Orthopedic Surgery

Background Femoral shaft fractures represent common fractures of the lower limb in the paediatric population. The objectives of our study were to analyse the static plantar pressure and functional capacity in children with surgically treated unilateral femoral shaft fractures, 1 month after the metallic implant removal. Methods Our study included 24 children with unilateral femoral shaft fracture (fracture site contralateral to the dominant leg) treated by titanium elastic nailing (TEN) implants, with the removal of the implant 6 months after initial surgery. The patients were divided into two groups: Group 1 (12 patients without inpatient rehabilitation) and Group 2 (12 patients who attended inpatient rehabilitation). The patients and 12 gender and age-matched healthy controls performed plantar pressure analysis and functional capacity testing (6-min walk test: 6MWT). For patients in Group 1 and 2 the assessments were performed 1 month after the TEN implant removal. Paired t-tests ...

Introduction: Multiple options are available for revising a failed anterior cruciate ligament (ACL) reconstruction. A staged procedure is considered only if there is significant tunnel widening. Here, we present a case of revision ACL reconstruction done in single sitting in spite of a widened tibial tunnel of 15.9 mm through an anterolateral tibial tunnel using a peroneus graft. Case Report: A 39-year-old male manual laborer with post-polio residual paralysis in the opposite leg with past history of trans-portal ACL reconstruction 11 years back using an ipsilateral hamstring graft presented to us with complaints of instability and swelling of the left knee following a slip and fall 2 months back. Magnetic resonance imaging showed a tear in the reconstructed ACL graft with cyclops and tibial tunnel widening of 15.9 mm. The patient underwent single stage revision ACL reconstruction through the anterolateral tibial tunnel using a peroneus longus tendon autograft. At 1 year follow-up, the patient has good knee movements with no signs of instability. Conclusion: Single stage revision ACL reconstruction through the anterolateral tibial tunnel in a case of significantly widened tibial tunnel gives satisfactory results similar to anteromedial tibial tunnel with advantages of not requiring a second surgery, faster recovery, and good bone for the tunnel compared to the previous medial tunnel.

The aim of this study is to compare two methods of internal fixations of fractured medial malleolus which are simple screw fixation and tension band wiring. Over 5 years we grouped 20 patients with fractured medial malleolus into two groups of operative treatments, group1 treated by malleolar screw fixation and group2 by tension band wiring. The patients were with same age group, gender, fracture type, and etiology. We use statistical analysis for make a comparative study between the two ways of surgical treatment. The mean time for radiologic bone union was 11.8 weeks in group1 patients and 9.4 weeks in group2 patients (P = 0.03). No patients had any sign of fixation failure or Kirschner wires migration. According to the modified ankle scoring system of Olerud and Molander, excellent and good results were achieved in 80 % in group1 patients and 90 % in group2 patients (P = 0.049). Conclusions: Tension-band wiring may be better treatment option for internal fixation of medial malleolar fractures than screw fixation. Recommendations: From these findings we recommend a further randomized clinical trial of larger number of cases and longer follow-up duration in order to regard tension-band wiring a better operative option for fixation of medial malleolar fractures.

Background: Spinal anaesthesia is a preferred method for lower limb surgeries. Levobupivacaine, an S-enantiomer of bupivacaine, is associated with fewer cardiotoxic effects. Fentanyl, an opioid adjuvant, may enhance the efficacy of local anaesthetics. The purpose was to compare the efficacy and safety of intrathecal hyperbaric levobupivacaine alone versus low-dose levobupivacaine with fentanyl in lower limb surgeries. Methodology: Eighty ASA I-II patients undergoing elective lower limb surgeries were randomly divided into two groups. Group L received 15 mg hyperbaric levobupivacaine; Group LF received 12.5 mg levobupivacaine with 25 µg fentanyl intrathecally. Sensory/motor block characteristics, haemodynamic stability, and side effects were assessed. Results: The onset of sensory block was faster in Group L (2.86 ± 0.97 min) than Group LF (3.42 ± 0.96 min) (p = 0.011). Sensory block lasted slightly longer in Group LF (102.37 ± 17.72 min vs. 96.88 ± 27.85 min; p = 0.305). Motor block durations were comparable (p = 0.952). Haemodynamic parameters remained stable and similar between groups. Side effects, including hypotension and bradycardia, were slightly more frequent in Group L, but not statistically significant. Conclusion: Both regimens are effective and safe. Levobupivacaine alone provides faster onset, while the addition of fentanyl permits dose reduction without compromising efficacy. The combination is a clinically useful alternative for lower limb surgeries with minimal side effects.

A study was done to note the communications between the Musculocutaneous nerve and Median nerve. Of the 50 arms studied, 17 had variations. Communications from the Musculocutaneous nerve to the Median nerve were seen in 76.47% of the variant arms. Of these, 53.8% were in the upper 1/3 of the arm, 38.46% in the middle 1/3 and 7.69% in the distal 1/3 of the arm. A communicating branch from the Median nerve to the Musculocutaneous nerve was found only in 5.88% of the variant arms. In 11.76% of the variant arms, the whole lateral cord joined the medial root to form the Median nerve. The Musculocutaneous nerve then arose from the Median nerve. When the communications were classified according to the classification by earlier authors [Venieratos D, Anagnostopoulou S 1998, Choi. D 2002] the percentage of the communicating branches agreed with those of the earlier studies. The results of this study show that the intercommunications between Musculocutaneous nerve and Median nerve are frequent. These variations are frequent and have to be studied in detail by every surgeon so as to prevent any iatrogenic damage during surgery. These intercommunications can result in neuropathies with atypical presentation. Incorrect diagnosis and unnecessary surgeries (e.g, carpal tunnel release) can be avoided if the surgeon keeps in mind these variations and the clinical presentation of these variant nerves in case of an injury.

Rehabilitation, the process of achieving maximum restoration of physical, psychological and social function, must be carefully planned and executed. It should be goal-directed, and based on a thorough assessment of the patient's medical, functional and psychosocial status. For patients with fracture of the hip, early mobilization and rapid restoration of function are paramount. A sound and consistent approach can be achieved only when there is a good collaboration between orthopedic surgeon, medical consultants, family physician and allied health personnel.

Objective. We report on the clinical and radiographic results obtained using surgical treatment with plates and screws in displaced intra-articular calcaneal fractures (DIACFs). Methods. 41 patients were included for a total of 43 DIACFs treated at our unit between 2008-2019. Fractures were classified by Sanders classification and radiographically we considered Böhler's angle. The American Orthopedic Foot and Ankle Score (AOFAS) was used for clinical evaluation. Results. Of 43 fractures, 3 were classified type I, 13 type II, 20 type III and 7 type IV. The mean follow-up was 87.51 months (min. 9, max. 136). The average AOFAS score was 82.88 and the post-operative mean Bohler angle was 22.65°. We observed the following complications: one infection requiring hardware removal and hyperbaric oxygen therapy and 3 instances of delay in wound healing treated with antibiotic and medications. Hardware removal was needed in 10 cases. Conclusions: the good functional and clinical results seen in our study encourage us to propose surgery as the first choice of treatment of DICFs.

Resection resulting in asymmetrically thick patellar arthroplasty in knee arthroplasty may lead to increased compression forces, wear, fracture, or loss of quadriceps power. Assessing the cut patella between the thumb and forefinger (haptic assessment) represents a convenient way to recognize asymmetry. In 2 test series, 8 orthopedic surgeons evaluated 24 precut solid foam patellae of varying asymmetric thickness by feeling the patella between thumb and forefinger, without visualization. Of 384 responses, in 73.2% asymmetry was underestimated, 10.4% assessments were exact, and in 16.4% asymmetry was overestimated. Specifically, 35.9% were correct within 1 mm, 60.7% within 2 mm, 81% within 3 mm, and 91.4% within 4 mm. The thickest half of the patella was correctly identified in 90.6% of responses. Haptic assessment of patellar symmetry is a useful technique in knee arthroplasty.

A 24-year-old female was diagnosed in 2018 with extraskeletal mesenchymal chondrosarcoma (MCS) of the left elbow (4 × 5 × 3 cm, antecubital fossa). TRU-CUT biopsy confirmed diagnosis neoadjuvant 3D conformal radiotherapy (RT) (25 Gy in 5 × 5 Gy fractions) was followed by R0 resection. Adjuvant chemotherapy (CHT) (VADRIAC: vincristine, actinomycin D, doxorubicin, ifosfamide, cyclophosphamide) was initiated. In Dec 2018, CT revealed pulmonary M1; thoracotomy achieved R0 resection of three nodules. CHT continued with EIAO (etoposide, ifosfamide, adriamycin, vincristine; total doxorubicin 1010 mg). FISH analysis excluded NR4A3 and DDIT3 rearrangements, confirming extraskeletal MCS (SOX9+, SOX10-). Platinum-based CHT (cisplatin-etoposide) was introduced. progressive disease (PD) in lungs by RECIST 1.1 (June 2019) led to first-line palliative CHT with gemcitabine (900 mg/m², D1 + 8) and docetaxel (75 mg/m², D8), achieving partial response (PR). In early 2020, liver M1 appeared (up to 24 × 19 mm). A second pulmonary metastasectomy was performed (December 2020). With further PD (mid-2021), VAI (vincristine, actinomycin D, ifosfamide) was administered for 7 cycles, achieving PR. Due to isolated mediastinal progression, RT (45 Gy in 15 × 3 Gy fractions) was delivered (October 2021) resulting in PD. Temozolomide-irinotecan failed (PD), as did rechallenge with gemcitabine-docetaxel (PD, January 2022). In Mar 2022, the patient developed symptomatic CNS metastases (largest 23 × 22 mm, frontoparietal region). Palliative care was initiated, and she died at home shortly after. The patient underwent eight systemic regimens over four years with initial PRs but eventual PD and CNS involvement.

The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of 21 cats that underwent coxofemoral toggle stabilization using the Mini TightRope® Fixation System (mTR®). Data were compiled from client-owned cats with traumatic hip luxation. Each cat underwent the same protocol including orthopedic assessment, preoperative radiographic evaluation, surgical procedure, postoperative management and clinical re-examination at 14 days, 8 weeks and 12 months following surgery. Age, body weight, implants and osteoarthritis progression were recorded. A lameness score 0-4 was assigned to each cat. Pain upon hip extension was not quantified but as pain reaction or no pain reaction. Major complications and osteoarthritic (OA) changes were recorded. Osteoarthritic changes were classified on a 0-4 scale. Twenty-one cats were included in the study. Coxofemoral luxations were stabilized using a mTR®. At 8 weeks, weight bearing was considered normal (grade 0) in all cat...

We examined sleep-related problems in adolescents and young adults after a mild traumatic brain injury (MTBI) or orthopedic injury. We extended the analysis of data from a study of early emotional and neuropsychological sequelae in these populations (McCauley et al. 2014. J Neurotrauma. 31:914). We gave the Pittsburgh Sleep Quality Index to 77 participants with MTBI, 71 with orthopedic injury, and 43 non-injured controls. The age range was 12 to 30 years. We tested sleep quality within 96 hours of injury and at 1- and 3-month follow-up. Participants also completed measures of pain and fatigue, drug and alcohol use, and post-traumatic stress symptoms. Older participants (mean age=25 years) in the MTBI group exhibited a sharp increase in sleep-related symptoms between the baseline assessment and 1 month, and still had difficulties at 3 months. Younger participants with MTBI (mean age=15 years) and older participants with an orthopedic injury had modest increases in sleep difficulties ...

Three-dimensional (3D) printing is a novel modality with the potential to make a huge impact in the surgical field. The aim of this paper is to provide an overview on the current use of 3D printing in shoulder surgery. We have reviewed the use of this new method in 3 fields of shoulder surgery: shoulder arthroplasty, recurrent shoulder instability and orthopedic shoulder traumatology. In shoulder arthroplasty, several authors have shown that the use of the 3D printer improves the positioning of the glenoid component, even if longer clinical follow-up is needed to determine whether the cost of this system rationalizes the potential improved functional outcomes and decreases glenoid revision rates. In the treatment of anterior shoulder instability, the literature agrees on the fact that the use of the 3D printing can: enhance the dept and size of bony lesions, allowing a patient tailored surgical planning and potentially reducing operative times; allow the production of personalized i...

Kyphoscoliosis is a complex spinal deformity with profound musculoskeletal, neurological, and cardiopulmonary implications. Management requires a patient-specific, multidisciplinary approach, integrating both conservative and surgical strategies. Conservative management encompasses observation, pain control, bracing, physical therapy, and cardiopulmonary optimization, particularly with noninvasive positive pressure ventilation for patients at risk of respiratory failure. These strategies aim to stabilize the deformity, relieve symptoms, and maintain function. Surgical management is reserved for progressive curves exceeding 45-50 degrees, refractory pain, neurological compromise, or significant cosmetic concerns, and includes spinal fusion, osteotomies, vertebral column resection, and growth-friendly techniques in children. Postoperative care emphasizes respiratory monitoring, pain control, and the prevention of surgical complications such as pseudoarthrosis and hardware failure. The ultimate goal is to improve quality of life while minimizing morbidity and mortality. Timely recognition of progression, vigilant follow-up, and multidisciplinary collaboration remain essential to optimize outcomes in this lifelong condition.

The incidence of traumatic injuries of the upper limbs in a tertiary hospital has a wide variety. This is why the creation of a unified database becomes important-to know the patients' profile. Objective: This study sought to determine the profile of patients with traumatic injuries of the upper limbs, treated by Physical Therapy in Rehabilitation Center of the Clinics Hospital of Ribeirão Preto. Method: Two hundred and twenty-three patient records were evaluated (58 women and 116 men). They had an average age of 34.54 (± 19.05) years and were referred by the orthopedic clinic of this hospital. Results: Of the cases studied, wrist and hand injuries had the highest incidence (60.99%), followed by injuries of the shoulder (20.63%), elbow (12.55%), arm (3.59%) and forearm (2.24%). In injuries of wrist and hand, the trauma mechanism with the highest percentage was the motorcycle accident, associated with multiple handbone fractures. Falling down, motorcycle accidents, and falling off a ladder were the mechanisms of injury correlated with proximal humerus fractures, shoulder dislocations, and broken scapulas, respectively. The incidence of injury, trauma mechanism, and characteristics of the population was verified and further improvements in protocols for specific disorders and prevention can be made.

The objective of this study was to assess the variables associated with complications of total hip replacement (THR) and report owner-assessed outcomes. Entries into the British Veterinary Orthopaedic Association-Canine Hip Registry (BVOA-CHR) between September 2011 and December 2012 were reviewed separately and in conjunction with previous data (January 2010-August 2011). An outcomes assessment questionnaire was used to collect data from owners. Incidences of surgeon-reported and owner-reported complications were 8.2 per cent and 4.3 per cent, respectively. THR using the BioMedtrix BFX cup/stem prosthesis had a greater incidence of complications compared with THR using the BioMedtrix CFX cup/stem prosthesis (P=0.002); complications were 4.48 times more likely when using the BioMedtrix BFX cup/stem prosthesis versus the BioMedtrix CFX cup/stem prosthesis. THR using the BioMedtrix BFX cup/stem prosthesis had a higher incidence of complications compared with THR using a hybrid prosthe...

Tooth dentin-derived autogenous bone graft material is very effective for dental bone defect repair but is limited by the need for sufficient material. A xenogeneic material with retained organic matrix, Ivory Dentin Graft, has thus been developed. The properties of this material in comparison to a bone-derived material were examined in a clinically relevant porcine model. Using a split-mouth design, two types of bone defects were created and grafted using either Ivory Dentin Graft or a bone-derived material with retained organic component. The extraction site of an extracted mandibular incisor modelled post-extraction socket preservation, while a mandibular sub-periosteal pouch modelled bone augmentation in procedures such as sinus lifting. At 10 weeks after grafting, when new bone growth and site remodeling is active, the graft sites were solid, dense and stable with no sign of loose particles with both materials. The dentin-derived material was distinguished by having a much higher mean percentage of intimate contact between the graft material and new bone growth (77.5% versus 45.5%) which was statistically different (p < 0.001, paired t-test, 2-tailed). This confirms that Ivory Dentin Graft retains the key property of autologous dentin, of forming an ankylosed network with new bone ingrowth which is key for early and maintained graft site stability.

Soft tissue complications following hip arthroplasty may occur either in cases of total hip arthroplasty or in hip resurfacing, a technique that has become popular in cases involving young patients. Both orthopedic and radiological literatures are now calling attention to these symptomatic periprosthetic soft tissue masses called inflammatory pseudotumors or aseptic lymphocytic vasculites-associated lesions. Pseudotumors are associated with pain, instability, neuropathy, and premature loosening of prosthetic components, frequently requiring early and difficult reoperation. Magnetic resonance imaging plays a relevant role in the evaluation of soft tissue changes in the painful hip after arthroplasty, ranging from early periprosthetic fluid collections to necrosis and more extensive tissue damage.

Soft tissue complications following hip arthroplasty may occur either in cases of total hip arthroplasty or in hip resurfacing, a technique that has become popular in cases involving young patients. Both orthopedic and radiological literatures are now calling attention to these symptomatic periprosthetic soft tissue masses called inflammatory pseudotumors or aseptic lymphocytic vasculites-associated lesions. Pseudotumors are associated with pain, instability, neuropathy, and premature loosening of prosthetic components, frequently requiring early and difficult reoperation. Magnetic resonance imaging plays a relevant role in the evaluation of soft tissue changes in the painful hip after arthroplasty, ranging from early periprosthetic fluid collections to necrosis and more extensive tissue damage.

Objective Objective Objective Objective: to characterize the epidemiological profile of patients undergoing hip replacement, primary or revisional. Methods Methods Methods Methods Methods: we conducted a retrospective, descriptive study, including hip arthroplasties performed from January 2009 to June 2012 in a Belo Horizonte teaching hospital, Minas Gerais State -MG, Brazil. Data were analyzed using descriptive statistics. Results Results Results: orthopedic procedures represented 45% of the operations at the hospital in the period, 1.4% hip arthroplasties. There were 125 hip replacements, 85 total, 27 partial and 13 reviews. Among the patients, 40% were male and 60% were female. Age ranged between 20 and 102 years, mean and median of 73 and 76 years, respectively. The most frequent diagnosis (82%) was femoral neck fracture by lowenergy trauma caused by falling form standing position. In 13 revision operations, 12 required removal of the prosthesis. The infectious complication led to revision in 54% of the time, followed by dislocation (15%), peri-prosthetic fracture (15%) and aseptic loosening (15%). The infection etiologic agent was identified in 43% of occasions. The average length of the prosthesis to a revision operation was eight months. : patients undergoing hip arthroplasty are elderly, with femoral neck fracture caused by falling form standing position, affecting more women. The incidence of hip prosthesis loosening was 10%. The main cause of the infection was loosening. The incidence of revisional hip arthroplasty was 10% and the incidence of hospital mortality in patients undergoing hip arthroplasty was 7.2%.

Soft tissue complications following hip arthroplasty may occur either in cases of total hip arthroplasty or in hip resurfacing, a technique that has become popular in cases involving young patients. Both orthopedic and radiological literatures are now calling attention to these symptomatic periprosthetic soft tissue masses called inflammatory pseudotumors or aseptic lymphocytic vasculites-associated lesions. Pseudotumors are associated with pain, instability, neuropathy, and premature loosening of prosthetic components, frequently requiring early and difficult reoperation. Magnetic resonance imaging plays a relevant role in the evaluation of soft tissue changes in the painful hip after arthroplasty, ranging from early periprosthetic fluid collections to necrosis and more extensive tissue damage.

The risk of developing a surgical site infection after extremity fracture repair is nearly 5 times greater than in most elective orthopedic surgical procedures. For all surgical procedures, it is standard practice to prepare the operative site with an antiseptic solution; however, there is limited evidence to guide the choice of solution used for orthopedic fracture repair. To compare the effectiveness of iodophor vs chlorhexidine solutions to reduce surgical site infections and unplanned fracture-related reoperations for patients who underwent fracture repair. Pre-operative Antiseptic Skin Solutions in Orthopaedic Trauma) master protocol will be followed to conduct 2 multicenter pragmatic cluster randomized crossover trials, Aqueous-PREP (Pragmatic Randomized Trial Evaluating Pre-Operative Aqueous Antiseptic Skin Solution in Open Fractures) and PREPARE (Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities). The Aqueous-PREP trial will compare 4% aqueous chlorhexidine vs 10% povidoneiodine for patients with open extremity fractures. The PREPARE trial will compare 2% chlorhexidine in 70% isopropyl alcohol vs 0.7% iodine povacrylex in 74% isopropyl alcohol for patients with open extremity fractures and patients with closed lower extremity or pelvic fractures. Both trials will share key aspects of study design and trial infrastructure. The studies will follow a pragmatic cluster randomized crossover design with alternating treatment periods of approximately 2 months. The primary outcome will be surgical site infection and the secondary outcome will be unplanned fracture-related reoperations within 12 months. The Aqueous-PREP trial will enroll a minimum of 1540 patients with open extremity fractures from at least 12 hospitals; PREPARE will enroll a minimum of 1540 patients with open extremity fractures and 6280 patients with closed lower extremity and pelvic fractures from at least 18 hospitals. The primary analyses will adhere to the intention-to-treat principle and account for potential between-cluster and between-period variability. The patient-centered design, implementation, and dissemination of results are guided by a multidisciplinary team that includes 3 patients and other relevant stakeholders. The PREP-IT master protocol increases efficiency through shared trial infrastructure and study design components. Because prophylactic skin antisepsis is used prior to all surgical procedures and the application, cost, and availability of all study solutions are similar, the results of the PREP-IT trials are poised to inform clinical guidelines and bring about an immediate change in clinical practice.

Os autores apresentam dois casos raros de complicacao em artroplastia do ombro ainda nao descritos na literatura ortopedica nacional: fratura da diafise do umero no pos-operatorio. Ambos os casos foram tratados de forma similar em diferentes servicos (fixacao ossea e enxertia do iliaco, sem a retirada da protese). Houve consolidacao da fratura, ambas as pacientes retornaram ao mesmo nivel de atividade, mas a mobilidade do ombro permaneceu diminuida. A conduta adotada para o tratamento dessas lesoes e semelhante ao apresentado na bibliografia internacional.

Patellofemoral instability (PFI) is a multifactorial condition typically observed following initial traumatic patellar dislocation. PFI depends on various factors such as limb alignment, bony structure, and the integrity of static and dynamic stabilizers. Patients with below-knee amputation have a higher risk of experiencing PFI. This report describes a successful case involving a patient with patellofemoral instability and a transtibial amputation. The patient was effectively treated with distal realignment and patellar stabilization achieved by reconstructing the medial patellofemoral complex (MPFC).

Background: Traditional bone setters (TBS) are widely consulted for trauma care in developing regions, often leading to severe complications due to inadequate medical knowledge. This practice poses significant risks to patient safety and outcomes. Objective: The study aimed to evaluate the frequency and nature of complications encountered by trauma patients treated by traditional bone setters.

This systematic review updates one conducted in 2008 into extended scope practice (ESP) in physiotherapy in orthopedics. Methods: A comprehensive open-ended search was conducted using electronic library databases and Google Scholar to identify any primary study design reporting on physiotherapists working in ESP roles within orthopedic settings. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, although only studies in levels I, II, or III_1 were critically appraised using a purpose-built critical appraisal tool. Information was extracted on the country of origin, ESP tasks, relevant training, patient types, health, process, and cost measures. Results: 1071 studies were identified, and twelve were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from II to IV, from which only two diagnostic studies met the criteria for critical appraisal. ESP tasks included injection therapy, removing k-wires, and requesting investigations. The education of ESP physiotherapists varied widely, and included formal and informal training. The positive outcomes of ESP initiatives were reported, in diagnostic ability, reduced costs and waiting times, and improved health outcomes. Conclusion: Despite the positive results, the generally low level of evidence and the range of outcome measures reported, constrained clear conclusions regarding the health, process, and cost implications of ESP physiotherapy roles in orthopedic settings. The need for formalized, widely recognized training was highlighted, to give ESP physiotherapy roles credibility.

Background and Objectives: Total knee arthroplasty (TKA) is a commonly performed orthopedic procedure, and is often accompanied by significant postoperative pain. The supra-inguinal fascia iliaca block (SIFIB), similar to an anterior lumbar plexus block, is frequently used in hip surgeries. The interspace between the popliteal artery and capsule of the posterior knee (IPACK) block is a regional anesthesia technique that targets the posterior innervation of the knee capsule. This retrospective study aimed to compare the analgesic effects of SIFIB and SIFIB + IPACK on patients undergoing TKA under spinal anesthesia. Materials and Methods: This retrospective study revealed the data collected from a tertiary hospital. Patient data were gathered for individuals who underwent unilateral TKA under spinal anesthesia during the period between 1 January 2023 and 1 September 2023. Inclusion criteria comprised patients falling within ASA class I–III, those following a standardized perioperative...

Background: Acute hematogenous osteomyelitis (OM) and septic arthritis require immediate diagnosis and treatment by an interdisciplinary team of pediatric infectious disease specialists and pediatric orthopedic surgeons. Adverse outcomes such as growth disturbance, bone deformity, and chronic infections have been described in older studies. However, there is only little known about long-term follow-up of patients of the last two decades. Therefore, we aimed to evaluate subjective and objective long-term outcomes of these children with osteoarticular infections treated in the millennial years.Methods: Cross-sectional study performed in two pediatric centers including patients admitted for OM and/or SA between 2005 and 2014 and follow-up consultations in 2019. Patients with symptoms of ≤2 weeks duration at initial presentation were contacted. Subjective outcomes were assessed by standardized interview, objective outcomes by clinical examination. Medical charts were used to extract dat...

Management of minimally displaced femoral neck fractures in paediatric patients with autosomal dominant osteopetrosis (ADO) remains unclear as only small numbers have been reported. There are no detailed reports on successful conservative treatment. Common causes of failure in this particular area include non-union and development of coxa vara. Although there are no quantitative studies, case reports have inXuenced most authors to recommend operative treatment. It is well recognised that operative treatment of osteopetrotic bone is challenging. Problems arise intraoperatively due to the bone hardness, and postoperatively due to altered biomechanics and defective remodelling. This case of a child with ADO who suVered two asynchronous compression-side stress fractures in the femoral neck demonstrates that non-operative management can be satisfactory. After 8 weeks with partial weight-bearing the fractures were stable. At the latest follow-up 2.5 and 4 years after the fractures the patient presented with an excellent clinical and radiological outcome. There was no development of coxa vara.

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children.

The aim of our study was to investigate the accuracy of dynamic ultrasound assessment of the anterior tibial translation, in diagnosing anterior cruciate ligament tears, and to assess its test–retest reliability. Twenty-three patients (32 ± 8.42 years; 69.56% males) with a history of knee trauma and knee instability participated in the study. Knee ultrasound was performed by an experienced orthopedic surgeon. The anterior tibial translation was measured in both knees and differences between the injured and uninjured knee were calculated. Side-to-side differences &gt; 1 mm were considered a positive diagnosis of an ACL tear. The anterior tibial translation values were 3.34 ± 1.48 mm in injured knees and 0.86 ± 0.78 mm in uninjured knees. Side-to-side differences &gt; 1 mm were found in 22 cases (95.65%). The diagnosis accuracy was 91.30% (95%CI: 71.96–98.92%) and sensitivity 95.45% (95%CI: 77.15–99.88%). The intraclass correlation coefficient showed an excellent test–retest reliabili...

INTRODUCCIÓN. Las enfermedades de las glándulas salivales ocupan un lugar relevante entre las patologías quirúrgicas de la cabeza y el cuello. El objetivo de este trabajo fue presentar la experiencia del tratamiento quirúrgico de tumores parotídeos benignos del lóbulo superficial, mediante anestesia local, en pacientes de la Republica de Haití atendidos como parte de la colaboración médica cubana en ese país. MÉTODOS. Se realizó un estudio prospectivo en pacientes con nódulos parotídeos, atendidos en la República de Haití entre los años 2005 y 2006. Según su naturaleza, los nódulos fueron agrupados en inflamatorios, neoplásicos y otros. Para el tratamiento quirúrgico se utilizó la anestesia local con lidocaína al 1 %, combinando el método infiltrativo y el bloqueo de campo. Se consultaron 149 pacientes con nódulos parotídeos, el mayor porcentaje de los cuales correspondió a procesos inflamatorios (68,0 %) y en 29 pacientes (19,0 %) se comprobó la presencia de nódulos neoplásicos. Las complicaciones fueron seroma (3 casos; 33,3 %), hematoma (2 casos; 22,2 %), y 4 pacientes no presentaron complicaciones. CONCLUSIONES. El abordaje quirúrgico con anestesia local probó ser una alternativa válida cuando el cirujano no cuenta con los recursos que convencionalmente se movilizan para el tratamiento quirúrgico de estos casos.

Objetivo: evaluar mediante un examen clínico ortopédico y un examen radiográfico la articulación del codo en perros de actividad policial. Se estudiaron 15 perros (13 machos y 2 hembras) entre 3 y 10 años de edad que realizan actividad policial en Concepción, Chile. Método: los individuos fueron sometidos a un examen físico general y ortopédico referido a la articulación del codo, luego se realizó el estudio radiográfico, en el cual se evaluaron ambos codos a través de 4 proyecciones que incluyeron una medio lateral extendida (ML), craneocaudal (CrCa), mediolateral en flexion 45° (ML 45° flex) y craneolateral-caudomedial oblicua (Cr15° LCdMO), a fin de establecer la presentación de alteraciones ostearticulares. Resultados: solo 2 perros presentaron signos clínicos (13,33 %) en los que se observaron dolor y crepitación mediante la palpación y la manipulación de la articulación; 8 individuos presentaron signos radiográficos (53,33 %). Los signos más comunes fueron osteofitos (40 %), esclerosis (20 %), incongruencia articular (20 %), desnivel entre radio y ulna (20 %), ausencia del proceso coronoideo medial de la ulna (6,67 %) y proceso ancóneo no unido (6,67 %). Conclusión: este estudio demostró una baja correlación entre la presencia de signos clínicos con la presencia de signos radiográficos (r: 0,327). Palabras clave: articulación codo, displasia de codo, perros de actividad policial, radiografía.

To determine the clinical effectiveness of arthroscopic debridement in patients with rotator cuff arthropathy that is refractory to non operative management, we retrospectively reviewed data for 29 consecutive patients (mean age, 70 years [range, 52-83 years]) with rotator cuff tear arthropathy who underwent arthroscopic debridement by 1 surgeon, had 24 months or more of follow-up (range, 24-69 months), and had complete subjective and objective outcomes evaluations. Statistical analysis involved paired Student's t-test, post hoc analysis, analysis of variance, and the Fisher exact test (significance, P<.05). At 2 years, 18 (62%) satisfied patients graded their shoulders as 66% of normal; the 11 dissatisfied patients graded their shoulders as 31% of normal (P=.006). Satisfied patients had lower visual analog scale scores for night and overall pain and higher mean American Shoulder and Elbow Surgeons (61±21 VS 40± 32) and University of California Los Angeles Shoulder Rating Scale (24±6 VS 11±4, P=.001) scores. Satisfaction was not correlated with biceps release or postoperative range of motion. Patients with Hamada classification of Grade 4 or 5 are poor candidates for this procedure (with a 2.5 times [95% confidence interval 93-6.61] greater probability of dissatisfaction).

Background For hip and knee arthroplasties, an American Society of Anesthesiologists (ASA) score greater than 2 is associated with an increased risk of medical and surgical complications. No study, to our knowledge, has evaluated this relationship for total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (reverse TSA). Questions/purposes We aimed to assess the relationship between the ASA score and (1) surgical complications, (2) medical complications, and (3) hospitalization length after TSA, reverse TSA, and revision arthroplasty. We retrospectively analyzed all patients who had undergone TSAs, reverse TSAs, or revision arthroplasties by the senior author (EGM) from November 1999 through July 2011 who had at least 6 months' followup. Of the 485 procedures, 452 (93.2%) met the inclusion criteria. Data were collected on patient demographics, comorbidities, hospitalization length, and shortterm (B 6 months) medical and surgical complications. Logistic regression analysis modeled the risk of having postoperative complications develop as a function of the ASA score. Results Patients with an ASA score greater than 2 had a greater risk of having a surgical complication develop (p \ 0.001; OR, 2.27; 95% CI, 1.36-3.70) and three times the risk of prosthesis failure (ie, component dislocation, component loosening, and hardware failure) (p \ 0.001; OR, 3.23; 95% CI, 1.54-6.67). Higher ASA scores were associated with prolonged length of hospitalization (effect size 0.46, p \ 0.001), but not medical complications. Conclusions ASA score is associated with surgical, but not medical, complications after TSA and reverse TSA. The ASA score could be used for risk assessment and preoperative counseling. Level of Evidence Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Abstrac Background and objectives Acetabular dysplasia in young adults occurs, despite screening for developmental hip dysplasia (DDH) in the neonatal period. We aimed to examine how early life factors predict radiographic measurements of acetabular dysplasia at 18–19 years of age. Methods From a previous randomized trial (n = 12,014; 1988–90) evaluating the role of hip ultrasound in newborn screening of DDH, 4469 participants (2193 males) were invited to a follow-up 18 years later (2007–09), of which 2370 (53% attendance; 932 males) met. We examined associations between early life factors and four radiographic measurements for acetabular dysplasia at skeletal maturity. Hierarchical regressions, with addition of variables observed/measured consecutively in time, were analyzed using mixed effects models considering hip as the unit in the analyses. The study is approved by the Regional Ethics Committee. Results In total, 2340 participants (921 boys), mean age 18.7 years, (SD 0.6) had ...

Background Fractures in children under 2 years of age are rare, and little has been published on their mechanisms. We aimed at examining the incidence, mechanisms, pattern and fracture characteristics in a large, population-based cohort of otherwise healthy children. Methods This retrospective, cross-sectional study includes all children aged 0–2 years, attending the Accident and Emergency department in Bergen between 2010 and 2015, due to an injury warranting radiography. Clinical data was categorized from the medical notes, and all radiographs were reviewed by an experienced paediatric radiologist. Results In total 408 children (212 male), 3–23 months of age (mean 17.7 months), were included. 149 (77 male) children had a total of 162 fractures, yielding an annual incidence of 5.4 per 1000, varying from 0.7 per 1000 for those under 12 months of age, increasing tenfold to 7.3 per 1000 for children aged 12–24 months of age. More than half of the fractures (53.1%) were seen in childre...

This work proposes a methodology, using plugins resources, for configuration of finite element simulation attributes in geometric modeling. The attributes are necessary additional information for the complete definition of a finite element model, as they constitute specific characterizations of the simulations. The configuration of these attributes allows a relatively simple extension of a given geometric modeler, so that it may be used in other types of finite element simulations. With the plugin methodology, it is possible incorporate to the modeler specific resources that were not initially considered. The strategy adopted in this work consists of using the plugin resource to link, through an interface, a geometric modeler to a library of classes of the module that manages simulation attributes. A simple example is presented to illustrate the proposed methodology.

Wstęp. Nie wy dol ność ścię gna mię śnia pisz cze lo we go tyl ne go (NMPT) jest jed ną z naj częst szych przy czyn na by tej sto py płasko -ko śla wej u do ro słych. De for ma cja roz wi ja się prze wle kle, cha rak te ry stycz ny mi eta pa mi, a po cząt ko we ob ja wy są czę sto baga te li zo wa ne lub błęd nie dia gno zo wa ne. Ce lem pra cy by ło po zna nie wie dzy na te mat dia gno sty ki i le cze nia sto py pła sko -ko ślawej wśród uczest ni ków V Kon gre su Pol skie go To wa rzy stwa Sto py i Sta wu Sko ko wo -Go le nio we go. Materiał i metody. W ano ni mo wej an kie cie przed sta wio no ob raz kli nicz ny hi po te tycz ne go pa cjen ta z utrwa lo ną sto pą płasko -ko śla wą na by tą w prze bie gu NMPT w stop niu III we dług John so na i Stro ma. Roz pro wa dzo no 65 an kiet i uzy ska no 51 (78%) od po wie dzi. W ba da niu wzię ło udział 40 spe cja li stów or to pe dii oraz 11 re zy den tów spe cja li zu ją cych się w or to pe dii i trau ma to lo gii. Śred nia sta żu pra cy spe cja li stów wy no si ła 17,5 ro ku, a re zy den tów 3,5 ro ku. Wyniki. Wła ści wą dia gno zę po sta wi ło 36 (71%) ba da nych, w tym 29 (73%) spe cja li stów i 7 (63%) re zy den tów. Pra wi dło we lecze nie ope ra cyj ne za sto so wa ło 28 (52%) uczest ni ków -24 (60%) spe cja li stów i 4 (36%) re zy den tów. Po praw ne kom plek so we po stępo wa nie dia gno stycz ne i lecz ni cze ra zem prze pro wa dzi ło je dy nie 19 (35%) an kie to wa nych, w tym 17 spe cja li stów (32%) i 2 re zyden tów (4%). Mniej niż po ło wa an kie to wa nych pra wi dło wo za pla no wa ła dia gno sty kę i le cze nie sto py pła sko -ko śla wej na by tej w prze bie gu NMPT a dłu gość sta żu pra cy nie mia ła związ ku z pro po no wa nym po stę po wa niem. Wnioski. 1. Zau wa ża się istot ny brak wie dzy o NMPT wśród spe cja li zu ją cych się. 2. Człon ko wie PFAS w więk szo ści wy bra li właści wy spo sób dia gno sty ki i le cze nia, lecz ró żni ce w sto sun ku do po zo sta łych uczest ni ków ba da nia nie okazały się statystycznie istotne. Słowa kluczowe: nabyta stopa płasko-koślawa u dorosłych, niewydolność ścięgna mięśnia piszczelowego tylnego, stan wiedzy, diagnostyka, leczenie operacyjne SUMMARY Background. Posterior tibial tendon dysfunction (PTTD) ranks among the most common causes of adult acquired flatfoot deformity. The deformity develops gradually through characteristic stages and its early manifestations are often ignored or misdiagnosed. The aim of the study was to gain an insight into what the participants of the 5 th Polish Foot and Ankle Society Congress knew about the diagnosis and treatment of flatfoot. Material and methods. An anonymous survey described the clinical presentation of a hypothetical patient with fixed stage III (according to the Johnson and Strom classification) acquired flatfoot deformity in PTTD. A total of 65 questionnaires were distributed and 51 (78%) were completed and returned. The respondents included 40 orthopaedics consultants and 11 orthopaedics and traumatology resident doctors. The mean time of work experience of the specialists was 17.5 years and that of resident doctors, 3.5 years. Results. The deformity was properly diagnosed by 36 respondents (71%), including 29 specialists (73%) and 7 resident doctors (63%). Proper operative treatment was selected by 28 respondents (52%): 24 specialists (60%) and 4 residents (36%). Overall, appropriate comprehensive diagnostic work-up and treatment was planned only by 19 respondents (35%), including 17 specialists (32%) and 2 residents (4%). Appropriate diagnostic work-up and treatment of acquired flatfoot deformity in PTTD was planned by less than half of the respondents and their work experience did not have any relation with the management they suggested. Conclusions. 1. There is a significant lack of knowledge about PTTD among residents. 2. The majority of PFAS members surveyed selected the correct method of diagnostic work-up and treatment, but the differences with respect to non-PFAS respondents were not statistically significant.

Issue 4, October 2020 About IJMA  The Egyptian Knowledge Bank hosts the web site of IJMA  The Egyptian Knowledge Bank supports IJMA  IJMA follows the regulations of the International Committee of Medical Journal Editors  IJMA is indexed in the "Directory of Open Access Journals" [15 January 2021].

Issue 4, October 2020 About IJMA  The Egyptian Knowledge Bank hosts the web site of IJMA  The Egyptian Knowledge Bank supports IJMA  IJMA follows the regulations of the International Committee of Medical Journal Editors  IJMA is indexed in the "Directory of Open Access Journals" [15 January 2021].

Introduction: Biodegradable Temporizing Matrix (BTM) is a new synthetic dermal substitute suitable for wound closure and tissue regeneration. The data in paediatric population remain limited. The study purpose is to review the indications for BTM application in paediatric patients, evaluate the short-term and long-term results, including complications and functional outcomes, as well as to share some unique observations regarding the use of BTM in paediatric population. Patients and Methods: Patients undergoing reconstructive surgery and BTM application during the last three years were included. Data collected included patient demographics, primary diagnosis, previous surgical management, postoperative complications and final outcomes. BTM was used in 32 patients. The indications varied including epidermolysis bullosa (n = 6), burns (n = 4), trauma (n = 7), infection (n = 4), ischemia or necrosis (n = 11). Results: The results were satisfying with acceptable aesthetic and functional outcomes. Complications included haematoma underneath the BTM leading to BTM removal and re-application (n = 1), BTM infection (n = 1) and split-thickness skin graft failure on top of BTM requiring re-grafting (n = 2). Conclusions: BTM can be a good alternative to large skin grafts, locoregional flaps or even free flaps. The big advantages over other dermal substitutes or skin grafts are that BTM is less prone to infection and offers excellent scarring by preserving the normal skin architecture. Specifically in children, BTM might not require grafting, resulting in spontaneous healing with good scarring. In critically ill patients, BTM reduces the operation time and there is no donor site morbidity. BTM should be considered in the reconstructive ladder when discussing defect coverage options in children and young people.

Introduction: Infection is the most prominent cause of delayed or non-union in tibial fractures because of the bone&#39;s sensitive subcutaneous location. Ilizarov external fixator application is regarded as the best approach for treating them because of several benefits. Analysis of the role of Ilizarov fixation in infected tibial non-union was the goal of this investigation and evaluating clinical & functional outcomes of infected tibial non-union. Materials and Methods: A Multicenter based non-randomized quasi-experimental prospective study was performed in Rajshahi Medical College Hospital, Rajshahi, Bangladesh. From 1st January 2015 to 31st December 2020. The study comprised a total of 61 (n=61) Tibial non-union patients treated with the Ilizarov fixator who also had an infection. ASAMI score criteria were used to evaluate the outcome. Results: The most common organism for infection was identified to be at Staphylococcus Aureus. The final follow-up showed that all but one patie...

La caviglia comprende le articolazioni tibio-astragalica e tibio-peroneale distale. Le fratture di caviglia risultano essere particolarmente frequenti in soggetti che praticano attività sportiva con interessamento delle strutture: ossea, legamentosa e tendinea. Secondo la classificazione AO verrà presa in considerazione in questo capitolo la regione distale di tibia e perone nella sua porzione intra ed extra-articolare, dedicando anche attenzione alle fratture lussazioni complesse, mentre verrà fatta una trattazione a parte per l'astragalo che rientrerà nel capitolo del piede. Le fratture a livello della caviglia sono dovute prevalentemente a traumi in inversione o in eversione oltre che a traumi diretti. Fig. 14.1) Trauma in inversione (Fig. 14.2) Trauma diretto (Fig. 14.3

To the present day, literature has only discussed how to treat extensive plantar plate and collateral ligament lesions, with gross joint subluxation and obvious clinical instability. The treatment options for early stages of the disease with minor injuries and subtle instabilities have not been described. The main purpose of this prospective study is to evaluate the efficacy of the combination of the arthroscopic radiofrequency shrinkage and distal Weil osteotomy in the treatment of subtle metatarsophalangeal joint instability. Prospective data (clinical, radiological, and arthroscopic findings) of 19 patients, with a total of 35 slightly unstable joints, was collected. The physical examination defined the hypothesis for plantar plate lesions (grades 0 and 1), which was confirmed during the diagnostic step of the arthroscopic procedure. Among our patients, 73 % were females and 63 % reported wearing high heels. The average age was 59 years and post-operative follow-up was 20 months....