World Journal of Orthopedics最新文献

Background: Sleeve fracture of the patella is an unusual fracture, almost unique to children. The majority of sleeve fractures involve the inferior patellar pole. However, sleeve fractures of the superior pole of the patella are extremely rare in adults.

Case summary: An 18-year-old male patient fell while running in the morning. The patient had tenderness to palpation at the superior pole of the patella, with a palpable gap over the upper part of the patella in both knees. We applied two 4.5-mm suture anchors with the Krackow stitch to repair the sleeve fracture, augmented by autogenous gracilis through performing the figure-of-eight technique. The patient regained approximately the full range of motion of the knee joint without any quadriceps weakness and a normal gait 6 weeks after surgery.

Conclusion: Sleeve fractures of the superior pole of the patella are extremely rare in adults, especially bilateral sleeve fractures. Suture anchors, augmented by autogenous gracilis, provided secure fixation and achieved excellent results in this rare injury.

Osteoarthritis (OA) is an extremely prevalent degenerative joint disease which commonly occurs in the knee. In severe cases of knee OA, total knee arthroplasty (TKA) is often indicated to relieve pain and restore limb alignment. While studies have shown how TKA improves knee symptoms, the relationship between the operated knee with the hip and ankle remains understudied. A prospective study by Buterin et al showed a significant relationship between reduced ankle symptoms and better TKA recovery. The objective of this paper is to explore ways to expand the completed study to make it more widely applicable. These include sampling patients from multiple surgical centers in different cultural backgrounds, including different etiologies of OA, extending the study time points, and evaluating the contralateral limb. Together, the study by Buterin et al combined with future work can elucidate new TKA rehabilitation techniques which focus on the entire lower extremity.

Background: Osteoarthritis (OA) is a common degenerative joint disease that considerably affects the quality of life (QoL) of individuals, especially the elderly. The Kellgren-Lawrence (KL) grading system assesses the severity of OA through radiographic evaluation, whereas the Knee Injury and Osteoarthritis Outcome Score (KOOS) measures clinical symptoms and functional status.

Aim: To analyze the relationship between KL grades and KOOS to elucidate the association between radiographic severity and clinical manifestations of knee OA.

Methods: A cross-sectional study was performed at King Fahd Hospital of the University, involving 164 adult patients diagnosed with knee OA. Patients were evaluated using the KL system, based on standing knee X-rays performed within the last six months. The KOOS questionnaire was utilised for clinical assessment, evaluating five domains: (1) Pain; (2) Symptoms; (3) Activities of daily living; (4) Sport and recreation function; and (5) Knee-related QoL. Analysis of variance was utilised to examine variations in KOOS domain scores among different patient variables. The correlations between KOOS domains were determined using Pearson's correlation.

Results: KOOS scores demonstrated a significant decline in patients with elevated KL grades, with Grade 4 exhibiting the lowest scores and grade 1 the highest (P < 0.001). The correlation between pain and activities of daily living was strong (r = 0.871, P < 0.001), as was the correlation with knee-related QoL (r = 0.754, P < 0.001). Notable age-related disparities were observed, as older patients (≥ 60 years) indicated poorer pain and functional outcomes. Gender differences were noted exclusively in symptoms, with females exhibiting lower scores than males (P = 0.022).

Conclusion: The association between radiographic severity and clinical impact is shown by the substantial correlation between KL grading and KOOS results, especially in later stages of OA. The results highlight the necessity for thorough assessments that integrate radiographic and clinical evaluations for individualized therapy choices for OA patients.

Background: Comminuted calcaneal fractures present significant treatment challenges. Open reduction and internal fixation carries risks such as infection and skin necrosis, while minimally invasive techniques may compromise reduction stability. Conservative management is generally limited to minimally displaced fractures. Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction. It offers distinct advantages including lower cost, minimal soft tissue trauma, and the avoidance of expensive reduction equipment or internal fixation materials.

Case summary: A 60-year-old female presented with left foot pain and limited mobility following a fall. Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°. A standardized, stepwise Traditional Chinese manual bone-setting was initially performed, followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy. The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3. The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months, indicating rapid functional recovery and high patient satisfaction. At 7 months postoperatively, the American Orthopaedic Foot and Ankle Society score reached 95, prompting removal of internal fixation. At the 6-year follow-up, reduction remained well maintained, with the Böhler angle preserved at 22°.

Conclusion: The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.

The mini-review explores the potential use of alginates produced biotechnologically by bacteria for the development of various implantable biomaterials intended for bone and cartilage tissue regeneration in orthopedics: the recent studies on the use of algal alginate-based biomaterials in the form of hydrogels, scaffolds, and microparticles for medical applications are considered as a potential opportunity to use bacterial alginate for these applications, taking into account the advantages of biotechnological production of a polymer with desired properties. The methods of producing different alginate-based biomaterials, the manufacturing of implantable medical devices using them, and the surgical techniques for bone and cartilage tissue regeneration using these materials for orthopedic purposes are discussed.

Early diagnosis of rapidly progressive osteoarthritis of the hip (RPOH) remains clinically challenging due to the lack of unified guidelines and standardized diagnostic criteria. Current diagnostic criteria (chondrolysis > 2 mm/year) require follow-up for at least 12 months. This review characterizes two types of early-stage RPOH progression: Chondrolysis with or without subsequent femoral head destruction within 12 months of onset. Based on their association with early disease progression in RPOH, elevated serum matrix metalloproteinase-3 levels and spinopelvic malalignment may serve as predictive factors for subsequent bone destruction when only joint space narrowing is observed. This review also proposes potential mechanisms of pathogenesis and intervention strategies for RPOH at its initial stage. Cartilage matrix fragments generated by stress concentrations on the hip joint, resulting from spinopelvic malalignment, may trigger inflammatory pathways involving proinflammatory cytokines and inflammasome activation, ultimately leading to joint destruction in the initial phase of RPOH. Suppression of these early pathological events may prevent joint destruction caused by RPOH. However, further elucidation of the cellular and molecular pathways involved in rapid joint destruction is necessary to identify specific biomarkers for early diagnosis and to facilitate the development of targeted therapies in the initial phase of RPOH.

Background: Surgical site infection (SSI) is a major concern in orthopaedic surgery procedures as they can have devastating consequences for patients and their outcomes. Many infection prevention measures are routinely taken in order to prevent infection during surgery, the main one being surgical skin preparation prior to any incision.

Aim: To investigate the efficacy of different perioperative surgical skin preparation products commonly used in orthopaedic surgery.

Methods: Seven databases were searched from inception to January 25, 2025, using a combination of keywords and medical subject headings terms, specifically for studies comparing any two surgical skin preparation products used at any point prior to skin incision for orthopaedic procedures. Titles and abstracts were screened and full texts reviewed based on inclusion criteria. Data was extracted on study design, interventions, and outcomes from studies that met inclusion criteria. Meta-analysis was not completed due to heterogeneity.

Results: Thirty-two studies met the inclusion criteria in this systematic review. In extremity fracture surgery, evidence was mixed on whether iodine or chlorhexidine-based solutions are more effective at preventing SSI. No significant difference was found between iodine and chlorhexidine-based solutions in total joint arthroplasty, spine surgery, foot and ankle surgery, or upper extremity surgery. No tested preparation method was superior in reducing positive Cutibacterium acnes culture rates in upper extremity (shoulder) surgery. Adding adjuncts to iodine and chlorhexidine methods, such as isopropyl alcohol, hydrogen peroxide, or benzoyl peroxide showed no significant changes to SSI or bacterial cultures.

Conclusion: Current literature shows no significant difference between chlorhexidine-based and iodine-based skin preparation solutions in orthopaedic extremity or spine surgery regarding SSI prevention or culture results. Likewise, adding other antiseptic agents provided no clear benefit. While skin antisepsis is important, many different factors contribute to SSI risk outside of the skin preparation solution.

Background: Supracondylar humeral fractures are among the most common paediatric injuries. Displacement and consequent need for reduction impose operative treatment. Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb. Stable K-wire fixation can be succeeded either by closed or open reduction method.

Aim: To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.

Methods: We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department. All patients underwent clinical and radiological examination recording elbow range of motion, function and deformity.

Results: The standard lateral approach was carried out in all patients while in 47 cases (35.9%) additional medial approach was used. Average follow-up time was 5.4 years (1-14 years). Fracture healing was completed at 4-6 weeks. The average operative time was 50 min (range: 37-75 minutes, SD: 11.307) and the average duration of radiation exposure based on image intensifier usage time was 20 seconds (range: 7-45 seconds, SD: 9.864). No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion, Patient-Reported Outcome Measures (Disabilities of the Arm, Shoulder, and Hand questionnaire, Mayo Elbow Performance Scores) at 2-year follow-up was satisfying.

Conclusion: Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden. Moreover, the risk of neurovascular injuries due to manipulations of closed reduction, is minimized while complications related to surgical approaches are insignificant provided there is expertise.

This narrative review evaluated the potential of nanotechnology platforms (DepoFoam bupivacaine^®, DepoDur^®, Exparel^®, Zynrelef^®, NeuroCuple^™) in the control of postoperative pain following orthopedic procedures. In individuals experiencing bunionectomy DepoFoam bupivacaine^® 120 mg and placebo via wound infiltration before wound closure was compared. The area under the curve for numeric rating scale scores was substantially less in individuals treated with DepoFoam bupivacaine^® vs individuals receiving placebo at 24 h and 36 h. In individuals undergoing total hip arthroplasty, a single dose of 15 mg, 20 mg, or 25 mg DepoDur^® [extended-release epidural morphine (EREM)] and placebo were compared. All EREM dosages diminished the mean fentanyl usage vs placebo and delayed the median time to first dose of fentanyl. All EREM cohorts had substantially improved pain control at rest for up to 48 h post-surgery compared with placebo. No supplementary analgesia was required in 25% of individuals treated with EREM and 2% of individuals treated with placebo at 48 h. In individuals undergoing total knee arthroplasty, iPACK (local anesthetic infiltration of the interspace between the popliteal artery and the posterior knee capsule) adductor canal block was compared to adductor canal block with Exparel^®. Individuals in the Exparel^® cohort experienced an improvement in numeric rating scale pain scores at all postsurgical time points. These individuals also utilized a lower dose of inpatient opioids. In individuals undergoing bunionectomy a single intraoperative dose of Zynrelef^® prolonged release (PR) was compared to bupivacaine HCl 0.5% via wound infiltration before wound closure. Zynrelef^® PR diminished pain intensity by 18% compared with bupivacaine HCl. Opioid consumption was reduced by 37% in the Zynrelef^® PR cohort vs 25% in the bupivacaine HCl cohort. In individuals experiencing total knee arthroplasty and total hip arthroplasty, the use of a nanotechnology-based NeuroCuple^TM device diminished postoperative pain at rest by 34% and reduced pain with movement by 18%.

Background: Two-stage revision is the most common treatment for chronic periprosthetic joint infection of the hip, involving a resection arthroplasty with or without placement of an antibiotic-loaded spacer, followed by antibiotic therapy before reimplantation.

Aim: To compare the outcomes and complications of two consecutive treatment protocols for two-stage revision arthroplasty of the infected hip: One using Girdlestone with an antibiotic holiday, the other using custom-made articulating spacers (CUMARS) without an antibiotic holiday.

Methods: In this retrospective study, two consecutive cohorts were compared. Group A (2017-2020) underwent two-stage revision with a Girdlestone and an antibiotic holiday before reimplantation, while Group B (2020-2023) received CUMARS whenever possible, and no antibiotic holiday, or a Girdlestone if indicated. The primary outcome was successful infection eradication after one year. Secondary outcomes included surgical duration, length of hospital stay, weight-bearing allowance, discharge destination, and complications.

Results: A total of 98 patients were included: 39 patients in Group A and 59 patients in Group B. Successful infection eradication after one year was achieved in 69% of Group A and 83% of Group B (P = 0.164). Patients in Group B were more frequently allowed to bear weight (64% vs 18%, P < 0.001), had a shorter in-hospital stay (9 vs 16 days, P < 0.001), and were more often discharged home after the first surgery (48% vs 24%, P = 0.048). No significant differences were found in (mechanical) complications.

Conclusion: A protocol including CUMARS is a safe and effective treatment, offering faster recovery, shorter length of hospital stay, and enabling more patients to return home during the interval. This reduces strain on patients and the healthcare system, potentially saving costs, without compromising infection control or increasing (mechanical) complications.