Joint diseases and related surgery最新文献

Pulled elbow (PE) is one of the most common upper limb injuries in children. The success rate of manipulation for PE ranges from 74 to 99%, with a favorable prognosis. However, the diagnosis of PE is often determined by the typical injury pattern, and there is a lack of diagnostic certainty. In recent years, ultrasonography has been used for the diagnosis of PE; however, it is still not a commonly used modality for the diagnosis. Moreover, manual reduction of PE is often difficult, and there is no consensus on the management of the elbow when the reduction maneuver fails. Further, it is unclear whether surgery or external immobilization is necessary. We followed two cases of irreducible PE with ultrasonography without aggressive treatment such as surgery or external immobilization. Both cases were initially irreducible, but spontaneous reduction was confirmed by ultrasonography seven days after injury in one case and nine days after injury in the other case. To the best of our knowledge, this is the first report of cases of irreducible PE in which the patients were carefully followed by ultrasonography without external immobilization or other intervention, and spontaneous resolution was confirmed. Although careful follow-up is necessary as ultrasonography may show no normalization in the radiocapitellar joint immediately after reduction, supervised neglect without external immobilization could be an optional treatment for irreducible PE and reduce unnecessary surgery.

Objectives: This study aims to assess the effect of addition of a Kirschner wire (K-wire) to a headless compression screw on biomechanical and clinical outcomes in the treatment of scaphoid fractures and nonunions.

Patients and methods: Between January 2020 and November 2023, a total of 23 patients (20 males, 3 females; mean age: 29.7±7.2 years; range, 18 to 43 years) who underwent surgical treatment for scaphoid fractures and nonunion were retrospectively analyzed. The patients were divided into two groups: those who received only a headless compression screw (Group 1), and those who received both a screw and a supplementary K-wire, which was removed after three months (Group 2). In cases of nonunion, autografting was also performed. Postoperative clinical outcomes were evaluated using Visual Analog Scale (VAS), Mayo Wrist Score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). Finite element analysis was conducted to assess the biomechanical performance of both fixation methods.

Results: Patients treated with screw combined with the K-wire demonstrated significantly improved postoperative functional scores and lower pain levels compared to those treated with screw alone (p=0.011 for VAS, p=0.027 for Mayo Wrist Score and p=0.009 for QuickDASH). Finite element analysis revealed a reduction in stress concentration at the fracture site in the screw + K-wire group.

Conclusion: The addition of a K-wire to screw fixation seems to enhance biomechanical stability and clinical outcomes in scaphoid fractures. These findings suggest that K-wire augmentation may be a beneficial strategy for improving healing and reducing postoperative discomfort.

Objectives: This study aims to identify the optimal suture-button orientation which supports physiological ligament healing by limiting pathological lateral and posterior translation, as well as rotational motion in the axial plane of the syndesmosis joint, through dynamic suture-button fixation.

Materials and methods: A solid ankle model and a syndesmotic injury model were developed using finite element analysis. To address the syndesmotic injury, five different suture-button fixation configurations were designed. These models were analyzed by simulating the loading conditions during the heel-off phase of the stance phase. Evaluations included fibular displacement in the anterior-posterior and medial-lateral planes, rotational angles in the axial plane, and measurements of anterior and posterior tibiofibular clear space (A-TFCS and P-TFCS).

Results: All models utilizing double suture-buttons demonstrated superior control of pathological fibular motion compared to the conventional single suture-button fixation technique (Model 1). Among them, the configuration employing double suture-buttons aligned with the anatomical orientations of the AITFL and PITFL (Model 3) was the most effective in achieving anatomical reduction and preserving physiological fibular motion. Model 5, which was specifically designed to minimize the risk of injury to neurovascular structures, tendons, and articular cartilage, reduced pathological displacement in the coronal and sagittal planes by 3% and 1%, respectively, compared to Model 3. However, it exhibited a 0.5° deficiency in limiting external rotation relative to Model 3.

Conclusion: The results obtained with Model 5 closely approximate those of the healthy ankle and demonstrate its potential as a promising fixation method which preserves critical anatomical structures. This model allows for anatomical reduction of the syndesmosis, effectively prevents pathological syndesmotic motion, and maintains physiological fibular movement. In light of these findings, we believe that Model 5 may be among the preferred techniques in the treatment strategies for syndesmotic injuries.

Objectives: The aim of this study was to evaluate the biomechanical efficiency of different Schanz screw positions for indirect reduction of distal femur fractures using finite element analysis.

Materials and methods: A three-dimensional finite element model of a comminuted distal femur fracture was constructed, incorporating relevant anatomical structures including ligaments, menisci, and the gastrocnemius muscle. A 30 N posterior force simulated gastrocnemius-induced deformity, followed by a 15 N horizontal traction force applied through Schanz screws inserted at six positions (hole 1 to 6) on a standard distal femur locking plate. Residual displacement and reduction ratios were measured to assess reduction efficiency.

Results: The model successfully replicated the characteristic posterior displacement (~15 mm) caused by gastrocnemius contraction. Among the six pin positions, hole 6 (most anterior and distal position) achieved the greatest reduction (12.90 mm) with an 86.83% correction ratio, while hole 4 (most posterior and distal position) performed the worst (26.88%). More anterior and distal pin locations provided superior reduction outcomes due to improved mechanical advantage and alignment with the deforming force vector.

Conclusion: Schanz screw placement significantly influences the effectiveness of traction-assisted reduction in distal femur fractures. Hole position 6 yielded the most optimal biomechanical performance and may serve as a practical reference for optimizing intraoperative pin placement, potentially improving surgical efficiency and outcomes.

Objectives: The aim of this study was to compare the radiological and functional results of femoral tunnels created in Figure-4 and 110° flexion positions in anterior cruciate ligament (ACL) reconstruction.

Patients and methods: Between January 2016 and December 2019, a total of 84 patients (78 males, 6 females; mean age: 29.2±6.1 years; range, 17 to 46 years) who underwent anatomic ACL reconstruction (ACLR) were retrospectively analyzed. The patients were divided into two groups according to femoral tunnel drilling technique: 110° knee flexion (Group 1) and the Figure-4 position (Group 2). Demographic data were recorded. Radiological measurements (femoral tunnel position, length, angles, and distances to the lateral epicondyle) were performed on postoperative Day 1 computed tomography (CT) scans. Functional scores (Lysholm, Cincinnati, IKDC-SKF, Tampa Kinesiophobia, Return to Sport) were assessed at 12 months postoperatively. Radiological and functional outcomes were compared between groups.

Results: The mean anterior distance and axial tunnel angle were higher in the 110° flexion group than in the Figure-4 group (AD: p=0.001; ATA: p=0.035). The superior distance, femoral tunnel length, coronal tunnel angle, and femoral tunnel positioning measurements were significantly higher in the Figure-4 group (SD: p=0.001; FTL: p=0.006; CTA: p=0.001; FTP deep-shallow: p=0.001; FTP high-low: p=0.001). The Cincinnati Knee Rating System scores were also significantly higher in the Figure-4 group (p=0.001).

Conclusion: Anterior cruciate ligament reconstruction using the Figure-4 method provides satisfactory and comparable results with the conventional method. The Figure-4 position allows for 130 to 140º flexion of the knee and tunneling closer to the anatomical ACL insertion owing to the ease of application without creating any operational difficulties.

Objectives: This study aims to compare clinical and radiographic outcomes of arthroscopic repair versus conservative management in patients with medial meniscus posterior root tears (MMPRTs).

Patients and methods: Between January 2019 and December 2021, a total of 41 patients (9 males, 32 females; mean age: 49±12 years; range, 35 to 68 years) who underwent MMPRT repair and 123 patients (11 males, 112 females; mean age: 52±7 years; range, 26 to 74 years) who refused to undergo MMPRT repair and were managed conservatively were included in the study. Surgical candidates had neutral or mild varus alignment (≤5°), preserved joint space, and Kellgren-Lawrence (K-L) Grade 1-2 osteoarthritis. Baseline K-L grades, Lysholm Knee Scores (LKS), and International Knee Documentation Committee (IKDC) scores were recorded.

Results: The mean follow-up was 32±11 (range, 24 to 60) months in the repair group and 28±6 (range, 24 to 48) months in the control group (p=0.025). Baseline LKS scores were similar between the groups (p=0.685), while IKDC scores were lower in the repair group (p=0.001). At final follow-up, the repair group showed higher LKS scores (78±19 vs. 65±32; p=0.021) and greater improvements in LKS (+46±25 vs. +36±38; p=0.046) and IKDC scores (+38±18 vs. +26±27; p=0.002). No repair patients progressed to K-L Grade 4, compared to 11% of controls (p=0.027). No repair patients required further surgery, whereas 20% of conservative patients did, including 7% undergoing arthroplasty.

Conclusion: Arthroscopic MMPRT repair yielded a more favorable functional improvement, no subsequent surgeries, and improved radiographic preservation compared to conservative management, supporting early surgical intervention in selected patients.

Objectives: This study aims to investigate whether thymoquinone (TQ) accelerates fracture healing and modulates inflammatory and regenerative markers in a rat model.

Materials and methods: Forty-five male Wistar-Albino rats were randomly divided into seven groups and administered intraperitoneal doses of TQ. A femur fracture was surgically induced, and healing was assessed through radiological, histological, and biochemical analyses. The study included seven groups: a sham-operated control (Group 1), untreated fracture controls at two and four weeks (Groups 2 and 5), and fracture groups treated with TQ at 2.5 or 5 mg/kg/day for two weeks (Groups 3 and 4) or four weeks (Groups 6 and 7). Fracture healing was evaluated at two time points: at the end of two weeks (Groups 1-4) and at the end of four weeks (Groups 5-7). Intraperitoneal administration was chosen to ensure accurate and consistent dosing, as oral administration could lead to variability in bioavailability and potential loss during ingestion. Radiological assessments included measuring total callus diameter, radiopacity ratios, and callus surface area using high-resolution tomography. Histological analysis involved hematoxylin-eosin and immunohistochemical staining. Biochemical analyses measured complete blood count, sedimentation rate, C-reactive protein (CRP), total protein, albumin, calcium, alkaline phosphatase (ALP) and phosphorus.

Results: Significant differences in callus diameter were observed between the high dose TQ group (Group 7) and the untreated control (Group 5), while callus area showed significant differences among Groups 5, 6 and 7, and callus surface differed significantly between Groups 3 and 6. In Group 6, total protein and calcium levels increased, while albumin and ALP were lower in Group 7. Histological findings demonstrated that TQ treatment reduced dense fibrous tissue, with initial formation of spongy structures followed by trabecular bone development, indicating enhanced bone formation. Immunohistochemical analysis showed increased interleukin (IL)-10 and proliferating cell nuclear antigen (PCNA) levels, supporting improved fracture healing in high-dose groups.

Conclusion: Thymoquinone enhanced fracture healing, particularly in the fourth-week groups, improving callus formation, biochemical markers, and histological outcomes.

Objectives: This study aims to describe the double-hinge medial open wedge high tibial osteotomy (DH-MOWHTO) with two lateral hinges and to investigate its feasibility and its utility in prevention of lateral hinge fractures (LHFs) using a finite element analysis (FEA) model.

Materials and methods: Three osteotomies were modeled. Model 1 (DH-MOWHTO) involved two monoplanar osteotomies from the same starting point, while Models 2 and 3 were standard monoplanar osteotomies using one osteotomy line from Model 1. They were compared in terms of maximum von-Mises stress value (MPa) in the hinges at 10° correction angle, gap distance at 10° correction angle (mm), force required to achieve a 10° correction angle (N), and total surface area (mm² ) of osteotomy surfaces contacting the saw.

Results: In DH-MOWHTO, the maximum anterior hinge stress at 10º correction angle was reduced by 28.1 to 39.6% and the maximum posterior hinge stress was reduced by 19.2 to 60.1% compared to single monoplanar osteotomies. The average stress reduction in the hinges was 36%. The force required for a 10° correction was approximately 78 N, 114 N and 85 N for Models 1, 2 and 3, respectively. The model with two monoplanar osteotomies had approximately 1.8 and 2 times more osteotomy surface area than Models 2 and 3, respectively.

Conclusion: In this FEA study, two lateral hinges can be created in MOWHTO and lower hinge stresses can be obtained by applying lower forces with this osteotomy. In the light of these findings, DH-MOWHTO may be a novel osteotomy technique to avoid LHF.

Objectives: This study aims to evaluate the predictive accuracy and clinical applicability of the OPTIModel Scoring System in Turkish patients with long bone diaphyseal metastases and to compare its survival predictions and surgical recommendations with real-world outcomes.

Patients and methods: Between April 2013 and June 2021, a total of 108 patients (52 males, 56 females; mean age: 64.5±10.6 years; range, 45 to 83 years) with histologically confirmed metastatic bone disease affecting the diaphysis of long bones and who underwent surgical treatment were retrospectively analyzed. The OPTIModel Scoring System was applied to estimate survival and guide surgical planning. The prognostic accuracy of the model was statistically analyzed. The patients were stratified into low-, intermediate-, and high-risk groups based on their predicted survival.

Results: The most common primary tumors were breast (24.1%), lung (23.1%), and multiple myeloma (13.0%). The femur (46.3%) was the most frequently affected site. The OPTIModel-predicted median survival was 10 months (95% confidence interval [CI]: 7.9-12.1), comparable to the real-world median survival of 13 months (95% CI: 10.8-15.2). Agreement between OPTIModel's surgical recommendations and real-world procedures was substantial (kappa [κ]=0.74, 95% CI: 0.63-0.85, p<0.001). The Kaplan-Meier analysis revealed no significant difference between predicted and real-world survival distributions (p=0.126). The ROC analysis yielded an area under the curve [AUC] of 0.61 (95% CI: 0.52-0.70), indicating moderate prognostic accuracy.

Conclusion: The OPTIModel Scoring System demonstrated substantial agreement with real-world surgical decisions and moderate accuracy in survival prediction for Turkish patients with metastatic long bone diaphyseal tumors. While the model provides valuable insights for clinical decision-making, further refinements incorporating emerging oncological advancements and biomarker-based risk stratification are needed. Future multi-ethnic validation studies are essential to enhance its applicability in diverse populations.

Objectives: This study aims to determine the antimicrobial efficacy and mechanical strength of antibiotic-loaded cement samples in which daptomycin, vancomycin, teicoplanin, meropenem and piperacillin-tazobactam agents were mixed at different doses and to investigate the differences between agents and between doses.

Materials and methods: We prepared standardized bone cement samples incorporating vancomycin, teicoplanin, daptomycin, piperacillin-tazobactam, and meropenem at concentrations ranging from 0.625 to 15%. Samples underwent six-week phosphate-buffered saline immersion simulating physiological conditions. Mechanical testing employed four-point bending analysis following ISO 5833 standards. Antimicrobial efficacy was assessed using liquid microdilution against Staphylococcus aureus and Pseudomonas aeruginosa over 21 days.

Results: All antibiotics demonstrated strong negative correlation between concentration and mechanical strength (r=-0.883 to -0.914, p<0.001). Critical threshold emerged at 5% antibiotic concentration, above which mechanical integrity was significantly compromised. Daptomycin and meropenem maintained superior mechanical properties at effective antimicrobial concentrations. At 2-g doses, daptomycin achieved significantly higher strength than piperacillin-tazobactam and teicoplanin (p=0.021). All antibiotics except low-dose piperacillin-tazobactam maintained complete antimicrobial efficacy throughout 21-day testing. Electron microscopy revealed increased porosity, which correlated with reduced mechanical strength, particularly in piperacillin-tazobactam and teicoplanin groups.

Conclusion: Antibiotic selection significantly impacts both mechanical and antimicrobial properties of bone cement. Daptomycin and meropenem offer optimal balance of antimicrobial efficacy and mechanical integrity. These findings provide evidence-based guidelines for antibiotic selection in resistant infection management while maintaining structural requirements.