Department Of Orthopaedic Surgery Research Articles

Frequency and determinants of serum calcium monitoring during eldecalcitol therapy in patients with osteoporosis.

Eldecalcitol (ELD) is an active vitamin D3 analog (AVD) commonly used to treat osteoporosis in Japan. Although routine monitoring of serum calcium levels during ELD therapy is recommended, little is known about the actual frequency and determinants of monitoring. This was a descriptive cohort study using a Japanese electronic medical records database. We identified osteoporosis patients who initiated treatment with ELD or other AVDs (alfacalcidol and calcitriol) between April 1, 2011 and September 10, 2021. The index date for cohort entry was the first prescription date of ELD or other AVDs. The frequency of serum calcium monitoring was evaluated every 6 months. Determinants of serum calcium monitoring were identified using multivariable logistic regression models. We also calculated the incidence of hypercalcemia and the frequency of serum calcium monitoring within 6 months before hypercalcemia. We identified 12,671 ELD users and 7867 other AVD users. Within 6 months after cohort entry, 45.9% of ELD users and 58.7% of other AVD users underwent serum calcium monitoring. Female sex, no use of systemic corticosteroids, moderate-to-good renal function, treatment in smaller hospitals, and treatment in orthopedic surgery departments were associated with a lower likelihood of receiving serum calcium monitoring during ELD therapy. The incidence of hypercalcemia among ELD users was 6.36 per 100 person-years, with 20.6% of cases not receiving serum calcium monitoring before hypercalcemia. Our findings suggest that serum calcium monitoring is not given adequate attention during ELD therapy in routine clinical practice.

Comparison Between Multisite Injection and Single Rotator Interval Injection of Corticosteroid in Primary Frozen Shoulder (Adhesive Capsulitis): A Randomized Controlled Trial

BACKGROUND: Steroid injection is a commonly used conservative treatment for primary frozen shoulder (PFS), but the optimal injection site remains undetermined. OBJECTIVES: We conducted a prospective randomized controlled trial of multisite combined injection (MCI) vs single rotator interval injection (SRI). STUDY DESIGN: A randomized double-blinded controlled trial. SETTING: Center for Joint Surgery, Department of Orthopaedic Surgery, the Second Affiliated Hospital of Chongqing Medical University. METHODS: Sixty-four patients with PFS were randomly assigned to 2 groups. The experimental group received MCI in the rotator interval, intraarticular, and subacromial bursa; the control group received an SRI. Both groups were injected with one mL of 40 mg triamcinolone acetonide and 4 mL of 2% lidocaine. The injection process was completed under ultrasound guidance. Follow-up points were 4, 8, and 12 weeks postinjection. The outcome measures included the Visual Analog Scale (VAS) score, the American Shoulder and Elbow Surgeons (ASES) score, the Constant-Murley Shoulder (CMS) score, passive range of motion of the shoulder, and patient satisfaction rating. RESULTS: Thirty patients in the MCI group and 29 patients in the SRI group were included in the data analysis. All the outcomes in the 2 groups were significantly better postinjection than preinjection. The MCI group had a lower VAS score than the SRI group at 4 weeks (3.1 ± 1.2 vs 4.3 ± 1.6) and 8 weeks (2.2 ± 1.2 vs. 3.4 ± 1.2) (P < 0.05). Compared with the SRI group, the MCI group had a significant improvement in flexion and abduction (P < 0.01). Additionally, the ASES and CMS scores in the MCI group were better than those in the SRI group at 4, 8 and 12 weeks (P < 0.01). LIMITATIONS: Limitations include the sample size of this study is small and a that it was conducted at a single-center. CONCLUSIONS: Both MCI and SRI effectively alleviated pain and restored range of motion in patients with PFS. However, the MCI group had obviously lower early pain scores, better flexion and abduction, and better function scores than the SRI group; no additional adverse events were observed. KEY WORDS: Primary frozen shoulder, adhesive capsulitis, steroid injection, rotator interval, intraarticular, subacromial bursa

FUNCTIONAL OUTCOME OF COMMINUTED PATELLAR FRACTURE FIXATION USING PATELLAR MESH PLATE

Comminuted patellar fractures pose a challenging problem in orthopedic surgery due to the complexity of fracture patterns and the potential for compromised knee function. This study aimed to evaluate the functional outcomes of patients with comminuted patellar fractures treated with patellar mesh plate fixation at CMH Rawalpindi's Department of Orthopedic Surgery. A retrospective study was conducted at the Department of Orthopedic Surgery at CMH Rawalpindi between September 2022 and August 2023. This retrospective study comprised 28 patients with comminuted patellar fractures treated at the Department of Orthopedic Surgery at CMH Rawalpindi between September 2022 and August 2023. The non-probability purposive sample approach was utilized to enroll 28 patients. who had surgery with a patellar mesh plate. The patients were seen in the outpatient department at 6 and 18 weeks. At 18 weeks, the variables specified in the Modified Hospital for Special Surgery Knee Score were recorded, and the Knee Score was computed and analyzed. This study included 18(64.28%) male patients and 10(35.71%) female patients. The average age was 24.96±5.09 years, ranging from 15 to 75 years. There were 2(7.14%) patients aged 15-25 years, 10(39.28%) patients aged 26-35, 8(28.57%) patients aged 36-45, 2(7.14%) patients aged 46-55, 3(10.71%) patients aged 56-65, and 2(7.14%) patients aged 66-75 years. The MHSSKS assessed the patient's well-being. The age distribution of our patients was: 11 patients (39.28%) were 75–56 years old, 12(42.85%) were 55–36 years old, and 5(17.85%) were 35–25 years old. This mean score quantifies our patients' knee function and health. The "Excellent" category indicated significant improvements in knee function and quality of life in 13 patients (46.42%). Twelve patients (42.85%) had a "Good" functional result, and three patients (10.71%) had a "Fair" functional result, suggesting some knee function improvement, but less than those in the Excellent and Good groups. Patellar mesh plate fixation affects comminuted fracture rehabilitation and recovery via functional outcome categories. Patellar mesh plate fixation could be an effective surgical treatment for comminuted patellar fractures with good functional results. However, patient considerations and fracture characteristics should be addressed while choosing a therapy. These results need to be confirmed by larger future studies with longer follow-ups.

FREQUENCY OF IPSILATERAL FEMORAL NECK FRACTURES IN PATIENTS WITH FEMORAL SHAFT FRACTURES

Young people are regularly injured and get femoral shaft fractures. Comprehensive data is needed to determine the frequency of ipsilateral femoral neck fractures in people with femoral shaft fractures. In the present study, individuals with femoral shaft fractures will be examined to determine the frequency of ipsilateral femoral neck fractures. A retrospective study was conducted at the Department of Orthopedic Surgery, Combined Military Hospital (CMH) Rawalpindi, from January 2023 to August 2023. There were 160 participants in the research who had femoral shaft fractures. Preoperative radiographs and intraoperative results were examined to determine if the patients had ipsilateral femoral neck fractures. This retrospective study covered 160 femoral shaft fracture patients with averaged 35 years old, with 75% being male and 25% female. Road traffic accidents (62.5%), falls from height (25%) and sports injuries (3.75%) caused the greatest injuries. 8(5%) had ipsilateral femoral neck fractures. Patients with ipsilateral femoral neck fractures were 35 years old and were 75% male. 87.5% of patients had good surgical results, 6.3% fair, and 6.3% poor. The most frequent consequences were non-union (3.1%), malunion (1.3%), and infection (1.9%). This study identified 5% of ipsilateral femoral neck fractures in femoral shaft fracture patients. These patients must be carefully evaluated and managed to minimize missing or delayed identification of concomitant femoral neck fractures. There were 5% ipsilateral femoral neck fractures in femoral shaft fracture patients. These patients must be carefully evaluated and managed to minimize missing or delayed identification of concomitant femoral neck fractures. Early detection and treatment of these fractures may improve results and avoid complications.

Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient's Individual Type of Fracture and Its Treatment.

Hip fractures are common injuries in the elderly and are usually treated with timely surgery. While severe postoperative complications are reported for up to 10% of patients, many studies identified predictive factors for the occurrence of complications postoperatively. A controversially discussed factor is "time-to-surgery". The aim of the study was to examine if time-to-surgery was associated with the occurrence of complications and if the complication rate differed between the patient individual fracture types of intracapsular on the one hand and extracapsular hip fractures on the other hand. We hypothesized that time-to-surgery had less impact on complications in intracapsular hip fractures compared to extracapsular ones, and therefore, guidelines should pay attention to the patient individual case scenario. All patients who were admitted to the Department of Trauma and Orthopaedic Surgery of an academic teaching hospital for hip fracture surgery (n = 650) over a five-year period were included in the study. After the application of the exclusion criteria, such as periprosthetic or pathologic fractures, cases needed immediate surgical treatment, and after outlier adjustment, 629 cases remained in the study. Hip fractures were classified into intracapsular fractures (treated by hip arthroplasty) and extracapsular fractures (treated by intramedullary nailing osteosynthesis). The occurrence of severe complications in patients treated within 24 h was compared with patients treated later than 24 h after injury. For statistical evaluation, a multivariate logistic regression analysis was performed to investigate the impact of time-to-surgery interval on the occurrence of complications. Patients with an extracapsular fracture, which was treated with intramedullary nailing (44.5%), rarely suffered a serious complication when surgery was performed within 24 h after injury. However, when the interval of the time-to-surgery was longer than 24 h, the complication rate increased significantly (8.63% vs. 25.0%, p = 0.002). In contrast to this finding in patients with intracapsular fractures (55.5%), which were treated with cemented arthroplasty, complication rates did not depend on the 24 h interval (26.17% vs. 20.83%, p = 0.567). The occurrence of complications after surgical treatment of hip fractures is associated with the time interval between injury and surgery. A 24 h time interval between injury and surgical procedure seems to play a major role only in extracapsular fractures treated with osteosynthesis but not in intracapsular fractures treated with arthroplasty. Therefore, guidelines should take notice of the patient individual case scenario and, in particular, the individual hip fracture type.

Surgical Stabilization for Post-Operative Discitis Patients Concerning Pain Relief and Functional Outcomes

OBJECTIVES This study evaluated pain relief and functional outcomes in patients who underwent surgical stabilization following post-operative discitis. METHODOLOGY A cross-sectional was conducted at the Department of Orthopedic and Spine Surgery, Peshawar. The study duration spanned from 2020-2023. The inclusion criteria for participants involved patients who had experienced post-operative discitis and subsequently underwent surgical stabilization, with a stipulated minimum follow-up period of two weeks. Pain relief was measured using the Visual Analogue Score (VAS) for back and leg pain, while functional outcomes were evaluated using the Oswestry Disability Index (ODI). The acquired data were subjected to analysis utilizing SPSS version 26.0. RESULTSOut of the 35, 51.4% were male, and 48.6% were female, with a mean age of 47.5 years (SD ± 10.9 years). The most frequently affected lumbar spine level was L4-L5 in 57.1% of patients. 31.4% were smokers, and 45.7% had comorbidities, primarily consisting of diabetes or hypertension. Significant improvements were observed for back pain (baseline: 9.29 ± 0.71, post-stabilization: 5.37 ± 1.47, p = 0.001) and leg pain (baseline: 3.32 ± 2.17, post-stabilization: 1.91 ± 1.02, p = 0.001). Functional outcomes also showed substantial recovery (baseline: 51.57 ± 6.91, post-stabilization: 34.89 ± 6.85, p = 0.001). Preoperatively, the patients exhibited a spectrum of disability levels, with 29% experiencing severe disability. After two weeks of surgical intervention, substantial improvement was noted, 6% had severe disability. At the last follow-up, only 1% remained severely disabled, underlining the significant enhancement in functional outcomes post-stabilization. CONCLUSION Surgical stabilization is associated with significant pain relief and improved functional outcomes in patients with post-operative discitis.

Ecological Burden of Modern Surgery: An Analysis of Total Knee Replacement's Life Cycle.

It is estimated that surgical procedures account for 20%-30% of the greenhouse gases emissions from health-care systems. Total knee replacements (TKR) are one of the most frequently performed procedures in orthopaedics. The aim of this study was to identify and quantify the environmental impacts generated by TKRs, the factors that generate the most emissions, and those that can be easily modified. To calculate the life cycle carbon footprint of a posterior stabilized cemented TKR performed in a single orthopaedic surgery department, 17 TKRs performed between October 12 and 20, 2020 by 4 senior surgeons were analysed. The analysis of the life cycle included the manufacture of the implant, from raw materials to distribution; the journey made by patients and staff; and the surgery including all consumables required to facilitate the procedure. The overall life cycle carbon footprint of a single TKR was 190.5 kg of CO2. This consisted of 53.7 kg CO2 (28%) for the manufacture of the prosthesis, 50.9 kg CO2 (27%) for travel, 57.1 kg CO2 (30%) for surgery, and 28.8 kg CO2 (15%) for waste management. This is comparable to a New York-Detroit direct flight. The production of a total knee prosthesis, throughout its life cycle, generates emissions with important consequences on the environment and therefore on our health. Although much data are currently missing to make precise estimates, and especially regarding benefits in terms of patient function and its impact on carbon emissions, these data serve as a starting point for other more detailed or comparative studies.

Comparative Study of Efficacy Between Platelet-Rich Plasma vs Corticosteroid Injection in the Treatment of Lateral Epicondylitis

Background: Lateral epicondylitis, commonly known as "tennis elbow," is a painful condition affecting the tendons on the outer part of the elbow. Managing lateral epicondylitis is essential to relieve discomfort and improve the patient's quality of life. Various treatment options are available for lateral epicondylitis, including Platelet-Rich Plasma (PRP) therapy and corticosteroid injections. The technique if proved better in pain control would be later on preferred as it will contribute significantly to reduce indoor patient burden, earlier recovery of patients and to their overall satisfaction. Objective: To assess and comparative effectiveness of corticosteroid injections with platelet-rich plasma injections in the management of lateral epicondylitis. Study Design: Randomized controlled trial (RCT). Settings: Department of Orthopedic Surgery, PIMS, Islamabad Pakistan. Duration: From December 2019 to May 2020. Methods: Overall, 162 adult patients having clinical features of chronic lateral epicondylitis unilateral/bilateral not responding to conservative management of either gender with age between 18-60 years were included. Patients were randomly assigned into two intervention groups. Patients of Group A underwent local steroid injections, while Group B received platelet-rich plasma (PRP) injections. Patients of the PRP group, were administered 2 mL of PRP, derived from their own blood, at the most sensitive spot on the lateral epicondyle. Patients of the steroid group, were given 2 mL of methylprednisolone (40 mg/mL). Following the injections, patients were instructed to rest for 15 minutes and advised against massaging the treated area. VAS score was calculated at baseline before giving treatment in both groups and was subsequently assessed at 6th week, 3rd month and 6th month post therapy. VAS score was compared in both groups at different time intervals using student-t test for independent samples. Results: Mean age in group A was 47.4 ± 7.5 years and in group B was 48.1 ± 8.2 years. In group A, 56.8% of the participants were males, and 43.2% were females, whereas in group B, 54.3% were males, and 45.6% were females. Baseline average score of VAS was almost equal among both groups at baseline (7.69 ± 1.03 and 7.74 ± 1.06) in group A and B respectively. At 6th weeks, average score of VAS in steroid group was 3.7 ± 1.79 and in PRP group was 3.23 ± 2.05 (P=0.440). At 3 months, average score of VAS in steroid group was 2.73 ± 1.48 and it was 2.53 ± 1.82 SD in PRP group (P=0.451). At 6 months, VAS average score was noted significantly decreased 2.11±1.29 compared to steroid group was 4.83 ± 2.11 (P=0.001). Conclusion: The study revealed that PRP injections are more effective than local steroid injections for chronic lateral epicondylitis. Initial VAS scores were similar for both treatments up to three months, but PRP showed significantly better results at the 6-month follow-up, indicating its long-term effectiveness.

Clinical and Functional Outcomes of Arthroscopic Bankart Repair among Patients with Recurrent Anterior Shoulder Dislocation

OBJECTIVE: To note the functional outcome of recurrent anterior shoulder dislocation with Bankart repair (BR) treated with arthroscopic stabilisation with suture anchors. METHODOLOGY: This prospective cohort study was conducted at the Department of Orthopedic Surgery, Lahore General Hospital, Lahore, from January 2021 to June 2022. Patients undergoing arthroscopic BR with anterior instability of the glenohumeral joint with at least >6 episodes of dislocation/subluxation in the last six months were analysed. Functional outcomes were assessed at one-month, three-month and six month intervals post-surgery using "Modified University of California Los Angeles (UCLA)" and "Simple Shoulder Test (SST)". RESULTS: Of 25 patients, 24 (96.0%) were male. The mean age was 27.20±4.0 years. The mean duration of symptoms was 9.1±6.2 months. In 16 (64.0%) patients, 2-suture anchors were utilised, while 3-suture anchors were used in the remaining 9 (36.0%) patients. Pre-surgery, the mean UCLA score was 16.4±5.6 and improved to 1-month, 3-month and 6-month as 16.6±5.1, 22.8±6.2 and 28.4±6.6 respectively (p<0.001). Pre-surgery, the mean SST score was 4.7±2.4 which improved to 1-month, 3-month and 6-month as 5.4±2.6, 8.1±3.3 and 11.2±3.1 respectively (p<0.001). All patients (100%) had full range of motion after six months post-surgery. CONCLUSION: Arthroscopic BR in recurrent anterior shoulder dislocation was a reliable procedure regarding functional outcomes and range of motion after six months of follow-up. KEYWORDS: Arthroscopy, Bankart repair, shoulder dislocation, suture anchors, range of motion

Erratum: Immunofluorescence Imaging of Neutrophil Extracellular Traps in Human and Mouse Tissues.

An erratum was issued for:Immunofluorescence Imaging of Neutrophil Extracellular Traps in Human and Mouse Tissues. The Authors section was updated from: Lavinia Schöenfeld1 Birgit Appl1 Laia Pagerols-Raluy1 Annika Heuer3 Konrad Reinshagen1 Michael Boettcher1,2 1Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg 2Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg 3Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf (UKE) to: Lavinia Schoenfeld1 Birgit Appl1 Laia Pagerols-Raluy1 Annika Heuer3 Konrad Reinshagen1 Michael Boettcher1,2 1Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg 2Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg 3Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf (UKE).

Comparison Of Prophylactic Injection Of Corticosteroid With Placebo, In Management Of Wrist Pain On Ulnar Aspect In Patients Of Fractures Of Distal Radius

INTRODUCTION: Distal radius fractures are one of the commonest fractures experienced by the Orthopaedic surgeons. Pain on the ulnar aspect of the wrist is the most usual complication of such fractures. Corticosteroid injection is a simple and effective method for elevating pain of such nature. OBJECTIVE: To compare the mean pain score with prophylactic corticosteroid injection versus placebo in management of wrist pain on ulnar aspect in patients presenting with fracture of distal radius. MATERIAL AND METHODS: Study Design: Randomized controlled trial Setting: Orthopedic Surgery Department, Benazir Bhutto Hospital, Rawalpindi Duration: Six months (March 5, 2018 to Sept 5, 2018) Data Collection Procedure: 80 patients were included by using non-probability consecutive sampling after fulfilling the selection criteria. Demographic profile (patient name, age, gender, anatomical side and contact details) was obtained. Patients were splitted in two random groups by simple lottery method. Patients of group A were given one shot of 80mg corticosteroid in the area of ulnar styloid process near TFCC and group B patients were given a shot of distilled water (2 cc). Both group of patients were followed in OPD for 3 months in their postoperative visits. Visual analogue scale (VAS) score was recorded. Data was analyzed using SPSS version 21. Results: The mean age of the patients was 41.05 ± 11.05 years and age range of 40 years. The mean age in the corticosteroid and placebo groups was 39.68±10.67 years and 42.42 ± 11.39 years respectively. There were 42 (52.50%) male and 38 (47.50%) female patients with a higher male ratio i.e., 1.10:1. In corticosteroid and placebo groups there were 21 (52.50%) male and 19 (47.50%) female cases. The mean pain at baseline was 7.72 ± 1.66 while in the corticosteroid and placebo group, the mean pain was 7.60 ± 1.67 and 7.85 ± 1.65 respectively with statistically equal mean pain p-value = 0.504. After 3 months of treatment, mean pain in the corticosteroid group was 1.30 ± 0.66 and was 2.60 ± 1.58 in the placebo group, p-value < 0.001. Conclusion: Our findings suggested that prophylactic corticosteroid injection is more effective in reducing pain in patients with distal radial fracture than placebo. By using prophylactic corticosteroid injections in the future, we can reduce pain to achieve more satisfaction of patients.

Clinical features and prognostic factors of extraskeletal osteosarcoma: A single-center retrospective study from China

ObjectiveExtraskeletal osteosarcoma (EO) represents a rare manifesting variant of soft tissue sarcoma. This study aims to analyze clinical characteristics, natural course, and potential prognostic factors of EO based on literature review. MethodsClinical data of 12 patients with EO admitted to Department of Orthopedic Oncology Surgery of Beijing Ji Shui Tan Hospital from March 1995 to October 2019 were retrospectively analyzed, and clinical profile, therapies, and endpoints were summarized. ResultsEight patients were previously untreated, and four cases were recurrent. The median age on diagnosis was 53 years, and the mean follow-up time was 41.4 (range: 25 to 72) months. The lesions were located in the thigh of 5 patients, calf in 3, buttock in 2 and upper arm in 2. The lesions were located in the deep layer of fascia in 10 cases and in the superficial layer in 2, with a maximum diameter of 13 (4–19) cm on average, and Ennecking stage was IIB for 10 patients and III for 2. All patients underwent surgery, with a marginal resection in 8 cases, and wide resection in 4. Eight patients received chemotherapy, including two patients with neoadjuvant chemotherapy and 7 with postoperative adjuvant chemotherapy. Three patients with marginal resection had local recurrence and two of them underwent radical amputation. Five patients died from lung metastases, including two patients with pre-existing metastasis at presentation. ConclusionsEO is a rare high-grade soft tissue sarcoma. Age<50 years, no metastasis at presentation, superficial location of the tumor, and negative resection margin are favourable prognostic factors. For patients with positive margins, adjuvant radiotherapy is recommended to improve local control rates. High-risk patients may benefit from platinum-based chemotherapy regimens.

Preoperative hemoglobin levels and mortality outcomes after hip fracture patients

PurposeHip fracture surgery is associated with a risk of morbidity and mortality, with admission hemoglobin levels being a significant predictor of mortality risk. The aim of this study is to evaluate the relationship between the preoperative hemoglobin (Hb) levels and mortality in patients who underwent hip fracture surgeries, with the goal of enhancing prognosis prediction and reducing complications within this patient subset. In addition, to assess the characteristics of patients at a higher risk of postoperative mortality.MethodsThis retrospective study was conducted at Jordan University Hospital, a single tertiary care and educational center. It included patients with hip fractures who underwent surgical repair at the Department of Orthopedic Surgery and were recruited between December 2019 and February 2022. We examined the relationships between preoperative hemoglobin status and variables such as age at admission, gender, fracture type, surgery type, comorbidities, duration of hospital stay, intensive care unit (ICU) admission, and survival outcomes.ResultsWe included 626 patients; the mean age was 76.27 ± 9.57 years. 3-month and 6-month mortality rates were 11.2% and 14.1%, respectively. The highest mortality was observed in patients aged over 80 years (n = 53/245, 21.6%), and in male patients (n = 53/300, 17.7%). The Hb level upon admission was lower in individuals who died within 6 months compared to those who survived (10.97 ± 2.02 vs. 11.99 ± 2.39, p < 0.001). In multivariate analysis, the independent factors that were statistically significant in the model included gender (OR = 1.867; 95% CI 1.122–3.107, p = 0.016), age (OR = 1.060; 95% CI 1.029–1.092; p < 0.001), hemoglobin level upon admission (OR = 0.827; 95% CI 0.721–0.949; p = 0.007), history of renal disease (OR = 1.958; 95% CI 1.014–3.784; p = 0.045), length of hospital stay (OR = 1.080; 95% CI 1.036–1.126; p < 0.001), and ICU admission (OR = 1.848; 95% CI 1.049–3.257; p = 0.034).ConclusionOur study illustrates that low hemoglobin levels, history of renal disease, along with male gender, advanced age, extended hospital stays, and ICU admission were significantly associated with 6-month mortality. Future investigations should consider assessing varying degrees of anemia based on hemoglobin concentrations to provide a more comprehensive understanding of anemia’s impact on mortality.Mini-abstractThis study investigated the relationship between preoperative hemoglobin levels, patient characteristics, and mortality in patients who underwent hip fracture surgeries. The results showed that lower hemoglobin levels, history of renal disease, male gender, advanced age, extended hospital stays, and ICU admission were significant predictors for mortality.

Etiologies of Orthopedic Implant Removal Among Patients Who Underwent Orthopedic Fixation Surgeries in King Abdulaziz Medical City.

Hardware removal surgeries are considerably common. However, the justifications for these surgeries are debatable. The indications may vary from pain, surgical site infection, or failure of osteosynthesis. Additionally, the surgery can be performed withoutmedical indication. Following these surgeries, many complications can occur. Therefore, surgeons and patients should be aware of the appropriate indications and have realistic expectations of the risks and benefits of implant removal. This was a retrospective chart review study. We included all patients aged 17-86 years who underwent hardware removal surgery in the orthopedic surgery department of King Abdulaziz Medical City, Riyadh, Saudi Arabia, from 2010 to 2019. All relevant data, such as demographic characteristics, location and type of hardware, indication for hardware removal, duration between insertion and removal, and complications after removal were recorded and analyzed. A total of 244 medical records were reviewed with a mean patient age of 34years. Out of the total, 190 patients (77.9%) were male. The femur was the most common location of hardware removal, in 50 cases (20.58%). Plates and screws were the most common type of implants (40.2%). Most patients underwent hardware implantation because of fractures (89.3%). In total, 119 patients (48.8%) had the hardware removed electively. Only 29 patients (12%) reported postoperative complications; 190 patients (77.9%) were advised by their surgeon against hardware removal. Hardware removal procedures are commonly performed worldwide for various reasons, including infection, pain, and loosening. In this study, we have outlined the reasons for implant removal, the locations, complications, and the rationale behind this surgery. We have provided a new decision-making assessment, aimed at the general population and surgeons alike, that will help patients better comprehend the complications and risks associated with this elective surgery.

How does trauma secondary to unexpected extreme weather affect orthopaedic surgery departments? An epidemiological study on the Filomena snowstorm.

Trauma secondary to extreme weather events may heavily impact the normal activity of orthopaedic surgery departments, especially in places not prepared to deal with them. The Filomena snowstorm, which happened in January 2021, has been one of the greatest snowstorms ever in Spain. During it, the constant influx of trauma patients made the Orthopaedic Emergencies Department (OED) to collapse. The primary objective of this study was to describe the orthopaedic injuries and changes in fracture's epidemiology observed during this exceptional period. Secondary objectives were to analyse the collected variables in order to minimize the future impact of these unexpected extreme weather events. Retrospective cohort study between patients that came to the OED during the snowstorm (Filomena group) and those who came on the same period of the previous year (Control group). The following data were collected: age, sex, injury location, injury mechanism, diagnosis, AO/OTA fracture classification, treatment type (conservative vs surgical) and delay to surgical treatment. A total of 1237 patients were included in total, 655 patients from the Filomena group and 582 from the Control group. One in two patients in the Filomena group sustained a fracture (50.7% vs 23.2%). The most frequent diagnosis on the Filomena group was distal radius fracture (16.2%), five times more frequent than in the Control group (3.4%). A significant increment was also observed in the incidence of ankle (21.7%) and proximal humerus (33%) fractures. In Filomena, surgically treated fractures increased by 168%, being more severe, as C-type fractures were more prevalent (23% vs 13%). Mean delay to surgery was 6.78days during the snowstorm. Unexpected snowstorms entail an exponential rise in orthopaedic care demand and OED pressures. A significant increment in orthopaedic trauma surgery, up to 168% more, particularly distal radius, proximal humerus and ankle fractures it is to be expected, which will imply elective surgery cancellation, damaging patients and increasing costs.

The Traumatic Hand by Spinning Top: About 7 Patients and review of the Literature

The traumatic hand by spinning top occurs frequently in developing countries. It tends to occur in young people, leading to psychologic and socio-economic disability and loss. In this series of 7 patients, the middle age was 37 years. The left hand was involved in 72% and was treated in the Department of Traumatology and Orthopedic Surgery affiliated to Ibn Sina Hospital in Rabat. These accidents are correlated with somnolence and lack of vigilance. The most frequent causes are absence of security systems and heterogeneity of the wood but also the unpredictability of the machines used in butchery. Prevention in this pathology is considered the main treatment.

Risk factors, classification, and operative choices of femur fractures at a Tertiary Hospital: first report from Somalia

A traumatic femur fracture is a significant cause of morbidity, affecting one to three million individuals annually. The present is the first study investigated the epidemiological characteristics, risk factors, classification, mechanisms of injury, and early management of femoral fractures in Somalia. This retrospective epidemiological study included all patients with a femur fracture who were admitted for four years between November 2018 and December 2022 to the orthopedic and trauma surgery department. We reviewed patient demographic characteristics, including age and gender, the mechanism of injury, injury characteristics, and the type of fixation performed. We reviewed the radiographs and classified the fracture using the AO/OTA classification system. During the study period, a total of 402 patients were treated for femur fractures; 256 (64%) were males, and 144 (36%) were females. The mean patient age was 47.7 ± 8.5 years. Regarding the anatomical location of femur fractures, the proximal (31A, 31B) was the most common, accounting for 50% of the patients. Femur neck fracture (31B) was the most common in the proximal femur fractures. Gunshot 82 (59.42%) was the leading cause of femur shaft fractures. Most patients with femur shaft fractures were males; 150 (86.20%) and 152 (64.47%) were young patients between 19 and 40 years old. Almost half of the patients (86) with femur shaft fractures had open fractures. The distribution of the mechanism of injury significantly differed according to age (p < 0.001). Younger patients (< 40 years) were predominantly injured due to gunshot injuries compared to elderly cases (> 60 years), where falls from standing height were the primary mechanism of injuries. There was a statistically significant difference between the mechanism of injury and gender categories (p < 0.001). Male patients were injured mainly by gunshots in about 40%, while 80% of fractures in female patients were due to falls from standing height. Female fractures occurred primarily in the proximal, while the males had an equal fracture rate for proximal and shaft fractures. Femur fracture causes significant morbidity and mortality. The study findings revealed that the most common femur fracture type was femur neck fracture, and low-energy injuries were the most common mode of injury in the elderly. Proximal femur fractures occur in older age and mainly in females. Gunshots were the most common cause of femur shaft fractures in Somalia, a country that has struggled with wars for over 30 years.

Anatomical single bundle anterior cruciate ligament reconstruction using the hamstring tendon graft to restore knee function in patients with sport injury, falling trauma or road traffic accident

The purpose of this study was to evaluate the effect of anatomic single bundle ACL reconstruction using the hamstring tendon to restore knee function in patients with anterior cruciate ligament (ACL) injury. This was a prospective study with 30 patients (3 women and 27 men, aged 20-40 years) who underwent the arthroscopic single bundle ACL reconstruction using semi-tendinosus and gracilis autograft fixed with an interference screw with anatomical femoral tunnel placement at the Orthopaedic Surgery Department of Sohag University Hospital. All patients were followed up at 2 weeks, 6 weeks, 3 months and 6 months to assess their progress in the rehabilitation program and to address any complications. They were examined preoperatively for knee stability and associated injuries (i.e., meniscal injury), knee X-ray and MRI. All patients were assessed using the Lysholm score, the IKDC score, the Lachman score, and the pivot shift score preoperatively and six months postoperatively, and the results were compared. For data analysis, we used the Statistical Program for the Social Sciences (SPSS). Our study showed highly statistically significant differences between the preoperative and postoperative Lysholm scores, the IKDC score, the Lachman score, and the pivot shift score in favor of the postoperative scores (p &lt; 0.001**). Anatomic single bundle ACL reconstruction using the hamstring tendon is an effective technique for restoring knee function and in patients with deficient ACL.

Clinical and Epidemiological Aspects of Bone Metastases: Experience of the Orthopedic and Traumatological Surgery Department of the Ibn Sina Hospital in Rabat

The occurrence of a bone metastasis marks a turning point in the evolution of a cancer patient. Except for a very particular primary cancer, the chances of definitive cure have practically disappeared and the treatment is therefore essentially oriented towards the patient's quality of life. This highlights the need for close medical and paramedical collaboration, each of the specialists being at the service of the other to increase the effectiveness of the treatment and limit its heaviness for the patient as much as possible. We mainly detail the surgical strategies and combinations of techniques likely to meet the patient's needs, without going back over the basic techniques, but specifying the specificities of the gestures according to the location of the damage.

A medium- and long-term comparative observation on volumetric changes of cervical disc herniation after symmetrically or asymmetrically decompression and conservative treatment for cervical spondylotic myelopathy

Objective: To compare the volumetric changes of cervical disc herniation (CDH) after cervical microendoscopic laminoplasty(CMEL),expansive open-door laminoplasty (EOLP) and conservative treatment. Methods: A retrospective study was conducted involving 101 patients with cervical spondylotic myelopathy(CSM),at the Department of Orthopaedic Surgery,the First Affiliated Hospital of Zhengzhou University from April 2012 to April 2021. The patients included 52 males and 49 females with an age of (54.7±11.8) years(range:25 to 86 years). Among them, 35 patients accepted CMEL treatment,33 patients accepted EOLP treatment,while 33 patients accepted conservative treatment. Volume data of CDH were measured by three-dimensional analysis of the initial and follow-up MRI images. The absorption rate and reprotrusion rate of CDH were calculated. The happening of resorption or reprotrusion was defined when the ratio was greater than 5%. The clinical outcomes and quality of life were evaluated by the Japanese Orthopaedic Association (JOA) score and the neck disability index (NDI).Quantitative data was analyzed by one-way ANOVA with post LSD-t test (multiple comparison) or Kruskal-Wallis test. Categorical data was analyzed by χ2 test. Results: The follow-up time of the CMEL group,EOLP group and the conservative treatment group were (27.6±18.8)months,(21.6±6.9)months and(24.9±16.3)months respectively with no significant difference(P>0.05). Changes of CDH volume in patients:(1) There were 96 CDH of 35 patients in the CMEL group,among which 78 showed absorption. The absorption frequency was 81.3%(78/96) and the absorption rate was ranged 5.9% to 90.9%;9 CDH showed reprotrusion,the reprotrusion frequency was 9.4% (9/96) and the reprotrusion rate was 5.9% to 13.3%;(2) There were 94 CDH of 33 patients in the EOLP group,of which 45 showed absorption. The absorption prevalence was 47.9% (45/94) and the absorption rate was 5.0% to 26.7%;20 CDH showed reprotruded,with the reprotrusion frequency of 21.3% (20/94) and the reprotrusion rate was 5.8% to 28.3%;(3) There were 102 CDH in 33 patients of the conservative group. Among them, 5 showed absorption. The absorption frequency was 4.9% (5/102),and the absorption rate was 7.2% to 14.3%;58 CDH showed reprotruded with the re-protrusion ratio of 56.9% (58/102) and the re-protrusion rate was 5.4% to 174.1%. The absorption ratio and reprotrusion ratio of the CMEL group were statistically different from EOLP group or the conservative group (P<0.01).The absorption ratio and reprotrusion ratio of the EOLP group was different from conservative group (all P<0.01). In terms of clinical outcomes, the excellent/good rate of the JOA score and NDI scores in the CMEL group were different from that of conservative group (all P<0.01) but not from that of the EOLP group(P>0.05). Conclusions: CMEL is an effective method for the treatment of CSM,making CDH easier to resorption compared to the EOLP or conservative treatment,thus making a better decompression effect on the nerves. This study enlightened on a new strategy for the clinical treatment of CSM.