Journal of Southeast Asian Orthopaedics <p><strong>Editor-in-Chief </strong>▪️ Thanainit Chotanaphuti, MD. <br /><strong>Editorial Secretary </strong>▪️ Satit Thiengwittayaporn, MD.</p> <p><strong>ISSN: XXXX-XXXX (online)<br />ISSN: XXXX-XXXX (print)</strong></p> The Royal College Of Orthopaedic Surgeons Of Thailand en-US Journal of Southeast Asian Orthopaedics 0125-7552 Accuracy of Revised Tokuhashi Scoring System and Prognostic Factors to Predict Life Expectancy in Lung Cancer Patients with Spinal Metastasis <p><strong>Purpose:</strong> This study aimed to verify the accuracy of the revised Tokuhashi scoring system to identify the prognosis and life expectancy of lung cancer patients with spinal metastasis. We also aimed to find the factors that were related to the prognosis and actual death.</p> <p><strong>Method:</strong> Lung cancer patients with spinal metastasis who were diagnosed between January 2014 to December 2018 were included in this study. Demographic data, radiographic data, revised Tokuhashi score parameters, actual death, and treatment administered were collected from the hospital tumor database. The relationship between each parameter and actual death were collected and multivariable logistic regression analysis was used to explore the associated factors.</p> <p><strong>Results:</strong> Totally 181 patients were included in this study. The accuracy of the revised Tokuhashi scoring system in this study was 80.68% for scores 0-8 and 100% for scores ≥ 9. Sensitivity and specificity were 100%and 80.7%, respectively, for the prediction of life expectancy ≥ 6 months. LR+ was 5.18. Female (HR=0.58, <em>P</em>=0.001), good general condition (HR=0.34, <em>P</em>=0.036), none of extra spinal foci metastasis (HR=0.40, <em>P</em>=0.002), 1 or 2 extra spinal foci metastasis (HR=0.54, <em>P</em>=0.003), radiation (HR=0.57, <em>P</em>=0.02), and chemotherapy (HR=0.51, <em>P</em>=0.004) were the associated factors with statistical significance.</p> <p><strong>Conclusion:</strong> The revised Tokuhashi scoring system for lung cancer with spinal metastasis had satisfactory accuracy rate to predict life expectancy, especially for &gt; 6 months (score ≥ 9). We also found that females, good general condition, number of extra spinal foci &lt; 3, radiation, and chemotherapy were significantly good prognoses for life expectancy.</p> Kongtush Choovongkomol, MD Veerapat Sirisopikun, MD Urawit Piyapromdee, MD Terdpong Tanaviriyachai, MD Sarut Jongkittanakul, MD Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-07-28 2022-07-28 46 2 3 9 10.56929/jseaortho.v46i2.150 Comparison of Dynamic Versus Static Lag Screw Modes for Short Cephalomedullary Nails in the Treatment of Unstable Intertrochanteric Fractures: A Randomized Controlled Trial <p><strong>Purpose:</strong> To compare the static locked and sliding proximal lag screw modes of short cephalomedullary nail in the treatment of unstable intertrochanteric fractures.</p> <p><strong>Methods:</strong> Ninety-four patients (age&gt;60 years) with low energy unstable intertrochanteric fractures were randomized for treatment into two groups. They were treated with static and sliding proximal lag screw modes of short cephalomedullary nail. The pre-operative variables, operative time, fluoroscopy time, blood loss, tip apex distance, and reduction quality were recorded for each patient. Post-operative follow-ups were undertaken every other week until bone union or implant failure occurred. Plain anteroposterior and lateral radiographs (both hip) were obtained at all visits. Ipsilateral leg length discrepancy (LLD), radiographic union score for hip complications, and fixation failure were recorded.</p> <p><strong>Results:</strong> The mean follow-up time was 16.7 months (range 12–24). The mean bone union times of static locked (n=35) and sliding proximal (n=34) screw mode groups were 12.4 weeks and more than 11.2 weeks, respectively; the difference was not significant (p=0.213). The ipsilateral LLD of the sliding proximal (mean 4 mm) and static locked (mean 2 mm) screw mode groups showed a statistically significant difference (p&lt;0.001). Post-operative complications (lag screw perforated to hip joint, lag screw cutout from the femoral head, and excessive inferolateral lag screw sliding) developed in 8.82% patients in sliding proximal group, whereas, no complications were reported in the static locked group.</p> <p><strong>Conclusions:</strong> Treatment of unstable intertrochanteric fracture using static locked proximal lag screw mode of cephalomedullary nail showed some advantages over sliding proximal lag screw in terms of less complication and ipsilateral LLD; however, the bone union times were not different. Therefore, a static locked proximal screw mode is preferable over sliding proximal screw mode in treating unstable intertrochanteric fractures.</p> Naruepol Ruangsillapanan, MD Tana Rattanakitkoson, MD Teerayut Ittimongkonkul, MD Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-07-28 2022-07-28 46 2 10 16 10.56929/jseaortho.v46i2.156 Comparison Between Minimally Invasive Anterolateral and Conventional Posterior Hip Approaches for Hemiarthroplasty in Hip Fractures <p><strong>Purpose:</strong> To compare the results between minimally invasive anterolateral and conventional posterior hip approaches for hemiarthroplasty in hip fractures.</p> <p><strong>Methods:</strong> The elderly patients who had undergone hip hemiarthroplasty for hip fractures in Maharaj Nakhon Si Thammarat Hospital, were randomly divided into two groups: minimally invasive anterolateral and posterior approach groups Data were collected from March 2020 to November 2021, which included the duration of the surgery, length of the surgical wound, intraoperative bleeding volume, postoperative days of walking with a walker, morphine dosage for pain relief, and postoperative complications.</p> <p><strong>Results:</strong> No significant difference (P-value &gt; 0.05) was found between the baseline data of patients in both the groups, which included sex, age, body mass index, underlying musculoskeletal disease, and drug usage. The minimally invasive anterolateral approach group used an average surgical time of 53.48 ± 8.22 min, while the conventional posterior approach group required 65 ± 20.41 min; the length of the surgical wound was 7.78 ± 0.87 and 13.78 ± 1.37 cm, respectively; the volume of intraoperative bleeding was 82.17 ± 48.94 and 195.65 + 163.24 ml, respectively; the postoperative days of walking with a walker were 3.09 ± 0.92 and 6.59 ± 2.52 days, respectively; and the postoperative analgesic doses of morphine were 6.59 ± 2.80 and 11.09 ± 3.89 mg, respectively. The blood transfusion was required in 4 patients in the minimally invasive anterolateral approach group, while it was required in 14 patients in the conventional posterior approach group. Statistically significant (P-value &lt; 0.05). Postoperative complications included, prosthetic hip joint dislocation in a patient in each group and sciatic nerve neurapraxia in a patient in the conventional posterior approach group.</p> <p><strong>Conclusions:</strong> Hip hemiarthroplasty with the minimally invasive anterolateral approach in elderly patients with hip fractures was found to be superior to the conventional posterior approach.</p> Pranpawee Rojcharoenngam, MD Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-07-28 2022-07-28 46 2 17 23 10.56929/jseaortho.v46i2.22 Midterm Outcome of Open Wedge High Tibial Osteotomy without Bone Graft with Locking Plate Fixation <p><strong>Purpose: </strong>The purpose of this study was to assess the midterm outcomes of open-wedge high tibial osteotomy without bone graft (OWHTO) in patients with advanced medial compartment arthritis.</p> <p><strong>Methods: </strong>From January 2014 to December 2020, all patients treated with OWHTO had medial compartmental arthritis. Twenty patients underwent OWHTO. Clinically, we evaluated the Oxford Knee Score (OKS), Knee Society Score (KSS), and range of motion (ROM) at the five years follow-up.</p> <p><strong>Results: </strong>The mean age of the patients was 52.65±4.88 years. All clinical outcomes gradually improved from the postoperative period to the final follow-up period. The mean follow-up duration was 5.05±0.43 years. Pre-operative OKS was 20.85±3.47; Post-operative OKS was 36.70±2.16; P = 0.034. Pre-operative KSS was 35.8±20, Post-operative KSS was 53.2±20.2, and P = 0.02. Pre-operative ROM was 100.59±11.22; Post-operative ROM was 120.57±11.06; P = 0.044.</p> <p><strong>Conclusions: </strong>OWHTO has good clinical outcomes. Thus, the results of this study suggest that OWHTO may be a good alternative treatment for medial unicompartmental arthritis.</p> Pawaris Sungkhun, MD Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-07-29 2022-07-29 46 2 24 30 10.56929/jseaortho.v46i2.157 Closed Spontaneous Rupture of the Flexor Tendon in Zone 3: A Case Series <p><strong>Purpose:</strong> The pathophysiology of spontaneous rupture is not fully understood. Spontaneous rupture has been questioned, as some authors have stated that most spontaneous ruptures cannot be attributed to a cause or have not yet been investigated. Zone 3 was the most common place for flexor tendon ruptures to happen on their own, but the risk factor was not found.</p> <p><strong>Methods:</strong> From 2019 to 2022, we recorded four cases of closed rupture of the flexor tendon in zone 3 caused by agricultural activity. The history of all patients such as steroid injections, pain, and underlying conditions, was reviewed. Some parts of the tendon, debrided from the injury site, were sent for pathologic examination. The final range of motion and activity were recorded.</p> <p><strong>Results:</strong> All our patients had acute symptoms while gripping tools and excavating dirt during gardening. All flexor tendon ruptures occurred in zone 3, and were repaired by core and epitendinous suture. There was no actual condition believed to be the cause of the rupture. All patients achieved nearly full range of motion in the final follow-up.</p> <p><strong>Conclusions:</strong> A firm grip while performing agricultural tasks appears to be a risk factor of closed rupture flexor tendon. Although it is uncommon for a closed rupture of a flexor tendon injury to occur without ascertainable causes, this condition should be recognized while facing weakness or an inability to flex the finger.</p> Navapong Thitiworakarn, MD Chaiyos Vinitpairot, MD Surut Jianmongkol, MD Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-07-28 2022-07-28 46 2 39 43 10.56929/jseaortho.v46i2.24 The Role of Plasma, Platelets, and Growth Factors in Knee Osteoarthritis: The Evidence-Based Medicine 2022 <p>Knee osteoarthritis greatly affects the quality of life of numerous people worldwide. Study in 2020 estimated that the global incidence of knee osteoarthritis was 203 per 10,000 person-years and the global prevalence was 16%. Biologic derivatives, such as plasma, platelets, and growth factors, have gained popularity due to their efficacy and safety; however, several controversies related to the treatment of knee osteoarthritis with orthobiologics still exist. The purpose of this review is to provide recent evidence about the use of growth factors as orthobiologics for the treatment of knee osteoarthritis, to summarize the up-to-date clinical practice guidelines provided by American Academy of Orthopedic Surgeons (AAOS) and American College of Rheumatology (ACR), and to discuss these guidelines based on the latest research.</p> Vorasilp Cheeva-akrapan, MD Thana Turajane, MD Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand 2022-07-28 2022-07-28 46 2 31 38 10.56929/jseaortho.v46i2.34