Joint diseases and related surgery最新文献

Objectives: This study aimed to compare the AO, Schatzker, and Three-Column classification systems for tibial plateau fractures, focusing on their prognostic and functional outcome prediction and influence on clinical decisions across different trauma types.

Patients and methods: In this retrospective study, we examined 49 patients (36 males, 11 females; mean age: 40.6±11.8 years; range, 19 to 67 years) with tibial plateau fractures between January 2011 and January 2017. The fractures were classified using the AO, Schatzker, and three-column systems. The main outcome measurements included functional scores (Knee Injury and Osteoarthritis Outcome Score [KOOS], Hospital for Special Surgery [HSS]), range of motion (ROM), duration of hospitalization, thigh atrophy, operation time, and the development of osteoarthritis. The impact of smoking was also assessed.

Results: According to the AO classification, type B fractures obtained higher KOOS and HSS scores compared to type C fractures (p=0.013 and p=0.007, respectively). According to the Schatzker classification low-energy fractures achieved higher KOOS and HSS scores than high-energy fractures (p=0.013 and p=0.026, respectively). One-column fractures had higher KOOS and HSS scores compared to two-column and three-column fractures (p=0.007 and p=0.001, respectively). Two-column fractures had a lower ROM compared to other column fractures (p=0.022). Shorter hospital stays were recorded for Schatzker low-energy fractures (p=0.016), whereas higher thigh atrophy was found in Schatzker high-energy fractures (p=0.022) and AO type C fractures (p=0.018). Longer operation times were observed in AO type C fractures (p=0.037) and Schatzker high-energy fractures (p=0.017). According to the Kellgren-Lawrence classification, AO type C fractures and three-column fractures yielded worse outcomes (p=0.039 and p=0.001, respectively). Smoking had a negative impact on functional KOOS and HSS scores across all groups (p=0.022 and p=0.001, respectively).

Conclusion: This study highlights the predictive value of the AO, Schatzker, and Three-Column classification systems in determining functional outcomes and clinical data in tibial plateau fractures. Each system provides unique insights into different outcomes, suggesting their concurrent application may yield a more comprehensive prognosis.

Objectives: The study aimed to analyze the application of controlled hypotension and tourniquets in total knee arthroplasty (TKA) to evaluate their early postoperative period effects in TKA.

Patients and methods: A total of 183 patients (43 males, 140 females; mean age: 67.8±6.4 years; range, 50 to 84 years) with knee osteoarthritis who needed TKA were recruited for this prospective, randomized controlled clinical study between August 2022 and May 2023. The study included a tourniquet group (group T, 94 patients) and a controlled hypotension group (group H, 89 patients). In group T, an inflatable tourniquet was used throughout the operation, with the pressure of the tourniquet set at 300 mmHg. In group H, controlled hypotension was used, with the mean arterial pressure controlled at 55-65 mmHg. The outcome measures of this study included blood loss, coagulation function, inflammatory mediators, knee joint function, permeation thickness of bone cement around the tibial prosthesis, and cognitive function.

Results: The baseline demographics and clinical characteristics of the two groups of patients were comparable (p>0.05). Intraoperative blood loss in group H was higher than that in group T (p<0.05), whereas hemoglobin decrease, postoperative drainage flow, hidden blood loss, and total blood loss in group T were higher than in group H (p<0.05). Fibrinogen, D-dimer, C-reactive protein, and interleukin-6 levels were higher in group T than in group H on the first and third postoperative days (p<0.05). The knee joint function of group H was significantly better than that of group T on the fifth day and one month after the operation (p<0.05). There was no significant difference in the penetration thickness of bone cement around the tibial prosthesis between the two groups (p>0.05). There was no significant difference in Mini-Mental State Examination scores between the two groups on the same day (p>0.05).

Conclusion: Controlled hypotension technology in TKA can reduce total blood loss by reducing hidden blood loss and can help to alleviate the postoperative hypercoagulable state, relieve inflammatory reactions, and facilitate early recovery of knee joint function after surgery.

Objectives: The study aimed to compare the outcomes of single-dose cross-linked hyaluronic acid and the linear regimen of three doses of HA knee injections among patients with gonarthrosis.

Patients and methods: This single-center, retrospective study was conducted with 60 patients (47 females, 13 males; mean age: 57.9±4.29 years; range, 50 to 65 years) with Kellgren-Lawrence Grade 2 or 3 gonarthrosis between February 2020 and February 2022. Patients were either subjected to intra-articular cross-linked hyaluronic acid (n=30) or linear hyaluronic acid (n=30) injection treatments. Comprehensive assessments of the patients were conducted prior to the injections, as well as at three and six months after injection. The two injection groups were compared regarding the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score.

Results: Both injections showed a statistically significant improvement from baseline in both WOMAC and Oxford Knee Score at three and six months (p<0.001). There was no notable distinction in the alteration of WOMAC knee scores between the two injection types. However, a notable discrepancy was observed in the elevation of Oxford Knee Score among patients who received cross-linked knee injections compared to those who underwent linear hyaluronic acid knee injections, signifying a significant increase in the former group (p<0.001).

Conclusion: The advantage of a single-dose administration of cross-linked HA knee injections, as opposed to the three-dose regimen required for linear hyaluronic acid, translates into reduced time and cost for the injection process. Moreover, this approach minimizes injection-associated discomfort for patients due to the singular dose administration.

Objectives: This study aims to examine the relationship between foot angles and the presence and localization of osteochondral lesions of the talus (OLTs).

Patients and methods: Between January 2014 and January 2019, a total of 152 patients with a diagnosis of medial OTLs (95 males, 57 females; mean age: 28.8±6.4 years; range, 18 to 40 years), 51 patients with a diagnosis of lateral OTLs (36 males, 15 females; mean age: 27.1±6.2 years; range, 18 to 39 years), and 114 patients without known foot-ankle trauma as the control group (56 males, 58 females; mean age: 29.0±6.1 years; range, 18 to 40 years) were included. Magnetic resonance imaging and radiographs of each group were analyzed retrospectively. Lateral talocalcaneal angle (LTCA), calcaneal inclination angle (CIA), Böhler angle (BA), and Gissane angle (GA) were measured on the images and the values were compared among the groups.

Results: The CIA had a significant relationship with the localization (p<0.001). It was higher in patients with OLTs and had an effect on localization. The mean CIA was 26.6º±3.9º in the medial OLTs group, 23.0º±3.5º in the lateral OLTs group, and 18.5º±3.6º in the control group. There was a significant difference in the LTCA between the control and OLTs groups (p<0.001). The LTCA was higher in patients with OLTs, but had no effect on localization. The mean LTCA was 41.1º±4.2º for medial OLTs, 41.3º±4.2º for lateral OLTs, and 35.7º±6.8º for the controls. No significant relationship was found for BA and GA among the three groups.

Conclusion: Factors affecting the localization of OLTs are still not fully understood. However, foot morphology seems to play a role in determining medial or lateral localization. The LTCA is not related to the localization of OLTs; however, an increased LTCA may be related to the occurrence of OLTS. Increased CIA may be related to both OLTS localization and OLTs occurrence.

Objectives: In this study, we aimed to investigate the morphological and histological effects of tranexamic acid (TA) on wound healing in a rat wound model.

Materials and methods: A total of 24 adult male Wistar Albino rats were used in this study. All rats were simple randomly divided into three groups including eight rats in each group. A full-thickness skin defect was created on the back of the rats in all groups. Serum physiological (2 mL) was instilled saline drops after wound formation (control group). Wound was created and topical TA (0.12 to 0.15 mL [30 mg/kg]) was applied (local group). Intravenous TA (0.12 to 0.15 mL [30 mg/kg]) was applied intravenously before the wound was created (intravenous group). The wound diameters of the groups were photographed and measured on Days 0, 3, 7, 10, 14 and, at the end of Day 14, the rats were sacrificed and their histopathological results and wound diameters were compared.

Results: Fibroblast count values of the control group were found to be significantly lower than the local group (p=0.002), and no significant difference was observed between the local and intravenous groups (p>0.05). The collagen density (%) values of the control group were found to be significantly higher than the local and intravenous groups (p=0.016 and p=0.044). Wound diameter values of the control group on Day 10 day were found to be significantly higher than the local and intravenous groups (p=0.001). In addition, the wound diameter values of the control group on Day 14 were found to be significantly higher than the local and intravenous groups (p=0.001 and p=0.0001). The wound diameter changes of the control group on Days 0-10 were found to be significantly lower than the local and intravenous groups (p=0.001). In addition, the wound diameter changes of the control group on Days 0-14 were found to be lower than those of the local and intravenous groups (p=0.001 and p=0.0001).

Conclusion: The use of local or intravenous TA may have positive effects on the fibroblast count and wound contraction in a rat wound model.

Objectives: This study aimed to determine the influences of vitamin D3 and omega-3 polyunsaturated fatty acids (PUFAs) on fracture union in rats radiologically, histologically, and biomechanically.

Materials and methods: Forty-eight male Sprague-Dawley rats (mean weight: 435±31.15 g; range, 398 to 510 g) were indiscriminately separated into four groups, with 12 rats in each: Group 1 was the control group, Group 2 received vitamin D3, Group 3 received omega-3 PUFA, and Group 4 received both vitamin D3 and omega-3 PUFA. One day after surgery, only one intramuscular dose of 50,000 IU/kg vitamin D3 was administered to Group 2. From the first postoperative day until sacrification, 300 mg/kg omega-3 PUFA by oral feeding was administered to Group 3. In Group 4, both an intramuscular dose of 50,000 IU/kg vitamin D3 on the initial postoperative day and 300 mg/kg omega-3 PUFA were administered by oral feeding until sacrification. All rats were sacrificed by intracardiac potassium injection at the sixth postoperative week, and radiological, biomechanical, and histological studies were conducted.

Results: According to the radiological scores, the best scores were obtained in Group 4, and callus density and ossification were advanced in Groups 2 and 3 compared to Group 1. There was no statistically significant distinction between Groups 3 and 4, while a significant distinction was found between Group 4 and Groups 1 and 2. Biomechanically, the advanced values were attained in Groups 1 and 3. However, there was no statistically significant distinction among the groups. Histologically, although the advanced scores were attained in Groups 3 and 4, there was no statistically significant distinction among the groups.

Conclusion: The use of omega-3 PUFA together with vitamin D3 might have beneficial influences on fracture union. In the future, the combination of omega-3 PUFA and vitamin D3 might be used as an encouraging treatment choice that contributes to fracture healing.

Objectives: This study aimed to evaluate the effectiveness of a 1-min 10% povidone-iodine immersion in the decontamination of dropped osteochondral fragments.

Materials and methods: Forty-eight sets of sterile osteochondral bone fragments, each consisting of three samples, were prepared from removed femoral heads that would otherwise be discarded during different hip replacement surgeries. Immediately afterward, each set was dropped on the floor right behind the surgeon in another operating room in which fracture fixation operations were being performed. Samples were picked up with sterile gloves. A swab culture of the floor was taken. One of the three pieces was kept as the control group. The second one (saline group) was washed with saline and subsequently soaked in saline for 1 min. The last one (treatment group) was first immersed in a 10% povidone-iodine solution for 1 min, then rinsed with saline and soaked in saline for 1 min. The samples were cultured in nutrient media, and microorganisms were identified at the microbiology laboratory. The groups were compared in terms of positive culture rates.

Results: The positive culture (contamination) rates were 100%, 58.3%, 39.6%, and 10.4% for the swab samples, control group, saline group, and treatment group respectively. The decontamination ratio in the treatment group was significantly more than both the control group (p<0.001) and the saline group (p=0.001). Handling only with saline did not significantly decontaminate compared to the control group (p=0.066).

Conclusion: Immersing the dropped osteochondral fragments in 10% povidone-iodine solution for 1 min and then rinsing with saline may provide statistically significant decontamination but cannot be accepted to be safe enough for clinical practice. Further studies are needed to find the optimal time needed for safe decontamination without compromising the viability of cartilage tissue.

Objectives: This study presents the first investigation into the potential of ChatGPT to provide medical consultation for patients undergoing orthopedic interventions, with the primary objective of evaluating ChatGPT's effectiveness in supporting patient self-management during the essential early recovery phase at home.

Materials and methods: Seven scenarios, representative of common situations in orthopedics and traumatology, were presented to ChatGPT version 4.0 to obtain advice. These scenarios and ChatGPT̓s responses were then evaluated by 68 expert orthopedists (67 males, 1 female; mean age: 37.9±5.9 years; range, 30 to 59 years), 40 of whom had at least four years of orthopedic experience, while 28 were associate or full professors. Expert orthopedists used a rubric on a scale of 1 to 5 to evaluate ChatGPT's advice based on accuracy, applicability, comprehensiveness, and clarity. Those who gave ChatGPT a score of 4 or higher considered its performance as above average or excellent.

Results: In all scenarios, the median evaluation scores were at least 4 across accuracy, applicability, comprehensiveness, and communication. As for mean scores, accuracy was the highest-rated dimension at 4.2±0.8, while mean comprehensiveness was slightly lower at 3.9±0.8. Orthopedist characteristics, such as academic title and prior use of ChatGPT, did not influence their evaluation (all p>0.05). Across all scenarios, ChatGPT demonstrated an accuracy of 79.8%, with applicability at 75.2%, comprehensiveness at 70.6%, and a 75.6% rating for communication clarity.

Conclusion: This study emphasizes ChatGPT̓s strengths in accuracy and applicability for home care after orthopedic intervention but underscores a need for improved comprehensiveness. This focused evaluation not only sheds light on ChatGPT̓s potential in specialized medical advice but also suggests its potential to play a broader role in the advancement of public health.

Objectives: The study aimed to explore the effect of hip strategybased motion control training on the recovery of walking function after ankle injury and the optimization of the rehabilitation program.

Patients and methods: In the study, 62 patients with ankle injuries were randomly divided into the observation group (n=30; 24 males, 6 females; mean age: 41.9±8.5 years; range, 28 to 56 years) and the control group (n=32; 26 males, 6 females; mean age: 42.0±9.3 years; range, 27 to 55 years) between September 2021 and September 2022. Both groups were treated using routine rehabilitation training, including conventional drug and rehabilitation treatment. The observation group additionally received hip strategy-based motion control training, which included hip muscle strength training, hip joint stability control training, balance testing and training system training, and three-dimensional gait analysis system training for six weeks. All patients were evaluated before and after the treatment using the balance function parameters (motion length and motion ellipse area), Berg Balance Scale, the timed up-and-go test, and three-dimensional gait analysis system (step length and step frequency).

Results: There was no significant difference in the evaluation indexes between the two groups before treatment (p>0.05). After treatment, the evaluation indexes of the two groups were significantly better than those before treatment (p<0.05), and all the indexes in the observation group were significantly better than those in the control group (p<0.05).

Conclusion: Hip strategy-based motion control training could significantly improve the recovery of walking function in patients with ankle injuries.