Journal of Orthopaedic Science最新文献

Background: Femoral shaft fractures represent common pediatric injuries. AO/OTA 32-A3 fractures pose significant challenges for closed reduction due to shortening displacement and muscular traction, frequently necessitating open reduction. This study describes a novel Kirschner-wire distractor-assisted technique and evaluates its efficacy versus traditional manual reduction in children with AO/OTA 32-A3 femoral shaft fractures.

Methods: A retrospective study was conducted on 33 pediatric patients with AO/OTA 32-A3 femoral shaft fractures treated at our hospital from October 2014 to January 2025. The patients were divided into two groups (Group A and Group B) based on the reduction methods used. Group A (n = 15) underwent closed reduction assisted by a Kirschner-wire distractor, whereas Group B (n = 18) received traditional manual reduction. Both groups underwent fracture stabilization using elastic stable intramedullary nailing. We compared closed reduction success rates between Group A and Group B. Group B was further subdivided into successful closed reduction cases (Subgroup B1) and failed closed reduction cases (Subgroup B2). Surgical parameters including incision length, operative time, number of intraoperative fluoroscopy exposures, intraoperative blood loss, postoperative pain scores, and bone union time were then compared between Group A and B.

Results: The K-wire distractor group (Group A) achieved 100 % closed reduction success (15/15) versus 66.7 % (12/18) in the manual reduction group (Group B) (P = 0.02). Compared to Group B1, Group A required significantly fewer fluoroscopies and less operative time (P = 0.01), no statistically significant differences were observed in the remaining postoperative parameters, include incision length, intraoperative blood loss, postoperative pain scores and bone union time. Compared to Group B's failed reduction subgroup (B2), Group A showed superior outcomes in all parameters (all P < 0.001): shorter incision, operative time, reduced Fluoroscopy, reduced blood loss, lower pain scores, and faster union.

Conclusion: Kirschner-wire distractor-assisted closed reduction demonstrates superior efficacy compared to conventional manual reduction for AO/OTA 32-A3 femoral fractures.

Background: Although the significance of preoperative denosumab administration for giant cell tumor of bone (GCTB) is still controversial, sporadic reports have suggested a clinical benefit of administration prior to surgery for spinal GCTB. In this retrospective, multi-institutional study, we assessed the effects of preoperative denosumab administration for spinal GCTB.

Methods: Ten cases of GCTB in the spine with preoperative denosumab administration (the denosumab group) and 19 cases without preoperative denosumab administration (the control group) were included. Oncological outcomes (local recurrence, distant metastasis, and overall survival), duration of the surgery, intraoperative blood loss, functional outcomes as evaluated by the Frankel classification, perioperative complications, adverse events associated with denosumab administration, and margin status in resection cases were surveyed.

Results: The median frequency of preoperative denosumab administration was four times in the denosumab group. Curettage against resection and no preoperative denosumab administration were revealed as independent risks for local recurrence. Preoperative denosumab administration significantly reduced intraoperative blood loss. It also resulted in significantly better postoperative function. Periodontitis as an adverse effect of denosumab administration was found only in two cases in the control group, where it was applied for controlling local recurrence. Cases with local recurrence showed worse function at the final follow-up, suggesting the significant impact of local recurrence on function. The negative margin rate was significantly higher in the denosumab group. No significant difference was noted in the risk for metastasis and lethal events, duration of surgery, and incidence of postoperative complications between the two groups.

Conclusions: Preoperative denosumab administration resulted in better local control, reduced intraoperative blood loss, and better function. The present data suggest that it has a clinical benefit in the treatment of spinal GCTB.

Background: To examine the characteristics of hip dynamics caused by abnormal spinopelvic alignment in patients with spinal fusion and identify appropriate targets for acetabular component placement in such patients undergoing total hip arthroplasty.

Methods: Dynamic imaging of the chair-rising motion and computed tomography images in the supine position were obtained for 40 patients with spinal fusion and normal hips. The sagittal pelvic tilt and hip flexion angle were measured with three-dimensional dynamic analysis using the image-matching method. The hip flexion angle based on the functional pelvic plane in the supine position (supine-FPP) was calculated using pelvic tilt and hip flexion angles. The hip flexion angle based on supine-FPP was compared in participants with and without adverse pelvic mobility in extension (APM; posterior pelvic tilt >13° from supine to standing), flatback deformity (pelvic incidence-lumbar lordosis mismatch ≥10°), and stiff spinopelvic mobility (stiff-SPM; posterior pelvic tilt <10° between standing and sitting).

Results: The flexion angle based on supine-FPP was 5.4°-7.2° lower in patients with APM than in those without APM throughout the chair-rising motion (sitting, deep-sitting, and standing), and there were no significant differences between patients with and without flatback deformity throughout the chair-rising motion and 11.1° and 9.9° higher in patients with stiff-SPM than in those without stiff-SPM in sitting and deep-sitting positions, respectively, but there were no significant differences in standing position.

Conclusions: The importance of adjusting cup placement according to abnormal spinopelvic alignment was demonstrated in the following cases: APM requires a decrease in cup anteversion based on supine-FPP, cup anteversion based on supine-FPP is an appropriate target for flatback deformity, and stiff-SPM requires an increase in cup anteversion.

Introduction: The reconstruction of upper extremity bone defects remains a complex challenge in orthopedic surgery, frequently arising from trauma, infection, or tumor resection. The Masquelet technique, a two-stage reconstructive approach, has demonstrated promising outcomes in addressing such defects. This study aims to assess the efficacy of the Masquelet technique in the management of upper extremity bone loss.

Methods: This retrospective study reviewed 13 cases in 10 patients treated with the Masquelet technique between 2015 and 2024. Patient demographics, defect characteristics, surgical details, healing time, complications, and functional outcomes were analyzed. Bone healing was assessed radiographically, while clinical outcomes were evaluated using VAS and QuickDASH scores.

Results: The mean bone defect length was 4.26 ± 2.46 cm, and the average healing time was 13.6 ± 3.18 weeks. The second-stage surgery was performed at an average of 10.1 ± 4.2 weeks after the first stage. Bone union was achieved in all patients, with three experiencing range of motion limitations. The mean postoperative VAS and QuickDASH scores were 3.54 ± 1.05 and 34.75 ± 11.2, respectively. The average return-to-work time was 5.69 months post-treatment. Only one patient experienced a complication requiring reoperation.

Conclusion: The Masquelet technique is an effective and reliable option for reconstructing upper extremity bone defects, demonstrating satisfactory bone healing, functional recovery, and low complication rates. Further studies with larger patient groups are needed to validate these findings.

Background: Cerebrovascular disorders are known risk factors for hip fractures in the elderly. However, their impact on postoperative complications following hip fracture surgery remains insufficiently studied.

Methods: This retrospective cohort study utilized the Japanese Diagnosis Procedure Combination (DPC) database from April 2016 to March 2022. Patients aged ≥65 years who underwent surgical treatment for hip fractures were included. Individuals with cerebrovascular disorders were identified via ICD-10 codes (I60-I64). Propensity score matching (1:1) was performed based on age, sex, BMI, Charlson Comorbidity Index, anesthesia type, fracture classification, and surgical procedure. Outcomes included venous thromboembolism, urinary tract infection, pneumonia, postoperative cognitive dysfunction, and in-hospital mortality. Secondary outcomes were length of hospital stay, blood transfusion volume, and use of anti-osteoporotic agents.

Results: Out of 474,293 eligible patients, 46,158 matched pairs were analyzed. Multivariate logistic regression showed cerebrovascular disorders were independently associated with higher risks of pneumonia (adjusted OR: 1.515; 95 % CI: 1.418-1.619), urinary tract infection (adjusted OR: 1.336; 95 % CI: 1.245-1.433), and cognitive dysfunction (adjusted OR: 1.237; 95 % CI: 1.117-1.371). No significant difference in in-hospital mortality was observed. Patients with cerebrovascular disorders had longer hospital stays (38.2 vs. 35.6 days).

Conclusions: Cerebrovascular disorders are associated with increased postoperative infectious and cognitive complications in elderly hip fracture patients. These findings underscore the importance of incorporating cerebrovascular history into perioperative risk assessment and optimizing multidisciplinary care strategies.

Background: Several studies have reported surgical techniques and favorable postoperative outcomes of post-axial polydactyly of the foot; however, few studies have investigated the long-term postoperative outcomes. The aim of this study was to evaluate long-term results of our surgical treatment, which emphasized the alignment between the distal and proximal phalanges, and the ligamentous stability.

Methods: This is a retrospective chart review of patients who underwent surgery for post-axial polydactyly and were followed up until epiphyseal closure of the foot. The study included 13 feet from 12 patients with a mean age at initial surgery of 22 months and postoperative follow-up of 161 months. The surgical method emphasized phalangeal alignment during resection of excess bones and collateral ligament reconstruction to obtain joint stability. Postoperative outcomes included functional problems, varus or valgus deformities, thickening of the reconstructed toe, postoperative complications, additional surgery, esthetic appearance evaluated using the scoring system, and subjective evaluation by patients and the parents.

Results: At the latest evaluation after epiphyseal closure of the foot, there were no cases with functional problem or valgus deformities based on morphologic findings. The esthetic appearance of the reconstructed toes was favorable in all but 1 case. Subjective evaluation was more than "satisfied" in 12 toes. In one case, additional surgery to excise scar and excessive soft tissue was performed due to pain. Visible thickening was found in 5 toes, although subjective evaluation by patients and their parents was more than "satisfied."

Conclusion: We have demonstrated the long-term postoperative outcomes in post-axial polydactyly of the foot with an emphasis on the phalangeal alignment and ligamentous stability until epiphyseal closure as a sign of skeletal maturity. We obtained favorable long-term postoperative outcomes of the reconstructed toes.

Clinical question/level of evidence: Therapeutic, IV.

Background: There is biomechanical evidence of the contribution of meniscal tears on knee stability when anterior cruciate ligament (ACL) is torn. However, clinical studies on this topic remain limited, and the conclusions derived from existing research are still incomplete. This study aims to clinically evaluate the impact of medial and lateral meniscus tears on anteroposterior laxity and the pivot-shift phenomenon in a cohort of patients with ACL-deficient knees.

Methods: A retrospective analysis was conducted on 306 ACL-deficient patients, which were categorized into 4 groups: 1) isolated ACL injury, 2) ACL injury with medial meniscus tears (ACL + MM), 3) ACL injury with lateral meniscus tears (ACL + LM), 4) ACL injury with combined medial and lateral meniscus tears (ACL + MM + LM). Statistical comparison was performed regarding demographic characteristics, sport activity level, time from injury to treatment, prevalence of high-grade Lachman test, prevalence of high-grade pivot-shifts and KT1000 arthrometric measurements. Statistical significance was set at p < 0.05.

Results: Associated meniscal tears were observed in 202 out of 306 cases (66.0 %). Patients in ACL + MM group presented significant higher age, body mass index, longer time from injury, and lower activity level compared to those with isolated ACL tears. Patients in the ACL + MM group showed higher KT1000 values (5.5 ± 1.3 mm) when compared to isolated tears (4.9 ± 1.2 mm, p = 0.0012), but not significant difference in rates of high-grade pivot shift grade. Patients in the ACL + LM group demonstrated significantly increased rates of high-grade pivot-shift grade (p < 0.0001), but no significant differences in KT1000 values. Patients in the ACL + MM + LM group showed increased rates of pivot shift grade ≥2 (p = 0.0003) and significantly increased KT1000 values (6.1 ± 1.9 mm) compared to isolated ACL tears (p < 0.0001) but also compared to ACL + MM patients (p = 0.0153) and ACL + LM patients (p = 0.0030).

Conclusions: Concomitant meniscus tears in ACL-deficient knees significantly increase anterior tibial translation and rotational joint laxity, suggesting a secondary but significant role in knee stability.

Level of evidence: IV, retrospective case series.

Background: Neurofibromatosis Type 1 (NF1) is a genetic disorder characterized by the presence of neurofibromas, including diffuse cutaneous and plexiform variants. In large lesions, debulking surgery is often indicated, but presents challenges due to the hypervascularity of the tumor and the risk of hemorrhage. Circumferential parallel ligation (CPL), originally developed for the management of vascular malformations, may be an effective approach for controlling hemorrhage during debulking surgery.

Methods: A retrospective review was conducted of 19 surgeries performed on 12 patients with NF1 and very large neurofibromas, between 2003 and 2024. All patients underwent debulking surgery using CPL. Data on tumor size, operative time, intra-operative blood loss, transfusion requirements, resection rate and post-operative complications were collected and analyzed.

Results: The mean tumor size was 26.6 cm, and the mean blood loss was 263.6 ml. Only two of the 19 surgeries required a blood transfusion. CPL was consistently effective in minimizing intra-operative hemorrhage without the use of specialized hemostatic devices. The mean resection rate was 71.9 %, indicating that significant tumor debulking was achieved in the majority of cases. Post-operative complications occurred in four surgeries but resolved with appropriate treatment.

Conclusion: CPL is safe and effective for debulking large neurofibromas in patients with NF1, offering reliable hemostasis without requiring costly surgical devices.

Introduction: Guided growth using tension band plates is a common treatment for genu varum and valgum deformities in children. Reoperation is a significant adverse event in surgical treatments. This study aims to identify the causes and risk factors for reoperations following guided growth around the knee.

Methods: This retrospective study reviewed children who underwent guided growth for genu varum and valgum deformities between 2012 and 2019. Reoperation was defined as revision surgeries for deformities at the same knee, excluding procedures for implant removal. Potential risk factors including age, sex, body mass index, surgical location, underlying etiology, and knee deformities were compared between cases with and without reoperation using the t-test and chi-square test. Risk factors were determined by logistic regression.

Results: A total of 91 patients who underwent guided growth on 142 knees were included, with a mean age of 10.9 years at the time of surgery. Reoperations were performed in 36 patients (39.5 %). These included reoperations for recurrence of deformity in 26 knees, slow response in 13 knees, overcorrection in 5 knees, recurvatum of the tibial plateau in 1 knee, and infection in 1 knee. Logistic regression revealed younger age (Odds ratio [OR] 0.6 per older by 1 year, 95 % confidence interval [CI] 0.5-0.8) and non-idiopathic etiologies (OR 3.5, 95 % CI 1.0-11.8) as risk factors. Receiver operating characteristic curve determined age 10.1 years as a cutoff point that had sensitivity 73 % and specificity 91 % in predicting reoperation.

Conclusions: The reoperation rate can exceed 50 % in patients with specific etiologies such as rickets, Blount's disease, physeal injuries, and osteochondroma. Timely guided growth is essential for patients with progressive deformities, and retaining the epiphyseal screw and plate for potential recurrence is recommended. In cases of asymptomatic idiopathic knee deformities, delaying guided growth until after age 10 may be considered to reduce the risk of reoperation.