MUSCULOSKELETAL SURGERY最新文献

Backgrounds: Clavicle fractures are a common injury, with lesions of the middle third accounting for 80% of all clavicle fractures. The most suitable approach to address these fractures remains debated, especially at long term. The aim of this study was to compare surgical and conservative treatments of displaced midshaft clavicle fractures at long-term follow-up.

Materials and methods: A total of 123 patients (≥18 years) with a displaced midshaft clavicle fracture, treated surgically with plate fixation (68 patients) or conservatively (55 patients) and evaluated at a mean follow-up 6.7±2.6 years, were included in this study. Shoulder function was evaluated with the Constant-Murley score (CMS) and disabilities of the arm, shoulder, and hand (DASH) score. Aesthetic satisfaction, scapular dyskinesia, radiological outcomes, and overall patient satisfaction were documented as well. A sub-analysis was performed to evaluate the influence of the radiological outcome on the functional outcome.

Results: The mean CMS was 94.1±10.6 points in the surgical group and 88.5±16.8 points in the conservative group (p=0.03). The DASH score was 5.1±11.3 in the surgical, 6.7±13.1 in the conservative group (n.s). The incidence of scapular dyskinesis was significantly lower (p<0.001) in the surgical group. Radiological follow-up documented a lower rate of non-unions (p<0.001) and mal-unions (p<0.001) in the surgical group. Regarding patient satisfaction, there was no difference in terms of aesthetic satisfaction, while the overall satisfaction favored the surgical treatment (p=0.02). Patient with a non-union or a mal-union showed a worse outcome regarding CMS, overall and aesthetic satisfaction, and incidence of scapular dyskinesis.

Conclusions: These findings support surgical fixation in patients at risk of malalignment or with high activity demands, as it significantly improves long-term function, biomechanics, and patient satisfaction compared to non-operative management.

Level of evidence: III.

Purpose: Durability of anterior-only fixation for posterior column acetabular fractures remains debated, particularly regarding potential loss of reduction over time. This study prospectively evaluated radiographic stability and functional outcomes following fixation performed exclusively through the anterior approach.

Methods: Between 2019 and 2023, forty-five consecutive patients with displaced acetabular fractures requiring posterior column fixation were enrolled. All underwent reduction and fixation via the anterior approach in the supine position. Patients with old fractures (> 3 weeks), pathological fractures, or prior hip surgery were excluded. Standardized radiological assessments measured posterior column height and displacement immediately postoperatively and at 12-month follow-up (mean 15.6 ± 1.2 months). Reduction loss was defined as ≥ 2 mm displacement. Functional recovery was evaluated using the Harris Hip Score (HHS). Complications were prospectively recorded.

Results: Mean age was 49.3 years. Radiological assessment showed minimal change between immediate postoperative and final follow-up: mean posterior column height increased 0.4 mm and posterior displacement 0.7 mm. No patient demonstrated displacement ≥ 2 mm. Functional outcomes were excellent, with mean HHS of 92.7 ± 6.4. Subgroup analysis revealed slightly lower scores in cases requiring posterior column fixation with infrapectineal buttressing (mean HHS 89.4 ± 5.1 vs. 94.1 ± 4.2, p < 0.05). One deep infection occurred (2.2% complication rate), managed successfully with debridement. No reoperation for fixation failure or nonunion was required.

Conclusion: Anterior-only fixation of posterior column acetabular fractures provided durable radiographic stability and excellent short-term functional outcomes at one year, with a low complication rate. While exclusion of irreducible fragments limits generalizability, these findings support the anterior intrapelvic approach as a reliable option in appropriately selected patients. Longer-term follow-up and comparative studies are warranted to determine its role relative to combined or posterior approaches.

Purpose: Neglected pelvic ring injuries are rare but pose significant reconstructive challenges due to chronic deformity, soft-tissue contracture, and pelvic instability. Evidence on prognostic factors and optimal fixation strategies is limited. This prospective study evaluates radiological and functional outcomes after delayed reconstruction, identifies predictors of reduction quality and complications, and compares minimally invasive INFIX versus open anterior plating.

Methods: Twenty patients presenting ≥ 6 weeks post-injury with pelvic malunion or nonunion underwent individualized staged reconstruction between 2019 and 2022. Posterior stabilization was performed first, followed by anterior fixation using either open plating or INFIX. Radiological alignment was graded by Matta's criteria, and functional recovery was assessed with the Majeed Pelvic Score. Correlation and multivariable analyses identified independent predictors of outcomes.

Results: At a mean follow-up of 13.2 months, bone union was achieved in 95% of cases, and anatomical or satisfactory reduction in 90%. Mean Majeed scores improved from 48.7 ± 12.4 to 82.5 ± 9.7 (p < 0.001). Multivariable analysis identified surgical delay > 12 weeks and type C morphology as independent predictors of suboptimal reduction, while minimally invasive INFIX fixation reduced wound complications, providing an evidence-based framework for decision-making. Overall complications occurred in 20% of cases, and the predictive model showed good discriminative power (AUC = 0.81).

Conclusion: Delayed reconstruction of neglected pelvic fractures can achieve high union rates and meaningful functional recovery when guided by meticulous planning, staged fixation, and anatomical reduction. Reduction quality and surgical timing are key determinants of outcome, and INFIX constructs reduce wound complications. Neglected pelvic fractures are uncommon, representing fewer than 5% of all pelvic injuries; despite the small cohort, this study is among the largest prospective series reported, offering novel predictive data to inform timing, technique, and functional expectations in delayed reconstruction.

Background: Bunionette deformity (BD), also referred to as Tailor's bunion, is characterized by a lateral prominence of the fifth metatarsal head, frequently associated with pain, inflammation, and shoe-related discomfort. This narrative review synthesizes current knowledge on the pathogenesis and clinical presentation of BD, while placing particular emphasis on recent developments in minimally invasive surgery (MIS) techniques compared with traditional open approaches.

Methods: A narrative review of the literature was conducted using PubMed, Scopus, and Embase databases up to July 2025, focusing on the etiology, clinical presentation, and treatment strategies for BD. Both conservative and surgical approaches, including open and MIS techniques, were critically analyzed.

Results: Conservative management, including footwear modification and orthoses, is recommended as first-line treatment. However, no long-term studies have demonstrated sustained symptom relief with non-operative modalities. Surgical options include exostectomy and a range of metatarsal osteotomies (distal, diaphyseal, and proximal), performed via open or MIS techniques. Complication rates in open surgery are reported as highest in proximal (22%) and diaphyseal (21%) osteotomies, followed by distal osteotomies (11%). Revision surgery is more frequent in diaphyseal osteotomies (n = 5; 2%). MIS techniques demonstrate complication rates ranging from 0% to 21.4%, with nonunion rates between 0% and 5.6%. MIS appears to reduce wound-related and hardware complications compared to open techniques; however, direct comparative studies are lacking.

Conclusion: While MIS techniques demonstrate favorable complication and recovery profiles in retrospective studies, the lack of high-quality prospective trials prevents definitive conclusions. Future research should prioritize randomized comparative designs to establish clear treatment guidelines.

Bone-anchored prostheses (BAPs) are an alternative option for lower-limb amputees with problematic suspended socket prostheses (SSPs). We sought to meta-analytically quantify complication burden and revision-free survival for BAPs, whilst investigating possible differences in complication rates between common screw-fit (OPRA) and press-fit (ILP/OPL) designs. A multi-database search of PubMed, EMBASE, CiNAHL, Cochrane Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus and Web of Science from inception to September 2025 was conducted. Proportions were pooled using a random-effects model. This review was registered in PROPSPERO (ID: CRD42024507070). A total of 22 studies reporting 979 patients were included. An overall complication rate of 65% (95% CI: 0.53-0.75, I² = 69%) was found. The most common complication was breakage of the abutment or dual-cone adaptor (DCA) (0.38, 95% CI: 0.19-0.62, I² = 97%), which constituted 94% of all mechanical failures (95% CI: 0.87-0.98, I² = 51%). Second was infection (0.36, 95% CI: 0.25-0.50, I² = 92%) with 72% of infections being grade I (95% CI: 0.57-0.83, I² = 72%). Estimated revision-free survival was 89% (95% CI: 0.84-0.93, I² = 0%) at five years and 77% (95% CI: 0.70-0.82, I² = 0%) at ten years. The largest difference between implant designs was for overall proportion of mechanical failure, OPRA at 68% (95% CI: 0.34-0.90, I² = 98%), ILP/OPL at 19% (0.09-0.36, I² = 85%). BAPs do carry appreciable risks for superficial infection and mechanical (abutment/DCA) breakage, with screw-fit designs appearing to have a higher mechanical failure rate. However, the revision-free survival rate overall remains acceptable up to 10 years demonstrating the viability of BAPs in lower-limb amputees.

Background: Blood flow restriction (BFR) therapy has emerged as a promising rehabilitation modality to enhance post-operative recovery following knee arthroplasty. This study evaluates the efficacy of BFR rehabilitation in patients undergoing primary total and partial knee arthroplasty compared to standard physiotherapy protocols.

Methods: A single-center, case-control study was conducted on patients undergoing knee arthroplasty. Participants were divided into two groups: one receiving conventional physiotherapy and the other incorporating BFR rehabilitation. Outcome measures included postoperative range of motion (ROM), quadriceps strength, functional mobility (assessed via the Timed Up and Go test), and patientreported pain and satisfaction scores.

Results: Patients in the BFR group demonstrated significantly greater improvements in quadriceps strength (p 0.05) and functional mobility compared to the control group. ROM and pain scores also showed favorable trends in the BFR group, indicating enhanced postoperative recovery. No significant adverse effects were reported.

Conclusions: BFR rehabilitation appears to be an effective adjunct to conventional physiotherapy in enhancing functional recovery after knee arthroplasty. Further large-scale studies are warranted to validate these findings and optimize rehabilitation protocols.

The surgical management of spontaneous osteonecrosis of the knee (SONK) in its advanced stages typically involves joint replacement procedures such as unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). This study aims to compare the risk of complications, revisions, and costs between patients undergoing TKA and UKA for SONK. This study is a retrospective review of the PearlDiver Mariner Database. The patients with a diagnosis of SONK undergoing surgical management were divided into 2 groups: patients with TKA, and patients with UKA. The two groups were matched based on age, gender, the Charlson comorbidity index (CCI), and obesity. There was a higher rate of transfusions at 30 days (< 10 vs. 0%, p = 0.04) and 90 days (< 10 vs. 0%, p = 0.02) in the TKA group. In addition, there was a higher rate of stiffness and manipulation under anesthesia (MUA) in the TKA group at 1 year (3.2% vs. < 10, p = 0.01; and 4.1% vs. < 10, p < .001 respectively), 2 years (3.6% vs. < 10, p = 0.01; and 4.5% vs. < 10, p < .001 respectively), and 3 years (3.8% vs. < 10, p = 0.003; and 4.7% vs. < 10, p < .001 respectively). Furthermore, the TKA group had higher costs at 3 years compared to the UKA group (35,269 ± 61,459 vs. 25,141 ± 25,185, p = 0.001). This study highlights the increased risks of transfusion, stiffness, MUA, and higher costs after TKA compared to patients with UKA for SONK. Our study shows that UKA seems to be a safer and less expensive option for patients with SONK.

Background: Reverse shoulder arthroplasty (RSA) is a widely used procedure for glenohumeral joint degeneration. Despite advancements in 3D preoperative planning, the concordance between planned and intraoperatively implanted components remains unclear. This study evaluates the accuracy of 3D preoperative planning in predicting humeral and glenoid components size in RSA with a 135° neck-shaft angle (NSA) short-stem.

Materials and methods: A retrospective study was conducted on 84 RSA cases performed between October 2023 and September 2024 at a specialized shoulder surgery center. All cases underwent standardized preoperative imaging, including anteroposterior and axillary radiographs and a 3D CT scan-based planning protocol using BluePrint software. The planned and intraoperatively implanted humeral stems, glenoid baseplates, and glenospheres were compared. Statistical analyses were performed to assess concordance in term of size and identify factors influencing deviations from the preoperative plan.

Results: The preoperative plan was fully respected in 23.1% of cases for both the humeral and glenoid components. The humeral stem size matched the preoperative plan in 28.6% of cases, with a deviation within one adjacent size in 67.9%. The glenoid baseplate size was concordant in 92.6%, while the glenosphere size matched in 60.7%. Kappa values indicated slight agreement for stem size (κ = 0.12) and moderate agreement for glenosphere size (κ = 0.54). A statistically significant correlation was observed between changes in humeral stem and glenosphere size (p < 0.05). No significant correlation was found with patient age, while sex significantly influenced stem and glenosphere size variation (p < 0.05).

Conclusion: 3D preoperative planning demonstrated moderate to high accuracy for glenoid component selection but lower concordance for humeral stem size. Intraoperative adjustments were mainly related to metaphyseal bone quality and soft tissue tension. Future improvements in planning software should incorporate bone mineral density and humeral osteotomy variability to enhance predictive accuracy.

Scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) are well-recognised degenerative wrist conditions. Debate persists over optimal treatment, particularly since 4 corner fusion (4CF) emerged in the 1980s. Reviews have compared the outcomes of 4CF and PRC; however, none of these have looked at whether the initial diagnosis determines the final outcome. This systematic review hypothesises that the outcome of PRC and 4CF for the treatment of stage 2 and 3 SNAC and SLAC varies depending on the initial diagnosis. Searches of PubMed, Google Scholar and Cochrane database using the terms 'SNAC' and 'SLAC' were performed. Studies were excluded based on results recorded, study nature and whether results were separated according to the initial diagnosis. Studies were assimilated using weighted averages and further analysed using Microsoft Excel and GraphPad Prism software. A total of 3320 studies were identified; however, only 6 studies (8 study arms) were included. Of these, 7 study arms recorded pre- and post-operative range of movement data, 4 with pre- and post-operative disabilities of the arm, shoulder and hand (DASH) scores and 5 with pre- and post-operative Visual Analogue Score (VAS) pain scores. There was no statistical difference in these outcome measures with a mean follow-up of 62 months (38-120). This review found no significant difference in the outcomes of these procedures; however, there is a high level of uncertainty. Further studies should focus on reporting data by procedure as well as initial diagnosis with appropriate power calculations and should be designed as prospective randomised control trials.

Background: Adhesive capsulitis (AC) is a painful shoulder condition characterized by limited motion due to fibrosis and contracture of the joint capsule. Secondary AC frequently occurs after upper limb fractures and immobilization, delaying recovery.

Methods: This retrospective study analyzed 11 patients with post-traumatic AC (< 3 months) following non-displaced humeral fractures treated conservatively with a median immobilization period of 25 days. The cohort included seven men and four women (mean age 52.6 years), five of whom also had rotator cuff injuries. Treatments involved hydrodistension, with glenohumeral drainage in seven cases and subacromial bursa drainage in four cases. Range of motion (ROM), pain (VAS), and functionality (DASH) were assessed at baseline, 1-, 2-, and 3-month post-treatment.

Results: Significant improvements in ROM were seen across all planes: flexion increased from 80° to 150°, extension from 15° to 60°, abduction from 55° to 160°, internal rotation from 10° to 85°, and external rotation from 10° to 80° (all p < 0.001). Pain levels (VAS) decreased from a mean score of 8 at baseline to 3 at 3 months (p < 0.001), and functional capacity (DASH) improved from a score of 45-10 (p < 0.001). Among the five patients with rotator cuff injuries, despite improved ROM and pain, strength deficits persisted, leading to subsequent arthroscopic repairs.

Conclusion: Hydrodistension resulted in significant improvements in ROM, pain relief, and functionality, suggesting it is a promising treatment for post-traumatic AC. Early intervention may aid faster recovery after shoulder immobilization.