Acta orthopaedica Belgica最新文献

Despite an increasing number of studies examining the effect of Single-Photon Emission Computed Tomography/ Computed Tomography (SPECT/CT) on improvement of diagnosis of aseptic loosening, there is still a great deal of uncertainty regarding its applicability in diagnostic algorithm. Therefore, in this meta-analysis, we aimed to investigate the diagnostic performance of SPECT/CT for identification of aseptic loosening in patients with persistent pain following the total knee arthroplasty (TKA) and total hip arthroplasty (THA). Electronic databases including Medline, Scopus, Web of Science, Cochrane library, and Embase were systematically searched for identifying relevant published studies from their inception to April 2023. Quality evaluation of the included studies was carried out using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). SPECT/CT had pooled sensitivity of 94% (95% CI: 92-95%) and pooled specificity of 86% (95% CI: 83-89%) for diagnosis of aseptic loosening. The pooled positive likelihood ratio (LR) was estimated as 6.92 (95% CI: 3.74-12.81), the pooled negative LR was estimated as 0.1 (95% CI: 0.06-0.16), and the pooled diagnostic odds ratio (DOR) was estimated as 89.82 (95% CI: 33.04- 244.21). The Summary receiver operating characteristics (SROC) analysis revealed high accuracy with an area under curve (AUC) of 0.96. The findings of this meta-analysis revealed that SPECT/CT has high sensitivity and specificity for diagnosis of aseptic loosening in patients who underwent TKA or THA. Therefore, SPECT/CT can be considered as an encouraging diagnostic adjunct, particularly in cases with uncertain results of bone scan.

Cephalomedullary nail is the gold standard treatment for intertrochanteric fracture in geriatric population. The aim of the study was to investigate the differences of the reamed versus the unreamed short proximal femoral nailing (PFN), in terms of the duration of surgery and the outcome. The impact of patients and fracture characteristics to the outcome was also evaluated. A retrospective analysis of 158 elderly patients, who sustained intertrochanteric fracture of the femur, with a minimum follow up of one year, was performed. 78 patients underwent a reamed proximal femoral nailing (PFN) whereas 80 patients underwent an unreamed PFN. The duration of surgery, the outcome and the complications between the reamed and the unreamed nailing were compared. A logistic regression was also conducted to estimate the risk factors affecting mortality. The mean duration of surgery for reamed and unreamed G nail was 48,87 min (C.I.: 47,30-50,44) and 42,45 min (C.I.: 41,30-43,60) respectively. No statistically significant difference regarding the need for transfusion and complications, such as wound healing problems and screw cut out was identified between the two types of nailing. The most important factors affecting mortality were the ASA (beta coefficient: 3,127, p-value: 0,002) and the need for transfusion (beta coefficient: 1,367, p-value: 0,05). The only difference found between the reamed and the unreamed PFN was the operation time, which was less for the later one. Both types of fixation were similar in terms of outcome and complications.

The aim of this study was to investigate the effect of the presence of the "cortex sign" (corticalization) in femoral diaphysis fractures determined by the dynamization of nails because of delayed union. The study included 12 patients with a closed transverse femoral fracture (AO 32a3) treated with dynamization (all the screws distal of the nail were removed) because of delayed healing and followed up for at least 2 years. These patients were evaluated for the presence of bone union, cortex-like sclerosis (corticalization) distal to the nail, and the distance of the corticalization from the joint during follow- up after dynamization. The nail lengths and diameters, and time of dynamization were evaluated. In cases that developed pseudarthrosis and were treated with nailing, the length and diameter of the new nails were evaluated. Corticalization and hypertrophic pseudarthrosis were present in 12 patients after dynamization. The old nail was removed and nail exchange was performed with a longer and larger diameter nail to pass the region formed in the cortex approximately 2-3 cm inferior to the old nail. Union was obtained in 3-4 months in all patients. When corticalization is seen during follow up after dynamization is performed because of non-union of a transverse femoral fracture, nail exchange should be performed without further delay. More rigid fixation should be applied with a longer and thicker nail crossing the area of corticalization.

Clavicle fractures represent one of the most frequent type of fractures. However, there is no consensus on the treatment of these fractures and their relative indications for surgery. The purpose of this study is to determine whether surgical treatment of mid-diaphyseal clavicular fractures indeed results in fewer complications and better radiological outcomes, as current trends suggest, in comparison to conservative treatment. A retrospective multicenter study was conducted between January 2005 and April 2017, involving adult patients aged 16 to 75 years with mid-diaphyseal clavicular fractures. Out of a total of 715 clavicle fractures assessed, 220 met the inclusion criteria for this study. The research encompassed a matched-pair cohort, comparing clavicle fractures treated surgically and those managed conservatively. The consolidation rate was respectively 94.5% In the operative group, and 89.1% in the conservative group. There was no statistically significant difference in terms of consolidation (p-value: 0.219). The surgical group had an infection rate of 1.8%. Additionally, 31.8% of patients experienced hardware-related discomfort, and 43.6% required a secondary surgery to remove the plate. The results of this study reveal a similar rate of consolidation between the two treatment approaches. However, there is a noticeable but not significant difference in pseudarthrosis incidence in the conservative group, which is typically asymptomatic and does not usually require surgical intervention. On the other hand, patients who have undergone osteosynthesis often experience hardware-related discomfort and may require a subsequent procedure for hardware removal. Low profile dual plating might reduce this inconvenient.

The aim of this study is to investigate whether not using the calcar screw in proximal humerus fractures affects functional and radiological outcomes. Thirty patients (21 females and 9 males) who presented with proximal humerus fractures and were treated with plate- screw fixation were evaluated. The patients were divided into two groups: group 1 included patients with the use of the calcar screw, and group 2 included patients without the calcar screw. Radiological evaluation was performed by measuring the neck-shaft angle on postoperative day 1 and at 1 year in true anteroposterior radiographs. The groups were compared regarding demographic characteristics, functional outcomes, radiological scores, and complications. The mean age was 60 (27-92) years. In group 1, a mean decrease of 5.2° in the neck-shaft angle was observed (136.1° on postoperative day 1 and 130.6° at 1 year; p<0.05). In group 2, a mean decrease of 3.1° was observed (133.5° on postoperative day 1 and 130.0° at 1 year; p>0.05). There was no significant difference in the change of the humerus neck- shaft angle between the two groups (p>0.05). The mean Constant score was 70.8 in group 1 and 76.7 in group 2, (p>0.05). There was no significant difference in varus displacement and functional outcomes between the groups using and not using the calcar screw in proximal humerus fractures. Good reduction, stable fixation with locking plates, and preservation of soft tissue integrity are crucial to avoid complications and promote healing in proximal humerus fractures.

Distal tibial fractures are common lower-limb injuries and are generally associated with a high risk of postoperative complications, especially in patients with multiple medical comorbidities. This study sought to ascertain the efficacy of retrograde intramedullary tibial nails (RTN) for treating extra-articular distal tibial fractures in high-risk patients. Between January 2019 and December 2021, 13 patients considered at high risk for postoperative complications underwent RTN fixation. Comorbidities in the patient sample included diabetes, renal disease, hypertension, severe osteoporosis, hemorrhagic blisters, long-term smoking, alcoholism and so on. Medical records were retrospectively reviewed to assess treatment data, wound complications, infections, hardware failure, time to bone union, and functional outcomes. The mean preoperative waiting time and operation duration was 7.1 ± 1.7 days and 61.1 ± 7.1 minutes, respectively. The hospital stay time ranged from 10 to 16 days, with a mean of 12.6 ± 1.9 days. All patients were monitored for a mean follow-up time of 17.5 ± 3.3 months. All patients achieved fracture union with an average healing time of 5.0 ± 0.7 months. No implant failure or persistent pain was observed in the surgical site. Two patients had superficial infection, but no further complications resulted from the incision. At the final follow-up, the average AOFAS score was 84.0 ± 7.3 points, with an excellent and good rate of 76.9%. RTN appears to be a reliable treatment option for extra-articular distal tibial fractures in high-risk patients.

Alkaptonuria (AKU) is an extremely rare autosomal recessive metabolic disorder caused by deficiency of homogentisic acid oxidase and resulting in accumulation of homogentisic acid in collagenous structures. It is characterized by a triad of homogentisic aciduria, bluish-black discoloration of connective tissues (ochronosis) and arthropathy of large weight bearing joints. We report on a middle-aged female patient with bilateral severe ochronotic arthritis of both hips and shoulder joints requiring total joint replacements as staged procedures which were done without complications offering a complete pain relief and a satisfactory clinical and functional outcome. Ochronosis can cause severe arthropathy of peripheral joints. Multiple joint affection is common. Total joint replacement can yield persistent pain relief with complete functional recovery in patients with severe ochronotic arthropathy.

The aim of the study was to compare the outcomes of bone transport in treating upper- middle vs. lower- middle tibial bone defects. Sixty-two patients with tibial infected large segmental defects treated by bone transport were analyzed retrospectively and divided into distal group (lower- middle tibial bone defects and proximal transport, n=38) and proximal group (upper- middle tibial bone defects and distal transport, n=24). The demographic data were not significant different (P > 0.05). External fixation index (ETI), bone defect union time (BDUT), regenerate consolidation time (RCT), bone healing and functional outcomes evaluated by Association for the Study and Application of the Methods of Ilizarov score, postoperative complications evaluated by Paley classification, and the American Orthopaedic Foot and Ankle Society (AOFAS) score were recorded and compared at a minimum follow-up of 20 months. There were no significant differences in flap repair, follow-up time, ETI, RCT, bone healing, functional outcomes and complications between the two groups (P > 0.05). However, in the distal group, the BDUT was significantly longer, and the AOFAS score was significantly lower than those in the proximal group (17.5±2.5 vs 15.9±3.1 months, 70.0±5.5 vs 72.8±4.8, respectively) (P < 0.05). The overall outcomes of bone transport in treating upper- middle vs. lower- middle tibial bone defects are similar. However, the upper- middle tibia bone defects heal faster than the lower- middle tibial bone defects, and distal transport has a greater adverse effect on the ankle and foot joints than proximal transport. Therefore, traditional distal tibial transport near the ankle joint should be taken with caution.

Wounds from gunshots and other explosive devices are a source of loss of substances directly or secondary to a well- conducted debridement. In addition, these types of wounds are by definition contaminated. The major challenge in this context for any surgeon remains coverage. The use of flap-type plastic surgery is one of the options if feasible. Another option is the use of vacuum dressing. VAC therapy gives better results than sugar and honey. In a humid environment, it ensures the drainage of exudates. It causes an increase in local blood flow by stimulating neoangiogenesis, it stimulates cell proliferation and also the granulation tissue. It leads to a decrease in bacterial colonization and tissue oedema. Four observations are presented to illustrate the feasibility of this treatment in developing country and to show its beneficial effects.

There is a lack in understanding the reasons for different lengths of sick leave in patients who sustain ankle fractures. The aim of this study is to examine variations in the length of sick leave in ankle fracture patients and how treatment, type of ankle fracture and the patient-reported outcome are associated with the length of sick leave. In this study were data from the Swedish Social Insurance Agency (SSIA) and the Swedish Fracture Register (SFR), combined. Patients who sustained an ankle fracture were identified and the length of the sick leave calculated. Variables associated to the length of the sick leave were analysed. Fifty-three percent of the patients were on sick leave for an average of 88 days. Factors that were associated with the length of sick leave were an open fracture, operative treatment, multiple treatments, AO/OTA classification, and previous sick leave. Patients on sick leave for 22 weeks or more scored 15 points (CI 95% 12-18) worse on the dysfunction index of the Short Musculoskeletal Function Assessment in the 1-year follow-up compared to the pre- injury survey. This can be compared to 3 points (CI 95% 2-5) lower in patients with the shortest sick leave. There is an association between the severity of the injury and the length of sick leave following an ankle fracture, as well as between the patient-reported outcome after one year and the length of the sick leave.