Archives of Bone and Joint Surgery-ABJS最新文献

The standard treatment for displaced pediatric supracondylar fracture of humer us (PSCFH) is closed reduction and percutaneous pinning under image intensifier guidance. This technical note describes Kapandji intrafocal pinning technique (KIPT) for achieving optimal fracture reduction and stable fixation in Gartland Type III or IV extension type PSCFH. In KIPT, a K wire was introduced into the fracture site from the posterior aspect, fracture manipulation was done by levering with wire reducing the posterior displacement of the distal fragment and the wire was fixed to the anterior cortex of the proximal fragment. After this sagittal plane reduction and stabilization with intrafocal wire , coronal plane reduction could be carried out easily. This was followed by pinning of columns: all lateral or crossed (medial and lateral). In completely displaced extension type PSCFH, KIPT achieves ideal fracture reduction without vigorous manipulation in short surgical time and enables easy column pinning.

A 19-year-old male competitive figure skater presented to clinic with a 3-year history of right ankle swelling. Exam demonstrated a ~6cm diameter mass over the medial malleolus. MRI revealed a well-circumscribed fluid-filled mass. After failing conservative management, the patient underwent surgical excision. Anatomic pathology revealed a pseudocyst with pseudosynovial metaplasia, consistent with malleolar bursitis. Competitive figure skaters can develop significant medial malleolar bursitis due to excessive shear forces from ill-fitting skates. If non-operative management is ineffective, patients can be managed successfully with surgical excision. The patient made a full recovery and has returned to competitive skating without recurrence.

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 ultrasound examination of the hip joint is performed in the static (Graf) technique in the lateral recumbent position and in the dynamic technique in the supine position. This study compares the two static and dynamic techniques and assesses the role of the patient's position in the examination of DDH.

Methods: This cross-sectional study was conducted in 2020-2021 at Akbar Hospital, Mashhad University of Medical Sciences, Iran. 126 patients suspected of having DDH (199 hip) infants were enrolled in the study. All ultrasound examinations were performed with two static and dynamic techniques by a pediatric radiologist.

Results: In the static and dynamic ultrasound examinations, the average alpha angle was 51.57 ± 6.41 degrees, and 53.41 ± 6.94 degrees, respectively. These changes were not statistically significant (P = 0.312). The relationship and agreement between instability with dynamic technique and instability with static technique (IIC unstable, D, III, and IV) were investigated. Significant agreement (Kappa=0.77 (95% CI: 0.66-0.87) with excellent clinical significance was obtained between the two ultrasound examination method. Also, in terms of DDH types in the static method with instability types in the dynamic method, a substantial agreement was found between the two examination methods (Kappa =0.67; (95% CI: 0.59-0.75) with good clinical significance.

Conclusion: In the ultrasound examination of DDH with static and dynamic techniques, the change in the alpha angle was not statistically significant. Therefore, the hand of the radiologist is open in measuring alpha angles and there is no need to emphasize a specific position. The type of DDH in the static technique completely corresponded to the type of stability or instability in the dynamic technique.

Medial patellofemoral ligament reconstruction is a standard treatment option for patients with patellar instability. The main purpose of this study was to determine whether isolated anatomic medial patellofemoral ligament reconstruction using double folded, four-strand plantaris tendon autograft restores patellar stability in adolescent patients. Plantaris tendon autografts were harvested through proximal approach and used in four adolescent patients. A four-strand autograft was prepared in a double-limbed configuration and fixed on the patella and the femur with suture anchors and interference screws, respectively. The mean Kujala score improved significantly from 44 ± 24 SD (range, 19 to 69) points preoperatively to 94 ± 10 SD (range, 78 to 100) points postoperatively (P< 0.001). All patients reported excellent subjective outcomes and returned to their pre-injury level of sporting activities. The use of a four-strand plantaris tendon autograft in isolated anatomic medial patellofemoral ligament reconstruction can restore patellar stability in adolescents.

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: 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.

The aim of this study is to provide a radiologic description of periacetabular vascularization. A computed tomography angiography was used to analyze the vascularization patterns of the periacetabular region, describing for the first time "in vivo" the periacetabular branches of the superior and inferior gluteal artery, obturator artery, and of the medial circumflex femoral artery. The analysis revealed the possibility of visualizing clearly all the previously described vessels of the aforementioned arteries. Both acetabular and supra-acetabular arteries, the rami of the OA directed to the lamina quadrilateral, and the rami of the IGA directed to the posterior wall were identified. In conclusion, understanding the periacetabular vascularization patterns is pivotal for effective clinical decision-making in pelvic trauma, and conservative and reconstructive surgery of the hip. The radiologic description provided in this study, along with the associated literature review, offers valuable insights into the clinical implications of periacetabular vascularization.