Orthopaedic Surgery最新文献

Objectives: Proximal humeral fractures (PHFs) show a high incidence in aged patients. While nondisplaced fractures achieve good results by conservative treatment, surgical procedures are discussed controversially. Next to open reduction and internal fixation (ORIF), the primary use of reverse shoulder arthroplasty (RSA) has become increasingly important. The aim of this study was to investigate the clinical function, activities of daily living (ADL), as well as pain assessment in patients with PHFs, treated by ORIF or RSA.

Methods: A retrospective comparison study was assessed. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF or RSA of the proximal humerus, were included in this study. Pain was measured by numeric rating scale (NRS). ADL were obtained by Katz-Index and SF-12. Moreover, shoulder function was assessed using the Oxford Shoulder Score (OSS). The maximum range of motion (ROM) was also recorded. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF (Figure or RSA of the proximal humerus) were included in this study. For statistical analyses, Student's t-test, Wilcoxon test, and Chi-Quadrat test were used. Statistical significance was indicated with p < 0.05.

Results: Totally 34 patients with an average age of 76.6 years were included. Surgical treatment was performed on average 5.2 days after diagnosis, differing significantly between the two groups (RSA/ORIF: 6.9/3.5 days) The operation time of RSA (97 min) was significantly longer than for ORIF (78 min). Pain assessment, as well as the Katz-Index and the SF-12, showed no significant differences. Moreover, clinical shoulder function showed no significant discrepancies between the two surgical techniques.

Conclusions: Aged patients with PHFs treated with RSA display similar results regarding clinical function, ADL as well as pain perception compared with ORIF. However, revision surgery rate was lower in patients who underwent RSA. Thus, the surgical treatment of PHFs by RSA represents an excellent alternative, especially with regard to an aging patient population.

Objectives: The biomechanical mechanism of brace intervention on bone, muscle, and disc should be comprehensively considered for AIS patients. We aimed to developmentally construct a musculoskeletal finite element model of adolescent idiopathic scoliosis to simulate the coupling of corrective forces and analyze the mechanical properties of bone, muscle, and disc. Investigateing, more effective clinical interventions to break the vicious cycle of patients during growth.

Methods: A finite element model, including muscle, bone, and disc, was established using computed tomography data of a patient with RigoA3 adolescent idiopathic scoliosis. The three-point force coupling, antigravity, and bending effects of the Chêneau brace were simulated, and the correction force of the secondary lumbar bend was gradually reduced while observing the mechanical characteristics of bone, muscle, and disc. The correction force in line with symmetrical spine growth was comprehensively evaluated.

Results: The correction rate of the main thoracic (MT) curve, the intervertebral space height on the concave side of the vertebrae at the apex, and the stress ratio of the intervertebral discs were optimal when the maximum corrective pressure threshold was reached. However, the proximal thoracic (PT) curve was aggravated and the axial forces on the concave side were unbalanced. At this time, the biomechanical performance of the model is also not optimal. The correction rate of the Cobb Angle of the MT curve decreased with the decrease of the correction pressure in the lumbar region. When reduced to 25% of the maximum threshold, the convex side of disc stress, intervertebral space, and muscle axial force is more in line with the biomechanical mechanism of correction and can avoid sacrificing the PT curve.

Conclusions: Downward adjustment of the corrective force to the secondary lumbar curve, using the Chêneau brace, results in better primary thoracic curvature mechanics in the musculoskeletal finite element model, suggesting that breaking the vicious cycle of scoliosis progression to guide benign spinal growth is beneficial.

Objective: Patients with osteoporotic vertebral compression fractures (OVCF) treated with vertebroplasty (PVP) are experiencing an increasing number of problems such as pain recurrence, mainly due to recompression fractures of the operated vertebral body within a certain period of time after the operation, which is closely related to the distribution of intraoperative bone cement. The aim of this study is to investigate the effect of different spacing distributions between the upper boundary of the cement and the upper endplate of the operated vertebra on the biomechanics of the operated vertebra after percutaneous vertebroplasty for OVCF using finite element analysis (FEA).

Methods: One patient with L1 vertebral body OVCF was selected, and computed tomography (CT) of the thoracolumbar segment was performed. The CT data were extracted to establish an FEA model of the T12-L2 vertebral bodies. Bone cement was injected into the L1 vertebral body. Based on the spacing between the upper boundary of the bone cement and the vertebral body's upper endplates, the model vertebrae were divided into 0, 2, 4, and 6 mm spacing groups, and the human body's upright, flexion-extension, lateral flexion, and rotational positions were simulated. The biomechanical effects of different spacing distributions on the postoperative L1 vertebral body and the injected bone cement were evaluated.

Results: In this paper, we found that the Von Mises stress of the L1 vertebrae was the smallest when the spacing between the upper boundary of the bone cement and the vertebral body's upper endplates was 0 mm. The larger the spacing in a certain range between the upper boundary of the bone cement and the vertebral body's upper endplates, the greater the Von Mises stress of the L1 vertebrae. However, in the stress comparison of the injected bone cement, the Von Mises stress of the bone cement was greatest when the spacing between the upper boundary of the bone cement and the upper endplate of the vertebral body was 0 mm; the larger the spacing, the smaller the Von Mises stress.

Conclusion: When the contact spacing between the upper boundary of the bone cement and the upper endplate of the vertebral body is 0 mm, it can effectively eliminate and transfer the pressure caused by the load, thus reducing the stress on the cancellous bone and further reducing the risk of vertebral refracture after surgery.

Background: Malignant tumors originating in the talus are rare and present significant challenges in reconstruction. Traditional treatments, such as below-knee amputation or tbiocalcaneal fusion, often result in significant loss of ankle function. After tumor resection, reconstruction of the talus and calcaneus is necessary to preserve ankle function. However, the intricate anatomical structure and unique location of the talus and calcaneus present significant challenges for prosthetic reconstruction.

Case presentation: Here, we present the case of an 11-year-old adolescent patient diagnosed with Ewing's sarcoma of the talus, accompanied by suspected involvement of the calcaneus. Following a comprehensive evaluation, a 3D-printed talus-calcaneus prosthesis, which is composed of a ultrahigh-molecular weight polyethylene (UHMWPE) part and a titanium alloy part, was designed for talus and calcaneus reconstruction. In addition, a porous structure was designed to promote the integration of bone-prosthesis interface. The lesion was completely resected and the prosthesis was precisely installed. After 12 months follow-up, patients demonstrated favorable function results with the Musculoskeletal Tumor Society (MSTS) score was 27/30, and the American Orthopedic Foot and Ankle Society (AOFAS) score was 92/100. The range of motion for dorsiflexion, plantarflexion, inversion, and eversion of the right ankle joint was measured as 10° and 35°, 15°, and 10°, respectively. The postoperative radiograph showed a good position of the prosthesis. No narrowed joint space was observed. Tomosynthesis shimadzu metal artifact reduction technology (T-SMART) revealed that integration between bone and prosthesis was good.

Conclusion: In this case, we present a case of 3D-printed talus-calcaneal prosthesis reconstructing talus and calcaneus. Favorable postoperative function outcome and good integration of the interface were observed. Therefore, this case provides an alternative therapeutic option for the treatment invasive talus tumor accompanied by suspicious contamination of the calcaneus. Nevertheless, a larger cohort study and with longer follow-up is needed to evaluate the effectiveness and potential complications of this novel prosthesis.

Objectives: Currently, there are various surgical options for the treatment of lateral ankle sprains, and deciding which surgical option to use is a question worth considering. Furthermore, there is a relative scarcity of mechanical research comparing suture anchor repair (SAR) and suture tape augmentation (STA) internal brace for the repair of the anterior talofibular ligament (ATFL). Therefore, this study aimed to compare the efficacy of arthroscopically all-inside ATFL SAR and STA for reconstruction to treat lateral ankle sprains through biomechanical testing.

Methods: Eighteen fresh-frozen cadaver ankles were used for the study and divided into one of three groups: (1) intact ATFL group, (2) arthroscopically reconstructed with suture tape augmentation internal brace of the ATFL (STA group), and (3) arthroscopically repaired ATFL with suture anchors (SAR group). We used custom fixtures to test the specimens for loading to ultimate failure and stiffness.

Results: The mean load to failure of the STA group (311.20 ± 52.56 N) was significantly higher than that of the intact ATFL group (157.37 ± 63.87 N; p = 0.0016) and the SAR group (165.27 ± 66.81 N; p = 0.0025). The mean stiffness of the STA group (30.10 ± 5.10 N/mm) was significantly higher than that of the intact ATFL (14.17 ± 6.35 N/mm; p = 0.0012) and the SAR group (15.15 ± 6.89 N/mm; p = 0.0021). The suture anchor repair withstood failure loads and stiffness similar to the intact ATFL.

Conclusions: In terms of failure load and stiffness, the reconstructive outcome of ATFL reconstruction with STA is markedly superior to that of SAR reconstruction of the ATFL and the intact ATFL. Additionally, the novel technique of the SAR was a reliable technique that offered biomechanical properties similar to intact ATFL.

Objective: The impact of preoperative consultations on mortality and morbidity rates, and their association with delays and hospital stays for surgery, remains a topic of discussion. This study aims to elucidate the necessity of consultations for those undergoing femoral neck fracture surgery, examining their influence on delays, hospital durations, and their correlation with mortality rates.

Methods: The study examined data from 320 emergency department patients with femoral neck fractures undergoing hip arthroplasty surgery at our hospital between 2011 and 2021, using digital medical records. Patients were consulted in relevant departments for risk optimization. They were categorized into two groups based on the time of surgery: Group 1 (operated within 48 h) and Group 2 (delayed surgery). The analysis included days from admission to surgery, total hospital stay, and time from surgery to discharge. Mortality rates, with a minimum 2-year follow-up, were assessed using digital records, patient contact, or a death notification system. Statistical analyses involved Mann-Whitney U, Kruskal-Wallis, post hoc analysis, Pearson's chi-squared, and Fisher-Freeman-Halton tests (α = 0.05). SPSS v25.0 software was used.

Results: Patients with consultation requests experience significantly delayed surgery compared to those without (p < 0.001). Statistically significant differences were observed between consulted and nonconsulted groups in time until surgery (p < 0.001), time from surgery to discharge (p < 0.001), and overall length of hospital stay (p < 0.001). However, there is no statistically significant difference in 30-day and 1-year mortality between consulted and nonconsulted patients, both departmentally and overall.

Conclusion: This study found that advanced age and high ASA scores were the main factors causing surgical delays in hip fracture patients. While modifiable comorbidities could reduce hospital stays, they did not significantly affect postoperative mortality. Streamlining elective consultations and reducing organizational delays could help prevent delayed surgeries and improve outcomes.

Background: Chondroblastoma is a rare bone tumor that originates from the epiphysis, constitutes around 1% of all primary bone tumors and is recognized for its tendency to exhibit local invasiveness, as well as the possibility of metastasis and recurrence in nearby areas. Currently, the main surgical treatment for chondroblastoma is open surgery, involving excision of the lesion. There are relatively few reports on arthroscopic surgery for the treatment of chondroblastoma. However, open surgical curettage is associated with operation-related trauma and potential for damage to the osteoepiphysis resulting in growth disturbances.

Case presentation: This case study presents the application of an arthroscopic technique in a 14-year-old male patient with chondroblastoma affecting the proximal tibia and tibial eminence. The procedure involved thorough removal of the lesion using direct visualization with the management of the cavity utilizing a substitute for autologous bone graft. After 1 year of follow-up, the patient remains free from symptoms, exhibits normal knee functionality, and radiographic analysis reveals a good autologous bone graft fusion without any signs of recurrence.

Conclusions: Based on the existing cases of arthroscopic treatment for chondroblastoma and the report of this case, arthroscopic treatment for chondroblastoma can be considered as a specific treatment option for certain patients. In some cases, this technique could be an effective alternative to open surgery.

Purpose: Infection after fracture fixation (IAFF) is a severe complication. There are few multicenter studies targeting IAFF. This paper identifies independent risk factors associated with IAFF by analyzing multicenter clinical data. Appropriate interventions should be implemented to reduce the risk of IAFF.

Methods: This is a multicenter retrospective cohort study. This study screened medical records of patients who underwent internal fixation for fractures at participating medical institutions from January 1, 2011, to December 31, 2020. Data extraction included demographic characteristics, disease features, surgical variables, and laboratory indicators. Logistic regression analysis was employed to identify the relationship between relevant risk factors and IAFF. Research data were sourced from the hospital's electronic medical record system and self-constructed databases.

Results: In our study, 202 patients who underwent internal fixation for fractures experienced postoperative infections, which corresponds to an overall incidence rate of approximately 1.7%. The predominant pathogen identified in these infections was Staphylococcus aureus. A multifactorial analysis indicated that several factors were independently associated with the occurrence of IAFF. These factors included BMI ranges of 24.0-27.9 and 28.0-31.9, smoking, a high ASA score, high-energy trauma, diabetes, open fracture, seasonal timing of the surgery (summer), bone grafting, drainage duration, surgical duration ≥ 180 min, and A/G ratio < 1.2.

Conclusions: We strongly recommend that orthopedic surgeons perform comprehensive preoperative assessments on fracture patients to identify factors that may increase the risk of infection. Through the implementation of targeted interventions and beneficial modifications to these modifiable risk factors, it is possible to lower the incidence of IAFF. Additionally, proactive screening, risk stratification, and thorough patient education should be prioritized for patients with high risk but nonmodifiable factors.

Background: Flatfoot is a common foot disorder involving progressive foot deformity of the three-dimensional structures of the forefoot, midfoot, and hindfoot. Currently, Chinese surgeons and patients favor subtalar arthroereisis (SA) due to its minimally invasive and low-damage characteristics. HyProCure device is widely used. However, there is limited analysis of large sample sizes. This study utilized statistical evaluation with a large sample size to analyze clinical characteristics trends of SA for flatfoot, including baseline indicators, selection of HyProCure size and surgical strategy, complications, and implant removal. This study will enhance the understanding of SA in China.

Methods: A retrospective analysis of 732 patients (1008 ft) who underwent SA from June 2015 to June 2023, with 509 pediatric and adolescent patients (772 ft) and 223 adult patients (236 ft). Based on the patient's age, patients aged ≤ 18 were included in the children and adolescent group, while adult acquired flatfoot deformity (AAFD) patients aged > 18 were included in the adult group. General data was collected, including patient sex, age, side, body mass index (BMI), surgery date, HyproCure size, and surgical data, and trends were analyzed. Postoperative complications and HyProCure removal were collected as outcome measures during follow-up.

Results: The age of patients treated with SA was gradually getting younger, with male patients predominating, mainly concentrated in the 11-14 age group. HyProCure 7 has the highest usage rate. In the children and adolescent group, 288 ft (37.31%) only underwent SA. In the adult group, 18 ft (7.63%) only underwent SA. Complications include sinus tarsi pain, peroneal spasms, achilles tendon tension, and muscle strength decline. The complication rate in the children and adolescent group was 5.05%, while in the adult group it was 28.81%. Overall, it was 10.62%. The removal rate of HyProCure in the children and adolescent group is 1.04%, in the adult group is 15.25%, and overall is 4.37%.

Conclusions: The trend in flatfoot treated with SA was towards children and adolescent male patients, and sinus tarsi pain was the most common complication after SA. The complication rate and removal rate in the children and adolescent group were lower than those in the adult group. HyProCure can be removed without additional adverse effects.

Objective: The type of atlantodental space tissue in patients with atlantoaxial dislocation (AAD) can help doctors understand the possibility of reduction before surgery. However, relevant research on this topic is lacking. This study aimed to summarize cases of AAD, classified based on the atlantodental space using magnetic resonance imaging (MRI), and preliminarily explore its impact on the degree of reduction.

Methods: Preoperative T2-weighted MRIs and dynamic digital radiographs of patients who underwent posterior reduction and fixation surgery for congenital AAD between September 2012 and February 2023 were collected. The patients were classified into flexible and inflexible tissue sign groups based on T2-weighted imaging. Patients with an atlantodental interval < 3 mm on extension digital radiography were considered radiographically reducible. Three radiologists read and recorded the MRI results using standard protocols. Kappa and Fleiss kappa values were used to evaluate intra- and inter-observer agreements for MRI signs and dynamic digital radiography findings. Multivariate logistic regression and receiver operating characteristic curves were used to analyze the relationships between imaging parameters and the reduction degree.

Results: In total, 118 patients with AAD were included in the analysis. Inter-observer agreement among the three readers was higher for MRI than for dynamic digital radiography (0.816 vs. 0.668). The intra-observer consistency for MRI signs was also better than that of dynamic digital radiography. Both the flexible tissue sign and radiographically reducible groups showed a higher rate of satisfactory reduction. However, only the flexible tissue sign showed positive results in the multivariate regression. The receiver operating characteristic curve for MRI signs as a predictor of satisfactory reduction yielded an area under the curve of 0.776 (95% confidence interval, 0.667-0.875, p < 0.0001).

Conclusions: Novel MRI signs of the atlantodental space exhibited high inter- and intra-observer agreement. Patients with flexible tissue signs were more likely to achieve satisfactory reduction after direct posterior surgery.