Journal of Clinical Medicine

Research

11 pages, 2019 KiB

Open AccessArticle

Trends and Changes in Treating Proximal Humeral Fractures in Italy: Is Arthroplasty an Increasingly Preferred Option? A Nation-Wide, Population-Based Study over a Period of 22 Years

by Enrico Ciminello, Andrea Modesti, Emilio Romanini, Stefano Lepore, Gabriele Tucci, Stefano Di Gennaro, Giandomenico Logroscino, Paola Ciccarelli, Tiziana Falcone and Marina Torre

J. Clin. Med. 2024, 13(19), 5780; https://doi.org/10.3390/jcm13195780 - 27 Sep 2024

Viewed by 414

Abstract

Background: Proximal humeral fractures (PHFs) are common, especially in the elderly, and account for 4% to 10% of all fractures, with women more often affected than men. Treatments include conservative methods, internal fixation and arthroplasty, with surgical approaches increasingly being used due [...] Read more.

Background: Proximal humeral fractures (PHFs) are common, especially in the elderly, and account for 4% to 10% of all fractures, with women more often affected than men. Treatments include conservative methods, internal fixation and arthroplasty, with surgical approaches increasingly being used due to technological advancements. This study analyzes the evolution of PHF treatments in Italy from 2001 to 2022, using data from the Italian Hospital Discharge Records (HDRs) Database, and includes a stratified analysis by age and sex. Methods: Using HDR data from 2001 to 2022, records with ICD9-CM codes for proximal humeral fractures (812.0 and 812.1) among diagnoses were selected and categorized into three treatment groups: arthroplasty, fixation and conservative. Time series were analyzed with stratification by sex and age. Results: The extracted data included 486,368 records of PHFs, with 223,742 cases treated surgically (arthroplasty or internal fixation) and 262,626 treated conservatively; the average patient age was 66.6 years, with a higher proportion of women, especially among arthroplasty patients. Over time, the use of fixation and arthroplasty increased from 20% of treatments in 2001 to over 60% in 2022, with fixation becoming the most common treatment method by 2014 and arthroplasty significantly increasing among women, particularly in the 65–74 and 75–84 age groups. Conclusions: The study shows that in Italy, over the past two decades, treatment for PHFs has shifted from conservative methods to a preference for internal fixation and increasingly for arthroplasty, particularly among women and patients aged 65–84, reflecting evolving trends and technological improvements. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

Figure 1
Data extraction flowchart. Full article ">Figure 2
Trends by treatment group (2001–2022). Counts (left column) and proportions (right column), overall and by sex. Dark gray: arthroplasty; gray: fixation; light gray: conservative. Full article ">Figure 2 Cont.
Trends by treatment group (2001–2022). Counts (left column) and proportions (right column), overall and by sex. Dark gray: arthroplasty; gray: fixation; light gray: conservative. Full article ">Figure 3
Trends by treatment group (2001–2022). Counts by age class. Full article ">Figure 3 Cont.
Trends by treatment group (2001–2022). Counts by age class. Full article ">Figure 4
Trends by treatment group (2001–2022). Proportions by age class. Dark gray: arthroplasty; gray: fixation; light gray: conservative. Full article ">Figure 4 Cont.
Trends by treatment group (2001–2022). Proportions by age class. Dark gray: arthroplasty; gray: fixation; light gray: conservative. Full article ">

13 pages, 9168 KiB

Open AccessArticle

Management Options for Traumatic Posterior Sternoclavicular Joint Dislocation: A Narrative Review with a Single Institution’s Experience

by Corrado Ciatti, Virginia Masoni, Pietro Maniscalco, Chiara Asti, Calogero Puma Pagliarello, Gianfilippo Caggiari, Marco Pes, Fabrizio Rivera and Fabrizio Quattrini

J. Clin. Med. 2024, 13(18), 5428; https://doi.org/10.3390/jcm13185428 - 13 Sep 2024

Viewed by 523

Abstract

Background: Posterior sternoclavicular joint (SCJ) dislocations are rare events that can evolve into real emergencies due to the vital structures in the mediastinum. When closed reduction maneuvers fail, open SCJ reconstruction becomes mandatory, with literature proposing several stabilization techniques that either preserve or [...] Read more.

Background: Posterior sternoclavicular joint (SCJ) dislocations are rare events that can evolve into real emergencies due to the vital structures in the mediastinum. When closed reduction maneuvers fail, open SCJ reconstruction becomes mandatory, with literature proposing several stabilization techniques that either preserve or remove the SCJ’s mobility. This study is a narrative review of the most recent literature regarding posterior trauma to the SCJ along with a single institution’s experience of this pathology, managed either conservatively or surgically, with a figure-of-eight autologous semitendinosus graft in case of closed reduction failure. Methods: This article provides an overview of posterior traumatic SCJ dislocation, and it describes five cases of patients managed for traumatic posterior SCJ dislocation treated either conservatively or surgically with a figure-of-eight semitendinosus tendon autograft reinforced with high-strength suture tape. A comparison with the most recent literature is performed, focusing on biomechanics. Results: The demographics, the mechanism of injury, the management algorithm and the surgical strategy align with the most recent literature. Despite the final treatment, at one year of follow-up, the ROM was restored with full strength throughout the range of motion of the shoulder with no neurological deficits. The reduced joint successfully healed in imaging, and patients returned to their daily lives. The surgical site wounds and donor harvest sites were perfectly healed. Conclusions: Although recent recommendations for treating posterior traumatic SCJ dislocation have advanced, no universally accepted method of stabilization exists, and the surgical strategy is generally entrusted to the surgeon’s experience. The literature still increasingly supports figure-of-eight ligament reconstruction with a biological or synthetic graft. This work further implements the literature by reporting good outcomes at follow-up. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

Figure 1
Preoperative evaluation of posterior SCJ dislocation: (a) chest X-ray; (b) 3D reconstruction; (c) axial CT scan bone view; (d) axial CT scan. Full article ">Figure 2
Surgical setting: (a) anatomical landmarks for identification of SCJ and drill hole planning; (b) double sterile field for SCJ access and tendon harvest; (c) tubularized autologous semitendinosus tendon graft. Full article ">Figure 3
Preoperative planning. Full article ">Figure 4
Intraoperative details of reconstruction with autologous semitendinosus tendon graft augmented with high-strength suture tape: (a) clavicle and sternum exposure; (b) graft passage in the drilled holes in the clavicle and sternum; (c) graft realization in the figure-of-eight; (d) figure-of-eight repair augmented with high-strength suture tape. Full article ">Figure 5
CT scan at 3 months post operation: reduction confirmed on axial and coronal scan on both patients. Full article ">Figure 6
Clinical evaluation, 1 year follow-up, ROM restored and wound healed. Full article ">Scheme 1
Inclusion and Exclusion Criteria. Full article ">

13 pages, 2530 KiB

Open AccessArticle

Anatomical Posterior Acetabular Plate Versus Conventional Reconstruction Plates for Acetabular Posterior Wall Fractures: A Comparative Study

by Chang-Han Chuang, Hao-Chun Chuang, Jou-Hua Wang, Jui-Ming Yang, Po-Ting Wu, Ming-Hsien Hu, Hong-Lin Su and Pei-Yuan Lee

J. Clin. Med. 2024, 13(17), 5341; https://doi.org/10.3390/jcm13175341 - 9 Sep 2024

Viewed by 540

Abstract

Background: Functional recovery following the surgical fixation of acetabular posterior wall fractures remains a challenge. This study compares outcomes of posterior wall fracture reconstruction using an anatomical posterior acetabular plate (APAP) versus conventional reconstruction plates. Methods: Forty patients with acetabular fractures involving the [...] Read more.

Background: Functional recovery following the surgical fixation of acetabular posterior wall fractures remains a challenge. This study compares outcomes of posterior wall fracture reconstruction using an anatomical posterior acetabular plate (APAP) versus conventional reconstruction plates. Methods: Forty patients with acetabular fractures involving the posterior wall or column underwent surgery, with 20 treated using APAPs (APAP group) and 20 with conventional pelvic reconstruction plates (control group). Baseline patient characteristics, intraoperative blood loss and time, reduction quality, postoperative function, and postoperative complications were compared using appropriate non-parametric statistical tests. A general linear model for repeated measures analysis of variance was employed to analyze trends in functional recovery. Results: No significant differences were observed in baseline characteristics. APAP significantly reduced surgical time by 40 min (186.5 ± 51.0 versus 225.0 ± 47.7, p =0.004) and blood loss (695 ± 393 versus 930 ± 609, p = 0.049) compared to conventional plates. At 3 and 6 months following surgery, the APAP group exhibited higher functional scores (modified Merle d’Aubigné scores 10 ± 1.8 versus 7.8 ± 1.4, p < 0.001; 13.4 ± 2.8 versus 10.1 ± 2.1, p = 0.001), converging with the control group by 12 months (modified Merle d’Aubigné scores 14.2 ± 2.6 versus 12.7 ± 2.6, p = 0.072; OHS 31.6 ± 12.3 versus 30.3 ± 10.1, p = 0.398). Radiologically, the APAP group demonstrated superior outcomes (p = 0.047). Complication and conversion rates to hip arthroplasty did not significantly differ between groups (10% versus 15%, p = 0.633). Conclusions: The use of an APAP in reconstructing the posterior acetabulum significantly reduces surgical time, decreases intraoperative blood loss, and leads to earlier functional recovery compared to conventional reconstruction plates. The APAP provides stable fixation of the posterior wall and ensures the durable maintenance of reduction, ultimately yielding favorable surgical outcomes. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

Figure 1
Patient inclusion flow chart. Full article ">Figure 2
Design and application of the anatomical posterior acetabular plate (APAP). (A) A 3D reconstruction of the right hip joint demonstrates the APAP’s design and optimal positioning for plating the posterior wall of the acetabulum. (B,C) Application of the APAP on a sawbone model in posteroanterior and iliac oblique views, respectively. (D) Radiograph displaying a case with a posterior wall fracture and concurrent posterior hip dislocation. (E) Postoperative radiograph illustrates the case after open reduction and internal fixation with the APAP, achieving anatomical reduction and concentric alignment of the hip joint. Full article ">Figure 3
Functional recovery following open reduction and internal fixation of acetabular fractures involving the posterior wall. Patients treated with the anatomical posterior acetabular plate were placed into the study group (black dots), while those with conventional pelvic reconstruction formed the control group (hollow circles). A statistically significant difference in functional recovery emerged (p = 0.007, determined through tests of between-subjects effects of repeated measures ANOVA). At 3 and 6 months following surgery, the modified Merle d’Aubigné scores were significantly higher in the study group (p < 0.001 and p = 0.001, respectively; determined through Mann–Whitney U tests). However, by the 12-month mark, there was no statistically significant difference between the two groups (p = 0.072). Full article ">Figure 4
A case of acetabular fracture treated with conventional pelvic reconstruction plate complicated by recurrent dislocation. (A) The patient sustained concurrent left acetabular posterior wall fracture and posterior dislocation of the left hip joint. (B) The patient underwent open reduction and internal fixation with a conventional pelvic reconstruction plate. (C) Eight months after the index surgery, the patient experienced recurrent hip dislocation, accompanied by a concurrent femoral head fracture. (D) Eventually, the patient underwent secondary surgery and conversion to bipolar hemiarthroplasty. Full article ">

15 pages, 10380 KiB

Open AccessArticle

Bone Scintigraphy for Guidance of Targeted Treatment of Vertebral Compression Fractures

by Elite Arnon-Sheleg, Daniel Weiner, Saeda Haj, Alon Rod and Nimrod Rahamimov

J. Clin. Med. 2024, 13(12), 3627; https://doi.org/10.3390/jcm13123627 - 20 Jun 2024

Viewed by 603

Abstract

Background: Vertebral compression fractures (VCFs) are prevalent in the elderly population and might be the source of back pain if they are fresh and yet unhealed. In many cases, it is a diagnostic challenge to differentiate fresh VCFs from healed united fractures, which [...] Read more.

Background: Vertebral compression fractures (VCFs) are prevalent in the elderly population and might be the source of back pain if they are fresh and yet unhealed. In many cases, it is a diagnostic challenge to differentiate fresh VCFs from healed united fractures, which retain similar radiographic characteristics but no longer generate pain. This information is crucial for appropriate management. The aim of this study was to evaluate the role of bone scintigraphy (BS) in identifying fresh VCFs appropriate for targeted treatment when compared to the findings of Computerized Tomography (CT). Methods: We retrospectively reviewed 190 patients with back pain suspected to stem from a recent VCF that underwent both a CT and a BS and compared the imaging patterns per vertebra. Results: The studies were concordant in the majority of cases (95.5%), diagnosing 84.4% normal vertebrae, 6.4% acute VCFs, and 4.7% chronic VCFs. However, in 37 patients, 45 occult acute VCFs were only detected on BS and not on CT. Multivariate logistic regression analysis revealed that these patients were older and had lower bone density compared to the rest of the study population. Additionally, 40 patients had acute VCFs visible on CT, but with no increased or low intensity uptake on BS. These cases were associated with a shorter time period between trauma and BS, a higher prevalence of male patients, and a higher bone density. Acute VCFs with no increased uptake or low levels of uptake were found only within the first six days of the trauma. Conclusions: BS detects radiologically occult fractures and can differentiate if a radiographically evident VCF is indeed clinically active, guiding possible treatment options. To avoid missing acute VCFs, BS should be performed six days or more after the injury. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

Figure 1
Patterns of vertebrae appearance on sagittal spine CT. (A) Normal vertebra—retained height and continuous cortex. (B) Acute VCF showing a “step defect” in the anterior border and a “zone of impaction” caused by impaction of the trabeculae. (C) Non-union fracture—a non-healed fracture with an intervertebral cleft (white arrow). (D) Ankylotic fracture—a transverse fracture below an ankylotic spine segment. (E) Chronic fracture showing loss of height and smooth cortical borders. (F) State after percutaneous vertebroplasty (Post VP)—chronic fracture with loss of height and hyperdense cement in the vertebral body. Full article ">Figure 2
Distribution of VCFs according to type and location on CT. Full article ">Figure 3
Distribution of VCFs according to uptake intensity and location on bone scintigraphy. Full article ">Figure 4
Radiotracer uptake intensity according to time after trauma. Full article ">Figure 5
Occult fractures. A 78-year-old female complaining of back pain, without known trauma. CT was acquired on the day of admission and bone scintigraphy was performed 2 days after the CT. (A)—Sagittal spine CT shows a non-union fracture in L4. No other fractures are demonstrated. Bone density measured in L3 was 7 HUs, consistent with severe osteoporosis. (B)—Planar anterior and posterior bone scintigraphy shows high-intensity uptake in L2 and L3, suggestive of acute fractures. (C)—Axial, coronal, and sagittal SPECT show high-intensity uptake in L2 and L3. Full article ">Figure 6
High-intensity uptake in an acute fracture, no uptake in chronic fractures post-vertebroplasty. A 77-year-old female after trauma. CT was acquired on the day of injury and bone scintigraphy was performed 3 days after the injury. (A,B)—Sagittal spine CT (enlarged in B) show an acute fracture in T11 (white arrow) and chronic fractures after vertebroplasty in T12 and L3. (C)—Planar anterior and posterior bone scintigraphy show high-intensity uptake in T11 (black arrow), indicating an acute fracture and no increased uptake in T12 and L3, consistent with chronic fractures. Note also, high-intensity uptake is seen in the anterior aspect of the left acetabulum (black arrow head), consistent with an acute fracture. Full article ">Figure 7
Low-intensity uptake in an acute ankylotic VCF. A 72-year-old male. CT was acquired on the day of injury and bone scintigraphy was performed 3 days after the injury. (A)—Coronal, axial, and sagittal spine CT show an acute ankylotic fracture in L2 and a fracture involving an osteophyte in L1 (white arrow). (B)—Planar anterior and posterior bone scintigraphy do not show any increased uptake in L2. (C)—Coronal, sagittal, axial, and MIP SPECT show only low-intensity uptake in L2 (black arrow). Full article ">Figure 8
VCF diagnostic flow-chart. When MRI is unavailable or contraindicated. ** Bone scan should be obtained at least 48 h after injury or onset of pain. Full article ">

12 pages, 1319 KiB

Open AccessArticle

Early Postoperative Weight-Bearing Ability after Total Hip Arthroplasty versus Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture

by Chiara Grabmann, Ibrahim Hussain, Anne Zeller, Sertac Kirnaz, Vincent Sullivan and Fabian Sommer

J. Clin. Med. 2024, 13(11), 3128; https://doi.org/10.3390/jcm13113128 - 27 May 2024

Viewed by 836

Abstract

Background: Femoral neck fractures are among the most common types of fractures and particularly affect elderly patients. Two of the most common treatment strategies are total hip arthroplasty (THA) and bipolar hemiarthroplasty (BA). However, the role of the different treatment strategies in the [...] Read more.

Background: Femoral neck fractures are among the most common types of fractures and particularly affect elderly patients. Two of the most common treatment strategies are total hip arthroplasty (THA) and bipolar hemiarthroplasty (BA). However, the role of the different treatment strategies in the postoperative weight-bearing ability in the early postoperative phase is still not entirely clear. Methods: Patients who underwent either THA or BA were consecutively included in our prospective cohort study. Gait analysis was performed during the early postoperative period. The gait analysis consisted of a walking distance of 40 m coupled with the turning movement in between. During the gait analysis, the duration of the measurement, the maximum peak force and the average peak force were recorded. Results: A total of 39 patients were included, 25 of whom underwent BA and 14 of whom underwent THA. The maximum peak force during the gait analysis was, on average, 80.6% ± 19.5 of the body weight in the BA group and 78.9% ± 21.6 in the THA group. The additionally determined average peak force during the entire gait analysis was 66.8% ± 15.8 of the body weight in the BA group and 60.5% ± 15.6 in the THA group. Conclusions: Patients with femoral neck fractures undergoing THA and BA can achieve sufficient weight bearing on the operated leg in the early postoperative period. In our study, BA did not allow for a significantly higher average and maximum loading capacity compared with THA. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Graphical abstract

Graphical abstract
Full article ">Figure 1
Early postoperative X-ray of the right hip joint in AP view of a male patient after femoral neck fracture who underwent total hip arthroplasty (THA). Full article ">Figure 2
Early postoperative X-ray of the right hip joint in AP view of a male patient after femoral neck fracture who underwent bipolar hemiarthroplasty (BA). Full article ">Figure 3
Example of a pair of insoles with integrated force sensors that were used for the gait analysis. The electronic hardware is located in a small box (yellow arrow) that is connected to the soles by a cable. The insoles are about 2–3 mm thick, so the soles do not significantly interfere with walking. Full article ">Figure 4
Examples of insoles with different sizes that were used for the gait analysis, each size being assigned a different color. The insoles were selected individually to match the patients’ shoe size and placed in the patients’ shoes before the gait analysis. The small box containing the hardware is attached to the outer shoe, where it does not interfere with walking. Full article ">Figure 5
Box plot comparing the maximum peak force during the gait analysis between the BA group and the THA group. The maximum peak force is presented in relation to the body weight of the study participants. There was no significant difference (p = 0.799) between both groups. Full article ">Figure 6
Box plot comparing the average peak force during the gait analysis between the BA group and the THA group. The average peak force is presented in relation to the body weight of the study participants. There was no significant difference (p = 0.272) between both groups. Full article ">

8 pages, 857 KiB

Open AccessArticle

Periprosthetic Hip Fractures around the Stem: Can the Stem Design Affect Fracture Features?

by Luca Costanzo Comba, Luca Gagliardi, Francesco Onorato and Fabrizio Rivera

J. Clin. Med. 2024, 13(9), 2627; https://doi.org/10.3390/jcm13092627 - 29 Apr 2024

Viewed by 710

Abstract

Background: Total hip arthroplasty is one of the most successful orthopedic surgeries; nevertheless, many of these surgeries are the causes of failure, and among them, periprosthetic fractures are one of the major causes of revision. Our study focuses on periprosthetic hip fractures with [...] Read more.

Background: Total hip arthroplasty is one of the most successful orthopedic surgeries; nevertheless, many of these surgeries are the causes of failure, and among them, periprosthetic fractures are one of the major causes of revision. Our study focuses on periprosthetic hip fractures with two different stem designs. The aim of the study was to analyze the obtained results, focusing on the features of periprosthetic stem fractures observed. Methods: We retrospectively reviewed periprosthetic fractures occurring between 2010 and 2023, involving Alloclassic^® or CLS^® uncemented femoral stems. We analyzed demographic data, proximal femur morphology, and the fracture type. Results: We identified 97 patients. Considering the proximal femur morphology, we found that there was statistically significant prevalence of Dorr A proximal femur morphology in the CLS^® group and of Dorr C in the Alloclassic^® group. Considering the distribution of the fracture pattern, we reported a non-statistically significant prevalence of the fracture pattern with stable stems in the CLS^® group. Conclusions: The choice of the prosthetic design of the femoral stem is a crucial element when planning total hip arthroplasty. However, we found a non-statistically significant difference between the two stems considered, raising questions about the real role of stem design as a primary determinant of periprosthetic hip fractures. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

12 pages, 1088 KiB

Open AccessArticle

Comparative Analysis of Complication Rates in Tibial Shaft Fractures: Intramedullary Nail vs. Ilizarov External Fixation Method

by Danilo Jeremic, Nikola Grubor, Zoran Bascarevic, Nemanja Slavkovic, Branislav Krivokapic, Boris Vukomanovic, Kristina Davidovic, Zelimir Jovanovic and Slavko Tomic

J. Clin. Med. 2024, 13(7), 2034; https://doi.org/10.3390/jcm13072034 - 31 Mar 2024

Viewed by 1114

Abstract

Background: The external fixation (EF) Ilizarov method, shown to offer efficacy and relative safety, has unique biomechanical properties. Intramedullary nail fixation (IMN) is an advantageous alternative, offering biomechanical stability and a minimally invasive procedure. The aim of this study was to assess [...] Read more.

Background: The external fixation (EF) Ilizarov method, shown to offer efficacy and relative safety, has unique biomechanical properties. Intramedullary nail fixation (IMN) is an advantageous alternative, offering biomechanical stability and a minimally invasive procedure. The aim of this study was to assess outcomes in patients undergoing tibia fracture fixation, comparing the Ilizarov EF and IMN methods in an early phase of IMN implementation in Serbia. Methods: This was a retrospective study including patients with radiologically confirmed closed and open (Gustilo and Anderson type I) tibial diaphysis fractures treated at the Institute for Orthopedic Surgery “Banjica’’ from January 2013 to June 2017. The following demographic and clinical data were retrieved: age, sex, chronic disease diagnoses, length of hospital stay, surgical wait times, surgery length, type of anesthesia used, fracture, prophylaxis, mechanism of injury, postsurgical complications, time to recovery, and pain reduction. Pain intensity was measured by the Visual Analog Scale (VAS), a self-reported scale ranging from 0 to 100 mm. Results: A total of 58 IMN patients were compared to 74 patients who underwent Ilizarov EF. Study groups differed in time to recovery (p < 0.001), length of hospitalization (p = 0.007), pain intensity at the fracture site (p < 0.001), and frequency of general anesthesia in favor of intramedullary fixation (p < 0.001). A shorter surgery time (p < 0.001) and less antibiotic use (p < 0.001) were observed when EF was used. Additionally, we identified that the intramedullary fixation was a significant predictor of pain intensity. Conclusions: The IMN method offers faster recovery and reduced pain intensity in comparison to EF, while the length of surgery predicted the occurrence of any complication. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

14 pages, 704 KiB

Open AccessArticle

Evaluation of Outcome after Total Hip Arthroplasty for Femoral Neck Fracture: Which Factors Are Relevant for Better Results?

by Paolo Schiavi, Francesco Pogliacomi, Matteo Bergamaschi, Francesco Ceccarelli and Enrico Vaienti

J. Clin. Med. 2024, 13(7), 1849; https://doi.org/10.3390/jcm13071849 - 23 Mar 2024

Viewed by 1024

Abstract

Background: Femoral neck fractures (FNFs) are frequent orthopedic injuries in elderly patients. Despite improvements in clinical monitoring and advances in surgical procedures, 1-year mortality remains between 15% and 30%. The aim of this study is to identify variables that lead to better outcomes [...] Read more.

Background: Femoral neck fractures (FNFs) are frequent orthopedic injuries in elderly patients. Despite improvements in clinical monitoring and advances in surgical procedures, 1-year mortality remains between 15% and 30%. The aim of this study is to identify variables that lead to better outcomes in patients treated with total hip arthroplasty (THA) for FNFs. Methods: All patients who underwent cementless THA for FNF from January 2018 to December 2022 were identified. Patients aged more than 80 years old and with other post-traumatic lesions were excluded. Patient data and demographic characteristics were collected. The following data were also registered: time trauma/surgery, surgical approach, operative time, intraoperative complications, surgeon arthroplasty-trained or not, and anesthesia type. In order to search for any predictive factors of better short- and long-term outcomes, we performed different logistic regression analyses. Results: A total of 92 patients were included. From multivariable logistic regression models, we derived that a direct anterior surgical approach and an American Society of Anesthesiologists (ASA) classification < 3 can predict improved short-term outcomes. Moreover, THAs performed by surgeons with specific training in arthroplasty have a lower probability of revision at 1 year. Mortality at 1 year was ultimately influenced by the ASA classification. Conclusions: A direct anterior approach and specific arthroplasty training of the surgeon appear to be able to improve the short- and long-term follow-up of THA after FNF. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

12 pages, 1200 KiB

Open AccessArticle

Angle-Adjustable Dynamic Hip Screw Plate for Unstable Trochanteric Fractures in Middle-Aged Patients: Mid-Term Outcomes and Return to Sport

by Luca Andriollo, Giorgio Fravolini, Rudy Sangaletti, Loris Perticarini, Francesco Benazzo and Stefano Marco Paolo Rossi

J. Clin. Med. 2024, 13(4), 988; https://doi.org/10.3390/jcm13040988 - 8 Feb 2024

Viewed by 1006

Abstract

Background: There are conflicting results in the literature regarding the superiority of proximal femoral nails over dynamic hip screw (DHS) plates. The primary aim of this study is to evaluate mid-term post-injury patient-reported outcome measures (PROMs) and return to sport (RTS) in middle-aged [...] Read more.

Background: There are conflicting results in the literature regarding the superiority of proximal femoral nails over dynamic hip screw (DHS) plates. The primary aim of this study is to evaluate mid-term post-injury patient-reported outcome measures (PROMs) and return to sport (RTS) in middle-aged patients treated with the DHS plate for unstable trochanteric fractures. Methods: Fifty-seven middle-aged patients (35–64 years) treated for proximal femoral fractures of type 31-A2 and 31-A3 according to the AO/OTA classification with the DMS Dynamic Martin Screw (KLS Martin Group, Jacksonville, FL, USA) between January 2017 and December 2019 were enrolled. Results: Forty-nine patients were included in this retrospective study, and the average age was 54.1 years (SD 8.4). The average follow-up duration at final follow-up was 60.5 months (SD 8.6). Post-operative complications included only one case of aseptic loosening of the implant, with a complication rate of 2%. There were no infections, peri-implant fractures, or other complications reported. Two out of the forty-nine patients (4.1%) required treatment with a total hip arthroplasty due to post-traumatic arthritis. The Harris Hip Score at final follow-up was 77.1 (SD 20.1), and the Western Ontario and McMaster Universities Osteoarthritis Index was 21.6 (SD 13.7). The overall rate of RTS was 57.7%. Conclusions: Treatment with DHS for unstable trochanteric fractures is a safe option in middle-aged patients, ensuring a good functional recovery. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

11 pages, 2996 KiB

Open AccessArticle

Vertebral Fractures in Pediatric Suicidal Jumpers: A Retrospective Study with Epidemiological and Clinical Analysis before and after the COVID-19 Pandemic

by Marco Crostelli, Osvaldo Mazza, Francesca Manfroni, Federico Tundo, Valeria Calogero, Marianna Mazza, Roberto Averna and Stefano Vicari

J. Clin. Med. 2023, 12(23), 7412; https://doi.org/10.3390/jcm12237412 - 29 Nov 2023

Viewed by 1261

Abstract

Background: From the beginning of the COVID-19 pandemic, reports in the literature confirm a significant increase in suicide attempts in children and adolescents. At the Bambino Gesù Pediatric Hospital Emergency Department (Rome, Italy), there was a dramatic increase in suicidal jumpers. Many of [...] Read more.

Background: From the beginning of the COVID-19 pandemic, reports in the literature confirm a significant increase in suicide attempts in children and adolescents. At the Bambino Gesù Pediatric Hospital Emergency Department (Rome, Italy), there was a dramatic increase in suicidal jumpers. Many of these presented vertebral fractures. Methods: This retrospective study includes all suicidal jumpers with vertebral fractures treated from April 2017 to March 2023. We collected and compared data from three years before to three years after the pandemic, analyzing vertebral fractures. Results: From April 2019 to March 2020, 141 cases of suicide attempt arrived at the emergency department. Five of these were suicidal jumpers without vertebral fractures. From April 2020 to March 2023, 362 cases of suicide were hospitalized and 19 were suicidal jumpers; 12 reported vertebral fractures (mean age 14 years). Seven patients were treated by percutaneous pedicle fixation. Three patients needed an open spinal surgery by posterior approach. One case with cervical fractures was treated by Halo-Vest. Conclusions: This is the first report that shows a sharp increase in vertebral body fractures due to suicide jumping attempts in children and adolescents. This could be a new epidemiological phenomenon persisting or even increasing over time in the pediatric population as a consequence of the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

10 pages, 974 KiB

Open AccessArticle

Functional Postoperative Outcome for 92 Cases of Radial Head Fractures: A PROM-Based Retrospective Study

by Michael Müller, Verena Mann, Julian Zapf, Konstantin Kirchhoff, Michael Zyskowski, Peter Biberthaler, Chlodwig Kirchhoff and Markus Wurm

J. Clin. Med. 2023, 12(18), 5870; https://doi.org/10.3390/jcm12185870 - 9 Sep 2023

Cited by 1 | Viewed by 1252

Abstract

Background: Fractures of the radial head are common injuries, whereas, in the case of displaced fractures, surgical treatment using screw or plate osteosynthesis, excision, or replacement of the radial head is required. However, data about patient-related outcomes (PROM) for different types of [...] Read more.

Background: Fractures of the radial head are common injuries, whereas, in the case of displaced fractures, surgical treatment using screw or plate osteosynthesis, excision, or replacement of the radial head is required. However, data about patient-related outcomes (PROM) for different types of radial head fractures is limited in the current literature. Therefore, this study was conducted to evaluate the functional outcome after operatively treated radial head fractures and to further correlate these results with the initial modified Mason classification. Methods: In this retrospective study, all suitable patients with surgical treatment of a radial head fracture were identified. Only patients with Mason II-IV fractures were included. All patients completed the Elbow Self-Assessment Score (ESAS) questionnaire. Data on fracture classification, type of surgery, and revision operations (if needed) were assessed. Results: A total of 92 patients suffering from fractures of the radial head (57 Mason II, 35 Mason III-fractures) who were operatively treated at our institution were enrolled. There were 42 (47.7%) female and 50 (54.3%) male patients with an average age of 47.5 ± 14.1 years. Screw osteosynthesis was performed in 67 patients, plate osteosynthesis in 20 patients, and five patients received radial head arthroplasty. The average ESAS score accounted for 89.7 ± 16.7. Mason II fractures showed significantly better functional results with higher ESAS scores (92.3 ± 13.9 vs. 85.4 ± 20.1) as well as significantly lower rates of necessary implant removal (0 vs. 5 (14.3%) than Mason III fractures. Screw osteosynthesis showed significantly better functional ESAS scores, 91.0 ± 16.5, than plate osteosynthesis, with 85.3 ± 17.6 (p = 0.041), but was predominantly used in Mason II fractures. Conclusions: Surgical treatment using screw- and plate osteosynthesis of radial head fractures provides a good overall outcome. The postoperative function is associated with the initial Mason classification as the patients’ reported outcome was worse in Mason III fractures compared to Mason type II fractures. In this context, the ESAS score can be considered a useful tool for the assessment of the patient-based functional outcome. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

Review

Jump to: Research, Other

21 pages, 1133 KiB

Open AccessReview

An Umbrella Review and Updated Meta-Analysis of Imaging Modalities in Occult Scaphoid and Hip and Femoral Fractures

by Patricia Jorisal, Callistus Bruce Henfry Sulay and Gilbert Sterling Octavius

J. Clin. Med. 2024, 13(13), 3769; https://doi.org/10.3390/jcm13133769 - 27 Jun 2024

Viewed by 840

Abstract

Background: Occult fractures may cause multiple morbidities. If occult fractures were detected earlier, complications may be preventable. This umbrella review and updated meta-analysis will aim to evaluate the use of imaging modalities in detecting occult scaphoid and hip fractures. Methods: The protocol for [...] Read more.

Background: Occult fractures may cause multiple morbidities. If occult fractures were detected earlier, complications may be preventable. This umbrella review and updated meta-analysis will aim to evaluate the use of imaging modalities in detecting occult scaphoid and hip fractures. Methods: The protocol for this study is available in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024525388). The literature search started and ended on 17 March 2024. We searched seven academic databases: MEDLINE, Cochrane Library, Pubmed, Science Direct, Google Scholar, WHO International Clinical Trials Registry Platform, and The Joanna Briggs Institute (JBI) database. The meta-analysis was conducted with the STATA program using the “midas” command. Results: There are four systematic reviews evaluating occult hip and femoral fractures with 6174 patients and two reviews evaluating occult scaphoid fractures with 1355 patients. The prevalence of occult scaphoid fracture and occult hip and femoral fractures is 23.87% (95% CI 18.25–29.49) and 44.8% (95% CI 39.38–51.4), respectively. Magnetic resonance imaging (MRI) had the best posterior probability of positive likelihood ratio (LR+) with 95% and 96% and negative likelihood ratio (LR-) with 0.15% and 1% for both occult scaphoid and hip fractures, respectively, assuming a 25% baseline. MRI could both confirm and exclude occult hip fractures while it can only confirm occult scaphoid fractures. Bone scans are inappropriate for either type of occult fractures The level of evidence for occult scaphoid fracture is weak while it is suggestive for occult hip fractures. Conclusion: The findings strengthen the use of MRI after an initially negative radiograph fracture for occult hip and femoral fractures, with a CT scan as a viable second option. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

Other

Jump to: Research, Review

22 pages, 914 KiB

Open AccessSystematic Review

Is There Any Purpose in Routine Syndesmotic Screw Removal? Systematic Literature Review

by Błażej G. Wójtowicz, Katarzyna Chawrylak, Jędrzej Lesman and Marcin Domżalski

J. Clin. Med. 2024, 13(16), 4805; https://doi.org/10.3390/jcm13164805 - 15 Aug 2024

Viewed by 546

Abstract

Introduction: The aim of this systematic review is to examine the recent evidence comparing the removal and non-removal of syndesmotic screws in tibiofibular syndesmosis injuries in terms of functional, clinical, and radiographic outcomes. Methods: A comprehensive literature review was conducted to [...] Read more.

Introduction: The aim of this systematic review is to examine the recent evidence comparing the removal and non-removal of syndesmotic screws in tibiofibular syndesmosis injuries in terms of functional, clinical, and radiographic outcomes. Methods: A comprehensive literature review was conducted to identify clinical studies on syndesmotic screw removal and its outcomes, searching the Cochrane Library and PubMed Medline for publications from 1 January 2004 to 12 February 2024. Studies were included if they involved tibiofibular syndesmotic screw fixation, assessed screw removal or retention, described clinical outcomes, and were original research with at least fifteen patients per group. Results: Most reviewed articles (18 out of 27; 67%) found no significant differences between the routine removal and retention of syndesmotic screws post-fixation. Four retrospective studies (15%) suggested that retaining screws might result in worse outcomes compared to removal. Two studies (7%) indicated that removing screws could introduce additional risks. One study (4%) observed that post-removal, there is some fibula–tibia separation without affecting the medial clear space. Another study (4%) noted that intraosseous screw breakage might increase the need for implant removal due to pain. Additionally, no significant differences in ankle function were found among groups with varying intervals of screw removal. Conclusions: The current literature does not definitively support routine removal of syndesmotic screws. Given the potential complications and financial costs, routine removal should not be performed unless specifically indicated. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

7 pages, 4294 KiB

Open AccessBrief Report

Potential of Titanium Pins Coated with Fibroblast Growth Factor-2–Calcium Phosphate Composite Layers to Reduce the Risk of Impaired Bone–Pin Interface Strength in the External Fixation of Distal Radius Fractures

by Hirotaka Mutsuzaki, Yohei Yanagisawa, Hiroshi Noguchi, Atsuo Ito and Masashi Yamazaki

J. Clin. Med. 2024, 13(11), 3040; https://doi.org/10.3390/jcm13113040 - 22 May 2024

Viewed by 555

Abstract

Background: The risk of impaired bone–pin interface strength in titanium (Ti) pins coated with fibroblast growth factor (FGF)–calcium phosphate (CP) composite layers is yet to be evaluated in a clinical study. This retrospective study used Weibull plot analysis to evaluate bone–pin interface [...] Read more.

Background: The risk of impaired bone–pin interface strength in titanium (Ti) pins coated with fibroblast growth factor (FGF)–calcium phosphate (CP) composite layers is yet to be evaluated in a clinical study. This retrospective study used Weibull plot analysis to evaluate bone–pin interface strength in Ti pins coated with FGF-CP layers for external distal radius fracture fixation. Methods: The distal radial fractures were treated with external fixation. The FGF-CP group comprised five patients (all women, aged 70.4 ± 5.9 (range: 62–77) years), and the uncoated pin group comprised ten patients (eight women and two men, aged 64.4 ± 11.7 (range: 43–83) years). The pins were removed after six weeks. The insertion and extraction peak torques were measured. The extraction peak torque was evaluated using Weibull plot analysis. Results: We compared the extraction torque of the two groups at or below 506 Nmm for a fair comparison using Weibull plot analysis. The Weibull plots were linear for both the FGF-CP and uncoated pin groups. The slope of the regression line was significantly higher in the FGF-CP group (1.7343) than in the uncoated pin group (1.5670) (p = 0.011). The intercept of the regression line was significantly lower in the FGF-CP group (−9.847) than in the uncoated pin group (−8.708) (p = 0.002). Thus, the two regression lines significantly differed. Conclusions: Ti pins coated with FGF-CP layers exhibit the potential to reduce the risk of impaired bone–pin interface strength in the external fixation of distal radius fractures. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Acute Trauma and Trauma Care in Orthopedics

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (14 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI