Posterior oblique technique for sacroiliac joint fusion leads to greater pain relief and similar improvement in function compared to the lateral technique: A retrospective, comparative study.

Background: Management of chronic sacroiliac joint (SIJ) pain among patients who do not respond to nonsurgical treatment is increasingly turning toward minimally invasive SIJ fusion. There are different techniques available to perform this procedure, with the lateral technique being more commonly studied than the posterior oblique technique. This study examined the effects of these techniques on pain relief and functional improvement, both preoperatively and at a 12-month follow-up. Methods: This retrospective cohort study analyzed data from 45 patients who underwent SIJ fusion. Included patients were ≥50 years old, nonresponsive to conservative treatment. Subjects were divided into 2 cohorts based on the SIJ fusion technique. Primary outcomes were pain relief, measured by Visual Analog Scale (VAS), and functional improvement, determined by the Oswestry Disability Index (ODI); both were recorded and assessed at baseline, postoperative, and the change from pre- to postoperative. Additionally, data regarding patient demographics, previous lumbar fusion, operative time, and duration of hospital stay were collected and analyzed. Results: Baseline demographic and clinical variables exhibited no significant differences in distribution between groups. The posterior oblique cohort demonstrated a substantial reduction in operative time (over 50%) and duration of hospital stay compared to lateral cohort. Pain relief (postoperative VAS: lateral 3.5±1.7 vs. posterior oblique 2.4±1.5 [p=.02]) and functional improvement (postoperative ODI: lateral 29.6±7.3 vs. posterior oblique 21±5.7 [p≤.001]) were significantly better in the posterior oblique group. Pre- to postoperative improvement analysis indicated greater reduction in pain (VAS: lateral -4.4±1.9 vs. posterior oblique -6.1±1.5 [p=.002]) in the posterior oblique group. Conclusions: Compared to the lateral technique group, patients undergoing minimally invasive SIJ fusion through the posterior oblique technique experienced greater pain relief and demonstrated a trend toward better functional improvement, with shorter operative times and duration of hospital stay. The posterior oblique technique may be more efficient and beneficial to manage patients suffering from chronic SIJ pain through joint fusion.

Brief report: the disability of chronic chikungunya arthritis.

In 50% of patients, chikungunya fever (CHIKF) is followed by arthritic pain that is often chronic, painful, and disabling. To better define the spectrum of pain and disability in chronic CHIK arthritis (CCA), we evaluated 35 consecutive CCA patients seen in a Brazilian rheumatology clinic, using a pain Visual Analog Scale and the Health Assessment Questionnaire Disability Index. In our patients, pain and disability levels were of the same magnitude as are seen in other serious rheumatic diseases. The mean score for 19 patients with moderate disability was 1.42± 0.20 (median 1.37). The median HAQ-DI score for the entire group was 1.25. These findings underscore the morbidity imposed by CCA and the urgent need for improvements in management.

Abordaje posteromedial y colocación de placa en fractura de meseta tibial con fragmento posterior / Posteromedial approach and plating for a tibial plateau fracture with a posterior fragment

Antecedentes: Las fracturas de meseta tibial representan 1% de todas las fracturas, de éste, 10% corresponde a la meseta medial. El espectro de lesiones va desde fracturas no desplazadas hasta fracturas devastadoras del platillo tibial completo que requieren manejo quirúrgico extenso. Literatura en cirugía ortopédica sugiere que los resultados funcionales y radiográficos positivos dependen del tipo de abordaje, la calidad de la reducción y el tipo de implante utilizado. Material y métodos: Reporte de casos ambispectivo; comprendió de siete pacientes con fractura de meseta tibial medial y fragmento posterior a los cuales se les colocó placa posterior luego del abordaje posteromedial en un período de tiempo entre Agosto 2012 y Agosto 2013. Se utilizó la clasificación de Khan para estadificar la fractura. Se evaluó el resultado funcional y radiográfico mediante escala de Rasmussen. Se realizó estadística de frecuencias y descriptiva. Resultados: Se midió el dolor utilizando la escala visual análoga (EVA), encontrando un mínimo de dos puntos y un máximo de cuatro puntos. La flexión osciló entre 40º y 110º con un déficit de extensión mínimo de 15º y máximo de 40º. La deformidad en varo se presentó en cuatro sujetos, la deformidad en valgo en tres. Conclusiones: El abordaje posteromedial y la colocación de placa posterior en fracturas de meseta tibial presentan arcos de movilidad adecuados para la función, así como un bajo grado de dolor. La angulación en varo se presenta en pacientes con fractura de ambos platillos tibiales.

Background: Tibial plateau fractures account for 1% of all fractures. Ten percent of them involve the medial plateau. The spectrum of lesions ranges from undisplaced fractures to devastating fractures involving the entire tibial plateau, which warrant extensive surgical management. The orthopedic surgery literature suggests that positive functional and radiographic results depend on the type of approach, the quality of reduction and the type of implant used. Material and methods: Ambispective case report: seven patients were enrolled, with fracture of the medial tibial plateau and a posterior fragment. A posterior plate was placed after a posteromedial approach, between August 2012 and August 2013. Fractures were staged according to the Khan classification. Functional and radiographic results were assessed using the Rasmussen scale. Frequency and descriptive statistics were used. Results: Pain was measured using a visual analog scale (VAS), with scores ranging from two to four. Flexion ranged between 40º and 110º, with a minimum extension deficit of 15º and a maximum of 40º. Four subjects had varus deformity, three had valgus deformity. Conclusions: The posteromedial approach and placement of a posterior plate for tibial plateau fractures results in ranges of motion that permit an appropriate function and involve mild pain. Varus angulation occurs in patients with bilateral tibial plateau fractures.