MUSCULOSKELETAL SURGERY最新文献

Background: Knee osteoarthritis (OA) is a common degenerative condition that significantly affects quality of life. Total Knee Arthroplasty (TKA) is an effective treatment for end-stage OA, but recovery can be challenging. Enhanced Recovery After Surgery (ERAS) protocols aim to optimize perioperative care and improve outcomes.

Methods: This prospective cohort study evaluated the impact of ERAS protocols on 300 patients undergoing primary TKA. Patients were divided into an ERAS group (n = 150) and a traditional care group (n = 150). ERAS included preoperative education, multimodal analgesia, early mobilization, and multidisciplinary care. Primary outcomes were postoperative pain, length of hospital stay (LOS), and complication rates. Secondary outcomes included functional recovery and patient satisfaction.

Results: The ERAS group had significantly shorter LOS (3 vs. 7 days, P = 0.01) and lower blood transfusion rates (21.3% vs. 36.7%, P = 0.01). Postoperative pain scores were consistently lower in the ERAS group (P = 0.01-0.04). Functional recovery, measured by Knee Society Score, and patient-reported outcomes were significantly better in the ERAS group at 3, 6, 12, and 24 months (P < 0.01).

Conclusion: ERAS protocols significantly improve outcomes in TKA, reducing hospital stays and enhancing patient satisfaction and recovery, supporting their broader use in orthopaedic surgery.

Traditional methods for evaluating spinal curves, such as the Cobb angle, are limited in their ability to capture the full complexity of spinal deformities. This manuscript presents a novel method that builds on Cobb's principle and Ferguson's approach to provide a more comprehensive assessment of spinal curves. The method involves identifying the centroid-based endpoints of the curve to define its "radius of curvature" and calculating the true curve length through a three-point measurement, including the apical vertebra. The curve's type and sharpness are determined using ratios of distances derived from apical and adjacent lines, enabling detailed geometric characterization.This approach allows for precise analysis of complex deformities, such as continuous kyphotic curves in ankylosing spondylitis, and facilitates improved preoperative planning by aligning surgical strategies with the geometry of the curve. Additionally, it extends to evaluating bent rods in spinal instrumentation, ensuring accurate alignment. The method's ability to integrate multiple curve characteristics addresses critical limitations of existing techniques and holds potential for enhancing outcomes in both clinical and research settings.

Purpose:  Ulnar nerve entrapment is a common condition, with a recurrence rate after surgery reaching up to 25%. In such cases, treatment remains controversial. During elbow surgery, management of the ulnar nerve and performing neurolysis are often the initial steps, even in the absence of clear symptoms. In this study, we assessed the clinical applicability of using an adipofascial flap to cover the nerve during elbow surgery.

Methods:  A retrospective study of 53 patients with elbow conditions who underwent surgery between December 2020 and December 2023 was performed. All patients received an X-ray of the elbow and electromyography (ENMG). The following scores were recorded: NRS, MEPS, and McGowan, both preoperatively and at the 1-year follow-up.

Results:  The NRS score decreased from 7.9 ± 0.8 (range: 6-9) to 2.8 ± 1.3 (range: 0-7) at the 1-year follow-up. MEPS improved from 70.7 ± 15.9 (range: 20-100) to 96.5 ± 7.2 (range: 70-100), indicating reduced pain and improved elbow function. The McGowan scale showed improvements in 49 out of 53 cases. All patients, except one, were satisfied with the surgery, and no recurrence of ulnar nerve-related pain was observed.

Conclusion:  Preliminary results suggest that covering the ulnar nerve with an adipofascial flap following neurolysis and/or anterior transposition is an effective method for managing ulnar nerve entrapment. It appears to help prevent post-surgical complications and adhesions, which are the main causes of the high recurrence rates reported in the literature.

Introduction: Previously published literature from our institution found that patients with a fragility hip fracture were estimated to have a 4-10% risk of sustaining a second contralateral hip fracture. A follow-up, multi-centre study found that 1 in 11 (9.1%) patients sustained a contralateral hip fracture within three years of index hip fracture. Previous studies have examined the anatomic geometry of the hip joint as a risk factor for hip fractures. Our study aimed to establish a relationship between the neck-shaft angle (NSA) of the contralateral hip in patients who had already suffered a hip fragility fracture in terms of timing to second hip fracture.

Methods: A 7-year, single-institution, retrospective cohort study of patients that presented with a second contralateral fragility hip fracture from 2013 to 2019 were reviewed. Inclusion criteria were all patients 60 years old and above who suffered a second contralateral hip fracture. Exclusion criteria were all patients who were aged less than 60 years old, high-energy injuries or those who suffered peri-prosthetic fractures. The NSA was calculated by measuring the intersection of the femoral neck axis and the femoral shaft axis of the hip. Age, gender, surgery type and American Society of Anaesthesiologists Physical Status Classification (ASA) score were also examined.

Results: Ninety-four patients were suitable for analysis. NSA ranged from 113 to 146.5 degrees with an average of 130.2 degrees. Female patients had an average NSA of 129.7 degrees compared to 131.3 degrees in male patients. Average time to second hip fracture was 3.5 years, ranging from 0.08 years (29 days) to 20 years (7326 days). There was a 2.3:1 ratio of female-to-male presentations. Patient age ranged from 60 to 100 years old. The largest age group included patients aged 80-89 years, with 38 patients (28 females and 10 males). Correlation analysis performed showed no statistical significance between NSA and timing of second contralateral hip fracture with a p value of 0.235. There was an association between fracture type, specifically intracapsular hip fractures, and time to second hip fracture, but this was not statistically significant (p value 0.052).

Conclusion: There is no statistically significant association between femoral NSA and time to second fragility hip fracture. As we have excluded NSA as an independent risk factor, further studies may now be carried out to look for other potential predictors of timing to second hip fracture.

Rotator cuff (RC) tears affect 22% of the population, increasing with age. While 48.4% are asymptomatic, 25% require surgery. Annually, over 400,000 RC repairs (RCRs) are performed in the USA, costing over $50,000 each. However, retear rates remain high (10-40%), with clinical outcomes stagnating since 1980. Platelet-rich plasma (PRP) has emerged as a potential adjunct to RCR, with its growth factors and regenerative properties offering promise for enhancing tendon healing and improving postoperative outcomes. A comprehensive search across four major databases selected studies utilising PRP in RCR. Out of 2709 studies initially identified, 22 were included, with 13 undergoing meta-analysis. The primary outcome measures were pain and functional scores, with secondary outcomes including patient-reported outcome measures (PROMs) and retear rates. PRP significantly reduced VAS scores, as a proxy of pain reduction at 6 months (MD = 0.34 [0.10, 0.59]) and at 12 months (MD = 0.24 [0.03, 0.44]) post-RCR. UCLA score improvements were significant at 3 months (MD = 2.98 [1.55, 4.40]), 6 months (MD = 1.96 [1.09, 2.83]) and 12 months (MD = 1.26 [0.39, 2.13]). Additionally, PRP significantly reduced retear rates at 24 months, with a mean risk reduction of 15.03%, indicating a substantial improvement in tendon healing. PRP offers substantial benefits in RCR, particularly in reducing pain and retear rates. However, further research is necessary due to observed heterogeneity and study biases. Future efforts should focus on incorporating PRP into clinical practice and guidelines.

Antibiotic-loaded spacers are widely used in the two-stage revision protocol for managing periprosthetic joint infections (PJIs) of the knee, offering effective local antibiotic delivery while maintaining joint space and soft tissue tension. However, despite their clinical benefits, complications such as extensor mechanism rupture remain under-recognized and can severely compromise functional outcomes. This retrospective case series presents consecutive patients treated between 2014 and 2022 by a single orthopedic team at our institution. All patients were diagnosed with knee PJI and experienced extensor mechanism rupture following the implantation of either static or dynamic antibiotic-loaded spacers. The analysis highlights the multifactorial etiology of this complication, including factors such as severe bone loss, suboptimal spacer positioning or design, repeated debridements, and individual patient risks such as obesity and previous surgical history. Dynamic spacers, while allowing partial joint mobility, were associated with a higher risk of mechanical overload, whereas static spacers posed risks related to rigidity and stress transmission. Surgical management in all cases involved radical debridement, assessment of bone loss and femoral canal diameter, and careful selection of spacer type. Awareness of the potential for extensor mechanism injury should inform both surgical technique and postoperative care strategies.

Purpose: Distal tibia nonunion poses a serious therapeutic challenge for orthopedic surgeons. Bone loss and soft tissue damage is relatively common. The aim of this study was to compare the healing rate and related functional outcomes between two retrospective series of distal tibia nonunion cases treated with internal fixation via the posterolateral approach and those managed with Ilizarov external fixation.

Methods: This retrospective cohort study included 47 affected by distal tibia nonunion. The subjects had undergone internal fixation with inter-tibiofibular graft through the posterolateral approach (Group A, n = 24) and Ilizarov method associated or not with bone transport procedures and osteotomies (Group B, n = 23). Results were assessed at a minimum 24 months after surgery. Consolidation rate, radiographic healing time of nonunion, the American Orthopedic Foot and Ankle Society (AOFAS), the short form health survey (SF-12) and Visual Analog Scale (VAS) scores (pain, ability to work and treatment satisfaction) were compared between the groups. Complications and reoperations were also recorded.

Results: The nonunion healing rate was 75% (18/24) in the group A and 91% in the group B (21/23)(p = 0.001). Consolidation was observed, on average, 5.7 months after surgery (range, 4-9) in the group A and 10.7 months in the B group (range, 5-24) (p = 0.001). All patients recovered have had good functional outcomes with no significant differences between the groups. At final follow-up, AOFAS scores in the A group were 74 (range 52-94), while in the B group it was 79 (range 57-100). Group A showed a better perception of mental health status (SF-12-MCS 46 vs. 45, p = 0.36) and a better satisfaction with the treatment received, but a worse perception of their physical health status (SF-12-PCS 49 vs. 50, p = 0.52) with a lower mean score on working ability.

Conclusion: Distal tibial nonunion can be successfully treated with the posterolateral approach, or external Ilizarov fixation. There are not significative outcomes differences when patients undergoing internal or external fixation. Although healing times are faster with internal fixation via the posterolateral approach, healing rates are higher with the Ilizarov method.

Background: Hallux valgus is a common pathology in the orthopedic daily practice. More than 100 techniques of surgical correction are currently described in the literature, mostly focused on osteotomies. Procedures based on soft tissues balancing are actually less described.

Materials and methods: Between May and October 2019, 20 patients, 16 females and 4 males, underwent surgery using mini TightRope® system. All were addressed to preoperative radiological and clinical assessment through the AOFAS-hallux scale and radiographs. Follow-up was performed postoperatively with weight-bearing radiographs and AOFAS-hallux score at 5 weeks, 3 months and 6 months. All patients were postoperatively allowed to immediately full weight-bear wearing a stiff sole orthopedic shoe (Donjoy, Podalux™).

Results: The results showed an improvement in the functional score (average AOFAS from 53.5 to 87 at 6 months) and a decrease in IMA and HVA in the direct postoperative with 9.2° and 28.3°, respectively. The reductions were maintained through 6 months and compared with the preoperative condition a reduction of 6.0° and 7.3°, respectively, were observed.

Conclusions: Correction of hallux valgus with the modified osteodesis procedure with the mini TightRope system with Full Weight-Bearing can be considered effective, safe and reliable.

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.