World Journal of Orthopedics最新文献

Background: The accuracy of blind intra-articular injections in the shoulder is rather low. Inaccurate injections tend to lead to poorer treatment outcomes. The "Delaware posterior bone touch technique" has shown higher accuracy in young, slender, healthy volunteers than the classical "Cyriax technique".

Aim: To investigate whether the Delaware technique would also be more accurate in older patients with capsulitis.

Methods: We analyzed the files of 100 consecutive patients with capsulitis who were treated with an intra-articular injection containing a mixture of triamcinolone, lidocaine, and air. After the injection, the shoulder was moved to determine whether a squishing sound could be produced. The squishing sound was interpreted as an accurate injection. The scores with the new Delaware technique were compared against those with the Cyriax technique in a previous study.

Results: Squishing was heard after 87% of the injections. This was 13% (10% points) more than the 77% in the previous study (P = 0.004).

Conclusion: The Delaware technique was significantly more accurate than the Cyriax technique also in middle aged patients with capsulitis. We hypothesize that the difference is caused by a lower risk that a part of the opening of the needle is still outside the capsule.

Background: Acromegaly, a disease of excess growth hormone, is known to alter bone structure and increase the risk of osteoporosis and fractures. This study aimed to assess the prevalence of vertebral, non-vertebral, and hip fragility fractures, as well as osteoporosis, in a cohort of patients with acromegaly.

Aim: To assess the prevalence of vertebral fragility fractures, non-vertebral fragility fractures, hip fragility fractures, and osteoporosis in patients diagnosed with acromegaly.

Methods: Data were collected on age, sex, body mass index (BMI), time from diagnosis of acromegaly, insulin-like growth factor (IGF-1) levels, disease control, pharmacological management, risk factors for osteoporosis, vertebral fragility fractures, non-vertebral fragility fractures, hip fragility fractures, and osteoporosis.

Results: A total of 124 patients with acromegaly were included (67 men and 57 women). The mean age at diagnosis was 44 ± 12 years; the mean time from diagnosis was 12 ± 8 years; and the mean BMI was 27 ± 4 kg/m². Fragility fractures were found in 27 patients (21%). There were no significant differences in the presence of osteoporosis or fragility fractures according to age, sex, BMI, duration of acromegaly, or IGF-1 levels at diagnosis. A higher percentage of patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis (46% vs 15%; P < 0.05).

Conclusion: A high prevalence of osteoporosis and fragility fractures was found in patients with acromegaly, regardless of age, sex, BMI, time from diagnosis, IGF-1 levels, and disease control. More patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis. Taken together, our results suggest that the severity of the disease and the need for second-line therapies, may be associated with the increased risk of osteoporosis.

Slipped capital femoral epiphysis (SCFE) is a hip disorder that predominantly affects adolescents. The primary pathological change involves the displacement of the femoral head epiphysis from its normal position at the growth plate toward the metaphysis of the femoral neck. This condition can result in hip pain, abnormal gait, and even avascular necrosis of the femoral head, significantly impacting the quality of life in adolescents. Currently, the exact etiology of SCFE remains unclear; however, evidence suggests that risk factors include endocrine disorders, metabolic conditions, and genetic diseases. Endocrine disorders encompass hypothyroidism, growth hormone abnormalities, hypogonadism, and obesity-related hormonal imbalances. Metabolic conditions involve obesity, vitamin D deficiency or rickets, and renal osteodystrophy. Genetic diseases include mutations in the COL2A1 gene, aromatase deficiency, and Prader-Willi syndrome. This review summarizes various medical conditions associated with SCFE and elucidates potential molecular mechanisms from abnormal chondrocyte function in the growth plate, hormonal imbalances and inflammatory/metabolic factors in SCFE based on relevant literature, aim to provide evidence for the prevention and treatment of SCFE.

Background: Spinal cord injury (SCI) imposes enduring physical impairments and substantial socio-economic burdens. These injuries are either traumatic incidents or ischemic but exhibit comparable clinical recoveries. This suggests shared underlying neurodegenerative mechanisms, such as neuronal cell death, demyelination, and axonal degeneration, regardless of aetiology.

Aim: To investigate the relationship between the magnetic resonance imaging (MRI) biomarkers (tissue bridges) and clinical outcome in acute traumatic SCI.

Methods: In this prospective study adult patients with acute SCI who were examined clinically and radiologically within first 48 hours and subsequently at intervals were included. Clinical assessment included sensory score, motor score and zone of partial preservation. Radiological scores included measurement kyphotic deformities - sagittal index, regional kyphosis, gardener segmental kyphotic deformity. MRI on 3 Tesla machine was done to evaluate quantitative & qualitative parameters, and tissue bridges at one and 6 months.

Results: There were 47 patients with a mean age of 40.43 ± 10.73 years and male/female ratio of 34:13. There was a significant (P < 0.05) improvement in clinical, radiological, and MRI parameters at 6 months. Maximum spinal cord compression (MSCC), maximal canal compression, lesion length, width, and area; dorsal tissue bridges; ventral tissue bridges, total width of tissue bridges; and midsagittal tissue bridge ratios at one month significantly (P < 0.05) correlated with the 6-month total motor score and total sensory score. Further, the regression analysis demonstrated clinical improvement to dimensions of tissue bridges at 6 months.

Conclusion: The MRI imaging biomarkers in SCI patients demonstrated substantial improvement over time. There was a negative correlation between neurological recovery, MSCC, maximum canal compromise, and lesion dimensions (lesion length, lesion width, and lesion area). Higher canal compromise and lesion dimensions were associated with a poorer outcome. The evaluation of the midsagittal tissue bridge (including the ventral tissue bridge, dorsal tissue bridge, total width of the tissue bridge, and tissue bridge ratios) at 1 and 6 months showed a positive correlation with the neurological recovery.

The Ilizarov apparatus was designed by its author 75 years ago and addresses a wide range of orthopedic conditions. Its classical assemblies are still self-sufficient and versatile. However, certain clinical scenarios require a more specialized approach, and some groups of patients may benefit from customized Ilizarov constructs. Engineering science has designed various external fixators for orthopedic purposes, and some of those have become the gold standard for specific clinical tasks. We aimed to determine the current state and novel modifications of specialized external fixators for specific clinical situations which are based on the principles of the Ilizarov method. They are half-pin-based fixators for temporal fracture fixation, ring or hybrid devices for gradual deformity correction, and compression-distraction devices tailored for definite limb segments. Gradual correction of deformities can be achieved with external hexapods incorporating universal reduction units. Alternatively, external fixators with special connection mechanisms are able to provide independent movement of the rings in six degrees of freedom. Deformity correction can be performed with combined or sequential use of external and internal fixators. Special devices were developed for moving the split fragment for revascularization of the tibia. The units of external frames on the foot were modified to consider its complex anatomy and the clinical needs ranging from correction of multi-plane deformities, joint arthrodesis to distraction arthroplasty. Mini-fixators are compact external fixators for small bones of the hand and foot. The varieties of external fixators based on the Ilizarov principles have been designed to fulfill an ultimate goal of improving treatment outcomes.

Background: The current method of cleaning and changing dressings for non-healing lumbar incisions post-radiotherapy is time-consuming and laborious, with very poor results. We here report a patient with radiation dermatitis who developed a non-healing wound after lumbar spinal surgery. The wound was successfully treated with vacuum sealing drainage therapy, confirming its feasibility in complex wound healing.

Case summary: The patient was a 76-year-old female with lung cancer, positron emission tomography/computed tomography showed bone metastasis in L2 and L3 vertebrae. After 2 months of local radiotherapy to the lumbar spine, symptoms did not improve and pain worsened. She had lumbar lesion clearance and internal fixation surgery, but developed a nonhealing wound of approximately 15 cm postoperatively. After 12 rounds of clearing necrotic and unhealthy tissue, 78 days of negative pressure therapy promoted granulation tissue growth and wound healing, resulting in wound healing.

Conclusion: Vacuum sealing drainage therapy has shown efficacy in treating nonhealing wounds after radiotherapy, promoting wound healing and reducing infection risk.

Background: Orthopedic training, one of the most useful but under-represented specialties in undergraduate medical curricula, has some difficulties in clinical teaching.

Aim: To determine if simulation-based learning (SBL) was effective in enhancing procedural accuracy, skill confidence, and knowledge recall in final-year medical students.

Methods: This was a cross-sectional observational study performed in the Department of Orthopaedics in a tertiary care teaching hospital with simulation training facilities. The trial was conducted over 2 months (January 2025-February 2025) and was designed to determine the effect of SBL on procedural skills, knowledge retention, and self-perceived confidence in a group of final-year medical students. The inclusion criterion was undergraduate medical students in their final year who had clinical postings in orthopedics. Convenience sampling was used to recruit 106 students. The sample size was estimated to achieve a post-training 50% improvement ratio in procedural accuracy, a confidence interval of 95%, and an absolute precision of 10%. The simulation sessions included exercises with synthetic bone models, cast equipment, and procedural packs [orthopedic skills: (1) Closed fracture reduction; (2) Application of plaster; and (3) Traction]. Each session consisted of an instructor-led demonstration, practice under supervision, and immediate feedback.

Results: In our study involving 106 final-year medical students, SBL significantly improved procedural accuracy with scores rising from 62.5% to 84.9% (P < 0.001). Knowledge retention also improved markedly with post-test scores increasing from 63.4% to 78.2% (P < 0.001). Self-reported confidence levels showed a substantial gain, increasing from 4.6 to 8.2 on a 10-point scale. Prior simulation exposure and academic performance ≥ 75% were significantly associated with higher post-training accuracy. Gender had no significant influence on outcomes.

Conclusion: The current study attested to the value of SBL in the enhancement of procedural skills, knowledge retention, and self-confidence of final-year medical students in orthopedics.

Sickle cell disease (SCD) is a genetic disorder characterized by chronic hemolysis and vaso-occlusive crises (VOCs), leading to musculoskeletal complications that significantly affect quality of life. Among these, shoulder complications are a concern, with humeral head avascular necrosis (AVN) being the second most common site of involvement after the femoral head. Other shoulder pathologies, including osteomyelitis and septic arthritis, further contribute to morbidity. However, these conditions remain underdiagnosed and understudied, often due to overlapping symptoms with VOC-related bone infarctions. Imaging, particularly magnetic resonance imaging, is crucial for early diagnosis and accurate differentiation. Management strategies range from conservative pain control to surgical interventions, including core decompression for early-stage AVN and arthroplasty for advanced joint destruction. Surgical outcomes in SCD, however, remain inconsistent due to higher complication rates and a lack of standardized guidelines. Despite advancements in diagnosis and treatment, shoulder pathology in SCD remains an area of limited research. This review highlights the need for larger, long-term studies with a homogeneous etiology to support and refine current treatment strategies and improve patient outcomes.

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.