Orthopedic Research and Reviews最新文献

This case study presents the successful management of a 21-cm tibial defect in a 38-year-old man smoker with longstanding osteomyelitis using trifocal Ilizarov bone transport. Despite the complexities posed by chronic infection and extensive bone loss, a meticulously planned staged reconstructive protocol involving aggressive debridement, targeted antimicrobial therapy, and advanced bone transport techniques culminated in remarkable limb salvage and functional recovery. Integration of low-intensity pulsed ultrasound (LIPUS) further optimized bone healing in this intricate scenario. This case report addresses these gaps by detailing a successful trifocal Ilizarov strategy augmented with LIPUS in a chronic smoker with an exceptionally large tibial defect.

Objective: This study aimed to evaluate the effect of an integrated orthopedic rehabilitation program on elbow joint function recovery in patients after surgical treatment for ulnar olecranon fractures, compared to conventional rehabilitation.

Methods: A retrospective cohort study was conducted on 87 patients who underwent surgery for ulnar olecranon fractures. Based on the standard of care at the time of admission, patients were assigned to a control group (n=42) receiving conventional rehabilitation or an observation group (n=45) receiving an integrated rehabilitation program. The integrated program comprised preoperative education, standardized in-hospital training, a structured 24-week home-based protocol with phased goals, and monitored follow-up. The primary outcome was the Mayo Elbow Performance Score (MEPS). Secondary outcomes included elbow range of motion (ROM), Activities of Daily Living (ADL) score, Visual Analog Scale (VAS) for pain, and complication rates.

Results: The observation group showed a significantly higher rehabilitation effectiveness rate (97.78% vs 80.95%, p=0.026). They also achieved superior MEPS (75.31 vs 53.85, p<0.001), ADL scores (62.64 vs 55.17, p<0.001), and lower VAS scores (2.36 vs 4.36, p<0.001). Elbow ROM improvements in flexion, extension, pronation, and supination were all significantly greater in the observation group (all p<0.001). Complication rates did not differ significantly (6.67% vs 9.52%, p=0.924).

Conclusion: The integrated orthopedic rehabilitation program is superior to conventional rehabilitation in promoting functional recovery, improving range of motion, enhancing daily living activities, and alleviating pain in patients after ulnar olecranon fracture surgery. However, these findings should be interpreted with caution due to the limitations of a retrospective design and a modest sample size. Integrated rehabilitation represents a highly effective postoperative management strategy for these patients.

Purpose: This study aimed to evaluate the effectiveness of microfracture augmentation in the intercondylar notch on healing outcomes after arthroscopic meniscal repair, with stratification by meniscal tear type (bucket-handle vs longitudinal).

Background: Meniscal tears are common knee injuries with variable healing potential. Microfracture augmentation, which involves small perforations in the intercondylar notch to release marrow elements, has been proposed as an adjunct to enhance meniscal repair. However, the impact of this technique across different tear types remains under investigation.

Patients and methods: In this retrospective cohort study, 173 patients aged 18-40 years with isolated bucket-handle or longitudinal meniscal tears undergoing arthroscopic repair were included. Patients were divided into two groups: microfracture-augmented repair (n = 87) and non-microfracture repair without augmentation (n = 86). All surgeries were performed by a single senior orthopedic surgeon, and postoperative rehabilitation protocols were standardized. Healing was assessed at 12 months using Barrett's criteria, the Apley Grinding Test, and clinical evaluation. Statistical analyses included chi-square tests, odds ratios, risk ratios, ROC curve analysis, and binary logistic regression to evaluate associations between surgical technique, tear type, and postoperative outcomes.

Results: Microfracture augmentation was associated with significantly higher overall healing rates compared to non-microfracture repair (88.5% vs 64.0%, p < 0.001). Stratified by tear type, microfracture had the greatest benefit in bucket-handle tears (79.4% vs 37.8%, p < 0.001; OR = 6.353, 95% CI: 2.275-17.737; RR = 3.022, 95% CI: 1.503-6.076), while healing rates were similar for longitudinal tears between techniques (94.3% vs 92.7%, p = 0.745). Age, gender, and side of injury were not significant predictors of outcomes.

Conclusion: Microfracture augmentation enhances healing after arthroscopic meniscal repair, particularly in bucket-handle tears, while longitudinal tear outcomes are favorable regardless of augmentation. These findings emphasize the importance of tear type in guiding the choice of surgical technique.

Purpose: To explore the long-term impact of prolonged screen exposure on postural and visual health in children and adolescents.

Patients and methods: A scoping review was conducted in December 2024 using PubMed, Scopus, and BIREME, focusing on articles from 2019 to 2024 in English and Spanish. The studies were categorized into visual and postural health domains and synthesized through graphs and tables. A total of 27 articles were analyzed. The snowball method was used to complement the literature search.

Results: The studies revealed a 55.3% increase in the use of portable electronic devices following the COVID-19 pandemic. Reported consequences included eye strain, computer vision syndrome, and musculoskeletal pain, especially in the cervical and lumbar regions. These effects were more prevalent in urban populations in Asia.

Conclusion: Prolonged screen time significantly affects children's visual and postural health. These findings highlight the need for public health policies to guide and regulate screen use in young populations and to educate parents, caregivers, and healthcare professionals.

Purpose: There was a strong correlation between adrenal adenoma and osteoporosis, the primary objective of this research was to establish and authenticate a radiomics nomogram using CT scan of adrenal adenoma to screen abnormal bone mineral density (BMD) opportunistically.

Methods and materials: A total of 161 patients with adrenal adenomas who underwent thoracoabdominal CT and quantitative CT (QCT) were enrolled retrospectively. The radiomics features were chosen from the cross-sectional CT images of adrenal adenomas and the nomogram models that including patient's clinical and radiomics features were then established. The receiver operating characteristic (ROC) curve was performed to evaluate the performance of the model and the decision curve analysis (DCA) was used to assess the clinical usefulness.

Results: To build a radiomics model, 11 radiomics features based on CT scans of adrenal adenomas were selected and showed good performance in distinguishing abnormal BMD from normal BMD. Moreover, the radiomics nomogram model demonstrated excellent ability to identify abnormal BMD of adrenal adenoma patients with area under the curve (AUC) of 0.87 (95% CI, 0.80-0.93) in training cohort and 0.85 (95% CI, 0.74-0.96) in validation cohort. The accuracy, sensitivity, specificity of the nomogram model were 79.7%, 78.3%, 81.1% in training cohort, and 72.9%, 67.7%, 82.4% in validation cohort respectively.

Conclusion: The radiomics nomogram based on clinical and radiomics features of adrenal adenoma CT images had a satisfying predictive ability and can be an opportunistic effective tool for identifying bone mass change.

Purpose: Femoroacetabular impingement syndrome (FAIS) can lead to pain, decreased mobility, and difficulty in performing activities of daily living. Symptoms can improve with surgery, often hip arthroscopy with osteoplasty. Radiological parameters such as the alpha angle can be utilized to determine the degree of cam morphology and assess resection after surgery. This study sought to evaluate the relationship between pre-operative alpha angle and the change in alpha angle on patient satisfaction post-surgical correction using the 12-item International Hip Outcome Tool (iHOT-12).

Patients and methods: Patients that underwent primary or revision hip arthroscopy with osteoplasty for FAIS by a single fellowship-trained surgeon at a tertiary academic center from September 1, 2014 to April 1, 2024 were eligible for this retrospective cohort study. Data collected included type of operation, preoperative and postoperative alpha angle, 6-month iHOT-12 scores, and demographic data. Multivariate proportional odds regression analyses were conducted to assess whether preoperative alpha angle and the change in alpha angle from pre- to post-operative were predictive of 6-month iHOT-12 scores. Additionally, Pearson correlation coefficients were reported for 6-month iHOT-12 association with preoperative alpha angle and alpha angle delta.

Results: 507 patients and 541 operative hips were identified during the study period. 99 (18%) hips were included in the final analysis. Mean alpha angle was 60.9 (SD = 9.8) preoperatively and 44.4 (SD = 6.1) postoperatively with a mean absolute change of 16.5 (SD = 8.6). The mean 6-month iHOT-12 score was 62.0 (SD = 26.9). Multivariate proportional odds regression analyses did not reveal significant predictors of 6-month iHOT-12 scores including preoperative alpha angle and alpha angle change.

Conclusion: This study found no association between preoperative alpha angle or postoperative change in alpha angle and 6-month iHOT-12 scores. Future research on other factors such as three-dimensional morphology may be warranted.

Background: To date, no comprehensive study has evaluated the outcomes of single-level full endoscopic posterior cervical foraminotomy and herniectomy in Vietnam.

Methods: This prospective, descriptive study was conducted before and after spinal disc herniation surgery at the Department of Spine Surgery, Viet Duc University Hospital, Hanoi, Vietnam, from March 2023 to December 2024. All patients follow-up during the 12 months with clinical, radiological and image outcomes.

Results: The study included 47 patients, with 23 males (48.9%) and 24 females (51.1%), with a mean age of 44.46 ± 8.47 years old. The location of the operated disc was predominantly at the C5-C6 level (61.7%) with 10.34 ± 0.7 incision length. The recovery outcomes revealed a strong trend toward excellent and good results, totalling 93.6% of the positive outcomes. A statistically significant reduction in all measured parameters over time (the Numerical Rating Scale (NRS) for pain and the Neck Disability Index (NDI) at multiple time points: pre-operation, post-operative day 1, and 1, 6, and 12 months post-operation) compared to pre-operative baseline values (p < 0.0001 for all comparisons). Radiological outcomes showed significantly improved cervical neural curvature from to C2-C7 at all the postoperative time points. Foraminal dimensions (height, diameter, and area) showed significant immediate postoperative increases. Disc height decreased significantly, while cervical range of motion showed variable changes. C2-C7 SVA and T1 slope remained stable, indicating no significant changes in the global alignment. Complications were generally low; two patients had intraoperative nerve root injury, and one patient had transient root palsy.

Conclusion: This study demonstrated that single-level full endoscopic posterior cervical foraminotomy and herniectomy are safe in the short-term with 12 months of follow-up and effective in the treatment of cervical disc herniation. Further study is needed with a larger sample size, with control group and long-term follow-up.

Background: Musculoskeletal (MSK) complaints are among the most common reasons for visits to primary care and outpatient clinics. While many cases are attributed to identifiable pathology, a significant proportion of patients present with persistent MSK symptoms despite normal physical examinations and imaging findings. These presentations pose diagnostic and management challenges and often result in patient frustration, clinician uncertainty, and overutilization of healthcare resources.

Objective: This narrative review aims to provide a comprehensive, evidence-informed, and practical framework for clinicians to evaluate and manage patients with MSK complaints in the absence of clear diagnostic abnormalities.

Methods: A targeted narrative review was performed using PubMed, MEDLINE, and major international clinical guidelines to identify relevant literature on the evaluation and management of musculoskeletal (MSK) pain without objective abnormalities. Evidence and expert consensus were synthesized into a biopsychosocial diagnostic and management framework specifically tailored for primary care and general outpatient settings.

Key findings: The review underscores the importance of empathetic communication, structured clinical assessment, and early exclusion of serious pathology. It presents a broad differential diagnosis encompassing mechanical, neuropathic, nociplastic, referred, and functional pain mechanisms. Management strategies are organized across key domains, including watchful follow-up, patient education, graded physical activity, stress and lifestyle management, psychosocial and occupational support, and functional goal setting. Pharmacologic therapy-such as short-term use of paracetamol or NSAIDs, and selected antidepressants for chronic nociplastic pain-should be considered cautiously and within a multidisciplinary, shared-decision framework. Opioid use is discouraged due to limited efficacy and high potential for harm.

Conclusion: Patients presenting with MSK complaints and normal diagnostic findings benefit most from a structured, individualized, and patient-centered approach that integrates clinical reasoning, effective communication, and functional rehabilitation. Applying this framework enables clinicians to address the multidimensional nature of such presentations while avoiding unnecessary investigations or interventions.

Introduction: Carpometacarpal (CMC) joint dislocations and fracture-dislocations are infrequent and often challenging to diagnose. Among these, dorsal fracture-dislocations involving the capitate and third metacarpal, as well as the hamate with the fourth and fifth metacarpals, represent an exceptionally rare subset. These injuries are typically the result of high-energy mechanisms, such as axial loading transmitted through a clenched fist striking a solid surface. Their subtle clinical signs and often inconspicuous radiographic findings, particularly in the context of polytrauma, contribute to a high rate of missed or delayed diagnoses. This paper aims to highlight the diagnostic challenges and management considerations of these rare dorsal CMC fracture-dislocations, emphasizing the importance of clinical suspicion and appropriate imaging in ensuring timely and effective treatment.

Case presentation: We report a rare case of dorsal fracture-dislocation involving the capitate-third metacarpal and hamate-fourth/ fifth metacarpal joints. The patient sustained the injury following blunt force trauma consistent with a clenched-fist mechanism. Definitive diagnosis was made following advanced imaging, which guided successful surgical management using open reduction and internal fixation of the hamate, capitate as well as the third and fourth CMC joints with excellent post-operative result and range of motion.

Conclusion: Dorsal fracture-dislocations of the capitate-third and hamate-fourth/fifth metacarpal joints are rare but potentially debilitating. Early recognition through careful clinical evaluation and targeted imaging is critical to prevent chronic pain, stiffness, and impaired hand function.

Introduction: Elbow ulnar collateral ligament (UCL) injuries can cause pain and decreased performance for the overhead athlete. Platelet-rich plasma (PRP) therapy is becoming more common to avoid surgery in partial UCL tears and improve return to play, but the literature is sparse regarding functional outcomes. This study aimed to characterize elbow UCL injuries among 5 collegiate baseball pitchers describe their return to play after PRP treatment, and compare dynamometry assessments before injury and after treatment.

Methods: Data from 5 Division 1 baseball pitchers who sustained low- to intermediate-grade UCL injuries determined by ultrasonography and/or magnetic resonance imaging were retrospectively reviewed. All athletes underwent one PRP injection, physical therapy, and a standardized return to play protocol as part of their treatment. Dynamometry measures were taken prior to injury (pre-season) as well as at the conclusion of the return-to-play protocol.

Results: Five consecutive baseball players with UCL injuries were evaluated. Pre-season dynamometry testing was performed on all players prior to the seasons and when they first arrived to the team. Players received PRP injections on average 36 days after their injury and started a standardized rehab program on average about 48 days after PRP. Players were cleared to full return to play at a mean 174 days post-injury. Follow-up examination at that time demonstrated full range of motion of the elbow without tenderness to palpation over the UCL for all athletes. All athletes were able to continue to play at the same level of competition as before the injury occurred without any complaints. No players had repeat injuries during the same or following seasons. Comparing pre-injury to clearance dynamometry, external rotation measures on average slightly decreased from 194 to 190 Newtons while grip strength increased from 586 to 646 Newtons, on average.

Conclusion: Successful return to play was possible in 5 collegiate baseball pitchers after nonoperative treatment including injection of PRP at a mean 174 days following injury. PRP treatment gives promising results in low and intermediate partial UCL injury. Performance metrics including external rotation and grip strength were consistent pre-injury and upon clearance.