SICOT-J最新文献

Purpose: The current study aimed to investigate the correlation between the grade of radiographic hip osteoarthritis (OA) and the fracture pattern observed in fragility fractures of the proximal femur. The information may help in cases of occult hip fractures.

Methods: In this retrospective study all 448 patients treated with fragility fractures of the proximal femur in the years 2014-2018 were included. Patients were allocated into two groups: Group I) intracapsular (femoral neck) fractures and Group II) extracapsular (pertrochanteric and subtrochanteric) femoral fractures. The radiographic grade of OA was determined according to Kellgren and Lawrence's classification. One single observer examined all radiographs.

Results: Patients' age ranged between 52 and 104 years with a mean of 80.0 years. There was a significant difference in mean age between the two groups (76.9 years intracapsular vs. 83.1 years extracapsular fractures). A total of 250 (55.8%) fractures were intracapsular (femoral neck) and 198 (44.2%) were located extracapsular (pertrochanteric, subtrochanteric). A significant correlation between the degree of OA to fracture pattern was observed: Higher degrees of OA were related to extracapsular fractures and lower degrees of OA to intracapsular fractures.

Conclusion: The results of this study support the hypothesis that hip osteoarthritis affects the fracture pattern in proximal femur fractures. More severe hip OA is associated with extracapsular fractures that can be treated surgically with lower complication rates compared to intracapsular fractures.

Introduction: Lateral fractures of proximal femur are the most frequent fractures in elderly people. Internal fixation using medullary nails is the gold standard of treatment (Gamma 3 nail is the most implanted device) due to reduced incidence of complications than other devices. We report our experience in treating this kind of fractures with Gamma 3 nail, between January 2015 and December 2021.

Methods: We performed a retrospective cohort study of patients treated in our orthopaedic department; level of clinical care is III: 559 patients (431 females and 128 males, with an average age of 85.3 years) with lateral femoral neck fracture. All patients were surgically treated with Gamma 3 standard nail (SGN). We evaluated preliminary X-rays to classify fractures, according to AO-OTA classification and post-operative X-ray to verify cephalic screw position site, according to areas described by Cleveland in 1959: we measured tip-to-apex distance (TAD) and tip-to-apex calcar referred distance (CalTAD). Finally Chang reduction quality criteria (CRQC) for fracture reduction of trochanteric fractures were determined using preoperative or postoperative Antero-Posterior (AP) and lateral radiographs in a Picture Archiving and Communication System (PACS). Incidence of cut-out was evaluated in relation with these parameters. Patients were divided into 2 groups: first group had cephalic screw in optimal positions (5-8-9), the other group had cephalic screw in other positions.

Results: In 328 patients (58.7%) screw was in positions 5-8-9, in 231 patients (41.2%) screw was in not-optimal position. Median TAD was 19.1 ± 7.0 mm (range = 0.0-50.5); in 463 patients (82.8%) TAD was ≤ 25 mm. Median CalTAD was 21.4 ± 4.7 mm (range = 5.7-39.2); in 105 patients (79.4%) CalTAD was ≤ 25 mm. Cut-out was observed in 8 cases (1.43%). Multivariate analysis showed a significant correlation (p < 0,05) between incidence of cut-out and fracture type 31A2 and with TAD values >25 mm. Cephalic screw position did not influence incidence of cut-out.

Discussion: In order to obtain fracture healing with a low risk of failure, in particular cut-out, it is necessary to obtain good reduction of fracture and optimal lag screw position in order to achieve a TAD inferior to 25 mm.

The integration of artificial intelligence (AI) into orthopaedic care has gained considerable interest in recent years, evidenced by the growing body of literature boasting wide-ranging applications across the perioperative setting. This includes automated diagnostic imaging, clinical decision-making tools, optimisation of implant design, robotic surgery, and remote patient monitoring. Collectively, these advances propose to enhance patient care and improve system efficiency. Musculoskeletal pathologies represent the most significant contributor to global disability, with roughly 1.71 billion people afflicted, leading to an increasing volume of patients awaiting planned orthopaedic surgeries. This has exerted a considerable strain on healthcare systems globally, compounded by both the COVID-19 pandemic and the effects of an ageing population. Subsequently, patients face prolonged waiting times for surgery, with further deterioration and potentially poorer outcomes as a result. Furthermore, incorporating AI technologies into clinical practice could provide a means of addressing current and future service demands. This review aims to present a clear overview of AI applications across preoperative, intraoperative, and postoperative stages to elucidate its potential to transform planned orthopaedic care.

Background: Correct acetabular component placement plays a critical role in reducing early revisions after dislocations in total hip arthroplasty (THA). Although the transverse acetabular ligament (TAL) guides anteversion, inclination can only be accurately guided by navigation. In order to overcome the initial disadvantages with navigation, an imageless, easy-to-use inertial navigation system has been recently introduced. This study aims to analyze the accuracy of inclination with this navigation system compared to the standard manual technique.

Methods: Two cohorts, manual technique (MT) and navigation (NAV) cohorts, consisted of 83 and 95 patients, respectively, after exclusion criteria were applied. Inclination target was 38° and anteversion was guided by TAL. Demographic data were collected, and anteroposterior (AP) pelvic and cross-table lateral radiographs were obtained 6 weeks post-operatively. Inclination and anteversion were determined on the AP pelvic and cross-table lateral radiograph, respectively.

Results: A mean inclination of 41.8° (±6.8°) and 38.9° (±4.4°) was found in the MT and NAV cohorts, respectively. There was no statistical difference in gender, age, and BMI. If the inclination was set within 10° of the target (i.e., 38°), 88% of the MT cohort and 97% of the NAV cohort were within the target zone. Accuracy decreased to 53% and 83%, respectively, if the target zone range was narrowed down to ± 5°.

Conclusion: Combining inertial imageless navigation for inclination and TAL as a landmark for anteversion is significantly more accurate compared to the manual technique, without having the limitations and disadvantages of current standard navigational techniques.

Introduction: This study aimed to investigate the anterior-posterior (AP) displacement of the tibial tuberosity (TT) and to assess the difference between closed wedge and opening wedge high tibial osteotomies (OWHTO and CWHTO).

Methods: One hundred consecutive knees with osteoarthritis that underwent OWHTO (50 knees) or CWHTO (50 knees) were investigated retrospectively. The femorotibial angle (FTA) was measured on AP radiographs of the knee. AP displacement of the TT, posterior tibial slope (PTS), the modified Blackburne-Peel index (mBPI), and the modified Caton-Deschamps index (mCDI) were measured on lateral radiographs of the knee.

Results: Patients had a mean correction angle of 12.58 ± 2.84° and 18.98 ± 5.14° (P < 0.001), with a mean AP displacement of TT of 0.84 ± 2.66 mm and 7.78 ± 3.41 mm (P < 0.001) in OWHTO and CWHTO, respectively. The AP displacement of the TT per correction of 1° was significantly greater in CWHTO than in OWHTO (P < 0.001). A significant correlation was found between the correction angle and AP displacement of the TT in CWHTO (r = -0.523, P < 0.001), but not in OWHTO. The change of PTS per correction of 1° was significantly greater in OWHTO than in CWHTO (P < 0.001). The changes of mBPI and mCDI per correction of 1° were significantly greater in CWHTO than in OWHTO (P < 0.001 and P < 0.001, respectively).

Conclusions: There was greater anterior displacement of the TT in CWHTO than in OWHTO, which was correlated with the correction angle. The results suggested that CWHTO would be better than OWHTO when a concomitant anteriorization of TT is required.

Introduction: The lesser trochanter profile (LTP) method is an intraoperative fluoroscopic technique that can assess the femoral version and limit malrotation. The purpose of this study was to directly assess the accuracy and reliability of the LTP method, as well as determine the incidence of malrotation produced by this technique.

Methods: Three groups of observers (fellowship-trained orthopedic surgeons, orthopedic residents, and medical students) utilized the LTP method to replicate pre-imaged rotation angles on a cadaveric femur bone. Recorded outcomes include rotational error and number of attempts. Accuracy and interobserver reliability were assessed by rotational error and the interclass correlation coefficient (ICC), respectively.

Results: Accuracy was within 3° for all three groups. ICC between each group was greater than 0.99. There was no statistical difference between the accuracy of fellowship-trained surgeons, orthopedic residents, and medical students. Medical students on average required more attempts to obtain their final image compared to fellowship-trained surgeons. There was no statistical difference in the number of attempts between residents and fellowship-trained surgeons.

Conclusion: None of the LTP measurements were greater than 15°, the clinical threshold for malrotation. The average error of the observers was less than 3°, demonstrating that the LTP is an effective method of assessing the femoral version. There was no statistically significant difference between the observers, indicating that this technique is reliable and easy to use. Ultimately, the LTP method is easily reproducible for surgeons to avoid femoral malrotation.

Introduction: Limb salvage surgery in children following bone sarcoma resection is a challenging problem because of the small size of the bones, the lack of appropriate size-matched implants, and the risk of limb-length discrepancy once skeletal growth is complete, secondary to the loss of the epiphyseal plate. Although several reconstruction options are available in children with bone sarcomas, such as vascularized fibula, massive bone allograft, extracorporeal devitalized autograft, endoprosthesis, and allograft-prosthesis composite, a consensus has not been reached on the best reconstruction method. The purpose of the present study is to propose an algorithm for reconstruction after resection of bone sarcomas in children.

Methods: In this review, we analyzed reports on limb reconstruction in children following treatment for bone sarcoma, to provide a comprehensive overview of the different reconstruction options in children with bone sarcomas, the outcomes, and the risks and benefits of the different surgical approaches.

Results: Despite a high risk of complications and the necessity for limb-lengthening procedures, prosthetic or biological reconstructions seem to achieve good functional outcomes in children with bone sarcoma. The use of massive bone graft seems to be recommended for intercalary reconstructions, with a free vascularized fibular graft for long defects, while for osteoarticular reconstruction a modular or expandable prosthesis or an allograft-prosthesis composite seems to have good results. For reconstruction of the proximal humerus, modular prosthesis or allograft-prosthesis composite are more commonly used than expandable prosthesis since there are fewer functional constraints related to possible limb-length discrepancy on the upper limb compared to the lower limb.

Discussion: We discuss the advantages and limitations of the different available surgical options for bone reconstruction following tumor resection in children and propose an algorithm of potential surgical treatments for children with bone sarcomas of the extremities.

Introduction: Precise implant positioning during total hip arthroplasty (THA) is an important factor affecting dislocation rate and long-term implant survival. Although a special carbon fiber traction table for THA improves the accuracy of implant positioning, it is too expensive. We aimed to report the accuracy of cup positioning and complication rate in patients undergoing THA using a conventional noncarbon fiber traction table, which is generally used for osteosynthesis of femoral fractures.

Methods: This retrospective study included 62 patients who received primary THA via the direct anterior approach using a conventional traction table with fluoroscopy between July 2022 and December 2023. Two observers recorded radiological outcomes using postoperative anteroposterior X-rays. The intraclass correlation coefficients of cup positioning angles were evaluated (inclination: 0.92, anteversion: 0.88 for intra-observer agreement; inclination: 0.91, anteversion: 0.84 for inter-observer agreement). Complications were defined as dislocation, periprosthetic fracture, ankle fracture, implant loosening, nerve injury, surgical site infection, deep vein thrombosis, and revision surgery for any reason.

Results: Radiographic analysis showed an average cup inclination of 38.5° ± 4.3° (98.4% within Lewinnek's safe zone). The average cup anteversion was 12.6° ± 4.6° (100% within Lewinnek's safe zone). None of the patients experienced any complications.

Discussion: A conventional traction table could be a feasible alternative to a carbon fiber traction table for performing THA via the direct anterior approach using fluoroscopy at general hospitals.

Introduction: A variety of techniques have been described for femoral fixation in medial patellofemoral ligament reconstruction (MPFLr). The aim of this study was to compare the biomechanical performance of the most used methods for graft fixation in the femur using human cadaveric tissue. We wondered what is the best fixation method for femoral fixation in MPFL reconstruction?

Hypothesis: A suspensory fixation device provides the best femoral fixation.

Material and method: Twenty cadaveric knees were tested. Four femoral fixation methods were compared (5 knees per group): interference fixation with a Biosure© RG 5 mm and a 7 mm, suture anchor (Healicoil Regenesorb 4.75 mm ©) and suspensory fixation with the Ultrabutton©. The testing was divided in preconditioning, cyclic loading and load to failure. Load to failure, elongation, stiffness and mode of failure were recorded and compared.

Results: The Ultrabutton© had the highest mean ultimate load (427 ± 215 N (p = 0.5)), followed by Healicoil anchor © (308 ± 44 N (p > 0.05)) and the interference screw of 7 mm (255 ± 170 N (p > 0.05)). Mean stiffness was similar in the Ultrabutton© and 4.75 mm. Healicoil anchor © groups (111 ± 21 N/mm and 119 ± 20 N/mm respectively), and lowest in 7 mm Biosure© screw fixation group (90 ± 5 N/mm). The Biosure© 5 mm RG screw presented 100% of premature rupture because of tendon slippage. The Ultrabutton© presented the lowest premature rupture (40%).

Discussion: A suspensory fixation for the femur had the lowest number of graft failures and highest load to failure. This study has implications for surgeons' choice of graft fixation in MPFLr. It is the first study to test the most commonly femoral used fixation methods, allowing direct comparisons between each method.

This review brings together a multidisciplinary, multinational team of experts to discuss the current state of knowledge in the detection and treatment of hip displacement in cerebral palsy (CP), a global public health problem with a high disease burden. Though common themes are pervasive, different views are also represented, reflecting the confluence of traditional thinking regarding the aetiology and treatment of hip displacement in CP with emerging research that challenges these tried-and-true principles. The development of hip displacement is most closely related to gross motor function, with radiographic surveillance programs based on the Gross Motor Function Classification System (GMFCS), the goal being early detection and timely treatment. These treatments may include non-operative methods such as abduction bracing and Botulinum Neurotoxin A (BoNT-A), but outcomes research in this area has been variable in quality. This has contributed to conflicting opinions and limited consensus. Soft tissue lengthening of the hip adductors and flexors has traditionally been employed for younger patients, but population-based studies have shown decreased survivorship for this treatment when performed in isolation. Concerns with the identification of hip displacement in very young children are raised, noting that early reconstructive surgery has a high recurrence rate. This has prompted consideration of viable minimally invasive alternatives that may have better success rates in very young children with CP, or may at least delay the need for osteotomies. Recent reports have implicated the role of abnormal proximal femoral growth and secondary acetabular dysplasia as a primary cause of hip displacement, related to ambulatory status and abductor function. As such, guided growth of the proximal femur has emerged as a possible treatment that addresses this purported aetiology, with promising early results.