Acta orthopaedica Belgica最新文献

Since most clinical studies on humeral shaft fractures exclude polytraumatized patients, the epidemiology in this population is largely unknown. The aim of this study was to describe the fracture type, treatment, and outcome of humeral shaft fractures in adult polytraumatized patients. A case series with a single follow-up questionnaire was performed in patients aged 16 years or older with a humeral shaft fracture and an injury severity score of 16 or higher, admitted to a level 1 trauma center between January 1, 2007, and July 31, 2021. Details on injuries, treatment, and clinical outcome were collected from the national trauma registry and medical records. Patients were asked to complete the Disabilities of the Arm, Shoulder, and Hand (DASH), EuroQol-5D (EQ-5D), and Short Form-36 (SF- 36). Twenty-nine patients were included. The median age was 41 years and 18 (62%) were male. Most fractures were type A (N=19; 66%). Most patients were treated operatively (N=26; 90%) within three days. Radial nerve palsy at presentation was reported in five (20%) patients. Infection occurred in one (4%) patient and nonunion in six (27%) patients. The patient-reported outcome measures were as follows (median; quartiles): DASH (20.0; P25-P75 5.6-35.2), EQ utility (0.75; P25-P75 0.58-0.88) and visual analog score (0.80; P25-P75 71-95), SF-36 physical (49; P25-P75 43- 55) and mental component summary (58; P25-P75 47-61). Humeral shaft fractures in adult polytraumatized patients were most often AO-type A and treated operatively. Radial nerve palsy at presentation and nonunion rates were high. Patients still reported upper extremity disability at approximately five years post trauma. Level of evidence: Prognosis study Level IV: Case series.

This study aims to investigate the anatomical incongruity between the proximal humerus and the PHILOS plate, which may lead to varus malreduction when this plate is used for indirect reduction. Fifty Asian cadaveric human humeri were included in the study. Three-hole and five-hole PHILOS plates were appropriately positioned on the lateral cortex of the proximal humerus. The gap distance between the plate and the lateral surface of the proximal humerus at each screw hole was measured using a digital vernier caliper. A Kirschner wire was inserted into the humeral head, guided by the locking sleeve. The angle between the plate and the lateral cortex was then measured. Differences in plate-bone distance and angles between the different plate lengths were analyzed using a paired t-test. The correlation between demographic variables and mismatched data was evaluated using Pearson correlation. All measurements were conducted by two observers to assess inter-observer reliability. In all specimens, the maximum gap distance was observed at the most proximal screw hole. The average plate-bone distance at this location was 2 mm for the 3-hole plate and 3 mm for the 5-hole plate. The average plate-bone angle was 2.9 degrees for the 3-hole plate and 3.2 degrees for the 5-hole plate. No correlation was found between total humeral length and either the plate-bone distance or the plate-bone angle. Due to the anatomical mismatch between the PHILOS plate and the proximal humerus, caution is advised when using the plate for indirect reduction, as it may lead to secondary varus malreduction.

The direct anterior approach (DAA) for total hip arthroplasty (THA) has gained increasing popularity; however, the incidence, causes and outcomes of dislocations following THA are rarely studied. This study aims to evaluate the incidence, causes, and outcomes of dislocations following DAA THA. This retrospective study included 2933 patients who underwent DAA THA for osteoarthritis between 2014 and 2019, with a one-year follow-up. Data were collected on dislocation rate, directions, timing, associated risk factors, and revision surgeries. Hip function outcomes were assessed using the Oxford Hip Score (OHS), comparing patients with and without dislocations. The dislocation rate was 0.7% (n=21), with 81% of dislocations occurring in the anterior direction and 86% occurring within the first postoperative month. Dislocations were most commonly associated with sitting or rising from a seated position. Patients with dislocations had a higher mean Body Mass Index (29.6 vs 27.0 kg/m², p=0.007). Five patients (24%) required revision surgery. At one-year follow-up, no significant differences in OHS were observed between patients with and without dislocations. Dislocation after DAA THA are rare, with the majority being anterior. Dislocations occur in different positions, but mostly in a seated position, suggesting that specific postoperative precautions may be unnecessary. Despite these dislocations, patients generally experience comparable hip function outcomes at one-year follow-up.

Intertrochanteric fractures and knee osteoarthritis are prevalent among elderly patients; however, the relationship between the complexity of these fractures and the severity of knee osteoarthritis remains poorly understood. This study aimed to investigate the correlation between the complexity of intertrochanteric fractures and the severity of knee osteoarthritis in elderly patients. A total of 130 elderly patients with knee osteoarthritis, admitted between February 2021 and June 2023, were divided into a non-fracture group (77 patients) and a fracture group (53 patients). The fracture group was further stratified into a simple fracture subgroup (23 cases) and a complex fracture subgroup (30 cases). The Hospital for Special Surgery (HSS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Kellgren-Lawrence (K-L) grade were compared across the groups. Pearson correlation analysis was employed to assess the relationship between these variables and fracture complexity. Results revealed that the non-fracture group exhibited significantly higher HSS scores (64.88 ± 9.87 vs. 57.36 ± 10.08) and a greater proportion of mild K-L grade cases (80.52% vs. 20.75%) compared to the fracture group. Conversely, the fracture group demonstrated higher WOMAC scores (35.67 ± 8.19 vs. 43.22 ± 10.77) and a higher proportion of severe K-L grade cases (19.48% vs. 79.25%). Within the fracture group, the simple fracture subgroup had higher HSS scores (63.14 ± 9.27 vs. 55.43 ± 9.54) and lower WOMAC scores and severe K-L grade proportions compared to the complex fracture subgroup. HSS scores were negatively correlated with fracture occurrence (r = -0.351), while WOMAC scores and K-L grades were positively correlated with fracture complexity (r = 0.372, 0.592). These findings suggest a positive correlation between the complexity of intertrochanteric fractures and the severity of knee osteoarthritis, indicating that more severe osteoarthritis may be predictive of more complex fractures.

Introduction: Currently the recommended treatment for an undisplaced intracapsular hip fracture is internal fixation. Recent studies have questioned this practice and suggested arthroplasty may be a more appropriate treatment method.

Methods: 54 patients with an undisplaced intracapsular fracture were randomised between a cemented polished tapered stem hemiarthroplasty and internal fixation with Targon hip screws. The principle outcome was regain of mobility. Secondary outcomes included degree of residual pain, mortality, secondary surgery and surgical complications. Follow-up was by a nurse blinded to the implant and continued till three years from surgery for the surviving patients.

Results: No significant differences in the primary outcome of regain of mobility were noted. Arthroplasty was associated with lower degrees of residual pain. No surgical complications were encountered in the arthroplasty group. In the fixation group there was one case of later fracture around the implant requiring surgery and two cases of avascular necrosis of the femoral head. There were no notable differences in mortality, hospital stay or general medical complications between the two groups.

Conclusions: Arthroplasty may lead to improved outcomes compared to internal fixation in the treatment of an undisplaced intracapsular fracture in the elderly but further studies are required to confirm this.

Much controversy exists about the reliability of cheap implants, often the only ones affordable in low income countries. Between August 1, 2021, and August 1, 2023, 110 patients were treated with a reamed unlocked 316L stainless steel Küntscher nail for a fracture of the femoral shaft in Mutoyi Hospital, Mutoyi (Gitega), Burundi. Not a single breakage occurred. Minimal bending (9°) without the need of a reoperation occurred in 2 cases (1,8%). Migration necessitated a small reintervention for a single nail (0,9%).

Using bone-cemented stems is recommended for femurs with severe osteoporosis and a large medullary cavity. This study aimed to evaluate postoperative bone changes around a collarless POLARSTEM◊ using simple X-ray images and the bone mineral density and compare them according to the medullary cavity geometry. The data used in this study consisted of 50 patients (54 joints in total) who underwent total hip arthroplasty with POLARSTEM◊ (Dorr type A: 19 joints, Dorr type B: 19 joints, and Dorr type C: 16 joints) between January 2018 and December 2021. Clinical evaluations included Harris' hip score, blood loss, radiological evaluation, and bone mineral density changes. The postoperative Harris hip score was better than that preoperatively in Dorr types A, B, and C. Radiolucent lines were observed in two joints, but there was no evidence of subsidence greater than 3 mm or cortical hypertrophy. Stress shielding was found proximally in zones 1 and 7, while cancellous condensation was found distally in zones 3, 4, and 5. The postoperative bone mineral density of the femoral condyle was greater than that preoperatively in all zones, with the highest and lowest bone mineral density in zones 5 and 1, respectively, in all medullary configurations. In Dorr type C, there was no postoperative femoral pain or stem subsidence. Good bone remodeling also occurred, suggesting that POLARSTEM◊ may be a valuable option for hip arthroplasty in older adults.

This study aims to investigate the correlation between axial and sagittal malrotation of distal humerus fractures and elbow mobility. A transverse distal humerus fracture was generated in 5 cadaveric specimens. Rotation of the distal humeral fragment was performed on the medial column with a stable lateral column, as well as rotation of the lateral column with a stable medial column. Elbow flexion and extension range of motion were measured and repeated with an additional 5° and 10° of sagittal flexion and extension fracture deformity. All 4 fracture types suffered extension loss with increasing rotation. A peak extension loss was found within the range of 10-14° rotational deformity. A significant decrease in flexion of up to 50° was found in type MS2 fractures due to the interference of the radial head and the humeral metaphysis. Conversely, increased flexion motion was found in MS1 types. Fracture types and rotational malalignment should be considered when analyzing distal humeral fractures to predict future mobility with conservative treatment. The radial head seems to be the dominant factor in type MS fractures to predict flexion increase or limitation, while the extension limitation will gradually increase in both LS and MS type fractures. Future in vivo radiological and clinical studies are needed to validate these results. Level of Evidence: 3b.

Introduction: Arthrodesis is the gold standard for treating distal interphalangeal arthropathy of the long fingers (IPD) and interphalangeal arthropathy of the thumb (IP). While many surgical techniques have been documented to have high consolidation rates (80-100%), none appeared to be superior to the others. In 2008, the intramedullary X-Fuse implant (Stryker, Switzerland) demonstrated favorable clinical and radiographic outcomes in a limited study with short-term follow-up. Building upon these findings, this study aimed to evaluate the objective and subjective findings of arthrodesis of IPD and IP using the X-Fuse® implant over a medium-term period.

Patients and methods: We retrospectively included 53 patients (49 women and 4 men) who underwent arthrodesis of the IPD or IP joint surgery between May 2012 and January 2021. All surgeries were performed by senior hand surgeons at the same hospital, employing identical surgical techniques. Afterward, patients were immobilized for 6 weeks postoperatively. For analyses, data were extracted from patients' medical records.

Results: A total of 64 arthrodeses were assessed (with 6 patients lost to follow-up). The average follow-up period was 59.8 (±28) months. The mean QuickDASH score at the last review was 17.1 (±17), and the mean visual analog scale score was 0.64 (±1.6). Notably, more than 90% of patients reported good or excellent satisfaction with the surgery, and radiographic fusion was achieved in over 90% of cases, with an average fusion period of 12.9 weeks (±1.3). However, six cases of pseudarthrosis were documented, with only one requiring revision surgery due to symptoms.

Discussion: X-Fuse® implant arthrodesis yields satisfactory clinical and radiographical outcomes, providing good long-term stability and low complication rates. This technique is considered reliable and reproducible for patients with primary osteoarthritis, inflammatory conditions, and post-traumatic arthropathies.

Nerve conduction study (NCS) is the most common investigative tool used in diagnosing and determining the severity of carpal tunnel syndrome (CTS). We aimed to evaluate the relationship between preoperative NCS and the outcome of patients who underwent carpal tunnel release (CTR). Medical records of patients who underwent CTR from January 2018 to December 2023 were reviewed retrospectively. Demographic, clinical characteristics and NCS reports were extracted. CTS severity was graded according to the Canterbury criteria. The outcome was defined as improved or not improved based on subjective symptoms at 2 months post-surgery. A total of 283 CTR cases were identified, with a mean patients age of 58.0±15.1 years and predominantly females (n=189, 75.0%). The main risk factors were obesity (34.6%) and diabetes mellitus (27.0%). Surgeries were performed on the right hand in 60.4% of cases. The mean duration of symptoms and the interval between NCS and surgery were 16.4±21.6 months and 10.1±13.4 months, respectively. Of the 201 reports of NCS, the majority had very severe CTS (25.4%), followed by mild (20.4%), moderate (18.9%), severe (17.4%), extremely severe (11.4%), normal (6.0%) and very mild (0.5%). From multivariate analysis, younger age (OR 0.95; 95% CI 0.91-0.99; p=0.024), more items of preoperative history and physical examination (OR 1.58; 95% CI 1.01-2.47; p=0.045) and preoperative NCS severity (p=0.006) were associated with improved outcomes. In addition to known prognostic factors, the utilization of NCS before CTR is crucial as the severity of preoperative NCS can be a predictor of postoperative outcomes.