Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2025.104179
Dhong-Won Lee, Sung-Wook Hong, Seung-Ik Cho, Sung-Gyu Moon, Ji-Hee Kang
<p><strong>Background: </strong>The effect of medial meniscus (MM) status on outcomes following high tibial osteotomy (HTO) combined with cartilage regeneration using human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) remains unclear.</p><p><strong>Purpose: </strong>This study aimed to evaluate the effect of preoperative MM status on the outcomes of HTO combined with cartilage regeneration using hUCB-MSCs. Specifically, clinical and radiological outcomes were compared between two groups of patients, which were divided according to their preoperative MM status. We hypothesized that patients with preserved meniscal integrity or those who underwent meniscal root repair would show better clinical and radiological outcomes compared to those with significant meniscal loss or untreated root tears.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 47 patients who underwent HTO with hUCB-MSC implantation. Patients were divided into group P (preserved MM integrity or medial meniscal root repair) and group L (loss of MM integrity, defined as a peripheral rim width <3 mm, unable to maintain hoop function). Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores after a minimum follow-up of 2 years. Cartilage regeneration was evaluated with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score and International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) score from second-look arthroscopy. Correlation analyses were conducted to examine the relationship between preoperative MM extrusion and cartilage repair.</p><p><strong>Results: </strong>Both groups demonstrated significant improvements in IKDC and WOMAC scores (p < 0.01). No significant differences were observed between groups in IKDC and WOMAC scores at final follow-up (p = 0.21, p = 0.42, respectively). MOCART 2.0 and ICRS CRA scores showed no significant differences between groups (p = 0.35, p = 0.08, respectively). Group P showed higher proportions of favorable outcomes compared to group L, including no major subchondral changes or only minor marrow edema (56% vs. 31.8%) and ICRS CRA grades I or II (84% vs. 72.7%). While these findings suggest potential differences in outcomes, neither comparison reached statistical significance (p = 0.09 and p = 0.48, respectively). Preoperative MM extrusion negatively correlated with MOCART 2.0 and subchondral bone changes (r = -0.24, p = 0.03; r = -0.29, p = 0.02, respectively).</p><p><strong>Conclusion: </strong>HTO with hUCB-MSC implantation provided significant clinical improvements and effective cartilage regeneration regardless of preoperative MM status. However, preoperative MM extrusion may influence subchondral bone changes, emphasizing the need to consider MM status for long-term outcomes.</p><p><strong>Level of evidence: </strong>III; retrospective compar
{"title":"Effect of preoperative medial meniscus status on the outcomes of high tibial osteotomy with human umbilical cord-derived mesenchymal stem cells cartilage regeneration.","authors":"Dhong-Won Lee, Sung-Wook Hong, Seung-Ik Cho, Sung-Gyu Moon, Ji-Hee Kang","doi":"10.1016/j.otsr.2025.104179","DOIUrl":"10.1016/j.otsr.2025.104179","url":null,"abstract":"<p><strong>Background: </strong>The effect of medial meniscus (MM) status on outcomes following high tibial osteotomy (HTO) combined with cartilage regeneration using human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) remains unclear.</p><p><strong>Purpose: </strong>This study aimed to evaluate the effect of preoperative MM status on the outcomes of HTO combined with cartilage regeneration using hUCB-MSCs. Specifically, clinical and radiological outcomes were compared between two groups of patients, which were divided according to their preoperative MM status. We hypothesized that patients with preserved meniscal integrity or those who underwent meniscal root repair would show better clinical and radiological outcomes compared to those with significant meniscal loss or untreated root tears.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 47 patients who underwent HTO with hUCB-MSC implantation. Patients were divided into group P (preserved MM integrity or medial meniscal root repair) and group L (loss of MM integrity, defined as a peripheral rim width <3 mm, unable to maintain hoop function). Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores after a minimum follow-up of 2 years. Cartilage regeneration was evaluated with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score and International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) score from second-look arthroscopy. Correlation analyses were conducted to examine the relationship between preoperative MM extrusion and cartilage repair.</p><p><strong>Results: </strong>Both groups demonstrated significant improvements in IKDC and WOMAC scores (p < 0.01). No significant differences were observed between groups in IKDC and WOMAC scores at final follow-up (p = 0.21, p = 0.42, respectively). MOCART 2.0 and ICRS CRA scores showed no significant differences between groups (p = 0.35, p = 0.08, respectively). Group P showed higher proportions of favorable outcomes compared to group L, including no major subchondral changes or only minor marrow edema (56% vs. 31.8%) and ICRS CRA grades I or II (84% vs. 72.7%). While these findings suggest potential differences in outcomes, neither comparison reached statistical significance (p = 0.09 and p = 0.48, respectively). Preoperative MM extrusion negatively correlated with MOCART 2.0 and subchondral bone changes (r = -0.24, p = 0.03; r = -0.29, p = 0.02, respectively).</p><p><strong>Conclusion: </strong>HTO with hUCB-MSC implantation provided significant clinical improvements and effective cartilage regeneration regardless of preoperative MM status. However, preoperative MM extrusion may influence subchondral bone changes, emphasizing the need to consider MM status for long-term outcomes.</p><p><strong>Level of evidence: </strong>III; retrospective compar","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104179"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anterior closing wedge osteotomy (ACWO) for tibial slope correction is a validated procedure in revision anterior cruciate ligament reconstruction (ACLR). This study aims to determine how different starting points of the osteotomy affect the amount of bone resection in ACWO.
Hypothesis
We hypothesized that the lower osteotomy starting points in ACWO imply larger bone resection.
Patients and methods
A total 52 patients who underwent ACWO using infra-tuberosity technique in our institution were included in this study. Each of patients was simulated using additional two separate methods (based on osteotomy level: supra- and trans-tuberosity) based on lateral calibrated pre-operative X-rays of the whole tibia according to the post-operative correction angle. The resection height of the closing wedge, which corresponded to the base of the osteotomy, was measured and compared among the three groups.
Results
The mean actual pre-operative proximal posterior tibial angle (PPTA) was 75.8 ± 2.0°. Post-operatively, PPTA was 84.0 ± 0.6°, and correction angle was 8.2 ± 2.2°. The mean resection height in the supra-tuberosity group was 7.5 ± 0.2 mm, 8.0 ± 2.1 mm in the trans-tuberosity group, and 9.2 ± 2.1 mm in the infra-tuberosity group. There were significant differences between each approach (p ≦ 0.0001). Resection height was moderate positively correlated with the starting point of osteotomy (r = 0.33, 95%CI: 0.18–0.46, p < 0.0001).
Conclusion
This study suggests that selecting a distal starting point for the osteotomy in ACWO is directly proportional to the observed increase in bone resection, providing valuable insights for pre-operative planning. These findings are clinically relevant and will aid in preoperatively deciding approach in ACWO.
{"title":"In proximal tibial anterior closing wedge (slope changing) osteotomy lower starting points imply larger bone resection","authors":"Youngji Kim , Shintaro Onishi , Mitsuaki Kubota , Raghbir Khakha , Muneaki Ishijima , Matthieu Ollivier","doi":"10.1016/j.otsr.2024.103979","DOIUrl":"10.1016/j.otsr.2024.103979","url":null,"abstract":"<div><h3>Background</h3><div>Anterior closing wedge osteotomy (ACWO) for tibial slope correction is a validated procedure in revision anterior cruciate ligament reconstruction (ACLR). This study aims to determine how different starting points of the osteotomy affect the amount of bone resection in ACWO.</div></div><div><h3>Hypothesis</h3><div>We hypothesized that the lower osteotomy starting points in ACWO imply larger bone resection.</div></div><div><h3>Patients and methods</h3><div>A total 52 patients who underwent ACWO using infra-tuberosity technique in our institution were included in this study. Each of patients was simulated using additional two separate methods (based on osteotomy level: supra- and trans-tuberosity) based on lateral calibrated pre-operative X-rays of the whole tibia according to the post-operative correction angle. The resection height of the closing wedge, which corresponded to the base of the osteotomy, was measured and compared among the three groups.</div></div><div><h3>Results</h3><div>The mean actual pre-operative proximal posterior tibial angle (PPTA) was 75.8 ± 2.0°. Post-operatively, PPTA was 84.0 ± 0.6°, and correction angle was 8.2 ± 2.2°. The mean resection height in the supra-tuberosity group was 7.5 ± 0.2 mm, 8.0 ± 2.1 mm in the trans-tuberosity group, and 9.2 ± 2.1 mm in the infra-tuberosity group. There were significant differences between each approach (p ≦ 0.0001). Resection height was moderate positively correlated with the starting point of osteotomy (r = 0.33, 95%CI: 0.18–0.46, p < 0.0001).</div></div><div><h3>Conclusion</h3><div>This study suggests that selecting a distal starting point for the osteotomy in ACWO is directly proportional to the observed increase in bone resection, providing valuable insights for pre-operative planning. These findings are clinically relevant and will aid in preoperatively deciding approach in ACWO.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective case-control study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103979"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104001
Thomas Hirardot , Germain Pomares , Pierre Menu , Jérôme Grondin , Marc Dauty , Alban Fouasson-Chailloux
Background
Chronic Exertional Compartment Syndrome (CECS) of the forearm is characterized by an increase of the pressure in the forearm compartments during repeated activities. Its diagnosis is challenging because of the lack of clearly established diagnostic criteria.
Purpose
We aimed to provide a comprehensive description of the diagnostic methods used for CECS of the forearm, to assess if a more effective diagnosis strategy could be identified.
Methods
We used PubMed, Google Scholar, Cochrane Library and Science Direct databases to search articles. We carried out multiple searches using the mesh terms (“Chronic Exertional Compartment Syndrome” OR “Chronic compartment syndrome” OR “Exertional compartment”) AND (“forearm” OR “upper limb”). Inclusion criteria were prospective or retrospective studies on CECS of the forearm including case reports. We used PRISMA guidelines. The included studies were critically appraised using GRADE approach.
Results
A total of 625 articles were screened and 33 studies were included. It represented 590 patients (505 men and 85 women), with a mean age of 26.6 years old. Among them, 282 competed at an elite level. Motorcycling and motocross were the most frequent sports (66%). Six diagnostic methods were employed. Intra-compartmental pressure (ICP) measurement was the most frequently used method in 26 studies. Magnetic resonance imaging was performed in 9 studies, while electromyography was employed in only 2 studies. One study reported the measurement of grip strength using a manual dynamometer, one study compared forearm circumference before and after effort, and one used myotonometry. Various exercise protocols were observed. Stress-testing using a hand-grip was the most common protocol in 14 studies. Exercise duration varied from 2 min to 60 min.
Conclusion
Existing data do not provide sufficient evidence to favor an alternative diagnostic method over ICP measurements that should be used cautiously given the absence of formal validation. Non-invasive methods might be easier to use, but should be subjected to further research.
{"title":"Diagnostic criteria of forearm Chronic Exertional Compartment Syndrome: A systematic review","authors":"Thomas Hirardot , Germain Pomares , Pierre Menu , Jérôme Grondin , Marc Dauty , Alban Fouasson-Chailloux","doi":"10.1016/j.otsr.2024.104001","DOIUrl":"10.1016/j.otsr.2024.104001","url":null,"abstract":"<div><h3>Background</h3><div>Chronic Exertional Compartment Syndrome (CECS) of the forearm is characterized by an increase of the pressure in the forearm compartments during repeated activities. Its diagnosis is challenging because of the lack of clearly established diagnostic criteria.</div></div><div><h3>Purpose</h3><div>We aimed to provide a comprehensive description of the diagnostic methods used for CECS of the forearm, to assess if a more effective diagnosis strategy could be identified.</div></div><div><h3>Methods</h3><div>We used PubMed, Google Scholar, Cochrane Library and Science Direct databases to search articles. We carried out multiple searches using the mesh terms (“Chronic Exertional Compartment Syndrome” OR “Chronic compartment syndrome” OR “Exertional compartment”) AND (“forearm” OR “upper limb”). Inclusion criteria were prospective or retrospective studies on CECS of the forearm including case reports. We used PRISMA guidelines. The included studies were critically appraised using GRADE approach.</div></div><div><h3>Results</h3><div>A total of 625 articles were screened and 33 studies were included. It represented 590 patients (505 men and 85 women), with a mean age of 26.6 years old. Among them, 282 competed at an elite level. Motorcycling and motocross were the most frequent sports (66%). Six diagnostic methods were employed. Intra-compartmental pressure (ICP) measurement was the most frequently used method in 26 studies. Magnetic resonance imaging was performed in 9 studies, while electromyography was employed in only 2 studies. One study reported the measurement of grip strength using a manual dynamometer, one study compared forearm circumference before and after effort, and one used myotonometry. Various exercise protocols were observed. Stress-testing using a hand-grip was the most common protocol in 14 studies. Exercise duration varied from 2 min to 60 min.</div></div><div><h3>Conclusion</h3><div>Existing data do not provide sufficient evidence to favor an alternative diagnostic method over ICP measurements that should be used cautiously given the absence of formal validation. Non-invasive methods might be easier to use, but should be subjected to further research.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104001"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104069
Guillaume Demey
Normal lower limb alignment is with the tibia in varus and the femur in valgus, forming an oblique joint line in bipedal stance and a horizontal line in unipedal stance. Alignment may be valgus or varus in case of femoral metaphyseal or tibial-femoral deformity, respectively.
Bone correction must be performed at the site of the deformity. If a femoral deformity is corrected at the tibia, this results in an oblique joint line and malunion, with poor functional outcome.
In genu valgum, distal femoral osteotomy (either medial closing or lateral opening wedge) may be indicated in case of lateral femorotibial osteoarthritis secondary to extra-articular femoral deformity. Likewise, in genu varum of femoral origin, lateral closing or medial opening wedge osteotomy is indicated.
Preoperative planning is essential to achieve the ideal correction target, which is a key to success. Surgery should adhere strictly to the plan, with ideally biplanar oblique osteotomy, precise correction and stable fixation by locking plate.
Complications are due to technical errors. The most frequent error is in correction, with malunion. Hinge fracture is also common, aggravating correction error.
Patient-specific cutting guides are the state-of-the-art means of improving preoperative planning, surgical precision and hinge protection.
{"title":"Distal femoral osteotomy for degenerative knee pathology","authors":"Guillaume Demey","doi":"10.1016/j.otsr.2024.104069","DOIUrl":"10.1016/j.otsr.2024.104069","url":null,"abstract":"<div><div>Normal lower limb alignment is with the tibia in varus and the femur in valgus, forming an oblique joint line in bipedal stance and a horizontal line in unipedal stance. Alignment may be valgus or varus in case of femoral metaphyseal or tibial-femoral deformity, respectively.</div><div>Bone correction must be performed at the site of the deformity. If a femoral deformity is corrected at the tibia, this results in an oblique joint line and malunion, with poor functional outcome.</div><div>In genu valgum, distal femoral osteotomy (either medial closing or lateral opening wedge) may be indicated in case of lateral femorotibial osteoarthritis secondary to extra-articular femoral deformity. Likewise, in genu varum of femoral origin, lateral closing or medial opening wedge osteotomy is indicated.</div><div>Preoperative planning is essential to achieve the ideal correction target, which is a key to success. Surgery should adhere strictly to the plan, with ideally biplanar oblique osteotomy, precise correction and stable fixation by locking plate.</div><div>Complications are due to technical errors. The most frequent error is in correction, with malunion. Hinge fracture is also common, aggravating correction error.</div><div>Patient-specific cutting guides are the state-of-the-art means of improving preoperative planning, surgical precision and hinge protection.</div></div><div><h3>Level of evidence</h3><div>expert opinion</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104069"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Corrigendum to: Comments on: “Lateral knee laxity increases the risk of excessive joint line obliquity after medial opening-wedge high tibial osteotomy” by BA Matache, PO Jean, S Pelet, AM Roger, J Dartus, E Belzile published in Orthop Traumatol Surg Res 2023: doi.10.1016/j.otsr.2023.103717 [Orthop Traumatol Surg Res (2024) 103862]","authors":"Matthieu Ehlinger , Grégoire Micicoi , Mekki Tamir , Henri Favreau , Matthieu Ollivier","doi":"10.1016/j.otsr.2024.104070","DOIUrl":"10.1016/j.otsr.2024.104070","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104070"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104055
Laurent Mathieu , Camille Choufani , Christophe Andro , Nicolas de l’Escalopier
While the first conflicts of the 21st century involved asymmetric warfare in the fight against terrorism, recent geopolitical events require us to prepare for the possibility of high-intensity conflicts. Modern wounding agents mainly consist of explosive devices and high-velocity bullets. Every trauma surgeon must be familiar with the mechanisms of injury specific to armed conflicts. The initial care of these injuries is based on applying damage control surgery to save the patient’s life, save their limb if possible and preserve their function. Blast injuries are the most common in modern armed conflicts; the resulting combination of severe injuries can be challenging to treat. Limb reconstruction involves a sequential strategy based on simple, reliable and reproducible techniques which can be used by non-specialized surgeons working in sometimes austere situations.
{"title":"Management of combat-related extremity injuries in modern armed conflicts","authors":"Laurent Mathieu , Camille Choufani , Christophe Andro , Nicolas de l’Escalopier","doi":"10.1016/j.otsr.2024.104055","DOIUrl":"10.1016/j.otsr.2024.104055","url":null,"abstract":"<div><div>While the first conflicts of the 21st century involved asymmetric warfare in the fight against terrorism, recent geopolitical events require us to prepare for the possibility of high-intensity conflicts. Modern wounding agents mainly consist of explosive devices and high-velocity bullets. Every trauma surgeon must be familiar with the mechanisms of injury specific to armed conflicts. The initial care of these injuries is based on applying damage control surgery to save the patient’s life, save their limb if possible and preserve their function. Blast injuries are the most common in modern armed conflicts; the resulting combination of severe injuries can be challenging to treat. Limb reconstruction involves a sequential strategy based on simple, reliable and reproducible techniques which can be used by non-specialized surgeons working in sometimes austere situations.</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104055"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104064
Cindy Mallet, Brice Ilharreborde, Marion Caseris, Anne-Laure Simon
Septic arthritis of the hip (SAH) in children is a common pediatric ailment that must be diagnosed immediately as proper treatment is needed to ensure good outcomes. It mostly affects children less than 2 years of age. The causative bacteria depend on age. The most widespread pathogen found at all ages is Staphylococcus aureus (S. aureus), while Kingella kingae (Kk) is most common in children 6 months to 4 years of age. SAH is suspected based on a wide set of clinical, laboratory and radiological (sonography) criteria. MRI is especially useful for diagnosing complications when the child’s condition worsens. The diagnosis is only confirmed when joint aspiration finds evidence of bacteria being present. Targeted PCR techniques have largely improved the microbiological diagnosis of Kk. The clinical presentation varies greatly from a limp to prevent weightbearing on the affected leg in a small child with or without fever and very mild to non-existent systemic inflammation, suggestive of SAH due to Kk, to septic shock with quasi-paralysis of the lower limb. Treatment mainly consists of joint drainage and surgical lavage, open or arthroscopic, combined with empirical antibiotic therapy against the likely cause of the infection. A short course of antibiotics is widely used in uncomplicated cases of SAH. The functional prognosis depends highly on the time elapsed before the diagnosis and the start of treatment. Functional sequelae can be severe (growth disturbances, long-term joint damage).
Level of evidence
Expert opinion.
儿童髋关节化脓性关节炎（SAH）是一种常见的儿科疾病，必须立即确诊，因为需要适当的治疗才能确保良好的疗效。它主要影响两岁以下的儿童。致病菌与年龄有关。各年龄段最常见的病原体是金黄色葡萄球菌（S. aureus），而 Kingella kingae（Kk）则最常见于 6 个月至 4 岁的儿童。怀疑 SAH 的依据包括一系列临床、实验室和放射学（超声）标准。当患儿病情恶化时，核磁共振成像尤其有助于诊断并发症。只有在关节抽吸术发现存在细菌的证据时才能确诊。有针对性的 PCR 技术在很大程度上改进了 Kk 的微生物学诊断。临床表现差异很大，有的患儿患肢跛行，不能负重，伴有或不伴有发热，全身炎症非常轻微或不存在，提示为 Kk 引起的 SAH；有的患儿出现脓毒性休克，下肢准瘫痪。治疗主要包括关节引流和手术灌洗（开放式或关节镜），同时针对可能的感染原因进行经验性抗生素治疗。短期抗生素治疗广泛用于无并发症的 SAH 病例。功能性预后在很大程度上取决于诊断和开始治疗前的时间。功能性后遗症可能很严重（生长障碍、长期关节损伤）。证据等级：专家意见。
{"title":"Treatment of septic arthritis of the hip in children","authors":"Cindy Mallet, Brice Ilharreborde, Marion Caseris, Anne-Laure Simon","doi":"10.1016/j.otsr.2024.104064","DOIUrl":"10.1016/j.otsr.2024.104064","url":null,"abstract":"<div><div>Septic arthritis of the hip (SAH) in children is a common pediatric ailment that must be diagnosed immediately as proper treatment is needed to ensure good outcomes. It mostly affects children less than 2 years of age. The causative bacteria depend on age. The most widespread pathogen found at all ages is <em>Staphylococcus aureus</em> (<em>S. aureus</em>), while <em>Kingella kingae</em> (Kk) is most common in children 6 months to 4 years of age. SAH is suspected based on a wide set of clinical, laboratory and radiological (sonography) criteria. MRI is especially useful for diagnosing complications when the child’s condition worsens. The diagnosis is only confirmed when joint aspiration finds evidence of bacteria being present. Targeted PCR techniques have largely improved the microbiological diagnosis of Kk. The clinical presentation varies greatly from a limp to prevent weightbearing on the affected leg in a small child with or without fever and very mild to non-existent systemic inflammation, suggestive of SAH due to Kk, to septic shock with quasi-paralysis of the lower limb. Treatment mainly consists of joint drainage and surgical lavage, open or arthroscopic, combined with empirical antibiotic therapy against the likely cause of the infection. A short course of antibiotics is widely used in uncomplicated cases of SAH. The functional prognosis depends highly on the time elapsed before the diagnosis and the start of treatment. Functional sequelae can be severe (growth disturbances, long-term joint damage).</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104064"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104047
Xavier Flecher , Matthieu Ehlinger
{"title":"Response to the letter from Xiaohua Jiang, Yabin Liu and Guowu Chen","authors":"Xavier Flecher , Matthieu Ehlinger","doi":"10.1016/j.otsr.2024.104047","DOIUrl":"10.1016/j.otsr.2024.104047","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104047"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.104059
David Ancelin
Metatarsal fractures are frequent, at one-third of all fractures in the foot.
The present study reviews the field, addressing 4 questions.
•
How to classify them according to location and mechanism?
Isolated or associated, benign but, in case of crush injury, sometimes severe, prognosis varies and sequelae can be serious. Fatigue fracture is common, often implicating sports activity. It is important to group metatarsal fractures according to the metatarsal or metatarsals involved: first (M1), central (CM) or fifth (M5). Lesion mechanism is a determining factor in management, especially for M5 fatigue fractures.
•
How to assess severity?
Severity is a matter of associated lesions, particularly in the tarsometatarsal joint and adjacent soft tissue, directly related to trauma kinetics and mechanism.
•
What are the means and results of treatment?
Treatment depends on the site of the fracture, whether it is recent or old, and the severity of the causal trauma. M1 fractures can be managed non-operatively if not displaced; otherwise, internal fixation is recommended. In the CMs and distal M5, non-operative treatment gives excellent results in fractures with little or no displacement, but reduction and internal fixation should be considered for displacement exceeding 3−4 mm or angulation exceeding 10° in whatever plane. In M5, non-operative treatment is indicated for fractures in Lawrence-Botte zones 1 or 2, but particular care is needed for high-level sports players; zone 3 fractures are fatigue fractures, requiring internal fixation.
•
What are the possible complications and sequelae?
High-energy trauma is associated with skin complications and infection. Surgery is also a risk factor, notably for neurologic complications. Non-union, delayed healing and iterative fracture mainly affect the base of M5, particularly in zone 3. Malunion is associated with poor prognosis due to severe functional disorder in the foot or limb. Post-traumatic osteoarthritis generally follows joint injury at M1 or a CM, or sometimes associated tarsometatarsal joint involvement.
{"title":"Metatarsal fracture without Lisfranc injury","authors":"David Ancelin","doi":"10.1016/j.otsr.2024.104059","DOIUrl":"10.1016/j.otsr.2024.104059","url":null,"abstract":"<div><div>Metatarsal fractures are frequent, at one-third of all fractures in the foot.</div><div>The present study reviews the field, addressing 4 questions.</div><div><ul><li><span>•</span><span><div><em>How to classify them according to location and mechanism?</em></div></span></li></ul></div><div>Isolated or associated, benign but, in case of crush injury, sometimes severe, prognosis varies and sequelae can be serious. Fatigue fracture is common, often implicating sports activity. It is important to group metatarsal fractures according to the metatarsal or metatarsals involved: first (M1), central (CM) or fifth (M5). Lesion mechanism is a determining factor in management, especially for M5 fatigue fractures.</div><div><ul><li><span>•</span><span><div><em>How to assess severity?</em></div></span></li></ul></div><div>Severity is a matter of associated lesions, particularly in the tarsometatarsal joint and adjacent soft tissue, directly related to trauma kinetics and mechanism.</div><div><ul><li><span>•</span><span><div><em>What are the means and results of treatment?</em></div></span></li></ul></div><div>Treatment depends on the site of the fracture, whether it is recent or old, and the severity of the causal trauma. M1 fractures can be managed non-operatively if not displaced; otherwise, internal fixation is recommended. In the CMs and distal M5, non-operative treatment gives excellent results in fractures with little or no displacement, but reduction and internal fixation should be considered for displacement exceeding 3−4 mm or angulation exceeding 10° in whatever plane. In M5, non-operative treatment is indicated for fractures in Lawrence-Botte zones 1 or 2, but particular care is needed for high-level sports players; zone 3 fractures are fatigue fractures, requiring internal fixation.</div><div><ul><li><span>•</span><span><div><em>What are the possible complications and sequelae?</em></div></span></li></ul></div><div>High-energy trauma is associated with skin complications and infection. Surgery is also a risk factor, notably for neurologic complications. Non-union, delayed healing and iterative fracture mainly affect the base of M5, particularly in zone 3. Malunion is associated with poor prognosis due to severe functional disorder in the foot or limb. Post-traumatic osteoarthritis generally follows joint injury at M1 or a CM, or sometimes associated tarsometatarsal joint involvement.</div></div><div><h3>Level of evidence</h3><div>V; expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104059"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.otsr.2024.103958
Pierre Tran , Siam Knecht , Lyna Tamine , Nicolas Faure , Jean-Christophe Orban , Nicolas Bronsard , Jean-François Gonzalez , Grégoire Micicoi
<div><h3>Introduction</h3><div>Total knee arthroplasty (TKA) is a procedure associated with risks of electrolyte and kidney function disorders, which are rare but can lead to serious complications if not correctly identified. A routine check-up is very often carried out to assess the seric ionogram and kidney function after TKA, that rarely requires clinical intervention in the event of a disturbance. The aim of this study was to identify perioperative variables that would lead to the creation of a machine learning model predicting the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.</div></div><div><h3>Hypothesis</h3><div>A predictive model could be constructed to estimate the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.</div></div><div><h3>Material and methods</h3><div>This single-centre retrospective study included 774 total knee arthroplasties (TKA) operated on between January 2020 and March 2023. Twenty-five preoperative variables were incorporated into the machine learning model and filtered by a first algorithm. The most predictive variables selected were used to construct a second algorithm to define the overall risk model for postoperative kalaemia and/or acute kidney injury (K<sup>+</sup> A). Two groups were formed of K<sup>+</sup> A and non-K<sup>+</sup> A patients after TKA. A univariate analysis was performed and the performance of the machine learning model was assessed by the area under the curve representing the sensitivity of the model as a function of 1 - specificity.</div></div><div><h3>Results</h3><div>Of the 774 patients included who had undergone TKA surgery, 46 patients (5.9%) had a postoperative kalaemia disorder requiring correction and 13 patients (1.7%) had acute kidney injury, of whom 5 patients (0.6%) received vascular filling. Eight variables were included in the machine learning predictive model, including body mass index, age, presence of diabetes, operative time, lowest mean arterial pressure, Charlson score, smoking and preoperative glomerular filtration rate.</div><div>Overall performance was good with an area under the curve of 0.979 [CI95% 0.938–1.02], sensitivity was 90.3% [CI95% 86.2–94.4] and specificity 89.7% [CI95% 85.5–93.8]. The tool developed to assess the risk of impaired kalaemia and/or acute kidney injury after TKA is available on <span><span>https://arthrorisk.com</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusion</h3><div>The risk of kalaemia disturbance and postoperative acute kidney injury after total knee arthroplasty could be predicted by a model that identifies low-risk and high-risk patients based on eight pre- and intraoperative variables. This machine learning tool is available on a web platform accessible for everyone, easy to use and has a high predictive performance. The aim of the model was to better identify and anticipate the complications of dyskalaemia and postoperative acute kidney injur
{"title":"Risk prediction of kalaemia disturbance and acute kidney injury after total knee arthroplasty: use of a machine learning algorithm","authors":"Pierre Tran , Siam Knecht , Lyna Tamine , Nicolas Faure , Jean-Christophe Orban , Nicolas Bronsard , Jean-François Gonzalez , Grégoire Micicoi","doi":"10.1016/j.otsr.2024.103958","DOIUrl":"10.1016/j.otsr.2024.103958","url":null,"abstract":"<div><h3>Introduction</h3><div>Total knee arthroplasty (TKA) is a procedure associated with risks of electrolyte and kidney function disorders, which are rare but can lead to serious complications if not correctly identified. A routine check-up is very often carried out to assess the seric ionogram and kidney function after TKA, that rarely requires clinical intervention in the event of a disturbance. The aim of this study was to identify perioperative variables that would lead to the creation of a machine learning model predicting the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.</div></div><div><h3>Hypothesis</h3><div>A predictive model could be constructed to estimate the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.</div></div><div><h3>Material and methods</h3><div>This single-centre retrospective study included 774 total knee arthroplasties (TKA) operated on between January 2020 and March 2023. Twenty-five preoperative variables were incorporated into the machine learning model and filtered by a first algorithm. The most predictive variables selected were used to construct a second algorithm to define the overall risk model for postoperative kalaemia and/or acute kidney injury (K<sup>+</sup> A). Two groups were formed of K<sup>+</sup> A and non-K<sup>+</sup> A patients after TKA. A univariate analysis was performed and the performance of the machine learning model was assessed by the area under the curve representing the sensitivity of the model as a function of 1 - specificity.</div></div><div><h3>Results</h3><div>Of the 774 patients included who had undergone TKA surgery, 46 patients (5.9%) had a postoperative kalaemia disorder requiring correction and 13 patients (1.7%) had acute kidney injury, of whom 5 patients (0.6%) received vascular filling. Eight variables were included in the machine learning predictive model, including body mass index, age, presence of diabetes, operative time, lowest mean arterial pressure, Charlson score, smoking and preoperative glomerular filtration rate.</div><div>Overall performance was good with an area under the curve of 0.979 [CI95% 0.938–1.02], sensitivity was 90.3% [CI95% 86.2–94.4] and specificity 89.7% [CI95% 85.5–93.8]. The tool developed to assess the risk of impaired kalaemia and/or acute kidney injury after TKA is available on <span><span>https://arthrorisk.com</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusion</h3><div>The risk of kalaemia disturbance and postoperative acute kidney injury after total knee arthroplasty could be predicted by a model that identifies low-risk and high-risk patients based on eight pre- and intraoperative variables. This machine learning tool is available on a web platform accessible for everyone, easy to use and has a high predictive performance. The aim of the model was to better identify and anticipate the complications of dyskalaemia and postoperative acute kidney injur","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103958"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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