilitation needs to shift from eminence to evidence.

Purpose: To explore the efficacy and feasibility of arthroscopy combined with bone tunnel technique in treating Berndt and Harty stage III or IV osteochondral lesions of the talus (OLT).

Methods: A retrospective analysis was conducted on the clinical data of 21 patients with Berndt and Harty stage III or IV OLT who underwent surgical treatment at our institution from September 2017 to September 2022. Under arthroscopy, the displaced talar osteochondral lesion was restored. A 2.0 mm Kirschner wire (K-wire) was used to create a bone tunnel from the medial (or lateral) malleolus to the realigned osteochondral lesion. A 1.5 mm K-wire was then used to drill through this tunnel into the osteochondral fragment, and a 1.5 mm absorbable bone rod was inserted for fixation. Preoperative and final follow-up visual analogue scale (VAS) for pain and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were recorded and compared.

Results: All 21 patients were followed up for an average of 23.95 ± 6.01 months. All wounds healed by primary intention, with no nerve, blood vessel, or tendon injuries. All osteochondral lesions healed, with an average healing time of 3.71 ± 0.62 months. The VAS score decreased from a preoperative average of 5.38 ± 0.59 to 0.48 ± 0.51 at the final follow-up. The AOFAS ankle-hindfoot scale increased from a preoperative average of 56.29 ± 5.98 to 88.43 ± 2.68 at the final follow-up (P < 0.05), showing statistically significant differences. Two cases experienced medial pain after 12 months, which was tolerable with non-steroidal anti-inflammatory drugs.

Conclusion: Arthroscopy combined with bone tunnel technique for treating Berndt and Harty stage III or IV OLT has the advantages of minimal injury, visualization of fracture reduction, and fewer complications.

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.