1
|
Wardle B, Lynch JT, Staniforth T, Ward T, Smith P. Weightbearing versus non-weight bearing in geriatric distal femoral fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02550-7. [PMID: 38777887 DOI: 10.1007/s00068-024-02550-7] [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: 12/05/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Demographics of patients who sustain geriatric distal femoral fractures (DFF) match those of patients with neck-of-femur fractures but have limited evidence with which to support post-operative weightbearing protocols. PURPOSE This systematic review sought to identify any difference in outcomes for elderly patients with DFF who were allowed early versus delayed weightbearing postoperatively. METHODS DATA SOURCES: PubMed, Medline, Embase and The Cochrane Library, reference lists of retrieved articles. STUDY SELECTION English language papers published between January 2010 and February 2023 with AO-OTA type 33A, B and C femoral fractures as well as Lewis and Rorabeck Type I and II periprosthetic DFF surgically treated with either a lateral locking plate or retrograde intramedullary nail and an average patient age of ≥ 60 years. DATA EXTRACTION Studies were assessed for inclusion by two authors and quality was assessed using the MINORS tool. DATA SYNTHESIS Sixteen studies were included, Meta-analysis of non-union, malunion, infection, delayed union and implant complications was performed using Microsoft Excel and the MetaXL extension. The data on return to mobility were presented in narrative form. The analyses demonstrated no difference between the early and delayed weightbearing groups. CONCLUSIONS There are no significant differences in complication rates between early versus delayed weightbearing after surgery for DFF in an elderly population. The study results are limited by high heterogeneity and low-quality studies. High quality, prospective studies are needed to determine the ideal postoperative weightbearing protocol. LEVEL OF EVIDENCE Level III, Systematic Review and Meta-analysis of Level III studies. International Prospective Register of Systematic Reviews registration-Prospero CRD42022371460.
Collapse
Affiliation(s)
- Blaise Wardle
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia.
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia.
- The Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Joseph T Lynch
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia
- The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Thomas Staniforth
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia
| | - Thomas Ward
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia
- The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Paul Smith
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia
- The Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
2
|
Jang SJ, Alpaugh K, Kunze KN, Li TY, Mayman DJ, Vigdorchik JM, Jerabek SA, Gausden EB, Sculco PK. Deep-Learning Automation of Preoperative Radiographic Parameters Associated With Early Periprosthetic Femur Fracture After Total Hip Arthroplasty. J Arthroplasty 2024; 39:1191-1198.e2. [PMID: 38007206 DOI: 10.1016/j.arth.2023.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND The radiographic assessment of bone morphology impacts implant selection and fixation type in total hip arthroplasty (THA) and is important to minimize the risk of periprosthetic femur fracture (PFF). We utilized a deep-learning algorithm to automate femoral radiographic parameters and determined which automated parameters were associated with early PFF. METHODS Radiographs from a publicly available database and from patients undergoing primary cementless THA at a high-volume institution (2016 to 2020) were obtained. A U-Net algorithm was trained to segment femoral landmarks for bone morphology parameter automation. Automated parameters were compared against that of a fellowship-trained surgeon and compared in an independent cohort of 100 patients who underwent THA (50 with early PFF and 50 controls matched by femoral component, age, sex, body mass index, and surgical approach). RESULTS On the independent cohort, the algorithm generated 1,710 unique measurements for 95 images (5% lesser trochanter identification failure) in 22 minutes. Medullary canal width, femoral cortex width, canal flare index, morphological cortical index, canal bone ratio, and canal calcar ratio had good-to-excellent correlation with surgeon measurements (Pearson's correlation coefficient: 0.76 to 0.96). Canal calcar ratios (0.43 ± 0.08 versus 0.40 ± 0.07) and canal bone ratios (0.39 ± 0.06 versus 0.36 ± 0.06) were higher (P < .05) in the PFF cohort when comparing the automated parameters. CONCLUSIONS Deep-learning automated parameters demonstrated differences in patients who had and did not have early PFF after cementless primary THA. This algorithm has the potential to complement and improve patient-specific PFF risk-prediction tools.
Collapse
Affiliation(s)
- Seong J Jang
- Weill Cornell College of Medicine, New York, New York; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Kyle Alpaugh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Tim Y Li
- Weill Cornell College of Medicine, New York, New York
| | - David J Mayman
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Seth A Jerabek
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| |
Collapse
|
3
|
Kalmet P, Maduro C, Verstappen C, Meys G, van Horn Y, van Vugt R, Janzing H, van der Veen A, Jaspars C, Sintenie JB, Blokhuis T, Evers S, Seelen H, Brink P, Poeze M. Effectiveness of permissive weight bearing in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities: a prospective comparative multicenter cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1363-1371. [PMID: 38159217 PMCID: PMC10980603 DOI: 10.1007/s00590-023-03806-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The aim of the present study was to investigate the effectiveness of a novel approach involving permissive weight bearing (PWB) in surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities. METHODS Prospective comparative multicenter cohort study in one level 1 trauma center and five level 2 trauma centers. Surgically treated trauma patients with peri- and intra-articular fractures of the lower extremities were included. Permissive weight bearing (PWB) in comparison to restricted weight bearing (RWB) was assessed over a 26-week post-surgery follow-up period. Patients' self-perceived outcome levels regarding activities of daily living (ADL), quality of life (QoL), pain and weight bearing compliance were used. RESULTS This study included 106 trauma patients (N = 53 in both the PWB and RWB groups). Significantly better ADL and QoL were found in the PWB group compared to the RWB group at 2-, 6-, 12- and 26-weeks post-surgery. There were no significant differences in postoperative complication rates between the PWB and RWB groups. CONCLUSION PWB is effective and is associated with a significantly reduced time to full weight bearing, and a significantly better outcome regarding ADL and QoL compared to patients who followed RWB regimen. Moreover, no significant differences in complication rates were found between the PWB and RWB groups. LEVEL OF EVIDENCE Level II. REGISTRATION This study is registered in the Dutch Trial Register (NTR6077). Date of registration: 01-09-2016.
Collapse
Affiliation(s)
- Pishtiwan Kalmet
- Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Cherelle Maduro
- Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Coen Verstappen
- Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Guido Meys
- Adelante Rehabilitation Center, Hoensbroek, The Netherlands
| | | | | | | | | | - Coen Jaspars
- Maxima Medical Center, Veldhoven, The Netherlands
| | | | - Taco Blokhuis
- Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Silvia Evers
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Henk Seelen
- Adelante Rehabilitation Center, Hoensbroek, The Netherlands
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Peter Brink
- Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Martijn Poeze
- Maastricht University Medical Center+, Maastricht, The Netherlands
- Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
4
|
Hajdu KS, Baker CE, Moore-Lotridge SN, Schoenecker JG. Sequestration and Involucrum: Understanding Bone Necrosis and Revascularization in Pediatric Orthopedics. Orthop Clin North Am 2024; 55:233-246. [PMID: 38403369 DOI: 10.1016/j.ocl.2023.09.005] [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: 02/27/2024]
Abstract
Sequestration, a condition where a section of bone becomes necrotic due to a loss of vascularity or thrombosis, can be a challenging complication of osteomyelitis. This review explores the pathophysiology of sequestration, highlighting the role of the periosteum in forming involucrum and creeping substitution which facilitate revascularization and bone formation. The authors also discuss the induced membrane technique, a two-stage surgical procedure for cases of failed healing of sequestration. Future directions include the potential use of prophylactic anticoagulation and novel drugs targeting immunocoagulopathy, as well as the development of advanced imaging techniques and single-stage surgical procedures.
Collapse
Affiliation(s)
- Katherine S Hajdu
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Courtney E Baker
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie N Moore-Lotridge
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan G Schoenecker
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, USA; Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
| |
Collapse
|
5
|
Gurung R, Terrill A, White G, Windolf M, Hofmann-Fliri L, Dlaska C, Schuetz M, Epari DR. Severity of Complications after Locking Plate Osteosynthesis in Distal Femur Fractures. J Clin Med 2024; 13:1492. [PMID: 38592416 PMCID: PMC10934512 DOI: 10.3390/jcm13051492] [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: 02/09/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Locked plating for distal femur fractures is widely recommended and used. We systematically reviewed clinical studies assessing the benefits and harms of fracture fixation with locked plates in AO/OTA Type 32 and 33 femur fractures. Methods: A comprehensive literature search of PubMed, Embase, Cinahl, Web of Science, and the Cochrane Database was performed. The studies included randomized and non-randomized clinical trials, observational studies, and case series involving patients with distal femur fractures. Studies of other fracture patterns, studies conducted on children, pathological fractures, cadaveric studies, animal models, and those with non-clinical study designs were excluded. Results: 53 studies with 1788 patients were found to satisfy the inclusion and exclusion criteria. The most common harms were nonunion (14.8%), malunion (13%), fixation failure (5.3%), infection (3.7%), and symptomatic implant (3.1%). Time to full weight-bearing ranged from 5 to 24 weeks, averaging 12.3 weeks. The average duration of follow-up was 18.18 months, ranging from 0.5 to 108 months. Surgical time ranged between 40 and 540 min, with an average of 141 min. The length of stay in days was 12.7, ranging from 1 to 61. The average plate length was ten holes, ranging from 5 to 20 holes. Conclusion: This review aimed to systematically synthesize the available evidence on the risk associated with locked plating osteosynthesis in distal femur fractures. Nonunion is the most common harm and is the primary cause of reoperation. The overall combined risk of a major and critical complication (i.e., requiring reoperation) is approximately 20%.
Collapse
Affiliation(s)
- Roshan Gurung
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Alexander Terrill
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Gentry White
- School of Mathematical Sciences, Queensland University of Technology, Brisbane City, QLD 4000, Australia
| | | | | | - Constantin Dlaska
- The Orthopaedic Research Institute of Queensland, Townsville, QLD 4812, Australia
| | - Michael Schuetz
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
- Jamieson Trauma Institute, Metro North Hospital and Health Services, Herston, QLD 4006, Australia
| | - Devakara R. Epari
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane City, QLD 4000, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| |
Collapse
|
6
|
Li W, Wang Y, Zhou S, Liu S, Di L, Chen W, Lv H. Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture. Sci Rep 2024; 14:3543. [PMID: 38347044 PMCID: PMC10861573 DOI: 10.1038/s41598-024-53356-x] [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: 06/26/2023] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
Closed femoral shaft fracture is caused by high-energy injuries, and non-union exists after operation, which can significantly damage patients' body and mind. This study aimed to explore the factors influencing postoperative non-union of closed femoral shaft fractures and establish a predictive nomogram. Patients with closed femoral shaft fractures treated at Hebei Medical University Third Hospital between January 2015 and December 2021 were retrospectively enrolled. A total of 729 patients met the inclusion criteria; of them, those treated in 2015-2019 comprised the training cohort (n = 617), while those treated in 2020-2021 comprised the external validation cohort (n = 112). According to multivariate logistic regression analysis, complex fractures, bone defects, smoking, and postoperative infection were independent risk factors. Based on the factors, a predictive nomogram was constructed and validated. The C-indices in training and external validation cohorts were 0.818 and 0.781, respectively; and the C-index of internal validation via bootstrap resampling was 0.804. The Hosmer-Lemeshow test showed good fit of the nomogram (P > 0.05) consistent with the calibration plot results. The clinical effectiveness was best at a threshold probability of 0.10-0.40 in decision curve analysis. The risk prediction for patients with fractures using this nomogram may aid targeted prevention and rehabilitation programs.
Collapse
Affiliation(s)
- Wenjing Li
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- School of Public Health, Hebei Medical University, No.361 Zhongshan East Road, Shijiazhuang, 050017, China
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Yan Wang
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- School of Public Health, Hebei Medical University, No.361 Zhongshan East Road, Shijiazhuang, 050017, China
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Shuai Zhou
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- School of Public Health, Hebei Medical University, No.361 Zhongshan East Road, Shijiazhuang, 050017, China
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Shihang Liu
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
- School of Public Health, Hebei Medical University, No.361 Zhongshan East Road, Shijiazhuang, 050017, China
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Luqin Di
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Wei Chen
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Hongzhi Lv
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Hebei Orthopaedic Research Institute, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
- School of Public Health, Hebei Medical University, No.361 Zhongshan East Road, Shijiazhuang, 050017, China.
- Trauma Emergency Center, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
| |
Collapse
|
7
|
Kim M, Wu MP, Miller LE, Meyer CD, Feng AL, Varvares MA, Deschler DG, Lin DT, Richmon JD. Early Weight-Bearing After Fibula Free Flap Surgery. JAMA Otolaryngol Head Neck Surg 2024; 150:127-132. [PMID: 38127340 PMCID: PMC10853825 DOI: 10.1001/jamaoto.2023.4024] [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: 07/31/2023] [Accepted: 10/27/2023] [Indexed: 12/23/2023]
Abstract
Importance Despite the widespread use of fibula free flap (FFF) surgery for head and neck reconstruction, there are no studies assessing if early weight-bearing (EWB) affects postoperative recovery, and the timing of weight-bearing initiation following FFF surgery varies considerably across institutions. Therefore, it is important to understand the effect of EWB in these patients and whether it could improve postoperative recovery. Objective To assess the association of EWB after FFF surgery with donor-site complications, length of stay, and discharge to home status. Design, Setting, and Participants This retrospective cohort study took place at Massachusetts Eye and Ear, a single tertiary care institution in Boston, Massachusetts. A total of 152 patients who received head and neck reconstruction with a fibula osteocutaneous free flap between January 11, 2010, and August 11, 2022, were included. Exposure EWB on postoperative day 1 vs non-EWB on postoperative day 2 or later. Main Outcomes and Measures Patient characteristics, including demographic characteristics and comorbidities, surgical characteristics, donor-site complications, length of stay, and discharge disposition, were recorded. Descriptive statistics and multivariate logistic regressions were used to compute effect sizes and 95% CIs to compare postoperative outcomes in EWB and non-EWB groups. Results A total of 152 patients (median [IQR] age, 63 [55-70] years; 89 [58.6%] male) were included. The median (IQR) time to postoperative weight-bearing was 3 (1-5) days. Among all patients, 14 (9.2%) had donor-site complications. EWB on postoperative day 1 was associated with shorter length of stay (adjusted odds ratio [AOR], 0.10; 95% CI, 0.02-0.60), increased rate of discharge to home (AOR, 7.43; 95% CI, 2.23-24.80), and decreased donor-site complications (AOR, 0.11; 95% CI, 0.01-0.94). Conversely, weight-bearing 3 or more days postoperatively was associated with an increased risk of pneumonia (AOR, 6.82; 95% CI, 1.33-34.99). Conclusions and Relevance In this cohort study, EWB after FFF surgery was associated with shorter length of stay, increased rate of discharge to home, and decreased donor-site complications. These findings support the role of early mobilization to optimize postoperative recovery after FFF surgery.
Collapse
Affiliation(s)
- Minjee Kim
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Michael P. Wu
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Lauren E. Miller
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Charles D. Meyer
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Allen L. Feng
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mark A. Varvares
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Daniel G. Deschler
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Derrick T. Lin
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Jeremy D. Richmon
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
8
|
Wong MYZ, Ghobrial M, Han WM, Alsousou J, Carrothers A, Hull P, Chou D, Rawal J. The floating hip injury: a descriptive study and case-control analysis. Hip Int 2024; 34:122-133. [PMID: 36912024 PMCID: PMC10787386 DOI: 10.1177/11207000231160075] [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: 03/14/2023]
Abstract
PURPOSE A "floating hip" (FH) injury is a rare injury describing the simultaneous ipsilateral fracture of the femur and pelvis or acetabulum (P/A). We describe our experience with patients presenting with FH injuries and compare them to controls with similar P/A fractures but without femoral involvement. METHODS Medical records and radiographs of FH patients and controls presenting to our tertiary centre between 2015 and 2020 were reviewed. Follow-up data from outpatient clinical records were also extracted. The control group were extensively matched by age, sex, body mass index, fracture classification and energy of injury. RESULTS From 1392 recorded P/A fractures, 42 FH cases were identified (average age 39 years, 78.6% males). The most common femoral fracture was the midshaft (35.7%), followed by the neck of femur (26.2%). 90.5% of FH injuries were due to high-energy mechanisms. 64.3% of P/A fractures, and 100% of femoral fractures were managed surgically. Compared to controls, FH cases were more likely to have additional orthopaedic injuries (73.8% vs. 40.5%, p = 0.002), more total theatre admissions (mean 2.5 vs. 1.19, p < 0.001), longer hospital stays (28.3 vs. 14.9 days, p = 0.02), and a higher rates of post-op complications (53.8% vs. 20%, p = 0.025). CONCLUSIONS We report differences in the presentation, management, and outcomes of FH injuries versus controls, even after extensive matching for confounders. These differences may inform future treatment strategies for the FH injury.
Collapse
Affiliation(s)
- Mark Y Z Wong
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Marios Ghobrial
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Win M Han
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joseph Alsousou
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrew Carrothers
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter Hull
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daud Chou
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jaikirty Rawal
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
9
|
Espey R, Stevenson L, Tucker A. Combined nail-plate constructs in the management of osteoporotic native distal femoral fractures: a systematic review of the available evidence. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3215-3223. [PMID: 37106139 DOI: 10.1007/s00590-023-03552-8] [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: 02/21/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Distal femoral fractures account for 4-6% of fragility fractures. These may be managed using a combined nail-plate construct (NPC). The use of NPCs is gaining traction. Whilst several theoretical advantages exist, there is little evidence reporting on binary or patient-reported outcomes. The aim of the current study was to perform a systematic review of the available literature pertaining to NPCs and their treatment of native distal femoral fractures, appraising the outcomes and focusing on the rationale for their increasing uptake in recent literature. METHODS A comprehensive search of MEDLINE, EMBASE, Clinical Key, PubMed and Cochrane library was performed from date of inception up to in August 9, 2022. All study languages were included initially. A further Google Scholar search review was performed to identify any other studies not identified in the database interrogation. Studies were eligible if they reported on the use of nail-plate constructs in managing distal femoral fractures. Any outcome metric was permitted. The study was conducted in accordance with PRISMA guidelines. Risk of bias was assessed using the Methodological Index for non-randomised Studies tool. Quantitative analysis was performed using a log odds ratio random effects model. The Knapp-Hartung adjustment was utilised if the total number of included studies was < 5. Study effect sizes and appropriate plots were constructed to illustrate the outcomes data. RESULTS A total of four studies were eligible for inclusion. Study data was extracted and summarised with their relevant outcomes presented. The literature review demonstrated that the use of NPCs led to significantly earlier full weight bearing (p < 0.001) and had reduced non-union rates over a single construct, without affecting infection rates (12.5% vs. 5.6%; p = 0.289) and significantly lower implant failure rates (10.5% vs. 0%; p = 0.011). A meta-analysis is performed of available studies and Forrest plots presented. CONCLUSION The use of NPC in the management of native osteoporotic DFFs is gaining traction but the available evidence is of low grade with significant heterogeneity in small cohorts of patients. We suggest that a large-scale, multicentre prospective study should be performed, with agreed functional and radiological outcome metrics, to provide a more robust evidence base.
Collapse
Affiliation(s)
- Robert Espey
- Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, UK
| | - Lewis Stevenson
- Ulster Hospital Dundonald, Upper Newtownards Road, Belfast, BT16 1RH, UK
| | - Adam Tucker
- Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
| |
Collapse
|
10
|
Balziano S, Baran I, Prat D. Hindfoot nailing without joint preparation for ankle fractures in extremely elderly patients: Comparison of clinical and patient-reported outcomes with standard ORIF. Foot Ankle Surg 2023; 29:588-592. [PMID: 37468359 DOI: 10.1016/j.fas.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/25/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Tibiotalocalcaneal (TTC) nailing without joint preparation has been indicated as an alternative to open reduction and internal fixation (ORIF) in the treatment of unstable fragility ankle fractures. We hypothesized that primary hindfoot nailing without joint preparation, and immediate weight bearing can provide a safe and effective treatment for unstable fragility fractures of the ankle compared to ORIF. METHODS A retrospectively single-center cohort was reviewed for all surgically treated ankle fractures in patients aged 75 years and older between 2016 and 2021. The cases were grouped by the surgical technique: ORIF or TTC nailing. Diagnosis and treatment were validated by a review of the radiographs and the patients' charts. Primary outcomes included complication rates and revision rates. The PROMs questionnaires included the Foot and Ankle-Ability Measure (FAAM-ADL) and the Olerud-Molander Ankle Score (OMAS). RESULTS Forty-six cases met the inclusion criteria during the study period. Eighteen in the TTC group and 28 in the ORIF group. The average follow-up was 46.4 months (Median 49.5, SD ± 25.3). The mean age of the TTC group was significantly higher (88.6 versus 81.8, p < 0.001). The mean surgery duration and length of stay were similar. The complication rates were 50.0 % in the ORIF group (28.6 % major) versus 22.2 % in the TTC group (5.6 % major), (p = 0.060). The revision rates were 28.6 % and 11.1 % in the ORIF and TTC groups respectively (p = 0.161). The FAAM-ADL was higher in the ORIF group (62.6 % versus 32.4 %, p = 0.020), as well as the OMAS (60.0 versus 32.8, p = 0.029). CONCLUSION TTC nailing without joint preparation for unstable fragility fractures of the ankle in the extremely elderly provided a better complication profile compared to traditional ORIF. However, PROMs were inferior.
Collapse
Affiliation(s)
- Snir Balziano
- Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel, Affiliated with the Faculty of Medicine of Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Isaac Baran
- Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel, Affiliated with the Faculty of Medicine of Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Dan Prat
- Department of Orthopaedic Surgery, Chaim Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel, Affiliated with the Faculty of Medicine of Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel.
| |
Collapse
|
11
|
Lisitano L, Röttinger T, Wiedl A, Rau K, Helling S, Cifuentes J, Jehs B, Härting M, Feitelson LM, Gleich J, Kiesl S, Pfeufer D, Neuerburg C, Mayr E, Förch S. Plain X-ray is insufficient for correct diagnosis of tibial shaft spiral fractures: a prospective trial. Eur J Trauma Emerg Surg 2023; 49:2339-2345. [PMID: 37269304 PMCID: PMC10728229 DOI: 10.1007/s00068-023-02285-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Tibial shaft spiral fractures and fractures of the distal third of the tibia (AO:42A/B/C and 43A) frequently occur with non-displaced posterior malleolus fractures (PM). This study investigated the hypothesis that plain X-ray is not sufficient for a reliable diagnosis of associated non-displaced PM fractures in tibial shaft spiral fractures. METHODS 50 X-rays showing 42A/B/C and 43A fractures were evaluated by two groups of physicians, each group was comprised of a resident and a fellowship-trained traumatologist or radiologist. Each group was tasked to make a diagnosis and/or suggest if further imaging was needed. One group was primed with the incidence of PM fractures and asked to explicitly assess the PM. RESULTS Overall, 9.13/25 (SD ± 5.77) PM fractures were diagnosed on X-ray. If the posterior malleolus fracture was named or a CT was requested, the fracture was considered "detected". With this in mind, 14.8 ± 5.95 posterior malleolus fractures were detected. Significantly more fractures were diagnosed/detected (14 vs. 4.25/25; p < 0.001/14.8 vs. 10.5/25; p < 0.001) in the group with awareness. However, there were significantly more false positives in the awareness group (2.5 vs. 0.5; p = 0.024). Senior physicians recognized slightly more fractures than residents (residents: 13.0 ± 7.79; senior physicians: 16.5 ± 3.70; p = 0.040). No significant differences were demonstrated between radiologists and trauma surgeons. The inner-rater reliability was high with 91.2% agreement. Inter-rater reliability showed fair agreement (Fleiss-Kappa 0.274, p < 0.001) across all examiners and moderate agreement (Fleiss-Kappa 0.561, p < 0.001) in group 2. CONCLUSION Only 17% of PM fractures were identified on plain X-ray and awareness of PM only improved diagnosis by 39%. While experiencing improved accuracy, CT imaging should be included in a comprehensive examination of tibial shaft spiral fractures. LEVEL OF EVIDENCE II. Diagnostic prospective cohort study. TRAIL REGISTRATION NUMBER DRKS00030075.
Collapse
Affiliation(s)
- Leonard Lisitano
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
| | - Timon Röttinger
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Andreas Wiedl
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Kim Rau
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Sönke Helling
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Jairo Cifuentes
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Bertram Jehs
- Department for Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Mark Härting
- Department for Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Laura-Marie Feitelson
- Department for Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Johannes Gleich
- Department for Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Sophia Kiesl
- Department of Radiology, University Hospital LMU Munich, Munich, Germany
| | - Daniel Pfeufer
- Department for Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Carl Neuerburg
- Department for Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Edgar Mayr
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Stefan Förch
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| |
Collapse
|
12
|
Junior MDSL, Ciardullo MB, Neto OC, Herrera YEG, Ochoa PGG, Silva JDS, Kojima KE. Protected immediate weight-bearing is safe after fixation of ankle fractures with syndesmosis injury fixed with position screw. A retrospective case-series study. Injury 2023; 54 Suppl 6:110745. [PMID: 38143122 DOI: 10.1016/j.injury.2023.04.032] [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: 02/17/2023] [Revised: 03/15/2023] [Accepted: 04/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND About 10% of ankle fractures are located above the syndesmosis, which causes injury to the ligament structure of the syndesmosis. There is no consensus regarding when to allow weight-bearing on the operated limb of patients who suffered ankle fractures requiring intraoperative fixation. OBJECTIVE The aim of this study is the evaluation of radiographic parameters of syndesmosis reduction and fixation in patients with ankle fracture who underwent immediate protected weight-bearing (use of walking-boot and crutches). PATIENT AND METHODS Retrospective case series from January 2015 to December 2020. Evaluation of the tibiofibular clear space, tibiofibular overlap, and medial clear space in the preoperative x-ray, immediate postoperative, 3-, 6- and 12-month after syndesmosis fixation and rehabilitation with protected immediate weight-bearing with crutches and walking-boot. RESULTS Out of 137 ankle fractures 39 were included. There was no significant difference in the tibiofibular clear space between the immediate x-ray and after 12 months (4.5 mm ± 1.1 vs. 4.6 mm ± 1.8; p > 0.999). Tibiofibular overlap hasn't shown significant difference between immediate and 12-month x-ray (6.2 mm ± 2.6 vs. 6.6 mm ± 2.6; p > 0.999). Medial clear space also has shown no worsening from immediate to 12-month x-ray (3.1 mm ± 0.9 vs. 2.8 mm ± 0.9; p > 0.999). There were no fixation failure nor postoperative infection. CONCLUSION Immediate weight-bearing for patients with ankle fractures with syndesmosis injury and treated with intraoperative fixation with positioning screw proved to be safe with good maintenance of the reduction, no failures of the synthesis material observed and no reports of postoperative infection in the period. LEVEL 3 EVIDENCE: therapeutic retrospective case-series.
Collapse
Affiliation(s)
- Milton da Silva Linhares Junior
- Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
| | - Marcos Broggi Ciardullo
- Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
| | - Orlando Colavolpe Neto
- Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
| | - Yasmín Estefanía González Herrera
- Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
| | - Pablo Gabriel Garcia Ochoa
- Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
| | - Jorge Dos Santos Silva
- Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
| | - Kodi Edson Kojima
- Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
| |
Collapse
|
13
|
North K, Simpson GM, Stuart AR, Kubiak EN, Petelenz TJ, Hitchcock RW, Rothberg DL, Cizik AM. Early postoperative step count and walking time have greater impact on lower limb fracture outcomes than load-bearing metrics. Injury 2023:S0020-1383(23)00388-1. [PMID: 37202224 DOI: 10.1016/j.injury.2023.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/11/2023] [Accepted: 04/23/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Weight-bearing protocols for rehabilitation of lower extremity fractures are the gold standard despite not being data-driven. Additionally, current protocols are focused on the amount of weight placed on the limb, negating other patient rehabilitation behaviors that may contribute to outcomes. Wearable sensors can provide insight into multiple aspects of patient behavior through longitudinal monitoring. This study aimed to understand the relationship between patient behavior and rehabilitation outcomes using wearable sensors to identify the metrics of patient rehabilitation behavior that have a positive effect on 1-year rehabilitation outcomes. METHODS Prospective observational study on 42 closed ankle and tibial fracture patients. Rehabilitation behavior was monitored continuously between 2 and 6 weeks post-operative using a gait monitoring insole. Metrics describing patient rehabilitation behavior, including step count, walking time, cadence, and body weight per step, were compared between patient groups of excellent and average rehabilitation outcomes, as defined by the 1-year Patient Reported Outcome Measure Physical Function t-score (PROMIS PF). A Fuzzy Inference System (FIS) was used to rank metrics based on their impact on patient outcomes. Additionally, correlation coefficients were calculated between patient characteristics and principal components of the behavior metrics. RESULTS Twenty-two patients had complete insole data sets, and 17 of which had 1-year PROMIS PF scores (33.7 ± 14.5 years of age, 13 female, 9 in Excellent group, 8 in Average group). Step count had the highest impact ranking (0.817), while body weight per step had a low impact ranking (0.309). No significant correlation coefficients were found between patient or injury characteristics and behavior principal components. General patient rehabilitation behavior was described through cadence (mean of 71.0 steps/min) and step count (logarithmic distribution with only ten days exceeding 5,000 steps/day). CONCLUSION Step count and walking time had a greater impact on 1-year outcomes than body weight per step or cadence. The results suggest that increased activity may improve 1-year outcomes for patients with lower extremity fractures. The use of more accessible devices, such as smart watches with step counters combined with patient reported outcome measures may provide more valuable insights into patient rehabilitation behaviors and their effect on rehabilitation outcomes.
Collapse
Affiliation(s)
- Kylee North
- University of Utah Department of Biomedical Engineering, 36 S Wasatch Dr, Salt Lake City, UT 84112, United States
| | - Grange M Simpson
- University of Utah Department of Biomedical Engineering, 36 S Wasatch Dr, Salt Lake City, UT 84112, United States
| | - Ami R Stuart
- Medtronic, 710 Medtronic Parkway, Minneapolis, MN 55432-5604 USA
| | - Erik N Kubiak
- University of Nevada Las Vegas Department of Orthopaedics, University of Nevada, Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV 89154
| | - Tomasz J Petelenz
- University of Utah Department of Biomedical Engineering, 36 S Wasatch Dr, Salt Lake City, UT 84112, United States
| | - Robert W Hitchcock
- University of Utah Department of Biomedical Engineering, 36 S Wasatch Dr, Salt Lake City, UT 84112, United States
| | - David L Rothberg
- University of Utah Department of Orthopaedics, 590 Wakara Way, Salt Lake City, Utah 84108
| | - Amy M Cizik
- University of Utah Department of Orthopaedics, 590 Wakara Way, Salt Lake City, Utah 84108.
| |
Collapse
|
14
|
Influence of muscle loading on early-stage bone fracture healing. J Mech Behav Biomed Mater 2023; 138:105621. [PMID: 36549248 DOI: 10.1016/j.jmbbm.2022.105621] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Designing weight-bearing exercises for patients with lower-limb bone fractures is challenging and requires a systematic approach that accounts for patient-specific loading conditions. However, 'trial-and-error' approaches are commonplace in clinical settings due to the lack of a fundamental understanding of the effect of weight-bearing exercises on the bone healing process. Whilst computational modelling has the potential to assist clinicians in designing effective patient-specific weight-bearing exercises, current models do not explicitly account for the effects of muscle loading, which could play an important role in mediating the mechanical microenvironment of a fracture site. We combined a fracture healing model involving a tibial fracture stabilised with a locking compression plate (LCP) with a detailed musculoskeletal model of the lower limb to determine interfragmentary strains in the vicinity of the fracture site during both full weight-bearing (100% body weight) and partial weight-bearing (50% body weight) standing. We found that muscle loading significantly altered model predictions of interfragmentary strains. For a fractured bone with a standard LCP configuration (bone-plate distance = 2 mm, working length = 30 mm) subject to full weight-bearing, the predicted strains at the near and far cortices were 23% and 11% higher when muscle loading was included compared to the case when muscle loading was omitted. The knee and ankle muscles accounted for 38% of the contact force exerted at the knee joint during quiet standing and contributed significantly to the strains calculated at the fracture site. Thus, models of bone fracture healing ought to account explicitly for the effects of muscle loading. Furthermore, the study indicated that LCP configuration parameters play a crucial role in influencing the fracture site microenvironment. The results highlighted the dominance of working length over bone-plate distance in controlling the flexibility of fracture sites stabilised with LCP devices.
Collapse
|
15
|
Park HJ, You KH, Huang B, Yoon JH, Kim HN. Can 3-Dimensional Printing for Calcaneal Fracture Surgery Decrease Operation Time and Improve Quality of Fracture Reduction? J Foot Ankle Surg 2022; 62:21-26. [PMID: 35418345 DOI: 10.1053/j.jfas.2022.03.004] [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: 04/27/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 02/03/2023]
Abstract
We investigated whether 3-dimensional (3D) printed models can decrease operation time and improve the quality of reduction for calcaneal fractures. The study involved 48 patients with unilateral intra-articular calcaneal fractures, who were retrospectively case-matched according to Sander's classification, age, and sex. Group A (24 patients) was operated using 3D printed models as a preoperative and intraoperative tool, and group B (24 patients) was operated using standard techniques without 3D printed model. Operation time was significantly shorter for group A, compared to group B (82.3 ± 13.2 vs 91.4 ± 16.0, p = .036). The differences between the radiological parameters of operated calcaneus, compared to the normal side was similar between the 2 groups (Böhler angle, 5.3° ± 3.9° vs 4.2° ± 4.7°, p = .45, Gissane angle, 5.9° ± 12.5° vs 8.4° ± 11.0°, p = .54). The number of screws projecting more than 5 mm from the cortex was lower in group A than in group B (7/187, 4% vs 16/208, 8%, p = .11). The number of screw holes of the plate cut intraoperatively was significantly lower for group A compared to group B (1 vs 138). Although group A started weightbearing 3 to 4 weeks earlier than group B, the radiological parameters were similar between groups that early weightbearing was possible for group A using the 3D printed models (Böhler angle, - 1.5° ± 0.8° vs - 1.8° ± 1.2°, p = .28, Gissane angle, 2.5° ± 2.6° vs 3.5° ± 4.3°, p = .39). The operation time was shorter while using the 3D printed models, compared to that of the standard technique without using the 3D printed model. The radiological parameters were not statistically different, and the quality of fracture reduction seemed similar. However, with the use of 3D printed models, early weightbearing was possible without significant subsidence of reduced fragments or failure of fracture reduction, comparable to non-weightbearing cases.
Collapse
Affiliation(s)
- Hyun-Jin Park
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ki-Han You
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Bingzhe Huang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Joon Hyeok Yoon
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
16
|
Adesina SA, Eyesan SU, Amole IO, Akinwumi AI, Awotunde OT, Durodola AO, Owolabi JI. Solid locked intramedullary nailing for expeditious return of bone-setting-induced abnormal fracture union victims to work in South-western Nigeria. Sci Rep 2022; 12:21432. [PMID: 36509831 PMCID: PMC9744724 DOI: 10.1038/s41598-022-25862-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Wage earning in low- and middle-income countries (LMICs) is predominantly through physical labour. Consequently, limb-related disabilities caused by abnormal fracture unions (AFUs) preclude gainful employment and perpetuate the cycle of poverty. Many AFUs result from traditional bone-setting (TBS), a pervasive treatment for long bone fractures in LMICs. The objective of this study was to accentuate the expediency of solid locked intramedullary nail in the early restoration of victims of TBS-induced abnormal fracture unions (AFUs) to their pre-injury functioning, including work. One hundred AFUs in 98 patients treated with a solid locked intramedullary nail in our center over a period of 7 years were prospectively studied. We found the mean age to be 47.97 years. Males constituted 63.9% of the patients' population. Atrophic non-union accounted for 54.1% of the AFUs. The mean fracture-surgery interval was 21.30 months. By the 12th post-operative week, more than 75% of the fractures had achieved knee flexion/shoulder abduction beyond 90°, were able to squat and smile (or do shoulder abduction-external rotation), and were able to bear weight fully. The study demonstrated the expediency of solid locked nail in salvaging TBS-induced abnormal fracture unions in a way that permitted early return to pre-injury daily activities and work, thereby reducing fracture-associated poverty.
Collapse
Affiliation(s)
- Stephen Adesope Adesina
- grid.459398.aDepartment of Family Medicine, Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State Nigeria ,grid.442598.60000 0004 0630 3934Department of Family Medicine, Bowen University, P.M.B 284, Iwo, Osun State Nigeria
| | - Samuel Uwale Eyesan
- grid.459398.aDepartment Surgery, Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State Nigeria ,grid.442598.60000 0004 0630 3934Department Surgery, Bowen University, P.M.B 284, Iwo, Osun State Nigeria
| | - Isaac Olusayo Amole
- grid.459398.aDepartment of Family Medicine, Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State Nigeria ,grid.442598.60000 0004 0630 3934Department of Family Medicine, Bowen University, P.M.B 284, Iwo, Osun State Nigeria
| | - Akinsola Idowu Akinwumi
- grid.448570.a0000 0004 5940 136XDepartment of Family Medicine, Afe Babalola University, km 8.5, Afe Babalola Way, Ado-Ekiti, Ekiti State Nigeria
| | - Olufemi Timothy Awotunde
- grid.459398.aDepartment of Family Medicine, Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State Nigeria ,grid.442598.60000 0004 0630 3934Department of Family Medicine, Bowen University, P.M.B 284, Iwo, Osun State Nigeria
| | - Adewumi Ojeniyi Durodola
- grid.459398.aDepartment of Family Medicine, Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State Nigeria ,grid.442598.60000 0004 0630 3934Department of Family Medicine, Bowen University, P.M.B 284, Iwo, Osun State Nigeria
| | - James Idowu Owolabi
- grid.459398.aDepartment Surgery, Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State Nigeria ,grid.442598.60000 0004 0630 3934Department Surgery, Bowen University, P.M.B 284, Iwo, Osun State Nigeria
| |
Collapse
|
17
|
Kojima KE, Munari BM, Kubota BS, Zanesco L, Proença DS, Leonhardt MDC, Silva JDS. RADIOGRAPHIC EVALUATION OF IMMEDIATE LOADING SAFETY AFTER SURGICAL REDUCTION IN ACETABULAR FRACTURES: A COMPARATIVE-RETROSPECTIVE STUDY. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e256907. [PMID: 36506862 PMCID: PMC9721436 DOI: 10.1590/1413-785220223002e256907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 07/21/2021] [Indexed: 12/05/2022]
Abstract
Objective Radiographically evaluate the quality of reduction over six weeks of follow-up in patients with surgically treated deviated acetabular fractures who underwent rehabilitation with immediate loading as tolerated and compare this with the results of the unloaded protocol. Methods We retrospectively evaluated the records of 137 patients with deviated acetabular fractures treated with open reduction and internal fixation. Sixty-six (48.2%) patients underwent postoperative rehabilitation with immediate loading as tolerated, while 71 (51.8%) patients completed rehabilitation using a no-load protocol. The quality of the reduction was assessed radiographically by measuring the fracturing step and gap on radiographs taken immediately after surgery and three and six weeks after surgery. Results Comparing the joint step, group 1 had an average of 0.44 ± 1.4 mm, 0.47 ± 1.5 mm, and 0.51 ± 1.6 mm immediately, three and six weeks after surgery, respectively. Group 2 had a mean step of 0.24 ± 0.8 mm, 0.27 ± 0.9 mm, and 0.37 ± 1.2 mm immediately, three, and six weeks after surgery. No statistically significant differences were observed between the groups. With a joint gap, group 1 had a mean of 1.89 ± 1.7 mm, 2.12 ± 1.8 mm, and 2.36 ± 2.1 mm; and group 2 had a mean of 2.16 ± 2.4 mm, 2.47 ± 2.6 mm, and 2.67 ± 2.8 mm in the immediate postoperative period, three, and six weeks, respectively. There was also no statistical difference between groups in these measurements. Conclusion Immediate loading after surgical treatment of deviated acetabular fracture had no negative impact on radiographic reduction parameters and had similar results to the protocol without weight bearing. Level of evidence III; Therapeutic Retrospective Cohort Study .
Collapse
Affiliation(s)
- Kodi Edson Kojima
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Bruno Mendes Munari
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Bruno Seiki Kubota
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Leonardo Zanesco
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Daniel Sonnewend Proença
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Marcos de Camargo Leonhardt
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Jorge dos Santos Silva
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| |
Collapse
|
18
|
Immediate Weight-Bearing Following Biplanar Plating of Periprosthetic Femoral Fractures. Tech Orthop 2022. [DOI: 10.1097/bto.0000000000000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
19
|
冀 家, 杨 博, 王 敏, 董 亮, 黄 小. [Research progress of femoral neck system in treatment of femoral neck fracture in young and middle-aged patients]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1434-1439. [PMID: 36382464 PMCID: PMC9681595 DOI: 10.7507/1002-1892.202205092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 01/25/2023]
Abstract
Objective To summarize the research progress of femoral neck system (FNS) in the treatment of femoral neck fracture in young and middle-aged patients. Methods The literature on FNS at home and abroad in recent years was extensively reviewed, and the results of mechanical and clinical studies on FNS were summarized based on clinical experience. Results FNS has good mechanical stability, which can reduce complications such as femoral neck shortening, internal fixation failure, and varus caused by mechanical instability. At present, FNS is mainly selected for comparison with cannulated compression screws and dynamic hip screws in clinical research. The results show that FNS has the advantages of minimally invasive, short operation time, less intraoperative fluoroscopy, earlier postoperative weight-bearing and fracture healing, and better hip function recovery. Conclusion As a new internal fixator, FNS has achieved satisfactory results in the current research. FNS has good mechanical advantages, which is beneficial to fracture healing and the recovery of hip joint function after operation. However, whether FNS can reduce the incidence of nonunion and osteonecrosis of the femoral head remains to be further clarified.
Collapse
Affiliation(s)
- 家琛 冀
- 西安医学院(西安 710068)Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China
- 西安交通大学医学院附属红会医院骨科(西安 710054)Department of Orthopedics, Honghui Hospital Affiliated to Medicine College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China
| | - 博 杨
- 西安医学院(西安 710068)Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China
- 西安交通大学医学院附属红会医院骨科(西安 710054)Department of Orthopedics, Honghui Hospital Affiliated to Medicine College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China
| | - 敏 王
- 西安医学院(西安 710068)Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China
| | - 亮 董
- 西安医学院(西安 710068)Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China
| | - 小强 黄
- 西安医学院(西安 710068)Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China
| |
Collapse
|
20
|
Gait Analysis in Orthopaedic Surgery: History, Limitations, and Future Directions. J Am Acad Orthop Surg 2022; 30:e1366-e1373. [PMID: 36026713 DOI: 10.5435/jaaos-d-21-00785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023] Open
Abstract
Gait analysis has expanding indications in orthopaedic surgery, both for clinical and research applications. Early work has been particularly helpful for understanding pathologic gait deviations in neuromuscular disorders and biomechanical imbalances that contribute to injury. Notable advances in image acquisition, health-related wearable devices, and computational capabilities for big data sets have led to a rapid expansion of gait analysis tools, enabling novel research in all orthopaedic subspecialties. Given the lower cost and increased accessibility, new gait analysis tools will surely affect the next generation of objective patient outcome data. This article reviews the basic principles of gait analysis, modern tools available to the common surgeon, and future directions in this space.
Collapse
|
21
|
Cheyrou-Lagreze A, Severyns M, Rongieras F, Germaneau A, Odri GA, Bertani A. Secondary intramedullary nailing for open tibial shaft fractures. Comparison of a one-stage versus two-stage surgical procedure. Orthop Traumatol Surg Res 2022; 108:103391. [PMID: 35944868 DOI: 10.1016/j.otsr.2022.103391] [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: 01/13/2021] [Revised: 03/13/2022] [Accepted: 05/05/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The objective of this study was to compare the rates of radiological and clinical complications after sequential treatment of a tibial shaft fracture by external fixation followed by secondary nailing with an early-stage conversion (C1S) versus a two-stage late conversion (C2S). The hypothesis of this work was that treatment with C1S does not increase the risk of surgical site infections compared to C2S, and allows faster healing with a lower malunion rate. MATERIAL AND METHODS We carried out a retrospective and comparative study based on the files of the traumatology department of the Édouard Herriot University Hospital in Lyon. We reviewed the records of patients who presented with a Gustilo grade 1, 2 or 3a open tibial fracture treated with external fixation with conversion by intramedullary nailing within 6 months from January 2010 to December 2020. We assessed the occurrence of Surgical Site Infections (SSI), consolidation time, time until resumption of weight bearing and the malunion rate. RESULTS Of the 55 patients included, a C1S procedure was performed in 25 cases (45.5%) versus 30 cases (54.5%) for C2S. No significant difference was found concerning the occurrence of SSI after intramedullary nailing between the two groups (p=0.81). A significant difference was observed in terms of bone healing (p=0.036) and the malunion rate (0.0013) in favor of nailing in one stage. DISCUSSION The strategy of converting an open leg fracture early, in one stage (C1S), after initial external fixator placement allows for faster healing and weight bearing, while ensuring a lower malunion rate compared to that of a late two-stage conversion. In the absence of a scar at the time of intramedullary nailing, C1S does not increase the risk of surgical site infections. While the choice of a late and sequential two-stage operation is likely related to the surgeon's apprehension around conversion of an open leg fracture by intramedullary nailing, this study could promote the use of C1S in a greater number of situations. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Adrien Cheyrou-Lagreze
- Service de chirurgie orthopédique et traumatologique Pavillon E, CHU Édouard Herriot, hospices civils de Lyon, Lyon, France
| | - Mathieu Severyns
- Service de chirurgie orthopédique, CHU La Meynard, Fort-de-France, Martinique; Institut Pprime Institut UP 3346, CNRS, Université de Poitiers, Poitiers, France.
| | - Frédéric Rongieras
- Service de chirurgie orthopédique et traumatologique Pavillon E, CHU Édouard Herriot, hospices civils de Lyon, Lyon, France
| | - Arnaud Germaneau
- Institut Pprime Institut UP 3346, CNRS, Université de Poitiers, Poitiers, France
| | | | - Antoine Bertani
- Service de chirurgie orthopédique et traumatologique Pavillon E, CHU Édouard Herriot, hospices civils de Lyon, Lyon, France
| |
Collapse
|
22
|
Van Wyngaarden JJ, Archer KR, Pennings JS, Matuszewski PE, Noehren B. Psychosocial Predictors of Chronic Pain 12 Months After Surgical Fixation for Lower Extremity Fracture: A Prospective Study. Phys Ther 2022; 102:6655886. [PMID: 35926071 DOI: 10.1093/ptj/pzac101] [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: 06/25/2021] [Revised: 03/07/2022] [Accepted: 05/29/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pain is a common outcome after lower extremity fracture (LEF) requiring surgical fixation. Although psychosocial characteristics have meaningful associations with adverse outcomes, no studies have evaluated how psychosocial characteristics throughout recovery are associated with pain outcomes. The primary purpose of this study was to determine whether psychosocial characteristics are early risk factors for pain outcomes in patients following LEF who have no history of chronic pain. METHODS Participants, 122 patients with a LEF, consented to this single-center, prospective cohort study. Measurements of depression, pain self-efficacy, pain catastrophizing, and fear of movement were completed at 1 week, 6 weeks, 3 months, 6 months, and 12 months after LEF. Chronic pain development and pain intensity were assessed at 12 months. Univariate analyses assessing the difference between means and corresponding effect sizes were evaluated between those individuals with and without chronic pain at 12 months. Separate logistic and linear regression models using psychosocial scores at each time point were used to determine the association with the development of chronic pain and pain intensity, respectively. RESULTS Of 114 patients (93.4%) who completed the study, 51 (45%) reported chronic pain at 12 months. In the univariate analysis, all psychosocial variables at 6 weeks, 3 months, 6 months, and 12 months were significantly different between those with and those without chronic pain at 12 months (Cohen d range = 0.84 to 1.65). In the multivariate regression models, all psychosocial variables at 6 weeks, 3 months, and 6 months were associated with chronic pain development (odds ratio range = 1.04 to 1.22) and pain intensity (β range = .05 to .14) at 12 months. CONCLUSION Psychosocial scores as early as 6 weeks after surgery are associated with pain outcomes 12 months after LEF. IMPACT Physical therapists should consider adding psychosocial screening throughout recovery after LEF to identify patients at increased risk for long-term pain outcomes.
Collapse
Affiliation(s)
- Joshua J Van Wyngaarden
- Army-Baylor University, Doctoral Program of Physical Therapy, Baylor University, San Antonio, Texas, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul E Matuszewski
- College of Medicine, Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Brian Noehren
- College of Medicine, Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA.,College of Health Sciences, Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
23
|
Biomechanical and anatomical considerations for dual plating of distal femur fractures: a systematic literature review. Arch Orthop Trauma Surg 2022; 142:2597-2609. [PMID: 34097123 DOI: 10.1007/s00402-021-03988-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/28/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Distal femur fractures are challenging injuries historically associated with high rates of nonunion and varus collapse with operative management. As a result, clinical and research interest in dual plating (DP) of distal femur fractures has seen a dramatic increase in recent years. The purpose of this study was to systematically review the literature regarding vascular anatomy and biomechanics of distal femur fractures treated with DP constructs. MATERIALS AND METHODS A systematic literature review of two medical databases (PubMed & Scopus) was performed to identify peer-reviewed studies on the anatomy and biomechanics regarding DP of distal femur fractures. A total of 1,001 papers were evaluated and 14 papers met inclusion criteria (6 anatomy and 8 biomechanics). Methodological quality scores were used to assess quality and potential bias in the included studies. RESULTS In the biomechanical studies, DP constructs demonstrated greater axial and rotational stiffness, as well as less displacement and fewer incidences of failure compared to all other constructs. Vascular studies showed that the femoral artery crosses the mid-shaft femur approximately 16.0-18.8 cm proximal to the adductor tubercle and it is located on average 16.6-31.1 mm from the femoral shaft at this location, suggesting that medial plate application can be achieved safely in the distal femur. The methodological quality of the included studies was good for biomechanical studies (Traa score 79.1; range 53-92.5) and excellent for anatomical studies (QUACs score 81.9; range 69.0-88.5). CONCLUSIONS Existing biomechanics literature suggests that DP constructs are mechanically stronger than other constructs commonly used in the treatment of distal femur fractures. Furthermore, medial distal femoral anatomy allows for safe application of DP constructs, even in a minimally invasive fashion. Dual plating should be considered for patients with distal femur fractures that have risk factors for instability, varus collapse, or nonunion.
Collapse
|
24
|
Sharma T, Farrugia P. Early versus late weight bearing & ankle mobilization in the postoperative management of ankle fractures: A systematic review and meta-analysis of randomized controlled trials. Foot Ankle Surg 2022; 28:827-835. [PMID: 35337752 DOI: 10.1016/j.fas.2022.03.003] [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: 11/12/2021] [Revised: 02/11/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND While open reduction and internal fixation is currently considered the optimum treatment option for displaced ankle fractures, the most optimal post-operative rehabilitation strategy in this setting remains unclear. The objective of this investigation was to compare the effect of early vs. late weight bearing and ankle mobilization in the post-operative management of ankle fractures. METHODS Medline, Embase, CENTRAL, Scopus, CINHAL, and Web of Science were searched to identify randomized controlled trials (RCTs) and quasi-RCTs. Two review authors screened articles, abstracted data, and evaluated risk of bias in duplicate. Outcomes of interest included post-operative ankle function and overall time to return to work. Studies on weight bearing and ankle mobilization were analysed separately and all data were pooled using random-effects models. RESULTS Eighteen trials were included in the review of which 14 were included in the meta-analysis of at least one outcome of interest. Majority of the studies presented a high overall risk of bias. Early weight bearing demonstrated significantly better short-term postoperative functional scores at 6-9 weeks postoperatively (SMD: 0.39, 95% CI: 0.19, 0.58; p < 0.0001; I2 = 0%). However, the functional effect of early weight bearing compared to late weight bearing gradually became equivalent by the 6 month postoperative time-period. Early weight bearing also demonstrated a significant reduction in the time to return to work/daily activities (MD: -12.29, 95% CI: -17.39, -7.19; p < 0.0001; I2 = 0%). In comparison, no significant differences were found between early ankle mobilization/exercises and immobilization. CONCLUSION Our findings suggest a potential role of EWB in improving post-operative ankle-function in the short-term and reducing the overall time to return to work/daily activities, but no clinical benefit associated with early ankle mobilization post-surgery.
Collapse
Affiliation(s)
- Tanmay Sharma
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Patricia Farrugia
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
25
|
Wang Y, Luo Y, Min L, Zhou Y, Wang J, Zhang Y, Lu M, Duan H, Tu C. The West China Hospital radiographic classification for fibrous dysplasia in femur and adjacent bones: A retrospective analysis of 205 patients. Orthop Surg 2022; 14:2096-2108. [PMID: 35924702 PMCID: PMC9483050 DOI: 10.1111/os.13404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023] Open
Abstract
Objective This study aims to investigate the reliability and clinical outcome of a newly developed classification system for patients with fibrous dysplasia (FD) of the femur and adjacent bones, optimizing its evaluation and management. Methods A total of 205 patients (121 female and 84 male) with FD in the femur and adjacent bones were included in this retrospective study. All affected femurs were measured and treated based on this classification at our institution between 2009 and 2019. Based on previous studies and extensive clinical follow‐up, we cautiously proposed the West China Hospital radiographic classification for FD in femur and adjacent bones following corresponding treatment options. There are five types with five radiographic features, including proximal femur bone loss, coxa vara, femoral shaft deformity, genu valgum, and hip arthritis. The intraobserver and interobserver reproducibility of this classification was assessed by four observers using the Cohen kappa statistic. The clinical outcome was evaluated using the criteria of Guille. Results At a median follow‐up of 60 months (range 6–120), 205 patients (median 34.8 years old, range 18–73 years old) were categorized into the following five types: Type I 31.7%, Type II 30.2%, Type III 20.5%, Type IV 10.2%, and Type V 7.3%. The mean interobserver and intraobserver kappa scores were 0.85 (range 0.77–0.89) and 0.85 (range 0.79–0.92), respectively. For clinical outcomes, there was no significant difference in the postoperative Guille score for Type I patients (mean 9.01 ± 1.22). There was a significant increase in the postoperative Guille score in Type II, III, IV, and V, compared to the preoperative values (P < 0.01). For complications, two Type III patients reported pain, and one Type III patient had mild‐to‐moderate Trendelenburg gait. One Type IV patient had a mild Trendelenburg gait. And two Type V patients still had mild limping. Conclusion This classification is reproducible and serves as a tool for evaluating and treating FD in the femur and adjacent bones. Therefore, we recommend this classification for the diagnosis and treatment of FD‐related deformities in the femur and adjacent bones.
Collapse
Affiliation(s)
- Yitian Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P. R. China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Yi Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P. R. China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P. R. China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P. R. China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Jie Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P. R. China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Yuqi Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P. R. China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P. R. China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Hong Duan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, P. R. China.,Bone and Joint 3D-Printing & Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| |
Collapse
|
26
|
Distal Femoral Replacement and Extensor Mechanism Repair Reinforced With Synthetic Mesh for Distal Femur Fracture With Patellar Ligament Avulsion. Arthroplast Today 2022; 16:31-38. [PMID: 35647247 PMCID: PMC9136045 DOI: 10.1016/j.artd.2022.04.001] [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: 01/06/2022] [Revised: 03/28/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022] Open
Abstract
Acute patellar ligament disruption in the setting of a distal femur fracture is an uncommon presentation with a variety of treatment options available to the practitioner. The following case report presents an 85-year-old female with a highly comminuted supracondylar distal femur fracture with intercondylar extension and a soft-tissue avulsion of the patellar ligament insertion discovered intraoperatively. A detailed technique review for acute patellar ligament repair with suture anchors and synthetic mesh reinforcement in the setting of distal femoral replacement is then provided. One-year follow-up revealed an intact extensor mechanism with minimal extensor lag and a painless gait. Surgeons faced with such a unique, complex problem may consider mesh augmentation of an acute patellar ligament repair while performing distal femoral replacement.
Collapse
|
27
|
Fisher ND, Parola R, Bi AS, Konda SR, Egol KA. Ambulation on hip fracture postoperative day 1: a marker for better outcomes following hip fracture surgery in patients 55 years or older. Hip Int 2022:11207000221107853. [PMID: 35773620 DOI: 10.1177/11207000221107853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to investigate if early postoperative ambulation metrics affect hospital quality measures and 1-year outcomes in operative hip fracture patients. METHODS A consecutive series of hip fracture patients [OTA/AO 31A, 31B, 32A-C] who underwent operative treatment were reviewed for demographic and clinical data. Chart review was performed to determine participation with physical therapy [PT] and ambulation distance on postoperative day (POD) 1, 3, and 5. POD1 ambulators and non-ambulators were statistically compared. Outcome correlates of postoperative ambulation distance were investigated by univariate and multivariate linear and logistic regression. RESULTS 1044 patients were identified with 546 (52.3%) able to ambulate on POD1. Those able to ambulate on POD1 were significantly younger (78.4 ± 10.9 vs. 82.1 ± 10.4, p < 0.001), had fewer co-morbidities (CCI 1.22 ± 1.60 vs. 1.73 ± 1.82, p < 0.001), and were more likely to be preoperative community ambulators (82.2% vs. 68.3%, p < 0.001). Patients unable to ambulate on POD1 had significantly higher rate of inpatient mortality (2.8% vs. 0.5%, p = 0.004), 1-year mortality (14.6% vs. 6.9%, p < 0.001), and a longer length of stay (7.94 ± 4.73 vs. 6.43 ± 4.02 days, p < 0.001). Non-ambulators more often required the intensive care unit postoperatively (18.7% vs. 7.1%, p < 0.001), and had increased rates of major complications (15.5% vs. 5.7%, p < 0.001). Patients with OTA 31B or 32A fractures were 1.63 times more likely to ambulate on POD1 while patients with an assistive device at baseline were 0.51 times less likely to ambulate on POD1. Increasing postoperative ambulation distance correlated with shorter length of stay (p < 0.001 for POD1, 3, and 5) and every foot walked was associated with 0.57% decreased odds of a hospital complication (p = 0.0353). CONCLUSIONS Failure to ambulate on POD1 following hip fracture surgery in >55 years is associated with an increased risk of in-hospital complications and mortality. Every effort should be made address this modifiable risk factor and mobilise patients on POD1 to improve patient outcomes.
Collapse
Affiliation(s)
| | - Rown Parola
- NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Andrew S Bi
- NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Sanjit R Konda
- NYU Langone Orthopedic Hospital, New York, NY, USA
- Jamaica Hospital Medical Center, Queens, NY, USA
| | - Kenneth A Egol
- NYU Langone Orthopedic Hospital, New York, NY, USA
- Jamaica Hospital Medical Center, Queens, NY, USA
| |
Collapse
|
28
|
Lowen GB, Garrett KA, Moore-Lotridge SN, Uppuganti S, Guelcher SA, Schoenecker JG, Nyman JS. Effect of Intramedullary Nailing Patterns on Interfragmentary Strain in a Mouse Femur Fracture: A Parametric Finite Element Analysis. J Biomech Eng 2022; 144:051007. [PMID: 34802060 PMCID: PMC8822464 DOI: 10.1115/1.4053085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/17/2021] [Indexed: 11/08/2022]
Abstract
Delayed long bone fracture healing and nonunion continue to be a significant socioeconomic burden. While mechanical stimulation is known to be an important determinant of the bone repair process, understanding how the magnitude, mode, and commencement of interfragmentary strain (IFS) affect fracture healing can guide new therapeutic strategies to prevent delayed healing or nonunion. Mouse models provide a means to investigate the molecular and cellular aspects of fracture repair, yet there is only one commercially available, clinically-relevant, locking intramedullary nail (IMN) currently available for studying long bone fractures in rodents. Having access to alternative IMNs would allow a variety of mechanical environments at the fracture site to be evaluated, and the purpose of this proof-of-concept finite element analysis study is to identify which IMN design parameters have the largest impact on IFS in a murine transverse femoral osteotomy model. Using the dimensions of the clinically relevant IMN as a guide, the nail material, distance between interlocking screws, and clearance between the nail and endosteal surface were varied between simulations. Of these parameters, changing the nail material from stainless steel (SS) to polyetheretherketone (PEEK) had the largest impact on IFS. Reducing the distance between the proximal and distal interlocking screws substantially affected IFS only when nail modulus was low. Therefore, IMNs with low modulus (e.g., PEEK) can be used alongside commercially available SS nails to investigate the effect of initial IFS or stability on fracture healing with respect to different biological conditions of repair in rodents.
Collapse
Affiliation(s)
- Gregory B. Lowen
- Vanderbilt University, Department of Chemical and Biomolecular Engineering, 2201 West End Ave, Nashville, TN 37235
| | - Katherine A. Garrett
- Vanderbilt University Medical Center, Department of Orthopaedic Surgery, 1215 21 Ave. S., Suite 4200, Nashville, TN 37232
| | - Stephanie N. Moore-Lotridge
- Vanderbilt University Medical Center, Department of Orthopaedic Surgery, 1215 21 Ave. S., Suite 4200, Nashville, TN 37232;Vanderbilt University Medical Center, Vanderbilt Center for Bone Biology, 1211 Medical Center Dr., Nashville, TN 37212
| | - Sasidhar Uppuganti
- Vanderbilt University Medical Center, Department of Orthopaedic Surgery, 1215 21 Ave. S., Suite 4200, Nashville, TN 37232;Vanderbilt University Medical Center, Vanderbilt Center for Bone Biology, 1211 Medical Center Dr., Nashville, TN 37212
| | - Scott A. Guelcher
- Vanderbilt University, Department of Chemical and Biomolecular Engineering, 2201 West End Ave, Nashville, TN 37235; Vanderbilt University, Department of Biomedical Engineering, 5824 Stevenson Center, Nashville, TN 37232; Vanderbilt University Medical Center, Vanderbilt Center for Bone Biology, 1211 Medical Center Dr., Nashville, TN 37212; Vanderbilt University Medical Center, Division of Clinical Pharmacology, 1211 Medical Center Dr, Nashville, TN 37217
| | - Jonathan G. Schoenecker
- Vanderbilt University, Department of Pharmacology, 465 21 Ave South, 7124 Medical Research Building III, Nashville, TN 37232; Vanderbilt University Medical Center, Vanderbilt Center for Bone Biology, 1211 Medical Center Dr., Nashville, TN 37212; Vanderbilt University Medical Center, Department of Pathology, Microbiology, and Immunology, 1161 21 Ave S C-3322 Medical Center North, Nashville, TN 37232; Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232
| | - Jeffry S. Nyman
- Vanderbilt University, Department of Biomedical Engineering, 5824 Stevenson Center, Nashville, TN 37232; Vanderbilt University Medical Center, Department of Orthopaedic Surgery, 1215 21 Ave. S., Suite 4200, Nashville, TN 37232; Vanderbilt University Medical Center, Vanderbilt Center for Bone Biology, 1211 Medical Center Dr., Nashville, TN 37212; Tennessee Valley Healthcare System, Department of Veterans Affairs, 1310 24 Ave. S, Nashville, TN 37212
| |
Collapse
|
29
|
Abstract
Disuse osteoporosis describes a state of bone loss due to local skeletal unloading or systemic immobilization. This review will discuss advances in the field that have shed light on clinical observations, mechanistic insights and options for the treatment of disuse osteoporosis. Clinical settings of disuse osteoporosis include spinal cord injury, other neurological and neuromuscular disorders, immobilization after fractures and bed rest (real or modeled). Furthermore, spaceflight-induced bone loss represents a well-known adaptive process to microgravity. Clinical studies have outlined that immobilization leads to immediate bone loss in both the trabecular and cortical compartments accompanied by relatively increased bone resorption and decreased bone formation. The fact that the low bone formation state has been linked to high levels of the osteocyte-secreted protein sclerostin is one of the many findings that has brought matrix-embedded, mechanosensitive osteocytes into focus in the search for mechanistic principles. Previous basic research has primarily involved rodent models based on tail suspension, spaceflight and other immobilization methods, which have underlined the importance of osteocytes in the pathogenesis of disuse osteoporosis. Furthermore, molecular-based in vitro and in vivo approaches have revealed that osteocytes sense mechanical loading through mechanosensors that translate extracellular mechanical signals to intracellular biochemical signals and regulate gene expression. Osteocytic mechanosensors include the osteocyte cytoskeleton and dendritic processes within the lacuno-canalicular system (LCS), ion channels (e.g., Piezo1), extracellular matrix, primary cilia, focal adhesions (integrin-based) and hemichannels and gap junctions (connexin-based). Overall, disuse represents one of the major factors contributing to immediate bone loss and osteoporosis, and alterations in osteocytic pathways appear crucial to the bone loss associated with unloading.
Collapse
Affiliation(s)
- Tim Rolvien
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529, Hamburg, Germany.
| |
Collapse
|
30
|
Preoperative prediction of tibial nail length using patient body height. J Orthop 2022; 31:121-123. [PMID: 35535233 PMCID: PMC9077524 DOI: 10.1016/j.jor.2022.04.011] [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: 02/15/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose No validated method currently exists to preoperatively estimate tibial nail length for tibial fractures. While various anthropometric measurements have been suggested, none seem to allow for both accuracy and practicality, complicating treatment. This study aimed to evaluate the use of patient body height in preoperatively predicting tibial nail length. Methods Patients with tibial fractures treated with intramedullary nail at a single level 1 trauma center were included. Patient body height and tibial nail size were used to develop a predictive equation. Results 220 patients were included and reviewed in this study. A logarithmic predictive equation was developed to accurately predict tibial nail length 82% of the time. Conclusions Tibial nail length can be accurately predicted from patient body height. Compared to other anthropometric measurements, patient body height can be easily and consistently measured. Additionally, this study involved the largest sample size compared to other anthropometric studies predicting tibial nail length.
Collapse
|
31
|
Reporting of anaesthesia and pain management in preclinical large animal models of articular cartilage repair - A long way to go. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100261. [DOI: 10.1016/j.ocarto.2022.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
|
32
|
Meyr AJ, Doyle MD, King CM, Kwaadu KY, Nasser EM, Ramdass R, Theodoulou MH, Zarick CS. The American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Hallux Valgus. J Foot Ankle Surg 2022; 61:369-383. [PMID: 34706857 DOI: 10.1053/j.jfas.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship - Palo Alto Medical Foundation, Mountain View, CA
| | - Christy M King
- Residency Director, Kaiser San Francisco Bay Area Foot & Ankle Residency Program and Attending Surgeon, Kaiser Foundation Hospital, Oakland, CA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | | | - Roland Ramdass
- Residency Training Committee, INOVA Fairfax Medical Campus, Fairfax, VA
| | - Michael H Theodoulou
- Chief Division of Podiatric Surgery, Cambridge Health Alliance, and Instructor of Surgery, Harvard Medical School, Boston, MA
| | - Caitlin S Zarick
- Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| |
Collapse
|
33
|
Nail diameter significantly impacts stability in combined plate-nail constructs used for fixation of supracondylar distal femur fractures. OTA Int 2022; 5:e174. [PMID: 35187412 PMCID: PMC8846389 DOI: 10.1097/oi9.0000000000000174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/17/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
Objectives: Plate-nail (PN) combinations have been described for fixation of supracondylar distal femur fractures. Small diameter retrograde intramedullary nails (rIMN) are commonly used. The purpose of this study was to investigate the effect of nail diameter on construct stability. We hypothesized that a larger diameter rIMN would not significantly change the stiffness of the PN construct when tested in torsional or axial loading. Methods: Twelve synthetic osteoporotic femurs were used to compare nail diameters in an extraarticular supracondylar distal femur fracture model (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen type 33-A3). Constructs were fixed with a 12-hole 4.5 mm pre-contoured lateral distal femoral locking plate combined with either a 9 mm (n = 6) or an 11 mm (n = 6) retrograde intramedullary nail (rIMN). Specimens were cyclically loaded in torsion and axial compression. The primary outcome was construct stiffness, calculated using the average slope of the force-displacement curves. Results: The 11 mm PN construct was approximately 1.6 times stiffer than the 9 mm PN construct averaged across all torsional loads (2.39 +/− 0.41 Nm/deg vs 1.44 +/− 0.17 Nm/deg) and approximately 1.3 times stiffer than the 9 mm PN construct averaged across all axial loads (506.84 +/− 44.50 N/mm vs 376.77 +/− 37.65 N/mm). There were no construct failures. Conclusions: In this biomechanical model, nail diameter had a significant effect on both torsional and axial stiffness in PN constructs. While the use of smaller diameter rIMNs has been proposed to allow for easier placement of implants, the effect on overall construct stiffness should be considered in the context of the patient, their fracture and desired postoperative weight bearing recommendations. Level of Evidence: N/A
Collapse
|
34
|
Alquhaibi MS, Ghaddaf AA, Alomari MS, Abdulhamid AS, Alsaygh EF, Alshehri MS, Alyami AH. Short leg cast versus orthotic removable support for the management of pseudo-Jones avulsion fracture: A systematic review and meta-analysis. Injury 2022; 53:739-745. [PMID: 34838261 DOI: 10.1016/j.injury.2021.11.032] [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: 09/10/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The fifth metatarsal base avulsion fracture (i.e., Pseudo-Jones fracture) is one of the most common foot fractures. The management of pseudo-Jones fractures could be carried out surgically or conservatively. This systematic review and meta-analysis aimed to provide an update about the efficacy of orthotic removable support compared to short-leg casting for individuals with pseudo-Jones fracture. METHODS We searched Embase, Medline, and Cochrane Central register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) that compared the clinical outcomes of orthotic removable support and short-leg cast for adult individuals with a fifth metatarsal base avulsion fracture. We used 95% as a confidence level and P <0.05 as a threshold. The standardized mean difference (SMD) was used for the continuous outcomes, and the risk ratio (RR) was used for the dichotomous outcomes. RESULTS A total of 6 RCTs incorporating 403 individuals out were deemed eligible. There was no significant difference between orthotic removable support and short-leg casting regarding AOFAS score (standardized mean difference (SMD)= 0.31, 95% CI -0.17 to 0.8), pain on VAS score (SMD= -0.08, 95% CI -0.39 to 0.22), VAS-FA score (SMD= 0.22, 95% CI -0.19 to 0.62) EQ-5D VAS score, and non-union rate (RR=0.37, 95% CI 0.05 to 2.74). CONCLUSION The current meta-analysis reveals that there is no difference between orthotic removable support and short-leg casting for the conservative management of individuals sustaining pseudo-Jones fracture.
Collapse
Affiliation(s)
- Mohammed S Alquhaibi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A Ghaddaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
| | - Mohammed S Alomari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed S Abdulhamid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ehab F Alsaygh
- College of Medicine, Taibah University, Medina, Saudi Arabia
| | - Mohammed S Alshehri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Surgery/Orthopedic Section, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Ali H Alyami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Surgery/Orthopedic Section, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| |
Collapse
|
35
|
Stinner DJ, Rivera JC, Smith CS, Weiss DB, Hymes RA, Matuszewski PE, Gary JL, Morshed S, Schmidt AH, Wilken JM, Archer KR, Bailey L, Kleihege J, McLaughlin KH, Thompson RE, Chung S, Remenapp C, MacKenzie EJ, Reider L. Early Advanced Weight-Bearing After Periarticular Fractures: A Randomized Trial Comparing Antigravity Treadmill Therapy Versus Standard of Care. J Orthop Trauma 2022; 36:S8-S13. [PMID: 34924513 DOI: 10.1097/bot.0000000000002285] [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] [Accepted: 10/07/2021] [Indexed: 02/02/2023]
Abstract
SUMMARY In current clinical practice, weight-bearing is typically restricted for up to 12 weeks after definitive fixation of lower extremity periarticular fractures. However, muscle atrophy resulting from restricting weight-bearing has a deleterious effect on bone healing and overall limb function. Antigravity treadmill therapy may improve recovery by allowing patients to safely load the limb during therapy, thereby reducing the negative consequences of prolonged non-weight-bearing while avoiding complications associated with premature return to full weight-bearing. This article describes a multicenter randomized controlled trial comparing outcomes after a 10-week antigravity treadmill therapy program versus standard of care in adult patients with periarticular fractures of the knee and distal tibia. The primary hypothesis is that, compared with patients receiving standard of care, patients receiving antigravity treadmill therapy will report better function 6 months after definitive treatment.
Collapse
Affiliation(s)
- Daniel J Stinner
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jessica C Rivera
- U.S. Army Institute for Surgical Research, Brooke Army Medical Center, San Antonio, TX. Dr. Rivera is now with the Department of Orthopaedic Surgery, Louisiana State University Medical Center, New Orleans, LA
| | - Christopher S Smith
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA
| | - David B Weiss
- Department of Orthopaedic Surgery, University of Virginia Medical Center, Charlottesville, VA
| | - Robert A Hymes
- Department of Orthopaedic Surgery, Inova Fairfax Medical Campus, Falls Church, VA
| | - Paul E Matuszewski
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Joshua L Gary
- Department of Orthopaedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX (now at the Department of Orthopaedic Surgery, at the Keck School of Medicine, University of Southern California, Los Angeles, CA)
| | - Saam Morshed
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Andrew H Schmidt
- Department of Orthopaedic Surgery, Hennepin Healthcare, Minneapolis, MN
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research and Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lane Bailey
- Memorial Hermann IRONMAN Sports Medicine Institute, Houston, TX
| | | | - Kevin H McLaughlin
- Department of Physical Medicine and Rehabilitation, John Hopkins University, Baltimore, MD
| | - Richard E Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Suna Chung
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Craig Remenapp
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ellen J MacKenzie
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
36
|
Van Wyngaarden JJ, Archer KR, Spencer A, Matuszewski PE, Brightwell B, Jacobs C, Noehren B. Early Pain Catastrophizing Exacerbates Impaired Limb Loading and 6-Minute Walk Test Distance 12 Months After Lower Extremity Fracture. Phys Ther 2021; 101:6352461. [PMID: 34403485 DOI: 10.1093/ptj/pzab194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 05/14/2021] [Accepted: 07/05/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Disability is common after lower extremity fracture (LEF). Although psychosocial factors have been associated with patient-reported outcomes after LEF, they have not been associated with objective measures of function. Aberrant gait patterns are important markers of function, but are poorly defined after LEF. The primary purpose of this study was to explore whether pain catastrophizing and fear of movement 6 weeks after surgery were associated with injured limb loading outcomes and 6-minute walk test (6MWT) distance 12 months after femur or tibia fracture. The secondary purpose was to determine if limb loading characteristics differed between injured and uninjured limbs. METHODS At 6 weeks after LEF, patients completed validated measures of pain catastrophizing, fear of movement, and depression. At 12 months, patients completed a 6MWT while wearing instrumented insoles that recorded the limb loading outcomes of stance time, impulse, and loading rate. Bivariate correlations assessed how patient and psychosocial characteristics at 6 weeks were associated with injured limb loading outcomes and 6MWT distance. Multivariable regression analyses were performed to determine if psychosocial variables were associated with each outcome after controlling for depression and patient demographic and clinical characteristics. Finally, paired t tests compared limb loading outcomes between limbs. RESULTS Forty-seven participants completed the 6MWT at 12 months (65%), and 38 completed the 6MWT with the instrumented insoles. Fear of movement carried a poor relationship (r = 0.11-0.32) and pain catastrophizing a moderate relationship (r = 0.46-0.54) with 12-month outcomes. The regression results indicated that pain catastrophizing continued to be associated with all outcomes. Finally, the injured limb had significantly lower limb loading outcomes than the uninjured limb at 12 months (Cohen d = 0.54-0.69). CONCLUSION Pain catastrophizing early after LEF was associated with impaired limb loading and 6MWT distance at 12 months. IMPACT Impaired limb loading persists 12 months after LEF. Further research is needed to determine whether rehabilitative efforts focused on pain catastrophizing can restore limb loading after LEF.
Collapse
Affiliation(s)
- Joshua J Van Wyngaarden
- Army-Baylor University, Doctoral Program of Physical Therapy, Baylor University, San Antonio, Texas, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alex Spencer
- College of Health Sciences, Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, USA
| | - Paul E Matuszewski
- College of Medicine, Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Benjamin Brightwell
- College of Health Sciences, Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, USA
| | - Cale Jacobs
- College of Medicine, Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Brian Noehren
- College of Health Sciences, Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, USA.,College of Medicine, Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
37
|
Rafiei S, Nourani A, Chizari M. A multi-objective approach to optimize the weight and stress of the locking plates using finite element modeling. Proc Inst Mech Eng H 2021; 236:188-198. [PMID: 34696646 DOI: 10.1177/09544119211048286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper aims to identify an optimum bone fracture stabilizer. For this purpose, three design variables including the ratio of the screw diameter to the plate width at three levels, the ratio of the plate thickness to the plate width at three levels, and the diameter of the bone at two levels were selected for analysis. Eighteen 3D verified finite element models were developed to examine the effects of these parameters on the weight, maximum displacement and maximum von Mises stress of the fixation structure. Considering the relations between the inputs and outputs using multivariate regression, a genetic algorithm was used to find the optimal choices. Results showed that the diameter of the bone and the amount of load applied on it did not have a significant effect on the normalized stresses on the structures. Furthermore, in all ratio of the plate thickness to the plate width, as the ratio of the screw diameter to the plate width increased, the amount of stress on the structure decreased. But, by further increasing the ratio of the screw diameter to the plate width, the amount of stress on the structure increased. On the other hand, by increasing the value of the ratio of the plate thickness to the plate width, the maximum amount of stress on the structure decreased. Finally, optimal solutions in terms of the weight and the maximum amount of stress on the structure were presented.
Collapse
Affiliation(s)
- Soroush Rafiei
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Amir Nourani
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mahmoud Chizari
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield, UK
| |
Collapse
|
38
|
Falls from height: Ambulation following spinal cord injury and lower extremity polytrauma. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
39
|
Fu R, Feng Y, Liu Y, Yang H. Mechanical regulation of bone regeneration during distraction osteogenesis. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
40
|
Torabi M, Khorramymehr S, Nikkhoo M, Rostami M. The effect of orthopedic screw profiles on the healing time of femoral neck fracture. Comput Methods Biomech Biomed Engin 2021; 25:97-110. [PMID: 34459294 DOI: 10.1080/10255842.2021.1932840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
One possible treatment for femoral neck fractures, especially in young people, is the use of bone screws or Lug screws. The design of these implants requires taking into account the biocompatibility of materials, mechanical properties plus surface properties, and thread's geometric, as well as chemical properties, etc. Various profiles are designed for fracture fixation. The most famous of these profiles, which are introduced by the ISO standard, are HB, HC, and HD type profiles. This article investigates the performance of these profiles in reducing or increasing the healing time. This study is based on the rule of bone remodeling and using a set of three-dimensional computational (finite element) models. The study revealed that the HB profile outperformed the other two profiles. Meanwhile, HD profile was also better than HC profile.
Collapse
Affiliation(s)
- Masoud Torabi
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Siamak Khorramymehr
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Nikkhoo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mostafa Rostami
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| |
Collapse
|
41
|
Park JY, Kim BS, Kim YM, Cho JH, Choi YR, Kim HN. Early Weightbearing Versus Nonweightbearing After Operative Treatment of an Ankle Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial. Am J Sports Med 2021; 49:2689-2696. [PMID: 34251882 DOI: 10.1177/03635465211026960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute ankle fractures can occur during sports activities, and unstable ankle fractures are commonly treated operatively. However, controversy exists about the optimal time to allow weightbearing. HYPOTHESIS Early weightbearing after the stable fixation of an ankle fracture is not inferior to nonweightbearing in terms of ankle function assessed at 12 months after injury. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 258 patients were assessed for eligibility. Of these patients, 194 were randomly allocated to either the early weightbearing group (95 patients who were allowed weightbearing at 2 weeks postoperatively) or the nonweightbearing group (99 patients who were not allowed weightbearing until 6 weeks postoperatively). The primary outcome measure was the mean difference in the Olerud-Molander ankle score (OMAS) between the groups, assessed at the 12-month follow-up examination. The secondary outcome measures were the time to return to preinjury activities and patients' subjective satisfaction. Complications such as hardware loosening or failure, fracture displacement, and nonunion were evaluated. RESULTS The mean difference in the OMAS for the early weightbearing group compared with the nonweightbearing group was 1.6 (95% CI, -1.9 to 5.0) in the intention-to-treat analysis. The lower limit of the 95% CI (-1.9) exceeded the noninferiority margin of -8, indicating that early weightbearing was not inferior to nonweightbearing. The difference in the proportion of patients who were satisfied or very satisfied with their treatment was not statistically significant (84.3% vs 76.2%; P = .19); however, the time taken to return to preinjury activities was shorter with early weightbearing than with nonweightbearing (9.1 ± 3.0 vs 11.0 ± 3.0 weeks; P < .001). No cases of nonunion were observed in either group. CONCLUSION Early weightbearing after the operative treatment of an unstable ankle fracture was not inferior to nonweightbearing in terms of OMAS assessed at 12 months after injury. The patients' subjective satisfaction was similar between the groups, although the time taken to return to preinjury activities was shorter in the early weightbearing group. REGISTRATION NCT02029170 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Jae Yong Park
- Department of Orthopedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Bom Soo Kim
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Yu Mi Kim
- Department of Orthopedic Surgery, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo-si, Gyeonggi-do, Republic of Korea
| | - Jae Ho Cho
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Young Rak Choi
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
42
|
Myers DM, Pulido SH, Forsting S, Umbel B, Taylor BC. Effect of Early Weight Bearing on Outcomes After Open Reduction and Internal Fixation of Trimalleolar Ankle Fractures. Orthopedics 2021; 44:160-165. [PMID: 33416898 DOI: 10.3928/01477447-20210104-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Current practice allows early weight bearing of unstable ankle fractures after fixation. This study offers a unique comparison of early weight bearing (EWB) vs late weight bearing (LWB) in operatively stabilized trimalleolar ankle fractures. The goal of this study was to evaluate union rates, clinical outcomes, and complications for patients who were managed with EWB vs LWB. The authors performed a retrospective review of 185 patients who underwent surgical stabilization for trimalleolar ankle fracture. Fixation of the posterior malleolus and weight bearing status were determined by surgeon preference. For this study, EWB was defined as 3 weeks or less and LWB was defined as greater than 3 weeks. Patients were evaluated for fracture union and implant failure. Complications and clinical outcomes included ambulatory status, infection rate, and return to surgery. The EWB group included 47 (25.4%) patients, and the LWB group included 138 (74.6%) patients. Of the 7 nonunions, 1 (14.3%) occurred in the EWB group and 6 (85.7%) in the LWB group. A total of 72 (38.9%) posterior malleolar fractures were operatively stabilized, and stabilization did not affect union rates. Syndesmotic fixation was required for 12.5% of patients, despite posterior malleolar stabilization. Syndesmotic fixation increased the union rate 2.5 times. Deep infection and open fracture decreased union. No difference was seen between groups in implant failure, union rate, infection, or return to the operating room. No deleterious effect of EWB in operatively treated trimalleolar ankle fractures was found for union, implant failure, infection, or reoperation. Syndesmotic fixation may offer an advantage over posterior malleolar fixation, with improved union rates. [Orthopedics. 2021;44(3):160-165.].
Collapse
|
43
|
Keenan OJF, Ross LA, Magill M, Moran M, Scott CEH. Immediate weight-bearing is safe following lateral locked plate fixation of periprosthetic distal femoral fractures. Knee Surg Relat Res 2021; 33:19. [PMID: 34172101 PMCID: PMC8229296 DOI: 10.1186/s43019-021-00097-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/29/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study aimed to determine whether unrestricted weight-bearing as tolerated (WBAT) following lateral locking plate (LLP) fixation of periprosthetic distal femoral fractures (PDFFs) is associated with increased failure and reoperation, compared with restricted weight-bearing (RWB). MATERIALS AND METHODS In a retrospective cohort study of consecutive patients with unilateral PDFFs undergoing LLP fixation, patients prescribed WBAT were compared with those prescribed 6 weeks of RWB. The primary outcome measure was reoperation. Kaplan-Meier and Cox multivariable analyses were performed. RESULTS There were 43 patients (mean age 80.9 ± 11.7 years, body mass index 26.8 ± 5.7 kg/m2 and 86.0% female): 28 WBAT and 15 RWB. There were more interprosthetic fractures in the RWB group (p = 0.040). Mean follow-up was 3.8 years (range 1.0-10.4). Eight patients (18.6%) underwent reoperation. Kaplan-Meier analysis demonstrated no difference in 2-year survival between WBAT (80.6%, 95% CI 65.3-95.9) and RWB (83.3%, 95% CI 62.1-100.0; p = 0.54). Cox analysis showed increased reoperation risk with medial comminution (hazard ratio 10.7, 95% CI 1.5-80; p = 0.020) and decreased risk with anatomic reduction (hazard ratio 0.11, 95% CI 0.01-1.0; p = 0.046). Immediate weight-bearing did not significantly affect the risk of reoperation compared with RWB (relative risk 1.03, 95% CI 0.61-1.74; p = 0.91). CONCLUSIONS LLP fixation failure was associated with medial comminution and non-anatomic reductions, not with postoperative weight-bearing. Medial comminution should be managed with additional fixation. Weight-bearing restrictions additional to this appear unnecessary and should be avoided.
Collapse
Affiliation(s)
- Oisin J F Keenan
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
| | - Lauren A Ross
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Matthew Magill
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Matthew Moran
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| |
Collapse
|
44
|
Potential Benefits of Limited Clinical and Radiographic Follow-up After Surgical Treatment of Ankle Fractures. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202105000-00009. [PMID: 33974571 PMCID: PMC8116015 DOI: 10.5435/jaaosglobal-d-21-00074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
Ankle fractures are one of the most prevalent musculoskeletal injuries, with a significant number requiring surgical treatment. Postoperative complications requiring additional interventions frequently occur during the early postoperative period. We hypothesize that there is a limited need for routine clinical and radiographic follow-up once the fracture is deemed healed.
Collapse
|
45
|
Khwaja A, Mahoney W, Johnson J, Trompeter A, Lowe J. Biomechanics of periprosthetic femur fractures and early weightbearing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:861-869. [PMID: 33852066 DOI: 10.1007/s00590-021-02969-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The incidence of periprosthetic fractures is expected to rise increase by 4.6% every 10 years between 2015 and 2060. There are few large series examining optimal fixation constructs or the influence of early ambulation on outcome. The purpose of this narrative review is to investigate the published biomechanical considerations for periprosthetic fracture fixation, with specific consideration of early postoperative weightbearing. METHODS A literature review was performed to identify fracture incidences, etiology, and current trends in weightbearing after fixation. Benefits of early weightbearing, current constructs, and biomechanics are reviewed. RESULTS The limited data available support medical benefits and increased union rates with early mobilization. Optimal fixation constructs are not agreed upon, but mechanical studies suggest that dual implant constructs can support physiologic weightbearing loads. CONCLUSION Further clinical trials are required to investigate fracture union and hardware complications in dual implant construct.
Collapse
Affiliation(s)
- Ansab Khwaja
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.
| | - William Mahoney
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA
| | - Jay Johnson
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.,Banner University Medical Group, Banner Health System Phoenix, Phoenix, AZ, USA
| | | | - Jason Lowe
- Department of Orthopaedics, University of Arizona, 1625 N Campbell Avenue, Tucson, AZ, 85719, USA.,Banner University Medical Group, Banner Health System Phoenix, Phoenix, AZ, USA
| |
Collapse
|
46
|
Wang Z, Lu Y, Huang Q, Xue H, Ran C, Wang Q, Ma T, Zhang K, Li Z, Sun L. Efficacy and Safety of Long-Term Intravenous Tranexamic Acid Administration for Blood Management in Revision Surgery for Femoral Shaft Nonunion: A Retrospective Case-Control Study. Clin Appl Thromb Hemost 2021; 27:10760296211002277. [PMID: 33845609 PMCID: PMC8047849 DOI: 10.1177/10760296211002277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Femoral shaft nonunion is a complication that seriously affects physiological functions. We aimed to assess the effectiveness and safety of short- and long-term intravenous tranexamic acid (TXA) administration in the perioperative period of revision surgery for femoral shaft nonunion. In this retrospective study, 53 patients undergoing double-locking plates with channel bone grafting technology for the treatment of femoral shaft nonunion were divided into 3 groups: the patients in group A without use TXA during hospitalization, the patients in group B received intravenous (IV) 1-g TXA at 30 min before the surgery and deep soaked 1-g TXA for 5 min before closing the incision, and then 1-g TXA IV again 6 h after surgery, and the patients in group C received 1-g TXA IV before the operation, 1-g TXA topically during the operation, and subsequent long-term 1-g TXA IV until discharged. The primary outcomes were total blood loss (TBL) and hidden blood loss (HBL). The secondary outcomes included actual hemoglobin (Hb) loss values, transfusion requirement, number of units transfused, postoperative laboratory values (Hb, hematocrit, fibrinogen, and D-dimer), visual analogue scale (VAS) scores, and hospitalization time. The mean TBL was lower in group C than in group A (1168 mL vs. 2714 mL, P < 0.001) and group B (1168 mL vs. 1557 mL, P = 0.008). The differences in HBL volumes were also significant between groups A and C (P < 0.001) and between groups A and B (P < 0.01). The actual Hb loss in the 3 groups showed a consistent trend with TBL, but no significant differences between groups B and C (P = 0.23). On postoperative day (POD) 3, the Hb level was higher in group C than in group A (111.1 g/L vs. 94.6 g/L, P = 0.02). No significant differences were found in VAS, hospital stay, thromboembolic complications, incision-related complications, and TXA adverse reactions among groups. Long-term intravenous TXA during hospitalization can effectively reduce perioperative blood loss, Hb drop, and postoperative hyperfibrinolysis, but is associated with an increased incidence of adverse reactions.
Collapse
Affiliation(s)
- Zhimeng Wang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Yao Lu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China.,The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, People's Republic of China.,Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Qiang Huang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Hanzhong Xue
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Cheng Ran
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Qian Wang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Teng Ma
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Kun Zhang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Zhong Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China
| | - Liang Sun
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, People's Republic of China
| |
Collapse
|
47
|
Extreme Nailing or Less Invasive Plating of Lower Extremity Periarticular Fractures. Orthop Clin North Am 2021; 52:111-121. [PMID: 33752832 DOI: 10.1016/j.ocl.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Periarticular fractures of the lower extremity can be difficult injuries to stabilize effectively. Modern advances in technique and implant design now allow many of these fractures to be fixed with an extreme intramedullary nail. When nailing is not possible, less invasive plating through percutaneous incisions is a reliable option. The decision to perform extreme nailing is multifactorial and is based on the fracture pattern, the condition of the soft tissues, the medical condition of the patient, and the importance of earlier or immediate weightbearing.
Collapse
|
48
|
de Krom MAP, Kalmet PHS, Jagtenberg EM, Jansen JJR, Versteegh VE, Verbruggen JPAM, Seelen HAM, Poeze M. Medium-Term Patient-Reported Quality of Life and Activities of Daily Living in Surgically Treated Trauma Patients With Pelvic, Acetabular or Combined Pelvic and Acetabular Fractures in a Retrospective Single-Center Study. J Orthop Trauma 2021; 35:192-197. [PMID: 32956206 DOI: 10.1097/bot.0000000000001965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To gain more insights in the medium-term patient-reported quality of life (QoL), activities of daily living (ADL), and number of complications in trauma patients with an acetabular fracture (AF), a pelvic fracture (PF), and those with a surgically combined pelvic and AF (PAF). DESIGN Retrospective single-center study. SETTING Level I academic trauma center. PATIENTS/PARTICIPANTS 51 trauma patients with PF, AF, or PAF who were surgically treated between 2014 and 2017. INTERVENTION Open reduction and internal fixation. MAIN OUTCOME MEASUREMENTS Primary outcome measures are patient-reported outcome questionnaire, which includes 2 items, the QoL, as measured with the Short Form-12, and the ADL, as measured with the Lower Extremity Functional Scale. The secondary outcome parameter was the occurrence of complications during a follow-up of at least 2 years. RESULTS The mean physical component score (PCS) of the QoL (P = 0.03) and the ADL (P = 0.03) were significantly higher in patients with AF compared with patients with PF. The incidence of the overall postoperative complications did not significantly differ between the PF, AF, and PAF groups (P = 0.28). CONCLUSIONS This study found that the PCS of the QoL and the ADL in surgically treated trauma patients with PF were significantly lower compared with patients with AF. No significant differences were found in overall complication rate between the PF, AF, and PAF groups. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Maartje A P de Krom
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pishtiwan H S Kalmet
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eline M Jagtenberg
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joey J R Jansen
- Department of Amputation, Adelante Rehabilitation Center, Traumatology and Orthopaedics, Hoensbroek, the Netherlands
| | - Viktor E Versteegh
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jan P A M Verbruggen
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Henk A M Seelen
- Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; and
| | - Martijn Poeze
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
49
|
Koenders N, Potkamp-Kloppers S, Geurts Y, Akkermans R, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Ban Bedcentricity: A Multifaceted Innovation to Reduce Sedentary Behavior of Patients During the Hospital Stay. Phys Ther 2021; 101:6131759. [PMID: 33564890 PMCID: PMC8280922 DOI: 10.1093/ptj/pzab054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 12/03/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to explore differences in sedentary behavior, length of hospital stay, and discharge destination of patients before and after the Ban Bedcentricity implementation at ward level. METHODS The Ban Bedcentricity innovation and implementation procedure were implemented at the cardiothoracic surgery, cardiology, and orthopedics-traumatology wards. Sedentary behavior data were collected 2 weeks before and after the implementation using behavioral observations and analyzed with Pearson chi-square. Length of hospital stay and discharge destination data were collected from all admitted patients and analyzed with multiple and logistic regression analyses. RESULTS Behavioral observations showed that in 52% of the observations, patients were lying in bed before implementation and 40% after implementation at the cardiothoracic surgery, 64% and 46% at the cardiology, and 53% and 57% at the orthopedics-traumatology wards, respectively. The mean length of hospital stay after implementation (compared with implementation before) was 5.1 days at the cardiothoracic surgery (n = 1923; mean = +0.13 days, 95% CI = -0.32 to 0.60), 2.6 days at the cardiology (n = 2646; mean = -0.22 days, 95% CI = -0.29 to -0.14), and 2.4 days at the orthopedics-traumatology wards (n = 1598; mean = +0.28 days, 95% CI = 0.06 to 0.50). After the implementation, more patients were discharged home from the cardiothoracic surgery (odds ratio [OR = 1.23], 95% CI = 1.07 to 1.37) and cardiology wards (OR = 1.37, 95% CI = 1.22 to 1.49), and no statistically significant difference was found at the orthopedics-traumatology ward (OR = 1.09, 95% CI = 0.88 to 1.27). CONCLUSION The results indicate beneficial outcomes after the implementation with less sedentary behavior and proportionately more patients being discharged home compared with before the implementation. However, little information is available about the adoption and fidelity of Ban Bedcentricity; therefore, outcomes should be interpreted with caution. IMPACT This multifaceted innovation to reduce sedentary behavior of patients during the hospital stay seems to be promising, with outcomes indicating less sedentary behavior in patients and more patients being discharged home after the implementation. LAY SUMMARY We introduced Ban Bedcentricity, an intervention to reduce the amount of time patients lie in the hospital bed during their hospitalization. This study shows that after the introduction of Ban Bedcentricity, patients lie in bed less and are more often discharged home.
Collapse
Affiliation(s)
- Niek Koenders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands,Address all correspondence to Mr Koenders at:
| | | | - Yvonne Geurts
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Reinier Akkermans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Allied Healthcare Sciences of IQ Healthcare, Nijmegen, the Netherlands,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Allied Healthcare Sciences of IQ Healthcare, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Allied Healthcare Sciences of IQ Healthcare, Nijmegen, the Netherlands
| |
Collapse
|
50
|
Choi YR, Kim BS, Kim YM, Park JY, Cho JH, Kim S, Kim HN. Hard-Soled Shoe Versus Short Leg Cast for a Fifth Metatarsal Base Avulsion Fracture: A Multicenter, Noninferiority, Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:23-29. [PMID: 33252586 DOI: 10.2106/jbjs.20.00777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether tolerated weight-bearing in a hard-soled shoe was noninferior to the use of a short leg cast for the treatment of a fifth metatarsal base avulsion fracture, as assessed with use of a 100-mm visual analog scale (VAS) for pain at 6 months after the fracture. METHODS A total of 145 patients were assessed for eligibility. Of these, 96 patients were randomly assigned to either the hard-soled shoe group (46 patients) or the cast group (50 patients). The primary outcome measure was the mean difference on the 100-mm VAS between groups at 6 months after the fracture. Secondary outcome measures included the time to return to preinjury activity and patient-reported satisfaction. Analysis was performed according to both an intention-to-treat basis (i.e., patients were included in the assessment of their assigned treatment arm, even if they crossed over to the other treatment arm prior to completing the 6-month follow-up) and a per-protocol basis (i.e., patients who completed the 6-month follow-up were analyzed according to the treatment they received). RESULTS At 6 months after the fracture, the mean 100-mm VAS was 8.6 ± 7.0 mm in the hard-soled shoe group and 9.8 ± 7.3 mm in the cast group (p = 0.41) according to intention-to-treat analysis. The mean difference in 100-mm VAS between the 2 groups was -1.3 mm (95% confidence interval, -4.3 to 1.8 mm). The upper limit of the 95% confidence interval did not exceed the noninferiority margin of 10 mm, indicating that treatment with the hard-soled shoe was noninferior to treatment with the short leg cast. The proportion of patients who reported satisfaction with their treatment was similar between the hard-soled shoe and cast groups (89.5% compared with 87.5%, respectively; p = 0.79), but the time to return to preinjury activity was significantly shorter in the hard-soled shoe group (37.2 ± 14.4 days compared with 43.0 ± 11.1 days in the cast group; p = 0.04). There were no cases of nonunion in either group. CONCLUSIONS Weight-bearing as tolerated in a hard-soled shoe for a fifth metatarsal base avulsion fracture was noninferior to the use of a short leg cast as assessed with use of a 100-mm VAS at 6 months after the fracture. Patient-reported satisfaction was similar between groups, but the time to return to preinjury activity was shorter in the hard-soled shoe group. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Young Rak Choi
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bom Soo Kim
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Republic of Korea
| | - Yu Mi Kim
- Department of Orthopedic Surgery, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Republic of Korea
| | - Jae Yong Park
- Department of Orthopedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Jae Ho Cho
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Shinseok Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyong Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|