Orthopaedics & Traumatology-Surgery & Research最新文献

This technical note describe the feasibility of a reproducible laparoscopic technique for acetabular fracture fixation, focusing on the feasibility of using infra-pectineal and supra-pectineal plates and proper screw placement. A standardized preperitoneal laparoscopic approach was performed on ten adult cadavers. Infra-pectineal and supra-pectineal plates were inserted under laparoscopic control, and screw placement was guided using an eight-zone pelvic classification. Feasibility criteria included exposure quality, implant positioning, operative time, and complications. The procedure was successfully completed in 9 of 10 specimens (90%). Key anatomical landmarks were consistently identified. All implants were positioned as planned. Mean operative time was 115 min (range 90-120), with no major vascular, visceral, or neurological injuries. This technique appears feasible and reproducible and may offer a minimally invasive alternative for selected acetabular fractures, particularly in fragile patients. LEVEL OF EVIDENCE: IV; cadaveric study.

Background: The incidence of Anterior Cruciate Ligament (ACL) tears among pediatric patients has risen. Meniscal and cartilage damage are commonly associated with ACL injuries. Recognizing concurrent injuries during ACL surgery is essential to ensure an appropriate treatment. However, there is a lack of focus on children in Tanner stages 1 and 2.

Hypothesis: This study aims to describe associated lesions in Tanner 1-2 patients undergoing ACL surgical treatment and identify demographics, injury and surgical factors associated with their presence.

Patients and methods: This multicentric retrospective study involved 92 patients with Tanner 1-2 treated surgically for ACL injuries from 2002 to 2019. Data included demographic information, injury and surgerical details.

Results: Older age was associated with a significantly increased risk of concomitant lesions (p = 0.005). Meniscal tears were observed in 48.9% of patients. Lateral meniscal tears and posterior horn involvement were the most common pattern, neither ACL tear location or mechanism of injury influenced the occurrence of meniscal tears. Concomitant cartilage injuries were detected in 10.9% of patients.

Discussion: Tanner 1-2 patients with ACL tears have a high rate of associated lesions, particularly as age increases. These findings can help the surgical decision making and support the importance of a careful pre and intra-operative evaluation.

Level of evidence: III; retrospective study.

Background: Sepsis is a cause of delayed morbidity and mortality after pelvic fracture surgery. Rectal injuries, although rare, may be underdiagnosed and contribute to infectious complications. Recent studies on this topic are scarce and often lack radiologic correlation. This study aimed to address the following questions: (1) What is the incidence of sepsis in surgically treated pelvic and/or acetabular fractures? (2) Which clinical and injury-related factors are associated with sepsis? (3) Are rectal injuries underdiagnosed? and (4) Do radiologic perirectal abnormalities correlate with sepsis?

Hypothesis: We hypothesized that sepsis is associated with identifiable clinical risk factors and that radiologic signs of rectal injury are underrecognized contributors to sepsis.

Patients and methods: In this retrospective cohort study, we included 1059 patients who underwent pelvic or acetabular fracture surgery at a Level 1 Trauma Center between 2009 and 2020. Clinical data and CT imaging were reviewed. Patients were stratified by sepsis status. Sepsis was defined according to the Sepsis-3 criteria. The primary outcome was occurrence of sepsis; secondary outcomes included ICU stay, length of hospitalization, and 90-day mortality. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for sepsis.

Results: Sepsis occurred in 71 patients (7%). In multivariate analysis, an Injury Severity Score ≥20 (OR 2.88, 95% CI 1.36-6.07), emergency laparotomy (OR 6.70, 95% CI 2.84-15.78), heart disease (OR 4.80, 95% CI 1.82-12.69), and liver disease (OR 3.67, 95% CI 1.11-12.08) were independently associated with sepsis. Rectal injury was diagnosed in 1 patient (0.1%), while perirectal CT abnormalities were observed in 107/766 (14%) patients. Sepsis was associated with longer ICU stays, longer hospitalization, and increased 90-day mortality.

Discussion: The incidence of sepsis remains clinically significant in pelvic fracture patients and is associated with identifiable injury and patient-related factors. Radiologic perirectal findings are more frequent than clinically diagnosed rectal injuries and may signal occult injury. These findings suggest a need for heightened vigilance and further investigation of subtle imaging abnormalities.

Level of evidence: IV; retrospective cohort study.

Purpose: Tibial plateau fractures are complex injuries with a considerable risk of early revision due to malalignment, infection, or post-traumatic osteoarthritis. This study aimed to identify predictors of early revision surgery and evaluate their clinical utility.

Hypothesis: Specific radiological alignment parameters and clinical factors can predict the need for early revision surgery within 12 months.

Methods: We retrospectively analyzed 153 patients who underwent surgical fixation for tibial plateau fractures at a Level I trauma center between 2012 and 2022. Radiological assessments included the Rasmussen Score, leg axis deviation, tibial slope, joint line convergence angle (JLCA), and medial proximal tibial angle (MPTA). Logistic regression was performed to identify predictors of revision within 12 months.

Results: Nineteen patients (12.4%) required revision surgery, comprising 10 reosteosynthesis procedures and 9 total knee arthroplasties (TKA). Patients undergoing revision had significantly lower Rasmussen Scores (12 vs. 14, p = 0.007) and greater fracture impression depth (3 mm vs. 2 mm, p = 0.004). No significant differences were found for other radiographic parameters. TKA patients were older (59.8 vs. 48.8 years, p = 0.01) and had higher Charlson Comorbidity Index scores (p = 0.013).

Conclusions: Patients requiring early conversion to endoprosthesis were older and had greater comorbidity burdens, supporting the ongoing debate about primary arthroplasty in selected cases. While the Rasmussen Score showed limited predictive value, most radiological parameters were not associated with revision risk. Integration of functional outcomes and advanced imaging may refine surgical decision-making in tibial plateau fracture management.

Level of evidence: IV, retrospective observational study.

Background: Ankle osteoarthritis affects approximately 3% of adults globally, and patients in the middle and late stages often face the risk of joint fusion or replacement. Although simple supranasal osteotomy is an accepted treatment for mid-stage ankle arthritis, its isolated application may alter the biomechanics of the talofibular joint, increase lateral pressure, and lead to postoperative pain; the role of combined fibular osteotomy remains controversial in existing literature. Therefore we performed a retrospective to investigate: 1) the clinical efficacy of the supramalleolar osteotomy (SMOT) combined with fibular osteotomy (FO) in the treatment of varus ankle arthritis, 2) to analyze the impact of this osteotomy procedure on ankle joint deformities through radiographic observations.

Hypothesis: SMOT combined with FO could improve the joint function and relieve pain of patients.

Patients and methods: This retrospective observational study included 16 patients (6 males and 10 females, aged 56.9 ± 8.2 years old), suffering from mid-stage varus ankle unilateral osteoarthritis (OA). In total 4 patients with traumatic arthritis and 12 patients with primary arthritis. The patients received SMOT combined with FO between February 2021 and March 2022.

Results: The average follow-up time was 19.5 ± 1.9 (range, 16.5-23) months. There were no surgical site infection or non-union after the surgery. American Orthopedic Foot and Ankle Society (AOFAS) score of the patients significantly increased (81.0 ± 6.0 vs. 46.6 ± 9.3 (p < 0.001)) and visual pain score (VAS) significantly decreased (1.1 ± 0.8 vs. 5.1 ± 0.9, P < 0.001) at last follow-up compared to those before treatment. The Tibial Articular Surface angle (88.6 ± 1.7 vs. 82.6 ± 3.1), Talar tilt (1.3 ± 0.7 vs. 6.4 ± 2.7), and Tibial Angle point angle (80.9 ± 3.0 vs. 72.5 ± 3.9) of patients were significantly improved immediately after surgery (all p < 0.001).

Discussion: Although limited by the retrospective design and lack of control group, this study shows SMOT combined with FO may be an optional therapy strategy for mid-stage varus ankle OA.

Level of evidence: IV.

Backgrounds: Achieving joint stability can be challenging in 1.5-stage exchange arthroplasty for periprosthetic joint infection (PJI) when substantial bone defects are present. Cement augmentation has been used to address these defects for stability, yet evidence regarding its mechanical durability and survivorship remains limited. This study aimed to compare the aseptic survival between 1.5-stage exchange arthroplasty with and without cement augmentation using an autoclaved original femoral component and a new polyethylene (PE) insert.

Hypothesis: There would not be significant inferior survival in 1.5-stage exchange arthroplasty with cement augmentation compared with arthroplasty without cement augmentation.

Patients and methods: This retrospective comparative study reviewed 130 cases of 1.5-stage exchange arthroplasty without reinfection, comprising 42 cases with cement augmentation (Group C) and 88 cases without cement augmentation (Group N). The cement augmentation technique was used when joint stability could not be achieved using the thickest PE because of severe bone loss. Demographics were not significantly different between the groups. The hip-knee-ankle angle (HKA) and component positions were measured; the proportions of appropriate HKA and component positions (HKA≤0 ± 3°, α≤95 ± 3°, β≤90 ± 3°, γ≤3 ± 3°, and δ≤87 ± 3°) were investigated. Survival and failure rates were analyzed, and failure was defined as reoperation for aseptic failure. Risk factors affecting survival were investigated in terms of demographics, cement augmentation, inappropriate HKA, and inappropriate component position for all patients in both groups.

Results: Although the average HKA and component positions were not different, appropriate proportion of coronal and sagittal PE position were significantly lower in the group C (appropriate β, 57.1% vs 90.9%; appropriate δ, 38.1% vs 77.3%; p < 0.001, respectively). All cases with aseptic loosening underwent reoperation. The 1-, 2-, and 5-year survival rates were 76.2%, 71.4%, and 71.4%, respectively, in group C and 89.8 %, 86.4 %, and 81.6 %, respectively, in group N (p = 0.063). The failure rates were 28.6% and 18.2% in group N, respectively (p = 0.253). The significant factor affecting the survival was only the inappropriate coronal positioning of the PE (β > 90 ± 3°) in overall cases (odds ratio = 2.957, p = 0.016).

Conclusion: Cement augmentation can be employed as a salvage-enabling technique to address bone loss and instability in 1.5-stage exchange arthroplasty, showing no significant inferiority in aseptic survival despite a trend toward lower survival. Meticulous attention to coronal PE alignment during cement hardening is essential to minimize the risk of aseptic failure.

Level of evidence: III.

Background: Posterior Humeral Head Subluxation (PHHS) is a critical aspect to consider during the preoperative planning for Total Shoulder Arthroplasty (TSA). This study aims to investigate how variations in the initial arm position affect PHHS measurements obtained from CT scans.

Methods: A prospective analysis was conducted involving patients diagnosed with primary osteoarthritis (OA) or rotator cuff tear arthropathy (CTA) from February 2021 to February 2025. The focus was on cases planned for TSA, utilizing data sourced from a single shoulder arthroplasty planning platform (Equinoxe, Exactech GPS, Blue Ortho). Validated three-dimensional (3D) bone models were employed to compute scapular and humeral landmarks automatically. The positioning of the humerus relative to the scapula was calculated, allowing assessment of abduction, flexion, and internal rotation angles at the scapulohumeral joint. HHS was measured as the ratio between the distance from the posterior border of the head to the Friedman axis and the diameter of a best-fit circle aligned with the humeral head.

Results: The study encompassed 21,863 patients. Preoperative measurements indicated a median abduction of 10.3 ± 12.4° (percentile range: -14.0°; 36.6°), median flexion of 3.5 ± 8.9° (percentile range: -16.0°; 26.1°), and median internal rotation of 7 ± 18.9° (percentile range: -41.4°; 48.9°). The median PHHS recorded was 57.9 ± 10.8% (percentile range: 23.7%; 81.2%). A correlation between preoperative humeral positioning and subluxation was identified-positive for abduction (β = 0.1302, p < 0.0001) and negative for flexion (β = -0.2490, p < 0.0001) as well as internal rotation (β = -0.1570, p < 0.0001). This correlation is weak but highly significant, probably due to the large cohort size. Thus, a change of 10° in abduction corresponded to a shift of approximately +1% in subluxation values while similar adjustments in flexion or internal rotation resulted in roughly -2%.

Conclusion: Posterior humeral head subluxation is significantly influenced by patient posture during scanning, particularly sensitive to changes in flexion and internal rotation which tend to decrease subluxation more than abduction does; however, these alterations remain minimal at about ±1-2%.

Level of evidence: IV; Case series with no comparison group.