Efort Open Reviews最新文献

Posterolateral tibial plateau fractures are complex injuries requiring a thorough understanding of the anatomical structures involved, including the popliteus tendon, lateral collateral ligament and posterior horn of the lateral meniscus. Standard anterolateral or midline approaches provide limited access to the posterolateral corner, often necessitating specific surgical techniques to achieve optimal fracture reduction and joint stability. This review explores the main surgical approaches used for these fractures outlining their indications, advantages and limitations. Each section provides a step-by-step guide for an effective surgical technique, based on experience from a high-volume trauma center, to optimize exposure, reduction and fixation. Understanding the biomechanical and anatomical aspects of these fractures is crucial for selecting the most appropriate surgical strategy, minimizing complications and improving patient outcomes.

The orthoplastic approach refers to an integrated evaluation of the surgical approach, the preoperative planning of surgical margins of resection, the loss of healthy tissue, the size of the resultant tissue defect, the functional defect, the impact of neoadjuvant therapies on local tissue, the patient's comorbidities, and predicted survival in order to decide the most favorable reconstruction option for the individual patient with a sarcoma. Microsurgical techniques are an essential component of the tissue reconstruction ladder. The vascularity of the flap used for reconstruction does not compromise the oncological outcomes, nor does it increase local recurrence or reduce overall survival. Free-vascularized fibula grafts are the most common osseous flaps used for bone defect reconstruction. Adequate fixation is necessary to provide mechanical stability and to increase the rate of primary bone union. Soft tissue wound closure under tension results in wound failure, especially when preoperative radiation therapy is used. Flap reconstruction decreases the rate of wound healing complications, allowing for continuation of adjuvant therapies. Soft-tissue local flaps are frequently used to treat tissue defects with a low complication rate. Plastic reconstruction should be tailored to the specific needs of patients.

Scepticism is still the most common attitude of orthopaedic surgeons toward short stems, despite the excellent survival rate reported in the International Registry, together with an acceptable complication risk. In surgical centres where these types of implants are commonly utilised, they account for a significant percentage of procedures (up to 50% of total hip replacements performed). Potential benefits of bone preservation were evident from the very early phase of introduction. Some complications have been experienced, especially with modular short stems. Some limitations and weak points during the evolution from early designs to modern short stems have been identified. With few exceptions, clinical results and survivorship were very good, despite widened indications (age- and pathology-related), giving an overall retrospective evaluation of our experience with short stems similar to primary hip implants. Failure of short stems is mostly related to the validity of bone preservation in terms of revision strategy. Standard surgical revision was generally performed with two-stage revisions in PJI and stem revision in periprosthetic fracture.

Patellar dislocations present predominantly during adolescence, with a higher incidence observed among female patients. Patellofemoral joint stability depends critically on both osseous anatomy and soft tissue structures. Patellofemoral pathology can be classified into three major groups: objective patellar instability OPI, potential patellar instability and painful patellar syndrome. Three primary risk factors predispose individuals to patellar dislocation: trochlear dysplasia, patella alta and increased tibial tuberosity-trochlear groove (TT-TG) distance. Three secondary risk factors should be considered: femoral and tibial rotational abnormalities and valgus deformity. MRI has become the imaging modality of choice, enabling precise quantification of OPI risk factors in a single imaging examination. The 'menu à la carte' approach guides the treatment of OPI by addressing the most relevant anatomical risk factors for each patient using statistical thresholds.

Crush injury arises from prolonged external force on soft tissues, resulting in muscle necrosis and systemic manifestations known as crush syndrome. Pathophysiology involves ischemia, reperfusion injury and the release of toxic metabolites, which lead to rhabdomyolysis, electrolyte imbalances, acute kidney injury and potential multi-organ failure. Early management emphasizes aggressive fluid resuscitation, urine alkalinization and electrolyte correction to avert life-threatening hyperkalemia and renal impairment. Controversies include the use of mannitol, indications for fasciotomy and optimal dialysis timing. Each must be individualized according to patient status and resource availability. Emerging therapies focus on addressing inflammation and oxidative stress, aiming to transition from largely supportive care to more causative interventions. Despite medical advances, prompt recognition, coordinated multidisciplinary care and proactive measures remain vital to reducing morbidity and mortality in crush syndrome, especially in disaster settings.

Surgical decompression of carpal tunnel syndrome is usually successful, and failure is rare. Diagnosis of persistent or recurrent carpal tunnel syndrome is based on thorough anamnesis and clinical examination, defining underlying comorbidities, nerve conduction studies and distinguish recurrent, persistent or new complaints. Management of failed carpal tunnel release may require revision surgery, which includes redo release of the transversal carpal ligament, external neurolysis and flaps. A hypothenar fat pad flap or other local, regional or distant flaps may be added to a redo release of the carpal tunnel. Currently, convincing evidence to superiority of additional flap surgery is lacking. Postoperative care is evolving toward early motion rather than immobilization, with nerve gliding exercises to prevent adhesions and promote nerve recovery. Virtual reality was recently added to postoperative protocol options.

Psychological consequences of trauma: Acute stress reactions and post-traumatic stress disorder are common psychological conditions that affect the healing process. Early interventions: Psychological first aid and psychoeducation are evidence-based approaches aimed at mitigating post-traumatic symptoms. Social support: It plays a central role in psychological stabilisation and promotion of functional recovery. Multidisciplinary approaches: Cooperation between orthopaedists, psychologists and social workers is crucial for optimal treatment results. Challenges in clinical practice: Limited time, stigmatisation of mental illness and inadequate resources are common barriers to effective care.

Background: Despite the growing burden of degenerative cervical myelopathy (DCM), consensus on the optimal timing of surgical intervention remains lacking, especially for patients with mild symptoms or asymptomatic cord compression or in the context of recent trauma. Different scores, such as the mJOA, Nurick scale and NDI are commonly used to classify disease severity, but guidelines for managing these patients do not provide a clear framework for intervention timing.

Materials and methods: We conducted a narrative review of the literature on the optimal timing of surgical intervention for DCM, using PubMed to identify relevant studies. The search was focused on surgical and non-operative management, clinical and radiological assessments, biomarkers and emerging technologies. The selected papers were reviewed for relevance and quality, with guidance from a senior author.

Results: The initial search identified 6,705 articles, which were narrowed down to 136 relevant studies after applying filters for study type and clinical focus. A final selection of 87 papers was categorized by topics and the findings were synthesized to highlight trends, challenges and knowledge gaps in surgical timing for DCM.

Focus of the study: This review article examines strategies for determining the optimal timing for surgery in DCM. It explores how radiological signs, clinical indicators and other markers may help identify patients at risk of rapid neurological deterioration, particularly in the 'grey-zone' population (mild symptoms or asymptomatic disease), enabling clinicians to assess correctly different clinical scenarios and to indicate timely surgical intervention.

The French paradox cementing technique encompasses a canal filling highly polished stem with a thin (<1 mm) cement mantle. The technique has been developed by Pr Marcel Kerboull in the late 1960s after he observed the patterns of debonding of the original Charnley stem. The key point of the technique is based upon removal of the metaphyseal cancellous bone (with hollow reamers or aggressive broaches) especially at the supero-medial region. Only two stems have been validated with this technique: the Charnley-Kerboull (CK) and the Ceraver Osteal stem, both of which are collared. This technique is neither a taper slip (the stem does not subside at long-term follow-up) nor a composite beam (a highly polished stem is used). A 12% shortened stem CK has shown similar results to the standard-length stem, including the absence of stem subsidence. Combined with the Hueter anterior approach, this technique has demonstrated one of the lowest femoral PPF rate in elderly patients in the literature.

Current non-surgical managements of osteoarthritis (OA) do not change the clinical course or arrest the progression of the disease, while joint replacement is indicated for end-stage disease. Given these limitations, there is an unmet clinical demand for new treatment modalities that can improve the pain and quality of life of patients suffering from OA without surgery. The recent surge of interest in regenerative medicine (RM) for OA is based on these circumstances. Unlike traditional medicine, RM products may be accompanied by many uncertainties and long-term consequences. Considering that OA directly affects quality of life rather than life and death, the 'first do no harm' principle is more important when applying RM technology to the disease. Presently, culture-expanded mesenchymal stromal cells (MSCs) and orthobiologics, including bone marrow aspirate concentrate, stromal vascular fraction from adipose tissue and platelet-rich plasma have been applied to patients in clinical trials. Results of randomized clinical trials using MSCs have demonstrated that structural improvement and reversal of the pathologic process in OA are not definitely shown, while symptomatic relief is apparent. Orthobiologics seem to have efficiency comparable to those of culture-expanded MSCs. With the advantage of avoiding the approval process from regulation agencies, orthobiologics might provide a less expensive and handier option to culture-expanded MSCs. High-quality data from a large number of patients and head-to-head comparisons of several RM products will be necessary to define the place of culture-expanded MSCs or orthobiologics for OA treatment and resolve the reimbursement issue.