Journal of Orthopaedic Surgery最新文献

PurposeWe aimed to compare radiological and clinical results between patients diagnosed with Intraosseous ganglion cysts of the lunate (IGCL)-treated arthroscopic dorsal ligamento capsulodesis (ADLC) with or without grafting.Methods26 patients who underwent wrist arthroscopy with the diagnosis of intraosseous ganglion cysts of the lunate were included in the study. The patients in the series were divided into two groups according to the surgery they underwent: patients who underwent isolated ADLC in group A and ADLC with autografting in group B. The wrist range of motion, patient satisfaction, Visual Analogue Scale (VAS) and the Mayo Wrist Score (MWS) were used for clinical and functional results.ResultsGroup A consisted of 12 (7 females - 5 males), Group B consisted of 14 (9 females - 5 males). The mean age was 33,1 years in Group A (range 22-49), and 32,3 years in Group B (range 21-47). The VAS, Mayo Wrist Score, wrist range of motion, and the level of patient satisfaction were similar in the two groups. In Group A, the postoperative mean cyst diameter (CD) was 4.2 (range: 1.3 - 7.3 mm), comparable to the mean cyst diameters before surgery. In Group B, trabeculation was observed in 13 patients, and CD was not calculated. Only one patient in Group B had a 3.5 mm (preoperative 3.6 mm) cyst, attributed to graft lysis.ConclusionAs we have observed scapholunate instability at different stages in this case series diagnosed with IGCL, we believe that the source of pain is related to instability and treatment should focus on the existing instability. This hypothesis is supported by our obtaining similar results when comparing only ADCLs for instability, which were chosen according to our clinical experience, with those who underwent ADCLs with bone grafting.

Background: This study evaluated a novel treatment for scaphoid nonunion combining pulsed CO₂ gas arthroscopy, autologous iliac bone grafting, and robot - navigated screw fixation. Methods: 18 patients (mean age 34 ± 5 years, injury duration 19 ± 7 months) with scaphoid nonunion underwent surgery. The procedure included pulsed CO₂ gas arthroscopy for improved visualization, autologous iliac bone grafting for fracture healing, and robot - navigated screw fixation for stability. Postoperative care involved immediate mobilization, electromagnetic therapy, physical therapy, and short - arm splint immobilization until union. Results: Mean surgical time was 103 ± 35 minutes, with CO₂ - assisted grafting taking 23.3 ± 6.2 minutes. Average blood loss was 80 ± 25 mL, and hospital stay was 4.0 ± 1.5 days. The scapholunate angle decreased from 61.8 ± 11.6° preoperatively to 52.9 ± 7.0° postoperatively (p < .001). Fracture union rates reached 38.9% at 2 months, 88.9% at 3 months, and 100% at 6 months. All patients had accurate screw positioning with no infections or loosening. At 6 months, mean grip strength was 36 kg, pinch strength was 9.0 kg, and the Modified Mayo Wrist Score was excellent in 15 cases and good in 3. Conclusion: By prioritizing vascular preservation through minimally invasive optics and precision fixation, this CO₂-robotic integrated approach achieved superior union rates. The paradigm shift from fluid irrigation to gas-phase visualization may redefine standards in extremity arthroscopy.

BackgroundThe study aims to evaluate the influence of tranexamic acid (TXA) on clinical outcomes in patients with elbow stiffness undergoing elbow arthrolysis.MethodsA systematic review of records up to December 2024 was conducted to screen research examining the role of TXA in patients with elbow stiffness undergoing elbow arthrolysis. The primary outcomes of interest included blood transfusion, hematoma formation, operative time, postoperative pain measured by the Mayo Elbow Performance Score (MEPS), Visual Analog Scale (VAS), total blood loss, changes in hemoglobin, drain output, and complications.ResultsFollowing an extensive search of relevant databases, a total of seven studies involving 995 patients (491 in the TXA group and 504 in the non-TXA group) undergoing elbow arthrolysis were included. The pooled analysis showed that TXA administration was associated with a significant reduction in total drain output (MD = -55.34, 95% CI: -80.67 to -30.02, p = .0001) and blood loss (MD = -39.07, 95% CI: -69.71 to -8.43, p = .01) compared to non-TXA group. Furthermore, patients treated with TXA had higher postoperative hemoglobin levels (MD = 11.73, 95% CI: 8.74 to 14.73, p = .00001). No significant differences were observed in operative time, tourniquet time, or functional outcomes as measured by MEPS, VAS, or range of motion (ROM). The pooled results indicated that TXA was associated with a significant reduction in hematoma formation (RR = 0.43, 95% CI: 0.19 to 0.97, p = .04) compared to the non-TXA group. However, no significant differences were found in other complications.ConclusionThe perioperative use of tranexamic acid is an effective strategy to reduce postoperative drainage in elbow arthrolysis while preserving joint function.

PurposeAlthough clavicular fracture nonunion is uncommon, it can lead to pain and alterations in clavicular length, potentially affecting shoulder function. This study investigated the relationship between clavicular length changes and clinical outcomes following nonunion treatment.MethodsThis retrospective study included 30 patients who underwent surgical treatment for clavicular nonunion between January 2013 and December 2021. The clavicle length was measured pre- and postoperatively using anteroposterior radiography. Clinical evaluation involved measuring pre- and postoperative outcomes using the Constant-Murley scoring system. Subgroup analysis was performed by dividing patients into two groups based on the median clavicle length difference.ResultsThe mean age was 45.8 years, and the mean follow-up period was 5.8 years. Osseous union was achieved in all cases. The mean clavicle length difference was 5.57 ± 8.45 mm, indicating a predominance of shortening in the affected clavicle. Functional outcomes demonstrated significant improvement following surgical intervention (p < .001). A weak negative correlation (r = -0.19, p = .296) was observed between clavicle length difference and score improvement. Subgroup analysis revealed no statistically significant differences in clinical outcomes between the low and high length difference groups (p = .757).ConclusionSurgical treatment of clavicular nonunion results in significant functional improvement. However, the extent of clavicular length change does not appear to be a major determinant of clinical outcomes. This finding has important implications for surgical planning and patient management in cases of clavicular nonunion.

Purpose: The purpose of this study was to evaluate the role of preoperative spinal flexibility in guiding osteotomy selection for idiopathic scoliosis (IS) surgery. Specifically, it aimed to identify a flexibility threshold to optimize the decision-making process between Grade I (Facet Joint Osteotomy, FJO) and Grade II (Ponte Osteotomy, PO) osteotomy techniques. Methods: This retrospective study included 77 IS patients who underwent osteotomy surgeries performed by two experienced spine surgeons at our hospital between 2018 and 2023. Based on the osteotomy type, patients were divided into the FJO group (n = 41) and the PO group (n = 36). Demographic data, preoperative spinal flexibility (measured as the ratio of curve correction on bending X-rays to the standing Cobb angle), and surgical correction rates were compared. Restricted cubic spline (RCS) analysis was used to identify the flexibility threshold. Complication rates, hospital stay duration, and blood loss were also analyzed. Results: RCS analysis identified a flexibility threshold of 0.657. Below this threshold, PO achieved superior correction rates, while above it, FJO showed comparable correction outcomes with fewer complications, shorter hospital stays, and lower blood loss. Spinal flexibility was significantly correlated with surgical outcomes, and the type of osteotomy influenced correction rates and complication severity. Conclusion: Preoperative spinal flexibility is a critical factor in osteotomy selection for IS surgery. PO is recommended for flexibility <0.657, while FJO is preferred for higher flexibility. Flexibility-based surgical planning can improve correction outcomes, minimize complications, and enhance recovery in IS patients.

Purpose: Popliteal artery (PA) injury during knee surgery poses significant challenges for orthopedic surgeons. This study aims to determine the precise distance between the PA and anatomical landmarks of the knee joint and identify influencing factors using knee magnetic resonance imaging (MRI), in order to establish targeted preventive measures for knee surgery based on the actual situation of the patient. Methods: We conducted a retrospective analysis of knee MRI scans from 172 patients. Patients were categorized into two groups: the osteoarthritis group (Group A) and the non-osteoarthritis group (Group B). We measured the shortest distance from the PA to the posterior femoral condyle (PFC), posterior horn of the lateral meniscus (PHLM), posterior wall of the joint capsule (JC), and the posterior tibial cortex (PTC) located 10 mm below the articular surface on MRI axial views. And we also analyzed the effects of age, height, weight, BMI, and leg circumference on the aforementioned distances. Results: The four distances in Group A were significantly greater than those in Group B. Height and thigh circumference mainly correlated with distance from the PA to the posterior femoral condyle. Height and weight mainly correlated with distance from the PA to posterior horn of the lateral meniscus. Weight, BMI, and calf circumference mainly correlated with distance from PA to posterior tibial cortex. Conclusions: The distance between the popliteal artery and the posterior bony landmarks of the knee joint increases in patients with osteoarthritis, higher stature, bigger weight, thicker leg circum ference and elderly patients, which maybe can reduce the risk of popliteal artery injury during surgical procedures.

Background: For total hip arthroplasty (THA), a number of different femoral stem designs exist, each offering potential benefits and risks to patients. Preparation and implantation of the femoral component may be performed with manual instrumentation or with automated broaching systems. The combination of stem and femoral preparation choice may influence patient outcomes. The purpose of this study was to report on a large consecutive series of a collared, triple tapered, cementless stem broached and impacted with an automated system through a mini-posterior approach. Methods: 1021 consecutive THAs with a cementless triple-tapered fully coated titanium femoral stem performed by a single surgeon via a minimally invasive posterior approach all utilizing automated broaching (AB) were collected retrospectively. Patient demographic data, proximal femoral anatomical features, radiographic outcomes (e.g., subsidence), PROMIS scores, and intra-operative and postoperative complications were collected and analyzed. Results: 7/1021 (0.68%) intra-operative calcar fractures and 11/1021 (1.08%) postoperative periprosthetic femoral fractures were observed. The average postoperative subsidence was 0.5 mm. Subsidence was not associated with age, BMI, or proximal femoral anatomy (Dorr C). There were no revisions for postoperative mechanical loosening or instability. No increase in periprosthetic fracture was noted amongst the first 100 cases using AB (0/100) when compared to the subsequent 100 (0/100). All patients experienced statistically significant improvement in PROMIS scores postoperatively at 1-year follow-up. Conclusion: This large, consecutive, single surgeon series demonstrates excellent results of the aforementioned stem prepared and impacted with AB. At mid-term follow-up, there were no revisions for mechanical loosening and all-cause survivorship was 98.2%.

Micromotion-defined as controlled cyclic axial movement at the fracture site-has emerged as a promising approach to enhance bone fracture healing. This review aims to evaluate micromotion-based fixation systems across biomechanical, preclinical, and clinical domains, highlighting their benefits, limitations, and technological progress. We summarize key micromotion technologies applied across various fixation systems, including far cortical locking and dynamic locking mechanisms in screws, suspension-based and shape-memory alloy-driven adjustments in plates, dynamization approaches in intramedullary nails through selective removal of interlocking components, and the evolution of external fixators from manually adjusted systems to intelligent, sensor-guided constructs such as the OrthoSpin frame.While internal fixations often rely on passive micromotion with limited controllability and potential safety concerns, external systems allow precise control but lack consensus on optimal stimulation parameters. Future advancements should focus on integrating real-time sensing and adaptive feedback to tailor micromotion based on healing stages and patient-specific needs.

Background: In deltoid ligament (DL) augmentation for the treatment of ankle fracture with both syndesmosis and DL injuries, the exact suture anchor insertion point of the ligament on the talus is likely to influence the repair strength. However, the ideal anchor position remains unclear. This biomechanical study aimed to compare the external rotation stability between cadaveric ankle fracture models with different insertion sites of the suture anchor. Methods: This biomechanical study evaluated seven formalin-fixed cadaveric ankle specimens. An ankle injury model with both syndesmotic disruption and DL injury was created and two suture anchor placements were tested: anterior and central placement on the talus side of the DL insertion footprint. External rotation stability was assessed by measuring the medial clear space and tibiofibular clear space. Results: There was no significant difference between the two groups in the tibiofibular clear space widening (p > .05). However, the anterior placement of the suture anchor significantly reduced the medial clear space widening compared with central placement (p < .05), suggesting better resistance to external rotation and talar anterior dislocation. Conclusions: Anterior placement of the suture anchor in DL augmentation may offer improved stability against external rotation forces in ankle fractures with syndesmotic and DL injuries. This study provides biomechanical evidence supporting the potential advantages of this technique.

BackgroundLateral hinge fracture (LHF) is a known complication of open-wedge high tibial osteotomy (OWHTO), potentially resulting in postoperative instability, displacement, loss of correction, malunion, and non-union. This study tested the hypothesis that patients who develop LHF after OWHTO can achieve clinical outcomes comparable to those without LHF, without requiring additional surgical intervention.MethodsThis retrospective study included 96 patients who underwent OWHTO with a locking plate between 2019 and 2021. Postoperative radiographs and computed tomography (CT) scans identified LHF in 24 patients (25%). Lower limb alignment was assessed using whole-leg standing radiographs at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) score, Knee Society Knee Score (KS), and Function Score (FS).ResultsIn patients with LHF, the mechanical axis was 59.0 ± 7.4% at 6 weeks, 57.7 ± 7.8% at 3 months, 55.9 ± 9.5% at 6 months, and 53.9 ± 12.2% at 12 months. In patients without LHF, the corresponding values were 58.5 ± 6.1%, 57.8 ± 6.7%, 56.7 ± 7.0%, and 55.6 ± 7.4%, respectively. Although the mechanical axis decreased by 5.2% in the LHF group and 2.9% in the non-LHF group by 12 months, the difference was not statistically significant (p = .219). Similarly, the longitudinal change in alignment did not differ significantly between groups (p = .743). Postoperative clinical scores improved in all patients, with no significant differences between groups regardless of LHF status.ConclusionPatients who experienced LHF following OWHTO demonstrated comparable clinical outcomes and alignment correction to those without LHF, suggesting that LHF does not adversely affect postoperative results.