MUSCULOSKELETAL SURGERY最新文献

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.

Purpose: Mastectomy and breast reconstruction surgery are often associated with postoperative pain and functional limitation at the ipsilateral shoulder, potentially leading to scapular dyskinesis. However, few studies have determined how the type of surgery and rehabilitation might affect the development of such clinical condition.

Methods: A retrospective observational study was performed on a clinical database of females who underwent surgical and adjuvant disease control treatment against breast cancer. Data included in this analysis were: demographics and clinical history, type of surgery and duration of physiotherapy, complications, as well as scapulohumeral rhythm and shoulder soreness evaluated during the orthopedic visit.

Results: Based on the inclusion and exclusion criteria, 67 females (age 52 y, range 30-69) entered the statistical analysis. Static dyskinesis was present in 64.2% of the sample at the time of the visit, and it was found present bilaterally in 29.9% of the sample, whereas dynamic dyskinesis was found in 73.1% of the sample at the time of the visit. Longer physiotherapy (> 20 sessions) showed a trend for a lower risk of dynamic dyskinesis (OR 0.228, 95% CI 0.046-1.114, p = 0.072), and compared to the Subpectoral Tissue Expander, Prepectoral Implant-Based Breast Reconstruction presented a reduced risk for dynamic dyskinesis (OR 0.265, 95% CI: 0.074-0.952, p = 0.042).

Conclusion: These preliminary findings suggest that some factors, such as the type of surgery and physiotherapy, might influence the development of scapular dyskinesis in females who undergo mastectomy and breast reconstruction.

Artificial intelligence (AI) is transforming orthopedic research by optimizing academic workflows, improving evidence synthesis, and expanding access to advanced data analysis tools. Generative AI models such as ChatGPT and GPT-4, alongside specialized platforms such as Consensus and SciSpace, empower researchers to refine search queries, enhance literature reviews, synthesize documents, and conduct advanced statistical analyses. These technologies enable the interpretation of large datasets, saving time and boosting efficiency. For orthopedic residents, AI is particularly impactful, revolutionizing their education and fostering greater independence in research. This review explores the key applications of AI as a research assistant in orthopedics, as well as its ethical considerations and challenges.

Introduction: This systematic review and meta-analysis compared orthogonal and parallel plating techniques for these fractures, focusing on functional recovery, complication rates, and biomechanical stability.

Methods: A comprehensive literature search was conducted on January 25, 2025, across PubMed, EMBASE, Europe PMC, and Scopus. Studies involving pediatric patients (aged 0-18 years) with distal humeral fractures treated using orthogonal or parallel plating were included. Eligible studies reported outcomes such as Mayo Elbow Performance Score (MEPS), range of motion (ROM), union time, and non-union rate. Two independent reviewers extracted data, and study quality was assessed using the Cochrane risk of bias (RoB) tool version 2.0. Statistical analyses were performed using a random-effects model in RStudio.

Results: From an initial pool of 659 records, five studies (three randomized controlled trials [RCTs] and two cohort studies) met the inclusion criteria. Meta-analyses revealed no significant differences between orthogonal and parallel plating in MEPS (SMD - 0.25, p = 0.07), ROM (SMD - 0.15, p = 0.27), flexion range (SMD - 0.11, p = 0.46), non-union rate (RR 1.01, p = 0.99), union time (RR 1.01, p = 0.99), or surgical duration (SMD 0.06, p = 0.74). However, orthogonal plating showed a statistically significant advantage in extension range (SMD 0.45, p = 0.005). The risk of bias was minimal, and the certainty of evidence was rated as high.

Conclusions: Both orthogonal and parallel plating techniques demonstrated comparable efficacy in managing pediatric distal humeral fractures, with no significant differences in most outcomes. Orthogonal plating exhibited a slight advantage in extension range, though its clinical relevance requires further investigation.

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.

To systematically review the variability of reporting of clinically significant outcomes (CSOs) including minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptom state (PASS), and threshold calculation methods following surgical treatments for cartilage defects of the knee. A systematic review was performed using the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A literature search was performed on August 12th, 2024, using the PubMed, Embase, and Scopus online databases for human clinical studies with publication dates ranging from 2010 to 2024 reporting on MCID, SCB, or PASS following surgical treatments for cartilage defects of the knee. Study demographics, patient-reported outcome measures (PROMs), CSO thresholds, and methods of CSO calculation were collected. A total of 19 studies (n = 3659 patients) with an average follow-up of 36.5 months were included. A total of 14 (93.3%) studies reported MCID, six (31.8%) studies reported SCB, and five (26.3%) studies reported PASS. Of the included studies, 16 (80%) referenced another study for calculating their CSO whereas three (20%) studies calculated their own CSO. A total of 16 different PROMs were reported among the included studies. Eight studies utilized the anchor-based method for CSO calculation, ten studies used both the anchor and the distribution-based methods for calculation, while only one study used the distribution-based method alone. There is considerable variation in the reporting and calculation methods of MCID, SCB, and PASS for different PROMs following surgical treatments for cartilage defects of the knee.Level of Evidence: IV, Systematic Review of Level I-IV studies.

Blount disease is a genetic disorder affecting the proximal tibial bone, resulting in a complex deformity of the knee. In the absence of timely treatment, the likelihood of developing degenerative arthritis increases. A total knee arthroplasty (TKA) is the conventional treatment for adult patients with Blount disease or Blount-like deformity with advanced degenerative changes. The aim of this systematic review is to evaluate the results of TKA in this particular cohort of patients. The present systematic review comprised a total of 5 articles. The 5 evaluated studies included data from 9 patients who undergone 12 TKAs. The patients were assessed throughout an average follow-up duration of 4 years. In all, there were three revisions of the prosthetic components. All studies achieved successful clinical scores at the last follow-up. A thorough exploration of PubMed, Embase, and Web of Science was conducted to identify research that documented the results of TKA in patients diagnosed with Blount disease or Blount-like deformity. TKA in patients with Blount disease or Blount-like deformities is intricate and demanding. Constrained implants can effectively mitigate the possible problem of persistent instability. Notwithstanding the unfavorable circumstances, TKA in this cohort of patients appears to yield satisfactory outcomes during the short- to medium-term period of observation. Other study is necessary to establish the enduring outcomes of TKA in this particular cohort of patients.

Introduction: Traditional management of forearm fractures involves open reduction and internal fixation (ORIF) using plates and screws after wound healing. However, recent years have seen the emergence of minimally invasive techniques like titanium elastic nailing (TENS) as potential alternatives. This retrospective study evaluates the role of TENS in managing open forearm fractures in adults.

Methodology: A retrospective analysis was conducted over 5 years, including 18 adult patients with open forearm fractures without neurovascular or tendon injury, classified as Gustilo Anderson III A and IIIB. Surgical management involved TENS insertion following debridement with patients undergoing general anaesthesia or brachial block. Patients were positioned supine, and reduction was performed under fluoroscopy. TENS nails were inserted into the radius and ulna, with appropriate sizing and positioning. Plastic surgical interventions were performed as necessary.

Results: There were satisfactory outcomes in 14 patients, with four patients achieving excellent outcomes at 12-month follow-up. The radiological union was observed in 12 patients, while six required revision surgeries. Deep tissue infection occurred in two patients, managed with debridement and vacuum-assisted closure. No forearm shortening was observed, with average supination and pronation of 70° and 80°, respectively. No evidence of infection was noted at the last follow-up.

Conclusion: The study underscores the feasibility of TENS as an alternative to external fixation or ORIF in managing open forearm fractures. TENS provides a viable option, particularly in combined orthopaedic and plastic surgery management, offering satisfactory outcomes and allowing for subsequent plating if needed. Ultimately, treatment decisions should be individualised, weighing various factors to optimise patient care and outcomes.