Acta orthopaedica et traumatologica turcica最新文献

Objective: This study aimed to compare the effects of a medial buttress plate (MBP) or a trochanteric lag screw (TLS) to augment cannulated screws (CSs) in fixing Pauwels type III femoral neck fractures.

Methods: This retrospective study included 58 patients (21 female, 37 male; mean age=46 years; age=19-64 years) treated by CSs for Pauwels type III femoral neck fractures from 2014 to 2017. All the patients were divided into 2 groups based on the internal fixation patterns: the MBP-augmented group (group A, n=26) and the TLS group (group B, n=32). The mean age was 47 (range=24-57) years in group A and 45 (range=19-64) years in group B. The operation time, intraoperative blood loss, reduction quality, Harris score, and postoperative complications were recorded and compared between both groups.

Results: All patients were followed up for an average of 44.8 months in group A and 47.3 months in group B (P=.406). No significant difference was noted in reduction quality (P=1.000). However, group A had a longer operation time (100.2 vs. 64.3 minutes, P < .001) and greater intraoperative blood loss (153.1 vs. 30.0 mL, P < .001) than group B. At the final follow-up, the union rate was equal between group A (96.2%) and group B (90.6%) (P=.760). The mean bone union time was 21.6 weeks in group A and 23.6 weeks in group B (P=.431). The delayed union rate was lower in group A (0%) than in group B (15.6%) (P < .001). The incidence of postoperative complications in terms of implant failure (7.7% vs. 28.1%, P=.048) and femoral neck shortening (7.7% vs. 28.1%, P=.048) were lower in group A than in group B. No significant difference was noted in avascular femoral head necrosis (P=1.000) and the Harris score (P=.659) between the 2 groups.

Conclusion: In the surgical treatment of Pauwels type III femoral neck fractures, medial buttress plating can offer fewer complications but equal avascular femoral head necrosis rate and functional outcome compared to trochanteric screw application.

Level of evidence: Level III, Therapeutic study.

Objective: The optimal glycemic control marker before total hip or knee arthroplasty remains inconclusive. Hemoglobin A1c (HbA1c) is widely used, while fructosamine may be valuable for predicting periprosthetic joint infection (PJI). Fructosamine levels can be affected by serum albumin levels; albumin-corrected fructosamine (AlbF) can be calculated to overcome this issue. The objective of this study was to evaluate the predictive value of different markers for complications after primary total hip or knee arthroplasty.

Methods: This prospective cohort study included 304 patients (mean age: 65 years [range, 16-85), mean follow-up: 32 months (range, 12-49)] who underwent primary total hip or knee arthroplasty between 2018 and 2021. Of them, 156 patients had diabetes. Mean HbA1c was 6.5% (range, 4.8%-13%), fructosamine 244 µmol/L (range, 98-566 µmol/L), and AlbF 632 (range, 238-2308). Patients who did and did not have diabetes were matched 1 : 1. Hemoglobin A1c 7% and fructosamine 292 µmol/L were used as cutoff. Complications were documented. Glycemic markers were compared using logistic regression analyses, with a special focus on PJI.

Results: In the logistic regression analyses, HbA1c was strongly associated with total complications [adjusted odds ratio (OR): 3.61; 95% CI, 1.65-7.91, P = .001], while fructosamine was associated with PJI (adjusted OR: 13.68; 95% CI, 1.39-134.89, P = .025). Albumin-corrected fructosamine did not show any additional benefits.

Conclusion: Preoperative assessment before total hip or knee arthroplasty must not focus on a single marker; HbA1c is a good predictor of total complications, while fructosamine is a better predictor of PJI. To the best of our knowledge, in its first orthopedic study, AlbF did not show any advantages.

Level of evidence: Level II, Prognostic Study.

Venous thromboembolism (VTE) is a severe complication that can occur after major orthopedic procedures. As VTE-related morbidity and mortality are a significant concern for both medical professionals and patients, and preventative measures are typically employed. Multiple organizations, including the American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS), have developed guidelines for VTE prophylaxis specifically in patients undergoing joint replacement procedures. However, recently, the International Consensus Meeting (ICM) was convened, which brought together over 600 experts from 68 countries and 135 international societies. These experts, spanning a range of medical disciplines including orthopedic surgery, anesthesia, cardiology, hematology, vascular, and internal medicine, conducted a comprehensive review of the literature using a strict Delphi process to generate practical recommendations for VTE prophylaxis across all types of orthopedic procedures. This review article summarizes some of the recommendations of the ICM.

Objective: The purpose of this study was to examine the effect of prophylactic tadalafil use on a steroid-induced femoral head avascular necrosis model in terms of microscopic, imaging, and molecular biological changes.

Methods: Twenty-four New Zealand rabbits were divided into 3 equal groups. Eight rabbits were designated as the control group and did not receive treatment. Rabbits in group 1 (G1) received 0.1 mg/kg Escherichia coli lipopolysaccharide (LPS) intravenously and 40 mg/ kg methylprednisolone sodium succinate (MP) was administered intramuscularly for 3 days consecutively. Rabbits in group 2 (G2) were given 5 mg/kg tadalafil orally for 10 consecutive days. Starting on the eighth day, 0.1 mg/kg LPS was given, and following this 40 mg/kg MP injections were administered for 3 days. All animals were sacrificed 3 weeks after the final MP injection. Magnetic resonance imaging was performed, and bilateral femora were harvested. Half of the femoral head was stored for Vascular Endothelial Growth Factor (VEGF) examination with Western blot analysis. The other half was examined microscopically for the presence of osteonecrosis.

Results: In G1, 15 out of 16 hips (93%) of the 8 rabbits had osteonecrosis compared to 8 out of 12 hips (67%) of 6 rabbits in G2 (P > .05). The VEGF expression in G2 was significantly higher than in the control group and G1 (P < .05 and P < .001, respectively). There was no significant difference in VEGF expression between the control group and G1 (P > .05).

Conclusion: This study has shown us that femoral head osteonecrosis can be reliably induced with LPS and corticosteroid, as described in the literature. Prophylactic tadalafil use did not decrease the occurrence of osteonecrosis significantly. However, it significantly increased VEGF expression in the femoral head independent of the effects of steroids and LPS.

Objective: This study aimed to investigate the role of an exogenous Epidermal Growth Factor and a hyaluronic acid-based scaffold on fracture healing in a rat femoral fracture model Methods: Forty-eight male Wistar-Albino rats, each weighing a mean 392 grams (range= 350-450 grams) and aged 8.2 months (6-9 months), were used for this experimental study. All surgical procedures were performed on the left femur by a single surgeon. An open femoral fracture was created in all rats. The animals were randomly divided into one of the four groups: Control (12), EGF (12), HA (12) and Combined (12). In the 4th and sixth weeks, samples were processed and analyzed using biomechanical and histological methods.

Results: Fracture healing was significantly improved in the Combined group compared to the control one, EGF and HA groups in all parameters at both experimental time points. At the fourth and sixth weeks after surgery, fracture healing in the EGF and HA groups was significantly increased at histological evaluation compared to controls. In addition, compared with EGF, HA and Control groups, a significant difference in callus tissue was detected in the Combined group at 4 and 6-week time points in biomechanical features.

Conclusion: This study has shown that combining local EGF and HA scaffold accelerates bone healing and strengthens the bony callus histologically and biomechanically. Using EGF-HA combined scaffolds may represent a possible future strategy in trauma surgery.

Level of evidence: N/A.

Objective: To compare the use of cannulated screws in an inverted triangular configuration, medial buttress plates, and the combination of these 2 fixation methods in the treatment of Pauwels type 3 femoral neck fractures.

Methods: Twenty-eight anatomical composite third-generation femoral bone models were divided into 4 groups. The control group (group 1) was formed with 7 third-generation intact bone models. The fracture model was created with a 70° cutting block to fit 21 Pauwels type 3 fracture configurations. Seven models were fixed with an isolated 3.5 mm one-third semi-tubular medial buttress plate (group 2), 7 were fixed in an inverted triangular configuration with 6.5 mm cannulated screws (group 3), and 7 were fixed using a combination of 6.5 mm cannulated screws and a medial buttress plate (group 4). Cyclic loading was applied using axial forces ranging from 60 N to 600 N and moments ranging from 0.7 Nm to 7.0 Nm for 500 cycles. Once the cyclic loading stage was completed, the loads were removed from the system, and the quasi-static loading stage was employed to determine the stiffness and failure forces of the system under both axial and torsional forces. Quasi-static tests were performed with an axial speed of 1.8 mm/min and a torsional speed of 4.5°/min. The biomechanical properties of all groups were examined in terms of axial stiffness, torsional stiffness, and maximum axial force parameters.

Results: The stiffness values of groups 1, 2, 3, and 4 were 303 ± 35.8 N/mm, 159.6 ± 25 N/mm, 232 ± 35.9 N/mm, and 366.9 ± 58 N/mm, respectively, under axial forces (P < .01); 2172.7 ± 252.1 Nmm/°, 1225.3 ± 238.6 Nmm/°, 2123 ± 359.4 Nmm/°, and 2721.85 ± 304 Nmm/°, respectively, under torsional moments (P < .01); and 2072.1 ± 256.1 N, 1379.9 ± 290.6 N, 2099.1 ± 454.2 N, and 2648.4 ± 364.6 N, respectively, under the maximum force (P < .01).

Conclusion: This study showed that in the fixation of Pauwels type 3 fractures formed on third-generation bone models, the utilization of half-thread cannulated screws in an inverted triangle configuration, along with a medial buttress plate, provided stronger fixation compared to the remaining implant groups and the control group. According to the evaluation of the parameters, the isolated application of a medial buttress plate had poorer biomechanical properties than other fixation methods.

Objective: This study aimed to determine whether a standard anesthetic protocol consisting of combined spinal epidural anesthesia (CSEA) in conjunction with controlled hypotensive anesthesia (CHA), which was used for conventional total knee arthroplasty (cTKA), could provide equally effective anesthetic conditions for robotic total knee arthroplasty (rTKA).

Methods: Data were collected from the medical records of 113 patients (median age=67 years; age range=55-84) who underwent elective unilateral cTKA (n=52) or rTKA (n=61) without a tourniquet from 2021 to 2023. The primary outcome measure was the rate of patients whose anesthetic method did not provide adequate motor and sensory block during the surgery and had to be converted to general anesthesia. The secondary outcome measure was to compare perioperative variables, including pain scores, analgesic consumption, blood loss, transfusions, and complications.

Results: In 6 patients (11.5%) in group rTKA, it was required to convert CSEA to general anesthesia at 160-180 minutes due to the pain at the operative knee and/or to the movement of the operative leg during surgery compared to none / zero in group cTKA (P=.008). Motor and sensory blocks terminated earlier than the total surgery time in those patients. Mean total surgery time was significantly higher in group rTKA than in group cTKA (151.25 ± 24.51 (120-240) minutes vs. 116.72 ± 4.99 (105-125) minutes, P < .001). Total surgery times tended to decrease gradually in group rTKA after the 11th case, indicating a learning curve for surgical performance. Conversion to general anesthesia was required only in 1 patient after the 11th case compared to the previous 5 patients. Mean pain scores and rescue analgesic consumption were higher in group rTKA at postoperative 0 hour and between 0 and 4 hours (P < .05) but similar at the following time points (P > .05). Blood loss, transfusion, and complication rates were similar (P > .05). Hospital discharge times were higher in group rTKA (P < .05).

Conclusion: Although our standard CSEA protocol failed due to the regression of motor and sensory block during surgery in 11.5% of patients in rTKA, the CSEA technique combined with controlled hypotensive anesthesia provided similar anesthetic conditions in the remaining patients in group rTKA as in group cTKA. The CSEA may be considered an effective and safe anesthetic method for rTKA if interventions are applied to extend the duration of the CSEA for this novel surgical technique.

Level of evidence: Level III, Therapeutic Study.

Objective: The aim of this study was to assess the effects of tranexamic acid on fracture healing in the rat tibia closed fracture model.

Methods: Sixty-four male Sprague-Dawley rats were included in this study, where closed fracture and intramedullary nailing were performed on their right tibial diaphyses. They were divided into 2 main groups, the experimental group, which was given weekly tranexamic acid injections, and the control group, which received no additional treatment. Eight rats from each group were sacrificed and evaluated for fracture healing at the first experimental group and control group, second experimental group and control group, third experimental group and control group, and fourth experimental group and control group weeks. Fracture healing was radiologically assessed according to the "Spencer Index" and "Lane and Sandhu Scoring System," and histologically evaluated according to the scoring system devised by Huo et al. Results: According to the Spencer Index, the mean union score was statistically significantly higher in the E3 group than in the third con- trol group (P = .014). Furthermore, the mean union score was statistically significantly higher in the fourth experimental group compared to the fourth control group (P=.047). According to the Lane and Sandhu Scoring System, only the mean union scores of the E3-4 groups were statistically significantly higher than the mean union scores of the C3-4 groups (P=.048). There was no histological difference between groups in terms of union, according to the criteria defined by Huo et al (P > .05).

Conclusion: This study showed us that repeated intravenous administrations of tranexamic acid had no negative effect on fracture heal- ing in the rat tibia fracture model. Although tranexamic acid demonstrated better radiological healing in the late period, it had no effect on histological union.