MUSCULOSKELETAL SURGERY最新文献

Background: This study aims to evaluate the incidence of clinically significant heterotopic ossification (HO) in primary total hip arthroplasty (THA), comparing outcomes with and without the adoption of an HO prophylactic protocol in male patients under 70 years of age.

Methods: The prophylactic protocol involved the administration of 50 mg of Indomethacin twice daily for 3 weeks. HO presence was classified according to the Brooker classification system, considering "severe" clinically significant HO (Brooker grade 3 and 4).

Results: Two hundred and seventy-nine patients were included in our study, and an overall HO rate of 68.2% versus a rate of 61.5% was found respectively in patients not subjected and subjected to prophylactic protocol, without significant difference (PR 0.062). However, patients not subjected to the HO prophylactic protocol exhibited a severe HO rate of 22.4% compared to 7.7% in the prophylactic group, with a statistically significant difference (P = 0.008).

Conclusions: Our study demonstrated that prophylactic protocol adoption is significantly associated with lower rate of severe HO in male patients under 70 years of age. Currently, there are no orthopedic guidelines for the prevention and management of HO after THA, but in the absence of contraindications, the adoption of a prophylactic protocol for HO should always be considered in high-risk patients.

The selection of graft type for anterior cruciate ligament reconstruction remains a topic of debate, taking into consideration patient characteristics, as well as the type and level of sports involvement. The aim of this scoping review was to investigate patient characteristics that might influence the selection of graft type for anterior cruciate ligament reconstruction. PubMed and Scopus were searched to identify articles for inclusion. All included studies focused on one or more patient characteristics involved in the decision-making process regarding anterior cruciate ligament reconstruction autograft, including the hamstrings tendon (HT), patellar tendon (BPTB) and quadriceps tendon (QT). Out of the 1,977 initial studies, 27 studies were included in this review. The BPTB graft seems to be the preferred choice in young patients, females, and athletes-especially those engaged in pivoting sports. The HT graft seems to be the preferred choice in less active and older patients, along with those involved in sports where knee extensors are vital. The HT graft is not preferable in patients with a small body height and graft diameter. Moreover, surgeon preferences were also of importance for graft selection. The success of a specific graft type in anterior cruciate ligament reconstruction is highly dependent on the patient's characteristics and type of sport. Patient characteristics such as age, gender, body height, graft diameter, and the patient's activity level should all be considered when choosing the appropriate graft type.

Little evidences are available in the literature concerning the outcomes of total knee replacement (TKR) in poliomyelitis patients with severe knee deformities or degeneration. Encouraging results have been reported concerning the use of constrained implants, i.e., rotating hinge knee prosthesis (RHK), compared to less constrained ones. The purpose of this paper is to report our experience with rotating hinge total knee replacement, using only RHK prosthesis, to determine functional results, complications, and survival of TKR in poliomyelitis patients. We performed a retrospective chart review of 14 patients with a history of knee osteoarthritis following poliomyelitis that underwent primary TKR, for a total of 15 surgical procedure (one bilateral case). Preoperative and postoperative clinical measurements have been conducted for all patients using the Knee Society Score (KSS). Hip-knee angle, recurvatum knee angle, and Insall-Salvati index were evaluated with full weight-bearing panoramic view X-ray preoperatively and postoperatively. The 2-year postoperative clinical KSS significantly improved from the preoperative scores. The average clinical KSS improved from 32,9 (range 3-48) preoperatively to 77,4 (range 60-88) postoperatively (P value < 0.005). The average functional KSS improved from 32,5 (range 10-60) preoperatively to 59,4 (range 30-95) postoperatively (P value < 0.005). TKR is a successful treatment in improving knee function and patient's quality of life. Using constrained implants, especially rotating hinge implants in polio patients with a quadriceps muscle weakness, could be a good alternative to maintain a physiological kinematics and reducing the revision rate due to knee instability.

With the advanced arthroscopic technique, arthroscopic-assisted reduction and internal fixation (ARIF) is gaining popularity for Glenoid fractures with and without scapular involvement. ARIF offers a complete view of the articular surfaces and diagnoses and treats other associated injuries. ARIF provides less soft tissue trauma than open reduction internal fixation (ORIF). The aim of this systemic review is to look at the functional outcomes and complications of ARIF. A systematic review of the PubMed, Embase, and Scopus databases was performed. The search terms included "glenoid fracture" OR "scapula fracture" AND "arthroscopic fixation" OR "arthroscopy" OR "arthroscopic-assisted reduction and internal fixation". Studies were limited to English publications with reported functional outcome measures and complications. Patient demographic characteristics, clinical outcomes including range of motion, outcome performance scores including ROWE score, visual analogue scale and American shoulder and elbow surgeons score and complications were extracted. Five studies met the inclusion criteria. The participants ranged in age from 41 to 48, and the mean length of follow-up ranged from 12 to 41 months postoperatively. The mean ROWE scores for the ARIF group were significantly better postoperatively. ARIF allows accurate diagnosis of the fracture pattern and associated injuries, in addition to representing a safe option to treat glenoid fractures with or without scapular fractures with fewer complications compared to ORIF. Level of Evidence: Level IV, Systematic review.

Purpose: The aim of this study is to report the prevalence of femoral bowing in the Egyptian arthritic knees as a representative of the middle eastern population and to study the correlation between the femoral bowing and the degree of arthritis, varus deformity and the distal femoral valgus cut angle (VCA).

Methods: This is a single-center observational cross-sectional study. Out of 562 knees Scheduled for TKA, 124 knees were excluded leaving 438 knees eligible for the study. The following angles were measured by two independent orthopedic surgeons: Femoral bowing angle (FBA), HKA angle, LDFA, MPTA and VCA.

Results: Out of 438 knees, 21knees (4.8%) had medial bowing (< - 3°), 111 (25.3%) had normal bowing (+ 3° to - 3°) and 306 (69.9%) had LFB of which 111 (25.34%) had mild LFB (+ 3 to + 5°) and 195 (44.52%) had severe LFB (> + 5°) bowing. LFB was more in older age group (p = 0.005), in females (p < 0.001), and in grade 4 OA, (p < 0.001). Also, there was a significant positive correlation between FBA and age and increasing varus HKA, and with varus orientation of the distal femur and the tibial plateau. The mean and the 95% confidence interval of the VCA for the medial bowing group was 3.43 (3.01-3.85°), for the normal bowing group was 5.42 (5.15-5.68°), for the mild lateral bowing was 6.74 (6.47-7°), and for the severe bowing group was 9.23 (8.89-9.55°).

Conclusions: There is no single safe zone for the VCA to reproduce postoperative neutral coronal alignment especially in cases of severe lateral femoral bowing in TKA. However, the VCA should be analyzed in term of how much femoral bowing exists. In other words, for each subset of femoral bowing there is a safe zone for the VCA.

Purpose: Surgical treatment of chronic Achilles tendon rupture is a technically challenging procedure. We aimed to compare the clinical outcomes, range of motion, and strength of ankle plantar- and dorsiflexors between two techniques for fixation of flexor hallucis longus tendon to the calcaneus: interference screw and suture-external button.

Methods: Twenty-five patients participated in this retrospective comparative study. All patients underwent short harvest FHL tendon transfer for chronic AT rupture were asked for a follow-up visit, at least one year following surgery. The outcomes were evaluated by visual analog scale (VAS), AOFAS ankle-hindfoot score, and VISA-A questionnaire. Ankle ROM with possible restriction in addition to isokinetic strength of ankle plantar- and dorsiflexors was assessed.

Results: No statistically significant difference was observed between the groups for pain (P = 0.81), AOFAS ankle-hindfoot scale (P = 0.97), and VISA-A (P = 0.44). Notably, more decrease in ankle dorsiflexion was seen in interference screw group in comparison with suture-external button group (4.4 ± 6.6 vs. 9.5 ± 6.1 degrees, P = 0.06). The difference of active dorsiflexion between operated and non-operated side in interference screw group was statistically significant (P = 0.02). Biotenodesis screw imposed more limb asymmetry in comparison with suture-external button technique.

Conclusions: Fixation of transcalcaneal FHL tendon transfer for chronic AT either by interference screw or suture-external button has encouraging postoperative clinical results. Although ROM of the ankle joint reduced in both techniques, interference screw may result in more reduction in dorsiflexion of the ankle.

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.

Background: A persistent fracture gap following femoral nailing increases the risk of delayed and nonunion development. A forward-striking technique for reducing the gap in femoral nailing has been described, but its efficacy and therapeutic consequences have not been investigated in comparative studies. We provide the results of a comparative study that investigated the forward-striking technique's efficacy in terms of remaining fracture gaps and surgical outcomes.

Methods: Between 2017 and 2022, a retrospective cohort study was undertaken on 193 skeletal mature patients obtaining reamed femoral nailing for closed femoral shaft fractures. Comparisons of residual fracture gaps, timing to union, complications and re-operation rates were made between 80 patients (41.45%) undergoing femoral nailing with the forward striking procedure and 113 patients (58.55%) undergoing traditional nailing, accompanied by minimal 1-year follow-ups. In addition, the potential difference between fracture gaps before and after applying the forward striking procedure was compared.

Results: Both groups had similar age, sex, presence of diabetes, smoking status, body mass index and time to surgery. However, the forward-striking group demonstrated significantly lower rates of postoperative complications, including delayed, nonunion, and the need for re-operation. Conversely, no significant differences were found in time to union (p = 0.222). The forward-striking procedure can significantly reduce residual fracture gaps from 3.99 to 1.66 mm (p < 0.001). No major complications in the forward-striking group including nonunion were observed.

Conclusion: This study suggests that the forward-striking technique effectively reduces residual fracture gap during femoral nailing. The technique not only could be easily performed but is also reproducible. In addition, it can lower the risk of delayed union, nonunion and obviates the necessity for re-operation.

Level of evidence: Level III, retrospective cohort study.

Introduction: The Wide-Awake-Local-Anesthesia-No-Tourniquet (WALANT) technique is being used progressively more and more in hand surgery as it avoids tourniquet-related complications and saves money.

Materials and methods: In the present study, we analyzed our cases of carpal tunnel syndrome or trigger finger operated upon with this technique from January 1, 2018 to December 31, 2022.

Results: We obtained 822 cases (426 carpal tunnel syndrome, 396 trigger finger) with an overall anesthesiologic efficacy (no need of additional anesthetic) of 97.8%. Patients were satisfied or very satisfied with the anesthetic choice in 99.8% of cases.

Conclusions: We believe WALANT to be a safe and effective technique that every hand surgeon should have in his/her repertoire.