Journal of Orthopaedic Surgery最新文献

BackgroundThe utilization of all-suture anchors in coracoclavicular (CC) suture fixations offers satisfactory clinical advantages. This study aimed to compare the biomechanical properties of suture looping, conventional metallic anchors, and all-suture anchors in CC suture fixation in a synthetic bone model.HypothesisSuture looping for CC fixation would result in smaller cyclic elongation and greater ultimate pull-out strength than suture anchor techniques.MethodsA total of 27 composite scapula were divided into three groups: suture looping group (group L), metallic anchor group (group M), and all-suture anchor group (group A). In group L, two No. 2 braided sutures were looped into the coracoid base for CC fixation. In groups M and A, 5.0 mm metallic suture anchors and 2.8 mm all-suture anchors were used, respectively. Prepared specimens were secured using a material testing machine. Each specimen was tested with a preload between 0 and 20 N for 10 cycles, cyclic loading between 20 and 70 N for 1000 cycles, and final loading to failure. Cyclic elongation, linear stiffness, ultimate load, and failure modes were recorded.ResultsAll the specimens were subjected to cyclic loading tests. Elongation after cyclic loading in group L (1.0 ± 0.2 mm) was significantly smaller than that in groups M (1.4 ± 0.2 mm) (p = .002) and A (2.5 ± 1.1 mm) (p < .001). Cyclic elongation in group M was also significantly lower than that in group A (p = .004). Ultimate failure load in group L (472 ± 53 N) was significantly greater than that in group M (380 ± 35 N) (p = .002) and A (354 ± 94 N) (p = .010). Suture rupture was the most common failure pattern in group L, whereas two specimens failed because of a coracoid fracture. Both suture rupture and anchor pull-out were common in groups M and A.ConclusionsThe suture looping technique in CC fixation provides a significantly smaller cyclic displacement and greater ultimate failure load than metallic and all-suture anchors. The clinical relevance is that smaller cyclic elongation and greater ultimate failure load imply a reduced risk of fixation construct failure.

PurposeThe aim is to explore the impact of rotator cuff repair on sleep quality and its correlation with postoperative pain and recovery.MethodsA prospective cohort study from December 2022 to May 2023 was conducted on 28 patients undergoing arthroscopic rotator cuff repair. Pre- and postoperative sleep quality was assessed using the Korean version of the Pittsburgh Sleep Quality Index (K-PSQI), and pain was measured using the pain visual analog scale (pVAS). Sleep duration was monitored using Fitbit Inspire 2 trackers post-surgery. Statistical analyses were conducted to evaluate the relationship between sleep quality, pain, and postoperative recovery.ResultsThe mean preoperative PSQI score (9.5 ± 6.0) indicated sleep disturbances, with elevations in sleep latency and disturbances. Six weeks post-surgery, PSQI decreased significantly to 6.4 ± 3.3 (p = .03), with marked improvements in sleep quality and efficiency. Mean pVAS scores consistently declined post-operation, while sleep duration increased. A statistically significant correlation (p < .05) existed between pVAS score reduction and sleep duration increment. Additionally, preoperative PSQI scores significantly correlated with 'Daily pVAS decrease' and 'Daily sleep duration increase'.ConclusionsWe demonstrate that rotator cuff repair leads to improvements in sleep quality and reductions in pain. However, the persistently high postoperative PSQI scores suggest that sleep disturbances may not be entirely resolved by surgery alone. These findings highlight the need for comprehensive perioperative care in rotator cuff tear patients, incorporating both surgical and non-surgical strategies to manage sleep disturbances and enhance overall patient outcomes.Level of evidenceLevel III, Prospective cohort study.

PurposeThe primary objective of this study was to establish the anatomical landmarks intra-operatively to serve as safe zones at the wrist joint during percutaneous K-wire fixation of closed perilunate dislocation(PLD). The study then correlated the same landmarks in cadavers to look for potential neurotendinous injuries.MethodsA cohort of 10 individuals with closed acute peri lunate dislocation underwent closed reduction and percutaneous K-wire pinning. We identified the precise locations for the K-wire entrance and the angle of trajectory for a diamond construct using prominent bone landmarks. We subsequently repeated the process on five cadaveric wrists to establish the accuracy of landmarks and safety of trajectory. We assessed the correctness of the K-wire trajectory using radiographic imaging. The five cadaveric wrists were later dissected to determine the precise trajectory of the K-wire and ascertain whether critical structures like the superficial radial nerve, the dorsal sensory ulnar nerve and the extensor tendons were compromised during the procedure. The clinical cohort was examined for any postoperative complications related to the K-wire placement postoperatively.ResultsWith well-defined anatomical landmarks and a constant angular trajectory, we could achieve the diamond construct in all the cases of acute PLD. We avoided injury to the vital structures and confirmed the safety of these landmarks with the cadaveric correlation. None of the patients exhibited any sensory loss or pain and or any finger or wrist extension deficits postoperatively.ConclusionThe anatomical described landmarks have produced a consistent fixation pattern and would help surgeons mark the entry points with great accuracy while performing closed reduction of acute PLD.

BackgroundThrombocytopenia leads to increased postoperative complications and mortality in elective surgeries.Questions/purposesSpecific roles of thrombocytopenia on outcomes in orthopedic surgery remain relatively unexplored. This study aimed to assess the impact of chronic thrombocytopenia on outcomes of metastatic spinal tumor surgery.Patients and MethodsData from the United States Nationwide Inpatient Sample database 2005 to 2018 were examined. Patients ≥20 years old with metastatic spinal tumors undergoing surgery were identified. Propensity score matching (PSM) was used to balance the baseline characteristics between patients with and without chronic thrombocytopenia. Associations between chronic thrombocytopenia and hospitalization outcomes were determined by logistic regression analyses, adjusted for demographic and clinical factors.ResultsAfter PSM, a total of 8915 patients were included in the analysis. Chronic thrombocytopenia was associated with increased risk of in-hospital mortality (adjusted odds ratio [aOR] = 2.28; 95% confidence interval [CI]: 1.82-2.86), prolonged length of stay (aOR = 1.89; 95% CI: 1.67-2.14), non-home discharge (aOR = 1.52; 95% CI: 1.35-1.71), and perioperative complications (aOR = 3.14; 95% CI: 2.79-3.54) compared to no chronic thrombocytopenia (all, p < .001). Chronic thrombocytopenia was also significantly associated with increased risk of acute respiratory distress (ARDS) syndrome/respiratory failure (aOR = 2.49), tracheostomy/mechanical ventilation (aOR = 2.49), acute kidney injury (AKI) (aOR = 1.71), venous thromboembolism (aOR = 1.87), transfusion (aOR = 2.41), acute postoperative hemorrhagic anemia (aOR = 2.44), hematoma/seroma (aOR = 2.13), shock (aOR = 2.74), and sepsis (aOR = 1.56).ConclusionChronic thrombocytopenia is a strong independent predictor of worse outcomes following surgery for metastatic spinal tumors.Clinical RelevanceWhen managing these patients' careful consideration of thrombocytopenia is imperative for informed decision-making.

BackgroundThe suture-bridge technique (SBT), with its various modifications, is frequently utilized in rotator cuff tear repairs. This study aimed to assess and compare the clinical and radiological tendon integrity outcomes of conventional and triple-row SBTs in patients with full-thickness rotator cuff tears (RCTs). Additionally, it evaluated the construct strength of each technique through biomechanical experiments. We hypothesized that the triple-row SBT would yield better clinical and radiological outcomes, as well as superior biomechanical properties, compared to the conventional SBT.MethodsA retrospective evaluation was conducted on 62 patients who underwent arthroscopic rotator cuff repair using either conventional or triple-row SBT from January to December 2019. The conventional SBT was performed on 26 patients, while the triple-row SBT was used on 36 patients. Clinical evaluations were conducted preoperatively, and at 1 and 2 years post-surgery using the ASES; UCLA; Constant scores; and VAS scores. Magnetic resonance imaging was performed before surgery, and the postoperative rotator cuff integrity was evaluated 6 months after surgery. Mechanical testing on seven pairs of sawbone and allodermal patch models was also performed. These specimens underwent horizontal and vertical axial load tests on a material testing machine, and the ultimate failure load was measured.ResultsBoth techniques significantly improved the clinical outcomes at postoperative 1 and 2 years (p < .001), with no significant difference between-group (p > .05). The retear rate was 19.2% in the conventional group and 11.1% in the triple-row group, but the difference was not statistically significant (p = .379). The failure load of the triple-row suture-bridge technique was higher than that of conventional suture-bridge technique.ConclusionBoth the conventional and triple-row SBT techniques were effective in achieving favorable clinical outcomes in patients with full-thickness rotator cuff tears, with no statistically significant differences between the two groups. Although the triple-row technique suggested a potential for a reduced retear rate, the difference was not statistically significant. However, in our biomechanical study, the triple-row SBT demonstrated superior mechanical stability compared to the conventional technique. Specifically, the triple-row configuration showed greater resistance to displacement under cyclic loading and improved load distribution across the repair site. These findings suggest that the triple-row SBT may offer biomechanical advantages that could contribute to enhanced structural integrity of the repair, especially in challenging cases.

BackgroundDistal chevron osteotomy is a common procedure for hallux valgus. Alteration of the osteotomy axis and angle can result in excessive change in length of the first metatarsal and hence the increased risk of transfer metatarsalgia. However, many of the Chevron osteotomies were performed freehand without objective guidance.MethodTwo surgeons with different experience levels (Resident trainee, consultant) using two techniques (freehand or with cutting guide) to perform 15 distal chevron osteotomies on 3D-printed identical first metatarsal sawbone models. The medial cutting angle and lateral exit angle and their difference were analysed. The time taken for each osteotomy was also recorded.ResultsThe use of cutting guide brought the medial angle significantly closer to the desired angle of 60° (as described by Austin) for both surgeons, regardless of experience. The lateral angle was significantly closer to 60° in the consultant subgroup.ConclusionThe study demonstrated that the cutting guide improves accuracy in the osteotomy angle of distal Chevron osteotomy in hallux valgus surgery, regardless of level of experience of the surgeon. Precise osteotomy angles are critical for optimising hallux valgus deformity correction in clinical practice. The cutting guide reduces inter-surgeon variability, enabling less experienced surgeons to achieve reliable results. By standardising the technique, it enhances procedural consistency. While these findings suggest improved reliability for hallux valgus correction, further clinical studies are required to evaluate the direct impact on patient outcomes.

IntroductionFractures of the tibia and fibula occurring at the same level can be technically challenging. Fibular plating (FP) prior to intramedullary nailing (IMN) may facilitate tibial reduction, stabilization, and subsequent tibial healing. The primary goal of this study was to compare tibial fracture healing between FP and no fibular plating (NFP) in patients with same-level distal third tibia/fibula fractures.MethodsPatients ≥18 years with distal third tibia/fibula fractures occurring at the same level were randomized to FP or NFP prior to infrapatellar IMN. Same-level fractures were defined as distal third tibia fractures with an ipsilateral supra-syndesmotic distal third fibula fracture. Intraoperative parameters, patient-reported outcome measures (PROMs), modified Radiographic Union Scale in Tibial fractures (mRUST) scores, radiographic alignment, and adverse events were recorded.Results30 patients were recruited, with 15 randomized to each group. There were no differences in baseline characteristics between groups. Total operative time was longer in FP compared with NFP (105.5 vs 65.8 minutes, p = .001). Mean duration of fibular fixation was 28.1 minutes (SD = 11.9). There was no difference in duration of IMN; however, less time was required to pass the guidewire in FP (4.5 vs 11.8 minutes, p = .01). Patients in FP had higher mRUST scores at 6 months, lower incidence of delayed union, and shorter fibular time-to-union. There were no differences in alignment between groups.ConclusionFibula-first fixation facilitated passage of the tibial guidewire and resulted in a modest improvement in the rate of tibia fracture healing. The results of this pilot study suggest that fibula-first fixation may be beneficial in patients with same-level distal third tibia/fibula fractures. Further research with larger sample sizes is needed to determine which patients may benefit most from fibula-first fixation.