MUSCULOSKELETAL SURGERY最新文献

Purpose: Effective rehabilitation following ankle fracture surgery is essential for optimal recovery and patient satisfaction. However, traditional rehabilitation strategies often lack personalisation, leading to suboptimal outcomes. This study aimed to co-design a rehabilitation package, collaborating directly with patients, to understand their individual needs, using the Behaviour Change Wheel (BCW) framework.

Methods: Integrated within the larger weight-bearing in ankle fractures (WAX) trial, this study employed the BCW to understand behaviour, intervention options and content implementation. Nominal Group Technique was used to facilitate a workshop with 10 ankle fracture patients, and subsequent surveys were used to gather and prioritise rehabilitation needs and strategies. Participants were aged between 28 and 69, and nine (90%) were female, with representation from seven different NHS hospital trusts. Two experienced patient representatives facilitated the workshop.

Results: Rehabilitation strategies were developed focussing on interventions that included education, training, environmental restructuring, persuasion and enablement, delivered through an app or website. Survey results indicated high patient enthusiasm for structured, accessible rehabilitation support, including instructional videos, live chats with physiotherapists and peer support forums. Patients desired advice on returning to hobbies and life roles, and particularly returning to driving, bathing and work.

Conclusion: The BCW framework facilitated the development of a patient-centred rehabilitation package, highlighting the importance of tailored, accessible interventions. Patients expressed strong support for the proposed strategies, suggesting potential for improved rehabilitation outcomes through personalised, digitally delivered support. These components will be used to co-design future rehabilitation interventions.

Purpose: Over the past three decades, percutaneous needle aponeurotomy (PNA) for Dupuytren's disease has become increasingly prevalent and offers numerous potential benefits. However, significant rates of recurrences are observed in literature. We aimed to evaluate the effectiveness of our technical modifications of percutaneous needle aponeurotomy that significantly separates the cord in the palm and digits, thereby minimizing recurrences.

Methods: We treated 23 consecutive patients with our modified technique. We use a larger-bore needle in the dorsovolar direction which involves a more controlled extensive disruption of the cord under local anesthesia. The mean total passive extension deficit (TPED) and the Dupuytren's contracture-specific Unité rhumatologique desaffections de la main (URAM) scores were calculated at final follow-up.

Results: Twenty-three patients underwent the procedure, involving 28 affected hands and 38 fingers, including 22 ring fingers, 6 little fingers, and 10 middle fingers. The average follow-up period was 22 months, ranging from 12 to 28 months. At presentation, the mean total passive extension deficit TPED was 50°. At the time of the final follow-up, the mean (TPED) was 10°, with a mean percent correction of 83% which was found to be statistically significant. This included 82% correction at the metacarpophalangeal joint and 81% at the proximal interphalangeal joint. Only four experienced recurrences, accounting for 14.2% of the total with a mean TPED of 30°. Lower URAM score indicated a significant short-term functional improvement.

Conclusion: Our modified PNA technique enhances cord division in the palm and fingers, leading to improved contracture correction and lower recurrence rates. However, further studies with larger cohorts and control groups are needed to validate these findings.

Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by pain and progressive loss of shoulder motion. This condition typically affects individuals between 40 and 60 years of age and can severely impact daily functioning and quality of life. The etiology of adhesive capsulitis is multifactorial, with contributions from systemic conditions such as diabetes and thyroid disorders, as well as idiopathic factors. This review provides an overview of current concepts in the diagnosis and management of adhesive capsulitis, highlighting advancements in both conservative and surgical treatments. Conservative management remains the first-line approach, emphasizing pain relief and restoration of shoulder mobility through physical therapy, analgesics, and corticosteroid injections. Techniques such as the suprascapular nerve block have gained prominence for their effectiveness in reducing pain and facilitating rehabilitation. Recent studies underscore the importance of early intervention and individualized treatment plans tailored to the patient's needs. Surgical intervention, including arthroscopic capsular release, is considered when conservative measures fail to yield satisfactory results. While effective in restoring shoulder function, surgery carries risks and necessitates a comprehensive rehabilitation program to prevent recurrence of stiffness. This review also addresses potential complications associated with both conservative and surgical treatments, and the role of emerging techniques and technologies in improving patient outcomes. The integration of evidence-based practices and personalized care strategies is crucial for optimizing treatment efficacy and enhancing the quality of life for individuals affected by adhesive capsulitis.

Background: Chronic periprosthetic knee infection is a highly debilitating complication. In case of failed R-TKA, with significant bone loss and extensor mechanism failure, re-revision procedures could not even be feasible. The most appropriate therapeutic strategy in these cases remains unclear. This study aims to evaluate the clinical and subjective outcomes, as well as the reinfection rate, in nine patients with extensor mechanism failure following chronic PJI treated with knee arthrodesis using a cemented intramedullary nail with a bridging technique.

Methods: The series included nine patients who underwent knee arthrodesis with a cemented intramedullary nail at our Institute between 2020 and 2024. All patients were treated by a single operator using a standardized two-stage revision procedure. Clinical scores (OKS and VAS), subjective scores (SF-36), postoperative limb length discrepancy, and the reinfection rate were evaluated for each patient.

Results: All patients achieved good clinical and subjective scores, indicating good functional recovery and pain reduction. No patient had clinically relevant limb length discrepancy. One patient (11.1%) experienced a recurrence of infection. Literature shows that re-revision surgery with extensor mechanism reconstruction has high complication and reinfection rates, while transfemoral amputation results in lower clinical and functional scores. Knee arthrodesis ensures good functionality and a low reinfection rate.

Conclusions: Knee arthrodesis with a cemented intramedullary nail is a valid therapeutic alternative for patients with extensor mechanism failure following chronic periprosthetic infection. Patients in our study achieved good functional recovery and pain reduction. Further comparative studies with larger series are needed to confirm these results.

Background: Given the increased life expectancy, an increasing number of proximal femur fractures (PFFs) will occur in centenarian patients. In these patients, PFF has a serious impact on quality of life with high morbidity and mortality and an increase in total cost of care. Therefore, it is important to understand the surgical outcome for this group of patients defining preoperative risk factors.

Material and method: From January 1, 2010, to December 31, 2020, 33 centenarian patients with PFF were treated with locked nail or hemiarthroplasty. Mortality risk factors were assessed. Several survival-related factors were evaluated using the log-rank test and univariate Cox regression statistical analysis for categorical and quantitative variables, respectively. Significative variables at the univariate analysis were included in the Cox multivariate model, using Backward Elimination technique. A P value of < 0.05 was considered statistically significant for all tests. Software STATA 17.0 was used for statistical analysis.

Results: Centenarians with femoral neck and pertrochanteric fracture were treated with hemiarthroplasty and locked nail, respectively. At the time of admission, only 21% had normal hemoglobin value. Postoperatively, a moderate anemia was observed in 45% of patients and a severe dementia was observed in 18%. In 85% of patients, Charlson Index was less than 3. At the time of admission, 30% of them were considered independent in walking and activity of daily living (ADL), but at discharge ambulation was worsened and none of them were independent in ADL at one month. Postoperative delirium was observed in 30% of patients preventing a complete rehabilitation program. One month after discharge 27% of patients were readmitted in hospital for complications. Mortality was 16%, 59%, and 66% at 1-6-12 months, respectively. At a multivariate evaluation, male, severe anemia and Functional Ambulation Categories (FAC) score < 3 at admission were the only variables statistically related to high risk of mortality.

Conclusion: The anemia value was found to be related to mortality, and a quick restoration of these values is necessary. Geriatric and functional status scores, especially FAC score, are related to survival, providing an accurate prognosis. In our study, a high percentage of patients are unable to return to their pre-fracture level of independence. This suggests that the prognosis for centenarian patients with PFF may be as poor as previously thought.

Objective: This retrospective study compares two techniques of fixation of midshaft clavicle fractures: nail fixation versus plate fixation. We compared titanium elastic nail fixation with plate fixation in patients with uncomplicated midshaft clavicle fractures.

Methods: In total, 84 patients were included in our study: 35 in the nail fixation group and 49 in the plate fixation group. We compared the 12-month postoperative shoulder function and scar assessment. Primary outcome was measured by the DASH score and POSAS score. Secondary outcome was measured by Constant score, surgery complications, implant removal, hospitalization days, and size and quality of the scar.

Results: Here was no significant difference in DASH and Constant scores between the two groups. However, the nail group leads in the POSAS (12 (12 - 12) 25 (17 - 30) p < 0.001) and in all scar parameters (size, scar influence). There were no significant differences in the complications despite implant removal where more removals were noted in the nail group (16 (44.4%) 4 (8.3%) p < 0.001).

Conclusions: Fixation of uncomplicated midshaft clavicle fractures with nail provides better cosmetic results and scar quality than fixation with plate, and presents no significant differences in functional ability or complications.

Purpose: Quality of care in total knee arthroplasty (TKA) between implants was assessed using a novel composite outcome measure, early optimal recovery (EOR), to indicate ideal clinical outcomes and minimal healthcare resource utilization.

Methods: Patients that underwent primary TKA in the study group (ATTUNE® Knee System) or control group (LCS® COMPLETE Knee System) were included in this retrospective, single-center study. EOR was defined as no complications, no readmissions, no extra outpatient visits, ≤ 48 h length of hospital stay (LOS), and restored range of motion and pain perception at 3-month follow-up. Multivariate logistic regression was used to compare EOR between the study and control groups. Results were adjusted for differences in baseline characteristics and are presented with 95% confidence intervals (CI). Data were collected from a specialized clinic for elective surgeries in the Netherlands, between January 2017 and December 2020.

Results: A total of 566 patients (62.4% female, mean age 67 years) were included for analysis; 185 patients (32.7%) underwent TKA in the study group. Compared to the control group, patients in the study group had greater probability of achieving EOR (65.8% [95% CI: 55.1-75.2] vs. 38.9% [95% CI: 32.8-45.3]; p < 0.001), a LOS ≤ 48 h (77.2% [95% CI: 67.7-84.5] vs. 61.4% [95% CI: 54.7-67.7]; p < 0.05), and ideal pain perception at 3-month follow-up (93.3% [95% CI: 85.7-97.0] vs. 78.2% [95% CI: 71.0-83.9]; p < 0.05).

Conclusion: The study group was associated with a greater probability of achieving EOR versus the control group, suggesting improved quality of care.

Purpose: The close proximity of the radial nerve to the humerus poses a risk during upper arm surgery. Although the general course of the radial nerve is well-known, its exact position in relation to anatomical reference points remains poorly investigated. This study aimed to develop a standardized protocol for the sonographic and clinical identification of the radial nerve in the upper arm. The ultimate goal is to assist surgeons in avoiding iatrogenic radial nerve palsy.

Methods: A total of 76 measurements were performed in 38 volunteers (both sides). Ultrasound measurements were performed using a linear transducer (10 MHz) to identify the radial nerve at two key points: RD (where the radial nerve crosses the dorsal surface of the humerus) and RL (where the radial nerve crosses the lateral aspect of the humerus). Distances from specific reference points (acromion, lateral epicondyle, medial epicondyle, olecranon fossa) to RD and RL were measured, and the angle between the course of the nerve and the humeral axis was recorded. Humeral length was defined as the distance between the posterodorsal corner of the acromion and the lateral epicondyle.

Results: The distance from the lateral epicondyle to RD was on average 15.5 cm ± 1.3, corresponding to 50% of the humeral length. The distance from the lateral epicondyle to RL was on average 6.7 cm ± 0.8, corresponding to 21% of the humeral length. The course of the nerve between RD and RL showed an average angulation of 37° to the anatomical axis of the humerus. Gender, BMI, dominant hand, and arm thickness did not correlate with the distances to RD or RL. Measurements were consistent between the left and right side.

Conclusion: The radial nerve can typically be identified by employing a 1/2 and 1/5 ratio on the dorsal and lateral aspects of the humerus. Due to slight variations in individual anatomy, the utilization of ultrasound-assisted visualization presents a valuable and straightforward approach to mitigate the risk of iatrogenic radial nerve palsy during upper arm surgery. This study introduces an easy and fast protocol for this purpose.

Purpose: The purpose of this study was to evaluate the anterior tibial translation (ATT) in the prone position after total knee arthroplasty (TKA).

Methods: Fifty subjects (50 knees) undergoing bi-cruciate substituting (BCS)-TKA (Journey II: Smith and Nephew) and age-gender matching 50 subjects (50 knees) undergoing posterior stabilizing (PS)-TKA, were included in this study. Approximately, six months after surgery, and when the subjects had recovered their range of knee motion, following the Mae's method, accurate lateral radiographic imaging of the knee was performed with full knee extension in both supine and prone positions. The maximal protrusion length of the femoral posterior component, posterior to the extension line parallel to the tibial shaft from the edge of the posterior tibial plateau, was measured on lateral radiographs. The difference in length between the prone and supine positions was regarded as the prone-ATT. The posterior protrusion length of the femoral component, and the prone-ATT were compared between BCS and PS-TKA.

Results: The posterior protrusion length of the femoral component in the supine position was BCS-TKA 4.3 ± 1.9 mm, and PS-TKA 8.7 ± 2.3 mm. The length in the prone position was BCS-TKA 4.8 ± 2.3 mm, and PS-TKA 10.7 ± 2.2 m. Posterior protrusion length of the femoral component was significantly larger in both positions in PS-TKA when compared with BCS-TKA. In PS-TKA, posterior protrusion length of the femoral condyle was significantly larger in the prone position when compared to the supine position. No significant difference was observed in BCS-TKA. Prone-ATT was significantly larger in PS-TKA (2 ± 1.9 mm) when compared to BCS-TKA (0.7 ± 2 mm).

Conclusion: Even in a position corresponding to daily movement such as the prone position, ATT was significantly larger in PS-TKA, when compared to BCS-TKA.