Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: This study analyzed cases of plate breakage following internal fixation of long bone diaphyseal fractures to identify contributing factors and inform clinical practice.

Methods: A retrospective analysis of 150 plate breakage cases after diaphyseal fracture fixation was conducted using data from the "DXY" forum in November 2023. Patient demographics, fracture characteristics, plate specifications, surgical techniques, and outcomes were evaluated.

Results: Plate breakages occurred most frequently in the femur (67.3%), predominantly in wedge or multifragmentary fractures (60.7%). Locking plates were used in 64.7% of cases. Despite high rates of anatomical reduction (87.9% in complex fractures), plate failures occurred at an average of 11.3 months post-operation. High screw density (0.83-0.89 screws used/total holes) was observed across fracture types. In femoral fractures, the fracture zone length to working plate length ratio was notably high (0.91), indicating a relatively short working length.

Conclusion: Findings suggest that prioritizing anatomical reduction and rigid fixation may contribute to plate breakage, potentially due to impaired biological healing. Adherence to contemporary AO principles, emphasizing relative stability and biological fixation techniques, may be crucial in preventing these complications. The study highlights the need for a balanced approach between mechanical stability and biological considerations in fracture management.

Objectives: We aimed to measure lumbosacral vertebral angles in routine lumbar sagittal MRIs and assess their association with lumbosacral transitional vertebrae (LSTV).

Methods: We recruited 220 patients referring to our hospital for routine lumbar MRI during 2020-2021. All the participants were subject to routine sagittal lumbar MRI, whole spine localizer scan, and coronal MRI to numerate lumbar vertebrae. Five vertebral angles (A, B, C, D, and delta) and dehydration in L4-L5 and L5-S1 discs were assessed in sagittal MRI scans. Data were analyzed using SPSS 26.

Results: Out of 220 participants (mean age: 44.29 ± 14.14 years), 36 (16.36%) were diagnosed with LSTV. Among those diagnosed with LSTV, L5-S1 dehydration was less frequently observed compared to other participants (P < 0.001). Multivariate regression showed that dehydrated L4-L5 disc, non-dehydrated L5-S1 disc, increased A-angle, and decreased D-angle can independently predict LSTV. The median A-angle was significantly larger in LSTV patients than in non-LSTV participants (P = 0.038), while the medians of C-angle, D-angle, and delta-angle were significantly smaller in the LSTV group (P < 0.05). A C-angle ≤ 35.5˚ could diagnose LSTV with sensitivity and specificity of 72.2% and 57.6%, respectively. A delta angle ≤ 8.5˚ could diagnose type 2 LSTV with 92.3% sensitivity and 87.9% specificity.

Conclusion: Measuring lumbosacral vertebral angles, especially delta-angle, in routine sagittal MRI can potentially alert physicians of a likely LSTV diagnosis.

Objectives: The primary objective of this study was to evaluate the correlation between height and metacarpal length in normal adults using computed tomographic (CT) scans. A secondary aim was to determine if differences exist between various finger metacarpals. We hypothesized a direct correlation between height and metacarpal length, with consistent proportions across different finger metacarpals.

Methods: This radiographic study analyzed 40 CT scans of skeletally mature adult patients. Measurements of the metacarpal lengths were taken using the Sectra IDS7 diagnostic imaging platform. Patient demographics, including age, sex, height, weight, and BMI, were collected. Differences between genders and among metacarpals were assessed using independent sample t-tests, while Pearson correlation coefficients determined the relationship between height and metacarpal length. Statistical significance was defined at P<0.05.

Results: The study population consisted of 28 men and 12 women, with an average age of 42.6 years. The mean heights and weights were 175.3 cm and 87.4 kg, respectively. The average lengths of the metacarpals were: index, 67.7 mm; long, 66.1 mm; ring, 58 mm; small, 52.3 mm. Pearson correlation coefficients between height and metacarpal lengths averaged 0.71, indicating a statistically significant positive correlation across all metacarpals. The index metacarpal most closely correlated with patient height.

Conclusion: Our findings confirm a significant positive correlation between height and metacarpal length, supporting the hypothesis of a direct relationship. These results suggest that height can be a useful predictor for metacarpal length, potentially aiding in the selection of orthopedic implants and surgical planning for metacarpal fractures. CT scans provide precise measurements, underscoring their value in assessing bony anatomy. Future studies with larger and more diverse populations are needed to validate these findings and explore potential sex-based differences in metacarpal dimensions.

Objectives: Musculoskeletal disorders (MSDs), notably neck pain, are important occupational health issues in the field of dentistry. The aim of the present study was to systematically review the literature for significant ris k factors for neck pain in dentists.

Methods: PubMed and Scopus were searched with the following search strategy: (neck AND dentist AND pain). Data regarding the prevalence of each estimated risk factor were extracted, and studies with enough quantitative data were further analyzed using meta-analysis. The last search was done on October 2023. The calculated effect size for each study was based on the odds ratio (OR). All statistical analyses were performed using Comprehensive Meta-Analysis Software (version 2).

Results: In total, 42 cross-sectional studies met our inclusion criteria for the current systematic review, with 34 of them selected for inclusion in the meta-analysis. There was a significant relationship between dentists' neck pain and age (over 40 years old), female gender, working experience (more than 10 years), and height (exceeding 180 cm). Dentists with physical activity (OR=0.2, 95% CI: 0.04-0.9) and stretching (OR=0.6, 95% CI: 0.4-1.0) had a significantly lower risk of neck pain compared to dentists without physical activity and stretching during the week after the treatment session. The use of vibrating tools increased the risk of neck pain among dentists (OR=1.6, 95% CI: 1.1-2.4). The number of compromised and harmful postures was significantly associated with an increased risk of neck pain across studies; however, the data were not enough for running a meta-analysis on this subject.

Conclusion: Poor cervical posture, older age, prolonged working experience, and a larger number of treated patients were identified as significant risk factors associated with neck pain. Ergonomic improvements, regular physical activity, rest breaks, stretching, and indirect vision play a crucial role in mitigating the risk of neck pain.

Medial open-wedge high tibial osteotomy (MOWHTO) is increasingly recognized as the preferred treatment option for active patients with varus malalignment and medial compartment osteoarthritis of the knee. This procedure aims to delay the degenerative process while alleviating pain and dysfunction. In this technical note, we aim to describe the tips and tricks for performing a safe MOWHTO, drawing on recent literature.

Objectives: Bennett's fracture, the most common intra-articular fracture occurring at the base of the thumb, accounts for less than 1% of all hand fractures. It typically results from specific traumatic mechanisms, deforming forces, and ligamentous injuries. To compare the functional outcomes and sequelae in patients with Bennett's fracture treated surgically using: Open reduction and internal screw fixation, closed reduction and percutaneous fixation, arthroscopy-assisted reduction and screw fixation.

Methods: A systematic literature review was conducted to identify studies on Bennett's fracture dislocations in patients over 18 years of age without additional injuries. Searches were performed in PubMed, Scopus, Cochrane Central, Web of Science, Scielo, Lilacs, Oneme, and Epistemonikos databases, with language restrictions in English, French, Spanish, Portuguese, Italian, and German, and no date restrictions. Primary outcome variables included measures of functionality and secondary outcomes such as pain, stiffness, and osteoarthritis.

Results: A total of 18 studies met the selection criteria, with most being retrospective (94.45%). Pain measures were reported in 77.78% of the studies, predominantly using the VAS (min=0 and max=2). All techniques seemed to achieve similar functional outcomes. The main difference was the pain registered at follow-up, mainly by patients treated with open reduction. Osteoarthritis appeared as a common consequence of these fractures, regardless of the treatment type -excluding arthroscopy-assisted reduction as there was not enough data.

Conclusion: The three techniques had similar functional outcomes. Closed reduction and percutaneous fixation appear to result in less pain; however, both closed reduction with percutaneous fixation and open reduction with internal screw fixation have similar rates of osteoarthritis at follow-up. Unfortunately, there is insufficient data to evaluate arthroscopy-assisted reduction with screw fixation, suggesting the need for rigorous follow-up in patients undergoing this surgical intervention.

Objectives: Hospitals represent one of the most complex subjects in architectural design. Over time, many hospitals undergo changes in their initial spatial layouts to accommodate evolving needs. This process often presents various challenges and problems, and the absence of an optimal design process for hospitals is a primary contributor to these issues. Artificial intelligence (AI), with its advanced capabilities, can offer highly accurate and rapid solutions. This research aims to present an integrated approach that combines architecture and AI for AI-based hospital design through neuro-symbolic strategies.

Methods: This research employs a theoretical-applied framework, and utilizes a descriptive-analytical method to investigate the role of artificial intelligence in the design process, particularly within hospitals. The data collection methods include a literature review and an examination of texts and studies related to architectural design and AI. Furthermore, by analyzing the data through content analysis, integrated neuro-symbolic strategies were introduced as a comprehensive approach to AI. The final model of the hospital design process, based on this approach, was subsequently presented.

Results: Unified and hybrid techniques are two methods for integrating symbolic and sub-symbolic algorithms within the integrated neuro-symbolic approach. This innovative methodology leverages the strengths of both categories of algorithms while mitigating their respective weaknesses. Among the six methods presented in this paper, the hybrid strategy-method number three (neuro-symbolic) - emerges as the most effective means of achieving an integrated process that merges AI and architecture in hospital design.

Conclusion: In this process, the designer's interventions are minimized, allowing AI to produce the most optimal architectural design for a hospital by leveraging its capabilities.

Objectives: Pilon fractures are among the difficult injuries to treat in orthopedic surgery. We aim to evaluate the feasibility, advantages, and disadvantages of temporary external fixation for pilon fractures and compare its outcomes with cases managed with internal fixation and primary open reduction.

Methods: In a prospective trial, 30 patients were divided into two cohorts: a two-stage cohort with external fixation and secondary ORIF (15 patients) and a one-stage primary ORIF cohort (15 patients). We compared the two cohorts' rates of infection (deep or superficial infection), non-union, malunion, length of hospital stay, patient satisfaction with the American Orthopaedic Foot and Ankle Society (AOFAS) score, and pain level.

Results: All assessed variables showed no significant variations between the two cohorts, except for hospital stay duration, which was substantially more prolonged in the two-stage cohort.

Conclusion: This study demonstrates that both temporary external fixation with secondary ORIF and primary ORIF are viable options for managing pilon fractures. While there were no significant differences in complications between the two treatment modalities, the two-stage approach was associated with a longer hospital stay. These findings suggest that primary ORIF may be preferable when aiming to reduce the duration of hospitalization without compromising clinical outcomes.

Objectives: We performed a systematic review and meta-analysis to evaluate complication rates and hip function following the revision of infected hip arthroplasty with bone defects using bone allografts.

Methods: A comprehensive search of the PubMed, Web of Science, Embase, and Cochrane Library databases was conducted up to January 2024 to identify pre-post clinical trials. The primary outcomes assessed were the risk of reinfection, a critical concern for surgeons, and hip functional scores. The methodological quality of the included studies was also evaluated. A weighted mean difference (WMD) with a 95% confidence interval (CI) was used as the pooled estimate for clinical outcomes through random-effects meta-analysis, accounting for heterogeneity across studies.

Results: Of the 2,189 records retrieved, 12 pre-post clinical trials (with fair to good quality) were included in the meta-analysis, involving a total of 342 participants. The pooled mean difference in Harris Hip Score (HHS) was 36.86 (95% CI: 29.58 to 44.13) post-surgery. In a subgroup analysis of studies employing structural grafts, the HHS increased by 36.99 (95% CI: 29.56 to 44.42). The overall reinfection rate was 6%. Subgroup analysis revealed that in studies utilizing morselized and structural allografts, the reinfection rates were 6% and 3%, respectively. The overall mean rate of aseptic loosening was 5%. Subgroup analysis showed that in studies using morselized grafts, the rate of aseptic loosening was 4%. The incidence of dislocation was 2% in the morselized group and 5% in the structural group.

Conclusion: Revision of infected hip arthroplasty with bone defects using bone allografts may improve hip function. Interestingly, morselized allografts are often associated with higher rates of reinfection. Additionally, our findings suggest that structural allografts are associated with increased dislocation rates compared to morselized allografts. This difference may be attributed to the larger and more complex defects that necessitated the use of structural allografts rather than morselized grafts.