Hasil untuk "Orthopedic surgery"

A. Oryan, Soodeh Alidadi, A. Moshiri et al.

This review analyzes the literature of bone grafts and introduces tissue engineering as a strategy in this field of orthopedic surgery. We evaluated articles concerning bone grafts; analyzed characteristics, advantages, and limitations of the grafts; and provided explanations about bone-tissue engineering technologies. Many bone grafting materials are available to enhance bone healing and regeneration, from bone autografts to graft substitutes; they can be used alone or in combination. Autografts are the gold standard for this purpose, since they provide osteogenic cells, osteoinductive growth factors, and an osteoconductive scaffold, all essential for new bone growth. Autografts carry the limitations of morbidity at the harvesting site and limited availability. Allografts and xenografts carry the risk of disease transmission and rejection. Tissue engineering is a new and developing option that had been introduced to reduce limitations of bone grafts and improve the healing processes of the bone fractures and defects. The combined use of scaffolds, healing promoting factors, together with gene therapy, and, more recently, three-dimensional printing of tissue-engineered constructs may open new insights in the near future.

N. Simunovic, P. Devereaux, S. Sprague et al.

Background: Guidelines exist for the surgical treatment of hip fracture, but the effect of early surgery on mortality and other outcomes that are important for patients remains unclear. We conducted a systematic review and meta-analysis to determine the effect of early surgery on the risk of death and common postoperative complications among elderly patients with hip fracture. Methods: We searched electronic databases (including MEDLINE and EMBASE), the archives of meetings of orthopedic associations and the bibliographies of relevant articles and questioned experts to identify prospective studies, published in any language, that evaluated the effects of early surgery in patients undergoing procedures for hip fracture. Two reviewers independently assessed methodologic quality and extracted relevant data. We pooled data by means of the DerSimonian and Laird random-effects model, which is based on the inverse variance method. Results: We identified 1939 citations, of which 16 observational studies met our inclusion criteria. These studies had a total of 13 478 patients for whom mortality data were complete (1764 total deaths). Based on the five studies that reported adjusted risk of death (4208 patients, 721 deaths), irrespective of the cut-off for delay (24, 48 or 72 hours), earlier surgery (i.e., within the cut-off time) was associated with a significant reduction in mortality (relative risk [RR] 0.81, 95% confidence interval [CI] 0.68–0.96, p = 0.01). Unadjusted data indicated that earlier surgery also reduced in-hospital pneumonia (RR 0.59, 95% CI 0.37–0.93, p = 0.02) and pressure sores (RR 0.48, 95% CI 0.34–0.69, p < 0.001). Interpretation: Earlier surgery was associated with a lower risk of death and lower rates of postoperative pneumonia and pressure sores among elderly patients with hip fracture. These results suggest that reducing delays may reduce mortality and complications.

L. Aiken, S. Clarke, D. Sloane et al.

M. Liang, A. Fossel, M. Larson

D. Spahn

L. Glance, A. Dick, D. Mukamel et al.

Weihong Zhu, M.D., Zhenmu Xu, MMed., Qian Liu, M.D. et al.

Recurrent patella dislocation is a common orthopaedic condition in adolescents, with medial patellofemoral ligament injuries found in most cases. Double-bundle anatomic medial patellofemoral ligament reconstruction (MPFLR) has been widely used for managing patellofemoral instability. However, traditional MPFLR uses suture anchors for graft fixation, which requires a 3- to 5-cm medial incision. In addition, potential suture anchor pullout and injury to the extensor mechanism may delay postoperative recovery and increase the risk of recurrent dislocation. In this article, we propose an anchor-free double-bundle anatomic MPFLR technique. This approach uses high-strength sutures for transosseous fixation and achieves medial retinacular tightening under arthroscopy. The preservation of extensor mechanism minimizes postoperative pain and promotes faster rehabilitation.

Andrzej Żyluk, Bernard Piotuch

Introduction. Although there is no clear scientific evidence justifying antibiotic prophylaxis in operative treatment of hand and wrist bone fractures, it is commonly used, mostly due to the concern about possible medicolegal problems caused by bone infection after surgery. Aim. This study’s aim was to review literature on the justification for the use of antibiotic prophylaxis in surgical treatment of hand and wrist fractures. Results. For operative treatment of hand fractures, 3 studies and one systematic review were found. All these articles indicate a lack of scientific evidence to justify the routine administration of antibiotics in these injuries. For operative treatment of distal radial fractures, only 1 study was found suggesting that antibiotic prophylaxis does not affect the risk of infection. Further literature review showed that redundant antibiotic use may be associated with harmful and adverse effects and substantial costs. Conclusion. Current scientific evidence does not support the routine use of antibiotic prophylaxis in the operative treatment of hand and wrist bone fractures. Antibiotic administration in these operations has no effect on decreasing infection rate and, therefore, can be safely avoided.

Nezir Okumuş, Ahmet Nadir Aydemir

<i>Background and Objectives</i>: Our study aimed to retrospectively examine the routine radiographs on the first postoperative day of osteosynthesis applications performed in the supine position with the help of a traction table, in the lateral decubitus position, and in the supine position in patients with intertrochanteric fractures of the femur who had a proximal femoral nail applied. It also aimed to compare them in terms of radiology. This study investigated the effects of three different patient positions on fracture reduction, a topic rarely encountered in the literature. <i>Materials and Methods</i>: Patients who underwent proximal femoral nailing in three different positions—the supine, traction table, and lateral decubitus positions—due to femoral intertrochanteric fractures in two different centers were analyzed. A total of 157 patients with complete early radiographs were included in this study to evaluate the quality of postoperative reduction and fixation. <i>Results</i>: There was a significant difference between the traction table-assisted supine position group (mean: 25.31 mm) and both the lateral decubitus position (mean: 31.91 mm) and supine position (mean: 31.79 mm) groups in terms of the TAD (<i>p</i> = 0.000). Regarding the collodiaphyseal angle, the traction table-assisted supine position (mean: 130.720°) and lateral decubitus position (mean: 130.290°) groups showed significantly higher values than the supine position group (mean: 124.190°) (<i>p</i> = 0.000). The average lengths of the lag and compression screws were lower in the lateral decubitus position group compared with the other groups (<i>p</i> = 0.000). Patients in the supine position group had smaller nail diameters and lengths (<i>p</i> = 0.000). When examining the Cleveland–Bosworth lag screw placements, the most frequent position was center–center, including 22 patients (31%) in the traction table-assisted supine position group, 15 patients (30.6%) in the lateral decubitus position group, and 9 patients (24.3%) in the supine position group, though the difference was not statistically significant (<i>p</i> = 0.203). Among the reduction criteria we investigated, the TAD on the traction table was statistically significantly closer to the targeted measurement, with an average of 25.31 mm, compared with the other two positions (<i>p</i> = 0.000). The collodiaphyseal angle was significantly within the target range in the traction table-assisted supine group, averaging 130.720°, compared with the supine position (<i>p</i> = 0.000). In the traction table group, according to the modified Baumgaertner classification, 59.2% achieved a good reduction; according to the Ikuta classification, subtype N accounted for 69.4%; and according to the Cleveland–Bosworth classification, a center–center placement was present in 31% of patients. <i>Conclusions</i>: All three types of operation can be preferred according to the habits of the surgeon operating and the variables during the operation (the fracture type, history of orthopedic surgery, and the material components of the application phase). Accompanied by these data, we recommend the traction table operation as a priority and the lateral decubitus position operation as a second preference in compliance with the technical requirements.

Lu Yang, Li Xiang, Li Huafeng et al.

Background In many countries, disposable high-value consumables are sterilized and reused for economic reasons. We aimed to study the feasibility and ways to reduce potential risks of reusing these consumables in shoulder arthroscopy. Methods We reported cases with complications potentially related to reusing high-value consumables. We evaluated the outflow water temperature from new and reused radiofrequency (RF) devices of different brands and under varying surgical practices. We also conducted fatigue tests on suture-passing needles from different brands subjected to various disinfection methods. Results Reused RF devices from MECHAN demonstrated significantly higher peak temperature (PT) (68.3 ± 2.3°C vs 63.9 ± 3.0°C, P < 0.001) and peak sustaining temperature (PST) (62.6 ± 2.3°C vs 58.5 ± 3.1°C, P < 0.001) compared to new devices. The mean flow rate of MECHAN devices was higher than that of DePuy (63.2 ± 8.2 ml/min vs 42.0 ± 11.1 ml/min, P < 0.001). Ethylene oxide disinfection did not significantly affect the excitation times before fatigue fracture of Arthrex (291.6 ± 76.9 vs 305.1 ± 86.6, P = 0.717) and DePuy (173.3 ± 26.8 vs 174.6 ± 31.7, P = 0.922) suture-passing needles. High-pressure steam disinfection also did not markedly affect the fatigue time of Arthrex (291.6 ± 76.9 vs 292.0 ± 65.7, P = 0.990) and DePuy (173.3 ± 26.8 vs 168.8 ± 36.1, P = 0.755) suture-passing needles. Conclusions For both RF devices and suture-passing needles, being reused after ethylene oxide disinfection for appropriate times can be feasible and safe if surgeons and disinfection suppliers exercise caution.

Carson McKoon BA MS, Paul Pottanat MD, Joshua Morningstar BS et al.

Submission Type: Ankle Fractures Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Estimated glomerular filtration rate (eGFR) is commonly used as a preoperative evaluation of kidney function in patients undergoing surgery. To date, there is a paucity of literature investigating the effect of eGFr on outcomes following ankle fracture open reduction and internal fixation (ORIF). As such, this study aims to analyze the effect of kidney function, as measured by eGFR, on short-term adverse outcomes following ankle fracture ORIF procedures. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 – 2019 to identify patients undergoing ankle ORIF. After exclusion of patients missing data for age, race, gender, preoperative creatinine, or with eGFR greater than 3 standard deviations from the mean (91.1 mL/min/1.73 m2), 21,815 patients met criteria for the study. Patients were grouped by eGFR into cohorts: ESRD ( < 15 [1.49%]), moderate to severe kidney function loss (15-60 [17.73%]), mild kidney function loss (60-90 [33.76%]), and normal kidney function (>90 [47.01%]). Results: Nearly half of patients were found to have “normal” eGFR criteria of greater than 90mL/min/1.73m2. As eGFR decreased, indicating poorer kidney function, patient age (p <.001), BMI, rate of female sex, and rate of numerous comorbidities statistically significantly increased. Multivariate regression to control for differences in demographics and comorbidities found that as compared to a normal eGFR, patients with ESRD or moderate to severe loss of kidney function had statistically significantly predicted increased risk of any complication (ESRD: Odds Ratio [OR]=1.505)(15-60:1.261), reoperation (ESRD: OR=1.706)(15-60: 1.314), and readmission (ESRD: OR=1.890)(15-60: 1.649). Conclusion: Low eGFR values, indicative of kidney injury or disease, are significantly predictive of increased risk of postoperative complications, reoperation, and readmission for patients undergoing ankle fracture ORIF. This finding should be considered by surgeons and patients when considering ankle ORIF for patients with decreased kidney function.

Michael Buldo-Licciardi, B.S., Nicole D. Rynecki, M.D., Naina Rao, B.S. et al.

Purpose: To compare psychological readiness to return to sport (RTS), RTS rate, level of return, and time to return between patients who underwent bilateral anterior cruciate ligament reconstruction (ACLR) and those who underwent unilateral ACLR. Methods: The electronic medical record at a single academic medical center was queried for patients who underwent ACLR from January 2012 to May 2020. The inclusion criteria were skeletally mature patients who underwent either single or sequential bilateral ACLR and who had undergone either the primary ACLR or second contralateral ACLR at least 2 years earlier. Bilateral ACLRs were matched 1:3 to unilateral reconstructions based on age, sex, and body mass index. Psychological readiness to RTS was assessed using the validated ACL Return to Sport After Injury (ACL-RSI) scale. This, along with time to return and level of RTS, was compared between the 2 cohorts. Results: In total, 170 patients were included, of whom 44 underwent bilateral ACLR and 132 underwent unilateral ACLR. At the time of the first surgical procedure, patients in the unilateral cohort were aged 28.8 ± 9.4 years and those in the bilateral cohort were aged 25.7 ± 9.8 years (P = .06). The average time difference between the first and second surgical procedures was 28.4 ± 22.3 months. There was no difference in psychological readiness to RTS (50.5 in bilateral cohort vs 48.1 in unilateral cohort, P = .66), RTS rate (78.0% in unilateral cohort vs 65.9% in bilateral cohort, P = .16), percentage of return to preinjury sport level (61.2% in unilateral cohort vs 69.0% in bilateral cohort, P = .21), or time to return (41.2 ± 29.3 weeks in unilateral cohort vs 35.2 ± 23.7 weeks in bilateral cohort, P = .31) between the 2 cohorts. Conclusions: Compared with patients who undergo unilateral ACLR, patients who undergo bilateral ACLR are equally as psychologically ready to RTS, showing equal rates of RTS, time to return, and level of return. Level of Evidence: Level III, retrospective cohort study.

Avani Chopra BS, Zachary A. Koroneos BS, Christian Benedict BS et al.

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: This study aims to evaluate the influence of foot deformity severity, as assessed by radiographic measurements, on the efficacy of total contact casting (TCC) in patients with Charcot neuroarthropathy. TCC is a common treatment in this patient population that aims to immobilize the foot and ankle to mitigate trauma, preventing additional damage, and safeguard the foot structure. There is limited data on the optimal radiographic measurement in predicting which patients will be successfully treated with TCC (Griffiths et al., 2021). By comparing radiographic outcomes between patients who were successfully treated with TCC and those who required surgical intervention following TCC failure, we seek to clarify the role of anatomical deformity in treatment prognosis. Methods: We retrospectively analyzed a cohort of Charcot neuroarthropathy patients treated within a single healthcare system. Patients with radiographs of the affected foot within 2 years prior to or 1 year after the initiation of TCC. Patients were divided into two groups: those successfully managed with TCC (n=10) and those necessitating surgery due to TCC failure (n=16). Ten measurements of standard radiographic parameters used for quantifying the level of deformity in Charcot (Wukich et al., 2014) were included in this study. These measurements were Meary’s angle, Calcaneal pitch, medial and lateral column height, calcaneal 5th metatarsal angle, talar declination, tibiotalar angle, Kite’s angle, hindfoot-forefoot angle, and talonavicular coverage angle. All measurements were collected using Phillips PACS Software (Release 4.7) by three trained evaluators with two evaluators assigned per scan. Differences in the average [value] between groups were assessed using an unpaired t-test. Results: The cohort was comprised of 26 patients (16 males, 10 females). Our analysis revealed that lateral column height was the only parameter with a statistically significant difference in the height measurement (p< 0.05) between the groups. There were no other significant differences detected amongst any of the 9 other measurements. Conclusion: This study revealed that there is a lack of significant differences in most radiographic measurements between patients successfully treated with TCC and those requiring surgical intervention. This may suggest that standard radiographic measurements used for characterizing foot deformity does not help to predict the outcomes of TCC for CN. These findings emphasize the need for a more comprehensive understanding of treatment success predictors beyond anatomical considerations.

Ki-Han You, Jin-Tak Hyun, Sang-Min Park et al.

Abstract Biportal endoscopic spinal surgery has become increasingly popular, and indications have expanded. Among these, biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) has yielded good results. Herein, we compared the clinical and radiological outcomes of 155 patients treated with BE-TLIF and open posterior lumbar interbody fusion (PLIF) for single-level lumbar degenerative diseases. Clinical outcomes included the visual analog scale for the back (VAS-back) and leg (VAS-leg), Oswestry Disability Index, and EuroQol 5-Dimensions. Radiological parameters and fusion rates were evaluated, and postoperative complications were recorded. In this cohort 68 and 87 patients were treated with BE-TLIF and PLIF, respectively. Both groups showed significant improvements in all clinical parameters compared with baseline, but BE-TLIF exhibited a more significant improvement in VAS-back at 1 and 6 months postoperatively. There were no significant differences in the radiological parameters or fusion rates. BE-TLIF had a significantly longer operation time, whereas PLIF exhibited a significantly higher estimated blood loss and surgical drainage, but no significant differences in postoperative complications. Compared to PLIF, BE-TLIF showed similarly good clinical and radiologic outcomes, with better results in terms of early postoperative outcomes. Thus, BE-TLIF is a viable alternative to PLIF with less back pain at 1 and 6 months postoperatively.

Stephen J. McConoughey, R. Howlin, J. Granger et al.

Peyman Mirghaderi, MD, Reza Mirghaderi, MD, S.M. Javad Mortazavi, MD

Alejandro Mejía-Grueso, Daniela Gutiérrez-Zúñiga, Nicolle Visbal-Otero et al.

Introducción: El abordaje y el tratamiento de los defectos óseos glenohumerales han evolucionado con la intención de brindar un manejo más individualizado para los pacientes. Sin embargo, hasta la fecha, no existen artículos que recopilen dichos avances históricos. Objetivo: Describir la bibliografía más relevante sobre el análisis diagnóstico y las opciones terapéuticas de los defectos óseos glenohumerales en los últimos 20 años. Materiales y Métodos: Se realizó una búsqueda en la base de datos PubMed con los términos “Glenoid defect”, “Humeral defect”, “Shoulder instability” y “Glenoid track”, filtrada por año desde 2000 hasta 2021. Se incluyeron estudios publicados en inglés y español, de pacientes adultos. Resultados: En la búsqueda, se revisaron 56 artículos según los criterios planteados. Se llevó a cabo una revisión narrativa cronológica sobre el abordaje de los defectos óseos glenohumerales en inestabilidad anterior. Conclusiones: Los avances tecnológicos han permitido desarrollar algoritmos de evaluación y manejo dirigidos a lograr los mejores desenlaces según las características de cada paciente. La bibliografía actual recomienda el tratamiento quirúrgico basado en la medición objetiva de los defectos óseos glenohumerales, para lo cual la artroscopia y la tomografía con reconstrucción 3D ofrecen la cuantificación más acertada.

Jason Long MD, MBA, Jordan Liles MD, Oke Anakwenze MD, MBA et al.

The location and course of the suprascapular nerve (SSN) to the glenohumeral joint places this nerve at risk when operating around the shoulder. Iatrogenic injury to the suprascapular nerve has been described in several different procedures including, rotator cuff repairs, posterior capsulorraphy, Bankart repairs, SLAP lesion repairs, Latarjet procedures, and shoulder arthroplasty. We present a case of iatrogenic suprascapular nerve injury due to superior glenoid baseplate screw placement following primary reverse shoulder arthroplasty (RSA), a novel approach to diagnosis of nerve injury, and treatment.

Gyorgy Lovasz, Attila Aros, Ferenc Toth et al.

Abstract Purpose We investigated the safety of primary hip and knee replacements with same day discharge (SDD) and their effect on length of stay (LOS) of traditional inpatient arthroplasties at our elective orthopaedic ward. Methods 200 patients underwent elective, unilateral primary day case total hip (THA, n = 94), total knee (TKA, n = 60) and unicondylar knee replacements (UKA, n = 46). SDD rates, reasons for failure to discharge, readmission, complication and satisfaction rates were recorded at 6-week follow up. Changes in LOS of inpatient arthroplasties (n = 6518) and rate of patients discharged with only one night stay treated at the same ward were tracked from 1 year prior to introduction of day case arthroplasty (DCA) program to the end of observation period. Results 166 patients (83%) had SDD while 34 (17%) needed overnight stay. Main reasons for failure to discharge were lack of confidence (4%) fainting due to single vasovagal episode (3.5%), urine retention (3%) and late resolution of spinal anaesthesia (3%). 5 patients (3%) had readmission within 6 weeks, including 1 (0.6%) with a partial and treated pulmonary embolism. 163 patients were satisfied with SDD (98%). After launching the DCA program, average LOS of inpatients was reduced from 2.3 days to 1.8 days and rate of discharge with only 1-night stay increased from 12% to around 60%. Conclusion Introduction of routine SDD hip and knee arthroplasty programme at an elective orthopaedic centre is safe and also may confer wider benefits leading to shorter inpatient hospital stays.

Jiaduo Sun, Qingguo Zhang, Baojia Lin et al.

BackgroundPostoperative delirium (POD) is a common complication after orthopedic surgery in elderly patients. The elderly may experience drastic changes in autonomic nervous system (ANS) activity and circadian rhythm disorders after surgery. Therefore, we intend to explore the relationship between postoperative long-term heart rate (HR) variability (HRV), as a measure of ANS activity and circadian rhythm, and occurrence of POD in elderly patients.MethodsThe study population of this cohort was elderly patients over 60 years of age who scheduled for orthopedic surgery under spinal anesthesia. Patients were screened for inclusion and exclusion criteria before surgery. Then, participants were invited to wear a Holter monitor on the first postoperative day to collect 24-h electrocardiographic (ECG) data. Parameters in the time domain [the standard deviation of the normal-to-normal (NN) intervals (SDNN), mean of the standard deviations of all the NN intervals for each 5-min segment of a 24-h HRV recording (SDNNI), and the root mean square of successive differences of the NN intervals (RMSSD)] and frequency domain [heart rate (HR), high frequency (HF), low frequency (LF), very low frequency (VLF), ultra low frequency (ULF), and total power (TP)] were calculated. Assessment of delirium was performed daily up to the seventh postoperative day using the Chinese version of the 3-Min Diagnostic Interview for CAM-defined Delirium (3D-CAM). The relationship between HRV and POD, as well as the association between HRV and duration of POD, was assessed.ResultsOf the 294 cases that finally completed the follow-up, 60 cases developed POD. Among the HRV parameters, SDNNI, VLF, and ULF were related to the occurrence of POD. After adjustment for potential confounders, the correlation between HRV indices and POD disappeared. Through stratified analysis, two significant negative correlations emerged: ULF in young-old participants and SDNNI, VLF, and ULF in male patients.ConclusionThe lower HRV parameters may be related to the occurrence of POD, and this correlation is more significant in young-old and male patients. ANS disorders and rhythm abnormalities reflected by HRV changes may represent a possible mechanism that promotes POD.