BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are e...BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.展开更多
BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years,as they enhance precision compared to conventional hardware.The expansion of computer assistance is evolvi...BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years,as they enhance precision compared to conventional hardware.The expansion of computer assistance is evolving with the employment of augmented reality.Yet,the accuracy of augmented reality navigation systems has not been determined.AIM To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty(TKA),utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon.METHODS From May 2021 to December 2021,30 patients,25 women and five men,under-went a primary unilateral TKA.Revision cases were excluded.A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment.All patients were operated on by the same team,without a tourniquet,utilizing three distinct prostheses with the assistance of the Knee+™augmented reality navigation system in every operation.Postoperatively,the same radiographic exam protocol was executed to evaluate the implants’position,orientation and coronal plane alignment.We recorded measurements in 3 stages regarding femoral varus and flexion,tibial varus and posterior slope.Firstly,the expected values from the Augmented Reality system were documented.Then we calculated the same values after each cut and finally,the same measurements were recorded radiolo-gically after the operations.Concerning statistical analysis,Lin’s concordance correlation coefficient was estimated,while Wilcoxon Signed Rank Test was performed when needed.RESULTS A statistically significant difference was observed regarding mean expected values and radiographic mea-surements for femoral flexion measurements only(Z score=2.67,P value=0.01).Nonetheless,this difference was statistically significantly lower than 1 degree(Z score=-4.21,P value<0.01).In terms of discrepancies in the calculations of expected values and controlled measurements,a statistically significant difference between tibial varus values was detected(Z score=-2.33,P value=0.02),which was also statistically significantly lower than 1 degree(Z score=-4.99,P value<0.01).CONCLUSION The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized.Augmented reality navigation systems can bolster orthopaedic surgeons’accuracy in achieving precise axial alignment.However,further research is required to further evaluate their efficacy and potential.展开更多
BACKGROUND Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty.Implanting the accurate size of the acetabular component can occasionally be exacting,chiefly for surgeon...BACKGROUND Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty.Implanting the accurate size of the acetabular component can occasionally be exacting,chiefly for surgeons with little experience,whilst the complications of imprecise acetabular sizing or over-reaming can be potentially devastating.AIM To assist clinicians intraoperatively with a simple and repeatable tip in elucidating the ambivalence when determining the proper acetabular component size is not straightforwardly achieved,specifically when surgeons are inexperienced or preoperative templating is unavailable.METHODS This method was employed in 263 operations in our department from June 2021 to December 2022.All operations were performed by the same team of joint reconstruction surgeons,employing a typical posterior hip approach technique.The types of acetabular shells implanted were:The Dynasty®acetabular cup system(MicroPort Orthopedics,Shanghai,China)and the R3®acetabular system(Smith&Nephew,Watford,United Kingdom),which both feature cementless press-fit design.RESULTS The mean value of all cases was calculated and collated with each other.We distinguished as oversized an implanted acetabular shell when its size was>2 mm larger than the size of the acetabular size indicator reamer(ASIR)or when the implanted shell was larger than 4 mm compared to the preoperative planned cup.The median size of the implanted acetabular shell was 52(48–54)mm,while the median size of the preoperatively planned cup was 50(48–56)mm,and the median size of the ASIR was 52(50–54)mm.The correlation coefficient between ASIR size and implanted acetabular component size exhibited a high positive correlation with r=0.719(P<0.001).Contrariwise,intraoperative ASIR measurements precisely predicted the implanted cups’size or differed by only one size(2 mm)in 245 cases.CONCLUSION In our study,we demonstrated that the size of the first acetabular reamer not entering freely in the acetabular rim corroborates the final acetabular component size to implant.This was also corresponding in the majority of the cases with conventional preoperative templating.It can be featured as a valid tool for avoiding the potentially pernicious complications of acetabular cup over-reaming and over-sizing in primary total hip arthroplasty.It is a simple and reproducible technical note useful for confirming the predicted acetabular cup size preoperatively;thus,its application could be considered routinely,even in cases where preoperative templating is unavailable.展开更多
文摘BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.
文摘BACKGROUND Computer-assisted systems obtained an increased interest in orthopaedic surgery over the last years,as they enhance precision compared to conventional hardware.The expansion of computer assistance is evolving with the employment of augmented reality.Yet,the accuracy of augmented reality navigation systems has not been determined.AIM To examine the accuracy of component alignment and restoration of the affected limb’s mechanical axis in primary total knee arthroplasty(TKA),utilizing an augmented reality navigation system and to assess whether such systems are conspicuously fruitful for an accomplished knee surgeon.METHODS From May 2021 to December 2021,30 patients,25 women and five men,under-went a primary unilateral TKA.Revision cases were excluded.A preoperative radiographic procedure was performed to evaluate the limb’s axial alignment.All patients were operated on by the same team,without a tourniquet,utilizing three distinct prostheses with the assistance of the Knee+™augmented reality navigation system in every operation.Postoperatively,the same radiographic exam protocol was executed to evaluate the implants’position,orientation and coronal plane alignment.We recorded measurements in 3 stages regarding femoral varus and flexion,tibial varus and posterior slope.Firstly,the expected values from the Augmented Reality system were documented.Then we calculated the same values after each cut and finally,the same measurements were recorded radiolo-gically after the operations.Concerning statistical analysis,Lin’s concordance correlation coefficient was estimated,while Wilcoxon Signed Rank Test was performed when needed.RESULTS A statistically significant difference was observed regarding mean expected values and radiographic mea-surements for femoral flexion measurements only(Z score=2.67,P value=0.01).Nonetheless,this difference was statistically significantly lower than 1 degree(Z score=-4.21,P value<0.01).In terms of discrepancies in the calculations of expected values and controlled measurements,a statistically significant difference between tibial varus values was detected(Z score=-2.33,P value=0.02),which was also statistically significantly lower than 1 degree(Z score=-4.99,P value<0.01).CONCLUSION The results indicate satisfactory postoperative coronal alignment without outliers across all three different implants utilized.Augmented reality navigation systems can bolster orthopaedic surgeons’accuracy in achieving precise axial alignment.However,further research is required to further evaluate their efficacy and potential.
文摘BACKGROUND Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty.Implanting the accurate size of the acetabular component can occasionally be exacting,chiefly for surgeons with little experience,whilst the complications of imprecise acetabular sizing or over-reaming can be potentially devastating.AIM To assist clinicians intraoperatively with a simple and repeatable tip in elucidating the ambivalence when determining the proper acetabular component size is not straightforwardly achieved,specifically when surgeons are inexperienced or preoperative templating is unavailable.METHODS This method was employed in 263 operations in our department from June 2021 to December 2022.All operations were performed by the same team of joint reconstruction surgeons,employing a typical posterior hip approach technique.The types of acetabular shells implanted were:The Dynasty®acetabular cup system(MicroPort Orthopedics,Shanghai,China)and the R3®acetabular system(Smith&Nephew,Watford,United Kingdom),which both feature cementless press-fit design.RESULTS The mean value of all cases was calculated and collated with each other.We distinguished as oversized an implanted acetabular shell when its size was>2 mm larger than the size of the acetabular size indicator reamer(ASIR)or when the implanted shell was larger than 4 mm compared to the preoperative planned cup.The median size of the implanted acetabular shell was 52(48–54)mm,while the median size of the preoperatively planned cup was 50(48–56)mm,and the median size of the ASIR was 52(50–54)mm.The correlation coefficient between ASIR size and implanted acetabular component size exhibited a high positive correlation with r=0.719(P<0.001).Contrariwise,intraoperative ASIR measurements precisely predicted the implanted cups’size or differed by only one size(2 mm)in 245 cases.CONCLUSION In our study,we demonstrated that the size of the first acetabular reamer not entering freely in the acetabular rim corroborates the final acetabular component size to implant.This was also corresponding in the majority of the cases with conventional preoperative templating.It can be featured as a valid tool for avoiding the potentially pernicious complications of acetabular cup over-reaming and over-sizing in primary total hip arthroplasty.It is a simple and reproducible technical note useful for confirming the predicted acetabular cup size preoperatively;thus,its application could be considered routinely,even in cases where preoperative templating is unavailable.
