Clinics in Orthopedic Surgery最新文献

Backgroud: Approximately 5%-7% of patients who have had Achilles tendon rupture (ATR) suffer from contralateral ATR. However, no studies have evaluated the clinical outcomes of contralateral ATR in patients with an existing ATR. Therefore, in this study, we aimed to investigate patient-reported ankle function and activity levels in patients with nonconcurrent bilateral ATR.

Methods: We retrospectively reviewed the data of 222 patients with an acute ATR who presented at our 2 institutions between 2005 and 2017. All patients had a minimum 2-year follow-up period, with no other major injuries to the ankle joint. Of these patients, 17 patients had nonconcurrent bilateral ATR. Patient-reported outcomes were assessed by telephone interview, using the Achilles tendon Total Rupture Score (ATRS), the ankle activity score, and a patient satisfaction questionnaire. Telephonic interviews were conducted by 2 authors, using a prepared script to minimize bias owing to individual interviewers.

Results: The mean age of the patients was 45.1 ± 9.8 years, and 89% were men. Patients with nonconcurrent bilateral ATR had significantly lower values in terms of ATRS, ankle activity score, and satisfaction with current activity level, compared to patients who had unilateral ATR (p < 0.001, p = 0.027, and p = 0.012, respectively).

Conclusions: Patients with nonconcurrent bilateral ATR had poorer ankle function, activity levels, and satisfaction than those with unilateral ATR in terms of patient-reported outcome measures with an intermediate-term result and a 2-year minimum follow-up period. These results emphasize the importance of the impact of contralateral injury on the prognosis of patients with ATR and the need for efforts to prevent contralateral rupture.

Background: The treatment of chronic scapholunate dissociation (SLD) can be challenging due to several factors such as poor quality of ligament, malalignment of the carpus, limited surgical options, and risk of recurrent instability. Various surgical techniques have been developed, but there is ongoing debate regarding the optimal surgical technique. This study aimed to report the clinical and radiological outcomes after dorsal scapholunate (SL) ligament complex reconstruction using suture tape-augmented autologous tendon graft.

Methods: The study included patients with Garcia-Elias stage 3-4 chronic SLD, SL advanced collapse (SLAC) stage 1, and a follow-up period exceeding 1 year. Pre- and postoperative SL gap, SL angle (SLA), radiolunate angle (RLA), and dorsal scaphoid translation (DST) were measured, and wrist active range of motion, Modified Mayo Wrist Score (MMWS), and visual analog scale (VAS) were evaluated.

Results: Nine patients were included in this study with a mean follow-up period of 17 months (range, 15-31 months). All patients were male, with a mean age of 49 years (range, 30-62 years). Eight patients were classified as Garcia-Elias stage 4, while one was classified as SLAC 1. The median (range) of preoperative, immediate postoperative, and final follow-up measurements for SL gap, SLA, RLA, and DST were 5.4 mm (4.5-5.9), 2.1 mm (1.8-2.5), and 2.5 mm (2.0-2.8) (p = 0.008); 76° (69°-88°), 50° (32°-56°), and 54° (50°-64°) (p = 0.008); 22° (11.5°-33°), 2.8° (0.5°-3.8°), and 3.8° (2.2°-5.6°) (p = 0.008); and 2.8 mm (2.0-3.4), 0.8 mm (0.1-1.2), and 1.0 mm (0.1-2.0) (p = 0.008), respectively. Immediately after surgery, all radiological measurements showed significant improvement, which persisted up to 15 months postoperatively. The preoperative and final follow-up measurements of active flexion, extension, radial deviation, and ulnar deviation of the wrist showed significant improvement. The median preoperative and final follow-up values of MMWS were 51.1 (range, 40-60) and 88.3 (range, 85-95) (p = 0.007), respectively, and those of VAS were 7 (range, 6-8) and 2 (range, 1-3) (p = 0.007), respectively.

Conclusions: Dorsal SL ligament complex reconstruction using suture tape-augmented autologous free tendon graft could be regarded as a feasible and straightforward technique for addressing irreparable chronic SLD.

Background: Degeneration of nucleus pulposus (NP) cells involves multiple factors. The relationship between the canonical Wnt/β-catenin signaling pathway and matrix metalloproteinases (MMPs) is important in cellular senescence. Protein kinase C (PKC), an intermediate of the non-canonical Wnt pathway stimulated by phorbol myristate acetate (PMA), possibly prevents NP cell senescence, although not yet demonstrated in human-based studies. This study aimed to investigate the effect of PMA stimulation on the non-canonical and canonical Wnt pathways and MMP expression in human NP cells to ascertain its inhibitory effects on the senescence of NP cells.

Methods: Human disc tissues of Pfirrmann grades 1 and 2 were collected from patients during spinal surgery and subsequently cultured. Protein and ribonucleic acid (RNA) were isolated from NP cells treated with PMA (400 nM) for 24 hours. Expression of MMP1, MMP13, tissue inhibitor of matrix metalloproteinase 1 (TIMP1), a disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS5), transient receptor potential vanilloid 4 (TRPV4), interleukin-6 (IL-6), and β-catenin were detected using western blot analysis. Messenger RNA (mRNA) expression of type II collagen and glycosaminoglycan (GAG) were analyzed using reverse transcription polymerase chain reaction. IL-6 and prostaglandin E2 (PGE₂) levels were measured using enzyme-linked immunosorbent assay.

Results: Expression of PKC-δ (intermediate of the non-canonical Wnt pathway) and β-catenin (intermediate of the canonical Wnt pathway) was increased by PMA treatment. The mRNA levels of type II collagen and GAG increased; however, their protein levels were not altered. PMA treatment increased the expression of MMP1, TIMP1, ADAMTS5, IL-6, PGE₂, and TRPV4; however, the expression of MMP13 and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) was unaltered.

Conclusions: PMA activated PKC-δ, affecting the non-canonical Wnt pathway; however, its effect on β-catenin in the canonical Wnt pathway was limited. β-catenin activation through the TRPV4 channel led to increased expression of MMP1 and ADAMTS5 and that of IL-6 and PGE₂ owing to NF-κB expression. Consequently, the degeneration of NP cells was not prevented.

Background: Fracture healing or nonunion refers to a process in which many factors interact. In this study, we aimed to evaluate the radiological, histological, and biomechanical effects of phenyramidol and diclofenac, which are frequently used to treat post-fracture ture pain worldwide, on fracture healing and nonunion in a rat femur fracture model.

Methods: In this study, 72 male Wistar-Albino rats aged 2-3 months and weighing 250 ± 30 g were divided into 4 main groups. The rats were divided into 12 subgroups according to the early, middle, and late periods. A fracture model was created in rat femurs, and surgical fixation was performed. Postoperative analgesic treatment protocols included phenyramidol, diclofenac, phenyramidol + diclofenac, and the control group. The rats were sacrificed on the fifteenth, thirtieth, and forty-fifth days and were evaluated radiologically, histopathologically, and biomechanically.

Results: Scoring was conducted independently by 2 orthopedists not involved in the study. When the results were analyzed statistically, no statistically significant difference was observed between the fifteenth and thirtieth day radiology score values of the control, diclofenac, phenyramidol, and Phenyramidol + diclofenac groups (p > 0.05), but there was a statistically significant difference (p < 0.05) between the forty-fifth day radiology score values of the control, diclofenac, phenyramidol, and phenyramidol + diclofenac groups.

Conclusions: Our study shows that the use of diclofenac or phenyramidol alone negatively affects postoperative fracture healing. However, this effect was less pronounced in the combined treatment group. Histologic examination revealed that neither treatment had a significant effect on healing. There were statistical differences in biomechanical and radiologic properties between the phenyramidol and diclofenac groups; in particular, the diclofenac group had lower biomechanical properties.

Backgroud: In total hip arthroplasty (THA), the ideal stem length remains uncertain; different stem lengths are used in different cases or institutions. We aimed to compare the stress distributions of cementless tapered wedges and short stems in femurs with different femoral marrow geometries and determine the appropriate fit.

Methods: Finite element models were created and analyzed using HyperMesh and LS-DYNA R11.1, respectively. The 3-dimensional shape data of the femurs were extracted from computed tomography images using the RETOMO software. Femurs were divided into 3 groups based on the Dorr classification. The computer-aided design data of cementless tapered wedge-type and short stems were used to select the appropriate size. In the finite element analysis, the loading condition of the femur was assumed to be walking. Volumes of interest (VOIs) were placed within the femur model at the internal and external contact points of the stem based on Gruen zones. The average stresses and strain energy density (SED) of the elements included in each VOI were obtained from the preoperative and postoperative models.

Results: The von Mises stress and SED distributions of the cementless tapered wedge and short stems were similar in their respective Dorr classifications. In both stems, the von Mises stress and SED after THA were lower than before THA. The von Mises stress and SED of the cementless tapered wedge stem were higher than those of short stems. Cementless tapered wedge-type stems tended to have lower rates of change than short stems; however, Dorr C exhibited the opposite trend. In the Dorr classification comparison, the von Mises stress and SED were greater for both stems in the order of Dorr C > Dorr B > Dorr A, from Zone 2 to Zone 6.

Conclusions: In Dorr A and B, the short stem exhibited a natural stress distribution closer to the preoperative femur than the tapered wedge stem; however, in Dorr C, the short stem may have a greater effect on stress distribution, suggesting that it may cause greater effects, such as fracture in the early postoperative period, than other Dorr types.

Background: The Arbeitsgemeinschaft für Osteosynthesefragen (AO) and the Orthopaedic Trauma Association (OTA) classification system for diaphyseal fracture has been recently revised to refine and enhance the accuracy of fracture categorization. This study aimed to investigate the interobserver reliability of the new AO/OTA classification and to compare it with the older version in femoral shaft fractures.

Methods: We retrospectively analyzed 139 patients (mean age, 43.8 ± 19.5 years; 92 men and 47 women) with femoral shaft fractures who were treated from 2003 to 2017. Four well-trained observers independently classified each fracture following the previous and revised AO/OTA classification system. We calculated the Fleiss kappa for the interobserver reliability.

Results: The previous classification showed the kappa value of 0.580 (95% confidence interval [CI], 0.547-0.613), and the revised version showed 0.528 (95% CI, 0.504-0.552). Both the old and the revised versions showed moderate reliability.

Conclusions: Our study highlights the moderate interobserver reliability of both the previous and new AO/OTA classification systems for diaphyseal femur fractures. These findings emphasize the importance of standardized systems in clinical decision-making and underscore the need for ongoing education and collaboration to enhance fracture classification.

Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with knee osteoarthritis. The patellar component plays a crucial role in knee biomechanics and can influence postoperative outcomes. This study aimed to investigate the relationship between radiological indices of patellar height and patient outcomes following TKA.

Methods: A retrospective analysis was conducted on patients who underwent TKA for osteoarthritis. Radiographic measurements of patellar height, including the Insall-Salvati (IS) ratio, modified Blackburne-Peel (mBP) ratio, Caton-Deschamps ratio, and plateau-patellar angle (PPA), were obtained. Clinical outcomes were assessed using the Knee Society Score (KSS) and the Forgotten Joint Score-12 (FJS-12). Patient satisfaction and postoperative complications were also evaluated. Statistical analyses, including correlation analysis and multiple regression models, were performed to determine the association between radiological indices and patient outcomes.

Results: The study included 330 cases that met the inclusion criteria. The analysis revealed significant correlations between different radiological indices of patellar height and patient outcomes. Lower postoperative PPA was correlated with worse KSS and range of motion scores. A decreased mBP ratio was associated with poorer FJS-12 responses and higher risks of dissatisfaction and patellar clunk or crepitus. Increased IS ratio was linked to a lower likelihood of incidental giving way of the knee. Advanced age was associated with reduced dissatisfaction and incidental giving way probabilities.

Conclusions: The findings of this study demonstrate that radiological indices of patellar height can predict patient outcomes following TKA. Assessing patellar height using various radiographic measurements provides valuable information for surgical planning and prognostic evaluation. Understanding the impact of patellar height on clinical outcomes can aid in optimizing TKA procedures and improving patient satisfaction. These findings emphasize the importance of considering patellar height as a predictive factor in TKA and highlight its potential role in guiding postoperative management and rehabilitation strategies.

Background: The proximal humerus, a common site for osteoporotic fractures, is frequently overlooked in osteoporosis evaluations. This study aimed to evaluate the relationship between the conventional bone mineral density (BMD) measurement (at the lumbar spine and femur) and the BMD measurement at both proximal humeri (the asymptomatic side and the side with a rotator cuff tear [RCT]) in patients with unilateral RCT. Furthermore, we investigated clinical features indicative of osteoporosis in RCT patients and assessed the utility of proximal humerus BMD measurements.

Methods: From April 2020 to September 2020, 87 patients who underwent arthroscopic repairs for unilateral RCTs were examined for age, onset, body mass index, menopause duration, passive range of motion, global fatty degeneration index, and RCT and retraction size. The regions of interest (ROIs) for the conventional BMD included the lumbar spine, femur neck, femur trochanter, and total femur. For the proximal humerus BMD, the ROIs included the head, lesser tuberosity, greater tuberosity (medial, middle, and lateral rows), and total humerus.

Results: The conventional BMD of the lumbar spine, femur neck, femur trochanter, and femur total were 1.090, 0.856, 0.781, and 0.945 g/cm², respectively. The head, lesser tuberosity, greater tuberosity (medial, middle, and lateral rows), and total BMD of the asymptomatic-side proximal humerus were 0.547, 0.544, 0.697, 0.642, 0.554, and 0.610 g/cm², respectively. The average of proximal humerus BMD was significantly lower than that of conventional BMD (p < 0.001). All ROIs BMD of the RCT-side proximal humerus were 0.497, 0.507, 0.619, 0.598, 0.517, and 0.560 g/cm². There was no correlation between the conventional BMD and each proximal humerus BMD. All ROI BMD of the RCT-side proximal humerus was not significant in the multiple regression analysis with age, onset, body mass index, passive range of motion, global fatty degeneration index, and RCT and retraction size (p > 0.05).

Conclusions: The proximal humerus BMD showed a completely different trend from that of conventional BMD and had no significant association with clinical features. Therefore, the proximal humerus BMD needs to be measured separately from the conventional BMD, as it may provide important information before rotator cuff repair surgery.

Background: Carpal tunnel syndrome (CTS) and trigger finger are representative pathologic conditions of the hand. Although several studies have evaluated the epidemiology of these diseases as nationwide population-based research, they had several limitations including old data and short study period.

Methods: We conducted a retrospective cohort study of patients aged ≥ 20 years diagnosed with CTS or trigger finger between 2009 and 2019 using the Korean Health Insurance Review and Assessment Service database. The annual incidence of these diseases was standardized based on age and sex. The proportion of patients who received corticosteroid injections or surgery within 1 year of their diagnoses was calculated annually.

Results: The mean annual incidence of CTS was 360.26 per 100,000 person-years and that of trigger finger was 63.09 per 100,000 person-years. The annual incidence of CTS (incidence rate ratio [IRR], 0.979; 95% confidence interval [CI], 0.972-0.985; p < 0.001) and trigger finger (IRR, 0.976; 95% CI, 0.967-0.985; p < 0.001) significantly decreased. The proportion of patients who received corticosteroid injections for CTS significantly increased (relative risk [RR], 1.025; 95% CI, 1.020-1.031; p < 0.001), while the number of surgeries significantly decreased (RR, 0.949; 95% CI, 0.940-0.957; p < 0.001). The proportion of patients who received corticosteroid injections for trigger finger significantly increased (RR, 1.021; 95% CI, 1.009-1.033; p < 0.001), while the number of surgeries did not change significantly (RR, 1.006; 95% CI, 0.988-1.023; p = 0.523).

Conclusions: In the past 10 years, the incidence of CTS and trigger finger decreased. The portion of patients who received corticosteroid injections increased for both diseases, but the portion of patients who had surgery decreased for CTS within 1 year after diagnosis. This study provides insight into the epidemiology of these diseases in an Asian population and may inform estimates of healthcare costs.

Background: Skin and soft-tissue defects in the lower legs present significant challenges for surgeons, especially when tendons, bones, or implants are exposed. In such cases, simple dressings or skin grafts are insufficient, necessitating flap surgery. The bipedicled flap is a simpler and more reliable method with a high success rate compared to other flaps, showing minimal flap failures. This study aimed to examine the advantages and limitations of using a bipedicled flap for soft-tissue reconstruction in the lower legs.

Methods: This retrospective study reviewed medical records from January 2013 to May 2020, involving 10 bipedicled flaps performed on the lower legs. The study included 5 male and 5 female patients, with an average age of 54.5 years. The defects were due to various causes, including trauma, tumor surgery, postoperative complications such as dehiscence and skin necrosis, and chronic osteomyelitis. The size of the defects ranged from 4 × 3 cm to 16 × 13 cm. The outcomes assessed included flap viability, postoperative complications, and patient satisfaction. Patient satisfaction was assessed on a 15-point scale, evaluating appearance, function, and sensation with up to 5 points each, and categorizing scores as poor (1-3), below average (4-6), average (7-9), good (10-12), and excellent (13-15).

Results: All flaps were successfully performed, and there were no cases showing any special complications. Patient satisfaction following the operation was excellent in 3 patients, good in 6 patients, and average in 1 patient, with an overall average score of 11.5 (good) out of 15 among the 10 patients evaluated.

Conclusions: The bipedicled flap is a simple and secure method for treating soft-tissue defects in the lower legs. Therefore, this technique can be considered as one of the viable options for treating such defects.