Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Midfoot fractures: Patterns of injury and predictors of stability","authors":"Serena Patel,&nbsp;Danielle Piper,&nbsp;Paul Fenton","doi":"10.1016/j.jcot.2024.102874","DOIUrl":"10.1016/j.jcot.2024.102874","url":null,"abstract":"<div><h3>Background</h3><div>Lisfranc injuries describe a spectrum of midfoot and tarsometatarsal joint (TMTJ) trauma ranging from purely ligamentous to multiple fracture-dislocations. Lisfranc injuries represent 0.2 % of all fractures and are seen predictably, with mechanisms involving a fall from height, crushing, or torsion. Diagnosis can be challenging, with approximately 20 % of cases being missed, and relies upon clinical acumen and proficient image interpretation. Whilst multiple classification systems have described Lisfranc injuries using a 3-column concept, these add zero prognostic value and are therefore rarely used clinically. Furthermore, existing literature on diagnosis and management is limited to retrospective small series.</div></div><div><h3>Methods</h3><div>We present a review of 161 midfoot injuries, with the aim of highlighting characteristics of radiological instability and indication for operative management. CT scans and weight-bearing and non-weight-bearing X-rays were reviewed for features of joint instability. These features included metatarsal base, cuneiform and cuboid fractures, tarsometatarsal joint subluxation or dislocation and C1-MT2 diastasis. The subsequent “stable” and “unstable” injury groups were then compared to identify statistically significant indicators for instability.</div></div><div><h3>Results</h3><div>Avulsion and intra-articular fractures of the medial, middle, or lateral column were all suggestive of instability. Although these appeared in multiple combinations, 95 % involved the middle column. Concomitant inter-cuneiform and cuboid fractures were additional indicators of instability. In cases of uncertain midfoot instability, weight-bearing radiographs were of value with 14.2 % demonstrating a diastasis of C1-MT2 &gt;2 mm.</div></div><div><h3>Conclusion</h3><div>We propose the need for a new classification of midfoot injuries which emphasises the diagnosis of instability and guides surgical management. We propose that, based on non-weight-bearing X-ray and CT scans, these injuries can be initially classified as “stable”, “unstable”, or “stability uncertain”. Weight-bearing X-rays are a safe and reliable method of detecting instability in the “stability uncertain” group. Fractures of the medial column and cuneiform on initial imaging were suggestive of midfoot instability.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102874"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016303","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":"Magnetic resonance imaging of knee arthropathies: A pictorial review","authors":"Shayeri Roy Choudhury ,&nbsp;Mahesh Prakash ,&nbsp;Madhurima Sharma ,&nbsp;Anindita Sinha ,&nbsp;Devendra Kumar Chouhan","doi":"10.1016/j.jcot.2024.102872","DOIUrl":"10.1016/j.jcot.2024.102872","url":null,"abstract":"<div><div>A wide variety of degenerative, inflammatory and infective arthropathies with overlapping clinical features can involve the knee joint. Due to its excellent soft tissue contrast resolution and multiplanar capability, magnetic resonance imaging (MRI) plays a significant role in early and accurate diagnosis of various arthropathies. In this article, we have provided a brief review of MRI features of various arthropathies involving the knee joint.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102872"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016285","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 patellofemoral ligament reconstruction using synthetic suture tape: A systematic review of biomechanical and clinical outcomes","authors":"Muzammil Akhtar ,&nbsp;Sonia Aamer ,&nbsp;Mohammad Asad ,&nbsp;Daniel Razick ,&nbsp;Mustafa Jundi ,&nbsp;Trevor Shelton","doi":"10.1016/j.jcot.2024.102883","DOIUrl":"10.1016/j.jcot.2024.102883","url":null,"abstract":"<div><h3>Purpose</h3><div>To review outcomes of medial patellofemoral ligament reconstruction (MPFLR) using synthetic suture tape in biomechanical and clinical studies.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was performed in three databases. Studies reporting biomechanical and/or clinical outcomes of MPFLR using synthetic suture tape were included. For clinical studies, the primary outcome measures included patient-reported outcomes (PROs) and adverse events.</div></div><div><h3>Results</h3><div>Three biomechanical studies were included. One study reported stronger integrity of fixation with suture tape versus semitendinosus autografts. One study reported similar integrity of MPFLR with knotless anchor versus soft tissue fixation. Another study found suture tape fixation between 60° and 90° of knee flexion to avoid excessive medial patellofemoral joint contact pressure after MPFLR. Eight clinical studies with 287 patients and 317 knees (36.1 % male, pooled mean age: 23.2 years old, pooled mean follow-up: 41.6 months) were included. All studies reported significant preoperative to postoperative improvement for all PROs except for the Tegner score in one study. The range of PROs were as follows (preoperative and postoperative): Lysholm (32.8–72.0 and 78.0 to 96.7), Kujala (36.0–75.2 and 78.8 to 97.7), International Knee Documentation Committee (IKDC) (48.6–69.8 and 71.3 to 91.3), and Tegner (1.0–4.6 and 4.0 to 6.5). Two studies comparing suture tape with autografts (quadriceps and gracillis tendons) reported similar postoperative PROs. The pooled rate of adverse postoperative events was 8.2 %. The pooled rate of positive patellar apprehension tests at follow-up was 3.2 %.</div></div><div><h3>Conclusions</h3><div>Patients undergoing MPFLR with suture tape fixation achieved significant improvements in PROs and demonstrated low rates of postoperative complications. Compared to autograft fixation, suture tape fixation provided comparable or superior clinical and biomechanical outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102883"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016289","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":"Mid-term outcomes of elbow hemiarthroplasty using the triceps-on approach for comminuted distal humerus fractures","authors":"Siddharth Virani ,&nbsp;Karim M. Abdelghafour ,&nbsp;Angelos Assiotis ,&nbsp;Clarence Yeoh ,&nbsp;Adam Rumian ,&nbsp;Harpal Uppal","doi":"10.1016/j.jcot.2024.102886","DOIUrl":"10.1016/j.jcot.2024.102886","url":null,"abstract":"<div><h3>Background</h3><div>There has been an increasing interest in elbow hemiarthroplasty to circumvent the problems with total elbow arthroplasty for comminuted distal humerus fractures in the elderly. The primary aim of the study is to assess the mid-term clinical and radiological outcomes of patients undergoing TEA and hemiarthroplasty for distal humerus fractures.</div></div><div><h3>Methods</h3><div>Retrospective analysis of data for patients undergoing hemiarthroplasty for distal humerus fractures (OTA- C3 Comminuted total articular fractures) was done. This is a non-randomized consecutive series from a single centre. A minimum follow-up of 3 years was required for inclusion. Patients with delayed/neglected presentation (&gt;3 weeks), those needing total elbow arthroplasty and conservatively managed fractures needing delayed arthroplasty were excluded.</div></div><div><h3>Results</h3><div>A total of 12 patients were operated in the period between 2016 and 2021(mean follow-up-59.4 months). The mean age of the patients undergoing hemiarthroplasty was 68.4 years. The mean arc of flexion extension was 21–115°. The mean range of supination was 75° while pronation was 86° (p &gt; 0.05). The mean QuickDASH score was 8.7. There were no cases of infection, dislocations, intra-operative fractures or revision surgery. Two patients had transient weakness in the ulnar nerve distribution that recovered on follow-up.</div><div>Evidence of heterotrophic ossification was seen in 8 patients. None of the patients showed radiological evidence of loosening but trochlear cartilage wear was seen in 2 patients. None of the radiographs showed migration of the condyles. There were 5 cases where the medial condyle though approximated had not healed.</div></div><div><h3>Conclusions</h3><div>Elbow hemiarthroplasty provides predictably good clinical and radiological outcomes on mid-term follow-up. Longer follow-up is necessary to determine the survival of these prostheses in the long term.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102886"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030000","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":"Complications in anterior cruciate ligament reconstruction Articular cartilage reconstruction: Review of concepts, techniques, complications, risk factors, and Bail out/salvage strategies","authors":"Melanio Acosta IV,&nbsp;Alberto Gobbi","doi":"10.1016/j.jcot.2024.102875","DOIUrl":"10.1016/j.jcot.2024.102875","url":null,"abstract":"<div><div>Chondral lesions are difficult and challenging depending on their size, location, and chronicity. In cartilage reconstruction, our aim is to employ techniques to help save the joint, regenerate lost or diseased cartilage, and hopefully prevent or delay the progression of osteoarthritis and the need for arthroplasty. As patient and lesion characteristics differ from case to case, there is no single surgical strategy ideal to treat all chondral lesions. With the advancement of our knowledge and comprehensive research efforts, marrow-stimulating techniques like microfracture and microdrilling, as well as cartilage regeneration methods such as autologous chondrocyte implantation, autologous matrix-induced chondrogenesis, and the application of hyaluronic acid-based scaffolds with MSCs, have become fundamental approaches in confronting this growing challenge. Emphasizing the importance of patient selection is vital, given that compliance with rehabilitation and return-to-play protocols, along with adherence to established timelines, is essential. Furthermore, it is necessary to select patients who are free from biomechanical malalignment and do not present with concomitant meniscal or ligamentous issues that must be addressed prior to surgery. However, despite all our attempts to ensure the best outcomes for our patients, complications are sometimes unavoidable. Thus, being able to recognize possible complications, utilize strategies to prevent these complications, and knowing how to manage complications when encountered are important for any orthopaedic surgeon.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102875"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176165","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":"Complications in anterior cruciate ligament reconstruction","authors":"David Figueroa,&nbsp;Waldo Gonzalez,&nbsp;Loreto Figueroa,&nbsp;Francisco Figueroa,&nbsp;Alex Vaisman","doi":"10.1016/j.jcot.2024.102876","DOIUrl":"10.1016/j.jcot.2024.102876","url":null,"abstract":"<div><div>Anterior cruciate ligament reconstruction (ACLR), despite its effectiveness in restoring knee stability and function, can have associated morbidity. The most frequent complications are technical errors, which have been described during graft harvesting, tunnel placement or graft fixation. The most serious complications are neurovascular injuries, arthrofibrosis and infections. Recently, several high-quality studies have been published to help surgeons improve their performance in this surgery. Each stage of the surgical process carries potential complications, even when safe techniques are followed. When complications arise, it is crucial to promptly recognize them and adhere to established guidelines to effectively correct, minimize, or resolve the issues. In this review article, we have attempted to summarise the best available evidence addressing ACLR complications, following our primary goal of improving the outcomes for patients who suffer an ACL injury.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102876"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016254","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":"A comparative analysis of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty for posterior glenoid wear patterns","authors":"Austin Hardaway ,&nbsp;Andrew Renshaw ,&nbsp;Tyler Brolin ,&nbsp;David Bernholt ,&nbsp;Frederick Azar ,&nbsp;Thomas Throckmorton","doi":"10.1016/j.jcot.2024.102868","DOIUrl":"10.1016/j.jcot.2024.102868","url":null,"abstract":"<div><h3>Introduction</h3><div>Reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (TSA) are well-known methods of treating glenohumeral arthritis, which often leads to posterior wear of the glenoid. This study compared minimum two-year outcome measures in patients treated with RSA and TSA for Walch B2 and B3 glenoids.</div></div><div><h3>Methods</h3><div>Thirty-eight shoulders underwent TSA and 40 shoulders underwent RSA by two fellowship-trained shoulder surgeons at a tertiary referral center.</div></div><div><h3>Results</h3><div>The mean time for follow-up was 25.9 months and 25.5 months for RSA and TSA groups, respectively (<em>P</em> = 0.47). The RSA group consisted of 27 males and 13 females; whereas the TSA group had 37 males and 1 female (<em>P</em> = &lt;0.001). The mean age for RSA was 71 years old, 61 years for TSA (<em>P</em> = &lt;0.001). TSA patients demonstrated superior average active external rotation (47° vs 40°; <em>P</em> = 0.003) and internal rotation (60° vs 52°; <em>P</em> = 0.002). Active forward elevation did not significantly differ. The TSA group had 7 (18.4 %) postoperative complications, the RSA group had 3 (7.5 %) (<em>P</em> = 0.27). The most common complication was cephalic vein thrombosis. No complication required revision.</div></div><div><h3>Conclusions</h3><div>Patients with shoulder osteoarthritis and posterior glenoid wear patterns with an intact rotator cuff who underwent TSA had similar outcomes as RSA. While the TSA group had superior active external rotation and internal rotation at 2 years postoperative compared with RSA, the 2-year active forward elevation was equivalent. Both groups had similar 2-year outcomes for strength in all planes and in all three clinical-outcome scoring systems. The TSA group demonstrated a higher incidence of postoperative complications. Neither group required reoperations. These results indicate that TSA and RSA can be safely utilized in posterior glenoid wear patterns with good clinical outcomes.</div></div><div><h3>Level of evidence</h3><div>Level III; Retrospective cohort study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102868"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016260","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":"Guide-wire and K-wire readjustment jig for osteotomy and osteosynthesis: An instrument","authors":"Sandeep Patil ,&nbsp;Sachin Patil ,&nbsp;Punam Patil","doi":"10.1016/j.jcot.2024.102841","DOIUrl":"10.1016/j.jcot.2024.102841","url":null,"abstract":"<div><h3>Introduction</h3><div>Numerous orthopaedic procedures including dynamic hip screw plating and various osteotomies require placement of a reference guide pin or K wire to direct bone cuts or for drilling screw holes. Appropriate positioning of these wires is a critical component of surgery. Irrespective of whether one is a seasoned surgeon or an apprentice, these wires often need repositioning and readjustment. Parallel wire positioning is needed even during procedures like osteotomies or patellar fracture fixation. Though there are several tools available to help with accurate placement of wires and saving operating time, there are very few tools which can actually control the direction or angulation of the wire. The ones which are available are usually difficult to use, are bulky, have long attachments arms or have too many fine adjustments. We propose a device that not only directs the positioning of the parallel wires but also helps with a 360-degree correction in direction of the wrongly positioned wire. It is a multipurpose jig that can be used in patella fracture, inter-trochanteric fracture femur, fracture neck of femur, osteotomies around knee, elbow and distal femur, etc.</div></div><div><h3>Material and methods</h3><div>We proposed, designed and manufactured a new device for the guide wire insertion. Our jig design has three tunnels. Two tunnels, primary and secondary run parallel to each other and the oblique tunnel runs at an angle and is positioned 7 mm away from the parallel tunnel at one end and shares a common opening with the secondary tunnel on opposite end. Other similar jigs either have only parallel tunnels (primary and secondary) or an oblique tunnel which is at the far end of metal bar, making it difficult to be used to correct the angular direction of the guidewire in reference to primary or secondary wire.</div></div><div><h3>Results and conclusions</h3><div>Using our newer device, wires can be guided in all directions and in all planes (sagittal, coronal, axial, and 360°). Correction of the wire direction using this jig is significantly easier and faster, a process which can take anywhere between 15 min and an hour of surgical time for a beginner orthopaedic surgeon. The need for multiple repeated attempts to insert wires, resulting in a bone void and damage to the surrounding structures, is minimised or eliminated. Applications include a variety of surgical procedures of osteosynthesis and osteotomies. In conclusion, our device is easier to use as it is smaller in size and available in different sizes and angles. It not only avoids bone loss and fragmentation due to repetitive insertion of wires but also improves the accuracy of primary reference wire placement or revision of its direction.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102841"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016277","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":"Induced membrane technique for aseptic recalcitrant nonunion of the femur and tibia: Bone union and deformity correction outcomes","authors":"Germán Garabano ,&nbsp;Andres Juri ,&nbsp;Renan Issac Guerrero Alvarado ,&nbsp;Lucrecia Vena ,&nbsp;Cesar Angel Pesciallo ,&nbsp;Rafael Amadei Enghelmayer","doi":"10.1016/j.jcot.2024.102879","DOIUrl":"10.1016/j.jcot.2024.102879","url":null,"abstract":"<div><h3>Introduction</h3><div>Aseptic recalcitrant nonunion (ARNU) of the femur and tibia is an entity in which the absence of bony union, misalignment, and limb length discrepancies (LLD) coexist. Currently, the management of these cases lacks consensus. This study aimed to describe the bone union rate and deformity correction outcomes in patients with ARNU of the femur or tibia treated with the Induced Membrane Technique (IMT).</div></div><div><h3>Methods</h3><div>We retrospectively review ten consecutive patients with ARNU (eight femoral and two tibial) treated with IMT in two stages, between January 2021 and May 2023, at a single center. The median age was 47.6 years (range 28–67), with an average of 2.76 previous surgeries (range 2–5). Six were atrophic, and four were eutrophic nonunions. All had LLD ranging from 11 to 35 mm (median 23.9), with coronal or sagittal plane misalignment between 10 and 15° (median 11.8) in six cases and rotational misalignments between 10 and 30° (median 17.5) in six cases, assessed by lower limb scanograph and rotations by computed tomography (CT) scan.</div></div><div><h3>Results</h3><div>The median bone defect length was 43 mm (range 30–60). Treatment involved a traction table in five cases, manual traction in three, and a femoral distractor in two. Fixation in the first stage included eight intramedullary nails and two locked plates. In the second stage, we filled the defect with autograft in eight cases and mixed (auto-allograft) in two (1:1 ratio). At the end of the follow-up, 9/10 patients showed bone union (seven without additional surgeries). There was one failure due to graft resorption. LLD was wholly corrected in four cases; the remaining six had a median discrepancy of 8.16 mm (range 2–15). No patients had axial or rotational misalignment exceeding 5°.</div></div><div><h3>Conclusion</h3><div>The results of this study suggest that IMT is viable for complex cases such as ARNU. Manipulating the defect allowed us to achieve an acceptable bone union rate, correcting length discrepancies up to 35 mm, axial misalignment up to 15°, and rotational misalignment up to 30°.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102879"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016281","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":"Survivorship of hip after acetabulum fracture fixation – Analysing risk factors associated with early THR","authors":"Sandeep Kumar ,&nbsp;Priya Yadav ,&nbsp;Akash Mishra ,&nbsp;Shataayu Gugale ,&nbsp;Rohit Goyal ,&nbsp;Vivek Bhambhu","doi":"10.1016/j.jcot.2024.102873","DOIUrl":"10.1016/j.jcot.2024.102873","url":null,"abstract":"<div><h3>Introduction</h3><div>Acetabular fracture fixation principles stated by Letournel and Judet have contributed significantly towards advancement in treatment methodologies. Current day techniques helps to achieve anatomical reduction, still post-traumatic arthritis ensues in some patients. A meta-analysis by Giannoudis et al. revealed osteoarthritis incidence of 13 % in patients with satisfactory reductions (&lt;2 mm) and 44 % with unsatisfactory reductions (&gt;2 mm). Predicting poor outcomes before treatment could improvise patient counselling and treatment selection. This study aims to assess the functional outcomes and analyze risk factors for early total hip replacement (THR) in acetabulum fractures.</div></div><div><h3>Materials and methods</h3><div>From 2017 to 2024, 560 patients with acetabulum fractures were managed surgically. Out of them 316 had more than 2 years follow up, and were included in this study. Fracture patterns involved 5 elementary and 5 associated types, treated through various surgical approaches and followed up for an average of 3 years. Data collection included demographics, lab investigations, radiographs, and CT scans. Statistical analysis using SPSS version 29.0.2.0 employed Chi-square tests, Fisher's exact tests and Cox proportional hazards regression to identify significant predictors of THR, with P-values &lt;0.05 considered significant.</div></div><div><h3>Results</h3><div>The study involved 316 patients, with a mean age of 43 years, followed up for 2–7 years. 81 % were males. Most fractures were T-type (17.1 %) and treated using the Modified Stoppa Approach (43.7 %). Anatomic reduction was achieved in 77.2 % patients. Overall, 75.3 % patients had excellent to good outcomes. 32 (10.12 %) of the patients were converted to THR, while 46 (14.5 %) had fair outcomes, and were considered as cases of impending THR. Significant predictors for THR included age, surgical delay, fracture pattern and reduction quality. Age 60 and above, and poor reduction quality were associated with higher THR rates (Hazard ratio = 1.00).</div></div><div><h3>Conclusion</h3><div>Survivorship of the hip joint post-acetabulum fracture is influenced by age, fracture pattern, surgical delay, and post operative reduction quality. Addressing modifiable factors such as anatomical reductions of the fracture and surgical intervention within one week of injury are crucial for improving long-term outcomes, further reducing the need for THR after acetabular fracture fixation.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102873"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016400","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}