Bony Mallet Finger: A Comparative Review of Approaches in Pediatric vs. Adult Populations
Davide Gravina1*, Alessandro Portoghese2, Filippo Pantaleoni1, Marta Montanari1, Andrea Manfredi1, Andrea Leti Acciaro1
1Department of Hand Surgery and Microsurgery, AOU Policlinico di Modena, Italy
2Department of Plastic, Reconstructive and Aesthethic Surgery, University of Modena and Reggio Emilia, AOU Policlinico di Modena, Italy
Background: Bony mallet finger injuries result from distal phalanx fracture, often involving avulsion fractures of the distal phalanx. Optimal management remains debated, particularly between pediatric and adult populations.
Objective: This review compares surgical and conservative treatments for acute bony mallet finger fractures, focusing on healing times, functional recovery, and complications.
Methods: A systematic search of PubMed, Scopus, and Cochrane Library (2014–2024) identified studies evaluating treatment strategies in adults and children. Outcomes assessed included healing time, clinical recovery, and complication rates.
Results: Conservative treatment, was preferred in adults, leading to healing times of 6–8 weeks but with a higher incidence of deformities. Surgery, useful in pediatric cases, provided faster recovery and superior functional outcomes. The Ishiguro method in children showed improved extension recovery with shorter immobilization. Surgery in adults led to quicker functional recovery but had higher complication rates. Pediatric surgical cases had a slightly higher risk of growth disturbances, though overall better functional outcomes.
Conclusions: Pediatric patients had superior long-term outcomes regardless of treatment modality. While conservative treatment in adults resulted in prolonged recovery and more deformities, surgery carried a higher complication risk. Both groups showed a favorable prognosis, warranting further research to refine treatment strategies.
DOI: 10.29245/2767-5130/2025/2.1221 View / Download PdfRevision of Dual Mobility Implants Due to Impingement and Femoral Neck Notching: A Case Series
Cameron Bussey-Sutton1, Peter K. Sculco3, Stephen Duncan2, Ran Schwarzkopf1, Matthew Hepinstall1*
1Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
2Department of Orthopaedic Surgery, University of Kentucky, Lexington, KY, USA
3Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
Impingement of femoral stems against metal dual mobility (DM) acetabular components after total hip arthroplasty (THA) can lead to notching of the femoral neck. The consequences may include debilitating pain, mechanical symptoms, release of metal debris, aseptic cup loosening, joint instability, dislocations, and the theoretical risk of femoral implant fracture. We report a primary case of a 35-year-old female who experienced impingement and femoral notching following DM THA and subsequently underwent revision due to these complications. This case is part of a series of 4 patients with similar complications. Following revision, all patients experienced symptom relief. Further studies are needed to determine the incidence of this issue, identify risk factors, and evaluate the outcomes of revision versus nonsurgical management for both symptomatic and asymptomatic cases.
DOI: 10.29245/2767-5130/2025/2.1220 View / Download PdfPreemptive Analgesia for Pain Management in Total Knee Arthroplasty: An Asian Perspective
Shaam Achudan*, Kevin Anthony Jing Ming Chong, Remesh Kunnasegeran
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
Background: Knee osteoarthritis is a debilitating condition affecting up to 11% of individuals in Singapore. Total knee arthroplasty (TKA) is one of the most effective treatments for this condition. However, it is also associated with significant post-operative pain that can limit post-operative rehabilitation and outcomes. Preemptive analgesia (PA) is a proactive approach to pain management and has shown promising outcomes.
Objective: To study the short-term outcomes of preemptive analgesia in patients undergoing TKA.
Method: A retrospective review of a database from January 2022 to December 2022 identified all TKA cases performed by one senior orthopaedic surgeon. Eligible patients were divided into those who received PA and those who did not receive PA. The PA group received oral medications consisting of 50 mg tramadol, 200 mg celecoxib, 1000 mg paracetamol, and 300 mg gabapentin one hour before surgery. No preoperative analgesia was given in the non-PA group. Outcome assessments included VAS scores at 6 and 24 hours postoperatively, degree of active range of motion (ROM) of the knee and the ability to perform a straight leg raise (SLR) 24 hours after surgery, requirement of breakthrough analgesia and length of stay (LOS) in the hospital.
Results: 104 patients were identified, with 53 patients in the PA group and 51 patients in the non-PA group. The PA group had lower VAS scores at 6 hours (1.94 vs. 2.24), but higher VAS scores at 24 hours compared to the non-PA group (3.75 vs. 3.43). Differences in VAS scores were not statistically significant. The ROM and SLR were similar between the PA and the non-PA group (83.4° vs. 81.3°, P = 0.44) and (77.4% vs. 68.6%, P = 0.25). There was no significant difference in requirements of breakthrough analgesia between both groups. LOS was comparable between both groups as well.
Conclusion: The use of preemptive analgesia with a combination of tramadol, celecoxib, paracetamol, and gabapentin did not significantly reduce postoperative pain after TKA.
DOI: 10.29245/2767-5130/2025/2.1210 View / Download Pdf