MUSCULOSKELETAL SURGERY最新文献

Purpose: Distal radius fractures are the most common upper limb fractures in adults (up to 18% of all fractures in the Emergency Department). Conservative management is possible for the majority, the preferred surgical technique being volar plate fixation. Dorsal bridge plating (DBP) is an alternative method of treatment for complex fractures. DBP acts as an internal fixator and can be used in patients needing early rehabilitation. This systematic review assesses the demographics, functional and radiological outcomes and complications of using DBP in patients with distal radius fractures compared to volar plate fixation.

Methods: A literature search of PubMed, Cochrane, EMBASE and Google Scholar was performed according to PRISMA guidelines. Seven hundred and sixty-one articles were found; 11 articles met the inclusion criteria. Cadaveric studies and case studies of less than five patients were excluded. Primary outcome measures were functional and radiological outcomes. Complications were recorded as secondary outcomes.

Results: Three hundred and ninety-four patients were included in the study with an average age of 54.8 years (53.9% male and 46.1% female). Weighted mean follow-up was 55.2 weeks; the mean time to plate removal was 17.3 weeks with a mean DASH score of 25.7. The weighted range of movement was 46.9° flexion, 48.8° extension, 68.4° pronation and 67.5° supination. The radiological parameters show satisfactory outcomes with a mean radial height of 10mm, volar tilt of 3.1°, ulnar variance of 0.5mm and radial inclination of 18.8°. The complication rate was 11.4%. Digital stiffness was the most common complication but improved if tenolysis was performed at plate removal.

Conclusions: DBP is a good alternative to volar plating for complex distal radius fractures. The functional outcomes showed a slight loss of range of movement, whereas the radiological outcomes were within recommended limits. A significant disadvantage of the plate is the need for further surgical removal.

Purpose: The Oberlin II double fascicular nerve transfer has been evaluated extensively for objective outcomes for elbow flexion in brachial plexus injuries (BPI). However, there is limited information available on the recovery pattern of supination and patient-reported activity in the long-term. Our study aimed to assess the functional results with a minimum of five years of follow-up.

Methods: We evaluated patients with a minimum of five years after the Oberlin II procedure for post-traumatic BPI. They were evaluated using MRC grading, range of active movements, QuickDASH score and activity to check elbow flexion and forearm supination independent of finger and wrist flexion.

Results: 18 out of 26 patients responded with a mean follow-up of 79.4 months (range: 61-98). 16 (88.9%) (p < 0.000) patients recovered to achieve active elbow flexion and forearm supination of either MRC grade 3 power or more. The average range of active elbow flexion was 113.9^° (range: 0-140^°) and active supination was 67.8^° (0-90^°). Patients who achieved grade 3 flexion or higher were found to regain supination after a delay. The recovery continues even after two years of surgery. The mean QuickDASH score was 21.8 (range: 2.3-63.6). There's a significant inverse correlation between QuickDASH with both flexion and supination (p < .001 and < 0.05). 15 patients (83.3%) could demonstrate a dissociation of elbow and forearm movements from digital and wrist movements.

Conclusion: Our study demonstrated reliable functional results with independent elbow flexion, forearm supination and acceptable patient-reported outcomes for Oberlin II procedure in BPI.

This systematic review compares Kirschner wires versus a single cannulated screw for the treatment of lateral humeral condyle fractures in children. The purpose of this review is to review the current literature on fixation of lateral condyle fractures of the humerus, and to ascertain whether there is a difference in clinical outcomes of these fractures when fixated with K-wires vs screws. This systematic review of the literature comparing surgical management of paediatric (0-17 years of age) lateral condyle fractures with K-wire versus screw fixation was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches of three databases from inception to March 2022 yielded 17 studies which satisfied inclusion criteria, comprising 1,272 patients with a median age of 8.5 years. Eight hundred and fifty-five (67.2%) patients underwent K-wire fixation and 417 (32.8%) underwent screw fixation. Results were divided into comparative and single-arm studies. The median follow-up time was 23.3 months (range 3 months-22 years). A lateral prominence was observed in 114 (13.3%) patients with K-wires and 41 (9.8%) patients with a cannulated screw. An infection developed in 52 (6.1%) patients with K-wires, while only five (1.2%) patients with a screw developed an infection. A carrying angle deformity occurred in 61 (7.1%) patients with K-wires and seven (1.7%) patients with a screw. K-wires and cannulated screws are effective and safe methods of fixation for lateral humeral condyle fractures in children. K-wire fixation may have a greater incidence of infection but allows for safe non-operative removal and versatility with fractures of greater comminution, while screw fixation necessitates a second operation for removal following union.Level of Evidence III Systematic review.

Purpose: To assess whether 5 mL would not be less effective than 10 mL when performing a suprascapular nerve block, regarding shoulder function and quality of life in primary adhesive capsulitis.

Methods: This is a pilot study of a randomized, controlled, double-blind clinical trial conducted at a single center. Patients with AC characterized by constant pain and restricted movements in anterior elevation, 0°/90° external rotation, and internal rotation were selected. Two groups were randomly selected. In group I, a dose of 10 mL of bupivacaine was applied, while in group II, only 5 mL, in four weekly blocks. Sealed and sequentially numbered envelopes were used. The SF-36 and DASH questionnaires were applied in five moments. The t-Student test was used to compare the means, with a probability of rejecting null hypothesis of 5%.

Results: There were 17 participants with primary AC, seven in group I and 10 in group II. The average age was 54.30 and 50.43 years in the 5 mL and 10 mL groups, respectively. There were no differences when the means were compared by DASH: T0 (p = 0.074); T2 (p = 0.285); T4 (p = 0.333); T8 (p = 0.392), and T12 (p = 0.453). As for the SF-36, there were sparse differences in T2 in the domains of vitality (p = 0.006) and social aspects (p = 0.036) in favor of group I, and in the general health status domain in T8, in favor of group II (p = 0.033).

Conclusion: The volume of 5 mL is not less effective than 10 mL when performing SSNB in the treatment of primary adhesive capsulitis.

Background: We created a Multicenter Survey for Italian orthopedics surgeons on how they approach leg length discrepancy when dealing with primary total hip arthroplasty. Aim of the study was to show how surgeons manage LLD and follow literature recommendations during clinical practice.

Methods: The Survey was composed of 25 questions divided in 4 sections: surgeon's profile, preoperative and intraoperative evaluation, postoperative management. In this paper, we report the absolute and relative frequencies of answers to section on "postoperative management." Then, regarding the treatment of residual LLD, we reported whether trauma surgeons and experts in replacement surgery had higher odds ratios for providing "literature-based" answers compared to orthopedics physicians.

Results: Only four questions received more than 70% agreement on one of the answers. The OR for giving the "literature-based" answer, taking OP as the reference group was 1.57 for TR and 1.72 for RS for 10 mm LLD at first follow-up (FU) and 1.23 TR and 1.32 RS when 20 mm. When 10 mm LLD at 3 months FU the OR was 0.88 TR and 1.15 RS. The OR for treatment of LLD after the first examination of a new patient was 2.16 TR and 1.85 RS.

Conclusions: LLD is a debated topic with no definitive recommendations. Many decisions still depend on tradition. Treatment of LLD during clinical practice often differs from literature recommendations.

Purpose: Quality of care in total knee arthroplasty (TKA) between implants was assessed using a novel composite outcome measure, early optimal recovery (EOR), to indicate ideal clinical outcomes and minimal healthcare resource utilization.

Methods: Patients that underwent primary TKA in the study group (ATTUNE® Knee System) or control group (LCS® COMPLETE Knee System) were included in this retrospective, single-center study. EOR was defined as no complications, no readmissions, no extra outpatient visits, ≤ 48 h length of hospital stay (LOS), and restored range of motion and pain perception at 3-month follow-up. Multivariate logistic regression was used to compare EOR between the study and control groups. Results were adjusted for differences in baseline characteristics and are presented with 95% confidence intervals (CI). Data were collected from a specialized clinic for elective surgeries in the Netherlands, between January 2017 and December 2020.

Results: A total of 566 patients (62.4% female, mean age 67 years) were included for analysis; 185 patients (32.7%) underwent TKA in the study group. Compared to the control group, patients in the study group had greater probability of achieving EOR (65.8% [95% CI: 55.1-75.2] vs. 38.9% [95% CI: 32.8-45.3]; p < 0.001), a LOS ≤ 48 h (77.2% [95% CI: 67.7-84.5] vs. 61.4% [95% CI: 54.7-67.7]; p < 0.05), and ideal pain perception at 3-month follow-up (93.3% [95% CI: 85.7-97.0] vs. 78.2% [95% CI: 71.0-83.9]; p < 0.05).

Conclusion: The study group was associated with a greater probability of achieving EOR versus the control group, suggesting improved quality of care.

Purpose SARS-CoV-2 is an RNA virus responsible for COVID-19 pandemic. Some authors described the set of persistent symptoms COVID-related as "Long-COVID Syndrome." Several cases of post-COVID-19 osteonecrosis (ON) are described. Our primary aim was to study the hypothetical correlation between SARS-CoV-2 infection and ON; our secondary aim was to understand if ON can be considered part of Long-COVID. Materials and methods We performed a systematic review following the Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines. Because COVID-19 is a recently described disease, we included all levels of evidence studies. We excluded studies lacking specification regarding the use of corticosteroids (CCS) and studies not related to COVID-19. The variables extracted were age, sex, risk factors, affected joints, signs and symptoms, magnetic resonance imaging (MRI) and X-ray features, histology, treatment of COVID-19, dose and duration of treatment with CCS, treatment of ON, follow-up, and treatment outcome. Results A total of 13 studies were included, involving 95 patients and 159 joints. Time between the diagnosis of COVID-19 and the onset of symptoms related to ON was 16 weeks on average. Time between the onset of symptoms and the MRI was 6 weeks. An average of 926.4 mg of prednisolone equivalent per patient were administered. On average, CCS were administered for 20.6 days. Conclusions Patients with a history of COVID-19 infection developed osteonecrosis prematurely and with a lower dose of CCS than usually reported in the literature. Symptoms of osteonecrosis occur within the interval of the period described as Long-COVID. Surgeons should not underestimate the persistence of arthralgia when a history of SARS-CoV-2 infection and use of CCS is reported.

Background: Surgery is the gold standard treatment of displaced olecranon fracture, but it presents a high rate of complications, especially in the elderly, including wound breakdown and fixation failure. Conservative treatment of these fractures has recently been proposed with good functional outcomes. The aim of this retrospective study was to compare the functional results and level of satisfaction of displaced olecranon fractures which were managed surgically or conservatively in geriatric patients. The rate of implant removal and reoperation in the surgical group were also calculated.

Materials and methods: Sixteen and eleven patients aged ≥ 75 years (mean 83 and 86.2, respectively) with isolated Mayo IIA or IIB olecranon fracture were surgically and conservatively treated, respectively. All but 1 were females. Due to coronavirus pandemic, they were contacted by phone to validated clinical scores (QuickDASH, PREE and VAS), which were used to assess the outcome.

Results: At an average follow-up of 26.5 months in the conservative group and 53.1 in the surgical group (range 4-82), the mean Quick DASH was 11.67 and 11.2, respectively, while the mean PREE was 11.36 and 12.67, respectively. There was no significant difference in functional outcomes between the two groups, and all patients were satisfied. Seven complications occurred in the surgical cohort (33.3%), requiring reoperation in 4 cases (19%).

Conclusions: Displaced olecranon fractures can successfully be treated conservatively in low-demand geriatric patients with good functional results and high satisfaction rate.

Objective: This retrospective study compares two techniques of fixation of midshaft clavicle fractures: nail fixation versus plate fixation. We compared titanium elastic nail fixation with plate fixation in patients with uncomplicated midshaft clavicle fractures.

Methods: In total, 84 patients were included in our study: 35 in the nail fixation group and 49 in the plate fixation group. We compared the 12-month postoperative shoulder function and scar assessment. Primary outcome was measured by the DASH score and POSAS score. Secondary outcome was measured by Constant score, surgery complications, implant removal, hospitalization days, and size and quality of the scar.

Results: Here was no significant difference in DASH and Constant scores between the two groups. However, the nail group leads in the POSAS (12 (12 - 12) 25 (17 - 30) p < 0.001) and in all scar parameters (size, scar influence). There were no significant differences in the complications despite implant removal where more removals were noted in the nail group (16 (44.4%) 4 (8.3%) p < 0.001).

Conclusions: Fixation of uncomplicated midshaft clavicle fractures with nail provides better cosmetic results and scar quality than fixation with plate, and presents no significant differences in functional ability or complications.

Purpose: The close proximity of the radial nerve to the humerus poses a risk during upper arm surgery. Although the general course of the radial nerve is well-known, its exact position in relation to anatomical reference points remains poorly investigated. This study aimed to develop a standardized protocol for the sonographic and clinical identification of the radial nerve in the upper arm. The ultimate goal is to assist surgeons in avoiding iatrogenic radial nerve palsy.

Methods: A total of 76 measurements were performed in 38 volunteers (both sides). Ultrasound measurements were performed using a linear transducer (10 MHz) to identify the radial nerve at two key points: RD (where the radial nerve crosses the dorsal surface of the humerus) and RL (where the radial nerve crosses the lateral aspect of the humerus). Distances from specific reference points (acromion, lateral epicondyle, medial epicondyle, olecranon fossa) to RD and RL were measured, and the angle between the course of the nerve and the humeral axis was recorded. Humeral length was defined as the distance between the posterodorsal corner of the acromion and the lateral epicondyle.

Results: The distance from the lateral epicondyle to RD was on average 15.5 cm ± 1.3, corresponding to 50% of the humeral length. The distance from the lateral epicondyle to RL was on average 6.7 cm ± 0.8, corresponding to 21% of the humeral length. The course of the nerve between RD and RL showed an average angulation of 37° to the anatomical axis of the humerus. Gender, BMI, dominant hand, and arm thickness did not correlate with the distances to RD or RL. Measurements were consistent between the left and right side.

Conclusion: The radial nerve can typically be identified by employing a 1/2 and 1/5 ratio on the dorsal and lateral aspects of the humerus. Due to slight variations in individual anatomy, the utilization of ultrasound-assisted visualization presents a valuable and straightforward approach to mitigate the risk of iatrogenic radial nerve palsy during upper arm surgery. This study introduces an easy and fast protocol for this purpose.