Ortopedia, traumatologia, rehabilitacja最新文献

Background: The steady increase in the number of implants of so-called short-stem hip endoprostheses has prompted clinical evaluation of new models being introduced to the market. The purpose of this study was to evaluate the clinical and radiological early results and experience of the new Medgal-HIp short-stem endoprosthesis implant.

Material and methods: This prospective study involved 121 patients at a mean age of 65.2 years (range 42-87) who underwent implantation of a short-stem Medgal-HIp cementless prosthesis. Clinical and radiological evaluations were performed the day before surgery and at 6 weeks, 6 months, 1 year and 2 years after surgery. Functional outcomes were assessed with the HHS scale and pain, with a VAS scale. Radiological examinations evaluated the presence of osteolytic foci, radio-opaque lines, ossifications and axial stem migration as well as limb length difference.

Results: Functional tests showed an increase in mean HHS scores at 2 years post-surgery from 39.1 points (range 34-56) to 88.9 points. (range 59-100) at p=0.041. The mean VAS pain score had decreased at 2 years from a value of 8.7 to 0.81 at p=0.012. No infections, thigh pain or periarticular fractures were noted in any patient. No foci of osteolysis or radio-opaque lines around the implant were noted on radiographs. Minor asymptomatic ossification (Brooker grade 1) appeared in 2 patients. In each case, stem healing occurred through osteointegration between 6 months and 2 years post-surgery. Mean axial migration of the stem was 1.6 mm (SD 1.79 mm and range from 0 to 6mm) at p <0.05. Limb length difference reached a mean value of 6.5 mm (SD 6.7 mm with a range from -11 mm to +12 mm) at p= 0.23. Two cases required revision surgeries related to the acetabulum. Survival of the prosthesis after 2 years according to Kaplan-Meier was 98.3% and that of the stem alone was 100%Conclusions 1. These early clinical results of the Medgal-HIp short-stem endoprosthesis are comparable to data regarding other commercially available short-stem implants. 2. The results of radiological analysis together with clinical results suggest that the stem of the endoprosthesis carries minimal risk of thigh pain, peri-prosthesis fracture or excessive stem migration. 3. Due to the short follow-up period, an authoritative evaluation of the implant will be possible when the distant outcomes are available.

Background: Limb length discrepancy is a concern following total hip arthroplasty for hip pathologies. THA aims to alleviate pain and restore function, but LLD can impact satisfaction and outcomes. This study aimed to detect LLD following THA for neck of femur fractures and evaluate its effect on functional outcomes.

Material and methods: A retrospective study was conducted from 01/2019 to 12/2021, including NOF fracture patients eligible for THA based on mobility and clinical assessment. Data were obtained from patient records, postoperative notes, radiographs, and physiotherapy assessments.

Results: Fifty-eight patients underwent THA for NOF fractures, with an average age of 75.6 years (range 62-92). Most (96%) were ASA 2. The average time to surgery was 38.6 hours (range 8-266). No patients reported LLD postoperatively. Radiological measurements showed a vertical offset mean of 0.47 cm (range 3.46-7.1 mm) and a horizontal offset mean of 0.51 cm (range 3.34-6.89 mm) between operated and normal sides.

Conclusions: 1. Following total hip arthroplasty for neck of femur fractures, patients were able to achieve full weight-bearing and ambulation with clinically no significant leg length discrepancies or functional limitations. 2. Radiographic analysis showed moderate variations, but no functional impairment. 3. Surgical techniques and prosthetic selection minimized discrepancies. 4. Radiological and minor clinical discrepancies require further follow-up and research for identifying long-term effects on biomechanics.

Background: The success of cementless total hip arthroplasty (THA) relies on its primary mechanical stability and secondary biological fixation, which can be assessed by specific exams like dual-energy x-ray absorptiometry (DEXA) or computed tomography (CT). We evaluated the bone adaptation of a cementless primary THA using a validated image analysis tool and plain radiographs.

Material and methods: Patients who received a cementless THA from September 2020 to July 2022 were included in the study. Clinical scores and X-rays were collected prospectively. Relative bone density (RBD) was calculated for each patient, using Rossler validated method with Image-J software, to assess bone density changes after THA.

Results: 155 patients at a mean age of 56.4 years (range 31-84) were followed up for 38.5 months. Harris Hip Score was 92.2 at the latest follow-up. Radiographically, all the cups were positioned in the Lewinnek safe zone. Five cups showed non-progressive radiolucent lines. RBD showed a significant decrease in Gruen zone 1, while the percentage difference in the other zones ranged from -9% to +4%. In the cohort, there were 2 intraoperative fractures treated with cerclage wires. One patient had a superficial infection, and another one had a deep infection.

Conclusions: 1. ImageJ stands out as a robust tool for the quantitative assessment of osteointegration in uncemented hip implants. 2. Its ability to analyse regular x-ray data with precision supports better clinical outcomes. 3. By incorporating ImageJ into routine assessments, orthopaedic surgeons can achieve a more accurate understanding of bone-implant interactions, leading to optimized patient care and improved implant survival rates analysis. 4. The consideration of cost and time efficiency further underscores the value of ImageJ in clinical practice, making it a valuable asset.

Iliopsoas bursitis (IB) is a rare entity and usually presents with ambiguous clinical presentation similar to other musculoskeletal conditions in the anatomic area. In septic IB, patients usually present with vague complaints of hip pain and fever.To better understand this vague clinical entity, a systematic review of cases of iliopsoas bursitis published in the open literature was performed to better characterize the clinical presentation, demographics and clinical outcome in patients with IB. An analysis of 50 articles and 54 patients including our index case revealed that hip pain was the most common presenting complaint in 74% of the patients, followed by lower limb edema (16.7% of patients). Common etiologies were total hip arthroplasty (16.7%) and infection (14.8%). The mortality rate calculated in the reported cases of septic IB was high. Therefore, knowledge of this entity is important as delay in diagnosis and management, especially in septic IB, can result in fatal outcome.

Bilateral open knee dislocation is an extremely rare injury, with only one previously documented case in the literature. A 65-year-old male sustained bilateral open knee dislocations in an agricultural accident. The left knee was treated with early multiligamentous reconstruction, achieving full recovery. The right knee, complicated by infection and extensive bone loss, required multiple debridements, soft tissue coverage with a medial gastrocnemius flap, and primary arthrodesis. At 18 months, the patient walked independently, with full function in the left knee and a stable, painless right knee. This case highlights the importance of staged management and individualized treatment strategies in complex knee trauma.

Background: Literature data shows that the incidence of acetabular fractures is 3/100,000 patients/year. Men account for 69.4% of the patients. The mean age is 38.6 +/- 4.6 years and mortality is 3% (1). The causes are high-energy trauma, traffic accidents (80%), and falls from a height (10.7%) (1). Conventional plain radiographs and 2D and 3D CT scans (3) are usually used to assess the extent of damage. The aim of the study was to analyze the determinants of distant outcomes of surgical treatment of acetabular fractures depending on the type of fracture and the degree of reconstruction of the joint surface.

Material and methods: A retrospective analysis was performed of 1,186 patients treated at the Pelvic Trauma and Pathology Ward, Orthopedic Department, Postgraduate Medical Education Centre in Otwock between 1990 and 2020 (30 years). Associated injuries were treated surgically in 29% of cases (n= 344)Results. The radiographic and CT evidence showed that during the early surgical reduction of acetabular fragments, the following results were obtained: very good in 77.2% of the patients (n=916), congruence in 3.9% (n=46), fair in 12.8% (n=152), and poor results in 6% (n=72). Distant outcomes were assessed according to the Merle d 'Aubigne-Postel Score (modified by Matta). Excellent, very good and good results were obtained in 79.8% of patients (n=947), fair results in 8.7% (n=103) and poor results in 11.5% (n=136).

Conclusions: 1. Distant outcomes of surgical treatment of acetabular fractures depend on numerous factors such as: stability of the patient's general condition, which may delay surgical treatment, detailed radiographic and CT assessment, which make it possible to assess the fractures 3-dimensionally and classify them according to the Judet and Letournel classification, degree of anatomical reduction of the fragments, especially in regard to the weight-bearing portion of the acetabulum, visible on postoperative 2D and 3D CT images. 2. Complex fractures according to Judet and Letournel, especially those that involve the posterior wall of the acetabulum or the acetabular dome, have poorer outcomes.

Background: The modified Stoppa approach has gained widespread acceptance for managing acetabular fractures. This study explores its effectiveness as a comprehensive solution for a majority of acetabular, pelvic and combined injuries.

Material and methods: This prospective study enrolled 27 patients [21 males, 6 females, mean age 45.4 years] with acetabular fractures and pelvic injury fulfilling the inclusion criteria. The modified Stoppa approach with a transverse incision was used in all cases. The brim plate was used to fix the anterior column, the infra-pectineal plate, hook plate and lag screws were used to fix the posterior column. Symphyseal and ramus fixation was done using a recon plate and the sacroiliac joint was fixed with illiosacral screws. The mean follow up was 3.21 years. The radiological and functional outcome was evaluated by Matta's criteria and the modified D'Aubigne and Postel criteria, respectively, for acetabular fractures and the Matta and Tornetta criteria and Majeed's score, respectively, for pelvic fractures.

Results: There were 24 acetabular fractures and 4 pelvic injuries (including 1 combined injury). Average blood loss and operation times were 750 mL and 140 min, respectively. Among 24 acetabular fractures, 22 had congruent reduction and 2 had non-congruent reduction. Functional outcome was excellent in 7, good in 11, fair in 4 and poor in 2 patients. Among 4 pelvic fractures, 2 had excellent and 2 had good reduction. Majeed's score was excellent in 1 and good in 2 patients (the patient with a combined injury had an excellent functional outcome).

Conclusions: 1. This study confirms the efficacy and safety of the modified Stoppa approach in treating anterior injuries of the acetabulum. 2. This study also underlines the possibility of managing the minimally displaced posterior column injuries and a good portion pelvic ring injuries through anterior approach. 3. The modified Stoppa approach may be considered a workhorse approach for treating a majority of acetabular fractures.

Background: Distal radius fractures are the second most common type of fractures encountered in the emergency room, with an incidence of 16 to 32 fractures per 10,000 person/year (the most common being hand bone fractures). The objective of this study was to review the literature on the long-term (a minimum of 3 years' follow-up) functional outcomes of treating distal radial fractures with different methods and get insight into the possible superiority of certain treatment methods (operative vs conservative) over other methods.

Material and methods: Randomized clinical trials and observational studies reporting on functional and radiological outcomes of distal radial fractures treated conservatively vs operatively in adult patients found in the PubMed and Medline databases were reviewed. Published papers from the PubMed and Medline databases were included.

Results: Nine studies were found that met the inclusion criteria for the analysis. The range of follow-up duration varied from 3 to 14 years, the size of the study groups ranged from 32 to 342 individuals and age of the patients ranged from 18 to 76 years. All the papers reported no significant differences between long-term functional outcomes after surgical vs conservative treatment. All studies reported better radiological outcomes after surgical treatment and worse outcomes for plaster cast immobilization, the latter combined with a high rate of re-dislocations and frequent malunions. This, however, did not translate into worse clinical outcomes. We noticed some significant bias in the studies analysed that significantly affects the reliability and validity of conclusions drawn from these studies.

Conclusions: 1. Our review shows that treatment outcomes of distal radial fractures are generally good regardless of the method used. 2. Current literature does not provide uniform evidence to prove the superiority of a particular treatment method when long-term functional outcomes are compared. 3. Conservative treatment by closed reduction and plaster cast immobilization still appears to be a good option for treatment of these fractures, particularly in older patients. 4. There is still a need for research conducted according to trustworthy and credible scientific criteria, to obtain reliable data and improve the treatment guidelines.

We present a case of giant bilateral iliopsoas bursitis (IB) in a patient with Human Immunodeficiency Virus (HIV) who presented to the emergency department with bilateral hip pain and fever. He was initially worked up for septicemia. Inflammatory markers at the time of admission were elevated. He was started on IV antibiotics. Contrast-enhanced CT scan of the abdomen and pelvis demonstrated a retrocrural collection secondary to discitis/osteomyelitis, as well as large bilateral multilocular collections deep to the iliacus muscle concerning for bilateral septic giant IB. The collections were drained and grew MRSA and tailored antibiotics were started. Despite adequate treatment he succumbed to his illness. Knowledge of this entity is important, as delay in diagnosis and management of septic IB can result in a fatal outcome, especially in immunocompromised patients.

Background: Pediatric supracondylar humerus fractures are common in children aged 5-7. The mechanism of injury, fracture type, and its relationship to the epiphysis significantly affect long-term outcomes. This study examines the impact of demographic data, fracture characteristics, and surgical timing and duration on postoperative results.

Material and methods: Patients treated for supracondylar humerus fractures between February 2009 and January 2021 were included. Pre- and postoperative radiographs were analyzed, and surgical timing and duration were compared with fracture type and clinical outcomes.

Results: A total of 121 patients (72 males, 49 females) at a mean age of 6.6 2.8 years were evaluated. The mean surgery duration was 50.1 29.2 minutes. Fractures were classified as Gartland type 2a (38 patients), type 2b (59 patients), and type 3 (24 patients). Closed reduction with percutaneous pinning was performed in 82 cases. Complications occurred in 7 patients with surgery delays of less than 8 hours and in 4 patients with delays over 8 hours. A significant correlation was found between surgical timing, hospital stay, and complications (p<0.05). The Flynn criteria indicated better outcomes in patients with surgery performed between midnight and 08 a.m. and within 8 hours of injury.

Conclusions: 1. Pediatric patients operated on during nighttime hours exhibited higher complication rates and longer hospital stays. 2. Outcomes assessed using the Flynn criteria were superior in patients operated on during daytime hours or with surgical waiting times of less than 8 hours. 3. These findings suggest that there is no universal definitive limit for optimal surgical timing. 4. Patient-specific conditions and clinical features should guide surgeons in determining the appropriate timing for surgery.