Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: Anterior cruciate ligament (ACL) injuries can go undetected in the initial encounter, and delayed diagnosis can cause instability and an elevated risk of osteoarthritis. We hypothesized that dynamic testing under handheld ultrasound assessments of ACL insufficiency offers high diagnostic accuracy and reliability.

Methods: Ten fresh-frozen knee specimens were evaluated in three conditions: (1) intact ACL, (2) complete ACL deficiency, and (3) ACL and Anterolateral ligament (ALL) deficiency. Dynamic testing under ultrasound was performed while simulating the Lachman test (tibial anterior translation with 0 and 100N, at 20 degrees knee flexion) and pivot shift test (internal rotation torque with 0 and 10Nm). The probe was placed at the anterior medial (AM) and lateral (AL) joint line, and anterior translation of the tibia (ΔD) relative to the femur was calculated. Intra-observer and inter-observer reliability were calculated, and receiver operating characteristic (ROC) curve analysis was performed for an ideal cutoff point for detecting knee instability.

Results: From the AM view, ACL-deficient and ACL+ALL-deficient conditions significantly increased ΔD of the tibia during anterior loading compared to the intact ACL condition. The median ΔD values of the tibia in AM view with anterior drawer load were 0.64 (-0.10, 2.67) mm (intact ACL), 4.76 (2.46, 7.21) mm (ACL deficiency), and 3.88 (2.08, 7.23) mm (ACL+ALL deficiencies). The area under the ROC curve identifying ACL deficiency was 0.89 (95%CI, 0.66-0.97) in the AM view with anterior loading simulating the Lachman test. The optimal cut-off value to distinguish between the intact and ACL-deficient condition for anterior tibial translation with loading was 2.6 mm (sensitivity=80%, specificity=90%).

Conclusion: Dynamic examination of the knee using portable handheld ultrasound from an AM view has high sensitivity and specificity in diagnosing ACL injury.

Objectives: The study evaluated sensory and motor block onset time, duration, and intensity, as well as pain intensity, sedation levels, and vital signs, showing that adding dexamethasone to bupivacaine improved sensory and motor block onset time, duration, and intensity, enhanced sedation effects. Axillary plexus block is a common type of anesthesia for surgical management of upper extremity injuries.

Methods: This prospective clinical trial included 72 patients over 18 years of age who were candidates for surgical management of upper extremity injuries with the axillary plexus block approach. The patients were randomly divided into two groups: group BD [30 ml bupivacaine 0.25% with 2ml dexamethasone (n=36)] and group B [30 ml bupivacaine 0.25% with 2ml distilled water (n=36)]. The Pinprick test and Modified Bromage Scale (MBS) were used to evaluate the sensory and motor block levels. Additionally, the Visual Analogue Scale (VAS) and Ramsay Sedation Scale (RSS) were used to assess pain intensity and degree of sedation. All collected data were analyzed using IBM SPSS Statistics version 20 software.

Results: The mean age of patients in the B and BD groups was 34.41±11.11 and 36.8±13.3, respectively. According to the results, there was a significant difference in the average time of sensory and motor block onset between two groups, with group BD showing shorter onset time compared to group B (P<0.001). Moreover, the mean duration and intensity of the sensory and motor block were significantly higher in group BD (P<0.05). Additionally, the degree of sedation changes after the block started were more pronounced in group BD. There was no statistically significant difference between the two groups regarding changes in pain intensity, heart rates (HR), mean arterial blood pressure (MABP), and complications (P>0.05).

Conclusion: Adding dexamethasone to bupivacaine as a safe adjuvant drug effectively prolongs the axillary plexus block time duration and reduces post-surgery pain. Furthermore, it accelerates the onset time of sensory and motor block.

The re-revision of anterior cruciate ligament reconstruction (ACLR) can be contemplated a secure and efficacious surgical technique with good results, whether it is performed in one-stage or two-stages or is performed with autograft or allograft. With regard to the surgical technique, there is no evidence that performing ACLR in one stage is superior to performing it in two stages. With respect to graft choice, allograft is the most chosen, and the allograft most frequently utilized is the Achilles tendon. However, the best graft to use for re-revision is not yet known. For revision ACLR orthopedic surgeons have to contemplate the amendment of an outrageous posterior tibial slope, especially after having failed two or more consecutive interventions. The potential benefit of combining ACLR with an anterolateral ligament reconstruction is to achieve greater rotational stability. It will diminish both the elevated failure percentages observed specifically in young individuals and increasing osteoarthritic changes encountered following sole ACLR.

Objectives: Shoulder pain is a prevalent reason in orthopedic clinic patients, with rotator cuff disorders being the most common cause. The Constant-murley Score (CMS) questionnaire is a practical and reliable tool for the assessment of shoulder joint function.

Methods: The CMS questionnaire was translated into Persian and completed by 57 patients with persistent shoulder pain due to rotator cuff tears (case group) and 50 healthy controls. The case group refilled the questionnaire after 7-10 days without receiving any special treatment. The reliability and validity of the questionnaire were measured via the test-retest method and known-groups validity with the t-test, respectively. The intraclass correlation coefficient (ICC) was calculated to estimate the agreement as a measure of test-retest reliability.

Results: The mean ages of the case (51.8±14.2) and control groups (52.0±10.0) were similar (P=0.94). No significant difference was found between the groups regarding co-existing clinical conditions (P=0.74). The mean CMS values of the case and control groups were 46.2 (±22.3) and 87.4 (±5.7), respectively, showing a statistically significant difference (P<0.001). Moreover, the ICC was 0.95.

Conclusion: The findings indicated that the Persian version of the CMS questionnaire was reliable (ICC=0.95) and valid (P<0.001) for the assessment of shoulder pain and functional status in the Southern Iranian population with rotator cuff tear disorders.

Objectives: Hand fracture is one of the most common fractures in the skeletal system. The present study aimed to introduce a newly designed external fixator and assess the results of treatment of patients with unstable and complex fractures of the proximal and middle phalanges of the fingers with two treatment methods: "fixation with percutaneous pins (PCP) + splint" and "fixation with mini external fixator.

Methods: In this prospective cohort study, patients with acute unstable and complex fractures of the proximal and middle phalanges of the second to fifth fingers were treated with two treatment methods, including "fixation with PCP + splint" and "the use of mini external fixator." At the final follow-up visit, union, pain, function, finger range of motion (ROM), and possible complications were considered.

Results: Among 52 patients included in the study, 33 cases were treated with a mini external fixator, and 19 patients underwent fixation with PCP and splint. All patients in both groups had a union, and none of them complained of pain during the final visit. Functional outcomes were good, and there was no statistically significant difference between the two groups. The mini external fixator group had a significantly greater finger ROM (P=0.012), with a lower number of physiotherapy sessions (P=0.018). Moreover, patients returned to work more promptly (P=0.012).

Conclusion: The treatment of unstable finger fractures with a mini external fixator had three advantages: the possibility of early initiation of finger movement and improvement of finger ROM, the need for fewer physical therapy sessions, and early return to work. It can be an effective treatment option for unstable and complex finger fractures.

Objectives: Periarticular fractures of the shoulder and elbow are spatially complex injuries that may be challenging to interpret on radiographs and advanced imaging. As three-dimensional (3D) printing technology has become less expensive and more available, 3D printed fracture models have gained attention for use in surgical preparation. In this study, we evaluated the effects of 3D printed fracture models on orthopedic trainee surgical planning and injury understanding for injuries of the shoulder and elbow.

Methods: Models of periarticular fractures of the shoulder and elbow were manufactured by 3D printing at the medical school design lab. Eleven Orthopedic trainees viewed X-rays and computed tomography (CT) scans for each injury, and completed a preoperative questionnaires. They were then given access to the 3D model of each injury, in addition to the previously viewed imaging. They again completed a preoperative plan and questionnaire. Preoperative plans were graded for feasibility by a preestablished template. Results were compared for each participant with and without the 3D models.

Results: Within all trainees and fractures, trainees were more likely to have feasible preoperative plans when given a 3D model, compared to access to x-rays and CT scans alone (74% vs. 62%). In all cases where preoperative plans were changed after handling the 3D models (46/77 changed, 60%), they stayed static or improved in feasibility. Participants reported significantly improved understanding of injury anatomy (P<0.0001), increased confidence in choosing operative positioning and surgical approaches (P<0.0001), desired implants (P=0.011), and better conceptualization of how to perform fracture reduction (P=0.0038).

Conclusion: Orthopedic trainees benefit from 3D printed fracture models when performing preoperative planning of complex periarticular shoulder and elbow injuries. Given the rarity and difficulty of these injuries, use of this technology could allow for shortened learning curves and improved surgical results in the field of orthopedic fracture care.

Over the past few decades, the engineering of helical, spring, curled, and hierarchically structured nano/microfibers has attracted considerable attention due to their unique characteristics and potential applications in tissue engineering and various industrial fields. Understanding the parameters and processes involved in the fabrication of these fibers is essential. This comprehensive review outlines recent advancements in research on helical nano/microfibers, focusing on processing techniques, fiber structure, and property characterization, and their applications in fields such as tissue engineering and regenerative medicine. The study also investigates the mechanical and hydrodynamic parameters that influence the fabrication of helical fibers using contemporary techniques. It highlights that helical structures form when electric and elastic forces are balanced due to non-uniform electric fields. The coaxial electrospinning technique, along with the use of polymers with varying elastic and conductive properties, plays a crucial role in producing these structures. The distinctive properties of helical nanofibers, such as their mechanical strength, high porosity, biocompatibility, and ability to promote cellular activities, make them promising candidates for developing scaffolds in bone tissue engineering.

Objectives: High ulnar nerve injuries often cause severe functional impairment, and the best secondary repair method remains debated. This study compared the effectiveness of sural nerve grafting and anterior interosseous nerve (AIN) transfer following failed primary ulnar nerve repairs.

Methods: This retrospective cohort study included 42 patients with isolated high ulnar nerve injuries who required secondary surgical intervention. Patients were allocated to either the sural nerve grafting (n = 23) or AIN transfer (n = 19) group based on predefined clinical criteria. Motor and sensory functions were assessed using the British Medical Research Council (BMRC) grading system and a two-point discrimination (2PD) test. Grip and pinch strength were measured, and functional recovery was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.

Results: The AIN transfer group exhibited significantly superior motor recovery, with 68.5% of patients achieving BMRC grades M4-M5, compared to only 17.4% in the sural grafting group (P = 0.03). Sensory recovery was also markedly better in the AIN group, with a higher proportion of patients reaching BMRC sensory grades S3-S4 (P = 0.04). Additionally, the AIN transfer group demonstrated significantly greater grip strength (30.1 ± 6.1 kg vs. 24.3 ± 5.2 kg; P = 0.03) and pinch strength (7.2 ± 1.5 kg vs. 5.8 ± 1.3 kg; P = 0.04). Improvement in DASH scores was more substantial in the AIN group (-26.6 ± 5.7 vs. -14.6 ± 4.3; P = 0.02), indicating better functional recovery. Although the AIN group showed a trend toward improved 2PD, the difference was not statistically significant (P = 0.18).

Conclusion: AIN transfer provides superior outcomes compared to sural nerve grafting for the secondary repair of high ulnar nerve injuries, demonstrating significantly enhanced motor and sensory recovery, grip and pinch strength, and overall functional improvement.

Objectives: We hypothesized that the prevalence of carpal tunnel syndrome (CTS) in wrists with surgically treated Kienböck disease does not differ from its prevalence in the general population.

Methods: This cross sectional study investigated 53 patients (25 males and 28 females) with surgically treated Kienböck disease for clinical and electrophysiological CTS. The mean age of the patients was 37±11 years (SD), and the mean interval between treatment and this study was 64±9 months (SE). Among these cases, 29 involved the right wrist and 24 involved the left wrist. Based on the Lichtman staging system, there were 17 stage II cases, 18 stage IIIA cases, 15 stage IIIB cases, and 3 stage IV cases. Surgical interventions included radial shortening osteotomy with plate and screw fixation in 38 patients, capitate shortening osteotomy in 12 patients, vascularized bone graft in 2 patients, and wrist arthrodesis in one patient.

Results: Five patients (9.4 %) had clinically and electrophysiologically confirmed CTS; all of whom were housewives, aged between 24 and 60 years. Two of these patients were explicitly treated for CTS in the Kienböck disease affected wrist.

Conclusion: The prevalence of CTS in the wrists Kienböck disease was higher than 3-4% prevalence reported in the general population. These findings suggest a potential relationship between the two conditions rather than a coincidental occurrence within a similar population.

We presented the case of a patient who experienced a loss of responsiveness shortly after the tourniquet was deflated following knee arthroscopy. Incorrect intra-articular drug administration was suspected, and upon investigation, a used ampule of atracurium, instead of tranexamic acid, was found in the safety box. The patient was promptly treated with neostigmine and received supportive respiratory care, resulting in the reversal of symptoms, full recovery, and discharge after two days. Adhering to the six rules of drug administration is essential to prevent patient harm due to incorrect drug administration. We recommend placing warning notes in each operating room to raise awareness of potential drug mix-ups due to their similar appearances. Furthermore, during intra-articular injections, the technician needs to verify the medication with the surgeon before administering the injection.