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Surgical management of the diabetic foot:The current evidence

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World Journal of Orthopedics 2024年第5期15卷 404-417页

作者： Richard Henry Randall Roberts Gareth Rhys Davies-Jones James Brock Vaishnav Satheesh Greg AJ Robertson Department of trauma and orthopaedics Wrexham Maelor HospitalWrexham LL137TDUnited Kingdom Department of trauma and orthopaedics The Robert Jones and Agnes Hunt Orthopaedic HospitalOswestry SY107AGUnited Kingdom

The prevalence of diabetes mellitus and its associated complications,particularly diabetic foot pathologies,poses significant healthcare challenges and economic burdens *** review synthesises current evidence on the surgical management of the diabetic foot,focusing on the interplay between neuropathy,ischemia,and infection that commonly culminates in ulcers,infections,and,in severe cases,*** escalating incidence of diabetes mellitus underscores the urgency for effective management strategies,as diabetic foot complications are a leading cause of hospital admissions among diabetic patients,significantly impacting morbidity and mortality *** review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers,infections,and skeletal pathologies such as Charcot arthropathy,emphasising the critical role of early diagnosis,comprehensive management strategies,and interdisciplinary care in mitigating adverse *** addressing surgical interventions,this review evaluates conservative surgeries,amputations,and reconstructive procedures,highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot *** integration of advanced diagnostic tools,novel surgical techniques,and postoperative care,including offloading and infection control,are discussed in the context of optimising healing and preserving limb function.

关键词： Diabetes Diabetic foot Charcot Osteomyelitis Amputation Diabetic foot attack Conservative surgery

Outcome of meniscal repairs in paediatric population:A tertiary centre experience

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World Journal of Orthopedics 2024年第6期15卷 547-553页

作者： Ayman Gabr Samson Williams Sophie Dodd Nick Barton-Hanson Department of trauma&orthopaedics West Suffolk HospitalSuffolk IP332QZUnited Kingdom Department of trauma and orthopaedics Alder Hey Children's HospitalLiverpool L145ABUnited Kingdom

BACKGROUND Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards ***,there is limited data in the literature on meniscal repair outcomes in skeletally immature *** To evaluate the re-operation rate and functional outcomes of meniscal repairs in children and *** We performed a retrospective review of all patients who underwent arthroscopic meniscal repair surgery between January 2007 and January *** patients were under the age of 18 at the time of *** were all performed by a single *** was gathered from our hospital Electronic Patient Records *** primary outcome measure was re-operation rate(need for further surgery on the same meniscus).Secondary outcome measures were surgical complications and patient reported outcome measures that were International Knee Documentation Committee(IKDC),Tegner and Lysholm *** We identified 59 patients who underwent 66 All-inside meniscal repairs(32 medial meniscus and 34 Lateral meniscus).Meniscal repairs were performed utilizing FasT-Fix(Smith and Nephew)*** were 37 males and 22 females with an average age of 14 years(range 6-16).The average follow-up time was 53 months(range 26-140).Six patients had concomitant anterior cruciate ligament reconstruction surgery along with the meniscal *** were no requiring further meniscal repairs and 9 patients underwent partial *** mean postoperative IKDC score was 88(44-100),Tegner score was 7(2-10)and Lysholm score was 94(57-100).CONCLUSION Our results showed that arthroscopic repair of meniscal tears in the paediatric population is an effective treatment option that has a low failure rate and good postoperative clinical with the advantage of preserving meniscal tissues.

关键词： Meniscus Meniscal repair Outcome Meniscal preservation

Health economics for intra-capsular hip fractures undertaking fixation

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World Journal of Orthopedics 2024年第1期15卷 30-38页

作者： Anatole Wiik Thomas Ashdown Ian Holloway Department of Surgery Trauma and OrthopaedicsLondon North West University HealthcareLondon HA13UJUnited Kingdom Department of Surgery Trauma and OrthopaedicsLondon North West University HospitalLondon HA13UJUnited Kingdom

BACKGROUND Hip fracture is a common musculoskeletal injury in the elderly requiring surgery *** operative mainstay of intra-capsular hip fractures is arthroplasty with a smaller proportion for *** To determine the most beneficial method of fixation for patients with intracapsular hip *** A registered audit from 2012-2018 was conducted on all intra-capsular hip fractures treated with 2 commonly used fixation *** notes,electronic records and clinical codes for cost benefit were evaluated.A validated quality of life measure was collected at least 1 year after *** A total of 83 patients were identified with intra-capsular fractures undergoing fixation during the retrospective *** were 47 cannulated cancellous screw and 36 sliding hip screw fixations with the case mix comparable for age,gender,co-morbidities and fracture *** was no significant difference in blood loss,tip apex distance,radiation exposure,length of stay,radiological union time,collapse,avascular necrosis or re-operation between fixation *** regression analysis demonstrated displaced intracapsular hip fractures correlated significantly with an undesirable outcome conferring a relative odds ratio of *** were 9(19%)and 4(11%)patients respectively,who required *** was no significant difference in health resource group tariff and implant cost with comparable EQ-5D and visual CONCLUSION No significant advantage was identified with differing fixation type,but irrespective there were a high number of patients requiring *** was predicted by initial fracture displacement and patient *** may need to be carefully considered for health economics and patient benefit.

关键词： Hip fracture Fixation Patient reported outcome measure Cost

Tendoscopic Surgery for Peroneal Tendons Instability: A Literature Review

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Open Journal of Orthopedics 2024年第3期14卷 139-148页

作者： Islam Mubark Amr Abouelela Mahmoud Elbakry Tarek El Gamal Department of trauma and orthopaedics University Hospitals Birmingham NHS Foundation Trust Birmingham UK Department of trauma and orthopaedics Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK Department of trauma and orthopaedics University Hospitals of Derby and Burton NHS Foundation Trust Derby UK

Introduction: There has been a surge in the use of tendoscopic surgery for treating peroneal tendons instability. The novelty of this approach demanded a literature review of its indications, limitations, and clinical outcomes. Aim: a literature review of the clinical studies reporting on tendoscopic peroneal tendon stabilisation surgery along with its outcomes and complications. Methods: We carried out a comprehensive review of the literature up until September 2022 with an extensive search of the MEDLINE, Embase and Cochrane library databases. Results: Initial search resulted in 66 articles. Four duplicate articles were removed. Further 30 articles were excluded after title and abstract screening. Eight studies satisfied the inclusion criteria and were included in this review. Articles were analysed for outcomes and complications. Conclusion: The tendoscopic technique for peroneal tendon instability is an effective and safe surgical technique with very low failure rate. Levels of Evidence: Level IV.

关键词： Peroneal Tendons Instability Tendoscopy

Artificial Intelligence ChatGPT’s Perspective on Implementation of Augmented Intelligence within Orthopaedic Practice—A Comparative Narrative Synthesis?

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Intelligent Information Management 2024年第1期16卷 10-20页

作者： Neil Capes Hiran Patel Islam Sarhan Gur-Aziz S. Sidhu Neil Ashwood Andrew Dekker Department of trauma & orthopaedics University Hospitals Derby and Burton Derby United Kingdom Department of trauma & orthopaedics University Hospital Lewisham London United Kingdom Research Institute University of Wolverhampton Wolverhampton United Kingdom

ChatGPT has obvious benefits in the way it can interrogate vast amounts of reference information and utilise metadata generation to answer questions posed to it and is freely available having been developed through human feedback. Already there are ethical and practical implications on its impact on learning and research. Artificial Intelligence (AI) has been seen as a way of improving healthcare provision by delivering more robust outcomes but measuring these and implementing AI within this setting is at present limited and disjointed. Methods: ChatGPT was interrogated to see what it felt were the barriers to its implementation within healthcare and in particular orthopaedic practice. The evidence for this determination was then examined for validity and applicability for a practical roll out at a Trust, Regional or National level. Results: AI can synthesise a vast amount of information to help it answer specific questions. The context and structure of any question will determine the usefulness of the answer which can then be used to develop practical solutions based on experience and resource limitations. Conclusions: AI has a role in service development and can quickly focus a working group to areas to consider when practically implementing change.

关键词： Artificial Intelligence ChatGPT

Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

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Open Journal of Orthopedics 2024年第4期14卷 173-186页

作者： Loïc Fonkoue Gaspary Fodjeu Kennedy Olivier Muluem Olivier Ngongang Theophile Nana Marie Ange Ngo Yamben DésiréAkaba Urich Tambekou Daniel Eone Handy Department of orthopaedics and trauma Yaound&#233 General Hospital Yaound&#233 Cameroon. Department of Surgery and Specialities University of Yaound&#233 1 Yaound&#233 Cameroon Department of orthopaedics and trauma Yaound&#233 Emergency Center Yaound&#233 Cameroon Department of orthopaedics and trauma Yaound&#233 Central Hospital Yaound&#233 Cameroon

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas o

关键词： Proximal Femoral Fracture Watson-Jones Approach Dynamic Hip Screw Low Resource Setting

Advancing orthopaedic trauma care through WhatsApp:An analysis of clinical and non-clinical applications,challenges,and future directions

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World Journal of Orthopedics 2024年第6期15卷 529-538页

作者： Ravi Saini Madhan Jeyaraman Naveen Jeyaraman Vijay Kumar Jain Swaminathan Ramasubramanian Karthikeyan P Iyengar Department of orthopaedics Atal Bihari Vajpayee Institute of Medical SciencesDr Ram Manohar Lohia HospitalNew Delhi 110001India Department of orthopaedics ACS Medical College and HospitalDr MGR Educational and Research InstituteChennai 600077Tamil NaduIndia Department of orthopaedics Government Medical CollegeOmandurar Government EstateChennai 600002Tamil NaduIndia Department of trauma and orthopaedics Southport and Ormskirk HospitalsMersey and West Lancashire Teaching NHS TrustSouthport PR86PNUnited Kingdom

The integration of WhatsApp,a widely-used instant messaging application(IMA),into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent *** paper explores the multifaceted role of WhatsApp in orthopaedics,focusing on its clinical and non-clinical applications,advantages,disadvantages,and future *** study synthesizes findings from various research papers,emphasizing the growing reliance on mobile technology in ***’s role in orthopaedics is notable for its ease of use,real-time communication,and ***,it facilitates triage,teleconsultation,diagnosis,treatment,patient advice,and post-operative ***-clinically,it supports telemedicine,teleradiology,virtual frac-ture clinics,research,and education in orthopaedic *** application has proven beneficial in enhancing communication among healthcare teams,providing quick responses,and motivating junior *** use in educational settings has been shown to improve learner’s understanding and patient ***,the use of WhatsApp in orthopaedics is not without *** include the potential spread of misleading information,privacy concerns,and issues with image quality affecting diagnosis and treatment *** paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content *** forward,the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval,improve doctor-patient communication,and address challenges like bureaucratic red tape and limited *** paper suggests that future orthopaedic practice,particularly in emergency departments,will increasingly rely on such technologies for efficient patient *** shift,however,must be approached with an understanding of the ethical,legal,and practical implications of integrating social media and mobile

关键词： Social media WhatsApp orthopaedics trauma Research

Biophysical-driven piezoelectric and aligned nanofibrous scaffold promotes bone regeneration by re-establishing physiological electrical microenvironment

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Nano Research 2024年第8期17卷 7376-7393页

作者： Aoao Wang Xinbo Ma Yafeng Yang Guoliang Shi Liwei Han Xiantong Hu Rui Shi Jun Yan Quanyi Guo Yantao Zhao Senior Department of Orthopedics the Fourth Medical Center of PLA General HospitalBeijing 100048China Department of Chemistry Capital Normal UniversityBeijing 100048China National Center for orthopaedics Beijing Research Institute of Traumatology and OrthopaedicsBeijing Jishuitan HospitalCapital Medical UniversityBeijing 100035China Xijing 986 Hospital Department The Fourth Military Medical UniversityXi'an 710032China Institute of Orthopedics Chinese PLA General HospitalBeijing Key Laboratory of Regenerative Medicine in OrthopedicsKey Laboratory of Musculoskeletal Trauma&War Injuries PLABeijing 100853China

The initial healing stages of bone fracture is a complex physiological process involving a series of spatially and temporally overlapping events,including pathogen clearance,immunological modulation,and *** this study,we have developed a piezoelectric and aligned nanofibrous scaffold composed of ZnO@PCL/PVDF with multiple antibacterial,immunomodulatory,and osteogenic effects using electrospinning *** scaffold’s piezoelectric signal output under ultrasound(US)control can be similar to the physiological electrical signals of healthy bone tissue,creating a truly biomimetic electrical microenvironment in the bone *** vitro studies have shown that ZnO@PCL/PVDF scaffold significantly enhances the proliferation,migration,and osteogenic differentiation of MC3T3-E1 cells under piezoelectric drive provided by ***,the scaffold exhibits inhibitory effects on the growth of *** and ***,as well as the ability to induce M2 macrophage polarization,indicating potent antibacterial and immunomodulatory *** vivo experiments demonstrated that the ZnO@PCL/PVDF scaffold can accelerate the repair of mandibular defects in rats,effectively inhibit bacterial colonization,and reduce inflammatory ***,this study confirms that the newly developed ZnO@PCL/PVDF scaffold effectively promotes bone repair by truly mimicking the endogenous electrical microenvironment and precisely regulating the temporospatial disorders of initial bone healing,thus providing a simple and effective solution for bone defects.

关键词： piezoelectricity bone defect bacterial infection ZnO nanoparticles immunomodulation osteogenesis

Development of an experimental method for well-controlled blast induced traumatic limb fracture in rats

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Defence Technology（防务技术） 2024年第4期34卷 168-176页

作者： Luyang Xu Xiancheng Yu Clement DFavier Ibidumo Igah Thuy-Tien Nguyen Warren Macdonald Anthony MJ.Bull Centre for Blast Injury Studies Imperial College LondonLondonUnited Kingdom Department of Bioengineering Imperial College LondonLondonUnited Kingdom Dyson School of Design Engineering Imperial College LondonLondonUnited Kingdom Department of trauma and orthopaedics Royal Free London National Health Service Foundation TrustLondonUnited Kingdom

Heterotopic ossification(HO)is a consequence of traumatic bone and tissue damage,which occurs in 65%of military casualties with blast-associated ***,the mechanisms behind blast-induced HO remain *** models are used to study blast-induced HO,but developing such models is challenging,particularly in how to use a pure blast wave(primary blast)to induce limb fracture that then requires an *** studies,including our recent study,have developed platforms to induce limb fractures in rats with blast loading or a mixture of blast and impact ***,these models are limited by the survivability of the animal and repeatability of the *** this study,we developed an improved platform,aiming to improve the animal's survivability and injury repeatability as well as focusing on primary blast *** platform exposed only one limb of the rat to a blast wave while providing proper protection to the rest of the rat's *** obtained very consistent fracture outcome in the tibia(location and pattern)in cadaveric rats with a large range of size and ***,the rats did not obviously move during the test,where movement is a potential cause of uncontrolled *** further conducted parametric studies by varying the features of the design of the *** factors,such as how the limb is fixed and how the cavity through which the limb is placed is sealed,significantly affect the resulting *** platform and test setups enable well-controlled limb fracture induced directly by pure blast wave,which is the fundamental step towards a complete in vivo animal model for blast-induced HO induced by primary blast alone,excluding secondary and tertiary blast *** addition,the platform design and the findings presented here,particularly regarding the proper protection of the animal,have implications for future studies investigating localized blast injuries,such as blast induced brain and lung injuries.

关键词： Blast injury Biomechanics Heterotopic ossification Limb fracture Blast wave Animal model