Pub Date : 2025-02-01DOI: 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.
{"title":"Distal radius fractures after 75 years of age: are six-month functional and radiological outcomes better with plate fixation than with conservative treatment?","authors":"Safire Ballet , Inès Guerzider-Regas , Zouhair Aouzal , Astrid Pozet , Alexandre Quemener-Tanguy , Axel Koehly , Laurent Obert , François Loisel","doi":"10.1016/j.otsr.2024.103959","DOIUrl":"10.1016/j.otsr.2024.103959","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Hypothesis</h3><div>Surgery provides better clinical and radiological outcomes than does non-operative treatment.</div></div><div><h3>Patients and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> < 0.05 for all comparisons). At 6 months, pronation and the radio-ulnar index were better with surgery (<em>p</em> < 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 (<em>p</em> < 0.05 for all comparisons).</div></div><div><h3>Discussion</h3><div>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.</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 103959"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768098","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.2024.104054
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.
{"title":"Does internal fixation of shaft fracture show specificities in over-80 year-olds?","authors":"Guy Piétu","doi":"10.1016/j.otsr.2024.104054","DOIUrl":"10.1016/j.otsr.2024.104054","url":null,"abstract":"<div><div>Osteoporotic fractures in the elderly are increasingly numerous, but diaphyseal locations on native bone are quite rare.</div><div>Pathological and periprosthetic fractures are not included in this review, as they are specific in terms of context and treatment.</div><div>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.</div><div>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.</div><div>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.</div><div>In the humerus, the choice is wider. For nailing, passage through the rotator cuff seems acceptable in elderly patients.</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 104054"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696247","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.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.
{"title":"Intraoperative reference points on the proximal tibia in image-free robotic-assisted total knee arthroplasty should be determined by preoperative posterior tibial slope.","authors":"Yutaka Nakamura, Hiroyasu Ogawa, Haruhiko Akiyama","doi":"10.1016/j.otsr.2025.104180","DOIUrl":"10.1016/j.otsr.2025.104180","url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Hypothesis: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Discussion: </strong>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.</p><p><strong>Level of evidence: </strong>III.<sup>1</sup>.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104180"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124025","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.2024.103983
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
{"title":"New comprehensive score for predicting difficulties in revision total hip arthroplasty","authors":"Olivier Roche , Arthur Schmitz , Maxime Lefevre , François Sirveaux , François Bonnomet","doi":"10.1016/j.otsr.2024.103983","DOIUrl":"10.1016/j.otsr.2024.103983","url":null,"abstract":"<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","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}
Pub Date : 2025-02-01DOI: 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.
{"title":"High-energy tibial plateau fracture","authors":"Pierre Martz , Marie Le Baron","doi":"10.1016/j.otsr.2024.104072","DOIUrl":"10.1016/j.otsr.2024.104072","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>The present review addresses 6 questions:</div><div><ul><li><span>•</span><span><div>How to describe these fractures so as to understand them and plan treatment?</div></span></li><li><span>•</span><span><div>What should be the immediate treatment, to avoid acute complications?</div></span></li><li><span>•</span><span><div>What are the principles of definitive treatment?</div></span></li><li><span>•</span><span><div>How to deal with associated meniscal and ligament lesions?</div></span></li><li><span>•</span><span><div>Is there a role for arthroscopic assistance? - navigation? – balloon reduction?</div></span></li><li><span>•</span><span><div>What are the long-term results?</div></span></li></ul></div><div>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.</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 104072"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741401","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.2024.104056
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.
{"title":"Iatrogenic nerve injury during upper limb surgery (excluding the hand)","authors":"Laurent Obert , Sophie Spitael , François Loisel , Matthieu Mangin , Victor Rutka , Christophe Lebrun , Frédéric Sailhan , Philippe Clavert","doi":"10.1016/j.otsr.2024.104056","DOIUrl":"10.1016/j.otsr.2024.104056","url":null,"abstract":"<div><div>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.</div><div>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.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104056"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696251","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.2024.104058
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).
{"title":"Pediatric soft tissue tumors","authors":"Pierre Mary , Clelia Thouement , Tristan Langlais","doi":"10.1016/j.otsr.2024.104058","DOIUrl":"10.1016/j.otsr.2024.104058","url":null,"abstract":"<div><div>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).</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 104058"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696254","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.2024.103996
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。
{"title":"What does the SOFCOT-RENACOT 2024 hip prosthesis register tell us?","authors":"Christian Delaunay , Christian Brand , Antoine Poichotte , Alexandre Poignard , Stéphane Boisgard","doi":"10.1016/j.otsr.2024.103996","DOIUrl":"10.1016/j.otsr.2024.103996","url":null,"abstract":"<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","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103996"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262213","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.2024.104043
Xiaohua Jiang, Yabin Liu, Guowu Chen
{"title":"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","authors":"Xiaohua Jiang, Yabin Liu, Guowu Chen","doi":"10.1016/j.otsr.2024.104043","DOIUrl":"10.1016/j.otsr.2024.104043","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104043"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632134","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}
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.
{"title":"Non-operative treatment of adolescent idiopathic scoliosis","authors":"Audrey Angelliaume , Clémence Pfirrmann , Toulla Alhada , Jérôme Sales de Gauzy","doi":"10.1016/j.otsr.2024.104078","DOIUrl":"10.1016/j.otsr.2024.104078","url":null,"abstract":"<div><div>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.</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 104078"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787806","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}