The Relation of Comorbidities with Outcomes of Carpal Tunnel Release Surgery
Canser Yilmaz Demir1*, Celaleddin Soyalp2, Burak Necati Isik1, Borhan Mohammed Abdo Radman1
1Department of Plastic, Reconstructive and Aesthetic Surgery, Van Yuzuncu Yil University, Medical Faculty, Van, Turkey
2Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University, Medical Faculty, Van, Turkey
Objective: Systemic diseases negatively affect carpal tunnel syndrome (CTS). Therefore, it is logical to hypothesize that systemic diseases may also be related to poor post-operative outcomes. Herein, the authors aimed to address the relationship between systemic diseases and carpal tunnel release outcomes.
Methods: Cases with carpal tunnel release were grouped and compared regarding to presence or absence of systemic diseases such as rheumatoid arthritis, diabetes mellitus, hypothyroidism, obesity, and hypertension. In this study, 48 cases were included (24 with and 24 without systemic diseases). The Boston Carpal Tunnel Questionnaire was used to evaluate the symptoms and functions in cases. Its higher scores indicate more negative symptoms and functional capacity.
Results: The groups with and without systemic diseases exhibited similarity in age and gender scores. Given symptoms and functions, cases with systemic diseases had significantly higher pre- and post-operative scores than cases without systemic diseases. In both groups, the scores from post-operative period were significantly lower than those in the pre-operative period (p<0.001). However, the groups exhibited similarity in mean difference in symptom and function scores between pre- and post-operative periods. Also, there were significant positive correlations between pre- and post-treatment scores.
Conclusion: This study demonstrated that systemic diseases are negatively associated with poor pre- and post-operative outcomes in CTS. These findings may contribute to more realistic post-operative expectations.
DOI: 10.29245/2767-5130/2025/3.1238 View / Download PdfClinical Case Report on Neglected Traumatic Subtalar Dislocation
Biruk Ferede Zewdu*, Endalk Fenta Andualem
Department of Orthopedics & Trauma Surgery, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
The subtalar joint is a complex joint in the foot formed by the articulation of the talus, calcaneus and navicular bone. Subtalar dislocations occur due to simultaneous dislocation of both talocalcaneal and talonavicular joints, without significant talus fracture. Neglected talar dislocations pose a significant challenge due to the high risk of complications. Tibiotalocalcaneal arthrodesis is an effective treatment for neglected talar dislocations, providing pain relief and functional improvement. Early surgical intervention is crucial to prevent long-term complications and achieve optimal outcomes. We report the functional results of case of a neglected subtalar dislocation in a 23-year-old man treated with open reduction and a tibiotalocalcaneal arthrodesis with a tibiotalocalcaneal nailing.
DOI: 10.29245/2767-5130/2025/3.1232 View / Download PdfOrthopedic Manifestations of Mucopolysaccharidoses and Perioperative Considerations: A Review of Literature
Isabell Igo*, Anderson Lee, Cody Smith, Maged Hanna
Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
Aims: This review investigates the musculoskeletal complications across all mucopolysaccharidosis types, highlighting those specific to each subtype and exploring perioperative concerns.
Methods: A comprehensive literature review was conducted using PubMed, Google Scholar, and Cochrane without restrictions on publication date, language, or article type. Search terms included: mucopolysaccharidoses, MPS, Hurler, Hunter, Sanfilippo, Morquio, Maroteaux-Lamy, Sly, Natowicz, orthopedic, musculoskeletal, anesthesia and perioperative complications.
Conclusions: MPS disorders are multifaceted conditions with diverse musculoskeletal involvement. Orthopedic management is crucial, as these abnormalities impair mobility, reduce quality of life, and pose unique perioperative challenges. Common findings include joint contractures, dysostosis multiplex, and spinal malformations, all of which increase operative risk. Limited joint and spine mobility, or cervical instability may complicate intubation and anesthesia.
Radiologic screening for cervical instability and early neurological evaluation are recommended before anesthesia. Orthopedic surgeons must recognize these manifestations and perioperative complications to ensure proper multidisciplinary management and improve surgical safety.
DOI: 10.29245/2767-5130/2025/3.1235 View / Download PdfReduction Techniques for Intramedullary Nailing of Subtrochanteric Femur Fractures: A Narrative Review
Akhil John*, Reuben Nappoly, Viju Daniel
Department of Orthopaedics, Christian Medical College (CMC), Vellore, India
Objective: To provide a state-of-the-art narrative review of contemporary reduction techniques for the intramedullary nailing (IMN) of subtrochanteric femur fractures (SFFs). This review critically appraises the evidence for various methods, culminating in a synthesized, evidence-based clinical algorithm to guide surgical decision-making.
Evidence Acquisition: A comprehensive literature search of the PubMed and Embase databases was conducted to identify relevant clinical studies, meta-analyses, biomechanical reports, and authoritative reviews published through 2024. The search focused on the biomechanics of SFFs, fracture classification, reduction techniques (including percutaneous joysticks, soft tissue rebalancing, and open cerclage/clamping), implant-related considerations, and the management of atypical femur fractures (AFFs). Emphasis was placed on incorporating high-quality evidence from 2018 to 2024 to ensure timeliness and comprehensiveness.
Evidence Synthesis: Anatomical reduction prior to fixation is the most critical determinant of successful outcomes in SFFs treated with IMN. The choice of reduction technique exists on a spectrum, balancing the biological benefits of minimally invasive surgery against the mechanical necessity of stable fixation. Recent evidence suggests that novel minimally invasive approaches, such as the soft tissue rebalancing technique, can achieve clinical and radiological outcomes equivalent to more invasive open methods while significantly improving operative efficiency. However, these techniques have specific limitations and learning curves. A balanced perspective on IMN reveals not only its clear biomechanical advantages but also potential risks, including iatrogenic malreduction, implant failure, and challenges in revision surgery. The management of AFFs requires distinct strategic modifications due to altered bone pathology and femoral geometry.
Conclusions: The optimal management of SFFs requires a versatile, graduated approach to reduction. Surgeons should begin with the least invasive methods and maintain a low threshold to escalate to more direct or open techniques as dictated by fracture complexity to achieve an anatomical result. The proposed clinical algorithm provides a systematic framework for technique selection. While novel techniques show promise, there is a clear need for high-level evidence, including prospective randomized controlled trials, to definitively establish their role. Future advancements in computer navigation, robotics, and implant design may further refine the treatment of these challenging injuries.
DOI: 10.29245/2767-5130/2025/3.1234 View / Download PdfCommentary: Tweaking The Fulcrum: Troubleshooting and barriers to implementation of a novel technique for reduction of shoulder dislocations
DOI: 10.29245/2767-5130/2025/3.1231 View / Download PdfPaul Carr
Department of Emergency Medicine, Northumberland Hills Hospital, Cobourg, Ontario, Canada
Rehabilitation Research Must Catch Up: A Call to Integrate Sex and Gender in Distal Radius Fracture Trials
DOI: 10.29245/2767-5130/2025/3.1228 View / Download PdfChristina Ziebart
School of Physical Therapy, Western University, London, Canada
High Fusion Rates Using Trinity Elite Cellular Bone Allograft in High-Risk Patients
Todd Lansford1, Anthony Russo2, Nasim Eshragh Nia3, Ian Cowgill3*
1South Carolina Sports Medicine, North Charleston, SC, USA
2Benefis Health System, Great Falls, MT, USA
3Orthofix US LLC, Lewisville, TX, USA
Introduction: Solid fusion is critical for successful spine and foot and ankle arthrodesis. Risk factors including smoking, obesity, diabetes, osteoporosis, and multilevel surgery elevate the risk of non-union. Cellular bone allografts (CBAs) have emerged as alternatives to autograft, but outcomes in high-risk populations remain insufficiently characterized.
Methods: This review examines a cellular bone allograft (TE-CBA) in spine and foot and ankle fusion procedures, with a particular emphasis on outcomes in patients with risk factors for non-union. Clinical endpoints included fusion success, patient-reported outcomes, complication rates, and the influence of patient risk profiles. Only studies that included high-risk populations were analyzed. The included studies were primarily Level IV evidence (prospective/retrospective with comparisons to previously published outcomes).
Results: In the lumbar spine, TE-CBA achieved a 90.5% fusion rate at 12 months and 95.3% at 24 months, with significant improvements in pain and function, even among high-risk patients. In ACDF procedures up to four levels, TE-CBA achieved a 97.4% fusion rate at 12 months, including 100% in one-, two-, and four-level procedures. In foot and ankle arthrodesis, 95.5% of patients achieved fusion within 12 months, with an average time to union of 6 months across patients with major risk factors. Studies employed strict fusion criteria, including combined motion analysis and CT-confirmed bridging bone.
Conclusion: TE-CBA demonstrated consistently high fusion success across anatomical sites in cohorts that included patients at high risk for non-union. Further controlled trials and mechanistic studies are needed to elucidate how CBAs might mitigate biologically impaired bone healing environments.
DOI: 10.29245/2767-5130/2025/3.1226 View / Download Pdf