Orthopedic Reviews最新文献

A peripheral nerve injury is a great burden for the patient and a challenge for the clinician. In a complete injury (axonotmesis or neurotmesis), the slow nature of nerve regeneration after repair or reconstruction hardly catches up to the target organ's degeneration rate, leading to a poor prognosis. The current advance in regenerative medicine has shown the potency of stem cells and their products for healing many human body structures, including the nerve. A comprehensive literature search was conducted using an internet-based search engine for current advances in regenerative medicine to augment peripheral nerve repair or reconstruction. Stem cells can differentiate into nerve cells and have paracrine and immunomodulatory effects. Its products, such as the secretome and exosome, have also been studied, and they have many benefits for the regeneration process. This novel treatment possesses significant potential to accelerate nerve healing after nerve reconstruction and potentially postpone the degenerative process in the target organ, allowing it to respond to the new signal once nerve regeneration is complete. The aim of this article is to summarized the application of stem cells and its products for nerve healing.

Purpose of the review: Regional anesthesia has become a cornerstone in orthopedic surgeries due to its ability to provide precise, localized pain relief while minimizing the systemic risks associated with general anesthesia and opioid use. This review aims to provide a compact guide for anesthesia trainees and practicing anesthesiologists on the use of regional anesthesia techniques for upper and lower extremity procedures.

Summary: This guide outlines the main regional block options for orthopedic surgeries, detailing the targeted anatomy, common surgical indications, important adjacent structures, and potential complications for each technique. Key blocks for upper extremity surgeries include interscalene, supraclavicular, infraclavicular, axillary, and intercostobrachial blocks, while lower extremity techniques encompass femoral, adductor canal, sciatic, popliteal, and lumbar plexus blocks. Advances in ultrasound guidance have enhanced the safety and efficacy of these techniques, making them indispensable for modern anesthesiology practice. By mastering these approaches, providers can optimize patient outcomes, expand their skillset, and contribute to enhanced perioperative care in orthopedic surgery.

Musculoskeletal injuries and degenerative conditions necessitate advanced regenerative solutions. Tissue engineering has emerged as a pivotal field in orthopedic care, particularly in vascularized bone and cartilage regeneration. This narrative review examines the latest advancements in vascular tissue engineering, including scaffold design, cell-based techniques, and growth factor delivery. A comprehensive literature search was conducted using PubMed, ScienceDirect, and Google Scholar, focusing on innovations and challenges in the field. Vascularized bone grafts (VBGs) outperform non-vascularized counterparts in promoting healing and integration. Advances in scaffold materials, such as smart scaffolds and hybrid biomaterials, enhance osteogenesis and angiogenesis. Cellular therapies, utilizing mesenchymal stem cells and induced pluripotent stem cells, synergistically improve vascularization and bone regeneration. Growth factors like VEGF and bone morphogenic protein (BMP-2), integrated with innovative delivery systems, enable sustained angiogenic stimulation and scaffold integration. While significant strides have been made, challenges persist in achieving full vascular integration and replicating native tissue architecture. Innovations in scaffold technology and vascular surgery techniques hold promise for transforming orthopedic tissue engineering and improving patient outcomes.

Objectives: Describing the clinical features, image diagnosing and evaluating clinical outcomes combining the open modified Broström procedure and InternalBrace augmentation with ankle arthroscopic surgery in patients with ATFL repaired.

Subjects and methods: The study included 15 patients diagnosed with ATFL torn and underwent surgical treatment. A descriptive, retrospective study from 2019 to 2022 at Viet Duc University Hospital.

Result: All of the patients satisfied with the surgery results. The AOFAS significantly improved from preoperative averaging from 63.6 ±10.4 (55-70) up to 92.7±4.5 (70-100), respectively (P <0,001) with an average follow-up time of 39.86 months. Intra-articular lesions were found in 14 ankles (93.3%), including 10 with synovitis and soft-tissue impingement, 6 with chondral injuries, 6 with anterior tibial and talus osteophytes.

Conclusions: Surgical repair of ATFL by modified Broström procedure augmentated with InternalBrace is an effective technique, which helps stabilizing the ankle joint, improve the clinical outcomes significantly.

Introduction: Lisfranc injuries, characterized by abnormal forces on the tarsometatarsal (TMT) joints in the feet, are common foot injuries in athletes. This study aims to evaluate the outcomes of Lisfranc injuries in advanced basketball athletes, including retirement rates and time to return (TTR) to play.

Methods: A retrospective analysis was conducted on advanced basketball athletes who suffered Lisfranc injuries. Data was collected from reputable news sources and cross-referenced for accuracy. The inclusion criteria encompassed multiple basketball leagues, including the NBA, WNBA, NCAA Men's, and NCAA Women's. The study evaluated the number of players who returned to play, their TTR, and the incidence of Lisfranc injuries in each league.

Results: Out of the 22 athletes included in the study, 73% (n=16) returned to play after a Lisfranc injury, while 27% retired from the sport. The average TTR for the athletes who resumed playing was 307 days (10.09 months). The average age of players who returned was 24.6 years, with the NBA having the highest average age of 29.5 years. The incidence of Lisfranc injuries varied across leagues, with the NFL having the highest incidence over a specific time span.

Discussion: The study highlights the significant impact of Lisfranc injuries within the NBA, with a substantial number of players opting for retirement after such injuries. The TTR for basketball athletes was longer compared to other sports, such as the NFL. The physical nature of football may explain the increased incidence of Lisfranc injuries in that sport. The rarity of Lisfranc injuries in basketball poses challenges in conducting statistical analyses, emphasizing the need for larger sample sizes and specific focus on basketball players in future research.

Background: Caudal epidural steroid injections (ESIs) are a common intervention for lumbar radicular pain, but responses can be variable. When initial injections provide suboptimal relief, targeted approaches using an epidural catheter may enhance efficacy.

Case series: We describe three patients with unilateral lumbar radicular pain who underwent caudal ESIs using a 22-gauge spinal needle. Each patient experienced suboptimal pain relief following the initial injection. Patient 1 reported only 30% improvement at the 2-week follow-up. Patient 2 initially experienced 80% pain relief, but this improvement lasted only 3 days, returning to baseline by the 2-week follow-up. Patient 3 reported 40% improvement at the 2-week follow-up. Given their limited response, all three patients underwent a repeat caudal ESI using an epidural catheter advanced toward the symptomatic side and area of interest. After the catheter-guided injection, Patient 1 experienced 70% pain relief, Patient 2 achieved 60% relief, and Patient 3 reported 100% relief, all assessed at the 2-week follow-up.

Conclusion: This case series highlights the potential benefit of catheter-guided caudal ESIs in patients with suboptimal responses to single-shot caudal injections. The improved outcomes suggest that targeted epidural drug delivery may enhance pain relief in select cases of unilateral lumbar radicular pain. Further research is needed to evaluate this approach's long-term efficacy and optimal patient selection.

Background: Total joint arthroplasty (TJA) is a common orthopedic procedure.

Objective: The primary objective of this retrospective cohort study was to investigate 30-day postoperative complication rates following five major types of TJA (shoulder, elbow, hip, knee, ankle). Independent risk factors for adverse outcomes were also assessed.

Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was filtered using current procedural terminology (CPT) codes to identify patients undergoing TJA from 2015 to 2020. Patients were divided into cohorts by joint replaced. Nearest neighbor matching and statistical analyses were performed to compare complication rates between cohorts.

Results: A total of 605,158 patients were identified, with 457 patients included per matched cohort. Mean age was youngest in the ankle cohort. Operative time and proportion of patients with dependent functional status were greatest in the elbow cohort. Length of stay (LOS) and risk of any adverse event (AAE) were greatest for elbow and hip arthroplasty. Risk of AAE was lowest with ankle arthroplasty. Wound dehiscence and return to the operating room (OR) were most common following elbow arthroplasty. Postoperative blood transfusion occurred most often after hip arthroplasty. Operative time, LOS, BMI, American Society of Anesthesiologists (ASA) class, and preoperative blood transfusion were independently associated with postoperative complications.

Conclusion: Elbow and hip arthroplasty appear to confer greater risk of short-term postoperative complications compared to other TJA types. This data can help inform clinical decision-making and may facilitate adoption of measures within orthopedic practice to optimize outcomes and minimize financial burden.

Introduction: Musculoskeletal discomfort is prevalent in primary care, with conditions such as osteoarthritis and osteoporosis being significant contributors. Collagen, particularly type I, is a major structural protein found in connective tissues. The supplementation of type I hydrolyzed collagen has been investigated for its potential benefits in musculoskeletal health.

Objective: This systematic review aims to evaluate the current literature on the effects of type I hydrolyzed collagen supplementation on bones, muscles, and joints.

Methods: A systematic search was conducted in August 2024 using four electronic databases - PubMed, Scopus, EMBASE, and CINAHL. The inclusion criteria were randomized controlled trials (RCTs) and systematic reviews evaluating oral supplementation with type I hydrolyzed collagen. Exclusion criteria were pre-clinical studies, experimental studies, studies not focusing on type I hydrolyzed collagen, studies with beauty-related endpoints, studies that combined collagen with other ingredients, and unblinded, nonrandomized, and uncontrolled trials.

Results: Out of 4,246 articles screened, 36 RCTs met the inclusion criteria. The study protocols varied in population, health conditions, and study duration. Studies focused on bone health faced limitations that prevent definitive conclusions about the effects of collagen supplementation. In contrast, studies on joint health reported beneficial outcomes, such as pain reduction, improvements in clinical parameters, increased physical mobility, and enhanced ankle function. The muscle health studies were inconsistent, with positive effects predominantly observed when supplementation was associated with physical exercise.

Conclusion: Collagen supplementation demonstrates promising results. However, heterogeneity among studies limits the generalizability of findings. Future research should prioritize standardized protocols and consistent outcome measures.

The neurophysiology of ACL injury extends beyond the mechanical rupture of the ligament to encompass profound alterations in the central and peripheral nervous systems, impacting sensorimotor integration and neuromuscular control. The ACL, densely populated with mechanoreceptors, plays a critical role in joint proprioception, dynamically regulating knee stability through complex neural circuits that connect to the spinal cord and brain. When disrupted by injury, these neural pathways contribute to delayed muscular activation, altered motor planning, and compromised joint stability. Such neuromechanical deficits increase the likelihood of reinjury and highlight the need for comprehensive neuroplastic rehabilitation. Neuroplastic therapy, employing tools like external focus strategies, stroboscopic glasses, smartboards, and virtual reality, aims to restore and enhance neural connectivity, sensory integration, and motor coordination. These advanced tools target distinct phases of motor learning, promoting automaticity and resilience in movement patterns. By integrating visual-cognitive, proprioceptive, and reflexive controls, this therapeutic approach not only accelerates recovery but also optimizes performance and reduces the risk of re-injury, representing a paradigm shift in ACL rehabilitation.

Bilateral clavicle fractures are rare, with an overall incidence of 0.43%. Various treatment methods exist, but no consensus has been reached. We report a case of a 51-year-old male patient with bilateral midshaft clavicle fractures treated with minimally invasive Osteosynthesis. After 14 months of follow-up, bone healing and functional recovery were excellent. In conclusion, minimally invasive fixation is a viable alternative treatment for this fracture type, complementing established methods. The selection of a suitable minimally invasive fixation device should be individualized for each fracture type.