Pub Date : 2023-10-25DOI: 10.1177/22104917231197233
Chung Pui Man, Chow Esther Ching-San
Introduction: Ulnar nerve enlargement is observed in ultrasound (USG) in patients with cubital tunnel syndrome (CuTS). This study aims to compare the ultrasound size of the ulnar nerve between CuTS patients and control subjects, to find the cut off size for diagnosis, and to validate the use of USG as an adjunct in CuTS diagnosis. Materials and Methods: There were 23 elbows with clinical and nerve conduction test (NCT) confirmed CuTS, and 42 elbows in the control group. Cases with elbow deformities, old ulnar nerve injuries and postoperative cases were excluded. The ulnar nerve cross sectional area (CSA) was measured at 6 different levels and positions: over the medial epicondyle (ME) in elbow flexion/extension, 2 cm and 5 cm distal to the ME, 2 cm and 5 cm proximal to the ME. A cut off CSA value for CuTS diagnosis was derived. Correlation between ulnar nerve CSAs and NCT was analysed. Results: The age and gender distribution were similar in both groups (61.2 vs 56.6; M > F, p > 0.05). The mean CSA of the CuTS group vs control group was 19.2 mm2 vs 7.0 mm2, 19.5 mm2 vs 7.1 mm2, 20.8 mm2 vs 8.1 mm2 at ME flexion, ME extension and maximal CSA respectively. The derived CSA cut off value for CuTS at ME flexion, ME extension and maximal CSA were 10.5 mm2, 11.5 mm2, and 15 mm2 respectively. The CSA difference at different levels between the 2 groups were significant except at 5 cm proximal to ME. A strong negative correlation was seen between the CSA and the across elbow nerve conduction velocity, with correlation coefficient of −0.748 at ME flexion, −0.654 at ME extension and –0.676 at maximal CSA. Conclusion: USG can be used as an adjunct for the diagnosis of CuTS with high accuracy and patient safety. It can also be used to delineate possible anatomical etiologies at the cubital tunnel.
摘要:肘管综合征(CuTS)患者在超声(USG)下可观察到尺神经扩张。本研究旨在比较CuTS患者与对照组尺神经的超声大小，寻找诊断的截断尺寸，验证USG在CuTS诊断中的辅助应用。材料与方法:临床及神经传导试验(NCT)证实有切口的肘关节23例，对照组42例。排除肘部畸形、陈旧性尺神经损伤及术后病例。测量尺神经横截面积(CSA)在6个不同的水平和位置:肘关节屈伸时内侧上髁(ME)上方，ME远端2 cm和5 cm, ME近端2 cm和5 cm。导出了诊断CuTS的截断CSA值。分析尺神经csa与NCT的相关性。结果:两组患者的年龄和性别分布相似(61.2 vs 56.6;米比;F, p >0.05)。在ME屈、ME伸和最大CSA时，CuTS组与对照组的平均CSA分别为19.2 mm2 vs 7.0 mm2、19.5 mm2 vs 7.1 mm2、20.8 mm2 vs 8.1 mm2。在ME屈曲、ME伸展和最大CSA处的cut off值分别为10.5 mm2、11.5 mm2和15 mm2。除ME近5 cm外，两组间不同水平CSA差异均有统计学意义。CSA与跨肘神经传导速度呈显著负相关，ME屈曲时相关系数为- 0.748,ME伸展时相关系数为- 0.654，最大CSA时相关系数为-0.676。结论:超声心动图可作为诊断切口的辅助手段，具有较高的准确性和患者安全性。它也可以用来描绘可能的肘管解剖病因。
{"title":"Ultrasonic measurement for the diagnosis of cubital tunnel syndrome: A study in the Hong Kong Chinese population","authors":"Chung Pui Man, Chow Esther Ching-San","doi":"10.1177/22104917231197233","DOIUrl":"https://doi.org/10.1177/22104917231197233","url":null,"abstract":"Introduction: Ulnar nerve enlargement is observed in ultrasound (USG) in patients with cubital tunnel syndrome (CuTS). This study aims to compare the ultrasound size of the ulnar nerve between CuTS patients and control subjects, to find the cut off size for diagnosis, and to validate the use of USG as an adjunct in CuTS diagnosis. Materials and Methods: There were 23 elbows with clinical and nerve conduction test (NCT) confirmed CuTS, and 42 elbows in the control group. Cases with elbow deformities, old ulnar nerve injuries and postoperative cases were excluded. The ulnar nerve cross sectional area (CSA) was measured at 6 different levels and positions: over the medial epicondyle (ME) in elbow flexion/extension, 2 cm and 5 cm distal to the ME, 2 cm and 5 cm proximal to the ME. A cut off CSA value for CuTS diagnosis was derived. Correlation between ulnar nerve CSAs and NCT was analysed. Results: The age and gender distribution were similar in both groups (61.2 vs 56.6; M > F, p > 0.05). The mean CSA of the CuTS group vs control group was 19.2 mm2 vs 7.0 mm2, 19.5 mm2 vs 7.1 mm2, 20.8 mm2 vs 8.1 mm2 at ME flexion, ME extension and maximal CSA respectively. The derived CSA cut off value for CuTS at ME flexion, ME extension and maximal CSA were 10.5 mm2, 11.5 mm2, and 15 mm2 respectively. The CSA difference at different levels between the 2 groups were significant except at 5 cm proximal to ME. A strong negative correlation was seen between the CSA and the across elbow nerve conduction velocity, with correlation coefficient of −0.748 at ME flexion, −0.654 at ME extension and –0.676 at maximal CSA. Conclusion: USG can be used as an adjunct for the diagnosis of CuTS with high accuracy and patient safety. It can also be used to delineate possible anatomical etiologies at the cubital tunnel.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"24 15","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135113268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-26DOI: 10.1177/22104917231191804
Hiu Yan Leung, Janus Siu Him Wong, Christian Fang, Calvin Tsoi
Femoral neck system (FNS) is a novel fixed-angle gliding device combining a sliding bolt and an anti-rotational screw to treat femoral neck fractures. It was proven to have comparable biomechanical strength to sliding hip screws. Tip-to-apex distance (TAD) is an established assessment for fixation quality in sliding hip screws. The purpose of our study was to evaluate whether TAD can be used in FNS implant to predict fixation failure. Seventy-six patients receiving FNS fixation for intra-capsular hip fracture were included. TAD was measured from post-operative radiographs and clinical outcomes were collected with a mean follow-up of 14.1 months. The mean TAD for patients who experienced fixation failure was 20.7 mm, versus 19.7 mm for those who did not ( p = 0.395). Subgroup analysis among fractures with good reduction quality, defined as no varus angulation, less than 5 degrees of retroversion, and less than 4 mm cortical translation, did not demonstrate statistically significant difference in the mean TAD between failure and non-failure group (20.7 mm vs 19.5 mm, p = 0.68). We conclude that in our study of modest sample size, there was not demonstrable association between TAD and fixation failure in intra-capsular neck of femur patients treated with FNS.
股骨颈系统(FNS)是一种结合滑动螺栓和防旋转螺钉的新型固定角度滑动装置，用于治疗股骨颈骨折。它被证明具有与滑动髋关节螺钉相当的生物力学强度。尖端到尖端距离(TAD)是滑动髋关节螺钉固定质量的公认评价指标。本研究的目的是评估TAD是否可以用于FNS种植体预测固定失败。76例髋关节囊内骨折患者接受FNS固定治疗。通过术后x线片测量TAD，平均随访14.1个月收集临床结果。固定失败患者的平均TAD为20.7 mm，而未固定失败患者的平均TAD为19.7 mm (p = 0.395)。亚组分析复位质量好的骨折，定义为无内翻角，内翻小于5度，皮质平动小于4mm，失败组和非失败组的平均TAD没有统计学差异(20.7 mm vs 19.5 mm, p = 0.68)。我们得出结论，在我们适度样本量的研究中，经FNS治疗的股骨包膜内颈患者的TAD与固定失败之间没有明显的关联。
{"title":"Tip-to-apex distance does not predict fixation failure regardless of reduction quality in intra-capsular neck of femur fractures treated with femoral neck system","authors":"Hiu Yan Leung, Janus Siu Him Wong, Christian Fang, Calvin Tsoi","doi":"10.1177/22104917231191804","DOIUrl":"https://doi.org/10.1177/22104917231191804","url":null,"abstract":"Femoral neck system (FNS) is a novel fixed-angle gliding device combining a sliding bolt and an anti-rotational screw to treat femoral neck fractures. It was proven to have comparable biomechanical strength to sliding hip screws. Tip-to-apex distance (TAD) is an established assessment for fixation quality in sliding hip screws. The purpose of our study was to evaluate whether TAD can be used in FNS implant to predict fixation failure. Seventy-six patients receiving FNS fixation for intra-capsular hip fracture were included. TAD was measured from post-operative radiographs and clinical outcomes were collected with a mean follow-up of 14.1 months. The mean TAD for patients who experienced fixation failure was 20.7 mm, versus 19.7 mm for those who did not ( p = 0.395). Subgroup analysis among fractures with good reduction quality, defined as no varus angulation, less than 5 degrees of retroversion, and less than 4 mm cortical translation, did not demonstrate statistically significant difference in the mean TAD between failure and non-failure group (20.7 mm vs 19.5 mm, p = 0.68). We conclude that in our study of modest sample size, there was not demonstrable association between TAD and fixation failure in intra-capsular neck of femur patients treated with FNS.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134958272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-26DOI: 10.1177/22104917231200648
Erica Kholinne, Hyun-Joo Lee, In-Ho Jeon
Purposes This study aim to describe surgical outcome in treating postoperative radial neck nonunion and to perform a systematic review to evaluate the surgical outcome of symptomatic radial neck nonunion. Methods The study included ten patients with symptomatic postoperative radial neck nonunion from 2010 to 2016 which were treated surgically with either bone grafting (bone-grafting group) or radial head resection (resection group). The patient demographics, pre- and postoperative clinical scores were recorded. The PubMed, OVID/Medline, Cochrane, Google Scholar, and EMBASE databases were searched using the keywords “radial neck nonunion” according to the MeSH index. A systematic review was performed using PRISMA guidelines. Results Average time from primary surgery to nonunion was 10.7 months. Four and six patients received bone-grafting and radial head resection procedure. The mean age for resection group is older than bone grafting group (59 versus 28.75 years). The resection group patients presented with more significant pre-operative symptoms, associated injuries, loss of radial head articular congruity, and bone loss. All patients achieved favorable outcome. The systematic review included 12 publications with a total of 19 patients. The incidence of radial neck nonunion was 73.7% and 26.3% following conservative and operative treatment respectively. About 42.1% received operative treatment due to symptomatic progression. Conclusions Radial neck nonunion is rare and mostly appears asymptomatic. Operative treatment is advocated for symptomatic cases. Articular congruity and degree of bone loss are major determinant for surgical treatment of radial neck nonunion. Surgical treatment for symptomatic radial neck nonunion resulted in favorable outcome.
{"title":"The surgical outcome of postoperative radial neck nonunion: Retrospective case series with systematic review","authors":"Erica Kholinne, Hyun-Joo Lee, In-Ho Jeon","doi":"10.1177/22104917231200648","DOIUrl":"https://doi.org/10.1177/22104917231200648","url":null,"abstract":"Purposes This study aim to describe surgical outcome in treating postoperative radial neck nonunion and to perform a systematic review to evaluate the surgical outcome of symptomatic radial neck nonunion. Methods The study included ten patients with symptomatic postoperative radial neck nonunion from 2010 to 2016 which were treated surgically with either bone grafting (bone-grafting group) or radial head resection (resection group). The patient demographics, pre- and postoperative clinical scores were recorded. The PubMed, OVID/Medline, Cochrane, Google Scholar, and EMBASE databases were searched using the keywords “radial neck nonunion” according to the MeSH index. A systematic review was performed using PRISMA guidelines. Results Average time from primary surgery to nonunion was 10.7 months. Four and six patients received bone-grafting and radial head resection procedure. The mean age for resection group is older than bone grafting group (59 versus 28.75 years). The resection group patients presented with more significant pre-operative symptoms, associated injuries, loss of radial head articular congruity, and bone loss. All patients achieved favorable outcome. The systematic review included 12 publications with a total of 19 patients. The incidence of radial neck nonunion was 73.7% and 26.3% following conservative and operative treatment respectively. About 42.1% received operative treatment due to symptomatic progression. Conclusions Radial neck nonunion is rare and mostly appears asymptomatic. Operative treatment is advocated for symptomatic cases. Articular congruity and degree of bone loss are major determinant for surgical treatment of radial neck nonunion. Surgical treatment for symptomatic radial neck nonunion resulted in favorable outcome.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134958258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.1177/22104917231203340
Lauren Milton, Etinosa Oliogu, Samuel Finkelstein, Liying Zhang, Lucas Azevedo, Tara Behroozian, Albert Yee, Patrick Henry, Edward Chow, Joel Finkelstein
Introduction Management of orthopaedic fractures involves acute intervention and follow up through to recovery. Patient-centered care needs to encompass all aspects of this treatment. Limited research is available on outpatient satisfaction and patient-reported outcomes from fracture clinic (FRCL). The purpose of this evaluation is to report on pain levels perceived by patients from minor orthopaedic procedures that were necessary for the continued management of fracture care. Methods Patients were recruited in the FRCL if they were planned to undergo minor orthopaedic procedures. They were asked to report the pain they experienced at baseline, during the procedure, 20 min post-procedure, and 24 h following the procedure on a verbal numeric rating scale of 0–10. Healthcare professionals (HCP) were then asked to rank their perception of the severity of pain from each procedure type. Finally, qualitative interviews were conducted on a convenience sample of patients. Results 51 patients were included in this evaluation. Halo pin, external fixation device, Kirschner wire, and screw removal exhibited a mean increase in pain from baseline greater than 3 units during the procedure. The external fixation device removal group showed the greatest pain reported with a statistically significant increase from baseline to the end of the procedure (mean = 7.1; p = 0.002). There was good concordance of pain perception by the HCP to patient experience. Qualitative interviewing revealed two major themes. Discussion This study provided valuable qualitative and quantitative insight into the pain perceptions by FRCL patients. This data may help improve the patient experience inside the FRCL.
{"title":"Real world patient-reported and health care professional-perceived pain severity in outpatient fracture clinic procedures","authors":"Lauren Milton, Etinosa Oliogu, Samuel Finkelstein, Liying Zhang, Lucas Azevedo, Tara Behroozian, Albert Yee, Patrick Henry, Edward Chow, Joel Finkelstein","doi":"10.1177/22104917231203340","DOIUrl":"https://doi.org/10.1177/22104917231203340","url":null,"abstract":"Introduction Management of orthopaedic fractures involves acute intervention and follow up through to recovery. Patient-centered care needs to encompass all aspects of this treatment. Limited research is available on outpatient satisfaction and patient-reported outcomes from fracture clinic (FRCL). The purpose of this evaluation is to report on pain levels perceived by patients from minor orthopaedic procedures that were necessary for the continued management of fracture care. Methods Patients were recruited in the FRCL if they were planned to undergo minor orthopaedic procedures. They were asked to report the pain they experienced at baseline, during the procedure, 20 min post-procedure, and 24 h following the procedure on a verbal numeric rating scale of 0–10. Healthcare professionals (HCP) were then asked to rank their perception of the severity of pain from each procedure type. Finally, qualitative interviews were conducted on a convenience sample of patients. Results 51 patients were included in this evaluation. Halo pin, external fixation device, Kirschner wire, and screw removal exhibited a mean increase in pain from baseline greater than 3 units during the procedure. The external fixation device removal group showed the greatest pain reported with a statistically significant increase from baseline to the end of the procedure (mean = 7.1; p = 0.002). There was good concordance of pain perception by the HCP to patient experience. Qualitative interviewing revealed two major themes. Discussion This study provided valuable qualitative and quantitative insight into the pain perceptions by FRCL patients. This data may help improve the patient experience inside the FRCL.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135817437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-24DOI: 10.1177/22104917231201984
Wai Kiu Thomas Liu, Tak Man Wong
Introduction: Elective orthopaedic service has been reduced during the COVID-19 pandemic, and sports activities of the population have been minimised due to the social distancing strategies. This study aimed to quantify the change in sports medicine operations and its distributions during the COVID-19 pandemic, which could be useful for healthcare providers and policymakers plan in terms of resource planning in case of another severe infection outbreak in the future. Methods: Data, including age and gender of the patients and the types of operation, of all the surgeries performed by the Division of Sports and Arthroscopic Surgery in our institution from September 2017 to June 2022 was retrieved. The first 29 months of the 58 months period were classified as pre-COVID-19. Result: During the COVID-19 pandemic, there was a 20.9% reduction in the total number of sports and arthroscopic surgeries performed, from 10.1 to 8.0 per month ( p = 0.042). The number of shoulder operations was significantly reduced by 32% ( p = 0.029), with rotator cuff surgery reduced by 42% ( p = 0.022). The number of knee operations decreased by 15% ( p = 0.278), with anterior cruciate ligament (ACL) surgery reduced by 20% ( p = 0.093). Notably, the relative proportion of knee and shoulder operations, as well as the patient demographics, remained similar during the COVID-19 pandemic. Conclusion: The reduction in the number of ACL and rotator cuff surgeries could be related to the reduced sports activity and manual labour activity during the lockdown periods of the pandemic. This study provides information and insight into the demand for sports medicine-related operations during the pandemic. It may be practical to limit elective operation sessions for sports and arthroscopic surgery during the pandemic, especially when resources are scarce. However, it is essential to strike a good balance between providing necessary care for patients who require these surgeries, while also taking appropriate measures to combat the pandemic.
{"title":"Impact of COVID-19 pandemic on sports and arthroscopic surgery in local hospitals","authors":"Wai Kiu Thomas Liu, Tak Man Wong","doi":"10.1177/22104917231201984","DOIUrl":"https://doi.org/10.1177/22104917231201984","url":null,"abstract":"Introduction: Elective orthopaedic service has been reduced during the COVID-19 pandemic, and sports activities of the population have been minimised due to the social distancing strategies. This study aimed to quantify the change in sports medicine operations and its distributions during the COVID-19 pandemic, which could be useful for healthcare providers and policymakers plan in terms of resource planning in case of another severe infection outbreak in the future. Methods: Data, including age and gender of the patients and the types of operation, of all the surgeries performed by the Division of Sports and Arthroscopic Surgery in our institution from September 2017 to June 2022 was retrieved. The first 29 months of the 58 months period were classified as pre-COVID-19. Result: During the COVID-19 pandemic, there was a 20.9% reduction in the total number of sports and arthroscopic surgeries performed, from 10.1 to 8.0 per month ( p = 0.042). The number of shoulder operations was significantly reduced by 32% ( p = 0.029), with rotator cuff surgery reduced by 42% ( p = 0.022). The number of knee operations decreased by 15% ( p = 0.278), with anterior cruciate ligament (ACL) surgery reduced by 20% ( p = 0.093). Notably, the relative proportion of knee and shoulder operations, as well as the patient demographics, remained similar during the COVID-19 pandemic. Conclusion: The reduction in the number of ACL and rotator cuff surgeries could be related to the reduced sports activity and manual labour activity during the lockdown periods of the pandemic. This study provides information and insight into the demand for sports medicine-related operations during the pandemic. It may be practical to limit elective operation sessions for sports and arthroscopic surgery during the pandemic, especially when resources are scarce. However, it is essential to strike a good balance between providing necessary care for patients who require these surgeries, while also taking appropriate measures to combat the pandemic.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135926482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-28DOI: 10.1177/22104917231197234
Tsz Ying Giselle Ho, Michelle Lee Syn Yuk
Patella fracture fixations were traditionally done using metal tension band wiring techniques. However, complications associated with metallic implants causing soft tissue irritation are not infrequent. Since 1998, there have been emerging case reports and series reporting the use of non-metallic implants, such as braided sutures, in the fixation of patella fractures 3. However, there is a limited clinical study on a direct comparison between metal and suture fixation in patella fractures. The aim of this study is to evaluate the outcome of all-suture fixation in patella fractures and to compare all-suture and metal fixation in mid-pole fractures. A total number of 50 patients with operated fracture patella were retrospectively reviewed in a 2.5-year period. Primary outcomes included operation time, time for fracture union and postoperative knee function. Secondary outcomes include complications, need for secondary operations due to prominent implants, infection or loss of fixation. There was no statistically significant difference concerning time for fracture union, operation time and postoperative functional knee score between the three fixation methods. The rate of secondary operations was higher in the hybrid group (7 out of 11, 63.6%) and metal group (7 out of 13, 53.8%), and was lowest in an all-suture group (0 out of 28, 0%). Metal implant breakage and soft tissue irritation were the main reasons for secondary operations, which was significantly lower in the all-suture group ( p < 0.0003). Subgroup analysis for mid-pole patella fractures showed similar results in which all primary outcomes showed no statistically significant difference, while the need for secondary operations was higher in the metal group ( p < 0.003). All-suture fixation for patella fractures is a feasible option not limited to distal pole fractures. In our series, this technique achieved similar outcomes when compared with traditional metal implants, with lower rates of secondary operations, and could be safely employed in mid-pole fractures as well.
{"title":"Fixation of patella fracture with non-metallic implant","authors":"Tsz Ying Giselle Ho, Michelle Lee Syn Yuk","doi":"10.1177/22104917231197234","DOIUrl":"https://doi.org/10.1177/22104917231197234","url":null,"abstract":"Patella fracture fixations were traditionally done using metal tension band wiring techniques. However, complications associated with metallic implants causing soft tissue irritation are not infrequent. Since 1998, there have been emerging case reports and series reporting the use of non-metallic implants, such as braided sutures, in the fixation of patella fractures 3. However, there is a limited clinical study on a direct comparison between metal and suture fixation in patella fractures. The aim of this study is to evaluate the outcome of all-suture fixation in patella fractures and to compare all-suture and metal fixation in mid-pole fractures. A total number of 50 patients with operated fracture patella were retrospectively reviewed in a 2.5-year period. Primary outcomes included operation time, time for fracture union and postoperative knee function. Secondary outcomes include complications, need for secondary operations due to prominent implants, infection or loss of fixation. There was no statistically significant difference concerning time for fracture union, operation time and postoperative functional knee score between the three fixation methods. The rate of secondary operations was higher in the hybrid group (7 out of 11, 63.6%) and metal group (7 out of 13, 53.8%), and was lowest in an all-suture group (0 out of 28, 0%). Metal implant breakage and soft tissue irritation were the main reasons for secondary operations, which was significantly lower in the all-suture group ( p < 0.0003). Subgroup analysis for mid-pole patella fractures showed similar results in which all primary outcomes showed no statistically significant difference, while the need for secondary operations was higher in the metal group ( p < 0.003). All-suture fixation for patella fractures is a feasible option not limited to distal pole fractures. In our series, this technique achieved similar outcomes when compared with traditional metal implants, with lower rates of secondary operations, and could be safely employed in mid-pole fractures as well.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"24 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87678879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-09DOI: 10.1177/22104917231191800
M. Karimi, M. Kavyani
Background: Various treatment approaches are used for subjects with idiopathic scoliosis, however using a brace is one of the most common approaches in this regard. The braces used for idiopathic scoliosis can be divided into soft and rigid braces. SpineCor brace is mostly recommended for subjects who refused to use rigid braces. However, it is not well understood whether soft braces are as effective as rigid braces to control scoliosis curve progression or not. Therefore, this study aimed to evaluate the effectiveness of soft braces used for idiopathic scoliotic curves compared to other available braces. Method: A search was done in databases including PubMed, Google Scholar, ISI Web of Knowledge, Ebsco, Embasco, and Scopus. Keywords of the soft brace, SpineCor were used in combination with scoliosis. The quality of the selected studies was evaluated by use of the Down and Black tool, which is a reliable method to evaluate the quality of the studies. Results: Based on the aforementioned keywords, 52 studies were achieved. After reviewing the title and abstract of each study 11 papers were selected for final analysis. Eight studies were on the evaluation of the effectiveness of the SpineCor brace on scoliosis. There were three studies on the comparison of the SpineCor with other available rigid braces. Conclusion: The results of selected studies confirmed that the SpineCor brace can be used to control the progression of idiopathic scoliosis. However, its effectiveness is limited to the curves with a severity of fewer than 30° and for the patients with Risser signs 0–3. The effectiveness of SpineCor is not comparable with a rigid brace, especially for the curve above 40°. SpineCor stabilizes the spine with high compliance and with significant improvement in posture, rib hump, lumbar predominance, and muscle contraction.
背景:特发性脊柱侧凸的治疗方法多种多样，但支架是最常用的治疗方法之一。用于特发性脊柱侧凸的牙套可分为软牙套和硬牙套。SpineCor支具主要推荐给拒绝使用刚性支具的受试者。然而，软牙套是否与硬牙套一样有效地控制脊柱侧凸曲线进展尚不清楚。因此，本研究旨在评估软牙套与其他可用牙套相比用于特发性脊柱侧凸弯曲的有效性。方法:检索PubMed、Google Scholar、ISI Web of Knowledge、Ebsco、embassy、Scopus等数据库。关键词:软支具;脊柱侧凸;脊柱侧凸;所选研究的质量通过使用Down和Black工具进行评估，这是评估研究质量的可靠方法。结果:基于上述关键词共获得52项研究。在审阅了每一篇研究的题目和摘要后，我们选择了11篇论文进行最终分析。8项研究评估了脊柱侧凸的脊柱支撑的有效性。SpineCor与其他刚性支具的比较研究有三篇。结论:选定的研究结果证实SpineCor支具可用于控制特发性脊柱侧凸的进展。然而，其有效性仅限于严重程度小于30°的弯曲和Risser体征0-3的患者。SpineCor的有效性无法与刚性支撑相比，特别是对于40°以上的弯曲。SpineCor稳定脊柱，具有高度顺应性，并显著改善姿势、肋骨隆起、腰椎优势和肌肉收缩。
{"title":"Evaluation of the effectiveness of soft braces on idiopathic scoliosis: A review of literature","authors":"M. Karimi, M. Kavyani","doi":"10.1177/22104917231191800","DOIUrl":"https://doi.org/10.1177/22104917231191800","url":null,"abstract":"Background: Various treatment approaches are used for subjects with idiopathic scoliosis, however using a brace is one of the most common approaches in this regard. The braces used for idiopathic scoliosis can be divided into soft and rigid braces. SpineCor brace is mostly recommended for subjects who refused to use rigid braces. However, it is not well understood whether soft braces are as effective as rigid braces to control scoliosis curve progression or not. Therefore, this study aimed to evaluate the effectiveness of soft braces used for idiopathic scoliotic curves compared to other available braces. Method: A search was done in databases including PubMed, Google Scholar, ISI Web of Knowledge, Ebsco, Embasco, and Scopus. Keywords of the soft brace, SpineCor were used in combination with scoliosis. The quality of the selected studies was evaluated by use of the Down and Black tool, which is a reliable method to evaluate the quality of the studies. Results: Based on the aforementioned keywords, 52 studies were achieved. After reviewing the title and abstract of each study 11 papers were selected for final analysis. Eight studies were on the evaluation of the effectiveness of the SpineCor brace on scoliosis. There were three studies on the comparison of the SpineCor with other available rigid braces. Conclusion: The results of selected studies confirmed that the SpineCor brace can be used to control the progression of idiopathic scoliosis. However, its effectiveness is limited to the curves with a severity of fewer than 30° and for the patients with Risser signs 0–3. The effectiveness of SpineCor is not comparable with a rigid brace, especially for the curve above 40°. SpineCor stabilizes the spine with high compliance and with significant improvement in posture, rib hump, lumbar predominance, and muscle contraction.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"55 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84874431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-08DOI: 10.1177/22104917231191801
Anthony Sleiman, Nicolas Revelt, Sowmyanarayanan V Thuppal, Christopher Bejcek, Austin M. Beason, Kathryn Besserman, Kristin Delfino, Matthew P. Gardner
Introduction: The objective of this study is to comprehensively evaluate fracture type, category of nonunion, and metabolic profile to identify metabolic causes that may impact fracture union. Methods: A retrospective chart review of patients diagnosed with nonunion after fracture fixation was performed. Patient demographics, fracture characteristics, and metabolic profiles were assessed. Results: Data was collected from 94 patients with nonunion, with a mean age of 54.7 years, 50% men, 47.3% obese, and 60.8% current/former smokers. The most common nonunited bone was the femur (48%), tibia (22%), humerus (15%), ulna (5%), clavicle (3%), and fibula (2%). The distal femur, femoral shaft, and tibial shaft made up 50% of the nonunion. The intra-articular fracture was diagnosed in 13% and open injuries in 27%. The most common metabolic abnormalities were low hemoglobin (62.3%), elevated neutrophil percentage (61.9%), elevated erythrocyte sedimentation rate in women (51.8%), low testosterone (46.9%), and hypovitaminosis D (44.3%). Conclusion: The prevalence of metabolic abnormalities was documented across all nonunion types, suggesting this is not unique to atrophic nonunion. Given the high morbidity and cost of nonunion, and low cost of vitamin supplementation, future prospective studies are warranted to identify effective prevention and treatment.
{"title":"Metabolic abnormalities underlying nonunion in the adult fracture patient","authors":"Anthony Sleiman, Nicolas Revelt, Sowmyanarayanan V Thuppal, Christopher Bejcek, Austin M. Beason, Kathryn Besserman, Kristin Delfino, Matthew P. Gardner","doi":"10.1177/22104917231191801","DOIUrl":"https://doi.org/10.1177/22104917231191801","url":null,"abstract":"Introduction: The objective of this study is to comprehensively evaluate fracture type, category of nonunion, and metabolic profile to identify metabolic causes that may impact fracture union. Methods: A retrospective chart review of patients diagnosed with nonunion after fracture fixation was performed. Patient demographics, fracture characteristics, and metabolic profiles were assessed. Results: Data was collected from 94 patients with nonunion, with a mean age of 54.7 years, 50% men, 47.3% obese, and 60.8% current/former smokers. The most common nonunited bone was the femur (48%), tibia (22%), humerus (15%), ulna (5%), clavicle (3%), and fibula (2%). The distal femur, femoral shaft, and tibial shaft made up 50% of the nonunion. The intra-articular fracture was diagnosed in 13% and open injuries in 27%. The most common metabolic abnormalities were low hemoglobin (62.3%), elevated neutrophil percentage (61.9%), elevated erythrocyte sedimentation rate in women (51.8%), low testosterone (46.9%), and hypovitaminosis D (44.3%). Conclusion: The prevalence of metabolic abnormalities was documented across all nonunion types, suggesting this is not unique to atrophic nonunion. Given the high morbidity and cost of nonunion, and low cost of vitamin supplementation, future prospective studies are warranted to identify effective prevention and treatment.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"84 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83807271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-08DOI: 10.1177/22104917231191806
B. Bosakhar, L. Nairn, Kathy Liu, Julien Chapleau, Dale Williams, H. Johal
Pelvic and acetabular fractures are challenging injuries to treat. This review evaluates three-dimensional intraoperative imaging and navigation-guided percutaneous SI, trans-iliac, trans-sacral, and acetabular screw placement versus conventional methods performed with C-arm imaging. A systematic search of MEDLINE, Embase, and Cochrane was performed. Two reviewers independently extracted data into a collaborative data form designed a priori and piloted prior to its use. Descriptive statistics are presented where applicable. Summary statistics analysis was presented based on the fracture type. Continuous data such as fluoroscopic and operative time were compared with unpaired Student t-test and pooled data of revision rate and complications were compared with chi-square analysis with an alpha set at 0.05. The rate of complications using conventional fluoroscopy was 11.3% (26/230) compared to three-dimensional navigation (6.7% (40/597), X2 (DF: 1, N = 827) = 4.79, p = .028.) which translated to a higher rate of revision surgeries in the conventional fluoroscopy group (10.9% vs. 0.8%) X2 (DF: 1, N = 827) = 47.8, p ≤.001. Average fluoroscopic time was lower for studies using three-dimensional navigation (28.8 ± 14.3 s, n = 71) compared to conventional fluoroscopy (57.8 ± 4.2 s, n = 38, p ≤.001). Three-dimensional navigation during minimally invasive pelvis and acetabular fracture fixation may have some benefits. Level of evidence: IV.
骨盆和髋臼骨折是具有挑战性的损伤治疗。本文综述了术中三维成像和导航引导下经皮SI、经髂、经骶骨和髋臼螺钉置入与常规c臂成像方法的比较。对MEDLINE、Embase和Cochrane进行系统检索。两名审稿人独立地将数据提取到一个预先设计并在使用之前进行试点的协作数据表单中。在适用的情况下提供描述性统计。根据骨折类型进行汇总统计分析。透视和手术时间等连续资料采用unpaired Student t检验比较，翻修率和并发症合并资料采用卡方分析比较，alpha集为0.05。常规透视组的并发症发生率为11.3%(26/230)，而三维导航组为6.7% (40/597)，X2 (DF: 1, N = 827) = 4.79, p = 0.028 .这意味着常规透视组的翻修手术率更高(10.9% vs. 0.8%) X2 (DF: 1, N = 827) = 47.8, p≤0.001。三维导航研究的平均透视时间(28.8±14.3 s, n = 71)低于常规透视(57.8±4.2 s, n = 38, p≤0.001)。三维导航在微创骨盆和髋臼骨折固定中可能有一定的好处。证据等级:四级。
{"title":"The use of three-dimensional navigation and advanced intraoperative imaging in minimally invasive pelvic and acetabular fracture fixation: A systematic review","authors":"B. Bosakhar, L. Nairn, Kathy Liu, Julien Chapleau, Dale Williams, H. Johal","doi":"10.1177/22104917231191806","DOIUrl":"https://doi.org/10.1177/22104917231191806","url":null,"abstract":"Pelvic and acetabular fractures are challenging injuries to treat. This review evaluates three-dimensional intraoperative imaging and navigation-guided percutaneous SI, trans-iliac, trans-sacral, and acetabular screw placement versus conventional methods performed with C-arm imaging. A systematic search of MEDLINE, Embase, and Cochrane was performed. Two reviewers independently extracted data into a collaborative data form designed a priori and piloted prior to its use. Descriptive statistics are presented where applicable. Summary statistics analysis was presented based on the fracture type. Continuous data such as fluoroscopic and operative time were compared with unpaired Student t-test and pooled data of revision rate and complications were compared with chi-square analysis with an alpha set at 0.05. The rate of complications using conventional fluoroscopy was 11.3% (26/230) compared to three-dimensional navigation (6.7% (40/597), X2 (DF: 1, N = 827) = 4.79, p = .028.) which translated to a higher rate of revision surgeries in the conventional fluoroscopy group (10.9% vs. 0.8%) X2 (DF: 1, N = 827) = 47.8, p ≤.001. Average fluoroscopic time was lower for studies using three-dimensional navigation (28.8 ± 14.3 s, n = 71) compared to conventional fluoroscopy (57.8 ± 4.2 s, n = 38, p ≤.001). Three-dimensional navigation during minimally invasive pelvis and acetabular fracture fixation may have some benefits. Level of evidence: IV.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73060930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-07DOI: 10.1177/22104917231191803
S. Man, W. Chau, Xieyang Zheng, M. Ong, K. Ho
Total knee arthroplasty (TKA) is a successful procedure in treatment of degenerative disease of the knee, and optimal component placement is essential for long-term implant survival. The purpose of this study was to compare the accuracy of the accelerometer-based KneeAlign 2 (KA2) navigation system against conventional methods for accurate positioning of the femoral and tibial components in TKA in a Chinese population. A total of 123 (37 conventional and 86 KA2) cases of elective primary TKA were reviewed. Hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), and anatomical lateral distal femoral angle (aLDFA) were measured from hip-to-ankle EOS radiographs. Accuracy of conventional alignment and KA2 navigation system was assessed by measuring the difference between intraoperative goal and postoperative radiographic measurements of the components for each respective case. There was no significant difference between conventional alignment methods and KA2 navigation in achieving a neutral mechanical alignment of the lower limb. KA2 navigation was significantly more accurate than conventional alignment methods for optimal positioning of the tibial component in both the coronal and sagittal plane, while no significant difference between the two groups was appreciated in the positioning of the femoral component in the coronal plane. TKA using the accelerometer-based KA2 system was found to offer a high degree of accuracy in component alignment, and in particular, significantly improved tibial component alignment in comparison with conventional alignment methods in a Chinese population. However, no significant improvements were observed in neutral mechanical axis of the lower limb alignment and femoral component placement in the coronal plane.
{"title":"Accuracy and outcome of a handheld accelerometer-based navigation device compared to conventional alignment method in total knee arthroplasty in a Chinese population","authors":"S. Man, W. Chau, Xieyang Zheng, M. Ong, K. Ho","doi":"10.1177/22104917231191803","DOIUrl":"https://doi.org/10.1177/22104917231191803","url":null,"abstract":"Total knee arthroplasty (TKA) is a successful procedure in treatment of degenerative disease of the knee, and optimal component placement is essential for long-term implant survival. The purpose of this study was to compare the accuracy of the accelerometer-based KneeAlign 2 (KA2) navigation system against conventional methods for accurate positioning of the femoral and tibial components in TKA in a Chinese population. A total of 123 (37 conventional and 86 KA2) cases of elective primary TKA were reviewed. Hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), and anatomical lateral distal femoral angle (aLDFA) were measured from hip-to-ankle EOS radiographs. Accuracy of conventional alignment and KA2 navigation system was assessed by measuring the difference between intraoperative goal and postoperative radiographic measurements of the components for each respective case. There was no significant difference between conventional alignment methods and KA2 navigation in achieving a neutral mechanical alignment of the lower limb. KA2 navigation was significantly more accurate than conventional alignment methods for optimal positioning of the tibial component in both the coronal and sagittal plane, while no significant difference between the two groups was appreciated in the positioning of the femoral component in the coronal plane. TKA using the accelerometer-based KA2 system was found to offer a high degree of accuracy in component alignment, and in particular, significantly improved tibial component alignment in comparison with conventional alignment methods in a Chinese population. However, no significant improvements were observed in neutral mechanical axis of the lower limb alignment and femoral component placement in the coronal plane.","PeriodicalId":42408,"journal":{"name":"Journal of Orthopaedics Trauma and Rehabilitation","volume":"4 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89274414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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