Acta orthopaedica Belgica最新文献

Background: Aim of the randomised controlled trial was to compare the long-term outcomes following external fixation with wrist distractor and Kirschner wires (EF) with those after internal fixation with volar locking plates (IF) of displaced, intra-articular distal radius fractures in patients 18 to 65 years of age.

Methods: Surgery was performed after taking informed written consent following inclusion and randomisation. The primary outcomes were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and Jakim's score, and secondary outcomes included wrist range of motion, grip strength and pain. Linear mixed models were employed to assess and compare the 2 groups.

Results: The patients in both groups had comparable mean Quick DASH and Jakim's score, range of motion, and grip strength with no significant differences between the groups at all follow-ups. The overall complication rate was equivalent between the 2 groups, although, the rate of reoperations was higher in the IF group (p=0.03). Implant prominence or impingement was responsible for the IF group result values falling short of normal limb values even on long-term follow-up. While, results of EF group homogenously and successfully achieved normal limb functionality. At 3 years the rate of follow-up was 97%.

Conclusions: Biological healing through EF offers more natural anatomical restoration of the distal radius as evident by better long-term scores and statistically significant low reoperations rate. Absence of long-term bone-implant contact in EF group is identified as the sole factor promoting complete functional and clinical recovery.

Level of evidence: Therapeutic Level I.

The infrapatellar branch of the saphenous nerve (IPBSN) is susceptible to injury during common knee procedures, occasionally leading to the development of painful neuromas which are refractory to conservative management strategies. As a result, surgical resection has emerged as a viable treatment option for patients with persistent symptoms, and this study aims to assess the efficacy of IPBSN neuroma resection in terms of pain alleviation, functional improvement, and patient satisfaction. A retrospective study was conducted on 40 patients who underwent IPBSN neuroma resection between 2017 and 2023. Pre- and postoperative VAS scores were collected and patients were surveyed on pain relief, functional outcomes, and satisfaction of the surgery. The average VAS score for medial pain decreased from 6.5 ± 2.2 to 3.8 ± 2.8, and for anteromedial pain from 6.1 ± 2.6 to 3.1 ± 2.8. Overall, the majority of patients rated the outcome of the surgery positively with 73% reporting significant pain relief and 58% experiencing functional improvement postoperatively. Surgical resection of IPBSN neuromas is a viable treatment option for patients with chronic anteromedial knee pain after previous surgeries, resulting in significant pain relief and functional improvements in a majority of challenging cases.

Despite increased sizing possibilities for implants in total knee arthroplasty (TKA) complications such as mechanical loosening and unexplained pain still exist. Similarly, approximately 20% of patients remain dissatisfied postoperatively. This study aims to evaluate the effectiveness and precision of the custom ORIGIN® TKA and assess the learning curve for its implementation. This retrospective, single-institution cohort study was conducted from March 2023 to June 2024. Forty-one patients with end-stage primary osteoarthritis, treated with custom TKA, were included. Primary outcomes measured alignment precision comparing the preoperative plan and the postoperative result on weightbearing full leg radiographs; secondary outcomes assessed the learning curve for operation time and alignment using cumulative summation (CUSUM) analysis. No significant differences between the planned and postoperative coronal alignment parameters were found, with a difference in means of -0.30° [95% CI: -1.40; 0.70] for HKA (P > 0.41), 0.30° [95% CI: -0.40; 1.60] for mLDFA (P > 0.43) and 0,10° [95% CI: -0.80; 1.00] for mMPTA (P > 0.75) . However, significant deviations were observed in sagittal alignment, with a difference of -2.5° [95% CI: -5.10; -0.50] and -2.7° [95% CI: -4.00; -1.70] for PDFA (P < 0.01) and PPTA (P < 0.000) respectively. This indicates a loss of tibial slope and femoral flexion compared to the preoperative plan. CUSUM analysis indicated an inflexion point in operative time after twenty- six procedures. Linear regression did not show a significant correlation between the number of cases and operative time. No learning curve for alignment could be demonstrated. Custom TKA with patient-specific instruments provides high precision in coronal alignment but shows variability in sagittal alignment. The learning curve for operative time is short, indicating the practicality of integrating this technology into surgical practice.

The aim of the study was to determine the efficacy of wrapping nerve suture over recovery. In this prospective study, 72 patients with injured digital collateral nerves were studied during six months after microsurgical repair. 28 patients had nerve epiperineural suture with vein conduit wrapping and 44 patients had simple epiperineural nerve suture. We compare these two groups in terms of spontaneous pain, pain caused by impact and cold intolerance. We also investigated sensitive recovery with Weber test, Dellon test and the five monofilaments test. We also performed ultrasound at six months after surgery. The result of this study is in favor of using wrapping with vein to decrease presence of neuroma, pain and discomfort caused by contact without negative effect on sensitive recovery.

Osteochondral Defects of the knee joint are a common diagnosis. We report a case in which such a lesion was treated by using a polyvinylalcohol cylinder (SaluCartilage™, SaluMedica, Atlanta, USA) presented with increasing complaints 22 years after implantation. During workup the cylinder was shown to be completely dislodged from its implant site. Despite these findings, the patient remained mobile and active. Arthroscopic extraction of the cylinder and inspection of the joint was performed, which revealed fibrous repair of the lesion. During follow up, the patient reported minor discomfort on activity, but is satisfied with the outcome.

Chryseobacterium indologenes is a rare human pathogen which is nowadays considered an emerging fearsome organism because of its upcoming antibiotic resistance. We present a quite unique case of a multi drug resistant C. indologenes surgical wound infection in a patient submitted to cannulated screw fixation of a displaced medial malleolus fracture. The microorganism was identified only after three months of attempts to treat pharmacologically the unhealed wound, by removing the ostheosynthesis device and sonicating it, and the surgical wound progressively restored by second intention.

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.