Arthroereisis in juvenile flexible flatfoot:Which device should we implant?A systematic review of literature published in the last 5 years

BACKGROUND Flexible flatfoot(FFF)is a very common condition in children,characterized by the loss of the medial arch and by an increase in the support base with valgus of the hindfoot.Arthroereisis(AR)procedures are widely performed corrective surgeries and are classified as subtalar AR and calcaneo-stop(CS).AIM We investigated the literature published in the last 5 years with the aim of providing an update on the evidence related to AR treatment in FFF patients.We report the principal findings of subtalar AR and CS procedures concerning clinical and radiological outcomes and complication rates in the general population,young athletes,and obese people according to material device.METHODS Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses,a systematic review of studies published in the past 5 years and included the PubMed and Science Direct databases was performed on May 6,2020.The research string used was(pediatric OR children OR Juvenile NOT adult)AND(flexible NOT rigid)AND(flat foot OR pes planus)AND(calcaneo-Stop OR arthroereisis OR subtalar extra-articular screw OR SESA OR subtalar arthroereisis OR endosinotarsal).The risk of bias assessment was performed using the Dutch checklist form for prognosis.RESULTS A total of 47 articles were found.Ultimately,after reading the full text and checking reference lists,we selected 17 articles that met the inclusion and exclusion criteria.A total of 1864 FFFs were identified.Eight studies concerned the subtalar AR(47.1%)and nine concerning CS(52.9%).The average age of patients at start of treatment was 11.8 years,the average follow-up of the studies was 71.9 mo(range 29.1-130).Globally,complications occurred in 153 of the 1864 FFF treated,with a rate of 8.2%.CONCLUSION Both AR procedures are valid surgical techniques for treating FFF.Surgeon experience,implant cost,and cosmetic correction are the most common considerations included in the orthopedic device decision-making process.In obese patients,the subtalar AR is not recommended.In adolescents who need to improve sports performance,the CS screw had better results compared with other implants.

Total hip arthroplastyvs. osteosynthesis in acute complex acetabular fractures in the elderly:Evaluation of surgical management and outcomes

Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. <br> Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification) were treated. The patients were divided into two groups. The total hip arthoplasty (THA) group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12) health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group.P≤ 0.05 was considered statistically significant according to the analytical Student’s t-test. <br> Results: TheP < 0.05 in favor of theTHAgroup was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. <br> Conclusions: Our experience shows that theTHA treatment for acetabular fractures in the elderly is to be preferred.

Study on clinical effects of pedicle screw combined with immobilized implantation bone by wirerope and hallow compression screw immobilization in treating spondylolysis of lumbar vertebra of multiple segments of adults

Objective:To observe clinical effects of pedicle screw fixation combined with cable wires and bone graft and cannulated compression screws on adult multi-segment lumbar spondylolysis.Methods:70 cases of patients with multi-segment lumbar spondylolysis were selected in our hospital.According to different surgical schemes,these patients were divided into the observation group(35 cases)and the control group(35 cases).The observation group received pedicle screw fixation combined with cable wires and bone graft and the control group received cannulated compression screw fixation.Macnab criteria were adopted to implement a therapeutic evaluation of two groups of patients to make an observation and comparison of the excellent and good rate of surgery and a series of indicators including perioperative clinical effects,intraoperative blood loss,duration of surgery,hospital length of stay(HLOS),visual analogue scale(VAS),Oswestry disability index and Japanese Orthopaedic Association(JOA)score.Results:The excellent and good rate of the observation group was 97.14%,and that of the control group was 82.86%,the difference between two groups was statistically significant(χ^(2)=6.248,p=0.012).The differences in intraoperative blood loss,duration of surgery and HLOS between two groups were statistically significant(t=-4.55,t=-4.55,t=-4.55;p<0.05).Oswestry index,VAS score and JOA score of the observation group were(2.4±0.9),(28.5±6.4)and(27.1±3.1)respectively,and these of the control group were(3.5±1.2),(37.1±7.8)and(21.3±2.7)respectively,the differences between two groups were statistically significant(t=4.338,t=5.043,t=8.347,p<0.05).Conclusions:Pedicle screw combined with immobilized implantation bone by wirerope has an excellent clinical effect on the treatment of adult multi-segment lumbar spondylolysis,and it has a series of advantages such as fast postoperative recovery,small surgical trauma and so on.In addition,this technique can also restore the stability of spinal segments and relieve pains to a greater degree.

Fifth metatarsal fractures and current treatment

Metatarsal fractures are one of the most common injuries of the foot. There has been conflicting literatureon management of fifth metatarsal fractures due to inconsistency with respect to classification of these fractures. This article provides a thorough review of fifth metatarsal fractures with examination of relevant literature to describe the management of fifth metatarsal fractures especially the proximal fracture. A description of nonoperative and operative management for fifth metatarsal fractures according to anatomical region is provided.

Outcome ofJudet＇s quadricepsplasty for knee contractures and the effect of local infiltration of epinephrine on reducing blood loss

Objective： To evaluate the effectiveness ofJudet＇s quadricepsplasty for treatment of knee contractures and to identify the effect of local infiltration of epinephrine on blood loss associated with this procedure. Methods： A retrospective cohort study was conducted in which all cases of knee contractures managed with Judet＇s quadricepsplasty from 1st January 2009 to 31st December 2013 were included and were divided into two groups. The epinephrine group included patients who were infiltrated with diluted epinephrine （1：400,000） along with xylocaine, around the operative field 15 min prior to the incision time, while the control group did not receive any infiltration. Judet＇s outcome, blood loss, drop in he- moglobin and required blood transfusion were noted for all patients and compared between both groups. Results： Most common preceding pathology identified for the development of knee contractures was periarticular fracture while ilizarov application was the most common etiology. Both groups were found similar in all preoperative characteristics except preoperative flexion contracture （p = 0.02）. All func- tional outcome measures including Judet＇s outcome were similar in both groups. In contrast, duration of surgery （p = 0.01）, blood loss （p = 0.02）, drop in hemoglobin （p = 0.01） and number of transfusions （p = 0.03） were significantly reduced in epinephrine group. Conclusion： Judet＇s quadricepsplasty is a useful procedure to increase the range of motion of rigid knees and local infiltration of epinephrine is effective in decreasing the amount of subsequent blood loss and transfusion requirements.