Acta orthopaedica Belgica最新文献

Due to the high incidence of proximal femoral fractures, classifications of these fractures are often used in daily practice. Most classifications are eponymous terms since they bear the name of the person(s) who developed them. In this study we provide an insight in the origin of the classifications and the background of their name givers. The clinical implication and background of the eponymous proximal femur fracture classifications of Garden, Pauwels and Evans-Jensen are discussed. With the rising use of modern classification systems, the relevance of historically important classifications is food for discussion. Nevertheless, these classification systems are still used in daily communication and decision making.

Chondrosarcomas are the second most common primary bone sarcoma. Due to chondrosarcomas relative resistance to chemotherapy and radiation, surgical treatment has become the mainstay treatment option. The purpose of our study was to understand the proportion of patients in this population who undergo non-operative treatment options secondary to various reasons and analyze the difference in survival as well as patient and cancer specific characteristics between the two groups. We retrospectively reviewed the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with primary chondrosarcoma from 1973 to 2015. We evaluated the patients for both descriptive characteristics as well as cancer specific characteristics. We then performed a propensity matched analysis and other analyses to compare difference in cancer characteristics as well as survival. There were 3048 patients with chondrosarcoma of the bone during our study period of which 188(6.2%) patients did not undergo operative treatment either due to refusal of cancer directed surgery or contraindicated to surgery. A one unit increase in age was significantly associated with increased odds of not undergoing surgery(Odds Ratio 1.04;95% CI, 1.03- 1.05). No statistically significant difference(P = 0.9) in survival was noted between patients with long bone, grade 1 chondrosarcomas regardless of if they did or did not undergo operative treatment. This study provides data to inform the patient on their decisions for or against surgery and may assist the surgeons in counseling patients regarding the surgical treatment of chondrosarcomas. Patients not undergoing operative treatment for chondrosarcomas are at statistically significantly increased risk of mortality.

Atypical mycobacteria can cause rare and atypical infections of the hand. We report the case of an immunocompetent 46-year-old male initially presenting with thumb felon and progressively developing symptoms of carpal tunnel syndrome, tenosynovitis of multiple fingers and a sporotrichoid lymphocutaneous infection causing chronic cutaneous lesions all over the body. We would like to highlight the diagnostic and therapeutic difficulties of these atypical infections, which mimic other conditions and can cause a lot of morbidity.

Deep venous thrombosis (DVT) has insidious clinical symptoms, and only a few patients suffer from lower limb swelling, tenderness and dorsal flexion pain. We aimed to explore the ultrasonographic features and risk factors of postoperative lower limb DVT in patients with lower limb fractures. Ninety patients with lower limb fractures admitted from January 1st, 2021 to June 30th, 2023 were selected. Color Doppler ultrasonography was performed one month after operation, and the ultrasonographic features were recorded. DVT was diagnosed according to the results of venography, based on which the patients were divided into a DVT group and a non-DVT group. Their basic and treatment-related data were compared. The risk factors for postoperative DVT were screened by multivariate logistic regression analysis. A total of 63 cases were diagnosed with DVT by venography, with a detection rate of 70.00%. A total of 69 cases were diagnosed with DVT by ultrasonography, with a detection rate of 76.67% (P>0.05). The concurrent internal medicine diseases, associated injuries, no preventive measures for thrombosis, operation time ≥2 h, no active or passive exercise after operation, pelvic and proximal femoral fractures, knee fractures and tibiofibular fractures were risk factors for postoperative DVT in patients with lower limb fractures (P<0.05). Ultrasonography is effective for diagnosing postoperative lower limb DVT in patients with lower limb fractures. Related preventive measures should be taken promptly to control the risk factors.

This prospective, observational cohort study compares the clinical and radiographic outcomes of the modified Weaver and Dunn (WD) technique with the newer, anatomical double-button plus tendon allograft technique (DB), and the suture anchor repair plus tendon allograft (SA). The study cohort includes 53 patients, who underwent surgery for acromioclavicular joint (ACJ) dislocation Rockwood type 3, 4 and 5. Patient-reported outcome scores and clinical results, including Disabilities of the Arm, Shoulder and Hand (DASH), the Subjective Shoulder Value (SSV), the Visual Analogue Scale (VAS) and the Constant score (CS) results as well as loss of reduction rates on plain radiographs were compared. Nineteen patients in the DB group, 19 patients in the SA group and 15 patients in the WD group were included. Average time of follow up was 5 years. The mean VAS scores (SD) were 0.3 (0.6), 0.5 (0.8) and 1.2 (1.4) in the WD, DB and SA groups (p=0.06). There were no significant differences in DASH, SSV and Constant scores between groups. Loss of reduction on plain radiographs occurred in 4 patients in total (1 WD, 1 DB, 2 SA). The SSV score, the DASH score, the Constant score and the VAS-score revealed no statistically significant differences between the group with good alignment compared to groups with partial reduction or loss of reduction. In conclusion we can state that the use of anatomical reconstruction techniques with tendon allograft and additional button or suture anchors fixation does not affect the clinical and radiographical outcomes compared to the classic Weaver and Dunn procedure. Loss of reduction was not correlated to worse clinical outcome scores.

Fracture-related infection (FRI) is a serious orthopaedic complication and its diagnosis, particularly in the upper extremity, is difficult and poorly defined in current literature. An international consensus definition of FRI was published in 2018, and our scoping review aims to investigate FRI diagnostic tools reported in the primary literature and their biostatistical utility. A review of articles generated from the PubMed/NCBI search term "fracture-related infection" was undertaken using PRISMA methodology. The included studies were published from January 2018 to June 2022 and referred to FRI diagnosis in the upper extremity. Of 224 returned studies, 32 articles were selected for further review after fellowship-trained senior author assessment. Of these, 16 had quantitative and reportable data regarding the diagnosis of upper extremity FRI. The most common diagnostic methods reported were CRP (8 studies), WBC (7), and ESR (5), consistent with 1 of the six suggestive criteria from the consensus definition. Meta-analysis was performed. Primary literature regarding the diagnosis of upper extremity fracture-related infections is sparse and variable despite FRI's diagnostic and therapeutic complexity. Recent literature does not reflect the proposed criteria of the 2018 consensus definition; further primary research is needed to validate these criteria and their accuracy and utility Level of Evidence: 3b.

Carbon fibre reinforced polyetheretherketone (CFR-PEEK) implants have gained interest because of reported biomechanical advantages and radio-lucent properties. The aim of this study was to evaluate the role of CFR-PEEK nails in patients with metastatic bone disease (MBD). We performed a retrospective cohort study evaluating patients with MBD undergoing intramedullary (IM) nailing for prophylaxis or fixation of pathological fractures using CFR- PEEK or titanium implants. Patient survival, implant failure rates, ability to visualise disease progression on post- operative CT/MRI, and post-operative radiotherapy dose were reported. Fifty patients underwent 56 IM nails (26 CFR-PEEK and 30 titanium). Median survival was 8 months for the entire cohort, 6 months for patients with CFR- PEEK nails and 8 months for those with conventional nails (p=0.691). No implant failures were recorded in either group. There was no correlation between implant type and post-operative radiotherapy dose given (χ 2 = 0.139, p=0.710). Artefact on MRI was less evident with CFR-PEEK nails when hybrid imaging and metal artefact reduction techniques were used. The advantages of CFR-PEEK nails might not be realised in clinical practice for most patients with MBD requiring IM nailing except for in those likely to require prolonged disease surveillance.

Correct treatment of chronic osteomyelitis depends on proper identification of the bone-infecting microorganism, but it is difficult identify the specific etiology in previously treated patients and in those with implants. Small colony variants auxotrophyc for menadione had been related with false-negative results in culture of patient with chronic osteomyelitis, but menadione supplementation can increase bone culture performance. The purpose was to evaluate the effect of menadione supplementation on isolates in bone cultures, in a cohort of patients with osteomyelitis, Medellín- Colombia. We performed a study of a retrospective cohort with 40 adult patients with culture-negative and chronic osteomyelitis, supplemented with 3 doses of menadione. Effect was defined as the proportion of positive bone cultures after treatment administration. The comparison of the effect with clinical variables was made with Chi-square, Fisher and Mann-Whitney U test in SPSS 29.0. Microbiological isolates from bone culture ranged from 0% (pre- treatment) to 62.5% (post-treatment), mainly S. aureus sensitive to methicillin, coagulase-negative Staphylococcus, E. coli and Enterobacter spp. This effect did not present statistical differences according to the clinical characteristics or comorbidities of the patients. We concluded that in patients with chronic osteomyelitis and negative bone cultures, menadione supplementation produces a high proportion of isolates and identification of the etiological agent, which favors correct treatment and reduces readmissions, complications, and resistance to antibiotics.

Patients with anterior cruciate ligament reconstruction frequently present asymmetries in the sagittal plane dynamics when performing single leg jumps but their assessment is inaccessible to health-care professionals as it requires a complex and expensive system. With the development of deep learning methods for human pose detection, kinematics can be quantified based on a video and this study aimed to investigate whether a relatively simple 2D multibody model could predict relevant dynamic biomarkers based on the kinematics using inverse dynamics. Six participants performed ten vertical and forward single leg hops while the kinematics and the ground reaction force "GRF" were captured using an optoelectronic system coupled with a force platform. The participants are modelled by a seven rigid bodies system and the sagittal plane kinematics was used as model input. Model outputs were compared to values measured by the force platform using intraclass correlation coefficients for seven outcomes: the peak vertical and antero-posterior GRFs and the impulses during the propulsion and landing phases and the loading ratio. The model reliability is either good or excellent for all outcomes (0,845 ≤ ICC ≤ 0.987). The study results are promising for deploying the developed model following a kinematics analysis based on a video. This could enable clinicians to assess their patients' jumps more effectively using video recordings made with widely available smartphones, even outside the laboratory.

TKA is routinely done orthopaedic procedure done that aims at improving the quality of patients' life by providing pain relief, functional improvement and deformity correction. This study aims to study the efficacy and safety of a Periarticular analgesic cocktail including ropivacaine injection and epidural ropivacaine for early rehabilitation after a total knee replacement.

Methods: Total of 100 patients divided into two groups, one group received epidural ropivacaine and second group given periarticular cocktail containing ropivacaine. Then postoperatively their pain score comparison using VAS score and their functional status is documented knee society score.

Results: The mean age for the epidural group is 60.28 years, while for the periarticular cocktail group it's 60.88 years. For female patients, 34 (68%) received epidural analgesia, while 24 (48%) received periarticular cocktail. Among male patients, 16 (32%) had epidural analgesia, and 26 (52%) received periarticular cocktail. For pre-operative pain scores, patients receiving Epidural analgesia had a slightly higher mean score of 7.24 compared to those receiving Periarticular Cocktail, who had a mean score of 7.12. Patients in the Epidural group had a higher mean knee flexion of 83.84 degrees compared to the Periarticular Cocktail group, which had a mean flexion of 79.36 degrees. The Knee Society Scores (KSS) for the post-operative scores; The Epidural group had a mean score of 80.16. The Periarticular Cocktail group had a mean score of 88.40.

Conclusion: In conclusion, this study supports the periarticular analgesic cocktail over epidural analgesia for pain management and early rehabilitation following TKR.