Journal of Orthopaedic Science最新文献

{"title":"Symptoms of sacral fractures after posterior spinal instrumented fusion: A case series","authors":"","doi":"10.1016/j.jos.2023.09.006","DOIUrl":"10.1016/j.jos.2023.09.006","url":null,"abstract":"<div><h3>Background</h3><p>Improvements in spinal fusion devices and techniques have enabled stronger spinal fusion, resulting in excellent clinical outcomes. Nevertheless, complications associated with implants, such as screw misalignment, screw lubrication, cage dislocation, and skin issues, might occur. This study aimed to investigate the characteristics and symptoms of sacral fractures after spinal instrumented fusion.</p></div><div><h3>Methods</h3><p>This case series retrospectively examined the medical records of eight patients (one man and seven women; mean age: 74 years) diagnosed with sacral fractures after undergoing posterior spinal instrumented fusion from February 2015 to March 2022.</p></div><div><h3>Results</h3><p><span>The average number of fusion levels in all patients was 3.5 (range, 1–10). The lowest instrumented vertebrae<span> (LIV) ranged from L5 to the ilium. Sacral fractures were diagnosed at 18.8 (range, 0.5–84) months postoperatively. The average time from consultation to diagnosis was nine days (range, 0–25 days). Two patients had subclinical fractures, two had H-shaped fractures with the LIV at L5, and four had U-shaped fractures, including screw holes. Buttock pain and lower extremity pain, the most commonly reported symptoms, were observed in seven patients each. There were also instances of leg numbness, muscle weakness, and unilateral leg pain that may be related to L5 or S1 radiculopathy. In all patients, leg and buttock pain were worse during movement and in the sitting position, and better while resting and in the </span></span>supine position. Three patients were treated conservatively, and five were treated with extended fixation to the ilium.</p></div><div><h3>Conclusions</h3><p>Sacral fractures following posterior spinal fusion can cause radiculopathy and buttock pain. Symptoms are especially severe when instability occurs in the pelvic region, such as during movements or sitting. As atypical radiculopathy may lead to delays in diagnosis, spine surgeons should recognize the symptoms of this condition.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49678786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphology and deformity of the distal phalanx in hallux valgus","authors":"","doi":"10.1016/j.jos.2023.09.010","DOIUrl":"10.1016/j.jos.2023.09.010","url":null,"abstract":"<div><h3>Background</h3><p>Studies have shown that the first metatarsal contributes to hallux valgus<span><span><span>. The proximal phalanx, another factor that defines the hallux </span>valgus angle, also contributes to the development of hallux valgus. There have been no reports on the use of </span>computed tomography to evaluate bone morphology of the proximal phalanx. The purpose of this study was to analyze the morphology and deformity of the proximal phalanx and its relationship to hallux valgus using computed tomography, and to consider the indications for proximal phalanx surgery in hallux valgus.</span></p></div><div><h3>Methods</h3><p>Patients who consulted at our clinic for foot and ankle disorders<span> and underwent both weight-bearing radiography and computed tomography between May 2019 and March 2022 were included in the study. The hallux valgus angle, sesamoid subluxation, first metatarsal length, proximal phalanx length, metatarsal-proximal phalanx ratio, proximal phalanx valgus angle, metatarsal-proximal phalanx angle, proximal phalanx rotation angle, and distal phalanx-proximal phalanx angle were measured. These parameters were compared between the hallux valgus and control groups. In the hallux valgus group, the hallux valgus and proximal phalanx valgus angles were measured and compared using weight-bearing radiographs.</span></p></div><div><h3>Results</h3><p>A total of 83 feet in 65 patients were diagnosed with hallux valgus (hallux valgus group; mean age of 68.0 ± 13.8 years) and 30 feet in 22 patients without hallux valgus (control group; mean age of 67.0 ± 25.8 years) were included in the study. The proximal phalanx length, metatarsal-proximal phalanx ratio and angle, and distal phalanx-proximal phalanx angle were significantly greater in the hallux valgus group than in the control group. However, the proximal phalanx valgus and rotation angles were not significantly different between the groups.</p></div><div><h3>Conclusion</h3><p>Since there was no significant difference in the proximal phalanx morphology, except length, between the hallux valgus and control groups, the indications for osteotomy of the proximal phalanx should be carefully considered.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49678783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of lumbar lordosis angle on the development of lumbar spondylolysis in adolescent baseball players: A cross-sectional study","authors":"","doi":"10.1016/j.jos.2023.09.004","DOIUrl":"10.1016/j.jos.2023.09.004","url":null,"abstract":"<div><h3>Background</h3><p><span>Lumbar spondylolysis<span> (LS) is a lumbar vertebral arch stress fracture that often occurs in adolescent athletes, especially baseball players. An increase in lumbar </span></span>lordosis angle (LLA) increases the compressive stress on the vertebral arch, influencing the development of LS. However, the effect of LLA on LS development in adolescent baseball players is unknown. Therefore, it is necessary to elucidate the risk factors that influence the development of LS. This cross-sectional study aimed investigate the effect of LLA on LS development in adolescent baseball players.</p></div><div><h3>Methods</h3><p><span>Patients were male baseball players aged 11–18 years who visited an orthopedic clinic with a chief complaint of lumbar pain and underwent a </span>magnetic resonance imaging<span><span> (MRI) examination between January 1, 2018, and October 31, 2021. LLA was defined as the angle formed by the line parallel to the superior endplate of the L1 and S1. A person other than the data analyst measured LLA three times from the MRI, and the average value was used for data analysis. Logistic regression analysis was performed, with the presence or </span>absence<span> of LS as the objective variable and LLA, age, and previous pitching experience as explanatory variables.</span></span></p></div><div><h3>Results</h3><p>Of the 112 subjects included, 79 were in the LS group and 33 in the non-LS group. The LLA was 45.42 ± 8.19° in the LS group and 36.68 ± 8.26° in the non-LS group, with significant differences between the groups. Logistic regression analysis showed that LLA significantly differed with an odds ratio of 1.140 (95% confidence interval: 1.070–1.21), even after adjusting for age and previous pitching experience.</p></div><div><h3>Conclusions</h3><p>LLA in adolescent baseball players was significantly greater in the LS group than in the non-LS group, which may influence the development of LS.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61563266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on Yamato et al.: Impact of multi-rod reinforcement on rod fractures in adult spinal deformity: A retrospective case series with a minimum follow up of 5 years","authors":"","doi":"10.1016/j.jos.2024.05.006","DOIUrl":"10.1016/j.jos.2024.05.006","url":null,"abstract":"","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141457641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of pre-operative HbA1c and blood glucose level on the surgical site infection after lumbar instrumentation surgery","authors":"","doi":"10.1016/j.jos.2023.08.015","DOIUrl":"10.1016/j.jos.2023.08.015","url":null,"abstract":"<div><h3>Background</h3><p><span>This study aims to investigate the effect of pre-operative hemoglobin A1c<span> (HbA1c) and pre-operative blood glucose control on the rate of </span></span>surgical site infection (SSI) after posterior lumbar instrumentation surgery in diabetes mellitus (DM) patients.</p></div><div><h3>Methods</h3><p>A total of 1046 patients who had undergone posterior lumbar instrumentation surgery were reviewed. Based on pre-operative HbA1c, patients were divided into three groups: non-DM group, low HbA1c group (HbA1c &lt; 7.0 % in DM) and high HbA1c group (≥7.0). As well, based on the status of blood glucose control in DM patients immediately before surgery, patients were divided into two groups: good control group (post-prandial blood glucose [PBG] &lt; 200 mg/dl) and poor control group (≥200). The rate of SSI was compared among these groups.</p></div><div><h3>Results</h3><p>SSI occurred in 1.9 % in non-DM group, 2.4 % in low HbA1c group, and 9.3 % in high HbA1c group. Compared with non-DM group, high HbA1c group had significantly higher rate of SSI (p = 0.001). There was not statistically different between non-DM and low HbA1c groups (p = 0.550). SSI occurred in 2.2 % in good control group, and 10.2 % in poor control group. The rate of SSI was significantly lower in good control group (p = 0.013).</p></div><div><h3>Conclusion</h3><p>This study showed that the rate of SSI after posterior lumbar instrumentation surgery tend to be higher in DM patients with high HbA1c. However, the rate might be reduced to the same level as that of non-DM group by lowering PBG to &lt;200 mg/dl immediately before surgery.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49678758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to letter to the editor by Li et al.","authors":"","doi":"10.1016/j.jos.2024.06.001","DOIUrl":"10.1016/j.jos.2024.06.001","url":null,"abstract":"","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141457642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the radiological and functional results of a plaster splint and dynamic stabilization splint for Boxer's fractures: A prospective randomized controlled study","authors":"","doi":"10.1016/j.jos.2023.08.004","DOIUrl":"10.1016/j.jos.2023.08.004","url":null,"abstract":"<div><h3>Purpose</h3><p>This study compared the clinical and radiological results of fifth metacarpal neck fractures treated with a short-arm plaster splint (SAPS) versus a dynamic metacarpal stabilization splint (DMSS).</p></div><div><h3>Materials and methods</h3><p>The 119 patients were referred to our institute between 2018 and 2019 and treated with SAPS or DMSS after appropriate initial closed reduction<span>. Follow-up examinations were conducted at days 10 and 20, and at 1, 2, and 3 months after treatment. Alignment of the fracture, range of motion (ROM), and complications were evaluated during each visit. Grip strength was evaluated using a dynamometer. Self-care, usual daily activities, pain/discomfort, and anxiety/depression were evaluated using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) and a VAS.</span></p></div><div><h3>Results</h3><p><span>Of the 119 patients, 103 completed all follow up examinations. In total, 51 patients were treated with SAPS and 52 with DMSS. Skin lesions were detected in five patients in the DMSS group, but none in the SAPS group (p = 0.008). The grip strength of patients in the DMSS group was statistically better at the 1-, 2-month and 3-month follow-up visits (p &lt; 0.001). ROM of the interphalangeal and </span>metacarpophalangeal joints were statistically better in the DMSS group at the 1-month visit (p &lt; 0.001) but similar at the 3-month visit (p = 0.27). Wrist ROM was statistically higher in the DMSS group at the 3-month visit (p &lt; 0.05). Self-care, usual daily activities, pain/discomfort, and anxiety/depression were statistically better in the DMSS group at all follow-up visits (p &lt; 0.05), as determined by the EQ-5D-5L.</p></div><div><h3>Conclusion</h3><p>Dynamic stabilization of a stable boxer's fracture with DMSS is as effective as static stabilization with SAPS for maintaining the reduction and ensuring union. However, DMSS provides better early ROM, comfort, and muscle strength, as well as an earlier return to usual daily activities despite the occasional skin lesions happened.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9991015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiome of infected fracture nonunion: Does it affect outcomes?","authors":"","doi":"10.1016/j.jos.2023.08.018","DOIUrl":"10.1016/j.jos.2023.08.018","url":null,"abstract":"<div><h3>Background</h3><p>Infected fracture nonunions<span> often require prolonged treatment and recovery courses. It is unclear whether the bacterial microbiome<span> influences the time to healing as well as the eradication of infection. The goals of this study are (1) to assess the bacterial microbiome affecting infected nonunions and (2) to evaluate the effects of bacterial speciation on associated outcomes.</span></span></p></div><div><h3>Methods</h3><p><span>Between 2006 and 2022, data from 551 adult patients from a single academic institution who presented with a fracture nonunion were analyzed retrospectively for infection. All patients underwent revision surgery with three sets of cultures obtained intra-operatively. Patients with significant intra-operative cultures were grouped into gram-positive and gram-negative culture cohorts. These patients were managed with a standardized protocol involving surgical debridement, nonunion site fixation, and culture-directed </span>antibiotic<span> treatment. Primary outcome was time to fracture union<span>. Secondary outcomes included number of re-operations and eventual amputation or reconstructive surgery.</span></span></p></div><div><h3>Results</h3><p><span>56 nonunion patients (10 %) were diagnosed with an infected nonunion (44 g-positive, 12 g-negative). Of these, 3 g-positive patients received an amputation or arthroplasty procedure prior to </span>fracture union, and seven were lost to follow-up. There were no significant differences in age, gender, or nonunion site between cohorts. Most nonunions occurred in the lower extremity. The most common bacteria were staph species (54.3 %). 36 g-positive and 10 g-negative patients achieved fracture union. Time to union was on average 158.4 days longer in the gram-negative cohort—but did not reach statistical significance (446.8 days gram-positive, 662.3 days gram-negative, p = 0.69). There was no difference in re-operation rates (1.9 % gram-positive, 2.2 % gram-negative, p = 0.84).</p></div><div><h3>Conclusions</h3><p>Patients with infected nonunions had wide-ranging bacterial contamination that were treated successfully using a standardized protocol. However, patients with any gram-negative culture trended toward a delay in time to union.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial patient demographics affecting return to original work after traumatic hand injury in a rural area in Japan: A retrospective single-center study","authors":"","doi":"10.1016/j.jos.2023.09.002","DOIUrl":"10.1016/j.jos.2023.09.002","url":null,"abstract":"<div><h3>Background</h3><p>Time off work after traumatic hand injury not only affects individuals but also has socioeconomic repercussions, becoming a serious problem from the viewpoint of labor shortages. In depopulated rural areas, the impact of labor shortages due to time off work is more serious than in urban areas; however, few studies have examined return to original work in rural areas. The purpose of this study was to investigate the patient demographics at the time of hand injury that affect return to original work in a rural area of Japan.</p></div><div><h3>Methods</h3><p><span>We retrospectively examined 246 patients with traumatic hand and/or forearm injuries who were working at the time of injury, and who underwent surgical operations and postoperative rehabilitation in a level II hospital in a rural agricultural area. We examined patients' initial demographic data, including gender, age, occupation (white or blue collar), employment status (self-employed, full-time, or part-time workers), complications other than hand injury, workers’ compensation, dominant hand injury, and </span>injury severity<span> as determined using the modified Hand Injury Severity Score<span>. Multivariate logistic regression analysis examined the association between initial patient demographics and return to original work within 150 days after injury.</span></span></p></div><div><h3>Results</h3><p>In total, 186 patients (76 %) were able to return to original work within 150 days. A multivariate logistic regression analysis showed that three explanatory variables (i.e., severity of injury, complications other than hand injury, and female gender) significantly compromised return to original work.</p></div><div><h3>Conclusions</h3><p>In the treatment of traumatic hand injury, intensive support should be provided for return to original work for patients who are expected to have difficulty returning to work quickly. In addition, labor shortages can be mitigated by sharing information with the workplace about patients’ prospects of return to original work.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel diagnostic examination for dropped head syndrome (DHS) (Prone position cervical extension test; DHS test)","authors":"","doi":"10.1016/j.jos.2023.09.003","DOIUrl":"10.1016/j.jos.2023.09.003","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Dropped head syndrome (DHS) is followed by severe cervical extension muscle weakness that results in chin-on </span>chest deformity. However, maintaining a neutral cervical position can be temporarily possible, and the diagnosis of DHS might sometimes be difficult. The purpose of the present study is to examine a novel clinical test (DHS test) as the diagnostic utility for objective evaluation that focuses on cervical extension condition in the </span>prone position.</p></div><div><h3>Methods</h3><p>One hundred subjects were diagnosed with isolated neck extensor myopathy<span> (INEM)-DHS at our hospital (17 men and 83 women, mean age 75.0 ± 8.5 years), and 62 subjects were enrolled as age-matched controls. The DHS test consisted of three examinations; the first was “Ceiling gazing test” in standing position, the second was horizontal gazing in “Sphinx prone position test”, and the third was horizontal gazing in “Hands and knees prone position test”. We investigated the sensitivity and specificity of the DHS test for DHS.</span></p></div><div><h3>Results</h3><p>The patients showing positive in the INEM-DHS group were 63/100 in Ceiling gaze test, 73/100 in the Sphinx prone position test, and 91/100 in the Hands and knees prone position test. In the control group, 0/62 patients presented positive in the Ceiling gaze test, 4/62 in the Sphinx prone position test, and 0/62 in the Hands and knees prone position test. Sensitivity and specificity of the DHS test were 63.0%/100%, 73.0%/93.5%, and 91.0%/100% in the Ceiling gaze test, Sphinx position prone position test, and Hands and knees prone position test, respectively.</p></div><div><h3>Conclusion</h3><p>The prone position cervical extension test (DHS test) would be useful as a novel objective diagnostic tool for INEM-DHS.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}