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Journal of Orthopaedic Surgery and... Jun 2024Charcot arthropathy is a progressive disorder of the ankle and foot joints that can lead to foot deformity and instability. Surgical intervention is often necessary for... (Clinical Trial)
Clinical Trial
INTRODUCTION
Charcot arthropathy is a progressive disorder of the ankle and foot joints that can lead to foot deformity and instability. Surgical intervention is often necessary for deformity and ulcer management during the chronic phase. The device used for arthrodesis remains a challenge.
METHODS
This clinical trial study included diabetic patients aged 40 years or older with Charcot foot. Lateral approach with lateral malleolar osteotomy was used to access the ankle joints and remove the cartilage. A small incision was made on the plantar aspect of the foot to pass an appropriately sized intramedullary nail. Demographic information, medical history, surgical details and Clinical data were collected at 2-week and 1-year follow-ups using the Ankle-Hindfoot Scale (AOFAS) score and the EuroQol 5-Dimensional 5-Level (EQ-5D-5L) health utility score.
RESULTS
Twenty-six patients with a mean age of 63 ± 0.23 years were included in the study. The findings showed significant improvements in AOFAS questionnaire items related to pain score, length of the walk, walking surfaces, walking disorders, sagittal alignment, back leg alignment, sustainability, alignment and the total score (P value < 0.001). The EQ-5D-5L questionnaire also showed a significant improvement in the total score (P value = 0.002).
CONCLUSION
This study provides evidence supporting the effectiveness of tibiotalocalcaneal arthrodesis by hindfoot nailing in diabetic patients with Charcot foot joints and demonstrated comparable and superior outcomes in terms of patient satisfaction and complication rate when compared to previous studies.
Topics: Humans; Middle Aged; Arthrodesis; Female; Male; Arthropathy, Neurogenic; Quality of Life; Ankle Joint; Bone Nails; Aged; Treatment Outcome; Follow-Up Studies; Tibia; Adult
PubMed: 38831325
DOI: 10.1186/s13018-024-04787-9 -
Clinics in Orthopedic Surgery Jun 2024The objective of this study was to investigate the incidence of osteonecrosis of the femoral head (ONFH) after cephalomedullary nailing in elderly patients with... (Observational Study)
Observational Study
BACKGROUND
The objective of this study was to investigate the incidence of osteonecrosis of the femoral head (ONFH) after cephalomedullary nailing in elderly patients with pertrochanteric fractures and to analyze the risk factors related to ONFH.
METHODS
A total of 689 consecutive patients with cephalomedullary nailing for pertrochanteric fractures at our hospital were recruited. Of these, 368 patients who met the inclusion criteria were finally enrolled. ONFH after cephalomedullary nailing was identified by reviewing patients' electronic charts and serial radiographs. The ONFH group was then compared with the non-ONFH group.
RESULTS
ONFH was identified in 9 of 368 patients (2.4%). The time to diagnosis of ONFH averaged 23.8 months (range, 5-54 months) after index surgery. The mean age, body mass index, and bone mineral density (T-score in femur neck) were 84.1 ± 7.1 years, 23.7 ± 3.6 kg/m, and -3.1 ± 0.7 kg/m, respectively. The times from injury to surgery, from admission to surgery, and operation time averaged 4.2 ± 2.7 days, 3.6 ± 2.6 days, and 87.2 ± 30.0 minutes, respectively. Among 9 patients, 3 underwent conversion arthroplasty. The ONFH group had advanced age ( = 0.029), more basicervical fracture components ( = 0.002), and inadequate reduction ( = 0.045) compared to the non-ONFH group. On multivariate analysis, advanced age (odds ratio [OR], 1.61;, = 0.022), basicervical fracture components (OR, 24.58; = 0.001), and inadequate reduction (OR, 4.11; = 0.039) were identified as risk factors of ONFH.
CONCLUSIONS
Although ONFH is relatively rare after cephalomedullary nailing for pertrochanteric fractures in elderly patients, its risk may increase with advanced age, basicervical fracture components, and inadequate reduction. Therefore, in patients with these risk factors, meticulous and longer follow-up is needed even after bone union.
Topics: Humans; Male; Female; Risk Factors; Aged; Aged, 80 and over; Hip Fractures; Fracture Fixation, Intramedullary; Incidence; Femur Head Necrosis; Postoperative Complications; Bone Nails; Retrospective Studies
PubMed: 38827762
DOI: 10.4055/cios23287 -
Clinics in Orthopedic Surgery Jun 2024Operative management with intramedullary nail fixation remains the definitive treatment of choice for osteoporotic subtrochanteric (ST) fractures; however, there remains...
BACKGROUND
Operative management with intramedullary nail fixation remains the definitive treatment of choice for osteoporotic subtrochanteric (ST) fractures; however, there remains no consensus regarding the proper nail length. We aimed to use 3-dimensional finite element (FE) analysis to determine the optimal nail length for the safe fixation of osteoporotic ST fractures.
METHODS
Nine modes of FE models were constructed using 9 different lengths of cephalomedullary nails (short nails: 170, 180, and 200 mm; long nails: 280, 300, 320, 340, 360, and 380 mm) from the same company. The interfragmentary motion was analyzed. Additionally, the peak von Mises stress (PVMS) in the cortical bone, cancellous bone of the femoral head, and the nail were measured, and the yielding risk for each subject was investigated.
RESULTS
Long nails were associated with less interfragmentary motion. In the cortical bone, the PVMS of short nails was observed at the distal locking screw holes of the femoral medial cortex; however, in long nails, the PVMS was observed at the lag screw holes on the lateral cortex. The mean yielding risk of long nails was 40.1% lower than that of short nails. For the cancellous bone of the femoral head, the PVMS in all 9 FE models was in the same area: at the apex of the femoral head. There was no difference in the yielding risk between short and long nails. For implants, the PVMS was at the distal locking screw hole of the nail body in the short nails and the nail body at the fracture level in the long nails. The mean yielding risk was 74.9% lower for long nails than that for short nails.
CONCLUSIONS
Compared to short nails, long nails with a length of 320 mm or more showed less interfragmentary motion and lower yielding risk in low-level osteoporotic ST fractures. The FE analysis supports long nails as a safer option than short nails, especially for treating transverse-type low-level osteoporotic ST fractures.
Topics: Humans; Finite Element Analysis; Bone Nails; Osteoporotic Fractures; Fracture Fixation, Intramedullary; Hip Fractures; Female; Aged
PubMed: 38827761
DOI: 10.4055/cios23234 -
Bone & Joint Open Jun 2024Proximal femur fractures treatment can involve anterograde nailing with a single or double cephalic screw. An undesirable failure for this fixation is screw cut-out. In...
AIMS
Proximal femur fractures treatment can involve anterograde nailing with a single or double cephalic screw. An undesirable failure for this fixation is screw cut-out. In a single-screw nail, a tip-apex distance (TAD) greater than 25 mm has been associated with an increased risk of cut-out. The aim of the study was to examine the role of TAD as a risk factor in a cephalic double-screw nail.
METHODS
A retrospective study was conducted on 112 patients treated for intertrochanteric femur fracture with a double proximal screw nail (Endovis BA2; EBA2) from January to September 2021. The analyzed variables were age, sex, BMI, comorbidities, fracture type, side, time of surgery, quality of reduction, pre-existing therapy with bisphosphonate for osteoporosis, screw placement in two different views, and TAD. The last follow-up was at 12 months. Logistic regression was used to study the potential factors of screw cut-out, and receiver operating characteristic curve to identify the threshold value.
RESULTS
A total of 98 of the 112 patients met the inclusion criteria. Overall, 65 patients were female (66.3%), the mean age was 83.23 years (SD 7.07), and the mean follow-up was 378 days (SD 36). Cut-out was observed in five patients (5.10%). The variables identified by univariate analysis with p < 0.05 were included in the multivariate logistic regression model were screw placement and TAD. The TAD was significant with an odds ratio (OR) 5.03 (p = 0.012) as the screw placement with an OR 4.35 (p = 0.043) in the anteroposterior view, and OR 10.61 (p = 0.037) in the lateral view. The TAD threshold value identified was 29.50 mm.
CONCLUSION
Our study confirmed the risk factors for cut-out in the double-screw nail are comparable to those in the single screw. We found a TAD value of 29.50 mm to be associated with a risk of cut-out in double-screw nails, when good fracture reduction is granted. This value is higher than the one reported with single-screw nails. Therefore, we suggest the role of TAD should be reconsidered in well-reduced fractures treated with double-screw intramedullary nail.
PubMed: 38823797
DOI: 10.1302/2633-1462.56.BJO-2023-0163.R1 -
JBJS Case Connector Apr 2024A 34-year-old man was acutely treated with radial head arthroplasty and central band repair following Essex-Lopresti injury. A 38-year-old man presented with chronic...
CASE
A 34-year-old man was acutely treated with radial head arthroplasty and central band repair following Essex-Lopresti injury. A 38-year-old man presented with chronic longitudinal instability following failed radial head arthroplasty, which was performed for failed fixation. Treatment with revision radial head arthroplasty and central band reconstruction restored longitudinal stability.
CONCLUSION
We have a low threshold to repair the central band in acute Essex-Lopresti injury with sufficient evidence of disruption. Nearly all chronic cases require central band reconstruction to restore longitudinal stability. We do not temporarily pin the DRUJ, and distal ulnar shortening is rarely indicated.
Topics: Humans; Male; Adult; Joint Instability; Elbow Injuries; Radius Fractures; Wrist Injuries; Arthroplasty
PubMed: 38820195
DOI: 10.2106/JBJS.CC.24.00059 -
Acta Orthopaedica May 2024Orthopedic trainees frequently perform short antegrade femoral nail osteosynthesis of trochanteric fractures, but virtual reality simulation-based training (SBT) with...
BACKGROUND AND PURPOSE
Orthopedic trainees frequently perform short antegrade femoral nail osteosynthesis of trochanteric fractures, but virtual reality simulation-based training (SBT) with haptic feedback has been unavailable. We explored a novel simulator, with the aim of gathering validity evidence for an embedded test and setting a credible pass/fail standard allowing trainees to practice to proficiency.
PATIENTS AND METHODS
The research, conducted from May to September 2020 across 3 Danish simulation centers, utilized the Swemac TraumaVision simulator for short antegrade femoral nail osteosynthesis. The validation process adhered to Messick's framework, covering all 5 sources of validity evidence. Participants included novice groups, categorized by training to plateau (n = 14) or to mastery (n = 10), and experts (n = 9), focusing on their performance metrics and training duration.
RESULTS
The novices in the plateau group and experts had hands-on training for 77 (95% confidence interval [CI] 59-95) and 52 (CI 36-69) minutes while the plateau test score, defined as the average of the last 4 scores, was 75% (CI 65-86) and 96% (CI 94-98) respectively. The pass/fail standard was established at the average expert plateau test score of 96%. All novices in the mastery group could meet this standard and interestingly without increased hands-on training time (65 [CI 46-84] minutes).
CONCLUSION
Our study provides supporting validity evidence from all sources of Messick's framework for a simulation-based test in short antegrade nail osteosynthesis of intertrochanteric hip fracture and establishes a defensible pass/fail standard for mastery learning of SBT. Novices who practiced using mastery learning were able to reach the pre-defined pass/fail standard and outperformed novices without a set goal for external motivation.
Topics: Humans; Clinical Competence; Simulation Training; Bone Nails; Hip Fractures; Female; Male; Adult; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Orthopedics; Denmark
PubMed: 38819402
DOI: 10.2340/17453674.2024.40812 -
Clinical and Experimental Dental... Jun 2024This study aimed to compare the flexural strength of monolithic zirconia with different thicknesses and two sintering techniques. (Comparative Study)
Comparative Study
OBJECTIVES
This study aimed to compare the flexural strength of monolithic zirconia with different thicknesses and two sintering techniques.
MATERIALS AND METHODS
This in vitro, experimental study was conducted on 28 monolithic zirconia discs with 10 mm diameter and 0.5 (n = 14) and 1.2 mm (n = 14) thickness. Each group was divided into two subgroups (n = 7) for fast (60 min) and conventional (120 min) sintering at 1450°C. After sintering, the specimens were thermocycled and their flexural strength was measured by piston-on-3-balls technique in a universal testing machine (0.5 mm/min, 1.2 mm pin diameter). Data were analyzed by the Weibull test, one-way analysis of variance, and Tukey's test (α = .05).
RESULTS
The flexural strength of specimens with 1.2 mm thickness was significantly higher than that of specimens with 0.5 mm thickness (p < .05). The flexural strength of 1.2 mm/120-min group was slightly, but not significantly, higher than that of 1.2 mm/60-min group (p > .05). The flexural strength of 0.5 mm/120-min group was slightly, but not significantly, higher than that of 0.5 mm/60-min group (p > .05).
CONCLUSION
The increase in thickness of monolithic zirconia increases its flexural strength; however, increasing the sintering time appears to have no significant effect on the flexural strength of monolithic zirconia.
Topics: Zirconium; Flexural Strength; Materials Testing; Dental Materials; Dental Stress Analysis; Surface Properties; Hot Temperature; In Vitro Techniques
PubMed: 38818850
DOI: 10.1002/cre2.856 -
JOR Spine Jun 2024The first experimental study to produce cervical facet dislocation (CFD) in cadaver specimens captured the vertebral motions and axial forces that are important for...
BACKGROUND
The first experimental study to produce cervical facet dislocation (CFD) in cadaver specimens captured the vertebral motions and axial forces that are important for understanding the injury mechanics. However, these data were not reported in the original manuscript, nor been presented in the limited subsequent studies of experimental CFD. Therefore, the aim of this study was to re-examine the analog data from the first experimental study to determine the local and global spinal motions, and applied axial force, at and preceding CFD.
METHODS
In the original study, quasistatic axial loading was applied to 14 cervical spines by compressing them between two metal plates. Specimens were fixed caudally via a steel spindle positioned within the spinal canal and a bone pin through the inferior-most vertebral body. Global rotation of the occiput was restricted but its anterior translation was unconstrained. The instant of CFD was identified on sagittal cineradiograph films ( = 10), from which global and intervertebral kinematics were also calculated. Corresponding axial force data ( = 6) were extracted, and peak force and force at the instant of injury were determined.
RESULTS
CFD occurred in eight specimens, with an intervertebral flexion angle of 34.8 ± 5.6 degrees, and a 3.1 ± 1.9 mm increase in anterior translation, at the injured level. For seven specimens, CFD was produced at the level of transition from upper neck lordosis to lower neck kyphosis. Five specimens with force data underwent CFD at 545 ± 147 N, preceded by a peak axial force (755 ± 233 N) that appeared to coincide with either fracture or soft tissue failure.
CONCLUSIONS
Re-examining this rich dataset has provided quantitative evidence that small axial compression forces, combined with anterior eccentricity and upper neck extension, can cause flexion and shear in the lower neck, leading to soft tissue rupture and CFD.
PubMed: 38803524
DOI: 10.1002/jsp2.1336 -
A Comparative Study of Dynamic Hip Screws and Proximal Femoral Nails in Intertrochanteric Fractures.Cureus Apr 2024Background Intertrochanteric fractures, which occur in the hip of older individuals due to the weak and brittle structure of the bone caused by osteoporosis, make up...
Background Intertrochanteric fractures, which occur in the hip of older individuals due to the weak and brittle structure of the bone caused by osteoporosis, make up over 50% of all hip fractures. There are several treatment options available for these fractures. The major objective of this study was to carry out a comparative analysis to evaluate the efficacy of dynamic hip screws (DHS) and proximal femoral nails (PFN) in treating intertrochanteric fractures. Methodology Two hundred instances of intertrochanteric hip fractures were surgically treated between July 2022 and January 2024 at a tertiary care facility. The evaluation of fractures was conducted in two groups, namely, group 1, which consisted of 140 patients, each having a fracture in one hip, treated using the DHS method. Group 2 consisted of 60 patients, each having a fracture in one hip, treated using the PFN technique. The evaluation of functional results was performed with the Harris hip score. Results In the investigation within these groups, group 1 produced excellent outcomes in 53 patients, which accounts for 37.86% of the total. In group 2, the expected results were achieved in 34 patients (56.67%). Achieved outcomes were favorable in 75 (53.57%) individuals in group 1 and 21 (35%) in group 2. Out of the individuals in group 1, eight (5.71%) saw benefits, whereas four (1.6%) did not gain significantly. In group 2, five (8.33%) individuals benefitted. None of the patients in group 2 had unfavorable outcomes. Conclusion While both PFN and DHS provide comparable outcomes in stable bone, PFN demonstrated superior results in cases of unstable bone. The use of PFN results in reduced surgical duration and a smaller surgical opening. Additionally, PFN exhibited superior specificity compared to DHS, especially in cases with stable intertrochanteric bone.
PubMed: 38800311
DOI: 10.7759/cureus.59063 -
Journal of Immunological Methods Jul 2024Autoantibodies against type I interferon (IFN) are associated with a worse outcome in COVID-19. The measurement of cytokine-neutralizing autoantibodies has been limited,...
Autoantibodies against type I interferon (IFN) are associated with a worse outcome in COVID-19. The measurement of cytokine-neutralizing autoantibodies has been limited, hindering understanding of their role in clinical practice. We showed that an easy and reliable assay can be reproduced and validated to measure the neutralizing potency of autoantibodies directed to type I or type II IFN. Identifying of anti-cytokine autoantibodies might reflect on early treatments for subsequent infections, such as with antivirals or virus-neutralizing monoclonal antibodies.
Topics: Humans; Autoantibodies; COVID-19; Antibodies, Neutralizing; SARS-CoV-2; Cytokines; Interferon Type I; Male; Female; Middle Aged; Reproducibility of Results
PubMed: 38797274
DOI: 10.1016/j.jim.2024.113696