Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: The medial collateral ligament (MCL) injury is one of the possible complications of primary total knee arthroplasty (TKA), which can lead to coronal-plane instability that requires surgical revision. Injured MCL can result in joint instability and polyethylene wear. Different strategies have been proposed for MCL reconstruction based on the location of the injury. However, there is a lack of clarity regarding the optimal method for handling an iatrogenic MCL injury throughout a TKA.

Methods: A PRISMA flow diagram was used to guide the systematic literature review. An extensive search was conducted in PubMed, Embase, Scopus, Web of Science, and Google Scholar. Newcastle Ottawa scale checklist was used to assess the methodological quality of the articles.

Results: A total of 19 qualitative studies, including non-cadaveric patients with MCL injury during TKA, were identified after analyzing the full text of the articles. All included studies were either retrospective, observational cohort or case series. A total of 486 patients were studied to gather information on the methods used to repair the MCL and their results. Most injuries arose in the tibial attachment, which surgeons mostly realized during the final stages of surgery. Used techniques can be categorized into three main groups: Primary repair, Repair with augmentation, and changing prosthesis characteristics.

Conclusion: This systematic review demonstrated that the most popular management of iatrogenic MCL injury was using suture anchors, staples, screws and washers, and more constrained prostheses. The proper method should be decided considering the site of the MCL injury.

Objectives: To investigate whether patients with impending or completed fracture of the proximal femur who were treated with bevacizumab in the six weeks prior to surgery are at higher risk of surgical complications than patients given bevacizumab outside of the six-week period.

Methods: We retrospectively reviewed cases of hip fracture treated between 1995 and 2020 at our institution. Patients were included if they were age 18 years or older, underwent hip surgery for impending or completed fracture, and received bevacizumab preoperatively but not postoperatively. Charts were reviewed for demographic, surgical, and postoperative details. A Cox model was applied to assess whether the timing of preoperative bevacizumab administration (≤6 weeks vs. >6 weeks) was associated with the risk of a postoperative complication.

Results: Two of the 23 patients who received bevacizumab ≤6 weeks before surgery experienced complications (deep vein thrombosis [n=1] and intraoperative fracture related to progression of disease [n=1]). Of the 53 patients who received bevacizumab more than six weeks preoperatively, five experienced complications (wound drainage [n=2] and deep vein thrombosis [n=3]). In the Cox model, timing of bevacizumab was not associated with postoperative complications (univariable hazard ratio, 0.92; 95% confidence interval, 0.18-4.73).

Conclusion: In this cohort of patients who underwent surgery for hip fractures, we did not observe an increased risk of postoperative complications among those who received bevacizumab within six weeks of surgery relative to those who received bevacizumab more than six weeks before surgery. The retrospective nature of the study and small sample size are limiting factors in this study.

Objectives: Aseptic loosening (AL) is one of the leading causes of total joint arthroplasty (TJA) revision. Discovering the roles of microRNAs (miRNA/miR) in ontogenesis and osteolysis has attracted more attention to diagnosing and treating bone disorders. This review aimed to summarize miRNA biogenesis and describe the involvement of miRNAs in AL of implants.

Methods: A detailed search was carried out on scientific search engines, including Google Scholar, Web of Science, and PubMed, to find appropriate papers related to subjects. The search process was performed using the following keywords: "Implant", "miRNAs", "Wear particles", "Osteoclasts", "Total joint replacement", and "Osteolytic diseases".

Results: miRNAs play an essential role in the regulation of gene expression. AL is associated with several pathologic properties, including wear particle-induced persistent inflammatory response, unbalanced osteoclastogenesis, abnormal osteoblast differentiation, and maturation. Recent researches have revealed that these pathological events are closely associated with miRNA deregulation, confirming the relationship between miRNA and AL of prostheses.

Conclusion: With the results of the new approaches to target miRNA, the essential role of miRNA is further defined. Understanding the mechanisms of miRNAs and related signaling pathways in the pathophysiology of AL will help scientists illuminate novel therapeutic strategies and specific targeted drugs.

Objectives: Moire Topography (MT) is a non-invasive technique that uses patterned light projection and has been used to qualitatively characterize scapular winging. The purpose of the present study was to quantitatively characterize scapular winging using a novel method of MT.

Methods: A total of 20 shoulders in ten healthy subjects were analyzed. The mean age for subjects was 27.9 ± 1.0 years and mean BMI was 22.8 ± 2.8. Two scenarios were used to simulate scapular winging: Group 1) the hand-behind-back (HBB) position and Group 2) weighted scaption after a muscle fatigue protocol. A calibration object was used to validate the MT method. This was followed by a use of a control object with known dimensions (OKD) to evaluate subjects. The measured height (z) of the OKD with MT, as determined by the known dimensions of the OKD, was then compared to the scapula winging in Groups 1 and 2. Scapular winging was characterized by measuring the height or prominence (z) of the scapula.

Results: There were significant differences between the baseline scapular measurements and scapular winging measurements in both Group 1, 4.0 cm ± 1.3 (P=0.0004), and Group 2, 3.7 ± 1.6 (P=0.0178). Scapular winging was most prominent with the hand in the highest position on the back in Group 1 and at lower degrees of scaption (<60 degrees) in Group 2.

Conclusion: Quantitative characterization of scapular winging was achieved using a novel method using MT. Scapular winging was found at lower degrees of shoulder elevation. Future applications of this technique should focus on characterizing scapular winging in multiple planes in real-time and in patients with known shoulder pathology.

Objectives: To compare the effect of using custom-made orthosis on improving extension lag and reducing disability in acute and chronic mallet fingers.

Methods: We recruited 51 patients with acute or chronic Doyle type-1 mallet fingers, who were provided with a custom-made thermoplastic anti-mallet finger orthosis to wear full-time for 6 weeks and an additional 2 weeks at nighttime. The primary outcome, extension lag, was assessed at enrollment as well as six- and twelve-week follow-ups. Secondary outcomes included disability and satisfaction, which were evaluated using the Disability of the Arm, Shoulder, and Hand questionnaire at enrollment and 12 weeks, and a satisfaction scale at 12 weeks follow-up. Data analysis was conducted using univariate analysis of variance (ANOVA), one-way repeated measure mixed model analysis of covariance (ANCOVA), and independent sample t-test.

Results: A total of 43 participants, 25 acute and 18 chronic mallet fingers, completed the 12-week evaluation. The study found no significant difference between the two groups in terms of improvement in extension lag at either follow-up time point (P=0.21). Disability improved in both the acute and chronic groups at follow-up (P<0.05). Additionally, both groups expressed satisfaction with the treatment outcome, and no statistically significant difference was observed (t=0.173, P=0.51). We could not identify any clinically significant difference between the two groups in regard to extension lag, disability, or satisfaction at follow-up. Notably, 96% of the patients in the acute group and 88% of the patients in the chronic group demonstrated good to excellent outcomes.

Conclusion: Orthotic intervention with custom-made thermoplastic material in acute and chronic mallet fingers improved extension lag and disability, and both groups were satisfied with the treatment outcomes. The findings of our study indicated that patients with chronic mallet fingers benefited from orthotic interventions in the same way that patients with acute mallet fingers did.

Objectives: In the treatment of closed intertrochanteric fractures, the two most common treatment options are intramedullary medullary nail (IMN) and dynamic hip screw (DHS), yet the best treatment method remains controversial. The purpose of this study is to determine the difference in mortality and morbidity between IMN and DHS. Secondarily, this study determines which pre-operative risk factors affect rates of morbidity and mortality.

Methods: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2006-2016 database was used to search for patients with a closed intertrochanteric hip fracture. Bivariate analysis was performed using Pearson's Chi Square test to determine pre-operative risk factors associated with complications in fixation with IMN and DHS. Significant variables in this analysis, as well as demographic data, were analyzed via binary logistic regression. The results were recorded as odds ratio (OR) and significant differences were based on a P<0.05.

Results: After adjusting for demographics and clinical covariates, patients who underwent fixation with IMN had higher 30-day mortality, reintubation, UTI, bleeding, prolonged length of stay, and non-home discharged destination rates compared to DHS. Mortality risk was increased by ascites, disseminated cancer, impaired functional status, history of congestive heart failure, and hypoalbuminemia. Bleeding risk was increased by previous percutaneous coronary (PCI) and transfusions and was decreased by impaired functional status. Myocardial infarction risk was increased by female gender.

Conclusion: Our study found that IMN fixation increased risk of mortality, UTI, reintubation, bleeding, prolonged length of stay, and a non-home discharge destination compared to DHS. This study also identified patient risk factors associated with several postoperative complications. These data may better inform orthopaedic surgeons treating closed intertrochanteric fractures.

Objectives: Acute compartment syndrome of the thigh (CST) is an ongoing challenge for orthopaedic surgeons as the diagnosis is often difficult to establish. Currently, there is a shortage of studies investigating risk factors for the development of thigh compartment syndrome following subtrochanteric and diaphyseal femoral fractures. This study aimed to identify risk factors associated with the development of CST following femoral fractures.

Methods: Retrospective review performed in a level one trauma center from January 2011 to December 2020 for all patients with non-pathological acute subtrochanteric or diaphyseal femoral fractures. Variables collected included demographics, injury severity score (ISS) scores, mechanism of injury, classification of femoral fracture, open versus closed injuries, development of compartment syndrome, time to compartment syndrome diagnosis, number of subsequent surgeries, and primary wound closure versus split-thickness skin graft. The statistical analysis of this study included descriptive analysis, simple logistic regression, paired T-test, and Wilcoxon Signed Rank.

Results: Thirty-one (7.7%) patients developed thigh compartment syndrome following 403 subtrochanteric or diaphyseal femoral fractures. The mean (SD) age for those who developed CST was 27.35 (8.42). For every unit increase in age, the probability of developing CST decreased. Furthermore, male gender had 18.52 times greater probability of developing CST (P <0.001). AO/OTA 32-C3 and subtrochanteric femoral fracture patterns demonstrated 15.42 (P = 0.011) and 3.15 (P <0.001) greater probability of developing CST, respectively. Patients who presented to the hospital following a motor vehicle accident (MVA) or gunshot wound (GSW) had 5.90 (P= 0.006) and 14.87 (P < 0.001) greater probability of developing CST, respectively.

Conclusion: Patients who were male, younger in age, and had a 32-C3 and subtrochanteric femoral fractures were at increased probability of developing CST. High energy trauma also increased the risk of developing CST. A high index of suspicion should be expressed in patients with these risk factors.

Objectives: The rising popularity of reverse total shoulder arthroplasties (RTSA) demands attention to its growing costs on the healthcare system, especially with the implementation of bundled payments. Charges associated with patients' inpatient stays can be mitigated with a better understanding of the drivers of cost following RTSA. In this study, we evaluate potential pre-operative and post-operative factors associated with higher inpatient costs following RTSA.

Methods: We identified 59,925 patients who underwent RTSA using the National Inpatient Sample between 2016 and 2019. Total inpatient hospital charges were collected, and patients were divided into "normal cost" or "high cost" groups. The high cost group was defined as patients with total costs greater than the 75th percentile. Univariate and multivariate analyses were performed on pre-operative demographic and comorbidity variables as well as post-operative surgical and medical complications to predict factors associated with higher costs. T-tests and Chi-squared tests were performed, and odds ratios were calculated.

Results: The mean total charges were $141.213.93 in the high cost group and $59,181.94 in the normal cost group. Following multivariate analysis, non-white patients were associated with higher costs by 1.31-fold (P<0.001), but sex and age were not. Cirrhosis and non-elective admission had higher odds of higher costs by 1.56-fold (P<0.001) and 3.13-fold (P<0.001), respectively. Among surgical complications, there were higher odds of high costs for periprosthetic infection by 2.43-fold (P<0.001), periprosthetic mechanical complication by 1.28-fold (P<0.001), and periprosthetic fracture by 1.56-fold (P<0.001). Medical complications generally had higher odds of high costs than surgical complications, with deep vein thrombosis having nearly five times (P<0.001) and myocardial infarction almost four times (P<0.001) higher odds of high inpatient costs.

Conclusion: Post-operative medical complications were the most predictive factors of higher cost following RTSA. Pre-operative optimization to prevent infection and medical complications is imperative to mitigate the economic burden of RTSA's.

Here we present a novel adaptation of the previously described fibula pro-tibial fixation in a case requiring salvage fixation of a bimalleolar ankle fracture in an osteoporotic patient. Unstable osteoporotic ankle fractures are a challenging injury to manage and typically occur in a frail and comorbid subgroup of patients. Various techniques have been described in the evolution of managing these injuries, e.g. hindfoot nailing and anatomical locking plates, however in this uniquely challenging case a novel strategy was required to mitigate bone loss in the distal fibular fracture fragment. There is some evidence to suggest fibular protibial fixation offers a lower complication profile to its alternatives. The novel use of distal fibula pro-tibial screws offers a new alternative to hindfoot nailing of bimalleolar ankle fracture in osteoporotic bone with compromised distal fibular fragment bone purchase. Further research is required to investigate the compatibility of this technique with early weightbearing.

Total hip arthroplasty (THA) is the mainstay therapy for patients with terminal hemophilic arthropathy of the hip. However, the largest case series published between 2017 and 2023 in the literature on THA in patients with hemophilia have found a higher 1-year infection rate (8.1% versus 3.4%) in hemophilia patients than in the general population, a higher rate of in-hospital bleeding complications (38.7% versus 16.1%), a higher length of stay (6 days versus 3 days) and a higher 30-day readmission rate (22.6% versus 4.1%). Finally, a lower 5-year survival rate has also been observed in hemophilia patients than in the general population (91.9% versus 95.3%). In the last decade there have been dramatically positive improvements in implant designs and hematological treatment, and therefore it does not seem that THA in hemophilia is so far from that in osteoarthritic patients.