Orthopedic Research and Reviews最新文献

The syndesmosis is an important fibrous joint that plays a crucial role in normal ankle weight-bearing and movements. Syndesmosis injuries include disruption of one or more of the ligaments comprising the distal tibiofibular syndesmosis and are commonly associated with ankle fractures. The treatment of grade 1 syndesmosis injury should be conservative, such as immobilization for one to three weeks followed by gradual return to activity. For the treatment of grade 2 syndesmosis injury, if it was stable enough, the patients still could be managed with conservative therapies. But majority of them strongly favor surgical treatment. For the treatment of grade 3 syndesmosis injury, it should treat with surgical reconstruction. If syndesmosis injury is associated with ankle fractures, surgical reduction, fixation, and reconstruction are usually required. Common surgical treatment methods include syndesmosis screws, composed of either metallic or bioabsorbable material; fibula intramedullary nails; and dynamic button-suture fixation, TightRope or ZipTight. Each method has advantages and disadvantages which must be considered while determining which treatment will provide the best outcomes depending on the patient's needs. Continued exploration of new materials, devices, and methods for surgical fixation is necessary for advancement in this field.

Background: Adolescent Idiopathic Scoliosis (AIS) is the most common type of scoliosis affecting adolescents, with approximately 2-4% of children being diagnosed. Crucial to the diagnosis and management are radiographic imaging, which allow physicians to assess and treat - from initial visits through surgical planning and post-operative management. While initial stages require low levels of exposure to radiation, via x-rays, as patients progress in disease severity exposure becomes larger with pre-operative, intra-operative and post-operative CT scans. While many studies have evaluated exposure during AIS treatment, few have assessed the cumulative radiation exposure adolescents receive during their evaluation. The purpose of our study is to complete a comprehensive review on cumulative radiation exposure and determine what stages in AIS treatment expose patients to the highest level of radiation over a duration of 2 years.

Methods: A retrospective chart review of 109 AIS cases (29M, 80F), mean age 14.9 ± 2.3 years was completed to assess and quantify each imaging modality used. Employing a radiation detector, each imaging modality was then assessed, and estimated radiation exposures were determined. Statistical analysis was completed utilizing averaged patient exposures during each selected period in AIS management.

Results: Mean estimated radiation doses (StDev) were 60.94 mrem (±0.609 mrem) for two x-rays (full-length AP and lateral radiograph of the entire spine), 12.92 mrem (±1.292 mrem) for each fluoroscopy exposure, and 1340.60 mrem (±13.406 mrem) per CT scan. Based on these values, estimated subject exposures were calculated. The total estimated radiation exposure over a 2-year period was 5572.74 mrem (±1428.88 merm) or 2786.37 mrem (±714.43 mrem) per year.

Conclusion: The two-year cumulative radiation exposure is below the recommended exposure by Nuclear Regulatory Commission and OSHA. As expected, CT exposure presents the largest radiation exposure to patients with AIS throughout their operative management.

Level of evidence: III, retrospective study.

Purpose: During the COVID-19 quarantine period, most outdoor activities and events were banned, resulting in a decrease in physical activity (PA) and prolonged sitting (PS) time, which are significant factors in the development of lower back pain (LBP). The aim of this study was to evaluate the association between physical inactivity and daily sitting time during quarantine with LBP among the Saudi Arabian population.

Patients and methods: In this cross-sectional study conducted at King Abdulaziz University Hospital, 288 participants were recruited using an online, self-administered questionnaire in Arabic. It consisted of 21 questions assessing back pain, PA, and daily sitting time before and during quarantine. The main outcome measures included demographics, low back pain levels, daily sitting time, and PA level.

Results: The participants consisted of 236 women and 52 men aged 18-65 years. During quarantine, 74% of participants sat most of the time and did not exercise or performed less exercise. Furthermore, almost half of the participants did not engage in PA both before and during the quarantine. There was an increase in the prevalence of LBP, with only 44.8% of participants presenting with LBP before quarantine and 59.4% having it during quarantine. A statistically significant association was found between daily sitting time and LBP (P=0.007) and PA and LBP (P=0.045) during quarantine. However, there was no significant association between age and painkiller use for LBP (P=0.251).

Conclusion: Our study highlights the relationship of physical inactivity and PS during quarantine with an increase in the prevalence and intensity of LBP. The limitations of the study include the use of self-reports, a small sample size, and unequal survey distribution. A well-distributed survey with a larger sample size is necessary to obtain an adequate representation of the entire Saudi population.

Background: Lateral elbow tendinopathy (LET) is one of the most common causes of musculoskeletal pain. The diagnosis is based on the clinical history and different physical maneuvers. Ultrasound (US) is a complementary diagnostic method to detect degenerative tendon changes and intrasubstance tears (IST). To date, there is no available physical maneuver to identify an IST in patients with LET.

Aim: To evaluate the diagnostic accuracy of an index test to detect an IST confirmed by ultrasound in patients with LET.

Methods: A diagnostic retrospective study was performed. Patients who presented medical records with LET were recruited. Two orthopaedic surgeons developed the physical maneuver. The index test was considered positive when the position failed to resist the wrist extension maximum effort. Clinical findings were associated with confirmation of IST by US. Data were calculated using diagnostic accuracy, sensitivity, and specificity with 95% confidence intervals.

Results: Thirty-nine patients (39 elbows) were analyzed, 25 (64%) women and 14 (36%) men, with an average age of 47.7 years. The index test's sensitivity was 0.86 (95% CI, 0.67-0.96). Accuracy was 0.79 (95% CI, 0.64-0.91), and the specificity was 0.64 (95% CI, 0.31-0.89).

Conclusion: The index test presented very good sensitivity and good accuracy in patients with LET with US diagnostic confirmation of IST.

Level of evidence: Diagnostic study, Level III.

With an increasingly aging population globally, a confluence has emerged between the rising prevalence of degenerative spinal disease and osteoporosis. Fusion of the anterior spinal column remains the mainstay surgical intervention for many spinal degenerative disorders. However, decreased vertebral bone mineral density (BMD), quantitatively measured by dual x-ray absorptiometry (DXA), complicates treatment with surgical interbody fusion as weak underlying bone stock increases the risk of post-operative implant-related adverse events, including cage subsidence. There is a necessity for developing cages with advanced structural designs that incorporate bioengineering and architectural principles to tailor the interbody fusion device directly to the patient's BMD status. Specifically, lattice-designed cages that mimic the web-like structure of native cancellous bone have demonstrated excellent resistance to post-operative subsidence. This article provides an introductory profile of a spinal interbody implant designed intentionally to simulate the lattice structure of human cancellous bone, with a similar modulus of elasticity, and specialized to match a patient's bone status across the BMD continuum. The implant incorporates an open pore design where the degree of pore compactness directly corresponds to the patient's DXA-defined BMD status, including patients with osteoporosis.

Background: Kyphosis in spondylitis tuberculosis (STb) is more than just a cosmetic issue. It has a potentially detrimental effect on both spine-associated structures and cardiopulmonary function. It can be corrected in any stage of STb; however, the corrective surgery is challenging, especially in the late case, in which the additional stiffness of the spine can come into consideration. To date, the cantilever technique is still a gold standard for sagittal plane deformity correction. However, no study to date has explored its effectiveness for thoracolumbar kyphotic deformity, especially that caused by spondylitis tuberculosis.

Methods: This is a retrospective study of 16 consecutive cases of spondylitis tuberculosis with thoracolumbar kyphosis that underwent corrective surgery in our center in the period of 2020-2021. We aim to evaluate the effectiveness of the cantilever technique that we use for kyphotic correction in thoracolumbar STb patients.

Results: At the 3-months follow-up, the mean Cobb angle was 14.6°±10.27°, with the mean gain of 20.90°±12.00° and positively correlate with the thoracolumbar kyphosis (TLK) correction (68.69%, r = 0.654, p = 0.001). The mean thoracic kyphosis, lumbar lordosis, and sagittal vertebral axis were 30.6°±13.08°, 39.4°±16.02°, and 1.4±4.09 cm, respectively, with sagittal Cobb difference of 12.70±9.85.

Conclusion: The kyphotic Cobb angle reduction by cantilever technique in the thoracolumbar area significantly improved the thoracolumbar kyphosis and realign the spinal sagittal axis. Thus, the cantilever technique remains the gold standard for sagittal plane deformity correction which can be applied for kyphotic deformity correction in thoracolumbar STb cases.

We report the case of an eleven-year-old girl with untreated bilateral clubfoot. She had a total of nine long leg castings changed weekly, Achilles tendon Z-lengthening and posterior ankle release followed by another six weeks of long leg cast immobilization post-operatively. We encouraged using night-time foot abduction brace for twelve months. Independent walking was achieved six months post-treatment. No recurrence was noted at eighteen months following treatment. The modified Ponseti weekly casting method was successful up to adolescent age; however, more cast changes, longer stretching before each cast application and posterior ankle release will be needed to achieve functional correction.

Osteoarthritis (OA) is a significant cause of disability. Considering the increasing diffusion of the viscosupplementation (VS) with hyaluronic acid (HA), the International Symposium Intra Articular Treatment (ISIAT) appointed a Technical Expert Panel (TEP) to identify the criteria for successful VS with a specific HA in OA; this through a systematic literature review (SLR), performed following the PRISMA guidelines interrogating Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Grey Matters and American College of Rheumatology (ACR/EULAR) databases and the opinion of international experts. The research included only studies on adults and humans without limitations of language or time of publication. Researchers extracted both quantitative and qualitative data from each study. Mixed Methods Appraisal Tool (MMAT) was used to perform quality analysis for the level of evidence. The SLR retrieved 385 papers, 25 of which were suitable for the analysis. The TEP focused on the different formulations of the product Sinovial^® [HA 0.8%, HA 1.6%, HA 2%, 800-1200 kDa, HA 3.2% (1400-2100 kDa/65-110 kDa)]. The choice was due to the vast amount of evidence available. The TEP weighed the evidence in two rounds of a Delphi survey; the results, and any disagreement, were discussed in a final session. Three domains were considered: 1) the patients' characteristics associated with the best results; 2) the contraindications and the conditions linked to increased risk of failure; 3) the clinical conditions in which VS is considered appropriate. The TEP concluded that VS with HA is safe and effective in the treatment of knee and hip OA of grades I to III and that it is possible to undertake VS in other situations (eg grade IV Kellgren-Lawrence - KL); a comprehensive examination of the patient should be performed before the procedure.

To the best of the authors' knowledge, this is the first published case of monophasic synovial sarcoma (SS) initially diagnosed as Ewing's sarcoma (ES), yet successfully treated with chemotherapy in a 24-year-old patient. The initial diagnosis showed a monotonous round cell tumor and positivity for CD99, characteristic of ES; however, the cytology was negative for the classic EWSR1 rearrangement of ES. The patient was treated with the standard chemotherapy protocol of ES - COG AEWS1031 Regimen A with vincristine, doxorubicin, cyclophosphamide, and mesna - as well as with wide resection. Post-resection tissue submission showed additional morphologic features which led to a re-evaluation of the classification of the tumor as well as additional molecular studies; these revealed positivity for translocations of SS18 (18q11.1) in 100% of the nuclei, which is most characteristic of SS, thus, reclassifying the neoplasm as a SS tumor. This case underscores the importance of considering several pathologic entities in the differential diagnosis of small, round blue cell tumors, including ES, SS, and lymphoma. It also demonstrates the importance of using chromosomal identification for a more definitive diagnosis, rather than relying on histological features and markers which are found in more than one tumor classification. There is conflicting evidence of the impact of chemotherapy on survival in SS, as it is primarily treated with radiation therapy. Since SS is rare, prospective studies on the effect of chemotherapy on survival are limited in number. However, our case study demonstrates that chemotherapy is another modality that can be used in the treatment of SS neoplasms.

Background: Benchmarking arthroplasty implant revision risk is an informative way to address implant performance. National benchmarking efforts exist in the United Kingdom, Netherlands, and Australia. Recently, the International Prosthesis Benchmarking Working Group, including representatives from industry, academia, and national registries, produced a guideline describing arthroplasty benchmarking methodology. The proposal was applied to data from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) to assess its feasibility for benchmarking implants in the United States.

Methods: Primary elective total hip arthroplasty procedures performed for osteoarthritis between 2/15/2012 and 12/31/2018 and their associated revisions were identified in the MARCQI registry. The guidelines recommend that all prostheses combinations receive an early benchmark if they have at least 250 procedures at risk and the revision rate does not exceed the pre-determined standard of 2% at 2 years and 3% at 5 years.

Results: A total of 72,949 primary cases met the inclusion criteria. Of these, 1369 had revisions. Twenty-nine and six stem/cup combinations satisfied the minimum case requirement at 2 and 5 years, respectively. Three implant combinations would not receive a benchmark at 2 years: Secur-Fit/Trident, Anthology/Reflection 3, Taperloc 133/G7.

Conclusion: The guideline can be implemented in the United States by a regional registry. Moreover, not all hip implants currently in use would receive an early benchmark. This raises concern as these implant combinations represent a significant number of cases in Michigan, some with increasing utilization.