The Thai Journal of Orthopaedic Surgery

Editorial

Theerachai Apivatthakakul, MD — 2021-10-15

The Thai Journal of Orthopaedic Surgery Volume 45 / Number 3-4 July-October 2021 is continue to published in this period of the COVID-19 pandemic. The third and fourth wave of the pandemic hit Thailand hardly started from mid April which effect the Orthopaedic treatment and the training program. The elective surgery has to be postponed, only the urgency and emergency cases can be done with limited resource. The RCOST 2021 meeting will be held at Royal Cliff Beach resort with the new hybrid format under strictly COVID-19 regulation. The onsite meeting and online meeting is possible for all RCOST members. However, the academic activities including the RCOST journal still moving forward. This issue in your hand consists of several interesting articles with 6 original papers from 5 subspecialtly including; spine, foot and ankle, arthroplasty, sports and hand.

Our journal is making progress in a positive way with supporting from the RCOST committee and all RCOST members who submit their valuable work in Orthopaedic field to demonstrated the up to date knowledge and skill or basic knowledge of Administration system to improve national policy in treating Orthopaedic patients. We hope we will pass this pandemic in very near future and setup not only the new normal for life but also for the new normal treatment for our patient.

Professor Theerachai Apivatthakakul, M.D.

Editor, The Thai Journal of Orthopaedic Surgery

Comparison of Non-continuous Versus Continuous Drain Use Following Thoracolumbar Spine Surgery

Kanthika Wasinpongwanich, MD — 2021-10-15

Purpose: To evaluate the efficacy and safety of non-continuous drain use following posterior instrumented fusion in thoracolumbar spinal injury.

Methods: Retrospective identification of patients with thoracolumbar spinal injury operated posterior instrumented fusion during the period 2013-2016 into 2 groups. Group I (non-continuous drain use): received 2-hour temporary drain clamping and group II (continuous drain use): no clamping. The groups were evaluated the amount of drain content in 8^th, 16^th, 24^th, 48^th, and 72^nd hour. The entire period of drain use, the hemoglobin level change, post-operative Packed Red Cell (PRC) transfusion, Visual Analogue Scale (VAS), and wound complications between two groups were also compared.

Results: A total of 56 patients were included; their age was 51.50 years and 36 years on average in non-continuous drain group and continuous drain group retrospectively. 53.6% and 75% were male in non-continuous drain group and continuous drain group retrospectively. The drain content in 8-hour postoperative period and hemoglobin level change were significantly lower in the non-continuous drain group than the continuous group whereas the post-operative PRC transfusion, VAS, hospital length stay, total drain content, total drain use time and wound complications were not different between two groups.

Conclusion: The use of non-continuous drain following posterior instrumented fusion in thoracolumbar spinal injury can reduce patients’ post-operative hemoglobin level difference. However, there was no statistically significant difference in term of postoperative blood transfusion, VAS, total drain content, entire period of drain use, the length of hospital stay as well as wound complications.

The Prevalence and Correlation of Foot Deformity in Primary Osteoarthritis of the Knee

Daman Kumar Jha, MS — 2021-10-15

Background: Foot deformities have long been recognized as highly prevalent in older people. Knee osteoarthritis (OA) is a common painful and chronic condition that affects a large proportion of older people. The presence of foot deformities increase disability levels in knee osteoarthritis.

The purpose of our study is to investigate the prevalence and correlation of foot deformity in primary knee OA.

Methods: The study design was a cross-sectional survey study of the primary OA knee patients during 4 years period presented in the IPD and OPD patient in Siriraj Orthopedic Department. 113 patients were enrolled in the study. The measure for the association was between the femur-tibia angle (FTA), the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the calcaneal pitch angle.

Results: The prevalence of foot deformities in primary OA knee patients was 70.5% (n=80). The prevalence of the hallux valgus, pes planus and hind foot varus in primary OA knee patients were 51.9%, 41.8%, and 32.9%. The radiographic measurements have no statistically significant association between the alignment of osteoarthritis of the knee (the femur-tibia angle) and foot deformities. No significant association was seen between the femur-tibia angle (FTA), the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the calcaneal pitch.

Conclusions: The prevalence of foot deformities is significantly higher in OA knee. Hallux valgus, pes planus and hind foot varus were the most common foot deformity associated with OA knee.

Anteroposterior Stability and Knee Strength after Anterior Cruciate Ligament Reconstruction in Patients Older than 50 Years Compared to Younger Patients

Sombun Wutphiriya-angkun, MD — 2021-10-15

Purpose: The treatment for anterior cruciate ligament injury in middle-aged people older than 50 years remains controversial. This retrospective study was conducted to test the hypothesis that clinical outcomes are similar in the two age groups for anterior cruciate ligament reconstruction.

Methods: A total of 41 patients were included. Twenty patients older than 50 years and 21 younger than 40 years. Patient data collected included preoperative and postoperative range of motion, visual analog scale, Lysholm Knee Scoring, International Knee Documentation Committee Knee Evaluation Form scores, anterior drawer test, Lachman test and pivot-shift test.

Results: There were no significant differences in postoperative range of motion, visual analog scale score, anterior drawer test, Lachman test and pivot-shift test. Lysholm score and International Knee Documentation Committee knee evaluation form score between the two groups were significantly better in the younger age than the older group.

Conclusions: Anterior cruciate ligament reconstruction in younger patient is more effective comparable to patients older than 50 years in the treatment of anterior cruciate ligament tears.

Comparison Outcomes of Opening-Wedge High Tibial Osteotomy without Bone Graft and Unicondylar Knee Replacement at 5-year Follow up

Pawaris Sungkhun, MD — 2021-10-15

Purpose: The purpose of this study is to compare midterm outcomes of opening-wedge high tibial osteotomy (HTO) without bone graft and unicompartmental arthroplasty (UKA) in advance medial compartment arthritis.

Materials and Methods: Fifty patients were divided into the HTO (n=20) and UKA (n=30) groups. Clinically, we evaluated range of motion, the Oxford knee scoring scale, and Knee Society Score at the five years follow-up postoperatively.

Results: All clinical outcomes gradually improved in both groups from the postoperative period to the final follow-up. At the final follow-up, all clinical outcomes were slightly better in the HTO group than in the UKA group; however, differences were not statistically significant.

Conclusions: HTO is comparable to UKA in terms of clinical outcomes. Thus, the results of this study suggest that HTO might be a good alternative treatment to UKA for medial unicompartmental arthritis.

Results of Cement with Screw Augmentation for Large Tibial Defects in Primary TKA

Wasu Techapaitoon, MD — 2021-10-15

Objectives: To compare the outcome of TKAs using screw augmentation and cement in cases involving a large tibial defect with conventional TKA procedures in cases with no tibial defect using clinical and radiographic data.

Materials and Methods: A retrospectively reviewed of 217 TKAs that operated at Nakhon Pathom Hospital from January 2010 - March 2021.TKAs have divided into 54 knees with a large tibial defect treated using screws with cement augmentation (the screws group), and 163 knees with a small or no tibial defect treated with conventional TKA procedures (the no screws group). Patient information collected included age, gender, limb alignment, length of follow-up period, defect depth, presence of radiolucency lines, Knee Society scores and incidence of prosthesis loosening.

Results: There was no statistically significant differences between the groups in mean ages (64 yrs.), follow-up period (6 yrs.), BMI, gender (female 88%) and post-operative overall alignment (4.35^o). While pre-operative varus angle of screw group (-15.96^o), incidence of radiolucency lines of screw group (59%) and improvement of Knee Society Scores after surgery were significantly differences (P-value < 0.001). The average defect depth was 11.99 mm and most of the depths was in range of 10-20 mm. There were 6 cases of loosening prosthesis in the no screws group and 3 cases in the screws group. The survival rate of implants was 96% in the no screws group and 94% in the screws group with no difference in statistic.

Conclusions: At mean follow-up of 6 years, the cement with screw augmentation for large tibial defects had a survival rate equal to conventional TKA in cases without bone defect and had a lower cost than metal augmentation. This technique is recommended for defect depths of between 6-20 mm.

Functional and Results from Nail Lengthening with the Eponychial Folding Procedure Reconstruction of the Fingertip Amputation

Thepraksa Hemphomraj, MD — 2021-10-15

Purpose: Fingertip amputation usually involved soft tissue, bone, and nail. Various local flaps reconstruct only soft tissue volar pulp dose not restore nail length after fingertip amputation. To overcome this problem “The Eponychial Folding Procedure” lengthens the nail plate and restore a good appearance of the nail apparatus was employed. The purposes of this study were present the outcomes of nail salvage by Eponychial Folding Procedure combined with several local flaps following fingertip amputation.

Methods: In the period between January 2018 and October 2019 at Samutsakorn Hospital. 30 cases of fingertip amputation with nail bed defects underwent pulp reconstruction with different local flaps depending on the geometry of the amputated digit tip. We increased nail bed exposure by creating 4-6 mm parallel incision at distal eponychium. The eponychium flap was elevated then fold proximally to expose more nail matrix, thereby effectively lengthening the exposed nail bed. The outcomes for fingertip appearance, nail length, and nail bed area at pre and postoperative treatment were evaluated. The finger’s range of motion (ROM) was compared to the contralateral uninjured fingers as control. The paired t test was employed for α<.05 considered statistically significant

Results: There were 25 patients (5 patients were affected 2 fingers) with mean age of 31 (18-51 years). The procedures were performed initial injury and secondary treatment after consequence previous operation, neither pulp reconstruction nor eponychial flap loss occurred. The visible nail increased 5.78 mm (4-7mm), nail bed area was enlarged 60% (25-150%). All patients were satisfied with the appearance and function of the reconstructed fingertips.

Conclusions: Fingertip amputation with nail bed involvement should be reconstructed not only volar soft tissue but considered the nail as well. Eponychial folding Procedure combined with different local flaps provided for the aesthetic and functional restoration of the fingertip amputation, both initial injury and its consequence.