Orthopaedic Surgery最新文献

{"title":"Innovative 3D Navigation Module for Precise Unilateral Pedicle Screw Combined with Contralateral Translaminar Facet Screw Placement in Lumbar Spine Surgery.","authors":"Xu Chen, Hanhao Dai, Jun Luo, Huaizhi Zhang, Chao Song, Zhibo Deng, Yanyan Zhang, Xing Li, Jianhui Dai, Jie Xu","doi":"10.1111/os.14241","DOIUrl":"10.1111/os.14241","url":null,"abstract":"<p><strong>Objective: </strong>The incidence of degenerative diseases of the lumbar spine has increased in recent years. Unilateral pedicle screw combined with contralateral translaminar facet screw fixation offers the advantages of less trauma, better stability, and fewer complications. However, the surgical difficulty and suboptimal pinning accuracy of translaminar facet screw placement in clinical practice limit its use. Therefore, in this study, we designed a novel suspended 3D-printed navigation module to facilitate fast and accurate intraoperative screw placement. The aim of this study is to investigate the digital design, precise implementation, and evaluation methods for placing unilateral pedicle screws in the lumbar spine combined with translaminar facet screw placement using a new suspended 3D navigation module.</p><p><strong>Methods: </strong>This retrospective study included 46 patients with single-level lumbar lesions who underwent spine surgery at the Affiliated Hospital of Putian University between June 2022 and December 2023. The suspended navigation module was designed digitally. Preoperative screw placement was simulated using 3D printed models, followed by an intraoperative accurate screw placement facilitated by the navigation module and a postoperative evaluation of the accuracy of screw placement. The absolute difference in three-dimensional coordinates of the inlet and outlet points of the preoperative design and the postoperative screw-nail channel served as the precision index.</p><p><strong>Results: </strong>In a study involving 46 patients, surgery was successful with 92 pedicle screws and 46 translaminar facet screws placed without any penetration of the cortex. The difference in coordinates before and after screw insertion was minimal, with entry points varying between 1.21 to 1.36 mm and exit points between 1.97 to 2.46 mm. When screw accuracy met certain thresholds, there was no significant difference between preoperative design and postoperative coordinates, indicating precise replication of the surgical plan.</p><p><strong>Conclusion: </strong>The new suspended 3D navigation module enables the precise placement of unilateral pedicle screws in the lumbar spine combined with translaminar pedicle screws for precise surgery.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"3026-3035"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunistic Assessment of Hip Fracture Risk Based on Chest CT.","authors":"Xiong Yi Wang, Si Min Yun, Wei Feng Liu, Yi Ke Wang, Sheng Pan, You Jia Xu","doi":"10.1111/os.14224","DOIUrl":"10.1111/os.14224","url":null,"abstract":"<p><strong>Objective: </strong>Hip fracture (HF) has been described as the \"last fracture of life\" in the elderly, so the assessment of HF risk is extremely important. Currently, few studies have examined the relationship between imaging data from chest computed tomography (CT) and HF. This study demonstrated that pectoral muscle index (PMI) and vertebral body attenuation values could predict HF, aiming to opportunistically assess the risk of HF in patients without bone mineral density (BMD) based on chest CT for other diseases.</p><p><strong>Methods: </strong>In the retrospective study, 800 participants who had both BMD and chest CT were enrolled from January 2021 to January 2024. After exclusion, 472 patients were finally enrolled, divided into the healthy control (HC) group and the HF group. Clinical data were collected, and differences between the two groups were compared. A predictive model was constructed based on the PMI and CT value of the fourth thoracic vertebra (T4HU) by logistic regression analysis, and the predictive effect of the model was analyzed by using the receiver operating characteristic (ROC) curve. Finally, the clinical utility of the model was analyzed using decision curve analysis (DCA) and clinical impact curves.</p><p><strong>Results: </strong>Both PMI and T4HU were lower in the HF group than in the HC group (p < 0.05); low PMI and low T4HU were risk factors for HF. The predictive model incorporating PMI and T4HU on the basis of age and BMI had excellent diagnostic efficacy with an area under the curve (AUC) of 0.865 (95% confidence interval [CI]: 0.830-0.894, p < 0.01), sensitivity and specificity of 0.820 and 0.754, respectively. The clinical utility of the model was validated using calibration curves and DCA. The AUC of the predictive model incorporating BMD based on age and BMI was 0.865 (95% CI: 0.831-0.895, p < 0.01), with sensitivity and specificity of 0.698 and 0.711, respectively. There was no significant difference in diagnostic efficacy between the two models (p = 0.967).</p><p><strong>Conclusions: </strong>PMI and T4HU are predictors of HF in patients. In the absence of dual-energy x-ray absorptiometry (DXA), the risk of HF can be assessed by measuring the PMI and T4HU on chest CT examination due to other diseases, and further treatment can be provided in time to reduce the incidence of HF.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2933-2941"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complicated Spinal Stenosis and Spinal Deformity in Patients with Achondroplasia: Case Series and Review of the Literature.","authors":"Wenyang Fu, Xianlei Gao, Xia Wang, Rongkun Xu, Shangye Li, Lianlei Wang, Xinyu Liu","doi":"10.1111/os.14246","DOIUrl":"10.1111/os.14246","url":null,"abstract":"<p><strong>Objective: </strong>Due to the low incidence of achondroplasia (Ach), there is a relative lack of research on the treatment and management of spinal complications of Ach. Characteristics and interventions for spinal complications in patients with Ach are in urgent need of investigation. This study aimed to summarize the common spinal complications in patients with Ach and the corresponding treatment strategies.</p><p><strong>Methods: </strong>This study is a retrospective case series. We retrospectively collected and analyzed Ach cases who presented to our hospital with neurological symptoms due to skeletal anomalies between February 2003 and October 2023. A total of seven patients were included, four males (57.1%) and three females (42.9%) with a mean age of 38.57 years. Patient pain/numbness visual analog scale (VAS), preoperative Oswestry disability index (ODI), development of neurological complaints, and presentation of skeletal abnormalities were collected and followed up routinely at 3, 6, 12 and 24 months postoperatively. The relevant literature was reviewed.</p><p><strong>Results: </strong>Seven patients were included in this series. The mean preoperative VAS was 4, and the mean preoperative ODI was 50.98%. All patients had concomitant spinal stenosis, four with thoracolumbar kyphosis (TLK), and one with scoliosis. Six of the seven patients underwent surgery, and one patient received conservative treatment. In the routine follow-ups, all patients experienced satisfactory relief of symptoms. Only one of the seven patients developed a new rare lesion adjacent to the primary segments. Six months after the first surgery, a follow-up visit revealed thoracic spinal stenosis caused by ossification of the ligamentum flavum, and his symptoms were relieved after thoracic decompression surgery.</p><p><strong>Conclusions: </strong>Ach seriously affects the skeletal development of patients and can lead to the development of spinal stenosis, spinal deformities, and other complications of the locomotor system. Surgery remains the primary treatment for complications of the musculoskeletal system. Specific surgical approaches and comprehensive, long-term management are critical to the treatment of patients with spinal complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"3059-3067"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sub-Acromioclavicular Decompression Increases the Risk of Postoperative Shoulder Stiffness after Arthroscopic Rotator Cuff Repair.","authors":"Cheng Li, Zhiling Wang, Maslah Idiris Ali, Yi Long, Ymuhanmode Alike, Min Zhou, Dedong Cui, Zhenze Zheng, Ke Meng, Jingyi Hou, Rui Yang","doi":"10.1111/os.14225","DOIUrl":"10.1111/os.14225","url":null,"abstract":"<p><strong>Objective: </strong>The sub-acromioclavicular (SAC) decompression is often performed during arthroscopic rotator cuff repair. However, the impact of SAC decompression on patients with postoperative shoulder stiffness (POSS) are controversial and unclear. This study is aim to evaluate the impact of additional sub-acromioclavicular (SAC) decompression during arthroscopic rotator cuff repair on the postoperative shoulder stiffness (POSS) in patients.</p><p><strong>Methods: </strong>This retrospective study examined digital data from patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair at a local institution. Patient-reported outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) Score, the University of California-Los Angeles (UCLA) score, and visual analog scale (VAS) scores. Restricted shoulder mobility occurring within 6 months postoperatively, lasting more than 12 weeks, characterized by a passive forward flexion angle of <120° or an external rotation angle of <30°, with or without associated shoulder pain was identified as POSS. Factors affecting POSS were analyzed by binary logistic regression analysis. The patient-reported outcomes scores were analyzed by generalized estimating equations to examine the impact of SAC decompression.</p><p><strong>Results: </strong>A total of 155 patients met the set criteria and were included in the study. The analysis of binary logistic regression showed that diabetes (p = 0.001) and SAC decompression (p = 0.003) were independent factors for POSS. In the analysis of each follow-up point, only at the 3-month follow-up, the ASES scores (p = 0.003), UCLA scores (p = 0.045), and VAS scores (p = 0.005) showed significant differences between the SAC decompression group and the non-decompression group. For the intergroup comparison, the results showed a significant difference in the ASES scores (β = -4.971, p = 0.008), UCLA scores (β = -1.524, p = 0.019), and VAS scores (β = 0.654, p = 0.010) throughout the study duration between the SAC decompression group and the non-decompression group.</p><p><strong>Conclusion: </strong>The findings of this study suggested that SAC decompression during arthroscopic rotator cuff repair increase the risk of POSS compared with those without the decompression, which indicate surgeons do not perform SAC decompression unless necessary.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2942-2949"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Red Blood Cell Distribution Width and Platelet Count Useful for Diagnosing Periprosthetic Joint Infection in Patients Undergoing Re-Revision Arthroplasty.","authors":"Yangming Zhang, Qiyu Xie, Boyi Jiang, Wenyu Jiang, Hong Xu, Zongke Zhou","doi":"10.1111/os.14219","DOIUrl":"10.1111/os.14219","url":null,"abstract":"<p><strong>Objective: </strong>Accurate and prompt identification of periprosthetic joint infections (PJIs) is critical prior to re-revision arthroplasty to ensure optimal surgical outcomes. Among routinely measured blood indices, red blood cell distribution width (RDW) and platelet count (PLT) have shown strong correlations with infection presence. This study aimed to assess the utility of RDW and PLT for diagnosing PJI in patients scheduled for re-revision arthroplasty.</p><p><strong>Methods: </strong>This retrospective research encompassed all patients who underwent re-revision hip or knee arthroplasty at our institution from 2008 to 2022. Participants were categorized into either the PJI (n = 41) or the non-PJI (n = 47) group following the guidelines established in the 2013 International Consensus Meeting on PJI. In this analysis, RDW and PLT counts were evaluated alongside conventional inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The efficacy of these diagnostics was evaluated by the area under the receiver operating characteristic (ROC) curve ([area under the curve AUC]).</p><p><strong>Results: </strong>RDW demonstrated a modest AUC of 0.678 with sensitivity at 61.0% and specificity at 71.7%, using a threshold of 14.5%. PLT was on par with ESR, showing an AUC of 0.773, and both sensitivity and specificity around 73% at a threshold of 201 × 10⁹/L. CRP presented the highest diagnostic accuracy with an AUC of 0.815, achieving a sensitivity of 82.9% and specificity of 73.9% at a 6.9 mg/L threshold, surpassing ESR's AUC of 0.754. None of the biomarkers, individually or combined, outperformed CRP alone (p > 0.05).</p><p><strong>Conclusions: </strong>In the context of re-revision arthroplasty, RDW and PLT demonstrate limited efficacy as diagnostic biomarkers for PJI. However, CRP retains its reliability as a biomarker when the diagnostic threshold is appropriately recalibrated.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2916-2923"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Modified Skin Stretching for Soft Tissue Defect Reconstruction in the Ankle and Foot: A Retrospective Report.","authors":"Xiaqing Yang, Yuping Liu, Weixing Wang, Xue Fang, Wang Zhang, Changhuan Liu, Xin Wang","doi":"10.1111/os.14265","DOIUrl":"10.1111/os.14265","url":null,"abstract":"<p><strong>Objective: </strong>The failure rate of foot and ankle soft tissue defect reconstruction with flap is relatively high, often posing a significant burden on patients. The aim of this study is to explore the effectiveness of repeated stretch sutures in repairing skin and soft tissue defects of the ankle and foot.</p><p><strong>Methods: </strong>Twenty-three patients with ankle and foot skin and soft tissue defects were retrospectively analyzed between February 2016 and February 2019. Sutures were repeatedly stretched every 3-5 days. Local skin grafting was performed if necessary after wound surfaces disappeared or exposed tendons and bones were covered by soft tissue. Wound healing time, postoperative healing area, Vancouver Scar Assessment Scale, sensation, and function of the new skin were evaluated.</p><p><strong>Results: </strong>Healing time was 17-35 (24.43 ± 5.29) days. Ten patients wholly healed, and 13 healed by approximately 70.08% ± 6.59%. The Vancouver Scar Assessment Scale average score was 2.83 ± 1.19 points, of which 15 cases were excellent (0-3 points) and 8 cases were good (4-7 points). The sensation and function of the new skin after repair were equivalent to those of normal skin after the last follow-up.</p><p><strong>Conclusions: </strong>Applying repeated tension sutures on the skin and soft defects of the ankle and foot reduced the skin graft area and decreased complex high-risk surgical flaps' use and transplantation area.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"3179-3184"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overloaded Vertebral Body Following Consecutive Three-Level Hybrid Surgery Comparing with Anterior Cervical Discectomy and Fusion.","authors":"Shi-Hao Chen, Ya-Ling Li, Hao Liu, Ting-Kui Wu, Kang-Kang Huang, Ming-He Yao, Bei-Yu Wang","doi":"10.1111/os.14242","DOIUrl":"10.1111/os.14242","url":null,"abstract":"<p><strong>Objective: </strong>Based on the varying number and relative positions of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF) procedures, three-segment hybrid surgery (HS) presents a diverse structural approach. Currently, the potential differential effects of HS with different segment combinations and surgical procedures on overloaded vertebral body (OVB) occurrence remain unexplored. The purpose of this retrospective study is to compare the clinical and radiological outcomes of HS and ACDF in treating cervical degenerative disc disease (CDDD), aiming to provide further insights into OVB.</p><p><strong>Methods: </strong>This study included patients with three-level CDDD who underwent ACDF or HS at our institution. Eligible patients were divided into three groups: Type I (one-level CDR and two-level ACDF), Type II (two-level CDR and one-level ACDF), and ACDF (three-level ACDF). For radiographic analysis, patients were further divided into the Replacement Segment Group and the Nonreplacement Segment Group based on the presence of replacement segments above and below the OVB. Clinical outcomes were evaluated using visual analog scale (VAS) scores for neck and arm pain, Japanese Orthopedic Association (JOA) scores, and neck disability index (NDI) scores. The cervical radiological parameters assessed included (1) vertebral cross-sectional area (CSA), (2) wedge angle (WA), (3) anterior vertebral height (AH), (4) posterior vertebral height (PH), and (5) Hounsfield unit (HU) values. Statistical methods included paired t-test, ANOVA test, and chi-square test. Independent samples t-test, Mann-Whitney U test, and Wilcoxon signed-rank test were used to compare the differences between two groups according to the results of normal distribution test.</p><p><strong>Results: </strong>A total of 123 patients, evenly distributed among three groups, were included and were well matched in terms of demographic characteristics. The likelihood of vertebral body collapse (VBC) was notably higher in the ACDF group (41.5%) compared with the Type I (17.9%) and Type II (8.9%) groups (p < 0.01). Following surgery, both at 3 and 6 months, the ACDF group demonstrated higher VAS neck scores and NDI scores compared with the Type I and Type II groups (p < 0.01). Additionally, the WA and AH values of the upper and lower adjacent OVB were consistently lower in the ACDF group than in the Type I and Type II groups at 6 and 12 months and at the final follow-up (p < 0.01). Notably, in the Nonreplacement Segment Group, WA significantly decreased at 12 months postoperatively and at the final follow-up compared with the Replacement Segment Group (p < 0.01).</p><p><strong>Conclusions: </strong>Three levels of HS appear to reduce stress concentrations and alleviate morphological changes in OVB. The occurrence of more VBC patients with OVB was associated with the use of Zero-P or Zero-P VA implants.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"3036-3046"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-Shortening Screw for the Prevention of Postoperative Shortening in Displaced Femoral Neck Fractures: A Retrospective Cohort Study.","authors":"Dongze Lin, Weipeng Gong, Chaohui Lin, Jiajie Liu, Ke Zheng, Peisheng Chen, Fengfei Lin","doi":"10.1111/os.14232","DOIUrl":"10.1111/os.14232","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Early femoral neck shortening after femoral neck system (FNS) fixation for displaced femoral neck fractures can occur in 22.3%-39.1% of cases, leading to decreased hip joint function. This study aimed to investigate the effectiveness of using an anti-shortening screw (ASS) in FNS fixation to prevent postoperative femoral neck shortening in displaced femoral neck fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively analyzed 106 cases of displaced femoral neck fractures treated with FNS at the Hospital from April 2020 to April 2023. Patients were divided into two groups based on the use of an ASS: the traditional group and the ASS group, each consisting of 53 cases. The ASS group was age-matched with the traditional group treated during the same period without an ASS. The study variables included age, sex, body mass index (BMI), smoking and drinking history, injury mechanism, side of injury, fracture type, surgical time, intraoperative blood loss, Harris Hip Score (HHS) at the final follow-up, radiographic assessment (femoral neck shortening), and complications (infection, femoral head necrosis, nonunion, and secondary surgery). Statistical analysis was performed using SPSS software, with continuous and categorical variables analyzed using appropriate parametric (t-test) and nonparametric (Mann-Whitney U test) tests, and chi-square or Fisher's exact tests, respectively. A p-value &lt;0.05 was considered significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were no significant differences in background characteristics between the traditional and ASS groups. The shortening distance at postoperative day 1 did not differ significantly between the two groups (0 vs. 0 mm, p = 0.120). However, at 1, 3 months, and 1 year postoperatively, the femoral neck shortening in the ASS group was significantly less than that in the traditional group (1 month: 2.3 vs. 3.1 mm, p = 0.007; 3 months: 2.6 vs. 3.5 mm, p = 0.005; 1 year: 2.6 vs. 3.5 mm, p = 0.002). The ASS group also had a significantly lower shortening distance during the fracture healing process (0.9 vs. 2.7 mm, p = 0.005). The incidence of moderate to severe shortening (≥5 mm) at 1 year postoperatively was lower in the ASS group compared with the traditional group (15.1% vs. 37.7%, p = 0.001). The ASS group had a longer surgical time (63.0 ± 13.4 vs. 73.0 ± 23.2 min, p = 0.008) and a higher HHS (90.7 vs. 94.8, p = 0.008). There was no significant difference in fracture healing time or postoperative complications between the two groups. The traditional group had 3.8% cutouts, 7.5% nonunions, 5.7% avascular necrosis, and 7.5% secondary hip replacements. The ASS group saw 0% cutouts, 1.9% nonunions, 3.8% avascular necrosis, and 3.8% hip replacements. No significant differences in complication rates (p &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The use of an ASS in FNS fixation for displaced femoral neck fractures can reduce the degree of postoperative shortening and improv","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2967-2975"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Arthroscopic Resection of the Talocalcaneal Coalition in Adults: Key Points of Surgical Technique.","authors":"Yiyuan Sun, Wufeng Cai, Xihao Huang, Jian Li, Qi Li","doi":"10.1111/os.14228","DOIUrl":"10.1111/os.14228","url":null,"abstract":"<p><strong>Objective: </strong>Potential disadvantages of open technique for talocalcaneal coalition (TCC) include a risk of wound infection, opioid drug dependence, and prolonged hospitalization. The purpose of this study was to retrospectively evaluate the effectiveness and safety of endoscopic resection of the TCC.</p><p><strong>Methods: </strong>A retrospective study from June 2019 to February 2023was conducted on 16 consecutively admitted patients who were diagnosed by imaging to have TCC for whom conservative treatment had failed and who undergone arthroscopic resection. The mean age of this cohort was 31.56 ± 10.39 years (range, 16-57 years). The mean follow-up period was 38.93 ± 15.69 months (range, 11-59 months). The site of the coalition, comorbidities, satisfaction with treatment, visual analog scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale scores were evaluated pre- and postoperatively. Preoperative magnetic resonance imaging (MRI) scans were used to categorize the coalition according to the Lim classification. Postoperative computed tomography (CT) scans were used to assess recurrence. The distribution of TCC cases according to the Lim classification was type I in one case, type II in four cases, and type III in 11 cases.</p><p><strong>Results: </strong>The site of coalition involved the middle facets in seven patients, the posterior facets in three patients, and both the above sites in six patients. All patients underwent total arthroscopic resection of TCC. An auxiliary mini-incision was made for three patients due to serious tibial nerve compression. Radiographics showed that the coalition disappeared and pain was relieved postoperatively. The mean VAS score decreased from 4.31 ± 1.54 to 1.81 ± 0.98 points (p < 0.001). The mean AOFAS ankle-hindfoot score improved from 65.56 ± 5.82 to 87.31 ± 6.30 points (p < 0.001). Fifteen patients were satisfied with the procedure, and one patient experienced numbness after surgery. No recurrence was reported based on CT scan and clinical results up to the end of the study.</p><p><strong>Conclusion: </strong>Surgical reconstruction employing total arthroscopic resection of TCC can achieve significant functional and radiographic improvements and symptom relief in selected patients with TCC. Auxiliary mini-incisions were necessitated in complex situations.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2960-2966"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age Is a Key Factor Influencing the Choice of Treatment for Primary Patellar Dislocation: A Systematic Review and Meta-analysis.","authors":"Yi Chen, Yaobin Wang, Hefang Xiao, Ao Yang, Fei Teng, Zhi Yi, Xiaoyun Sheng, Shifeng Zhang, Bin Geng, Yayi Xia","doi":"10.1111/os.14259","DOIUrl":"10.1111/os.14259","url":null,"abstract":"<p><p>Primary patellar dislocation has a certain recurrence rate after either conservative or surgical treatment, and the optimal treatment for patients with primary patellar dislocation of different ages remains unclear. This study aims to compare the clinical efficacy of surgical and conservative treatments for primary patellar dislocation across different age groups. According to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist, we conducted a systematic search for randomized controlled trials. We searched the PubMed, EMBASE, Cochrane Library, and Web of Science databases for randomized controlled trials of primary patellar dislocation treated surgically or conservatively up to January 2023. Data searching, extraction, analysis, and quality assessment were carried out in accordance with the Cochrane Collaboration guidelines. A total of nine studies with 433 patients were included in our study. There was no statistically significant difference between the two treatment modalities in terms of Kujala score, pain score, patient satisfaction, reoperation, and Tegner score. The rate of re-dislocation after surgical treatment is lower than that after conservative treatment. Subgroup analysis based on mean age showed that when the age was >20 years, Kujala scores were higher after surgical treatment than after conservative treatment (p < 0.0001, 95% confidence interval [CI] = 10.41-21.30). When the age was ≤20 years, the difference in Kujala scores between the two treatment modalities was not statistically significant. When the age was >20 years, the recurrence rate of patellar dislocation was lower after surgical treatment than after conservative treatment (p = 0.009, 95% CI = 0.08-0.70). When the age was ≤20 years, the difference in the recurrence rate of patellar dislocation between the two treatment modalities was not statistically significant. When the age of patients with primary patellar dislocation is ≤20 years, both surgical and conservative treatments result in similar clinical outcomes. When the age is >20 years, better clinical outcomes can be achieved by opting for surgical treatment. Therefore, surgery may be a better option for patients with primary patellar dislocation whose age is >20 years.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2887-2896"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}