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Jin WT, Huang LF, Guo HH, Wang L, Li X, Wang ZJ. Two mini transverse-incision repair yields better results than percutaneous repair for acute closed midsubstance Achilles tendon rupture: a retrospective case-control study. J Orthop Surg Res 2024; 19:452. [PMID: 39085847 PMCID: PMC11289924 DOI: 10.1186/s13018-024-04904-8] [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: 05/24/2024] [Accepted: 07/09/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Acute closed midsubstance Achilles tendon rupture(ACMATR) is common, with various treatment methods developed over time. We retrospectively compared the two mini transverse-incision repair (2MTIR) with percutaneous repair (PR) to determine which method yields better results. METHODS All cases meeting criteria from 2018 to 2021 in our hospital were included and followed up for 1 to 5 years. A final questionnaire with multiple indexes was conducted via phone call. Comparative analysis of these indexes between the two groups was performed using IBM SPSS Statistics (V.26). Continuous variables that passed tests for normality and equal variance were compared using the Student's t-test. Ranked data were compared using the Mann-Whitney U test. Categorical variables were tested with the chi-square test or Fisher's exact test. A p-value of less than 0.05 was considered statistically significant. RESULTS There was one rerupture in the PR group. The final indexes for "Tightness Feeling", "Heel Rising Strength", and "Foot Numbness" were statistically different (P < 0.05) between the two groups. The "Re-rupture" and "Return to Sports" indexes showed no statistical difference (P > 0.05). CONCLUSIONS The 2MTIR technique provided a technically straightforward, minimally invasive procedure with well-preserved paratenon and direct end-to-end firm fixation in cases of ACMATR. It resulted in very low complications, easy rehabilitation, and full weight-bearing as early as 5-6 weeks postoperatively, yielding better functional outcomes compared to the PR technique in the 1-5 year follow-up. TRIAL REGISTRATION The study was preliminarily registered and approved by the University of Hong Kong-Shenzhen Hospital Ethical Board with Project number: hkuszh2023074 on May 4, 2023.
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Affiliation(s)
- Wen Tao Jin
- Sports Medicine Division, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Li Fang Huang
- Sports Medicine Division, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Hai Hua Guo
- Sports Medicine Division, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lei Wang
- Sports Medicine Division, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiang Li
- Sports Medicine Division, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ze Jin Wang
- Sports Medicine Division, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Freude T, Krappinger D, Lindtner RA, Stuby F. The Pararectus approach: a preferred surgical approach for fixation of acetabular fractures predominantly involving the anterior column - a narrative review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05455-7. [PMID: 39078483 DOI: 10.1007/s00402-024-05455-7] [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: 06/18/2024] [Accepted: 07/03/2024] [Indexed: 07/31/2024]
Abstract
Beginning in France in the 1960s, the management of acetabular fractures has increasingly evolved toward surgical treatment strategies. The basic principles established by the pioneers of acetabular surgery, Letournel and Judet - anatomical reconstruction of the joint and stable osteosynthesis - remain unchanged. Modern advancements in surgical techniques aim to reduce access-related trauma and minimize complications. The notable rise in acetabular fractures among the elderly, which predominantly affect the anterior aspects of the acetabulum, has driven the development of less invasive, soft tissue-sparing anterior approaches. This evolution began with the ilio-inguinal approach in the 1960s, progressed to the modified Stoppa approach in the 2000s and, most recently, the Pararectus approach in the 2010s. Each of these approaches upholds the fundamental principles of effective acetabular fracture care, while offering distinct advantages and disadvantages. In this review, we examine the merits and limitations of the Pararectus approach, specifically focusing on its utility in the surgical treatment of anterior column posterior hemitransverse acetabular fractures. Ultimately, the success of the individual patient's outcome is less dependent on the chosen approach and more on the surgeon's experience and expertise. Ideally, surgeons should be proficient in all these approaches to tailor the surgical strategy to the individual patient's requirements, thereby ensuring optimal outcomes.
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Affiliation(s)
- Thomas Freude
- Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Dietmar Krappinger
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard A Lindtner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Fabian Stuby
- Department of Traumatology and General Surgery, BG Unfallklinik Murnau, Murnau Am Staffelsee, Germany
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Zhao K, Wang Y, Li D, Ding Y, Yang Y, Yin Q, Ma Y. Implantation of S1AIS has priority as a sacroiliac joint fixation technique. 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 2024:10.1007/s00586-024-08423-2. [PMID: 39073459 DOI: 10.1007/s00586-024-08423-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/26/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE The sacral alar-iliac screw (SAIS) fixation technique has evolved from spinopelvic fixation which originated from S2AIS to sacroiliac joint fixation, with more reports regarding its application of S2AIS than S1AIS. However, there is a lack of comparative evidence to determine which technique is superior for sacroiliac joint fixation. This study aimed to determine which of the screws was superior in terms of implantation safety and biomechanical stability for sacroiliac joint fixation. METHODS CT data of 80 normal pelvises were analyzed to measure the insertable range, trajectory lengths and widths of both S1AIS and S2AIS on 3D reconstruction models. Φ 6.5 mm and 8.0 mm screws were implanted on the left and right sides of fifty 3D printed pelvic models respectively to observe for breach of screw implantation. Ten synthetic pelvis models were used to simulate type C Tile injuries, and divided into 2 groups with an anterior plate and posterior fixation using one S1AIS or S2AIS on each side. The stiffness and maximum load of the plated and fixated models were measured under vertical loading. RESULTS The trajectory lengths and widths of the S1AIS and S2AIS were similar (p > 0.05) and there was no breach for Φ 6.5 mm SAIS. However, both the insertable range and trajectory length on the sacral side of S2AIS (234.56 ± 10.06 mm2, 40.97 ± 2.81 mm) were significantly less, and the breach rate of the posterior lateral cortex of the Φ 8.0 mm S2AIS (46%) was significantly higher than the S1AIS (307.55 ± 10.42 mm2, 42.16 ± 3.06 mm, and 2%, p < 0.05). The stiffness and maximum load of S2AIS were less than S1AIS but the difference was not statistically significant (p > 0.05). CONCLUSION S1AIS and S2AIS have similar screw trajectories and stability. However, S1AIS has a larger insertable range, less breach of the posterior lateral sacral cortex and longer trajectory length on the sacral side than S2AIS, which indicates S1AIS has higher implantation safety and a trend of better mechanical performance over S2AIS for sacroiliac joint fixation. Furthermore, S2AIS with an excessively large diameter should be used with caution for sacroiliac joint fixation.
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Affiliation(s)
- Kai Zhao
- Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Yapeng Wang
- Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China
| | - Dong Li
- Department of Radiology, Liyang Peoples's Hospital, Changzhou, 213000, Jiangsu, China
| | - Yanping Ding
- Department of Radiology, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China.
| | - Ying Yang
- Department of Radiology, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, 214062, Jiangsu, China
| | - Qudong Yin
- Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.
| | - Yunhong Ma
- Department of Orthopaedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi, 214062, Jiangsu, China.
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Pham C, Ebner PJ, Yoshida R, McCullough MC, Brown T, Tanabe K, Kulber DA. Outcomes of Patients Receiving Proximal Row Carpectomy and Meniscus Interposition Allografts for the Treatment of End-Stage Wrist Arthritis: A Comparative Study. Hand (N Y) 2024:15589447241262052. [PMID: 39066490 DOI: 10.1177/15589447241262052] [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: 07/28/2024]
Abstract
BACKGROUND Proximal row carpectomy (PRC) is a mainstay of wrist arthritis treatment; however, it is traditionally contraindicated in patients with an affected capitate. The use of soft tissue interposition grafts to resurface the radiocapitate articulation has been previously described to allow for PRC in these patients. In the current study, we reviewed our outcomes using knee meniscus allograft interposition to resurface the radiocapitate articulation in patients who would have otherwise been contraindicated for PRC. METHODS A retrospective study of patients who underwent PRC with or without meniscus interposition arthroplasty was performed from 2011 to 2022. Patient demographics (age, sex, occupation, hand dominance, etc) were collected. Improvement in pain was the primary outcome. Wrist range of motion and reconstructive failure requiring fusion were the secondary outcomes. RESULTS We identified a total of 83 patients and 43 met the inclusion criteria. Fifteen patients (35%) underwent PRC with meniscus interposition arthroplasty, and 28 patients (65%) underwent PRC alone. Patients with and without meniscus interposition arthroplasty had documented improvement in pain postoperatively (93% vs 95%, P > .05) at a median follow-up time of 11 (range, 3-38 months) and 9 months (range, 3-64 months), respectively. Postoperative wrist range of motion (flexion: +9 vs -4, P > .05, extension: +12 vs -4, P = .10) trended toward increase in patients undergoing meniscus interposition arthroplasty compared with PRC alone. CONCLUSIONS Our short- to mid-term outcomes in patients with end-stage wrist arthritis affecting the capitate who undergo PRC and meniscus interposition arthroplasty are comparable with those receiving PRC alone.
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Affiliation(s)
| | | | - Ryu Yoshida
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Kylie Tanabe
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Valan B, Anastasio AT, Kim B, Krez A, Wu KA, Talaski GM, Nunley J, DeOrio JK, Easley ME, Adams SB. The INVISION Talar Component in Revision Total Ankle Arthroplasty: Analysis of Early Outcomes. Diagnostics (Basel) 2024; 14:1612. [PMID: 39125488 PMCID: PMC11311589 DOI: 10.3390/diagnostics14151612] [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: 06/20/2024] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Launched in 2018 for revision total ankle arthroplasty (rTAA), the INVISION talar component addresses subsidence when poor talar bone stock is present. Due to the recency of the market-availability of the INVISION, studies evaluating its efficacy are lacking. This study presents the first analysis of early-term outcomes of patients undergoing rTAA with the INVISION talar component. METHODS This was a single-center, retrospective review of 28 patients undergoing rTAA with the INVISION talar component and INBONE II tibial component performed between 2018 and 2022. Data on preoperative characteristics, postoperative complications, secondary procedures, and survivorship were collected. The primary outcome measures were rates of major complications, re-operation, and implant failure. Secondary outcomes included post-operative changes in varus and valgus alignment of the tibia and talus. RESULTS The most common secondary procedures performed with rTAA were medial malleolus fixation (n = 22, 78.6%) and gastrocnemius recession (n = 14, 50%). Overall, 10.7% (n = 3) of patients underwent reoperation and 14.3% (n = 4) suffered major complications. Incidence of implant failure was 10.7% (n = 3). All reoperations were caused by infection. Mean varus alignment of the tibia and talus improved from 4.07 degrees and 4.83 degrees to 1.67 degrees and 1.23 degrees, respectively. Mean valgus alignment of the tibia and talus improved from 3.67 degrees and 4.22 degrees to 2.00 degrees and 2.32 degrees, respectively. CONCLUSIONS In a series of 28 patients undergoing rTAA with the INVISION talar component, we discovered comparatively low rates of reoperation, major complication, and implant failure (10.7%, 14.3%, and 10.7%). The INVISION system appears to have a reasonable safety profile, but further studies evaluating long-term outcomes are required to assess the efficacy of the INVISION system.
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Affiliation(s)
- Bruno Valan
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Albert T. Anastasio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Billy Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY 10021, USA;
| | - Alexandra Krez
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Kevin A. Wu
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Grayson M. Talaski
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - James Nunley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - James K. DeOrio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Mark E. Easley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Samuel B. Adams
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
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Gao AY, Whitrock JN, Goodman MD, Nathwani JN, Janowak CF. The Next Generation: Surgeon Learning Curve in a Mature Operative Rib Management Program. J Surg Res 2024; 301:461-467. [PMID: 39033597 DOI: 10.1016/j.jss.2024.06.041] [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: 12/05/2023] [Revised: 05/28/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Prior work has demonstrated utility in using operative time to measure surgeon learning for surgical stabilization of rib fractures (SSRF); however, no studies have used operative time to evaluate the benefit of proctoring in subsequent generations of surgeons. We sought to evaluate whether there is a difference in learning between an original series (TOS) of self-taught surgeons versus the next generation (TNG) of proctored surgeons using cumulative summation (CUSUM) analysis. We hypothesized that TNG would have a comparatively accelerated learning curve. METHODS A single-center retrospective review of all SSRF at a level 1 trauma center was performed. Data were collected from the beginning of an operative chest injury program to include at least 2 y of TNG experience. Operative time was used to determine success and misstep based on prior methods. Learning curves using CUSUM analysis were calculated based on an anticipated success rate of 90% and compared between TOS and TNG groups. RESULTS Over 7 y, 163 patients with a median Injury Severity Score of 24 underwent SSRF. Median operative time was 165 min with a 0.5 plate-to-fracture ratio. All three TOS surgeons experienced a positive slope indicative of early missteps for their first 15-20 cases. By contrast, all three TNG surgeons demonstrated a series of early successes resulting in negative CUSUM slopes which coincided with a period of proctoring. By the end of TNG series, the composite cumulative score was less than half of the TOS surgeon' scores. CONCLUSIONS Operative time continues to be a useful surrogate for observing SSRF learning curves. In a mature institutional program, proctored novice surgeons appear to have an accelerated learning curve compared to novice surgeons developing a new operative rib program.
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Affiliation(s)
- Angela Y Gao
- University of Cincinnati - College of Medicine, Cincinnati, Ohio
| | - Jenna N Whitrock
- Department of Surgery, University of Cincinnati - College of Medicine, Cincinnati, Ohio
| | - Michael D Goodman
- Department of Surgery, University of Cincinnati - College of Medicine, Cincinnati, Ohio
| | - Jay N Nathwani
- Department of Surgery, University of Cincinnati - College of Medicine, Cincinnati, Ohio
| | - Christopher F Janowak
- Department of Surgery, University of Cincinnati - College of Medicine, Cincinnati, Ohio.
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Poutoglidou F, Yousaf S. Takedown of Ankle Arthrodesis and Conversion to Total Ankle Arthroplasty: A Systematic Review. J Foot Ankle Surg 2024:S1067-2516(24)00149-2. [PMID: 39033845 DOI: 10.1053/j.jfas.2024.07.002] [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: 03/14/2024] [Revised: 06/07/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
Management of the nonunited or painful ankle arthrodesis remains a difficult challenge. The aim of this systematic review was to investigate the clinical outcomes and complications of conversion of an ankle fusion to a total ankle replacement (TAR). The PRISMA statement guidelines were followed. A literature search was performed in PubMed, Science Direct and Cochrane Central Register of Controlled Trails (CENTRAL) from their inception up to October 10th, 2023. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tool and the Methodological Index for NonRandomized Studies (MINORS). Seven studies with 220 patients (223 ankles) with a mean follow-up of 64.9 months were included. Takedown of an ankle fusion and conversion to a TAR led to a significant improvement in all functional and clinical scores and with an acceptable range of motion. Most common complications were malleolar fractures (12.8%) and arthrofibrosis (5.6%). The revision rate was 8% and 4 cases resulted in a below-knee amputation. Cases with an insufficient fibula had a good outcome when a fibular reconstruction was performed. In conclusion, takedown of an ankle fusion and conversion to a TAR has satisfactory clinical outcomes and with a limited number of complications. Future well-designed studies are needed to validate the results of the present study.
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Affiliation(s)
- Freideriki Poutoglidou
- Trauma & Orthopaedics, Epsom and St Helier University Hospitals NHS Trust/SWLEOC Epsom, Surrey KT18 7EG, United Kingdom.
| | - Sohail Yousaf
- Trauma & Orthopaedics, Epsom and St Helier University Hospitals NHS Trust/SWLEOC Epsom, Surrey KT18 7EG, United Kingdom
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Padgett AM, Kothari E, Conklin MJ. Two-stage corrective operation for the treatment of pes cavovarus in patients with spina bifida. World J Orthop 2024; 15:618-626. [PMID: 39070932 PMCID: PMC11271695 DOI: 10.5312/wjo.v15.i7.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/26/2024] [Accepted: 06/05/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Pes cavovarus has an estimated incidence of 8%-17% in patients with spina bifida (SB). The majority of the current literature on surgical treatment of cavovarus feet in children and adolescents includes a variety of diagnoses. There are currently no case series describing a treatment algorithm for deformity correction in this specific patient population. The authors of this study present the results of a retrospective case series performed to assess the radiographic outcomes of two-stage corrective surgery in patients with SB. AIM To assess the radiographic outcomes of a staged operation consisting of radical plantar release followed by osteotomy for pes cavovarus in patients with SB. METHODS Retrospective chart review was performed on patients with SB with a diagnosis of pes cavovarus at a freestanding children's hospital who underwent surgical correction of the deformity. Patients were excluded for lack of two-stage corrective operation, nonambulatory status, lack of at least six months follow-up, and age > 18 years at the time of surgery. This resulted in a cohort of 19 patients. Radiographic analysis was performed on 11 feet that had a complete series of preoperative and postoperative weightbearing X-rays. Preoperative and postoperative radiographic outcome measurements were compared using a two-sample t-test. RESULTS Significant changes between the preoperative and postoperative measurements were seen in Meary's angle, the anteroposterior talo-first metatarsal (AP TMT1) angle, and the talonavicular coverage. Mean values of Meary's angle were 17.9 ± 13.1 preoperatively and 4.7 ± 10.3 postoperatively (P = 0.016). Mean AP TMT1 angle was 20.6 ± 15.1 preoperatively and 9.3 ± 5.5 postoperatively (P = 0.011). Mean talonavicular coverage values were -10.3 ± 9.6 preoperatively and -3.8 ± 10.1 postoperatively (P = 0.025). CONCLUSION The two-stage corrective procedure demonstrated efficacy in correcting cavovarus deformity in patients with SB. Providers should strongly consider employing the staged surgical algorithm presented in this manuscript for management of these patients.
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Affiliation(s)
- Anthony Mack Padgett
- Department of Orthopedics, Indiana University, Indianapolis, IN 46202, United States
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Ezan Kothari
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Michael J Conklin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, United States
- Department of Orthopedic Surgery, Children’s of Alabama, Birmingham, AL 35233, United States
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Guo Z, Guo Y, Wang Y, Bi Y, Deng Y, Cao Y, Huang M. Finite element analysis of the treatment of a minimally invasive approach combined with a novel anatomical locking plate for scapular body fractures. J Orthop Surg Res 2024; 19:410. [PMID: 39014468 PMCID: PMC11253453 DOI: 10.1186/s13018-024-04905-7] [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: 04/07/2024] [Accepted: 07/09/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The minimally invasive approach for the treatment of displaced scapular neck or body fractures has the advantages of less trauma and minimal muscle dissection. In clinical practice, the minimally invasive approach combined with an anatomical locking plate has been used to treat scapular body fractures. In addition, we have made minor modifications to the minimally invasive approach. However, the biomechanical study about the approach combined with an anatomical locking plate in treating scapular body fractures was limited. METHODS Finite element analysis (FEA) was used to conduct the biomechanical comparison between the anatomical locking plate (AP model) and reconstructive plate (RP model) in the treatment of scapular body fractures through the modified minimally invasive approach. A healthy male volunteer with no history of scapula or systemic diseases was recruited. High-resolution computed tomography images of his right scapula were obtained. Two scapula models were constructed and analyzed by the software of Mimics 21.0, Geomagic Wrap 2021, SolidWorks 2021, and ANSYS Workbench 2022, respectively. RESULTS Through static structural analysis, in terms of equivalent von Mises stress, equivalent elastic strain, and total deformation, the AP model exhibited superior safety characteristics, enhanced flexibility, and anticipated stability compared with the RP model. This was evidenced by lower maximum stress, lower maximum strain and displacement. CONCLUSION The minimally invasive approach combined with an anatomical locking plate for scapular body fractures had better biomechanical stability. The study provided a biomechanical basis to guide the clinical treatment of scapular body fractures.
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Affiliation(s)
- Zhanpeng Guo
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yue Guo
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yansong Wang
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yunlong Bi
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yu Deng
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yang Cao
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Mina Huang
- School of Nursing, Jinzhou Medical University, Jinzhou, China.
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Jiang JH, Zhao CM, Zhang J, Xu RM, Chen L. Biomechanical effects of posterior lumbar interbody fusion with vertical placement of pedicle screws compared to traditional placement. World J Clin Cases 2024; 12:4108-4120. [PMID: 39015896 PMCID: PMC11235545 DOI: 10.12998/wjcc.v12.i20.4108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/24/2024] [Accepted: 05/31/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND The pedicle screw technique is widely employed for vertebral body fixation in the treatment of spinal disorders. However, traditional screw placement methods require the dissection of paraspinal muscles and the insertion of pedicle screws at specific transverse section angles (TSA). Larger TSA angles require more force to pull the muscle tissue, which can increase the risk of surgical trauma and ischemic injury to the lumbar muscles. AIM To study the feasibility of zero-degree TSA vertical pedicle screw technique in the lumbosacral segment. METHODS Finite element models of vertebral bodies and pedicle screw-rod systems were established for the L4-S1 spinal segments. A standard axial load of 500 N and a rotational torque of 10 N/m were applied. Simulated screw pull-out experiment was conducted to observe pedicle screw resistance to pull-out, maximum stress, load-displacement ratio, maximum stress in vertebral bodies, load-displacement ratio in vertebral bodies, and the stress distribution in pedicle screws and vertebral bodies. Differences between the 0-degree and 17-degree TSA were compared. RESULTS At 0-degree TSA, the screw pull-out force decreased by 11.35% compared to that at 17-degree TSA (P < 0.05). At 0-degree and 17-degree TSA, the stress range in the screw-rod system was 335.1-657.5 MPa and 242.8-648.5 MPa, separately, which were below the fracture threshold for the screw-rod system (924 MPa). At 0-degree and 17-degree TSA, the stress range in the vertebral bodies was 68.45-78.91 MPa and 39.08-72.73 MPa, separately, which were below the typical bone yield stress range for vertebral bodies (110-125 MPa). At 0-degree TSA, the load-displacement ratio for the vertebral bodies and pedicle screws was slightly lower compared to that at 17-degree TSA, indicating slightly lower stability (P < 0.05). CONCLUSION The safety and stability of 0-degree TSA are slightly lower, but the risks of screw-rod system fracture, vertebral body fracture, and rupture are within acceptable limits.
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Affiliation(s)
- Ji-Hong Jiang
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Chang-Ming Zhao
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Jun Zhang
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Rong-Ming Xu
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
| | - Lei Chen
- Department of Orthopedic Surgery, Zhejiang University Mingzhou Hospital, Ningbo 315000, Zhejiang Province, China
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Ripoll T, Attas J, Fairag R, Lopez M, Gonzalez JF, Badet R, Micicoi G. Trans-medial gastrocnemius approach (Badet approach) for displaced posterior cruciate ligament tibial avulsion. Orthop Traumatol Surg Res 2024:103939. [PMID: 39019691 DOI: 10.1016/j.otsr.2024.103939] [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: 04/07/2024] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
Avulsions of the retrospinal surface are rare injuries resulting from high-energy trauma. Displacement of this fracture frequently indicates a surgical treatment to restore posterior cruciate ligament function. Several approaches have been proposed in the literature, either open or arthroscopic, which can be tricky due to the fracture's proximity to the popliteal vascular-nervous elements. Badet's open approach is a medial trans-gastrocnemius approach, providing a direct access to the retro-spinal surface for osteosynthesis. In this technique, an L-shaped incision is made along precise skin lines, followed by discision of the muscle fibers. The capsule is then approached, allowing a view of the retro-spinal surface protected from the popliteal vasculo-nervous elements by the muscular lateral lip of the gastrocnemius. A reduction followed by screw osteosynthesis is usually performed, allowing early mobilization of the patient. In this technical note, we describe the Badet approach supporting by video and case series. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Thomas Ripoll
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
| | - Joseph Attas
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
| | - Rayan Fairag
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
| | - Michael Lopez
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
| | - Jean-François Gonzalez
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France
| | - Roger Badet
- Osteo-articular Fleming Center, Bourgoin-Jallieu, France
| | - Grégoire Micicoi
- University Institute of Locomotor and Sports (iULS), Pasteur II Hospital, 30, Voie Romaine, 06000, Nice, France.
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Yu D, Guo L, Li C, Chen B. Comparison of mini-plate versus Kirschner wire internal fixation for fifth metacarpal basal fractures with carpometacarpal joint dislocation. Am J Transl Res 2024; 16:3129-3138. [PMID: 39114674 PMCID: PMC11301464 DOI: 10.62347/wwza3041] [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: 03/13/2024] [Accepted: 05/29/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To compare the outcome of mini-plate versus Kirschner wire (K-wire) internal fixation for treating fifth metacarpal basal fractures with carpometacarpal joint dislocation. METHOD A total of 46 patients with fifth metacarpal basal fractures combined with carpometacarpal joint dislocation were divided into two groups. The control group received K-wire fixation, while the observation group underwent mini-plate fixation. We assessed treatment effectiveness, surgical parameters, range of motion, serum stress markers, quality of life scores, and postoperative complication rates. A multivariable logistic regression analysis was performed to identify factors influencing postoperative joint function. RESULTS The observation group demonstrated a significantly higher excellent and good rate compared to the control group (P<0.05). Additionally, the observation group had a lower intraoperative bleeding volume, shorter incision lengths, and faster fracture healing times, all significant differences (all P<0.05). Postoperative assessments indicated that range of motion, quality of life scores, and superoxide dismutase levels were significantly improved in the observation group (P<0.05). Conversely, cortisol, angiotensin II, and norepinephrine levels, along with the incidence of postoperative complications, were lower in the observation group compared to the control group (all P<0.05). Logistic regression analysis identified the surgical method as an independent factor affecting postoperative metacarpal joint function (OR = 0.16, P = 0.003). CONCLUSION Mini-plate internal fixation is superior to K-wire fixation for the treatment of fifth metacarpal basal fractures with carpometacarpal joint dislocation. It promotes faster fracture healing, reduces serum stress markers, enhances joint mobility and quality of life, and decreases postoperative complications.
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Affiliation(s)
- Dadong Yu
- Department of Hand and Foot Surgery, Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology Hangzhou, Zhejiang, China
| | - Lijun Guo
- Department of Hand and Foot Surgery, Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology Hangzhou, Zhejiang, China
| | - Cheng Li
- Department of Hand and Foot Surgery, Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology Hangzhou, Zhejiang, China
| | - Bin Chen
- Department of Hand and Foot Surgery, Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology Hangzhou, Zhejiang, China
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Page BJ, Sheridan GA, Greenstein MD, Reif TJ, Fragomen AT, Rozbruch SR. Percutaneous removal of hardware after orthopedic surgery: Is it safe? and What are patients saying? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04038-x. [PMID: 38981919 DOI: 10.1007/s00590-024-04038-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES To analyze our patient's complication profile and rate after removal of hardware (ROH) surgery, and survey our patients to ask their overall status and improvement in symptomatology post-operatively. DESIGN Retrospective chart review and survey. SETTING Academic, tertiary referral center. PATIENTS/PARTICIPANTS 173 patients with 314 pieces of hardware. Seventy-six patients (43.9%) responded to our survey. INTERVENTION ROH surgery. MAIN OUTCOME MEASUREMENTS Patient demographics and complications were recorded. All patients were sent a brief 3-question survey which asked: (1) Why did you get your hardware removed? (2) How did your overall status change after ROH? (3) How did the ROH affect your stiffness, pain, swelling, and mobility? RESULTS There were 10 complications (5.5%): 5 infections, 2 with unresolved pain, 1 hematoma, 1 chronic regional pain syndrome exacerbation, and 1 recurrent deformity. All infections were treated with oral antibiotics and improved. All other complications resolved with treatment except for the patient who developed recurrent deformity. Patients underwent ROH surgery because their doctor suggested it (76.3%) and to improve mobility (39.5%). 86.9% reported their overall status improved after ROH. They improved regarding stiffness (73.7%), pain (73.6%), swelling (61.8%), and mobility (76.3%). Similar results were seen among different implants removed. CONCLUSIONS The majority of patients who underwent percutaneous ROH were satisfied. They reported improvement in stiffness, pain, swelling and mobility (greatest improvement). The complication rate was low (5.5%). ROH can be a meaningful operation to patients allowing them to improve their quality of life with a low complication rate. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Brian Joseph Page
- Orthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian - Weill Cornell Medical Center, New York, NY, USA.
| | - Gerard A Sheridan
- Department of Orthopaedic Surgery, University Hospital Galway, Galway, Ireland
| | | | - Taylor J Reif
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - Austin T Fragomen
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
| | - S Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
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McChesney GR, Al Farii H, Singleterry S, Lewis VO, Moon BS, Satcher RL, Bird JE, Lin PP. Can Periprosthetic Joint Infection of Tumor Prostheses Be Controlled With Debridement, Antibiotics, and Implant Retention? Clin Orthop Relat Res 2024:00003086-990000000-01672. [PMID: 38991232 DOI: 10.1097/corr.0000000000003184] [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: 12/15/2023] [Accepted: 06/17/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Two-stage revision for periprosthetic joint infection (PJI) in patients who have undergone segmental replacement of the distal femur or proximal tibia after tumor resection can be associated with considerable morbidity, pain, and risk of complications because the procedure often results in removal of long, well-fixed stems from the diaphysis. A less-aggressive surgical approach, such as debridement, antibiotics, and implant retention (DAIR), may be attractive to patients and surgeons because of less morbidity, but the likelihood of eradicating infection in comparison to the traditional two-stage revision is not well established for oncology patients. Furthermore, the relative risk of subsequent amputation for DAIR versus two-stage revision has not been defined for this population. QUESTIONS/PURPOSES (1) How does DAIR compare with two-stage revision in terms of infection control for patients with distal femoral or proximal tibial segmental modular endoprostheses? (2) Is DAIR as an initial procedure associated with an increased risk of amputation compared with two-stage revision for infection? METHODS From the longitudinally maintained orthopaedic oncology surgical database at our institution, we identified 69 patients who had been treated for a clinical diagnosis of PJI at the knee between 1993 and 2015. We excluded 32% (22) of patients who did not meet at least one of the major criteria of the Musculoskeletal Infection Society (MSIS) for PJI, 3% (2) of patients who underwent immediate amputation, 3% (2) of patients who had a follow-up time of < 24 months, and 7% (5) of patients who did not have a primary tumor of the distal femur or proximal tibia. The study consisted of 38 patients, of whom eight underwent two-stage revision, 26 underwent DAIR, and four underwent extended DAIR (removal of all segmental components but with retention of stems and components fixed in bone) for their initial surgical procedure. To be considered free of infection, patients had to meet MSIS standards, including no positive cultures, drainage, or surgical debridement for a minimum of 2 years from the last operation. Factors associated with time-dependent risk of infection relapse, clearance, amputation, and patient survival were analyzed using Kaplan-Meier survivorship curves and the log-rank test to compare factors. Association of demographic and treatment factors was assessed using chi-square and Fisher exact tests. RESULTS Continuous infection-free survival at 5 years was 16% (95% CI 2% to 29%) for patients undergoing DAIR compared with 75% (95% CI 45% to 100%) for patients undergoing two-stage revision (p = 0.006). The median (range) number of total surgical procedures was 3 per patient (1 to 10) for DAIR and 2 (2 to 5) for two-stage revision. Twenty-nine percent (11 of 38) of patients eventually underwent amputation. Survival without amputation was 69% (95% CI 51% to 86%) for DAIR compared with 88% (95% CI 65% to 100%) for two-stage revision at 5 years (p = 0.34). The cumulative proportion of patients achieving infection-free status (> 2 years continuously after last treatment) and limb preservation was 58% (95% CI 36% to 80%) for patients initially treated with DAIR versus 87% (95% CI 65% to 100%) for patients first treated with two-stage revision (p = 0.001). CONCLUSION Infection control was better with two-stage revision than DAIR. The chance of eventual clearance of infection with limb preservation was better when two-stage revision was chosen as the initial treatment. However, the loss to follow-up in the two-stage revision group would likely make the true proportion of infection control lower than our estimate. Our experience would suggest that the process of infection eradication is a complex and difficult one. Most patients undergo multiple operations. Nearly one-third of patients eventually underwent amputation, and this was a serious risk for both groups. While we cannot strongly recommend one approach over the other based on our data, we would still consider the use of DAIR in patients who present with acute short duration of symptoms (< 3 weeks), no radiographic signs of erosion around fixed implants, and organisms other than Staphylococcus aureus. We would advocate the extended DAIR procedure with removal of all segmental or modular components, and we would caution patients that there is a high likelihood of needing further surgery. A prospective trial with strict adherence to indications may be needed to evaluate the relative merits of an extended DAIR procedure versus a two-stage revision. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Grant R McChesney
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Humaid Al Farii
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sydney Singleterry
- Neuropsychiatric Institute, Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA
| | - Valerae O Lewis
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan S Moon
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Robert L Satcher
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Justin E Bird
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick P Lin
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
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Qu YP, Jin W, Huang B, Shen J. Combination of manual lymphatic drainage and Kinesio taping for treating pigmented villonodular synovitis: A case report. World J Clin Cases 2024; 12:3971-3977. [PMID: 38994276 PMCID: PMC11235440 DOI: 10.12998/wjcc.v12.i19.3971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/30/2024] [Accepted: 05/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder that affects the synovial joints, bursae, and tendon sheaths. To date, few studies have reported on the treatment of postoperative pain and edema in patients with PVNS. Herein, we present the case of a woman who developed pain and edema in the left lower limb 1 wk after synovectomy and arthroscopic partial meniscectomy and was unable to walk due to limited flexion and extension of the left knee. CASE SUMMARY A 32-year-old woman underwent synovectomy and arthroscopic partial meniscectomy successively and was treated with a combination of manual lymphatic drainage (MLD) and kinesio taping (KT) in our hospital to alleviate postoperative pain and edema. The following parameters were assessed at 2 wk post-treatment and 1 wk post-discharge follow up: suprapatellar circumference, infrapatellar circumference, visual analog scale score, knee range of motion, pittsburgh sleep quality index score, hamilton anxiety rating scale (HAMA) score, and hamilton depression rating scale (HAMD) score. After treatment, the postoperative pain and edema in the patient's left knee were effectively relieved, resulting in improved sleep quality and remarkably attenuated HAMA and HAMD scores. CONCLUSION Combined MLD and KT may be an effective approach for relieving postoperative pain and edema in patients with PVNS.
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Affiliation(s)
- Yan-Ping Qu
- Department of Rehabilitation Medicine, Shanghai Eighth Peoples Hospital, Shanghai 200235, China
| | - Wei Jin
- Department of Rehabilitation Medicine, Shanghai Eighth Peoples Hospital, Shanghai 200235, China
| | - Ben Huang
- Department of Rehabilitation Medicine, Shanghai Eighth Peoples Hospital, Shanghai 200235, China
| | - Jie Shen
- Department of Rehabilitation Medicine, Shanghai Eighth Peoples Hospital, Shanghai 200235, China
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Groisser BN, Thakur A, Hillstrom HJ, Adhiyaman A, Zucker C, Du J, Cunningham M, Hresko MT, Haddas R, Blanco J, Potter HG, Mintz DN, Breighner RE, Heyer JH, Widmann RF. Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms. J Robot Surg 2024; 18:278. [PMID: 38960985 PMCID: PMC11222209 DOI: 10.1007/s11701-024-02001-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024]
Abstract
Historically, pedicle screw accuracy measurements have relied on CT and expert visual assessment of the position of pedicle screws relative to preoperative plans. Proper pedicle screw placement is necessary to avoid complications, cost and morbidity of revision procedures. The aim of this study was to determine accuracy and precision of pedicle screw insertion via a novel computer vision algorithm using preoperative and postoperative computed tomography (CT) scans. Three cadaveric specimens were utilized. Screw placement planning on preoperative CT was performed according to standard clinical practice. Two experienced surgeons performed bilateral T2-L4 instrumentation using robotic-assisted navigation. Postoperative CT scans of the instrumented levels were obtained. Automated segmentation and computer vision techniques were employed to align each preoperative vertebra with its postoperative counterpart and then compare screw positions along all three axes. Registration accuracy was assessed by preoperatively embedding spherical markers (tantalum beads) to measure discrepancies in landmark alignment. Eighty-eight pedicle screws were placed in 3 cadavers' spines. Automated registrations between pre- and postoperative CT achieved sub-voxel accuracy. For the screw tip and tail, the mean three-dimensional errors were 1.67 mm and 1.78 mm, respectively. Mean angular deviation of screw axes from plan was 1.58°. For screw mid-pedicular accuracy, mean absolute error in the medial-lateral and superior-inferior directions were 0.75 mm and 0.60 mm, respectively. This study introduces automated algorithms for determining accuracy and precision of planned pedicle screws. Our accuracy outcomes are comparable or superior to recent robotic-assisted in vivo and cadaver studies. This computerized workflow establishes a standardized protocol for assessing pedicle screw placement accuracy and precision and provides detailed 3D translational and angular accuracy and precision for baseline comparison.
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Affiliation(s)
- Benjamin N Groisser
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ankush Thakur
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Howard J Hillstrom
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Akshitha Adhiyaman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Colson Zucker
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jerry Du
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Matthew Cunningham
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Ram Haddas
- University of Rochester Medical Center, Rochester, NY, USA
| | - John Blanco
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Hollis G Potter
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Douglas N Mintz
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ryan E Breighner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jessica H Heyer
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Roger F Widmann
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Quinn M, Lemme N, Morrissey P, Fadale P, Owens BD. An Update on Emerging Techniques and Considerations in Revision Anterior Cruciate Ligament Reconstruction. JBJS Rev 2024; 12:01874474-202407000-00007. [PMID: 39018384 DOI: 10.2106/jbjs.rvw.24.00047] [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: 07/19/2024]
Abstract
» The rate of primary anterior cruciate ligament reconstruction (ACLR) failure in at-risk populations remains unacceptably high and necessitates thorough evaluation of native alignment and concomitant injuries.» Posterior tibial slope of >12° is a substantial risk factor of ACLR failure and should be corrected through anterior closing wedge osteotomy.» Varus malalignment of >5° exacerbates stress on the ACL graft, increases ACLR failure risks, and should be considered for correction through high tibial osteotomy at the time of revision ACLR.» Injuries to the anterolateral ligamentous complex are prevalent in ACL ruptures, and high-risk patients have shown benefit from anterolateral ligament reconstruction or lateral extra-articular tenodesis in the revision setting.» Addressing posterolateral corner, collateral ligament, and meniscal injuries, during revision ACLR, is vital to mitigate increased graft forces and optimize knee stability and functional outcomes.
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Affiliation(s)
- Matthew Quinn
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Semenistyy AA, Kehayov RI. Ankle arthrodesis through minimally-invasive transfibular approach: a new surgical technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2483-2492. [PMID: 38644419 DOI: 10.1007/s00590-024-03950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE The purpose of our work was to demonstrate the surgical technique of ankle arthrodesis using the minimally-invasive transfibular (MITF) approach, which minimizes soft tissue damage and is advantageous for high-risk patients. METHODS In this prospective study, a total of 12 patients with end-stage varus ankle osteoarthritis, including high-risk individuals, underwent ankle arthrodesis using the MITF approach. The technique involves a unique osteotomy at the joint space level, minimizing soft tissue detachment from the fibula. The primary outcomes assessed included bony union, time to weight-bearing, correction of varus deformity, and functional outcomes measured by the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale. However, the study's limitations encompass a small sample size and the absence of a control group. RESULTS At 6 months post-operation, all patients achieved bony union, with a mean time to union of 13.7 ± 5.2 weeks. The average time to initiate weight-bearing without additional support was 11.2 ± 3.8 weeks. Preoperative varus deformity (17.08 ± 8.36 degrees) and talar tilt (8.75 ± 4.33 degrees) were successfully corrected, with postoperative alignment within 0-5 degrees of valgus. Functional outcomes showed a significant improvement in AOFAS scores from 37.83 ± 7.79 points preoperatively to 77.42 ± 5.63 points one year after surgery (p = 0.002). Minor complications occurred in two patients, both effectively treated with local therapy and antibiotics. CONCLUSIONS The MITF approach for ankle arthrodesis demonstrates promising results in addressing end-stage varus ankle osteoarthritis, even in high-risk patients. However, the study's limitations highlight the need for a prospective comparative clinical trial with a larger sample size to ascertain the technique's effectiveness and safety definitively.
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Affiliation(s)
- Anton A Semenistyy
- Department of Pediatric Orthopedics and Hand Surgery, Specialized Orthopedic University Hospital "Prof. B. Boychev", Nikola Petkov str. 56, Gorna Banya, 1614, Sofia, Bulgaria.
- Department of Orthopedics and Traumatology, Medical University of Sofia, Sofia, Bulgaria.
| | - Raytcho I Kehayov
- Department of Pediatric Orthopedics and Hand Surgery, Specialized Orthopedic University Hospital "Prof. B. Boychev", Nikola Petkov str. 56, Gorna Banya, 1614, Sofia, Bulgaria
- Department of Orthopedics and Traumatology, Medical University of Sofia, Sofia, Bulgaria
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Corban J, Shah S, Ramappa AJ. Current Evidence Based Recommendations on Rehabilitation following Arthroscopic Shoulder Surgery: Rotator Cuff, Instability, Superior Labral Pathology, and Adhesive Capsulitis. Curr Rev Musculoskelet Med 2024; 17:247-257. [PMID: 38668940 PMCID: PMC11156828 DOI: 10.1007/s12178-024-09899-7] [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] [Accepted: 04/17/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Arthroscopy has become increasingly popular for a addressing a wide variety of shoulder pathology. However, despite increasing interest, there is still much uncertainty and variability amongst providers regarding optimal post-operative rehabilitation. This review provides an overview of the evidence underlying common rehab protocols used following arthroscopic interventions for rotator cuff disease, shoulder instability, superior labral anterior to posterior (SLAP) tears and adhesive capsulitis. RECENT FINDINGS For small and medium sized rotator cuff tears, early motion protocols do not seem to affect healing or retear rates, however there is no difference with regards to long term functional outcomes when compared to standard motion protocols. For larger tears (> 3 cm), early active motion may be associated with impaired tendon integrity. Early range of motion following arthroscopic Bankart repair has not been shown to increase rate of recurrence, however the data on return to sport requires more granularity to effectively guide care. Further research needs to be done to compare rehab protocols following SLAP repair and arthroscopic capsular release. Rehabilitation protocols following rotator cuff surgery and anterior shoulder stabilization have garnered the most research interest. However, there is still a need for larger higher-level studies examining the long-term effects of different rehab protocols. Regarding the arthroscopic management of other types of shoulder instability, SLAP tears and adhesive capsulitis, there is paucity of high-quality evidence. This knowledge gap likely underpins the variability in different rehab protocols seen in clinical practice, highlighting the need for more research.
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Affiliation(s)
| | - Sarav Shah
- New England Baptist Hospital, Boston, MA, USA
| | - Arun J Ramappa
- New England Baptist Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Nguyen K, Cooperman S, Ng A. Osteochondral Injuries of the Talus. Clin Podiatr Med Surg 2024; 41:437-450. [PMID: 38789163 DOI: 10.1016/j.cpm.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Osteochondral lesions of the talus are a common sequelae of trauma and are often associated with ankle sprains and ankle fractures. Because the surface of the talus is composed primarily of hyaline cartilage, the regenerative capacity of these injuries is limited. Therefore, several open and arthroscopic techniques have been described to treat osteochondral injuries of the talus and underlying bone marrow lesions. Throughout this review, these treatment options are discussed along with their indications and currently reported outcomes. A commentary on the authors' preferences among these techniques is also provided.
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Affiliation(s)
- Kevin Nguyen
- Advanced Orthopedic & Sports Medicine Specialists, Denver, CO, USA; Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA.
| | - Steven Cooperman
- Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA; HCA Presbyterian Saint Lukes, Denver, CO, USA
| | - Alan Ng
- Department of Podiatric Surgery, Orthopedic Centers of Colorado, Advanced Orthopedic & Sports Medicine Specialists, 8101 East Lowry Boulevard, Suite 230, Denver, CO 80230, USA
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Jayne C, Medina G, Grottkau B, Paschos N. Management of pediatric posterior cruciate ligament avulsion fractures: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2279-2287. [PMID: 38653925 DOI: 10.1007/s00590-024-03920-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/14/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Both open and arthroscopic surgical techniques have been used for PCL avulsion fractures. The goal of this study is to evaluate the effectiveness and safety of the different management strategies proposed for PCL avulsion fractures in children. METHODS A systematic literature review was performed utilizing Medline, Scopus, and EMBASE databases from 1977 to the present. PRISMA guidelines were followed. Data were selected and extracted by two independent reviewers. Inclusion criteria were clinical studies reporting injuries in pediatric patients with PCL avulsion injuries. Exclusion criteria were combined PCL and ACL injuries and ligamentous injuries requiring reconstruction. A subgroup analysis was performed between open reduction and arthroscopic surgeries. FINDINGS/RESULTS Twenty-six studies were included in this systematic review. Patient sex was reported in 39 patients with a higher number of males (32/39). The age range was 7-18 years old. In the open group, 30/31 patients had clinical improvement or returned to pre-injury activity level with two complications. Lysholm scores ranged from 66 to 99. In the arthroscopic group, 11/12 patients experienced clinical improvement or returned to normal activity levels with only one complication. Lysholm scores ranged from 90 to 100 with a mean of 95. In the non-operative group, 3/3 recovered with evidence of fracture healing, full or near full knee range of motion. One Lysholm score was reported 14 months after injury and was 100/100. CONCLUSIONS Open reduction and arthroscopic surgeries are effective and safe treatment options for pediatric PCL avulsion fractures-97% of open reduction and 92% of arthroscopic patients significantly improved symptoms. The complication rates for the open and arthroscopic groups were 11 and 9%, respectively. All three non-operative made full or near full recovery of pre-injury knee status. LEVEL OF EVIDENCE IV Systematic review of Level-II-IV studies. Prospero Registration No CRD42021290899.
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Affiliation(s)
| | - Giovanna Medina
- Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Brian Grottkau
- Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Nikolaos Paschos
- Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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72
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Herman ZJ, Keeling LE, Fox MA, Dadoo S, Musahl V. The Role of Osteotomy in Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:383-398. [PMID: 38811117 DOI: 10.1016/j.csm.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Coronal and sagittal plane knee malalignments have been shown to increase the forces on anterior cruciate ligament (ACL) grafts after ACL reconstruction (ACLR). Studies have shown the benefit of high tibial osteotomy to address coronal and sagittal imbalance in revision ACLR. The purpose of this article is to further describe the use of osteotomy by reviewing preoperative planning, indications, techniques, and outcomes of high tibial opening and closing wedge as well as anterior tibial closing wedge osteotomies in the setting of ACLR.
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Affiliation(s)
- Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA.
| | - Laura E Keeling
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Michael A Fox
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
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73
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Bryson XM, Pham NS, Hollyer I, Hu S, Rinsky LA, Vorhies JS. 3D CT modeling demonstrates the anatomic feasibility of S1AI screw trajectory for spinopelvic fixation in neuromuscular scoliosis. Spine Deform 2024; 12:933-939. [PMID: 38733488 DOI: 10.1007/s43390-024-00840-z] [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: 06/26/2023] [Accepted: 02/07/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE In patients with neuromuscular scoliosis undergoing posterior spinal fusion, the S2 alar iliac (S2AI) screw trajectory is a safe and effective method of lumbopelvic fixation but can lead to implant prominence. Here we use 3D CT modeling to demonstrate the anatomic feasibility of the S1 alar iliac screw (S1AI) compared to the S2AI trajectory in patients with neuromuscular scoliosis. METHODS This retrospective study used CT scans of 14 patients with spinal deformity to create 3D spinal reconstructions and model the insertional anatomy, max length, screw diameter, and potential for implant prominence between 28 S2AI and 28 S1AI screw trajectories. RESULTS Patients had a mean age of 14.42 (range 8-21), coronal cobb angle of 85° (range 54-141), and pelvic obliquity of 28° (range 4-51). The maximum length and diameter of both screw trajectories were similar. S1AI screws were, on average, 6.3 ± 5 mm less prominent than S2AI screws relative to the iliac crests. S2AI screws were feasible in all patients, while in two patients, posterior elements of the lumbar spine would interfere with S1AI screw insertion. CONCLUSION In this cohort of patients with neuromuscular scoliosis, we demonstrate that the S1AI trajectory offers comparable screw length and diameter to an S2AI screw with less implant prominence. An S1AI screw, however, may not be feasible in some patients due to interference from the posterior elements of the lumbar spine.
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Affiliation(s)
- Xochitl M Bryson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Nicole S Pham
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Ian Hollyer
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Serena Hu
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - Lawrence A Rinsky
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA
| | - John S Vorhies
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, USA.
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Kwak DS, Woo I, Lee JM, Hong E, Park CH. The effects of medial soft tissue release for varus deformity during medial open wedge supramalleolar osteotomy: a cadaveric study. Biomed Eng Lett 2024; 14:747-754. [PMID: 38946821 PMCID: PMC11208347 DOI: 10.1007/s13534-024-00370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 07/02/2024] Open
Abstract
This study was performed to investigate the effects of fibular osteotomy and release of medial soft tissues including posterior tibial tendon (PTT), and deep deltoid ligaments, which act as medial stabilizing structures in medial open wedge SMO. Twelve fresh frozen human legs were obtained and disarticulated below the knee. Experiments were conducted in four steps. First, medial open wedge tibial osteotomy was performed. Second, fibular osteotomy was performed in an inferomedial direction at the same level as the tibial osteotomy. Third, the deep deltoid ligament was released from tibial attachments. Forth, total tenotomy of the PTT was performed behind the medial malleolus. After finishing each step, contact area and peak and mean pressures were measured in the tibiotalar and talofibular joints. Fibular osteotomy after medial open wedge SMO significantly decreased mean pressure in the tibiotalar joint, mean and peak pressures in the talofibular joint. Medial soft tissue release resulted in a remarkable lateral shift and decreased tibiotalar joint loading. However, no remarkable change was observed in the tibiotalar joint during releasing medial soft tissues. The overall peak pressure distribution tended to shift more laterally compared to the value of normal alignment. In conclusion, concomitant fibular osteotomy and release of the deltoid ligament and PTT provide a useful means of minimizing tibiotalar joint stress. Supplementary Information The online version contains supplementary material available at 10.1007/s13534-024-00370-7.
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Affiliation(s)
- Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591 Republic of Korea
| | - Inha Woo
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jung-Min Lee
- Industry-Academic Cooperation Foundation, Keimyung University, Daegu, 42601 Republic of Korea
| | - Eunah Hong
- Arthrex Korea, 20th fl. Parnas Tower 521, Teheran-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Chul Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415 Republic of Korea
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75
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Winter JE, Budin JS, Delvadia BP, Cole MW, Waters TL, Schiff AP, Sherman WF. Association of Smokeless Tobacco and Complications Following Ankle and Hindfoot Arthrodesis. Foot Ankle Int 2024; 45:679-689. [PMID: 38529955 DOI: 10.1177/10711007241238213] [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] [Indexed: 03/27/2024]
Abstract
BACKGROUND The purpose of this study was to (1) evaluate the rates of postoperative complications following ankle or hindfoot arthrodesis among current smokeless tobacco users and people who smoke compared to matched controls, and (2) compare rates of postoperative complications in current smokeless tobacco users vs people who smoke tobacco cigarettes. METHODS A retrospective cohort study was conducted using a large national database. For patients who underwent ankle or hindfoot arthrodesis, smokeless tobacco users (n = 131) and people who smoke (n = 1948) were matched 1:4 with controls, and smokeless tobacco users (n = 131) were matched 1:4 with people who smoke tobacco cigarettes (n = 524). Orthopaedic complications within 90 days, 1 year, and 2 years were compared using multivariable logistic regressions. RESULTS Within 90 days of ankle or hindfoot arthrodesis, smokeless tobacco users demonstrated significantly higher rates of hardware removal (odds ratio [OR] 5.01, 95% CI 1.65-15.20), wound disruption or dehiscence (OR 3.00, 95% CI 1.21-7.44), and pooled complications (16.0% vs 5.9%, OR 2.84, 95% CI 1.50-5.38) compared with tobacco-naïve controls. The rates of hardware removal, wound disruption and dehiscence, and pooled complications remained significant in the smokeless tobacco cohort at 1 and 2 years. At 2 years following ankle or hindfoot arthrodesis, smokeless tobacco users additionally demonstrated significantly higher rates of infection (OR 6.08, 95% CI 1.15-32.05) and nonunion (OR 2.35, 95% CI 1.31-4.20) compared with tobacco-naïve controls. Within 90 days of ankle or hindfoot arthrodesis, smokeless tobacco users demonstrated significantly lower rates of malunion or nonunion than patients who smoke tobacco cigarettes (OR 0.34, 95% CI 0.12-0.97), whereas all other complications were not significantly different. CONCLUSION Smokeless tobacco use is associated with higher rates of complications following ankle or hindfoot arthrodesis compared with tobacco-naïve controls, and physicians should screen for smokeless tobacco use specifically and encourage cessation before operating electively. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Julianna E Winter
- Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA
| | - Jacob S Budin
- Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA
| | - Bela P Delvadia
- Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA
| | - Matthew W Cole
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Timothy L Waters
- Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA
| | - Adam P Schiff
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - William F Sherman
- Department of Orthopaedic Surgery, Tulane University, New Orleans, LA, USA
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Echevarria AC, Hershfeld B, Verma R, Bruni M. Recurrent Laryngeal Nerve Injury During Anterior Cervical Discectomy and Fusion (ACDF): A Case Presentation and Review of the Literature. Cureus 2024; 16:e64603. [PMID: 39144844 PMCID: PMC11323947 DOI: 10.7759/cureus.64603] [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: 06/11/2024] [Accepted: 07/14/2024] [Indexed: 08/16/2024] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) is a surgical procedure used to manage spine pathology including disc herniation, spondylosis, and myelopathy. During the operation, the vertebral segment of interest is accessed via the anterior neck and the disc space is fully resected along with osteophytes to relieve the compression along the affected nerve. While the procedure is regarded as being highly effective in improving symptoms, there are several complications associated with the surgery that patients should be cautioned about. We present a case of a patient with oropharyngeal and cervical esophageal dysphagia and left vocal cord paralysis following a C5/C6, C6/C7, and C7/T1 ACDF for multilevel cervical stenosis and disc herniation. Otolaryngology evaluation confirmed vocal cord paralysis from recurrent laryngeal nerve palsy (RLNP) and the patient's symptoms were managed with a vocal cord injection and speech therapy. This report explores the surgical approach for ACDF along with its complications and postoperative care.
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Affiliation(s)
- Alexandra C Echevarria
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | | | - Rohit Verma
- Orthopedic Surgery, Northwell Health, Manhasset, USA
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Lo YS, Shi BL, Lin ETE, Yeh CW, Tsai CH, Chen HT, Zhu ZZ, Qiu Y. Assessing Neurological Complications in Thoracic Three-Column Osteotomy: A Clinical Application of a Novel MRI-Based Classification Approach. Spine (Phila Pa 1976) 2024; 49:950-955. [PMID: 38221840 DOI: 10.1097/brs.0000000000004924] [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: 10/11/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE To investigate the occurrence of neurological complications in patients undergoing thoracic three-column osteotomy (3CO) utilizing an magnetic resonance imaging (MRI)-based classification that assesses spinal cord shape and the presence of cerebrospinal fluid at the curve apex and evaluate its prognostic capacity for postoperative neurological deficits. SUMMARY OF BACKGROUND DATA Recent advancements in correction techniques have improved outcomes for severe spinal deformity patients undergoing 3CO. A novel MRI-based spinal cord classification system was introduced, but its validation and association with postoperative complications remain unexplored. MATERIALS AND METHODS Between September 2012 and September 2018, a retrospective analysis was conducted on 158 adult patients with spinal deformities undergoing 3CO. Radiographic parameters were measured. T2-weighted axial MRI was used to describe spinal cord morphology at the apex. Intraoperative neurophysiological monitoring alerts were recorded, and preoperative and postoperative neurological functions were assessed using the Frankel score. Categorical data were compared using the χ 2 or the Fisher exact test. The paired t test was utilized to assess the mean difference between preoperative and postoperative measurements, while the one-way analysis of variance and independent t test were used for comparative analyses among the different spinal cord types. RESULTS Patients were categorized into three groups: type 1, type 2, and type 3, consisting of 12, 85, and 61 patients. Patients with type 3 morphology exhibited larger Cobb angles of the main curve ( P <0.001). This disparity persisted both postoperatively and during follow-up ( P <0.05). Intraoperative neurophysiological monitoring alerts were triggered in 32 patients (20.3%), with a distribution of one case in type 1, six cases in type 2, and 22 cases in type 3 morphologies ( P <0.001). New neurological deficits were observed in 15 patients (9.5%), with 1, 3, and 11 cases in type 1, 2, and 3 morphologies, respectively. CONCLUSIONS Patients with type 3 morphology exhibited greater spinal deformity severity, a higher likelihood of preoperative neurological deficits, and an elevated risk of postoperative neurological complications. This underscores the utility of the classification as a tool for predicting postoperative neurological complications in patients undergoing thoracic 3CO. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Yuan-Shun Lo
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan
| | - Ben-Long Shi
- Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Erh-Ti Ernest Lin
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chen-Wei Yeh
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ze-Zhang Zhu
- Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Yong Qiu
- Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
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Alkhateeb J, Langley C, Wong I. Arthroscopic Augmentation of Subscapularis Revision Repair Using a Bioinductive Collagen Implant. Arthrosc Tech 2024; 13:102993. [PMID: 39100260 PMCID: PMC11293337 DOI: 10.1016/j.eats.2024.102993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/25/2024] [Indexed: 08/06/2024] Open
Abstract
The overall failure rate of rotator cuff healing after primary repair is high and is even greater in revision cases. This worrisome outcome has spurred the development and use of biological materials to help promote healing potentials. This Technical Note describes an all-arthroscopic technique for the application of a bioinductive collagen patch to augment subscapularis full-thickness tear repair. We describe in detail a stepwise approach to guide surgeons in patient positioning, portal placement, diagnostic arthroscopy, graft preparation, deployment, and fixation.
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Affiliation(s)
- Jawaher Alkhateeb
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Charlotte Langley
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Abd-Elsayed A, Matta AY, Nitz JN, Henjum LJ, Shiferaw BT, May R, Fiala KJ. Efficacy of Cooled-Radiofrequency Ablation of the Genicular Nerve as Treatment for Chronic Knee Pain: A Retrospective Study. Adv Ther 2024; 41:2859-2867. [PMID: 38802633 DOI: 10.1007/s12325-024-02892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Chronic pain is one of the leading causes of reduced quality of life in the USA, with knee pain commonly reported. Multiple therapeutic modalities are traditionally utilized for pain management; however, some patients may have pain refractory to these techniques. Cooled radiofrequency ablation (c-RFA) of the geniculate nerve is a growing and promising therapy offering a potentially long-term solution to chronic knee pain. METHODS This study assessed the efficacy, average duration of relief, and potential adverse events using a retrospective chart review of 406 procedures. A two-tailed paired t test was used to assess the statistical significance between pre-RFA vs. post-RFA visual analog scale (VAS) pain scores self-reported by patients. An analysis of variance (ANOVA) test was used to evaluate for statistical differences in pre-RFA pain scores and post-RFA pain scores among the categories of age, sex, body mass index (BMI), and diagnosis group. RESULTS The mean percent in pain improvement calculated was 65.5% with an average duration of relief of 7.20 months. The average pre-RFA pain score on the VAS was 6.26 out of 10 and 2.59 out of 10 post-RFA. The ANOVA post-RFA pain scores demonstrated statistically significant differences among the categories of age and sex. A total of 54 adverse events were reported, including worsening pain, numbness, paresthesia, and knee swelling. CONCLUSION The study demonstrated that c-RFA can potentially be utilized as an alternative safe therapy for chronic knee pain, providing pain relief with a relatively prolonged duration. Inherent challenges of retrospective studies remain a part of the limitations of this study.
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Affiliation(s)
- Alaa Abd-Elsayed
- Madison School of Medicine and Public Health, Anesthesiology, Division of Chronic Pain Medicine, University of Wisconsin, Madison, USA.
| | - Andrew Y Matta
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - James N Nitz
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Lukas J Henjum
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Barnabas T Shiferaw
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Raven May
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Kenneth J Fiala
- Madison School of Medicine and Public Health, University of Wisconsin, Madison, USA
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Li Y, Liu H, Guo Y, Chen S, Canavese F, Liu Y, Li J, Xu H, Xia H. Factors influencing outcomes of pelvic osteotomy for residual acetabular dysplasia following closed reduction in patients with developmental dysplasia of the hip. J Pediatr Orthop B 2024; 33:340-347. [PMID: 37610089 DOI: 10.1097/bpb.0000000000001117] [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: 08/24/2023]
Abstract
To investigate the factors influencing outcome of pelvic osteotomy (PO) for residual acetabular dysplasia (RAD) following closed reduction (CR) in patients with developmental dysplasia of the hip (DDH). We retrospectively reviewed 91 patients (95 hips) with DDH who underwent PO for RAD. Tönnis grade, Acetabular index, Center Edge Angle, Reimer's Index (RI), and avascular necrosis of the femoral head (AVN) were assessed. Hips were divided into satisfactory (Severin I/II) and unsatisfactory group (Severin III/IV). Finally, 87 hips (91.5%) had satisfactory and 8 (8.5%) unsatisfactory outcomes. The RI before PO was significantly higher in unsatisfactory (49.6 ± 9%) than in satisfactory group (30.6%±11.8%). All patients without AVN had satisfactory outcome, while it was 78.9% of patients with AVN. Logistic regression analysis showed that higher AVN grade and RI before PO were risk factors for unsatisfactory outcome. Satisfactory outcome was obtained in all hips with RI < 33% before PO, while it was 79.5% if RI > 33% before PO (79.5%). There was no difference in the satisfactory rate between patients undergoing open reduction (66.7%) and those not undergoing (83.3%). The rate of satisfactory outcome in patients undergoing femoral osteotomy (63.6%) was lower than those without it (100%). In patients with RAD following CR, good outcome can be expected after PO alone. AVN and preoperative RI > 33% are risk factors for poor outcome. Additional open reduction and femoral osteotomy do not significantly improve outcome of PO in patients with preoperative RI > 33%.
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Affiliation(s)
- YiQiang Li
- The First Affiliated Hospital of Jinan University, Jinan University
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
| | - Hang Liu
- Department of Pediatric Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing
| | - YueMing Guo
- Department of Pediatric Orthopaedics, FoShan Hospital of Traditional Chinese Medicine, Foshan
| | - ShunYou Chen
- Department of Pediatric Orthopedics, Fuzhou Second Hospital, Xiamen University, Fuzhou, China
| | - Federico Canavese
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
- Department of Pediatric Orthopedics, Jeanne de Flandre Hospital, Lille University Center, Lille, France
| | - YanHan Liu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
| | - JingChun Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
| | - HongWen Xu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
| | - HuiMin Xia
- The First Affiliated Hospital of Jinan University, Jinan University
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou
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Pintore A, Astone A, Vecchio G, Asparago G, Calabrò G, Migliorini F, Maffulli N. Percutaneous transverse pinning for metacarpal fractures: a clinical trial. Arch Orthop Trauma Surg 2024; 144:3129-3136. [PMID: 38965077 PMCID: PMC11319403 DOI: 10.1007/s00402-024-05422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Metacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure. METHODS Between March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05. RESULTS The mean age was 40.21 ± 17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5 ± 1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory. CONCLUSION Percutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Andrea Pintore
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Alberto Astone
- Department of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy
| | - Gianluca Vecchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Giampiero Calabrò
- Department of Orthopaedics and Traumatology, San Francesco D'Assisi Hospital, Oliveto Citra, Italy
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
| | - Nicola Maffulli
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke On Trent, England, UK.
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, England, E1 4DG, UK.
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy.
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Odland K, Chanbour H, Zuckerman SL, Polly DW. Spinopelvic fixation failure in the adult spinal deformity population: systematic review and meta-analysis. 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 2024; 33:2751-2762. [PMID: 38619634 DOI: 10.1007/s00586-024-08241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Despite modern fixation techniques, spinopelvic fixation failure (SPFF) after adult spinal deformity (ASD) surgery ranges from 4.5 to 38.0%, with approximately 50% requiring reoperation. Compared to other well-studied complications after ASD surgery, less is known about the incidence and predictors of SPFF. AIMS/OBJECTIVES Given the high rates of SPFF and reoperation needed to treat it, the purpose of this systematic review and meta-analysis was to report the incidence and failure mechanisms of SPF after ASD surgery. MATERIALS/METHODS The literature search was executed across four databases: Medline via PubMed and Ovid, SPORTDiscus via EBSCO, Cochrane Library via Wiley, and Scopus. Study inclusion criteria were patients undergoing ASD surgery with spinopelvic instrumentation, report rates of SPFF and type of failure mechanism, patients over 18 years of age, minimum 1-year follow-up, and cohort or case-control studies. From each study, we collected general demographic information (age, gender, and body mass index), primary/revision, type of ASD, and mode of failure (screw loosening, rod breakage, pseudarthrosis, screw failure, SI joint pain, screw protrusion, set plug dislodgment, and sacral fracture) and recorded the overall rate of SPF as well as failure rate for each type. For the assessment of failure rate, we required a minimum of 12 months follow-up with radiographic assessment. RESULTS Of 206 studies queried, 14 met inclusion criteria comprising 3570 ASD patients who underwent ASD surgery with pelvic instrumentation (mean age 65.5 ± 3.6 years). The mean SPFF rate was 22.1% (range 3-41%). Stratification for type of failure resulted in a mean SPFF rate of 23.3% for the pseudarthrosis group; 16.5% for the rod fracture group; 13.5% for the iliac screw loosening group; 7.3% for the SIJ pain group; 6.1% for the iliac screw group; 3.6% for the set plug dislodgement group; 1.1% for the sacral fracture group; and 1% for the iliac screw prominence group. CONCLUSION The aggregate rate of SPFF after ASD surgery is 22.1%. The most common mechanisms of failure were pseudarthrosis, rod fracture, and iliac screw loosening. Studies of SPFF remain heterogeneous, and a consistent definition of what constitutes SPFF is needed. This study may enable surgeons to provide patient specific constructs with pelvic fixation constructs to minimize this risk of failure.
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Affiliation(s)
- Kari Odland
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, 37204, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, 37204, USA
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
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83
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Odri GA, Yatim C, Yoon DJY, Bouche PA, Severyns M, Bizot P. Extra-articular hip resection with maintenance of pelvic continuity in malignant tumours of the proximal femur with articular invasion. Hip Int 2024; 34:537-545. [PMID: 38716792 DOI: 10.1177/11207000241249135] [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] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Extra-articular hip resection may be necessary in cases of malignant tumour of the pelvic bone or of the proximal femur invading the hip joint. When the tumour is in the proximal femur, it is possible to resect the acetabulum en bloc by performing a periacetabular osteotomy, but this creates a discontinuity in the pelvic ring with difficult reconstruction and diminished function. Several techniques described recently seek to be as sparing as possible on the pelvic bone by preserving the posterior column or both columns in order to facilitate reconstruction and improve function. However, these still require complex reconstructions and can necessitate intra-pelvic dissection. TECHNIQUE We describe here an extra-articular hip resection technique for tumours of the proximal femur invading the joint, with maintenance of pelvic continuity by preserving both columns and the quadrilateral plate of the acetabulum, without intra-pelvic dissection, that can be performed on patients in whom the medial wall of the acetabulum is thick enough. Our preliminary assessments have included studies on dry bone and imaging analyses. The technique was first tested on a single cadaver pelvis (encompassing 2 hips) and subsequently performed on a patient with a pathological fracture of the femoral neck due to osteosarcoma secondary to Paget's disease. CONCLUSIONS Further clinical applications are essential to evaluate the overall effectiveness, safety and impact on patient functionality of this experimental technique.
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Affiliation(s)
- Guillaume-Anthony Odri
- Orthopaedics and Traumatology, CHU Lariboisière, Paris, France
- Inserm U1132 BIOSCAR, Université Paris Cité, Paris, France
| | - Cédric Yatim
- Orthopaedics and Traumatology, CHU Lariboisière, Paris, France
| | | | | | - Mathieu Severyns
- Orthopaedic Surgery, CHU de Martinique, Fort-de-France, Martinique
| | - Pascal Bizot
- Orthopaedics and Traumatology, CHU Lariboisière, Paris, France
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84
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Atkinson CJ, Seth I, Seifman MA, Rozen WM, Cuomo R. Enhancing Hand Fracture Care: A Prospective Study of Artificial Intelligence Application With ChatGPT. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:524-528. [PMID: 39166196 PMCID: PMC11331228 DOI: 10.1016/j.jhsg.2024.03.014] [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: 03/03/2024] [Accepted: 03/26/2024] [Indexed: 08/22/2024] Open
Abstract
Purpose The integration of artificial intelligence and machine learning technologies into the medical field has brought about remarkable advancements, particularly in the domain of clinical decision support systems. However, it is uncertain how they will perform as clinical decision-makers. Methods This prospective cohort study evaluates the potential of incorporating ChatGPT-4 plus into the management of subcapital fifth metacarpal fractures. The treatment recommendations provided by ChatGPT-4 plus were compared with those of the two control groups-the attending clinic plastic surgeon and an independent expert panel. The primary outcome measures, operative or conservative, were compared between the groups. Intraclass correlation of 0.61 infers moderate reliability in the consistency of recommended management plans across all groups. Results Key predictors for opting for operative management, regardless of the decision-maker, included clinical signs of scissoring, extension deficit, and radiographic evidence of intra-articular extension. Conclusions These findings support the potential for artificial intelligence applications in enhancing diagnostic and treatment decisions. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Connor John Atkinson
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
| | - Ishith Seth
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Alfred Hospital, Prahran, VIC, Australia
| | - Marc Adam Seifman
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
| | - Warren Matthew Rozen
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
- Department of Surgery, Central Clinical School, Monash University, Alfred Hospital, Prahran, VIC, Australia
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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85
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Saliba I, Hardy A. Four-Stranded Semitendinosus Tendon Anterior Cruciate Ligament Reconstruction With Mini-invasive Anterolateral Ligament Reconstruction. Arthrosc Tech 2024; 13:102988. [PMID: 39100262 PMCID: PMC11293334 DOI: 10.1016/j.eats.2024.102988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/17/2024] [Indexed: 08/06/2024] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) is presently acknowledged as a prevalent procedure within the field of sports medicine surgery. Among the various graft options available, autograft hamstring tendons have emerged as one of the frequently used choices. This selection is primarily driven by the advantages it offers, such as reduced postoperative knee pain and a comparatively smoother surgical recovery process, when compared with the use of bone-patellar tendon-bone autografts. Quadrupled (4-stranded) semitendinosus tendon grafts have gained substantial popularity in recent years. This graft option offers the advantage of preserving the gracilis tendon while simultaneously exhibiting exceptional biomechanical strength. Furthermore, clinical studies have shown that the combination of ACLR and anterolateral ligament reconstruction yields superior outcomes, circumventing the application of nonanatomic extra-articular procedures involving the use of the fascia lata. The objective of this technical note is to outline a meticulous approach for ACLR using a 4-stranded semitendinosus tendon graft, applying a double-suspensory fixation method, and incorporating a minimally invasive procedure for anterolateral ligament reconstruction.
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Affiliation(s)
- Ibrahim Saliba
- Department of Orthopedic Surgery, Clinique Du Sport, Paris, France
| | - Alexandre Hardy
- Department of Orthopedic Surgery, Clinique Du Sport, Paris, France
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86
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Romandini I, Grassi A, Andrea Lucidi G, Filardo G, Zaffagnini S. 10-Year Survival and Clinical Improvement of Meniscal Allograft Transplantation in Early to Moderate Knee Osteoarthritis. Am J Sports Med 2024; 52:1997-2007. [PMID: 38857030 PMCID: PMC11264561 DOI: 10.1177/03635465241253849] [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: 11/20/2023] [Accepted: 03/22/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Meniscal allograft transplantation (MAT) is a viable option for patients experiencing unicompartmental knee pain after total or subtotal meniscectomy. Nonetheless, caution is recommended when suggesting this procedure in the presence of knee osteoarthritis (OA) because of the higher risk of poor survival and outcomes. PURPOSE/HYPOTHESIS The purpose was to document the long-term survival of MAT performed as a salvage procedure in patients with knee OA. The hypothesis was that MAT would significantly reduce pain and increase the function of the affected joint at a long-term follow-up compared with the preoperative condition, with a low number of failures and knee replacement surgeries. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 47 patients (37 men and 10 women) with symptomatic knee OA (Kellgren-Lawrence grades 2 or 3) treated with MAT were evaluated at baseline, 5 years, and a minimum 10-year final follow-up (11.1 ± 1 years) using the Lysholm score, the visual analog scale for pain, the Knee injury and Osteoarthritis Outcome Score subscales, and the Tegner score. A total of 44 patients had undergone previous surgeries. Patient satisfaction, revision surgeries, and failures were also recorded. RESULTS A statistically significant improvement was observed in all clinical scores from the baseline assessment to the final follow-up. The Lysholm score improved significantly from 46.4 ± 17.2 at the preoperative assessment to 77.7 ± 20.4 at the intermediate follow-up (P < .001), with a significant decrease at the final follow-up (71 ± 23.3; P = .018). A similar trend was reported for the visual analog scale scale for pain, Knee injury and Osteoarthritis Outcome Score, and Tegner score, with no complete recovery to the previous sports activity level. A total of 33 patients required concurrent procedures, such as anterior cruciate ligament reconstructions, osteotomies, and cartilage procedures. Five patients underwent reoperation and were considered surgical failures, while 15 patients presented a clinical condition of <65 of the Lysholm score and were considered clinical failures. Among these, 4 patients were considered both surgical and clinical failures. CONCLUSION MAT surgery has proven to be a valid option for improving pain and function even in OA joints (Kellgren-Lawrence grades 2 or 3), yielding satisfactory results despite a worsening clinical outcome in the long-term follow-up. Therefore, based on the data from this study, orthopaedic surgeons may consider recommending MAT as a salvage procedure even in knees affected by early to moderate OA, while advising patients that the need for combined interventions could potentially reduce graft survival.
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Affiliation(s)
- Iacopo Romandini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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87
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Getgood AMJ. Avoiding Graft Failure: Lessons Learned from the Stability Trial. Clin Sports Med 2024; 43:367-381. [PMID: 38811116 DOI: 10.1016/j.csm.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The Stability Study was a multicenter, pragmatic, parallel groups, randomized clinical trial comparing hamstring tendon autograft anterior cruciate ligament reconstruction with or without the addition of lateral extra-articular tenodesis in young patients at high risk of graft failure. Having recruited 618 patients with a 5% loss to follow up, we were able to demonstrate a clinically and statistically significant reduction in clinical failure and graft rupture at 2 years postoperative. No differences in patient-reported outcomes (PROs) were demonstrated between groups; however, patients who experienced an adverse event had significantly worse PROs than those who did not.
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Affiliation(s)
- Alan M J Getgood
- Western University, Fowler Kennedy Sport Medicine Clinic, 3M Centre, London, Ontario N6A 3K7, Canada.
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88
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von Pfeil DJF, Tan D, Adams R, Glassman M. Outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning. Vet Surg 2024; 53:904-917. [PMID: 38741348 DOI: 10.1111/vsu.14096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/07/2024] [Accepted: 03/23/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To report the outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning (FGNMP). STUDY DESIGN Retrospective case series. ANIMALS A total of 15 client owned dogs and two cats with 57 metabone fractures. METHODS Description of FGNMP and reporting of the following data: signalment, pre- and postoperative radiographs, intramedullary pin diameter used, anesthesia, surgery and coaptation times, duration to normal weightbearing and bone union, postoperative care and complications. RESULTS Median surgery time was 54 min (range: 26-99), median duration of coaptation was 14 days (range: 1-5 weeks), median time to normal weightbearing was 16 days (range: 2-45) and median time to bone union was 6 weeks (range: 4-12). All cases had at least 12 months of post-surgical follow-up with a median follow-up of 18 months (range: 12-70). No major complications occurred. Mild radiographic changes associated with subchondral bone sclerosis were noted on follow-up radiographs in 13/57 fractures. All cases returned to normal gait and full (15) or acceptable (2) function. CONCLUSION In this study, FGNMP was an effective and safe technique for metabone fracture repair, requiring only short-term external coaptation in most patients. Time to bone union and return to normal function compared favorably to previously reported techniques. CLINICAL RELEVANCE Fluoroscopically guided normograde metabone pinning provides an alternative technique for treatment of metabone fractures.
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Affiliation(s)
| | - Desmond Tan
- Sirius Veterinary Orthopedic Center, Omaha, Nebraska, USA
| | | | - Mathieu Glassman
- Friendship Surgical Specialists of the Friendship Hospital for Animals, Washington, District of Columbia, USA
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Hoellwarth JS, Tetsworth K, Al Muderis M. Single-Stage Press-Fit Osseointegration of the Radius and Ulna for Rehabilitation After Trans-Forearm Amputation. JBJS Essent Surg Tech 2024; 14:e23.00015. [PMID: 38988477 PMCID: PMC11233105 DOI: 10.2106/jbjs.st.23.00015] [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: 07/12/2024] Open
Abstract
Background Upper limb (UL) amputation is disabling. ULs are necessary for many domains of life1, and few effective motor and sensory replacements are accessible2. Approximately 41,000 people in the United States have UL amputation proximal to the fingers3, two-thirds of (all) traumatic amputations are UL4, and 80% of UL amputations are performed for trauma-related etiologies5. Socket prosthesis (SP) abandonment remains high because of the lack of sensation, limited prosthesis control, perceived weight, and difficulty comfortably wearing the SP6. Transcutaneous osseointegration7,8 surgically inserts a bone-anchored implant, passed through a transcutaneous portal to attach a terminal device, improving amputee rehabilitation by reducing perceived weight, conferring osseoperception9, and increasing wear time10. Without the socket, all residual skin and musculature remain available for transcutaneous myoelectrodes. The present article describes single-stage radius and ulna press-fit osseointegration (PFOI) after trans-forearm amputation. Description This technique resembles a lower-extremity PFOI11,12. Importantly, at-risk nerves and vessels are different, and implant impaction must be gentler as a result. The surgery is indicated for patients who are dissatisfied with SP rehabilitation or declining alternative rehabilitative options, and who are motivated and enabled to procure, train with, and utilize a forearm prosthesis. An engaged prosthetist is critical. Surgical steps are exposure, bone-end and canal preparation, first implant insertion (in the operative video shown, in the radius), purse-string muscle closure, confirmation that radius-ulna motion remains, performing the prior steps for the other bone (in the video, the ulna), and closure (including potential nerve reconstruction, soft-tissue contouring, and portal creation). Although the patient in the operative video did not require nerve procedures to address pain or to create targets for transcutaneous myoelectrodes, targeted muscle reinnervation or a regenerative peripheral nerve interface procedure could be performed following exposure. Alternatives Alternatives include socket modification, bone lengthening and/or soft-tissue contouring13, Krukenberg-type reconstructions14, or accepting the situation. An alternative implant is a screw-type osseointegration implant. Our preference for press-fit implants is based on considerations such as our practice's 12-year history of >1,000 PFOI surgeries; that the screw-type implant requires sufficient cortical thickness for the threads15, which is compromised in some patients; the lower cost per implant; that the procedure is performed in 1 instead of 2 surgical episodes15,16; and the documented suitability of press-fit implants for patients with challenging anatomy or comorbidities17-19. Rationale PFOI can be provided for amputees having difficulty with socket wear. PFOI usually provides superior prosthesis stability, which can confer better prosthesis control versus nonoperative and other operative options in patients expressing dissatisfaction for reasons such as those mentioned above, or for poor fit, compromised energy transfer, skin pinching, compression, and abrasions. For patients who want myoelectric control of their prosthesis but who are unable because the optimal myoelectric location is obstructed by the socket, osseointegration may provide access for the electrodes by eliminating the socket. Expected Outcomes Only 3 trans-forearm osseointegration20-22 publications totaling 10 limbs could be identified, limiting the ability to determine generalizable outcomes. Osseointegrated prostheses, being skeletally anchored, feel lighter to patients than SPs, which should confer better outcomes. In 1 patient, multiple implant fractures and infection prompted additional surgeries. Periprosthetic bone fractures and non-infectious loosening have not been documented for UL osseointegration. Important Tips Osseointegration eliminates the socket, relieving socket-based pain. However, neurogenic pain relief requires specific nerve procedures.Osseointegration provides a prosthesis connection. Nerve- or muscle-based prosthesis control requires separate, potentially integrated planning.Osseointegrated prostheses confer osseoperception (i.e., mechanical force transmission), not "normal" skin-mediated afferent sensation (i.e., light touch, temperature, pain) or native proprioception.Prostheses must be individualized to the patient's elbow flexion and radioulnar rotation. An attentive prosthetist must be ensured preoperatively.Achieving the demonstrated outcomes requires more therapy and retraining than walking with an osseointegrated lower-extremity prosthesis. Patients must expect at least several months of spending multiple hours daily engaging in self-directed rehabilitation.Prosthesis utilization decision aids23 may minimize non-beneficial surgeries. Acronyms and Abbreviations UL = upper limbSP = socket prosthesisPFOI = press-fit osseointegrationperi-pros fx = periprosthetic fractureMRI = magnetic resonance imagingCT = computed tomography.
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Affiliation(s)
- Jason S. Hoellwarth
- Osseointegration Limb Replacement Center, Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Munjed Al Muderis
- Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia
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Hassan WM, Mahmoud H. Effectiveness of Regional Nerve Blocks Versus Local Anesthetic Infiltration for Elective Hand and Wrist Surgery. Cureus 2024; 16:e63569. [PMID: 39087155 PMCID: PMC11289853 DOI: 10.7759/cureus.63569] [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] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Pain relief by different methods in elective hand and wrist surgery is pivotal for patients undergoing elective wrist and hand surgery. AIM To evaluate the effectiveness and duration of peripheral nerve block versus local surgical site anesthetic infiltration among patients undergoing elective wrist and hand surgery. SUBJECTS AND METHODS This study was carried out in the Orthopaedic Department of Duhok Emergency Teaching Hospital, Duhok, Kurdistan region, Iraq. All patients who attended the Orthopaedic Department (total number=496) for elective hand and wrist surgery between November 2021 and November 2022 were included in the study, but only 300 patients completed the study protocol after the exclusion of 196 patients. Three methods of nerve block were used for postoperative pain relief. The degree and duration of pain relief were assessed. RESULTS Patients who underwent ultrasound-guided nerve block had more duration of pain relief when compared to those patients who underwent local surgical site anesthetic infiltration and anatomical landmark nerve block (p<0.01), while patients who underwent local surgical site anesthetic infiltration had better pain relief when compared to those patients who underwent ultrasound-guided nerve block and anatomical landmark nerve block (p<0.01 for the group experiencing mild pain and p=0.12 for the group experiencing moderate pain and p<0.01 for the group experiencing severe pain). CONCLUSION Ultrasound-guided nerve block is better for a longer duration of pain relief postoperatively than local surgical site anesthetic infiltration, while local surgical site anesthetic infiltration more effectively controls the severity of pain following elective hand and wrist surgery.
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Affiliation(s)
| | - Hivi Mahmoud
- Medical Chemistry, University of Duhok, Duhok, IRQ
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Fischer M, Nonnenmacher L, Zimmerer A, Reichert JC, Möller A, Hofer A, Matziolis G, Wassilew GI. The role of different acetabular morphologies on patient-reported outcomes following periacetabular osteotomy in borderline hip dysplasia. Arch Orthop Trauma Surg 2024; 144:3073-3081. [PMID: 38967778 PMCID: PMC11319516 DOI: 10.1007/s00402-024-05432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION The treatment option for borderline hip dysplasia (BHD) includes hip arthroscopy and periacetabular osteotomy (PAO). To the present day the controversial discussion remains, which intervention to prefer. Literature reports supporting an educated choice are scare, based on small patient cohorts and do not address the variability of acetabular morphology. Consequently, we intended to report PAO outcomes, from patients diagnosed with BHD, dependent on acetabular morphology, in a large patient cohort and aimed to define risk factors for poor clinical results and patient satisfaction. MATERIALS AND METHODS A prospective monocentre study was conducted. Patients enrolled underwent PAO for symptomatic BHD (LCEA, 18°-25°). A total of 107 hips were included with 94 complete data sets were available for evaluation with a minimum follow-up of 1 year and a mean follow-up of 2.3 years. The mean age was 31 ± 8.2 years, and 81.3% were female. As the primary outcome measure, we utilized the modified Harris hip score (mHHS) with minimal clinically important change (MCID) of eight to define clinical failure. Results were compared after a comprehensive radiographic assessment distinguishing between lateral deficient vs. anterior/posterolateral deficient acetabular and stable vs. unstable hip joints. RESULTS Overall, clinical success was achieved in 91.5% of patients and the mHHS improved significantly (52 vs. 84.7, p < 0.001). Eight hips failed to achieve the MCID and four had radiographic signs of overcorrection. Comparing variable joint morphologies, the rate of clinical success was higher in patients with an anterior/posterolateral deficient acetabular covarage compared to lateral deficient acetabular (95.2% vs. 90.4%). tThe highest rate of clinical failure was recorded in unstable hip joints (85.7% vs. 92.5% in stable hips). CONCLUSIONS This study demonstrates that PAO is an effective means to treat symptomatic BHD with variable acetabular morphologies, achieving a clinical success in 91.5% of all patients. To maintain a high level of safety and patient satisfaction technical accuracy appears crucial.
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Affiliation(s)
- Maximilian Fischer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Lars Nonnenmacher
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Zimmerer
- Diakonieklinikum Stuttgart, Department of Orthopaedic and Trauma Surgery, Orthopädische Klinik Paulinenhilfe, Stuttgart, Germany
| | - Johannes C Reichert
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Möller
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Andre Hofer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Georg Matziolis
- Orthopaedic Department, Jena University Hospital, Campus Eisenberg, Eisenberg, Germany
| | - Georgi I Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
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92
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Polly D, Mundis G, Eastlack R, Leveque JC, Elder BD, Martin C, Kent R, Snowden R, Kim HJ, Sembrano J, Herzog J, Lieberman I, Matheus V, Buchholz A, Franke J, Lee R, Shaffrey C. Randomized Trial of Augmented Pelvic Fixation in Patients Undergoing Thoracolumbar Fusion for Adult Spine Deformity: Initial Results from a Multicenter Randomized Trial. World Neurosurg 2024; 187:e15-e27. [PMID: 38310950 DOI: 10.1016/j.wneu.2024.01.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND The optimal configuration for spinopelvic fixation during multilevel spine fusion surgery for adult spine deformity remains unclear. Postoperative sacroiliac (SI) joint pain, S2AI screw loosening and implant breakage could be related to continued motion of the SI joint with use of only a single point of fixation across the SI joint. METHODS Prospective, international, multicenter randomized controlled trial of 222 patients with adult spine deformity scheduled for multilevel (4 or more levels) spine fusion surgery with pelvic fixation. Subjects were randomized to sacroalar (S2) iliac (S2AI) screws alone for pelvic fixation or S2AI + triangular titanium implants placed cephalad to S2AI screws. Quad rod techniques were not allowed or used. Baseline spinal deformity measures were read by an independent radiologist. Site-reported perioperative adverse events were reviewed by a clinical events committee. Quality of life questionnaires and other clinical outcomes are in process with planned 2-year follow-up. RESULTS One hundred thirteen participants were assigned to S2AI and 109 to S2AI + titanium triangular implants (TTI). 35/222 (16%) of all subjects had a history of SI joint pain or were diagnosed with SI joint pain during preoperative workup. Three-month follow-up was available in all but 4 subjects. TTI placement was successful in 106 of 109 (98%) subjects assigned to TTI. In 2 cases, TTI could not be placed due to anatomical considerations. Three TTI ventral iliac breaches were observed, all of which were managed non-surgically. One TTI subject had a transverse sacral fracture and 1 TTI subject had malposition of the implant requiring removal. CONCLUSIONS SI joint pain is common in patients with adult spinal deformity who are candidates for multilevel spine fusion surgery. Concurrent placement of TTI parallel to S2AI screws during multilevel spine fusion surgery is feasible and safe. Further follow-up will help to determine the clinical value of this approach to augment pelvic fixation.
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Affiliation(s)
- David Polly
- University of Minnesota, Minneapolis, Minnesota, USA.
| | - Greg Mundis
- San Diego Spine Foundation, San Diego, California, USA
| | | | | | | | | | - Roland Kent
- Axis Spine Center, Coeur D'Alene, Idaho, USA
| | - Ryan Snowden
- Tennessee Orthopaedics Associates, Nashville, Tennessee, USA
| | - Han Jo Kim
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | | | | | | | - Robert Lee
- Royal National Orthopaedic Hospital, Stanmore, UK
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93
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Nair A, Deshmukh A, Solunke S, Chopra S, Gupta A. Fixation of Paediatric Proximal Humerus Fractures Using Percutaneous Pinning: A Case Report. Cureus 2024; 16:e64888. [PMID: 39156472 PMCID: PMC11330684 DOI: 10.7759/cureus.64888] [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: 06/29/2024] [Accepted: 07/19/2024] [Indexed: 08/20/2024] Open
Abstract
A 12-year-old male came to our Emergency Department with chief complaints of pain and inability to move the right shoulder for one day following a fall while playing. The range of motion of the right shoulder was restricted and painful in all directions. Initial radiographs revealed a transverse, displaced proximal humerus fracture at the head-shaft junction. The patient was managed by closed reduction internal fixation with percutaneous K-wiring (Kirschner wires). The K-wires were removed after four weeks, and the shoulder was mobilized. The patient had a near-normal and pain-free range of motion at three months of follow-up. Percutaneous K-wiring remains a viable option for the treatment of paediatric proximal humerus fractures, and good post-operative rehabilitation can help restore near-normal function, as demonstrated in this report.
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Affiliation(s)
- Abhishek Nair
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Ashwin Deshmukh
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Swaroop Solunke
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Shubhankar Chopra
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Archit Gupta
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
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94
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Reutersberg B, Wolk S, Knappich C, Busch A. [Ischemia-related compartment syndromes in vascular surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:513-519. [PMID: 38634918 DOI: 10.1007/s00104-024-02080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
Even after the endovascular revolution, acute compartment syndrome (CS) remains an important and frequently present differential diagnosis after many operations. Based on a qualitative review this article gives an overview of the most frequent forms of CS as well as some less frequent entities that require attention in the routine clinical practice. Additionally, the pathophysiology, diagnostics and treatment as well as current research topics for CS, especially concerning the lower leg, are dealt with in detail. In summary, nothing has essentially changed ever since the first description of CS in that the clinical estimation remains the gold standard. The detection and the adequate treatment especially of abdominal CS and CS of the lower leg remain a key competence of vascular surgeons.
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Affiliation(s)
| | - Steffen Wolk
- Bereich Gefäßchirurgie, Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Medizinische Fakultät Carl Gustav Carus und Universitätsklinikum, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Christoph Knappich
- Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Münchner Aorten Centrum (MAC), Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Albert Busch
- Bereich Gefäßchirurgie, Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie (VTG), Medizinische Fakultät Carl Gustav Carus und Universitätsklinikum, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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95
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Gillinov SM, Lee JS, Siddiq BS, Dowley KS, Torabian KA, Dean MC, Cherian NJ, Cote MP, Martin SD. Association Between Severity of Chondrolabral Junction Breakdown and Functional Outcomes After Hip Arthroscopy for Acetabular Labral Tears. Am J Sports Med 2024; 52:2295-2305. [PMID: 38872427 DOI: 10.1177/03635465241255950] [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] [Indexed: 06/15/2024]
Abstract
BACKGROUND Despite focus on surgical preservation of the chondrolabral junction (CLJ), the transition zone between the acetabular cartilage and labrum, the association between severity of CLJ breakdown and functional outcomes after hip arthroscopy remains unexplored. PURPOSE To assess the influence of CLJ breakdown on patient-reported outcome measures (PROMs) at a 24-month follow-up after hip arthroscopy for symptomatic labral tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective review of prospectively collected data was conducted to identify patients ≥18 years of age with a minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for the treatment of symptomatic labral tears secondary to femoroacetabular impingement. The Beck classification of transition zone cartilage was used to grade CLJ damage; patients with grades 0 to 2 were stratified into the mild CLJ damage cohort, and those with grades 3 and 4 were stratified into the severe CLJ damage cohort. PROMs were collected at baseline and at 3, 6, 12 months, and annually thereafter postoperatively. Linear mixed-effects models were used to compare PROMs. Rates of achieving clinically meaningful thresholds and subsequent surgery rates were also compared. RESULTS In total, 198 patients met the inclusion criteria, with a mean follow-up of 3.54 ± 1.26 years. A total of 95 patients with severe CLJ damage (mean age, 34.9 ± 10.5 years) were compared with 103 patients with mild CLJ damage (mean age, 38.2 ± 11.9 years). Hip Outcome Score-Activities of Daily Living (HOS-ADL), Non-Arthritic Hip Score (NAHS), and visual analog score for pain were inferior in the severe CLJ group at enrollment and all follow-up time points (P≤ .05). However, patients with severe CLJ breakdown exhibited greater improvements in HOS-ADL and NAHS at the 24-month follow-up and achieved clinically meaningful thresholds at equivalent rates to patients with mild CLJ breakdown. Subsequent surgery rates were 6.8% and 12.6% in patients with mild versus severe CLJ damage, respectively (P = .250). CONCLUSION Severe CLJ breakdown is associated with increased pain and decreased functional level preoperatively and up to 24 months after hip arthroscopy. Despite this, patients with severe CLJ breakdown experienced greater improvements in functional outcomes at a 24-month follow-up and achieved clinical thresholds at similar rates to patients with mild CLJ damage. Thus, while worse baseline pain and functional levels may indicate severe CLJ breakdown, these patients still benefit substantially from hip arthroscopy.
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Affiliation(s)
- Stephen M Gillinov
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan S Lee
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bilal S Siddiq
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kieran S Dowley
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kaveh A Torabian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael C Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathan J Cherian
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Scott D Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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96
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Gupta R, Weisberger J, Herzog I, Roth J, Lee ES. Utilization of the gastrocnemius flap for post-traumatic knee reconstruction: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2255-2261. [PMID: 38634884 PMCID: PMC11291595 DOI: 10.1007/s00590-024-03938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE High-energy injuries to the knee may lead to extensive soft tissue loss, fractures, and potential loss of extensor function. The gastrocnemius flap is a prominent reconstructive option for patients with injuries involving the knee and proximal third of the lower extremity. To the best of our knowledge, there has not been an informative review that has evaluated outcomes of patients who have undergone post-traumatic knee reconstruction with a pedicled medial or lateral gastrocnemius flap. The goal of this study is to assess outcomes in patients who have undergone gastrocnemius flap reconstruction after traumatic injuries to the knee. METHODS The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology. Four databases were utilized including PubMed, Cochrane Reviews, Embase, and CINAHL. Our search criteria consisted of the following keywords: gastrocnemius, flap, knee, and traum*. RESULTS A total of 204 studies were imported for screening, from which five papers met our final inclusion/exclusion criteria. The most common studies utilized in this review were case series followed by retrospective chart reviews. In total, 43 patients with traumatic soft tissue knee defects were included with an average patient age of 27.28 years. All patients had successful and clinical viable flaps post-operatively, and there were a total of five patients who had complications. CONCLUSION The gastrocnemius flap has demonstrated to be an effective option for individuals undergoing post-traumatic knee reconstruction. Infection rates, loss of mobility, and scarring represent a minority of complications that may be seen when this reconstructive technique is utilized. Still, additional randomized controlled trials and retrospective studies are required in order to further evaluate for other potential complications that may occur in this patient population.
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Affiliation(s)
- Rohun Gupta
- Oakland University William Beaumont School of Medicine Auburn Hills, Rochester, MI, USA
| | | | | | | | - Edward S Lee
- Department of Plastic Surgery, University Hospital, Newark, NJ, USA
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97
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Thilak J, Venugopal A, Menon V. Fourteen-Year Follow-Up of a Patient With a Hydroxyapatite Ceramic Matrix Reconstruction of and a Bone Graft for a Critical-Size Cortical Bone Defect: A Case Report. Cureus 2024; 16:e63901. [PMID: 39100051 PMCID: PMC11298163 DOI: 10.7759/cureus.63901] [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] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
A 42-year-old man diagnosed with chondrosarcoma of the proximal femur underwent limb salvage by compartmental excision of the lesion and reconstruction with a custom-made hip prosthesis. The critical-size defect in the proximal femur was reconstructed with ceramic hemicylinders that were tied in place with sutures and augmented with two fibular strut grafts and an autologous cancellous iliac crest bone graft. A fourteen-year follow-up of the same case revealed that substituted ceramic matrices can be converted into dynamic, metabolically active, living bone.
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Affiliation(s)
- Jai Thilak
- Orthopaedic Surgery, Amrita Hospital, Kochi, Kochi, IND
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98
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Shaty W. Dega Osteotomy for the Treatment of Developmental Dysplasia of the Hip, a Clinical Evaluation and an Anatomic Study based on X-ray and CT Scan. Orthop Rev (Pavia) 2024; 16:120304. [PMID: 38957743 PMCID: PMC11218868 DOI: 10.52965/001c.120304] [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: 05/20/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
Background Dega osteotomy is becoming more widely used for the treatment of developmental dysplasia of the hip (DDH). Objective A thorough description of this procedure is needed as many of the technical aspects are not fully defined. Moreover, more follow-up series are also needed to evaluate its outcomes. Methods In this study, we gave a detailed anatomic description for this procedure and also presented our experience as a retrospective radiographic and case-note study. We examined the clinical and radiographic records of 44 patients (48 hips) with varying degrees of DDH. Results The average age of the patients was 2 months and 7 months while the average follow up period was 41 months. Clinical and radiographic assessment including CT with 3D reconstruction to examine the anatomic characteristics of the osteotomy were undertaken. We found that concentric reduction was achieved in 93.7% with excellent clinical and radiographic outcomes. Only 3 cases needed revision of the Dega osteotomy. The re-operation rate was 12.5%. CT scan revealed that the arcuate line was crossed by the osteotomy in the majority of cases. In 20.7% of cases, a bone cut that was intended to be a Dega osteotomy was found to have been inadvertently implemented as another osteotomy variant. However, this bore no significant effect on the outcome. Conclusion We found that a well-implemented Dega osteotomy is a reliable tool to cope with the acetabular changes in DDH.
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Affiliation(s)
- Wahby Shaty
- Department of Surgery, College of Medicine University of Thi Qar, Iraq
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99
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Wang D, Gu S, Shen H, Li T, Yin E, Wang X, Gao W, Liao Y. The therapeutic value of vacuum external fixation in polytrauma patients with multiple ribs fracture. Postgrad Med J 2024; 100:496-503. [PMID: 38366645 DOI: 10.1093/postmj/qgae020] [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: 11/11/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Multiple displaced rib fractures often result in a poor prognosis. Open reduction and internal fixation has been shown to provide benefits for patients with displaced rib fractures and flail chest. Nevertheless, for patients who are unwilling or unsuitable for surgery, the therapeutic options are limited. We developed a novel plastic vacuum device for rib fractures external stabilization. This study aims to compare the therapeutic efficacy of this device against a traditional chest strap in polytrauma patients with multiple rib fractures. METHODS A retrospective investigation was conducted on polytrauma patients with multiple rib fractures admitted to our trauma center between March 2020 and March 2023. Patients were categorized into two groups: vacuum external fixation and chest strap. Comparative analysis was conducted on baseline parameters, injury characteristics, and clinical outcomes between the two groups. RESULTS In this study, 54 patients were included, with 28 receiving chest strap and 26 undergoing vacuum external fixation. Results showed that, at 3 days and 7 days postintervention, the vacuum external fixation group had significantly lower visual analog scale scores during deep breathing and coughing (P < .05). Vacuum external fixation also reduced pleural drainage duration and volume, as well as lowered the risk of pneumonia and other complications (P < .05). Furthermore, the vacuum external fixation group demonstrated notable improvements in vital capacity, tidal volume, blood-gas test results, and a shorter hospital length of stay. CONCLUSIONS According to the study findings, vacuum external fixation appears to offer benefits to patients with multiple rib fractures, potentially reducing the risk of complications and improving overall clinical outcomes.
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Affiliation(s)
- Dongfang Wang
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Shuaipeng Gu
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Huaqing Shen
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Tonghan Li
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Enzhi Yin
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Xiang Wang
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Wei Gao
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
| | - Yiliu Liao
- Division of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
- Department of Emergency and Critical Care Medicine, Tongji Medical College, Huazhong University of Science and Technology, Tongji Hospital, Wuhan 430030, China
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100
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Peez C, Hägerich LM, Ruhl F, Klimek M, Briese T, Glasbrenner J, Deichsel A, Raschke MJ, Kittl C, Herbst E. Collateral ligament strain is linearly related to coronal lower limb alignment: A biomechanical study. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38932622 DOI: 10.1002/ksa.12340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/07/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The purpose of this study was to analyse the influence of coronal lower limb alignment on collateral ligament strain. METHODS Twelve fresh-frozen human cadaveric knees were used. Long-leg standing radiographs were obtained to assess lower limb alignment. Specimens were axially loaded in a custom-made kinematics rig with 200 and 400 N, and dynamic varus/valgus angulation was simulated in 0°, 30°, and 60° of knee flexion. The changes in varus/valgus angulation and strain within different fibre regions of the collateral ligaments were captured using a three-dimensional optical measuring system to examine the axis-dependent strain behaviour of the superficial medial collateral ligament (sMCL) and lateral collateral ligament (LCL) at intervals of 2°. RESULTS The LCL and sMCL were exposed to the highest strain values at full extension (p < 0.001). Regardless of flexion angle and extent of axial loading, the ligament strain showed a strong and linear association with varus (all Pearson's r ≥ 0.98; p < 0.001) and valgus angulation (all Pearson's r ≥ -0.97; p < 0.01). At full extension and 400 N of axial loading, the anterior and posterior LCL fibres exceeded 4% ligament strain at 3.9° and 4.0° of varus, while the sMCL showed corresponding strain values of more than 4% at a valgus angle of 6.8°, 5.4° and 4.9° for its anterior, middle and posterior fibres, respectively. CONCLUSION The strain within the native LCL and sMCL was linearly related to coronal lower limb alignment. Strain levels associated with potential ultrastructural damages to the ligaments of more than 4% were observed at 4° of varus and about 5° of valgus malalignment, respectively. When reconstructing the collateral ligaments, an additional realigning osteotomy should be considered in cases of chronic instability with a coronal malalignment exceeding 4°-5° to protect the graft and potentially reduce failures. LEVEL OF EVIDENCE There is no level of evidence as this study was an experimental laboratory study.
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Affiliation(s)
- Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Luise Maria Hägerich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Felix Ruhl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Matthias Klimek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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