Introduction Limb deformities of the lower extremity are frequently managed with gradual correction using external fixators. Some authors have described utilizing computer-assisted hexapod external fixators for precise intraoperative Deformity Correction (DC). However, external fixator correction is both costly and time-intensive, and intramedullary nail-guided correction (IMNG) may be an acceptable alternative. The purpose of this study was to assess the efficacy of IMNG as a non-inferior cost-effective alternative approach to lower extremity long bone DC. Methods All patients who underwent femoral or tibial IMNG at a single institution from 2006 to 2022 were retrospectively reviewed. Pre- and postoperative deformity measurements, including Mechanical Axis Deviation (MAD), Lateral Distal Femoral Angle (LDFA), Medial Proximal Tibial Angle (MPTA), and Lateral Distal Tibial Angle (LDTA), were recorded using standing hip-to-ankle radiographs. Radiographic and clinical outcomes were recorded. Results Twenty-four IMNG Deformity Correction (DC) procedures performed on 18 patients were included [10 (56%) female, mean age 30 (15-62) years, mean body mass index 31 (21-67) kg/m 2 , mean follow-up 36 (9-111) months]. There were 10 (45%) isolated femoral DC, 10 (45%) isolated tibial DC, and 2 (9%) ipsilateral femoral and tibial DC in a single operation. All patients were followed until clinical and radiographic union. Mean MAD was corrected from 42.5 ± 35.0 mm preoperatively to 10.2 ± 4.8 mm from the targeted MAD. Complications occurred in 9 (50%) patients, predominantly related to symptomatic hardware and delayed healing. The rate of soft tissue complications was 5.6%. Discussion The IMNG achieved accurate correction with lower rates of soft tissue complications compared to computer-assisted hexapod fixators. Furthermore, the rate of hardware removal with IMNG was approximately half of that seen with external fixator methods. Conclusion IMNG correction is an effective and cost-conscious technique to correct complex long bone deformities of the femur and tibia.
Introduction/Background Osteochondromas are the most common benign bone tumors, typically presenting as cartilage-capped bony projections on the external surface of bones. Recurrent isolated osteochondromas are uncommon and have a low recurrence rate after surgical resection. Previous literature has documented solitary osteochondromas in the calcaneus, but to our knowledge, recurrent cases have not been reported. Case Presentation A 20-year-old female presents after the removal of a calcaneal osteochondroma by podiatry at the age of 12 and again at the age of 17. The lesion recurred again at age 18, and the patient was then referred to orthopedic oncology. The patient’s primary presenting symptom was a slowly enlarging bump on her heel. The lesion was again excised, and the pathology was consistent with osteochondroma. She had no recurrence until 23 months postoperatively. At that point, she presented again with a bump slowly increasing in size as well as pain after several months of significantly increased walking while abroad. The lesion was again removed with care taken to remove all satellite lesions and to bur the main lesion down to normal calcaneus. The patient has had no recurrence at the most recent follow-up of 6 months. Conclusion This case report highlights the unusual presentation of a multiply recurrent calcaneal osteochondroma, emphasizing the need for comprehensive surgical excision and diligent follow-up. Incomplete resection is the most common reason for recurrence. However, given the lesion's location, this case raises the question of whether repetitive stress from increased walking may have contributed to its recurrence.
Introduction Ankle fractures are increasingly common in older adults, with complication rates of up to 30% following surgical treatment. Identifying risk factors for fracture-related infections (FRI) could enable surgeons to reduce the complication rate. Methods In this retrospective case-control study, we screened 950 patient records and documented 59 patients aged 50 years and older with an FRI in the first 3 months after operative treatment of an ankle fracture. Cases of FRI were matched with controls without FRI based on age and sex. Results The risk factor analyses identified hypoalbuminemia (OR=17,7), non-compliance (OR=5,1), chronic alcohol abuse (OR=5,5), and high-impact trauma (OR=5,1) as patient-related risk factors. Larger blood loss during surgery, malreduction, and difficulties during surgery were identified as modifiable risk factors associated with operative skill level Discussion Early FRI occurred in 6.2% of patients, aligning with reported rates in the literature. The study highlights several modifiable factors associated with increased infection risk, including hypoalbuminemia, substance abuse, postoperative non-compliance, and surgical issues such as malreduction and intraoperative difficulties. High-energy trauma was also strongly associated with infection. Open fractures showed a non-significant trend toward higher risk, likely reflecting limited sample size and optimized management protocols. Overall, the findings underscore the importance of addressing patient-related vulnerabilities and ensuring high surgical quality to reduce infection risk in older adults undergoing ankle fracture fixation. Conclusion This study highlights the importance of careful patient selection, optimization of modifiable risk factors, and surgical expertise to improve outcomes for patients undergoing ankle fracture fixation.
Introduction Kinematic and electromyography (EMG) studies concerning internal rotation (IR) of the shoulder are limited. This study investigated the kinematic components and EMG activity of the rotator cuff muscles during IR at the side (IRs), IR at 90 ° of abduction (IRa), and IR to the posterior (IRp). Methods Ten healthy young men attended this study. The angles of IR, extension, and abduction of the humerothoracic joint, and angles of scapular IR, anterior tilt, and upward rotation were measured using a three-dimensional (3-D) motion analyzer. EMG activities in the 4 rotator cuff muscles were simultaneously recorded using synchronized 3-D motion analysis. Results The maximum IR angles were 56.6°, 72.4°, and 31.6° in IRs, IRa, and IRp, respectively. The maximum extension angle was 34.1° in IRp, and the maximum abduction angles were 1.4°, 87.4°, and 24.1° in IRs, IRa, and IRp, respectively. The EMG activity patterns of the rotator cuff muscles differed across the 3 IR types. %IEMGs of the subscapularis in IRs were approximately 20%, gradually increased up to 18.2% in IRa, and greatly increased to 29.8% at maximum IRp. %IEMGs of the supraspinatus were constant during the 3 movements, and EMG activities of the infraspinatus and teres minor decreased preceding IRa, whereas those increased up to maximum IRp. Discussion The rotation axes of IRs and IRa are constant, but that of IRp always changes. Our results show that the internal rotation angles for IRs and IRa are nearly identical to those reported previously. In contrast, the rotation angle for IRp differs from those in the current reports. EMG analysis of the 3 types of IR movements reveals different muscle activity patterns. Conclusion Kinematic and EMG analyses revealed that the three types of IR completely differ. The total IR angles in the humerothoracic joint increased in the order IRa > IRs > IRp. The highest activity of the subscapularis was observed in IRp. The internal rotation angle is the smallest, and the internal rotation movement of the IRp is completed in the early phase of the movement. The joint structure itself is presumed to limit the internal rotation movement of the IRp.
This pilot study investigated the potential clinical benefits of a compression knee sleeve containing Far-Infrared Ray (FIR) emitting particles in patients with knee Osteoarthritis (OA). We conducted a retrospective cohort study at a single institution. Among 48 patients initially fitted with FIR knee sleeves, 22 patients (30 sleeves) had complete one-month follow-up data and were included in the analysis. Two groups were identified: (1) patients who received only the FIR knee sleeve (HA-/Sleeve+), and (2) patients who received both the FIR sleeve and Hyaluronic Acid (HA) injection concurrently (HA+/Sleeve+). Patient-Reported Outcome Measures (PROMs) were collected at baseline and one-month follow-up, including the Knee Injury and Osteoarthritis Outcome Score, JR (KOOS JR), Numeric Pain Rating Scale (NPRS), and a Five-Point Likert Satisfaction Scale. At one month, both groups demonstrated improvement in knee health, pain, and satisfaction. KOOS JR scores improved by 12.27 points in the HA-/Sleeve+ group and 9.809 points in the HA+/Sleeve+ group. Pain scores decreased by 3 points and 2 points, respectively. Satisfaction scores increased by 1.416 points in the HA-/Sleeve+ group and 0.278 points in the HA+/Sleeve+ group. Improvements were greater in the HA-/Sleeve+ group across all measures. Limitations include a small sample size, an inability to ensure knee sleeve compliance, and the need for further research to explore potential synergies between knee compression, injections, and other treatments. This preliminary study suggests that a FIR-emitting compression knee sleeve may improve symptoms in patients with knee OA. The greater improvements observed in patients who did not receive HA injections may warrant further investigation. Larger prospective, randomized studies are necessary to validate these findings and define optimal use cases for this emerging nonoperative therapy.
Arthrofibrosis is a well-known knee surgery complication. Optimal treatment of postoperative knee arthrofibrosis is very important. Arthroscopic lysis and manipulation are often effective. We evaluated the indications for and the utility of arthroscopic lysis and knee manipulation. Ten patients (10 knees) underwent arthroscopic lysis of arthrofibrosis and knee manipulation. The follow-up evaluation included a clinical assessment. The mean follow-up time was 3.3 ± 1.2 months (from 2 to 6 months). The mean final gained arc of motion was 35.2°± 14.4°. The mean preoperative Lysholm score was 73.5 ± 2.5. The mean postoperative score was 90.5 ± 9.5. At the time of the initial surgery, the ROM tended to be lower in patients who had undergone surgery for > 6 months prior. Final ROM outcomes were better in cases within 6 months of the initial surgery than in cases over 6 months. Arthroscopic lysis and manipulation for postoperative arthrofibrosis of the knee should be performed as early as possible, within 6 months of the initial surgery.
Anatomic shoulder arthroplasty replicates joint anatomy, while Reverse Total Shoulder Arthroplasty (RSA) is preferred for rotator cuff deficiency or bone loss. This study compares pre- and post-operative function after TSA and RSA using outcome measures and the Kinesiological Instrument for Normal and Altered Reaching Movement (KINARM). A cohort of 81 shoulders in 74 patients (mean age 71 ± 8) underwent Total Shoulder Arthroplasty (TSA) or Reverse Total Shoulder Arthroplasty (RSA). Outcomes included lateral and forward elevation; WOOS, Constant, Oxford, and SF-36 scores; and Kinarm sensorimotor tasks (visually guided reaching, object hit, arm position matching). Patients were evaluated pre-operatively and at 6 weeks, 3, 6, and 12 months. Analyses used paired and independent t-tests, ANOVA, and Pearson correlation. ROM improved at 3, 6, and 12 months in TSA and at 6 and 12 months in RSA (p < 0.01), with TSA showing better ROM at 3 months (p < 0.01). Both groups showed improvement in WOOS, Oxford, and Constant scores (p < 0.01). The TSA group had higher SF-36 mental scores, while the RSA had higher physical scores beyond 3 months. TSA showed better early WOOS, Oxford, and Constant scores. Kinarm tasks improved at 1 year in both groups (p < 0.01), and RSA showed greater improvement in arm matching. Kinarm scores correlated strongly with WOOS, Constant, and Oxford. Early recovery favored TSA; by 12 months, outcomes converged. Kinarm offers an objective complement to PROMs. TSA and RSA showed similar 1-year outcomes, with earlier recovery after TSA. Kinarm is a reliable objective tool for pre- and post-operative upper extremity assessment. Level of Evidence: Level II.
Carpal tunnel syndrome (CTS) is a compressive neuropathy of the median nerve at the wrist, yet the role of lumbrical muscles in CTS remains unclear. This study investigates the impact of lumbrical muscle position on the outcomes of open carpal tunnel release in CTS patients. Patients with CTS indicated for surgical release underwent pre-operative ultrasound to dynamically assess lumbrical positioning, followed by open carpal tunnel release with flexor tenosynovectomy. Intra-operative assessment of lumbrical position was recorded relative to the transverse carpal ligament (TCL), and patients completed the Boston Carpal Tunnel Questionnaire pre-and post-operatively. A total of 147 wrists in 114 patients were included in the study. On pre-operative ultrasound assessment, the most proximal lumbrical position in maximal passive finger flexion was distal to the TCL in 13 cases, at the level of the TCL in 19 cases, and proximal in 115 cases. Intra-operatively, the most proximal lumbrical muscle position was distal in 19 cases, at the level of the TCL in 69 cases, and proximal in 59 cases. Patients with more proximal lumbrical positioning had poorer clinical outcomes, with less improvement in manual workers compared to non-manual workers. Intra-operatively, greater excursion was observed in manual workers compared with non-manual workers. Manual workers were seen to have less clinical improvement post-operatively. This study suggests that greater lumbrical excursion into the carpal tunnel is associated with worse outcomes following release, especially in manual workers. These findings may assist in patient discussions on surgical expectations and outcomes.
Discharge Medication Reconciliation (DMR) is critical in the transition from inpatient to outpatient care. Incomplete or inaccurate DMR results in medication errors, polypharmacy, or missed medications. Our high-volume tertiary care orthopaedic division was identified as an underperformer in DMR. Therefore, this Quality Improvement initiative aimed to achieve >85% DMR completion at hospital discharge by June 30, 2023. An interrupted time series study design, following the “Model for improvement” of the Institute for Healthcare Improvement, was used with a committee formed with CTU representatives, a resident, and two facilitators. Diagnostic tools, including root cause analysis, stakeholder interviews, process mapping, and driver diagrams, were employed. Multiple Plan-Do-Study-Act cycles were executed, along with interventions, such as audit and feedback and involvement of medical residents and nurse practitioners. Electronic medical record functionality was enhanced to facilitate medication reconciliation, with 'Continue all Remaining Home Medications'. In addition, for monthly data tracking, statistical process control charts were employed. Initial analysis showed a 38% DMR completion rate pre-implementation. Post-intervention, completion rates rose to 90%. The 'Continue all Remaining Home Medications' feature saw near-universal adoption among orthopaedic residents. The initiative boosted the timely completion rates of DMR, achieving project-specific and institutional objectives. Key factors contributing to this success included active stakeholder engagement, representation from CTUs, timely analysis of performance data, and thorough root cause analysis. Resident involvement was pivotal in identifying and implementing workflow improvements. The audit and feedback system fostered a competitive environment, driving enhancements. Overall, this project improved DMR timeliness, enhancing the safety of patient transitions from hospital to outpatient care.
The discharge summary is crucial for transitioning from inpatient to outpatient care, serving as a key communication tool between hospital and primary care providers. Our multi-site, high-volume tertiary care orthopedic division was identified as a low performer in completing discharge summaries within the institutional 48-hour target. This quality improvement initiative aimed to improve the timeliness of discharge summary completion, targeting >80% completion within 48 hours by June 30th, 2023. This study aimed to achieve at least 80% discharge summary completion within 48 hours in the Division of Orthopaedic Surgery. An interrupted time series study, based on the Institute for Healthcare Improvement’s ‘Model for Improvement’, was conducted. A quality committee, including representatives from each Clinical Teaching Unit (CTU), a resident representative, and two quality facilitators, utilized root cause analysis, stakeholder interviews, process mapping, and driver diagrams. Interventions included implementing an auto-authenticate option, an audit and feedback system, and engaging medical residents and nurse practitioners. Monthly data tracking used statistical process control charts. Pre-implementation, the completion rate within 48 hours was 48%. Auto-authentication significantly improved completion rates, with 63% completed within 48 hours compared to 16% with manual authentication. Overall, completion rates rose from 48% to 89%, with auto-authentication usage increasing from 50% to 91%. This initiative significantly improved timely discharge summary completion, meeting targets. Key success factors included stakeholder engagement, timely performance data, and effective root cause analysis. Medical resident involvement and the audit and feedback system fostered improvements, enhancing patient transitions from hospital to outpatient care.
Cartilage lesion size is an essential component in treatment algorithms for various therapeutic and surgical interventions. Obtaining accurate and precise measurements is critical to formulating a comprehensive treatment plan. Standard measurement methods overestimate lesion size due to inadequate shape evaluation. Furthermore, currently accepted surgical intervention thresholds are elevated beyond the level at which rim stress demonstrates significant load distribution within the knee. Based on the current literature, evaluating a chondral lesion based on the oval area proved to be a novel proposition. The excess area (EA) that accounted for in following the rectangular area (RA) measurement method is described by the following equation: EA 0.858 ( r 1 x r 2 ). Furthermore, the EA occupies roughly 21.45% of the defect area regardless of lesion size. Additionally, the lesion size threshold within the knee has significant implications beginning at 1cm 2 , as opposed to the currently accepted surgical threshold of 2cm 2 . However, how cartilage defects are measured needs to be rooted in more scientific and precise manners to best aid in clinical and pre-operative decision-making. Utilizing the alternative measurement method, surgeons can make more informed treatment plans with each patient. While the decision to treat cartilage defects is multifactorial, surgical intervention algorithms should be re-evaluated, provided the refined measurement methods and newer threshold recommendations.
Background Adhesive capsulitis is a common cause of glenohumeral joint pain and stiffness that significantly interferes with patients' lives and ability to work. Since no specific treatment options have been well established, this research examines arthrographic injection of the glenohumeral joint with steroid and local anesthetic versus local anesthetic alone for the treatment of adhesive capsulitis. Methods A double-blinded randomized controlled trial was conducted with patients diagnosed with idiopathic adhesive capsulitis. They were randomized to one of two groups: (1)local anesthetic plus steroid or (2)local anesthetic. A musculoskeletal radiologist performed all of the image-guided injections using a standardized patient-blinded technique. Outcome measures included shoulder range of motion, grip strength, and scores on the Shoulder Pain and Disability Index (SPADI), Constant Score, and Visual Analog Scale (VAS) for pain. Evaluations occurred at baseline and 3-, 6- and 12-weeks post-injection. Results Thirty-seven patients were enrolled in the study. There was no significant improvement in shoulder range of motion and grip strength with local anesthetic plus corticosteroid injection compared to local anesthetic alone. Shoulder range of motion was better at all time points for the group with local anesthetic alone. Both groups showed significant improvements in their VAS and SPADI pain scores at all post-injection follow-up appointments (p=.011). The SPADI results showed significantly better disability scores for the local anesthetic plus steroid group (p=.012) and improved pain scores from baseline at all follow-up times (p=.011), whereas the local anesthetic group had significant pain relief for only the first 3 weeks (p=.050). Conclusion Intra-articular injection with local anesthetic plus steroid was beneficial in improving pain but not range of motion when compared to injection with local anesthetic alone.
Introduction Joint fusion is a widely accepted treatment option for debilitating arthritis and deformity in the foot and ankle. Autologous bone grafting has long been accepted as the gold standard form of bone grafting; however, it can still be associated with non-union. This study aims to investigate joint fusion rates using Composite Peptide Enhanced Bone Graft (CPEBG) as an adjunct during ankle fusion surgery. Methods Data was collected retrospectively for patients over the age of 18 years, undergoing ankle fusion between June 2016 and August 2020 with autologous bone graft and CPEBG. All patients had their primary or secondary procedure performed by a single surgeon with follow-up at 6 and 12 months post-operatively. Data included baseline demographic data and procedural characteristics. The primary endpoint was to assess joint union at 6 and 12 months, respectively. Secondary objectives included post-operative pain, mobility and the use of walking aids. Results Radiographic union rates for the primary group were 40/48 (83%) and 43/48 (90%) at 6 and 12 months and 2/3 (67%) and 3/3 (100%) at 6 and 12 months for the secondary group, respectively. The overall non-union rate for primary ankle fusions was 8%, while no non-unions were observed in the secondary group. Conclusion CPEBG in foot and ankle fusion procedures yields similar union rates compared to other graft options. Further well-designed randomised control trials are warranted to confirm these findings.
Background Although postoperative shoulder pain surgery is severe, the quality of its management has not been studied in comparison with pain after other orthopedic surgeries. Furthermore, reports have investigated daytime pain, but none have discussed nighttime pain. Objective This study aimed to compare perioperative pain management in patients who underwent Arthroscopic Rotator Cuff Repair (ARCR) and those who underwent lower extremity arthroplasty. Methods The study population included 33 patients who underwent ARCR and 21 patients who underwent lower-extremity arthroplasty between August 2015 and March 2016. For postoperative analgesia, an interscalene brachial plexus block was used for ARCR, and an epidural block was used for lower extremity arthroplasty. The Visual Analog Scale (VAS) for rest and night pain was measured from the day before the operation to the fourth postoperative day. Results In ARCR, night pain was significantly weaker on the day of surgery (VAS, ARCR 23.9 vs . lower extremity arthroplasty 47.9; P = 0.008); however, it was significantly stronger on the second and third postoperative days (2 nd , 45.6 vs . 23.2; P = 0.002 / 3 rd , 38.1 vs . 23.5; P = 0.021). There were no significant differences in rest pain. Conclusion It was confirmed that postoperative pain can be well managed in patients undergoing ARCR. However, because the pain worsened after the removal of the block, further improvement is required.
Background: Three-dimensional (3D) printing technology allows for patient-specific anatomical reconstruction. This study aims to summarize and critique the current literature on 3D-printed carpal bone implants used in various carpal pathologies. Methods: Web of Science, PubMed, Scopus, Google Scholar, and Cochrane Central Register of Controlled Trials databases were searched from January 1901 to October 2022. PRISMA guidelines were adhered to, and the study was registered on PROSPERO. Articles utilizing 3D printed carpal bone implants were selected based on pre-determined inclusion and exclusion criteria. The outcomes included intraoperative/postoperative complications, visual analogue score (VAS), disabilities of the arm, shoulder and hand (DASH) score, radial and ulna deviation. The Murad tool was used to assess the quality of case reports and Newcastle Ottawa scale was used to assess the observational studies. Results: A total of 6 studies comprising of 47 patients (34 males) were included. The average age was 35.3 years and indications for 3D printed implants included Fenton syndrome, Kienböck’s disease, and scaphoid non-union with and without necrosis. The overall postoperative VAS ranged from 0 to 1.4 and a significant reduction was noted from preoperatively with both rest and loading. The overall postoperative DASH score ranged from 9.2 to 25 and significant improvement was noted from preoperatively. The radial deviation ranged from 16.4° to 28.5° and while ulna deviation was from 23.8° to 36.4°. Only one complication was reported in included studies, a dislocation of the prosthesis. The overall quality of included studies was poor. Conclusion: 3D-printed carpal bone implants improved outcomes in pain and function with minimal complications. The current study only reported only one complication postoperatively with no intraoperative complications. These results suggest that while 3D-printed carpal bone implants are still being optimized, large-scale clinical studies comparing the current options with the standard of care would provide better insights for recommendations and counseling.
Background: Hyperkyphosis, an excessive curvature of the upper back, has been linked to increased falls and fear of falling. Previous work has focused on improving the hyperkyphosis curve itself. There is, however, a dearth of studies that have focused on improving falls, fear of falling, and participants’ satisfaction with the educational material. Objective: This study aimed to determine the effect of a hyperkyphotic-specific exercise programme on falling, fear of falling, and satisfaction with the educational material. Methods: Thirteen individuals with a hyperkyphosis of over 40 degrees were randomly divided into an exercise group (n=6; age: 71.50 ± 7.84 years) and a control group (n=7; age: 67.29 ± 9.76 years). The exercise group received a 16-week hyperkyphosis-specific exercise programme with educational material. The control group received only the educational material. Before and after the exercise programme, the history of falls in the past year and fear of falling were assessed by 2 questionnaires (the history of falls in the past year and the Fall Efficacy Scale-International). Satisfaction with the educational material was evaluated after the exercise programme. Data were analysed by descriptive statistics and a 2×2 model mixed between-within subjects analysis of variance. Results: There was no significant interaction between group and time for the history of falls in the past year (p = .182, effect size = .156) and fear of falling (p = .216, effect size = .135), but the effect size of the interaction effect was large. Furthermore, participants in both groups expressed positive satisfaction with the educational material. Conclusion: Hyperkyphosis-specific exercise programme resulted in improvement in the history of falls and fear of falling, but the results were not significant. A larger randomised controlled trial is needed to clarify the effectiveness of the exercise programme in reducing the number of falls and fear of falling in this population.
Background: Symptomatic lumbar degenerative spondylolisthesis (DS) is most commonly treated with decompression and fusion to address both the neurologic symptoms and underlying instability. However, fusion has known drawbacks, including invasiveness, recovery time and cost. A novel dynamic sagittal tether (DST) was developed to provide anatomic segmental stabilization after decompression by augmenting the posterior tension band. Objective: The objective of this study was to evaluate perioperative, work status and activity outcomes of decompression and DST stabilization (D + DST) vs. decompression and fusion (D + TLIF) from an ongoing FDA IDE study. Methods: Preoperative through 3-month outcomes and safety data from the IDE study (NCT03115983) are presented here. All patients had symptomatic Grade I DS with spinal stenosis, preoperative ODI≥35 and VAS leg/hip pain≥50. A propensity score (PS) model was utilized to control for inter-group differences in this parallel assignment (non-randomized) study. One hundred forty (140) patients had D + DST and 147 had D + TLIF. Perioperative characteristics, patient-reported outcomes, work status and activities of daily living (ADL) were analyzed with propensity score PS-adjusted difference and confidence intervals or chi-squared tests for multiple categorical variables. Kaplan-Meier survivorship analyses were performed for return-to-work and ADLs. Results: There were no significant PS-adjusted demographic, functional, disease or radiographic characteristic differences between groups preoperatively. The D + DST group had a PS-adjusted mean 70-minute shorter operative time, 183-ml less estimated blood loss and 2.3-day shorter hospital stay, with 66% of D + DST patients discharged the day of surgery and 88% discharged by the first postoperative day. At both the 6-week and 3-month intervals, more D + DST patients reported returning to work and ADLs. Both groups experienced significant reductions in leg/hip and back pain as well as disability 3-months postoperatively, while the D + DST group had significantly lower disability scores 6-weeks postoperatively. There were no significant differences in safety outcomes between the two groups, with 29 serious adverse events (SAEs) and 2 secondary surgeries (1.5%) in the D + DST group vs. 28 SAEs and 3 secondary surgeries (2.1%) in the D + TLIF group. Conclusion: Compared to D + TLIF, the D + DST procedure was shorter, less invasive and had a faster discharge. Faster recovery, return to work and ADLs with lower disability at 6 weeks were noted in the D + DST group. If longer-term results are durable, the DST may represent a less invasive stabilization alternative after decompression compared to instrumented fusion. Trial Registration Number: NCT03115983
Introduction: Osgood-Schlatter's disease (OSD) is a well-known condition; however, a tibial tubercle avulsion fracture following an OSD is rare. We reported a case of tibial tubercle avulsion fracture with pre-existing OSD in a 12-year-old boy. Case Presentation: A 12-year-old boy had right knee pain and could not walk after kicking a ball with his right leg during a soccer game. He had been diagnosed with OSD at another hospital 2 months previously. He was then diagnosed with a right tibial tubercle avulsion fracture. The fragment was thin, and the patient was treated with internal fixation using cannulated cancellous screws. The patient demonstrated near-normal knee function and was allowed to return to sporting activities 6 months postoperatively. Conclusion: In this case, the tibial tubercle avulsion fracture might have been associated with OSD. Care should be taken while treating OCD to prevent tibial tubercle avulsion fractures.
Aims: To investigate the ultrasound and clinical features of constrained Extensor Carpi Ulnaris (ECU) tendinopathy to have a better understanding of ulnar-sided wrist pain. Background: The cause of dorsal ulnar-sided wrist pain tends to be vague and unclear due to too many closely adjacent small structures. Constrained ECU tendinopathy has been scarcely reported, and it is unknown how often this disorder is found among the wrists with such pain. Objective: The purpose of this study was to compare the patients’ backgrounds between two groups; the wrists diagnosed as constrained ECU tendinopathy by using ultrasonography and the other dorsal ulnar-sided painful wrists. Methods: Totally 103 wrists from 103 consecutive patients (45 men and 58 women; age 13-78 years; mean age 43.7 years) who visited our clinic with dorsal ulnar-sided wrist pain were examined by physical test and sonography. We separated them into two groups of wrists with or without constrained ECU tendinopathy and compared patients’ data between them. Results: Twenty-six wrists (25%) were diagnosed as constrained ECU tendinopathy mainly located in the distal area than the ulnar osseous groove. All of them were ECU tendovaginitis and 15 wrists were concomitant with ECU tendinosis. The results of the comparison showed the proportion of females was higher, that of patients who have relevant sports activity was lower, and patients’ age was slightly higher in the wrists with constrained ECU tendinopathy (p<0.05). Conclusion: Among the wrists with dorsal ulnar-sided pain, constrained ECU tendinopathy occurs more frequently in middle-aged to elderly women and less frequently in sports-related patients, These tendencies are similar to other stenosing synovitis such as de Quervain`s disease. Others: For vague dorsal ulnar-sided wrist pain, physician should be aware of these tendencies and the advantage of ultrasonography given that constrained ECU tendinopathy might be frequently encountered more than expected.
Golf is a sport enjoyed by a rapidly growing population. While it is perceived as a low-demand activity, golf and its thousands of high-energy rotational swings can result in a plethora of upper extremity injuries. We examine the biomechanics of the golf swing and carry out a review, divided by anatomical region of the upper extremity (shoulder, elbow, forearm, wrist, and hand), of common injuries associated with golf. Part I of this review details the shoulder and elbow pathology seen in golfers, while Part II covers the forearm, wrist, and hand injuries associated with the sport. PubMed was searched for articles using terms that corresponded to the specific injury and golf. Additional data was obtained via outside journal searches that did not appear in PubMed. This is a clinical review. Specific phases of the golf swing place golfers at risk for unique injuries that may affect either the leading (left side in a right-handed golfer) or trailing (right side in a left-handed golfer) extremity. Amateur and professional golfers are at higher risk for different injuries, as pros are more likely to suffer overuse injuries, while amateurs may have injuries secondary to improper grip or swing form. We identify and comment on six shoulders, two elbow, eight forearm and wrist, and three hand injuries associated with golf. Current trends in management, as well as golf-specific rehabilitation and return to sport timelines, are discussed for each injury. Growing participation and an aging population make golf a common source of upper extremity injury. We delineate 19 of the most common upper extremity injuries that golfers face and equip providers with up-to-date information to appropriately diagnose, manage, and rehabilitate these injuries.
