SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Correlation between cephalic screw positioning of Standard Gamma 3 Nail for intertrochanteric fractures and cut-out incidence
No full textIntroduction: Lateral fractures of proximal femur are the most frequent fractures in elderly people. Internal fixation using medullary nails is the gold standard of treatment (Gamma 3 nail is the most implanted device) due to reduced incidence of complications than other devices. We report our experience in treating this kind of fractures with Gamma 3 nail, between January 2015 and December 2021. Methods: We performed a retrospective cohort study of patients treated in our orthopaedic department; level of clinical care is III: 559 patients (431 females and 128 males, with an average age of 85.3 years) with lateral femoral neck fracture. All patients were surgically treated with Gamma 3 standard nail (SGN). We evaluated preliminary X-rays to classify fractures, according to AO-OTA classification and post-operative X-ray to verify cephalic screw position site, according to areas described by Cleveland in 1959: we measured tip-to-apex distance (TAD) and tip-to-apex calcar referred distance (CalTAD). Finally Chang reduction quality criteria (CRQC) for fracture reduction of trochanteric fractures were determined using preoperative or postoperative Antero-Posterior (AP) and lateral radiographs in a Picture Archiving and Communication System (PACS). Incidence of cut-out was evaluated in relation with these parameters. Patients were divided into 2 groups: first group had cephalic screw in optimal positions (5-8-9), the other group had cephalic screw in other positions. Results: In 328 patients (58.7%) screw was in positions 5-8-9, in 231 patients (41.2%) screw was in not-optimal position. Median TAD was 19.1 ± 7.0 mm (range = 0.0–50.5); in 463 patients (82.8%) TAD was ≤ 25 mm. Median CalTAD was 21.4 ± 4.7 mm (range = 5.7–39.2); in 105 patients (79.4%) CalTAD was ≤ 25 mm. Cut-out was observed in 8 cases (1.43%). Multivariate analysis showed a significant correlation (p 25 mm. Cephalic screw position did not influence incidence of cut-out. Discussion: In order to obtain fracture healing with a low risk of failure, in particular cut-out, it is necessary to obtain good reduction of fracture and optimal lag screw position in order to achieve a TAD inferior to 25 mm
Biomechanical comparison of the tensile strength of fixation implants used for pull-out repair of medial meniscus posterior root tear
No full textPurpose: Medial meniscus posterior root tears (MMPRT) pull-out repair aims to restore the meniscus’ anatomical structure. Different implants are utilized for thread fixation in the pull-out repair technique for MMPRT. However, biomechanical evidence comparing the fixation strengths of these implants remains unavailable. This study investigated the tensile strength of three fixation implants in porcine knee models of MMPRT pull-out repair. Methods: This study categorized 30 porcine MMPRT models undergoing pull-out repair into three groups (10 specimens each) based on the implant utilized for fixation, including double spike plate, metallic interference screw (IFS), and resorbable IFS fixed group. A tensile tester was used to track the suture wire threaded to the medial meniscus anterior root. The displacement length was recorded after 10 and 20 loading cycles (10–30 N, 100 mm/min cross-head speed). Each specimen was then stretched to failure (50 mm/min cross-head speed), failure modes were recorded, and structural properties (maximum load, linear stiffness, elongation at failure, and elongation at yield) were compared. Fisher’s exact test and one-way analysis of variance were utilized to assess the differences. Results: No significant differences in displacement length, upper yield load, maximum load, linear stiffness, elongation at yield, elongation at failure, and frequency of failure mode were observed between the three groups. Conclusion: All implants were comparable in terms of fixation strength. Thus, resorbable interference screws may be particularly useful in this technique and does not require implant removal surgery. Level of evidence: IV
Therapeutic effect of intramedullary reaming and nailing for long bones lengthening in children with Ollier disease and Maffucci syndrome on enchondromas: multicentric retrospective case series
No full textIntroduction: Leg length discrepancy (LLD) and malalignment of long bones are frequent orthopedic problems encountered in Maffucci syndrome and Ollier disease (OD). Orthopedic surgeons used historically external fixators to address the deformities. In this multicentric case series, we propose the use of motorized intramedullary nails. Methods: We retrospectively reviewed for 9 years, in four different centers, patients with OD and Maffucci’s syndrome that had lengthening nails for LLD with or without associated deformities. The minimum follow-up period was 24 months. We reported complications, clinical tolerance of lengthening, lengthening rate and target, bone healing index, and EQ-5D-Y functional and visual analog scores (VAS). We also saw on X-rays the whole lengthened bone and its regenerate zone to assess the evolution of the enchondromas. Results: we used the nailing technique in 8 femurs and 2 tibias in 8 patients (mean age: 13.3 years, range: 11–16, mean follow-up time: 53.8 months, range: 26–108). The mean correction amount was 6.44 cm for the femur over 76.8 days and 3.75 cm over 44 days for the tibia with a mean VAS score of 6.63/15 and mean EQ-5D-Y of 81/100. The lengthening goal was achieved in all patients. No mechanical complications were noted. The medullary canal of the operated bones showed improvement and healing in 8 out of 10 segments. Discussion: Besides achieving the goals of surgery with good functional outcomes, lengthening nails has a therapeutic effect on enchondromas with fewer complications than traditional correction methods
Artificial intelligence in planned orthopaedic care
No full textThe integration of artificial intelligence (AI) into orthopaedic care has gained considerable interest in recent years, evidenced by the growing body of literature boasting wide-ranging applications across the perioperative setting. This includes automated diagnostic imaging, clinical decision-making tools, optimisation of implant design, robotic surgery, and remote patient monitoring. Collectively, these advances propose to enhance patient care and improve system efficiency. Musculoskeletal pathologies represent the most significant contributor to global disability, with roughly 1.71 billion people afflicted, leading to an increasing volume of patients awaiting planned orthopaedic surgeries. This has exerted a considerable strain on healthcare systems globally, compounded by both the COVID-19 pandemic and the effects of an ageing population. Subsequently, patients face prolonged waiting times for surgery, with further deterioration and potentially poorer outcomes as a result. Furthermore, incorporating AI technologies into clinical practice could provide a means of addressing current and future service demands. This review aims to present a clear overview of AI applications across preoperative, intraoperative, and postoperative stages to elucidate its potential to transform planned orthopaedic care
Intraoperative patellar tracking assessment during image-based robotic-assisted total knee arthroplasty: technical note and reliability study
No full textIntroduction: Restoration of the anterior knee compartment is increasingly studied with the development of personalized surgery. However, evaluating the patellar tracking during the surgery is still subjective and at the surgeon’s discretion. This study aimed 1) to describe the assessment of the patellar tracking during robotic-assisted total knee arthroplasty (TKA), 2) to describe a new measurement technique for evaluating the evolution of this patellar tracking, and 3) to assess its reliability and repeatability. Method: This monocentric study assessed the evolution of patellar tracking for 20 robotic-assisted TKA. The sharp probe was used to perform patellar tracking in all the arcs of knee flexion before and after the bone cuts. The patella positioning was recorded every 10° of flexion between the full extension and 90° knee flexion and was assessed in the coronal and sagittal planes. For the measurements of the patellar tracking, we used a sagittal view and a coronal view of the knee on the MAKO software. From these two views, the difference between the patellar tracking before and after the bone cuts with the definitive implants was measured. 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 68.7 years old ± 5.2 [61; 75], the mean body mass index was 28.8 kg/m2 ± 4.2 [21.4; 36.2], the mean HKA angle was 176.3° ± 3.7° [174.1.4; 179.7]. The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements (0.60 to 1.0). Conclusion: This new measurement technique assessed the evolution of patellar tracking after TKA with good inter and intra-observer reliability
Proximal femoral nailing for unstable trochanteric fractures: lateral decubitus position or traction table? A case-control study of 96 patients
No full textPurpose: This study aimed to compare the treatment of unstable intertrochanteric femoral fractures with short proximal femoral nailing in elderly patients in the lateral decubitus position versus the supine position on traction tables. Methods: From June 2020 to January 2022, a prospective case-control study was performed on 96 patients who presented with unstable trochanteric fractures treated by internal fixation via short proximal femoral nail (PFN). Patients were divided into two groups: Group A, which included patients who underwent surgery in the lateral position; and Group B, which included those in the supine position. Both groups were subjected to follow-up for 12 months. Results: The mean setup time, surgery time, and blood loss were significantly greater in Group B than in Group A, while the hospital stay and fluoroscopy duration were similar in both groups. Regarding reduction quality and fixation (TAD (tip-apex distance), CDA (collodiaphyseal angle), and Reduction CRQC (change reduction quality criterion)), there were no statistically significant differences between the two groups; moreover, there were no intraoperative or postoperative complications in either group or the Harris hip score (67.65 ± 17.06 in Group A vs. 67.15 ± 17.05 in Group B). Conclusion: The lateral decubitus and supine positions on a traction table are suitable for proximal femoral nailing with comparable outcomes, and surgeons can use either position according to their preferences and resources
Functional outcomes of three-corner fusion without triquetrum excision versus conventional four-corner fusion in scaphoid non-union advanced collapse G II and III in active patients: a prospective randomized control trial
No full textIntroduction: Four-corner fusion has long been the preferred treatment for stages II and III of scaphoid nonunion advanced collapse with intact radiolunate articulation. Three corner fusions were then proposed as a more limited procedure with improved ulnar deviation through triquetrum excision. However, we believe triquetrum preservation would decrease the radiolunate contact pressure without affecting the ulnar deviation range. Methods: This prospective randomized study was performed between March 2019 and May 2021 and involved a total of 34 patients who underwent four corner fusions or three corner fusions without triquetrum excision for SNAC grade II and III. The average follow-up period was 2 years. Follow-up included radiological and clinical evaluation (range of motion, grip strength, visual analogue scale, and modified Mayo wrist scores). Results: There were no significant differences between the two groups as regards the postoperative range of motion, grip strength, visual analogue scale, modified Mayo wrist scorers, and complication rate. However, the three-corner fusion group had less mean operative time compared to the four-corner fusion (mean ± SD; 77.6 ± 16.9, 103.8 ± 10.2 min – P < 0.001) respectively. Conclusion: The authors concluded that three-corner fusion without triquetrum excision offered a comparable functional outcome and complication rate to four-corner fusion with less operative time in the three-corner fusion group
Accuracy of acetabular cup positioning in robotic-assisted total hip arthroplasty: a CT-based evaluation
No full textIntroduction: Robot-assisted instrumentation during total hip arthroplasty (THA) has the potential to improve acetabular cup positioning. This study aimed to evaluate the precision of robotic-arm-assisted THA (rTHA) and assess whether the system can provide accurate cup positioning comparable to conventional THA (cTHA). Methods: A single-center prospective cohort study consisting of 151 patients who underwent THA (108 rTHA and 43 cTHA). The robotically assisted system was used to match the postoperative computed tomography (CT) image of the pelvis with the planned and intraoperative anatomical landmarks. The cTHA cohort underwent hip replacement using the standard manual procedure, with acetabular component locations assessed during and after surgery. Results: The rTHA cohort was significantly younger, but no other significant differences were found between the two cohorts in preoperative baseline data. In rTHA cohort, the planned inclination (40.0 ± 0.3°) closely matched the intraoperative (40.2 ± 2.7°; p = 0.54) and postoperative (40.7 ± 4.0°; p = 0.07) measurements. However, anteversion showed a significant increase from planned (19.4 ± 1.5°) to postoperative CT scan (28.7 ± 7.0°; p < 0.001). There was evidence of proportional bias in the measurements (p < 0.001). In the cTHA cohort, the mean inclination (43.1 ± 5.1°) did not show any significant change between the preoperative plans and postoperative assessments (p = 0.12); however, there was a remarkable change in the mean anteversion (17.6 ± 6.4°) between postoperative measurements and the preoperative plans (p < 0.001). The average anteversion in the preoperative plans did not differ remarkably between the rTHA and cTHA cohorts. However, the average inclination was substantially different between the two cohorts (p < 0.001). Both groups had no significant differences in the proportion of cups outside the referenced safe zones. Conclusion: The results suggest that while robotic-assisted guidance ensures consistent cup inclination, there may be more variability in achieving the planned anteversion, which warrants further investigation into the factors influencing postoperative changes in acetabular orientation
Modified triple pelvic osteotomy for residual acetabular dysplasia through double incisions: Technical note and review of short-term results
No full textPurpose: To assess validity, safety, and efficacy of the modified triple pelvic osteotomy (TPO) approach for correction of residual acetabular dysplasia. Methods: This is a retrospective case series conducted on 15 hips in 15 patients from 2019 to 2023 with residual acetabular dysplasia treated by modified TPO as described by Tonnis with two modifications. The first modification is using a single medial incision for pubic and ischial cuts (the Vladimirov modification). The second modification is having the ischial cut closer to the acetabulum (Li modification) allowing free movement of the acetabular fragment for better femoral head coverage. The mean age at the time of surgery was 11.85 years, (range 8–23). Cases presenting were 10 males (66.7%) and 5 females (33.3%). The mean follow-up period was 36.533 months (24–60 months). Results: Our study revealed significant clinical and radiological improvement. The CE angle improved from a mean value of 10° (range 2–17) pre-operatively to 32.785° (range 18°–40°) post-operatively. The AI improved from a mean value of 32° pre-operatively to a mean value of 13.89° post-operatively. HHS increased from a preoperative mean value of 74.80° to a post-operative mean value of 90.67°. Also, there was a significant improvement in ROM (abduction and internal rotation). LLD improved from a mean value of 2.60 cm preoperatively to a mean value of 0.37 cm postoperatively. Delayed union was found in 3 cases. No cases of osteonecrosis or neurovascular complication were encountered in our study. Conclusion: The modified TPO technique using dual incisions can be considered safe and effective, providing adequate coverage of the femoral head in acetabular dysplasia with less surgical time, satisfactory functional outcomes, and minimal complications.
Level of Evidence: I
Pre-operative planning for reverse shoulder arthroplasty in low-resource centres: A modified Delphi study in South Africa
No full textBackground: Pre-operative planning for reverse shoulder arthroplasty (RSA) poses challenges, particularly when dealing with glenoid bone loss. This modified Delphi study aimed to assess expert consensus on RSA planning processes and rationale, specifically targeting low-resourced institutions. Our objective was to offer pre-operative decision-making algorithms tailored for surgeons practising in resource-constrained hospitals with limited access to computed tomography (CT) scans. Methods: A working group generated statements on pre-operative imaging and glenoid of glenoid morphology and intra-operative decision-making. The study was conducted in three stages, with virtual consensus meetings in between. Stages 2 and 3 consisted only of closed questions/statements. The statements with over 70% were considered consensus achieved and those with less than 10% were considered disagreement consensus achieved. Results: Twelve shoulder surgeons participated, with 67% having over five years of experience in shoulder arthroplasty. In the absence of glenoid bone loss, the sole use of plain radiographs for pre-operative planning reached consensus and is recommended by these groups, while 100% advise using CT scans when bone loss is present. Most surgeons (70%) recommend using patient-specific instrumentation (PSI) in cases of structural bone loss. Most of the statements on intra-operative decision-making related to component placement and enhancing stability failed to reach consensus. Conclusion: While consensus was achieved on most aspects of pre-operative imaging and planning, technical aspects of surgery lacked consensus. Planning for patients with structural glenoid bone loss necessitates CT scans and planning tools