Final Follow-up Research Articles

Does the presence or absence of preoperative lower extremity neurologic symptoms influence postoperative clinical outcome in patients with cervical intradural extramedullary tumors?: a single-center retrospective comparative study.

Retrospective comparative study OBJECTIVES: To investigate whether the presence or absence of preoperative lower extremities neurological symptoms (LENS) influences clinical outcomes following tumor resection in patients with cervical intradural extramedullary (IDEM) tumors. The single institution in Japan. Ninety-two patients with cervical IDEM tumors requiring surgical resection were included. Based on the degree of preoperative LENS assessed using the modified McCormick scale (MMCS), patients were categorized into LENS (-) and (+) groups. Demographic and surgical characteristics were compared between both groups. There were no significant differences observed in sex, tumor location, tumor size, surgical time, estimated blood loss, approach for tumorectomy, or tumor histopathology between the two groups. Additionally, the overall surgical outcomes were favorable for both groups. At the final follow-up, 91.1% of the patients in the LENS (+) group were able to walk without support. Improvement in LENS was observed after surgery in most patients with preoperative MMCS II-IV, but it persisted in approximately 40% of patients with preoperative MMCS V. In the LENS (+) group, there were no significant differences in demographic or surgical data between the patients with MMCS I and II-III at the final follow-up. Regardless of the presence or absence of preoperative LENS, clinical improvement was observed after tumor resection in most patients with cervical IDEM tumors. These findings suggest that neurological status is likely to improve sufficiently if tumor resection is performed before preoperative LENS deteriorates to an extremely severe stage as MMCS V.

Clinical Outcomes of a Minimally Invasive Percutaneous Brostrom Technique without Arthroscopic Assistance.

Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon's arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology.

Impact of teardrop angle correction on functional outcomes in die punch fractures of the distal radius: retrospective study

Background: Anatomic reduction of die punch fractures of the distal radius is crucial to optimize functional outcomes. The teardrop angle, formed by the volar cortex and articular surface, reflects distal radius alignment and articular congruity. This study evaluated the relationship between teardrop angle correction and clinical/functional results following surgical fixation of these injuries. Methods: This retrospective study included patients undergoing open reduction and internal fixation for die punch distal radius fractures between 2015-2020. Patients were divided into two groups based on teardrop angle correction: group 1 (≤10°) and group 2 (&gt;10°). Disabilities of the arm, shoulder and hand (DASH) scores, patient-rated wrist evaluation (PRWE) scores, range of motion, and grip strength were assessed at final follow-up (minimum 12 months). Multivariate analysis identified predictors of functional outcomes. Results: 60 patients were included (32 in group 1, 28 in group 2). Groups were similar in baseline demographics and injury characteristics. Group 2 (&gt;10° correction) had significantly better outcomes including lower DASH scores (14.5 versus 24.6, p=0.003), lower PRWE scores (21.6 versus 36.8, p=0.002), greater grip strength (84.6% versus 71.2%, p=0.005), increased flexion (62.5° versus 52.7°, p=0.004), and extension range of motion (55.8° versus 43.5°, p&lt;0.001). On multivariate analysis, greater teardrop angle correction was an independent predictor of improved DASH and PRWE scores. Conclusions: Obtaining &gt;10° of teardrop angle correction during surgical fixation of die punch distal radius fractures correlated with superior functional outcome scores, grip strength, and mobility compared to ≤10° of correction. These findings emphasize the importance of restoring distal radius anatomy and articular congruity in this injury pattern. Precise intraoperative correction of the teardrop angle deformity should be a key goal.

Percutaneous kyphoplasty combined with pediculoplasty (PKCPP) augments and internally fixates the severe osteoporotic vertebral fractures: a retrospective comparative study.

Vertebral augmentation (VA) has emerged as a satisfactory and minimally invasive surgical approach for severe osteoporotic vertebral fractures (OVFs). However, treating severe OVFs with advanced collapse, burst morphology with MC injury, posterior wall retropulsion, high degree of osseous fragmentation, pediculo-somatic junction fracture, and large vacuum cleft presents significant challenges. This study aimed to evaluate the effectiveness of percutaneous kyphoplasty combined with pediculoplasty (PKCPP) in reducing refracture, preventing further collapse and bone cement displacement, reconstructing vertebral body (VB) stability, and providing internal fixation of the anterior column (AC), middle column (MC), and the bilateral pedicles. The current study was designed as a retrospective review of clinical and radiologic parameters. From July 2018 to September 2021, ninety-six patients with severe OVFs and without neurological deficit were treated either with simple percutaneous kyphoplasty (simple PKP group, n = 54) or with percutaneous kyphoplasty combined with pediculoplasty (PKCPP group, n = 42). All patients were followed up for at least 1year, and clinical and radiological outcomes were assessed. Surgery duration and bone cement volume were compared between the two groups, as well as analgesic dosage and hospital stay. Anterior wall height (AWH), posterior wall height (PWH), and Cobb angle (CA) were measured and analyzed before and after surgery. The simple PKP group had significantly shorter surgery duration and lower bone cement volume compared to the PKCPP group (P < 0.05). Conversely, the simple PKP group had significantly higher analgesic dosage and longer hospital stay than the PKCPP group (P < 0.05). Both groups showed significant improvements in AWH, PWH, and CA after surgery (P < 0.05). At the final follow-up, the PWH in the simple PKP group was significantly lower than the preoperative measurement (P < 0.05), and the difference in PWH between the two groups was statistically significant (P > 0.05). Moreover, both groups demonstrated a significant reduction in CA after surgery, with the PKCPP group showing a greater reduction compared to the simple PKP group throughout the postoperative period to the final follow-up (P < 0.05). VAS and ODI scores significantly decreased in both groups after surgery (P < 0.05), with no significant difference between the groups at the final follow-up (P > 0.05). However, the PKCPP group achieved better VAS scores than the simple PKP group at postoperative 1day, 1month, and 3months (P < 0.05), and the ODI in the PKCPP group was lower than the simple PKP group at 1month after surgery (P < 0.05). Furthermore, the overall complication rate in the PKCPP group was significantly lower than that in the simple PKP group (P < 0.05). If performed by appropriately trained surgeons, both PKP and PKCPP are safe and effective treatments for patients with severe OVFs. However, PKCPP offers additional benefits in the setting of bothersome fractures, including rapid pain relief, improved spinal stability, satisfactory restoration of vertebral body height, and better correction of kyphotic deformity. These promising results have been tested in a single center but require further confirmation in multiple centers.

Clinical Outcome of Endoscopically Assisted Mini-open Carpal Tunnel Release.

Background: Carpal tunnel syndrome (CTS) can be treated surgically. Although the minimally invasive open surgical method is widely used, it is not possible to directly visualise the entire length of the carpal tunnel, especially the proximal end, which is on the side away from the skin incision. In this study, we performed a mini-open carpal tunnel release with endoscopic assistance to release the entire length of the carpal tunnel under direct vision and investigated the treatment outcomes. Methods: The surgical method included an incision of ≤2 cm in the palm, cutting of the transverse carpal ligament under direct vision and cutting of the forearm fascia under endoscopic vision. A uniquely designed sheath was used for the endoscopic resection. We investigated the sex, age, medical history, symptoms, examination findings, anaesthesia method, operation time, thenar motor branch variation, postoperative complications, presence or absence of pillar pain and final examination findings of the target patients. Results: A total of 100 hands (85 patients) were included. Anatomical variations of the thenar motor branches were observed in 19 hands. At the final follow-up, hand numbness improved in all patients, while mild numbness was observed in 25 hands. The abductor pollicis brevis muscle improved in all patients with paresis, but 8 of the 27 hands remained completely paralysed. Pillar pain was observed in 36 hands at 8 weeks postoperative, but the condition improved in all patients. The clinical outcomes of this study were good with no cases of major complications or reoperation. Conclusions: The minimally invasive open surgical method described here can be reliably used to release the forearm fascia proximal to the carpal tunnel. The thenar motor branch can also be confirmed under direct visualisation, making it a relatively safe and useful approach. Level of Evidence: Level Ⅳ (Therapeutic).

Unbalanced metaphyseal fixation is associated with an increased aseptic loosening of revision total knee arthroplasty at mean 4-year follow-up.

The total number of total knee arthroplasty performed is rising, and the number of revisions is rising accordingly. Periprosthetic joint infection emerged in recent years as a leading cause of total knee revisions. Bone loss is a real challenge when facing septic knee revisions since radical debridement is crucial to overcome infection. Many devices have already demonstrated to reliably address bone loss and guarantee enhanced fixation. However, the role of balancing metaphyseal fixation and its interplay with the level of constraint has not been elucidated yet. An institutional arthroplasty registry was retrospectively reviewed looking for patients who underwent two-stage revision of the knee and metaphyseal cones implantation. Patients were divided into two groups based on the presence of cones only on one side (femoral or tibial, Group U) or both femoral and tibial side (Group B). Failure, aseptic loosening, and revision rates were compared between groups, as were values of patient-reported outcome measure. Kaplan-Meier analysis was used to assess survival of implants. A total of 65 patients were included in the analysis and were evaluated at a mean final follow-up of 4years (range, 2-7). Mean age was 67 (range, 43-81) years. Mean BMI was 27.4 (range, 20-37) kg/m2. The overall mean KSS, OKS, ROM significantly increased from baseline values to last follow-up (p < 0.001). Kaplan-Meier analysis demonstrated that patients included in Group U had a significantly lower rate of implant survival compared to those included in Group B. Patients undergoing revision total knee arthroplasty for periprosthetic infection present considerable rates of complication and failure. Management of bone loss represents a concern for the surgeon, who must achieve a stable fixation. Our study demonstrated that implants characterized by an unbalanced metaphyseal fixation are at higher risk of aseptic loosening and consequent revision, especially when coupled with hinged inserts.

Ten-year clinical and radiological outcomes with a vitamin E-infused highly cross-linked polyethylene acetabular cup.

Limited implant survival due to aseptic cup loosening is most commonly responsible for revision total hip arthroplasty (THA). Advances in implant designs and materials have been crucial in addressing those challenges. Vitamin E-infused highly cross-linked polyethylene (VEPE) promises strong wear resistance, high oxidative stability, and superior mechanical strength. Although VEPE monoblock cups have shown good mid-term performance and excellent wear patterns, long-term results remain unclear. This study evaluated migration and wear patterns and clinical and radiological outcomes at a minimum of ten years' follow-up. This prospective observational study investigated 101 cases of primary THA over a mean duration of 129 months (120 to 149). At last follow-up, 57 cases with complete clinical and radiological outcomes were evaluated. In all cases, the acetabular component comprised an uncemented titanium particle-coated VEPE monoblock cup. Patients were assessed clinically and radiologically using the Harris Hip Score, visual analogue scale (pain and satisfaction), and an anteroposterior radiograph. Cup migration and polyethylene wear were measured using Einzel-Bild-Röntgen-Analyze software. All complications and associated treatments were documented until final follow-up. Clinical assessment showed persistent major improvement in all scores. On radiological assessment, only one case showed a lucent line (without symptoms). At last follow-up, wear and migration were below the critical thresholds. No cup-related revisions were needed, indicating an outstanding survival rate of 100%. Isoelastic VEPE cups offer high success rates and may prevent osteolysis, aseptic loosening, and the need for revision surgeries in the long term. However, longer follow-up is needed to validate our findings and confirm the advantages offered by this cup.

Performance assessment of the Surpass Evolve flow diverter for the treatment of intracranial aneurysms: A systematic review and meta-analysis.

The Surpass Evolve (SE) has emerged as a promising alternative treatment from the flow diverter series. The utilization of the SE has gradually increased, however, there is a scarcity of comprehensive data on the solidity of this technology in the endovascular treatment of intracranial aneurysms (IAs). This meta-analysis aimed to evaluate the safety and effectiveness of the SE flow diverter. A systematic literature search from inception to April 2024 was conducted across five databases for studies involving IAs treated with the SE. The primary effectiveness outcome was the proportion of complete aneurysm occlusion at the final follow-up, and the primary safety outcome comprised a composite of early and delayed complications. Subgroup analyses based on aneurysm size, anatomical location, and rupture status were also conducted. Our analysis included nine studies with 645 patients and 722 IAs. Effectiveness outcomes revealed an overall complete aneurysm occlusion rate of 69% (95% confidence interval (CI) = 58%-78%; I2 = 72%) and a favorable aneurysm occlusion rate of 91% (95% CI = 82%-96%; I2 = 49%). Safety outcomes demonstrated an overall complications rate of 6% (95% CI = 3%-12%; I2 = 66%), with an early complications rate of 6% (95% CI = 4%-11%; I2 = 0%), and a delayed complications rate of 0% (95% CI = 0%-7%; I2 = 0%). Our findings suggest a favorable outcome with a high rate of complete aneurysm occlusion at the last follow-up, with acceptable rates of neurological complications. Future research efforts should focus on larger, prospective studies with standardized outcome measures to further elucidate the clinical utility of the SE flow diverter in the management of IAs.

Efficacy and Safety of Intravitreal Faricimab in Neovascular Age-Related Macular Degeneration, Diabetic Macular Edema, and Retinal Vein Occlusion: A Meta-Analysis.

Intravitreal anti-vascular endothelial growth factor (VEGF) therapy has become the mainstay of treatment in many retinal diseases. The comparative efficacy and safety of newer bispecific anti-VEGF/angiopoietin 2 (Ang2) agents in the treatment paradigm versus widely used monospecific anti-VEGF agents remains unclear. A systematic literature search of MEDLINE, Embase, and Cochrane Library was conducted to identify comparative observational studies and randomized controlled trials published from 2015 to Jul 2024. With assessment by three independent reviewers, original English peer-reviewed full-text articles evaluating faricimab versus monospecific anti-VEGF agent(s) in FDA-indicated retinal disease with data on at least one set of efficacy and/or safety outcomes for each treatment arm and a minimum 3-month follow-up period were included. Data were appraised using the Cochrane RoB2 and ROBINS-I tools, PRISMA, and GRADE guidelines. All outcomes were collected at last follow-up. Random effects meta-analyses with 95% confidence intervals (CI) were conducted to calculate weighted mean differences (WMD) and risk ratios (RR). Change in best-corrected visual acuity (BCVA, ETDRS letters), change in central subfield thickness (CSFT, μm), and presence of retinal fluid were primary endpoints; ocular adverse events were secondary endpoints. Across 13 studies, in the context of neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO), 2226 eyes received anti-VEGF monotherapy and 3022 received faricimab. Final and change in BCVA were similar between treatment groups. Faricimab was associated with a significantly higher reduction in CSFT in DME and RVO eyes but not in nAMD eyes. The incidence of ocular adverse events were similar between groups. There was no difference in BCVA between faricimab and anti-VEGF monotherapy in nAMD, DME, and RVO. While faricimab offered superior improvement in central subfield thickness at final follow-up for DME and RVO eyes, this effect was not seen in nAMD eyes. Future studies are needed to establish the long-term safety and efficacy of faricimab for retinal vascular disease.

Analysis of risk factors and construction of nomogram model for arthroscopic single-row rivet repair

BackgroundThe factors influencing the clinical outcome of arthroscopic rotator cuff repair are not fully understood.PurposeTo explore the factors related to the postoperative outcome of arthroscopic single-row rivet rotator cuff repair in patients with rotator cuff injury and to construct the related nomogram risk prediction model.Methods207 patients with rotator cuff injury who underwent arthroscopic single-row rivet rotator cuff repair were reviewed. The differences of preoperative and postoperative Visual Analogue Score (VAS) scores and University of California, Los Angeles (UCLA) scores were analyzed and compared. The postoperative UCLA score of 29 points was taken as the critical point, and the patients were divided into good recovery group and poor recovery group, and binary logstic regression analysis was performed. According to the results of multivariate logistic regression analysis, the correlation nomogram model was constructed, and the calibration chart was used, AUC, C-index. The accuracy, discrimination and clinical value of the prediction model were evaluated by decision curve analysis. Finally, internal validation is performed using self-random sampling.ResultsThe mean follow-up time was 29.92 ± 17.20 months. There were significant differences in VAS score and UCLA score between preoperative and final follow-up (p < 0.05); multivariate regression analysis showed: Combined frozen shoulder (OR = 3.890, 95% CI: 1.544 ∼ 9.800), massive rotator cuff tear (OR = 3.809, 95%CI: 1.218 ∼ 11.908), More rivets number (OR = 2.118, 95%CI: 1.386 ∼ 3.237), lower preoperative UCLA score (OR = 0.831, 95%CI: 0.704–0.981) were adverse factors for the postoperative effect of arthroscopic rotator cuff repair. Use these factors to build a nomogram. The nomogram showed good discriminant and predictive power, with AUC of 0.849 and C-index of 0.900 (95% CI: 0.845 ∼ 0.955), and the corrected C index was as high as 0.836 in internal validation. Decision curve analysis also showed that the nomogram could be used clinically when intervention was performed at a threshold of 2%∼91%.ConclusionCombined frozen shoulders, massive rotator cuff tears, and increased number of rivets during surgery were all factors associated with poor outcome after arthroscopic rotator cuff repair, while higher preoperative UCLA scores were factors associated with good outcome after arthroscopic rotator cuff repair. This study provides clinicians with a new and relatively accurate nomogram model.

Redefining Surgical Boundaries for Obese Patients? Full Endoscopic Lumbar Discectomy Proves Equally Effective With Shorter Hospital Stay in Obese Patients.

This cohort study aims to evaluate the impact of obesity on the outcomes of full endoscopic lumbar discectomy (FELD) in patients with lumbar disc herniation. We conducted a retrospective analysis of 156 adult patients who underwent FELD for lumbar disc herniation from January 2015 to February 2023. Patients were divided into 3 groups: obese endoscopic (n = 71), obese open surgery (n = 31), and nonobese endoscopic (n = 54). Clinical outcomes were assessed using the visual analog scale for leg and back pain, the Oswestry Disability Index, and patient satisfaction rates. Operative time, hospital stay duration, and complication rates were also analyzed. No significant differences were observed in patient-reported outcome measures, operative time, or complication rates between obese and nonobese patients undergoing FELD. The mean operative time was longer in the endoscopic group compared with the open surgery group (70.2 vs 59.8 minutes), but the hospital stay was significantly shorter for endoscopic patients (1.7 vs 2.4 nights, P = 0.0006). Both obese and nonobese groups showed significant improvements in visual analog scale and Oswestry Disability Index scores at the final follow-up, with satisfaction rates of 85.7% in the endoscopic group reporting good to excellent outcomes. FELD is a viable and effective alternative to traditional open surgery for obese patients, offering comparable clinical outcomes and the added benefit of a shorter hospital stay. These findings suggest that obesity does not inherently affect surgical outcomes, underscoring the need for further research with larger sample sizes and longer follow-up periods. FELD offers a viable and effective surgical option for obese patients, with outcomes comparable to traditional surgery but with the added benefit of shorter hospital stays.

Clinical Outcomes of Full-Endoscopic Visualized Foraminoplasty and Discectomy for Lumbar Disc Herniation with Bilateral Radiculopathy.

The treatment of lumbar disc herniation (LDH) with bilateral radiculopathy using transforaminal endoscopic lumbar discectomy (TELD) remains challenging, especially at the L5/S1 level with narrow foramen or high iliac crest. Full-endoscopic visualized foraminoplasty and discectomy (FEVFD) is a newly developed technique for LDH and lumbar stenosis. However, there is limited evidence on the efficacy of FEVFD technique in the treatment of LDH with bilateral radiculopathy. This study was to assess the clinical outcomes and safety of using FEVFD in the treatment of LDH with bilateral radiculopathy. This retrospective study enrolled 63 patients with LDH presenting with bilateral radiculopathy between January 2018 and January 2022. Patients enrolled before January 2020 were treated using a conventional transforaminal endoscopic surgical system (TESSYS) technique (TESSYS, n = 33) and treated using a FEVFD technique after that (FEVFD, n = 30). The total operation time and the number of intraoperative fluoroscopies were recorded. The Oswestry Disability Index (ODI) and visual analog scale (VAS) were evaluated preoperatively and postoperatively (at 1-month, 3-month, 6-month, and final follow-ups). Global outcomes at final follow-up were assessed using modified MacNab criteria. Compared with TESSYS, patients in FEVFD group had a shorter operation time (92.9 vs. 78.0 min). The intraoperative fluoroscopies in FEVFD group were significantly lower than those in TESSYS group (18.7 vs. 4.9). After the operation, the VAS and ODI scores at all follow-ups in the two groups were significantly lower than those before operation. For the L5/S1 level, the values of VAS and ODI scores in FEVFD group were significantly lower than those of in TESSYS group at 3-month, 6-month, and final follow-up. For the L4/5 level, however, no significant difference was found in VAS and ODI scores between these two groups at the follow-ups. According to the modified MacNab criteria, the excellent-to-good rate in TESSYS and FEVFD groups was 84.8% and 90.0%, respectively. For LDH with bilateral radiculopathy, using the FEVFD technique could not only reduce the operation time and radiation, but also improve the clinical outcomes at the L5/S1 level.

Comparative study of dorsiflexion closing wedge osteotomy of the metatarsal head and osteochondral autologous transplantation for Freiberg disease treatment: A multicenter analysis

Freiberg disease (FD) is a condition characterized by osteochondrosis affecting the metatarsal heads, with the second metatarsal head being the most commonly affected. Dorsiflexion Closing Wedge Osteotomy of the Metatarsal Head (DCWMO) has been conventionally employed, whereas Osteochondral Autologous Transplantation (OAT) represents a more recent technique with restricted comparative research. This study aimed to compare the outcomes of DCWMO and OAT for treating Freiberg disease (FD). Groups were established among two institutions. Institution-1 has made the treatment with OAT (8 patients) and Institution-2 has made the treatment with DCWMO (8 patients). The primary outcomes collected, including complications, range of motion, length of the metatarsal, American-Orthopaedic-Foot-and-Ankle-Society–lesser MTP-interphalangeal (AOFAS-LMI) score, visual-analog-scale (VAS), Foot-and-Ankle-Disability (FADI) score, and Short-Form-12 (SF-12), were all compared. The Sport-FADI and activity-FADI scores at final follow-up were significantly greater in the OAT group than in the DCWMO group (94.04 vs 84.75 and 97 vs 92, P = 0.021 and P = 0.04, respectively), whereas plantarflexion at final follow-up was significantly lower in the DCWMO group than in the OAT group (43.13 vs 6.88 degrees, P < 0.001). The AOFAS-LMI score at final follow-up was significantly greater in the DCWMO group than in the OAT group (86.75 vs 75.38, P = 0.013). In conclusion, this study highlights the effectiveness of both OAT and DCWMO in treating Freiberg's disease, as evidenced by significant postoperative improvements in various functional scores, including AOFAS-LMI, VAS and FADI. Notably, OAT demonstrated favorable outcomes in SFADI and AFADI and plantarflexion ROM, while DCWMO led to improved the AOFAS-LMI score.Level of Evidence: Level 3

A Percutaneous Triple K-Wire Fixation Technique for Nascent Malunion of Proximal Interphalangeal Joint Fracture-Dislocation: A Case Series With an Assessment of Functional Outcome

Fracture-dislocations of the proximal interphalangeal (PIP) joint are difficult to manage. In the case of a 2- to 4-week delay in definitive treatment, a nascent malunion may result. This study aimed to evaluate the effectiveness of the percutaneous triple K-wire technique for treatment of the PIP joint nascent malunion. We treated 13 patients with nascent malunion of PIP joint fracture-dislocations using the percutaneous triple K-wire fixation technique based on the principle of soft callus manipulation to achieve congruity and reduction in the joint. The study included cases where the percentage of articular involvement exceeded 40% and in whom there was a minimum follow-up of 12 months. At the final follow-up, we measured the range of motion at the PIP joint. The Ishida and Ikuta scores were determined. The mean period between injury and surgery was 17.2 days. The average follow-up time was 14.2 months. The mean active arc of motion before surgery in the PIP joint was 15 degrees and that at the final follow-up was 83 degrees. Seven patients achieved excellent outcomes according to the Ishida and Ikuta scores. The final postoperative range of motion at the PIP joint was comparable with that reported in the literature for patients who underwent different procedures. This procedure can be considered a viable alternative to open reduction and plating, hemihamate arthroplasty, and ligamentotaxis with distraction, particularly in the presence of nascent malunion. Therapeutic IV.

Spontaneous Resolution of Congenital Insufficiency of the Extensor Tendon Central Slip.

The congenital insufficiency of the extensor tendon central slip of the fingers is a relatively rare condition, with only a few reported cases in pediatric patients, as described in 2 clinical series. In this study, we aimed to present the natural history of a significant number of untreated patients with this deformity. This study has received institutional review board approval, and parents provided informed consent following the Declaration of Helsinki guidelines for biomedical research involving humans. A retrospective analysis of children with this deformity, ranging from June 2008 to July 2021, was collected by 1 surgeon. The inclusion criteria included children with a supple PIP flexion deformity, characterized by MP hyperextension and PIP extension lag, which had been present since birth. Complete passive PIP extension and the absence of volar skin webbing differentiated this condition from camptodactyly. The mean age of 24 children with 57 involved digits at diagnosis was 7 months (range, 1 to 17) and the mean follow-up was 6 years to 9 months (2yr to 1mo to 13yr). Six patients had an incorrect previous diagnosis of camptodactyly.Active PIP extension recovered progressively. At the final follow-up, complete PIP extension occurred in all except 4 cases in which a residual 10° extension lag. The mean time for a complete active PIP extension was 2 years to 7 months (20mo to 3yr to 9mo). Nineteen cases (79%) showed a mild FDS contracture of the involved digits at the final follow-up.The deformity was bilateral in 15 children (62.5%) and involved only 1 finger (unilaterally or bilaterally) in 15 cases (62.5%), and 2 fingers in 6 (25%). Little and ring fingers were most commonly involved. In 7 cases, there was a family history of finger deformity. Congenital insufficiency of the extensor tendon central slip typically resolves spontaneously within the first 4 years of life. Literature suggests that splinting can expedite the correction of the deformity and thus, if possible, it can be used. In most cases, a residual, clinically insignificant FDS contracture may be present. This condition is often misdiagnosed as camptodactyly. IV.

Patient-Reported Outcome Measures After Direct Anterior Total Hip Arthroplasty Are Comparable Between Patients With Rheumatoid Arthritis and Osteoarthritis: A Propensity-Matched Analysis

Introduction: It is currently unclear whether patients with rheumatoid arthritis have similar functional outcomes after total hip arthroplasty (THA) as those with osteoarthritis, particularly given that rheumatoid arthritis may have systemic manifestations in terms of pain and function. The purpose of this study was to compare patient-reported outcome measures between patients with rheumatoid arthritis and matched control patients with osteoarthritis who underwent direct anterior THA. Methods: All patients who underwent direct anterior THA from 2010 to 2022 at a single academic institution were retrospectively reviewed. Hips with rheumatoid arthritis were propensity matched to hips with osteoarthritis on a 1:4 basis. Patient-reported outcome measures, including visual analog scale (VAS) pain at rest and with use, Hip Disability and Osteoarthritis Outcome Score Pain, and Forgotten Joint Score-12, were obtained at follow-up. In addition, modified Harris Hip Scores (mHHS) were obtained both preoperatively and at the final follow-up. Results: Forty-six hips with rheumatoid arthritis and 184 hips with osteoarthritis were followed for a mean of 6.3 ± 3.6 years. Both cohorts demonstrated notable preoperative to postoperative improvements in mHHS (P &lt; 0.001). No differences were observed at the final follow-up between cohorts for VAS at rest (0.8 vs. 0.5, P = 0.333), VAS with use (1.3 vs. 0.9, P = 0.234), Hip Disability and Osteoarthritis Outcome Score Pain (90.4 vs. 93.6, P = 0.113), Forgotten Joint Score-12 (80.3 vs. 82.8, P = 0.529), and mHHS (86.9 vs. 89.0, P = 0.335). One patient with rheumatoid arthritis had an intraoperative periprosthetic calcar fracture, whereas none underwent subsequent revision THA. Conclusion: Patients with rheumatoid arthritis and osteoarthritis who underwent direct anterior THA achieved comparable outcomes in this propensity-matched analysis. Although patients with rheumatoid arthritis may be at an increased risk of complications and revision surgery, patients can expect reduced pain and improved functional outcomes similar to those with osteoarthritis following primary THA.

Clinical outcomes of retrograde intramedullary multiple pinning for proximal humeral fractures using a modified palm tree technique

BackgroundRetrograde intramedullary multiple pinning using a modified palm tree technique for proximal humeral fractures has attracted interest from surgeons because of its minimal invasiveness into the soft tissue around the shoulder joints. We aimed to evaluate the clinical and radiological outcomes of this procedure. MethodsThis retrospective study included 21 patients who underwent surgery using a modified palm tree technique for proximal humeral fractures between March 2010 and March 2022. Patients with two- and three-part proximal humeral fractures that could be reduced by closed manipulation under general anesthesia were included in this study. All patients were clinically evaluated using the Japanese Orthopaedic Association (JOA) and University of California at Los Angeles (UCLA) shoulder scores. Postoperative radiographic findings, including fracture healing and signs of pinning-related complications, were evaluated. ResultsTwenty-one shoulders in 21 patients (9 men and 12 women) with mean age at surgery of 66.3 ± 19.3 years were evaluated. The mean period until bone union was 2.6 ± 0.7 months. The mean JOA and UCLA shoulder scores at the final follow-up were 84.8 ± 12.1 and 27.5 ± 5.4, respectively. Perforation of the humeral head by Kirschner (K) wires was observed in 9 of the 21 (42.9 %) shoulders. The JOA and UCLA shoulder scores at the final follow-up were not significantly different between the groups with and without perforations (p = 0.41 and 0.27, respectively). The oblique or Y-view detected significantly more wires with perforation of the humeral head than did the anteroposterior view (6 vs. 15 wires, p < 0.01). ConclusionsThe modified palm tree technique for proximal humeral fractures demonstrated good postoperative clinical outcomes and early fracture healing. However, modifications in postoperative management and surgical techniques should be considered to reduce the high rate of perforation of the humeral head by K-wires.

Clinical Outcomes and Long-term Survivorship After Osteochondral Autologous Transfer Combined With Valgus High Tibial Osteotomy: An Analysis After 19 Years With 56 Patients

Background: Osteochondral defects of the medial femoral condyle combined with varus malalignment in young and active patients are a debilitating condition, which can result in early osteoarthritis. Osteochondral autologous transfer (OAT) combined with valgus high tibial osteotomy (HTO) might therefore be a comprehensive solution to maintain long-term knee function. Purpose/Hypothesis: The purpose of this study was to report clinical results and survivorship after combined OAT and valgus HTO for symptomatic osteochondral defects of the medial femoral condyle in the setting of varus malalignment at a long-term follow-up. It was hypothesized that undergoing combined OAT and valgus HTO would produce favorable clinical results along with a low rate of conversion to arthroplasty. Study Design: Case series; Level of evidence, 4. Methods: All patients treated between 1998 and 2008 with combined valgus HTO and OAT for deep osteochondral defects of the medial femoral condyle and concomitant varus malalignment >2° without meniscal repair/transplantation, osteoarthritis, or ligamentous instability/reconstruction were included. The survival rates of this combined procedure were evaluated. Failure was defined as conversion to knee joint arthroplasty during the follow-up period. Patient-reported outcomes were collected pre- and postoperatively, including the Lysholm score, visual analog scale score, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale score, and subjective level of satisfaction (scale 0-10). Results: Of 74 patients who were included for 10-year follow-up, 3 had died. A total of 15 patients were lost to follow-up, so 56 patients could be reevaluated, for a follow-up rate of nearly 80%. The mean age at surgery was 38.8 ± 9.9 years (range, 19.9-62.4 years), and the mean follow-up time was 18.9 ± 3.0 years (median, 18.8 years; range, 14.1-24.8 years). The survival rates were 87% at 10 years, 86% at 15 years, and 77% at 19 years after surgery. At final follow-up, the Lysholm score showed a mean increase of 39 points (95% CI, 25.4-50.0 points; P < .001) from 40 points to 79 points, representing a significant improvement. Overall, 96% of patients surpassed the minimal clinically important difference (MCID) for the Lysholm score. The visual analog scale score decreased by a mean of 4.8 points (range, 5-10 points) from 7.5 points to 2.7 points (P < .001), and 80% of patients surpassed the MCID. The mean Tegner Activity Scale score was 4.5 ± 1.6, and the mean KOOS subscale scores at final follow-up were as follows: Pain: 81 ± 21 (range, 19-100), Symptoms: 80 ± 22 (range, 21-100), Activities of Daily Living: 85 ± 21 (range, 18-100), Sports: 68 ± 32 (range, 0-100), and Quality of Life: 67 ± 28 (range, 0-100). Overall, 78% of the patients were satisfied with the results of the operation. Conclusion: The combination of OAT and valgus HTO presents a viable treatment option for patients affected by osteochondral defects of the medial femoral condyle and concurrent varus malalignment. A sustained and substantial improvement in clinical outcomes, significantly reduced pain severity, and a high rate of long-term survivorship can be anticipated in the long-term follow-up.

Stereotactic radiosurgery for arteriovenous malformations in pediatric patients: an updated systematic review and meta-analysis.

Intracranial arteriovenous malformations are the most common cause of intracranial hemorrhages in pediatric patients. Stereotactic radiosurgery (SRS) has been used extensively to treat these lesions. The authors conducted a systematic review and meta-analysis to report treatment outcomes and long-term complications. This study follows the PRISMA and MOOSE guidelines, with the search spanning electronic databases up to February 6, 2024. The outcome measures included obliteration rate, hemorrhage in the latency period, symptomatic radiation-induced changes (RICs), cyst formation, and radiation-induced tumorigenesis. A total of 1493 patients across 24 studies were included. The pooled complete obliteration after single-fraction SRS was 64.7% (95% CI 58%-69%). The pooled post-SRS hemorrhage rate at the final follow-up was 6.2% (95% CI 5%-8%). The overall incidence rate of RIC was 31.3% (267/854 patients), and the incidence of symptomatic RIC was 8.8% (114/1289 patients). For permanent symptomatic RIC, the pooled incidence was 4.8% (62/1283 patients). At final follow-up, 17 cases of radiation-induced necrosis were documented among 654 patients (2.6%). Similarly, cyst formation was reported in 1.3% of cases (17/1265 patients) and radiation-induced tumors occurred in 0.15% of cases (2/1342 patients). SRS can be considered an effective intervention for appropriately selected pediatric patients with arteriovenous malformations. Long-term complication rates appear to be low but additional longitudinal studies are required to better define the long-term outcomes.

Surgical Treatment of Insertional Achilles Tendinopathy Augmented With Human Acellular Dermal Matrix: A Retrospective Case Series

Background: Insertional Achilles tendinopathy (IAT) is often surgically treated with Achilles tendon partial or total detachment, debridement and repair of the Achilles tendon, excision of retrocalcaneal exostosis, and suture anchor reattachment. To date, there is no report that examines the use of acellular dermal matrix (ADM) augmentation in this procedure without the use of suture anchor reattachment. Methods: Thirty-two female and 10 male patients (mean age 52 years) with IAT underwent surgical treatment including partial detachment of the Achilles tendon, excision of the retrocalcaneal exostosis, debridement and repair of the Achilles tendon, and augmentation with human acellular dermal matrix allograft. Outcomes measured were the visual analog scale (VAS) score, time to weightbearing, major and minor complications. Results: Forty-two patients were followed for a mean of 20.8 months. The VAS score improved from a mean of 5.1 to 1.9 at final follow-up. The mean time to weightbearing was 4.4 weeks. Eleven patients (26.2%) experienced complications. One patient (2.4%) suffered a rupture of the Achilles in the early postoperative period. Three patients (7.1%) had delayed wound healing, with 1 (2.4%) requiring surgical debridement. Two (4.8%) experienced continued pain requiring further surgical treatment. Conclusion: This protocol for surgical treatment of IAT with the use of human ADM allograft augmentation resulted in improved VAS scores and was associated with a low risk of postoperative infection without a prolonged nonweightbearing period. Level of Evidence: Level IV, retrospective case series.