Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: We aimed to report radiological and clinical features of single bone intramedullary fixation of the radius in pediatric both bone forearm fractures using straight stainless steel Kirschner (K) wire.

Methods: Fifty-eight children (42 boys and 16 girls) referred to our hospital with both bone diaphyseal forearm fractures were operated on by using the single bone rigid K-wire intramedullary fixation and mini-open technique. The mean follow-up time was 8.9 months (6-12).

Results: The mean age of the patients was 7.4 years (4-12). More than 2/3 of the fractures were in the right hand. Around 63% of the fractures were in the middle third, 28% in the distal third, and 9% in the proximal third. Moreover, 12% were open type I Gustilo-Anderson fractures. The mean time from injury to surgery was two days (1-4), and the mean length of hospital stay was 2.8 days (2-5). The mean duration of surgery was 24.7 minutes (18-38), and the mean follow-up time was 8.9 months (6-12). All fractures united within 4-16 weeks (mean: 7.62). The cast and implant were removed simultaneously as the radiographic fracture union. There was no serious complication. Superficial infection of the pin track and loosening of the pin occurred in three cases (5%), all controlled by antibiotics and timely removal of the pins. Mild restriction of elbow extension (less than 20 degrees) was observed in three cases, which returned to normal at the last follow-up. Limitation of dorsiflexion of the wrist by more than 20° occurred in two patients (35° and 45°), which reverted to 25° and 25°, respectively, at the last follow-up.

Conclusion: In both bone forearm fractures in children, open reduction and internal fixation of only the radius with a stainless steel straight Kirschner wire could be a promising method with good results. This retrograde technique of intramedullary fixation is a simple and cost-effective method with minimal complications and acceptable outcomes in children aged 4-12 years.

Objectives: The hand is one of the most commonly fractured parts of the body. Many of these injuries are treated operatively. This study compares short-term outcomes between general anesthesia and other forms of anesthesia in the open treatment of hand fractures.

Methods: Procedures related to the open treatment of carpal, metacarpal, and phalangeal fractures from the years 2005-2017 were queried from the National Surgical Quality Improvement Program (NSQIP) database. Outcome measures included 30-day reoperation rate, length of stay (LOS), minor complications, and major complications. Chi-squared tests were used to identify significant demographics and comorbidities. Significant variables were included in a logistic regression model.

Results: A total of 5,907 patients were included, of which 4,547 (77%) received general anesthesia, and 1,360 (23%) received local anesthesia, regional anesthesia, sedation, or monitored anesthesia care. Patients treated with general anesthesia were younger and more likely to be male. Operative time was longer with general anesthesia (65.0 vs. 59.8minutes, P<0.01). Anesthesia technique had no statistically significant association with thirty-day rate of reoperation, minor complications, or major complications (P=0.32, 0.91, and 0.07, respectively). General anesthesia had greater odds for LOS exceeding the 75th percentile (OR 2.05, P<0.01).

Conclusion: In the open treatment of hand fractures, short-term complication rates are similar between general anesthesia and other forms of anesthesia, but extended LOS is more likely with general anesthesia. When practical, surgeons can consider local anesthesia, regional anesthesia, sedation, and monitored anesthesia as reasonably safe alternatives to general anesthesia.

Objectives: Gartland type III supracondylar humerus fractures frequently occur as traumatic injuries in children and often require surgical intervention. This study aimed to compare the efficacy of anterior and posterior surgical approaches to treating these fractures.

Methods: This retrospective study analyzed 48 patients under the age of 10 with Gartland type III fractures. These patients were treated with either the anterior (n=23) or the posterior approach (n=25). At three and six months post-surgery, elbow range of motion (ROM), complications, and functional/cosmetic outcomes were assessed using Flynn's criteria.

Results: No significant differences were found between the groups regarding age or gender. At three months, the anterior group showed significantly better extension (-8.26° vs. -13.20°, P=0.032), but this difference was not significant at six months. No significant differences were observed in flexion, pronation, or supination at any time point. Both groups showed significant ROM improvements from three to six months (P<0.001); however, these improvements were slightly below the normative values (P<0.05). The overall complication rates were low and comparable between the two approaches (anterior: 8.70%; posterior: 12.00%; P=0.700), primarily comprising reversible ulnar nerve injuries and superficial infections. Furthermore, based on Flynn's criteria, there were no significant differences in functional or cosmetic outcomes, with most patients achieving excellent or good results in both groups.

Conclusion: Both anterior and posterior approaches for pediatric Gartland type III supracondylar humerus fractures resulted in satisfactory outcomes. Therefore, the choice of surgical approach will depend on patient-related factors and surgeons' preferences.

Objectives: This study aims to provide a comprehensive comparative analysis of functional outcomes between Unicompartmental Knee Arthroplasty (UKA) and Total Knee Arthroplasty (TKA) in patients diagnosed with bilateral knee osteoarthritis. Both procedures were performed simultaneously on separate knees to evaluate their respective efficacy.

Methods: The study included 25 patients (18 women and 7 men) with a mean age of 59.6 years, all meeting the criteria for administering UKA on one knee and TKA on the other. Radiographic and clinical data were collected over a two-year period, with assessments conducted at 6 months, 1 year, and 2 years postoperatively. Data included age, gender, and body mass index, medical history, surgical procedures, and various scores and measurements related to knee function.

Results: The UKA group exhibited significant improvements in functional scores compared to the TKA group. Specifically, the Western Ontario and McMaster Universities Osteoarthritis Index score for the UKA knee was 24.5% higher than that of the TKA knee, indicating better functional outcomes. Radiographically, the tibio-femoral angle was more than two times greater in the UKA method, while the Varus angle was significantly greater in the TKA method. No post-operative complications were reported.

Conclusion: This study underscored the safety and efficacy of both UKA and TKA procedures in the treatment of bilateral knee osteoarthritis. UKA demonstrated superior functional outcomes, while TKA displayed distinct advantages in radiographic alignment. Individual patient characteristics and preferences should guide the selection of the most appropriate surgical approach.

This study presents a case of repeated prosthetic fractures in a modular hip prosthesis in a 56-year-old male patient. After the initial implantation of a modular total hip prosthesis in 2006, the patient experienced two instances of prosthetic implant fractures over seventeen years. In this study, we analyze the clinical case, explore potential underlying causes of this complication, and delve into current indications and strategies for the revision of fractured prosthesis stems. The discussion is informed by a literature review and underscores the significance of selecting appropriate revision techniques to address this challenge.

Objectives: Reverse total shoulder arthroplasty (RTSA) continues to increase in popularity as a surgical operation in the United States. As indications for this procedure expand, more attention is needed to evaluate perioperative risk factors and patient characteristics. Postoperative anemia requiring blood transfusion (BT) is a well-documented risk factor for increased in-house mortality although little has been studied on the relationship between RTSA and postoperative BT. The purpose of this study was to identify comorbidities and patient characteristics as risk factors for BT in patient's undergoing RTSA.

Methods: Using the Nationwide Inpatient Sample (NIS) database, 59,925 RTSA patients (2016-2019) were analyzed, with 1.96% requiring postoperative BT. Demographics, comorbidities, and preoperative factors were compared between BT and non-BT groups via univariate and multivariate analyses.

Results: Overall prevalence of blood transfusion in all patients was 1.96%. Male sex (OR 1.75, p < 0.001), Asian ethnicity (OR 1.96, p = 0.012), age >80 (OR 1.51, p < 0.001), age >90 (OR 2.26, p < 0.001), CKD (OR 1.94, p < 0.001), and Parkinson's disease (OR 2.08, p < 0.001) were associated with increased BT odds. Cirrhosis exhibited the highest impact (OR 5.7, p < 0.001). Conversely, Caucasian ethnicity (OR 0.76, p = 0.023), uncomplicated DM (OR 0.73, p = 0.002), tobacco-related disorders (OR 0.43, p < 0.001), BMI >30 (OR 0.8, p = 0.011), and elective procedures (OR 0.16, p < 0.001) decreased BT odds.

Conclusion: These results were useful with identifying several risk factors that predispose to a higher risk of postoperative BT in patients undergoing RTSA including male sex, people of Asian descent, age > 80, CKD, Parkinson's disease, and cirrhosis. These findings provide clinicians with information that may be helpful with preoperative planning and perioperative management of complex patient populations.

Objectives: 3D-printing is a rapidly developing technology with applications in orthopaedics including pre-operative planning, intraoperative guides, design of patient specific instruments and prosthetics, and education. Existing literature demonstrates that in the surgical treatment of a wide range of orthopaedic pathology, using 3D printing shows favourable outcomes. Despite this evidence 3D printing is not routinely used in orthopaedic practice. We aim to evaluate the advantages of 3D printing in orthopaedic surgery to demonstrate its widespread applications throughout the field.

Methods: We performed a comprehensive systematic review and meta-analysis. AMED, EMBASE, EMCARE, HMIC, PsycINFO, PubMed, BNI, CINAHL and Medline databases were searched using Healthcare Databases Advanced Search (HDAS) platform. The search was conducted to include papers published before 8th November 2020. Clinical trials, journal articles, Randomised Control Trials and Case Series were included across any area of orthopaedic surgery. The primary outcomes measured were operation time, blood loss, fluoroscopy time, bone fusion time and length of hospital stay.

Results: A total of 65 studies met the inclusion criteria and were reviewed, and 15 were suitable for the meta-analysis, producing a data set of 609 patients. The use of 3D printing in any of its recognised applications across orthopaedic surgery showed an overall reduction in operative time (SMD = -1.30; 95%CI: -1.73, -0.87), reduction in intraoperative blood loss (SMD = -1.58; 95%CI: -2.16, -1.00) and reduction in intraoperative fluoroscopy time (SMD = -1.86; 95%CI: -2.60, -1.12). There was no significant difference in length of hospital stay or in bone fusion time post-operatively.

Conclusion: The use of 3D printing in orthopaedics leads to an improvement in primary outcome measures showing reduced operative time, intraoperative blood loss and number of times fluoroscopy is used. With its wide-reaching applications and as the technology improves, 3D printing could become a valuable addition to an orthopaedic surgeon's toolbox.

Objectives: To compile the existing literature on bilateral anterior shoulder dislocation (BASD) and analyze patient demographics, mechanisms of injury, injury characteristics, management, and outcome.

Methods: This systematic review was conducted in accordance with Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines. Online databases, including Ovid Medline 1946-, Embase.com 1947-, Scopus 1960-, Cochrane Central, and Clinicaltrials.gov were systematically queried. Studies eligible for inclusion were case reports or case-series, documenting BASD. Two reviewers independently screened and applied a set of a priori exclusion criteria to each returned study. Data were extracted, compiled, and synthesized from each reported case of BASD. Contingency tables/Chi-Square Analyses, T-tests, and univariate regression analyses were conducted to assess relationships between different variables.

Results: Eighty-one studies (87 cases of BASD) were included. Patients were 41.1 (SD± 19.5) years old and most were male (n=63; 72.4%). Around a quarter of patients (28.7%) had a history of epilepsy/seizures or were being worked-up for such. Younger males were more likely to have BASD due to a seizure or electrocution (P<0.05). Close to a third of cases (n=27; 31.0%) were delayed in presentation. Those sustaining seizures or electrocutions were more likely to be delayed in presentation (P=0.013). Most events resulted in simple dislocations that were closed reduced successfully. BASD resulting from seizures or electrocutions were more likely to be fracture-dislocations (P=0.018); and in younger patients with fracture-dislocations, closed reduction was more often to fail or not be attempted (P<0.05). Median follow-up was 6 months (IQR: 3 months - 12 months). Seven patients (10.6%) had complications and 4 (2.3%) demonstrated recurrent instability.

Conclusion: In young males presenting with BASD without known trauma, suspicion should be high for a convulsant event. In patients with a known seizure disorder who present with chronic bilateral shoulder or arm pain, BASD should be considered and work-up should be expedited to avoid misdiagnosis.

Objectives: This meta-analysis was conducted to study the hemostatic efficacy of bone wax in total joint arthroplasty (TJA) defined in this manuscript as total knee arthroplasty and total hip arthroplasty.

Methods: PubMed, Embase, Google Scholar (page 1-20), and Scopus were searched updated to November 2023. Only comparative studies were included. The clinical outcomes evaluated were the transfusion rate, total blood loss, and the loss of hemoglobin on day 1, 3, and 5 post-operatively.

Results: Only 3 studies met the inclusion criteria and were included in this meta-analysis. Bone wax was associated with a reduced transfusion rate (p=0.01), reduced total blood loss (p=0.001), and a decrease in hemoglobin loss on day 1 (p<0.00001), day 3 (p<0.0001), and day 5 (p<0.00001) after the surgery.

Conclusion: Bone wax reduced the rate of transfusion, total blood loss, and hemoglobin loss after the surgery. This may induce a reduction the cost of correcting post-operative anemia as well as decrease hospital stay and improving functional outcomes in patients undergoing TJA. Better-conducted randomized controlled studies and cost-effectivity studies could strengthen these findings.

Objectives: The ideal timing for patients undergoing bilateral total knee arthroplasty (TKA) remains unknown. The purpose of this study was to compare 90-day outcomes between unilateral, simultaneous bilateral, and staged bilateral TKA.

Methods: The PearlDiver database was used to retrospectively identify 231,119 patients undergoing primary TKA during 2015-2020, of which 67,956 (29.4%) were bilateral. Bilateral TKA patients were divided into cohorts of simultaneous bilateral TKA and staged bilateral TKA at 1-14 days, 15-30 days, 31-90 days, and 91-365 days. Each bilateral TKA cohort underwent one-to-one matching with unilateral TKA patients based on age, gender, year, Elixhauser Comorbidity Index (ECI), and a history of obesity, diabetes, and tobacco use. Ninety-day outcomes were compared between matched groups via univariate and multivariate analysis. In staged bilateral TKA groups, outcomes were collected beginning after the second TKA.

Results: Compared to unilateral TKA, simultaneous bilateral TKA was associated with higher rates of venous thromboembolism (VTE; odds ratio [OR] 1.28, 95% confidence interval [CI] 1.07-1.54, p=0.007), acute kidney injury (AKI; OR 1.47, CI 1.17-1.84, p=0.001), blood transfusion (OR 6.81, CI 5.43-8.65, p<0.001), and any complication (OR 1.63, CI 1.49-1.78, p<0.001). Staged bilateral TKA at any time interval studied was associated with a similar or decreased risk of individual complications, emergency department visits, readmissions, reoperations, and any complication relative to unilateral TKA.

Conclusion: Simultaneous bilateral TKA is associated with an increased risk of adverse events compared to unilateral TKA. However, bilateral TKA staged at a short interval appears safe in appropriately selected patients.