Purpose of the study: Lumbar Degenerative Disc Disease is a pathologic process that affects a large portion of aging population. Mobile lumbar disc replacement is a treatment option that preserves the natural movement of the functional spinal unit. The study aimed to evaluate the long-term functional and radiological outcomes of Maverick and Prodisc implants.
Material and methods: Monocentric longitudinal observational study with a follow up ≥ 10 years. ODI and VAS were assessed and functional radiographs were evaluated. Analysis of revision surgery via Cox regression, analysis of quantitative data by linear regression and Mann-Whitney-Wilcoxon test.
Results: There were 3 revision surgeries in the Maverick group and no revision surgery in the Prodisc group (p=0.1012). The mean ODI (Maverick) was 16.5 (95% CI 10.3-22.8) vs. 11.8 (95% CI 5.6-17.9) in Prodisc, p = 0.5999. Mean lumbar VAS in Maverick reached 4.11 (2.78-5.45), in Prodisc 3.13 (1.99-4.26), p = 0.3100. Both ODI and VAS correlated negatively with the left-sided lateroflexion. R = (-0.5084), p = 0.0312 for ODI and R = (-0.538), p = 0.0210 for VAS. Heterotopic calcifications were significantly higher in men with the mean grading of 2.8 vs.1.7 in women, p = 0.0251. Urogenital complication was reported in one patient.
Discussion: The results of our study were concordant with similar longitudinal studies. A more detailed discussion is included in our full-text paper.
Conclusions: The long-term outcomes were poorer than the short-term ones, but satisfactory. A decrease in the range of motion and an increase in ODI and VAS scores were observed due to ongoing degenerative changes of the posterior segment. The heterotopic calcifications were common but were not associated with the revision surgery.
Purpose of the study: Untreated osteoporosis often leads to subsequent fractures associated with high morbidity and mortality. In the Czech Republic, approximately 15,000 patients are hospitalized annually with femoral neck fractures, with up to 25% mortality within the first year after a hip fracture. Establishing a coordinated post-fracture care program, such as Fracture Liaison Services (FLS), may substantially reduce this burden. In the FLS model, the role of the coordinator is pivotal. This study aimed to assess baseline adherence to national postfracture care guidelines and to evaluate nurses' attitudes toward the FLS program and the role of FLS coordinators in the Czech Republic.
Material and methods: Between May 25 and July 14, 2023, an anonymous electronic questionnaire was distributed to members of the Czech Association of Nurses working in surgical, orthopedic, and trauma departments. The survey assessed adherence to guideline-recommended discharge procedures and attitudes toward FLS implementation and coordinator certification.
Results: Adherence to national guidelines was poor across all evaluated domains of post-fracture care. Only a minority of respondents reported consistent patient education, scheduling of follow-up visits, referral for DXA examination, or prescription of vitamin D and calcium supplements. Nevertheless, 76% of participants believed that implementing an FLS program would improve the quality and effectiveness of post-fracture care, and 61% expressed interest in specialized training to become certified FLS coordinators.
Conclusions: Despite substantial gaps in current adherence to post-fracture care guidelines, nurses demonstrated strong support for the FLS model and recognized the importance of the coordinator role. These baseline findings indicate that successful implementation of FLS programs in the Czech Republic will require both system-level coordination and motivated, trained nurse coordinators.
Purpose of the study: Congenital hallux varus associated with preaxial polysyndactyly of the foot is a rare deformity for which standardized treatment protocols and outcome data remain limited. The purpose of this study was to evaluate the mid-term clinical and radiographic outcomes of early surgical reconstruction in a consecutive pediatric series.
Material and methods: Between 2015 and 2023, eight affected feet in seven children with congenital preaxial polysyndactyly and hallux varus were surgically treated at a single tertiary pediatric orthopedic center. The diagnosis was established at birth. The mean age at surgery was 31.62 ± 36.64 months. All patients exhibited varus deviation of the first ray, duplication of the distal phalanx, complete or partial duplication of the proximal phalanx, soft-tissue syndactyly, duplicated or shared nail plates, and a hypoplastic medial ray. Surgical treatment consisted of resection of the hypoplastic medial hallux, abductor hallucis tenotomy, excision of chondrofibrous bands when present, subtotal periosteal stripping of the first metatarsal, and medial open-wedge osteotomy of the first metatarsal or proximal phalanx in selected cases. Outcomes were assessed clinically and radiographically, and graded using the Phelps and Grogan classification.
Results: At a mean follow-up of 45.14 ± 18.79 months (range, 24 to 82 months), satisfactory outcomes were achieved in 87.5% of the treated feet. Significant correction of the hallux varus deformity was obtained, with preservation of motion of the first metatarsophalangeal and interphalangeal joints. No patient required secondary surgical procedures. One patient who did not undergo initial metatarsal osteotomy demonstrated progressive recurrent varus during follow-up.
Conclusions: Early surgical correction of congenital hallux varus polysyndactyly (between 12 and 18 months of age) yields favorable mid-term outcomes. Medial open-wedge osteotomy of the first metatarsal represents a critical component for durable correction and should be considered even in low-grade deformities.
Tendinopathies are common and hete- rogeneous, and recovery depends on both the local biological milieu and appropriately progressed mechanical loading. Platelet-rich plasma (PRP) is a biologically plausible adjunct, yet reported clinical effects are inconsistent, likely due to variation in phenotype, PRP formulation and dosing, delivery technique, and rehabilitation protocols. Ultrasound guidance improves injection accuracy and safety, but its incremental clinical value may be context dependent. This review outlines tendon-healing biology, summarizes evidence for conservative management, and appraises PRP - its putative mechanisms, sources of heterogeneity, and its integration into individualized, multimodal care.
Purpose of the study: Fifth metacarpal neck fractures rank among the most common fractures of the hand skeleton. Only about 10% of these fractures are treated surgically. There are multiple surgical treatment options. This study aims to compare the outcomes of plate osteosynthesis with those of the "bouquet" technique.
Material and methods: Two cohorts of patients with fractures to the neck of fifth metacarpal treated at a district hospital and at a university hospital between 2017 and 2022 were evaluated, namely due to a different approach to fracture management. The district hospital cohort included 240 patients (215 men and 25 women). The mean age of patients was 31.5 years (15-91). At the university hospital, 363 patients were treated (323 men, 40 women), with a mean age of 30.3 years (16-87). In both cohorts, men outnumbered women (p < 0.0001). The exclusion criteria were age under 15 years and open fractures.
Results: There were differences between the centers in both the indications for and the performance of non-surgical and surgical treatment. At the district center, 48 patients (20%) underwent surgery. All patients were treated using the "bouquet" technique. At the university center, 27 patients (7%) underwent surgery. Two different methods were used for osteosynthesis. Plate osteosynthesis prevailed (21 patients), while the "bouquet" technique was used less frequently (6 patients). The higher proportion of patients who underwent surgery at the district center was statistically significant (p < 0.0001).
Discussion: There are no studies in the current literature that clearly give preference to one method over the others. At both centers, a volar angulation of the peripheral fragment exceeding 30° was considered a radiographic indication for surgical treatment. A high percentage of patients who underwent surgery in the district cohort was due to a different non-surgical treatment approach. The study found no difference in clinical findings after fracture healing between patients treated surgically using the "bouquet" technique and those treated with plate osteosynthesis.
Conclusions: Appropriate non-surgical treatment is essential for successful management of boxer's fractures. Physicians who treat musculoskeletal traumas should be adequately trained in this field. Where adequate non-surgical treatment is provided, only a small percentage of fractures require surgery. There are many surgical treatment options available; currently, none can be clearly recommended over the others. When comparing plate osteosynthesis and the "bouquet" technique, the authors' experience confirmed the well-known fact that displacement of fragments in the postoperative period can be prevented by adhering to all principles of good surgical practice for each treatment method.
Purpose of the study: The indication for surgery for isolated lateral malleolar fracture (AO/OTA 44B1) is debatable and in many cases, relies upon radiographic assessment of fracture stability. Artificial intelligence chatbots with visual analysis capabilities offer a potential attribute for radiographic assessment. This study compared the diagnostic performance of a commercially available AI chatbot with that of three fellowship-trained orthopedic trauma surgeons in evaluating equivocal isolated lateral malleolar fractures.
Material and methods: A retrospective study. 50 patients with isolated lateral malleolar injury at the level of the syndesmosis (AO/OTA 44B1) were evaluated by three blinded fellowship-trained orthopedic trauma surgeons. Each rater measured standardized radiographic ankle parameters, medial clear space, tibiofibular clear space, and tibiofibular overlap, on anteroposterior and mortise views and determined a surgical versus nonoperative treatment recommendation. Subsequently, the same sets of radiographs were independently evaluated by an AI chatbot (Claude, Anthropic). The observers and AI decisions were compared to the actual outcome of the patients (operative vs. nonoperatives).
Results: All raters recommended surgery at lower rates (34.0-46.0%) than the actual operative rate (56.0%). The difference in outcomes between the actual treatment and the observers varied and ranged between 67.3-86% with the AI within the same ranges. The AI's radiographic measurements differed systematically from all surgeons across five of six parameters. Inter-rater agreement between the AI and surgeons was slight, while inter-surgeon agreement was moderate (κ = 0.457-0.589). ROC analysis showed comparable AUC values (0.63-0.67) for all raters.
Discussion: The AI chatbot demonstrated diagnostic accuracy comparable to orthopedic trauma surgeons in directing treatment for isolated lateral malleolar fractures, despite using a systematically different measurement strategy. All raters exhibited conservative bias as comparted with the actual outcome with modest discriminatory ability, reflecting the inherent difficulty of this clinical issue. These findings support a potential complementary role for AI in ankle fracture triage, while final clinical management decisions should remain in the hands of the orthopedic surgeon.
The case report describes the option of percutaneous CT-guided ablation of osteoid osteoma with a double nidus to combine minimally invasive approach and CT(O-arm)-guided technique. Following X-ray, CT and MRI examinations, osteoid osteoma was diagnosed in the body of the second sacral vertebra (S2) in a 31-year-old female patient. CT reconstructions detected a double nidus with a defective, sclerotic rim. MRI demonstrated reaction in the surrounding tissue and edema in the nerve root. In consideration of the anatomic location of the osteoid osteoma and vicinity of the irritated S2 root percutaneous CT-guided intralesional resection of a double nidus was performed. There was immediate pain relief after the surgery, and the patient was discharged on the second postoperative day. The follow-up histological examination confirmed the diagnosis. During a five-year follow-up, the patient remained symptom-free and without recurrence of the disease. CT-guided minimally invasive resection of osteoid osteoma is an option in cases of benign tumor-like lesions located in the spine, as well as in cases of a double nidus. In comparison to radiofrequency ablation, percutaneous curettage enables obtaining valid histological specimens and does not bear the risk of thermal damage to neural tissue.
Purpose of the study: Treatment of classical Hodgkin lymphoma (cHL) can be eventually complicated by avascular necrosis of the femoral head (AVN FH). Stages 1 and 2 of AVN FH can be treated conservatively, but stages 3 and 4 are indicated for surgery. In adults, total hip replacement (THR) is the preferred method. The goal of our study was to analyze the risk factors for AVN FH and functional results after THR.
Material and methods: This is a single-center retrospective observational longitudinal study. Patients with AVN FH after previous cHL treatment were included. Basic epidemiological data, time to AVN FH and THR, and complications of hemato-oncological treatment and THRs were recorded. Risk ratios, derived from 2×2 tables and from univariate Cox regression and Kaplan-Meier graphs, were analyzed. Categorical data were evaluated using the Fisher exact test and quantitative data using the Mann-Whitney-Wilcoxon test. Outcomes were measured using the modified Harris Hip Score (MHHS).
Results: The mean incidence of AVN HF was 1.7 per year (95% CI 1.1-2.2). Patients with THRs tended to be older (p = 0.0424), the highest risk was ≥ 50 years. Mixed cellularity (MC) cHL had a higher risk of THR (log-rank test p = 0.0249) compared to nodular sclerosis (NS) cHL. Clinical stage IIB with massive mediastinal tumor was associated with the lowest risk of THR, p = 0.0348. The mean modified Harris Hip Score (MHHS) was higher in NS compared to MC subtype (85.1 (82.7-87.6) vs. only 75.4 (66.6-84.2), p = 0.0311). Periarticular calcification grade 1 was diagnosed in 84.6% of patients (95% CI 54.6-98.1). Revision surgery with cup and stem replantation was performed in one patient. No infections or cases of deep venous thrombosis were recorded.
Conclusions: THR is a causal treatment of symptomatic AVN FH following cHL treatment. Age ≥ 50 years, MC subtype cHL, and AVN FH stages 3 and 4 were associated with a higher risk of THR. The mean MHHS was fully comparable with THRs for other indications. Higher calcification rates had no impact on the clinical outcome.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：