Bicondylar tibial plateau fractures are technically demanding fractures that have a high rate of complications. The aim of this study was to analyse the outcomes of patients diagnosed with bicondylar tibial plateau fractures (AO41.C of the AO/ASIF classification) who were treated by osteosynthesis with plates and screws. A retrospective observational study of 27 patients was conducted. The mean follow-up was 49.52 months. The minimum follow-up was 2 years. The mean age of the patients was 51.44 years. Fifty-two percent of the patients required external fixation due to poor soft tissue condition, with a mean time to definitive surgery of 9.42 days. The 27 patients were definitively treated by open reduction and internal fixation with plates and screws. In 21 patients, the osteosynthesis was carried out with two plates using a dual approach (anterolateral and posteromedial). In addition to the medial and lateral plate, in 2 patients, a posterior plate was used. In 4 patients, the chosen option was a synthesis with a single plate through the anterolateral approach. The average score on the KOOS (Knee Injury and Osteoarthritis Outcome Score) scale at the end of the follow-up was 53.26 points. The use of external fixation did not correlate with a worse clinical result at the end of the follow-up. According to the Kellgren-Lawrence scale, all patients presented different degrees of arthritic changes. The main complication was discomfort related to the hardware, and 15 patients (55,56%) underwent hardware removal. One of the patients also required a high tibial corrective osteotomy due to the malunion of the fracture in valgus. Although a notable reduction and union of the fracture are achieved, bicondylar tibial plateau fractures result in a major loss of articular function and posttraumatic radiological changes.
The use of antibiotic-loaded bone cement (ALBC) is a common strategy for preventing periprosthetic joint infection (PJI) after total knee arthroplasty (TKA); however, its effectiveness remains controversial. This study aimed to provide a clear, evidence-based recommendation regarding the use of ALBC versus plain bone cement (PBC) for the prevention of PJI after TKA. This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 reporting guidelines. PubMed, Embase, and Scopus were searched to identify relevant studies evaluating PJI in patients who received ALBC versus PBC. Eligible studies were screened, selected, and assessed for risk of bias using appropriate checklists. Random-effects meta-analyses were performed to calculate odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. The effects of antibiotic type and dose were examined through subgroup analyses. Meta-regression was performed to evaluate the effects of age, sex, follow-up duration, and diabetes mellitus on the occurrence of PJI. Eighteen studies including 72,928 TKAs (20,201 in the ALBC group and 52,727 in the PBC group) were included. The overall analysis showed no significant difference in PJI rates between the ALBC and PBC groups (OR, 0.92; 95% CI, 0.67-1.27; p = 0.6). However, cefuroxime-loaded cement was associated with a significantly lower risk of PJI (p = 0.01). In contrast, cement containing gentamicin (p = 0.08), vancomycin (p = 0.3), or tobramycin (p = 0.6) did not show a similar protective effect. Antibiotic dose, age, sex, diabetes mellitus, and follow-up duration did not appear to influence the results. Most ALBC formulations were not associated with a significant reduction in the risk of PJI. Larger, dedicated trials are needed to further evaluate the effect of ALBC on PJI risk in selected patient populations.
Total knee arthroplasty (TKA) relies on precise soft tissue releases and bone cuts for balanced weight distribution. Challenges include the lack of predictors to guide the extent and timing of soft tissue release. This study examines the relationship between radiographic parameters and the distal femur valgus cut angle (VCA), and their correlation with the medial soft tissue release (MSTR) stage in TKA patients. The goal is to identify predictors that aid in achieving optimal biomechanics and tissue balance. In this prospective cohort study, we examined preoperative standard lower limb three-joint views of 62 limbs (57 patients) to explore the relationship between radiographic parameters, the stage of MSTR, and VCA. Univariate and multivariate linear regression analyses, along with various statistical tools, were used to identify relationships and determine cut-off values. A notable positive correlation was observed between VCA and medial hip offset (MHO), as well as between VCA and femoral length (FL), with both correlations yielding P < .001. Patients with shorter femurs and an MHO greater than 4.35 cm required a distal femoral cut angle of 6 degrees or more, while those with longer femurs and an MHO less than 4.35 cm needed an angle of less than 6 degrees (sensitivity: 83%, specificity: 80%). Additionally, the joint line congruency angle (JLCA), varus angle (VA), and lateral distal femoral angle (LDFA) showed significant correlations with the stage of MSTR. Among these variables, the VA emerged as the most accurate predictor, with a sensitivity of 91.7% and a specificity of 100%. Increasing the LDFA to above 93.5°, JLCA to above 7.5°, and the VA to above 19° would heighten the probability of requiring extensive MSTR. Additionally, MHO and FL are the most crucial predictive factors for determining the VCA.
This study comprehensively examined the influence of cutting depth during dry milling on the structural, mechanical, and biocompatibility characteristics of commercially pure titanium. The primary objective was to evaluate how variations in cutting depth can alter the crystallite size, microstrain, and wear resistance, as well as to investigate their correlation with essential biocompatibility parameters including cellular interactions, osteointegration potential, and corrosion resistance in a simulated body fluid environment. Understanding these interrelations is crucial for improving the overall performance of titanium implants used in biomedical applications. Pure titanium specimens were precisely machined at cutting depths of 0.1, 0.2, and 0.3 mm under dry conditions, ensuring that all other machining parameters remained constant. The structural characteristics were analyzed using X-ray diffraction to determine crystallite size and microstrain variations. Wear resistance was evaluated through sliding wear tests that quantified material loss, while biocompatibility performance was assessed via immersion tests in simulated body fluid. This evaluation included corrosion resistance measurements, quantification of calcium-phosphate deposition on the surface, and analysis of the initial interactions with osteoblast-like cells to determine cellular affinity and bioactivity. The experimental results indicated that increasing the cutting depth led to a significant reduction in crystallite size (28, 50, and 25 nm for 0.1, 0.2, and 0.3 mm, respectively) and a corresponding increase in microstrain (0.0011, 0.0011, and 0.009). Specimens machined at cutting depths of 0.2 and 0.3 mm exhibited superior wear resistance, with lower weight losses (7.9 and 5.3 mg) compared with the 0.1 mm specimen (12.1 mg). Biocompatibility assessments revealed that higher cutting depths enhanced corrosion resistance, promoted calcium-phosphate deposition, and improved osteointegration potential. optimizing the cutting depth to 0.2-0.3 mm during dry milling can substantially improve both mechanical performance and biocompatibility, offering valuable guidance for implant manufacturing and long-term in vivo functionality.
Partial weight bearing (PWB) is a cornerstone of post-operative rehabilitation after lower extremity surgery (LES), balancing mechanical stimulation needed for bone, tendon, and cartilage healing with protection against excessive load that precipitates malunion, non-union, or joint dehiscence. This narrative review synthesizes literature to clarify current indications for PWB, evaluate traditional and emerging methods for prescribing and monitoring load, and identify factors influencing patient adherence. Hip, knee, ankle, and foot procedures commonly warrant PWB, yet optimal targets and progression schedules remain surgeon-dependent and inconsistently standardized. Household scales fail to replicate dynamic gait and are associated with poor long-term accuracy when compared to biofeedback devices, although these are the most widely adopted PWB adjuncts. Recent clinical trials demonstrate that wearable pressure-sensing insoles, audio or visual biofeedback, smartphone applications, telerehabilitation platforms, and virtual/augmented reality (VR/AR) or robotic off-loading devices markedly improve PWB precision, range of motion, muscle preservation, and functional scores without increasing complications. Nevertheless, widespread adoption is limited by cost, device sizing, battery life, and the requirement for continuous wear. Across studies that objectively quantified loading, adherence remains suboptimal, particularly among elderly and obese patients, underscoring the need for targeted educational interventions. Formal patient education, integrated into routine follow-up, may enhance understanding of PWB rationale, foster self-efficacy, and amplify the benefits of technology. Future research should prioritize high-quality randomized trials that combine sensor-derived compliance metrics with machine-learning analytics to individualize loading protocols, elucidate the drivers of non-adherence, and determine the cost-effectiveness of digital health solutions. Standardizing PWB guidelines while leveraging wearable, telehealth, and VR/AR technologies holds promise for accelerating recovery, reducing revision surgeries, and improving quality of life in an aging, fracture-prone population.
Spinal tumors account for 6-8% of all bone tumors, with spinal metastatic bone disease being the most commonly found spinal tumor. Patients with spinal metastatic bone disease typically present with symptoms such as pain, neurological impairments, and potential paralysis. The morbidity associated with spinal metastatic bone disease significantly impacts the patients' quality of life. This study aims to investigate the outcomes of quality of life and functional outcomes in patients with spinal metastatic bone disease. A retrospective observational study was conducted involving patients with spinal metastatic bone disease treated at Dr. Cipto Mangunkusumo Hospital from January 2021 to December 2023. The functional outcomes in this study were assessed using the Short Form-36 (SF-36) and the Oswestry Disability Index (ODI). A total of 73 patients were included in this study, with breast cancer being the most common primary tumor (53%). Significant associations were found between gender and pain component (P = 0.045) and general health component (P = 0.047) of SF-36 scores. Significant differences were also observed in SF-36 components - physical functioning (P = 0.046, r = -0.562), energy/fatigue (P = 0.035, r = -0.621), and general health (P = 0.027, r = -0.513) with age. Significant differences were observed between pre-therapy and post-therapy in SF-36 scores for physical functioning, role limitations due to physical health, energy/fatigue, pain, general health, and ODI. Post-surgery, SF-36 role limitations due to physical health and ODI scores showed significant improvement. No significant relationships were found between pain severity, extremity weakness, type of therapy, and SF-36 or ODI scores. There are significant associations between gender, age, and functional outcomes in patients with spinal metastatic bone disease. There is improvement in SF-36 scores and ODI scores post-therapy, especially after surgery.
Clavicle fractures are the most common injuries of the scapular girdle. These fractures can be treated surgically using two primary methods: open reduction with internal plate fixation or intramedullary fixation. Plate fixation can be performed in two commonly used positions: anterior and superior. This randomized, double-blind clinical trial aimed to compare the outcomes of superior versus anterior plate fixation in the treatment of clavicle fractures. This randomized, double-blind clinical trial focused on patients with clavicle fractures who underwent internal plate fixation between 2020 and 2021. The patients were divided into two groups: the anterior group, which received internal plate fixation using an anterior-inferior plating technique, and the superior group, which received internal plate fixation using a superior plating technique. A total of 75 patients were included in this study, with an average age of 42.32 years in the anterior group and 40.92 years in the superior group. Sixty-three (84%) of the patients were male, and 39 (52%) of the patients sustained their fractures as a result of vehicle accidents. Patients in the anterior group reported a satisfaction score of 96.68 (±1.13), compared to 58.08 (±12.32) in the superior group (p<0.05). Ten (20%) patients in the superior group reported plate-related irritation after three months, while only four (16%) patients in the anterior group experienced irritation (p<0.05). Two patients in the superior group developed non-union and required re-surgery. No cases of infection or pneumothorax occurred due to the surgery. Out of the 75 patients included in the study, two in the superior group and one in the anterior group reported a loss of function at the three-month follow-up. Anterior plating is usually correlated with higher rates of patient satisfaction.
This study hypothesizes that, in patients undergoing four-corner fusion (4CF) surgery, the choice of fixation method-either headless compression screw (HCS) or staples (ST)-will not significantly impact postoperative complication rates, union rate, and functional outcomes. A retrospective chart review was conducted on patients who underwent 4CF for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrist at a single institution over thirteen years. Functional outcomes included postoperative complications, nonunion, subsequent surgery, wrist flexion-extension range of motion (ROM), Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score, and the 12-Item Short Form Survey (SF-12). Thirty-seven patients were identified with an average follow-up of 9.1 months (range: 3-24 months). Nineteen patients were treated with HCS, and 18 were treated with ST. There were no significant differences in the complication rates between the HCS and ST groups (P=0.73). In the HCS group, the main complications were pain (n=4), subsequent surgeries for revision or hardware removal (n=3), and nonunion (n=2). For the ST group, these were pain (n=5), subsequent surgeries for revision or hardware removal (n=5), and hardware loosening (n=4). Postoperatively, wrist flexion and extension ROM did not significantly change in either group. QuickDASH improved postoperatively in both groups (P<0.005). Only the ST group improved in the SF-12 physical component postoperatively (P=0.01). In this small, retrospective case series with short follow-up, fixation choice between HCS and ST in 4CF for SLAC or SNAC did not significantly impact complication rates or functional recovery. Postoperative complications occurred at similar rates, with pain and the need for subsequent surgery being the most common.
The Patient-Rated Ulnar Nerve Evaluation (PRUNE) is a validated, condition-specific instrument designed to assess symptoms and functional limitations in individuals with ulnar nerve disorders. However, no Persian adaptation has been developed to date. The present study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Persian version of the PRUNE among patients with Cubital Tunnel Syndrome (CuTS). Following international guidelines, the PRUNE was translated and culturally adapted into Persian. A total of 106 patients with clinically diagnosed Cubital Tunnel Syndrome (CuTS) were enrolled in the study. Internal consistency was evaluated using Cronbach's alpha, and test-retest reliability was determined with the Intraclass Correlation Coefficient (ICC) over a two-week interval. Construct validity was examined through an exploratory factor analysis (EFA) using principal component extraction and Varimax rotation. Convergent validity was examined by assessing the correlations between PRUNE scores and those of established instruments, including the QuickDASH, DASH, and Visual Analog Scale (VAS). The Persian version of the PRUNE demonstrated excellent internal consistency (Cronbach's α = 0.889) and strong test-retest reliability (ICC = 0.886). Exploratory factor analysis confirmed a multidimensional factor structure consistent with that of the original instrument. Significant positive correlations were observed between the PRUNE and the QuickDASH (r = 0.768), DASH (r = 0.699), and VAS (r = 0.664), supporting its convergent validity. The Persian version of the PRUNE proved to be a reliable and valid instrument for assessing symptoms and functional limitations in Persian-speaking patients with Cubital Tunnel Syndrome. It can be confidently applied in both clinical practice and research contexts.
Osteoid osteoma (OO) is one of the most common benign bone tumors and can occur in various skeletal structures. It often presents with symptoms, such as nocturnal pain, which may mimic constitutional conditions, and it is characterized by a distinct radiological appearance that allows for easy differentiation from other lesions. Over the past decade, numerous studies have evaluated the efficacy of both surgical and radiological interventions for treating OO. While several treatment methods are available, each carries distinct advantages and disadvantages. This study aims to report the outcomes of surgical resection for ocular (OO) lesions. A total of 29 patients were enrolled in this study. Of these, 14 patients chose surgical resection as their primary treatment, while 15 patients opted for radiofrequency (RF) ablation. Three patients who exhibited a lack of response to RF ablation subsequently underwent surgical resection, bringing the total number of patients in the surgery group to 17. This study specifically focused on lesions located in the peritrochanteric region. For lesions that recurred at the same site, whether due to recurrence or lack of response to initial treatment, the same treatment modality used in the first instance was applied. Among the 17 individuals who initially underwent surgical resection, 11 had extracapsular lesions, and 6 had intracapsular lesions. All patients who underwent surgical resection became symptom-free, and no complications were observed during the procedure. Furthermore, all cases that received surgical resection were confirmed through pathological assessment. Additionally, three patients with extracapsular lesions had previously been treated with RF thermoablation but had not fully recovered from their symptoms, necessitating surgical resection. Based on the results, although RF is the first choice of treatment for OO, surgical resection could be a vital and safe option for peritrochanteric OO.
Bone is a mineralized connective tissue composed of osteoblasts, osteocytes, and osteoclasts, and its integrity is essential for structural and physiological function. Defects arising from trauma, tumors, or developmental abnormalities often require surgical reconstruction to restore normal performance. Autografts and allografts have long served as standard treatments for bone repair, however, their usefulness is restricted by limited availability, donor‑site complications, and the potential transmission of underlying diseases. These challenges have accelerated interest in bone tissue engineering (BTE) as an alternative strategy capable of enhancing regeneration while reducing postoperative risks. Advances in three‑dimensional (3D) printing have introduced powerful technique for fabrication of scaffolds with precisely controlled architectures and tunable mechanical and biological characteristics. This technology enables the creation of porous constructs that mimic the structural complexity of native bone, supporting cell infiltration, nutrient transport, and vascularization. Effective scaffolds for BTE must demonstrate biocompatibility, biodegradability, appropriate strength and stiffness, and the ability to promote osteogenesis and angiogenesis. Among natural polymers, alginate (Alg) has become a prominent candidate due to its inherent biocompatibility, degradability, abundance, low cost, and non‑immunogenic nature. Its versatility makes it suitable for developing customized 3D‑printed scaffolds. Additionally, bioactive glasses (BGs) are widely incorporated into composite scaffolds because their composition closely resembles the mineral phase of bone. BGs significantly enhance osteoconductivity, support mineral deposition, and can improve the mechanical resilience of polymer-based constructs. This review highlights recent progress in 3D‑printed Alg-based scaffolds for BTE, emphasizing how advanced fabrication techniques and BGs incorporation contribute to improved biological performance and structural reinforcement.
Several case studies have reported the use of a two-stage primary total knee replacement as a last resort for managing infected, arthritic knee joints. However, the exact treatment protocol has not yet been clearly defined. The objective of this study was to assess the effectiveness of a two-stage primary total knee replacement, using an antibiotic-loaded cement spacer block, in treating patients with concurrent osteoarthritis and refractory joint infection. This retrospective study evaluated the outcomes of a two-stage primary total knee arthroplasty (TKA) for the treatment of refractory septic osteoarthritic knees. A total of six cases were included. In the first stage, open debridement was performed, followed by insertion of a well-designed antibiotic-loaded static cement spacer. Systemic antibiotics were administered during the interval period between the two stages. Once the infection had been eradicated, the second-stage TKA was performed. No suppressive antibiotic therapy was prescribed after the second stage. Clinical outcomes were assessed using pre- and postoperative knee range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and visual analog scale (VAS) scores. The mean follow-up duration was two years (range, 1-4 years). Complete eradication of infection was successfully achieved within an average follow-up period of two years. Before the initial stage surgery, the average range of motion (ROM) was 60 degrees (range, 40-120 degrees). Following the two-stage TKA, the ROM significantly improved to an average of 118 degrees (range, 100-130 degrees). Additionally, the WOMAC scores improved from an initial score of 40 to 20 after TKA. The mean VAS scores also showed significant improvement, decreasing from 50 preoperatively to 19 after the TKA procedure. The promising final clinical outcomes observed in this study suggest that this treatment protocol could serve as a reliable alternative for patients with infected osteoarthritic knees, providing a viable option for both restoring function and eradicating infection.
Two frequently used surgical interventions for knee joint osteoarthritis include closing wedge high tibial osteotomy (CW-HTO) and opening wedge high tibial osteotomy (OW-HTO). Studies showed that, most to near all cases lead to failure, requiring a total knee arthroplasty (TKA). This systematic review aimed at answering this question: What are the outcomes of TKA following CW-HTO and OW-HTO? The main electronic databases were searched up to November 2025. Only studies that included comparative arms for both closing-wedge high tibial osteotomy (CW-HTO) and opening-wedge high tibial osteotomy (OW-HTO) were considered for further assessment. The primary outcomes included knee joint function scores, such as the International Knee Society (IKS) score and the Knee Society Score (KSS). A meta-analysis was not feasible because of heterogeneity in the reported data and follow-up periods. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the methodological quality of each included study. Of the 6,756 records identified and screened, three comparative clinical studies, including a total of 541 TKA cases, were included in this systematic review. Two studies reported no significant difference in KSS or range of motion after TKA between patients who had previously undergone CW-HTO and those who had undergone OW-HTO. However, one study reported improvements in walking ability in both groups after 80-90 months of follow-up. Post-operative complication rates were comparable between groups (OW-HTO: 12.3% vs. CW-HTO: 8.3%); however, one study noted a significantly higher incidence of specific complications, such as skin necrosis and nerve injury, in the CW-HTO cohort (12% vs. 6%, P<0.05). Intra-operative complications were rare, affecting 2.8% of cases with no significant between-group difference. The limited available evidence precludes definitive conclusions. Current data suggest potential benefits after TKA following either CW-HTO or OW-HTO, including earlier relief of joint loading, shorter recovery time, and improved clinical outcomes, with no significant differences in clinical outcomes and complications between the two HTO techniques.
Total knee arthroplasty (TKA) is a standard treatment for advanced knee osteoarthritis (OA), but intramedullary reaming used in conventional (CON)-TKA may increase surgical trauma, blood loss, and systemic inflammation. Computer-assisted surgery (CAS)-TKA avoids canal entry and may reduce these adverse effects. This study compared postoperative inflammatory markers between CON-TKA and CAS-TKA. The study was approved by the Institutional Review Board on September 25, 2019 (COA no. 161/61). Participants were recruited from May 2019 to August 2020, and the trial was retrospectively registered with the Thai Clinical Trials Registry on February 24, 2021 (TCTR20210224007). Forty patients with primary knee OA (mean age 67 years) were randomly assigned to CON-TKA or CAS-TKA. Serum inflammatory markers-interleukin-6, C-reactive protein, and erythrocyte sedimentation rate (sIL-6, sCRP, ESR)-were collected at baseline and at 24 h, 72 h, and 2 weeks after surgery. Synovial markers (jIL-6, jCRP) were obtained intraoperatively and from Hemovac drainage at 24 h. Functional outcomes were assessed using the Knee Osteoarthritis Outcome Score (KOOS) at 2 weeks. The sIL-6 and sCRP levels and ESR at 24 h, 72 h, and 2 weeks after surgery were significantly elevated compared with those at baseline. The CAS-TKA group had a significantly lower change in the sIL-6 and ESR at 2 weeks than the CON-TKA group (5.3 ± 2.9 vs 7.9 ± 4.8, P = 0.040, and 35 ± 16 vs 51 ± 22, P = 0.013). Synovial marker levels did not significantly differ between the two groups. Further, there were no significant differences in KOOS at 2 weeks between the two groups. Compared with CON-TKA, CAS-TKA had a lower inflammatory response and a smaller change in sIL-6 and ESR levels at 2 weeks after surgery. However, its functional benefits should be further investigated.
Implantable contraceptive implants placed at the medial arm are often misapplied relatively deep, sometimes in muscle or adjacent to neurovascular structures. We reviewed the available evidence regarding non-palpable medial arm implants and factors associated with deep application to help inform specialists who may be asked to assist with removal in order protect nearby nerves. Following PRISMA guidelines, the authors systematically reviewed PubMed, Embase, and Cochrane Library for case series and reports of complications associated with the removal of nonpalpable contraceptive implants in September of 2025. Rates and features of routine and problematic implant removal were studied. Factors potentially related to deep placement were identified. The NIH tool for case series (2021) was used to assess study quality. We identified 16 case series and 10 case reports related to problematic implant removal from an initial search of 219 publications. In a series of routine insertions and removals, nonpalpable surgical implant removal was uncommon. Compared to routine removal, problematic removal was associated with subfascial implants, intramuscular implants, and previous attempts. A subset of implants was removed in the operating room. Transient paresthesia of the ulnar, median, and medial antebrachial cutaneous nerves was common after surgical removal of deep nonpalpable implants. Factors potentially associated with non-palpable implants included provider training, time since insertion, greater BMI, and weight gain during implant use. Among the 10 case reports, 6 orthopedic surgeons and one plastic surgeon performed removal. Hand surgeons may receive requests for assistance removing deep, nonpalpable contraceptive implants in order to limit the potential for neurovascular damage given that the medial arm insertion site is associate with the possibility of injury to adjacent to major nerves.
The simultaneous double dislocation of the distal interphalangeal joint (DIPJ) and proximal interphalangeal joint (PIPJ) in one finger is a rare injury. We present the case of a right-hand dominant male in his late teens who sustained a hyperextension injury to the tip of his left ring finger while playing football. A physical examination followed by anteroposterior and lateral radiographs confirmed dorsal dislocations at both the PIPJ and DIPJ in a "stepladder" deformity. His finger was subsequently splinted for 1 week after which hand physiotherapy was initiated. At 6 weeks follow-up, the patient demonstrated full functional recovery with a full range of motion in both DIPJ and PIPJ with no pain or stiffness. We also provide an up-to-date review of PubMed-indexed case reports regarding simultaneous double dislocations of the DIPJ and PIPJ.
This study aimed to evaluate the effect of iliotibial band (ITB) release on postoperative pain and functional outcomes following total knee arthroplasty (TKA) in patients with varus gonarthrosis. This clinical trial included patients with varus gonarthrosis undergoing total knee arthroplasty (TKA). Participants were stratified into three groups: Group A, patients with a tight ITB who did not undergo ITB release; Group B, patients with a tight ITB who underwent ITB release; and Group C, patients with a loose ITB who did not undergo release. Outcome measures included the Knee Society Score (KSS) knee and function subscales and the Oxford Knee Score (OKS), which assesses pain and functional status. Evaluations were performed preoperatively and at three months and one year postoperatively. No significant differences were observed among the three groups regarding age or gender (P > 0.05). At baseline, Group B demonstrated a significantly lower mean KSS compared with the other groups (P = 0.017). Although Group B showed improvement in mean KSS at the final follow-up, no statistically significant differences in postoperative KSS (P = 0.468) or OKS (P = 0.194) were found among the groups at any follow-up time point. Furthermore, the incidence of subluxation and the severity of varus deformity were comparable across all groups. In patients with a tight ITB undergoing TKA, ITB release is associated with improvement in functional scores compared with preoperative values; however, it does not lead to significant differences in clinical or radiographic outcomes when compared with patients who do not undergo ITB release. These findings suggest that ITB release may have a limited effect on overall postoperative outcomes, underscoring the need for further studies to more comprehensively evaluate the role and indications of surgical release techniques.
Proximal femoral nails (PFNs) are widely used in managing unstable proximal femur fractures. These implants are designed with fixed femoral neck-shaft angles in different sizes, based on anthropometric studies of the Western population. In this study, we aimed to evaluate the Caput-collum-diaphyseal (CCD) angle in the Iranian population and determine whether any design modification for PFNs is needed for this population. In this retrospective study, we evaluated patients who underwent hip and pelvic radiography at our hospital between 2015 and 2023. The CCD angles were measured on AP pelvic and hip radiographs. The mean CCD angle of the Iranian population was calculated. Correlation analysis was also conducted to evaluate the CCD angle in different age and sex groups. The CCD angle was evaluated in 1040 patients with a median age of 72 (range 60-99) in this study. The mean CCD angle in the Iranian population was 130.6 ± 5.9 (range: 115.4-149). 117 (11.3%) of the patients had Coxa Vara or Coxa Valga. The CCD angles did not differ significantly between men and women. We observed a significant correlation between the patient's age and the CCD angle. It was found that 20.35% of our population's CCD is not covered by the most commonly available Western PFN designs. This study's findings demonstrated that the Iranian population's mean CCD angle is higher than in Western countries. Therefore, future PFN designs should consider the CCD angles of the specific populations.
Limited evidence exists on alterations in postural response kinematics following external perturbations in individuals with chronic low back pain (LBP). Therefore, this study aimed to investigate differences in automatic postural responses between individuals with chronic LBP and asymptomatic controls during forward translation of the support surface. A total of 21 participants with chronic non-specific low back pain (LBP) and 21 age- and sex-matched healthy adults participated in this study. Participants were exposed to both predicted and unpredicted perturbations through forward translation of the support surface, which were analyzed using a motion analysis system. Angular displacements of the trunk and lower limbs were measured across four predefined time intervals corresponding to anticipatory postural adjustments (APA) and compensatory postural adjustments (CPA). In the unpredicted condition, trunk angular displacement during the APA1 phase was significantly lower in the LBP group compared with the control group (P = 0.04). A significant main effect of group was observed for hip (P = 0.009, ηp² = 0.17), knee (P = 0.01, ηp² = 0.16), and ankle (P = 0.01, ηp² = 0.14) displacements during the CPA1 phase. Moreover, a significant group effect was found for knee (P = 0.01, ηp² = 0.20) and ankle (P = 0.04, ηp² = 0.09) displacements during the CPA2 phase. Participants with LBP exhibited greater lower-limb joint displacements than controls under predicted and unpredicted conditions. Individuals with chronic low back pain (LBP) demonstrated altered kinematic strategies of the trunk and lower-limb joints in response to forward translation of the support surface. These findings suggest clinicians should consider evaluating and addressing automatic postural responses in this population.
Soft tissue sarcoma is commonly misdiagnosed as a benign tumor and excised without appropriate precautions mandatory to deal with malignancy. Referrals after inadequate initial excision account for 19-35% of new patients in sarcoma centers. The objective of this study was to assess the oncological outcome of inappropriately treated soft tissue sarcomas in a retrospective, single-center analysis. This study included 43 patients who had soft tissue sarcomas in the extremities and were inadequately treated. They were referred to Cairo University Hospitals, Egypt and managed from November 1999 to April 2017. The minimum follow-up period was 1 year after adequate resection. The oncological outcome was assessed regarding the incidence of local recurrence, chest metastasis as well as the overall survivorship. This study included 23 males and 20 females. 19 patients developed local recurrence (44.2%). 17 patients developed chest metastasis (39.5%). The incidence of local recurrence and chest metastasis was significantly affected by the type of the margin. Regarding the overall survival, 14 patients (32.6%) died during the follow up, while 29 patients (67.4%) were still alive by the end of the study. In our study, oncological outcome was significantly affected only by the margin status. Chest metastasis affected overall survival dramatically. Although it is challenging to achieve resection with wide margin, it is mandatory to get good oncological outcome.