Archives of Orthopaedic and Trauma Surgery最新文献

Displaced intracapsular femoral neck fractures (FNF) are the most frequent surgical pathology in orthopedics. Controversy surrounds optimal treatment, with little consensus, particularly in the elderly multimorbid at risk population. For over a decade, our institution adopts a standardized protocol for FNF, utilizing cemented hip hemiarthroplasty (HA) via the posterior approach. This study evaluates the outcomes of this approach, contributing to the ongoing debate and potentially guiding future treatment strategies.

This retrospective study included patients (≥ 60 years) who underwent HA for FNF from January 1, 2008, to June 30, 2019, at a University Hospital. Our primary endpoint was revision surgery for HA (rHA) within four years after HA. Secondary endpoints included hip-related and unrelated complications.

Of 1001 patients, 40 (3.9%) underwent rHA. Indications were periprosthetic fractures (5; 0.5%), dislocation (15; 1.5%), suspected prosthetic joint infection (17; 1.7%), and acetabular erosion (3; 0.3%). Four-year mortality was 51%. Cox regression revealed age > 80 years (aHR 1.86, p < 0.001), ASA score III or IV (aHR 2.11, p < 0.001), and postoperative delirium (aHR 1.29, p < 0.05), as independent predictors of higher 4-year mortality. No difference was observed among patients with and without revision indication for ASA scores III or IV (64% vs. 64%; p = 0.912), surgery within 24 h (52% vs. 57%; p = 0.334), duration over 90 min (46% vs. 53%; p = 0.201), and surgery during the night shift (24% vs. 19%; p = 0.285). Board certification did not impact revision rates (39% vs. 39%; p = 1.000).

Cemented HA is a safe and reliable treatment option for FNF, delivering consistent outcomes in the elderly multimorbid population, with low rates of rHA (3.9%). The posterior surgical approach, even in patients with heightened dislocation risk, remains a viable option. Timing of surgery (night/day) does not significantly affect revision rates, which could have substantial implications for surgical planning and healthcare resource allocation.

Purpose

Revision total knee arthroplasty (rTKA) is more complex and carries higher risks than primary TKA, especially in patients aged ≥ 80 years. This study examines whether elective rTKA yields similar clinical outcomes and complication rates in octogenarians compared to septuagenarians (70–79 years).

Methods

From 2010 to 2022, we identified 57 patients aged ≥ 80 years who underwent their first rTKA with at least a two-year follow-up at a single institution. These patients were matched 1:2 based on rTKA indication with 114 patients aged 70–79 years. Data collected included demographics, revision indications, perioperative outcomes, complications, reinterventions, and Knee Society Scores (KSS). These variables were compared between septuagenarians and octogenarians with student-t tests or Mann-Whitney u tests.

Results

Aseptic loosening was the most common revision indication in both groups (32.8% of all cases). Septuagenarians received more constrained condylar knee (CCK) implants (51% vs. 23%), while octogenarians received more hinged implants (54% vs. 38%). At 2 years, septuagenarians had higher KSS Function scores (72.7 ± 14.9 vs. 56.8 ± 11.4, p < 0.001). Octogenarians experienced higher complication rates (26.3% vs. 9.6%, p = 0.006) and reinterventions (15.8% vs. 6.2%, p = 0.05).

Conclusion

Octogenarians undergoing rTKA exhibited lower functional outcomes and gains, along with higher rates of postoperative complications and reinterventions compared to septuagenarians. Further evaluation using patient frailty indices may improve understanding and help balance the risks and benefits of revision surgery in this population.

Introduction

The autologous shaver-based minced cartilage implantation is increasingly used for the treatment of focal cartilage lesions of the knee. However, in the absence of randomised controlled studies on this specific technique, its efficacy in comparison to established cartilage repair methods is a matter of debate.

Materials and methods

Eleven patients (12 cases) were prospectively included in this study. One female patient was excluded due to conversion to total knee arthroplasty. All 11 analysed cases (8 females, 3 males; mean age: 42.7 ± 11.8 years, body mass index (BMI): 29.6 ± 6.1 kg/m², lesion size: 3.2 ± 1.6 cm²) received autologous shaver-based minced cartilage implantation (AutoCart™, Arthrex Inc.) due to full thickness cartilage lesion of the knee. The patients were evaluated preoperatively and at 6, 12- and 24-months follow-up, using the International Knee Documentation Committee (IKDC) Questionnaire, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale (VAS) pain. The minimal clinically important difference (MCID) was calculated using the half-standard deviation method. Magnetic resonance imaging (MRI) was performed after 24 months and evaluated using the Magnetic resonance Observation of Cartilage Repair Tissue grading scale (MOCART) and the calculation of a T2-Index comparing T2 relaxation times of transplanted cartilage with intact cartilage of the same joint.

Results

Statistically significant improvement at 24 months follow up was observed for pain relief, as documented by the VAS and KOOS total, as well as the KOOS subsccores pain and activities of daily living. Out of 11 cases the MCID was reached in 9 cases considering VAS, 5 cases considering IKDC, 7 cases considering KOOS total and sport, 6 cases considering quality of life and 5 cases considering symptoms and activities of daily living. The postoperative mean MOCART score was 51.4 ± 22.0 and the mean T2-Index was 0.72 ± 0.18. In 3 of 11 postoperative MRIs no transplanted cartilage was observed.

Conclusion

Treatment of focal cartilage lesions at the knee with the autologous shaver-based minced cartilage implantation provided pain relief and improved function at 2 years follow up. Radiologic results indicated that on average the transplanted cartilage was different from hyaline cartilage, however, according to the T2-Index, in two cases the transplanted cartilage exhibited qualitative MR morphological properties similar to hyaline cartilage.

Aims

The aim of this retrospective study was the evaluation of the patient-reported and radiological outcome of intravenous Iloprost therapy in the treatment of spontaneous osteonecrosis of the knee (SONK).

Methods

36 patients (age 57.3 ± 8.7 years, 38.9% women, 61.1% men) who received Iloprost between 2018 and 2021 due to SONK (ARCO I and II) were included in this retrospective cohort study. Outcome was evaluated by pre- and postinterventional pain (Numeric Rating Scale - NRS), patient reported outcome (subjective knee value (SKV), Oxford Knee Score (OKS)) at latest follow-up (2.9 months ± 1) as well as quantitative artificial intelligence assisted analysis of bone marrow edema (BME) in Magnetic Resonance Imaging (MRI) before and after 3 months.

Results

Radiologically, there was a 71% reduction in edema (pre-intervention: 37.0 cm³±37.7, post-intervention: 10.8 cm³ ± 14.9, p < 0.01). Overall satisfaction was 2.0 ± 1.3, SKV was 83.3%±16.6 and NRS at follow-up was 1.3 ± 1.8. OKS reached 33.6 ± 12.0. No major complications were observed. Rare side effects were dizziness which required premature termination of Ilomedin therapy on day 3.

Conclusion

Iloprost treatment seems a safe and promising therapeutic option also in SONK with excellent subjective outcome and reduction of BME of 70% within 3 months after Iloprost infusion.

Introduction

Total hip arthroplasty (THA) is a major success in the management of osteoarthritis and is increasingly performed worldwide. As a result, complications related to hip prostheses—particularly periprosthetic femoral fractures (PPF)—are becoming more frequent, occurring in 4–5% of THA cases. These fractures often require surgical intervention. However, the optimal treatment strategy remains controversial, especially for Vancouver B1 and C fractures with stable implants. The literature lacks sufficient comparative studies evaluating the benefit of cortical strut allografts in this context.

Methods

A retrospective, monocentric, comparative study was conducted including 41 patients with Vancouver B1 or C periprosthetic femoral fractures treated between 2016 and 2020. Patients were divided into two groups based on whether cortical strut allografts were used in addition to standard internal fixation. Clinical and radiographic outcomes were compared between groups.

Results

Radiographic union was achieved more frequently in the group treated with adjunctive allografts. Mean mRUST at last follow-up was higher with allograft (14.75 ± 2.24) than without (12.25 ± 2.97), an absolute difference of 2.50 points (p = 0.007). The association of an allograft was not associated with an increase of complication or any infection rate.

Discussion

The addition of cortical strut allografts appears to improve mechanical stability, reduce surgical failure, and enhance healing in Vancouver B1 and C fractures without increasing postoperative morbidity.

Introduction

Closed treatment of comminuted, displaced greater tuberosity fractures (GTFs) can result in nonunion or malunion, causing rotator cuff dysfunction and/or subacromial impingement. This study evaluates the outcomes and complications of combined suture anchor and screw fixation technique for the treatment of GTFs.

Materials and methods

This retrospective case series included 13 patients with displaced GTFs (> 5 mm) who underwent screw and double-row suture bridge fixation from 2019 to 2024 at a single institution. Patient demographics, injury mechanisms, fracture characteristics, associated injuries, and operative data were collected. All fractures were fixed using screw and double row suture bridge fixation via a lateral deltoid split approach. Postoperative outcomes included range of motion, Patient-Reported Outcome Measurement Information System (PROMIS) scores, American Shoulder and Elbow Surgeons (ASES), Visual Analogue Scale (VAS), radiographic outcomes, and postoperative complications.

Results

Thirteen patients (13 shoulders; 9 males, 4 females) with a mean age of 53.2 (29–73) years were followed for an average of 11.7 (6–27) months. The most common mechanism of injury was a traumatic fall (9/13). The mean postoperative PROMIS Upper Extremity score was 42.7 ± 8.9, and the mean ASES score was 79.3 ± 13.8. Latest postoperative radiographs showed evidence of healed fractures in 12 out of 13 patients (92%) with no further fracture displacement. Two patients (15%) required reoperation: one for screw migration/loosening and one for late infection with greater tuberosity resorption and screw displacement.

Conclusion

Treatment of displaced GT fractures with combined screw fixation and double row suture bridge technique results in predictable fracture healing and favorable functional outcomes. Limitations include the retrospective case series design, small cohort size, and absence of a control group.

Level of evidence

IV, case series.

Supracondylar humerus fractures in children are common elbow injuries. This finite element analysis (FEA) study investigates the biomechanical properties of five Kirschner pin fixation techniques for pediatric extension-type fractures, with a focus on proposing a novel posterolateral double-pin caudal fixation method (Group E).

A three-dimensional finite element model was developed based on CT scans of a 5-year-old child’s humerus to simulate extension-type fractures. Five fixation configurations were compared: Group A: Mediolateral cross-pinning (3 pins); Group B: Cross-pinning (2 pins); Group C: Lateral fan-pinning (3 pins); Group D: Lateral fan-pinning (2 pins); Group E: Novel technique with two lateral pins connected extracorporeally (2 pins) Biomechanical testing includes tensile (30 N·mm), torsion (135 N·mm), and inversion (100 N·mm) load testing for all groups.

Optimal stability: Group A (tensile: 167.15 MPa, torsion: 153.96 MPa, inversion: 146.98 MPa).Novel Group E performance: Tensile: 174.02 MPa (vs. 176.98 MPa in Group D), Torsion: 162.99 MPa (vs. 236.8 MPa in Group D), Inversion: 169.19 MPa (vs. 151.11 MPa in Group D), Group E significantly outperformed Group D and approached the stability of Groups B/C.

The novel extracorporeal-connected double-pin fixation (Group E) provides comparable biomechanical stability to conventional three-pin techniques while eliminating medial pinning-related ulnar nerve injury risks. It represents a viable optimized option for clinical practice.

IV (Computational biomechanical study).

Introduction

To evaluate changes in sexual function and return to sexual activity following total hip arthroplasty (THA), comparing patients who underwent emergency THA for femoral neck fractures with those who underwent elective THA for osteoarthritis, and to identify clinical and demographic predictors of postoperative sexual outcomes.

Methods

This retrospective study included 68 THA patients (37 Emergency THA after Fracture, 31 Elective THA for Osteoarthritis; 54.4% male and 45.6% female). Data included age, sex, BMI, pain during sex, time to resume sex, and postoperative UCLA (University of California–Los Angeles) and FJS-12 (Forgotten Joint Score) scores. Analyses involved t-tests, Chi-square, regression models, and Spearman correlation.

Results

Time to sexual activity resumption did not differ significantly between groups. However, the nature of change varied: patients undergoing elective THA for osteoarthritis more often reported improvement or no change, while patients undergoing emergency THA for femoral neck fractures more commonly reported reduced or ceased activity (p = 0.001). Female sex, older age, and higher BMI were associated with delayed sexual resumption (p < 0.01). Patients who experienced hip pain interfering with sexual activity before surgery were significantly less likely to report improvements in sexual quality after total hip arthroplasty. Although FJS-12 and UCLA scores were strongly correlated (r = 0.869, p < 0.01), they did not independently predict resumption. The multinomial logistic model explained 59.2% of the variance (Nagelkerke R² = 0.592).

Conclusions

Post-THA sexual outcomes are influenced by more than physical function. Preoperative pain, age, sex, and psychological readiness are key factors. Comprehensive counseling, especially for patients undergoing emergency THA for femoral neck fractures and for women, should address sexual health expectations during recovery.

Level of evidence

Level III, retrospective cohort study.

Mechanical metatarsalgia (MM) is a condition marked by forefoot overload, causing pain and functional limitations. While conservative treatments like insoles are often effective, surgery is considered when these fail. Traditional approaches focus on the midfoot or forefoot; however, gastrocnemius release (GR) has emerged as an alternative due to the link between equinus contractures and forefoot overload. This systematic review examines the role of GR in MM treatment, analyzing five studies that met the inclusion criteria. These studies evaluated outcomes following either minimally invasive proximal gastrocnemius release or ultrasound-guided needle-based lengthening. Results showed significant pain reduction, improved American Orthopedic Foot and Ankle Society (AOFAS) scores, and greater ankle dorsiflexion. Patient satisfaction was also high. Despite encouraging outcomes, limitations such as small sample sizes, short follow-ups, and methodological differences highlight the need for further research. Nevertheless, GR appears to be a promising option for MM, particularly in cases of isolated gastrocnemius contracture.