Background The use of three-dimensional (3D) navigation percutaneous screw fixation has been reported in non-displaced or minimally displaced pelvi-acetabular fractures. For carefully selected displaced acetabular fractures, 3D navigation technique can be applied, which traditionally required open approach. Methods From 2018 to 2024, 29 patients underwent 3D-guided navigation percutaneous screw fixation. Various reduction techniques were used. Functional and radiological outcomes were assessed. Results Twenty-four patients were followed up after definitive fixation with average duration of 33 months. All patients showed fracture union with average union time of 7.3 months. The mean Merle d’Aubigne and Harris Hip scores were 14.3 and 86.2 points, respectively. Younger age, lower injury severity score and earlier definitive operation correlated with improved functional outcome. Percutaneous fixation demonstrates advantages in terms of operative duration, blood loss, length of stay. Conclusion This surgical technique safely and effectively manages pelvi-acetabular fractures, resulting in pain relief, early mobilization and favourable patient outcomes.
Background In-person therapy (IPT) after orthopedic surgery can be costly, time-consuming, and difficult to access, particularly for patients affected by social determinants of health. Free web-based therapy (WBT) programs may offer a more accessible alternative. This study evaluated patient interest, barriers, and preferences for WBT following shoulder or wrist surgery. Methods A cross-sectional survey was administered to 50 postoperative patients at a level 1 trauma center during 2- or 6-week follow-up visits, assessing willingness to use WBT, barriers to IPT and WBT, and desired program features. Results Participants were 18–70 years old; 60% underwent wrist and 40% shoulder surgery. Fifty-eight percent had not attended IPT, most commonly due to time, cost, and distance. Interest in WBT was high (78%), particularly for free and customized programs. Reported WBT barriers included limited personal interaction, computer access, and customization. Conclusions Patients demonstrated a strong interest in WBT, especially when free and personalized. Virtual platforms may help address common barriers to postoperative therapy, though concerns regarding personalization, interaction, and technology access remain important considerations.
Introduction : Total hip arthroplasty (THA) is a common orthopaedic procedure that significantly alleviates pain and enhances the quality of life for patients with hip osteoarthritis. Precise implant placement is critical for successful outcomes. Robotic-assisted THA has been developed to improve surgical accuracy and predictability, offering three-dimensional computed tomography-based planning and haptic guidance during key steps of surgery such as reaming and cup impaction. This study aims to compare (i) the accuracy of implant positioning between robotic-assisted and conventional THA, and (ii) other intra-operative and post-operative outcomes, including blood loss, operative time, length of stay, and associated complications. Materials and Methods : In total, 97 THA cases performed between November 2017 and October 2023, with a minimum follow-up of one year, were retrospectively analyzed. Fifty patients underwent robotic-assisted THA, while 47 received conventional THA. Demographic data, radiographic outcomes, surgical time, blood loss, length of stay, and surgical complications were evaluated. Intra- and Inter-observer reliability of radiographic measurements was confirmed. Results : Robotic-assisted THA demonstrated significantly greater accuracy and consistency in achieving targeted acetabular inclination and anteversion (p < 0.001). More cases in this group fell within the Lewinnek (<0.001) and Callanan safe zones (<0.001). Improvements in femoral offset ( p < 0.001) and maintenance of global offset ( p = 0.264) were also observed. More cases achieved balanced limb length discrepancy ( p = 0.047). No significant differences were found in operative time ( p = 0.196), blood loss ( p = 0.775), or length of stay ( p = 0.236). Similar rates of surgical complication were observed in both groups. Discussion and conclusion : Robotic-assisted THA provides more precise and consistent implant positioning without increasing operative time, blood loss, length of hospital stay, or associated complications.
Background Tranexamic acid is commonly used for bleeding control. This study investigated the effect of a single dose of tranexamic acid on blood loss and packed cell transfusion rates in geriatric hip fracture fixation surgery. Methods This retrospective cohort study involved a total of 218 patients who were admitted to a single trauma centre in Hong Kong between January 2023 and July 2024. The treatment group was given 1 g of intravenous tranexamic acid upon induction of anaesthesia. Intra-operative blood loss, packed cell transfusion rate, post-operative haemoglobin change and length of stay were compared. The incidence of post-operative thromboembolic complications (cerebrovascular accident, myocardial infarction, deep vein thrombosis and pulmonary embolism) was also compared. Results There was no significant difference in terms of intra-operative blood loss, packed cell transfusion rate, post-operative haemoglobin drop, thromboembolic events and length of stay. Conclusion One gram intravenous tranexamic acid did not influence blood loss or transfusion requirement, nor increase thromboembolic events.
Background/Purpose This study explored the need for distal radio-ulnar joint (DRUJ) stabilization and its effects on patients’ functional outcomes. Methods A retrospective chart review at level I trauma center was performed to identify all Galeazzi fractures between 2014 and 2022. CPT codes were pulled for any radius fracture, and then X-rays were reviewed to identify the Galeazzi fractures. Once the patient population was identified, chart reviews, including imaging study evaluation, were conducted. Statistics were performed with α =0.05 for the Chi-square tests and t -tests. Results Sixty-five Galeazzi fractures were included. Seventeen (26%) patients required DRUJ stabilization. DRUJ widening and ulnar variance were indicators for DRUJ stabilization ( p = 0.03, p = 0.006, respectively). Fracture distance from DRUJ was not predictive of need for stabilization ( p = 0.405). Current guidelines of ulnar variance > 2 mm and fracture distance <75 mm were not predictive of DRUJ instability ( p = 0.09, p = 0.422, respectively). DRUJ widening >6 mm was associated with the need for stabilization ( p = 0.0012). Patients who underwent DRUJ stabilization had significantly decreased pronation compared to the non-stabilized patients ( p = 0.01), while other range of motion were similar in both groups. Conclusion There are likely combinations of factors that predict DRUJ instability, while they are inconclusive factors on their own. DRUJ stabilization may limit pronation but have otherwise comparable functional outcomes.
Background Leg length discrepancy (LLD) remains a significant complication of total hip arthroplasty (THA), affecting patient's satisfaction and functional outcomes. Methods We have performed a prospective randomized control study to evaluate the efficacy of intraoperative technique with Steinmann pin as fixed supra-acetabular point to measure the leg length compared with preoperative planning with OrthoView digital software alone. Results Results showing that group A (Steinmann pin group) has a significantly lower postoperative LLD (p < 0.05) compared to group B (preoperative planning alone). There were no significant differences in operative time or blood loss between both groups. Conclusion The combination of preoperative digital imaging templating and intraoperative measurement using Steinmann pin as a fixed supra-acetabular marker for reference in THA can optimize leg length control on a posterolateral approach. The use of intraoperative measurement using Steinmann pin does not statistically increase the blood loss or operation time.
Background Cancellation during elective surgeries on the day of surgery is one of the many challenges that cause operational disruptions, resource waste, low patient satisfaction, and adverse influences on medical outcomes. Therefore, this study was conducted to determine the frequency of cancellation of elective orthopedic operations performed on the day of surgery. Methods This retrospective study was conducted to evaluate same-day cancellations of elective orthopedic surgeries over a one-year period from March 2022 to February 2023. Data were collected via hospital records, focusing on demographic information, type of operation, and causes of cancellation. Results Among 4954 intended elective orthopedic surgeries, 299 were cancelled on the day of surgery. Cancellations occurred mostly because of administrative (29.8%), surgeon-related (28.4%), and medical and anesthesiology factors (27.1%). Other factors included the administration of preoperative preparations (8.4%) and patient-related factors (6.4%). Fracture surgeries have the highest cancellation rates owing to administrative and anesthesia-related causes. Conclusions Cancellations of elective orthopedic surgery were due mainly to administrative, surgeon-related, and anesthesia-related factors. Improvements in theater resources, perioperative optimization, and good communication between surgeons and patients could effectively reduce such cancellation rates.
Background Arthroscopic Bankart repair is a widely accepted treatment for anterior shoulder instability. The choice between knotted and knotless suture anchors has biomechanical implications, though clinical outcomes remain unclear. Purpose This study compares clinical outcomes of knotted versus knotless suture anchors in arthroscopic Bankart repair. Methods A retrospective single-centered review of 22 patients undergoing arthroscopic Bankart repair (July 2022 to December 2024) was conducted. Patients were categorized into two equal groups based on knotted or knotless anchor types. The Constant-Murley Shoulder (CMS) score was used as the primary outcome. Secondary outcomes included recurrence and surgical complications. Results There was no significant difference in postoperative CMS between knotted and knotless groups ( p = 0.058). Both groups showed significant improvements from baseline; no recurrences occurred. One case of wound infection was observed in the knotted group. Conclusion Knotted and knotless suture anchors showed comparable clinical outcomes in arthroscopic Bankart repair. Biomechanical advantages of knotless anchors may not necessarily translate into better clinical outcomes. Surgeons may choose anchor type based on preference and case-specific considerations.
Hallux valgus is a common disorder of the foot that is often coupled with metatarsus varus, which may cause pain, discomfort and affect shoe wear. Studies have shown that the first intermetatarsal angle (IMA) can be significantly reduced after first metatarsophalangeal joint arthrodesis alone; however, the presence of long-term interval change in the first IMA after first MTPJ arthrodesis is still controversial. This retrospective observational study aims to evaluate the radiographic outcomes of first metatarsophalangeal joint arthrodesis for hallux valgus deformities. Patients who received first MTPJ arthrodesis for management of hallux valgus deformity between January 2011 and December 2018 were reviewed. Angular measurements of the HVA and first IMA were performed on X-Rays of these patients taken at pre-operation, early post-operative (4–6 weeks) and at final follow up. Patients who received X-rays at 1 year, 2 years, and 4 years post-operation, were also evaluated for first IMA and HVA on these X-rays. About 88 patients were evaluated, with final follow up ranging between 9 and 565 weeks. The pre-operative mean HVA of 42.6 (95% CI [40.3, 44.9]) degrees was significantly reduced (p < 0.001) to a mean HVA of 10.4 (95% CI [8.9, 11.7]) degrees at 4–6 weeks after first MTPJ arthrodesis. The pre-operative mean first IMA of 16.9 (95% CI [16.2, 17.7]) degrees was significantly reduced (p < 0.001) to a mean IMA of 11.8 (95% CI [11.2, 12.5]) degrees at 4–6 weeks after first MTPJ arthrodesis. There was a small statistically significant reduction in the first IMA between early post-operation and at 1 year post-operation (0.96 degrees – 1.87 degrees, depending on subgroup). First metatarsophalangeal joint arthrodesis is effective in reducing the widened first IMA associated with hallux valgus deformity, and is able to maintain the correction upon long-term follow-up.
Introduction Cephalomedullary device is a well-established method for trochanteric hip fracture fixation. This study investigated the fracture union rate, fixation failure rate and clinical outcomes of TFN-ADVANCED Proximal Nailing (TFNA) helical blade versus screw. Method This retrospective cohort study involved 180 geriatric extracapsular hip fracture cases fixed with TFNA from January 2024 to September 2025. The primary outcome was fracture union rate at 6 months and fixation failure rate. Secondary clinical outcomes were intra-operative blood loss, length of hospital stay, post-operative functional status, and mortality rate. Results There was no significant difference between TFNA helical blade and screw in terms of fracture union rate and fixation failure rate. Secondary clinical outcomes were comparable for both groups. Fracture reduction quality was identified as an independent risk factor for fixation failure. Conclusions TFNA helical blade and screw have no significant difference in fracture union rate at 6 months and fixation failure rate.
Background Conversion total hip arthroplasty (THA) is a procedure performed to often address complications from previous hip surgery. The objective was (i) to compare primary THA with conversion THA, and (ii) to evaluate the clinical outcomes and complications of different types of conversion THA. Methods This was a retrospective study that included primary and conversion THA operated from 2020 to 2024, aged ≥50 years. Operative time, intraoperative blood loss, post-operative functional status, complication and mortality were evaluated. Results A total of 107 THA (51 conversion THA, 56 primary THA) in Chinese patients were evaluated. Patients with conversion THA were significantly older than primary THA. Comparing with primary THA, the conversion THA group had worse function. Mean operative time for conversion THA from hip screws was significantly shorter compared to conversion from other implants. Conclusion With proper patient counselling and patient selection, conversion THA is a treatment option for complications arising from previous hip fracture surgery.
Background Segmental fractures of long bones often result from high energy trauma. Anatomical reduction of the intercalated segment results in further devascularisation and increases risk of non-union. A less invasive approach is presented here in an attempt to handle these difficult fractures. Methods From 2008 to 2023, eight consecutive cases of patients with segmental forearm fractures treated with pre-bend or anatomical plate using either minimal or less invasive approach were analysed retrospectively. The surgical techniques and relevant anatomy are explained and illustrated with cases. The clinical outcomes including range of rotation and function, and rates of non-union and infection were compared to eight other cases of segmental forearm fractures treated with traditional open reduction and internal fixation (ORIF). Results Seven segmental ulna and three segmental radius fractures were fixed using less invasive approach. Four patients attained good range of movement and normal activity of daily living function. One patient required revision ORIF with bone graft. No iatrogenic neurovascular injury was noted. Conclusion Less invasive approach is a feasible alternative for segmental forearm fractures, especially if there is severe soft tissue injury. High rate of fracture union can be achieved with less surgical damage to the injured forearm.
Introduction Reverse shoulder arthroplasty (RSA) was traditionally used in treatment of massive rotator cuff arthropathy. In recent years, this surgical modality was adopted to be an alternative in the treatment of acute complex fracture of proximal humerus for geriatric patient and this management is gaining its popularity. This is a local study that aims at comparing the functional outcomes among the two surgical options in treatment of acute complex fracture of proximal humerus (3-parts, 4-parts, and fracture dislocation), i.e. open reduction and internal fixation (ORIF), and RSA. Methods A retrospective review was conducted on patients aged ≥60 years who underwent RSA or ORIF for acute proximal humeral fractures between 2015 and 2023 at a single local center. Data were extracted from the Clinical Management System. Outcomes included Oxford shoulder score (OSS), range of motion (ROM), revision rates, and intra-operative parameters. This study incorporates computed tomography-based stratification of Neer classification to optimize fracture characterization and ensure appropriate treatment allocation. Statistical analysis employed Chi-square test for categorical comparison, and ANOVA for group comparisons. Results 60 patients were included (29 ORIF, 31 RSA). RSA patients were older (mean age 77 vs. 67 years, p < 0.001) with higher Charlson Comorbidity Index (CCI) scores ( p = 0.040). For 4-part fractures , RSA showed superior OSS (41.2 vs. 30.2, p = 0.006) despite older age/poorer CCI. For 3-part fractures , no significant differences were observed in OSS or ROM. Revision rates were higher in ORIF (6.9% vs. 0%, p = 0.137). Conclusion RSA is preferable for 4-part fractures due to better functional outcomes, even in older patients with poorer comorbidities. ORIF remains appropriate for 3-part fractures and dislocations, offering comparable outcomes with less operative time and cost. Still, careful case selection, pre-operative planning, good surgical technique, and rehabilitation are the keystones for successful surgery.
Introduction Developmental dysplasia of hip (DDH) is a major paediatric musculoskeletal problem that can cause lifelong disability if left untreated. Hong Kong currently adopts universal clinical assessment and selective ultrasound screening. This study aims to obtain a cluster-based epidemiology of DDH and to evaluate the effectiveness of the current screening system. It is also aimed to look for implication of capsular laxity and to propose optimal timing for first ultrasound. Methods Records of children referred to orthopaedics clinic in a major regional hospital for suspected DDH with ultrasound hips performed in 2017–2019 were reviewed. Patient demographics, ultrasound results, treatment and outcome of DDH were reviewed. Results Totally, 929 patients were referred with ultrasound hips done. Twelve of them were diagnosed with DDH. Another 2 patients presented late. The incidence of DDH in 2017–2019 was 0.89/1000 live births and delay diagnosis was 0.13/1000 live births. The open reduction rate was 0.19/1000 live births. Ninety-one patients had capsular laxity and normal follow-up ultrasound. Patients with capsular laxity were significantly younger than those without capsular laxity by Mann–Whitney U test. A statistically significant higher proportion of patients was found to have capsular laxity if first ultrasound was done before 6 weeks old ( p < 0.001). Conclusion The incidence of DDH in the studied cluster is comparable to local study published a decade ago. The current system is justified given the comparable results of late diagnosis and open reduction rate to other developed countries. Purely capsular laxity is benign ultrasonographic finding and 6weeks old is a reasonable time to perform the first ultrasound to prevent overdiagnosis of it.
Introduction Current studies indicate that delayed soft-tissue coverage for Gustilo III open fractures of extremities is associated with higher complication rates. However, achieving the recommended time frame for coverage is often not possible, and may result in worse outcomes. Objective Our goal was to determine infection rates and complications of prolonged recumbency in patients with delayed coverage. Methods A retrospective review of patients from January 2018 to March 2023 with Gustilo IIIB and IIIC fractures of the distal tibia, ankle, and foot that underwent free flap reconstruction was performed. We excluded patients with less than 2 initial debridements, less than 6 months of follow-up, and those with locoregional flaps. Results 18 patients were included, with a mean follow-up duration of 13.9 months. The mean time to coverage procedure was 12.9 days. 16 patients had delayed coverage performed 8 or more days from index injury, of which, only 1 developed a soft-tissue infection, and none in either group developed osteomyelitis or complications of prolonged recumbency. Discussion Contrary to published literature, our study showed that delayed coverage did not yield a very significant infection rate. We postulate that these lower rates may be due to: (i) multiple debridements performed (mean = 4), (ii) consultant-led debridements, (iii) the use of adjuncts including antibiotic cement beads, local vancomycin powder, and gentamicin-collagen sponge.
Background Implant cut-out is the commonest post-fixation complication of intertrochanteric fractures. It increases socioeconomic and healthcare burdens as well as patient morbidity in its geriatric population. This study identifies cut-out risk factors to prevent its occurrence. Materials and Methods This is a retrospective analysis of 203 patients with intertrochanteric fractures treated with a short Proximal Femur Nail Antirotation (PFNA) nail from April 2021 to March 2022 at a major Hong Kong tertiary hospital. Variables studied included gender, age, pre-morbidities, fracture side, fracture type, reduction quality, Tip-Apex Distance (TAD), and Cleveland 9 zones. Results The cut-out rate was 2.72%. Significant risk factors included male gender (p = 0.036), chronic kidney disease (p = 0.039), and TAD≥25 mm (p < 0.001). Cut-out likelihood increased 263.53 times with a TAD>25 mm. Patients with good reduction quality had significantly lower cut-out rates (p = 0.018). Conclusion Both preoperative and operative variables affect cut-out rates. Optimizing TAD and reduction quality is crucial.
Purpose To compare the long-term oncological outcome of neoadjuvant bisphosphonates and denosumab in extremity giant cell tumor of bone (GCTB) with curettage. Methods Fifty-five patients were retrospectively reviewed from 2003 to 2023. All patients underwent curettage and cementation and received three doses of postoperative zoledronate. They received either preoperative zoledronate (n = 41) or denosumab (n = 14). Both groups’ local recurrence (LR) rate and LR-free survival were calculated. Results The mean follow-up time for the zoledronate and denosumab group were 10.7 and 5.1 years, respectively (p = 0.006). The LR rate in the denosumab group (57%) was significantly higher than the zoledronate group (27%), p = 0.039. The zoledronate group had significantly greater LR-free survival than the denosumab group (p = 0.020). There was no correlation between the number of upfront denosumab doses and local recurrence (p = 0.573). Conclusion Upfront zoledronate showed a higher LR-free survival for extremity GCTB with curettage at a mean follow up of 9.3 years.
Laminoplasty is a common surgical procedure in our daily practice as a way for posterior decompression by expanding the spinal canal, for example in patients with cervical myelopathy. There are primarily two mainstays of laminoplasty, that is, single-door (open-door) and double-door (French-door) laminoplasty. Single-door laminoplasty was initially developed by Hirabayashi in which an asymmetrical canal opening was created on one side and hinged on the other. In contrast, the double-door technique was first described by Kurokawa, in which a symmetrical canal opening was created in the midline with hydroxyapatite block spacers in between the opened laminae hinging on two sides. Both techniques have been performed in our center and are options to provide adequate posterior decompression. We would like to evaluate any potential difference in outcomes between the patients receiving the two techniques of laminoplasty in our center, which may provide insight into future operative planning and practice. During 2018–2022, 40 patients who had received either single-door or double-door laminoplasty were recruited for analysis. This is a retrospective review of clinical and radiological outcomes of patients between the groups of patients receiving single-door and double-door laminoplasty in our local center. Our study showed that single-door and double-door laminoplasty were both effective in neural decompression to allow functional improvement by improving both post-operative Pavlov ratio and modified Japanese Orthopaedic Association scores. Single-door group had significantly shorter operative time, and less blood loss compared to double-door group. Given that single-door laminoplasty is an effective technique with shorter operative time and less blood loss, we concluded that it may be considered as a primary technique in laminoplasty in novice surgeons or in emergency setting.
Background Metacarpal (MC) epiphyses are normally found proximally for the first and distally for the second to fifth metacarpal bones. Pseudoepiphyses are infrequently found at the non-epiphyseal ends of metacarpal bones during the normal pediatric growth process. This is the first study aiming to investigate the radiological prevalence and features of metacarpal pseudoepiphyses in the Hong Kong Chinese population. Methods Standard bone age radiographs of children (chronological age 5 to 10) taken in two regional hospitals from Jan 2016 to Dec 2020 were analyzed. Exclusion criteria include: advanced bone age older than 11 years old, non-Chinese ethnic origin, history of hand trauma and skeletal dysplasia. Partial pseudoepiphyses can involve either or both the radial or ulnar cortices with no continuation in between. Complete pseudoepiphyses are those that extended across the full width of the metacarpal bone. The prevalence of metacarpal pseudoepiphysis was documented. The effect of Gender and Age differences on the prevalence of pseudoepiphysis was analyzed with chi-squared test using SPSS 26. Results A total of 421 radiographs (94 males; 327 females) were reviewed. The prevalence of pseudoepiphysis of 1st, 2nd, 3rd, 4th and 5th metacarpal bones was 25.7%, 21.1%, 0%, 0% and 23.5%, respectively. Complete pseudoepiphysis was most commonly seen in the 1st metacarpal bone (3.3%). Occurrence of pseudoepiphysis in single bone (36.1%) is more common than occurrence in multiple bones (15.4%). Combined 2nd and 5th metacarpal pseudoepiphysis is the most common pattern (38.5%). Gender (1st MC p = 0.19; 2nd MC p = 0.592; 5th MC p = 0.159) and Age (1st MC p = 0.103; 2nd MC p = 0.093; 5th MC p = 0.211) showed no differences on the prevalence of pseudoepiphysis. Conclusion There is a high prevalence of metacarpal pseudoepiphysis in the Hong Kong Chinese population. Understanding the radiological prevalence and features of metacarpal pseudoepiphyses is important to avoid misinterpretation as fractures in pediatric patients.
This study investigates the use of a bioinductive collagen scaffold patch to enhance the surgical repair of “degenerative” Achilles tendon ruptures in individuals with pre-existing tendinopathy. The aim is to improve tendon healing quality and enhance clinical function. A retrospective case series of patients with acute Achilles tendon ruptures and pre-existing tendinopathy who underwent surgical repair augmented with a collagen implant was analyzed. A mini-open surgical repair was performed using Krakow locking sutures with the augmentation of a collagen patch. Standardized rehabilitation protocols were followed, and participants were followed up for at least 6 months post-surgery. Nine participants were included in the study. No major complications, including re-ruptures, were reported within six months of surgery. Statistically significant improvements were observed in foot and ankle outcome scores. The Victorian Institute of Sports Assessment – Achilles score also showed progressive improvement. The use of a bioinductive collagen patch augmentation in patients with degenerative Achilles tendon rupture appears to be safe and feasible. However, the study's limitations include its retrospective nature and small sample size. Future prospective studies with a control group are needed to provide more comprehensive insights into the efficacy of this surgical procedure. This is the first published case series utilizing this novel bioinductive collagen patch to augment Achilles tendon repairs. These preliminarily positive results on improving the surgical management and outcomes of individuals with this challenging condition of tendinopathy complicated Achilles ruptures warrant further research in this area.
