Pub Date : 2024-11-01DOI: 10.1016/j.jcot.2024.102793
Lavindra Tomar, Gaurav Govil
Mucormycosis of tibia is a highly aggressive fungal infection. It is an uncommon affection especially in immunocompromised host who have more propensity for such affections.
The nonhealing ulcer of the left leg in an immunocompromised host status of a 45-year-old male presented with a radiological lytic lesion of the distal lower fourth of tibia. The initial biopsy confirmed tubercular affection which responded to antitubercular medications to allow radiological healing. However, the repeat biopsy showed Mucormycosis which remained recalcitrant to antifungal medications with unresponsive wound healing and persisting suppuration. The case presented unique scenario of superadded fungal infection in a healing tubercular osteomyelitis tibia with alcoholic liver disease compromised host immunity.
The fungal infection of tibia remains an unsolved entity with poor clinical and functional outcomes. An early detection, high degree of suspicion with an adequate dosage of antifungal medications may allow resolution of the dreaded infection though an effective treatment remains an unsolved entity.
{"title":"Mucor mycosis of tibia: A case report of An unsolved entity","authors":"Lavindra Tomar, Gaurav Govil","doi":"10.1016/j.jcot.2024.102793","DOIUrl":"10.1016/j.jcot.2024.102793","url":null,"abstract":"<div><div>Mucormycosis of tibia is a highly aggressive fungal infection. It is an uncommon affection especially in immunocompromised host who have more propensity for such affections.</div><div>The nonhealing ulcer of the left leg in an immunocompromised host status of a 45-year-old male presented with a radiological lytic lesion of the distal lower fourth of tibia. The initial biopsy confirmed tubercular affection which responded to antitubercular medications to allow radiological healing. However, the repeat biopsy showed Mucormycosis which remained recalcitrant to antifungal medications with unresponsive wound healing and persisting suppuration. The case presented unique scenario of superadded fungal infection in a healing tubercular osteomyelitis tibia with alcoholic liver disease compromised host immunity.</div><div>The fungal infection of tibia remains an unsolved entity with poor clinical and functional outcomes. An early detection, high degree of suspicion with an adequate dosage of antifungal medications may allow resolution of the dreaded infection though an effective treatment remains an unsolved entity.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102793"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571373","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jcot.2024.102792
Murodjon E. Irismetov , Kudratbek K. Tursunov , Kobiljon T. Khudayberdiev , Markhabo A. Tursunova , Yulia Roitblat
Aims
We assessed diagnostic and arthroscopic surgery challenges the ruptured Baker's cysts (RBC) cases may present compared to intact Baker's cyst cases (IBC). The main question to explore was: Is RBC arthroscopic surgery more complex than IBS surgery? The null hypothesis was that RBC cases might present additional, and specific challenges for a surgeon and the arthroscopic procedure may be more complicated.
Methods
The prospective cohort study analyzed 100 operated patients (43 % female; mean age 61 ± 9.5 years) (2005–2022; follow-up to August 2023) diagnosed with RBC. The comparison group consisted of 100 operated patients (48 % female; mean age 57 ± 12.5 years) with IBC. We compared diagnostic challenges, surgical approaches, functional outcomes, the rates of postsurgical complications and recurrence, durations of surgery and immobilization, and the time to recovery.
Results
Among statistically significant results, RBCs were more frequently detected during the differential diagnosis with thrombophlebitis (28 vs. 17, p = 0.04) and by 99m-Tc-MDP radiography (30 vs. 10, p = 0.03). They frequently involved a three-port arthroscopic approach (89 vs. 71, p = 0.04), the cyst wall preservation (p = 0.03), and had the eight-day shorter time to recovery (p = 0.05). Other above-mentioned variables were similar in both groups of patients.
Conclusion
RBCs do not present an additional challenge for a surgeon if an arthroscopic technique is used, but the diagnostic process may be challenging. Most RBCs require a three-port arthroscopic approach and permit cyst wall preservation.
{"title":"Diagnostics and surgical treatment of ruptured Baker's cysts: A prospective study","authors":"Murodjon E. Irismetov , Kudratbek K. Tursunov , Kobiljon T. Khudayberdiev , Markhabo A. Tursunova , Yulia Roitblat","doi":"10.1016/j.jcot.2024.102792","DOIUrl":"10.1016/j.jcot.2024.102792","url":null,"abstract":"<div><h3>Aims</h3><div>We assessed diagnostic and arthroscopic surgery challenges the ruptured Baker's cysts (RBC) cases may present compared to intact Baker's cyst cases (IBC). The main question to explore was: Is RBC arthroscopic surgery more complex than IBS surgery? The null hypothesis was that RBC cases might present additional, and specific challenges for a surgeon and the arthroscopic procedure may be more complicated.</div></div><div><h3>Methods</h3><div>The prospective cohort study analyzed 100 operated patients (43 % female; mean age 61 ± 9.5 years) (2005–2022; follow-up to August 2023) diagnosed with RBC. The comparison group consisted of 100 operated patients (48 % female; mean age 57 ± 12.5 years) with IBC. We compared diagnostic challenges, surgical approaches, functional outcomes, the rates of postsurgical complications and recurrence, durations of surgery and immobilization, and the time to recovery.</div></div><div><h3>Results</h3><div>Among statistically significant results, RBCs were more frequently detected during the differential diagnosis with thrombophlebitis (28 vs. 17, p = 0.04) and by 99m-Tc-MDP radiography (30 vs. 10, p = 0.03). They frequently involved a three-port arthroscopic approach (89 vs. 71, p = 0.04), the cyst wall preservation (p = 0.03), and had the eight-day shorter time to recovery (p = 0.05). Other above-mentioned variables were similar in both groups of patients.</div></div><div><h3>Conclusion</h3><div>RBCs do not present an additional challenge for a surgeon if an arthroscopic technique is used, but the diagnostic process may be challenging. Most RBCs require a three-port arthroscopic approach and permit cyst wall preservation.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102792"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586120","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jcot.2024.102554
Gaurav Gupta , Sudhanshu Bansal , Chinmay Sangole
Elbow injuries are one of the commonest paediatric musculoskeletal injuries. Their spectrum varies from pulled elbow to elbow dislocation. Supracondylar fractures are the most common type of paediatric elbow fractures accounting for 65–75 % of all paediatric elbow injuries. Other common paediatric elbow injuries include Lateral condyle fractures, Medial epicondyle fractures, Radial neck fractures, olecranon fractures, TRASH injuries and Elbow dislocations. Osteochondral fractures in kids can be missed due to their benign appearance or invisibility on x rays. TRASH stands for “The Radiological Appearance Seems Harmless”. In contrast to the full form, the abbreviation TRASH tells the harmful consequences of missing these injuries. This article will discuss the salient points regarding common elbow injuries, their diagnosis and best treatment practices. It will help the caregivers to be more prepared to deal with these situations and thus avoiding complications and getting better outcomes.
肘部损伤是最常见的儿科肌肉骨骼损伤之一。其范围从肘关节牵拉到肘关节脱位不等。髁上骨折是最常见的儿科肘部骨折类型，占所有儿科肘部损伤的 65-75%。其他常见的儿科肘部损伤包括外侧髁骨折、内侧上髁骨折、桡骨颈骨折、肩胛骨骨折、TRASH损伤和肘关节脱位。儿童骨软骨骨折可能因其良性外观或在X光片上不明显而被漏诊。TRASH是 "The Radiological Appearance Seems Harmless "的缩写。与全称相比，缩写TRASH告诉人们遗漏这些损伤的危害后果。本文将讨论有关常见肘部损伤、诊断和最佳治疗方法的要点。它将帮助护理人员在处理这些情况时做好更充分的准备，从而避免并发症，获得更好的治疗效果。
{"title":"Common elbow injuries in children","authors":"Gaurav Gupta , Sudhanshu Bansal , Chinmay Sangole","doi":"10.1016/j.jcot.2024.102554","DOIUrl":"10.1016/j.jcot.2024.102554","url":null,"abstract":"<div><div>Elbow injuries are one of the commonest paediatric musculoskeletal injuries. Their spectrum varies from pulled elbow to elbow dislocation. Supracondylar fractures are the most common type of paediatric elbow fractures accounting for 65–75 % of all paediatric elbow injuries. Other common paediatric elbow injuries include Lateral condyle fractures, Medial epicondyle fractures, Radial neck fractures, olecranon fractures, TRASH injuries and Elbow dislocations. Osteochondral fractures in kids can be missed due to their benign appearance or invisibility on x rays. TRASH stands for “The Radiological Appearance Seems Harmless”. In contrast to the full form, the abbreviation TRASH tells the harmful consequences of missing these injuries. This article will discuss the salient points regarding common elbow injuries, their diagnosis and best treatment practices. It will help the caregivers to be more prepared to deal with these situations and thus avoiding complications and getting better outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102554"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555571","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 emergence of antimicrobial resistance (AMR) has profoundly impacted the management of osteoarticular infections (OAIs), presenting significant challenges for healthcare systems worldwide. This review provides a comprehensive overview of the current landscape of AMR in OAIs, emphasizing the necessity for assertive and innovative strategies to combat this escalating health threat. It discusses the evolution of resistance among key pathogens, including ESKAPEE organisms, and the implications for treatment protocols and healthcare outcomes. The importance of antibiotic stewardship programs (ASPs) is highlighted as a core strategy to optimize antibiotic use and mitigate the development of resistance. Additionally, the review explores the potential of pharmacological approaches, including novel antibiotic regimens and combination therapies, alongside surgical interventions and alternative therapies such as bacteriophage-based treatments and probiotics, in managing these complex infections. The role of rapid diagnostic methods in improving treatment accuracy and the critical need for global surveillance to track AMR trends are also examined. By integrating insights from recent literature and expert recommendations, this review underscores the multifaceted approach required to address the challenge of AMR in OAIs effectively. It calls for a concerted effort among clinicians, researchers, and policymakers to foster innovation in treatment strategies, enhance diagnostic capabilities, and implement robust stewardship and surveillance programs. The goal is to adapt to the evolving landscape of OAIs and ensure optimal patient care in the face of rising AMR.
抗菌药耐药性（AMR）的出现对骨关节感染（OAIs）的管理产生了深远影响，给全球医疗保健系统带来了重大挑战。本综述全面概述了当前 OAIs 中的 AMR 状况，强调必须采取果断而创新的策略来应对这一不断升级的健康威胁。它讨论了包括 ESKAPEE 微生物在内的主要病原体耐药性的演变，以及对治疗方案和医疗效果的影响。抗生素监管计划 (ASP) 作为优化抗生素使用和减轻耐药性发展的核心战略，其重要性得到了强调。此外，该综述还探讨了药物治疗方法的潜力，包括新型抗生素治疗方案和联合疗法，以及外科干预和替代疗法，如基于噬菌体的治疗和益生菌，以管理这些复杂的感染。此外，还探讨了快速诊断方法在提高治疗准确性方面的作用，以及全球监测以跟踪 AMR 趋势的迫切需要。通过整合最新文献中的见解和专家建议，本综述强调了有效应对非传染性感染中的 AMR 挑战所需的多方面方法。它呼吁临床医生、研究人员和决策者共同努力，促进治疗策略的创新，提高诊断能力，并实施强有力的监管和监测计划。目标是适应 OAIs 不断变化的形势，确保在 AMR 不断增加的情况下为患者提供最佳护理。
{"title":"Combating antimicrobial resistance in osteoarticular infections: Current strategies and future directions","authors":"Madhan Jeyaraman , Tarun Jayakumar , Naveen Jeyaraman , Arulkumar Nallakumarasamy , Swaminathan Ramasubramanian , Sathish Muthu , Vijay Kumar Jain","doi":"10.1016/j.jcot.2024.102791","DOIUrl":"10.1016/j.jcot.2024.102791","url":null,"abstract":"<div><div>The emergence of antimicrobial resistance (AMR) has profoundly impacted the management of osteoarticular infections (OAIs), presenting significant challenges for healthcare systems worldwide. This review provides a comprehensive overview of the current landscape of AMR in OAIs, emphasizing the necessity for assertive and innovative strategies to combat this escalating health threat. It discusses the evolution of resistance among key pathogens, including ESKAPEE organisms, and the implications for treatment protocols and healthcare outcomes. The importance of antibiotic stewardship programs (ASPs) is highlighted as a core strategy to optimize antibiotic use and mitigate the development of resistance. Additionally, the review explores the potential of pharmacological approaches, including novel antibiotic regimens and combination therapies, alongside surgical interventions and alternative therapies such as bacteriophage-based treatments and probiotics, in managing these complex infections. The role of rapid diagnostic methods in improving treatment accuracy and the critical need for global surveillance to track AMR trends are also examined. By integrating insights from recent literature and expert recommendations, this review underscores the multifaceted approach required to address the challenge of AMR in OAIs effectively. It calls for a concerted effort among clinicians, researchers, and policymakers to foster innovation in treatment strategies, enhance diagnostic capabilities, and implement robust stewardship and surveillance programs. The goal is to adapt to the evolving landscape of OAIs and ensure optimal patient care in the face of rising AMR.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102791"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578073","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}
Using ergonomic orthopaedic chairs can address spinal issues, particularly HNP, due to their flexible and elastic properties. By achieving optimal ergonomic design, various positive aspects can be achieved, such as increasing work quality productivity and reducing the cost of injuries or accidents. This research demonstrates diverse product design approaches to enhance posture health ergonomics, address specific musculoskeletal disorder issues, and consider local needs and available materials. Rattan is a tropical vine widely used in the furniture industry and predominantly found in wooded areas such as Indonesia. This research combines market research, morphology, ergonomic study, concept selection, QFD, HoQ, stiffness test, and prototype review. The QFD method was chosen in this study due to its excellence in connecting consumer desires with the product development process. Data of respondents consist of 51 % of respondents were male, 49 % were female, 88 % were aged between 18 and 34 years old, and 10 % were aged between 35 and 54 years old. The approach of 6 stages of product design as the primary framework for developing our product such as: planning, concept development (concept screening, product morphology, concept selection), system-level design, detailed design, testing, refinement and launching. Based on the calculations using the HOQ, it is identified that the primary focus in designing the rattan-based orthopaedic seating, lies in the orthopaedic design that provides maximum comfort for the spine. The comparison results indicate that the stiffness level of rattan weaving is nearly like latex, with a similarity percentage of 89 %. Data analysis using the QFD method indicates that the primary priority aspect is the orthopaedic design, followed by the selection of quality materials, cost-effectiveness, versatility, and appealing design aspects. Rattan's superior air circulation provides comfort by preventing excessive heat accumulation, excellence in strength and durability, ensuring ease of lightweight modelling, and providing more sustainable material.
{"title":"Designing orthopaedic seat cushion made of rattan using quality function deployment approach","authors":"Lina Gozali , Ambrosius Milano Lo'o Ukeng Watun , Lamto Widodo , Syuhaida Ismail , Abdoulmohammad Gholamzadeh Chofreh , Dyah Erni Herwindiati , Ariawan Gunadi , Feybi Ariani Goni , Sani Susanto , Wan Hee Cheng","doi":"10.1016/j.jcot.2024.102771","DOIUrl":"10.1016/j.jcot.2024.102771","url":null,"abstract":"<div><div>Using ergonomic orthopaedic chairs can address spinal issues, particularly HNP, due to their flexible and elastic properties. By achieving optimal ergonomic design, various positive aspects can be achieved, such as increasing work quality productivity and reducing the cost of injuries or accidents. This research demonstrates diverse product design approaches to enhance posture health ergonomics, address specific musculoskeletal disorder issues, and consider local needs and available materials. Rattan is a tropical vine widely used in the furniture industry and predominantly found in wooded areas such as Indonesia. This research combines market research, morphology, ergonomic study, concept selection, QFD, HoQ, stiffness test, and prototype review. The QFD method was chosen in this study due to its excellence in connecting consumer desires with the product development process. Data of respondents consist of 51 % of respondents were male, 49 % were female, 88 % were aged between 18 and 34 years old, and 10 % were aged between 35 and 54 years old. The approach of 6 stages of product design as the primary framework for developing our product such as: planning, concept development (concept screening, product morphology, concept selection), system-level design, detailed design, testing, refinement and launching. Based on the calculations using the HOQ, it is identified that the primary focus in designing the rattan-based orthopaedic seating, lies in the orthopaedic design that provides maximum comfort for the spine. The comparison results indicate that the stiffness level of rattan weaving is nearly like latex, with a similarity percentage of 89 %. Data analysis using the QFD method indicates that the primary priority aspect is the orthopaedic design, followed by the selection of quality materials, cost-effectiveness, versatility, and appealing design aspects. Rattan's superior air circulation provides comfort by preventing excessive heat accumulation, excellence in strength and durability, ensuring ease of lightweight modelling, and providing more sustainable material.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102771"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555570","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jcot.2024.102797
Cara Mohammed , Ronny Kong , Venkataramana Kuruba , Vikramaditya Rai , Shahzad Waqas Munazzam
Hip arthroscopy has emerged as the primary surgical intervention for Femoroacetabular Impingement Syndrome (FAIS), a common cause of hip pain in young adults, particularly athletes. This narrative review examines the long-term outcomes, complications, and debates surrounding arthroscopic management of FAIS. Key findings include sustained improvements in patient-reported outcomes, return to sport, and functional recovery, particularly in younger patients and those with cam-type FAIS. However, some patients may eventually require total hip arthroplasty (THA), highlighting the variability in long-term durability. Complications, though infrequent, remain a significant concern, with the most common being transient neuropathy due to prolonged traction, heterotopic ossification, and iatrogenic cartilage damage. Recent studies emphasize the importance of patient selection, with younger patients, those with capsular closure, and those without pre-existing osteoarthritis showing superior outcomes. Additionally, sex-based differences suggest females may experience higher complication rates, though they often report better functional improvements post-surgery. Areas of ongoing debate include the role of labral debridement versus repair, the optimal management of mixed-type FAIS, and the potential benefits of adjunctive procedures such as ligamentum teres debridement. Future research should focus on refining surgical techniques and identifying patient-specific factors to further optimize outcomes. Despite its complexities, hip arthroscopy remains an effective treatment for FAIS, though individualized treatment plans are crucial to addressing the unique needs of each patient. By synthesizing current evidence, this review aims to guide clinicians in optimizing FAIS management and identifying areas for future research.
{"title":"Outcomes and complications of hip arthroscopy for femoroacetabular impingement syndrome: A narrative review","authors":"Cara Mohammed , Ronny Kong , Venkataramana Kuruba , Vikramaditya Rai , Shahzad Waqas Munazzam","doi":"10.1016/j.jcot.2024.102797","DOIUrl":"10.1016/j.jcot.2024.102797","url":null,"abstract":"<div><div>Hip arthroscopy has emerged as the primary surgical intervention for Femoroacetabular Impingement Syndrome (FAIS), a common cause of hip pain in young adults, particularly athletes. This narrative review examines the long-term outcomes, complications, and debates surrounding arthroscopic management of FAIS. Key findings include sustained improvements in patient-reported outcomes, return to sport, and functional recovery, particularly in younger patients and those with cam-type FAIS. However, some patients may eventually require total hip arthroplasty (THA), highlighting the variability in long-term durability. Complications, though infrequent, remain a significant concern, with the most common being transient neuropathy due to prolonged traction, heterotopic ossification, and iatrogenic cartilage damage. Recent studies emphasize the importance of patient selection, with younger patients, those with capsular closure, and those without pre-existing osteoarthritis showing superior outcomes. Additionally, sex-based differences suggest females may experience higher complication rates, though they often report better functional improvements post-surgery. Areas of ongoing debate include the role of labral debridement versus repair, the optimal management of mixed-type FAIS, and the potential benefits of adjunctive procedures such as ligamentum teres debridement. Future research should focus on refining surgical techniques and identifying patient-specific factors to further optimize outcomes. Despite its complexities, hip arthroscopy remains an effective treatment for FAIS, though individualized treatment plans are crucial to addressing the unique needs of each patient. By synthesizing current evidence, this review aims to guide clinicians in optimizing FAIS management and identifying areas for future research.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102797"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571368","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jcot.2024.102796
Mohit J. Jain , Giovanna Medina , Aashish V. Jog , Arthur R. Bartolozzi , Craig Morgan
Background
Anterior rotator interval lesions (ARIL) have been associated with shoulder instability. However, a paucity of data exists on its association with labrum pathology as a source for persistent anterior shoulder pain. This study primarily aims to describe pathoanatomy of ARIL and the parameters we used that aid in the diagnosis of ARIL. Secondly, the objective is to describe and report the prevalence of ARIL in combination with labrum injuries presenting as anterior shoulder pain with mild or no instability. Lastly, we intend to present a cohort of patients with combined labrum injury and ARIL and report on the clinical results after labrum repair with Arthroscopic Rotator Interval Closure (ARIC).
Methods
Consecutive patients at a single center in United States treated for labrum tears were included by retrospective chart-review. Patients presenting with anterior shoulder pain with mild or no instability were included. Patients with recurrent dislocations, moderate to severe instability and those with bony lesions were excluded. Besides history and physical examination, Magnetic Resonance Arthrography (MRA) was used to aid the diagnosis. Labrum tears with ARIL were treated with an additional ARIC procedure along with arthroscopic labrum repair.
Results
Out of two hundred fourty patients with a labrum tear, 114 had associated ARIL. The prevalence of ARIL ranged from 71 % with reverse Bankart tears to 46 % with anterior Bankart and 36 % in Type II SLAP tears. The success rate after labrum tear repair with ARIC performed in patients with ARIL with labrum pathology was 94.7 % at a 2-year follow-up in terms of relief from anterior shoulder pain.
Conclusion
Almost half (47.5 %) of our patients presented with anterior shoulder pain with labrum tears were associated with ARIL. We recommend keeping a high index of suspicion for ARIL in labrum injuries presenting mainly with anterior shoulder pain for better treatment planning.
Level of evidence
Level IV (Retrospective case series without a comparision group)
{"title":"Anterior Rotator Interval Lesion (ARIL), its association with glenoid labrum pathology in patients with anterior shoulder pain and surgical outcome of Arthroscopic Rotator Interval Closure (ARIC)","authors":"Mohit J. Jain , Giovanna Medina , Aashish V. Jog , Arthur R. Bartolozzi , Craig Morgan","doi":"10.1016/j.jcot.2024.102796","DOIUrl":"10.1016/j.jcot.2024.102796","url":null,"abstract":"<div><h3>Background</h3><div>Anterior rotator interval lesions (ARIL) have been associated with shoulder instability. However, a paucity of data exists on its association with labrum pathology as a source for persistent anterior shoulder pain. This study primarily aims to describe pathoanatomy of ARIL and the parameters we used that aid in the diagnosis of ARIL. Secondly, the objective is to describe and report the prevalence of ARIL in combination with labrum injuries presenting as anterior shoulder pain with mild or no instability. Lastly, we intend to present a cohort of patients with combined labrum injury and ARIL and report on the clinical results after labrum repair with Arthroscopic Rotator Interval Closure (ARIC).</div></div><div><h3>Methods</h3><div>Consecutive patients at a single center in United States treated for labrum tears were included by retrospective chart-review. Patients presenting with anterior shoulder pain with mild or no instability were included. Patients with recurrent dislocations, moderate to severe instability and those with bony lesions were excluded. Besides history and physical examination, Magnetic Resonance Arthrography (MRA) was used to aid the diagnosis. Labrum tears with ARIL were treated with an additional ARIC procedure along with arthroscopic labrum repair.</div></div><div><h3>Results</h3><div>Out of two hundred fourty patients with a labrum tear, 114 had associated ARIL. The prevalence of ARIL ranged from 71 % with reverse Bankart tears to 46 % with anterior Bankart and 36 % in Type II SLAP tears. The success rate after labrum tear repair with ARIC performed in patients with ARIL with labrum pathology was 94.7 % at a 2-year follow-up in terms of relief from anterior shoulder pain.</div></div><div><h3>Conclusion</h3><div>Almost half (47.5 %) of our patients presented with anterior shoulder pain with labrum tears were associated with ARIL. We recommend keeping a high index of suspicion for ARIL in labrum injuries presenting mainly with anterior shoulder pain for better treatment planning.</div></div><div><h3>Level of evidence</h3><div>Level IV (Retrospective case series without a comparision group)</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102796"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142660870","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}
Orthopedic surgery and traumatology necessitate cost-effective approaches that can be replicated across multiple venues. Finite Element (FE) simulation models have evolved as a solution, allowing for consistent investigations into biomechanical systems. Finite Element Analysis (FEA), which began in the 1950s aviation industry, has since expanded into orthopedics. Its progress, fueled by improved computing, has a significant impact on orthopedic surgery, helping to understand biomechanics and post-implantation responses. The use of FEA has increased in recent decades, demonstrating its critical importance in modern orthopedic research. Methodologies for FEA include both generic and patient-specific approaches, each customized to individual needs. FEA goes through three stages: preprocessing, solution, and postprocessing, all of which require exact material property assignment and boundary conditions. Pathophysiology, orthopedic biomechanics, implant design, fracture fixation, bracing, and preoperative planning are all applications of FEA, which has revolutionized surgical methods. However, FEA has drawbacks such as oversimplification, processing needs, and validation issues. Future FEA advances aim to improve model accuracy, add active muscle simulation, and standardize procedures, resulting in significant advancements in orthopedic research and treatment planning.
{"title":"Finite element analysis and its application in Orthopaedics: A narrative review","authors":"Aman Verma , Aakash Jain , Siddharth Sekhar Sethy , Vishal Verma , Nikhil Goyal , Madhubari Vathulya , Pankaj Kandwal","doi":"10.1016/j.jcot.2024.102803","DOIUrl":"10.1016/j.jcot.2024.102803","url":null,"abstract":"<div><div>Orthopedic surgery and traumatology necessitate cost-effective approaches that can be replicated across multiple venues. Finite Element (FE) simulation models have evolved as a solution, allowing for consistent investigations into biomechanical systems. Finite Element Analysis (FEA), which began in the 1950s aviation industry, has since expanded into orthopedics. Its progress, fueled by improved computing, has a significant impact on orthopedic surgery, helping to understand biomechanics and post-implantation responses. The use of FEA has increased in recent decades, demonstrating its critical importance in modern orthopedic research. Methodologies for FEA include both generic and patient-specific approaches, each customized to individual needs. FEA goes through three stages: preprocessing, solution, and postprocessing, all of which require exact material property assignment and boundary conditions. Pathophysiology, orthopedic biomechanics, implant design, fracture fixation, bracing, and preoperative planning are all applications of FEA, which has revolutionized surgical methods. However, FEA has drawbacks such as oversimplification, processing needs, and validation issues. Future FEA advances aim to improve model accuracy, add active muscle simulation, and standardize procedures, resulting in significant advancements in orthopedic research and treatment planning.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102803"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142660871","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}
Total knee arthroplasty is the commonest procedure being done for Osteoarthritis of knee in current practice. In spite of its success many patients suffer from post-operative pain especially in the early post-operative period. The study aimed to evaluate the pain relief and functional benefit of periarticular cocktail infiltration.
Methodology
Sixty-four patients undergoing simultaneous bilateral total knee were randomised to receive peri-articular cocktail injection in one knee and a similar amount of normal saline in contralateral knee. Cocktail consisted of ketorolac, ropivacaine and epinephrine. Patients’ visual analog pain score (VAS), knee range of motion, quadriceps strength, single step test (SST) were recorded post-operatively.
Results
The cocktail infiltrated knee had significantly lesser pain scores during the first 48 h. Intervened knee achieved better knee range of motion at 72 h and 14 days post-surgery. Quadriceps power and SST had better results in cocktail injected knees at 72 h, but no significant difference was detected at 14-day follow-up.
Conclusion
Use of peri-articular cocktail injection is an effective modality to achieve better pain relief in early post-operative period. Though the benefits are not long lived, but its superior effects can be utilised for early functional recovery after TKA and improved patient rehabilitation.
{"title":"Effect of periarticular cocktail of analgesia on immediate post-operative clinical outcomes after bilateral simultaneous total knee arthroplasty: a randomized placebo controlled, split-body superiority trial","authors":"Arghya Kundu Choudhury , Kshitij Gupta , Anil Regmi , Bishwa Bandhu Niraula , Divyansh Sharma , Tushar Gupta , Roop Bhushan Kalia","doi":"10.1016/j.jcot.2024.102794","DOIUrl":"10.1016/j.jcot.2024.102794","url":null,"abstract":"<div><h3>Introduction</h3><div>Total knee arthroplasty is the commonest procedure being done for Osteoarthritis of knee in current practice. In spite of its success many patients suffer from post-operative pain especially in the early post-operative period. The study aimed to evaluate the pain relief and functional benefit of periarticular cocktail infiltration.</div></div><div><h3>Methodology</h3><div>Sixty-four patients undergoing simultaneous bilateral total knee were randomised to receive peri-articular cocktail injection in one knee and a similar amount of normal saline in contralateral knee. Cocktail consisted of ketorolac, ropivacaine and epinephrine. Patients’ visual analog pain score (VAS), knee range of motion, quadriceps strength, single step test (SST) were recorded post-operatively.</div></div><div><h3>Results</h3><div>The cocktail infiltrated knee had significantly lesser pain scores during the first 48 h. Intervened knee achieved better knee range of motion at 72 h and 14 days post-surgery. Quadriceps power and SST had better results in cocktail injected knees at 72 h, but no significant difference was detected at 14-day follow-up.</div></div><div><h3>Conclusion</h3><div>Use of peri-articular cocktail injection is an effective modality to achieve better pain relief in early post-operative period. Though the benefits are not long lived, but its superior effects can be utilised for early functional recovery after TKA and improved patient rehabilitation.</div></div><div><h3>Level of evidence</h3><div>I, Randomized Controlled Trial.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102794"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571367","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}
Pub Date : 2024-11-01DOI: 10.1016/j.jcot.2024.102795
Rachna Rohilla , Harmeet Kaur , Punit Tiwari
Background
To compare the efficacy and safety of the USG-guided vs blind pulley release (PR) for Trigger Finger by performing a meta-analysis of all relevant studies in the published literature.
Methods
A thorough and methodical search of the PubMed, Embase, Scopus, and Cochrane Library databases was carried out. Review Manager Software (RevMan) 5.4.1 was used to analyze the extracted data, and the results were displayed as forest plots with matching 95 % confidence intervals.
Results
The primary efficacy outcome i.e. residual triggering was significantly lower in USG-guided PR as compared to blind PR with a risk ratio of 0.16 (95 % CI 0.03–0.87), p = 0.03. The primary safety outcome i.e., percentage of complications was lower in the USG-guided procedure group, although the result was not statistically significant with a risk ratio of 0.25 (95 % CI 0.05–1.16), p = 0.08 with I2 of 0 %. The operation time was longer in the USG-guided PR as compared to the blind procedure, although the difference was not statistically significant with a mean difference of 5.36 (95 % CI: −3.73, 14.46), p = 0.25. The postoperative visual analog scale (VAS) score at 4 weeks was significantly lower in USG-guided PR versus blind PR with a mean difference of −0.40 (95 % CI: −0.68, −0.33), p = 0.004.
Conclusion
When compared to blind PR, ultrasound-guided A1 PR for trigger finger was proven to be a safer and more economical method.
{"title":"Comparison of efficacy and safety of USG-guided versus blind pulley release for trigger finger: A systematic review and meta-analysis","authors":"Rachna Rohilla , Harmeet Kaur , Punit Tiwari","doi":"10.1016/j.jcot.2024.102795","DOIUrl":"10.1016/j.jcot.2024.102795","url":null,"abstract":"<div><h3>Background</h3><div>To compare the efficacy and safety of the USG-guided vs blind pulley release (PR) for Trigger Finger by performing a meta-analysis of all relevant studies in the published literature.</div></div><div><h3>Methods</h3><div>A thorough and methodical search of the PubMed, Embase, Scopus, and Cochrane Library databases was carried out. Review Manager Software (RevMan) 5.4.1 was used to analyze the extracted data, and the results were displayed as forest plots with matching 95 % confidence intervals.</div></div><div><h3>Results</h3><div>The primary efficacy outcome i.e. residual triggering was significantly lower in USG-guided PR as compared to blind PR with a risk ratio of 0.16 (95 % CI 0.03–0.87), p = 0.03. The primary safety outcome i.e., percentage of complications was lower in the USG-guided procedure group, although the result was not statistically significant with a risk ratio of 0.25 (95 % CI 0.05–1.16), p = 0.08 with I<sup>2</sup> of 0 %. The operation time was longer in the USG-guided PR as compared to the blind procedure, although the difference was not statistically significant with a mean difference of 5.36 (95 % CI: −3.73, 14.46), p = 0.25. The postoperative visual analog scale (VAS) score at 4 weeks was significantly lower in USG-guided PR versus blind PR with a mean difference of −0.40 (95 % CI: −0.68, −0.33), p = 0.004.</div></div><div><h3>Conclusion</h3><div>When compared to blind PR, ultrasound-guided A1 PR for trigger finger was proven to be a safer and more economical method.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"58 ","pages":"Article 102795"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571369","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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