Orthopedic Reviews最新文献

Background: Level I trauma centers employ various orthopaedic call strategies based on resources and surgeon subspeciality availability.

Objective: We hypothesize when surgeons fellowship trained in trauma are solely on call that patient outcomes will be improved compared to a combined plan.

Methods: Retrospective cohort study from two 24-month time periods at an academic level one trauma center. The first cohort consisted of only trauma surgeons taking call. The second cohort consisted of a combination of trauma and other subspecialities taking call. The primary outcome analyzed was time from admission to operating room for hip, femoral shaft, distal femur, tibia shaft, pelvic ring and acetabulum fractures. Secondary outcomes analyzed included length of stay, 90 day incidence of reoperation, mortality, VTE and readmission.

Results: Eight hundred and fifty seven patients in the trauma cohort and 992 patients in the combined cohort met the inclusion criteria. The time from admission to index surgical procedure was significantly shorter in the trauma cohort (1.7 vs 2.4). Length of stay (8.95 vs 11 days) and 90 day mortality (1.8% vs 3.8%) was improved in the trauma cohort. There was no difference in 90 day rate of VTE, readmission or reoperation. Length of stay and time to OR in pelvic ring injuries and acetabulum fractures were doubled compared to the hybrid group.

Conclusions: Our findings suggest that when trauma fellowship trained surgeons are the only ones taking call patients have a shorter time from admission to index surgical procedure, length of stay and lower mortality rate.

Background: The trapeziometacarpal (TMC) joint is critical for thumb function, and its instability leads to significant disability. While the volar-only Eaton-Littler ligament reconstruction is a classic treatment, its efficacy is debated. Modern techniques like the Zhang method address both volar and dorsal ligaments, but comparative biomechanical data are scarce. This study aimed to biomechanically compare the stability of the traditional Eaton-Littler technique with the Zhang technique and a modified Zhang technique using a palmaris longus (PL) tendon graft.

Methods: A descriptive comparative study was conducted on 21 cadaveric specimens from 14 hands. Three techniques were evaluated: Eaton-Littler (n=7), Zhang (n=7), and modified Zhang (n=7). The Modified Zhang technique utilized PL tendon instead of flexor carpi radialis (FCR). Biomechanical testing measured joint displacement under controlled loads (10N, 20N, 30N) in four anatomical directions (dorsal, volar, radial, ulnar). Statistical analysis employed Wilcoxon signed-rank test with significance at p<0.05.

Results: The Eaton-Littler technique demonstrated significantly greater displacement compared to both Zhang methods in dorsal (5.27mm vs 3.75mm vs 3.95mm at 30N; p<0.03), volar (6.29mm vs 5.27mm vs 5.05mm at 30N; p<0.03), and ulnar (5.73mm vs 3.90mm vs 3.68mm at 30N; p=0.018) directions. No significant differences existed between techniques for radial displacement (p>0.05) or between Zhang and modified Zhang methods (p>0.05). The PL and half-slip FCR grafts showed equivalent cross-sectional diameters (2.11mm vs 2.08mm; p=0.499).

Conclusion: Both Zhang and modified Zhang techniques demonstrate superior biomechanical stability profiles compared to the traditional Eaton-Littler procedure. The PL tendon represents a viable alternative graft option with comparable biomechanical properties, offering potential advantages in preserving FCR function.

Objective: To describe the clinical and paraclinical features and the surgical outcomes of multiple flexor tendon ruptures in a patient with neglected lunate dislocation.

Methods: A case report.

Results: Lunate dislocation is rare and easily missed at initial diagnosis. Delayed/neglected cases can lead to wrist osteoarthritis, median nerve involvement, and flexor tendon injury. We report a patient with multiple flexor tendon ruptures associated with a 4-year neglected lunate dislocation. The patient underwent flexor tendon reconstruction using an autologous palmaris longus graft combined with lunate excision. At 1-year follow-up, finger motion was good and there was no evidence of wrist osteoarthritic change.

Conclusion: Multiple flexor tendon ruptures associated with neglected lunate dislocation are rare. Surgery achieved successful functional recovery, allowing the patient to return to everyday work.

Objective: The incidence of hip osteoarthritis (OA) is increasing with the aging population, leading to interest in intra-articular orthobiologic injections to alleviate symptoms and potentially slow disease progression. This systematic review aims to evaluate the clinical outcomes associated with six orthobiologic therapies for hip OA: hyaluronic acid (HA), platelet-rich plasma (PRP), autologous cells therapy (ACT), microfragmented adipose tissue (MFAT), and bone marrow aspirate (BMA) and its concentration (BMAC).

Methods: We conducted a literature search according to the PRISMA guidelines. Studies were included in our review if they used at least one of the four orthobiologic therapies and reported on the clinical outcome using patient reported outcome measures (PROMs). Since there is a large variability among clinical outcomes, we focused on the three most utilized PROMs (VAS, WOMAC, and HHS) and the latest follow-up time point.

Results: Of the 716 studies reviewed, thirty-six studies (n=36) fit inclusion criteria. There were 21 studies examining HA, 11 on PRP, 3 for MFAT, 2 for ACT, and 3 on BMA/BMAC. Eight studies were randomized controlled trials and 28 were cohort studies. The mean age of the patient population ranged from 45 ± 17.0 to 74 ± 8.0. The baseline grade of osteoarthritis ranged from 1-4 but was most reported as moderate (2-3). Overall, there was an improvement in PROMs at the latest follow-up after receiving orthobiologic interventions.

Discussion: Orthobiologic injections have shown promise for improving PROMs in patients with hip OA. Future studies should evaluate long-term efficacy and include randomized trials to establish efficacy.

Background: Developmental dysplasia of the hip (DDH) Crowe type IV poses significant surgical challenges during total hip arthroplasty (THA), often necessitating subtrochanteric shortening osteotomy (SSO) to achieve proper reduction and limb length restoration. Stable fixation of the osteotomy site is crucial for achieving reliable union and favorable functional outcomes.

Objective: To evaluate early clinical and radiographic outcomes of stable fixation using a derotational plate in subtrochanteric osteotomy for Crowe IV DDH.

Methods: A prospective cohort study was conducted on 28 patients (30 hips) with Crowe IV DDH who underwent THA combined with subtrochanteric osteotomy stabilized by a derotational plate. Clinical evaluation included the Harris Hip Score (HHS), Oxford Hip Score (OHS), and Visual Analogue Scale (VAS) for pain, assessed preoperatively and at 12 months postoperatively. Radiographic analysis focused on osteotomy union, implant stability, and restoration of limb length.

Results: All patients achieved union at the osteotomy site within 6 months, with no cases of nonunion or implant failure. Mean HHS improved from 38.5 ± 6.2 preoperatively to 89.7 ± 4.3 postoperatively (p < 0.001). Mean OHS increased from 17.4 ± 3.1 to 41.2 ± 2.8 (p < 0.001). VAS scores significantly decreased from 7.8 ± 1.0 to 1.6 ± 0.7 (p < 0.001). Complications were minimal, with one intraoperative femoral fissure (3.3%).

Conclusion: Stable fixation with a derotational plate in subtrochanteric osteotomy for Crowe IV DDH provides reliable union, excellent early functional recovery, and significant pain reduction at 12 months. These findings support its clinical effectiveness as a fixation method in complex THA cases.

Background and aim: Bone metastases cause pain and disability in advanced prostate, breast, and lung cancers. Traditional treatments may not work for all patients. Minimally invasive procedures such as cryoablation (CA) and radiofrequency ablation (RFA) have emerged as good options. This review aims to evaluate and summarize the effectiveness and safety of CA and RFA separately in managing painful bone metastases.

Methods: We performed a comprehensive search of Ovid Medline, Google Scholar, Web of Science, CENTRAL, and ClinicalTrials.gov covering studies published between January 2000 and January 2025. The search included English-language cohorts. or randomized trials of adults (≥18 years) with bone metastases treated using RFA or CA. Outcomes such as pain levels, tumor recurrence, and adverse events were collected from each study. To assess the quality and reliability of the studies, we used the Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials and the ROBINS-I tool for nonrandomized studies. We performed separate single-arm meta-analyses for RFA and for CA and integrated findings from the small number of direct comparative studies using a narrative synthesis.We performed separate single-arm meta-analyses for RFA and for CA and integrated findings from the small number of direct comparative cohort studies using a narrative synthesis.

Results: A total of 30 studies involving 1121 patients were included in the qualitative synthesis, and 24 were included in the meta-analysis. Separate single-arm meta-analyses revealed that both radiofrequency ablation (RFA) and cryoablation (CA) significantly reduced pain at all follow-up timepoints. RFA had the greatest pain reduction at 6 months (SMD: -3.50; 95% CI: -4.42, -2.27), whereas CA had a greater effect at 24 hours (SMD: -2.43; 95% CI: -3.84, -1.02) but ,a smaller effect at 6 months (SMD: -2.14; 95% CI: -3.43, -0.85). Both were safe, with mostly mild adverse events. The reported tumor control outcomes have been inconsistent, limiting conclusions in this area.

Conclusion: On separate analyses, CA appeared to produce larger short-term effect sizes (greater early pain reduction) while RFA had larger medium/long-term effect sizes in the available studies. Because direct comparative data are sparse and heterogeneous, these observations do not establish superiority of one modality over the other. Both techniques demonstrated favorable safety profiles across included studies. Ablation combined with external beam radiation therapy (EBRT) was superior to either modality alone. Standardized measures and more comparative studies are needed to guide treatment.

Introduction: Distal clavicle fractures are uncommon and present clinical challenges due to complex anatomy and instability. Standard fixation plates often fail to match the clavicle's contour, requiring bending that may weaken fixation and cause irritation.

Case presentation: A 39-year-old male sustained a Neer type IIb distal clavicle fracture after a fall on the right shoulder. Clinical and radiographic evaluation revealed a comminuted fracture with pain and restricted motion. Management and Outcomes: Open reduction and internal fixation with a newly designed anatomical plate were performed under general anesthesia using seven locking screws. Rehabilitation began early, and recovery was uneventful. At two months, radiographs confirmed union and alignment, with full, pain-free motion and improved Constant and ASES scores.

Conclusion: The newly developed anatomical plate provided stable fixation and excellent functional recovery. Further studies with larger cohorts and longer follow-up are required to validate long-term efficacy.

Background & objective: To compare long-term outcomes of single-stage and two-stage revision procedures for prosthetic joint infection (PJI) in total joint arthroplasty, with a focus on infection clearance and treatment failure rates in demographically similar patient cohorts. # Methods A retrospective cohort study was conducted at a tertiary referral centre between 2011 and 2021. Patients who underwent either single-stage or two-stage revision for PJI and completed a minimum of two years of follow-up were included. They were identified from electronic health records and hospital databases. Infection clearance at final follow-up was the primary outcome. Treatment failure was defined as need for further revision or long-term suppressive antibiotics.

Results: A total of 75 patients were included, with 50 undergoing single-stage revision and 25 undergoing two-stage revision. The groups were similar for age, joint type and MacPherson host grade. Mean follow-up was 4.2 years (range 2-9). Infection clearance was achieved in 48 patients (96%) in the single-stage group and 23 patients (92%) in the two-stage group (p = 0.624). Treatment failure occurred in two patients (4%) in the single-stage group and in two patients (8%) in the two-stage group. Patients in the single-stage group received significantly longer courses of post-operative antibiotics (mean 6.2 weeks vs 4.8 weeks; p= 0.0058). All-cause 5-year and 10-year mortality was similar between groups (p=0.85).

Conclusion: In patients with chronic PJI and similar demographic profiles, selected patients undergoing single-stage revision demonstrated comparable infection clearance and mortality compared with two-stage revision. These findings support the increasing use of single-stage revision in appropriately selected patients.

Pulmonary complications, such as pneumonia, ventilator dependence, and unplanned intubation, can occur after femoral open reduction and internal fixation (ORIF). This study aimed to identify predictors of pulmonary complications including unplanned intubation within 30 days of femoral open reduction and internal fixation, using the large NSQIP surgical database. # Methods This study used the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, which is a de-identified registry that includes the surgical data from over 700 hospitals each year. The NSQIP database was queried for patients undergoing femoral open reduction and internal fixation. Multivariate logistic analysis models identified predictors for postoperative pneumonia, ventilator dependence >48 hours, and unplanned intubation. Predictors examined included demographics, comorbidities (COPD, CHF, renal failure), anesthesia type, ASA classification, and smoking status. Statistical significance was set at p<0.05. # Results Significant independent predictors were found for all 3 pulmonary complications analysed for. Significant independent predictors for postoperative pneumonia included male sex (p<0.0001), COPD (p<0.0001), CHF (p=0.0015), renal failure (p<0.0001), higher ASA class (p<0.0001), and current smoking (p=0.0099). For ventilator dependence >48 hours, significant predictors were COPD (p<0.0001), CHF (p=0.0067), renal failure (p<0.0001), higher ASA class (p<0.0001), smoking (p<0.0001), and epidural or spinal anesthesia compared to general anesthesia (p=0.0017). For unplanned intubation, COPD (p<0.0001), CHF (p=0.0015), renal failure (p<0.0001), and higher ASA class (p<0.0001) were significant predictors. # Conclusion In this database, higher ASA class, COPD, CHF, renal failure, male sex, and smoking were independently associated with increased risk of pulmonary complications after femoral ORIF. This information can help surgeons further understand the pulmonary risks in this procedure, watch high risk patients closer, and help patients lower their risks of pulmonary complications through lifestyle changes, regarding variables like smoking, and drug interventions.

Primary cardiac sarcomas are exceedingly rare, with a very low incidence in the general population. A variety of sarcoma subtypes can originate in the heart, including angiosarcoma, rhabdomyosarcoma, leiomyosarcoma, fibrosarcoma, and osteosarcoma. These tumors are typically classified based on histological characteristics, most often determined following surgical excision or biopsy. Among them, primary cardiac osteosarcoma is one of the rarest forms, with fewer than 60 cases reported in the literature to date. This narrative review aims to provide an overview of primary cardiac osteosarcoma, including its epidemiology, clinical presentation, and current management strategies. Additionally, we highlight several remarkable case reports to illustrate the variability and complexity of this rare malignancy. # Summary The clinical presentation of primary cardiac osteosarcoma often mimics other cardiac conditions such as heart failure, mitral stenosis, or coronary artery disease, making diagnosis challenging. Transthoracic echocardiography (TTE) is typically the first imaging modality to detect a cardiac mass. Due to the rarity of the tumor, established treatment protocols are limited. Surgical resection is generally the preferred initial approach for localized disease without metastasis. Chemotherapy and radiation therapy may also be used, but their application must be carefully considered given the heart's sensitivity to these treatments. Despite advances in imaging, surgical techniques, and adjuvant therapies that have improved survival in some cases, the overall prognosis for primary cardiac osteosarcoma remains poor. # Conclusion Because primary cardiac osteosarcoma is so rare, establishing standardized treatment guidelines remains challenging. By reviewing historical cases and examining current clinical management strategies, we aim to contribute to a better understanding of this aggressive malignancy and ultimately improve patient outcomes.