MUSCULOSKELETAL SURGERY最新文献

Purpose: Autogenous bone grafting is a widely used technique in orthopaedic and reconstructive surgeries. The anterior superior iliac crest (AIC) and proximal tibia (PT) are common sources for bone grafts. While, AIC is the gold standard, PT is popular for lower extremity procedures due to its proximity. The research investigates early complications associated with these donor sites in a tertiary orthopaedic centre in Nigeria.

Methods: This randomized controlled study was conducted from July 2020 to December 2021. It includes 66 patients randomized into AIC and PT groups. Pain score analysis and the incidence of surgical site infections were compared between both groups.

Results: There was no statistical difference in the incidence of surgical site infections (SSI) in both groups. The study also reveals that patients in the AIC group experienced more significant pain in the immediate postoperative period and up to two weeks after surgery, with the severity particularly pronounced on the first postoperative day. (p < 0.001).

C conclusions: The PT had less pain severity than the AIC bone graft donor sites. The authors recommend that surgeons consider PT if bone grafting is required.

Total knee arthroplasty (TKA) is the gold standard for advanced knee osteoarthritis and is increasingly performed on younger, active individuals. While low-impact sports are recommended after TKA, running remains controversial due to concerns about implant loosening. Cemented implants have durability issues at the bone-cement interface, while cementless designs seem to promote better osseointegration. Despite limited research, running after TKA is gaining acceptance. The purpose of this paper is to present a systematic review of the literature and present a novel and specific protocol to guide motivated patients in safely resuming running. We conducted a systematic review of PubMed studies regarding running after TKA and the PRISMA flow diagram shows the inclusion and exclusion criteria adopted. In addition, we present a novel protocol (FAST) specifically designed for TKA patients aiming to return to running which combines surgical techniques, perioperative analgesia, and physical therapy. It has been approved by the Ethics Board, the prospective trial is registered (NCT06383936), and we are currently enrolling participants. After screening according to inclusion and exclusion criteria, six studies were included in the analysis. The FAST protocol combines cementless CR-design implants, minimally invasive surgery, and personalized functional alignment. Local infiltration analgesia reduces pain and enables rehabilitation within 24 h. Rehabilitation progresses with range-of-motion exercises, muscle strengthening, and gradual return to running at 6-8 months. Monitoring activity carefully prevents inflammation, optimizing recovery. Running after TKA, once discouraged, now shows low complication rates. Preoperative fitness and patient-specific factors are key predictors of success. The FAST protocol integrates cementless implants, personalized alignment, and structured rehabilitation. Proper patient selection and communication are essential. Further research is required to validate long-term outcomes.

Continuity of care has been linked to patient satisfaction and self-reported outcomes. Following hip fractures in the elderly, rehabilitation aims at restoring patients' mobility and independence at the pre-fracture level and at the earliest possible time. Despite the potential role of physiotherapists' continuity on functional outcomes, this correlation has not yet been studied in an acute orthopaedic setting. Guaranteeing the presence of the same physical therapist on individual patients is challenging from an organizational point of view. An observational retrospective study was conducted on 129 aged patients (84 ± 8 years) who underwent surgery for proximal hip fracture. Indicators of outcomes were ILOA score at discharge, length of stay and achievement of rehabilitation goals as defined by the Individual Rehabilitation Project. The number of physical therapists taking care of patients was monitored during the patient's hospital stay. No correlation was found between the number of physical therapists and functional goals at discharge. The frequent change of physical therapists providing rehabilitation to elderly patients who underwent surgery for hip fragile fracture is not related to functional outcomes.

Knee needle arthroscopy (NA) represents a minimally invasive diagnostic and therapeutic approach for managing a variety of knee joint pathologies. This innovative technique, characterized by a thin, flexible, needle-like device, offers a less invasive alternative to conventional arthroscopy (CA), enabling outpatient procedures with reduced postoperative pain, faster recovery, and minimal scarring. This systematic review examines the current applications, diagnostic accuracy, clinical outcomes, and patient benefits of needle arthroscopy. Studies reveal that NA demonstrates comparable diagnostic efficacy to CA and superior accuracy to MRI for intra-articular knee pathology, particularly in meniscal injuries and anterior cruciate ligament assessments. NA facilitates real-time visualization and interventions under local anesthesia, promoting cost-efficiency and patient satisfaction. Despite its advantages, there are challenges such as limited visualization and technical proficiency. While NA emerges as a promising modality in knee diagnostics and treatment, further large-scale clinical trials are essential to validate its long-term efficacy, safety, and broader applications.

Calcaneus fractures are severe injuries often resulting from traumatic falls or motor vehicle accidents. Surgical treatment through open reduction and internal fixation (ORIF) is considered the standard approach for displaced intra-articular calcaneal fractures (DIACFs), but it is associated with many complications. Our study aimed to review the current literature available on primary subtalar arthrodesis (PSA) as a first-line treatment for DIACFs, mostly Sanders type IV. In this study, we conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords were searched in PubMed, MEDLINE and the Cochrane Library. This review included articles where primary arthrodesis was performed in calcaneal fractures, with or without associated implants. Nine articles were included in the review. The total population comprised 184 patients with 192 calcaneal fractures. The mean age was 44.9 ± 6.9 years old. The mean follow-up period was 30.28 ± 15.29 months when reported. The mean time to surgery was 13.33 ± 7.02 days from injury. All studies reported a good fusion rate (between 94 and 100%) and an average fusion time of 4.05 ± 2.19 months. The mean American Orthopedic Foot & Ankle Society (AOFAS) score was 71.26 ± 8, and the mean Visual Analog Scale (VAS) score for pain was 3.26 ± 0.91. Primary arthrodesis of the subtalar joint for treating DIACFs, mostly Sanders type IV, provides good results due to the avoidance of further procedures, reduced postoperative pain, and a high rate of bony union. However, success heavily depends on factors such as patient comorbidities and addressing hindfoot deformity. Further studies with larger patient populations and more standardized protocols are necessary to draw definitive conclusions about the best management strategies for DIACFs. Systematic review, level III of evidence.

Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by pain and progressive loss of shoulder motion. This condition typically affects individuals between 40 and 60 years of age and can severely impact daily functioning and quality of life. The etiology of adhesive capsulitis is multifactorial, with contributions from systemic conditions such as diabetes and thyroid disorders, as well as idiopathic factors. This review provides an overview of current concepts in the diagnosis and management of adhesive capsulitis, highlighting advancements in both conservative and surgical treatments. Conservative management remains the first-line approach, emphasizing pain relief and restoration of shoulder mobility through physical therapy, analgesics, and corticosteroid injections. Techniques such as the suprascapular nerve block have gained prominence for their effectiveness in reducing pain and facilitating rehabilitation. Recent studies underscore the importance of early intervention and individualized treatment plans tailored to the patient's needs. Surgical intervention, including arthroscopic capsular release, is considered when conservative measures fail to yield satisfactory results. While effective in restoring shoulder function, surgery carries risks and necessitates a comprehensive rehabilitation program to prevent recurrence of stiffness. This review also addresses potential complications associated with both conservative and surgical treatments, and the role of emerging techniques and technologies in improving patient outcomes. The integration of evidence-based practices and personalized care strategies is crucial for optimizing treatment efficacy and enhancing the quality of life for individuals affected by adhesive capsulitis.

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.

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.

Introduction: Elbow fractures, characterized by their complexity, present significant challenges in post-surgical recovery, with rehabilitation playing a critical role in functional outcomes. This study explores the efficacy of rehabilitative interventions in enhancing joint range of motion (ROM) and reducing complications following surgery for both stable and unstable elbow fractures.

Methods: A cohort of 15 patients, divided based on the stability of their elbow fractures and whether they received post-operative rehabilitation, was analyzed retrospectively. Measurements of ROM-including flexion, extension, pronation, and supination-were taken at three follow-ups: 15-, 30-, and 45-day post surgery. The study assessed the impact of rehabilitation on ROM recovery and the resolution of post-surgical complications.

Results: The findings indicated no statistically significant differences in ROM improvements between patients who underwent rehabilitation and those who did not, across all types of movements measured. However, early rehabilitative care was observed to potentially aid in the mitigation of complications such as joint stiffness, especially in patients with stable fractures.

Conclusion: While rehabilitation did not universally improve ROM recovery in elbow fracture patients, it showed potential in addressing post-operative complications. The study underscores the importance of individualized rehabilitation plans and highlights the need for further research to establish evidence-based guidelines for post-surgical care in elbow fractures.