Intraarticular distal radial fractures External fixation versus open reduction with internal fixation

Results of three randomized controlled trials, class of evidenceⅡ, comparing external fixation (EF) with open reduction and internal fixation (ORIF) for the treatment of intraarticular distal radial fractures described no consistent benefit of one treatment over another. Only grip strength was significantly better with EF compared with ORIF in two studies. There was a suggestion of fewer complications, more rapid return of function, and better functional outcome with EF, but these results were not consistent across studies. No statistically significant differences in rates of infection or reflex sympathetic dystrophy were seen between treatment groups. Larger, methodologically sound randomized controlled trials are needed to determine whether treatment with EF is indeed preferable to ORIF.     

Patient reported outcome measures in ankle replacement versus ankle arthrodesis – A systematic review

ObjectivesCompare the functional outcomes of comparative studies of ankle arthrodesis (AA) and total ankle replacements (TAR).DesignSystematic review using PRISMA guidelines.Data SourcesMedline, Cochrane and EMBASE databases in July 2020.Eligibility CriteriaStudies that directly compared TAR and AA which reported patient reported outcomes measures (PROMs) of pain, function and quality of life.Data Extraction and SynthesisTwo authors independently reviewed all papers. PROMs were allocated into pain, function or quality of life domains. Two summary statistics were created to allow for analysis of the PROMs. These statistics were the mean difference in post-operative score and the mean difference in the change of score.Results1323 papers were assessed of which 20 papers were included. 898 ankle arthrodesis and 1638 ankle replacements were evaluated. The mean follow up was 3.3 years (range 0.5–13.0 years). AA patients had a mean age of 55.7 (range 20–82) and TAR 62.5 (range 21–89).There was major heterogeneity in outcomes used. We were unable to find a significant difference between the reported change in PROMs following TAR and AA. 29.3% of PROMs and their subscores showed TAR had better outcomes, 68.7% showed no significant difference and only 2.0% showed AA to have better outcomes.ConclusionsThe majority of published studies found equality in patient reported outcomes following TAR and AA although the quality of the studies was of low-level evidence. There is an urgent need for randomised controlled studies to definitively answer this important clinical question.     

Vancouver B2 periprosthetic femoral fractures: a comparative study of stem revision versus internal fixation with plate

Introduction

The aim is to compare stem revision versus internal fixation with plate in the treatment of Vancouver B2 periprosthetic femoral fractures.

Materials and methods

This is a retrospective review of 34 consecutive patients admitted from June 1998 to May 2017. One patient was treated conservatively, 11 with stem revision (group 1), 20 with plate, screws and cerclage (group 2), one patient with cerclage alone and another by Girdlestone procedure. We assessed surgical complications, mortality within 1 year, functional outcome with Harris Hip Score and radiographic outcome with Beals and Tower’s criteria.

Results

At an average follow-up of 30.1 months in group 1, we had 36.4% of patients with complications, HHS of 66.8, radiographic outcome “excellent-good” in 91% of cases. In group 2 we had 25% of patients with complications, HHS of 71.8, radiographic outcome “excellent-good” in 80% of cases. There were no significant differences in 1-year mortality between the two groups. In group 2, the best outcomes were obtained in uncemented straight stems with Johansson type 1 fracture and in cemented polished stems with stem detachment from the cement–bone complex. Whatever treatment was adopted, there was an overall worsening in quality of life.

Conclusions

Stem revision remains the treatment of choice in Vancouver B2 fractures, but, in selected cases, internal fixation with plate, screws and cerclage can be a viable alternative option.

     

Comparison of low-profile locking plate fixation versus antegrade intramedullary nailing for unstable metacarpal shaft fractures––A prospective comparative study

BackgroundThe purpose of this study was to compare the effectiveness of mini-open antegrade intramedullary nailing (AIN) and open reduction and internal fixation (ORIF) using the low-profile locking plate for angulated metacarpal shaft fractures, through prospective comparative trial.MethodsGroup 1 (mini-open AIN; 40 patients) and the other consecutive patients in group 2 (locking plate; 35 patients) who met our inclusion/exclusion criteria were investigated between January 2010 and December 2016. We compared radiological findings (e.g., union and residual angulation or shortening); clinical conditions (e.g., pain, measured on a visual analog scale (VAS), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores); active range of motion (ROM); and grip strength.ResultsUnion was achieved in both groups without any major complications. The final angulation measurements were not significantly different (p = 0.402). The final VAS scores were not different (p = 0.868); however, the final DASH score was better in group 1 than in group 2 (p = 0.034). The plates were removed in 14 patients at 9.6 months postoperatively for various reasons. Mean ROM at the time of hardware removal in these 14 patients was significantly lower compared with the final ROM in groups 1 and 2 (non-removal patients). Final grip strengths recovered significantly more in group 1 than in group 2 (p = 0.029). Extension lag was found in four patients in group 2, and the mean amount was 15°; however, it was resolved by tenolysis during hardware removal.ConclusionsBoth mini-open AIN and low-profile plate fixation are excellent options for metacarpal shaft fractures without significant radiological or clinical problems; however, some clinical outcomes evaluated at least 2 years postoperatively, such as DASH scores and grip strength, were better in the AIN group than in the locking plate group. Plate removal was performed under anesthesia in some patients in the plate group for various reasons, and this may have caused the small differences in the final outcomes evaluated 2 years after surgery.     

Outcome after operative treatment for chronic versus acute Achilles tendon rupture — A comparative analysis

Background

This study compared outcomes after treatment of acute Achilles tendon (AT) rupture via percutaneous suturing, with those after chronic AT rupture treated via open reconstruction.

A retrospective multicenter study of the Artelon? carpometacarpal joint implant

Background

This study aims to evaluate patient outcomes associated with use of the Artelon® Spacer for the treatment of arthritis of the carpometacarpal joint (CMCJ) of the thumb.

Methods

Patients with Eaton stage I, II, or III carpometacarpal (CMC) joint arthritis and disabling pain that had failed conservative treatment were evaluated at 12, 36, and 48 months postsurgery for changes in pinch, patient satisfaction, pain, range of motion, grip strength, grind test, operative time, and X-ray evidence of subsidence.

Results

Complete data was available for 46 subjects and 49 thumbs. A statistically significant improvement in pain when subjected to a first CMC joint grind test, CMCJ stability and patient perception of hand and wrist function following implant insertion was seen. Patient-oriented outcomes showed statistically significant improvement in the Disabilities of the Arm, Shoulder, and Hand; pain; pinch and grip strength; and range of motion. X-ray analysis revealed that none of the distributions of measures of osteophytes, subluxation, and joint space narrowing showed statistically significant change. Bone erosion/remodeling changes of the first metacarpal were statistically significant.

Conclusions

At a follow-up period of 4 years, patients had measured improvement as well as positive self-reported functional improvements following Artelon® implant insertion for the treatment of arthritis of the thumb CMCJ.     

Is adjunction of advanced platelet-rich fibrin (A-PRF) useful in first metatarsophalangeal joint arthrodesis? A retrospective cohort study

PurposeFirst metatarsophalangeal (MTPJ1) fusion represents the gold standard treatment for end-stage hallux rigidus (HR). The aim of this study was to assess efficacy and safety of A-PRF in promoting union after MTPJ1 arthrodesis. Our hypothesis was that the use of A-PRF may reduce the non-union rate and the time to fusion in the treatment of HR.Methods14 patients that had undergone MTPJ1 arthrodesis with A-PRF adjunction with 21 standard MTPJ1 fusions were retrospectively reviewed. The fusion rate and time to fusion (clinically and radiographically) were assessed at 6, 12 weeks and at the longest follow-up; the clinical status at final follow-up through forefoot AOFAS, EQ5d, SEFAS and VAS-pain scores; the complication rate.ResultsAt 6-weeks, bony union was achieved in 100% of patients in the A-PRF group compared to 70% in the control group, but this difference was not statistically significant (p = 0.22). At final follow-up (41 months), union rate in the control group reached 92% (one non-union). AOFAS, VAS and EQ-5d scores showed similar results for the two groups (p = 0.86, p = 0.12 and p = 0.61, respectively); only SEFAS score revealed a difference favoring the A-PRF group (p = 0.04). No revision surgery or complication was recorded in any group.ConclusionsA tendency for increased union rate was mainly found at 6 weeks in patients treated with MTPJ1 fusion associated to A-PRF compared to isolated fusion. The use of A-PRF was not associated with an increased complication rate at final follow-up.Level of evidenceLevel 3, therapeutic study, retrospective comparative study.     

Are our expectations bigger than the results we achieve? A comparative study analysing potential advantages of ankle arthroplasty over arthrodesis

Purpose

Prior studies have reported improved gait performance and kinematics after total ankle arthroplasty (TAR) compared to ankle arthrodesis (AAD). Given these findings, AAD has been primarily considered as a salvage procedure that may lead to adjacent joint degeneration.

Methods

A total of 101 TAR and 40 screw arthrodeses were enrolled in a retrospective study with a prospectively designed follow-up examination that included gait analysis and outcome assessment with the AOFAS hindfoot score and FAOS questionnaire.

Results

Significant asymmetry in gait and reduced range of motion compared to normal remained after both procedures. Subjective outcome improved after both procedures, and pain was significantly better after TAR. Limited functional gains after TAR and joint degeneration to the same degree after both procedures was seen in the mid-term. Hindfoot fusion seemed to have a greater impact on postoperative function than ankle arthrodesis.

Conclusion

Considering only minor functional gains of TAR compared to AAD the implantation of current TAR designs in large patient series may be questioned.     

Do local antibiotics reduce periprosthetic joint infections? A retrospective review of 744 cases

Periprosthetic joint infections (PJI) are uncommon but not rare and have significant morbidity and financial implications. Local antibiotics have been used successfully in other areas of orthopedics to reduce postoperative infections, but this method has not been proven in total joint arthroplasty (TJA). Beginning January 1, 2014, our primary investigators began using surgical site lavage with providone-iodine solution and administering 2 g of vancomcyin powder in the surgical wound prior to capsule closure for all primary and revision total hip and knee arthroplasties. We performed a retrospective chart review of patients two years prior to this date and two years after to compare occurrence of PJI. The groups were broken down into patients who received local antibiotics versus those who did not. The groups were further broken down by type of surgery performed; primary or revision total hip or knee arthroplasty. Administration of local antibiotics was preventative for PJI only in the primary total knee arthroplasty group (aOR = 0.28, 0.09–0.89). Administration of local antibiotics trended towards a preventative effect for PJI in the other groups but was not statistically significant. Patients receiving local antibiotics had similar blood urea nitrogen and creatinine levels postoperatively compared to the no antibiotics group indicating minimal systemic effects of local vancomycin powder. While the use of local antibiotics may prevent PJI, more data is required especially in the revision arthroplasty groups.     

Evaluation of a modified Broström–Gould procedure for treatment of chronic lateral ankle instability: A retrospective study with critical analysis of outcome scoring

BackgroundChronic lateral ankle instability accounts for 20% of the ankle injuries. This study evaluates functional outcome of the modified Broström–Gould technique using suture anchors, with 4 different clinical scores.MethodsA consecutive series of 41 patients were included with a minimum follow-up of one year. The function was assessed using 4 clinical scores including: the AOFAS for hind foot; the FAAM; the CAIT and the CAIS.ResultsOut of 41 patients; 27 patients were very satisfied, 11 satisfied and 3 were not satisfied. Ankle mobility returned to normal in 93% of patients. At follow-up the AOFAS was 89/100 (37–100), the FAAM 85/100% (35–100%), the CAIT 20/30 (5–30), and the CAIS 74/100% (27–100%).ConclusionOutcome of modified Broström–Gould procedure is good with high satisfaction rate in terms of ankle mobility. The disparity in outcome of scores, signals towards the need of a standard evaluation system.     

Limb salvage versus below knee amputation for severe adult lower limb deformity — A retrospective,comparative series

BackgroundThis study compares outcomes of patients with severe, multiplanar, fixed, pantalar deformities undergoing limb preservation with either pantalar fusion (PTF) or talectomy and tibiocalcaneal fusion (TCF), versus below knee amputation (BKA).MethodsFifty-one patients undergoing either PTF, TCF and BKA for failed management of severe pantalar deformity were evaluated retrospectively. Twenty-seven patients underwent PTF, 8 TCF and 16 BKA. Median age at surgery was 55.0 years (17–72 years) and median follow-up duration was 49.9 months (24.0–253.7 months). Clinical evaluation was undertaken using the MOxFQ, EQ-5D and Special Interest Group in Amputee Medicine score (SIGAM). Patients were also asked whether they were satisfied with their surgery and whether they would have the same surgery again.ResultsThere was no statistically significant difference in functional outcomes, satisfaction, or complications between the groups. Twenty-two patients undergoing PTF (81.5%), 6 patients undergoing TCF (75%), and 15 patients undergoing BKA (93.8%) were satisfied overall (p = 0.414). There was no difference in the proportion of patients who would opt for the same procedure again (p = 0.142): 23 in the PTF group (85.2%), 8 in the TCF group (100%), and 11 in the BKA group (68.8%). Seven patients undergoing PTF (25.9%), 2 patients undergoing TCF (25%) and 6 patients undergoing BKA (37.5%) had major complications (p = 0.692).ConclusionThis study concludes that PTF, TCF and BKA can all provide an acceptable outcome in treatment of severe, degenerative pantalar deformities. This data may be useful in counselling patients when considering salvage versus amputation in such cases.Level of evidenceLevel 3(Original) Clinical Research Article.     

Is there a difference in clinical outcomes and repair integrity between arthroscopic single-row versus transosseous (anchorless) fixation? A retrospective comparative study

Background

Few studies have investigated clinical and structural outcomes after transosseous (TO) repair. The purpose of this study was to compare structural and clinical outcomes of rotator cuff tear, repaired arthroscopically, with a single row (SR) or transossoeus (TO) anchorless technique.

The anatomical study of transoral atlantoaxial reduction plate internal fixation

Irreducibleanterioratlantoaxialdislocationwithventralspinalcordcompressionpresentsadifficultsurgicalchallenge.Nowasagenerallyacceptedoptionforthiscondition,decompressionthroughtransoralapproachhastobefollowedby anotheroperationwithinstrumentationandfusionofthe uppercervicalspinetoachievesegmentalstability.HarmsandKandziora1havedescribeddirectinternal platefixationsthroughtransoralapproach,buttheplate adoptedbyHarmsdidnothavealockingmechanism andtheplateusedbyKandziorafailedtoachieve immediate…     

Posterolateral plate fixation with Talarlock® is more stable than screw fixation in ankle arthrodesis in a biomechanical cadaver study

Background

A number of studies report on limitations of the screw arthrodesis in severe malalignment of the hindfoot, neuropathic deformity, poor bone quality and osteoporosis.