Operative Treatment Research Articles

Repair of Full-Thickness Gluteus Maximus Tear With Suture Anchors

Gluteal tendon tears are a common cause of hip pain. Most commonly, tears occur in the gluteus medius and minimus, and there are well-established nonoperative or operative treatment pathways. In this Technical Note, we describe our technique for repair of a full-thickness gluteus maximus tendon tear using anchor fixation.

Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis.

Lisfranc fracture-dislocation is an uncommon but serious injury that currently lacks universal consensus on optimal operative treatment. Two common fixation methods are open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The objective of this study is to analyze the cost difference between ORIF and PA of Lisfranc injuries, along with the contribution of medical services to overall costs. This was a retrospective cost analysis of the MarketScan database from 2010 to 2020. MarketScan is an insurance and commercial claims database that integrates deidentified patient information. It captures person-specific clinical utilization, expenditures, and enrollment across inpatient and outpatient services. Patients undergoing primary ORIF (CPT code 28615) vs PA (28730 and 28740) for Lisfranc fracture-dislocation were identified. The primary independent variable was ORIF vs PA of Lisfranc injury. Total costs due to operative management was the primary objective. The utilization of and costs contributed by medical services was a secondary outcome. From 2010 to 2020, a total of 7268 patients underwent operative management of Lisfranc injuries, with 5689 (78.3%) ORIF and 1579 (21.7%) PA. PA was independently associated with increased net and total payment and coinsurance, clinic visits, and imaging, and patients attended significantly more PT sessions. Using this large database that does not characterize severity or extent of injury, we found that treatment of Lisfranc fracture-dislocation with ORIF was associated with substantially lower initial episode of treatment costs compared with PA. Specific excessive cost drivers for PA were clinic visits, PT sessions, and imaging. Level III, retrospective cohort study.

A Major Orthopaedic Surgery in a Hundred-year-old Patient During Pandemic of COVID 19: A Case Report

It has been undoubtedly assumed that COVID-19 imposes an immense economical and psychological trauma to all common people. It is also true that COVID-19 had been appeared like a “world war” for health care workers all over the world. However, either conservative or operative treatment were offered for all trauma patients even during that period. We report a 100 years old female patient with femoral shaft fracture who was treated with intramedullary interlocking nail with full precautions to prevent virus transmission during lock down period. The post and perioperative complications were uneventful, and she was walking comfortably after surgery. Keywords: COVID 19; Femoral fracture; Lock down; Pandemic

Therapeutic Prediction of Osteoporotic Vertebral Compression Fracture Using the AO Spine-DGOU Osteoporotic Fracture Classification and Classification-Based Score: A Single-Center Retrospective Observational Study.

The treatment of osteoporotic vertebral compression fractures (OVCFs) is based on their severity; however, an efficient prediction tool is lacking. We aimed to evaluate the validity of the osteoporotic fracture classification (OF classification) and scoring system (OF score) in predicting the treatment strategy for patients with OVCF, defined according to the Japanese criteria. We retrospectively investigated 487 consecutive patients diagnosed with vertebral body fractures between January 2018 and December 2022. Only patients with their fresh vertebral fracture episode during the study period were included. Patients were classified into 3 groups: conservative treatment, balloon kyphoplasty (BKP), and open surgery. OF classification and OF scores were assessed for each patient. A total of 237 patients with OVCF were included. There were 127, 81, and 29 patients in the conservative, BKP, and open surgery groups, respectively. The OF score was significantly higher in the BKP and open surgery groups than in the conservative group (p < 0.001). Multivariate logistic regression analysis showed that antiosteoporotic drug use, OF classification, progressive deformity, neurological symptoms and mobilization were independent risk factors for operative treatment (all p < 0.001). Receiver operating characteristic analysis showed that the cutoff OF score for operative indication was 5.5, with a sensitivity of 91.9%, specificity of 56.5%, and area under the curve of 0.820 (95% confidence interval, 0.769-0.871). The OF score identified patients who required operative treatment with a high degree of accuracy. This is especially important for ruling out patients who definitely require operative treatment.

The Salter-Harris Type I Femur Fractur Depending on Dystocia in A Newborn Lamb

In this case report, it is aimed to inform about the results of operative treatment of Salter-Harris Type I fracture in the left femur condylar, due to dystocia in a lamb, using intramedullary pin.&#x0D; In the clinical examination of a 2 days old Akkaraman breed male lamb, which was brought with a complaint of lameness, was found unable to use left leg, only able to walk on 3 legs. When the palpation performed, a closed fracture was discovered in the left femur. Radiologic examination revealed a Salter-Harris Type I fracture in the left femur condyle.&#x0D; Under general anesthesia, Osteosynthesis was performed with intramedullary Steinmann pin to provide reduction of the fracture. On the postoperative PVC splint guided bandage was applied to the extremity. At postoperative 15 day intervals, clinical and radiological examinations were performed. On the 45th day of the controls, it was observed that the lamb was comfortably use the extremity and there was no problem in its walk.

Early history of posterior malleolus fractures in ankle fractures.

No comprehensive treatise on the early history of fractures of posterior malleolus (PM) has yet been published, and many substantial discoveries have fallen into oblivion-particularly if not having been published in English originally. Literature search was performed in original publications and historical sources. Early history of PM fractures from their first description up to the beginnings of their operative treatment may be divided into three basic periods, covering the era between 1828 and 1940. In the pre-radiological period (1828-1895), description of PM injuries was based merely on the autopsy findings in deceased patients. The first mentions of this injury were published by the British authors. In the radiologic period (1899-1916), the x-ray examination started a revolution also in diagnostics of ankle fractures, with the first radiographs performed as early as in 1899. Radiographic examination had subsequently become an integral part of the diagnostics of these injuries and initiated a number of significant studies of PM fractures. The first detailed mention of a PM injury may be found in the French and German literature. The period of early operative treatment (1918-1940), i.e., open reduction and internal fixation of PM, was started by the younger post-WWI generation, primarily the French surgeons, represented by Gaston Picot. His operative technique and the first six cases treated operatively between 1918 and 1921 were described in 1921 by Edouard Huc. Picot himself published his technique in great detail in 1923. The early history of diagnostics and treatment of PM fractures witnesses the remarkable body of knowledge gathered about that topic by numerous visionary surgeons predominantly French and German surgeons immediately before and after World War I. They substantially contributed to the radiological examination and operative treatment of this injury.

Comparison of the radiographic and functional outcome in pediatric orthopaedic patients with Gartland type II supracondylar fracture treated by operative versus non operative management

Background: The non-operative method of closed reduction and application of long arm posterior splint and the operative method of closed reduction and percutaneous pinning are both putative management for Gartland II supracondylar fracture. The purpose of this study is to compare which method is superior in the management of this type of fracture thru the comparison of the radiographic as well as the functional outcome. Methods: This study includes 51 pediatric patients undergoing supracondylar fracture treatment. The enrolled participants were randomly allocated to one of the two groups to receive either non operative or operative treatment. Radiographic and functional outcome was assessed post treatment. Results: The operative group exhibited significant superiority versus the non operative group as reflected by the results of the post-treatment radiographs utilizing the anterior humeral line while the Baumann’s angle showed no significant difference between the two groups. Moreover, the operative group demonstrated a better Mayo elbow performance score total per follow up, only in the first 3 months but showed no significant difference thereafter. Conclusions: We therefore conclude that non operative and operative management are both effective treatment for Gartland II supracondylar fracture. The operative group showed significant superiority with results of the anterior humeral line falling mostly at the central one-third of the capitellum. The operative group manifested a better Mayo elbow performance score total only during the first 3 months of follow up.

The Impact of Operative Correction of Equinus in Cerebral Palsy on Gait Patterns.

This study aimed to evaluate gait outcomes and strength following the surgical correction of equinus in cerebral palsy (CP) based on different surgical procedures. We included the Baumann and Strayer procedures, as well as the Achilles tendon lengthening (ATL). A retrospective analysis was performed in patients with infantile, bilateral CP who received instrumental 3D gait analysis before and after surgical correction (18.66 months postoperatively). Patients were divided into 3 groups: Strayer surgery, Baumann surgery, and ATL. Gait performance and muscle strengths were compared between studied surgeries. A total population of 204 patients (15.43 years) with 341 operated lower limbs (LLs) was analyzed. Dorsiflexion in swing and stance phases significantly improved in all groups postoperatively. The Strayer and the ATL group showed higher postoperative dorsiflexion than the Baumann group. However, no loss of strength was observed with the Baumann method. Maximum power improved in this group postoperatively. An 8.2% loss in calf muscle strength was recorded in the Strayer group. Operative pes equinus treatment successfully improved the gait of children and adults with CP postoperatively. There were differences in postoperative results between studied operative techniques regarding range of motion and power. Level III, retrospective cohort study.

Diagnosis and Treatment of Athletic Pubalgia

Athletic palagia, frequently termed as sports hernia or core muscle injury, is a prevailing cause of groin discomfort in athletes. Originating from potentially multifaceted interactions in the anterior pelvic region, its diagnosis is convoluted, owing to overlapping symptoms with other conditions and the absence of definitive diagnostic tools. Treatment approaches oscillate between conservative and operative modalities. Conservative treatment typically constitutes rest, physical therapy, and medication, while operative treatment comprises techniques like open, laparoscopic, and endoscopic repairs. Efficacy of treatments can significantly be modulated by personalized rehabilitation protocols. Recent studies indicate that while both treatments can be effective, surgery might facilitate a marginally quicker return to sports. Continued research aims at refining the understanding of athletic palagia, its treatment, and rehabilitation, underscoring the need for standardized measures, randomized trials, exploration of etiological factors, and enhanced preventative strategies. This paper provides an exhaustive overview of current methods, challenges, and prospective avenues in athletic palagia management.

Оніхокриптоз у дітей: огляд літератури та узагальнення досвіду лікування на базі клініки дитячої хірургії Вінницького національного медичного університету імені М.І. Пирогова

Onychocryptosis in children is a medico-social problem, since the suffering associated with this pathology affects the general state of health and the formation of children's psyche, which significantly worsens the quality of life in pediatric practice. Purpose - to highlight the problem of treatment of an ingrown toenail in children to determine the optimal therapeutic and diagnostic tactics. The article analyzes the possible causes and risk factors of ingrown toenails, describes the symptoms of this disease. The experience of treating onychocryptosis in children is considered, namely, the methods of surgical intervention, taking into account the frequency of relapses, treatment terms, levels of trauma, and cosmetic results. The work summarizes the experience of treating 167 patients with onychocryptosis who were treated in the pediatric surgery clinic of the National Pirogov memorial Medical University from 2011 to 2020. A clinical case of operative treatment of onychocryptosis using the Schmiden method is demonstrated. Conclusions. The appearance of an ingrown toenail in children is explained by various congenital and acquired causes. Onychocryptosis occurs mainly in adolescence. The choice of the method of surgical treatment depends on the severity of local pathological changes and the presence of complications, the frequency of relapses, and the duration of treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Омфалоцеле - щодо тактики ведення та лікування

An omphalocele is an abdominal defect covered by a membranous sac consisting of three layers: peritoneum, jelly of the ventricle and amnion as the outer layer. The vessels of the umbilical cord flow into the top of the pouch, which usually contains the herniated abdominal contents: intestines, liver, spleen, bladder and/or gonads. The pouch covers and protects the herniated organs from harmful external influences. Purpose - to improve care for patients with omphalocele, improve their life quality by updating treatment standards using the experience of other countries around the world. A literature review is provided and personal experience is highlighted - 2 clinical cases with a diagnosis of omphalocele. Both underwent operative treatment. All children recovered and were discharged from the clinic. Depending on the clinical manifestations, the size of the defect and the content of the hernia sac, the term and tactics of treatment differ. Conclusions. The discussion about the tactics of omphalocele treatment depending on the size is still relevant. Clinical recommendations for the management of omphalocele remain only recommendations, and in each individual case, the decision regarding the terms and methods of treatment remains with the surgeon. It is necessary to remember the possibility of entrapment, which forces the surgeon to perform urgent surgical intervention. No conflict of interests was declared by the authors.

The Rough with the Smooth of the Light Cone String

The polynomials in the generators of a unitary representation of the Poincaré group constitute an algebra which maps the dense subspace D\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\mathcal D$$\\end{document} of smooth, rapidly decreasing wavefunctions to itself. This mathematical result is highly welcome to physicists, who previously just assumed their algebraic treatment of unbounded operators be justified. The smoothness, however, has the side effect that a rough operator R, which does not map a dense subspace of D\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\mathcal D$$\\end{document} to itself, has to be shown to allow for some other dense domain which is mapped to itself both by R and all generators. Otherwise their algebraic product, their concatenation, is not defined. Canonical quantization of the light cone string postulates operators -iX1\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$-\ extrm{i}X^1$$\\end{document} and P-=(P0-Pz)/2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P^-=(P^0 - P^z)/2$$\\end{document} and as their commutator the multiplicative operator R=P1/(P0+Pz)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$R=P^1/(P^0 + P^z)$$\\end{document}. This is not smooth but rough on the negative z-\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$z-$$\\end{document}axis of massless momentum. Using only the commutation relations of Pm\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P^m$$\\end{document} with the generators -iMiz\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$-\ extrm{i}M_{iz}$$\\end{document} of rotations in the Pi\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P^i$$\\end{document}-Pz\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P^{z}$$\\end{document}-plane we show that on massless states the operator R is inconsistent with a unitary representation of SO(D-1)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$(D-1)$$\\end{document}. This makes the algebraic determination of the critical dimension, D=26\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$D=26$$\\end{document}, of the bosonic string meaningless: if the massless states of the light cone string admit R then they do not admit a unitary representation of the subgroup SO(D-1)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$(D-1)$$\\end{document} of the Poincaré group. With analogous arguments we show: Massless multiplets are inconsistent with a translation group of the spatial momentum which is generated by a self-adjoint spatial position operator X\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ extbf{X}$$\\end{document}.

Comparative assessment of methods of the operative treatment of facial nerve damage caused during cerebellopontine angle neurinoma and meningioma removals

The aim of this research paper is to point out the preconditions for facial nerve damage during CPA tumour removals and, in such cases, the appropriate choice of reconstructive surgery. Materials and methods. In Uzhhorod National University, during the period of 2008 to 2019, surgical treatment of 212 patients with neurinomas and meningiomas of the CPA has been carried out. We have analyzed the cases of 35 (16.5%) patients with intraoperative damage of the facial nerve. The mentioned 35 patients underwent appropriate clinical examinations during the post-operative period, which confirmed the facial nerve damage to one degree or another according to the House-Brackmann scale. The clinical signs manifested as full eyelid contact with slight effort and slight facial asymmetry during maximal effortful laughter. Slight synkinesias were noticeable, and there were no contractures until the expression of clinical signs corresponding to grade 6 - total nerve paralysis in 5 patients. Results. The research demonstrated that patients with neurinomas larger than 3 cm in size are 5 times more likely to undergo intraoperative damage to the facial nerve than patients with the same tumour but 3 cm or less in size and 5 times more likely than patients with meningiomas as a whole. In the group of patients aged 20-40, there were twice as many men; in the group aged 40-50, women predominated; among patients older than 50, there were equal numbers of men and women. Remote catamnesis was traced in 19 patients, and contact with the rest of the patients was lost due to the war. Among the interviewed patients, 58% of the anastomosis was performed in the first 3 months after the initial surgery, 21% - in 4-6 months, and 21% - in more than 12 months. The optimal timing of reinnervation after the initial surgery is the first 6 months after tumour removal. Сonclusions. Nerve damage is more common during the removal of neurinomas 4cm or bigger in size. Reinnervation is accomplished by anastomosing the central end of the hypoglossal or accessory nerves to the peripheral end of the facial nerve, and both procedures are equally effective. Reinnervation should be performed 2 to 3 months after confirming nerve injury, but no later than 6 months.

Jones Fracture in the National Football League.

Background: Jones fracture, or proximal fifth metatarsal fracture, is a common injury in National Football League (NFL)-caliber athletes. Combine draft performance can greatly impact the long-term success of these athletes, and substantial emphasis has been placed on early return to play (RTP) and the minimization of post-operative complications after Jones fracture in these athletes. To date, no study has specifically described the treatment and outcomes of this injury specifically in NFL-caliber players, considering factors relevant to this unique population. Thus, the purpose of this review is to delve into Jones fracture in NFL-caliber athletes, evaluating the diagnostic, treatment, and RTP considerations. Methods: We searched Medline (PubMed), Embase (Elsevier), Scopus (Elsevier), and SPORTDiscus (EBSCOhost) for the concept of Jones fractures in the NFL. Using the PRISMA guidelines, a team of three reviewers conducted abstract screenings, full-text screenings, and the extraction of studies describing Jones fractures specifically in the NFL. Results: Of the 1911 studies identified, 6 primary retrospective studies met the inclusion and exclusion criteria. The heterogeneity of the outcome reporting precluded a meta-analysis; thus, a qualitative review of manuscripts describing Jones fracture was carried out. Classification, diagnosis, and treatment considerations, RTP statistics and outcomes, and complications were discussed. Amongst the primary studies, there were 285 Jones fractures, all athletes were able to RTP, and the average time to RTP ranged from 6 weeks to 27 weeks. For complications, with operative treatment, the refracture rate ranged from 4 to 12%, and incomplete healing ranged from 7 to 50%. RTP was 15 weeks for refractures. There were no patient-reported outcomes. Conclusions: The vast majority of Zone 2/3 Jones fractures are treated with IM screw fixation with or without adjunctive orthobiologics, such as bone marrow aspirate concentrate, in NFL-caliber athletes. The six major series investigating outcomes after the operative treatment of Jones fractures in NFL players reveal very positive findings overall with regard to RTP, reoperation, and career continuation.

SURGICAL TREATMENT OF PATIENTS WITH OSTEOARTHRITIS OF THE KNEE JOINTS

Introduction. Osteoarthritis affects 7 % of the world’s population. The number of affected people worldwide increased by 48 % from 1990 to 2019. At the initial stages of knee osteoarthritis treatment, conservative treatment and corrective osteotomies are used. Corrective osteotomies in the area of the knee joint have shown excellent results for the treatment of limited arthrosis with a predominant lesion of the medial part of the joint in relatively young patients. However, despite the good results reported in the literature, patient satisfaction usually deteriorates over time, and some inevitably require further treatment with total knee arthroplasty in cases of progression of osteoarthritis.&#x0D; The aim of the study. On the basis of a retrospective analysis of surgical treatment of patients with osteoarthritis of the knee joints, justify the differentiated use of surgical interventions.&#x0D; Materials and methods. The article considers a differentiated approach to peri-articular osteotomies and primary endoprosthesis in gonarthrosis, in particular, in the focus of the endoprosthesis selection algorithm, based on related factors, such as the stage of the disease, the patient’s age, and the presence of concomitant complications, including the presence or absence of aseptic necrosis, contractures, instability ligamentous apparatus and defects of the condyles of the tibial bone. 391 knee joints were operated on in 383 patients.&#x0D; Results. In general, good results were obtained in 65 % (210 people) of endoprosthetics. The patients felt well, did not feel pain, did not limp, the range of motion was restored within normal limits, there was no deformation of the joint, the axis of the limb was correct, the joint was stable. Satisfactory results were obtained in 35 % (114 people), the patients felt well, did not feel pain, moderate lameness remained, range of motion was limited to no more than 800, there was no joint deformation, the axis of the limb was correct, the joint was stable. No unsatisfactory results were obtained.&#x0D; Conclusions. The developed differentiated approach to operative treatment of patients with osteoarthritis of the knee joints allowed to obtain 65 % good and 35 % satisfactory results.&#x0D; The prospect of further development in this direction continues due to the improvement of the design of endoprostheses and the technique of surgical intervention

Operative Treatment of Patients with Fractures During COVID-19

Introduction: The objective of this work was to evaluate the clinical and radiological results; and the quality of life of patients with THA at final follow-up. Patients and Method: This was a prospective, multicenter, multi-operator study, which was carried out in patients with THA, between January 1, 2014 and December 31, 2022. The clinical evaluation was carried out with the PMA, Devane and WOMAC activity scores. Radiologically, the analysis focused on the inclination of the cup, the peri-prosthetic lines and the bony integration of the implants. Results: 85 patients were re-evaluated out of 145; 60 were lost to follow-up including 16 due to death, the average follow-up was 5.85 years. The average age was 51.81 years (39-85). The functional scores were generally satisfactory at the last follow-up with a mean PMA, Devane and WOMAC score of 15.8 respectively; 2 and 76.54 and a rate of resumption of sexual intercourse after THA of 54.11%. The mechanical complications were: 8 revisions for prosthetic loosening, 4 wear and osteolysis, 02 periprosthetic margins. The patients were much more optimistic than the surgeon: 94.73% of the patients judged their results to be excellent or good while the surgeon only accepted 85.96%. Conclusion: Degenerative hip joint pathologies seem to be increasing due to the incidence of complications of sickle cell disease. The need for joint replacement is growing despite the still expensive cost. At the last follow-up, the overall results are satisfactory and a rate of resumption of sexual intercourse after THA of 54.11%. Chronic pain and muscle atrophy have had a significant impact on quality of life and sexual activity. Our study confirms the medium-term reliability of dual mobility with a survival rate of 90.60%. These results must be tempered because of the occurrence of long-term complications, linked to the risk of dual mobility in young subjects.

Operative versus non-operative treatment of extra-articular distal humeral shaft fractures: a retrospective comparative study evaluating clinical and radiological outcomes.

There is limited evidence for comparing operative and non-operative management of closed, extra-articular distal humeral shaft fractures. This study aims to evaluate these outcomes. A comparative retrospective study was performed for patients who underwent either operative fixation or conservative management with a humeral brace, with clinical and radiological outcomes at minimum 2-year follow-up. Forty-two patients with median 4.6years follow-up were included; 24 had surgical fixation and 18 were managed with humeral brace. Assessment of clinical and radiological outcomes demonstrated few statistically significant functional differences between the two groups. Surgical patients achieved faster union for non-comminuted fractures. All patients maintained functional range of motion, with similar complication rates. This study suggests that similar outcomes can be achieved with both managements, though faster union times may be seen in the operative group. Further studies are recommended to evaluate the impact of fracture comminution causing delayed unions.

Comparing survival rates and mortality in operative versus nonoperative treatment for femoral neck fractures among Alzheimer's disease patients: A retrospective cohort study.

Addressing femoral neck fractures resulting from ground-level falls in older adults with Alzheimer's disease (AD) involves a personalized treatment plan. There is considerable ongoing debate concerning the relative advantages and disadvantages of surgical treatment (internal fixation or arthroplasty) vs nonoperative treatment for femoral neck fractures in older persons with AD. This retrospective cohort study compared the mortality, hazard ratio, and survival rate between operative and nonoperative treatments, controlling for patients' demographic information and baseline health status. The study population consisted of Optum beneficiaries diagnosed with AD who experienced an initial femoral neck fracture claim between January 1, 2012, and December 31, 2017. Kaplan-Meier survival curves were applied to compare the treatment groups' post-fracture survival rates and mortality. Cox regression was used to examine the survival period by controlling the covariates. Out of the 4157 patients with AD with femoral neck fractures, 59.8% were women (n = 2487). The median age was 81 years. The 1-year survival rate for nonoperative treatment (70.19%) was lower than that for internal fixation (75.27%) and arthroplasty treatment (82.32%). Compared with the nonoperative group, arthroplasty surgical treatment had significant lower hazard risk of death (arthroplasty hazard ratio: 0.850, 95% CI: 0.728-0.991, P < 0.05). The findings suggest that the operative treatment group experiences higher survival rates and lower mortality rates than the nonoperative group. This paper provides insights into treatment outcomes of older adults with AD receiving medical care for femoral neck fractures.

Patella and Trochlea Osteochondritis Dissecans: Demographics and Treatment Paradigms.

Previous research on patellar and trochlear groove osteochondritis dissecans (OCD) is limited by small sample sizes. This study aims to describe the presentation of patients with OCD lesions of the patella and trochlea and characterize the outcomes of operative and nonoperative treatments. This retrospective cohort study identified all patients from a single institution from 2008 to 2021 with patellar and/or trochlear OCD lesions. Patients were excluded from the study if surgical records were unavailable or if the patient had knee surgery for a different injury at index surgery or in the 12 months postoperative. Minimum follow-up was 12 months. Outcomes included a return to sports (RTS), pain resolution, radiographic healing, and treatment "success" (defined as full RTS, complete pain resolution, and full healing on imaging). A total of 68 patients (75 knees) were included-45 (60%) with patellar OCD and 30 (40%) with trochlear. Of the patients, 69% were males. The median age at knee OCD diagnosis was 14 years. At the final follow-up, 62% of knees (n = 44) recovered sufficiently to allow a full RTS and 54% of knees (n = 39) had full pain resolution. Of the 46 knees with radiographic imaging at least 1 year apart, 63% had full healing of the lesion. There was no significant difference in RTS, pain resolution, radiographic healing, or overall success when comparing treatments. This study provides valuable epidemiologic demographic and outcome data regarding the scarcely reported patellar and trochlear OCD. While over half of patients fully returned to sports and reported full pain resolution, a large proportion continued to experience symptoms over a year after presentation. Future research should aim to better define the treatment algorithms for these OCD subtypes. Level III.

Evaluation of Patient's Quality of Life before and after Implantation of Abbott's Proclaim™ XR Spinal Cord Stimulator with BurstDR™ Stimulation in Chronic Pain Syndrome.

Background and Objectives: In case of the ineffectiveness of pharmacological and non-pharmacological treatments in managing chronic neuropathic pain, spinal cord stimulation (SCS) with BurstDR™ stimulation may reduce pain and increase the quality of life. The term "burst" refers to a series of stimulation impulses that are compressed into small packets and separated by intervals of latency. Materials and Methods: A group of 30 consecutive patients who received the BurstDR™ stimulator using the minimally invasive percutaneous method was selected. Patients selected for our study underwent numerous spinal surgeries before SCS implantation. In the study, analgesics and co-analgesics and their doses used by patients before and 6 months after SCS implantation were examined and compared. Using the visual analogue scale (VAS), pain was compared before and after the procedure. Patients` quality of life was assessed using the Oswestry Disability Index (ODI). Results: We observed a significant reduction in opioid daily doses by an average of 32.4% (±36.1%) and a reduction in paracetamol daily doses by an average of 40% (±33.4%). There was a reduction in pregabalin doses as well. Ketoprofen daily dose reduction was 85.4 mg. The mean VAS difference before and after procedure was 3.9 (±2.3), and the mean difference in ODI was 12.9 (±9), which benefits operative treatment. The VAS and ODI results were statistically significant as well. Conclusions: According to our research, BurstDR™ stimulation improves the quality of life by reducing doses of analgesics and the level of pain.