Posterior hip dislocation in a non-professional football player: a case report and review of the literature.

The majority of injuries during a football game are contusions, sprains and/or strains in the thigh, knee and ankle. Hip dislocations account for 2-5% of total hip dislocations, and they can be posterior or anterior. Major complications of traumatic hip dislocation include avascular necrosis of femoral head, secondary osteoarthritis, sciatic nerve injury and heterotopic ossification. On the occasion of a case of a 33-year-old football player, who suffered a posterior hip dislocation, associated with a posterior wall fracture of the acetabulum, while playing football, we review the literature and analyze the various mechanisms of injury, the possible complications and the management including surgery and rehabilitation.

Percutaneous versus open repair of acute Achilles tendon ruptures.

BACKGROUND: Controversy exists regarding the optimal treatment for acute Achilles tendon ruptures. Conservative and surgical treatments have been reported with variable results and complications rates. The purpose of this study is to compare the postoperative clinical and functional results of percutaneous versus open repair of acute Achilles tendon ruptures. MATERIALS AND METHODS: We present 34 patients with acute Achilles tendon ruptures treated with open and percutaneous surgical repair. There were 15 patients who had open surgical repair and 19 patients who had percutaneous repair. The mean follow-up was 22 months (range 10-24 months) for the open repair group and 20 months (range 9-24 months) for the percutaneous repair group; no patient was lost to follow-up. Postoperative rehabilitation was the same for both groups. Wound healing, complications, ankle range of motion, and patients' return to work, activity level, weight-bearing, and subjective assessment of their treatment were recorded. RESULTS: No significant difference was observed with respect to any of the examined variables between the open and percutaneous repair groups. Tendon healing was observed in all patients of both groups by 7-9 weeks. The mean time of patients' return to work was 7 weeks for the open repair group and 9 weeks for the percutaneous repair group. All patients were capable of full weight bearing by the 8th postoperative week time; the time to return to previous activities including non-contact sports was 5 months for both groups. All patients expressed satisfaction and graded their treatment as good. As expected, cosmetic appearance was significantly better in the percutaneous repair group. One patient who had open repair experienced skin incision pain and dysesthesia and graded his operation as fair. No patient experienced other complications such as re-rupture, infection, sural neuroma, or Achilles tendinitis within the period of this study. CONCLUSIONS: The present study showed similarly successful clinical and functional results after both open and percutaneous repair of acute Achilles tendon ruptures are similar. Cosmetic appearance is superior in the group of patients who had a percutaneous treatment.

The Use of TNF-α Inhibitors in Active Ankylosing Spondylitis Treatment.

Ankylosing spondylitis (AS) is a challenging disease, characterized by chronic inflammation and structural damage primarily affecting the axial skeleton, while extra-articular manifestations may also appear. This results in the deterioration of patients' quality of life. Over the past few decades, tumor necrosis factor-α (TNF-α) inhibitors have revolutionized the management of AS, offering substantial relief from symptoms and improving patient outcomes. The aim of this review is to assess the efficacy of TNF-α inhibitors in patients with active AS. A search was performed in the PubMed database using the following keywords: ("TNF alpha inhibitors" OR "anti TNF-a" OR "TNF-a inhibitors" OR "anti TNF-alpha" OR "Etanercept " OR "Golimumab" OR "Infliximab" OR "Certolizumab pegol" OR "Adalimumab") AND "ankylosing spondylitis". The search was completed in February 2024, and 35 studies were included in this review following PRISMA guidelines. The findings reveal evidence supporting the efficacy of TNF-α inhibitors in reducing inflammation, preventing structural damage, and enhancing overall well-being in AS patients. Overall, TNF-α inhibitors have emerged as a cornerstone in the therapeutic algorithm against AS with a very satisfactory safety profile.

Electrical Stimulation and Motor Function Rehabilitation in Spinal Cord Injury: A Systematic Review.

Spinal cord injury (SCI) often leads to devastating motor impairments, significantly affecting the quality of life of affected individuals. Over the last decades, spinal cord electrical stimulation seems to have encouraging effects on the motor recovery of impacted patients. This review aimed to identify clinical trials focused on motor function recovery through the application of epidural electrical stimulation, transcutaneous electrical stimulation, and functional electrical stimulation. Several clinical trials met these criteria, focusing on the impact of the aforementioned interventions on walking, standing, swimming, trunk stability, and upper extremity functionality, particularly grasp. After a thorough PubMed online database research, 37 clinical trials were included in this review, with a total of 192 patients. Many of them appeared to have an improvement in function, either clinically assessed or recorded through electromyography. This review outlines the various ways electrical stimulation techniques can aid in the motor recovery of SCI patients. It stresses the ongoing need for medical research to refine these techniques and ultimately enhance rehabilitation results in clinical settings.

Machine Learning Applications in Spine Surgery.

This literature review sought to identify and evaluate the current applications of artificial intelligence (AI)/machine learning (ML) in spine surgery that can effectively guide clinical decision-making and surgical planning. By using specific keywords to maximize search sensitivity, a thorough literature research was conducted in several online databases: Scopus, PubMed, and Google Scholar, and the findings were filtered according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 46 studies met the requirements and were included in this review. According to this study, AI/ML models were sufficiently accurate with a mean overall value of 74.9%, and performed best at preoperative patient selection, cost prediction, and length of stay. Performance was also good at predicting functional outcomes and postoperative mortality. Regression analysis was the most frequently utilized application whereas deep learning/artificial neural networks had the highest sensitivity score (81.5%). Despite the relatively brief history of engagement with AI/ML, as evidenced by the fact that 77.5% of studies were published after 2018, the outcomes have been promising. In light of the Big Data era, the increasing prevalence of National Registries, and the wide-ranging applications of AI, such as exemplified by ChatGPT (OpenAI, San Francisco, California), it is highly likely that the field of spine surgery will gradually adopt and integrate AI/ML into its clinical practices. Consequently, it is of great significance for spine surgeons to acquaint themselves with the fundamental principles of AI/ML, as these technologies hold the potential for substantial improvements in overall patient care.

Incidence of vertebral artery injury in patients undergoing cervical spine trauma surgery in correlation with surgical approach: A review.

Spinal cord injuries at the cervical spine level represent the most consequential of the related injuries at all levels of the spine. They can trigger permanent unilateral or bilateral damage with conspicuous disability. Regarding unstable injuries, the gold standard approach is open reduction and osteosynthesis, which can select between anterior and posterior surgical access. Each of the aforementioned approaches demonstrates both advantages and disadvantages; thus, it is up to the surgeon to determine the optimal option concerning the patient's safety. Diligent intraoperative control of anatomical reduction is pivotal to obtaining the best feasible postoperative outcomes. Literature data delineate copious complications following surgical intervention in the cervical spine. Indubitably, the most crucial intraoperative complication accounts for vascular injuries, with the most preponderant being the corrosion of the vertebral artery, as it is potentially life-threatening. This paper aims to provide a succinct and compendious review of the existing literature regarding cervical spinal cord injuries and to deduce many inferences concerning the incidence of iatrogenic vertebral artery injuries in relation to the surgical approach for fracture reduction.

Bone Mineral Density Post a Spinal Cord Injury: A Review of the Current Literature Guidelines.

BACKGROUND: Spinal cord injury (SCI) causes rapid osteoporosis below the level of injury in a multi-factorial manner. This literature review focused on the early diagnosis of low bone mass (LBM) in SCI patients and aimed to summarize all the available recent data on the diagnosis and treatment of osteoporosis in this unique patient population.  Materials and Methods: Advanced literature research was conducted in the online PubMed database using the keywords 'bone mineral density, 'spinal cord injury, 'skeletal fragility', and 'osteoporotic fractures'. Out of the initial 430 articles, duplicates were removed and the remaining studies were assessed for eligibility. Two reviewers independently extracted data from each study and assessed variable reporting of outcome data. The exclusion criteria were: studies not measuring bone mineral density (BMD), studies comparing SCI to other diseases, animal studies, molecular studies, studies including children, and studies not written in English. The 83 remaining papers were divided into studies focusing on treatment and studies investigating LBM in SCI. Following this step, studies with small patient samples set at 20 patients with SCI for the treatment group and 30 patients for the diagnosis of the LBM group, were also excluded. RESULTS: In the remaining 32 studies, 18 focused on the diagnosis of LBM in SCI and 14 focused on the various treatment options to address this phenomenon. Most of these studies (n=13) used the dual-energy X-ray absorptiometry (DXA) method to evaluate bone mass while five studies preferred quantitative computed tomography (QCT) measurements and one evaluated LBM using calcaneal qualitative ultrasound. In the treatment group of studies, seven papers administered medication to address LBM and four clinical protocols used physiotherapy methods to reduce bone loss post-SCI while three studies combined medical treatment with physiotherapy. CONCLUSION: The unawareness of the unique mechanism through which bone is rapidly lost in the first months post-SCI led to initial scientific confusion. In this review, we summarize information to increase physicians' awareness of the dangers of 'silent' osteoporosis progression post-SCI. We have also provided information on the best timing to evaluate bone loss as well as treatment options that could prevent fragility fractures in this population.

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion.

Anterior cervical discectomy and fusion (ACDF), despite its possible complications, remains the gold standard for the surgical treatment of patients with radiculopathy and/or myelopathy caused by cervical intervertebral disc herniation or spondylosis. Despite its high rate of incidence, postoperative dysphagia following ACDF is still poorly understood; its pathogenesis remains relatively unknown, and its risk factors are still a subject of debate. The aim of this study is to review the incidence, pathogenesis, diagnosis, and methods of prevention of dysphagia in ACDF patients. To this end, a literature review was conducted based on the PubMed internet database. Article titles were searched by using the following keywords: "dysphagia" and "anterior cervical discectomy and fusion" or "ACDF". The search was limited to prospective clinical studies evaluating dysphagia after ACDF surgery. Studies published in non-English languages, retrospective studies, cadaveric studies, reviews, case reports, study protocols, and commentary studies were excluded. Initially, 335 studies were identified after a primary search. After the application of the exclusion criteria, 73 studies remained for the final analysis. This literature review focused on identifying the rate of dysphagia and the various risk factors leading to this complication by comparing and evaluating the current literature with a wide spectrum of heterogeneity concerning patients, surgeons, and surgical techniques. A mean dysphagia rate of 19.4% (95% CI: 9.6%-29.1%) based on the findings of the included studies correlating dysphagia directly with ACDF procedures was calculated. Various established risk factors leading to dysphagia include the female sex, smoking, the surgical approach, rhBMP-2 use, and multilevel surgery, while zero-profile devices seem to reduce dysphagia risk. The diagnosis is based on clinical and radiological findings, especially prevertebral soft-tissue swelling. However, videofluoroscopic and endoscopic studies have been recently used for the evaluation of dysphagia. The role of local administration of steroids in the prevention of dysphagia has not yet been clarified. This review underscores the prevailing rudimentary understanding of the problem of dysphagia after ACDF procedures and highlights the need for more sensitive, factor-specific studies for understanding the impact of various risk factors on the incidence rate of dysphagia.

Stem Cell Therapy for Spinal Cord Injury: A Review of Recent Clinical Trials.

Spinal cord injury (SCI) remains an incurable, life-changing neurological condition, causing permanent loss of motor and sensory function in millions of people worldwide and affecting them in every aspect of their personal and social life. In the last two decades, after its success in various fields of medicine, stem cell therapy has been investigated in the research field as a potential treatment for SCI. This review focuses on the pathophysiology of SCI, the characteristics of the different stem cell therapies used for its treatment, and the results of these therapies in recently published clinical trials.

The Role of Sclerostin in Bone Diseases.

Sclerostin has been identified as an important regulator of bone homeostasis through inhibition of the canonical Wnt-signaling pathway, and it is involved in the pathogenesis of many different skeletal diseases. Many studies have been published in the last few years regarding sclerostin's origin, regulation, and mechanism of action. The ongoing research emphasizes the potential therapeutic implications of sclerostin in many pathological conditions with or without skeletal involvement. Antisclerostin antibodies have recently been approved for the treatment of osteoporosis, and several animal studies and clinical trials are currently under way to evaluate the effectiveness of antisclerostin antibodies in the treatment of other than osteoporosis skeletal disorders and cancer with promising results. Understanding the exact role of sclerostin may lead to new therapeutic approaches for the treatment of skeletal disorders.

Angiogenesis in Spinal Cord Injury: Progress and Treatment.

Traumatic spinal cord injury (SCI) provokes the onset of an intricate pathological process. Initial primary injury ruptures local micro-neuro-vascularcomplex triggering the commencement of multi-factorial secondary sequences which exert significant influence on neurological deterioration progress. Stimulating by local ischemia, neovascularization pathways emerge to provide neuroprotection and improve functional recovery. Although angiogenetic processes are prompted, newly formed vascular system is frequently inadequate to distribute sufficient blood supply and improve axonal recovery. Several treatment interventions have been endeavored to achieve the optimal conditions in SCI microenvironment, enhancing angiogenesis and improve functional recovery. In this study we review the revascularization pathogenesis and importance within the secondary processes and condense the proangiogenic influence of several angiogenetic-targeted treatment interventions.

Vascular Injury in Elective Anterior Surgery of the Lumbar Spine: A Narrative Review.

The incidence of anterior lumbar surgery is increasing as the population is aging. Although adverse events regarding vasculature injury are uncommon, several have been described in the current literature. Complications can be categorized based on the time of occurrence, more specifically intraoperative or postoperative, but also regarding the nature of vascular damage such as thrombosis, occlusion, or rupture. The rate of complications is higher in the setting of revision anterior surgery than with primary anterior lumbar surgery. Moreover, the incidence of revision anterior surgery is also increasing in contrast to the past. Through this narrative review, an effort is made for a thorough understanding of the complications associated with anterior lumbar surgery, which will aid in the prevention, recognition, and management of this rare complication.

How to avoid the risk of intraoperative cartilage damage in anatomic four tunnel double bundle anterior cruciate ligament reconstruction.

Double bundle (DB) anterior cruciate ligament (ACL) reconstruction is technically demanding. In order to create four anatomical anteromedial (AM) and posterolateral (PL) bone tunnels many surgeons adopt new ways of tibial and femoral bone tunnel drilling. From surgical experience, these technical changes might increase the risk for intraoperative pitfalls. An intraoperative articular cartilage damage to the medial femoral condyle or the medial tibial plateau could be disastrous for the patient. It may be caused by an insufficient anteromedial portal technique for femoral AM and PL bone tunnel drilling or flat tibial AM or PL bone tunnel reaming. Potential pitfalls may be avoided by small modifications to the surgical technique. In this present technical note, a sequence of surgical steps are described, which may help to avoid articular cartilage damage to the medial femoral condyle and medial tibial plateau in anatomical four tunnel DB ACL reconstruction.

Endoscopic treatment of chronic mid-portion Achilles tendinopathy: novel technique with short-term results.

In this prospective study, we present the short-term clinical results of a novel endoscopic surgical technique for patients suffering from chronic painful mid-portion Achilles tendinopathy. Eight consecutive patients (seven men and one woman, mean age 52 years) diagnosed with chronic painful mid-portion Achilles tendinopathy were included in this study and were treated with endoscopic debridement of the ventral neovascularized area, the peritendineum and the Achilles tendon. Patients recorded the function of the Achilles tendon and the severity of Achilles tendon pain during tendon loading activity, pre and postoperatively in a visual analogue scale. Patient global satisfaction was also assessed in a similar manner. Patients were followed-up for 6 months. All patients experienced immediate postoperative pain relief. In terms of Achilles tendon pain, the median visual analogue score (VAS) increased from 40 (10-60) (preoperatively) to 97.5 (85-100) (last follow-up examination). In terms of Achilles tendon function, the median VAS increased from 22.5 (0-30) (preoperatively) to 90 (80-95) (last follow-up examination). In terms of global satisfaction, the median VAS in the last follow-up examination was 85 (70-95). No postoperative complications were recorded. In conclusion, the short-term clinical results were satisfactory.

Intra-operative hamstring tendon graft contamination in anterior cruciate ligament reconstruction.

We aimed to evaluate the possibility of hamstring tendon contamination, the correlation with clinical infection and its association with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values in 89 anterior cruciate ligament reconstructions. Two tissue samples were obtained for culture from each graft: immediately after harvesting the graft and before implantation. The ESR and the CRP were evaluated preoperatively and on the 4th and 20th postoperative days. Nine patients (10%) had positive cultures but no patient had signs of postoperative infection. All patients had ESR and CRP values elevated at the 4th postoperative day. ESR and CRP values returned to normal levels at the 20th postoperative day. Higher mean values of CRP levels at the 4th day were observed in patients with contaminated grafts compared to those with uncontaminated. Both values reached normal levels at the 20th postoperative day.

A Rare Cause of Anterior Knee Pain in a Young Athlete and a Delayed Diagnosis: Osteoid Osteoma of the Patella.

Intra-articular osteoid osteomas are a rare cause of articular pain. Their diagnosis can be challenging due to their non-specific clinical presentation and imaging characteristics. We present the case of a young soccer player with a 12-month history of anterior knee pain that was first attributed to Sinding Larsen Johansson syndrome and then to Hoffa's syndrome. A CT scan was performed that revealed the localization of an osteoid osteoma of the patella. The patient was successfully treated by percutaneous radiofrequency ablation under CT guidance without complications and returned to full sports activity. Although a rare entity, osteoid osteoma of the patella with its atypical clinical features could be included in the differential diagnosis of persistent anterior knee pain in the young adult. High clinical suspicion is necessary to avoid delay in diagnosis and irrelevant procedures for the patient.

Outcome of Percutaneous Fixation of Acute Achilles Tendon Ruptures.

BACKGROUND: Conservative treatment of an acute Achilles rupture remains a viable and acceptable option as does surgical fixation, with open and percutaneous repair consisting the main operative techniques. The purpose of this study was to compare the outcomes and complication rates of open versus percutaneous surgical procedures. METHODS: From 2009 to 2016, 131 patients were admitted to our department with clinically and radiologically confirmed acute Achilles tendon ruptures. Of those, 82 patients met our inclusion criteria and were randomized into 2 groups, group A (open repair) and group B (percutaneous suturing). Suture equipment was the same for both groups. All patients followed the same rehabilitation protocol. Functional evaluation was made using American Orthopaedic Ankle & Foot Society (AOFAS) hindfoot and Achilles tendon Total Rupture Score (ATRS) questionnaires at the 12-month follow-up. Ankle range of motion (ROM), return-to-work time, and complication rates were additionally measured. RESULTS: Both techniques had similar results regarding complication rates and return-to-work time. The major complication in group A was superficial infection (7%) and skin necrosis (3%), whereas 3 patients in group B developed paresthesias due to sural nerve entrapment. Patients in group B had better AOFAS hindfoot (96/100) and ATRS (95/100) scores, but the difference was not significant. ROM was similar in both groups at the 12-month follow-up. CONCLUSION: Percutaneous suturing seems to be a safe and effective technique that offers good functional outcomes and low complication rates in patients with acute Achilles tendon ruptures who elect to have surgery. LEVEL OF EVIDENCE: Level II, prospective case series.

Ewing's sarcoma of the hip presenting as a benign cystic lesion.

A 14-year-old girl with a Ewing's sarcoma of the left femoral head and neck is presented. The imaging features mimicked a benign cystic lesion. Biopsy and molecular analysis confirmed the diagnosis. The patient was treated with chemotherapy, wide tumor resection, and proximal femoral reconstruction using an allograft-prosthesis composite. Differential diagnosis, imaging, and pathologic features of Ewing's sarcoma are discussed.

Stabilization of the lumbar spine using the dynamic neutralization system.

The records of 68 patients (42 men and 26 women) who underwent spine stabilization with a dynamic neutralization system were reviewed. Mean patient age at operation was 42.8 years. The primary indication for surgery was degenerative spine disease and instability with neurogenic or radicular pain and/or chronic back pain. Forty-one (60.2%) patients had degenerative diskopathy or disk herniation, and 27 (39.8%) patients had lumbar spine stenosis. One-motion segment spine stabilization was performed in 30 patients, 2-motion segment spine stabilization in 32 patients, and 3-motion segment spine stabilization in 6 patients. Within a mean follow-up of 36.2 months (range, 12.9-75.3 months), there were 2 re-operations, and 3 patients with screw loosening. Re-operations were for a deep infection in 1 patient and left leg pain in another patient. Both patients were managed with early implant removal and spinal arthrodesis. Self-assessment questionnaires showed improvement of patients' clinical and functional status. The Oswestry Disability Index and the Roland-Morris Disability Questionnaire score improved from a mean preoperative score of 55.4% (severe disability) and 52% respectively to a mean postoperative score of 22.9% (moderate disability) and 35% respectively. The overall results of this study are highly comparable to fusion procedures. The dynamic neutralization system can be a safe and effective alternative technique to spine arthrodesis in selected cases of degenerative lumbar spine instability.

Diving injuries of the cervical spine in amateur divers.

BACKGROUND CONTEXT: Diving injuries are the cause of potentially devastating trauma, primarily affecting the cervical spine. PURPOSE: Our purpose was to describe our experience with diving injuries treatment. STUDY DESIGN: Retrospective review. PATIENT SAMPLE: Twenty patients with diving injuries. OUTCOME MEASURES: Using the American Spinal Injury Association (ASIA) impairment scales as the primary outcome measure, the patients' neurological status before and after treatment was assessed. In this way we were able to draw conclusions about neurological improvement or deterioration in response to conservative or operative treatment. METHODS: We retrospectively reviewed 20 patients with diving injuries of the cervical spine who were admitted to our institute over a 34-year period from 1970 until 2004. RESULTS: The typical patient profile was of a young, healthy, athletic male who suffered an injury to the cervical spine after diving into shallow water. The number of cases corresponds to 2.6% of all admitted cervical spine injuries. All injures occurred between May and September. The most commonly fractured vertebrae were C5 and C6. Four patients were treated operatively and 16 conservatively. The indications for surgical treatment were posttraumatic instability and persistent neurological deficit. The mean follow-up of the patients was 17 years. Five patients died within the first month of their hospitalization and 1 patient died 1 year after his injury. Of the 14 patients who were available for follow-up 5 years past injury time, 6 improved neurologically and 8 remained unchanged in relation to their neurology upon admission. Of the 11 patients who were available for follow-up 10 years past injury time, 9 remained neurologically unchanged, 1 deteriorated, and 1 improved in relation to their neurology in the 5-year follow-up. CONCLUSION: Diving injuries of the cervical spine demonstrate high mortality and morbidity rates. Recovery depends on the severity of the initial neurological damage. Conservative treatment is justified in specific patients and can lead to improvement of the initial neurological deficit.