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Distal radius fractures after 75 years of age: are six-month functional and radiological outcomes better with plate fixation than with conservative treatment? 75 岁以后的桡骨远端骨折:钢板固定的 6 个月功能和放射学疗效是否优于保守治疗?
IF 2.3 3区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.otsr.2024.103959
Safire Ballet , Inès Guerzider-Regas , Zouhair Aouzal , Astrid Pozet , Alexandre Quemener-Tanguy , Axel Koehly , Laurent Obert , François Loisel

Background

Surgery and non-operative treatment produce similar 1-year functional outcomes in patients older than 65 years. Data are lacking for patients older than 75 years. The main objective of this study was to compare surgical vs. non-operative treatment regarding short-term outcomes in patients older than 75 years. In addition to an overall analysis, sub-group analyses were done in patients with displacement and severe displacement (>20 ° posterior tilt).

Hypothesis

Surgery provides better clinical and radiological outcomes than does non-operative treatment.

Patients and methods

Patients older than 75 years at the time of a distal radius fracture were included prospectively over a 2-year period. A follow-up duration of at least 6 months was required. Treatment choices were based on displacement, Charlson’s Co-morbidity Index, and patient autonomy. Surgery consisted in open fixation using an anterior locking plate and non-operative treatment in a short arm cast without reduction. The main assessment was based on clinical criteria: range of motion, strength, visual analogue scale (VAS) scores, the short version of the Disabilities of the Arm, Shoulder, and Hand tool (QuickDASH), the Patient Rated Wrist Evaluation (PRWE), and the 36-Item Short Form Health Survey (SF-36). The secondary assessment criteria were the radiological outcomes and the complications.

Results

74 patients were included, among whom 24 were treated surgically and 50 non-operatively. At 1.5 months, surgery was associated with significantly better results for flexion, ulnar inclination, and supination, with range increases of at least 7 ° vs. non-operative treatment, and with greater dorsal angle and ulnar variance values (p < 0.05 for all comparisons). At 6 months, pronation and the radio-ulnar index were better with surgery (p < 0.05 for both comparisons). In the patients with displacement or severe displacement, surgery was associated with 10° gains vs. conservative treatment for flexion, ulnar inclination, and supination at 1.5 months (p < 0.05 for all comparisons).

Discussion

In patients older than 75 years, surgery for distal radius fracture was associated with significantly better clinical and radiological outcomes within 6 months. Surgery is recommended for displaced and severely displaced distal radius fractures to expedite the recovery of joint motion ranges. Beyond 6 months, the outcomes are similar.

Level of evidence

III.
背景:对于 65 岁以上的患者,手术和非手术治疗的 1 年功能疗效相似。对于 75 岁以上的患者则缺乏相关数据。本研究的主要目的是比较 75 岁以上患者手术治疗与非手术治疗的短期疗效。除总体分析外,还对有移位和严重移位(后倾>20°)的患者进行了分组分析:假设:与非手术治疗相比,手术治疗能提供更好的临床和放射学效果:患者和方法:对桡骨远端骨折时年龄超过 75 岁的患者进行为期两年的前瞻性研究。随访时间至少需要 6 个月。根据移位情况、查尔森共病指数和患者自主性选择治疗方案。手术包括使用前方锁定钢板进行开放式固定,以及使用短臂石膏进行非手术治疗,但不进行复位。主要评估基于临床标准:活动范围、力量、视觉模拟量表(VAS)评分、短版手臂、肩部和手部残疾工具(QuickDASH)、患者腕部评价(PRWE)和 36 项简表健康调查(SF-36)。次要评估标准为放射学结果和并发症:共纳入 74 名患者,其中 24 人接受手术治疗,50 人接受非手术治疗。1.5 个月后,手术治疗在屈曲、尺侧倾斜和仰卧方面的效果明显更好,与非手术治疗相比,手术范围至少增加了 7°,背角和尺侧变异值也更大(P 讨论):对于 75 岁以上的患者,桡骨远端骨折手术治疗在 6 个月内的临床和影像学效果明显更好。建议对移位和严重移位的桡骨远端骨折进行手术治疗,以加快关节活动范围的恢复。6个月后的结果类似:证据等级:III。
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引用次数: 0
Does internal fixation of shaft fracture show specificities in over-80 year-olds? 轴骨折内固定术在 80 岁以上老人中是否有特异性?
IF 2.3 3区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.otsr.2024.104054
Guy Piétu
Osteoporotic fractures in the elderly are increasingly numerous, but diaphyseal locations on native bone are quite rare.
Pathological and periprosthetic fractures are not included in this review, as they are specific in terms of context and treatment.
Cortical thinning and widening of the medullary canal alter local mechanical properties, necessitating adaptation of internal fixation. Thus, for nailing, the diameter of the implant has to be greater, and fixed-angle or multidirectional locking screws are used; for plate fixation, locking screws are required.
To avoid secondary periprosthetic fracture, fixation must protect the entire bone segment. Long plates should be used, with several divergent epiphyseal end-screws; in the femur, cervicocephalic proximal fixation is recommended.
In practice, nailing is mostly used in femoral and tibial isthmic locations. In case of metaphyseal extension, nail and locking plate fixation, ideally percutaneous, show comparable results in terms of function, consolidation and complications. In the tibia, it is mandatory to be soft-tissue friendly given the fragility of pretibial skin in the elderly.
In the humerus, the choice is wider. For nailing, passage through the rotator cuff seems acceptable in elderly patients.

Level of evidence

V; expert opinion.
老年人骨质疏松性骨折越来越多,但发生在原生骨上的骺端骨折却非常罕见。由于病理骨折和假体周围骨折在背景和治疗方面具有特殊性,因此本综述未将其包括在内。皮质变薄和髓质管变宽会改变局部的机械性能,因此需要对内固定进行调整。因此,在使用钉子时,植入物的直径必须更大,并使用固定角度或多方向锁定螺钉;在使用钢板固定时,则需要使用锁定螺钉。为避免继发性假体周围骨折,固定必须保护整个骨段。应使用长钢板,并配有多个不同的骺端螺钉;在股骨中,建议采用颈椎近端固定。在实践中,钉子主要用于股骨和胫骨峡部。在骨骺延伸的情况下,钉子和锁定板固定(最好是经皮固定)在功能、巩固和并发症方面显示出相似的效果。在胫骨部位,由于老年人胫骨前皮肤脆弱,因此必须对软组织友好。在肱骨中,选择范围更广。对于老年患者来说,钉子穿过肩袖似乎是可以接受的。证据等级:V;专家意见。
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引用次数: 0
Intraoperative reference points on the proximal tibia in image-free robotic-assisted total knee arthroplasty should be determined by preoperative posterior tibial slope.
IF 2.3 3区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.otsr.2025.104180
Yutaka Nakamura, Hiroyasu Ogawa, Haruhiko Akiyama

Background: The purpose of this study was to investigate the accuracy of the tibial cut in sagittal plane and intraoperative optimal reference points on the proximal tibia for achieving the targeted posterior tibial slope (PTS) in image-free, robotic-assisted total knee arthroplasty (TKA).

Hypothesis: A mechanical tibial axis determined by intraoperative reference points would affect the measurement of the PTS and thereby postoperative PTS in image-free robotic assist TKA.

Patients and methods: Fifty-eight patients (70 knees) who underwent primary image-free robotic-assisted TKA were included. Pre- and postoperative PTS were evaluated using whole-leg computed tomography images, which were analysed with three-dimensional planning software. Change in PTS (ΔPTS) was calculated by subtracting the target PTS from postoperative PTS. The proximal tibial axis ratio was defined as the proportion of distance between the anterior border of the anterior cruciate ligament (ACL) footprint and the tibial axis on the proximal joint surface to the anteroposterior width of the ACL footprint.

Results: The mean ΔPTS was -0.4 ± 2.0 °. Eight outliers (11.4%; |ΔPTS| >3°) were identified. The proximal tibial axis ratio was -13.2 ± 19.9% and showed a significant negative correlation with preoperative PTS and ΔPTS (r = -0.87 and -0.29, p < 0.001 and p = 0.01, respectively). The tibial axis passed through the anterior border of the ACL footprint when preoperative PTS was 9.6 °. These results indicated that a larger preoperative PTS was associated with a more anterior tibial axis on the proximal joint surface. Preoperative PTS significantly correlated with ΔPTS (r = 0.34 and p = 0.004).

Discussion: In image-free robotic-assisted TKA, when the preoperative PTS is >9.6 °, positioning the proximal tibial reference point anterior to the anterior border of the ACL footprint is recommended.

Level of evidence: III.1.

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引用次数: 0
New comprehensive score for predicting difficulties in revision total hip arthroplasty 预测翻修全髋关节置换术难度的新综合评分。
IF 2.3 3区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.otsr.2024.103983
Olivier Roche , Arthur Schmitz , Maxime Lefevre , François Sirveaux , François Bonnomet
<div><h3>Background</h3><div>Revision total hip arthroplasty (THA) can be complex, and assessing possible difficulties is important to predict the operative time. No simple score for predicting difficulties has been assessed prospectively. We therefore developed an original score for the pre-operative evaluation of extraction and reconstruction difficulties. The objectives of this prospective study were to (1) assess correlations between score values and operative time, (2) determine whether the score predicted the need for revision implants and/or filling material, (3) determine whether the score predicted intra-operative and post-operative complications, and (4) evaluate the inter-observer and intra-observer reproducibility of the score.</div></div><div><h3>Hypothesis</h3><div>The score is reproducible and correlates well with the operative time, thereby allowing prediction of this parameter before surgery.</div></div><div><h3>Material and methods</h3><div>A prospective study of 103 revision THA procedures performed between March 2018 and August 2023 was conducted. The primary outcome was operative time and the secondary outcomes were use of a revision implant, use of filling material, and intra-operative and post-operative complications. The score was determined by four observers to allow evaluation of inter-observer agreement. Intra-observer agreement was assessed by having one of the observers determine the score a second time after inclusion of the last patient. The score has a maximum value of 20 and allows classification of the procedure as very difficult, difficult, and moderately difficult.</div></div><div><h3>Results</h3><div>Mean operative time correlated with the score value: 136.0 ± 33.9 min in the very difficult group, 102.0 ± 34.8 min in the difficult group, and 75.4 ± 65.5 min in the moderately difficult group (<em>p</em> = 0.0002). The score predicted the use of a reinforcement ring (40 procedures: 12/17 [70%], 11/25 [44%], and 17/61 [28%] in the very difficult, difficult, and moderately difficult groups, respectively; <em>p</em> = 0.01) and of a long stem (20 procedures: 8/17 [47%], 7/25 [28%], and 5/61 [8%] patients in the very difficult, difficult, and moderately difficult groups, respectively; <em>p</em> < 0.001). The score did not predict the use of filling material (42 procedures: 10/17 [59%], 9/25 [36%], and 23/61 [37%] in the very difficult, difficult, and moderately difficult groups, respectively; <em>p</em> = 0.250). The score predicted both intra-operative complications (5/17 [29%], 4/25 [16%], and 4/61 [6%] procedures in the very difficult, difficult, and moderately difficult groups, respectively; <em>p</em> = 0.028) and post-operative complications (4/17 [23%], 0/25 [0%], and 6/61 [9%] in the very difficult, difficult, and moderately difficult groups, respectively; <em>p</em> = 0.15). Inter-observer agreement was strong according to Landis-Koch criteria, with kappa values ranging from 0.70 to 0.79 [0.57–0.90]. Th
背景:翻修全髋关节置换术(THA)可能很复杂,评估可能出现的困难对于预测手术时间很重要。目前尚未对预测困难的简单评分进行过前瞻性评估。因此,我们开发了一种用于术前评估摘除和重建困难的原始评分方法。这项前瞻性研究的目的是:(1) 评估评分值与手术时间之间的相关性;(2) 确定评分是否能预测是否需要翻修种植体和/或填充材料;(3) 确定评分是否能预测术中和术后并发症;(4) 评估评分在观察者之间和观察者内部的可重复性:假设:该评分具有可重复性,并与手术时间密切相关,因此可在手术前预测该参数:对2018年3月至2023年8月期间进行的103例翻修THA手术进行了前瞻性研究。主要结果是手术时间,次要结果是翻修植入物的使用、填充材料的使用以及术中和术后并发症。评分由四名观察者确定,以评估观察者之间的一致性。在纳入最后一名患者后,由其中一名观察者进行第二次评分,以评估观察者之间的一致性。该评分的最大值为 20,可将手术分为非常困难、困难和中等困难:平均手术时间与评分值相关:非常困难组为(136.0 ± 33.9)分钟,困难组为(102.0 ± 34.8)分钟,中度困难组为(75.4 ± 65.5)分钟(p = 0.0002)。该评分预测了强化环的使用情况(40 个程序:非常困难组、困难组和中度困难组分别为 12/17[70%]、11/25[44%]和 17/61 [28%];P = 0.01)和长杆(20 例手术:非常困难组、困难组和中度困难组分别有8/17[47%]、7/25[28%]和5/61[8%]名患者;P 讨论:该评分通过增加骨质破坏的标准来预测手术难度,这与广泛使用的翻修THA分类方法不同。此外,该评分具有可重复性,并能预测手术时间,因此可能在术前计划中发挥重要作用:证据级别:IV;前瞻性观察非比较研究。
{"title":"New comprehensive score for predicting difficulties in revision total hip arthroplasty","authors":"Olivier Roche ,&nbsp;Arthur Schmitz ,&nbsp;Maxime Lefevre ,&nbsp;François Sirveaux ,&nbsp;François Bonnomet","doi":"10.1016/j.otsr.2024.103983","DOIUrl":"10.1016/j.otsr.2024.103983","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Revision total hip arthroplasty (THA) can be complex, and assessing possible difficulties is important to predict the operative time. No simple score for predicting difficulties has been assessed prospectively. We therefore developed an original score for the pre-operative evaluation of extraction and reconstruction difficulties. The objectives of this prospective study were to (1) assess correlations between score values and operative time, (2) determine whether the score predicted the need for revision implants and/or filling material, (3) determine whether the score predicted intra-operative and post-operative complications, and (4) evaluate the inter-observer and intra-observer reproducibility of the score.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;The score is reproducible and correlates well with the operative time, thereby allowing prediction of this parameter before surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and methods&lt;/h3&gt;&lt;div&gt;A prospective study of 103 revision THA procedures performed between March 2018 and August 2023 was conducted. The primary outcome was operative time and the secondary outcomes were use of a revision implant, use of filling material, and intra-operative and post-operative complications. The score was determined by four observers to allow evaluation of inter-observer agreement. Intra-observer agreement was assessed by having one of the observers determine the score a second time after inclusion of the last patient. The score has a maximum value of 20 and allows classification of the procedure as very difficult, difficult, and moderately difficult.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Mean operative time correlated with the score value: 136.0 ± 33.9 min in the very difficult group, 102.0 ± 34.8 min in the difficult group, and 75.4 ± 65.5 min in the moderately difficult group (&lt;em&gt;p&lt;/em&gt; = 0.0002). The score predicted the use of a reinforcement ring (40 procedures: 12/17 [70%], 11/25 [44%], and 17/61 [28%] in the very difficult, difficult, and moderately difficult groups, respectively; &lt;em&gt;p&lt;/em&gt; = 0.01) and of a long stem (20 procedures: 8/17 [47%], 7/25 [28%], and 5/61 [8%] patients in the very difficult, difficult, and moderately difficult groups, respectively; &lt;em&gt;p&lt;/em&gt; &lt; 0.001). The score did not predict the use of filling material (42 procedures: 10/17 [59%], 9/25 [36%], and 23/61 [37%] in the very difficult, difficult, and moderately difficult groups, respectively; &lt;em&gt;p&lt;/em&gt; = 0.250). The score predicted both intra-operative complications (5/17 [29%], 4/25 [16%], and 4/61 [6%] procedures in the very difficult, difficult, and moderately difficult groups, respectively; &lt;em&gt;p&lt;/em&gt; = 0.028) and post-operative complications (4/17 [23%], 0/25 [0%], and 6/61 [9%] in the very difficult, difficult, and moderately difficult groups, respectively; &lt;em&gt;p&lt;/em&gt; = 0.15). Inter-observer agreement was strong according to Landis-Koch criteria, with kappa values ranging from 0.70 to 0.79 [0.57–0.90]. Th","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103983"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114846","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}
引用次数: 0
High-energy tibial plateau fracture 高能胫骨平台骨折。
IF 2.3 3区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.otsr.2024.104072
Pierre Martz , Marie Le Baron
High-energy tibial plateau fracture is complex and hard to treat, with functional sequelae and frequent soft-tissue lesions. Several classifications, strategies, approaches and fixation techniques have been reported. High-energy trauma is defined by high-velocity impact: fall from height, high-speed road or sport accident, firearm injury, etc.
Description should include all components, and notably posterior components (on the “3 column” theory), for integral management. A sequential strategy, with temporary fixation, imaging assessment and then definitive fixation, seems mandatory, controlling cutaneous and infectious risks. Long-term results suffer from serious functional sequelae and progression toward osteoarthritis, with a rate of at least 5% secondary knee arthroplasty.
The present review addresses 6 questions:
  • How to describe these fractures so as to understand them and plan treatment?
  • What should be the immediate treatment, to avoid acute complications?
  • What are the principles of definitive treatment?
  • How to deal with associated meniscal and ligament lesions?
  • Is there a role for arthroscopic assistance? - navigation? – balloon reduction?
  • What are the long-term results?
These fractures should ideally be described according to mechanism and to the involvement of the various columns or quadrants (medial/lateral, anterior/posterior) on the modified Schatzker classification. Immediate management comprises systematic neurovascular and soft-tissue assessment. For such high-energy fractures, a sequential “scan-span-plan” strategy with temporary external fixation is indicated. Definitive treatment consists in internal fixation by plate, with reduction and fixation of the various bone lesions, and especially fixation of posterior lesions. The surgical approach should be adapted to the fracture. Arthroscopy can be useful for controlling reduction and treating any meniscal and/or ligament lesions and fractures showing little or no displacement. A strategy that avoids acute complications provides satisfactory medium-to-long-term results if definitive treatment objectives are achieved. Despite a fairly low rate of 5% conversion to total knee replacement, progression often shows impaired quality of life and of activities.

Level of evidence

V; expert opinion
高能量胫骨平台骨折是一种复杂而难以治疗的骨折,会造成功能性后遗症,并经常出现软组织病变。目前已有多种分类、策略、方法和固定技术的报道。高能量创伤的定义是高速撞击:高空坠落、高速道路或运动事故、枪支伤害等。描述应包括所有组成部分,尤其是后部组成部分(根据 "3 柱 "理论),以便进行综合管理。在控制皮肤和感染风险的前提下,似乎必须采取顺序策略,先进行临时固定,再进行影像学评估,最后进行最终固定。长期结果会导致严重的功能性后遗症和骨关节炎,二次膝关节置换术的比例至少为 5%。本综述涉及 6 个问题:这些骨折最好按照机制和改良 Schatzker 分类法中的不同柱或象限(内侧/外侧、前方/后方)受累情况进行描述。即时处理包括系统的神经血管和软组织评估。对于此类高能量骨折,应采取 "扫描-跨度-计划 "的顺序策略,并进行临时外固定。最终治疗包括钢板内固定、各种骨质病变的复位和固定,尤其是后方病变的固定。手术方法应与骨折情况相适应。关节镜检查有助于控制骨折的复位,治疗半月板和/或韧带病变,以及显示少量或无移位的骨折。如果能达到明确的治疗目标,避免急性并发症的策略会带来令人满意的中长期效果。尽管转为全膝关节置换的比例相当低,仅为5%,但病情发展往往会影响生活质量和活动能力。证据等级:V级;专家意见。
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引用次数: 0
Iatrogenic nerve injury during upper limb surgery (excluding the hand) 上肢手术(不包括手部)中的先天性神经损伤。
IF 2.3 3区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.otsr.2024.104056
Laurent Obert , Sophie Spitael , François Loisel , Matthieu Mangin , Victor Rutka , Christophe Lebrun , Frédéric Sailhan , Philippe Clavert
Nerve injury is the most feared complication of upper limb surgery. In about 17% of cases, the injury is iatrogenic and the potential for recovery is poor. In this context, patients file for compensation in about a quarter of cases. Defective patient installation or locoregional anaesthesia are rarely the cause of nerve injury. Nerves may be injured during creation of the surgical approach, implantation of the material or reduction of a traumatic injury. The injury is usually related to nerve release, retractor positioning or inappropriate limb-segment lengthening. Stretching and/or compression of a nerve trunk or branch is thus often the main cause.
Among diagnostic tools, imaging studies (ultrasonography, computed tomography, and magnetic resonance imaging) provide information on nerve structure but not on the potential for recovery. Electromyography combined with a neurological examination establishes the diagnosis, guides the management strategy, allows nerve-function monitoring, and indicates when nerve repair or palliative surgery is indicated. Electromyography also has prognostic value, both at diagnosis and during follow-up, by showing whether nerve regeneration is taking place. When creating the surgical approaches, thorough familiarity with anatomic safe zones and nerve trajectories is crucial to ensure full control of the zones at highest risk for nerve injury.

Level of evidence

IV.
神经损伤是上肢手术最可怕的并发症。在大约 17% 的病例中,损伤是先天性的,康复的可能性很低。在这种情况下,约有四分之一的病例患者会申请赔偿。病人安装不当或局部麻醉很少是神经损伤的原因。神经可能是在创建手术方法、植入材料或缩小外伤的过程中受伤的。损伤通常与神经松解、牵引器定位或不适当的肢体部分延长有关。因此,神经干或神经分支的拉伸和/或压迫通常是主要原因。在诊断工具中,影像学检查(超声波检查、计算机断层扫描和磁共振成像)可提供有关神经结构的信息,但不能提供有关恢复潜力的信息。肌电图结合神经系统检查可确定诊断,指导治疗策略,监测神经功能,并指出何时需要进行神经修复或姑息性手术。肌电图还具有预后价值,无论是在诊断时还是在随访期间,都能显示神经是否正在再生。在制定手术方法时,彻底熟悉解剖安全区和神经轨迹至关重要,以确保完全控制神经损伤风险最高的区域。证据等级:四级。
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引用次数: 0
Pediatric soft tissue tumors 小儿软组织肿瘤
IF 2.3 3区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.otsr.2024.104058
Pierre Mary , Clelia Thouement , Tristan Langlais
The initial approach to soft tissue tumors in children and teenagers is everyone’s responsibility. While the vast majority is benign, all practitioners dread missing a malignant lesion. The first step involves taking the patient’s history and performing a clinical examination. Useful information can be gained from radiographs, ultrasound imaging and MRI. If there is no diagnosis at this stage, a biopsy (preferably percutaneous) is essential because unplanned excision can have serious consequences in terms of morbidity and even mortality. This should only be undertaken at a specialized facility after careful planning by the surgeon and interventional radiologist. Once the diagnosis has been made, the case should be discussed at a tumor board meeting to benefit from multidisciplinary expertise and input. Surgery is an essential component of the treatment and must be done at the appropriate time, after potential systemic (chemotherapy, targeted therapy) or local treatment (radiation therapy).

Level of evidence

Expert opinion.
儿童和青少年软组织肿瘤的初期治疗是每个人的责任。虽然绝大多数肿瘤是良性的,但所有医生都害怕漏诊恶性病变。第一步需要了解患者的病史并进行临床检查。通过X光片、超声波成像和核磁共振成像可以获得有用的信息。如果在这一阶段还不能确诊,就必须进行活检(最好是经皮活检),因为计划外的切除可能会导致严重的发病率甚至死亡率。只有经过外科医生和介入放射科医生的精心策划,才能在专业机构进行活检。一旦确诊,应在肿瘤委员会会议上讨论病例,以便从多学科专业知识和意见中获益。手术是治疗的重要组成部分,必须在可能的全身治疗(化疗、靶向治疗)或局部治疗(放疗)后的适当时机进行。证据级别:专家意见。
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引用次数: 0
What does the SOFCOT-RENACOT 2024 hip prosthesis register tell us? SOFCOT-RENACOT 2024 髋关节假体注册表说明了什么?
IF 2.3 3区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.otsr.2024.103996
Christian Delaunay , Christian Brand , Antoine Poichotte , Alexandre Poignard , Stéphane Boisgard
<div><h3>Introduction</h3><div>The French Society of Orthopedic and Traumatology Surgery (SOFCOT) multicenter register of hip prostheses (HP) has been collecting data from nearly 100 centers in France since 2006. After 18 years of collection, this analysis was carried out to deduce the main conclusions.</div></div><div><h3>Hypothesis</h3><div>Despite its low representativeness (3%), this register provides instructive information on the evolution of hip arthroplasty techniques and implants in France.</div></div><div><h3>Material and methods</h3><div>As of the 31st of December 2023, 58,314 primary HP were recorded, mainly for primary osteoarthritis (44,535 hips, 76.4%), followed by femoral neck fractures (4,880, 8.4%). The mean age was 71 years (SD, 11.6) with 57% (33,305) women. In total, 73% of the implants were uncemented and 170 brand names were listed. Over the same period, 5,853 first reoperations were recorded. Social security number matching identified 777 revisions of an already registered primary HP. The revision index for 100 components observed per year (RCOY) allows the performance of implants to be compared (alert threshold if >1.3).</div></div><div><h3>Results</h3><div>The causes of these 777 early first revisions at a short mean follow-up (MF) of 1.4 years were: dislocation (191/777, 24.6%), peri-prosthetic fracture (175, 22.5%), aseptic loosening (103, 13.3%) and acute infection (101, 13%). The RCOY for all primary HP was 0.25 at 5.4 years of MF. This index: (i) Depended on the type of implant: 0.23 for HP with dual-mobility cups (DMC) at 4.7 years of MF; 0.25 for HP with short femoral stems at 4.4 years; and 0 for resurfacing after only 2.5 years (due to the creation of a specific mandatory register, since 2015, which put an end to the voluntary inclusion of resurfacing in this general register). (ii) Depended on the method of fixation: 0.21 for completely cemented HP at 7.8 years of MF and 0.29 at 4.9 years for completely uncemented HP. (iii) Based on the friction torque: 0.12 for conventional metal-metal HP at 9.7 years of MF and 0.29 at 5.1 years for alumina-alumina HP. (iv) Finally, 3 arthroplasties with 3 uncemented stems had an RCOY > 1.3.</div></div><div><h3>Discussion</h3><div>Although the RCOY of HP with conventional cemented femoral stems is only 0.16 at 6.6 years of MF, while that of HP with conventional uncemented stems is 0.29 at 4.9 years, the trend towards uncemented femoral fixation has continued to intensify. Resurfacing gives good results following careful selection of implants but with a short MF of 2.5 years. Conventional metal-metal bearings continue to give excellent results at almost 10 years of MF. The 10-year survival of HP with short femoral stems is favorable compared to that of HP with conventional stems. There is no significant difference between the survival of HP with conventional versus highly cross-linked polyethylene liner.</div></div><div><h3>Conclusion</h3><div>Despite its low representati
简介法国整形外科和创伤外科学会(SOFCOT)髋关节假体(HP)多中心登记册自2006年以来一直在收集来自法国近100个中心的数据。尽管该登记册的代表性较低(3%),但它提供了有关法国髋关节置换术技术和植入物演变的指导性信息。材料和方法截至2023年12月31日,共记录了58314例初次髋关节置换术,主要用于原发性骨关节炎(44535例,76.4%),其次是股骨颈骨折(4880例,8.4%)。平均年龄为 71 岁(标准差为 11.6),其中女性占 57%(33 305 例)。73%的植入物为非骨水泥植入物,共有170个品牌。同期记录了 5853 例首次再手术。通过社会保险号比对,确定了 777 例已注册初级 HP 的翻修手术。结果在1.4年的短期平均随访(MF)中,这777例早期首次翻修的原因是:脱位(191/777,24.6%)、假体周围骨折(175,22.5%)、无菌性松动(103,13.3%)和急性感染(101,13%)。在 5.4 年的人工关节置换过程中,所有原发性 HP 的 RCOY 均为 0.25。该指数(i) 取决于植入物的类型:使用双活动度杯(DMC)的人工关节置换术在使用人工关节4.7年后的RCOY为0.23;使用短股骨柄的人工关节置换术在使用人工关节4.4年后的RCOY为0.25;而人工关节置换术在使用人工关节2.5年后的RCOY为0(由于自2015年起建立了专门的强制性登记册,从而终止了将人工关节置换术自愿纳入常规登记册的做法)。(ii) 取决于固定方法:完全粘接 HP 在 7.8 年的 MF 时为 0.21,完全非粘接 HP 在 4.9 年的 MF 时为 0.29。(iii) 取决于摩擦力矩:传统金属-金属 HP 的摩擦力矩为 0.12,MF 为 9.7 年;氧化铝-氧化铝 HP 的摩擦力矩为 0.29,MF 为 5.1 年。(iv)最后,使用 3 个非骨水泥柄的 3 例关节置换术的 RCOY > 1.3。讨论虽然使用传统骨水泥股骨柄的 HP 在 6.6 年的 MF 时 RCOY 仅为 0.16,而使用传统非骨水泥柄的 HP 在 4.9 年时 RCOY 为 0.29,但非骨水泥股骨固定的趋势仍在继续加强。在仔细选择植入物后,人工股骨头置换术取得了很好的效果,但其有效期较短,仅为 2.5 年。传统的金属-金属支架在近 10 年的 MF 期内仍能保持良好的效果。与使用传统股骨柄的 HP 相比,使用短股骨柄的 HP 的 10 年存活率更高。尽管代表性较低,但该登记册提供了有关法国使用的技术和植入物的信息。在新的SOFCOT-RENACOT登记册中增加临床监测和PROM以及重新认证义务应有助于促进其发展。
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引用次数: 0
Comments to: “Management of periprosthetic femoral fractures following total knee arthroplasties using locking plates or intramedullary nailing. Comparative study of 567 cases” by J Abboud, M-K Moussa, Z Sader, H Favreau, T Bégué, X Flecher, M Ehlinger, Sofcot, published in Orthop Traumatol Surg Res 2024;110:103814. doi: 10.1016/j.otsr.2024.103814 评论:对 "使用锁定钢板或髓内钉治疗全膝关节置换术后的股骨假体周围骨折。作者:J Abboud、M-K Moussa、Z Sader、H Favreau、T Bégué、X Flecher、M Ehlinger、Sofcot,发表于《Orthop Traumatol Surg Res》2024;110:103814.doi:10.1016/j.otsr.2024.103814。
IF 2.3 3区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.otsr.2024.104043
Xiaohua Jiang, Yabin Liu, Guowu Chen
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引用次数: 0
Non-operative treatment of adolescent idiopathic scoliosis 青少年特发性脊柱侧凸的非手术治疗。
IF 2.3 3区 医学 Q2 ORTHOPEDICS Pub Date : 2025-02-01 DOI: 10.1016/j.otsr.2024.104078
Audrey Angelliaume , Clémence Pfirrmann , Toulla Alhada , Jérôme Sales de Gauzy
Adolescent idiopathic scoliosis worsens mainly during growth at puberty. This is when non-operative treatment, by brace and physiotherapy, comes into its own. Only the brace has proven efficacy in stabilizing Cobb’s angle. There are numerous types of brace and modalities of application, to be adapted to the scoliosis and the patient. What is crucial is that the patient should accept the brace, as compliance is one of the keys to success. The aim is, by the end of growth, to have a balanced spine with as little curvature as possible, to avoid aggravation and impaired quality of life in adulthood.

Level of evidence

Expert opinion
青少年特发性脊柱侧凸主要在青春期生长期间恶化。这时非手术治疗,通过支架和物理治疗,发挥了作用。只有支架被证实对稳定科布的角度有效。有许多类型的支撑和应用方式,以适应脊柱侧凸和患者。关键是患者应该接受支架,因为依从性是成功的关键之一。这样做的目的是,在生长结束时,拥有一个平衡的脊柱,尽可能少的弯曲,以避免恶化和成年后的生活质量受损。证据级别:专家意见。
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引用次数: 0
期刊
Orthopaedics & Traumatology-Surgery & Research
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