MUSCULOSKELETAL SURGERY最新文献

Background: Isolated distal fibula fractures (DFF) are usually treated with open reduction and internal fixation (ORIF) and non-weight-bearing protocols. The study assessed the outcomes of immediate weight-bearing on DFF healing and stability after lateral locking plating.

Materials and methods: For this study, 49 patients affected by isolated DFF were enrolled. They underwent ORIF with a lateral polyaxial locking plate and were allowed immediate weight-bearing with crutches postoperatively. Clinical and radiographic evaluations were performed at 2, 6, and 12 weeks using the AOFAS (American Orthopedic Foot and Ankle Society) score and X-rays evaluations..

Results: Immediate weight-bearing yielded positive outcomes, with a significant increase of the AOFAS score during the clinical re-evaluations. All patients tolerated early and progressive full weight-bearing without complications. Radiographic findings at 12 weeks showed complete bone healing in all cases.

Conclusions: The immediate weight-bearing protocol combined with lateral locking plating resulted in favorable clinical outcomes, accelerated recovery, and successful bone healing for stable DFF cases.

Spontaneous osteonecrosis of the knee (SONK) was first described by Ahlbäck et al. in 1968. However, subsequent studies revealed that subchondral fractures, rather than necrosis, are the most common histopathological finding in bone samples from patients diagnosed with SONK. This has led to ongoing debate regarding the accuracy of the term "SONK." Therefore, SONK is an inappropriate definition for this condition since the absence of necrosis in most histopathological samples of patients with such diagnosis. A PRISMA-compliant scoping review was conducted using PubMed, Scopus, and Cochrane databases. All original research studies reporting histological analyses of bone samples from patients who underwent surgery following a diagnosis of SONK were considered for inclusion. Extracted data included general study characteristics, radiographic and magnetic resonance imaging (MRI) findings, time elapsed between arthroscopy and histological sampling, and the results of histological examinations of bone samples. Eight articles met the inclusion criteria, comprising 90 patients (91 knees), of which 87 bone samples were analyzed histologically. Of these, 7 showed undetermined outcomes. Among the remaining 80 samples, necrosis was identified in 35 cases and absent in 45. Subchondral insufficiency fractures (SIFs) were detected in 41 cases, with 19 of these also showing necrosis. The histopathological evidence suggests that the term "SONK" is inappropriate, as SIFs, rather than necrosis, are the predominant finding. We therefore recommend adopting "SIF" as a more accurate descriptor for this condition.

Purpose: Magnetic resonance imaging (MRI) is often used to evaluate patients with patellar dislocations to facilitate diagnosis and management strategies. Many radiological parameters have been described in the literature. The aim of this study was to assess the significance of tibial-tubercle trochlear groove distance (TT-TG) distance and other MRI measurements in patients with and without patellar instability.

Methods: This case-control study included 41 patients with recurrent patellar instability and 50 patients with stable knees, all of whom underwent MRI scans. A total of 19 radiological parameters were measured in both groups.

Results: All measured MRI parameters had statistically significant differences between both groups (p < 0.05) apart from trochlear cartilage length. TT-TG distance. 20 mm had the strongest association with patellar instability (OR 53.3, p = 0.006, 95%CI [3.1- 927.4]) and the highest specificity (100%) but had the lowest sensitivity (34%) out of all the measured parameters. TT-TG. 13 mm had a higher sensitivity (68%) but lower specificity (72%) and weaker association with patellar instability (OR 5.5, p < 0.001, 95%CI [2.2. 13.7]). TT-TG/trochlear articular cartilage width ratio also had a strong association with patellar instability (OR 14.7, p < 0.001, 95%CI [4.5. 48.5]) with high specificity (92%) but lower sensitivity (56%).

Conclusion: The cut-off values for TT-TG distance at 13 mm and 20 mm both had advantages and disadvantages which supports the concept of using patient-individualised ratios. Patellar instability is associated with many radiological abnormalities demonstrated on MRI scans. Selection of the most appropriate measurement is dependent on the philosophy and preference of the treating clinician.

Post-surgical rehabilitation advice after ankle fracture surgery, particularly regarding weight-bearing, varies significantly, leading to patient frustration and inconsistent recovery outcomes. This study aimed to establish a consensus for ankle fracture rehabilitation advice and identify content and implementation options for future interventions through consultation with healthcare professionals (HCPs). This study was part of the weight-bearing in ankle fractures (WAX) trial, a multicentre, randomised controlled trial. Using the behaviour change wheel (BCW) framework, three online workshops with HCPs were conducted between April 25, 2022, to May 4, 2022, to generate consensus on rehabilitation interventions. Participants completed pre-workshop tasks, and data were collected using an adapted nominal group technique (NGT). Workshop data were collated to create a survey with indicative statements about rehabilitation preferences. An online survey was subsequently disseminated to surgeons and physiotherapists between May 5, 2022, and July 13, 2022. Respondents were asked to indicate how strongly they agreed with various statements by ranking statements on a 5-point Likert scale from "strongly disagree" to "strongly agree"; 75% was used as a threshold for consensus agreement. Eight HCPs participated in the workshops, and 79 HCPs responded to the survey, representing 38 different NHS hospital trusts. Consensus was achieved on several key aspects: Patients could rest their foot on the floor while seated during non-weight-bearing periods and gradually increase weight-bearing based on comfort. It was agreed that orthotic boots are for comfort, and patients can discontinue use as early as two weeks post-operatively if weight-bearing is permitted. Guidelines for wound management, including when to get wounds wet and how to handle numbness, were also established. This study established a consensus for ankle fracture rehabilitation, emphasising patient autonomy and clear, standardised advice. The findings support the development of a tailored, patient-centred rehabilitation interventions, potentially delivered through digital platforms, to enhance recovery outcomes.

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.

Medial patellofemoral ligament (MPFL) reconstruction is a widely recognized treatment for recurrent patellar dislocation. However, limited research addresses the outcomes of combining MPFL reconstruction with distal femoral varus osteotomy, particularly in patients with genu valgum. This study aims to evaluate the clinical outcomes of this combined surgical approach in individuals experiencing recurrent patellar dislocation associated with genu valgum. A systematic review followed PRISMA guidelines by searching the PubMed, Scopus, and Cochrane Library databases through July 1, 2024. Studies included patients whose MPFL reconstruction was combined with distal femoral varus osteotomy to treat recurrent patellar dislocation and genu valgum. A meta-analysis was performed to evaluate pain, clinical and functional outcomes, with data reported as mean difference (MD) and 95% confidence interval (CI). A total of three studies with 58 knees were included. Most of the patients were female 62.5%, with a mean patient age of 20.5 years and a mean follow-up of 26.4 months. The mean preoperative mechanical leg axis was 6.8° of valgus. After MPFL reconstruction with distal femoral varus osteotomy significant improvements were found in the Kujala score (MD, 33.64 [95% CI 31.3-35.99]), Lysholm score (MD, 34.89 [95% CI 23.27-46.51]), visual analog scale score for pain (MD, - 3.99 [95% CI - 5.66 to - 2.31]), and Tegner Activity Score (MD, 1.96 [95% CI 1.63-2.29]). No subluxation or redislocation occurred in any study during the follow-up period, and all reported radiological correction of genu valgum. Combined medial patellofemoral ligament reconstruction and distal femoral varus osteotomy in patients with recurrent patellar dislocation and genu valgum lead to significant improvements in clinical outcomes, such as pain relief and functional scores, as well as effective radiological correction of valgus deformity. However, further high-quality studies are needed to confirm these findings and establish stronger evidence for this combined approach. Systematic review and meta-analysis, level IV.

Purpose: Measures directed at infection prevention, particularly perioperative systemic antibiotic prophylaxis, have received widespread implementation and are considered a standard of care for patients undergoing operative management of fractures, especially with implant use. This study aimed to review the microbiology profile of patients with fracture-related infections (FRIs) in a sub-Saharan African country in order to establish the necessity or otherwise of Gram-negative cover in the selection of antibiotics for perioperative prophylaxis.

Methodology: This study retrospectively reviewed records of adult patients (aged 18 years and above) diagnosed with FRI from January 2018 to December 2022 in ten tertiary hospitals in Nigeria. Data related to demographics, fracture and FRI classification as well as pathogenic bacteria were obtained while data were analyzed with SPSS version 23.

Results: Over the study period, 137 cases met the inclusion criteria and their data were obtained for analysis. Gram-positive and Gram-negative bacteria species accounted for 70 (51%) and 67 (49%), respectively, of the entire microorganisms identified by bacteriological culture. The most common organisms isolated from culture include Staphylococcus aureus (62, 45.3%), Escherichia coli (29, 21.2%), Klebsiella pneumonia (17, 12.4%) and Pseudomonas aeruginosa (11, 8.1%). The distribution of pathogenic bacteria isolated from positive cultures of infected closed and open fractures revealed a predominance of Gram-negative bacteria in closed fractures accounting for 45(55.6%) of the 81 organisms isolated; however, Gram-negative organisms accounted for only 22 (39.3%) of the 56 organisms isolated in open fractures (P = 0.061).

Conclusion: The findings in this study suggest that Gram-negative cover may be necessary for optimal perioperative antibiotic coverage, particularly in the sub-Saharan Africa setting in patients undergoing internal fixation of fractures. We recommend that individual institutions should establish local prophylactic protocols that provide Gram-positive and Gram-negative pathogen coverage guided by local microbiological flora.

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: Short-stem implants offer several advantages, including the preservation of bone stock and a physiological load transfer in the subtrochanteric area. The aim of this study was to compare the radiological and functional outcomes of short stem and traditional stem during midterm follow-up.

Materials and methods: We conducted a retrospective analysis of a consecutive series of 50 patients with Fitmore and CLS stems. Clinical assessment was performed by Harris hip score; additionally, thigh pain was assessed at six months, one year, and the latest follow-up. The following radiological parameters were evaluated: stem alignment, presence of radiolucent lines and osteolysis around the stem, stem subsidence, cortical hypertrophy, femoral stress-shielding, pedestal formation at the tip of the stem, calcar resorption, heterotopic ossification, and implant loosening.

Results: The mean follow-up duration was 8.4 ± 2.1 years in the CLS group and 7.6 ± 2.2 years in the Fitmore group. The mean HHS improved from 43.0 ± 3.3 to 93.2 ± 2.5 for the CLS group and from 43.2 ± 4.4 to 93.6 ± 3.2 for the Fitmore group, without any statistical differences between the two groups. Thigh pain disappeared in all patients in the Fitmore group, while it persisted in 8% of the patients in the CLS group. There was a significant difference in the level of cortical hypertrophy between the two groups, with 28% in the Fitmore group compared to 12% in the CLS group. No statistically significant difference was observed for other radiological parameters.

Conclusions: Both short stems and standard stems demonstrated stable fixation and satisfactory clinical and radiological outcomes.