Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Contribution of MRI and imaging exams in the diagnosis of lumbar pseudarthrosis","authors":"Maxime Huneidi ,&nbsp;Pawel P. Jankowski ,&nbsp;Benjamin Bouyer ,&nbsp;Camille Damade ,&nbsp;Jean-Marc Vital ,&nbsp;Olivier Gille ,&nbsp;Louis Boissière","doi":"10.1016/j.otsr.2024.103817","DOIUrl":"10.1016/j.otsr.2024.103817","url":null,"abstract":"<div><h3>Introduction</h3><div><span>The diagnosis of pseudoarthrosis is based on imaging and clinical exam findings. The standard for pseudarthrosis diagnosis remains postoperative observation through </span>computer tomography<span> (CT) and patient's symptoms. This can be further augmented by dynamic X-ray imaging or nuclear positron emission tomography (PET) CT to demonstrate an absence of fusion by showing a persistence of mobility. However, there is not a uniform diagnostic approach that is a standard of care amongst spine practioners. The aim of this study is to describe the timeline and diagnostic analysis for pseudoarthrosis between the initial surgery and follow-up procedure.</span></div></div><div><h3>Methods</h3><div>This is a single-center retrospective observational study. The aim was to enroll patients reoperated for pseudarthrosis after 1 or 2 level lumbar fusions, between August 1st, 2008 and August 1st, 2018. The exams were reviewed by one surgeon and one radiologist, defining a status either in favor of pseudarthrosis, or against it, or inconclusive, based on the radiological criteria mentioned below. We then investigated different combinations of exams and their specific chronology before a diagnosis was established.</div></div><div><h3>Results</h3><div>Forty-four patients were included, 70.5% male and with a mean age of 47.3 years. The median time between the 2 surgeries was 23.7 months. Plain X-rays supported the diagnosis in 38.7% of cases, dynamic X-rays showed hypermobility in 50% of cases. The CT-scan demonstrated pseudarthrosis in 94,4% of cases. A MODIC 1 signal was observed in 87,2% of cases on MRI. SPECT-CT showed a tracer uptake in 70% of cases.</div></div><div><h3>Conclusion</h3><div>Reducing the time to reintervention is a key objective for improving the management and clinical outcomes of these patients. We suggest that MRI is an additional tool in combination with CT in the assessment of suspected mechanical pseudarthrosis, in order to optimize the diagnosis and shorten the time to revision surgery.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 3","pages":"Article 103817"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139508050","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":"Triangular pelvic fixation in the management of adult spinal deformities: technical note and preliminary results","authors":"Solène Prost ,&nbsp;Sébastien Pesenti ,&nbsp;Stéphane Bourret ,&nbsp;Romain Ambrosino ,&nbsp;Stéphane Fuentes ,&nbsp;Jean-Charles Le Huec ,&nbsp;Benjamin Blondel","doi":"10.1016/j.otsr.2024.104081","DOIUrl":"10.1016/j.otsr.2024.104081","url":null,"abstract":"<div><h3>Introduction and hypothesis</h3><div>Optimal choice of the lower instrumented vertebra in the management of adult spinal deformity that include lumbosacral junction is still unclear. It is therefore possible to stop fixation in S1 but also lower (S2AI or iliac screws) in order to reduce the risk of implants pullout. In such situations, mechanical solicitations can lead to secondary degradation of sacro-iliac joints.</div></div><div><h3>Technique and results</h3><div>Based on triangular pelvic fixation described for pelvic trauma, a posterior only fixation that combine S1 screws, iliac screws and sacro-iliac implants can be performed.</div></div><div><h3>Discussion</h3><div>We are describing here the operative technique of this « bedrock » fixation under fluoroscopic guidance and its preliminary results about 15 patients.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 3","pages":"Article 104081"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792863","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":"Minimally invasive sacroiliac joint fusion secondary to lumbosacral fusion: Clinical and functional results at 2 years of follow-up","authors":"Renaud Bricard ,&nbsp;Yann Pelletier ,&nbsp;Jeremy Allia ,&nbsp;Antoine Raffaelli ,&nbsp;Jean-François Gonzalez ,&nbsp;Régis de Dompsure ,&nbsp;Nicolas Bronsard","doi":"10.1016/j.otsr.2024.103892","DOIUrl":"10.1016/j.otsr.2024.103892","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Degenerative sacroiliac (SI) joint syndrome is known to be more common after lumbosacral fusion. While this diagnosis is suspected based on various clinical criteria and diagnostic tests, it is confirmed with a diagnostic nerve block. If conservative treatment fails, SI joint fusion through a minimally invasive approach is a useful palliative approach for patients at a treatment crossroads. The aim of this study was to evaluate the clinical and functional results at 2</span> <!-->years postoperative after minimally invasive SI joint fusion in patients with SI joint syndrome following lumbosacral fusion.</div></div><div><h3>Materials and methods</h3><div>We carried out a single-center retrospective study of patients operated between June 2017 and October 2020. Included were patients who had a confirmed diagnosis of SI joint syndrome after lumbosacral fusion surgery, who underwent SI joint fusion and had at least 2<!--> <span>years’ follow-up. The primary outcome was the improvement in lumbar and radicular pain<span> on a numerical rating scale (NRS). The secondary outcomes were the functional scores (Oswestry and SF-12) along with the level of patient satisfaction. Our study population consisted of 54 patients (41 women, 13 men) with a mean age of 59</span></span> <!-->years (27–88). Thirty-one of these patients were operated on both sides (85 fusions in all). The patients had undergone a mean of 3 lumbar surgeries (1–7) before the SI fusion.</div></div><div><h3>Results</h3><div>The lumbar and radicular NRS were 8.4 (7–10) and 5.1 (2–10) preoperatively and 5.2 (0–8) and 3.0 (0–8) at 2<!--> <!-->years postoperatively, which was a reduction of 37% and 42% (<em>p</em> <!-->&lt;<!--> <!-->0.001), respectively. The Oswestry score went from 69.4 (52–86) preoperatively to 45.6 (29–70) at 2<!--> <!-->years, which was a 33% improvement (<em>p</em> <!-->&lt;<!--> <!-->0.001). Eighty-six percent of patients were satisfied or very satisfied with the surgery.</div></div><div><h3>Discussion</h3><div>After minimally invasive SI joint fusion, the patients in this study had clear clinical and functional improvements. Previous publications analyzing the results of SI joint fusion found even more improvement, but those patients were relatively heterogenous; in our study, only patients who had a history of lumbosacral fusion were included.</div></div><div><h3>Conclusion</h3><div>Minimally invasive SI joint fusion helped patients who developed SI joint syndrome after lumbosacral fusion to improve clinically and functionally.</div></div><div><h3>Level of evidence</h3><div>IV, retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 3","pages":"Article 103892"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868239","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":"Efficacy of intraoperative use of tranexamic acid in reducing blood loss from telescoping nail application in osteogenesis imperfecta. A randomized controlled trial","authors":"Hesham Mohamed Elbaseet,&nbsp;Ammar Jamal Aldeen,&nbsp;Abdel Khalek Hafez Irahim","doi":"10.1016/j.otsr.2024.103927","DOIUrl":"10.1016/j.otsr.2024.103927","url":null,"abstract":"<div><h3>Background</h3><div><span>Osteogenesis imperfecta<span><span><span> (O.I) is a rare disease caused by an abnormality in </span>type 1 collagen synthesis leading to repeated fractures after low-energy </span>trauma<span> and progressive long bones deformity. Telescoping nail application and surgical correction of these deformities usually necessitates multiple </span></span></span>osteotomies<span><span> and significant bleeding occur due to weakened capillaries and impaired platelet activity. </span>Tranexamic acid<span> (TXA) has an antifibrinolytic<span> effect which is useful in reducing bleeding and need for blood transfusions following several orthopaedic procedures.</span></span></span></div></div><div><h3>Hypothesis</h3><div>The use of intraoperative (Local and Intravenous) tranexamic acid reduces blood loss during femoral telescoping nail application in O.I. patients.</div></div><div><h3>Material and methods</h3><div>A prospective randomized controlled study was carried out on 40 patients during applying femoral telescoping nail divided into <strong>Group A: (case TXA)</strong>; 20 patients receiving intraoperative TXA and <strong>Group B: (control)</strong>; 20 patients not receiving TXA. Blood loss and perioperative Hemoglobin (Hb) and Hematocrit Level (Hct) were assessed.</div></div><div><h3>Results</h3><div>The study included 29 males and 11 females with mean age 7.98 years. The number of osteotomies in both groups ranged from zero to 3 osteotomies with a median one osteotomy. A significant decrease in <em>blood loss</em> was observed in TXA group (mean 241.5 cc) compared to control group (mean 461.5 cc). Postoperative <em>Hb</em> was significantly lower in control group (mean 12.30 g/dL changed to 10.45 g/dL) compared to TXA group (mean 12.26 g/dL changed to 11.52 g/dL). Also, postoperative <em>Hct</em> was significantly lower in control group (m:ean 37.37 % changed to 32.03%) compared to TXA group (mean 36.53 % changed to 34.66 %).</div></div><div><h3>Discussion</h3><div>The use of TXA during femoral telescoping nail application in OI patients has contributed to a remarkable reduction in overall blood loss. Consideration of adding it to management protocol is advised.</div></div><div><h3>Level of Evidence</h3><div>II; Randomized Controlled Trial (RCT).</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 3","pages":"Article 103927"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581468","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":"Influence of preoperative rotational shoulder stiffness on rate of motion restoration after anatomic and reverse total shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff","authors":"Kevin A. Hao ,&nbsp;Terrie Vasilopoulos ,&nbsp;Erick M. Marigi ,&nbsp;Jonathan O. Wright ,&nbsp;Jean-David Werthel ,&nbsp;Thomas W. Wright ,&nbsp;Joseph J. King ,&nbsp;Bradley S. Schoch","doi":"10.1016/j.otsr.2024.104036","DOIUrl":"10.1016/j.otsr.2024.104036","url":null,"abstract":"<div><h3>Background</h3><div>A subset of patients undergoing anatomic and reverse total shoulder arthroplasty (aTSA and rTSA) lag behind their peers in regaining overhead range of motion (ROM) after surgery. The primary purpose of this study was to compare the rate of recovery of ROM after aTSA and rTSA performed in stiff (preoperative passive external rotation [ER] ≤0 °) versus non-stiff (preoperative passive ER &gt;0°) shoulders with RCI-GHOA.</div></div><div><h3>Hypothesis</h3><div>We hypothesized that preoperatively stiff shoulders (preoperative passive ER ≤0 °) would have slower recovery in ROM postoperatively with lower postoperative motion compared to non-stiff shoulders.</div></div><div><h3>Methods and materials</h3><div>A retrospective review of a multi-institution shoulder arthroplasty database was performed between 2001 and 2021. We identified 1,164 aTSAs and 539 rTSAs performed for RCI-GHOA with a minimum of 2-year clinical follow-up along with follow-up between 3–6 months and a third visit at any other time point. Primarily, the rate of recovery in ROM and time to maximum ROM was evaluated. Secondarily, we assessed six outcome scores and the influence of subscapularis repair during rTSA. Recovery in each outcome was modeled using continuous two-phase segmented linear regression models with random effects. Rate of recovery was defined as the slope of the first segment. Patients were considered to have recovered after surgery at the timepoint corresponding to the inflection point between piecewise segments.</div></div><div><h3>Results</h3><div>Of the 1,164 aTSAs and 539 rTSAs included, 172 aTSAs (15%) and 80 rTSAs (15%) were stiff preoperatively, respectively. Compared to preoperatively stiff aTSAs, non-stiff aTSAs regained ER, abduction, internal rotation (IR), and forward elevation (FE) faster over a shorter duration. Similarly, non-stiff rTSAs regained ER, abduction, and FE faster and over a shorter duration compared to stiff rTSAs, but regained IR more slowly over a longer duration. Stiff rTSAs performed with subscapularis repair did not have any appreciable gain in ER after the immediate postoperative period. Although non-stiff and stiff rTSAs performed without subscapularis repair regained ER at a similar rate (4.4 vs. 4.2 °/month), stiff rTSAs continued to regain ER 1.9-times longer (11.9 vs. 6.4 months). When the subscapularis was repaired, non-stiff rTSAs regained abduction and IR faster over a short duration compared to stiff rTSAs.</div></div><div><h3>Conclusions</h3><div>Preoperative stiffness is associated with slower recovery of active ROM over a longer duration in patients undergoing shoulder arthroplasty for RCI-GHOA.</div></div><div><h3>Level of evidence</h3><div>III; Retrospective Cohort Comparison; Treatment Study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 3","pages":"Article 104036"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632481","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":"Fascia lata autograft for chronic Pectoralis Major ruptures - A technical note","authors":"Julien Thiebaud ,&nbsp;Alexandre Sabate-Ferris ,&nbsp;Guillaume David ,&nbsp;James-Charles Murison","doi":"10.1016/j.otsr.2024.103937","DOIUrl":"10.1016/j.otsr.2024.103937","url":null,"abstract":"<div><div>Rupture of the pectoralis major tendon is an uncommon injury but increasing in incidence. Surgical management is often needed, and ruptures treated acutely show more favorable results. However, a significant number of ruptures are missed and diagnosed later in a chronic state. Direct suture without tension is a major challenge in these cases, and interposition grafts are required.</div><div>Several techniques have been described however none uses a fascia lata<span> autograft.</span></div><div>This technical note aims to describe fascia lata autograft as a valid option to treat retracted chronic pectoralis major ruptures.</div></div><div><h3>Level of evidence</h3><div>IV; Study Design: Technical Note.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 3","pages":"Article 103937"},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735712","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":"Injury epidemiology related to personal mobility devices in the pediatric population.","authors":"Lorie Bellity, Alain Masquelet, Elie Saghbini, Helena Guerra, Romain Guedj, Frank Fitoussi","doi":"10.1016/j.otsr.2025.104270","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104270","url":null,"abstract":"<p><strong>Background: </strong>The use of personal mobility devices (PMDs) in daily life has significantly increased in France over the past two decades. These devices, popular both as a mode of transportation-especially among adolescents-and as a source of leisure or physical activity, are not without risk. The hypothesis of our study was to assess the dangers associated with PMDs in the pediatric population.</p><p><strong>Objectives: </strong>The aim of this study was to describe the epidemiology of non-fatal injuries related to the use of both motorized and non-motorized PMDs in children treated in the emergency department of our university hospital in 2019, and to identify factors associated with an increased risk of hospitalization.</p><p><strong>Patients and methods: </strong>All children presenting to the pediatric emergency department in 2019 for an injury related to a PMD accident (including electric scooters, manual scooters, bicycles, skateboards, hoverboards, and rollerblades) were included in this study. Data collected included age, sex, type of PMD used, location of the accident (roadway or sidewalk), and helmet use. The type of injury (laceration, sprain, fracture) and management (outpatient care, hospitalization, surgery) were also analyzed.</p><p><strong>Results: </strong>Out of 52,993 emergency consultations at our pediatric center in 2019, 10,417 were trauma-related, and 625 children met the inclusion criteria, with a mean age of 8.47 years. Manual or electric scooters accounted for 50.4% of the accidents. Among the children included, 22.08% sustained fractures, with 7.69% requiring surgical intervention. Helmet use was absent in 87.52% of cases. The most common injuries affected the upper limbs (34.56%) and the face (26.88%). Although the absence of helmet use was not statistically associated with greater injury severity in our study (p = 0.604), it is important to note that our center does not manage severe head trauma. Injury severity was significantly correlated with age (p = 1.724e-06) and was higher in cases involving electric PMDs (p = 1.722e-06).</p><p><strong>Conclusion: </strong>Despite various prevention campaigns, PMD use remains a major source of injury in children and is one of the leading reasons for emergency visits. Helmet and protective gear use should be strongly encouraged. Injuries are more severe among adolescents using electric PMDs.</p><p><strong>Level of evidence: </strong>IV; descriptive epidemiological study. Non-interventional research.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104270"},"PeriodicalIF":2.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057958","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":"Antegrade versus retrograde elastic stable intramedullary nail in treating different types of distal femoral fracture: A finite element study.","authors":"Danjiang Zhu, Yuwei Wen, Qiang Wang, Baojian Song, Wei Feng","doi":"10.1016/j.otsr.2025.104269","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104269","url":null,"abstract":"<p><strong>Introduction: </strong>Titanium elastic nails (TEN) was the optimal treatment for diaphyseal fractures of femoral in children. However, achieving similar stability in distal femur was more challenging. The optimal needle insertion method is still controversial. The purpose of the study was to compare the stability of antegrade and retrograde TEN for the treatment of distal femoral metaphyseal-diaphyseal junction (MDJ) fracture in children.</p><p><strong>Hypothesis: </strong>We hypothesized that retrograde approach will provide greater stability in both fracture models.</p><p><strong>Material and methods: </strong>The computed tomography (CT) data of the femur of a 10-year-old boy were imported into the computer software to create transverse and oblique MDJ fractures. The finite element method was used to calculate the axial, rotational and bending stability of the two fracture models with different TEN insertion methods.</p><p><strong>Results: </strong>In transverse fractures, the rotational, axial, and bending stability with retrograde approach was better than antegrade approach. In oblique fractures, the rotation and axial stiffness of retrograde approach were greater than anterograde approach. However, the bending stiffness of anterograde approach was greater than retrograde approach. The rotation stiffness of oblique fracture was greater than transverse fracture in two fixation methods.</p><p><strong>Discussion: </strong>Retrograde approach can provide better stability in the transverse fracture. Antegrade approach has better bending stiffness in the fixation of oblique fractures. The mechanical testing results suggest that retrograde nailing is suitable for transverse fractures, while antegrade nailing is better for oblique fractures.</p><p><strong>Level of evidence: </strong>II; Comparative biomechanical study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104269"},"PeriodicalIF":2.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046348","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":"C1-C2 fixation: Effects on cervical range of motion and quality of life.","authors":"Nicola Pagani, Francesco Tengattini, Costanza Maria Zattra, Giorgio Saraceno, Luca Zanin, Firas Mourad, Andrea Giudice, Leonardo Pellicciari, Claudio Cornali, Pier Paolo Panciani, Marco Maria Fontanella, Francesco Belotti","doi":"10.1016/j.otsr.2025.104246","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104246","url":null,"abstract":"<p><strong>Background: </strong>C1-C2 fusion is a well-established procedure for treating instability at the upper cervical spine. However, its precise impact on cervical range of motion (ROM) and the degree to which thoracolumbar or global compensations can restore functional mobility remain incompletely understood. Moreover, patient-reported outcomes after such surgery are not fully characterized. This study addresses four questions: (1) How does C1-C2 fusion affect cervical ROM compared to healthy controls? (2) Can thoracolumbar and global compensations restore normal mobility? (3) What is the impact on quality of life measured by the Neck Disability Index (NDI) and the Short Form Health Survey 36 (SF-36)? (4) Are these compensations sufficient for activities of daily living?</p><p><strong>Hypothesis: </strong>We hypothesized that while C1-C2 fusion would significantly reduce cervical ROM, compensatory mechanisms would enable patients to preserve sufficient motion for daily activities, albeit with a potential decrease in quality of life.</p><p><strong>Patients and methods: </strong>This retrospective observational study included 19 patients (11 males, 8 females) who underwent Goel-Harms C1-C2 fusion between 2010 and 2021, with a minimum six-month postoperative follow-up. Cervical ROM (flexion-extension, lateral bending, rotation) was measured using the Cervical Range of Motion (CROM) device in three scenarios: no compensation, thoracolumbar compensation, and global compensation. We performed a comparison with the normal values reported in literature. Patient-reported outcomes were evaluated using the NDI and SF-36 questionnaires. Statistical analyses included t-tests, repeated measures ANOVA, and correlation tests.</p><p><strong>Results: </strong>(1) Cervical ROM was significantly reduced in operated patients compared to controls (p < 0.001). (2) Thoracolumbar and global compensations partially restored mobility, with extension remaining notably limited. (3) Patients reported moderate disability on the NDI and lower SF-36 subscale scores (particularly in physical functioning and pain domains). (4) Despite reduced cervical motion, most activities of daily living were achievable through compensatory mechanisms.</p><p><strong>Discussion: </strong>C1-C2 fusion substantially restricts upper cervical mobility, yet thoracolumbar and global compensations help maintain functional ROM for daily tasks. Nevertheless, the observed reduction in quality of life highlights the importance of thorough preoperative counseling. These findings align with existing literature on balancing spinal stability with motion preservation. Larger prospective studies are needed to refine patient selection and optimize postoperative rehabilitation.</p><p><strong>Level of evidence: </strong>IV; retrospective observational study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104246"},"PeriodicalIF":2.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013548","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":"Excellent long-term outcomes with an anatomic cementless stem (SPS Evolution) designed using a CT-scan database and inserted with 3D CT-scan preoperative planning: A prospective cohort study.","authors":"Elhadi Sariali, Sena Boukhelifa","doi":"10.1016/j.otsr.2025.104245","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104245","url":null,"abstract":"<p><strong>Background: </strong>Recently, improved hip reconstruction accuracy after total hip arthroplasty (THA) was reported with a specific anatomic stem featuring helicoidal torsion and a double sagittal curvature (SPS Evolution™), compared to the standard double-tapered straight stem, which remains the most widely used design globally. However, no studies have analyzed the ten-year outcomes of THA using this stem. The objective of this study was to assess the survivorship of SPS Evolution™ at ten-year follow-up.</p><p><strong>Hypothesis: </strong>The use of the modified SPS Evolution™ design provides excellent long-term fixation, a low risk of stress shielding and thigh pain, and a reduced dislocation rate.</p><p><strong>Material and methods: </strong>A prospective cohort study included 134 consecutive patients who underwent surgery between December 2011 and December 2013. An anatomic stem (SPS Evolution™) with exclusive proximal surface treatment, a cementless acetabular component, and a Delta ceramic-ceramic bearing couple were used in all patients. In total, 102 patients (118 hips), with a mean age of 60 ± 11 years (range, 32-83 years), were evaluated after an average follow-up of 10.6 ± 0.6 years (range, 10-12 years), using the Harris Hip Score (HHS) and the Oxford Hip Score (OHS) self-assessment questionnaires. The fixation and stability of the femoral stem were assessed using the Engh and ARA scores.</p><p><strong>Results: </strong>An early femoral revision was performed on a 69-year-old woman following a post-traumatic femoral fracture. With aseptic loosening as the endpoint, the survival rate was 100% in 118 hips (95% CI, 96.7-100%) at 10 years. Excellent clinical outcomes were observed, with a mean HHS score of 97.6 ± 6.2 (range, 69-100) and an OHS score of 44.9 ± 5.2 (range, 23-48). All stems were found to be stable and well-osseointegrated.</p><p><strong>Discussion: </strong>The SPS Evolution™ stem demonstrated an excellent ten-year survival rate. In addition to precise hip reconstruction, it provided excellent clinical and radiological outcomes, indicating that the SPS Evolution™ is a reliable and \"conservative\" implant.</p><p><strong>Level of evidence: </strong>IV, prospective cohort study without control group.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104245"},"PeriodicalIF":2.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052271","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}