Acta orthopaedica et traumatologica turcica最新文献

Isolated dislocation of the scaphoid bone is an extremely rare injury. If left untreated, results may be catastrophic. This paper presents a late complication of a neglected open scaphoid dislocation injury. A 63-year-old woman was admitted to the orthopedic outpatient department with symptoms of pain and restricted movement in her left wrist. Her medical history revealed a previous open injury to her left wrist approximately 45 years ago due to being trapped between a cart and a tree. X-ray and computed tomography showed volar dislocation of the scaphoid bone, collapse of the lunate bone, advanced arthritic changes, and cystic alterations in the lunocapitate joint. The decision on surgical treatment was made. Scaphoid excision and radiometacarpal fusion surgery were performed on her left wrist. Isolated scaphoid dislocations are rare injuries. Early recognition and treatment in the acute phase prevent severe complications and yield successful results. Advanced wrist arthritis can be observed in delayed cases. Radiometacarpal fusion is a successful treatment option for advanced cases with complete loss of motion.

Objective: This study aimed to compare the clinical results and determine functional superiority in patients treated with scaphocapitate fusion (SCF) versus proximal row carpectomy (PRC) for advanced-grade Kienböck disease.

Methods: The patients were assessed in terms of demographic data, follow-up duration, disease stage, preoperative and final follow-up values of the disability of arm, shoulder, and hand (DASH) score, patient-rated wrist evaluation (PRWE) score, and visual analog scale (VAS) pain score, together with the key-pinch grip and palmar grip values. The preoperative and postoperative flexion and extension angles and radial and ulnar deviation angles were also recorded and compared. As there were no records of preoperative grip strength values, comparisons were made with the healthy contralateral hand.

Results: A total of 26 patients were evaluated, including 10 who underwent PRC surgery and 16 who underwent SCF. Preoperatively, the flexion range was 65.8% in the PRC group and 58.8% in the SCF group, the extension range was 65.8% and 56.7%, radial deviation was 35% and 40.6%, and ulnar deviation was 65% and 61.1%, respectively. Postoperatively, the mean values of these parameters were comparable between the 2 groups. When grip strength was compared with the non-operated hand, it was determined to be 58.8% of the healthy hand in the PRC group and 60.9% in the SCF group. Similarly, pinch strength was 45.5% of the healthy hand in the PRC group and 55.6% in the SCF group. In all patients, a statistically significant reduction was observed in postoperative DASH, PRWE, and VAS scores compared to preoperative values. Specifically, in the PRC group, the postoperative scores were DASH: 22.6, PRWE: 43.6, and VAS: 3.2, while in the SCF group, the corresponding values were DASH: 26.5, PRWE: 38.2, and VAS: 2.9.

Conclusion: In advanced-grade Kienböck disease, PRC appears to be a more favorable option when preserving joint range of motion is a priority, whereas SCF may provide better outcomes in terms of grip strength. Both techniques seem to o!er comparable pain relief and functional results, suggesting that the choice of procedure should be tailored to the patient's individual needs and priorities.

Level of evidence: Level IV, Therapeutic Study.

Objective: To compare the clinical and radiological e!cacy of bone cement volumes injected during unilateral percutaneous balloon kyphoplasty for thoracolumbar vertebral compression fractures.

Methods: In this retrospective study, we reviewed data from 96 patients who underwent single-level unilateral kyphoplasty. The patients were categorized into 2 groups based on the cement volume injected: group 1 (cement volume "4 mL, minimum 3 mL; n=48) and group 2 (cement volume >4 mL, maximum 6 mL; n=48). The clinical outcomes, as assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, were evaluated preoperatively and then at the final follow-up 1 month postoperatively. The vertebral corpus height at the fracture level was measured at the anterior, middle, and posterior regions through sagittal computed tomography scanning.

Results: The mean age of the patients was 64.2 years in group 1 and 63.8 years in group 2. In group 1, the mean anterior vertebral height increased from 19.0 ± 3.3 mm preoperatively to 19.9 ± 3.2 mm postoperatively, whereas in group 2, it increased from 17.9 ± 3.8 mm to 19.6 ± 3.7 mm, respectively. The middle vertebral heights were 15.4 ± 2.5 mm preoperatively and 16.9 ± 2.8 mm postoperatively in group 1 and 16.0 ± 3.6 mm and 17.5 ± 3.2 mm, respectively, in group 2. Both groups exhibited significant improvements in ODI and VAS scores, with no significant di#erence between the groups. A statistically significant increase was recorded within each group for the anterior, middle, and posterior vertebral heights. However, a significantly greater increase was noted in the anterior height in group 2 compared to that in group 1 (P < .05).

Conclusion: Unilateral kyphoplasty is an e#ective procedure for managing painful vertebral compression fractures. The greatest loss of vertebral height occurred in the middle column, which also exhibited the greatest potential for restoration. Thus, a higher cement volume facilitated greater restoration of the anterior column height.

Level of evidence: Level III, Therapeutic Study.

Objective: This meta-analysis aimed to evaluate the e!ectiveness of arthroscopic irrigation and debridement in the management of septic arthritis following anterior cruciate ligament reconstruction (ACL-R), with a focus on graft retention rates, functional outcomes, and the microbiological profile of infections.

Methods: This meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024562550). PubMed, Cochrane, ProQuest, and ScienceDirect databases were searched for studies published before July 2024 using predefined Medical Subject Headings terms and keywords related to ACL-R infections and arthroscopic irrigation and debridement. Inclusion criteria followed the PICO framework: Population (patients with septic arthritis following ACL-R), intervention (arthroscopic irrigation and debridement), comparator (none), and outcomes (graft retention rate, Lysholm Knee Score, International Knee Documentation Committee [IKD] score, and Tegner Activity Scale [TAS], and microbiology data). The risk of bias was assessed using the Cochrane Risk of Bias in Non-Randomized Studies-of Interventions. Meta-analyses were performed using R Studio, with results presented as pooled proportions or means with 95% confidence intervals (95% CI).

Results: A total of 20 studies involving 333 patients were analyzed, with follow-up periods ranging from 18 days to 67 months. The pooled graft retention rate was 92% (95% CI [88-94%]), confirmed by proportional meta-analysis with low heterogeneity (I"=0%, P=2.0948). Functional knee outcomes showed pooled mean scores of 82.41 for Lysholm (95% CI [78.15-86.66], I"=87.3%-92.7%), 79.37 for IKDC (95% CI [74.00-84.75], I"=68.3%-82.2%), and 5.08 for TAS (95% CI [4.87-5.30], I"=0%-52.6%), indicating moderate to satisfactory recovery. Coagulase-negative Staphylococcus (42.34%) and Staphylococcus aureus (23.12%) were the most frequently isolated pathogens, with 9.91% of cases involving antibiotic-resistant strains, including MRSA (4.50%) and MR-CNS (5.41%). Cephalosporin or vancomycin was the most commonly administered first-line antibiotic, often combined with other agents.

Conclusion: The findings suggest that arthroscopic irrigation and debridement, combined with appropriate antibiotic therapy, are e!ective in managing septic arthritis following ACL-R, achieving a high graft retention rate of 92% and moderate to satisfactory functional outcomes. However, the presence of antibiotic-resistant pathogens and challenges in returning to high-level sports highlight the importance of preventive measures to protect athlete performance and recovery.

Level of evidence: Level IV, Therapeutic Study.

Objective: This study aimed to investigate the clinical outcomes of employing Endobutton with a mini-plate for managing Neer IIB (IIC) type distal clavicle fractures.

Methods: A retrospective case-control approach was utilized, examining clinical data from 62 patients with Neer IIB (IIC) type distal clavicle fractures treated at our institution from January 2018 to December 2022. Patients were divided into 2 groups: 32 treated with an Endobutton and a mini-plate (study group) and 30 with a clavicular hook steel plate (control group). Surgical metrics such as duration, incision length, and hospital stay were documented. Follow-up assessments included fracture healing, postoperative complications, and the necessity for secondary internal fixation removal. Preoperative and postoperative coracoclavicular distances (CCD) were recorded at various intervals. Pain and shoulder joint functionality were evaluated using the Visual Analog Scale (VAS) and Constant-Murley score.

Results: All patients successfully underwent surgery and were followed up. The follow-up period for the study group was 12-23 months (18.7 ± 2.7), and for the control group, it was 12-22 months (15.8 ± 1.6). The surgery duration was significantly shorter in the control group [(65.12 ± 9.88) minutes] compared to the study group [(82.58 ± 7.36) minutes, P < 0.05]. In comparison, the incision length in the control group was longer than that in the study group [(69.58 ± 6.43) mm vs. 58.24 ± 4.83 mm, P < .05]. There were no significant di!erences in hospital stay and fracture healing time between the 2 groups (P > .05). In the control group, all patients required secondary removal of internal fixation, while in the study group, only 1 patient needed it. Complications such as subacromial bone erosion, distal clavicle osteolysis, subacromial impingement with shoulder pain, and skin irritation were observed in the control group, while only skin irritation due to thinness was noted in the study group, with statistically significant di!erences between the groups (P < .05). Postoperative CCD improved significantly in both groups. At the final follow-up, the increase in CCD was greater in the control group (1.819 ± 0.97 mm) compared to the study group (0.274 ± 0.18 mm, P < .05). The study group showed better VAS scores at 6months (1.22 ± 0.96) and the last follow-up [(1.22 ± 0.96), (0.68 ± 0.57) points] compared to the control group [(2.97 ± 0.86), (1.98 ± 0.84) points, P < .05]. The Constant-Murley functional scores were also better in the study group [(81.67 ± 5.54), (90.45 ± 3.42) points] than in the control group [(91.45 ± 3.44), (94.21 ± 1.43) points, P < .05].

Conclusion: The use of an Endobutton combined with a mini-plate for Neer IIB (IIC) type distal clavicle fractures offers significant advantages, including improved recovery of shoulder joint function, fewer postoperative complications, and reduced

Objective: Septic arthritis of the hand often leads to sti!ness or even complete loss of joint function. Septic arthritis with osteomyelitis is especially severe. In this case, most experts recognize the need to perform arthrodesis. This study is devoted to another way of solving this problem.

Methods: The results of treatment of 240 patients (255 joints) treated for septic arthritis of the hand were retrospectively analyzed. In most cases, septic arthritis with osteomyelitis was noted-145 (56.9%). All patients were operated on. After resection of osteochondral structures, in most cases, the developed method named distraction (gap) arthroplasty was used. Mid-term results were assessed within 7 months (interquartile range [IQR]: 4-9). Finger function was assessed using the total active motion (TAM) system.

Results: With the development of osteomyelitis, the delay in treatment was longer than in patients without osteomyelitis: 13 days (IQR: 4-22). Tendon destruction, which prevents the restoration of joint function, was observed in 12 (4.7%) cases. After rehabilitation, the maximum median TAM was in patients after arthritis with osteomyelitis of the metacarpophalangeal (MCP) joint-68.1% (IQR: 50.1-86.2), 65.3% (IQR: 49.4-75.4), 60.8% (IQR: 58.7-72.4), and 63.8% (IQR: 51.7-71.9) after arthritis with osteomyelitis of the proximal interphalangeal (PIP) joint, distal interphalangeal (DIP) joint, and thumb interphalangeal (IP) joint, respectively.

Conclusion: Septic arthritis of the hand is a severe disease that is often accompanied by the development of osteomyelitis, the spread of a purulent process to the paraarticular soft tissues, and sometimes the destruction of the tendons. It often leads to the need for arthrodesis or amputation of the finger. As an alternative to this, a treatment method named "distraction (gap) arthroplasty" after resection of the a!ected structures of the joint can be considered.

Level of evidence: Level IV, Therapeutic Study.

Objective: This study aimed to assess the necessity of routine pathological examination of femoral heads in detecting incidental metastatic bone disease in patients undergoing elective and emergency hip arthroplasty.

Methods: A retrospective review was conducted on medical records, operative notes, and histopathology reports of patients who underwent hip arthroplasty between 2016 and 2024. Patients without pathological evaluation or with known metastases were excluded. The study included patients with hip osteoarthritis undergoing total hip arthroplasty and those with femoral neck fractures undergoing bipolar hemiarthroplasty. Preoperative diagnoses, comorbidities, and operative and histopathological findings were analyzed.

Results: The study included 193 patients with femoral neck fractures (mean age: 76.8 years, age range=60 - 98 years) and 257 with osteoarthritis (mean age: 60.4 years, age range= 23 - 88). After excluding 22 femoral neck fracture and 90 osteoarthritis patients, 36 patients in the fracture group and 18 in the osteoarthritis group had a history of malignancy, with 10 and 2 patients, respectively, having known metastases. Incidental metastatic bone disease was identified in four femoral neck fracture patients, while no neoplastic findings were detected in the osteoarthritis group.

Conclusion: Routine pathological examination of femoral heads is particularly relevant in femoral neck fracture cases, where the risk of detecting metastatic disease is higher. While thorough preoperative assessments and meticulous intraoperative evaluations aid diagnosis, the decision to submit specimens for pathology should be guided by the surgeon's clinical judgment and patient-specific factors.

Level of evidence: Level III, Diagnostic Study.