关节镜下重建前交叉韧带移植物的选择与疗效比较

目的 比较分析膝关节镜下自体和异体骨-髌腱-骨、自体半腱肌腱、异体胫前肌肌腱、LAPS人工韧带五种重建前交叉韧带方法的疗效.方法 回顾分析112例膝关节镜下自体骨-髌腱-骨移植、23例自体半腱肌肌腱移植、87例异体骨-髌腱-骨移植、126例异体胫前肌肌腱、28例LARS人工韧带重建前交叉韧带的情况.采用Lysholm评分、IKDC分级和KT-1000评价疗效.结果 前四组中期关节稳定性及功能差异无统计学意义.LAPS人工韧带近期效果与其他移植物相比有统计学意义.自体骨-髌腱-骨组膝前痛发生率高,异体骨-髌腱-骨排斥反应发生率高于异体胫前肌肌腱.结论 关节镜下前四种前交叉韧带替代物重建前交叉韧带的疗效大致相同,但LARS人工韧带近期效果优于其他移植物.     

Comparison of Plantar Pressure Distribution and Functional Outcome after Scarf and Austin Osteotomy

Objective

To investigate the changes of plantar pressure distribution in patients who underwent either Austin or Scarf osteotomy and underwent a postoperative rehabilitation program.

Methods

Between September 2006 and December 2007, 50 participants who suffered from mild to moderate hallux valgus deformity were prospectively included in this study. An Austin osteotomy (Austin group) was performed in 25 patients and a Scarf osteotomy (Scarf group) in 25 patients. Indication for the Scarf or Austin technique was made according to the consensus of the Austrian society of foot and ankle surgery. Plantar pressure analysis was performed at 4 weeks, 8 weeks, and 6 months postoperatively. Furthermore, range of motion and the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were evaluated.

Results

In the big toe and first metatarsal head region in groups, maximum force, peak pressure, and force‐time integral increased significantly from 4 weeks to 6 months postoperatively (P ≤ 0.001). The mean AOFAS score increased from 60.7 preoperatively to 93.1 6 months after Austin surgery and from 56.7 preoperatively to 94.4 6 months after Scarf surgery. The Austin group had a mean range of motion (ROM) of 68.5° that increased to a mean ROM of 75.5° 6 months postoperatively, while the Scarf group had a mean ROM of 67.8° that increased to a mean ROM of 68.2° 6 months postoperatively.

Conclusion

Despite different surgical techniques and the degree of deformity, there were no differences in plantar pressure parameters and functional outcomes between both groups.

     

Hamstring tendon autograft versus LARS artificial ligament for arthroscopic posterior cruciate ligament reconstruction in a long-term follow-up

Introduction

Surgical reconstruction has been increasingly recommended for the surgical management of posterior cruciate ligament (PCL) ruptures. While the choice of tissue graft still remains controversial. Currently both hamstring tendon autograft (HTG) and ligament advanced reinforcement system (LARS) artificial ligament are widely used but there are seldom reports on the comparisons of their clinical results. Our study was aimed to assess the effectiveness of these two grafts.

Materials and methods

Thirty-five patients with unilateral PCL rupture were enrolled in this retrospectively study. Sixteen of them received arthroscopically assisted PCL reconstruction using hamstring tendon autografts (HTG group) and nineteen using LARS ligaments (LARS group). All cases were followed up for 46–57 months with a mean of 51 months. Follow-up examinations included radiographic assessment, Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) rating scales and KT-1000 test.

Results

All patients improved significantly at the final follow-up compared with the examinational results preoperatively and there were no significant differences between HTG group and LARS group with respect to the results of radiographic assessment, Lysholm score, Tegner score, IKDC rating scales and KT-1000 test.

Conclusions

Similar good clinical results were obtained after PCL reconstruction using hamstring tendon autografts and LARS ligaments. Both LARS ligament and hamstring tendon autograft are ideal grafts for PCL reconstruction.     

Delay in Diagnosis and Its Effect on Clinical Outcome in High‐grade Sarcoma of Bone: A Referral Oncological Centre Study

Objective

To investigate delay in diagnosis by both patients and doctors, and to evaluate its effect on outcomes of high‐grade sarcoma of bone in a single‐referral oncological center.

Methods

Fifty‐four patients with osteosarcoma, 29 with Ewing sarcoma and 19 with chondrosarcoma were enrolled in this retrospective study. Delay in diagnosis was defined as the period between initial clinical symptoms and histopathological diagnosis at our center. The delays were categorized as patient‐ or doctor‐related. Short total delays were defined as <4 months; prolonged delays >4 months were assumed to have prognostic relevance.

Results

Total delay in diagnosis was 688.0 days in patients with chondrosarcoma, which is significantly longer than the 163.3 days for osteosarcoma (P < 0.01) and 160.2 days for Ewing sarcoma (P < 0.01). Most doctor‐related delays were at the pre‐hospital stage, occurring at the general practitioner (GP)'s office. However, prolonged total delays (≥4 months) did not result in lower survival rates. Five‐year‐overall survival rates were 67.0% for osteosarcoma, 49.0% for Ewing sarcoma and 60.9% for chondrosarcoma. Survival was significantly lower for patients with metastatic disease for all three types of sarcoma.

Conclusion

Prolonged delay in diagnosis does not result in lower survival. Metastatic disease has a pronounced effect on survival. Aggressive tumor behavior results in shorter delays. Minimizing GP‐related delays could be achieved by adopting a lower threshold for obtaining plain radiographs at the pre‐hospital stage.

     

Patterns of Compartment Involvement in End‐stage Knee Osteoarthritis in a Chinese Orthopedic Center: Implications for Implant Choice

Objectives

Knee osteoarthritis (OA) is a prevalent disease in the elderly, causing pain and contributing to poor quality of life. Surgical intervention, such as knee arthroplasty, can be used in those with end‐stage knee OA. Total knee arthroplasty (TKA) is one of the most common surgical procedures for end‐stage knee OA, with promising clinical outcomes. However, a large proportion of patients with isolated compartment OA can be treated with unicompartmental knee arthroplasty (UKA) instead. UKA has shown better patient‐reported functional outcomes, and lower mortality and major complication rates than TKA. The percentage of UKA in knee arthroplasty varied in different orthopedic centers, and we believed that the requirement for UKA was underestimated in many centers. A retrospective study was carried out on our Chinese patient population presenting for knee arthroplasty; it aimed to identify the proportion of patients that might be suitable for UKA.

Methods

A retrospective cross‐sectional study of 155 consecutive patients (168 knees) awaiting TKA for end‐stage primary OA was performed. The pattern and grade of OA was recorded from preoperative weight‐bearing anteroposterior and non‐weight‐bearing lateral radiographs. The medial, lateral, patellofemoral compartment was given an individual Kellgren–Lawrence grade on the radiographs, and those grade ≥3 were defined as end‐stage OA. The compartments involvement was established then. The integrity of the anterior cruciate ligament (ACL) was determined by the modified Keyes classification on lateral radiographs. The applicability for total or partial knee arthroplasty was determined according to the compartments involvement.

Results

Medial compartment involvement was found in 154 (91.7%) knees, while the involvement of the lateral compartment and patellofemoral joint was found in 54 (32.1%) and 57 (33.9%) knees, respectively. Eighty‐one (48.2%) of the knees showed medial compartment OA with or without patellofemoral joint involvement, and modified Keyes classification grade 1, indicating an intact ACL, and, hence, potential suitability for medial UKA. Isolated lateral OA indicating possible suitability for lateral UKA was identified in 11 knees (6.5%). No patients showed isolated patellofemoral joint OA. The other 76 (45.2%) knees could be treated by TKA.

Conclusions

The medial compartment was the most commonly affected in our Chinese patients indicated for knee arthroplasty. More than half of the patients in this group could be treated by either medial or lateral UKA.

     

Angle Stable Interlocking Intramedullary Nails for Tibial Plateau Fractures

Objective

Angle stable interlocking intramedullary nail (ASIN), a novel technique, has rarely been used for treatment of tibial plateau fractures (TPF). This retrospective study was designed to introduce this novel technique, ASIN, as well as to describe the initial experience and verify the effectiveness when ASIN was used for the management for TPF.

Methods

A cohort of 19 cases with closed TPF aged from 18–70 years with at least 23 months follow‐up from November 2008 to September 2013 was analyzed retrospectively. All patients underwent the ASIN procedure, which was performed by the same group of surgeons. Perioperative and postoperative parameters like the measurement of radiographic pictures, surgical data, and clinical function were recorded including the changes in treatment. A modified Hohl–Luck radiological and functional score combined with the Hospital for Special Surgery (HSS) score were applied to evaluate the final results and to provide reliable data through the whole procedure when applying the ASIN procedure.

Results

The patients were followed up regularly for an average of 26.3 (range, 23–34) months. All patients achieved a bony union at an average of 15.1 weeks with no incidences of malunion, nonunion, or infection. Anatomical reduction of the articular surface was obtained in 16 patients. No secondary failure of fixation occurred. The mean postoperative knee flexion was 122.9°. The modified Hohl–Luck radiological and functional score was excellent and good, respectively, in 16 patients. The mean HSS score was 89.4.

Conclusion

The angle stable interlocking intramedullary nail system turned out to be a viable alternative protocol in the treatment of tibia plateau fractures and provided satisfactory results, with good fracture reduction, biomechanical fixation, low rates of complications, and passable postoperative knee function.

     

Diagnosis of Compressed Nerve Root in Lumbar Disc Herniation Patients by Surface Electromyography

Objective

To establish a logistic regression model using surface electromyography (SEMG) parameters for diagnosing the compressed nerve root at L₅ or S₁ level in patients with lumbar disc herniation (LDH).

Methods

This study recruited 24 patients with L₅ nerve root compression and 23 patients with S₁ nerve root compression caused by LDH from May 2014 to May 2016. SEMG signals from the bilateral tibialis anterior and lateral gastrocnemius were measured. The root mean square (RMS), the RMS peak time, the mean power frequency (MPF), and the median frequency (MF) were analyzed. The accuracy, sensitivity, and specificity values were calculated separately. The areas under the curve (AUC) of the receiver‐operating characteristic (ROC) curve and the kappa value were used to evaluate the accuracy of the SEMG diagnostic model.

Results

The accuracy of the SEMG model ranged from 85.71% to 100%, with an average of 93.57%. The sensitivity, specificity, AUC, and kappa value of the logistic regression model were 0.98 ± 0.05, 0.92 ± 0.09, 0.95 ± 0.04 (P = 0.006), and 0.87 ± 0.11, respectively (P = 0.001). The final diagnostic model was: ; y = 10.76 ? (5.95 × TA_RMS Ratio) ? (0.38 × TA_RMS Peak Time Ratio) – (5.44 × 44 × LG_RMS Peak Time Ratio). L₅ nerve root compression is diagnosed when P < 0.5 and S₁ nerve root compression when P ≥ 0.5.

Conclusions

The logistic regression model developed in this study showed high diagnostic accuracy in detecting the compressed nerve root (L₅ and S₁) in these patients with LDH.

     

En Bloc Resection of Primary Malignant Bone Tumor in the Cervical Spine Based on 3‐Dimensional Printing Technology

Objective

To investigate the feasibility and safety of en bloc resection of cervical primary malignant bone tumors by a combined anterior and posterior approach based on a three‐dimensional (3‐D) printing model.

Methods

Five patients with primary malignant bone tumors of the cervical spine underwent en bloc resection via a one‐stage combined anteroposterior approach in our hospital from March 2013 to June 2014. They comprised three men and two women of mean age 47.2 years (range, 26–67 years). Three of the tumors were chondrosarcomas and two chordomas. Preoperative 3‐D printing models were created by 3‐D printing technology. Sagittal en bloc resections were planned based on these models and successfully performed. A 360° reconstruction was performed by spinal instrumentation in all cases. Surgical margins, perioperative complications, local control rate and survival rate were assessed.

Results

All patients underwent en bloc excision via a combined posterior and anterior approach in one stage. Mean operative time and estimated blood loss were 465 minutes and 1290 mL, respectively. Mean follow‐up was 21 months. Wide surgical margins were achieved in two patients and marginal resection in three; these three patients underwent postoperative adjuvant radiation therapy. One vertebral artery was ligated and sacrificed in each of three patients. Nerve root involved by tumor was sacrificed in three patients with preoperative upper extremity weakness. One patient (Case 3) had significant transient radiculopathy with paresis postoperatively. Another (Case 4) with C ₄ and C ₅ chordoma had respiratory difficulties and pneumonia after surgery postoperatively. He recovered completely after 2 weeks’ management with a tracheotomy tube and antibiotics in the intensive care unit. No cerebrovascular complications and wound infection were observed. No local recurrence or instrumentation failure were detected during follow‐up.

Conclusion

Though technically challenging, it is feasible and safe to perform en bloc resection of cervical primary bone tumors. This is the most effective means of managing cervical spine tumors. Preoperative 3‐D printing modelling enables better anatomical understanding of the relationship between the tumor and cervical spine and can assist in planning the surgical procedure.

     

A New Intraoperative Syndesmosis Instability Classification System: Utility and Medium‐term Results in Closed Displaced Ankle Fractures

Objective

To investigate the utility and medium‐term results of a new intra‐operative classification system for distal tibiofibular syndesmosis injury in ankle fractures.

Methods

Between January 2010 and January 2015, 116 patients diagnosed with displaced closed Weber B and C ankle fractures were treated in our department. The etiology of injury was 56 cases of fall‐sprain, 36 of traffic injury, 14 of fall from a height, and 10 of multiple injuries. After fixation of the fibular fracture, we classify syndesmosis stability as either normal or one of three grades of instability using the fibular hook traction test. This determined further fixation selection and final syndesmosis treatment.

Results

Of 116 cases, 82 (71%) demonstrated a tibiofibular syndesmosis injury and 52 (45%) were unstable. Twenty‐six cases were type I injuries (<4 mm displacement), 41% cases were type II injuries (4–7 mm displacement), and 3% of cases were type III injuries (>7 mm displacement). Types II and III are defined as unstable and require stabilization. Type III injuries have multiplanar instability and require two screws at the syndesmosis. Weber C fractures demonstrate significantly greater degrees of instability than Weber B fractures (χ² = 15.50, P = 0.0014). All patients were followed up for 12–24 months, with no cases of non‐union or broken screws. Good and excellent results were achieved in 93% of cases (according to the American Orthopaedic Foot and Ankle Society scoring system).

Conclusion

The syndesmosis instability classification system provides a rational and efficient basis for managing syndesmosis instability. Our results from application of the algorithm justify its further evaluation in the treatment of patients with closed displaced Weber B and C ankle fractures.

     

Evaluation of Quality of Life Using EORTC QLQ‐BM22 in Patients with Bone Metastases after Treatment with Magnetic Resonance Guided Focused Ultrasound

Objective

To reveal the alterations in quality of life (QOL) in bone metastases patients after magnetic resonance guided focused ultrasound (MRgFUS).

Methods

This retrospective study enrolled 26 patients diagnosed with bone metastases. Patients had various primary malignant tumors and tumor lesions in different locations. All patients received MRgFUS for bone metastasis. Each focal spot sonication pulse that was applied to create energy deposition lasted 20 s and was performed at a frequency of 1.05 MHz. The visual analog scale (VAS) was used to measure pain level and the EORTC QLQ‐BM22 was applied to evaluate QOL for 12 months. The lower the QLQ‐BM22 score, the better the QOL of patients.

Results

The painful site subscale of the EORTC QLQ‐BM22 was observed without significant change. Significant reductions in the functional subscales were observed after therapy compared with the baseline. The functional interference was reduced significantly during the first 12 months. From the 2‐month time point onwards, the pain characteristics subscale also decreased significantly. VAS scores had decreased by 40.8% 1 month after the operation and had decreased 10.9% compared with VAS scores preoperation. Scores for pain characteristics decreased by 28.8% after the operation and the scores were still down by 10.8% 1 year after the treatment. VAS scores indicated a significant reduction in pain over the course of the research until the 12‐month time point follow‐up compared with the baseline.

Conclusion

MRgFUS therapy improved the QOL of patients with bone metastasis by relieving bone pain.

     

Schmid's Type of Metaphyseal Chondrodysplasia: Diagnosis and Management

Objectives

There are several types of metaphyseal chondrodysplasia and various clinical types have been differentiated. The Schmid type of metaphyseal chondrodysplasia is the most common. Diffuse metaphyseal flaring, irregularity, and growth plate widening, which are most severe in the knees, are the most striking radiological features of this disease. The Schmid type of metaphyseal dysostosis is characterized by failure of normal mineralization of the zone of provisional calcification, leading to widened physes and enlarged knobby metaphyses, effectively causing shortening of the tubular bones, splaying of the metaphyses, coxa vara, and bow legs. Orthopaedic interventions were primarily performed on the lower extremities.

Methods

Twelve children (seven girls and five boys) aged 7–10 years were enrolled in this study. Moderate short stature was a uniform feature associated with predominant involvement of the proximal femora and bow legs resulted in the development of angular deformities. A waddling gait was a consequence of coxa vara in eight children. Valgus osteotomy of the proximal femur was planned after physeal closure for the group of children with coxa vara. Hemiepiphysiodesis was performed to re‐align the genu varum in three children.

Results

Other forms of metaphyseal dysostosis were ruled based on full clinical and radiographic phenotypes, with confirmation through molecular pathology. Mutations in the COL10A1 gene located on chromosome 6q21‐q22.3 were confirmed. Re‐alignment was accomplished in our group of patients.

Conclusion

The most striking clinical features of Schmid metaphyseal chondrodysplasia which appear within the first 2–3 years of life are: moderate short limbs and short stature, a waddling gait, and increasing shortness of stature with age. The Schmid type of metaphyseal chondrodysplasia is a disorder that arises from defective type X collagen, which is typically found in the hypertrophic zone of the physes. Moderate short stature and a waddling gait associated with pain are the most common clinical presentations. Osteotomies to correct bow legs are sometimes combined with lengthening procedures. Recurrence of the deformities with growth is not uncommon; therefore, hemiepiphysiodesis or stapling might be indicated in some cases.

     

Traumatic Spino‐pelvic Dissociation with Bilateral Triangular Fixation

Objective

To evaluate the clinical outcomes of traumatic spino‐pelvic dissociation (TSD) treated with modified bilateral triangular fixation.

Methods

Eighteen consecutive patients of TSD were included in the study from March 2011 to March 2015, and the medical records of patients were reviewed retrospectively. There were 14 men and 4 women with an average age of 33.1 ± 1.4 years (range, 18–55 years). A total of 16 cases were caused by falling, and 2 cases were caused by traffic accident. All sacral fractures had associated injuries. According to the morphology of sacral fracture, U‐shaped fractures were present in 10 cases, H‐shaped fractures in 6 cases, and Y‐shaped fractures in 2 cases. According to Roy–Camille classification, there were 12 cases of type II and 6 cases of type III. All patients received surgical treatment with modified bilateral triangular fixation, and the sacral plexus decompression was performed simultaneously on 6 cases whose scores were more than 2 according to Gibbons classification and were found having traumatic canal stenosis or sacral nerve compression detected by preoperative imaging examination. Mears’ radiological evaluation criterion was applied to evaluate the reduction quality of fractures; Gibbons score was applied as the index of neurological deficiency healing, and the clinical outcome of fracture was evaluated with Majeed function assessment at last follow‐up.

Results

All patients were followed up continuously within an average of 32.4 ± 3.6 months (range, 22–48 months). All sacral fractures were healed in an average time of 11.3 ± 2.8 months (range, 8–28 months). According to the Majeed function evaluation, 12 cases were classified as excellent, 4 cases as good, and 2 cases as fair. Meanwhile, the anatomical reduction was obtained in 11 cases, satisfactory reduction in 6 cases, and unsatisfactory reduction in 1 case according to Mears’ radiological evaluation criterion. The average Gibbons score changed from 2.5 ± 0.2 preoperatively to 1.4 ± 0.5 24 months postoperatively, which had a significant difference (t = 2.15, P < 0.05).

Conclusion

Modified triangular fixation combined with internal fixations shows satisfactory clinical outcomes in the treatment of TSD, which is recommended as an effective and advanced surgical choice.

     

The efficacy and safety of cold‐induced lipolysis in the treatment of pseudogynecomastia

Background

The treatment options for pseudogynecomastia have been limited. Cold‐induced lipolysis provides a noninvasive, localized subcutaneous adipocyte destruction by inducing adipocyte apoptosis.

Objective

This study has been designed to evaluate the efficacy of cold‐induced lipolysis as a treatment modality for pseudogynecomastia.

Methods

In this 28‐week prospective trial, a total of 12 male pseudogynecomastia patients (Korean) were treated twice with cold‐induced lipolysis. Efficacy was determined by chest circumference, ultrasonographic measurement of fat thickness, Simon's Gynecomastia class (SGC), photographic assessment, and the patient's satisfaction (baseline, weeks 4, 8, 16, and 28). Using a questionnaire, safety was evaluated at each visit.

Results

For 10 subjects that completed the trial, chest circumference and fat thickness significantly improved by week 8. This same improvement was gradually noticed through week 28. The patients SGC scores continuously decreased after two sessions. Photographic assessment showed an improvement until week 28. The result of the patient's satisfaction score was also meaningful. While there were no adverse events observed, transient pain and bruising at the treatment site were noticed.

Limitations

We recruited a limited number of participants. Also, we could not exclude there might be other individual factors in association with the patients pseudogynecomastia.

Conclusion

Cold‐induced lipolysis is a safe, effective therapeutic option in the treatment of pseudogynecomastia. Lasers Surg. Med. 48:584–589, 2016. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals Inc.

     

Silk enhances the ligamentization of the polyethylene terephthalate artificial ligament in a canine anterior cruciate ligament reconstruction model

Anterior cruciate ligament (ACL) reconstruction is the leading treatment for ACL rupture. Ligament Advanced Reinforcement System (LARS), which is made of polyethylene terephthalate (PET), is the most frequently used artificial ligament for ACL reconstruction. However, PET is hydrophobic, so it is difficult to induce the ingrowth of the autologous tissue. The aim of this study is to explore the effects of silk hybrid on the ligamentization of the PET artificial ligament in a canine ACL reconstruction model. Silk/PET hybrid suspensory ligament was fabricated with silk in the weft yarn and PET in the warp yarn, while PET suspensory ligament was fabricated with PET in both the weft and warp yarns. After fabrication, the micromorphology of the ligaments was observed and mechanical testing was performed. Though the failure loads of the degummed silk/PET hybrid suspensory ligaments were significantly lower than those of the PET suspensory ligaments (P < 0.001), both of them were enough for ACL reconstructions of beagle dogs. In the animal study, 14 beagle dogs were divided into PET suspensory ligament group and silk/PET hybrid suspensory ligament group randomly, with 7 dogs in each. The dogs underwent ACL reconstructions in their right knees. At postoperative 6 months, the dogs were sacrificed, and the specimens were evaluated with gross observation, histology, immunohistochemistry, and mechanical testing. The histological and immunohistochemical results showed that the native ACL of the beagle dog held abundant fibroblasts and collagen. The PET‐regenerated ligament was loose, and there was a small amount of autologous tissue and collagen. Compared to the PET‐regenerated ligament, the silk/PET hybrid‐regenerated ligament had a compact structure, and there was more regenerated autologous tissue and collagen. In conclusion, compared to the PET ligament, the silk/PET hybrid ligament kept greater ability to induce the ingrowth of the autologous tissue, indicating that the silk hybrid had enhanced the ligamentization of the PET artificial ligament.     

Association of Insulin‐like Growth Factor‐1, Bone Mass and Inflammation to Low‐energy Distal Radius Fractures and Fracture Healing in Elderly Women Attending Emergency Care

Objective

Elderly patients suffer fractures through low‐energy mechanisms. The distal radius is the most frequent fracture localization. Insulin‐like growth factor‐1 (IGF1) plays an important role in the maintenance of bone mass and its levels decline with advancing age and in states of malnutrition. Our aim was to investigate the association of IGF1 levels, bone mass, nutritional status, and inflammation to low‐energy distal radius fractures and also study if fracture healing is influenced by IGF1, nutritional status, and inflammation.

Methods

Postmenopausal women, 55 years or older, with low‐energy distal radius fractures occurring due to falling on slippery ground, indoors or outdoors, were recruited in the emergency department (ED) and followed 1 and 5 weeks after the initial trauma with biomarkers for nutritional status and inflammation. Fractures were diagnosed according to standard procedure by physical examination and X‐ray. All patients were conservatively treated with plaster casts in the ED. Patients who needed interventions were excluded from our study. Fracture healing was evaluated from radiographs. Fracture healing assessment was made with a five‐point scale where the radiological assessment included callus formation, fracture line, and stage of union. Blood samples were taken within 24 h after fracture and analyzed in the routine laboratory. Bone mineral density (BMD) was measured by dual‐energy X‐ray absorptiometry (DXA).

Results

Thirty‐eight Caucasian women, aged 70.5 ± 8.9 years (mean ± SD) old, were recruited. Nutritional status, as evaluated by albumin (40.3 ± 3.1 g/L), IGF1 (125.3 ± 39.9 μg/L), body mass index (26.9 ± 3.6 kg/m²), arm diameter (28.9 ± 8.9 cm), and arm skinfold (2.5 ± 0.7 cm), was normal. A positive correlation was found between IGF1 at visit 1 and the lowest BMD for hip, spine, or radius (r = 0.39, P = 0.04). High sensitive C‐reactive protein (hsCRP) and leukocytes were higher at the fracture event compared to 5 weeks later (P = 0.07 and P < 0.001, respectively). Fracture healing parameters (i.e. callus formation, fracture line, and stage of union) were positively correlated with the initial leukocyte count and to difference in thrombocyte count between visit 1 and 3.

Conclusions

In elderly women with low‐energy distal radius fractures, an association between IGF1 and lowest measures of BMD was found, indicating that low IGF1 could be an indirect risk factor for fractures. Fracture healing was associated with initial leukocytosis and a lower thrombocyte count, suggesting that inflammation and thrombocytes are important components in fracture healing.

     

Assessment of Change of Shoulder Balance in Patients with Adolescent Idiopathic Scoliosis after Correctional Surgery

Objective

To identify factors that influence shoulder balance and to determine whether a model can be made to predict shoulder balance after corrective surgery.

Methods

This is a retrospective study in which we examined the records of with adolescent idiopathic scoliosis (AIS) patients who underwent single posterior spinal correction and fusion using all pedicle screws with derotation in our institution between January 2008 and June 2010. For the radiographic outcome measurement, we measured the preoperative lumbar curve, the main thoracic curve, and their difference (L_TH_D), and the degree of correction of the lumbar curve, the main thoracic curve, and their difference (c_L_TH_D) to evaluate their influence on postoperative shoulder balance. The preoperative flexibility of the proximal non‐fusion curve on the immediate postoperative tilt of the upper endplate of the uppermost vertebra of fusion segments (Up_FuS) was used to evaluate and predict the shoulder balance at follow‐up.

Results

For patients who had shoulder balance at follow‐up, the average balance time was 7.1 months, and in most of them, balance was detected within 12 months. The main thoracic curve has the greatest influence on preoperative shoulder tilt and correction of the main thoracic curve has the greatest influence on the postoperative alteration in shoulder balance. To evaluate the influence on the preoperative shoulder tilt, the lumbar curve must be larger than the main thoracic curve both pre operatively and postoperatively. If the preoperative flexibility of the proximal non‐fusion curve on the immediate postoperative Up_FuS includes the horizontal line (With Horizontal group), shoulder balance can be ensured. The postoperative Up_FuS can be evaluated based on the preoperative Up_FuS and the degree of correction of the lumbar and main thoracic curves.

Conclusion

Shoulder balance can be ensured in patients in the With Horizontal group after surgery. If the preoperative Up_FuS and the degree of correction of the main thoracic curve and the lumbar curve are considered in the preoperative plan, the desired postoperative Up_FuS can be achieved, ensuring shoulder balance at follow‐up.

     

Surgical Infection after Posterolateral Lumbar Spine Arthrodesis: CT Analysis of Spinal Fusion

Objective

To determine the incidence of infection after instrumented lumbar spine surgery, the demographic and surgical variables associated with acute infection, and the influence of infection and debridement on the consolidation of spinal fusion.

Methods

After obtaining approval from the hospital ethics committee, an observational study was made on a prospective cohort of consecutive patients surgically treated by posterolateral lumbar spine arthrodesis (n = 139, 2005–2011). In all cases, the minimum follow‐up period was 18 months. The following bivariate analysis was conducted of demographic and surgical variables: non‐infection group (n = 123); infection group (n = 16). Fusion rates were determined by multislice CT. Logistic regression analysis was performed.

Results

Incidence of deep infection requiring debridement: 11.51% (95% confidence interval, 5.85–17.18]). Bivariate analysis: differences were observed in hospital stay (7.0 days [range, 4–10] vs 14.50 days [range, 5.25–33.75]; P = 0.013), surgical time (3.15 h vs 4.09 h; P = 0.004), body mass index (25.11 kg/m² [22.58–27.0] vs 26.02 kg/m² [24.15 to 29.38]; P = 0.043), Charlson comorbidity index (median, 0 vs 1; P = 0.027), and rate of unsuccessful consolidation according to CT (18.4% vs 72.7%; P = 0.0001). In a model of multivariate logistic regression, taking as the dependent variable unsuccessful arthrodesis after 1 year, and adjusting for the other independent variables (infection, body mass index, Charlson comorbidity index, and surgical time), the only variable that was significantly associated with an outcome of unsuccessful spinal fusion after 1 year was infection, with OR = 12.44 (95% confidence interval, 2.50–61.76).

Conclusion

Deep infection after instrumented lumbar spine arthrodesis is a common complication that compromises the radiographic outcome of surgery. Patients who develop a postoperative infection and require debridement surgery are 12 times less likely to achieve satisfactory radiological fusion.

     

Total Hip Arthroplasty in Hemophilia Patients: A Mid‐term to Long‐term Follow‐up

Objective

To report the results of mid‐term to long‐term follow‐up after primary total hip arthroplasty (THA) in hemophiliacs and to hypothesize that THA can provide satisfactory outcomes in these patients.

Methods

Twenty‐four primary THA performed in 21 hemophilia patients between 2002 and 2012 were reviewed retrospectively, including 20 cases of hemophilia A and 1 case of hemophilia B. The standard lateral approach was used for all implantations. Substitution therapy for factor VIII and activated prothrombin complex concentrates were administered to patients with hemophilia A and B, respectively. Total and hidden blood loss were calculated. Outcomes were assessed using the Harris hip score before surgery and at the final follow‐up visit. Complications were recorded by clinical and radiographic assessment and then compared to those in previous reports.

Results

The mean follow‐up period was 113 months (range, 5–15 years). The average total blood loss was 3559 mL (range, 1494–7506 mL). The mean amount of red blood cell (RBC) transfusion was 4.4 U (range, 0–14 U). The mean amount of clotting factor used in the perioperative period for management of hemophilia was 14 031.3 U (range, 8100–25 200 U). Harris hip scores improved from 37 points (range, 15–81) before surgery to 90 points (range, 70–96) at the last follow‐up. No signs of loosening, infection or other complications of the implant components occurred after discharge. The overall survivorship of the implants was 100% for all patients, and no revision surgery was performed.

Conclusions

With modern techniques and hematological management, THA in patients with hemophilia leads to significant improvement in joint function with a relatively low incidence of complications. Increased blood loss and substitution therapy have no obvious negative influences on the mid‐term to long‐term results of THA.

     

Comparative Study Between M6‐C and Mobi‐C Cervical Artificial Disc Replacement: Biomechanical Outcomes and Comparison with Normative Data

Objective

Cervical spondylosis affects a huge proportion of the middle‐aged population. Degenerative changes can occur in multiple regions of the cervical spine typically affecting the joints, intervertebral discs and endplates. These changes lead to compression of adjacent nervous structures, which results in radiculopathic and myelopathic pain. Various treatment modalities are currently available with non‐surgical approaches the initial go to if there is no symptomatic cord compression. Anterior cervical discectomy and fusion, or arthroplasty are the two common surgical approaches if non‐surgical treatments fail to relieve symptoms of the patients or there are signs of central cord compression. However, studies have shown that there is an increased risk of adjacent segment disease related to fusion. Cervical disc arthroplasty aims to restore normal range of motion (ROM) in patients with pain and disability due to degenerative disc disease resistant to conservative care. Two common disc prostheses used include M6‐C and Mobi‐C. Both prostheses comprise a mobile polymer segment sandwiched between two metal endplates with mechanisms resembling an actual intervertebral disc. This study aims to compare the kinematics associated with these prostheses, against the normal range of motion in the non‐degenerative population.

Method

Patients who underwent M6‐C or Mobi‐C disc replacements by the senior author from 2012 to 2015 were identified at a single tertiary institution. Routine 3‐month postoperative lateral radiographs were analyzed for flexion and extension ROM angles at the involved vertebral level by two independent authors. Data was compared to previous published studies investigating cervical spine ROM of asymptomatic patients.

Results

There was no statistical significance in the difference of overall flexion range between M6‐C and Mobi‐C prostheses. However, overall range of extension of Mobi‐C was greater compared to M6‐C (P = 0.028). At C_5–6, the range of flexion for both implants were similar but lesser compared to asymptomatic patients (P < 0.001). Range of extension was greater in the Mobi‐C group (14.2° ± 5.1°) compared to the M6‐C (7.3° ± 4.6°) (P = 0.0009). At C_6–7, there were no statistical differences in both range of flexion and extension between the two prostheses and asymptomatic patients (P > 0.05).

Conclusion

The early results regarding restoration of ROM following cervical arthroplasty using either M6‐C or Mobi‐C prosthesis are encouraging. Long‐term follow‐up studies are necessary to observe the change in ROM over time with physiological loading and wear patterns.

     

Orientation changes in the cruciate ligaments of the knee during skeletal growth: A porcine model

Musculoskeletal injuries in pediatric patients are on the rise, including significant increases in anterior cruciate ligament (ACL) injuries. Previous studies have found major anatomical changes during skeletal growth in the soft tissues of the knee. Specifically, the ACL and the posterior cruciate ligament (PCL) change in their relative orientation to the tibial plateau throughout growth. In order to develop age‐specific treatments for ACL injuries, the purpose of this study was to characterize orientation changes in the cruciate ligaments of the Yorkshire pig, a common pre‐clinical model, during skeletal growth in order to verify the applicability of this model for pediatric musculoskeletal studies. Hind limbs were isolated from female Yorkshire pigs ranging in age from newborn to late adolescence and were then imaged using high field strength magnetic resonance imaging. Orientation changes were quantified from the magnetic resonance images using image segmentation software. Statistically significant increases were found in the coronal and sagittal angles of the ACL relative to the tibial plateau during pre‐adolescent growth. Additional changes were observed in the PCL angle, Blumensaat angle, intercondylar roof angle, and the aspect ratio of the intercondylar notch. Only the sagittal angle of the ACL relative to the tibial plateau experienced statistically significant changes through late adolescence. The age‐dependent properties of the ACL and PCL in the female pig mirrored results found in female human patients, suggesting that the porcine model may provide a pre‐clinical platform to study the cruciate ligaments during skeletal growth. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2725–2732, 2017.