Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Impact of the nail insertion angle on the wedge effect in intramedullary nail fixation of intertrochanteric hip fractures.","authors":"Wenhui Zhang, Ping Chen, Ji Qi, Zhirong Fan, Xiubing Yu, Haizhou Wang","doi":"10.1016/j.otsr.2024.103989","DOIUrl":"10.1016/j.otsr.2024.103989","url":null,"abstract":"<p><strong>Background: </strong>The wedge effect is known to be influenced by the insertion of the proximal femoral intramedullary nail through the fracture line and the large proximal diameter of the nail. However, the impact of the nail insertion angle (NIA) on the wedge effect remains unclear. This study aimed to investigate: (1) how to evaluate the NIA intraoperatively, (2) whether the NIA is associated with the wedge effect, (3) whether the NIA can serve as a reliable predictor of the wedge effect, (4) which factors affect the NIA, and (5) which surgical techniques can prevent the occurrence of the wedge effect associated with the NIA.</p><p><strong>Hypothesis: </strong>We hypothesized that an excessive NIA is related to the wedge effect and that lateral deviation of the entry point is associated with an excessive NIA.</p><p><strong>Patients and methods: </strong>Intraoperative fluoroscopy images of patients who underwent intramedullary nail fixation for intertrochanteric hip fractures between 2013 and 2023 were analyzed. NIA and insertion point distance (IPD) were measured on hip anteroposterior radiographs with the guidewire inserted. Femoral shaft lateralization (FSL) and neck-shaft angle (NSA) were measured on hip anteroposterior radiographs before and after nail insertion; differences in FSL and NSA were calculated. A negative difference in FSL combined with a positive difference in NSA indicated the occurrence of the wedge effect. Pearson's correlation test was used to determine relationships between continuous variables (NIA, FSL, NSA, and IPD). Binary logistic regression analyzed the association between NIA and the wedge effect. Receiver operating characteristic (ROC) curve analysis was used to determine the threshold value of NIA, with predictive performance assessed using the area under the ROC curve (AUC). Other potential factors influencing the wedge effect were also examined.</p><p><strong>Results: </strong>A total of 408 patients were included. The mean NIA was 15.61 ± 4.49 °. Post-nail insertion, the average increase in FSL was 3.20 mm, and the average decrease in NSA was 1.90 °. Pearson's correlation test revealed that NIA was negatively correlated with the difference in FSL (R = 0.565, P < 0.001) and positively correlated with the difference in NSA (R = 0.509, P < 0.001). Binary logistic regression showed a significant correlation between NIA and the wedge effect (P < 0.001). ROC analysis indicated that the AUC for NIA was 0.813, with an optimal cutoff point of 14.85 °. IPD was positively correlated with NIA (R = 0.519, P < 0.001). Unstable fractures were associated with increased lateralization of the femoral shaft after nail insertion (P = 0.003).</p><p><strong>Discussion: </strong>The NIA is positively correlated with the wedge effect in intramedullary nail fixation of intertrochanteric hip fractures. The wedge effect tends to occur when the NIA is >14.85 °, particularly in unstable fractures. Lateral deviation of the ent","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156698","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":"The RM Press fit cup™: an investigation in 182 hips at ten-year follow-up.","authors":"Adrien Portet, Marion Besnard, Carole Ratsimbazafy, Julien Berhouet, Ramy Samargandi, Louis-Romée Le Nail","doi":"10.1016/j.otsr.2024.103988","DOIUrl":"10.1016/j.otsr.2024.103988","url":null,"abstract":"<p><strong>Introduction: </strong>For over 10 years, the RM Pressfit cup™ has been used in our department. This is a one-piece, elastic, cementless implant designed with standard polyethylene (PE), covered with a thin coating of titanium particles. To date, there is no French study evaluating this cup after more than 10 years. Therefore, we conducted a retrospective study in order to: (1) evaluate the survival of the implant with a minimum follow-up of 10 years, (2) evaluate the functional scores at the last follow-up, (3) measure the wear of the PE, (4) identify radiological loosening, (5) search for risk factors for cup removal, (6) identify complications that required management in the operating theatre.</p><p><strong>Hypothesis: </strong>The working hypothesis was that the survival of this implant was greater than 95% at 10 years' follow-up, in accordance with the criteria of the National Institute for Health and Care Excellence (NICE).</p><p><strong>Materials and methods: </strong>This was a retrospective monocentric study, including adult patients who underwent total hip arthroplasty (THA) with an RM Pressfit cup™ (28 mm friction size) for coxarthrosis (primary or secondary) or femoral head osteonecrosis. Exclusion criteria were a follow-up period of less than 10 years, the placement of an RM Pressfit cup™ as a secondary intention for a THA (n = 5) or following a trochanteric fracture (n = 1). In total, 163 patients (182 hips) with a median age (Q1-Q3) of 63 (56-68) years, and a sex ratio (M/F) of 1.7 were included. Functional scores were evaluated using the Harris and Oxford scores. Radiographs were analyzed in the immediate postoperative period and at the last follow-up.</p><p><strong>Results: </strong>The median follow-up was 10.5 (10-11.5) years. Of the 182 included hips, 7 cups were removed, corresponding to a 10-year survival rate of 96.1% (95% CI [93.3; 96.9]). The median Harris and Oxford scores at 10.5 years were 95 (90-98) and 19 (17-23) points, respectively. The median PE wear rate was 0.058 (0.039-0.087) mm/year. Univariate analysis showed that male gender was associated with PE wear (OR = 3.6; 95% CI [1.3; 12.9] [p = 0.012]). Ten cups (6%) showed radiological instability with migration greater than 3 mm and/or variation in inclination greater than 8 °, and only 9 hips (6%) showed bone resorption. No preoperative or perioperative factors analyzed were associated with cup removal. Dislocation accounted for 71% (n = 5) of the causes of cup removal. Additionally, 6 hips experienced at least one dislocation episode requiring reduction by external maneuvers in the operating room, bringing the overall dislocation rate in the series to 6% (n = 11). Increased cup inclination was the only risk factor for prosthetic dislocation (OR = 1.2; 95% CI [1.09; 1.4] [p = 0.0003]). Overall complications requiring surgical intervention included 15 (8.3%) implanted cups (7 removed cups, 6 dislocation episodes requiring reduction by external maneuvers","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156699","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 estimated glomerular filtration rate using five equations to predict acute kidney injury following hip fracture surgery.","authors":"Kevin L Mekkawy, Yash P Chaudhry, Colton Mowers, Alyssa Wenzel, Micheal Raad, Sandesh S Rao, Rachel B Sotsky, Harpal S Khanuja, Raj M Amin","doi":"10.1016/j.otsr.2024.103987","DOIUrl":"https://doi.org/10.1016/j.otsr.2024.103987","url":null,"abstract":"<p><strong>Background: </strong>Decreased estimated glomerular filtration rate (eGFR) is associated with acute kidney injury (AKI) following hip fracture surgery. Delaying surgery for preoperative treatment of comorbidities is controversial in this patient population. The purpose of this study was 1) to assess differences in demographics and comorbidities between AKI and non-AKI groups, 2) to analyze equations used in calculating eGFR, and 3) to identify the equation which best predicts the development of AKI following hip fracture surgery. We hypothesize that one of the equations used to calculate eGFR will be superior to the others.</p><p><strong>Patients and methods: </strong>124,002 cases of hip fracture surgery were performed from 2012 to 2019, based upon a query of the National Surgical Quality Improvement Program (NSQIP). Preoperative eGFR was calculated using the following: Modification of Diet in Renal Disease (MDRD) II, re-expressed MDRD II, Chronic Kidney Disease Epidemiology Collaboration, Mayo quadratic, and Cockcroft-Gault equations. Independent associations between preoperative eGFR and postoperative renal failure were evaluated using multivariate regression analysis. The predictive ability of each equation was determined using the Akaike information criterion (AIC).</p><p><strong>Results: </strong>AKI was diagnosed in 584 (0.71%) out of the 82,326 patients following hip fracture surgery. The AKI and no AKI cohorts differed significantly by patient sex (p = <0.001), race (p = <0.001), BMI (p = < 0.001), preoperative hematocrit (p = <0.001), preoperative albumin (p = <0.001), diabetes mellitus (p = <0.001), hypertension (p = <0.001), and congestive heart failure (p = <0.001). The Mayo equation (84.0 ± 23.7) was the equation with the highest calculated mean eGFR, followed by the CKD-EPI equation (83.6 ± 20.0), MDRD II equation (83.0 ± 38.9), CG equation (74.7 ± 35.5), and finally the re-expressed MDRD II equation (68.5 ± 36.0) which had the lowest calculated mean eGFR.. All five equations detected that a decrease in preoperative eGFR was associated with an increased risk of postoperative AKI. Lower preoperative eGFR, as calculated by each of the five equations, was significantly associated with an increased risk of AKI following surgical fixation of hip fracture. The AIC was the lowest in the Mayo equation, demonstrating the best fit of the equations to predict postoperative AKI CONCLUSIONS: We propose that using the equation that best identifies those at risk of developing postoperative AKI may help with perioperative decision making and treatment to improve outcomes, which we found to be the Mayo equation. The risk of postoperative AKI was independently associated with decreased preoperative eGFR. The results of this study may warrant further investigation utilizing prospective studies.</p><p><strong>Level of evidence: </strong>III; retrospective cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146895","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":"Rate of complications and short-term Functional Results of Revision Total Knee Arthroplasty for Tibio-femoral Instability: do stability and range of motion are restored in 62 revisions.","authors":"Antoine Labouyrie, Julien Dаrtus, Sophie Putman, Teddy Trouillez, Henri Migаud, Gilles Pаsquier","doi":"10.1016/j.otsr.2024.103986","DOIUrl":"10.1016/j.otsr.2024.103986","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tibio-femoral instability (TFI) due to ligament imbalance is a growing cause of revision total knee arthroplasty (TKA). The results are heterogeneous in the event of revision and literature is scarce regarding this issue particularly when use of hinge prostheses is not exclusive to manage this complication. Therefore, a retrospective investigation was conducted aiming to (1) analyze the one-year functional results, (2) determine the rate of complications after revision for TFI using posterior-stabilized or condylar constrained knees (CCK), 3) identify the factors that could influence the function outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;Patients undergoing revision TKA for TFI would show an improvement in Oxford Knee Score at one year postoperative.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Sixty-two patients were included (40 females, 22 males) mean age 62,9 years ± 8.2 (range, 45,7-78,4). Instability was classified as instability in extension (n = 28), midflexion (n = 12), flexion (n = 12) or global (n = 15). Revisions were done because of isolated instability. Revision consisted in implant revision using a CCK (n = 42), a hinge prosthesis (n = 12) or an isolated polyethylene insert exchange (n = 8). Patients were assessed at one year by the difference between the preoperative Oxford Knee Score (OKS) and the score at one year postoperatively. The results were deemed satisfactory if the variation between preoperative OKS and one-year follow-up was greater than or equal to 5 points (Minimal Clinically Important Difference (MCID) following TKA). Complication rate and risk factors influencing the outcome were also analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 62 patients, 59 could be assessed at one year using postoperative OKS (one death at 0.66 years from unrelated reason, and two had repeated revision within one year postoperative [1 aseptic loosening and 1 Co-Cr allergy]). Preoperative OKS was 15.5 points ± 7.1 (range, 2-37), rising to 28.9 points ± 8.7 (range, 11-45) at follow-up. The mean OKS improvement was 13.4 points ± 10.3 (range, -8 to 33) (p &lt; 0.001) and 47 patients (79.6%) reached the MCID at follow-up. Female gender was associated with a worse evolution of OKS (-5.8, 95% CI: -11.26 to -0.34 (p = 0.038)). In contrast, there was no significant difference in the evolution of the OKS according to the type of TFI in extension or in flexion, in midflexion or global (p = 0.5). Likewise, there was no significant difference in the evolution of the OKS between RTKA using CCK, hinged prosthesis or isolated polyethylene insert exchange (p = 0.3). There was no recurrence of instability at final follow-up (3.04 years ± 1.5 (range, 0.66-6.25)). Revision for instability did not drive to stiffness since mean flexion prior to RTKA was 116 ° ± 13 ° (range, 90 ° to 130 °) versus 116.7 ° ± 12 ° (range, 90 ° to 130 °) at follow-up. Fourteen patients (22.6%) experienced postoperative complications, including 3 revisions (4.8%) at","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146810","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":"Prediction of transfusion risk after total knee arthroplasty: use of a machine learning algorithm.","authors":"Nicolas Faure, Siam Knecht, Pierre Tran, Lyna Tamine, Jean-Christophe Orban, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi","doi":"10.1016/j.otsr.2024.103985","DOIUrl":"10.1016/j.otsr.2024.103985","url":null,"abstract":"<p><strong>Introduction: </strong>Total knee arthroplasty (TKA) carries a significant hemorrhagic risk, with a non-negligible rate of postoperative transfusions. The blood-sparing strategy has evolved to reduce blood loss after TKA by identifying the patient's risk factors preoperatively. In practice, a blood count is often performed postoperatively but rarely altering the patient's subsequent management. This study aimed to identify the preoperative variables associated with hemorrhagic risk, enabling the creation of a machine-learning model predictive of transfusion risk after total knee arthroplasty and the need for a complete blood count.</p><p><strong>Hypothesis: </strong>Based on preoperative data, a powerful machine learning predictive model can be constructed to estimate the risk of transfusion after total knee arthroplasty.</p><p><strong>Material and methods: </strong>This retrospective single-centre study included 774 total knee arthroplasties (TKA) operated between January 2020 and March 2023. Twenty-five preoperative variables were integrated into the machine learning model and filtered by a recursive feature elimination algorithm. The most predictive variables were selected and used to construct a gradient-boosting machine algorithm to define the overall postoperative transfusion risk model. Two groups were formed of patients transfused and not transfused after TKA. Odds ratios were determined, and the area under the curve evaluated the model's performance.</p><p><strong>Results: </strong>Of the 774 TKA surgery patients, 100 were transfused postoperatively (12.9%). The machine learning predictive model included five variables: age, body mass index, tranexamic acid administration, preoperative hemoglobin level, and platelet count. The overall performance was good with an area under the curve of 0.97 [95% CI 0.921-1], sensitivity of 94.4% [95% CI 91.2-97.6], and specificity of 85.4% [95% CI 80.6-90.2]. The tool developed to assess the risk of blood transfusion after TKA is available at https://arthrorisk.com.</p><p><strong>Conclusion: </strong>The risk of postoperative transfusion after total knee arthroplasty can be predicted by a model that identifies patients at low, moderate, or high risk based on five preoperative variables. This machine learning tool is available on a web platform that is accessible to all, easy to use, and has a high prediction performance. The model aims to limit the need for routine check-ups, depending on the risk presented by the patient.</p><p><strong>Level of evidence: </strong>II; diagnostic study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141816","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":"Does the use of topical vancomycin during primary hip or knee arthroplasty protect from infections?","authors":"François Laudet, Alice Gay, Hervé Dutronc, Thierry Fabre, Pierre Meynard, Stéphane Costes","doi":"10.1016/j.otsr.2024.103984","DOIUrl":"10.1016/j.otsr.2024.103984","url":null,"abstract":"<p><strong>Background: </strong>Infection is one of the main complications of hip and knee arthroplasties. Topical application vancomycin to prevent postoperative infections is efficient in spine surgery, and is spreading in prosthetic surgery. However, its clinical relevance and safety are still under debate. Thus, we conducted the present study to (1) assess whether topical vancomycin reduces peri-prosthetic infection rate, and (2) investigate its influence on surgical wound complications.</p><p><strong>Hypothesis: </strong>Our hypothesis was that topical administration of diluted vancomycin during arthroplasty would reduce infection rate within the first postoperative year.</p><p><strong>Material and methods: </strong>In total, 1900 hip and knee arthroplasties were performed between 2014 and 2021 in a single hospital. From July 2018 and December 2021, 910 prostheses were implanted with intra-articular instillation of vancomycin and tranexamic acid. From November 2014 to June 2018, 990 prostheses were set up without vancomycin. During a follow-up of minimum 12 months, we reported periprosthetic infections occurring during the first postoperative year, as well as vancomycin-induced general or cutaneous complications.</p><p><strong>Results: </strong>We observed periprosthetic infections in 9/990 cases (0.91%) of the control group and 10/910 cases (1.1%) of the vancomycin group (p = 0.82). In parallel, we observed wound complications (erythema, seroma, hematoma, dehiscence and delay in wound healing) in 19/990 (1.9%) and 10/910 cases (1.1%) of the control and vancomycin group, respectively (p = 0.19). There were no general complications resulting from the application of vancomycin.</p><p><strong>Discussion: </strong>Topical diluted vancomycin does not reduce periprosthetic infection risk, and has no effect on the occurrence of surgery wound complications. Considering the present findings, the use of vancomycin cannot be recommended in current practice to prevent infections following hip and knee arthroplasties. Finally, its use does not induce any specific complications, whether local (cicatrisation) or general (related to ototoxicity or nephrotoxicity).</p><p><strong>Level of evidence: </strong>III; case control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141815","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":"New comprehensive score for predicting difficulties in revision total hip arthroplasty.","authors":"Olivier Roche, Arthur Schmitz, Maxime Lefevre, François Sirveaux, François Bonnomet","doi":"10.1016/j.otsr.2024.103983","DOIUrl":"10.1016/j.otsr.2024.103983","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Revision total hip arthroplasty (THA) can be complex, and assessing possible difficulties is important to predict the operative time. No simple score for predicting difficulties has been assessed prospectively. We therefore developed an original score for the pre-operative evaluation of extraction and reconstruction difficulties. The objectives of this prospective study were to (1) assess correlations between score values and operative time, (2) determine whether the score predicted the need for revision implants and/or filling material, (3) determine whether the score predicted intra-operative and post-operative complications, and (4) evaluate the inter-observer and intra-observer reproducibility of the score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;The score is reproducible and correlates well with the operative time, thereby allowing prediction of this parameter before surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;A prospective study of 103 revision THA procedures performed between March 2018 and August 2023 was conducted. The primary outcome was operative time and the secondary outcomes were use of a revision implant, use of filling material, and intra-operative and post-operative complications. The score was determined by four observers to allow evaluation of inter-observer agreement. Intra-observer agreement was assessed by having one of the observers determine the score a second time after inclusion of the last patient. The score has a maximum value of 20 and allows classification of the procedure as very difficult, difficult, and moderately difficult.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean operative time correlated with the score value: 136.0 ± 33.9 min in the very difficult group, 102.0 ± 34.8 min in the difficult group, and 75.4 ± 65.5 min in the moderately difficult group (p = 0.0002). The score predicted the use of a reinforcement ring (40 procedures: 12/17 [70%], 11/25 [44%], and 17/61 [28%] in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.01) and of a long stem (20 procedures: 8/17 [47%], 7/25 [28%], and 5/61 [8%] patients in the very difficult, difficult, and moderately difficult groups, respectively; p &lt; 0.001). The score did not predict the use of filling material (42 procedures: 10/17 [59%], 9/25 [36%], and 23/61 [37%] in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.250). The score predicted both intra-operative complications (5/17 [29%], 4/25 [16%], and 4/61 [6%] procedures in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.028) and post-operative complications (4/17 [23%], 0/25 [0%], and 6/61 [9%] in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.15). Inter-observer agreement was strong according to Landis-Koch criteria, with kappa values ranging from 0.70 to 0.79 [0.57-0.90]. The kappa value for intra-observer agreement was 0.74 [0.63-0.85].&lt;/p&gt;&lt;","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114846","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":"What is the clinical detection threshold for lower limb length inequality? In silico study of reproducibility and optimization using a centimeter graduated support.","authors":"Roger Erivan, Antoine Urbain, Tony Santorum, Gérard Giordano, Nicolas Reina, François Bonnomet, Jean Yves Jenny, Henri Peuchot, Nicolas Bonin, Mehdi Hormi-Menard, Bruno Miletic, Julien Wegrzyn, Fredson Razanabola, Christophe Jardin, Hervé Nieto, François Loubignac, Jean Matsoukis, Jérémy Hardy, Alain Duhamel, Henri Migaud, SoFCOT","doi":"10.1016/j.otsr.2024.103981","DOIUrl":"https://doi.org/10.1016/j.otsr.2024.103981","url":null,"abstract":"<p><strong>Introduction: </strong>The threshold of a Leg Length Discrepancy (LLD) by clinical examination on a sheet or centimeter paper (CP) is not known precisely whether or not it concerns limbs equipped with a hip prosthesis. We therefore conducted a prospective in silico study in order to: (1) determine the reproducibility and sensitivity of the clinical measurement of the LLD in different ideal and \"degraded\" clinical situations, (2) determine the threshold from which the human eye is capable of detecting a length inequality in clinic, (3) to determine whether the use of a graduated support (centimeter paper) improves the clinical measurement threshold.</p><p><strong>Hypothesis: </strong>Our hypothesis was that clinical measurement on a centimeter support would improve clinical measurement accuracy.</p><p><strong>Material and methods: </strong>This was an in silico study, the experiment was conducted on a mannequin. Different inequalities were created on a mannequin and photographed with a total of 30 inequalities from -22 to +22 mm on sheet or centimeter paper (CP). This was a multicenter study, with 40 different readers. We asked the readers to make a second measurement one month later. We evaluated the inter- and intra-observer reproducibility. The error rate at the threshold of 3 mm and 5 mm were calculated versus the gold standard. Finally, we determined at which thresholds respectively 75% and 95% of the measurements were correct.</p><p><strong>Results: </strong>A total of 4140 measurements were performed and compared to the gold standard. With a threshold of 75% accurate measurement, the LLD detection threshold was 2.8 mm on centimeter paper and 4.5 mm on sheet. With a threshold of 95% accurate measurement, the LLD detection threshold was 3.4 mm on centimeter paper and 5.2 mm on sheet. Interobserver agreement (assessed overall on the 40 observers by Krippendorff's generalized Kappa) was 0.86 (95% confidence interval (CI95%) = 0.79 to 0.92) on CP and 0.71 (CI95% = 0.63 to 0.79) on sheet. Intra-observer agreement assessed by the intraclass correlation coefficient among observers who made 2 measurements had a median value (IQR) of 0.96 (0.94 to 0.99) on CP and 0.90 (0.83 to 0.94) on sheet.</p><p><strong>Discussion: </strong>The clinical detection threshold on sheet at the patient's bed appears close to 5 mm. A more precise measurement is possible with graduated centimeter paper. A study in daily practice on patients in real situations would confirm our results.</p><p><strong>Level of evidence: </strong>III; prospective diagnostic comparative in Silico study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114847","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":"Morphological characteristics of the cubital tunnel as indication for anterior interosseous nerve supercharge end-to-side transfer in treating advanced cubital tunnel syndrome.","authors":"Jang Won Lee, Sang Ki Lee, Young Sun An","doi":"10.1016/j.otsr.2024.103982","DOIUrl":"10.1016/j.otsr.2024.103982","url":null,"abstract":"<p><strong>Background: </strong>Cubital tunnel syndrome (CuTS) is a prevalent compressive neuropathy addressed through various treatments, including the anterior interosseous nerve (AIN) supercharge end-to-side (SETS) transfer for advanced CuTS. Decision to add AIN-SETS is based on various indicators and protocols, but deciding on the appropriate method for borderline cases can be challenging. Therefore, this study aims to non-invasively examine the cubital tunnel anatomy of patients using CT scans and compare the findings with existing indicators and measurements, to determine if they can serve as supplementary indicators to aid in treatment decisions.</p><p><strong>Hypothesis: </strong>The bony cubital tunnel volume is correlated to other traditional indicators and can be used as an additional indication for deciding whether to perform AIN-SETS in treating advanced CuTS.</p><p><strong>Patients and methods: </strong>This is a single-center retrospective cohort study from South Korea, including 91 patients aged 20-70 years with CuTS. Participants were classified into Group A (n = 43), who underwent both cubital tunnel release (CuTR) and AIN-SETS, and Group B (n = 48), who underwent only CuTR. Preoperative elbow CT data were analyzed for cubital tunnel morphology analysis, with follow-up assessments such as grip strength and electromyography/ nerve conduction velocity (EMG/NCV) tests at 3, 6, and 12 months postoperatively.</p><p><strong>Results: </strong>Group A and B showed no significant differences in demographic parameters, except for a longer disease duration in Group A (p = 0.032). Group A had a smaller cubital tunnel volume (CTV) compared to Group B (1150.6 ± 52.8 mm³ vs. 1173.5 ± 56.2 mm³, p = 0.014) and a smaller cross-sectional area (40.9 ± 10.2 mm² vs. 45.1 ± 11.7 mm², p = 0.033). Pearson correlation analysis revealed statistically significant positive correlations between CTV measurements and pre-operative grip strength, as well as EMG results, a key indicator for AIN-SETS (R² = 0.48, 0.23, p = 0.01).</p><p><strong>Discussion: </strong>Measuring the cubital tunnel anatomy using CT can aid in determining the treatment approach for advanced CuTS patients and assist in deciding whether to perform AIN-SETS surgery, serving as a supplementary indicator for cases at the borderline limits of other indicators. Future research may be necessary to establish control groups without symptoms and determine appropriate cut-off values.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114845","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":"Which type of supra-syndesmal fractures Weber C or Equivalent Weber C have the best reduction of the distal tibio-fibular syndesmosis? A prospective CT-scan investigation on 60 ankles.","authors":"Guillaume David, Quentin Hamel, Laurent Hubert, Clément Marc, Vincent Steiger, Louis Rony","doi":"10.1016/j.otsr.2024.103980","DOIUrl":"10.1016/j.otsr.2024.103980","url":null,"abstract":"<p><strong>Introduction: </strong>The reduction of the distal tibiofibular syndesmosis (SyTFd) is a crucial factor in the functional prognosis following a suprasyndesmotic ankle fracture. Few studies have compared, using computed tomography (CT), the quality of SyTFd reduction in Weber C ankle fractures (WebC) and Equivalent Weber C (EqWebC) fractures, where there is a medial ligament injury instead of a bony malleolar lesion. This CT-based study aimed to answer the following questions: (1) Do Weber C fractures allow for better reduction of the distal tibiofibular syndesmosis compared to Equivalent Weber C fractures? (2) Are the functional outcomes one year postoperatively better for Weber C fractures compared to Equivalent Weber C fractures?</p><p><strong>Hypothesis: </strong>The hypothesis was that WebC fractures would present better reduction of the SyTFd than EqWebC fractures due to the restoration of bone anatomy, considering the bony nature of the medial ligament involvement.</p><p><strong>Materials and methods: </strong>Since December 2021, all patients presenting with an ankle fracture were included in a database. Suprasyndesmotic fractures were extracted, and between December 2021 and February 2022, 60 patients underwent surgery for a suprasyndesmotic fracture (28 WebC - 32 EqWebC). All patients were operated on using the same technique and underwent a postoperative bilateral CT scan in axial slices with both ankles in a neutral position (foot at 90 ° to the leg). An analysis of 8 measurements was performed under the same conditions. Each fractured ankle was compared to the healthy contralateral ankle, and a delta was obtained for each measurement. The follow-up was standardized. At one year, an AOFAS Score and a Maryland Foot Score (MFS) were recorded. Statistical differences between the two groups were measured using the Student's t-test and Chi-square test.</p><p><strong>Results: </strong>There was a significant difference between the WebC and EqWebC groups for clinical scores at one year postoperatively: AOFAS: 92.0 ± 6.3 [78-100] vs. 80.1 ± 5.4 [62-100], p < 0.05; MFS: 90.9 ± 6.4 [78-100] vs. 81.6 ± 5.2 [64-100], p < 0.05. CT scan analysis of the SyTFd reduction found significantly better reduction in the WebC group.</p><p><strong>Discussion: </strong>WebC fractures showed better clinical scores associated with better SyTFd reduction on postoperative CT scans. The anatomical reduction related to the bone reduction criteria during surgery could explain our findings.</p><p><strong>Level of evidence: </strong>III; Case-Control Comparative Study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114848","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}