Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Validity, reliability and responsiveness of a French translation of the Western Ontario Osteoarthritis of the Shoulder index (WOOS)","authors":"","doi":"10.1016/j.otsr.2024.103912","DOIUrl":"10.1016/j.otsr.2024.103912","url":null,"abstract":"<div><h3>Introduction</h3><p>While several general questionnaires can be used to evaluate shoulder conditions, very few tools specifically evaluate the impact of shoulder osteoarthritis<span><span>. The Western Ontario Osteoarthritis of the Shoulder index (WOOS) is a patient-reported outcome measure with excellent psychometric properties intended for patients suffering from shoulder </span>osteoarthritis. Unfortunately, there is no validated French version of this questionnaire.</span></p></div><div><h3>Objective</h3><p>Produce a validated French version of the WOOS that is suitable for the Francophone populations of Europe and North America.</p></div><div><h3>Material and methods</h3><p><span>A validated protocol was used to create a French version of the WOOS (WOOS-Fr). Included were patients whose first language was French, who could read French and who had shoulder osteoarthritis destined for treatment (surgical treatment</span> <!-->=<!--> <!-->arthroplasty). The WOOS-Fr was compared to the Disability of the Arm, Shoulder and Hand–French translation (F-QuickDASH-D/S) to assess its validity. Reliability and responsiveness were also analyzed.</p></div><div><h3>Results</h3><p>A French version of the WOOS (WOOS-Fr) was accepted by a multinational committee. The WOOS-Fr was validated in 71 French-speaking subjects. A strong positive correlation was found between the WOOS-Fr and the F-QuickDASH-D/S during the initial evaluation. The intra-class correlation (ICC) of the total WOOS-Fr score indicated good reliability between the initial WOOS and the 1-week WOOS (ICC: 0.84; 95% CI: [0.767; 0.896]; <em>p</em>-value: <!--> <!-->&lt;<!--> <!-->0.001) in 57 patients. The responsiveness between the initial WOOS-Fr and at 1 year postoperative was high in the 36 operated patients (standardized mean response of 1.95).</p></div><div><h3>Discussion</h3><p>A French translation of the WOOS questionnaire was created and validated for use in French-speaking populations. This questionnaire will make it easier to evaluate the psychometric results of patients with shoulder osteoarthritis in Francophone countries.</p></div><div><h3>Level of evidence</h3><p>III; multicenter cohort study.</p></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141181449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach","authors":"","doi":"10.1016/j.otsr.2024.103911","DOIUrl":"10.1016/j.otsr.2024.103911","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Femoral neck fractures constitute a </span>public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates.</p></div><div><h3>Hypothesis</h3><p>Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach.</p></div><div><h3>Material and methods</h3><p>This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative “hidden” blood loss. The risk of early dislocation (less than 6 months) was also analyzed.</p></div><div><h3>Results</h3><p>Total blood loss was similar between the two groups, AA: 1626<!--> <!-->±<!--> <!-->506<!--> <!-->mL versus PA: 1746<!--> <!-->±<!--> <!-->692<!--> <!-->mL (<em>p</em> <!-->=<!--> <!-->0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (<em>p</em> <!-->=<!--> <!-->0.31) as well as the duration of hospitalization, AA: 8.5<!--> <!-->±<!--> <!-->3.2 versus PA: 8.2<!--> <!-->±<!--> <!-->3.3 days (<em>p</em> <!-->=<!--> <!-->0.54). The operating time was shorter in the PA group (Δ<!--> <!-->=<!--> <!-->10.3<!--> <!-->±<!--> <!-->14.1<!--> <!-->minutes [<em>p</em> <!-->&lt;<!--> <!-->0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (<em>p</em> <!-->=<!--> <!-->0.03).</p></div><div><h3>Conclusion</h3><p>This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk.</p></div><div><h3>Level of proof</h3><p>III, comparative study of continuous series.</p></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141159219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tendon transfers in reverse total shoulder arthroplasty: A systematic review and descriptive synthesis of biomechanical studies.","authors":"Kevin A Hao, Keegan M Hones, Taylor R Raukaskas, Jonathan O Wright, Joseph J King, Thomas W Wright, Jean-David Werthel, Bradley S Schoch","doi":"10.1016/j.otsr.2024.103903","DOIUrl":"10.1016/j.otsr.2024.103903","url":null,"abstract":"<p><strong>Background: </strong>The role of tendon transfer and ideal insertion sites to improve axial rotation in reverse total shoulder arthroplasty (RTSA) is debated. We systematically reviewed the available biomechanical evidence to elucidate the ideal tendon transfer and insertion sites for restoration of external and internal rotation in the setting of RTSA and the influence of implant lateralization.</p><p><strong>Patients and methods: </strong>We queried the PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify biomechanical studies examining the application of tendon transfer to augment shoulder external or internal rotation range of motion in the setting of concomitant RTSA. A descriptive synthesis of six included articles was conducted to elucidate trends in the literature.</p><p><strong>Results: </strong>Biomechanics literature demonstrates that increasing humeral-sided lateralization optimized tendon transfers performed for both ER and IR. The optimal latissimus dorsi (LD) transfer site for ER is posterior to the greater tuberosity (adjacent to the teres minor insertion); however, LD transfer to this site results in greater tendon excursion compared to posterodistal insertion site. In a small series with nearly 7-year mean follow-up, the LD transfer demonstrated longevity with all 10 shoulders having>50% ER strength compared to the contralateral native shoulder and a negative Hornblower's at latest follow-up; however, reduced electromyography activity of the transferred LD compared to the native contralateral side was noted. One study found that transfer of the pectoralis major has the greatest potential to restore IR in the setting of lateralized humerus RTSA.</p><p><strong>Conclusion: </strong>To restore ER, LD transfer posterior on the greater tuberosity provides optimal biomechanics with functional longevity. The pectoralis major has the greatest potential to restore IR. Future clinical investigation applying the biomechanical principles summarized herein is needed to substantiate the role of tendon transfer in the modern era of lateralized RTSA.</p><p><strong>Level of evidence: </strong>IV; systematic review.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal femoral varus osteotomy for Legg-Calvé-Perthes disease: Do age and lateral pillar classifications influence short-to-mid-term clinical and radiological outcomes?","authors":"Nima Hoseini-Zare, Peyman Mirghaderi, Brice Ilharreborde, Kiarash Roustai-Geraylow, Alireza Moharrami, Taghi Baghdadi, Seyed Hadi Kalantar, Mohammad Hossein Nabian","doi":"10.1016/j.otsr.2024.103909","DOIUrl":"10.1016/j.otsr.2024.103909","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal femoral varus osteotomy (FVO) is one of the most used treatment methods with acceptable outcomes for Legg-Calvé-Perthes disease (LCPD). We aimed to investigate the influence of age at disease onset and the Lateral Pillar classification on clinical and radiological outcomes of FVO surgery LCPD patients between 6-12years of age.</p><p><strong>Hypothesis: </strong>Proximal FVO surgery in the early fragmentation phase of LCPD patients led to acceptable clinical and radiographic outcomes in a 3-year follow-up, regardless of preoperative age and Herring type.</p><p><strong>Material and methods: </strong>Fifty patients with LCPD (Herring groups B, B/C, and C) who underwent FVO were retrospectively reviewed. We evaluated radiological [center-edge angle, extrusion index, epiphyseal index, acetabular index, articulo-trochanteric distance (ATD)] and clinical [hip abduction range of motion (ROM), Trendelenburg sign, pain, and Harris hip score (HHS)] outcomes with a follow-up of 37.3±10.5months (range: 24-180months). Finally, the overall treatment outcome was assessed using the Stulberg classification.</p><p><strong>Results: </strong>The ROC curve analysis did not reveal any significant relationship between age and clinical or radiological outcomes, and there was no predictable age cut-off for surgical outcomes (p=0.13). No significant difference was found in Stulberg classification at the follow-up between patients with type B, B/C, and C of the lateral pillar (p>0.05).</p><p><strong>Discussion: </strong>Our results demonstrated that open-wedge proximal FVO surgery in the early fragmentation phase of LCPD patients led to acceptable clinical and radiographic outcomes in a 3-year follow-up. Each sample of our study was very small and a lot of variables were measured, making this result not adequately strong enough to draw a robust conclusion. However, FVO surgery remains a possible suggestion for patients in the early fragmentation phase, and age and lateral pillar type may not be limiting factors.</p><p><strong>Level of evidence: </strong>IV; therapeutic retrospective cohort.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Average total weight of surgical waste and CO₂ carbon footprint of orthopedic surgery in France, estimated on the basis of a representative panel.","authors":"Pierre Ogeron, Baptiste Boukebous, Anthony Desender, Philippe Massard-Combe, Camille Vorimore, Pascal Guillon","doi":"10.1016/j.otsr.2024.103910","DOIUrl":"10.1016/j.otsr.2024.103910","url":null,"abstract":"<p><strong>Background: </strong>Reduction of waste and carbon footprint can be optimized. Awareness of carbon sources and quantification of the waste are two key parameters. To our knowledge, there is no study in France on waste production by the surgical team during the operation in orthopedic surgery, in a global scope. Therefore, we performed an observational investigation aiming to: (1) quantify and characterize the weight of the wastes generated after a panel of orthopedic procedures, (2) calculate the CO₂ footprint generated by these wastes and extrapolate the figure at the national scale.</p><p><strong>Hypothesis: </strong>Waste production is highly variable according to the types of procedures and infectious clinical waste is still a predominant source of waste and CO₂ emission.</p><p><strong>Materials and methods: </strong>It is a comparative and prospective study in which a total of 14 procedures were selected as a representative panel: arthroplasties (hip, knee), spine fusions, arthroscopic procedures (shoulder, knee), nerve release, forefoot osteotomies, trauma procedures. The main outcome was the average total weight of waste for each of the fourteen categories (280 measurements: 140 times 2, at the end of each procedure), expressed in kilograms (kg), and the proportions of infectious clinical waste (ICW) and household wastes (HW), expressed in percentages. Ten measures were prospectively recorded for each type of procedure in a single teaching hospital from January to September 2022. The theoretical carbon footprint generated by the treatment of the wastes was estimated in kilograms of CO₂ equivalent (KgEqCO₂). The national extrapolation of the carbon footprint was performed by collecting the total number of procedures in France in 2021 using the VisuChir tool.</p><p><strong>Results: </strong>A total of 937kg of waste were produced for the 140 procedures, amongst which 514kg of ICW (54.8%) and 423kg of HW (45.2%). The overall median waste weight was 5.9kg (Q1: 4.4, Q3: 8.1), ranging from 1.8kg to 18.3kg. The overall median waste weight for HW was 2.8kg (Q1: 2.5, Q3: 3.4), ranging from 1.8kg to 17.8kg. The overall median waste weight for ICW was 3.8kg (Q1: 2.7, Q3: 4.8), ranging from 0.8kg to 7.2kg. The knee surgeries were responsible for the heaviest waste weight; the least waste-productive procedures were the foot and the carpal tunnel release. The median proportions of ICW varied from 39% for the total knee replacements to 72% for the femoral nails. There was a significant inverse correlation between the total waste weight and the proportion of ICW: r=-0.47, p<10^-4. The total median estimated carbon footprint was 4.3KgCO₂Eq (Q1: 3.1, Q3: 5.8), ranging from 1.59KgCO₂Eq (Q1: 1.5, Q3: 1.8) and 7.07KgCO₂Eq (Q1: 6.7, Q3: 8.17). The total median estimated carbon footprint was 3.5KgCO₂Eq for ICW (Q1: 2.5, Q3: 4.5) and 0.76KgCO₂Eq","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in imaging for pre-surgical planning in hip resurfacing arthroplasty","authors":"","doi":"10.1016/j.otsr.2024.103908","DOIUrl":"10.1016/j.otsr.2024.103908","url":null,"abstract":"<div><h3>Background</h3><p>Accurate preoperative templating is essential for the success of hip resurfacing arthroplasty (HRA). While digital radiograph is currently considered the gold standard, stereoradiograph and CT converted 3D methods have shown promising results. However, there is no consensus in the literature regarding the preferred modality for HRA templating, and angular measurements are often overlooked. Thus, this study aimed to: (1) compare the performances of different modality in implant sizing and angle measurements, (2) evaluate the measurement reproducibility, (3) assess the impact of severe osteoarthritis on femoral head sizing, and (4) based on the analysis above, explore the optimal imaging and planning strategy for HRA.</p></div><div><h3>Hypothesis</h3><p>An optimal imaging modality exists for HRA planning regarding implant sizing and angular measurements.</p></div><div><h3>Materials and methods</h3><p>Preoperative imaging data from seventy-seven HRA surgeries were collected. Three raters performed templating using digital radiograph, stereoradiograph, and CT converted 3D models. Measurements for femoral head size, neck-shaft angle, and calcar-shaft angle were obtained. The femoral head sizing was compared to the intraoperative clinical decision. The reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC). Correlations were examined between sizing disagreement and osteoarthritis grade (Tonnis Classification).</p></div><div><h3>Results</h3><p>Digital radiograph, stereoradiograph, and 3D techniques predicted one size off target in 27/77 (35%), 49/70 (70%), and 75/77 (97%) of cases, respectively, corresponding to 1.8<!--> <!-->±<!--> <!-->1.6 (0 to 5.67), 0.9<!--> <!-->±<!--> <!-->0.7 (0 to 2.67), and 0.4<!--> <!-->±<!--> <!-->0.4 (0 to 1.67) sizes off target, indicating statistically significant differences among all three modalities, with <em>p</em>-values all below 0.01. There were no statistically significant differences among the different modalities for angular measurements. Measurements showed moderate to excellent reproducibility (ICC<!--> <!-->=<!--> <!-->0.628–0.955). High-grade osteoarthritis did not impact image sizing in any modality (r<!--> <!-->=<!--> <!-->0.08–0.22, all <em>p</em> <!-->&gt;<!--> <!-->0.05).</p></div><div><h3>Discussion</h3><p>CT converted 3D models were more accurate for implant sizing in HRA, but did not significantly outperform other modalities in angular measurements. Given the high costs and increased radiation exposure associated with CT, the study recommended using CT scans selectively, particularly for precise femoral head sizing, while alternative imaging methods can be effectively used for angular measurements.</p></div><div><h3>Level of evidence</h3><p>III; retrospective comparative diagnostic study.</p></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S187705682400152X/pdfft?md5=0875c14e0c14f8ac54249ab5daabfa41&pid=1-s2.0-S187705682400152X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical evaluation of the modified lasso technique.","authors":"Shelby Rider, Christopher Caldwell, Brad Chauvin, R Shane Barton, Kevin Perry, Giovanni Francesco Solitro","doi":"10.1016/j.otsr.2024.103900","DOIUrl":"10.1016/j.otsr.2024.103900","url":null,"abstract":"<p><strong>Background: </strong>The Terrible Triad of the elbow is a constellation of elbow dislocation, radial head fracture and coronoid process fracture. A common type of coronoid fracture documented with this triad is type II Regan-Morrey coronoid fractures. The preferred fixation method for this fracture type is the lasso technique, medial-lateral tunnel orientation being the traditional approach. Considering elbow anatomy, we saw an opportunity to potentially improve fixation by altering the suture lasso tunnel orientation to a proximal-distal orientation.</p><p><strong>Hypothesis: </strong>Two tunnels in the proximal-distal direction would result in greater biomechanical stability as compared to the traditional lasso technique.</p><p><strong>Material and methods: </strong>A type 2 Regan-Morrey fracture was created in 12 fresh frozen cadaveric elbows at 50% of the coronoid height using an oscillating saw. The humero-ulnar joint was placed in 0 degrees flexion then loaded at a rate of 10mm/min to failure.</p><p><strong>Results: </strong>The control technique (medio-lateral tunnels) showed failure load of 150±81N that was not significantly different (p=0.825) than the 134±116N measured for the modified technique (distal-proximal tunnels). The portion of the load-displacement curve used to calculate stiffness was linear (R^2=0.94±0.04) with determination coefficients that did not differ between the two groups (p=0.351). For stiffness, we measured 17±13N/mm and 14±12N/mm respectively for control and modified techniques that did not result in a significant difference (p=0.674).</p><p><strong>Conclusion: </strong>In this attempt to improve the shortcomings of the lasso technique, we found that changing from medio-lateral to proximal-distal drilling directions did not result in an appreciable biomechanical benefit.</p><p><strong>Level of evidence: </strong>Basic science study; Biomechanics.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dedicated locking plate reduces non-union risk in open ankle fusion in obese patients.","authors":"Claire Nicot, Guillaume David, Clément Marc, Laurent Hubert, Louis Rony","doi":"10.1016/j.otsr.2024.103901","DOIUrl":"10.1016/j.otsr.2024.103901","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is a growing public health concern. In ankle osteoarthritis, non-conservative treatment in advanced stages consists in ankle fusion, or else total ankle replacement, for which obesity is a relative contraindication. One of main complications of ankle fusion is non-union. Devascularization, obesity and fixation material are all factors involved in postoperative non-union, and have to be taken into account in surgical strategy for reliable results. The objective of this study was to compare the rate of ankle non-union in obese patients using quadruple screwing or a dedicated locking plate. The hypothesis was that the locking plate limits the risk of non-union in this population.</p><p><strong>Methods: </strong>All patients were obese (BMI>30kg/m²) and presented ankle osteoarthritis with>10° intra-articular deformity. The approach and joint preparation were performed via an anteromedial approach. Group S was composed of 32 patients, operated on by quadruple screwing; group P comprised 10 patients operated on using a dedicated locking plate. The main endpoint was a significant difference in the rate of non-union between the 2 groups. The secondary endpoint was improvement in pre- and 6-month postoperative AOFAS score.</p><p><strong>Results: </strong>Group S presented 31% non-union (10/32) and group P 0% (0/10) (p<0.05). Postoperative AOFAS score was significantly higher in group P: 67.8±10.4 [range, 40-92] vs. 83.1±8.0 [range, 64-92] (p<0.05).</p><p><strong>Conclusion: </strong>The dedicated anterior locking plate is a technique of choice for ankle fusion in obese patients with intra-articular deformity>10°, to limit the risk of non-union.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral trochlear groove cartilage damage after open-wedge high tibial osteotomy is associated with the change in patellar height relative to the femoral condyle.","authors":"Mitsuru Hanada, Kensuke Hotta, Yukihiro Matsuyama","doi":"10.1016/j.otsr.2024.103898","DOIUrl":"https://doi.org/10.1016/j.otsr.2024.103898","url":null,"abstract":"<p><strong>Background: </strong>Medial open-wedge high tibial osteotomy (OWHTO) is performed for isolated medial compartment osteoarthritis or osteonecrosis of the knee and correction of varus deformity of the full lower extremity. OWHTO may induce sagittal parameter changes, including these in the tibial posterior slope (TPS), patellar height (PH), and patellofemoral joint problems. This study aimed to identify radiographic parameters associated with patellofemoral cartilage damage after OWHTO.</p><p><strong>Hypothesis: </strong>The patellofemoral joint cartilage worsens after OWHTO and is adversely affected by PH changes.</p><p><strong>Patients and methods: </strong>Twenty patients (25 knees) who underwent primary OWHTO and subsequent implant removal surgery, including second-look arthroscopy for evaluation of the patellofemoral cartilage condition were enrolled. The patients were received 12 to 35 months of postoperative follow-up, and categorized into two groups according to whether patellofemoral cartilage damage worsened. TPS and PH parameters, including the Insall-Salvati, Blackburne-Peel, Caton-Deschamps, and modified Blumensaat (MBI) indices, were measured on lateral knee radiographs. The hip-knee-ankle and medial proximal tibial angles were measured using an anteroposterior radiograph of the full lower extremity. The extent of change from preoperative to postoperative (Δ) was calculated for all indices.</p><p><strong>Results: </strong>Eleven knees (44%) had worsening cartilage conditions in the femoral trochlear groove, with>1-degree of deterioration in the International Cartilage Repair Society grade. The radiographic measure for predicting patellofemoral cartilage deterioration was ΔMBI (95% confidence interval [CI]: 3.53×10^-14-0.812, p=0.047). PF cartilage damage tended to progress in ΔMBI<-0.145. The postoperative TPS and HKAA in patients with deterioration in patellofemoral cartilage damage was greater than that in patients without deterioration in patellofemoral cartilage damage (p=0.037 and 0.038, respectively).</p><p><strong>Discussion: </strong>The patellofemoral cartilage damage tends to progress after OWHTO. ΔMBI is a factor for predicting worsening patellofemoral cartilage condition. However, attention should be paid to the excessive posterior slope as high TPS and valgus alignment as valgus HKAA because intraoperative control of MBI is impossible.</p><p><strong>Level of evidence: </strong>IV, retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic scoping review of the latest data on orthobiologics in the surgical treatment of non-union","authors":"","doi":"10.1016/j.otsr.2024.103896","DOIUrl":"10.1016/j.otsr.2024.103896","url":null,"abstract":"<div><h3>Introduction</h3><p>Recent studies have shown a growing concern regarding the cost-effectiveness and the lack of supporting data for the biologic agents that are being increasingly used in the orthopedic field. Our aim was to conduct a systematic scoping review of recent publications (last five years) on the use of orthobiologics to treat fracture non-union and summarize the latest available data.</p></div><div><h3>Patients and methods</h3><p>The inclusion criteria for this review were articles published in English, from 2016 to 2022, and focusing on the use of orthobiologics for the surgical treatment of non-union. Searches were conducted in March 2023 using Pubmed/MEDLINE and Embase. Studies on spinal fusion<span> or gene therapy were excluded. Reviews, case reports with five cases or less, conference proceedings, preliminary reports, pediatric or non-human studies were excluded as well.</span></p></div><div><h3>Results</h3><p>The search found 1807 articles, 15 were eligible after PRISMA checklist and exclusions. The evidence was heterogenous and there was only one level II RCT<span>. Recent data suggests that bone morphogenic protein<span><span> (BMP-2) products could be effective for septic and aseptic tibial non-unions. However, the evidence was not conclusive regarding BMP-7, plasma rich platelets (PRP), stem cells or </span>demineralized bone matrix (DBM).</span></span></p></div><div><h3>Discussion</h3><p>Every non-union case is different in terms of bone defect, biology, mechanical stability, surgical technique and host factors, which contributes to the conflicting reports on the efficacy of orthobiologics in the literature. We might never see a level 1, high powered and robust study defining the efficacy, safety profile and cost-effectiveness of such products.</p></div><div><h3>Level of evidence</h3><p>IV.</p></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}