Journal of Clinical Orthopaedics and Trauma最新文献

Clinical and functional outcomes of a modular fluted titanium stem in complex hip surgery with femoral bone loss

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-12-01 DOI: 10.1016/j.jcot.2024.102843

Imran Shah , Zeeshan Khan , Zainab Aqeel Khan , Ali Ekram , Umer Butt , Junaid Ali Shah

Background

The tapered fluted titanium stem is a viable option for complex hip reconstruction. We therefore, evaluate the results of complex hip arthroplasty for femoral bone loss (Paprosky type IIIA to type IV femoral defect), using a modular fluted titanium stem.

Methods

Data for this retrospective study was collected from the medical records of the 2 participating orthopaedic units from December 2018 to December 2021. Twenty-seven patients who underwent reconstruction of femoral bone loss with a modular fluted titanium stem were included in this study. General, demographic and clinical data including patient's age, comorbidities, ambulatory status before and after surgery, blood transfusion, surgical complications, rehabilitation after surgery, length of stay in hospital (in days), readmission after surgery, implant details and mortality rate were recorded. Clinical evaluation was performed using the oxford hip score and 12-item short-form health survey (SF-12). Complications and survivorship were evaluated using Kaplan–Meier survival rate with 95 % confidence interval.

Results

The mean age for the cohort was 60.14 ± 11.58 years, with mean follow-up of 3.2 years for the study. The median pre-operative OHS was 10 (8), which improved to 39 (12) and 41 (4) at 1 and 2-year postoperative follow-up, respectively (P < 0. 001). The quality of life measures (SF-12 scores) in both mental and physical components showed progressive improvement at 2 years follow-up with P- value < 0.001. A total of five patients (18.5 %) had postoperative complications, including deep venous thrombosis in one patient, dislocations in two patients and one patient each with superficial and deep infection. The implant survival rate was 100 % at mean follow-up of 3.2 years.

Conclusions

Proximal femur reconstruction with a modular fluted titanium stem restores mobility, improves the quality of life and reduces pain significantly. It can be considered as a good option as a salvage procedure.

{"title":"Clinical and functional outcomes of a modular fluted titanium stem in complex hip surgery with femoral bone loss","authors":"Imran Shah , Zeeshan Khan , Zainab Aqeel Khan , Ali Ekram , Umer Butt , Junaid Ali Shah","doi":"10.1016/j.jcot.2024.102843","DOIUrl":"10.1016/j.jcot.2024.102843","url":null,"abstract":"<div><h3>Background</h3><div>The tapered fluted titanium stem is a viable option for complex hip reconstruction. We therefore, evaluate the results of complex hip arthroplasty for femoral bone loss (Paprosky type IIIA to type IV femoral defect), using a modular fluted titanium stem.</div></div><div><h3>Methods</h3><div>Data for this retrospective study was collected from the medical records of the 2 participating orthopaedic units from December 2018 to December 2021. Twenty-seven patients who underwent reconstruction of femoral bone loss with a modular fluted titanium stem were included in this study. General, demographic and clinical data including patient's age, comorbidities, ambulatory status before and after surgery, blood transfusion, surgical complications, rehabilitation after surgery, length of stay in hospital (in days), readmission after surgery, implant details and mortality rate were recorded. Clinical evaluation was performed using the oxford hip score and 12-item short-form health survey (SF-12). Complications and survivorship were evaluated using Kaplan–Meier survival rate with 95 % confidence interval.</div></div><div><h3>Results</h3><div>The mean age for the cohort was 60.14 ± 11.58 years, with mean follow-up of 3.2 years for the study. The median pre-operative OHS was 10 (8), which improved to 39 (12) and 41 (4) at 1 and 2-year postoperative follow-up, respectively (P < 0. 001). The quality of life measures (SF-12 scores) in both mental and physical components showed progressive improvement at 2 years follow-up with P- value < 0.001. A total of five patients (18.5 %) had postoperative complications, including deep venous thrombosis in one patient, dislocations in two patients and one patient each with superficial and deep infection. The implant survival rate was 100 % at mean follow-up of 3.2 years.</div></div><div><h3>Conclusions</h3><div>Proximal femur reconstruction with a modular fluted titanium stem restores mobility, improves the quality of life and reduces pain significantly. It can be considered as a good option as a salvage procedure.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102843"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744044","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}

引用次数: 0

Prospective study of the functional and radiological outcome of subtrochanteric femur fractures treated by long proximal femoral nailing in lateral decubitus position

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-12-01 DOI: 10.1016/j.jcot.2024.102842

Dr Karan R. Lakhani , Dr Sumedh Chaudhary , Dr Shrikant Gade , Dr Aashay Sonkusale

Background

Subtrochanteric fractures are subject to a variety of deforming forces that pose challenges to achieving an optimal reduction. This study aims to assess and highlight the advantages of treating these fractures with a long proximal femoral nail while in the lateral decubitus position.

Method

This prospective study was carried out on 35 patients in our institute, managed with long proximal femoral nailing in lateral decubitus position. After surgery, the patients underwent functional and radiological evaluations one, three, and six months later.

Results

Patients in the age group of 18–80 were operated on in this study. The mean age was 52.57, with 14 % [20/35] being males and 42.86 % [15/35] being females. 65 % [23/35] patients had a Russell Taylor type 1A fracture, 20 % [7/35] had 1B type, 8.6 % [3/35] had 2A type and 5.7 % [2/35] had 2B type. The average duration of the surgical procedures was 80 min. The average intraoperative blood loss was 105 ml. Intraoperative reduction assessment using the Modified Baumgartner classification showed 60 % [21/35] having a good reduction, 31.5 % [11/35] having an acceptable reduction, and 8.5 % [3/35] having poor reduction. Mean Harris Hip Score at the end of 6 months was 88 with 38.7 % [12/35] having excellent outcome, 41.9 % [13/35] having good outcome, 12.9 % [4/35] having fair outcome, 6.4 % [2/35] having poor outcome. The most common postoperative complication was shortening with 8.5 % [3/35].

Conclusion

The lateral decubitus position when by utilizing a long proximal femoral nail in subtrochanteric fractures has been demonstrated to facilitate easier identification of the entry point and provide easier access for reaming. This also reduced operative time while improving fracture reduction and subsequently radiological and functional outcomes.

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引用次数: 0

Optimizing surgical management of acetabulum fractures involving both columns using buttress plating of posterior column through AIP approach

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-12-01 DOI: 10.1016/j.jcot.2024.102837

Sandeep Kumar , Shataayu Gugale , Rohit Goyal , Akash Mishra , Vivek Bhambhu , Ganpat Choudhary

Introduction

Acetabulum fractures involving both columns are complicated injuries to treat, and achieving satisfactory post operative reduction with less extensile approaches is difficult. These injuries often require dual approaches, associated with their own share of complications. The anterior intrapelvic approach (AIP) addresses both columns through a single approach, minimizing these complications. Specifically, posterior column fixation is of utmost importance. This study aims to evaluate functional outcomes and complications of posterior column fixation using medial surface buttress plate in fractures involving both columns.

Materials and methods

Between 2017 and 2024, 366 patients had fractures involving both columns, out of which 64 were operated using the AIP approach. Excluding patients with displaced posterior wall fractures, transverse fractures, delayed treatment, or aged under 18 years. Out of 64, we collected data from 60 patients, as 4 patients could not be followed up. All patients were operated using the AIP approach, and posterior column fixation was done using 3.5 mm reconstruction plates. Patients were followed for minimum 6 months–70 months, with an average of 29 months. The associations between variables and functional outcomes were examined using the Chi-Square Test or Fisher's Exact Test.

Results

The study included 60 patients, with 48.3 % under 40 years old and 51.7 % older. Males comprised 68.3 % of the cohort. 46.7 % sustained road traffic accidents and 53.3 % had fall from height. T-type fractures were most common (50.0 %), with high posterior column fractures in 66.7 % of patients. Post-operative reductions less than 1 mm were achieved in 80.0 % of patients. Functional outcomes using the Harris hip Scores were found to be excellent to good in 90.0 % of patients.

Conclusion

We conclude that medial surface buttress plating of the posterior column using the standard AIP approach can be utilised to treat even the most complex of acetabular fracture patterns involving both anterior as well as posterior columns, excluding those that contain a displaced posterior wall.

{"title":"Optimizing surgical management of acetabulum fractures involving both columns using buttress plating of posterior column through AIP approach","authors":"Sandeep Kumar , Shataayu Gugale , Rohit Goyal , Akash Mishra , Vivek Bhambhu , Ganpat Choudhary","doi":"10.1016/j.jcot.2024.102837","DOIUrl":"10.1016/j.jcot.2024.102837","url":null,"abstract":"<div><h3>Introduction</h3><div>Acetabulum fractures involving both columns are complicated injuries to treat, and achieving satisfactory post operative reduction with less extensile approaches is difficult. These injuries often require dual approaches, associated with their own share of complications. The anterior intrapelvic approach (AIP) addresses both columns through a single approach, minimizing these complications. Specifically, posterior column fixation is of utmost importance. This study aims to evaluate functional outcomes and complications of posterior column fixation using medial surface buttress plate in fractures involving both columns.</div></div><div><h3>Materials and methods</h3><div>Between 2017 and 2024, 366 patients had fractures involving both columns, out of which 64 were operated using the AIP approach. Excluding patients with displaced posterior wall fractures, transverse fractures, delayed treatment, or aged under 18 years. Out of 64, we collected data from 60 patients, as 4 patients could not be followed up. All patients were operated using the AIP approach, and posterior column fixation was done using 3.5 mm reconstruction plates. Patients were followed for minimum 6 months–70 months, with an average of 29 months. The associations between variables and functional outcomes were examined using the Chi-Square Test or Fisher's Exact Test.</div></div><div><h3>Results</h3><div>The study included 60 patients, with 48.3 % under 40 years old and 51.7 % older. Males comprised 68.3 % of the cohort. 46.7 % sustained road traffic accidents and 53.3 % had fall from height. T-type fractures were most common (50.0 %), with high posterior column fractures in 66.7 % of patients. Post-operative reductions less than 1 mm were achieved in 80.0 % of patients. Functional outcomes using the Harris hip Scores were found to be excellent to good in 90.0 % of patients.</div></div><div><h3>Conclusion</h3><div>We conclude that medial surface buttress plating of the posterior column using the standard AIP approach can be utilised to treat even the most complex of acetabular fracture patterns involving both anterior as well as posterior columns, excluding those that contain a displaced posterior wall.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102837"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744046","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}

引用次数: 0

Etiology and prosthesis model have no influence in the functional outcomes of total knee arthroplasty revision surgery at five years 病因和假体型号对五年后全膝关节置换术翻修手术的功能效果没有影响

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-25 DOI: 10.1016/j.jcot.2024.102844

Vicent Hurtado-Oliver, Marta Gracia-Ochoa, Sonia Orenga-Montoliu, Sonia Escribano-Zacarés, José Carlos Martínez-Algarra, Damián Mifsut

Background

The rising number of total knee arthroplasty (TKA) replacements and their uncertain functional results according to the revision etiology and the prosthesis model implanted are a challenge for orthopedic surgeons and patients. A better knowledge of these results is mandatory to make the best decision. We present our clinical outcomes with a 5-year follow-up.

Methods

We retrospectively reviewed 104 patients, 108 knees (77 aseptic and 31 septic), who underwent TKA revision surgery from 2007 to 2017 with three different models of prosthesis. KSS score, range of motion (ROM), pain, and independence for walking were recorded at 5 years according to our own database and the clinical interview and compared to the different models of prosthesis and the etiology of the revision.

Results

The results showed 81.5 % of good or excellent functional outcomes in our patients with a mean KSS score of 76,7 ± 14,3, a mean ROM of 1.68 ± 0.30 radians, and 77 % of them are independent for walking without any aids. The results do not show any difference between the groups comparing the model of prosthesis and the etiology of the revision surgery.

Conclusions

At 5 years, TKA revision surgery offers good clinical and functional outcomes, independence for walking, good range of motion, and low residual pain regardless of the cause of the revision or the model of prosthesis.

背景全膝关节置换术（TKA）的数量不断增加，而根据翻修病因和植入的假体型号不同，其功能效果也不确定，这对骨科医生和患者来说都是一个挑战。为了做出最佳决策，必须更好地了解这些结果。方法我们回顾性分析了2007年至2017年期间接受TKA翻修手术的104例患者，108个膝关节（77个无菌性膝关节和31个化脓性膝关节），使用了三种不同型号的假体。根据我们自己的数据库和临床访谈记录了患者5年后的KSS评分、活动范围（ROM）、疼痛和行走独立性，并与不同型号的假体和翻修的病因进行了比较。结果结果显示，我们的患者中有81.5%的功能结果良好或极佳，平均KSS评分为76.7±14.3分，平均活动范围（ROM）为1.68±0.30弧度，77%的患者无需任何辅助工具即可独立行走。结论无论翻修原因或假体型号如何，TKA 翻修手术在 5 年后都能提供良好的临床和功能预后、独立行走、良好的活动范围和较低的残余疼痛。

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引用次数: 0

Takeout or delivery? Reoperation rates in lower extremity long bone osteomyelitis treated with debridement and local antibiotic delivery systems 外卖还是送餐？采用清创和局部抗生素给药系统治疗下肢长骨骨髓炎的再手术率

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-22 DOI: 10.1016/j.jcot.2024.102839

Nolan M. Reinhart , Jackson P. Tate , Jacob S. Budin , Julianna E. Winter , Olivia C. Lee , William F. Sherman

Background

Early diagnosis and treatment of osteomyelitis is essential to prevent potential complications including sepsis, extensive bone resection, amputation, and death. Despite current treatment strategies for management of osteomyelitis, recurrence rates reported in the literature are upwards of 25 %. Current evidence comparing the efficacy of differing surgical treatments of osteomyelitis is inconclusive. The purpose of this study is to compare rates of re-debridement and amputation in patients who receive either debridement alone or debridement with placement of local antibiotic delivery systems as initial treatment for lower extremity long bone osteomyelitis.

Methods

A retrospective cohort study was performed to investigate complication rates after surgical treatment methods for osteomyelitis of the femur and tibia. The rates of re-debridement and amputation were compared in patients who received either debridement alone or debridement with placement of local antibiotic delivery systems.

Results

This study reports 73 % lower rates of re-debridement after debridement and local antibiotic delivery in tibial osteomyelitis, and 83 % lower rates of re-debridement after debridement and placement of local antibiotic delivery systems in femoral osteomyelitis compared to debridement alone. There was no significant difference in amputation rates between treatment groups for either tibial (7.4 vs 5.7 %; OR: 1.31; 95 % CI, 0.92–1.87) or femoral osteomyelitis (2.4 vs 1.4 %; OR: 1.65; 95 % CI, 0.71–4.01).

Conclusion

There was a significantly decreased likelihood of re-debridement for patients who underwent initial treatment with combined debridement and placement of antibiotic delivery systems compared to debridement alone. Providers may consider this when comparing treatment options for their patients with lower extremity osteomyelitis.

背景骨髓炎的早期诊断和治疗对于预防潜在并发症（包括败血症、大面积骨切除、截肢和死亡）至关重要。尽管目前有治疗骨髓炎的策略，但文献报道的复发率高达 25%。目前，比较不同骨髓炎手术疗法疗效的证据尚无定论。本研究旨在比较下肢长骨骨髓炎患者在接受单纯清创术或清创术并放置局部抗生素给药系统作为初始治疗时的再次清创率和截肢率。方法本研究进行了一项回顾性队列研究，调查股骨和胫骨骨髓炎手术治疗方法后的并发症发生率。结果该研究报告显示，与单纯清创相比，胫骨骨髓炎患者在清创并使用局部抗生素后的再清创率降低了73%，股骨骨髓炎患者在清创并使用局部抗生素后的再清创率降低了83%。胫骨骨髓炎（7.4 vs 5.7 %；OR：1.31；95 % CI，0.92-1.87）或股骨髓炎（2.4 vs 1.4 %；OR：1.65；95 % CI，0.71-4.01）的截肢率在治疗组之间没有明显差异。医疗服务提供者在比较下肢骨髓炎患者的治疗方案时可以考虑这一点。

{"title":"Takeout or delivery? Reoperation rates in lower extremity long bone osteomyelitis treated with debridement and local antibiotic delivery systems","authors":"Nolan M. Reinhart , Jackson P. Tate , Jacob S. Budin , Julianna E. Winter , Olivia C. Lee , William F. Sherman","doi":"10.1016/j.jcot.2024.102839","DOIUrl":"10.1016/j.jcot.2024.102839","url":null,"abstract":"<div><h3>Background</h3><div>Early diagnosis and treatment of osteomyelitis is essential to prevent potential complications including sepsis, extensive bone resection, amputation, and death. Despite current treatment strategies for management of osteomyelitis, recurrence rates reported in the literature are upwards of 25 %. Current evidence comparing the efficacy of differing surgical treatments of osteomyelitis is inconclusive. The purpose of this study is to compare rates of re-debridement and amputation in patients who receive either debridement alone or debridement with placement of local antibiotic delivery systems as initial treatment for lower extremity long bone osteomyelitis.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed to investigate complication rates after surgical treatment methods for osteomyelitis of the femur and tibia. The rates of re-debridement and amputation were compared in patients who received either debridement alone or debridement with placement of local antibiotic delivery systems.</div></div><div><h3>Results</h3><div>This study reports 73 % lower rates of re-debridement after debridement and local antibiotic delivery in tibial osteomyelitis, and 83 % lower rates of re-debridement after debridement and placement of local antibiotic delivery systems in femoral osteomyelitis compared to debridement alone. There was no significant difference in amputation rates between treatment groups for either tibial (7.4 vs 5.7 %; OR: 1.31; 95 % CI, 0.92–1.87) or femoral osteomyelitis (2.4 vs 1.4 %; OR: 1.65; 95 % CI, 0.71–4.01).</div></div><div><h3>Conclusion</h3><div>There was a significantly decreased likelihood of re-debridement for patients who underwent initial treatment with combined debridement and placement of antibiotic delivery systems compared to debridement alone. Providers may consider this when comparing treatment options for their patients with lower extremity osteomyelitis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102839"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705321","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}

引用次数: 0

An updated meta analysis on traumatic causes of thigh compartment syndrome 关于大腿间室综合征外伤原因的最新荟萃分析

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-22 DOI: 10.1016/j.jcot.2024.102840

Amber Park , Josie Bunstine , Tyler Williamson , Lisa K. Cannada

引用次数: 0

Metal backed glenoid vs all polyethylene glenoid components in total shoulder arthroplasty, a narrative review 全肩关节置换术中金属背盂顶组件与全聚乙烯盂顶组件的对比综述

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-21 DOI: 10.1016/j.jcot.2024.102838

Mr John Ranson , Mr Alastair Konarski , Mr Chris Peach

引用次数: 0

Novel technique for achieving the under-correction of native tibial varus in calipered restricted kinematically aligned total knee arthroplasty - A validation study 在卡钳限制的运动学对齐全膝关节置换术中实现原生胫骨内翻矫正的新技术--一项验证研究

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-20 DOI: 10.1016/j.jcot.2024.102832

Arghya Kundu Choudhury , Shivam Bansal , Souvik Paul , S. Raja Balgovind , Sajid Ansari , Roop Bhushan Kalia

Purpose

Restricted kinematic alignment (rKA) TKA is relatively newer technique for achieving an overall under-corrected limb alignment. The present study aims to provide an easy and reproducible technique for achieving calipered rKA-TKA (crKA-TKA) using routine instrumentation.

Method

A prospective study was conducted including 30 patients (30 knees). All patients underwent crKA-TKA by the same surgeon. Pre-operatively all patients underwent long film standing radiographs, and coronal angles were measured to plan tibial bony cuts and the femoral axis angle (FAA) to restore tibial varus under correction and native distal femoral anatomy, respectively. Intra-operatively while taking tibial cuts, the alignment rod was noted to be always pointing towards the “third metatarsal” of the ipsilateral foot.

Results

30 patients underwent total knee replacement with crKA technique. Angular corrections were satisfactory with all patients reaching the target MPTA of 87.48 ± 0.78 and LDFA of 90.301 ± 2.66 as planned, with an overall under-corrected limb alignment. HKA was achieved within a target of < ± 3 degrees of the native knee (3.56 ± 1.29). Post-operative radiological parameters were checked by two separate observers with excellent intra-class correlation coefficients.

Conclusion

The present study validates a novel intra-operative technique of confirming an under-corrected native tibial varus while performing crKA-TKA. The radiological outcomes of the study confirm that with careful pre-operative planning, coronal angular targets were easily achievable with very less outliers. Study further establishes that this method of calipered technique in rKA-TKA using routine digital templating software and standard instrumentations is an alternative method of executing rKA.

Level of evidence

IV, Prospective case series.

目的限制性运动对位（rKA）TKA 是一种相对较新的技术，可实现整体欠矫正肢体对位。本研究旨在提供一种简便、可重复的技术，使用常规器械实现校正后的 rKA-TKA（crKA-TKA）。所有患者均由同一位外科医生进行 crKA-TKA 手术。术前，所有患者均接受了长片立位X光片检查，并测量了冠状角，以规划胫骨骨性切口和股骨轴角（FAA），从而分别恢复胫骨外翻矫正下和原生股骨远端解剖结构。术中进行胫骨切口时，注意对位杆始终指向同侧足的 "第三跖骨"。所有患者都按计划达到了 87.48 ± 0.78 的 MPTA 目标值和 90.301 ± 2.66 的 LDFA 目标值，角度校正效果令人满意，但肢体对线总体校正不足。HKA的目标值为原生膝关节的< ± 3度（3.56 ± 1.29）。本研究验证了一种新颖的术中技术，即在进行 crKA-TKA 时确认未充分矫正的原生胫骨外翻。研究的放射学结果证实，通过仔细的术前规划，冠状角度目标很容易实现，异常值非常小。研究进一步证实，这种使用常规数字模板软件和标准器械的rKA-TKA卡钳技术是实施rKA的另一种方法。

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引用次数: 0

The kinematic coupling during Ponseti correction in idiopathic clubfoot: A quantitative analysis 特发性马蹄内翻足在 Ponseti 矫正过程中的运动耦合：定量分析

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-19 DOI: 10.1016/j.jcot.2024.102831

Anil Agarwal , Sitanshu Barik , Yogesh Patel , Abdus Sami , Mohit Gera

Background

The study aimed to quantify and correlate kinematic coupling linkage of foot abduction (correction of adduction) and inversion, heel varus and ankle equinus for clubfeet corrected by Ponseti technique.

Methods

Measurements of foot abduction (derotation of carpopedal block), heel varus and ankle equinus were available from Dimeglio scores in 25 feet. Radiological angles were considered for foot inversion-eversion. Values of above parameters were obtained at the start of treatment (T1), pre tenotomy (T2) and after tenotomy (T3). The values of T2-T1 corresponded to the manipulative phase of Ponseti technique while T3-T2 corresponded to the Achilles tenotomy.

Results

During the manipulative phase, coupling rhythm between foot abduction to correction of equinus, heel varus and inversion was calculated to be 1:0.3, 1:1.1 and 1:0.5 respectively. Post tenotomy, coupling rhythm between ankle dorsiflexion to changes in foot abduction, heel varus and inversion was calculated to be 1:0.5, 1:0.1 and 1:0.4 respectively. A moderate significant correlation was obtained on comparison of T3-T2 values between clinical equinus and foot abduction (r = 0.54, p = 0.05).

Conclusion

The foot inversion, heel varus and ankle equinus corrected at 1.1, 0.5 and 0.3 times respectively of foot abduction in the manipulative phase. The phenomenon of kinematic coupling between various foot movements was however inconsistent during Ponseti treatment of clubfoot. More significant associations were obvious towards late phase of deformity correction when foot alignments were much improved. Larger prospective studies are needed to delineate the precise linkage between foot movements in a pathological condition such as clubfoot.

Level of evidence - II.

背景该研究旨在量化和关联通过 Ponseti 技术矫正的马蹄内翻足的足外展（内收矫正）和内翻、足跟外翻和踝关节等位的运动耦合联系。足内翻-外翻的放射学角度被考虑在内。上述参数值分别在治疗开始时（T1）、腱膜切开术前（T2）和腱膜切开术后（T3）获得。结果在操作阶段，足外展与矫正马蹄内翻足、足跟外翻和足内翻之间的耦合节奏分别为 1:0.3、1:1.1 和 1:0.5。韧带切除术后，踝关节外展与足外展、足跟内翻和足内翻变化之间的耦合节律分别为 1:0.5、1:0.1 和 1:0.4。临床马蹄内翻足与足外展之间的 T3-T2 值比较结果呈中度显着相关性（r = 0.54，p = 0.05）。然而，在庞塞蒂治疗马蹄内翻足的过程中，各种足部运动之间的运动耦合现象并不一致。在畸形矫正的后期，足部排列得到了很大改善，此时足部运动之间的关联更为明显。需要进行更大规模的前瞻性研究，以确定足部运动在足外翻等病理情况下的确切联系。

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引用次数: 0

Accuracy and reliability of the AO/OTA classification for tibial shaft fractures 胫骨轴骨折 AO/OTA 分类的准确性和可靠性

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-19 DOI: 10.1016/j.jcot.2024.102826

Rasmus Stokholm , Peter Larsen , Jan Duedal Rölfing , Marie Arildsen , Christian Grundtvig Rasmussen , Rasmus Elsoe

Background

Available literature lacks information regarding the accuracy and reliability of the AO/OTA classification for tibial shaft fractures. This study aimed to assess the inter- and intra-observer agreement and accuracy of the AO/OTA 42 classification (4-signs) for adult patients with tibial shaft fractures.

Materials and methods

The study design is an accuracy, inter- and intra-observer agreement study. Anterior posterior (AP) and lateral X-rays of the fracture were used in the examination. The raters comprised of two junior doctors and two orthopedic trauma consultants, who underwent patient scoring twice in a blinded and randomized set-up. A committee including two consultant orthopedic trauma surgeons, one consultant orthopedic radiologist, and one associate professor was established to represent the “gold standard.” The 3- and 4-signs AO/OTA 42 classification was used for classification.

Results

A total of 101 patients were included. X-rays were available for all 101 patients. Based on the gold standard classification, AO/OTA 42-A1 (56 %) was the most common fracture type, followed by AO/OTA 42-A3 (14 %). The agreement at 4-signs, when comparing the four raters and the gold standard classification was between 75 % and 86 % (Choen's kappa 0.53 to 0.79). Choen's kappa coefficient at 4-sgns for intra-and inter-observer agreement was between 0.47 and 0.74 and 0.31 and 0.60, respectively.

Conclusion

This study showed substantial to moderate accuracy of the 4-signs AO/OTA 42- classification for tibial shaft fractures. Intra-observation agreements at 4-signs showed moderate to substantial agreement with and without available CT scans. Inter-observer agreements at 4-signs showed moderate to substantial agreement with only X-rays available. Inter-observer agreements for CT scan at 4-signs showed slight to moderate agreements.

背景现有文献缺乏有关胫骨轴骨折 AO/OTA 分类准确性和可靠性的信息。本研究旨在评估成年胫骨轴骨折患者的 AO/OTA 42 分类（4-标志）的观察者之间和观察者内部的一致性和准确性。在检查中使用了骨折的前后位（AP）和侧位 X 光片。评分者包括两名初级医生和两名创伤骨科顾问，他们在盲法和随机设置的情况下对患者进行了两次评分。成立了一个委员会，其中包括两名创伤骨科顾问医生、一名骨科放射顾问医生和一名副教授，以代表 "金标准"。结果共有 101 名患者被纳入其中。所有 101 名患者都有 X 光片。根据金标准分类，最常见的骨折类型是 AO/OTA 42-A1（56%），其次是 AO/OTA 42-A3（14%）。在比较四位评分者和金标准分类时，四次评分的一致性在 75% 到 86% 之间（Choen's kappa 0.53 到 0.79）。观察者内部和观察者之间在 4 次评分时的 Choen's kappa 系数分别为 0.47 至 0.74 和 0.31 至 0.60。在有CT扫描和没有CT扫描的情况下，4-signs的观察内一致性显示为中度到高度一致。在只有 X 光片的情况下，4-signs 的观察者之间的一致性为中等至基本一致。CT扫描的4点观察值的观察者间一致性为轻微至中等。

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引用次数: 0