MUSCULOSKELETAL SURGERY最新文献

Background: Major musculoskeletal oncology procedures often result in perioperative bleeding. This exposes patients to allogeneic red blood cell transfusion and its potential complications, thus increasing the risk of surgical wound infection and prolonged hospital stay. This study aimed to investigate the efficacy of oxidised cellulose, a topical haemostatic agent, in reducing postoperative blood loss and its subsequent risks.

Methods: In this randomised controlled trial, 40 patients undergoing major musculoskeletal oncology procedures were assigned to control and intervention groups. Oxidised cellulose was inserted into the surgical wound after the resection's conclusion before the wound's closure to reduce postoperative bleeding for patients in the intervention group. Postoperative closed suction drain system (Redivac TM) volume, drop in haemoglobin level, allogeneic red blood cell transfusion rate, duration of surgery, and length of hospital stay were compared between the two groups.

Results: The postoperative Redivac volume (Control: 432 MLS vs. Intervention: 431.75 MLS), drop in haemoglobin level (Control: 3.12 g/dL vs. Intervention: 3.06 g/dL), duration of surgery (Control: 134 vs. Intervention: 156 min), and allogeneic red blood cell transfusion were lower in the intervention group (Control: 204 MLS vs. Intervention: 170 MLS), but they were not statistically significant (p > 0.05) (Control: 134 vs. Intervention: 156 min). Mean hospital stay was similar in both groups (Control: 5.45 days vs. Intervention: 5.85 days).

Conclusion: Oxidised cellulose use does not significantly affect postoperative blood loss, the rate of allogeneic blood transfusion, and hospital stay. However, we believe its use contributes positively but not considerably towards lower postoperative blood loss in musculoskeletal oncology surgeries.

Hallux valgus (HV) is a frequent forefoot deformity affecting about 23% of adults and 35.7% of people over 65. The exact etiology is not fully understood. The first ray plays a significant role in walking cause it bears the principal amount of weight and maintains the position of the medial arch. Several factors that deteriorate the integrality of the first ray, such as foot deformities, restrictive footwear, and pes planus, may be ascribed to the HV occurrence. Before any surgical correction, conservative treatment should always be initiated first. Currently, there is no consensus that conservative management by shoe modification and foot orthoses could correct the pathology or terminate the clinical worsening of the condition.From a careful analysis of the literature, proper footwear should be a shoe with an adequate length, wide toe box, cushioned sole, and a lowered heel to not increase the load on the metatarsal heads and cause pain. Personalized 3D printed customized toe spreaders may be applied in patients with HV, improving symptoms and bringing pain relief. Compensating the subtalar joint hyperpronation through foot orthoses plays a fundamental role in the HV development, preventing or at least controlling the condition's progress; this, along with weight reduction and regular physical activity.Data obtained suggest that dynamic foot orthoses prefer a biomechanical type with 3/4-length, which is less likely to negatively affect the dorsal or medial pressures, which instead were noted to increase with the sulcus- and full-length orthoses.Although some studies suggest that foot orthoses would favor the correction of HV deformity, results have been very variable and just in few studies appear to correct HV or reduce its progression, improving symptoms and bringing pain relief. In the case of HV surgical correction, orthoses seem to maintain the correct position acquired over time.

Purpose: Specialized devices for fixation of the acetabulum quadrilateral plate (QP) fractures may not be readily available in resource-constrained settings. In this article, we aim to explore the use of a 3.5-mm locking calcaneal plate in fixation of QP fractures.

Methods: Twenty-eight patients with QP fractures underwent surgery using the modified Stoppa approach. Follow-up at 12 months assessed fracture healing and functional outcomes using the Majeed pelvic outcome score. Descriptive statistics summarized patient demographics and fracture characteristics. Analysis of variance (ANOVA) and exact logistic regression explored associations between factors (age, AO/OTA classification, gender, and time to surgery) and Majeed scores.

Results: The mean age of patients was 42.71 years, with the majority being male (64.29%). All patients achieved bony union. Post-traumatic arthritis developed in three patients, while two patients experienced post-operative fracture redisplacement. Evaluation using the Majeed pelvic outcome score revealed generally favorable outcomes, with 32.14% achieving excellent, 39.29% good, 21.43% fair, and 7.14% poor outcome. Only an older age was associated with a worse outcome score (excellent/good versus fair/poor, odds ratio: 0.87, 95% confidence interval: 0.77, 0.96).

Conclusion: Surgical management of quadrilateral plate fractures using 3.5-mm locking calcaneal plates demonstrates promising outcomes, particularly in resource-constrained settings, where specialized devices may be lacking.

Background: Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by skeletal deformities, bone fragility, and spinal complications. Various studies' insights underscored the impact of scoliosis on pulmonary function, positive outcomes with spinal fusion, and improved functional abilities post-surgery. However, partial loss of correction remains inevitable.

Methods: This study examines six surgically treated OI patients with scoliosis. Surgical intervention using a posterior approach with pedicle screws and hooks aimed to correct spinal deformities. Preoperative, postoperative, and follow-up radiological assessments were conducted, revealing significant reductions in scoliotic angles post-surgery.

Results: Complications included infections and proximal junctional kyphosis requiring revision surgeries. Despite the challenges posed by poor bone quality and implant stability, no implant failures occurred in this series. Ponte osteotomies at the apex of deformity aided in corrective maneuvers.

Conclusion: Surgical treatment of scoliosis in patients affected by OI is challenging and may be associated with perioperative and postoperative complications. Ponte osteotomy may improve the correction and reduce necessary force at the time of correction.

Introduction: Medial congruent (MC) systems and Posterior stabilized (PS) systems are widely utilized as implant options in total knee arthroplasties (TKAs). Nevertheless, determining which system yields superior clinical outcomes remains unresolved. This study seeks to compare these two systems by conducting a retrospective analysis of data from a single surgeon's registry encompassing both systems. Evaluation parameters consist of range of motion (ROM) and various clinical scoring systems.

Methods: A retrospective analysis of data from a single surgeon's registry compared 45 MC with PCL resected (MC-PCLR) TKAs with 44 PS TKAs. Inclusion criteria comprised primary knee osteoarthritis with a minimum 1-year follow-up, while exclusion criteria involved secondary knee osteoarthritis and revision TKAs. Range of motion, Oxford Knee Score (OKS), Knee Society Scoring System (KS) Function Score (KS-FS), and KS Knee Score (KS-KS) were assessed preoperatively, at 3 months, and at 12 months postoperatively. Statistical analysis was performed on retrieved data.

Results: Both group has similar baseline demographics in terms of gender (68% vs. 73% female, p = 0.60), BMI (26.4 ± 5.7 vs. 28.3 ± 5.1 p = 0.81) and American Society for Anaesthesiology score (75% vs. 84% score of 2, p = 0.12), with the exception of age where the PS group is significantly greater (71 ± 8 vs. 66 ± 7 years, p < 0.01). There was no significant difference in range of motion (ROM), Oxford Knee Score (OKS), Knee Society Scoring System (KS) Function Score (KS-FS) and KS Knee Score (KS-KS) for all time periods except for one time stamp where preoperatively, the preoperative KS Knee Score (KS-KS) was significantly lower in the PS group. However, when comparing the change between KS-KS of pre-operation and 3 months post operation (44 ± 18 vs. 31 ± 18,p < 0.01), and pre-operation and 1 year post operation (46 ± 16 vs. 34 ± 17,p < 0.01), it is found to be significantly higher in the PS group for both time periods. All other comparisons between the three time periods were found to have similar parameters.

Conclusions: PS and MC-PCLR demonstrates similar outcomes at the 1-year mark. However PS exhibits a faster rate of improvement from pre-operation to 3 months as compared to MC-PCLR.

Purpose: The assessment of functional outcomes after pelvic ring fracture remains a controversial topic. The Majeed pelvic score (MPS) is the most commonly used pelvic-specific questionnaire in the literature. The aim of this study is translation, cross-cultural adaptation and validation of the Italian version of MPS.

Methods: The study was articulated in two phases. Phase 1 consisted in translation and cross-cultural adaptation of MPS, from English into Italian. The psychometric properties were tested on 52 Italian patients (Phase 2). Construct validity was assessed by correlation with Short-Form 12 (SF-12). 33 patients repeated the questionnaire after 14 days to assess its reproducibility. All data were subsequently analyzed (descriptive statistics, multitrait analysis, reliability and construct validity assessment).

Results: The questionnaire was clear and easily understood (no missing data). A ceiling effect was detected for all items of the scale. Multitrait analysis showed good results for each outcome measure, except for the item "walking distance" that showed poor item discriminant validity. A significant correlation between the MPS and the physical component summary (PCS) of the SF-12 was found, while there was a weak correlation with the mental component summary (MCS). The questionnaire showed high internal consistency (Cronbach's alpha: 0.91-0.99) and very good test-retest reliability (intraclass correlation coefficients: 0.92-0.96).

Conclusions: The Italian version of the MPS has demonstrated to be reliable and valid in the evaluation of patients with pelvic ring fractures. There is still however a need for an instrument capable of evaluating the mental component in these types of injuries.

Forefoot disorders are prevalent in the general population, with an incidence between 2 and 20%. Among them, lesser toe deformities (hammer, claw, and mallet toes) are frequent disorders, and their conservative management is often not adequately considered but usually attempted before surgical indication. Among conservative treatments, shoe modifications and the application of orthoses may, in most cases, alleviate symptoms. From a careful analysis of the available literature, it emerged that treatment approaches should be individualized, and patient education has to be a central aspect of therapy. Proper footwear includes rocker and cushioned soles shoes, a wide toe box, proper length, and a lowered heel, eventually combined with the placement of a felt pad. Narrowed shoes must be avoided, limiting the impaction of the distal phalanx and toenail into the ground. A custom-made silicone orthosis applied at the second digit metatarsophalangeal (MTP) joint in a hammer or claw toe seems to reduce mean peak plantar pressure in the rigid stage of deformity but not the flexible one. A metatarsal pad placed 6.5 mm proximal to the second metatarsal head was demonstrated to diminish peak pressures by 33%, and a 12.5-mm insole further reduced peak metatarsal head pressures by 23% compared with a 2.5-mm insole. The best comfort of orthoses seems to be given by treating metatarsalgia resulting from deformities such as MTP joint instability, mallet, and claw toe. Little orthotic relevance is given to deformities such as hammer toes. Although the most significant obstacle appears to be the psychological aspect of patients, who must accept the placement of compensatory orthoses, some studies show that all these management appear to be often beneficial for the treatment of these disorders. However, none of them are permanent solutions to the deformity and they can be treatment of choice just in advanced stages, in elderly and low functional demand patients.

Purpose: Autogenous bone grafting is a widely used technique in orthopaedic and reconstructive surgeries. The anterior superior iliac crest (AIC) and proximal tibia (PT) are common sources for bone grafts. While, AIC is the gold standard, PT is popular for lower extremity procedures due to its proximity. The research investigates early complications associated with these donor sites in a tertiary orthopaedic centre in Nigeria.

Methods: This randomized controlled study was conducted from July 2020 to December 2021. It includes 66 patients randomized into AIC and PT groups. Pain score analysis and the incidence of surgical site infections were compared between both groups.

Results: There was no statistical difference in the incidence of surgical site infections (SSI) in both groups. The study also reveals that patients in the AIC group experienced more significant pain in the immediate postoperative period and up to two weeks after surgery, with the severity particularly pronounced on the first postoperative day. (p < 0.001).

C conclusions: The PT had less pain severity than the AIC bone graft donor sites. The authors recommend that surgeons consider PT if bone grafting is required.

Background and aim: Hallux valgus is the most common forefoot disease that can cause pain and be disabling for the patient. Many surgical procedures have been described to correct this deformity; over the last years, the minimally invasive Chevron and Akin osteotomies (MICA) technique has become very popular. The aim of this review was to assess if MICA technique is a reliable procedure for treating severe hallux valgus.

Methods: A systematic review was performed according to the Preferred Reporting Items for systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords were searched in PubMed Medline and Cochrane library. To minimise the number of missed studies, no filters were applied to the search strategy. To be considered for this review, the articles needed to comply with the following inclusion criteria: Minimally invasive Chevron and Akin osteotomy (MICA) for severe hallux valgus (HVA > 40°, IMA > 16°), patient age over 18 years and minimum follow-up of 6 months.

Results: Following the PRISMA flow chart 7 studies met the inclusion criteria and were taken into consideration in the review. We reached a population of 582 patients for a total of 676 feet. Males and females were 64 and 518, respectively. The mean age was 54.15 ± 8.25. The mean follow-up was 23.74 ± 9.60 months. All the studies reported an improvement in clinical results, in terms of function and quality of life. Radiological variables, mostly IMA and HVA, assessed pre- and postoperatively showed significant improvement in all studies included.

Conclusions: Despite the limited number of published studies in the literature, the available evidence reveals good clinical outcomes and high levels of patient satisfaction. Percutaneous surgery for severe hallux valgus can achieve great deformity correction with reasonable rates of residual deformity. Patient satisfaction and quality of life following third-generation MICA surgery is very high.