Journal of Clinical Orthopaedics and Trauma最新文献

Background: The shoulder girdle and proximal humerus are common sites for neoplastic lesions be it benign or malignant. We aimed to evaluate the outcomes of a frugal method of reconstruction of the proximal humerus for neoplastic lesions at short to medium term follow-up.

Methods: Data for this retrospective case series was collected from an electronic data base held at the primary authors institution. All patients who had resection of the proximal humerus for any neoplastic lesion and reconstructed with a nail cement spacer were included in the study from January 2016 to January 2023. The functional outcomes were measured by Musculoskeletal tumour society score (MSTS) and the Toronto extremity salvage score (TESS). The survivorship and post-operative complications were also reported.

Results: Twenty-two patients were available at final follow up with a mean follow-up time of 37 ± 18 months (range 12-81 months) with Ewing's sarcoma, giant cell tumour, osteosarcoma and metastatic disease as the commonest indications for surgery with a mean age of 29 ± 17 years. The Kaplan-Meier estimates indicated that the survival rate for 22 patients with endpoint (event) taken as death was 63.6 % and for endpoint taken (event) as implant failure was 95.5 % with mean survival time of 58.1 and 77 months respectively. At final follow up, the mean MSTS score was 23.6 ± 2.9 (78.7 %). One patient had superficial infection which settled with a short course of oral antibiotics and one patient had breakage of nail, which was revised.

Conclusion: These results prove that this frugal method of reconstruction is comparable with endoprosthesis when considering clinical and functional outcomes but significantly cost effective and should be considered for the individual patient.

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic illness marked by progressive heterotopic ossification of tendons, ligaments, fascia, and skeletal muscle, leading to immobility and reduced quality of life. Early recognition is critical to avoiding flare-ups often triggered by trivial trauma or medical interventions. This report presents two early-diagnosed FOP cases-one at 6 months, the other at 18 months-both with typical features and congenital great toe abnormalities. Early detection enables preventive strategies that enhance the quality and longevity of affected children's lives. Increased awareness among healthcare professionals about the unique presentation of FOP is vital for prompt diagnosis.

Matta's Roof Arc Angle (RAA) is utilised to evaluate the load-bearing dome in cases of acetabular fractures, assisting clinicians in making informed decisions regarding treatment options through the measurement of angular displacement. This assessment is crucial for the assessment of acetabular coverage and the stability of the femoral head, helping to determine whether surgical intervention or non-operative approaches are more suitable. Nevertheless, the variability of this method underscores the importance of incorporating additional criteria to ensure the best possible clinical outcomes for patients.

Introduction: medial patellofemoral ligament reconstruction (MPFLr) is a common surgical procedure for treating patellar instability. Grafts can be fixed to the femur using a bone-tunnel technique with an interference screw. However, this may lead to femoral tunnel enlargement (FTE) post-operatively. The aim of this study was to assess the correlation between time after MPFLr and FTE, to evaluate factors that might influence FTE and to determine if FTE can be reliably evaluated with plain radiographs.

Methods: we conducted a single-surgeon series, retrospective review of 70 MPFLr (52 female; 18 male) between 2014 and 2022. We assessed change in femoral tunnel area compared with original tunnel area (TP0), on lateral radiographs at two time points. Time point one (TP1): mean 34 days (standard deviation (SD): 25); and Time Point 2 (TP2): mean 490 days (SD: 333). We analysed the relationship between surgical characteristics to FTE, and assessed inter- and intra-rater reliability of FTE.

Results: tunnel area significantly increased from TP0 to TP1 and TP2 (p < 0.001). Mean percentage increase in cross-sectional tunnel area (CTA) between TP0 and TP1 was 113 % (SD: 49 %). Mean percentage increase in CTA between TP0 and TP2 was 139 % (SD: 64 %). There were 25 cases (36 %) of tunnel malposition. There was no significant correlation between distance from the isometric point and FTE at TP1 (r = 0.05; 95 % confidence intervals (CI): -0.19 to 0.29) or TP2 (r = 0.17: 95 % CI: -0.068 to 0.39). There were no other significant correlations with FTE. Inter-rater reliability for FTE at TP1 was moderate (Inter-Class Coefficient (ICC): 0.67; 95 % CI: 0.47 to 0.80; p < 0.001), with intra-rater reliability being excellent (ICC: 0.94; 95 % CI: 0.90 to 0.96; p < 0.001).

Conclusion: FTE after MPFLr is common. Plain radiographs can be used reliably to monitor tunnel enlargement in clinical practice.