Acta orthopaedica Belgica最新文献

Introduction: The treatment of Galeazzi fractures is definitely surgical. However, the choice of therapeutic strategy remains controversial. The aim of this study was to report our results of surgical treatment of Galeazzi fractures.

Patients and methods: A retrospective descriptive study was carried out over 3 years. Were included 32 patients operated for Galeazzi fracture. The average age was 32 years. Front and lateral forearm x-rays were used for lesion diagnosis and measurements. The radius fracture was located in the middle third for 71% of cases. The average distal radio- ulnar index was 3.6 mm. Osteosynthesis of the radius was carried out using a screwed plate before stability testing of the distal radio-ulnar joint. In case of instability, ulno-radial pin fixation wirst in supination was done for 45 days. At the mean follow-up of 38 months, all patients were evaluated using Mestdagth score.

Results: Bone consolidation was achieved within an average time of 75 days. At a mean follow-up of 38 months, internal fixation by radial plate and ulno-radial pinning achieved a good functional result in 73.7% of cases (p=0.03). Patients treated only by pinning without use of plate had a poor functional score.

Conclusion: The treatment of Galeazzi fractures using a radial screwed plate and radioulnar pinning provides satisfactory results and a low complication rate.

Managing greater tuberosity (GT) fractures, especially those with glenohumeral (GH) dislocations, poses a challenge in balancing stable fixation while promoting early mobilization. While surgical fixation is often required for significant displacement, the optimal fixation technique remains debated due to the risk of complications and inconsistent outcomes. This study aimed to evaluate the outcomes of the Modified Hook Wiring (MHW) technique for open reduction and internal fixation of isolated displaced GT fractures. Thirteen patients with a mean age of 49.4±4.7 years were treated using the MHW technique, with 84.6% presenting concomitant GH dislocations. The mean follow-up was 16±3.3 months. The functional evaluation using the Constant-Murley and ASES scores yielded averages of 77.9±16.9 and 83.1±19.6 at one year, with no relevant changes at the final follow-up. The average range of motion showed forward flexion of 148°±31° and abduction of 142.3°±26.2°. The mean subjective shoulder value reached 81.5%±13.6%, while the mean visual analog scale score was 1.46±1.7. Radiographic analysis confirmed complete fracture healing in all cases by 9.7±1.3 weeks, with no evidence of displacement or malunion. Two patients (15.3%) experienced postoperative stiffness, and one developed a superficial wound infection. The results suggest that the MHW technique offers stable fixation, reliable union, and satisfactory shoulder function, making it a promising alternative for treating displaced GT fractures, particularly in the setting of GH dislocation. Its facilitation of early shoulder mobilization and low complication profile highlight potential benefits over conventional fixation methods. This study provides Level IV evidence. Trial registration: NCT05403879.

Osteoarthritis (OA) is the most common joint disorder and the microstructural changes in trabecular bone remain unclear. The present study aimed to evaluate the fractal dimensions of the trabecular bone structure of the femoral neck on pelvic radiograph images of patients with unilateral end-stage hip OA. The trabecular structures of the femoral neck of 130 patients (57 with right-sided hip joint OA and 73 with left-sided hip joint OA) were evaluated and compared with the Fractal Analysis Method, taking into account gender and hip joint orientation. The fractal dimension calculated from the femoral neck on the right and left sides was similar to the healthy side in individuals with OA (p=0.647, p=0.929, respectively). When OA and healthy joints were compared separately on the right and left sides, the value on the osteoarthritic side was found to be significantly lower (p<0.05). When examined without distinguishing between the right and left sides, the fractal dimensions were found to be significantly lower in osteoarthritic joints than in the healthy side (p=0.001). When gender was taken into account, the fractal dimension calculated in both healthy individuals and individuals with OA was found to be similar in women and men (p>0.05). The fractal dimensions of the femoral neck trabecular structure of the osteoarthritic hip joint that was evaluated in pelvis radiography were low on the osteoarthritic side. With its cost-free and harmless use, the Fractal Analysis Method can be used by clinicians in planning therapeutic procedures in OA in the medical examination of OA patients.

Chondral and osteochondral lesions of the knee in skeletally immature patients, can result in serious long-term sequelae, such as early knee arthrosis. While there is an abundance of studies concerning chondral repair techniques, there have been relatively few studies that have examined outcomes following cartilage repair in skeletally immature patients. Therefore, we planned to answer the following question: does the AMIC® technique result in positive outcomes for the repair of cartilage lesions in the knee in adolescent patients ? Our hypothesis was that the AMIC® technique improves outcomes for skeletally immature patients with an ICRS stage III or IV osteochondral lesion two year after the surgery. This was an European retrospective, multicenter study, including 27 patients aged from 12 to 19 years. We included adolescents with open epiphysis on x-ray, with an ICRS stage III or IV symptomatic lesion of the knee. The average defect size was 2.3 cm2. All patients had been treated with the surgical technique AMIC®. Post-operative outcomes were assessed by the Knee injury and Osteoarthritis Outcome Score (KOOS). Results showed a significant improvement at a mean follow-up of 2.6 years (min 2; max 6 years) across all KOOS domains: 55 vs. 69% (p<0.001) on symptoms, 58 vs. 87% (p<0.001) on pain, 31 vs. 71% (p<0.001) on quality of life, 29 vs. 73% (p<0.001) on sports and leisure activities, and 67 vs. 90% (p<0.001) on activities of daily life. AMIC® technique performed for the repair of stage III or IV ICRS articular cartilage lesions in the knees of adolescent patients, provides clinical improvements 2.6 years after surgery, but results are not perfect with adolescents who may still symptomatic.

Background and study aim: Scapholunate interosseous ligament (SLIL) injuries, crucial for wrist stability, can cause significant dysfunction and lead to scapholunate advanced collapse (SLAC) wrist. This review compares open and arthroscopic dorsal capsulodesis techniques for chronic (pre-)dynamic SLIL tears, aiming to identify the most effective method for optimizing outcomes and preventing SLAC wrist progression.

Methods: A systematic search of PubMed, Embase, Web of Science, and Cochrane Library was performed. Fourteen studies met inclusion criteria. Included studies assessed long-term clinical, patient reported and radiographic outcomes (≥6 weeks post-injury). Studies combining dorsal capsulodesis with other techniques (except primary ligament repair) were excluded. Heterogeneous outcome measures precluded statistical comparison.

Results: While older techniques (Lavernia, Blatt) resulted in significant ROM loss and failed to prevent SLAC wrist, newer open procedures (Berger, Modified Viegas) showed improved results, with the Modified Viegas technique demonstrating less ROM decrease. The all-arthroscopic Mathoulin procedure showed the most promising results regarding clinical, patient-reported outcomes, and SLAC wrist prevention. Thermal shrinkage/abrasion showed the worst outcomes.

Conclusion: Since open procedures also require arthroscopy, all-arthroscopic techniques may be more cost efficient. The Mathoulin procedure appears the most effective even in severe tears and less favorable cases, although this review suggests some open procedures may not necessarily lead to greater ROM loss than arthroscopic ones. The Mathoulin procedure shows promise for chronic SLIL tears without arthritis and may fit into current treatment algorithms. However, larger trials with longer follow-up are needed.

Objective is to investigate the potential of DMMO to restore a harmonious forefoot morphotype according to Maestro criteria. Retrospective study investigated 51 feet in 48 patients with central primary metatarsalgia between the 2nd and 4th metatarsal. Associated procedures included hallux valgus and lesser toe corrections. Patients were evaluated radiographically with comparison of their forefoot morphotypes after the DMMO procedure to their preoperative state regarding the Maestro criteria. A subgroup of 17 patients was evaluated for union in 3 months and functionally by the AOFAS and VAS scale. Ten percent of the 48 patients were male and ninety percent were female with a mean age of 52.1 ± 11.7 (range 23 to 70) years. In total 148 DMMOs were performed in 51 feet. Osteotomies were localized on M2 and M3 in 10% and on three metatarsals (M2-M3-M4) in 90%). In 84% associated procedures were performed. All radiographic parameters of the Maestro criteria were significantly different preoperative compared to postoperative (p<0.05). In 94% patients of the subgroup there was a bony consolidation at three months. There was a mean AOFAS-score of 76.8 ± 15.1 (range 49-95) and a mean VAS-score of 2.7 ± 1.7 (range 1-6). There were late complications in 8% of the patients. DMMO is effective for treating primary central metatarsalgia unless the ideal harmonious forefoot was not restored. For DMMO the Maestro criteria have no predictive value for clinical outcome in preoperative planning. Further studies are necessary to correlate the functional improvement. Level of evidence: Level IV retrospective case series.

Purpose: Upper extremity fractures are increasingly common in Western Europe due to an aging population and rising osteoporosis rates. Treatment approaches vary significantly, influenced by fracture type, bone quality, and patient- surgeon preferences, with limited consensus on optimal rehabilitation. A key challenge is identifying when to initiate safe, early functional rehabilitation, as guidelines lack clarity on progressive mobilization.

Materials & methods: A prospective observational study of operatively treated proximal humeral and distal radius fractures was performed. Feasibility was assessed through clinical observation of patient progress using patient- reported outcome measures and feedback from both medical and paramedical professionals.

Results: Twenty patients and 10 professionals participated. Feasibility questionnaires indicated high protocol usability, though suggestions included simplifying it into a pocket card. Rapid functional improvement was observed within six weeks, with one complication (material failure) noted.

Conclusion: The PERFoRM protocol is safe and feasible, though larger-scale studies are needed. Future research should examine its applicability to a broader patient population, potentially extending to all upper extremity fractures except hand fractures.

Background: Hemi-epiphysiodesis using percutaneous transphyseal screws is an established technique with good results to treat idiopathic genua valga in children. However, there is no evidence-based consensus on the optimal age for correction.

Purpose: This study aims to determine best age for optimal correction of the knee alignment.

Methods: All medical records of patients in our department treated by percutaneous hemiepiphysiodesis for idiopathic genua valga between 2007 and 2017 were reviewed. Skeletal age was determined pre-operatively. The hip-knee-ankle angle was measured on a standard frontal full leg radiograph, preoperatively, at time of removal of the screws and at skeletal maturity. The occurrence of correction loss and progression and the velocity of correction based on skeletal age were evaluated.

Results: A total of 164 legs were reviewed, of which 120 were followed until skeletal maturity. We perceived more insufficient valgus correction when treated at a skeletal age approximating skeletal maturity, however, also rebound valgus was noted in patients with only a short time to skeletal maturation at time of treatment. Overcorrection after screw removal was only perceived in 4.27%. A large individual variation in velocity of correction was observed.

Conclusion: In our study protocol with hemi-epiphysiodesis at 2 years from skeletal maturation, good results were obtained. Velocity of correction can be calculated to determine a patient specific timing for clinical and radiographical follow-up to avoid overcorrection.

Level of evidence: IV.

Purpose: Numerous papers present in-vivo knee kinematics data following total knee arthroplasty (TKA) from fluoroscopic testing. Comparing data is challenging given the large number of factors that could potentially affect the reported kinematics. This paper aims to understand the effects of some of the most pertinent factors: 1. What is the role of post-cam interaction and implant geometry in total knee kinematics? 2. Do tibiofemoral kinematics vary with different activities? 3. Is there a correlation between landmark-based and contact points kinematics?

Methods: Thirty patients who underwent TKA between 2014 and 2016 were assessed at a minimum follow-up period of six months. Given the use of three different posterior stabilized implants in the hospital, the first ten patients per implant who attended follow-up consultations and demonstrated a minimum of 90° knee flexion, were included in the study. The tibiofemoral kinematics during both open kinetic chain flexion-extension and closed kinetic chain exercises, such as rising from a chair and squatting, were examined using fluoroscopy. Single-plane fluoroscopic analysis (2D) was used to record the data, which was subsequently converted to 3D implant positions to evaluate the tibiofemoral contact points and landmark-based kinematic parameters.

Results: Significantly different anteroposterior translations and internal-external rotations were observed between the considered implants. Comparing the activities, a significantly more posterior position was observed for both the medial and lateral compartments in the closed chain activities during mid-flexion. A strong and significant correlation was found between the contact points and landmark-based analysis methods. However, large individual variations were also observed, yielding a difference of up to 25% in anteroposterior position between both methods.

Conclusion: In conclusion, all three evaluated factors significantly affect the obtained tibiofemoral kinematics.

Level of evidence: Diagnostic, Level IV Case series.

Total hip replacement revision surgery has become increasingly prevalent in today's society. This causes issues since, for each revision surgery, the quantity of accessible bone stock decreases and the complexity of surgery increases. As a result, readily available implants may not always address the patient's individual demands. For those patients, custom- made implants may be a feasible option. This paper is a retrospective cohort-analysis of 5 patients who received an aMace custom-made acetabular implant produced by Materialise, placed by a single surgeon. At the time of writing, we conducted a cross-sectional cohort analysis of patients who received this custom-made acetabular implant between 2014 and 2016. The mean follow-up time of 5 patients was 7.8 years (range: 6.3 - 10.6 years). All patients achieved excellent outcomes; there were no implant failures or known adverse events. Radiographic images demonstrate significant implant ingrowth with no signs of loosening. All patients expressed satisfaction and withheld no to minor complaints. Harris Hip Score (HHS) values ranged between 70.7 and 99.5, with a mean score of 85.6. The aMace custom-made acetabular implant is a feasible option in patients with severe acetabular defects undergoing revision arthroplasty. At this moment, the primary issues are the cost of the cup and the reimbursement criteria.