Orthopedic Research and Reviews最新文献

Synovial chondromatosis (SC) is a rare, benign condition characterized by the formation of cartilaginous nodules within the synovial membrane of joints. We present a case of primary SC of the ankle in a 49-year-old female who experienced persistent ankle pain and restricted range of motion. She was successfully treated with arthroscopic removal of loose bodies and synovial debridement. A review of the literature since 2010 was conducted to compare outcomes between open and arthroscopic management of ankle SC. The findings suggest that while both approaches are effective and have similar long term outcomes, arthroscopy may offer slight advantage in terms of reduced morbidity, faster rehabilitation, and improved patient satisfaction.

The purpose of this study was to conduct a review of contemporary definitive treatment options, potential complications and clinical outcomes for open tibial shaft fractures and while assessing their relevance and applicability within South African context. Treatment options available in high-income countries may not be accessible in low-resource settings, requiring adaptations to the treatment approach based on local conditions. Only one African country has attempted to establish principal guidelines for the treatment of open tibial fractures through a consensus-based approach. These guidelines cover primary assessment, antibiotics, initial stabilization, referral criteria, debridement and irrigation, documentation, wound closure, soft-tissue management, amputation, and definitive internal fixation. Unfortunately, definitive fracture management recommendations for African low-resource countries are not yet available. There is a lack of data regarding the treatment of open tibial fractures in low-resource countries, particularly in regional and rural areas. Existing guidelines address antibiotic prophylaxis and treatment, debridement and lavage, initial surgical fixation, wound closure (both primary and definitive), soft-tissue management (including flap coverage), and bone fragment retention, all adapted to local resource availability. However, guidelines for definitive treatment remain unavailable. Treatment options recommended by high-income countries are largely unsuitable, and Southern African nations should focus on developing guidelines tailored to their available resources.

A 70-year-old female with a history of hypertension presented with a complex elbow injury following a fall. Imaging revealed fractures of the capitellum, lateral epicondyle, and olecranon. The fractures were managed using an extensile posterolateral approach through the anconeus muscle, achieving anatomical reduction and satisfactory functional outcomes 110° of flexion and full pronation/supination and Mayo Elbow Performance Score (MEPS) indicated an excellent outcome. This approach preserved the extensor origin and facilitated access for fixation, suggesting its potential as an alternative for managing such rare injuries.

Objective: This study evaluated early clinical and radiographic outcomes of robotic-assisted total knee arthroplasty (RA-TKA) in Indonesia using the ROSA^® Knee System, hypothesizing that outcomes would be comparable to high-income countries.

Methods: A retrospective observational study was conducted including patients undergoing primary RA-TKA between July 2024 and July 2025. Perioperative variables, radiographic alignment, postoperative mobilization, and patient satisfaction were assessed. Outcomes were compared qualitatively with published benchmarks. All procedures were performed by a single surgeon.

Results: A total of 40 patients (44 knees) were included. Median operative time was 110 minutes. Standing long-leg radiographs demonstrated mechanical alignment within ±3° of neutral in all knees. Median time to ambulation was 6 hours (unilateral) and 19.5 hours (bilateral). No intraoperative complications occurred. Overall satisfaction was 95%. Outcomes were consistent with reports from high-income countries.

Conclusion: RA-TKA can be safely and effectively implemented within a developing healthcare system, achieving alignment accuracy, mobilization times, and satisfaction rates comparable to global benchmarks.

Purpose: To introduce a technique to reconstruct soft tissue defects around the space of lateral malleolus by using the peroneal artery "terminal" perforator flap (the lowest perforating branch of the peroneal in the posterior compartment artery of lateral malleolus), and to report its effectiveness.

Methods: From January 2018 to April 2020, 7 patients with soft tissue defects around the space of lateral malleolus were treated with the peroneal artery "terminal" perforator flap. Ultrasound was used to determine the perforating site of the peroneal artery. The lowest perforating branch adjacent to the wound margin was used as the rotation point to design the peroneal artery perforator flap.

Results: One case had venous crisis. However, no urgent operative revision was performed. All of the 7 flaps survived completely. The grafted skins at donor site survived, and primary healing of incision was obtained. The follow-up period was 6 to 17 months with an average of 10.7 months. The flaps exhibited favorable color, texture, and overall appearance. The ability to wear shoes remained unaffected, and ankle mobility was not restricted. Surgeries for thinning the flaps were not necessary. All of the patients were satisfied with the cosmetic and functional result.

Conclusion: The peroneal artery terminal perforator flap is a useful and reliable choice for coverage of soft tissue defects around the space of lateral malleolus in clinical application.

This case study presents the successful management of a 21-cm tibial defect in a 38-year-old man smoker with longstanding osteomyelitis using trifocal Ilizarov bone transport. Despite the complexities posed by chronic infection and extensive bone loss, a meticulously planned staged reconstructive protocol involving aggressive debridement, targeted antimicrobial therapy, and advanced bone transport techniques culminated in remarkable limb salvage and functional recovery. Integration of low-intensity pulsed ultrasound (LIPUS) further optimized bone healing in this intricate scenario. This case report addresses these gaps by detailing a successful trifocal Ilizarov strategy augmented with LIPUS in a chronic smoker with an exceptionally large tibial defect.

Objective: This study aimed to evaluate the effect of an integrated orthopedic rehabilitation program on elbow joint function recovery in patients after surgical treatment for ulnar olecranon fractures, compared to conventional rehabilitation.

Methods: A retrospective cohort study was conducted on 87 patients who underwent surgery for ulnar olecranon fractures. Based on the standard of care at the time of admission, patients were assigned to a control group (n=42) receiving conventional rehabilitation or an observation group (n=45) receiving an integrated rehabilitation program. The integrated program comprised preoperative education, standardized in-hospital training, a structured 24-week home-based protocol with phased goals, and monitored follow-up. The primary outcome was the Mayo Elbow Performance Score (MEPS). Secondary outcomes included elbow range of motion (ROM), Activities of Daily Living (ADL) score, Visual Analog Scale (VAS) for pain, and complication rates.

Results: The observation group showed a significantly higher rehabilitation effectiveness rate (97.78% vs 80.95%, p=0.026). They also achieved superior MEPS (75.31 vs 53.85, p<0.001), ADL scores (62.64 vs 55.17, p<0.001), and lower VAS scores (2.36 vs 4.36, p<0.001). Elbow ROM improvements in flexion, extension, pronation, and supination were all significantly greater in the observation group (all p<0.001). Complication rates did not differ significantly (6.67% vs 9.52%, p=0.924).

Conclusion: The integrated orthopedic rehabilitation program is superior to conventional rehabilitation in promoting functional recovery, improving range of motion, enhancing daily living activities, and alleviating pain in patients after ulnar olecranon fracture surgery. However, these findings should be interpreted with caution due to the limitations of a retrospective design and a modest sample size. Integrated rehabilitation represents a highly effective postoperative management strategy for these patients.

Purpose: This study aimed to evaluate the effectiveness of microfracture augmentation in the intercondylar notch on healing outcomes after arthroscopic meniscal repair, with stratification by meniscal tear type (bucket-handle vs longitudinal).

Background: Meniscal tears are common knee injuries with variable healing potential. Microfracture augmentation, which involves small perforations in the intercondylar notch to release marrow elements, has been proposed as an adjunct to enhance meniscal repair. However, the impact of this technique across different tear types remains under investigation.

Patients and methods: In this retrospective cohort study, 173 patients aged 18-40 years with isolated bucket-handle or longitudinal meniscal tears undergoing arthroscopic repair were included. Patients were divided into two groups: microfracture-augmented repair (n = 87) and non-microfracture repair without augmentation (n = 86). All surgeries were performed by a single senior orthopedic surgeon, and postoperative rehabilitation protocols were standardized. Healing was assessed at 12 months using Barrett's criteria, the Apley Grinding Test, and clinical evaluation. Statistical analyses included chi-square tests, odds ratios, risk ratios, ROC curve analysis, and binary logistic regression to evaluate associations between surgical technique, tear type, and postoperative outcomes.

Results: Microfracture augmentation was associated with significantly higher overall healing rates compared to non-microfracture repair (88.5% vs 64.0%, p < 0.001). Stratified by tear type, microfracture had the greatest benefit in bucket-handle tears (79.4% vs 37.8%, p < 0.001; OR = 6.353, 95% CI: 2.275-17.737; RR = 3.022, 95% CI: 1.503-6.076), while healing rates were similar for longitudinal tears between techniques (94.3% vs 92.7%, p = 0.745). Age, gender, and side of injury were not significant predictors of outcomes.

Conclusion: Microfracture augmentation enhances healing after arthroscopic meniscal repair, particularly in bucket-handle tears, while longitudinal tear outcomes are favorable regardless of augmentation. These findings emphasize the importance of tear type in guiding the choice of surgical technique.

Purpose: To explore the long-term impact of prolonged screen exposure on postural and visual health in children and adolescents.

Patients and methods: A scoping review was conducted in December 2024 using PubMed, Scopus, and BIREME, focusing on articles from 2019 to 2024 in English and Spanish. The studies were categorized into visual and postural health domains and synthesized through graphs and tables. A total of 27 articles were analyzed. The snowball method was used to complement the literature search.

Results: The studies revealed a 55.3% increase in the use of portable electronic devices following the COVID-19 pandemic. Reported consequences included eye strain, computer vision syndrome, and musculoskeletal pain, especially in the cervical and lumbar regions. These effects were more prevalent in urban populations in Asia.

Conclusion: Prolonged screen time significantly affects children's visual and postural health. These findings highlight the need for public health policies to guide and regulate screen use in young populations and to educate parents, caregivers, and healthcare professionals.

Purpose: There was a strong correlation between adrenal adenoma and osteoporosis, the primary objective of this research was to establish and authenticate a radiomics nomogram using CT scan of adrenal adenoma to screen abnormal bone mineral density (BMD) opportunistically.

Methods and materials: A total of 161 patients with adrenal adenomas who underwent thoracoabdominal CT and quantitative CT (QCT) were enrolled retrospectively. The radiomics features were chosen from the cross-sectional CT images of adrenal adenomas and the nomogram models that including patient's clinical and radiomics features were then established. The receiver operating characteristic (ROC) curve was performed to evaluate the performance of the model and the decision curve analysis (DCA) was used to assess the clinical usefulness.

Results: To build a radiomics model, 11 radiomics features based on CT scans of adrenal adenomas were selected and showed good performance in distinguishing abnormal BMD from normal BMD. Moreover, the radiomics nomogram model demonstrated excellent ability to identify abnormal BMD of adrenal adenoma patients with area under the curve (AUC) of 0.87 (95% CI, 0.80-0.93) in training cohort and 0.85 (95% CI, 0.74-0.96) in validation cohort. The accuracy, sensitivity, specificity of the nomogram model were 79.7%, 78.3%, 81.1% in training cohort, and 72.9%, 67.7%, 82.4% in validation cohort respectively.

Conclusion: The radiomics nomogram based on clinical and radiomics features of adrenal adenoma CT images had a satisfying predictive ability and can be an opportunistic effective tool for identifying bone mass change.