SURGICAL PROCEDURES PROLONG AMBULATION IN PATIENTS WITH DUCHENNE MUSCULAR DYSTROPHY

The intensity of pain after surgical treatment of hip fracture has a negative effect on functional recovery. However, the effects of acute postoperative pain on the recovery of walking ability after the surgery remain unclear. This study aimed to investigate the association between acute postoperative pain and the recovery of functional gait among patients who had independent walking ability prior to hip fracture. This was an observational study that included 41 patients with a mean age of 81.3±7.3 years who underwent surgical treatment for traumatic hip fracture at a general hospital. The primary outcome was the time to recovery of independent gait postsurgery. Based on the median time to recovery, patients were classified into an early independent walking group and an independent walking group. Stepwise logistic regression analysis was performed to identify predictive factors of the time to recovery of independent walking. The median time to recovery of independent gait was 24 days (range, 7-50 days). In total, 20 patients were classified in the early independent walking group and 21 in the independent walking group. On logistic regression analysis, the total pain intensity, reported during activities of daily living (ADL) on postoperative days 5 and 6, and the knee extensor strength were predictive of the time to recovery of independent walking. The degree of recovery of gait function of patients surgically treated for hip fracture was found to be predicted by the pain intensity measured during ADL and the knee extensor strength assessed in the acute phase. Effective management of acute pain after surgical treatment of hip fracture may help improve functional recovery of gait.

Beta-band oscillations as a biomarker of gait recovery in spinal cord injury patients: A quantitative electroencephalography analysis

Enlarged perivascular spaces are associated with worse gait velocity and recovery in individuals with a small ischemic hemisphere stroke: A cross-sectional study.

P57. Management of type II displaced dens fractures

Recovery in horizontal gait after hip resurfacing vs. total hip arthroplasty at 6-month follow-up - a randomized clinical trial

The position of the centre of rotation (COR) for the best function and recovery of gait after total hip arthroplasty (THA) in patients with Hartofilakidis type B developmental dysplasia of the hip (DDH) remains controversial. This study aimed to compare the functional outcomes between two methods of reconstruction and quantify the optimal COR for the recovery of gait. Out of 1,359 THAs which were identified, 223 patients (223 hips) with unilateral Hartofilakidis type B DDH and a normal contralateral hip who underwent anatomical mirroring reconstruction using autografts (Group A, 115 hips) or high hip centre (HHC) reconstruction (Group H, 108 hips) between January 2011 and June 2021 were reviewed. Functional and radiological results, including patient-reported outcome measures (PROMs), the height of the COR and offset, and recovery of gait, were compared between the groups. Factors associated with a limp were identified by Cox regression analysis and used to develop a nomogram. A power analysis indicated that 54 patients were required to detect a 25% difference in recovery of gait (α = 0.05, power = 0.80). During mean lengths of follow-up of 9.09 years (SD 3.21) and 8.62 years (SD 2.74) in Groups A and H, respectively, the Harris and Oxford Hip Scores significantly improved in both groups, with significantly better improvements in Group A than in Group H (both p < 0.001). Significantly more patients in Group A achieved recovery of gait than in Group H (103 (89.6%) vs 72 (66.7%); p < 0.001) at final follow-up. Early recovery of gait was significantly more likely in patients with smaller differences in COR height bilaterally (p < 0.001), younger patients (p = 0.021), and those who had not previously undergone a shelf acetabuloplasty (p < 0.001). The nomogram showed good performance (area under the receiver operating characteristic curve = 83.9%). Significant functional improvement, with the COR placed < 1.18 cm above the normal contralateral hip, was achieved in both groups, but mirroring reconstruction provided earlier and better recovery of gait. We recommend that surgeons use this nomogram to assess the odds of there remaining a limp postoperatively before undertaking THA, in order to improve expectations and rehabilitation.

BackgroundThe role of sensory pathways in gait recovery remains unclear. We hypothesized that preservation of the somatosensory pathway may play a key role in gait recovery in patients with stroke and severe motor pathway impairment.ObjectiveThis study aimed to investigate the impact of preserving the somatosensory pathway, spinothalamic tract (STT), and superior thalamic radiation (STR) on gait recovery in patients with chronic stroke and severe damage to motor pathways.MethodsThis retrospective cross-sectional study included 85 patients and investigated the association between functional ambulation categories and the integrity of sensory pathways, as represented by fractional anisotropy values. Diffusion tensor imaging was performed to assess the integrity of the corticospinal tract (CST), cortico-ponto-cerebellar tract, STT, and STR 6 months after stroke.ResultsMultivariable logistic regression analysis revealed that severe damage to the CST with the STT preserved yielded an odds ratio of 8.49 (p = 0.030) for functional gait, compared to when both tracts were damaged.ConclusionsSomatosensory pathways may play a critical role in gait recovery for patients with chronic stroke and severe motor tract damage. Preserving the somatosensory pathway could facilitate gait recovery in patients with severe motor pathway damage, offering valuable insights for future stroke rehabilitation strategies.

PurposeThe optimal management of colorectal lung metastases (CRLM) is still controversial. The aim of this study was to compare surgical and non-surgical treatment for CRLM regarding the prognostic outcome.MethodsThis retrospective single-center cohort study included 418 patients, who were treated from January 2000 to December 2018 at a German University Hospital due to their colorectal carcinoma and had synchronous or metachronous lung metastases. Patients were stratified according the treatment of the CRLM into two groups: surgical resection of CRLM versus no surgical resection of CRLM. The survival from the time of diagnosis of lung metastasis was compared between the groups.ResultsTwo- and 5-year overall survival (OS) from the time of diagnosis of lung metastasis was 78.2% and 54.6%, respectively, in our cohort. Patients undergoing pulmonary metastasectomy showed a significantly better 2- and 5-year survival compared to patients with non-surgical treatment (2-year OS: 98.1% vs. 67.9%; 5-year OS: 81.2% vs. 28.8%; p < 0.001). Multivariate Cox regression revealed the surgical treatment (HR 4.51 (95% CI = 2.33–8.75, p < 0.001) and the absence of other metastases (HR 1.79 (95% CI = 1.05–3.04), p = 0.032) as independent prognostic factors in patients with CRLM.ConclusionOur data suggest that patients with CRLM, who qualify for surgery, benefit from surgical treatment. Randomized controlled trials are needed to confirm our findings.Clinical trial registry numberThe work has been retrospectively registrated at the German Clinical Trial Registry (DRKS00032938).

This article provides a summary of orthopaedic foot and ankle research from September 2021 to September 2022. The included studies were published in The Journal of Bone & Joint Surgery, Foot & Ankle International, Foot and Ankle Surgery, Clinical Orthopaedics and Related Research, the Journal of Orthopaedic Trauma, The American Journal of Sports Medicine, JAMA (Journal of the American Medical Association), The New England Journal of Medicine, The Bone & Joint Journal, and the Journal of the AAOS (American Academy of Orthopaedic Surgeons). Forefoot Minimally invasive techniques involving the lesser metatarsals continue to grow in popularity. Neunteufel et al.1 reported a case series of 30 patients (31 feet) who underwent minimally invasive distal metatarsal metaphyseal osteotomy for metatarsalgia of ≥1 lesser metarsals2–5. All clinical scores (American Orthopaedic Foot & Ankle Society [AOFAS] Forefoot Score, Foot Function Index, Foot and Ankle Outcome Score [FAOS], and visual analog scale [VAS] pain score) improved significantly at a mean follow-up of 15.5 months. Plantar peak pressure at the relevant area was also reduced significantly. The mean metatarsal shortening across all osteotomies was 6.6 mm. Del Vecchio et al.2 reported the results of a sliding distal metatarsal minimally invasive osteotomy for the correction of a bunionette deformity in 57 patients (74 feet). At a minimum follow-up of 30 months, all radiographic and clinical outcome measures improved, with 89.1% of patients rating the procedure as excellent. The overall complication rate was 6.75%. Syndactyly release remains surprisingly problematic. Langlais et al.3 retrospectively reviewed 38 pediatric patients with 68 syndactylies who underwent syndactyly release with a dorsal commissural flap and cutaneous resurfacing. The recurrence rate was 28.1% and the complication rate was 11.7% at a mean follow-up of 6.9 years. Age of >2 years at the time of the surgical procedure was a risk factor for recurrence. Of the patients with simple syndactylies, only one-half were satisfied. Hallux Valgus Further data continue to demonstrate short-term equivalency but not superiority for minimally invasive hallux valgus surgery compared with open techniques. Hernández-Castillejo et al.4 performed a longitudinal, prospective study on 72 patients (72 feet) who underwent open chevron, open scarf, or percutaneous Reverdin-Isham osteotomy for the correction of hallux valgus deformity. At a mean follow-up of 17.7 months, all patient-reported outcome measures, including the VAS pain score and Manchester Oxford Foot Questionnaire (MOXFQ), demonstrated significant improvement independent of the preoperative radiographic parameters and type of surgical procedure. Lewis et al.5 prospectively reported on 106 consecutive feet (78 patients) that underwent third-generation minimally invasive chevron and Akin (MICA) osteotomies for severe hallux valgus. In the 86 feet (81.1%) with a minimum 2-year follow-up, there was significant improvement in all MOXFQ domains. The mean intermetatarsal angle and hallux valgus angle also improved significantly. The authors reported an 18.8% overall complication rate. Mikhail et al.6 retrospectively reviewed 248 patients (274 feet) who underwent MICA osteotomies for hallux valgus correction. At a mean follow-up of 12.9 months, the intermetatarsal angle, hallux valgus angle, and Foot Function Index improved significantly. The overall satisfaction rate was 91.6%, the mean number of 5-mg oxycodone tablets consumed postoperatively was 2.2 tablets, and the complication rate was 8.4%. The Lapidus procedure continues to grow in popularity. A retrospective review comparing Lapidus bunionectomy (73 patients) with scarf bunionectomy (63 patients) found no difference in Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function scores between groups, although patients in the scarf group had a 25% lower chance of achieving a normal intermetatarsal angle, at a mean follow-up of 17.8 months7. Veracruz-Galvez et al.8 prospectively followed 82 patients who underwent scarf osteotomy for moderate to severe hallux valgus. Normal postoperative sesamoid position (48 patients) was associated with significantly less pain (VAS), higher Self-Reported Foot and Ankle Score, and higher patient satisfaction (Likert scale) than the group with outlier sesamoid positions (34 patients). In a retrospective study comparing patients with hallux valgus (34 feet) with normal controls (20 feet), Lalevée et al.9 found that the distal metatarsal articular angle was overestimated on conventional radiographs compared with weight-bearing computed tomographic (CT) scans by a mean of 14°. However, even after computerized correction of the first metatarsal rotation and plantar flexion, the valgus alignment of the first metatarsal distal articular surface was 8.6° higher in patients with hallux valgus than in the control patients on weight-bearing CT scans. Hallux Rigidus Cichero et al.10 retrospectively reviewed 280 first metatarsophalangeal arthrodeses. The overall nonunion rate was 7.9% (22 feet). The risk of nonunion was >3 times higher in patients who had a single-construct locking plate with an interfragmentary compression screw inserted through the plate compared with patients who had a locking plate and a lag screw inserted outside of the plate. Hindfoot Tarsal Tunnel Syndrome The results of tarsal tunnel release remain inconsistent. Bouysset et al.11 retrospectively reviewed 73 patients (84 feet) who underwent tarsal tunnel release with follow-up of at least 1 year. The effectiveness of the release, based on patient willingness to repeat the procedure under similar preoperative circumstances, was significantly lower in patients with marked hindfoot varus or valgus and in patients with plantar fasciitis. Patients in only 51% of cases (43 feet) said that they would undergo the procedure again. Plantar Fasciitis Bildik and Kaya12 performed a double-blinded, randomized controlled trial that compared platelet-rich plasma (30 patients) with autologous blood (30 patients) for the treatment of plantar fasciitis. At 6 months after the injection, both groups demonstrated significant and similar improvements in the VAS pain scores and the Foot and Ankle Disability Index health-related quality-of-life scores compared with baseline. Kaiser et al.13 performed a prospective randomized controlled trial comparing a 6-week formal physical therapy program (27 patients) with a 6-week home stretching program (30 patients) for the treatment of plantar fasciitis. At 6 months, both groups significantly and identically improved from baseline in terms of VAS pain scores, Foot and Ankle Ability Measure scores, and Short Form-36 (SF-36) scores, and results were maintained through the 1-year follow-up. Insertional Achilles Tendinitis Arunakul et al.14 compared conventional rehabilitation (18 patients) with accelerated rehabilitation (31 patients) after debridement and reattachment of the Achilles tendon. At 3 months, the mean scores for VAS pain, Foot and Ankle Ability Measure, and SF-36 were significantly better in the accelerated rehabilitation group, but by 6 and 12 months there were no differences. There also were no complications. In a retrospective series of 50 open Zadek osteotomies fixed with a 6-hole lateral plate for treatment of Haglund syndrome, Tourne et al.15 reported significant improvement in the AOFAS Hindfoot scores and the Victorian Institute of Sport Assessment–Achilles scores at a mean follow-up of 7 years. Of 50 patients, 46 (92%) returned to the same or higher level of sports activity. The authors recommended using the Zadek osteotomy for the treatment of Haglund syndrome in the setting of a long calcaneus or when the novel X/Y ratio proposed in the study is <2.5, where X is the length of the calcaneus and Y is the length of the tuberosity on a lateral weight-bearing radiograph. Pes Planus In an attempt to establish the diagnostic reliability of a new classification for progressive collapsing foot deformity, Li et al.16 distributed a survey to current trainees, graduates, and faculty of 13 foot and ankle fellowship programs. For the entire cohort, the diagnostic accuracy rates were 71.0% overall, 78.3% for class, and 81.7% for stage. The misdiagnosis rates for the entire cohort for were 3.3% for class A, 17.5% for class B, 11.1% for class C, 26.0% for class D, and 3.7% for class E. Importantly, this survey used example patients for whom the physical examination findings were provided to the raters. The reliability of the scheme would likely be even lower in a real-world practice situation. The classification scheme for progressive collapsing foot deformity was evaluated with actual patients by Lee et al.17. Three independent observers assessed 92 feet (84 patients). The authors reported very good intraobserver reliability (Cohen kappa, 0.851; p < 0.001) and much worse interobserver reliability (Fleiss kappa, 0.561; p < 0.001). The classification scheme should not be considered reliable until changes result in improved interobserver reliability. The Cotton osteotomy is a dorsally based opening-wedge osteotomy of the medial cuneiform that is utilized to correct the forefoot varus component of adult-acquired flatfoot deformity, but it may not provide lasting results. Abousayed et al.18 reported a mean 8.6-year follow-up for the Cotton osteotomy performed with either allograft wedges (17 feet) or metal wedges (2 feet). Although a significant improvement was noted in the lateral talus-first metatarsal angle from preoperatively to the first postoperative follow-up (p < 0.0001), approximately one-half of the patients lost >50% of that correction at the final follow-up. The lengthened angular shape of the medial cuneiform was maintained, indicating that collapse occurred through surrounding medial column joints. Sports Osteochondral Lesions of the Talus The management of large osteochondral lesions of the talus is challenging. Shi et al.19 retrospectively compared autologous osteoperiosteal transplantation from the iliac crest (23 patients) with autologous osteochondral transplantation from the ipsilateral knee (23 patients) for the treatment of large, cystic, medial osteochondral lesions of the talus. At a mean follow-up of 48 months, there was no difference between the groups in terms of VAS pain scores, AOFAS scores, or Tegner scores. There was significantly less donor site morbidity in the autologous osteoperiosteal transplantation group. Magnetic resonance observation of cartilage repair tissue (MOCART) scores and International Cartilage Regeneration & Joint Preservation Society (ICRS) scores from second-look arthroscopy showed no differences between groups. Fletcher et al.20 reported on a prospective series of 31 patients who underwent fresh structural allograft transplantation for osteochondral lesions of the talar shoulder. At a mean 56.2-month follow-up, significant improvement was found in VAS scores, SF-36 scores, and the Short Musculoskeletal Functional Assessment Bother Index and Function Index compared with the preoperative status. The overall graft survival was 96.8%. Fifteen patients (48.4%) underwent an additional surgical procedure, typically implant removal or arthroscopic debridement. Microfracture for osteochondral lesions of the talus that have previously undergone a surgical procedure (secondary lesions) may not be as beneficial as previously reported. Arshad et al.21 performed a systematic review of 12 studies to assess patient-reported outcomes and pain scores after arthroscopic bone marrow stimulation for secondary talar lesions. No perioperative complications were noted, but, in studies that reported a revision surgical procedure as an end point, 26 (34%) of 77 patients underwent a revision procedure. Overall, patient-reported outcomes such as AOFAS score and VAS pain score showed inconsistent improvements, and many positive changes were less than the minimal clinically important difference (MCID) for these scales. Enthusiasm for subchondroplasty in the talus has waned. Hanselman et al.22 retrospectively reviewed 7 cases of talar osteonecrosis after subchondroplasty for bone marrow lesions. The mean time to radiographic confirmation of osteonecrosis was 23 months. Three of 7 patients had osteonecrosis risk factors (alcoholism and/or chronic corticosteroid use). The authors urged caution with this procedure, especially in patients with osteonecrosis risk factors. Achilles Rupture and Tendinosis Research continues on the optimal management of acute Achilles tendon ruptures. Seow et al.23 performed a meta-analysis to determine complication rates after the treatment of acute Achilles tendon ruptures and included a best-case and worst-case scenario analysis for rerupture rates. The best-case scenario assumed a 0% rerupture rate in those lost to follow-up, and the worst-case scenario assumed a 100% rerupture rate. Surgical treatment significantly reduced the risk of rerupture compared with nonoperative management. The pooled rerupture rate was 3.6% (3.4% best-case scenario, 8.3% worst-case scenario) in the surgical treatment arm and 12.1% (11.7% best-case scenario, 15.0% worst-case scenario) in the nonoperative treatment arm. The rate of complications, excluding reruptures, was significantly lower with nonoperative treatment (pooled complication rate, 7.1%) compared with surgical treatment (pooled complication rate, 18.5%). Percutaneous Achilles repair may be better paired with less aggressive rehabilitation to avoid stretching the repair. Maffulli et al.24 compared a traditional rehabilitation protocol (31 patients) with a slowed-down rehabilitation protocol (29 patients) for patients undergoing percutaneous repair of an acute Achilles tendon rupture. At a 12-month follow-up, the Achilles tendon resting angle and Achilles Tendon Rupture Score were significantly better in the slowed-down rehabilitation protocol group. Additionally, calf circumference and isometric strength were more similar to those in the contralateral, uninjured leg in the slowed-down rehabilitation protocol group. Trauma The Major Extremity Trauma Research Consortium (METRC)25 published a randomized controlled trial comparing a high perioperative FiO2 (fraction of inspired oxygen) of 80% with a standard perioperative FiO2 of 30% and its effect on surgical site infections in patients undergoing a surgical procedure for tibial plateau, tibial pilon, or calcaneal fractures. At 6 months postoperatively, they found a significant difference in overall surgical site infections (superficial and deep) between the groups: 7.0% for the experimental group compared with 10.7% for the control group (relative risk [RR], 0.65; p = 0.03). The difference was driven by fewer superficial infections in the experimental group (1.7%) compared with the control group (4.3%), for which the RR was 0.41 (p = 0.02); there was no difference in the risk of deep infections (5.6% in the experimental group compared with 6.6% in the control group [RR, 0.86; p = 0.5]). Anterior impaction of the tibial plafond has been shown to portend a particularly poor prognosis. Jo et al.26 retrospectively reviewed 50 patients (52 fractures) who underwent open reduction and internal fixation (ORIF) of OTA/AO 43B and C pilon fractures. At a mean follow-up of 25 months, the group with anterior impaction (28 fractures) had significantly higher rates of implant removal for pain, significantly greater anterior subluxation, and significantly worse posttraumatic arthritis than the group without anterior impaction. Noori et al.27 found that the Lawrence and Botte classification of proximal fifth metatarsal fractures has a low level of interrater reliability (an observed agreement of 77% compared with a chance agreement of 33%). Classification at the interface between Zones 2 and 3 was much less reliable than that between Zones 1 and 2. The authors suggested that a new classification system for these fractures is required for both clinical and research purposes. Ankle Fractures Allen et al.28 studied the effect of acute, intermediate, and late-phase synovial fluid fracture hematoma on cartilage discs from fresh allograft human tali. Compared with controls, the cartilage discs cultured in synovial fluid fracture hematoma demonstrated a significantly greater production of inflammatory cytokines, metalloproteinases, and cartilage matrix fragments, suggesting that cartilage-damaging pathways had been activated. The addition of compounds that inhibit inflammation (interleukin 1 receptor antagonist or doxycycline) decreased the pro-inflammatory effect of synovial fluid fracture hematoma on the cartilage tissue. Clinical tests for fracture stability continue to be debated. In a retrospective Level-III study of supination-external rotation 2 (SER-2) ankle fractures, Ali et al.29 reported no difference (p = 0.595) between manual stress views and gravity stress views for determining fracture stability and the need for a surgical procedure. Despite their ability to limit complications in older patients, fibular nails appear to have drawbacks when used in younger patients. Kho et al.30 retrospectively compared young patients (mean age, 41.4 years) who underwent closed reduction and intramedullary fixation (CRIF) with a fibular nail (n = 94) compared with ORIF with a locking plate (n = 110). At a minimum follow-up of 3 years, complications were lower in the CRIF group (9.5% compared with 39%; p < 0.001). However, the CRIF group demonstrated significantly higher rates of posttraumatic arthritis (21.3% compared with 9.1%; p = 0.024) and fair or poor reduction (p < 0.001) on 3-D CT scans. The authors recommended that surgeons consider ORIF in active young patients, especially for more complex fracture patterns. Stupay et al.31 performed a retrospective cohort study to identify risk factors for aseptic revision of operatively treated ankle fractures. Using multivariable logistic regression modeling, the authors reported that falls in the early postoperative period, movement-altering disorders, a nonanatomic mortise (medial clear space was greater than superior clear space) on initial postoperative imaging, more severe initial fracture displacement, substance abuse, and polytrauma are independent risk factors for aseptic revision after ankle ORIF. Identifying these risk factors may help surgeons to counsel patients and improve safety and outcomes after ankle fracture surgery. Syndesmotic Injuries Bhimani et al.32 retrospectively reviewed preoperative bilateral weight-bearing CT scans in patients with unilateral Weber B fibular fractures and a symmetric medial clear space who did (n = 23) and did not (n = 18) have intraoperatively confirmed syndesmosis instability. The authors found that weight-bearing CT was able to distinguish a stable from an unstable syndesmosis even in the presence of a Weber B fibular fracture. Syndesmotic volume measured to a height of 5 cm proximal to the tibial plafond was the best measurement for diagnosing syndesmosis instability. Wong et al.33 utilized 4-D CT scans to characterize the of ankle of on The authors found significant medial and rotation of the ankle plantar but no in with in There was no difference in between in The authors that reduction in the setting of an ankle fracture be from the uninjured ankle the ankle position is The same used 4-D CT scans to at 12 months after syndesmosis fixation (n = and syndesmosis fixation (n = Although the patient were with initial fixation demonstrated significantly reduced syndesmosis of in of 5 measures (p < when compared with the uninjured No differences in syndesmosis of between and uninjured were observed in the group with Lee et retrospectively reviewed patients with a minimum follow-up after surgical fixation of the syndesmosis in the setting of an ankle fracture. patients had chronic syndesmosis as pain with a and >2 of syndesmosis compared with the ankle on bilateral CT scans at 5 years analysis a of (p = and the presence of a fracture (p = as risk factors for chronic syndesmosis instability. et performed a study the as the of the syndesmosis on a mortise of the The authors a 12 from the which that utilized to fractures are not in the syndesmosis and not the tendon. Ankle and outcomes of 3-D and for ankle and hindfoot have been reported. In a of ankle cases with and 25 cases with standard et found no difference between the techniques for component position or of the surgical procedure. All cases were performed by a In a study of cases that utilized 3-D for of the hindfoot and/or et found that of cases required secondary and of cases required removal of the implant for or aseptic outcomes are at least similar to or better than findings using allograft for these in the of was associated with the need for a secondary procedure ratio p = 0.03). and follow-up of ankle has been including of the first Using the et found of metal to be at 5 years and at years. age, and low volume for the procedure were independent of The first data for ankle were reported by et who reviewed the cases performed by the of the Of the for the were with the in at the follow-up or at the time of The authors proposed as a for and third-generation have compared the results of ankle with those of revision ankle an important the of when a et performed a cohort study of patients with ankle and 23 patients with revision ankle No were There was significantly greater improvement (p = 0.024) in the overall MOXFQ scores for ankle compared with revision deformity for ankle or is less than previously but In an et found at follow-up of 2 to 3 years, patients with deformity of who underwent either or from the procedure. No difference between the 2 be using the SF-36 and the Musculoskeletal Functional but the results as a were to those of a control cohort without deformity. ankle is an to the more anterior procedure. rates using this procedure have to be reported. et reported radiographic in of 86 cases at a mean follow-up of months. Using more CT imaging, et reported lesions in of cases at a mean follow-up of months. rates of are similar to those observed for The to the lateral are to by the same on the same cohort of patients found a rate of early complications and in The results of may be In a retrospective review of patients who underwent hindfoot with an intramedullary et reported an overall hindfoot rate at a mean follow-up of months. A greater nail ratio (p = and hindfoot compression (p = were associated with a higher rate. medial was nonunion (p = and hindfoot (p = and clinical factors including age, and did not rates. and retrospectively reviewed patients (23 feet) who underwent with internal fixation for and At a mean follow-up, the authors reported a 100% rate of with of 23 patients weight-bearing There were 6 The authors for a a and and the of in the Although is as a risk factor for is a of patients age, was associated with a of to and a of The risk was in patients with ratio p = followed by chronic and p < The study the need for improved early and for patients with Orthopaedics The of reviewed a large number of published studies to the system that a higher of In addition to in this relevant to foot and ankle surgery are to this review after the standard with a article to help in an in this Orthopaedics of corticosteroid to therapy for Achilles a randomized clinical JAMA In a randomized controlled trial on the treatment of Achilles et compared corticosteroid and physical therapy with and physical were and were in the tissue anterior to the of the tendon than in the tendon At 6 months, the corticosteroid group had significantly greater improvement in the Victorian Institute of Sport Assessment–Achilles score compared with the group. There was no of improvement at the 2-year follow-up. There were no infections and no ruptures in either group. Although traditional corticosteroid for the treatment of Achilles of corticosteroid the anterior tissue to be a and to physical therapy when Achilles or surgical treatment of acute tendon rupture. In this large randomized controlled et compared open and minimally invasive surgical treatment of acute Achilles tendon ruptures. This is by the study of the The authors reported no significant difference between groups in the mean in the Achilles Tendon Rupture Score from the baseline to and 12 months Although was not reported by the the study was for a of rerupture rates. The rate of rerupture was significantly higher in the nonoperative treatment group of patients) compared with the groups of patients in the open repair group and 1 of patients in the repair were reported in the group, and 5 were reported in the open repair group. Although this study suggested that there was no difference in patient-reported between and operatively treated acute Achilles tendon ruptures at 1 it is important to that the results may have been by the to Achilles Tendon Rupture of patients who a as in the protocol This the likely results from the nonoperative group. A study without data that patient-reported outcomes through the entire of of complications, be required to more the for a surgical procedure. Patients a surgical procedure to an Achilles should be that they similar results for nonoperative management and management as long as they not a but the risk of rerupture is higher with nonoperative management. A, of platelet-rich plasma on ankle and in patients with ankle a randomized clinical 2021 clinical improvement of ankle arthritis after platelet-rich plasma has been by and case et found no to platelet-rich plasma at 26 in a randomized Although the outcome was the AOFAS Hindfoot Score, which has a and is not an patient-reported secondary outcome also their Patients should be that there is no for platelet-rich plasma in ankle C, blood with treatment for chronic plantar a randomized controlled Foot Ankle This double-blinded, randomized controlled trial compared autologous blood patients) and patients) for the treatment of chronic plantar fasciitis. The mean pain scores both groups improved by at a final follow-up. There were no differences in patient-reported or pain scores at time plantar should patients that there is no clear to autologous blood to

Objectives: This paper's objective was to identify clinical predictors, especially modifiable ones, associated with postoperative gait recovery in total hip arthroplasty (THA) patients, utilizing propensity score weighting (PSW) to control confounding factors. Methods: This retrospective cohort study included 221 patients who underwent primary unilateral THA. We used PSW analysis to balance patient characteristics. Univariate and multivariate logistic regression analyses were applied to determine predictors of improved gait recovery, assessing variables such as age, gender, and postoperative muscle strength. Results: Independent predictors of favorable gait recovery were male gender (Odds Ratio [OR]: 1.382; 95% Confidence Interval [CI]: 1.225-1.560; p < 0.001), younger age (OR: 0.990 per year; 95% CI: 0.985-0.995; p < 0.001), and postoperative hip flexor muscle strength greater than grade 3 (OR: 1.516; 95% CI: 1.177-1.953; p = 0.002). Muscle strength emerged as a modifiable factor, suggesting that targeted rehabilitation may enhance functional outcomes. Conclusions: Enhancing hip flexor strength postoperatively could significantly improve gait recovery in THA patients. These findings support developing individualized rehabilitation strategies to optimize functional outcomes.

to evaluate the quality of surgical treatment of ovarian cancer patients and assess the impact of adequate surgical oncological treatment on disease-free survival and overall survival of patients with advanced epithelial ovarian cancer. this is an observational, retrospective study with quantitative analysis, with the collection of data in medical records of a temporal convenience sample of patients diagnosed with ovarian cancer admitted to a High Complexity Oncology Unit, in Belo Horizonte, from the period of 2014 to 2020. a total of 91 patients diagnosed with ovarian cancer were evaluated, with the epithelial histopathological type being the most frequent (85%). Of this total, 68 patients (74.7%) had advanced-stage ovarian cancer. Appropriate surgical treatment was performed in 30.9% of patients with advanced epithelial ovarian cancer and the type of performed surgery was statistically significant for overall survival. This low proportion of appropriate surgical oncological treatment was not related to surgical specially or surgeon competence, but mainly to advanced disease related to patient flow at UNACON. It was not possible to confirm if the advanced-stage disease was related to tumor biology or losing time from diagnosis to oncological surgery. overall survival of advanced-stage epithelial ovarian cancer patients is directly influenced by appropriate surgical treatment, however, in this study, the percentage of advanced ovarian cancer receiving adequate surgical treatment was much lower than the rates reported in the literature. To improve these outcomes, we believe that surgeons should keep following patients during neoadjuvant chemotherapy to point to a better time for surgery, and clinical oncologists should better consider adequate oncological surgery as one of the pillars of ovarian cancer treatment and get more involved in facilitating surgeries.

PICO question In dogs suffering from degenerative lumbosacral stenosis (DLSS), is surgical treatment more effective than nonsurgical therapy in reducing lumbosacral pain and neurological dysfunction in the long-term? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Two papers were critically reviewed. They were prospective and retrospective studies. Strength of evidence Weak. Outcomes reported Besides the two studies, there are no other studies currently available that directly compare long-term clinical outcome of patients that have undergone nonsurgical and surgical treatment respectively. In the study comparing clinical outcome of nonsurgical treatment by epidural steroid injection (ESI) and surgical treatment of degenerative lumbosacral stenosis, dogs were classified into clinical severity groups ranging from mild to moderate to severe. Mild cases demonstrated degenerative lumbosacral stenosis (DLSS) compatible clinical signs such as lumbosacral pain, reluctance to climb stairs / jump / raise up, lameness and muscle atrophy but no neurological deficits. Moderate cases presented DLSS compatible clinical signs in combination with neurological deficits such as reduced flexor withdrawal, proprioceptive deficits and nerve root signature. Severe cases demonstrated DLSS compatible clinical signs with more severe neurological deficits such as tail paresis and absent perineal reflex. Clinical outcomes were considered complete if clinical signs had resolved at follow-up consultations, partial if there was substantial but incomplete improvement in clinical signs and failed if the dog did not improve or deteriorated further. Improvements in patient condition were measured in terms of clinical outcome grading which is in relation to the initial clinical severity group assigned to each dog. Improvement after single dose of ESI was seen in 27/32 dogs, with 17/22 (after accounting for four dogs whose owners have refused further treatment, five dogs lost to follow-up after re-check as well as one dog whose owners have opted for repeated ESI instillations) relapsing within 6 months. All 17 of these dogs that suffered a relapse after single ESI subsequently underwent surgical treatment and demonstrated improvement in clinical signs, with a complete response seen in eight dogs and a partial response seen in nine dogs. In the study comparing clinical outcome of conservative treatment of exercise restriction with phenylbutazone administration and surgical treatment of degenerative lumbosacral stenosis, outcomes were classified as good in dogs that regained preoperative activity levels; acceptable in dogs with persistent abnormality or requiring continued medication though otherwise active, and poor in all other cases. Out of 16 dogs treated surgically, 11 were treated by dorsal lumbosacral laminectomy and excision of the dorsal portion of the lumbosacral disc, while the other five had additional unilateral facetectomy to decompress the seventh lumbar nerve. Out of the 11 dogs treated with dorsal lumbosacral laminectomy and excision of the dorsal portion of the lumbosacral disc, 6/11 (54.5%) of dogs were deemed to have a good outcome, while 3/11 (27.3%) of dogs were deemed to have an acceptable outcome. Out of the five dogs treated with dorsal lumbosacral laminectomy and excision of the dorsal portion of the lumbosacral disc with additional unilateral facetectomy, 3/5 (60%) of dogs were deemed to have an acceptable outcome. The outcome of conservative treatment was deemed good in 8/16 (50%) of dogs in the conservative treatment group. Conclusion There is evidence suggesting that both nonsurgical and surgical treatments can improve clinical outcomes and reduce lower back pain and neurological deficits. However, based on the current limited literature, it cannot be ascertained whether surgical treatments are more effective than nonsurgical treatments in improving long-term clinical outcomes and vice versa. In the study that tested the efficacy of epidural steroid injection, only a single dose of steroids was given in this study, making it a potential reason for the high rate of relapse following nonsurgical treatment. For surgical treatment of DLSS, the type of surgical procedure chosen would also depend on the part of the lumbosacral region which fails and leads to compression. In conclusion, randomised controlled trials that compare different forms of nonsurgical treatment with surgical treatment for dogs with DLSS caused by different underlying factors need to be conducted to properly address the PICO question. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

ObjectiveTubo‐ovarian abscesses (TOAs) cause significant morbidity. Surgical intervention is required if broad‐spectrum intravenous antibiotics are unsuccessful. This study aimed to describe admission characteristics that predict failed medical management and to evaluate a previously developed risk score for predicting the need for surgical intervention in cases of TOA.DesignSingle centre, retrospective cohort study.Setting and PatientsPatients admitted to a tertiary‐level public teaching hospital with a radiologically or surgically proven TOA between January 1, 2012 and December 31, 2018.MeasuresDemographic and clinical details were obtained from electronic clinical records. Medical treatment was considered “failed” when surgical intervention was required beyond 24 h of antibiotics. Multivariable analyses using logistic regression was used to determine predictors of failed medical management. Risk scores were calculated as per Fouks et al. and a receiver operating characteristic curve was constructed to assess correlation with outcomes.ResultsThere were 425 patients and 522 admissions with TOA. In the first 24 h, 14% (72/522) of admissions were treated with a surgical intervention in addition to intravenous (IV) antibiotics, while 86% (450/522) were treated with IV antibiotics alone. In those treated with IV antibiotics alone, medical treatment was successful in 65% (293/450) of cases, with 35% (159/450) requiring additional surgical or radiological intervention prior to discharge.Variables independently associated with failed medical treatment were fever at admission (adjusted odds ratio [aOR] 1.72, 95% confidence interval [CI] 1.11–2.67), larger mean diameter of TOA (2% higher odds for every 1‐mm increase in abscess size) and higher C‐reactive protein value (1% higher odds for every unit increase) at admission. The area under the curve (95% CI) for Fouks et al. scoring system was 0.63 (0.58–0.68), indicating poor discriminatory ability.ConclusionsA third of TOAs managed medically required surgical intervention. Fever, higher inflammatory markers, and larger mass were predictive of requiring surgery. However, a scoring system using these variables had poor discriminatory ability to predict treatment failure. Prospective studies are needed to determine whether earlier recourse to surgery can improve outcomes.

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