Formosan Journal of Musculoskeletal Disorders/中華骨科醫學雜誌
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- Ahead-of-Print
中華民國骨科醫學會,正常發行
選擇卷期
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Background: The center-center (CC) lag screw position has been widely accepted as the optimal lag screw position in femoral intertrochanteric fracture (FITF) surgery to achieve a tip-apex distance (TAD) of ＜ 25 mm. Despite some biomechanical advantages regarding the inferior-center (IC) lag screw position and the emergence of the calcar-referenced tip-apex distance (CalTAD), the clinical differences between the two commonly placed lag screw positions remain unclear. Purpose: This study aimed to report radiological outcomes in managing geriatric FITFs and identify the influences of the lag screw position. Methods: We retrospectively assessed the clinical and radiographic findings of geriatric patients (age ≥ 60 years) who underwent osteosynthesis for acute closed FITFs using either dynamic hip screw (DHS) or Gamma 3 nail (Gamma) fixation during a 1-year period and were followed up for a minimum of 12 months. The radiographic parameters and incidence of fixation failure were compared between different lag screw positions (CC vs. IC). Subgroup analyses of different implant types (DHS and gamma) were also performed to compare different lag screw positions. Results: A total of 112 patients (4.5%) with fixation failure were included. There were no differences in the incidence of fixation failure between the commonly inserted 2 lag screw positions, regardless of the implant type. The lag position other than the CC or IC position revealed a higher rate of poor reduction quality, lesser neck-shaft angle, and a higher rate of fixation failure. Regarding each implant, comparable results were obtained for either the lag screw positioned in the CC or IC. Conclusion: Regardless of implant type, the surgical results were comparable between the CC and IC positions of the lag screw as long as the rules of TAD and CalTAD were followed.
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Background: The apex of tibial tuberosity (TT) is traditionally used to represent the insertion of patellar tendon (PT) in various clinical applications. However, whether the TT is located at the PT center and can represent the PT in all studies has not been verified before. Purpose: The purpose of this retrospective study is to verify such a doubt, and consequently using the TT in clinical application might be wider and believable. Methods: The locations of the apex of TT and the PT center in magnetic resonance imaging were investigated in 100 consecutive young adult patients (50 men and 50 women; average, 27 years). The tibial width (TW), the distance from the apex of TT and the PT center to the lateral end of TW, and the PT width were measured. The ratios of the TT distance and the PT center distance to the TW were compared statistically. Results: The TW was on average 64 mm (62-66 mm). The apex of TT was on average 38% (37%-39%) from the lateral end of TW. The PT center was on average 37% (36%-38%) from the lateral end of TW. Except the TW and the PT width (both, p ＜ 0.001), there was no statistical significance in all other comparisons between sexes (p ＞ 0.05). The correlation between the TT distance and PT center distance in 100 patients was 0.84. There was statistical difference between the two parameters (p = 0.02). Conclusion: Although the PT center is lateral to the apex of TT, the discrepancy is minimal (on average 1% of TW, about 0.6 mm; or 3% of PT width). Clinically, using the apex of TT to represent the insertion of PT may be reasonable.
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Background: Pedicle screws have been used and modified in spinal surgeries for several decades. Several methods of pedicle screws implantation and assisted tools have been invented and modified. For minimally invasive pedicle screws insertion, we introduce a novel 3D-printed guiding apparatus. Purpose: The purpose of this study is to present the design, demonstrate the protocol, and discuss the advantages of the novel guiding apparatus. Methods: First, the design process of 3D-printed guiding apparatus was presented. Then, the spinal model from Sawbones was used to demonstrate the procedure of pedicle screw insertion using this surgical template. Results: A prototype of 3D-printed guiding apparatus was created from computed tomography (CT) scans of the spinal model. The testing procedure showed that pedicle screw insertion could be performed without pedicle violation. Conclusion: The novel 3D-printed guiding apparatus can be easily customized by 3D-printer from CT scans. It can also reduce radiation exposure, decrease skin damage, and minimize soft tissue disruption. However, in the future, further research including an experimental testing with a larger sample size is needed to verify the preliminary outcome and assumption, and additional clinical studies are required to determine the safety, efficacy of the device in humans. In the end, the newly designed apparatus can be an alternative to pedicle screw placement.
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This case demonstrates the risk factor analysis and nonsurgical treatment for a 66-year-old woman who sustained a femoral neck fracture following intramedullary fixation of ipsilateral femoral shaft fracture. She was managed with non-steroidal anti-inflammatory drug, rest, early mobilisation with walking aid, calcium, vitamin D, and anti-osteoporosis drugs. She can walk full weight bearing without any walking aid after 8 months of conservative treatment. Femoral shaft fracture in a group of patients with combination of elderly age, valgus hip, metabolic bone disease, and obesity needs meticulous planning and keeping high vigilance over ipsilateral femoral hip joint. It is utmost important to make early diagnosis and find out the cause of femoral neck fractures along with assessment of underlying systemic diseases like hypothyroidism. Conservative treatment for lesser symptomatic minimally displaced impacted fractures is a patient-friendly approach, as the inherent stability of the fracture can allow rapid healing without further surgical attempts.
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Simultaneous bilateral proximal tibial stress fractures in a healthy male non-athlete: A case report
Although stress fractures commonly occur in the tibia, tarsals, and metatarsals, simultaneous bilateral stress fractures of proximal tibiae are rare entities. Herein, we present a 46-year-old male patient with no history of knee trauma developing bilateral stress fractures of the proximal tibiae. He presented with persistent bilateral anteromedial knee pain that was exacerbated after he jogged on impulse. The radiographs were normal, but magnetic resonance imaging revealed proximal tibial stress fractures 2 weeks later. Under proper diagnosis, the patient finally achieved a good outcome by conservative treatment with brace protection, multimodal pain-killers, and strontium ranelate. Stress fractures may be easily misdiagnosed especially when we dealt with fit adult patients who present with anteromedial knee pain even in non-athletes with sudden changes in exercise habits.
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Ankylosing spondylitis (AS) is an inflammatory disorder of unknown cause that primarily affects the axial skeleton. Kyphotic deformity is common, and spinal osteotomy is usually mandatory to restore trunk balance. Many spinal osteotomy techniques show good results in mild to moderate kyphosis (＜ 70°). However, only a little literature focuses on the patients with severe kyphosis (＞ 70°). We report the case of a 28-year-old man with clinical and radiological diagnosis of AS with severe thoracolumbar kyphosis (110°) who received staged pedicle subtraction osteotomy at two levels. Literature review was performed. This technique is a safe and effective alternative to correct thoracolumbar kyphosis and to restore spine balance.
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Monteggia fracture is rare in infants and is frequently overlooked initially. This is especially true in cases that occur before the appearance of ossification centers in the elbow. Treatment should be optimized to avoid long-term complications. We report a 12-month-old child with neglected Monteggia fracture who achieved a successful outcome after receiving an arthrography-assisted closed reduction of the radial head dislocation and an ulnar osteotomy with plate fixation and bone graft. The patient had a stable radiocapitellar joint with full range of motion at the final follow-up.