Joint diseases and related surgery最新文献

Women face a higher risk of musculoskeletal disorders, particularly during and after pregnancy, due to complex hormonal and biomechanical changes. Pregnancy-associated hormonal fluctuations, primarily involving estrogen, progesterone, and relaxin, contribute to increased joint laxity, altered collagen dynamics, and ligamentous instability. Simultaneously, anatomical adaptations, including shifts in the center of gravity, increased lumbar lordosis, and altered gait mechanics, further strain the musculoskeletal system. These changes predispose pregnant women to conditions such as low back pain, pelvic girdle dysfunction, hip pathologies, and peripheral neuropathies, significantly impacting daily function and quality of life. While many of those disorders resolve postpartum, their long-term effects remain inadequately studied, raising concerns about potential chronic musculoskeletal complications, including osteoarthritis and persistent joint instability. Despite the prevalence of these conditions, there is a lack of standardized, evidence-based clinical pathways for assessment, early intervention, and postpartum rehabilitation. Current management strategies tend to focus on short-term symptomatic relief, such as analgesic use and activity modification, while often overlooking preventive strategies like routine musculoskeletal screening during prenatal visits, structured exercise programs tailored to pregnancy, and postpartum rehabilitation protocols. A well-tailored interdisciplinary collaboration is critical to address this gap. Obstetricians are well-positioned to identify early signs of musculoskeletal problems and initiate referrals. Physiatrists can develop and implement nonpharmacological treatment plans, including therapeutic exercise, physical therapy, and posture correction. They are also able to initiate targeted injections for musculoskeletal problems. Orthopedic surgeons provide expertise in diagnosing and managing structural abnormalities or persistent biomechanical dysfunction. Together, these disciplines can design comprehensive, longitudinal care models that prioritize both prevention and recovery. Research is still needed to delineate the long-term consequences of pregnancy on the musculoskeletal system and to establish preventive measures that enhance maternal health beyond the perinatal period. In this review, we address this gap by providing a comprehensive discussion regarding the effects of pregnancy and hormonal changes on the musculoskeletal system, as well as the commonplace conditions in daily clinical practice.

Objectives: The aim of this study was to evaluate whether fracture shortening, displacement, and the length of butterfly fragments were reliable radiographic indicators of secondary healing failure in displaced midshaft clavicle fractures with butterfly fragments and to determine whether these radiographic parameters were effective in predicting healing disorders and could be utilized as prognostic factors.

Patients and methods: Between January 2015 and January 2020, a total of 31 adult patients (29 males, 2 females; mean age: 43.6±13.2 years; range, 21 to 74 years) who presented with a closed displaced clavicle shaft fracture with butterfly fragments and were treated conservative using figure of eight bandages were retrospectively analyzed. Shortening, displacement, and butterfly fragment length were measured radiographically at diagnosis. The patients were evaluated at Weeks 4, 6, 12, and 24 after injury. The patients were divided into three groups: patients with unionized fractures, patients with delayed union, and patients with nonunion. In patients where radiographic union was not observed after four to six weeks, the figure-of-eight bandage treatment was continued. Delayed union was defined as the absence of radiographic signs of fracture consolidation within 12 weeks, and nonunion as the absence of fracture consolidation within 24 weeks.

Results: Fractures in 13 (42%) patients healed within 12 weeks, 10 (32.2%) patients had delay healing between 12 and 24 weeks, and eight (25.8%) patients had nonunion. The median shortening was 18.37 (range, 3 to 42.9) mm, while median displacement ratio and butterfly fragment length were 125% (range, 83 to 93%) and 21.7 (range, 12 to 47.2) mm, respectively. No statistically significant difference in shortening was observed among the three groups (p=0.71). There was a significant difference in the amount of displacement between the healed fractures and delayed union groups (p=0.006) and the healed fractures and nonunion groups (p=0.002). There was also a significant difference in the butterfly fragment length between the healed fractures and nonunion groups (p=0.008). For each 1% increase in displacement, the relative risk of delayed union increased by 8%, and the risk of nonunion increased by 10%. A cut-off value of 125% optimally distinguished healed from unhealed fractures (area under the curve [AUC]=0.874). For differentiating delayed union from nonunion, the optimal threshold was 142.5% (AUC=0.713), indicating moderate diagnostic performance.

Conclusion: In adult clavicle shaft fractures with butterfly fragments, butterfly fragment length and clavicle shortening did not affect bone healing. In contrast, displacement was the only significant predictor of impaired bone healing.

Objectives: This study aims to compare the functional scores and gait analysis data of patients undergoing conservative treatment after calcaneal fractures with healthy individuals and to evaluate both success of conservative treatment and the applicability and effectiveness of a novel smartphone-based gait analysis method in assessing post-fracture mobility.

Patients and methods: Between January 2017 and December 2022, a total of 30 patients (10 females, 20 males; mean age: 48.6±12.6 years; range, 19 to 65 years) who underwent conservative treatment due to calcaneal fractures and 30 healthy controls (12 females, 18 males; mean age: 45.3±12.7 years; range, 21 to 63 years) were retrospectively analyzed. Patients with completed fracture union and mobilized by full weight bearing on the fractured extremity were evaluated with ankle joint range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS), Short Form-36 (SF-36), Visual Analog Scale (VAS) functional scoring and gait analysis using the smartphone-based Gait Analyzer application, and the results were compared with the control group.

Results: After conservative treatment, there was no statistically significant difference in the ankle ROM values (dorsiflexion p=0.359, plantarflexion p=0.240), AOFAS (p=0.211), and SF-36 scores (physical function p=0.188, pain p=0.483, health change p=0.894) of the patient and control groups. The mean VAS score of the patient group was 2.83±1.80, indicating higher scores than those of the control group (p=0.035). There was a statistically significant change between the groups in terms of all gait parameters (gait velocity p=0.010, step time p<0.001, step length p<0.001, cadence p<0.001, step time symmetry p<0.001, step length symmetry p<0.001, vert-COM p<0.001).

Conclusion: Although the functionality and gait patterns of the patients may be affected after conservative treatment of calcaneal fractures, the fact that there was no significant difference between the patient and control groups indicates that this treatment method can be preferred in this group of patients, particularly in extraarticular and Sanders type 1 intra-articular fractures, with appropriate rehabilitation.

Objectives: This study aims to evaluate delayed diagnosis of osteoid osteoma (OO) in pediatric patients with hip pain and to identify the diagnostic challenges and errors encountered during this period.

Patients and methods: Between May 2010 and July 2022, a total of 18 patients (11 males; 7 females; median age: 12 years; range, 6 to 20 years) with a confirmed diagnosis of OO were retrospectively analyzed. Demographic, clinical, and radiographic data were recorded. The time from symptom onset to diagnosis was calculated for each patient. The date of radiological diagnosis was accepted as the time of diagnosis.

Results: The median time from symptom onset to diagnosis was 12 months. Right-sided involvement was observed in 61.1% of cases. The most common lesion location was the femoral neck (61.1%), and 66.7% of cases had intra-articular lesions. A limping gait was observed in 61.1% of patients. Additionally, 33.3% of cases reported atrophy of the thigh muscles and/or lower extremities. Night pain was present in 83.3% of cases. A total of 72.2% of cases had a diagnostic delay exceeding six months. Half (50%) of the patients required more than five visits to healthcare providers before receiving an accurate diagnosis.

Conclusion: The diagnostic delays for OO located in the hip region can be seen in among children and young adults, primarily due to misdiagnosis and reliance on inconclusive initial imaging findings. To minimize such delays, clinicians should maintain a high index of suspicion, particularly in patients with persistent, unexplained hip pain, and consider imaging studies. Pain lasting over three weeks warrants further diagnostic evaluation in this patient group.

Objectives: This study aims to compare the clinical and radiographic outcomes of open (lateral transfibular) and arthroscopic joint debridement techniques in tibiotalocalcaneal arthrodesis (TTCA) using the same nail system.

Patients and methods: Between January 2011 and December 2022, a total of 62 patients (21 males, 41 females; mean age 53.81±16.68 years; range 18 to 82 years) who underwent TTCA with retrograde intramedullary nail were retrospectively analyzed. The patients were classified as open (n=30) or arthroscopy (n=32) based on the method used for joint debridement. Data including demographic characteristics, pre-and postoperative radiographs, skin-to-skin operative times, and fluoroscopy times were recorded. Tibiotalar and subtalar union rates, coronal and sagittal ankle alignment examined through coronal tibiotalar (CTT) and sagittal tibiotalar (STT) angles were also noted. Functional outcomes were measured using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AHS) and Visual Analog Scale (VAS). Complications were evaluated.

Results: A total of 34 ankles (n=30) underwent open TTCA, while 34 ankles (n=32) had arthroscopic TTCA. Baseline characteristics and follow-up duration were similar between the groups (p>0.05). The overall fusion rate (tibiotalar and subtalar) was 94.1% in the open group and 85.3% in the arthroscopic group (p=0.425). Both open and arthroscopy groups achieved satisfactory coronal and sagittal ankle alignment. The median CTT angles were 94° and 91°, and STT angles were 109° and 112°, respectively. The arthroscopy group had significantly shorter operative time, fluoroscopy time, and hospital stay (p<0.001, p=0.019, p<0.001, respectively). No significant differences were found in complication rates, postoperative AOFAS-AHS, and VAS scores (p>0.05).

Conclusion: Both open and arthroscopic TTCA approaches yielded similar radiographic and clinical outcomes. Based on these findings, we can speculate that the arthroscopic technique may offer advantages in perioperative efficiency, suggesting it is a viable alternative in appropriately selected patients.

Objectives: This study aims to compare the biomechanical performances of five fixation techniques, posteroanterior (PA) screw, anteroposterior (AP) screw, posterior locking compression plate (LCP), anatomic posteromedial plate (PMP), and anterolateral plate (ALP), for isolated posteromedial tibial plateau fractures using cadaveric models under static and dynamic axial loading conditions.

Materials and methods: Twenty-five fresh-frozen cadaveric tibias were used to create standardized posteromedial split-type fractures. Specimens were divided equally into five groups based on the fixation method. Biomechanical testing involved cyclic axial loading (10-250 N, 2500 cycles at 2 Hz), followed by load-to-failure testing under static compression. Outcome parameters included stiffness, load at 3 mm displacement, ultimate load, displacement at failure, and photographic displacement.

Results: The PMP group demonstrated the highest biomechanical stability, with the greatest ultimate load (805.60±218.96 N) and minimal displacement. The PA screw fixation also showed acceptable performance, offering a minimally invasive alternative. In contrast, the AP and ALP groups exhibited the lowest values for load tolerance and fragment control. There were significant differences between the groups, particularly favoring posterior-based techniques (p<0.05).

Conclusion: Anatomic PMP provides superior biomechanical stability for isolated posteromedial tibial plateau fractures. The PA screw fixation offers a less invasive, yet stable alternative. Anterior-based fixation strategies such as AP screws and ALP should be avoided due to biomechanical insufficiency.

Objectives: In this meta-analysis, we discuss the complication rates of conversion to total hip arthroplasty (cTHA) following failed internal fixation (IF) of femoral neck fractures (FNFs) versus primary total hip arthroplasty (pTHA).

Materials and methods: The Cochrane Library, Web of Science, PubMed, Embase, and Science Direct databases were searched for eligible publications published prior to December 2024. The search terms included "femoral neck fracture", "internal fixation failure", and "total hip arthroplasty". The mean difference (MD) and risk difference (RD) were used as combined variables, and 95% confidence intervals (CIs) were chosen.

Results: Six non-randomized-controlled clinical trials comprising 1,301 patients were included in this meta-analysis. The pooled data revealed statistically significant differences in postoperative deep infection rates (RD=0.04; 95% CI: 0.01- 0.08; p=0.009), periprosthetic fractures (RD=0.03; 95% CI: 0.00-0.05; p=0.03), and reoperation rates (RD=0.07; 95% CI: 0.03-0.11; p=0.0002) between the cTHA and pTHA groups. However, no significant differences were observed in the incidence of postoperative dislocations (RD=0.05; 95% CI: -0.03-0.13; p=0.19), deep vein thrombosis (RD= -0.01; 95% CI: -0.04-0.03; p=0.77), superficial infections (RD=0.02; 95% CI: -0.02-0.06; p=0.37), or revision surgeries (RD=0.02; 95% CI: -0.01-0.05; p=0.13).

Conclusion: Compared to pTHA, cTHA following failed IF of FNFs was associated with higher deep infection, periprosthetic fractures, and reoperation rates.

Objectives: This study aims to investigate the predictive value of the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score for six-month mortality in patients undergoing hemiarthroplasty for femoral neck fractures (FNFs).

Patients and methods: Between March 2019 and March 2022, a total of 60 patients (32 males, 28 females; mean age: 83.2±6.3 years; range, 67 to 95 years) who underwent hemiarthroplasty for FNFs were retrospectively analyzed. Complete blood count and albumin levels were analyzed in venous blood samples at the time of hospital admission. The neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), prognostic nutritional index (PNI), systemic immune-inflammation index (SII), and HALP scores were calculated. The six-month mortality rates of the patients were recorded.

Results: At six-month follow-up, 22 (36.6%) patients died and 38 (63.4%) survived. In logistic regression analysis, only HALP score was found to be associated with six-month mortality independently of other parameters (p=0.001 odds ratio [OR]=1.09, 95% confidence interval [CI]: 1.06-1.13). The six-month survival increased 1.09-fold for each unit increase in HALP score. In the receiver operating characteristics (ROC) curve analysis, the HALP score showed 71.1% sensitivity and 72.7% specificity using a cut-off value of 19.95 (area under the curve [AUC]: 0.804, 95% CI: 0.687-0.921).

Conclusion: Our study results show that low HALP score is associated with six-month mortality in this patient group. Based on these findings, we suggest that the clinical use of the HALP score as a prognostic marker in hip fracture patients.

Immune dysregulation in children can lead to a variety of health issues, including infections, allergies and autoimmune diseases. However, the coexistence of autoimmune diseases and primary immunodeficiency disorders is extremely rare in clinical practice. A 4-year-old male patient was admitted in July 2017 with joint swelling and pain, alongside a history of recurrent respiratory infections and severe pneumonia. Physical examination revealed tenderness and swelling in multiple joints, and laboratory tests indicated elevated inflammatory markers. Imaging studies showed joint effusion and inflammatory lesions in the lungs. He was diagnosed with rheumatoid factor-negative polyarticular juvenile idiopathic arthritis (PJIA) and treatment was initiated with naproxen, methotrexate and etanercept, leading to significant symptom improvement. In July 2019, following a decline in immunoglobulin (Ig) M (IgM) levels (IgM 0.36 g/L) and recurrent infections, genetic testing was conducted, revealing a frameshift mutation in the CD40LG gene (c.621dup A, p.A208Sfs * 23), which confirmed the diagnosis of X-linked hyper IgM syndrome (XHIGM). The treatment regimen was adjusted to include monthly intravenous Ig infusions and prophylactic antibiotics, significantly reducing the frequency of respiratory infections. By January 2021, PJIA was in clinical remission, allowing for the discontinuation of immunosuppressive therapy, with follow-ups indicating continued recovery without discomfort. In conclusion, this case underscores the rare coexistence of XHIGM and PJIA in the field of pediatrics and identified a new pathogenic variant in CD40LG, enhancing our understanding of the clinical management of individuals with concurrent autoimmune and immunodeficiency disorders.

Objectives: In this review, we discuss the clinical outcomes of plates and headless screws (HSs) for Mason Type 3 radial head fractures to determine the superior approach.

Materials and methods: A comprehensive literature search was conducted across multiple databases for studies on internal fixation of Mason Type 3 radial head fractures, covering publications from inception to December 2024. Literature was screened, and data were extracted according to predefined inclusion criteria. The quality of randomized-controlled trials (RCTs) was assessed using the Cochrane Handbook for Systematic Reviews of Interventions, while the Methodological Index for Non-Randomized Studies (MINORS) recommended by the Cochrane Collaboration was used for non-RCT studies. Systematic review was performed using RevMan version 5.1 software provided by the Cochrane Collaboration.

Results: A total of five studies were included in the systematic review, comparing 89 cases treated with plate fixation and 136 cases treated with HS fixation. The systematic review revealed that plate fixation increased the time to bone union (mean difference [MD]=26.89; 95% confidence interval [CI]: 18.84-34.93; p<0.0001) without significant heterogeneity (p=0.51, I²=0%). Plate fixation was also associated with a decrease in the postoperative Mayo Elbow Performance Score (MEPS) (MD=-5.86; 95% CI: -9.11 to -2.61; p=0.0004) with no significant heterogeneity (p=0.34, I²=6%), although the result was not clinically significant. Plate fixation resulted in reduced postoperative pronation (MD=-8.82; 95% CI: -13.02 to -4.63; p=0.0001) and supination (MD=-8.79; 95% CI: -12.09 to -5.49; p=0.0001). No significant differences were found between the two methods in terms of operation time, length of hospital stay, postoperative flexion-extension, flexion, extension, complications, or postoperative Disabilities of the Shoulder, Arm, and Hand (DASH) scores.

Conclusion: The results of our systematic review indicate that HSs offer a faster bone union time and better functional outcomes in terms of pronation and supination, compared to plate fixation. However, the clinical significance of differences in MEPS and DASH scores is questionable, as they still remain below the minimal clinically important difference thresholds. Given the varying fracture configurations, further studies with larger sample sizes are needed to confirm these findings and determine the most clinically relevant treatment approach.