Orthopedics最新文献

Background: Shoulder injuries are a significant cause of musculoskeletal complaints in emergency departments (EDs), but data on these injuries in the United States are limited. This study analyzed shoulder injuries reported to US EDs from 2006 to 2016, focusing on trends in injury mechanisms, diagnoses, and demographics.

Materials and methods: Data from the National Electronic Injury Surveillance System (NEISS) database were used to analyze 6,689,422 shoulder injuries reported to US EDs during 11 years, examining injury rates, causes, diagnoses, and demographics.

Results: An estimated 6,689,422 shoulder injuries were reported during the study period, accounting for 4.35% of all injuries reported to US EDs. The highest injury rate was observed in individuals 15 to 24 years (3.15 per 1000 US population), while children younger than 5 years had the lowest rate (0.97 per 1000). The most common causes of injury were sports and recreation (45.84%), home structure (20.79%), and home furniture (18.91%). The most frequent diagnoses included fractures (20.30%), contusions (18.23%), and dislocations (12.92%). More than one-third of the injuries (39.2%) occurred at home. Injury rates decreased for individuals younger than 25 years but increased for those 45 to 64 years during the study period. Younger individuals and males showed greater sport-related injuries, while older populations and females more commonly presented with home-related injuries.

Conclusion: This study revealed unique demographic patterns in the causes and mechanisms of shoulder injuries. These findings suggest that tailored prevention strategies could be particularly effective, helping to improve both injury prevention efforts and the clinical care of patients with shoulder injuries. [Orthopedics. 202x;4x(x):xx-xx.].

There is debate over the treatment of displaced femoral neck fractures with either hemiarthroplasty or total hip arthroplasty. This study aimed to evaluate the fragility index (FI) of randomized controlled trials (RCTs) comparing these methods. We queried for these RCTs containing dichotomous outcomes, finding 11 RCTs with 63 dichotomous outcomes. The median FI for all outcomes was 6, signifying that 6 event reversals would change the statistical significance of an outcome. The median FI was 2 for significant outcomes and 6 for nonsignificant outcomes, indicating that outcomes favoring one surgical method are more statistically fragile than those demonstrating equivalency. [Orthopedics. 202x;4x(x):xx-xx.].

Background: Maintaining appropriate soft tissue tension is essential in total hip arthroplasty (THA). Surgeons generally achieve this by altering the neck length. However, experimenting with different neck lengths is time-consuming, as it requires repeated hip dislocations. To address this, we have used a new extensible trial neck device that allows for easy adjustment of neck length during surgery. This device can help surgeons avoid the need for repeated hip dislocations to determine the correct neck size. The objective of this research was to investigate whether this device could help shorten operative times and decrease surgical invasion for patients.

Materials and methods: Patients undergoing THA were randomly separated into two groups. The first group used the extensible trial neck during trial reduction after the stem and cup were placed (group M), while the second group used a conventional trial neck (group C). Operative time, blood loss, number of additional dislocations needed during the operation, and C-reactive protein (CRP) and creatine phosphokinase (CPK) levels after the operation were compared.

Results: Operative time was significantly shorter and the number of additional dislocations required to choose the final neck size was significantly lower in group M compared with group C. No significant difference in blood loss was observed. CRP and CPK levels days 3 and 7 after surgery decreased in group M compared with group C.

Conclusion: The extensible trial neck was useful for THA by greatly reducing operative time and stress on the patient. [Orthopedics. 202x;4x(x):xx-xx.].

Background: Surgical timing after distal radius fracture may impact patient outcome. This retrospective study assessed the timing of surgery after distal radius fracture and predictors of delayed surgery.

Materials and methods: Patients who had distal radius fractures were identified from the PearlDiver M161Ortho dataset. Those who went on to have surgery in the subsequent 52 weeks were identified, with immediate surgery designated as occurring in weeks 0 to 2 after fracture and delayed surgery designated as occurring in weeks 3 to 52 after fracture. Demographics of patients with immediate and delayed surgery, including age, sex, comorbidity burden (measured by Elixhauser Comorbidity Index [ECI]), region of the country where surgery was performed, insurance (commercial, Medicare, Medicaid), and smoking status (non-smoker, cannabis, tobacco, both), were assessed and compared by multivariate analyses.

Results: A total of 90,570 patients undergoing surgery for distal radius fractures were identified, of whom immediate surgery was performed for 76,683 (88.0%) and delayed surgery was performed for 10,887 (12.0%). Independent predictors of delayed surgery included non-clinical factors (Medicaid [vs commercial insurance]: odds ratio [OR], 1.62, P<.0001; and region [vs Midwest]: West, OR, 1.39, P<.0001; Northeast, OR, 1.37, P=.0115; and South, OR, 1.21, P=.0001) as well as clinical factors (smoking tobacco [vs non-smoker]: OR, 1.31, P<.0001; and increased ECI: OR, 1.14 per 2-point increase, P<.0001).

Conclusion: In a large cohort of patients, 12% of distal radius fracture surgeries occurred outside the 2-week window. These cases were predicted by non-clinical and clinical factors that deserve attention to limit the delay of such surgeries. [Orthopedics. 202x;4x(x):xx-xx.].

Background: As arthroplasty techniques become more advanced, patients recover more rapidly. Is this same trend observed with patients' ability to drive after hip and knee replacement? The purpose of this study was to evaluate the impact of various factors on patients' ability to drive within 4 weeks after primary hip or knee arthroplasty to better counsel patients on their return to driving postoperatively.

Materials and methods: This retrospective cohort study investigated 1146 patients who underwent primary joint arthroplasty. These patients were surveyed 3 to 4 weeks after surgery, and 851 patients were included in the analysis. Univariate and multivariate analyses were performed to determine which factors were associated with return to driving.

Results: Among the patients, 47.0% (n=382) returned to driving within 4 weeks of their procedure, with a mean postoperative time of 16.0±6.3 days. Factors significantly correlated with an early return to driving based on univariate analysis included younger age at surgery, lower body mass index, male sex, prior daily driving, same-day discharge, higher scores on patient-reported outcome measures, left-sided procedure, unicompartmental knee arthroplasty (UKA), no walking aids, and no use of narcotic pain medication. Multivariate Cox regression analysis revealed that male sex (hazard ratio [HR], 2.19), same-day discharge (HR, 1.86), prior daily driving (HR, 1.81), left-sided surgery (HR, 1.62), and type of procedure (UKA: HR, 1.65; total hip arthroplasty by the direct anterior approach: HR, 1.50) were associated with early return to driving.

Conclusion: Many patient, surgical, and rehabilitation factors can impact the ability of primary arthroplasty patients to return to driving within 4 weeks of surgery. This large cohort incorporating current surgical techniques can support surgeons to better counsel patients on their expected return to driving. [Orthopedics. 202x;4x(x):xx-xx.].

Background: Wearable activity-measurement devices are increasingly popular among the public, but there is little information regarding their use among patients undergoing sports medicine procedures. The purpose of this study was to compare accelerometer-measured data with traditional patient-reported measures and to determine the trajectory of physical activity from before surgery to 1 year after anterior cruciate ligament reconstruction.

Materials and methods: Adult patients undergoing primary anterior cruciate ligament reconstruction were enrolled in this prospective cohort pilot study. The Tegner activity scale, Marx activity scale, International Physical Activity Questionnaire Short Form (IPAQ-SF), Knee injury and Osteoarthritis Outcome Score (KOOS), and EuroQoL-5D were administered preoperatively and 3, 6, and 12 months postoperatively. At these intervals, each patient was asked to wear an accelerometer for 7 consecutive days. Time spent in moderate-to-vigorous physical activity (MVPA min/wk), metabolic equivalents of physical activity, and average daily steps were calculated from the accelerometer output and correlated with patient-reported measures.

Results: Twenty-eight patients were included in this study. Of the 28 patients, 20 remained, and at the 12-month analysis, 18 patients were analyzed. There were significant improvements in Tegner activity scale score, KOOS symptoms, sports/recreation, and quality of life subscales, and IPAQSF MVPA min/wk at final follow-up. All accelerometer-based outcomes had improvements at 3, 6, and 12 months.

Conclusion: The accelerometer may be a useful tool for understanding patients' activity levels at different time points during their recovery and for providing tangible targets for patients to achieve at least an average recovery. [Orthopedics. 202x;4x(x):xx-xx.].

Background: Lumbar fusion is the most common surgical intervention for chronic or severe low back pain. However, lumbar disk replacement (LDR) may be appropriate for certain patients. The objective of this study was to describe the postoperative management costs associated with both lumbar fusion and LDR in the 2-year period after surgery.

Materials and methods: An observational cohort study was conducted using the Merative MarketScan databases. Patients who underwent lumbar fusion or LDR between January 1, 2017, and December 31, 2017, were identified and included in the study. The primary outcome was the cost of payments for physical therapy, pain medication, injections, and bladder management in the 2-year period after surgery.

Results: A total of 1660 patients (mean age, 50.1±10.6 years; lumbar fusion, 99%; LDR, 1%) were included in the study. The mean total cost of postoperative interventions identified was $2832±$5461 per patient, with no differences found between patients for identified interventions. The mean 30-day episode-of-care cost was $65,777±$40,869 and was similar (P=.894) between the two groups of patients. The main driver of cost was physical therapy for both groups of patients (lumbar fusion, 53.7%; LDR, 64.9%).

Conclusion: Patients who underwent lumbar fusion and LDR had similar postoperative management costs. The shorter recovery periods associated with LDR may not necessarily translate into reduced long-term health care expenditure. [Orthopedics. 202x;4x(x):xx-xx.].

Background: The purpose of this study was to evaluate the performance and evolution of Chat Generative Pre-Trained Transformer (ChatGPT; OpenAI) as a resource for shoulder and elbow surgery information by assessing its accuracy on the American Academy of Orthopaedic Surgeons shoulder-elbow self-assessment questions. We hypothesized that both ChatGPT models would demonstrate proficiency and that there would be significant improvement with progressive iterations.

Materials and methods: A total of 200 questions were selected from the 2019 and 2021 American Academy of Orthopaedic Surgeons shoulder-elbow self-assessment questions. ChatGPT 3.5 and 4 were used to evaluate all questions. Questions with non-text data were excluded (114 questions). Remaining questions were input into ChatGPT and categorized as follows: anatomy, arthroplasty, basic science, instability, miscellaneous, nonoperative, and trauma. ChatGPT's performances were quantified and compared across categories with chi-square tests. The continuing medical education credit threshold of 50% was used to determine proficiency. Statistical significance was set at P<.05.

Results: ChatGPT 3.5 and 4 answered 52.3% and 73.3% of the questions correctly, respectively (P=.003). ChatGPT 3.5 performed significantly better in the instability category (P=.037). ChatGPT 4's performance did not significantly differ across categories (P=.841). ChatGPT 4 performed significantly better than ChatGPT 3.5 in all categories except instability and miscellaneous.

Conclusion: ChatGPT 3.5 and 4 exceeded the proficiency threshold. ChatGPT 4 performed better than ChatGPT 3.5, showing an increased capability to correctly answer shoulder and elbow-focused questions. Further refinement of ChatGPT's training may improve its performance and utility as a resource. Currently, ChatGPT remains unable to answer questions at a high enough accuracy to replace clinical decision-making. [Orthopedics. 202x;4x(x):xx-xx.].

Background: Tetrahydrocannabinol (THC)-based and cannabidiol (CBD)-based products are increasing in popularity for the management of pain. Cannabis-based products may serve as a valuable alternative to traditional analgesics such as opioids for pain management among orthopedic patients. The purpose of this study was to investigate the perspective of orthopedic sports medicine patients regarding the use of THC- and CBD-based products for the management of musculoskeletal pain.

Materials and methods: A short, 11-question survey was distributed to orthopedic sports medicine patients in clinic and via email. Survey participation was voluntary. Retrospective chart review was conducted for participating patients to collect additional data such as visit diagnosis.

Results: A total of 182 patients completed the survey. Most were familiar or somewhat familiar with THC (61%) and CBD (63.2%) products and their use for musculoskeletal pain. Of the patients, 53.3% were aware of friends and family currently using CBD products to help manage musculoskeletal pain. Of the patients, 81.3% were amenable to receiving THC-based products and 90.1% were amenable to receiving CBD-based products for the management of their musculoskeletal pain. The patients were statistically more amenable to receiving CBD-based products than THC-based products (P=.017). Among the patients, 85.3% believed cannabis-based products would help in the fight against the opioid epidemic.

Conclusion: Orthopedic patients are aware of THC- and CBD-based products, and the majority are willing to receive these products to help manage their musculoskeletal pain and orthopedic-related issues. Orthopedic surgeons should be aware of the increasing popularity of CBD-based products and educate themselves and their patients regarding the appropriate use of them. [Orthopedics. 202x;4x(x):xx-xx.].

Background: As the prevalence of osteoporotic fractures increases, impacting the health of the aging population significantly, understanding the genetic link between chronic diseases such as primary biliary cholangitis (PBC) and osteoporosis (OP) is crucial. Despite existing research, the direct genetic relationship between these conditions remains unclear.

Materials and methods: This study used a two-sample Mendelian randomization approach, drawing on the largest available genome-wide association studies. Instrumental variables were selected based on single nucleotide polymorphisms to explore the genetic correlations affecting the association between PBC and OP. This method helps overcome the limitations of traditional observational studies by reducing confounding factors and preventing reverse causation.

Results: The results, primarily derived from the inverse variance weighted method along with MR-Egger and weighted median supplementary methods, demonstrated a significant causal link between the genetic markers associated with PBC and an increased risk of OP. Sensitivity analyses reinforced these findings, affirming the robustness of the genetic associations.

Conclusion: These findings highlight the genetic underpinnings that potentially link PBC to an increased risk of OP, suggesting that genetic factors play a significant role in the progression of chronic diseases. This knowledge could lead to better prevention and treatment strategies for OP, emphasizing the need for integrated treatment approaches that account for genetic predispositions of patients with chronic conditions. Future research should focus on validating these genetic links further and exploring them as potential therapeutic targets. [Orthopedics. 202;4x(x):xx-xx.].