Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Hallux valgus treatment by percutaneous scarf-like screwless osteotomy: surgical technique and medium-term outcomes.","authors":"Yair Green Halimi, Ben Efrima, Marc Elkaïm","doi":"10.1016/j.otsr.2024.103963","DOIUrl":"10.1016/j.otsr.2024.103963","url":null,"abstract":"<p><strong>Background: </strong>Hallux valgus is a common condition. There is a consensus that distal metatarsal osteotomies have positive outcomes for the correction of mild-to-moderate deformities, and that proximal osteotomies are preferable for more severe ones. The well-known scarf osteotomy technique is considered powerful enough for both types of deformation and is described without internal fixation. We aimed to describe a new surgical technique for hallux valgus percutaneous scarf like osteotomy (PSLO) without internal fixation, and to report the medium-term radiological and clinical outcomes.</p><p><strong>Hypothesis: </strong>A combination of a PSLO without internal fixation will lead to optimal results.</p><p><strong>Patients and methods: </strong>This retrospective case series reports on 126 cases involving 106 patients who underwent hallux valgus surgery with the PSLO technique +/- Akin, +/- lateral release. The osteotomy was stabilized by a bandage, and immediate weight bearing was allowed. The surgeries took place in 3 clinics in France from March 2016 to July 2017.</p><p><strong>Results: </strong>All radiological parameters: hallux valgus angle (HVA), the 1-2 intermetatarsal angle (IMA) and the distal metatarsal articular angle (DMAA) showed statistically significant improvement. The mean preoperative HVA, IMA and DMAA were 27.7 °, 14.2 ° and 12.7 ° respectively. The mean postoperative HVA, IMA and DMAA were 8.23 °, 8.1 ° and 3.8 °, respectively. Clinically, 97% were satisfied or very satisfied with the results, 92% could wear \"normal\" shoes (45 days - 6 months), 99% returned to the same athletic activities after surgery (3-5 months), and the average time to return to work was 4 weeks (1 day - 51 days).</p><p><strong>Discussion: </strong>The combination of scarf -like osteotomy and the percutaneous technique provide sufficient initial stabilization through the large horizontal area of contact between the fragments and the preservation of the attachment of the soft tissue. The lack of internal fixation significantly shortens the surgery time, cost, and reduces x-ray exposure without compromising the results.</p><p><strong>Level of evidence: </strong>III, retrospective comparative study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768099","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":"Subscapularis atrophy and function after arthroscopic Trillat procedure.","authors":"Arnaud Gonnachon, Bastien Michon, Timothée Savoye-Laurens, Romain Colombi, Emmanuel Baulot, Ludovic Labattut, Pierre Martz","doi":"10.1016/j.otsr.2024.103961","DOIUrl":"10.1016/j.otsr.2024.103961","url":null,"abstract":"<p><strong>Introduction: </strong>Several studies have reported a strength deficit in internal rotation (IR) following a Latarjet procedure, which can persist for months or even years. The arthroscopic Trillat procedure does not require splitting the subscapularis muscle, potentially making it less damaging.</p><p><strong>Hypothesis: </strong>The arthroscopic Trillat procedure does not cause any atrophy or strength deficit in the subscapularis muscle.</p><p><strong>Methods: </strong>This was a single center, retrospective study of patients treated between 2013 and 2021. Included were patients who had chronic anterior shoulder instability with an indication for surgical stabilization using an arthroscopic Trillat procedure and who underwent a CT scan before surgery and a second one at 6 months postoperative. The following morphological parameters were measured on all the rotator cuff muscles: cross-sectional area (CSA), thickness and fatty infiltration using the mean muscle attenuation (MMA) measurement. Isokinetic tests were done 1 year post-surgery.</p><p><strong>Results: </strong>One hundred seventeen patients underwent arthroscopic Trillat surgery between 2013 and 2021; 58 were included, 30 were analyzed and 17 patients underwent isokinetic testing. The CSA of the subscapularis was significantly smaller by 5.3% (17.0 vs. 16.1; p = 0.03). None of the other rotator cuff muscles had a smaller CSA. The MMA of the subscapularis increased significantly while the MMA of the external rotators decreased postoperatively. No strength deficit was found at 1 year postoperative in the internal and external rotators.</p><p><strong>Discussion: </strong>The arthroscopic Trillat procedure produces minor atrophy of the subscapularis muscle at 6 months, with no strength deficit at 1 year postoperative. Several studies have reported a deficit in internal rotation strength after a Latarjet procedure, ranging from 6% to 19% depending on the study.</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":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768100","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 survival between cemented vs cementless unicompartimental knee arthroplasty: a case control study with propensity score matching.","authors":"Pierre-Alban Bouché, Nicolas Gaujac, Wilfrid Graff, Luc Lhotellier, Vincent Le Strat, Simon Marmor","doi":"10.1016/j.otsr.2024.103960","DOIUrl":"10.1016/j.otsr.2024.103960","url":null,"abstract":"<p><strong>Introduction: </strong>The first results of cementless prosthesis were rather disappointing. However recent progress in methods of cementless fixation of prosthesis should lead to better results in terms of survival of these prostheses. The main objective is to compare the survival rate at last follow-up of UKA with cemented tibial or cementless.</p><p><strong>Hypothesis: </strong>We hypothesize that UKAs with uncemented tibial implants have better survival compared to UKAs with cemented tibial implants.</p><p><strong>Material and methods: </strong>This single center case-control study included 94 medial UKA with a cemented tibial component that were paired by propensity score matching to 94 medial UKA with a uncemented tibial component. The main evaluation criterion was the comparison of the survivorship of the UKA between a cemented tibial implant and those with a cementless tibial implant in terms of all-cause revision surgery at last follow-up. The secondary endpoints were the analysis of the causes of failure.</p><p><strong>Results: </strong>The mean final follow-up was 6.1years (2.3). The overall survival rate in our serie of medial UKA was 92.4% [88.7%-96.3%] at five years. The overall survival rate in cemented group was and 91.5% [86.0%-97.3%] at five years and at 93.2% [88.1%-98.7%] at five years, in the uncemented group. No differences significant were observed in the two groups (p.value = 0.6). Only the tibial preoperative deformity was a risk factor of failure (HR: 1.11 [1.02, 1.20], value = 0.02).</p><p><strong>Discussion: </strong>The use of a cemented or a cementless tibial component in a medial UKA did not influence the survival rate.</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":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768097","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":"Distal radius fractures after 75 years of age: are six-month functional and radiological outcomes better with plate fixation than with conservative treatment?","authors":"Safire Ballet, Inès Guerzider-Regas, Zouhair Aouzal, Astrid Pozet, Alexandre Quemener-Tanguy, Axel Koehly, Laurent Obert, François Loisel","doi":"10.1016/j.otsr.2024.103959","DOIUrl":"10.1016/j.otsr.2024.103959","url":null,"abstract":"<p><strong>Background: </strong>Surgery and non-operative treatment produce similar 1-year functional outcomes in patients older than 65 years. Data are lacking for patients older than 75 years. The main objective of this study was to compare surgical vs. non-operative treatment regarding short-term outcomes in patients older than 75 years. In addition to an overall analysis, sub-group analyses were done in patients with displacement and severe displacement (>20 ° posterior tilt).</p><p><strong>Hypothesis: </strong>Surgery provides better clinical and radiological outcomes than does non-operative treatment.</p><p><strong>Patients and methods: </strong>Patients older than 75 years at the time of a distal radius fracture were included prospectively over a 2-year period. A follow-up duration of at least 6 months was required. Treatment choices were based on displacement, Charlson's Co-morbidity Index, and patient autonomy. Surgery consisted in open fixation using an anterior locking plate and non-operative treatment in a short arm cast without reduction. The main assessment was based on clinical criteria: range of motion, strength, visual analogue scale (VAS) scores, the short version of the Disabilities of the Arm, Shoulder, and Hand tool (QuickDASH), the Patient Rated Wrist Evaluation (PRWE), and the 36-Item Short Form Health Survey (SF-36). The secondary assessment criteria were the radiological outcomes and the complications.</p><p><strong>Results: </strong>74 patients were included, among whom 24 were treated surgically and 50 non-operatively. At 1.5 months, surgery was associated with significantly better results for flexion, ulnar inclination, and supination, with range increases of at least 7 ° vs. non-operative treatment, and with greater dorsal angle and ulnar variance values (p < 0.05 for all comparisons). At 6 months, pronation and the radio-ulnar index were better with surgery (p < 0.05 for both comparisons). In the patients with displacement or severe displacement, surgery was associated with 10° gains vs. conservative treatment for flexion, ulnar inclination, and supination at 1.5 months (p < 0.05 for all comparisons).</p><p><strong>Discussion: </strong>In patients older than 75 years, surgery for distal radius fracture was associated with significantly better clinical and radiological outcomes within 6 months. Surgery is recommended for displaced and severely displaced distal radius fractures to expedite the recovery of joint motion ranges. Beyond 6 months, the outcomes are similar.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768098","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":"Archetype analysis of the spine-hip relationship identifies distinct spinopelvic profiles","authors":"Thomas Aubert ,&nbsp;Aurélien Hallé ,&nbsp;Philippe Gerard ,&nbsp;Michael Butnaru ,&nbsp;Wilfrid Graff ,&nbsp;Guillaume Rigoulot ,&nbsp;Guillaume Auberger ,&nbsp;Olivier Aubert","doi":"10.1016/j.otsr.2024.103944","DOIUrl":"10.1016/j.otsr.2024.103944","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt;The position of the pelvis in the sagittal plane can vary considerably between different functional positions. Adapting the position of the acetabular cup in relation to the alignment between the spine and the hip of each individual, prior to prosthesis placement, can prevent the risk of prosthetic impingement. Taken individually, risk factors for unfavorable spinopelvic kinematics can be difficult to interpret when trying to precisely predict which patients are at risk. Furthermore, the use of classifications or algorithms can be complex, most often associated with limited values and often difficult to apply in current practices of risk assessment.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;p&gt;We hypothesized that the deconstruction of the data matrix including age and spinopelvic parameters (SPT, LL, PI, LF and PI-LL) correlated with the analysis of spinopelvic kinematics could be used to define an individualized hip-spine relationship.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and method&lt;/h3&gt;&lt;p&gt;We applied archetypal analysis, which is a probabilistic, data-driven and unsupervised approach, to a complete phenotype cohort of 330 patients before total hip arthroplasty to define the spinopelvic profile of each individual using the spinopelvic parameters without threshold value. For each archetype, we analyzed the spinopelvic kinematics, not implemented in the creation of the archetypes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;An unsupervised learning method revealed seven archetypes with distinct spinopelvic kinematic profiles ranging from −8.9 ° to 13.15 ° (p = 0.0001) from standing to sitting and −5. 35 ° to −10.81 ° (p = 0.0001) from supine to standing. Archetype 1 represents the “ideal” patient (A1); young patients without spinopelvic anomaly and the least at risk of mobility anomaly. Followed by 3 archetypes without sagittal imbalance according to their lumbar lordosis and pelvic incidence, from the highest to the lowest (archetypes 2–4), archetype 4 exposing a greater risk of spinopelvic kinematic anomaly compared to others. Then 2 archetypes with sagittal imbalance: archetype 5, with an immobile pelvis in the horizontal plane from standing to sitting position in anterior tilt and archetype A6, with significant posterior pelvic tilt standing, likely compensating for the imbalance and associated with the greatest anomaly of spinopelvic kinematics. Finally, archetype 7 with the stiffest lumbar spine without sagittal imbalance and significant unfavorable kinematics from standing to sitting.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;An archetypal approach to patients before hip replacement can refine diagnostic and prognostic features associated with the hip-spine relationship and reduced heterogeneity, thereby improving spinopelvic characterization. This risk stratification of spinopelvic kinematic abnormalities could make it possible to target patients who require adapted positioning or types of implants before prosthetic surgery.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Lev","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1877056824002007/pdfft?md5=35275327ce3c95235a5d89d03e25a40e&pid=1-s2.0-S1877056824002007-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of mediCAD® software for fully digital preoperative planning of total hip arthroplasty: a retrospective study","authors":"Pierre-Alban Bouché ,&nbsp;Simon Corsia ,&nbsp;Guillaume Auberger ,&nbsp;Jules Descamps ,&nbsp;Philippe Anract ,&nbsp;Moussa Hamadouche","doi":"10.1016/j.otsr.2024.103941","DOIUrl":"10.1016/j.otsr.2024.103941","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt;The planning step that precedes a total hip arthroplasty (THA) procedure is crucial. Digital planning software programs are being increasingly used, although few studies have reported on the reliability of such tools. Furthermore, no studies have been conducted on the mediCAD® software, despite it being widely used in France. This led us to conduct a retrospective study to: (1) assess the accuracy of this planning software, (2) determine the intra- and inter-rater reliability, (3) determine how obesity affects the accuracy of planning.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;p&gt;THA planning is accurate and reliable when using the mediCAD® software.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;p&gt;This was a single center, retrospective study. One hundred one consecutive cases performed by a single experienced surgeon were planned retrospectively by two blinded surgeons on two separate occasions. The acetabular cup was cemented in 90 hips (89%), cementless in 11 hips (11%). A dual mobility cup was used in 21 hips (21%). The femoral stem was cemented in 60 hips (59%). The endpoint was the number of exact plans, defined as the same size as the actual implants. An acceptable match was defined as a difference of one size. The match was unacceptable if the planned and implanted size differed by more than 2 for the acetabular cup or by more than 1 size for the femoral stem. The intra-rater and inter-rater reliability were calculated using the intraclass correlation coefficient (ICC) with 95% confidence intervals (CI).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Exact agreement was found by the first rater for 15 planned acetabular cups (15%) and for 45 planned femoral stems (45%) relative to the implants used. The second rater reached exact agreement for 20 planned acetabular cups (20%) and 50 planned femoral stems (50%). The intra-rater reliability for the acetabular cup was average (ICC = 0.57; 95%CI [0.43–0.69]) and poor (ICC = 0.38 95%CI [0.20–054]) for the 1st and 2nd rater, respectively. The intra-rater reliability for the femoral stem was poor for the 1st rater (ICC = 0.47 95%CI [0.30–0.61]) and the 2nd rater (ICC = 0.45 95%CI [0.29–0.60]). The interobserver reliability was low for the planned acetabular cup (ICC = 0.39 95%CI [0.21–0.54]) and the planned femoral stem (ICC = 0.42 95%CI [0.24–0.57]). Overall, when combining the two raters, exact prediction of the acetabular cup was achieved in 31 hips (19%) in non-obese patients and in 7 hips (21%) in obese patients (p = 0.62).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;p&gt;This study found acceptable reliability of the mediCAD® software. Experience level, radiograph magnification affected the planning outcome in this study, but obesity did not. We currently do not have the ability to incorporate a reliable radiological scale for two-dimensional templating. Some surgeons prefer using a CT scan, but this costs more than conventional radiographs and exposes the patient to more radiation. This study show","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753349","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":"First cuneo-metatarsal arthrodesis (Modified Lapidus) with plantar plate for the treatment of hallux valgus: clinical and radiological outcomes at one year follow-up.","authors":"Ramy Samargandi, Maxime Saad, Rayane Benhenneda, Louis-Romée Le Nail, Jean Brilhault","doi":"10.1016/j.otsr.2024.103957","DOIUrl":"10.1016/j.otsr.2024.103957","url":null,"abstract":"<p><strong>Introduction: </strong>The modified Lapidus arthrodesis, involving the first cuneo-metatarsal joint, is a well-established surgical method and widely utilized for treating moderate to severe hallux valgus deformities with hypermobility in the first tarsometatarsal joint. The purpose of this study was to assess the rate of union following the Lapidus procedure using a plantar plate and an immediate full weight-bearing protocol. Secondary objectives included examining radiological corrections and potential associated complications.</p><p><strong>Methods: </strong>A retrospective study included 66 patients (80 feet) who underwent a modified Lapidus procedure for the treatment of hallux valgus associated with hypermobility of the first ray, performed by a single senior surgeon at our institution between May 2013 and November 2019. All patients had a minimum follow-up of 12 months. Patients were clinically assessed at 3 weeks, 3 months, and 1 year. Radiological measurements were taken on weight-bearing dorsoplantar views preoperatively, at 3 months, and at 12 months postoperatively.</p><p><strong>Results: </strong>Bone union was achieved in 79 cases (98.75%). There was one case of non-union, two wound complications (one infection and one dehiscence), two cases of symptomatic hardware requiring hardware removal, and one stress fracture associated with recurrence of hallux valgus that required revision. The mean hallux valgus angle (HVA) improved from 30.5 ° ±10.4 ° to 10.1 ° ±6.6 ° (p < .001), the mean intermetatarsal angle (IMA) improved from 13.4 ° ±3.6 ° to 5.6 ° ±2.9 (p < .001), The average sesamoid position improved from stage 5.9 ± 1.6 to stage 2.6 ± 1.2 (p < .001). The mean shortening of the first metatarsal was 3.6 mm ± 1.8. There was no significant difference between measurements at 3 and 12 months postoperatively.</p><p><strong>Conclusion: </strong>Modified Lapidus with a planter plate and compression screw is a reliable method of fixation with a high union rate, permit an immediate protected weight bearing and a low complications rate.</p><p><strong>Level of evidence: </strong>IV; Retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762630","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":"Risk prediction of kalaemia disturbance and acute kidney injury after total knee arthroplasty: use of a machine learning algorithm.","authors":"Pierre Tran, Siam Knecht, Lyna Tamine, Nicolas Faure, Jean-Christophe Orban, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi","doi":"10.1016/j.otsr.2024.103958","DOIUrl":"10.1016/j.otsr.2024.103958","url":null,"abstract":"<p><strong>Introduction: </strong>Total knee arthroplasty (TKA) is a procedure associated with risks of electrolyte and kidney function disorders, which are rare but can lead to serious complications if not correctly identified. A routine check-up is very often carried out to assess the seric ionogram and kidney function after TKA, that rarely requires clinical intervention in the event of a disturbance. The aim of this study was to identify perioperative variables that would lead to the creation of a machine learning model predicting the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.</p><p><strong>Hypothesis: </strong>A predictive model could be constructed to estimate the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.</p><p><strong>Material and methods: </strong>This single-centre retrospective study included 774 total knee arthroplasties (TKA) operated on between January 2020 and March 2023. Twenty-five preoperative variables were incorporated into the machine learning model and filtered by a first algorithm. The most predictive variables selected were used to construct a second algorithm to define the overall risk model for postoperative kalaemia and/or acute kidney injury (K⁺ A). Two groups were formed of K⁺ A and non-K⁺ A patients after TKA. A univariate analysis was performed and the performance of the machine learning model was assessed by the area under the curve representing the sensitivity of the model as a function of 1 - specificity.</p><p><strong>Results: </strong>Of the 774 patients included who had undergone TKA surgery, 46 patients (5.9%) had a postoperative kalaemia disorder requiring correction and 13 patients (1.7%) had acute kidney injury, of whom 5 patients (0.6%) received vascular filling. Eight variables were included in the machine learning predictive model, including body mass index, age, presence of diabetes, operative time, lowest mean arterial pressure, Charlson score, smoking and preoperative glomerular filtration rate. Overall performance was good with an area under the curve of 0.979 [CI95% 0.938-1.02], sensitivity was 90.3% [CI95% 86.2-94.4] and specificity 89.7% [CI95% 85.5-93.8]. The tool developed to assess the risk of impaired kalaemia and/or acute kidney injury after TKA is available on https://arthrorisk.com.</p><p><strong>Conclusion: </strong>The risk of kalaemia disturbance and postoperative acute kidney injury after total knee arthroplasty could be predicted by a model that identifies low-risk and high-risk patients based on eight pre- and intraoperative variables. This machine learning tool is available on a web platform accessible for everyone, easy to use and has a high predictive performance. The aim of the model was to better identify and anticipate the complications of dyskalaemia and postoperative acute kidney injury in high-risk patients. Further prospective multicentre series are needed to","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762631","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":"In silico analysis of the patient-specific acetabular cup anteversion safe zone","authors":"Thomas Aubert,&nbsp;Philippe Gerard,&nbsp;Giacomo Galanzino,&nbsp;Simon Marmor","doi":"10.1016/j.otsr.2024.103940","DOIUrl":"10.1016/j.otsr.2024.103940","url":null,"abstract":"<div><h3>Introduction</h3><p>Various computer-assisted surgical systems claim to improve the accuracy of cup placement in total hip arthroplasties after assessing spinopelvic mobility to prevent prosthetic impingement. However, no study has yet analyzed the extent of the patient-specific cup anteversion safe zones.</p></div><div><h3>Hypothesis</h3><p>We hypothesized that most patients have a safe zone &gt;10 °, except those with abnormal spinopelvic mobility, who have a much narrower safe zone.</p></div><div><h3>Materials and methods</h3><p>We simulated the risks of prosthetic impingement using the planned cup anteversion. The consecutive cohort included 341 patients who underwent total hip arthroplasty. Our primary endpoint was the patient-specific impingement-free zone for cup anteversion, which was then divided into four subgroups: 0 °, 1 ° to 5 °, 6 ° to 10 °, and &gt;10 °. This data was then secondarily analyzed for abnormal spinopelvic mobility (the difference in the spinopelvic tilt [ΔSPT] from a standing to a flexed seated position &gt;20 °).</p></div><div><h3>Results</h3><p>The mean anteversion safe zone was 22.8 ° with 82.4% (281/341) of patients with a zone strictly &gt;10 °. The mean safe zone was 8.9 ° (+/− 9 °) in patients with an ΔSPT ≥20 ° (18.2%), with 37.1% of these patients having a zone of 0 °, 16.13% a zone between 1 ° and 5 °, 8.06% a zone between 6 ° and 10 ° and 38.71% a zone &gt;10 °. The mean safe zone was 25.9 ° (+/− 9 °) in patients with an ΔSPT &lt;20 ° (81.8%), and the proportion of cases in each zone was 2.51%, 1.08%, 4.3%, and 92.11%, respectively (p &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>The safe zone for anteversion appears to be fairly wide in most patients. However, identifying patients at risk of abnormal spinopelvic mobility seems necessary to identify the two-thirds of patients with a narrow safe zone.</p></div><div><h3>Level of evidence</h3><p>IV; retrospective study</p></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753348","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":"Fingertip amputations in children: Atasoy flap's indications and limitations.","authors":"Raphaël Nguyen, Jean-Gabriel Delvaque, Virginie Mas, Brice Ilharreborde, Pascal Jehanno","doi":"10.1016/j.otsr.2024.103954","DOIUrl":"10.1016/j.otsr.2024.103954","url":null,"abstract":"<p><strong>Introduction: </strong>The Atasoy flap is considered simple and reliable for covering distal digital defects in adults. Various studies in children have shown more contrasting results, particularly in terms of aesthetics and function. The aim of this study is to evaluate the long-term results of this flap specifically in children, in order to determine its limitations and indications.</p><p><strong>Hypothesis: </strong>The Atasoy flap is reliable and reproducible for coverage of distal digital substance loss up to zone 2 in children.</p><p><strong>Materials and methods: </strong>Fifty-six children who benefited from an Atasoy flap operated on between January 2017 and January 2020 were included. Lesion area, operative technique, postoperative complications (infection, healing difficulties, necrosis), and ultimately nail appearance, cold intolerance or finger pain, finger eviction, extension defect, and final parental satisfaction were analyzed.</p><p><strong>Results: </strong>Forty-nine children were evaluated with a mean follow-up of 18 months (min = 3 months, max = 38 months, SD = 11.3 months). Eighteen children had a hook nail, resulting in 6 of them having their finger excluded. The majority of hook nails were found in zone III and in proximal zone II lesions (12 cases). Eighty-nine percent of children with distal suture fixation to the nail bed (8 children) had this complication. Cold intolerance was present in 9 children. There were no cases of extension failure or early post-operative complications. Final parent satisfaction was 9.1/10 (min = 5, max = 10, SD = 1.3).</p><p><strong>Conclusion: </strong>The Atasoy flap in children appears reliable for covering loss of distal digital substance. The main complication is the occurrence of hook nails. Compliance with its indications (transverse substance loss not exceeding the proximal third of zone II) and a precise surgical technique (distal needle fixation without suturing to the nail bed, deep flap lift, non-closure of the donor site) help limit this risk.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749782","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}