Journal of orthopaedic surgery (Hong Kong)最新文献

{"title":"Adductor canal block in outpatient clinic for pain control after knee arthroplasty: A randomized controlled, clinical trial.","authors":"Sholahuddin Rhatomy,&nbsp;Faiz A Rasyid,&nbsp;Michael A Romulo,&nbsp;Imelda Lumban-Gaol,&nbsp;Nicolaas C Budhiparama","doi":"10.1177/10225536221122246","DOIUrl":"https://doi.org/10.1177/10225536221122246","url":null,"abstract":"<p><strong>Background: </strong>Successful total knee replacement surgery is influenced by surgery and rehabilitation program. We hypothesized the adductor canal block (ACB) in the outpatient clinic is safe, effective for pain relief and decreases analgesic consumption compared with controls.</p><p><strong>Methods: </strong>a paired, randomized controlled trial. The intervention group received ACB with 15 mL mixture of ropivacaine 0.2% with isotonic saline and steroids on post-operative day 14 (POD-14) at the outpatient clinic, the control group received daily consumption of analgesic. We evaluated Visual Analog Score (VAS) pain score, and analgesic consumption.</p><p><strong>Results: </strong>35 subjects for each group. In the ACB group, mean of age was 66.42 years old, mean of BMI was 25.87. The control group, mean of age was 64.11 years old, mean of BMI was 25.95. There were significantly different mean VAS scores of both groups and analgesic consumption of both groups on POD 15^th, 17^th and 19^th (<i>p</i> = 0.00, 0.000 and 0.001, respectively). Two patients complained about hematoma in their thigh (insertion needle) and recovered.</p><p><strong>Conclusions: </strong>Single-shot ACB in the outpatient clinic is safe, significantly decreased pain and analgesic consumption and may enhance the rehabilitation program.</p>","PeriodicalId":520682,"journal":{"name":"Journal of orthopaedic surgery (Hong Kong)","volume":" ","pages":"10225536221122246"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40630716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy evaluation and systematic review of supramalleolar osteotomy for treatment of varus-type ankle arthritis.","authors":"Wang Xue,&nbsp;Tiannan Chen,&nbsp;Paerhati Wahafu,&nbsp;Fei Li,&nbsp;Ayiding Xiahatai,&nbsp;Aikeremu Wufuer,&nbsp;Yanan Tuo,&nbsp;Bo Zhao,&nbsp;Chengwei Wang","doi":"10.1177/10225536221122286","DOIUrl":"https://doi.org/10.1177/10225536221122286","url":null,"abstract":"<p><strong>Background: </strong>The current surgical treatment plan for medium-term varus-type ankle arthritis is primarily supramalleolar osteotomy (SMOT), but the reliability of this procedure still lacks high-quality evidence-based medical studies, such as randomized controlled clinical trials and meta-analyses of comparative studies.</p><p><strong>Objective: </strong>The current study explored whether significant differences were present in the clinical effect, reoperation rate, complications, and failure rate of this type of surgery.</p><p><strong>Method: </strong>Two researchers searched the relevant literature in seven databases, including PubMed, Cochrane Library, EMBASE, the China Biomedical Literature Database, the China Academic Journals Full-text Database, the Wanfang database, and the Weipu Chinese Science and Technology Journal Database. The retrieval time spanned the establishment of the specific database up to September 2020, and the literature was screened to determine their final inclusion in the study.</p><p><strong>Results and conclusions: </strong>A total of 20 studies were included, including one Chinese and 19 English language studies. The primary indicators included a definitive effect of SMOT on the treatment of medium-term varus-type ankle arthritis. Concerning secondary indicators, although the surgery effect was satisfactory, some patients may require follow-up surgery, which may be unsuccessful with complications. The study results showed that, based on existing literature reports, the effect of SMOT for varus-type ankle arthritis was a satisfactory surgical method with some clinical value for correcting the ankle force line and relieving or even reversing ankle arthritis. However, its risk of complications and failure rate were comparatively high and, accordingly, requires good preoperative planning and close communication with patients. Due to the limited sample size of this study, more data and longer follow-up times involving this type of surgery should be reviewed to confirm this conclusion.</p>","PeriodicalId":520682,"journal":{"name":"Journal of orthopaedic surgery (Hong Kong)","volume":" ","pages":"10225536221122286"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40413491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimum effective concentration of ropivacaine for ultrasound-guided adductor canal + IPACK block in total knee arthroplasty.","authors":"Qiuru Wang,&nbsp;Jian Hu,&nbsp;Lijun Cai,&nbsp;Aergen Bahete,&nbsp;Jing Yang,&nbsp;Pengde Kang","doi":"10.1177/10225536221122339","DOIUrl":"https://doi.org/10.1177/10225536221122339","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the minimum effective concentration (MEC_90, defined as effective in 90% of patients) of ropivacaine during the combined procedure of adductor canal block (ACB) and infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block for patients undergoing total knee arthroplasty.</p><p><strong>Methods: </strong>This double-blind, randomized dose-finding trial was based on a biased coin up-and-down sequential design, where the concentration of ropivacaine administered to a given patient depended on the previous patient's response. Before surgery, the first patient received 20 mL of 0.2% ropivacaine for ACB and again for IPACK. If the block failed, the next subject received a 0.025% higher ropivacaine concentration; otherwise, the next subject received either a 0.025% smaller dose (probability of 0.11) or the same dose (probability of 0.89). The primary outcome was whether the block was successful. Block success was defined as the patient did not suffer significant pain and did not receive rescue analgesia within 6 h after surgery. MEC₉₀ was estimated by isotonic regression, and the 95% confidence interval (CI) was calculated by bootstrapping. Secondary outcomes were numerical rating scale (NRS) pain scores at postoperative 24 h and 48 h, postoperative morphine consumption, and time to hospital discharge. Secondary outcomes were compared between patients whose blocks succeeded with those which failed.</p><p><strong>Results: </strong>Based on analysis of 52 patients, the MEC₉₀ was 0.247% (95% CI 0.227-0.271%), MEC₉₅ was 0.260% (95% CI 0.244-0.282%) and MEC₉₉ was 0.272% (95% CI 0.260-0.291%). In contrast, four of nine trials in a recent systematic review reported ropivacaine concentrations below 0.247%. Patients whose blocks succeeded (<i>n</i> = 45) had significantly lower NRS pain scores, lower morphine consumption, and shorter hospitalization than patients whose blocks failed (<i>n</i> = 7).</p><p><strong>Conclusions: </strong>Our small trial suggests that 0.247% ropivacaine in 20 mL respectively can provide successful ACB + IPACK block in 90% of patients. However, given that many published trials have used lower concentrations, our findings should be verified in larger studies.</p>","PeriodicalId":520682,"journal":{"name":"Journal of orthopaedic surgery (Hong Kong)","volume":" ","pages":"10225536221122339"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40619631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome after resection arthroplasty or shortening oblique osteotomy of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal joint for severe rheumatoid forefoot deformities.","authors":"Masahiro Horita,&nbsp;Keiichiro Nishida,&nbsp;Yoshihisa Nasu,&nbsp;Ryuichi Nakahara,&nbsp;Kenta Saiga,&nbsp;Masanori Hamada,&nbsp;Toshifumi Ozaki","doi":"10.1177/10225536221117903","DOIUrl":"https://doi.org/10.1177/10225536221117903","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated objective and patient-reported outcomes after resection arthroplasty or shortening oblique osteotomy (SOO) of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal (MTP) joint for severe rheumatoid forefoot deformities.</p><p><strong>Methods: </strong>17 feet from 14 women (mean age, 67.8 years) underwent resection arthroplasty of the lesser metatarsal heads (MTH resection group), while 13 feet from nine women and two men (mean age, 68.7 years) underwent SOO of the lesser metatarsals (MTH preservation group). Arthrodesis of the first MTP joint was performed in all cases. Mean follow-up in the MTH resection and preservation groups was 25.0 and 21.3 months, respectively. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q) scores.</p><p><strong>Results: </strong>Mean total JSSF scale significantly improved from 53.4 to 76.4 in the MTH resection group (<i>p</i> < .001) and from 50.1 to 74.2 in the MTH preservation group (<i>p</i> = .002). Pain and pain-related and shoe-related SAFE-Q subscale scores significantly improved after surgery in both groups. In the MTH resection group, recurrence of painful callosities and claw toe deformity was observed in four and three feet, respectively. In the MTH preservation group, one patient experienced recurrence of painful callosities and one underwent revision surgery for IP joint dislocation.</p><p><strong>Conclusion: </strong>Resection arthroplasty or SOO of the lesser metatarsals combined with arthrodesis of the first MTP joint achieved significant improvement with respect to pain relief, deformity correction, and footwear comfort.</p>","PeriodicalId":520682,"journal":{"name":"Journal of orthopaedic surgery (Hong Kong)","volume":" ","pages":"10225536221117903"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40678673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The outcome of type 1 pelvic resection and reconstruction with pedicle screw-rod system without bone grafting in malignant pelvic tumour: A case series and short term review.","authors":"Vivek Ajit Singh,&nbsp;Nor Faissal Yasin,&nbsp;Azura Mansor,&nbsp;Ahmed Elsiddig Mohamed Elhadi,&nbsp;Mohd Ariff Sharifudin","doi":"10.1177/10225536221119510","DOIUrl":"https://doi.org/10.1177/10225536221119510","url":null,"abstract":"<p><strong>Introduction: </strong>There is no consensus regarding the reconstruction method for type 1 resections around the pelvis. Various methods are currently used, such as resection without reconstruction, bone graft (autologous, recycled, allograft) with simple fixation, and pedicle screw-rod fixation with or without bone grafting. We aim to study the outcome of pedicle screw-rod reconstruction without bone grafting in type 1 pelvic resections involving sacroiliac joint to show that pedicle screw-rod construct alone is stable and has low risk of failure.</p><p><strong>Material and methods: </strong>This is a retrospective review of eight patients who underwent type 1 resection of malignant pelvic tumours and reconstruction with a pedicle screw-rod system between 2011 and 2018. All patients who underwent type 1 resection and reconstruction with pedicle screw without bone grafting were included into this study. We reported their clinical (complication and radiological outcome), oncological (local recurrence and metastasis), and functional outcome based on Musculoskeletal Tumour Society Score (MSTS) and The Toronto Extremity Salvage Score (TESS) at their last follow-up.</p><p><strong>Results: </strong>Eight patients were recruited into the study. The mean follow-up period was 58.5 months (range: 40 - 121 months). There were three postoperative complications in three different patients: superficial infection, surgical hernia with ipsilateral femoral avascular necrosis (AVN), and femoral nerve injury. At the end of the study period, one patient passed away due to disease progression, one patient was alive with disease, and the rest were disease-free. Mean MSTS score during last follow-up was 77.1% (range: 66.7% - 93.3%), while mean TESS score was 75.6% range (63.3% - 80.2%). There were no cases of implant failure.</p><p><strong>Conclusion: </strong>Type 1 pelvic reconstruction with a pedicle screw-rod system is stable without a concurrent biological reconstruction, and it is feasible, with few complications, and an excellent functional outcome.</p>","PeriodicalId":520682,"journal":{"name":"Journal of orthopaedic surgery (Hong Kong)","volume":" ","pages":"10225536221119510"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40425892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial Soft tissue and medial malleolus loss-the posterior tibial artery perforator technique combined with iliac crest autograft to Stabilize the ankle and cover Soft tissue defect: A case Series.","authors":"Xiaodong Li,&nbsp;Xiaowei Yan,&nbsp;Qiang Xie,&nbsp;Rui Gu,&nbsp;Zhixue Wang,&nbsp;Fei Liu,&nbsp;Lei Sui,&nbsp;Changyu Yu,&nbsp;Pei Wang","doi":"10.1177/10225536221111588","DOIUrl":"https://doi.org/10.1177/10225536221111588","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to investigate clinical efficacy of posterior tibial artery perforator technique combined with iliac crest autograft in treatment of medial soft tissue and medial malleolus loss.</p><p><strong>Methods: </strong>This study involved 11 cases of medial soft tissue and medial malleolus loss from October 2011 to March 2016. Patients were treated with posterior tibial artery perforator technique combined with iliac crest autograft, and given routine treatment, such as rehydration, anti-inflammation, anticoagulation and vasodilation. Ankle function of patients was evaluated according to the American Orthopedic foot and ankle Association (AOFAS) ankle-hind foot scoring system.</p><p><strong>Results: </strong>All flaps survived without bone exposure, and the appearance of skin flaps was satisfactory. There was one case of arterial crisis, one case of venous crisis, one case of skin edge necrosis and one case of incision infection. Wounds of the above patients were healed. Skin flap was soft and elastic without secondary contracture. The two-point discrimination of skin flap was 5-11 mm. The ankle range of motion was 10-60°. X-Ray showed that grafts healed within 8.6 months. According to AOFAS evaluation, four cases were excellent, four cases were good, and three cases were poor. The excellent and good rate was 72.8%.</p><p><strong>Conclusions: </strong>In this study, posterior tibial artery perforator technique combined with iliac crest autograft was used to treat medial soft tissue and medial malleolus loss. The findings demonstrated that this treatment was reliable and efficacious.</p>","PeriodicalId":520682,"journal":{"name":"Journal of orthopaedic surgery (Hong Kong)","volume":" ","pages":"10225536221111588"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40721100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous local antibiotic perfusion: A treatment strategy that allows implant retention in fracture-related infections.","authors":"Akihiro Maruo,&nbsp;Takahiro Oda,&nbsp;Ryowa Mineo,&nbsp;Hidetoshi Miya,&nbsp;Hirotsugu Muratsu,&nbsp;Tomoaki Fukui,&nbsp;Keisuke Oe,&nbsp;Ryosuke Kuroda,&nbsp;Takahiro Niikura","doi":"10.1177/10225536221111902","DOIUrl":"https://doi.org/10.1177/10225536221111902","url":null,"abstract":"<p><strong>Purpose: </strong>Fracture-related infections are difficult to treat because of the formation of biofilms around implants. Systemic antibiotics are notoriously ineffective against biofilms due to their insufficient penetration of tissues with poor vascularity. The goal of treating fracture-related infections is to achieve bone union while retaining the implant. Our proposal of continuous local antibiotic perfusion is a sustained local delivery system of sufficient antibiotics to bone and soft tissue infection sites, including to bone marrow via needles as intra-medullary antibiotics perfusion and to soft-tissue via double-lumen subcutaneous tubes as intra-soft tissue perfusion.</p><p><strong>Methods: </strong>In this study, we examined the outcomes of 40 patients treated for fracture-related infections using continuous local antibiotic perfusion between 2015 and 2021 at Steel Memorial Hirohata Hospital, Himeji, Japan.</p><p><strong>Result: </strong>The antibiotic used for continuous local antibiotic perfusion was gentamicin in all cases. Implant removal was required in five patients. Two patients required toe amputation and knee arthrodesis, while the remaining 38 patients achieved fracture union. Only one case of transient acute renal injury as a systemic side effect was observed, but it soon resolved. The blood concentration of gentamicin could be adjusted to less than the trough level.</p><p><strong>Conclusions: </strong>Continuous local antibiotic perfusion is a novel local drug delivery system that has the potential of delivering sufficient concentrations of antibiotics with few systemic side effects; it is a useful option for the treatment of fracture-related infections.</p>","PeriodicalId":520682,"journal":{"name":"Journal of orthopaedic surgery (Hong Kong)","volume":" ","pages":"10225536221111902"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40407525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thumb fingertip injuries reconstruction using a dorsoulnar flap of the thumb combined with relay V-Y flaps for donor site repair.","authors":"Jin Wang,&nbsp;Xiao Zhou,&nbsp;Li Qiang,&nbsp;Mingyu Xue","doi":"10.1177/23094990211025089","DOIUrl":"https://doi.org/10.1177/23094990211025089","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the clinical value and feasibility of the dorsoulnar flap of the thumb combined with relay V-Y flaps for reconstruction of the thumb fingertip injuries.</p><p><strong>Methods: </strong>In this retrospective study, we retrospectively reviewed 20 patients (13 men, 7 women; June 2014-June 2016) with thumb fingertip defects who underwent reconstructive procedures with transfer of the dorsoulnar flap of the thumb. The average size of the defects ranged from 1.8 cm × 2.0 cm to 2.0 cm × 3.0 cm, whereas the reconstructed dorsoulnar flap of the thumb ranged in size from 2.0 cm × 2.2 cm to 2.2 cm × 3.0 cm. A V-Y flap was used to repair the donor site at the same time. Sensation within the reconstructed thumb, the aesthetic appearance of both the donor and recipient sites, functional recovery, and return-to-work (RTW) time were measured.</p><p><strong>Results: </strong>All 40 flaps survived without necrosis. The follow-up period ranged from 6 to 24 months. There were no complications reported. The mean static two-point discrimination values at the reconstructed thumb fingertip and donor site were 8.5 mm (range 8-10 mm) and 12.5 mm (range 12-14 mm), respectively. The average visual analog scores for the aesthetic appearance of the recipient and donor sites were 8.4 (range 8-9.5) and 9.6 (range 9-10), respectively. The average Michigan Hand Outcome Questionnaire score for the reconstructed hand was 9.4 (range 6-16). The average RTW time was 9.8 weeks (range 6-13 weeks). All patients were satisfied with the aesthetic outcome.</p><p><strong>Conclusion: </strong>The dorsoulnar flap of the thumb is an ideal alternative for reconstruction of the thumb fingertip injuries, and a V-Y flap was suitable for repairing the donor site with a reduced incidence of complications.</p>","PeriodicalId":520682,"journal":{"name":"Journal of orthopaedic surgery (Hong Kong)","volume":" ","pages":"23094990211025089"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40581356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulnar nerve decompression with osteocapsular arthroplasty for primary elbow osteoarthritis.","authors":"Hyojune Kim,&nbsp;Erica Kholinne,&nbsp;Jae-Man Kwak","doi":"10.1177/10225536221109914","DOIUrl":"https://doi.org/10.1177/10225536221109914","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to suggest treatment guidline for primary elbow OA with ulnar nerve neuropathy or high-grade stiffness by evaluating the effect of ulnar nerve decompression on the outcome of osteocapsular arthroplasty.</p><p><strong>Methods: </strong>A total of 30 patients who underwent primary osteocapsular arthroplasty for elbow OA were retrospectively reviewed. The surgical outcomes were evaluated for pain score (visual analog scale; VAS), range of motion (ROM), and Mayo Elbow Performance Score (MEPS). The ulnar nerve decompression was performed for (1) ulnar nerve neuropathy, and (2) high-grade stiffness of flexion, defined as the flexion angle, is <90°. Patients were categorized into the two groups: ulnar nerve decompression group (UD group, <i>n</i> = 11) and the non-decompression group (Non-UD group, <i>n</i> = 19). The surgical outcome was compared between the groups.</p><p><strong>Results: </strong>Primary elbow OA with cubital tunnel syndrome or high-grade stiffness showed comparable improvement in MEPS, VAS, and ROM arc at final follow-up in the UD group compared with the non-UD group (UD group vs. non-UD group: MEPS 85.91 vs 86.84, <i>p</i>-value = 0.824, VAS 1.46 vs 1.16, <i>p</i>-value = 0.588, ROM arc 108 vs 109, <i>p</i>-value = 0.949). Improvement in ROM arc at 2 years follow-up was significantly higher in UD group (UD group vs. non-UD group: ROM arc difference, 42 vs 14, <i>p</i> = 0.002).</p><p><strong>Conclusion: </strong>Osteocapsular arthroplasty with ulnar nerve decompression for primary elbow OA with ulnar nerve neuropathy or high-grade stiffness provided improved motion arc and compatible clinical results.</p><p><strong>Level of evidence: </strong>Level III, Retrospective comparative study.</p>","PeriodicalId":520682,"journal":{"name":"Journal of orthopaedic surgery (Hong Kong)","volume":" ","pages":"10225536221109914"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40396894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of outcomes of different osteotomy sites for hallux valgus: A systematic review and meta-analysis.","authors":"Jun-Ichi Fukushi,&nbsp;Hirofumi Tanaka,&nbsp;Takayuki Nishiyama,&nbsp;Makoto Hirao,&nbsp;Makoto Kubota,&nbsp;Masataka Kakihana,&nbsp;Daisuke Nozawa,&nbsp;Kota Watanabe,&nbsp;Ryuzo Okuda","doi":"10.1177/10225536221110473","DOIUrl":"https://doi.org/10.1177/10225536221110473","url":null,"abstract":"<p><strong>Background: </strong>Hallux valgus (HV) is a common foot deformity for which several corrective surgical procedures, with different osteotomy sites, have been reported. The purpose of the present study was to systematically review randomized (RCTs) or controlled (CCTs) clinical trials and perform meta-analysis on outcomes of different osteotomy sites of the first metatarsal.</p><p><strong>Methods: </strong>An extensive literature search was conducted in PubMed and the Cochrane Library from January 1983 to July 2020. Studies were identified using the terms \"hallux valgus\" and \"osteotomy\". We included RCTs or CCTs comparing different locations of osteotomy for the first metatarsal bone (distal vs. mid-shaft, distal vs. proximal, and mid-shaft vs. proximal). The surgical outcomes included postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), American Orthopaedic Foot and Ankle Society (AOFAS) score, pain visual analog scale (VAS) score, perioperative complications and recurrence of deformity. We enrolled 10 studies with a total of 793 feet in the qualitative synthesis following full-text screening.</p><p><strong>Results: </strong>A majority of patients included in the enrolled trials showed mild to moderate deformity, with mean HVA <40°. Out of the 10 enrolled studies; six compared distal osteotomies with mid-shaft osteotomies and showed no significant differences in the surgical outcomes between the scarf and chevron groups; three RCTs compared distal osteotomies with proximal osteotomies with conflicting results, one RCT showed the superiority of proximal osteotomy while the other two RCTs showed equivalent outcomes; one study that compared between mid-shaft and proximal osteotomies showed equivalent outcomes between the groups.</p><p><strong>Conclusion: </strong>For the management of mild to moderate HV deformity, we found no significant clinical and radiological differences between patients treated with scarf and chevron osteotomies. Further controlled trials comparing different sites of osteotomies for moderate to severe HV deformity are needed.</p>","PeriodicalId":520682,"journal":{"name":"Journal of orthopaedic surgery (Hong Kong)","volume":" ","pages":"10225536221110473"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40506688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}