European Journal of Orthopaedic Surgery and Traumatology最新文献

Background and objectives: Paediatric spine deformity, often arising from congenital or neuromuscular causes, can significantly impair cardiopulmonary and intra-abdominal function. Early identification and timely management are crucial to slowing curve progression. However, in LMICs, patients present late with severe curvatures exceeding 90°. Preoperative reduction is useful to mitigate surgical risks. This study assessed the feasibility of a modified halo-pelvic distraction device, focusing on major curve correction and complication rates.

Methods: Patients with severe scoliosis were enrolled from November 2023-October 2024, each undergoing treatment with a modified halo-pelvic Ilizarov distraction device over a 13-week period. Radiographic major curve changes, neurological function, and complication rates were assessed at defined treatment intervals.

Results: Seven patients were included, with a median age of 15 years (IQR 14-20); four were male. The baseline median major curve was 110° (IQR 92°-120°), including three cases of adolescent idiopathic scoliosis (AIS). Following 13 weeks of distraction, the median curve improved to 69°, representing a 63% correction (p = 0.027). One patient developed transient lower limb weakness (MRC 2/5), and another experienced superior mesenteric artery syndrome; both resolved after adjustment of traction forces and subsequent removal of the device. Definitive corrective surgery was performed in six patients, achieving a final curve correction to 49° (32°-55°).

Conclusions: The modified halo-pelvic Ilizarov distraction technique can be a feasible preoperative strategy for achieving meaningful correction in severe spinal deformities. Expanding the use of this technique especially in LMICs could offer greater insight into its potential benefits and safety.

Purpose: The surgical management of severe adolescent idiopathic scoliosis (AIS) remains a subject of ongoing discussion among spine-deformity surgeons. While there has been a prevailing shift towards posterior-only fusion (PF) techniques, anterior release with posterior fusion (ARPF) may still be valuable for the correction of large or stiff curves. This study compared the clinical and radiological outcomes of PF and ARPF in a high-volume spinal deformity unit.

Methods: Patients aged 10-18 years with AIS and a major thoracic curve ≥ 70^° (Lenke Types 1-4), who underwent PF or ARPF between 2010 and 2019, with ≥ 2 years of follow-up were included. Correction index formed the primary outcome, complemented by several secondary radiological and clinical measures assessed preoperatively, at first-erect radiograph and final follow-up.

Results: Eighty-nine patients were included (PF = 51; ARPF = 38). Baseline characteristics were similar except ARPF patients were younger (13.7 vs 1.4.8, p = 0.001) and less skeletally mature (Risser 0-2: 60.5% vs 37.3%). Baseline Cobb angle was comparable (p = 0.0634), but ARPF patients had stiffer curves (p = 0.0257), reduced flexibility (p = 0.0408), and achieved a significantly higher CI at final follow-up (248.2% vs. 168.1%, p = 0.0024). Operative time, blood loss and length of stay were greater for ARPF.

Conclusions: ARPF offers a corrective advantage for patients with stiffer curves and lower skeletal maturity, who are at risk of developing crankshaft phenomena. However, the increased operative morbidity supports PF alone as sufficient for most patients. These results highlight the importance of tailoring surgical strategy to curve characteristics and skeletal maturity to optimise correction and minimise risk.

Purpose: Hip fracture (HF) is a common geriatric trauma resulting in a substantial rate of mortality and morbidity. Previous studies have shown that the application of leg compression significantly reduced the incidence of perioperative hypotension (PeH) and hypotension-related complication in obstetric surgery. The objective of this study was to evaluate the effect of medical compression stocking for prevention of PeH in elderly patients undergoing HF surgery.

Methods: Sixty patients were randomized in 2 groups: compression stocking (CS) group and no compression stocking (NCS) group (n = 30 each). Compression stockings were worn on the uninjured leg after spinal anesthesia and then removed after 24 h postoperatively. Demographic and perioperative data were collected. Primary outcome was the incidence of PeH measuring as 3 methods: intraoperative hypotension (IoH), postoperative hypotension (PoH), and concomitant intraoperative and postoperative hypotension (CoIPH). The secondary outcomes were the incidence of using intraoperative vasopressor and in-hospital hypotension-related complications related to hip fracture.

Results: Baseline characteristics such as age, gender, diagnosis and operation were not significant difference between groups (p > 0.05 all). Regards the PeH, CS group demonstrated a significantly lower incidence in CoIPH than NCS group (0 patients vs. 6 patients, p = 0.02), and also showed a non-significantly lower incidence of the PoH and hypotension-related complication (p = 0.13 and 0.10, respectively). However, the IoH, and the need of intraoperative vasopressor did not significantly differ between both groups (p > 0.05 all).

Conclusion: The application of medical compression stocking in elderly patients undergoing HF surgery demonstrated an ability to reduce the incidence of hypotension perioperatively and might prevent in-hospital hypotension-related complication.

Introduction: Patella fractures are articular injuries that can alter knee biomechanics, disrupt joint contact forces, and promote cartilage degeneration. However, progression to reconstructive surgery is not fully characterized. This study investigates the risk of progression to total knee arthroplasty (TKA) following patella fractures and assesses whether initial operative versus nonoperative management impacts this risk.

Methods: We retrospectively analyzed TKA progression in patients with patella fractures using synthetic data from a large Level I academic trauma center (1996-2024). Patients were identified by historic diagnostic codes for patella fractures and TKA. Age-stratified TKA rates were compared to published national data, and indirect standardization was used to calculate the age-adjusted standardized incidence ratio (SIR), risk difference (RD), and attributable risk percent (AR%).

Results: Among 3212 native patella fractures, 263 patients (8.2%) later underwent TKA. The mean age at fracture was 58.1 years (SD 17.5) with a mean time to TKA of 4.1 years (SD 4.9). The SIR for TKA was 1.6 (95% CI 1.3-1.9), RD 3.1%, and AR% 37.2%. In the 406 operatively treated fractures (mean age 55.3 years, SD 18.6; 60.8% female), TKA occurred in 5.4% (SIR 1.4, 95% CI 0.9-2.2), compared to 8.6% in the 2,806 nonoperatively treated fractures (mean age 58.5 years, SD 17.4; 61.8% female; SIR 2.1, 95% CI 1.8-2.3) (p = 0.04).

Conclusion: Individuals with patella fractures face an increased lifetime risk of advanced joint degeneration and subsequent TKA compared to the general population, with nonoperative treatment linked to a higher risk than operative management. Further analysis of initial injury patterns, radiographic findings, and patient factors are in need for further research to understand and validate these findings.