European Journal of Orthopaedic Surgery and Traumatology最新文献

Purpose: Several risk factors for adjacent segment disease (ASD) after posterior lumbar interbody fusion (PLIF) have been reported. High pelvic incidence (PI) has been identified as risk factors for L4 anterior slip in cases of lumbar degenerative spondylolisthesis. Correcting the slip with L4-L5 fixation merely restores the lumbar alignment, but the PI itself remains unchanged. We hypothesized that the fused L4 vertebral body might continue to be subject to the slip-inducing force, even after fixation, and that slip correction might be a cause of ASD. The purpose of this study is to identify the risk factors for adjacent ASD following single-segment PLIF in patients with L4 spondylolisthesis, with a particular focus on the reduction of vertebral body slippage.

Methods: Fifty-two patients who underwent posterior lumbar interbody fusion at the L4-L5 level for L4 degenerative spondylolisthesis were investigated. Patients were divided into two groups: the ASD group (n = 12) and the non-ASD group (n = 40). %Slip before surgery and at follow-up, Δ%Slip (Δ%Slip = %Slip before surgery-%Slip at follow-up), L4-L5 interbody height, and L4-L5 lordosis angle were evaluated.

Results: Stepwise multivariate regression analysis revealed Δ%Slip to be a risk factor for ASD (odds ratio: 1.22, 95% confidence interval: 1.04-1.43, p = 0.015). In the receiver operating characteristic analysis, the cutoff value for Δ%Slip was 7.3% (sensitivity: 75.0%, specificity: 67.5%, and area under the curve = 0.725).

Conclusions: Our findings suggest that the reduction of L4 slippage may contribute to the development of ASD in patients with L4 spondylolisthesis.

Introduction: An association between type 2 diabetes and osteoarthritis has been postulated. The present umbrella review of systematic reviews and meta-analyses investigated possible bidirectional relationships between type 2 diabetes and osteoarthritis.

Methods: PubMed, Scopus, Web of Science, and Cochrane Library databases were accessed. All the available systematic reviews and meta-analyses on the relationship between type 2 diabetes and osteoarthritis were accessed. The odds ratio (OR) effect measure and 95% confidence interval (CI) were used for the statistical analyses.

Results: Four systematic reviews, of whom three meta-analyses, were considered. Data from 26209 patients with osteoarthritis were considered: 3530 with type 2 diabetes and 22679 without type 2 diabetes. A significantly increased rate of osteoarthritis was evidenced in patients with type 2 diabetes than in patients without it (OR = 1.43; 95% CI 1.01 to 2.02). The effect persisted after in the subgroups age, sex, and obesity (pooled adjusted OR = 1.22; 95% CI 1.05 to 1.42).

Conclusion: Patients with type 2 diabetes might present an increased risk of developing osteoarthritis.

Purpose: Revision total joint arthroplasty cases including those complex enough to require limb-salvage procedures are expected to significantly increase. Total femoral replacements represent a limb-preserving procedure with potential utility for these complicated cases. This review seeks to summarize the outcomes of total femoral replacements when used in the revision arthroplasty setting.

Methods: A systematic review was performed by searching Embase, Ovid MEDLINE, PubMed, Wiley Cochrane Library: Central Register of Controlled Trials, and Thompson Reuters Web of Science: Citation Index on February 8, 2024 for studies describing any outcomes and complications of total femur replacements performed for revision arthroplasty. Functional outcomes and postoperative complications were subsequently summarized. This study was registered with PROSPERO (CRD42024509031). Risk of bias assessment was performed using the Methodological Index for Nonrandomized Studies.

Results: Eleven of 4817 initially screened studies were included. Indications for total femur replacement largely consisted of periprosthetic infection, periprosthetic fracture, hardware loosening, or a combination thereof. Articles described variable benefit in function, pain, and ambulatory ability. Patients had improved hip and knee function, reduced pain levels, and preserved independent ambulatory ability, though patients largely still required assistive devices. Benefits were limited by the high risk of postoperative complications, especially infection and dislocation.

Conclusion: Total femur replacement is an option for limb-salvage surgery in complex revision arthroplasty cases but has high complication rates, particularly infection and dislocation. Advancements aimed at minimizing these complication rates including silver- and iodine-coated implants will be critical in establishing the viability of total femur replacements in this setting.

Purpose: To evaluate the clinical efficacy of ultrasound-guided local anesthetic injection combined with myofascial trigger point mini-needle knife therapy for acute lumbar sprain management.

Methods: In this prospective study, 60 patients (January-July 2024) received ultrasound-guided injections at the third lumbar (L3) transverse process attachment and posterior medial spinal nerve branch, combined with miniscalpel-needle release of MTrPs. Visual analog scale (VAS), modified Oswestry disability index (MODI), and lumbar range of motion (ROM) were assessed pre-treatment and on days 3 and 7 post-treatment.

Results: VAS scores, modified ODI scores, and ROM scores on days 3 and 7 post-treatment were significantly reduced compared to baseline (all P < 0.001). Further pairwise comparisons revealed statistically significant improvements in VAS scores (MD - 1.25; 98.33% CI - 1.50 to - 0.75; P < 0.001) and modified ODI scores (MD - 2.50; 98.33% CI - 3.00 to - 2.00; P < 0.001) from day 3 to day 5. However, no significant change in ROM scores was observed between days 3 and 7, indicating rapid stabilization of mobility metrics.

Conclusions: The integration of ultrasound-guided anesthesia and miniscalpel-needle therapy provides rapid pain relief, functional recovery, and mobility restoration in acute lumbar sprain. This multimodal approach demonstrates clinical efficacy with minimized invasiveness, aligning with evidence supporting ultrasound-guided precision and MTrP-targeted interventions.

Surgical correction of neuromuscular scoliosis is a challenging problem facing spine surgeons. Many patients require long constructs and pelvic fixation to obtain adequate curve correction and pelvic obliquity correction. The aim of this technical note is to describe a technique for sequential pelvic obliquity and scoliotic curve correction in patients with neuromuscular scoliosis using four rods in upper thoracic to pelvis posterior spinal fusion, without the need for intraoperative traction. We present 5 cases of neuromuscular scoliosis that underwent upper thoracic to pelvis posterior spinal fusion using the four-rod technique and demonstrate improvement in major Cobb angle and pelvic obliquity immediately postoperatively and maintained at final follow-up (range: 2-16 years). Preliminary findings from this small case series support the use of four-rod correction technique for correction of neuromuscular scoliosis and pelvic obliquity.

Purpose: Total knee arthroplasty (TKA) is considered the gold standard treatment for end-stage knee osteoarthritis. Common complications associated with TKA include implant loosening and periprosthetic fractures, which often require revision surgery or fixation. Challenges arise when medical records related to the knee prosthesis are lost, making it difficult to plan for revision surgery effectively. This study aims to develop an artificial intelligence (AI) system to classify the types of knee prosthetic implants using plain radiographs.

Methods: This retrospective experimental study includes seven types of knee prostheses commonly used in our hospital. The artificial intelligence (AI) system was trained using YOLO (You Only Look Once) version 9, utilizing a dataset of 3228 post-operative and follow-up knee arthroplasty X-ray images. The plain radiographic images were augmented, resulting in a dataset of 25,800 images. Model parameters were fine-tuned to optimize performance for implant classification.

Results: The mean age of the patients was 62.8 years. Right knee arthroplasty was performed in 48.3% of cases, while left knee arthroplasty was performed in 51.7%. The images of knee prostheses comprised 50.9% of the dataset from the anteroposterior (AP) view and 49.1% from the lateral view. The AI model demonstrated exceptional performance metrics, achieving precision, recall, and accuracy rates of 100%, with an F1 score of 1. Additionally, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated to be 100%.

Conclusion: This AI model successfully classifies knee prosthetic implants from plain radiographs. This capability serves as a valuable tool for surgeons, enabling precise planning for revision surgeries and periprosthetic fracture fixation surgery, ultimately contributing to improved patient outcomes. The high accuracy achieved by the AI underscores its potential to enhance surgical efficiency and effectiveness in managing knee arthroplasty complications.

Purpose: This study seeks to (1) describe the management of civilian ballistic extra-capsular proximal femur fractures (2) assess the rate of nonunion and complications and (3) compare the time to union of ballistic and blunt pertrochanteric femur fractures. Given the enhanced and widened extensive inflammatory response with ballistic trauma, we hypothesized that hip fractures from ballistic mechanisms would have faster times to union.

Methods: Patients were included if they were skeletally mature with extra-capsular pertrochanteric femur fractures and radiographic and clinical follow-up of at least 6 months. Additional exclusion criteria included prior femur fractures and pathologic fractures. Orthopedic Trauma Association classification of all fractures was included. Union rate, time to union and complications were measured. Clinical union was defined as absence of pain with ambulation at the fracture site. Radiographic union was defined as mRUST ≥ 11. mRUST was measured at 6 weeks, 3 months and 6 months. Patients were included if they met study end points of a minimum of 6 months of follow-up, achieved union, or underwent revision surgery for nonunion.

Results: 52 fractures (23 ballistic, 29 blunt fractures) matched by age, BMI, sex, diabetes, and current smoking status were included in the study. 95.7% of the ballistic (22/23) and 100% of the blunt (29/29) fractures united. Average time to union was 90.5 days for the ballistic cohort and 114.9 days for the blunt cohort (p = 0.03). There were six additional complications: three broken interlocks, one varus malalignment, one superficial infection, and one infection requiring an antibiotic spacer.

Conclusion: In our series, we found the average time to union for ballistic pertrochanteric femur fractures was significantly less than that for blunt pertrochanteric femur fractures. There was no significant difference in complications or total nonunion. Overall, our study shows both subgroups achieved union in 3 months, which is less than previously reported. The time to union may be increased in the ballistic fractures by the enhanced and widened extensive inflammatory response or the blast effect may inoculate osteogenic material in to the soft tissues that enhances the healing process. This study demonstrates unique characteristics of ballistic fracture healing.

Introduction: Historically, surgical training has been primarily carried out in the operating theatre, using mentoring for the surgical resident to reach the appropriate skill level (3/5). Other surgical training methods also improve performance, but do not always lead to the highest level of expertise (5/5). Another training method, sometimes termed- deliberate practice, by setting objectives based on feedback, may be more effective. In this study we compared resident learning of osteosynthesis for a fibular fracture model between deliberate practice and traditional teaching or naive practice. The main hypothesis was that deliberate practice would result in better objective performance, better subjective performance and reduced stress levels.

Materials and methods: The study involved a level 3 expert and ten level 1 surgeon-in-training subjects divided into two groups naive practice and deliberate practice. Each subject placed 5 plates on a synthetic fibula model. The deliberate practice group received feedback from the expert after each trial. Stress level was measured using the Analgesia Nociception Index (ANI). Objective performance was assessed by OSATS and subjective performance by self-assessment.

Results: Based on initial performance measurements, the two groups were comparable. The mean progression of objective performance over the five osteosynthesis was 10.3 in the naive practice group and 17.1 in the deliberate practice group, with a strong difference in favor of the deliberate practice group. Subjective performance and ANI improved in both groups, with no significant difference.

Discussion: The main hypothesis was disproven: the improvement in objective performance was not significantly greater (< 97.5%) with deliberate practice. However, there was a substantial difference in favor of the deliberate practice group (93%). Secondary hypotheses were not proven too, as neither PS nor ANI were affected by deliberate practice. In conclusion, deliberate practice complements mentoring but must adhere to strict guidelines to be effective: level 5 expertise, precise criteria for defining OSATS, and the use of high- profile simulators.

Purpose: The purpose of this study was to compare the S2-alar-iliac (S2AI) technique with the iliac screw (IS) technique in adult spinal deformity (ASD) patients in terms of clinical and radiographical outcomes, focusing on reoperations, complications, and change in radiographic parameters.

Methods: This is a retrospective review of a prospective, multicenter database. ASD patients who underwent long fusion to the pelvis with 2-year postoperative follow-up were included. To compare outcomes (radiographic, clinical, and complications), matching was performed based on the type of pelvic fixation (IS vs. S2AI) using propensity score matching (PSM), 1:1 ratio, caliper 0.1, tolerance ≤ 0.001, with a 95% confidence interval. Kaplan-Meier survival curves were generated for each group and compared between the two groups by the log-rank test. Hazard ratio (HR) was calculated using the Cox proportional hazards model.

Results: Out of 1442 patients undergoing intervention with a 2-year follow-up, 555 were identified as having pelvic instrumentation. Among them, 52 patients fixed with S2AI screws were matched with 52 patients fixed with IS using PSM for age, body mass index (BMI), number of fused levels, and global tilt. No significant differences were found in radiographic correction, reoperation rates, or infection rates. The percentage of mechanical complications (MC) was higher in the IS screw group, with a statistically significant increase in MC-free survival in the S2AI screw group (80.6 vs. 61.2 months; p = 0.022), with a HR of 0.43 (p = 0.027). Patients with S2AI screws reported higher immediate postoperative pain at 6 weeks, with this difference leveling off in subsequent assessments. At 2 years, a higher percentage of radiolucent halos were observed in the S2AI screw group (59.6% vs. 34%; p = 0.017), but there were no differences in pain assessments in the quality-of-life tests.

Conclusion: After a thorough comparison, both pelvic fixation methods showed similar deformity correction and reintervention rates. However, iliac screws had more mechanical complications, while S2AI screws, crossing the sacroiliac joint, led to higher short-term postoperative pain and increased radiological loosening at 2 years.

Purpose: The aim of this study was to identify causes for recurrent PLRI, compare surgical treatment options, and analyze functional outcomes following revision LUCL reconstruction.

Methods: A retrospective multicentric case analysis was conducted, including patients who underwent revision LUCL surgery due to recurrent PLRI. Demographic data, surgical techniques (for primary and revision LUCL reconstruction) and postoperative rehabilitation protocols were analyzed, and causes of failure documented. Functional outcomes were assessed using the Patient-Rated Elbow Evaluation (PREE) and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaires.

Results: A total of 37 patients with a mean age of 44.3 years (± 12.3) and a median follow-up of 40.9 months (interquartile range, 20.5-77.0) with revision LUCL surgery were included. Recurrent instability was mainly attributed to graft insufficiency or loosening (59.5%) and rupture of the humeral graft (37.8%). Failure of humeral fixation occurred in 48.7% of cases, often due to loosening or widening of the drill hole. While triceps tendon autografts were most commonly used for primary LUCL reconstruction (89.2%), triceps and hamstring tendon autografts were used in revision procedures (35.1% and 32.4%, respectively). Fixation of the humerus was most commonly performed with tenodesis screws (83.8% in primary procedures and 73.0% in revision procedures), and fixation of the ulnaris was generally performed with biceps buttons in both primary procedures (75.7%) and revision procedures (51.4%). Out of 37 patients, eight complications (21.6%) were reported following revision surgery, including three cases of recurrent instability (8.1%). The median QuickDASH score was 42.5 (IQR, 25.4-80.2), and the median PREE score was 13.0 (IQR, 1.0-41.4).

Conclusion: Revision LUCL reconstructions remain challenging. The most common causes of failure are graft insufficiency or loosening, and humeral graft rupture, resulting in recurrent PLRI. Additionally, revision LUCL reconstruction is associated with moderate to poor postoperative outcome scores and a relatively high complication rate.