Journal of Clinical Orthopaedics and Trauma最新文献_第3页

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。

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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

Outcomes following functionally aligned total knee arthroplasty in severe varus deformity. 功能对齐全膝关节置换术治疗严重内翻畸形的疗效。

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-20 eCollection Date: 2025-01-01 DOI: 10.1016/j.jcot.2024.102836

Richard Hogan, Baha John Tadros, Serene Lee, Dermot Collopy, Gavin Clark

Introduction: Total knee arthroplasty (TKA) in severe varus deformity still remains a challenge. Alternative alignment TKA aims to improve outcomes and satisfaction. The purpose of this study is to report on the outcomes of a functionally aligned TKA in severe varus deformity.

Methods: This is a retrospective review of single surgeon series. 92 patients with a varus deformity of >15⁰ on varus stress underwent a functionally aligned, TKA (Stryker Triathlon, Mahwah, New Jersey, USA) between 2016 and 2022. A control group, matched for age, gender and body mass index (BMI) from the same period was also identified with mild varus deformity (<10⁰). Intra-operative robotic data collected included gap measurements, bone resection depths, alignment, and rate of soft tissue releases. Clinical outcome data was collected as part of the prospective registry which included patient reported outcome measures (Forgotten Joint Score 12, Oxford Knee Score and Knee Injury and Osteoarthritis Outcome Score Joint Replacement), pain Visual analogue score (VAS), patient satisfaction and range of motion. We reported a minimum follow-up of 12 months.

Results: Medial soft tissue release was performed in 7.6 % of patients in the severe varus group. No soft tissue release was required in the control group. 96.7 % of TKAs achieved coronal balance in extension within 1 mm in the severe varus group. The varus stressed Hip knee ankle angle (HKA) was corrected by 8.5⁰ (95 % CI -9.4 to -7.6, p < 0.001). Patients in both group achieved excellent clinical outcomes scores and satisfaction (Severe varus: 91.9 % vs control: 92.7 %) at the final follow-up.

Conclusion: Patient with severe varus deformity (>15⁰) undergoing a functionally aligned TKA achieve a well-balanced TKA with excellent clinical outcomes and small rates of soft tissue release.

全膝关节置换术（TKA）治疗严重内翻畸形仍然是一个挑战。TKA旨在提高结果和满意度。本研究的目的是报道功能对准TKA治疗严重内翻畸形的结果。方法：这是一个回顾性的回顾单一外科系列。在2016年至2022年期间，92名因内翻应力导致bbb15⁰的内翻畸形患者接受了功能对齐的TKA （Stryker Triathlon, Mahwah, New Jersey， USA）。同一时期年龄、性别和体重指数（BMI）相匹配的对照组也被确定为轻度内翻畸形（结果：严重内翻组中7.6%的患者进行了内侧软组织松解术）。对照组不需要软组织释放。在严重内翻组中，96.7%的tka在1 mm以内达到冠状平衡。内翻应力髋关节踝关节角（HKA）被纠正8.5⁰（95% CI -9.4至-7.6,p）。结论：严重内翻畸形（>15⁰）患者接受功能对齐TKA可获得平衡良好的TKA，具有良好的临床结果和较小的软组织释放率。

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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。

{"title":"Accuracy and reliability of the AO/OTA classification for tibial shaft fractures","authors":"Rasmus Stokholm , Peter Larsen , Jan Duedal Rölfing , Marie Arildsen , Christian Grundtvig Rasmussen , Rasmus Elsoe","doi":"10.1016/j.jcot.2024.102826","DOIUrl":"10.1016/j.jcot.2024.102826","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102826"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Measurable progression of giant cell tumour of bone associated with pregnancy - A tertiary sarcoma centre analysis 与妊娠有关的骨巨细胞瘤的可测量进展--三级肉瘤中心分析

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-17 DOI: 10.1016/j.jcot.2024.102825

Henderson RD , Shirodkar K , Hussein M , Jenko N , Jeys L , Botchu R

Introduction

Giant cell tumour of bone (GCTB) is a benign but locally aggressive bone tumour with a higher predilection for females of reproductive age. GCTB management poses a unique set of challenges during pregnancy due to risks associated with imaging and treatment options. Pregnancy has been implicated in GCTB progression and tumour recurrence, however an exact mechanism has not been established. This study aims to confirm the relationship between the diagnosis and progression of GCTB during pregnancy.

Methods

A 17-year retrospective analysis of our tertiary sarcoma referral centre database was performed to identify the relevant patients. Pregnancy-associated tumours were defined by those already present or diagnosed during pregnancy, and up to 12 months postpartum. Lesion volume was determined by mathematical ellipsoidal modelling technique to simplify the estimation, with cross-sectional measurements obtained from the three standard orthogonal planes on initial and surveillance imaging. Due to logistical challenges, follow-up imaging was performed at either our tertiary sarcoma centre or under guidance at regional imaging centres convenient to the patient.

Results

The diagnosis of GCTB was made in 113 female patients during this 17-year period, of which 20 were associated with pregnancy with a mean age of 28.8 years (range 19–40 years). 12 patients had their primary or recurrent GCTB diagnosed, or known tumour progress during pregnancy, whilst the remaining 8 were diagnosed shortly thereafter to within 12 months postpartum. The most common tumour sites were located around the knee (30 %) and distal radius (25 %). A statistically significant pattern of growth was observed through the surveillance period (p 0.018), within a relatively short mean follow-up period of only 89.8 days (SD 54.5; 13–192 days).

Conclusion

This study demonstrates the significant association that pregnancy has with the growth and progression of both primary and recurrent GCTB. Pregnant patients should be subject to close surveillance well into the postpartum period due to possible accelerated disease progression and potential for disease recurrence.

导言骨巨细胞瘤（GCTB）是一种良性但具有局部侵袭性的骨肿瘤，好发于育龄女性。由于成像和治疗方案的相关风险，妊娠期 GCTB 的治疗面临一系列独特的挑战。妊娠与 GCTB 的进展和肿瘤复发有关，但确切的机制尚未确定。本研究旨在证实妊娠期 GCTB 诊断和进展之间的关系。方法对我们的三级肉瘤转诊中心数据库进行了长达 17 年的回顾性分析，以确定相关患者。与妊娠相关的肿瘤是指在妊娠期和产后12个月内已经存在或确诊的肿瘤。为了简化估算，病变体积是通过数学椭圆模型技术确定的，横截面测量是在初始和监测成像的三个标准正交平面上进行的。由于后勤方面的挑战，随访成像在我们的三级肉瘤中心或患者方便的地区成像中心指导下进行。有 12 名患者在怀孕期间被诊断出原发性或复发性 GCTB，或已知肿瘤进展，而其余 8 名患者是在怀孕后不久至产后 12 个月内被诊断出来的。最常见的肿瘤部位位于膝关节周围（30%）和桡骨远端（25%）。在相对较短的平均随访期（89.8 天，标差 54.5；13-192 天）内，观察到肿瘤在监测期内有统计学意义的增长模式（P 0.018）。由于妊娠可能加速疾病的进展，并有可能导致疾病复发，因此妊娠患者在产后仍需接受密切监测。

{"title":"Measurable progression of giant cell tumour of bone associated with pregnancy - A tertiary sarcoma centre analysis","authors":"Henderson RD , Shirodkar K , Hussein M , Jenko N , Jeys L , Botchu R","doi":"10.1016/j.jcot.2024.102825","DOIUrl":"10.1016/j.jcot.2024.102825","url":null,"abstract":"<div><h3>Introduction</h3><div>Giant cell tumour of bone (GCTB) is a benign but locally aggressive bone tumour with a higher predilection for females of reproductive age. GCTB management poses a unique set of challenges during pregnancy due to risks associated with imaging and treatment options. Pregnancy has been implicated in GCTB progression and tumour recurrence, however an exact mechanism has not been established. This study aims to confirm the relationship between the diagnosis and progression of GCTB during pregnancy.</div></div><div><h3>Methods</h3><div>A 17-year retrospective analysis of our tertiary sarcoma referral centre database was performed to identify the relevant patients. Pregnancy-associated tumours were defined by those already present or diagnosed during pregnancy, and up to 12 months postpartum. Lesion volume was determined by mathematical ellipsoidal modelling technique to simplify the estimation, with cross-sectional measurements obtained from the three standard orthogonal planes on initial and surveillance imaging. Due to logistical challenges, follow-up imaging was performed at either our tertiary sarcoma centre or under guidance at regional imaging centres convenient to the patient.</div></div><div><h3>Results</h3><div>The diagnosis of GCTB was made in 113 female patients during this 17-year period, of which 20 were associated with pregnancy with a mean age of 28.8 years (range 19–40 years). 12 patients had their primary or recurrent GCTB diagnosed, or known tumour progress during pregnancy, whilst the remaining 8 were diagnosed shortly thereafter to within 12 months postpartum. The most common tumour sites were located around the knee (30 %) and distal radius (25 %). A statistically significant pattern of growth was observed through the surveillance period (p 0.018), within a relatively short mean follow-up period of only 89.8 days (SD 54.5; 13–192 days).</div></div><div><h3>Conclusion</h3><div>This study demonstrates the significant association that pregnancy has with the growth and progression of both primary and recurrent GCTB. Pregnant patients should be subject to close surveillance well into the postpartum period due to possible accelerated disease progression and potential for disease recurrence.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"59 ","pages":"Article 102825"},"PeriodicalIF":0.0,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705324","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

Letter to Editor on “Efficacy of modified vacuum-assisted dressing versus conventional betadine dressing in wound healing of open fractures” 致编辑的信，主题为 "改良真空辅助敷料与传统倍他丁敷料在开放性骨折伤口愈合中的功效"。

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-16 DOI: 10.1016/j.jcot.2024.102827

Rajdeep Das

引用次数: 0

Perioperative Femur Fractures in muscle sparing anterolateral - Modified Watson-Jones approach to primary total hip arthroplasty: A retrospective cohort study 初级全髋关节置换术采用肌肉疏松前外侧--改良Watson-Jones方法的围手术期股骨骨折：回顾性队列研究

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma

Pub Date : 2024-11-16 DOI: 10.1016/j.jcot.2024.102828

N. Van Roekel, E. Lutnick, S. Pavlesen, M. Henry, M.N. Haider, M. Phillips

Background

Periprosthetic femur fractures (PFF) are a rare early complication in primary total hip arthroplasty (THA) that may result in revision and burden the healthcare system. A previous study identified a PFF rate of 8.3 % at 90 days with the modified anterolateral Watson-Jones (AL) approach to THA. This study assesses the PFF rate and risk factors with this approach at 90 days and 1-year post-operative follow-up.

Methods

580 primary THAs performed using the AL approach were retrospectively reviewed for risk factors associated with perioperative PFF including demographics, intra-operative and postoperative factors, and disposition.

Results

507 included patients had a 90-day PFF rate of 1.6 % (n = 8): 6 intraoperative (1.2 %), and 2 postoperative (0.4 %), significantly lower than previously reported (p < 0.001). 1 additional postoperative PFF fracture was operatively managed with open reduction internal fixation (ORIF) on day 302; 1-year PFF rate was 2.5 %. All fractures healed uneventfully after treatment. The 1-year return to operating room rate for PFF was 0.3 %. Patients with PFF were significantly older (p = 0.036) compared to non-PFF patients. Implant type significantly predicted PFF.

Conclusion

The rarity of PFF among our cohort highlights the efficacy of the AL approach to avoid this complication.

背景股骨假体周围骨折（PFF）是初级全髋关节置换术（THA）中一种罕见的早期并发症，可能导致翻修并给医疗系统造成负担。之前的一项研究发现，采用改良的Watson-Jones（AL）前外侧入路进行全髋关节置换术（THA），90天后的PFF发生率为8.3%。本研究评估了该方法在术后90天和1年随访时的PFF率和风险因素。方法回顾性分析了580例采用AL方法进行的初次THA，以了解与围手术期PFF相关的风险因素，包括人口统计学、术中和术后因素及处置。结果507例纳入患者的90天PFF率为1.6%（n = 8）：其中术中 6 例（1.2%），术后 2 例（0.4%），明显低于之前的报告（p < 0.001）。另有 1 例术后 PFF 骨折在第 302 天接受了切开复位内固定术（ORIF），1 年的 PFF 发生率为 2.5%。所有骨折在治疗后均顺利愈合。1年内因PFF重返手术室的比例为0.3%。与非PFF患者相比，PFF患者的年龄明显偏大（p = 0.036）。结论在我们的队列中，PFF的发生率很低，这突出表明了AL方法在避免这种并发症方面的有效性。

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引用次数: 0