Orthopaedic Diseases and Innovative Intervention Strategies

Background and Objectives: although musculoskeletal alterations are common in patients with Down syndrome (DS), studies investigating this association are scarce, and proposals for diagnostic standardization are limited. We aimed to evaluate the prevalence of musculoskeletal disorders in the lower limbs in a sample of children and adolescents with DS and to investigate the diagnostic capacity of orthopedic clinical examinations performed by orthopedists and pediatricians to diagnose these alterations. Materials and Methods: Twenty-two patients aged between three and ten years with DS were included. Patients and guardians answered a simple questionnaire regarding orthopedic complaints and underwent a systematic orthopedic physical examination, performed twice: once by an orthopedist and again by a pediatrician. Patients underwent a series of radiographs to diagnose anisomelia, hip dysplasia, epiphysiolysis, flatfoot valgus, mechanical axis varus, and mechanical axis valgus. The radiological diagnosis was considered the gold standard, and the diagnostic capacity of the physical examination performed by each physician was determined. Results: The median age was 6.50 years. Only four patients (18.2%) presented with orthopedic complaints. All patients were diagnosed with at least one musculoskeletal disorder. The only musculoskeletal disorder with a good diagnostic capacity was flatfoot valgus. Limited sensitivity values were found for hip dysplasia, mechanical axis varus, and mechanical axis valgus. The agreement between the orthopedic physical examinations performed by the two examiners was weak, poor, or indeterminate for most of the analyzed items. Conclusions: There was a high prevalence of orthopedic alterations in children with DS who did not present with musculoskeletal complaints. The diagnostic capacity of the physical examination was limited. Therefore, all children with DS should undergo a radiological evaluation of the musculoskeletal system and subsequent specialized orthopedic evaluation. Level of Evidence: Level II (Diagnostic Studies). Full article

Background and Objectives: The aim of this study was to evaluate the correlation between the mandibular arch shape and the vertical skeletal pattern in growing patients. Materials and Methods: A total of 73 Caucasian patients (33 males and 40 females; mean age 9.4) were retrospectively enrolled from a pool of patients treated in chronological order at the Department of Orthodontics, University of Foggia, Italy, from April 2018 to December 2021. Each patient received a laterolateral radiograph and a digital scan of the dental arch. Eight cephalometric parameters (lower gonial angle, intermaxillary angle, divergence angle, Wits index, Jarabak ratio, OP-MP angle, PP-OP angle, and ANB) and five dental measurements (posterior mandibular arch width, anterior mandibular arch width, mandibular occlusal angle, posterior width on distobuccal molar cusps, and molar angle) were analyzed and then compared. A Spearman’s rho correlation test between the cephalometric measurements and the dental measurements was performed. Statistical significance was set at p < 0.05. Results: A negative statistically significant correlation was found between the Jarabak ratio and the intermolar angle; a statistically significant correlation was also observed between the Wits index, the posterior mandibular width, and the occlusal mandibular angle; the ANB angle and the occlusal mandibular angle; the intermaxillary angle (PP-PM) and the mandibular occlusal angle, posterior mandibular width on the disto-vestibular cusp, and the intermolar angle; and the OP-MP angle and mandibular occlusal angle and the posterior mandibular width on the disto-vestibular cusp. Conclusions: The mandibular arch form may be related to certain predisposing features in craniofacial morphology, such as jaw divergence, the Jarabak ratio, and the intermaxillary angle. Full article

Non-prosthetic peri-implant fractures (NPPIFs) are often reported mixed with periprosthetic fractures (PPFs), but they are different entities. Due to the increase in the age of the world’s population and to the intensification of surgeries for fractures, nowadays, peri-implant fractures are a very frequent entity in clinical practice, with an increasing trend expected in the future. A clear exclusive classification of NPPIFs is not reported in the literature. The aim of this study is to provide a valid comprehensive classification for all the NPPIFs. X-rays of all the peri-implant cases treated in our unit in a 3-year period were retrospectively collected. Five orthopedic surgeons reviewed 30 X-rays of NPPIFs, providing a code according to the classification proposed. After a 3-month interval, they reviewed the same X-rays. Eighteen femoral, eight humeral, and four forearm peri-implant fractures were collected and showed to the raters. Inter- and intra-observer reliability was calculated using a k-statistic, showing a moderate agreement between observers (κ = 0.73) and a substantial agreement between the observations of the same viewer (κ = 0.82). The literature lacks a comprehensive classification for peri-implant fractures that considers all the bones and all the types of implants. The proposed classification is meant to be an instrument for orthopedic surgeons to categorize these types of fractures and seems to be simple, easy to comprehend, and reproducible. This new classification can provide the orthopedic surgeon a reliable method to clearly catalogue different fractures according to the site and the implants; the physicians can use it, through a code, in clinical practice to describe an NPPIF without the need of images. Further studies may be necessary to confirm the validity and eventually to improve the suggested classification. Full article

Introduction: Concomitant nerve injuries with musculoskeletal injuries present a challenging problem. The goals of nerve reconstruction for the shoulder include shoulder abduction and external rotation. When patients fail to achieve acceptable shoulder external rotation and shoulder abduction, tendon transfers such as trapezius transfer offer a reliable option in the subsequent stage. Case Presentation: A 32-year-old male presented with weak external rotation in his left shoulder, after previous axillary nerve reconstruction. He received the ipsilateral lower trapezius transfer with the aim of improving the external rotation. Discussion: The lower trapezius restores a better joint reaction force in both the compressive–distractive and anterior–posterior balancing and provides a centering force through the restoration of the anterior–posterior force couple. Conclusion: We believe that the ipsilateral lower trapezius transfer to the infraspinatus is a good outcome and is effective in improving overall shoulder stability and the shoulder external rotation moment arm or at least maintaining in neutral position with the arm fully adducted in patients with post axillary nerve injuries post unsatisfactory nerve reconstruction to increase the quality of life and activities of daily living. Full article

Objectives: We aimed to investigate the therapeutic effects of thymoquinone (TMQ) treatment in osteonecrotic rats by evaluating protein levels, osteonecrosis (ON) levels, fatty acid degeneration, oxidative status, and plasma levels of Urotensin-II (U-II) and transforming growth factor-beta (TGF-β1). Materials and Methods: 40 weight-matched adult male Wistar rats were grouped as control (n = 10), methylprednisolone acetate (MPA) (n = 10), thymoquinone (TMQ) (n = 10), and MPA + TMQ (n = 10). To induce ON, 15-week-old animals were subcutaneously injected with MPA at a dose of 15 mg/kg twice weekly for 2 weeks. TMQ was injected into 15-week-old rats via gastric gavage at a dose of 80 mg/kg per day for 4 weeks. The rats in the MPA + TMQ group were administered TMQ 2 weeks before the MPA injection. At the end of the treatments, cardiac blood samples and femur samples were collected for biochemical and histological evaluations. Results: In the control and TMQ groups, no ON pattern was observed. However, in tissues exposed to MPA, TMQ treatment resulted in significantly decreased ON levels compared to the MPA group. The number of cells that were positive for 8-OHdG and 4-HNE was significantly lower in the MPA + TMQ group than in the MPA group (p < 0.05). In terms of TGF-β1 and U-II levels, we observed that both TGF-β1 (367.40 ± 23.01 pg/mL vs. 248.9 ± 20.12 pg/mL) and U-II protein levels (259.5 ± 6.0 ng/mL vs. 168.20 ± 7.90 ng/mL) increased significantly in the MPA group compared to the control group (p < 0.001). Furthermore, TGF-β1 (293.50 ± 14.18 pg/mL) and U-II (174.80 ± 4.2 ng/mL) protein levels were significantly decreased in the MPA + TMQ group compared to the MPA group (p < 0.05 and p < 0.01, respectively). There was a statistically positive correlation (p < 0.05) between the TGF-β1 and U-II protein levels in all groups (p = 0.002, r_control = 0.890; p = 0.02, r_TMQ = 0.861; p = 0.024, r_MPA+TMQ = 0.868) except for the MPA group (p < 0.03, r_Medrol = −0.870). Conclusions: As far as we know, this is the first study to demonstrate the curative functions of TMQ on ON by causing a correlated decrease in the expression of U-II and TGF-β1 in the femoral heads of rats. Full article

The purpose of this study was to determine if there is a difference in hip survivorship rates and patient-reported outcomes (PROs) at a 5-year follow-up after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) between patients with versus without systemic inflammatory diseases (SIDs). A retrospective single-surgeon matched cohort study of FAIS patients who underwent hip arthroscopy and had a minimum of a 5-year follow-up was conducted. Subjects with SIDs were matched at a ratio of 2:3 of age and body mass index (BMI) with respect to controls without SIDs. Subjects completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) prior to surgery and at a 2-year and 5-year follow-up. Survival distributions for time to reoperation and to total hip arthroplasty (THA) were compared between groups using the log-rank test. Fifteen subjects with SIDs (mean age 41.5 years) were matched with twenty-five controls (41.8 years). There were no significant differences in reoperation rates (SIDs 27% vs. controls 20%, p = 0.71) or THA conversion rates (SIDs 7% vs. controls 12%, p = 1.00) at the 5-year follow-up, nor were there differences in survival distributions for reoperations (p = 0.72) or THAs (p = 0.55). There were no significant differences in postoperative mHHS (SIDs 79.3 vs. controls 88.5, p = 0.09) or NAHS (SIDs 82.7 vs. controls 89.3, p = 0.77) by the 5-year follow-up. At the 5-year follow-up, FAIS patients with comorbid SIDs experienced a significant clinical improvement from hip arthroscopy that is comparable to that of FAIS patients without SIDs. Full article

Background and Objectives: The goal of this study was to evaluate the functional outcomes of patient treatment using an allograft after chronic locked posterior shoulder dislocation associated with a bony defect of the upper edge of the humerus that involves 25–50% of the articular surfaces. Materials and Methods: A total of 20 patients were included in this study. Electrocution was the cause of injury in eight patients; in ten patients, the cause was direct trauma; and in two patients, the cause of injury was a fall due to hypoglycemic coma. A standard deltoid pectoral approach was used and a fresh-frozen osteochondral allograft of the femoral condyle was applied. In evaluating the results, Constant’s scoring scale was used. Results: The average value of Constant’s point scale for the operated shoulder is 84.14 points. This result is good according to the average value of Constant’s point scale. Conclusions: Patients with locked chronic posterior dislocation in combination with a bony defect of the humeral head that covers 25–50% of the articular surface, in our opinion, should be treated using bone allografts rather than non-anatomical reconstruction methods. Full article

The expected rate and timing of return to work (RTW) following hip arthroscopy is an important consideration for patients. The purpose of this study was to evaluate the rates of RTW following hip arthroscopy, the time required to RTW, and factors correlated with successful RTW. A retrospective review was performed of patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) from 2018–2021. Data were collected regarding pre-injury employment, work activity level, workers’ compensation (WC) status, ability to return to work, the pre- and postoperative pain visual analog score (VAS), and the Nonarthritic Hip Score (NAHS). Overall, 76 patients (90.5%) returned to their pre-surgical occupation at an average of 9.3 weeks (range: 0.14–56 weeks) postoperatively. Of those who returned, 62 patients (81.6%) returned to full work duties. The NAHSs improved significantly from the preoperative period to follow-up at 1 year (64.7 vs. 83.7, p < 0.001). A linear regression found elevated BMI to be associated with an increased time to return (β = 0.757, p = 0.012). On average, patients with WC status returned to work 9 weeks later than non-WC patients, though this difference did not reach statistical significance (18.4 vs. 9.9 weeks, p = 0.130). There is a high rate of return to full work duties at an average of 9.3 weeks following hip arthroscopy for FAIS. Full article

Background and purpose: Cannulated screws are standard implants for percutaneous fixa-tion of posterior pelvis ring injuries. The choice of whether to use these screws in combination with a washer is still undecided. The aim of this study was to evaluate the biomechanical competence of S1-S2 sacroiliac (SI) screw fixation with and without using a washer across three different screw designs. Material and Methods: Twenty-four composite pelvises were used and an SI joint injury type APC III according to the Young and Burgess classification was simulated. Fixation of the posterior pelvis ring was performed using either partially threaded short screws, fully threaded short screws, or fully threaded long transsacral screws. Biomechanical testing was performed under progressively increasing cyclic loading until failure, with monitoring of the intersegmental and bone-implant movements via motion tracking. Results: The number of cycles to failure and the corresponding load at failure (N) were significantly higher for the fully threaded short screws with a washer (3972 ± 600/398.6 ± 30.0) versus its counterpart without a washer (2993 ± 527/349.7 ± 26.4), p = 0.026. In contrast, these two parameters did not reveal any significant differences when comparing fixations with and without a washer using either partially threaded short of fully threaded long transsacral screws, p ≥ 0.359. Conclusions: From a biomechanical perspective, a washer could be optional when using partially threaded short or fully threaded long transsacral S1-S2 screws for treatment of posterior pelvis ring injuries in young trauma patients. Yet, the omission of the washer in fully threaded short screws could lead to a significant diminished biomechanical stability. Full article

Peripheral nerve disorder of the lower extremities causes drop foot and disturbs the daily living activities of patients. The ankle joint hybrid assistive limb (HAL) provides voluntary ankle joint training using surface bioelectrical signals from the muscles of the lower extremities. We investigated the neurological effects of ankle joint HAL training in three patients. Sensory nerve action potentials (SNAPs) and compound muscle action potentials (CMAPs) were analyzed for the peroneal and tibial nerves prior to the first ankle joint HAL training session. Integrated surface electromyography EMG signals were recorded before and after the HAL training sessions to evaluate the effects of training for neuromuscular disorders. The patients were hospitalized to receive rehabilitation with HAL training for 2 weeks. The HAL training was performed daily with two 60 min sessions. All cases demonstrated severe neuromuscular impairment according to the result of the CMAP. All integrated EMG measurements of antagonistic muscle activities decreased after the ankle joint HAL training. The manual muscle testing (MMT) scores of each muscle were slightly increased after the HAL intervention for Case 2(tibialis anterior, from 2 to 2+; gastrocnemius muscles, from 2− to 2; extensor digitorum longus, and extensor hallucis longus, from 1 to 3). The MMT scores were also slightly increased except for gastrocnemius muscle for Case 3 (tibialis anterior, extensor digitorum longus, and extensor hallucis longus, from 2− to 2). These two patients demonstrated voluntary muscle contractions and nerve signals in the CMAP before the HAL training. Even though the amplitude of CMAPs was low, the HAL training may provide voluntary ankle joint movements by reducing the antagonistic muscle contraction via computer processing. The HAL training may enhance muscle movement and coordination through motor learning feedback. Full article

Background and Objectives: Minimally invasive surgeries for acetabulum fracture fixation are gaining popularity due to their known advantages versus open reduction and internal fixation. Antegrade or retrograde screw fixation along the long axis of the posterior column of the acetabulum is increasingly applied in surgical practice. While there is sufficient justification in the literature for the application of the anterior approach, there is a deficit of reports related to the posterior approach. The aim of this study was to evaluate the biomechanical competence of posterior column acetabulum fracture fixation through antegrade screw placement using either a standard cannulated screw or a cannulated compression headless screw (CCHS) via posterior approach. Materials and Methods: Eight composite pelvises were used, and a posterior column acetabulum fracture according to the Letournel Classification was simulated on both their left and right sides via an osteotomy. The sixteen hemi-pelvic specimens were assigned to two groups (n = 8) for either posterior column standard screw (group PCSS) or posterior column CCHS (group PCCH) fixation. Biomechanical testing was performed by applying steadily increased cyclic load until failure. Interfragmentary movements were investigated by means of motion tracking. Results: Initial stiffness demonstrated significantly higher values in PCCH (163.1 ± 14.9 N/mm) versus PCSS (133.1 ± 27.5 N/mm), p = 0.024. Similarly, cycles and load at failure were significantly higher in PCCH (7176.7 ± 2057.0 and 917.7 ± 205.7 N) versus PCSS (3661.8 ± 1664.5 and 566.2 ± 166.5 N), p = 0.002. Conclusion: From a biomechanical perspective, CCHS fixation demonstrates superior stability and could be a valuable alternative option to the standard cannulated screw fixation of posterior column acetabulum fractures, thus increasing the confidence in postoperative full weight bearing for both the patient and treating surgeon. Whether uneventful immediate postoperative full weight bearing can be achieved with CCHS fixation should primarily be investigated in further human cadaveric studies with a larger sample size. Full article

Background and Objectives: Post-COVID-19 syndrome is commonly used to describe signs and symptoms that continue or develop after acute COVID-19 for more than 12 weeks. The study aimed to evaluate a treatment strategy in patients with adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome. Materials and Methods: The method used was an interventional pilot study in which 16 vaccinated patients presenting with the clinical and ultrasound features of adhesive capsulitis (phase 1) developed during post-COVID-19 syndrome were treated with infiltrative hydrodistension therapy under ultrasound guidance associated with early rehabilitation treatment. Results: Sixteen patients with post-COVID-19 syndrome treated with ultrasound-guided infiltration and early rehabilitation treatment showed an important improvement in active joint ROM after 10 weeks, especially in shoulder elevation and abduction movements. The VAS mean score before the treatment was 6.9 ± 1.66. After 10 weeks of treatment, the VAS score was 1 ± 0.63. Conclusions: The study demonstrated that the management of adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome, as conducted by physiotherapists in a primary care setting using hydrodistension and a rehabilitation protocol, represented an effective treatment strategy. Full article

Background and Objectives: Diesel exhaust particles (DEPs) are a major component of air pollution and adversely affect respiratory and cardiovascular disease and diabetic foot ulcers if diabetic patients are exposed to them. There are currently no studies on treating diabetic wounds exposed to DEPs. So, the effect of a combination of probiotics and Korean red ginseng on a diabetic wound model exposed to DEPs was confirmed. Materials and Methods: Rats were randomly divided into three groups according to DEP inhalation concentration and whether they underwent applications of probiotics (PB) and Korean red ginseng (KRG). Wound tissue was collected from all rats, and wound healing was evaluated using molecular biology and histology methods. Results: The wound size of all groups decreased over time, but there was no significant difference. As a result of the molecular biology experiment, the expression of NF-κB p65 on day 7 was significantly higher in group 2 than in the normal control group. As a result of histological analysis, unlike the primary control group, it was confirmed that granule tissue was formed on the 14th day in the normal control group and group 2. Conclusions: The findings in this study suggest that combined treatment with PB and KRG can promote the healing of DEP-exposed diabetic wounds. Full article

Retrospective analytical study that aims to evaluate the kinematic and kinetic results obtained after percutaneous lengthening with an intramuscular needle (PLIN) of gastrocsoleus complex (GSC) zones I, II, and III, performed outside the operating room between 2018 and 2019, in pediatric patients with equinus gait resistant to non-operative treatment. Gait analysis was performed prior to treatment and 6 months post treatment in 48 ankles (30 patients), with a median patient age of 10.11 (2.85) years. Twelve patients had a diagnosis of idiopathic equinus, twelve spastic hemiplegia, and six spastic diplegia. Statistical analysis included pre–post comparison, correlation, and linear regression of critical kinematic and kinetic ankle values. Significant improvement was observed for the following parameters: ankle angle at initial contact, −4.57(10.31)/0.05(3.04)°; maximum ankle dorsiflexion in the stance phase (mADFStP), 3.70(7.56)/10.42(4.52)°; and maximum ankle dorsiflexion in the swing phase (mADFSwP), −6.54(8.41)/−0.35(6.17)°. In addition, an inversely proportional correlation with pre-intervention values was obtained for those parameters, with rho values of −0.864, −0.755, and −0.696, respectively (p < 0.0005). No significant changes in ankle kinetics were evidenced. Linear regression equations allowed for estimation of the post mADFStP, with a standard error (SE) = 1.82; R² = 0.797 (p < 0.0005), and the post mADFSwP, with an SE = 2.376; R² = 0.829 (p < 0.0005). To conclude, the addition of the GSC in patients with resistant equinus significantly improves ankle initial contact, mADFStP, and mADFSwP, with greater changes occurring with worse initial values. The regression formulas used to estimate post-procedure results will allow therapeutic indications to be adjusted. Full article

Background and Objectives:: There were limited studies which investigated nail diameter as a predictor for cephalomedullary nail (CMN) failure in intertrochanteric fracture (ITF). We aimed to evaluate the surgical outcomes of CMN in fragility ITF following nail–canal (N–C) diameter discordance. Materials and Methods: From November 2010 to March 2022, we retrospectively reviewed 120 consecutive patients who underwent CMN surgeries due to fragility ITF. We included patients with acceptable reduction and a tip–apex distance ≤ 25 mm. The N–C diameter differences both in anterior–posterior (AP) and lateral-view X-rays were measured, and we compared the number of excessive sliding instances and the rate of implant failure between the N–C concordance (≤3 mm) and discordance (>3 mm) group. Simple linear regression was used to determine the strength of the relationship between the N–C difference and sliding distance. Results: The sliding distance showed no differences between the groups in the AP (3.6 vs. 3.3 mm, p = 0.75) and lateral view (3.5 vs. 3.4 mm, p = 0.91). For analyses in the AP view, the AP-concordance and AP-discordance groups had 14 (25%) and 14 patients (22%) with a sliding distance of >5 mm (p = 0.69), while treatment failure occurred in 3 (5%) and 3 (3%) patients, respectively (p = 0.66). For analyses in the lateral view, the lat-concordance and lat-discordance groups had 8 (27%) and 20 patients (22%) with a sliding distance of >5 mm (p = 0.62), while treatment failure occurred in 1 (3%) and 4 (4%) patients, respectively (p = 1.00). Linear regression analyses showed that the N–C difference in either views was not a significant predictor of sliding distance in both the AP (R² = 0.002, p = 0.60) and lateral views (R² = 0.007, p = 0.35). Conclusions: If appropriate fracture reduction and fixation are achieved, the N–C discordance of short CMN does not affect treatment outcomes in ITF. Full article

A retrospective study that aims to analyze the safety and efficacy of single-event multilevel surgery (SEMLS) involving bifocal femoral osteotomy (BFO) performed in nine non-ambulatory children with neuromuscular diseases (NMD), with a median age of 12.86 years, to resolve both hip subluxation and ipsilateral knee flexion contracture that impaired standing, and to evaluate patient and caregiver satisfaction. Results: Median surgical time was 4 h 15 min (2 h 35 min–5 h 50 min). Hip flexion deformity improved by a median of 30° (15–35), while median improvement in knee flexion deformity was 30° (20–50). Only two patients could use a standing frame prior to surgery, although with increasing difficulty, while all children could use it following SEMLS. Mean follow-up was 27.47 months (24.33–46.9). Significant blood loss requiring transfusion was the only complication recorded (8/9). All caregivers reported slight, moderate, or significant improvement in all domains of the questionnaire, and all would undergo the procedure again and recommend it to others, as nearly all (8/9) were very satisfied. Conclusion: The findings of this study suggest that SEMLS including BFOs in non-ambulatory children with NMD can correct hip, knee, and foot deformities and simultaneously realign lower limbs to restore functional standing and wheelchair transfer. The functional results, safety, and degree of satisfaction achieved justify offering this strategy to families. Full article

Background and Objectives: The purpose of this study was to assess the cytotoxicity and antibacterial effects of AgNP-impregnated Tetracalcium phosphate-dicalcium phosphate dihydrate (TTCP-DCPD). Materials and Methods: Using in vitro experiments, the cytotoxicity of AgNP-impregnated TTCP-DCPD against fibroblasts and osteocytes was assessed in terms of cell viability by water-soluble tetrazolium salt assay. To assess antibacterial effects, a disc diffusion test was used; osteomyelitis was induced first in vivo, by injection of methicillin-resistant Staphylococcus aureus into the tibia of rats. AgNP-impregnated TTCP-DCPD bone cement was then applied at various silver concentrations for 3 or 12 weeks. Antibacterial effects were assessed by culturing and reverse transcription-polymerase chain reaction (RT-PCR). For histological observation, the bone tissues were stained using hematoxylin and eosin. Results: Cell viability was decreased by the impregnated bone cement but did not differ according to AgNP concentration. The diameter of the growth-inhibited zone of MRSA was between 4.1 and 13.3 mm on the disks treated with AgNP, indicating antimicrobial effects. In vivo, the numbers of bacterial colonies were reduced in the 12-week treatment groups compared to the 3-week treatment groups. The groups treated with a higher (10×) dose of AgNP (G2–G5) showed a tendency of lower bacterial colony counts compared to the group without AgNP (G1). The PCR analysis results showed a tendency of decreased bacterial gene expression in the AgNP-impregnated TTCP-DCPD groups (G2–G5) compared to the group without AgNP (G1) at 3 and 12 weeks. In the H&E staining, the degree of inflammation and necrosis of the AgNP-impregnated TTCP-DCPD groups (G2–G5) showed a tendency to be lower at 3 and 12 weeks compared to the control group. Our results suggest that AgNP-impregnated TTCP-DCPD cement has antimicrobial effects. Conclusions: This study indicates that AgNP-impregnated TTCP-DCPD bone cement could be considered to treat osteomyelitis. Full article

Background and Objectives: Fractures are common in pediatric trauma, and they are caused by a broad spectrum of factors. Only a few studies have discussed the mechanisms of injury and their relationships to different types of fractures. The most frequent type of fractures in different age groups remains unclear. Therefore, we aim to summarize the epidemiological characteristics of pediatric fractures in a medical center in Zhuhai, China from 2006 to 2021 and analyze the causes of fractures with the highest frequency in different age groups. Materials and Methods: We extracted the information from the Zhuhai Center for Maternal and Child Health Care of those under 14 years old who had fractures from 2006 to 2021. Results: We reviewed the information of 1145 children. The number of patients increased during the 15 years (p < 0.0001). The number of patients was significantly different between genders after Y2 (p = 0.014). In addition, more than two-thirds of patients (71.3%) had upper limb fractures, and all types of falls were the most common cause of fractures (83.6%). The incidence demonstrated an insignificant difference in age groups except for the fractures of humerus and radius. Moreover, we discovered that the prevalence of fall-related injuries decreased with age, while that of sports-related injuries increased with age. Conclusions: Our study demonstrates that the prevalence of fall-related injuries decreases with age, and that of sports-related injuries increases with age. Most patients have upper limb fractures, and all types of falls are the most common cause of fractures. Fracture types with the highest frequency differ in each age group. These findings might supplement current epidemiological knowledge of childhood fracture and provide references for decision-making in children’s health policies. Full article

Background and Objectives: Clinically, it is beneficial to determine the knee osteoarthritis (OA) subtype that responds well to conservative treatments. Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. We hypothesized that valgus arthritic knees would respond better to conservative treatment than varus arthritic knees. Materials and Methods: Medical records of 834 patients who received knee OA treatment were retrospectively reviewed. Patients with Kellgren–Lawrence grades III and IV were divided into two groups according to knee alignment (varus arthritic knee, hip-knee-ankle angle [HKA] > 0° or valgus arthritic knee, HKA < 0°). The Kaplan–Meier curve with total knee arthroplasty (TKA) as an endpoint was used to compare the survival probability between varus and valgus arthritic knees at one, two, three, four, and five years after the first visit. A receiver operating characteristic (ROC) curve was used to compare the HKA thresholds for TKA between varus and valgus arthritic knees. Results: Valgus arthritic knees responded better to conservative treatment than varus arthritic knees. With TKA as an endpoint, the survival probabilities for varus and valgus arthritic knees were 24.2% and 61.4%, respectively, at the 5-year follow-up (p < 0.001). The thresholds of HKA for varus and valgus arthritic knees for TKA were 4.9° and −8.1°, respectively (varus: area under the ROC curve [AUC] = 0.704, 95% confidence interval [CI] 0.666–0.741, p < 0.001, sensitivity = 0.870, specificity = 0.524; valgus: AUC = 0.753, 95% CI 0.693–0.807, p < 0.001, sensitivity = 0.753, specificity = 0.786). Conclusions: Conservative treatment is more effective for valgus than for varus arthritic knees. This should be considered when explaining the prognosis of conservative treatment for knees with varus and valgus arthritis. Full article

Variation during practice is widely accepted to be advantageous for motor learning and is, therefore, a valuable strategy to effectively reduce high-risk landing mechanics and prevent primary anterior cruciate ligament (ACL) injury. Few attempts have examined the specific effects of variable training in athletes who have undergone ACL reconstruction. Thereby, it is still unclear to what extent the variations in different sensor areas lead to different effects. Accordingly, we compared the effects of versatile movement variations (DL) with variations of movements with emphasis on disrupting visual information (VMT) in athletes who had undergone ACL reconstruction. Forty-five interceptive sports athletes after ACL reconstruction were randomly allocated to a DL group (n = 15), VT group (n = 15), or control group (n = 15). The primary outcome was functional performance (Triple Hop Test). The secondary outcomes included dynamic balance (Star Excursion Balance Test (SEBT)), biomechanics during single-leg drop-landing task hip flexion (HF), knee flexion (KF), ankle dorsiflexion (AD), knee valgus (KV), and vertical ground reaction force (VGRF), and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)) assessed before and after the 8 weeks of interventions. Data were analyzed by means of 3 × 2 repeated measures ANOVA followed by post hoc comparison (Bonferroni) at the significance level of p ≤ 0.05. Significant group × time interaction effects, main effect of time, and main effect of group were found for the triple hop test and all eight directions, SEBT, HF, KF, AD, KV, VGRF, and TSK. There was no significant main effect of group in the HF and triple hop test. Additionally, significant differences in the triple hop test and the seven directions of SEBT, HF, KF, KV, VGRF, and TSK were found between the control group and the DL and VMT groups. Between group differences in AD and the medial direction of SEBT were not significant. Additionally, there were no significant differences between VMT and the control group in the triple hop test and HF variables. Both motor learning (DL and VMT) programs improved outcomes in patients after ACL reconstruction. The findings suggest that DL and VMT training programs lead to comparable improvements in rehabilitation. Full article

Background and Objectives: Pubic ramus fractures are common in compound pelvic injuries known to have an increased rate of morbidity and mortality along with recurrent and chronic pain, impeding a patient’s quality of life. The current standard treatment of these fractures is percutaneous screw fixation due to its reduced risk of blood loss and shorter surgery times. However, this is an intricate surgical technique associated with high failure rates of up to 15%, related to implant failure and loss of reduction. Therefore, the aim of this biomechanical feasibility study was to develop and test a novel intramedullary splinting implant for fixation of superior pubic ramus fractures (SPRF), and to evaluate its biomechanical viability in comparison with established fixation methods using conventional partially or fully threaded cannulated screws. Materials and Methods: A type II superior pubic ramus fracture according to the Nakatani classification was created in 18 composite hemi-pelvises via a vertical osteotomy with an additional osteotomy in the inferior pubic ramus to isolate the testing of three SPRF fixation techniques performed in 6 semi-pelvises each using either (1) a novel ramus intramedullary splint, (2) a partially threaded ramus screw, or (3) a fully threaded ramus screw. Results: No significant differences were detected among the fixation techniques in terms of initial construct stiffness and number of cycles to failure, p ≥ 0.213. Conclusion: The novel ramus intramedullary splint can be used as an alternative option for treatment of pubic ramus fractures and has the potential to decrease the rate of implant failures due to its minimally invasive implantation procedure. Full article

Slipped capital femoral epiphysis (SCFE) is the most common adolescent hip disorder in children 9–15 years old with an incidence that ranges from 0.33:100,000 to 24.58:100,000. Idiopathic SCFE is strongly associated with obesity, while atypical SCFE is associated with endocrinopathies, metabolic and renal disease, radiation therapy, and chemotherapy. In this review, we summarized the current data regarding the pathogenesis of SCFE and its association to obesity. In the last years, there have been increasing evidence regarding the implication of obesity in the pathogenesis of SCFE, but no definitive mechanism has been proven. The etiology is probably multifactorial, with both mechanical and metabolic factors contributing to the disease, with the later gaining more ground, especially in obese patients. Understanding what causes the disease will help paediatricians and orthopaedists develop more efficient strategies for treating patients and diminishing complication rates. Full article

Background and Objectives: This study aimed to evaluate the effectiveness and safety of endoscopic gastrocnemius recession using the self-developed Modified Soft Tissue Release Kit. Materials and Methods: This retrospective review followed up 22 patients (34 feet) who underwent endoscopic surgery and 20 patients (30 feet) who received open surgery between January 2020 and January 2022. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the maximum ankle dorsiflexion angle were evaluated preoperatively and at the last follow-up. Postoperative complications were recorded. Patient satisfaction was surveyed at the last follow-up. The comparison between quantitative data was analyzed with the Wilcoxon signed-rank test. The comparison between qualitative data was analyzed with the chi-square test. Results: There was no significant difference in the baseline characteristics between the two groups. The AOFAS score in the endoscopic group increased from 50 (18) points preoperatively to 90 (13) points at the last follow-up; the maximum ankle dorsiflexion angle increased from −7.7 (2.8) degrees to 10.6 (3.6) degrees. The AOFAS score in the open group improved from 47 (15) points preoperatively to 90 (18) points at the last follow-up; the maximum ankle dorsiflexion angle increased from −7.6 (4.0) degrees to 10.7 (3.3) degrees. The change values of the AOFAS scores in the endoscopic and open groups were 39 (15) and 40.5 (11) points, respectively, and there was no significant difference between them. The change values of the maximum ankle dorsiflexion angles in the endoscopic and open groups were 19.5 (4.3) and 19.1 (4.9) degrees, respectively, and there was no significant difference between them. There were no complications, such as sural nerve injury, in both groups. There was no significant difference between the two groups in satisfaction with the surgical outcome. Conclusions: Endoscopic gastrocnemius recession using the Modified Soft Tissue Release Kit can significantly improve the foot function with significant mid-term efficacy and high safety. Full article

Background and Objectives: Patients with adolescent idiopathic scoliosis (AIS) more frequently present significant back-related body image disturbances compared with healthy controls. The study aimed to adapt two screening questionnaires: Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) and Cosmetic Procedure Screening Questionnaire (COPS), that could identify AIS patients, especially those threatened with body image disorders and might predict dissatisfaction with a desired-by-patients cosmetic result of treatment. Materials and Methods: In total, 34 AIS patients who undergo Cheneau brace treatment were asked to complete SATAQ-3 and COPS. Results: AIS patients presented a high level of internalization. Clinical and radiological factors that play a crucial role in the evaluation and decision process during brace treatment were not significantly associated with COPS and SATAQ-3 total scores. The SATAQ-3 total score and COPS results were also not related to sociodemographic parameters of the analyzed group. Conclusions: The presented study confirms the usefulness of the questionnaires, which aimed to isolate sociocultural risk factors of body image disorders in scoliosis patients as predictors of treatment dissatisfaction and worse compliance. Full article

Sarcopenia is a progressive and generalized skeletal muscle disorder associated with poor outcomes and complications, including falls, fractures, physical disability, and death. The aim of this review is to assess the possible influence of sarcopenia on outcomes of sarcopenia in patients who underwent knee or hip replacement. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Medline, EMBASE, Scopus, CINAHL, and CENTRAL bibliographic databases were searched. General study characteristics extracted were: primary author and country, year of publication, type of study, level of evidence (LOE), sample size, mean age, gender, follow-up, type of surgery, diagnosis, and outcomes. At the final screening, five articles met the selection criteria and were included in the review. Sarcopenia influences the Barthel Index (BI), which is significantly lower compared to patients without sarcopenia, which indicates that the patient is subjected to a worsening of this condition that can influence their normal life since they will become dependent on someone else. No difference in mortality rate was found was found between the studies. This systematic review addressed the possible role of sarcopenia in patients undergoing joint replacement surgery. Despite the lack of high-quality literature on this topic, a general trend in considering sarcopenia as a negative factor for quality of life in joint replacement patients was reported. However, the lack of significant results means it is not possible to report useful conclusions. Full article

This study describes the trends of elbow arthroscopy in Italy and other countries in order to evaluate the yearly rates of EA. Its purpose is for future epidemiological studies to be able to compare their data between countries in order to understand the reasons for the increasing and decreasing trends. Data for this study were obtained from National Hospital Discharge records (SDO) at the Italian Ministry of Health (INHS). Data regarding sex, age, region of residence, region of surgery, length of hospitalization, and procedure codes were included. In total, 2414 elbow arthroscopies were performed in Italy from 2001 to 2016 in the adult population. The highest number of procedures was found in the 40–44 and 45–49 years age groups. Males represented the majority of patients undergoing EA both in total and over the years. An increase from 2001 to 2010 and a decrease from 2010 to 2016 were reported in the present analysis. According to other studies, males of 40–44 and 45–49 years age groups represent the most treated patients. Further epidemiological studies would provide data that could be compared between countries, reaching a general consensus on the best indications for this procedure. Full article

Aims: An increase in temperature in an area suspected of septic arthritis is a clinically important finding. The aim of this study is to evaluate temperature changes in septic arthritis with a high-resolution thermal camera. Methods: A total of 49 patients, who were evaluated with a prediagnosis of arthritis (septic or non-septic), were included in this study. A temperature increase in the knee with suspected septic arthritis was evaluated by using thermal imaging and compared with the opposite-side joint. Then, in order to confirm the diagnosis, a culture was taken using routine intra-articular aspiration. Results: The thermal measurements were compared in 15 patients with septic arthritis and 34 patients with non-septic arthritis. The mean temperature was 37.93 °C in the septic group, while it was 36.79 °C in the non-septic group (p < 0.000 *). The mean temperature difference in both joints was 3.40 °C in the septic group, while it was 0.94 °C in the non-septic group (p < 0.000 *). While the mean temperature was 37.10 °C in the group with septic arthritis, it was measured to be 35.89 °C in the group non-septic arthritis (p < 0.020). A very strong positive correlation was found between the difference in the mean temperatures of both groups and the values of the hottest and coldest points (r = 0.960, r = 0.902). Conclusions: In the diagnosis of septic arthritis, thermal imagers can be used as a non-invasive diagnostic tool. A quantitative value can be obtained to indicate to a local temperature increase. In future studies, specially designed thermal devices can be developed for septic arthritis. Full article

Background and Objectives: Rheumatoid Arthritis (RA) is an auto-immune disease in which the body mistakenly considers some parts of its own system as pathogens and attacks them. Prevalence is approximately 0.75% in India. About 40% of the diseased become work disabled within 5 years from the onset of symptoms. The objective of this paper is to assess the sign/symptoms, joints’ involvement, difficulties in daily activities and screening accuracy of serology tests of clinically suspected RA patients. Material and Methods: A cross-sectional cohort study design was conducted on two hundred ninety clinically suspected subjects who were referred by different OPDs of hospitals for screening. The profiles of study subjects were carried through a semi-structured, pre-tested schedule method. About 2 mL of blood samples were collected in a plain vial from each patient and tested for diagnostic tests RF, CRP and AntiCCP by using RF-Latex, CRP Latex and ELISA method, respectively, by the laboratory persons. Results: Joint pain shows to be a leading problem in RA as compared to other signs and symptoms. The majority of the study subjects suffer from knee problems (62%). Approximately equal numbers of RA-positive cases were screened by RF and AntiCCP tests. The CRP test screened about one-third of cases. CRP+ AntiCCP, RF+ AntiCCP and RF + CRP all have good sensitivity, and RF+ AntiCCP + CRP has a very high sensitivity for diagnosing RA. Conclusions: This study found that a substantiation of a major proportion of clinically suspected RA patients were suffering from knee pain. Predication of AntiCCP increased the possibility for the diagnosis of RA. However, RF was also moderately related to the diagnosis of RA, and the combination of both tests was more valuable. Full article

Introduction: Neuromuscular Diseases (NMD) are associated with decreased bone strength due to altered muscle–bone interaction. However, the evaluation of bone quality remains a certain challenge in these patients. The purpose of this scoping review is to investigate the recent literature regarding the assessment of Bone Mineral Density (BMD) in this population. Methods: An electronic search of the PubMed and Scopus database was performed considering studies published in the English literature after 2007 that evaluated BMD in pediatric and adolescent patients with NMD. We excluded studies that evaluated patients > 20 years, studies not involving humans, and studies investigating bone mineral density in various pediatric conditions, but without specific data on NMD. Results: Overall, 19 studies were included that evaluated BMD in 1983 patients with NMD. Duchenne Muscular Dystrophy was the most widely studied disease (n = 11 studies). Dual energy X-ray absorptiometry (DEXA) was the most common diagnostic modality for BMD evaluation, while the most frequent site for BMD measurement was the lumbar spine (89.4%, n = 17 studies), followed by total body BMD (68.4%, n = 13 studies). Low BMD in children with NMD was demonstrated in all studies, especially after loss of ambulation. Moreover, a positive correlation between lower BMD and older age was shown. Conclusions: BMD evaluation in NMD remains a clinical challenge, as indicated by the high heterogeneity regarding the optimal site and technique for the evaluation of bone quality in these patients. Although DXA is currently the diagnostic modality of choice, a consensus regarding the optimal site for BMD measurement, and the adjustment method for its obtained measurements for parameters such as age and height is needed. Full article

Introduction: Anticoagulation use in the elderly is common for patients undergoing femoral neck hip surgery. However, its use presents a challenge to balance it with associated comorbidities and benefits for the patients. As such, we attempted to compare the risk factors, perioperative outcomes, and postoperative outcomes of patients who used warfarin preoperatively and patients who used therapeutic enoxaparin. Methods: From 2003 through 2014, we queried our database to determine the cohorts of patients who used warfarin preoperatively and the patients who used therapeutic enoxaparin. Risk factors included age, gender, Body Mass Index (BMI) > 30, Atrial Fibrillation (AF), Chronic Heart Failure (CHF), and Chronic Renal Failure (CRF). Postoperative outcomes were also collected at each of the patients’ follow-up visits, including number of hospitalization days, delays to theatre, and mortality rate. Results: The minimum follow-up was 24 months and the average follow-up was 39 months (range: 24–60 months). In the warfarin cohort, there were 140 patients and 2055 patients in the therapeutic enoxaparin cohort. Number of hospitalization days (8.7 vs. 9.8, p = 0.02), mortality rate (58.7% vs. 71.4%, p = 0.003), and delays to theatre (1.70 vs. 2.86, p < 0.0001) were significantly longer for the anticoagulant cohort than the therapeutic enoxaparin cohort. Warfarin use best predicted number of hospitalization days (p = 0.00) and delays to theatre (p = 0.01), while CHF was the best predictor of mortality rate (p = 0.00). Postoperative complications, such as Pulmonary Embolism (PE) (p = 0.90), Deep Vein Thrombosis (DVT) (p = 0.31), and Cerebrovascular Accidents (CVA) (p = 0.72), pain levels (p = 0.95), full weight-bearing status (p = 0.08), and rehabilitation use (p = 0.34) were similar between the cohorts. Conclusion: Warfarin use is associated with increased number of hospitalization days and delays to theatre, but does not affect the postoperative outcome, including DVT, CVA, and pain levels compared to therapeutic enoxaparin use. Warfarin use proved to be the best predictor of hospitalization days and delays to theatre while CHF predicted mortality rate. Full article

Metabolic diseases such as obesity and diabetes mellitus seem to have an influence on reoperation and long-term functional outcomes after arthroscopic repair of chronic rotator cuff tears. High prevalence of these pathologies can be found in the Canary Islands. A retrospective cohort study was carried out, in which 80 patients undergoing shoulder arthroscopic surgery for the repair of chronic rotator cuff tears were included, with a minimum follow up of 5 years, to study the occurrence of complications, reoperation, and functional outcomes. Functionality after surgery improved in 75% of patients with diabetes and remained the same or worsened in 25% (OR = 1.444). In the group of non-diabetic patients, 83.9% had improved function after surgery while it remained the same or worsened in 16.1% (OR = 0.830). Functionality after surgery improved in 76.6% of obese patients and remained the same or worsened in 23.4% (OR = 1.324). In the non-obese group, 87.9% had improved function after surgery, while it remained the same or worsened in 12.1% (OR = 0.598). Despite not obtaining statistically significant differences, the analysis of the results obtained suggests that obesity and diabetes could act by decreasing the subjective improvement in functionality after surgery, and, in the case of obesity, also increase the risk of reoperation. Full article

The Weil osteotomy is an established procedure to reduce plantar pressure in chronic metatarsalgia. Historically, the refixation of the displaced metatarsal head is performed by screw fixation. We aimed to demonstrate that screw fixation is not always necessary. Between 2016 and 2021, 155 patients with 278 Weil osteotomies (20 males and 135 females, mean age: 63 years) were retrospectively enrolled. Group A (n = 96) underwent 195 Weil osteotomies with screw fixation; group B (n = 59), 83 without screw fixation. Demographic, Visual Analog Scale Foot and Ankle (VAS-FA), SF-12 questionnaire, and toe mobility data were recorded. The mean follow-up period was 4.5 years. The mean VAS-FA was 75.5; mean SF-12 physical component summary, 42.0; and mean SF-12 mental component summary, 51.0. The overall revision rate was 20% (group A: 25%, group B: 10.2%), primarily for arthrolysis of the metatarsophalangeal joint in group A. Clinical comparisons showed no significant difference between the groups (p > 0.05). The revision rate was significantly higher in group A (p < 0.05), with equal satisfaction in clinical outcomes. Based on the available data, the need for regular screw fixation after a Weil osteotomy cannot be justified. Full article

Sensory ataxia due to posterior cord syndrome is a relevant, disabling condition in nontraumatic spinal cord dysfunction. Ataxic gait is a common symptom of sensory ataxia that restricts activities of daily living. A 70-year-old woman with severe sensory disturbance was diagnosed with intradural extramedullary spinal cord tumors found in the thoracic spine region (T8). Surgical management of the tumors was performed. The patient received gait training 20 days after surgery (postoperative acute phase) using a hybrid assistive limb (HAL). HAL is a wearable exoskeleton cyborg that provides real-time assistance to an individual for walking and limb movements through actuators mounted on the bilateral hip and knee joints. Walking ability was assessed using the 10 m walking test, which included evaluating walking speed, step length, and cadence in every session. To evaluate the immediate effects of HAL training, walking speed and step length were measured before and after the training in each session. During the 10 m walking test, gait kinematics and lower muscle activity were recorded using a motion capture system and wireless surface electromyography before the first session and after completion of all HAL sessions. After the HAL training sessions, improvement in the patient’s gait performance was observed in the gait joint angles and muscle activity of the lower limb. After 10 training sessions, we observed the following changes from baseline: walking speed (from 0.16 m/s to 0.3 m/s), step length (from 0.19 m to 0.37 m), and cadence (from 50.9 steps/min to 49.1 steps/min). The average standard deviations of the knee (from right, 7.31; left, 6.75; to right, 2.93; p < 0.01, left, 2.63; p < 0.01) and ankle joints (from right, 6.98; left, 5.40; to right, 2.39; p < 0.01, left, 2.18; p < 0.01) were significantly decreased. Additionally, walking speed and step length improved immediately after completing all the HAL training sessions. This suggests that HAL gait training might be a suitable physical rehabilitation program for patients with sensory ataxia causing dysfunctional movement of the lower limb. Full article

Platelet-Rich Plasma (PRP) injection has become a desirable alternative to Partial Plantar Fasciotomy (PPF) surgery and steroid injection for patients with chronic plantar fasciitis (CPF) due to its potential for shorter recovery times, reduced complications, and similar activity scores. As such, we compared PRP treatment to PPF surgery in patients with CPF. Between January 2015 and January 2017, patients were randomly divided into two groups, a PRP treatment group, and a PPF group. All procedures were performed by a single foot and ankle fellowship-trained specialist surgeon. Visual Analog Score (VAS) and Roles-Maudsley Scale (RM) were collected during the preoperative visit and 3, 6, and 12 months postoperatively. The patients were also closely followed by a physiotherapist. There were 16 patients in each group after four patients refused to participate. Patients in the PPF had low Roles-Maudsley Scale (RM) scores compared to the PRP group one-year after treatment (3.77 vs. 2.72, p < 0.0001). Both procedures showed a reduction in RM scores during the follow-up year (9 to 1.62 for PPF and 8.7 to 2.4 for PRP). There was no significant change in VAS pain between the two groups (p = 0.366). Patients treated with PRP injection reported a significant increase in their activity scores, shorter recovery time, and lower complication rates compared to PPF treatment. Moreover, with respect to existing literature, PRP may be as efficient as steroid injection with lower complication rates, including response to physical therapy. Therefore, PRP treatment may be a viable option before surgery as an earlier line treatment for CPF. Level of Clinical Evidence: II. Full article

Arthroscopic capsular release allows direct visualization and release of inflamed tissues in refractory frozen shoulder. The reticular neural network in the long head of the biceps tendon (LHBT) and nerve endings of the transverse humeral ligament (THL) might be responsible for shoulder pain. We hypothesized that patients with painful refractory frozen shoulder benefited from pan-capsular release, THL release, and LHBT tenodesis. The LHBT tenodesis decreased the possibility of LHBT instability. The balance of the shoulder joint was maintained after such extensive release. From October 2013 to June 2019, patients with painful refractory frozen shoulder were enrolled consecutively at the same institute. All patients received arthroscopic pan-capsular, THL release, and suprapectoral LHBT tenodesis with a minimum of 2-year follow-up. Preoperative and postoperative shoulder range of motion (ROM), pain visual analog scale (PVAS), subjective shoulder value (SSV), constant score, LHBT score, acromio-humeral distance (AHD), and critical shoulder angle (CSA) were recorded. In total, 35 patients with an average age of 53.1 ± 9 years were enrolled. The average follow-up period was 24 ± 1.5 months. Forward elevation improved from 105.1° ± 17° to 147° ± 12° (p < 0.001), external rotation improved from 24.1° ± 13.3° to 50.9° ± 9.7° (p < 0.001), and internal rotation improved from L3 to T9 (p < 0.001), respectively, at final follow-up. PVAS improved from 7.3 ± 1.1 to 1.8 ± 0.6 (p < 0.001), constant score from 23.4 ± 11 to 80.7 ± 5.2 (p < 0.001), and SSV from 27.7 ± 10.5 to 77.4 ± 3.8, respectively, at follow-up. No differences were found in AHD and CSA after surgery (p = 0.316, and p = 0.895, respectively). Patients with painful refractory frozen shoulder benefited from pan-capsular and THL release. A radiographically balanced shoulder joint was maintained even after such extensive release. Full article

When visualizing biological activity at nonunion sites by the radioisotopes, gamma rays are more attenuated if metal implants are placed in the bone. However, the effects of various implant types and their placement on gamma ray attenuation in quantitative evaluation remain unknown. To elucidate these effects, we created a phantom that simulated the nonunion of the femur in this study. The count of gamma rays was measured by single-photon emission computed tomography/computed tomography (SPECT/CT) while considering CT-based attenuation correction (CTAC), metal implant placement, type (intramedullary nail or plate), and position. The count differed significantly with and without CTAC and with and without implants (both types) under CTAC. Significantly different counts were observed between the intramedullary nail and plate placed contralaterally to the lesion (i.e., non-lesion side). No significant difference was observed between the intramedullary nail and plate on the lesion side or between plates on the non-lesion and lesion sides. The measured standardized uptake value (SUV) was closer to the true SUV with CTAC than without. Moreover, the count was higher with implants than without. However, even with implants, it was lower than the actual count, indicating the absence of overcorrection. Implant type and position do not seem to influence the count. Full article

Background and Objectives: Due to the rarity of radial nerve palsy in humeral shaft fractures in the paediatric population and the lack of data in the literature, the purpose of our study was to report the treatment results of six children who sustained a radial nerve injury following a humeral shaft fracture. Materials and Methods: We treated six paediatric patients with radial nerve palsy caused by a humeral shaft fracture in our department from January 2011 to June 2022. The study group consisted of four boys and one girl aged 8.6 to 17.2 (average 13.6). The mean follow-up was 18.4 months. To present our results, we have used the STROBE protocol designed for retrospective observational studies. Results: We diagnosed two open and four closed humeral shaft fractures. Two simple transverse AO 12A3c; one simple oblique AO 12A2c; two simple spiral AO 12A1b/AO 12A1c and one intact wedge AO 12B2c were recognized. The humeral shaft was affected in the distal third five times and in the middle third one time. In our study group, we found two cases of neurotmesis; two entrapped nerves within the fracture; one stretched nerve over the bone fragments and one case of neuropraxia. We found restitution of the motor function in all cases. For all patients, extensor muscle strength was assessed on the grade M4 according to the BMRC scale (except for a patient with neuropraxia—M5). The differences in patients concerned the incomplete extension at the radiocarpal and metacarpophalangeal (MCP) joints. Conclusions: In our small case series, humeral shaft fractures complicated with radial nerve palsy are always challenging medical issues. In paediatric patients, we highly recommend an US examination where it is possible to be carried out to improve the system of decision making. Expectant observation with no nerve exploration is reasonable only in close fractures caused by low-energy trauma. Early surgical nerve exploration related with fracture stabilisation is highly recommended in fractures after high-energy trauma, especially in open fractures and where symptoms of nerve palsy appear at any stage of conservative treatment. Full article

Background and Objectives: Plantar fasciitis (PF) is a prevalent musculoskeletal disease, with inflammation at the origin of the plantar fascia, that affects sedentary people, particularly middle-aged women. Foot pain and functional limitations lead patients to seek treatment. Investigate the therapeutic effect of conservative treatment combining a custom insole with minimalist flexible shoes and the shoes alone in a gait-training protocol, in the short and long term, in women with PF. Materials and Methods: Design: A randomized, controlled, and single-blind trial. Setting: Biomechanics laboratory. Participants: 36 women, 26 with acute PF and 10 controls. Intervention: Gait-training protocol wearing the minimalist shoes alone (SG, n = 12, age: 46.4 ± 9.6, height: 1.60 ± 0.2, BMI: 28.8 ± 4.2), with a custom insole in the shoes (CIG, n = 14, age: 48.9 ± 9.8, height: 1.60 ± 0.1, BMI: 26.7 ± 5.6), and control (CG, n = 10, age: 46.1 ± 10.7, height: 1.61 ± 0.2, BMI: 26.4 ± 4.8). Evaluations were performed at baseline (T0) and after three (T3) and six (T6) months. The intervention had a duration of six months (six hours a day, seven days a week). Primary outcomes were rearfoot pain (visual analogue scale), the Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br), and 6 min walk test (6MWT). The secondary outcomes were plantar pressure distribution during gait, measured by the pressure platform, and foot posture. Results: The CIG was effective for reducing pain and improving the FPI after T6 compared to CG. The FPI, FHSQ-Br and 6MWT demonstrated improvements after T6 in both the CIG and SG, compared to the CG. After T6, contact area (rearfoot) and maximum force (forefoot) reduced with CIG. Maximum force (midfoot and rearfoot) reduced with CIG and SG, as did peak pressure (forefoot and midfoot) in relation to CG. Conclusions: A customized insole associated with minimalist flexible shoes during a gait-training protocol can be recommended as a more effective treatment than minimalist flexible shoes alone over the short and long term, for reduction in calcaneus pain, increased function and foot health, and improved walking through reduced plantar load in women with PF. Full article

Background and Objectives: The aim of this study was to determine whether a non-contact sensor that detects complexion changes can be used to assess the psychological state of patients with chronic lower back pain (LBP). Materials and Methods: Twenty-six patients with LBP (LBP group; mean age = 68.0 ± 13.9 years) and 18 control subjects without LBP (control group; mean age = 60.8 ± 16.1 years) were included in the study. All the subjects in the two groups wore headphones when asked LBP-related and LBP-unrelated questions. During questioning, the facial image of the subjects was captured using a video camera, and the complexion of the subjects was converted into red, green, and blue (RGB) values. RGB correlation coefficients (RGBCCs; range: 0–1) represent the difference in complexion between LBP-related and LBP-unrelated questions. A high RGBCC indicates that the brain is more activated by LBP-related questions than by LBP-unrelated questions. We also noted the scores of subjects on the Numerical Rating Scale (NRS), Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scale (HADS). Results: There were no significant differences in RGBCC between the control and LBP groups (0.64 versus 0.56, p = 0.08). In the LBP group, no correlation was observed between RGBCC and each examination item of NRS, JOABPEQ, and HADS. In contrast, a correlation was observed between RGBCC and the rumination subscale of PCS in the LBP group (Spearman’s rank correlation coefficient = 0.40, p = 0.04). Conclusions: The complexion of patients with catastrophic thinking changes when the patients are asked LBP-related questions. Full article

Background and Objectives: Although distal interphalangeal (DIP) arthrodesis is an effective surgical method for end-stage osteoarthritis of the phalangeal joint, the nonunion rate of DIP arthrodesis has been reported to range from 15% to 20%. To this end, we devised an inlay technique with a cortico-cancellous olecranon bone graft for failed DIP arthrodesis. This study aimed to introduce the inlay bone grafting technique for failed arthrodesis of the DIP joint and demonstrate its advantages. Materials and Methods: We reviewed consecutive 19 digits (15 patients) who had undergone DIP revision arthrodesis using the technique at our institution between January 2010 and December 2020. The observed outcome measures were the bone union rate, and related complications. Bone union was evaluated using follow-up radiography. The quick Disabilities of the Arm, Shoulder and Hand (DASH), visual analog scale (VAS) for pain, and VAS for satisfaction assessed patient function and perceived clinical outcomes. Results: No major complications were observed at the recipient site. The average VAS for pain and satisfaction and DASH score improved from preoperatively to 6 months after surgery (both, p = 0.001). Conclusions: The inlay technique with cortico-cancellous olecranon bone grafts showed excellent bone union rates and functional scores with nonunion of the DIP joint. This technique may be an adequate surgical option for patients with confirmed nonunion of the DIP joint and persistent symptoms. Full article

Submuscular plating and osteotomy using power saw have shown the benefits in certain situations of limb lengthening. However, no previous studies combining both procedures have been conducted for acute tibial deformity correction and limb lengthening. Nineteen cases were enrolled in this study. Ten patients received tibial lengthening with acute knee angular deformity correction using high-energy osteotomy (Group 1), and nine patients received tibial lengthening only with osteotomy using multiple drills and osteotome (Group 2). Radiographic parameters retrieved before and after the operation included leg-length discrepancy, tibial length, length gained, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and mechanical axis deviation (MAD). There were significant differences between groups in terms of external fixator index (EFI) (p = 0.013) and healing index (HI) (p = 0.014), but no significance in the length gained (p = 0.356). The latest postoperative mLDFA (p = 0.315), MPTA (p = 0.497), and MAD (p = 0.211) of Group 1 were not distinguishable from Group 2. The functional outcomes were excellent, and there were no permanent complications. Despite showing a longer healing time, this alternative lengthening procedure which combines fixator-assisted plate lengthening in the tibia with simultaneous surgical intervention of acute tibial deformity correction using an oscillating saw is appropriate for patients with leg-length discrepancy and angular deformity of the tibia. Full article

Selective Nerve Root Block (SNRB) is a precise local injection technique that can be utilised to target a particular inflamed nerve root causing lumbar radiculopathy for both diagnostic and therapeutic purposes. Usually, for SNRB to be therapeutic, a combination of a local anaesthetic agent and a steroid is injected under imaging guidance, whereas for diagnostic purposes, just the local anaesthetic agent is injected. While the ideal treatment strategy is to relieve the nerve root from its compressing pathology, local injection of steroids targeted at the affected nerve root can also be attempted to reduce inflammation and thus achieve pain relief. Although the general principle for administering an SNRB remains largely the same across the field, there are differences in techniques depending on the region and level of the spine that is targeted. Moreover, drug combinations utilised by clinicians vary based on preference. The proven benefits of SNRBs largely outweigh their risks, and the procedure is deemed safe and well tolerated in a majority of patients. In this narrative, we explore the existing literature and seek to provide a comprehensive understanding of SNRB as a treatment for lumbar radiculopathy, its indications, techniques, outcomes, and complications. Full article

(1) Background: This is the first systematic review concerning the treatment of osteochondritis dissecans with the use of bioabsorbable implants. The study was done as a comprehensive review to identify important factors affecting the results of OCD treatment in children and adolescents; (2) Methods: We searched electronic bibliographic databases including PubMed, Cochrane Library, Scopus, and Web of Knowledge until May 2022. This systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PICO (Patients, Interventions, Comparisons, Outcomes) guidelines; (3) Results: We identified 2662 original papers of which 11 were found to be eligible for further analysis. The study group included a total of 164 OCD lesions in 158 patients. In 94.86% of postoperative cases, there was complete healing or local improvement on follow-up CT or MRI scans. The great majority of patients achieved a good clinical effect. Out of 164 OCD lesions, 10 did not heal (6.09%); (4) Conclusions: Surgical treatment of stable and unstable OCD in children with the use of bioabsorbable implants facilitates a high rate of healing and a good clinical outcome; treatment of juvenile OCD is associated with a better outcome compared to adult OCD; the use of bioabsorbable implants for the treatment of humeral capitellum OCD is associated with a more frequent incidence of synovitis (18.2%). Full article

Background and Objectives: Tenosynovial giant cell tumors (TSGCTs) are benign soft tissue tumors that are divided into localized- and diffuse-type tumors, according to the World Health Organization classification of soft tissue tumours. The diffuse-type TSGCT sometimes behave aggressively and poses treatment challenges especially in patients with neurovascular involvement. Symptomatic patients who are not good candidates for surgery due to high morbidity risk may benefit from medical therapy. Objectives: Drugs that target programmed death ligand 1 (PD-L1) are among a new generation of medical therapy options, which, recently, have been explored and have displayed promising results in various cancer types; therefore, we aimed to investigate the PD-L1 status of TSGCTs as a possible therapeutic target. Materials and Methods: We assessed the PD-L1 status of 20 patients (15 men and 5 women, median age = 39 years) that had been diagnosed with TSGCTs in a single institution, between 2018 and 2020. The patients had localized- (n = 7) and diffuse-type (n = 13) TSGCTs. Formalin-fixed paraffin-embedded (FFPE) blocks were retrospectively retrieved from the pathology department. An immunohistochemical analysis was performed in sections of 3 micron thickness from these blocks. Results: Seventy-five percent of our patients with TSGCTs were immunopositive to PD-L1 staining. Conclusions: Taking into consideration the high positivity rate of PD-L1 staining in TSGCTs, PD-L1 blockage may be used as a valuable medical treatment for TSGCTs; however, further studies are needed. Full article

The purpose of this study was to report the clinical validation of the posture analyzing and virtual reconstruction device (PAViR) system, focusing on the accuracy of sagittal spinal parameters, compared with the EOS imaging system. Seventy patients diagnosed with segmental and somatic dysfunction were recruited between February 2020 and November 2020. Each patient was examined using the EOS imaging system and PAViR; the sagittal parameters of human body posture [forward head posture (FHP), T1 tilt angle (T1t), knee flexion angle (KF), lumbar lordosis angle (LL), and pelvic tilt angle (PT)] were analyzed to verify the correlation between the results of the two devices. The median differences in the results of the two devices showed significant differences in FHP (T4-frontal head and T4-auditory canal), T1t, and PT. In the correlation analysis, the values of FHP (C7-auditory canal, T4-frontal head, and T4-auditory canal), T1t, and PT showed a moderate correlation between the two devices (r = 0.741, 0.795, 0.761, 0.621, and 0.692, respectively) (p < 0.001). The KF and LL was fairly correlated (r = 0.514 and 0.536, respectively) (p = 0.004, both). This study presents the potential of a novel skeletal imaging system without radiation exposure, based on a 3D red-green-blue-depth camera (PAViR), as a next-generation diagnostic tool by estimating more accurate parameters through continuous multi-data-based upgrades with artificial intelligence technology. Full article

A high percentage of patients with lateral ankle sprains report poor outcomes and persistent neuromuscular impairment leading to chronic ankle instability and re-injury. Several interventions have been proposed and investigated, but the evidence on manual therapy combined with therapeutic exercise for pain reduction and functional improvement is still uncertain. The purpose was to study the effectiveness of adding manual therapy to therapeutic exercise in patients with lateral ankle sprains through a critically appraised topic. The literature search was performed in PubMed, PEDro, EMBASE and CINAHL databases, and only randomized clinical trials were included according to following criteria: (1) subjects with acute episodes of lateral ankle sprains, (2) administered manual therapy plus therapeutic exercise, (3) comparisons with therapeutic exercise alone and (4) reported outcomes for pain and function. Three randomized clinical trials (for a total of 180 patients) were included in the research. Meta-analyses revealed that manual therapy plus exercise was more effective than only exercises in improving dorsal (MD = 8.79, 95% CI: 6.81, 10.77) and plantar flexion (MD = 8.85, 95% CI 7.07, 10.63), lower limb function (MD = 1.20, 95% CI 0.63, 1.77) and pain (MD = −1.23; 95% IC −1.73, −0.72). Manual therapy can be used with therapeutic exercise to improve clinical outcome in patients with lateral ankle sprains. Full article

Plantar fasciitis is a common cause of heel pain, and the disorder is generally self-limiting after adequate conservative treatment. When conservative treatment is unsuccessful, surgical release is an effective treatment option. Here we report a case of iatrogenic plantar fascia rupture after surgical release for treatment of recalcitrant plantar fasciitis. Preoperative MRI revealed a 4.2 cm gap between the distal fascia stump and the calcaneal tuberosity in the sagittal view at 8 months post-injury. To circumvent the possibility of rupture site retear or poor tissue healing by direct repair, we used tendon allografting for the reconstruction of the chronic plantar fascia rupture. The patient gradually recovered after the surgery. Complications of plantar fascia rupture after surgical release is a potential risk but rarely observed. Chronic plantar fascia rupture with medial arch collapse is difficult to treat. We used a tendon allograft to reconstruct the plantar fascia, restoring its function and mechanical strength. After 5 years of follow-up, no complications were reported, and magnetic resonance imaging indicated the reconstructed plantar fascia tissue to be in good condition. Full article

The lateral wedge insole (LWI) is a typical orthopedic treatment for medial knee osteoarthritis pain, chronic ankle instability, and peroneal tendon disorders. It is still unknown what the effects are in the most important joints of the foot when using LWIs as a treatment for knee and ankle pathologies. Objectives: The aim of this study was to determine the influence of LWIs on the position of the midfoot and rearfoot joints by measuring the changes using a tracking device. Methods: The study was carried out with a total of 69 subjects. Movement measurements for the midfoot were made on the navicular bone, and for the rearfoot on the calcaneus bone. The Polhemus system was used, with two motion sensors fixed to each bone. Subjects were compared by having them use LWIs versus being barefoot. Results: There were statistically significant differences in the varus movement when wearing a 4 mm LWI (1.23 ± 2.08°, p < 0.001) versus the barefoot condition (0.35 ± 0.95°), and in the plantarflexion movement when wearing a 4 mm LWI (3.02 ± 4.58°, p < 0.001) versus the barefoot condition (0.68 ± 1.34°), in the midfoot. There were also statistically significant differences in the valgus movement when wearing a 7 mm LWI (1.74 ± 2.61°, p < 0.001) versus the barefoot condition (0.40 ± 0.90°), and in the plantar flexion movement when wearing a 4 mm LWI (2.88 ± 4.31°, p < 0.001) versus the barefoot condition (0.35 ± 0.90°), in the rearfoot. Conclusions: In the navicular bone, a varus, an abduction, and plantar flexion movements were generated. In the calcaneus, a valgus, an adduction, and plantar flexion movements were generated with the use of LWIs. Full article

Background and Objectives: Adolescent idiopathic scoliosis (AIS) is a prevalent spinal disorder in adolescents. Previous studies have shown biomechanical changes of the gait in the lower limb of AIS patients. To minimize the progression of scoliotic curvature, a spinal brace is used, which has been shown to be efficient. Usually, a brace is worn strictly for 20–22 h every day. To our knowledge, no study has assessed the short- and long-term effects of spinal brace use with or without an exercise program (6 months) to improve clinical and biomechanical parameters. The aim of our study was to verify the effects of short- and long-term spinal brace use, with or without an exercise program on the spine, body balance, and plantar load distribution during gait in AIS. Materials and Methods: A prospective randomized study was conducted with intention-to-treat analysis in forty-five adolescents diagnosed with AIS undergoing conservative treatment at a center specialized in spinal rehabilitation. Adolescents were evaluated at two stages of intervention: (1) spinal orthopedic brace, with acute use 24 h/day (n = 22) and (2) spinal orthopedic brace, with acute use between 15–18 h/day associated with a specific rehabilitation exercise protocol for six consecutive months (six months and 12 total sessions, n = 23). The evaluated parameters were: spine pain, using a visual analog scale (VAS); Cobb angle measurement using radiograph exams, as well as the Risser sign; and static balance and plantar pressure of the feet during gait, carried out using a pressure platform. Results: AIS patients showed significant improvements in the main scoliotic curvature, with a 12-degree reduction in Cobb angle pre- and post-short-term immediate use of spinal brace and a 5.3 degree correction after six months of spinal brace use in combination with specific exercises (long term). In addition, short- and long-term brace use with an exercise program showed a significant increase in anteroposterior and mediolateral balance and a reduction in plantar overload on the heel during gait, with an effect size between moderate and high. Conclusions: Intervention via the short- or long-term use of a spinal brace combined with specific exercises in adolescents with idiopathic scoliosis proved to be effective for correcting scoliotic curvature. In addition, intervention also showed improvements to the antero-posterior and mediolateral body balance and a reduction in the plantar load on the rearfoot region during gait, demonstrating effective mechanical action on the spine. Full article

Background and Objectives: Latarjet is among the procedures indicated to treat shoulder instability, producing excellent results, including low instability rates and high patient satisfaction. The aim of this study was to report the characteristics of scientific articles that address the subject of the Latarjet procedure through the use of bibliometric analysis. Materials and Methods: Bibliographic searches were performed for original articles published in journals indexed by the Web of Science database until 2021, with no language restrictions. Results: A total of 668 articles published in 87 journals were included. The first publication was in 1981; the most registered publications were in 2018 and 2021 (89 articles), with an annual percentage growth rate of 11.9. Provencher MT was the author with the most published articles, and the institutional affiliation with the most original articles was the Steadman Philippon Research Institute. The most cited article was a study by Burkhart and Beer, and the scientific journal with the most publications on the subject was the Journal of Shoulder and Elbow Surgery. Most published studies included keywords such as dislocation, instability, and meta-analysis. Conclusion: There has been a sustained increase in original articles on the Latarjet procedure. However, the greatest growth in articles has occurred during the last decade, demonstrating the considerable interest among the world scientific community. Full article

Background: Hallux valgus (HV) is one of the most common forefoot deformities, and its prevalence increases with age. HV has been associated with poor foot function, difficulty in fitting footwear and poor health-related quality of life. The aims of this study were to design and develop an easy-to-use measurement device for measuring hallux valgus angle (HVA) in patients with HV and to assess the measurement reliability of the newly designed measurement device. Methods: A manual measurement device for measuring HVA was designed and developed to test on patients with HV. Two measuring methods, i.e., test–retest and intra-observer measurements, were used to evaluate the repeatability and reliability of the newly designed measurement device. In the test–retest measurements, a total of 42 feet from 26 patients with HV were repeatedly measured by the same researcher using the manual measurement device every 3 weeks over a period of 12 months. The measurement reliability of the newly designed measurement device was analysed based on the collected HVA data. In the intra-observer measurements, a total of 22 feet from the same group of HV patients were measured by the same researcher using the manual measurement device and by a consultant using X-ray measurement for comparison. The intraclass correlation coefficient (ICC) was used to determine the correlation of measurements between the manual measurement device and X-ray measurement. Results: The mean of the difference between the two repeat measurements of HVA using the newly designed manual device was 0.62°, and the average of ICC was 0.995, which indicates excellent reliability. The ICC between X-ray and the average of twice-repeated manual measurements was 0.868, with 95% CI (0.649, 0.947) (p = 0.000). When the relationship in HVA between X-ray measurement and manual measurement using the new device was regressed as a linear relationship, the regression equation was y = 1.13x − 4.76 (R² = 0.70). Conclusions: The newly designed measurement device is easy to use, with low-cost and excellent reliability for HVA measurement, with the potential for use in clinical practice. Full article

Chronic pain is common after burn injuries, and post-burn neuropathic pain is the most important complication that is difficult to treat. Scrambler therapy (ST) is a non-invasive modality that uses patient-specific electrocutaneous nerve stimulation and is an effective treatment for many chronic pain disorders. This study used magnetic resonance imaging (MRI) to evaluate the pain network-related mechanisms that underlie the clinical effect of ST in patients with chronic burn-related pain. This prospective, double-blinded, randomized controlled trial (ClinicalTrials.gov: NCT03865693) enrolled 43 patients who were experiencing chronic neuropathic pain after unilateral burn injuries. The patients had moderate or greater chronic pain (a visual analogue scale (VAS) score of ≥5), despite treatment using gabapentin and other physical modalities, and were randomized 1:1 to receive real or sham ST sessions. The ST was performed using the MC5-A Calmare device for ten 45 min sessions (Monday to Friday for 2 weeks). Baseline and post-treatment parameters were evaluated subjectively using the VAS score for pain and the Hamilton Depression Rating Scale; MRI was performed to identify objective central nervous system changes by measuring the cerebral blood volume (CBV). After 10 ST sessions (two weeks), the treatment group exhibited a significant reduction in pain relative to the sham group. Furthermore, relative to the pre-ST findings, the post-ST MRI evaluations revealed significantly decreased CBV in the orbito-frontal gyrus, middle frontal gyrus, superior frontal gyrus, and gyrus rectus. In addition, the CBV was increased in the precentral gyrus and postcentral gyrus of the hemisphere associated with the burned limb in the ST group, as compared with the CBV of the sham group. Thus, a clinical effect from ST on burn pain was observed after 2 weeks, and a potential mechanism for the treatment effect was identified. These findings suggest that ST may be an alternative strategy for managing chronic pain in burn patients. Full article

The causes of carpal tunnel syndrome are complex. However, little is known about the risk factors for carpal tunnel syndrome occurrence on simple radiographic images. To determine the X-ray imaging factors that can predict idiopathic carpal tunnel syndrome occurrence, we compared a group diagnosed with idiopathic carpal tunnel syndrome who received carpal tunnel release with a control group that had no symptoms. The simple wrist X-ray findings of 75 patients diagnosed with idiopathic carpal tunnel syndrome and 87 patients selected for the control group were evaluated. All the carpal tunnel syndrome patients were diagnosed based on clinical symptoms and nerve conduction studies. Anteroposterior and lateral radiographs of the wrists were taken in all the groups. The radial inclination, volar tilt, ulnar variance, radiolunate angle, and lunate-to-axis-of-radius distance were measured. Data were measured using two independent raters. After calculating the average of each value, the two groups were statistically compared. The diagnostic performance of statistically different figures was confirmed by drawing receiver operator characteristic curves. There was a significant difference in the radiolunate angle and lunate-to-axis-of-radius distance between the two groups (p < 0.01 and p = 0.028, respectively). The odd ratios for each parameter were 1.052 and 1.319, respectively. The area under the receiver operator characteristic curves were 0.715 and 0.601, respectively. In this study, radiolunate angle and lunate-to-axis-of-radius distance were useful as radiographic diagnostic tools. In other words, excessive dorsiflexion and volar displacement of the lunate can be considered as risk factors that may cause idiopathic carpal tunnel syndrome in the future. Full article

The trend of Total Hip Arthroplasty (THA) is projected to grow. Therefore, it has become imperative to find new measures to improve the outcomes of THA. Several studies have focused attention on the influence of psychological factors and sleep quality on surgical outcomes. The consequences of depressive states may affect outcomes and also interfere with rehabilitation. In addition, sleep quality may be an essential factor in determining surgical outcomes. To our knowledge, few articles focus on the influence of these factors on THA results. The present study investigates a possible correlation between preoperative depression or sleep quality and postoperative outcomes of THA. This study was conducted with 61 consecutive patients undergoing THA from January 2020 to January 2021. Patients were assessed preoperatively using GDS and PSQI, and six months postoperatively using FJS-12, SF-36, WOMAC, PSQI, and GDS. To simplify comparisons, the overall scores were normalized to range from 0 (worst condition) to 100 points (best condition). A total of 37 patients (60.7%) were classified as depressed and 24 as not depressed (39.3 %) in the preoperative assessment. A low–moderate positive correlation between preoperative GDS score and FJS-12 (rho = 0.22, p = 0.011), SF-36-PCS (rho = 0.328, p = 0.01), and SF-36-MCS (rho = 0.293, p = 0.022) scores at six-month follow-up was found. When the normalized preoperative GDS score was high (no depression), the FJS-12, SF-36-PCS, and SF-36-MCS scores tended to increase more compared to the other group. Statistically significant differences between the two groups were found in postoperative FJS-12 (p = 0.001), SF-36-PCS (p = 0.017), and SF-36-MCS scores (p = 0.016). No statistically significant correlation between preoperative PSQI score and postoperative outcome measures was found. Preoperatively depressed patients had a low–moderate positive correlation with postoperative SF-36 and FJS-12 scores. There was no correlation between sleep quality and postoperative outcome measures of THA. Full article

The aim of this study was to have updated scrutiny of the influence of the humeral neck-shaft angle (HNSA) in patients who underwent reverse shoulder arthroplasty (RSA). A PRISMA-guided literature search was conducted from May to September 2021. Clinical outcome scores, functional parameters, and any complications were reviewed. Eleven papers were identified for inclusion in this systematic review. A total of 971 shoulders were evaluated at a minimum-follow up of 12 months, and a maximum of 120 months. The sample size for the “HNSA 155°” group is 449 patients, the “HNSA 145°” group involves 140 patients, and the “HSNA 135°” group comprises 291 patients. The HNSA represents an important variable in choosing the RSA implant design for patients with rotator cuff arthropathy. Positive outcomes are described for all the 155°, 145°, and 135° HSNA groups. Among the different implant designs, the 155° group show a better SST score, but also the highest rate of revisions and scapular notching; the 145° cohort achieve the best values in terms of active forward flexion, abduction, ASES score, and CMS, but also the highest rate of infections; while the 135° design obtains the best results in the external rotation with arm at side, but also the highest rate of fractures. High-quality studies are required to obtain valid results regarding the best prosthesis implant. Full article

Background: This study aims to identify genotype variants of the platelet-derived growth factor alpha polypeptide gene (PDGFA) that can influence the individual response to the treatment with platelet-rich plasma (PRP) in tennis elbow patients. Methods: We observed a cohort of 107 patients (132 elbows) with tennis elbow who received treatment with PRP. Patients have been followed-up for two years after PRP injection and the effectiveness of the treatment was measured using universal patient-reported outcome measures (PROMs): visual analog scale (VAS), quick version of disabilities of the arm, shoulder and hand score (QDASH), and patient-rated tennis elbow evaluation (PRTEE). PROMs values, and clinical and platelet parameters were compared between genotype variants of the studied polymorphisms (rs1800814, rs2070958 and rs62433334). Results: The A allele carriers (rs1800814) had significantly lower values of VAS (week 12), QDASH, and PRTEE (weeks 8, 12). The T allele carriers (rs2070958) had significantly lower values of VAS (weeks 8, 12), QDASH, and PRTEE (weeks 4–12). Additional forms of therapy (manual and physical) were necessary significantly more often in GG (rs1800814) and CC (rs2070958) homozygotes. Conclusions: The PDGFA gene’s polymorphisms influences the effectiveness of PRP therapy in tennis elbow treatment. The effectiveness of PRP is greater in A allele (rs1800814) and T allele (rs2070958) carriers. Full article

Background: Acetabular cage reconstruction with bone allografts is among the successful strategies to deal with massive acetabular bone loss. However, the nonbiological fixation nature of cages can compromise long-term success. Tantalum trabecular metal acetabular cups (TM cups) have been used in acetabular revision surgery because of their increased initial stability and good bone ingrowth features. This study was performed to determine whether the bone stock of the acetabulum is enough to support a hemispheric TM cup after failed cage reconstruction with bone allografts. Methods: We retrospectively reviewed patients who received acetabular revision surgery with TM cups after failed cage reconstruction with bone allografts from 2006 to 2017. There were 12 patients (5 males and 7 females) included in this study, with a mean age of 61.5 years (38 to 81) at the time of re-revision surgery. The mean follow-up after re-revision surgery was 8.6 years (2.6 to 13.3). The endpoint was defined as the aseptic loosening of the TM cup and reoperation for any causes. The change in bone stock of the acetabulum between index revision and re-revision was assessed according to the Gross classification for acetabular bone loss. Results: One patient died after eight years of follow-up of a cause not related to hip surgery. Two patients received two-stage revision arthroplasty due to PJI after 3.2 and 9.4 years of follow-up, respectively. The bone stock of the acetabulum was significantly improved between index revision and re-revision surgery (p < 0.0001). The Kaplan–Meier survivorship was 100% with aseptic loosening as the endpoint and 90% and 75% at five- and ten-year follow-up, respectively, with reoperation for any reason as the endpoint. Even cage reconstruction with bone allografts will fail eventually, and the bone stock of the acetabulum will improve after union and incorporation between host bone and allografts. The restored bone stocks will facilitate further revision surgery with hemispheric TM cups. The biological fixation between host bone and tantalum trabecular metal can provide longstanding stability of the TM cup. Conclusions: The results of our study offer a viable option for patients with failed cage reconstruction with bone allografts. Full article

Background and Objectives: Falls from heights are a common mechanism of trauma in children. However, data on bunk-bed-related (BBR) fractures are scarce. We aimed to assess types of fractures and age groups most at risk for BBR fractures. Material and Methods: We analyzed medical records and imaging procedures of patients aged <18 years who sustained a bunk bed injury and were treated at our department between January 2014 and December 2021. Demographic data, including age groups, mechanisms, types and anatomical regions of fractures, were assessed. Results: A total of 162 patients (median age 5 years, range 0–15; 59.9% male) was included. Fractures were recorded in 80 (49.4%) and contusions and abrasions in 49 (30.2%) cases. BBR fractures were recorded in 44.8% of children below the age of 3, in 50.8% aged 3–5, in 58.5% aged 6–9 and in 28.6% ≥ 10 years. Forearm fractures were most common (n = 34, 42.5%), followed by fractures of the clavicle (n = 13, 16.3%), humerus (n = 10, 12.5%), foot (n = 8, 10.0%), hand (n = 5, 6.3%), lower leg (n = 5, 6.3%) and skull (n = 5, 6.3%). Surgery was required in 12 (15.0%) cases, including closed reduction (n = 7) and closed reduction with internal fixation (n = 5). Overall, 21 (26.3%) patients were hospitalized with a mean length of stay of 2 ± 1.6 days. Conclusions: Caregivers should be aware that bunk beds cause a significant amount of severe trauma in children and adolescents, especially in those younger than 10 years of age. Caregivers would benefit from receiving information about these risks and evidence-based strategies to prevent BBR fractures. Full article

Night wrist splinting has been a conservative treatment for carpal tunnel syndrome. The addition of extracorporeal shock wave therapy provides an alternative treatment. However, strong evidence on the clinical effectiveness of extracorporeal shock wave therapy for carpal tunnel syndrome is still lacking. This study aimed to investigate the effectiveness and safety of extracorporeal shock wave therapy compared with treatments of night wrist splints alone for patients with carpal tunnel syndrome. In this systematic review and meta-analysis, no limitation criteria were used for study selection. All available articles that compare the effectiveness between extracorporeal shock wave therapy combined with night wrist splint and night wrist splint alone for treating carpal tunnel syndrome published up to 20 January 2022 were identified from the databases of PubMed, Embase, and Cochrane Central Register of Controlled Trials Central. The primary outcomes were a standard mean difference with a 95% confidence interval on the improvement of symptom severity and functional impairment between the two groups. In an attempt to analyze trends over time in studies that report repeated measurements, an all time-points meta-analysis (ATM) was undertaken. Seven randomized controlled trials with a total of 376 participants were included in this study. Significant improvements in functional impairment and symptom remission were only observed in the extracorporeal shock wave group at four weeks post-treatment. Extracorporeal shock wave therapy did not demonstrate superior efficacy compared to treatment with night wrist splint alone at 8–10 and 12–14 weeks post-treatment, or through the ATM approach. In conclusion, the therapeutic effect of extracorporeal shock wave therapy is transient and mostly nonsignificant compared with using night wrist splint alone. No serious side effects were reported in all included studies. Other conservative treatments to ameliorate carpal tunnel syndrome symptoms are warranted. Full article

While short stems in total shoulder arthroplasty (TSA) preserve bone stock and facilitate revision surgery, they have been associated with higher rates of malalignment and loosening in some cases compared to standard length stems. The purpose of this study was to analyze the intramedullary canal in progressive increments distal to the greater tuberosity to provide anatomic information about the optimal length of press-fit short stems for alignment and stability in TSA. We hypothesized that the humeral canal diameter will remain variable for the first 50 to 75 mm distal to the greater tuberosity and will become consistent thereafter. A retrospective review of 99 consecutive patients undergoing TSA with CT scans was performed. Intramedullary anterior-posterior (AP) and medial-lateral (ML) width as well as diameter were analyzed on two-dimensional computed tomography following multiplanar reconstruction. Measurements were taken at consistent distances distal to the greater tuberosity (GT). The transition point was measured at the proximal level of the humerus where endosteal borders of the medial and lateral cortices became parallel. The mean transition point was 73 mm from the GT (range: 53 to 109 mm). ML and AP widths became consistent 80 mm distal to the GT. IM diameter became consistent after 90 mm distal to the GT and a stem length of 90 mm extended past the transition point in 91.9% of cases. In TSA, a humeral stem length of 90 mm is required to predictably reach points at which the humeral canal becomes cylindrical and consistent in diameter. This information may aid data-driven decisions on humeral stem length during press-fit fixation, assuring consistency of alignment and implant stability, while maintaining ease of revision associated with a short stem implant. Level of evidence: III Full article

Knee osteoarthritis (OA) is one of the most common degenerative diseases in old age. Recent studies have suggested new treatment approaches dealing with subchondral remodeling, which is a typical feature of OA progression. However, diagnostic tools or therapeutic approaches related to such a process are still being researched. The automated artificial intelligence (AI) algorithm-based texture analysis is a new method used for OA-progression detection. We designed a prospective case series study to examine the efficacy of the AI algorithm-based texture analysis in detecting the restoration of the subchondral remodeling process, which is expected to follow therapeutic intervention. In this study, we used polynucleotide (PN) filler injections as the therapeutic modality and the treatment outcome was verified by symptom improvement, as well as by the induction of subchondral microstructural changes. We used AI algorithm-based texture analysis to observe these changes in the subchondral bone with the bone structure value (BSV). A total of 51 participants diagnosed with knee OA were enrolled in this study. Intra-articular PN filler (HP cell Vitaran J) injections were administered once a week and five times in total. Knee X-rays and texture analyses with BSVs were performed during the screening visit and the last visit three months after screening. The Visual Analogue Scale (VAS) and Korean-Western Ontario MacMaster (K-WOMAC) measurements were used at the screening visit, the fifth intra-articular injection visit, and the last visit. The VAS and K-WOMAC scores decreased after PN treatment and lasted for three months after the final injection. The BSV changed in the middle and deep layers of tibial bone after PN injection. This result could imply that there were microstructural changes in the subchondral bone after PN treatment, and that this change could be detected using the AI algorithm-based texture analysis. In conclusion, the AI- algorithm-based texture analysis could be a promising tool for detecting and assessing the therapeutic outcome in knee OA. Full article

Knee arthroplasties are strongly associated with blood transfusion to compensate for perioperative bleeding. The purpose of this study was to evaluate trends of transfusion associated with knee arthroplasties using nationwide data of the National Health Insurance Service-National Sample Cohort (NHIS-NSC). Using data from the nationwide claims database of the Health Insurance Review Assessment Service managed by the NHIS, 50,553 knee arthroplasties under three categories (total knee replacement arthroplasty, uni-knee replacement arthroplasty, and revision arthroplasty) from 2012 to 2018 were identified. Overall transfusion rate, transfusion count, proportion of each type of transfusion, and cost associated with each type of operation were investigated. Overall transfusion rate was 83.4% (5897/7066) in 2012, 82.7% (5793/7001) in 2013, 79.6% (5557/6978) in 2014, 75.9% (5742/7557) in 2015, 73.1% (6095/8337) in 2016, 68.2% (4187/6139) in 2017, and 64.6% (4271/6613) in 2018. The proportion of each type of transfusion was 1.8% for fresh frozen plasma, 0.5% for platelets, and 97.7% for red blood cells. The average cost of transfusion was $109.1 ($123 in 2012, $124 in 2013, $123.3 in 2014, $110.6 in 2015, $100 in 2016, $92.9 in 2017, and $90.1 in 2018). In this nationally representative study of trends in transfusion associated with knee arthroplasty, we observed significantly high rates of blood transfusion among patients undergoing knee arthroplasties. Although the overall rate of transfusion had declined, the allogeneic transfusion rate was still high from 2012 to 2018 in Korea. Thus, surgeons need to develop various patient blood management plans and minimize the use of allogeneic transfusion when performing knee arthroplasties. Full article

Background: Acute syndesmosis injury (ASI) is an indication for surgical stabilization if instability is confirmed. In recent years, fixation using the knotless suture-button (SB) device has become increasingly established as an alternative to set screw fixation (SF). This study directly compared the clinical long-term results after prospective randomized inclusion. Materials and Methods: Between 2011 and 2012, 62 patients with ASI were enrolled in a prospective, randomized, and monocentric study. Forty-one patients were available for a 10-year follow-up ((31 males and 10 females), including 21 treated with SB (mean age 44.4 years), and 20 with SF (mean age 47.2 years)). In addition to comparing the demographic data and syndesmosis injury etiology, follow-up assessed the Olerud–Molander Ankle Score (OMAS) and FADI-Score (Foot and Ankle Disability Index Score) with subscales for activities of daily living (ADL) and sports activity. Results: The mean OMAS was 95.98 points (SB: 98.81, SF: 93.00), the mean FADI ADL was 97.58 points (SB: 99.22, SF: 95.86), and the mean FADI Sport was 94.14 points (SB: 97.03, SF: 91.10). None of the measurements differed significantly between the groups (p > 0.05). No clinical suspicion of chronic instability remained in any of the patients, regardless of treatment. Conclusions: The short-term results showed that athletes in particular benefit from SB fixation due to their significantly faster return to sports activities. However, the available long-term results confirm a very good outcome in the clinical scores for both approaches. Chronic syndesmotic insufficiency was not suspected in any of the patients. Level of evidence: I, randomized controlled trial. Full article

Background and Objectives: Thoracolumbar kyphosis is one of the most frequent skeletal manifestations in patients with achondroplasia. Few papers have been published on the surgical treatment of this condition, especially in skeletally mature patients. With this study, we presented a retrospective case series of long-term surgical results for achondroplastic patients with severe thoracolumbar kyphosis. This study was conducted to evaluate the outcome of surgical treatment for thoracolumbar kyphosis in patients associated with achondroplasia presenting with paraparesis. Materials and Methods: Three patients with achondroplasia who developed neurologic deficits due to severe thoracolumbar kyphosis and underwent surgical treatment were evaluated (mean age 22.3 years; mean follow-up 9.3 years). All patients were treated with posterior vertebral column resection (p-VCR) of hypoplastic apical vertebrae with a cage and segmental instrumentation. Neurologic outcomes (JOA scores), correction of kyphosis, and operative complications were assessed. Results: All patients had back pain, neurological deficits, and urinary disturbance before surgery. The average preoperative JOA score was 8.3/11 points, which was improved to 10.7/11 points at the final follow-up (mean recovery rate 83%). All patients obtained neurologic improvement after surgery. The mean preoperative kyphotic angle was 117° (range 103°–126°). The postoperative angles averaged 37° (range 14°–57°), resulting in a mean correction rate of 67%. All patients had postoperative complications such as rod breakage and/or surgical site infection. Conclusions: The long-term results of p-VCR were acceptable for treating thoracolumbar kyphosis in patients with achondroplasia. To perform this p-VCR safely, spinal navigation and neuromonitoring are inevitable when resecting non anatomical fused vertebrae and ensuring correct pedicle screw insertion. However, surgical complications such as rod breakage and surgical site infection may occur at a high rate, making informed consent very important when surgery is indicated. Full article

Background and Objectives: Ultrasound (US) and Doppler (DP) guided arthroscopic shaving targeting the area with neovessels and nerves on the dorsal side of the tendon has shown good clinical results. Recently, we observed that in a sub-group of patients there is also local tenderness on the superficial side of the proximal patellar tendon; Material and Methods: The aim was to examine morphology and innervation patterns of the superficial peritendinous tissue from patients (four men and two women; mean age 23 years, range 17–31 years) that on US+DP examination showed a locally thickened paratenon including high blood flow. Tissue sections were stained for morphology (hematoxylin and eosin, H&E) and immunohistochemically for nerve markers (β-tubulin; tyrosine hydroxylase, TH; calcitonin related gene peptide, CRGP); Results: All tissue specimens contained high levels of blood vessels and nerves (fascicles, sprouting nerve fibers, perivascular innervation) as evidenced by evaluation for H&E and β-tubulin reactions. Nerve fascicles mainly contained sensory but also sympathetic axons. Nerves related to blood vessels were sympathetic fibers; Conclusions: There was a marked innervation in the superficial peritendinous tissue in a sub-group of patients with patellar tendinopathy and severe tenderness in the proximal patellar tendon. The results indicate that this tissue might be an additional pain driver in some patients and should be considered in further studies. Full article

Background: Ferric carboxymaltose (FCM) is an intravenous (IV) high-dose iron that is effective in the treatment of iron deficiency anemia. This study was performed to determine whether postoperative FCM infusion is effective at improving hemoglobin (Hb) responders, Hb and iron profiles, and the patient’s quality of life (QOL). Methods: A total of 110 patients with postoperative anemia, defined by a Hb < 10 g/dL within 3 days of unilateral primary TKA, between June 2018 and February 2020 were randomized into either the FCM or Control group. On postoperative day 3, the FCM group (55 patients) received IV FCM while the Control group (55 patients) did not. The Hb responders (Hb increase ≥ 2 g/dL compared to baseline), Hb level, iron profiles (ferritin, total iron-binding capacity (TIBC), transferrin saturation (TSAT)), and EQ-5D scores were compared at weeks 2, 4, and 8. Results: The FCM group demonstrated a significantly greater number of Hb responders (p < 0.001) and a higher Hb level (p = 0.008) at 2 weeks postoperative than did the Control group. The FCM group recovered its preoperative Hb level between 4 and 8 weeks. In contrast, the Control group did not recover its preoperative level until 8 weeks. The FCM infusion group also had higher serum ferritin, iron and TSAT, and lower TIBC levels than those of the Control group between 2 and 8 weeks (all p < 0.001). However, there was no significant difference in the postoperative transfusion rate (p = 0.741) or EQ-5D score between the two groups (all p > 0.05). Discussion: In postoperative anemia following TKA, IV FCM increases the Hb response and improves Hb and iron metabolism variables, however, it does not affect the transfusion rate or QOL. Full article

We aimed to comprehensively characterize degenerative findings associated with various types of lumbosacral transitional vertebra (LSTV) on magnetic resonance images. Three hundred and fifty patients with LSTV (52.3 ± 10.9 years), including 182 Castellvi type I, 107 type II, 43 type III, and 18 type IV, and 179 controls without LSTV (50.6 ± 13.1 years), were studied. Discs, endplates, and posterior vertebral structures were assessed and compared to those of controls for the most caudal three discs on MRIs. There were no differences in degenerative findings between patients with type I LSTV and controls. For types III and IV, the transitional discs had smaller sizes, lower Pfirrmann scores, and lower rates of disc bulging (2.3% and 5.6% vs. 39.1%), osteophytes (2.3% vs. 15.1%), disc herniation (2.3% and 5.6% vs. 31.8%), and Modic changes (2.3% and 5.6% vs. 16.8%) than controls. However, the cranial discs had more severe Pfirrmann scores, disc narrowing and spinal canal narrowing, and greater rates of disc herniation (41.9% and 50.0% vs. 25.7%), endplate defects (27.9% and 33.3% vs. 14.4%) and spondylolisthesis (18.6% vs. 7.3%) than controls. Type II LSTV was associated with degenerative findings in the cranial segments but to a lesser degree, as compared with type III/IV LSTV. Thus, Castellvi type III/IV LSTV predisposed the adjacent spinal components to degeneration and protected the transitional discs. Type II LSTV had significant effects in promoting transitional and adjacent disc degeneration. Type I LSTV was not related to spinal degeneration. Full article

University students have the highest smartphone-use addiction, which coincides with a rising number in instances of neck pain. As the time in smartphone use increases, neck flexion tends to increase. These positions can affect the spinal cord by the direct and indirect mechanisms which lead to cervical myelopathy. Thus, the current study aimed to determine the prevalence and associated factors of clinical myelopathic signs in smartphone-using university students with neck pain. A total of 237 smartphone-using university students with neck pain participated in the study. They were 20 to 25 years old. Their clinical myelopathic signs were evaluated using standardized test procedures. The prevalence of the clinical myelopathic sign was the Trömner sign at 41.35%, the finger escape sign at 28.27%, Hoffmann’s sign at 25.74%, and the inverted supinator sign at 18.14%. Smartphone usage ≥9.15 h per day was associated with ≥1 of a positive clinical myelopathic sign (adjusted OR = 1.85, 95% CI = 1.05 to 3.26, p = 0.05). The current study highlighted that prolonged smartphone usage may affect the spinal cord. Long duration (≥9 h per day) was associated with at least one positive clinical myelopathic sign. Therefore, smartphone-using university students need to keep their duration of smartphone use to less than 9 h per day. More attention should be given to increasing awareness about the importance of having healthy positions when using smartphones and using them for restricted durations in order to control the increasing prevalence of cervical myelopathy among smartphone-using university student in our societies. Full article

Background: A convincing association between the foot and ankle alignment (FAA) and patellofemoral pain syndrome (PFPS) remains debatable in the literature. Therefore, all studies investigating the role of FAA in patients with PFPS were systematically reviewed. Methods: A systematic literature search was performed on the databases PubMed, Embase, Cochrane Library, and Web of Science. Inclusion criteria were all studies investigating static and/or dynamic FAA factors and PFPS. Studies with less than 20 patients or with patellofemoral osteoarthritis were excluded. The quality assessment was based on Cochrane study criteria, and the maximum score was set at eight. Results: Of 2246 articles, only 13 case-control studies were eligible. Considering static FAA factors, two studies found an association with rearfoot eversion and one with rearfoot inversion. While examining dynamic FAA characteristics, one study found an association with rearfoot eversion range of motion and three with gait kinematics. No further associations were reported. The quality assessment mean score was 5.5 (SD = 0.97) corresponding to moderate quality. Conclusions: In contrast to our expectations, a limited number of studies were founded supporting an association between FAA and PFPS. At present, the quality of the literature is still poor and conflicting, thus the need for further studies to determine any association between FAA and PFPS. Full article

(1) Background: In this study, two types of implants were compared—a conventional hip stem and a femoral neck prosthesis. (2) Methods: The femoral neck prosthesis study group included 21 patients, while the conventional hip stem control group was 40 patients. The first examination was the pre-op check, while the next ones were performed 6 weeks, 1 year, and 3 years after surgery. The Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), University of California at Los Angeles Activity Score (UCLA), and Visual Analog Scale EQ (VAS EQ) forms were completed at each clinical study visit. (3) Results: The HHS in the femoral neck prosthesis group and the conventional hip stem group 6 weeks after surgery was 68.8 ± 16.47 and 67.6 ± 8.92, respectively, and 1 year after surgery, this was 93 ± 5.58 vs. 90.6 ± 5.17, respectively. The OHS of the femoral neck prosthesis group was 34.8 points after 6 weeks, 45.5 points after 1 year, and 43.9 points after 3 years. The respective values in the conventional hip stem group were 35.5, 41.55, and 42.13 points. The WOMAC values for the femoral neck prosthesis group were 70.6, 92.7, and 86 points, respectively, while for the conventional hip stem group, they were 74, 88.1, and 86.1 points. The UCLA scores recorded in the conventional hip stem group ranged from 3.15 to 5.05 points, but a higher mean value of 5.33 points was obtained in the femoral neck prosthesis group. VAS EQ was equal to 84 points three years after the operation. (4) Conclusions: The study showed no significant differences in the functional scores of both groups, and the new type of cervical femoral stem could be the first choice in younger patients. Full article

An inability to bear self-weight is one of the unfavorable results in geriatric hip fracture, which needs to be prevented. This study determines pre-operative, intra-operative, and post-operative prognostic factors of the inability to bear self-weight at discharge in patients with fragility femoral neck fracture. This retrospective study was conducted at Chiang Mai University (CMU) hospital with an observational cohort design. Electronic medical records of patients aged ≥ 50 years old with fragility femoral neck fractures between 1 January 2015 and 31 December 2019 were reviewed. Pre-, intra-, and post-operative factors were collected. Ambulation status at discharge time was classified into either ability or inability to bear self-weight. Analysis of prognostic factors was done using multivariable risk ratio regression. In total, 269 patients were recruited in this study. Significantly prognostic factors of inability to bear self-weight at discharge were end-stage renal disease (ESRD), cirrhosis, cerebrovascular disease, pre-fracture ambulatory status, having associated fractures, increasing intra-operative blood loss, and having pressure sore. These prognostic factors could be used to predict patients’ outcomes at discharge. Proper management could then be offered to the patients by the multidisciplinary care team to enhance surgical outcomes. Full article

Background and Objectives: This study tested the hypothesis that treatment of myofascial trigger points (MTrPs) in the upper trapezius muscle (UTM) with repeated injection of 1% lidocaine results in better alleviation of muscular stiffness and soreness as well as improved metabolism in the hypercontracted MTrP area than treatment with radial extracorporeal shock wave therapy (rESWT). Materials and Methods: A single-blinded, prospective, randomized controlled trial was conducted on patients suffering from MTrPs in the UTM. Thirty patients were treated with repeated injection of 2 mL of 1% lidocaine (three injections; one injection per week). Another 30 patients were treated with rESWT (three treatment sessions; one treatment session per week; 2000 radial extracorporeal shock waves per treatment session; positive energy flux density = 0.10 mJ/mm²). The primary outcome measure was pain severity using the VAS score. The secondary outcome measures included muscle elasticity index, pressure pain threshold and neck disability index. Evaluation was performed at baseline (T1), 15–30 min after the first treatment in order to register immediate treatment effects (T2), before the second treatment (i.e., one week after baseline) (T3) and one week after the third treatment (i.e., four weeks after baseline) (T4). Results: There were no statistically significant differences in the primary and secondary outcome measures between the patients in the lidocaine arm and the patients in the rESWT arm at T1 and T4. Within the arms, the mean differences of all outcomes were statistically significant (p < 0.001) when comparing the data obtained at T1 with the data obtained at T3 and the data obtained at T4. Conclusions: The results of this pilot study suggest that the use of rESWT in patients with MTrPs in the UTM is safe and leads to reduced pain and improved muscle elasticity, pressure pain threshold and neck disability index, without adverse effects. Larger trials are necessary to verify this. Clinicians should consider rESWT instead of injections of lidocaine in the treatment of MTrPs in the UTM. Full article

Orthopedic surgeons often face a clinical dilemma on how to manage antiplatelet therapies during the time of surgery. This retrospective study is aimed to investigate the bleeding risk and adverse events in patients who hold or keep clopidogrel during elective major joints arthroplasty. Two hundred and ninety-six patients that were treated with clopidogrel while undergoing total hip or knee joint replacement between January 2009 and December 2018 were studied. Group 1 included 56 patients (18.9%) who kept using clopidogrel preoperatively. Group 2 included 240 patients who hold clopidogrel use ≥5 days preoperatively. Blood transfusion rates, estimated blood loss, complication rates, and adverse cardiocerebral events were collected and analyzed. The mean total blood loss was more in the group 1 patients as compared with that in the group 2 patients (1212.3 mL (685.8 to 2811.8) vs. 1068.9 mL (495.6 to 3294.3), p = 0.03). However, there was no significant difference between the two groups of patients regarding transfusion rates, bleeding-related complications, and infection rates. There was a trend toward a higher incidence of adverse cardiocerebral events in patients withholding clopidogrel for more than 5 days before surgery. The results of this study suggest that clopidogrel continuation could be safe and advisable for patients at thrombotic risk undergoing primary major joint replacement. Acute antiplatelet withdrawal for an extended period of time might be associated with an increased risk of postoperative thromboembolic events. More studies are required in the future to further prove this suggestion. Full article

Purpose: Hardly any other topic is as current as the gender-conscious medical treatment of every individual. Similarly, in sports, there are crucial differences that should be considered in order to treat everyone appropriately, with the aim to prevent injuries according to their needs. The objective of this study is to show that the differences between biological males and females are so significant that they require both specific injury prevention and therapy programs. Methods: This study is a retrospective analysis of letters from a department of orthopedics and trauma surgery between the years 2000 and 2015. Results: The analysis of 20,567 inpatient and outpatient letters of a level 1 trauma center in Germany revealed that 5455 patients suffered 7279 injuries; 1475 of the patients were female and suffered 2035 injuries, and 3890 patients were male and suffered 5244 injuries. Conclusion: The results show the differences between males and females with regard to sport-specific injuries, pointing out the sex differences in the sport-specific area in relation to the body region. Full article

Background and Objectives: In patients with ankle fractures complicated by syndesmotic injuries, no consensus has been reached on the best method of syndesmosis fixation using syndesmotic screws. One previous study revealed no difference in the tibiofibular overlap between two groups with or without syndesmotic screw removal. Other studies have indicated that distal tibiofibular diastasis exists after the removal of syndesmotic screws. In this study, we aimed to confirm the effect of syndesmotic screw removal on diastasis occurrence. We further analyzed the risk factors that may contribute to the widening of the tibiofibular syndesmosis. Materials and Methods: This retrospective study involved a review of the records of 63 patients with ankle fractures accompanied by syndesmosis injuries that required syndesmotic screw fixation. Anteroposterior radiographs were analyzed for each patient at various time points, from syndesmotic screw fixation to outpatient department follow-ups after screw removal. The changes in tibia–fibula overlap (OL), tibia–fibula clear space (CS), and medial clear space (MCS) were analyzed. Further analysis was performed to reveal potential factors that may have contributed to radiographic differences. Results: Compared with the postoperation radiographs following syndesmotic screw fixation, OL decreased (2.0 mm) and CS increased (0.8 mm) in the anteroposterior radiographs from outpatient department follow-ups. No significant changes were noted in OL or CS after syndesmotic screw removal. However, OL decreased (1.8 mm) and CS increased (0.5 mm) before syndesmotic screw removal. No significant change in MCS occurred during the whole observation period. Linear regression analysis did not reveal any significant correlations between potentially related factors and radiographic changes. Conclusions: Marked diastasis had occurred at final follow-up. Notably, the diastasis occurred before rather than after screw removal. This implies that screw removal does not significantly influence the radiographic outcomes of rotational ankle fractures. Full article

The aim of the study was to evaluate the levels of selected MMPs (matrix metalloproteinases) and osteocalcin in the serum and synovial fluid of obese women with osteoarthritis and their correlations with clinical status. The studied group consisted of 39 overweight females undergoing primary total knee arthroplasty due to osteoarthritis (OA). The staging of knee OA was evaluated according to the Ahlbӓck and Kellgren–Lawrence scores. Synovial fluid and peripheral blood samples were obtained. The levels of selected MMPs and osteocalcin were assessed using commercial ELISA kits. The mean value of MMP3 was significantly higher in patients with more advanced disease in both serum (p = 0.0067) and synovial fluid (p = 0.0328). The pro-MMP13 level tended to be higher in synovial fluid in the case of more advanced stages (p = 0.0882), with no tendency regarding the serum level (p = 0.9595). The synovial level of pro-MMP1 was significantly correlated with the synovial concentration of MMP9 and MMP3. The synovial level of MMP9 also showed a significant correlation with the synovial level of MMP3 and pro-MMP13. Furthermore, it was found that the serum level of MMP3 was significantly correlated with the synovial pro-MMP13 level. A correlation between the osteocalcin level in serum and its synovial level was determined. The serum MMP9 level showed a significant correlation with BMI, whereas the synovial MMP9 level was notably correlated with age. Our results showed that the levels of MMP3, MMP9, and pro-MMP13 increased in more advanced radiological stages of OA, indicating the underlying inflammatory process of OA. Full article

Background: Two-stage exchange arthroplasty remains the gold standard in the United States for treatment of chronic periprosthetic joint infection (PJI). Long-term reinfection rates and clinical outcomes with sufficient subject numbers remain limited. The purpose was to evaluate the long-term outcomes following two-stage exchange following hip arthroplasty. Methods: Retrospective review of 221 patients who underwent two-stage exchange hip arthroplasty for chronic PJI at three large tertiary referral institutions from 1990–2015. Outcomes including reinfection, mortality, and all-cause revision were calculated. Cumulative incidence of reinfection with death as competing factor was also calculated. Risk factors for reinfection were determined using Cox multivariate regression analysis. Results: Rate of infection eradication and all-cause revision was 88.24% and 22.6%, respectively. Overall mortality rate was 40.72%. Patients with minimum five-year follow-up (n = 129) had a success rate of 91.47% with mortality rate of 41.1%. Major risk factors for reinfection included polymicrobial infection (HR = 2.36, 95% CI: 1.08–5.14) and antibiotic resistant organism (HR = 2.36, 95% CI: 1.10–5.04). Conclusion: This is the largest series with greater than 5-year follow-up evaluating outcomes of two-stage exchange hip arthroplasty. This technique resulted in a relatively high infection eradication, however, the mortality rate is alarmingly high. Antibiotic resistant organisms appear to be highest risk factor for failure. Full article

The study aimed to estimate the ability to tolerate body balance disturbance in relation to selected changes in the sagittal plane of the spine in early school-age children. The study involved 189 children with an average age of 8.3 ± 0.7 years (aged 7–10). The tests included an interview, clinical examination (measurement of body weight and height, assessment of the course of the spinous processes of the thoracic and lumbar vertebrae, assessment of the location of selected anatomical landmarks of the torso), and a physical examination in which the shape of the spine surface was examined with the use of the photogrammetric method and the moiré effect projection. Body balance disturbance tolerance skills (BBDTS) were measured with the rotational test (RT). In the rotational test, the results of body balance disturbance tolerance skills show a slight but statistically significant correlation with the bodyweight of the examined children (Rs = 0.35, p < 0.001). This relationship was also statistically significant in the groups by gender. Among the measured indicators of the curvature of the spine in the sagittal plane, the correlation with the RT test result was mostly related to the α angle and the value was Rs = 0.15 (p = 0.04). In the group of girls, this correlation was stronger and amounted to Rs = 0.26 (p = 0.015). Among other measured correlations, the dependence of variables such as the bodyweight of the subjects and the α angle was shown. In conclusion, increasing lumbar lordosis results in the deterioration of balance disturbance tolerance skills. As body weight increases, body balance disturbance tolerance skills decrease. Full article

Background and Objectives: Steinmann pins are commonly used in orthopedics, with a low rate of complications. However, thermal osteonecrosis may occur when a pin is inserted using a drill. There have been no reports on late-onset fractures at the Steinmann pin insertion site. Materials and Methods: A 32-year-old man who underwent surgery for a femoral shaft fracture 5 years ago complained of proximal thigh pain 1 month after the removal of the internal device. On physical examination, the patient showed a limping gait due to pain, and tenderness was observed on the lateral aspect of the proximal thigh. Magnetic resonance imaging was performed because the symptoms did not improve, despite conservative treatment. A new fracture line was observed in the lateral cortical bone of the proximal femur. It was found that a fracture occurred at the site where the Steinmann pin was inserted for a closed reduction at the time of the first operation. The patient was instructed to limit weight bearing and to use crutches while walking. Parathyroid hormone was additionally administered to promote bone formation. Results: Six months after diagnosis, a complete union was achieved at the subtrochanteric fracture site, and the patient’s pain subsided. Conclusions: A fracture that occurs as a late onset at the provisional Steinmann pin insertion site is an extremely rare complication; however, orthopedic surgeons must consider this possibility and make more efforts to lower the occurrence of thermal damage. In addition, if the patient complains of pain in the region where the pin was inserted after surgery, surgeons should spare no effort to determine whether a new fracture has occurred. Full article

Foot and ankle disabilities (foot drop) due to common peroneal nerve palsy and stroke negatively affect patients’ ambulation and activities of daily living. We developed a novel robotics ankle hybrid assistive limb (HAL) for patients with foot drop due to common peroneal nerve palsy or stroke. The ankle HAL is a wearable exoskeleton-type robot that is used to train plantar and dorsiflexion and for voluntary assistive training of the ankle joint of patients with palsy using an actuator, which is placed on the lateral side of the ankle joint and detects bioelectrical signals from the tibialis anterior (TA) and gastrocnemius muscles. Voluntary ankle dorsiflexion training using the new ankle HAL was implemented in a patient with foot drop due to peroneal nerve palsy after lumbar surgery. The time required for ankle HAL training (from wearing to the end of training) was approximately 30 min per session. The muscle activities of the TA on the right were lower than those on the left before and after ankle HAL training. The electromyographic wave of muscle activities of the TA on the right was slightly clearer than that before ankle HAL training in the resting position immediately after ankle dorsiflexion. Voluntary ankle dorsiflexion training using the novel robotics ankle HAL was safe and had no adverse effect in a patient with foot drop due to peroneal nerve palsy. Full article

Epidural fibrosis is a common cause of pain after lumbar surgeries. There are no previous reports documenting profound limb weakness associated with epidural fibrosis. A 43-year-old woman uneventfully underwent microscopic discectomy. However, six additional surgeries were needed due to recurrent pain and weakness episodes, several days after the surgery. Operative findings were severe epidural fibrosis around the thecal sac and nerve roots. Epidural fibrosis excision did not prevent recurrent fibrosis; therefore, we performed a lordotic fusion with posterior column shortening to reduce neural tension and nerve-root stretching. Eventually, she became free from recurrent episodes of deteriorations and repetitive surgeries. Full article

Introduction: Minimally invasive surgical techniques for hallux valgus have gained popularity, showing good results characterized by smaller postoperative scars, less pain, lower infection risk, and fewer wound complications. Given the lack of evidence available in our country regarding this subject, especially about this type of surgical technique, our paper aims to compare open and MIS approaches for chevron osteotomy. We evaluated the outcome and complications after 12 months. Materials and Methods: We undertook a prospective, randomized, controlled, single-center study between October 2017 and December 2020. The patients were randomized into two groups: one group that received percutaneous chevron osteotomy (MIS), and the other, open chevron osteotomy (OC). For clinical assessment, we determined the function and the level of pain using the Visual Analogue Scale (VAS) and The American Orthopaedic Foot and Ankle Surgery score (AOFAS). The VAS scale was measured before the surgical procedure, at discharge, and at 3 weeks, 6 weeks, 6 months, and 12 months after surgery. The AOFAS score was calculated preoperatively and after 6 months. The hallux angle (HVA) and intramedullary angle (IMA) were measured preoperatively, and at 6 weeks, 6 months and 12 months. Results: We included 26 cases in the open chevron osteotomy group (24 female, 2 male) and 24 in the MIS group (24 female, 0 male). Both groups demonstrated improvements regarding the IMA and HVA at the last follow-up without any significant differences between the groups at the final assessment. The VAS showed significantly better post-operative results for the MIS group at discharge (p < 0.001) and 3 weeks (p < 0.001), 6 weeks (p < 0.001), and 6 months (p = 0.004) post-surgery. The AOFAS showed no significant differences either before or after surgery. Four cases with screw prominence were reported, three of which belonged to the MIS group. Only one case with metatarsalgia was found in the OC group. Conclusions: This paper demonstrates that minimally invasive chevron osteotomy has comparable results with open chevron osteotomy, even though surgical time and radiological exposure are significantly longer. More studies are required to evaluate the complications and the risk of recurrences. Full article

Background: Over-supination processes of the foot and ankle involving peroneus longus (PL) damage during running sports have been treated conservatively with passive control tools, such as tapes, braces, or external ankle supports, but the effect of orthoses with typical lateral wedging orthoses (TLWO) on the muscular activity of PL during running remains unclear. Here we investigate the effects of innovative medial cushioning orthoses (IMCO) on PL activity during the full running gait cycle. In addition, we wished to ascertain the effects of innovative medial cushioning orthoses (IMCO) on PL activity during running. Methods: Thirty-one healthy recreational runners (mean age 34.5 ± 3.33) with neutral foot posture index scores, were selected to participate in the present study. They ran on a treadmill at 9 km/h wearing seven different orthoses (NRS, IMCO 3 mm, IMCO 6 mm, IMCO 9 mm, TLWO 3 mm, TLWO 6 mm and TLWO 9 mm), randomly performed on the same day while electromyographic activity of the PL muscle was recorded. Statistical intraclass correlation coefficient (ICC) to test reliability was carried out and the Wilcoxon test with Bonferroni’s correction was developed to analyze the differences between the conditions. Results: the reliability of all assessments showed data higher than 0.81, that is, “almost perfect reliability”; all EMG PL values wearing either TLWO or IMCO showed a statistically significant reduction versus NRS during the fully analyzed running gait cycle; the highest difference was set on NRS 23.08 ± 6.67 to TLWO 9 mm 17.77 ± 4.794 (p < 0.001). Conclusions: Muscular EMG activity of the PL during the full running gait cycle decreases when wearing either TLWO or IMCO relative to NRS; therefore, these orthoses could be prescribed to treat the strain and overload pathologies of PL. In addition, IMCO—as it less thick, compared with TLWO—can be used when aiming to achieve better running economy. Full article

Background and objective: It is important to introduce respiratory exercises to the therapy of patients after the surgical treatment of adolescent idiopathic scoliosis. Surgical correction is the best way to prevent hypoxia in scoliosis, but whether pulmonary rehabilitation increases the effectiveness of scoliosis surgery has not yet been confirmed. Therefore, the aim of the study was to evaluate the function of respiratory muscles after surgical correction of idiopathic scoliosis. Methods: The study involved 24 patients, aged 13.6 ± 0.6. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were measured using the Mikro RPM. In all patients, before the procedure, 7 days after and 3 months after the procedure, the MIP and MEP were measured. Results: MIP was the lowest 7 days after the procedure; it was 45.28 cmH2O and was statistically significantly lower compared to the measurement before the procedure (p < 0.001) and 3 months after the procedure (p < 0.001). Conclusions: The degree of curvature of the spine before the procedure does not significantly affect initial values of the strength of respiratory muscles. The level of MIP is not dependent on the type of surgery. Full article

Objective: percutaneous pedicle screw (PPS) fixation has been widely used in minimally invasive spine stabilization. Triggered electromyogram (TrEMG) monitoring is performed to prevent PPS misplacement, but is not widely accepted. We have newly developed an insulating tap device to minimize the misplacement of PPS. Methods: TrEMG was measurable in insulation tap devices in 31 cases, and in non-insulating tap devices in 27 cases. Fluoroscopy was used to insert 194 PPS and 154 PPS, respectively. Based on the Rampersaud classification of postoperative computed tomography, we classified PPS insertion into four categories (Grade A as no violation, Grade D as more than 4 mm perforation). Results: Grade A was noted in 168 PPSs (86.6%) and Grade B to D in 26 PPSs in the insulation tap device group, and Grade A was noted in 129 PPSs (83.8%) and Grade B to D in 25 PPSs in the non-insulating tap device group, respectively. At a cutoff value of 11 mA, the sensitivity was 41.4% and the specificity was 98.2%. The sensitivity and specificity of the non-insulating tap device were 4.0% and 99.2%, respectively. Conclusions: The insulation treatment of the tap device has improved the sensitivity of TrEMG. TrEMG using the insulating tap device is one of the methods for safe PPS insertion. Full article

Background and Objectives: Rotator cuff disease (RCD) is a prominent musculoskeletal pain condition that spans a variety of pathologies. The etiology and precise diagnostic criteria of this condition remain unclear. The current practice of investigating the biochemical status of RCD is by conducting biopsy studies but their invasiveness is a major limitation. Recent biochemical studies on RCD demonstrate the potential application of serological tests for evaluating the disease which may benefit future clinical applications and research. This systematic review is to summarize the results of available studies on serological biochemical investigations in patients with RCD. Methods: An electronic search on databases PubMed and Virtual Health Library was conducted from inception to 1 September 2021. The inclusion criteria were case-control, cross-sectional, and cohort studies with serological biochemical investigations on humans with RCD. Methodological quality was assessed using the Study Quality Assessment Tool for Observational Cohort and Cross-sectional studies from the National Heart, Lung, and Blood Institute. Results: A total of 6008 records were found in the databases; of these, 163 full-text studies were checked for inclusion and exclusion criteria. Nine eligible studies involving 984 subjects with RCD emerged from this systematic review. The quality of the studies found ranged from poor to moderate. In summarizing all the studies, several fatty acids, nonprotein nitrogen, interleukin-1 β, interleukin-8, and vascular endothelial growth factor were found to be significantly higher in blood samples of patients with RCD than with control group patients, while Omega-3 Intex, vitamin B12, vitamin D, phosphorus, interleukin-10, and angiogenin were observed to be significantly lower. Conclusions: This is the first systematic review to summarize current serological studies in patients with RCD. Results of the studies reflect several systemic physiological changes in patients with RCD, which may prove helpful to better understand the complex pathology of RCD. In addition, the results also indicate the possibility of using serological tests in order to evaluate RCD; however, further longitudinal studies are required. Full article

Background and Objectives: Due to inferior survival rates compared to hip and knee arthroplasty, total ankle arthroplasty (TAA) was previously mainly recommended for older and less active patients. However, given the encouraging survival rates and clinical outcomes of modern generations of TAA, some authors have also advocated TAA in young patients. Thus, the aim of this study was to evaluate age related reoperation, revision and survival rates of third-generation mobile-bearing TAAs. Materials andMethods: In this retrospective study, 224 consecutive TAA patients with a minimum follow up (FU) of 2 years were analyzed. Patients were retrospectively assigned to two study groups (Group A: age < 50 years; Group B: age ≥ 50 years). Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. Results: After a mean FU of 7.1 ± 3.2 years, the reoperation rate (Group A: 22.2%; Group B: 5.3%; p = 0.003) and revision rate (Group A: 36.1%; Group B: 13.8%; p = 0.003) were higher within Group A. An age of under 50 years at time of surgery was associated with higher reoperation (odds ratio (OR): 6.54 (95% CI: 1.96–21.8); p = 0.002) and revision rates (OR: 3.13 (95% CI: 1.22–8.04); p = 0.018). Overall, lower patient age was associated with higher reoperation (p = 0.009) and revision rates (p = 0.001). Conclusions: The ideal indication for TAA remains controversial, especially regarding patient age. The findings of this study show high reoperation and revision rates in patients aged under 50 years at time of surgery. Therefore, the outcomes of this study suggest that the indication for TAA in young patients should be considered very carefully and that the association between low patient age and high reoperation rate should be disclosed to all eligible patients. Full article

Background: Adult-acquired flatfoot deformity due to posterior tibial tendon dysfunction (PTTD) is one of the most common foot deformities among adults. Hypothesis: Our study aimed to confirm that the combined procedures of calcaneal displacement osteotomy and talonavicular arthrodesis are equivalent to double arthrodesis. Methods: Between 2016 and 2020, 41 patients (13 male and 28 females, mean age of 63 years) were retrospectively enrolled in the comparative study. All deformities were classified into Stages II and III of PTTD, according to Johnson and Strom. All patients underwent isolated bony realignment of the deformity: group A (n = 19) underwent calcaneal displacement osteotomy and talonavicular arthrodesis, and group B (n = 23) underwent double arthrodesis. Measurements from the Foot Function Index-D (FFI-D) and the SF-12 questionnaire were collected, with a comparison of pre- and post-operative radiographs conducted. The mean follow-up period for patients was 3.4 years. Results: The mean FFI-D was 33.9 (group A: 34.5; group B: 33.5), the mean SF-12 physical component summary was 43.13 (group A: 40.9; group B: 44.9), and the mean SF-12 mental component summary was 43.13 (group A: 40.9; group B: 44.9). The clinical data and corrected angles showed no significant intergroup differences. Conclusion: Based on the available data, our study confirmed that the combined procedures of talonavicular arthrodesis and calcaneal shift, with preservation of the subtalar joint, can be considered equivalent to the established double arthrodesis, with no significant differences in terms of clinical and radiological outcomes. Full article

Background and Objectives: One of the most difficult aspects of hip revision is to remove the stem from the femoral canal with or without cement while maintaining the maximal amount of bone stock to obtain the best possible press-fit of the revision prosthesis. The transfemoral approach ensures direct access to the medullary canal so that the content removal is completed under direct control, while protecting the bone. This type of approach is particularly efficient for special conditions, such as deformation of the proximal femoral region, broken stems, or the presence of cement over a long distance distal to the prosthesis. The aim of this study was to evaluate the main advantages of transtrochanteric approach in hip revisions. Materials and Methods: Our series included 36 revisions performed using the transfemoral approach. We have analyzed the following postoperative radiological aspects: the length of the fixation zone distal to the osteotomized bone fragment (OBF), the gap between the OBF and the diaphysis, stem subsidence over time, and OBF consolidation. Results: The results were very good, both in terms of the rate of intraoperative complications and postoperative evolution. The fixation zone length was 4.2 cm on average (range: 2 to 5.8 cm). The distal gap between the OBF and the diaphysis was 1.2 cm on average (range: 0 to 2.3 cm). Stem subsidence was noted in four cases (11.1%). In all cases, stem subsidence occurred between three and six months and was 6 to 8 mm without affecting hip stability. OBF consolidation was radiologically confirmed for all cases at one year follow-up. Clinical assessment based on the Harris Hip Score showed an overall improvement from 43.2 preoperatively to 79.7 at 12 months and 83 at two years, respectively. The most important rate of progress was between 6 months and 12 months. Conclusions: The transtrochanteric approach has been shown to be very efficient for hip revisions. Understanding the hip biomechanics, applying a less aggressive surgical technique, and using efficient fixation methods such as cables significantly improved the results. Full article

Background: Vertebral compression fractures, resulting in significant pain and disability, commonly occur in elderly osteoporotic patients. However, the current literature lacks long-term follow-up information related to image parameters and bone formation following vertebroplasty. Purpose: To evaluate new bone formation after vertebroplasty and the long-term effect of vertebroplasty. Methods: A total of 157 patients with new osteoporotic compression fractures who underwent vertebroplasty were retrospectively analyzed. The image parameters, including wedge angles, compression ratios, global alignment, and new bone formation, were recorded before and after vertebroplasty up to three years postoperatively. Results: The wedge angle improved and was maintained for 12 months. The compression ratios also improved but gradually deteriorated during the follow-up period. New bone formation was found in 40% of the patients at 36 months, and the multivariate analysis showed that this might have been related to the correction of the anterior compression ratio. Conclusions: Vertebroplasty significantly restored the wedge angles and compression ratios up to one year postoperatively, and new bone formation was noted on plain radiographs, which increased over time. Last, the restoration of vertebral parameters may contribute to new bone formation. Full article

Background and Objectives: This study shows a sufficient treatment with the Pavlik harness for all patients through all phases of developmental dysplasia of the hip (DDH) if there is a strict regime. Materials and Methods: There was an ultrasound measurement stage of IIc or worse (D, IIIa/b, IVa/b) in 159 out of 7372 newborns between 1995 and 2006 (2.15%). This is an indication for treatment with the Pavlik harness. Overall, 203 dysplastic hips were treated initially with our regime. After detection, we started the application of the Pavlik harness immediately in the ‘human position’. There were appointments every 10–14 days to check the setting combined with ultrasound controls. The treatment stopped if a mature, well-developed picture of both hips was seen when compared to Graf type Ia/b. Afterwards, an X-ray control was carried out at about one year of age. Results: 159 newborns with 203 dislocated hips were treated. The distribution following Graf’s classification was as follows: 150 type IIc (73.9%), 18 type D (8.9%), 31 type IIIa/b (15, 3%) and 4 type IV (1.9%). To summarize, there were 150 (73.9%) type IIc hips at risk of developing a dislocation but also 53 hips (26.1%) which were already dislocated at the moment of birth. There was a loss to follow-up in three patients (1.8%), and the therapy had to be changed in six cases. There was no degradation in our study population during therapy. Conclusion: The treatment with the Pavlik harness of DDH at every stage in newborns was possible and showed good results in 189 hips. Full article

Robotic-arm-assisted unicompartmental knee arthroplasty (RUKA) was developed to increase the accuracy of bone alignment and implant positioning. This retrospective study explored whether RUKA has more favorable overall outcomes than conventional unicompartmental knee arthroplasty (CUKA). A total of 158 patients with medial compartment osteoarthritis were recruited, of which 85 had undergone RUKA with the Mako system and 73 had undergone CUKA. The accuracy of component positioning and bone anatomical alignment was compared using preoperative and postoperative radiograph. Clinical outcomes were evaluated using questionnaires, which the patients completed preoperatively and then postoperatively at six months, one year, and two years. In total, 52 patients from the RUKA group and 61 from the CUKA group were eligible for analysis. The preoperative health scores and Kellgren–Lawrence scores were higher in the RUKA group. RUKA exhibited higher implant positioning accuracy, thus providing a superior femoral implant angle, properly aligned implant placement, and a low rate of overhang. RUKA also achieved higher accuracy in bone anatomical alignment (tibial axis angle and anatomical axis angle) than CUKA, but surgical time was longer, and blood loss was greater. No significant differences were observed in the clinical outcomes of the two procedures. Full article

Background: The aim of this study is to determine the effect of three doses of intra-articular injection of platelet-rich plasma (PRP) into the osteoarthritic (OA) knee joint on the functional status and on the changes in the levels of specific OA biomarkers in blood serum. Methods: Forty patients with unilateral primary knee osteoarthritis were enrolled in this single center, prospective clinical trial. For each patient, three intra-articular PRP injections were administered one week apart. Clinical and laboratory assessment was performed before the first PRP injection (baseline), and 3 months after the third PRP application (3-month follow up). Pain in the affected knee joint was assessed with the Visual Analog Scale for Pain (VAS). Change in clinical status was evaluated with the Western Ontario and McMaster Universities Arthritis Index Questionnaire (WOMAC). Concentrations of 19 biomarkers (EGF, Eotaxin, FGF-2, GRO, IL-10, IL-1RA, IL-8, IP-10, MCP-1, PDGF-AB/BB, RANTES, MMP-3, MMP-13, Collagen type 2, BMP-2, TIMP-1, TIMP-2, TGF beta 1, and COMP) in the serum of studied patients were quantified. Results: At 3-month follow up, there was a significant decrease in the VAS score and significant improvement in the WOMAC score. There was a significant decrease in the levels of Eotaxin, MCP-1, MMP-1, IL-10, EGF, PDGF-AB/BB, TGF- β1 compared to baseline levels. A significant increase in markers BMP-2, COMP, Collagen type 2 and GRO was found at the same time point. There was no significant change in the concentrations of other biomarkers (FGF-2, IL-1RA, IL-8, IL-10, MMP-3, RANTES, TIMP-1, TIMP-3). Conclusions: We found an increase in specific pro-anabolic and anti-inflammatory biomarkers with a concomitant decrease in pro-inflammatory biomarkers at 3 months after three intra-articular applications of PRP. Significant improvement in VAS and WOMAC scores was observed. Treatment with PRP may be an effective therapeutic option with anti-inflammatory and regenerative potential in patients with primary knee OA. Full article