Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Distal femoral osteotomy for the treatment of chronic patellofemoral instability improves gait patterns","authors":"Peter Rab,&nbsp;Romed P. Vieider,&nbsp;Lorenz Fritsch,&nbsp;Matthias Cotic,&nbsp;Florian B. Imhoff,&nbsp;Sebastian Siebenlist,&nbsp;Andrea Achtnich,&nbsp;Maximilian Hinz","doi":"10.1007/s00402-025-05788-x","DOIUrl":"10.1007/s00402-025-05788-x","url":null,"abstract":"<div><h3>Purpose</h3><p>The purpose of this study was to evaluate pre- to postoperative changes in clinical and functional outcomes as well as gait patterns in patients who underwent surgery for chronic patellofemoral instability (PFI).</p><h3>Methods</h3><p>Patients who underwent surgery for the treatment of recurrent PFI according to an individual risk factor analysis were included. Pre- and minimum 12 months postoperatively, patient-reported outcome measures (PROM; Kujala score, Lysholm score, Tegner Activity Scale [TAS] and Visual Analog Scale for pain) as well as gait (dynamic Q-angle) and function (dynamic valgus and dynamic Trendelenburg during single-leg squat) via videography were evaluated. Subgroup analysis was performed based on whether or not patients underwent concomitant distal femoral osteotomy (DFO) due to coronal and/or torsional malalignment.</p><h3>Results</h3><p>Twenty-three patients were included (follow-up: 12.5 [12.1–13.0] months), of which 60.9% patients underwent a concomitant DFO. All PROM improved significantly (<i>p</i> &lt; 0.05). Overall, dynamic Q-angle (<i>p</i> = 0.016) and dynamic valgus (<i>p</i> = 0.041) were observed significantly less frequently postoperatively when to compared to preoperatively. Subgroup analysis showed that only the group that underwent DFO had a significant improvement of dynamic Q-angle (<i>p</i> = 0.041). Dynamic Trendelenburg did not improve (<i>p</i> &gt; 0.05). Regression analysis showed that the presence of a postoperative dynamic Q-angle was associated with a worse postoperative Kujala score (<i>p</i> = 0.042) and TAS (<i>p</i> = 0.049).</p><h3>Conclusion</h3><p>Patient-individualized surgery for PFI improved gait patterns and functional testing, especially in patients who also underwent DFO. The presence of dynamic Q-angle postoperatively was associated with significantly worse functional outcome and sporting ability.</p><h3>Level of evidence</h3><p>Level III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05788-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571104","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":"Postoperative muscle atrophy and fatty degeneration with respect to surgical approaches in total hip arthroplasty","authors":"Grigorios Svarnas,&nbsp;Vlad Popa,&nbsp;Theofania-Sotiria Patsiou,&nbsp;Joseph Michael Schwab,&nbsp;Moritz Tannast","doi":"10.1007/s00402-025-05793-0","DOIUrl":"10.1007/s00402-025-05793-0","url":null,"abstract":"<div><h3>Background</h3><p>Total hip arthroplasty is the gold standard for treatment of hip osteoarthritis. The different surgical approaches utilize different intervals to access the hip joint. There is concern that some surgical approaches cause soft tissue trauma resulting in post-operative muscle weakness of patients undergoing THA. We therefore asked whether the implantation of a total hip prosthesis by each of four common surgical approaches (anterior, anterolateral, direct lateral and posterior) leads to (i) muscle atrophy (defined as decreased muscle cross-sectional area [CSA]) and (ii) muscle degeneration (defined as fatty infiltration) of 12 specific periarticular hip muscles. Further, if significant change is found, can we establish an associated pattern with a particular surgical approach?</p><h3>Method</h3><p>We retrospectively evaluated 493 patients undergoing computed tomography of the pelvis in HFR hospital Fribourg, Switzerland, between 2014 and 2020. All patients had undergone a primary THA at some point prior to their CT scan. Trauma, metastasis, bone tumor, neurologic disorder, infection, and revision cases were excluded. Twelve periarticular hip muscles were measured for CSA and degree of fatty infiltration according to the Goutallier scale on axial and sagittal views of both the operative and nonoperative hips.</p><h3>Results</h3><p>CSA of the operative hip muscles differed significantly depending on approach. Similarly, there was a statistically significant difference in muscle degeneration in the operative hips according to the Goutallier classification. We observed a specific level and pattern of muscle atrophy for each approach.</p><h3>Conclusion</h3><p>In all approaches, there is a trade-off between the muscles they affect, their role, and whether there is a possibility of partial compensation by other muscles. The anterior approach was the least harmful to the gluteus medius muscle.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05793-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571103","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":"Efficacy of a novel, fluoroscopy-based robotic-assisted total hip arthroplasty system in restoring limb length and offset","authors":"Graham B.J. Buchan,&nbsp;Christian J. Hecht II,&nbsp;Mary Nugent,&nbsp;Nathanael D Heckmann,&nbsp;Arihiko Kanaji,&nbsp;Atul F. Kamath","doi":"10.1007/s00402-024-05648-0","DOIUrl":"10.1007/s00402-024-05648-0","url":null,"abstract":"<div><p>Introduction. Optimizing leg length discrepancy (LLD) and restoring global and femoral offset (GO, FO) are integral to improving the stability and longevity of total hip arthroplasty (THA). A novel robotic-assisted THA (RA-THA) platform has been developed to utilize pre-operative templating and intraoperative fluoroscopic imaging to guide the restoration of native biomechanics. We sought to evaluate the effectiveness of this novel, pin-less, fluoroscopy-based RA-THA system to restore templated LLD and offset parameters. Materials and Methods. We performed a retrospective analysis on a consecutive series of 98 patients who underwent fluoroscopy-based RA-THA at our institution. The primary outcomes were the differences between preoperatively templated LLD, GO, and FO parameters with intraoperatively achieved parameters measured by the robotic system and with postoperatively achieved parameters measured from postoperative radiographs. Results. The mean difference between achieved and preoperatively templated values of LLD (−1.5 ± 5.5 mm), GO (−0.1 ± 5.5 mm), and FO (−0.1 ± 5.4 mm) were all within − 1.5 mm of establishing equalized leg length and offset. The proportion of patients with a difference in achieved and templated values &lt; 10 mm were 92% for LLD, 91% for GO, and 93% for FO. For 43 of the 98 (44%) patients in this study, the surgeon referenced intraoperative robotic data to adjust femoral components from the preoperative plan in order to optimize LLD and offset parameters. Conclusions. The results of our present study demonstrated that fluoroscopy-based RA-THA is associated with high levels of accuracy in restoring key biomechanics of the hip. In a large number of patients, the surgeon used intraoperative robotic data to more closely achieve LLD and offset goals. This demonstrates the ability of this system to merge preoperative data with intraoperative, actionable data provided by the robotic software to restore leg length and global/femoral offset parameters. Words: 279/ 300.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143553790","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":"Scaphocapitate fusion in stage III Kienböck’s disease: effects of lunarectomy on postoperative pain and function","authors":"Amr Elshahhat,&nbsp;Khaled Nour,&nbsp;Yasser Abed","doi":"10.1007/s00402-025-05783-2","DOIUrl":"10.1007/s00402-025-05783-2","url":null,"abstract":"<div><h3>Background</h3><p>Kienböck’s disease (KD) is a progressive condition characterized by avascular necrosis of the lunate, leading to carpal collapse and wrist dysfunction. Scaphocapitate fusion (SCF) is a salvage procedure often used in advanced stages of KD to stabilize the wrist and alleviate symptoms. This study aimed to evaluate the clinical and radiological outcomes of SCF in stage III KD, with a specific focus on the impact of lunarectomy on postoperative pain and function.</p><h3>Materials and methods</h3><p>This retrospective study included 25 patients with stage III KD who received SCF treatment and were followed between December 2019 and August 2024. Patients were categorized into groups of lunarectomy (<i>n</i> = 14) and lunate preservation (<i>n</i> = 11). Clinical outcomes were assessed using grip strength, range of motion (ROM), Visual Analog Scale (VAS) for pain, Modified Mayo Wrist Score (MMWS), and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Radiological evaluations included measurements of carpal alignment and fusion success.</p><h3>Results</h3><p>SCF significantly improved grip strength, ROM, and pain levels across all patients (<i>p</i> &lt; 0.05). Patients with lunarectomy showed greater improvements in combined flexion-extension ROM (<i>p</i> = 0.001), grip strength (<i>p</i> = 0.0023), MMWS (<i>p</i> = 0.0033), and pain reduction (<i>p</i> = 0.037) compared to those with lunate preservation. Fusion was achieved in 92% of patients, with no significant differences in radiological outcomes between the two groups.</p><h3>Conclusion</h3><p>SCF is an effective intervention for Stage III KD, offering pain relief and functional improvement. Lunarectomy may provide advantages over lunate preservation, particularly in terms of pain reduction and ROM, making it a considerable option for the surgical management of advanced KD.</p><h3>Level of evidence</h3><p>level IV.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05783-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143533002","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":"Clinical added value of 3D printed patient-specific guides in orthopedic surgery (excluding knee arthroplasty): a systematic review","authors":"Nick Kampkuiper,&nbsp;Romy ten Heggeler,&nbsp;Jorm Nellensteijn,&nbsp;Marjolein Brusse-Keizer,&nbsp;Gabriëlle Tuijthof,&nbsp;Maaike Koenrades,&nbsp;Femke Schröder","doi":"10.1007/s00402-025-05775-2","DOIUrl":"10.1007/s00402-025-05775-2","url":null,"abstract":"<div><h3>Introduction</h3><p>Patient-specific guides (PSGs) provide customized solutions and enhanced precision. However, the question remains: does clinical evidence support the added value of PSGs? This study critically appraises, summarizes, and compares the literature to assess the clinical value of PSGs in orthopedic surgery.</p><h3>Materials and methods</h3><p>PubMed and Embase were used to search for studies reporting on randomized controlled trials (RCTs) that compared the use of PSGs with a control group for an orthopedic intervention, excluding knee arthroplasty. The risk of bias was assessed using the Cochrane risk-of-bias tool (RoB 2). The clinical value was expressed as patient reported outcome measures (PROMs), complications, accuracy, surgery duration, blood loss, and radiation exposure. Relative and absolute differences were determined, and whether these were negative or positive for using PSGs.</p><h3>Results</h3><p>From 6310 studies, 27 RCTs were included, covering various interventions. The studies' heterogeneity prevented meta-analysis. Six (22.2%) of the included articles scored low risk of bias. Significant differences in the benefit of PSGs were reported across all included metrics: 32.2% in PROMs, 22.7% in complications, 69.8% in accuracy, 42.1% in surgery duration, 46.7% in blood loss, and 93.3% in radiation exposure. No significant negative differences were found in any of the studies.</p><h3>Conclusion</h3><p>PSGs generally show superior outcomes for accuracy and radiation exposure across multiple intervention types, while the reduction in complications was primarily significant in spinal fusion surgery. For PROMs, complications in other treatments, surgery duration, and blood loss, there may be clinical added value but future well-designed RCTs are needed to provide stronger evidence.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05775-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529967","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":"Impact of septic arthritis on quality of life: arthroscopy vs. arthrotomy","authors":"Nike Walter,&nbsp;Lorenz Huber,&nbsp;Melanie Schindler,&nbsp;Josina Straub,&nbsp;Dominik Szymski,&nbsp;Volker Alt,&nbsp;Markus Rupp","doi":"10.1007/s00402-024-05655-1","DOIUrl":"10.1007/s00402-024-05655-1","url":null,"abstract":"<div><h3>Introduction</h3><p>Septic arthritis poses significant challenges due to its potential for joint damage and life-threatening complications. The choice between arthroscopy and open arthrotomy as surgical approaches remains a critical decision in septic arthritis management. However, limited research has focused on patient-reported outcomes and quality of life following treatment.</p><h3>Materials and Methods</h3><p>A retrospective study was conducted at a German level 1 trauma center, including 58 adult septic arthritis patients treated with arthroscopy (n = 29) or open arthrotomy (n = 29). Quality of life was assessed using the EQ-5D instrument. Functional mobility was evaluated with the Parker Mobility Score, while the Katz Score assessed activities of daily living (ADL). The mean follow-up time was 5.6 years.</p><h3>Results</h3><p>Comparable EQ-5D VAS scores were observed in both groups, with no significant difference in the quality of life between arthroscopy and open arthrotomy patients (64.8 ± 19.3 vs. 64.7 ± 19.6, p = 0.749). Notably, both groups reported limitations in pain/discomfort and mobility, while the open arthrotomy group exhibited more anxiety/depression limitations (p = 0.024). Functional mobility, as assessed by the Parker Mobility Score (6.50 ± 2.62 vs. 6.51 ± 2.60, p = 0.617), and ADL independence, using the Katz Score (5.06 ± 1.72 vs. 5.05 ± 1.71, p = 0.181) remained similar between the two groups.</p><h3>Conclusion</h3><p>In septic arthritis management, arthroscopy and open arthrotomy yield similar long-term QoL outcomes, functional mobility, and ADL independence. Despite these findings, it is crucial to interpret the results with caution, given potential limitations associated with retrospective studies, and external factors influencing long-term outcomes. Further prospective research, incorporating larger sample sizes and extended follow-up, is necessary to refine our understanding of septic arthritis management strategies and their impact on patient well-being.</p><h3>Level of evidence</h3><p>III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-024-05655-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527612","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":"ROTEM’s utility in guiding resuscitation of traumatic lower extremity fracture patients","authors":"Brandi M. Mize,&nbsp;Rebecca J. Reif,&nbsp;Garrett L. Spears,&nbsp;Kyle J. Kalkwarf,&nbsp;Hanna K. Jensen,&nbsp;Steven M. Cherney,&nbsp;Simon C. Mears","doi":"10.1007/s00402-025-05773-4","DOIUrl":"10.1007/s00402-025-05773-4","url":null,"abstract":"<div><h3>Introduction</h3><p>Rotational thromboelastometry (ROTEM) is a method for real-time detection of clotting derangements allowing for targeted blood product resuscitation. We sought to determine if coagulopathy profiles differed based on fracture location (comparing pelvic versus tibia and femur fractures), if ROTEM profiles correlated between both total hospital and intensive care unit length of stay (LOS), and if ROTEM profiles correlated with patients undergoing an immediate definitive fixation versus an early damage control approach to care.</p><h3>Materials and methods</h3><p>A retrospective cohort study was performed using data from a level 1 trauma registry database. ICD codes were used to isolate operative lower extremity fractures that had a ROTEM on admission. Two cohorts were created: (1) stratification by fracture location including pelvis, femur, and tibia (<i>n</i> = 498) and (2) stratification by fixation method including external fixation versus early definitive fixation (<i>n</i> = 154). The fracture location cohort assessed length of stay parameters while the fixation cohort assessed fixation approaches with ROTEM profiles.</p><h3>Results</h3><p>The majority of fracture location patients with ROTEM APTEM and ROTEM EXTEM profiles were physiologically coagulable with all three fracture locations. Most patients with ROTEM INTEM profiles showed hypocoagulable derangements with femur (75.2%), tibia (68.1%), and pelvic fractures (68.8%). Fractures classified as ROTEM APTEM hypocoagulable indicated a longer hospital LOS (<i>r</i> = 0.282) and ICU LOS (<i>r</i> = 0.510). No correlation was found between coagulopathy profiles and fixation approaches.</p><h3>Conclusions</h3><p>ROTEM studies on fracture types showed little consensus on ROTEM profiles correlating to a specific fracture location. ROTEM profiles collected showed limited predictive ability of a patient’s hospital and ICU LOS. Early definitive fixation versus external fixation did not correlate between specific ROTEM profiles. Overall, there did not appear to be utility in routine use of ROTEM in fracture patients and this should be limited to those with severe multisystem injuries.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143489457","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":"Comparative study of the 3D morphological differences in associated both-column acetabular fractures between elderly and young adults","authors":"Longxiang Shen,&nbsp;Kai Ye,&nbsp;Jianfei Tang,&nbsp;Zhiquan An","doi":"10.1007/s00402-025-05784-1","DOIUrl":"10.1007/s00402-025-05784-1","url":null,"abstract":"<div><h3>Introduction</h3><p>The occurrence of associated both-column acetabular fractures (ABC-AFs) is common in the elderly, yet their morphological characteristics compared to younger adults remain unclear.</p><h3>Materials and methods</h3><p>This retrospective study analyzed 123 cases of ABC-AFs: elderly patients (≥ 65 years, <i>n</i> = 47, group A) and younger adults (&lt; 65 years, <i>n</i> = 76, group B). Using Mimics and 3-matic, fracture line (FL) distributions in the anterior column (AC), quadrilateral plate (QP), and posterior wall (PW) fragments were examined. Comparisons focused on the articular surface, ilium, QP area, and retro-acetabular surface (RAS). Harris hip scores (HHS) were recorded and compared one-year post-surgery.</p><h3>Results</h3><p>The distribution of FLs of the AC fragment on the anteroinferior wall, acetabulum, inner and outer sides of the ilium was similar between groups A and B except that group A had sparser FL distribution on the posterosuperior rim and fewer FLs extending into the sacroiliac joint. A comparable pattern of FLs of the QP fragments on the QP area and the RAS was also confirmed. On the RAS, group A exhibited fewer cranial transverse lines (8.5% vs. 25.0%) and more inverse lines (44.7% vs. 23.7%) than group B (<i>p</i> = 0.011). A higher incidence of PW fragments was identified in group A (72.3% vs. 53.9%, <i>p</i> = 0.042). The number of intra-articular fragments was higher in group A than group B (3.8 vs. 3.4, <i>p</i> = 0.031), but the composition of the articular surface was similar. The average HHS was 77.6 in group A and 83.0 in group B (<i>p</i> = 0.007), with excellent/good ratios of 59.5% and 74.7% (<i>p</i> &lt; 0.001), respectively.</p><h3>Conclusions</h3><p>The similar morphological patterns of ABC-AFs and favorable functional outcomes suggest that surgical principles for younger patients could be applicable to elderly patients, with careful considerations for osteoporosis and co-morbidities.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143489458","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":"Correction: Noise in operating theatres, is it safe?","authors":"Maliha Ayoola,&nbsp;Diego Agustín Abelleyra Lastoria,&nbsp;Laura Casey,&nbsp;Sara Dardak,&nbsp;Roshan Rupra,&nbsp;Amar Khamis,&nbsp;Caroline Blanca Hing,&nbsp;Sarah Radcliffe,&nbsp;Catherine Kellett","doi":"10.1007/s00402-024-05747-y","DOIUrl":"10.1007/s00402-024-05747-y","url":null,"abstract":"","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-024-05747-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143489373","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":"Arthroscopic treatment of scaphoid nonunion, a new algorithm after six years practice","authors":"Christian Windhofer,&nbsp;Patrik Ivusic,&nbsp;Peter Jakob,&nbsp;Markus Lill,&nbsp;Josef Schauer","doi":"10.1007/s00402-025-05777-0","DOIUrl":"10.1007/s00402-025-05777-0","url":null,"abstract":"<div><h3>Introduction</h3><p>Scaphoid nonunion is still a challenging problem in hand surgery. Till now most of the patients have been treated with open revision, bone grafting and internal stabilization. Arthroscopy plays an increasing role in hand surgery since the last decade. In this retrospective study, we want to present our results and current treatment protocol, adapted after midterm analysis.</p><h3>Material and methods</h3><p>In 2017, arthroscopic treatment of scaphoid nonunion was started at our department. Debridement is done arthroscopically as well as insertion of radius cancellous bone graft. Fixation has been accomplished with K-wires and/or head compression screws percutaneously, by help of fluoroscopy. Till 2020, 24 patients were treated, observing three delayed unions, treated successfully by extra corporal shockwave therapy and modifying the fixation. A subsequent analysis of the results yielded the modification of our fixation methods, and consequently, all patients received shockwave therapy as well.</p><h3>Results</h3><p>Comparing the success rate with the 28 operated after 2020, the adaption of our algorithm showed an improvement of the healing rate from 87 to 96%. There we found only one ongoing nonunion in the proximal 1/3. The median time to bony healing was comparable in the two groups, operation time showed no significant difference. After a median follow-up of 30 months, an excellent range of motion could be found, as well as a significant reduction in pain and grip strength matchable with the unaffected hand in all 52 patients. DASH and Mayo Wrist Score showed satisfactory results, and 45 patients came back to their earlier occupation and sports.</p><h3>Conclusion</h3><p>Arthroscopy has a fix place in the algorithm for scaphoid nonunion in our institution. It is hypothesized that the implementation of an adequate and stable fixation on the section of the nonunion is indispensable. The distal radius is a sufficient donor-site for cancellous bone grafting. Extra corporal shockwave therapy is from now on used routinely in arthroscopic treatment of scaphoid nonunion.</p><h3>Level of evidence</h3><p>IV.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05777-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143446586","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}