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.
