Orthopedic Research and Reviews最新文献

In the context of the digital revolution, 3D printing technology brings innovation to the personalized treatment of cervical spondylosis, a clinically common degenerative disease that severely impacts the quality of life and increases the economic burden of patients. Although traditional surgeries, medications, and physical therapies are somewhat effective, they often fail` to meet individual needs, thus affecting treatment adherence and outcomes. 3D printing, with its customizability, precision, material diversity, and short production cycles, shows tremendous potential in the treatment of cervical spondylosis. This review discusses the multiple applications of 3D printing in the treatment of cervical spondylosis, including the design, manufacture, and advantages of 3D-printed cervical collars, the role of 3D models in clinical teaching and surgical simulation, and the application of 3D-printed scaffolds and implants in cervical surgery. It also discusses the current challenges and future directions.

The creation of a functional tibial stump after combat injuries is sometimes too difficult. We describe a case of high amputation after a mine-blast injury. In this case, the tibia stump was too short (5 cm) and the fibula stump was too long (12 cm). There was a soft tissue reserve. The Ilizarov method was used to lengthen the tibia. The technique of the operation with exposure of the anterior medial ligament, its separation from the distal part of the bone, subperiosteal excision of the medial part of the patellar tendon from the tibia, oblique-frontal corticotomy of the tibia, which allowed to avoid undesirable complications during the distraction and to obtain a wide, strong regenerate, is described in detail. The alignment of the tibia lengths resulted in a highly functional stump with the possibility of full prosthetics. The proposed technique can be used in reconstructive operations on short stumps that require lengthening.

The Anterior Cruciate Ligament (ACL) is considered the most commonly injured ligament of the knee. Magnetic Resonance Imaging (MRI) has become an indispensable imaging tool and modality of choice for assessing and managing knee conditions. This article outlines an effective MRI imaging technique that improves the diagnostic accuracy of ACL injuries of the knee, covering the appropriate pulse sequences and optimal imaging planes. Furthermore, the article provides a comprehensive review of the appearance of complete and partial ACL tears on MRI in the acute and chronic phases. In addition, it identifies and illustrates the primary MRI signs (signs related to the absence or abnormal visualization of the ACL fibers) and secondary MRI signs (signs related to the mechanism of injury or associated knee injuries) of ACL injury.

Background: Supracondylar humeral fracture (SCHF) is a common injury in children, and early treatment provides excellent results and prevents disabilities. Delayed presentation is still prevalent, mainly in developing countries, because many factors hinder the opportunity to receive appropriate treatment. Currently, there are no standard treatment protocols, and there is insufficient published literature on this topic. This study aimed to evaluate the effectiveness and outcomes of open reduction and Kirschner wire fixation using a triceps-sparing posterior approach in neglected cases with complicated fractures.

Methods: This was a prospective multicenter clinical study conducted between July 2016 and June 2021, which included 28 pediatric patients with neglected SCHF who presented to the hospital for definitive treatment five days or more after initial trauma without previous surgical intervention. All the patients underwent open reduction and K-wire fixation using a posterior triceps-sparing approach. The final functional outcome was assessed using the Mayo Elbow Performance Index (MEPI) and Flynn criteria.

Results: All fractures (100%) united within 3-5.5 weeks (mean 4 ± 0.7 weeks). Excellent scores observed in 67.9% (n = 19), good in 21.4% (n = 6), fair in 7.1% (n=2), and poor in 3.6% (n = 1) patients according to MEPI. Correspondingly, Flynn's criteria showed 96.4% (n = 27) satisfactory and 3.6% (n = 1) unsatisfactory outcome.

Conclusion: Open reduction and fixation using Kirschner wires through the posterior triceps-sparing approach is an effective treatment method for late-presenting SCHF in children with consequent satisfactory results.

Introduction: Although kissing spine syndrome in the lumbar spinal region is a relatively common condition in older adults, no study examining its biomechanical characteristics has been reported. We hypothesized that kissing of the spinous processes during extension causes an increase in the flexural rigidity of the spine and significantly limits the deformation behavior of extension, which in turn might cause lower back pain.

Methods: Three test models (human cadavers A, B, and C) were prepared by removing supraspinal/interspinous ligaments between L4 and L5. The dental resin was attached to the cephalocaudal spinous process so that the spinous processes between L4 and L5 were almost in contact with each other to simulate the condition of a kissing spine. The flexion-extension direction's torque-range-of-motion (torque-ROM) curve was generated with a six-axis material tester for biomechanical measurements.

Results: In all three models, the maximum ROMs at the time of extension were smaller than those at the time of flexion, and no sudden increase in torque was observed during extension.

Conclusion: The results indicated no apparent biomechanical effects of kissing between the spinous processes, suggesting that the contact between the spinous processes has little involvement in the onset of lower back pain.

Purpose: Capitellum and trochlea fractures, also referred to as coronal shear fractures of the distal humerus, are infrequent yet challenging intra-articular fractures of the elbow. There are a variety of surgical approaches and fixation methods with often variable outcomes. This systematic review investigates interventions, outcomes and complications of capitellum and trochlea fractures.

Methods: A systematic review of studies published in MEDLINE, EMBASE, Web of Science and Cumulative Index to Nursing and Allied Health literature (CINAHL) was conducted to assess the clinical outcomes of capitellum and trochlea fractures managed surgically. Data on patient demographics, surgical approach, implant usage, postoperative outcomes and complications were compiled.

Results: Forty-one studies met the inclusion criteria with a total of 700 patients. Surgical interventions primarily utilized either the lateral (79%) or antero-lateral (15%) approaches with headless compression screws as the most common fixation method (68%). Clinical outcomes were measured using the Mayo Elbow Performance Index (MEPI) with a mean score of 89.9 (±2.6) and the DASH score with a mean of 16.9 (±7.3). Elbow range of motion showed a mean flexion of 126.3° (±19.4), extension of 5.71° (±11.8), pronation of 75.23° (±12.2), and supination of 76.6° (±9.8). The mean flexion-extension arc was 113.7° (±16.9), and the mean pronation-supination arc was 165.31° (±9.41). Complications occurred in 19.8% of cases, with re-interventions required in 8.3% of cases, mainly due to symptomatic implants and elbow stiffness requiring surgical release. Other complications included implant removal (10.4%), overall reported stiff elbows (6%), nerve palsies (2%), non-union (1.5%), and infection (1.2%).

Conclusion: The treatment of capitellum and trochlea fractures yields satisfactory outcomes but has a considerable rate of complications and reoperations primarily due to symptomatic implants and elbow stiffness. There is noteworthy variability in the achieved range of motion, suggesting unpredictable outcomes. Deficits in functionality and range of motion are common after surgery, especially with more complex injury patterns.

Background: Despite a sufficient number of papers on the technique of transtibial amputations, the technique of Ertl-type reamputation in short tibial stump remains unreported.

Aim: To propose a modification of the Ertl operation in the proximal tibia.

Case presentation: The technique of bone bridge creation in a patient with a malformed stump in the upper third of the tibia at the expense of the regenerate formed after corticotomy of the tibial remnant and dosed distraction of the graft by the Ilizarov apparatus is described. Radiological, ultrasound and MRI methods were used to control the regenerate. The follow-up period was 36 months. At 3.5 months, a synostosis was formed, which allowed primary and then permanent prosthesis with a full-contact prosthesis. At 36 months, the organotypic remodelling of the regenerate was completed. The patient works, uses the prosthesis for 15-16 hours a day, and walks on average 8-10 km.

Conclusion: The use of the proposed method makes it possible to obtain tibial synostosis without their shortening with elimination of valgus deviation of the fibula stump and the possibility of early functional loading. Synostosis formation occurs within 3.5 months after surgery. Organotypic bone remodelling occurs during primary and then permanent prosthetics. The formed bone bridge has a large support area, which is maintained during the whole follow-up period of 36 months and allows to perform full-contact prosthetics with maximum load on the residual limb end.

Introduction: Ankle arthrodesis is one of the treatments of choice, particularly in late-stage and unstable diabetic Charcot arthropathy. Unfortunately, poor healing capacity might play a role in the high nonunion rate (10-40%). The advancement in regenerative medicine opens a new horizon for enhancing fusion after ankle arthrodesis in patients with poor healing capacity. However, a suitable small animal model is warranted to study the effectivity of these regenerative medicine approaches. Streptozotocin (STZ)-induced diabetes models and adjuvant-induced arthritis models with complete Freund's adjuvant are two established models. However, no study has combined those two models to make a diabetic arthritic model that more closely resembles the condition in Charcot arthropathy.

Methods: Twenty male Sprague-Dawley rats were assigned into five groups, consisting of one control group, and four diabetic groups which were induced by STZ injection and a high-fat diet. Among these diabetic rats, two groups received complete Freund's adjuvant (CFA) injections to the left ankle of the hind limb. The control group, one of the diabetic-only groups, and one of the arthritic-diabetic-induced groups were euthanized at 4 weeks after STZ induction, and the remainder were euthanized 6 weeks after STZ induction. Clinical, radiological, and histological examinations were then compared in all five groups.

Results: Diabetic status was successfully achieved in the model, which was maintained until the completion of the study. The CFA-induced ankles were significantly larger than the contralateral ankles in all groups (p<0.05). Histopathological evaluation confirmed arthritic changes in the CFA-induced group with less variability after 4 weeks of arthritis induction.

Conclusion: This rat model of arthritic diabetic mimics the progressive and chronic nature of Charcot arthropathy in humans. This model can be further use to study treatments that might enhance the fusion rate in ankle arthrodesis in healing-defective patients such as those with diabetes.

Level of clinical evidence: 5.

Purpose: Carpal tunnel syndrome (CTS) is a common condition characterized by compression of the median nerve (MN) within the carpal tunnel. Accurate diagnosis and assessment of CTS severity are crucial for appropriate management decisions. This study aimed to investigate the combined diagnostic utility of B-mode ultrasound (US) and shear wave elastography (SWE) for assessing the severity of CTS in comparison to electrodiagnostic tests (EDT).

Materials and methods: This prospective observational study was conducted over 9-month periods at a tertiary care hospital. A total of 48 patients (36 females, 12 males; mean age 44 ± 10.9 years; age range 28-57 years) with clinically suspected CTS were enrolled. All patients underwent EDT, US, and SWE. Based on the EDT results, CTS cases were categorized into four groups: mild, moderate, severe, and negative. The cross-sectional area (CSA) and elasticity (E) of the MN were measured at the tunnel inlet (CSAu and Eu) and pronator quadratus region (CSAo and Eo). The differences (CSAu-CSAo and Eu-Eo) were calculated. The primary outcomes were the diagnostic performance of CSAu, CSAu-CSAo, Eu, and Eu-Eo in differentiating moderate/severe from mild/negative CTS compared to EDT findings. Secondary outcomes included a correlation of US/SWE parameters with EDT grades and between each other. ANOVA, correlation, regression, and receiver operating characteristic (ROC) curve analyses were performed.

Results: CSAu and CSAu-CSAo increased progressively with worsening CTS severity. E measurements were significantly higher in moderate-to-severe CTS compared to mild or negative cases. The combined metric of CSAu-CSAo at a 5 mm threshold exhibited enhanced performance, with a higher sensitivity (83.3%), specificity (100%), and area under the curve (AUC) (0.98), surpassing the results of CSAu when used independently. Similarly, the SWE measurements indicated that Eu-Eo at a 56.1kPa cutoff achieved an AUC of 0.95, with a sensitivity of 93.3% and specificity of 94.4%, outperforming the metrics for Eu when used alone, which had an AUC of 0.93, with identical sensitivity and specificity values (93.3% and 94.4%, respectively).

Conclusion: The integration of ultrasound, shear wave elastography, and electrodiagnostic tests provides a comprehensive approach to evaluate anatomical and neurological changes and guide management decisions for CTS.