Reliability of Modified Pauwels Angle in Preoperative Plain X-ray and Intraoperative Fluoroscope in Young Femoral Neck Fracture Fixation.

Purpose: This research aims to evaluate the reliability of modified Pauwels angle in preoperative plain X-ray and intraoperative fluoroscope. Method: This study included 48 male and 18 female patients with an average age of 36.95 years. Seven observers contributed to this study by measuring the modified Pauwels types and angles on 66 anterior-posterior (AP) views from preoperative radiographs and intraoperative fluorography. Intra-observer and inter-observer reliability was calculated using Fleiss's kappa and intraclass correlation coefficient (ICC). Results: The results showed that the intra-observer reliability for the modified Pauwels type using Kappa coefficient in preoperative and intraoperative assessments was 0.584 and 0.823, respectively. The inter-observer reliability for preoperative and intraoperative evaluations was 0.467 and 0.753 for all observers, 0.647 and 0.783 for specialized trauma orthopedists, and 0.41 and 0.752 for the residents. The modified Pauwels angle assessment in intra-observers using ICC was 0.804 preoperatively and 0.943 intraoperatively. The inter-observer for preoperative and intraoperative assessments was 0.675 and 0.834 for all observers, 0.977 and 0.982 for specialized trauma orthopedists, and 0.622 and 0.823 for residents. The difference between preoperative and intraoperative modified Pauwels angles was 9.75 ± 6.76 (p < 0.05). Eleven patients had their modified Pauwels type changed, which altered the implant selection in 8 patients. Conclusion: The modified Pauwels angle together with type assessment has excellent reliability for implant selection when implemented intraoperatively, and at least two specialized trauma orthopedists should evaluate the fracture lines.

Outcomes of supra-acetabular pin placement with and without fluoroscopic assisted: a prospective randomized controlled trial.

PURPOSE: To compare outcomes of fluoroscopic-assisted supra-acetabular pin placement percutaneous technique versus the open technique in traumatic pelvic fractures. METHODS: Prospective randomized controlled trial was performed at Maharat Nakhon ratchasima hospital from January 2020 to March 2021. Time, size of wound, and position of supra-acetabular pin were recorded intraoperatively. Pin positions were confirmed and measured by postoperative CT scan. Complications such as cortex penetration, infection, hip joint violation, and lateral thigh numbness were recorded at 2 weeks postoperatively. RESULTS: Twenty patients (40 hemipelvis) were randomized to fluoroscopic-assisted and non-fluoroscopic groups. Time taken for supra-acetabular pin placement for fluoroscopic-assisted and non-fluoroscopic-assisted groups was 211 and 522 s, respectively (P value < 0.001). Average wound size was 2.81 cm in the fluoroscopic-assisted group and 6.01 cm in the non-fluoroscopic-assisted group (P value < 0.001). Overall complications were similar in both groups with higher infection rates in the fluoroscopic-assisted group (5 and 0%, respectively). DISCUSSION: Pelvic fracture is a life-threatening condition, which requires emergency pelvic stabilization. This study examined operative times for supra-acetabular placement and complication rates. The results show shorter operative times for the non-fluoroscopic-assisted technique without significant differences in complication rates. CONCLUSION: Non-fluoroscopic technique greatly reduced operative times for supra-acetabular pin placement with comparable safety to the fluoroscopic-assisted technique.

No association between different in tibial resection level and clinical outcomes six months after Oxford unicompartmental knee arthroplasty: a prospective cohort study.

BACKGROUND: Localized tibial strain is one of the hypotheses to explain residual pain after Oxford UKA. We evaluate whether the depth of the vertical cut during tibial resection correlates with medial knee pain. We aimed to investigate the association between the depth of tibial resection and medial knee pain after OUKA. METHODS: This prospective cohort study enrolled 85 patients (mean age: 64.5 ± 7.7 years) who underwent cemented OUKA at our institute during October 2018-June 2019. The depth of tibial resection was measured intraoperatively as the thickness of the anterior, middle, and posterior parts. The greatest of the three thicknesses was recorded. Medial knee pain was assessed at 6 weeks and followed to 6 months. Patients were divided into the pain (P) and no pain (NP) groups. Preoperative and postoperative radiographic findings and OKS were compared between groups. We used logistic regression to analyze the independent association. RESULTS: The mean preoperative Oxford Knee Score (OKS) was 27.2 ± 7.6. The incidence of medial knee pain was 23.5% at 6 weeks after OUKA. The P group had a significantly lower OKS at 6 weeks compared to the NP group (28.9 ± 9.7 vs 33.7 ± 6.5, p = 0.049). There was no significant difference in the depth of tibial resection between groups. Medial knee pain had resolved by 6 months in all patients, and the 6-month OKS was similar between groups. CONCLUSION: Medial knee pain was found to be common in the early postoperative period after OUKA, but this pain spontaneously resolved by 6 months. As a range of tibial resection level, post-operative pain is not associated with tibial resection thickness in this study. LEVEL OF EVIDENCE: Level II. TRIAL REGISTRATION: The study was approved by the Institutional review board of Siriraj Hospital, Mahidol university. [SIRB 691/2560(EC4)].