Search

Oblique lumbar interbody fusion (OLIF) is a minimally invasive lateral lumbar fusion technique and patients are discharged 1–2 days after surgery. Because OLIF utilizes a retroperitoneal approach close to the superior hypogastric plexus, postoperative urinary retention (POUR) may not be an uncommon problem. The purpose of this study was to present the incidence and outcomes of POUR with a systematic care protocol. The records of 102 consecutive patients (M:F = 34:68; mean age, 68.0 ± 8.4 years) were retrospectively reviewed. After OLIF, the indwelling urinary catheter was immediately removed, and every patient was encouraged to void within 6 h. The POUR care protocol, following a clinical pathway, was based on residual urine (RU), which was monitored with an ultrasound bladder scan after each voiding or every 6 h for 48 h. The incidence rate of POUR was 44% (45/102) at 24 h, 17% (17/102) at 48 h, and 2% (2/102) at 1 month. Preoperative urological symptoms (odds ratio [OR] 3.2) and violation of the protocol (OR 28.3) were risk factors at 24 h. At 48 h, violation of the protocol was the only risk factor (OR 9.6). Identifying risk factors and a preemptive care protocol may reduce permanent POUR. [ABSTRACT FROM AUTHOR]

Pain after trapeziectomy is a vexing problem, most commonly due to scaphometacarpal impingement. A number of treatment strategies have been described and are examined in this systematic review. In total, 27 studies describing revision surgery for unsatisfactory results after trapeziectomy were included. Results after soft tissue or synthetic suspensionplasties, arthrodesis procedures, implant arthroplasty and costochondral autografting were included. Most studies were heterogeneous in terms of patient selection and procedure performed, and the level of evidence and methodological quality were uniformly low. Autologous suspensionplasty procedures are the best studied and most rigorously reported techniques, with modest improvements in pain widely reported. Newer techniques using synthetic suture button suspension are encouraging with the benefit of earlier mobilization but require further study. Due to high incidences of complication and revision, the literature does not support the use of implant arthroplasty after trapeziectomy. Arthrodesis appears to be a reasonable last resort when attempts at suspension have failed. [ABSTRACT FROM AUTHOR]

Shoulder arthrodesis is a recognised procedure for incapacitating shoulder conditions in dogs in cases where traditional surgical or medical interventions are not feasible. However, the use of shoulder arthrodesis in the feline patient has not been described. This case report details the novel use of shoulder arthrodesis in a 10‐month‐old cat with a chronic right forelimb lameness attributed to humeral head dysplasia. Surgical stabilisation of the right shoulder arthrodesis was achieved with two 2.4 mm Synthes locking compression plates and two 2.4 mm inter‐fragmentary positional screws. Short‐term follow‐up indicated adequate bone healing with good alignment and implant integrity. Subsequent long‐term phone follow‐up 22 months after surgery revealed a successful outcome with no visible stiffness and only a mechanical lameness. This result underscores the viability of shoulder arthrodesis as a potential option for feline patients necessitating shoulder salvage procedures. [ABSTRACT FROM AUTHOR]

Copyright of Die Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Titanium plantar plates have proven successful in the fixation of the first tarsometatarsal arthrodesis (TMT). However, a second surgery is typically needed for implant removal, and potential adverse effects, carried by the conventional implantations, are not uncommon. The purpose of this study was to determine whether a novel magnesium-based plantar plate system provides similar fusion stability to a titanium-based plantar plate system under various loading conditions. Methods: Six matched-pair human cadaveric specimens underwent TMT fusions using either a magnesium plantar plate system prototype or a titanium plantar plate system. Specimens were cyclically loaded with a force ranging from 5 N to 50 N for 5,000 cycles, and displacement was recorded. Axial stiffness (N/mm) was calculated from load-displacement curves. Each specimen was loaded to failure at a rate of 5 mm/min, and the ultimate load was recorded. Results: No significant difference was found in the vertical displacement between Ti group and Mg group after 100 cycles (2.4 ± 1.0 mm vs. 1.3 ± 1.4 mm, p = 0.196), 500 cycles (3.3 ± 1.3 mm vs. 1.7 ± 1.7 mm, p = 0.142), 1,000 cycles (3.7 ± 1.5 mm vs. 1.9 ± 1.9 mm, p = 0.128), 2,500 cycles (4.2 ± 1.7 mm vs. 2.3 ± 2.2 mm, p = 0.172) and 5,000 cycles (4.5 ± 1.8 mm vs. 2.3 ± 3.3 mm, p = 0.125), Additionally, no significant differences were observed in initial stiffness (53.1 ± 19.2 N/mm vs. 82.2 ± 53.9 N/mm, p = 0.257), final stiffness (90.6 ± 48.9 N/mm vs. 120.0 ± 48.3 N/mm, p = 0.319), or maximum load-to-failure (259.8 ± 98.2 N vs. 323.9 ± 134.9 N, p = 0.369). Conclusions: Based on the performed biomechanical testing, the magnesium plantar plate system provides mechanical stability equivalent to the titanium plantar plate system in fixation for the first TMT joint fusion. [ABSTRACT FROM AUTHOR]

Purpose: The conversion of knee arthrodesis to total knee arthroplasty (TKA) is a challenging procedure. This article aims to report a case of fusion knee with patellar absence who was converted to TKA and has achieved good results. Methods: The patient, a 23 years old Tibetan Buddhist monk, sustained a left knee joint injury at the age of 12 due to a car accident, leading to subsequent knee arthrodesis at 18 years old as a result of recurrent severe infections. However, this procedure hindered his ability to perform daily meditation practices that required bending both knees and sitting cross-legged. After adequate preoperative preparation, with the help of customized osteotomy guide plate and customized 3D-printed porous tantalum patella, the 3D preoperative plan assisted TKA after arthrodesis was performed. The knee function was followed up to explore the clinical effect of above-mentioned surgical procedure. Results: A 1-year follow-up showed significant improvement in postoperative knee function with improved scores for function outcomes, and the patient was satisfied with the conversion. The patient’s left knee improved significantly from preoperative immobility with 5° of fixed fusion to postoperative ROM of 0° to 100°, and the patient could squat and stand up, walk on the flat ground, and go up and down stairs. Conclusion: Adequate preoperative communication with patients and good expectation management are crucial for ensuring favorable prognoses. Perfect preoperative planning and its reliable implementation during operation are essential. Additionally, postoperative rehabilitation and proactive management of complications play pivotal roles in achieving optimal clinical outcomes. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to explore the feasibility and accuracy of a robot-assisted technique in four-corner fusion compared with traditional freehand operation. Methods: Twenty cadaver specimens were randomly assigned to the robot-assisted group and freehand groups. Three screws were placed percutaneously to fix the capitate-lunate joint, lunate-triquetrum joint, and triquetrum-hamate-capitate joint in each specimen by robot-assisted or freehand technique. The offset between the actual and planned screw positions was determined by merging the images of intraoperative and postoperative CT scans in the robot-assisted group. The centrality of the screw, time-consuming, drilling attempts, and radiation exposure were compared between the two groups. Results: The mean offset between the actual and planned screw position was 1.09 (SD: 0.56) mm. The offset at the start point of the screw was significantly lower than that at the endpoint. There was no significant difference in the centrality of the screws, surgical time between the two groups. The number of drilling attempts and the radiation dose received by surgeons were significantly lower in the robot-assisted group. Conclusions: Although there was no significant difference in screw centrality between the two groups, the slight offset between the actual and planned screw positions confirmed the feasibility of the robot-assisted technique in four-corner fusion. The robot-assisted technique has advantages in reducing the difficulty of surgery and protecting the surgeon from exposure to large doses of radiation. [ABSTRACT FROM AUTHOR]

Objectives: Although numerous surgical techniques and fixation methods have been described for the treatment of hallux rigidus (HR) with arthrodesis, consensus on the gold standard treatment has not been reached. The aim of this study is to retrospectively compare the clinical and radiological outcomes of compression screw fixation and plate fixation in the treatment of HR with arthrodesis. Methods: Patients who underwent arthrodesis surgery due to HR between January 2021 and December 2023 at a single center were retrospectively reviewed. Patients who met the inclusion criteria were divided into two groups: those who underwent arthrodesis with plate fixation (PLATE) and those who underwent arthrodesis with compression screw fixation (SCREW). Demographic data including age, gender, affected side, operative time, hallux valgus angle (HVA), dorsiflexion angle, AOFAS scores, and implant irritation data were compared among patients with at least 3 months of follow-up. Results: It was observed that all patients included in the study had successful bone union without any complications. There were no significant differences between the two groups in terms of age, gender, affected side, preoperative HVA, and preoperative AOFAS scores (P= 0.970, P= 0.426, P= 0.694, P= 0.216, and P= 0.905, respectively). The mean operation time and postoperative AOFAS score were lower in the PLATE group compared to the SCREW group (P=0.006 and P=0.004, respectively). However, in the SCREW group, the dorsiflexion angle and the rate of implant irritation were lower compared to the PLATE group (P=0.016 and P=0.01, respectively). Conclusions: In the surgical treatment of HR, both plate fixation arthrodesis and compression screw arthrodesis are reliable surgical techniques. While plate fixation arthrodesis is a faster and more practical method, arthrodesis with a compression screw results in fewer complaints related to the implant and provides a more functional recovery. [ABSTRACT FROM AUTHOR]

Purpose: Arthrodesis of the first ray metatarsophalangeal joint (MPJ) is the gold standard in iatrogenic hallux varus (IHV) in the presence of stiffness and osteoarthritis. The purpose of this study is to collect clinical and radiographic results and complications of MPJ arthrodesis in rigid iatrogenic HV. Methods: A retrospective evaluation of rigid iatrogenic HV undergoing arthrodesis with a minimum follow-up (FU) of two years was performed. The clinical parameters assessed were visual analog scale (VAS), the AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score and the satisfaction scale. The radiological parameters evaluated the first to second metatarsal angle (IMA) and the angle of hallux valgus (HVA). Complications were also analysed. Result: A total of 18 patients (19 procedures) with a mean FU of 5.5 ± 2.5 years were included. The mean VAS improved from 7.3 ± 1.6 to 1.3 ± 1.2 (p < 0.05) at the last FU. Similarly, the AOFAS Hallux Metatarsophalangeal-Interphalangeal scale score significantly improved to 82 ± 9.2 (p < 0.05). Radiological evaluation demonstrated a 1–2 IMA improvement from 4.4 ± 2.2° preoperatively to 8.9 ± 2.4° at 3 months post-operatively. Similarly, there was a significant (p < 0.05) improvement of the HVA from − 22.7 ± 4.1° to 13.1 ± 4.1° at three months post-operative (p < 0.05). No signification loss of correction was noted at the last follow-up (p > 0.05). In one case, a delayed fusion at the arthrodesis site required surgical revision to promote fusion. No patient experienced pain with stress from the first MTP joint arthrodesis site or identified the arthrodesis site as a source of pain. No patient required implant removal. Re-operation and revision rates were 5.3%. The overall complications rate was 15.8%. Conclusions: MPJ fusion effectively corrects Iatrogenic Hallux Varus in cases of rigid and fixed deformities in the medium- to long-term follow-up, with lasting improvements in AOFAS and VAS scores. The procedure is characterised by a non-negligible risk of complications, reoperations and revisions. Level of evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Pancarpal arthrodesis was performed in 21 dogs, using orthogonal (cranial/dorsal and medial) plates without postoperative rigid external coaptation. Short-term and long-term outcomes, arthrodesis progression, and complications were assessed using a retrospective review of case records and radiographs. Three of 21 (14.2%) dogs required a revision surgery: 2 had total implant explantation and 1 had a screw removed. Other complications were managed successfully medically. One of 21 (4.8%) dogs had confirmed deep surgical site infection requiring implant removal, and 4 of 21 (19%) had suspected (not confirmed on microbiology) superficial surgical site infections that resolved with medical management. Long-term outcomes were assessed via owner questionnaire (Canine Brief Pain Inventory) and were available for nine dogs at a mean of 26.78 mo after surgery. The mean score for the first part (assessment of pain) was 7.83/40, which is classified as no pain to mild pain. The mean score for the second part (assessment of function) was 12.67/60, which is classified as very good. The last part (overall impression) was defined as excellent in four dogs (44.44%), very good in one dog (11.11%), and good in the other four dogs (44.44%). This retrospective study documents a suitable technique for pancarpal arthrodesis in dogs with carpal injuries. [ABSTRACT FROM AUTHOR]

Nitinol staple use in orthopedic surgery has increased in recent years. Biomechanical studies provide useful data for use in foot/ankle; however, clinical data is limited. This study's purpose is to determine the efficacy of nitinol staples to achieve stable, bony arthrodesis in midfoot and Chopart joints, and examine their clinical outcomes and pain scores. A retrospective chart review was performed on 127 midfoot/Chopart joint arthrodeses (71 patients) using nitinol staples in isolation. The primary outcome variable was radiographic evidence of healing. Radiographs were blinded, randomized, and independently reviewed by 3 board certified foot and ankle surgeons. Complete/partial union was seen in 89% of all joints (113/127), increasing to 93% when including only midfoot joints (98/106). Chopart joints had significantly lower healing rates (15/21; 71%) compared to all midfoot joints (p =.01) and isolated tarsometatarsal joints (86/91; 95%) (p =.006). Neuropathy and smoking did not affect arthrodesis, but diabetes did (p =.004). Joints requiring bone grafting had worse rates of arthrodesis (38/49; 76%) (p =.002). For all joints, postoperative visual analog scale scores were significantly lower than preoperative (p <.001). Preoperative midfoot and Chopart pain scores were similar (p =.30). Midfoot joints had significantly lower pain scores postoperatively than preoperatively (p <.001). No such significance existed in Chopart joints (p =.07). Isolated nitinol staples are a viable option for midfoot arthrodesis, especially tarsometatarsal joints, and offer significant pain improvement. Chopart joints may require more rigid fixation than nitinol staples, given the lower healing rate. [ABSTRACT FROM AUTHOR]

Ankle arthrodesis is an effective surgical intervention for end-stage arthritis or severe ankle joint deformity. Both internal (IF) and external fixation (EF) techniques are valid options, but there is controversy regarding the most effective technique. This study compares the safety and efficacy of EF and IF fixation techniques for ankle arthrodesis. A systematic review and meta-analysis was conducted according to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) Guidelines. A literature search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL), was performed to identify all studies directly comparing the two techniques. Both fixed and random effects models of analysis were used depending on heterogeneity. Odds of union in the EF and IF groups were comparable (OR = 0.60, CI 0.36-1.02, p =.06) however, EF was associated with greater odds of deep hardware infections (OR = 3.67, 1.97-6.83, p <.05) and amputations (OR = 3.17, CI 1.06-9.54, p =.04). Odds of revision surgery and superficial wound complications were similar between groups. EF techniques had significantly longer operation times (MD = 31.23, CI-25.11-37.34, p <.05) and intraoperative blood loss (MD = 44.1, CI 28.77-59.43, p <.05). No significant difference was noted in pain and functionality scores. IF and EF techniques have reasonable union rates with similar postoperative outcomes. [ABSTRACT FROM AUTHOR]

Case history: A 4-month-old male Shih Tzu dog (Case 1) and an 11-month-old female Devon Rex cat (Case 2) were referred to specialist veterinary hospitals for evaluation of right thoracic lameness and growth abnormality in the distal aspect of the forelimb. Clinical findings: Non-weight-bearing lameness and decreased range of motion were noted in the affected limbs of both cases. Case 1 had a plantigrade stance, and a cleft separation between the first and second digits extending upwards to the distal third of the antebrachium. There was no pain on palpation, and the affected limb was shorter than the contralateral. Radiographic examination revealed cleft separation between metacarpal bones I and II, and carpal bone fusion (I, II, III), and the distal radius ended freely and was attached to the first metacarpal bone. Case 2 had a small cleft medial to metacarpal III. The limb was consistently held in abduction and had marked carpal varus. The limb had never been used for weight bearing. Radiographic examination showed agenesis of metacarpal bone II and separation of metacarpals I and III. The radius and ulna were separated and the radial head did not articulate normally at the elbow, leading to marked elbow incongruity. Diagnosis: Ectrodactyly in both cases. Treatment and outcome: Amputation of the radius followed by ulnocarpal arthrodesis were performed in both cases. Follow-up evaluations up to 1 year (Case 1) and 10 weeks (Case 2) after surgery indicated satisfactory arthrodesis fusion, owner satisfaction, and a good clinical outcome. Clinical relevance: Ectrodactyly is a rare congenital deformity of the forelimb with a heterogeneous character, requiring an individualised treatment plan. These are the first cases reported in the literature of ectrodactyly in small animals that were treated successfully with ulnocarpal arthrodesis. This case series therefore provides evidence in support of this treatment option for this heterogeneous congenital deformity. [ABSTRACT FROM AUTHOR]

Background: Four-corner fusion (4CF) is a common treatment for midcarpal arthritis; however, alternatives including 2-corner fusion (2CF) and 3-corner fusion (3CF) have been described. Limited literature suggests 2CF and 3CF may improve range of motion but have higher complication rates. Our objective is to compare function and patient-reported outcomes following 4CF, 3CF, and 2CF at our institution. Methods: Adult patients undergoing 4CF, 3CF, and 2CF from 2011 to 2021 who attended at least one follow-up were included. Four-corner fusion patients were compared with those who underwent either 3CF or 2CF using staple fixation. Outcomes include nonunion rate, reoperation rate, progression to wrist fusion, range of motion, and patient-reported pain, satisfaction, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Results: A total of 58 patients met inclusion criteria. There were 49 4CF and 9 2CF or 3CF patients. Nonunion rates, progression to wrist fusion, and repeat surgery for any indication were not significantly different among groups. Range of motion (flexion-extension, radial-ulnar deviation) and grip strength at postoperative visits were not significantly different. Significantly more 4CF patients required bone grafting. Pain, overall satisfaction, and DASH scores were similar. Conclusions: Although prior studies suggest increased risk of nonunion and hardware migration after 2CF/3CF, we did not observe higher complication rates compared with 4CF. Range of motion, strength, and patient-reported outcomes were similar. While 4CF is traditionally the procedure of choice for midcarpal fusion, we found that when using a staple fixation technique, 2CF and 3CF have comparable clinical and patient-reported outcomes yet decrease the need for autologous bone grafting. [ABSTRACT FROM AUTHOR]

OBJECTIVE To report the surgical technique, complications, and outcomes of 8 dogs that underwent a unilateral pantarsal arthrodesis stabilized using a circular external skeletal fixator (CESF) construct for the treatment of uni- or multilevel tarsal instability. ANIMALS 8 dogs. CLINICAL PRESENTATION Medical records from 2010 to 2023 from 2 small animal hospitals were retrospectively reviewed for dogs undergoing pantarsal arthrodeses stabilized with CESF. Data collected for each dog included signalment, injury etiology, construct configuration, radiographic imaging, antimicrobial use, complications, length of time until construct removal, and outcome based on clinical evaluation by the owner and veterinary surgeon. RESULTS 8 dogs met the requirements of inclusion for the study. Dogs had a mean age of 5.5 years (range, 0.42 to 13 years) and weight of 15.1 kg (range, 2.5 to 26.4 kg). Angulated 3- and 4-ring constructs were used in 5 and 3 dogs, respectively, with or without hybridization. Tarsi were stabilized with a mean angle of extension of 124.80 (range, 111.5° to 136.5°). Fixator removal was performed at a mean time of 11.3 weeks (range, 6 to 16 weeks). Complications developed in 4 dogs, 2 of which had poor clinical outcomes despite additional interventions, including recurrent digit trauma and poor limb use postoperatively. Six dogs had excellent outcomes. CLINICAL RELEVANCE A CESF may be considered as an alternative to plate stabilization when performing a pantarsal arthrodesis. This fixation requires rigorous postoperative care but obviates the need for supplemental postoperative coaptation. [ABSTRACT FROM AUTHOR]

Case: A 71-year-old man with a history of C5-7 anterior cervical discectomy and fusion (ACDF) sustained a C7 spinous process fracture after falling from a ladder. He was initially managed nonoperatively but developed anterolisthesis and kyphosis at C7-T1 with left hand weakness over the course of 11 days. Surgical treatment included spinous process wiring and C5-T3 posterior fusion. At 14-month follow-up, he demonstrated resolution of pain and returned motor function. Conclusion: The patient's ACDF likely created a longer lever arm, allowing the force of his fall to be concentrated at C7-T1. Patients with a suspected Clay-Shoveler's fracture require close follow-up. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to describe the use of retrograde gentamicin-coated tibial intramedullary nail (ETN PROtect™) in patients with tibial defects who required a tibiotalocalcaneal arthrodesis (TTC). Methods: Consecutive series case review of seven men treated with TTC using retrograde PROtect™ between January 2018 and December 2023. The main outcomes evaluated were fracture union, complications, and the health-related quality of life using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). Results: The mean age was 45.3 ± 8.0 years. Six patients had a clinical history of chronic osteomyelitis, and one case underwent TTC for congenital pseudoarthrosis. Fracture union was achieved in 5 of 7 patients between 4 and 11 months after surgery. Three patients developed complications; two patients had fistulas, and one had persistent pain. At the end of the follow-up, a median of 70 points (interquartile range: 60 to 90) on the EQ-5D-3L was reported. No complications directly attributed to the use of the PROtect™ were reported. Conclusion: TTC with retrograde PROtect™ is a prophylactic treatment option in patients with tibial defects treated with external fixation requiring a tibiotalar and subtalar arthrodesis. This novel use of PROtect™ allows simultaneous fixation of the tibiotalocalcaneal joint and protection of the regenerated bone, facilitating earlier rehabilitation in patients at high risk for postoperative infections. [ABSTRACT FROM AUTHOR]

The present study described a modified technique of atlantoaxial arthrodesis in patients with atlantoaxial instability (AAI) along with the postoperative clinical and radiological results. Five patients underwent this method for their AAI concurrent with C1 arch hypoplasia and/or the development of odontoid pannus causing myelopathy. After thorough exposure of the posterior surface of the C1-2 complex, the bilateral C2 nerve roots were sectioned to allow for easier access to the C1/2 facet joints. To prepare a suitable grafting bed, the C1/2 facet capsule was opened, and then the articular cartilaginous and synovial tissues were thoroughly removed. After being properly fashioned to match the gap between the C1/2 facet joint spaces, the structural bone grafts from the iliac crest were directly inserted into the facet joint spaces. To alleviate cord compression caused by concomitant odontoid pannus and/or hypoplastic C1 arch, C1 laminectomy was necessitated in all cases. Subsequently, posterior screw-rod instrumental fixation was conducted. All 5 patients underwent this procedure successfully. Clinical and radiological follow-up data of all patients indicated favorable relief of clinical symptoms and early rigid C1-2 stability. The sequelae of C2 nerve resection were not remarkable. No other neural or vascular damage associated with this technique was observed. Modified atlantoaxial arthrodesis via intraarticular autografting using the structural iliac bone combined with posterior instrumentation appears to be an efficient alternative treatment method for AAI patients with concurrent pathologies, even when the C1-2 posterior arches are unavailable for the grafting bed. [ABSTRACT FROM AUTHOR]

Objective: Arthrodesis, usage of metallic implants for internal fixation, is commonly employed as the primary treatment modality for Müller‐Weiss disease (MWD). Nevertheless, the efficacy of the current methods of fixation leaves room for improvement. Inadequate fixation strength and the risk of fixation failure are both critical concerns requiring attention. This study explored the clinical effects of implementing a modified fixation technique in talonavicular arthrodesis for the treatment of MWD. Methods: A total of 14 cases diagnosed with MWD undergoing talonavicular (TN) arthrodesis from January 2021 toMarch 2023 were included in the retrospective study. The fixation method for fusion involved the use of screws, with additional support from the shape‐memory alloy (SMA) staple. Relevant clinical outcomes and complications were evaluated preoperatively and postoperatively. Paired‐samples t‐test was used for all data comparisons. Results: Radiographic evidence confirmed solid fusion, and follow‐up evaluations showed satisfactory results in all cases. The American Orthopedic Foot and Ankle Society (AOFAS) scores were elevated from 32.21 ± 4.0 (range: 22–38) preoperatively to 86.5 ± 2.7 (range: 81–90) postoperatively (p < 0.001). The visual analog scale (VAS) scores declined from 7.40 ± 0.8 (range: 6–8.5) preoperatively to 1.21 ± 1.1 (range: 0–3) postoperatively (p < 0.001). The lateral Meary's angle changed from 13.50 ± 5.2 (range: 8–24) preoperatively to 4.14 ± 2.9 (range: 1–11) degrees postoperatively (p < 0.001). The calcaneal pitch angle increased from 10.07 ± 4.0 (range: 5–19) preoperatively to 14.35 ± 4.0 (range: 8–21) degrees postoperatively (p < 0.001). The talar‐first metatarsal angle decreased from 11.71 ± 3.8 (range: 8–18) preoperatively to 4.28 ± 3.1 (range: 0–9) degrees postoperatively (p < 0.001). One patient was observed to experience delayed wound healing and wound infection. No nerve damage, malunion, pseudoarthrosis, or fixation failure were observed. Conclusion: The results indicated that the fusion of the TN joint using a combination of screws and shape memory alloy staples, could lead to favorable clinical outcomes and significantly enhance the quality of life for patients with MWD. This technique is not only safe and effective but also straightforward to perform. [ABSTRACT FROM AUTHOR]

Purpose: The management of odontoid fractures in adult patients has been widely described. However, there is sparse literature about this injury in the pediatric population. This study aimed to review published literature regarding the management and outcomes of pediatric odontoid fractures to develop a stepwise treatment algorithm. Methods: A literature review was conducted using PRISMA guidelines on PubMed to identify studies between 1960 and 2023 that reported on the management and outcomes of odontoid fracture in pediatric patients. Studies were included if they were published in English and if their sample included at least four patients aged 0–18, minimum follow-up of 6 weeks, and outcomes for each patient clearly differentiated. Results: In total, 15 studies including 125 pediatric patients with odontoid fractures were included. Treatment options varied from non-operative management with immobilization in rigid collars, halo vests, cervicothoracic orthosis, or soft collars to surgical management with fixation and/or arthrodesis. There were 73 patients initially treated nonoperatively, 47 initially treated surgically, 2 who healed with observation alone, and 3 who died acutely of concomitant injuries. The nonunion rate for nonoperative management was 5.5%. Surgery was successful, demonstrating bony union at final follow-up, in 94.6% of cases treated via a posterior approach and 85.7% of cases treated with an anterior approach. Conclusions: Odontoid fractures must be considered in pediatric patients with cervical spine trauma. This is the largest literature review of pediatric odontoid fractures. Various management strategies exist and can be considered. The proposed algorithm offers an evidence-based framework for the management of pediatric odontoid fractures. [ABSTRACT FROM AUTHOR]

Hallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief, but sacrifices ROM. The Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is limited. The aim was to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre. A retrospective cohort study was conducted, enrolling all adult patients who underwent primary first MTPJ SCI arthroplasty or arthrodesis for the treatment hallux rigidus. The primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included EQ-5D, complication rates, VAS Pain and FAAM (ADL). Between 2017 and 2020 there were 33 cases divided into two groups (17 Cartiva SCI, 16 arthrodesis, mean age 59.0 ± 9.9 years) with a mean follow up of 2.3 years. There was no statistically significant difference in any of the MOXFQ, EQ-5D, VAS Pain or FAAM (ADL) outcome scores between the Arthrodesis and SCI groups (p > 0.05). The mean MOXFQ Index score was 7.2 ± 6.4 for the SCI group and 3.9 ± 5.8 for the Arthrodesis group at final follow up (p = 0.15). Although complications were high in both groups, the overall hallux reoperation rate was 29.4 % in the SCI cohort and 0.0 % for arthrodesis. This retrospective comparative study found no significant superiority of Cartiva SCI over arthrodesis in terms of PROMs. Due to the higher rate of further surgical intervention in the SCI cohort, we recommend arthrodesis as the preferred surgical option for hallux rigidus. III [ABSTRACT FROM AUTHOR]

Purpose: To concurrently assess and compare the fixation efficacy, invasiveness, and fusion potential of a posterior integrated transfixation cage system to the posterolateral threaded implant and lateral triangular rod systems, in a cadaveric model. Methods and Materials: Twelve (12) cadaveric sacroiliac joint specimens were utilized and tested within the single-leg stance multidirectional pure moment bending model. Each specimen was tested in the intact, destabilized, treated (using posterior, posterolateral, and lateral systems), and post-fatigue conditions by applying 0 to ± 7.5 Nm of moment in flexion-extension, axial rotation, and lateral bending while measuring the angular range of motion between the sacrum and ilium. Computational models were reconstructed from Computed Tomography (CT) scans and manufacturer surgical technique guides. The models were utilized to quantify the volume of bone removed during implantation and the surface area available for fusion. Results: The posterior integrated transfixation cage system and the lateral triangular rods produced equivalent motion reduction in all motion planes (P > 0.583). The posterolateral cylindrical threaded implant produced less motion reductions than the posterior and lateral implants in flexion-extension (6% ± 3% vs 37% ± 10% and 33% ± 11%, respectively, P < 0.05). The posterior system removed 22%-60% less bone volume from the sacrum and ilium (P< 0.10), introduced 200%-270% more implant surface to the joint space (P< 0.01) and decorticated 75%-375% more joint surface area (P< 0.01). Conclusion: The posterior integrated transfixation single-implant cage system is superior to the posterolateral cylindrical threaded single-implant system. Its performance in osteopenic bone is equivalent to the lateral triangular rod system in healthy bone; however, the posterior integrated transfixation cage system requires a single implant, while the lateral triangular rod system requires three. The posterior implant removes the least bone volume and has the most surface area for fusion, providing a significantly better opportunity for robust sacroiliac joint arthrodesis. [ABSTRACT FROM AUTHOR]

The claw toe deformity is a painful condition that mainly affects the adult population. Although there are many different treatments to solve the deformity, there is no optimal procedure to restore the normal foot mechanics. The objective of this review was to identify the technical features of the kinematic evaluation methods used in patients with claw toes. Furthermore, the aim of this review was to clarify what is known and what is needed apart from the surgical procedures to correct the claw toe deformity, with the purpose of reducing risk factors of falling in elderly people. A search in electronic databases, such as Scopus (n = 78), Google Scholar (n = 705) and ScienceDirect (n = 290) was conducted. There were seven articles (43.75%) related to the fixation (arthrodesis) of proximal and distal interphalangeal joints, one article (6.25%) describes the correction of the claw toe through plantar plate tenodesis and release of collateral ligaments, four articles (25%) describe the procedure of tendon transfer, one article (6.25%) describes flexor digitorum brevis tenotomy and a proximal interphalangeal joint arthrolysis, and another article (6.25%) presented the impact of partial phalanx osteotomy to treat the claw toe deformity. In conclusion, the review indicates that there are several studies related to the treatment or correction of claw toe deformity. However, there is a lack of knowledge of the postsurgical effects of treating claw toe condition, especially in the structural mechanics (plantar pressure distribution, stability, gait, foot mechanics and so on) of the foot after the correction of the claw toe deformity. The analysis of the foot mechanics after the correction of the claw toes has to be paramount to determine the benefits of the correction. [ABSTRACT FROM AUTHOR]

Abstract Oblique lumbar interbody fusion (OLIF) is a minimally invasive lateral lumbar fusion technique and patients are discharged 1–2 days after surgery. Because OLIF utilizes a retroperitoneal approach close to the superior hypogastric plexus, postoperative urinary retention (POUR) may not be an uncommon problem. The purpose of this study was to present the incidence and outcomes of POUR with a systematic care protocol. The records of 102 consecutive patients (M:F = 34:68; mean age, 68.0 ± 8.4 years) were retrospectively reviewed. After OLIF, the indwelling urinary catheter was immediately removed, and every patient was encouraged to void within 6 h. The POUR care protocol, following a clinical pathway, was based on residual urine (RU), which was monitored with an ultrasound bladder scan after each voiding or every 6 h for 48 h. The incidence rate of POUR was 44% (45/102) at 24 h, 17% (17/102) at 48 h, and 2% (2/102) at 1 month. Preoperative urological symptoms (odds ratio [OR] 3.2) and violation of the protocol (OR 28.3) were risk factors at 24 h. At 48 h, violation of the protocol was the only risk factor (OR 9.6). Identifying risk factors and a preemptive care protocol may reduce permanent POUR.

Abstract Purpose The conversion of knee arthrodesis to total knee arthroplasty (TKA) is a challenging procedure. This article aims to report a case of fusion knee with patellar absence who was converted to TKA and has achieved good results. Methods The patient, a 23 years old Tibetan Buddhist monk, sustained a left knee joint injury at the age of 12 due to a car accident, leading to subsequent knee arthrodesis at 18 years old as a result of recurrent severe infections. However, this procedure hindered his ability to perform daily meditation practices that required bending both knees and sitting cross-legged. After adequate preoperative preparation, with the help of customized osteotomy guide plate and customized 3D-printed porous tantalum patella, the 3D preoperative plan assisted TKA after arthrodesis was performed. The knee function was followed up to explore the clinical effect of above-mentioned surgical procedure. Results A 1-year follow-up showed significant improvement in postoperative knee function with improved scores for function outcomes, and the patient was satisfied with the conversion. The patient’s left knee improved significantly from preoperative immobility with 5° of fixed fusion to postoperative ROM of 0° to 100°, and the patient could squat and stand up, walk on the flat ground, and go up and down stairs. Conclusion Adequate preoperative communication with patients and good expectation management are crucial for ensuring favorable prognoses. Perfect preoperative planning and its reliable implementation during operation are essential. Additionally, postoperative rehabilitation and proactive management of complications play pivotal roles in achieving optimal clinical outcomes. Level of evidence IV.

Objectives The occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study was to investigate the outcomes of one‐stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis with external fixation in the treatment of septic ankle and hindfoot arthritis. Methods A retrospective consecutive case‐series study was conducted involving six patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one‐stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle‐hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow‐up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded. Comparisons of AOFAS ankle‐hindfoot score and VAS pain score between preoperative measures and those at the final follow‐up were conducted using paired t‐tests or paired Wilcoxon rank‐sum tests. Results The study cohort comprised two males and four females, with a mean age of 48.7 years (range, 26–75) at the time of surgical intervention. At the final follow‐up (mean, 26.5 months; range, 16–48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12–57) to 80.0 (range, 54–92) (p = 0.007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4–9) to 0 (range, 0–5) (p = 0.046). All patients had achieved osseous consolidation, with a hindfoot infection control rate of 100%. Conclusion One‐stage arthroscopic ankle and TTC arthrodesis with external fixation is as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb.

Abstract Purpose We aimed to report the union rate after only utilizing a locally obtained autologous bone graft while correcting the deformity and performing joint arthrodesis in patients with foot and ankle Charcot neuropathy (CN) and to report on the radiographic, functional, complications incidence outcomes at a minimum of two years of follow up. Methods We included 24 patients having a mean age of 55.4 ± 10.1 years diagnosed with CN of the foot, ankle, or both. Seven (29.2%) cases were classified as Brodsky type 1, 11 (45.8%) as type 3 A, and six (25%) were type 4. Hindfoot and Midfoot bi-columnar arthrodesis was performed in 70.8% and 29.2% of the patients, respectively. Eight (33.3%) cases had preoperative ulcers. Functional outcomes were evaluated using a modified AOFAS score. Arthrodesis site union was assessed clinically and radiographically. All patients were available for a mean follow up of 35.7 ± 9.5 (24–54) months. Results Arthrodesis site union was achieved in 23 (95.8%) cases after a mean of 4 ± 1.7 (2-7.5) months. The mean modified AOFAS score was 72.4 ± 10.41 (46–83) points; 79.2% achieved excellent and good scores. Ulcers healed in 87.5% of the patients. Twenty-two (91.7%) patients were satisfied with their functional results. Infection incidence was 12.5%, and no patients required revision or amputation. Conclusion Foot and ankle Charcot neuroarthropathy deformity correction by arthrodesis of the affected joint as a salvage management option resulted in acceptable clinical and radiological outcomes. To enhance the local environment for arthrodesis consolidation, locally obtained autografts led to higher union rates and avoided the drawbacks of using other graft types.

Abstract Purpose This study aimed to analyse the clinical outcomes of preoperative adjuvant denosumab therapy (PADT) combined with resection and arthrodesis for recurrent grade 3 giant cell tumor of bone (GCTB) in the distal radius. Methods A retrospective study was conducted on twenty-three patients (8 males, 15 females) who were treated with the adjuvant denosumab combined with en bloc resection (EBR) and arthrodesis for biopsy confirmed recurrent Campanacci III giant cell tumor of bone in the distal radius between January 2015 and December 2022. All 23 patients were treated with wrist arthrodesis reconstruction using autogenous free iliac crest bone graft (ICBG), bridging plate and screws. The local control, metastasis and overall survival were evaluated during the follow-up period. Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score, Musculoskeletal Tumor Society Score (MSTS-87 and MSTS-93), and grip strength in the follow-up period. Additionally, all surgical or denosumab-related complications that occurred were recorded in this study. Results Twenty-three patients were included in this retrospective study and no patients were lost in the follow-up period. The average patient age was 32.5 ± 10.2 years (range, 19–53 years) and the mean follow-up time was 35.5 ± 18.4 months (range, 13–72 months). The average tumor length was 71.7 ± 8.7 mm (range, 50 to 85 mm) and bone reconstruction length was 78.5 ± 8.5 mm (range, 60 to 90 mm). Four patients (17.4%) had secondary local recurrence after reoperation and two patients had (8.7%) multiple recurrences. One patient (4.3%) was deceased in the last follow-up due to multiple metastases. The estimated 5-year recurrence-free survival rate was 81.3% and 5-year metastasis-free survival rate was 95.7%. The mean union time was 8.5 ± 1.9 (6–12) months and the overall survivorship of the allograft was 82.7% (21/23) at an average 35 month follow-up. The average MSTS-87 and MSTS-93 scores were 27.8 ± 1.6 (range, from 23 to 30) and 91.5 ± 5.0 (range, from 76 to 100), and the average DASH score was 8.9 ± 3.2 (range, from 3 to 15), respectively. The average grip strength was 64.6 ± 15.7% (range, from 30 to 95%) of the uninvolved side. Eight patients (34.7%) had at least one complication in the follow-up time. Two autografts (8.7%) were removed due to local recurrence and bone nonunion, and the average autograft survival time was 32.8 ± 18.5 months (range, 12 to 72 months). Conclusions Preoperative adjuvant denosumab therapy (PADT) combined with en bloc resection and arthrodesis is a promising method for the treatment of recurrent Campanacci III GCTB in distal radius with acceptable short-term local control and functional satisfaction. Level of evidence: level IV Therapeutic.

Abstract Purpose The treatments for hallux rigidus (HR) encompass a wide spectrum, including conservative methods and surgical approaches such as arthroplasty and arthrodesis. This study aims to evaluate the outcomes of revision with arthrodesis following the failure of the first metatarsophalangeal joint total arthroplasty (MTPJ1TA). Materials and methods Patients who had surgery at two advanced orthopedic centers between January 1, 2020, and January 1, 2024, were reviewed. Those with at least 6 months of postoperative follow-up were assessed for demographics (gender, age, side), reoperation rates, complications, Visual Analogue Scale (VAS) scores, Foot and Ankle Disability Index (FADI) scores, and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal and Interphalangeal Scale (AOFAS-HMI) scores. Radiological evaluations included hallux valgus angle (HVA), intermetatarsal angle (IMA), dorsiflexion angle (DFA), and first ray length (FRL) in anteroposterior and lateral views. Results Of 27 patients, 4 were male (15%) and 23 female (85%), with an average age of 56.18 ± 7.49 years (range 41–72). Arthrodesis was performed in 26 patients, with one requiring reoperation due to implant failure. Average VAS scores were 7.14 preoperatively and 3.55 postoperatively (p

Abstract Background All orthopaedic procedures, comprising foot and ankle surgeries, seemed to show a positive trend, recently. Bone grafts are commonly employed to fix bone abnormalities resulting from trauma, disease, or other medical conditions. This study specifically focuses on reviewing the safety and efficacy of various bone substitutes used exclusively in foot and ankle surgeries, comparing them to autologous bone grafts. Methods The systematic search involved scanning electronic databases including PubMed, Scopus, Cochrane online library, and Web of Science, employing terms like 'Bone substitute,' 'synthetic bone graft,' 'Autograft,' and 'Ankle joint.' Inclusion criteria encompassed RCTs, case-control studies, and prospective/retrospective cohorts exploring different bone substitutes in foot and ankle surgeries. Meta-analysis was performed using R software, integrating odds ratios and 95% confidence intervals (CI). Cochrane's Q test assessed heterogeneity. Results This systematic review analyzed 8 articles involving a total of 894 patients. Out of these, 497 patients received synthetic bone grafts, while 397 patients received autologous bone grafts. Arthrodesis surgery was performed in five studies, and three studies used open reduction techniques. Among the synthetic bone grafts, three studies utilized a combination of recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) and beta-tricalcium phosphate (β-TCP) collagen, while four studies used hydroxyapatite compounds. One study did not provide details in this regard. The meta-analysis revealed similar findings in the occurrence of complications, as well as in both radiological and clinical evaluations, when contrasting autografts with synthetic bone grafts. Conclusion Synthetic bone grafts show promise in achieving comparable outcomes in radiological, clinical, and quality-of-life aspects with fewer complications. However, additional research is necessary to identify the best scenarios for their use and to thoroughly confirm their effectiveness. Levels of evidence Level II.

Purpose: This study aimed to analyse the clinical outcomes of preoperative adjuvant denosumab therapy (PADT) combined with resection and arthrodesis for recurrent grade 3 giant cell tumor of bone (GCTB) in the distal radius. Methods: A retrospective study was conducted on twenty-three patients (8 males, 15 females) who were treated with the adjuvant denosumab combined with en bloc resection (EBR) and arthrodesis for biopsy confirmed recurrent Campanacci III giant cell tumor of bone in the distal radius between January 2015 and December 2022. All 23 patients were treated with wrist arthrodesis reconstruction using autogenous free iliac crest bone graft (ICBG), bridging plate and screws. The local control, metastasis and overall survival were evaluated during the follow-up period. Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score, Musculoskeletal Tumor Society Score (MSTS-87 and MSTS-93), and grip strength in the follow-up period. Additionally, all surgical or denosumab-related complications that occurred were recorded in this study. Results: Twenty-three patients were included in this retrospective study and no patients were lost in the follow-up period. The average patient age was 32.5 ± 10.2 years (range, 19–53 years) and the mean follow-up time was 35.5 ± 18.4 months (range, 13–72 months). The average tumor length was 71.7 ± 8.7 mm (range, 50 to 85 mm) and bone reconstruction length was 78.5 ± 8.5 mm (range, 60 to 90 mm). Four patients (17.4%) had secondary local recurrence after reoperation and two patients had (8.7%) multiple recurrences. One patient (4.3%) was deceased in the last follow-up due to multiple metastases. The estimated 5-year recurrence-free survival rate was 81.3% and 5-year metastasis-free survival rate was 95.7%. The mean union time was 8.5 ± 1.9 (6–12) months and the overall survivorship of the allograft was 82.7% (21/23) at an average 35 month follow-up. The average MSTS-87 and MSTS-93 scores were 27.8 ± 1.6 (range, from 23 to 30) and 91.5 ± 5.0 (range, from 76 to 100), and the average DASH score was 8.9 ± 3.2 (range, from 3 to 15), respectively. The average grip strength was 64.6 ± 15.7% (range, from 30 to 95%) of the uninvolved side. Eight patients (34.7%) had at least one complication in the follow-up time. Two autografts (8.7%) were removed due to local recurrence and bone nonunion, and the average autograft survival time was 32.8 ± 18.5 months (range, 12 to 72 months). Conclusions: Preoperative adjuvant denosumab therapy (PADT) combined with en bloc resection and arthrodesis is a promising method for the treatment of recurrent Campanacci III GCTB in distal radius with acceptable short-term local control and functional satisfaction. Level of evidence: level IV Therapeutic. [ABSTRACT FROM AUTHOR]

Summary A 1‐month‐old Paint filly was diagnosed with a latero‐distal luxation of the fourth carpal bone associated with avulsion fractures of the third and fourth carpal bones and rupture of intercarpal ligaments based on clinical, radiography and computed tomography examination. A carpometacarpal (CMC) joint arthrodesis was performed using a lateral 3.5 mm 5‐hole Locking Compression Plate (LCP) T‐plate and a medial 3.5 mm 5‐hole narrow LCP plate associated with mediocarpal arthroscopic exploration. An external coaptation was maintained for 6 weeks. No complication was reported and the filly was full loading the day after surgery. Radiographical follow‐up was available 6 and 14 weeks after surgery showing an intact construct and stable fixation with a complete fusion of the lateral part of the carpometacarpal joint at 14 weeks postoperatively. The filly was sound on pasture without angular deformity 4 months after surgery. Luxation of the fourth carpal bone was successfully stabilised using two LCP plates, leading to complete soundness and preservation of middle carpal joint motion. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to report the union rate after only utilizing a locally obtained autologous bone graft while correcting the deformity and performing joint arthrodesis in patients with foot and ankle Charcot neuropathy (CN) and to report on the radiographic, functional, complications incidence outcomes at a minimum of two years of follow up. Methods: We included 24 patients having a mean age of 55.4 ± 10.1 years diagnosed with CN of the foot, ankle, or both. Seven (29.2%) cases were classified as Brodsky type 1, 11 (45.8%) as type 3 A, and six (25%) were type 4. Hindfoot and Midfoot bi-columnar arthrodesis was performed in 70.8% and 29.2% of the patients, respectively. Eight (33.3%) cases had preoperative ulcers. Functional outcomes were evaluated using a modified AOFAS score. Arthrodesis site union was assessed clinically and radiographically. All patients were available for a mean follow up of 35.7 ± 9.5 (24–54) months. Results: Arthrodesis site union was achieved in 23 (95.8%) cases after a mean of 4 ± 1.7 (2-7.5) months. The mean modified AOFAS score was 72.4 ± 10.41 (46–83) points; 79.2% achieved excellent and good scores. Ulcers healed in 87.5% of the patients. Twenty-two (91.7%) patients were satisfied with their functional results. Infection incidence was 12.5%, and no patients required revision or amputation. Conclusion: Foot and ankle Charcot neuroarthropathy deformity correction by arthrodesis of the affected joint as a salvage management option resulted in acceptable clinical and radiological outcomes. To enhance the local environment for arthrodesis consolidation, locally obtained autografts led to higher union rates and avoided the drawbacks of using other graft types. [ABSTRACT FROM AUTHOR]

Background: Pancarpal arthrodesis (PCA) is a commonly performed procedure in the UK. However, it is not known whether working dogs in the UK and other European countries with carpal injuries that have undergone unilateral PCA are able to return to working ability as determined by the owner. Medical records from a referral hospital in the UK were reviewed retrospectively for cases of working dogs treated using unilateral PCA. Case files and radiographs were retrospectively analysed for cause of injury, diagnosis, and complications. The ability of the dog to work after surgery and owner satisfaction with the outcome were assessed using telephone questionnaire. Results: 50% (5/10, 50%) owners stated their dog could perform normal duties, 4/10 (40%) could perform most duties with some allowances. Outcome was not as good for dogs working on steep, uneven fell terrain. 80% (8/10, 80%) owners rated the level of post-operative lameness as unaffected with a normal gait. 90% (9/10, 90%) owners were either very satisfied or satisfied with the outcome of the procedure, and 90% owners stated the financial investment was worthwhile. Conclusions: Unilateral PCA carries a good prognosis for working dogs with high owner satisfaction. Caution should be advised for dogs expected to work on steep, uneven fell terrain. [ABSTRACT FROM AUTHOR]

Background: End-stage post-traumatic osteoarthritis of the ankle joint may require arthrodesis if conservative treatment fails and a decision against total ankle replacement is made. We aimed to compare the sex-specific differences in outcomes and objectify them using validated specific scores. Methods: Between 2010 and 2021, 221 patients underwent ankle arthrodesis at our institution, including 143 men (MAA) and 78 women (FAA). In addition to demographic data, the aetiology of osteoarthritis, the Foot Function Index (FFI-D), the Olerud-Molander Score (OMAS), and the Short Form-12 questionnaire (SF-12) were collected in this monocentric study. The mean follow-up time was 5.8 years. End-stage osteoarthritis was mostly due to ankle fractures as a result of sprains, falls, and road traffic accidents. Results: Post-operatively, the mean FFI-D for pain was 17.3 (MAA: 14.7; FAA 22.2) and 43.9 for function (MAA: 41.1; FAA 49.5); the mean OMAS was 58.2; and the mean SF-12 physical component score was 42.5. Women achieved significantly worse results in all scores; only the mental component summary of the SF-12 did not differ between the sexes (p > 0.05). Approximately 34% of women stated that the result in terms of gait pattern was worse than expected (MAA 16.1%; p < 0.05). Again, significantly more men stated that the result was better than expected (MAA: 48.3%; FAA: 31.5%, p < 0.05). Conclusions: The fact that the clinical results were significantly worse in women after ankle arthrodesis should be considered when determining the indication. However, the expectations of men and women also need to be individually adjusted. [ABSTRACT FROM AUTHOR]

Dynamic tracking of spinal instrumentation could facilitate real-time evaluation of hardware integrity and in so doing alert patients/clinicians of potential failure(s). Critically, no method yet exists to continually monitor the integrity of spinal hardware and by proxy the process of spinal arthrodesis; as such hardware failures are often not appreciated until clinical symptoms manifest. Accordingly, herein, we report on the development and engineering of a bio-adhesive metal detector array (BioMDA), a potential wearable solution for real-time, non-invasive positional analyses of osseous implants within the spine. The electromagnetic coupling mechanism and intimate interfacial adhesion enable the precise sensing of the metallic implants position without the use of radiation. The customized decoupling models developed facilitate the precise determination of the horizontal and vertical positions of the implants with incredible levels of accuracy (e.g., <0.5 mm). These data support the potential use of BioMDA in real-time/dynamic postoperative monitoring of spinal implants. No method exists for real-time evaluation of the status of spinal implants. Here, the authors developed a bio-adhesive metal detector array (BioMDA) that provides a wearable, non-invasive solution for positional analyses of osseous implants within the spine. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the outcome of the Cartiva synthetic cartilage implant (SCI) in the treatment of hallux rigidus. Methods: In the present retrospective matched case-control study, we compared 18 patients with Cartiva SCI (mean follow-up: 17.7 months) to 18 patients with metatarsophalangeal joint arthrodesis (mean follow-up: 20 months) using multiple function measures, along with four specified visual analog subscales for pain. Pre- and postoperative radiographs were compared, and radiographic abnormalities were documented. Results: We observed no significant differences in function measures between groups. While both groups experienced significant pain reduction, the arthrodesis group reported significantly lower exertion pain than the Cartiva SCI group (p = 0.004). Radiographic abnormalities, including implant site enlargement (6/18, 33.3%), erosive changes of the metatarsal bone (11/18, 61.1%) or articular surfaces (10/18, 55.6%), and bright sclerotic margins (12/18, 66.7%), occurred in the Cartiva SCI group. Conclusion: The present study showed good functional results and a high satisfaction rate after MTP joint arthrodesis, which is considered the gold standard surgical treatment for higher grade hallux rigidus. While the Cartiva SCI group did not show significant differences from the arthrodesis in most aspects of function and clinical scores, the arthrodesis group tended to have better results in terms of satisfaction, residual pain, and revision rate. Even after the short follow-up period, there were some remarkable radiographic findings in the Cartiva SCI group, the long-term effects of which are not yet evident, but which may lead to implant loss. Cartiva SCI has advantages for patients who prioritize postoperative mobility, but the potential risks should be considered in the patient's informed consent. Therefore, the present study highlights the importance of MTP joint arthrodesis for the treatment of hallux rigidus. Level of evidence: Level IV – Retrospective matched case-control study. [ABSTRACT FROM AUTHOR]

Objectives: The occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study was to investigate the outcomes of one‐stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis with external fixation in the treatment of septic ankle and hindfoot arthritis. Methods: A retrospective consecutive case‐series study was conducted involving six patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one‐stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle‐hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow‐up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded. Comparisons of AOFAS ankle‐hindfoot score and VAS pain score between preoperative measures and those at the final follow‐up were conducted using paired t‐tests or paired Wilcoxon rank‐sum tests. Results: The study cohort comprised two males and four females, with a mean age of 48.7 years (range, 26–75) at the time of surgical intervention. At the final follow‐up (mean, 26.5 months; range, 16–48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12–57) to 80.0 (range, 54–92) (p = 0.007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4–9) to 0 (range, 0–5) (p = 0.046). All patients had achieved osseous consolidation, with a hindfoot infection control rate of 100%. Conclusion: One‐stage arthroscopic ankle and TTC arthrodesis with external fixation is as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb. [ABSTRACT FROM AUTHOR]

Neuropathic arthropathy (Charcot arthropathy) is a progressive joint disease often associated with conditions such as diabetes, leading to severe joint deformity and pain. However, its occurrence in patients with rheumatoid arthritis (RA) is rare and not well documented. This case report describes a 48-year-old woman with a long history of RA who developed a severe deformity of her right ankle, identified as neuropathic arthropathy extending to the subtalar joint (Brodsky classification type 3A). After excluding other potential causes, the condition was determined to be secondary to RA-associated peripheral neuropathy. Surgery, including allograft and autograft fixation, was performed to correct the deformity. Post-operative complications, such as wound infection, were treated with negative pressure wound therapy and skin grafting. At the 18-month follow-up, the patient was able to walk without pain, demonstrating successful joint fusion. [ABSTRACT FROM AUTHOR]

Müller-Weiss is a disease characterized by deformation, fragmentation and necrosis of the navicular, which presents with midfoot varus and longstanding pain, mostly in females. It is related to delayed ossification due to physical or nutritional stress, associated with abnormal force distribution. There are still few studies on this condition and there is no consensus in the literature on its classification and treatment. At first, conservative treatment does not show positive results, only acute symptomatic improvement. Isolated talonavicular arthrodesis is the method most commonly adopted by specialists, showing good results and scores in the early stages, while triple and double arthrodesis is the choice in advanced stages. Knowledge of the radiology and findings is important for planning and individualizing the choice of treatment in each case. At the moment, there are several different techniques for approaching Müller-Weiss disease, however, studies evaluating long-term approaches as well as their complications need to be carried out. We present a systematic review on this disease. [ABSTRACT FROM AUTHOR]

Background: The management of failed total ankle replacements, with significant loss of bone stock, is challenging with high rates of complications and associated morbidity. Recent technological advances have enabled the development of patient-customized 3D-printed titanium truss arthrodesis implants, which offer an alternative salvage option for failed total ankle replacements. Methods: A prospective observational study was performed of 6 cases of failed total ankle replacements that were managed using custom patient-specific 3D-printed titanium truss arthrodesis implants. Technical tips, classification, and a treatment algorithm were developed based on our initial experience. Results: Between November 2018 and March 2022, 6 patients underwent arthrodesis for failed total ankle replacements. Follow-up was available for all cases. The mean follow-up was 3.0 years (range 1-4.5). The mean MOXFQ Index improved from 73.1 to 32.3 (P <.05). The mean EQ-5D-5L Index improved from 0.366 to 0.743 (P <.05) and the EQ-VAS also improved from 53.0 to 63.3 (P =.36). The mean VAS-Pain score at final follow-up was 27.5. There were no cases of nonunion. None of the patients were smokers. The overall complication rate was 50%. Two patients returned to surgery: one for wound washout following TAR explantation and a second for removal of metalwork 2 years following surgery for a prosthetic joint infection secondary to hematogenous spread. No patients underwent revision fixation or amputation. Conclusion: Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable treatment option for failed total ankle replacements. [ABSTRACT FROM AUTHOR]

There have been many reports describing the proposed alignment of a first metatarsal phalangeal arthrodesis to obtain optimum function. Most of these recommendations are based upon historical and anecdotal evidence. Furthermore, there are few reports directly comparing alignment to patient reported function. We studied radiographic sagittal plane alignment in a group of 60 patients (80 feet) who had undergone a first metatarsal phalangeal joint arthrodesis (20 of the 60 had bilateral arthrodesis) to better understand how this component of the arthrodesis position translates to real world function. The patients in this study had completed a functional survey in 2022 at a mean of 28.4 (median 27.8; range 13.2-45.7) months with very high satisfaction for return to activities of daily living and recreational sports. We measured the sagittal plane position of the first metatarsal relative to the proximal phalanx in this cohort with known post operative activity data. We found that a mean (standard of deviation) sagittal plane angle (angle between the anatomic axis of the first metatarsal and the proximal phalanx) of 15.4 (SD 7.4) degrees and a proximal phalanx head to ground height of 12.7 (SD 3.3) mm was present in this group. Comparing the functional and positional results we conclude that this sagittal plane position provides a good recommendation for alignment. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Osteoarthritis (OA) of the joints of the hand is one of the most common musculoskeletal disorders in the elderly population. It is a complex, degenerative disease affecting all components of the joint. Surgical treatment is indicated when conservative therapy fails. The ultimate solution is arthrodesis of the distal interphalangeal (DIP) joint. Various methods of arthrodesis have been described, ranging from the use of K-wires or compression screw to different types of intra-articular (intramedullary) implants. The aim of this study is to evaluate the surgical outcomes of arthrodesis of the distal interphalangeal (DIP) joint of the fingers using intramedullary implants. MATERIAL AND METHODS Since 2011, arthrodesis of the distal interphalangeal joint using an intramedullary implant has been performed at our department 97 times in total, in 59 patients. 9 patients (15 cases of arthrodesis) were excluded from the study group due to their failure to complete the questionnaire, 1 female patient died. In the fi nal group, 82 cases of arthrodesis in 49 patients (47 women, 2 men) were evaluated. In 72% of cases, the surgery was performed on the dominant hand. The mean age at the time of surgery was 58 years (median 59 years). The patients were indicated for surgery after the failure of all conservative treatment options. In addition to radiographs, also the hand function and pain were assessed based on the preand postoperative DASH score questionnaires. RESULTS The surgical outcomes for all implants are satisfactory. In all 82 patients, the surgical wounds healed per primam. In one case, implant extraction was performed due to infection. Another complication was an unhealed fusion and formation of a non-union with minimum pathological mobility (the patient is satisfi ed with the outcome). In three patients, a fracture at the base of the distal phalanx was observed on postoperative radiographs, which fully healed within 3 months after surgery. The mean DASH score decreased from 41.95 preoperatively to 14.93 postoperatively. The mean time to healing of the arthrodesis observed on radiographs was 9.1 weeks. DISCUSSION Currently, there are many different types of arthrodesis of the distal interphalangeal joint of the hand. Each method has its pros and cons. Arthrodesis using an intramedullary implant has the advantages of the older methods while minimizing postoperative complications. Our results are comparable to those reported in the foreign literature. CONCLUSIONS Based on the evaluated outcomes, arthrodesis of the distal interphalangeal joint using an intramedullary implant can be considered valid. It defi nitely deserves to be included in the portfolio of surgical treatment of osteoarthritis of the DIP joints of the hand. According to our observation, the differences between various types of implants are minimal and their outcomes are comparable to those reported in foreign publications. The pain relief, restored fi nger function and fusion rate are comparable to, if not better than, those achieved by the older surgical methods. The advantage of this method is mainly easier implantation, fewer complications, and the possibility of implantation without the use of an X-ray image intensifi er, which ultimately reduces the cost of surgery. The main disadvantage is the higher purchase price of the implant. [ABSTRACT FROM AUTHOR]

Copyright of Obere Extremitat is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study presents a detailed case analysis of a 40-year-old male patient with hemophilia A and severe chronic elbow arthropathy, exploring the surgical challenges and outcomes within the context of the current literature. The patient, with a history of multiple comorbidities including Hodgkin's lymphoma and cardiomyopathy, exhibited significant joint damage and functional impairment. A comprehensive approach was employed, collecting all relevant clinical data, including radiographic and MRI findings, to inform treatment decisions. Clinical findings and treatment decisions are presented as they occurred in real time, simulating the clinical reasoning process. Subsequent references to the clinical and instrumental findings as well therapeutic interventions are discussed in light of the current literature to reinforce the decision-making framework. This report underscores the importance of multidisciplinary care in optimizing patient outcomes and contributes to the ongoing discourse on the management of advanced musculoskeletal conditions in hemophilic patients. The findings emphasize the necessity for early intervention and specialized care to mitigate complications and improve long-term prognosis. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Sacroiliac joint (SIJ) dysfunction can occur as a result of injury, degeneration, or inflammation. This dysfunction presents symptoms of pain at various locations, including the low back, hips, buttocks, and legs. The diagnosis of SIJ dysfunction is challenging and cannot be achieved solely with imaging studies such as X‐rays, MRI, or CT. The current gold standard diagnostic modality is intra‐articular SIJ blocks using two differing local anesthetics. Current treatments for SIJ dysfunction may be beneficial for short‐term relief but lack long‐term efficacy. The purpose of our study was to examine the outcomes of patients who underwent minimally invasive, posterior SIJ fusion using allograft at a single center.This was a retrospective study which received exemption from the WCG IRB. Data regarding preoperative and postoperative pain levels, surgical time, complications, and medication usage were obtained retrospectively from patient electronic medical records and prescription drug monitoring program reports. No mapping was completed prior to the procedure. Pain was assessed with the 11‐point (0–10) Visual Analogue Scale (VAS) and medication usage was assessed using Morphine Milligram Equivalents (MME). Patients were included if they had been diagnosed with SIJ dysfunction using two intra‐articular diagnostic blocks that resulted in at least an 80% decrease in pain and had failed conservative management. Patients with sacral insufficiency fractures were excluded.VAS scores reduced from 8.26 (SD = 1.09) at baseline to 2.59 (SD = 2.57), 2.55 (SD = 2.56), 2.71 (SD = 2.88), and 2.71 (SD = 2.88) at 3, 6, 9, and 12 months, respectively. MME reduced from 78.21 mg (SD = 51.33) to 58.95 mg (SD = 48.64), 57.61 mg (SD = 47.92), 61.71 mg (SD = 45.64), and 66.29 mg (SD = 51.65) at 3, 6, 9, and 12 months, respectively. All reductions in VAS scores and MME were statistically significant. No adverse events occurred, and the average operating room time was 40.16 min (SD = 6.27).Minimally invasive, posterior SIJ fusion using allograft is a safe and efficacious method for managing SIJ dysfunction. [ABSTRACT FROM AUTHOR]

Background: Scaphoid nonunion advanced collapse (SNAC) injuries are frequently associated with irreversible degenerative wrist arthritic changes that necessitate surgical intervention. Midcarpal fusion remains the mainstay of the management of SNAC II and III injuries. A successful four-corner fusion (4CF) relies on a stable lunate-capitate fusion (LCF). There have been reports of management relying solely on LCF. The outcomes of LC- and 4 C-fusions in SNAC injuries were not widely documented. The objective of this research is to provide valuable insights into the effectiveness of both fusion procedures in the management of SNAC II and III wrist injuries, with a focus on reporting associated complications, functional and radiological outcomes. Patients and methods: This retrospective study encompassed 65 patients diagnosed with SNAC II and III wrist injuries who underwent limited wrist fusion procedures between 2015 and 2024, with a minimum of 2 years of postoperative follow-up. Exclusion criteria encompassed patients with carpal instability, prior wrist surgical interventions, and scapholunate advanced collapse. Following the fusion procedure performed, patients were stratified into two groups: the LCF group consisting of 31 patients, and the 4CF group comprising 34 patients. Preoperative and intraoperative data were retrieved from the patient's medical records. At their final follow-up appointments, patients underwent comprehensive radiographic and clinical evaluations. Clinical outcomes including hand grip strength, range of motion, the Disabilities of the Arm, Shoulder, and Hand Score, and the Mayo Modified Wrist Score, were compared between groups. Any associated complications were reported. Results: The average healing time was 74.7 ± 15.6 and 72.2 ± 13.2 days for the LCF and 4CF groups, respectively. At the final visit, all patients showed functional improvement relative to their preoperative status, with comparable wrist range of motions observed in both groups. The functional wrist scores were slightly better in the LCF patients (P > 0.05). The average grip strength was significantly greater in the LCF group (P = 0.04), with mean strength values of 86.8% and 82.1% of the contralateral side, for the LCF and 4CF groups, respectively. Conclusion: The LCF is not less efficient than the 4CF in the treatment of SNAC II and III wrist injuries. Through a less time-consuming procedure, LCF can efficiently provide comparable results to 4CF. Level of evidence: level IV evidence. [ABSTRACT FROM AUTHOR]

Introduction: Shoulder arthrodesis is typically seen as a salvage procedure with limited functional objectives. In appropriately selected patients, it may effectively alleviate pain, provide stable motion, and offer patient function satisfaction. However, there have been few reports on the outcomes following shoulder arthrodesis. Methods: A multicenter, retrospective chart review of patients undergoing shoulder arthrodesis between 2001 and 2023 in Western Australia was conducted. Clinical records and imaging were then reviewed to determine patient demographics. A cross-sectional analysis of Visual Analogue (VAS), Oxford Shoulder (OSS), and American Shoulder and Elbow Surgeons Shoulder (ASES) Scores, satisfaction and complication rates was conducted. Results: In total, 14 patients with a mean age of 39.5 years (range 22–52 years, 71% male) with a mean follow-up of 7.4 years (range 3 months–18 years) were identified. The most common indications for arthrodesis included osteoarthritis (8, 57%) and instability (6, 43%). Major contributory factors were recurrent seizures (5, 36%) and multiple surgeries (4, 29%). Radiographic union was observed in 13 (93%) patients. The mean VAS was 2.8 (range 0–7), mean OSS was 33.0 (range 23–42) and ASES score was 55.4 (range 37–82). In total, 11 patients (79%) reported being satisfied. Five (36%) patients returned to theatre for complications. Conclusions: In this patient series, shoulder arthrodesis demonstrates a notable efficacy in pain reduction, high satisfaction, acceptable function, and complication rates. [ABSTRACT FROM AUTHOR]

Study Design. A retrospective single-center study between January 2019 and January 2023. Objective. The role and contribution of drainage in the anterior approach to the cervical spine (cervicotomy) is much debated, motivated primarily by the prevention of retropharyngeal hematoma, so are there still any benefits to drainage? Background. The anterior approach to the cervical spine is a widespread and common procedure performed in almost all spine surgery departments for the replacement of cervical intervertebral discs and medullar or radicular decompression. The primary endpoint was the occurrence of symptomatic postoperative cervical hematoma. Patients and Methods. Four hundred thirty-one patients who had undergone cervical spine surgery by anterior cervicotomy for cervicarthrosis or cervical disc herniation (anterior cervical discectomy and fusion and anterior cervical disc replacement) were consecutively included. Patients were separated into 2 groups: (1) Group A, 140 patients (with postoperative drainage) and (2) Group B, 291 patients (without drainage). Results. The mean follow-up was 2.8 months. The 2 groups were comparable on all criteria, but there was a predominance of arthroplasty (P < 0.0001), use of anticoagulants/antiaggregants (P < 0.0001) and a greater number of stages (P < 0.0001) in group A. Therewere a total of 4/431 symptomatic postoperative hematomas (0.92%) in this study. Two hematomas occurred in group A (2/140, 1.4%) and 2 in group B (2/291, 0.68%; P < 0.0001). One patient in group A (0.71%) required surgical drainage for cavity hematoma revealed by marked dyspnea, swallowing, and neurological disorders. One case of hematoma diagnosed by dysphonia and neurological deficit was reported in group B (0.34%; P < 0.0001). Conclusions. The placement of a drain during anterior cervicotomy (anterior cervical discectomy and fusion/anterior cervical disc replacement) did not limit the occurrence of symptomatic postoperative hematoma. [ABSTRACT FROM AUTHOR]

Introduction: Arthrodesis of a (diseased) ankle joint is usually performed to achieve pain relief and stability. One basic principle of arthrodesis techniques includes rigid fixation of the surfaces until union. It seems plausible that stable anchoring and homogeneous pressure distribution should be advantageous, however, it has not been investigated yet. The aim is to achieve uniform compression, as this is expected to produce favorable results for the bony fusion of the intended arthrodesis. Numerous implants with different biomechanical concepts can be used for ankle fusion. In this study, headless compression screws (HCS, DePuy Synthes, Zuchwil, Switzerland) were compared biomechanically to an alternative fixation System, the IOFix device (Extremity Medical, Parsippany, NJ, USA) in regard to the distribution of the compression force (area of contact) and peak compression in a sawbone arthrodesis-model (Sawbones® Pacific Research Laboratories, Vashon, WA, USA). This study aims to quantify the area of contact between the bone interface that can be obtained using headless compression screws compared to the IOFix. In current literature, it is assumed, that a large contact surface with sufficient pressure between the bones brings good clinical results. However, there are no clinical or biomechanical studies, that describe the optimal compression pressure for an arthrodesis. Material and methods: Two standardized sawbone blocks were placed above each other in a custom-made jig. IOFix and headless compression screws were inserted pairwise parallel to each other using a template for a uniform drilling pattern. All screws were inserted with a predefined torque of 0.5 Nm. Pressure transducers positioned between the two sawbone blocks were compressed for the measurement of peak compression force, compression distribution, and area of contact. Results: With the IOFix, the compression force was distributed over significantly larger areas compared to the contact area of the HCS screws, resulting in a more homogenous contact area over the entire arthrodesis surface. Maximum compression force showed no significant difference. Conclusion: The IOFix system distributes the compression pressure over a much larger area, resulting in more evenly spread compression at the surface. Clinical studies must show whether this leads to a lower pseudarthrosis rate. [ABSTRACT FROM AUTHOR]