Clinics in Orthopedic Surgery最新文献

{"title":"Comparison of Time Taken in Conventional versus Active Robotic-Assisted Total Knee Arthroplasty.","authors":"Sanjay Bhalchandra Londhe, Santosh Shetty, Vijay Shetty, Clevio Desouza, Paras Banka, Nicholas Antao","doi":"10.4055/cios23062","DOIUrl":"10.4055/cios23062","url":null,"abstract":"<p><strong>Background: </strong>Computer- and robotic-assisted total knee replacement procedures have been shown to improve the accuracy of the implant size. It also allows dynamic confirmation of the implant and limb alignment during total knee arthroplasty (TKA). The major inhibition of the arthroplasty surgeon in adapting to the robotic-assisted TKA (RA-TKA) is the extra time spent during the registration process and milling of the bone with the robot. The aim of the study was to ascertain the extra time spent during these 2 steps as compared to the conventional TKA (C-TKA).</p><p><strong>Methods: </strong>It is a prospective study involving 30 patients each in the conventional TKA and RA-TKA operated by the same surgical team. The patients were given a choice between the C-TKA and RA-TKA and consecutive 30 cases in each group were studied by an independent observer. In the C-TKA group, the time for the application of appropriate zigs and execution of the bone cuts and soft-tissue release was recorded whereas in the RA-TKA group, the time taken for fixation of the tibial and femoral arrays and bone registration and bone milling with robot and required soft-tissue release was measured.</p><p><strong>Results: </strong>The preoperative patient characteristics were the same in both groups. The time taken in the C-TKA and RA-TKA groups was 24.77 ± 1.92 minutes and 25.03 ± 3.27 minutes, respectively, which is statistically insignificant (<i>p</i> = 0.709).</p><p><strong>Conclusions: </strong>The study findings show that RA-TKA does not take additional time than C-TKA.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 2","pages":"259-264"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337241","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":"Biomechanical Characteristics of Glenosphere Orientation Based on Tilting Angle and Overhang Changes in Reverse Shoulder Arthroplasty.","authors":"Jae-Hoo Lee, Seong Hun Kim, Jae Hyung Kim, Gyurim Baek, Andrew Nakla, Michelle McGarry, Thay Q Lee, Sang-Jin Shin","doi":"10.4055/cios23217","DOIUrl":"10.4055/cios23217","url":null,"abstract":"<p><strong>Background: </strong>Glenoid position and inclination are important factors in protecting against scapular notching, which is the most common complication that directly affects the longevity of reverse shoulder arthroplasty (RSA). This study aimed to investigate the biomechanical characteristics of glenosphere orientation, comparing neutral tilt, inferior overhang with an eccentric glenosphere at the same placement of baseplate, and inferior tilt after 10° inferior reaming in the lower part of the glenoid in RSA.</p><p><strong>Methods: </strong>Nine cadaveric shoulders were tested with 5 combinations of customized glenoid components: a centric glenosphere was combined with a standard baseplate (group A); an eccentric glenosphere to provide 4-mm inferior overhang than the centric glenosphere was combined with a standard baseplate (group B); a centric glenosphere was combined with a wedge-shaped baseplate tilted inferiorly by 10° with the same center of rotation (group C); an eccentric glenosphere was attached to a wedge-shaped baseplate (group D); and 10° inferior reaming was performed on the lower part of the glenoid to apply 10° inferior tilt, with a centric glenosphere secured to the standard baseplate for simulation of clinical tilt (group E). Impingement-free angles for adduction, abduction, forward flexion, external rotation, and internal rotation were measured. The capability of the deltoid moment arm for abduction and forward flexion, deltoid length, and geometric analysis for adduction engagement were evaluated.</p><p><strong>Results: </strong>Compared with neutral tilt, inferior tilt at the same position showed no significant difference in impingement-free angle, moment arm capability, and deltoid length. However, group D resulted in better biomechanical properties than a central position, regardless of inferior tilt. Group E demonstrated a greater range of adduction, internal and external rotation, and higher abduction and forward flexion capability with distalization, compared to corresponding parameters for inferior tilt with a customized wedge-shaped baseplate.</p><p><strong>Conclusions: </strong>A 10° inferior tilt of the glenosphere, without changing the position of the baseplate, had no benefit in terms of the impingement-free angle and deltoid moment arm. However, an eccentric glenosphere had a significant advantage, regardless of inferior tilt. Inferior tilt through 10° inferior reaming showed better biomechanical results than neutral tilt due to the distalization effect.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 2","pages":"303-312"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337234","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":"Cardiovascular Disease in Total Knee Arthroplasty: An Analysis of Hospital Outcomes, Complications, and Mortality.","authors":"Shawn Okpara, Tiffany Lee, Nihar Pathare, Abdullah Ghali, David Momtaz, Ugo Ihekweazu","doi":"10.4055/cios23224","DOIUrl":"10.4055/cios23224","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular comorbidities have been identified as a significant risk factor for adverse outcomes following surgery. The purpose of this study was to investigate its prevalence and impact on postoperative outcomes, hospital metrics, and mortality in patients undergoing total knee arthroplasty (TKA). Our hypothesis was that patients with cardiovascular comorbidities would have worse outcomes, greater postoperative complication rates, and increased mortality compared to patients without cardiovascular disease.</p><p><strong>Methods: </strong>In this retrospective study, data from the National Inpatient Sample database from 2011 to 2020 were queried for patients who underwent TKA with preexisting cardiac comorbidities, including congestive heart failure (CHF), coronary artery disease (CAD), valvular dysfunction, and arrhythmia. Multivariate logistic regression analyses compared hospital metrics (length of stay, costs, and adverse discharge disposition), postoperative complications, and mortality rates while adjusting for demographic and clinical variables. All statistical analyses were performed using R studio 4.2.2 and Stata MP 17 and 18 with Python package.</p><p><strong>Results: </strong>A total of 385,585 patients were identified. Those with preexisting CHF, CAD, valvular dysfunction, or arrhythmias were found to be older and at higher risk of adverse outcomes, including prolonged length of stay, increased hospital charges, and increased mortality (<i>p</i> < 0.001). Additionally, all preexisting cardiac diagnoses led to an increased risk of postoperative myocardial infarction, acute kidney injury (AKI), and need for transfusion (<i>p</i> < 0.001). The presence of valvular dysfunction, arrhythmia, or CHF was associated with an increased risk of thromboembolic events (<i>p</i> < 0.001). The presence of CAD and valvular dysfunction was associated with an increased risk of urologic infection (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>This study demonstrated that CHF, CAD, valvular dysfunction, and arrhythmia are prevalent among TKA patients and associated with worse hospital metrics, higher risk of perioperative complications, and increased mortality. As our use of TKA rises, a lower threshold for preoperative cardiology referral in older individuals and early preoperative counseling/intervention in those with known cardiac disease may be necessary to reduce adverse outcomes.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 2","pages":"265-274"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337235","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":"Comments on the Article \"Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions\": In Reply.","authors":"Jun-Il Yoo, Yonghan Cha, Jung-Taek Kim, Chan Ho Park, Wonsik Choy, Kyung-Hoi Koo","doi":"10.4055/cios23323re","DOIUrl":"10.4055/cios23323re","url":null,"abstract":"","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 2","pages":"344-345"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337237","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 Ulnar Shortening Osteotomy with an Intramedullary Bone Graft for Idiopathic Ulnar Impaction Syndrome.","authors":"Kyung Wook Kim, Ji Hyeung Kim, Hyung Ryul Lim, Kee Jeong Bae, Yo Han Lee, Young Kwang Shin, Goo Hyun Baek","doi":"10.4055/cios23266","DOIUrl":"10.4055/cios23266","url":null,"abstract":"<p><strong>Background: </strong>Although several techniques for the treatment of ulnar impaction syndrome (UIS) have been introduced, there have still been reports on various complications such as delayed union, nonunion, refracture, wrist pain, plate irritation, and chronic regional pain syndrome. This study aimed to compare the differences in radiological and clinical outcomes of patients in which intramedullary bone grafting was performed in addition to plate stabilization with those without additional bone grafting during ulnar shortening osteotomies (USOs).</p><p><strong>Methods: </strong>Between November 2014 and June 2021, 53 wrists of 50 patients with idiopathic UIS were retrospectively reviewed. Patients were divided into 2 groups according to whether intramedullary bone grafting was performed. Among the 53 wrists, USO with an intramedullary bone graft was performed in 21 wrists and USO without an intramedullary bone graft was performed in 32 wrists. Demographic data and factors potentially associated with bone union time were analyzed.</p><p><strong>Results: </strong>There was no significant difference between the 2 groups when comparing postoperative radioulnar distance, postoperative ulnar variance, amount of ulnar shortening, and postoperative Disabilities of the Arm, Shoulder and Hand score. Compared to the without-intramedullary bone graft group, bone union time of the osteotomy site was significantly shortened, from 8.8 ± 3.0 weeks to 6.7 ± 1.3 weeks in the with-intramedullary bone graft group. Moreover, there were no cases of nonunion or plate-induced symptoms. Both in univariable and multivariable analyses, intramedullary bone grafting was associated with shorter bone union time.</p><p><strong>Conclusions: </strong>USO with an intramedullary bone graft for idiopathic UIS has favorable radiological and clinical outcomes. The advantage of this technique is the significant shortening of bone union time.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 2","pages":"313-321"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337250","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":"Low Hand Grip Strength, Mid-Upper Arm Muscle Area, Calf Circumference, Serum Albumin Level, and Muscle Fiber Diameter as Risk Factors for Independent Walking Inability in Patients with Hip Fracture 6 Weeks after Bipolar Hemiarthroplasty Surgery.","authors":"Sherly Desnita Savio, I Ketut Siki Kawiyana, I Gede Eka Wiratnaya, I Wayan Juli Sumadi, I Ketut Suyasa","doi":"10.4055/cios23256","DOIUrl":"10.4055/cios23256","url":null,"abstract":"<p><strong>Background: </strong>Bipolar hemiarthroplasty, one of the main treatment modalities for hip fracture, does not always promise the ability to walk independently after surgery. Patients with the same fracture characteristics and comorbidities, implants, and operators may also have different outcomes. Sarcopenia is thought to be one of the causes of the inability to walk independently after this operation; however, it has not been widely studied and is often overlooked.</p><p><strong>Methods: </strong>This study used a case-control design with 23 patients in the case group (patients unable to walk independently) and 23 patients in the control group (patients able to walk independently). Sampling was carried out consecutively according to the inclusion and exclusion criteria based on the medical records of patients with hip fractures after bipolar hemiarthroplasty at our hospital. In the preoperative period, hand grip strength (HGS), mid-upper arm muscle area (MUAMA), calf circumference (CC), serum albumin level, and total lymphocyte count were measured. A muscle biopsy was performed intraoperatively from the gluteus muscle with the amount of 200-350 mg. The patient's walking ability was assessed in the polyclinic using the Timed Up and Go test 6 weeks postoperatively. The statistical tests used were descriptive statistics, proportion comparison analysis with the chi-square test, and multiple logistic regression test.</p><p><strong>Results: </strong>Univariate analysis using chi-square test proved HGS, MUAMA, CC, serum albumin level, and muscle fiber diameter as risk factors for inability to walk independently 6 weeks after bipolar hemiarthroplasty (<i>p</i> = 0.003, <i>p</i> = 0.003, <i>p</i> = 0.006, <i>p</i> = 0.044, and <i>p</i> = 0.000, respectively). Logistic regression test proved 3 direct risk factors for the inability to walk independently 6 weeks after bipolar hemiarthroplasty, namely MUAMA, serum albumin level, and muscle fiber diameter, as the strongest predictive factor (adjusted odds ratio, 63.12).</p><p><strong>Conclusions: </strong>Low MUAMA, serum albumin levels, and muscle fiber diameter are direct risk factors for the inability to walk independently in hip fracture patients 6 weeks after bipolar hemiarthroplasty.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 2","pages":"230-241"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337248","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":"Assessment of Automated Identification of Phases in Videos of Total Hip Arthroplasty Using Deep Learning Techniques.","authors":"Yang Jae Kang, Shin June Kim, Sung Hyo Seo, Sangyeob Lee, Hyeon Su Kim, Jun-Il Yoo","doi":"10.4055/cios23280","DOIUrl":"10.4055/cios23280","url":null,"abstract":"<p><strong>Background: </strong>As the population ages, the rates of hip diseases and fragility fractures are increasing, making total hip arthroplasty (THA) one of the best methods for treating elderly patients. With the increasing number of THA surgeries and diverse surgical methods, there is a need for standard evaluation protocols. This study aimed to use deep learning algorithms to classify THA videos and evaluate the accuracy of the labelling of these videos.</p><p><strong>Methods: </strong>In our study, we manually annotated 7 phases in THA, including skin incision, broaching, exposure of acetabulum, acetabular reaming, acetabular cup positioning, femoral stem insertion, and skin closure. Within each phase, a second trained annotator marked the beginning and end of instrument usages, such as the skin blade, forceps, Bovie, suction device, suture material, retractor, rasp, femoral stem, acetabular reamer, head trial, and real head.</p><p><strong>Results: </strong>In our study, we utilized YOLOv3 to collect 540 operating images of THA procedures and create a scene annotation model. The results of our study showed relatively high accuracy in the clear classification of surgical techniques such as skin incision and closure, broaching, acetabular reaming, and femoral stem insertion, with a mean average precision (mAP) of 0.75 or higher. Most of the equipment showed good accuracy of mAP 0.7 or higher, except for the suction device, suture material, and retractor.</p><p><strong>Conclusions: </strong>Scene annotation for the instrument and phases in THA using deep learning techniques may provide potentially useful tools for subsequent documentation, assessment of skills, and feedback.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 2","pages":"210-216"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337233","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":"Collagen Meniscal Scaffold Implantation Can Provide Meniscal Regeneration in Asian Patients with Partial Meniscal Defects: A Prospective Randomized Controlled Study with Three-Dimensional Volume Analysis of the Meniscus.","authors":"Kyoung Ho Yoon, Jin Goo Kim, Jun Ho Wang, Jeong Hyun Lee, Cheol Hee Park","doi":"10.4055/cios24062","DOIUrl":"10.4055/cios24062","url":null,"abstract":"<p><strong>Background: </strong>To date, the efficiency of collagen meniscal scaffold implantation in Asian patients with partial meniscal defects has not been evaluated. In addition, no study has quantitatively analyzed meniscal regeneration using three-dimensional (3D) volume analysis after collagen scaffold implantation. We aimed to compare meniscal regeneration using 3D volume analysis between Asian patients undergoing collagen-based meniscal scaffold implantation after partial meniscectomy and those undergoing only partial meniscectomy.</p><p><strong>Methods: </strong>Nineteen patients who underwent collagen-based meniscal scaffold implantation and 14 who underwent partial meniscectomy were analyzed with a prospective randomized control design for 12 months postoperatively. The demographic characteristics, Kellgren-Lawrence grade, and location of the injury lesion (medial or lateral meniscus) were not significantly different between the groups. Using 3D volume analysis with magnetic resonance imaging (MRI), the meniscus-removing ratio during the operative procedure and the meniscus defect-filling ratio were measured during the 12-month postoperative period. Clinically, the visual analog scale, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score were evaluated. The Whole-Organ Magnetic Resonance Imaging Score (WORMS) and Genovese grade were also evaluated using MRI.</p><p><strong>Results: </strong>In the 3D volume analysis, the average meniscus-removing ratio during surgery was not significantly different between the groups (-9.3% vs. -9.2%, <i>p</i> = 0.984). The average meniscus defect-filling ratio during the postoperative 12-month period was 7.5% in the scaffold group and -0.4% in the meniscectomy group (<i>p</i> < 0.001). None of the clinical results were significantly different between the scaffold and meniscectomy groups at 12 months postoperatively. The average change in the total WORMS score was not significantly different between the groups (0 vs. 1.9, <i>p</i> = 0.399). The Genovese grade of the implanted collagen scaffold did not significantly change during the follow-up period in terms of morphology and size (<i>p</i> = 0.063); however, the grade significantly improved in terms of signal intensity (<i>p</i> = 0.001).</p><p><strong>Conclusions: </strong>Definite meniscal regeneration and stable scaffold incorporation were observed after collagen-based meniscal scaffold implantation in Asian patients during 12 months of follow-up. A long-term follow-up study with a larger cohort is required to determine the advantages of collagenous meniscal scaffold implantation in Asian patients.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 2","pages":"275-285"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337236","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":"Does Preoperative Radiation Therapy Performed for Metastatic Spine Cancer at the Cervical Spine Increase Perioperative Complications of Anterior Cervical Surgery?","authors":"Jae Hwan Cho, Dong-Ho Lee, Chang Ju Hwang, Jae Woo Park, Jin Hoon Park, Sehan Park","doi":"10.4055/cios23322","DOIUrl":"10.4055/cios23322","url":null,"abstract":"<p><strong>Background: </strong>Radiation therapy (RT) performed before anterior cervical spine surgery (ACSS) may cause fascial plane fibrosis, decreased soft-tissue vascularity, and vertebral body weakness, which could increase the risk of esophageal and major vessel injuries, wound complications, and construct subsidence. Therefore, this study aimed to evaluate whether preoperative RT performed for metastatic spine cancer (MSC) at the cervical spine increases perioperative morbidity for ACSS.</p><p><strong>Methods: </strong>Forty-nine patients who underwent ACSS for treatment of MSC at the cervical spine were retrospectively reviewed. All the patients underwent anterior cervical corpectomy via the anterior approach. Patient demographics, surgical factors, operative factors, and complications were recorded. Results of patients who were initially treated with RT before ACSS (RT group) were compared with those who did not receive RT before ACSS (non-RT group).</p><p><strong>Results: </strong>Eighteen patients (36.7%) were included in the RT group, while the remaining 31 (63.3%) were included in the non-RT group. Surgery-related factors, including operation time (<i>p</i> = 0.109), estimated blood loss (<i>p</i> = 0.246), amount of postoperative drainage (<i>p</i> = 0.604), number of levels operated (<i>p</i> = 0.207), and number of patients who underwent combined posterior fusion (<i>p</i> = 0.768), did not significantly differ between the 2 groups. Complication rates, including esophageal injury, dural tear, infection, wound dehiscence, and mechanical failure, did not significantly differ between the RT and non-RT groups. Early subsidence was significantly greater in the non-RT group compared to that in the RT group (<i>p</i> = 0.012).</p><p><strong>Conclusions: </strong>RT performed before surgery for MSC does not increase the risk of wound complication, mechanical failure, or vital structure injury during ACSS. The surgical procedural approach was not complicated by previous RT history. Therefore, surgeons can safely choose the anterior approach when the number of levels or location of MSC favors anterior surgery, and performing a posterior surgery is unnecessary due to a concern that previous RT may increase complication rates of ACSS.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 2","pages":"286-293"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337243","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":"Is Surgical Treatment Necessary for the Treatment of a Jones Fracture?: A Retrospective Study.","authors":"Changsu Kim, Dong Young Shin, Jiyoun Kim","doi":"10.4055/cios23333","DOIUrl":"10.4055/cios23333","url":null,"abstract":"<p><strong>Background: </strong>Jones fractures are common injuries that can be treated conservatively or surgically. However, the optimal treatment approach remains controversial. This study aimed to compare the clinical outcomes of conservative and operative treatments for Jones fractures and determine whether surgical treatment is necessary.</p><p><strong>Methods: </strong>A retrospective study was conducted on 69 patients with Jones fractures treated at our hospital. The patients were divided into 2 groups: conservative (C group; n = 46) and operative (O group; n = 23) treatments. Patients were followed up after 2, 6, and 12 weeks, and every 3 months thereafter. However, outpatient follow-ups were conducted between 8 and 10 weeks as needed. The mean follow-up period was 14.5 weeks (range, 12-24 weeks). In group C, the patients were treated with a non-weight-bearing cast for 4-6 weeks, followed by additional weight-bearing boot immobilization before returning to exercise. In group O, patients were treated surgically using a bicortical screw or intramedullary internal fixation. Time to radiologic union, clinical union, return to sports, visual analog scale (VAS), Foot Function Index-Revised Short Form (FFI-RS), and American Orthopedic Foot and Ankle Society (AOFAS) scores were evaluated.</p><p><strong>Results: </strong>Sixty-nine patients were included in the analysis. There were statistically significant differences in the time to radiologic union and return to sports, VAS score in the second week, and FFI-RS score in the 12th week. In group C, favorable outcomes were observed in terms of the time to return to sports, VAS score in the second week, and FFI-RS score in the 12th week. Contrastingly, in group O, better results were observed in time to radiologic union. The AOFAS score was excellent at the final follow-up, with no significant differences between groups. Complication rates were 10.8% and 13% in groups C and O, respectively.</p><p><strong>Conclusions: </strong>Surgical treatment is sometimes necessary for Jones fractures, but conservative treatment should also be considered because of the favorable outcomes. Conservative treatment can be a good option for patients who are risk-averse and place a high value on fracture healing without surgery.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"16 2","pages":"335-341"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337246","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}