Orthopedic Surgical Intervention Research Articles

219. Evaluation of health related quality of life improvement in patients undergoing spine vs adult reconstructive surgery

BACKGROUND CONTEXT The discussion regarding value based care has evolved in recent years, yet the ability to report Health Related Quality of Life (HRQoL) between different disease states has been limited by lack of validated standardized metrics to compare them. The recent advent of computer adaptive Patient Reported Outcome Information System (PROMIS), which allows for standardized assessment across health conditions, provides the ability to compare differing disease states and procedures. PURPOSE To compare baseline and postoperative PROMIS scores for patients undergoing common single-level spinal surgery procedures, total hip arthroplasty (THA) and total knee arthroplasty (TKA). STUDY DESIGN/SETTING Retrospective clinical cohort study of patients undergoing common single-level spine surgery procedures, THA and TKA at 6-month postoperative follow-up. PATIENT SAMPLE A total of 505 orthopedic surgical patients were included who underwent either: single level anterior cervical discectomy and fusion (ACDF, N=37), lumbar laminectomy (Lami, N=31), microscopic lumbar discectomy (MLD, N=58), transforaminal lumbar interbody fusion (TLIF, N=46), total hip arthroplasty (THA, N=131), or total knee arthroplasty (TKA, N=202) at a single institution. OUTCOME MEASURES Baseline (BL) and 6 month (6M) PROMIS metrics (Physical Function, Pain Interference, Pain Intensity). Patients were compared by T-values, which is age and gender adjusted to give a normal distribution of the general population, as the mean is scored at 50, and each 10 point deviation reflects 1SD of the population in improving or worsening function. METHODS Patients>18 years old who underwent spine surgery (ACDF, Lami, MLD, TLIF) or adult reconstruction surgery (THA or TKA) with BL & 6M PROMIS scores of physical function, pain interference and pain intensity were separately grouped based on surgery type. Paired t-tests compared differences in BL, 6M and the change in PROMIS scores for spine vs adult reconstruction procedures. RESULTS A total of 172 spine surgery patients (age=54.6±15.6; 42.9% female) and 333 adult reconstruction patients were compared (age=65.8±9.5; 59.8% female). Spine surgery patients were significantly younger (p CONCLUSIONS Patients undergoing single level spinal surgery had lower initial and 6 month postoperative PROMIS scores compared to those undergoing total hip and knee arthroplasty. All procedure cohorts demonstrated meaningful improvement after orthopaedic surgical treatment, but spinal surgery patients demonstrated more improvement in physical function and pain interference scores compared to arthroplasty patients. Future study is required to assess the value base of spinal and adult reconstruction surgery, including durability. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

In situ reconstruction of an MRSA-infected paravisceral aortic pseudoaneurysm with cryopreserved aortic allograft

ObjectivesTreatment of paravisceral aortic infections poses several challenges because standard therapy with excision of all infected tissues and extraanatomic reconstruction is frequently not possible without jeopardizing visceral perfusion. In situ reconstruction with rifampin-soaked prosthetic graft or endovascular repair with stent grafts runs the risk of reinfection. We present a case of a paravisceral aortic infection, where cryopreserved allograft was used for the reconstruction of the aorta.MethodsMedical documentation and CT angiography studies were retrospectively reviewed for a patient in a tertiary care center.ResultsA 62-year-old male patient presented with an infected pseudoaneurysm of the paravisceral aorta at the level of the celiac artery. He had previously undergone multiple orthopedic surgical interventions and developed methicillin-resistant Staphylococcus aureus infections. We successfully repaired the paravisceral pseudoaneurysm with excision of all infected tissues and in situ aortic replacement with a cryopreserved allograft.ConclusionIn case of infected aortic pseudoaneurysm, the use of cryopreserved aortic allograft is a reliable choice for reconstruction of the aorta.

Identifying a Niche: Development of the Orthopedic Radiation Oncology Clinic

The Orthopedic Radiation Oncology Clinic (OROC) was recently developed to identify patients at risk of pathologic fracture of weight bearing long bones, to provide education to patients and staff regarding fracture risk and weight bearing restrictions, to provide rapid access for radiation therapy services, to provide timely access for orthopedic surgical interventions and to provide follow-up services for patients with Metastatic Bone Disease (MBD). At our institution, prior to the development of the OROC clinic, on-call orthopedic evaluation was utilized to determine a patient’s pending fracture risk as identified in the radiographic report. The use of orthotic devices was limited to spinal braces and Radiation Oncology follow-up care and rehabilitation services was minimal and inconsistent. As orthopedic surgical intervention reduces pain, preserves function, minimizes fracture risk and improves quality of life, the OROC clinic was developed as an interdisciplinary assessment for patients with MBD to the appendicular skeleton. It is facilitated by an Orthopedic Oncology Surgeon, a Radiation Oncologist and a Clinical Specialist Radiation Therapist (CSRT) and operates weekly. The CSRT is the liaison and primary contact for referring physicians and specialists. Within the OROC clinic, the responsibilities of the CSRT are to triage referrals, identify diagnostic imaging required for patient fracture risk assessment, coordinate rapid access radiation therapy, patient navigation including assessment and education. From April to July 2018, a retrospective quality assurance chart review from the OROC clinic was completed. Information regarding fracture risk category and interventions including referrals, orthotic devices and patient education material were collected. 29 patient consultations and 9 follow-up visits occurred. 11/29 (38%) patients were identified as high risk of pathologic fracture and received restricted weight bearing instructions. 5/29 (17%) were offered prophylactic orthopedic intervention. 20/29 (69%) received palliative radiation therapy. 4/29 (14%) were referred for prosthetic and orthotic devices and 3/29 (10%) were referred for physiotherapy services. Preliminary data supports the interdisciplinary OROC objective of providing rapid access to centralized coordinated care in an effort to improve patient education, time to treatment, provide follow-up and rehabilitation services. Future partnership with a community based rehabilitation program will ensure consistency of post treatment care for patients with skeletal related events of the appendicular skeleton. Further research is required to measure outcomes in addition to establishing best practices for patients with MBD of the appendicular skeleton.

SAT-491 Severe Hypercalcemia Secondary to Primary Skeletal Sarcoidosis

Introduction: Sarcoidosis is an autoimmune disorder that is characterized by non-caseating granulomas found throughout affected tissues. It has an incidence of 10-12 per 100,000 patients per year (2). Common clinical manifestations of sarcoidosis include hilar adenopathy, abnormally high angiotensin-converting enzyme (ACE), abnormally high vitamin D, and respiratory symptoms such as cough. While the lungs are commonly affected by sarcoidosis, extrapulmonary involvement occurs in over 30% of cases of sarcoidosis (1). The incidence of musculoskeletal involvement, specifically, is approximately 14%, however, most cases are asymptomatic (2). Case Presentation: A 79-year-old female with a past medical history of asthma, dementia, CAD, CKD, and HTN presents with asymptomatic hypercalcemia. She was directly admitted for hypercalcemia, AKI, and UTI and was started on Keflex and IV fluid therapy. Endocrinology, rheumatology, oncology, and nephrology were consulted. Over the course of her evaluation, further labs revealed: continued hypercalcemia: with a nadir of 13.5, elevated 1,25 vitamin D with a nadir of 100.0, and elevated ACE levels with a nadir of 125. Phosphorus, magnesium, PTH, and PTHrP levels were all within normal limits. The patient’s only complaint was dry mouth. Repeat physical examinations were stable and within normal limits other than increasing blood pressure, as high 172/70. She was started on dexamethasone to decrease conversion of Vitamin D to 1,25 hydroxyvitamin D. Throughout her stay, the patient had a negative NM parathyroid scan and a negative full body PET-CT. A CT chest w/o contrast revealed nonsp ecific ground-glass opacification with interval resolution of a small pulmonary nodule. Her diagnosis of sarcoidosis was only confirmed with a bone marrow biopsy of her right posterior iliac crest that revealed multiple non-necrotizing granulomas. Discussion: Atypical presentations of illnesses warrant exhaustive diagnostic workup. Although this patient’s laboratory values classically pointed towards a granulomatous process - elevated vitamin D and ACE levels - her diagnostic imaging studies, including full body PET-CT, were negative, steering away from a diagnosis of skeletal sarcoidosis. If it were not for a bone marrow biopsy, this patient would have potentially suffered greatly with the development of cystic bony degeneration and consequences such as fracture needing invasive orthopedic surgical intervention.

New Methodology for Diagnosis of Orthopedic Diseases through Additive Manufacturing Models

Our purpose is to develop the preoperative diagnosis stage for orthopedic surgical treatments using additive manufacturing technology. Our methods involve fast implementations of an additive manufactured bone model, converted from CAT data, through appropriate software use. Then, additive manufacturing of the formed surfaces through special 3D-printers. With the structural model redesigned and printed in three dimensions, the surgeon is able to look at the printed bone and he can handle it because the model perfectly reproduces the real one upon which he will operate. We found that additive manufacturing models can precisely characterize the anatomical structures of fractures or lesions. The studied practice helps the surgeon to provide a complete preoperative valuation and a correct surgery, with minimized duration and risks. This structural model is also an effective device for communication between doctor and patient.

Self Efficacy Meningkatkan Perilaku Pasien Dalam Latihan Mobilisasi Post Operasi ORIF Pada Ekstremitas Bawah

Surgery for bone repositioning through internal fixation (Open Reduction Internal Fixation) is a medical action to improve the position of the fractured bone. The purpose of the ORIF action is to restore the function of bone movement and stabilization so that patients are expected to mobilize early after surgery. One of the treatment focuses on postoperative patients with ORIF is gradual exercise and activity. The purpose of the study was to determine the effect of self-efficacy of postoperative patients with ORIF in the exercise of lower extremity mobilization. The cross sectional research method that involving 80 respondents who had been carried out ORIF installation surgery in the orthopedic surgical treatment room. Data analysis using linear regression test, the results showing that there is a positive and significant effect of the patient's self-efficacy on lower limb mobilization exercises at p-value = 0.005 with the R square value = 0.495 which means that the effect of self-efficacy is moderate on post ORIF patient mobilization exercises. So in general it can be concluded that the effect of increasing patient efficacy will increase the behavior of lower limb mobilization exercises in lower limb patients.

The orthopaedic management of long bone deformities in genetically and acquired generalized bone weakening conditions.

PurposeDiseases such as osteogenesis imperfecta, fibrous dysplasia, hypophosphataemic rickets and others lead to soft and weak bones and long bone deformity in affected patients. As a consequence, these patients lose their walking capacity and functional abilities of the upper extremities as well.MethodsIn combination with bisphosphonate treatment and physical rehabilitation programmes surgical interventions are being applied to correct and stabilize the deformed and less mechanically resistant long bones. Intramedullary devices, ideally with an elongating telescopic mechanism, have proven to be the most suitable implants.ResultsThe surgical correction and stabilization of deformed bones in weak bone diseases is very beneficial to the patients. Pain restriction, reduction of fracture events, minimization of consequences of traumatic events and falls have resulted in a significant functional improvement. The patients live on a better activity level with a much-improved individual independence. Despite a high complication and revision rate of the intramedullary rods the gain of quality of life outweighs these negative aspects by far.ConclusionOrthopaedic surgical treatment for deformed bones in patients with weak bone diseases has changed the life of the patients and plays a very important role in the disease management protocols.This paper was written under the guidance of the Study Group Genetics and Metabolic Diseases of the European Paediatric Orthopaedic Society.

Cone beam computed tomography in assessment on pharynx effects of orthopedic-surgical treatment - a review of the literature.

The cone beam computed tomography (CBCT) image provides clear differentiation of soft tissues from empty spaces. This paper presents a literature review to evaluate the effects of orthopedic and surgical treatment on the pharyngeal dimension by CBCT. It was concluded that treatments involving dentofacial orthopedics and orthognathic surgery have been related with an increase in the upper airway volume. Standardized capturing of tomographic images and more controlled and randomized studies are necessary.

Periodontopathogenic bacteria in prosthetic joint infection: a retrospective analysis of 1,673 patients.

Prosthetic joint infection (PJI) is a severe complication for patients and represents an increasing health problem. At present, very limited data are available on the potential role of periodontopathogenic bacteria in PJI. The aim of this analysis was to compare the presence of periodontopathogenic bacteria in surgically treated patients diagnosed with PJI (study) to that of surgically treated infected orthopedic patients without PJI (controls). Patient records of all orthopedic surgical treatments performed between January 2009 and March 2014 were retrospectively screened. The study group consisted of 996 PJI patients, and the control group of 677 individuals, following surgical treatment of orthopedic infections. During surgery, microbiologic smears were taken and processed by standard procedures for microbiologic diagnosis. Periodontopathogenic bacteria were detected in both groups (4.3% study and 5.6% control group). Nine periodontal pathogenic species from the yellow, violet, and orange complex were identified, without any statistically significant difference between the two groups. Within their limits, the presented results indicate that periodontal bacteria may contribute similarly to PJI and other surgically treated orthopedic infections. The finding that periodontal pathogenic bacteria were identified in both groups highlights the importance of oral infection control prior to orthopedic surgery.

Pilot randomized controlled trials in the orthopaedic surgery literature: a systematic review

BackgroundThe primary objective of this systematic review is to examine the characteristics of pilot randomized controlled trials (RCTs) in the orthopaedic surgery literature, including the proportion framed as feasibility trials and those that lead to definitive RCTs. This review aim to answer the question of whether pilot RCTs lead to definitive RCTs, whilst investigating the quality, feasibility and overall publication trends of orthopaedic pilot trials.MethodsPilot RCTs in the orthopaedic literature were identified from three electronic databases (EMBASE, MEDLINE, and Pubmed) searched from database inception to January 2018. Search criteria included the evaluation of at least one orthopaedic surgical intervention, research on humans, and publication in English. Two reviewers independently screened the pool of pilot trials, and conducted a search for corresponding definitive trials. Screened pilot RCTs were assessed for feasibility outcomes related to efficiency, cost, and/or timeliness of a large-scale clinical trial involving a surgical intervention. The quality of the pilot and definitive trials were assessed using the Checklist to Evaluate a Report of a Non-Pharmacological Trial (CLEAR NPT).ResultsThe initial search for pilot RCTs yielded 3857 titles, of which 49 articles were relevant for this review. 73.5% (36/49) of the orthopaedic pilot RCTs were framed as feasibility trials. Of these, 5 corresponding definitive trials (10.2%) were found, of which four were published and one ongoing. Based on author responses, the lack of a definitive RCT following the pilot trial was attributed to a lack of funding, inadequacies in recruitment, and belief that the pilot RCT sufficiently answered the research question.ConclusionsBased on this systematic review, most pilot RCTs were characterized as feasibility trials. However, the majority of published pilot RCTs did not lead to definitive trials. This discrepancy was mainly attributed to poor feasibility (e.g. poor recruitment) and lack of funding for an orthopaedic surgical definitive trial. In recent years this discrepancy may be due to researchers saving on time and cost by rolling their pilot patients into the definitive RCT rather than publish a separate pilot trial.

Ефективність вживання вуглеводного напою перед ортопедичними хірургічними втручаннями у дітей

Мета. Визначити вплив передопераційного вживання вуглеводного напою на метаболічні показники стресової відповіді на ортопедичні хірургічні втручання у дітей.
 Матеріали і методи. У дослідній групі 30 дітей віком старше 1 року вживали напій, що містив 25 мг харчового вуглеводу мальтодекстрину на 100 мл води, за дві години до індукції анестезії. У контрольній групі 30 дітям призначали стандартне передопераційне голодування. Порівнювали концентрації глюкози, інсуліну, кортизолу у плазмі крові, індекси інсулінорезистентності та чутливості до інсуліну та наявність кетонових тіл у сечі після операції.
 Результати. Перед операцією показники концентрації глюкози у плазмі крові в дослідній групі були вище, ніж у контрольній групі (р = 0,02). Наприкінці операції в дослідній групі були вище показники індексу чутливості до інсуліну (р = 0,01), нижче показники концентрації інсуліну у плазмі крові (р=0,008) та індексу інсулінорезистетності (р = 0,01). У контрольній групі індекс інсулінорезистентності перевищував норму у 30% хворих. Кетонові тіла в сечі в дослідній групі спостерігали у 20%, в контрольній - у 50% хворих.
 Висновки. Вживання вуглеводного напою за дві години до хірургічного втручання покращувало метаболічний профіль у дітей, яким виконували ортопедичні операції, та зменшувало прояви хірургічного стресу.

Essential fracture and orthopaedic equipment lists in low resource settings: consensus derived by survey of experts in Africa

IntroductionLow/middle-income countries (LMICs) have a growing need for trauma and orthopaedic (T&O) surgical interventions but lack surgical resources. Part of this is due to the high amount of road traffic...

Reduced deoxyribonuclease enzyme activity in response to high postinjury mitochondrial DNA concentration provides a therapeutic target for Systemic Inflammatory Response Syndrome.

Cell-free mitochondrial DNA (mtDNA) is proinflammatory and has been detected in high concentrations in trauma patients' plasma. Deoxyribonuclease (DNAse) is the free plasma enzyme responsible for the digestion of extracellular DNA. The relationship between mtDNA and DNAse after major trauma is unknown. We hypothesized that DNAse activity would be elevated after injury and trauma surgery and would be associated with high concentrations of extracellular DNA. Two-year prospective study was performed on 103 consecutive trauma patients (male, 81%; age, 38 years [interquartile range, 30-59 years]; injury severity score, 18 [interquartile range, 12-26 years]) who underwent standardized major orthopedic trauma surgical interventions. Blood was collected at five perioperative time points (preoperative, postoperative, 7 hours, 24 hours, and 3 days postoperatively). Healthy control subjects (n = 20) were also sampled. Cell-free mtDNA and nuclear DNA (nDNA) were measured using quantitative polymerase chain reaction. Deoxyribonuclease was also assayed in the same plasma samples. Increased levels of mtDNA (from preoperative 163 ± 86 ng/mL to 3 days 282 ± 201 ng/mL, p < 0.0001) and nDNA (from preoperative 28 ± 20 ng/mL to 3 days 37 ± 27 ng/mL, p < 0.05) were present in trauma patients at all perioperative time points compared with healthy controls (mtDNA: 4 ± 2 ng/mL; nDNA: 10 ± 5 ng/mL). Deoxyribonuclease activity was lower in the trauma cohort (from preoperative 0.06 ± 0.04U/mL to 3 days 0.08 ± 0.04U/mL, p < 0.0001) compared with healthy controls (DNAse: 0.17 ± 0.03U/mL). There was no correlation between DNAse and perioperative DNA concentrations. Elevated mtDNA (but not nDNA) correlated with the development of systemic inflammatory response syndrome (SIRS) (p = 0.026) but not multiple organ failure. The significant perioperative elevation in plasma-free mtDNA concentration is associated with the development of SIRS. The fact that increased cell-free DNA concentrations present with significantly lower than healthy control DNAse activity suggests a potential therapeutic opportunity with DNAse administration to modulate postinjury severe SIRS. Prognostic/Epidemiological, level II.

Acute Pulmonary Embolism in a Teenage Female - A Case Report.

Thrombophilia represents a tendency towards excessive blood clotting and the subsequent development of venous thromboembolism (VTE). VTE is a rare condition in children that comprises both deep venous thrombosis (DVT) and pulmonary embolism (PE). This paper reports the case of a 16-year-old girl, admitted to the Pediatrics Clinic No. 1, Tîrgu Mureș, Romania, for dyspnea, chest pain and loss of consciousness. Her personal history showed that she had had two orthopedic surgical interventions in infancy, two pregnancies, one spontaneous miscarriage and a recent caesarian section at 20 weeks of gestation for premature detachment of a normally positioned placenta associated with a deceased fetus. Laboratory tests showed increased levels of D-dimers. Angio-Computed Tomography (Angio-CT) showed multiple filling defects in both pulmonary arteries, establishing the diagnosis of PE. The laboratory tests were undertaken to assist in the diagnoses of a possible thrombophilia underlined a low level of antithrombin III. Antiphospholipid syndrome was ruled out and genetic tests revealed no specific mutation. Anticoagulant therapy was initiated with unfractionated heparin and afterwards subcutaneously low molecular heparin was prescribed for three months. Later it has been changed to oral therapy with acenocoumarol. The patient was discharged in good general status with the recommendation of life-long anticoagulation therapy. Thrombophilia is a significant risk factor for PE, and it must be ruled out in all cases of repeated miscarriage.

Особенности ортопедического и соматического статуса у пациентов с несовершенным остеогенезом

Introduction Osteogenesis imperfecta (OI) is a group of rare and relatively diverse genetic disorders, characterized by frequent fractures, bone deformities, low bone mineral density and osteopenia. Frequent fractures, bone deformities, and nonunion are among orthopedic problems in OI patients. Varus deformity of the femoral neck, scoliosis, protrusion of the acetabulum, static deformities of the feet are considered separately. The main goal of surgical treatment of the limb deformities and fractures in OI patients is restoration and maintenance of their motor activity, autonomy and preservation of quality of life in severe OI types. The purpose of this study was to assess the deformities in the lower extremities and other accompanying orthopedic disorders, as well as the somatic status of patients with severe OI types (Sillence’s types III and IV) at the point of admission to operative orthopedic treatment. Material and methods Between 2003 and 2016, we examined 43 patients with severe OI (types III and IV) which were admitted for operative correction of deformities of the lower and upper extremities, nonunion, and varus deformity of the femoral neck. The average age at the time of admission was 14.4 ± 9.74 years (from 2 years 9 months to 46 years). Results Treatment of fractures was conservative in most cases; however, osteosynthesis with wires or flexible nails was used, followed by their removal in 4 patients; bone plates were applied in 4 patients; osteosynthesis with the Ilizarov apparatus was used in 3 cases, and intramedullary osteosynthesis with rigid rods in 4 patients. Regular administration of bisphosphonate preparations was conducted in 9 patients. Last dose of the drug was introduced at least 4 months before admission to surgical treatment. Thirteen patients had undergone reconstructive surgeries on the bones of lower extremities to correct the deformities. Conclusion Deformities of the lower limbs in patients with severe OI types are complex and multilevel, which implies the need for multilevel orthopedic interventions to correct them. High incidence of fractures and a complex nature of severe bone deformities result in the loss of the skills to move independently, or even its initial absence. Inadequate surgical interventions, untimely performed, non-telescopic nature of osteosynthesis, and absent bisphosphonate therapy contribute to the formation of additional orthopedic problems and aggravation of the loss of autonomy in such patients, which may complicate subsequent specific orthopedic surgical treatment.

Surgical treatment in bone metastases in the appendicular skeleton

IntroductionMetastatic bone disease is the most common neoplastic process that affects the skeletal system. Eighty percent of bone metastases come from carcinomas of the breast, lung, kidney, thyroid and prostate. The Katagiri scale enables an estimation of the survival of patients based on the presence or absence of visceral metastases, multiple bone metastases and functional status according to the ECOG scale. Material and methodsA retrospective, descriptive and observational study conducted between March 1, 2013 and June 30, 2015. Thirty-two patients were studied with a diagnosis of metastatic bone disease and who had undergone some type of orthopaedic surgical treatment for pathological fracture or impending fracture. Results28 cases (87.5%) presented pathological fracture and 4 cases (12.5%) impending fracture according to the Mirels score. Fifteen cases (46.875%) were treated by placing a central medullary nail+spacer in the long bone diaphysis, 15 cases (46.875%) with modular arthroplasties and 2 patients (6.25%) with forequarter amputation. Eleven patients (34.375%) died during the course of this study, all with a Katagiri greater than or equal to 4. DiscussionThe presence of a fracture in previously damaged territory is a catastrophic complication for most cancer patients. A clear understanding of the life expectancy of patients with bone metastases is of great help to prevent errors and failures in treatment.

Mucolipidosis type III, a series of adult patients

BackgroundMucolipidosis type III α/β or γ (MLIII) are rare autosomal recessive diseases, in which reduced activity of the enzyme UDP-N-acetyl glucosamine-1-phosphotransferase (GlcNAc-PTase) leads to intra-lysosomal accumulation of different substrates. Publications on the natural history of MLIII, especially the milder forms, are scarce. This study provides a detailed description of the disease characteristics and its natural course in adult patients with MLIII.MethodsIn this retrospective chart study, the clinical, biochemical and molecular findings in adult patients with a confirmed diagnosis of MLIII from three treatment centres were collected.ResultsThirteen patients with MLIII were included in this study. Four patients (31%) were initially misdiagnosed with a type of mucopolysaccharidosis (MPS). Four patients (31%) had mild cognitive impairment. Six patients (46%) needed help with activities of daily living (ADL) or were wheelchair-dependent. All patients had dysostosis multiplex and progressive secondary osteoarthritis, characterised by cartilage destruction and bone lesions in multiple joints. All patients underwent multiple orthopaedic surgical interventions as early as the second or third decades of life, of which total hip replacement (THR) was the most common procedure (61% of patients). Carpal tunnel syndrome (CTS) was found in 12 patients (92%) and in eight patients (61%), CTS release was performed.ConclusionsSevere skeletal abnormalities, resulting from abnormal bone development and severe progressive osteoarthritis, are the hallmark of MLIII, necessitating surgical orthopaedic interventions early in life. Future therapies for this disease should focus on improving cartilage and bone quality, preventing skeletal complications and improving mobility.

Overall benefits provided by orthopedic surgical intervention in patients with rheumatoid arthritis

Objectives: To clarify systemic effects of orthopedic surgical intervention in patients with rheumatoid arthritis (RA).Methods: A prospective observational cohort study was performed in RA patients who were scheduled to have primary elective orthopedic surgeries. Assessments were performed at baseline, 6 and 12 months after surgery using J-HAQ, General Health, EQ-5D, BDI-II, DAS28-CRP(4) and CRP for all registered patients, DASH and grip power for patients with upper-extremity surgeries, TUG for patients with lower-extremity surgeries, and JSSF for patients with ankle and forefoot surgeries.Results: There were 294 sites in 276 patients whose average age was 64 (19–89) years and average disease duration was 16 (1–60) years. Surgical site was shoulder in six patients, elbow in 26, wrist in 74, hand in 63, hip in 13, knee in 50, ankle in 12, and forefoot in 50. In total, physical function (J-HAQ, grip power, DASH, TUG, JSSF), quality of life (J-HAQ, General Health, EQ-5D) and depression (BDI-II) improved and disease activity (CRP, DAS28-CRP(4)) decreased significantly 6 and 12 months after surgery (p<.01), despite some differences in their outcomes by the preoperative disease activity and the surgical site.Conclusion: Overall benefits were provided by orthopedic surgical intervention generally in patients with RA.

Tratamiento quirúrgico de las metástasis óseas en el esqueleto apendicular

IntroductionMetastatic bone disease is the most common neoplastic process that affects the skeletal system. Eighty percent of bone metastases come from carcinomas of the breast, lung, kidney, thyroid and prostate. The Katagiri scale enables an estimation of the survival of patients based on the presence or absence of visceral metastases, multiple bone metastases and functional status according to the ECOG scale. Material and methodsA retrospective, descriptive and observational study conducted between March 1, 2013 and June 30, 2015. Thirty-two patients were studied with a diagnosis of metastatic bone disease and who had undergone some type of orthopaedic surgical treatment for pathological fracture or impending fracture. Results28 cases (87.5%) presented pathological fracture and 4 cases (12.5%) impending fracture according to the Mirels score. Fifteen cases (46.875%) were treated by placing a central medullary nail + spacer in the long bone diaphysis, 15 cases (46.875%) with modular arthroplasties and 2 patients (6.25%) with forequarter amputation. Eleven patients (34.375%) died during the course of this study, all with a Katagiri greater than or equal to 4. DiscussionThe presence of a fracture in previously damaged territory is a catastrophic complication for most cancer patients. A clear understanding of the life expectancy of patients with bone metastases is of great help to prevent errors and failures in treatment.

Diagnosis and Management of Polytraumatized Patients With Severe Extremity Trauma.

Multiply injured patients with severe extremity trauma are at risk of acute systemic complications and are at high risk of developing longer term orthopaedic complications including soft-tissue infection, osteomyelitis, posttraumatic osteoarthritis, and nonunion. It is becoming increasingly recognized that injury magnitude and response to injury have major jurisdiction pertaining to patient outcomes and complications. The complexities of injury and injury response that affect outcomes present opportunities to apply precision approaches to understand and quantify injury magnitude and injury response on a patient-specific basis. Here, we present novel approaches to measure injury magnitude by adopting methods that quantify both mechanical and ischemic tissue injury specific to each patient. We also present evolving computational approaches that have provided new insight into the complexities of inflammation and immunologic response to injury specific to each patient. These precision approaches are on the forefront of understanding how to stratify individualized injury and injury response in an effort to optimize titrated orthopaedic surgical interventions, which invariably involve most of the multiply injured patients. Finally, we present novel methods directed at mangled limbs with severe soft-tissue injury that comprise severely injured patients. Specifically, methods being developed to treat mangled limbs with volumetric muscle loss have the potential to improve limb outcomes and also mitigate uncompensated inflammation that occurs in these patients.