Journal of Bone and Joint Surgery, American Volume最新文献

Background: This prospective cohort study determined the prevalence of intimate partner violence (IPV) across gender groups, investigated timing of disclosures during the standard-of-care follow-up period, and examined if there was an association between IPV and clinical outcomes.

Methods: This study included 314 patients ≥18 years of age presenting with orthopaedic injuries to the fracture clinics at 2 academic hospitals. Participants were asked about experiences with IPV, return to function, and overall health at each routine clinical follow-up. Cox proportional-hazards regression models were used to explore associations between IPV status and return to work, leisure activities, home responsibilities, and overall functioning.

Results: Of the 528 patients approached, 314 provided consent and completed at least the initial visit. Of these, 184 (58.6%) self-identified as women, 126 (40.1%) identified as men, and 3 (1.0%) self-identified as non-binary. Forty-six percent of women reported lifetime experience of IPV, compared with 35% of men and 100% of gender-diverse participants. A smaller proportion of men who disclosed IPV did so at their first visit compared with women, especially with respect to sexual IPV: 6 men (50.0%) compared with 42 women (79.2%). During follow-up, 16 participants (6.7% of 238 who returned to the clinic at least once), including 8 men, 7 women, and 1 gender-diverse participant, disclosed experiencing IPV during their recovery period. Disclosing IPV at any visit was associated with a 45% lower likelihood of returning to a pre-injury level of function with respect to work (hazard ratio [HR], 0.55 [95% confidence interval (CI), 0.33 to 0.91]; p = 0.021) and a 36% lower likelihood of returning to a pre-injury overall level of functioning (HR, 0.64 [95% CI, 0.46 to 0.90]; p = 0.01).

Conclusions: Results showed an unacceptably high prevalence of IPV in all genders. Gender differences in timing of disclosure emphasize the need for tailored approaches in clinical settings and repeated opportunities for IPV disclosure. This study emphasizes the hidden nature of IPV among patients with orthopaedic trauma and its effects on their health and recovery.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Background: Patellofemoral instability is a difficult problem to assess because of its dynamic nature, which is not easily quantified using physical examination techniques. This study aimed to describe and evaluate a novel examination method using stress ultrasonography to quantify patellar instability. The secondary aim was to assess the relationship of stress ultrasonography measurements with clinical and morphologic risk factors for patellar instability.

Methods: Knees with symptomatic patellar instability underwent the ultrasound-assisted patellar glide test. In this test, the patella was translated laterally from its resting position during ultrasound visualization until an endpoint was reached. The medial patellofemoral distance (MPFD) was used to quantify the gap between the medial boundary of the patella and the trochlea, and the difference in MPFD between the resting (unloaded) and loaded conditions was defined as the delta MPFD. Measurements were compared with those in asymptomatic contralateral knees of patients with unilateral instability, asymptomatic knees after patellar stabilization surgery, and control knees. Regression analyses assessed for relationships of MPFD with morphological and clinical risk factors. Receiver operating characteristic (ROC) curve analysis assessed the ability of stress ultrasonography measurements to discriminate between knees with and without symptomatic patellar instability.

Results: Four hundred and seventy-seven knees in 277 patients were included in this study; 173 of the knees had patellar instability (patient age, 24 ± 8 years; 72% female). Delta MPFD was 3 times greater in knees with patellar instability (median, 3.3 mm [95% confidence interval, 3.1 to 3.4 mm]) than in the contralateral asymptomatic (1.1 mm [0.9 to 1.3 mm]), postoperative (1.0 mm [0.8 to 1.2 mm]), and control knees (1.4 mm [1.1 to 1.6 mm]). ROC analysis demonstrated an optimal threshold value for delta MPFD of 2.0 mm, which had an area under the curve (AUC) of 0.97 (0.94 to 0.99), demonstrating excellent discrimination in identifying knees with patellar instability. No relationships of clinical or morphologic risk factors with delta MPFD were found.

Conclusions: A delta MPFD of ≥2 mm on the ultrasound-assisted patellar glide test had an AUC of 0.97 for identifying knees with symptomatic patellar instability, indicating excellent discriminatory ability. Additional studies utilizing this method are recommended to standardize and quantify assessments of patellar instability.

Level of evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.