Pub Date : 2024-07-01DOI: 10.1016/j.jos.2023.05.015
Shaozheng Yang , Yongqiang Liu , Sushuang Ma , Chao Ding, Zhen Kong, Heng Li, Feng Huang, Hongfen Chen, Hua Zhong
Objective
This study aimed to analyze the stress and strain changes of the anterior cruciate ligament (ACL) at different knee flexion angles using a three-dimensional finite element model.
Methods
Computed tomography and magnetic resonance imaging scans were performed on the right knee of 30 healthy adult volunteers. The imaging data were used to construct a three-dimensional finite element model of the knee joint. The magnitude and concentration area of stress and strain of ACL at knee flexion angles 0°, 30°, 60° and 90° were assessed.
Results
The magnitude of stress remained consistent at 0–30° (P > 0.999) and decreased at 30–90° (P < 0.001, P = 0.005, respectively), while the magnitude of strain increased between 0° and 30° (P = 0.004) and decreased between 30° and 90° (P < 0.001, P = 0.004, respectively). The stress concentration area remained consistent at the proximal end, midsubstance, and distal end between 0° and 60° (P > 0.05). The concentration area of strain increased at the proximal end, decreased at the midsubstance between 0° and 30°, and remained consistent between 30° and 90° (P < 0.001).
Conclusion
At the low knee flexion angle, ACL's magnitude of stress and strain reached the peak, and the concentration area of ACL strain gradually shifted from midsubstance to the proximal end.
{"title":"Stress and strain changes of the anterior cruciate ligament at different knee flexion angles: A three-dimensional finite element study","authors":"Shaozheng Yang , Yongqiang Liu , Sushuang Ma , Chao Ding, Zhen Kong, Heng Li, Feng Huang, Hongfen Chen, Hua Zhong","doi":"10.1016/j.jos.2023.05.015","DOIUrl":"10.1016/j.jos.2023.05.015","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to analyze the stress and strain changes of the anterior cruciate ligament (ACL) at different knee flexion angles using a three-dimensional finite element model.</p></div><div><h3>Methods</h3><p>Computed tomography and magnetic resonance imaging scans were performed on the right knee of 30 healthy adult volunteers. The imaging data were used to construct a three-dimensional finite element model of the knee joint. The magnitude and concentration area of stress and strain of ACL at knee flexion angles 0°, 30°, 60° and 90° were assessed.</p></div><div><h3>Results</h3><p>The magnitude of stress remained consistent at 0–30° (P > 0.999) and decreased at 30–90° (P < 0.001, P = 0.005, respectively), while the magnitude of strain increased between 0° and 30° (P = 0.004) and decreased between 30° and 90° (P < 0.001, P = 0.004, respectively). The stress concentration area remained consistent at the proximal end, midsubstance, and distal end between 0° and 60° (P > 0.05). The concentration area of strain increased at the proximal end, decreased at the midsubstance between 0° and 30°, and remained consistent between 30° and 90° (P < 0.001).</p></div><div><h3>Conclusion</h3><p>At the low knee flexion angle, ACL's magnitude of stress and strain reached the peak, and the concentration area of ACL strain gradually shifted from midsubstance to the proximal end.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0949265823001781/pdfft?md5=8d41da1bb3c2451a8a2a8f37683d999e&pid=1-s2.0-S0949265823001781-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The concept of the tibial condylar valgus osteotomy (TCVO) could be applied to the impacted anteromedial tibial plateau fracture with a thin fragment","authors":"Tomoyuki Shimakawa , Ryuichi Nakamura , Akira Okano","doi":"10.1016/j.jos.2024.04.012","DOIUrl":"10.1016/j.jos.2024.04.012","url":null,"abstract":"","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141186710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the increasing prevalence of cervical odontoid fractures in older adults, the treatment strategy is controversial. The objectives of the current study are to investigate the prognosis and complications of cervical odontoid fractures in elderly patients and to identify factors associated with worsening of ambulation after 6 months.
Methods
This multicenter, retrospective study included 167 patients aged 65 years or older with odontoid fractures. Patient demographic and treatment data were investigated and compared according to the treatment strategy. To determine associations with worsening ambulation after 6 months, we focused on the treatment strategies (nonsurgical treatment [collar immobilization or halo vest], conversion to surgery, or initial surgery) and patients’ background.
Results
Patients who received nonsurgical treatment were significantly older, and patients who underwent surgery had more Anderson-D’Alonzo type 2 fractures. Of the patients initially treated nonsurgically, 26% later underwent surgery. Numbers of complications, including death, and degrees of ambulation after 6 months did not differ significantly among treatment strategies. Patients who had worsened ambulation after 6 months were significantly more likely to be older than 80 years, to have needed assistance with walking before injury, and to have cerebrovascular disease. Multivariable analysis showed that a score of ≥2 on the 5-item modified frailty index (mFI-5) was significantly associated with worsening ambulation.
Conclusions
Preinjury mFI-5 scores of ≥2 were significantly associated with worsening ambulation 6 months after treatment of cervical odontoid fractures in older adults.
{"title":"Worsening ambulation in elderly patients with cervical odontoid fractures: A nationwide multicenter study in Japan","authors":"Naoki Segi , Hiroaki Nakashima , Sadayuki Ito , Noriaki Yokogawa , Shota Ikegami , Kota Watanabe , Toru Funayama , Tomohiko Hasegawa , Hitoshi Tonomura , Kenichiro Kakutani , Takeo Furuya , Nobuyuki Suzuki , Katsuhito Kiyasu , Hiroyuki Tominaga , Masashi Miyazaki , Yoshinori Terashima , Hidenori Suzuki , Ko Hashimoto , Hiroshi Uei , Haruki Funao , Satoshi Kato","doi":"10.1016/j.jos.2023.05.006","DOIUrl":"10.1016/j.jos.2023.05.006","url":null,"abstract":"<div><h3>Background</h3><p><span>Despite the increasing prevalence of cervical odontoid fractures in older adults, the </span>treatment strategy is controversial. The objectives of the current study are to investigate the prognosis and complications of cervical odontoid fractures in elderly patients and to identify factors associated with worsening of ambulation after 6 months.</p></div><div><h3>Methods</h3><p>This multicenter, retrospective study included 167 patients aged 65 years or older with odontoid fractures. Patient demographic and treatment data were investigated and compared according to the treatment strategy. To determine associations with worsening ambulation after 6 months, we focused on the treatment strategies (nonsurgical treatment [collar immobilization or halo vest], conversion to surgery, or initial surgery) and patients’ background.</p></div><div><h3>Results</h3><p>Patients who received nonsurgical treatment were significantly older, and patients who underwent surgery had more Anderson-D’Alonzo type 2 fractures. Of the patients initially treated nonsurgically, 26% later underwent surgery. Numbers of complications, including death, and degrees of ambulation after 6 months did not differ significantly among treatment strategies. Patients who had worsened ambulation after 6 months were significantly more likely to be older than 80 years, to have needed assistance with walking before injury, and to have cerebrovascular disease<span>. Multivariable analysis showed that a score of ≥2 on the 5-item modified frailty index (mFI-5) was significantly associated with worsening ambulation.</span></p></div><div><h3>Conclusions</h3><p>Preinjury mFI-5 scores of ≥2 were significantly associated with worsening ambulation 6 months after treatment of cervical odontoid fractures in older adults.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9569436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In Japan, orthopaedics is one of the medical fields with the lowest proportion of women. This study analyses the change in gender diversity over the past decade and estimates the time required to achieve the 30% gender diversity goal, according to the critical mass in Japan in 2020.
Methods
We investigated the demographic composition of orthopaedic surgeons in 2020 by age group, the gender ratio of the main clinical fields from 2010 to 2020, and estimated the time required for the bottom 10 (i.e., least diverse) medical departments in Japan to reach the proportion of 30% women. We used simple linear regression analyses to clarify the number of years.
Results
In 2020, the population pyramid of orthopaedic surgeons showed that those in their 50s were the largest component with 24.1%, followed by those in their 40s and 30s with 22.3% and 19.4%, respectively. The percentage of women orthopaedic surgeons increased slightly from 4.1% in 2010 to 5.7% in 2020. This means that to achieve the proportion of 30% women at the current annual increase rate, orthopaedics would require up to 160 years, cardiovascular 149 years, and neurosurgery 135 years.
Conclusion
Contrary to the recent increase in the number of women physicians, there has been only a slight increase in the number of women orthopaedic surgeons over the past decade. Moreover, the number of young male orthopaedic surgeons has decreased. As current orthopaedic surgeons age and retire, Japan will soon face an overall shortage of orthopaedic surgeons. Issues that must still be addressed in Japanese orthopaedics include educating men and women about gender diversity and bias, changing stereotypes about surgical lifestyles, improving work-life balance, and diligent and collaborative efforts at both the individual and community levels.
{"title":"How long will it take to reach the gender diversity goal for orthopaedics in Japan?","authors":"Tadatsugu Morimoto , Takaomi Kobayashi , Kazuyo Yamauchi , Satomi Nagamine , Miho Sekiguchi , Masatsugu Tsukamoto , Tomohito Yoshihara , Hirohito Hirata , Shiori Tanaka , Masaaki Mawatari","doi":"10.1016/j.jos.2023.05.011","DOIUrl":"10.1016/j.jos.2023.05.011","url":null,"abstract":"<div><h3>Background</h3><p>In Japan, orthopaedics is one of the medical fields with the lowest proportion of women. This study analyses the change in gender diversity over the past decade and estimates the time required to achieve the 30% gender diversity goal, according to the critical mass in Japan in 2020.</p></div><div><h3>Methods</h3><p>We investigated the demographic composition of orthopaedic surgeons in 2020 by age group, the gender ratio of the main clinical fields from 2010 to 2020, and estimated the time required for the bottom 10 (i.e., least diverse) medical departments in Japan to reach the proportion of 30% women. We used simple linear regression analyses to clarify the number of years.</p></div><div><h3>Results</h3><p>In 2020, the population pyramid of orthopaedic surgeons showed that those in their 50s were the largest component with 24.1%, followed by those in their 40s and 30s with 22.3% and 19.4%, respectively. The percentage of women orthopaedic surgeons increased slightly from 4.1% in 2010 to 5.7% in 2020. This means that to achieve the proportion of 30% women at the current annual increase rate, orthopaedics would require up to 160 years, cardiovascular 149 years, and neurosurgery 135 years.</p></div><div><h3>Conclusion</h3><p>Contrary to the recent increase in the number of women physicians, there has been only a slight increase in the number of women orthopaedic surgeons over the past decade. Moreover, the number of young male orthopaedic surgeons has decreased. As current orthopaedic surgeons age and retire, Japan will soon face an overall shortage of orthopaedic surgeons. Issues that must still be addressed in Japanese orthopaedics include educating men and women about gender diversity and bias, changing stereotypes about surgical lifestyles, improving work-life balance, and diligent and collaborative efforts at both the individual and community levels.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9622284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recently, we identified artifactual hypoglycemia in patients with soft tissue sarcoma (STS) who received pegfilgrastim-supported chemotherapy. In the present study, we measured white blood cell count and fasting blood glucose levels after the administration of pegfilgrastim in patients with STS and showed the relationship between artifactual hypoglycemia and white blood cell count.
Patients
A total of 19 patients were included in this study. The mean age of the patients was 54 years. They received chemotherapy and administration of pegfilgrastim. Pegfilgrastim was injected subcutaneously 48 h after chemotherapy. No patient had a history of diabetes mellitus.
Results
Fifty-nine cycles were administered to 19 patients. One hundred and twenty-eight samples were obtained within one week after the of pegfilgrastim administration. Hypoglycemia was observed in 38 of the 13 patients. There were no symptoms of hypoglycemia in any patient. The white blood cell count in samples from patients with hypoglycemia was significantly higher than that in samples without hypoglycemia (p < 0.001). The median white blood cell count in samples with hypoglycemia was 29,415 and 3420 in samples without hypoglycemia. Age, sex, body mass index, performance status, and red blood cell count were not associated with hypoglycemia. White blood cell count was strongly negatively correlated with fasting blood glucose levels (Pearson's r: 0.786, 95% confidence interval: 0.844–0.709, p < 0.001). Of the 38 samples with hypoglycemia, 32 were measured within 2 days after pegfilgrastim administration.
Conclusion
If a lack of symptoms due to hypoglycemia and leukocytes is confirmed, physicians should wait and identify the normalization of the level of glucose according to the neutrophil nadir following temporal leukocytes, which prevents further invasive examination for hypoglycemia.
{"title":"Artifactual hypoglycaemia may be common in patients with soft tissue sarcoma who received pegfilgrastim-supported chemotherapy","authors":"Tomoki Nakamura, Kunihiro Asanuma, Tomohito Hagi, Akihiro Sudo","doi":"10.1016/j.jos.2023.05.008","DOIUrl":"10.1016/j.jos.2023.05.008","url":null,"abstract":"<div><h3>Background</h3><p><span>Recently, we identified artifactual hypoglycemia in patients with </span>soft tissue sarcoma<span><span> (STS) who received pegfilgrastim-supported chemotherapy. In the present study, we measured white blood cell count and fasting blood glucose levels after the administration of </span>pegfilgrastim in patients with STS and showed the relationship between artifactual hypoglycemia and white blood cell count.</span></p></div><div><h3>Patients</h3><p>A total of 19 patients were included in this study. The mean age of the patients was 54 years. They received chemotherapy and administration of pegfilgrastim. Pegfilgrastim was injected subcutaneously 48 h after chemotherapy. No patient had a history of diabetes mellitus.</p></div><div><h3>Results</h3><p>Fifty-nine cycles were administered to 19 patients. One hundred and twenty-eight samples were obtained within one week after the of pegfilgrastim administration. Hypoglycemia was observed in 38 of the 13 patients. There were no symptoms<span> of hypoglycemia in any patient. The white blood cell count in samples from patients with hypoglycemia was significantly higher than that in samples without hypoglycemia (p < 0.001). The median white blood cell count in samples with hypoglycemia was 29,415 and 3420 in samples without hypoglycemia. Age, sex, body mass index<span>, performance status, and red blood cell count were not associated with hypoglycemia. White blood cell count was strongly negatively correlated with fasting blood glucose levels (Pearson's r: 0.786, 95% confidence interval: 0.844–0.709, p < 0.001). Of the 38 samples with hypoglycemia, 32 were measured within 2 days after pegfilgrastim administration.</span></span></p></div><div><h3>Conclusion</h3><p>If a lack of symptoms due to hypoglycemia and leukocytes is confirmed, physicians should wait and identify the normalization of the level of glucose according to the neutrophil nadir following temporal leukocytes, which prevents further invasive examination for hypoglycemia.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9627415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical outcomes of Chiari pelvic osteotomy for acetabular dysplasia, including conversion to total hip arthroplasty (THA), have not been adequately explored. The purpose of this study was to examine the long-term results and clinical outcomes of Chiari pelvic osteotomy as the primary outcome and to analyze its prognostic factors as the second outcome.
Methods
This study was a multicenter, retrospective cohort study. Ninety-seven patients underwent Chiari pelvic osteotomy at three hospitals between March 1975 and October 1997. The long-term clinical outcomes of Chiari pelvic osteotomy, including conversion to THA and hip pain, were analyzed using the Kaplan–Meier method. In addition, the prognostic factors for conversion to THA after Chiari pelvic osteotomy were evaluated with clinical variables and radiographic parameters.
Results
The study included 51 hips in 45 patients (4 men and 41 women) with long-term follow-up. The survival rates assessed by Kaplan–Meier analysis with conversion to THA as an endpoint, were 90.2% (95% confidence interval (CI) 82.0–98.4%) at 20 years and 73.5% (95% CI 61.1–86.0%) at 30 years. In contrast, the Kaplan–Meier survival rates with the Japanese Orthopaedic Association hip score for pain ≤20 as an endpoint, were 86.3% (95% CI 76.8–95.7%) at 20 years and 65.6% (95% CI 52.3–79.0%) at 30 years. Only older age at osteotomy was the significantly poor prognostic factor for conversion to THA, with a hazard ratio of 1.11/year, 95% CI 1.06 to 1.18, (p < 0.01).
Conclusion
Chiari pelvic osteotomy may still be a good alternative to bony reconstructive surgery for acetabular dysplasia especially in young patients. Only older age at the osteotomy was related to the poor prognosis of preserving hip function.
背景：目前尚未充分探讨Chiari骨盆截骨术治疗髋臼发育不良的临床效果，包括转为全髋关节置换术（THA）的效果。本研究的目的是以Chiari骨盆截骨术的长期结果和临床疗效为首要结果，分析其预后因素为次要结果：本研究是一项多中心、回顾性队列研究。方法：本研究是一项多中心回顾性队列研究。1975年3月至1997年10月期间，97名患者在三家医院接受了Chiari骨盆截骨术。研究采用Kaplan-Meier法分析了Chiari骨盆截骨术的长期临床结果，包括转为THA和髋关节疼痛。此外，还通过临床变量和放射学参数评估了基底骨盆截骨术后转为全髋关节置换术的预后因素：该研究纳入了45名患者（4男41女）的51个髋关节，并进行了长期随访。以转为全髋关节置换术为终点，Kaplan-Meier分析评估的生存率为：20年为90.2%（95%置信区间（CI）82.0-98.4%），30年为73.5%（95%置信区间（CI）61.1-86.0%）。相比之下，以日本骨科协会髋关节疼痛评分≤20分为终点，20岁时的卡普兰-米尔生存率为86.3%（95% CI 76.8-95.7%），30岁时为65.6%（95% CI 52.3-79.0%）。只有截骨时的年龄较大才是转为 THA 的显著不良预后因素，其危险比为 1.11/年（95% CI 1.06 至 1.18）（P 结论：Chiari 骨盆截骨术是一种非常有效的治疗方法：Chiari骨盆截骨术可能仍然是髋臼发育不良骨性重建手术的良好替代方案，尤其是对于年轻患者。只有截骨时年龄较大的患者在保留髋关节功能方面预后较差。
{"title":"Long-term results of Chiari pelvic osteotomy on the preservation of hip function with mean follow-up of more than 30 years and its prognostic factors","authors":"Hiroaki Kurishima , Daisuke Chiba , Kazuyoshi Baba , Soshi Hamada , Takayuki Suzuki , Ryuichi Kanabuchi , Genji Fujii , Masamizu Oyama , Tatsuhiro Ochiai , Yu Mori , Toshimi Aizawa","doi":"10.1016/j.jos.2023.05.013","DOIUrl":"10.1016/j.jos.2023.05.013","url":null,"abstract":"<div><h3>Background</h3><p>Clinical outcomes of Chiari pelvic osteotomy<span> for acetabular<span> dysplasia<span><span>, including conversion to total hip arthroplasty<span> (THA), have not been adequately explored. The purpose of this study was to examine the long-term results and clinical outcomes of Chiari pelvic osteotomy as the primary outcome and to analyze its </span></span>prognostic factors as the second outcome.</span></span></span></p></div><div><h3>Methods</h3><p>This study was a multicenter, retrospective cohort study. Ninety-seven patients underwent Chiari pelvic osteotomy at three hospitals between March 1975 and October 1997. The long-term clinical outcomes of Chiari pelvic osteotomy, including conversion to THA and hip pain, were analyzed using the Kaplan–Meier method. In addition, the prognostic factors for conversion to THA after Chiari pelvic osteotomy were evaluated with clinical variables and radiographic parameters.</p></div><div><h3>Results</h3><p>The study included 51 hips in 45 patients (4 men and 41 women) with long-term follow-up. The survival rates assessed by Kaplan–Meier analysis with conversion to THA as an endpoint, were 90.2% (95% confidence interval (CI) 82.0–98.4%) at 20 years and 73.5% (95% CI 61.1–86.0%) at 30 years. In contrast, the Kaplan–Meier survival rates with the Japanese Orthopaedic Association hip score for pain ≤20 as an endpoint, were 86.3% (95% CI 76.8–95.7%) at 20 years and 65.6% (95% CI 52.3–79.0%) at 30 years. Only older age at osteotomy was the significantly poor prognostic factor for conversion to THA, with a hazard ratio of 1.11/year, 95% CI 1.06 to 1.18, (p < 0.01).</p></div><div><h3>Conclusion</h3><p>Chiari pelvic osteotomy may still be a good alternative to bony reconstructive surgery for acetabular dysplasia especially in young patients. Only older age at the osteotomy was related to the poor prognosis of preserving hip function.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9674096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jos.2023.06.003
Tsutomu Akazawa , Yoshiaki Torii , Jun Ueno , Tasuku Umehara , Masahiro Iinuma , Atsuhiro Yoshida , Ken Tomochika , Seiji Ohtori , Hisateru Niki
Background
The present study aimed to evaluate the safety of robot-assisted screw placement in 125 cases after introducing a spinal robotics system and to identify the situations where deviation was likely to occur.
Methods
The subjects were 125 consecutive patients who underwent robotic-assisted screw placement using a spinal robotics system (Mazor X Stealth Edition, Medtronic) from April 2021 to January 2023. The 1048 screws placed with robotic assistance were evaluated. We investigated intraoperative adverse events of the robotics system and complications occurring within 30 days after surgery. We evaluated screw accuracy and deviation and compared them for vertebral levels, screw insertion methods (open traditional pedicle screw [Open-PS], cortical bone trajectory screw [CBT], percutaneous pedicle screw [PPS], and S2 alar iliac screw [S2AIS]), diagnosis, and phases of surgical cases.
Results
The deviation rate of robotic-assisted screw placement for spine surgery was 2.2%. Complications were reoperation due to implant-related neurological deficit in 0.8% and surgical site infection in 0.8%. There was significant difference in the deviation rate between vertebral levels. The deviation rate of the T1–T4 level was high at 10.0%. There was significant difference in the deviation rate between Open-PS, CBT, PPS, and S2AIS. The PPSs had a high deviation rate of 10.3%. The deviation rates were not significantly different between patients with and without deformity. The deviation rate did not change depending on the experience of surgical cases, and the deviation rate was favorable from the onset.
Conclusion
Although the robotic-assisted screw placement was safe, we should be extra vigilant when placing screws in the upper thoracic region (deviation rate 10.0%) and when using PPSs (deviation rate 10.3%).
{"title":"Safety of robotic-assisted screw placement for spine surgery: Experience from the initial 125 cases","authors":"Tsutomu Akazawa , Yoshiaki Torii , Jun Ueno , Tasuku Umehara , Masahiro Iinuma , Atsuhiro Yoshida , Ken Tomochika , Seiji Ohtori , Hisateru Niki","doi":"10.1016/j.jos.2023.06.003","DOIUrl":"10.1016/j.jos.2023.06.003","url":null,"abstract":"<div><h3>Background</h3><p>The present study aimed to evaluate the safety of robot-assisted screw placement in 125 cases after introducing a spinal robotics system and to identify the situations where deviation was likely to occur.</p></div><div><h3>Methods</h3><p><span>The subjects were 125 consecutive patients who underwent robotic-assisted screw placement using a spinal robotics system (Mazor X Stealth Edition, Medtronic) from April 2021 to January 2023. The 1048 screws placed with robotic assistance were evaluated. We investigated intraoperative adverse events of the robotics system and complications occurring within 30 days after surgery. We evaluated screw accuracy and deviation and compared them for vertebral levels, screw insertion methods (open traditional pedicle screw [Open-PS], </span>cortical bone trajectory screw [CBT], percutaneous pedicle screw [PPS], and S2 alar iliac screw [S2AIS]), diagnosis, and phases of surgical cases.</p></div><div><h3>Results</h3><p><span>The deviation rate of robotic-assisted screw placement for spine surgery was 2.2%. Complications were reoperation due to implant-related neurological deficit in 0.8% and </span>surgical site infection in 0.8%. There was significant difference in the deviation rate between vertebral levels. The deviation rate of the T1–T4 level was high at 10.0%. There was significant difference in the deviation rate between Open-PS, CBT, PPS, and S2AIS. The PPSs had a high deviation rate of 10.3%. The deviation rates were not significantly different between patients with and without deformity. The deviation rate did not change depending on the experience of surgical cases, and the deviation rate was favorable from the onset.</p></div><div><h3>Conclusion</h3><p>Although the robotic-assisted screw placement was safe, we should be extra vigilant when placing screws in the upper thoracic region (deviation rate 10.0%) and when using PPSs (deviation rate 10.3%).</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9677169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical site infection (SSI)/periprosthetic joint infection (PJI) is a devastating complication in limb salvage surgery with endoprosthesis reconstruction for malignant bone tumors. The main bottleneck for data collection and analysis for the status of SSI/PJI in tumor endoprosthesis is the low absolute case numbers of this rare cancer. The accumulation of many cases is possible by administrating nationwide registry data.
Methods
The data on malignant bone tumor resection with tumor endoprosthesis reconstruction were extracted from the Bone and Soft Tissue Tumor Registry in Japan. The primary endpoint was defined as the need for additional surgical intervention for infection control. The incidence of postoperative infection and its risk factors were analyzed.
Results
A total of 1342 cases were included. The incidence of SSI/PJI was 8.2%. The incidence of SSI/PJI in the proximal femur, distal femur, proximal tibia, and pelvis were 4.9%, 7.4%, 12.6%, and 41.2%, respectively. Location in the pelvis or proximal tibia, tumor grade, indication of myocutaneous flaps, and delayed wound healing proved to be independent risks for SSI/PJI, whereas age, sex, previous surgery, tumor size, surgical margin, application of chemotherapy and radiotherapy were not significant.
Conclusions
The incidence was equal to those in previous studies. The result reconfirmed the high incidence of SSI/PJI in pelvis and proximal tibia cases and cases with delayed wound healing. Novel risk factors such as tumor grade and application of myocutaneous flaps were marked. The administration of nationwide registry data was informative for the analysis of SSI/PJI in tumor endoprosthesis.
{"title":"Incidence and risk of surgical site infection/periprosthetic joint infection in tumor endoprosthesis—data from the nationwide bone tumor registry in Japan","authors":"Takeshi Morii , Koichi Ogura , Kenji Sato , Akira Kawai","doi":"10.1016/j.jos.2023.06.008","DOIUrl":"10.1016/j.jos.2023.06.008","url":null,"abstract":"<div><h3>Background</h3><p>Surgical site infection (SSI)/periprosthetic joint infection (PJI) is a devastating complication in limb salvage surgery with endoprosthesis reconstruction for malignant bone tumors. The main bottleneck for data collection and analysis for the status of SSI/PJI in tumor endoprosthesis is the low absolute case numbers of this rare cancer. The accumulation of many cases is possible by administrating nationwide registry data.</p></div><div><h3>Methods</h3><p>The data on malignant bone tumor resection with tumor endoprosthesis reconstruction were extracted from the Bone and Soft Tissue Tumor Registry in Japan. The primary endpoint was defined as the need for additional surgical intervention for infection control. The incidence of postoperative infection and its risk factors were analyzed.</p></div><div><h3>Results</h3><p>A total of 1342 cases were included. The incidence of SSI/PJI was 8.2%. The incidence of SSI/PJI in the proximal femur, distal femur, proximal tibia, and pelvis were 4.9%, 7.4%, 12.6%, and 41.2%, respectively. Location in the pelvis or proximal tibia, tumor grade, indication of myocutaneous flaps, and delayed wound healing proved to be independent risks for SSI/PJI, whereas age, sex, previous surgery, tumor size, surgical margin, application of chemotherapy and radiotherapy were not significant.</p></div><div><h3>Conclusions</h3><p>The incidence was equal to those in previous studies. The result reconfirmed the high incidence of SSI/PJI in pelvis and proximal tibia cases and cases with delayed wound healing. Novel risk factors such as tumor grade and application of myocutaneous flaps were marked. The administration of nationwide registry data was informative for the analysis of SSI/PJI in tumor endoprosthesis.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jos.2023.07.011
Ryuzo Okuda , Minako Sumikawa , Hiroaki Shima
Background
No evidence has been found to support the hypothesis that there is a correlation between hallux valgus (HV) and intermetatarsal (IM) angles in HV with metatarsus adductus (MA) and that IM angle in HV with MA is lower than that in HV without MA. The present study aimed to analyze the radiographic characteristics of HV with MA compared to matched controls and to clarify the differences between HV with MA and without MA.
Methods
Preoperative radiographs of 126 female patients (164 feet) who underwent hallux valgus surgery were reviewed. The HV, IM, and MA angles were measured. The MA was defined as MA angle of 20° or greater. Of all the feet, 37 (22.6%) had HV with MA (MA group). Control A (111 feet) having HV without MA was matched by age, gender, and BMI to MA group; Control B (79 feet) having HV without MA was matched by age, gender, BMI, and HV angle to the sub-MA group (31 feet) having HV with MA.
Results
The correlation coefficient between the HV and IM angles in the MA group was considered negligible (r = 0.08, p = 0.63), whereas the correlation coefficient in Control A was considered moderate (r = 0.57, p < 0.00001). The correlation coefficient in the MA group was significantly smaller than in Control A (p < 0.01). There was no significant difference in the HV angle between the sub-MA group and Control B (p = 0.23), but the IM angle was significantly smaller than in Control B (p = 0.002).
Conclusion
There is no significant correlation between the HV and IM angles in HV with MA, as there is in HV without MA. HV with MA has a significantly smaller IM angle for the HV angle compared to HV without MA.
背景：跖骨内收症（MA）HV患者的跖外翻（HV）和跖骨间（IM）角度之间存在相关性，且跖骨内收症HV患者的IM角度低于无跖骨内收症HV患者。本研究旨在分析伴有跖骨内收的 HV 与匹配对照组相比的放射学特征，并明确伴有跖骨内收的 HV 与无跖骨内收的 HV 之间的差异：方法：回顾性分析了126名接受Halux Valgus手术的女性患者（164英尺）的术前X光片。测量了 HV、IM 和 MA 角。MA定义为MA角度大于等于20°。在所有患者中，有 37 人（22.6%）患有 HV 和 MA（MA 组）。对照组 A（111 英尺）的 HV 无 MA，在年龄、性别和体重指数方面与 MA 组相匹配；对照组 B（79 英尺）的 HV 无 MA，在年龄、性别、体重指数和 HV 角度方面与有 MA 的 HV 亚 MA 组（31 英尺）相匹配：MA 组的 HV 角和 IM 角之间的相关系数可忽略不计（r = 0.08，p = 0.63），而对照组 A 的相关系数为中等（r = 0.57，p 结论）：与无 MA 的 HV 一样，有 MA 的 HV 的 HV 角和 IM 角之间没有明显的相关性。与无 MA 的 HV 相比，有 MA 的 HV 的 HV 角的 IM 角明显较小。
{"title":"Radiological characteristics of hallux valgus with metatarsus adductus: A matched case-control study","authors":"Ryuzo Okuda , Minako Sumikawa , Hiroaki Shima","doi":"10.1016/j.jos.2023.07.011","DOIUrl":"10.1016/j.jos.2023.07.011","url":null,"abstract":"<div><h3>Background</h3><p>No evidence has been found to support the hypothesis that there is a correlation between hallux valgus (HV) and intermetatarsal (IM) angles in HV with metatarsus adductus (MA) and that IM angle in HV with MA is lower than that in HV without MA. The present study aimed to analyze the radiographic characteristics of HV with MA compared to matched controls and to clarify the differences between HV with MA and without MA.</p></div><div><h3>Methods</h3><p>Preoperative radiographs of 126 female patients (164 feet) who underwent hallux valgus surgery were reviewed. The HV, IM, and MA angles were measured. The MA was defined as MA angle of 20° or greater. Of all the feet, 37 (22.6%) had HV with MA (MA group). Control A (111 feet) having HV without MA was matched by age, gender, and BMI to MA group; Control B (79 feet) having HV without MA was matched by age, gender, BMI, and HV angle to the sub-MA group (31 feet) having HV with MA.</p></div><div><h3>Results</h3><p>The correlation coefficient between the HV and IM angles in the MA group was considered negligible (<em>r</em> = 0.08, p = 0.63), whereas the correlation coefficient in Control A was considered moderate (<em>r</em> = 0.57, p < 0.00001). The correlation coefficient in the MA group was significantly smaller than in Control A (p < 0.01). There was no significant difference in the HV angle between the sub-MA group and Control B (p = 0.23), but the IM angle was significantly smaller than in Control B (p = 0.002).</p></div><div><h3>Conclusion</h3><p>There is no significant correlation between the HV and IM angles in HV with MA, as there is in HV without MA. HV with MA has a significantly smaller IM angle for the HV angle compared to HV without MA.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9894528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jos.2023.07.020
Erdinc Acar
Background
The aim of this study was to compare the functional outcomes and direct costs of Stack splints and aluminum finger splints when used in the conservative management of patients with acute Doyle type IVb bony mallet finger.
Methods
We retrospectively analyzed demographic and clinical characteristics, functional outcomes (using the Crawford classification, DIP flexion angles, and extension lag measurements), time to confirmation of union, and splint costs of 24 patients treated with aluminum finger splints (Group 1) and 20 patients treated with Stack splints (Group 2).
Results
Of 44 patients, the median age was 38 (range, 20–59) years, 14 (32%) were smokers, 23 (52%) had fourth digit injuries, 32 (70%) had injuries to the dominant hand, 30 (68%) had a mechanism of injury of a fall, and median follow-up was 15 (range, 12–18) months; none of these differed significantly between Group 1 and Group 2 (all p > 0.05). In Group 1, functional outcomes were excellent and good in 14 (58%) and 10 (42%) patients, respectively; in Group 2 functional outcomes were excellent and good in 13 (62%) and 7 (35%) patients, respectively; and there was no significant difference between the groups. Median extension lag was 3.2° (range, 3.0°–3.5°) in group 1 and 3.4° (range, 3.2°–3.8°) in group 2, indicating no significant difference between groups. Complete union was confirmed radiographically in all patients. Per-patient cost was significantly lower for aluminum finger splints (0.208 TRY [US $0.03]) than for Stack splints (25 TRY [US $3.60]).
Conclusions
Good functional outcomes are possible with the use of either Stack or aluminum finger splints in patients with acute Doyle type IVb mallet finger, confirming that conservative management may be appropriate for these injuries. Direct costs of Stack splints are many times greater than those of aluminum splints, though the costs for both are relatively low.
{"title":"The use of Stack splint or aluminum finger splint in the conservative management of acute Doyle type IVb bony mallet finger","authors":"Erdinc Acar","doi":"10.1016/j.jos.2023.07.020","DOIUrl":"10.1016/j.jos.2023.07.020","url":null,"abstract":"<div><h3>Background</h3><p>The aim of this study was to compare the functional outcomes and direct costs of Stack splints and aluminum finger splints when used in the conservative management of patients with acute Doyle type IVb bony mallet finger.</p></div><div><h3>Methods</h3><p>We retrospectively analyzed demographic and clinical characteristics, functional outcomes (using the Crawford classification, DIP flexion angles, and extension lag measurements), time to confirmation of union, and splint costs of 24 patients treated with aluminum finger splints (Group 1) and 20 patients treated with Stack splints (Group 2).</p></div><div><h3>Results</h3><p>Of 44 patients, the median age was 38 (range, 20–59) years, 14 (32%) were smokers, 23 (52%) had fourth digit injuries, 32 (70%) had injuries to the dominant hand, 30 (68%) had a mechanism of injury of a fall, and median follow-up was 15 (range, 12–18) months; none of these differed significantly between Group 1 and Group 2 (all <em>p</em> > 0.05). In Group 1, functional outcomes were excellent and good in 14 (58%) and 10 (42%) patients, respectively; in Group 2 functional outcomes were excellent and good in 13 (62%) and 7 (35%) patients, respectively; and there was no significant difference between the groups. Median extension lag was 3.2° (range, 3.0°–3.5°) in group 1 and 3.4° (range, 3.2°–3.8°) in group 2, indicating no significant difference between groups. Complete union was confirmed radiographically in all patients. Per-patient cost was significantly lower for aluminum finger splints (0.208 TRY [US $0.03]) than for Stack splints (25 TRY [US $3.60]).</p></div><div><h3>Conclusions</h3><p>Good functional outcomes are possible with the use of either Stack or aluminum finger splints in patients with acute Doyle type IVb mallet finger, confirming that conservative management may be appropriate for these injuries. Direct costs of Stack splints are many times greater than those of aluminum splints, though the costs for both are relatively low.</p></div><div><h3>Level of evidence</h3><p><em>Therapeutic, Level III</em>.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9951149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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