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Abstract Knee osteoarthritis (OA) is an inflammatory and degenerative condition resulting in articular cartilage destruction and functional loss. Its prevalence has grown considerably due to increased life expectancy and obesity, and its diagnosis relies on evaluation, medical examination, and confirmation by supplementary radiographic images. Knee OA is multifactorial and influenced by several local, systemic, and external aspects. In addition, its progress and therapeutic responses highly depend on the characteristics of each subject. The initial recommendation is drug treatment and alternative therapies to improve quality of life. However, if these treatments are unsuccessful, one must consider surgical treatment. Surgical options include arthroscopies, osteotomies, and partial and total arthroplasties, while non-surgical treatments include medications and alternative therapies such as infiltrations, acupuncture, and physical exercise. It is worth highlighting that biomarkers can be a significant strategy for early disease detection, assessment of disease activity, prediction of prognosis, and monitoring a better response to therapy. Nevertheless, this topic must be the focus of further research to confirm its findings.
Resumo A osteoartrite (OA) do joelho é uma doença inflamatória e degenerativa que ocasiona a destruição da cartilagem articular e leva à perda de funções. Sua prevalência vem crescendo consideravelmente devido ao aumento da expectativa de vida e da obesidade, e o diagnóstico pode ser feito por meio de avaliação e exames médicos, e é confirmado em imagens radiográficas complementares. Uma condição multifatorial, a OA do joelho pode ser influenciada por diversos aspectos locais, sistêmicos e externos; além disso, a sua evolução e as respostas aos tratamentos dependem muito das características de cada indivíduo. Inicialmente, recomenda-se proceder a um tratamento medicamentoso e a terapias alternativas que melhorem a qualidade de vida do paciente; mas, a partir do momento em que se verifica que tais terapias não estão proporcionando resultados satisfatórios, um tratamento cirúrgico deve ser considerado. Entre os tratamentos cirúrgicos, as artroscopias, as osteotomias e as artroplastias parciais e totais são destacadas; os métodos não cirúrgicos incluem o uso de medicamentos e de terapias alternativas, como infiltrações, acupuntura e prática de exercícios físicos. Vale ressaltar ainda que a utilização de biomarcadores pode ser uma importante estratégia para detectar precocemente a doença, avaliar sua atividade, prever um prognóstico e monitorar uma melhor resposta à terapia; porém, esse tema ainda deve ser foco de mais estudos para que os seus resultados sejam comprovados.
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Background and purpose: Dashboard injuries with forced lateral rotation of the leg can cause tibial plateau fractures with medial meniscus and ACL injuries. Tibial plateau fractures are difficult to treat and can have devastating effects such as discomfort, deformity, restricted ROM causing early degenerative changes in the knee joint. The purpose of this case report is to explain the physiotherapy intervention options and to assess their success in the conservative management of such injury. Case description: 33-year-old female presented to physical therapy with severe pain over the right knee while standing, unable to bend or straighten the knee and had a feeling of giving away of knee while walking since the time patient experienced a fall from her motorcycle. The condition was managed with supervised and unsupervised physiotherapy for 8 weeks. Intervention consisted of patient’s education about the condition, immobilization, electrotherapeutic modalities, exercise therapy, posture, gait, balance and proprioception training and counselling for 8 weeks, six days a week, for 45–60 minutes each day Outcome: The patient gained the knee ROM and strength in the lower extremities while achieving all short-term goals. She began ambulating independently and was mobile and autonomous in most situations. Her Oxford knee score improved by 75%.Discussion: It has been demonstrated that physical therapy interventions are helpful in reducing patients’ functional limitations. Due to a lack of supporting data, this case report describes specific procedures that were used to reduce functional restrictions caused by a medial meniscus rupture and a lateral tibial plateau fracture.
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Objective:To observe the clinical effect of arthrocentesis combined with liquid phase con-centrated growth factor(CGF)injection in the treatment of unilateral temporomandibular joint osteoarthri-tis(TMJOA),in order to provide a new treatment option for TMJOA patients.Methods:In this non-randomized controlled study,patients diagnosed with unilateral TMJOA who visited the center for tem-poromandibular joint disorder and orofacial pain of Peking University School and Hospital of Stomatology from June 2021 to January 2023 were selected as research objects.The patients were divided into experi-mental group and control group,which were selected by patients themselves.The experimental group re-ceived arthrocentesis combined with liquid phase CGF injection and the control group received arthrocen-tesis combined with HA injection.Both groups were treated 3 times,once every two weeks.The clinical effect was evaluated by the maximum mouth opening,pain value and the degree of mandibular function limitation 6 months after treatment.The change of condylar bone was evaluated by cone beam CT(CBCT)image fusion technology before and after treatment.Results:A total of 20 patients were included in the experimental group,including 3 males and 17 females,with an average age of(34.40± 8.41)years.A total of 15 patients were included in the control group,including 1 male and 14 females,with an average age of(32.20±12.00)years.There was no statistical difference in general information between the two groups(P＞0.05).There were no statistical differences in the mouth opening,pain value and the degree of jaw function limitation between the two groups before treatment(P＞0.05),and all of them improved 6 months after treatment compared with before treatment(P＜0.05).However,the mouth opening of experimental group was significantly higher than that of control group 6 months after treatment(P＜0.05),and the degree of jaw function limitation was significantly lower than that of con-trol group(P＜0.05).CBCT 2D images showed that the condylar bone of both groups was smoother after treatment than before treatment,and image fusion results showed that 10 patients(50.0％)in the experimental group and 5 patients(33.3％)in the control group had reparative remodeling area of con-dylar bone,and there was no statistical difference between them(P＞0.05).Except for one CGF pa-tient,the other patients in both groups had some absorption areas of condylar bone.Conclusion:The ar-throcentesis combined with liquid phase CGF injection can improve the clinical symptoms and signs of unilateral TMJOA patients in short term,and is better than HA in increasing mouth opening and impro-ving jaw function.CBCT fusion images of both patient groups show some cases of condylar bone repara-tive remodeling and its relevance to treatment plans still requires further study.
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BACKGROUND:Intra-articular injection played an important role in the treatment of osteoarthritis and has more options with the development of novel drug delivery systems.The cartilage targeting function is aimed at the adhesion or retention of drugs in the cartilage layer to form a drug bank to achieve slow release and precise drug delivery. OBJECTIVE:To review various cartilage targeting biomaterials and their characteristics in the treatment of osteoarthritis by articular injection. METHODS:Using the term"osteoarthritis,drug carrier,drug delivery,cartilage targeting,penetrate"as key words,relevant articles were searched in CNKI,WanFang and PubMed databases.According to inclusion and exclusion criteria,67 articles were finally selected for further review. RESULTS AND CONCLUSION:The research on cartilage-targeting biomaterials is mainly divided into two directions.One is the combination of electrostatic interaction,such as the combination of positively charged biomaterials and negatively charged polysaccharides in cartilage.This kind of scheme is operable and easy to modify,but limited by the shortcomings of electrostatic interaction itself,it performs badly in advanced osteoarthritis.Another one is the specific binding of various components in cartilage which is strong and reliable,and related biomaterials have excellent performance in advanced osteoarthritis,which is an important direction for future cartilage-targeted therapy.
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BACKGROUND:In recent years,tranexamic acid has been extensively used to mitigate the substantial blood loss associated with total knee arthroplasty.However,the optimal method of topical application has not yet been established. OBJECTIVE:To evaluate the effectiveness and safety of intraoperative topical application of tranexamic acid combined with physical compression dressing in reducing perioperative blood loss in total knee arthroplasty. METHODS:A retrospective analysis was conducted on 90 patients who underwent total knee arthroplasty at the Honghui Hospital in Xi'an from January 2021 to December 2022.Based on the different topical use methods of tranexamic acid during surgery,patients were divided into three groups,with 30 cases in each group.In the compression dressing group,2 g of tranexamic acid was placed in the articular cavity,and after packing the wound with gauze and cotton pads,a bandage was used to compress the wound.In the periarticular injection group,2 g of tranexamic acid was injected into the surrounding tissue of the articular cavity.In the intra-articular injection group,2 g of tranexamic acid was injected into the articular cavity.The blood loss,operation time,coagulation indicators,inflammatory indicators,and postoperative complications of the three groups were statistically analyzed. RESULTS AND CONCLUSION:(1)In terms of total blood loss,hidden blood loss,and maximum hemoglobin drop,the periarticular injection group had the least amount,and there was no statistically significant difference between the compression dressing group and periarticular injection group(P>0.05).In terms of intraoperative blood loss,the compression dressing group had the least amount,and there were statistically significant differences compared with the periarticular injection group and intra-articular injection group(P<0.05).There was no statistically significant difference in operation time among the three groups(P>0.05).(2)There were no statistically significant differences in coagulation indicators(D-dimer and fibrinogen degradation products)and inflammation indicators(C-reactive protein and erythrocyte sedimentation rate)among the three groups preoperatively and on the first and third days after operation(P>0.05).(3)There was no statistically significant difference observed among the three groups in terms of slow blood flow in the affected limb,intramuscular venous thrombosis,soft tissue swelling,and incidence of wound complications(P>0.05).Additionally,no cases of deep vein thrombosis or pulmonary embolism were detected in any of the groups.(4)The topical application of tranexamic acid combined with compression dressing achieves the same effect as a periarticular injection in terms of simplicity of operation and reduced perioperative blood loss.This method also avoids the trauma caused by repeated punctures and does not increase the incidence of postoperative complications,making it a worthwhile option for clinical promotion.
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BACKGROUND:For early knee osteoarthritis in which total knee arthroplasty fails to achieve satisfactory results,high tibial osteotomy that has been found to promote regeneration of damaged cartilage and alleviate symptoms in patients is considered a classic knee-preserving procedure. OBJECTIVE:To review and discuss the effectiveness,mechanism,and application prospects of high tibial osteotomy in stimulating cartilage regeneration in knee osteoarthritis and to provide a theoretical basis for the use of high tibial osteotomy in the treatment of knee osteoarthritis. METHODS:A computerized search was conducted in PubMed,Web of Science,CNKI and WanFang databases for relevant literature published from 2013 to 2023.The search terms used were"knee osteoarthritis,high tibial osteotomy,limb alignment,chondrocytes,biomechanics,intra-articular"in both English and Chinese.Finally,75 articles were included for review. RESULTS AND CONCLUSION:High tibial osteotomy correcting the lower limb alignment has been found to be effective in alleviating symptoms and potentially delaying or preventing the need for total knee arthroplasty.This is an important aspect of orthopedic step-down treatment in knee osteoarthritis.Maintaining a normal mechanical microenvironment is crucial for the proper functioning and maintenance of chondrocyte phenotype.Abnormal mechanical signals can be converted into intracellular chemical signals through mechanosensors like primary cilia,integrins,cytoskeleton and nucleoskeleton,resulting in disruptions to the balance of matrix metabolism and regulation of inflammatory responses.Chondrocytes after abnormal stress action still have the potential to revert to a normal phenotype under appropriate stress;correction of the mechanical microenvironment by high tibial osteotomy leads to spontaneous cartilage repair and remission of synovial inflammation.The combination of high tibial osteotomy and cartilage regeneration strategy holds promising prospects for patients with early knee osteoarthritis who are not candidates for total knee arthroplasty.
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Objective:To explore the clinical outcome of internal fixation in the treatment of AO C-type distal radius fracture accompanied with dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet.Methods:A total of 55 patients of AO C-type distal radius fracture accompanied with dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet from July 2017 to July 2022 in Tongji Hospital Affiliated to Tongji University were retrospectively analyzed. In the volar plate group (volar locking plate treatment alone), there were 22 cases, 11 males and 11 females, aged 56.7±10.1 years, 10 C1 type, 7 C2 type and 5 C3 type. There were 15 patients in the volar plate+dorsal plate group (treated with volar locking plate combined with dorsal plate), including 6 males and 9 females, aged 55.7±8.1 years old, 4 C1 type, 5 C2 type and 6 C3 type. In the volar plate+dorsal screw group (treated with volar locking plate combined with dorsal screw), there were 18 cases, 8 males and 10 females, aged 53.5±11.6 years, 7 cases of C1 type, 5 cases of C2 type, and 6 cases of C3 type. The operation time, postoperative radiographic indicators, wrist range of motion (ROM), disability of arm, shoulder and hand (DASH) score, visual analogue scale (VAS) and postoperative complications were evaluated and compared between the three groups.Results:All operations were successfully completed. Patients were followed up for 14.9 ± 2.2 months (range, 12-18 months), and the fracture healing time was 12.4±2.3 weeks (range, 9-16 weeks). The operative time of patients in the volar plate group, volar plate+dorsal plate group and volar plate+dorsal screw group was 54.3±7.6 min, 70.7±5.9 min and 65.8± 7.1 min, respectively. Patients in the volar plate group had less operative time ( F=27.04, P<0.001). The residual displacement of the dorsoulnar fragment in sagittal, coronal, and axial CT scans in the three groups were (1.3±0.8 mm, 0.6±0.4 mm, 0.7±0.4 mm), (1.1±0.8 mm, 0.6±0.4 mm, 0.6±0.6 mm), (1.4±0.8 mm, 0.7±0.4 mm, 0.7±0.5 mm). The displacement of the dorsoulnar fragment of the two groups of combined volar and dorsal internal fixation was smaller than that of the volar plate group ( P<0.05). The ROM of wrist flexion of the three groups at 3 months after operation were 44.2°±4.6°, 47.7°±5.9°, 48.8°±5.1°, the ROM of wrist extension were 39.8°±6.2°, 44.3°± 4.6°, 44.7°±5.1°, the wrist DASH scores were 23.0±4.2, 20.1±4.1 and 19.4±3.0, and the VAS were 2.3±1.2, 1.6±1.3 and 1.3±1.0, respectively. The ROM of wrist flexion and extension and DASH score in volar plate+dorsal plate group were better than those in volar plate group ( P<0.05). The ROM of wrist flexion and extension, DASH score and VAS in the volar plate+dorsal screw group were better than those in the volar plate group ( P<0.05). There were no significant differences in terms of the wrist ROM, DASH score and VAS at 12 months after operation among the three groups ( P>0.05). There were 2 patients in the volar plate group with reduction loss, 3 patients with wrist chronic pain; 1 patient in the volar plate combined with dorsal plate group with dorsal tendon irritation, and no complications in the volar plate combined with dorsal screw group. Conclusion:For AO C-type distal radius fractures accompanied with a dorsoulnar fragment involving 1/8 to 1/3 of the articular surface of the lunate facet, the use of combined volar and dorsal internal fixation can improve the reduction accuracy and stability of the dorsoulnar fragment, and contribute to the early rehabilitation of postoperative wrist joint function. The effect of combined dorsal screw is comparable to that of dorsal plate internal fixation, but the complications of screw internal fixation are less.
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Las fracturas triplanares de tibia distal, son fracturas complejas caracterizadas por afectación multiplanar, clasificándose como Salter Harris tipo IV, en el periodo de cierre fisiario. Son poco frecuentes, representando el 5-15% de las fracturas pediátricas. El mecanismo de lesión que ocurre con mayor frecuencia, consiste en supinación y rotación externa. La tomografía computarizada es actualmente el Gold Standard para el diagnóstico de este tipo de fractura, nos permite evaluar todos los planos, siendo la radiografía simple insuficiente para el diagnóstico ya que puede pasar desapercibida. Paciente de 14 años de edad con fractura triplanar en 2 partes de tibia distal, con resolución quirúrgica. Nuestro caso es un ejemplo de una fractura triplanar de tibia distal, la cual es de baja frecuencia, difícil diagnostico e interpretación. Presentamos imágenes preoperatorias, intraoperatorias y postoperatorias del manejo de esta lesión, obteniendo resultados satisfactorios clínicos, funcionales y en estudios de imágenes. Es indispensable lograr una reducción anatómica de la superficie articular para lograr una evolución satisfactoria. Se recomienda una tomografía computarizada para diagnosticar y manejar esta lesión de manera adecuada. El seguimiento postoperatorio es crucial para el manejo de este paciente, ya que se espera una discrepancia en la longitud de las extremidades y/o deformidad(AU)
Triplane fractures of the distal tibia are complex fractures characterized by multiplane effects. They are classified in the Salter-Harris system as type IV in the period of physeal closure. These fractures are rare and represent 5-15% of pediatric fractures. The most common mechanism of injury is supination and external rotation. Computed tomography is currently the Gold Standard for the diagnosis of this type of fracture since it allows us to evaluate all planes, while plain radiography is insufficient because the fracture can go unnoticed. The objective is to report the clinical case of a 14-year-old patient with triplanar fracture in 2 parts of the distal tibia with surgical resolution. This case is an example of a triplanar fracture of the distal tibia, which is of low frequency, and difficult to diagnose and interpret. Preoperative, intraoperative and postoperative images of the management of this lesion are presented, obtaining satisfactory clinical, functional and imaging study results. It is essential to achieve an anatomical reduction of the joint surface to achieve a satisfactory evolution. A CT scan is recommended to properly diagnose and manage this injury. Postoperative follow-up is crucial for the management of this patient, as a limb length discrepancy and/or deformity is expected(AU)
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Humans , Male , Adolescent , Rotation , Tibial Fractures/surgery , SupinationABSTRACT
Abstract Objective The present study aims to evaluate the effectiveness of the periarticular hip infiltration technique in the postoperative period of total hip arthroplasty. Methods This is a randomized double-blind controlled clinical trial in patients with femoral neck fractures or hip osteoarthritis submitted to a total hip arthroplasty at our institution. The periarticular infiltration technique consisted of the administration of an anesthetic (levobupivacaine) and a steroid (dexamethasone) agent in the nociceptor-rich tissues of the hip after orthopedic implants placement. The control group received an injection of 0.9% saline into the same tissues. Pain, range of motion, and use of opioid analgesic agents after 24 and 48hours of the procedure were evaluated, as well as the presence of adverse effects, time to resume walking, and total hospitalization time. Results The study evaluated 34 patients. The experimental group required fewer opioid agents between 24 and 48 hours. The reduction in pain scores was greater in the placebo group. Conclusion Periarticular anesthetic infiltration as a method of postoperative analgesia for total hip arthroplasty reduced the rates of opioid intake between 24 and 48hours. It provided no benefits regarding pain, mobility, length of stay, or complications.
Resumo Objetivo Este estudo tem como objetivo avaliar a eficácia da técnica de infiltração periarticular do quadril no pós-operatório de artroplastia total do quadril. Métodos Estudo clínico randomizado duplo-cego controlado. O estudo foi realizado nos pacientes com fratura de colo femoral ou osteoartrose de quadril, submetidos ao procedimento cirúrgico de artroplastia total do quadril em nossa instituição. A técnica de infiltração periarticular consistiu na aplicação da combinação de um anestésico (levobupivacaína) com um corticosteroide (dexametasona) nos tecidos ricos em nociceptores do quadril, após a colocação dos implantes ortopédicos. No grupo controle, foi realizada infiltração de soro fisiológico 0,9% nos mesmos tecidos. Após 24 e 48 horas do procedimento, foram avaliados os quesitos de dor, amplitude de movimentos, uso de analgésicos opióides, presença de efeitos adversos, período do início da deambulação e o tempo total de hospitalização. Resultados Trinta e quatro pacientes foram estatisticamente avaliados no estudo. Foi observada uma redução no consumo de opioides entre 24 e 48 h no grupo experimental. Uma redução maior da pontuação de dor foi observada no grupo placebo. Conclusão A infiltração periarticular anestésica como método de analgesia pós-operatória de artroplastia total do quadril, neste estudo, reduziu as taxas deconsumo de opioides
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Humans , Male , Female , Rehabilitation , Arthroplasty, Replacement, Hip , Analgesia , Injections, Intra-ArticularABSTRACT
Abstract: The need for total knee arthroplasty is increasing considerably and one of the goals is to achieve post-surgical coronal alignment. Robotic surgical assistance achieves a functional alignment, which is a hip-knee-ankle angle of 0o. However, it is not possible to provide robotic assisted surgery to all our patients so we must include the full-length hip-to-ankle AP weight-bearing radiograph in preoperative planning to obtain a «safe zone¼ alignment, which is a post-surgical hip-knee-ankle Angle of 0 ± 3o. How can we achieve a «safe zone¼ alignment total knee arthroplasty in patients with extra-articular deformity?
Resumen: La necesidad de artroplastia total de rodilla está aumentando considerablemente y uno de los objetivos es lograr la alineación coronal postquirúrgica. La asistencia quirúrgica robótica consigue una alineación funcional, que es un ángulo cadera-rodilla-tobillo de 0o. Sin embargo, no es posible ofrecer cirugía asistida por robot a todos nuestros pacientes, por lo que debemos incluir la radiografía AP de soporte de peso de cadera a tobillo de cuerpo entero en la planificación preoperatoria para obtener una alineación de «zona segura¼, que es un ángulo postquirúrgico cadera-rodilla-tobillo de 0 ± 3o. ¿Cómo podemos conseguir una artroplastia total de rodilla con alineación de «zona segura¼ en pacientes con deformidad extraarticular?
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Background: Adhesive capsulitis is a debilitating disease in an otherwise healthy individual. Intra-articular corticosteroid injections offer a cost-effective, non-operative treatment option. However, it is currently unclear whether an ultrasound-guided injection relieves the symptoms of shoulder pain more effectively than if the injection was delivered landmark-guided. Methods: Eighty patients with adhesive capsulitis were randomized to two intervention groups - landmark guided and ultrasound (USG) guided. The functional status of the patients was documented prior to the intervention. Following allocation, the intra-articular steroid was administered either under USG guidance or following identification of the site of injection using landmarks. Follow-up was done on day 5, 3 weeks, 6 weeks, and 12 weeks post procedure to document the functional status. Results: The difference in visual analogue score (VAS) between the two arms was found to be statistically significant in favour of the ultrasound guided technique only on day 5 and day 21. On the other hand, the difference in disability of arm, shoulder, and hand (DASH) score between the 2 arms was found to be statistically significant in favour of the ultrasound guided technique on day 5, 21, 42 and 84. Finally, in our study, both shoulder flexion and abduction on day 84 achieved a statistically significant improvement, favouring the ultrasound guided arm. Conclusions: Ultrasound guided corticosteroid injections may offer modestly better short-term functional outcome and symptom relief when compared with landmark guided corticosteroids.
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Background: Hyaluronic acid (HA) has been used for many years for intra-articular treatment of knee osteoarthritis with satisfactory results. HA associated with Adelmidrol – an anti-neuroinflammatory compound – have been only recently introduced in orthopedic clinical practice with good preliminary results.Objective: To investigate whether HA associated with Adelmidrol provides better results than HA alone.Methods: Two cohorts of patients with moderate knee osteoarthritis were treated. Cohort 1 received 5 weekly intra-articular injections of HA during 2017 while Cohort 2, 4 weekly intra-articular injections of HA associated with Adelmidrol during 2018. The patients of the two Cohorts were assessed by WOMAC scale, SF-12 questionnaire and PGIC scale at 1 week (T0), 6 months (T1), 1 year (T2), and 2 years (T3) after the end of treatment. All the data were statistically analyzed. A p-value of <0.05 was considered statistically significant.Results: According to the WOMAC Scale Cohort 1 had higher mean scores than Cohort 2 at each follow-up time, with a statistically significant difference between the two cohorts at T3 (p<0.03) for all the WOMAC components, except for Stiffness. WOMAC Total mean score worsened statistically significantly only in Cohort 1, from T1 to T3 (T2 vs T1: p=0.0033; T3 vs T2: p=0.0007). The same happened for WOMAC Physical Function (T2 vs T1: p=0.0146; T3 vs T2: p=0.0046) and WOMAC Pain (T2 vs T1: p=0.0004; T3 vs T2: p=0.0002). WOMAC Stiffness worsened statistically significantly in Cohort 1 from T2 to T3 (T3 vs T2: p=0.0041), while in Cohort 2 no change on WOMAC scale was statistically significant at any time-point, for any components. The mean scores of the SF-12 questionnaire were better in Cohort 2 than in Cohort 1 at each follow-up time for both the Physical and the Mental components, with a statistically significant difference between the two groups for the latter, at T0 (p=0.0001). In both cohorts the mean score of the Physical component decreased from T0 to T3, but the difference was not statistically significant between the two groups (p=0.25). The mean score of the Mental component slightly increased in Cohort 1 and decreased in Cohort 2, without statistically significant differences between the two groups at any time-point. PGIC showed that Cohort 2 scored significantly better than Cohort 1 at T3 (p=0.0336).Conclusions: Overall, HA associated with Adelmidrol gave better long-term results than HA alone.
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Background: Intra articular fractures of the distal humerus are uncommon injuries and present the most difficult challenge among fractures of the distal end of the humerus. Objective of this study is to evaluate the functional outcome following bicolumnar plating of AO-Type 13C distal humerus fractures. A total of 20 int Materials and Methods: ra articular (AO TYPE C) distal humerus fractures were operated within a period of 2 years in KVG medical college and hospital Sullia were included in the study in which there were 12 males and 8 females.16 cases were due to RTA, 4 were due to self-fall, Out of 20 cases,1 (5%) was of AO C1 type of fracture, 16(80%) were of C2 and 3 (15%) were of C3 type of fractures. All the patients were operated with pre-countered distal humerus locking plates in orthogonal fashion and functional outcome was measured by Mayo's Elbow Performance Score (MEPS). In our series of 20 cases, the Results: average duration of the radiological union was 16±02 weeks. Excellent results were seen in 10, good in 6 and fair in 3, and poor in 1 According to Mayo's Elbow Performance Score (MEPS) at the end of 12 months follow up. Open reduct Conclusion: ion and internal fixation with bicolumnar plating is the ideal fixation for AO 13 type C distal humerus fractures. Use of locking plates, stable fixation, along with early elbow mobilization influence the final functional outcome. Bicolumnar plating provides better stability, allows early elbow range of motion and prevents elbow stiffness.
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@#Introduction: Various non-operative treatment modalities have been advocated for a frozen shoulder. In the present study we compared the efficacy of single intra-articular steroid injection vs hydrodilatation with intra-articular steroids for frozen shoulder (FS) in the frozen phase. Materials and methods: This was a prospective, randomised control trial (RCT) done at a tertiary care centre. A total of 108 participants were randomised into two groupsone group received intra-articular steroid with hydrodilatation (HDS) and other group received intraarticular steroid injection only (S). Shoulder Pain and Disability Index (SPADI) scores were taken, and statistical analysis was done to measure the outcome at two weeks, six weeks and three-month intervals after the injection. Result: There was significant improvement in symptoms at each interval for both the groups (p=0.0). There was no statistically significant difference in the SPADI score between the two groups at two weeks post injection, however at six weeks (p=0.04) and 3 months (p=0.001) significant difference in the SPADI score was demonstrated with better scores in group S. The mean duration of analgesia required in group HDS was 5.17 days (S.D.=1.73) and for group S was 4.28 days (S.D.=1.01), with a statistical significance (p=0.002). Conclusion: Better clinical results were obtained at six weeks and three months with the group receiving corticosteroid only and also had a lesser requirement of analgesia post-intervention. Thus, intra-articular steroid injection only seems to be a more desirable method of management during the frozen phase of FS than that of hydrodilatation with intra-articular steroid injection.
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@#Introduction: Proximal tibial plateau fractures are one of the major problems in orthopaedic surgery and are associated with high complication rates. Intra-articular proximal tibia plateau fractures represent approximately 1% of fractures in adults. Various modalities of proximal tibial plateau fracture management have been considered, ranging from simple external fixators in impending compartment syndrome to periarticular proximal tibia plates and inter-locking nails with poller screws. Purpose of this study is to determine clinical outcomes of proximal tibial plateau fractures treated with plate. Materials and methods: We did this study of proximal tibial plateau fracture according to Schatzker’s classification treated with proximal tibial periarticular plates in 53 patients prospectively admitted at the author’s institute from June 2018 to May 2020 with follow-up period of 6 months. Results: In our study, the average knee score was 89.30 (ranging from 79 to 93) and functional knee score was 97.92 (ranging from 75 to 100). Fifty-one (51) patients (96.23%) showed excellent results and 2 patients (3.77%) showed good results according to Knee Society Score, which suggest that internal fixation of proximal tibia plateau fracture with plating provides better results. Out of 53 patients, 9 patients had post-operative complications. Average radiological union was seen at 14 weeks. Conclusion: Locking compression plate in proximal tibia plateau fractures act as a good biological fixation provide stable fixation, articular reduction and limb alignment even in difficult fracture situations. Fixation of proximal tibia plateau fractures with plate gives excellent to good knee society score, with satisfactory functional and radiological outcome.
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Objective To investigate biomechanical differences of two posterior occipitocervical internal fixation techniques for treating basilar invagination with atlantoaxial dislocation (BI-AAD). Methods Intra-articular cage + posterior occipital plate+C2 pedicle screw (Cage+C2PS+OP), and intra-articular cage+C1 lateral mass screw+C2PS (Cage+C1LMS+C2PS) models were established based on occipitocervical CT data of the BI-AAD and clinical operation scheme, and the stability of atlantoaxial joint and stress distribution characteristics of C2 endplate and implanted instruments under different motion states were analyzed. Results Compared with the Cage+C1LMS+C2PS model, the atlantoaxial range of motion ( ROM) under flexion, extension, lateral bending and axial rotation in the Cage+C2PS+OP model were reduced by 5. 26% , 33. 33% , 43. 75% , -5. 56% , and stress peak of screw-rod fixation system were reduced by 47. 81% , 60. 90% , 48. 45% , 39. 14% , respectively. Under two internal fixation modes, stresses of C2 endplate and cage were mainly distributed on the compressive side during the motion, and both the screw-bone interface and the caudal side of screw subjected to large loading. Conclusions Two internal fixation methods could provide similar stability. However, the stress concentration of screw-rod system was more obvious and the possibility of screw loosening and fracture was greater under Cage+ C1LMS+C2PS fixation.
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Objective:Managing 33-C3 femur fractures with medial wall bone defects poses a significant challenge for orthopedic surgeons.The gold standard treatment for arbeitsgemeinschaftfür osteosynthesefragen(AO)/orthopedic trauma association(OTA)33-C3 distal femur fractures with medial wall bone defects remains elusive.This study employs finite element analysis to compare the stability and mechanical behavior of 3 internal fixation patterns(single lateral distal locking plate,retrograde intramedullary nail,and dual plates)for 33-C3 femur fractures with medial wall bone defects.The aim is to provide a theoretical basis for the selection of internal fixation modalities in clinical practice. Methods:Enrollment included a 43-year-old male volunteer weighing 60 kg,without a history of femur fracture.Bilateral femur normality was verified through X-ray and CT scan assessments.A finite element simulation model of AO/OTA 33-C3 distal femur fracture with medial wall bone defect was established.Three fixation methods,named single lateral locking plate(single-plate group),retrograde intramedullary nail(retrograde intramedullary nail group),and dual plates(dual-plate group),were evaluated using finite element analysis under an axial load of 300 N.The assessment included an examination of von Mises stress distribution,shear stress,and displacement patterns at the internal fixation and femur fracture sites. Results:The finite element analysis revealed that dual-plate fixation effectively reduced the concentration of von Mises stress at the plate on the fracture site.Under full weight-bearing conditions,the maximum von Mises stress in the implants occurred at the distal femur defect level,with values of 149.30,59.281,and 58.03 MPa for single-plate fixation,retrograde intramedullary nail,and dual-plate fixation methods,respectively.Similarly,the maximum shear stress in the implants was 77.867,30.136,and 33.505 MPa for single-plate fixation,retrograde intramedullary nail,and dual-plate fixation methods,respectively,all presenting at the distal femur defect level.The maximum relative displacements of implants during compressive loading were 1.34,1.25,and 0.83 mm for the single-plate,retrograde intramedullary nail,and dual-plate groups,respectively.Consistently,the maximum loading-point displacements of fracture sites were 1.529,1.264,and 0.880 mm for the single-plate fixation group,retrograde intramedullary nail group,and dual-plate fixation group,respectively.Furthermore,at the distal femur defect level,the maximum von Mises stress was 72.682,112.430,and 40.716 MPa for the single-plate,retrograde intramedullary nail,and dual-plate fixation groups,respectively. Conclusion:Dual-plate fixation demonstrates superior biomechanical outcomes and exhibites the lowest maximum von Mises stress and shear stress,along with minimal relative movements between fracture fragments.This configuration offers optimal mechanical stability for managing AO/OTA 33-C3 distal femur fractures with medial wall bone defects.Consequently,dual-plate fixation emerges as a better treatment strategy for patients presenting with comminuted intra-articular distal femur fractures accompanied by medial wall bone defects.
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Objective:To compare the clinical outcomes of internal fixation of McCrory-Bladin type III fracture of the lateral process of the talus (FLPT) with Kirschner wire Double-pully technique under subtalar arthroscopy and open reduction with Kirschner wire fixation.Methods:A retrospective cohort study was conducted to analyze the clinical data of 42 patients (42 feet) with McCrory-Bladin type III FLPT admitted to Xuzhou Central Hospital from May 2017 to May 2022, including 15 males (15 feet) and 27 females (27 feet); aged 18-55 years [(33.3±9.8)years]. Among them, 24 patients were treated with Kirschner wire Double-pully technique under subtalar arthroscopy (arthroscopy+Kirschner group), and 18 with open reduction and Kirschner wire fixation (open reduction+Kirschner group). The surgical duration, wound healing status, and assessment outcomes at 12 weeks, 12 months and the last follow-up, including American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) score, and Foot and Ankle Ability Measure (FAAM) [Activities of Daily Living (ADL) and Sports (S) subscores], were compared between the two groups, respectively. Complication rates were also compared at the last follow-up.Results:All the patients were followed up for 12-27 months [(17.6±4.9)months]. The surgical duration in the arthroscopy+Kirschner group [(53.7±11.8)minutes] was longer than that in the open reduction+Kirschner group [(43.9±7.2)minutes] ( P<0.05). Bone grafting was not required in either group and all incision healing was achieved by primary intention. At 12 weeks, 12 months and the last follow-up, the arthroscopy+Kirschner group had higher AOFAS ankle-hindfoot score [(91.3±4.4)points, (94.0±4.2)points, (94.7±4.5)points] compared with the open reduction+Kirschner group [(74.7±11.2)points, (77.9±12.0)points, (79.2±12.0)points] (all P<0.01); the arthroscopy+Kirschner group had higher PROMIS-PF score [(69.5±3.7)points, (71.6±3.3)points, (72.5±3.2)points] compared with the open reduction+Kirschner group [(61.7±6.7)points, (62.9±6.8)points, (63.3±7.0)points] (all P<0.01); the arthroscopy+Kirschner group had higher FAAM-ADL score [(89.8±3.8)points, (92.5±3.3)points, (93.2±3.4)points] compared with the open reduction+Kirschner group [(70.3±15.2)points, (72.1±15.2)points, (73.1±16.0)points] (all P<0.01); and the arthroscopy+ Kirschner group had higher FAAM-S score [(91.5±3.6)points, (94.4±3.6)points, (94.9±3.5)points] compared with the open reduction+Kirschner group [(76.9±15.0)points, (78.6±16.2)points, (79.0±16.0)points] (all P<0.01). Subtalar joint arthritis developed in 2 patients [8.3% (2/24)] in the arthroscopy+Kirschner group at the last follow-up, but in 6 [33.3% (6/18)] in the open reduction+Kirschner group ( P<0.05). No nerve injury was found in either group. Conclusion:For McCrory-Bladin type III FLPT, the Kirschner wire Double-pully technique under subtalar arthroscopy, despite longer surgical duration, results in better physical function, improved activities of daily living, enhanced ankle function, and a lower rate of subtalar joint arthritis compared with open reduction with Kirschner wire fixation.
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Objective:To compare the clinical effects of platelet-rich plasma (PRP) and sodium hyaluronate on rotator cuff injury.Methods:From February 2022 to December 2022, 226 patients with rotator cuff injury caused by military training were treated at Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University. They were all male, aged (24.5±3.7) years, and their time from injury to treatment was (4.6±2.2) months. They were divided into 2 even groups according to different treatments: an observation group of 113 cases into whose subacromial space PRP was injected, and a control group of 113 cases into whose subacromial space sodium hyaluronate was injected. In both groups, the injection was performed once a week for consecutive 3 weeks. The 2 groups were compared in terms of visual analogue scale (VAS) and Constant-Murley shoulder function scale (CMS) before treatment and 4 and 8 weeks after treatment, and the levels of TNF- α and IL-6 in the shoulder synovial fluid before treatment and 8 weeks after treatment. Results:There was no statistical difference between the 2 groups in general clinical data before treatment, indicating comparability ( P>0.05). At 4 and 8 weeks after treatment, compared with the pre-treatment values, the VAS scores were significantly decreased and the Constant-Murley scores significantly increased in both groups ( P<0.001). At 4 and 8 weeks after treatment, the VAS scores in the observation group (3.1±0.9 and 1.5±0.5) were significantly lower than those in the control group (3.7±0.8 and 2.3±0.6) while the Constant-Murley scores in the observation group (58.6±4.5 and 72.2±4.1) significantly higher than those in the control group (55.2±5.3 and 67.8±5.0) ( P<0.001). At 8 weeks after treatment, the levels of TNF- α and IL-6 in the 2 groups were significantly lower than the levels before treatment ( P<0.001). At 8 weeks after treatment, the levels of TNF- α and IL-6 in the observation group [(2.9±0.9) μg/L and (0.8±0.2) μg/L] were significantly lower than those in the control group [(4.0±0.4) μg/L and (1.1±0.4) μg/L] ( P<0.001). Conclusion:Injection of PRP or sodium hyaluronate can relieve pain and improve shoulder function obviously in patients with rotator cuff injury, but PRP is superior to sodium hyaluronate in the treatment of rotator cuff injury.
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Osteochondral lesion of talus (OLT) is a foot and ankle disease characterized by ankle pain, which may impact the joint function and life quality. If managed improperly, it may lead to a further ankle arthritis, severely compromising the prognosis. The therapeutic effect of conservative treatment for OLT is still uncertain. Surgery is still the main treatment modality for OLT with various techniques. However, the optimized surgical technique is still inconclusive, furthermore, regeneration and repair of cartilage after debridement is also a great challenge for the treatment of OLT. Platelet-rich plasma (PRP) with good repair effect on cartilage injury is gradually applied in the treatment of OLT. However, there still lacks the unified understanding of the technique and specification of PRP for the treatment of OLT. Therefore, National Orthopedics Center of Shanghai Sixth People′s Hospital allied Foot Ankle Basic Research & Orthopedics Group, Chinese Association of Orthopedic Surgeons; Foot and Ankle Committee of Chinese Association of Sports Medicine Physicians; and Foot and Ankle Group of Orthopedic Specialized Branch of Shanghai Medical Association to organize related experts to formulate the Expert consensus on platelet- rich plasma treatment for osteochondral lesion of talus ( version2023). Fifteen recommendations were put forward upon PRP preparation, indications, contraindications and treatment methods of PRP for OLT, so as to standardize the PRP treatment for OLT.