Orthopedics最新文献_第5页

Sagittal Pelvic Tilt Directly Influences the Ischiofemoral Space: A Cadaveric Study. 骨盆矢状倾斜直接影响股骨峡部间隙：尸体研究

IF 1.1 4区医学 Q2 Medicine

Orthopedics

Pub Date : 2024-05-01 Epub Date: 2024-01-25 DOI: 10.3928/01477447-20240122-03

Luke Spencer-Gardner, Brandon Nunley, Juan Gómez-Hoyos, Joel Wells, Anthony N Khoury

Background: Ischiofemoral impingement (IFI) is understood to be a pain generator in the deep gluteal space. Femoral position is known to influence the ischiofemoral space (IFS), but there has been no study examining the effect of sagittal pelvic tilt on the IFS. The purpose of this study was to determine whether changes in pelvic tilt in the sagittal plane lead to changes in the dimensions of the IFS.

Materials and methods: Five fresh frozen cadavers (10 hips) were used for this anatomic study. The specimens were skeletonized and placed in the prone position with the pelvis fixed to a custom-built hinged table. A digital inclinometer was used to tilt the pelvis -10°, 0°, and 10° simulating posterior, neutral, and anterior pelvic tilt, respectively. Digital calipers were used to measure the dimensions of the IFS in all three positions of sagittal pelvic tilt.

Results: Changes in pelvic tilt resulted in significant changes in the dimensions of the IFS. Mean IFS dimensions measured 29.3±9.7 mm, 37.2±9.0 mm, and 24.3±9.2 mm in the neutral, anterior, and posterior pelvic tilt positions, respectively (P<.0001).

Conclusion: Changes in sagittal pelvic tilt influence the dimensions of the IFS, with posterior pelvic tilt noted to significantly decrease the IFS when compared with neutral and anterior pelvic tilt. These findings suggest that further evaluation of sagittal spinopelvic balance in the etiology of symptomatic IFI may be warranted. [Orthopedics. 2024;47(3):167-171.].

背景：据了解，股骨峡部撞击（IFI）是臀深间隙疼痛的诱因。已知股骨位置会影响股骨峡部间隙（IFS），但尚未有研究探讨骨盆矢状倾斜对 IFS 的影响。本研究的目的是确定矢状面骨盆倾斜度的变化是否会导致 IFS 尺寸的变化：这项解剖研究使用了五具新鲜冷冻尸体（10 个髋关节）。标本被制成骨架并置于俯卧位，骨盆固定在定制的铰链台上。使用数字倾斜仪将骨盆分别倾斜-10°、0°和10°，模拟骨盆后倾、中立和前倾。在骨盆矢状倾斜的所有三个位置上，使用数字卡尺测量 IFS 的尺寸：结果：骨盆倾斜度的变化导致 IFS 的尺寸发生了显著变化。在骨盆中性、前倾和后倾位置，IFS的平均尺寸分别为（29.3±9.7）毫米、（37.2±9.0）毫米和（24.3±9.2）毫米（PC结论：骨盆矢状倾角的变化会导致IFS的尺寸发生显著变化：骨盆矢状倾角的变化会影响 IFS 的尺寸，与中性和骨盆前倾相比，骨盆后倾会显著减少 IFS。这些发现表明，有必要进一步评估矢状脊柱骨盆平衡在症状性 IFI 病因中的作用。[骨科。202x;4x(x):xx-xx]。

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引用次数: 0

Geographic Access to Pediatric Orthopedic Surgeons in the United States: An Analysis of Sociodemographic Factors 美国儿科矫形外科医生的地理位置：社会人口因素分析

IF 1.1 4区医学 Q2 Medicine

Orthopedics

Pub Date : 2024-05-01 DOI: 10.3928/01477447-20240424-03

Daniel Farivar, BS, Nicholas J. Peterman, BS, Paal K. Nilssen, BA, Kenneth D. Illingworth, MD, Teryl K. Nuckols, MD, MSHS, David L. Skaggs, MD, MMM

Background:

It is unclear how pediatric orthopedic surgeons are geographically distributed relative to their patients. The purpose of this study was to evaluate the geographic distribution of pediatric orthopedic surgeons in the United States.

Materials and Methods:

County-level data of actively practicing pediatric orthopedic surgeons were identified by matching several registries and membership logs. Data were used to calculate the distance between counties and nearest surgeon. Counties were categorized as “surgeon clusters” or “surgeon deserts” if the distance to the nearest surgeon was less than or greater than the national average and the average of all neighboring counties, respectively. Cohorts were then compared for differences in population characteristics using data obtained from the 2020 American Community Survey.

Results:

A total of 1197 unique pediatric orthopedic surgeons were identified. The mean distance to the nearest pediatric orthopedic surgeon for a patient residing in a surgeon desert or a surgeon cluster was 141.9±53.8 miles and 30.9±16.0 miles, respectively. Surgeon deserts were found to have lower median household incomes (P<.001) and greater rates of children without health insurance (P<.001). Multivariate analyses showed that higher Rural-Urban Continuum codes (P<.001), Area Deprivation Index scores (P<.001), and percentage of patients without health insurance (P<.001) all independently required significantly greater travel distances to see a pediatric orthopedic surgeon.

Conclusion:

Pediatric orthopedic surgeons are not equally distributed in the United States, and many counties are not optimally served. Additional studies are needed to identify the relationship between travel distances and patient outcomes and how geographic inequalities can be minimized. [Orthopedics. 202x;4x(x):xx–xx.]

背景：目前尚不清楚小儿矫形外科医生与其病人的地理分布情况。本研究的目的是评估美国小儿骨科医生的地理分布情况。材料与方法：通过比对多个登记册和会员日志，确定了积极执业的小儿骨科医生的县级数据。数据用于计算县与最近外科医生之间的距离。如果各县与最近外科医生的距离分别小于或大于全国平均水平和所有邻近县的平均水平，则被归类为 "外科医生集群 "或 "外科医生荒漠"。然后，利用从 2020 年美国社区调查中获得的数据，比较各组群在人口特征方面的差异。对于居住在外科医生荒漠或外科医生聚集区的患者来说，他们到最近的小儿骨科医生的平均距离分别为（141.9±53.8）英里和（30.9±16.0）英里。外科医生荒漠地区的家庭收入中位数较低（P< .001），没有医疗保险的儿童比例较高（P< .001）。多变量分析表明，较高的农村-城市连续代码（P< .001）、地区贫困指数得分（P< .001）和没有医疗保险的患者比例（P< .001）都要求看小儿骨科医生的旅行距离明显更远。需要进行更多的研究，以确定旅行距离与患者治疗效果之间的关系，以及如何将地理上的不平等降至最低。[202x;4x(x):xx-xx]。

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引用次数: 0

Total Humeral Endoprosthetic Reconstruction: A Systematic Review 全肱骨假体重建：系统回顾

IF 1.1 4区医学 Q2 Medicine

Orthopedics

Pub Date : 2024-05-01 DOI: 10.3928/01477447-20240424-01

Neil Jain, MD, Dominic Campano, MD, Caleb Gottlich, MD, Austin Yu, BS, George Brindley, MD, Alexandra Callan, MD, Alan Blank, MD

Background:

Total humeral endoprosthetic reconstruction (THER) is a rare reconstruction option for limb salvage surgery for large humeral neoplasms or bone destruction.

Materials and Methods:

Because of the limited data and need for this procedure, we reviewed the literature surrounding THER and assessed functionality, complications, and revisions using the PubMed, Embase, Ovid, and Scopus databases.

Results:

Among 29 articles and 175 patients, the most common indication was neoplasm (n=25, 86%), mean follow-up was 61.98 months (SD=55.25 months), and mean Musculoskeletal Tumor Society score was 73.64% (SD=10.69%). Reported complications included 26 (23%) revisions in 7 studies, 35 (36%) cases of shoulder instability in 7 studies, and 13 (13.54%) cases of deep infection in 4 studies.

Conclusion:

THER should be considered with a thorough knowledge of outcomes and potential complications to guide patient and clinician expectations. [Orthopedics. 202x;4x(x):xx–xx.]

背景：全肱骨假体内重建（THER）是一种罕见的肢体挽救手术，用于治疗肱骨大面积肿瘤或骨质破坏。材料与方法：由于该手术的数据和需求有限，我们回顾了有关THER的文献，并使用PubMed、Embase、Ovid和Scopus数据库评估了其功能、并发症和翻修情况。结果：在29篇文章和175名患者中，最常见的适应症是肿瘤（25人，86%），平均随访时间为61.98个月（SD=55.25个月），平均肌肉骨骼肿瘤协会评分为73.64%（SD=10.69%）。报告的并发症包括7项研究中的26例（23%）翻修，7项研究中的35例（36%）肩关节不稳定，4项研究中的13例（13.54%）深部感染。[Orthopedics.202x;4x(x):xx-xx.］

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引用次数: 0

Cannabis Use Is Associated With Fewer Filled Opioid Prescriptions After Treatment of Proximal Humerus Fractures. 大麻的使用与肱骨近端骨折治疗后阿片类药物填充处方的减少有关。

IF 1.1 4区医学 Q2 Medicine

Orthopedics

Pub Date : 2024-05-01 Epub Date: 2023-11-01 DOI: 10.3928/01477447-20231027-07

Jacob Silver, Brian T Ford, Colin J Pavano, Nicholas Bellas, Cory Hewitt, Matthew Solomito, Christopher McCarthy

The purpose of this study was to use a large claims database to determine if there is a difference in opioid use after operative intervention for proximal humerus fractures in patients with known cannabis use compared with those who do not report cannabis use. The PearlDiver database was queried to find all patients who underwent proximal humerus open reduction and internal fixation. A group of patients with reported cannabis use or dependence was matched to a cohort without known cannabis use. Between the two groups, differences in the number of opioid prescriptions filled in the postoperative period (within 3 days), the morphine milligram equivalents (MMEs) prescribed in total and per day, and the number of opioid prescription refills were explored. There were 66,445 potential control patients compared with 1260 potential study patients. After conducting the propensity score match, a total of 1245 patients were included in each group. The patients in the cannabis group filled fewer opioid prescriptions (P=.045) and were prescribed fewer total MMEs (P=.044) in the first 3 days postoperatively. Results of this study indicate that patients who use cannabis products may use fewer opioids after proximal humerus open reduction and internal fixation. [Orthopedics. 2024;47(3):147-151.].

这项研究的目的是使用一个大型索赔数据库来确定已知使用大麻的患者在肱骨近端骨折手术干预后与未报告使用大麻的人相比，阿片类药物的使用是否存在差异。PearlDiver数据库被查询，以查找所有接受肱骨近端切开复位和内固定的患者。将一组报告有大麻使用或依赖的患者与一组没有已知大麻使用的患者进行匹配。研究了两组在术后（3天内）开具的阿片类药物处方数量、每天和每天开具的吗啡毫克当量（MME）以及阿片类处方再配药数量方面的差异。有66445名潜在的对照患者，而1260名潜在的研究患者。在进行倾向评分匹配后，每组共有1245名患者。大麻组患者在术后前3天服用的阿片类药物处方较少（P=.045），服用的MME总量较少（P=0.044）。这项研究的结果表明，使用大麻产品的患者在肱骨近端切开复位和内固定后可能会使用更少的阿片类药物。[骨科.202x；4x（x）；xx-xx.]。

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引用次数: 0

Enhanced Total Hip Arthroplasty Education Using Augmented Reality: A Survey From a Tertiary Center 使用增强现实技术加强全髋关节置换术教育：来自一家三级医疗中心的调查

IF 1.1 4区医学 Q2 Medicine

Orthopedics

Pub Date : 2024-04-04 DOI: 10.3928/01477447-20240325-02

Sean P. Ryan, MD, Niall Cochrane, MD, Michael P. Bolognesi, MD, Samuel S. Wellman, MD

Background:

For total hip arthroplasty (THA), a new technology in the evolution of computer-assisted surgery has emerged in the form of augmented reality (AR). We sought to determine the impact of AR on resident and fellow education after implementation at an academic teaching center.

Materials and Methods:

The senior author's intraoperative technique allows for the orthopedic trainee to use AR to correct the acetabular component's position after an attempt is made with standard instrumentation. One year after the implementation of this AR method, both resident and fellow trainees were issued an anonymous survey regarding their experience and descriptive statistics were calculated for the results.

Results:

Sixteen trainees responded to the survey. One hundred percent felt the use of AR improved their understanding of acetabular component placement and improved their intraoperative experience. Sixty-nine percent reported feeling there was a small increase in operative time but 25% reported no increase in operative time when using AR. Seventy-five percent of trainees felt that patients benefited from the technology and would be in favor of AR if they were having a THA. The majority of those surveyed reported a desire to use AR in their practice if it is available.

Conclusion:

Computer-assisted surgery has demonstrated variable impacts on orthopedic education. After the implementation of AR at an academic teaching center, all trainees reported it improved their intraoperative experience and their understanding of acetabular component placement. Further studies are needed to determine if AR is able to improve a trainee's component placement. [Orthopedics. 202x;4x(x):xx–xx.]

背景：对于全髋关节置换术（THA）而言，计算机辅助手术发展过程中出现了一种新技术，即增强现实技术（AR）。材料与方法：资深作者的术中技术允许骨科受训者在尝试使用标准器械后使用增强现实技术纠正髋臼组件的位置。在这种AR方法实施一年后，向住院医师和研究员学员发放了一份匿名调查问卷，了解他们的经验，并对结果进行了描述性统计。结果：16 名学员回答了调查，100% 的学员认为 AR 的使用提高了他们对髋臼组件置入的理解，改善了他们的术中体验。69%的受训者认为使用AR后手术时间略有增加，但25%的受训者认为手术时间没有增加。75%的受训人员认为患者能从该技术中受益，如果他们要做全髋关节置换术，也会支持使用 AR。结论：计算机辅助手术对骨科教育的影响各不相同。结论：计算机辅助手术对骨科教育的影响不尽相同。在一个学术教学中心实施 AR 后，所有学员都表示 AR 改善了他们的术中体验以及对髋臼组件置入的理解。还需要进一步的研究来确定 AR 是否能够改善受训者的组件置放。[骨科。202x;4x(x):xx-xx。］

{"title":"Enhanced Total Hip Arthroplasty Education Using Augmented Reality: A Survey From a Tertiary Center","authors":"Sean P. Ryan, MD, Niall Cochrane, MD, Michael P. Bolognesi, MD, Samuel S. Wellman, MD","doi":"10.3928/01477447-20240325-02","DOIUrl":"https://doi.org/10.3928/01477447-20240325-02","url":null,"abstract":"<section><h3>Background:</h3><p>For total hip arthroplasty (THA), a new technology in the evolution of computer-assisted surgery has emerged in the form of augmented reality (AR). We sought to determine the impact of AR on resident and fellow education after implementation at an academic teaching center.</p></section><section><h3>Materials and Methods:</h3><p>The senior author's intraoperative technique allows for the orthopedic trainee to use AR to correct the acetabular component's position after an attempt is made with standard instrumentation. One year after the implementation of this AR method, both resident and fellow trainees were issued an anonymous survey regarding their experience and descriptive statistics were calculated for the results.</p></section><section><h3>Results:</h3><p>Sixteen trainees responded to the survey. One hundred percent felt the use of AR improved their understanding of acetabular component placement and improved their intraoperative experience. Sixty-nine percent reported feeling there was a small increase in operative time but 25% reported no increase in operative time when using AR. Seventy-five percent of trainees felt that patients benefited from the technology and would be in favor of AR if they were having a THA. The majority of those surveyed reported a desire to use AR in their practice if it is available.</p></section><section><h3>Conclusion:</h3><p>Computer-assisted surgery has demonstrated variable impacts on orthopedic education. After the implementation of AR at an academic teaching center, all trainees reported it improved their intraoperative experience and their understanding of acetabular component placement. Further studies are needed to determine if AR is able to improve a trainee's component placement. [<i>Orthopedics</i>. 202x;4x(x):xx–xx.]</p></section>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140583552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fluoroscopy-Assisted Computer Navigation Accurately Determines Cup Position and Leg Length for Anterior Hip Arthroplasty 透视辅助计算机导航准确确定髋关节前路成形术的髋臼杯位置和腿长

IF 1.1 4区医学 Q2 Medicine

Orthopedics

Pub Date : 2024-04-04 DOI: 10.3928/01477447-20240325-01

Raymond L. Kitziger, BA, Annie L. Dugan, BS, Bradford S. Waddell, MD, Kurt J. Kitziger, MD, Paul C. Peters Jr, MD, Brian P. Gladnick, MD

Background:

Recently, fluoroscopy-assisted computer navigation has been developed to assess intraoperative cup inclination/anteversion and leg-length discrepancy (LLD) in the operating room. However, there is a relative dearth of studies investigating the accuracy of this software compared with postoperative radiographs.

Materials and Methods:

We prospectively enrolled 211 navigated anterior total hip arthroplasties using fluoroscopy-assisted computer navigation software. Intraoperative navigated measurements were compared with postoperative anteroposterior radiographs to assess accuracy of cup inclination/anteversion and LLD. Continuous variables were analyzed using the Student's t test, and categorical variables were analyzed using Fisher's exact test.

Results:

On postoperative radiographs, 94.3% of cups (199 of 211) were positioned within the Lewinnek “safe zone,” compared with 99.1% navigated intraoperatively (P=.01). Eighty-two percent of hips (174 of 211) were navigated intraoperatively to LLDs within ±2 mm; on postoperative radiographs, 65% of hips (138 of 211) had LLDs within ±2 mm (P=.0001). Intraoperatively, 100% of hips (211 of 211) were navigated to LLDs within ±5 mm; similarly, on postoperative radiographs, 98% of hips (207 of 211) had LLDs within ±5 mm (P=.12).

Conclusion:

A novel fluoroscopy-assisted computer navigation platform accurately assessed intraoperative cup position and LLD during anterior total hip arthroplasty. Careful attention to fluoroscopic technique, positioning of radiographic landmarks, and knowledge of the limitations of fluoroscopy, including parallax effect, are important concepts that surgeons should incorporate into their decision algorithm. [Orthopedics. 202x;4x(x):xx–xx.]

背景：最近，开发了荧光屏辅助计算机导航，用于在手术室评估术中髋臼杯倾斜/倒转和腿长不一致（LLD）。材料与方法：我们前瞻性地登记了211例使用透视辅助计算机导航软件导航的前路全髋关节置换术。将术中导航测量结果与术后前胸X光片进行比较，以评估髋臼杯倾斜/倒转和LLD的准确性。结果：术后X光片显示，94.3%的髋臼杯（211例中的199例）位于Lewinnek "安全区 "内，而术中导航结果为99.1%（P=0.01）。82%的髋关节（211例中的174例）在术中被导航至LLD在±2毫米以内；在术后X光片上，65%的髋关节（211例中的138例）的LLD在±2毫米以内（P=.0001）。术中，100% 的髋关节（211 个中的 211 个）被导航到 LLD 在 ±5 mm 以内；同样，在术后 X 光片上，98% 的髋关节（211 个中的 207 个）的 LLD 在 ±5 mm 以内（P=.12）。外科医生应将透视技术、放射标志定位和透视局限性知识（包括视差效应）等重要概念纳入其决策算法。[Orthopedics.202x;4x(x):xx-xx.］

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引用次数: 0

Clinical Outcome of Chemotherapy and Radiation Therapy Versus Chemotherapy, Radiation Therapy, and Multilevel Vertebroplasty or Kyphoplasty for Multiple Myeloma 化疗和放疗与化疗、放疗和多层次椎体成形术或椎体后凸成形术治疗多发性骨髓瘤的临床疗效比较

IF 1.1 4区医学 Q2 Medicine

Orthopedics

Pub Date : 2024-04-04 DOI: 10.3928/01477447-20240325-06

Mohammad Alkhatatba, MD, Ala'a Alma' aiteh, MD, Ziad Audat, MD, Suhaib Bani Essa, MD, Ahmad Radaideh, MD, Ziyad Mohaidat, MD, Hamzeh Ziad Audat, MD, Tarek Manasreh, MD

Background:

Vertebral augmentation including vertebroplasty and kyphoplasty may restore function without interfering with the therapeutic regimen of patients with multiple myeloma. We sought to evaluate the effects of adding multilevel vertebral augmentation to conventional therapy protocols for patients with multiple myeloma.

Materials and Methods:

Forty-four patients recently diagnosed with multiple myeloma were randomly assigned to two groups. One group received multilevel vertebral augmentation (kyphoplasty or vertebroplasty) in addition to conventional therapy (MVA), and the other group received conventional therapy alone (CTA). Patients were evaluated before treatment and at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years after treatment by using the Oswestry Disability Index (ODI), the Stanford Score (SS), and the Spinal Instability Neoplastic Score (SINS).

Results:

The mean ODI, SS, and SINS were nearly equal before treatment, being 34.19 (68.38%), 4.58, and 12.30, respectively, for the MVA group and 32.29 (64.58%), 4.63, and 13.88, respectively, for the CTA group. There were significant differences in the ODI, SS, and SINS between the two groups at all follow-up intervals. The ODI and SINS were statistically significantly different between the two groups (P=.020 and P<.001, respectively). There was an insignificant difference in SS between the two groups.

Conclusion:

This study found that performing kyphoplasty and vertebroplasty in addition to conventional therapy for patients with multiple myeloma resulted in enhanced morbidity and functional outcomes. [Orthopedics. 202x;4x(x):xx–xx.]

背景：包括椎体成形术和椎体后凸成形术在内的椎体增强术可在不影响多发性骨髓瘤患者治疗方案的情况下恢复其功能。我们试图评估在多发性骨髓瘤患者的常规治疗方案中加入多级椎体增强术的效果。材料与方法：44 名近期诊断为多发性骨髓瘤的患者被随机分配到两组。一组在常规治疗（MVA）的基础上接受多级椎体增强术（椎体成形术或椎体成形术），另一组仅接受常规治疗（CTA）。在治疗前、治疗后3个月、6个月、1年、2年、3年、4年和5年，使用奥斯韦特里残疾指数（ODI）、斯坦福评分（SS）和脊柱不稳定性肿瘤评分（SINS）对患者进行评估。结果：治疗前的平均 ODI、SS 和 SINS 几乎相同，MVA 组分别为 34.19（68.38%）、4.58 和 12.30，CTA 组分别为 32.29（64.58%）、4.63 和 13.88。在所有随访时间间隔内，两组患者的 ODI、SS 和 SINS 均存在明显差异。两组的 ODI 和 SINS 在统计学上有显著差异（分别为 P=.020 和 P<.001）。结论：本研究发现，在对多发性骨髓瘤患者进行常规治疗的同时进行椎体成形术和椎体后凸成形术可提高发病率和功能预后。[骨科。202x;4x(x):xx-xx。］

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引用次数: 0

Factors Associated With Episode of Care Adverse Events After Humerus Nonunion Repair 肱骨骨不连修复术后护理不良事件的相关因素

IF 1.1 4区医学 Q2 Medicine

Orthopedics

Pub Date : 2024-04-04 DOI: 10.3928/01477447-20240325-03

Dafang Zhang, MD, Jesse B. Jupiter, MD, Philip Blazar, MD, Brandon E. Earp, MD, George S. M. Dyer, MD

Background:

Humeral nonunions have devastating negative effects on patients' upper extremity function and health-related quality of life. The objective of this study was to identify factors independently associated with 30-day complication, hospital readmission, and reoperation after surgical treatment of humeral nonunions.

Materials and Methods:

A retrospective case-control study was performed using the American College of Surgeons National Surgical Quality Improvement Program database by querying the Current Procedural Terminology codes for patients who underwent humeral nonunion repair from 2011 to 2020. The study outcomes were 30-day complication, hospital readmission, and reoperation.

Results:

Of the 1306 patients in our cohort, 135 patients (10%) developed a complication, 66 patients (5%) were readmitted to the hospital, and 44 patients (3%) underwent reoperation during the 30-day postoperative period. Multivariable logistic regression analysis showed that older age, longer operative time, partially dependent functional status, congestive heart failure, bleeding disorder, and contaminated wound classification were associated with 30-day complication after humeral nonunion repair. Older age and disseminated cancer were associated with 30-day reoperation after humeral nonunion repair. Disseminated cancer was associated with 30-day readmission after humeral nonunion repair.

Conclusion:

Using a large database over a recent 10-year period, we identified demographic and comorbid factors independently associated with episode of care adverse events after humeral nonunion repair. Patients 50 years or older had approximately three times the incidence of complications, readmissions, and reoperations in the first month after humeral nonunion repair compared with patients younger than 50 years. Our findings are relevant for preoperative risk stratification and counseling. [Orthopedics. 202x;4x(x):xx–xx.]

背景：肱骨骨不连对患者的上肢功能和与健康相关的生活质量具有破坏性的负面影响。本研究旨在确定与肱骨骨不连手术治疗后 30 天并发症、再次入院和再次手术独立相关的因素。材料与方法：研究人员利用美国外科学院国家外科质量改进计划数据库，通过查询当前程序术语代码，对 2011 年至 2020 年期间接受肱骨骨不连修复术的患者进行了一项回顾性病例对照研究。研究结果为30天并发症、再次入院和再次手术。结果：在我们队列中的1306名患者中，135名患者（10%）出现并发症，66名患者（5%）再次入院，44名患者（3%）在术后30天内再次手术。多变量逻辑回归分析表明，年龄较大、手术时间较长、部分依赖性功能状态、充血性心力衰竭、出血性疾病和污染伤口分类与肱骨不连修复术后 30 天并发症的发生有关。高龄和播散性癌症与肱骨不连修复术后 30 天再次手术有关。结论：通过使用近10年来的大型数据库，我们确定了与肱骨内外翻修复术后护理不良事件独立相关的人口统计学和合并症因素。与50岁以下的患者相比，50岁或以上的患者在肱骨非整复术后第一个月的并发症、再入院和再手术发生率大约是后者的三倍。我们的研究结果与术前风险分层和咨询有关。[Orthopedics.202x;4x(x):xx-xx.］

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引用次数: 0

Psychiatric Diagnosis Does Not Influence Management or Resolution of Confirmed Fracture-Related Infection 精神诊断不会影响已确认的骨折相关感染的处理或缓解

IF 1.1 4区医学 Q2 Medicine

Orthopedics

Pub Date : 2024-04-04 DOI: 10.3928/01477447-20240325-08

Nina D. Fisher, MD, Lauren A. Merrell, BA, Sara J. Solasz, BA, Abhishek Ganta, MD, Sanjit R. Konda, MD, Kenneth A. Egol, MD

Background:

The purpose of this study was to determine if the presence of a standing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, psychiatric diagnosis is associated with worse outcomes for patients who develop a confirmed fracture-related infection (FRI).

Materials and Methods:

Included patients had open or closed fractures managed with internal fixation and had confirmed FRIs. Baseline demographics, injury information, and outcomes were collected via chart review. All patients who had a diagnosis of psychiatric illness, which included depression, bipolar disorder, anxiety disorder, and schizophrenia, were identified. Patients with and without a psychiatric diagnosis were statistically compared.

Results:

Two hundred eleven patients were diagnosed with a confirmed FRI. Fifty-seven (27.0%) patients had a diagnosis of a psychiatric illness at the time of FRI diagnosis. Patients with a psychiatric diagnosis had a higher rate of smoking (56% vs 40%, P=.039) and drug use (39% vs 19%, P=.004) and a higher American Society of Anesthesiologists (ASA) classification (2.35±1.33 vs 1.96±1.22, P=.038); however, there were no other demographic differences. Clinical outcomes also did not differ between the groups, as patients with an FRI and a psychiatric diagnosis had a similar time to FRI diagnosis, similar confirmatory FRI characteristics, and a similar rate of reoperation. Furthermore, there was no difference between patients with FRI with and without a psychiatric diagnosis regarding rate of infection resolution (89% vs 88%, P=.718) or time to final follow-up (20.13±24.93 vs 18.11±21.81 months, P=.270).

Conclusion:

The presence of a psychiatric diagnosis does not affect clinical outcomes in the patient population with FRI. This is the first study exploring the impact of psychiatric illness on patient outcomes after a confirmed FRI diagnosis. [Orthopedics. 202x;4x(x):xx–xx.]

背景：本研究的目的是确定存在《精神疾病诊断与统计手册》第五版精神疾病诊断是否与确诊骨折相关感染（FRI）患者的不良预后有关。通过病历审查收集了基线人口统计学特征、损伤信息和预后。所有被诊断患有精神疾病（包括抑郁症、躁郁症、焦虑症和精神分裂症）的患者均被确定。结果：有 211 名患者被确诊为 FRI。57名患者（27.0%）在确诊FRI时被诊断患有精神疾病。有精神病诊断的患者吸烟率（56% vs 40%，P=.039）和吸毒率（39% vs 19%，P=.004）较高，美国麻醉医师协会（ASA）分级（2.35±1.33 vs 1.96±1.22，P=.038）也较高；但两者在人口统计学方面没有其他差异。两组患者的临床结果也没有差异，因为FRI和精神疾病患者确诊FRI的时间相似，确诊FRI的特征相似，再次手术率相似。此外，在感染缓解率（89% vs 88%，P=.718）或最终随访时间（20.13±24.93 个月 vs 18.11±21.81个月，P=.270）方面，有精神病学诊断和没有精神病学诊断的 FRI 患者之间没有差异。这是第一项探讨确诊 FRI 后精神疾病对患者预后影响的研究。[骨科。202x;4x(x):xx-xx。］

{"title":"Psychiatric Diagnosis Does Not Influence Management or Resolution of Confirmed Fracture-Related Infection","authors":"Nina D. Fisher, MD, Lauren A. Merrell, BA, Sara J. Solasz, BA, Abhishek Ganta, MD, Sanjit R. Konda, MD, Kenneth A. Egol, MD","doi":"10.3928/01477447-20240325-08","DOIUrl":"https://doi.org/10.3928/01477447-20240325-08","url":null,"abstract":"<section><h3>Background:</h3><p>The purpose of this study was to determine if the presence of a standing <i>Diagnostic and Statistical Manual of Mental Disorders, </i>Fifth Edition, psychiatric diagnosis is associated with worse outcomes for patients who develop a confirmed fracture-related infection (FRI).</p></section><section><h3>Materials and Methods:</h3><p>Included patients had open or closed fractures managed with internal fixation and had confirmed FRIs. Baseline demographics, injury information, and outcomes were collected via chart review. All patients who had a diagnosis of psychiatric illness, which included depression, bipolar disorder, anxiety disorder, and schizophrenia, were identified. Patients with and without a psychiatric diagnosis were statistically compared.</p></section><section><h3>Results:</h3><p>Two hundred eleven patients were diagnosed with a confirmed FRI. Fifty-seven (27.0%) patients had a diagnosis of a psychiatric illness at the time of FRI diagnosis. Patients with a psychiatric diagnosis had a higher rate of smoking (56% vs 40%, <i>P</i>=.039) and drug use (39% vs 19%, <i>P</i>=.004) and a higher American Society of Anesthesiologists (ASA) classification (2.35±1.33 vs 1.96±1.22, <i>P</i>=.038); however, there were no other demographic differences. Clinical outcomes also did not differ between the groups, as patients with an FRI and a psychiatric diagnosis had a similar time to FRI diagnosis, similar confirmatory FRI characteristics, and a similar rate of reoperation. Furthermore, there was no difference between patients with FRI with and without a psychiatric diagnosis regarding rate of infection resolution (89% vs 88%, <i>P</i>=.718) or time to final follow-up (20.13±24.93 vs 18.11±21.81 months, <i>P</i>=.270).</p></section><section><h3>Conclusion:</h3><p>The presence of a psychiatric diagnosis does not affect clinical outcomes in the patient population with FRI. This is the first study exploring the impact of psychiatric illness on patient outcomes after a confirmed FRI diagnosis. [<i>Orthopedics</i>. 202x;4x(x):xx–xx.]</p></section>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140583428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Shoulder Hemiarthroplasty Is Associated With Higher 30-Day Complication Rates Compared With Total Shoulder Arthroplasty for Glenohumeral Osteoarthritis: A Propensity Score Matched Analysis 与治疗盂肱关节骨关节炎的全肩关节置换术相比，肩关节半关节置换术的 30 天并发症发生率更高：倾向得分匹配分析

IF 1.1 4区医学 Q2 Medicine

Orthopedics

Pub Date : 2024-04-04 DOI: 10.3928/01477447-20240325-05

Phillip B. Wyatt, DPT, Charles R. Reiter, BS, James R. Satalich, MD, Conor N. O'Neill, MD, Alexander R. Vap, MD

Background:

Anatomical total shoulder arthroplasty (TSA) and shoulder hemiarthroplasty (HA) have both been shown to have good outcomes in patients with osteoarthritis of the glenohumeral joint. However, evidence comparing perioperative complications between these procedures in this population is heterogeneous.

Materials and Methods:

The American College of Surgeons National Surgical Quality Improvement Program database was queried between the years 2012 and 2021 (10 years in total) for records of patients who underwent either TSA or HA for osteoarthritis of the glenohumeral joint. Patients in each group underwent a 1:1 propensity match for demographic variables. Bivariate and multivariate analyses were performed to compare complications and risk factors between these cohorts.

Results:

A total of 4376 propensity-matched patients, with 2188 receiving TSA and 2188 receiving HA, were included in the primary analyses. The HA cohort had a higher rate of any adverse event (7.18% vs 4.8%, P=.001), death (0.69% vs 0.1%, P=.004), sepsis (0.46% vs 0.1%, P=.043), postoperative transfusion (4.62% vs 2.2%, P<.001), postoperative intubation (0.5% vs 0.1%, P=.026), and extended length of stay (23.77% vs 13.1%, P<.001). HA was found to increase the odds of developing these complications when baseline demographics were controlled. Older age (odds ratio, 1.040; 95% CI, 1.021–1.059; P<.001) and lower body mass index (odds ratio, 0.949; 95% CI, 0.923–0.975; P<.001) increased the odds of having any adverse event in the HA cohort but not in the TSA cohort.

Conclusion:

Compared with TSA, HA appears to be associated with significantly higher rates of 30-day postoperative complications when performed for glenohumeral osteoarthritis. [Orthopedics. 202x;4x(x):xx–xx.]

背景：解剖性全肩关节置换术（TSA）和肩关节半关节置换术（HA）对盂肱关节骨性关节炎患者都有良好的疗效。材料与方法：在2012年至2021年（共10年）期间，我们查询了美国外科医生学会国家外科质量改进计划数据库，以获得因盂盂关节骨性关节炎而接受TSA或HA手术的患者记录。每组患者的人口统计学变量进行了1:1倾向匹配。结果：共有4376名倾向匹配患者参与了主要分析，其中2188人接受了TSA治疗，2188人接受了HA治疗。HA队列中发生任何不良事件（7.18% vs 4.8%，P=.001）、死亡（0.69% vs 0.1%，P=.004）、败血症（0.46% vs 0.1%，P=.043）、术后输血（4.62% vs 2.2%，P<.001）、术后插管（0.5% vs 0.1%，P=.026）和住院时间延长（23.77% vs 13.1%，P<.001）。在控制了基线人口统计学特征后，发现 HA 会增加出现这些并发症的几率。年龄较大（几率比，1.040；95% CI，1.021-1.059；P<.001）和体重指数较低（几率比，0.949；95% CI，0.923-0.975；P<.001）增加了HA队列中发生任何不良事件的几率，而TSA队列中则没有。[Orthopedics.202x;4x(x):xx-xx.］

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引用次数: 0