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Management of syndesmotic injuries:What is the evidence?

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World Journal of Orthopedics 2016年第11期7卷 718-725页

作者： Marc Schnetzke Sven Y Vetter Nils Beisemann Benedict Swartman Paul A Grützner Jochen Franke Department for trauma and orthopaedic surgery MINTOS-Medical Imaging and Navigation in Trauma and Orthopaedic SurgeryBG Trauma Center Ludwigshafen at Heidelberg University Hospital

Ankle fractures are accompanied by a syndesmotic injury in about 10% of operatively treated ankle fractures. Usually, the total rupture of the syndesmotic ligaments with an external rotation force is associated with a Weber type B or C fracture or a Maisonneuve fracture. The clinical assessment should consist of a comprehensive history including mechanism of injury followed by a specific physical examination. Radiographs, and if in doubt magnetic resonance imaging, are needed to ascertain the syndesmotic injury. In the case of operative treatment the method of fixation, the height and number of screws and the need for hardware removal are still under discussion. Furthermore, intraoperative assessment of the accuracy of reduction of the fibula in the incisura using fluoroscopy is difficult. A possible solution might be the assessment with intraoperative three-dimensional imaging. The aim of this article is to provide a current concepts review of the clinical presentation, diagnosis and treatment of syndesmotic injuries.

关键词： Ankle sprain Syndesmotic injury Syndesmotic screw Ankle TightRope Three-dimensional

Application of artificial intelligence in trauma orthopedics: Limitation and prospects

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World Journal of Clinical Cases 2023年第18期11卷 4231-4240页

作者： Maryam Salimi Joshua A Parry Raha Shahrokhi Seyedarad Mosalamiaghili Department of orthopaedic surgery Denver Health Medical CenterDenverCO 80215United States Student Research Committee Shiraz University of Medical SciencesShiraz ***Iran

The varieties and capabilities of artificial intelligence and machine learning in orthopedic surgery are extensively *** promising method is neural networks,emphasizing big data and computer-based learning systems to develop a statistical fracture-detecting *** derives patterns and rules from outstanding amounts of data to analyze the probabilities of different outcomes using new sets of similar *** sensitivity and specificity of machine learning in detecting fractures vary from previous *** may be most promising in the diagnosis of less-obvious fractures that are more commonly *** studies are necessary to develop more accurate and effective detection models that can be used clinically.

关键词： Artificial intelligence Machine learning Orthopedics trauma Neural network

Distal clavicle fractures treated by anteroinferior plating with a single screw: Two case reports

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World Journal of Clinical Cases 2023年第30期11卷 7502-7507页

作者： Xin-Lei Zhao Yan-Qing Liu Jian-Guo Wang You-Cai Liu Jia-Xuan Zhou Bei-Yu Wang Yi-Jun Zhang Department of orthopaedic surgery The First Affiliated Hospital of Baotou Medical CollegeInner Mongolia University of Science and TechnologyBaotou 014010Inner Mongolia Autonomous RegionChina

BACKGROUND For the treatment of distal clavicle fractures,each treatment method has its own advantages and disadvantages,and there is no optimal surgical *** SUMMARY Based on this,we report 2 cases of distal clavicle fractures treated utilizing an anterior inferior plate with a single screw placed in the distal,in anticipation of providing a better surgical approach to distal clavicle fracture *** patients were admitted to the hospital after trauma with a diagnosis of distal clavicle fracture,and were admitted to the hospital for internal fixation of clavicle fracture by incision and reduction,with good postoperative functional *** With solid postoperative fixation and satisfactory prognostic functional recovery,this technique has been shown to be simple,easy to perform and effective.

关键词： Distal clavicle fractures Anteroinferior Plating Single screw Case report

Hip hemi-arthroplasty for neck of femur fracture:What is the current evidence?

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World Journal of Orthopedics 2018年第11期9卷 235-244页

作者： Greg AJ Robertson Alexander M Wood Edinburgh orthopaedic trauma Unit Royal Infirmary of Edinburgh orthopaedic Department Leeds General Infirmary

This editorial reviews and summarises the current evidence(meta-analyses and Cochrane reviews) relating to the use of hip hemi-arthroplasty for neck of femur fractures. Regarding the optimal surgical approach,two recent meta-analyses have found that posterior approaches are associated with: higher rates of dislocation compared to lateral and anterior approaches; and higher rates of re-operation compared to lateral approaches. Posterior approaches should therefore be avoided when performing hip hemi-arthroplasty procedures. Assessing the optimal prosthesis head component,three recent meta-analyses and one Cochrane review have found that while unipolar hemiarthroplasty can be associated with increased rates of acetabular erosion at short-term follow-up(up to 1 year),there is no significant difference between the unipolar hemi-arthroplasty and bipolar hemi-arthroplasty for surgical outcome,complication profile,functional outcome and acetabular erosion rates at longer-term follow-up(2 to 4 years). With bipolar hemi-arthroplasty being the more expensive prosthesis,unipolar hemi-arthroplasty is the recommended option. With regards to the optimal femoral stem insertion technique,three recent metaanalyses and one Cochrane Review have found that,while cemented hip hemi-arthroplasties are associated with a longer operative time compared to uncemented Hip Hemi-arthroplasties,cemented prostheses have lower rates of implant-related complications(particularly peri-prosthetic femoral fracture) and improved postoperative outcome regarding residual thigh pain and mobility. With no significant difference found between the two techniques for medical complications and mortality,cemented hip hemi-arthroplasty would appear to be the superior technique. On the topic of wound closure,one recent meta-analysis has found that,while staples can result in a quicker closure time,there is no significant difference in post-operative infections rates or wound healing outcomes when comparing staples

关键词： Hemi-arthroplasty Prosthesis Stem Head Hip Femoral Neck Fracture Cement

Return to sport following tibial plateau fractures: A systematic review

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World Journal of Orthopedics 2017年第7期8卷 574-587页

作者： Greg A J Robertson Seng J Wong Alexander M Wood Edinburgh orthopaedic trauma Unit Royal Infirmary of Edinburgh orthopaedic Department Leeds General Infirmary

AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment *** A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords "tibial", "plateau", "fractures", "knee", "athletes", "sports", "non-operative", "conservative", "operative", "return to sport". All studies which recorded return rates and times to sport following tibial plateau fractures were included. RESULTS Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management(n = 3); 27 reported on the outcome of surgical management(n = 917). Nine studies reported on Open Reduction Internal Fixation(ORIF)(n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation(ARIF)(n = 253) and 7 on Frame-Assisted Fixation(FRAME)(n = 262). All studies recorded "return to sport"rates. Only one study recorded a "return to sport" time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF(OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME(OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME(OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo(median), from a study reporting on *** Return rates to sport for tibial pl

关键词： Tibial Plateau Fracture Knee Return Sport Rate Time

Predicting lower limb periprosthetic joint infections: A review of risk factors and their classification

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世界骨科杂志：英文版 2017年第5期8卷 400-411页

作者： David A George Lorenzo Drago Sara Scarponi Enrico Gallazzi Fares S Haddad Carlo L Romano Department of trauma and orthopaedics University College London Hospitals Microbiological Laboratory Orthopaedic Re-search Institute Galeazzi Centre for Reconstructive surgery and Osteoarticular Infections Orthopaedic Research Institute Galeazzi

AIM To undertook a systematic review to determine factors that increase a patient's risk of developing lower limb periprosthetic joint infections(PJI).METHODS This systematic review included full-text studies that reviewed risk factors of developing either a hip or knee PJI following a primary arthroplasty published from January 1998 to November 2016. A variety of keywords were used to identify studies through international databases referencing hip arthroplasty, knee arthroplasty, infection, and risk factors. Studies were only included if they included greater than 20 patients in their study cohort, and there was clear documentation of the statistical parameter used; specifically P-value, hazard ratio, relative risk, or/and odds ratio(OR). Furthermore a quality assessment criteria for the individual studies was undertaken to evaluate the presence of record and reporting bias. RESULTS Twenty-seven original studies reviewing risk factors relating to primary total hip and knee arthroplasty infections were included. Four studies(14.8%) reviewed PJI of the hip, 3(11.21%) of the knee, and 20(74.1%) reviewed both joints. Nineteen studies(70.4%) were retrospective and 8(29.6%) prospective. Record bias was identified in the majority of studies(66.7%). The definition of PJI varied amongst the studies but there was a general consensus to define infection by previously validated methods. The most significant risks were the use of preoperative high dose steroids(OR = 21.0, 95%CI: 3.5-127.2, P < 0.001), a BMI above 50(OR = 18.3, P < 0.001), tobacco use(OR = 12.76, 95%CI: 2.47-66.16, P= 0.017), body mass index below 20(OR = 6.00, 95%CI: 1.2-30.9, P = 0.033), diabetes(OR = 5.47, 95%CI: 1.77-16.97, P = 0.003), and coronary artery disease(OR = 5.10, 95%CI: 1.3-19.8, P = 0.017).CONCLUSION We have highlighted the need for the provider to optimise modifiable risk factors, and develop strategies to limit the impact of non-modifiable factors.

关键词： Periprosthetic joint infection Risk factor Predictive Hip arthroplasty Knee arthroplasty

Applications of finite element simulation in orthopedic and trauma surgery

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World Journal of Orthopedics 2012年第4期3卷 25-41页

作者： Antonio Herrera Elena Ibarz José Cego?ino Antonio Lobo-Escolar Sergio Puértolas Enrique López Jesús Mateo Luis Gracia Department of orthopaedic and trauma surgery Miguel Servet University HospitalMedicine SchoolUniversity of Zaragoza Department of Mechanical Engineering University of Zaragoza

Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography(CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element(FE) simulation lets us know the biomechanical changes that take place after hipprostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints applied

关键词： Finite element simulation Hip prosthesis Lumbar spine Lumbar fixations Osteoporotic fractures Splints

Novel Application of Vacuum Sealing Drainage with Continuous Irrigation of Potassium Permanganate for Managing Infective Wounds of Gas Gangrene

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2015年第4期35卷 563-568页

作者：胡宁吴星火刘融杨述华黄玮蒋电明吴强夏天邵增务叶哲伟 Department of orthopaedic surgery Institute for Orthopaedic Research and EducationThe First Affiliated Hospital of Chongqing Medical University Department of orthopaedic surgery Union HospitalTongji Medical CollegeHuazhong University of Science and Technology Department of orthopaedic surgery Wuhan Puren HospitalWuhan University of Science and Technology

Summary： traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputa- tion. The aim of the present study was to use vacuum sealing drainage （VSD） with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical effi- cacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Am- putations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol （PVA） foam dress- ing and polyurethane （PU） film, with continuous irrigation of 1：5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one pa- tient who suffered from severe septic shock. Emergent resuscitation was performed and the patient re- turned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenviroument and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection.

关键词： vacuum sealing drainage potassium permanganate irrigation gas gangrene trauma

Growth factor delivery using extracellular matrix-mimicking substrates for musculoskeletal tissue engineering and repair

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Bioactive Materials 2021年第7期6卷 1945-1956页

作者： Robert C.H.Gresham Chelsea S.Bahney J.Kent Leach UC Davis Department of Biomedical EngineeringDavisCAUSA Steadman Phillippon Research Institute VailCOUSA UCSF orthopaedic trauma Institute San FranciscoCAUSA UC Davis Health Department of Orthopaedic SurgeryDavisCAUSA

Therapeutic approaches for musculoskeletal tissue regeneration commonly employ growth factors(GFs)to influence neighboring cells and promote migration,proliferation,or *** promising results in preclinical models,the use of inductive biomacromolecules has achieved limited success in translation to the *** field has yet to sufficiently overcome substantial hurdles such as poor spatiotemporal control and supraphysiological dosages,which commonly result in detrimental side *** presentation and retention of biomacromolecules is regulated by the extracellular matrix(ECM),which acts as a reservoir for GFs via electrostatic *** in the manipulation of extracellular proteins,decellularized tissues,and synthetic ECM-mimetic applications across a range of biomaterials have increased the ability to direct the presentation of *** application of biomaterial technologies utilizing ECM mimetics increases tissue regeneration without the reliance on supraphysiological doses of inductive *** review describes recent strategies to manage GF presentation using ECM-mimetic substrates for the regeneration of bone,cartilage,and muscle.

关键词： Growth factor Extracellular matrix Spatiotemporal control Tissue engineering Affinity