Joint diseases and related surgery最新文献

Objectives: The aim of this study was to measure the reliability of the expanded and revised Melbourne Cerebral Palsy Hip Classification System (r-MCPHCS) across different medical specialties.

Patients and methods: Anteroposterior pelvic radiographs of a total of 44 patients (20 males, 24 females; median 16.7 years; range, 12 to 32 years) with cerebral palsy (CP) were analyzed between January 2005 and December 2020. Four medical specialists (an orthopedic surgeon, a pediatric neurologist, a radiologist, and a physical medicine and rehabilitation specialist) were included in the study. The time gap between the first and the second assessment was at least three months. The intra- and inter-observer intraclass correlation coefficient (IntraOb. and InterOb. ICCs) were calculated. An ICC of >0.8 was considered excellent fit.

Results: The median IntraOb. ICC was found to be 0.93 (range, 0.89 to 0.97), the median InterOb. ICC was found to be 0.88 for the first assessment (A) and 0.93 for the second assessment (B). Both results were interpreted as excellent in terms of compatibility.

Conclusion: Our study results suggest that r-MCPHCS is a well-designed, reliable and reproducible scale that is easy to use among different medical specialists.

Objectives: This study aims to investigate the relationships among factors affecting complication development and premature physeal closure (PPC) in patients undergoing surgical treatment within 12 h of the time of injury.

Patients and methods: Between January 2015 and January 2021, a total of 46 patients (37 males, 9 females; mean age: 11.9±2.5 years; range, 6 to 16 years) who were operated within 12 h due to displacement >2 mm after reduction were retrospectively analyzed. Demographics, fracture type (Salter-Harris [SH]), fracture mechanism (Dias & Tachdjian [DT]), accompanying fibula fracture, and initial displacement were assessed with preoperative radiographs. At two years of follow-up, PPC, angular deformity, and length discrepancy were evaluated.

Results: Of the patients, PPC was observed in 21.7%. Angular deformity and length discrepancy were noted in 6.5% of cases. The average initial displacement was 6.8 mm, with no significant correlation between displacement and complications (p>0.05). While the rates of PPC varied by fracture type, there was no statistically significant relationship between fracture types and the development of complications (p>0.05). Premature physeal closure was more common in fractures caused by the supination-plantar flexion (SPF) mechanism (60%) compared to the pronation-eversion external rotation (PEER) mechanism (5.3%) (p=0.018). Angular deformity and length discrepancy were only associated with SH type 3 and 4 fractures. Although fibular fractures accompanied 25% of distal tibial epiphyseal fractures, their presence did not show a significant correlation with complications (p>0.05).

Conclusion: Our study findings indicate that factors previously thought to influence the development of complications may be insufficient to predict PPC occurrence in distal tibial epiphyseal fractures, once anatomical reduction is achieved within 12 h. As the preoperative delay shortens, the impact of fracture-related factors on complication development may reduce.

Objectives: This study was to evaluate the radiological and clinical outcomes of patients with juxta-articular giant-cell tumors (GCTs) around the knee treated with bone cement filling and internal fixation after extensive curettage.

Patients and methods: A total of 15 patients (6 males, 9 females; mean age: 35.3±8.4 years; range, 24 to 53 years) with juxta-articular GCTs around the knee were retrospectively reviewed between January 2010 and June 2020. Wound healing, functional status as assessed by the Musculoskeletal Tumor Society (MSTS) scores, local recurrence, metastasis, and complications were evaluated.

Results: The mean follow-up was 41.3±9.9 (range, 24 to 69) months with an overall survival of 93.3%. The mean distance between tumor and cartilage was 6.29±3.73 mm. Five patients underwent reconstruction with cancellous allografts and the mean distance between tumor and cartilage was 2.20±1.48 mm in these patients. At the final follow-up, three patients had Kellgren-Lawrence Grade 2 tibiofemoral osteoarthritis in the operated knee. Lucent zones around the bone cement with no further progression were found in five patients. One patient experienced recurrence 17 months after surgery and was treated by en-bloc resection and reconstructed with a tumor endoprosthesis. The remaining 14 patients had a mean MSTS score of 26.86±2.11 (range, 23 to 30) at the final follow-up. The mean overall range of motion at the final follow-up was 109.20±14.20° (range, 85 to 130°).

Conclusion: Bone cement filling and internal fixation after extensive curettage is a viable strategy for accessing juxta-articular GCTs around the knee. The choice of local adjuvants, subchondral bone grafting, and the thickness of subchondral bone require more attention to preserve the continuity of articular cartilage.

Objectives: This study aims to compare the radiographic results with and without postoperative metal augmentation in varus knee patients with primary total knee arthroplasty (TKA) with a hip-knee-ankle (HKA) angle >10° and to determine a cut-off value using radiographic parameters to predict the need for metal augmentation.

Patients and methods: Between October 2022 and April 2024, a total of 87 knees (51 right and 36 left) of 82 patients (11 males, 71 females; mean age: 68.7±8 years; range, 53 to 86 years) who underwent primary TKA were retrospectively analyzed. The patients were divided into two groups as patients who underwent primary TKA with and without tibial metal augmentation. There were 39 patients and 42 knees in the group with metal augmentation and 43 patients and 45 knees in the group without metal augmentation. The HKA angles and amount of preoperative planned tibial resection (ETR) were evaluated. Cut-off values for preoperative HKA angle and ETR were determined using receiver operating characteristic (ROC) analysis.

Results: The mean pre- and postoperative HKA angles were 18.98±4.42° and 6.58±3.48°, respectively and the mean ETR was 13.91±3.02 mm. Both groups were comparable in terms of postoperative HKA angles p=0.283). The mean preoperative HKA and ETR were significantly higher in TKAs with augmentation (p<0.001 for both). The probability of needing augmentation was approximately six times higher in knees with a preoperative HKA angle of >20.6° (OR=5.909, 95% CI: 2.065-16.91, p<0.001) or ETR of >12.52 mm (OR=5.816, 95% CI: 2.202-15.359, p<0.001).

Conclusion: In TKA with advanced varus deformity, tibial metal augment is a method that can be used to provide soft tissue balance. The need for metal augmentation should be kept in mind, particularly if the preoperative evaluation indicates that the HKA angle exceeds 20.6° or ETR exceeds 12.5 mm.

Subcutaneous emphysema, caused by the presence of air or gas in subcutaneous tissues, can be infectious or noninfectious. A thorough clinical evaluation, including both physical examination and radiological imaging, is required to distinguish benign subcutaneous emphysema from necrotizing soft tissue infections. In this article, we report a 12-year-old female patient with benign subcutaneous emphysema of the upper extremity and highlight the importance of an accurate diagnosis to avoid unnecessary surgical intervention. The rarity of benign subcutaneous emphysema in non-traumatic and non-infectious cases underscores the need for clinicians to differentiate it from more severe conditions, such as life-threatening infections. Conservative treatment is typically sufficient for benign subcutaneous emphysema, with fasciotomies reserved for emergencies. Proper diagnosis and treatment are essential to avoid unnecessary surgical procedures.

Objectives: This study aimed to investigate the importance of the Dorr index in the preoperative evaluation of implant failure in patients who underwent proximal femoral nail (PFN).

Patients and methods: This retrospective study examined 312 patients who underwent PFN for intertrochanteric fractures between January 2016 and January 2020. Patients with unstable fractures according to the AO/OTA (AO Foundation/Orthopaedic Trauma Association) classification, those over 65 years of age, with at least one year of regular follow-up, a tip-apex distance <25 mm, and a caput-collum-diaphyseal angle between 125° and 135°, were included. Seventy patients (19 males, 51 females; mean age: 72±3.8 years; range, 65 to 88 years) who met the inclusion criteria were included in the study. According to the Dorr index, patients were type A if the ratio was <0.5, type B if the ratio was between 0.50 and 0.75, and type C if the ratio was >0.75.

Results: The mean follow-up period was 46.2±4.4 months. As indicated by the Dorr index, the failure rates were 0%, 17%, and 63% for Dorr types A, B, and C, respectively. The comparison of failure rates between Dorr types A and B (p=0.02), B and C (p=0.016), and A and C (p=0.001) yielded statistically significant results. Patients with Dorr types B and C exhibited significantly inferior outcomes compared to those with type A. The mean time to failure was 27±3 days after surgery.

Conclusion: Dorr index is an important parameter that can be easily checked and used on preoperative radiographs to predict implant failure. The high probability of failure in the early period should be taken into account, particularly if PFN is planned in Dorr type C.

Objectives: This study aimed to compare the outcomes and conduct a cost analysis between plate screw fixation and conservative treatment.

Patients and methods: The retrospective study was conducted with 36 patients (32 males, 4 females; mean age: 30.3±13.4 years; range, 16 to 65 years) between May 2019 and July 2023. The patients were divided into two groups: those who underwent surgery with miniplate fixation (n=21) and those who were conservatively managed (n=15). The differences in postoperative shortening and angulation were compared between these groups. Additionally, the patients' postoperative functional scores, complication rates, examination findings, and cost analyses were compared.

Results: The per-patient cost in the surgical group was higher than in the conservatively treated group (€246.96 vs. €45.07; p<0.001). While postoperative shortening and angulation were more pronounced in the nonoperative group, the other clinical parameters and functional scores were improved. The return-to-work time was longer in the nonoperative group due to prolonged immobilization.

Conclusion: Nonoperative splint treatment for metacarpal shaft fractures shows better radiological and clinical outcomes than surgery, except for angulation and shortening, which have limited impact on function. Due to higher costs in surgical cases, nonoperative treatment is more cost-effective. Larger, randomized trials are needed to confirm these findings.

Objectives: The study aimed to evaluate the efficacy and safety of hollow pedicle screw-anchored bone cement combined with posterior long-segment fixation (LSF) for the treatment of Stage III Kümmell's disease.

Patients and methods: The study retrospectively analyzed 23 patients (18 females, 5 males; mean age: 70.1±6.2 years; range, 58 to 80 years) with Stage III Kümmell's disease who underwent hollow pedicle screw-anchored bone cement combined with posterior LSF between March 2017 and April 2020. The clinical efficacy was evaluated using the Visual Analog scale (VAS), the Oswestry Disability Index (ODI), anterior vertebral height, kyphotic Cobb angle, and neurological function by Frankel classification. Complications, operation time, intraoperative blood loss, and complications were obtained from the hospital records. Data recorded at three time intervals (before the surgery, early postoperative period, and the last follow-up) were compared.

Results: The mean follow-up time was 20.8±6.1 months. The mean operation time was 102±16.5 min, and the mean intraoperative blood loss was 225±41.3 mL. The VAS, ODI, anterior vertebral heights, and local kyphosis angle showed statistically significant differences between preoperative and postoperative values, as well as the preoperative and the final follow-up values (p<0.05). However, the differences between postoperative and final follow-up values were not statistically significant (p>0.05). Six patients (26%) had mild preoperative neurological deficits and normalized neurological function at the final follow-up evaluation. Asymptomatic leakage of cement occurred in five (22%) cases. There was no fixation failure (rod breakage or screw loosening).

Conclusion: Hollow pedicle screw-anchored bone cement combined with posterior LSF is a safe and effective surgical option for the treatment of Stage III Kümmell's disease.

Objectives: This study aimed to evaluate the responses provided by ChatGPT-4o to the most frequently asked questions by patients regarding hip arthroscopy.

Materials and methods: In this cross-sectional survey study, a new Google account without a search history was created to determine the 20 most frequently asked questions about hip arthroscopy via Google. These questions were asked to a new ChatGPT-4o account on June 1, 2024, and the responses were recorded. Ten orthopedic surgeons specializing in sports surgery rated the responses using a rating scale to assess relevance, accuracy, clarity, and completeness. The responses were scored on a scale from 1 to 5, with 1 being the worst and 5 being the best. The interrater reliability assessed via the intraclass correlation coefficient (ICC).

Results: The lowest score given by the surgeons for any response was 4/5 in each subcategory. The highest mean scores were in accuracy and clarity, followed by relevance, with completeness receiving the lowest scores. The overall mean score was 4.49±0.16. Interrater reliability showed insufficient overall agreement (ICC=0.004, p=0.383), with the highest agreement in clarity (ICC=0.039, p=0.131) and the lowest in accuracy (ICC=-0.019, p=0.688).

Conclusion: The study confirms our hypothesis that ChatGPT-4o provides above-average quality responses to frequently asked questions about hip arthroscopy, as evidenced by the high scores in relevance, accuracy, clarity, and completeness. However, it is still advisable to consult orthopedic specialists on the subject, incorporating ChatGPT's suggestions during the final decision-making process.