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Tay HW, Tay KS. Future directions for early detection of fracture related infections. J Orthop 2024; 55:64-68. [PMID: 38655538 PMCID: PMC11035015 DOI: 10.1016/j.jor.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Fracture related infection (FRI) refers to pathogens infecting a fracture site and hence impeding fracture healing. It is a significant complication that carries substantial disease burden and socio-economic costs, but has had limited scientific development. Hence, this paper will review the existing strategies for early detection of FRI, in the form of serum markers, molecular diagnostics and imaging modalities, and further discuss potential future directions for improved detection of FRI. Existing Strategies for Diagnosis of FRI The Anti-infection Global Expert Committee (AIGEC) developed a consensus definition for FRI in 2017, which includes confirmatory and suggestive criteria for diagnosis of FRI. Existing strategies for diagnosis include clinical, laboratory, histopathological, microbiological and radiological investigations. Future Directions for Early Detection of FRI With increasing recognition of FRI, early detection is crucial for early treatment to be enforced. We have identified potential areas for future development in diagnostics for early detection of FRI, which are discussed in this manuscript. They include inflammatory cytokines, serum calcium levels, platelet count, improved management of histopathological and microbiological specimens, metagenomics, wound biomarkers, gut microbiota analysis, and novel imaging technologies.
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Affiliation(s)
- Hui Wen Tay
- Singapore General Hospital Department of Orthopaedic Surgery, Singapore
| | - Kae Sian Tay
- Singapore General Hospital Department of Orthopaedic Surgery, Singapore
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Vorbau R, Hulthén M, Omar A. Task-based image quality assessment of an intraoperative CBCT for spine surgery compared with conventional CT. Phys Med 2024; 124:103426. [PMID: 38986263 DOI: 10.1016/j.ejmp.2024.103426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/24/2024] [Accepted: 06/29/2024] [Indexed: 07/12/2024] Open
Abstract
PURPOSE To analyze the image quality of a novel, state-of-the art platform for CBCT image-guided spine surgery, focusing particularly on the dose-effectiveness compared with conventional CT (the gold standard for postoperative assessment). METHODS The ClarifEye platform (Philips Healthcare) with integrated augmented-reality surgical navigation, has been compared with a GE Revolution CT (GE Healthcare). The 3D spatial resolution (TTF) and noise (NPS) were evaluated considering relevant feature contrasts (200-900 HU) and background noise for differently sized patients (200-300 mm water-equivalent diameter). These measures were used to determine the noise equivalent quanta (NEQ) and observer model detectability. RESULTS The CBCT system exhibited a linear response with 50% TTF at 5.7 cycles/cm (10% TTF at 9.2 cycles/cm), and the axial noise power peaking at about 3.6 cycles/cm (average frequency of 4.1 cycles/cm). The noise magnitude and texture differed markedly compared to iteratively reconstructed CT images (GE ASiR-V). The CBCT system had 26% lower detectability for a high-frequency task (related to edge detection) compared with CT images reconstructed using the Bone kernel combined with ASiR-V 50%. Likewise, it had 18% lower detectability for low- and mid-frequency tasks compared with CT images reconstructed using the Standard kernel. This difference translates to 50%-80% higher CBCT imaging doses required to match the CT image quality. CONCLUSIONS The ClarifEye platform demonstrates intraoperative CBCT-imaging capabilities that under certain circumstances are comparable with conventional CT. However, due to limited dose-effectiveness, a trade-off between timeliness and radiation exposure must be considered if end-of-procedure CBCT is to replace postoperative CT.
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Affiliation(s)
- Robert Vorbau
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Markus Hulthén
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Artur Omar
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden.
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Vicenti G, Buono C, Albano F, Ladogana T, Pesare E, Colasuonno G, Passarelli AC, Solarino G. Early Management for Fracture-Related Infection: A Literature Review. Healthcare (Basel) 2024; 12:1306. [PMID: 38998841 PMCID: PMC11241692 DOI: 10.3390/healthcare12131306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/15/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Fracture-related infections (FRIs), as shown in the literature, represent one of the main complications of trauma surgery. They are a consequence of an implant-related "biofilm" formation and are a challenge for surgeons, microbiologists, and infectious disease specialists. For a correct diagnosis, careful clinical evaluation, to look for signs/symptoms attributable to an infectious condition, and instrumental examinations, to highlight the site of infection, its extent, and its severity, are both essential. Unfortunately, due to the lack of data in the literature, there is no consensus about guidelines on the diagnosis and treatment of FRIs. The purpose of this study is to present an up-to-date concept evaluation of the diagnostic procedures and treatment options available in the management of fracture-related infections.
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Affiliation(s)
| | - Claudio Buono
- Orthopaedic & Trauma Unit, Department of Traslational Biomedicine and Neuroscience (DiBraiN), School of Medicine, University of Bari Aldo Moro, AOU Consorziale “Policlinico”, 70124 Bari, Italy; (G.V.); (F.A.); (T.L.); (E.P.); (G.C.); (A.C.P.); (G.S.)
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Moreno-Vásquez M, Vidal-Alaball J, Saez M, Barceló MA. Impacts of COVID-19 on clinical indicators and mortality in patients with chronic conditions in Catalonia, Spain: A retrospective population-based cohort study. J Glob Health 2024; 14:05020. [PMID: 38900506 PMCID: PMC11189023 DOI: 10.7189/jogh.14.05020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Background The reallocation of health care services during the coronavirus disease 2019 (COVID-19) pandemic disrupted the continuity of primary care. This study examines the repercussions of the COVID-19 pandemic on clinical indicators within the Catalan population, emphasising individuals with chronic conditions. It provides insights into mortality and transfer rates considering intersectional perspectives. Methods We designed a retrospective, observational population-based cohort study based on routinely collected data from January 2015 to June 2021 for all individuals available in the Information System for Research in Primary Care (Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP)), the largest public primary care database in Catalonia, Spain. We included 6 301 095 individuals, constituting 81.6% of Catalonia's population in 2020. To perform a repeated measurements analysis of the indicators, we focussed on individuals who had one or more indicators in both the pre-pandemic (January 2015 to March 2020) and pandemic periods (March 2020 to June 2021), and those diagnosed with type 2 diabetes mellitus (T2D), high blood pressure, and heart failure. We selected key clinical indicators for analysis, including systolic and diastolic blood pressure, body mass index (BMI), cholesterol (total, high, and low-density lipoprotein), triglycerides, glycosylated haemoglobin, the Barthel index, and cardiovascular risk (Registre Gironí del cor (REGICOR) index). Results Mortality and transfer rates increased during the pandemic, contributing to a decline in the active population in the public health system. We also observed a reduction in pandemic period prevalence of patients with chronic conditions: -26.7% for heart failure, -15.1% for high blood pressure, and -14.6% for T2D. In both pre-pandemic and pandemic periods, 1 632 013 subjects had at least one clinical indicator record. Clinical indicators worsened in patients diagnosed with chronic conditions during the pandemic. Most indicators worsened, with differences between men and women (+9.4% vs +3.7% for the REGICOR index and -14.1% vs -16.6% for the Barthel index in men and in women, respectively), and to a similar extent (or greater in some cases) in individuals without these conditions. Conclusions We used longitudinal data to assess the repercussions of the COVID-19 pandemic on population health while considering a wide range of clinical indicators and socioeconomic determinants. Our analysis shows a deterioration in clinical indicators during the pandemic, particularly in cardiometabolic factors, underscoring the importance of continuous primary care for individuals with chronic conditions.
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Affiliation(s)
- Manuel Moreno-Vásquez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Manresa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Manresa, Barcelona, Spain
- Health Promotion in Rural Areas Research Group, Gerencia d’Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Manresa, Barcelona, Spain
- Faculty of Medicine, University of Vic – Central University of Catalonia, Vic, Barcelona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - PERIS Project collaborative team
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, Manresa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Health Promotion in Rural Areas Research Group, Gerencia d’Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Manresa, Barcelona, Spain
- Faculty of Medicine, University of Vic – Central University of Catalonia, Vic, Barcelona, Spain
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Charles-Lozoya S, Cobos-Aguilar H, Alvarado-Alanis JL, De la Parra-Márquez ML, Salas-Delgado A, Segoviano-Mendoza MA, Arriaga-Cazares HE, Montes-Cruz JV. Reproducibility of pop sensation, Thompson sign in achillotomy, and final Pirani score to predict clubfoot relapse: Achillotomy clinical signs and Pirani predictive ability. Medicine (Baltimore) 2024; 103:e38377. [PMID: 38875390 PMCID: PMC11175865 DOI: 10.1097/md.0000000000038377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore, surgeons' reported feelings of tendon release ("click" or "pop") and the Thompson sign could demonstrate that they are sensitive and reliable for confirming complete tendon release. The purpose of this study was to compare the reproducibility of clinical maneuvers that aim to detect the reported "click" or "pop" sensation by the surgeon and the Thompson sign after surgical release in percutaneous achilles tenotomy compare with US in patients with clubfoot. A cross-sectional reproducibility study of consecutive patients with idiopathic clubfoot was conducted. All the patients were scheduled to undergo tenotomy in the operating room using the standard percutaneous achilles tenotomy technique under sedation. The surgeon's reported surgical sensation ("click" or "pop") and Thompson signs were compared to the US assessment of the cut. The final Pirani score was used to predict recurrence risk and was correlated with the number of plaster casts and age. Forty-five feet were affected in 30 patients. Eighteen (60%) men. Age range: 1 to 60 months. The sensation of "click" or "pop" was recorded in 38 patients, and complete release was confirmed by US in 37 patients, for a sensitivity (Se) of 0.95 and specificity (Sp) of 0.63. Thompson signs were positive in 33 and 36 patients at 2 evaluations, with Se values of 0.87 and 0.92 and Sp values of 0.88 and 0.75, respectively. The Pirani final score, a predictor of recurrence risk, had an area under the curve of 0.80 (95% CI = 0.63-0.97; P = .005), Se = 0.78, and Sp = 0.56, with a cutoff point of 2.75. The feeling of achilles tendon release and Thompson sign had high sensitivity, prevalence, accuracy, and posttest probability. The confirmation of tendon release based on clinical signs could prevent the use of US.
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Affiliation(s)
- Sergio Charles-Lozoya
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Monterrey, NL, Mexico
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza Garcia, NL, Mexico
| | - Héctor Cobos-Aguilar
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza Garcia, NL, Mexico
| | - Jorge Luis Alvarado-Alanis
- Coordination of the Doctorate of Medical Sciences, Universidad Juárez del Estado de Durango, Durango, Durango, Mexico
| | - Miguel Leonardo De la Parra-Márquez
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Monterrey, NL, Mexico
| | | | - Marcela Araceli Segoviano-Mendoza
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Monterrey, NL, Mexico
| | - Héctor Eliud Arriaga-Cazares
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Monterrey, NL, Mexico
| | - Jocelyn Verónica Montes-Cruz
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Monterrey, NL, Mexico
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Gustafsson A, Rölfing JD, Palm H, Viberg B, Grimstrup S, Konge L. Setting proficiency standards for simulation-based mastery learning of short antegrade femoral nail osteosynthesis: a multicenter study. Acta Orthop 2024; 95:275-281. [PMID: 38819402 PMCID: PMC11141712 DOI: 10.2340/17453674.2024.40812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/05/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND PURPOSE Orthopedic trainees frequently perform short antegrade femoral nail osteosynthesis of trochanteric fractures, but virtual reality simulation-based training (SBT) with haptic feedback has been unavailable. We explored a novel simulator, with the aim of gathering validity evidence for an embedded test and setting a credible pass/fail standard allowing trainees to practice to proficiency. PATIENTS AND METHODS The research, conducted from May to September 2020 across 3 Danish simulation centers, utilized the Swemac TraumaVision simulator for short antegrade femoral nail osteosynthesis. The validation process adhered to Messick's framework, covering all 5 sources of validity evidence. Participants included novice groups, categorized by training to plateau (n = 14) or to mastery (n = 10), and experts (n = 9), focusing on their performance metrics and training duration. RESULTS The novices in the plateau group and experts had hands-on training for 77 (95% confidence interval [CI] 59-95) and 52 (CI 36-69) minutes while the plateau test score, defined as the average of the last 4 scores, was 75% (CI 65-86) and 96% (CI 94-98) respectively. The pass/fail standard was established at the average expert plateau test score of 96%. All novices in the mastery group could meet this standard and interestingly without increased hands-on training time (65 [CI 46-84] minutes). CONCLUSION Our study provides supporting validity evidence from all sources of Messick's framework for a simulation-based test in short antegrade nail osteosynthesis of intertrochanteric hip fracture and establishes a defensible pass/fail standard for mastery learning of SBT. Novices who practiced using mastery learning were able to reach the pre-defined pass/fail standard and outperformed novices without a set goal for external motivation.
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Affiliation(s)
- Amandus Gustafsson
- Orthopaedic Department, Slagelse Hospital, Region Zealand, Slagelse; Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen.
| | - Jan D Rölfing
- Department of Orthopaedics, Aarhus University Hospital, Aarhus; MidtSim, Corporate HR, Central Denmark Region, Aarhus
| | - Henrik Palm
- Orthopaedic Department, Bispebjerg Hospital, Region H, Copenhagen
| | - Bjarke Viberg
- Orthopaedic Department, Odense Hospital, Region Syd, Odense, Denmark
| | - Søren Grimstrup
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen
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Li J, Fang M, Van Oevelen A, Peiffer M, Audenaert E, Burssens A. Diagnostic applications and benefits of weightbearing CT in the foot and ankle: A systematic review of clinical studies. Foot Ankle Surg 2024; 30:7-20. [PMID: 37704542 DOI: 10.1016/j.fas.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Foot and ankle weightbearing CT (WBCT) imaging has emerged over the past decade. However, a systematic review of diagnostic applications has not been conducted so far. METHOD A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines after Prospective Register of Systematic Reviews (PROSPERO) registration. Studies analyzing diagnostic applications of WBCT were included. Main exclusion criteria were: cadaveric specimens and simulated WBCT. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. RESULTS A total of 78 studies were eligible for review. Diagnostic applications were identified in following anatomical area's: ankle (n = 14); hindfoot (n = 41); midfoot (n = 4); forefoot (n = 19). Diagnostic applications that could not be used on weightbearing radiographs (WBRX) were reported in 56/78 studies. The mean MINORS was 9.8/24 (range: 8-12). CONCLUSION Diagnostic applications of WBCT were most frequent in the hindfoot, but other areas are on the rise. Post-processing of images was the main benefit compared to WBRX based on a moderate quality of the identified studies.
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Affiliation(s)
- Jing Li
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | - Mengze Fang
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | - Aline Van Oevelen
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | - Matthias Peiffer
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | | | - Arne Burssens
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium.
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Rajasekaran RB, Krishnamoorthy V, Kamashi J, Thippeswamy PB, Singh R, Rajasekaran S. Is Intraoperative CT Navigation feasible for excision of osteoid osteoma in the appendicular skeleton? - Retrospective analysis of 58 cases. J Orthop 2024; 47:28-34. [PMID: 38022841 PMCID: PMC10679521 DOI: 10.1016/j.jor.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background The use of intraoperative CT navigation to manage osteoid osteoma is not common. We report our experience managing osteoid osteoma in the appendicular skeleton using an intraoperative AIRO CT navigation system. Materials & methods Between May 2013 and December 2022, 59 patients underwent Navigation-assisted excision of osteoid osteoma in the appendicular skeleton. Our primary study outcome was to assess for recurrence of the tumour with recurrence of symptoms. For our secondary outcomes, we evaluated the complications associated with the procedure and evaluated the histological slides of all patients to see for the presence of nidus. Results Of the 58 patients available for review, no patient had a lesion recurrence, and all were symptom-free at an average follow-up of 45.6 months (6-100). Two patients (3.5%) had a superficial infection managed conservatively, and 43 patients (74.1%) had the presence of nidus in curetted samples. No patient developed a pathological fracture after the procedure. Conclusion Using intraoperative CT navigation to manage osteoid osteoma in the appendicular skeleton is safe, minimally invasive, and effective in completely removing the nidus with a negligible complication rate. The absence of nidus on histology should not be a concern to clinicians once thorough burring and verification of excision of nidus has been confirmed intra-operatively. Study design Retrospective Case Series. Level of evidence Level IV.
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Affiliation(s)
- Raja Bhaskara Rajasekaran
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Venkatadass Krishnamoorthy
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Jayanthi Kamashi
- Department of Pathology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Rithika Singh
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
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Wu Y, Dai R, Yan W, Ren S, Ao Y. Characteristics of Sports Injuries in Athletes During the Winter Olympics: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231209286. [PMID: 38107844 PMCID: PMC10722932 DOI: 10.1177/23259671231209286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 12/19/2023] Open
Abstract
Background Athletes in the Winter Olympic Games are subject to high injury rates given the physical demands of sports. Comprehensive data regarding injury characteristics in these athletes are limited. Purpose To summarize and analyze data regarding the incidence and characteristics of sports injuries occurring in the Winter Olympic Games. Study Design Scoping review; Level of evidence, 4. Methods A systematic review of the PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure databases was conducted. Included were studies reporting the incidence of sports injuries during the Winter Olympics Games from 1995 through 2021. From 168 studies initially retrieved, 4 studies (8824 athletes, 1057 injured athletes) were included. A single-group meta-analysis of sports injury characteristics was performed, with subgroup analysis performed according to the different sports, injury locations, and injury types. Injury severity (time lost from sport) and mechanism were also assessed. Result The overall injury incidence rate (IIR) during the Winter Olympic Games was 9.6% (95% CI, 4.1%-19.8%). Snow sports were associated with the highest IIR (11.3%), with the top 3 events being the snowboard cross event in snowboarding (31.4%), the aerials event in freestyle skiing (28.6%), and the slopestyle event in snowboarding (27.7%). The most common injury locations were the knee (IIR = 20.0%; 95% CI 17.9%-22.0%), head (IIR = 10.6%; 95% CI, 9.4%-11.9%), and ankle (IIR = 8.2%; 95% CI 7.8%-8.7%). The most common injury types were contusion/hematoma/bruise (IIR = 29.9%; 95% CI 29.7%-30.0%), sprain (dislocation, subluxation, instability, ligamentous, rupture) (IIR = 21.9%; 95% CI 21.4%-22.3%), and strain (muscle rupture, tear, tendon rupture) (IIR = 11.3%; 95% CI 11.0%-11.6%). Regarding injury severity, most athletes had no time lost from sport (64.5%); 24.0% lost fewer than 7 days, and 11.5% lost more than 7 days. The most common injury mechanism was noncontact-related injury (63.3%). Conclusion In Winter Olympics sports, snow-sport injuries were more common than those associated with other sports, and the most common injury location was the knee. Most injuries did not require time loss, and the most were noncontact-related injuries.
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Affiliation(s)
- Yue Wu
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Ruilan Dai
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Wenqiang Yan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yingfang Ao
- Tianjin Key Laboratory of Exercise Physiology and Sports Medicine, Institute of Sport, Exercise and Health, Tianjin University of Sport, Tianjin, China
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
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Wu W, Kang Z, Mu D, Zhao H, Yang F. T2 mapping for quantitative assessment of ankle cartilage of weightlifters. Sci Rep 2023; 13:19160. [PMID: 37932324 PMCID: PMC10628267 DOI: 10.1038/s41598-023-46259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
The research into the prevention of sports injuries among the population, particularly juveniles, has become crucial due to the increasing participation in physical exercises like fitness. To assess the difference in T2 values of ankle talar cartilage between weightlifters and healthy volunteers using quantitative magnetic resonance imaging (MRI) technique T2 mapping. Study design: Prospective. Prospective evaluation of T2 values of ankle cartilage of 50 weightlifters (30 adults and 20 juveniles) and 100 healthy volunteers (80 adults and 20 juveniles) using Siemens 3.0 T MRI with PDWI, T1WI, and T2 mapping sequences. Three physicians manually divided the talar cartilage of the ankle joint into six regions of interest. Three physicians utilized the anterior and posterior cut edges of the tibial cartilage as markers to identify the corresponding anterior and posterior cut edges of the talar cartilage on the sagittal MRI images. The medial and lateral sides were defined as half of the talar articular surface on the coronal plane. Differences in T2 values in each cartilage region were compared using independent sample T test or Mann-Whitney U test. The T2 values of talar cartilage were significantly increased in the athlete group relative to the volunteer group (35.11 and 31.99, P < 0.001), with the most significant difference observed in the juvenile athlete group compared to the volunteer group (34.42 and 28.73, P < 0.001). There was a significant difference in the T2 value of ankle talar cartilage between weightlifters and healthy volunteers, and juveniles may be more vulnerable to overuse sports injuries. This study contributes to understanding the cartilage health of juvenile athletes and the prevention of sports injuries.
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Affiliation(s)
- Weibiao Wu
- Radiology Department, Central Hospital Affiliated to Shenyang Medical College, No.5 NanQiXi Road, TieXi District, Shenyang, Liaoning, 110024, People's Republic of China
| | - Zhuanzhuan Kang
- Radiology Department, Central Hospital Affiliated to Shenyang Medical College, No.5 NanQiXi Road, TieXi District, Shenyang, Liaoning, 110024, People's Republic of China
| | - Di Mu
- Radiology Department, Central Hospital Affiliated to Shenyang Medical College, No.5 NanQiXi Road, TieXi District, Shenyang, Liaoning, 110024, People's Republic of China
| | - Huiyu Zhao
- Radiology Department, Central Hospital Affiliated to Shenyang Medical College, No.5 NanQiXi Road, TieXi District, Shenyang, Liaoning, 110024, People's Republic of China
| | - Feng Yang
- Radiology Department, Central Hospital Affiliated to Shenyang Medical College, No.5 NanQiXi Road, TieXi District, Shenyang, Liaoning, 110024, People's Republic of China.
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11
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Gharios M, El-Hajj VG, Frisk H, Ohlsson M, Omar A, Edström E, Elmi-Terander A. The use of hybrid operating rooms in neurosurgery, advantages, disadvantages, and future perspectives: a systematic review. Acta Neurochir (Wien) 2023; 165:2343-2358. [PMID: 37584860 PMCID: PMC10477240 DOI: 10.1007/s00701-023-05756-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Hybrid operating rooms (hybrid-ORs) combine the functionalities of a conventional surgical theater with the advanced imaging technologies of a radiological suite. Hybrid-ORs are usually equipped with CBCT devices providing both 2D and 3D imaging capability that can be used for both interventional radiology and image guided surgical applications. Across all fields of surgery, the use of hybrid-ORs is gaining in traction, and neurosurgery is no exception. We hence aimed to comprehensively review the use of hybrid-ORs, the associated advantages, and disadvantages specific to the field of neurosurgery. MATERIALS AND METHODS Electronic databases were searched for all studies on hybrid-ORs from inception to May 2022. Findings of matching studies were pooled to strengthen the current body of evidence. RESULTS Seventy-four studies were included in this review. Hybrid-ORs were mainly used in endovascular surgery (n = 41) and spine surgery (n = 33). Navigation systems were the most common additional technology employed along with the CBCT systems in the hybrid-ORs. Reported advantages of hybrid-ORs included immediate assessment of outcomes, reduced surgical revision rate, and the ability to perform combined open and endovascular procedures, among others. Concerns about increased radiation exposure and procedural time were some of the limitations mentioned. CONCLUSION In the field of neurosurgery, the use of hybrid-ORs for different applications is increasing. Hybrid-ORs provide preprocedure, intraprocedure, and end-of-procedure imaging capabilities, thereby increasing surgical precision, and reducing the need for postoperative imaging and correction surgeries. Despite these advantages, radiation exposure to patient and staff is an important concern.
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Affiliation(s)
- Maria Gharios
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Victor Gabriel El-Hajj
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurosurgery, Karolinska University Hospital, Eugeniavägen 6, 4Th Floor, Solna, 17164, Stockholm, Sweden.
| | - Henrik Frisk
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Ohlsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Artur Omar
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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12
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Crawford AM, Striano BM, Giberson-Chen CC, Xiong GX, Lightsey HM, Schoenfeld AJ, Simpson AK. Projected Lifetime Cancer Risk Associated With Intraoperative Computed Tomography for Lumbar Spine Surgery. Spine (Phila Pa 1976) 2023; 48:893-900. [PMID: 37040462 DOI: 10.1097/brs.0000000000004685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE (1) To determine the incremental increase in intraoperative ionizing radiation conferred by computed tomography (CT) as compared with conventional radiography; and (2) to model different lifetime cancer risks contextualized by the intersection between age, sex, and intraoperative imaging modality. SUMMARY OF BACKGROUND DATA Emerging technologies in spine surgery, like navigation, automation, and augmented reality, commonly utilize intraoperative CT. Although much has been written about the benefits of such imaging modalities, the inherent risk profile of increasing intraoperative CT has not been well evaluated. MATERIALS AND METHODS Effective doses of intraoperative ionizing radiation were extracted from 610 adult patients who underwent single-level instrumented fusion for lumbar degenerative or isthmic spondylolisthesis from January 2015 through January 2022. Patients were divided into those who received intraoperative CT (n=138) and those who underwent conventional intraoperative radiography (n=472). Generalized linear modeling was utilized with intraoperative CT use as a primary predictor and patient demographics, disease characteristics, and preference-sensitive intraoperative considerations ( e.g. surgical approach and surgical invasiveness) as covariates. The adjusted risk difference in radiation dose calculated from our regression analysis was used to prognosticate the associated cancer risk across age and sex strata. RESULTS (1) After adjusting for covariates, intraoperative CT was associated with 7.6 mSv (interquartile range: 6.8-8.4 mSv; P <0.001) more radiation than conventional radiography. (2) For the median patient in our population (a 62-year-old female), intraoperative CT use increased lifetime cancer risk by 2.3 incidents (interquartile range: 2.1-2.6) per 10,000. Similar projections for other age and sex strata were also appreciated. CONCLUSIONS Intraoperative CT use significantly increases cancer risk compared with conventional intraoperative radiography for patients undergoing lumbar spinal fusions. As emerging technologies in spine surgery continue to proliferate and leverage intraoperative CT for cross-sectional imaging data, strategies must be developed by surgeons, institutions, and medical technology companies to mitigate long-term cancer risks.
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Affiliation(s)
- Alexander M Crawford
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brendan M Striano
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Carew C Giberson-Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Grace X Xiong
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Harry M Lightsey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew J Schoenfeld
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Andrew K Simpson
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
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13
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Jungmann PM, Schaeffeler C. Bone Stress Injuries at the Ankle and Foot. Semin Musculoskelet Radiol 2023; 27:283-292. [PMID: 37230128 DOI: 10.1055/s-0043-1766098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Bone stress injuries (BSIs) are a frequent finding in athletes, particularly of the foot and ankle. A BSI is caused by recurring microtrauma to the cortical or trabecular bone exceeding the repair capacity of normal bone. The most frequent fractures at the ankle are low risk, characterized by a low risk for nonunion. These include the posteromedial tibia, the calcaneus, and the metatarsal diaphysis. High-risk stress fractures have a higher risk for nonunion and need more aggressive treatment. Examples are the medial malleolus, navicular bone, and the base of the second and fifth metatarsal bone.Imaging features depend on the primary involvement of cortical versus trabecular bone. Conventional radiographs may remain normal up to 2 to 3 weeks. For cortical bone, early signs of BSIs are a periosteal reaction or the "gray cortex sign," followed by cortical thickening and fracture line depiction. In trabecular bone, a sclerotic dense line may be seen. Magnetic resonance imaging enables early detection of BSIs and can differentiate between a stress reaction and a fracture. We review typical anamnestic/clinical findings, epidemiology and risk factors, imaging characteristics, and findings at typical locations of BSIs at the foot and ankle that may help guide treatment strategy and patient recovery.
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Affiliation(s)
- Pia M Jungmann
- Musculoskeletal Imaging, Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Freiburg, Germany
| | - Christoph Schaeffeler
- Musculoskeletal Imaging, Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
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14
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Jungmann PM, Lange T, Wenning M, Baumann FA, Bamberg F, Jung M. Ankle Sprains in Athletes: Current Epidemiological, Clinical and Imaging Trends. Open Access J Sports Med 2023; 14:29-46. [PMID: 37252646 PMCID: PMC10216848 DOI: 10.2147/oajsm.s397634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/06/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose Ankle injuries are frequent sports injuries. Despite optimizing treatment strategies during recent years, the percentage of chronification following an ankle sprain remains high. The purpose of this review article is, to highlight current epidemiological, clinical and novel advanced cross-sectional imaging trends that may help to evaluate ankle sprain injuries. Methods Systematic PubMed literature research. Identification and review of studies (i) analyzing and describing ankle sprain and (ii) focusing on advanced cross-sectional imaging techniques at the ankle. Results The ankle is one of the most frequently injured body parts in sports. During the COVID-19 pandemic, there was a change in sporting behavior and sports injuries. Ankle sprains account for about 16-40% of the sports-related injuries. Novel cross-sectional imaging techniques, including Compressed Sensing MRI, 3D MRI, ankle MRI with traction or plantarflexion-supination, quantitative MRI, CT-like MRI, CT arthrography, weight-bearing cone beam CT, dual-energy CT, photon-counting CT, and projection-based metal artifact reduction CT may be introduced for detection and evaluation of specific pathologies after ankle injury. While simple ankle sprains are generally treated conservatively, unstable syndesmotic injuries may undergo stabilization using suture-button-fixation. Minced cartilage implantation is a novel cartilage repair technique for osteochondral defects at the ankle. Conclusion Applications and advantages of different cross-sectional imaging techniques at the ankle are highlighted. In a personalized approach, optimal imaging techniques may be chosen that best detect and delineate structural ankle injuries in athletes.
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Affiliation(s)
- Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland
| | - Thomas Lange
- Department of Radiology, Medical Physics, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Markus Wenning
- Department of Orthopedic and Trauma Surgery, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frédéric A Baumann
- Department of Vascular Medicine, Hospital of Schiers, Schiers, Switzerland
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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15
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Keil H, Beisemann N, Swartman B, Schnetzke M, Vetter SY, Grützner PA, Franke J. Intraoperative revision rates due to three-dimensional imaging in orthopedic trauma surgery: results of a case series of 4721 patients. Eur J Trauma Emerg Surg 2023; 49:373-381. [PMID: 36048181 PMCID: PMC9925545 DOI: 10.1007/s00068-022-02083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Intraoperative 3D imaging has become a valued tool in assessing the quality of reduction and implant placement in orthopedic trauma surgery. In our institution, 3D imaging is used routinely since 2001. To evaluate the intraoperative findings and consequences of this technique, intraoperative revision rates in cases with 3D imaging were analyzed. METHODS All operative procedures carried out with intraoperative 3D imaging between August 2001 and December 2016 were included. The scans were assessed intraoperatively and documented thereafter. In case of malreduction or misplaced implants, an immediate revision was performed. The number of scans per case as well as the findings and consequences drawn regarding the anatomical region were analyzed. RESULTS 4721 cases with 7201 3D scans were included in this study. The most common anatomical regions were the ankle (22.3%), the calcaneus (14.8%) and the tibial head (9.5%). In 19.1% of all cases, an intraoperative revision was performed. The highest revision rates were found with 36.0% in calcaneal fractures, 24.8% in fractures of the tibial plateau, 22.3% in injuries of the ankle. In 52.0% of revisions, the reduction was improved regarding intra-articular steps or joint congruency. In 30.5% an implant was corrected. CONCLUSION Intraoperative revision due to results of 3D imaging was performed in almost one-fifth of cases. This illustrates the improved possibilities to detect malreduction and implant misplacements intraoperatively and thus the abilities to improve surgical outcome. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Holger Keil
- grid.5330.50000 0001 2107 3311Department of Trauma and Orthopedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Krankenhaus-street. 12, 91054 Erlangen, Germany
| | - Nils Beisemann
- grid.7700.00000 0001 2190 4373BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071 Ludwigshafen, Germany
| | - Benedict Swartman
- grid.7700.00000 0001 2190 4373BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071 Ludwigshafen, Germany
| | - Marc Schnetzke
- grid.7700.00000 0001 2190 4373BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071 Ludwigshafen, Germany
| | - Sven Yves Vetter
- grid.7700.00000 0001 2190 4373BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- grid.7700.00000 0001 2190 4373BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071 Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Center Ludwigshafen at Ruprecht-Karls-Universität Heidelberg, Ludwig-Guttmann-Street. 13, 67071, Ludwigshafen, Germany.
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16
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He SY, Yu B, Jiang N. Current Concepts of Fracture-Related Infection. Int J Clin Pract 2023; 2023:4839701. [PMID: 37153693 PMCID: PMC10154639 DOI: 10.1155/2023/4839701] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/24/2023] [Accepted: 04/08/2023] [Indexed: 05/10/2023] Open
Abstract
Currently, fracture-related infection (FRI) still represents great challenges in front of orthopaedic surgeons, despite great advances that have been achieved regarding its diagnosis and treatment. Although both FRI and prosthetic joint infection (PJI) belong to osteoarticular infections and share similarities, FRI displays unique characteristics. Diagnosis of FRI is sometimes difficult owing to the nonspecific symptoms, and treatment is usually tricky, with a high risk of infection recurrence. In addition, the long disease course is associated with a significantly elevated risk of disability, both physically and psychologically. Moreover, such a disorder still poses heavy economic burdens to the patients, both personally and socially. Therefore, early diagnosis and reasonable treatment are the key issues for increasing the cure rate, decreasing the risks of infection relapse and disability, and improving the life quality and prognosis of the patients. In this review, we summarized the present concepts regarding the definition, epidemiology, diagnosis, and treatment of FRI.
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Affiliation(s)
- Si-ying He
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| | - Bin Yu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| | - Nan Jiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
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Tsukamoto S, Mavrogenis AF, Honoki K, Kido A, Tanaka Y, Fujii H, Takakura Y, Tanaka Y, Errani C. Reconstruction after Talar Tumor Resection: A Systematic Review. Curr Oncol 2022; 29:9788-9800. [PMID: 36547183 PMCID: PMC9777178 DOI: 10.3390/curroncol29120769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
This systematic review investigated the functional outcomes and complications of reconstruction methods after talar tumor resection. A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases identified 156 studies, of which 20 (23 patients) were ultimately included. The mean Musculoskeletal Tumor Society scores in the groups reconstructed using tibiocalcaneal fusion (n = 17), frozen autograft (n = 1), and talar prosthesis (n = 5) were 77.6 (range 66-90), 70, and 90 (range 87-93), respectively. Regarding complications, sensory deficits were observed in one patient (6%) and venous thrombosis in two patients (12%) in the tibiocalcaneal fusion group, while osteoarthritis was observed in one patient (100%) in the frozen autograft group. No complications were observed in the talar prosthesis group. Reconstruction with talar prosthesis seems preferable to conventional tibiocalcaneal fusion after talar tumor resection because it offers better function and fewer complications. However, as this systematic review included only retrospective studies with a small number of patients, its results require re-evaluation in future randomized controlled trials with larger numbers of patients.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara 634-8521, Japan
- Correspondence: ; Tel.: +81-744-22-3051
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Greece
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, Nara 634-8521, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Nara 634-8521, Japan
| | - Yuu Tanaka
- Department of Rehabilitation Medicine, Wakayama Professional University of Rehabilitation, Wakayama 640-8222, Japan
| | - Hiromasa Fujii
- Department of Orthopaedic Surgery, Nara Medical University, Nara 634-8521, Japan
| | - Yoshinori Takakura
- Department of Orthopaedic Surgery, Nishi Nara Central Hospital, Nara 631-0022, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara 634-8521, Japan
| | - Costantino Errani
- Orthopaedic Oncology Service, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Kamal AF, Hilmy F. Giant cell tumor with secondary aneurysmal bone cyst of the left calcaneus. Int J Surg Case Rep 2022; 100:107697. [PMID: 36242890 PMCID: PMC9574781 DOI: 10.1016/j.ijscr.2022.107697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Giant cell tumors (GCT) of the feet bones are rare, comprising of <1 % of cases. The lack of well-documented cases and similarity with other tumors under radiologic and histological evaluation makes diagnosis difficult. Current treatment modalities for GCT still result in a relatively high recurrence rate, making the overall management of the case a challenge. We reported a 27-year-old male diagnosed with GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) treated with curettage and femoral head allograft combined with bone cement application. Case presentation A 27-year-old male presented with lump on the left heel since seven months before admission. Physical examination demonstrated solid, palpable mass on the left heel region and limited ankle motion. Magnetic resonance imaging examination demonstrated expansile bone tumor at the left calcaneus with cystic components building fluid levels and hemorrhagic components, suggestive of giant cell tumors with secondary ABC. The patient is diagnosed with giant cell tumor with secondary ABC of the left calcaneus Campanacci grade 2. The patient was managed limb salvage surgery by curettage and subsequent mix of femoral head allograft and bone cement application to fill the defect. Discussion Conservative surgery via careful curettage is typically preferred for lower Campanacci grade lesions followed by bone reconstruction. In terms of filling bone defects, it is known that both bone cement and allografts have advantages and disadvantages. We hence decided to perform limb salvage surgery via curettage due to the size of the tumor and bone reconstruction using a mix of femoral head allograft and bone cement to fill the defect. Conclusion Curettage and bone allograft with bone cement reconstruction is an option for surgical management of lower Campanacci grade 2 GCT of the calcaneus. A 27-year-old male diagnosed with GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) treated with curettage and femoral head allograft combined with bone cement application. Conservative curettage, followed by bone allograft application is effective and safe to manage lower Campanacci grades of giant cell tumors of the calcaneus
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Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopaedics and Traumatology, dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fahresa Hilmy
- Department of Orthopaedics and Traumatology, dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
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Rangasamy K, Baburaj V, Gopinathan NR, Sudesh P. Techniques, anaesthesia preferences, and outcomes of Achilles tenotomy during Ponseti method of idiopathic clubfoot correction: A systematic review. Foot (Edinb) 2022; 52:101922. [PMID: 36030649 DOI: 10.1016/j.foot.2022.101922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Achilles tenotomy (AT) forms an important aspect of Ponseti's casting method and is performed in 80-90% of idiopathic clubfoot cases to correct residual hindfoot equinus. Different techniques are described in the literature with no clarity on which method is superior. This review aims to analyse the various techniques described, anaesthesia preferences, and outcomes of AT. METHODS We searched PubMed, Embase, Scopus, and Ovid MEDLINE for articles describing idiopathic clubfoot cases undergoing primary AT during Ponseti's casting method. Data were extracted from eligible studies for qualitative and quantitative synthesis. The repeat tenotomy and complication rates were taken as outcome parameters. RESULTS Nineteen studies were included for systematic review. A percutaneous AT using a scalpel or needle is adequate in most cases and shows promising results. The out-patient department (OPD) tenotomies under local anaesthesia (LA) and operation room (OR) tenotomies under general anaesthesia (GA) were associated with a repeat tenotomy (RT) rate of 2.5% (95%CI, 0.4-5.4%) and 0.8% (95%CI, 0-1.6%), respectively. The difference between OPD and OR groups was not statistically significant (p = 0.875). The pooled analysis shows a failure/relapse rate of 4.2% (1.9-6.4%, p < 0.001) after AT. OPD and OR tenotomies were associated with a complication rate of 1.6% (95%CI, 0.2-3.0%) and 0.5% (95%CI, 0.1-0.8%), respectively, and the difference was not statistically significant (p = 0.807). Bleeding is the most common complication and is controlled in most cases by applying local pressure. CONCLUSION Performing Achilles tenotomy in OPD under LA is safe and cost-effective with similar success rates to those done under GA. With the lack of many comparative and higher-level evidence studies at present, we can't conclude if one technique is better than another.
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Affiliation(s)
- Karthick Rangasamy
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Vishnu Baburaj
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Nirmal Raj Gopinathan
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Pebam Sudesh
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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20
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Effects of Body Posture and Different Exercise Intensity on Athletes’ Limb Injury. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5103017. [PMID: 35799669 PMCID: PMC9256291 DOI: 10.1155/2022/5103017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to solve the problem of the influence of body posture and different exercise intensity on athletes' limb injuries, to meet the needs of understanding athletes' injuries, and to make up for the lack of investigations on athletes' limb injuries; this also increases the chances of an athlete avoiding injury. Severe acute sports injuries of high-level gymnasts endanger the personal safety of athletes. Many movements in gymnastics are done in the air much higher than the ground, and there is no fulcrum when the athlete does the movements; this just can only maintain balance and change your body posture through your own feelings, a slight error can easily cause your head or upper body to fall down, and the fragile spine cannot withstand the strong impact of the ground, resulting in high vertebral fractures, high paraplegia, and even death. Therefore, through a survey of 126 rhythmic gymnasts who participated in the 2011 “China Art Sports Cup” China Rhythmic Gymnastics Championship, a total of 172 injuries were found in 136 gymnasts, and the injury risk analysis was carried out from the main characteristics of the injuries.
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Ilyas MS, Akram R, Zehra U, Aziz A. Management of Giant Cell Tumor of Talus With Extended Intralesional Curettage and Reconstruction Using Polymethylmethacrylate Cement. Foot Ankle Spec 2022:19386400221079487. [PMID: 35229671 DOI: 10.1177/19386400221079487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An 18-year-old man presented with complaints of pain and swelling around the left ankle region. Local examination revealed diffuse, hard, mildly tender swelling with ill-defined margins over the medial aspect of the left ankle joint just below the medial malleolus. Radiographic and computed tomographic assessment revealed osteolytic lesion with moderately defined margins. Provisional diagnosis of Campanacci grade 2 giant cell tumor was made, which was later confirmed on histopathology. Extended intralesional curettage and reconstruction with polymethylmethacrylate cement was done under spinal anesthesia. Full weight bearing was allowed at 4 weeks when the below knee back slab was removed. Radiographic assessment was done every 3 months during the first year of follow-up and then every 6 months. No evidence of recurrence of tumor, collapse of talus, or avascular necrosis was found during follow-up. Managing such rare form of bone tumors with extended intralesional curettage and bone cement is an appropriate treatment and gives good functional results.Level of Evidence: Level V.
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Affiliation(s)
- Muhammad Saad Ilyas
- Department of Orthopaedics and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Rizwan Akram
- Department of Orthopaedics and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Uruj Zehra
- Department of Anatomy, University of Health Sciences, Lahore, Pakistan
| | - Amer Aziz
- Department of Orthopaedics and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
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22
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Al-Kharouf KF, Abbas K, Anjum S, Khan FI. Removal of Broken Cannulated Drill Bit. Cureus 2021; 13:e19706. [PMID: 34812332 PMCID: PMC8604092 DOI: 10.7759/cureus.19706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/05/2022] Open
Abstract
Breaking of surgical drill bits and subsequent dislodging in the bone are quite common in the field of orthopedics. Even though a few methods have been reported to remove dislodged drill bits, we present a novel method to remove a broken drill bit without additional instruments or a secondary incision. A broken cannulated drill bit within the locking screw hole inside the neck of a femur was retrieved using a depth gauge with a curved tip that hooked onto the edge of the drill bit. By employing a clockwise and counter-clockwise twisting, the broken drill bit was retrieved through the proximal reaming tract. The 4mm tract, which was established by proximal reaming, immensely facilitated safe and time-efficient removal of the drill tip without further trauma or prolonging the surgery time. With our technique, the removal was simple and safe without further soft tissue trauma and blood loss. We advocate this approach for implementation in similar cases.
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Affiliation(s)
- Khaled F Al-Kharouf
- Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Kashif Abbas
- Trauma and Orthopaedics, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Syed Anjum
- Trauma and Orthopaedics, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Faisal I Khan
- Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
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Hennings R, Souleiman F, Heilemann M, Hennings M, Klengel A, Osterhoff G, Hepp P, Ahrberg AB. Suture button versus syndesmotic screw in ankle fractures - evaluation with 3D imaging-based measurements. BMC Musculoskelet Disord 2021; 22:970. [PMID: 34809628 PMCID: PMC8609744 DOI: 10.1186/s12891-021-04834-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Inadequate reduction of syndesmotic injuries can result in disabling clinical outcomes. The aim of the study was to compare syndesmosis congruity after fixation by syndesmotic screws (SYS) or a suture button system (SBS) using three-dimensional (3D) computed imaging techniques. METHODS In a retrospective single-center study, patients with unilateral stabilization of an ankle fracture with a syndesmotic injury and post-operative bilateral CT scans were analyzed using a recently established 3D method. The side-to-side differences were compared for tibio-fibular clear space (∆CS), translation angle (∆α), and vertical offset (∆z) among patients stabilized with syndesmotic screws or suture button system. Syndesmotic malreduction was defined for ∆CS > 2 mm and for |∆α| > 5°. ∆CS and ∆α were correlated with two-dimensional (2D) measurements. RESULTS Eighteen patients stabilized with a syndesmosis screw and 29 stabilized with a suture button system were analyzed. After stabilization, both groups revealed mild diastasis (SYS: mean ∆CS 0.3 mm, SD 1.1 mm vs SBS: mean ∆CS 0.2 mm, SD 1.2 mm, p = 0.710). In addition, both stabilization methods showed slight dorsalization of the fibula (SYS: mean ∆α 0.5°, SD 4.6° vs SBS: mean ∆α 2.1°, SD 3.7°, p = 0.192). Also, restoration of the fibula-to-tibia length ratio also did not differ between the two groups (SYS: mean Δz of 0.5 mm, SD 2.4 mm vs SBS: mean Δz of 0 mm, SD 1.2 mm; p = 0.477). Malreduction according to high ∆α was most common (26% of cases), with equal distribution between the groups (p = 0.234). ∆CS and ∆α showed good correlation with 2D measurements (ρ = 0.567; ρ = 0.671). CONCLUSION This in vivo analysis of post-operative 3D models showed no differences in immediate post-operative alignment after syndesmotic screws or suture button system. Special attention should be paid to syndesmotic malreduction in the sagittal orientation of the fibula in relation to the tibia in radiological control of the syndesmotic congruity as well as intra-operatively.
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Affiliation(s)
- Robert Hennings
- Department of Orthopaedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Saxony, Germany.
| | - Firas Souleiman
- Department of Orthopaedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Saxony, Germany
| | - Martin Heilemann
- ZESBO - Centre for Research on Musculoskeletal Systems, University of Leipzig, Semmelweisstraße 14, 04103, Leipzig, Saxony, Germany
| | - Mareike Hennings
- Department of Orthopaedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Saxony, Germany
| | - Alexis Klengel
- Department of Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Saxony, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Saxony, Germany
| | - Pierre Hepp
- Department of Orthopaedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Saxony, Germany
| | - Annette B Ahrberg
- Department of Orthopaedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Saxony, Germany
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Tulendiyeva A, Saliev T, Andassova Z, Issabayev A, Fakhradiyev I. Historical overview of injury prevention in traditional martial arts. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00785-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Western LF, Dhawan R, Cribb G, Shepherd K, Cool P. Bone Tumours of the Talus: 18-Year Cohort of Patients With Rare Osteoid Lesions. Cureus 2021; 13:e13565. [PMID: 33791180 PMCID: PMC8005272 DOI: 10.7759/cureus.13565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/05/2022] Open
Abstract
Background Bone tumours of the talus are a rare cause of ankle pain. This study aims to provide additional clinical clarity regarding the presentation and management of a minimally researched topic. Methods Sixteen patients were diagnosed with bone tumour of the talus between 2002 and 2020 following referral for ankle pain. Symptoms, diagnosis, and management were retrospectively reviewed. Patients were actively followed up until consistently symptom-free and consenting to discharge (mean of 2.9 years). An open appointment was offered to all patients to reattend the unit if symptoms recurred. Results The most common diagnosis was osteoid osteoma/osteoblastoma (nine patients), chondroblastoma (four patients), a giant cell tumour of bone, a chondral lesion in Ollier's disease and a rare metastatic renal cancer case. The mean age of onset was 29 years. Thirteen patients experienced ankle pain without a clear precipitating cause. Night pain was less common in osteoid osteoma/osteoblastoma than usually observed in the literature. The mean delay in diagnosis was two years, often due to an incorrect diagnosis of soft tissue injury. Plain radiographs are insufficient to identify most lesions. Ten patients underwent computed tomography (CT)-guided radiofrequency ablation and five patients had open surgical curettage. Ollier's disease was managed with orthotics. The five cases of recurrence across four patients were managed operatively. Conclusions Patients are usually young and healthy with benign disease, but talus tumours can cause significant functional impairment. Unexplained ankle pain should be extensively examined and be further investigated with magnetic resonance imaging (MRI) and CT scanning to avoid missing these rare tumours.
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Affiliation(s)
- Luke F Western
- Orthopaedic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
| | - Rohit Dhawan
- Arthroplasty, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR
| | - Gillian Cribb
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR
| | - Karen Shepherd
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR
| | - Paul Cool
- Medical Sciences, Keele University, Keele, GBR
- Orthopaedic Oncology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, GBR
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Management and retrospective analysis of tumors and tumor-like lesions localized in the talus. Jt Dis Relat Surg 2021; 32:218-223. [PMID: 33463440 PMCID: PMC8073425 DOI: 10.5606/ehc.2021.78769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aims to investigate the characterization and follow-up results of tumors and tumor-like lesions in the talus. PATIENTS AND METHODS Twenty-one patients (15 males, 6 females; mean age: 31.6±17 years; range, 4 to 67 years) with benign and malignant tumors or tumor-like lesions in the talus region treated and followed in our clinic between January 2007 and January 2019 were evaluated retrospectively. Radiological, pathological, surgical, and demographic features were scanned from the database. RESULTS Patients were followed for mean 80±45.1 (range, 25 to 156) months. The most common complaint was pain and antalgic gait. Benign bone tumors were found in 15 (71%) of 21 patients, while tumor-like lesions (two intraosseous ganglia, osteomyelitis, and bone infarction) were found in four patients. The remaining two were patients with lung and bladder cancer metastasis. Lesion size was mean 2.1±0.5 (range, 1.1 to 3.3) cm. Recurrence developed in 14.3% (n=3) of the patients during follow-up. CONCLUSION The talus is a rare location for tumors; however, benign and malignant tumors and tumor-like lesions may be localized in the talus.
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27
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Ndwandwe D, Mathebula L, Adetokunboh O, Kamadjeu R, Wiysonge CS. Cochrane corner: universal screening for SARS-CoV-2 infection. Pan Afr Med J 2020; 37:48. [PMID: 33552376 DOI: 10.11604/pamj.supp.2020.37.48.26881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most people infected with SARS-CoV-2 have mild disease with non-specific symptoms, although a few becoming critically ill with septic shock and multiple organ failure. There is an unknown proportion of infected individuals who remain asymptomatic and infectious. Universal screening for COVID-19 infections to detect individuals who are infected before they present clinically could therefore be an important measure to contain the spread of the disease. We highlight a Cochrane rapid review which assessed the effectiveness and accuracy of universal screening for COVID-19 infection. Methods the authors of the Cochrane review searched multiple electronic databases to identify studies reporting on the effectiveness of universal screening and reporting on screening test accuracy. Eligible participants for the review included people who had not sought care for potential COVID-19 symptoms. Results the authors included 22 publications, with none of them conducted in Africa. Two modelling studies reported on the beneficial and negative effects of screening; and 20 studies (cohort and modelling) reported data on the accuracy of screening tests. The included studies had wide variability in the baseline prevalence of COVID-19 infection as well as study settings and methods. All cohort studies compared screening strategies to reverse transcriptase-polymerase chain reaction (RT-PCR) as the gold standard. The rapid review suggests that there is low certainty of evidence that screening at travel hubs may slow the importation of infected cases. Furthermore, the review highlights the uncertainty and variation in the accuracy of screening. Conclusion given the low accuracy of the tests included in this review, a high proportion of COVID-19 infected individuals may be missed and go on to infect others. In addition, some healthy individuals may be falsely identified as positive, requiring confirmatory testing and potentially leading to the unnecessary isolation of these individuals.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Communicable Disease Control, Department of Health, Western Cape, South Africa
| | - Olatunji Adetokunboh
- Department of Science and Innovation-National Research Foundation (DSI-NRF) Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Raoul Kamadjeu
- UNICEF Program Division, Public Health Emergencies Team, New York, USA
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Yao Y, Yan J, Jiang F, Zhang S, Qiu J. Comparison of Anterior and Posterior Decompressions in Treatment of Traumatic Thoracolumbar Spinal Fractures Complicated with Spinal Cord Injury. Med Sci Monit 2020; 26:e927284. [PMID: 33211674 PMCID: PMC7684844 DOI: 10.12659/msm.927284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background For patients with thoracolumbar spinal fractures complicated with spinal cord injury, timely surgery is the first choice. We compared the effects of anterior and posterior decompressions in treatment of these patients. Material/Methods A total of 80 male patients with traumatic thoracolumbar spinal fractures and spinal cord injury were prospectively selected and divided into 2 groups. The control group underwent posterior decompression and internal fixation and the observation group underwent real-time anterior decompression. Results The observation group had longer operative time and length of postoperative hospital stay, larger intraoperative blood loss, remarkably greater immediate postoperative anterior height and middle column height of the fractured vertebrae, and a notably smaller Cobb’s angle than in the control group. The total ASIA score was significantly higher in the observation group than in the control group immediately after surgery and at 6 months and 1 year after surgery. The maximal urine flow, maximal detrusor pressure, and bladder compliance were also evidently higher in the observation group than in the control group during 1 year of follow-up. Compared with the control group, the International Index of Erectile Function-5 (IIEF-5) score in the observation group was significantly higher at 3 months, 6 months, and 1 year after surgery. Conclusions Compared with the posterior approach, anterior decompression in patients with thoracolumbar spinal fractures complicated with spinal cord injury can effectually enhance the surgical efficiency, and restore the physiological anatomy of the fractured vertebrae, thereby improving patient quality of life.
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Affiliation(s)
- Yilun Yao
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Junwei Yan
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Fan Jiang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Sheng Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Junjun Qiu
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
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Galvan D, Mullins C, Dudrey E, Kafchinski L, Laks S. Giant cell tumor of the talus: A case report. Radiol Case Rep 2020; 15:825-831. [PMID: 32346462 PMCID: PMC7182696 DOI: 10.1016/j.radcr.2020.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/28/2022] Open
Abstract
Giant cell tumor is a benign primary bone neoplasm which most often occurs in a periarticular location. Involvement of the bones of the foot and ankle is rare, and there have been a limited number of previous case reports involving the talus. Here we report a case of giant cell tumor of the talus, which was initially radiographically occult in a 43-year-old female, with emphasis on MRI imaging characteristics. The patient underwent surgical excision and curettage. Histological examination revealed the presence of spindle cells admixed with giant cells, confirming GCT. We further provide an overview of the radiological findings of GCT. Giant cell tumor is a benign bone neoplasm of mesenchymal origin, identified by multinucleated giant cells [1]. GCT is locally aggressive and can destroy adjacent bone and articulations. The most commonly affected bones are the distal femur, proximal tibia, and distal radius, with an epiphyseal predominance in 90% of cases [2]. Presentations are mostly mono-ostotic, however multicentricity may occur in younger patients [3]. Very few cases have been reported in the bones of the feet, an incidence of 1%-2% have been previously reported [4]. GCT is seen between ages 20 and 40 years, with a 56% predominance in females [3]. Although benign, 1%-9% cases may “metastasize” to the lungs. The initial treatment is surgical removal, either en bloc, or more commonly intralesional curettage and the use of adjuvants. Even after resection, GCT has a high recurrence rate [2]. The trigger for GCT is currently unknown. However, a majority of cases have cytogenetic abnormalities of telomeric associations (tas). Involvement of the RANK pathway is also believed to contribute to the pathogenesis of GCT [2].
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Affiliation(s)
- Dana Galvan
- Transitional Year Department, University of Rio Grande Valley
| | - Carola Mullins
- Department of Radiology, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, CSB-A02, El Paso, TX 79905
| | - Ellen Dudrey
- Department of Pathology, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Lisa Kafchinski
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, TX
| | - Shaked Laks
- Department of Radiology, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, CSB-A02, El Paso, TX 79905
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Yang X, Luo C, Liu L, Song Y, Li T, Zhou Z, Hu B, Zhou Q, Xiu P. Minimally invasive lateral lumbar intervertebral fusion versus traditional anterior approach for localized lumbar tuberculosis: a matched-pair case control study. Spine J 2020; 20:426-434. [PMID: 31669614 DOI: 10.1016/j.spinee.2019.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Minimally invasive lateral lumbar intervertebral fusion (LLIF) procedure has been reported as a feasible alternative to the traditional anterior approach for patients with lumbar tuberculosis. However, there is still no study in the existing literature comparing LLIF to traditional surgeries in the treatment of such patients. PURPOSE To evaluate the clinical, radiological, and functional outcomes of LLIF versus the traditional anterior approach for treating localized lumbar tuberculosis. STUDY DESIGN Retrospective case-control study. PATIENT SAMPLE A total of 60 patients with single-level localized lumbar tuberculosis. OUTCOME MEASURES The outcome parameters included incision length, operation time, blood loss, complications, segmental lordosis, fusion status, Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analog scale (VAS), and Oswestry Disability Index (ODI). METHODS We matched 20 patients treated by LLIF with 40 patients undergoing traditional anterior surgery (ratio, 1:2) by age, sex, lesion level, and radiographic features. The LLIF group consisted of 12 men and eight women with a mean age of 42.2±11.1 years, while the traditional group consisted of 22 men and 18 women with a mean age of 40.0±14.5 years. Both the demographics and radiographic data were reviewed. Pre- and postoperative segmental lordosis Cobb angle was measured on lateral X-ray films, while fusion status was assessed on computed tomography scans. The VAS and ODI were used to evaluate functional outcomes. RESULTS The average follow-up was 24 months in the LLIF group and 39 months in the traditional group. Incision length, operation time, and blood loss were significantly less in the LLIF group than in the traditional group. A similar improvement in segmental lordosis after operation was found in both groups. There was no significant difference between the two groups in neurological recovery, blood infection markers (ESR, CRP), functional outcome, or fusion rate, except for the postoperative VAS score, which was significantly lower in the LLIF group than in the traditional group (2.7±1.0 vs. 3.6±1.0, p=.003). Four patients in the traditional group received a transfusion and 4 patients had a superficial wound infection, while no patient in the LLIF group received a transfusion or experienced any infection; however, the difference between the two groups was not statistically significant (p=.291). CONCLUSIONS Both LLIF and traditional anterior surgery are sufficient for treating patients with localized lumbar tuberculosis, but the LLIF approach results in significantly shorter operation time and less blood loss.
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Affiliation(s)
- Xi Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Chao Luo
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China.
| | - Yueming Song
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Tao Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Zhongjie Zhou
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Bowen Hu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Quan Zhou
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
| | - Peng Xiu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu, Sichuan, China
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Sakamoto A, Okamoto T, Matsuda S. Reconstruction with β-tricalcium phosphate for giant cell tumor of the talus. Foot (Edinb) 2020; 42:101643. [PMID: 31743864 DOI: 10.1016/j.foot.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/14/2019] [Accepted: 09/25/2019] [Indexed: 02/04/2023]
Abstract
Giant cell tumor of bone (GCTB) is a locally aggressive tumor, commonly occurs in the long bones, and is rare in the talus and the foot. The talus is a weight-bearing bone and strut reconstruction is preferred. Reconstruction with low porosity β-tricalcium phosphate (β-TCP) blocks is reported for GCTB in the knee. In the current report, a 25-year-old female suffered from GCTB in the talus extending to the subchondral bone. The tumor was treated by curettage and the bone was reconstructed with low porosity β-TCP blocks, which have strong compressive strength. The implanted β-TCP blocks were incorporated successfully. The current reconstruction method can be applied for GCTB in the talus.
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Affiliation(s)
- Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
| | - Takeshi Okamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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A simple reproducible technique for the retrieval of broken proximal femoral blades, a technical note and review of literature. J Clin Orthop Trauma 2020; 11:S7-S10. [PMID: 31992909 PMCID: PMC6978186 DOI: 10.1016/j.jcot.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/24/2022] Open
Abstract
Despite advances in metallurgy, fatigue failure of hardware in orthopaedics is common especially when a fracture fails to heal. Revision procedures can be difficult, usually requiring removal of intact or broken hardware. Several different methods are usually used to successfully remove the intact or broken hardware. The proximal blade fracture is rare and under-reported in the literature. In our tertiary non-union and limb reconstruction unit, we have developed a technique for an easy and quick removal of a broken proximal femoral blades.
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Abstract
RATIONALE Primary lymphoma of the bones (PLB) is a rare extranodal non-Hodgkin lymphoma (NHL) that is particularly rare in children. The clinical presentation and radiological features of PLB are often nonspecific, making clinical diagnosis challenging and misdiagnosis frequent. Here, we report 2 children with PLB focusing on clinical presentation, differential diagnosis, and treatment outcomes. PATIENTS CONCERNS A 9-year-old boy presented with left knee swelling and pain for 4 months after a fall. He was previously misdiagnosed with traumatic soft tissue injury. The second patient was an 11-year-old boy with a 6-month history of intermittent left knee pain. He was previously misdiagnosed with bone tuberculosis and chronic osteomyelitis. DIAGNOSES A 9-year-old boy showed an abnormal signal of the left tibia metaphysis, diaphysis, and epiphysis, and tibia with periosteal reactions and surrounding soft tissue swelling. Tumor biopsy and immunohistochemistry confirmed a diagnosis of B-cell lymphoblastic lymphoma.An 11-year-old boy showed a permeative lesion in the metaphysis and diaphysis of the left proximal tibia. Tumor biopsy and immunohistochemistry confirmed the diagnosis of diffuse large B-cell lymphoma. INTERVENTIONS Both patients were treated with 6 courses of NHL-Berlin-Frankfurt-Münster-95. OUTCOMES Both patients are in complete clinical remission with a follow-up of 27 and 18months after treatment, respectively. LESSONS PLB is a rare malignancy that is difficult to diagnose, particularly in children. Clinicians should increase the awareness of the disease and consider a differential diagnosis of bone lesions. Chemotherapy combined with radiotherapy is a favorable treatment for children with PLB. Early diagnosis and active treatment can improve patient prognosis.
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Affiliation(s)
- Haiqiang Suo
- Department of Bone and Joint, The First Hospital of Jilin
| | - Li Fu
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University Changchun, Jilin, China
| | - Zhiwei Wang
- Department of Bone and Joint, The First Hospital of Jilin
| | - Hanguang Liang
- Department of Bone and Joint, The First Hospital of Jilin
| | - Zhe Xu
- Department of Bone and Joint, The First Hospital of Jilin
| | - Wei Feng
- Department of Bone and Joint, The First Hospital of Jilin
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Dharmshaktu G, Adhikari N, Mourya P, Bhandari S, Singh P. Intraoperative instrument breakage during the orthopedic elective procedures: A retrospective single-center experience. JOURNAL OF ORTHOPAEDICS AND SPINE 2020. [DOI: 10.4103/joasp.joasp_18_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wang S, Duan CY, Yang H, Kang JP, Wang Q. Novel Screw Insertion Method for Anterior Surgical Treatment of Unstable Thoracolumbar Fracture: Quadrant Positioning Method. Orthop Surg 2019; 11:613-619. [PMID: 31387160 PMCID: PMC6712382 DOI: 10.1111/os.12506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/20/2019] [Accepted: 06/20/2019] [Indexed: 12/02/2022] Open
Abstract
Objective To develop a novel screw positioning method to improve the treatment of unstable thoracolumbar fractures. Methods A total of 72 patients with unstable thoracolumbar fractures who were treated with anterior screw–rod interfixation from January 2011 to October 2015 were included in this clinical study. Those patients included 48 male and 24 female patients with an average age of 45.10 years (range, 26–63 years). Patients were randomly divided into two groups: an observation group (n = 36) and a control group (n = 36). The quadrant positioning method was used for screw insertion in the observation group during the operation, while the traditional screw positioning method was used in the control group. The quadrant positioning method targeted four quadrants, including the superior anterior (SA), superior posterior (SP), inferior anterior (IA) and inferior posterior (IP) quadrants, while for the traditional screw positioning, four screws were inserted into the vertebral bodies above and below the excision. Patients were followed up for approximately 40 months to record recovery. Clinical and radiological records, local angle and fractured vertebra body height, clinical outcomes, complications, neurological improvement, and fusion rate were recorded and compared between the two groups. Results The quadrant positioning method was successfully used for anterior screw insertion. The quadrant center in the lateral view of the vertebral body was well marked, and screws were easily located on the scheduled quadrant. Blood loss (BL), hospital stay (HS), and operation time (OP) in the observation group were 749.40 ± 379.90 mL, 17.10 ± 4.10 days, and 167.40 ± 44.70 min, respectively. While those parameters in the control group were 1198.40 ± 339.27 mL, 23.22 ± 3.77 days, and 221.47 ± 32.15 min, respectively. The average operation time and hospital stay time were significantly shorter, and blood loss was significantly less in the observation group than in the control group (P < 0.05). Local angle and vertebral body height were markedly improved and 1–2 grade improvement was achieved in patients with neurological deficits in both groups. Both groups of patients achieved bony fusion during follow‐up. No incision infection or internal fixation failure was observed in the two groups, and complications including cerebrospinal fluid and chylous leakage and hemothorax were resolved. Conclusions The quadrant positioning method can shorten operation time, reduce blood loss, and accelerate postoperative recovery. The technique provides an effective method for screw insertion for double screw–rod instrumentation fixation in the treatment of thoracolumbar fracture via the anterior approach.
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Affiliation(s)
- Song Wang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chun-Yan Duan
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Han Yang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian-Ping Kang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qing Wang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Hip Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med 2018; 54:339-347. [PMID: 29331493 DOI: 10.1016/j.jemermed.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/03/2017] [Accepted: 12/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hip dislocations are a common presentation in the Emergency Department (ED) and require urgent reduction to reduce the risk of avascular necrosis. Over 90% of all dislocations can successfully be reduced in the ED and there is evidence that cases awaiting operative reduction result in significant delays. DISCUSSION While there is limited data comparing specific techniques, the individual success rates of most maneuvers range from 60-90%. Additionally, each technique has distinct advantages and limitations associated with its use. CONCLUSIONS It is important for Emergency Physicians to be familiar with several different reduction techniques in case the initial reduction attempt is unsuccessful or patient characteristics limit the use of certain maneuvers. This article reviews a number of reduction techniques for hip dislocations, variations on these techniques, and advantages and disadvantages for each approach.
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Sato S, Kaneuchi Y, Hakozaki M, Yamada H, Kawana S, Hasegawa O, Konno S. Primary malignant lymphoma of the talus: A case report and review of the literature. Mol Clin Oncol 2017; 7:574-578. [PMID: 28855991 PMCID: PMC5574142 DOI: 10.3892/mco.2017.1362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/03/2017] [Indexed: 12/28/2022] Open
Abstract
Malignant lymphoma commonly occurs in adults, with a peak incidence between the seventh and ninth decades of life. Although malignant lymphoma usually occurs in the lymph nodes, it rarely occurs primarily in the bone. We herein describe an extremely rare case of primary malignant lymphoma of the talus in a 74-year-old man. Although plain radiographs showed no abnormality, gadolinium-enhanced magnetic resonance imaging (MRI) revealed a well-circumscribed intra- and extraosseous tumor of the talus. 18F-fluorodeoxyglucose (FDG) positron emission tomography/MRI revealed a marked increase of FDG uptake in the right ankle and the right inguinal lymph nodes. As the tumor was diagnosed as diffuse large B-cell lymphoma by core needle biopsy, combination therapy with chemo- and radiotherapy was initiated. The patient achieved complete remission, with no sign of recurrence at 8 months after initial chemoradiotherapy. Since primary malignant lymphoma of the bone is chemo- and radiosensitive and has a good prognosis, accurate staging by radiological investigation as well as correct pathological diagnosis by biopsy are required for optimal treatment.
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Affiliation(s)
- Shunsuke Sato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yoichi Kaneuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hitoshi Yamada
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Satoshi Kawana
- Department of Pathology and Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Osamu Hasegawa
- Department of Radiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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Kamal AF, Waryudi A, Effendi Z, Kodrat E. Management of aggressive giant cell tumor of calcaneal bone: A case report. Int J Surg Case Rep 2016; 28:176-181. [PMID: 27718436 PMCID: PMC5061111 DOI: 10.1016/j.ijscr.2016.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022] Open
Abstract
This is an advanced case of aggressive GCT of calcaneus. It is not only a rare case but also an interesting diagnosis and surgical management. Limb salvage surgery which consists of wide excision-total calcaneoctomy, followed by reconstruction with femoral head allograft and soft tissue coverage with sural flap is a good option.
Introduction Prevalence of giant cell tumor (GCT) at atypical locations like bones of the feet are rare, seen in <1% of cases. GCT may have aggressive features, including cortical expansion or destruction with a soft-tissue component. Difficult diagnosis most often followed with complicated management and high recurrence rate remains a challenge that is rarely reported. Presentation of case We presented a case of forty-six-year-old male patient with giant cell tumor of the right calcaneus Campanacci 3 with secondary aneurysmal bone cyst (ABC). Wide excision total calcaneoctomy, followed by reconstruction bone defect using femoral head allograft and soft tissue coverage with sural flap had been done. Discussion Conservative surgery with careful curettage and placement of bone cement should be considered the treatment of choice when feasible. However, aggressive GCTs may require wide excision and reconstruction or may be amputation. We decided to do salvage surgery since: traditionally curettage is not possible, adequately wide resection of local tumor could be achieved, neurovascular bundle was not involved, and also bone and soft tissue reconstructions could be done. In addition, he refused for amputation. Conclusion Wide excision total calcaneoctomy, bone allograft reconstruction and soft tissue coverage with sural flap is a good option for surgical management in aggressive GCT of calcaneus instead of amputation.
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Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopaedic and Traumatology Cipto Mangunkusumo National Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | - Agus Waryudi
- Department of Orthopaedic and Traumatology Cipto Mangunkusumo National Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Zuhri Effendi
- Department of Orthopaedic and Traumatology Cipto Mangunkusumo National Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Evelina Kodrat
- Department of Anatomic Pathology Cipto Mangunkusumo National Central Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Abstract
Idiopathic clubfoot has a tremendous worldwide prevalence. If left untreated, the deformity has severely disabling effects on mobility and quality of life. Given its prevalence and significance, numerous studies are published on this condition every year. In this article, we attempt to highlight important themes and findings of studies published on idiopathic clubfoot over the past 3 years.
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Affiliation(s)
- Ryan M O'Shea
- San Francisco Orthopaedic Residency Program, 450 Stanyan Street, San Francisco, CA, 94117, USA
| | - Coleen S Sabatini
- UCSF Benioff Children's Hospital Oakland, 747 52nd Street, OPC 1st Floor, Oakland, CA, 94609, USA.
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Skoch J, Zoccali C, Zaninovich O, Martirosyan N, Walter CM, Maykowski P, Baaj AA. Bracing After Surgical Stabilization of Thoracolumbar Fractures: A Systematic Review of Evidence, Indications, and Practices. World Neurosurg 2016; 93:221-8. [DOI: 10.1016/j.wneu.2016.05.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/21/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
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Sadiqi S, Verlaan JJ, Mechteld Lehr A, Dvorak MF, Kandziora F, Rajasekaran S, Schnake KJ, Vaccaro AR, Oner FC. Universal disease-specific outcome instruments for spine trauma: a global perspective on relevant parameters to evaluate clinical and functional outcomes of thoracic and lumbar spine trauma patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1541-1549. [DOI: 10.1007/s00586-016-4596-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 11/30/2022]
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Weinberg DS, Scarcella NR, Napora JK, Vallier HA. Can Vascular Injury be Appropriately Assessed With Physical Examination After Knee Dislocation? Clin Orthop Relat Res 2016; 474:1453-8. [PMID: 26847454 PMCID: PMC4868171 DOI: 10.1007/s11999-016-4730-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/27/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Knee dislocations are rare injuries with potentially devastating vascular complications. An expeditious and accurate diagnosis is necessary, as failing to diagnose vascular injury can result in amputation; however, the best diagnostic approach remains controversial. QUESTIONS/PURPOSES We asked: (1) What patient factors are predictors of vascular injury after knee dislocation? (2) What are the diagnostic utilities of palpable dorsalis pedis or posterior tibial pulses, and the presence of an ankle-brachial index (ABI) of 0.9 or greater? METHODS A database at a Level I trauma center was queried for patients with evidence of knee dislocation, demographic information (age at the time of injury, sex, Injury Severity Score, BMI, mechanism of injury), and the presence of open injury were recorded. One-hundred forty-one patients underwent screening at initial presentation, of whom 26 (24%) underwent early vascular exploration based on an abnormal physical examination. One-hundred five (91%) of the remaining 115 patients were available at a minimum followup of 6 months (mean, 19 ± 10 months). In total, 31 unique patients were excluded, including 10 patients (7%) who were lost to followup before 6 months. Among the 110 patients who met inclusion criteria, the mean age and SD was 37 ± 13 years, and the Injury Severity Score was 15 ± 9. There were 71 males (65%). Logistic regression was used to determine independent correlates of vascular injury. The vascular examination was reviewed for the presence of a palpable pulse in the dorsalis pedis artery, the presence of a palpable pulse in the posterior tibial artery, and whether the ABI in the dorsalis pedis was 0.9 or greater. Contingency tables were generated to assess the sensitivity, specificity, and accuracy of physical examination maneuvers. The physical examination was collectively regarded as "normal" when both pulses were palpable and the ABI was 0.9 or greater. The initial physical examination as just described was considered the diagnostic test being evaluated in this study; "positive" tests were evaluated by and confirmed at vascular surgery, and 6 months clinical followup without symptoms or progressive signs of vascular injury confirmed the absence of injury in the remainder of the patients. Contingency tables were generated again to assess the sensitivity, specificity, and accuracy of the combined physical examination. RESULTS Increased BMI (odds ratio [OR], 1.077; 95% CI, 1.008-1.155; p = 0.033) and open injuries (OR, 3.366; 95% CI, 1.008-11.420; p = 0.048) were associated with vascular injury. No single physical examination maneuver had a 100% sensitivity for ruling out vascular injury. A normal physical examination (palpable pulses and ABI ≥ 0.9) had 100% sensitivity for ruling out vascular injury. CONCLUSIONS Increased BMI and the presence of open dislocation are associated with a greater risk for vascular injury after knee dislocation. The combination of a palpable dorsalis pedis and posterior tibial pulse combined with an ABI of 0.9 or greater was 100% sensitive for the detection of vascular injury based on clinical followup at 6 months. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Douglas S Weinberg
- Department of Orthopaedic Surgery, University Hospitals, Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | | | - Joshua K Napora
- Department of Orthopaedic Surgery, University Hospitals, Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
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Yu Y, Wang J, Shao G, Wang Q, Li B. Comparing Single Versus Double Screw-Rod Anterior Instrumentation for Treating Thoracolumbar Burst Fractures with Incomplete Neurological Deficit: A Prospective, Randomized Controlled Trial. Med Sci Monit 2016; 22:1687-93. [PMID: 27197020 PMCID: PMC4918524 DOI: 10.12659/msm.898347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Following a thoracolumbar burst fracture (TCBF), anterior screw-rods apply pressure upon the graft site. However, there is limited evidence comparing single screw-rod anterior instrumentation (SSRAI) to double screw-rod anterior instrumentation (DSRAI) for TCBFs. Our objective was to compare SSRAI versus DSRAI for TCBFs with incomplete neurological deficit. Material/Methods A total of 51 participants with T11-L2 TCBFs (AO classification: A3) were randomly assigned to receive SSRAI or DSRAI. Key preoperative, perioperative, and postoperative data were collected. Statistical analysis was conducted to determine the independent factors associated with inferior clinical outcomes, as well as the comparative efficacy of SSRAI and DSRAI. Results There were no significant differences in the key demographic and clinical characteristics between the two groups (all p>0.05). Smoking status was significantly associated with inferior three-month and six-month Denis pain scores (Wald statistic=4.246, p=0.039). Both SSRAI and DSRAI were significantly effective in improving three-month and six-month postoperative degree of kyphosis, three-month and six-month postoperative ASIA impairment scale scores, three-month and six-month postoperative Denis pain score, and three-month and six-month postoperative Denis work score (all p<0.001). Although there were no significant differences between DSRAI and SSRAI with respect to all outcomes (all p>0.05), DSRAI displayed significantly longer operating times, as well as significantly larger operative blood losses (both p<0.001). Conclusions SSRAI may be preferable over DSRAI for TCBFs with incomplete neurological deficit due to its lower operating time and amount of operative blood loss.
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Affiliation(s)
- Yu Yu
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Juan Wang
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Gaohai Shao
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Qunbo Wang
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Bo Li
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China (mainland)
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Jeon JY, Chung HW, Kwon JW, Hong SH, Lee GY, Ryu KN. Imaging findings of various talus bone tumors-clinico-radiologic features of talus bone tumors. Clin Imaging 2016; 40:666-77. [PMID: 27317211 DOI: 10.1016/j.clinimag.2016.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
Osseous neoplasms of the foot are uncommon, accounting for only 3.3% of all primary bone tumors. Bone tumors of the talus are even rarer, and there are not many publications that comprehensively evaluate the imaging findings of talus tumors. The purpose of this article is to review the benign and malignant bone tumors affecting this uncommon site and to describe the clinical and radiologic features of each tumor.
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Affiliation(s)
- Ji Young Jeon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center.
| | - Jong Won Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea.
| | - Sung Hwan Hong
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Guen Young Lee
- Departments of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundanggu, Seongnam-si, Gyeonggi-do, 436-707, Korea.
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Medical Center, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-702, Korea.
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Abstract
PURPOSE A tendoachilles lengthening (TAL) is indicated in over 85 % of cases treated with the Ponseti technique. A percutaneous TAL is often performed in the clinic. Reported complications from a TAL performed in the clinic include: bleeding due to injury to the peroneal artery, posterior tibial artery, or lesser saphenous vein; injury to the tibial or sural nerves; and incomplete release. The purpose of the present study is to report the results and complications of a mini-open TAL performed in the operating room (OR). METHODS The current study is a retrospective review performed among infants with idiopathic clubfoot who underwent a mini-open TAL from 2008 to 2015. RESULTS Forty-one patients underwent 63 TALs via a mini-open technique in day surgery. The average Pirani score was 5.8 prior to casting. The average number of casts applied prior to surgery was 5.2. The average age at the time of the TAL was 12.5 weeks (range 5-48 weeks). The average weight at the time of surgery was 7.3 kg (range 3.6-13 kg). No child had a delay in discharge or stayed overnight in the hospital. No anesthesia-related complications or neurovascular injuries occurred. No child needed a repeat TAL due to an incomplete tenotomy. CONCLUSIONS In conclusion, mini-open TAL performed in the OR is safe and effective in infants with clubfeet. No complications occurred and all patients were discharged on the day of surgery. Direct visualization of the Achilles tendon via a mini-open technique minimizes the risk of neurovascular injury and incomplete tenotomy.
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Abstract
Giant cell tumor in small bones is a rare condition characterized by extensive bony destruction and a high recurrence rate. Intralesional excision with curettage and autologous bone grafting has been used as a standard treatment method for giant cell tumor of the bones. We report the case of a 30-year-old female with giant cell tumor of the talar body. She was followed up for 19 years after intralesional curettage and autologous bone grafting treatment.
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Affiliation(s)
- Kwang-Soon Song
- Department of Orthopedic Surgery, Keimyung University Hospital, Daegu, Korea
| | - Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Hospital, Daegu, Korea.
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Bertrand ML, Andrés-Cano P. Management of the Floating Knee in Polytrauma Patients. Open Orthop J 2015; 9:347-55. [PMID: 26312119 PMCID: PMC4541470 DOI: 10.2174/1874325001509010347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/26/2015] [Accepted: 05/18/2015] [Indexed: 12/24/2022] Open
Abstract
Ipsilateral fracture of the femur and tibia, or floating knee, is a rare injury that is found almost exclusively in polytrauma or high-energy trauma patients. It presents a combination of diaphyseal, metaphyseal and intra-articular fractures of the femur and tibia, with a high incidence of neurovascular, ligamentous and soft-tissue injuries. The functional outcome and, in some cases, the life, of such polytrauma patients depends largely on a correct therapeutic approach being taken. In general, the treatment decided upon will depend on the individual characteristics present, regarding aspects such as the patient’s general condition, the fracture line and the state of the soft tissues. The treatment provided may be the same as when single fractures are presented, but it is often necessary to consider whether certain techniques or surgical approaches may interfere with other lines of treatment. It is essential at all times to take into consideration the associated injuries and complications before deciding upon a treatment strategy. Ligamentous injuries play an important role in these injuries, much more so than when fractures occur singly. Therefore, these injuries require management by an experienced multidisciplinary team.
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Affiliation(s)
- M L Bertrand
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol. University of Malaga, Spain
| | - P Andrés-Cano
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol. University of Malaga, Spain
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Extended curettage and adjuvant therapy for benign tumors of the talus. Foot (Edinb) 2015; 25:79-83. [PMID: 25998197 DOI: 10.1016/j.foot.2015.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/07/2015] [Accepted: 02/13/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Benign tumors of the talus are rare, and their management is controversial. Recent efforts have extended the safety margin of intralesional excision and curettage by chemical and physical means. Cryotherapy as adjuvant therapy is associated with risks of local wound and bony complications (delayed healing, potential for pathological fractures). METHODS We retrospectively reviewed six cases of benign talar tumors (three giant cell tumors, two aneurysmal bone cysts, one osteoblastoma) treated by extended curettage and adjuvant cryotherapy. Talar bone stock was restored by bone grafting the residual cavity with fibular strut grafts and/or cancellous bone grafts. Patients were followed for a mean of 40 months. RESULTS At latest follow-up, each patient had a mobile painless ankle and good functional outcome. No patient experienced recurrence or complications related to cryotherapy. CONCLUSIONS Intralesional extended curettage with bone grafting and cryotherapy is a successful, safe, and efficient treatment of benign tumors of the talus.
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50
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Tang HZ, Xu H, Yao XD, Lin SQ. Single-stage posterior vertebral column resection and internal fixation for old fracture-dislocations of thoracolumbar spine: a case series and systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:2497-513. [PMID: 25953526 DOI: 10.1007/s00586-015-3955-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 04/11/2015] [Accepted: 04/11/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the efficacy of single-stage posterior vertebral column resection for old thoracolumbar fracture-dislocations with spinal cord injury. METHODS From January 2007 to June 2013, twelve male patients (average age, 32.6 years; range 19-57 years) with old fracture-dislocations of the thoracolumbar spine and spinal cord injury underwent single-stage posterior vertebral column resection and internal fixation. All patients were assessed for relief of the pain and restoration of neurologic function. Postoperative Cobb angle was measured and bone graft fusion was evaluated by X-ray. A systematic review of 25 studies evaluating surgical management of thoracolumbar fractures with spinal cord injuries was also performed. RESULTS From our case series, six of the nine patients with Frankel grade A had significant improvement in urination and defecation after surgery. The three patients with Frankel grades B and C had progression of 1-2 grades after surgery. Bony fusion was achieved and local back pain was relieved in all patients after surgery. From our systematic review of 25 studies, the majority of patients had improved back pain, the postoperative kyphotic angle was significantly reduced compared with pre-operative kyphotic angle. CONCLUSION Single-stage posterior vertebral column resection and internal fixation for old thoracolumbar fracture-dislocations is an ideal treatment allowing for thorough decompression, relief of pain, correction of deformities, and restoration of spinal stability. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Huan-Zhang Tang
- Department of Orthopaedic Surgery, Fuzhou General Hospital of Nanjing Command PLA, No. 156, North Xi-er-huan Road, Fuzhou, 350025, China.
| | - Hao Xu
- Department of Orthopaedic Surgery, Fuzhou General Hospital of Nanjing Command PLA, No. 156, North Xi-er-huan Road, Fuzhou, 350025, China
| | - Xiao-Dong Yao
- Department of Orthopaedic Surgery, Fuzhou General Hospital of Nanjing Command PLA, No. 156, North Xi-er-huan Road, Fuzhou, 350025, China
| | - Song-Qing Lin
- Department of Orthopaedic Surgery, Fuzhou General Hospital of Nanjing Command PLA, No. 156, North Xi-er-huan Road, Fuzhou, 350025, China
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