Journal of Orthopaedic Surgery最新文献

Purpose: The rectus femoris has three myotendinous or myoaponeurosis junctions and causes three types of muscle strain anatomically. We aimed to investigate the anatomical injury site of the rectus femoris muscle strain in professional soccer players as well as the characteristic findings on magnetic resonance imaging (MRI) and to evaluate its relationship with the time taken to return to play at competition levels.

Methods: Thirteen Japanese professional soccer players who sustained injuries to the rectus femoris were included in this study. The mechanism of injury, anatomical injury site, severity, absence of hematomas, and time taken to return to competition were evaluated.

Results: Ten patients were injured while kicking and three while sprinting. The anatomical injury site was the origin aponeurosis in two cases, intramuscular tendon in eight cases, and distal aponeurosis in three cases. The severity was one-degree in three cases and two-degree in 10 cases. Hematomas were observed in five cases. Cases with injuries caused by sprinting, two-degree injuries, or clear hematomas were associated with significantly longer periods of return to play than the other cases. Additionally, patients with distal aponeurosis-type injuries tended to take a long time to return to the competition.

Conclusions: In rectus femoris muscle strain, it is important to evaluate the anatomical injury site, severity, and absence of hematomas on MRI. Not only the injury mechanism, a clear hematoma, and high severity but also distal aponeurosis injuries may be associated with long periods of return to play at competition levels.

Objective: The purpose of this study is to present a surgical technique that simultaneously reduces and fixates the transverse parts of U-shaped sacral fractures.

Methods: The sacral fracture was exposed through a posterior median approach. In a flexion injury, the rotation of the lower sacral segment is reduced by distraction along a pre-curved rod. Then, lordotic restoration is performed with a Weber clamp placed at the lower sacral segment through dragging. In an extension injury, longitudinal distraction is performed along the spinopelvic rod to reduce the vertical displacement. Next, the transverse displacement is reduced by a dissector placed between the upper and lower sacral segments through levering. The sagittal reduction on the lateral pelvic view was judged by PI. A regression analysis of Oswestry disability index (ODI) with Z-scores of PI, lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT) was performed.

Results: At the 1-year follow-up, the average PI, LL, SS, and PT values were 51.6 (range: 43.1-76.0), 44.8 (34.6 - 60.1), 35.4 (18.1 - 48.0), and 16.7 (2.2-35.4) degrees, respectively. All patients were able to maintain an upright stance. The average ODI was 27.6% (2-72%). Surprisingly, the regression analysis demonstrated a significant linear relationship between ODI and LL (R² = 0.367, p = .048) but not between ODI and PI (R² = 0.227, p = .138).

Conclusions: Using PI as guidance, the surgical procedures were helpful to reduce the PI of transverse sacral fractures into the normal range. However, the relationship between PI and the prognosis remains to be evaluated by future researches.

Fracture related infections (FRIs) are a disabling condition causing significant concern within the orthopaedic community. FRIs have a huge societal and economic burden leading to prolonged recovery times and the potential for becoming chronic conditions or being life-threatening. Despite its importance in our field, the surgical community has just recently agreed on a definition which, added to the lack of surgical trials assessing preventive and treatment interventions have limited our understanding and precipitated wide variations in surgeons' practice. This article aims to review the current practices that can be supported with high-quality evidence. Currently, we have a limited body of high-quality evidence on FRI prevention and treatment. A handful of measures have proven effective, such as the use of prophylactic antibiotics, the use of saline and low pressure as the preferred irrigation solution and the safety of delaying initial surgical débridement more than 6 hours without impacting infection rates for open fracture wounds débridement. Future multicentre trials, properly powered, will shed light on current areas of controversy regarding the benefit of different preoperative and perioperative factors for the prevention and treatment of FRIs. Higher quality evidence is needed to guide surgeons to offer an evidence-based approach to prevent FRI occurrence and to treat patients suffering from them.

Fracture-related infection (FRI) is a complication that impacts care costs, quality of life, and patient function. Great strides have been made in the last decade to obtain a common language for definition and diagnosis with the contribution of the Fracture-Related Infection Consensus. Although FRI treatment requires the participation of clinical specialists in infectious diseases for the management of antibiotics, it is necessary to understand that this complication is an eminently surgical pathology. The orthopedic surgeon must play a leadership role in the prevention and treatment of this complex disease. In this review, the most relevant aspects of prevention are updated, and a strategy for a sequential and comprehensive approach to the patient with this complication is presented.

Purpose: The epidemiology of shoulder instability in the general population is lacking. The aim of the current study was to determine the incidence rate of primary shoulder dislocations requiring surgical interventions in a major trauma center within a large maintenance organization.

Methods: A retrospective cohort analysis of electronic health records database from 1 January 2014 and 31 December 2020 was conducted in major rural trauma center. This study included all patients aged 10 years or older with a primary shoulder dislocation that were treated with closed reduction in the emergency room department. An overall incidence density rates (IDR) (per 100,000 person-years) of primary shoulder dislocations and stabilization surgeries were determined for the entire cohort. The data was used to evaluate the age-specific and gender-specific epidemiology.

Results: During the study period of 7 years there were 1,302 patients who underwent closed reduction after a primary shoulder dislocation (mean age 45 years). Of those, a total of 106 shoulder stabilization surgeries (8%) were performed. The IDR of primary shoulder dislocations was 179 per 100,000 person-years. The IDR of primary shoulder stabilizations was 15 per 100,000 person-years. The peak in number of dislocations was observed in the age groups of 20-29 years and over 60 years. In the age groups under 59 years dislocations were more common in men while in ages over 60 years dislocations were more common in women. The vast majority of shoulder stabilization surgeries were performed in young patients (age under 39 years).

Conclusion: The IDR of primary shoulder dislocations calculated from a major trauma center of the largest health maintenance organization in Israel was 179 per 100,000 person-years. Shoulder dislocations had bimodal age distribution. Overall, eight percent of the patients (mainly young) with shoulder dislocations underwent shoulder stabilization surgery during the study period.

Purpose: Fixed bearing (FB) UKA constituted 63.7% of unicondylar knee arthroplasties in 2020 Australian Registry with the longest UKA survivorship. The significance of patellofemoral joint (PFJ) arthritis, ACL deficiency, post-operative anteromedial pain, radiosclerosis or radiolucency on survivorship of FB UKA is not established. The aim of this study was to analyze the medium-term survivorship of fixed-bearing UKA with no exclusion of PFJ OA and ACL deficiency. Predictors for failure were analyzed.

Methods: FB UKA performed in 2011-17 were reviewed. Cases with PFJ OA or ACL deficiency were not excluded. The effect on survivorship by ACL deficiency, PFJ arthritis, post-operative anteromedial pain and radiological abnormalities were analyzed.

Results: There were 96 UKA with follow-up time of 66 ± 18 months (27-98). The mean age was 70 ± 9 years, BMI 25.8 ± 2.6 kg/m². Alignment was varus 9° ± 4° pre-operatively and varus 3° ± 3° post-operatively. There were four revisions (4.2%) and 4 deaths (4.2%). Reasons for revisions were loosening (n = 1), persistent pain (n = 2) and lateral compartment disease (n = 1). Estimated survival at 8.3 years was 94.7% (95% CI 91.6-97.7). BMI ≥30 was found to be a significant predictor for failure. The incidence of radiographic abnormalities was 75% for PFJ arthritis, 39% for tibial tray overhang, 14% for radiolucency or radiosclerosis, 5% for ACL deficiency and 5% for edge loading respectively but they were not significantly associated with lower survivorship or anteromedial knee pain. The presence of anteromedial pain after surgery in 36.5% was also not significantly associated with survivorship.

Conclusion: FB UKA with no exclusion of early PFJ arthritis and ACL deficiency has satisfactory medium-term survivorship. BMI ≥30 could have higher risk of all-cause revision. Tibial tray overhang, non-progressive radiolucency or radiosclerosis do not seem to be associated with anteromedial knee pain or poorer medium term survivorship.

The concept of antibiotic-coated implants, mainly coated intramedullary nails, has become increasingly used for the treatment of fracture related infections. After a long period of hand-made implants, commercially fabricated implants combine several benefits. Antibiotic-coated nails constitute a solid treatment option for unstable diaphyseal infections with fractures or non-unions. They release high concentrations of antibiotics locally, while retaining reduction and providing axial stability. This review aims to provide an overview about the background, the development, the indications, the treatment strategies and the outcomes of antibiotic-coated intramedullary nails.

Purpose: This study aimed to confirm the usefulness of surgery that avoids the cervicothoracic junction (CTJ) by comparing the clinical and radiographic outcomes after posterior cervical fusion at C5/6 with those at C7/T1.

Methods: Patients who underwent laminectomy and posterior cervical instrument fusion for cervical spondylotic myelopathy (CSM) from 2012 to 2019 were retrospectively reviewed and divided according to whether the end level was at C5/6 (group 1) or C7/T1 (group 2). Demographic variables and incidence of distal junctional kyphosis (DJK) were compared between the groups. Clinical outcomes (visual analog scale [VAS] score for arm and neck pain and the Neck Disability Index value) and radiologic outcomes (T1 slope, cervical lordosis, segmental lordosis, C2-7 sagittal vertical axis, T1 slope-cervical lordosis mismatch) were compared over time.

Results: Sixty-seven patients were included. There were 32 patients in group 1 and 35 in group 2. The VAS score for neck pain was significantly lower in group 1 than in group 2 at 2 years after surgery (p = 0.03). The C2-7 sagittal vertical axis was significantly larger in group 2 than in group 1 at 1 year and 2 years postoperatively (p = 0.04). The incidence of DJK was higher in group 2 than in group 1 (28.57% vs 9.37%, p = 0.04).

Conclusion: This study found that when CTJs are included in the posterior cervical long fusion surgery, although it would be better than preoperation, postoperative kyphosis and consequent neck pain may progress. The results of this study advocate the concept of avoiding CTJ fusion if possible.