Acta orthopaedica Belgica最新文献

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.

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.