MUSCULOSKELETAL SURGERY最新文献

Purpose: To evaluate the radiographic and functional outcomes of scaphoid fractures and nonunions treated with volar locked plate fixation, with or without autologous bone grafting, and to explore whether graft use was associated with improved consolidation or function.

Methods: This retrospective cohort study included 19 adult patients who underwent surgical treatment with volar anatomical plates for scaphoid fractures or nonunions. Radiographic union was assessed at 3, 6, and 12 months. Functional outcomes were measured using the QuickDASH score preoperatively and at 12 months postoperatively. Graft use was determined intraoperatively based on defect characteristics. Statistical analyses included non-parametric tests and multivariable models.

Results: The mean patient age was 24.5 ± 5.4 years, and 94.7% were male. Scaphoid nonunion was present in 11 patients (57.9%), and autologous bone grafting was performed in 15 (78.9%). Radiographic consolidation was achieved in 94.7% of cases at 12 months. QuickDASH scores improved significantly (mean change: 20.6 points; p < 0.001). There were no significant differences in union or functional outcomes between grafted and non-grafted patients (p = 1.000 and p = 0.115, respectively). Interestingly, patients with nonunions demonstrated significantly better postoperative function than those with acute fractures (p = 0.034), although this did not exceed the minimal clinically important difference. Multivariable analysis failed to identify predictors of union or function, explaining only 37% of the variance.

Conclusion: Volar locked plate fixation provides high union rates and significant functional improvement in scaphoid fractures and nonunions. Bone grafting did not confer additional benefit, supporting selective rather than routine use. Further studies are warranted to clarify prognostic factors and optimize treatment strategies.

Background: Patellofemoral joint instability is the most common knee pathology observed in childhood and adolescence. One significant contributing factor to this condition is trochlear dysplasia (TD) of the femoral trochlea, which can lead to chronic pain, recurrent instability, and premature wear of the patellofemoral joint. Amongst the identified risk factors, breech presentation (BP) at birth has been highlighted as a potential contributor to the development of trochlear dysplasia. This study explores the association between breech presentation and the femoral trochlea's increased sulcus angle (SA), further emphasising its role in patellofemoral joint pathology.

Methods: A prospective cohort study was conducted with 85 newborns (170 knees), including healthy infants born in breech presentation (BP) between weeks 31 and 42 and those born in cephalic presentation (CP) between weeks 35 and 41. Sulcus angle (SA) values were measured using ultrasound, and a physical examination was performed for each group.

Results: We observed significant differences in the SA measurements between the two groups (p < 0.05): 149.92º (95% CI 148.81-151.04; SD = 5.56), compared to the CP group, which had a mean SA of 142.52º (95% CI 141.83-143.21; SD = 2.94). The BP group also had shorter gestation periods (267 days, SD = 11 vs 274 days, SD = 8) and lower birth weights (3091.71 g, SD = 500.94 vs. 3380.74 g, SD = 424.72, p < 0.05). Additionally, the rate of caesarean-section deliveries was higher in the BP group (44.8%) compared to the CP group (17.14%) (p < 0.05).

Conclusion: Newborns with breech presentation exhibit significantly higher SA values, suggesting a flatter trochlear groove and a potential predisposition to patellofemoral joint instability.

Background: Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain, primarily affecting middle-aged women. It involves tendinopathy or tears of the gluteus medius and minimus tendons, often misdiagnosed as trochanteric bursitis. Accurate diagnosis and management require thorough clinical assessment and diagnostic imaging.

Methods: This review examines the pathogenesis, clinical examination, and diagnostic tools like ultrasound (US) and magnetic resonance imaging (MRI) for GTPS. A narrative literature was conducted from May 2002 to February 2024 using PubMed. A total of 85 articles were reviewed, with 56 included, focusing on conservative and interventional treatments such as physical therapy, extracorporeal shock wave therapy (ESWT), corticosteroid injections, and platelet-rich plasma (PRP).

Results: Non-surgical interventions showed variable efficacy. ESWT provided significant long-term pain relief, while corticosteroid injections offered short-term benefits that diminished over time. PRP injections demonstrated sustained improvement. US-guided procedures were found superior in precisely targeting anatomical structures.

Conclusions: GTPS remains a challenging, often chronic condition. Non-surgical approaches can effectively manage early stages, but persistent cases may require advanced interventional strategies. Further research is needed to standardize treatment protocols, particularly for severe tendinopathy cases.

Introduction: Anterior femoral notching during TKA is thought to weaken the distal femur, potentially increasing periprosthetic fracture risk, but its clinical impact remains debated. This study examines whether notching independently predicts such fractures and assesses related clinical outcomes using the Tayside classification system for cortical violations.

Methods: A retrospective cohort study was conducted on 715 patients who underwent primary TKA. Patients were divided into Group 1 without notching (control group) and Group 2 with any presence of notching according to Tayside classification system, which assesses cortical violations based on the extent of involvement. Fracture incidence and additional multivariate analysis were used to control for confounding factors, including bone quality (presence of osteoporosis) and demographics.

Results: PPFs were significantly more frequent in the notching group (2.67%) than in the control group (0.24%) (p < 0.01). Despite 6.68% of patients having osteoporosis, no correlation with PPFs was found. All fractures occurred in female patients due to falls. A cortical defect > 2.5 mm was a potential predictor of femoral weakness, with larger defects in the notching group (2.20 ± 0.54 mm) vs. control (0.02 ± 0.16 mm), p < 0.01. PPF incidence was 1.33% for Grade 1 and 2 defects and 0.33% for Grade 3 defects.

Conclusion: Preventive strategies, including meticulous surgical technique and tailored postoperative rehabilitation, are essential to minimize PPF risk. Anterior femoral notching compromises femoral integrity, with defects > 2.5 mm significantly increasing fracture risk. Careful surgical planning, especially in patients with poor bone quality or advanced age, is crucial to optimize outcomes and reduce complications.

Introduction: Sarcopenia is a pathologic condition frequent in aged population, leading to functional and cognitive impairment. Given the ageing of the population worldwide, the topic has generated interest in the last decades and is expected to be more relevant in the near future. This paper aims to present the mechanism of sarcopenia, the current state of knowledge regarding diagnosis and treatment and the role of sarcopenia in orthopaedic and traumatological settings. Sarcopenia is an age-related condition which overlaps with other features of frailty syndrome by similar biochemical pathways. It is characterized by a loss of muscle mass and function, mainly due to reduced anabolism. The importance of prompt diagnosis is highlighted; however, there is a lack of standardized cut-offs, thus affecting also non-pharmacological and pharmacological therapeutic options, which are not well defined. The increased risk of falls, disability, cognitive impairment and association with osteoporosis exacerbates fracture risk. Post-surgery inactivity contributes to sarcopenia, which also leads to prolonged hospital stays, increased complications and worse clinical outcomes.

Conclusion: Ageing of population will increase chronic-related conditions. Sarcopenia is a growing and still largely unexplored clinical challenge. Research should focus on diagnostic thresholds and therapeutic protocols to promote interdisciplinary assessment and targeted interventions. In the orthopaedic field, attention ranges from the prevention of fragility fractures to proper perioperative management.

Purpose: The aim of this study was to evaluate the radiological-functional outcomes and rotator cuff (RC) status following humeral intramedullary nailing (IMN), comparing the anterolateral standard approach (group 1) and the percutaneous antero-acromial approach (group 2).

Methods: This observational prospective monocentric study was conducted from August 2021 to March 2023. Inclusion criteria included: two-parts proximal (surgical neck) and diaphyseal Humeral fractures treated with IMN; 12-month follow-up; age between 18 and 85 years; good performance status (excluding neurologic deficits or mental disorders). Evaluations included RC status via ultrasound, Constant, DASH, and SPADI scores, as well as fracture healing times. A T-test was used or statistical analysis.

Results: Sixty-one patients were enrolled during the study period (34 in group 1; 27 in group 2). The mean bone healing time resulted 2.9 ± 0.5 months in group 1 and 2.4 ± 0.7 months in group 2, with a statistically significant reduction of 17% in favor of group 2 (p < 0.05). No significant differences were found in the Constant scores at 6 and 12 months of follow-up; however, significant differences were observed in DASH and SPADI scores (p < 0.05). Supraspinatus tears were detected in both groups: 6 in Group 1 (2 full-thickness and 4 partial) localized at the footprint, and 4 in Group 2 (1 full-thickness and 3 partial) assessed medially in the musculotendinous portion.

Conclusion: Intramedullary nailing with a percutaneous approach proved to be a minimally invasive technique with better functional outcomes and shorter fracture healing times. The impact on the RC was comparable to the standard approach.

Total hip arthroplasty (THA) via the direct anterior approach (DAA) is a preferred surgical technique due to its benefits, including reduced soft tissue disruption and faster recovery. However, obesity, defined as a body mass index (BMI) ≥ 30 kg/m², poses unique challenges in DAA-THA, increasing the risk of complications and technical difficulties. This systematic review aims to assess the clinical and functional outcomes, complication rates, and reoperation rates in obese patients undergoing DAA-THA compared to non-obese patients. A systematic search was conducted in PubMed, Cochrane Library, and Web of Science for studies published between January 2000 and December 2024, following PRISMA guidelines. Inclusion criteria focused on studies reporting outcomes for obese patients undergoing DAA-THA. Data on functional outcomes, complications, and reoperations were extracted, and methodological quality was evaluated using the Modified Coleman Methodology Score (mCMS). Eleven studies involving 8,062 THAs (3,658 in obese patients, 4,386 in non-obese patients) met the inclusion criteria. Both groups showed significant postoperative improvements in functional outcomes, with similar Harris Hip Scores (HHS) (94.38 in obese vs. 93.85 in non-obese patients). Obese patients, however, had longer surgical times (82.52 vs. 68.82 min) and higher complication rates (5.5% vs. 4.88%), including increased risks of superficial wound infections, periprosthetic joint infections, and deep vein thrombosis. Reoperation rates were also higher in obese patients (1.69% vs. 0.7%). DAA-THA provides comparable functional improvements for obese and non-obese patients. However, the higher complication and reoperation rates in obese patients emphasize the need for preoperative optimization, meticulous surgical technique, and targeted perioperative care. Further high-quality studies with longer follow-up are necessary to refine strategies for optimizing outcomes in obese patients undergoing DAA-THA.

Introduction: Cervical spine surgeries pose unique challenges due to the proximity of critical structures and limited visualization with traditional techniques. Robotic assistance offers potential solutions by providing precise navigation and reducing radiation exposure. We present a series of 30 consecutive patients undergoing various cervical spine procedures utilizing the MazorX Stealth Edition (MXSE) robotic system with intraoperative imaging.

Methods: Anterior and posterior surgeries were performed using the MXSE system. Surgical parameters, implant placement accuracy, and patient outcomes were assessed. Data analysis included anthropometric measurements, surgical times, blood loss, radiation exposure, and patient-reported outcomes.

Results: Mean age was 52.43 years, with 43.33% females. Procedures included anterior cervical discectomy and fusion, corpectomy, disc replacement, and posterior decompression and fusion. Implant placements were accurate, with no neurological deficits or reoperations. Surgical parameters were comparable to standard techniques.

Discussion: Robotic assistance offers accurate implant placement and reduced radiation exposure. Challenges such as vertebra segmentation and surgical approach were addressed. Further research and instrument development are needed for wider adoption.

Conclusion: Robotic navigation in cervical spine surgeries enhances precision and safety. Continued advancements in technology and technique are essential for broader implementation.

Purpose: Poland syndrome is a congenital malformation characterized by agenesis or hypoplasia of pectoralis muscles. There is a limited literature on how the anatomic anomalies of PS may impact the movement of the shoulder. This study analyzes the effects of absence of the pectoralis muscles on the shoulder kinematic.

Methods: Clinical evaluation was performed analyzing range of motion (RoM), stability, cuff disease and internal rotation strength. In all patients, we used inertial sensors to analyze scapular motion in three degrees of freedom: medium-lateral rotation, posterior tilting and protraction-retraction. The same analysis was performed by dividing the patients into two groups by age to evaluate the presence of age-related alterations.

Results: No differences in RoM between pathological and healthy side were observed. All patients were positive for posterior instability. No significant differences in strength in internal rotation were observed with average + 6,91% (s = 2,14) on the healthy side's strength. Kinematic analysis showed higher values of scapular medium-lateral rotation and anticipation of retraction of the pathological side during flexion and abduction. Reduced scapular tilt in under 18 years old was found.

Conclusions: The absence of the pectoralis muscles seems not to affect the RoM. The increased scapular rotation on the medium-lateral axis is probably due to the absence of humeral insertion of the pectoralis major and the absence of the scapular insertion of the pectoralis minor. The increased retraction in abduction it can be explained by a hypercontraction of the scapular stabilizers. The reduced tilt in under 18 years old is influenced by the lack of adaptation by the muscle groups involved.

Introduction: Irreparable rotator cuff tears (IRCTs) are large tears that can't be surgically repaired due to poor tissue quality, degeneration, or severe tendon retraction. These tears often involve multiple tendons and lead to fatty infiltration, humeral head migration, and tendon retraction. Patients with IRCTs typically present with pseudoparalysis, muscle atrophy, or anterosuperior escape. While various surgical options exist, outcomes are often inconsistent. This case series presents a novel technique for managing massive IRCTs, showing excellent, consistent results and offering a promising advancement for treating these challenging cases.

Methodology: Our case series involved 20 patients with massive irreparable rotator cuff tears, presenting clinically with pseudoparalysis and radiographically with signs of fatty infiltration, anterosuperior escape, and tendon retraction. The outcomes of interest included the Western Ontario Rotator Cuff Index (WORI), Oxford Shoulder Score (OSS), and range of motion arc (forward flexion and abduction), measured both preoperatively and postoperatively.

Results: The mean age of our patient cohort was 53.6 years, with a mean follow-up time of 40 months. The mean preoperative WORI score was 155.3, which improved to 54.2 postoperatively, showing an improvement of 101 points from the baseline. The mean preoperative OSS was 34.4, improving to 10.5 postoperatively, with a gain of 23.8 points. The mean preoperative range of motion for forward flexion was 67.0°, which improved to 164° postoperatively, resulting in a mean gain of 97°. The mean preoperative abduction was 57°, which improved to 166° postoperatively, with a mean gain of 109°. All these findings were statistically significant (p < 0.05).

Conclusion: In our surgical technique, all patients demonstrated clinically and statistically significant improvements in both range of motion and patient-reported outcomes. This makes our approach a novel, robust, and reliable technique for managing massive irreparable tears, particularly in young adult patients.

Level of evidence: Case Series, Level IV.