International Orthopaedics最新文献

Purpose: Aseptic loosening of the acetabular cup component is the primary cause for complex revision surgery following total hip arthroplasty. However, the extent to which the different zones of the prosthetic contribute to successful osseointegration and how reliable this integration can be assessed using conventional radiographs remain unclear. The aim of the study was to evaluate the osseointegration of cementless threaded acetabular cups through a combination of radiological analysis and histological validation.

Methods: Eight hemipelves of body donors with cementless threaded acetabular cups were included in this study. Conventional radiographs were used to assess the specimens for existing radiolucent lines, periprosthetic osteolysis, or fractures. For histological analysis, thin sections of the acetabular cup were examined for the presence of a periprosthetic membrane, particle debris or inflammatory cells. The areas of visible contact were identified and the bone-to-implant contact (BIC) was calculated.

Results: Radiographic analysis revealed no signs of insufficient osseointegration, osteolytic lesions, or periprosthetic loosening, in any of the specimens. Histological examination showed an average osseointegration rate of 41.84%. Bone-to-implant contact analysis showed no significant differences between different sectors or zones, or between conical and bi-conical acetabular cups.

Conclusion: This study highlights successful osseointegration of cementless threaded acetabular cups, with a mean survival of 18.2 years. Radiological imaging aligned closely to histological finding, confirming implant stability and long-term clinical effectiveness.

Purpose: To compare functional and radiological outcomes between two stage ORIF and single stage external fixation for complex pilon fractures.

Methods: Prospective, single-center randomized controlled trial at a Level I trauma facility (April 2021-April 2023). Sixty skeletally mature patients with AO/OTA 43-C pilon fractures unsuitable for primary ORIF were randomized to two-stage ORIF (control group) or single-stage limited internal fixation with external fixation (LIFEF) (treatment group). Minimum follow-up was 24 months. The primary outcome was the AOFAS score at final follow-up. Secondary outcomes included time to union, time to return to work, ankle range of motion (ROM), fracture-related infection (FRI), bone-healing complications (nonunion, malunion, delayed union), post-traumatic osteoarthritis (PTOA), and need for secondary procedures.

Results: All 60 patients completed follow-up. Compared with LIFEF, two-stage ORIF achieved higher AOFAS scores (85 ± 9 vs. 77 ± 10; P = 0.006), earlier return to work (7 ± 1.5 vs. 10 ± 3 months; P < 0.001), and shorter time to union (17 ± 3.6 vs. 19 ± 3.5 weeks; P = 0.02). Groups did not differ in quality of reduction (P = 0.14), ankle ROM (P = 0.10 and 0.058 for dorsiflexion and plantarflexion), FRI (P = 0.69), PTOA (P = 0.64), or bone-healing complications (nonunion, delayed union, malunion; P = 0.24, 0.39, 0.39).

Conclusion: Two-stage ORIF provided superior functional outcomes and faster recovery (earlier union and return to work) compared with LIFEF, with similar reduction quality and complication rates. These findings support two-stage ORIF as the preferred strategy for AO/OTA 43-C pilon fractures with soft-tissue compromise.

Registry: ClinicalTrials.gov , NCT05141227, Registration date: 29 July 2021.

Purpose: Children with chronic diseases are at a significant risk of radiation exposure. This cohort study evaluates the effectiveness and reliability of ultrasonography (US) for detecting femoral head decentration in children with cerebral palsy (CP) and developmental dysplasia of the hip (DDH), comparing it with traditional radiographic techniques to reduce radiation exposure.

Methods: A total of 169 patients were enrolled in the study. Both hips were evaluated in 158 patients, resulting in a total of 327 hips. Patients underwent clinical and radiological assessments, including standardized US. Parameters measured included the ventral and lateral bony and cartilaginous ultrasonographic migration indices (bUMI and cUMI), which were compared with standardized radiographic indices (Reimers index (RI) and extrusion index (EI)).

Results: The lateral bUMI (17.4%) was significantly lower than the lateral cUMI (25.9%). RI values were lower than EI values (16.8% vs. 27.7%). No significant differences were observed between the bUMI and RI, or between the cUMI and EI, indicating the reliability of US. All lateral parameters correlated well with the lateral centre-edge angle (LCE). Positive correlations were found between the lateral cUMI and the radiological indices, with high inter- and intra-rater reliability (ICC). Significant differences in lateral and ventral UMIs were noted when comparing DDH and CP patients.

Conclusion: US is a reliable alternative to radiography for hip surveillance in detecting hip decentration in children with CP and DDH. It reduces radiation exposure while maintaining diagnostic accuracy. The findings support the adoption of US in clinical practice to improve early diagnosis and intervention.

Purpose: The goal of surgery for pelvic metastasis is pain-free reconstruction that enables daily activity without complications for the patient's remaining life. The purpose of our study was to assess complications, reoperations, functional outcomes, and survival in patients with pelvic metastasis treated with standard or dual mobility total hip arthroplasty (THA) and antiprotrusio cage.

Methods: We prospectively analyzed 36 patients with pelvic metastasis who underwent reconstruction with standard (n = 20) or dual mobility (n = 16) bearing THA and antiprotrusio cage between 2015 and 2024 at a single institution. We evaluated complications, reoperations, functional outcomes and survival.

Results: Infection occurred in five of 36 patients (14%): three patients required surgical debridement and two were managed with antibiotics. No dislocations were observed in both standard and dual mobility bearing groups. Local disease progression developed in seven of 36 patients (19%), with only one patient requiring acetabular revision at 63 months postoperatively. Survival of implant was 85.8% (95% CI 74.9%-98.2%) at one year after reconstruction. Median MSTS scores were 22.5 and 20.0 in the standard and dual mobility bearing groups, respectively (p = 0.564), with no difference in ambulation status. Patient survival was 77.7% (95% CI 65.2%-92.6%) at one year and 12.8% (95% CI 4.5%-36.1%) at five years.

Conclusion: Patients with pelvic metastasis treated with standard or dual mobility bearing THA with antiprotrusio cage may effectively restore painless function. Despite high risk of infection and local disease progression, no dislocation occurred, supporting this reconstruction as an acceptable surgical option for patients with pelvis metastasis who need surgical treatment.

Purpose: This study aimed to assess the functional and radiological outcome of transpedicular fixation system for managing unstable sacral fractures in adults.

Methods: This prospective case series study included 21 patients with unstable type C sacral fractures according to AO Spine classification of sacral fractures. The patients were treated by a transpedicular fixation system connecting the lower lumbar spine to the ilium, as a vertical element, which was bilateral in seven cases and unilateral in 14 cases. A transverse element connecting both sides of the posterior pelvic ring was added to augment fixation in the transverse plane. The minimum period of follow-up was 12 months.

Results: Mean Majeed Score was 84,29 ± 9.97; excellent, good and fair classes were present in 14 (66.7%), five (23.8%) and two (9.5%) patients, respectively. There was a significant reduction of the vertical, anterior posterior and rotational displacement postoperatively in comparison to preoperative measures. There was a significant improvement in neurological deficit postoperatively. Eight (38.1%) patients developed complications postoperatively. Wound Infection was the most common complication.

Conclusion: The use of transpedicular fixation as a vertical element combined with a transverse element connecting both sides of the posterior pelvic ring, to treat unstable sacral fractures, offers adequate fixation strength that helps to achieve union in a well reduced position, leads to satisfactory functional outcome and improves neurological deficit.

Trial registration: (ID/NCT06888583) retrospectively registered.

Purpose: Eccentric rotational acetabular osteotomy (ERAO) is an effective treatment for acetabular dysplasia, but delayed union of the superior pubic ramus is a concern. This study identified risk factors for delayed pubic union post-ERAO and evaluated its clinical impact.

Methods: This retrospective study included 101 patients who underwent ERAO during 2014-2022, grouped according to one year pubic union status: union (n = 78) and delayed union (n = 23). We compared demographics, pre-and postoperative radiographic parameters (including lateral, anterior, and posterior centre-edge angles; acetabular sector angles; acetabular anteversion; pubic osteotomy site; and femoral head centre lateralisation), and clinical outcomes.

Results: Multivariate logistic regression identified older age (odds ratio [OR], 1.07; 95% CI, 1.00-1.13), a more medial pubic osteotomy site relative to the iliopectineal eminence (OR, 1.28; 95% CI, 1.10-1.49), and insufficient femoral head centre medialisation (OR, 1.40; 95% CI 1.12-1.74) as independent risk factors for delayed union. The pubic osteotomy site cutoff was 12.0 mm medial to the iliopectineal eminence (AUC 0.759). The delayed union group exhibited significantly higher rates of inferior pubic ramus stress fractures (17.4% vs. 1.3%, p = 0.009), although two year JOA scores were similar between groups.

Conclusion: Older age, pubic osteotomy more medial to the iliopectineal eminence, and insufficient femoral head medialisation are key risk factors for delayed pubic union after ERAO. While these factors did not directly affect hip function at two years postoperatively, they significantly increased the risk of inferior pubic ramus stress fractures. Therefore, accurate pubic osteotomy and careful avoidance of femoral head lateralisation are essential.

Purpose: Displaced intra-articular calcaneal fracture treatment may involve surgical intervention to restore the anatomy of the calcaneus and promote proper healing. Numerous surgical techniques, such as open reduction internal fixation (ORIF) or percutaneous fixation, have been utilized with varying degrees of success in achieving anatomical reduction and functional outcomes. However, complication rates are still high, and there is ongoing debate regarding the optimal surgical approach. This study presents a delta-frame triplanar external fixation technique combining intra- and extra-calcaneal distraction, specifically designed for Sanders III/IV fractures with soft-tissue compromise.

Methods: The technique combines intra-calcaneal and extra-calcaneal distraction principles to restore calcaneal morphology in three planes. 18 patients with Sanders type III and IV DIACFs were definitively surgically treated using a delta type triplanar fixator in a single stage between 2017 and 2020. Calcaneal restoration was achieved through the intra- and extra-articular distraction principle. Outcome measures included clinical, radiological and patient-reported outcomes including the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and the Foot and Ankle Disability Index (FADI).

Results: Eighteen patients (mean age 38 years) representing 26 fractures were evaluated. Two patients required subtalar arthrodesis by one year post injury. The post-operative Bohler and Gissane angles averaged 29.1° and 112.4°, respectively. Calcaneal inclination angle, height, and Böhler angle were restored within appropriate limits in all cases. At a mean follow-up of 52 ± 8.6 months (range 42 to 84 months), mean AOFAS and FADI scores were 82.5 and 85.5, respectively.

Conclusion: The delta-framed triplanar external fixation technique appears safe, yielding favorable radiological outcomes and a low complication rate in the management of displaced intra-articular calcaneus fractures. These findings suggest effective restoration of calcaneal anatomy using triplanar external fixation.