Higher Rate Of Heterotopic Ossification Research Articles

Antegrade vs Retrograde Intra-Medullary Nailing in Femoral Shaft Fractures: A Systematic Review and Meta-Analysis.

Femoral shaft fractures are one of the most prevalent fractures found in clinical practice. Numerous operative and non-operative options are readily available for the treatment of such fractures with intra-medullary nailing being the gold standard. To date, no consensus has been reached favoring one approach over the other. Thus, this meta-analysis aims to compare the outcomes between an antegrade and retrograde intra-medullary nailing for the treatment of femoral shaft fractures. PubMed, Cochrane, Google Scholar (page 1-20), and Embase were searched till January 2024. The clinical outcomes evaluated were the incidence of adverse events, reoperations, hip and knee pain, and surgery-related parameters. Higher rates of hip pain, and heterotopic ossification (p=0.0003, and p=0.0002 respectively) was observed with antegrade nailing. However, a higher rate of knee pain (p=0.02) was appreciated in retrograde nailing. There was no statistically significant difference in the remaining analyzed outcomes such as operative time, reoperation rate or other complications. Despite a higher rate of heterotopic ossification using the antegrade nailing technique, both the antegrade and retrograde nailing techniques yield overall similar outcomes. Therefore, the decision to choose one or the other should be based on patient-related factors, and the surgeon's experience and preference.

Complications of Early Versus Delayed Total Elbow Arthroplasty for the Treatment of Distal Humerus Fractures

The purpose of this study was to compare the rates of wound complications and heterotopic ossification (HO) between patients who underwent acute total elbow arthroplasty (TEA) and those who underwent delayed TEA performed for the treatment of distal humerus fractures. Our hypothesis was that delayed surgery will have fewer wound complications but a higher rate of HO. We retrospectively reviewed 104 patients who had undergone TEA performed at 1 of 3 institutions following a distal humerus fracture. The acute cohort, comprising 69 patients, underwent TEA within 2 weeks; the delayed cohort, comprising 35 patients, received treatment between 2 weeks and 6 months. The rates of wound complications, HO, clinically relevant HO (requiring excision or resulting in loss of functional range of motion), and reoperation were recorded. These patients were followed up for an average of 52 (interquartile range, 18.5-117) weeks. Wound complications occurred in 10 patients (14.5%) in the early group and 7 (20.0%) in the delayed group. The overall rate of HO was 56.7% (59 patients). The rate of clinically relevant HO was 26.0% (27 patients), which was similar between the groups. Reoperation occurred in 20 patients (19.2%), which was similar between the groups. In the early group, 3 reoperations were performed for wound complications and 4 for HO. No patients required reoperation for these indications in the delayed group. The mean flexion-extension and supination-pronation arcs were 20°-130° and 80°-80°, respectively, which were similar between the groups. Rheumatoid arthritis and younger age were associated with increased odds of wound complications and reoperation. The rates of reoperation, wound complications, and HO were overall higher than those previously reported; however, the study was underpowered to determine a difference between early and delayed treatment. Therapeutic IV.

ДИАГНОСТИКА И ЛЕЧЕНИЕ СВЕЖИХ РАЗРЫВОВ ДИСТАЛЬ-НОГО СУХОЖИЛИЯ ДВУГЛАВОЙ МЫШЦЫ ПЛЕЧА

Distal biceps ruptures occur mostly in 40–60 y. o. men during rapid elbow flexion against significant external force. Clinical examination remains the mainstay of the diagnostics of the distal biceps tendon rupture (“Popeye” deformity, ecchymosis, and hook-test), ultra-sound and MR investigations may be used in doubtful cases. Non-operative treatment leads to the decrease of flexion and external rota-tion forces, thus surgical treatment is preferable in most cases. The choice of surgical approach depends on the fixation method. Transos-seous fixation with bone tunnels and two-incision technique is valid and pro-vides low level of re-ruptures with more anatomic restoration of the insertion point, but is associated with higher rate of heterotopic ossification. Newer methods of fixation (buttons, anchors, interferential screws) may allow the sin-gle approach, but not always provide anatomic reinsertion and may lead to higher rate of complications at the site of surgical approach in the elbow crease. Functional post-operative care in majority of cases leads to the restoration of range of movements at 6 weeks, and muscle forces at 12 weeks. This usually allows full restoration of the physical activity at 3 to 6 months after the sur-gery.

Outcomes of Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head Following Surgical Treatment of Brain Tumors.

Corticosteroids have been widely used in patients with brain tumors to reduce tumor-associated edema and neurological deficits. This study examined the outcomes of total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) following brain tumor surgery. We identified 34 THAs performed in 26 patients with steroid-induced ONFH among 9254 patients undergoing surgical treatment for primary brain tumors. After propensity score matching with demographics, 68 THAs (52 patients) in ONFH unrelated to brain tumors were selected as the control group. At the time of THA, 54% of brain tumor patients had neurological sequelae and 46% had adrenal insufficiency. After THA, patients with brain tumor required longer hospital stay, reported a lower functional score, and showed a higher rate of heterotopic ossification compared to the control group. However, hip pain score improved significantly after THA in the brain tumor group, and did not differ from that of the control group (P-value = 0.168). Major complication rates were similar (2.9% and 1.5% for the brain tumor and control groups, respectively; P-value = 1.000), and implant survivorships were not different at 7 years (100% and 98.1% for the brain tumor and control groups, respectively; P-value = 0.455). Our findings suggest that THA can be safely performed to reduce hip pain in patients with steroid-induced ONFH after surgical treatment of primary brain tumors.

The Mobi-C cervical disc for one-level and two-level cervical disc replacement: a review of the literature.

BackgroundCervical disc arthroplasty (CDA) is a novel motion-preserving procedure that is an alternative to fusion. The Mobi-C disc prosthesis, one of many Food and Drug Administration (FDA)-approved devices for CDA, is the only FDA-approved prosthesis for two-level CDA. Hence, it may allow for improved outcomes compared with multilevel fusion procedures.PurposeTo critically assess the available literature on CDA with the Mobi-C prosthesis, with a focus on two-level CDA.MethodsAll clinical articles involving the Mobi-C disc prosthesis for CDA through September 1, 2014 were identified on Medline. Any paper that presented Mobi-C CDA clinical results was included. Study design, sample size, length of follow-up, use of statistical analysis, quality of life outcome scores, conflict of interest, and complications were recorded.ResultsFifteen studies were included that investigated Mobi-C CDA, only one of which was a level Ib randomized control trial. All studies included showed non-inferiority of one-level Mobi-C CDA to one-level anterior cervical discectomy and fusion (ACDF). Only one study analyzed outcomes of one-level versus two-level Mobi-C CDA, and only one study analyzed two-level Mobi-C CDA versus two-level ACDF. In comparison with other cervical disc prostheses, the Mobi-C prosthesis is associated with higher rates of heterotopic ossification (HO). Studies with conflicts of interest reported lower rates of HO. Adjacent segment degeneration or disease, along with other complications, were not assessed in most studies.ConclusionOne-level Mobi-C CDA is non-inferior, but not superior, to one-level ACDF for patients with cervical degenerative disc disease. The Mobi-C CDA procedure is associated with high rates of HO. Two-level Mobi-C CDA may be superior to two-level ACDF. However, insufficient evidence exists, thereby mandating a need for unbiased, well-designed prospective studies with well-defined outcomes in the future.

Cervical Motion Preservation Surgery: Why Sometimes Failed? A Biomechanical Point of View

In the 2012 a literature review was done about the results of the total disk replacement in terms of wear and durability; this review showed that the materials of the prosthesis and biomechanical tests in vitro give very good results in terms of motility predictable for 50 years, but no study was performed in terms of which grade of involvement the artificial motion gives to the remaining structures of the vertebral segment [8]. Kim et al. [9] hypothesized that the prosthesis can influence the biomechanical sagittal alignment of the cervical spine. Other studies have shown that there is a higher rate of heterotopic ossification in multilevel systems than in single-level, hypothesizing that this is a result of a high grade degeneration of the metameres involved [10].

Multilevel Arthroplasty for Cervical Spondylosis

Retrospective cohort study. To investigate the differences between single- and multilevel degenerative disc diseases (DDDs) treated with cervical arthroplasty. The US Food and Drug Administration clinical trials compared arthroplasty with anterior cervical discectomy and fusion for single-level DDD. However, cervical arthroplasty for multilevel DDD is rarely addressed in the literature. A total of 102 consecutive patients who underwent Bryan arthroplasty were divided into either a single- or multilevel group. Clinical outcomes were measured by the visual analogue scale (VAS) of neck and arm, and by the neck disability index with a minimum follow-up of 25 months. Every patient had radiographical evaluations, and computed tomography. Eighty-six patients (84.3%) completed the follow-up with a mean time of 38.3 ± 8.7 months. Postoperatively, there were significant improvements in clinical outcomes (i.e., VAS neck, VAS arm, and neck disability index) at each time point of evaluation (i.e., 3-, 6-, 12-, and 24 mo postoperation). The sex composition and clinical outcome improvements between the single- and multilevel groups were not significantly different. The multilevel group was older (51.3 ± 8.6 vs. 46.3 ± 11.2 yr; P = 0.02), had more intraoperative blood loss (218.0 ± 182.4 vs. 102.8 ± 79.2 mL; P = 0.001), and demonstrated a higher rate of heterotopic ossification (HO) than the single-level group (66.0% vs. 25.0%; P < 0.001). The majority (97.7%) of the artificial discs in this series remained mobile despite HO. Clinical outcomes of cervical arthroplasty in multilevel spondylosis are similar to single-level outcomes. However, the significantly higher rate of HO found in multilevel arthroplasty and its long-term effect warrant further investigation.

Does a Plastic Drape Reduce Incidence of Heterotopic Ossification After Hip Resurfacing?

High rates of heterotopic ossification have been associated with hip resurfacing as compared to THA. Bone debris from femoral head reamings is cited as one of the risk factors linked to increased rates of heterotopic ossification. We therefore asked whether (1) the incidence of heterotopic ossification differed with and without the use of a plastic drape used to collect bone debris and (2) any of a number of variables (age, gender, diagnosis, previous hip surgery, operative time, and blood loss) related to the occurrence of HO. We retrospectively reviewed 136 hip resurfacings performed using one of two techniques: Group 1 contained 64 hip resurfacings performed using a sterile drape around the femoral neck while reaming the femoral head to collect bone debris; Group 2 contained 72 hip resurfacings carried out with manually removing bone debris and utilizing a pulse lavage. Data were collected with respect to diagnosis, gender, previous surgery, postoperative complications, operative time, and blood loss to rule out confounding variables. The amount of heterotopic ossification was measured radiographically in hips after undergoing resurfacing arthroplasty. The minimum followup was 6 months (mean, 15 months; range, 6-27 months). No patient had heterotopic ossification of clinical importance and none had resection of the heterotopic ossification. Group 1 had a lower overall incidence of minor heterotopic ossification (32%) than Group 2 (58%). Risk factors linked to heterotopic ossification include male gender and operative time. The use of a plastic drape to collect bone debris from femoral head reamings decreased the incidence of heterotopic ossification in resurfacing arthroplasty of the hip.