Good Radiographic Results Research Articles

The radiographic and clinical outcomes of stemless reverse total shoulder arthroplasty: a minimum 2-year follow-up study.

The purpose of this study was to examine the radiographic and clinical outcomes of stemless reverse total shoulder arthroplasty (RTSA) after a minimum 2-year follow-up. Between July 2018 and March 2023, 50 patients underwent 50 stemless RTSA with the Lima component. Twenty-eight patients with a follow-up of more than 2 years were reviewed. The average age was 71.9 years (range, 61-85 years), and the average follow-up period was 2.2 years (range, 2.0-5.1). Bone marrow density of the proximal humerus was measured before RTSA. We evaluated preoperative and postoperative range of motion, clinical score, radiographic change, and postoperative complications. Significant increases were observed postoperatively in forward flexion (112.0º-162.5º, P<0.01) and internal rotation (from L3 to T12 level; P<0.05). No changes were observed in external rotation (from 43.0º to 45.2º; P=0.762). The clinical scores improved for Korean Shoulder Scoring system (from 64 to 93, P<0.01) and American Shoulder and Elbow Surgeons score (from 17.5 to 27.3, P<0.01). Although radiolucent lines of less than 2 mm were observed in all cases, no osteolysis and loosening of the stemless humeral component was found. In one case, the stemless humeral component pulled out at the 1-week follow-up, and a revision was implemented to replace it with a stemmed humeral component. Scapular notching was observed in 18 cases. Stemless RTSA showed good radiographic and clinical results after a minimum 2-year follow-up. Level of evidence: IV.

The Long-Term Clinical and Radiographic Outcomes of Cerclage Cable Fixation for Displaced Acetabular Fractures Using a Posterior Approach: A Retrospective Cohort Study.

Background and Objectives: Cerclage cable fixation with 2 mm multiple-braided cables for displaced acetabular fractures has shown good midterm functional and radiographic outcomes. We retrospectively evaluated the clinical and radiographic outcomes of cerclage cable fixations over ten years. Materials and Methods: We extracted data for patients who underwent cerclage cable fixation for acetabular fractures at a single institution from 2007 to 2012. We adopted this procedure for acetabulum fractures with posterior column fractures. Postoperative reduction quality, complications, reoperations, and Japanese Orthopedic Association (JOA) hip objective functional scores were analyzed. Postoperative reduction quality was classified using plain radiography and computed tomography. Results: We evaluated nine patients with a mean follow-up period of 14.1 ± 2.6 years (range: 10.8-18.1 years). The mean age was 47.1 ± 15.5 years old (range: 28-74 years); the mean injury severity score was 13.6 ± 4.7 (range: 9-22). The most frequent type of fracture was a both-column fracture. Anatomical reduction quality was achieved in five cases. Four patients had hip osteoarthritis at the last follow-up; among them, one patient had worsening hip arthritis > 5 years after surgery, and one patient developed osteoarthritis > 10 years after surgery. Their postoperative reduction quality was worse than their anatomical reduction quality, and both engaged in physical labor. None of the patients underwent revision total hip arthroplasty. The mean JOA hip score was 90.9 ± 7.9 (range: 74-100); seven patients scored >90 at the last follow-up. Conclusions: Cerclage cable fixation showed satisfactory postoperative reductions and favorable long-term clinical outcomes. Long-term follow-up might be necessary for patients whose postoperative reduction is not anatomical to detect late occurrence of hip osteoarthritis, even if osteoarthritis is not evident during short-term follow-up periods.

Straight intramedullary MultiLoc nails for displaced proximal humeral fractures: health status, radiographic results, clinical outcome, and complications

BackgroundThe treatment of the displaced proximal humerus fractures (PHF) still facing a lot of unsolved problems. The aim of this study was to evaluate the clinical effect of MultiLoc nails for the treatment of PHF and present outcomes of patients with different Neer’s classification and reduction quality.MethodsAdult patients with PHFs were recruited and treated with MultiLoc nail. Intraoperative data, radiographic and functional outcomes, as well as occurrence of postoperative complications were assessed.Results48 patients met inclusion and exclusion criteria and were included in this study. The DASH Score were 32.2 ± 3.1 points at 12 months, and 37.3 ± 2.5 points at the final follow-up. The mean ASES score at 12 months and final follow-up were 74.4 ± 6.2 and 78.8 ± 5.1, respectively. The mean CM Score in all 48 patients reached 68 ± 6.4 points at the final follow-up, relative side related CM Score 75.2 ± 7.7% of contralateral extremity. The incidence rate of complications was 20.8%. Patients with fracture mal-union, adhesive capsulitis were observed but no secondary surgeries were performed. There was no significantly difference of DASH Score 12 months after surgery and at the last follow-up among patients with different Neer’s classification or reduction quality. However, functional outcomes such as ASES score and CM score were significantly influenced by severity of fracture and the quality of fracture reduction.ConclusionsOur study demonstrated that MultiLoc nails is well suited for proximal humeral fractures, with satisfactory health status recovery, good radiographic results, positive clinical outcomes and low rates of complications. The treatment for four part PHF still faces great challenges. Accurate fracture reduction was an important factor for good functional result.

Lateral interbody fusion for adjacent segment disease: a narrative review.

Adjacent segment disease (ASD) is a late complication of lumbar fusion characterized by persistent symptoms correlating to radiographic changes in the levels immediately above or below the prior fusion. Lateral interbody fusion (LIF) through a direct lateral approach is a minimally invasive and effective surgical treatment for ASD. Biomechanically, LIF for ASD provides significantly decreased motion in multiple planes. While hardware failure and injury to the lumbar plexus are potential complications, these risks may be outweighed by decreased blood loss, shorter operating room (OR) times, and possibly superior patient reported visual analog scale (VAS) scores compared to traditional posterior spinal fusion (PSF) alone. The purpose of this review is to summarize the history, uses, outcomes, and future directions of LIF for ASD. A review of national databases (PubMed and SCOPUS) was performed using literature from 1900 to 2022. Keywords included terms "LATERAL" and "LUMBAR" and "INTERBODY" and "FUSION" and "ADJACENT" and "SEGMENT" and "DISEASE". Studies that aimed to describe the biomechanical, clinical course and complications, radiological outcomes, biomechanical aspects, need for revision surgery, and/or patient reported outcomes of the XLIF/LIF technique were included. This review includes a brief overview of the natural history of ASD and current approaches to address it. It then summarizes the main indications and utilization of LIF to address ASD, summarizing reported outcomes in regard to biomechanical, clinical, and radiographic outcomes. LIF has emerged as a minimally invasive and effective surgical treatment for ASD. This mini-review suggests that LIF provides a solid foundational biomechanical construct that has been paired with good patient-reported, clinical, and radiographic outcomes. While further research is required, current literature suggests that LIF for ASD results in fewer complications, decreased morbidity, and decreased need for subsequent surgery compared to other commonly utilized techniques.

Are osseous cyst‐like lesions in the subchondral bone of the proximal phalanx a precursor to fracture and how are they best managed?

SummaryOsseous cyst‐like lesions (OCLL) in the proximal subchondral bone of the proximal phalanx have been seen in association with fractures of the proximal phalanx and other bone abnormalities consistent with prodromal fracture pathology. There is reasonable circumstantial evidence to support that OCLL in this location can be a precursor to fracture. Repair of short incomplete sagittal fractures of the proximal phalanx with cortical bone screws placed in lag fashion has been associated with good clinical and variable radiographic outcomes. Stabilisation of OCLL by placement of a cortical screw in lag fashion appears a logical approach, but the outcome following surgery should be critically evaluated before a wider recommendation is made.

Remission definitions guiding immunosuppressive therapy in rheumatoid arthritis: which is best fitted for the purpose?

ObjectiveTo assess which definition of remission best predicts good radiographic outcome (GRO) and good functional outcome (GFO) in rheumatoid arthritis, focusing the updated American College of Rheumatology/European Alliance of Associations...

AESTHETIC AND FUNCTIONAL REHABILITATION BY ASSOCIATING INJECTION-MOLDED, IMMEDIATE-LOADED, TWO-PIECE ZIRCONIA IMPLANTS AND CERAMIC VENEERS

The present case describes the clinical and radiographic results of 24 months of two-piece injection-molded zirconia implants with immediate loading, as well as the aesthetic and functional planning performed in the anterior maxilla. Case presentation: A 36-year-old female patient was referred to a dental school due to dissatisfaction with the aesthetics of her smile and the absence of dental elements 22 and 24. Prosthetic rehabilitation of the anterior maxilla was performed, including implant-supported prosthesis with zirconia implants and ceramic veneers, using a digital workflow. The patient was followed up for 24 months, with good clinical and radiographic results. Conclusions: The aesthetic and functional rehabilitation performed in the patient's maxilla, with veneers and ceramic crowns, was successful and contributed to the patient's psychological and emotional well-being, in addition to restoring occlusal stability, through the orientation of the canine and the adequate protrusion of the anterior teeth.

Cementless reverse total shoulder arthroplasty implantation with humeral matchstick autograft augmentation: early radiographic outcomes

IntroductionHumeral-sided complications account for up to 21% of all revision Reverse Total Shoulder Arthroplasty (RTSA) surgeries.1 Stress shielding with large bulky stems can lead to proximal bone resorption per Wolff’s law, complicating further surgeries.14,28 Previously published studies suggest that lowering the metaphyseal implant fill ratio can lead to fewer adaptive radiographic changes and decreased bone resorption.25,26,29 Inspired by these studies, cementless primary RTSA implantation technique with humeral matchstick autografts was proposed to augment cementless humeral constructs, foster the use of a smaller size stem, and create primary stability of the humeral implant even in osteoporotic or in-between size medullary canals. In this study, retrospective review of this cementless RTSA technique with short term radiographic evaluation was performed. MethodsForty-six nonconsecutive patients underwent primary RTSA with a short-stem cementless prosthesis (Stryker Ascend Flex, Kalamazoo, MI, USA) augmented by matchstick bone grafting from January to July 2020. Patient demographics were recorded, and follow-up x-rays were retrospectively reviewed to assess metaphyseal fill ratios and incidence of stress shielding at minimum 1-year follow-up. Discrepancies between templated and final stem sizes were recorded, along with all intraoperative and postoperative complications. ResultsOf the 46 patients originally identified, there were 5 men and 41 women with a mean age of 71 years (SD ± 7, range 53-88). Mean templated stem size was 4 (SD ± 2, range 1-8), while mean final implant size was 2 (SD ± 1, Range 1-3). Mean fill ratios were 0.76 (SD ± 0.06, range 0.54-0.89) along the metaphysis and 0.67 (SD ± 0.09, range 0.49-0.83) along the diaphysis. There were no intraoperative humeral fractures from implantation. All patients were available for radiographic follow-up with a mean of 19 months (SD ± 8, range 12-40). There were three cases (7%) of proximal humeral stress shielding, with average fill ratios of 0.857 and 0.807 in the metaphysis and diaphysis, respectively. There were 3 patients (7%) who underwent revision surgeries for baseplate failure and periprosthetic humeral fracture. There were no cases of early humeral loosening. DiscussionMatchstick autograft humeral augmentation is a simple, promising surgical technique with low intraoperative complication rates and good short-term radiographic outcomes. When the implant fill ratio is successfully reduced, there is possible lower risk of humeral stress shielding. The authors believe this technique can help maximize implant stability in cementless shoulder arthroplasty and preserve humeral bone stock for future revision surgeries.

COMPARAÇÃO ENTRE OS MÉTODOS DE ESTABILIZAÇÃO DAS FRATURAS DIAFISÁRIAS DO FÊMUR NO ESQUELETO IMATURO, ENTRE HASTE FLEXÍVEIS E FIXADOR EXTERNO: REVISÃO SISTEMÁTICA E METANÁLISE

ABSTRACT Flexible intramedullary nailing and external fixation have become the main methods to surgically treat femur fractures in children. This study aimed to search the current literature and evaluate the clinical and radiographic results of surgical treatment by comparing these methods and investigating their associated complications. This systematic review was carried out following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) recommendations. Searches were carried out on the PubMed, Embase, and Web of Science databases. The search for journals in these databases was carried out from January 2023 to August 2023, retrieving 695 studies. This systematic review included 11 articles, which encompassed 718 patients who underwent surgical external fixation and flexible nailing. The most frequently observed complications referred to late or malunion, superficial and deep infections, skin irritation, angular deformity, and length discrepancy between lower limbs. Both methods of stabilization of pediatric femoral fractures can provide good clinical and radiographic results. However, the choice of treatment with flexible nails is certainly more valid and has greater acceptance than external fixation. Level of Evidence III, Systematic Review .

Prospective evaluation of clinical and radiographic 10-year results of Fitmore short-stem total hip arthroplasty

BackgroundShort stems were introduced into total hip arthroplasty (THA) to preserve bone stock, to transmit more load to the proximal femur, and to enable minimal invasive approaches. This study is the first long-term study (with a follow-up of 10 years) of the survival as well as the clinical and radiographic outcomes of the Fitmore hip stem, a short curved uncemented stem.MethodsIn total, 123 Fitmore hip stems were prospectively evaluated. At the final 10-year follow-up, 80 Fitmore stems (78 patients: 30 female, 48 male) were eligible for evaluation. Clinical parameters were thigh pain, EQ-5D, Harris Hip Score (HHS) and Oxford Hip Score. Radiographic parameters were cortical hypertrophy (CH), bone condensation, cortical thinning, radiolucency, reactive lines, calcar rounding, calcar resorption, subsidence and varus/valgus position.ResultsAfter 10 years, there was a survival rate of 99% (1 revision because of aseptic stem loosening). HHS had improved from 59 to 94 and Oxford Hip Score from 22 to 43. CH rate after 1 year was 69% and after 10 years 74%. In the first year, radiolucency was found in 58% and in 17.5% after 10 years. Subsidence after 1 year was 1.6 ± 1.6 mm and 5.0 ± 3.1 mm after 10 years.ConclusionsThe Fitmore hip stem showed a survival rate of 99% as well as good clinical and radiographic outcomes in the long-term follow-up of 10 years.

Equivalence of clinical and radiological outcomes in cruciate-retaining and cruciate-substituting total knee arthroplasty with medial pivot knee: A comparative study

IntroductionTotal knee arthroplasty (TKA) has been recognized as the most efficacious surgical intervention for individuals suffering from advanced arthritis; however, there is ongoing debate on the technical details of the procedure. It remains unknown whether preservation of the posterior cruciate ligament (PCL) significantly affects the mid-to long-term performance of ADVANCE® medial-pivotal (AMP) knee implants to enhance patient satisfaction. The hypothesis of this study was to investigate whether the preservation of the PCL has a substantial impact on the functional outcomes of medial pivot (MP) implants in patients undergoing TKA. Therefore, this study aimed to compare the midterm clinical and radiographic outcomes of cruciate-retaining (CR) and cruciate-substituting (CS) TKA using MP prostheses. MethodsWe included 376 consecutive patients who underwent unilateral TKA between January 2011 and April 2014. Follow-up evaluations were conducted in April 2021. After propensity score matching analysis, clinical and radiological outcomes and complication rates were compared between patients in the CR and CS groups. ResultsThe postoperative outcomes in the two groups significantly improved the preoperative conditions of the patients (all p > 0.05). The postoperative outcomes (WOMAC score, p = 0.517; KSS, p = 0.107; KSFS, p = 0.240; ROM, p = 0.795; FJS, p = 0.822) and radiographic outcomes (preoperative FTA, p = 0.997; postoperative FTA, p = 0.646; aLDFA, p = 0.094; aMPTA, p = 0.970; PTS, p = 0.243) were comparable between the two groups. The complication and revision rates between the groups were not statistically significant (p = 0.34). The Kaplan–Meier cumulative survival of patients in the CRTKA and CSTKA groups was 100 % and 98.6 %, respectively. ConclusionsThis study supports the hypothesis that when MP prostheses are used, both CR and CS procedures achieve equally good mid-to long-term clinical and radiographic outcomes and complication rates. These findings suggest that PCL preservation may not significantly affect the overall performance of MP implants in patients undergoing TKA.

Clinical outcomes of anterior tibial tendon transfer combined with supramalleolar osteotomy in stage 3b of varus ankle osteoarthritis

To investigate the clinical and radiographic results of anterior tibial tendon (ATT) transfer combined with supramalleolar osteotomy in stage 3b of varus ankle osteoarthritis. Totally 13 patients with stage 3b of varus ankle osteoarthritis who received ATT transfer combined with supramalleolar osteotomy in Beijing Tongren Hospital from January 2018 to May 2021 were recruited. There were 6 males and 7 females with a mean age of (57.8±9.3) years. The overall evaluations included the preoperatively and postoperatively radiographic alignments, visual analog scale (VAS) score, and the American Orthopaedic Foot & Ankle Society (AOFAS) clinical ankle-hindfoot scale. The mean follow-up period was (33.5±13.4) months. The tibial articular surface (TAS), talar tilt (TT), and foot and ankle offset (FAO) changed from 83.3°±2.4° to 92.8°±1.7°, 12.3°±4.5° to 7.0°±4.7°, and -7.4%±2.8% to -0.7%±2.2% after the operation, respectively (all P<0.001). The AOFAS and VAS score improved significantly at the final follow-up when compared with those before the operation (both P<0.001). It indicated that ATT transfer after supramalleolar osteotomy can achieve good clinical and radiographic results in the treatment of varus ankle arthritis in Takakura stage 3b.

Heterotopic hip ossification resection: monocentric experiences of associated factors, outcomes, and complications.

The exponential increase in total hip arthroplasty (THA) has led to acute and chronic surgery-related complications. Common chronic and local complications are represented by hip ossification (HO). The aim of our study was to assess the clinical and radiological correlates of patients undergoing surgical removal of heterotopic ossifications after THA and the possible association between HO and prosthetic joint infection. Data of 26 patients who underwent surgical removal of periprosthetic calcifications after THA from 2000 to 2022 were analyzed and compared with characteristics of 156 subjects without HO. The preoperative radiographs of patients showed a high-grade Brooker, 3 or 4, later reduced to 1 or 2 in the postoperative radiographs. Ten (38.5%) patients underwent radiotherapy prophylaxis, administered as a single dose 24h before surgery. In 19 (73%) patients, pharmacological prophylaxis with indomethacin was added in the 30 postoperative days. Only one patient who underwent radiotherapy had a recurrence, while new ossifications were found in three patients without prophylaxis (11.5%). Intraoperative cultures were performed for suspected periprosthetic infection in 8 study group patients. In logistic regression, the presence of HO was significantly and inversely associated with the ASA score (OR = 0.27, 95% CI = 0.09-0.82; P = 0.021) after adjusting. Surgical HO removal in symptomatic patients with high-grade disease produces good clinical and radiographic results. Radiotherapy was a good perioperative and preventive strategy for recurrence, also associated with NSAIDs and COX-2 inhibitors.

Pre-operative parameters influencing vertebral body tethering outcomes: patient's characteristics play an important role in determining the outcomes at a minimum of 2 years post-op.

The aim of this study is to determine preoperative predictors of good radiographic outcomes in VBT patients at a minimum 2-year follow-up. From a single-center dataset, we reviewed patients who underwent VBT from January 2014 to November 2018. Data analysis included age, gender, Risser grade and biometric data. Radiographically, maximum Cobb angle, C-DAR and apical vertebral and disc wedging were measured preop and at a minimum 2-year follow-up. Patients were divided into two cohorts following two different outcome measures: (1) vertebral growth modulation, those patients that growth modulated or corrected ≥ 5° and those who did not; and (2) Maximum Cobb angle at 2years, < and ≥ 40°. Student T and Chi2 tests were used for comparison and a multiple linear correlation test was implemented between statistically significant variables. 79 patients were recruited. 26 patients (33%) did growth modulate their spine at 2-year follow-up. These patients were significantly younger, and more skeletally immature with less height (147cm vs 155cm;p < 0.0001), weight (38kg vs. 45kg;p = 0.0009) and BMI (17 vs 18.8;p = 0.0229) as those who did not. Multiple linear regression model with these variables resulted in a moderate correlation (r2 = 0.234). 67 patients (85%) finished at a 2-year follow-up with a maximum Cobb angle < 40°. These patients were also younger and skeletally immature. We found significant differences in outcome 2 regarding the average preoperative maximum Cobb angle (48.5° ± 9.5 vs. 59.1° ± 10), average C-DAR (7 ± 1.5 vs. 8.5 ± 2.1), average apical vertebral wedging (6.5° vs. 8.3°), average vertebral/disc wedging ratio (1.5 vs. 2.4) and the average immediate postoperative Cobb angle (25° vs. 38°). These variables predicted a 36% of the variation in final Cobb angle measurement at a 2-year follow-up (r2 = 0.362). Curve severity determined by a preoperative C-DAR, preoperative Cobb angles and immediate postoperative Cobb angle are significantly related to curves < 40° at a minimum 2-year follow-up, while the potential to growth modulate the spine is more dependent on skeletal maturity, lower body weight and lower BMI. These patients' characteristics should be considered preoperatively.

Clinical and radiographic long-term outcomes of hemiarthroplasty for complex proximal humeral fractures

Hemiarthroplasty (HA) is a treatment option for complex proximal humerus fractures not suitable for conservative treatment or open reduction and internal fixation (ORIF). Long-term outcomes using a large metaphyseal volume prosthesis in the management of fractures of the proximal humerus have not been reported thus far. Between 2006 and 2010, 41 patients with a proximal humerus fracture were treated with HA (average age: 62 years: range, 38-85) at our institution. Nine patients underwent revision surgery, three patients were lost to follow-up and seven died unrelated to the index surgery. Twenty-two patients were reviewed clinically and radiographically at a mean period of 10.4 years (range, 9-13 years). Seven out of nine failures of HA occurred within the first 2 postoperative years: 2 infections and 5 greater tuberosity non-/mal-unions. The other two patients underwent revision for rotator cuff deficiency more than 5 years after initial surgery. Of those patients available for final follow-up, the implant survival rate was 71% (22 out of 31 patients). Their mean relative Constant score was 76 % (range, 49-96), the mean active elevation was 116° (range, 60-170) and the mean external rotation was 28° (range, 0-55), at the final follow-up. The majority had a good/excellent internal rotation, with 13 patients (59%) to the 12th thoracic vertebra and 7 patients (31%) to the 8th thoracic vertebra. The mean Subjective Shoulder Value was 76% (range, 40-100). Clinical outcomes did not significantly deteriorate over a period of 10 years, except for flexion (p<0.001) and internal rotation (p=0.002). Analyzing greater tuberosity healing, one patient had a non-union, 10 (45%) had a mal-union, and in 12 patients (55%) the greater tuberosity healed in an anatomical position. Patients with a displaced mal-union of the greater tuberosity did not have inferior clinical results at last follow-up. Only two patients showed glenoid erosion and in no patient stem loosening could be identified at the final follow-up. The revision rate following large metaphyseal volume HA to treat a proximal humerus fracture was 29% after 10 years postoperatively, with failure within 2 years largely related to greater tuberosity non-/mal-union and later related to rotator cuff insufficiency. Patients with a retained implant showed good clinical and radiographic long-term results, without relevant deterioration over time even when the greater tuberosity healed in a non-anatomical position.

Short-term effectiveness of INBONE TM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis

To investigate the short-term effectiveness of INBONE TM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis. The clinical and radiographic data of patients with moderate to severe varus-type ankle arthritis, who were admitted between May 2017 and November 2021 and treated with total ankle arthroplasty (TAA) using INBONE TM Ⅱ prosthesis, was retrospectively analyzed. A total of 58 patients (58 ankles) met the selection criteria and were included in the study. Among them, there were 24 males and 34 females, with an average age of 62.6 years (range, 41-85 years). According to the preoperative tibiotalar angle (TTA), the patients were divided into a moderate varus group (group A, TTA 5°-15°, n=34) and a severe varus group (group B, TTA>15°, n=24). There was no significant difference in gender, side, etiology, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle dorsiflexion, plantarflexion, and total range of motion, and tibial lateral surface angle (TLS) between the two groups ( P>0.05). Yet the patients in group A were younger than group B, the degrees of oesteoarthritis (Takakura stage) and ankle pain [visual analogue scale (VAS) score] were milder, and the TTA, talar tilt angle (TT), hindfoot alignment angle (HAA) were smaller while the tibial articular surface angle (TAS) was larger, showing significant differences ( P<0.05). The pre- and post-operative VAS score, AOFAS score, the occurrence of early and late complications, the radiographic parameters of the ankle (TTA, TAS, TT, HAA, TLS), ankle dorsiflexion, plantarflexion, and total range of motion were recorded and compared. All patients were followed up 19-72 months, with an average of 38.9 months. Compared with the preoperative data, the VAS score of all patients significantly decreased ( P<0.05); the AOFAS score, ankle dorsiflexion range of motion, and total range of motion significantly increased ( P<0.05); and the TTA, TAS, TT, HAA, and TLS significantly improved at last follow-up ( P<0.05); but there was no significant difference in plantarflexion range of motion ( P>0.05). Early complications occurred in 13 patients, and only 1 patient underwent revision surgery due to a larger size of the talar component. At last follow-up, there was no significant difference in the difference of clinical parameters before and after operation between the two groups ( P>0.05); there was a significant difference in the difference of other radiographic parameters ( P<0.05) except TLS. No significant difference in the incidence of complications between the two groups was found ( P>0.05). TAA using the INBONE TM Ⅱtotal ankle prosthesis is an effective treatment for moderate or severe varus-type ankle arthritis, and good clinical and radiographic results can be obtained. Correcting bony deformities and balancing soft tissue are the keys to successful surgery.

An Institutional Standardised Protocol for the Treatment of Acute Displaced Midshaft Clavicle Fractures (ADMCFs): Conservative or Surgical Management for Active Patients?

Background and Objectives: The treatment of acute displaced midshaft clavicle fractures (ADMCFs) is still under debate. The aim of this study was to verify the effectiveness of our institutional protocol by comparing the clinical and radiographic outcomes of two groups of patients with ADMCFs treated operatively and non-operatively. Materials and Methods: active patients with a traumatic, isolated non-pathological ADMCF with at least 1-year clinical and radiographic follow up were included. Surgical treatment was performed in the cases where the residual displacement was higher than 140% after the application of a figure-of-eight bandage (F8-B). All other cases were treated conservatively with a F8-B. A total of 134 patients were enrolled and divided into two groups: surgical and conservative groups, with 59 and 75 patients, respectively. Radiological and clinical parameters were evaluated. Results: Good clinical (Constant-Murley Score, the Quick Disability of the Arm, Shoulder and Hand score, and VAS satisfaction) and radiographic outcomes (initial and residual shortening, initial and residual displacement) were obtained for ADMCFs in both groups. Multivariate analysis showed that patients treated conservatively had better clinical outcomes compared to surgically treated patients (p &lt; 0.001). Return to sports was longer in those treated with surgery. Initial shortening was found to impact clinical outcomes as well as initial displacement. None of the patients showed signs of non-union in both groups. Conclusions: Very good mid-term clinical results can be obtained in adult patients with ADMCFs, conservatively or operatively managed, by applying our institutional treatment protocol based on objective radiographic parameters evaluated in the ER.

Image-Guided Percutaneous Multilevel Pediculosynthesis for Treatment of Contiguous Pedicle Stress Fractures: Technical Case Report

Nontraumatic pedicle fracture is uncommon, with sparsely described cases of conservative management versus surgical treatment by open fusion or percutaneous fixation. We report the case of a 60-year-old woman with nontraumatic L4 and L5 pedicle fracture who developed additional pedicle fractures at L3 while undergoing conservative management in a brace. The patient underwent percutaneous pediculosynthesis with screw fixation without fusion at L3-5 bilaterally. The treatment led to fracture healing with good radiographic result and resolution of her symptoms. A trial of conservative management is typically warranted in most cases of nontraumatic pedicle fracture, but there is risk of refractory or progressive symptoms and subsequent fracture. Minimally invasive fixation is a viable surgical option that can be used in multilevel fractures.

Management of perinatal cervical spine injury using custom-fabricated external orthoses: design considerations, narrative literature review, and experience from the Hospital for Sick Children. Illustrative cases.

Cervical spine injuries in neonates are rare and no guidelines are available to inform management. The most common etiology of neonatal cervical injury is birth-related trauma. Management strategies that are routine in older children and adults are not feasible due to the unique anatomy of neonates. Here, the authors present 3 cases of neonatal cervical spinal injury due to confirmed or suspected birth trauma, 2 of whom presented immediately after birth, while the other was diagnosed at 7 weeks of age. One child presented with neurological deficits due to spinal cord injury, while another had an underlying predisposition to bony injury, infantile malignant osteopetrosis. The children were treated with a custom-designed and manufactured full-body external orthoses with good clinical and radiographic outcomes. A narrative literature review further supplements this case series and highlights risk factors and the spectrum of birth-related spinal injuries reported to date. The current report highlights the importance of recognizing the rare occurrence of cervical spinal injury in newborns and provides pragmatic recommendations for management of these injuries. Custom orthoses provide an alternate option for neonates who cannot be fitted in halo vests and who would outgrow traditional casts.

Ulnar osteotomy and monolateral external fixator for the treatment of chronic Monteggia fractures in children: comparison between gradual and acute radial head reduction.

This study evaluated the outcomes of chronic Monteggia fractures (CMFs) treated by ulnar osteotomy and monolateral external fixator (MEF), and compare the outcome of gradual versus acute radial head reduction. Two groups of patients were identified. Group 1: gradual reduction of the radial head ( n = 13); group 2: acute reduction ( n = 6). Clinical outcome was evaluated by Kim Elbow Score, whereas radiographic outcome was assessed on plain radiographs. The effect of age, side, time from initial trauma to surgery, rate of unplanned surgery, amount of angulation and lengthening, and final outcome were evaluated. Univariate analysis was performed to identify factors associated with good radiographic outcome. Thirteen patients underwent gradual correction of the ulna. The mean duration of correction was 43.4 days (range, 21-82); the mean angulation and lengthening of the ulna were 22.8° (range, 0°-35°) and 22.2 mm (range, 12.2-40.9), respectively. Six patients underwent acute reduction intraoperatively, the mean angulation and lengthening of the ulna were 17.2° (range, 4°-33.9°) and 5.2 mm (range, 2.5-12.2), respectively. CMF treated by ulnar osteotomy and gradual distraction had better radiological outcome (Group 1; 92.3% 12/13) than those treated by acute reduction of the radial head (Group 2; 3/6, 50%) ( P = 0.071). Reoperation rate was found to be significantly correlated with a fair or poor radiographic results ( P = 0.016). Good clinical and radiological outcomes should be expected in CMF patients treated by gradual lengthening and angulation of the ulna with a MEF.