Hip & pelvis最新文献

Purpose: Several studies have compared various methods of treatment for displaced femoral neck fractures (FNF), including multiple cannulated screw fixation, in young and active patients. However, there have been few studies on the cephalomedullary nail with additional cannulated screw fixation in displaced FNF. Therefore, the aim of this study is to evaluate the outcomes of the cephalomedullary nail technique with either a cannulated screw or multiple cannulated screw fixation in displaced FNF.

Materials and methods: Among 69 consecutive patients who underwent internal fixation for displaced FNF, 64 were included. Patients were divided into two groups. Patients in Group 1 underwent fixation utilizing a cephalomedullary nail with an additional screw. Group 2 patients underwent fixation utilizing a cephalomedullary nail with additional multiple cannulated screws. Radiologic and clinical outcomes were assessed at the final follow-up clinical appointment.

Results: No significant difference was found in basic characteristics such as mean age, male to female ratio, and fracture classification between the study groups. The mean time to ambulation after surgery was significantly shorter in Group 1 (P<0.001). There was no statistically significant difference between the two groups in procedure-specific complication rate. However, the immobilization-related complication rate was significantly higher in Group 2 (P=0.017).

Conclusion: In terms of enabling early ambulation in young and active patients, the cephalomedullary nailing with additional cannulated screws has the advantage in the management of displaced FNF. Furthermore, early ambulation lowers the rate of immobilization-related complications and shortens hospital stays.

Purpose: Chloroprocaine spinal anesthetic may facilitate quicker postoperative recovery in total hip arthroplasty (THA) than mepivacaine due to its shorter duration of action and rapid metabolization, which could reduce time to ambulation and discharge. Given the increasing emphasis on same-day discharge (SDD) protocols in THA to improve efficiency and reduce healthcare costs, evaluating the impact of chloroprocaine on discharge timing and postoperative outcomes is critical. This study compared the clinical outcomes and safety of chloroprocaine compared to mepivacaine in SDD primary THA.

Materials and methods: This retrospective study compared the spinal anesthesia used on 226 patients who underwent primary THA performed between November 2020 to June 2023. The surgical outcomes of chloroprocaine (n=97) versus mepivacaine (n=129) spinal anesthesia, including estimated blood loss (EBL), operative time, discharge time, and 90-day readmissions or emergency department visits, were assessed. Anesthesia-related complications such as hypotension, bradycardia, urinary retention, and post anesthesia care unit outcomes were also documented.

Results: Baseline characteristics were similar between groups. The chloroprocaine group had significantly lower EBL, shorter operative times, and faster discharge times. No significant differences were observed between groups in anesthesia complications or postoperative nausea, vomiting, or headaches. Additionally, there were no differences in surgical complications.

Conclusion: For direct anterior approach primary THA, chloroprocaine spinal anesthesia was associated with reduced blood loss, shorter operative times, and faster SDD, with no cases of unplanned direct admissions. These results indicate that chloroprocaine spinal anesthesia can be utilized as a safe and effective alternative to mepivacaine in outpatient THA.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic led to mandatory screening of hospitalized patients. This study aims to assess the impact of COVID-19 admission delays on clinical outcomes, specifically complications and mortality, in elderly patients following hip fracture surgery.

Materials and methods: This study included 563 patients (aged ≥70 years) who underwent hip fracture surgery between February 2018 to January 2021 and were followed up for at least one year. The cohort was divided into two groups: a pre-COVID-19 pandemic group (control group) and a COVID-19 pandemic group (study group). The patients who tested positive for COVID-19 were excluded. The demographic data, the time from injury to surgery, admission to surgery, postoperative complications, and 1-year mortality were collected and compared between the two groups.

Results: The time from injury to surgery was significantly longer in the study group compared to the control group, primarily due to delays in the time from injury to hospital visit and from hospital visit to admission (4.6 days vs. 3.7 days, P=0.026). However, there was no significant difference between the groups from admission to operation. The incidence of postoperative medical complications and one-year mortality rate were significantly higher in the study group (P=0.025 and P=0.034).

Conclusion: Our findings suggest that delays in the time from injury to hospital visit and hospital visit to admission during the COVID-19 pandemic led to significant delays in hip fracture surgery for elderly patients. These delays were associated with increased postoperative medical complications and a higher one-year mortality rate.

Due to the presumed inherent stability of valgus-impacted femoral neck fractures (VIFNF), in-situ fixation has traditionally been the preferred surgical treatment. However, regarding the particular need for reduction before fixation, the optimal surgical strategy for this type of injury remains controversial. A comprehensive literature search was performed using PubMed, Embase, and Cochrane Library databases. Studies comparing outcomes between in-situ fixation and reduction with fixation for VIFNF published between 2014 and 2024 were included. Utilizing the Modified Coleman Methodology Score, study quality was assessed by two independent reviewers. Eleven studies published during the selected timeframe met the inclusion criteria. Studies on in-situ fixation reported significant femoral neck (FN) shortening regardless of screw configuration. Two of three comparative studies between in-situ and reduction demonstrated significantly less FN shortening in the in-situ group at the postoperative one year follow-up. Furthermore, all three comparative studies reported significantly higher postoperative 1-year Harris hip scores in the reduction group. For VIFNF, anatomical reduction prior to fixation may improve functional outcomes and reduce FN shortening compared to in-situ fixation. However, reduction techniques may offer better long-term stability and lower complication rates although they require additional surgical steps. Nevertheless, patient selection remains crucial, particularly in elderly or osteoporotic patients where in-situ fixation may still be a viable option. Further prospective randomized controlled trials are needed to confirm these findings.

This study presents a case report of a 54-year-old female patient with osteopetrosis who experienced re-fracture after undergoing osteosynthesis for a femoral shaft fracture. The patient visited our emergency department for a right distal femur fracture. The patient had undergone surgery for a right femoral shaft fracture six years prior to this visit, at which time osteopetrosis was diagnosed at another medical facility. Following three years of postoperative care, successful osteosynthesis was achieved, and the surgical implant was removed. The re-fracture occurred at the site of the previous screw fixation which had not healed sufficiently. We performed an open reduction and internal fixation. We concluded that, during fracture surgery in patients with osteopetrosis, caution should be exercised as technical challenges like thermal injury may arise due to the hardness of the bone. Furthermore, careful evaluation is necessary when considering implant removal because of increased recurrent fracture risk.

Purpose: Complex acetabular fractures involving both columns often require two approaches, one anterior and other posterior, for adequate reduction and fixation. Treatment of such fractures using modified Stoppa approach (MSA) either alone or in combination with lateral window of the ilio-inguinal approach has been reported. Whether this line of management is appropriate or not is a matter of further investigation. This study presents the clinical and radiological outcomes of acetabular both-column fractures using this approach.

Materials and methods: Forty-one patients treated with MSA for anterior column with posterior hemi transverse (AC with PHT), associated both columns, T-type, and transverse fractures were postoperatively assessed at a minimum of one year. Their immediate postoperative reduction quality, as well as the clinical, radiological, and functional outcomes at the most recent follow-up visit were reviewed.

Results: Most patients were young males injured in motor vehicle accidents who underwent surgery after a mean delay of 4.8 days. The mean surgical time was 122.44 minutes, and mean blood loss was 413.41 mL. AC with PHT fracture was the most common. In 78.0% of cases, anatomical reduction was achieved. At one year, excellent radiologic, clinical, and functional outcomes were observed in 78.0%, 51.2%, and 73.2% patients, respectively. There were eight cases with major complications.

Conclusion: Using the MSA with satisfactory short-term results, it was possible to address acetabular fractures involving both the anterior and posterior elements in a select group of patients. A pelvi-acetabular surgeon should have expertise in using multiple surgical approaches including the MSA.

Purpose: The study investigated the benefits of the direct anterior approach (DAA) compared to the posterolateral approach (PLA) in patients over 75 years of age.

Materials and methods: This study included 144 patients who underwent total hip arthroplasty (THA) from December 2012 to November 2021. Group A had 93 patients with a mean age of 80.8±5.0 years, who underwent DAA. Group B had 51 patients with a mean age of 79.7±4.6 years, who underwent PLA. Clinical outcomes included operative time, time to ambulation, walking ability, and complications.

Results: There were no demographic differences between the groups. The mean age was 80.9±5.0 years in Group A and 80.5±4.8 years in Group B. Mean operative time was 94.2±7.2 minutes in Group A and 91.2±8.8 minutes in Group B (P=0.02). Early ambulation within 3 days postoperatively was seen in 72 patients (77.4%) in Group A and 31 patients (60.8%) in Group B (P=0.03). No significant change was seen in modified Koval Index in Group A (4.35 to 4.06, P=0.51), while Group B showed a significant decrease (4.47 to 3.88, P=0.04). The postoperative modified Koval index negatively correlated with time to ambulation (P=-0.17, P=0.04). Dislocation occurred in 3 patients (3.2%) in Group A and 7 patients (13.7%) in Group B (P=0.02). No differences were found in medical complications or mortality.

Conclusion: THA via DAA may provide earlier functional recovery than PLA, with comparable safety in patients over 75 years of age.

Purpose: Through the measurement of Graf's alpha (α) angle, the Graf method uses two-dimensional ultrasound (US) to diagnose developmental dysplasia of the hip (DDH) in infants. However, this unidimensional index cannot fully reflect anatomic shape features and variations of iliac wing and bony acetabular roof (IW-AR) coronal outlines that may influence DDH. This study aimed to analyze the shapes of IW-AR outlines by revealing their mean shape, possible shape variations, and the impact of these variations on the α angle variability.

Materials and methods: By segmenting US images of 510 infant hips, IW-AR outlines in Graf's standard plane were obtained from a mixed screening population. A statistical shape model (SSM) was then developed to analyze the outline shapes.

Results: In the IW-AR outlines, shape variations were described by linear combinations of six global and local shape modes. A global mode, dominantly causing an entire outline to bend about the vicinity of its apex, could affect the α angle in a large range (38°-70°). Although a local mode produced bending patterns that had a lesser impact on the α angle (up to 6°), it may relate to DDH diagnosis and clinical outcome.

Conclusion: Shape variations in IW-AR outlines can be effectively modeled by using a compact SSM representative of the variations as linear combinations of a few global and local modes. The shape variations and the angle variability by the local modes should not be underestimated even though the effect of global modes on the α angle is dominant.

Purpose: To compare the risk of periprosthetic and medical complications following dual mobility cup total hip arthroplasty (DMC-THA) and bipolar hemiarthroplasty (BHA) for femoral neck fractures in patients with neurological disorders.

Materials and methods: This retrospective study included patients with neurological disorders who underwent DMC-THA (n=1,153) or BHA (n=4,612) between 2016 and 2022, identified from the Korean Health Insurance Review and Assessment Service database. Propensity score matching was performed at a 1:4 ratio to adjust for baseline characteristics. The primary outcome was periprosthetic complications; the secondary outcome was medical complications.

Results: Compared with the BHA-matched group, the DMC-THA group showed a higher rate of early periprosthetic fracture (2.6% vs. 1.4%, P=0.02) and late dislocation (1.1% vs. 0.5%, P=0.03). No significant differences were observed in periprosthetic joint infection or revision. Regarding medical complications, DMC-THA was associated with more transfusions (63.1% vs. 57.6%, P<0.001) but fewer urinary tract infections (3.4% vs. 5.1%, P=0.01). Multivariable analysis identified DMC-THA as an independent risk factor for early periprosthetic fracture (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.39-6.80, P=0.004) and late dislocation (OR 2.53, 95% CI 1.18-5.42, P=0.02).

Conclusion: DMC-THA was not superior to BHA in preventing dislocation and was associated with a higher risk of periprosthetic fracture and late dislocation in neurologically impaired patients. Surgeons should recognize the risks of using DMC-THA implants as a sole strategy to prevent instability in this high-risk population.

Purpose: The textured titanium surfaces used in many total hip arthroplasty (THA) implants are designed to promote osseointegration. However, these surface types may also facilitate bacterial adherence and risk of infection. This aim of this study is to characterize the bacterial growth and viability on the different titanium surfaces used in THA implants.

Materials and methods: Smooth and rough titanium samples were cleaned, sterilized, and prepared for bacterial testing. Staphylococcus aureus cultures were applied to the samples, incubated to allow for bacterial adherence, and stained to visualize and quantify bacterial coverage using fluorescence imaging and ImageJ software. Student's t-test was used to compare the percentage of bacterial coverage at each timepoint between smooth and rough samples. Finally, scanning electron microscopy (SEM) was used to observe and compare the surface structure and bacterial adherence at a microtopographic level.

Results: Microtopographic differences between surfaces showed extensive irregularities in the rough samples as compared to the uniform grooved surface of the smooth samples. Confocal imaging showed greater bacterial coverage on the rough surfaces compared to smooth ones at all timepoint including 6 hours (7.85% vs. 3.89%, P=0.049), 12 hours (17.68% vs. 9.54%, P=0.0038), and 24 hours (20.77% vs. 13.26%, P=0.0024). SEM images further confirmed more bacterial proliferation on rough titanium surfaces, especially at the 12-hour mark, with evidence of extra-cellular-matrix.

Conclusion: Our findings demonstrate that rough titanium surfaces allow for greater in-vitro S. aureus growth with biofilm formation as early as 24 hours.