Hasil untuk "Orthopedic surgery"

Y. Falck-Ytter, C. Francis, N. Johanson et al.

Fernando N. Martín Cocilova, Elisabetta Neri, Filippo Nozzoli et al.

Pseudomyogenic hemangioendothelioma (PHME) is a very rare vascular tumor that usually arises in the extremities, mainly cutaneous or subcutaneous, but also occurs in deeper locations, such as muscles and bone. Less than 200 cases have been reported so far, and primary intraosseous PHMEs are further infrequent. We present a clinical case of PMHE of the femur in a young male adult successfully treated by intercalary resection and massive allograft reconstruction with plates fixation. After more than 2 years of follow-up, the patient is disease-free and asymptomatic, walking with full weight-bearing with radiographic evidence of allograft union.

Jens T. Verhey, J. Haglin, Erik M. Verhey et al.

Innovation in computer‐assisted surgery (CAS) aims to increase operative accuracy and improve safety by decreasing procedure‐related complications. The application of reality technologies, to CAS has begun to revolutionize orthopedic training and practice.

Prerak Deep, Dheeraj Kulkarni

We introduce the notion of round surgery diagrams in $S^3$ for representing 3-manifolds similar to Dehn surgery diagrams. We give a correspondence between a certain class of round surgery diagrams and Dehn surgery diagrams for 3-manifolds. As a consequence, we recover Asimov's result, stating that any closed connected oriented 3-manifold can be obtained by a round surgery on a framed link in $S^3$. There may be more than one round surgery diagram giving rise to the same 3-manifold. Thus, it is natural to ask whether there is a version of Kirby Calculus for round surgery diagrams, similar to the case of Dehn surgery diagrams with integral framings. In this direction, we define four types of moves on round surgery diagrams such that any two round surgery diagrams corresponding to the same 3-manifold can be obtained one from another by a finite sequence of these moves, thereby establishing a version of Kirby Calculus. As an application, we prove the existence of taut foliations, hence the existence of tight contact structures on 3-manifolds obtained by round 1-surgery on fibred links with two components on $S^3$.

Kristen Hendricks, Abhishek Mallick, Matthew Stoffregen et al.

We prove an equivariant version of the Heegaard Floer link surgery formula. As a special case, this gives an equivariant knot surgery formula for equivariant knots in $S^3$. Our proof goes by way of a naturality theorem for certain bordered modules described by the last author. As a sample application, we prove the kernel of the forgetful map from the equivariant homology cobordism group to the homology cobordism group contains a $\Z^\infty$-summand.

Marc Kegel, Isacco Nonino, Monika Yadav

In this article, we define the contact surgery distance of two contact 3-manifolds $(M,ξ)$ and $(M',ξ')$ as the minimal number of contact surgeries needed to obtain $(M,ξ)$ from $(M',ξ')$. Our main result states that the contact surgery distance between two contact $3$-manifolds is at most $5$ larger than the topological surgery distance between the underlying smooth manifolds. As a byproduct of our proof, we classify the rational homology $3$-spheres on which the $d_3$-invariant of a $2$-plane field already determines its $Γ$-invariant and Euler class.

Gongan Jiang, Weijun Wang, Yuhao Yang et al.

Abstract Objective Information on pathogens and sensitive antibiotics is crucial for treating periprosthetic joint infection (PJI), one of the most severe complications of joint arthroplasty. Lacking this information is not uncommon, and empirical antibiotic treatment should be adopted as a compromise. This study aimed to develop regional-specific antimicrobial regimens and provide a reference for empirical antibiotic treatment for PJI by retrospectively analyzing the pathogen profiles of PJI patients treated in our center and their antibiotic sensitivities. Methods PJI patients treated at our center from January 2018 to December 2024 were retrospectively recruited. Joint aspiration was performed preoperatively to collect synovial fluid for culture and differential cell counting, and synovial tissue samples were obtained intraoperatively from at least three different sites for culture. Patients were diagnosed according to the guidelines of the 2018 International Consensus Meeting and the European Bone and Joint Infection Society. The culture-positive rate, distribution of gram-positive pathogens, methicillin resistance, mixed infections, and multidrug resistance were analyzed. The effective coverage rates of antibiotics were determined, and appropriate empirical antibiotic regimens were proposed. Results A total of 255 PJI patients, comprising 104 males and 151 females, were included; 141 patients had hip PJI, and 114 had knee PJI. Among them, 224 patients (87.8%) had positive culture results. We isolated 335 pathogens, including 218 coagulase-negative staphylococcal infections (65.1%). Staphylococcus epidermidis was the most prevalent pathogen, with 86 isolates (25.7%), followed by Staphylococcus aureus, with 45 isolates (13.4%), and Streptococci, with 20 isolates (6.0%). In hip PJI, the most common pathogens were Staphylococcus epidermidis (50 isolates, 26.6%) and Staphylococcus aureus (30 isolates, 16.0%), and in knee PJI, Staphylococcus epidermidis was predominant (36 isolates, 24.5%). In terms of drug resistance, 48.1% of the staphylococcal strains were methicillin resistant, and 57.6% of the pathogens were multidrug resistant. Staphylococci showed 100% sensitivity to vancomycin and linezolid but were highly resistant to β-lactams and quinolones. In patients with acute postoperative PJI, the combination of vancomycin combined with ceftazidime was 98.4% effective. In patients with chronic PJI, vancomycin combined with imipenem and meropenem achieved effective coverage rates of 94.4% and 95.5%, respectively. The combination of linezolid with meropenem also achieved a 95.5% effective coverage rate. Conclusion Gram-positive bacteria were the predominant pathogens associated with PJI, with high rates of methicillin resistance and multidrug resistance. The combination of vancomycin and meropenem is an empirical antibiotic regimen for culture-negative chronic PJI patients in this region, with the combination of linezolid and meropenem as an alternative. For patients with culture-negative acute postoperative PJI, vancomycin combined with ceftazidime is suggested as the preferred empirical therapy.

Charles C. White, IV, M.D., Brandon A. Cincere, M.D.

Many techniques and combinations of procedures exist for reconstruction of an injured acromioclavicular (AC) joint. Recently, there has been a focus on controlling anterior and posterior translation of the AC joint after the reduction of superior translation and coracoclavicular (CC) ligament stabilization. Diagnosis and treatment of anterior and posterior instability of the AC joint is critical, yet when AC/CC ligament reconstruction fails, this is often the result of recurrent superior migration of the clavicle relative to the acromion. We present a technique using knotless, all-suture anchor technology intended for higher-grade, operative AC joint injuries in “high-risk” patients, i.e., those returning to a collision sport such as football, rugby, hockey, or wrestling. Consideration also could be given to those performing a high-demand occupation, such as overhead work or manual labor. In addition, this technique could be employed in patients at risk for delayed or nonhealing, such as those with diabetes or who are smokers, those at risk of noncompliance, and revision cases. The all-suture anchor, knotless “suture staple” technique can be implemented easily to provide backup fixation of the AC joint directly as an augmentation to CC reconstruction, preferably arthroscopic-assisted reduction, and fixation with a cortical button and, when indicated, concomitant allograft reconstruction.

Agathe Yvinou, Romain Alain

Abstract Gender and sex disparities persist in orthopaedic and traumatology surgery, making it one of the least diverse medical specialties worldwide. Despite growing women representation in medical education, women continue to be significantly underrepresented in orthopaedics, occupying only 6–8% of surgical roles. This underrepresentation extends to academic leadership, research, and public speaking opportunities, ultimately limiting innovation and the quality of patient care. Systemic barriers—such as gender bias, lack of mentorship, and misperceptions about physical demands—discourage women from entering and advancing in the field. This manuscript explores the current landscape of gender inequality in orthopaedics and identifies strategic interventions to promote equity. Solutions include enhancing recruitment through early exposure, fostering inclusive institutional cultures, expanding mentorship and sponsorship opportunities, and implementing supportive policies for work-life integration. In patient care, disparities in diagnosis, pain management, surgical decision-making, and rehabilitation access disproportionately impact women. We advocate for the development of gender-inclusive clinical guidelines, equitable research funding, and standardized assessment tools. Additionally, the role of public awareness is examined, emphasizing the need to highlight success stories, engage male allies, and conduct outreach through educational and community initiatives. Programs such as the Perry Initiative, Nth Dimensions, and campaigns like HeForShe are shown to play pivotal roles in shifting perceptions and increasing diversity. Addressing these disparities is not only a matter of justice but also essential to achieving excellence in clinical outcomes. This article offers a comprehensive framework for fostering gender and sex equality in orthopaedic and traumatology surgery through systemic, cultural, and policy-level change.

Yuxin Zhang, Xiaoyu Liao, Dahe Zhang et al.

Background: Temporomandibular disorder (TMD) is the most common maxillofacial musculoskeletal disease involving various conditions such as chewing muscle disorders, disc displacement and osteoarthritis. However, its intricate pathogenesis remains unclear. Herein, by integrating evidence at the blood, tissue and cell levels, we aimed to investigate the association of cell death-related genes with TMD and predict potential target drugs. Methods: Summary-level data on methylation, expression and protein abundance levels of cell death-related genes were used to identify drug-targeted genes at the blood level. FUSION tool was employed to identify and validate associations at the tissue level. Single-cell analysis was utilised to determine whether TMD-associated cell death genes exhibited higher expression in specific cell types. Drug prediction and molecular docking was used to confirm drug-related effects of TMD-associated cell death genes. Results: Integrating the overlapping results of summary-data-based Mendelian randomisation of mQTL, eQTL and pQTL at the blood level with Bayesian co-localisation analysis, 3 cell death-related genes were identified as causally associated with TMD: TIE1 (Tier 1), IFI16 (Tier 1) and GATM (Tier 2). Based on tissue-level FUSION analysis, we validated the specific effects of TIE1 and GATM genes in muscle-skeletal histology. Meanwhile, single-cell data were utilised to further analyse the cell type-specific enrichment of the 3 target genes in TMD. Finally, drug prediction and molecular docking identified 5 pharmacokinetic associations of 3 TMD-associated cell death genes. Conclusion: Based on multilevel evidence of the blood, tissue and cell, we found that cell death-related genes TIE1, IFI16 and GATM were associated with TMD risk and predict potential target drugs such as fostamatinib. This study further elucidates the critical role of cell death-related molecules and drugs in TMD.

Siddhart Yadav, K P Chiranjeevi, Akash Singh Jadon et al.

Introduction: Ipsilateral tibia and fibula shaft fractures with trimalleolar fracture are quite rare in clinical practice. Case Report: This is a case report of a 49-year-old female presented on March 6th, 2024, and was diagnosed to have an ipsilateral left comminuted distal tibia shaft and fibula shaft fracture with an anterior lacerated wound 2 cm over the fracture site with trimalleolar fracture after falling twice while walking. The patient was treated with wound debridement, intramedullary interlocking nailing for the left tibia shaft, and open reduction internal fixation with coracoclavicular screw for posterior malleolus, K-wires + FiberWire tension band wiring for medial malleolus, and K-wires for lateral malleolus on March 07th, 2024. K-wires from the lateral malleolus were removed and tibia nail dynamization was done on April 10th, 2024. All fractures united in 4 months and the patient was followed up for a period of 1 year post-operatively. Conclusion: Various treatment options were possible, of which we chose implants and a sequence of fixation based on the fracture pattern being comminuted and an open fracture.

Bangyu Lan, Momen Abayazid, Nico Verdonschot et al.

In Total Knee Replacement Arthroplasty (TKA), surgical robotics can provide image-guided navigation to fit implants with high precision. Its tracking approach highly relies on inserting bone pins into the bones tracked by the optical tracking system. This is normally done by invasive, radiative manners (implantable markers and CT scans), which introduce unnecessary trauma and prolong the preparation time for patients. To tackle this issue, ultrasound-based bone tracking could offer an alternative. In this study, we proposed a novel deep learning structure to improve the accuracy of bone tracking by an A-mode ultrasound (US). We first obtained a set of ultrasound dataset from the cadaver experiment, where the ground truth locations of bones were calculated using bone pins. These data were used to train the proposed CasAtt-UNet to predict bone location automatically and robustly. The ground truth bone locations and those locations of US were recorded simultaneously. Therefore, we could label bone peaks in the raw US signals. As a result, our method achieved sub millimeter precision across all eight bone areas with the only exception of one channel in the ankle. This method enables the robust measurement of lower extremity bone positions from 1D raw ultrasound signals. It shows great potential to apply A-mode ultrasound in orthopedic surgery from safe, convenient, and efficient perspectives.

John B. Etnyre, Tanushree Shah

We demonstrate that the contact cosmetic surgery conjecture holds true for all non-trivial Legendrian knots, with the possible exception of Lagrangian slice knots. We also discuss the contact cosmetic surgeries on Legendrian unknots and make the surprising observation that there are some Legendrian unknots that have a contact surgery with no cosmetic pair, while all other contact surgeries are contactomorphic to infinitely many other contact surgeries on the knot.

Tobias Ekholm

This is an overview paper that describes Eliashberg's Legendrian surgery approach to wrapped Floer cohomology and use it to derive the basic relations between various holomorphic curve theories with additional algebraic constructions. We also give a brief discussion of further results that use the surgery perspective, e.g., for holomorphic curve invariants of singular Legendrians and Lagrangians.

Avimita Chatterjee, Subrata Das, Swaroop Ghosh

Quantum error correction (QEC) plays a crucial role in correcting noise and paving the way for fault-tolerant quantum computing. This field has seen significant advancements, with new quantum error correction codes emerging regularly to address errors effectively. Among these, topological codes, particularly surface codes, stand out for their low error thresholds and feasibility for implementation in large-scale quantum computers. However, these codes are restricted to encoding a single qubit. Lattice surgery is crucial for enabling interactions among multiple encoded qubits or between the lattices of a surface code, ensuring that its sophisticated error-correcting features are maintained without significantly increasing the operational overhead. Lattice surgery is pivotal for scaling QECCs across more extensive quantum systems. Despite its critical importance, comprehending lattice surgery is challenging due to its inherent complexity, demanding a deep understanding of intricate quantum physics and mathematical concepts. This paper endeavors to demystify lattice surgery, making it accessible to those without a profound background in quantum physics or mathematics. This work explores surface codes, introduces the basics of lattice surgery, and demonstrates its application in building quantum gates and emulating multi-qubit circuits.

Elisa Cassart, Joan Miquel, Fernando Santana et al.

Margaret Wooddell PhD, MBA, Dong Dai PhD, Feng Lin PhD et al.

Category: Other Introduction/Purpose: Tenosynovial giant cell tumors (TGCT) are neoplastic, inflammatory lesions that arise within the synovium and can be locally aggressive. Patients with TGCT frequently experience pain and joint swelling, stiffness, reduced range of motion, and instability in affected joints. Surgical resection is standard treatment for TGCT; however, the diffuse subtype is associated with poor surgical outcomes and high rates of disease recurrence. Pexidartinib (Turalio ® ), a CSF-1R antagonist, is the first and only systemic therapy approved by the FDA for treatment of adult patients with symptomatic TGCT associated with severe morbidity or functional limitations and not amenable to improvement with surgery. The objective of this study was to assess symptom change over time among adult patients who were treated with pexidartinib for TGCT in a real-world setting. Methods: This was a longitudinal observational study of patients receiving pexidartinib for TGCT treatment in the real-world setting. The study collected Patient Reported Outcomes (PRO) from patient surveys prospectively and clinical data from medical charts retrospectively. The surveys were administered to adult patients enrolled in the post-market Turalio ® Risk Evaluation and Mitigation Strategy (REMS) program: the first wave was sent in 2021 (“Baseline”) and the final was sent in 2022 (“Follow-up”). Patients were required to be receiving pexidartinib before the Baseline Survey and to be on pexidartinib when they accessed the Follow-up Survey. The surveys consisted of validated instruments to measure PROs. The EQ-5D-5L was administered in the Follow-up Survey to understand patients’ general health state. The scores and paired changes from baseline were summarized by descriptive statistics and a random slope regression model was developed to adjust for the time since first pexidartinib dose. Results: Forty-five patients actively taking pexidartinib to treat TGCT were invited to participate in both waves of the survey; 31 (68.9%) participated in both surveys. Mean (SD) time between baseline and follow-up was 1.02 (0.17) years, mean (SD) age at follow-up was 41.9 (13.70) years, and 67.7% were female. The most common tumor sites were at the knee (67.7%), ankle (16.1%), foot (9.7%), and hip (9.7%) (non-mutually exclusive). Changes in PROs are shown in Table 1. During follow-up, at least 71% of respondents indicated slight or no problems in each of the five EQ-5D-5L domains. Since the start of the study, the majority (85.7%) of respondents experienced improved overall symptoms. Conclusion: In this study, most TGCT patients reported symptom improvement in physical function, stiffness and pain during pexidartinib treatment. After an additional year of follow-up, the PROs of physical function, worst stiffness, worst pain, and treatment satisfaction were sustained. The findings suggest longer-term benefits for patients continuing treatment with pexidartinib. Outcomes for patients who discontinued pexidartinib should be evaluated in future studies.

Yavuz Kocabey, M.D., Ahmet Fırat, M.D., Ahmet Yıldırım, M.D. et al.

Optimal graft choice and fixation technique are still ongoing topics of debate for primary and revision anterior cruciate ligament reconstruction. Interference screws are frequently used as graft fixation devices but can sometimes lead to tunnel widening, cyst formation, chronic inflammation, screw breakage, and persistent pain. Tibial tunnel widening is of special concern because it is often associated with graft failure. This technical note introduces a graft technique with a periosteum–patellar tendon–bone autograft and a press-fit tibial fixation approach that could be a viable option for secure anterior cruciate ligament reconstruction while offering the possibility of a quicker postoperative recovery, less pain, and a quicker return to everyday activities.

Xin Yang, Yimurang Hamiti, Kai Liu et al.

Abstract Background The management of docking site healing in bone transport remains a significant challenge in orthopedic surgery. Traditional assessment methods rely heavily on qualitative radiographic evaluations. This study investigates the utility of pixel value ratio (PVR), an objective quantitative measure, in assessing bone healing at the docking site during bone transport. Methods This retrospective study included 47 patients who underwent bone transport for lower limb reconstruction between January 2015 and January 2020. Patients were categorized into bone union (n = 35) and nonunion (n = 12) groups based on docking site outcomes. PVR was calculated using two methods (PVR1 and PVR2) at six time points over 24 months post-docking. Subgroup analyses were performed based on gender, age, and surgical site. Results Of 47 patients, 35 achieved bone union and 12 experienced nonunion. Both PVR1 and PVR2 were consistently lower in the union group compared to the nonunion group at all time points (p < 0.001). In the union group, PVR1 ranged from 1.064 ± 0.050 to 1.108 ± 0.062, while PVR2 ranged from 0.926 ± 0.079 to 0.946 ± 0.062. In the nonunion group, PVR1 ranged from 1.204 ± 0.057 to 1.273 ± 0.020, and PVR2 from 1.039 ± 0.060 to 1.148 ± 0.022. Subgroup analyses revealed that males had significantly lower PVR values compared to females, and tibial cases had lower PVR values compared to femoral cases in both union and nonunion groups (p < 0.05). All juvenile patients achieved union, compared to 71.4% of adults (p < 0.01). Conclusion PVR demonstrates significant potential as an objective tool for assessing docking site healing in bone transport procedures. The distinct patterns observed between union and nonunion cases provide a foundation for developing clinical guidelines to monitor and predict healing outcomes. Integration of PVR assessment into clinical practice could improve decision-making and optimize treatment protocols in bone transport procedures.

Kanehiro Hiyama, MD, PhD, Takuya Takakuwa, MD, Reiko Yamaguchi, MD et al.