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BACKGROUND CONTEXT: Domino osteoporotic vertebral fractures (OVFs) involve multiple OVFs occurring simultaneously or sequentially, before healing of the initial OVFs. However, the risk factors and long-term clinical outcomes of domino OVFs are unclear. PURPOSE: To identify the risk factors associated with domino OVFs and to assess their impact on patients' quality of life (QOL). STUDY DESIGN/SETTING: Multicenter prospective observational cohort study. PATIENT SAMPLE: Patients (nâ¯=â¯190) treated conservatively for acute OVFs in eight hospitals with 12-month follow-up. OUTCOME MEASURES: Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Multivariate analyses were performed to identify risk factors for domino OVFs. METHODS: All patients underwent magnetic resonance imaging (MRI) at 3 months to detect subsequent domino OVFs. Domino OVF group included initial domino OVFs (multiple acute OVFs at baseline) and subsequent domino OVFs at 3 months. Paraspinal muscle assessment was performed using the lumbar indentation value and Goutallier classification. Patient characteristics, bone quality, paravertebral muscle degeneration, nutritional status, radiographic parameters, and QOL scores were compared between the non-domino and domino OVF groups. RESULTS: We evaluated 50 (26.3%) patients with domino OVFs (34 with initial domino OVFs; 20 with subsequent domino OVFs). Walking ability was poorer in the domino than in the non-domino OVF group, from baseline to the 12 months follow-up. Groups with three or more adjacent domino OVFs showed worse VAS and ODI scores. Multivariate logistic regression analysis revealed that severe fatty degeneration of the paraspinal muscle was an independent risk factor for domino OVFs. CONCLUSIONS: Severe paraspinal muscle fatty degeneration is an independent risk factor for domino OVFs. Our study showed that the quality, rather than the quantity, of paraspinal muscles had an impact on domino OVFs. Early assessment of fatty degeneration in the paraspinal muscles is essential for predicting the development of domino OVFs.
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Study Design: Prospective cohort study. Purpose: This study aimed to identify the optimal preoperative bone health assessment for adult spinal deformity (ASD) surgery through correlation analysis between intraoperative pedicle screw (PS) insertion torque and various bone quality measures, including bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DEXA), Hounsfield unit (HU) by computed tomography (CT), and vertebral bone quality (VBQ) score by magnetic resonance imaging. Overview of Literature: Existing data on optimal assessment tools for ASD surgery are limited. Methods: The study included patients with ASD aged >60 years who underwent spinal corrective fusion surgery from the lower thoracic spine to the pelvis. The intraoperative PS insertion torque was measured using a torque meter. Pearson correlation coefficients were calculated between the PS insertion torque and the BMD, HU, and VBQ score. Preoperative bone quality was compared between the proximal junctional failure (PJF) and non-PJF groups. Results: Thirty-one patients with 177 PS at T10, T11, and T12 were analyzed. The PS insertion torque showed a moderate positive correlation with lumbar spine BMD (r=0.59-0.69, p<0.01), total hip BMD (0.58-0.62, p<0.01), and HU value (r=0.58-0.66, p<0.01). However, the VBQ score did not show significant correlation (r=-0.28 to -0.23, p >0.05). Notably, a strong correlation was found between the PS insertion torque and the HU value for screws of the same size (r=0.71 and 0.74, p<0.01). The HU value at T12 and the PS insertion torque at T10 were significantly lower in the PJF group than in the non-PJF group. Conclusions: This study demonstrates a positive correlation between the PS insertion torque and HU value in the lower thoracic spine and a moderate correlation with BMD but not the VBQ score. Preoperative assessment using DEXA and CT is crucial for optimizing bone health management in ASD surgery.
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BACKGROUND: It has been reported on the relationship between the medial cuneiform bone morphology, especially in terms of obliquity, and the severity of hallux valgus (HV), however, no consensus has been obtained. On the other hand, there are no reports on the relationship between the difference in height between the medial and intermediate cuneiforms and the severity of hallux valgus. The purpose of this study was to clarify the relationship between the medial cuneiform bone morphology and the severity of HV. METHODS: The authors retrospectively analyzed 200 feet of 116 patients who had a weightbearing anteroposterior foot radiograph taken between April 2017 and July 2022 and diagnosed with HV. Measurements included the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal medial cuneiform angle (DMCA) and the cuneiform first-second length (C1-2D). HV groups were classified into one of three groups: mild (15 ⦠HVA<30°, 9 < IMA<13°), moderate (30 ⦠HVA<40°, 13 ⦠IMAâ¦20°) and severe groups (HVAâ§40°, IMA>20°), and the relationship to DMCA or the difference in height between the medial and intermediate cuneiforms was analyzed. RESULTS: A total of 163 feet of 93 patients were included in this study. There were significant correlations between the HVA and the DMCA (r = 0.47, p <0.001) or the C1-2D (r = 0.64, p <0.001). There was no significant difference in DMCA between the mild and moderate groups (p = 0.14). On the other hand, significant differences in C1-2D were observed between the three groups (mild-moderate; p <0.001, moderate-severe; p = 0.03, mild-severe; p <0.001). IMA was also positively correlated with the DMCA (r = 0.30, p <0.001) or the C1-2D (r = 0.47, p <0.001). However, the DMCA (p = 0.07) and the C1-2D (p = 0.39) did not differ significantly from IMA between the moderate and severe groups. CONCLUSIONS: The difference in height between the medial and intermediate cuneiforms, referred to as C1-2D, is closely associated with the HVA. The C1-2D may influence the progression of HV and be a novel radiographic parameter that indicates severity of HV.
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Introduction: Domino osteoporotic vertebral fracture (OVF) is as a subsequent fracture that develops within 3 months before the initial OVF heals. There is limited evidence regarding the efficacy of osteoanabolic agents on its treatment. This study evaluated the effects of bisphosphonates and anabolic agents teriparatide and romosozumab on subsequent domino OVF. Methods: This was post hoc analysis of a prospective, multicenter, observational study conducted across 8 hospitals, enrolling 144 patients with conservatively treated OVF, grouped into patients receiving bisphosphonate (BP, n = 55), teriparatide (TPTD, n = 62), and romosozumab (Romo, n = 27). The primary outcome was the incidence of subsequent OVF at 3 and 12 months, whereas the secondary outcomes included the incidence of pseudoarthrosis and progression of vertebral collapse (VC). Pseudoarthrosis was classified as stable or unstable based on vertebral instability. Results: The use of osteoanabolic agents did not reduce the incidence of subsequent OVF at 3 and 12 months. There were no significant differences in the background data or type of conservative treatment among the three groups. However, the TPTD and Romo groups had significantly lower rates of unstable pseudarthrosis (p = 0.03). Additionally, there were no significant differences in VC progression between groups, but it tended to be higher in the BP group than the TPTD and Romo group (p = 0.07). Conclusion: Osteoanabolic agents were beneficial in reducing unstable pseudoarthrosis, but were not more effective than bisphosphonates in the development of subsequent domino OVF. A more comprehensive approach to the treatment of osteoporosis is needed to prevent domino OVFs.
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An open reduction-internal fixation is generally recommended in Type I lateral process fractures of the talus when the dislocation of the fragment is >2 mm. This report describes a case of a lateral process fracture of the talus in a 24-year-old male basketball player who underwent arthroscopic reduction-internal fixation. The patient complained of pain on the lateral aspect of his left ankle during a cutting motion. Based on physical examination and radiological findings, the patient was diagnosed with a lateral process fracture of the talus and underwent surgical treatment with arthroscopic reduction-internal fixation. At 12 weeks after the surgery, bone union was achieved, and the patient was able to resume playing basketball at his pre-injury level without symptoms, complications, or functional impairment. Lateral process fracture of the talus in a 24-year-old male basketball player was successfully treated with arthroscopic reduction-internal fixation.
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Charcot spinal arthropathy (CSA) is a very rare condition that causes destruction and deformity of the spine due to impaired sensation. We report a case of an infected Charcot spine arthropathy (ICSA) treatment with spinal reconstruction surgery using a minimally invasive surgery (MIS) technique. A 49-year-old man who had a spinal cord injury (SCI) at age 19 presented with a destructive lesion in the L2/3 and a fistula in his lower back. Spinal reconstruction surgery using a penetrating endplate screw, lateral lumbar interbody fusion (LLIF), and a computer-assisted rod bending system were performed. A CT scan taken six months after surgery showed bony fusion. Reconstruction of the destructive spine is necessary to control the infection and symptoms due to kyphotic deformity for ICSA. Although the treatment of ICSA generally requires a highly invasive approach, we have achieved good clinical results with minimally invasive reconstructive surgery.
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Background: While cementless short stems have become popular in total hip arthroplasty (THA), Metha is a relatively recent development that differs from other short stems in its initial fixation concept of partial collum-sparing metaphyseal anchorage. The purpose of this study was to quantify the contact state between Metha and the femur. Additionally, we investigated the difference in contact points between Meta and Fitmore, which is one of the more popular curved short stems. Methods: We conducted a retrospective review of 42 hips that underwent THA using Metha and 41 hips using Fitmore. Stem-to-femur contact was evaluated by density mapping using a three-dimensional digital template system to quantify the contact condition according to the modified Gruen zone. The criterion for the stem-to-bone contact boundary was defined as a computed tomography value of 543 Hounsfield. Results: Quantitative evaluation of Metha according to the modified Gruen zones showed the ratio of surface area with high cortical contact in each zone. The results were 4.6% ± 5.7% in zone 1, 0.9% ± 2.3% in zone 2, 19.1% ± 12.9% in zone 3, 1.4% ± 3.2% in zone 5, 29.6% ± 16.4% in zone 6, and 25.1% ± 17.7% in zones 7. Evaluation of Fitmore for the same zones was as follows: 1.6% ± 2.4%, 18.5% ± 16.9%, 20.8% ± 17.4%, 12.7% ± 12.8%, 3.7% ± 5.8%, and 13.3% ± 10.3%. Comparing the two groups, the contact area was significantly greater for Metha in zones 1, 6 and 7 and Fitmore in zones 2 and 5 (p < 0.05). Conclusions: It is possible for Metha to achieve metaphyseal anchoring by contacting the cortical bone at the proximal femur, thus avoiding proximal offloading. To the best of our knowledge, no previous studies have quantitatively reported stem-to-cortical bone contact conditions in curved short stems.
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Artroplastia de Quadril , Prótese de Quadril , Humanos , Artroplastia de Quadril/métodos , Tomografia Computadorizada por Raios X , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Software , Desenho de PróteseRESUMO
Background: The Landing Error Scoring System (LESS) has been utilized on the field or in the clinic to identify patients with an increased risk for anterior cruciate ligament (ACL) injuries; however, its validity and efficacy have not been fully confirmed. Purpose: To assess the efficacy of the LESS in identifying the ACL injury risk by examining the correlation between the LESS score and motion patterns on 3-dimensional kinematic analysis. Study Design: Controlled laboratory study. Methods: The jump-landing motion was analyzed for 16 female basketball or badminton players who volunteered to participate in the study. All study participants were aged 19 or 20 years. The sequence of motion was evaluated with the LESS, while kinematic data were simultaneously acquired with a 3-dimensional motion analysis system utilizing the point cluster method. The correlation between the LESS score and knee kinematics was statistically analyzed. Results: When a LESS score ≥6 was defined to be a risk factor for ACL injuries, 7 of the 16 participants (43.8%) were found to exhibit risky motion patterns. Significant correlations were noted between the LESS score and knee valgus (r = 0.87; P < .0001) and internal tibial rotation (r = 0.57; P = .02) at landing. By contrast, a substantial variability was present in knee flexion, showing no correlation with the LESS score. Conclusion: Significant correlations were found between the LESS score and knee valgus and internal tibial rotation during a jump-landing task. Clinical Relevance: The LESS can be regarded as an effective measure to identify risky motion patterns that may increase the likelihood of ACL injuries.
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Osteochondral autologous transplantation (OAT) is one of the most common surgical options for osteochondral disorders of the knee. In cases where OAT is performed for steroid-induced osteonecrosis, there are several problems potentially affecting the surgical outcomes such as large chondral damage area and compromised host bone. In addition, steroid administration for a long period of time may lead to extensive lesion, which poses difficulty in obtaining sufficient donor tissue. Those factors affect the prognosis of steroid-induced osteonecrosis resulting in inferior treatment outcomes. We present a young female with a large steroid-induced osteonecrosis lesion repaired only with two osteochondral plugs harvested from the healthy area. The reported case indicates that only partial osteochondral grafting limiting to the weight-bearing area may yield satisfactory outcome when OAT is performed for large steroid-induced osteonecrosis of the knee.
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BACKGROUND: It still unclear whether copers may bear the same time-sensitive risk of intra-articular injury as non-copers. The objectives were to investigate the clinical characteristics of copers and non-copers that have sustained an anterior cruciate ligament (ACL) injury, and to examine and compare the intra-articular pathologies in delayed ACL reconstruction (ACLR) in copers and noncopers. METHODS: Patients who sustained ACL injury while participating in high-performance sports and opted for non-operative treatment were enrolled in this study. Depending on the occurrence of the knee giving way, patients were classified into copers and noncopers. Clinical characteristics were compared between the two groups. Additionally, intra-articular injuries were evaluated for those who eventually underwent delayed ACLR. RESULTS: 11 of the 75 patients (14.7%) were classified as copers. No major differences were found in the clinical characteristics between groups. Following the initial non-operative treatment, 67 patients underwent delayed ACLR. When examining intra-articular abrasions at the time of surgery, non-copers who continued sports activities for 3 to 12 months exhibited a significantly higher rate of injury as opposed to their coper counterparts. However, the difference in the prevalence of intra-articular lesions between the two groups in patients who continued to play sports for at least 12 months before surgery was nominal. CONCLUSION: The rate of copers was relatively low in patients who resumed playing high-level sports after ACL injury. Additionally, even in copers, those who continued sports activities for more than 12 months had comparably high prevalence of intra-articular injuries with noncopers. STUDY DESIGN: Retrospective case-control study; Level of evidence, 3.
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Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Humanos , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Ligamento Cruzado Anterior/cirurgia , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Estudos de Casos e Controles , Estudos Retrospectivos , PrevalênciaRESUMO
Background: The purpose of this study was to examine the biomechanical significance of supplemental fixation using a positional screw in prevention of the hinge fracture in lateral closed-wedge distal femoral osteotomy (LCW-DFO) by means of a three-dimensional finite element analysis. Methods: The three-dimensional numerical knee models with LCW-DFO were developed. To assess the mechanical efficacy of the positional screw and determine its optimal position and orientation, in total, 13 screwing methods were analyzed. In the first four methods, the screw was supported by the cortical bone only on the medial surface (mono-cortical). In the other 9 models, the screw was supported by both medial and lateral cortical bones (bi-cortical). Under 1000 N of vertical force and 5 Nm of rotational torques, the highest shear stress value around the medial hinge area was adopted as an analytical parameter. Results: In mono-cortical methods, with the cancellous bone support, all methods were able to reduce the highest stress value compared to the value without the screw, while the efficacy was rather inferior when the screw was in horizontal direction. Without the cancellous bone support, however, all methods were not able to reduce the stress value. In bi-cortical methods, with the cancellous bone support, almost all screw augmentation methods were able to reduce the stress value. When screwing from the medial to the lateral, it only gets worse when going extremely posterior. Without the cancellous bone support, all methods were able to reduce the stress value. Conclusion: The mechanical efficacy of the bi-cortical method was proven regardless of the quality of the local cancellous bone.
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Introduction: In this case report, we report a patient with complicated with persistent hemarthrosis following arthroscopic meniscal repair. Case Presentation. A 41-year-old male patient presented with persistent swelling of the knee 6 months after arthroscopic meniscal repair and partial meniscectomy performed for lateral discoid meniscal tear. The initial surgery was performed at another hospital. Four months after the surgery, swelling of the knee was noted when he resumed running. At his initial visit to our hospital, intra-articular blood accumulation was revealed via joint aspiration. A second arthroscopic examination performed 7 months after the initial procedure showed healing of the meniscal repair site and synovial proliferation. The suture materials identified during the arthroscopy were removed. Histological examination of the resected synovial tissue showed inflammatory cell infiltration and neovascularization. In addition, a multinucleated giant cell was identified in the superficial layer. After the second arthroscopic surgery, the hemarthrosis did not recur, and the patient was able to resume running without symptom one and a half years post-surgery. Conclusion: Bleeding from the proliferated synovia at or near the periphery of the lateral meniscus was thought to be the cause of the hemarthrosis as a rare complication following arthroscopic meniscal repair.
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Bacillus Calmette-Guérin osteomyelitis is a rare complication following Bacillus Calmette-Guérin vaccination. Here, we describe a rare case of Bacillus Calmette-Guérin osteomyelitis of the fifth metatarsal in a 21-month-old Japanese infant. A 21-month-old Japanese female infant presented with a swollen mass on the dorsolateral aspect of the left foot. Based on physical examination, radiological and histopathologic findings and laboratory results, a diagnosis of Bacillus Calmette-Guérin osteomyelitis of the fifth metatarsal bone was made, and an oral anti-tuberculosis treatment was initiated. However, the mass recurred 10 months after the start of the anti-tuberculosis treatment, so additional surgical debridement was performed. Six months after surgery, clinical findings and plain radiograph images revealed complete improvement of the affected area, and anti-tuberculosis treatment was stopped. Bacillus Calmette-Guérin osteomyelitis of the fifth metatarsal in a 21-month-old Japanese infant was successfully treated with oral anti-tuberculosis therapy and surgical debridement.
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Background and Objectives: In this retrospective cohort study, we investigate associations between the Hounsfield units (HU) value of upper instrumented vertebra (UIV) and proximal junctional kyphosis (PJK) after adult spinal deformity (ASD) surgery. Materials and Methods: The cohort consisted of 60 patients (mean age 71.7 years) who underwent long instrumented fusion surgery (≥6 vertebrae) for ASD with at least 1 year of follow-up. The preoperative bone mineral density (BMD) measured on DXA scans, the HU values at UIV and UIV+1, and the radiographic parameters were compared between the PJK and non-PJK groups. The severity of UIV fracture was assessed using a semiquantitative (SQ) grade. Results: PJK occurred in 43% of patients. No significant differences in patient age, sex, BMD, and preoperative radiographic parameters were observed between the PJK and non-PJK groups. The HU values of the UIV (103.4 vs. 149.0, p < 0.001) and UIV+1 (102.0 vs. 145.7, p < 0.001) were significantly lower in the PJK group. The cutoff values of HU at UIV and UIV+1 were 122.8 and 114.9, respectively. Lower HU values at UIV (Grade 1: 134.2, Grade 2: 109.6, Grade 3: 81.1, p < 0.001) and UIV+1 (Grade 1: 131.5, Grade 2: 107.1, Grade 3: 82.1, p < 0.001) were associated with severe SQ grade. Conclusions: Lower HU values at UIV and UIV+1 had a negative impact on signal incidence of PJK and were correlated with the severity of UIV fractures. Preoperative treatment of osteoporosis seems necessary for preoperative UIV HU values less than 120.
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Cifose , Fraturas da Coluna Vertebral , Humanos , Adulto , Idoso , Estudos Retrospectivos , Coluna Vertebral/cirurgia , Cifose/diagnóstico por imagem , Cifose/etiologia , Cifose/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Incidência , Complicações Pós-Operatórias/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgiaRESUMO
PURPOSE: This study aimed to compare the accuracy of pedicle screw (PS) placement between a low-profile three-dimensional (3D) printed patient-specific guide system and freehand technique for adolescent idiopathic scoliosis (AIS) surgery. METHODS: Patients with AIS who underwent surgery between 2018 and 2023 at our hospital were included in the study. The 3D-printed patient-specific guide was used since 2021 (guide group). PS perforation was classified using Rao and Neo's classification (grade 0, no violation; grade 1, < 2 mm; grade 2, 2-4 mm; grade 3, > 4 mm). Major perforations were defined as grades 2 or 3. The major perforation rate of PS, operative time, estimated blood loss (EBL), and correction rate were compared between the two groups. RESULTS: A total of 576 PSs were inserted in 32 patients (20 patients in the freehand (FH) group and 12 patients in the guide group). The major perforation rate was significantly lower in the guide group than in the FH group (2.1% vs. 9.1%, p < 0.001). Significantly fewer major perforations were observed in the guide group than in the FH group in the upper thoracic (T2-4) region (3.2% vs. 20%, p < 0.001) and lower thoracic (T10-12) region (0% vs. 13.8%, p = 0.001). The operative time, EBL, and correction rate were equivalent between the two groups. CONCLUSION: The 3D-printed patient-specific guide notably reduced the major perforation rate of PS without increasing EBL and operative time. Our findings indicate that this guide system is reliable and effective for AIS surgery.
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Cifose , Parafusos Pediculares , Escoliose , Fusão Vertebral , Humanos , Adolescente , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Parafusos Pediculares/efeitos adversos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Duração da Cirurgia , Estudos RetrospectivosRESUMO
Purpose: The main purpose of this study was to compare the clinical outcome of surgery versus observation in young athletes with fractured osteochondromas in the knee. The secondary aim was to evaluate displacement versus non-displacement fractures with regards to functional recovery. Methods: A retrospective analysis was performed in young athletes with fractures of osteochondromas in the knee. In the surgery group, resection of the osteochondromas was performed due to pain persisting at 4 weeks after injury. In contrast, patients with pain diminishing within 4 weeks after injury were observed without surgery. Displacement was defined as a gap widening of ≥1 mm between fragments, or translation of >50% of the distal fragment in relation to the proximal fragment. The time to return to the original sport was compared between groups. Results: The study sample was composed of 21 patients with a mean age of 12 years (range 9-16 years). There were 14 patients in the surgery group and 7 patients in the observation group. There were 10 patients (71%) with displacement and 4 patients (29%) with non-displacement fractures in the surgery group. Surgery was required more frequently in displacement than in non-displacement fracture patients (p = 0.01). The mean time to return to the original sport was 2.1 ± 1.1 and 7.2 ± 4.1 weeks in the surgery and observation groups, respectively (p < 0.01). Conclusions: Surgical excision is preferable in a young athlete's knee presenting with displacement of fractured osteochondromas due to disabling symptoms and in order to allow them to return faster to original sports activities.
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A chronic Achilles tendon rupture (ATR) is generally defined as a rupture that occurs more than 4-6 weeks after the initial injury. A variety of corrective techniques have been reported, such as direct repair, V-Y plasty, turndown flap, tendon transfer and free tendon grafting. These procedures generally produce good results, but have the disadvantage of requiring prolonged immobilization and weight-bearing restrictions. This may be a risk factor for falls and decreased function in the lower limbs, especially in older patients. Side-locking loop sutures (SLLS) were first introduced in 2010 as a direct repair technique for acute ATR. This technique provides higher tensile strength, which may allow for early rehabilitation protocols such as early range of motion and early weight-bearing of the ankle without postoperative immobilization. In this report, we describe two cases of chronic ATR in elderly patients treated with SLLS and an early rehabilitation protocol.
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BACKGROUND: Anterior quadratus lumborum block (AQLB) is one of the compartment blocks and has recently attracted attention as a new method of analgesia for postoperative hip surgery analgesia. This study aimed to compare the analgesic efficacy of AQLB in patients undergoing primary total hip arthroplasty (THA). METHODS: There were 120 patients undergoing primary THA under general anesthesia randomly allocated to receive a femoral nerve block (FNB) or an AQLB. The primary outcome was total morphine consumption over the initial 24-hour postoperative period. Secondary outcomes included the pain score evaluation while at rest and during active and passive motion over the 2 days following surgery and the manual muscle testing of the quadriceps femoris. The numerical rating scale (NRS) score was used for evaluating the postoperative pain score. RESULTS: There were no significant differences between the 2 groups concerning morphine consumption within 24 hours after surgery (P = .72). The NRS score at rest and passive motion were similar at all-time points (P > .05). However, there was a statistically significant difference in pain reported during the active motion for the FNB group compared to the AQLB (P = .04). No significant differences were found between the 2 groups concerning muscle weakness incidence. CONCLUSION: Both AQLB and FNB demonstrated adequate efficacy for postoperative analgesia at rest in THA. However, based on our study, whether AQLB is inferior or noninferior to FNB as an analgesic method for THA was inconclusive.
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Artroplastia de Quadril , Humanos , Artroplastia de Quadril/efeitos adversos , Analgésicos Opioides/uso terapêutico , Analgésicos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Morfina/uso terapêutico , Anestésicos LocaisRESUMO
A 78-year-old woman complained of right heel pain when tripping during walking. Radiographs revealed an avulsion fracture of the calcaneal tuberosity. Because the bone fragment was displaced, a novel osteosynthesis using the side-locking loop suture (SLLS) and ring pins was performed. At 3 months after the surgery, non-contrast computed tomography revealed complete bone union. At 2 years postoperatively, she had no symptoms and dysfunctions. Here, we describe a case of avulsion fracture of the calcaneal tuberosity in a 79-year-old female who treated with a novel surgical technique using combination the SLLS technique and ring pins. This surgical technique may be a useful option in the treatment for avulsion fractures of the calcaneal tuberosity.