Clinics in Orthopedic Surgery最新文献

Backgroud: This study aimed to investigate changes in gene expression related to matrix synthesis in individuals with full-thickness rotator cuff tears (RCTs) and normal tendon tissues. The study also aimed to examine the differences in gene expression according to 4 distinct tear sizes.

Methods: A total of 12 patients with full-thickness RCTs were included in the study, all of whom underwent arthroscopic rotator cuff repair. The RCTs were stratified by size into small, medium, large, and massive. Tendon samples were harvested from the midpoint between the lateral end of the torn tendon and the musculotendinous junction. Subsequent analysis of the tissue samples revealed the mRNA expression levels of 11 collagen types, 6 proteoglycans, and 8 glycoproteins through real-time polymerase chain reaction techniques. For control purposes, supraspinatus tendon tissue was sourced from 3 patients who had proximal humerus fractures but did not present with RCTs.

Results: Among the 11 collagens and 14 non-collagenous protein (NCP) genes examined in this study, COL3A1 and COL10A1 showed a significant increase, whereas COL4A1 and COL14A1 showed a tendency to decrease compared to those in the normal group. ACAN significantly increased by 8.92-fold (p < 0.001) compared to that in the normal group, whereas DCN and LUM showed a tendency to decrease. FN1 and TNC increased significantly by 3.47-fold (p = 0.003) and 5.38-fold (p = 0.005), respectively, and the genes ELN, LAMA2, and THBS1 were all significantly reduced compared to those in the normal group. In the NCPs, almost all the genes with increased expression levels had the highest level in small size RCTs, and gene expression decreased as the size increased. The 3 proteoglycans (ACAN, BGN, and FMOD) showed the highest levels of expression in small size RCTs compared to those in the normal group, and 5 glycoproteins (COMP, FBN1, FN1, HAPLN1, and TNC) also showed the highest expression in small size RCTs.

Conclusions: We confirmed that most of the detected extracellular matrix gene expression changes were related to the size of the full-thickness RCTs. In NCPs, gene expression was increased in small-size tears, and gene expression levels were significantly reduced when the size increased.

Backgroud: This retrospective midterm study aimed to analyze seating properties, fracture types, noisy hips, and survivorship of a delta ceramic liner with a titanium taper locking band.

Methods: A total of 451 patients (538 hips) underwent cementless total hip arthroplasty using the same design delta ceramic liner. Patients' clinical functions were evaluated using Harris Hip score, and the radiological migration or loosening of cementless cups was recorded. Component survival was evaluated by Kaplan-Meier survivorship analysis, with failure defined as revision of any component or ceramic bearing for any reason. The worst-case survival scenario for noisy hip revision recommendations was estimated.

Results: A total of 475 patients (514 hips) were evaluated with an average follow-up of 9.5 years (range, 5-13.9 years). One hip (0.19%) had intraoperative asymmetric seating. No hips had loosening, osteolysis, wear, or delta ceramic liner or head fracture. Three patients (0.58%) reported reproducible squeaking. Two cups were revised due to recurrent dislocation, 2 femoral stems were revised for periprosthetic fractures, and 1 hip was treated for deep periprosthetic joint infection. Kaplan-Meier survivorship analysis showed a 10-year cup survival rate of 97.8% (95% CI, 95.2%-99.9%), with any revision as the endpoint. The worst-case scenario showed a 10-year survival rate of 96.4% (95% CI, 94.2%-99.2%).

Conclusions: The Delta ceramic liner with a titanium locking band on the mutlibearing cementless cup offered secure intraoperative seating properties with fewer ceramic-related complications at the midterm follow-up.

Background: Three-dimensional (3D) printing allows anatomical models, guides, and implants to be easily customized to individual patients. Three-dimensional-printed devices can be used for a number of purposes in the medical field, yet there is a lack of data on the implementation of 3D-printed patient-specific implants and surgical guides in orthopedics. The objective of this review of the literature was to summarize the implementation of 3D printing in orthopedic surgery and identify areas that require more investigation.

Methods: PubMed and Scopus were used to perform a literature search. Articles that described 3D-printed patient-specific orthopedic implants or intraoperative guides were reviewed. Relevant articles were compiled and summarized to determine the role of personalized 3D-printed implants in orthopedic surgery.

Results: A total of 58 papers were selected. Overall, 3D-printed implants and surgical guides were shown to be effective in the selected cases. Patients with bone tumors benefitted from custom 3D-printed implants, which allow aggressive resection while preserving the function and mechanical stability of the limb. Eighty-one percent of devices were made using titanium, and 48% of articles reported the use of 3D printing in oncology. Some reported adverse events including wound dehiscence, periprosthetic infection, dislocation, and sequelae of malignancy. Regulations surrounding the use of 3D-printed surgical devices are ambiguous.

Conclusions: Three-dimensional-printed orthopedic implants and guides present an alternative to commercial devices, as they allow for customizability that is useful in cases of anatomic complexity. A variety of materials were surveyed across multiple subspecialties. Large controlled studies are necessary to compare patient-specific implants with the standard of care and evaluate their safety profiles over time.

Background: This retrospective study aimed to analyze avulsion and osteochondral fractures associated with patellar dislocation using 3-dimensional (3D) computed tomography (CT).

Methods: A retrospective analysis was conducted on patients admitted between 2015 and 2023 with acute or recurrent patellar dislocations. A musculoskeletal radiologist and 2 orthopedic surgeons evaluated CT scans of 148 patients (160 knees) to identify and categorize all avulsion and osteochondral fractures. The included fracture patterns were as follows: pattern I: medial patellofemoral ligament (MPFL) avulsion from the upper two-thirds of the patella, pattern II: medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML) avulsion from the lower one-third, pattern III: inferomedial patellar facet osteochondral fracture, pattern IV: lateral femoral condyle osteochondral fracture, and pattern V: MPFL avulsion from the femoral footprint. The dimensions of patellar articular surface osteochondral fractures were measured, and patient age, sex, and side were recorded. Descriptive statistics and chi-squared tests were performed.

Results: A total of 148 patients (93 female and 55 male patients) with a mean age of 18.7 ± 6.8 years were included. Of these, 116 patients (72.5%) had 1 or more fractures, with 71 (44.4%) having isolated lesions and 45 (28.1%) having combined lesions. Pattern II was the most prevalent, observed in 66 knees (41.2%), followed by pattern I in 52 knees (32.5%), and pattern III in 45 knees (28.1%). Patterns IV and V were seen in 4 (2.5%) and 1 (0.6%) knee, respectively. The mean articular fragment size in pattern III was 128.4 ± 95.6 mm² (range, 12-412.5 mm²), all involving the inferomedial facet of the patella. Osteochondral fragments were found in the lateral gutter (35.5%), anterior joint space (51.1%), posterior joint space (8.9%), and suprapatellar space (4.5%). No significant sex differences were observed in isolated versus combined lesions (p = 0.542) or fracture patterns (p = 0.274).

Conclusions: This study, the first to evaluate fractures after patellar dislocation using 3D CT, identified 5 distinct fracture patterns. The results show that MPTL/MPML injuries are more common than previously thought, challenging traditional views on patellar dislocation injuries and emphasizing the need for a comprehensive diagnostic approach.

Background: A 24-item early-onset scoliosis questionnaire (EOSQ-24) has been developed as a valid tool for assessing the physical and emotional function of patients with early-onset scoliosis (EOS). Previous studies that conducted transcultural adaptation of the original EOSQ-24 into other languages have demonstrated the high reliability of the questionnaire. However, a Korean version of the EOSQ-24 is not available, limiting optimal patient assessment in this nation. Therefore, this study was conducted to develop and validate a Korean version of EOSQ-24.

Methods: The original English version of the EOSQ-24 was cross-culturally adapted following standard guidelines. The final version of the Korean EOSQ-24 was prospectively applied to a group of patients who were native Korean speakers. Internal consistency was evaluated using the Cronbach α coefficient and item-total correlations. The mean, standard deviation, floor effect, and ceiling effect of each item were also assessed.

Results: A total of 102 caregivers of patients with EOS (45 males and 57 females) completed the Korean EOSQ-24. The patients' average age was 6.39 ± 2.16 years. The Cronbach α coefficient for the 24-item scale was 0.942, indicating excellent reliability. The corrected item-total correlation coefficients ranged between 0.449 and 0.788. The mean value of the EOSQ-24 questionnaire was 3.19. Floor and ceiling effects for all questionnaires were below 30%, which could be considered acceptable.

Conclusions: Our study successfully developed and validated the Korean version of the EOSQ-24, providing a reliable instrument for assessing the physical and emotional well-being of patients with EOS and their caregivers in the Korean context. The widespread adoption of the Korean EOSQ-24 in clinical practice and research settings can enhance the quality of care and improve outcomes for individuals affected by EOS in Korea.

Backgroud: This study aimed to compare the intraoperative stability and early clinical outcomes of 40-mm diameter dual mobility (DM)-total hip arthroplasty (THA) with 36-mm ceramic head (large head) THA in active elderly patients with hip fractures.

Methods: A prospective randomized controlled trial was conducted from May 2022 to December 2022. Inclusion criteria were as follows: age ≥ 60 years, displaced femoral neck fracture, Koval grade 1 or 2, planned 54-mm acetabular component, and over 1-year follow-up. Intraoperative stability tests were performed on all patients (internal rotation at 45°, 60°, and 90° of hip fracture). Functional outcomes (Harris Hip Score and University of California, Los Angeles [UCLA] Score) were evaluated at 6 weeks and 3 months postoperatively. Gait analysis using artificial intelligence (AI) techniques was conducted at 3 months postoperatively.

Results: The study included 36 DM-THA patients (mean age, 69.6 ± 2.2 years; 44% women) and 37 large head THA patients (mean age, 69.6 ± 1.2 years; 64% women). No statistically significant differences were observed in functional outcomes and hip range of motion between the 2 groups. However, there was a significant difference in the gait speed and stance-swing phase of the large head THA group and the DM-THA group: the DM-THA group demonstrated superior gait speed (2.85 ± 0.83 kph vs. 2.04 ± 1.04 kph, p = 0.003) and higher stance phase ratios (operated side: 63.57% ± 3.82% vs. 48.19% ± 5.50%, p < 0.001; opposite side: 62.77% ± 2.27% vs. 49.93% ± 6.94%, p < 0.001). In the stability test at 90° of hip flexion, the DM-THA group had a measurement of 48.40° ± 5.17°, while the large head THA group had a measurement of 30.94° ± 2.98° (p = 0.012). Despite the lack of statistical significance, the intraoperative stability test showed the dislocation angle was notably different between the groups in the hip flexion position of 60° (51.60° ± 6.09° in the DM-THA group and 40.00° ± 2.80° in the large head THA group, p = 0.072).

Conclusions: Superior results were observed in the intraoperative stability test and early recovery of gait after DM-THA compared to large head THA. We believe that DM-THA can be a useful surgical option for THA in elderly patients with hip fractures.

Backgroud: The purpose of our study was to analyze the effects of hospital volume and region on in-hospital and long-term mortality, direct medical costs (DMCs), and length of hospital stay (LOS) in elderly patients following hip fracture, utilizing nationwide claims data.

Methods: This retrospective nationwide study sourced its subjects from the Korean National Health Insurance Review and Assessment Service database spanning from January 2011 to December 2018. A generalized estimating equation model with a Poisson distribution and logarithmic link function was used to estimate adjusted odds ratios (aORs) and 95% CIs to assess the association of hospital volume with in-hospital and 1-year mortality, DMCs, and LOS.

Results: A total of 172,144 patients were included. Comparing the risk of in-hospital death between high-volume and low-volume hospitals, the risk of in-hospital death was 1.2 times higher at low-volume hospitals (aOR, 1.20; 95% CI, 1.07-1.33; p = 0.002). Additionally, the risk of death at 1 year was 1.05 times higher at low-volume hospitals (aOR, 1.05; 95% CI, 1.01-1.09; p = 0.008) compared to high-volume hospitals. DMCs were 0.84 times lower at low-volume hospitals for in-hospital period (aOR, 0.84; 95% CI, 0.84-0.85; p < 0.001) and 0.87 times lower for 1 year (aOR, 0.87; 95% CI, 0.86-0.88; p < 0.001) compared to high-volume hospitals. In-hospital LOS was 1.21 times longer at low-volume hospitals (aOR, 1.21; 95% CI, 1.20-1.22; p < 0.001) than at high-volume hospitals. In addition, the risk of in-hospital death was 1.22 times higher (aOR, 1.22; 95% CI, 1.12-1.33; p < 0.001) and the risk of 1-year death was 1.07 times higher (aOR, 1.07; 95% CI, 1.04-1.10; p < 0.001) at rural hospitals compared to urban hospitals.

Conclusions: Clinicians should focus on improving clinical outcomes for hip fracture patients in low-volume and rural hospital settings, with a specific emphasis on reducing mortality rates.

Backgroud: Enchondroma is a common benign bone tumor in the hand, often leading to delayed diagnosis due to its asymptomatic nature. The surgical treatment strategy for enchondroma, particularly in pathologic fractures, remains unclear. This study aimed to evaluate the outcomes of treatment for non- or minimally displaced pathologic fractures in enchondroma using autogenous bone grafts alone, without metal fixation.

Methods: A retrospective analysis was conducted on 34 patients who underwent surgery for enchondroma and pathologic fractures. Clinical and radiographic outcomes were assessed, including pain scores, range of motion (ROM), Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, fracture union time, and complications.

Results: All patients reported pain at the fracture site preoperatively. The preoperative pain visual analog scale (VAS) score was 4.5. Postoperatively, the pain VAS score improved significantly to 2.3. The postoperative average total ROM was 253.8°. The average DASH score was 5.1, and grip strength was 97.8% compared to the unaffected side. Bony union was achieved in all cases with an average union time of 10.9 weeks. No complications were observed except for 1 suspected recurrence.

Conclusions: Early single-stage surgical treatment with curettage and autogenous bone grafts without fixation yielded satisfactory results for non- or minimally displaced pathologic fractures in enchondroma. This non-fixative technique offers a viable option with reduced treatment duration and implant-related complications.

Backgroud: Strain elastography (SE) and shear wave elastography (SWE) are emerging techniques for evaluating the elasticity of soft tissue. This study aimed to determine interobserver and intraobserver reliability for elasticity measurements of different tissues and anatomic locations using SE and SWE.

Methods: Ten healthy adult male individuals with 20 upper extremities participated in this study. The elasticities of the wrist extensor muscle, the common extensor tendon, and supraspinatus tendon were measured. Strain ratio and shear wave velocity were measured twice by 2 different examiners (examiner 1 with over 20 years of experience in musculoskeletal sonography and examiner 2 with 1 year of experience). Interobserver and intraobserver reliability was assessed using the intraclass correlation coefficient (ICC).

Results: The 10 individuals' age ranged from 28 to 35 years. In SE, interobserver reliabilities at the 3 anatomic locations (wrist extensor muscle, common extensor tendon, and supraspinatus tendon) showed fair to moderate agreement (ICC = 0.489, p = 0.076; ICC = 0.408, p = 0.131; and ICC = 0.296, p = 0.711, respectively). The intraobserver reliabilities of examiner 1 were moderate to substantial only at the wrist extensor muscle and the common extensor tendon (ICC = 0.563, p = 0.039 and ICC = 0.702, p = 0.006, respectively). In SWE, interobserver reliabilities for the wrist extensor muscle and the supraspinatus tendon were moderate to substantial (ICC = 0.756, p = 0.002 and ICC = 0.565, p = 0.039, respectively). The intraobserver reliabilities of examiner 1 at the 3 anatomic locations were almost perfect (ICC = 0.843, p = 0.001; ICC = 0.800, p = 0.001; and ICC = 0.825, p = 0.001, respectively). The results of examiner 2 showed almost perfect agreement at the wrist extensor muscle (ICC = 0.886, p = 0.001) and moderate to substantial agreement at the tendons of the common extensor and supraspinatus (ICC = 0.592, p = 0.029 and ICC = 0.682, p = 0.008, respectively).

Conclusions: SWE is a reliable method for assessing the flexibility of soft tissue, but it is affected by expertise and the specific anatomical site.

Background: This study aimed to report the radiological outcomes and risk factors for malalignment of fractures in the distal one-fourth of the tibia treated with intramedullary nailing via the infrapatellar approach.

Methods: This study retrospectively analyzed 60 patients (37 men and 23 women; mean age, 45.4 years) who had distal one-fourth tibial fractures and were treated with intramedullary nailing using the infrapatellar approach. These patients were treated between January 2009 and December 2021, with a minimum follow-up of 1 year. Fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association system: 25 were type 42A, 30 were type 42B, and 5 were type 43A. Radiographic outcomes focused on bone union and malalignment, defined as a valgus deviation greater than 5° compared to the unaffected side. Potential risk factors for malalignment, including open fractures (9 cases, 15%), distal tibial extension (20 cases, 33%), and distal fibular fractures (24 cases, 40%), were documented.

Results: Bone union was achieved in all cases, with an average duration of 3.2 months (range, 3-5 months). No cases of postoperative wound infection or neurovascular damage were observed. The average coronal plane malalignment was 2.6° of valgus (range, 0°-9.3°), with significant malalignment (over 5°) occurring in 5 patients (8.3%). Comparison of the malalignment (n = 5) and normal (n = 55) groups showed a statistically significant difference in distal bone fragment length (average, 66.5 mm vs. 77.2 mm; p = 0.008) but no significant differences in other variables. A change-point analysis revealed that cases with a primary fracture line < 65 mm showed 4.5° of coronal malalignment, while those with > 65 mm showed 2.3°; the difference was statistically significant (p = 0.01).

Conclusions: Intramedullary nailing using the infrapatellar approach for distal one-fourth tibial fractures results in successful bone union with a low incidence of valgus malalignment. However, careful attention is necessary to prevent angular deformities, especially when the distal fragment is short.