Advances in Orthopedics最新文献

Objectives: To investigate variables associated with improvement in quality of life (QOL) after primary knee replacement. QOL outcomes between individuals undergoing total knee replacement (TKR) and unicompartmental knee replacement (UKR) were compared. Materials and Methods: Participants were adults (n = 497) undergoing TKR or UKR for osteoarthritis between January 2017 and October 2020 in a large publicly funded tertiary hospital in New Zealand. Participants completed patient-reported outcome measures of QOL, pain and function, preoperatively, 6 and 12 months postoperatively. Results: QOL improved pre- to postoperatively for both TKR and UKR groups, and the main QOL gains for both groups were evident in the first 6 months after joint replacement. Notably, QOL did not differ between groups at any assessment point (p > 0.05). Improvement in QOL was more correlated with improved pain and function than with person factors such as demographics and comorbidity burden (p < 0.01). Conclusions: This study adds to a growing literature showing that knee replacement contributes to substantial improvements in QOL outcomes. Future QOL outcome research in the knee replacement population should consider using more precise measures of function to better understand the impacts of these factors on QOL improvement.

Background: The optimal length of cephalomedullary nails for treating unstable pertrochanteric fractures, particularly in populations with distinct femoral anatomy, remains debated. This study compares the clinical outcomes of using the shortest effective cephalomedullary nails (170 mm) to various short length (200 mm and 240 mm), focusing on Asian patients. Methods: In this randomized controlled trial, 50 patients aged 50 years or older with unstable intertrochanteric fractures (AO types 31A2-3) were randomly assigned to two groups. The shortest-nail group (n = 25) received a 170 mm cephalomedullary nail, while the control group (n = 25) received either a 200 mm or 240 mm nail based on patient height. Primary outcomes were assessed using the Harris Hip Score (HHS) at multiple postsurgery intervals. Secondary outcomes included operative time, hospital stay, hidden blood loss (HBL) (calculated using Sehat's formula), and complication rates. Results: There were no significant differences in HHSs, hospital stay durations, or operative times between the two groups. The median time to fracture union was also comparable between groups (18.1 weeks vs. 18.2 weeks, p=0.9). However, the shortest-nail group showed significantly lower HBL (860.52 mL) compared with the control group (1183.40 mL, p=0.04). Complications included five cases of blade cut-out or refracture, with no significant differences between groups. Conclusion: The shortest effective cephalomedullary nails (170 mm) may offer benefits, particularly in reducing HBL, compared with various short-length nails. However, this advantage may not be solely attributable to nail length, as both groups underwent similar surgical techniques and other factors, such as fracture patterns or patient anatomy, may have influenced the outcomes. While short nails are effective for treating unstable pertrochanteric fractures, larger studies with longer follow-up periods are necessary to validate these findings and assess the long-term safety and efficacy of short nails.

Introduction: Tibial shaft fractures, particularly those classified as AO 42-C3, represent a significant orthopedic challenge due to their high risk of delayed union or nonunion. Intramedullary nailing is a widely used treatment, though optimizing biological healing remains essential. Platelet-rich plasma (PRP), containing abundant growth factors, has been suggested as a therapeutic aid to enhance fracture healing. Methods: A randomized controlled trial was conducted, including 32 patients diagnosed with acute AO 42-C3 pure diaphyseal tibial fractures. Patients were randomized into two groups: 16 received PRP injections, while 16 received normal saline solution (NSS) injections as a control. The primary outcome, cortex-to-callus ratio, was assessed via radiographs over a 6-month follow-up. Secondary outcomes included patient-reported measures such as the SF-36 and EQ-5D-3L questionnaires and time to union. Results: The PRP group exhibited a significantly higher cortex-to-callus ratio during the third and fourth months of follow-up (p < 0.05), indicating accelerated callus formation. Moreover, the PRP group exhibited a statistically significant reduction in time to union compared with the NSS group (p < 0.05). Although other patient-reported outcomes did not show significant differences, the PRP group displayed an upward trend in SF-36 scores (p < 0.05). Discussion: PRP significantly enhances midstage fracture healing in tibial shaft fractures, as evidenced by improved callus formation and reduced time to union. These results indicate that PRP holds promise as a therapeutic adjunct for managing tibial fractures. Additional studies with larger sample sizes and diverse fixation techniques are needed to validate these findings and further assess the broader potential of PRP in orthopedic practice.

Background: Preoperative anaemia has been shown to increase the risk of adverse outcomes following hip fracture. To date, the association between haemoglobin (Hb) on admission and longer-term outcomes has not been studied extensively in the Irish hip fracture population. This study aimed to ascertain the mean Hb on admission and investigate the relationship with 1-year mortality. Methods: A retrospective review of all hip fracture cases in older adults discharged from an Irish urban trauma centre over a 4-year period was conducted. Hb on admission was obtained using electronic patient records. Mortality status was obtained via the Inpatient Management System and correlated with the Irish Death Events Register. Logistic regression was performed on a range of routinely collected patient and care pathway variables. Results: A total of 833 patients were included. Mean Hb on admission was 12.1 g/dL (SD 1.7), with 11.4% (95/833) of patients having a Hb ≤ 10 g/dL. Within 1 year of fracture 20.5% (171/833) of patients had died. On multivariate analysis, those with a Hb ≤ 10 g/dL on admission were 76% more likely to die within one year (OR 1.76, p < 0.02, 95% CI 1.07-2.90) compared to those with a Hb ≥ 10.1 g/dL. Patients admitted from a nursing home were also more likely to die within 1 year (OR 2.09, p < 0.001, 95% CI 1.26-3.45), compared to those admitted from home. Early postoperative mobilisation (OR 0.32, p < 0.001, 95% CI 0.22-0.48) and female gender (OR 0.49, p < 0.001, 95% CI 0.34-0.71) reduced the likelihood of 1-year mortality (AUC 0.71). Conclusion: Anaemia is common in hip fracture patients and may be viewed as a surrogate marker of frailty. In this cohort, Hb ≤ 10 g/dL on admission was a statistically significant predictor of 1-year mortality. Recognising and managing anaemic patients preoperatively may provide an opportunity to improve longer-term outcomes in hip fracture patients.

Background and Objectives: When operating on acetabular fractures in conventional open surgery, visualization of crucial structures can be challenging. In recent years there have been several case reports on laparoscopy-assisted acetabulum surgery in the literature. Therefore, we have developed this method further using extraperitoneal endoscopy to manage acetabulum fractures. Methods: Operative technique: An experienced hernia surgeon familiar with the totally extraperitoneal laparoscopic technique facilitates access to the acetabulum area so that orthopaedic surgeons can focus on fixing the area with a plate and screws through laparoscopy ports. Results: We developed this operative technique in a cadaver laboratory where we could easily fix and plate the acetabulum area with extraperitoneal endoscopy visualization in seven cadavers both on the left and right sides. Conclusions: A minimally invasive full endoscopic procedure for acetabular fractures offers significant benefits over traditional open surgery due to faster rehabilitation, potentially less blood loss, and fewer wound complications. According to our initial experiences with cadavers, this minimally invasive method appears promising in terms of superior visibility and easier access to the otherwise narrow and difficult fracture site in the pelvic region compared to open surgery. Furthermore, this minimally invasive method seems feasible for exact plate placement under combined endoscopic and fluoroscopic visual control. The usefulness of this novel method in the minimally invasive treatment of acetabular fractures in real life, especially considering the practicality of proper fracture reduction, should be confirmed in future clinical trials.

Background: Hip joint replacement surgery or total hip arthroplasty (THA) is an effective procedure for elderly patients. It can improve their quality of life and functionality while reducing the direct costs associated with arthritis. With increased THA procedures being performed on patients of different ages, it is essential to identify factors that may affect mortality for better patient care. Objective: This study aimed to identify the early mortality rate and potential risk factors among patients undergoing primary total hip replacement (THR) at a tertiary hospital in Tanzania. Methodology: This was a retrospective cohort study conducted from January 2020 to December 2021, which involved patients who had undergone THR. Result: The study involved 183 participants, 53.6% of which were male with a mean age of 55.9 ± 18.4 years. Early mortality (death before 3 months) was found to be 7%. Having hypertension and being seropositive for HIV were independent prognostic factors for survival. Hypertension was associated with an increased chance of death by 4.8 times. The likelihood of death was eleven times higher among participants who were HIV+. Conclusion: Hypertensive patients had an increased chance of death of five times more compared to those with no hypertension. HIV+ patients had an increased chance of death, up to eleven times higher with difference in disease profiles and HIV endemicity in our settings this calls for a different approach to THR.

Background: Adequate implantation is important to avoid complications following total hip arthroplasty (THA). This study aimed to evaluate the accuracy and precision of implant placement in the direct anterior approach (DAA) using fluoroscopy in comparison with the anterolateral approach in lateral decubitus position (OCM) using a single implant. Methods: We retrospectively compared propensity score-matched THAs in DAA with fluoroscopy and in OCM. The achievement ratio of the Lewinnek cup safe zone, absolute difference in alignment, and positioning from preoperative planning was evaluated and compared between each approach. Results: 33 patients in both groups were eligible for this study. Significantly more cups were inside the safe zone in the DAA group than in the OCM group (33/33 vs. 25/33, p=0.0048). No significant differences were found between the DAA group and OCM group regarding the discrepancy from the target cup inclination, anteversion, and three-dimensional positioning. No significant difference was noted in stem alignment; however, the equality of coronal alignment variances was smaller in the DAA group (p=0.0047). No significant differences were found in the clinical score and complication rate. Conclusion: The DAA using fluoroscopy may provide more accuracy for cup placement and precision for stem placement than OCM.

Introduction: Femoral neck fractures (FNFs) in young adults are relatively uncommon but pose significant clinical and surgical challenges. Hip arthroplasty is rarely used as a treatment option in this population but has seen rising use over the previous decade. This study seeks to compare hip arthroplasty outcomes among young adult patients in the United States admitted with FNF by evaluating hip hemiarthroplasty (HHA) and total hip arthroplasty (THA). Materials and Methods: Using the National Inpatient Sample (NIS) data, adult patients less than 50 years old who underwent HHA or THA from 2016 to 2020 were analyzed. Both groups' postoperative length of stay (pLOS), total hospital charges, and prosthesis-related complications (PRCs), including mechanical loosening (ML), prosthesis dislocation (PD), and periprosthetic fracture (PPF), were analyzed and compared. Results: Out of 174,776,205 hospitalizations between 2016 and 2020, 15,590 young adult patients had FNF, and 2970 patients (2.18%) underwent hip arthroplasty (1195 HHAs and 1775 THAs). After controlling for demographic, clinical and hospital characteristics, HHA was associated with a 22.4% longer pLOS compared to THA [rate ratio: 1.224, 95% CI: 1.183 to 1.266; p < 0.001]. Patients in the HHA group also had higher odds of PPF (aOR: 9.06, 95% CI: 4.21, 19.48; p < 0.001). Conversely, patients in the THA group had higher odds of PD (aOR: 6.00, 95% CI: 1.78, 20.24; p=0.004). There was no statistically significant difference in total hospital charges between the groups [cost ratio: 1.03, 95% CI: 0.995 to 1.075; p=0.092]. Conclusion: Among young adults with FNF undergoing hip arthroplasty, HHA is associated with a longer postoperative hospital stay and higher risk of PPF as a major early complication, while THA is associated with a higher risk of PD. Financial burden is comparable for both procedure groups. When hip arthroplasty is a preferred treatment for FNFs, individual patient factors are important considerations that should guide the choice of procedure.

Background: High median nerve injury leads to an absence of thumb opposition and irreversible thenar atrophy. Currently, distal nerve transfer is a new option for opponensplasty. The superiority of nerve transfer over traditional tendon transfer is that in nerve transfer, all thenar muscles may be reinnervated and so thumb functions are fully achieved, while in tendon transfer, the goal is to reanimate the function of abductor pollicis brevis (APB). This study aims to describe the results of opponensplasty using distal nerve transfer. Materials and Methods: This article analyses the results of opponensplasty using the transfer of abductor digiti minimi (ADM) branch of the ulnar nerve to the recurrent branch of the median nerve. Clinical outcomes were assessed by objectively evaluating APB strength, degree of thumb opposition, and thenar muscle bulk. APB strength and degree of thumb opposition measured by Medical Research Council (MRC) and Kapandji scoring systems, respectively. Results: From 2016 to 2019, six patients with a mean age of 29.5 years (five males and one female) with high median nerve injury were considered for opponensplasty using nerve transfer. Clinical improvement, including APB strength regaining and thumb opposition, was achieved in all patients. Moreover, recovery of thenar atrophy was observed in five patients. Conclusion: In high median-nerve injury, early reconstructive intervention can prevent the thenar muscle atrophy and leads to prompt reinnervation and complete restoration of thenar function. ADM branch of the ulnar nerve is a superior donor for this purpose.

Introduction: The management of complex limb injuries can be very challenging, and it demands a multidisciplinary approach to treatment. Amputation and limb reconstruction are the two options that clinicians must choose. This study aims to comprehensively synthesize existing tools and resources from the literature that can assist clinicians in the decision-making process. Evaluation: The initial resuscitation and the prehospital care are the first important steps in the management of these injuries, while the immediate transfer to trauma centers is recommended for complex cases. After the stabilization of the patient, a thorough clinical examination of the limb is necessary with emphasis on the degree of soft tissue damage. Blunt trauma in the lower limb is associated with a higher risk of early amputation. Polytrauma patients with complex limb injuries require a holistic approach, with Damage Control Orthopedics (DCO) principles. Traumatic bleeding significantly increases mortality rates, necessitating prompt control using pressure bandages or tourniquets. Computed tomography angiography (CTA) is necessary in order to assess the viability of the limb. Management: Scoring systems can be used as a tool in the management of complex lower and upper limb injuries. Mangled Extremity Severity Score (MESS) calculates ischemia, shock, bone and soft tissue damage, and patient characteristics. The Narakawa Index (NISSSA score) constitutes an alteration of MESS with the implementation of a nerve injury element. The Musculoskeletal Score for Severity of Injury (MESI score) estimates the risk of limb amputation by evaluating injury, neurovascular damage, type of fracture, patient characteristics, and the period from the occurrence of trauma to the definitive treatment. Further interventions and patient preferences should be incorporated into the decision-making process. Outcome: The outcomes of limb salvage versus amputation for complex limb injuries encompass various factors, including patient's preinjury health status, psychological well-being, functional outcomes, and economic impact. While some studies suggest better psychological outcomes with limb reconstruction and others find similar functional outcomes between the two approaches, economic considerations play a significant role in decision-making. Conclusion: Managing complex limb injuries effectively necessitates a comprehensive approach involving thorough assessment, multidisciplinary collaboration, and patient-centered care. Given the diverse factors influencing management and long-term outcomes, it is crucial to integrate medical expertise with patient preferences and expectations.