Rohit Ailani, Sanjeev Kumar Bhuyan, B. Prasad, Amit Kumar, Namrata Dawani
BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation. While there is consensus about the posterior approach, several posterior approaches have been developed. It is debatable as to which approach is best. AIM To compare triceps reflecting anconeus pedicle (TRAP) and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture. METHODS In total, 40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C, closed, and Gustilo type I intercondylar humeral fractures were included. Patients ranged in age from 18 years to 70 years. The patients were randomized into two groups: TRAP group and olecranon osteotomy group, with 20 cases in each. All were followed up at 6 wk, 3 months, 6 months, and 12 months. Functional outcomes were measured in terms of flexion-extension arc, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score. RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group. The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group (119.5 vs 111.5 min and 9.85 vs 5.45 d, respectively). The mean arc of flexion-extension, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up (107.0 vs 106.2, 18.3 vs 15.7, and 84.2 vs 86.2, respectively). Ulnar paresthesia and superficial infections were comparable in both groups (2 cases vs 3 cases and 3 cases vs 2 cases, respectively). Hardware prominence was significantly higher in the olecranon osteotomy group, mostly due to tension band wiring. CONCLUSION Both approaches were equivalent, but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.
背景肱骨远端髁间骨折的首选治疗方法是切开复位和内固定。虽然人们对后路治疗方法已达成共识，但目前已开发出多种后路治疗方法。哪种方法最好尚存争议。目的 比较肱骨远端髁间骨折内固定的肱三头肌反射髁（TRAP）和肩胛骨截骨法。方法 共纳入 40 例 Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation C 型、闭合型和 Gustilo I 型肱骨髁间骨折病例。患者年龄从18岁到70岁不等。患者被随机分为两组：TRAP组和骨髁截骨组各20例。所有患者均接受了6周、3个月、6个月和12个月的随访。功能结果根据屈伸弧度、手臂、肩部和手部残疾评分以及梅奥肘关节表现评分进行测量。结果 TRAP 组的平均年龄为 43.2 岁，而骨肘截骨术组的平均年龄为 37.5 岁。TRAP组的平均手术时间和平均住院时间（分别为119.5分钟对111.5分钟和9.85天对5.45天）明显高于肩胛骨截骨组。随访12个月时，两组的平均屈伸弧度、手臂、肩部和手部残疾评分以及梅奥肘关节功能评分相当，无明显差异（分别为107.0 vs 106.2、18.3 vs 15.7和84.2 vs 86.2）。两组的尺神经麻痹和浅表感染情况相当（分别为 2 例 vs 3 例和 3 例 vs 2 例）。肩胛骨截骨术组的硬件突出度明显更高，这主要是由于张力带接线造成的。结论 两种方法效果相当，但仍需进一步研究，包括增加受试者人数和延长研究时间，以证明一种方法比另一种方法更有优势。
{"title":"Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures","authors":"Rohit Ailani, Sanjeev Kumar Bhuyan, B. Prasad, Amit Kumar, Namrata Dawani","doi":"10.5312/wjo.v15.i6.570","DOIUrl":"https://doi.org/10.5312/wjo.v15.i6.570","url":null,"abstract":"BACKGROUND\u0000 The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation. While there is consensus about the posterior approach, several posterior approaches have been developed. It is debatable as to which approach is best.\u0000 AIM\u0000 To compare triceps reflecting anconeus pedicle (TRAP) and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.\u0000 METHODS\u0000 In total, 40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C, closed, and Gustilo type I intercondylar humeral fractures were included. Patients ranged in age from 18 years to 70 years. The patients were randomized into two groups: TRAP group and olecranon osteotomy group, with 20 cases in each. All were followed up at 6 wk, 3 months, 6 months, and 12 months. Functional outcomes were measured in terms of flexion-extension arc, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score.\u0000 RESULTS\u0000 The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group. The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group (119.5 vs 111.5 min and 9.85 vs 5.45 d, respectively). The mean arc of flexion-extension, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up (107.0 vs 106.2, 18.3 vs 15.7, and 84.2 vs 86.2, respectively). Ulnar paresthesia and superficial infections were comparable in both groups (2 cases vs 3 cases and 3 cases vs 2 cases, respectively). Hardware prominence was significantly higher in the olecranon osteotomy group, mostly due to tension band wiring.\u0000 CONCLUSION\u0000 Both approaches were equivalent, but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.","PeriodicalId":506838,"journal":{"name":"World Journal of Orthopedics","volume":"40 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141334730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection (SSI). Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI. According to the American College of Surgeons (ACS) Best Practice Guidelines, in 2015, irrigation and debridement should be done within 24 hours. AIM To identify whether early irrigation and debridement, within 8 hours, vs late, between 8 hours and 24 hours, for pediatric open long bone fractures impacts rate of SSI. METHODS Using retrospective data review from the National Trauma Data Bank, Trauma Quality Improvement Project (TQIP) of 2019. TQIP database is own by the ACS and it is the largest database for trauma quality program in the world. Propensity matching analysis was performed for the study. RESULTS There were 390 pediatric patients with open long bone fractures who were included in the study. After completing propensity score matching, we had 176 patients in each category, irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours. We found no significant differences between each group for the rate of deep SSI which was 0.6% for patients who received surgical irrigation and debridement within 8 hours and 1.1% for those who received it after 8 hours [adjusted odd ratio (AOR): 0.5, 95%CI: 0.268-30.909, P > 0.99]. For the secondary outcomes studied, in terms of length of hospital stay, patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days, and those who received it after 8 hours stayed for an average of 3 days, with no significant difference found, and there were also no significant differences found between the discharge dispositions of the patients. CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS: Complete surgical irrigation and debridement within 24 hours.
{"title":"Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures","authors":"Riya Savla, Yen-Hong Kuo, N. Ahmed","doi":"10.5312/wjo.v15.i6.539","DOIUrl":"https://doi.org/10.5312/wjo.v15.i6.539","url":null,"abstract":"BACKGROUND\u0000 Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection (SSI). Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI. According to the American College of Surgeons (ACS) Best Practice Guidelines, in 2015, irrigation and debridement should be done within 24 hours.\u0000 AIM\u0000 To identify whether early irrigation and debridement, within 8 hours, vs late, between 8 hours and 24 hours, for pediatric open long bone fractures impacts rate of SSI.\u0000 METHODS\u0000 Using retrospective data review from the National Trauma Data Bank, Trauma Quality Improvement Project (TQIP) of 2019. TQIP database is own by the ACS and it is the largest database for trauma quality program in the world. Propensity matching analysis was performed for the study.\u0000 RESULTS\u0000 There were 390 pediatric patients with open long bone fractures who were included in the study. After completing propensity score matching, we had 176 patients in each category, irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours. We found no significant differences between each group for the rate of deep SSI which was 0.6% for patients who received surgical irrigation and debridement within 8 hours and 1.1% for those who received it after 8 hours [adjusted odd ratio (AOR): 0.5, 95%CI: 0.268-30.909, P > 0.99]. For the secondary outcomes studied, in terms of length of hospital stay, patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days, and those who received it after 8 hours stayed for an average of 3 days, with no significant difference found, and there were also no significant differences found between the discharge dispositions of the patients.\u0000 CONCLUSION\u0000 Our findings support the recommendation for managing open long bone fractures from the ACS: Complete surgical irrigation and debridement within 24 hours.","PeriodicalId":506838,"journal":{"name":"World Journal of Orthopedics","volume":"32 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141334780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Mazabraud’s syndrome (MS) is a rare and slowly progressive benign disease characterized by the concurrent presence of fibrous dysplasia of bone and intramuscular myxoma, and is thought to be associated with mutations of the GNAS gene. To date, only about 100 cases of MS have been reported in the literature, but its standard treatment strategy remains unclear. CASE SUMMARY We report two cases of MS in young women who underwent different treatments based on their symptoms and disease manifestations. The first patient, aged 37, received internal fixation and intravenous bisphosphonate for a pathological fracture of the right femoral neck, excision of a right vastus medialis myxoma was subsequently performed for pain control, and asymptomatic psoas myxomas were monitored without surgery. Genetic testing confirmed a GNAS gene mutation in this patient. The second patient, aged 24, underwent right vastus intermedius muscle myxoma resection, and conservative treatment for fibrous dysplasia of the ilium. These patients were followed-up for 17 months and 3 years, respectively, and are now in a stable condition. CONCLUSION Various treatments have been selected for MS patients who suffer different symptoms. The main treatment for myxomas is surgical resection, while fibrous dysplasia is selectively treated if the patient experiences pathological fracture or severe pain. However, given the documented instances of malignant transformation of fibrous dysplasia in individuals with MS, close follow-up is necessary.
{"title":"Mazabraud’s syndrome in female patients: Two case reports","authors":"Xiu-Mao Li, Ze-Hao Chen, Ke-Yi Wang, Jun-Nan Chen, Zhao-Nong Yao, Yu-Hong Yao, Xiao-Wei Zhou, Nong Lin","doi":"10.5312/wjo.v15.i6.593","DOIUrl":"https://doi.org/10.5312/wjo.v15.i6.593","url":null,"abstract":"BACKGROUND\u0000 Mazabraud’s syndrome (MS) is a rare and slowly progressive benign disease characterized by the concurrent presence of fibrous dysplasia of bone and intramuscular myxoma, and is thought to be associated with mutations of the GNAS gene. To date, only about 100 cases of MS have been reported in the literature, but its standard treatment strategy remains unclear.\u0000 CASE SUMMARY\u0000 We report two cases of MS in young women who underwent different treatments based on their symptoms and disease manifestations. The first patient, aged 37, received internal fixation and intravenous bisphosphonate for a pathological fracture of the right femoral neck, excision of a right vastus medialis myxoma was subsequently performed for pain control, and asymptomatic psoas myxomas were monitored without surgery. Genetic testing confirmed a GNAS gene mutation in this patient. The second patient, aged 24, underwent right vastus intermedius muscle myxoma resection, and conservative treatment for fibrous dysplasia of the ilium. These patients were followed-up for 17 months and 3 years, respectively, and are now in a stable condition.\u0000 CONCLUSION\u0000 Various treatments have been selected for MS patients who suffer different symptoms. The main treatment for myxomas is surgical resection, while fibrous dysplasia is selectively treated if the patient experiences pathological fracture or severe pain. However, given the documented instances of malignant transformation of fibrous dysplasia in individuals with MS, close follow-up is necessary.","PeriodicalId":506838,"journal":{"name":"World Journal of Orthopedics","volume":"36 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141334979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raymond Klumpp, Linda Boerci, Francesco Buonanotte, Marco Zeppieri
Dual mobility (DM) bearings have gained significant attention in the field of total hip arthroplasty (THA) as a valid treatment option in cases of revision for instability after THA whereas its use in primary THA is still a matter of debate. This manuscript explores the pathology, incidence, diagnosis, treatment options, prognosis, ongoing studies in the literature, and future perspectives related to the use of DM bearings employed in primary THA. DM bearings are primarily designed to address one of the major concerns in THA: Instability of the prosthetic hip. Instability is both for the surgeon and the patient a devastating postoperative complication, leading to significant pain and subsequent apprehension by the patient and may require revision surgeries. The use of DM implants poses the worry of wear-related complications, such as accelerated polyethylene wear and osteolysis, which also pose challenges to long-term implant survival. This technique has seen a steady rise in recent years, with multiple studies reporting favorable outcomes. The incidence of their utilization varies among institutions and surgeons, reflecting differing preferences and patient populations. The diagnosis of instability and wear-related complications in THA often involves clinical assessment, imaging modalities such as X-rays, computed tomography scans, and sometimes advanced imaging techniques like magnetic resonance imaging. DM bearings can be considered as an option when patients present neurologic pathologies such as Parkinson's disease or recurrent dislocations after THA. DM bearings provide an additional articulation point within the implant, facilitating a greater range of motion and inherent stability. This design allows for reduced risk of dislocation and improved functional outcomes. Various implant manufacturers offer different designs and sizes of DM bearings to suit individual patient needs. Current literature suggests that the use of DM bearings in primary THA has demonstrated promising outcomes in terms of enhanced stability, reduced dislocation rates, and improved patient satisfaction. However, long-term studies with larger patient cohorts are necessary to establish the durability and longevity of these implants. Several ongoing studies are investigating the role of DM bearings in primary THA. These studies focus on evaluating long-term implant survivorship, assessing wear patterns, analyzing patient-reported outcomes, and comparing the effectiveness of DM bearings with traditional THA designs. The future of DM bearings in primary THA holds potential for further advancements. Research efforts are aimed at refining implant materials, optimizing designs, and studying the influence of surgical techniques on implant performance. Additionally, continued investigation into the long-term outcomes and cost-effectiveness of DM bearings will play a crucial role in shaping their future use. While further research is warranted, the current evidence supports their
{"title":"Dual mobility in primary total hip arthroplasty: A temptation from the devil or a blessing from above","authors":"Raymond Klumpp, Linda Boerci, Francesco Buonanotte, Marco Zeppieri","doi":"10.5312/wjo.v15.i6.512","DOIUrl":"https://doi.org/10.5312/wjo.v15.i6.512","url":null,"abstract":"Dual mobility (DM) bearings have gained significant attention in the field of total hip arthroplasty (THA) as a valid treatment option in cases of revision for instability after THA whereas its use in primary THA is still a matter of debate. This manuscript explores the pathology, incidence, diagnosis, treatment options, prognosis, ongoing studies in the literature, and future perspectives related to the use of DM bearings employed in primary THA. DM bearings are primarily designed to address one of the major concerns in THA: Instability of the prosthetic hip. Instability is both for the surgeon and the patient a devastating postoperative complication, leading to significant pain and subsequent apprehension by the patient and may require revision surgeries. The use of DM implants poses the worry of wear-related complications, such as accelerated polyethylene wear and osteolysis, which also pose challenges to long-term implant survival. This technique has seen a steady rise in recent years, with multiple studies reporting favorable outcomes. The incidence of their utilization varies among institutions and surgeons, reflecting differing preferences and patient populations. The diagnosis of instability and wear-related complications in THA often involves clinical assessment, imaging modalities such as X-rays, computed tomography scans, and sometimes advanced imaging techniques like magnetic resonance imaging. DM bearings can be considered as an option when patients present neurologic pathologies such as Parkinson's disease or recurrent dislocations after THA. DM bearings provide an additional articulation point within the implant, facilitating a greater range of motion and inherent stability. This design allows for reduced risk of dislocation and improved functional outcomes. Various implant manufacturers offer different designs and sizes of DM bearings to suit individual patient needs. Current literature suggests that the use of DM bearings in primary THA has demonstrated promising outcomes in terms of enhanced stability, reduced dislocation rates, and improved patient satisfaction. However, long-term studies with larger patient cohorts are necessary to establish the durability and longevity of these implants. Several ongoing studies are investigating the role of DM bearings in primary THA. These studies focus on evaluating long-term implant survivorship, assessing wear patterns, analyzing patient-reported outcomes, and comparing the effectiveness of DM bearings with traditional THA designs. The future of DM bearings in primary THA holds potential for further advancements. Research efforts are aimed at refining implant materials, optimizing designs, and studying the influence of surgical techniques on implant performance. Additionally, continued investigation into the long-term outcomes and cost-effectiveness of DM bearings will play a crucial role in shaping their future use. While further research is warranted, the current evidence supports their","PeriodicalId":506838,"journal":{"name":"World Journal of Orthopedics","volume":"26 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141335012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Waleed Albishi, Amjad Albaroudi, Abdulrahman M Alaseem, Sarah Aljasser, Ibrahim Alshaygy, Abdullah Addar
A discoid meniscus is a morphological abnormality wherein the meniscus loses its normal ‘C’ shape. Although most patients are asymptomatic, patients might still present with symptoms such as locking, pain, swelling, or giving way. Magnetic resonance imaging is usually needed for confirmation of diagnosis. Based on a constellation of factors, including clinical and radiological, different approaches are chosen for the management of discoid meniscus. The purpose of this review is to outline the treatment of discoid meniscus, starting from conservative approach, to the different surgical options for this condition. The PubMed and Google Scholar databases were used for this review. Studies discussing the treatment of discoid meniscus from 2018 to 2023 were searched. Initially there were 369 studies retrieved, and after removal of studies using the exclusion criteria, 26 studies were included in this review. Factors such as stability, presence of tear, and morphology can help with surgical planning. Many approaches have been used to treat discoid meniscus, where the choice is tailored for each patient individually. Postoperatively, factors that may positively impact patient outcomes include male sex, body mass index < 18.5, age at symptom onset < 25 years, and duration of symptoms < 24 months. The conventional approach is partial meniscectomy with or without repair; however, recently, there has been an increased emphasis on discoid-preserving techniques such as meniscoplasty, meniscopexy, and meniscal allograft transplantation.
{"title":"Discoid meniscus: Treatment considerations and updates","authors":"Waleed Albishi, Amjad Albaroudi, Abdulrahman M Alaseem, Sarah Aljasser, Ibrahim Alshaygy, Abdullah Addar","doi":"10.5312/wjo.v15.i6.520","DOIUrl":"https://doi.org/10.5312/wjo.v15.i6.520","url":null,"abstract":"A discoid meniscus is a morphological abnormality wherein the meniscus loses its normal ‘C’ shape. Although most patients are asymptomatic, patients might still present with symptoms such as locking, pain, swelling, or giving way. Magnetic resonance imaging is usually needed for confirmation of diagnosis. Based on a constellation of factors, including clinical and radiological, different approaches are chosen for the management of discoid meniscus. The purpose of this review is to outline the treatment of discoid meniscus, starting from conservative approach, to the different surgical options for this condition. The PubMed and Google Scholar databases were used for this review. Studies discussing the treatment of discoid meniscus from 2018 to 2023 were searched. Initially there were 369 studies retrieved, and after removal of studies using the exclusion criteria, 26 studies were included in this review. Factors such as stability, presence of tear, and morphology can help with surgical planning. Many approaches have been used to treat discoid meniscus, where the choice is tailored for each patient individually. Postoperatively, factors that may positively impact patient outcomes include male sex, body mass index < 18.5, age at symptom onset < 25 years, and duration of symptoms < 24 months. The conventional approach is partial meniscectomy with or without repair; however, recently, there has been an increased emphasis on discoid-preserving techniques such as meniscoplasty, meniscopexy, and meniscal allograft transplantation.","PeriodicalId":506838,"journal":{"name":"World Journal of Orthopedics","volume":"41 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141334720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katherine Esser, J. Butler, Mackenzie Roof, Nathaniel P. Mercer, Michael C Harrington, A. P. Samsonov, Andrew J Rosenbaum, J. Kennedy
BACKGROUND Cheilectomy of the 1st metatarsophalangeal joint (MTPJ) is one of the most common procedures for the management of hallux rigidus. However, there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy (MIDC) for the management of hallux rigidus. AIM To evaluate outcomes following MIDC for the management of hallux rigidus. METHODS During November 2023, the PubMed, EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus. RESULTS Six studies were included. In total, 348 patients (370 feet) underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9 ± 16.5 months. The distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows: I (58 patients, 27.1%), II (112 patients, 52.3%), III (44 patients, 20.6%). Three studies performed an additional 1st MTPJ arthroscopy and debridement following MIDC. Retained intra-articular bone debris was observed in 100% of patients in 1 study. The weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9 ± 3.2 to a postoperative score of 87.1. The complication rate was 8.4%, the most common of which was persistent joint pain and stiffness. Thirty-two failures (8.7%) were observed. Thirty-three secondary procedures (8.9%) were performed at a weighted mean time of 8.6 ± 3.2 months following the index procedure. CONCLUSION This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up. A moderate re-operation rate at short-term follow-up was recorded. The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.
{"title":"Outcomes following minimally invasive dorsal cheilectomy for hallux rigidus: A systematic review","authors":"Katherine Esser, J. Butler, Mackenzie Roof, Nathaniel P. Mercer, Michael C Harrington, A. P. Samsonov, Andrew J Rosenbaum, J. Kennedy","doi":"10.5312/wjo.v15.i6.585","DOIUrl":"https://doi.org/10.5312/wjo.v15.i6.585","url":null,"abstract":"BACKGROUND\u0000 Cheilectomy of the 1st metatarsophalangeal joint (MTPJ) is one of the most common procedures for the management of hallux rigidus. However, there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy (MIDC) for the management of hallux rigidus.\u0000 AIM\u0000 To evaluate outcomes following MIDC for the management of hallux rigidus.\u0000 METHODS\u0000 During November 2023, the PubMed, EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus.\u0000 RESULTS\u0000 Six studies were included. In total, 348 patients (370 feet) underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9 ± 16.5 months. The distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows: I (58 patients, 27.1%), II (112 patients, 52.3%), III (44 patients, 20.6%). Three studies performed an additional 1st MTPJ arthroscopy and debridement following MIDC. Retained intra-articular bone debris was observed in 100% of patients in 1 study. The weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9 ± 3.2 to a postoperative score of 87.1. The complication rate was 8.4%, the most common of which was persistent joint pain and stiffness. Thirty-two failures (8.7%) were observed. Thirty-three secondary procedures (8.9%) were performed at a weighted mean time of 8.6 ± 3.2 months following the index procedure.\u0000 CONCLUSION\u0000 This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up. A moderate re-operation rate at short-term follow-up was recorded. The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.","PeriodicalId":506838,"journal":{"name":"World Journal of Orthopedics","volume":"25 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141334939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) that is typically reserved for young active patients because it preserves bone. However, the benefits of HRA only hold true if conversion THA after failed HRA provides acceptable outcomes. AIM To compare patient reported outcomes for conversion THA after HRA failure to primary THA. METHODS A retrospective review of 36 patients (37 hips) that underwent conversion THA for failed HRA between October 2006 and May 2019 by a single surgeon was performed. Patient reported outcomes [modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score] were obtained via an email-based responder-anonymous survey. Outcomes were compared to normative data of a primary THA cohort with similar demographics. Subgroup analysis was performed comparing outcomes of conversion THA for adverse local tissue reaction (ALTR) vs all other causes for failure. RESULTS The study group had a lower mHHS than the control group (81.7 ± 13.8 vs 90.2 ± 11.6, P < 0.01); however, both groups had similar UCLA activity levels (7.5 ± 2.3 vs 7.2 ± 1.6, P = 0.51). Patients that underwent conversion for non-ATLR causes had similar mHHS (85.2 ± 11.5 vs 90.2 ± 11.6, P = 0.11) and higher UCLA activity levels (8.5 ± 1.8 vs 7.2 ± 1.6, P < 0.01) compared to the control group. Patients that underwent conversion for ATLR had worse mHHS (77.1 ± 14.5 vs 90.2 ± 11.6, P < 0.01) and UCLA activity levels (6.1 ± 2.3 vs 7.2 ± 1.6, P = 0.05) when compared to the control group. CONCLUSION Patient outcomes equivalent to primary THA can be achieved following HRA conversion to THA. However, inferior outcomes were demonstrated for ALTR-related HRA failure. Patient selection and perhaps further studies examining alternative HRA bearing surfaces should be considered.
背景 髋关节置换术（HRA）是全髋关节置换术（THA）的替代手术，因其能保留骨质，通常只用于年轻活跃的患者。然而，只有在 HRA 失败后进行 THA 转换并获得可接受的疗效时，HRA 的益处才能得到证实。目的 比较患者报告的 HRA 失败后转换 THA 与初次 THA 的疗效。方法 对2006年10月至2019年5月期间因HRA失败而接受转换THA的36名患者（37个髋关节）进行回顾性研究，研究由一名外科医生负责。患者报告的结果[改良哈里斯髋关节评分（mHHS）、加州大学洛杉矶分校（UCLA）活动评分]是通过电子邮件匿名调查获得的。结果与具有相似人口统计学特征的初级 THA 队列的标准数据进行了比较。对因局部组织不良反应（ALTR）与所有其他失败原因而转换 THA 的结果进行了分组分析比较。结果 研究组的 mHHS 低于对照组（81.7 ± 13.8 vs 90.2 ± 11.6，P < 0.01）；但两组的 UCLA 活动水平相似（7.5 ± 2.3 vs 7.2 ± 1.6，P = 0.51）。与对照组相比，因非 ATLR 原因接受转换的患者具有相似的 mHHS（85.2 ± 11.5 vs 90.2 ± 11.6，P = 0.11）和更高的 UCLA 活动水平（8.5 ± 1.8 vs 7.2 ± 1.6，P < 0.01）。与对照组相比，因 ATLR 而接受转换的患者的 mHHS（77.1 ± 14.5 vs 90.2 ± 11.6，P < 0.01）和 UCLA 活动水平（6.1 ± 2.3 vs 7.2 ± 1.6，P = 0.05）更差。结论 HRA 转换为 THA 后，患者的治疗效果可与初级 THA 相媲美。但是，ALTR相关的HRA失败的治疗效果较差。应考虑对患者进行选择，或许还应就替代 HRA 轴承表面进行进一步研究。
{"title":"Examining the “revisability” benefit of hip resurfacing arthroplasty","authors":"Jose George, Adam J Taylor, T. Schmalzried","doi":"10.5312/wjo.v15.i6.554","DOIUrl":"https://doi.org/10.5312/wjo.v15.i6.554","url":null,"abstract":"BACKGROUND\u0000 Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) that is typically reserved for young active patients because it preserves bone. However, the benefits of HRA only hold true if conversion THA after failed HRA provides acceptable outcomes.\u0000 AIM\u0000 To compare patient reported outcomes for conversion THA after HRA failure to primary THA.\u0000 METHODS\u0000 A retrospective review of 36 patients (37 hips) that underwent conversion THA for failed HRA between October 2006 and May 2019 by a single surgeon was performed. Patient reported outcomes [modified Harris Hip Score (mHHS), University of California Los Angeles (UCLA) activity score] were obtained via an email-based responder-anonymous survey. Outcomes were compared to normative data of a primary THA cohort with similar demographics. Subgroup analysis was performed comparing outcomes of conversion THA for adverse local tissue reaction (ALTR) vs all other causes for failure.\u0000 RESULTS\u0000 The study group had a lower mHHS than the control group (81.7 ± 13.8 vs 90.2 ± 11.6, P < 0.01); however, both groups had similar UCLA activity levels (7.5 ± 2.3 vs 7.2 ± 1.6, P = 0.51). Patients that underwent conversion for non-ATLR causes had similar mHHS (85.2 ± 11.5 vs 90.2 ± 11.6, P = 0.11) and higher UCLA activity levels (8.5 ± 1.8 vs 7.2 ± 1.6, P < 0.01) compared to the control group. Patients that underwent conversion for ATLR had worse mHHS (77.1 ± 14.5 vs 90.2 ± 11.6, P < 0.01) and UCLA activity levels (6.1 ± 2.3 vs 7.2 ± 1.6, P = 0.05) when compared to the control group.\u0000 CONCLUSION\u0000 Patient outcomes equivalent to primary THA can be achieved following HRA conversion to THA. However, inferior outcomes were demonstrated for ALTR-related HRA failure. Patient selection and perhaps further studies examining alternative HRA bearing surfaces should be considered.","PeriodicalId":506838,"journal":{"name":"World Journal of Orthopedics","volume":"25 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141334942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adriano Cannella, Ludovico Caruso, G. Sassara, G. Taccardo, M. Passiatore, M. Marescalchi, R. De Vitis
BACKGROUND Elderly patients maintaining functional independence can now be candidates for primary wrist hemiarthroplasty to manage acute irreparable distal radius fractures (DRFs). However, further investigation with long-term follow-up is required to validate these initial findings. AIM To review the literature on the outcomes of distal radius hemiarthroplasty with available implants to assess its viability as a treatment option. METHODS A comprehensive review of the literature was conducted using electronic databases, including PubMed, Medline, and Scopus. The search terms employed were "distal radius fracture" , "hemiarthroplasty" , "wrist arthroplasty" , and related terminology. The search was restricted to articles published in English from 1980 until June 2023. Inclusion criteria encompassed cases or case series of DRF treated with hemiarthroplasty, providing clinical or radiographic outcomes, and published in peer-reviewed journals. RESULTS A total of 2508 articles from PubMed and 883 from Scopus were identified initially. Following screening and removal of duplicates, 13 articles met the inclusion criteria. These articles, predominantly clinical retrospective studies, provided insights into hemiarthroplasty outcomes, including functional improvements and complications. Hemiarthroplasty was a treatment option for complex DRF, particularly those cases with severe comminution, intraarticular involvement, or severe osteoporosis. Functional outcomes demonstrated improvements in pain relief, wrist mobility, and grip strength, with variability across studies. Complications included implant loosening, infection, nerve injury, and stiffness, with varying incidence rates influenced by surgical techniques and implant choice. Long-term outcomes were inadequately documented, warranting further research. CONCLUSION Hemiarthroplasty is a promising treatment for irreparable DRF in the elderly. Long-term outcomes and complications require further study.
{"title":"Hemiarthroplasty for irreparable distal radius fractures in the elderly: A comprehensive review","authors":"Adriano Cannella, Ludovico Caruso, G. Sassara, G. Taccardo, M. Passiatore, M. Marescalchi, R. De Vitis","doi":"10.5312/wjo.v15.i6.578","DOIUrl":"https://doi.org/10.5312/wjo.v15.i6.578","url":null,"abstract":"BACKGROUND\u0000 Elderly patients maintaining functional independence can now be candidates for primary wrist hemiarthroplasty to manage acute irreparable distal radius fractures (DRFs). However, further investigation with long-term follow-up is required to validate these initial findings.\u0000 AIM\u0000 To review the literature on the outcomes of distal radius hemiarthroplasty with available implants to assess its viability as a treatment option.\u0000 METHODS\u0000 A comprehensive review of the literature was conducted using electronic databases, including PubMed, Medline, and Scopus. The search terms employed were \"distal radius fracture\" , \"hemiarthroplasty\" , \"wrist arthroplasty\" , and related terminology. The search was restricted to articles published in English from 1980 until June 2023. Inclusion criteria encompassed cases or case series of DRF treated with hemiarthroplasty, providing clinical or radiographic outcomes, and published in peer-reviewed journals.\u0000 RESULTS\u0000 A total of 2508 articles from PubMed and 883 from Scopus were identified initially. Following screening and removal of duplicates, 13 articles met the inclusion criteria. These articles, predominantly clinical retrospective studies, provided insights into hemiarthroplasty outcomes, including functional improvements and complications. Hemiarthroplasty was a treatment option for complex DRF, particularly those cases with severe comminution, intraarticular involvement, or severe osteoporosis. Functional outcomes demonstrated improvements in pain relief, wrist mobility, and grip strength, with variability across studies. Complications included implant loosening, infection, nerve injury, and stiffness, with varying incidence rates influenced by surgical techniques and implant choice. Long-term outcomes were inadequately documented, warranting further research.\u0000 CONCLUSION\u0000 Hemiarthroplasty is a promising treatment for irreparable DRF in the elderly. Long-term outcomes and complications require further study.","PeriodicalId":506838,"journal":{"name":"World Journal of Orthopedics","volume":"30 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141334785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood. Dislocation, a severe complication associated with increased mortality and often requiring additional surgery, may occur less frequently with the direct anterior approach compared to the posterior approach. Careful consideration of patient demographics is essential when planning the surgical approach. Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.
{"title":"Direct anterior compared to posterior approach for hip hemiarthroplasty following femoral neck fractures","authors":"Kevin A. Wu, Alexandra N. Krez, A. Anastasio","doi":"10.5312/wjo.v15.i6.605","DOIUrl":"https://doi.org/10.5312/wjo.v15.i6.605","url":null,"abstract":"The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood. Dislocation, a severe complication associated with increased mortality and often requiring additional surgery, may occur less frequently with the direct anterior approach compared to the posterior approach. Careful consideration of patient demographics is essential when planning the surgical approach. Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.","PeriodicalId":506838,"journal":{"name":"World Journal of Orthopedics","volume":"32 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141334782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ravi Saini, Madhan Jeyaraman, Naveen Jeyaraman, V. Jain, Swaminathan Ramasubramanian, K. Iyengar
The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects. The study synthesizes findings from various research papers, emphasizing the growing reliance on mobile technology in healthcare. WhatsApp’s role in orthopaedics is notable for its ease of use, real-time communication, and accessibility. Clinically, it facilitates triage, teleconsultation, diagnosis, treatment, patient advice, and post-operative monitoring. Non-clinically, it supports telemedicine, teleradiology, virtual fracture clinics, research, and education in orthopaedic surgery. The application has proven beneficial in enhancing communication among healthcare teams, providing quick responses, and motivating junior physicians. Its use in educational settings has been shown to improve learner’s understanding and patient care. However, the use of WhatsApp in orthopaedics is not without challenges. Risks include the potential spread of misleading information, privacy concerns, and issues with image quality affecting diagnosis and treatment decisions. The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy. Looking forward, the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval, improve doctor-patient communication, and address challenges like bureaucratic red tape and limited resources. The paper suggests that future orthopaedic practice, particularly in emergency departments, will increasingly rely on such technologies for efficient patient management. This shift, however, must be approached with an understanding of the ethical, legal, and practical implications of integrating social media and mobile technology in healthcare.
WhatsApp 是一种广泛使用的即时通讯应用程序 (IMA)，它与骨科和创伤外科的结合是近年来的一项重大发展。本文探讨了 WhatsApp 在骨科领域的多方面作用，重点关注其临床和非临床应用、优势、劣势和未来前景。本研究综合了多篇研究论文的结论，强调了医疗保健领域对移动技术日益增长的依赖。WhatsApp 在骨科领域的作用主要体现在其易用性、实时通信和可访问性上。在临床上，它有助于分诊、远程会诊、诊断、治疗、患者咨询和术后监测。在非临床方面，它支持远程医疗、远程放射学、虚拟骨折诊所、研究和矫形外科教育。事实证明，该应用程序有利于加强医疗团队之间的沟通，提供快速反应，并激励初级医师。它在教育环境中的使用已被证明可以提高学习者的理解能力和病人护理水平。然而，WhatsApp 在骨科领域的使用并非没有挑战。风险包括误导信息的潜在传播、隐私问题以及影响诊断和治疗决策的图像质量问题。该文件承认了保持专业界限的重要性以及采取监督措施确保内容准确性的必要性。展望未来，WhatsApp 和类似的 IMA 在骨科领域的潜力在于它们能够简化数据收集和检索，改善医患沟通，应对官僚主义和资源有限等挑战。论文认为，未来的骨科实践，尤其是急诊科，将越来越多地依赖此类技术来实现高效的患者管理。然而，要实现这一转变，必须了解将社交媒体和移动技术融入医疗保健的道德、法律和实际影响。
{"title":"Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions","authors":"Ravi Saini, Madhan Jeyaraman, Naveen Jeyaraman, V. Jain, Swaminathan Ramasubramanian, K. Iyengar","doi":"10.5312/wjo.v15.i6.529","DOIUrl":"https://doi.org/10.5312/wjo.v15.i6.529","url":null,"abstract":"The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects. The study synthesizes findings from various research papers, emphasizing the growing reliance on mobile technology in healthcare. WhatsApp’s role in orthopaedics is notable for its ease of use, real-time communication, and accessibility. Clinically, it facilitates triage, teleconsultation, diagnosis, treatment, patient advice, and post-operative monitoring. Non-clinically, it supports telemedicine, teleradiology, virtual fracture clinics, research, and education in orthopaedic surgery. The application has proven beneficial in enhancing communication among healthcare teams, providing quick responses, and motivating junior physicians. Its use in educational settings has been shown to improve learner’s understanding and patient care. However, the use of WhatsApp in orthopaedics is not without challenges. Risks include the potential spread of misleading information, privacy concerns, and issues with image quality affecting diagnosis and treatment decisions. The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy. Looking forward, the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval, improve doctor-patient communication, and address challenges like bureaucratic red tape and limited resources. The paper suggests that future orthopaedic practice, particularly in emergency departments, will increasingly rely on such technologies for efficient patient management. This shift, however, must be approached with an understanding of the ethical, legal, and practical implications of integrating social media and mobile technology in healthcare.","PeriodicalId":506838,"journal":{"name":"World Journal of Orthopedics","volume":"29 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141334918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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