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Posterior Cruciate Ligament Injuries in Very Young Children - A Case Report and Modern Review. 年幼儿童的后十字韧带损伤--病例报告和现代回顾。
Pub Date : 2024-01-01
Matthew J Folkman, Amog Mysore, Raymond W Liu, Allison Gilmore

Background: Posterior cruciate ligament (PCL) tears in young children are rare and optimal treatment is poorly described. Diagnosis may prove challenging as young children may not be able to verbalize a complete history of injury, may be difficult to examine, and plane film radiographs often appear within normal limits. Surgical treatment carries a risk of physeal arrest, but non-operative treatment may lead to recurrent instability and pain.

Methods: We present a case report of a fouryear- old child with a PCL avulsion off the femoral insertion who received an open reduction and internal fixation (ORIF) with combined arthroscopic synovial debridement. We performed a literature review which compared the mechanism, location, concomitant injuries, work up and management of PCL injuries in children under the age of ten compared to adolescents and adults.

Results: Nineteen months following surgery, physical examination revealed full knee range of motion and return to baseline function. Imaging studies confirmed there was no evidence of physeal arrest.

Conclusion: ORIF with arthroscopy can be an effective method to treat PCL avulsions in children under the age of 10 years. This is similar to other case reports which reported positive outcomes with ORIF in this population. Large studies are needed to best understand optimal treatment modalities for PCL injuries in very young children. Level of Evidence: IV.

背景:幼儿后交叉韧带(PCL)撕裂十分罕见,最佳治疗方法也鲜有描述。诊断可能具有挑战性,因为幼儿可能无法说出完整的受伤史,可能难以进行检查,而且平面X光片往往显示在正常范围内。手术治疗存在趾骨停滞的风险,但非手术治疗可能会导致反复不稳和疼痛:我们报告了一例 4 岁儿童 PCL 从股骨插入处撕脱的病例,该患儿接受了开放复位内固定术(ORIF)并联合关节镜滑膜清创术。我们对文献进行了回顾,比较了 10 岁以下儿童与青少年和成人 PCL 损伤的机制、位置、并发损伤、治疗和管理:术后19个月,体格检查显示膝关节活动范围完全恢复,功能也恢复到基线水平。影像学检查证实没有趾骨停滞的迹象:结论:关节镜下的ORIF手术是治疗10岁以下儿童PCL撕脱的有效方法。这与其他病例报告相似,这些病例报告称,在这一人群中采用ORIF术取得了积极的疗效。我们需要进行大量研究,以便更好地了解治疗幼童 PCL 损伤的最佳方法。证据等级:IV级。
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引用次数: 0
A Case Report of Isolated Cervical Ligament Rupture With Hyper-Pronation Injury: Specific MRI Protocol and Surgical Reconstruction. 孤立性颈椎韧带断裂伴过度棘突损伤的病例报告:特定的磁共振成像方案和手术重建。
Pub Date : 2024-01-01
Aly M Fayed, Nacime Salomao Barbachan Mansur, Nastaran Fatemi, John E Femino

Background: The aim of this case report is to present a case of chronic cervical ligament tear and instability, which occurred by an unusual work injury with an eversion/hyper-pronation mechanism in contrast to the usual mechanism of inversion. The ligament was reconstructed using an allograft with satisfactory results up to 30 months after surgery. A new magnetic resonance imaging protocol (MRI) was developed to better evaluate the cervical ligament/graft.

Conclusion: In diagnosis of foot sprains, a specific ligament injury should always be sought. In this case, physical examination producing tenderness at the location of the cervical ligament and correlating this with an oblique intercolumn stress test that reproduced pain with apprehension and gross instability supported the diagnosis. Retrospectively applying anatomic knowledge to the earlier MRI findings of bone marrow edema at the insertion points of the cervical ligament on the talus and calcaneus was important in confirming the diagnosis. To better evaluate the cervical ligament allograft tendon reconstruction, a novel volumetric MRI sequence was developed which may prove helpful to also diagnose cervical ligament injuries in future cases. Anatomic reconstruction of the cervical ligament provided satisfactory clinical and radiographic results at 30-month follow-up.Level of Evidence: V.

背景:本病例报告的目的是介绍一例慢性颈椎韧带撕裂和不稳定病例,该病例发生于一次不寻常的工伤,其外翻/过度外翻机制与通常的内翻机制不同。该病例采用同种异体材料重建韧带,术后 30 个月效果令人满意。为了更好地评估颈韧带/移植物,我们制定了新的磁共振成像方案(MRI):结论:在诊断足部扭伤时,应始终寻找特定的韧带损伤。在该病例中,体格检查发现颈韧带位置有压痛,斜柱间应力试验显示疼痛伴有忐忑不安和严重不稳,与之相关的体格检查结果支持了诊断。在核磁共振成像中发现颈韧带在距骨和小方块上的插入点处有骨髓水肿,将解剖学知识应用到早期的核磁共振成像中对确诊非常重要。为了更好地评估颈韧带同种异体肌腱重建,研究人员开发了一种新的容积核磁共振成像序列,该序列可能有助于在未来的病例中诊断颈韧带损伤。在30个月的随访中,颈韧带解剖重建的临床和影像学效果令人满意:V.
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引用次数: 0
Utility of Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection in Revision Total Knee Arthroplasty. 翻修全膝关节置换术中急性假体周围关节感染的清创、抗生素和植入物保留的效用。
Pub Date : 2024-01-01
Matthew Van Engen, Taylor Den Hartog, Bennett Feuchtenberger, Natalie Glass, Nicolas Noiseux

Background: Periprosthetic joint infection (PJI) in revision arthroplasty presents as a challenging complication that is difficult to manage. Debridement, antibiotics, and implant retention (DAIR) is a recognized treatment option, although few studies have investigated success rates in addition to eventual amputation rates for failed cases.

Methods: A retrospective review of 365 DAIR cases was performed at a single institution from 2008-2020. Patient records were thoroughly reviewed for inclusion and exclusion criteria by multiple members of the research team, discovering 45 cases met criteria for the study cohort. Demographic information, medical history, culture data, and surgical history, were recorded. DAIR's overall survivorship was evaluated with a Kaplan-Meier (KM) survival curve. Additional KM curves were constructed to compare acute postoperative versus acute hematogenous infections as well as DAIR survivorship relative to infecting organism.

Results: DAIR's success rate in revision TKA was 77% at 0.5 years, 56% at 2 years and 46% at 5 years. No significant difference was noted in survivorship when comparing acute postoperative and acute hematogenous cases at 5 years (29 vs 51%, P=0.64). No significance differences in survivorship were noted according to infecting organism (P =0.30). Median follow up duration was significantly lower in the failed DAIR cohort with a median time of 0.5 years in comparison to 1.7 years for the successful DAIR group (P =0.012). There were 20 DAIR cases that failed, 10 of which resulted in eventual amputation.

Conclusion: DAIR's success rate for managing acute PJI in revision arthroplasty cases was 46% at 5 years. Of the 20 failed DAIR cases, 10 resulted in eventual amputation. DAIRs utility in managing these complicated PJI cases in the setting of revision arthroplasty is concerning with low success rates and high rates of amputation in failed cases. Level of Evidence: III.

背景:翻修关节置换术中的假体周围感染(PJI)是一种难以处理的挑战性并发症。清创、抗生素和植入物保留(DAIR)是公认的治疗方案,但很少有研究对失败病例的成功率和最终截肢率进行调查:方法:2008-2020年间,一家医疗机构对365例DAIR病例进行了回顾性研究。研究团队的多名成员根据纳入和排除标准对患者记录进行了全面审查,发现 45 例符合研究队列的标准。研究人员记录了患者的人口统计学信息、病史、培养数据和手术史。用 Kaplan-Meier (KM) 存活率曲线评估了 DAIR 的总体存活率。另外还构建了 KM 曲线,以比较术后急性感染与急性血源性感染,以及与感染病原体相关的 DAIR 存活率:结果:在翻修 TKA 中,DAIR 的成功率在 0.5 年为 77%,2 年为 56%,5 年为 46%。急性术后病例与急性血源性病例在 5 年后的存活率比较无明显差异(29 vs 51%,P=0.64)。感染病原体不同,存活率也无明显差异(P=0.30)。DAIR失败组的中位随访时间明显较短,为0.5年,而DAIR成功组为1.7年(P=0.012)。共有 20 例 DAIR 失败,其中 10 例最终导致截肢:结论:5 年后,DAIR 治疗翻修关节成形术病例急性 PJI 的成功率为 46%。在 20 例失败的 DAIR 中,有 10 例最终导致截肢。DAIR在处理翻修关节成形术中的复杂PJI病例方面的效用令人担忧,因为成功率较低,失败病例的截肢率较高。证据等级:III.
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引用次数: 0
Evaluating One-Week Post-Casting Alignment Checks and Surgical Intervention Rates in Pediatric Type IIA Supracondylar Humeral Fractures. 评估儿童IIA型肱骨髁上骨折铸造后一周的对准检查和手术干预率。
Pub Date : 2024-01-01
Jason Z Amaral, Rebecca J Schultz, Benjamin M Martin, Jacob P Scioscia, Basel Touban, Barkha N Chhabra, Kelly Cline, Scott D McKay

Background: This study aims to determine the rate of surgical intervention in children with type IIA supracondylar humerus fractures (SCHF) following routine post-casting radiographic assessment. We hypothesized that no cases would convert to operative management following one-week post-casting alignment assessments.

Methods: This single-center retrospective study focused on pediatric patients diagnosed with type IIA SCHF from 2019 to 2022. Patients were treated with initial long arm cast immobilization, followed by a one-week post-casting radiographic alignment check in cast. Fractures were graded in consensus using the Wilkins-Modified Gartland classification system by three fellowship-trained pediatric orthopaedic surgeons. Demographics, casting details, follow-up dates, and treatment histories were examined. Alignment was considered acceptable or requiring surgery based on the treating surgeons' discretion. The study excluded patients with concomitant ipsilateral upper extremity fractures, flexion-type fractures, lost to follow-up before cast removal, or with type I, IIB or III SCHFs.

Results: Of the 128 patients reviewed in our study, 85 were classified as type IIA SCHF by consensus. The cohort had an average age of 4.2 years (range: 1.1-10.2 years) and was 52% male. The patient population was ethnically diverse, with Hispanic patients constituting the majority (56%), followed by White patients (26%), Black patients (9%), and Asian patients (8%).Patients presented for definitive treatment an average of 2.8 days post-injury and spent an average of 28.8 days in casts. Alignment checks occurred an average of 10.3 days post-injury (SD ±2.5 days). Alignment shifts were noted in 7.1% of cases (n=6). Of these six cases, two were assessed by surgeons as having acceptable alignment, not requiring further intervention. The remaining four cases underwent closed reduction and percutaneous pinning. The rate of conversion to surgical treatment for type IIA supracondylar humerus fractures in our study was 4.7%.

Conclusion: This investigation found that 4.7% of nonoperative type IIA SCHFs converted to operative treatment at the one-week post-casting alignment check. Future studies are warranted to determine specific risk factors for alignment loss in type IIA SCHFs. Level of Evidence: IV.

背景:本研究旨在确定IIA型肱骨髁上骨折(SCHF)儿童在常规铸造后影像学评估后的手术干预率。我们假设没有病例会在铸造后一周的定位评估后转为手术治疗。方法:本研究为单中心回顾性研究,研究对象为2019 - 2022年诊断为IIA型SCHF的儿科患者。患者接受初始长臂石膏固定治疗,随后在石膏内进行一周的浇铸后放射检查。三位接受过培训的儿科骨科医生一致采用Wilkins-Modified Gartland分类系统对骨折进行分级。调查了人口统计学、铸型细节、随访日期和治疗史。根据治疗外科医生的判断,矫正被认为是可接受的或需要手术。该研究排除了伴有同侧上肢骨折、屈曲型骨折、移除石膏前未随访或I、IIB或III型schf的患者。结果:在我们的研究中回顾的128例患者中,85例被一致归类为IIA型SCHF。该队列平均年龄为4.2岁(范围1.1-10.2岁),男性占52%。患者群体具有种族多样性,西班牙裔患者占多数(56%),其次是白人患者(26%),黑人患者(9%)和亚洲患者(8%)。患者在受伤后平均2.8天接受最终治疗,平均28.8天使用石膏。损伤后平均10.3天(SD±2.5天)进行对齐检查。7.1%的病例发生对齐移位(n=6)。在这6例病例中,2例经外科医生评估为可接受的对齐,不需要进一步干预。其余4例行闭合复位和经皮钉扎术。在我们的研究中,IIA型肱骨髁上骨折转为手术治疗的比率为4.7%。结论:本研究发现,非手术治疗的IIA型schf在铸造后1周检查时转为手术治疗。未来的研究有必要确定IIA型schf中排列丧失的具体危险因素。证据等级:四级。
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引用次数: 0
Utility of Recovery Room vs Post-Operative Day 1 Radiographs Following Shoulder Arthroplasty. 肩关节置换术后恢复室与术后第 1 天 X 射线照相的实用性。
Pub Date : 2024-01-01
Taylor Den Hartog, Maria Bozoghlian, Garrett Christensen, Daniel Meeker, James V Nepola, Brendan M Patterson

Background: Postoperative radiographs may be performed on different timelines after shoulder arthroplasty. Radiographs obtained in the post-operative recovery unit (PACU) are often of poorer quality. The purpose of the current study was to explore and compare the quality of PACU radiographs and radiographs performed in the radiology suite on post-operative Day 1 (POD1), as well as determine their impact on changes in post-operative management.

Methods: Our series included 50 consecutive anatomic total shoulder arthroplasties (TSA) for which post-operative radiographs were obtained in the PACU and 50 consecutive TSA for which post-operative radiographs were obtained in the radiology suite on POD 1. TSA radiographs were blinded and reviewed by 3 authors and graded on their quality using criteria described using previously published methods. The weighted kappa was used to describe the intra-rater agreement and inter-rater agreement between two raters.

Results: There was no difference in age, sex, BMI, and comorbidities between cohorts. Intra-observer reliability was moderate to substantial with weighted kappa values of 0.65±0.07 (p<0.001), 0.58±0.09 (p<0.001), and 0.67±0.07 (p<0.001). Inter-observer reliability was moderate to substantial with weighted kappa values of 0.605±0.07 (p<0.001), 0.66±0.07 (p<0.001), and 0.65±0.08 (p<0.001). When assessing quality of radiographs, 30% of radiographs obtained in PACU were deemed quality while 57% of radiographs obtained in the radiology suite were deemed quality (p<0.001).

Conclusion: Post-operative radiographs in the PACU do not alter patient management and are often inadequate to serve as baseline radiographs. Conversely, radiographs obtained in the radiology suite are of higher quality and can serve as a superior baseline radiograph. Level of Evidence: IV.

背景:肩关节置换术后可能需要在不同的时间段进行术后X光检查。在术后恢复室(PACU)获得的射线照片通常质量较差。本研究旨在探讨和比较术后第 1 天 (POD1) 在 PACU 和放射科病房拍摄的射线照片的质量,并确定它们对术后管理变化的影响:我们的系列研究包括 50 例连续的解剖型全肩关节置换术(TSA)和 50 例连续的全肩关节置换术(TSA),前者的术后射线照相是在 PACU 进行的,后者的术后射线照相是在 POD1 当天在放射室进行的。TSA X 光片由 3 位作者进行盲法审核,并采用之前发表的方法中描述的标准对其质量进行分级。加权卡帕用于描述两位评分者之间的评分内一致性和评分间一致性:结果:不同组群之间在年龄、性别、体重指数和合并症方面没有差异。观察者内部的可靠性为中度到高度,加权卡帕值为 0.65±0.07(p 结论:观察者内部的可靠性为中度到高度,加权卡帕值为 0.65±0.07(p):PACU 中的术后射线照片不会改变患者的管理,而且通常不足以作为基线射线照片。相反,在放射室获得的射线照片质量较高,可作为较好的基线射线照片。证据等级:四级。
{"title":"Utility of Recovery Room vs Post-Operative Day 1 Radiographs Following Shoulder Arthroplasty.","authors":"Taylor Den Hartog, Maria Bozoghlian, Garrett Christensen, Daniel Meeker, James V Nepola, Brendan M Patterson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Postoperative radiographs may be performed on different timelines after shoulder arthroplasty. Radiographs obtained in the post-operative recovery unit (PACU) are often of poorer quality. The purpose of the current study was to explore and compare the quality of PACU radiographs and radiographs performed in the radiology suite on post-operative Day 1 (POD1), as well as determine their impact on changes in post-operative management.</p><p><strong>Methods: </strong>Our series included 50 consecutive anatomic total shoulder arthroplasties (TSA) for which post-operative radiographs were obtained in the PACU and 50 consecutive TSA for which post-operative radiographs were obtained in the radiology suite on POD 1. TSA radiographs were blinded and reviewed by 3 authors and graded on their quality using criteria described using previously published methods. The weighted kappa was used to describe the intra-rater agreement and inter-rater agreement between two raters.</p><p><strong>Results: </strong>There was no difference in age, sex, BMI, and comorbidities between cohorts. Intra-observer reliability was moderate to substantial with weighted kappa values of 0.65±0.07 (p<0.001), 0.58±0.09 (p<0.001), and 0.67±0.07 (p<0.001). Inter-observer reliability was moderate to substantial with weighted kappa values of 0.605±0.07 (p<0.001), 0.66±0.07 (p<0.001), and 0.65±0.08 (p<0.001). When assessing quality of radiographs, 30% of radiographs obtained in PACU were deemed quality while 57% of radiographs obtained in the radiology suite were deemed quality (p<0.001).</p><p><strong>Conclusion: </strong>Post-operative radiographs in the PACU do not alter patient management and are often inadequate to serve as baseline radiographs. Conversely, radiographs obtained in the radiology suite are of higher quality and can serve as a superior baseline radiograph. <b>Level of Evidence: IV</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 1","pages":"99-103"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141452616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Efficacy of Prophylactic Vancomycin in Decreasing Surgical Site Infections in Adolescent Idiopathic Scoliosis Patients: A Large Multicenter Cohort Study. 预防性万古霉素减少青少年特发性脊柱侧凸患者手术部位感染的疗效:一项大型多中心队列研究。
Pub Date : 2024-01-01
De-An Zhang, Stephen R Stephan, Robert H Cho, Marilan Luong, Evan D Nigh, Shriners Spine, Selina Poon

Background: The use of vancomycin powder in spine surgery has been supported in adult populations, however, its efficacy in preventing postoperative surgical site infections in AIS patients is yet to be determined.

Methods: A multi-center review was conducted from June 2010 to February 2019, using ICD and CPT codes to identify AIS patients who underwent primary PSF. The patients were divided into two groups: the vancomycin cohort (receiving local vancomycin powder prior to wound closure) and the non-vancomycin cohort. Demographic and surgical data, microbial data, and SSI rates were compared between the two groups.

Results: A total of 1,917 AIS patients underwent PSF during the study period. There were no significant differences in age at surgery, BMI, sex, or presence of osteotomy between the two groups. The vancomycin cohort had 65.3% patients (n=1,252) with 0.5% (n=6) diagnosed SSIs, while the non-vancomycin cohort had 34.7% patients (n=665) with 0.8% (n=5) SSIs (p=0.451). Four (66.7%) gram-negative bacteria were isolated in the vancomycin cohort, compared to one (20%) in the non-vancomycin cohort.

Conclusion: The results showed no significant reduction in surgical site infections with the use of prophylactic, local vancomycin in AIS patients undergoing PSF (0.5% versus 0.8%). Further studies are needed to fully assess the effectiveness of vancomycin in this population. Level of Evidence: III.

背景:在成人脊柱手术中使用万古霉素粉末已得到支持,然而,其在预防AIS患者术后手术部位感染方面的效果尚未确定。方法:2010年6月至2019年2月进行了一项多中心综述,使用ICD和CPT代码识别患有原发性PSF的AIS患者。将患者分为两组:万古霉素组(伤口闭合前局部服用万古霉素粉末)和非万古霉素组。比较两组患者的人口学和手术数据、微生物数据和SSI发生率。结果:在研究期间,共有1,917名AIS患者接受了PSF。两组患者在手术年龄、身体质量指数、性别或截骨术方面均无显著差异。万古霉素组有65.3% (n= 1252)患者诊断为ssi,其中0.5% (n=6)为ssi;非万古霉素组有34.7% (n=665)患者诊断为ssi,其中0.8% (n=5)为ssi (p=0.451)。在万古霉素组中分离出4个(66.7%)革兰氏阴性菌,而在非万古霉素组中分离出1个(20%)革兰氏阴性菌。结论:结果显示,在接受PSF的AIS患者中,预防性局部万古霉素的使用没有显著降低手术部位感染(0.5%对0.8%)。需要进一步的研究来充分评估万古霉素在这一人群中的有效性。证据水平:III。
{"title":"The Efficacy of Prophylactic Vancomycin in Decreasing Surgical Site Infections in Adolescent Idiopathic Scoliosis Patients: A Large Multicenter Cohort Study.","authors":"De-An Zhang, Stephen R Stephan, Robert H Cho, Marilan Luong, Evan D Nigh, Shriners Spine, Selina Poon","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The use of vancomycin powder in spine surgery has been supported in adult populations, however, its efficacy in preventing postoperative surgical site infections in AIS patients is yet to be determined.</p><p><strong>Methods: </strong>A multi-center review was conducted from June 2010 to February 2019, using ICD and CPT codes to identify AIS patients who underwent primary PSF. The patients were divided into two groups: the vancomycin cohort (receiving local vancomycin powder prior to wound closure) and the non-vancomycin cohort. Demographic and surgical data, microbial data, and SSI rates were compared between the two groups.</p><p><strong>Results: </strong>A total of 1,917 AIS patients underwent PSF during the study period. There were no significant differences in age at surgery, BMI, sex, or presence of osteotomy between the two groups. The vancomycin cohort had 65.3% patients (n=1,252) with 0.5% (n=6) diagnosed SSIs, while the non-vancomycin cohort had 34.7% patients (n=665) with 0.8% (n=5) SSIs (p=0.451). Four (66.7%) gram-negative bacteria were isolated in the vancomycin cohort, compared to one (20%) in the non-vancomycin cohort.</p><p><strong>Conclusion: </strong>The results showed no significant reduction in surgical site infections with the use of prophylactic, local vancomycin in AIS patients undergoing PSF (0.5% versus 0.8%). Further studies are needed to fully assess the effectiveness of vancomycin in this population. <b>Level of Evidence: III</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 2","pages":"93-99"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tourniquet and/or Adductor Canal Block Use Confer No Additional Early Quadriceps Weakness Following Total Knee Arthroplasty: An Analysis of 203 Patients. 203例全膝关节置换术后使用止血带和/或内收管阻断不会导致额外的早期股四头肌无力。
Pub Date : 2024-01-01
Kyle W Lawrence, Jaclyn A Konopka, Jerry Arraut, Thomas Bieganowski, Ran Schwarzkopf, Joshua C Rozell

Background: Quadriceps weakness following total knee arthroplasty (TKA) delays rehabilitation and increases fall risk. The combined impact of tourniquets and adductor canal blocks (ACBs) on postoperative quadriceps strength has not been defined. This study evaluated the early effects of tourniquet and/or ACB usage on quadriceps strength following TKA.

Methods: Primary, elective TKA patients were assigned to one of four groups based on whether they received an ACB and/or tourniquet. We prospectively measured bilateral, isometric knee extension strength preoperatively and within 36 hours postoperatively. Pre/post-change (Δ) and percent strength change were calculated and standardized to the contralateral leg. Strength, postoperative pain, mobility, knee buckling incidence, and falls were compared across groups. Measurements were collected for 203 patients: 68, 45, 45, and 45 in the tourniquet/ACB, tourniquet/ no ACB, ACB/no tourniquet, and no tourniquet/ no ACB groups, respectively.

Results: Tourniquet use was associated with shorter operative time (p=0.004), while ACB use was associated with longer lengths of stay (p=0.005). Average preoperative (p=0.53), postoperative (p=0.12), pre/post-Δ (p=0.60), percent change (p=0.14), and standardized percent change (p=0.85) in strength measures were comparable across groups. Postoperative pain (p=0.67) and knee buckling events (p=0.18) were also comparable across groups. The no tourniquet/no ACB group had decreased postoperative mobility (p=0.004), though it was not clinically significant. No patients sustained inpatient falls.

Conclusion: Combined tourniquet and ACB use during TKA does not lead to additional weakness in postoperative knee extension or buckling events. Concern for impaired early postoperative functionality should not influence arthroplasty surgeons' decision to use a tourniquet or ACB. Level of Evidence: II.

背景:全膝关节置换术(TKA)后四头肌无力延迟康复并增加跌倒风险。止血带和内收管阻滞(ACBs)对术后股四头肌力量的联合影响尚未明确。本研究评估了TKA后止血带和/或ACB使用对股四头肌力量的早期影响。方法:原发性、选择性TKA患者根据是否接受ACB和/或止血带分为四组。我们在术前和术后36小时内前瞻性地测量了双侧、等距膝关节伸展强度。计算前后(Δ)和对侧腿强度变化百分比并将其标准化。各组患者的力量、术后疼痛、活动能力、膝关节屈曲发生率和跌倒情况进行比较。收集203例患者的测量数据:止血带/ACB组、止血带/无ACB组、止血带/无止血带组和无止血带/无ACB组分别为68、45、45和45例。结果:止血带的使用缩短了手术时间(p=0.004), ACB的使用延长了住院时间(p=0.005)。各组间力量测量的平均术前(p=0.53)、术后(p=0.12)、术前/术后-Δ (p=0.60)、百分比变化(p=0.14)和标准化百分比变化(p=0.85)具有可比性。术后疼痛(p=0.67)和膝关节屈曲事件(p=0.18)在两组间也具有可比性。无止血带/无ACB组术后活动能力下降(p=0.004),但无临床意义。没有病人住院摔倒。结论:TKA期间联合止血带和ACB的使用不会导致术后膝关节伸展或屈曲事件的额外虚弱。术后早期功能受损的担忧不应影响关节成形术医生使用止血带或ACB的决定。证据水平:II。
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引用次数: 0
Canal Fill Ratio in Hemiarthroplasty Compared to Total Hip Arthroplasty: A Case Control Study. 半髋关节置换术与全髋关节置换术的髋臼沟充盈率比较:病例对照研究。
Pub Date : 2024-01-01
Justin A Magnuson, Nihir Parikh, Sundeep Kahlon, Jamie Henzes, Andrew J Hughes, Kerri-Anne Ciesielka, Arjun Saxena, Andrew M Star

Background: Cementless stems are commonly used in hemiarthroplasty (HA) for femoral neck fractures. Recent studies have reported increased risk of periprosthetic fracture with cementless stems compared to cemented HA. In elective total hip arthroplasty (THA), lower proximal canal fill ratios (CFR) of cementless stems have been associated with worse outcomes. The purpose of this study was to compare CFRs and complications following HA for femoral neck fracture compared to THA for arthritis. We hypothesized that HA would have lower CFRs.

Methods: 130 patients undergoing cementless hemiarthroplasty for femoral neck fracture were identified and matched by age, sex, and BMI to 328 patients undergoing elective cementless THA. Postoperative radiographs were independently evaluated by two investigators to determine Dorr femur type and CFR at four points. Interrater agreement was calculated for CFR and Dorr type. Complication rates were compared between HA and THA groups.

Results: Dorr type and CFR measurements showed strong agreement between investigators. Dorr type was similar between groups. Hemiarthroplasties had significantly lower CFR at each level, with the greatest difference at the lesser trochanter. Dorr C femurs had worse CFR, specifically in the HA group. Complications rates were similar between HA and THA.

Conclusion: Worse CFR in HA compared to THA further suggests that cemented stems should be considered in HA. Suboptimal CFR represents a potential cause of complications including periprosthetic fracture following HA. Level of Evidence: III.

背景:无骨水泥假体常用于股骨颈骨折半关节置换术。最近的研究表明,与骨水泥相比,无骨水泥假体周围骨折的风险增加。在选择性全髋关节置换术(THA)中,较低的近端管填充率(CFR)与较差的结果相关。本研究的目的是比较HA治疗股骨颈骨折与THA治疗关节炎后的CFRs和并发症。我们假设HA会有较低的CFRs。方法:选取130例股骨颈骨折行无骨水泥半关节置换术的患者,按年龄、性别、BMI与328例择期行无骨水泥全髋关节置换术的患者进行匹配。术后x线片由两名研究者独立评估,以确定股骨Dorr类型和四个点的CFR。计算了CFR和Dorr类型间的一致性。比较HA组和THA组的并发症发生率。结果:Dorr类型和CFR测量结果在研究者之间显示出强烈的一致性。各组间Dorr型相似。半关节置换术在各节段的CFR均显著降低,其中小转子的差异最大。C段股骨的CFR更差,特别是HA组。HA和THA之间的并发症发生率相似。结论:与THA相比,HA的CFR更差,进一步表明HA应考虑骨水泥茎。不理想的CFR是HA后假体周围骨折等并发症的潜在原因。证据水平:III。
{"title":"Canal Fill Ratio in Hemiarthroplasty Compared to Total Hip Arthroplasty: A Case Control Study.","authors":"Justin A Magnuson, Nihir Parikh, Sundeep Kahlon, Jamie Henzes, Andrew J Hughes, Kerri-Anne Ciesielka, Arjun Saxena, Andrew M Star","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cementless stems are commonly used in hemiarthroplasty (HA) for femoral neck fractures. Recent studies have reported increased risk of periprosthetic fracture with cementless stems compared to cemented HA. In elective total hip arthroplasty (THA), lower proximal canal fill ratios (CFR) of cementless stems have been associated with worse outcomes. The purpose of this study was to compare CFRs and complications following HA for femoral neck fracture compared to THA for arthritis. We hypothesized that HA would have lower CFRs.</p><p><strong>Methods: </strong>130 patients undergoing cementless hemiarthroplasty for femoral neck fracture were identified and matched by age, sex, and BMI to 328 patients undergoing elective cementless THA. Postoperative radiographs were independently evaluated by two investigators to determine Dorr femur type and CFR at four points. Interrater agreement was calculated for CFR and Dorr type. Complication rates were compared between HA and THA groups.</p><p><strong>Results: </strong>Dorr type and CFR measurements showed strong agreement between investigators. Dorr type was similar between groups. Hemiarthroplasties had significantly lower CFR at each level, with the greatest difference at the lesser trochanter. Dorr C femurs had worse CFR, specifically in the HA group. Complications rates were similar between HA and THA.</p><p><strong>Conclusion: </strong>Worse CFR in HA compared to THA further suggests that cemented stems should be considered in HA. Suboptimal CFR represents a potential cause of complications including periprosthetic fracture following HA. <b>Level of Evidence: III</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 2","pages":"37-43"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Do Percutaneously Applied Medial Proximal Tibia Plates Need To Go Beneath the Pes Tendons? 经皮应用胫骨内侧近端钢板需要到足腱下方吗?
Pub Date : 2024-01-01
Andrew T Chen, Brad M Askam, John S Hwang, Madhav A Karunakar, Joseph R Hsu

Background: Bicondylar tibial plateau fractures are often associated with significant soft tissue compromise making operative treatment challenging. Dual plating through a two-incision approach following temporary external fixation has been shown to improve complication rates although deep infection rates remain high.The objective was to evaluate early outcomes following a novel technique of percutaneous application of the medial plate superficial to the pes anserinus tendons. Indications for a percutaneous medial plate included local soft tissue conditions, lack of or minimal involvement of medial articular surface with no displaced fragment requiring a posteromedial plate.

Methods: A retrospective chart review at a Level 1 Trauma Center identified twenty-four bicondylar tibial plateaus that were treated from 2015-2017 with standard lateral plate fixation and a medial plate that was percutaneously applied. Fractures were classified according to the AO/OTA classification. Demographic, injury characteristics, and co-morbidities were collected. The primary outcome was presence of a deep infection postoperatively. Secondary outcomes included secondary procedures, range of motion, and maintained radiographic alignment.

Results: The pre-dominant fracture pattern was AO/OTA 41-C3 (75%). The percutaneous medial plate was applied first (71%). The average follow-up was 427 days. Ninety-five percent achieved at least 90 degrees of flexion. All had satisfactory coronal alignment (≤5 degrees) and condylar width (<5mm). Satisfactory articular reductions (≤2mm) were noted in 76% and satisfactory sagittal alignment (≤5 degrees) in 94%. One patient had persistent wound drainage and underwent hardware removal after union. Another patient is pending hardware removal with concerns for deep infection five years post-surgery.

Conclusion: Early results demonstrate that it is safe to place the medial proximal tibia plate above the pes anserinus tendons percutaneously for select fracture patterns with maintained alignment and reduction. This technique may help to minimize deep infection rates. Level of Evidence: IV.

背景:胫骨双髁平台骨折通常伴有明显的软组织损伤,使得手术治疗具有挑战性。临时外固定后经双切口入路行双钢板可改善并发症发生率,但深度感染发生率仍然很高。目的是评估一种经皮在鹅足肌腱表面内侧钢板应用的新技术的早期结果。经皮内侧钢板的适应症包括局部软组织状况,内侧关节面不受援或极少受援,无移位碎片需要后内侧钢板。方法:回顾性分析某一级创伤中心2015-2017年24例采用标准外侧钢板固定和经皮内侧钢板治疗的双髁胫骨平台。根据AO/OTA分类对骨折进行分类。收集了人口统计学、损伤特征和合并症。主要结果是术后出现深部感染。次要结果包括二次手术、活动范围和维持的x线对准。结果:AO/OTA 41-C3型骨折占主导地位(75%)。首先应用经皮内侧钢板(71%)。平均随访时间为427天。95%的人达到了至少90度的屈曲。所有患者的冠状位对齐(≤5度)和髁突宽度均令人满意。结论:早期结果表明,经皮将胫骨内侧近端钢板置于鹅足肌腱上方,对于选择的骨折模式是安全的,并保持对齐和复位。这项技术可能有助于减少深部感染率。证据等级:四级。
{"title":"Do Percutaneously Applied Medial Proximal Tibia Plates Need To Go Beneath the Pes Tendons?","authors":"Andrew T Chen, Brad M Askam, John S Hwang, Madhav A Karunakar, Joseph R Hsu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Bicondylar tibial plateau fractures are often associated with significant soft tissue compromise making operative treatment challenging. Dual plating through a two-incision approach following temporary external fixation has been shown to improve complication rates although deep infection rates remain high.The objective was to evaluate early outcomes following a novel technique of percutaneous application of the medial plate superficial to the pes anserinus tendons. Indications for a percutaneous medial plate included local soft tissue conditions, lack of or minimal involvement of medial articular surface with no displaced fragment requiring a posteromedial plate.</p><p><strong>Methods: </strong>A retrospective chart review at a Level 1 Trauma Center identified twenty-four bicondylar tibial plateaus that were treated from 2015-2017 with standard lateral plate fixation and a medial plate that was percutaneously applied. Fractures were classified according to the AO/OTA classification. Demographic, injury characteristics, and co-morbidities were collected. The primary outcome was presence of a deep infection postoperatively. Secondary outcomes included secondary procedures, range of motion, and maintained radiographic alignment.</p><p><strong>Results: </strong>The pre-dominant fracture pattern was AO/OTA 41-C3 (75%). The percutaneous medial plate was applied first (71%). The average follow-up was 427 days. Ninety-five percent achieved at least 90 degrees of flexion. All had satisfactory coronal alignment (≤5 degrees) and condylar width (<5mm). Satisfactory articular reductions (≤2mm) were noted in 76% and satisfactory sagittal alignment (≤5 degrees) in 94%. One patient had persistent wound drainage and underwent hardware removal after union. Another patient is pending hardware removal with concerns for deep infection five years post-surgery.</p><p><strong>Conclusion: </strong>Early results demonstrate that it is safe to place the medial proximal tibia plate above the pes anserinus tendons percutaneously for select fracture patterns with maintained alignment and reduction. This technique may help to minimize deep infection rates. <b>Level of Evidence: IV</b>.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"44 2","pages":"145-148"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictive Factors for Intraoperative Determination for the Need of Femoral Osteochondroplasty After Periacetabular Osteotomy for Acetabular Dysplasia. 针对髋臼发育不良进行髋臼周围截骨术后,术中确定是否需要进行股骨骨软骨成形术的预测因素。
Pub Date : 2024-01-01
Matthew W Booth, Kyle P O'Connor, Frank W Parilla, Tanner Thornton, Jeffrey J Nepple, John C Clohisy

Background: Determination of need for osteochondroplasty (OCP) during periacetabular osteotomy (PAO) commonly relies on intraoperative assessment of internal rotation at 90° flexion (IRF). Performing an OCP helps decrease the risk of iatrogenic femoroacetabular impingement from PAO reduction. Avoiding impingement helps decrease risks of accelerated secondary osteoarthritis. The literature is limited for factors that predict need for OCPs during PAOs. The purpose of this study was to (1) define the characteristics of patients needing concurrent OCP and provide OCP rate based on IRF and femoral version and (2) identify predictive factors (clinical, radiographic) associated with need for OCP during PAO. As some surgeons determine need for OCP pre-operatively, predictive factors would aid decision making.

Methods: This was a prospective cohort of 224 hips (207 patients) who underwent PAO for symptomatic acetabular dysplasia, of which 154 hips (69%) underwent OCP between years 2013 and 2017. Patients underwent OCP if they had restrictions in motion or impingement intra-operatively. Pre-operative factors such as age, sex, BMI, and CT findings were recorded that underwent univariate and multivariable analyses. Multivariable analysis found predictors that were described using odds ratios and 95% confidence intervals. IRF>30° and femoral version 10°-25° were used as the reference groups during categorical analysis. P-values ≤0.05 were considered significant.

Results: Alpha angles >55° (OR= 2.20, CI: 1.08-4.52, p= 0.03), IRF≤20° (OR: 9.52, CI: 3.87-23.40, p<0.001), IRF >20°-30° (OR: 2.68, CI: 1.08-6.62, p=0.03), and femoral version <10° (OR: 5.26, CI: 1.09-25.30, p=0.04) were associated with increased odds of OCP. On continuous modeling, decreasing femoral version (OR: 1.07, CI: 1.02-1.12, p=0.002) and IRF (OR: 1.06, CI: 1.03-1.09, p<0.001) were associated with increased chance of OCP. For 5° changes, the chance of OCP increased by 40% (OR: 1.40, CI: 1.13-1.73, p=0.002) and 35% (OR: 1.35, IC: 1.16-1.57, p<0.001), respectively.

Conclusion: Awareness of need for OCP may be valuable in peri-operative planning for these patients especially since some surgeons perform this technique arthroscopically before PAO. Factors associated with increased chances of OCP were alpha angles >55°, decreased IRF, and decreased femoral version. More studies in the future would help determine how OCP affects patient outcomes. Level of Evidence: III.

背景:在髋臼周围截骨术(PAO)中确定是否需要进行骨软骨成形术(OCP)时,通常依赖于术中对屈曲 90° 内旋(IRF)的评估。实施 OCP 有助于降低 PAO 切除术造成的先天性股骨髋臼撞击风险。避免撞击有助于降低加速继发性骨关节炎的风险。有关预测 PAO 期间是否需要进行 OCP 的因素的文献很有限。本研究的目的是:(1) 根据IRF和股骨型号确定需要同时进行OCP的患者的特征并提供OCP率;(2) 确定与PAO期间需要OCP相关的预测因素(临床、影像学)。由于一些外科医生会在术前确定是否需要 OCP,因此预测因素将有助于做出决策:这是一项前瞻性队列研究,共有224个髋关节(207名患者)因症状性髋臼发育不良接受了PAO手术,其中154个髋关节(69%)在2013年至2017年间接受了OCP手术。如果患者术中出现活动受限或撞击,则接受 OCP。记录了年龄、性别、体重指数和CT结果等术前因素,并进行了单变量和多变量分析。多变量分析发现了一些预测因素,并用几率比和95%置信区间进行了描述。在分类分析中,IRF>30°和股骨版10°-25°被用作参考组。P值≤0.05为显著:结果:α角>55°(OR= 2.20,CI:1.08-4.52,P= 0.03)、IRF≤20°(OR:9.52,CI:3.87-23.40,P20°-30°(OR:2.68,CI:1.08-6.62,P=0.03)和股骨转位 结论:对 OCP 需求的认识不足:认识到 OCP 的必要性可能对这些患者的围手术期规划很有价值,尤其是有些外科医生在 PAO 之前就在关节镜下实施了这项技术。α角>55°、IRF减少和股骨转位减少是增加OCP几率的相关因素。未来更多的研究将有助于确定 OCP 如何影响患者的预后。证据等级:三级。
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引用次数: 0
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The Iowa orthopaedic journal
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