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Cureus May 2024Multiple fractures are frequently encountered in adults following road traffic accidents. A 32-year-old male presented with multiple fractures in his right lower...
Multiple fractures are frequently encountered in adults following road traffic accidents. A 32-year-old male presented with multiple fractures in his right lower extremity, including a femoral shaft fracture, distal third fractures of the tibia and fibula, as well as a calcaneal fracture. The patient provided a history indicative of a road traffic accident. X-rays were performed on both hip joints, both knee joints, and the ankle joints. Treatment involved open reduction and internal fixation (ORIF) with interlocking nailing for the femur, tibia, and fibula, alongside ORIF with plating using a screw-out set (SOS) and cannulated cancellous (CC) screw fixation for the calcaneal fracture. Additionally, the Ilizarov procedure was conducted following debridement over the right foot. Post-surgery, the patient experienced primary symptoms of hip joint pain and restricted hip joint movement. Physiotherapy was initiated to address these issues. Evaluation of outcome measures indicated a reduction in joint pain, significant enhancement in joint mobility, and an increase in muscle strength.
PubMed: 38947633
DOI: 10.7759/cureus.61427 -
World Journal of Orthopedics Jun 2024Cheilectomy of the 1 metatarsophalangeal joint (MTPJ) is one of the most common procedures for the management of hallux rigidus. However, there is no consensus regarding...
BACKGROUND
Cheilectomy of the 1 metatarsophalangeal joint (MTPJ) is one of the most common procedures for the management of hallux rigidus. However, there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy (MIDC) for the management of hallux rigidus.
AIM
To evaluate outcomes following MIDC for the management of hallux rigidus.
METHODS
During November 2023, the PubMed, EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus.
RESULTS
Six studies were included. In total, 348 patients (370 feet) underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9 ± 16.5 months. The distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows: I (58 patients, 27.1%), II (112 patients, 52.3%), III (44 patients, 20.6%). Three studies performed an additional 1 MTPJ arthroscopy and debridement following MIDC. Retained intra-articular bone debris was observed in 100% of patients in 1 study. The weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9 ± 3.2 to a postoperative score of 87.1. The complication rate was 8.4%, the most common of which was persistent joint pain and stiffness. Thirty-two failures (8.7%) were observed. Thirty-three secondary procedures (8.9%) were performed at a weighted mean time of 8.6 ± 3.2 months following the index procedure.
CONCLUSION
This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up. A moderate re-operation rate at short-term follow-up was recorded. The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.
PubMed: 38947256
DOI: 10.5312/wjo.v15.i6.585 -
Orthopedic Reviews 2024Hip-knee-ankle angle (HKA) on Full Limb Radiographs (FLRs) is the gold standard for coronal knee alignment assessment. Despite the widespread utilization of the more...
Femorotibial angle on short knee radiographs fails to accurately predict the lower limb mechanical alignment. A systematic review and meta-analysis on different femorotibial angle definitions and short knee radiograph types.
INTRODUCTION
Hip-knee-ankle angle (HKA) on Full Limb Radiographs (FLRs) is the gold standard for coronal knee alignment assessment. Despite the widespread utilization of the more convenient femorotibial angle (FTA) on either antero-posterior (AP) or postero-anterior (PA) short knee radiographs (SKRs), its definition and correlation with HKA remains controversial. This review is the first to systematically investigate FTA-HKA correlation and the effect of different FTA methods and SKRs.
METHODS
Systematic literature search (Pubmed, Scopus, Cochrane Library) followed PRISMA guidelines, to evaluate studies examining the FTA-HKA correlation. Meta-analyses compared the 3 most common FTA methods, knee center determination method and SKR types.
RESULTS
17 studies (2597 patients, 3234 knees) were included. The strongest correlation with HKA (r = 0.78) was found for FTA Method 1 (angle formed by lines drawn from the midpoint of tibial spines to points 10 cm above and below the joint line). No significant differences were observed when grouping the FTA methods by knee center assessment (Group I, r = 0.78; Group II, r = 0.77). AP SKRs showed a trend towards stronger FTA-HKA correlation compared to PA SKRs, in both Method 1 (r = 0.79 vs 0.75) and Method 3 (r = 0.80 vs 0.66).
CONCLUSION
Irrespective of its definition or type of SKR used, FTA lacks reliable accuracy in predicting the HKA in most knees. FLRs should be used whenever precise estimation of the patient's alignment is necessary. Caution is warranted in interpreting studies investigating knee alignment or knee arthroplasty outcomes based on FTA.
PubMed: 38947178
DOI: 10.52965/001c.120053 -
Biomedical Engineering Letters Jul 2024This study was performed to investigate the effects of fibular osteotomy and release of medial soft tissues including posterior tibial tendon (PTT), and deep deltoid...
UNLABELLED
This study was performed to investigate the effects of fibular osteotomy and release of medial soft tissues including posterior tibial tendon (PTT), and deep deltoid ligaments, which act as medial stabilizing structures in medial open wedge SMO. Twelve fresh frozen human legs were obtained and disarticulated below the knee. Experiments were conducted in four steps. First, medial open wedge tibial osteotomy was performed. Second, fibular osteotomy was performed in an inferomedial direction at the same level as the tibial osteotomy. Third, the deep deltoid ligament was released from tibial attachments. Forth, total tenotomy of the PTT was performed behind the medial malleolus. After finishing each step, contact area and peak and mean pressures were measured in the tibiotalar and talofibular joints. Fibular osteotomy after medial open wedge SMO significantly decreased mean pressure in the tibiotalar joint, mean and peak pressures in the talofibular joint. Medial soft tissue release resulted in a remarkable lateral shift and decreased tibiotalar joint loading. However, no remarkable change was observed in the tibiotalar joint during releasing medial soft tissues. The overall peak pressure distribution tended to shift more laterally compared to the value of normal alignment. In conclusion, concomitant fibular osteotomy and release of the deltoid ligament and PTT provide a useful means of minimizing tibiotalar joint stress.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s13534-024-00370-7.
PubMed: 38946821
DOI: 10.1007/s13534-024-00370-7 -
The Bone & Joint Journal Jul 2024Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but... (Comparative Study)
Comparative Study
AIMS
Robotic arm-assisted surgery offers accurate and reproducible guidance in component positioning and assessment of soft-tissue tensioning during knee arthroplasty, but the feasibility and early outcomes when using this technology for revision surgery remain unknown. The objective of this study was to compare the outcomes of robotic arm-assisted revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) versus primary robotic arm-assisted TKA at short-term follow-up.
METHODS
This prospective study included 16 patients undergoing robotic arm-assisted revision of UKA to TKA versus 35 matched patients receiving robotic arm-assisted primary TKA. In all study patients, the following data were recorded: operating time, polyethylene liner size, change in haemoglobin concentration (g/dl), length of inpatient stay, postoperative complications, and hip-knee-ankle (HKA) alignment. All procedures were performed using the principles of functional alignment. At most recent follow-up, range of motion (ROM), Forgotten Joint Score (FJS), and Oxford Knee Score (OKS) were collected. Mean follow-up time was 21 months (6 to 36).
RESULTS
There were no differences between the two treatment groups with regard to mean change in haemoglobin concentration (p = 0.477), length of stay (LOS, p = 0.172), mean polyethylene thickness (p = 0.065), or postoperative complication rates (p = 0.295). At the most recent follow-up, the primary robotic arm-assisted TKA group had a statistically significantly improved OKS compared with the revision UKA to TKA group (44.6 (SD 2.7) vs 42.3 (SD 2.5); p = 0.004) but there was no difference in the overall ROM (p = 0.056) or FJS between the two treatment groups (86.1 (SD 9.6) vs 84.1 (4.9); p = 0.439).
CONCLUSION
Robotic arm-assisted revision of UKA to TKA was associated with comparable intraoperative blood loss, early postoperative rehabilitation, functional outcomes, and complications to primary robotic TKA at short-term follow-up. Robotic arm-assisted surgery offers a safe and reproducible technique for revising failed UKA to TKA.
Topics: Humans; Arthroplasty, Replacement, Knee; Male; Female; Prospective Studies; Robotic Surgical Procedures; Aged; Middle Aged; Reoperation; Treatment Outcome; Range of Motion, Articular; Follow-Up Studies; Length of Stay; Postoperative Complications; Knee Prosthesis; Aged, 80 and over; Osteoarthritis, Knee
PubMed: 38945538
DOI: 10.1302/0301-620X.106B7.BJJ-2023-0943.R2 -
The Journal of Foot and Ankle Surgery :... Jun 2024Ankle arthrodesis is an effective surgical intervention for end-stage arthritis or severe ankle joint deformity. Both internal (IF) and external fixation (EF) techniques... (Review)
Review
Ankle arthrodesis is an effective surgical intervention for end-stage arthritis or severe ankle joint deformity. Both internal (IF) and external fixation (EF) techniques are valid options, but there is controversy regarding the most effective technique. This study compares the safety and efficacy of EF and IF fixation techniques for ankle arthrodesis. A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A literature search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL), was performed to identify all studies directly comparing the two techniques. Both fixed and random effects models of analysis were used depending on heterogeneity. Odds of union in the EF and IF groups were comparable (OR=0.60, CI 0.36-1.02, p=0.06) however, EF was associated with greater odds of deep hardware infections (OR=3.67, 1.97-6.83, p <0.05) and amputations (OR=3.17, CI 1.06-9.54, p =0.04). Odds of revision surgery and superficial wound complications were similar between groups. EF techniques had significantly longer operation times (MD=31.23, CI-25.11-37.34, p <0.05) and intraoperative blood loss (MD=46.31, CI-24.93-67.69, p <0.05). No significant difference was noted in pain and functionality scores. IF and EF techniques have reasonable union rates with similar postoperative outcomes. However, IF patients are more likely to achieve primary union and less likely to have deep infections, being mindful that EF techniques were usually indicated for more complex cases. LEVEL OF EVIDENCE: IV.
PubMed: 38944233
DOI: 10.1053/j.jfas.2024.05.010 -
The Journal of Foot and Ankle Surgery :... Jun 2024The modified Lapidus procedure has emerged as a versatile solution for various pedal pathologies, particularly hallux abducto valgus. There have been numerous...
The modified Lapidus procedure has emerged as a versatile solution for various pedal pathologies, particularly hallux abducto valgus. There have been numerous modifications over time regarding fixation techniques, joint preparation methods, graft utilization, and weightbearing protocols. However, concerns persist regarding prolonged non-weightbearing postoperatively, prompting the need for alternative approaches. This retrospective descriptive cohort analysis assessed the outcomes of 40 feet from 34 patients who underwent the modified Lapidus procedure with a medial plating system, aimed to evaluate immediate weightbearing outcomes on union rate, fixation-related complications, and functional outcomes. Among the 40 feet, findings showed a 95% (38/40) union rate within 6 months, with 2.5% (1/40) experiencing delayed union and 2.5% (1/40) facing fixation-related complications. There is a single case of malunion in the cohort. Additionally, statistically significant improvements were observed across all domains of the Manchester-Oxford Foot Questionnaire at p < .001. These findings suggest immediate weightbearing as a potential alternative to traditional non-weightbearing protocols. However, the study's retrospective nature and lack of a comparative group warrant cautious interpretation. Further research is essential to validate these findings and refine postoperative care protocols. By challenging conventional practices, this study underscores the complexity of optimizing patient outcomes in modified Lapidus procedure management. Tailored approaches and prospective investigations are imperative for establishing definitive guidelines and enhancing surgical techniques in this domain.
PubMed: 38944232
DOI: 10.1053/j.jfas.2024.06.004 -
Computers in Biology and Medicine Jun 2024The sit-to-stand (STS) movement is fundamental in daily activities, involving coordinated motion of the lower extremities and trunk, which leads to the generation of...
The sit-to-stand (STS) movement is fundamental in daily activities, involving coordinated motion of the lower extremities and trunk, which leads to the generation of joint moments based on joint angles and limb properties. Traditional methods for determining joint moments often involve sensors or complex mathematical approaches, posing limitations in terms of movement restrictions or expertise requirements. Machine learning (ML) algorithms have emerged as promising tools for joint moment estimation, but the challenge lies in efficiently selecting relevant features from diverse datasets, especially in clinical research settings. This study aims to address this challenge by leveraging metaheuristic optimization algorithms to predict joint moments during STS using minimal input data. Motion analysis data from 20 participants with varied mass and inertia properties are utilized, and joint angles are computed alongside simulations of joint moments. Feature selection is performed using the Manta Ray Foraging Optimization (MRFO), Marine Predators Algorithm (MPA), and Equilibrium Optimizer (EO) algorithms. Subsequently, Decision Tree Regression (DTR), Random Forest Regression (RFR), Extra Tree Regression (ETR), and eXtreme Gradient Boosting Regression (XGBoost Regression) ML algorithms are deployed for joint moment prediction. The results reveal EO-ETR as the most effective algorithm for ankle, knee, and neck joint moment prediction, while MPA-ETR exhibits superior performance for hip joint prediction. This approach demonstrates potential for enhancing accuracy in joint moment estimation with minimal feature input, offering implications for biomechanical research and clinical applications.
PubMed: 38943945
DOI: 10.1016/j.compbiomed.2024.108812 -
Anatomical Record (Hoboken, N.J. : 2007) Jun 2024Riojasuchus tenuisceps was a pseudosuchian archosaur from the Late Triassic period in Argentina. Like other ornithosuchids, it had unusual morphology such as a unique...
Riojasuchus tenuisceps was a pseudosuchian archosaur from the Late Triassic period in Argentina. Like other ornithosuchids, it had unusual morphology such as a unique "crocodile-reversed" ankle joint, a lesser trochanter as in dinosaurs and a few other archosaurs, robust vertebrae, and somewhat shortened, gracile forelimbs. Such traits have fuelled controversies about its locomotor function-were its limbs erect or "semi-erect"? Was it quadrupedal or bipedal, or a mixture thereof? These controversies seem to persist because analyses have been qualitative (functional morphology) or correlative (morphometrics) rather than explicitly, quantitatively testing mechanistic hypotheses about locomotor function. Here, we develop a 3D whole-body model of R. tenuisceps with the musculoskeletal apparatus of the hindlimbs represented in detail using a new muscle reconstruction. We use this model to quantify the body dimensions and hindlimb muscle leverages of this enigmatic taxon, and to estimate joint ranges of motion and qualitative joint functions. Our model supports prior arguments that R. tenuisceps used an erect posture, parasagittal gait and plantigrade pes. However, some of our inferences illuminate the rather contradictory nature of evidence from the musculoskeletal system of R. tenuisceps-different features support (or are ambiguous regarding) quadrupedalism or bipedalism. Deeper analyses of our biomechanical model could move toward a consensus regarding ornithosuchid locomotion. Answering these questions would not only help understand the palaeobiology and bizarre morphology of this clade, but also more broadly if (or how) locomotor abilities played a role in the survival versus extinction of various archosaur lineages during the end-Triassic mass extinction event.
PubMed: 38943347
DOI: 10.1002/ar.25528 -
Foot and Ankle Surgery : Official... Jun 2024This study aimed to investigate ankle syndesmosis in healthy subjects under non-weight bearing (NWB) and weight bearing (WB) conditions using two US methods.
BACKGROUND
This study aimed to investigate ankle syndesmosis in healthy subjects under non-weight bearing (NWB) and weight bearing (WB) conditions using two US methods.
METHODS
The anterior tibiofibular clear space (ATFCS) was measured in healthy subjects in NWB and WB conditions using two US procedures. Method 1 measured 10 mm above the ankle joint and Method 2 measured 30° from the line of 10 mm above the ankle joint.
RESULTS
A total of 60 ankles from 30 subjects (male/female, 15/15) were included. There was a significant difference in the ATFCS between the two US methods (p < 0.001), and Method 2 was better at detecting the change in diastasis from NWB to WB conditions. The ATFCS was significantly greater on WB than on NWB, irrespective of the US method.
CONCLUSIONS
Method 2 was better at detecting diastasis of the syndesmosis from NWB to WB conditions. The influence of WB needs to be considered when evaluating syndesmosis using US.
LEVEL OF EVIDENCE
Cross-sectional cohort study; Level of evidence, Ⅳ.
PubMed: 38942675
DOI: 10.1016/j.fas.2024.06.002