Clinics in Orthopedic Surgery最新文献

{"title":"Incidence and Risk Factors of Deep Vein Thrombosis after Foot and Ankle Surgery.","authors":"Young Uk Park, Hyong Nyun Kim, Jae Ho Cho, Taehun Kim, Gunoo Kang, Young Wook Seo","doi":"10.4055/cios24163","DOIUrl":"https://doi.org/10.4055/cios24163","url":null,"abstract":"<p><strong>Background: </strong>Deep vein thrombosis (DVT) is a common complication in orthopedic surgery and has the potential to lead to fatal complications such as pulmonary thromboembolism. However, the precise incidence and risk factors for DVT in the foot and ankle fields remain unclear. This study aimed to analyze the prevalence of DVT and identify its risk factors after foot and ankle surgery.</p><p><strong>Methods: </strong>Between September 2020 and July 2023, screening duplex ultrasonography was performed on 278 patients who underwent foot and ankle surgery and required immobilization. The findings from screening duplex ultrasonography were assessed in conjunction with the symptoms present at the time of diagnosis. Heterogeneous demographic data that could serve as potential risk factors for DVT, including diagnosis, body mass index, and other medical histories, were examined alongside pertinent surgery-related data, such as tourniquet time.</p><p><strong>Results: </strong>Among the 278 individuals, DVT occurred in 41 patients (14.7%). Among these, 92.7% originated at the calf level and the majority were asymptomatic. The cases originating above the calf accounted for 3 cases, representing 7.3% of patients diagnosed with DVT (1.1% of the entire screened population). Acute trauma, history of previous DVT, and old age were identified as statistically significant risk factors for DVT occurrence, with odds ratios of 2.44 (<i>p</i> = 0.04), 6.40 (<i>p</i> = 0.02), and 1.16 (<i>p</i> = 0.03), respectively.</p><p><strong>Conclusions: </strong>After foot and ankle surgery, DVT occurred in 14.7% of cases. Acute trauma, history of DVT, and old age were identified as risk factors for DVT. These findings highlight the necessity of careful monitoring and appropriate prophylactic interventions for high-risk patients. Further investigation is required to determine effective prophylactic strategies for this patient population.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 6","pages":"994-1000"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773465","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":"Open Reduction and Internal Fixation of Distal Radius Fractures with Complete Intra-articular Involvement and Diaphyseal Extension.","authors":"Chi-Hoon Oh, Inseok Jang, Cheungsoo Ha, In-Tae Hong, Simho Jeong, Soo-Hong Han","doi":"10.4055/cios23385","DOIUrl":"https://doi.org/10.4055/cios23385","url":null,"abstract":"<p><strong>Backgroud: </strong>Distal radius fractures with complete intra-articular involvement and diaphyseal extension pose significant challenges for stable fixation. Treatment options vary, with no single method demonstrating superiority. This study analyzed the outcomes of fixing these type of fractures with volar locking plates, which are widely used worldwide, and the fracture length according to plate type to determine when an extra-long plate should be used.</p><p><strong>Methods: </strong>This retrospective review analyzed 89 consecutive patients surgically treated for Association of Osteosynthesis (AO) classification type C distal radius fractures with diaphyseal extension, excluding open fractures. The plate length was determined to be long enough accordingly to avoid placing screws in the fracture site. Radiographic evaluation and clinical outcomes were analyzed.</p><p><strong>Results: </strong>According to the AO system, C3 type fractures comprised 50%, C1 type 28%, and C2 type 22%. The average distance from the radiocarpal joint to the most proximal fracture line was 41.1 mm, with articular step off and gap of 1.7 mm and 3.7 mm, respectively. Concomitant distal ulna fractures were present in 81%. At final follow-up, the mean radial height was 10.9 mm, radial inclination was 22.8°, volar tilt was 5.7°, and ulnar variance was 0.6 mm. Fracture union occurred on average at 2.6 months. The average Disabilities of the Arm, Shoulder, and Hand score was 12.0 and the average Modified Mayo Wrist Score was 83.6. Regarding the average wrist range of motion, extension was 63.8°, flexion was 53.7°, ulnar deviation was 25.1°, and radial deviation was 16.7°. Complications included delayed wound healing in 3% and delayed union in 1 patient, who eventually achieved union at 10 months after surgery. APTUS Wrist Distal Radius Plates XL 2.5 and 2.4-mm Variable Angle LCP Two-Column Volar Distal Radius Plates showed a statistically significant difference in fracture length, with the former being longer than the latter (62 mm vs. 35 mm, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>If the fracture length from the articular surface to the diaphysis exceeds 60 mm, we recommend preparing an extra-long distal radius plate. Volar plate fixation with appropriate length selection has yielded favorable functional outcomes and few minor complications in distal radius fractures with complete intra-articular involvement and diaphyseal extension.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 6","pages":"979-986"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773467","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":"Isolated Latissimus Dorsi Transfer versus Combined Latissimus Dorsi and Teres Major Tendon Transfer for Irreparable Anterosuperior Rotator Cuff Tears.","authors":"Chang Hee Baek, Jung Gon Kim, Bo Taek Kim, Seung Jin Kim","doi":"10.4055/cios24115","DOIUrl":"10.4055/cios24115","url":null,"abstract":"<p><strong>Background: </strong>Irreparable anterosuperior rotator cuff tears (IASRCTs) present significant challenges, especially in young, active patients with limited joint-preserving options. Recently, latissimus dorsi (LD) transfer and combined latissimus dorsi and teres major (LDTM) transfer have gained attention as a potential surgical option. We aimed to compare the clinical and radiological outcomes of LD versus combined LDTM transfer in IASRCTs.</p><p><strong>Methods: </strong>In this retrospective comparative study, 53 patients with IASRCTs were analyzed after undergoing either LD transfer attached to lesser tuberosity (LT) (LD group, n = 23) or combined LDTM transfer attached to greater tuberosity (GT) (LDTM group, n = 30). Clinical evaluations included the visual analog scale score for pain, active shoulder range of motion (ROM), University of California Los Angeles Shoulder Score, American Shoulder and Elbow Surgeons score, activities of daily living that require active internal rotation (ADLIR) scores, and subscapularis (SSC)-specific examinations. Radiographic analyses involved assessing acromiohumeral distance (AHD), Hamada grade, the rate of anterior glenohumeral subluxation reduction, and integrity of the transferred tendon.</p><p><strong>Results: </strong>Postoperatively, both groups demonstrated significant improvements in pain and clinical scores (<i>p</i> < 0.001). At the 2-year follow-up, the LDTM group showed superior internal rotation strength (<i>p</i> < 0.001), ADLIR score (<i>p</i> = 0.017), and SSC-specific physical examination results (belly-press, <i>p</i> = 0.027; bear-hug, <i>p</i> = 0.031; lift-off, <i>p</i> = 0.032). No significant changes in AHD or Hamada grade were observed in either group. At final follow-up, no significant differences were found between the 2 groups in terms of AHD (<i>p</i> = 0.539) and Hamada grade (<i>p</i> = 0.974). Although preoperative anterior glenohumeral subluxation was improved in both groups, the LDTM group showed a statistically significantly higher rate of restoration compared to the LD group (<i>p</i> = 0.015).</p><p><strong>Conclusions: </strong>While both LD and combined LDTM transfers for IASRCTs improved postoperative pain relief, clinical scores, and active ROM, the combined LDTM transfer attached to GT was superior to LD transfer attached to LT in terms of internal rotational strength, ADLIR score, and SSC-specific examinations. Neither group showed significant progress in cuff tear arthropathy or decreased AHD at 2-year follow-up; however, the combined LDTM transfer notably improved preoperative anterior glenohumeral subluxation.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 5","pages":"761-773"},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373216","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":"Tissue-Engineered Bone Regeneration for Medium-to-Large Osteonecrosis of the Femoral Head in the Weight-Bearing Portion: An Observational Study.","authors":"Eui-Kyun Park, Bum-Jin Shim, Suk-Young Kim, Seung-Hoon Baek, Shin-Yoon Kim","doi":"10.4055/cios23344","DOIUrl":"10.4055/cios23344","url":null,"abstract":"<p><strong>Background: </strong>Stem cell therapy for the treatment of osteonecrosis of the femoral head (ONFH) showed promising outcomes. However, ONFH with a large lesion in the weight-bearing portion is a poor prognostic factor and still challenging issue to be solved. We aimed to evaluate the effect of tissue-engineered bone regeneration for this challenging condition to preserve the femoral head.</p><p><strong>Methods: </strong>A total of 7 patients (9 hips) with ONFH who received osteoblasts expanded ex vivo from bone marrow-derived mesenchymal stem cells (BMdMSCs) and calcium metaphosphate (CMP) as scaffolds from March 2002 to March 2004 were retrospectively reviewed. The median age was 27.0 years (interquartile range [IQR], 23.0-34.0 years), and the median follow-up period was 20.0 years (IQR, 11.0-20.0 years). After culture and expansion of stem cells, we performed core decompression with BMdMSC implantation at a median number of 10.1 ×10⁷ (IQR, 9.9-10.9 ×10⁷). To evaluate radiographic outcomes, the Association Research Circulation Osseous (ARCO) classifications, the Japanese Investigation Committee (JIC) classification, and modified Kerboul combined necrotic angle (mKCNA) were evaluated preoperatively and during follow-up. Clinical outcomes were evaluated by a visual analog scale (VAS) and Harris Hip Score (HHS).</p><p><strong>Results: </strong>The preoperative stage of ONFH was ARCO 2 in 5 hips and ARCO 3a in 4 hips. The ARCO staging was maintained in 3 hips of ARCO 2 and 4 hips of ARCO 3a. Two hips of ARCO 2 with radiographic progression underwent total hip arthroplasty. According to mKCNA, 2 hips showed medium lesions, and 7 hips showed large lesions. The size of necrotic lesion was decreased in 4 hips (2 were ARCO 2 and 2 were ARCO 3a). There were no significant changes in JIC classification in all hips (type C1: 3 hips and type C2: 6 hips) (<i>p</i> = 0.655). Clinically, there were no significant changes in the VAS and HHS between preoperative and last follow-up (<i>p</i> = 0.072 and <i>p</i> = 0.635, respectively).</p><p><strong>Conclusions: </strong>Tissue engineering technique using osteoblasts expanded ex vivo from BMdMSC and CMP showed promising outcomes for the treatment of pre-collapsed and early-collapsed stage ONFH with medium-to-large size, mainly located in weight-bearing areas.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 5","pages":"702-710"},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373234","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":"Fixed-Bearing and Higher Postoperative Knee Flexion Angle as Predictors of Satisfaction in Asian Patients Undergoing Posterior-Stabilized Total Knee Arthroplasty.","authors":"Sung Eun Kim, Byung Sun Choi, Du Hyun Ro, Myung Chul Lee, Hyuk-Soo Han","doi":"10.4055/cios23166","DOIUrl":"10.4055/cios23166","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported satisfaction following total knee arthroplasty (TKA) can be affected by various factors. This study aimed to assess patient satisfaction rates and identify factors related to patients, surgery, and postoperative knee motion associated with satisfaction in posterior-stabilized TKA among Asian patients.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted in patients with primary osteoarthritis who underwent TKA and had a follow-up period of over 2 years. Patient satisfaction was measured using a 5-point Likert scale, and the patients were divided into satisfied and dissatisfied groups. The factors potentially affecting satisfaction were collected, including demographics, comorbidities, surgical options, and knee motion. Univariate and multivariate regression analyses were performed.</p><p><strong>Results: </strong>Of the 858 patients included, 784 (91.4%) were satisfied and 74 (8.6%) were dissatisfied. Fixed-bearing implants and higher postoperative knee flexion angles were associated with satisfaction (odds ratio [OR], 2.366; <i>p</i> = 0.001 and OR, 1.045; <i>p</i> < 0.001, respectively), whereas cerebrovascular disease was related to dissatisfaction (OR, 0.403; <i>p</i> = 0.005). The regression model demonstrated moderate predictability (<i>R</i> ² = 0.112).</p><p><strong>Conclusions: </strong>Fixed-bearing implants and higher postoperative knee flexion angles were associated with patient satisfaction following TKA, whereas cerebrovascular disease was associated with dissatisfaction. The identification of these factors could help improve surgical outcomes and patient satisfaction following TKA.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 5","pages":"733-740"},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373213","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":"Fixing Cho Type IIC Distal Clavicle Fractures with Hook Plates Leads to a High Incidence of Subacromial Osteolysis: A Retrospective Study and Literature Review.","authors":"Po-Hsiang Chen, Chun-Yu Chen, Kai-Cheng Lin, Yih-Wen Tarng","doi":"10.4055/cios24009","DOIUrl":"10.4055/cios24009","url":null,"abstract":"<p><strong>Background: </strong>This retrospective study investigates the complications, particularly subacromial osteolysis (SAO), associated with hook plate (HP) fixation, in the treatment of unstable distal clavicle fractures characterized by complete coracoclavicular (CC) ligament rupture. The decision-making process for employing HP in fractures of this nature, such as Neer types IIB and V and Cho classification IIC, involves considerations of distal fragment size and displacement. While HP offers advantages in clinical practice, it is not without complications, with SAO being a notable concern. Factors such as non-anatomic hook tip placement and fracture classification may influence the risk of SAO.</p><p><strong>Methods: </strong>The study comprises a retrospective analysis of unstable distal clavicle fractures treated with HP at our institution from 2019 to 2022. Exclusions include non-displaced fractures, those treated with other locking plates, and pathologic fractures. A total of 91 patients with displaced distal clavicle fractures underwent open reduction and internal fixation with HP. Cho classification was employed to differentiate cases with CC ligament rupture. Patient demographics, classifications, postoperative radiographs, distal fragment size, plate position, timing of implant removal, and complications, including SAO, were recorded.</p><p><strong>Results: </strong>Among the 91 patients, 32 were classified as Cho IIB, 43 as Cho IIC, and 16 as Cho IID. Ninety-one percent exhibited solid union before implant removal. The prevalence of SAO was 43.8%, 76.7%, and 62.5% in Cho IIB, IIC, and IID, respectively. Univariate analysis revealed a significant difference only in Cho classification (<i>p</i> = 0.014). Binary logistic regression identified Cho classification type IIC as the sole risk factor for SAO (<i>p</i> = 0.021; odds ratio, 4.48; 95% confidence interval, 1.56-12.87).</p><p><strong>Conclusions: </strong>Cho type IIC fractures, characterized by CC ligament deficiency causing horizontal instability, demonstrated the highest SAO rate. In contrast, Neer type IIB fractures retained the trapezoid ligament, and Neer type V fractures had intact CC ligaments, resulting in lower SAO rates. Biomechanically, combining HPs with CC ligament reconstruction provided better structural stability than using HPs alone in treating Cho type IIC fractures.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 5","pages":"694-701"},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373214","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":"Intraoperative Navigation in Reverse Shoulder Arthroplasty: Advantages and Future Prospects.","authors":"Peter Boufadel, Ryan Lopez, Mohamad Y Fares, Mohammad Daher, Dineysh Dhytadak, Lawrence V Gulotta, Joseph A Abboud","doi":"10.4055/cios23407","DOIUrl":"10.4055/cios23407","url":null,"abstract":"<p><p>Intraoperative navigation is a novel technology that can provide real-time feedback to the surgeon during implantation and enhance the accuracy and precision of glenoid component positioning. Applications of intraoperative navigation systems have demonstrated increased precision in baseplate version and inclination, as well as improved baseplate screw placement, with fewer screws used and greater purchase length achieved when compared to standard instrumentation. Early clinical studies have shown favorable results, with significantly improved patient-reported and clinical outcomes and decreased complications. The implementation of intraoperative navigation is associated with a short learning curve and a minimal increase in operative time. Nevertheless, further research is necessary to substantiate the clinical benefit of navigation and evaluate its economic cost-effectiveness and impact on implant survival. Augmented reality and robotic-assisted surgery are additional emerging technologies that, while novel, hold the potential to further advance the field of shoulder arthroplasty.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 5","pages":"679-687"},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373215","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":"Outcomes of Hip Arthroplasty in Patients with Preoperative Thrombocytopenia.","authors":"Jong Jin Go, Minji Han, Tae Woo Kim, Byung Kyu Park, Jung-Wee Park, Young-Kyun Lee","doi":"10.4055/cios24082","DOIUrl":"10.4055/cios24082","url":null,"abstract":"<p><strong>Background: </strong>Thrombocytopenia is a condition where platelet counts are below the normal range (< 150 × 10³/µL), resulting in a higher risk of bleeding and affecting the results of hip arthroplasty. We assessed the impact of preoperative platelet counts on the clinical results of patients who underwent hip arthroplasty.</p><p><strong>Methods: </strong>Between April 2003 and March 2023, 437 patients (451 hips), who had preoperative thrombocytopenia of less than 150 × 10³/µL platelets, underwent hip arthroplasty. Preoperative platelet levels were categorized into severe thrombocytopenia (< 50 × 10³/µL) and non-severe thrombocytopenia (50-149 × 10³/µL). Total blood loss, operation time, requirement of transfusion, amount of transfusion, duration of surgical wound oozing, length of hospital stay, mortality rate at 1 year after surgery, and any complication were compared between the 2 groups.</p><p><strong>Results: </strong>No notable differences were observed in the surgery time or the total amount of blood loss between the groups. The requirement of transfusion and the amount of transfused blood were higher in the severe thrombocytopenia group. Prolonged oozing was found in around 18% in both groups, while periprosthetic joint infections occurred in 3 of the non-severe thrombocytopenia group. No significant difference was noted in the duration of hospital stay (25.6 ± 18.3 days vs. 19.4 ± 16.6 days, <i>p</i> = 0.067) and 1-year mortality (22.2% vs. 11.8%, <i>p</i> = 0.110).</p><p><strong>Conclusions: </strong>Hip arthroplasties are safe for patients with low platelet counts and do not lead to prolonged hospital stays. On the other hand, patients with severe thrombocytopenia tend to need blood transfusions more frequently than those with less severe thrombocytopenia.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 5","pages":"711-717"},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373217","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":"The Effects and Risk Factors of Femoral Neck Shortening after Internal Fixation of Femoral Neck Fractures.","authors":"Dae Hee Lee, Joo Han Kwon, Ki-Choul Kim","doi":"10.4055/cios24089","DOIUrl":"10.4055/cios24089","url":null,"abstract":"<p><strong>Backgroud: </strong>Internal fixation has been established as a treatment of choice in relatively young patients with femoral neck fractures. Due to the characteristics of femoral neck anatomy and blood supply, complications such as malunion, nonunion, avascular necrosis, and femoral neck shortening can occur after internal fixation of femoral neck fractures. Unlike other complications such as avascular necrosis or nonunion, femoral neck shortening has not been relatively well studied. This study aimed to investigate the risk factors and clinical outcomes of femoral neck shortening after internal fixation of femoral neck fractures.</p><p><strong>Methods: </strong>From June 2012 to July 2022, among 102 patients who underwent internal fixation of femoral neck fractures, 94 patients who met inclusion and exclusion criteria were retrospectively analyzed. Internal fixation of the femoral neck was done with cannulated compression screws or a femoral neck system. Patients were divided into 2 groups; femoral neck shortening (≥ 5 mm) and no shortening (< 5 mm) according to measurement on follow-up hip anteroposterior (AP) simple radiographs compared with postoperative hip AP simple radiographs. Demographic and radiographic data were compared between the 2 groups. The modified Harris Hip Score (mHHS) and a visual analog scale (VAS) were used to evaluate the clinical outcomes.</p><p><strong>Results: </strong>Among 94 patients, femoral neck shortening was observed in 33 (35.1%). In chi-square test, Pauwels angle, Garden type III or IV (displacement), and cortical comminution were significantly correlated with neck shortening (<i>p</i> < 0.05). In the multifactorial logistic regression test, cortical comminution was significantly correlated with femoral neck shortening (<i>p</i> < 0.01). The shortening group showed significantly lower clinical scores in terms of mHHS and VAS (<i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>The femoral neck shortening group showed significantly lower clinical scores of mHHS and VAS than the no-shortening group. The presence of cortical comminution in preoperative hip computed tomography is a risk factor of femoral neck shortening after internal fixation of femoral neck fractures.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 5","pages":"718-723"},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373232","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":"A Prospective Randomized Controlled Study of Stratafix versus Standard-of-Care for Deep Tissue Closure in Orthopedic Surgery.","authors":"Miok Song, Yongjin Cho","doi":"10.4055/cios22017","DOIUrl":"10.4055/cios22017","url":null,"abstract":"<p><strong>Background: </strong>Orthopedic deep surgical incisions require the approximation of 1 or multiple tissue layers. This prospective randomized controlled study aimed to assess the usefulness and effectiveness of a barbed suture technique (Stratafix symmetric PDS plus) versus the conventional interrupted knotted suture technique for deep tissue closure in orthopedic surgery by comparing deep fascia suture time, relative cost, and wound-related complications.</p><p><strong>Methods: </strong>A total of 254 patients with deep surgical incisions who underwent orthopedic surgery between October 1, 2020, and June 30, 2021, were recruited. Their general characteristics (age, sex, weight, height, body mass index, American Society of Anesthesiologists physical status score, total operation time, and length of deep incision) and factors related to deep incision wounds (suture type and number, wound closure time, and operation site outcomes) were collected.</p><p><strong>Results: </strong>The general characteristics did not differ between the Stratafix and conventional groups. There were no between-group differences observed in total operation time or total anesthesia time. The wound suture times differed significantly. In the conventional group, the suture time per unit length was lower in the group with the length of deep incision under 20 cm but did not differ significantly for each wound size. In the Stratafix group, the suture time per unit length was lower in the group under 15 cm, with the shortest time observed for 10-14.9 cm, followed by 5.0-9.9 cm and the group under 5 cm. The conventional group developed 4 cases of superficial wound infection or surgical wound necrosis. One case of protruded suture tap occurred in the Stratafix group.</p><p><strong>Conclusions: </strong>The average suture time per unit length increased for lengths under 5 cm as barbed sutures required more time from the start of the first suture to finish of the last suture. There was no significant benefit for very short suture length. One barbed suture material allows a suture of approximately 10-12 cm; sutures beyond that require more time because the surgeon has to start again. The Stratafix group used less suture material than the conventional group.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 5","pages":"820-826"},"PeriodicalIF":1.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373194","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}