Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 2025
Randomized Controlled Trial Comparative StudyContinuous local infiltration analgesia is equal to femoral and sciatic nerve block for total knee arthroplasty.
Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. Pain control is crucial for rapid mobilisation and reduces side effects as well as the length of hospital stay. In this context, a variety of multimodal pain control regimes show good pain relief, including several nerve blocks, iPACK and local infiltration analgesia (LIA). To compare the analgesic potency of LIA and the combination of continuous femoral nerve block + sciatic single-shot nerve block under general anaesthesia, we conducted a prospective, randomized, controlled, non-blinded single-centre study. ⋯ Both techniques are well established, provide equal pain relief for TKA and support early postoperative mobilisation.
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Arch Orthop Trauma Surg · Jan 2025
Treatment of both bone forearm fractures with 2.7 mm plates: a non-inferiority study.
To determine the effectiveness of 2.7 mm plates in treating both bone forearm fractures (BBFFs) compared to the current gold standard of 3.5 mm fixation. More specifically, to determine if 2.7 mm plates are non-inferior to the current standard of 3.5 mm plates. ⋯ Level III, retrospective cohort study.
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Arch Orthop Trauma Surg · Jan 2025
Leukocyte scintigraphy has high specificity but low sensitivity in diagnosing persistent periprosthetic joint infection before reimplantation in two-stage revision.
Two-stage revision is considered the gold standard treatment in chronic periprosthetic joint infection (PJI) but no specific criteria or examination exist to determine infection eradication before reimplantation. This study aimed to assess the diagnostic performance of leukocyte scintigraphy after the first-stage procedure in two-stage revision for chronic PJI. ⋯ Due to the high costs and the difficulty in its execution, LLS should not be used routinely but it could represent an additional criterion in doubtful cases. In any case, a thorough evaluation of other pre- and intra-operative tests is essential to determine whether reimplantation or spacer renewal is the best course of action. Special consideration should be given to positive LLS, as its results are highly specific and have a low rate of false positives. Conversely, in over half of infected patients, LLS could give false negatives, making negative LLS results less relevant.
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Arch Orthop Trauma Surg · Jan 2025
Factors predicting manipulation under anaesthesia after total knee replacement.
Manipulation under anesthesia (MUA) is a standard and effective treatment to correct stiffness and improve range of motion (ROM) following total knee arthroplasty (TKA). Delayed MUA has been associated with increased rates of revision surgeries and infections. Early MUA has been shown to double the mean gain in flexion compared to delayed interventions. To identify candidates early and effectively, this study aimed to evaluate various risk factors influencing the likelihood of undergoing MUA after TKA using statistical analysis. ⋯ Our study demonstrates that younger age, female sex, and Black race are significant predictors of MUA after TKA. Additionally, novel risk factors such as peripheral artery disease (PAD), chronic kidney disease (CKD), and sickle cell disease (SCD) were identified, with SCD notably increasing the likelihood of MUA. This study uniquely highlights reduced likelihoods of MUA in PAD and CKD patients, contrasting with prior literature. The significant association of SCD with MUA, alongside these novel findings, emphasizes the value of demographic and comorbidity-specific predictors in refining postoperative risk stratification.
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Arch Orthop Trauma Surg · Jan 2025
Predicting surgical site infections after open reduction and internal fixation for ankle fractures.
Surgical site infections (SSI) are one of the more severe complications following ankle surgery. It is associated with worse outcomes and re-admissions. Therefore, identification of risk factors is essential. The aim of this study was to identify risk factors for SSI in patients undergoing surgery for ankle fractures. ⋯ Higher age, DM, ASA 2 and 3, bi- and trimalleolar fractures, open fractures and standard plate-size implant placement were identified as significant risk factors for SSI. Open fracture was the only significant independent risk factor for SSI after ORIF of ankle fractures. In deep SSI, there were different risk factors. DM, ASA 3 and 4, and open fractures were significantly associated. Although, open fracture and ASA 3 and 4 were the significant independent risk factors.