Archives of Orthopaedic and Trauma Surgery最新文献

The lunate bone plays a central role in force transmission, proximal carpal row integrity, and kinematics of the wrist. In cases of irreparable pathologies to the lunate bone, prosthetic replacement is appealing to avoid salvage procedures. Previous attempts at lunate replacement yielded inconsistent results due to non-anatomical implant design and lack of ligament reconstruction, which posed a risk of dislocation and carpal collapse. Nowadays, the CAD design process and 3D printing of bio-compatible materials such as titanium make it possible to manufacture patient-specific lunate implants. We present a technique and first clinical results of a patient-specific lunate replacement that includes reconstruction of the most important perilunate ligaments to suspend the implant and restore carpal integrity.

Introduction

Hop distance tests are commonly used to determine when it is safe to return to sports (RTS), but symmetrical test results do not necessarily indicate the absence of biomechanical deficiencies. Three-dimensional motion analysis may quantify ongoing lower extremity instability following anterior cruciate ligament reconstruction (ACLR).

Materials and methods

We estimated the instantaneous knee rotation axis during the landing phase of the triple hop test. The angular deviation in the orientation of the knee rotation axis between two successive instants was computed and used as a variability measure at the knee joint rotation in three dimensions.

Results

Knee flexion was less, the duration of the landing interval was shorter, and the variation at the knee rotation axis orientation over landing duration was higher on the operated side. We then classified the participants into two groups due to the threshold (above versus below 90%) defined at the Range of Motion-Limb Symmetry Index. Significantly shorter landing intervals and higher variation at the knee rotation axis orientation over the landing period at the operated side persisted in the below-threshold group only.

Conclusion

We suggest an assessment of the variation in the orientation of the knee rotation axis over the hop test landing duration, which has the potential to be utilized for decisions in RTS at ACLR.

Background

Chronic quadriceps tendon ruptures (CQTR) result in tendon retraction, fibrosis and tissue loss, often precluding direct repair. Traditional transosseous techniques require large length grafts and full-thickness patellar tunnels, increasing the risk of fractures.

Objective

To present and evaluate a new surgical technique for reconstruction of CQTRs using an ipsilateral semitendinosus (ST) autograft fixed through a proximal patellar socket and Endobutton^® fixation, thus minimizing graft wastage and fracture risk.

Methods

With the knee flexed at 90° and a thigh tourniquet, the ipsilateral ST is harvested through a medial incision, reinforced with FiberWire^®-2 sutures, doubled and measured diametrically. A midline anterior approach exposed the chronic tendon defect, which must be debrided to the healthy margins. Three cavities are created in the proximal patella with an incannulated drill, each 5 mm laterally and medially and 7–8 mm centrally, only in the proximal part, to accommodate the thickness of the graft. The rest of the quadriceps is reinforced with FiberWire^®-5 Krakow sutures. Using transport sutures, the prepared ST graft is inserted into the tendon via a Pulvertaft weft, inserted into the central cavity, stretched and secured over the distal patellar cortex with an Endobutton^®. Krakow sutures for the native tendon and a FiberTape^® loop around the loop of the graft are passed through the respective tunnels and tied over the anterior patella. Intraoperative flexion confirms the stability of the construct; fluoroscopy verifies the height of the patella and the position of the Endobutton^®.

Conclusions

This proximal socket technique minimises the use of grafts and patellar stress, reliably restoring extensor mechanism function in CQTRs, offering a safe alternative to full transosseous tunnel methods.

Introduction

The decision to retain or remove blade plate implants after proximal femoral osteotomy (PFO) in paediatric patients remains contentious. While retention provides ongoing support, it increases stress shielding, potentially hindering bone remodelling and causing long-term complications. Conversely, early removal may restore normal mechanical loading and promote bone recovery. This study compares the effects of blade plate retention versus removal on bone density changes and implant risk of yield (RoY) over 36 months in a paediatric femur.

Materials and methods

A personalised neuromusculoskeletal modelling and finite element analysis framework was developed using computed tomography scans and gait data. Using a strain energy-based remodelling analysis, the framework assessed changes in bone density and RoY for two clinical participants, comparing intact femurs with those retaining the implant for three years or having it removed after one year.

Results

In both participants, implant retention diminished proximal femur remodelling. In P1, the average proximal bone density with implant increased by 0.11 g/cm³ over 36 months, compared to 0.38 g/cm³ in the intact model. In P2, the intact model’s average proximal density increased by 0.27 g/cm³ versus 0.11 g/cm³ with the implant. Implant removal after 12 months reactivated remodelling, yielding final density changes of 0.14 g/cm³ (P1) and 0.21 g/cm³ (P2). The RoY decreased over time, stabilising at 71–75% for blade plates and 56–62% for screws.

Discussion

These findings highlight the detrimental effects of prolonged retention due to stress shielding. Recovery in bone density after removal suggests that early removal may mitigate adverse effects and promote healthier bone adaptation, informing clinical decisions in paediatric PFO.

Background and objectives

Owing to a lack of evidence, the appropriate surgical treatment strategy for geriatric patients with Vancouver type B2 or B3 periprosthetic femoral fractures (PFFs) remains unclear. Data from a large international geriatric trauma registry were analyzed to investigate the medical care situation of such patients, as well as to examine the outcomes related to revision arthroplasty (RA) or open reduction and internal fixation (ORIF).

Materials and methods

Datasets from the Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie [DGU]) (ATR-DGU) were analyzed. The ATR-DGU is a prospective, multicenter registry that provides information on geriatric trauma patients. All patients who underwent surgery for PFF were included in this analysis. The outcome parameters included the mortality rate during hospitalization and at the 120-day follow-up, as well as mobility, the EQ-5D-5 L score and the reoperation rate, and were analyzed in relation to RA versus ORIF in Vancouver type B2 or B3 PFF patients.

Results

A total of 607 patients with Vancouver type B2 or B3 PFF met the inclusion criteria. Among these patients, 420 underwent RA, and ORIF was performed in 187 patients. Regression analysis of the parameters collected during the acute phase revealed that after 2:1 matching, compared with the RA group, the ORIF group had significantly lower odds for full weight bearing allowed one day after surgery (OR: 0.49; p < 0.001); walking ability after seven days (OR: 0.56; p = 0.005); and the occurrence of nonsurgical complications (OR: 0.59; p = 0.012). The probability of death during follow-up and the EQ-5D-5 L score after seven and 120 days remained unaffected.

Conclusions

The results of the present study support the estimate that ORIF represents a valid treatment alternative for Vancouver type B2 and B3 PFFs, as comparable midterm outcomes were demonstrated for each patient group. However, individualized decisions should always be made, especially for multimorbid geriatric patients, to reduce complications.

Purpose

To describe coronal plane alignment patterns and Coronal Plane Alignment of the Knee (CPAK) type distribution in an Austrian population, and to evaluate associations with sex, age, and body mass index (BMI).

Methods

In this retrospective study, 400 knees with complete demographic and radiographic data from standardized long-leg standing radiographs were analyzed. Mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), arithmetic hip–knee–ankle angle (aHKA), and joint line obliquity (JLO) were measured, and CPAK types were assigned. Statistical analysis included Shapiro–Wilk tests, Welch’s t-test, Chi-square, Fisher’s exact, binary logistic regression, linear regression, and multinomial logistic regression, with significance set at p < 0.05.

Results

The cohort comprised 266 females (68%) and 134 males (32%), with a mean age of 68.3 years and mean BMI of 30.4 kg/m². Mean aHKA was − 0.03°, with males showing greater varus alignment than females (− 1.40° vs. +0.67°, p = 0.00011). The most frequent CPAK types were I and II (each 21.8%), followed by VI (15.5%), III (15.3%), V (12.5%), and IV (11.3%). CPAK distribution differed by sex (p = 0.023) but not by age group. Male sex increased the odds of varus alignment (OR ≈ 2.27, p < 0.001) and reduced the odds of valgus alignment (OR ≈ 0.40, p < 0.001). BMI was associated with varus alignment in males (p = 0.033) but not in females.

Conclusion

In this Austrian cohort, males exhibited greater varus alignment and a distinct CPAK distribution compared to females, while age showed no effect on alignment patterns. BMI predicted varus alignment only in males. These findings provide valuable region-specific CPAK reference data for Austria, supporting individualized alignment strategies in total knee arthroplasty.

Objectives

Although there are different ways, the choice of treatment for grade-I–II anterior talofibular ligament (ATFL) injuries caused by acute ankle sprain is still controversial. The primary purpose of our study was to compare the efficacies of modified Broström-Gould surgery and conservative treatment in grade-I–II ATFL injuries caused by acute ankle sprain. The secondary goal was to assess the plantar pressure characteristics of ankle sprain.

Methods

Between Sep 2022 and December 2023, 63 patients diagnosed with acute ankle sprain (ATFL grade I-II injuries) were prospectively included in the arthroscopic modified Broström-Gould surgery group (n = 33) and conservative treatment group (n = 30). The main outcomes were the ankle functional rating scale, plantar pressure and gait parameters at preoperative, and 1, 3, 6, 12, 24months postoperative. One-way repeated measures analysis of variance ( ANOVA ) and Mann-Whitney U test were used to analyze the differences at different time points after treatment.

Results

There were significant differences in gait parameters between the surgical and conservative groups at one and three months post-treatment. Additionally, the American Orthopaedic Foot and Ankle Society (AOFAS) score, Maryland Foot Score, and Visual Analogue Scale (VAS) scores were significantly different between the surgical and conservative groups after 24 months of treatment (P < 0.001). Furthermore, at 24 months post-treatment, there were significant differences between the injured and normal groups in terms of foot contact area, foot load ratio, single and double support phases, and center of gravity shift (P < 0.001).

Conclusion

Surgical and conservative treatments may not fully restore ankle stability and gait in patients, yet the modified Broström-Gould procedure holds the potential to restore ankle function three months sooner.

Introduction

While the number of absolute and relative contraindications to total joint arthroplasty (TJA) has gradually decreased, active cancer patients have traditionally been challenging surgical candidates. We sought to compare perioperative and two-year postoperative clinical outcomes of patients with and without active cancer.

Methods

Patients over 18 years with active cancer undergoing primary, unilateral TJA from 2017 to 2023 at a single urban academic center were reviewed for a minimum two-year follow-up. Cancer status, type, and stage were confirmed manually. 68 cancer patients were propensity-matched 3:1 to 204 non-cancer patients from a pool of 9,382 based on age, sex, BMI, smoking status, race, and ASA class. Demographic, perioperative, and clinical data were analyzed using t-tests, Chi-square, and ANOVA. Subgroup analyses compared cancer patients receiving active therapy versus those not on treatment.

Results

There were no significant demographic differences between groups, except Charlson Comorbidity Index (P < 0.001). The most common cancers were breast (22%) and prostate (20%). There were no differences in discharge disposition (P = 0.20), operative time (P = 0.87), or length of stay (P = 0.29). The all-cause revision rate (including infection) was higher in patients with active cancer (7.4% vs. 2.5%), though not statistically significant (P = 0.15; Power = 46.5%). Of the various causes for revision, infection was significantly more likely in cancer patients than other causes compared (4.4% vs. 0%, P = 0.003). When analyzing only the active cancer group, those receiving cancer therapy had higher revision rates, though this was not statistically significant (11.1% vs. 6.0%, P = 0.487).

Discussion/conclusion

Despite often being excluded from arthroplasty studies, active cancer patients demonstrated comparable overall outcomes after primary TJA. Although infection-related revisions were more common, they were effectively treated. With proper preoperative optimization and multidisciplinary care, TJA can be safely performed in selected active cancer patients.

Objective

To compare soft and hard outcome measures after minimally invasive (MIS) and open (OS) surgical treatment of lesser toe deformities. It was hypothesised that MIS would be associated with fewer complications and comparable subjective and objective results.

Methods

A prospective randomised controlled study was designed. One hundred patients were included consecutively and allotted via block randomisation to two groups. The presence of co-pathologies at the forefoot and midfoot, which were treated simultaneously, was not an exclusion criterion. However, these cases were analysed to ensure an equal distribution across the study groups. Patients were evaluated clinically, functionally, and radiologically prior to surgery and at a 1.5-year follow-up. Additionally, they were asked about their personal satisfaction via patient-reported outcome measures.

Results

The distribution of co-pathologies at the foot was not significantly different between the two study groups. The same is true of co-morbidities. Significantly more wound complications, including infections, were found in the open surgery group (p = 0.029). K-wire issues were distributed equally between the groups, but differed in their clinical manifestation (p = 0.03). Only seven out of the 95 patients finally examined were dissatisfied with their long-term results, with an equal distribution between both groups (four MIS vs. three OS, p = 0.914). Clinical and radiological corrections of the lesser toes were comparable in both groups, but the open surgery (OS) group showed significantly more non-unions (p = 0.0013). Functional evaluation via the FFI-D (Foot Function Index Germany), a reliable, validated, internationally used, standardised questionnaire to assess the correlation between foot deformity and function, demonstrated relevant postoperative improvement in all patients, with no difference between the two technical approaches (p = 0.460).

Conclusion

Lesser toe surgery is a low-risk treatment with good overall results. MIS offers equivalent clinical outcomes to OS with a lower risk of complications in terms of soft tissue and bone healing.

Level of evidence

Level 1 Prospective randomised controlled study. TRN DKRS00034137 25/04/2024.