SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Arthroscopic reduction and internal fixation (ARIF) for talar body fractures: systematic review
No full textPurpose: This study aimed to systematically assess the available literature on the technique and results of arthroscopic reduction – internal fixation for displaced fractures of the talar body. Methods: A systematic review was made of the available literature on MEDLINE, EMBASE, and the Cochrane Library database, including studies from January 1985 to July 2021. The literature search, data extraction, and quality assessment were conducted by two independent reviewers. Surgical technique, perioperative management, clinical outcome scores, radiographic outcomes, and complication rates were evaluated. Results: Out of 37 articles reviewed, 12 studies met the inclusion criteria. The studies included reported on the results of 22 patients. No complications were observed in any of the patients treated. Conclusions: The included studies had too many weaknesses to allow the pooling of data or meta-analysis. However, percutaneous arthroscopic talar internal fixation appears to be a good option for uncomplicated displaced intra-articular talar fractures. Appropriately powered randomized controlled trials with long-term follow-ups are required to confirm the effectiveness of this technique. Level of Evidence: Level IV, a systematic review of Level IV studies
Percutaneous femoral de-rotational varus osteotomy for the treatment of acetabular dysplasia: surgical technique
No full textPediatric acetabular dysplasia is common in orthopedic practice. Femoral de-rotational varus osteotomy (FDVO) is one of the surgical options suggested for treatment. In this article, we describe a simplified surgical technique of performing FDVO percutaneously using a pediatric Limb Reconstruction System external fixator, and we discuss the advantages and disadvantages of the technique
Bridge enhanced ACL repair vs. ACL reconstruction for ACL tears: A systematic review and meta-analysis of comparative studies
No full textIntroduction: Anterior cruciate ligament (ACL) tear is one of the most frequent ligamentous injuries. The gold standard for ACL tears is autograft reconstruction. However, ACL repair has regained enthusiasm with more recent results showing comparable outcomes to its reconstructive counterpart. Methods: PubMed, Cochrane, and Google Scholar (pp. 1–20) were searched until November 2022. The clinical outcomes consisted of the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), the side-to-side difference in Anteroposterior (AP) knee laxity, the forces of the hamstring, quadriceps, and hip abduction as well as hopping tests. Results: Only two studies were included in this meta-analysis. ACL repair was shown to have better Hamstrings strength. The rest of the analyzed outcomes were comparable. Discussion: This is the first meta-analysis comparing these two treatments. The ACL repair showed no differences in muscle strength (quadriceps and hip abductors), postoperative knee scores, and knee joint laxity when compared to ACL reconstruction. However, it showed better hamstring strength. Further randomized clinical studies will be needed to compare both of these techniques
Artificial intelligence for fracture diagnosis in orthopedic X-rays: current developments and future potential
No full textThe use of artificial intelligence (AI) in the interpretation of orthopedic X-rays has shown great potential to improve the accuracy and efficiency of fracture diagnosis. AI algorithms rely on large datasets of annotated images to learn how to accurately classify and diagnose abnormalities. One way to improve AI interpretation of X-rays is to increase the size and quality of the datasets used for training, and to incorporate more advanced machine learning techniques, such as deep reinforcement learning, into the algorithms. Another approach is to integrate AI algorithms with other imaging modalities, such as computed tomography (CT) scans, and magnetic resonance imaging (MRI), to provide a more comprehensive and accurate diagnosis. Recent studies have shown that AI algorithms can accurately detect and classify fractures of the wrist and long bones on X-ray images, demonstrating the potential of AI to improve the accuracy and efficiency of fracture diagnosis. These findings suggest that AI has the potential to significantly improve patient outcomes in the field of orthopedics
Tibial tubercule osteotomy during the revision of total knee arthroplasty: The technique of a referral center with 10 years of experience
No full textIntroduction: The Tibial Tubercle Osteotomy (TTO) technique, by lifting the distal bony attachment of the extensor mechanism, allows efficient knee exposure while preserving soft tissues and tendinous attachments. The surgical technique seems essential to obtain satisfying outcomes with a low rate of specific complications. Several tip sand tricks can be used to improve this procedure during the revision of total knee arthroplasty (RTKA). Technique: The osteotomy should be at least: 60 mm in length and 20 mm in width to allow fixation with 2 screws; and 10–15 mm thick to resist to screw compression. The proximal cut of the osteotomy must keep a proximal buttress spur of 10 mm to get primary stability and avoid the tubercle ascension. A smooth end of the TTO distally reduces the risk of a tibial shaft fracture. The strongest fixation is obtained using two bicortical 4.5 mm screws slightly ascendant. Results: From January 2010 to September 2020, 135 patients received an RTKA with concomitant TTO and a mean follow-up of 51 ± 26 months [24–121]. The osteotomy was healed in 95% of patients (n = 128) with a mean delay of 3.4 ± 2.7 months [1.5–24]. However, there are some specific and significant complications related to the TTO. Twenty complications (15%) related to the TTO were recorded, with 8 (6%) requiring surgery. Conclusion: Tibial tubercle osteotomy in RTKA is an efficient procedure to improve knee exposure. To avoid tibial tubercle fracture or non-union, a rigorous surgical technique is primordial with a sufficient length and thickness of the tibial tubercle, a smooth end, a proximal step, a final good bone contact, and a strong fixation
Characteristics and clinical features of cauda equina syndrome: insights from a study on 256 patients
No full textObjective: To determine the frequency, clinical presentation, and etiological factors of cauda equina syndrome (CES). Materials and method: This retrospective study was done on 256 participants, and aimed to analyze the frequency and patterns of clinical presentation in suspected cases of CES. The inclusion criteria included participants aged 18 or older with medical records available for review and having red-flagged symptoms for CES. The study collected information on various factors such as age, gender, confirmation of CES on MRI, neurological deficits, etiological factors, duration of symptoms, and more. The data collected was analyzed using descriptive statistics and logistic regression to identify significant variables between MRI-proven CES and suspected CES. Results: The mean age was 58.05 ± 19.26 years, with 151 females (58.98%) and 105 males (41.02%). The majority (50.78%) had a neurological deficit, while other symptoms included difficulty initiating micturition or impaired sensation of urinary flow (17.58%), loss of sensation of rectal fullness (3.12%), urinary or faecal incontinence (35.16%), bilateral sciatica (21.88%), neurological symptoms in the lower limbs (25.00%), anaesthesia or any leg weakness (24.22%), and bilateral sciatica as the predominant symptom (21.88%). Symptoms were chronic in 47.27% and acute in 21.88%. The odds of MRI-proven CES increase by 3% per year of age. Neurological deficit was strongly associated with MRI-proven CES (OR = 14.97), while loss of sensation of rectal fullness increased the odds by 10-fold (OR = 10.62). Conclusion: CES can present with various symptoms, including the bilateral neurological deficit, urinary and faecal incontinence, and bilateral sciatica, with age, severe bilateral neurological deficit, and loss of sensation of rectal fullness being associated with MRI-proven CES. Early diagnosis and treatment are crucial for better outcomes
Effect of fracture level on the residual fracture gap during tibial intramedullary nailing for tibial shaft fractures
No full textIntroduction: The development of fracture gap during intramedullary nailing in tibial fractures is associated with poor fracture fragment contact and increased time to union and complications. This study aimed to evaluate the effect of the fracture level in the development of the fracture gap and the effect of the fracture gap on pain, radiologic and functional outcomes, and complication rate. Material and method: A total of 45 patients who underwent reamed intramedullary nailing due to closed transverse or short oblique tibial shaft fractures were divided into the proximal fracture group and the distal fracture group. The correlations between the visual analog scale (VAS) score, modified radiograph union score for tibias (RUST), and postoperative 1-year lower extremity functional scale scores, residual fracture gap, and time to union were evaluated. Results: The mean fracture gap amounts in the immediate postoperative anteroposterior and lateral radiographs were 5.6 ± 1.7 and 6.0 ± 1.7 mm in proximal fractures and 0.3 ± 2.4 mm and 0.4 ± 2.3 mm in distal fractures, respectively (p < 0.001 and p < 0.001, respectively). The mean time to union was 21.9 ± 2.9 weeks in the proximal fracture group and 16.7 ± 2.4 weeks in the distal fracture group (p < 0.000). The residual fracture gap amount significantly correlated with the level of fracture (r = 0.811, p < 0.001). Discussion: Tibial shaft fractures proximal to the isthmus level tend to develop significantly larger fracture gaps than distal fractures. It is associated with increased time to union and radiographic union scores as well as slightly higher complication and reoperation rates
New measurement technique for restoration of the trochlear offset after image-based robotic-assisted total knee arthroplasty: a reliability study
No full textIntroduction: The new concepts in total knee arthroplasty (TKA) tend to improve the alignment and ligament balancing after TKA. Nevertheless, the assessment of the anterior compartment is difficult. The purpose of this study was to describe a new measurement technique of trochlear offset restoration on CT-scan after primary robotic-assisted TKA and assess its reliability and repeatability. Method: This monocentric study assessed the trochlear offset restoration on a CT scan after 20 robotic-assisted TKA. To evaluate the trochlear offset restoration, we measured the depth difference between the native and the prosthetic trochlea. Four sequential positions were assessed on the trochlea: at full extension, at 30°, 70°, and 90° flexion. For each of these positions, we compared the highest point of the lateral native condyle and the lateral prosthetic condyle, the highest point of the medial native condyle and the medial prosthetic condyle, the deepest point of the native trochlear groove and the prosthetic trochlea. Two independent reviewers performed the measurements to assess their reliability. To determine intraobserver variability, the first observer performed the measurements twice. Results: The mean age was 67.3 years old ± 8.3. Mean values of the trochlear offset restoration for the medial condyle, trochlear groove and lateral condyle were respectively: 1.0 mm ± 1.6, 1.1 mm ± 1.5, −2.7 mm ± 2.3 in full extension; −3.5 mm ± 1.7, −1.5 mm ± 1.7, −3.9 mm ± 3.9 at 30° flexion; −5.1 mm ± 1.8, 2.1 mm ± 2.7, −3.8 mm ± 1.8 at 70° flexion; 2.0 mm ± 1.4 and 3.1 mm ± 1.5 for the medial and lateral condyles at 90° flexion. The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements with mean kappa values of 0.92 and 0.74. Conclusion: We present a novel measurement technique on CT scan for evaluating the restoration of the trochlear offset after TKA, demonstrating excellent inter and intra-observer reliability
Estimated diameter increase from a 4S to a 6S hamstring graft configuration – A cadaveric study
No full textPurpose: Graft diameter in anterior cruciate ligament reconstructions has been shown to influence the risk of failure. It is therefore important to be able to adjust the graft configuration to modify the diameter. To measure the impact of a 6-strand (6S) hamstring autograft configuration on graft diameter compared to the standard 4-strand (4S) configuration. Methods: Cadaveric study on 33 knees, using the usual hamstring graft harvesting technique. Semitendinosus and gracilis tendons were harvested and their length, width, and diameter were measured in 4S and 6S configurations separately by three evaluators. Results: 6S configuration leads to a median increase of 1.5 (range: 0.0–2.0) mm in diameter compared to 4S (p < 0.001). A graft diameter of more than 8 mm is attained in less than a third of 4S grafts within this population in comparison to 84% when the 6S configuration is used. Discussion: The 6S hamstring graft configuration increases the graft diameter by a median of 1.5 millimeters compared to the traditional 4S configuration. It can reliably be used to obtain an 8.5 mm graft diameter or more in cases where the semitendinosus measures at least 270.5 mm and the 4S configuration has a diameter of 7.5 mm or 8 mm. This information helps to better delineate the impact of a 6S configuration in a pre-operative or intra-operative setting to optimize the decisional process and surgical flow and to easily adapt the graft diameter.
Level of evidence: V (cadaveric study
