Two-week versus four-week immobilization of stable distal radioulnar joint following surgical fixation of Galeazzi fracture-dislocations: A randomized controlled trial.

Background: Postoperative immobilization protocols following surgical fixation of Galeazzi fracture-dislocations (GFD) in adults remain unresolved. This study aimed to compare outcomes of two different immobilization durations (two weeks versus four weeks) in terms of functional outcomes and complications. Methods: Participants were prospectively and randomly enrolled in two-week versus four-week immobilization after plate fixation of GFD when the distal radioulnar joint (DRUJ) was reducible and stable postoperatively. Immobilization involved an above-elbow splint with the forearm in full supination. Demographic data, including age, gender, mechanism of injury, fracture characteristics, and treatment approach, were recorded. The primary outcome was the abbreviated version of the Disability of Arm, Shoulder, and Hand (DASH) scores at three months post-operation. Secondary outcomes included wrist range of motion, mean grip strength differences between injured and uninjured sides, and complications. Results: A total of 54 participants were enrolled and randomized into two treatment groups. Demographics were similar between groups, with most participants being male, and the mean age was 35 years (range 18-65). Fractures were generally less than 10 cm. The mean DASH scores were slightly higher in the four-week immobilization group but not statistically significant (1.43 in the two-week immobilization group vs. 2.36 in the four-week immobilization group, p = 0.152). Range of motion and mean grip strength differences were similar between groups. Complication rates were also similar, with recurrent DRUJ dislocation occurring in two participants from each group. Conclusion: This study found no significant differences in functional outcomes and complications between two-week and four-week immobilization durations after plate fixation of GFD when the DRUJ was reducible and stable postoperatively. Level of evidence: Therapeutic Level I.

Clinical outcomes of extended intralesional curettage with cementation without implant augmentation in non-fracture giant cell tumor of bone around the knee.

There remains a lack of consensus regarding the necessity of implant augmentation or fixation after intralesional curettage in giant cell tumor of bone (GCTB) around the knee. This study assessed whether cementation alone is effective and safe in GCTB with a non-fracture around the knee. We retrospectively examined clinical data from 14 GCTB patients treated from 2012 to 2022. Outcome parameters were Musculoskeletal Tumor Society (MSTS) score, postoperative fracture, metastases, recurrence and complications. Of the 14 GCTB cases examined, 10 were at the distal femur and four were at the proximal tibia. Mean patient age was 32 years, and follow-up time was 61 months. Mean tumor size was 61 × 79 × 50 mm, and MSTS score was 89.2%. There were no cases of postoperative fracture. Defect reconstruction with cementation alone may be strong enough to provide immediate stability and prevent postoperative fracture in GCTB around the knee.

Osteochondral allograft in the treatment of an extruded osteoarticular segment of the distal tibia: A case report.

Open tibial plafond fracture with massive bone loss presents a challenge for orthopedic surgeons. Particularly unusual is extrusion of an osteoarticular segment of the distal tibia. Here we present the case of such a patient, who was treated using osteochondral allograft (OCA) and fusion procedures. The patients can regain independent walking without pain within 6 months, indicating that OCA may be a sensible option for the treatment of open tibial plafond fracture with extrusion of the osteoarticular distal tibia in cases in which the surrounding soft tissue is intact but bone reimplantation is not possible due to severe damage and contamination.

Bilateral displaced femoral neck stress fractures treated with valgus subtrochanteric osteotomy: A case report and two-year follow-up.

Bilateral femoral neck stress fractures are uncommon injuries that are successfully treated with surgical treatment; however, there is a high complication rate, as well as the challenging issue of the joint preserving procedure. This study reports the rare case of simultaneous valgus subtrochanteric osteotomy with a satisfactory outcome. A twenty-year-old male military recruit, with no history of previous hip pain or significant injury, presented with gradually progressive bilateral hip pain for three months after recruitment into military training. He was unable bear weight on both hips for one day prior to hospital without risk of sudden injury. A preoperative radiograph revealed displaced bilateral femoral neck fractures, and magnetic resonance imaging (MRI) demonstrated no evidence of avascular necrosis of the femoral heads. A bilateral valgus subtrochanteric osteotomy procedure was simultaneously and successfully performed on both hips. Six months after surgery, the patient was able to walk independently without any complications, and radiographic unions were presented. The two-year follow up radiographs showed no evidence of avascular necrosis of the femoral heads. The valgus subtrochanteric osteotomy procedure is an effective joint preserving procedure in femoral neck stress fractures, including the uncommon bilateral cases.

Analgesic efficacy of a single-dose, intraoperative, intra-articular morphine application in ACL reconstruction.

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is the mainstay treatment for the symptomatic anterior cruciate ligament insufficiency. Postoperative rehabilitation is the key main factor in successful surgical outcome but, the postoperative pain is a major obstacle to achieve good postoperative rehabilitation. The purpose of this study is to compare the effects of intra-articular morphine (IAMO) with normal saline [control group (C)] for postoperative pain control in the ACL reconstruction knees. METHODS: Patients who underwent ACL reconstruction during 2017-2019 were included, prospectively, from Khon Kaen hospital and randomized into 2 groups: IAMO group and the control group (C). After surgery, all patients received the same rehabilitation protocols. The results were assessed using the visual analogue scale (VAS), following the spinal block anesthesia at 6, 12,18 and 24 hours. Time to first analgesic request, range of motion and adverse effects were recorded. RESULTS: Forty patients were included and twenty were designated to the IAMO group. The mean age was 25.3±7.6 years and 80 percent of the patients were males. The IAMO group had lower VAS scores at the 12 and 24 hour postoperative periods [greatest variance at 12 hours (4.7±1.7 vs 5.8±1.6)]. In the IAMO group, time to first analgesic request was longer and morphine consumption was less, but these were not statistically significant. No complications were observed in both groups. CONCLUSIONS: The trend of VAS in the IAMO group was lower than in the control group, especially at 12 hours after surgery with no statistically significant differences. From this study and with the advantages of IAMO after ACL reconstruction, IAMO is useful in ACL reconstruction patients without complications.

Incidence and risk factors for complications after definitive skeletal fixation of lower extremity in multiple injury patients: a retrospective chart review.

Background: The management of multiple injuries is complex. Type and timing of treatment for lower extremity fractures is a controversial subject. Although many studies have demonstrated the safety and effectiveness of early treatment, others have suggested that early definitive stabilization may cause complications, especially with chest and head injuries. The aim of this study was to determine the complications and effects of timing of fixation, and investigate risk factors for complications in multiple injuries patients with lower extremity fractures. Methods: A Retrospective chart review from Khon Kaen Trauma Registry between 2008 and 2015 were collected. All major complications were identified and collected for example acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and sepsis.  The time to definitive skeletal fixation from initial injury was identified and analyzed with multiple logistic regression. Results: 1224 multiple injuries patients with lower extremity fractures were identified. The mean age was 34±19.5 years, 74.4% were male and 25.6% female. The mean time from initial injury to definitive operation was 55.7±53.9 hours. Complications occurred with 178 patients (14.5%), the most common of which were pneumonia, ARDS and AKI. After adjusting for sex, severity of injury, we found that the operation within 24-48 hours complication was 6.67 times less common than in the early treatment group (less than 24 hours) (95% CI: 3.03 to 10.00, P-value< 0.001). Conclusions: About 15% of the multiple injuries patients with lower extremity fracture had major complications. The optimal time for definitive fixation in lower extremity fractures to reduce complications was within 24-48 hours. We found that if we operated too early (before 24 hours) or more than 48 hours after the injury it could increase the morbidity and mortality.

Measurement of Patient's Perception on Limb-Length Discrepancy Compared With Weight-Bearing Orthoroentgenography in Total Hip Arthroplasty: A Prospective Study.

BACKGROUND: Aims of this study included providing a comparison of the measurement of limb-length discrepancy after primary total hip arthroplasty between patient's perception and weight-bearing orthoroentgenographic measurement. A comparison between patient's perception and pelvic radiographic measurement was examined as well. METHODS: This prospective study comprised patients who had already undergone total hip arthroplasty and were receiving postoperative outpatient care between April 2017 and July 2017. Block test was used to assess patient's perception on limb-length discrepancy. Weight-bearing orthoroentgenography and pelvic radiography were used for radiographic measurement. These 3 measurements were compared to find the difference, correlation, and reliability. RESULTS: Evaluations were carried out on 68 patients subsequent to primary total hip arthroplasty. The prevalence of limb-length discrepancy by orthoroentgenographic, patient's perception, and pelvic radiographic measurements was 60%, 57.35%, and 52.94%, respectively. Mean difference of limb-length discrepancy between the 3 measurements were not statistically significant. When compared with orthoroentgenography, sensitivity and specificity of patient's perception measurement were 60.98% and 48.15%, respectively. Likewise, sensitivity and specificity of pelvic radiographic measurement were 78.05% and 85.19%, respectively. Poor correlation and reliability were found between orthoroentgenographic and patient's perception measurement (concordance correlation coefficient = 0.21, intraclass correlation coefficient = 0.22). However, good correlation and reliability were found between orthoroentgenographic and pelvic radiographic measurement (concordance correlation coefficient = 0.85, intraclass correlation coefficient = 0.85). CONCLUSION: Patient's perception on limb-length discrepancy had poor correlation and reliability, low sensitivity and specificity when compared with orthoroentgenographic measurement. A physician should additionally perform measurement by orthoroentgenography or pelvic radiography.

Characteristics of Cervical Spine Motion in Different Types of Cervical Alignment: Kinematic MRI Study.

STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate how each type of sagittal cervical alignment affects the motion of the upper and subaxial cervical spine using kinematic magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: The sagittal malalignment of the cervical spine from degeneration in the subaxial cervical spine reflects a disruption in the kinematic properties of the cervical spine and affects the motion of adjacent segments. Changes in the sagittal parameters and kinematics of the upper cervical spine and upper thoracic spine due to the kyphosis are unknown. METHODS: Kinematic magnetic resonance imaging of the cervical spine in neutral position from 311 patients, including 90 lordotic, 90 straight, 90 global kyphotic, and 41 segmental kyphotic were analyzed. The lordotic angle at the upper and lower cervical spine, and T1 slope were measured in the neutral position and again in flexion and extension for dynamic analysis. RESULTS: The number of levels with significant disk degeneration was higher in the global kyphosis group. In the global kyphosis group, neutral sagittal parameters showed some characteristics of compensation to the malalignment. Compared with the lordotic group, patients with global kyphosis demonstrated significantly higher lordotic angle of the upper cervical spine and more horizontal T1 slope. The dynamic evaluation showed greater range of motion of the entire cervical spine and subaxial cervical spine in younger patients. However, we still found greater range of motion of the occipito-atlanto-axial complex in global kyphosis, even when controlling for age and number of levels with significant disk degeneration. CONCLUSION: Sagittal malalignment of the cervical spine affects all parts of the cervical motion complex. The global kyphotic alignment of subaxial cervical spine affects the kinematic properties of the occipito-atlanto-axial complex and upper thoracic spine to compensate for the alteration of cervical alignment. These differences are not seen in straight and segmental kyphosis. LEVEL OF EVIDENCE: Level 3.

Removal of the broken femoral nail with T-reamer technique: A three-case report.

Nonunion of femoral shaft fracture is an uncommon complication after closed intramedullary nailing which often leading to nail breakage. Removal of the broken femoral nail with closed manner is a challenging procedure for orthopedic surgeons. The removal technique with the T-reamer is a closed method, which does not require either a nonunion site opening or knee exposing. We reported 3 cases of nonunion femoral shaft with broken slotted and non-slotted hollow nail which were successfully removed without any complication. All fractures healed uneventfully without open the fracture site or bone grafting.

Risk factors for loss of fixation in pediatric supracondylar humeral fractures.

OBJECTIVE: The aim of this study was to determine the risk factors for loss of fixation in pediatric supracondylar humeral fractures. MATERIAL AND METHOD: The data were analyzed regarding assessed loss of fixation in 256 supracondylar fractures from January 2010 to December 2012, all of which were treated by closed or open reduction and Kirschner wire fixation. The confounding factors that were thought to cause loss of reduction were collected. Multivariate logistic regression analysis was performed to predict risk factors. RESULTS: Reduction was lost in 14.8% of the patients. Poor surgical technique was significantly higher in the cases with lost reduction (odds ratio: 15.21). Additionally, cases with only lateral pins placement (odds ratio: 2.57), Gartland type 3 fractures (odds ratio: 2.38), and, obesity with a BMI ≥ 25 (odds ratio: 14.35) had a significantly higher risk of losing reduction and fixation. Other factors including age, energy type of injury, time of surgery, and time to surgery were not associated with risk. CONCLUSION: The loss of reduction following fracture fixation is associated with poor surgical technique,fixation with lateral pinning only, Gartland type 3 fractures, and pediatric obesity (BMI > 25). The stability of fracture fixation in pediatric supracondylar fractures is largely dependent on the use of effective fixation techniques. Cross pinning provides a more stabile fixation than lateral pinning.

Is magnetic resonance imaging necessary for normal plain radiography evaluation of contralateral non-traumatic asymptomatic femoral head in high osteonecrosis risk patient.

OBJECTIVE: To examine the incidence rate and extension of non-traumatic asymptomatic osteonecrosis of the contralateral femoral head (ONFH) in high-risk patient groups. MATERIAL AND METHOD: A cross-sectional design was used. We studied patients who visited at Orthopedics department, Khon Kaen hospital between January 2007 and December 2008. Only high-risk patients diagnosed with non-traumatic osteonecrosis in index side by plain radiography and asymptomatic contralateral sides with normal plain radiography evaluated for non-traumatic femoral head osteonecrosis were included in the analysis. We evaluated both hips of individual patient by MRI to determine the incidence, staging, and extension area of osteonecrosis. RESULTS: Thirty-two patients with index femoral head osteonecrosis and non-traumatic asymptomatic contralateral femoral head were studied. Average age of these patients was 46.38 years. The most common risk factors were alcohol (78.12%) and corticosteroid use (18.75%). Osteonecrosis of the contralateral femoral head (ONFH) was found in 22 patients (68.75%). These hips were in stage VI (87.5%) with 99.05% extension area of osteonecrosis, large extension, C- location, and mix intensity of MRI on index side. We found stage I in all patients (100%), 80.62% extension area of osteonecrosis, large extension, C-location and mix intensity of MRI on ONFH at contralateral side with normal plain radiographic. CONCLUSION: We found the high incidence rate and high extension area of asymptomatic osteonecrosis of the contralateral femoral head of the hip in high-risk patient. This result supported that silent aggressive disease can rapidly progress to advanced stage in a short time. Early detection of osteonecrosis in contralateral hip by MRI is considered a clinically necessary procedure in high-risk patients with unilateral hip osteonecrosis.

'Rail road' proximal femoral osteotomy: a new technique to remove well-fixed femoral stem or cement mantle in revision total hip arthroplasty.

OBJECTIVE: To present the institutional experiences of using a new and simple surgical technique to remove well-fixed femoral stem or cement mantle in revision total hip arthroplasty (THA). MATERIAL AND METHOD: A retrospective chart review of patients who had revised total hip arthroplasty by the "railroad technique" between January 2007 and January 2009 at Orthopedics department, Khon Kaen hospital was done. The Railroad (long parallel) osteotomy was performed at proximal femur in patients who had complicated revision femoral stem or had removed cement mantle. Long revision stem was used together with the osteotomised bone fragment, which was fixed with cerclage wires. Outcomes of this technique were assessed based on the postoperatively revision stem stability, bone ingrowth, osteotomised bone fragment union, and complications. RESULTS: Twenty railroad proximal femoral osteotomies in 19 patients were performed to remove femoral stem or cement mantle. Postoperative assessment showed good stability, evidence of bone ingrowth, and bone fragment union. No complications including infection, fracture, dislocation, or subsidence were reported. CONCLUSION: Railroad technique used in the complicated femoral revisions provided great clinical outcomes with no complication. This evidence supports the practical use of railroad technique, which requires basic instruments to perform.