Clinics in Orthopedic Surgery最新文献

Backgroud: The effectiveness of deltoid ligament complex repair in bimalleolar equivalent fractures remains controversial. While direct repair of the superficial ligamentous structures is feasible, the necessity of primary repair for the deep component and the optimal approach for achieving this remain unclear. This study aimed to determine whether anterior deltoid ligament repair (ADLR; tibionavicular and tibiospring ligaments) can stabilize the ankle joint following a complete deltoid ligament rupture (cDLR).

Methods: Seventeen ankles from nine fresh-frozen cadavers were dissected from the knee downward and divided into 3 groups: normal (intact ankle ligaments), cDLR, and ADLR. The medial clear space and torque failure after ADLR were evaluated. Medial clear space was measured under non-weight-bearing conditions and during 8-lb (35 N) external rotation and gravity stress tests across the 3 groups. The medial clear space was measured using Adobe Photoshop's length measurement function.

Results: Significant differences (p < 0.001) were observed in the medial clear space measurements across the normal, cDLR, and ADLR groups during all test conditions. Torque failure occurred after ADLR at a mean of 73.3 lb (standard deviation, 28.5).

Conclusions: The stability observed in stress tests following ADLR and the results of torque failure testing suggest that ADLR alone is sufficient to restore ankle stability. Initial stability was achieved using ADLR, which can be performed relatively easily even in cases of cDLR.

Background: Segmental forearm fractures are challenging to treat due to their instability. A floating elbow, characterized by ipsilateral fractures of both the humerus and forearm, is a rare but severe injury often caused by high-energy trauma and associated with significant soft tissue damage. The objective of this study is to compare the surgical outcomes of plate osteosynthesis in segmental forearm fractures, with and without the concomitant presence of a floating elbow.

Methods: A total of 35 adult patients who underwent open reduction and internal fixation for segmental forearm fractures between 2010 and 2022 were included in this study. Patients were divided into 2 groups: group 1 (isolated forearm fractures, n = 26) and group 2 (floating elbow, n = 9). Radiological union time, forearm rotational range of motion (ROM), visual analog scale (VAS) scores, and Grace-Eversmann criteria were evaluated.

Results: All patients achieved bone union without additional procedures. The average union time was 15.0 weeks in group 1 and 17.3 weeks in group 2, with no statistically significant difference observed. However, functional outcomes were significantly worse in group 2, demonstrated by reduced supination (68.9° vs. 78.9°) and pronation (54.4° vs. 71.9°). VAS scores were higher in group 2 (3.4 vs. 1.9), and Grace-Eversmann criteria showed poorer ratings in the floating elbow group. Correlation analysis revealed a significant negative relationship between soft-tissue injury severity (assessed using Injury Severity Score and Gustilo-Anderson classification) and forearm rotational ROM (r = -0.50, p = 0.001; r = -0.58, p = 0.0002), but not with union time.

Conclusions: In our study, good bone union was achieved through open reduction and plate fixation in forearm segmental fractures, regardless of the presence of a floating elbow. However, functional outcomes were significantly worse in floating elbow cases, likely due to the combined effect of soft-tissue injuries and humeral fractures. This suggests that soft-tissue injuries play a key role in determining clinical outcomes. Therefore, meticulous management of soft tissue injuries, combined with rigid fixation, is essential for optimal outcomes.

Background: The purpose of this study is to evaluate the implications of greater tuberosity (GT) spurs by comparing findings from magnetic resonance imaging (MRI) and simple radiography. We hypothesize that observing hypertrophic changes in the GT will be more effective in predicting rotator cuff tears (RCTs) than relying on physical examinations alone and that plain radiography can serve as a reliable indicator for detecting RCTs and help with proceeding to special imaging studies.

Methods: This retrospective cohort study included 185 cases from January 2021 to August 2023, with 94 cases selected for the group showing GT spurs and 91 cases selected for the control group without GT spurs. Specifically, MRI was taken in those who had positive physical examination findings (Jobe's test and decreased external rotation power) of rotator cuff pathology without GT spur (control group) or had GT spur on a plain radiograph regardless of the physical examination findings (GT spur group).

Results: Physical examination findings suggesting RCTs (positive Jobe's test and decreased external rotation power) were more frequently observed in the control group (82 / 94 [87.2%] in GT spur group vs. 91 / 91 [100%] in control group, p = 0.001). However, when comparing MRI results, the group with GT spurs showed more severe RCTs, defined as high-grade partial to full-thickness tears (84 / 94 [89.3%] vs. 61 / 91 [67.0%], p < 0.001), and particularly, the ratio of full-thickness tears was higher. When only patients with partial tears were considered (23 / 94 [24.5%] vs. 31 / 91 [34.1%]), the GT spur group showed a higher proportion of bursal side tears (18 / 23 [78.3%] vs. 17 / 31 [54.8%], p = 0.012).

Conclusions: GT spurs observed in plain radiographs of patients with shoulder pain were found to be predictive of supraspinatus tendon tears. Even if there are negative findings in the physical examination, patients with GT spurs should be considered for special imaging to evaluate the possibility of an RCT.

Background: This cross-sectional study aimed to analyze temporal trends in handgrip strength (HGS) from 2014 to 2019 and explore potential contributors to such trends among Korean adults.

Methods: This study analyzed data from the Korea National Health and Nutrition Examination Survey, 2014-2019, among Korean adults aged ≥ 20 years (n = 20,038). Employing multiple linear regression models, we examined the influence of nutritional quality (mean nutrient adequacy ratio [MAR]), physical activity levels (metabolic equivalent of task [MET]), depressive symptoms, and sociodemographic factors on HGS. Higher MAR and MET values indicate better nutritional quality and greater physical activity, respectively. Temporal trends in HGS were also examined over the study period.

Results: A significant decline in HGS was observed over the study period, with a mean decrease of 2.28 kg (p < 0.001). This decline was paralleled by significant reductions in both physical activity (p for linear trend < 0.001) and nutritional quality (p for linear trend < 0.001). Specifically, MET values showed a notable decline, reflecting decreased engagement in both moderate and vigorous physical activities (p for linear trend < 0.001). Concurrently, a decline in MAR underscored a deterioration in dietary quality (p for linear trend < 0.001).

Conclusions: This study identified a significant decline in HGS among Korean adults between 2014 and 2019, in parallel with reductions in physical activity and nutritional quality. Efforts to reverse these trends are required for preserving functional health at the population level. Continuous monitoring of HGS trends might support the assessment of national health status.

Backgroud: Reduction of valgus-impacted femoral neck fractures remains a major challenge for orthopedic surgeons. Most reduction techniques require extensive surgical experience, and intraoperative reduction evaluation standards do not exist. The aim of this study is to report the use of a noninvasive extracapsular traction reduction technique for valgus-impacted femoral neck fractures and our innovative use of a smartphone application to evaluate reduction outcomes.

Methods: We conducted a retrospective study on patients with valgus-impacted femoral neck fractures who underwent the noninvasive extracapsular traction reduction technique at a hospital between December 2022 and January 2024. General medical records from the preoperative, intraoperative, and postoperative periods were collected, with particular emphasis on evaluating intraoperative reduction effectiveness. The primary reduction indicator was the reduction angle (RA). The principal functional assessment indicator was the Harris Hip Score (HHS).

Results: Radiographic measurements demonstrated significant differences between preoperative and postoperative RAs on the affected side (p < 0.05), while no differences in the RAs were observed between the unaffected side and postoperative affected side (p > 0.05). No statistically significant difference was detected between the intraoperative and postoperative radiographic measurements of the RAs on the affected side (p > 0.05). The follow-up period ranged from 12 to 25 months, with a mean duration of 17.7 ± 3.5 months. Preoperative HHS averaged 37.9 ± 5.2 points, increasing to 88.7 ± 4.1 points at final follow-up. Both 6-month and 1-year postoperative HHS showed significant improvement compared to preoperative values (p < 0.05). No fixation failure was observed during the follow-up, with a radiographic failure rate of 0% at final assessment.

Conclusions: For valgus-impacted femoral neck fractures, the bone hook-assisted noninvasive extracapsular traction reduction technique can achieve optimal reduction without causing intraarticular cartilage damage. The RA helps evaluate the quality of intraoperative reduction. ImageMeter can be an effective tool for evaluating fracture reduction intraoperatively.

Backgroud: Following rotator cuff repair surgery (RCR), patients can face considerable psychological distress due to factors such as ongoing intense pain, difficulties in the rehabilitation process, remnant functional limitations, and the potential risk of complications such as retear. The incidence and risk of suicide in these patients are poorly understood. Therefore, we aimed to investigate the incidence rate (IR) of suicide-related death over time and analyze the association between RCR and suicide using a representative nationwide large cohort database.

Methods: We selected RCR patients from the National Health Insurance Service (NHIS) Sample cohort (2007-2018) and a control group without rotator cuff tear. A time-dependent 1:1 propensity score matching (standardized differences < 0.1) was performed. Suicide cumulative incidence was analyzed using Kaplan-Meier curves and the stratified log-rank test. The suicide IR and 95% CI were calculated with a generalized linear model (Poisson distribution). The effect size was presented as a hazard ratio (HR) using Cox's proportional hazards model with robust variance to account for clustering within matched pairs.

Results: We included 3,992 incident RCR patients and 3,992 matched controls. The IR of suicide among RCR patients was 62.61 per 100,000 person-years for a period of more than 1 year and 56.15 per 100,000 person-years (95% CI, 32.61-96.68) during the entire follow-up period. During the entire follow-up and a period of more than 1 year after RCR, RCR patients were 3.19 times and 5.86 time more likely to die by suicide than their matched controls (95% CI, 1.04-9.76; p = 0.043 and 95% CI, 1.31-26.15; p = 0.021, respectively).

Conclusions: Patients who underwent RCR demonstrated no association with suicide within the first postoperative year, but a noticeable trend of increased suicide incidence emerged after this period. This finding suggests the potential impact of challenges, such as intense pain, rehabilitation difficulties, persistent functional limitations, and RC retear, on the psychological well-being of patients following RCR. It is imperative that these patients receive close monitoring and appropriate interventions for timely and appropriate psychiatric care.

Background: Osteoarthritis is a disease that occurs due to articular cartilage degeneration. It commonly manifests as fluctuating joint pain, stiffness, and locomotor restriction. In the past decade, researchers have discovered that mesenchymal stem cells (MSCs) could potentially treat osteoarthritis. However, improper administration of MSCs may cause serious adverse events, and the process can be costly. Recent findings suggest that MSC secretomes can reverse the damage caused by osteoarthritis. This study aims to systematically report the in vitro and in vivo potential of the secretome as a novel treatment for osteoarthritis.

Methods: We searched PubMed, the Cochrane Library, and the Directory of Open Access Journals (DOAJ) for open-access experimental articles in English containing primary data regarding in vivo and in vitro effects of secretome on osteoarthritis, excluding studies utilizing non-physiologic human stem cells. The outcomes assessed included method and timing of assessment, all reported outcomes, and any significant differences found.

Results: Secretome was significantly able to preserve mechanical tensile and compressive strength, increase chondrocyte survival and proliferation, promote autophagy of senescent and damaged cells, reduce fibrosis and joint stiffness, reduce joint inflammation, inhibit pathologic processes following inflammation, and reduce the expression of pain-associated genes in osteoarthritic joints. Experimental studies reported that joints receiving secretome therapy demonstrated histologic and functional recovery to levels comparable to healthy joints.

Conclusions: Secretome therapy represents a novel treatment modality with the potential to provide a definitive and comprehensive solution for osteoarthritis. Further research regarding the safety and efficacy of secretome therapy in human joints is needed to facilitate its clinical application as soon as possible.

The evolution of shoulder arthroplasty has seen transformative advancements to improve precision, minimize complications, and optimize functional outcomes. Patient-specific instrumentation and navigation systems are pivotal innovations that improve surgical accuracy and enable tailored approaches for complex anatomy. These tools also impact preoperative planning and decision-making, contributing to more efficient procedures and reduced intraoperative errors. Emerging technologies, including augmented reality, virtual reality, and robotic surgery, introduce novel opportunities for preoperative visualization, intraoperative guidance, and interactive training. These technologies demonstrate significant potential for improving guidewire placement accuracy, providing real-time procedural assistance, and transforming orthopedic education through immersive and efficient training platforms. While promising, these innovations require further research to validate their long-term efficacy and establish standardized protocols for broader clinical adoption. This review highlights current advancements and challenges, emphasizing the capability of these technologies to enhance patient care and advance shoulder arthroplasty.

Background: The Forgotten Joint Score (FJS) is a patient-reported outcome measure developed to assess the degree of joint awareness after arthroplasty surgeries. This study aimed to translate the FJS into Korean and assess its reliability and validity for application in patients undergoing total hip arthroplasty (THA).

Methods: Translation and transcultural adaptation of the FJS into Korean (K-FJS) was performed in accordance with international recommendations. All patients who attended our hospital's hip joint experts after unilateral THA from January 2021 to February 2021 were invited to complete K-FJS, EuroQol-5D (EQ-5D), modified Harris Hip Score (mHHS), and Hip disability and Osteoarthritis Outcome Score (HOOS). A total of 177 patients (mean age, 53.2 years) participated in evaluating the psychometric properties of the K-FJS. Feasibility was evaluated by assessing floor and ceiling effects. Internal consistency, using Cronbach's alpha, was evaluated to measure reliability. To investigate construct validity, correlation analysis was performed.

Results: The English version of the HOOS was translated and adapted to Korean without significant differences. The K-FJS exhibited a minimal ceiling effect of 8.5% and a floor effect of 2.3%. The K-FJS demonstrated excellent internal consistency (Cronbach's α = 0.964). Moderate correlations were found with EQ-5D (r = 0.388) and mHHS (r = 0.450), and a strong correlation was found with HOOS (r = 0.802), supporting the construct validity of the K-FJS.

Conclusions: The K-FJS is a reliable and valid method for assessing joint awareness in Korean THA patients. Its application in clinical practice may improve the assessment of patient outcomes following THA.

Backgroud: Conversion to total hip arthroplasty (THA) is the most common treatment for older patients following failed hip fracture fixation. However, the dislocation rate after conversion THA is higher than that after primary THA for arthritis. Recent studies have reported that a dual-mobility (DM) cup has a lower dislocation rate than fixed-bearing (FB) THA. This study aimed to assess the outcomes of conversion THA using a DM cup for failed hip fracture fixation.

Methods: Between April 2015 and June 2021, 116 patients underwent conversion THA for failed hip fracture fixation at a tertiary hospital. Among them, 83 and 33 cases using the FB and DM cups, respectively, were included in the study. The following outcomes were assessed and compared between the 2 groups: reoperation, dislocation, intraprosthetic dissociation (IPD), periprosthetic fracture, deep joint infection, and modified Harris hip score (mHHS).

Results: There were no significant differences between the FB and DM groups in terms of radiological outcomes, reoperation, IPD, periprosthetic fracture, deep joint infection, or mHHS. In particular, there was no statistically significant difference in the dislocation rate between the FB and DM groups (6.02% and 3.03%, respectively; p = 0.673).

Conclusions: The dislocation rate in the DM group was lower than that in the FB group, with a relative risk of 0.50, although this difference did not reach statistical significance. These findings suggest that DM implants may be potentially beneficial options in such cases; however, further research is required to confirm this trend.