The influence of obesity on clinical outcomes following primary total knee arthroplasty: A prospective cohort study

BackgroundThe aim of this study was to evaluate the influence of obesity on patients' function, pain, and complications following primary total knee arthroplasty (TKA) with an enhanced-recovery program.MethodsA total of 157 patients were enrolled into a prospective study and assigned into one of three groups on the basis of their body mass index (BMI): normal (BMI 18.0–24.9 kg/m²), overweight (BMI 25.0–29.9 kg/m²), or obese (BMI ≥ 30.0 kg/m²). The primary outcome was knee range of motion (ROM) on postoperative day (POD) 3, 15, 30, and 90, and secondary outcomes were visual analog scale (VAS) on POD 1, 2, 3, 15, 30, and 90, length of stay, and complications.ResultsThe ROM of patients in the obese group on POD 3 was higher than in the normal (104.4 ± 8.5 vs. 98.9 ± 8.9, P = .010) and overweight (104.4 ± 8.5 vs. 97.7 ± 7.8, P = .001) groups. Similarly, the VAS in the obese group at rest on POD 1 was lower than in the normal (2.0 ± 0.7 vs. 2.2 ± 0.6, P = .043) and overweight (2.0 ± 0.7 vs. 2.3 ± 0.6, P = .010) groups. In addition, the incidence of complications did not differ significantly among the three groups, but the length of hospital stay in the obese group was longer (P = .027).ConclusionsObesity may not affect patients' function and pain, and may not increase the incidence of complications following primary TKA. Obese patients may obtain satisfactory functional rehabilitation outcomes, but with a longer duration of rehabilitation.     

A contemporary prospective review of 205 consecutive patients with penetrating colon injuries

BackgroundManagement of colon injuries has significantly evolved in the recent decades resulting in considerably decreased morbidity and mortality. We set out to investigate penetrating colon injuries in a high-volume urban academic trauma center in South Africa.MethodsAll patients with penetrating colon injuries admitted between 1/2015 and 1/2018 were prospectively enrolled. Data collection included demographics, injury profile and outcomes. Primary outcome was in-hospital mortality. Secondary outcome was morbidity.ResultsTwo-hundred and five patients were included in the analysis. Stab and gunshot wounds constituted 18% and 82% of the cases, respectively. Mean age was 28.9 (10.2) years and 96.1% were male. Median injury severity score (ISS) and penetrating abdominal trauma index (PATI) were 16 (9-25) and 19 (10-26), respectively. A total of 47.8% of the patients had a complication per Clavien-Dindo classification. Colon leak rate was 2.4%. Wound and abdominal organ/space infection rate was 15.1 and 6.3%, respectively. Overall in-hospital mortality was 9.3%. Risk factors for mortality were higher ISS and PATI, shock on admission, need for blood transfusion, intra-abdominal vascular injury, damage control surgery, and extra-abdominal severe injuries.ConclusionsContemporary overall complication rate remains high in penetrating colon injuries, however, anastomotic leak rate is decreasing. Colon injury associated mortality is related to overall injury burden and hemorrhage rather than to colon injuries.     

Kirscner wire fixation versus suture anchor technique for mallet finger: A meta-analysis

Purpose:Though the previous studies had described various surgical techniques for the treatment of mallet finger injuries, consensus on which technique was the most effective and appropriate surgical methods had not yet reached. This review aimed to systematically compare the effectiveness and safety of the treatment for mallet finger injuries via Kirschner wire fixation versus suture anchor technique to recommend an optimum option.Methods:All literatures published until December 31, 2019 compared Kirschner wire fixation versus suture anchor technique to treat mallet finger were acquired through a comprehensive search in multiple databases. A meta-analysis was performed by the Cochrane Collaboration''s RevMan 5.3 software.Results:A total of 8 trials with 362 cases consisted of 4 randomized controlled trials and 4 prospective studies. The results suggested that the groups treated with kirschner wire fixation experienced more significant advantage in less complications than suture anchor groups (P < .05). On the other hand, no significant differences were found in terms of the total active range motion of the distal interphalangeal joint, the average distal interphalangeal joint extensor lag, Visual Analogue Scale scores, recurrence, as well as functional assessment at the final follow-up (P > .05, respectively) between the two surgical procedures.Conclusions:No obvious superiority were shown for the effectiveness between the two surgical interventions based on the above results. But in view of the less economic spending and complications, Kirschner wire fixation should be a better alternative relative to the suture anchor technique for inevitable surgical treatment of mallet finger lesions. However, a prudent attitude is still necessary to choose the two operative managements before a large sample and high-quality randomized controlled trials had been performed.     

Plate vs. nail for extra-articular distal tibia fractures: How should we personalize surgical treatment? A meta-analysis of 1332 patients

BackgroundTreatment for distal diaphyseal or metaphyseal tibia fractures is challenging and the optimal surgical strategy remains a matter of debate. The purpose of this study was to compare plate fixation with nailing in terms of operation time, non-union, time-to-union, mal-union, infection, subsequent re-interventions and functional outcomes (quality of life scores, knee- and ankle scores).MethodsA search was performed in PubMed/Embase/CINAHL/CENTRAL for all study designs comparing plate fixation with intramedullary nailing (IMN). Data were pooled using RevMan and presented as odds ratios (OR), risk difference (RD), weighted mean difference (WMD) or weighted standardized mean difference (WSMD) with a 95% confidence interval (95%CI). All analyzes were stratified for study design.ResultsA total of 15 studies with 1332 patients were analyzed, including ten RCTs (n = 873) and five observational studies (n = 459). IMN leads to a shorter time-to-union (WMD: 0.4 months, 95%CI 0.1 – 0.7), shorter time-to-full-weightbearing (WMD: 0.6 months, 95%CI 0.4 – 0.8) and shorter operation duration (WMD: 15.5 min, 95%CI 9.3 – 21.7). Plating leads to a lower risk for mal-union (RD: -10%, OR: 0.4, 95%CI 0.3 – 0.6), but higher risk for infection (RD: 8%, OR: 2.4, 95%CI 1.5 – 3.8). No differences were detected with regard to non-union (RD: 1%, OR: 0.7, 95%CI 0.3 – 1.7), subsequent re-interventions (RD: 4%, OR: 1.3, 95%CI 0.8 – 1.9) and functional outcomes (WSMD: -0.4, 95%CI -0.9 – 0.1). The effect estimates of RCTs and observational studies were equal for all outcomes except for time to union and mal-union.ConclusionSatisfactory results can be obtained with both plate fixation and nailing for distal extra-articular tibia fractures. However, nailing is associated with higher rates of mal-union and anterior knee pain while plate fixation results in an increased risk of infection. This study provides a guideline towards a personalized approach and facilitates shared decision-making in surgical treatment of distal extra-articular tibia fractures. The definitive treatment should be case-based and aligned to patient-specific needs in order to minimize the risk of complications.     

New standardization method of tibial tubercle-posterior cruciate ligament distance according to patient size in patients with patellofemoral instability

BackgroundLarge differences in tibial tubercle–posterior cruciate ligament (TT-PCL) distance were described in several reports between countries, suggesting that abnormal TT-PCL distance is variable due to individual patient size. This study aimed to clarify the relationship between TT-PCL distance and patient size, and to determine a method for describing individualized TT lateralization.MethodsWe analyzed 41 patients with recurrent patellar dislocation (RPD) and 41 age-matched patients without patellar instability who underwent primary anterior cruciate ligament reconstruction (control). TT-PCL distance and tibia width (TW) were measured based on preoperative T2-weighted magnetic resonance imaging. Then, TT-PCL distance was standardized based on TW (TT-PCL ratio), and TT-PCL distance and ratio were compared between groups. Correlations were investigated among TT-PCL distance, TT-PCL ratio and each measurement (patient height, weight, TW).ResultsStrong positive correlations were observed between TW and patient height, and weak or moderate positive correlations were found between TT-PCL distance and each parameter. The mean TT-PCL distance was 21.2 and 20.6 mm (P = .39), while the mean TT-PCL ratio was 31.6% and 29.0% (P = .0093) in the RPD and control groups, respectively. The TT-PCL ratio was < 34% in 39 of 41 knees (95.1%) in the control group. No correlation was indicated between the TT-PCL ratio and patient size.ConclusionsOur findings demonstrate that the TT-PCL ratio is not affected by patient size, although the TT-PCL distance is associated with knee size and patient height. The TT-PCL ratio could be an important index for identifying patients for whom distal realignment surgery should be considered.     

Distal locking of short cephalomedullary nails decreases varus collapse in unstable intertrochanteric fractures – a biomechanical analysis

IntroductionPeritrochanteric fractures are a growing problem and complications relating to operative fixation of these fracture, including varus collapse and screw cutout, are common in elderly osteoporotic patients. We hypothesize that unlocked nails will demonstrate increased varus collapse and inferior construct stiffness in specimens with increased diaphyseal medullary diameter.Materials and methodsSixteen non-cadaveric osteoporotic biomechanical femur specimens were utilized in this study, with eight specimens having an artificially large femoral canal to represent Dorr C femurs. All femurs were instrumented with a short cephalomedullary nail with and without distal cross-lock screw fixation and had an unstable intertrochanteric fracture created in a repeatable pattern. Specimens underwent cyclic compression to a maximal load of 1000N with segmental motion quantified through the use of visual tracking markers. Statistical comparisons were performed using one-way ANOVA with Tukey post-hoc analysis to determine differences between specific groups. Significance was defined as p<0.05.ResultsUnlocked short cephalomedullary nails showed increased varus collapse due to motion of the nail within the femoral canal in capacious femoral canals compared with narrow femoral canals and distally cross-locked nails. The coronal deformation of the wide canal unlocked group (17.9 ^o±2.6^o) was significantly greater in the varus direction than any other fixation under compressive load of 1000N. There was no significant difference in varus angulation between the wide canal or narrow canal locked groups (11.1^o±8.7^o vs. 8.2^o±1.7^o respectively, p=0.267). The narrow canal unlocked group (13.7^o±2.4^o) showed significantly greater varus angulation than the narrow canal locked (p=0.015). The wide canal unlocked group showed significantly greater varus angulation than the wide canal locked group (p=0.003). Motion between the femoral shaft and the cephalomedullary nail (toggling of the nail within the shaft) was significantly greater in narrow or wide canal unlocked specimens, 7.94^o±2.13^o and 10.2^o±1.7^o respectively, than in the narrow or wide canal locked specimens, 2.4^o±0.2^o and 4.2^o±0.5^o respectively (p<0.05)ConclusionUnlocked short intramedullary fixation for unstable peritrochanteric fractures results in increased varus collapse under axial compression. This study supports the use of distal cross-locking of short intramedullary fixation for unstable peritrochanteric fractures in patients with capacious femoral canals secondary to osteoporosis who might otherwise be as risk for varus collapse, device failure, and malunion.     

丙酸倍氯米松结合硫酸沙丁胺醇雾化治疗支气管肺炎

目的研究丙酸倍氯米松结合硫酸沙丁胺醇雾化治疗支气管肺炎的效果及患儿发病的危险因素。方法选取2019年3月至2020年2月治疗的120例支气管肺炎患儿作为研究对象,按照随机分组原则,将以上患儿随机分为对照组以及观察组,每组患儿60例,两组患儿均采取对症治疗及硫酸沙丁胺醇雾化治疗,观察组患儿在此基础上联合使用丙酸倍氯米松,两组患儿均治疗7d。比较两组患儿的治疗效果、肺功能、骨代谢指标、临床症状改善情况以及不良反应之间的差异。结果观察组患儿的治疗效果显著高于对照组,差异有统计学意义(P<0.05);经过治疗后,两组患儿的FEV、FEV1以及FEV1%均显著升高,且观察组患儿的FEV、FEV1以及FEV1%显著高于对照组(P<0.05);治疗前后,两组患儿的血钙、血磷以及碱性磷酸酶之间的差异无统计学意义(P>0.05);观察组患儿的发热消失时间、咳嗽消失时间、肺部罗音消失时间、住院时间显著低于对照组(P<0.05);两组患儿治疗期间的腹泻、皮疹、心率加快之间的差异无统计学意义(P>0.05)。结论丙酸倍氯米松结合硫酸沙丁胺醇雾化治疗支气管肺炎的效果显著。     

3DCT模拟手术辅助治疗大龄发育性髋关节脱位患儿既往手术后残余畸形

目的通过3DCT观察大龄(≥8岁)发育性髋关节脱位(DDH)手术后残余畸形病理改变,模拟手术预判治疗效果,探讨多种手术方式综合治疗的经验体会。方法回顾分析山东大学附属省立医院小儿骨科2012年7月至2017年6月综合运用多种截骨术治疗的大龄DDH治疗后残余畸形病例资料共27例35髋,手术时患儿年龄8岁至13岁9个月。根据Tonnis分型,Ⅰ型7髋,Ⅱ型22髋,Ⅲ型6髋。根据Kalamchi&MacEwen股骨头坏死分型,Ⅱ型6髋,Ⅲ型11髋,Ⅳ型8髋,10髋未见坏死。根据Ponseti标准评价髋关节功能,2级3髋,3级6髋,4级4髋,5级12髋,6级10髋。根据改良Severin分类,Ⅱ型3髋,Ⅲ型13髋,Ⅳ型12髋,Ⅴ型7髋。术前摄骨盆-双股骨全长CT。CT数据导入Mimics软件中建立3D骨模型。根据患儿年龄和头臼匹配情况模拟相应截骨术,观察截骨后股骨头覆盖和关节匹配情况,据此行手术治疗。以配对样本t检验比较手术前后Reimer指数和Sharp角的变化,P<0.01为差异有统计学意义,评价随访时影像学效果和关节功能恢复情况。以改良Severin分类评价影像学效果,以Ponseti标准评价关节功能。结果随访时间13~36个月。末次随访时Reimer指数由0.54±0.24改善至0.19±0.08,Sharp角由53°±8°改善至38°±6°,与术前相比差异均有统计学意义(P均<0.01)。按改良Severin分类,Ⅰ型5髋为优,Ⅱ型19髋为良,Ⅲ型11髋为可,优良率为68%(24/35)。按Ponseti标准,1级17髋,2级11髋,3级7髋,优良率80%(28/35)。结论在3DCT模拟手术的辅助下,综合运用多种手术方式治疗大龄DDH手术后残余畸形可缓解关节疼痛并改善跛行步态,早期效果良好,值得临床推广应用。