Mahesh B Shinde, Mihir R Patel, Kshitij Sarwey
et al.
Introduction The anterior cruciate ligament (ACL) is the main ligament that stabilizes the knee and stops
anterior translation. It is also essential to the screw-home mechanism and helps resist valgus and rotational
stress. For ACL reconstruction, autograft arthroscopic single-bundle surgery is regarded as the "gold standard"
procedure. Joint laxity is enhanced and cartilage degradation is avoided with anatomical ACL restoration.
Negative results are frequently caused by technical surgical errors, such as improper tunnel placement.
This study aims to evaluate the functional outcome in ACL-reconstructed patients when a graft is placed
in an anatomical position, as well as to compare it with when a graft is placed in a non-anatomical place.
Methodology This is a 24-month prospective observational study conducted on 44 patients who underwent
arthroscopic ACL reconstruction, with post-op CT scans performed after permission from the institutional
review board (IRB). The most common mode of injury was sports-related. Thirty patients belonged
to the anatomical group, and 14 patients belonged to the non-anatomical group based on inclusion
and exclusion criteria. The Lysholm scoring system was used for functional evaluation on follow-up at three,
six, and 12 months.
Results The mean Lysholm score was 41.24 before surgery for the entire sample. In the anatomical
group, the score improved to 80.91 at three months, 85.91 at six months, and 89.23 at twelve months.
In the non‑anatomical group, the score was 58.58 at three months, 65.13 at six months, and 58.58 at twelve
months. The improvement in Lysholm scores in the anatomical group was statistically significant.
Conclusion This study concludes that the functional outcome of ACL reconstruction is better when the graft
is placed in anatomical footprints than when it is placed in non-anatomical footprints.
José Carlos Baldocchi Pontin, Ana Paula Cortes Damasceno, Helder Joel Moreira de Souza
et al.
Abstract Objective: To outline the epidemiological profile of tibial fractures treated in a tertiary hospital and explore associations between the characteristics of the fractures and the clinical outcome of postoperative complications. Methods: Retrospective cross-sectional study involving adult patients diagnosed with tibial fractures who underwent surgical and/or conservative treatment in a tertiary hospital between January 2019 and December 2021. The variables sex, age, mechanism of injury, type and classification of fracture, associated injuries, personal history, length of hospital stay, surgical treatment, post-surgical complications (infections, loss of synthesis material, surgical wound dehiscence) and death. Results: The sample consisted of 100 individuals, with an average age of 35.8 years, 86% of whom were male, with a higher prevalence of motorcycle accidents. The most common treatment was intramedullary stem, and type C fractures, which are more complex, were more associated with complications. Conclusion: Given the predominance of motorcycle accidents involving young people, there is a need for intervention in accident prevention policies, aiming to reduce the incidence, as well as the morbidity and mortality, of these individuals and, consequently, to reduce costs to the health system. Level of evidence III, Retrospective Study.
Jan-Erik Gjertsen, Daniel Nilsen, Ove Furnes
et al.
Background and purpose: Uncemented stems increase the risk of revision in elderly patients. In 2018, we initiated a national quality improvement project aiming to increase the proportion of cemented stems in elderly female total hip arthroplasty (THA) and hip fracture hemiarthroplasty (HA) patients. We aimed to evaluate the association of this project on the frequency of cemented stems and the risk of secondary procedures in the targeted population.
Methods: 10,815 THAs in female patients ≥ 75 years in the Norwegian Arthroplasty Register and 19,017 HAs in hip fracture patients ≥ 70 years in the Norwegian Hip Fracture Register performed in 2015–2017 and 2019–2021 at all Norwegian hospitals were included in this retrospective cohort study. The quality improvement project was implemented at 19 hospitals (8,443 patients). 1-year revision risk (THAs) and reoperation risk (HAs) were calculated for uncemented and cemented stems by Kaplan–Meier and Cox adjusted hazard rate ratios (aHRRs) with all-cause revision/reoperation as main endpoint.
Results: The use of cemented stem fixation in the targeted population increased from 26% to 80% for THAs and from 27% to 91% for HAs. For THAs, the 1-year revision rate decreased from 3.7% in 2015–2017 to 2.1% in 2019–2021 (aHRR 0.7, 95% confidence interval [CI] 0.5–0.9) at the intervention hospitals. For HAs, the reoperation rate decreased from 5.9% in 2015–2017 to 3.3% in 2019–2021 (aHRR 0.6, CI 0.4–0.8) at the intervention hospitals.
Conclusion: The quality improvement project resulted in a significant increase in the proportion of cemented stems and reduced risk of secondary procedures for both THAs and HAs.
Belal Fouad Elsafty, Abdalla Abusenna, Waleed Eltohamy
et al.
Background: Fractures of the greater tuberosity of humerus account for one fifth of all fractures affecting the proximal ⅓ of humerus. Although a displacement of 3-5 mm in fractured greater tuberosity indicates surgical intervention, less displaced tuberosities can be managed nonoperatively in young athletes as well as more displacement in older groups. Surgical modalities include open reduction and internal fixation (ORIF) using plate and screws, fragment excision, and percutaneous fixation.Aim of the Work: This study aims to compare between the operative and conservative treatment of un-displaced isolated greater tuberosity fracture of the humerusPatients and Methods: We performed a prospective interventional study involved 20 patients with isolated greater tuberosity fractures. Divided equally into 10 patients in each group (conservative group and operative group). Radiographic healing was evaluated in the follow-up images. For the objective evaluation, the DASH score was used.Results: The mean age in conservative group was 37.7 years and in operative was 36.9 years. Male patients represented 60% and 70% within conservative and operative groups respectively. Four patient (40%) had anterior shoulder dislocation within operative group. The two groups were not different statistically regarding range of motion. The median DASH score of operative group 13.49, while it was 20.83 within the conservative group.Conclusion: Un-displaced greater tuberosity fractures can be treated without surgery with good outcome; however, there are indications for surgical interventional with benefit of provides early return to life activity as it enhances early union.
Chloe E.H. Scott, MD, FRCS, Aava Param, MBChB, Matthew Moran, FRCS
et al.
Tibial plateau fractures (TPFs) in older adults are increasing in incidence and now account for 8% of all fractures in patients over 60 years of age. Although primary fixation remains standard, the risk of fixation failure, loss of reduction, and the development of posttraumatic osteoarthritis are all markedly increased in this age group with higher rates of conversion to total knee arthroplasty (TKA) of 12%. When joint depression is severe with significant subchondral bone loss, up to half ultimately require TKA. TPFs with unicondylar depression can be managed primarily using tibial cones in acute TKA. In this study, we report the surgical technique for performing acute TKA using tibial cones for the primary management of TPFs in older adults and illustrate this technique with case examples.
Nick. D. Clement, Ewen Fraser, Alisdair Gilmour
et al.
Aims: To perform an incremental cost-utility analysis and assess the impact of differential costs and case volume on the cost-effectiveness of robotic arm-assisted unicompartmental knee arthroplasty (rUKA) compared to manual (mUKA). Methods: This was a five-year follow-up study of patients who were randomized to rUKA (n = 64) or mUKA (n = 65). Patients completed the EuroQol five-dimension questionnaire (EQ-5D) preoperatively, and at three months and one, two, and five years postoperatively, which was used to calculate quality-adjusted life years (QALYs) gained. Costs for the primary and additional surgery and healthcare costs were calculated. Results: rUKA was associated with a relative 0.012 QALY gain at five years, which was associated with an incremental cost per QALY of £13,078 for a unit undertaking 400 cases per year. A cost per QALY of less than £20,000 was achieved when ≥ 300 cases were performed per year. However, on removal of the cost for a revision for presumed infection (mUKA group, n = 1) the cost per QALY was greater than £38,000, which was in part due to the increased intraoperative consumable costs associated with rUKA (£626 per patient). When the absolute cost difference (operative and revision costs) was less than £240, a cost per QALY of less than £20,000 was achieved. On removing the cost of the revision for infection, rUKA was cost-neutral when more than 900 cases per year were undertaken and when the consumable costs were zero. Conclusion: rUKA was a cost-effective intervention with an incremental cost per QALY of £13,078 at five years, however when removing the revision for presumed infection, which was arguably a random event, this was no longer the case. The absolute cost difference had to be less than £240 to be cost-effective, which could be achieved by reducing the perioperative costs of rUKA or if there were increased revision costs associated with mUKA with longer follow-up. Cite this article: Bone Jt Open 2023;4(11):889–899.
Introduction. It is generally accepted that age influences neuropsychological and neurophysiological findings due to a decrease in memory and attention in older age groups as a result of diseases and damage to the central nervous system of various origins. This should be taken into account when dealing with patients who underwent mild blast traumatic brain injury (mbTBI), and focus on standard characteristics considering the age factor.
Purpose: to investigate the influence of the age factor on the characteristics of cognitive evoked potentials in patients with post-concussion syndrome (PCS) in the long-term period of mbTBI.
Materials and methods. The study involved 41 patients with PCS aged 18-45 years (study group) and 30 healthy subjects (control group). The patients were in the late period of trauma (from 6 months to 3 years). The age distribution of patients in the study group was the following: 6 patients under 30 years old, 18 patients aged 31-40 years, 17 patients over 40 years old. Neuropsychological testing was performed according to the Montreal Cognitive Assessment Scale. Quantitative electroencephalography was performed according to standard parameters (sensitivity ‒ 70 μV/cm, time constant ‒ 0.1 s, filter ‒ 40 Hz).
The results. Neurophysiological testing using the CEP P300 method allows us to verify the dysfunction of brain activity in the form of attention and memory disorders in patients with PCS as a result of mbTBI in the chronic period of damage. Exceeding the upper limit of the age norm of P2 and P3 latency components of CEP P300 is statistically significantly associated with the presence of cognitive impairment in patients with PCS.
Conclusions. The CEP P300 method can be recommended for the use in the complex diagnostics of cognitive disorders in patients with PCS in the subacute and chronic periods of the injury. In the clinical interpretation of latency characteristics of CEP P300 components, it is reasonable to focus on standard parameters, including age factor.
Orthopedic surgery, Neurology. Diseases of the nervous system
Daniel Quintero, BS, Nikhil Patel, BS, Griffin Harris, BS
et al.
Several studies have previously documented the development of complications stemming from injection with one of the various COVID-19 vaccines. No study, however, has discussed the spontaneous development of a soft tissue mass shortly after a COVID-19 vaccine injection. We report on 66-year-old female with concerns of a growing shoulder mass, 2 weeks after receiving a COVID-19 vaccine booster. Initial work-up with X-ray and MRI was concerning for a soft tissue neoplasm, specifically a soft tissue sarcoma. Subsequent ultrasound guided biopsy demonstrated a benign granulomatous lesion. No further management was required as the lesion spontaneously resolved during a 3-month follow-up period.
Medical physics. Medical radiology. Nuclear medicine
In Japan, the first endoscopic surgery, a laparoscopic cholecystectomy, was performed in 1990. Since then, operative procedures have been standardized, and the safety and efficacy of endoscopic surgery have been evaluated. In accordance with the social acceptance of endoscopic surgery as a less invasive type of surgery, the number of endoscopic procedures performed has increased in all surgical domains. The Japan Society for Endoscopic Surgery (JSES) has played an important role in the development of endoscopic surgery in Japan. Notably, a technical skills certification system for surgeons was established by the JSES to train instructors on how to teach safe endoscopic surgery. Furthermore, the JSES has conducted a national survey every two years to evaluate the status of endoscopic surgery over time. In 2017, 248 743 patients underwent endoscopic surgery in all surgical domains, such as abdominal, thoracic, mammary and thyroid gland, cardiovascular, obstetrics and gynecology, urologic, orthopedic, and plastic surgery. The 14th National Survey of Endoscopic Surgery conducted by the JSES demonstrated the status of laparoscopic surgery in Japan in 2016‐2017.
Abstract
Hashemi-Motlagh K (see Mardani-Kivi M et al.) 2013;47(5):307-310 Havitçio¤lu H, Çeçen B, Pasinli A, Yüksel M, Aydın ‹, Yıldız H. In vivo investigation of calcium phosphate coatings on Ti6-Al-4V alloy substrates using lactic acid - sodium lactate buffered synthetic body fluid. 2013;47(6):417-422 (Experimental Study)
Özet
osteoblastoma after intralesional curettage and cement packing: a case report. 2013;47(3):218-222 (Case Study) Günerbüyük C (see Kaya ‹ et al.) 2013;47(5):376-378 Güne? T (see Avcı CC et al.) 2013;47(1):1-7 Gürkan Y (see Acar S et al.) 2013;47(1):32-37 Gürses ‹A (see Bilgili F et al.) 2013;47(1):43-47 Güven G (see Çınar BM et al.) 2013;47(4):266-272 Güven M (see Uluçay Ç et al.) 2013;47(5):330-333
Hilgenreiner's height (H) and distan.ce (D) as well as AU line length were measured on the pelvic roentgenograms of 90 children (5-12 months old) of which 50 were normal and 40 rachitic. The relationship between AU line and epiphyses of femoral head:was also investigated. We found a highly significant difference between measurements of normal and rachitic children (p<O.OOI). It was seen that, the relations of AU line with epiphyses of femoral head were important among differential diagnosis criteria.
Torsten Grønbech Nielsen, Lene Lindberg Miller, Bjarne Mygind-Klavsen
et al.
Abstract Purpose To evaluate if High-volume Image-guided Injection (HVIGI)-treatment for chronic Patellar tendinopathy (PT) improve function and reduce pain at 16-months follow-up. Methods Patients with resistant PT who failed to improve after a three-month eccentric loading program were included in the study. Maximal tendon thickness was assessed with ultrasound. All patients were injected with 10 mL of 0.5% Marcaine, 0.5 mL Triamcinolonacetonid (40 mg/mL) and 40 mL of 0.9% NaCl saline solution under real-time ultrasound-guidance and high pressure. All outcome measures were recorded at baseline and at 16 months. A standardised Heavy Slow Resistance rehabilitation protocol was prescribed after HVIGI-treatment. Clinical outcome was assessed with the Victorian Institute of Sports Assessment-Patella tendon questionnaire (VISA-P) and statistically analyses were performed. Results The study included 28 single treatment HVIGI procedures in PT in 23 patients (19 men, 4 women) with a mean age of 30.3 (range 19–52). The mean duration of symptoms before HVIGI was 33 months. The baseline VISA-P score of 43 ± 17 (range 15–76) improved to 76 ± 16 (range 42–95) after 16 months (p < 0.01). Of the 28 HVIGI procedures 12 patients (15 PT) were not satisfied after the initial HVIGI procedure. Of these, 5 patients (5 PT) had additional HVIGI, 2 patients (2 PT) had corticoid injection and 6 patients (8 PT) needed surgery. Of the remaining 11 patients (13 PT), 9 patients had more than a 13-point improvement in the VISA-P score after 16 months. Conclusions In this retrospective case-study, only 9 patients (32%) did benefit of a single HVIGI treatment at 16-months and a 33-point significant improvement was seen on the VISA-P score.
G. Garrigues, Benjamin M. Zmistowski, Alexus M. Cooper
et al.
The Second International Consensus Meeting on Orthopedic Infections was held in Philadelphia, Pennsylvania, in July 2018. A multidisciplinary team of international experts from all 9 subspecialties of orthopedic surgery and allied fields of infectious disease, microbiology, and epidemiology was assembled to form the International Consensus Group. The following consensus proceedings from the International Consensus Meeting involve 30 questions pertaining to the management of periprosthetic shoulder infection.
Jorge Felipe Ramírez-León, Luis Alfredo Moreno-García, Fabio Restrepo-Tello
et al.
La evolución de las técnicas quirúrgicas tradicionales y los modelos de formación de los cirujanos exigen cambios, por esta razón el centro de investigación y entrenamiento en cirugía de mínima invasión (CLEMI) ha desarrollado y aplicado modelos de enseñanza que permiten aprender técnicas quirúrgicas mínimamente invasivas como la artroscopia de hombro. CLEMI propone un modelo basado en simulación impartido en un ambiente controlado, estructurado y progresivo que vaya al ritmo individual de cada uno de los estudiantes. Inicialmente el estudiante encontrará conceptos teóricos de instrumental, equipos y ergonomía, posteriormente en la fase práctica usando un modelo sintético anatómico del hombro y finalmente usando un modelo biológico con el que se realizan ejercicios para desarrollar destrezas exigidas por las técnicas quirúrgicas. El entrenamiento en modelos bajo ambiente controlado disminuye el período de aprendizaje y eleva la competencia del estudiante.
The sellar joint plays a key role in wrist function ensuring thumb contraposition when gripping. Lesions of sellar joint are accompanied by pain syndrome and deformity of the first metacarpal which substantially affects life quality of the patients. The authors carried the analysis of literature dedicated to surgical treatment of degenerative lesions of trapeziometacarpal joint. The present review describes features of joint anatomy and biomechanics, reports the key factors contributing to disease progression, covers various approaches and criteria for selection of surgical options for reconstruction of sellar joint.