Orthopedics最新文献

Background: Disruption of the distal tibiofibular syndesmosis is a common complication of ankle fractures that can result in chronic instability and early osteoarthritis. This study aimed to compare syndesmotic widening and complications after plate fixation versus intramedullary fibular nailing. We hypothesized that fibular nailing would be associated with more syndesmotic widening but fewer complications.

Materials and methods: Patients treated with plate or nail fixation for ankle fractures at a level 1 trauma center were identified through query of the electronic medical record. Data included demographics, fracture characteristics, medial clear space (MCS), tibiofibular clear space (TFCS), and complications. Mortise radiographs were assessed preoperatively, intraoperatively, and postoperatively. Syndesmotic widening was defined as MCS >4 mm and TFCS >5 mm at final follow-up.

Results: A total of 143 ankles were included; 84 patients (58.7%) received plate fixation, and 59 patients (41.3%) received fibular nailing. Mean follow-up was 6.1 ± 4.1 months and 6.5 ± 5.3 months, respectively. With the number of patients available, no significant differences were found between cohorts in the change in MCS (P = .663) or TFCS (P = .912) from fluoroscopy to 6 months postoperatively. No significant difference was observed in the proportion of patients with MCS >4 mm (P = .163) or TFCS >5 mm (P = .087) at final follow-up. Complication rates did not significantly differ between cohorts (20.2% plate cohort vs 16.9% nail cohort; P = .621).

Conclusion: Syndesmotic widening after ankle fracture fixation is comparable between plating and fibular nailing, suggesting both methods effectively maintain syndesmotic reduction.

Background: This study compared fracture healing and reoperation rates between early operative versus nonoperative management of ballistic humeral shaft fractures.

Materials and methods: A retrospective chart review was conducted at an academic trauma center. Patients ≥18 years treated for ballistic humeral shaft fractures (AO 1.2) between 2015 and 2022 were identified. Exclusion criteria included periarticular/intra-articular extension, non-ballistic mechanism, or age <18 years. Patients were stratified into operative versus nonoperative cohorts based on shared decision making. Outcome measures included time of union, postoperative visits, and reoperations. Time-to-event (TTE) analysis assessed duration of follow-up and time to healing. Discrete variables were compared for patients with >12 weeks follow-up using Fisher's exact tests and Student's t tests.

Results: Seventy-four patients (31 nonoperative, 43 operative) were included in TTE analysis. After excluding patients with <12 weeks follow-up, 43 patients (19 nonoperative, 24 operative) were included in discrete analysis (88% male, 86% Black, mean age 31 years). Operatively treated fractures included higher percentages of male patients (100% vs 71%, P < .01) and vascular injuries (25% vs 0%, P = .03), and a larger percentage of fractured humerus (21% vs 15%, P = .03). In TTE analysis, operative fractures demonstrated faster healing (P = .03). Nine patients (47%) in the nonoperative group underwent unplanned operations compared to two patients (8%) in the operative group (P < .01). No differences were found in follow-up visits or time to clinic discontinuation.

Conclusion: Operatively treated ballistic humeral shaft fractures demonstrated faster healing and lower reoperation rates than nonoperatively treated ballistic fractures, despite association with more profound injury.

Background: There is a paucity of research on the supply and adequacy of the orthopedic surgeon workforce. This study assessed United States federal government projections on the supply and demand of orthopedic surgeons to 2037.

Materials and methods: This was a cross-sectional analysis of orthopedic surgeons using data from the Health Resources and Services Administration (2025 to 2037). Supply was defined as the number of full-time equivalent (FTE) physicians. Demand was defined as the number of FTE physicians needed to support health care needs. Adequacy was defined as the ratio of supply and demand. Trends were analyzed with linear regression and comparisons were made with chi-squared tests.

Results: From 2025 to 2037, the supply of orthopedic surgeons was projected to decrease from 31,980 to 30,620 (4.3% decrease, P < .001), whereas demand was projected to increase from 33,690 to 35,850 (6.4% increase, P < .001). Orthopedic surgeon adequacy was projected to decrease from 94.9% to 85.4% (P < .001). By 2037, non-metropolitan areas were expected to have less adequacy than metropolitan areas (45.1% vs 91.6%, P < .001). The South (78.4%) had the lowest projected adequacy (P < .001). By 2037, the states with the lowest projected adequacy were West Virginia (54.5%), Arkansas (60.0%), and Delaware (61.5%). By 2037, orthopedic surgery ranked 9 out of 20 for physician adequacy relative to the 20 largest specialties by number of physicians.

Conclusion: There are projected deficiencies in the supply of orthopedic surgeons, which are greatest in non-metropolitan areas, the South, and certain states like West Virginia. Future work is needed to increase the supply of orthopedic surgeons in identified areas.

Background: The use of 3-dimensional (3D)-printed cutting guides for resection of long bone sarcoma may offer advantages over traditional free-hand or navigational osteotomy, including improved margin control and reconstruction accuracy. We evaluated long-term surgical and oncologic outcomes of limb salvage procedures using 3D-printed cutting guides, with updated follow-up from our previously published case series and the addition of new cases focusing on margin status, bony union, and local recurrence.

Materials and methods: We retrospectively reviewed 9 patients from our surgical database who underwent limb salvage surgery for long bone sarcoma using patient-specific 3D-printed cutting guides. This included extended follow-up of 6 previously reported cases and 3 new patients. Clinicopathologic, surgical, and radiographic data were collected and analyzed.

Results: All 9 patients (100%) achieved negative surgical margins (mean, 7.7 mm) with no local recurrences at a mean follow-up of 4.1 years (range, 0.5-11.6 years). Bony union was achieved at 16 of 18 (89%) osteotomy sites, comparing favorably to reported intercalary allograft nonunion rates of 6% to 43%. Two patients (22%) required revision to modular oncology devices due to nonunion. At most recent follow-up, no local recurrences were observed, while 7 grafts (78%) remained. Eight patients (89%) are continuously disease free, and 1 (11%) is alive with metastatic disease.

Conclusion: This expanded case series demonstrates excellent long-term oncologic and surgical outcomes using 3D-printed cutting guides for long bone sarcoma resection. Patient-specific guides achieved 100% negative margins with durable graft retention and no local recurrences at 4.1-year follow-up, supporting their continued use in complex limb salvage procedures.

Background: The anterolateral ligament (ALL) has gained interest due to ongoing debates on its clinical significance. This retrospective study aimed to determine the ALL-injury reporting rate on primary magnetic resonance imaging (MRI) assessment compared to a secondary review by a fellowship-trained musculoskeletal radiologist. We hypothesized that ALL injuries were underreported on routine MRI assessments.

Materials and methods: Inclusion criteria consisted of patients ≤25 years with sport-related anterior cruciate ligament (ACL) tears and concomitant injuries in the lateral compartment treated with primary ACL reconstructions from 2015 to 2019. ACL revisions and non-sport-related injuries were excluded. Secondary ALL visualization was defined as full, partial, or not visualized and characterized as Grade I (mild/intermediate sprain), II (severe sprain/partial tear), or III (complete tear/avulsion). Sample size was determined using chi-squared test of independence (P < .05).

Results: A total of 370 patients met the inclusion criteria and 200 were sequentially enrolled (average age: 21.1 ± 6.0 years, 34% women, 66% men). Injuries occurred during recreational (n = 86), high school (n = 83), college (n = 29), and professional sports (n = 2). The primary ALL-visualization rate was 0% (0/200) compared to 99.5% (199/200) during secondary review (133 fully, 66 partially). Of visualized ALLs, 67.5% (n = 135) demonstrated a concomitant injury that was missed on the initial MRI assessment: 41.5% Grade I, 44.4% Grade II, and 14.1% Grade III.

Conclusion: Concomitant ALL injuries are frequently missed on routine MRI in young patients with primary sports-related ACL tears. Education and heightened awareness of the ALL may improve diagnostic accuracy on routine MRIs and provide guidance for surgical management.

Background: This study compared the predictive performance of the Hounsfield unit (HU) value and vertebral bone quality (VBQ) score based on cage subsidence after anterior cervical discectomy and Zero-P fusion.

Materials and methods: We conducted a retrospective analysis of 104 patients who underwent Zero-P fusion surgery for cervical spondylosis in our hospital. Before surgery, the VBQ of each patient's C2-C7 vertebral body was measured by cervical magnetic resonance imaging, while the HU value was measured by cervical computed tomography. The maximum loss distance of vertebral height was measured immediately after surgery and at final follow-up. Patients were divided into a subsidence group (≥3 mm) and a non-subsidence group (<3 mm). Single-factor analysis was used to preliminarily determine the risk factors for Zero-P cage (ZPC) subsidence. For variables with statistical differences, logistic regression was further used for multivariate analysis to determine independent risk factors. Receiver operating characteristic (ROC) and area under the curve (AUC) were used to evaluate the ability of VBQ score and HU value to predict ZPC subsidence.

Results: Interbody ZPC subsidence was observed in 20 of 104 patients. Significant differences in HU value and VBQ score were found between the two groups. HU value (odds ratio [OR]=0.987, 95% CI 0.978-0.997, P=0.006) and VBQ score (OR=4.462, 95% CI 1.721-11.373, P=0.002) were independent risk factors for ZPC subsidence. On the ROC curve, the AUC of VBQ score was 0.776 (95% CI 0.669-0.883), and the optimal threshold of VBQ score was 3.860 (sensitivity: 60.0%, specificity: 86.9%). The AUC of HU was 0.757 (95% CI 0.645-0.869), and the optimal threshold of HU value was 298.44 (sensitivity: 60.7%, specificity: 90.0%). The AUC of HU value and VBQ score showed no statistical difference, whereas the AUC of the joint index of HU value and VBQ score was 0.833, which was higher than that of the single indicator, and the difference was statistically significant (P<0.05).

Conclusion: Higher VBQ score and lower HU value are independent predictors of ZPC subsidence in patients following Zero-P fusion. The joint index of HU value and VBQ score is more predictive of Zero-P fusion than a single indicator.

Background and objective: The aim of this study was to compare outcomes of endoscopic hip abductor repair with Healicoil^® Regenesorb (RG) vs Q-FIX^® anchors at 2-year follow-up.

Materials and methods: The 2-year follow-up modified Harris Hip Score of 51 consecutive hips (49 patients) repaired with Healicoil RG anchors were compared to that of 38 consecutive hips (35 patients) repaired with Q-FIX anchors.

Results: There was no statistically significant difference between the two groups in terms of age, sex, partial vs full thickness tears, one vs two tendon involvement, single vs double row repair, or concomitant correction of femoroacetabular impingement (FAI). For Healicoil, the mean improvement was 38.6 points, with 98% achieving minimal clinically important difference (MCID) of 6.8 points vs Q-FIX with mean improvement of 29.5 points and 92.1% achieving MCID of 7.5 points. The mean improvement was statistically superior for Healicoil. Within each of the two groups, there was no statistically significant difference in outcomes for partial vs full thickness tears, one vs two tendon involvement, single vs double row repairs, or concomitant correction of FAI. There were no complications in either group. One patient in the Healicoil group subsequently underwent total hip arthroplasty at 11 months following repair.

Conclusion: The Healicoil RG resulted in statistically significant greater improvement over the Q-FIX for endoscopic tendon repair. These two products demonstrate differing features, offering versatility in decision making for a variety of tear types, and both provide successful outcomes in terms of average improvement in modified Harris Hip Scores and percentage of patients achieving MCID with low likelihood of complications or need for further surgery.

Background: Testosterone replacement therapy (TRT) has increased in popularity over the past decade. However, TRT has been associated with medical risks, such as venous thromboembolism. The aim of this study was to characterize perioperative and postoperative complications in total hip arthroplasty (THA) patients taking TRT in the perioperative period.

Materials and methods: A retrospective review of patients from a large academic medical center was performed to identify primary THA patients who underwent TRT within 3 months prior to surgery. Cohorts were propensity score matched with controls using nearest-neighbor method with age, American Society of Anesthesiologists score, and body mass index as covariates. Outcomes studied included 90-day readmissions, emergency department (ED) encounters, infections, myocardial infarctions (MI), deep venous thrombosis (DVT), and pulmonary embolism (PE). Twenty-four-month revision rates were also collected.

Results: One hundred forty-six patients on TRT were evaluated with 294 consecutive control patients not on TRT. There was a significantly greater proportion of 90-day periprosthetic joint infection in the TRT cohort compared to the No TRT cohort (3.4%, n = 5, vs 0.3%, n = 1; P = .017). There was no significant difference in all other postoperative complications between TRT and No TRT cohorts. Ninety-day postoperative ED encounters, readmission rates, DVT, MI, and PE were similar and low between cohorts (P > .05). Twenty-four-month revision rates were also similar between study groups (P > .05).

Conclusion: This study found that TRT was associated with greater periprosthetic joint infection in THA. Further studies will need to be performed to identify optimal discontinuation of treatment prior to joint replacement.

Background: The purpose of this study was to compare rates of manipulation under anesthesia (MUA) and revision total knee arthroplasty (TKA) in patients undergoing TKA with and without perioperative use of an angiotensin-receptor blocker (ARB).

Materials and methods: Embase and PubMed/MEDLINE were searched, and peer-reviewed studies with a minimum follow-up period of 90 days comparing rates of MUA and revision surgery in patients undergoing TKA with and without perioperative use of an ARB were included. Studies that were not available in English and/or used animal models or cadavers, as well as case reports, non-full text articles, review articles, letters to the editor, and studies reporting data that was non-comparative or lacked outcome measures were excluded. Included studies were evaluated for quality using the Methodological Index for Non-Randomized Studies criteria. Patient demographics, comorbidities, and outcomes were extracted from the included studies.

Results: Six studies consisting of 997,086 control patients and 129,874 patients who received perioperative ARB were included. All included studies were at level III evidence. Patients taking an ARB had higher rates of diabetes (42% vs 28%), hypertension (87% vs 58%), obesity (34% vs 23%), and hyper-cholesterolemia (63% vs 35%) compared to the control groups. The rate of MUA across control patients ranged from 2.8% to 7.6%, compared to 2.5% to 6% in patients taking an ARB. The rate of revision TKA across control patients ranged from 1.4% to 7.6%, whereas the rate for patients taking an ARB ranged from 1.14% to 1.3%.

Conclusion: Perioperative ARB use may decrease rates of MUA and revisions after TKA. This study can guide risk stratification and counseling for patients undergoing TKA. Higher-level studies need to be conducted to determine whether ARBs should be prescribed for the sole purpose of preventing arthrofibrosis.