Treatment of the Hoffa fracture of the lateral femoral condyle with cannulated screws in combination with an anti-gliding steel plate, a retrospective observational study.

BACKGROUND: The stability of the Hoffa fracture fixed with a cannulated screw is limited. In the present work, we adopted two cannulated screws from anterior to posterior and posteriorly anti-gliding plate to treat 12 cases with Hoffa fracture of the lateral femoral condyle. METHODS: Open reduction and internal fixation were performed in 12 patients with Hoffa fractures of the lateral femoral condyle. The Hoffa fracture end was fixed with an anti-gliding steel plate based on cannulated screw fixation in the rear of the distal femur. All patients were followed for 12-24 months, with a median of 15.3 ± 4.6 months. RESULTS: All fractures were bony union, with a healing time of 3-6 months (median, 4.5 months). The Letenneur evaluation system was used to assess efficacy. Four indexes were observed, including knee range of motion (ROM), stability, pain, and dependent ambulation. The results revealed that eight cases were excellent and four cases good, with a good rate of 100%. CONCLUSION: The surgical treatment with cannulated screws in combination with an anti-gliding steel plate could fix the end of the Hoffa fracture, which could acquire strong internal fixation and a good curative effect.

Clinical impact and imaging results after a modified procedure of ACDF: a prospective case-controlled study based on ninety cases with two-year follow-up.

STUDY DESIGN: This is a prospective case-controlled study. BACKGROUND: To analyze the postoperative axial pain and cage subsidence of patients presenting with cervical spondylotic myelopathy (CSM) after a modified procedure of ACDF (mACDF). METHODS: Ninety patients with CSM were prospectively collected from 2014 to 2018. The patients were divided into spread group and non-spread group (48:42 ratio) according to the cage placement with or without releasing the Caspar cervical retractor after decompression. Spread group received conventional ACDF and non-spread group received mACDF. Patients were followed-up for at least 24 months after surgery. Radiologic data, including height of intervertebral space and Cobb Angle, were collected. Nervous system function was obtained using JOA scores, and level of pain was assessed using VAS scores. RESULTS: A total of 90 patients were enrolled and the patients were divided into spread group (n = 48) and none-spread group(n = 42). Cage subsidence of (spread group vs none-spread group) was (0.82 ± 0.68 vs 0.58 ± 0.81) mm, (0.64 ± 0.77 vs 0.34 ± 0.46) mm, (0.48 ± 0.43 vs 0.25 ± 0.28) mm, and (0.45 ± 0.47 vs 0.17 ± 0.32) mm at 3 months, 6 months, 12 months and 24 months, respectively. The period exhibiting the most decrease of the height of intervertebral space was 3 months postoperatively. However, there was no statistical difference in the height of intervertebral space, JOA or VAS scores at the final follow-up between the two groups. CONCLUSIONS: The mACDF can avoid excessive distraction by releasing the Caspar Cervical retractor, restore the "natural height" of cervical vertebra, relieve immediate pain after surgery, and prevent rapid Cage subsidence and the loss of cervical curvature.

Conversion Hip Arthroplasty Using Standard and Long Stems after Failed Internal Fixation of Intertrochanteric Fractures.

OBJECTIVE: Failed internal fixation of intertrochanteric fractures (FIF-ITF) is often treated by conversion hip arthroplasty (CHA). This study aimed to evaluate the results and complications of using standard and long femoral stems in this operation. METHODS: This retrospective, multi-center study enrolled 31 total hip arthroplasty (THA) and 23 hemiarthroplasties (HA) cases (30 women, 24 men; mean age 76 years) after FIF-ITF between 2012 and 2019, divided into two groups: standard stem group (n = 20) and long stem group (n = 34). The initial internal fixation includes 38 cases of proximal femoral nail anti-rotation (PFNA), eight cases of the dynamic hip screw (DHS), and eight cases of locking proximal femoral plate (LPFP). The indications for CHA included 38 cases of failure of fixation, seven cases of nonunion, and nine cases of avascular necrosis or posttraumatic osteoarthritis. Perioperative data and complications related to fracture and operation were collected, and preoperative and postoperative clinical and radiological data were analyzed. Clinical outcomes were assessed using Harris hip score (HHS) and 36-item Short Form survey (SF-36: including physical function (PF) score and body pain (BP) score). Statistical analyses were performed using the chi-square or Fisher's exact test, and the 2-sample t-test or Wilcoxon rank sum test. RESULTS: At an average of 5.6 years with a minimum of 2 years follow-up. A significant overall surgeon-related complication rate was detected (27.8% [15/54]), five cases had an intraoperative femur fracture, one case had a late periprosthetic femoral fracture, two cases had a stem penetration, one case had a cement leakage, and two patients had an early postoperative dislocation, one infection and three cases of stem loosening or subsidence. Long stems had an increased risk of complication (13/34) compared to standard stems (2/20) (P = 0.031). The operation time and blood loss in the long stem group were higher than those in the standard stem group (P = 0.002; 0.017). HHS and SF-36 significantly improved in both groups from preoperative to the final follow-up and did not present significant differences at the final follow-up (P > 0.05). CONCLUSION: CHA following FIF-ITF showed a successful mid-term clinical result, long stem arthroplasty should be approached with caution for the risks of higher complication rate, especially intraoperative femoral fractures.

Research on Influencing Factors of Clinical Efficacy of Meniscus Resection Based on Logistic Regression Analysis.

In order to solve the factors affecting the clinical efficacy of meniscus resection, a method based on logistic regression analysis is proposed. From May 2019 to May 2020, 60 patients with discoid meniscus who underwent arthroscopic surgery in the Joint Department of the Second Hospital of a certain city were selected as the research objects; the surgical methods are divided into partial meniscus excision and plasty and total meniscus resection. The Lysholm function score was used to evaluate the clinical efficacy of arthroscopic surgery for discoid meniscus injuries before and 3, 6, and 12 months after surgery and postoperative application of Ikeuchi score and Tegner exercise ability score to assess age, gender, body mass index (BMI), duration of symptoms, and the influence of meniscus injury types and surgical methods on the efficacy of arthroscopic surgery for discoid meniscus injuries. Experimental results show that Ikeuchi's assessment of the excellent and good rate of arthroscopic knee joints was significantly higher than that of the control group, the incidence of postoperative pain was significantly lower than that of the control group, and the difference was statistically significant (P < 0.05). Postoperative pain and premature weight-bearing of discoid meniscus injury of knee joint, factors such as noncold compress after operation, articular cartilage damage, age, and time from onset to operation are closely related; the difference was statistically significant (P < 0.05). Postoperative evaluation according to Ikeuchi score: excellent in 38 cases, good in 14 cases, 8 cases were poor, and the excellent and good rate was 86.7%. The patient's age, type of meniscus tear, and duration of symptoms have a certain impact on the postoperative clinical efficacy of discoid meniscus injury; BMI and surgical methods have no significant impact. Logistic regression analysis results show that postoperative pain and premature weight-bearing of discoid meniscus injury of the knee joint, no cold compress after operation, accompanied by articular cartilage damage, age, and factors such as onset to operation time are closely related; the difference was statistically significant (P < 0.05). It proves that arthroscopic surgery for discoid meniscus injury has the advantages of less damage and faster recovery, it is the first choice for the treatment of discoid meniscus injury, and the postoperative effect is significant in young patients and those with short duration of symptoms; mixed tears have a greater impact on the postoperative recovery of patients with discoid meniscus injury; therefore, patients with discoid meniscus injury should undergo surgery as soon as possible and perform active rehabilitation exercises after the operation.

MRI changes of adjacent segments after transforaminal lumbar interbody fusion (TLIF) and foraminal endoscopy: A case-control study.

BACKGROUND: Intervertebral foramen endoscopy has developed rapidly, but compared with transforaminal lumbar interbody fusion (TLIF), the progress of degeneration is unknown. We aim to compare the changes of intervertebral disc and intervertebral foramen in adjacent segments after TLIF and endoscopic discectomy for patients with lumbar disc herniation (LDH). METHODS: From 2014 to 2017, 87 patients who were diagnosed with single-level LDH and received surgery of TLIF (group T, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up (FU). The neurological function was originally evaluated by the Japanese Orthopaedic Association (JOA) scores. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration Pfirrmann scores. RESULTS: There was no significant difference in baseline characteristics, JOA improvement rate, reoperation rate and complications between the two groups. The age, average blood loss, average hospital stays and average operation time in group F were lower than those in group T. During the last FU, HIS, CA and FA decreased in both groups, and the changes in group T were more significant than those in group F (P < .05). There was no significant difference in FH changes between the two groups (P > .05). CONCLUSION: Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar disc height loss and intervertebral foramina reduction in the adjacent segment after endoscopic surgery is lower.

Clinical Research of Orthopedic Trauma Based on Computer 3D Image Analysis.

In order to improve the clinical research effect of orthopedic trauma, this paper applies computer 3D image analysis technology to the clinical research of orthopedic trauma and proposes the BOS technology based on FFT phase extraction. The background image in this technique is a "cosine blob" background image. Moreover, this technology uses the FFT phase extraction method to process this background image to extract the image point displacement. The BOS technology based on FFT phase extraction does not need to select a diagnostic window. Finally, this paper combines computer 3D image analysis technology to build an intelligent system. According to the experimental research results, the clinical analysis system of orthopedic trauma based on computer 3D image analysis proposed in this paper can play an important role in the clinical diagnosis and treatment of orthopedic trauma and improve the diagnosis and treatment effect of orthopedic trauma.

Long-Term Effectiveness of Total Hip Replacement with the Collum Femoris Preserving Prosthesis.

The objective of this study was to follow-up long term (5-12 years) patients with total hip arthroplasty with the collum femoris preserving prosthesis to evaluate clinical outcome and potential complications. Forty-six of 152 patients who underwent this procedure between September 2000 and September 2012 were followed up. The average follow-up time was 7.6 years, and assessed were radiographs, Harris score, limb length, hip function, and complications. Six patients had perioperative complications including five cases of femoral shaft fracture and one case of dislocation 1 week after the operation. No infections of the surgical site, no deep venous thrombosis or pulmonary embolism were observed. The last recorded Harris hip score improved from a preoperative average of 41.2 (range 17-60) to an average of 82.3 (74-96), with the score >80 in 38 patients, 70-80 in six patients, and <70 in two patients. Radiolucent lines were found on radiographs in two patients with acetabular prosthesis and one patient with femoral prosthesis. The remainder of patients had satisfactory positions of acetabular and femoral stem prostheses with no loosening or subsidence, and a good condition of femoral neck. Total hip arthroplasty with the collum femoris preserving prosthesis is a good option for younger patients who need prosthesis revision. This arthroplasty achieves satisfactory long-term effectiveness.