World Journal of Orthopedics最新文献

{"title":"Isolated lateral leg compartment syndrome: A case report.","authors":"Majd M Alrayes,&nbsp;Mohammad Alqudah,&nbsp;Walaa Bani Hamad,&nbsp;Mohamed Sukeik","doi":"10.5312/wjo.v14.i7.582","DOIUrl":"https://doi.org/10.5312/wjo.v14.i7.582","url":null,"abstract":"<p><strong>Background: </strong>Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately. Multiple compartments are usually involved with a clear history of trauma and classic symptoms and signs. However, isolated lateral leg compartment syndrome is relatively rare and is often misdiagnosed due to the atypical presentation of no trauma and the lack of pathognomonic signs.</p><p><strong>Case summary: </strong>A 31-year-old male patient presented to our emergency room with excruciating left calf pain and inability to mobilize one-day after participating in a football match despite no clear history of preceding trauma. The patient went to another hospital before presenting to us where he was diagnosed to have a soft tissue injury and was discharged home on simple analgesics. On clinical examination, the left leg showed a tense lateral compartment with severe tenderness. The pain was aggravated by dorsiflexion and ankle inversion. Neurovascular examination of the limb was normal. We suspected a compartment syndrome but as the presentation was atypical and an magnetic resonance imaging (MRI) was readily available in our institution, we immediately performed an MRI and this confirmed a large hematoma in the lateral compartment with a possible partial proximal peroneus longus muscle tear. The patient was taken immediately for an emergency open fasciotomy. The patient is now 18 mo postoperatively having recovered completely and engages fully in sports with no restrictions.</p><p><strong>Conclusion: </strong>Atypical presentation due to the lack of pathognomonic signs makes the diagnosis of isolated lateral leg compartment syndrome difficult. Pain on passive inversion and dorsiflexion and weak active eversion may be suggested as sensitive signs.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"14 7","pages":"582-588"},"PeriodicalIF":1.9,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/03/e6/WJO-14-582.PMC10359743.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10223135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcome of open ankle fractures in patients above 70 years of age.","authors":"Wajiha Zahra, Mina Seifo, Paul Cool, David Ford, Tosan Okoro","doi":"10.5312/wjo.v14.i7.554","DOIUrl":"10.5312/wjo.v14.i7.554","url":null,"abstract":"<p><strong>Background: </strong>Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and mortality. However, data on the clinical outcomes of open ankle fracture management in patients older than 70 is minimal.</p><p><strong>Aim: </strong>To evaluate the clinical outcomes following open ankle fracture management in patients older than 70. Our secondary aim is to look at predictors of poor outcomes.</p><p><strong>Methods: </strong>Following local research and audit department registration, 22 years of prospectively collated data from an electronic database in a district general hospital were assessed. All patients older than 70 years of age with an open ankle fracture requiring surgical intervention were identified. Demographic information, the nature, and the number of surgical interventions were collated. Complications, including surgical site infection (SSI), venous thromboembolic events (VTEs) during hospital stay, and mortality rate, were reviewed.</p><p><strong>Results: </strong>A total of 37 patients were identified (median age: 84 years, range: 70-98); <i>n</i> = 30 females median age: 84 years, range: 70-97); <i>n</i> = 7 males median age: 74 years, range: 71-98)) who underwent surgical intervention after an open ankle fracture. Sixteen patients developed SSIs (43%). Superficial SSIs (<i>n</i> = 8) were managed without surgical intervention and treated with antibiotics and regular dressing changes. Deep SSIs (<i>n</i> = 8; 20%) required a median of 3 (range: 2-9) surgical interventions, with four patients requiring multiple washouts and one patient having metalwork removed. VTE incidence was 5% during the hospital stay. Eight patients died within 30 d, and mortality at one year was 19%. The 10-year mortality rate was 57%. The presence of a history of stroke, cancer, or prolonged inpatient stay was found to be predictive of lower survivorship in this population (log-rank test: cancer <i>P</i> = 0.008, stroke <i>P</i> = 0.001, length of stay > 33 d <i>P</i> = 0.015). The presence of a cardiac history was predictive of wound complications (logistic regression, <i>P</i> = 0.045). Age, number of operations, and diabetic history were found to be predictive of an increase in the length of stay (general linear model; age <i>P</i> < 0.001, number of operations <i>P</i> < 0.001, diabetes <i>P</i> = 0.041).</p><p><strong>Conclusion: </strong>An open ankle fracture in a patient older than 70 years has at least a 20% chance of requiring repeated surgical intervention due to deep SSIs. The presence of a cardiac history appears to be the main predictor for wound complications.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"14 7","pages":"554-561"},"PeriodicalIF":2.0,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/7d/WJO-14-554.PMC10359747.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9865664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locking plates for distal fibula fractures in young and elderly patients: A retrospective study.","authors":"Francesco Roberto Evola,&nbsp;Giovanni Francesco Di Fede,&nbsp;Giuseppe Evola,&nbsp;Martina Barchitta,&nbsp;Antonella Agodi,&nbsp;Gianfranco Longo","doi":"10.5312/wjo.v14.i7.540","DOIUrl":"https://doi.org/10.5312/wjo.v14.i7.540","url":null,"abstract":"<p><strong>Background: </strong>Ankle fractures are common injuries in the young and elderly populations. To prevent post-traumatic arthritis, an anatomic reconstruction of the ankle structure is mandatory. Open reduction and internal fixation is the treatment of choice among orthopaedics. Conventional plates allow stability of the fracture if bone quality is present. Locking plates might offer an advantage for the treatment of lateral malleolar fracture in patients with comminution, severe instability, distal fractures, or osteoporotic bone. Our hospital introduced a new locking plate for fracture of the distal fibula.</p><p><strong>Aim: </strong>To evaluate locking plates in terms of outcomes and complications in young and elderly patients.</p><p><strong>Methods: </strong>We retrospectively reviewed a total of 67 patients treated for displaced distal fibula fractures. Demographic data, number of comorbidities, use of inter fragmentary screw, complication, time of fracture healing, partial or full weight bearing, and reoperation were recorded for all patients. Clinical outcome was assessed by the American Orthopedic Foot and Ankle Society clinical scoring system. Radiographs were obtained at 4, 8, 12, 16, 20, and 24 wk until radiographic union was obtained.</p><p><strong>Results: </strong>All patients displayed complete bony union on radiographic assessment, and no patients developed any serious complications. We observed two superficial infections, one delayed wound healing, and two plate intolerances. Significant differences were observed between the two age groups in terms of radiographic healing (11.9 wk in younger patients <i>vs</i> 13.7 wk in older patients; <i>P</i> = 0.011) and in the American Orthopedic Foot and Ankle Society score at 6 mo after surgery (88.2 in younger patients <i>vs</i> 86.0 in older patients; <i>P</i> = 0.001) and at 12 mo after surgery (92.6 in younger patients <i>vs</i> 90.0 in older patients; <i>P</i> = 0.000).</p><p><strong>Conclusion: </strong>Locking plates provide a stable and rigid fixation in multifragmentary and comminuted fractures or in the presence of poor bone quality.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"14 7","pages":"540-546"},"PeriodicalIF":1.9,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/91/WJO-14-540.PMC10359748.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9918995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Instrumented assisted soft tissue mobilization <i>vs</i> extracorporeal shock wave therapy in treatment of myofascial pain syndrome.","authors":"Nourhan Elsayed Shamseldeen,&nbsp;Mohammed Moustafa Aldosouki Hegazy,&nbsp;Nadia Abdalazeem Fayaz,&nbsp;Nesreen Fawzy Mahmoud","doi":"10.5312/wjo.v14.i7.572","DOIUrl":"https://doi.org/10.5312/wjo.v14.i7.572","url":null,"abstract":"<p><strong>Background: </strong>Active myofascial trigger points (TrPs) often occur in the upper region of the upper trapezius (UT) muscle. These TrPs can be a significant source of neck, shoulder, and upper back pain and headaches. These TrPs and their related pain and disability can adversely affect an individual's everyday routine functioning, work-related productivity, and general quality of life.</p><p><strong>Aim: </strong>To investigate the effects of instrument assisted soft tissue mobilization (IASTM) <i>vs</i> extracorporeal shock wave therapy (ESWT) on the TrPs of the UT muscle.</p><p><strong>Methods: </strong>A randomized, single-blind, comparative clinical study was conducted at the Medical Center of the Egyptian Railway Station in Cairo. Forty patients (28 females and 12 males), aged between 20-years-old and 40-years-old, with active myofascial TrPs in the UT muscle were randomly assigned to two equal groups (A and B). Group A received IASTM, while group B received ESWT. Each group was treated twice weekly for 2 weeks. Both groups received muscle energy technique for the UT muscle. Patients were evaluated twice (pre- and post-treatment) for pain intensity using the visual analogue scale and for pain pressure threshold (PPT) using a pressure algometer.</p><p><strong>Results: </strong>Comparing the pre- and post-treatment mean values for all variables for group A, there were significant differences in pain intensity for TrP1 and TrP2 (<i>P</i> = 0.0001) and PPT for TrP1 (<i>P</i> = 0.0002) and TrP2 (<i>P</i> = 0.0001). Also, for group B, there were significant differences between the pre- and post-treatment pain intensity for TrP1 and TrP2 and PPT for TrP1 and TrP2 (<i>P</i> = 0.0001). There were no significant differences between the two groups in the post-treatment mean values of pain intensity for TrP1 (<i>P</i> = 0.9) and TrP2 (<i>P</i> = 0.76) and PPT for TrP1 (<i>P</i> = 0.09) and for TrP2 (<i>P</i> = 0.91).</p><p><strong>Conclusion: </strong>IASTM and ESWT are effective methods for improving pain and PPT in patients with UT muscle TrPs. There is no significant difference between either treatment method.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"14 7","pages":"572-581"},"PeriodicalIF":1.9,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/9e/WJO-14-572.PMC10359744.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9865662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of an early operating room start time in managing pediatric trauma.","authors":"Dan Kym,&nbsp;Japsimran Kaur,&nbsp;Nicole Segovia Pham,&nbsp;Eric Klein,&nbsp;Joanna Lind Langner,&nbsp;Ellen Wang,&nbsp;John Schoeneman Vorhies","doi":"10.5312/wjo.v14.i7.516","DOIUrl":"https://doi.org/10.5312/wjo.v14.i7.516","url":null,"abstract":"<p><strong>Background: </strong>The timing of operative treatment for pediatric supracondylar humerus fractures (SCHF) and femoral shaft fractures (FSF) remains controversial. Many fractures previously considered to be surgical emergencies, such as SCHF and open fractures, are now commonly being treated the following day. When presented with an urgent fracture overnight needing operative treatment, the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day.</p><p><strong>Aim: </strong>To describe the effect of a program allowing an early operating room (OR) start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.</p><p><strong>Methods: </strong>Starting in October 2017, patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 21:00 the previous night and before 05:00. We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team.</p><p><strong>Results: </strong>Of the 44 SCHF meeting inclusion criteria, 16 received treatment before implementation while 28 were treated after. After implementation, the mean wait time for surgery decreased by 4.8 h or 35.4% (13.4 h <i>vs</i> 8.7 h; <i>P</i> = 0.001). There were no significant differences in the operative duration, time in the post anesthesia care unit, and wait time for discharge. Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons. Whereas 57% of the surgeons believed that the program was effective, only 9% of anesthesiologists and 16% of nurses agreed. The program was ultimately discontinued given the dissatisfaction.</p><p><strong>Conclusion: </strong>Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders. Although the program produced promising results, it also created new conflicts within the OR staff that led to its discontinuation at our institution. Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"14 7","pages":"516-525"},"PeriodicalIF":1.9,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/bd/WJO-14-516.PMC10359751.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9918999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of platelet-rich plasma in the treatment of rotator cuff tendinopathy.","authors":"Ausberto Velasquez Garcia,&nbsp;Liborio Ingala Martini,&nbsp;Andres Franco Abache,&nbsp;Glen Abdo","doi":"10.5312/wjo.v14.i7.505","DOIUrl":"https://doi.org/10.5312/wjo.v14.i7.505","url":null,"abstract":"<p><p>Shoulder pain is a common musculoskeletal complaint, and rotator cuff (RC) pathologies are one of the main causes. The RC undergoes various tendinopathic and avascular changes during the aging process. Other degenerative changes affecting its healing potential make it an appealing target for biological agents. Platelet-rich plasma (PRP) has demonstrated the potential to deliver a high concentration of several growth factors and anti-inflammatory mediators, and its clinical use is mainly supported by experiments that demonstrated its positive effect on muscle, ligaments, and tendinous cells. This review aimed to specify the role of PRP and its future applications in RC tendinopathies based on the current clinical evidence. Due to the different characteristics and conflicting outcomes, clinicians should use PRP with moderate expectations until more consistent evidence is available. However, it is reasonable to consider PRP in patients with contraindications to corticosteroid injections or those with risk factors for inadequate healing. Its autologous origin makes it a safe treatment, and its characteristics make it a promising option for treating RC tendinopathy, but the efficacy has yet to be established.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"14 7","pages":"505-515"},"PeriodicalIF":1.9,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/b9/WJO-14-505.PMC10359750.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiologic postoperative presepsin kinetics following primary cementless total hip arthroplasty: A prospective observational study.","authors":"Davide Bizzoca,&nbsp;Andrea Piazzolla,&nbsp;Lorenzo Moretti,&nbsp;Giovanni Vicenti,&nbsp;Biagio Moretti,&nbsp;Giuseppe Solarino","doi":"10.5312/wjo.v14.i7.547","DOIUrl":"https://doi.org/10.5312/wjo.v14.i7.547","url":null,"abstract":"<p><strong>Background: </strong>Presepsin is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in diagnosing and managing periprosthetic joint infections.</p><p><strong>Aim: </strong>To define the normal postoperative presepsin plasmatic curve, in patients undergoing primary cementless total hip arthroplasty (THA).</p><p><strong>Methods: </strong>Patients undergoing primary cementless THA at our Institute were recruited. Inclusion criteria were: Primary osteoarthritis of the hip; urinary catheter time of permanence < 24 h; peripheral venous cannulation time of permanence < 24 h; no postoperative homologous blood transfusion administration and hospital stay ≤ 8 d. Exclusion criteria were: The presence of other articular prosthetic replacement or bone fixation devices; chronic inflammatory diseases; chronic kidney diseases; history of recurrent infections or malignant neoplasms; previous surgery in the preceding 12 mo; diabetes mellitus; immunosuppressive drug or corticosteroid assumption. All the patients received the same antibiotic prophylaxis. All the THA were performed by the same surgical and anaesthesia team; total operative time was defined as the time taken from skin incision to completion of skin closure. At enrollment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS) and C-reactive protein 24 h before arthroplasty and at 24, 48, 72 and 96 h postoperatively and at 3, 6 and 12-mo follow-up.</p><p><strong>Results: </strong>A total of 96 patients (51 female; 45 male; mean age = 65.74 ± 5.58) were recruited. The mean PS values were: 137.54 pg/mL at baseline, 192.08 pg/mL at 24 h post-op; 254.85 pg/mL at 48 h post-op; 259 pg/mL at 72 h post-op; 248.6 pg/mL at 96-h post-op; 140.52 pg/mL at 3-mo follow-up; 135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up. In two patients (2.08%) a soft-tissue infection was observed; in these patients, higher levels (> 350 pg/mL) were recorded at 3-mo follow-up.</p><p><strong>Conclusion: </strong>The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection. The PS plasmatic concentration should be also assessed at 72 h post-operatively, evaluate the maximum postoperative PS value, and at 96 h post-operatively when a decrease of presepsin should be found. The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"14 7","pages":"547-553"},"PeriodicalIF":1.9,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/16/WJO-14-547.PMC10359746.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9918997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excision of trochanteric bursa during total hip replacement: Does it reduce the incidence of post-operative trochanteric bursitis?","authors":"Wai-Huang Teng,&nbsp;Adeel Ditta,&nbsp;Jane Webber,&nbsp;Oliver Pearce","doi":"10.5312/wjo.v14.i7.533","DOIUrl":"https://doi.org/10.5312/wjo.v14.i7.533","url":null,"abstract":"<p><strong>Background: </strong>Trochanteric bursitis is a common complication following total hip replacement (THR), and it is associated with high level of disability and poor quality of life. Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis.</p><p><strong>Aim: </strong>To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted in the secondary care setting at a large district general hospital. Between January 2010 and December 2020, 954 patients underwent elective primary THR by two contemporary arthroplasty surgeons, one excising the bursa and the other not (at the time of THR). All patients received the same post-operative rehabilitation and were followed up for 1 year. We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis. Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups.</p><p><strong>Results: </strong>554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not. A total of 5 patients (incidence 0.5%) developed trochanteric bursitis following THR; 4 of whom had undergone bursectomy as part of their surgical approach, 1 who had not. There was no statistically significant difference between the two groups (Z value 1.00, 95%CI: -0.4% to 1.3%, <i>P</i> = 0.32). There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR; all of whom were treated with THR and synchronous trochanteric bursectomy, and 7 had resolution of their lateral buttock pains but 1 did not.</p><p><strong>Conclusion: </strong>Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis. However, it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"14 7","pages":"533-539"},"PeriodicalIF":1.9,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f1/91/WJO-14-533.PMC10359745.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10223134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internal fixator <i>vs</i> external fixator in the management of unstable pelvic ring injuries: A prospective comparative cohort study.","authors":"Mohamed Abo-Elsoud,&nbsp;Mostafa I Awad,&nbsp;Mahmoud Abdel Karim,&nbsp;Sherif Khaled,&nbsp;Mohamed Abdelmoneim","doi":"10.5312/wjo.v14.i7.562","DOIUrl":"https://doi.org/10.5312/wjo.v14.i7.562","url":null,"abstract":"<p><strong>Background: </strong>Reconstruction of the pelvic ring anatomy in unstable anterior pelvic ring injuries is a significant step to reduce the mortality rate associated with these injuries efficiently. There is a debate on using either an anterior subcutaneous pelvis internal fixator (INFIX) or an anterior supra-acetabular external fixator (EXFIX) to manage an unstable anterior pelvic ring fracture.</p><p><strong>Aim: </strong>To compare the functional and radiological outcomes and complications of INFIX <i>vs</i> EXFIX in managing unstable pelvic ring injuries.</p><p><strong>Methods: </strong>A prospective cohort study included 54 patients with unstable pelvic ring fractures. The patients were divided into two groups; the INFIX group, in which 30 cases were fixed by INFIX, and the EXFIX group, in which 24 patients were treated by EXFIX. The average age in the EXFIX group was 31.17 years (16-57 years), while in the INFIX group, it was 34.5 years (17-53 years). The study included 20 (66.7%) males and 10 (33.3%) females in the INFIX group and 10 (41.7%) males and 14 (58.3%) females in the EXFIX group. The radiological outcomes were evaluated using Matta and Tornetta's score, and the functional outcomes using the Majeed score.</p><p><strong>Results: </strong>The results revealed a statistically significant difference between both groups (<i>P</i> = 0.013) regarding radiological outcomes, according to Matta and Tornetta's score in favor of the INFIX group. Sitting, standing, and walking abilities were measured at a 3-mo follow-up visit using Majeed score modules. It was significantly better among the INFIX group than the EXFIX group in all three modules. At the final follow-up, both groups had no statistically significant difference according to the Majeed score; 92.35 in the INFIX group and 90.99 in the EXFIX group (<i>P</i> = 0.513). A lower surgical site infection rate was noticed in the INFIX group (<i>P</i> = 0.007).</p><p><strong>Conclusion: </strong>Anterior subcutaneous pelvis INFIX is associated with better radiological outcomes and a lower infection rate than anterior supra-acetabular EXFIX in managing patients with unstable anterior pelvic ring fractures.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"14 7","pages":"562-571"},"PeriodicalIF":1.9,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/38/df/WJO-14-562.PMC10359749.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9918993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low risk of postoperative ulnar nerve affection in surgically treated distal humeral fractures when the nerve is released <i>in situ</i>.","authors":"Mustafa Al-Gburi,&nbsp;Ali Al-Hamdani,&nbsp;Jeppe Vejlgaard Rasmussen,&nbsp;Bo Sanderhoff Olsen","doi":"10.5312/wjo.v14.i7.526","DOIUrl":"https://doi.org/10.5312/wjo.v14.i7.526","url":null,"abstract":"<p><strong>Background: </strong>Adult distal humeral fractures (DHF) comprise 2%-5% of all fractures and 30% of all elbow fractures. Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures. Open reduction and internal fixation (ORIF) are often the treatment of choice, but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality. Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.</p><p><strong>Aim: </strong>To report the risk of ulnar nerve affection after surgery for acute DHFs.</p><p><strong>Methods: </strong>We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF, elbow hemiarthroplasty (EHA) or total elbow arthroplasty (TEA) between January 2011 and December 2019. In all cases, the ulnar nerve was released <i>in situ</i> without anterior transposition. We used our institutional database to review patients' medical records for demographics, fracture morphology, type of surgery and ulnar nerve affection immediately; records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up. Twenty-nine percent patients were excluded due to pre- or postoperative conditions. Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score. A total of 210 patients were eligible for interview, but 13 patients declined participation and 17 patients failed to respond. Thus, 180 patients were included.</p><p><strong>Results: </strong>Mean age at surgery was 64 years (range 18-88 years); 121 (67.3%) patients were women; 59 (32.7%) were men. According to the AO/OTA classification system, we recorded 47 patients with type A3, 55 patients with type B and 78 patients with type C fractures. According to the McGowen Classification Score, mild ulnar nerve affection was reported in nine patients; severe affection, in two. A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection. In all, 111 patients were treated with arthroplasty (67 EHA, 44 TEA) of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection. No further treatment was provided.</p><p><strong>Conclusion: </strong>The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released <i>in situ</i> without nerve transposition, independently of the treatment provided.</p>","PeriodicalId":47843,"journal":{"name":"World Journal of Orthopedics","volume":"14 7","pages":"526-532"},"PeriodicalIF":1.9,"publicationDate":"2023-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/51/WJO-14-526.PMC10359752.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9865665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}