SICOT-J最新文献

Purpose: This study will evaluate the outcomes of the combined latissimus dorsi tendon transfer and deltoid flap for the management of irreparable posterosuperior rotator cuff tears.

Methods: This is a retrospective study of 15 patients who have undergone double transfer surgery for their irreparable posterosuperior rotator cuff tears. These patients were followed up in three periods. Functional outcomes such as the constant score (CS), subjective shoulder value (SSV), and range of motion were assessed as well as radiographic outcomes such as the acromio-humeral distance.

Results: Fifteen patients were included in the early and intermediate follow-up while only 8 remained at the latest follow-up. At the early follow-up the SSV (p = 0.001), CS (p = 0.021), and A-H distance (p = 0.008) showed a statistically significant improvement from their pre-operative values. At the latest follow-up, only the external rotation decreased from its value at the intermediate follow-up (p = 0.027).

Conclusion: The double transfer technique showed sustainable improvement of the functional outcomes except for the external rotation. However, the loss of external rotation did not affect the remaining outcomes. Trials comparing this technique to other surgical managements or MIRCTs are needed to confirm these results.

Purpose: This study evaluates the functional and radiological outcomes of segmental and comminuted tibial fractures using a suprapatellar approach in semi extended position.

Methods: A total of 62 patients, with a mean age of 40.8 (range: 21-78 yrs) and 43 males and 19 females, were retrospectively evaluated between January 2017 and December 2022. Patients with comminated tibial fracture AO Type 42 C3 (32) and segmental AO Type 42 C2 (21) AO Type 42 C1 (9) were treated with a IMN using the suprapatellar technique. There were 51 closed fractures and 11 grade-one open fractures. All patients were subjected to the suprapatellar nailing technique in the semi-extended position.

Results: Fracture healing 20.4 weeks on average was needed for the fracture to heal in segmental and 21.2 weeks in comminuted fracture. There were two instances of the delayed union in comminuted fractures. In two cases of segmental fracture dynamization is required. One case of non-union required bone grafting in a segmental fracture and in two instances in comminuted fractures to improve union after four months of monitoring. Primary union occurred in 56 patients. After minimum of 10.2 months of follow-up. According to Johner and Wruh's criteria with modifications, out of 62 patients, 47 had excellent results, 10 had good results, and 5 had fair results.

Conclusions: In segmental and comminuted fracture tibia, the suprapatellar IMN technique in a semi-extended position results in a significantly lower rate of malalignment, and good union because of soft tissue friendly bypass surgery.

Introduction: Anterior cruciate ligament (ACL) tear is one of the most frequent ligamentous injuries. The gold standard for ACL tears is autograft reconstruction. However, ACL repair has regained enthusiasm with more recent results showing comparable outcomes to its reconstructive counterpart.

Methods: PubMed, Cochrane, and Google Scholar (pp. 1-20) were searched until November 2022. The clinical outcomes consisted of the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), the side-to-side difference in Anteroposterior (AP) knee laxity, the forces of the hamstring, quadriceps, and hip abduction as well as hopping tests.

Results: Only two studies were included in this meta-analysis. ACL repair was shown to have better Hamstrings strength. The rest of the analyzed outcomes were comparable.

Discussion: This is the first meta-analysis comparing these two treatments. The ACL repair showed no differences in muscle strength (quadriceps and hip abductors), postoperative knee scores, and knee joint laxity when compared to ACL reconstruction. However, it showed better hamstring strength. Further randomized clinical studies will be needed to compare both of these techniques.

Introduction: Pre-operative templating prior to hip arthroplasty has traditionally used implant-company-provided acetates, which assumed a magnification factor between 115% and 120%. In recent years, pre-operative planning has been performed with digital calibration devices, in order to calculate the magnification factor. However, these devices are not without their limitations and are not readily available at many institutions. As previous reports suggest a wide range of magnification factors, the determination of an optimal magnification factor is currently unclear. We investigated the relationship between obesity and gender on the magnification factor in order to improve the accuracy of pre-operative templating.

Patients and methods: Ninety-seven consecutive pre-operative calibrated pelvic radiographs using the KingMark calibration were analyzed using the TraumaCad templating software. The magnification factor calculated by the software was considered the true magnification factor and analysis was made in order to assess the effect of sex and body mass index (BMI) on the magnification factor. A linear regression analysis was utilized to create a predictive model for optimal magnification factor value.

Results: Magnification factor was significantly affected by sex (male, 120.0% vs. female 121.2%, p < 0.01) and by categorized BMI (obese 121.8% vs. non-obese 119.9%, p < 0.001). A positive linear association was found between BMI and the magnification factor (r = 0.544). The magnification factor was significantly different between the following sub-groups: obese female, non-obese female, obese male, and non-obese male (p < 0.001). When applying the model formulated by the linear regression analysis, the calculated magnification factor was within 2% of the true magnification factor for the majority of patients (n = 83, 85.6%).

Conclusions: BMI and gender have a significant effect on the magnification factor. Future determination of the magnification factor should consider the influence of these variables in order to improve the accuracy of pre-operative templating in THA.

Introduction: Stemmed total knee arthroplasty (STKA) periprosthetic fractures (PPFs) are an emerging problem affecting frail patients. Their surgical fixation is challenging, due to intramedullary involvement and poor bone stock. Polyaxial locking plating has yielded good results in implant-related femur fractures. We hypothesized that this treatment would provide similar results for STKA PPFs.

Methods: Retrospective analysis of consecutive patients with a femoral PPF or inter-implant fracture around a knee revision stem who had undergone open reduction and periprosthetic-specific polyaxial plate fixation.

Results: We found 14 cases of mean age 85.4 years. Cerclages were used in 80% of cases. Fixation of a mean 8.6 cortices around the revision stem was achieved, with an overall screw density of 1:2 or 1:3. Four patients lost their ability to walk, while four experienced postoperative local complications. Bone healing was achieved in all except one who died during hospitalization. The 13 remaining survived the first year of follow-up.

Conclusion: STKA PPFs are an emerging and challenging problem affecting frail patients. Treatment using polyaxial locking plates provides stable fixation allowing early mobilization despite high complication rates.

Introduction: Lag screw cut-out is a serious complication of dynamic hip screw fixation of trochanteric hip fractures. The lag screw position has been acknowledged as one of the important factors affecting the lag screw cut-out. We propose a modification of the Tip Apex Distance (TAD) and hypothesise that it could improve the reliability of predicting lag screws cut-out in these injuries.

Materials and methods: A retrospective study was conducted for hip fracture entries in the period from Jan 2018 to July 2022. A hundred and nine patients were suitable for the final analysis. The modified TAD was measured in millimetres based on the sum of the traditional TAD in the lateral view and the net value of two distances in the AP view, the first distance is from the tip of the lag screw to the opposite point on the femoral head along the axis of the lag screw while the second distance is from that point to the femoral head apex. The first distance is a positive value, whereas the second distance is positive if the lag screw is superior and negative if inferior. A receiver operating characteristic curve was used to evaluate the reliability of the different parameters assessing the lag screw position within the femoral head.

Results: Reduction quality, fracture pattern as per the AO/OTA classification, TAD, Calcar Referenced TAD, Axis Blade Angle, Parker's ration in the AP view, Cleveland Zone 1, and modified TAD were statistically associated with lag screw cut-out. Among the tested parameters, the modified TAD had 90.1% sensitivity and 90.9% specificity for lag screw cut-out at a cut-off value of 25 mm with a P-value < 0.001.

Conclusion: The modified TAD had the highest reliability in the prediction of lag screw cut-out. A value ≤ 25 mm could potentially protect against lag screw cut-out in trochanteric hip fractures.

Case: A dual mobility cup was implanted in 1983 in a 43-year woman. After 31 years of normal function, we analysed the explanted materials with modern techniques.

Conclusion: Volumetric wears of the small and large articulations of the dual-mobility construct were similar. For the first time, we demonstrated that the dual-mobility liner underwent parabolic (not linear) wear during the period of implantation.

Introduction: Hip fractures in the elderly are related to increased mortality. The identification of patients at risk is essential. Several nutritional and inflammatory parameters were investigated in an effort to find a prognostic indicator for mortality following fragility hip fractures (FHF) surgery. We aim to evaluate their utility and compare between the different factors.

Methods: A retrospective cohort study of patients 65 years and older, who underwent surgery following fragility hip fractures between January 2012 and June 2020, was conducted. Patients who died within 90 days were matched at a 1:1 ratio with surviving controls, based on age, gender, fracture type, and comorbidities. Nutritional and inflammatory indices, including serum albumin, protein energy malnutrition (PEM), albumin-to-globulin ratio (AGR), prognostic nutritional index (PNI), the systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), and the neutrophile-to-lymphocyte ratio (NLR), were compared between groups.

Results: 304 patients were included, 152 in each group. Patients' demographics were similar. Among all indices evaluated, only the PLR significantly differed between the study groups (236.9 ± 193.5 for the study group vs. 186.6 ± 119.3 for the control group (p = 0.007). In patients who survived the initial hospitalization, the PEM was also found to be correlated with 90 days mortality.

Discussion: The PLR was found to be correlated with mortality risk following FHF surgery. As it can be easily calculated from accessible blood tests, we recommend its' routine assessment as a screening tool for personalized management of patients at high risk for mortality.

Background: Navigation in total hip arthroplasty has been shown to improve acetabular positioning and can decrease the incidence of mal-positioned acetabular components. This study aimed to assess two surgical guidance systems by comparing intra-operative measurements of acetabular component inclination and anteversion with a post-operative CT scan.

Methods: We prospectively collected intra-operative navigation data from 102 hips receiving conventional THA or hip resurfacing arthroplasty through either a direct anterior or posterior approach. Two guidance systems were used simultaneously: an inertial navigation system (INS) and an optical navigation system (ONS). Acetabular component anteversion and inclination were measured on a post-operative CT.

Results: The average age of the patients was 64 years (range: 24-92) and the average BMI was 27 kg/m² (range 19-38). 52% had hip surgery through an anterior approach. 98% of the INS measurements and 88% of the ONS measurements were within 10° of the CT measurements. The mean (and standard deviation) of the absolute difference between the postoperative CT and the intra-operative measurements for inclination and anteversion were 3.0° (2.8) and 4.5° (3.2) respectively for the ONS, along with 2.1° (2.3) and 2.4° (2.1) respectively for the INS. There was a significantly lower mean absolute difference to CT for the INS when compared to ONS in both anteversions (p < 0.001) and inclination (p = 0.02).

Conclusions: We found that both inertial and optical navigation systems allowed for adequate acetabular positioning as measured on postoperative CT, and thus provide reliable intraoperative feedback for optimal acetabular component placement.

Level of evidence: Therapeutic Level II.

Pediatric acetabular dysplasia is common in orthopedic practice. Femoral de-rotational varus osteotomy (FDVO) is one of the surgical options suggested for treatment. In this article, we describe a simplified surgical technique of performing FDVO percutaneously using a pediatric Limb Reconstruction System external fixator, and we discuss the advantages and disadvantages of the technique.