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Jeyaraman M, Jeyaraman N, Nallakumarasamy A, Iyengar KP, Jain VK, Potty AG, Gupta A. Silver nanoparticle technology in orthopaedic infections. World J Orthop 2023; 14:662-668. [PMID: 37744720 PMCID: PMC10514710 DOI: 10.5312/wjo.v14.i9.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/24/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] [Imported: 09/14/2023] Open
Abstract
The irrational and prolonged use of antibiotics in orthopaedic infections poses a major threat to the development of antimicrobial resistance. To combat antimicrobial resistance, researchers have implemented various novel and innovative modalities to curb infections. Nanotechnology involves doping ions/metals onto the scaffolds to reach the target site to eradicate the infective foci. In this connotation, we reviewed silver nanoparticle technology in terms of mechanism of action, clinical applications, toxicity, and regulatory guidelines to treat orthopaedic infections.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
- Department of Orthopaedics, South Texas Orthopaedic Research Institute, Laredo, TX 78045, United States
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
| | - Arulkumar Nallakumarasamy
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600077, Tamil Nadu, India
| | - Karthikeyan P Iyengar
- Department of Trauma and Orthopaedics, Southport & Ormskirk Hosp NHS Trust Southport, Richmond PR8 6PN, Southport, United Kingdom
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, Delhi 110001, New Delhi, India
| | - Anish G Potty
- Department of Orthopaedics, South Texas Orthopaedic Research Institute, Laredo, TX 78045, United States
| | - Ashim Gupta
- Department of Orthopaedics, South Texas Orthopaedic Research Institute, Laredo, TX 78045, United States
- Department of Regenerative Medicine, Regenerative Orthopaedics, Noida 201301, Uttar Pradesh, India
- Department of Regenerative Medicine, Future Biologics, Lawrenceville, GA 30043, United States
- Department of Regenerative Medicine, BioIntegarte, Lawrenceville, GA 30043, United States
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Chen XX, Tian CW, Bai LY, Zhao YK, Zhang C, Shi L, Zhang YW, Xie WJ, Zhu HY, Chen H, Rui YF. Relationships among body weight, lipids and bone mass in elderly individuals with fractures: A case-control study. World J Orthop 2023; 14:720-732. [PMID: 37744715 PMCID: PMC10514712 DOI: 10.5312/wjo.v14.i9.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/15/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] [Imported: 09/14/2023] Open
Abstract
BACKGROUND The prevalence of osteoporosis and low bone mass is steadily rising each year. Low body weight is commonly linked to diminished bone mass and serves as a robust predictor of osteoporosis. Nonetheless, the connection between body mass index (BMI), bone mineral density, and lipid profiles among the elderly remains elusive. AIM To examine the association between BMI and bone mass, explore the correlation between lipid profiles and bone mass, and delve into the interplay between lipid metabolism and bone health. METHODS The study included 520 patients aged ≥ 65 years (178 men and 342 women). Age, sex, weight, and height were recorded. Femoral neck bone mineral density and T scores were determined using a dual-energy X-ray absorptiometry scanner. Blood calcium (Ca), phosphorus (P), albumin (ALB), alkaline phosphatase (ALP), aspartate aminotransferase, alanine aminotransferase, triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were measured. Patients were classified by sex (male and female), age (65-79 years and ≥ 80 years), and T score (normal bone mineral density, osteopenia and osteoporosis). RESULTS Age, sex, BMI, and ALP and TG levels were independent risk factors for osteoporosis. For the 65-79- and ≥ 80-year-old groups, females presented lower T scores than males. Ca, P, ALB, ALP, TC, HDL and LDL levels were significantly different between men and women in the 65-79-year-old group. In addition, BMI and TG levels were significantly decreased in osteoporotic patients compared with patients with normal bone mass. TC levels declined in 65- to 79-year-old male and female osteoporosis patients. In the group of women aged ≥ 80 years, osteoporotic patients showed significantly increased ALP levels. Furthermore, we found positive correlations between BMI and TG levels in the male and female patient groups. However, we found no significant differences in ALB, Ca, P, HDL and LDL levels in osteoporotic patients compared to patients with normal bone mass. CONCLUSION Osteoporotic patients showed significantly decreased BMI and TG levels compared with those with normal bone mass. BMI showed positive correlations with TG levels in male and female patients. These results indicate correlations between BMI and bone mass and between lipid profiles and bone mass.
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Affiliation(s)
- Xiang-Xu Chen
- Department of Orthopaedics, Trauma Center, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Chu-Wei Tian
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Li-Yong Bai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ya-Kuan Zhao
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Cheng Zhang
- Department of Orthopaedics, Trauma Center, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Liu Shi
- Department of Orthopaedics, Trauma Center, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Yuan-Wei Zhang
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Wen-Jun Xie
- Department of Orthopaedics, Trauma Center, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Huan-Yi Zhu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Hui Chen
- Department of Orthopaedics, Trauma Center, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Yun-Feng Rui
- Department of Orthopaedics, Trauma Center, Southeast University, Nanjing 210009, Jiangsu Province, China
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Weber KS, Jensen CL, Petersen MM. Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts: A single-center experience. World J Orthop 2023; 14:698-706. [PMID: 37744716 PMCID: PMC10514711 DOI: 10.5312/wjo.v14.i9.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023] [Imported: 09/14/2023] Open
Abstract
BACKGROUND Aneurysmal bone cysts (ABC) are benign cystic bone tumors of an osteolytic and locally aggressive nature. As an alternative to the primary treatment of choice, which consists of curettage with bone grafting, alternative treatment methods with promising results have been described. At our department, we have, in recent years, used percutaneous sclerotherapy with polidocanol. The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol. AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC. METHODS Twenty-two consecutive patients (median age 12.5 years; range 1-27) with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively. Eleven patients (48%) had undergone different forms of previous treatment with recurrence. Under general anesthesia and fluoroscopic guidance, repeated percutaneous injections of 4mg polidocanol/kg body weight were performed. Through review of the electronic medical records, the following were identified: healing and recurrence rate, number of treatments, gender, age, comorbidity, location of the tumor and side effects / complications, as well as any previous surgery for ABC. The median length of radiographic follow-up was 19.5 mo. RESULTS All ABCs except one (96%) showed healing or stable disease after a median of 4 (range 1-8) injections. Complete clinical and radiographic healing was observed in 16 cysts (70%), while partial radiographic healing with resolution of pain was seen in 6 cases (26%) and considered as stable disease. The cyst that failed to heal had previously undergone curettage twice with recurrence. One patient with a large pelvic ABC experienced, right after two injections, a sudden drop in blood pressure, which could quickly be reversed. One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity. Beyond that, no complications were observed. CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts. In our series of both primary and recurrent cysts, it showed the ability to achieve healing or stable disease in 22 of 23 cases (96%). Further studies are needed to decide if this provides a long-lasting effect.
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Amoako-Tawiah P, Love H, Chacko Madathilethu J, LaCourse J, Fortune AE, Sims JMG, Ampat G. Use of orthotics with orthotic sandals versus the sole use of orthotics for plantar fasciitis: Randomised controlled trial. World J Orthop 2023; 14:707-719. [PMID: 37744719 PMCID: PMC10514714 DOI: 10.5312/wjo.v14.i9.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023] [Imported: 09/14/2023] Open
Abstract
BACKGROUND Plantar fasciitis (PF) affects around 10% of the population. Prefabricated orthotics with arch support has been shown to provide symptom relief in PF by decreasing the repetitive stress sustained by the plantar fascia. However, prefabricated orthotics are only effective when shoes are worn, meaning the foot may be left unsupported when it is impractical to wear shoes. Using orthotic sandals in conjunction with prefabricated orthotics may increase PF symptom relief, as they can be worn inside the home, extending the period in which the foot is supported. AIM To compare the combined use of prefabricated orthotics and orthotic sandals vs the sole use of prefabricated orthotics in the treatment of PF. METHODS 98 participants with PF were randomised into two groups. The intervention group received the Aetrex L420 Compete orthotics and the Aetrex L3000 Maui Flips (orthotic sandals), whilst the control group received the Aetrex L420 Compete orthotics only. Foot pain was assessed both by the numerical rating scale (NRS) and the pain sub-scale of the foot health status questionnaire (FHSQ). Foot functionality was measured using the function sub-scale of the FHSQ. Symptom change was measured using the global rating of change scale (GROC). RESULTS Foot pain scores measured both by NRS and FHSQ pain sub-scale showed statistically significant reductions in foot pain in both groups (P < 0.05) at six months. Both groups also reported statistically significant improvements (P < 0.05) in function as measured by the FHSQ function subscale and improvement of symptoms as measured by the GROC scale. Between-group analysis showed that the intervention group with the combined use of orthotics and orthotic sandals scored better on all four outcome measures as compared to the control group with the sole use of orthotics. However, the between-group analysis only reached statistical significance on the NRS pain score (P < 0.05). CONCLUSION Combined use of prefabricated orthotics and orthotic sandals provides a greater decrease in foot pain and improvement in foot function in PF compared to using prefabricated orthotics alone.
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Affiliation(s)
- Portia Amoako-Tawiah
- School of Medicine, University of Liverpool, Merseyside, Liverpool L69 3GE, United Kingdom
| | - Holly Love
- School of Medicine, University of Liverpool, Merseyside, Liverpool L69 3GE, United Kingdom
| | | | - Jessica LaCourse
- School of Medicine, University of Liverpool, Merseyside, Liverpool L69 3GE, United Kingdom
| | - Alice E Fortune
- School of Medicine, University of Liverpool, Merseyside, Liverpool L69 3GE, United Kingdom
| | - Jonathan M G Sims
- Research Unit, Talita Cumi Ltd., Merseyside, Southport PR8 3NS, United Kingdom
| | - George Ampat
- School of Medicine, University of Liverpool, Merseyside, Liverpool L69 3GE, United Kingdom
- Research Unit, Talita Cumi Ltd., Merseyside, Southport PR8 3NS, United Kingdom
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Patrick CM, Snowden J, Eckhoff MD, Green CK, Scanaliato JP, Dunn JC, Parnes N. Epidemiology of shoulder dislocations presenting to United States emergency departments: An updated ten-year study. World J Orthop 2023; 14:690-697. [PMID: 37744717 PMCID: PMC10514709 DOI: 10.5312/wjo.v14.i9.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/05/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] [Imported: 09/14/2023] Open
Abstract
BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability. However, there is a paucity of current data available regarding the epidemiological trends of this injury. AIM To provide an updated, comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States. We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events. METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021. Incidence, age, sex, and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95% confidence intervals (CI). RESULTS In total, an estimated 773039 shoulder dislocations (CI: 640598-905481) presented to emergency rooms across the United States during the study period. The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years. Significantly more male patients sustained dislocations than female patients (537189, 69.5%, vs 235834, 30.5%, P < 0.001). With regard to associated consumer products, sports and recreation equipment were involved in the highest proportion of incidents (44.31%), followed by home structures and construction materials (21.22%), and home furnishings, fixtures, and accessories (21.21%). Regarding product sub-groups, stairs, ramps, landings, floors was cited in the greatest number of cases (131745). CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons. Male adolescents sustained the highest proportion of dislocations, with a peak incidence in age group 15-20 years, predominantly secondary to participation in sporting and recreational activities. Conversely, women experienced a relatively consistent incidence of dislocation throughout their lifespan. After age 63, the incidence rate of dislocations in females was found to surpass that observed in males.
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Affiliation(s)
- Cole M Patrick
- Department of Orthopaedics, William Beaumont Army Medical Center, Fort Bliss, TX 79918, United States
| | - Josiah Snowden
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76129, United States
| | - Michael D Eckhoff
- Department of Orthopaedics, William Beaumont Army Medical Center, Fort Bliss, TX 79918, United States
| | - Clare K Green
- School of Medicine and Health Sciences, George Washington University, Washington, WA 20052, United States
| | - John P Scanaliato
- Department of Orthopaedics, William Beaumont Army Medical Center, Fort Bliss, TX 79918, United States
| | - John C Dunn
- Department of Orthopaedics, William Beaumont Army Medical Center, Fort Bliss, TX 79918, United States
| | - Nata Parnes
- Department of Orthopaedic Surgery, Carthage Area Hospital, Carthage, NY 13619, United States
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Bondarenko S, Filipenko V, Ashukina N, Maltseva V, Ivanov G, Lazarenko I, Sereda D, Schwarzkopf R. Comparative study in vivo of the osseointegration of 3D-printed and plasma-coated titanium implants. World J Orthop 2023; 14:682-689. [PMID: 37744721 PMCID: PMC10514715 DOI: 10.5312/wjo.v14.i9.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] [Imported: 09/14/2023] Open
Abstract
BACKGROUND Total hip arthroplasty is a common surgical treatment for elderly patients with osteoporosis, particularly in postmenopausal women. In such cases, highly porous acetabular components are a favorable option in achieving osseointegration. However, further discussion is needed if use of such acetabular components is justified under the condition of normal bone mass. AIM To determine the features of osseointegration of two different types of titanium implants [3-dimensional (3D)-printed and plasma-coated titanium implants] in bone tissue of a distal metaphysis in a rat femur model. METHODS This study was performed on 20 white male laboratory rats weighing 300-350 g aged 6 mo. Rats were divided into two groups of 10 animals, which had two different types of implants were inserted into a hole defect (2 × 3 mm) in the distal metaphysis of the femur: Group I: 3D-printed titanium implant (highly porous); Group II: Plasma-coated titanium implant. After 45 and 90 d following surgery, the rats were sacrificed, and their implanted femurs were extracted for histological examination. The relative perimeter (%) of bone trabeculae [bone-implant contact (BIC%)] and bone marrow surrounding the titanium implants was measured. RESULTS Trabecular bone tissue was formed on the 45th day after implantation around the implants regardless of their type. 45 d after surgery, group I (3D-printed titanium implant) and group II (plasma-coated titanium implant) did not differ in BIC% (83.51 ± 8.5 vs 84.12 ± 1 .73; P = 0.838). After 90 d, the BIC% was higher in group I (87.04 ± 6.99 vs 81.24 ± 7.62; P = 0.049), compared to group II. The relative perimeter of the bone marrow after 45 d did not differ between groups and was 16.49% ± 8.58% for group I, and 15.88% ± 1.73% for group II. Futhermore, after 90 d, in group I the relative perimeter of bone marrow was 1.4 times smaller (12.96 ± 6.99 vs 18.76 ± 7.62; P = 0.049) compared to the relative perimeter of bone marrow in group II. CONCLUSION The use of a highly porous titanium implant, manufactured with 3D printing, for acetabular components provides increased osseointegration compared to a plasma-coated titanium implant.
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Affiliation(s)
- Stanislav Bondarenko
- Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv 61024, Ukraine
| | - Volodymyr Filipenko
- Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv 61024, Ukraine
| | - Nataliya Ashukina
- Laboratory of Connective Tissue Morphology, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv 61024, Ukraine
| | - Valentyna Maltseva
- Laboratory of Connective Tissue Morphology, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv 61024, Ukraine
| | - Gennadiy Ivanov
- Experimental Pathology, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv 61024, Ukraine
| | - Iurii Lazarenko
- Department of Traumatology, Military medical clinical center of the Central region, Vinnytsia 21018, Ukraine
| | - Dmytro Sereda
- Department of Surgery, Odesa city hospital 11, Odesa 65006, Ukraine
| | - Ran Schwarzkopf
- Hospital for Joint Diseases, NYU Langone Orthopedic Hospital, NY 10003, United States
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Zhou CX, Wang F, Zhou Y, Fang QZ, Zhang QB. Formation process of extension knee joint contracture following external immobilization in rats. World J Orthop 2023; 14:669-681. [PMID: 37744718 PMCID: PMC10514713 DOI: 10.5312/wjo.v14.i9.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023] [Imported: 09/14/2023] Open
Abstract
BACKGROUND Current research lacks a model of knee extension contracture in rats. AIM To elucidate the formation process of knee extension contracture. METHODS We developed a rat model using an aluminum external fixator. Sixty male Sprague-Dawley rats with mature bones were divided into the control group (n = 6) and groups that had the left knee immobilized with an aluminum external fixator for 1, 2, and 3 d, and 1, 2, 3, 4, 6, and 8 wk (n = 6 in each group). The passive extension range of motion, histology, and expression of fibrosis-related proteins were compared between the control group and the immobilization groups. RESULTS Myogenic contracture progressed very quickly during the initial 2 wk of immobilization. After 2 wk, the contracture gradually changed from myogenic to arthrogenic. The arthrogenic contracture progressed slowly during the 1st week, rapidly progressed until the 3rd week, and then showed a steady progression until the 4rd week. Histological analyses confirmed that the anterior joint capsule of the extended fixed knee became increasingly thicker over time. Correspondingly, the level of transforming growth factor beta 1 (TGF-β1) and phosphorylated mothers against decapentaplegic homolog 2 (p-Smad2) in the anterior joint capsule also increased with the immobilization time. Over time, the cross-sectional area of muscle fibers gradually decreased, while the amount of intermuscular collagen and TGF-β1, p-Smad2, and p-Smad3 was increased. Unexpectedly, the amount of intermuscular collagen and TGF-β1, p-Smad2, and p-Smad3 was decreased during the late stage of immobilization (6-8 wk). The myogenic contracture was stabilized after 2 wk of immobilization, whereas the arthrogenic contracture was stabilized after 3 wk of immobilization and completely stable in 4 wk. CONCLUSION This rat model may be a useful tool to study the etiology of joint contracture and establish therapeutic approaches.
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Affiliation(s)
- Chen-Xu Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Feng Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Yun Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Qiao-Zhou Fang
- The Second Clinical Medicine College, Anhui Medical University, Hefei 230000, Anhui Province, China
| | - Quan-Bing Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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Narayana Murthy S, Cheruvu MS, Siddiqui RS, Sharma N, Dass D, Ali A. Survival analysis in nonagenarian patients with non-hip lower limb fractures. World J Orthop 2023; 14:621-629. [PMID: 37662665 PMCID: PMC10473906 DOI: 10.5312/wjo.v14.i8.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/30/2023] [Accepted: 07/27/2023] [Indexed: 08/17/2023] [Imported: 08/17/2023] Open
Abstract
BACKGROUND The United Kingdom has an aging population with nearly 1 in 5 being over the age of 65, and over 0.5 million over the age of 90. The treatment of acute fractures of the lower limb in the nonagenarian cohort of patients poses a technical challenge to orthopaedic surgeons. AIM To report the fracture incidence, survival outcomes of treating acute non-hip lower limb fractures in nonagenarians in Major Trauma Centre. METHODS Thirty Lower limb long bone fractures in patients of age from 90 to 99 years were identified during 12-mo at a Level 1 trauma centre from a computerized database. A retrospective evaluation performed for fracture incidence, treatment, length of hospital duration and mortality at 30-d, 1-year and 2-year. RESULTS Thirty fractures (28 patients) were identified, twenty-four fractures were treated with surgery (mean age 93 years SD ± 2.59) and 6 managed conservatively (mean age 94 years SD ± 2.07). The mean length of the hospital stay was 18.2 d for both groups. The 30-d, 1-year and 2-year mortality risks were 1/23, 6/23 and 9/23 (4%, 26% and 39%) in the surgery group and 0/5, 1/5 and 2/5 (0%, 20% and 40%) in the conservative group, with no evidence for a difference between the two groups at any time point. CONCLUSION Nonagenarians in the surgical group had similar length of hospital stay and mortality risks as those treated conservatively. Patients with fewer comorbidities and admitted from their own home were offered surgery.
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Affiliation(s)
- Sanjay Narayana Murthy
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Stoke-On-Trent ST4 6QG, United Kingdom
| | - Manikandar Srinivas Cheruvu
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Stoke-On-Trent ST4 6QG, United Kingdom
| | - Raheel Shakoor Siddiqui
- Department of General Surgery, Birmingham Heartlands Hospital, Birmingham B9 5SS, United Kingdom
| | - Nikhil Sharma
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Stoke-On-Trent ST4 6QG, United Kingdom
| | - Debashis Dass
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Stoke-On-Trent ST4 6QG, United Kingdom
| | - Ashique Ali
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Stoke-On-Trent ST4 6QG, United Kingdom
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Tsikopoulos K, Drago L, Meroni G, Kitridis D, Chalidis B, Papageorgiou F, Papaioannidou P. In vitro laboratory infection research in orthopaedics: Why, when, and how. World J Orthop 2023; 14:598-603. [PMID: 37662661 PMCID: PMC10473912 DOI: 10.5312/wjo.v14.i8.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/07/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] [Imported: 08/17/2023] Open
Abstract
The musculoskeletal system involves multiple tissues which are constantly exposed to being exposed to various biological and mechanical stimuli. As such, isolating and studying a particular system from a complex human clinical environment is not always a realistic expectation. On top of that, recruitment limitations, in addition to the nature of orthopaedic interventions and their associated cost, sometimes preclude consideration of human trials to answer a clinical question. Therefore, in this mini review, we sought to rationalize the rapid evolution of biomedical research at a basic scientific level and explain why the perception of orthopaedic conditions has fundamentally changed over the last decades. In more detail, we highlight that the number of orthopaedic in vitro publications has soared since 1990. Last but not least, we elaborated on the minimum requirements for conducting a scientifically sound infection-related laboratory experiment to offer valuable information to clinical practitioners. We also explained the rationale behind implementing molecular biology techniques, ex vivo experiments, and artificial intelligence in this type of laboratory research.
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Affiliation(s)
- Konstantinos Tsikopoulos
- 1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Lorenzo Drago
- Department of Biomedical Sciences for Health, School of Medicine, University of Milan, Milan 20133, Italy
| | - Gabriele Meroni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20133, Italy
| | - Dimitrios Kitridis
- 1st Department of Orthopaedic, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Byron Chalidis
- 1st Department of Orthopaedic, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Fotios Papageorgiou
- Department of Orthopaedic Surgery, 404 General Army Hospital, Larisa 41222, Greece
| | - Paraskevi Papaioannidou
- 1st Department of Pharmacology, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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Elbardesy H, Anazor F, Mirza M, Aly M, Maatough A. Cemented versus uncemented stems for revision total hip replacement: A systematic review and meta-analysis. World J Orthop 2023; 14:630-640. [PMID: 37662666 PMCID: PMC10473907 DOI: 10.5312/wjo.v14.i8.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/20/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] [Imported: 08/17/2023] Open
Abstract
BACKGROUND The popularity of uncemented stems in revision total hip arthroplasty (THA) has increased in the last decade. AIM To assess the outcomes of both cemented and uncemented stems after mid-term follow up. METHODS This study was performed following both the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement and the Cochrane Handbook for systematic reviews and meta-analysis guidelines. Articles were chosen irrespective of country of origin or language utilized for the article full texts. This paper included studies that reviewed revision THA for both cemented or uncemented long stems. RESULTS Three eligible studies were included in the meta-analysis. Analysis was conducted by using Review Manager version 5.3. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used random-effect models. There were no significant differences found for intraoperative periprosthetic fractures [risk ratio (RR) = 1.25; 95% confidence interval (CI): 0.29-5.32; P = 0.76], aseptic loosening (RR = 2.15, 95%CI: 0.81-5.70; P = 0.13), dislocation rate (RR = 0.50; 95%CI: 0.10-2.47; P = 0.39), or infection rate (RR = 0.99, 95%CI: 0.82-1.19; P = 0.89), between the uncemented and the cemented long stems for revision THA after mid-term follow-up. CONCLUSION This study has evaluated the mid-term outcomes of both cemented and uncemented stems at first-time revision THA. In summary, there were no significant differences in the dislocation rate, aseptic loosening, intraoperative periprosthetic fracture and infection rate between the two cohorts.
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Affiliation(s)
- Hany Elbardesy
- Department of Trauma and Orthopaedics, University of Manitoba, Winnipeg MB R3T2N2, Manitoba, Canada
| | - Fitzgerald Anazor
- Nottingham University Hospitals NHS Foundation Trust, Nottingham NG7 2UH, United Kingdom
| | - Mohammad Mirza
- Department of Trauma and Orthopaedics, East Kent University Hospitals NHS Foundation Trust, Ashford TN240LY, Kent, United Kingdom
| | - Mohamed Aly
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London HA7 4LP, United Kingdom
| | - Annis Maatough
- Department of Trauma and Orthopaedics, East Kent University Hospitals NHS Foundation Trust, Ashford TN240LY, Kent, United Kingdom
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Kwan YH, Teo HLT, Dinesh SK, Loo WL. Metallosis with spinal implant loosening after spinal instrumentation: A case report. World J Orthop 2023; 14:651-661. [PMID: 37662668 PMCID: PMC10473909 DOI: 10.5312/wjo.v14.i8.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/26/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023] [Imported: 08/17/2023] Open
Abstract
BACKGROUND Spinal metallosis is a rare complication following spinal instrumentation whereby an inflammatory response to the metal implants results in the development of granulomatous tissue. CASE SUMMARY We describe the case of a 78-year-old woman who had recurrence of back pain 5 years after lumbar spine posterior decompression and instrumented fusion. Lumbar spine radiographs showed hardware loosening and magnetic resonance imaging showed adjacent segment disease. Revision surgery revealed evidence of metallosis intraoperatively. CONCLUSION Spinal metallosis can present several years after instrumentation. Radiography and computed tomography may demonstrate hardware loosening secondary to metallosis. Blood metal concentrations associated with spinal metallosis have yet to be established. Hence, metallosis is still an intraoperative and histopathological diagnosis. The presence of metallosis after spinal instrumentation likely indicates a more complex underlying problem: Pseudarthrosis, failure to address sagittal balance, infection, and cross-threading of set screws. Hence, identifying metallosis is important, but initiating treatment promptly for symptomatic implant loosening is of greater paramount.
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Affiliation(s)
- Yiu Hin Kwan
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore 529889, Singapore
| | - Hong Lee Terry Teo
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore 529889, Singapore
| | - Shree Kumar Dinesh
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore 529889, Singapore
| | - Wee Lim Loo
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore 529889, Singapore
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12
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Kraal T, Struijs PAA, Langenberg LC, van Bergen CJA. Fractures around the shoulder in the skeletally immature: A scoping review. World J Orthop 2023; 14:604-611. [PMID: 37662664 PMCID: PMC10473910 DOI: 10.5312/wjo.v14.i8.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/17/2023] [Imported: 08/17/2023] Open
Abstract
Fractures around the shoulder girdle in children are mainly caused by sports accidents. The clavicle and the proximal humerus are most commonly involved. Both the clavicle and the proximal humerus have a remarkable potential for remodeling, which is why most of these fractures in children can be treated conservatively. However, the key is to understand when a child benefits from surgical management. Clear indications for surgery of these fractures are lacking. This review focuses on the available evidence on the management of clavicle and proximal humerus fractures in children. The only strict indications for surgery for diaphyseal clavicle fractures in children are open fractures, tenting of the skin with necrosis, associated neurovascular injury, or a floating shoulder. There is no evidence to argue for surgery of displaced clavicle fractures to prevent malunion since most malunions are asymptomatic. In the rare case of a symptomatic malunion of the clavicle in children, corrective osteosynthesis is a viable treatment option. For proximal humerus fractures in children, treatment is dictated by the patient's age (and thus remodeling potential) and the amount of fracture displacement. Under ten years of age, even severely displaced fractures can be treated conservatively. From the age of 13 and onwards, surgery has better outcomes for severely displaced (Neer types III and IV) fractures. Between 10 and 13 years of age, the indications for surgical treatment are less clear, with varying cut-off values of angulation (30-60 degrees) or displacement (1/3 - 2/3 shaft width) in the current literature.
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Affiliation(s)
- Tim Kraal
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Centers, Amsterdam 1105 AZ, Netherlands
| | - Peter AA Struijs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Centers, Amsterdam 1105 AZ, Netherlands
| | - Lisette C Langenberg
- Department of Orthopedic Surgery, NoordWest Ziekenhuisgroep, Alkmaar 1815 JD, Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center – Sophia Children’s Hospital, Rotterdam 3015 GD, Netherlands
| | - Christiaan JA van Bergen
- Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center – Sophia Children’s Hospital, Rotterdam 3015 GD, Netherlands
- Department of Orthopedic Surgery, Amphia, Breda 4818 CK, Netherlands
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13
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Zicaro JP, Garrido N, Garcia-Mansilla I, Yacuzzi C, Costa-Paz M. Failure rate, return-to-sports and magnetic resonance imaging after meniscal repair: 119 patients with 7 years mean follow up. World J Orthop 2023; 14:612-620. [PMID: 37662662 PMCID: PMC10473908 DOI: 10.5312/wjo.v14.i8.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/18/2023] [Accepted: 06/14/2023] [Indexed: 08/17/2023] [Imported: 08/17/2023] Open
Abstract
BACKGROUND One of the most important factors to consider in relation to meniscal repair is the high failure rate reported in the existing literature. AIM To evaluate failure rates, return to sports (RTS) rate, clinical outcomes and magnetic resonance image (MRI) evaluation after meniscus suture repair for longitudinal tears at a minimum 2-year-follow-up. METHODS We conducted a retrospective review of meniscal repairs between January 2004 and December 2018. All patients treated for longitudinal tears associated or not with an anterior cruciate ligament reconstruction (ACL-R) were included. Meniscal ramp lesions, radial and root tears, associated with multiligament injuries, tibial fracture and meniscal allograft transplants were excluded. Surgical details and failure rate, defined as symptomatic patients who underwent a revision surgery, were analyzed. As isolated bucket handle tears (BHTs) were usually associated with higher failure rates, we compared BHTs and not BHTs associated or not with an ACL-R. Since 2014, the inside-out technique using cannulas and suture needles with 2-0 Tycron began to predominate. In addition, the number of stitches per repair was increased. In view of differences in surgical technique, we compared two different cohorts: before and after 2014. We recorded the RTS according to the level achieved and the time to RTS. Lysholm and IKDC scores were recorded. Patients were studied with x-rays and MRI as standard postoperative control. RESULTS One hundred and nineteen patients were included with a mean follow up of 7 years (SD: 4.08). Overall failure rate was 20.3% at a mean 20.1 mo. No statistically significant differences were found when comparing failure for medial and lateral meniscal repair (22.7% and 15.3%, P = 0.36), BHTs and not BHTs (26% and 17.6%, P = 0.27), isolated or associated with an ACL-R (22.9% and 18%, P = 0.47), or when comparing only BHTs associated with an ACL-R (23% and 27.7%, P = 0.9) or not. When comparing cohorts before and after 2014, we found a significant decrease in the overall failure rate from 26% to 11% (P < 0.03). Isolated lesions presented a decrease from 28% to 6.6% (P = 0.02), BHTs from 34% to 8% (P = 0.09) and those associated with an ACL-R from 25% to 10% (P = 0.09). Mean RTS time was 6.5 mo in isolated lesions and 8.64 mo when associated with an ACL-R. Overall, 56% of patients returned to the same sport activity level. Mean pre and postoperative Lysholm scores were 64 and 85 (P = 0.02), and IKDC 58 and 70 (P = 0.03). Out of 84 asymptomatic patients evaluated with MRI, 39% were classified as "not healed" and 61% as "healed". CONCLUSION Even though the overall failure rate of our series was 20.3%, we found a statistically significant decrease from 26% to 11%, not only for isolated lesions, but also for BHT's and those associated with an ACL-R when comparing our series in two different cohorts, most probably due to improvements in surgical technique.
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Affiliation(s)
- Juan Pablo Zicaro
- Department of Knee, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina
| | - Nicolas Garrido
- Department of Knee, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina
| | | | - Carlos Yacuzzi
- Department of Knee, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina
| | - Matias Costa-Paz
- Department of Knee, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina
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14
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Chen WY, Xiao X, Pan C, Huang FH, Xu HY, Wei QJ, Jiang H. Scientific publications on orthopedic surgery from three major East Asian countries (2012-2021). World J Orthop 2023; 14:641-650. [PMID: 37662667 PMCID: PMC10473913 DOI: 10.5312/wjo.v14.i8.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/08/2023] [Accepted: 07/07/2023] [Indexed: 08/17/2023] [Imported: 08/17/2023] Open
Abstract
BACKGROUND East Asia is the most dynamic region in the world and includes three major countries: Japan, South Korea and China. Due to rapid economic growth, orthopedics research in East Asia has achieved great advances during the past 10 years. However, the current status of orthopedic research in Japan, South Korea and China is still unclear. AIM To understand the current status of orthopedic research in Japan, South Korea, and China. METHODS Journals listed in the ''Orthopedics'' category of Science Citation Index Expanded subject categories were included. The PubMed and Web of Knowledge electronic databases were searched to identify scientific publications from the selected journals written by researchers from Japan, South Korea and China. A systematic analysis was conducted to analyze orthopedic research articles published in the three countries based on the number of articles, study design, impact factors (IFs) and citations. Furthermore, we also ranked the top 10 countries worldwide with the highest publications in the past 10 years. Additionally, we ranked the top 10 countries with the highest number of publications in the world in the past 10 years. Statistical analyses were performed using SPSS 20.0 software (SPSS Inc., Chicago, IL, United States), and statistical results are given in Tables and Figures. The Kruskal-Wallis test and the Mann-Whitney test were used to detect differences between countries. The tendency regarding the number of articles was analyzed by curvilinear regression. A two-tailed P < 0.05 was considered significant. RESULTS From 2012-2021, a total of 144518 articles were published in the 86 selected orthopedic journals. During this period, the number of worldwide published orthopedic articles has shown an annual increasing trend. A total of 27164 orthopedic research articles were published by Japan, South Korea and China during the past 10 years; 44.32% were from China, 32.98% were from Japan, and 22.70% were from South Korea. From 2012 to 2021, the annual number of articles markedly increased in each of the three countries. Over time, the worldwide share of articles increased substantially in South Korea (3.37% to 6.53%, P < 0.001) and China (5.29% to 9.61%, P < 0.001). However, the worldwide share of articles significantly decreased in Japan (5.22% to 3.80%, P < 0.001). The annual total IFs of articles from China were well above those of articles from Japan and South Korea (36597.69 vs 27244.48 vs 20657.83, P < 0.05). There was no significant difference among the articles in the top 10 high-IF orthopedics journals published from those three countries [South Korea (800) > China (787) > Japan (646), P > 0.05]. CONCLUSION Over the past 10 years, China's scientific publications in orthopedic journals have shown an increasing trend. Considering the relative scale of the populations, Japan and South Korea have outpaced China with respect to quality.
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Affiliation(s)
- Wei-You Chen
- Division of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xin Xiao
- Division of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Cheng Pan
- Division of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Fei-Hong Huang
- Division of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hong-Yuan Xu
- Division of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Qing-Jun Wei
- Department of Orthopedic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hua Jiang
- Division of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Department of Orthopedic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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15
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Mancino F, Yates PJ, Clark B, Jones CW. Use of topical vancomycin powder in total joint arthroplasty: Why the current literature is inconsistent? World J Orthop 2023; 14:589-597. [PMID: 37662663 PMCID: PMC10473911 DOI: 10.5312/wjo.v14.i8.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/28/2023] [Accepted: 04/20/2023] [Indexed: 08/17/2023] [Imported: 08/17/2023] Open
Abstract
Periprosthetic joint infection (PJI) is a rare but terrible complication in hip and knee arthroplasty, and the use of topical vancomycin powder (VP) has been investigated as a tool to potentially reduce its incidence. However, there remains no consensus on its efficacy. Therefore, the aim of this review is to provide an overview on the application of topical vancomycin in orthopaedic surgery focusing on the recent evidence and results in total joint arthroplasty. Several systematic reviews and meta-analyses on topical VP in hip and knee arthroplasty have been recently published reporting sometimes conflicting results. Apart from all being limited by the quality of the included studies (mostly level III and IV), confounding variables are often included potentially leading to biased conclusions. If taken into consideration the exclusive use of VP in isolation, the available data, although very limited, suggest that it does not reduce the infection rate in routine primary hip and knee arthroplasty. Therefore, we still cannot advise for a routinary application. A properly powered randomized-controlled trial would be necessary to clarify the role of VP in hip and knee arthroplasty. Based on the analysis of the current evidence, the use of topical VP appears to be safe when used locally in terms of systemic adverse reactions, hence, if proven to be effective, it could bring great benefits due to its low cost and accessibility.
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Affiliation(s)
- Fabio Mancino
- Department of Orthopaedics, Fiona Stanley Hospital, Perth 6150, Australia
| | - Piers J Yates
- Department of Orthopaedics, Fiona Stanley Hospital, Perth 6150, Australia
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia, Perth 6010, Australia
- Department of Orthopaedics, University of Western Australia, Perth 6009, Australia
| | - Benjamin Clark
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth 6150, Australia
| | - Christopher W Jones
- Department of Orthopaedics, Fiona Stanley Hospital, Perth 6150, Australia
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia, Perth 6010, Australia
- Department of Orthopaedics, Curtin University, Perth 6102, Australia
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16
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Bizzoca D, Piazzolla A, Moretti L, Vicenti G, Moretti B, Solarino G. Physiologic postoperative presepsin kinetics following primary cementless total hip arthroplasty: A prospective observational study. World J Orthop 2023; 14:547-553. [PMID: 37485426 PMCID: PMC10359746 DOI: 10.5312/wjo.v14.i7.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Presepsin is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in diagnosing and managing periprosthetic joint infections.
AIM To define the normal postoperative presepsin plasmatic curve, in patients undergoing primary cementless total hip arthroplasty (THA).
METHODS Patients undergoing primary cementless THA at our Institute were recruited. Inclusion criteria were: Primary osteoarthritis of the hip; urinary catheter time of permanence < 24 h; peripheral venous cannulation time of permanence < 24 h; no postoperative homologous blood transfusion administration and hospital stay ≤ 8 d. Exclusion criteria were: The presence of other articular prosthetic replacement or bone fixation devices; chronic inflammatory diseases; chronic kidney diseases; history of recurrent infections or malignant neoplasms; previous surgery in the preceding 12 mo; diabetes mellitus; immunosuppressive drug or corticosteroid assumption. All the patients received the same antibiotic prophylaxis. All the THA were performed by the same surgical and anaesthesia team; total operative time was defined as the time taken from skin incision to completion of skin closure. At enrollment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS) and C-reactive protein 24 h before arthroplasty and at 24, 48, 72 and 96 h postoperatively and at 3, 6 and 12-mo follow-up.
RESULTS A total of 96 patients (51 female; 45 male; mean age = 65.74 ± 5.58) were recruited. The mean PS values were: 137.54 pg/mL at baseline, 192.08 pg/mL at 24 h post-op; 254.85 pg/mL at 48 h post-op; 259 pg/mL at 72 h post-op; 248.6 pg/mL at 96-h post-op; 140.52 pg/mL at 3-mo follow-up; 135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up. In two patients (2.08%) a soft-tissue infection was observed; in these patients, higher levels (> 350 pg/mL) were recorded at 3-mo follow-up.
CONCLUSION The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection. The PS plasmatic concentration should be also assessed at 72 h post-operatively, evaluate the maximum postoperative PS value, and at 96 h post-operatively when a decrease of presepsin should be found. The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.
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Affiliation(s)
- Davide Bizzoca
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | - Andrea Piazzolla
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | - Lorenzo Moretti
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | | | - Biagio Moretti
- Di BraiN, University of Bari "Aldo Moro", Bari 70124, Italy
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Velasquez Garcia A, Ingala Martini L, Franco Abache A, Abdo G. Role of platelet-rich plasma in the treatment of rotator cuff tendinopathy. World J Orthop 2023; 14:505-515. [PMID: 37485430 PMCID: PMC10359750 DOI: 10.5312/wjo.v14.i7.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/11/2023] [Accepted: 05/15/2023] [Indexed: 07/18/2023] Open
Abstract
Shoulder pain is a common musculoskeletal complaint, and rotator cuff (RC) pathologies are one of the main causes. The RC undergoes various tendinopathic and avascular changes during the aging process. Other degenerative changes affecting its healing potential make it an appealing target for biological agents. Platelet-rich plasma (PRP) has demonstrated the potential to deliver a high concentration of several growth factors and anti-inflammatory mediators, and its clinical use is mainly supported by experiments that demonstrated its positive effect on muscle, ligaments, and tendinous cells. This review aimed to specify the role of PRP and its future applications in RC tendinopathies based on the current clinical evidence. Due to the different characteristics and conflicting outcomes, clinicians should use PRP with moderate expectations until more consistent evidence is available. However, it is reasonable to consider PRP in patients with contraindications to corticosteroid injections or those with risk factors for inadequate healing. Its autologous origin makes it a safe treatment, and its characteristics make it a promising option for treating RC tendinopathy, but the efficacy has yet to be established.
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Affiliation(s)
| | - Liborio Ingala Martini
- Department of Orthopedic Surgery, Hospital IVSS Dr. Luis Ortega, Porlamar 6301, Venezuela
- Department of Orthopedic Surgery, Hospital Clinicas del Este, Los Robles 6301, Venezuela
| | - Andres Franco Abache
- Department of Orthopedic Surgery, Hospital de Especialidades Guayaquil MSP, Guayaquil 090101, Ecuador
| | - Glen Abdo
- Department of Graduate Medical Education, Internal Medicine Residence Program, New York Medical College at St. Mary’s and St. Clare’s, Passaic, NJ 07055, United States
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18
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Kym D, Kaur J, Pham NS, Klein E, Langner JL, Wang E, Vorhies JS. Effectiveness of an early operating room start time in managing pediatric trauma. World J Orthop 2023; 14:516-525. [PMID: 37485431 PMCID: PMC10359751 DOI: 10.5312/wjo.v14.i7.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] [Imported: 07/18/2023] Open
Abstract
BACKGROUND The timing of operative treatment for pediatric supracondylar humerus fractures (SCHF) and femoral shaft fractures (FSF) remains controversial. Many fractures previously considered to be surgical emergencies, such as SCHF and open fractures, are now commonly being treated the following day. When presented with an urgent fracture overnight needing operative treatment, the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day.
AIM To describe the effect of a program allowing an early operating room (OR) start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.
METHODS Starting in October 2017, patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 21:00 the previous night and before 05:00. We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team.
RESULTS Of the 44 SCHF meeting inclusion criteria, 16 received treatment before implementation while 28 were treated after. After implementation, the mean wait time for surgery decreased by 4.8 h or 35.4% (13.4 h vs 8.7 h; P = 0.001). There were no significant differences in the operative duration, time in the post anesthesia care unit, and wait time for discharge. Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons. Whereas 57% of the surgeons believed that the program was effective, only 9% of anesthesiologists and 16% of nurses agreed. The program was ultimately discontinued given the dissatisfaction.
CONCLUSION Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders. Although the program produced promising results, it also created new conflicts within the OR staff that led to its discontinuation at our institution. Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.
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Affiliation(s)
- Dan Kym
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - Japsimran Kaur
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - Nicole Segovia Pham
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - Eric Klein
- Lucile Packard Children’s Hospital, Palo Alto, CA 94304, United States
| | - Joanna Lind Langner
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - Ellen Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - John Schoeneman Vorhies
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA 94304, United States
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19
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Shamseldeen NE, Hegazy MMA, Fayaz NA, Mahmoud NF. Instrumented assisted soft tissue mobilization vs extracorporeal shock wave therapy in treatment of myofascial pain syndrome. World J Orthop 2023; 14:572-581. [PMID: 37485429 PMCID: PMC10359744 DOI: 10.5312/wjo.v14.i7.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Active myofascial trigger points (TrPs) often occur in the upper region of the upper trapezius (UT) muscle. These TrPs can be a significant source of neck, shoulder, and upper back pain and headaches. These TrPs and their related pain and disability can adversely affect an individual’s everyday routine functioning, work-related productivity, and general quality of life.
AIM To investigate the effects of instrument assisted soft tissue mobilization (IASTM) vs extracorporeal shock wave therapy (ESWT) on the TrPs of the UT muscle.
METHODS A randomized, single-blind, comparative clinical study was conducted at the Medical Center of the Egyptian Railway Station in Cairo. Forty patients (28 females and 12 males), aged between 20-years-old and 40-years-old, with active myofascial TrPs in the UT muscle were randomly assigned to two equal groups (A and B). Group A received IASTM, while group B received ESWT. Each group was treated twice weekly for 2 weeks. Both groups received muscle energy technique for the UT muscle. Patients were evaluated twice (pre- and post-treatment) for pain intensity using the visual analogue scale and for pain pressure threshold (PPT) using a pressure algometer.
RESULTS Comparing the pre- and post-treatment mean values for all variables for group A, there were significant differences in pain intensity for TrP1 and TrP2 (P = 0.0001) and PPT for TrP1 (P = 0.0002) and TrP2 (P = 0.0001). Also, for group B, there were significant differences between the pre- and post-treatment pain intensity for TrP1 and TrP2 and PPT for TrP1 and TrP2 (P = 0.0001). There were no significant differences between the two groups in the post-treatment mean values of pain intensity for TrP1 (P = 0.9) and TrP2 (P = 0.76) and PPT for TrP1 (P = 0.09) and for TrP2 (P = 0.91).
CONCLUSION IASTM and ESWT are effective methods for improving pain and PPT in patients with UT muscle TrPs. There is no significant difference between either treatment method.
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Affiliation(s)
- Nourhan Elsayed Shamseldeen
- Department of Physical Therapy for Musculoskeletal Disorders & Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 14531, Egypt
| | - Mohammed Moustafa Aldosouki Hegazy
- Department of Physical Therapy for Musculoskeletal Disorders & Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 14531, Egypt
| | - Nadia Abdalazeem Fayaz
- Department of Physical Therapy for Musculoskeletal Disorders & Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 14531, Egypt
| | - Nesreen Fawzy Mahmoud
- Department of Physical Therapy for Musculoskeletal Disorders & Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 14531, Egypt
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Teng WH, Ditta A, Webber J, Pearce O. Excision of trochanteric bursa during total hip replacement: Does it reduce the incidence of post-operative trochanteric bursitis? World J Orthop 2023; 14:533-539. [PMID: 37485424 PMCID: PMC10359745 DOI: 10.5312/wjo.v14.i7.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/18/2023] [Imported: 07/18/2023] Open
Abstract
BACKGROUND Trochanteric bursitis is a common complication following total hip replacement (THR), and it is associated with high level of disability and poor quality of life. Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.
AIM To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.
METHODS This retrospective cohort study was conducted in the secondary care setting at a large district general hospital. Between January 2010 and December 2020, 954 patients underwent elective primary THR by two contemporary arthroplasty surgeons, one excising the bursa and the other not (at the time of THR). All patients received the same post-operative rehabilitation and were followed up for 1 year. We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis. Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.
RESULTS 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not. A total of 5 patients (incidence 0.5%) developed trochanteric bursitis following THR; 4 of whom had undergone bursectomy as part of their surgical approach, 1 who had not. There was no statistically significant difference between the two groups (Z value 1.00, 95%CI: -0.4% to 1.3%, P = 0.32). There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR; all of whom were treated with THR and synchronous trochanteric bursectomy, and 7 had resolution of their lateral buttock pains but 1 did not.
CONCLUSION Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis. However, it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.
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Affiliation(s)
- Wai-Huang Teng
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
| | - Adeel Ditta
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
| | - Jane Webber
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
| | - Oliver Pearce
- Division of Trauma and Orthopaedics, Milton Keynes University Hospital, Milton Keynes MK6 5LD, United Kingdom
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Abo-Elsoud M, Awad MI, Abdel Karim M, Khaled S, Abdelmoneim M. Internal fixator vs external fixator in the management of unstable pelvic ring injuries: A prospective comparative cohort study. World J Orthop 2023; 14:562-571. [PMID: 37485427 PMCID: PMC10359749 DOI: 10.5312/wjo.v14.i7.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/14/2023] [Accepted: 05/19/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently. There is a debate on using either an anterior subcutaneous pelvis internal fixator (INFIX) or an anterior supra-acetabular external fixator (EXFIX) to manage an unstable anterior pelvic ring fracture.
AIM To compare the functional and radiological outcomes and complications of INFIX vs EXFIX in managing unstable pelvic ring injuries.
METHODS A prospective cohort study included 54 patients with unstable pelvic ring fractures. The patients were divided into two groups; the INFIX group, in which 30 cases were fixed by INFIX, and the EXFIX group, in which 24 patients were treated by EXFIX. The average age in the EXFIX group was 31.17 years (16-57 years), while in the INFIX group, it was 34.5 years (17-53 years). The study included 20 (66.7%) males and 10 (33.3%) females in the INFIX group and 10 (41.7%) males and 14 (58.3%) females in the EXFIX group. The radiological outcomes were evaluated using Matta and Tornetta's score, and the functional outcomes using the Majeed score.
RESULTS The results revealed a statistically significant difference between both groups (P = 0.013) regarding radiological outcomes, according to Matta and Tornetta's score in favor of the INFIX group. Sitting, standing, and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules. It was significantly better among the INFIX group than the EXFIX group in all three modules. At the final follow-up, both groups had no statistically significant difference according to the Majeed score; 92.35 in the INFIX group and 90.99 in the EXFIX group (P = 0.513). A lower surgical site infection rate was noticed in the INFIX group (P = 0.007).
CONCLUSION Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures.
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Affiliation(s)
- Mohamed Abo-Elsoud
- Department of Orthopedics and Traumatology, Cairo University Hospitals, Cairo 11562, Egypt
| | - Mostafa I Awad
- Department of Trauma and Orthopedics, Mataria Teaching Hospital, Cairo 4540046, Egypt
| | - Mahmoud Abdel Karim
- Department of Orthopedics and Traumatology, Cairo University Hospitals, Cairo 11562, Egypt
| | - Sherif Khaled
- Department of Orthopedics and Traumatology, Cairo University Hospitals, Cairo 11562, Egypt
| | - Mohamed Abdelmoneim
- Department of Orthopedics and Traumatology, Cairo University Hospitals, Cairo 11562, Egypt
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Evola FR, Di Fede GF, Evola G, Barchitta M, Agodi A, Longo G. Locking plates for distal fibula fractures in young and elderly patients: A retrospective study. World J Orthop 2023; 14:540-546. [PMID: 37485428 PMCID: PMC10359748 DOI: 10.5312/wjo.v14.i7.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/16/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] [Imported: 07/18/2023] Open
Abstract
BACKGROUND Ankle fractures are common injuries in the young and elderly populations. To prevent post-traumatic arthritis, an anatomic reconstruction of the ankle structure is mandatory. Open reduction and internal fixation is the treatment of choice among orthopaedics. Conventional plates allow stability of the fracture if bone quality is present. Locking plates might offer an advantage for the treatment of lateral malleolar fracture in patients with comminution, severe instability, distal fractures, or osteoporotic bone. Our hospital introduced a new locking plate for fracture of the distal fibula.
AIM To evaluate locking plates in terms of outcomes and complications in young and elderly patients.
METHODS We retrospectively reviewed a total of 67 patients treated for displaced distal fibula fractures. Demographic data, number of comorbidities, use of inter fragmentary screw, complication, time of fracture healing, partial or full weight bearing, and reoperation were recorded for all patients. Clinical outcome was assessed by the American Orthopedic Foot and Ankle Society clinical scoring system. Radiographs were obtained at 4, 8, 12, 16, 20, and 24 wk until radiographic union was obtained.
RESULTS All patients displayed complete bony union on radiographic assessment, and no patients developed any serious complications. We observed two superficial infections, one delayed wound healing, and two plate intolerances. Significant differences were observed between the two age groups in terms of radiographic healing (11.9 wk in younger patients vs 13.7 wk in older patients; P = 0.011) and in the American Orthopedic Foot and Ankle Society score at 6 mo after surgery (88.2 in younger patients vs 86.0 in older patients; P = 0.001) and at 12 mo after surgery (92.6 in younger patients vs 90.0 in older patients; P = 0.000).
CONCLUSION Locking plates provide a stable and rigid fixation in multifragmentary and comminuted fractures or in the presence of poor bone quality.
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Affiliation(s)
- Francesco Roberto Evola
- Department of Surgery, Division of Orthopedics and Trauma Surgery, “Cannizzaro” Hospital, Catania 95100, Italy
| | - Giovanni Francesco Di Fede
- Department of Radiodiagnostics, Division of Radiology, “S. Marta and S. Venera” Hospital, Acireale 95024, Italy
| | - Giuseppe Evola
- Department of Surgery, Division of Surgery, “Garibaldi” Hospital, Catania 95100, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania 95100, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania 95100, Italy
| | - Gianfranco Longo
- Department of Surgery, Division of Orthopedics and Trauma Surgery, “Cannizzaro” Hospital, Catania 95100, Italy
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Zahra W, Seifo M, Cool P, Ford D, Okoro T. Clinical outcome of open ankle fractures in patients above 70 years of age. World J Orthop 2023; 14:554-561. [PMID: 37485433 PMCID: PMC10359747 DOI: 10.5312/wjo.v14.i7.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality. However, data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal.
AIM To evaluate the clinical outcomes following open ankle fracture management in patients older than 70. Our secondary aim is to look at predictors of poor outcomes.
METHODS Following local research and audit department registration, 22 years of prospectively collated data from an electronic database in a district general hospital were assessed. All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified. Demographic information, the nature, and the number of surgical interventions were collated. Complications, including surgical site infection (SSI), venous thromboembolic events (VTEs) during hospital stay, and mortality rate, were reviewed.
RESULTS A total of 37 patients were identified (median age: 84 years, range: 70-98); n = 30 females median age: 84 years, range: 70-97); n = 7 males median age: 74 years, range: 71-98)) who underwent surgical intervention after an open ankle fracture. Sixteen patients developed SSIs (43%). Superficial SSIs (n = 8) were managed without surgical intervention and treated with antibiotics and regular dressing changes. Deep SSIs (n = 8; 20%) required a median of 3 (range: 2-9) surgical interventions, with four patients requiring multiple washouts and one patient having metalwork removed. VTE incidence was 5% during the hospital stay. Eight patients died within 30 d, and mortality at one year was 19%. The 10-year mortality rate was 57%. The presence of a history of stroke, cancer, or prolonged inpatient stay was found to be predictive of lower survivorship in this population (log-rank test: cancer P = 0.008, stroke P = 0.001, length of stay > 33 d P = 0.015). The presence of a cardiac history was predictive of wound complications (logistic regression, P = 0.045). Age, number of operations, and diabetic history were found to be predictive of an increase in the length of stay (general linear model; age P < 0.001, number of operations P < 0.001, diabetes P = 0.041).
CONCLUSION An open ankle fracture in a patient older than 70 years has at least a 20% chance of requiring repeated surgical intervention due to deep SSIs. The presence of a cardiac history appears to be the main predictor for wound complications.
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Affiliation(s)
- Wajiha Zahra
- Department of Trauma and Orthopedics, Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ, United Kingdom
| | - Mina Seifo
- Department of Trauma and Orthopedics, Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ, United Kingdom
| | - Paul Cool
- Department of Trauma and Orthopedics, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, United Kingdom
- Department of Trauma and Orthopedics, Keele University, Stafford ST5 5BG, United Kingdom
| | - David Ford
- Department of Trauma and Orthopedics, Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ, United Kingdom
- Department of Trauma and Orthopedics, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, United Kingdom
| | - Tosan Okoro
- Department of Trauma and Orthopedics, Royal Shrewsbury Hospital, Shrewsbury SY3 8XQ, United Kingdom
- Department of Trauma and Orthopedics, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, United Kingdom
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Al-Gburi M, Al-Hamdani A, Rasmussen JV, Olsen BS. Low risk of postoperative ulnar nerve affection in surgically treated distal humeral fractures when the nerve is released in situ. World J Orthop 2023; 14:526-532. [PMID: 37485432 PMCID: PMC10359752 DOI: 10.5312/wjo.v14.i7.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Adult distal humeral fractures (DHF) comprise 2%-5% of all fractures and 30% of all elbow fractures. Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures. Open reduction and internal fixation (ORIF) are often the treatment of choice, but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality. Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.
AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.
METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF, elbow hemiarthroplasty (EHA) or total elbow arthroplasty (TEA) between January 2011 and December 2019. In all cases, the ulnar nerve was released in situ without anterior transposition. We used our institutional database to review patients’ medical records for demographics, fracture morphology, type of surgery and ulnar nerve affection immediately; records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up. Twenty-nine percent patients were excluded due to pre- or postoperative conditions. Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score. A total of 210 patients were eligible for interview, but 13 patients declined participation and 17 patients failed to respond. Thus, 180 patients were included.
RESULTS Mean age at surgery was 64 years (range 18-88 years); 121 (67.3%) patients were women; 59 (32.7%) were men. According to the AO/OTA classification system, we recorded 47 patients with type A3, 55 patients with type B and 78 patients with type C fractures. According to the McGowen Classification Score, mild ulnar nerve affection was reported in nine patients; severe affection, in two. A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection. In all, 111 patients were treated with arthroplasty (67 EHA, 44 TEA) of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection. No further treatment was provided.
CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition, independently of the treatment provided.
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Affiliation(s)
- Mustafa Al-Gburi
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Gentofte, Denmark
| | - Ali Al-Hamdani
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Gentofte, Denmark
| | - Jeppe Vejlgaard Rasmussen
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Gentofte, Denmark
| | - Bo Sanderhoff Olsen
- Section for Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Herlev and Gentofte University Hospital, Hellerup 2900, Gentofte, Denmark
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Alrayes MM, Alqudah M, Bani Hamad W, Sukeik M. Isolated lateral leg compartment syndrome: A case report. World J Orthop 2023; 14:582-588. [PMID: 37485425 PMCID: PMC10359743 DOI: 10.5312/wjo.v14.i7.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 07/18/2023] [Imported: 07/18/2023] Open
Abstract
BACKGROUND Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately. Multiple compartments are usually involved with a clear history of trauma and classic symptoms and signs. However, isolated lateral leg compartment syndrome is relatively rare and is often misdiagnosed due to the atypical presentation of no trauma and the lack of pathognomonic signs.
CASE SUMMARY A 31-year-old male patient presented to our emergency room with excruciating left calf pain and inability to mobilize one-day after participating in a football match despite no clear history of preceding trauma. The patient went to another hospital before presenting to us where he was diagnosed to have a soft tissue injury and was discharged home on simple analgesics. On clinical examination, the left leg showed a tense lateral compartment with severe tenderness. The pain was aggravated by dorsiflexion and ankle inversion. Neurovascular examination of the limb was normal. We suspected a compartment syndrome but as the presentation was atypical and an magnetic resonance imaging (MRI) was readily available in our institution, we immediately performed an MRI and this confirmed a large hematoma in the lateral compartment with a possible partial proximal peroneus longus muscle tear. The patient was taken immediately for an emergency open fasciotomy. The patient is now 18 mo postoperatively having recovered completely and engages fully in sports with no restrictions.
CONCLUSION Atypical presentation due to the lack of pathognomonic signs makes the diagnosis of isolated lateral leg compartment syndrome difficult. Pain on passive inversion and dorsiflexion and weak active eversion may be suggested as sensitive signs.
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