Journal of orthopaedics最新文献

{"title":"Countermovement jump and vertical hop demonstrate braking/deceleration and performance alterations after ACL reconstruction with BMA, DBM, and suture tape augmentation","authors":"J. Groves ,&nbsp;J.M. Keefer ,&nbsp;J. Peterson ,&nbsp;R. Hamrick ,&nbsp;T.E. Hewett ,&nbsp;C. Lavender","doi":"10.1016/j.jor.2024.08.019","DOIUrl":"10.1016/j.jor.2024.08.019","url":null,"abstract":"<div><h3>Objectives</h3><div>This study evaluated countermovement jump and Single Leg Jump measures to identify landing measures that best distinguish a novel Anterior Cruciate Ligament reconstruction technique using bone marrow aspirate, demineralized bone matrix, and suture tape augmentation patients from controls. The secondary objective assessed performance differences between operated and non-operated limbs post-reconstruction. The hypothesis was that novel Anterior Cruciate Ligament reconstruction patients at return to sport would not differ from controls during landing and that the operated limb's performance would not differ from the unoperated limb.</div></div><div><h3>Methods</h3><div>The study included 31 patients with the novel reconstruction technique matched with controls in a 1:10 ratio based on age, sex, weight, and height. Both groups underwent screening and were compared during a Countermovement Jump. Using a Sparta Science Force Platform, each patient's unoperated and operated limbs were also compared for Single Leg Jump post-op (6.5 months).</div></div><div><h3>Results</h3><div>Test patients showed no difference in center of pressure during landing of both jumps compared to controls (P=0.27) and the uninvolved limb (P=0.26). Test patients exhibited increased braking impulse relative to the uninvolved limb during Single Leg Jump (P&lt;0.001). Deceleration upon landing of Countermovement Jump was also increased compared to controls (P&lt;0.001). Test patients demonstrated slower concentric time during a Countermovement Jump compared to controls (P=0.03) and significantly slower compared to the uninjured leg (P&lt;0.001). Countermovement Jump height was decreased compared to controls (P&lt;0.001). Single-leg jump height was decreased in the injured limb compared to the uninjured limb (P&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Test patients did not show significant differences in landing motion compared to controls or the uninvolved leg. However, power and performance alterations were evident at Return to Sport after reconstruction. Although these results are quite promising, they may be too preliminary to draw definitive conclusions. Double and single-legged assessments should be considered in return-to-sport decision-making.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A finite element analysis of patellofemoral joint biomechanics: Exploring potential causes of postoperative anterior knee pain following unicompartmental knee arthroplasty","authors":"Ziyou Yan ,&nbsp;Deng Li ,&nbsp;Zhiqing Cai ,&nbsp;Hao Sun ,&nbsp;Ruofan Ma ,&nbsp;Shuqiang Ma ,&nbsp;Jie Xu","doi":"10.1016/j.jor.2024.08.017","DOIUrl":"10.1016/j.jor.2024.08.017","url":null,"abstract":"<div><h3>Purpose</h3><p>Anterior knee pain is a common complication following unicompartmental knee arthroplasty (UKA). This study aimed to elucidate the mechanism of anterior knee pain after UKA by examining the biomechanical characteristics of the patellofemoral joint.</p></div><div><h3>Methods</h3><p>This study employs the finite element analysis method. A healthy model of the right lower limb was created using CT scans of an intact right lower limb from a healthy woman. Based on this model, a preoperative pathological model was generated by removing the meniscus and part of the articular cartilage. The UKA prosthesis was then applied to this model with five different bearing thicknesses: 5 mm, 7 mm, 10 mm, 11 mm, and 13 mm. To simulate various degrees of knee joint flexion, the femur was rotated relative to the knee joint's rotational axis, producing lower limb models at flexion angles of 0°, 30°, 60°, 90°, and 120°. We applied a constant force from the center of the femoral head to the center of the ankle joint to simulate lower limb loading during squatting. The simulations were conducted using Ansys 17.0.</p></div><div><h3>Results</h3><p>Both overstuffing and understuffing increased the peak stress on the patellar cartilage, with overstuffing having a more pronounced effect. Compared to healthy and balanced models, overstuffed and understuffed models exhibited abnormal stress distribution and stress concentration in the patellar cartilage during knee flexion.</p></div><div><h3>Conclusion</h3><p>Overstuffing and understuffing lead to residual varus or valgus deformities after UKA, causing mechanical abnormalities in the patellofemoral joint. These abnormalities, characterized by irregular stress distribution and excessive stress, result in cartilage damage, exacerbate wear in the patellofemoral joint and consequently lead to the occurrence of anterior knee pain.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Greater readmission rates after total hip arthroplasty with discharge to a facility vs. home: A propensity score matched analysis","authors":"Sarah Cole ,&nbsp;Maria Peri ,&nbsp;Sarah Whitaker ,&nbsp;Brady Ernst ,&nbsp;Conor O'Neill ,&nbsp;James Satalich ,&nbsp;Alexander Vap","doi":"10.1016/j.jor.2024.08.016","DOIUrl":"10.1016/j.jor.2024.08.016","url":null,"abstract":"<div><h3>Purpose</h3><p>Provided that total hip arthroplasties (THA) are some of the most common surgical procedures performed, there is a necessity to understand all factors that contribute to risks of adverse outcomes postoperatively and to find solutions to avoid these events with preventive measures. This retrospective cohort study sought to assess differences in (1) postoperative complication rates, (2) readmission rates and reasons, and (3) demographic variables that contribute to readmissions based on discharge destination within the first 30 days after a THA.</p></div><div><h3>Methods</h3><p>Patients undergoing THA (27130) between 2015 and 2020 were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database based on procedural codes. Propensity score matching was then employed to reduce selection bias, and Chi-square tests and one-way analysis of variance (ANOVA) were performed. Multivariable analysis was then used to look for other factors associated with readmission risk.</p></div><div><h3>Results</h3><p>219,960 patients were identified with 189,841 discharged to home, 19,355 to a skilled nursing facility (SNF), and 10,764 to a rehabilitation facility. The rehabilitation and SNF cohorts both had greater rates of readmission (4.56 % home vs. 6.88 % SNF vs. 6.90 % rehabilitation, P&lt;0.001) and any adverse event (AAE, 9.02 % vs. 18 % vs. 21.3 %, P&lt;0.001) after matching. Older age, longer operative time, American Society of Anesthesiologists (ASA) classification four, chronic obstructive pulmonary disease (COPD), bleeding disorders, steroid use, and smoking were associated with an increased risk of readmission after THA.</p></div><div><h3>Conclusion</h3><p>Overall, THAs were shown to have low postoperative complications and readmissions in all patient populations despite differences in discharge destination which continues to demonstrate the safety and validity of this often elective procedure. However, the statistically significant risk of complications and readmissions in addition to the higher costs associated should be accounted for when considering patient discharges to a non-home facility.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972978X24003040/pdfft?md5=70b008fce15106cea1564771826f3699&pid=1-s2.0-S0972978X24003040-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Area Deprivation Index as a proxy for socioeconomic status in outpatient orthopaedic surgery patients – A prospective registry cross sectional study","authors":"Samir Kaveeshwar,&nbsp;Sania Hasan,&nbsp;Daniel Polsky,&nbsp;Nathan N. O'Hara,&nbsp;Evan L. Honig,&nbsp;Sam Li,&nbsp;Craig Shul,&nbsp;Julio Jauregui,&nbsp;R. Frank Henn III,&nbsp;Christopher G. Langhammer","doi":"10.1016/j.jor.2024.08.014","DOIUrl":"10.1016/j.jor.2024.08.014","url":null,"abstract":"<div><h3>Background</h3><p>We aimed to determine if Area Deprivation Index (ADI) is associated with self-reported metrics socioeconomic status (SES), and to assess the relationship between ADI and preoperative score on common patient reported outcome scores (PROS).</p></div><div><h3>Methods</h3><p>Patients presenting for outpatient orthopaedic surgery completed Patient-Reported Outcome Metric Information System (PROMIS) and joint-specific PROS. ADI was determined from geocoded home address. Sociodemographic data was collected from self-reported survey. Tests of association were used to describe the relationship between ADI and sociodemographic factors as well as the correlation between ADI and PROS. Extreme group analysis was used to examine which PROS may be subject to clinically meaningful variation.</p></div><div><h3>Results</h3><p>ADI was associated with self-reported SES. ADI was correlated with score on all baseline PROS. Extreme group analysis showed that low SES was associated with clinically meaningful differences in some, but not all, PROS.</p></div><div><h3>Conclusion</h3><p>ADI is associated with self-reported measures of SES in an orthopaedic outpatient surgical population. Lower SES correlates with worse function to a clinically significant degree for some PROS. SES should be considered in the context of preoperative symptom severity in outpatient orthopaedic surgery patients. ADI may be a useful adjunct to self-reported measures of SES for this purpose.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scholarly trends in global orthopedics research published through the journal of orthopaedics: A bibliometric analysis from 2013 to 2024","authors":"Raju Vaishya ,&nbsp;Patinharayil Gopinathan ,&nbsp;Brij Mohan Gupta ,&nbsp;Ghouse Modin N. Mamdapur ,&nbsp;Abhishek Vaish","doi":"10.1016/j.jor.2024.08.013","DOIUrl":"10.1016/j.jor.2024.08.013","url":null,"abstract":"<div><h3>Background and aims</h3><p>We provide an overview and data visualization trends of orthopaedic research published by the Journal of Orthopedics (JOO) from 2013 to 2024.</p></div><div><h3>Methods</h3><p>We used Scopus database to retrieve all articles published by the JOO from 2013 to 2024, as of 15.7.2024. Bibliometric analysis and visualization of the global orthopaedic literature were performed using Microsoft Excel and VOSviewer software to explore the research hotspots in this field in the past 12 years.</p></div><div><h3>Results</h3><p>The 2074 publications covered in the JOO published between 2013 and 2024 were identified. The annual average and six-year cumulative publications depicted growth rates of 36.23 % and 147.99 %, respectively. Of the 80 global publications, the main participating countries were from Europe (n = 26), and Asia (n = 13). North America (37.37 %), Europe (34.89 %) and Asia (30.42 %) contributed a significant share of journal output. The most contributing countries were the USA, followed by the U.K., India, and Japan. The visualization and analysis of topical research trends reveal that the JOO covers almost the entire spectrum of orthopaedic research, with the most focus on the Knee (26.38 %), Hip (21.53 %), Shoulder (8.79 %) and Spine (7.09 %) and its subfields, such as arthroplasty (882 papers), surgery (192 papers), radiography (177 papers), osteoarthritis (166), pain (135 papers), fractures (133) and arthroscopy (70). The 68 (3.32 %) of the 2047 publications received 30 and above citations and together received 3466 citations, constituting 51.73 % share of total citations. The Hospital for Special Surgery (USA), and Singapore General Hospital were the most productive organizations, while the most impactful organizations were the University of Toledo Medical Center (USA), and Università degli Studi di Messina (Italy). The most productive authors were R. Vaishya (India), and J.A. Dubin (USA), whereas V. Filardi (Italy) and J.M. Newman (USA) were the most impactful authors of the JOO.</p></div><div><h3>Conclusion</h3><p>The JOO is a destination for global orthopaedic research. It has progressively received an increasing number of manuscripts and depicted high annual average publication growth rates, besides witnessing an increase in the significant number of citations received. It has helped to improve the journal's ranking, impact and reputation.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tibial tubercle osteotomy (TTO): A review of impactful papers in the literature","authors":"Joseph P. Costello II ,&nbsp;Nikhil N. Patel ,&nbsp;Justin A. Chen ,&nbsp;Marissa C. Tandron ,&nbsp;Brandon Goldenberg ,&nbsp;Michael G. Baraga","doi":"10.1016/j.jor.2024.08.011","DOIUrl":"10.1016/j.jor.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Tibial tubercle osteotomy (TTO) is a procedure that can be used as an alternative to total knee arthroplasty (TKA) or to address patellar instability in patients experiencing dislocation events. The purpose of this paper is to systematically evaluate the most cited articles pertaining to TTO through bibliometric analysis.</div></div><div><h3>Methods</h3><div>A search using the Web of Science database with keywords pertaining to TTO was conducted in April 2024. Articles with the most citations that met all inclusion criteria were analyzed to determine information such as level of evidence (LoE), article topic, journal of publication, year published, country of origin, and institution of origin.</div></div><div><h3>Results</h3><div>The average number of citations was 79 (range of 42–334). The decade with the most publications was from 2010 to 2019 (n = 26; 52%). <em>Clinical Orthopaedics and Related Research</em> was the journal with the largest number of published articles (n = 9, 18%). The United States (US) (n = 25; 50%) and France (n = 4; 8%) were the two countries with the most publications. Mayo Clinic (n = 3, 6 %), Ohio State University (n = 3, 6%), and Rush University (n = 3, 6%) were the institutions contributing the most articles. The LoE most reported was level 4 (n = 22; 44%). Topics were primarily related to clinical outcomes (n = 38; 76%).</div></div><div><h3>Conclusion</h3><div>This analysis revealed that most articles were related to clinical outcomes and have been published since 2000. By analyzing the characteristics of the most cited articles, an understanding of current research and identification of areas for further exploration can be determined for TTO.</div></div><div><h3>Study Design</h3><div>Cross-sectional study.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trochleoplasty and à-la-carte procedures for patellar instability in young and active patients: Clinical outcomes at minimum 2 Years follow-up","authors":"Alice Montagna ,&nbsp;Rudy Sangaletti ,&nbsp;Fabio Nesta ,&nbsp;Luca Andriollo ,&nbsp;Stefano Marco Paolo Rossi ,&nbsp;Francesco Benazzo ,&nbsp;Luca Matascioli","doi":"10.1016/j.jor.2024.08.012","DOIUrl":"10.1016/j.jor.2024.08.012","url":null,"abstract":"<div><h3>Introduction</h3><p>Patellar instability is a common condition affecting approximately 6 individuals per 100,000, but among adolescents, this incidence is notably higher. Trochlear dysplasia has been recognized as the pathoanatomic risk factor exerting the most significant biomechanical influence. Over time, various surgical techniques have been developed to address trochlear dysplasia. The purpose of this study is to evaluate the clinical outcomes, return to sport, as well as complications and re-operation rate of sulcus deepening trochleoplasty performed in a cohort of young and active patients using the Bereiter technique.</p></div><div><h3>Materials and methods</h3><p>Between January 2019 and February 2022, 11 cases of recurrent patellar dislocations underwent trochleoplasty. Preoperative radiological assessment included X-rays, CT scans following the Lyons and MRI. Inclusion criteria for the study and trochleoplasty indications included patients aged 10–25 with recurrent patellar dislocations unresponsive to nonoperative treatment and minimum type B trochlear dysplasia. Clinical follow-up occurred at 1-3-6 months and annually, with control X-rays at these intervals. Patient-reported outcome scores included the Knee Society Score, Kujala score, and Karnofsky performance status scale.</p></div><div><h3>Results</h3><p>Between January 2019 and February 2022, 11 patients underwent trochleoplasty and were included in this study. Preoperative radiological measurements indicated mean values: sulcus angle (152.5°), trochlear depth (3.4 mm), Caton-Deschamps index (1.2), tibial tuberosity to trochlear groove (TT-TG) distance (17.5 mm), external patellar tilt angle (6.8°), femoral anteversion (11.5°), and tibial torsion (32°). All patients were followed up for at least 2 years, with an average of 43 months. Concurrent surgeries included tibial tuberosity transposition (100 %), MPFL reconstruction in 9 cases (81.8 %) and 2 patients also underwent division of the external alar ligament (18,2 %). PROMs at final follow-up showed mean values: Knee Society Score (KSS) (80.5), Kujala score (88.3), and Karnofsky performance status scale (88.8). Return to sport was reported by all active patients. Three cases required secondary surgical intervention for removal of the screws.</p></div><div><h3>Conclusion</h3><p>Trochleoplasty, especially with the Bereiter \"thin flap\" approach, improves patellofemoral congruency. Combining trochleoplasty with tibial tuberosity transposition addresses mal-tracking related to severe dysplasia and other à-la-carte procedures like medial patellofemoral ligament (MPFL) reconstruction enhance stability. In young and active patients, it resolves instability issues and reduces the likelihood of further dislocations with high return to sport rates.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sharma's risk assessment score as a decision making tool to decide between total hip arthroplasty or hemiarthroplasty as a treatment option for elderly patients with fracture neck of femur. A prospective observational study","authors":"Mrinal Sharma","doi":"10.1016/j.jor.2024.08.009","DOIUrl":"10.1016/j.jor.2024.08.009","url":null,"abstract":"<div><h3>Purpose</h3><p>The decision to do a total hip arthroplasty (THA) or a hemiarthroplasty (HA) in an elderly with a fracture neck of femur (FNOF) is commonly based upon the surgeon's preference, pre-anesthetic fitness, hospital setup, and intensive care backup. The author devised a Sharma's risk assessment score (SRAS), based upon all the common factors that affect the surgical outcomes following FNOF in the elderly, to help orthopedic surgeons decide between THA or HA as a treatment for FNOF.</p></div><div><h3>Material &amp; methods</h3><p>It was a prospective observational study conducted in a tertiary-level institute. SRAS is based upon 10 parameters with each parameter having a max score of 4 and a minimum score of 1. So the maximum score a patient can score is 40 and the minimum a patient can score is 10. It was hypothesized that a patient with FNOF with a preop SRAS score &gt;20 if subjected to a (HA) and a patient with a preop SRAS score ≤ 20 if subjected to a (THA) would have better outcomes and low complication rates. Out of Eighty-eight patients with FNOF, 7 were lost to follow-up. The remaining 81 patients with FNOF were prospectively followed between May 2018 and May 2022 and segregated into two groups THA (n = 47) and HA(n = 34) based on the SRAS.</p></div><div><h3>Results</h3><p>The average length of follow-up was 2.6 years (6 months–4 years). The average SRAS was an average 25.7(21–32) in the HA group and 16.2 (11–20) in the THA group. Complications were seen in 12.7 % of the THA group and 17.6 % of the HA group. We had a 2.1 % 90-day mortality in the THA group and a 2.9 % 90-day mortality in the HA group. One year mortality in THA was 2.1 % and it was increased to 5.8 % in the HA group.</p></div><div><h3>Conclusion</h3><p>SRAS is a useful decision-making tool that would guide surgeons to decide between THA or HA as a treatment option for elderly FNOF and would help minimize post-operative complications and reduce mortality.</p></div><div><h3>Level 3 study</h3><p>Prospective observational study.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142270942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the challenges of complex type III odontoid fractures: Clinical and radiological outcomes of various treatment modalities","authors":"Mahmoud Fouad Ibrahim,&nbsp;Mohammad Osama,&nbsp;Amr Hatem,&nbsp;Mohammad El-Sharkawi","doi":"10.1016/j.jor.2024.08.010","DOIUrl":"10.1016/j.jor.2024.08.010","url":null,"abstract":"<div><h3>Background</h3><p>Unlike simple fractures, complex Type III odontoid fractures—characterized by intricate morphology and pathomechanics—pose significant management challenges. This study aims to evaluate the clinical and radiological outcomes of conservative and surgical treatment modalities for these complex fractures, with a focus on assessing factors influencing fracture union.</p></div><div><h3>Methods</h3><p>Following approval of our institutional review board, this retrospective observational cohort study was conducted. All Patients with complex Type III odontoid fractures who were managed at our center from June 2016 to December 2022 were assessed for eligibility. The primary outcome was union status. Secondary outcomes included the ASIA impairment scale, neck disability index (NDI), and complications. Logistic regression analysis was conducted to identify risk factors for adverse union outcomes.</p></div><div><h3>Results</h3><p>A total of 39 patients were included in the final analysis, with a mean age of 36.10 years. Nine patients were managed conservatively, 12 patients underwent anterior odontoid screw (AOS) fixation, and 18 patients received posterior fusion (PF). The rate of bony union varied significantly across the treatment groups, 100 % in the PF group, 58 % in the AOS group and 22 % in the conservative group (p = 0.0012). The NDI revealed superior functional outcomes in the PF group compared to the other groups (p = 0.0436). Failure of primary treatment was observed in seven patients (three from the conservative group and four from the AOS), necessitating secondary treatment with PF. Lateral mass gap &gt;2 mm, coronal tilt &gt;5°, and atlantoaxial instability &gt;50 % were identified as significant risk factors for adverse union outcomes.</p></div><div><h3>Conclusions</h3><p>Surgical treatment, particularly PF, offers superior outcomes in terms of union rates and functional recovery for complex Type III odontoid fractures. The identification of specific radiological measurements as significant risk factors for non-union underscores the need for detailed imaging and careful patient selection for conservative versus surgical management.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinopelvic alignment and precise cup placement in total hip arthroplasty - A systematic review","authors":"S. Ram Sudhan ,&nbsp;Sibin Surendran ,&nbsp;Naveen P. Gopinath ,&nbsp;Jijulal C U ,&nbsp;V.V. Muhammed Fazil ,&nbsp;P. Gopinathan ,&nbsp;K.V. Nikhil","doi":"10.1016/j.jor.2024.08.008","DOIUrl":"10.1016/j.jor.2024.08.008","url":null,"abstract":"<div><h3>Study Design</h3><div>A systematic literature review and meta- analysis</div></div><div><h3>Objective</h3><div>To extract and combine the available literature focused on normal and abnormal biomechanical principles of spine-pelvis-hip complex and to sum up the data in the application of THA both in the setting with and without spinal disorders.</div></div><div><h3>Methods</h3><div>An extensive search and analysis of the articles was done by 3 authors independently in 7 platforms based on PRISMA and MOOSE guidelines. Selection criteria 1. Articles that assessed spinopelvic parameters (SS, SPT, PI, and acetabular cup orientation) in patients undergoing THA, Articles that assessed balance in spinopelvic complex after THA, Randomized control studies, Systematic literature reviews, Meta-analyses, Clinical trials / original research studies, Review articles and Articles after 2015 were included. Cochrane’s GRADE method was used to define the level of evidence. 2.Participants: Patients who underwent THA only (in asymptomatic spine), those who had ankylosing spondylitis and underwent THA and those who underwent THA with prior spinal arthrodesis. 3.Study parameters: Ante Inclination (AI), sacral slope (SS), pelvic Incidence (PI) and spinopelvic tilt (SPT) in both positions of standing and sitting. ΔAI, ΔSS and ΔSPT. Data were collected and analyzed, the means of the study parameters with SD were calculated and a meta-analysis is performed to evaluate the pooled means with optimal value range.</div></div><div><h3>Results</h3><div>From 218 abstracts extracted and after eligibility assessment and exclusion, 4 articles involving 439 patients were enrolled. The mean SS in standing and sitting calculated were 35.53±10.52 and 33.13±12.38. The mean of AI and SPT in standing /sitting positions are 29.7±12.29/34.69±12.96 (n = 242) and 19.56±8.9/21.22±12.53 (n=439) respectively. The ΔAI, ΔSS, and ΔSPT were 4.99,2.4 and 1.66 respectively.</div></div><div><h3>Conclusion</h3><div>There is a proportionate change between the spinopelvic tilt and the acetabular orientation in postural variations. Evaluation of spine, pelvis and hip becomes more critical in identifying these changes and thereby prompting the acetabular cup position in the functional safe zone.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}