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Management of proximal tibial stress fracture associated with advanced knee osteoarthritis:A systematic review

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Chinese Journal of Traumatology 2024年第3期27卷 147-152页

作者： Mukesh Kumar Saini Mahendra Singh Devendra Singh Prem Manohar Seervi Pera Jayavardhan Reddy Neelam Ramana Reddy department of orthopaedics Dr SN Medical CollegeJodhpur342011India department of orthopaedics Star HospitalsB Block Banjara HillsHyderabad500034India

Purpose:Tibial stress fracture associated with knee osteoarthritis is an unusual and difficult clinical scenario.There is no clear existing treatment guideline for this uncommon clinical disease.The aim of this study is to review the impact of various treatment options for patients with advanced knee osteoarthritis associated with proximal tibial stress fracture.Methods:The study was performed using the databases of PubMed and Scopus.Methodological index for non-randomized studies score was used to evaluate the included studies’bias.The concluded data included the treatment approach,reported outcome measure,and time to fracture union.The literature search was started in December 2021 and accomplished in January 2022.A narrative description of the different methods and comparison of their results were done.Results:Out of total assessed 69 studies,9 studies were included in our review.The commonest treatment approach used was total knee arthroplasty by long tibial stem extension.The mean preoperative knee society score and knee functional score were 30.62 and 23.17,respectively.The mean postoperative knee society knee score was 86.87,while the functional score was 83.52.The average reported time to achieve fracture union was 4 months(a range of 2.07-5.50 months).Conclusion:The optimal clinical outcome for treating either acute or mobile tibial stress fracture in patients with advanced knee osteoarthritis can be achieved with long stem total knee arthroplasty.However,due to heterogeneity of data,comparison of different treatment options for chronic proximal tibial stress fracture mal-union/non-union coexisting with knee osteoarthritic and such inferences need to be judged cautiously.

关键词： Tibial stress fracture Knee osteoarthritis Total knee arthroplasty

Ipsilateral fractures of the acromion and coracoid processes of the scapula

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Chinese Journal of Traumatology 2024年第2期27卷 121-124页

作者： Yusuf Omar Qalib Srinivasa Reddy Medagam Sunil Dachepalli department of orthopaedics The Fifth Affiliated Hospital of Sun Yat-Sen UniversityZhuhai519000GuangdongChina department of orthopaedics Yashoda HospitalsSomajigudaHyderabadTelangana500082India

A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic,due to the acromion's anatomical position and shape,as well as the strong ligaments and muscles that are attached to it.These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint,leading to severe pain and a grossly restricted range of motion.Several acromial classifications were reported,but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature.We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture.The closest to this is Kuhn's type III classification.A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident.The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications.He was asymptomatic postoperatively and regained full range of motion after 4 months.

关键词： Acromion Scapular fracture Coracoid process

Efficacy of stromal vascular fraction for knee osteoarthritis:A prospective,single-centre,non-randomized study with 2 years follow-up

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World Journal of Orthopedics 2024年第5期15卷 457-468页

作者： Madhan Jeyaraman Naveen Jeyaraman Tarun Jayakumar Swaminathan Ramasubramanian Rajni Ranjan Saurabh Kumar Jha Ashim Gupta department of orthopaedics ACS Medical College and HospitalDr MGR Educational and Research InstituteChennaiTamil Nadu 600077India department of Biotechnology School of Engineering and TechnologySharda UniversityGreater NoidaUttar Pradesh 201310India department of orthopaedics and Regenerative Medicine South Texas Orthopaedic Research InstituteLaredoTX 78045United States department of orthopaedics KIMS-Sunshine HospitalHyderabadTelangana 500032India department of orthopaedics Government Medical CollegeOmandurar Government EstateChennaiTamil Nadu 600002India department of orthopaedics School of Medical Sciences and ResearchSharda UniversityGreater NoidaUttar Pradesh 201306India department of Zoology Kalindi CollegeUniversity of DelhiNew Delhi 110008India department of orthopaedics and Regenerative Medicine Regenerative OrthopaedicsNoida 201301Uttar PradeshIndia department of orthopaedics and Regenerative Medicine Future BiologicsLawrencevilleGA 30043United States department of orthopaedics and Regenerative Medicine BioIntegrateLawrencevilleGA 30043United States

BACKGROUND Current osteoarthritis(OA)treatments focus on symptom relief without addressing the underlying disease process.In regenerative medicine,current treatments have limitations.In regenerative medicine,more research is needed for intra-articular stromal vascular fraction(SVF)injections in OA,including dosage optimization,long-term efficacy,safety,comparisons with other treatments,and mechanism exploration.AIM To compare the efficacy of intra-articular SVF with corticosteroid(ICS)injections in patients with primary knee OA.METHODS The study included 50 patients with Kellgren-Lawrence grades II and III OA.Patients were randomly assigned(1:1)to receive either a single intra-articular SVF injection(group A)or a single intra-articular ICS(triamcinolone)(group B)injection.Patients were followed up at 1,3,6,12,and 24 months.Visual analog score(VAS)and International Knee Documentation Committee(IKDC)scores were administered before the procedure and at all followups.The safety of SVF in terms of adverse and severe adverse events was recorded.Statistical analysis was performed with SPSS Version 26.0,IBM Corp,Chicago,IL,United States.RESULTS Both groups had similar demographics and baseline clinical characteristics.Follow-up showed minor patient loss,resulting in 23 and 24 in groups A and B respectively.Group A experienced a notable reduction in pain,with VAS scores decreasing from 7.7 to 2.4 over 24 months,compared to a minor reduction from 7.8 to 6.2 in Group B.This difference in pain reduction in group A was statistically significant from the third month onwards.Additionally,Group A showed significant improvements in knee functionality,with IKDC scores rising from 33.4 to 83.10,whereas Group B saw a modest increase from 36.7 to 45.16.The improvement in Group A was statistically significant from 6 months and maintained through 24 months.CONCLUSION Our study demonstrated that intra-articular administration of SVF can lead to reduced pain and improved knee function in patients with primary knee OA.More adequately powe

关键词： Knee osteoarthritis Adipose tissue Stromal vascular fraction Regenerative medicine Orthobiologics

Effect of weight-adjusted antimicrobial antibiotic prophylaxis on postoperative dosage and surgical site infection incidence in total joint arthroplasty

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World Journal of Orthopedics 2024年第4期15卷 318-320页

作者： Ashim Gupta Vijay Kumar Jain department of orthopaedics and Regenerative Medicine Future BiologicsLawrencevilleGA 30043United States department of orthopaedics South Texas Orthopaedic Research Institute(STORI Inc.)LaredoTX 78045United States department of Regenerative Medicine BioIntegrateLawrencevilleGA 30043United States department of orthopaedics and Regenerative Medicine Regenerative OrthopaedicsNoida 201301India department of orthopaedics Atal Bihari Vajpayee Institute of Medical SciencesDr Ram Manohar Lohia HospitalNew Delhi 110001India

Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.

关键词： Antibiotics Antimicrobial prophylaxis Weight-adjusted Surgical site infections Total joint arthroplasty Knee arthroplasty Hip arthroplasty

Autologous peripheral blood-derived orthobiologics:Different types and their effectiveness in managing knee osteoarthritis

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World Journal of Orthopedics 2024年第5期15卷 400-403页

Knees are the most commonly impacted weight-bearing joints in osteoarthritis(OA),affecting millions of people worldwide.With increasing life spans and obesity rates,the incidence of knee OA will further increase,leading to a significant increase in the economic burden.Conventional treatment modalities utilized to manage knee OA have limitations.Over the last decade,the role of various autologous peripheral blood-derived orthobiologics(APBOs)for the treatment of knee OA has been extensively investigated.This editorial provided an overview and focused on defining and shedding light on the current state of evidence based on the most recent published clinical studies concerning the use of APBO for the management of knee OA.While numerous studies have demonstrated promising results for these preparations,a notable gap exists in the comparative analysis of these diverse formulations.This absence of head-to-head studies poses a considerable challenge for physicians/surgeons in determining the optimal preparation for managing knee OA and achieving sustained longterm results.Thus,more adequately powered,multicenter,prospective,doubleblind,randomized controlled trials with longer follow-ups are needed to establish the long-term efficacy and to aid physicians/surgeons in determining the optimal APBO for the management of knee OA.

关键词： Knee osteoarthritis Platelet-rich plasma Platelet lysate Autologous conditioned serum Gold-induced cytokine Plasma rich in growth factors Growth factor concentrate Autologous protein solution Platelet-rich fibrin Hyperacute serum

Lateral clavicle fracture-plating options and considerations

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World Journal of Clinical Cases 2024年第6期12卷 1039-1044页

作者： Sathish Muthu Saravanan Annamalai Velmurugan Kandasamy department of orthopaedics Orthopaedic Research GroupCoimbatore 641045Tamil NaduIndia department of Biotechnology Karpagam Academy of Higher EducationCoimbatore 641021Tamil NaduIndia department of orthopaedics Government Karur Medical CollegeKarur 639004Tamil NaduIndia department of orthopaedics Government Thiruvallur Medical CollegeThiruvallur 631203Tamil NaduIndia department of orthopaedics Government Kilpauk Medical CollegeChennai 600010Tamil NaduIndia

Clavicle fractures are among the most prevalent types of fractures with numerous treatment strategies that have evolved over time.In the realm of lateral-third clavicle fracture management,several surgical methods are available,with plate and screw constructs being one of the most frequently employed options.Within this construct,numerous choices exist for fixing the fracture.This editorial provides an overview of the common plate options utilized in the management of distal third clavicle fractures underscoring the critical considerations and approaches that guide clinicians in selecting the most appropriate fixation techniques,considering the complex landscape of clavicle fractures and their challenging management.

关键词： Clavicle fracture Surgical management Distal clavicle plating Superior plating Anterior plating

Meta-analysis of new intervention measures for preventing side effects of artificial joint replacement

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World Journal of Orthopedics 2024年第5期15卷 469-476页

作者： Wei Jiang Ting-Biao Zhu department of orthopaedics Traditional Chinese Medicine Hospital of PingshanYibin 645350Sichuan ProvinceChina department of orthopaedics The First People's Hospital of QujingQujing 655099Yunnan ProvinceChina

BACKGROUND Intertrochanteric fracture of the femur occurs mostly among older people,and seriously affects daily life and quality of life.At present,physical intervention,drug treatment,routine intervention and rehabilitation training are widely used for prevention of side effects,but it is still inconclusive which intervention has the best effect.AIM To compare the effects of new intervention measures for preventing side effects of artificial joint replacement.METHODS We searched the Chinese and English literatures for comparative studies on the prevention of side effects of new interventions for artificial joint replacement from July 2013 to June 2023 in China HowNet,PubMed,Wanfang,Weipu and other databases.Study quality was evaluated by improved Jadad scoring standard,and the effects of different interventions on preventing different complications were analyzed by meta-analysis of evidence-based medicine with Review Manager 5.0 software.RESULTS Ten articles,including 869 cases,were finally included.The preventive effects of different interventions on the side effects of artificial joint replacement were studied,and valid data were extracted.There were two articles on the preventive effects of drug intervention,four on comparison of the preventive effects of combined and single interventions,and three on the preventive effects of physical intervention,rehabilitation training and routine intervention.Meta-analysis showed that the preventive effect of rivaroxaban was significantly better than low molecular weight heparin calcium[mean difference(MD)=-0.16,95%CI:-0.28 to-0.04,P<0.05].The effect of combined intervention was significantly better than that of single intervention(MD=-0.08,95%CI:-0.16 to-0.01,P<0.001).Physical intervention was significantly better than routine intervention and rehabilitation training(MD=0.26,95%CI:0.16–0.36,P<0.001).CONCLUSION Rivaroxaban combined with rehabilitation training is preferred for preventing deep vein thrombosis after artificial joint replacement.In the prevention of pulmonar

关键词： Artificial joint replacement Venous thromboembolism Side effects Interventions Meta-analysis

Outcome of percutaneous reconstruction of chronic lateral collateral ligament rupture

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Chinese Journal of Traumatology 2024年第1期27卷 58-62页

作者： Soliudeen Adebayo Arojuraye Ibrahim Abolaji Alabi Ibrahim Usman Mustapha department of orthopaedics National Orthopaedic Hospital Dala-KanoNigeria department of Surgery Bayero University KanoNigeria

Purpose:Many techniques have been described for the reconstruction of chronic lateral collateral ligament(LCL)rupture with different autograft options.The advantages of percutaneous LCL reconstruction include small incisions,minimal soft tissue disruption,less postoperative pain,and speedy rehabilitation and recovery.The aim of this study was to report the functional outcome of percutaneous LCL reconstruction and overall patient satisfaction in Africans.Methods:This prospective and interventional study involving 51 patients with chronic LCL rupture who had percutaneous LCL reconstruction using peroneus longus autograft was conducted between January 2021 and December 2022 in National Orthopaedic Hospital,Dala-Kano,Nigeria.The inclusion criteria were patients between the ages of 18 and 45 years with chronic isolated LCL and not more than 1 injury of knee ligament.Exclusion criteria were active infection,and multi-ligament knee injury requiring 2-staged surgery.The knee functions were assessed preoperatively,3 months,6 months,and 12 months postoperatively using the Lysholm scoring system.Patient satisfaction with the outcome of the treatment was assessed using a 5-point Likert scale.Relevant information was recorded into Microsoft Excel sheet and data was analyzed using SPSS version 23.0 for windows.The paired samples t-test was used to compare the clinical outcomes as continuous variables.Statistical significance was considered at p<0.05.Results:The mean age of the patients was(30.10±5.90)years.The median time from injury to surgery was 7 months(ranging from 3 to 28 months).The mean follow-up period was(14.07±3.13)months.The mean preoperative and 1-year postoperative Lysholm scores were 44.33±12.97 and 97.96±1.23,respectively.Conclusion:Percutaneous LCL reconstruction using peroneus longus autograft significantly improves patient knee function and results in excellent patient satisfaction。

关键词： rupture ligament percutaneous

Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures

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World Journal of Orthopedics 2024年第6期15卷 570-577页

作者： Rohit Ailani Sanjeev Kumar Bhuyan Brejesh Kumar Prasad Amit Kumar Namrata Dawani department of orthopaedics Lovee Shubh HospitalLucknowUttar Pradesh 226002India department of orthopaedics Gauhati Medical CollegeGuahati 781032India department of orthopaedics ESIC Medical College and HospitalFaridabadHaryana 121001India department of orthopaedics All India Institute of Medical SciencesKalyaniWest Bengal 741245India department of Obstetric and Gynecology Kannauj Medical CollegeKannaujUttar Pradesh 209732India

BACKGROUND The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation.While there is consensus about the posterior approach,several posterior approaches have been developed.It is debatable as to which approach is best.AIM To compare triceps reflecting anconeus pedicle(TRAP)and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.METHODS In total,40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C,closed,and Gustilo type I intercondylar humeral fractures were included.Patients ranged in age from 18 years to 70 years.The patients were randomized into two groups:TRAP group and olecranon osteotomy group,with 20 cases in each.All were followed up at 6 wk,3 months,6 months,and 12 months.Functional outcomes were measured in terms of flexion-extension arc,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score.RESULTS The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group.The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group(119.5 vs 111.5 min and 9.85 vs 5.45 d,respectively).The mean arc of flexion-extension,Disabilities of Arm,Shoulder and Hand score,and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up(107.0 vs 106.2,18.3 vs 15.7,and 84.2 vs 86.2,respectively).Ulnar paresthesia and superficial infections were comparable in both groups(2 cases vs 3 cases and 3 cases vs 2 cases,respectively).Hardware prominence was significantly higher in the olecranon osteotomy group,mostly due to tension band wiring.CONCLUSION Both approaches were equivalent,but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.

关键词： Elbow joint Humeral fracture Osteotomy Internal Fracture fixation