Radiological Outcomes Of Patients Research Articles

Osteosynthesis with anatomic reduction after malleolar fractures improves ten years outcome: a single center trial

IntroductionMalleolar fractures are the most common ankle fractures and a major risk factor for ankle osteoarthritis in the long-term. Little is known about modifiable risk factors for a satisfactory outcome. This study aimed to assess the long-term clinical, functional and radiological outcomes in patients after osteosynthesis.MethodsIn this retrospective single center study, we assessed the difference in patients who underwent surgical intervention for malleolar fractures sustained between 2007 and 2014. The reduction was assessed on the first postoperative radiograph. At follow-up patients completed a questionnaire, including the European Foot and Ankle Society (EFAS) and Short Form-12 (SF-12) scores to evaluate patient-reported outcomes and quality of life. Ankle osteoarthritis was assessed using the Kellgren and Lawrence classification.ResultsOne hundred seventeen patients, 102 with anatomic reduction and 15 with malreduction, were reached at mean follow-up at 11.4 years and 10.9 years. The mean EFAS score was 18,0 for anatomic and 16,1 for nonanatomic reduction and 6.1 and 4.5 for the sport component. The rate of satisfaction with the result was 8.2 in anatomic reduction and 7.5 in the malreduction. There was no significant difference in the SF-12 group between the two groups. Anatomic reduction is a protective facture for a satisfactory outcome in the univariate model with the hazard ratio of 5.94.ConclusionAnatomic reduction is one of the strongest protective factors for satisfactory outcome after malleolar fractures in a follow-up of more than 10 years.

A comparison of clinical and radiological outcomes following laminectomy and laminectomy with fusion in patients of cervical spondylotic myelopathy: A systematic review and meta-analysis.

To conduct a systematic review and meta-analysis comparing the functional and radiological outcomes in cervical spondylotic myelopathy (CSM) when treated by Laminectomy (LC) vs. laminectomy with instrumented fusion (LCF). The systematic review was conducted in accordance with PRISMA guidelines. A systematic electronic search was performed in PubMed, EMBASE, and CENTRAL databases. All Studies comparing clinical and radiological outcomes in patients with CSM when treated with LCF and LC were included in the systematic review. Neuromuscular function measured by modified Japanese orthopaedic association (mJOA), Cervical lordosis measured by C2-C7 Cobb's angle, and data on complications were retrieved from the studies. Random effect meta-analysis was used to account for heterogeneity. Quality assessment was performed using ROBINS-I and ROB-2 tools. Certainty of evidence was assessed using the GRADE working group recommendations. A total of 3985 articles were retrieved from the databases, of which 9 articles (1 RCT, 8 controlled comparative trials; n = 1146) met the eligibility criteria. The improvement in mJOA showed results favouring laminectomy with fusion with an SMD of 0.45 (95% CI, 0.07-0.84; p = 0.02). The loss of cervical lordosis was significantly lesser in the laminectomy with fusion group with an SMD of - 0.454 (95% CI, (- 0.12) - (- 0.79), p = 0.01). The complication rate in the LCF group was lower (LogOR = - 0.92; 95% CI: (- 1.30) - (- 0.55); p = < 0.05). In CSM, laminectomy with fusion is superior to standalone laminectomy in terms of improvement in m-JOA, maintenance of cervical lordosis and reduction in complications.

Comparison of Clinical Outcomes Between Nonoperative Treatment and Arthroscopically Assisted Stabilization in Patients With Acute Rockwood Type 5 Acromioclavicular Dislocation.

Currently, Rockwood type 3 acromioclavicular (AC) joint dislocations are initially treated nonoperatively, whereas surgery is recommended for Rockwood type 5 dislocations. However, multiple studies have been published favoring nonoperative approaches in patients with high-grade Rockwood injuries. To compare the clinical and radiological outcomes of patients with acute Rockwood type 5 AC joint dislocations treated nonoperatively versus with arthroscopically assisted stabilization. Cohort study; Level of evidence, 3. Included were 48 patients with acute Rockwood type 5 dislocation who were initially treated nonoperatively between June 2010 and June 2022 and 48 patients matched according to age, sex, affected side, and follow-up interval who underwent arthroscopically assisted coracoclavicular (CC) stabilization using a suture-button technique, with additional percutaneous AC tape cerclage. Clinical outcomes were assessed based on the Subjective Shoulder Value, Nottingham Clavicle Score, Constant score, and visual analog scale for pain. The radiographic assessment included the CC distance, CC difference ratio, and degree of horizontal instability at final follow-up (62 ± 43 months). At the final follow-up, the Constant score was significantly higher in the nonoperative group (P = .02). The operative group had significantly higher pain levels on palpation of the AC joint (1.2 ± 2.2 vs 0.19 ± 0.5 for the nonoperative group; P = .003). In the operative group, the mean CC difference ratio was significantly higher at the latest follow-up compared with postoperatively (1.3 ± 0.3 vs 0.67 ± 0.3, respectively; P < .001), whereas the CC difference ratio of the nonoperative group was significantly reduced at the latest follow-up compared with postinjury (2.0 ± 0.5 vs 2.6 ± 0.8, respectively; P < .001). The operative group had a significantly lower CC difference ratio compared with the nonoperative group at final follow-up (P < .001). More than half of the patients (56%) who were treated operatively had a loss of reduction resulting in a Rockwood type 3 state at the latest follow-up, whereas 54% of patients treated nonoperatively had spontaneous reduction of injury severity from Rockwood type 5 to Rockwood type 3. Although 15% of the nonoperatively treated patients eventually required surgery, successful nonoperative treatment showed similar outcomes to initial operative treatment in patients with acute Rockwood type 5 dislocation.

Functional and radiological outcomes and complications of bernese periacetabular osteotomy through modified Stoppa approach.

The Smith-Peterson approach and its modifications provide an extensive exposure and allow osteotomies through a single incision. However, the risk of complications increases when the quadrilateral surface, ischial and pubic osteotomy sites cannot be seen. This study aimed to evaluate the surgical characteristics, complications, and functional and radiological outcomes of patients with acetabular dysplasia who underwent Bernese periacetabular osteotomy (PAO) through modified Stoppa approach and plate-screw fixation. The study included 31 patients (41 hips) who had undergone PAO using a modified Stoppa approach. The characteristics of patients and the surgical procedure were described. The lateral centre-edge angle (LCEA) and Tönnis roof angle were evaluated in the radiological outcome evaluation. The modified Harris Hip Score (mHHS) was used to evaluate functional outcome. Furthermore, complications were described. The mean age of the patients was 20.4 ± 9.0 years. Of the 31 patients, 21 underwent unilateral Bernese PAO and 10 underwent bilateral Bernese PAO. The mean follow-up period was 25.1 ± 8.8 months. Postoperatively, the mean mHHS improved significantly (68.8 ± 9.4 vs. 88.8 ± 10.0, p < 0.001). Postoperatively, the mean LCEA and Tönnis roof angle improved significantly (17.7 ± 6.0 vs. 42.2 ± 4.8, p < 0.001 for LCEA and 18.3 ± 5.5 vs. 8.0 ± 2.2, p < 0.001 for Tönnis roof angle). There was no significant correlation between preoperative to postoperative improvement in LCEA or Tönnis roof angle and improvement and mHHS (p > 0.005). 5 complications were identified: 1 transient sciatic nerve palsy, 1 external iliac vein injury, 1 infection, and 2 screw irritations of acetabulum. Performing Bernese PAO through a modified Stoppa approach with plate-screw fixation results in acceptable complication rates, immediate early weight-bearing opportunity, and improved functional and radiological outcomes in patients with acetabular dysplasia.

ASYMMETRICAL CORTICAL VEIN SIGN (ACVS) PREDICT NEUROLOGICAL AND RADIOLOGICAL IMPROVEMENT IN LARGE AND DISTAL VESSEL OCCLUSION POST REPERFUSION THERAPY

ABSTRACT Purpose To investigate the dynamic changes in ACVS on SWIs in patients who underwent reperfusion therapy and evaluate their association with neurological and radiological improvement Materials and Methods All patients treated for acute ischemic stroke between June 2020 and June 2022, in a single tertiary centre (Hospital Sultan Abdul Aziz Shah) who underwent reperfusion therapy and MRI imaging were retrospectively identified based on clinical and radiology reports. Expected Results This study hypothesizes an improvement in ACVS is expected to correlate with favourable neurological outcomes (MRS at 3 months and NIHSS score) and radiological outcome (DWI / ASPECT scores and Modified Mori score). Conversely, a worsening of ACVS is anticipated to be associated with unfavourable neurological and radiological outcomes. Conclusion Asymmetrical Cortical Vein Signs (ACVS) can serve as a valuable predictor of neurological and radiological outcomes in patients with large and distal vessel occlusion after reperfusion therapy Keywords: ACVS (The Asymmetrical cortical vein sign), Ischemic penumbra , Large vessel occlusion (LVO), Distal vessel occlusion (DVO)

Cross-Screw Fixation in Isolated Medial Malleolar Fractures.

Isolated medial malleolar fractures are observed less often than are lateral malleolar fractures, bimalleolar fractures, and trimalleolar fractures. The aim of treatment is to provide anatomical reduction, protect this reduction until the fracture heals, and to regain normal ankle function. The aim of our study was to evaluate the clinical and radiological outcomes of patients with isolated medial malleolus fracture treated with cross-screw fixation. The study included 13 patients: 9 males with a mean age of 37.1 years (range, 25-64 years) and 4 females with a mean age of 40.2 years (range, 24-62 years) who were treated with the cross-screw fixation method for an isolated medial malleolar fracture. The fracture union status was evaluated on the 3-month postoperative radiographs, and the functional outcomes with the American Orthopaedic Foot and Ankle Scale (AOFAS) ankle score. The mean AOFAS score was 82 at 3 months postoperatively, evaluated as an excellent outcome in 2 patients, good in 9, and fair in 2. At the 24th month postoperatively, the mean AOFAS score was determined to be 92.2, evaluated as excellent in 11 patients and good in 2. On palpation of the medial malleolus, the mean VAS pain score was 2 (range, 1-3.8) at 3 months postoperatively, and a mean of 0.6 (range, 0.2-3) at 24 months. Cross-screw fixation can be preferred for the fixation of isolated medial malleolar fractures as it causes less soft-tissue damage because it can be performed percutaneously, and the screw head has a low profile, thereby eliminating the need for a Kirschner wire to be applied together with the screw to prevent rotational deformity.

Traumatic native hip dislocation in the absence of acetabular or femoral fracture in adults: a retrospective study reporting clinical and radiological outcomes from a major trauma centre in the United Kingdom.

Posterior native hip dislocations (NHD) are high-energy injuries. Thompson-Epstein Type I dislocations describe those without significant associated femoral or acetabular fracture. The aim of this study was to compare the clinical and radiological outcomes of patients with Type I NHDs. We also evaluate the association between radiological indicators of femoroacetabular impingement (FAI) and NHD. A retrospective study from January 2012 to May 2021 compared skeletally mature patients (⩾16 years) with Type I posterior NHD to age and gender-matched controls with Type II-V posterior NHD. Patient demographics, mechanism of injury, complications and patient-reported outcome measures (PROMs) are presented. Post reduction radiographs and computed tomography were used to assess for FAI. Univariate analyses were performed to evaluate radiological outcomes. 13 patients (77% male) with Type I posterior NHD were compared to a control group of 40 patients (80% male) with Type II-V posterior NHD. 11 patients in the study group and 14 in the control group experienced isolated injuries (p = 0.01). Post-reduction complications were similar. The study group had significantly lower post-injury osteoarthritis incidence (n = 0) compared to controls (n = 18, p = 0.0083). Patients reported a mean Oxford Hip Score of 43.5 ± 2.2 and EQ-5D-VAS score of 87.1 ± 7.4, with 6 patients indicating minimal symptoms across all EQ-5D-5L domains. Radiological femoroacetabular impingement (FAI) was prevalent in both groups, especially among males. Patients who underwent emergent closed reduction of Type I NHD demonstrated good short to medium term outcomes. Our radiological findings suggest a high prevalence of FAI. Future work should aim to quantify longer term outcomes following this injury. We call for further comparative studies of patients who suffer NHD with and without fractures to aid our understanding of risk factors. Given the rarity of this injury, multicentre efforts will be required to capture large numbers of patients.

A Comprehensive Characterization of Patients with Spinal Cord Neurosarcoidosis: A Single Center Cross-Sectional Study of Clinical Outcomes.

Background/Objective: To describe the clinical features and radiological outcomes of patients with spinal cord neurosarcoidosis, treatments, and long-term follow-up for this rare disorder. Methods: A cross-sectional, retrospective medical chart review was performed for all patients with spinal cord neurosarcoidosis treated at a single center between 01/1995 and 12/2020. Radiological imaging, laboratory test results, the type of immunosuppressive therapy, and function test scores were reviewed. Results: We assessed 39 patients with spinal cord neurosarcoidosis (23 men, 16 women, mean age at presentation 46.4 years, SD 10.2 years). The mean (SD) duration of spinal cord neurosarcoidosis at data abstraction was 9.8 (6.3) years. There were 24 patients (62%) with extensive intramedullary lesions, 8 (21%) with multiple patchy intramedullary lesions, 12 (31%) with leptomeningeal involvement, and 7 (18%) with nerve root enhancement. The cervical spine was the most commonly affected region in 33 patients (85%). The most common presenting symptoms were paresthesia/neuropathic pain in 20 (51%) and weakness of extremities in 15 (38%) patients. Most patients (n = 37; 95%) had been treated with corticosteroids at symptom onset, and methotrexate was the most used immunosuppressive therapy (n = 19; 49%). Of 34 patients with follow-up magnetic resonance imaging (MRI) available, the median time to improvement per MRI was 10.8 months (95% CI, 6.1-17.0 months). Of 31 patients with MRI enhancement at presentation, 18 (58%) had complete enhancement resolution at follow-up, with a median time to resolution of 51.8 months (95% CI, 24.9-83.4 months). Patients had significantly lower pyramidal (p = 0.004) and sensory functional (p = 0.031) systems scores from presentation to the last clinic visit. Conclusions: Because spinal cord neurosarcoidosis is challenging to diagnose and no set treatment guidelines exist, clarifying patients' clinical parameters and responses to various treatments is needed to improve timely and efficient care. The incidence of spinal cord involvement in sarcoidosis in our cohort was higher than intracranial involvement and most patients had a long extensive intramedullary lesion. We also observed that most patients with spinal cord neurosarcoidosis improved clinically and radiologically after treatment; however, the resolution of MRI enhancement after immunosuppressive therapy may take years. Prospective studies of neurosarcoidosis will be crucial to address questions about effective treatment and long-term prognosis.

Does the Angulation of the Screws in the Zero-P Implant Affect the Clinical and Radiological Outcomes of Patients?

When implanting the Zero-P device, the screws of Zero-P form a bone wedge with a 40 ± 5° cranial and caudal angle (CCA). However, no study has been performed in the optimal CCA of the Zero-P implant. To investigate whether the cranial/caudal angles (CCA) of the screws affect the clinical and radiological outcomes in patients undergoing ACDF with the Zero-P implant. From January 2016 to December 2023, we retrospectively analyzed 186 patients who underwent 1-level ACDF with the Zero-P device. The patients were divided into four groups: group A (cranial angle ≤40°, caudal angle ≤40°); group B (cranial angle ≤40°, caudal angle >40°); group C (cranial angle >40°, caudal angle ≤40°); and group D (cranial angle >40°, caudal angle >40°). The clinical outcomes, including Japanese Orthopaedic Association (JOA), neck disability index (NDI), and visual analogue scale (VAS) scores, the radiological parameters, including cervical lordosis (CL), cervical lordosis of operated segments (OPCL), intervertebral space height (ISH) and fusion rate (FR), and the complications, were evaluated and compared. Parametric tests, non-parametric tests, and chi-square tests were conducted to analyze the data. The OPCL of group A was significantly less than that of the other groups at the final follow-up (p < 0.05). The ISH of group D was significantly less than that of group A at the final follow-up (p < 0.05). The subsidence rate of group A was significantly less than that of group D at the final follow-up (p < 0.05). At the final follow-up, the upper adjacent-level degeneration (ASD) of group D was significantly less severe than that of groups A and B (p < 0.05). The clinical outcomes do not differ among groups (p > 0.05). A larger CCA of the screws (cranial angle >40°, caudal angle >40°) was better for maintaining OPCL and reducing the incidence of ASD. A smaller CCA of the screws (cranial angle ≤40°, caudal angle ≤40°) was better for maintaining ISH and reducing the rate of subsidence.

Double-bundle ACL combined with ALL reconstruction for patients at high risk of ACL failure: clinical and radiological results

BackgroundWe investigated whether double-bundle (DB) anterior cruciate ligament (ACL) reconstruction (ACLR) combined with anterolateral ligament reconstruction (ALLR) improved clinical and radiological outcomes in patients at high risk of ACL failure. The primary outcome was graft failure, and secondary outcomes included knee stability and patient-reported outcome measures (PROMs).Patients and methodsFifty-two patients who underwent DB ACLR combined with ALLR were included in this retrospective cohort study. Preoperative risk factors, including femorotibial angle (FTA), lateral tibial slope (LTS), medial tibial slope (MTS), and meniscal tears, were assessed using X-ray and magnetic resonance imaging (MRI). The grade of post-operative pivot shift, Lysholm score, and Tegner activity score were used to assess clinical outcomes. The minimum follow up duration was 2 years.ResultsThe cohort (mean age, 26.1 ± 9.4 years; 51.9% male) had a mean follow-up duration of 28.9 ± 3.4 months. Preoperatively, 57.8% had lateral meniscus (LM) tears, and 61.0% had a grade 2–3 pivot shift. Postoperatively, no graft failures or revision cases occurred during follow-up. Approximately 90.4% of the patients exhibited a negative pivot shift (p < 0.001), with Lysholm and Tegner activity scores of 92.5 ± 6.1 and 5.1 ± 2.0. The medial meniscus (MM) tear group had a significantly smaller FTA than the intact group (p = 0.043). No significant differences in PROMs were found between the LM tear and intact LM groups or between the high and low MTS or LTS groups (p = n.s.).ConclusionDB ACLR combined with ALLR had satisfactory clinical outcomes in patients at high risk of ACL failure, with no graft failures observed during a mean follow-up duration of 2.4 years. The technique effectively reduced the postoperative pivot shift, regardless of preoperative risk factors.Study designLevel IV, retrospective therapeutic case-series.Trail registrationethical approval number, 202300134B0; ethical committee, the Institutional Review Board of Chang Gung Medical Foundation.

Comparison of classical and minimally invasive superolateral approach for reconstruction of proximal humerus fractures with locking plates

ContextMinimally invasive (MI) approaches are purported to present advantages for osteosynthesis when compared with conventional approaches. This study aimed to compare the medium-term clinical and radiological outcomes of patients with proximal humerus fractures treated by plate osteosynthesis with conventional and MI superolateral approaches. MethodThe study carried out was a retrospective monocentric comparative analysis. Forty-three cases were followed up – 18 were treated with an MI approach and 25 with a conventional approach. Constant-Murley, DASH and SSV scores were established and standard complications were investigated. ResultsNo significant differences in functional scores or complications were found between the 2 groups. The only significant difference was for pain which was significantly lower for the MI group. The overall revision rate was 18.3 %. The mean adjusted Constant-Murley for the entire population was 80.1 ± 20.2; the mean DASH score was 17.8 ± 15.9 and the mean SSV was 73.2 ± 19.5. ConclusionThis study did not demonstrate any significant differences between the 2 approaches. Given the low patient population in our series, the superiority of the MI approach – as indicated in the literature – was not proven.

Cementless short stem total hip arthroplasty in patients older than 75 years: is it feasible?

BackgroundIn recent years, the indication for cementless short stem total hip arthroplasty (THA) has been widened to elderly patients as they might profit by the advantages of the short-curved implant design as well. Therefore, this study was conducted to evaluate the clinical and radiological outcome of a cementless short stem in elderly patients (≥ 75 years) compared to a young control group (≤ 60 years).MethodsA retrospective cohort of 316 THAs performed between 2014 and 2017 was prospectively examined. In all patients a cementless, curved short stem and press-fit cup (Fitmore® stem; Allofit®/-S cup; both ZimmerBiomet, Warsaw, IN, USA) were implanted via a minimally-invasive anterolateral approach. Clinical and radiological outcome as well as rate of complications and revision were assessed.ResultsIn total, 292 patients have been included for analysis of complications and revisions (Øfollow-up: 4.5 years) and 208 patients for clinical and radiological outcome (Øfollow-up: 4.4 years). Complication rate was significantly increased in elderly patients (13.7% vs. 5.8%, p = 0.023), while the revision rate was increased without statistical significance (5.2% vs. 2.2%, p = 0.169). Periprosthetic fractures occurred significantly higher in the elderly patients (5.2% vs. 0.7%; p = 0.026). Both groups showed a comparable clinical outcome in the Harris Hip Score (93.7 vs. 91.9; p = 0.224), Oxford Hip Score (44.5 vs. 43.7; p = 0.350), Forgotten Joint Score (81.7 vs. 81.5; p = 0.952) and WOMAC (7.4 vs. 9.3; p = 0.334).ConclusionCementless short stem total hip arthroplasty shows a comparable clinical and radiological outcome in patients over 75 years of age compared to younger patients under 60 years of age. However, cementless shorts stem THA shows an increased rate of overall complications and periprosthetic fractures in elderly patients over 75 years of age. Cemented fixation of the femoral component should be considered in patients over 75 years of age.Level of evidenceIII Case-controlled study.Trial registrationObservational study without need for trial registration due to ICMJE criteria.

Management of Neglected and Malunited Ankle Fractures

Abstract Background Ankle fractures are very frequent and they can present a variety of clinical features. Dislocated or unstable ankle fractures are generally treated with surgical anatomical reduction and internal fixation. Most of these fractures heal very well. However, some of these fractures fail to reduce and become malunited. Early biomechanical studies have demonstrated that lateral talar shift greater than 1mm may cause a loss of over 40% of the tibiotalar contact area. Aim of the Work The aim of the treatment is to obtain an ankle with normal alignment and function which exhibits no pain with preventing any degenerative changes that may take place in the future. Surgical options include refixation of non-united medial or lateral malleolus, lengthening of fibula, repair of neglected syndesmotic injury, and repair of other ligamentous injury. Patients and Methods Our study included 30 patients with malunited ankle fractures. The outcomes were compared pre and post operatively. The Inclusion criteria were patients with malunited or neglected ankle fractures, both sexes and Age between 20 – 60 years old. While, Exclusion criteria were patients suffering from peripheral vascular insufficiency, advanced ischemia, peripheral neuropathy, advanced tibiotalar osteoarthritis, soft tissue compromise, stiff ankle, infected non-union and skeletally immature patients. Results The AOFAS in patient with syndesmotic affection showed improvement from mean±SD 48.35±12.99 preoperatively to 82.71±10.32 postoperatively, while in patients with non syndesmotic affection showed improvement from 60.46±18.91 preoperatively to 86.77±20.79 post operatively. This means that this is significant increase in AOFAS score in both groups but its more obvious among patients with syndesmotic affection. The FAAM score in patient with syndesmotic affection showed improvement from mean±SD 46.47±15.96 preoperatively to 82.41±8.05 postoperatively, while in patients with non syndesmotic affection showed improvement from 54±18.96 preoperatively to 79.77±16.45 post operatively. It means that there is increase in FAAM score in both groups but its more significant among patients with syndesmotic affection. The FADI score among patients was mean±SD 49.87±11.39 preoperatively and 77.07±11.89 two years postoperative, there was statistically significant higher mean value of FADI in follow up compared to pre-operative. Conclusion There is statistically significant improvement in functional and radiological outcomes in patients with syndesmotic affections more than patients with non syndesmotic affection.

Haglund’s deformity: Clinical outcomes of endoscopic calcaneoplasty

Objective: Haglund’s deformity is characterized by a bony prominence of the calcaneus, leads to posterior heel pain, swelling, and morning stiffness. Endoscopic calcaneoplasty is becoming increasingly popular due to its numerous advantages over conventional surgical methods. This study aims to evaluate the clinical and radiological results of patients who underwent endoscopic calcaneoplasty. Materials and Methods: A total of 17 patients were diagnosed with Haglund’s deformity and underwent endoscopic calcaneoplasty surgery in our clinic between June 2019 and January 2023 were included in this retrospective study. Pre-operative and post-operative parameters of patients with 6 months or more of follow-up were compared. The VAS was used for pain assessment, the AOFAS score for functional outcomes, and the length of bone deformity for radiological assessment. Results: Significant pain resolution was observed at the final follow-up compared to the preoperative period. The mean VAS score decreased from 6.77±1.3 pre-operatively to 1.62±1.12 post-operatively (p&lt;0.001). The AOFAS score showed a significant increase from 61.23±7.7 preoperatively to 92.46±6.04 postoperatively (p&lt;0.001). Bony hump length decreased significantly from 4.12±1.14 preoperatively to -2.29±1.56 postoperatively (p&lt;0.001). Conclusion: Endoscopic calcaneoplasty is a reliable method in Haglund’s deformity, that provides rapid recovery, early return to daily activities and sports, and a low complication rate.

Radiological and functional outcomes of Reverdin Isham osteotomy in moderate Hallux Valgus: a systematic review and meta-analysis

This systematic review and meta-analysis addresses the effects of minimally invasive surgical techniques, specifically the Reverdin Isham osteotomy, on functional and radiological outcomes in patients with moderate Hallux Valgus, a common foot deformity. The review included randomized and non-randomized controlled trials, as well as case reports, assessing the osteotomy in adults with moderate to severe Hallux Valgus. Searches were conducted in electronic databases such as MEDLINE and Web of Science up until July 2023, and the Joanna Briggs Institute’s critical appraisal tool was used to assess the risk of bias. Meta-analytical analyses employed a random-effects model with small-sample correction, presenting results as standardized mean differences and mean differences with 95% confidence intervals. Seven studies involving 554 patients and 643 operated feet were included, showing significant improvements in AOFAS scores (an average improvement of 36 points from 28.61 to 45.16) and reductions in radiological angles such as the distal metatarsal angle and hallux valgus angle post-surgery (IMA improved by − 3.07° from − 4.68 to − 1.46, DMAA by − 6.12° from − 9.52 to − 2.71, and HVangle by − 15.27° from − 17.98 to − 12.57). Despite these positive outcomes, most studies exhibited risks of bias and other methodological limitations, impacting the generalizability of the results. Overall, the findings highlight the efficacy of the Reverdin Isham osteotomy in improving both functional and radiological parameters in patients with moderate Hallux Valgus, although further research is warranted to solidify these results. No specific funding was received for this study, and the protocol was registered on PROSPERO with the number CRD-42023445886.

The pie-crusting release of the medial collateral ligament in arthroscopic partial meniscectomy is associated with improved clinical outcomes without altering radiological measurements.

The aim of this study was to evaluate how the pie-crusting technique affects clinical and radiological outcomes in patients undergoing arthroscopic partial meniscectomy. A total of 68 patients with Kellgren-Lawrence (K-L) grade 2 who underwent arthroscopic partial meniscectomy between 2015 and 2021 were evaluated and divided into two groups as arthroscopic partial meniscectomy (36 patients) and arthroscopic partial meniscectomy with pie-crusting (32 patients) according to whether the pie-crusting technique was applied or not. All patients were evaluated at a minimum 2-year follow-up in terms of Lysholm score, Tegner activity score, International Knee Documentation Committee (IKDC) score and Visual Analogue Scale (VAS) score. To assess the impact of the pie-crusting technique, radiological measurements were conducted using radiographs taken before and after pie-crusting, as well as postoperative radiographs. Lysholm, Tegner, IKDC and VAS scores exhibited statistically significant differences after surgery compared to preoperative evaluations in both groups (p < 0.05). Furthermore, these scores were significantly superior in the arthroscopic partial meniscectomy with pie-crusting group compared to the arthroscopic partial meniscectomy group at 24 months postoperatively (p < 0.05). While the radiological measurements in the arthroscopic partial meniscectomy with pie-crusting group showed statistically significant differences before and after pie-crusting (p < 0.05), no significant difference was observed between before pie-crusting and 12 and 24 months postoperatively (n.s.). The current study is the first to demonstrate the true effectiveness of the pie-crusting technique. The application of the pie-crusting technique when necessary results in a statistically significant improvement in clinical scores without affecting radiological measurements for patients undergoing arthroscopic partial meniscectomy compared to not utilising it. Level III.

Which lumbar vertebra should be the lowest level of fusion in adolescent idiopathic scoliosis of Lenke types 5 and 6?

It is important to protect the mobile segment in the lumbar region in scoliosis surgery. The aim of this study was to compare the clinical and radiological results of patients who underwent surgery for a diagnosis of adolescent idiopathic scoliosis (AIS) with the lowest instrumented vertebra (LIV) at L3 or L4 level. The study included 36 patients who underwent surgical treatment in our institution for a diagnosis of Lenke type 5 and 6 AIS with a follow-up period of at least 24 months. The patients were separated into 2 groups according to the LIV level of L3 (n=21) and L4 (n=15). These 2 groups were compared preoperatively (PO), early postoperative (EPO), and at the final follow-up examination (last control (LC)) with respect to radiological parameters in the coronal and sagittal planes, and the Scoliosis Research Society - 22 (SRS-22) questionnaire values. In both groups the mean age (L3: 16 ± 7.3; L4: 17 ± 6.1 years) and follow-up periods (L3: 44 ± 20; L4: 47 ± 18 months) were similar. Radiologically, the L4 group had a greater Cobb angle in the scoliosis main curves measured PO (P=.001). The Cobb angles measured at EPO (P=.767) and at LC (P=.674) were similar in both groups. No significant difference was observed between the 2 groups in respect of the LIV tilt values at PO (P=.469), EPO (P=.297), and LC (P=.065). When the groups were evaluated separately, the LIV tilt values at EPO and LC were similar in the L4 group (EPO: 6.93 ± 3.058; LC: 7.26 ± 2.313; P=.618). In the L3 patients, although there seemed to be a significant increase in LIV tilt values when EPO values were compared with LC values (EPO: 8.47 ± 3.970; LC: 9.57 ± 3.76; P=.030), this was within the error range of Cobb angle measurement. The results of the SRS-22 questionnaire showed significantly better results in the L3 group in the domains of pain, function/activity, mental health, and satisfaction with treatment (P=.011, P=.002, P=.019, P=.046, respectively). There was no radiological superiority between L3 and L4 LIV groups in the thoracolumbar/lumbar curve patients. However, according to the SRS-22 questionnaire, the results of patients with L3 level LIV were better in the areas of pain, function/activity, mental health, and satisfaction with treatment. Cite this article as:Baymurat AC, Tokgoz MA, Abdulaliyev F, Tosun MF, Can MM, Senkoylu A. Which lumbar vertebra should be the lowest level of fusion in adolescent idiopathic scoliosis of Lenke types 5 and 6? Acta Orthop Traumatol Turc., 2024;58(2):116-123.

Clinical and radiological outcomes of extracranial carotid artery stent placement: A single-center study

Objectives: Carotid artery stenting (CAS) and carotid endarterectomy are established treatments for carotid artery stenosis. We evaluated the early and mid- to late-term clinical and radiological outcomes of patients who underwent CAS. Materials and Methods: This retrospective study included 98 patients (112 arteries), who underwent CAS. Baseline demographics, stent types, embolic protection devices, and procedural complication rates within 30-day and 3-year post-CAS, including transient ischemic attack (TIA), stroke, death, and stent restenosis, were analyzed. Results: The 30-day complication rates included TIA (5.1%), ipsilateral stroke (4.1%), and death (4.1%). At three-year follow-up, TIA (8.5%), ipsilateral stroke (2.1%), restenosis (1.1%), and death (6.4%) were observed. Contralateral carotid artery angiography revealed neointimal hyperplasia in two vessels (1.9%) and 70–99% restenosis 1 (1%). Notably, a significant association was observed between neointimal hyperplasia and stent geometry, with a higher incidence observed in open-cell stents compared to closed-cell stents (P = 0.03). Conclusion: Our study demonstrated comparable early-term and lower mid- to late-term complication rates compared to prior studies. A multidisciplinary approach with meticulous technique, appropriate materials, and careful patient selection can optimize CAS outcomes.

A retrospective investigation on clinical and radiographic outcomes of distal tibial fractures after intramedullary nailing using the lateral parapatellar extra-articular approach.

According to reports, the modified extra-articular parapatellar approach allows the performance of tibial nailing in the semi-extended position without the concern of joint violation. However, there remains no special study that has provided a detailed assessment of the benefits and risks of this approach for treating distal tibial fractures (DTFs). The aim of this retrospective study was to investigate the clinical and radiological outcomes of patients with DTFs after intramedullary nailing using a lateral parapatellar extra-articular (LPE) approach in comparison to using the suprapatellar (SP) and transpatellar (TP) approaches. Data were collected from 99 patients with a minimum follow-up period of 12 months. Comparisons were conducted between the groups regarding the number of intraoperative fluoroscopies, complications, knee pain, knee range of motion (ROM), the Lysholm Knee Scale (LKS), the Olerud-Molander Ankle Score (OMAS) and radiological findings. The demographic characteristics were comparable between the groups. Fewer intraoperative fluoroscopies were performed in the LPE (27.47 ± 4.98) and SP (26.03 ± 5.12) groups than in the TP group (30.20 ± 7.42; P<0.001). When compared with the other two approaches, the LPE approach was associated with less knee pain (P<0.001) and better knee ROM (P<0.001) at one week postoperative. No significant intergroup differences were detected in the incidence of complications, LKS scores (P = 0.687) and OMAS (P = 0.926). Radiological findings demonstrated that postoperative tibial alignment (P = 0.853), the time of bony union and rate of non-union were similar between the groups. The LPE approach can serve as a safe and effective option for tibial nailing, as it offers favourable outcomes in knee pain relief and knee ROM in the early postoperative period and is equivalent to the other two approaches in terms of the incidence of complications, fracture healing, functional recovery and postoperative alignment for patients with DTFs.

The small screw-apex distance is potentially associated with femoral head osteonecrosis in adults with femoral neck fractures treated by closed reduction and percutaneous 3 parallel cannulated screws

ObjectiveFemoral neck fractures (FNFs) are among the most common fractures in elderly individuals. Surgery is the main treatment for FNFs, and osteonecrosis of the femoral head (ONFH) is one of the unacceptable complications. This study aimed to assess both the clinical and radiological outcomes in patients with FNFs treated with three parallel cannulated screws and to identify relationship between screws position and ONFH.Patients and methodsA total of 100 patients who were treated with closed reduction and fixed with 3 parallel cannulated screws met the inclusion criteria between January 2014 and December 2020 at authors’ institution. The follow-up duration, age, sex, affected side, and injury-to-surgery interval were collected; the neck-shaft angle of both hips, screw-apex distance (SAD) and the tip-apex distance (TAD)were measured; and the Garden classification, quality of reduction and presence of ONFH were evaluated.ResultsThe sample consisted of 37 males and 63 females, with 60 left and 40 right hips affected. The mean age of patients was 54.93 ± 12.24 years, and the mean follow-up was 56.3 ± 13.38 months. The overall incidence of ONFH was 13%. No significant difference was observed in the incidence of ONFH by affected side, age, fracture displacement, injury-to-surgery interval, neck-shaft angle deviation, or reduction quality. The SAD was significantly shorter in ONFH patients than in normal patients for all three screws (p = 0.02, 0.02, and 0.01, respectively).ConclusionsThe short SAD of all screws is associated with femoral head necrosis of FNFs treated with 3 cannulated screws. The short SAD indicated that screws malpositioning in the weight-bearing area of the femoral head, potentially harming the blood supply and compromising the anchorage of the primary compressive trabeculae in this region.