Orthopedic Reviews最新文献

Objective: Distal femur fractures are challenging to treat, especially in elderly osteoporotic patients. Retrograde intramedullary nailing (RIMN) and lateral locking plate (LP) fixation are commonly used surgical methods for these fractures. This study aimed to compare the clinical and radiological outcomes of these two techniques.

Methods: In this retrospective study, a total of 72 patients with distal femur fractures classified according to the AO/OTA system and treated surgically were included. Patients were divided into two groups: RIMN (n=36) and LP (n=36). Demographic data, fracture classification, surgical method, operative time, intraoperative blood loss, early weight-bearing status, knee range of motion, union time, and complication rates were evaluated. Additionally, union rate, infection, implant failure, and reoperation requirement were compared. A power analysis was conducted assuming 70% power to detect a clinically significant difference. Statistical analyses included T-test, Mann-Whitney U test, Chi-square test, and Fisher's exact test. Kaplan-Meier analysis was used to assess union time. A p-value <0.05 was considered statistically significant.

Results: The union rate was 86.1% in the RIMN group and 75.0% in the LP group. The average union time was 15.4 weeks for RIMN and 17.2 weeks for LP. Knee range of motion was significantly better in the RIMN group (115.2° vs. 110.4°, p=0.03). Early weight-bearing was achieved in 61.1% of RIMN patients and 44.4% of LP patients (p=0.11). The overall complication rate was 16.7% in the RIMN group and 25.0% in the LP group. Infection rates were 5.6% and 8.3%, respectively. Implant failure was observed in 5.6% of patients in both groups. Reoperation was required in 8.3% of RIMN and 13.9% of LP patients.

Conclusion: Our findings suggest that RIMN may offer advantages over LP in terms of higher union rates, shorter union time, and better functional outcomes, particularly in osteoporotic patients. However, both techniques demonstrated acceptable complication rates, and treatment choice should be tailored to the fracture pattern and patient characteristics. Further prospective, randomized studies are needed to support these findings.

Introduction: Managing pain during pregnancy is challenging due to fetus safety and limited data on perinatal pain treatments. We report the first successful management of neuropathic back pain with high dose 8% Capsaicin patches (Qutenza) in a pregnant patient who failed other modalities.

Case presentation: A 34-year-old female with a history of migraines, childhood scoliosis status-post T5-L3 posterior spinal fusion complicated by post-laminectomy syndrome, presented with myofascial and neuropathic back pain. Her pain was refractory to oral agents, injections, field stimulator, and partial surgical revision. During patch treatments, she became pregnant.

Management and outcomes: A review of the patient's record and consent were obtained. Trial of an 8% capsaicin patch provided significant relief of her pain twice. Following OB/GYN consultation, she continued patch treatment, achieving significant relief without pregnancy complications into a subsequent pregnancy.

Conclusion: Following further study, 8% capsaicin patches may be suitable alternatives for pain management during pregnancy.

Introduction: Total hip arthroplasty (THA) is one of the most commonly performed procedures the last decades in the field of orthopaedics. However, there has been a subsequent increase in revision rates for various reasons with instability and aseptic loosening being the predominant ones. Revision surgeries pose many challenges to the treating orthopaedic surgeons as well as significant burdens on patients and on healthcare systems globally. After a revision procedure, in addition to the best possible functional outcomes, longer lifespan of the implants, the least possible bone loss and restoration of as much as possible of bone stock should also be of priority.

Materials & methods: A case series of 11 patients with aseptic loosening of the acetabular component having moderate-to-severe acetabular bone loss is presented. All patients were managed with a trabecular titanium cup-cage construct in conjunction with impaction of morselized allograft.

Results: This study assessed 11 patients (mean age 67.9 years) with Paprosky 2B-3B acetabular defects undergoing revision surgery (mean follow-up: 54.6 months). Functional outcomes improved significantly, including Harris Hip Score (44.8% to 80.7%), HOOS-JR (49.9% to 70.4%), and Forgotten Joint Score (13.6% to 81.8%). VAS and EQ-5D-5L scores also showed marked improvement. Logistic regression found no significant impact of age, sex, or ASA score on outcomes (p = 0.6). These results demonstrate notable functional recovery post-surgery.

Conclusions: Revision surgery for aseptic loosening of the acetabular component using a trabecular titanium cup-cage construct with morselized allograft demonstrates excellent functional improvement and patient satisfaction. The procedure is effective in managing moderate-to-severe acetabular bone loss (Paprosky 2B-3B), restoring function and quality of life. Despite the challenges associated with such revisions, these findings highlight the efficacy and reliability of this approach in addressing complex cases without being significantly influenced by patient demographics or preoperative risk factors.

Background: Hip joint fractures are the most common fractures in elderly patients and a major cause of neurological disorders.

Objective: The purpose of this non-interventional, observational, prospective study is to evaluate the effects of physiotherapeutic interventions on the neuropsychophysiological profile of patients during the rehabilitation period after hip fracture surgery, starting from discharge from the hospital.

Methods: This study involved 64 mainly elderly patients who underwent surgery for various hip fractures and followed a standardized physical therapy protocol in the rehabilitation center. The Mini-Mental State Examination (MMSE) and Confusion Assessment Method (CAM) scores which are part of the neurological assessment in the rehabilitation center, were recorded on the 1st, 5th, 15th, and 30th days of hospitalization. Statistical analysis followed and the results aimed to evaluate the role of physical therapy in enhancing recovery and preventing cognitive complications in the postoperative period.

Results: The first 64 patients with hip fractures admitted in the rehabilitation center after the initiation of the study protocol were enrolled in the study. Always the same two observers recorded MMSE and CAM scores for each patient during the four aforementioned time points. A statistical analysis included descriptive statistics for each of the four studied time points proved that both MMSE and CAM scores showed statistically significant positive outcomes in the neuropsychophysiological profile of patients following the same physical therapy protocol.

Conclusion: Suggesting and supporting physical therapy through well standardized protocols after hip fracture surgery is crucial for improving and maintaining neurological status, particularly for patients at high risk of neurological disorders and delirium during the immediate postoperative period.

Objective: Aimed at evaluating the impact of quadriceps muscle relaxation in the treatment of Osgood-Schlatter disease and analyzing the association between quadriceps tension and Osgood-Schlatter disease pathogenesis.

Methods: A retrospective cohort study was conducted on 78 Osgood-Schlatter disease patients. Participants were divided into a Local Treatment Group (n=31, receiving local treatment only) and an Combined Release Group (n=47, receiving combined local treatment and quadriceps release). The recovery time, number of treatments, time to relapse,number of relapsesand adverse reactions were compared .

Results: The Combined Release Group demonstrated significantly shorter recovery time (1.55 ± 1.23 weeks vs. 3.58 ± 4.26 weeks, P < 0.001) and fewer treatment sessions (3.17 ± 3.63 vs. 5.77 ± 5.47, P = 0.006) compared to the Local Treatment Group. However, no statistical differences were observed in relapse rates (34.0% vs. 35.5%, P = 0.896) or time to relapse (4.88 ± 5.00 months vs. 6.91 ± 5.13 months, P = 0.140).Both groups showed no adverse reactions.

Conclusion: Quadriceps release accelerates rehabilitation in Osgood-Schlatter disease and this study highlights the importance of reducing quadriceps tension. It also suggests a possible connection between quadriceps tension and the cause of OSD.

Introduction: In patients with shoulder impingement syndrome unresponsive to nonoperative treatment, surgical management is often recommended. This historical review goes into depth on how through research, evidence, and modern technologies, the surgical technique can evolve over time.

Objective: This study aims to provide a review of the literature comparing outcomes of arthroscopic versus open acromioplasty and discuss how the evidence influences surgical techniques and surgeons' modern day preferences.

Methods: Following PRISMA reporting standards, Medline, Embase (OVID), Web of Science, Pubmed, and Cochrane were searched through October 2024 for studies comparing arthroscopic and open acromioplasty for shoulder impingement syndromes. Outcomes of interest included operating time, hospital stay, range of motion, muscle strength, patient satisfaction, and UCLA shoulder score.

Results: Seventeen studies evaluated 1,293 patients (763 males and 530 females) with a mean age of 45.4 years old, who underwent either arthroscopic or open acromioplasty. Both groups showed similar improvements in range of motion, muscle strength, and patient satisfaction. Patients who underwent arthroscopic acromioplasty had quicker recovery and shorter hospital stays, with reduced operative times when performed by experienced surgeons. Outcome scores (UCLA and Constant scores) were generally higher in the arthroscopic group; however, the results were not always statistically significant.

Conclusion: Over time, the standard of care has shifted to arthroscopic acromioplasty as it offers better recovery times and improved cosmetic results, making it the favored approach for shoulder impingement syndromes in patients and surgeons alike. Through continued research and surgical innovation surgical techniques can evolve and ultimately improve patient care.

In this study, the authors report that in four cases of anterior shoulder dislocation resulting from trauma, where reduction attempts under emergency conditions failed due to muscle spasm caused by severe pain, the state of natural sleep induced by analgesic and sedative medications administered in the observation room helped relax the muscles around the shoulder joint. This relaxation prevented spasm and allowed spontaneous reduction of the shoulder joint to occur within a few hours, without the need for anesthetic intervention.

Medial patellofemoral ligament reconstruction is a widely used surgical technique to address patellar instability. This procedure is influenced by several key factors, including patient-specific factors, anatomical considerations, graft selection, tunnel placement, tensioning, fixation methods, postoperative rehabilitation, and potential complications. Various graft options, including autografts and allografts, have been studied, with research indicating no significant differences in pain reduction, return to activity, or failure rates between the two. However, some studies suggest allografts may have a lower failure rate and recurrence of patellar instability compared to autografts. The precise placement of the femoral tunnel is essential for successful reconstruction. Ensuring that the graft is neither too tight nor too loose during fixation contributes significantly to the biomechanical stability of the knee. Different fixation methods, including suture anchors and interference screws, have been compared, with both providing reliable initial fixation strength. Postoperative rehabilitation is another crucial aspect, with studies showing that accelerated protocols can yield favorable outcomes without increasing the risk of recurrent instability. Complications such as recurrent dislocations, patellar fractures, and infections have been reported, with technical errors during surgery being a major contributing factor. A comprehensive approach, involving precise surgical technique and tailored rehabilitation protocols, is necessary to minimize complications and optimize long-term success.

Introduction: Periprosthetic fractures following unicompartmental knee arthroplasty (UKA) are a relatively rare but clinically significant complication. Among these, proximal tibial and fibular fractures are even more uncommon. If not promptly and effectively treated, such fractures can significantly compromise the outcomes of UKA and the long-term survival of the prosthesis.

Case: A 64-year-old female patient suffered a proximal tibiofibular fracture after accidentally falling following a UKA.

Management and outcomes: We performed an open reduction and internal fixation (ORIF) for the femoral fracture. One year postoperatively, follow-up examination indicated good fracture healing, stable prosthesis, and satisfactory knee joint range of motion, with no reported pain.

Conclusion: The treatment of proximal tibiofibular fractures around the prosthesis after UKA should be based on the specific fracture location and type, the stability of the prosthesis, and the overall health condition of the patient, such as the presence of osteoporosis. Surgical intervention remains a viable option for treatment.

Purpose of the review: Lumbar epidural steroid injections (ESIs) have been used for decades for managing lumbosacral pain, particularly in patients with radiculopathy and chronic low back pain. Despite frequent use, there remains debate regarding their overall effectiveness, fueled by variability in physician technique and differing opinions on the optimal approach. This narrative review examines the three primary methods of lumbar ESI administration-transforaminal, interlaminar, and caudal-to evaluate their respective advantages, limitations, and clinical applications.

Summary: Each ESI technique offers unique benefits and potential risks. The transforaminal approach provides targeted delivery to affected nerve roots but is associated with higher risks of complications such as nerve injury or vascular compromise. The interlaminar approach allows broader spread of injectate with a lower technical complexity but may lack precision in targeting the specific source of pain. The caudal approach, typically reserved for patients with altered spinal anatomy or prior lumbar surgery, offers the safest trajectory but often the least precise medication delivery. Outcomes with ESIs are highly variable, which contributes to the ongoing debate about their role in lumbosacral pain management.

Conclusion: Understanding the technical differences, risk profiles, and clinical indications of each lumbar ESI approach can help guide treatment planning and optimize outcomes. By tailoring the injection technique to the individual patient's anatomy and clinical presentation, physicians may improve both the efficacy and safety of epidural steroid injections in the treatment of lumbosacral pain.