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Zone I Revision Finger Amputations Performed in the Emergency Department Compared With Those Performed in the Operating Room. 急诊科进行的I区翻修手指截肢与手术室进行的比较。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-11-01 DOI: 10.3928/01477447-20231027-04
Michael J Anderson, Brett R Campbell, Brittany E Homcha, Susan J Boehmer, Kenneth F Taylor

Finger amputations are commonly encountered. These may be revised in the emergency department (ED) or the operating room (OR). Previous studies have demonstrated the cost-effectiveness associated with procedures performed in the ED. Patient outcomes have not been described. We retrospectively reviewed patients who presented to our level 1 trauma center with a traumatic partial or complete finger amputation through flexor tendon zone I. All were treated with revision amputation performed in either the ED or the OR between January 2012 and December 2017. A total of 172 patient charts were included. Ninety-three of the revision amputations were performed in the ED, while 79 were performed in the OR. There was no difference in age, race, sex, having a manual labor job, medical comorbidities, or mechanism of injury between the groups. Compared with procedures performed in the ED, procedures performed in the OR had a higher rate of delayed healing, a longer stay in the hospital, and a higher referral to therapy postoperatively. Length of follow-up and number of follow-up visits were not statistically different based on location of procedure. There was no difference in post-procedural infection rate or need for revision procedure between the groups. Our data support the efficacy of performing revision amputation procedures in the ED. Recorded patient complications and subsequent treatment after revision amputations performed in the ED vs the OR were comparable. Those performed in the ED potentially decrease the burden placed on the patient and the health care system. [Orthopedics. 2024;47(3):152-156.].

手指截肢是常见的。这些可以在急诊科(ED)或手术室(or)进行修订。先前的研究已经证明了ED手术的成本效益。患者的结果尚未描述。我们回顾性回顾了2012年1月至2017年12月期间,在我们的一级创伤中心接受屈肌腱I区创伤性部分或完全手指截肢的患者。所有患者都接受了ED或or的翻修截肢治疗。共纳入172张病历。93例翻修截肢手术在急诊室进行,79例在手术室进行。两组之间在年龄、种族、性别、从事体力劳动、医疗合并症或损伤机制方面没有差异。与ED手术相比,OR手术的延迟愈合率更高,住院时间更长,术后转诊治疗的次数也更多。随访时间和随访次数根据手术地点没有统计学差异。两组患者术后感染率或是否需要翻修手术没有差异。我们的数据支持在ED中进行翻修截肢手术的疗效。记录的患者并发症和在ED和OR中进行翻修后的后续治疗具有可比性。在ED中进行的手术可能会减轻患者和医疗保健系统的负担。[骨科.202x;4x(x):xx-xx.]。
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引用次数: 0
Endoscopic Versus Open In Situ Decompression for the Management of Cubital Tunnel Syndrome. 内镜与开放式原位减压治疗肘管综合征。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-11-01 DOI: 10.3928/01477447-20231027-06
Byung-Sung Kim, Ki Jin Jung, Jae-Hwi Nho, Joo Young Cha

This study compared the results of endoscopic cubital tunnel release (eCuTR) with those of open cubital tunnel release (oCuTR) for the management of cubital tunnel syndrome (CuTS). In this retrospective study, 35 patients underwent eCuTR or oCuTR. Group I and group II consisted of 16 patients undergoing eCuTR and 19 patients undergoing oCuTR, respectively. Patients were asked to report paresthesia and pain, and electromyography was performed. The Dellon and Bishop classifications were used. The Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS) pain scores were recorded, as well as the key pinch strength and two-point discrimination. The incision length and operation duration were noted. The mean follow-up was 39 months. The mean operating time was longer in the endoscopy group (43 vs 22 minutes). Overall, 34.3% (n=12) of the cases were classified as Dellon grade II and 65.7% (n=23) were classified as Dellon grade III. According to the Bishop score, excellent or good results were obtained for 75% of the patients in the eCuTR group and 78.9% of the patients in the oCuTR group. In the eCuTR and oCuTR groups, all outcome measures improved after surgery: DASH score (preoperative, 37.7 vs 30.7; postoperative, 15.4 vs 20), VAS score (preoperative, 7.8 vs 7.3; postoperative, 4.3 vs 4.1), pinch strength (preoperative, 74 vs 66; postoperative, 93 vs 84), and two-point discrimination (preoperative, 5.6 vs 6.6; postoperative, 4.9 vs 4.5). No significant difference was apparent between the two techniques in outcomes. However, the endoscopic release had a higher reoperation rate and took twice as long to perform despite having a shorter incision. [Orthopedics. 2024;47(3):e119-e124.].

本研究比较了内镜下肘管松解术(eCuTR)和开放式肘管松脱术(oCuTR)治疗肘管综合征(CuTS)的结果。在这项回顾性研究中,35名患者接受了eCuTR或oCuTR。第一组和第二组分别由16名接受eCuTR的患者和19名接受oCuTR的患者组成。患者被要求报告感觉异常和疼痛,并进行肌电图检查。使用了Dellon和Bishop分类法。记录手臂、肩膀和手部残疾(DASH)和视觉模拟量表(VAS)疼痛评分,以及关键握力和两点辨别力。记录切口长度和手术时间。平均随访39个月。内窥镜检查组的平均手术时间更长(43分钟vs 22分钟)。总体而言,34.3%(n=12)的病例被归类为Dellon II级,65.7%(n=23)被归类为Dell III级。根据Bishop评分,eCuTR组75%的患者和oCuTR组78.9%的患者获得了优异或良好的结果。在eCuTR和oCuTR组中,术后所有结果指标均有所改善:DASH评分(术前37.7 vs 30.7;术后15.4 vs 20)、VAS评分(术后7.8 vs 7.3;术后4.3 vs 4.1)、握力(术前74 vs 66;术后93 vs 84),和两点判别(术前,5.6比6.6;术后,4.9比4.5)。两种技术在结果上没有明显差异。然而,内镜下松解术的再次手术率更高,尽管切口更短,但手术时间是原来的两倍。[骨科.202x;4x(x):xx-xx.]。
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引用次数: 0
A Novel Digital Templating Method for Total Hip Arthroplasty in Patients With Unilateral Hip Arthrosis. 用于单侧髋关节病变患者全髋关节置换术的新型数字模板法。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-12-28 DOI: 10.3928/01477447-20231220-04
Matthew Mazur, Ishan Patel, Abdul K Zalikha, Guillermo Rodriguez, Hussein Darwiche, Rahul Vaidya

Background: Identification of the hip center of rotation (HCOR) before total hip arthroplasty (THA) is crucial for achieving optimal implant position and size, and for restoring native biomechanics around the hip joint. Current techniques for determining the HCOR in cases of abnormal hip anatomy are limited and unreliable. This study presents a novel technique using open-access software for preoperative THA templating for patients with significantly abnormal hip anatomy due to unilateral hip arthrosis. The aim is to reliably predict the HCOR and acetabular implant size compared with a traditional intraoperative method.

Materials and methods: This retrospective study involved 20 patients with unilateral hip arthrosis who underwent THA. Preoperative templating was performed using the experimental technique, and the position of the HCOR was measured on preoperative and postoperative radiographs. The positions of the predicted and actual HCOR were compared, along with the inclination and size of the acetabular component.

Results: The difference between the predicted and actual HCOR positions was insignificant (0.43±0.22 mm vertically and 0.18±0.20 mm horizontally), and there was a positive correlation between them (r=0.78, P<.005; r=0.72, P<.005). The agreement between the predicted and actual acetabular implant sizes was 85%, with near-perfect interobserver agreement (Cohen's kappa=0.827).

Conclusion: This novel technique provides a reliable method for predicting HCOR and acetabular implant size for THA in cases of unilateral hip arthrosis. This technique may help optimize biomechanics and improve outcomes in challenging cases. Further research and validation are warranted to establish its broader applicability. [Orthopedics. 2024;47(3):e139-e145.].

背景:在全髋关节置换术(THA)前确定髋关节旋转中心(HCOR)对于获得最佳植入位置和尺寸以及恢复髋关节周围的原生生物力学至关重要。目前在髋关节解剖异常的情况下确定 HCOR 的技术有限且不可靠。本研究提出了一种新技术,使用开放式访问软件为因单侧髋关节病导致髋关节解剖结构明显异常的患者进行术前 THA 模板设计。与传统的术中方法相比,其目的是可靠地预测 HCOR 和髋臼植入物的大小:这项回顾性研究涉及 20 名接受全髋关节置换术的单侧髋关节炎患者。采用实验技术进行术前模板制作,并通过术前和术后X光片测量HCOR的位置。对预测的 HCOR 位置和实际的 HCOR 位置以及髋臼组件的倾斜度和尺寸进行了比较:结果:预测的 HCOR 位置与实际的 HCOR 位置差异不大(垂直方向为 0.43±0.22 mm,水平方向为 0.18±0.20 mm),两者之间存在正相关性(r=0.78,Pr=0.72,PC结论:这项新技术为预测单侧髋关节病例中 THA 的 HCOR 和髋臼假体尺寸提供了一种可靠的方法。该技术可帮助优化生物力学,改善高难度病例的治疗效果。需要进一步研究和验证,以确定其更广泛的适用性。[202x;4x(x):xx-xx]。
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引用次数: 0
Utility of Artificial Intelligence in Orthopedic Surgery Literature Review: A Comparative Pilot Study. 人工智能在骨科手术文献综述中的实用性:比较试点研究
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-12-28 DOI: 10.3928/01477447-20231220-02
Ryan Y Sanii, Johnny K Kasto, Wade B Wines, Jared M Mahylis, Stephanie J Muh

Objective: Literature reviews are essential to the scientific process and allow clinician researchers to advance general knowledge. The purpose of this study was to evaluate if the artificial intelligence (AI) programs ChatGPT and Perplexity.AI can perform an orthopedic surgery literature review.

Materials and methods: Five different search topics of varying specificity within orthopedic surgery were chosen for each search arm to investigate. A consolidated list of unique articles for each search topic was recorded for the experimental AI search arms and compared with the results of the control arm of two independent reviewers. Articles in the experimental arms were examined by the two independent reviewers for relevancy and validity.

Results: ChatGPT was able to identify a total of 61 unique articles. Four articles were not relevant to the search topic and 51 articles were deemed to be fraudulent, resulting in 6 valid articles. Perplexity.AI was able to identify a total of 43 unique articles. Nineteen were not relevant to the search topic but all articles were able to be verified, resulting in 24 valid articles. The control arm was able to identify 132 articles. Success rates for ChatGPT and Perplexity. AI were 4.6% (6 of 132) and 18.2% (24 of 132), respectively.

Conclusion: The current iteration of ChatGPT cannot perform a reliable literature review, and Perplexity.AI is only able to perform a limited review of the medical literature. Any utilization of these open AI programs should be done with caution and human quality assurance to promote responsible use and avoid the risk of using fabricated search results. [Orthopedics. 2024;47(3):e125-e130.].

目的:文献综述是科学研究过程中不可或缺的一部分,它能让临床研究人员增进常识。本研究旨在评估人工智能(AI)程序 Chat-GPT 和 Perplexity.AI 能否进行骨科手术文献综述:每个搜索臂选择了骨科手术中五个不同的搜索主题进行研究。人工智能实验搜索臂记录了每个搜索主题的唯一文章综合列表,并与两名独立审稿人的对照组结果进行了比较。两名独立审稿人对实验组的文章进行了相关性和有效性审查:ChatGPT 共识别出 61 篇独特的文章。其中 4 篇文章与搜索主题不相关,51 篇文章被认为是欺诈性的,因此有效文章为 6 篇。Perplexity.AI共识别出43篇独特的文章。有 19 篇文章与搜索主题无关,但所有文章都经过了验证,最终产生了 24 篇有效文章。对照组能够识别出 132 篇文章。ChatGPT 和 Perplexity.AI 的成功率分别为 4.6%(132 篇文章中的 6 篇)和 18.2%(132 篇文章中的 24 篇):结论:目前的 ChatGPT 无法进行可靠的文献综述,而 Perplexity.AI 只能对医学文献进行有限的综述。任何使用这些开放式人工智能程序的行为都应谨慎,并通过人为的质量保证来促进负责任的使用,避免使用捏造的搜索结果的风险。[骨科。202x;4x(x):xx-xx]。
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引用次数: 0
Optimal Immobilization After Fixation of Bennett's Fracture: A Cadaveric Study. 贝内特骨折固定后的最佳固定方式:尸体研究
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-12-28 DOI: 10.3928/01477447-20231220-03
Anthony J Mitchell, Robert H Ablove, Erik Bradley

Objective: Treating high-level athletes involves a balance between early and safe return to play. Various types of protective immobilization have been recommended after operatively treated Bennett's fracture. The purpose of this study was to investigate if hand-based immobilization offers protection equivalent to forearm-based immobilization.

Materials and methods: A cadaveric model of Bennett's fracture was created in 8 fresh-frozen, cadaveric forearms. Osteosynthesis was performed using a single headless compression screw. Three matched pairs were casted in either hand-based or forearm length, thumb spica casts, while 2 specimens remained un-casted as controls. Specimens were mounted on a custom testing apparatus. Weights were added in 6.8-kg increments until fixation failed and the fracture displaced. Fluoroscopy was performed after each trial. We used the Kruskal-Wallis non-parametric test to compare the groups. We considered P<.05 statistically significant.

Results: Failure of fixation occurred at 6.8 kg in the control specimens. Fixation failed in hand-based and forearm length casts at a mean of 18.1±5.1 kg. We did not find a statistically significant difference between median values of load at failure in kilograms across control specimens and 2 immobilization categories (P=.114). All specimens in the hand-based group sustained additional wrist injuries, while no additional injuries were noted in the forearm length group.

Conclusion: Our study results showed that hand-based immobilization provides equivalent protection against fixation failure for operatively treated Bennett's fractures but may predispose athletes to increased risk of wrist injury compared with traditional, forearm-based casting. [Orthopedics. 2024;47(3):157-160.].

目的:治疗高水平运动员需要在尽早恢复比赛和安全恢复比赛之间取得平衡。在手术治疗本内特骨折后,建议采用各种类型的保护性固定。本研究的目的是调查手部固定是否能提供与前臂固定相同的保护:在 8 个新鲜冷冻的尸体前臂上制作了贝内特骨折的尸体模型。使用单个无头加压螺钉进行骨合成。将三对匹配的标本制成手部或前臂长度的拇指棘突石膏模型,另外两个标本未制成石膏模型作为对照。试样安装在定制的测试仪器上。重量以 6.8 千克为单位递增,直至固定失败和骨折移位。每次试验后都要进行透视检查。我们使用 Kruskal-Wallis 非参数检验对各组进行比较。我们考虑了PR结果:对照组样本在 6.8 千克时发生固定失败。手部和前臂长度模型的固定失败平均为 18.1±5.1 kg。我们没有发现对照组标本和 2 个固定类别的失效载荷中位值(公斤)之间存在统计学意义上的显著差异(P=.114)。手部固定组的所有标本都有额外的腕部损伤,而前臂长度固定组没有发现额外的损伤:我们的研究结果表明,与传统的前臂固定相比,手部固定对手术治疗的贝内特骨折提供了同等的固定失败保护,但可能会增加运动员腕部受伤的风险。[骨科。202x;4x(x):xx-xx]。
{"title":"Optimal Immobilization After Fixation of Bennett's Fracture: A Cadaveric Study.","authors":"Anthony J Mitchell, Robert H Ablove, Erik Bradley","doi":"10.3928/01477447-20231220-03","DOIUrl":"10.3928/01477447-20231220-03","url":null,"abstract":"<p><strong>Objective: </strong>Treating high-level athletes involves a balance between early and safe return to play. Various types of protective immobilization have been recommended after operatively treated Bennett's fracture. The purpose of this study was to investigate if hand-based immobilization offers protection equivalent to forearm-based immobilization.</p><p><strong>Materials and methods: </strong>A cadaveric model of Bennett's fracture was created in 8 fresh-frozen, cadaveric forearms. Osteosynthesis was performed using a single headless compression screw. Three matched pairs were casted in either hand-based or forearm length, thumb spica casts, while 2 specimens remained un-casted as controls. Specimens were mounted on a custom testing apparatus. Weights were added in 6.8-kg increments until fixation failed and the fracture displaced. Fluoroscopy was performed after each trial. We used the Kruskal-Wallis non-parametric test to compare the groups. We considered <i>P</i><.05 statistically significant.</p><p><strong>Results: </strong>Failure of fixation occurred at 6.8 kg in the control specimens. Fixation failed in hand-based and forearm length casts at a mean of 18.1±5.1 kg. We did not find a statistically significant difference between median values of load at failure in kilograms across control specimens and 2 immobilization categories (<i>P</i>=.114). All specimens in the hand-based group sustained additional wrist injuries, while no additional injuries were noted in the forearm length group.</p><p><strong>Conclusion: </strong>Our study results showed that hand-based immobilization provides equivalent protection against fixation failure for operatively treated Bennett's fractures but may predispose athletes to increased risk of wrist injury compared with traditional, forearm-based casting. [<i>Orthopedics</i>. 2024;47(3):157-160.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"157-160"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139040336","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
Understanding Financial Relationships Between Orthopedic Surgeons and Industry for Research. 了解矫形外科医生与研究行业之间的财务关系。
IF 1.1 4区 医学 Q2 Medicine Pub Date : 2024-05-01 Epub Date: 2023-12-28 DOI: 10.3928/01477447-20231220-05
Abhishek Tippabhatla, Jason Silvestre, Beltran Torres-Izquierdo, Lawrence Garvin, Kevin G Shea, John D Kelly, Pooya Hosseinzadeh

Objective: This study sought to understand trends in industry payments for research awarded to orthopedic surgeons.

Materials and methods: The Centers for Medicare & Medicaid Services Open Payments database was queried for the years 2016 to 2021 for industry payments for research. Financial analyses were performed to understand temporal trends and differences by orthopedic subspecialty and principal investigator characteristics such as sex. The threshold for statistical significance was set at .05.

Results: A total of 2014 orthopedic surgeons were identified, among whom 542 adult reconstruction (27%) and 460 sports medicine (23%) surgeons were major beneficiaries. Seventy-one female orthopedic surgeons comprised the minority (4%). Total research payments awarded during the study period aggregated to $266,633,592, with adult reconstruction ($88,819,047; 33%) and sports medicine ($57,949,822; 22%) receiving the highest amounts. Total research payments awarded trended upward yearly except for a decline in 2020 that subsequently rebounded (P<.001). Median annual research payment per orthopedic surgeon was $13,375. Median total industry payments per orthopedic surgeon differed between specialties (P <.001), with the highest amounts for adult reconstruction ($44,063) and sports medicine ($34,567) and the lowest amounts for hand ($12,052) and foot and ankle ($19,233). Median total payments did not differ significantly when stratified by sex (P=.276) and region (P=.906). Specialties in which the respective top three companies offered the majority of the research funding were musculoskeletal oncology (90%), pediatric orthopedics (66%), and shoulder and elbow (64%).

Conclusion: These results can be used as a primer for orthopedic surgeons seeking to leverage industry relationships to fund translational research. [Orthopedics. 2024;47(3):172-178.].

目的本研究旨在了解骨科外科医生获得的行业研究付款趋势:查询了美国联邦医疗保险与医疗补助服务中心开放支付数据库 2016 年至 2021 年的行业研究支付情况。进行了财务分析,以了解骨科亚专科和主要研究者特征(如性别)的时间趋势和差异。统计显著性阈值设定为 0.05:共确定了 2014 名骨科外科医生,其中 542 名成人重建外科医生(27%)和 460 名运动医学外科医生(23%)是主要受益人。71名骨科医生中女性占少数(4%)。研究期间授予的研究经费总额为 266,633,592 美元,其中成人重建(88,819,047 美元;33%)和运动医学(57,949,822 美元;22%)获得的金额最高。科研经费总额呈逐年上升趋势,但 2020 年有所下降,随后有所回升(PP P=.276),地区也是如此(P=.906)。排名前三的公司提供了大部分研究经费的专业分别是肌肉骨骼肿瘤学(90%)、儿科矫形外科(66%)以及肩肘外科(64%):这些结果可作为骨科医生利用行业关系资助转化研究的入门指南。[骨科。202x;4x(x):xx-xx]。
{"title":"Understanding Financial Relationships Between Orthopedic Surgeons and Industry for Research.","authors":"Abhishek Tippabhatla, Jason Silvestre, Beltran Torres-Izquierdo, Lawrence Garvin, Kevin G Shea, John D Kelly, Pooya Hosseinzadeh","doi":"10.3928/01477447-20231220-05","DOIUrl":"10.3928/01477447-20231220-05","url":null,"abstract":"<p><strong>Objective: </strong>This study sought to understand trends in industry payments for research awarded to orthopedic surgeons.</p><p><strong>Materials and methods: </strong>The Centers for Medicare & Medicaid Services Open Payments database was queried for the years 2016 to 2021 for industry payments for research. Financial analyses were performed to understand temporal trends and differences by orthopedic subspecialty and principal investigator characteristics such as sex. The threshold for statistical significance was set at .05.</p><p><strong>Results: </strong>A total of 2014 orthopedic surgeons were identified, among whom 542 adult reconstruction (27%) and 460 sports medicine (23%) surgeons were major beneficiaries. Seventy-one female orthopedic surgeons comprised the minority (4%). Total research payments awarded during the study period aggregated to $266,633,592, with adult reconstruction ($88,819,047; 33%) and sports medicine ($57,949,822; 22%) receiving the highest amounts. Total research payments awarded trended upward yearly except for a decline in 2020 that subsequently rebounded (<i>P</i><.001). Median annual research payment per orthopedic surgeon was $13,375. Median total industry payments per orthopedic surgeon differed between specialties (<i>P</i> <.001), with the highest amounts for adult reconstruction ($44,063) and sports medicine ($34,567) and the lowest amounts for hand ($12,052) and foot and ankle ($19,233). Median total payments did not differ significantly when stratified by sex (<i>P</i>=.276) and region (<i>P</i>=.906). Specialties in which the respective top three companies offered the majority of the research funding were musculoskeletal oncology (90%), pediatric orthopedics (66%), and shoulder and elbow (64%).</p><p><strong>Conclusion: </strong>These results can be used as a primer for orthopedic surgeons seeking to leverage industry relationships to fund translational research. [<i>Orthopedics</i>. 2024;47(3):172-178.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"172-178"},"PeriodicalIF":1.1,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139040337","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
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 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 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 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 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
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Orthopedics
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