[Influencing factors of traumatic arthritis after ankle fracture surgery and construction of risk prediction model]

OBJECTIVE

To explore risk factors of post-operative traumatic arthritis in patients with ankle fracture,and to establish risk prediction model.

METHODS

Totally 550 patients with ankle fracture treated from May 2020 to May 2022 were selected as research objects and divided into modeling group (385 patients) and verification group (165 patients) according to 7:3. In modeling group,patients were classified as occurrence group (112 patients) and non-occurrence group (273 patients) according to whether traumatic arthritis occurred after opertaion. Age,body mass index(BMI),gender,smoking history,diabetes history,injury type,fracture type,operation time,manual labor,open injury,osteoporosis,poor reduction,postoperative weight-bearing time,vascular injury,and surgical method were recorded; risk factors of traumatic arthritis in ankle fracture patients were analyzed by single factor and multi factor logistic regression analyses; R software was used to build the prediction model of line graph;receiver operating characteristic (ROC) curve and calibration graph were applied to verify the discrimination and consistency of the model.

RESULTS

One hundred and twelve of 385 patients with ankle fracture were developed to post-operative traumatic arthritis,and 275 did not. Univariate analysis showed that there were significant differences in age,BMI,fracture type,operation time,physical labor aboveⅡ,open injury,osteoporosis and poor reduction between two groups (P<0.05). Multivariate Logistic regression analysis showed that age (OR=2.887),BMI (OR=4.042),fracture type (OR=4.244),operation time (OR=2.665),physical labor above gradeⅡ(OR=5.099),osteoporosis (OR=10.219),and poor reduction (OR=3.112) were independent risk factors for traumatic arthritis after ankle fracture (P<0.05). Based on the above risk factors,an nomogram model was established to predict the risk of postoperative traumatic arthritis in ankle fracture patients,and internal and external verification was conducted. The results showed calibration curve of modeling group and verification group showed a good fit between correction curve and ideal curve,indicating that the predicted risk of postoperative traumatic arthritis by the model was basically consistent with actual risk. Area runder ROC curve analysis results showed 0.867[(95%CI(0.826,0.908)] and 0.882 [95%CI(0.827,0.938)],respectively,indicating that the prediction model had good prediction ability.

CONCLUSION

Age,BMI,fracture type,operation time,physical labor above gradeⅡ,osteoporosis and poor reduction are all risk factors for post-operative traumatic arthritis in patients with ankle fracture. The prediction model based on the above risk factors could effectively evaluate risk of post-operative traumatic arthritis in patients with ankle fracture.

[Retrospective clinical study of hip replacement in the treatment of traumatic arthritis secondary to acetabular fracture]

OBJECTIVE

To investigate the clinical effect of total hip replacement (THA) in the treatment of traumatic arthritis secondary to acetabular fracture.

METHODS

From October 2019 to June 2022, 15 patients with secondary traumatic arthritis of acetabulum fracture were treated with THA. There were 8 males and 7 females, aged from 40 to 76 years old with an average of (59.20±9.46) years old. Prosthesis loosening, dislocation of hip joint, range of motion of hip joint, nerve injury and other conditions were recorded before and after surgery. Harris score, visual analogue scale (VAS) and imaging were used to evaluate hip joint function and surgical effect.

RESULTS

Follow-up time ranged 6 to 39 months with an average of (18.33±9.27) months. All the 15 patients successfully completed the operation, no nerve and blood vessel injury during the operation, postoperative wound healing was stageⅠ, no infection, one case of acetabular side prosthesis loosening at half a year after operation, and recovered well after revision surgery, one case of hip dislocation was cured after open reduction treatment, no adverse consequences. Harris score at the last postoperative follow-up was (88.60±4.01) points, compared with the preoperative (47.20±11.77) points, the difference was statistically significant (P<0.05), and VAS at the lateat postoperative follow-up was 1 (1) points, compared with the preoperative 8 (2) points, the difference was statistically significant (P<0.05). At the last follow-up, the pain symptoms were relieved or disappeared, and the joint function was satisfactory. The imaging data of the latest follow-up showed joint was well pseudoradiated, no abnormal ossification occurred, and the prosthesis was not loose.

CONCLUSION

THA is effective in the treatment of traumatic arthritis secondary to acetabular fracture and can effectively improve the quality of life of patients. Preoperative comprehensive evaluation and bone defect evaluation of patients, and intraoperative management of acetabulum, femur, internal fixation and bone defect are key factors for the success of surgery.

Cadaveric Meniscus Arthroplasty for Post-Traumatic Arthritis: A Case Report

We present a novel treatment for post-traumatic arthritis of the hand and fingers using joint resurfacing with cadaveric meniscus. A 20-year-old man presented to the clinic with chronic pain and stiffness after an intra-articular fifth metacarpal fracture. Meniscus allograft, which has been used successfully in treatments for thumb carpometacarpal and radiocarpal degenerative osteoarthritis, was used to reconstruct the joint surface with complete resolution of stiffness and pain.

Biomechanical insights into ankle instability: a finite element analysis of posterior malleolus fractures

BACKGROUND

Posterior malleolus fractures are known to be associated with ankle instability. The complexities involved in obtaining precise laboratory-based spatial pressure measurements of the ankle highlight the significance of exploring the biomechanical implications of these fractures.

METHODS

Finite element analysis was utilized to examine the stress distribution across the contact surface of the ankle joint, both in its natural state and under varied sagittal fracture line angles. The study aimed to identify stress concentration zones and understand the influence of sagittal angles on stress distribution.

RESULTS

Three distinct stress concentration zones were identified on the ankle's contact surface: the anterolateral tibia, the anteromedial tibia, and the fracture line. The most significant stress was observed at the fracture line when a fracture occurs. Stress at the fracture line notably spikes as the sagittal angle decreases, which can potentially compromise ankle stability. Larger sagittal angles exhibited only minor stress variations at the contact surface's three vertices. It was inferred that sagittal angles below 60° might pose risks to ankle stability.

CONCLUSIONS

The research underscores the potential implications of fractures on the stress profile of the ankle joint, emphasizing the role of the contact surface in ensuring stability. The identification of three zones of stress concentration and the influence of sagittal angles on stress distribution offers a valuable reference for therapeutic decision-making. Further, the study reinforces the importance of evaluating sagittal fracture angles, suggesting that angles below 60° may compromise ankle stability.

[Medium term follow up outcomes of uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture]

OBJECTIVE

To evaluate the effect of uncemented total hip arthroplasty(THA) on treatment of traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures.

METHODS

Total of 22 patients treated with THA due to traumatic arthritis caused by intramedullary nailing interfixation of intertrochanteric fractures from January 2012 to January 2017 were studied retrospectively, including 10 males and 12 females with a mean age of (72.5±9.8) years old ranging from 61 to 84 years old. Initial internal fixation method:14 patients were treated with Gamma nails and 8 patients were treated wit PFNA.The time from internal fixation surgery to THA was 10 to 68 months with an average of (32.2±21.3) months.Harris scores of the hip joint before and after surgery were compared, and the position of the prosthesis through postoperative imaging at 3, 6, 12 months and the last follow-up were evaluated.

RESULTS

One patient was died due to heart failure 1 year after operation. Two patients was died to advanced tumor 2 years after operation. The other 19 patients were followed up for 36 to 64 months with an average of (48.5±11.9) months. At final follow up, 14 patients regained the ability to walk independently, 4 patients needed support of a cane, 1 patient needed assistance of a walker. No serious complications such as joint dislocation, periprosthetic fracture and deep venous thrombosis occurred during follow-up. There were no signs of loosening and subsidence of the prosthesis at the final follow-up. Mean Harris hip score increased from (29.2±12.9) points preoperatively to (74.2±11.2) points at the final follow up(P<0.05);the score was excellent in 9 patients, good in 7 and fair in 3.

CONCLUSION

Uncemented total hip arthroplasty for traumatic arthritis after intramedullary nail fixation of femoral intertrochanteric fracture can significantly improve hip function and effectively avoid bone cement implantation syndrome. The medium-term effect is satisfactory.

Chronic Complex elbow fracture dislocation: Restoration of elbow function with ORIF and radial head replacement, a case report with long term follow up

INTRODUCTION

The dislocation of the elbow joint to the posterior or postero-lateral region accompanied by fractures in the radial head or neck and coronoid process of the Ulna is known as a terrible triad injury of the elbow (TTI).

IMPORTANCE

This injury presents as unique challenge for orthopedic surgeons due to elbow instability and stiffness, making the surgical intervention more difficult than usual.

CASE PRESENTATION

A 47-year-old man suffered from polytrauma, including a pelvis fracture, a left humerus shaft fracture, and left ulna shaft fracture. An open reduction and internal fixation were administered as a treatment option. However, during a follow-up examination four months later, a missed fracture dislocation of the right elbow was discovered.

CLINICAL DISCUSSION

The complex surgery required open reduction of the chronic dislocated joint, release of the triceps, resection of the radial head, replacement, bone grafting of the coronoid, reconstruction of the coronoid, and application of a spanning external fixation. The injury was complex, consisting of coronoid fractures, olecranon, a proximal third of the Ulna, and radial head malunion with heterotrophic ossification around the elbow joint.

CONCLUSION

After seven years, our patient had a full range of motion in elbow flexion with 20-25 lags in extension. The Mayo Elbow Performance Score (MEPS) was 100 and Disabilities of Arm, Shoulder and Hand (DASH) score was 0.

The effect of joint distraction osteogenesis combined with platelet-rich plasma injections on traumatic ankle arthritis

OBJECTIVE

To study effect of joint distraction osteogenesis combined with platelet-rich plasma injections on traumatic ankle arthritis (TAA).

METHODS

106 patients with TAA admitted to our hospital (from January 2018 to January 2020) were recruited as the study cohort and randomly divided into a surgical group and a combined group. The surgical group was treated with simple joint retraction surgery, and the combined group was treated with platelet-rich plasma injections in addition to the surgery administered to the operation group. After 6 months of treatment, the clinical efficacy of the two groups was evaluated, and the changes in the ankle joint function, the serum related factors, and the quality of life before and at six months after the treatment were observed. The incidences of adverse reactions (ARS) in the two groups were counted to evaluate the treatment safety.

RESULTS

The total effective rate was 98.11% in the combined group and 77.36% in the operation group. The overall curative effect of the combined group was better than it was in the operation group (P<0.05). After the treatment, the ankle joint movement angles, the joint function, the serum factor levels, and the quality of life of the patients in combined group were better than they were in the operation group (P<0.05). No significant difference was found in the incidence of ARs (P>0.05).

CONCLUSION

Arthroplasty with platelet-rich plasma injections can improve joint function recovery, inhibit the inflammatory factor expression levels, and enhance TAA patients' quality of life.

Comparison of different bone graft with arthroscopy-assisted arthrodesis for the treatment of traumatic arthritis of the subtalar joint

AIM OF THE STUDY

To compare the clinical outcomes of traumatic arthritis of the subtalar joint treated by arthroscopy-assisted arthrodesis with autologous bone graft, allogenous bone graft, artifical bone graft, and no bone graft .

METHODS

Sixty-two patients (64 ft) with traumatic arthritis of subtalar joint were randomly divided into four groups. The cases treated with arthroscopy-assisted arthrodesis were analyzed retrospectively. The mean follow-up time was about 22 months (18-28 months) in each group. Clinical outcomes were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) score, Visual Analog Scale (VAS), and radiographic examination. The post-operative complications in each group were recorded respectively.

RESULTS

All operations were successful, without incision complications. The subtalar joint obtained full osseous fusion in each group. The average time of osseous fusion was about 12 weeks. There was no significant difference in the fusion time with each group (P = 0.991). The AOFAS and VAS scores in each group were improved significantly in the pre-operative vs post-operative evaluation (all P < 0.01). The average operation time in autologous bone graft group was 74.56 ± 11.45 min which significantly different from that of other groups(P < 0.01).

CONCLUSION

Similar clinical outcomes were achieved among each type of bone graft. Therefore, which types of bone graft or not may be not the most important for arthroscopy-assisted subtalar arthrodesis.

The management of acetabular malunion with traumatic arthritis by total hip arthroplasty

Objective: To explore the treatment strategies and clinical effect of the acetabular malunion with traumatic arthritis by total hip arthroplasty.

Methodology: A retrospective analysis was conducted on 47 cases of acetabular malunion with traumatic arthritis from June 2000 to December 2009. All the patients underwent total hip arthroplasty with bone grafting or titanium cage for bone defect of the acetabulum. Harris hip scoring system was used for evaluating the functional recovery of the hip joint.

Results: Thirty three cases had an average of 47 months follow-up. No prosthesis was loosened and the function of hip joint was improved obviously with the Harris hip scores improving from 43.5 to 87.6. However, there were one case of sciatic nerve injury and four cases of heterotopic ossification postoperatively.

Conclusion: Total hip arthroplasty might be an effective treatment of acetabular malunion with traumatic arthritis. Proper evaluation and reasonable reconstruction of acetabular defect as well as reasonable selection of prosthesis are essential to obtain an excellent outcome.