Joint diseases and related surgery最新文献

Objectives: This study aims to compare the clinical and radiographic outcomes of proximal partial fibular resection (PPFR) and opening-wedge high tibial osteotomy (OWHTO) in middle-aged patients with early-stage medial compartment knee osteoarthritis (OA).

Patients and methods: Between January 2017 and January 2023, a total of 90 patients (47 males, 43 females; mean age: 50.9±5.8 years; range, 40 to 59 years) who underwent PPFR or OWHTO for early-stage medial compartment knee OA were retrospectively analyzed. The patients were divided into two groups based on the surgical technique: Group 1 (n=48) included those who underwent PPFR, while Group 2 (n=42) comprised those treated with OWHTO. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic measurements included femorotibial angle (FTA) and lateral joint space (LJS).

Results: Both procedures demonstrated a significant improvement in function and pain. The mean postoperative FTA change was greater in the OWHTO group (7.69±1.35°) compared to the PPFR group (2.87±1.24°, p=0.001). The mean LJS changes were not statistically significant between the groups. Postoperative WOMAC and VAS scores improved in both groups, indicating no significant difference. Minor complications included transient peroneal nerve symptoms in the PPFR group, which resolved spontaneously at three months postoperatively.

Conclusion: Both PPFR and OWHTO are effective surgical options for early-stage medial compartment knee OA. While OWHTO offers superior mechanical correction, PPFR provides a less invasive alternative with similar functional outcomes.

Objectives: This study aims to explore the therapeutic effects of medical ozone therapy on the frozen shoulder (FS) model and compares it with traditional corticosteroid treatments in rats.

Materials and methods: A total of 30 Sprague-Dawley rats aged 18 to 20 months weighing between 400 to 450 g were included in the study. The rats were randomly divided into three equal groups: a control group (C, n=10, FS model only), a corticosteroid treatment group (CST, n=10, FS model + intraarticular 0.5 mg/kg betamethasone), and an ozone treatment group (OT, n=10, FS model + intraarticular 1 mg/kg ozone). Frozen shoulder was induced via surgical immobilization, and treatments were administered intraarticularly. Outcomes were measured through histopathological and functional assessments.

Results: The CST and OT significantly reduced inflammation (p<0.001), capillary proliferation (p<0.001), fibroblastic proliferation (p=0.002), collagen type 3 staining (p=0.022), and mean capsular thickness (p<0.001), while improving the range of motion in all directions compared to the control group. Ozone therapy showed a comparable reduction in fibrosis and improvement in joint mobility to CST (p=0.001).

Conclusion: Ozone therapy effectively reduces fibrosis and improves mobility in an FS rat model, presenting a promising alternative to corticosteroids. However, further studies are still needed to elucidate the molecular mechanisms and optimize treatment protocols, underscoring the potential for future discoveries in this area.

Objectives: The aim of this study was to examine the effect of N-acetylcysteine (NAC), which has antioxidant properties, on healing in a rat femoral diaphysis fracture model.

Materials and methods: Twenty-four male Wistar-Hannover rats were randomly divided into two groups: experimental (n=12) and control groups (n=12). An open femur fracture model (osteotomy) was applied to the right femora of both groups. Fixation was performed with Kirschner wire. While intraperitoneal NAC treatment was given to the experimental group for 21 days after surgery, an equal volume of intraperitoneal saline injection was administered to the control group. At the end of this period, the femurs obtained from the sacrificed animals were examined histopathologically, radiologically, and biomechanically. Huo scoring was used for histopathological examination. The samples were examined radiologically according to the Radiographic Union Scale in Tibial Fractures (RUST) scoring system. The three-point bending test was used for the biomechanical examination.

Results: According to the third-week results, NAC could histopathologically contribute positively to fracture healing in rats (p=0.003 and p<0.05, respectively). Considering radiological and biomechanical parameters, no significant difference was observed between the groups in terms of healing (p>0.05). However, a positive significant correlation (67.7%) was found between histopathological results and radiological findings (p=0.016 and p<0.05, respectively).

Conclusion: Our study results indicate that NAC may have a histopathologically positive effect on the healing process in rat traumatic fractures. Based on these findings, NAC preparations may be used as a supportive agent in the treatment of fractures. Further clinical studies are needed.

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: 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.

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 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.

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.