Traumatology Department Research Articles

Predictive Factors of Amputation in Diabetic Foot

Background: Diabetic foot ulcers are a common complication of diabetes mellitus, often leading to progressive sensory deficits, impaired vascularization, and a predisposition to ulceration and gangrene. Untreated ulcers may cause recurrent infections that endanger a patient’s life. Amputation of part of the limb up to a well-vascularized level is one of the treatments employed for untreated ulcers. Objectives: Laboratory data were analyzed with the aim of identifying risk factors related to surgical amputation treatment of diabetic foot. We believe it is useful to identify risk factors that can be altered from a reversible condition in the clinical decision-making of treatment, thus manifesting themselves in a timely manner to provide the patient with an alternative to surgical amputation of the lower limb. Methods: Our retrospective study was conducted by the Department of Orthopedics and Traumatology at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome. We recruited 200 patients who underwent lower limb amputation for diabetic foot between 2017 and 2021 and had blood tests both 30 days and within 5 days before the first surgery. Results: This case–control study revealed a significant negative correlation between hemoglobin (Hb) levels and the occurrence of leg amputations. In contrast, C-reactive protein (CRP) levels, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) showed significant positive correlations with leg amputations. A 3-year follow-up of the cases also revealed a significative positive correlation between age, white blood cells (WBC) count, NLR, PLR, and death at 3 years. Conclusions: Our findings suggested that lower Hb levels and elevated CRP, NLR, and PLR levels in patients with diabetic foot disease may be associated with a higher risk of lower-limb amputation. Unexpectedly, this study also demonstrated that elderly age, WBC, CRP, NLR and PLR levels may be associated with a negative prognosis for these patients. These findings highlighted the importance of monitoring these laboratory values in diabetic patients to identify individuals at higher risk of leg amputations and implement appropriate interventions to prevent or minimize the occurrence of this severe complication.

Patterns of orthopedic injuries associated with increasing e-scooter-related trauma: A retrospective observational study with a 4-year evaluation from a tertiary center in Istanbul, Turkey.

The increasing use of electric scooters (e-scooters) has been accompanied by an increase in the number of traumas. Noncompliance with regulations and the effectiveness of legal measures remain subjects of ongoing debate. This study aimed to investigate the demographic characteristics of patients with e-scooter-related orthopedic injuries, temporal distribution of trauma, and patterns of these injuries. We retrospectively evaluated 534 patients with e-scooter-related injuries who were referred to the Department of Orthopedics and Traumatology between January 2020 and October 2023. Variables such as patient sex, age, time of trauma, type of hospital transfer, mechanism of trauma, injury location and type, accompanying head trauma in extremity injuries, and treatment approach were recorded. Temporal analysis was performed by hour, day, month, season, and weekday versus weekend. The majority of patients were male (80.0%), with injuries most common in the 25 to 39 age group (33.7%). Trauma was frequent in the summer (45.7%), especially in July (16.5%), with most hospital visits occurring on Fridays (18.2%) and weekends (32.2%). Blunt soft tissue injuries (47.3%) and fractures (42.4%) were prevalent, particularly in the elbow (18.4%), wrist (16.9%), and knees (14.3%). A total of 247 fractures were identified, with the radial head (17.0%) and distal radius (10.9%) being the most common fractures. Fracture rates have increased in 2022 and 2023 compared to those in previous years. While 86.0% of patients received nonsurgical treatment, 14.0% underwent surgery, with a rise in surgical cases in 2022 and 2023. Elbow (19.0%), knee (16.7%), and wrist (16.7%) were the most frequent surgical sites. The increasing use of e-scooters among young people has increased trauma cases, with a growing proportion of fractures over time. The higher incidence of injuries, particularly in the elbow and knee joints, underscores the importance of protective equipment. Therefore, additional legal regulations can help to prevent such injuries.

The Predictive Effect of the Level of Psychological Resilience on the Level of Readiness for Discharge in Patients Undergoing Orthopaedic Surgery.

The aim of this study is to establish the correlation between the degree of psychological resilience and readiness for discharge in patients undergoing orthopaedic surgery. This study is of a descriptive correlational type. This study comprised a cohort of 190 patients who were admitted to the orthopaedics and traumatology department and had surgical procedures performed between November 2023 and April 2024. The study data were gathered via completion of the Introductory Information Form, the Psychological Resilience Scale and the Hospital Discharge Readiness Scale. IBM SPSS 25 package program was used to analyse the research data. In this study, 34.2% of the participants stated that they did not feel ready for discharge. Predictors of Readiness for Hospital Discharge were identified as being male (β = 0.118, p = 0.003), living alone (β = 0.222, p < 0.001), having undergone prosthesis, fracture or amputation surgery (β = 0.161, p < 0.001), not having received discharge training (β = 0.122, p = 0.001), not feeling ready for discharge (β = 0.442, p < 0.001) and resilience (β = 0.246, p < 0.001). These variables were found to explain 88.7% of Readiness for Hospital Discharge (adjusted R2 = 0.773). The findings of this study emphasise that including patients in their healthcare and creating comprehensive discharge plans tailored to their specific care requirements have a beneficial impact on their readiness for discharge. Additionally, the study demonstrates that enhancing psychological resilience plays a mediating role in facilitating discharge readiness. Patients who feel ready for discharge are less likely to be hospitalised and their recovery may be faster. Including the patient in the discharge plan, taking individual needs into consideration and disseminating programmes to increase resilience should be an integral part of holistic care. The STROBE checklist was applied in the reporting of the finding.

Multivariate analysis of blood parameters for predicting mortality in patients with hip fractures.

The present retrospective cross-sectional study aimed to evaluate the predictive value of blood parameters and ratios for predicting mortality in patients with hip fractures. In total, 758 patients with hip fractures attending the Department of Orthopedics and Traumatology, Kütahya Health Sciences University Faculty of Medicine (Kütahya, Turkey) between January 2016 and January 2023 were included in the present study. Patients were then divided into two groups, namely the mortality (n=464; 61.2%) and survivor (n=294; 38.8%) groups. Patients in the mortality group were further sub-divided into the following three subgroups: i) Those who succumbed in <1 month (n=117; 25.2%); ii) those who succumbed between 1 and 12 months (n=185; 39.9%); and iii) those who succumbed >12 months later (n=162; 34.9%). In addition, the RDW coefficient of variation, mean platelet volume (MPV), MPV/platelet ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), mean platelet volume-to-lymphocyte ratio and monocyte-to-eosinophil ratio means were all found to be significantly higher in the mortality group (P<0.05). MPV (P<0.01), HGB (P<0.05), eosinophil, EOS (P<0.01), HRR (P<0.01), and PLR (P<0.05) were all revealed to exert significant effects on mortality. An age cut-off of 74.50 years had a sensitivity of 81.5% and specificity of 37.1%, whereas an MPV cut-off of 8.85 yielded a sensitivity of 73.5% and specificity of 36.1%. By contrast, an HGB cutoff of 11.05 had a sensitivity of 55.6% and specificity of 35.7%, an eosinophil cut-off of 0.065 had a sensitivity of 47.6% and specificity of 35.4%, whilst a HRR cut-off of 0.7587 had a sensitivity of 55.2% and specificity of 30.3%. Furthermore, a PLR cut-off of 152.620 had a sensitivity of 67.2% and specificity of 41.8% for hip fracture-associated mortality. An age cut-off of 79.50 years had a sensitivity of 70.9% and specificity of 41.5%, while an age cut-off of 83.50 years had a sensitivity of 46.2% and specificity of 64.0% for mortality occurring <1 month after hip fractures. To conclude, results from the present study suggested that HRR has potential predictive value for hip fracture-associated mortality and 30-day mortality, whereas the PLR could only predict hip fracture-associated mortality.

Efficacy of titanium locking plate combined with suture anchor repair on ankle joint functional recovery and quality of life in patients with ankle fractures.

To evaluate the efficacy of titanium locking plate combined with suture anchor (SA) repair in the treatment of ankle fractures (AF). Retrospective analysis of clinical data of 170 patients with AF who underwent surgical treatment at the Department of Traumatology and Orthopedics of Wuhan Fourth Hospital, China from May 2020 to June 2023 was conducted. A total of 83 patients underwent conventional open reduction and internal fixation (control group); 87 patients received titanium locking plates combined with SA repair (observation group). Ankle joint functional recovery (measured using the Mazur Ankle Grading Scale), quality of life (measured using the Generic Quality of Life Inventory-74), and incidence of complications were compared between two groups. Active range of motion and muscle strength of the ankle joint in plantar flexion and dorsiflexion states, and medial clear space and talar tilt angle were also analyzed. The rate of excellent recovery of ankle joint function in the observation group was significantly higher than that in the control group (P<0.05). Six months after surgery, active range of motion and muscle strength of the ankle joints in the plantar flexion and dorsiflexion states in the observation group was significantly higher than that in the control group (P<0.05). The medial clear space and talar tilt angle of the observation group was significantly smaller compared to the control group (P<0.05). The quality of life in the observation group was significantly higher than that in the control group, and the incidence of complications in the observation group was significantly lower than that in the control group (P<0.05). Titanium locking plates combined with SA repair for the treatment of AF can significantly improve ankle joint functional recovery, improve the quality of life of patients, and is associated with a lower incidence of complications.

Clinical, functional and neuropsychological status of joint replacement patients

Introduction The number of hip and knee replacement surgeries is increasing annually in Russia and worldwide. The majority of patients receiving joint arthroplasties are elderly women.The objective was to assess the clinical, functional and neuropsychological status of patients undergoing total knee or hip replacement.Material and methods The study included 448 patients admitted for elective surgery of total knee or hip replacement at the Department of Traumatology and Orthopedics of the Federal Center for High Medical Technologies (CHMT, Kaliningrad Region). Anthropometric parameters of the patients were measured, the medical history and concomitant diseases recorded. Common blood count and biochemistry test were evaluated preoperatively. Neuropsychological examination included assessment of cognitive and executive functions, levels of distress, depression, anxiety and somatization.Results Almost all patients studied were found to have varying degrees of obesity. A typical combination of concomitant pathology in volunteers was stage 2 hypertension, risk degree 2–3, and chronic gastritis in remission. Half of the volunteers showed moderate and high levels of distress, depression, anxiety and somatization. A significant number of volunteers showed moderate to high levels of cognitive decline. Age- and sex-related blood counts were slightly different from the normal ranges for a CBC and biochemistry. Changes in leukocyte count were detected.Discussion Leukocyte counts indicated the osteoarthritis induced inflammatory process in most patients. Mitochondrial dysfunction and aging of the immune system contributed to the “proinflammatory status.” The high rate of cognitive impairment in volunteers was associated with age and comorbidity, cardiovascular conditions, in particular. Distress and anxiety were associated with emotional reactions to surgery.Conclusion The factors reported can affect the duration and course of rehabilitation. The “pro-inflammatory status” of patients can complicate the healing of a postoperative wound. Neuropsychological disorders noted during postoperative rehabilitation can have a significant impact on physical recovery, social and professional adaptation.

Effectiveness of Soleus Muscle Flap for The Coverage of Wound in Open Tibia Fracture in The Mid Shaft

Introduction: An open fracture of the tibia has been one of the most common long bone injuries. Soleus muscle flap supply can be a remedy for this kind of soft tissue difficulties. The soleus muscle flap’s blood supply may help in the construction of a longer, safer, and more functional flap. When the incision is clinically fit for covering, the flaps from the same leg are elevated between 0 and 14 days following the damage. In the majority of these cases, the flaps are covered with a split-thickness skin graft taken from the anterior aspect of the thigh in the same sitting. This can be a great solution. Aim of the study: The study aimed to assess the effectiveness of soleus muscle flap for the coverage of wound in open tibia fracture in the mid shaft. Methods: This prospective interventional study aimed to evaluate the outcomes of early coverage using the soleus muscle flap in the management of Gustilo type-IIIB fractures of the mid-shaft tibia. The study followed a quasi-experimental design and was conducted over an 18-month period from January 1, 2010, to June 30, 2011. The research took place in the Department of Orthopaedics and Traumatology at Dhaka Medical College Hospital (DMCH) and the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) in Dhaka. The study population included all 15 patients admitted to the hospitals with clinical and radiological evidence of open Gustilo type-IIIB fractures of the mid-shaft tibia followed by the inclusion and exclusion criteria. Informed written consent was taken before data collection and confidentiality was maintained. The analysis was done by SPSS version 15. Result: Among 15 patients most (12) were male, 3 were female. Mean age was 38 ± 12 years. Majority were in 31-45 years. Male female ratio was 4:1. The selected study subjects were predominantly motor driver (26.66%), followed by day labor, housewife, service holder, farmer, and businessman (each was-13.33%), and student was 6.66%. ...

Complications following total wrist replacement: A single-center retrospective review

Background/Purpose: Total wrist replacement (TWR) is an alternative to wrist fusion in advance wrist arthritis with the advantage of preserving the wrist motion. TWR is, however, infrequently performed in Asia-Pacific region. This study aimed to describe our institution's experience in managing complications following TWR. Methods: This study represents a single-center retrospective review of all patients who underwent TWR at the Department of Orthopedics and Traumatology, Prince of Wales Hospital in Hong Kong. The study period spans from 1 January 2004 to 1 March 2023. Recorded demographic parameters include gender, age upon surgery, pathology, types of implants, and follow-up period. Outcomes focused particularly on postoperative complications and need for revision surgery. Results: Twelve TWR from 10 Chinese-Asian patients were reviewed with a mean follow-up duration of 97.4 months. The incidence of complications in our study was as follows: loosening (16.67%), metallosis (8.3%), infection (8.3%), and stiffness (8.3%). One patient required conversion to total wrist arthrodesis due to metallosis and stiffness. Conclusion: TWR offers promising solutions for managing painful arthritic wrists. However, it's crucial to recognize that complications can arise, necessitating further surgical intervention. Surgeons must thoroughly comprehend these risks to provide informed counseling to patients and explore alternative treatment approaches.

Magnetic Resonance Imaging Features and Functional Score in Patients Requiring Total Knee Arthroplasty.

Introduction Knee osteoarthritis (KOA) is a progressive degenerative disease, with an increasing prevalence among the population. The degenerative changes in KOA affect the cartilage, menisci, synovial tissue, and subchondral bone. The treatment for patients in advanced stages of the disease is total knee arthroplasty (TKA). The purpose of this descriptive study is to identify the MRI features in the case of patients with KOA who did not obtain an improvement in symptoms and joint function after the non-surgical treatmentsand who applied for surgical treatment, i.e. TKA. Also, we aimed to identify the correlations between the MRI changes and the functional score of the patients, as well as the inter-variable correlations. Materials and methods The study was conducted in the Department of Orthopedics and Traumatology at the University Emergency Hospital of Bucharest between January 1, 2023, and January 31, 2024. It included 50 patients who required TKA. This study is a prospective, observational, and descriptive analysis focusing on patients scheduled for TKA. Results The patients in the study group who required TKA had a Knee Society Score (KSS) ranging from 35 to 70and a KSS function score between 24 and 60. Among them, 98% had tricompartmental lesions of the articular cartilage, and 100% presented with osteophytes, even when they were not identifiable radiologically. Additionally, 58% of the patients had changes in the infrapatellar fat pad, 66% presented with joint effusion without any traumatic history, and 86% of the patients had partial or complete lesions of the anterior cruciate ligament. Conclusion TheMRI pattern of the patient who requires TKA consists of the presence of articular cartilage lesions in more than two compartments with exposure of the subchondral bone and diameter greater than 1 cm, meniscus lesions (>grade 2), meniscus extrusion (>grade 1), the presence of bone marrow lesions (BMLs) in the medial or lateral compartment of the femur or tibia, hyperintense signal of the infrapatellar fat pad, anterior cruciate ligament (ACL) lesions (>grade 2), and the presence of osteophytes together with the presence of effusion in the suprapatellar bursa. BMLs and changes in the infrapatellar fat pad may lead to the opening of new research perspectives explaining the complex changes in KOA in relation to the inflammatory process and gene expression.

Implementation of an Acute Pain Service in the Orthopedic Traumatology Department of the University Hospital of Batna.

Background and Objectives. Effective management of postoperative acute pain (POP) in surgical settings requires well-organized approaches. Our goal was to establish an economic model of the Acute Pain Service (APS), to ensure appropriate treatment of POP in adults undergoing orthopedic and traumatological surgery at the University Hospital Center of Batna between 2015 and 2017. Materials and Methods. A descriptive and evaluative study was conducted as part of a quality assurance initiative to establish a acute pain service (APS) between 2015 and 2017. This study focused on organization, training, information dissemination, and pain assessment. Participants included five medical practitioners, 37 paramedical professionals, as well as 104 patients audited before the PAS implementation and 136 patients audited after its establishment. All patients underwent orthopedic and traumatological surgeries. Results. The survey involved 5 physicians and 37 healthcare providers. The results of the reevaluation audit showed that practitioners acquired skills in 86% of cases, common protocols for managing postoperative pain (DPO) were present in 100% of cases, patient information was provided in 77% of cases, and the quality of DPO management was rated as good in 54% of cases. Conclusion. Implementing an organizational framework based on quality assurance principles led to a significant enhancement in postoperative pain management following the introduction of a functional analgesia unit of the acute pain service (APS).

Chronic shoulder instability using the Latarjet technique: About 20 cases

This retrospective study included 20 patients operated on in the Traumatology and Orthopedics Surgery Department (A) of the HASSAN II University Hospital in Fez, treated with a LATARJET · between January 2016 and December 2023, a 5-year period · In our series, the mean age at surgery was 27 years. · Male predominance was evident, with a traumatic context found in 90% of cases. · The apprehension test was positive in 65% of cases. · Our patients underwent a systematic standard preoperative radiological work-up. · We opted for the LATARJET technique · Elbow-to-body immobilization for 21 days post-operatively. · They were followed up in consultation with a 5-year follow-up. The results of our series are very satisfactory according to the ROWE score: · -85% of patients complained of no pain. Stability was perfect in 18 cases (90%). · -Unrestricted mobility was restored in 80% of cases. · -Only one case of recurrence (5%) · One patient with postoperative osteoarthritis, corresponding to 5%. In all, we had 85% good and excellent results, versus 15% fair and poor results. The results of this study are similar to those found in the literature, confirming that the LATARJET technique is the most reliable in the treatment of anterior shoulder instability, with good functional results and the fewest complications.

Clinical experience of a patient with hemopericardium

Introduction: pericardial effusion is a frequent entity in daily practice, which can occur due to a wide range of pathologies, it is the result of an increase in the blood content of the pericardial sac.Case presentation: female patient, white skin, 93 years old, presented with a fall on her own feet, was taken to the Orthopedics and Traumatology Department where a diagnosis of intertrochanteric right hip fracture was made and admission to the observation room was indicated for subsequent surgical treatment. The patient began to become tachycardic 110/min, hypotensive 80/50 mmHg, she began to resuscitate with volume responding to fluid minirection (4ml/Kg). Hematocrit was repeated and found to be 0.25, her state of shock was attributed as hypovolemic hemorrhagic. Signs of tissue hypoperfusion persisted, despite the prescribed measures and increased vasopressor requirements. It was decided to perform an echocardiogram where there were evident signs of pericardial effusion. Pericardial window and hemostasis of the bleeding site were performed, achieving the survival of this case. Conclusions: hemopericardium is an entity with a reserved prognosis, which may occur due to a wide range of traumatic and non-traumatic pathologies; imaging methods are a key diagnostic tool, transthoracic echocardiography is the first line method for its evaluation. Therapeutic percutaneous approach, surgical exploration, as well as pericardiocentesis are therapeutic methods

The Impact of the COVID-19 Pandemic on Medical Services Provided in Orthopedics and Traumatology Departments

The Impact of the COVID-19 Pandemic on Medical Services Provided in Orthopedics and Traumatology Departments

Comparative clinical and functional results of microfracture and mosaicoplasty in medial talus osteochondral lesions

Introduction: This study aimed to compare the early clinical and functional outcomes of two surgical interventions, microfracture and mosaicplasty, for the treatment of medial talus osteochondral lesions (OCLs). Materials and Methods: This retrospective study included patients treated at the Medical Faculty Orthopedics and Traumatology Department of XXX University from January 2016 to January 2022. Patients were divided into two groups: those who underwent microfracture (Group 1, n=20) and those who underwent mosaicplasty (Group 2, n=17). Preoperative and postoperative follow-up data at baseline, 6 months, and 12 months included visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores. Statistical analysis was conducted using NCSS software, with a significance level set at p

Predictive Factors for Total Knee Arthroplasty: An Observational Study.

Introduction Knee osteoarthritis (KOA) is the most common form of osteoarthritis. It is diagnosed based on clinical symptoms, physical examination, and imaging, most frequently by knee X-ray in at least two views. In front of a patient with early KOA, all the predictive factors and risk factors that can be modified, but also that can lead to a rapid evolution of the symptoms and the need for total knee arthroplasty (TKA), must be taken into account and identified. There were a series of prognostic factors associated with KOA, such as age, sex, BMI, degree of physical activity, decrease in bone mineral density, C-reactive protein, malalignment, clinical severity at baseline, and previous traumas. The treatment of KOA is varied and involves pharmacological and non-pharmacological measures and surgical treatment in the final stages of evolution. Materials and methods In the University Emergency Hospital of Bucharest, Bucharest, Romania, patients with KOA presented to the Department of Orthopedics and Traumatology, and those who required surgical treatment, such as TKA, arthroscopy, or non-surgical treatment, were enrolled. We conducted a descriptive and prospective observational study that included 70 patients clinically and imaging diagnosed with KOA. The inclusion criteria consisted of a patient over 45 years old with knee pain and radiological signs of KOA. The exclusion criteria referred to patients with recent traumatic history, signs of active osteoarticular infection, the lack of radiological changes of KOA that imposed the differential diagnosis, patients known to have rheumatological diseases in the Algic phase, and patients in whom it was not possible to collect complete required data. Results Patients who required TKA were older (65.12 ± 8.19 years) than patients who required other therapeutic interventions (52.55 ± 3.63 years), the difference of 12.57 years being statistically significant (t = -8.882, p ≤ 0.001). Women were more than three times more likely to require TKA than men (80.85% vs. 52.17%, OR = 3.87, CI [1.29, 11.56]). Patients with HBP were more than four times more likely to require TKA than patients without HBP (78.57% vs. 42.86%, OR = 4.88, CI [1.42, 16.82]). Patients with elevated ESR were more than 26 times more likely to require TKA than patients with normal ESR (96.67% vs. 52.50%, OR = 26.23, CI [3.25, 211.67]). There are statistically significant differences between the non-TKA group (mean rank = 60.20) and TKA patients' score (mean rank = 25.62) (U = 6.000, Z = -6.606, p ≤ 0.001). Thus, patients who required TKA had a significantly lower KSS score than patients who required other treatments. Conclusion According to the data obtained in the studied group of patients, the characteristics of the patient at high risk of requiring TKA are the following: a female patient over 65 years of age who associates hypertension, high ESR, and fibrinogen values ​​with KSS score and KSS function with low values, recording an average value of 56.70.

Evaluation of anatomo-radiological outcomes of volar plating for volar displaced distal radius fractures

Background: The purpose of this study was to evaluate the anatomo-radiological outcomes of volar displaced distal radial fractures managed by volar plating. Methods: It was a retrospective analytical and monocentric study performed within 8 years from 01 January 2014 to 31 December 2022; at the orthopedic and traumatological department of the university hospital Idrissa Pouye in Dakar (Republic of Senegal). All the patients managed by volar plating for volar displaced distal radial fractures during the period of the study were included; those managed through another treatment option, lost and whose folders could not be explored were excluded. Clinically, the patients were evaluated at the last follow up thanks to the Green and O’Brien scale; radiologically, the comparison was done among the preoperative, postoperative and the last follow up standard lateral view and antero-posterior view of the wrist. Results: There were 37 patients (31 males and 6 females), the average age was 40 years old with a range from 18 to 66 years old. The minimum follow-up was 10 months. The clinical results showed at the last follow up an average functional Green and O’Brien scale of 80.2 with a range from 15 to 95. The postoperative radiological results showed the average radial frontal tilt of 21.3° with a range from 11° to 25°; the average radial sagittal tilt of 12.6° with a range from 10° to 15° and the average ulnar-radial index of 0mm with a range from -2 to +2. Three cases of radiocarpal arthrosis were found. Conclusions: The volar plating of volar displaced distal radial fractures constitutes the indication of choice in order to restore the normal anatomy of the wrist and its function.

Outcomes of Hip Shelf Procedure in Treating Legg-Calvé-Perthes Disease

Introduction: Legg-Calvé-Perthes disease (LCPD) is a pediatric ischemic condition of the femoral head leading to necrosis. This study evaluates the hip shelf procedure's effectiveness in treating LCPD and the resulting clinical outcomes. Methods: A retrospective analysis of 17 patients treated with the hip shelf procedure at the Pediatric Orthopedics and Traumatology Department of CHU Hassan II, Fes, over ten years. Data on patient demographics, clinical presentations, radiological assessments, and surgical outcomes were analyzed. Results: The average age at consultation was 9 years, with a male predominance (88.2%). Radiological staging showed most patients in the fragmentation or reconstruction stages. Post-operative results indicated significant improvement in hip joint stability and remodeling. Conclusion: The hip shelf procedure is effective in managing LCPD, promoting favorable hip joint remodeling and function in pediatric patients. Early intervention is crucial for optimal outcomes.

Case Study on the Advancements in Diagnosis and Treatment Technologies for Military Personnel with Complex Explosive Injuries

Case(s): A 51-year-old military personnel with severe limb injury from mortar shelling, admitted to Orthopedic Traumatology Department, Ternopil Regional Hospital, Ukraine.Conclusions: Explosive injuries typically arise from the detonation of devices such as landmines, improvised explosive devices, or grenades, causing harm through blast, fragmentation, and thermal effects. Despite a delayed presentation to medical care, the patient underwent multiple debridement procedures, including Vacuum-Assisted Closure therapy, and vascular reconstruction, leading to limb salvage. This case underscore needs for timely medical care, addressing risks of mine blasts and cold weather injuries through training.

The Effects Of Surgical Arthroscopy And Intraarticular Medication On The Antioxidant System And Lipid Peroxidation In Knee Osteoarthritis

&lt;b&gt;Aim: &lt;/b&gt;This study aims to evaluate the effects of joint surgery through arthroscopy, intraarticular medication, and antioxidant therapy on the antioxidant system and lipid peroxidation in patients with knee osteoarthritis (KOA). The study examines the ability of high-molecular weight hyaluronan, sodium hyaluronate, and oral Vitamin E to modulate oxidative stress markers in the knee joint.&lt;br /&gt; &lt;b&gt;Methods and Materials: &lt;/b&gt;There were 60 patients diagnosed with KOA that were divided into four groups according to the type of treatment for this prospective study at the Department of Orthopaedics and Traumatology. Blood and synovial fluid samples collected before and after treatment were evaluated for superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), lipid peroxidation (malondialdehyde, MDA) catalase (CAT). SPSS software was used to perform statistical analysis where the significance level was set at p&amp;lt;0.05.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;Synovial fluid malondialdehyde levels that showed a decreased tendency among treated groups indicated a reduced state of antioxidant activity. However, no significant changes were observed in systemic oxidative stress markers. These findings show that localized antioxidant therapy within the knee can be effective in reducing oxidative stress, therefore, may have implications for nonsurgical treatment of KOA.&lt;br /&gt; &lt;b&gt;Conclusion: &lt;/b&gt;The results emphasize possible gains made from combining surgical arthroscopy together with antioxidant treatment in managing KOA. By reducing the level of oxidative stress within the knee joint, this combined method can provide a viable solution to improve symptoms and quality of life among KOA patients.

Risk factors and prediction model of delirium in elderly patients after hip arthroplasty.

To analyze the risk factors of delirium in elderly patients after hip arthroplasty and to construct a prediction model. Clinical data of 248 elderly patients who underwent hip arthroplasty in the Department of Traumatology and Orthopedics at Wuhan Fourth Hospital were retrospectively collected from November 2021 to February 2023. Logistic regression analysis was used to identify the risk factors of delirium after hip arthroplasty, and a nomogram prediction model was constructed using the RMS package of R4.1.2 software. The accuracy and stability of the model was evaluated based on the Hosmer-Lemeshow goodness-of-fit test and the receiver operating characteristic (ROC) curve. Age, nighttime sleep, anesthesia method, intraoperative blood loss, hypoxemia, and C-reactive protein (CRP) level were all risk factors of delirium after the hip arthroplasty (P<0.05). These factors were used to construct a nomogram prediction model that was internally validated using the Bootstrap method. The prediction model had the area under ROC curve (AUC) of 0.980 (95% CI: 0.964-0.996), indicating that it has certain predictive value for postoperative delirium. When the optimal cut off value was selected, the sensitivity and specificity were 92.7% and 92.3%, respectively, indicating that the prediction model is effective. Age, short nighttime sleep, general anesthesia, high intraoperative blood loss, hypoxemia, and high CRP levels are independent risk factors for delirium after hip arthroplasty. The nomogram prediction model constructed based on these risk factors can effectively predict delirium in elderly patients after hip arthroplasty.