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1. Suprapatellar tibial fracture nailing is associated with lower rate for acute compartment syndrome and the need for fasciotomy compared with the infrapatellar approach

Author

Essi E. Honkonen, Jussi P. Repo, Heidi Lehtokangas, Emma Luoma, Mikko Uimonen, Sami Nurmi, Antti Ylitalo, Antti Riuttanen, Tiia Kivelä, Ville M. Mattila, and Piia Suomalainen

Subjects
Acute compartment syndrome, Fasciotomy, Suprapatellar approach, Infrapatellar approach, Tibial saft fracture, Intramedullary nail, Orthopedic surgery, RD701-811
Abstract

Abstract Background Intramedullary tibial nailing (IMN) is the gold standard for stabilizing tibial shaft fractures. IMN can be performed through an infra- or suprapatellar approach. Purpose The aim of this study is to compare the rate of fasciotomies for acute compartment syndrome between infra- and suprapatellar approaches. Methods A total of 614 consecutive patients who were treated with IMN for tibial fracture between October 2007 and February 2020 were included in the study. The approach used for IMN was determined by the operating surgeon. Infrapatellar IMN was performed with the knee in deep flexion position, with or without calcaneal traction. Suprapatellar IMN was performed in straight or semiflexed position. The diagnosis of compartment syndrome was based on clinical analysis, but for some patients, a continuous compartment pressure measurement was used. The primary outcome was the rate of peri- and postoperative compartment syndrome treated with fasciotomies. Results The study sample included 513 patients treated with infrapatellar IMN and 101 patients treated with suprapatellar IMN technique. The mean age of the patients was 44.7 years (infrapatellar technique) and 48.4 years (suprapatellar technique). High energy trauma was seen in 138 (27%) patients treated with infrapatellar technique and in 39 (39%) patients treated with suprapatellar technique. In the suprapatellar group (n = 101), there were no cases of peri- or postoperative compartment syndrome treated with fasciotomies. In the infrapatellar group (n = 513), the need for fasciotomies was stated in 67 patients, 31 patients (6.0%) perioperatively and in 36 patients (7.0%) postoperatively. The rate of fasciotomies (0/101 versus 67/513 cases) differed significantly (p

Published
2024
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2. Non-surgical and surgical treatments for rotator cuff disease:a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation

Author

Juhana Leppilahti, Tero Irmola, Juha Paloneva, Sanna Cederqvist, Ilkka Kiviranta, Jari Ylinen, Tapio Flinkkilä, Markus J. Sormaala, Heidi Lehtokangas, Juho Liukkonen, Konsta Pamilo, Hannu Kautiainen, Kai Sirniö, Tero Ridanpää, Tampere University, Department of Musculoskeletal Diseases, Clinical Medicine, HUS Medical Imaging Center, Department of Diagnostics and Therapeutics, Clinicum, Medicum, HUS Musculoskeletal and Plastic Surgery, Department of Surgery, I kirurgian klinikka (Töölö), and Helsinki University Hospital Area

Subjects
CONSTANT SCORE, SURGERY, medicine.medical_treatment, law.invention, Arthroscopy, Rotator Cuff, CONSERVATIVE TREATMENT, 0302 clinical medicine, Randomized controlled trial, law, Immunology and Allergy, Medicine, 030212 general & internal medicine, tendinopathy, 030222 orthopedics, Rehabilitation, IMPINGEMENT SYNDROME, 3. Good health, Tendon, medicine.anatomical_structure, Treatment Outcome, PHYSIOTHERAPY, Adult, medicine.medical_specialty, Visual analogue scale, Shoulders, Immunology, EXERCISES, 3121 Internal medicine, General Biochemistry, Genetics and Molecular Biology, rehabilitation, 03 medical and health sciences, Rheumatology, Shoulder Pain, Humans, Rotator cuff, REPAIR, business.industry, TEARS, DECOMPRESSION, orthopedic procedures, ACROMIOPLASTY, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, Surgery, Clinical trial, Treatment, patient reported outcome measures, 3121 General medicine, internal medicine and other clinical medicine, Tendinopathy, business, Follow-Up Studies
Abstract

Background Rotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression and non-surgical treatments provide equivalent results in RCD without a full-thickness tendon lesion. However, the importance of surgery for full-thickness tendon tears remains unclear. Methods In a pragmatic, randomised, controlled trial, 417 patients with subacromial pain underwent 3-month initial rehabilitation and MRI arthrography (MRA) for the diagnosis of RCD. Of these, 190 shoulders remained symptomatic and were randomised to non-surgical or surgical treatments. The primary outcomes were the mean changes in the Visual Analogue Scale for pain and the Constant Murley Score for shoulder function at the 2-year follow-up. Results At the 2-year follow-up, both non-surgical and surgical treatments for RCD reduced pain and improved shoulder function. The scores differed between groups by 4 (95% CI −3 to 10, p=0.25) for pain and 3.4 (95% CI −0.4 to 7.1, p=0.077) for function. Among patients with full-thickness ruptures, the reduction in pain (13, 95% CI 5 to 22, p=0.002) and improvement in function (7.0, 95% CI 1.8 to 12.2, p=0.008) favoured surgery. Conclusions Non-surgical and surgical treatments for RCD provided equivalent improvements in pain and function. Therefore, we recommend non-surgical treatment as the primary choice for patients with RCD. However, surgery yielded superior improvement in pain and function for full-thickness rotator cuff rupture. Therefore, rotator cuff repair may be suggested after failed non-surgical treatment. Trial registration details ClinicalTrials.gov, NCT00695981 and NCT00637013.

Published
2021

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