Orthopedics最新文献

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.].

Background: The long-term clinical outcomes after open reduction and internal fixation (ORIF) for distal femoral fractures, both native and peri-prosthetic, are not yet well established in the literature.

Materials and methods: We used the clinically validated Western Ontario and McMaster Universities Arthritis Index (WOMAC) score to make the functional outcomes after ORIF comparable with the well-characterized results achieved after total knee arthroplasty (TKA) for osteoarthritis. After long-term clinical follow-up and prospectively collected WOMAC scores were obtained, pain, stiffness, and function were evaluated for 68 elderly patients with distal femur fractures (34 periprosthetic, 34 native; median follow-up time, 2.43 years).

Results: Although pain and stiffness scores were significantly lower than those achieved after TKA, functional and total WOMAC scores were similar. Pain and function continued to improve with greater time to follow-up. Although 32% (22/68) of patients had a return to the operating room (3 for infection, 11 for nonunion, and 7 for implant prominence), total WOMAC scores at long-term follow-up were not different for the patients who returned to the operating room. Although stiffness may persist for some patients, the functional outcomes after this procedure are similar to outcomes for patients after primary TKA. The rate of fracture-related re-operations was 32%, but was not associated with poor clinical outcomes.

Conclusion: The 91% rate of good to excellent outcomes seen in our cohort suggests ORIF is likely to provide a favorable result for distal femur fractures, both native and periprosthetic, among elderly patients. [Orthopedics. 2025;48(3):e124-e130.].

Background: Gardner-Wells tongs (GWT) are commonly used in cervical spine trauma for closed and open treatment of the cervical spine and for patient positioning and reduction, aiding in fracture reduction and providing temporary stabilization. Tongs are less commonly used for nontraumatic spine surgery, and a paucity of literature exists assessing the rates of complications associated with the use of GWT. The purpose of this study was to elucidate the incidence of major and minor complications associated with the use of GWT in traumatic and nontraumatic spine surgeries performed by a single surgeon at a single tertiary care academic institution.

Materials and methods: Adult patients who underwent traumatic or nontraumatic spinal surgery at any spine level with the use of GWT from a single surgeon between 2020 and 2023 met inclusion criteria for this retrospective case series. Major complications were defined as medial table breech, deep infection/abscess, pin pullout, neurovascular injury, and vision disturbances (ie, increased intraocular pressure) at any time point. Minor complications were defined as pin loosening, minor bleeding requiring staples, and superficial infection at any time point.

Results: Data from 322 patients, including 171 (53.1%) men and 151 (46.9%) women, were reviewed and analyzed. Mean patient age at the time of surgery was 57 years (range 18 to 89). Mean operative time was 165 minutes, and average traction weight applied was 14.7 pounds. Incidence of major complications was 0.3% and included just one instance of visual disturbance 6 weeks postoperatively that spontaneously resolved. Incidence of minor complications was 4.66% (15/322) and involved 14 cases (4.35%) of minor bleeding managed with staples and one occurrence of pin loosening.

Conclusion: The use of GWT in a variety of traumatic and nontraumatic spine surgeries was found to be safe and effective in this single-surgeon, single-institution study cohort. Only one patient developed a major complication, and the incidence of minor complications was less than 5%. [Orthopedics. 2025;48(3):153-158.].

Atraumatic avascular necrosis of the scaphoid is an extremely rare pathology. We present a case of avascular necrosis of the scaphoid following repeat local glucocorticoid injections. A 70-year-old, right-handed woman presented to our clinic with 2 years of atraumatic, progressively worsening left wrist pain and loss of range of motion. Imaging demonstrated fragmentation and avascular necrosis of the scaphoid. The patient underwent uncomplicated scaphoid excision, pisiform excision, and intercarpal arthrodesis, with a good functional outcome. This case highlights both the risk of repeated intra-articular steroid injections and the importance of obtaining serial radiographs when providing intra-articular steroid injections. [Orthopedics. 2025;48(3):188-191.].

Background: This study evaluated differences in orthopedic surgery residency applicant statistics in the 2024 National Resident Matching Program (NRMP) Charting Outcomes, the first report to include applicants with a pass/fail designation on the United States Medical Licensing Examination (USMLE) Step 1.

Materials and methods: Data were collected from the NRMP reports, which are released every 2 to 3 years, for 2011, 2014, 2016, 2018, 2020, 2022, and 2024. The number of research items (abstracts, presentations, and publications), USMLE Step 2 scores, volunteer experiences, and work experiences for matched and unmatched applicants were recorded. Linear regression analyses were performed with data from before 2024 to predict expected outcomes for the 2024 match. The percentage of change was calculated for each characteristic of matched and unmatched applicants.

Results: In 2024, a statistically significant increase was seen in the observed number of research items per matched applicant (23.8) compared with the predicted number (18.4; P=.009). The observed mean USMLE Step 2 score (257) for matched applicants was lower than the expected score (259.3), but was still higher than the 2022 score of 256 and the unmatched applicant score of 246. Volunteer and work experiences decreased to the lowest of any report since 2011.

Conclusion: Since the USMLE Step 1 examination became pass/fail, research productivity significantly increased and work and volunteer experiences decreased. These changes may reflect a perceived increased emphasis on research productivity because of the grading change or may be the result of various causes, including an increase in the number of applicants who take research gap years. [Orthopedics. 2025;48(3):e139-e146.].

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.].