Orthopedics最新文献

Background: As shared decision-making models gain prominence, patients are taking on more responsibility in deciding whether to undergo surgery. Decisional regret is a key patient-reported outcome (PRO) to evaluate quality of care and surgical success. With increased emphasis on decisional regret, determining the tools to measure regret is of increasing importance. The objectives of this study were to (1) investigate and identify the tools used to measure decisional regret in elective orthopedic surgery and (2) examine the time frame in which regret is measured postoperatively.

Materials and methods: The authors conducted a systematic literature review of PubMed/MEDLINE and Embase databases from database inception until September 5, 2024. All studies that discussed a patient's decisional regret in the context of elective orthopedic surgery were eligible.

Results: Initial results yielded 1,002 articles, and 26 were chosen for inclusion. The Decisional Regret Scale (DRS) was the most used tool, appearing in 54% of the articles. Novel, study-specific questions were used in 19% of the studies, while 15% used question 22 of the Scoliosis Research Society-22 tool and 11% used non-standardized patient interviews. Regret was assessed postoperatively at >24 months in 15% of studies, at 24 months in 17%, at 12 months in 22%, at 6 months in 26%, at multiple time frames in 4%, and was not stated in 8%.

Conclusion: Decisional regret is an increasingly important PRO that can help optimize medical interventions. The DRS, used in more than half of the studies analyzed, is the most widely adopted and validated tool for quantifying regret and should be prioritized in future research. While timing of regret assessment varied, the 6-month and 12-month postoperative intervals were the most common and are suggested as standard time points for measuring regret. Additionally, establishing clinical stratifications for regret scores will facilitate meta-analysis and improve risk factor identification, enhancing shared decision-making and patient care. [Orthopedics. 2025;48(4):e153-e161.].

Background: Depictions of skin color in medical journals have been observed to misrepresent the population in other fields but have not been studied in orthopedics. We assessed whether the spectrum of skin color depicted in orthopedic literature appropriately reflects the population and whether that representation has changed over time.

Materials and methods: We examined images of human patients published in four journals: Journal of Bone and Joint Surgery (JBJS), Clinical Orthopaedics and Related Research (CORR), Journal of the American Academy of Orthopaedic Surgeons (JAAOS), and The American Journal of Sports Medicine (AJSM) in 2010 and 2020. Fitzpatrick skin phototypes were used to categorize images as "lighter skin tone" (types I-III) or "darker skin tone" (types IV-VI), with the latter attributed to Black, Asian, Native American, and multiracial individuals. We compared published skin tones to 2020 United States census data (38% of the population being Fitzpatrick types IV-VI) using chi-square analysis.

Results: Of 649 eligible images, 13% depicted Fitzpatrick skin types IV-VI. There was no significant change from 2010 to 2020 (11% vs 16%, P=0.07) in depictions of Fitzpatrick types IV and above. Darker skin tones were underrepresented compared to the US population (13% vs 38%, P<0.001). In US-based articles representation increased from 11% to 18% (P=0.045), but no change was observed in non-US articles (12% vs 12%, P=0.9).

Conclusion: While there has been a mild improvement over time in the diversity of skin colors represented, the depiction of darker skin types in orthopedic literature still falls well short of that seen in the general population. [Orthopedics. 2025;48(4):197-202.].

Background: Each year, more than 1 million patients in the United States receive life-changing musculoskeletal (MSK) tissue transplants. These transformative gifts save and restore lives. Unfortunately, data from organ procurement organizations suggest that orthopedic patients rarely contact donor families to acknowledge the gift, with less than 1% of tissue donor families ever receiving communication from recipients of their loved one's gifts.

Materials and methods: In response, our team launched the "Connecting Lives" initiative in 2015 to address this gap. Initially focused on osteochondral and meniscus allograft, it expanded to all MSK allograft recipients at our facility in 2022.

Results: Among osteochondral and meniscus allograft recipients, this quality improvement initiative increased the percentage of MSK tissue transplant recipients writing to donor families from less than 1% to nearly 18%, comparable to organ donation rates (approximately 20%). The main barrier for non-writers was uncertainty about what to say. Despite this improvement, further efforts are needed to close the Tissue Donation Circle.

Conclusion: Engaging patients before and after transplant surgery can help address emotional and practical barriers, fostering connection and honoring tissue donors. Orthopedic health care teams must contribute to "closing the loop" between allograft recipients and donor families through education, advocacy, resourcing, and support that drive completion of the Tissue Donation Circle. [Orthopedics. 2025;48(4):234-238.].

Background: Despite numerous studies showing postoperative fever can be a common and benign occurrence, there is still a significant and costly workup when fevers occur after surgery, including for orthopedic patients with pelvic ring and acetabular injuries.

Material and methods: A total of 204 patients undergoing pelvis and/or acetabular fixation were analyzed for fever, with positive fever defined as temperature >38° Celsius. Age, sex, substance use, smoking history, body mass index, diabetes, comorbidities, American Society of Anesthesiologists (ASA) score, fracture morphology, polytrauma, surgical treatment, transfusion requirements, operative time, estimated blood loss, use of vancomycin powder, and surgical site infection (SSI) were all recorded. Surgical site infection was defined as an infection at the surgical site requiring reoperation, with positive cultures at time of secondary surgery.

Results: SSI was not associated with postoperative fever in patients undergoing pelvic and/or acetabular fixation. Higher ASA score, polytrauma, combined pelvic ring-acetabular fractures, open pelvic ring injuries, increased intraoperative blood loss, increased surgical time, and transfusions were associated with higher rates of fevers on univariate analysis. Multivariate analysis showed transfusions were the only independent risk factor for developing fever.

Conclusion: Surgeons and clinicians managing orthopedic patients should be aware that postoperative fever is common after pelvis and acetabular fixation and is rarely related to SSI. [Orthopedics. 2025;48(4):229-233.].

Background: Radial head fractures are common elbow fractures in adults, and their treatment algorithm remains controversial. Particularly with displaced Mason III or IV radial head fractures, studies have shown mixed results when comparing outcomes between radial head arthroplasty (RHA) and open reduction internal fixation (ORIF). Although multifactorial, patient characteristics often play a large role in treatment modality. The purpose of this study was to analyze the current trend in the management of radial head fractures, complications, and need for repeat operation among these groups.

Materials and methods: We conducted a retrospective database review using the IBM Truven MarketScan Databases and analyzing all available patients treated for radial head fractures between 2015 to 2020. Patients were grouped by treatment modality, including nonoperative, ORIF, radial head excision (RHE), and RHA. Patient characteristics, complication rates, reoperation rates, and predictive factors for undergoing surgery were assessed.

Results: Our search yielded 18,945 cases of radial head fractures that underwent treatment. The majority of patients were managed nonoperatively (16,035), and fewer were treated via ORIF, RHA, and RHE (1,636, 1,174, and 100, respectively). Of these, between 1% and 2.5% of patients in each group underwent revision surgery.

Conclusion: We found that patients who undergo RHA or RHE are typically older and have more comorbidities compared to patients who are treated nonoperatively or undergo ORIF. We found no significant difference in reoperation rates based on initial mode of treatment. Male sex, osteoporosis, coronary artery disease, and a displaced fracture are predictive of undergoing surgery for a radial head fracture. [Orthopedics. 2025;48(4):e169-e176.].

Background: Call patterns among hospital systems vary. At our institution, most pyogenic flexor tenosynovitis (FTS) patients receive irrigation and debridement (I&D) from non-hand-trained orthopedic specialists on call. Our hypothesis was that there would be no outcome differences among patients managed by hand surgeons versus non-hand surgeons.

Materials and methods: This was a retrospective cohort study of patients who underwent I&D for FTS over a six-year period. Demographic data, mechanism of injury, past medical history, laboratory results indicating inflammation, time to the operating room, and Kanavel signs were collected. Outcomes were range of motion (ROM) and pain at last follow-up, return to OR (RTOR) rate, and need for amputation. A significance level of P<0.05 was used.

Results: There were 128 patients and 153 digits with a postoperative diagnosis of FTS that underwent I&D. The most common medical comorbidities were diabetes, peripheral vascular disease, and end-stage renal disease. The most common presenting signs were pain with passive extension and resting digital flexion, but most patients presented with all four Kanavel signs. The RTOR rates for non-hand-and hand-trained surgeons were 22% and 26%, respectively (P>0.05). There were no significant differences when comparing postoperative pain and ROM, as well as RTOR rates. Amputation rates among non-hand and hand surgeons were similar at 7% and 5%, respectively (P>0.05).

Conclusions: There were no significant differences in outcomes, RTOR rates, or amputations among non-hand-versus hand-trained orthopedic surgeons acutely managing FTS. Surgical treatment for FTS should not be delayed if a hand surgeon is unavailable. [Orthopedics. 2025;48(4):e162-e168.].

Background: This study evaluated the relevance, construct validity, test-retest reliability, and responsiveness and estimate the minimal clinically important difference in the Knee Injury Osteoarthritis outcome score (KOOS) for patients with tibial shaft fractures.

Materials and methods: This prospective cohort study included adult patients who were surgically treated after tibial shaft fracture (AO 42-). The primary outcome measure was the score on the KOOS subscales of pain, symptoms, activities of daily living, sport and recreational activities, and knee-related quality of life. Scores were obtained at 14 days, 15 days, 6 weeks, and 3, 6, and 12 months postoperatively. Relevance was evaluated by patients' ranking all KOOS items; construct validity was evaluated by comparing KOOS scores with the Health-Related Quality of Life questionnaire; test-retest reliability was evaluated by comparing KOOS scores over a 24-hour period; and responsiveness was evaluated based on predefined hypotheses and effect size.

Results: Sixty patients (mean age, 47.1 years; range, 18-84 years) were included. Results showed acceptable relevance and construct validity for all KOOS subscales. Test-retest reliability was high for all 5 subscales, with an intraclass correlation coefficient of 0.9. Responsiveness was observed with moderate to high correlations (r≥0.3) for the predefined hypotheses and moderate to large effect sizes, ranging from 0.5 to 1.3, for the subscales of pain, activities of daily living, symptoms, and sport and recreational activities.

Conclusion: The KOOS showed acceptable relevance, construct validity, and responsiveness and moderate to high test-retest reliability for patients with tibial shaft fractures. Further validation of the psychometric properties of the KOOS for tibial shaft fractures may expand its usefulness for this patient group. [Orthopedics. 2025;48(3):146-152.].

Background: Total hip arthroplasty (THA) is a successful treatment for hip osteoarthritis, but the optimal surgical approach for this procedure is a topic of debate. This review uses fragility analysis to determine the statistical fragility of randomized controlled trials (RCTs) comparing the 3 most common surgical approaches for THA: direct anterior, direct lateral, and posterior.

Materials and methods: A systematic review was conducted to identify RCTs comparing 2 of the 3 surgical approaches for THA. Dichotomous outcomes and study characteristics were extracted from each study that met the inclusion criteria. Fragility index (FI) and fragility quotient (FQ) were calculated for each significant outcome (P≤.05), and reverse fragility index and quotient (rFI and FQ) were calculated for each nonsignificant outcome (P>.05).

Results: Our search yielded 20 studies in total, with 146 identified dichotomous outcomes. In total, the outcomes had a median FI of 5 and a median rFI of 5. Significant outcomes that favored the anterior approach had a median FI of 6, and significant outcomes that favored the posterior or lateral approach both had a median FI of 1.

Conclusion: The RCTs comparing approaches to THA had a median FI of 5, signifying that the reversal of 5 events would be sufficient to change the significance of the entire outcome. This value is comparable to other FI values within the orthopedic literature, but subgroup analyses elucidated areas of greater statistical fragility, particularly in outcomes favoring either the lateral or posterior approach in THA. [Orthopedics. 2025;48(3):166-173.].

Background: Cubital tunnel syndrome (CuTS) is a prevalent compressive neuropathy with various surgical treatments but no established consensus on the optimal technique. This study compared outcomes and electromyography (EMG) findings between in situ decompression (ISD) and anterior ulnar nerve transposition (AT) and assessed correlations between preoperative EMG parameters and muscle strength.

Materials and methods: We retrospectively analyzed 81 patients with unilateral idiopathic CuTS. Thirty-three underwent ISD and 48 underwent AT, determined by intraoperative ulnar nerve stability. Outcomes included pinch strength, 2-point discrimination, and functional scores (disabilities of the arm, shoulder and hand [DASH], visual analog scale, Bishop). Preoperative EMG measures were compound muscle action potential (CMAP) amplitude and conduction velocity. Correlations were analyzed with adjustment for age.

Results: Both ISD and AT improved DASH scores, pinch strength, and 2-point discrimination (P<.05), with no significant differences in postoperative outcomes. Preoperative CMAP amplitude correlated moderately with pinch strength in ISD (P<.05) but weakly or not at all in AT. Postoperatively, no strong correlations between EMG and pinch strength were observed.

Conclusion: Both ISD and AT yield comparable improvements in CuTS. Preoperative EMG, particularly CMAP amplitude, may predict muscle strength in ISD but is less predictive in AT, emphasizing the role of pathophysiology in interpreting results. Larger prospective studies are needed to refine surgical decision-making. [Orthopedics. 2025;48(3):159-165.].

Background: Anterior cruciate ligament reconstruction (ACLR) is being performed at increasing volumes. However, it is unknown whether public interest in ACLR has also increased over time. Google Trends provides the relative search volume (RSV) for Google search terms. This study was performed to evaluate through Google Trends whether public interest in ACLR has increased over time and to evaluate the readability of articles obtained through Google searches.

Materials and methods: A retrospective longitudinal study of public interest in anterior cruciate ligament (ACL) reconstruction was conducted from January 2004 to April 2023 with Google Trends. The RSV ranges from 0 to 100 and represents interest in a keyword at a specific point during the selected time frame; 0 indicates minimal interest and 100 indicates peak interest. Four terms were evaluated: "ACL surgery," "ACL reconstruction," "ACL repair," and "ACL procedure." Additionally, a Google search with the term "ACL surgery" was conducted and the readability of the first 25 articles was assessed.

Results: Between 2004 and 2023, there was a significant increase in mean RSV for "ACL surgery" (2004, 33.7; 2023, 93.6). Among the 4 search terms explored ("ACL surgery," "ACL reconstruction," "ACL repair," and "ACL procedure"), "ACL surgery" had a significantly higher mean RSV (57.7 vs 20.7 vs 9.7 vs 0, respectively). Among 25 articles, the mean Flesch-Kincaid reading level was 9.4, and only 12% of the articles were at or below the recommended 6th grade reading level.

Conclusion: Public interest in ACLR is increasing significantly. Despite this increase, articles in Google searches do not adhere to recommended reading levels. Virtual patient resources must be optimized to improve education and facilitate improved outcomes. [Orthopedics. 2025;48(3):133-138.].