Aims: Recent years have seen increased interest in tissue-sparing approaches for total hip arthroplasty (THA), which has led to innovations in implant design. Short cementless femoral components have gained traction, and the inclusion of a medial calcar collar to improve stability may offset the risk of fracture. The aim of this current study is to report short-term outcomes and survivorship for a novel design of femoral component across four non-designer centres. Methods: All patients undergoing primary THA across four centres from July 2020 to January 2025 were eligible for inclusion. Data were collected prospectively in a national arthroplasty register, with planned routine follow-up at six months and two years. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS) and EuroQol five-dimension questionnaire (EQ-5D) score. Results: A total of 517 components in 489 patients were included in the dataset: three patients (0.6%) died by final follow-up, and of the remaining 514 components, 512 components (99.6%) remain in situ. For the two patients (0.4%) undergoing revision surgery, indications for revision were periprosthetic fracture (PPF) and large postoperative haematoma. PPF affected four patients (0.8%) in total: two intraoperative events were managed with cables, and one Vancouver C fracture was managed with plate and screw fixation. The mean preoperative OHS was 17 (95% CI 16.3 to 17.7) with a mean postoperative score of 40.7 (95% CI 39.7 to 41.5), and mean preoperative EQ-5D score was 0.36 (95% CI 0.34 to 0.38), with a mean postoperative score of 0.80 (95% CI 0.78 to 0.82). Conclusion: This novel femoral component demonstrates excellent functional outcomes which are reproducible across multiple surgeons in non-designer centres, with low rates of revision surgery and PPF. Cite this article: Bone Jt Open 2026;7(3):366–372.
Erin E. Cunningham, Erin Bigney, Stephan U. Dombrowski
et al.
Abstract This study aimed to estimate the effects of preoperative psychological health on postoperative outcomes in patients undergoing surgery for cervical spondylotic radiculopathy. This retrospective cohort study included data from patients enrolled in the Canadian Spine Outcomes and Research Network who underwent anterior cervical discectomy and fusion for radiculopathy. Preoperative psychological health was measured with the Patient Health Questionnaire-8 (PHQ-8), and depression and severe psychological symptomology were measured with the Mental Component Score of the Short Form Survey-12 (MCS). Surgical outcomes comprised trajectory subgroups for neck pain and arm pain (numeric rating scales) and disability (neck disability index) measured preoperatively and 3, 12, and 24 months after surgery. For each outcome, patients were dichotomized as following either a poor or a fair-to-excellent trajectory. Average treatment effects were estimated with doubly robust propensity score models using inverse probability of treatment weights accounting for multiple confounders. We included data from 352 patients (43.8% female). Approximately half (52.1%) of patients were identified as depressed based on the PHQ-8, while 61.8% and 33.1% were classified as experiencing depression or severe psychological symptomology, respectively, on the MCS. In fully adjusted models, patients with PHQ-8-measured depression were at increased risk of poor postoperative outcomes for disability (risk ratio[95% CI] = 6.73[1.85 to 24.45]) and neck pain (RR[95% CI] = 1.90[1.09 to 3.32]). Patients with MCS-measured depression were at elevated risk of a poor disability outcome (RR[95% CI] = 2.77[1.30 to 5.90]). Patients reporting severe psychological symptomatology had an increased likelihood of poor disability, neck pain, and arm pain outcomes (RR[95% CI] = 1.82 [1.17 to 2.82] to 2.84[1.58 to 5.09]). These findings highlight the high prevalence of negative psychological features and their impacts on neck surgery outcomes. Future research should prioritize the development and evaluation of preoperative interventions to optimize psychological well-being and improve surgical outcomes in this population.
Reza Zandi, Shahin Talebi, Fargol Farahmandi
et al.
Background: Proximal humerus fracture (PHF) in pediatrics is managed with different options: nonoperative or operative. However, proximal humerus open fractures are sparse in the literature.
Case Report: We present a 9-year-old boy who presented to our institution with proximal humerus open fracture (type IIIA of Gustilo classification). After irrigation and debridement, reduction was satisfactory. We preferred to immobilize the fracture using sling- and-swathe and U-slab splint.
Conclusion: Satisfactory union, angulation, and range of motion (ROM) were achieved.
Patrick Waldron, D.O., Alvarho Guzman, M.D., Lucas Voyvodic, M.D.
et al.
Posterolateral rotatory instability of the elbow results from injury to the lateral collateral ligament complex, most often involving the lateral ulnar collateral ligament (LUCL). In the subacute or chronic setting, LUCL reconstruction is the technique of choice, although traditional graft-based techniques can be limited by morbidity and delayed recovery. Internal bracing offers improved early stability and graft protection. This Technical Note describes a reproducible technique for LUCL and radial collateral ligament reconstruction using semitendinosus allograft with suture tape augmentation. The graft is anatomically positioned to reconstruct both the LUCL and radial collateral ligament origins, restoring lateral collateral ligament complex integrity. This method is designed for subacute or chronic posterolateral rotatory instability and aims to minimize graft elongation and support early mobilization.
Background:
Anterior cruciate ligament reconstruction (ACLR) involves surgically restoring the injured ACL through the placement of graft material. The selection of graft material plays a crucial role in ensuring optimal knee stability postsurgery. Using autografts of the hamstring, bone-patellar tendon-bone (BPTP), quadriceps, and peroneus longus tendon (PLT), the current systematic study aimed to assess the clinical and functional results of patients undergoing ACLR.
Methods:
Literature search exploration was conducted using databases such as PubMed, Medline, Web of Science, and Cochrane Library, supplemented by additional resources such as Google Scholar and clinical trials.gov, spanning from 2014 to 2024. The two-part tool was employed to analyze five distinct domains. For evaluation of the quality of diagnostic accuracy studies, a quality assessment tool was implemented.
Results:
Seventeen studies were incorporated. Most studies indicated considerable enhancements in clinical function, postsurgical knee stability, and osteoarthritis alterations. Nonetheless, these autografts present a reduced risk of certain complications including anterior knee pain, discomfort during kneeling, and extension loss. The assessment of risks in the study revealed that 50% were categorized as having a low risk, whereas 32% had an unclear risk and 18% of cases were classified as not applicable.
Conclusion:
The present systematic review highlights the survival rates and joint stability across various graft options including BPTP, hamstring, quadricep, and especially PLT. These autografts are safe, reliable, and versatile choices deserving of attention in forthcoming ACL reconstruction investigations.
Liza I Ibrahim, Abeer M. ElDeeb, Hamed M. Elkozamy
et al.
Abstract Background Idiopathic scoliosis is a common musculoskeletal disorder that affects spinal and pelvic alignment and exacerbates menstrual discomfort in young females. Studies have reported the importance of involving myofascial components in treating scoliotic patients; however, few studies have been conducted. Therefore, this study aimed to investigate the effect of adding myofascial release (MFR) to corrective stabilizing exercise on spinal curvature, premenstrual symptoms, and health-related quality of life (HRQOL) in young females with idiopathic scoliosis. Methods Fifty-two females with idiopathic scoliosis, aged 18–25 years, and with a body mass index (BMI) of 18.5–24.9 kg/m2 were randomly assigned to two groups equal in number. The control group received corrective stabilizing exercises two sessions/week for 8 weeks. The MFR group received the same exercises and MFR therapy two sessions/week for 8 weeks. The scoliometer was used to evaluate thoracic and lumbar angles, Italian Spine Youth Quality of Life (ISYQOL) to assess HRQOL, and menstrual symptoms questionnaire (MSQ) to evaluate premenstrual symptoms before and after the treatment. Results There was a significant decrease (p < 0.05) in the thoracic and lumbar angles, menstrual backache, and PMS score and a significant increase (p < 0.05) in the HRQOL score in the control and MFR groups. However, there were no significant differences (p > 0.05) between both groups after treatment. Conclusion Corrective stabilizing exercises with or without MFR effectively improve thoracic and lumbar angles, HRQOL, menstrual backache, and premenstrual symptoms. The addition of MFR to stabilizing exercises produced changes that are clinically important for females with idiopathic scoliosis.
Wolf Petersen, Sebastian Bierke, Amelie Stöhr
et al.
Abstract Purpose Aim of this systematic review was to analyze the outcome after transphyseal ACL reconstruction in children and adolescents regarding the femoral drilling technique. Methods A systematic literature search was carried out in various databases on studies on transphyseal ACL reconstruction in children and adolescents. The literature search was limited to the last 20 years. Primary outcome criterion was the failure rate. Secondary outcome criteria were growth disturbances such as leg length discrepancies or deformities and clinical scores. The present study was registered prospectively (www.crd.york.ac.uk/PROSPERO; CRD42022345964). Results A total of 22 retrospective or prospective case series (level 4 evidence) were identified that reported on transphyseal ACL reconstruction in children and adolescents. The overall failure/rupture rate after transphyseal ACL reconstruction was 11.0%. The overall ACL rupture rate of the contralateral side was 9.7%. No statistical significant difference in the failure rates between independent and transtibial drilling techniques could be detected ((p = 0.76/p = 0.28)). Furthermore no statistical significant differences in the rate of reported growth disturbances between independent and transtibial drilling techniques were shown (p = 0.15). The reported clinical scores at follow‐up (mean follow‐up 5.05 years) revealed good to very good results. Conclusion This systematic review demonstrates that children and adolescents have a relatively high failure rate after transpyseal ACL reconstruction without any statistically significant differences between independent or transtibial drilling techniques regarding reruptur rates or the rate of growth disturbances. The results of this systematic review warrant a comparison of both techniques for femoral tunnel drilling in a controlled randomized trial.
Khaled Dibs, Joshua D. Palmer, Rahul N. Prasad
et al.
BackgroundWith advances in systemic therapy translating to improved survival in metastatic malignancies, spine metastases have become an increasingly common source of morbidity. Achieving durable local control (LC) for patients with circumferential epidural disease can be particularly challenging. Circumferential stereotactic body radiotherapy (SBRT) may offer improved LC for circumferential vertebral and/or epidural metastatic spinal disease, but prospective (and retrospective) data are extremely limited. We sought to evaluate the feasibility, toxicity, and cancer control outcomes with this novel approach to circumferential spinal disease.MethodsWe retrospectively identified all circumferential SBRT courses delivered between 2013 and 2019 at a tertiary care institution for post-operative or intact spine metastases. Radiotherapy was delivered to 14–27.5 Gy in one to five fractions. Feasibility was assessed by determining the proportion of plans for which ≥95% planning target volume (PTV) was coverable by ≥95% prescription dose. The primary endpoint was 1-year LC. Factors associated with increased likelihood of local failure (LF) were explored. Acute and chronic toxicity were assessed. Detailed dosimetric data were collected.ResultsFifty-eight patients receiving 64 circumferential SBRT courses were identified (median age 61, KPS ≥70, 57% men). With a median follow-up of 15 months, the 12-month local control was 85% (eight events). Five and three recurrences were in the epidural space and bone, respectively. On multivariate analysis, increased PTV and uncontrolled systemic disease were significantly associated with an increased likelihood of LF; ≥95% PTV was covered by ≥95% prescription dose in 94% of the cases. The rate of new or progressive vertebral compression fracture was 8%. There were no myelitis events or any grade 3+ acute or late toxicities.ConclusionsFor patients with circumferential disease, circumferential spine SBRT is feasible and may offer excellent LC without significant toxicity. A prospective evaluation of this approach is warranted.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Gregory R. Roytman, Alim F. Ramji, Brian Beitler
et al.
Abstract Background The goal of stabilization of the femoral neck is to limit morbidity and mortality from fracture. Of three potential methods of fixation, (three percutaneous screws, the Synthes Femoral Neck System, and a dynamic hip screw), each requires guide wire positioning of the implant(s) in the femoral neck and head. Consistent and accurate positioning of these systems is paramount to reduce surgical times, stabilize fractures effectively, and reduce complications. To help expedite surgery and achieve ideal implant positioning in the geriatric population, we have developed and validated a surgical planning methodology using 3D modelling and printing technology. Methods Using image processing software, 3D surgical models were generated placing guide wires in a virtual model of an osteoporotic proximal femur sawbone. Three unique drill guides were created to achieve the optimal position for implant placement for each of the three different implant systems, and the guides were 3D printed. Subsequently, a trauma fellowship trained orthopedic surgeon used the 3D printed guides to position 2.8 mm diameter drill bit tipped guide wires into five osteoporotic sawbones for each of the three systems (fifteen sawbones total). Computed Tomography (CT) scans were then taken of each of the sawbones with the implants in place. 3D model renderings of the CT scans were created using image processing techniques and the displacement and angular deviations at guide wire entry to the optimal sawbone model were measured. Results Across all three percutaneous screw guide wires, the average displacement was 3.19 ± 0.12 mm and the average angular deviation was 4.10 ± 0.17o. The Femoral Neck System guide wires had an average displacement of 1.59 ± 0.18 mm and average angular deviation of 2.81 ± 0.64o. The Dynamic Hip Screw had an average displacement of 1.03 ± 0.19 mm and average angular deviation of 2.59 ± 0.39o. Conclusion The use of custom 3D printed drill guides to assist with the positioning of guide wires proved to be accurate for each of the three types of surgical strategies. Guides which are used to place more than 1 guide wire may have lower positional accuracy, as the guide may shift during multiple wire insertions. We believe that personalized point of care drill guides provide an accurate intraoperative method for positioning implants into the femoral neck.
Medical physics. Medical radiology. Nuclear medicine
Sanne Lotte Journée, Sanne Lotte Journée, Henricus Louis Journée
et al.
Reason for Performing StudySo far, only transcranial motor evoked potentials (MEP) of the extensor carpi radialis and tibialis cranialis have been documented for diagnostic evaluation in horses. These allow for differentiating whether lesions are located in either the thoraco-lumbar region or in the cervical myelum and/or brain. Transcranial trapezius MEPs further enable to distinguish between spinal and supraspinal located lesions. No normative data are available. It is unclear whether transcranial electrical stimulation (TES) and transcranial magnetic stimulation (TMS) are interchangeable modalities.ObjectivesTo provide normative data for trapezius MEP parameters in horses for TES and TMS and to discern direct and indirect conduction routes by neurophysiological models that use anatomical geometric characteristics to relate latency times with peripheral (PCV) and central conduction velocities (CCV).MethodsTranscranial electrical stimulation-induced trapezius MEPs were obtained from twelve horses. TES and TMS-MEPs (subgroup 5 horses) were compared intra-individually. Trapezius MEPs were measured bilaterally twice at 5 intensity steps. Motoneurons were localized using nerve conduction models of the cervical and spinal accessory nerves (SAN). Predicted CCVs were verified by multifidus MEP data from two horses referred for neurophysiological assessment.ResultsMean MEP latencies revealed for TES: 13.5 (11.1–16.0)ms and TMS: 19.7 (12–29.5)ms, comprising ∼100% direct routes and for TMS mixed direct/indirect routes of L:23/50; R:14/50. Left/right latency decreases over 10 > 50 V for TES were: –1.4/–1.8 ms and over 10 > 50% for TMS: –1.7/–3.5 ms. Direct route TMS-TES latency differences were 1.88–4.30 ms. 95% MEP amplitudes ranges for TES were: L:0.26–22 mV; R:0.5–15 mV and TMS: L:0.9 – 9.1 mV; R:1.1–7.9 mV.ConclusionThis is the first study to report normative data characterizing TES and TMS induced- trapezius MEPs in horses. The complex trapezius innervation leaves TES as the only reliable stimulation modality. Differences in latency times along the SAN route permit for estimation of the location of active motoneurons, which is of importance for clinical diagnostic purpose. SAN route lengths and latency times are governed by anatomical locations of motoneurons across C2-C5 segments. TES intensity-dependent reductions of trapezius MEP latencies are similar to limb muscles while MEP amplitudes between sides and between TES and TMS are not different. CCVs may reach 180 m/s.
Case: This is a case report of a 23-year-old male who sustained right femur fracture. He presented to us with nonunion shaft of femur with intramedullary locking nail broken at second last locking hole. The patient has been operated wherein the broken nail has been removed with the help of a stainless-steel (SS) wire. Conclusion: Removal of broken intramedullary nail is often a challenging task. Many techniques have been described. We herein described a step-by-step approach of how to remove the retained fragment without opening the fracture site with the help of a SS wire, indigenously available.
Yulia Bugaevsky MD, Yochai Levy MD, Avital Hershkovitz MD, MHA
et al.
Introduction: Hip fractures are a significant health risk in older adults and a major cause of morbidity, functional decline and mortality. Our aim was to compare clinical outcomes of older patients hospitalized in an ortho-geriatric (OG) unit to those hospitalized in an orthopedic department (OD) for surgical treatment of a hip fracture. Methods: A retrospective cohort study of hip fractured patients hospitalized between 2015-2016 in a single tertiary university-affiliated medical center. Included were patients aged 65 and older who had undergone hip fracture surgery and were admitted to either a geriatric or orthopedic ward. Results: 441 patients met the inclusion criteria (195 in the OG unit, 246 in the OD); 257 were transferred to an affiliated geriatric center hospital (107 from the OG unit and 127 from the OD) for rehabilitation. Patients in the OG unit were older, more cognitively and functionally impaired and with more comorbidities. The 1-year mortality rate was significantly lower in the OD group (OR 0.32, CI 95% 0.19-0.53, p < 0.001), however, after propensity matching, the 30-day and 1 year mortality rates were similar in both groups. No difference was found in the rehabilitation length of stay between the groups. The functional independence measure improvement was similar in both groups, with a non-significant trend toward better functional improvement among OG unit patients. Conclusions: Despite the higher complexity of patients, worse baseline functional capacity in the OG unit, improvement after rehabilitation was similar in both groups. These results demonstrate the advantages of the OG unit in treating and stabilizing frail older adults, thus maximizing their chances for a successful recovery after hip fractures. Level of Evidence: Level IV
Hasan Havitcioglu, Mehmet Tiner, Sami Aksoy
et al.
Abstract
Many different external fixator desings have been developed. But most of the unilateral external fixator devices have unadequated for correction of the bone fragment positions and stabilization. We designed a new three dimensional unilateral fixator which easily allows antero-posterior, medio-lateral and rotation-motion This would give us a good reposition and lixation. We can correct the position of the bone with three dimension. This lecture contains detailed description of the techniques and their results it contains detailed data on the theory, design and application of the new three dimensional unilateral external fixator.
Özet
Son yıllarda birçok değişik eksternal fiksatör tasarlanıp geliştirilmiştir. Fakat unilateral eksternal fiksatör cihazlarından çoğu kırık fragmanlarına pozisyon vermede, stabilizasyonda ve redüksiyonlarında yetersiz kalmıştır. Bizim geliştirdiğimiz üç boyutlu eksternal fiksatörümüzle kırık fragmanlarına antero-posterior, medio-lateral ve rotasyonal yönde istenen düzeltmeler ve pozisyonlar kolayca sağlanabilmektedir. Bu bizlere iyi bir repozisyon ve fiksasyon üstünlüğü sağlamaktadır. Yayınımızla yeni eksternal fiksatörümüzün teorik ve teknik üstünlükleri ile biomekanik özellikleri anlatılmaktadır.
Masoud Tarbiat, Sayed Ahmad Reza Salimbahrami, Ali Goudarzi
et al.
Phenylketonuria is a rare disorder that increases the levels of phenylalanine in the blood. As there are scant articles about anesthesia management in phenylketonuria patients, this encouraged us to report a short-time anesthesia management of a child with phenylketonuria for bone fracture. The anesthesia was induced with intravenous ketamine and midazolam. During procedure, he received 100% oxygen via a face mask throughout spontaneous breathing. The operation was uneventful, and he was completely awakened in the recovery room. This report emphasizes that in some situations, the combination of midazolam with ketamine could be used safely for short time anesthesia in phenylketonuria patients.
W. Y. Liu, M. C. van derSteen, R. J. A. vanWensen
et al.
Abstract Purpose Despite good survival rates of revised knee prostheses, little is known about recovery trajectories within the first 12 months after surgery. This retrospective observational study explored recovery trajectories in terms of pain, function and quality of life in patients after revision knee arthroplasty over 12 months. Methods Eighty‐eight revision knee arthroplasty patients rated changes in daily physical functioning using the anchor question (0: very much worsened; 7: very much improved). Patient reported outcome measures (PROMs) of pain (range 0–10), function (Oxford Knee Score) and quality of life (EQ‐5D‐3L) were assessed preoperatively, at 3 and 12 months postoperatively. Four recovery trajectories were identified using the anchor question at 3 and 12 months postoperatively: no improvement, late improvement, early improvement, and prolonged improvement. Repeated measures ANOVA was conducted with recovery trajectories as dependent variable and PROM assessments as independent variables. Results Sixty percent reported improvement in daily physical functioning at 12 months postoperatively. Age and reason for revision differed between groups. Pain, function and EQ‐5D‐3L differed between groups over time. Late and prolonged improvement groups improved on all PROMs at 12 months. The early improvement group did not report improvement in daily physical functioning at 12 months, while improvements in function and pain during activity were observed. Conclusions Different recovery trajectories seem to exist and mostly match PROMs scores over time. Not all patients may experience beneficial outcome of revision knee arthroplasty. These findings are of importance to provide appropriate information on possible recovery trajectories after revision knee arthroplasty to patients. Level of evidence III
Abstract
Objectives: We evaluated the mid-term results of patients who underwent arthroscopic surgery for chronic ankle pain due to anterolateral impingement.\nMethods: The study included twenty-eight patients (12 males, 16 females, mean age 32.5 years; range 14 to 49 years). The mean duration between the first injury and operation was 10 months (range 6 to 19 months). Anterolateral impingement was localized on the right side in 16 patients. Eleven patients were recreational athletes, but at the time of the first examination they all had given up exercising. All patients but two had at least one episode of ankle sprain. Although roentgenograms failed to demonstrate any pathology, magnetic resonance imaging (MRI) confirmed anterolateral impingement in 11 patients. Qualitative and quantitative assessments of the results were made using the Martin’s classification and the American Orthopaedic Foot and Ankle Society (AOFAS) scoring table, respectively. The mean follow-up was 32.5 months (range 10 to 57 months). \nResults: According to the Martin’s classification, we obtained excellent, good, and fair results in seventeen, eight, and three patients, respectively. The mean AOFAS scores increased from 74.6 to 90.6 postoperatively. Two patients developed temporary superficial peroneal nerve lesions.\nConclusion: Anterolateral impingement of the ankle should be considered in the differential diagnosis of chronic ankle pain without demonstrable radiologic abnormalities. We believe that diagnosis and treatment of chronic ankle pain due to anterolateral impingement can be successfully made by ankle arthroscopy.
Özet
Amaç: Kronik ayak bileği ağnsı şikayeti ile başvuran ve anterolateral sıkışma tanışı ile artroskopik debridman uygulanan hastalarda orta dönem sonuçlar değerlendirildi.\nÇalışma planı: Çalişmaya 12 erkek, 16 kadın 28 hasta dahil edildi (ortalama yaş 32.5; dağılım 14-49). Travma ile ameliyat arasındaki ortalama süre 10 ay (dağılım 6-19 ay) idi. On altı hastada sağ, 12 sinde sol taraf tutulmuştu. On bir hasta travma öncesi sportif aktivite ile uğraşmakta, ancak başvuru anında spora ara vermiş bulunmaktaydı. Yirmi altı olguda en az bir kez ayak bileği burkulması anamnezi saptandı. Hiçbir olguda konvansiyonel radyolojik inceleme ile patolojik bulgu saptanmamakla birlikte, manyetik rezonans görüntüleme (MRG) tetkiki yapılan 11 hastada anterolateral sıkışma doğrulandı. Sonuçlar Martin in fonksiyonel ve sübjektif kriterlerine göre kalitatif olarak, Amerikan Ortopedik Ayak ve Ayak Bileği Cemiyeti nin (AOFAS) skorlama şemasi ile de kantitatif olarak değerlendirildi. Ortalama takip süresi 32.5 ay (dağılım 10-57 ay) idi.\nSonuçlar: Martin sınıflamasına göre 17 hastada mükemmel, sekiz hastada iyi ve üç hastada orta sonuç elde edildi. AOFAS skorlarının ameliyat öncesi ortalama 74.6 dan\nameliyat sonrasi 90.6 ya yükseldiği görüldü, ki olguda geçici olarak yüzeyel peroneal sinir lezyonu görüldü.\nÇıkarımlar: Radyolojik olarak bulgu vermeyen, MRG ile tanı konamayan kronik ayak bileği ağnsı şikayeti olan olgularda ayırıcı tanı olarak anterolateral yumuşak doku sıkışmasının da düşünülmesi gerektiği, artroskopik olarak tanışı doğrulanan olgularda tedavinin artroskopik teknikle güvenilir ve başarılı bir şekilde yapılabileceği sonucuna varıldı.
Timothy M. Clough, Nikhil Shah, Hiren Divecha
et al.
Aims: The exact risk to patients undergoing surgery who develop COVID-19 is not yet fully known. This study aims to provide the current data to allow adequate consent regarding the risks of post-surgery COVID-19 infection and subsequent COVID-19-related mortality. Methods: All orthopaedic trauma cases at the Wrightington Wigan and Leigh NHS Foundation Trust from ‘lockdown’ (23 March 2020) to date (15 June 2020) were collated and split into three groups. Adult ambulatory trauma surgeries (upper limb trauma, ankle fracture, tibial plateau fracture) and regional-specific referrals (periprosthetic hip fracture) were performed at a stand-alone elective site that accepted COVID-19-negative patients. Neck of femur fractures (NOFF) and all remaining non-NOFF (paediatric trauma, long bone injury) surgeries were performed at an acute site hospital (mixed green/blue site). Patients were swabbed for COVID-19 before surgery on both sites. Age, sex, nature of surgery, American Society of Anaesthesiologists (ASA) grade, associated comorbidity, length of stay, development of post-surgical COVID-19 infection, and post-surgical COVID-19-related deaths were collected. Results: At the elective site, 225 patients underwent orthopaedic trauma surgery; two became COVID-19-positive (0.9%) in the immediate perioperative period, neither of which was fatal. At the acute site, 93 patients underwent non-NOFF trauma surgery, of whom six became COVID-19-positive (6.5%) and three died. A further 84 patients underwent NOFF surgery, seven becoming COVID-19 positive (8.3%) and five died. Conclusion: At the elective site, the rate of COVID-19 infection following orthopaedic trauma surgery was low, at 0.9%. At the acute mixed site (typical district general hospital), for non-NOFF surgery there was a 6.5% incidence of post-surgical COVID-19 infection (seven-fold higher risk) with 50% COVID-19 mortality; for NOFF surgery, there was an 8.3% incidence of post-surgical COVID-19 infection, with 71% COVID-19 mortality. This is likely to have significance when planning a resumption of elective orthopaedic surgery and for consent to the patient.
Kalliopi Iliou, George Paraskevas, Panagiotis Kanavaros
et al.
Abstract
Objective: The aim of this study was to evaluate the correlation between the Manchester scale and foot pressure distribution in patients with hallux valgus deformity.
Methods: The study included 152 feet of 87 patients with hallux valgus and a control group of 391 feet of 241 individuals without hallux valgus deformity. The severity of hallux valgus was determined using the Manchester scale grading system. Plantar loading patterns in 10 foot areas were determined for all participants.
Results: According to the Manchester scale, 72% of the participants had no, 12.9% mild, 10.7% moderate and 4.4% severe deformity. The Manchester scale grade was highly correlated with both hallux valgus angle and first intermetatarsal angle (p=0.00). Significant differences between the four grades were present for mean pressure under the hallux and the first and second metatarsal heads only (p=0.00). The load distribution under these areas was higher as the hallux valgus progressed from mild to more severe. In all groups, the highest pressure was observed under the second metatarsal head.
Conclusion: The Manchester scale was strongly associated with both the hallux valgus angle and the first intermetatarsal angle. The progression from mild to moderate and severe deformation is associated with peak pressure raise at the hallux, first and second metatarsal heads. The Manchester scale appears to be a useful tool to provide information for the degree of deformity and the pressure under painful foot areas.
Özet
.