Orthopedics最新文献

Background: The objectives of this study were to analyze differences in deep vein thrombosis (DVT) incidence in both lower extremities before operation and blood coagulation function at admission in younger and older adults with hip fracture and to guide DVT prevention in these patients.

Materials and methods: The 505 hip fracture patients enrolled in this research were sorted into an older adult (≥60 years) group (424 cases) and a younger adult group (81 cases) based on age. Preoperative DVT incidence in both lower extremities was analyzed. Differences in demographic characteristics, comorbidities, and preoperative DVT incidence in both lower extremities, blood coagulation function, and platelet count at admission were compared.

Results: Preoperative DVT incidence in both lower extremities in hip fracture patients increased with age. Compared with the younger adult group, preoperative DVT incidence in both lower extremities was higher, the ratio of women was higher, the ratio of patients with comorbidities (eg, hypertension, diabetes) was higher, fibrinogen was higher, and antithrombin III was lower in the older adult group.

Conclusion: Preoperative DVT incidence in both lower extremities in these patients increased with age. Compared with the younger adult group, preoperative DVT incidence was higher, hypercoagulable state was more obvious, and anticoagulant activity was weaker in the older adult group. This may be related to more patients of advanced age, a higher ratio of female patients, and more comorbidities. Advanced age (≥60 years) is the independent risk factor for preoperative DVT. [Orthopedics. 2025;48(3):139-145.].

Background: This study evaluated the clinical and radiologic results of allarthroscopic treatment of terrible triad of the elbow over a minimum of 5 years.

Materials and methods: We retrospectively reviewed consecutive patients with terrible triad injury who underwent all-arthroscopic surgery between January 2011 and June 2018. We performed all-arthroscopic treatment for these patients, excluding those with a Regan-Morrey type III coronoid process fracture, involvement of the anteromedial facet, or a radial head fracture involving >50% of the articular surface. Elbow stability, range of motion, Mayo Elbow Performance Score, and radiologic outcomes were assessed at least 5 years postoperatively.

Results: Thirty-two patients met the inclusion criteria, and mean age was 49.5±15.9 years. At a mean follow-up of 6.9±1.8 years, mean arc of flexion for the affected elbow was 7.1°±7.4° to 132.4°±10.0°. Mean visual analog scale and Mayo Elbow Performance Score were 1.4±0.6 and 91±15.7 points, respectively. Clinical scores and range of motion showed no significant differences between the affected and contralateral elbows. Nonunion of the coronoid process occurred in 4 cases, but none led to instability or required reoperation. Heterotopic ossification was observed for 15 patients (47%), grade 1 arthritis for 7 patients (22%), and grade 3 arthritis for 3 patients (9%), but none progressed to joint stiffness or required reoperation. Two complications required reoperation: 1 case of pin site irritation that resolved after pin removal and 1 case of worsening arthritic degeneration leading to total elbow arthroplasty at 5-year follow-up. No other complications, such as infection or neurovascular injury, were observed.

Conclusion: In terrible triad elbow injuries, all-arthroscopic treatment restores elbow joint stability and achieves good clinical and radiologic outcomes compared with open treatment. We recommend this procedure as a treatment option for patients if the indications are met, such as Regan-Morrey type I or II coronoid process fractures and radial head fractures involving <50% of the articular surface. [Orthopedics. 2025;48(3):e131-e138.].

Background: This retrospective cohort study aimed to compare the clinical outcomes of percutaneous clamp-assisted reduction (PCR) and conventional direct reduction (DR) techniques prior to intramedullary nailing (IMN) in the management of tibial shaft fractures.

Materials and methods: The medical records of 68 consecutive patients treated via IMN via the infrapatellar approach between January 2020 and December 2023 were retrospectively reviewed. After the inclusion/exclusion criteria were applied, patients were divided into PCR (n=37) and DR (n=31) groups. Demographic data, fracture characteristics, surgical data, and prognostic outcomes were analyzed.

Results: Baseline characteristics showed no significant intergroup differences. PCR demonstrated a longer reduction time (25.3±1.9 min vs 21.4±1.4 min, P<0.01) but required less fluoroscopic exposure (18.0±1.4 vs 22.0±1.4, P<0.01), shorter surgical duration (73.0±3.1 min vs 88.7±8.6 min, P<0.01), and reduced blood loss (101.6±17.2 mL vs 153.2±52.9 mL, P<0.01). No open reductions occurred in the PCR group, whereas five cases occurred in the DR group (16.1%, P<0.05). Approximate anatomical union rates significantly favored PCR (62.2% vs 16.1%, P<0.01). No statistically significant differences were observed between the two groups in terms of American Orthopaedic Foot and Ankle Society score, union time, delayed union rate, or malunion rate.

Conclusion: Compared with conventional DR, PCR prior to IMN improves fracture reduction quality, reduces intraoperative invasiveness, and enhances procedural efficiency, with superior anatomical alignment outcomes. [Orthopedics. 2025;48(3):e147-e152.].

Background: Adult tibial spine fractures (TSFs) are rare but can cause significant morbidity.

Materials and methods: A systematic review identified studies on adult TSFs. Patient demographics, fracture characteristics, surgical details, outcomes, and complications were analyzed using descriptive statistics and meta-analysis.

Results: Twenty-eight studies (691 cases) were included. Most fractures were type III, treated arthroscopically with sutures or screws. Fracture type showed no significant differences in outcomes. Suture fixation yielded better functional scores and fewer complications than screws.

Conclusion: No definitive advantage was observed for either fracture type or fixation method. Further research is needed to establish optimal treatments. [Orthopedics. 2025;48(3):174-187.].

Background: Periacetabular osteotomy (PAO) has shown favorable outcomes. The goal of this study was to conduct a systematic review to assess the reoperation rates and long-term patient-reported outcomes (PROs) of PAO for the treatment of hip dysplasia.

Materials and methods: A systematic review was conducted. Studies that reported PROs with a minimum mean of 10-year follow-up were included.

Results: The 8 studies (984 hips) that were included reported a significant improvement between preoperative and postoperative PROs.

Conclusion: Patients who underwent PAO surgery showed significant improvement in PROs at a minimum mean 10-year follow-up. [Orthopedics. 2025;48(3):e113-e123.].

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. 2025;48(2):e81-e87.].

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. 2025;48(2):98-103.].

Bipolar hemiarthroplasty (BHA) for osteoporotic femoral neck fractures has a risk of proximal femoral fracture during trials, especially with larger trial bipolar shells. This study introduces a novel technique for BHA via the direct anterior approach, aiming to reduce trial use and lower the risk of iatrogenic femoral fractures. The "no trial reduction technique" involves positioning only the trial neck segment against the acetabulum's me-dial wall, without the bipolar shell and trial head. Fluoros-copy measures limb length differences to determine optimal femoral head and bipolar shell thickness, resulting in comparable limb lengths without early complications. [Orthopedics. 2025;48(2):74-78.].

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. 2025;48(2):69-73.].

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. 2025;48(2):111-115.].