Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: Primary idiopathic frozen shoulder (FS) causes pain and stiffness in the shoulder joint. Over time, this disease causes restriction of shoulder motion. We undertook this study to evaluate possible correlation of MRI findings with outcome of conservative management in FS.

Methods: A total of 65 cases participated in prospective cohort study. The correlation of MRI findings obtained before commencing the treatment with outcome of non-operative management (Mean of ROM, VAS, SST and OSS) was evaluated.

Results: Anterior extracapsular edema significantly correlated with FF, EXR, VAS (a) and OSS. The effusion in humeral side of axillary recess significantly correlated with ROM restriction in ABD, EXR. Capsular thickness of glenoid portion showed good significance with FF, ABD, VAS (a) and OSS. Increased thickness of CHL showed negative correlation with improvement of EXR (P=0.049) (r=-0.617). Thickening of IGHL showed negative correlation with improvement of ABD (p=0.005 r=-0.862) and FF (p=0.007 r=-0.831). Mean Height of Axillary recess (HAR) was 7.2mm (3.5-11mm). HAR showed negative correlation with VAS pain scale (P=0.036) (r=-0.682) and OSS (P=0.038) (r=-0.668).

Conclusion: Thickness of the joint capsule and effusion at the axillary fold are important factors for refractory frozen shoulder. We can recommend MRI for refractive cases and low threshold of expectation can be set for conservative management in patients with above findings.

Objectives: Proximal humerus fractures account for four-five % of all fractures. Shoulder hemiarthroplasty is indicated for complex fractures with high complication rates when treated with ORIF. This study aims to evaluate the correlation between the proper intraoperative tuberosity reduction, and the mid-to-long-term clinical outcome in a series of patients treated with hemiarthroplasty after proximal humerus fracture.

Methods: Forty-one patients with proximal humerus fractures who underwent hemiarthroplasty surgery between July 2009 and December 2019 were retrospectively reviewed. Quantitative analysis of the reduction of the tuberosities was performed on postoperative X-rays focusing on the distance between reconstructed greater tuberosity and the apex of the head of the prosthesis, (head-tuberosity distance), and contact between tuberosity and humerus diaphysis. The University of California Los Angeles Score (UCLA) was calculated for each patient.

Results: The mean time to surgery was 6.29 ± 2.8 days (range 2-18 days). Nine patients out of 41 (22%) had non anatomic tuberosity, and 32 (78%) were anatomic reduced. The UCLA score at the final follow-up was good and excellent (≥27) in 27 patients (66%), and poor (<27) in 14 (34%). A significant correlation was observed between proper tuberosity reduction and good/excellent UCLA scores (P<0.001).

Conclusion: Hemiarthroplasty is a valid and reliable technique for the treatment of proximal humerus fracture not eligible for internal fixation, with high risk of failure. The proper tuberosity reconstruction, paying special attention to the HTD and the contact between the cortical of the humeral diaphysis and the reconstructed tuberosity, is essential to reach a good clinical outcome.

Objectives: Since various medications can control the rate of fractures and subsequent complications of osteoporosis, the early detection of the disease is crucial. This systematic study aimed to compare the diagnostic accuracy of Singh index (SI) with dual-energy X-ray absorptiometry (DEXA) as a benchmark standard for diagnosing osteoporosis.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were utilized in the current study. A detailed search was carried out using PubMed and Scopus from inception to 30 May 2022. Examining quality of the studies was performed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).

Results: A total of 22 studies were included. In general, 50% of the studies considered SI a poor screening tool for detecting osteoporosis due to a negligible inter-observer agreement between SI and DEXA or a poor correlation of SI with the bone mineral density (BMD) category or DEXA T-score. A moderate inter-observer agreement was reported for SI in 5 (55.6%) studies. Among the studies assessing the sensitivity and specificity of SI compared to DEXA (n=13), six studies estimated a low sensitivity for SI.

Conclusion: While there is supporting evidence indicating the potential usefulness of SI for predicting femoral neck fractures in individuals with suspected osteoporosis, numerous studies challenge its reliability and diagnostic value as a screening tool for identifying femoral neck osteoporosis. Further primary studies are required to verify the effectiveness of the SI index in identifying populations at risk of osteoporosis.

Objectives: The present study aimed to investigate the responsiveness of the Persian version of the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Quebec Back Pain Disability Scale (QBPDS) and detect minimal clinically important changes (MCICs) of these questionnaires in people with lumbar disc herniation.

Methods: Ninety-two patients with lumbar herniated disc completed the Persianversion of the ODI, RMDQ, and QBPDS before and after the physiotherapy intervention. Additionally, they completed a global rating of change scale after the final physiotherapy session to give an account of non-improved and improved outcomes. The responsiveness of these three disability questionnaires was represented by Receiver Operating Characteristic (ROC) and correlation analyses. The MCIC was defined as the best cut-off when sensitivity and specificity were optimally balanced.

Results: Area under the ROC curves are in the acceptable range for ODI and QBPDS (0.78 and 0.70, respectively). Moreover, ODI, RMDQ, and QBPDS have significant positive fair to moderate correlation with the external anchor (P<0.001). The MCIC values for ODI, RMDQ, and QBPDS were 13, 5.5, and 14.5 points, respectively.

Conclusion: Our results revealed that the ODI and QBPDS questionnaires have adequate responsiveness to detect improvements in the functional status of lumbar herniated disc patients following a physiotherapy treatment. Therefore, the ODI and QBPDS seem to be superior to the RMDQ for use in randomized clinical trials and clinical settings in patients with herniated lumbar discs. The MCIC scores of 13 and 14.5 obtained for the ODI and QBPDS can help to identify important changes in the clinical status of an individual patient and treatment efficacy.

Objectives: It is crucial to investigate the daily functions commonly utilized by individuals with low back pain (LBP) due to their implications for recurrence and chronicity. Stand-to-sit (StTS) task is one of the more repetitive functions in human daily life. This study aims to evaluate pelvic and lower limb joint kinematics during the StTS task in individuals with Non-Specific Chronic Low Back Pain (NSCLBP) compared to a healthy control group.

Methods: Pelvic and lower limb joint kinematic data in all three planes were recorded from 20 individuals with LBP and 20 healthy individuals using a Qualisys motion capture system during the StTS task. A Functional Data Analysis statistical approach was employed to compare the kinematic data between the two groups.

Results: In the initial phase of the movement, we observed a greater anterior pelvic tilt (P=0.028) and an altered pelvic frontal plane motion pattern (P=0.029) in the LBP compared to the healthy group. The only significant differences between the lower limb joint kinematics of the two groups were a less hip external rotation position (P=0.025) and a more knee adduction pattern (P=0.002) on the right side in the LBP subjects compared to the healthy group.

Conclusion: Considering a few differences noted between the two groups across various joints and planes evaluated, it appears that the kinematic pattern of the lower limbs does not significantly differ between the NSCLBP and healthy groups during the StTS task in most comparisons. However, distinct kinematic patterns have been observed in the pelvic region, particularly in the sagittal and frontal planes, between the two groups.

Numerous surgical techniques have been developed to address recurrent anterior shoulder instability, with the Bankart repair and the Latarjet procedure emerging as dominant. With recent advancements in keyhole surgery, there's been a surge in popularity for all-arthroscopic procedures. Our systematic review aims to determine if there's justification for incorporating these techniques into a classification system for guiding treatment of traumatic anterior recurrent instability. We identified and analysed a variety of key studies, including 12 systematic reviews, three prospective studies, seven non-randomized prospective and retrospective studies, along with one biomechanical study. Our study sheds light on the wide range of procedures available to shoulder surgeons dealing with traumatic anterior recurrent instability. We introduce a novel classification system (BoTH) designed to simplify the decision-making process in this context.

Objectives: To compare the radiological outcomes after fixation of distal tibia fractures with IM nail between patients in whom poller screw was used vs those in whom it was not used.

Methods: A retrospective cohort study was conducted between 1st January 2009 to 31st June 2019 including patients treated with IM nail for distal tibial metaphyseal fractures. Patients were divided into 2 groups based on whether a poller screw was placed during surgery or not. The exposed group consisted of patients who underwent augmentation of IM nail with a poller screw, while control group included patients who underwent fixation with nail alone. All adult patients aged ≥18 years were included and patients with pathological fractures, known metabolic bone disease were excluded from the study. Follow-up x-rays were viewed through our hospital database and fracture healing was classified as either union, malunion or non-union based on radiographic parameters. A Radiographic Union Score in Tibia (RUST) score was calculated and a score of ≥9 was considered conclusive for complete union.

Results: 93 patients were included in the study with 21 patients in the exposed and 72 in the control group. According to the analysis, there were no significant differences in baseline characteristics of the study participants. The exposed group was found to be associated with increased rates of union and decreased non-union and mal-union rates compared to control group (P-value = 0.003). Mean RUST score was also noted to be significantly higher in exposed group compared to control group with a P-value of 0.025.

Conclusion: Use of poller screw with IM nail in treatment of distal tibial fractures is important in improving post-operative outcomes and decreasing mal-union and non-union.

Objectives: This meta-analysis studies and assesses the pain relief effect of different pre-operative traction systems in proximal and femoral shaft fractures as this subject is still debated and no clear guidelines are established.

Methods: PubMed, Cochrane, Embase and Google Scholar (page 1-20) were searched until January 2024. The clinical outcomes collected consisted of pain scales following traction.

Results: Two randomized clinical trials were included to compare skeletal (72 patients) to skin traction (80 patients) and eight randomized clinical trials with one prospective study were included to compare traction (457 patients) versus no traction (439 patients). Our results revealed no differences in terms of post-operative pain VAS between both the skeletal and skin traction as well as between traction and no traction.

Conclusion: No added benefit of traction was observed when pain relief is the main consideration. Furthermore, with their different potential complications, systematic pre-operative traction should not be implemented in all femoral fractures.

Objectives: The available evidence on the efficiency of well-known Schroth's exercises (SE) for correcting adolescent idiopathic scoliosis (AIS) is limited, especially in combination with the asymmetric spinal stabilization exercises (ASSE) method. Therefore, we hypothesized that, first, there is no difference in the efficiency of the combined exercises (SE+ASSE) and SE alone in improving Cobb angle, angle of trunk rotation (ATR), and quality of life (QoL) in AIS. Second, there is no difference in the efficiency of SE and no intervention on corresponding variables in treating AIS.

Methods: This randomized controlled trial (RCT) consisted of 40 patients with mild AIS (10-18-year-old boys) divided into three groups: SE (n=15), SE+ASSE (n=15), and a waitlist control group (n=10). For 12 weeks (three days a week), both experimental groups performed SE, the combined group additionally received ASSE, and the control group received no intervention. The assessment included Cobb angle (photogrammetry), ATR (Adam's test), and QoL (Scoliosis Research Society-22 questionnaire).

Results: It was found that Cobb angle, ATR, and QoL improved significantly in the combined SE+ASSE group (Cobb=16.45° to 9.01°; ATR=4.93° to 1.33°) compared to the SE group (P<.001). In addition, the SE group showed significant amelioration in the mentioned variables (Cobb=15.09° to 9.77°; ATR=4.23° to 2.17°) compared to the control group (P<.001), whereas the control group remained almost unchanged.

Conclusion: Based on the obtained results, the combination of SE and ASSE provided more benefits than SE alone, and the SE results were efficient compared to the no-intervention group regarding the correction of scoliosis and related problems. However, patients with moderate to severe scoliosis should also be investigated in longer treatment periods in future.

Objectives: Knee osteoarthritis is common among older individuals, necessitating Total Knee Arthroplasty (TKA) for end-stage cases. The aging population has increased TKA demand, leading to a rise in revision surgeries. Genu recurvatum, a rare complication, often requires surgical intervention, with late-onset cases linked to neuromuscular conditions. This case series focuses on the infrequent occurrence of late-onset genu recurvatum resulting from spinal stenosis in patients without other predisposing conditions.

Methods: A retrospective case series of 10 patients (11 knees) referred between February 2016 and August 2020 due to late recurvatum instability. Exclusion criteria encompassed neuromuscular diseases other than spinal stenosis, prosthetic joint infection, and pre-existing recurvatum deformity. Data, including demographics, medical history, imaging findings, and surgical details, were collected retrospectively. Patient performance was assessed using the Knee Society Score (KSS) at specified postoperative intervals.

Results: The study cohort, exhibiting hyperextension ranging from 11 to 30 degrees, underwent successful revision surgery using rotating hinge knee (RHK) implants after failed conservative measures. Follow-up assessments at 6, 18, and 24 months showed no recurrence of genu recurvatum.

Conclusion: Late-onset genu recurvatum poses a challenge, necessitating surgical intervention. Identifying predisposing factors is crucial, with spinal stenosis emerging as a rare cause. The use of posterior stabilized (PS) implants in primary surgery aligns with higher revision rates, possibly linked to PCL removal. Limited literature explores the spinal-genu recurvatum relationship. A stepwise screening protocol is proposed for high-risk patients, emphasizing history, physical examination, and imaging. Strategic considerations include lower constraining, a tighter extension gap, and potential use of Hinge implants.