Archives of Orthopaedic and Trauma Surgery最新文献

Research background and purpose

Unicompartmental knee arthroplasty (UKA) is well-established for mild varus deformity, but its application in moderate to severe varus cases remains technically challenging. This study aims to preliminarily evaluate whether adopting the traditional medial parapatellar approach in UKA procedures for these complex deformities can yield acceptable early outcomes.

Methods

A retrospective study was conducted. Between January 2023 and March 2024, 9 patients with moderate to severe varus deformity underwent medial UKA using a cemented fixed-bearing Link prosthesis by medial parapatellar approach. The cohort included 1 male and 8 females with a mean age of 65.3 years and mean weight of 60.6 kg. All procedures were performed by a single surgeon. Preoperative and final follow-up assessments included bilateral full-length standing radiographs for hip-knee-ankle angle (HKA), The Angle between the femoral mechanical axis and the tibial mechanical axis (hip-knee-ankle angle, HKA) was measured by software and recorded. The hip-knee-ankle (HKA) angle was reported directly as the angle between the femoral and tibial mechanical axes. The normal alignment range was defined as 178°–182°, with values below 178° indicating varus deformity and those above 182° indicating valgus deformity. Knee range of motion (ROM), Hospital for Special Surgery (HSS) score, and Knee Society Score (KSS). Statistical analysis was performed using SPSS 26.0, with P < 0.05 considered statistically significant.

Results

The follow-up of 15.20 ± 1.95 months, all patients demonstrated primary wound healing without perioperative complications. Significant improvements were observed in all measured parameters: HSS score improved from 50.11 ± 3.41 to 92.11 ± 2.37 95% CI: (40.12, 43.88); KSS score from 59.89 ± 3.55 to 88.78 ± 2.49 95% CI: (27.65, 30.13); KSS function score from 44.44 ± 6.82 to 76.67 ± 7.07 95% CI: (28.33,36.12); ROM from 94.22 ± 1.92° to 122.67 ± 2.83° 95% CI: (26.60, 30.29); and HKA from 164.58 ± 4.16° to 176.64 ± 2.20°95% CI: (10.16, 13.98). All improvements were statistically significant (P < 0.001). No cases of aseptic loosening, unexplained pain, or polyethylene liner dislocation were observed during follow-up.

Conclusion

This preliminary experience suggests medial parapatellar approach for UKA in moderate to severe varus deformity may represent a technical option for carefully selected cases. However, these observations are limited by the small sample size and relatively short follow-up. Further validation through larger-scale studies with extended follow-up is warranted to establish long-term efficacy and safety.

Introduction

Minimally invasive plate osteosynthesis (MIPO) has become an established method for treating humeral shaft fractures; however, achieving accurate intraoperative rotational alignment remains challenging. This study describes an intraoperative evaluation technique using combined fluoroscopic and endoscopic assistance to improve the precision and objectivity of rotational correction during MIPO.

Materials and methods

From September 2019 to June 2023, twenty adult patients with simple transverse or wedge-type midshaft humeral fractures (AO/OTA type A or B) who underwent MIPO fixation were retrospectively reviewed. Demographic data, operative time, intraoperative fluoroscopy time, and postoperative outcomes were analyzed. Rotational difference (RD) between the operated and contralateral arms was measured using computed tomography (CT). Continuous variables between AO type A and B fractures were compared using the Mann–Whitney U test (p < 0.05).

Results

The mean operative time was 113.5 min, and the mean fluoroscopy time was 75.9 s, which was significantly longer in AO type B fractures (p < 0.05). The average RD was 7.4° ± 4.7° (range, 1.9˚–17.5°). All fractures achieved union, with 18 cases healing within 3–6 months and 2 cases within 9–12 months. Mean angulation was 2.1° (coronal) and 2.0° (sagittal), and mean translation was 1.1 mm (coronal) and 1.3 mm (sagittal). No iatrogenic neurovascular injuries or infections were observed. There were no significant differences between AO type A and type B fractures in union rate or alignment parameters.

Conclusions

Combined fluoroscopic–endoscopic assistance enables objective intraoperative evaluation of humeral rotational alignment during MIPO without compromising soft-tissue preservation. This technique provides reliable reduction quality and consistent healing outcomes in AO type A and B humeral shaft fractures, representing a practical refinement of standard MIPO principles.

Introduction

: With increasing reliance on computed tomography (CT) in trauma care, the use of anteroposterior (AP) pelvis radiographs has declined. This study examined whether omitting an initial AP pelvis film affected time to hip reduction and the need for additional CT imaging in patients with traumatic hip dislocations.

Methods

We conducted a retrospective review at a Level I trauma center (2005–2016). Eligible patients were adults (> 17 years) with native hip dislocations evaluated under the Advanced Trauma Life Support (ATLS) protocol. Patients with incomplete records or irreducible hips requiring operative reduction were excluded. Data collected included patient demographics, AP pelvis use, CT imaging, time to reduction, and presence of acetabular or proximal femur fractures.

Results

The study cohort consisted of 50 patients, 76% male (n = 38), with a mean age of 33 years (range, 18–68). High-energy motor vehicle accident or motorcycle crash accounted for 90% (n = 45) of injuries, and 94% (n = 47) were posterior dislocations. Associated fractures were present in 76% (n = 38). Patients were divided into those who had no AP pelvis radiograph prior to CT scan (N-APP group, n = 8; 16%) and those who obtained an initial AP pelvis radiograph on presentation (APP group, n = 42; 84%). All patients in the N-APP group received an additional CT pelvis scan, while none in the APP group did. Average time to reduction was significantly shorter in the APP group compared with the N-APP group (69 vs. 216 min, p < 0.05).

Conclusions

Obtaining an initial AP pelvis radiograph provided a rapid and reliable means of diagnosing hip dislocations. Adherence to ATLS guidelines by performing a pelvic film before CT shortened time to reduction and prevented unnecessary repeat CT imaging in adult patients with traumatic native hip dislocations.

Purpose

To compare re-rupture rates and clinical outcomes between bone–patellar tendon–bone (BTB) and hamstring tendon (HT) grafts in anterior cruciate ligament (ACL) reconstruction according to patient risk levels.

Methods

This retrospective cohort study included patients who underwent primary ACL reconstruction at a single institution between 2018 and 2022, with outcomes assessed at a fixed 2-year postoperative follow-up. The primary endpoint was graft re-rupture, defined as a traumatic graft failure confirmed clinically and by magnetic resonance imaging, and the secondary endpoint was the Knee injury and Osteoarthritis Outcome Score (KOOS). High-risk status was defined as the presence of all three risk factors: age ≤ 20 years, posterior tibial slope. (PTS) ≥ 12°, and participation in pivoting sports. For patients with two or fewer risk factors, propensity score matching was performed using age, sex, body weight, generalized joint laxity, knee hyperextension, participation in pivoting sports, and PTS as covariates to compare outcomes between BTB and HT grafts.

Results

In the high-risk group, the BTB graft showed a significantly lower re-rupture rate compared to the HT graft (12.9% vs. 35.7%, p = 0.03), with no significant difference in KOOS overall score (96.3 ± 3.7 vs. 96.6 ± 6.3, p = 0.85). In the lower-risk group after matching, the BTB graft showed a similar re-rupture rate compared to the HT graft (6.9% vs. 5.2%, p = 0.99), with no significant difference in KOOS overall score (92.6 ± 6.9 vs. 94.8 ± 5.7, p = 0.10).

Conclusion

BTB grafts reduced re-rupture rates compared to HT grafts in high-risk ACL reconstruction patients, while clinical outcomes were similar. In lower-risk patients, no significant differences were observed between graft types in either re-rupture rates or KOOS overall score.

Level of evidence

Level III.

Purpose

Controversy still remains regarding the necessity of primary retropatellar resurfacing (RPR) in total knee arthroplasty (TKA). While some studies suggest retropatellar resurfacing reduces anterior knee pain (AKP) and revision rates, others report no significant differences compared to non-resurfaced TKA. This study aims to evaluate postoperative complications, pain levels, and functional outcomes in patients undergoing TKA with and without RPR.

Methods

A retrospective, single-center observational study was conducted including 121 patients who underwent primary TKA. Fifty-five patients (45.5%) had RPR, while 66 patients (54.5%) retained their native patella. Clinical outcomes were assessed using the knee society score (KSS), while radiological parameters such as femoral and patellar offset were analyzed. Statistical comparisons were performed using independent t-tests and chi-square tests, with significance set at p < 0.05.

Results

Radiological analysis revealed a significant reduction in femoral offset postoperatively (p < 0.001), with greater changes observed in the non-RPR group (p = 0.009). Patellar offset was also significantly reduced in non-RPR patients compared to RPR patients (p < 0.001). The revision rate was higher in the RPR group (10 cases) compared to the non-RPR group (1 case). Functional assessment using the KSS showed no significant differences in knee pain (p = 0.418) or knee scores (p = 0.461) between groups. However, patients in the RPR group were more likely to require walking aids postoperatively (p = 0.012).

Conclusions

RPR in primary TKA did not result in superior pain relief or functional outcomes compared to non-resurfacing but was associated with a higher revision rate and increased postoperative use of walking aids. These findings suggest that the decision to resurface should be individualized based on clinical and anatomical considerations.

Level of evidence

Level III (Retrospective Cohort).