International Orthopaedics最新文献

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.

Background: Malunions of tibial pilon fractures pose significant challenges for corrective reconstruction due to the solidly healed displaced fracture fragments and frequently defective articular cartilage. This study aims to introduce a joint-preserving reconstruction strategy for managing tibial pilon fracture malunions in young patients and to evaluate the clinical outcomes.

Methods: We retrospectively analyzed 39 patients (mean age: 32.7 ± 10.4 years) with malunions of tibial pilon fractures who were treated with corrective reconstruction surgeries from 2013 to 2021. This cohort included 11 patients who underwent corrective intra-articular osteotomy, 17 who received combined osteoperiosteal iliac autograft transplantation, and 11 who underwent combined osteochondral autograft transplantation. The median duration from the initial injury to joint-preserving treatment was 7.4 months (interquartile range [IQR], 4.4-11.1). Radiographic assessments included plain radiographs and computed tomography (CT) scans. Clinical outcomes were evaluated using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the 36-Item Short Form Health Survey (SF-36) score, and ankle range of motion (ROM).

Results: After a median follow-up of 41.5 months, patients showed significant improvements in pain and function. The median VAS score improved from 5 (IQR, 6-7) to 2 (IQR, 1-3), and the median AOFAS score increased from 42 (IQR, 33-58) to 79 (IQR, 73-87) (P < 0.001). The mean SF-36 scores increased from 37.2 ± 12.2 to 71.2 ± 9.6 (P < 0.001), and the median ankle ROM improved from 20 degrees (IQR, 16-30) to 25 degrees (IQR, 20-34) (P = 0.004). Major complications included two patients requiring reoperation, and two patients progressing to radiographic end-stage arthritis; however, the pain remained tolerable, and no secondary arthrodesis or arthroplasty was performed by the final follow-up.

Conclusion: Joint-preserving corrective reconstruction surgeries can offer reasonable improvement over a four-year follow-up period, making them a viable alternative for the reconstruction of tibial pilon fractures malunions in young patients.

Purpose: Fractures in persons with haemophilia (PWH) exhibit similarities and distinctions compared to typical fractures. However, complications confer an added increase in the risk of fractures. This study aimed to summarize the treatment experience of fractures in PWH based on a classification.

Methods: A retrospective cohort study was conducted on PWH between 2001 and 2023. The classification was developed into three types according to PWH's clinical presentations and imaging findings. Subsequently, the distribution and distinctions among subtypes were analyzed, followed by an exploration of risk factors for fracture-related complications.

Results: A total of 61 fractures in PWH met the inclusion and exclusion criteria. The median follow-up duration was 6.87 years. Type II and III fractures in PWH exhibited a longer time of fracture healing and hospital stay, along with increased fracture-related complication rates. In further analysis, the operative time and intraoperative blood loss also increased significantly. Furthermore, compared to non-surgical approaches, the surgical treatment appeared to reduce the incidence of fracture-related complications. Next, the femur was identified as the most frequently fractured site. Plate fixation was the predominant surgical approach for types II (20/29) and III (8/13).

Conclusion: This study reviews treatment experience for fractures in PWH according to a classification and stresses the importance of surgery. The classification may provide a potential strategy for post-operative care. However, further classification is required.

Purpose: Platelet-rich plasma (PRP) is a promising orthobiologic therapy for musculoskeletal pathologies. However, its clinical application is influenced by varying legal and regulatory frameworks across regions. This narrative review aims to discuss the regulatory and legal framework for PRP therapy in musculoskeletal pathologies in South America.

Methods: The authors searched and reviewed contemporary literature on laws and regulations governing platelet-rich plasma use for musculoskeletal pathologies in South America in electronic databases, summarising the findings in a narrative review.

Results: PRP regulation in South America falls into three categories: (1) countries with clear regulatory frameworks (Argentina, Bolivia, Colombia, Peru), where PRP is legally recognised and governed by specific provisions; (2) countries with emerging or developing regulations (Chile, Ecuador, Paraguay, Suriname, Uruguay, Venezuela, Guyana), where PRP is indirectly regulated under broader blood or tissue laws; and (3) countries permitting PRP only for experimental or research purposes (Brazil). Despite regional efforts to align with international standards, significant disparities exist in legal clarity, safety protocols, and clinical guidelines. These inconsistencies pose risks such as unregulated medical tourism and hinder scientific progress.

Conclusion: PRP in South America presents three distinct regulatory scenarios: clear, established regulations; emerging or developing frameworks; and use restricted to experimental or research contexts. While most countries align with international safety standards, significant variation persists in how orthobiologics are clinically governed. The future challenge is to unify these regulations and build an international consensus on processing standards that guarantee patient safety and quality, while enabling innovation and legal clarity for clinicians.

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.

Objective: Debridement, antibiotics, and implant retention (DAIR) is a widely used surgical approach for managing acute prosthetic joint infection (PJI) following knee arthroplasty (KA). However, limited studies have explored its application across different KA types. This study aims to compare the clinical outcomes of DAIR in acute PJI following unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA), with a focus on microbial profiles, treatment characteristics, and patient outcomes.

Methods: We retrospectively reviewed clinical data from 67 consecutive patients diagnosed with acute PJI, as defined by the Musculoskeletal Infection Society (MSIS) criteria, who underwent DAIR at our institution between January 2016 and April 2023. Patients were categorized into two groups based on the type of primary arthroplasty: 51 in the TKA-DAIR group and 16 in the UKA-DAIR group. Comparative analyses included pre- and postoperative serological inflammatory markers, microbiological findings, knee functional outcomes, and infection recurrence rates.

Results: Coagulase-negative staphylococci were the most frequently isolated organisms in both the TKA-DAIR (37.3%) and UKA-DAIR (43.8%) groups. On postoperative day one, ESR and CRP levels showed no significant differences between groups. However, by postoperative day three, the UKA-DAIR group exhibited significantly lower ESR (P = 0.005) and CRP (P = 0.007) levels, a trend that persisted through day five (ESR, P = 0.014; CRP, P = 0.015). At two year follow-up, there were no significant differences between groups in HSS knee scores (P = 0.107), VAS pain scores (P = 0.531), or range of motion (ROM; P = 0.128). Notably, Kaplan-Meier survival analysis demonstrated a significantly lower infection recurrence rate in the UKA-DAIR group over the two year follow-up period (P = 0.041).

Conclusion: In cases of acute PJI following UKA, where MRI confirms that the contralateral compartment remains uninvolved and the causative pathogen is clearly identified, DAIR yields superior clinical outcomes compared to TKA. This may be attributed to the reduced prosthetic surface area in UKA and the retention of native cartilage, which may serve as an effective barrier against infection. Based on these findings, we recommend DAIR as the preferred treatment strategy for acute UKA PJI under these conditions.