Postoperative Radiographic Evaluation Research Articles

Demographic-, Radiographic-, and Surgery-Related Factors Do Not Affect Functional Internal Rotation Following Reverse Total Shoulder Arthroplasty: A Retrospective Comparative Study.

This study aimed to identify the demographic-, radiographic-, and surgery-related factors influencing postoperative functional internal rotation (fIR) following reverse total shoulder arthroplasty (RTSA). In this retrospective cohort study, patients who underwent RTSA between June 2013 and April 2018 at a single institution were assigned to two groups ("IROgood" or "IRObad"). Patients were classified as having good fIR (≥8 points in the Constant-Murley score (CS) and fIR to the twelfth thoracic vertebra or higher) or poor fIR (≤2 points in the CS and fIR to the twelfth thoracic vertebra or lower) after RTSA with a single implant model. The minimum follow-up period was two years. Standardized shoulder-specific scores (Visual Analogue Scale (VAS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley score (CS)) were used to assess the pre- and postoperative functional status of patients. Postoperative radiographic evaluation included the distalization shoulder angle (DSA), lateralization shoulder angle (LSA), critical shoulder angle (CSA), acromiohumeral distance (AHD), glenoid inclination (GI), medialization of the center of rotation (COR), lateralization of the humerus, and distalization of the greater tuberosity. Additionally, preoperative evaluation included rotator cuff arthropathy according to Hamada, glenoid version, anterior or posterior humeral head subluxation, and fatty infiltration of the rotator cuff according to Goutallier. Univariate analysis of demographic, surgical, radiographic, and implant-associated parameters was performed to identify factors associated with postoperative fIR. The Shapiro-Wilk test assessed the normal distribution of the data. Intergroup comparisons regarding demographic and surgery-related factors were conducted using the Mann-Whitney-U Test. Radiographic changes were compared using chi-square or Fisher's exact tests. The significance level was set at p < 0.05. Of a total of 42 patients, 17 (age: 73.7 ± 5.0 years, follow-up (FU) 38 months [IQR 29.5-57.5]) were included in the "IRObad" group, and 25 (age: 72 ± 6.1 years, FU 47 months [IQR 30.5-65.5]) were included in the "IROgood" group. All patients were treated with the same type of implant (glenosphere size: 36 mm, 14.3%; 39 mm, 38.1%; 42 mm, 47.6%; neck-shaft angle: 135° in 68.0%; 155° in 32.0%) and had comparable indications. Univariate analysis did not reveal any of the investigated demographic, radiographic, or surgery-related parameters as risk factors for poor postoperative fIR (p > 0.05). None of the investigated factors, including implant-associated parameters, influenced postoperative fIR after RTSA in this cohort.

Percutaneous transverse pinning for metacarpal fractures: a clinical trial

IntroductionMetacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure.MethodsBetween March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05.ResultsThe mean age was 40.21 ± 17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5 ± 1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory.ConclusionPercutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale.Level of evidenceII, prospective cohort study.

Radiological Comparison of Canal Fill between Collared and Non-Collared Femoral Stems: A Two-Year Follow-Up after Total Hip Arthroplasty.

Collared femoral stems in total hip arthroplasty (THA) offer reduced subsidence and periprosthetic fractures but raise concerns about fit accuracy and stem sizing. This study compares collared and non-collared stems to assess the stem-canal fill ratio (CFR) and fixation indicators, aiming to guide implant selection and enhance THA outcomes. This retrospective single-center study examined primary THA patients who received Corail cementless stems between August 2015 and October 2020, with a minimum of two years of radiological follow-up. The study compared preoperative bone quality assessments, including the Dorr classification, the canal flare index (CFI), the morphological cortical index (MCI), and the canal bone ratio (CBR), as well as postoperative radiographic evaluations, such as the CFR and component fixation, between patients who received a collared or a non-collared femoral stem. The study analyzed 202 THAs, with 103 in the collared cohort and 99 in the non-collared cohort. Patients' demographics showed differences in age (p = 0.02) and ASA classification (p = 0.01) but similar preoperative bone quality between groups, as suggested by the Dorr classification (p = 0.15), CFI (p = 0.12), MCI (p = 0.26), and CBR (p = 0.50). At the two-year follow-up, femoral stem CFRs (p = 0.59 and p = 0.27) were comparable between collared and non-collared cohorts. Subsidence rates were almost doubled for non-collared patients (19.2 vs. 11.7%, p = 0.17), however, not to a level of clinical significance. The findings of this study show that both collared and non-collared Corail stems produce comparable outcomes in terms of the CFR and radiographic indicators for stem fixation. These findings reduce concerns about stem under-sizing and micro-motion in collared stems. While this study provides insights into the collar design debate in THA, further research remains necessary.

Evaluation of external surgical approaches used for fenestration of the dorsal and ventral conchal bullae in horses: An ex vivo study

SummaryBackgroundEmpyema of the conchal bullae, which is a possible additional source of chronic unilateral nasal discharge, affects up to 56% of horses with paranasal sinus disease.ObjectivesThis study aimed to determine the external surgical approaches for the fenestration of the conchal bullae in horses.Study designExperimental study.MethodsSix heads of horses were used for external surgical approaches in the maxillary region, and the bilateral ventral and dorsal conchal bullae were fenestrated. Radiographic projections were performed preoperatively, and a further radiographic examination was performed after the surgical procedure using a Steinmann pin inserted through the surgical approach as a radiopaque marker. The approach to the bullae was also assessed by rhinoscopy. Dissection, macroscopic evaluation and digital photographic records of the surgical approaches were performed.ResultsA total of 92% (22/24 bullae) of the evaluated conchal bullae were fenestrated. The approach allowed the fenestration of 11/12 dorsal conchal bullae and 11/12 ventral conchal bullae. The postoperative radiographic evaluation allowed identification of the surgical approach and fenestration positioning by observing the location of the radiopaque pin within the conchal bullae. The dissection showed that the surgical approach to the dorsal conchal bulla was 3 cm dorsal to the infraorbital foramen and dorsal to the levator nasolabialis muscle, with no damage to the vascular or neural structures.Main limitationThe surgical approach to the ventral conchal bulla, when performed 1 cm rostral to the infraorbital foramen, was very close to the branches of the infraorbital nerve, which were identified and moved away from the trephination site. This was an ex vivo study and it is possible that nasal haemorrhage would affect the usefulness in clinical cases.ConclusionThe surgical approaches described in this study allow the fenestration of dorsal and ventral conchal bullae in adult horses in a simple way without the need for specific equipment.

Outcomes of the Modified Stoppa Approach in Acetabular Fracture Management: Incidence of Nerve Injuries.

Displaced acetabular fractures are complex injuries that necessitate precise surgical intervention. Obturator nerve injuries occur in approximately 2% of cases. The modified Stoppa approach, offering enhanced exposure of the quadrilateral plate, has gained attraction as an alternative technique for anterior acetabular fractures. However, its proximity to the obturator nerve poses a risk of iatrogenic injury. This study aimed to investigate the incidence of nerve injuries and functional outcomes in patients undergoing the modified Stoppa approach for traumatic acetabular fractures. This retrospective study involved 86 patients with anterior column fractures, whose data were prospectively collected. The fractures were treated using the modified Stoppa approach. Exclusion criteria were pathological fractures, alternative surgical approaches, prior nerve injuries, hip issues, refusal to participate, or inadequate follow-up. Data collection involved pre-operative imaging, thorough post-operative neurological assessments, and post-operative radiographic evaluation. Functional outcomes were assessed using the Harris Hip Score (HHS). Most patients were male (n=54) with a mean age of 40±17.3 years. Post-operative infection occurred in six cases, with resolution in four through antibiotics and two necessitating device removal. Obturator nerve damage was detected in 14 patients, comprising nine traumatic and five iatrogenic cases. During the follow-up, symptoms improved in all patients, except for the four patients with iatrogenic nerve damage. Traumatic nerve injuries generally heal naturally over time. In contrast, iatrogenic injuries have a less optimistic prognosis, potentially resulting in lasting neurological deficits.

Comparison of Two Surgical Approaches for Trimalleolar Ankle Fracture Fixation

Ankle fractures account for 10% of all presenting fractures, with research quoting the involvement of the posterior malleolus in around 7% of cases. Trimalleolar fractures are estimated to have greater long-term complications due to the significant disruption to the articular surface of the joint and the reduced weight-bearing potential associated with this. Despite the well-documented role of the posterior malleolus in ankle fractures, its fixation is often a matter of debate. One barrier to this is the potential need for an additional surgical incision. Our study compared two surgical approaches to trimalleolar ankle fracture fixation: One through an extended posterolateral and medial approach (2-incision approach) and one through a combined posterolateral, direct lateral, and medial approach (3-incision approach). Thirty-eight open reduction and internal fixation of trimalleolar ankle fractures were performed by the senior author in a single institution between January 2017 and January 2020. Fifteen underwent a 2-incision approach and 3 separate incisions were used in 23 cases. Outcomes of the two different surgical methods included a postoperative functional score (Ankle-Hindfoot American Orthopedic Foot and Ankle Society), postoperative complications, and evaluation of postoperative radiographs. Twenty-three patients were recruited to the 3-incision group and 15 to the 2-incision group. The utilization of 3 separate incisions for the fixation of trimalleolar fractures showed fewer complications than a 2-incision approach. Further, smoking was positively correlated with reported complications. All other perioperative variables did not reach statistical significance. In our study, a 3-incision approach showed a tendency for lower complication rates in the surgical treatment of trimalleolar ankle fractures compared with a 2-incision approach. In our opinion, a direct approach to the 3 malleoli through individual incisions allows better visualization of the fracture site, including intercalary and incisura fragments, enabling better reduction and avoiding unnecessary destructive tissue handling. Level of Evidence: Diagnostic Level 2. See Instructions for Authors for a complete description of levels of evidence.

Three-dimensional customized titanium plate versus conventional titanium miniplate for management of mandibular angle fractures

Background Surgical treatment of mandibular angle fractures using an internal fixation has changed in the last decades to achieve the required rigidity, stability, and immediate restoration of function. Purpose The aim of the study was to evaluate both clinically and radiologically the efficacy of three-dimensional customized titanium plate versus conventional titanium miniplate in the management of mandibular angle fractures. Patients and methods Sixteen adult patients with unilateral mandibular angle fracture indicated for reduction and internal fixation were selected from the Outpatient Clinic, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Tanta University. Patients were divided into two equal groups according to the type of plating system used in fracture fixation, for group I mandibular angle fractures were fixed with 3-D customized titanium plate while for group II mandibular angle fractures were fixed with single conventional titanium miniplate. Postoperative clinical and radiographic evaluations were performed immediately, one week, two weeks, one month, three months and six months. The postoperative clinical evaluation included presence or absence of infection, position and stability of the mandibular lower border, state of occlusion, maximal mouth opening, sensory nerve function, condition of teeth related to the fracture line and patient's tolerance to the plate. The postoperative radiographic examinations evaluated the accuracy of reduction and bony union by measuring the inter-fragmentary gap and the intergonial distance. Results Uneventful wound healing was obtained in all cases of both groups except case no 4 of group II in which dehiscence and mild infection was happened. Satisfactory occlusion was obtained in all cases of both groups except case no 7 of group II where it had mild occlusal derangement. Other parameters including clinical stability, maximal mouth opening, sensory nerve function, and plate tolerance were comparable in both groups. There were no significant differences between group I and group II regarding inter-fragmentary gap and intergonial distance regarding postoperative radiographs. Conclusion The use of three-dimensional customized titanium plate and conventional titanium miniplate fixation systems provided enough stability for proper bone healing, establishment of optimal occlusion, and early return to normal function.

Post-operative Baseplate Radiographic Evaluation Using Routine pre-Operative CT.

There is limited data evaluating post-operative component position and fixation in reverse shoulder arthroplasty (RSA). Therefore, the purpose of this study was to evaluate baseplate position and fixation using routine pre-operative CT and post-operative radiographs. A retrospective analysis of a series consecutive patient who underwent primary RSA was performed. Pre-operative and post-operative glenoid retroversion and inclination were measured using radiographs aligned with projection silhouettes of 3D scapula models in Mimics software. Baseplate retroversion and inclination were measured followed by evaluating for the presence of radiolucent lines (RLLs). Twenty-four patients met inclusion criteria. The average age was 73.4 ± 10.7 years (range, 45-89 years). Radiographic follow-up was 3.4 ± 1.3 years. Post-operative glenoid baseplate retroversion was 2 ± 10 degrees (range, 30 to -9). Post-operative glenoid baseplate inclination was 3.8 ± 9.1 (range, -13 to 19). Five (21%) RSAs had baseplate retroversion >10 degrees. Follow-up radiographs revealed no RLLs around the baseplate, central post, or peripheral screws in any patient. Pre-operative CT imaging enabled evaluation of baseplate component placement and fixation on post-operative radiographs. Baseplate version was within 10 degrees of neutral in 79% (19/24) of patients. No RLLs or loss of fixation were found in any cases. Level IV: Diagnostic Study.

The Utility of Routine Postoperative Radiographs in the Asymptomatic Total Hip Arthroplasty Patient

BackgroundTotal hip arthroplasty (THA) patients often receive routine radiographs in the year following their index surgery. This study sought to investigate the clinical and economic value of obtaining routine postoperative hip radiographs for asymptomatic patients following primary elective THA. MethodsA retrospective cohort study of consecutive patients who underwent primary elective THA from 2016 to 2019 was conducted. Patients undergoing nonelective or revision THA, radiographic follow-up <10 months, and patients aged <18 years were excluded. All radiographs were reviewed for abnormalities in the first postoperative year by an arthroplasty fellowship-trained orthopaedic surgeon, blinded to the symptoms of the patient. ResultsOf the 327 patients (351 hips) included, 57.2% were women and 68.2% were White, with an average age of 65 years (range, 22-97 years) and average body mass index of 29.1 kg/m2 (range, 16.2-49.8 kg/m2). Only four (0.4%) radiographic series revealed abnormalities with the potential to alter postoperative management. One patient experienced a change in management directly related to their abnormal finding (closed reduction for dislocation at 10.2 months postoperatively). The remaining three abnormal radiographic findings included femoral stem subsidence, progressive radiolucencies around an acetabular component, and cement mantle fracture. The average cost for each radiographic series was $155.27, resulting in total direct charges of $167,691.60. ConclusionRoutine postoperative radiographs may be of limited utility in the asymptomatic patient in the first year following elective primary THA. Consideration should be given to limit postoperative radiographs following standard elective THA, while reserving postoperative radiographic evaluation for patients who are symptomatic. Level of EvidenceLevel III.

Twelve-Month Results from a Prospective Clinical Study Evaluating the Efficacy and Safety of Cellular Bone Allograft in Subjects Undergoing Lumbar Spinal Fusion.

While autologous bone grafts remain the gold standard for spinal fusion procedures, harvesting autologous bone is associated with significant complications, including donor site infection, hematomas, increased operative time, and prolonged pain. Cellular bone allograft (CBA) presents an alternative to autologous bone harvesting, with a favorable efficacy and safety profile. The current study further investigates CBA as an adjunct to lumbar spinal fusion procedures. A prospective, multicenter, open-label clinical study was conducted in subjects undergoing lumbar spinal fusion with CBA (NCT02969616). Radiographic fusion status was assessed by an independent review of dynamic radiographs and CT scans. Clinical outcome measures included the Oswestry Disability Index (ODI) and visual analogue scale (VAS) for back and leg pain. Adverse-event reporting was conducted throughout 12 months of follow-up. Available subject data at 12 months were analyzed. A total of 274 subjects were enrolled into the study, with available data from 201 subjects (73.3%) who completed 12 months of postoperative radiographic and clinical evaluation at the time of analysis. Subjects had a mean age of 60.2 ± 11.5 years. A higher number of women (n = 124, 61.7%) than men (n = 77, 38.3%) were enrolled, with a collective mean BMI of 30.6 + 6.5 kg/m² (range 18.0-51.4). At month 12, successful fusion was achieved in 90.5% of subjects. A significant (<i>p</i> &amp;lt; 0.001) improvement in ODI, VAS-back, and VAS-leg clinical outcomes was also observed compared to baseline scores. One adverse event related to CBA (postoperative radiculopathy) was reported, with surgical exploration demonstrating interbody extrusion of graft material. This subject reported successful fusion at month 12. CBA represents a viable substitute for harvesting of autograft alone with a high rate of successful fusion and significant improvements in subject-reported outcomes, such as pain and disability. Positive benefit was observed in subjects reporting single and multiple risk factors for pseudoarthrosis.

Resonance Frequency Analysis for Immediately Placed Dental Implants Replacing Periapically Infected Teeth

Aims: There is a controversy regarding the indication of implant insertion into the sockets of infected teeth. This study aimed to evaluate the outcome of immediate implants replacing periapically infected teeth utilizing Resonance Frequency Analysis (RFA) method. Materials and Methods: Preoperatively, clinical, and radiographic examination accomplished for the patients. After anesthetizing the surgical area, the accused tooth extracted, and the socket curetted by surgical curette to remove the periapical lesion then irrigated by normal saline solution. The implant inserted into its prepared site. Beta-tricalcium phosphate (β-TCP) (combined by collagen membrane) used to fill gaps ≥ 2 mm and to repair bone defects. Implant stability quotient (ISQ) values were measured for the implants during surgery and after 16 weeks. Postoperative clinical and radiographic evaluation were conducted for each patient. Results: Fourteen implants out of 41 immediate implants (34.1%) had been inserted in the extraction sockets of teeth have chronic periapical lesions (infected sites), T-test showed no significant difference in implant stability (ISQ value) between implant placed in infected and non-infected sites neither at baseline nor at 16-weeks. Paired t-test showed highly significant increase in implant stability (ISQ value) of implants placed in infected sites while in the other implants the mean ISQ value increased with no significant difference during the healing period. The success rate was 100% after 4 years of implantation. Conclusions: Presence of periapical lesion is not a contraindication to place immediate implant when properly managed and can provide similar survival rate to that of implants inserted into healthy sockets.

Versatility of various 3D non locking miniplates in treatment of mandibular fractures

Context: The optimal management of mandibular fractures continues to evolve. Fractures of mandible predispose the patients to structural, functional and aesthetic compromise if not treated. The current understanding of the biomechanics and fracture healing of the mandible has influenced the modern approach to the open reduction and internal fixation of these fractures. These help us to evaluate shortcomings of compression plates and 2D miniplates leading to development of 3D plates. Aims: To evaluate the versatility and efficacy and complication of 3 different varieties of 3D non locking plates–2x2 and 2x3 and delta plates in the treatment of mandibular fractures at different sites.Materials and Methods: A total of 86 patients of mandibular fractures were managed by open reduction and internal fixation utilizing total 114 three dimensional plates (109 non locking 3D plates (2X2,3X2) and 5 delta plates) were used for fractures of the mandible including symphysis, parasymphysis, body, angle, ramus and condyle over a period of 3 years.Results: The use of 3D plates provided semi-rigid fixation of fractured fragments with no immediate post-operative mobility. Immediate and subsequent postoperative clinical and radiographic evaluation was carried out at 15 days, 1 month, 3 months and 6 months. Post-operative complications observed were post-operative neurosensory deficit in 3 patients, occlusal discrepancy in 3 patients, wound dehiscence in 2 patient, plate exposure in 1 patient and parotid fistula in 1 patient which accounted for 8.6% of total patients. None of the patient suffered from Infection, segmental mobility, paraesthesia. Malunion, non-union. All these were treated successfully with definitive measures.Conclusion: The 3D mini-plate system is a versatile and efficient method for fixation of mandibular fractures. Delta plates are efficient method for reduction and fixation of subcondylar fracture. The only contraindication for 3D plates is their use in mental foramen region (where distance between mental foramen and inferior border is less than 1.5cm).

May the midline lumbar interbody fusion (MIDLIF) prevent the early radiographic adjacent segment degeneration? A minimum 3-year follow-up comparative study of MIDLIF in L4/5 with cortical bone trajectory screw versus traditional pedicle screw fixation

Study designRetrospective cohort study.ObjectiveTo compare the early radiographic adjacent segment degeneration (R-ASD) and regional lumbar sagittal alignment after midline lumbar interbody fusion (MIDLIF) with cortical bone trajectory (CBT) screw fixation (CBT-MIDLIF) and posterior lumbar interbody fusion (PLIF) with the traditional pedicle screw fixation (PS-PLIF) during long-term follow-up.MethodsAll patients who underwent CBT-MIDLIF or PS-PLIF were identified by a retrospective consecutive case review. Radiographic parameters in cephalad adjacent segment (L3/4), including intervertebral space height (ISH), foraminal height (FH), foraminal width (FW), range of motion were assessed. Lumbar lordosis (LL), sacral slope (SS), L4–L5 Cobb angle, Cobb angle of the intervertebral space at L4–L5, and height of the anterior and posterior edges of the intervertebral space at L4–L5, were measured and compared on preoperative, postoperative, and 3-year follow-up radiographic evaluation.ResultsSeventy-four patients underwent CBT-MIDLIF (CBT-MIDLIF group) and 114 patients underwent conventional PS-PLIF (PS-PLIF group). ISH, FH and FW were significantly smaller at 6-month follow-up than before operation with PS-PLIF (p < 0.001) but showed no significant changes with CBT-MIDLIF (p > 0.05). At the last follow-up, the changes in cephalad R-ASD parameters were more remarkable after PS-PLIF than after CBT-MIDLIF (p < 0.01). LL and SS were significant larger at the last follow-up than before operation in both groups (p < 0.001). Regarding long-term outcomes, the symptoms caused by degenerative spinal disorders significantly improved in both groups (p < 0.01).ConclusionCBT-MIDLIF had less radiographic degeneration in the adjacent segment than PS-PLIF at 3-year follow-up. The lumbar sagittal alignment could be improved significantly and the surgical outcomes were satisfactory after either CBT-MIDLIF or PS-PLIF.

Subtalar arthroereisis in pediatric flexible flat foot: Functional and radiographic results with 5 years of average follow-up

The aim of this retrospective study is to evaluate the clinical-functional and radiographic results in pediatric patients with painful and disabling Flexible Flat Foot (FFF) refractory to conservative treatment who underwent percutaneous subtalar arthroereisis with a Maxwell Brancheau Arthroereisis® (MBA) implant. Patients aged 8–14 years old with a minimum follow-up of 24 months were included. A pre and postoperative radiographic evaluation was carried out analyzing Meary's angle, internal Moreau-Costa-Bartani´s angle, Talar declination angle, Calcaneal Pitch, Kite's angle, Talar-1st metatarsal angle, and Talonavicular coverage angle. In those patients with more than 5 years of follow-up, the development of subtalar osteoarthritis was evaluated. A clinical-functional evaluation was carried out using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot rating scale. Pre and postoperative pain was evaluated using the visual analog scale (VAS). Postoperative complications were described. Fourteen patients (19 feet) met the inclusion criteria. The mean age at surgery was 12 years old with a mean follow-up of 68.26 months. All radiographic angles improved significantly. No signs of subtalar osteoarthritis were identified. The mean pre and postoperative pain according to VAS was 7.05 and 0.77 respectively. The mean pre and postoperative AOFAS was 75.42 and 97.05 respectively. One female patient had persistent pain in both feet (VAS = 4). However, she was able to do sports and daily life activities without restrictions. None of the implants needed to be removed due to intolerance or pain. Subtalar arthroereisis seems to be effective to improve the clinical-functional and radiographic parameters in moderate pediatric FFF.

Comparative Analysis of Radiological Evaluation and Early Functional Outcomes of Total Knee Arthroplasty Using an Accelerometer-Based Handheld Navigation System and Conventional Instrumentation: A Prospective Study.

BackgroundAn accelerometer-based handheld navigation system (HHNS) for total knee arthroplasty (TKA) does not require a large console needed for computer-assisted navigation systems and has been shown to decrease component malalignment in TKA. The study aimed to use HHNS with conventional instrumentation to compare the radiological evaluation and functional outcomes of TKA.Materials and methodsThis was a multi-surgeon, prospective, assessor-blinded comparative study of 122 patients undergoing unilateral TKA. We used a stratified randomized sampling method to select 35/48 patients undergoing TKA using a handheld navigation system and 35/74 patients undergoing TKA using conventional instrumentation and divided them into two groups: the HHNS group and (conventional) CONV group. Postoperative radiographic evaluation was based on the tibial and femoral alignment angle, posterior tibial slope, and tibiofemoral angle measured from full-length lower-limb anteroposterior and lateral views of the knee. The Oxford Knee Score (OKS) and Knee Society Score (KSS) with a two-year serial follow-up were used to evaluate functional outcomes.ResultsThe mean tibial alignment angle and posterior tibial slope were 0.78° ± 1.27° and 4.38° ± 0.86°, respectively, in the HHNS cohort and 2.63° ± 1.54° and 2.12° ± 1.82°, respectively, in the CONV group (p < 0.001). There was no significant difference in the femoral alignment angles. The overall alignment using the mean tibiofemoral angle was 179.21° ± 1.82° in the HHNS group and 177.31° ± 2.18° in the CONV group (p = 0.002). There were no significant differences in the KSS and OKS at the two-year follow-up between the groups.ConclusionsThe use of HHNS in TKA significantly increased accuracy in limb and implant alignment, but there was no significant difference in the two-years functional outcomes.

Use of hydroxyapatite-collagen bone graft substitute in long bone fracture management in canines

The present work was conducted on 6 clinical cases of dogs with fractures of femur (5) or humerus (1). In all the animals, the fracture was immobilized by an internal fixation technique using an appropriate size titanium elastic pin. The fracture gap was filled with hydroxyapatite-collagen granules. Postoperative radiographic evaluation on days 15 and 30 revealed mild to moderate periosteal reaction in four animals. Fracture union was seen in three animals by 60th day and in other three animals by 90th day. Post-surgery clinical examination revealed a continuous reduction in lameness and increase in weight-bearing. Based on the results, it was concluded that hydroxyapatite-collagen composite could be used as an alternative to bone graft to fill the fracture defect.

Satisfactory clinical and radiologic outcomes with a new shorter and modular stem for end-stage hip osteoarthritis: an international prospective multicentre pilot study.

Introduction: This multicenter prospective cohort study aimed to assess the safety and clinical and radiologic performance of the CLS® BreviusTM Stem with Kinectiv® Technology. Material and Methods: A total of 222 consecutive subjects, recruited in five different centers, qualifying for primary total hip arthroplasty (THA), were enrolled in the study. All the subjects received the CLS® BreviusTM Stem with Kinectiv® Technology. All the enrolled study subjects underwent pre-operative clinical and radiographic evaluation. Additionally, all subjects underwent post-operative clinical, functional and radiographic evaluations at 6 months and 1, 2, 3, and 5 years. These evaluations included implant survival, pain and functional performance (Harris Hip Score [HHS], University of California, Los Angeles [UCLA] Activity Score, Oxford Hip Score), subject quality-of-life (EQ-5D), radiographic parameters, complications, and concentration of metal ions (aluminum and titanium) in blood. Results: No revisions were performed during the follow-up period. Of the 222 patients, only 76 completed the 5-year follow-up. Only 7 and 5 patients had aluminum and titanium 5-year evaluations, respectively. All the clinical parameters showed an overall improvement in the overtime measured with ANOVA for repeated measures; furthermore, the clinical scores showed a statistically significant improvement at 5 years with respect to pre-operative value (p < 0.001). Aluminum and titanium showed no variation for repeated measures at different time points (p > 0.05). A total of six complications were reported, of which only two were hip-related. Conclusions: The function of the CLS® BreviusTM Stem with Kinectiv® Technology indicated that subject well-being significantly increased following THA regardless of age, gender, BMI, previous surgery, primary diagnosis, and lifestyle.

Effectiveness of a Superelastic Nitinol Device for Fixation of Syndesmosis in Ankle Fracture

Category:Ankle; TraumaIntroduction/Purpose:Syndesmosis injuries are increasingly common. Available fixation options are not yet optimal. The PUMA System (Panther Orthopedics, Sunnyvale, CA) is an FDA-cleared superelastic, nitinol-based fixation device for the ankle syndesmosis which provides stabilization without over-compression or loosening during cyclical loading. The spring-like design of the PUMA System allows physiological micro-motion while maintaining continuous compression and resisting syndesmosis widening, without material creep. The objective of this prospective study is to assess the effectiveness and complication rate of the PUMA device for treatment of fracture-associated syndesmosis injuries.Methods:We prospectively collected radiographic and clinical data on 32 consecutive patients treated for fracture-associated syndesmotic disruption with the PUMA SystemTM at 8 centers. Primary outcome measures included adverse event rates, radiographic evaluations for syndesmosis integrity and implant failure, and rates of revision surgery.Results:All 32 patients had successful repair of their ankle syndesmosis (Figure 1). The mean age of patients at time of operation was 42 years (range 16- 68). There were 13 females (13/32, 40.6%) and 19 (19/32, 59.4%) males. Postoperative radiographic evaluations confirmed satisfactory syndesmosis healing with maintained reduction in the ankle mortise in 33/33 (100%) ankles. There was no evidence of lysis, device migration or syndesmotic or medial clear space widening. There were no infections or soft tissue complications. All fractures healed. No devices required removal and there were no revision surgeries.Conclusion:The PUMA SystemTM provides physiologic stabilization of the syndesmosis due to the design features that allow for continuous compression without creep. We found no device-related complications nor construct failures in our series. The superelastic implant design allows physiologic motion at the syndesmosis but does not creep or stretch following displacement. This flexibility obviates the need for routine removal. The implant's low-profile buttons without suture and knot tying requirements eliminate the concern for subcutaneous knot irritation and slippage. Additional biomechanical and clinical outcomes study of this device may further optimize rehabilitation protocols for patients treated for syndesmotic injury.

The SUPERankle procedure in the treatment of foot and ankle deformities in fibular hemimelia

Objective: To review indications for limb amputation or reconstruction using the SUPERankle procedure in patients diagnosed with Paley type 3 or 4 fibular hemimelia; To evaluate the correction of deformities needed to achieve a stable plantigrade foot, review variations of the original technique and their applicability, and describe challenges encountered in their execution. Methods: Qualitative, retrospective, descriptive study of 4 patients who underwent the SUPERankle procedure between 2019 and 2020 for treatment of foot and ankle deformities in fibular hemimelia. Pre- and postoperative clinical and radiographic evaluations were performed to identify objective evidence of the correction of foot and ankle deformities. The operative techniques employed are described. Results: The included patients met anatomical and psychosocial criteria for reconstruction, as established in the literature. Clinical correction of foot and ankle deformities was achieved, but on radiographic evaluation, there was no statistical difference; this was likely due to the small number of patients, given the rarity of fibular hemimelia. Conclusion: The procedure is reproducible, but requires a knowledgeable, well-trained surgical team. Correction of foot and ankle deformities can be achieved. The choice between amputation or reconstruction should be the result of an informed decision by Family members, supported by a multidisciplinary team. Level of Evidence IV; Qualitative Study; Case Series.

P-BN15 Outcomes following surgical repair of giant para-oesophageal hernia of over 200 cases with long-term follow up: a 20-year experience

Abstract Background Symptomatic giant para-oesophageal hernia (PEH) can often be troublesome and may require surgical intervention. It commonly presents with dyspnoea, post-prandial pain, vomiting and dysphagia but rarely strangulation. In a good proportion of patients, iron deficiency anaemia may also be present. Patients are often elderly and may have co-morbidities and hence there may be a reluctance to refer and to offer surgery. This long-term study offers an insight to the outcomes following this complex surgery in a relatively elderly cohort of patients. Methods A retrospective analysis of prospectively collected data of patients who underwent surgery for symptomatic PEH from January 2001- June 2021 was performed. Clinical presentation, management, post-operative clinical outcomes, radiographic evaluation, pre and post-operative haemoglobin levels, respiratory function {Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 Second (FEV1)} as well as quality-of-life (QoL) with SF-36 questioners (including general health, physical, emotional and social components) were assessed. Results 202 patients (122-females) with median age 68 years (36-88) underwent PEH-surgery. The commonest symptomEighty-one presented with dyspnoea(41%). Ninety-five(47%) were ASA III, 119(59%) had microcytic-anaemia. 142(70%) had a fundoplication during PEHR. Hospital-stay was significantly lower in laparoscopic group Mortality:1.8%(2/112). Median follow-up:10 years. Symptoms improved in 166(82%) with respiratory function and anaemia. 42(21%) had radiological recurrences but only nine (4.5%) clinical recurrence requiring surgery. Conclusions Laparoscopic repair of giant para-oesophageal hernia is safe with good outcomes in all age groups with improvement in symptoms, quality of life, respiratory function and associated anaemia.