Journal of orthopaedics最新文献

{"title":"Preoperative external rotation lag sign doesn't diminish the efficacy of arthroscopy-assisted lower trapezius tendon transfer in posterosuperior irreparable rotator tears","authors":"Chang Hee Baek,&nbsp;Chaemoon Lim,&nbsp;Jung Gon Kim,&nbsp;Bo Taek Kim,&nbsp;Seung Jin Kim","doi":"10.1016/j.jor.2024.12.044","DOIUrl":"10.1016/j.jor.2024.12.044","url":null,"abstract":"<div><h3>Introduction</h3><div>The purpose of this study is to compare the clinical outcomes according to preoperative external rotation (ER) status, comparing patients with a preoperative ER lag sign (ERL group) to those with preoperative no ER lag sign (non-ERL group) in arthroscopy-assisted lower trapezius tendon transfer (aLTT) for posterosuperior rotator cuff tears (PSIRCTs).</div></div><div><h3>Methods</h3><div>This retrospective study reviewed 107 patients who were treated with aLTT for PSIRCTs between 2017 and 2022. The patients were divided into ERL group (n = 20) and non-ERL group (n = 87). Clinical outcomes were evaluated with shoulder pain, patients-reported clinical scores, active range of motion (aROM) and strength of aROM. Radiologic outcomes were evaluated with acromiohumeral distance and Hamada classification. The relationship between trophicity of teres minor (Tm) and clinical outcomes was evaluated.</div></div><div><h3>Results</h3><div>Preoperative patients-reported clinical scores, aROM, and strength of aROM were significantly lower in ERL group. Although a significant improvement of postoperative pain score, patients-reported clinical scores, aROM, and strength of aROM was observed in both groups, these postoperative outcomes were significantly lower in ERL group. However, the mean improvement of Constant score, University of California, Los Angeles (UCLA) score, and activities of daily living that require active external rotation (ADLER) score, forward elevation (FE), abduction, external rotation (ER) were significantly higher in ERL group than that of non-ERL group. Moreover, there was a significant correlation between Tm trophicity and postoperative Constant, UCLA, American Shoulder and Elbow Surgeons score, ADLER, FE and ER.</div></div><div><h3>Conclusion</h3><div>aLTT can be a reliable treatment option and should be considered as primary joint-preserving treatment option for patients with PSIRCTs regardless of preoperative ER lag sign.</div></div><div><h3>Level of study</h3><div>Level IV.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 27-33"},"PeriodicalIF":1.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical evaluation of therapeutic efficacy of Teriparatide in osteoporotic patients with vertebral degeneration","authors":"Masoud Mirkazemi ,&nbsp;Behdad Nadimi ,&nbsp;Parnin Soltani ,&nbsp;Golshan Eslami ,&nbsp;Yasaman Parvisi ,&nbsp;Maryam Garousi ,&nbsp;Azra Izanloo","doi":"10.1016/j.jor.2024.12.045","DOIUrl":"10.1016/j.jor.2024.12.045","url":null,"abstract":"<div><h3>Background/objective</h3><div>Osteoporosis is a common age-associated bone disease characterized by the decreased bone density and compromised bone strength. Osteoporotic patients are always at a risk of severe fractures and they experience chronic lumbar pain, highlighting the need for an effective treatment while having lowest side effects. This clinical evaluation of three years from 2018 to 2021 at a single clinic in western Tehran, Iran was aimed to evaluate the therapeutic effects of a biosimilar recombinant teriparatide traded as ‘Cinnopar®’ to alleviate the back pain and manage thoracolumbar osteoporosis.</div></div><div><h3>Methods</h3><div>In this study, a total of 180 osteoporotic patients diagnosed with lower back pain, were enrolled and later on 14 patients were excluded from the study due to lack of cooperation or follow-up. Patients were randomly assigned into two groups, one those who are willingly will be receiving CinnoPar® and second group who will be receiving bisphosphonates at an optimal monthly dose. Data was collected through reviews of medical records and comprehensive regular follow-up was performed via phone interviews to evaluate bone density and pain levels during specific intervals of time. Oswestry Disability Index (ODI) was developed and Short Form Health Survey (SF-36) was performed to analyses the results from two under treatment groups.</div></div><div><h3>Results and conclusion</h3><div>Significant improvement in pain and functional ability was observed in the patients who received CinnoPar® after two years as compared to the bisphosphonate group (P &lt; 0.05). It was also reported that patients who received CinnoPar® showed improvements in social functioning and pain reduction over the same period of time (P &lt; 0.05). CinnoPar® showed promising results and fall under a minimally invasive treatment category for reducing the lower back pain and managing osteoporosis in lumbar and thoracic vertebrae while having few side effects.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 104-109"},"PeriodicalIF":1.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes after revision total shoulder arthroplasty with pectoralis major transfer","authors":"Akshar V. Patel,&nbsp;David E. Kantrowitz,&nbsp;Kevin Chen,&nbsp;Christopher A. White,&nbsp;Christoph A. Schroen,&nbsp;Lauren Zurek,&nbsp;Michael R. Hausman,&nbsp;Bradford O. Parsons,&nbsp;Evan L. Flatow,&nbsp;Paul J. Cagle","doi":"10.1016/j.jor.2024.12.046","DOIUrl":"10.1016/j.jor.2024.12.046","url":null,"abstract":"<div><h3>Background</h3><div>Irreparable tears of the subscapularis muscle pose a difficult problem to patients and the treating physician. Pectoralis major transfers (PMTs) are often used in patients with irreparable tears of the subscapularis muscle with good outcomes. Similarly, PMT used in conjunction with shoulder arthroplasty has been proposed for patients with deficient subscapularis muscles and end stage glenohumeral arthritis. The data for PMT done in the setting of shoulder arthroplasty is sparse in the literature. This study aims to be among the first to report on long-term outcomes for arthroplasty done concomitantly with PMT.</div></div><div><h3>Methods</h3><div>This is a retrospective case series of patients who underwent PMT for subscapularis tendon deficiency in conjunction with revision total shoulder arthroplasty (TSA) by a single surgeon between 2000 and 2017. Patients indicated for shoulder arthroplasty who had an irreparable subscapularis tear were considered for pectoralis major transfer. Exclusion criteria were lack of postoperative radiographic imaging and follow-up time of less than 12 months. Primary endpoints included shoulder range of motion and patient reported outcomes.</div></div><div><h3>Results</h3><div>5 patients were included. The mean time to the last follow-up visit for revision TSA was 10.0 years (range 3.3–15.1). Only one patient had increased passive external rotation at final follow-up. Implant survivorship was 100 %; there were no further revisions or surgical interventions. Forward elevation increased from 69 ± 57° to 100 ± 69°, external rotation was 42 ± 19° to 42 ± 26°, and internal rotation improved from L4 to L2. ASES scores improved from 25 ± 11 to 39 ± 26, SST scores increased from 3 ± 3 to 6 ± 3, and VAS scores decreased 8 ± 1 to 6 ± 2.</div></div><div><h3>Conclusion</h3><div>PMT with revision shoulder arthroplasty provides satisfactory range of motion and shoulder function in patients with irreparable subscapularis tears. This study evaluated mid-to long-term data and demonstrated favorable outcomes in revision TSA with PMT patients. TSA concomitant with PMT for a deficient subscapularis was particularly effective in improving stability, internal rotation, and reducing passive external rotation.</div></div><div><h3>Level of evidence</h3><div>IV, retrospective case series.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 92-97"},"PeriodicalIF":1.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical functioning before knee arthroplasty is not associated with (standardized) preoperative physiotherapy, but is tied to physical functioning 1-year post-surgery: A prospective cohort study","authors":"Tessel F. Bax ,&nbsp;Dirk Jan Hofstee ,&nbsp;Lucien C.M. Keijser ,&nbsp;Joyce L. Benner","doi":"10.1016/j.jor.2024.12.024","DOIUrl":"10.1016/j.jor.2024.12.024","url":null,"abstract":"<div><h3>Background</h3><div>and purpose This study investigates whether a (regionally) standardized physiotherapy approach, employing a stepped-care model, can more effectively enhance preoperative physical function in end-stage osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) and improve postoperative outcomes, addressing the current gap in understanding the impact of such interventions.</div></div><div><h3>Methods</h3><div>This mono-center observational prospective cohort study followed 216 primary UKA or TKA patients for one-year post-surgery. Preoperative physiotherapy, recorded through self-reported questionnaires, included standardization and treatment frequency details. Physical functioning assessments encompassed quadriceps and hamstrings muscle strength, functional mobility (FM), and range of motion (ROM). Statistical analyses comprised multivariate and single linear regression for both UKA and TKA groups.</div></div><div><h3>Results</h3><div>Standardized preoperative physiotherapy correlated with superior preoperative extension ROM in TKA patients (B = −3.557, 95 % CI [-.915; −.241]), while less than 10 treatments were associated with superior preoperative extension ROM for both groups (β = −.202, p = .030 and β = −.228, p = .045). No associations were found between location or treatment frequency and preoperative muscle strength or FM. For both groups, preoperative FM, ROM, and muscle strength positively correlated with postoperative levels, except for extension ROM for UKA patients (p = .178).</div></div><div><h3>Conclusion</h3><div>While adherence to standardized preoperative physiotherapy at an affiliated practice did not significantly correlate with preoperative physical functioning levels, a strong relationship exists between preoperative and one-year postoperative physical functioning levels.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 127-134"},"PeriodicalIF":1.5,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial lateral patellar facetectomy is beneficial for patients with patellofemoral osteoarthritis: A systematic review and meta-analysis","authors":"Kennan ZG. Yeo ,&nbsp;Mark HX. Yeo ,&nbsp;Shawn JS. Seah ,&nbsp;Winston SR. Lim ,&nbsp;Denny TT. Lie","doi":"10.1016/j.jor.2024.12.038","DOIUrl":"10.1016/j.jor.2024.12.038","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical treatment for patellofemoral osteoarthritis (PFOA) consists of soft tissue, bony, and arthroplasty interventions. Partial lateral facetectomy (PLF) is a bone-reducing procedure, commonly done in conjunction with soft tissue and realignment procedures, that has grown in popularity after failure of conservative treatment due to its efficacy and minimally invasive nature. This systematic review and meta-analysis thus seeks to evaluate the efficacy of PLF in the absence of reviews on this topic.</div></div><div><h3>Methods</h3><div>A systematic review of three databases (PubMed, EMBASE, Scopus) was conducted, identifying studies that evaluated postoperative outcomes of PLF on patients who had PFOA. Pairwise meta-analysis was conducted between preoperative versus postoperative values of a subjective outcome measure (Knee Society Score (KSS)) and radiographic outcome measure (Congruence Angle (CA)). Subgroup analysis was performed on different concomitant procedures aside from PLF to determine their effect on clinical outcomes.</div></div><div><h3>Results</h3><div>Ten studies were included in this review, with 463 patients and 495 knees and a pooled mean follow-up of 63.2 months and age of 56.3 years. Six studies investigated PLF with lateral release, two with realignment procedures, one with lateral lengthening, and one with both lateral release and realignment. Five studies found significant improvement (p &lt; 0.01) in KSS (34.45; 95%CI: 26.41 to 42.49, and four studies reported significant improvement (p &lt; 0.01) in CA (−10.31; 95%CI: 13.80 to −6.81). Subgroup analysis showed a significant difference in KSS between PLF with lateral release, lateral lengthening, and realignment (p &lt; 0.01) but not for CA (p = 0.65).</div></div><div><h3>Conclusion</h3><div>PLF is an effective treatment for PFOA using subjective and radiographic outcome measures. Current cohort studies have shown significant improvement in PFOA treatment, even in the context of long-term outcomes and severe PFOA, and provides valuable insight into the use of PLF as a viable minimally invasive surgical option to treat PFOA in addition to other procedures such as lateral retinacular release and realignment procedures.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 135-145"},"PeriodicalIF":1.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biceps tenodesis in the setting of total shoulder arthroplasty: A matched cohort analysis","authors":"Priya Singh ,&nbsp;Akiro H. Duey ,&nbsp;Troy Li ,&nbsp;Akshar V. Patel ,&nbsp;William A. Ranson ,&nbsp;Evan M. Michaelson ,&nbsp;Bradford O. Parsons ,&nbsp;Evan L. Flatow ,&nbsp;Paul J. Cagle","doi":"10.1016/j.jor.2024.12.042","DOIUrl":"10.1016/j.jor.2024.12.042","url":null,"abstract":"<div><h3>Background</h3><div>Studies have theorized that pain refractory to anatomic total shoulder arthroplasty (aTSA) in patients who did not undergo a concomitant biceps tenodesis or tenotomy may be as a result of the pathologic interaction between the long head of the biceps tendon and the humeral prosthesis. This study evaluates the effect of concomitant biceps tenodesis during aTSA on long-term clinical and radiographic patient outcomes.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed patients who underwent aTSA with or without biceps tenodesis from 2000 to 2017. Preoperative and postoperative range of motion (ROM), American Shoulder and Elbow Surgeons (ASES), Visual Analog Scale (VAS), and Simple Shoulder Test (SST) scores were collected. Patients in the biceps tenodesis group were matched with those who underwent aTSA without tenodesis based on age, follow-up interval, sex, and preoperative ASES score.</div></div><div><h3>Results</h3><div>The study included 88 shoulders (44 tenodesis, 44 no tenodesis), with median follow-up of 9.9 years (range 3.3–19.0). No significant differences were observed between cohorts in postoperative forward elevation, external/internal rotation, VAS, ASES, or SST scores at most recent follow-up. There were no significant differences in pre-to postoperative improvement in ROM and patient-reported outcome scores. Both groups demonstrated excellent implant survival, with similar revision rates at nearly 10 years postoperatively.</div></div><div><h3>Conclusions</h3><div>Patients who underwent aTSA with concomitant biceps tenodesis did not demonstrate inferior long-term clinical outcomes or pain scores in comparison to patients who underwent aTSA with preservation of the biceps tendon. Appropriately selected patients may experience equivalent, satisfactory outcomes after aTSA, independent of concomitant biceps tenodesis.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 98-103"},"PeriodicalIF":1.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Notchplasty in anterior cruciate ligament reconstruction: A systematic review of clinical outcomes","authors":"Maxwell Harrell ,&nbsp;Clay Rahaman ,&nbsp;Dev Dayal ,&nbsp;Patrick Elliott ,&nbsp;Andrew Manush ,&nbsp;Caleb Brock ,&nbsp;Eugene Brabston ,&nbsp;Thomas Evely ,&nbsp;Aaron Casp ,&nbsp;Amit M. Momaya","doi":"10.1016/j.jor.2024.12.040","DOIUrl":"10.1016/j.jor.2024.12.040","url":null,"abstract":"<div><h3>Introduction</h3><div>Notchplasty is an adjuvant procedure performed during Anterior Cruciate Ligament reconstruction (ACLR) with the purpose of widening the intercondylar notch of the femur. Its use is controversial due to its biomechanical influence on the knee and the potential for increased complications. The purpose of this systematic review is to evaluate the outcomes of patients who underwent ACLR with notchplasty.</div></div><div><h3>Materials and methods</h3><div>A systematic search of Cochrane, Embase, and Medline was conducted to identify papers evaluating clinical outcomes of patients who underwent ACLR with notchplasty. Inclusion criteria encompassed human studies with a control group, reporting clinical outcomes such as graft failure, graft rupture, range of motion values, and patient-reported outcomes.</div></div><div><h3>Results</h3><div>A total of 4 studies were included comprising 396 patients (129 with notchplasty, 235 without). No significant differences were reported regarding graft survivability or Lysholm score between those with notchplasty and those without. One study reported significantly reduced rates of revision surgery after ACLR with notchplasty. There were conflicting complication rates between studies regarding chronic synovitis and arthrofibrosis.</div></div><div><h3>Conclusion</h3><div>Patients who undergo notchplasty during primary ACLR have similar outcome scores and risk of graft failure compared to those who do not undergo notchplasty. Notchplasty patients may also be at a higher risk for loss of extension and chronic synovitis.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 54-59"},"PeriodicalIF":1.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic patterns of varus deformity among osteoarthritic knees during computer-navigation assisted total knee arthroplasty and their surgical implications","authors":"Apurve Parameswaran ,&nbsp;Abhijith Annasamudram ,&nbsp;Deepak Gautam ,&nbsp;Sunil Apsingi ,&nbsp;Chandra Sekhar Dannana ,&nbsp;Krishna Kiran Eachempati","doi":"10.1016/j.jor.2024.12.041","DOIUrl":"10.1016/j.jor.2024.12.041","url":null,"abstract":"<div><h3>Aims</h3><div>The aims of this study were to (a) identify the dynamic patterns of varus deformity among osteoarthritic knees, (b) describe their surgical implications, and (c) compare post-operative lower limb alignment, clinical outcomes and satisfaction among patients with different deformity patterns managed intra-operatively based on deductions drawn from the same.</div></div><div><h3>Methods</h3><div>Patients with primary osteoarthritis of the knee with an intra-articular varus deformity, undergoing computer-navigation assisted total knee arthroplasty using a sub-vastus approach and the “femur-first” measured resection technique between October 2019 and June 2020 were recruited. Following surgical exposure, the coronal knee deformity was assessed during full extension and 15°, 30°, 45°, 60°, 75°, and 90° of flexion. The levels of bony and/or soft-tissue pathology were identified based on the deformity pattern noted. Mechanical bone resection and indicated soft-tissue releases were performed. Post-operative alignment and outcomes were compared among knees with different deformity patterns.</div></div><div><h3>Results</h3><div>In all, 127 patients (59.1 % women) with a mean age of 62.4 years were available for follow-up. The mean duration of follow-up was 24.7 months. Five patterns of varus deformity emerged, each indicating different levels of pathology: (i) pattern-1: the deformity increased on flexion, (ii) pattern-2: the deformity decreased on flexion, (iii) pattern-3: the deformity remained constant throughout flexion, (iv) pattern-4: the deformity increased initially, then decreased on flexion, and (v) pattern-5: the deformity decreased initially, then increased on flexion. Individualized soft-tissue release helped restore alignment within 3° of the mechanical axis in all knees. At the two years’ follow-up, the clinical outcomes and patient satisfaction were comparable among patients with all deformity patterns.</div></div><div><h3>Conclusions</h3><div>Knees with primary varus osteoarthritis demonstrate simple dynamic patterns of coronal deformity. An understanding of these patterns permits identification of the levels of pathology and helps in their optimal management, resulting in uniformly satisfactory outcomes.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 71-76"},"PeriodicalIF":1.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review of valgus intertrochanteric osteotomy in the setting of femoral neck fractures","authors":"B. Tanner Seibold ,&nbsp;Matthew J. Walker ,&nbsp;Christopher P. Bellaire ,&nbsp;Taylor Raffa ,&nbsp;Sarah Dance ,&nbsp;Alex Gu ,&nbsp;James N. DeBritz","doi":"10.1016/j.jor.2024.12.037","DOIUrl":"10.1016/j.jor.2024.12.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Valgus intertrochanteric osteotomy (VITO) is a fixation procedure to manage neglected femoral neck fractures (FNF) in young adults. While several studies have evaluated the efficacy of VITO, there remains variability in intraoperative technique and fixation devices. The study aims to systematically review the current orthopedic literature to summarize the patient outcomes and determine the efficacy of VITO in young adults with neglected FNFs.</div></div><div><h3>Methods</h3><div>All peer-reviewed studies written in English about VITO for neglected FNFs from 2000 to 2022 were searched using the National Center for Biotechnology Information (NCBI) PubMed MEDLINE database. Exclusion criteria included meta-analyses without primary data, single-patient case reports, and studies investigating pediatric populations. All included articles were analyzed for patient demographic data, Pauwels Classification, average time from injury to surgery and follow up, implant type, union versus nonunion, postoperative complications, need for corrective procedures, and surgical instrumentation utilized.</div></div><div><h3>Results</h3><div>Eighteen articles that collectively provided data on 481 patients who underwent VITO were included. Most patients (66 %) included in this study had a Pauwels Type III. The most notable postoperative complication was osteonecrosis, which had an incidence of 8.3 %. Union was achieved in 92 % of cases at a mean follow-up of 48.6 months.</div></div><div><h3>Conclusion</h3><div>VITO is a reliable and effective surgery to address nonunion of FNF in the young adult population. While the intraoperative device and correctional procedure used varied slightly, the majority of patients had an excellent postoperative Harris Hip Score (HHS) and achieved union by the last follow-up visit.</div></div><div><h3>Level of evidence</h3><div>Level IV.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 20-26"},"PeriodicalIF":1.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of traumatic Vancouver type AG periprosthetic fractures treated nonoperatively","authors":"William Oetojo ,&nbsp;Jackson Tate ,&nbsp;James Padley ,&nbsp;Steven Denyer ,&nbsp;Nicholas Brown","doi":"10.1016/j.jor.2024.12.035","DOIUrl":"10.1016/j.jor.2024.12.035","url":null,"abstract":"<div><h3>Introduction</h3><div>The optimal treatment for postoperative Vancouver AG fractures has not been established. This study is a case series investigating the outcomes of patients from a single, academic tertiary referral center with conservative management of postoperative, traumatic periprosthetic fractures, specifically Vancouver type AG fractures.</div></div><div><h3>Methods</h3><div>This study was a retrospective review of 225 patients diagnosed with periprosthetic fracture at an academic, tertiary referral center from January 2007 to June 2023. Of these patients, 18 were identified as having Vancouver Type AG fractures and underwent conservative treatment with a walker. Radiographic fracture healing, patient reported pain, ambulatory status, and abductor strength were evaluated.</div></div><div><h3>Results</h3><div>All 18 patients included in this case series suffered from traumatic postoperative periprosthetic fractures from falls, and none were noted to have any concomitant osteolytic changes. Mean age at the time of fracture of 81.4, range (62–96). Mean BMI at the time of fracture was 24.1, range (18–38.1). 1 patient passed away from unrelated medical problems 3 months after fracture onset, 2 were lost to follow-up after emergency department (ED) discharge, 3 demonstrated healing, but not yet fully healed fractures at their last follow-up, and 3 patients presented to the ED at a much later time for non-orthopaedic related issues and demonstrated healed fractures on radiographic. For the remaining 9 patients, mean length of time to heal after onset of fracture was 14.2 weeks, range (6-44). No weakness was noted during their last follow-up, and only 1 patient noted residual 1 of 10 pain. 5 patients noted to using walkers, 3 using canes, and 1 interchanging between a walker and cane during the last follow-up.</div></div><div><h3>Conclusion</h3><div>Patients with minimally to nondisplaced Vancouver type AG can achieve fracture healing and pain resolution with conservative, protected weight-bearing management in the setting of postoperative trauma.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 60-66"},"PeriodicalIF":1.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}