Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Postoperative management following degenerative cervical spine surgery: Results from a survey conducted by the French Society of Spine Surgery.","authors":"Henri-Arthur Leroy, Mourad Ould-Slimane, François Lucas, Jérôme Delambre, Martin Dupuy, Thais Dutra Vieira, Marc Szadkowski, Henri d'Astorg","doi":"10.1016/j.otsr.2025.104218","DOIUrl":"10.1016/j.otsr.2025.104218","url":null,"abstract":"<p><strong>Objective: </strong>To describe and evaluate postoperative care after degenerative cervical spine surgery among spine surgeons in France.</p><p><strong>Hypothesis: </strong>The postoperative management after degenerative cervical spine surgery varies considerably depending on the team caring for the patient. Based on a national survey, we aimed at providing trends and guidelines regarding the following points: 1/ clinical follow-up and postoperative imaging, 2/ the place and role of bracing after surgery, 3/ driving recommendation and 4/ return to sports activities after such surgery.</p><p><strong>Methods: </strong>Data were collected from spinal surgeons using a practice-based online questionnaire (SurveyMonkey Inc.). The survey comprised 15 questions on the current management following degenerative cervical spine surgery in France, especially single or multilevel anterior cervical discectomy fusion (ACDF). The surgeons were asked to answer several questions on 1) patient clinical follow-up, 2) postoperative imaging, 3) postoperative recommendation (e.g., bracing), and 4) time to return to work and sport practice.</p><p><strong>Results: </strong>A total of 239 surgeons participated in the survey, including 158 (66%) neurosurgeons and 81 (34%) orthopedic surgeons. A total of 218 (96.9%) investigators proposed a face-to-face follow-up consultation within 6 weeks after surgery. A total of 210 (92%) practitioners asked for systematic cervical imaging at the first clinical follow-up. In the latter situation, cervical radiography was requested by 195 (85.2%) surgeons, and cervical CT scans were requested by 15 (6.6%) surgeons. A minority of surgeons recommended bracing after monosegmental cervical surgery (n = 99, 43%), except among orthopedic surgeons (n = 51 (63%), p < 0.0001). 38 (16.6%) surgeons advocated for early postoperative physiotherapy, and 130 (56.8%) for delayed physiotherapy. A prolonged time off work (>1 month) was recommended by 133 (57.8%) practitioners. 139 (62.9%) surgeons agreed on returning to sports without load or constraint during the first postoperative month, although orthopedic surgeons were more conservative than neurosurgeons (p = 0.0019). Conversely, return to sport with load (n = 171, 75.3%) or rotation (n = 219, 98%) was delayed for at least 1 month.</p><p><strong>Conclusion: </strong>This nationwide study reflects the status of current postoperative management strategies after elective degenerative cervical spine surgery among the French spine community. Interestingly, the information provided to the patient may vary depending on the surgeon's specialty. Consensus-based recommendations are needed to homogenize practices.</p><p><strong>Level of evidence: </strong>V.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104218"},"PeriodicalIF":2.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587940","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":"Sagittal alignment of the spine and lumbar disc herniation in young adults: A historical, case-control study.","authors":"Mourad Ould-Slimane, François-Xavier Ferracci, André Gillibert, Marc Szadkowski, Caroline Lesage, Thais Dutra Vieira, Riccardo Sacco, Henri d'Astorg","doi":"10.1016/j.otsr.2025.104219","DOIUrl":"10.1016/j.otsr.2025.104219","url":null,"abstract":"<p><strong>Objectives: </strong>This study hypothesizes that the spinopelvic sagittal alignment can influence the development of lumbar disc herniation (LDH). To investigate this relationship, the spinopelvic data of surgical LDH patients was compared to that of a healthy historical control group.</p><p><strong>Methods: </strong>The spinopelvic data of LDH patients aged 15-45 years, undergoing herniated disc surgery (L4-L5/L5-S1) from 2015 to 2019, was compared to that from healthy controls reported by Roussouly et al. Sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), and Roussouly classification (spinal curves type 1-4) were assessed with full body radiographs in a standing weight-bearing position (EOS® system) using KEOPS software. The prevalence of spine types (1-4) were evaluated in both groups, with subgroup analysis based on herniation level. Proportions were compared using Fisher's exact tests, means by Student's t-tests, and confidence intervals for odds ratios (OR) using the exact conditional tail interval (ECTI) method.</p><p><strong>Results: </strong>Spinopelvic data from 350 patients (190 LDH/160 healthy controls) showed that LDH patients had a significantly higher prevalence of Roussouly type 2 spines (\"flat spine\") (27.9% vs. 11.2%, OR 3.04, p = 0.001). The LDH group also exhibited lower mean PI (-3.0°, p = 0.009), significantly lower mean SS (-6.9°, p < 0.001), lower lumbar lordosis angle (-10.6°, p < 0.001), and higher thoracic kyphosis angle (+3.6°, p < 0.001). The ratio of OR (2.73, p = 0.01) indicated that type 2 spines pose a stronger risk for LDH surgery at L5-S1 compared to L4-L5.</p><p><strong>Conclusions: </strong>Patients <45 years old undergoing surgery at L4-L5/L5-S1 showed a threefold higher prevalence of type 2 Roussouly spines, compared to a healthy control group, suggesting a potential role of \"flat spine\" and lower PI in the development of LDH.</p><p><strong>Level of evidence: </strong>III; case-control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104219"},"PeriodicalIF":2.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588100","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":"Comparison of endoscopic and open Achilles SpeedBridge techniques in the treatment of insertional Achilles tendinopathy: A prospective multicenter study of 89 patients by the Francophone Arthroscopy Society.","authors":"Ronny Lopes, David Ancelin, Olivier Boniface, Ali Ghorbani, Thomas Amouyel, Michael Andrieu, Alexis Thiounn","doi":"10.1016/j.otsr.2025.104220","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104220","url":null,"abstract":"<p><strong>Introduction: </strong>Insertional Achilles tendinopathy (IAT) is common, affecting 2% of the general population and up to 10% of runners. Despite this, medical and surgical treatments remain debated. When medical treatment fails, a procedure including open debridement, decompression, and reinsertion of the Achilles tendon is the recommended technique. However, this approach involves risks such as infection, shoe discomfort, or failure. In this context, endoscopic techniques have been developed. The primary objective of our study was to compare the outcomes of open and endoscopic surgical treatments for IAT. Our hypothesis was that endoscopic surgery would allow faster recovery (resumption of walking and sports activities) than would open surgery.</p><p><strong>Methods: </strong>A prospective multicenter study was conducted at 10 French centers specializing in foot and ankle surgery from May 2021 to May 2023. Patients over 18 years of age with IATs resistant to medical treatment for more than 6 months and who underwent decompression/reinsertion surgery were included. Two groups were formed based on surgical approach: open or endoscopic. Demographic data were collected, and functional evaluations were performed preoperatively and at 3, 6, and 12 months postoperatively using the EFAS (European Foot & Ankle Society) and VISA-A (Victorian Institute of Sport Assessment - Achilles tendinopathy questionnaire) scores. Postoperative complications were assessed at 1 month.</p><p><strong>Results: </strong>Of the 89 patients included, 53 (59.5%) underwent endoscopic surgery, and 36 (40.5%) underwent open surgery. The two groups were comparable preoperatively, except for higher functional scores in the endoscopic group. At 3 months, the VISA-A (p < 0.001), EFAS daily life (p < 0.001), and EFAS sports activity (p < 0.022) scores were significantly better in the endoscopic group. At longer follow-up, all functional scores improved in both groups, with no statistically significant difference. Shoe discomfort at 6 months was reported in 2/53 (3.7%) endoscopic patients and 5/36 (13.8%) open surgery patients (p = 0.099).</p><p><strong>Conclusion: </strong>Our prospective study reported good functional outcomes for IAT surgery. Endoscopic surgery appeared to allow faster recovery and less shoe discomfort.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104220"},"PeriodicalIF":2.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587999","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":"Redefining the gold standard in degenerative meniscus tear management—The rise of perimeniscal injections","authors":"Etienne Cavaignac ,&nbsp;Matthieu Ollivier ,&nbsp;Sophie Putman ,&nbsp;Jérôme Murgier","doi":"10.1016/j.otsr.2025.104214","DOIUrl":"10.1016/j.otsr.2025.104214","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 2","pages":"Article 104214"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544429","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":"Surgical treatment of non-insertional Achilles tendinopathy: Comparison of endoscopic and open approaches.","authors":"Olivier Barbier, Alexandre Hardy, Jonathan Benoist, Thomas Amouyel, David Ancellin, Thomas Bauer, Olivier Boniface, Nicolas Cellier, Guillaume Cordier, Ali Ghorbani, Frederic Leiber, Ronny Lopes, Carlos Maynou, François Molinier, Giovanni Padiolleau, Yves Tourné, Emilie Bilichtin, Michael Andrieu, Alexis Thiounn","doi":"10.1016/j.otsr.2025.104215","DOIUrl":"10.1016/j.otsr.2025.104215","url":null,"abstract":"<p><strong>Introduction: </strong>Non-insertional Achilles tendinopathy is a common condition, and endoscopic treatment is becoming an increasingly important therapeutic option. The aim of our study was to compare functional and anatomical results between open and endoscopic surgical treatment of non-insertional Achilles tendinopathy.</p><p><strong>Hypothesis: </strong>Endoscopic surgery provides better functional results and faster recovery than open surgery.</p><p><strong>Method: </strong>A multicenter non-randomized prospective study included all adult patients operated on for non-insertional Achilles tendinopathy resistant to medical treatment. Clinical evaluation was based on EFAS and VISA-A scores and return to sport.</p><p><strong>Results: </strong>Sixty patients were included, 22 of whom underwent endoscopic surgery and 38 open surgery. Skin healing was later following endoscopic surgery. No nerve damage was reported. There were no differences in functional scores between the two approaches. Walking was resumed before 6 weeks. Return to sport was progressive as of month 3 and achieved in 80% of cases by month 6, without significant difference according to approach.</p><p><strong>Discussion: </strong>Surgical management of non-insertional tendinopathy refractory to medical treatment presented low morbidity, allowed early resumption of walking by 6 weeks and return to sport in 80% of cases by month 6, but only a third of cases at the previous level. Results were comparable between endoscopic and open approaches.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104215"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544430","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":"Outcomes following anterior cruciate ligament injury with concomitant damage to the medial collateral ligament: an analysis from the registry of the francophone arthroscopic society.","authors":"Charles Kajetanek, Etienne Cavaignac, Emilie Bérard, Benjamin Freychet, Alexandre Hardy, Corentin Hercé, Christian Lutz, Thomas Neri, Matthieu Ollivier, Nicolas Bouguennec","doi":"10.1016/j.otsr.2025.104194","DOIUrl":"10.1016/j.otsr.2025.104194","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior cruciate ligament (ACL) rupture with concomitant damage to the medial collateral ligament (MCL) is frequently seen following knee trauma. Non-surgical treatment of the MCL lesion generally results in good internal healing, but surgery may be necessary depending on the location of the lesion, the severity, and the laxity.</p><p><strong>Objectives: </strong>To determine outcomes following ACL reconstruction surgery when there is concomitant damage to the MCL compared to isolated ACL lesions, as assessed through a prospective, multi-center cohort study in France.</p><p><strong>Materials and methods: </strong>In this prospective, multi-center cohort study, patients who had a primary ACL lesion with or without concomitant damage to the MCL, and who had undergone ACL reconstruction surgery were included. Complications related to the surgery were evaluated prospectively (ACL re-rupture, contralateral rupture, reoperation), and functional scores were obtained until the last follow-up (subjective IKDC, Tegner, ACL-RSI, and SKV).</p><p><strong>Results: </strong>A total of 722 patients were included in the study: 314 (43.5%) with an isolated ACL lesion and 408 (56.5%) with a combined ACL + MCL lesion. The ACL + MCL group had a significantly higher reoperation rate than the ACL group (7.4% versus 3.2%, p = 0.015). The ACL + MCL group also had mean IKDC and SKV scores at the last follow-up that were significantly poorer than the ACL group (p < 0.0001). High-grade MCL lesions (grade II or III) were identified in 18.2% of cases, and this was found to be predictive of poorer functional scores at the last follow-up. The mean IKDC score was significantly better when non-surgical MCL treatment was possible (p = 0.005). When MCL surgery was indicated, all of the functional scores were significantly better for ligament reinsertion surgery compared to ligament reconstruction.</p><p><strong>Conclusion: </strong>For combined ACL + MCL lesions, the outcomes are poorer, with a higher reoperation rate and lower functional scores. For high-grade MCL lesions, the functional recovery is poorer, particularly when there are chronic lesions that require multi-ligament reconstruction.</p><p><strong>Level of evidence: </strong>II; prospective cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104194"},"PeriodicalIF":2.3,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484600","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 nine-year retrospective study of bacterial epidemiology and culture optimization in four orthopaedic surgery departments.","authors":"Sylvain Robinet, François Parisot, Arnaud Clavé","doi":"10.1016/j.otsr.2025.104193","DOIUrl":"10.1016/j.otsr.2025.104193","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Management of device-associated bone and joint infections combines surgical treatment and antibiotic therapy. Immediate postoperative broad-spectrum empiric treatment is often recommended pending complete microbiology results. The probabilistic antibiotics often used are not harmless, and expose the patient to the selection of resistant bacteria and changes in bacterial ecology within the healthcare units. The aim of this study was to answer the following questions: (1) Have the pathogenic bacteria isolated in osteoarticular infections and/or their antibiotic susceptibility profile changed over a 9-year period at our center, with possible implications for antibiotic therapy protocols? (2) Is there a way to optimize the incubation time for microbiological cultures while still being acceptable for slow growing pathogens?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;Our hypothesis was that no difference in microbial epidemiology and antibiotic resistance rates would be found over this 9-year period, confirming antibiotic protocols.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We conducted a retrospective study describing a nine-year bacterial epidemiology in four traumatology and orthopedic surgery departments. Bacteria identified, site of infection, and antibiotic resistance were evaluated. Antibiotics for use in probabilistic protocols and after documentation of infection were selected for follow-up. Bacterial species were isolated after a maximum incubation period of 15 days up to 2020, and 10 days from 2021 with the addition of a solid culture medium that promotes anaerobic bacterial growth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 648 clinical situations, 824 bacteria were identified. Gram-positive cocci accounted for 61.4% (506/824) of the strains, including 291/824 (35.3%) Staphylococcus aureus and 136/824 (16.5%) coagulase-negative staphylococci. For the latter, fluoroquinolone resistance remained stable at 7.3% (18/291 (p = 0.086)) and 22.8% (34/136 (p = 0.432)), respectively. Resistance to rifampicin was also stable for Staphylococcus aureus (1.2%,4/291 (p = 0.486)) and for coagulase-negative staphylococci (10.7%, 15/136 (p = 0.596)). Enterobacteriaceae accounted for 148/824 (18.0%) of identifications and were more resistant to piperacillin/tazobactam (15.1%, 24/148) than to cefepime (5.6%,9/148 (p = 0.006)). There was no significant difference between the 15-day and 10-day culture protocols in the proportion of anaerobic bacteria isolated from shoulder (p = 0.721), hip and knee (p = 0.530) prosthesis infections and spinal device-associated infections (p = 0.373). A microbiological diagnosis was made within five days using the 10-day culture protocol in 333/344 (96.8%) cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The increase in Cutibacterium acnes isolates is mainly explained by the increased number of patients recruited for shoulder arthroplasty. No change in antibiotic resistance was observed in our retrospective study","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104193"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476934","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":"Strain analysis of intra- and extra-medullary implants for fixing the subtrochanteric femoral fractures.","authors":"Jie Wang, Hongqiang Jiang, Haomin Li, Haobo Jia, Lei Wang","doi":"10.1016/j.otsr.2025.104192","DOIUrl":"10.1016/j.otsr.2025.104192","url":null,"abstract":"<p><strong>Background: </strong>Intra or extra medullary fixation for subtrochanteric fractures (STF) is still controversial. And the strain on fracture site and implant have not been reported. The aim of our study is to evaluate the differences in strain at the medial and lateral cortex of the subtrochanteric region with PFNA, 'upside-down' LISS and PFLP fixing different types of subtrochanteric femoral fractures under static loads.</p><p><strong>Hypothesis: </strong>Our hypothesis was that the PFNA was superior than LISS and PFLP for fixation of STF. However, PFNA also had some weakness.</p><p><strong>Methods: </strong>Thirty composite femurs with PFNA, LISS or PFLP fixation were divided into three groups. Four models of implant-femur constructs were tested under axial compression load with strain recording by gauges. While finite element analysis (FEA) was performed to simulate the biomechanical test with synthetic bone and implant construct finite element model in order to measure the strain on femur and implant.</p><p><strong>Results: </strong>In model I, both of the strains recorded by gauge 2 of PFNA and LISS were significantly lower than that of PFLP (PFNA: p = 0.002; LISS: p = 0.038). In model II, both of the strains recorded by gauge 2 (PFNA: p = 0.019; LISS: p = 0.016) and 3 (PFNA: p = 0.016; LISS: p = 0.006) of PFNA and LISS were significantly lower than that of PFLP. In model III, the strain recorded by gauge 2 (p = 0.007) and 3 (p = 0.002) of PFNA were significantly lower than that of LISS. While the strain recorded by gauge 1 (p = 0.028) and 2 (p < 0.0001) of PFNA were significantly lower than that of PFLP. The strain value recorded by four gauges in each femur construct group changed from model I to IV similar to the results of FEA, except for individual gauges.</p><p><strong>Discussion: </strong>Our study demonstrated that PFNA and reverse LISS fixation were superior to PFLP for stable subtrochanteric fractures and unstable subtrochanteric fractures that have restored medial bone support. For comminuted subtrochanteric fracture, PFNA fixation was slightly superior to reverse LISS and PFLP. However, it was needed to know that the main nail of PFNA had huge compress force on the subtrochanteric medial bone area.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104192"},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473243","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":"High trans-iliac incomplete bi-cortical pelvic osteotomy vs dega osteotomy in treatment of developmental dysplasia of the hip in young children: A new technique.","authors":"Hosam El-Din Amin, Hisham Abdel-Ghani, Naguib Basha, Mahmoud Badawy, Alaa Abououf, Ahmed Darweash, Ebeed Yasin","doi":"10.1016/j.otsr.2025.104191","DOIUrl":"10.1016/j.otsr.2025.104191","url":null,"abstract":"<p><strong>Introduction: </strong>There are many controversies regarding the ideal pelvic osteotomy in managing Developmental dysplasia of the hip (DDH). We introduce a new high trans-iliac incomplete bi-cortical pelvic osteotomy (HTIBO) by starting the osteotomy at a higher point proximal to the anterior superior iliac spine and hinging on the post limb of the triradiate cartilage, comparing the results with Dega osteotomy (DO).</p><p><strong>Hypothesis: </strong>HTIBO has superior clinical outcomes to Dega osteotomy and minimizes reliance on intraoperative fluoroscopic guidance.</p><p><strong>Patients and methods: </strong>This retrospective multicenter comparative study included 72 patients (81 hips) with DDH aged between 18 and 30 months between March 2019 and March 2021. There were 34 patients (38 hips) managed by HTIBO, and 38 patients (43 hips) managed by DO, the mean follow-up was 53.74 ± 7.57 & 52.91 ± 7.59 respectively. Intra-operative fluoroscopic guidance and surgery time were recorded. Patients were evaluated clinically according to McKay criteria, limb length discrepancy, cosmetic deformity, and radiographically for acetabular index, central edge angle, Shenton line continuity, osteotomy site union, and avascular necrosis according to Kalamachi classification.</p><p><strong>Results: </strong>The HTIBO group recorded lower intra-operative x-ray exposure (P <  0.01) and post-operative cast duration (P < 0.01), and better clinical outcome (P = 0.01). The final acetabular index was 15.11 ± 3.84, 37.68 ± 7.5, and the central edge angle was 14.56 ± 2.65, 34.47 ± 6.26, in HTIBO & DO groups respectively. In both groups, we recorded no cases of limping, restricted ROM, pain, LLD, re-dislocation, graft dislodgement, non-union, infection, or cosmetic deformity.</p><p><strong>Discussion: </strong>The current osteotomy (HTIBO) is feasible, and reliable, with a satisfactory clinical and radiological outcome, and can be safely performed in young DDH children without fluoroscopic guidance.</p><p><strong>Level of evidence: </strong>III, retrospective comparative study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104191"},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460756","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":"Liposomal bupivacaine after arthroscopic rotator cuff repair moderately decreases early postoperative pain and demonstrates equivocal opioid consumption compared to traditional interscalene nerve blocks: A systematic review and meta-analysis of level 1 studies.","authors":"Jaden Hardrick, Anna M Ifarraguerri, Michael S Collins, David P Trofa, James E Fleischli, Nady Hamid, Patrick N Siparsky, Bryan M Saltzman","doi":"10.1016/j.otsr.2025.104190","DOIUrl":"10.1016/j.otsr.2025.104190","url":null,"abstract":"<p><strong>Background: </strong>Interscalene nerve blocks (ISNBs) reduce length of stay, postoperative pain, and opioid consumption following arthroscopic rotator cuff repair (ARCR). ISNBs with anesthetic agents like bupivacaine are associated with intense rebound pain, while liposomal bupivacaine (LB) can potentially extend pain relief up to 72 h and reduce opioid consumption. The purpose of this systematic review and meta-analysis is to compare the efficacy of LB versus traditional ISNB for postoperative pain management and opioid consumption following ARCR.</p><p><strong>Methods: </strong>A systematic review following PRISMA guidelines was performed from inception through March 2024. Randomized controlled trials comparing LB and traditional ISNB for postoperative pain management and opioid consumption following ARCR were included. The meta-analysis on each outcome measure was outlined in a forest plot detailing the standard mean difference (SMD) for continuous variables.</p><p><strong>Results: </strong>Data was extracted from 5 articles on 362 patients who underwent ARCR, 196 of whom received LB and 166 with a control non-LB ISNB. LB interventions had significantly lower pain scores than controls on postoperative day (POD) 1 and POD 2 (SMD -3.45, 95% CI [-5.20, -1.60]; P = 0.0003 and SMD -2.39, 95% CI [-4.01, -0.77]; P = 0.004, respectively). There was a significantly lower oral morphine equivalent dosage consumption in the LB cohort than controls on POD 0, POD 1, POD 2, and POD 3 (SMD -4.66; 95% CI, -7.95 to -1.36; p = 0.006; SMD -3.77; 95% CI, -5.69 to -1.85; p = 0.0001, SMD -3.34 95% CI [-5.13, -1.56]; p = 0.0002, and SMD -3.43; 95% CI, -5.74 to -1.12; p = 0.004, respectively).</p><p><strong>Discussion: </strong>LB moderately decreased pain scores 24-72 h postoperatively and reduced opioid consumption for up to 96 h following ARCR compared to a control ISNB cohort. However, the clinical difference in opioid usage may not translate to patient benefits or justify the increased cost.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104190"},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460760","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}