Orthopedic Reviews最新文献

Osteoporosis is a degenerative bone disease that causes the weakening of bone structure. Since bone structure is dynamic throughout a person's lifespan, bones are under constant growth and destruction in a process known as bone turnover or bone remodeling. Osteoporosis involves the disruption of this growth/destruction equilibrium towards the destructive side. An increase in bone turnover leads to a lower bone density and therefore a greater risk of fracture or injury of higher severity. Bone turnover markers serve as indicators of the process of bone turnover. These markers are split into two groups: formation (building up) markers and resorption (breaking down) markers. Using biochemical techniques and assays, these markers can be measured to monitor the activity of the markers as well as determine treatment options and efficacy based on this activity. The use of biomarkers in osteoporosis can pave the way for their use in other diseases such as cancer.

Introduction: Opioid use disorder is a chronic illness with significant morbidity and mortality. Opioid agonists, like buprenorphine, are commonly used to prevent relapse. Recent changes in buprenorphine legislation are expected to increase prescription and guidelines recommend its continuation during the perioperative period for many patients. However, buprenorphine's strong affinity for mu receptors can complicate perioperative pain management, requiring high doses of analgesics and increasing risks like respiratory depression. A newly FDA-approved sublingual sufentanil system, with higher mu receptor affinity, may offer a solution.

Case presentation: A series of three cases with patients undergoing outpatient surgery procedures while continuing buprenorphine treatment are presented.

Management and outcomes: Sublingual sufentanil was effective in lowering pain with no adverse effects for the buprenorphine patients undergoing surgery with general anesthesia without a missed dose.

Conclusion: Further research is needed to make conclusive remarks on the efficacy of this treatment, but the quick onset and effective treatment make this route worthwhile to consider.

Introduction: Undertaking a primary total knee arthroplasty for chronic complete patellectomy knees is an infrequent and complex scenario. The technical demands are high, often leading to suboptimal outcomes. However, our innovative approach, which involves a patellar autograft from an intraoperatively cut femoral condyle placed into the extensor mechanism following cement resurfacing, has shown promising results.

Case presentation: A 74-year-old man had been living with the consequences of a road accident that occurred 40 years ago. This incident led to an open knee injury in his right knee and a thorough patellectomy. He arrived at Ratchaburi Hospital in 2017 with pain in both knees and had been using crutches for 40 years.

Management and outcomes: His left knee had primary total knee arthroplasty in December 2017, and his right knee was scheduled for 2019; but, because of the COVID-19 pandemic, his procedure was postponed and performed as of February 2022. Our patient's knee function significantly improved after using an unconstrained posterior stabilized prosthesis on both knees and the right knee using the patient's patellar autograft from an intraoperatively cut femoral condyle. At 12 weeks postoperatively, the Oxford Knee Society Scores increased from 12 to 45, while the Feller Patellar Scores increased from 8 to 26.

Conclusion: These successful outcomes at 12 weeks postoperatively and even more so after two years demonstrate the significant potential of this new technique, instilling hope for improved outcomes in similar cases.

Background: The complex nature of musculoskeletal diseases and the limitations of existing treatments have driven researchers to explore innovative solutions, particularly those involving stem cells and their derivatives. The utilization of the IPFP as a source of MSC-derived non-cellular products for the treatment of musculoskeletal diseases has gained recognition in recent years. This study aimed to identify the progress of IPFP-derived acellular biologics use in the treatment of orthopedic conditions such as osteoarthritis and ligament and/or tendon injuries.

Methods: A literature search was conducted through PubMed, Scopus and Google Scholar databases including studies over the past 10 years. This scoping review includes studies discussing the development of intercellular messenger signaling molecules (non-cellular products) in the form of exosomes, secretomes, and conditioned medium derived from the IPFP in the management of musculoskeletal diseases. The PRISMA-ScR guidelines were utilized in this review.

Results: Six studies met the inclusion criteria. Most studies reported the beneficial anti-inflammatory effects of IPFP-derived noncellular products in musculoskeletal conditions. The effects of IPFP-derived exosomes, secretomes, and conditioned medium administration are mostly reported in microscopic changes through cellular and matrix changes. Additionally, quantitative analyses involved assessing levels of anti-inflammatory and pro-inflammatory markers, proteins, fatty acids, and gene expression.

Conclusions: The use of IPFP-derived non-cellular products has shown significant promise in the regenerative therapy for musculoskeletal diseases. These agents have demonstrated beneficial effects, particularly in reducing inflammation, promoting cellular changes, and enhancing tissue regeneration. However, further research is needed to fully understand the characteristics and explore the potential applications of IPFP-derived non-cellular products in musculoskeletal cases.

Skeletal fractures are traumatic injuries that are widely accepted as requiring acute treatment to avoid long-term disability and dysfunction. There are a number of soft-tissue injuries or non-traditional fractures, frequently treated by sports medicine surgeons, which additionally require treatment in an expedited fashion in order to optimize healing and function. Sports medicine injuries of the lower extremity requiring acute treatment include, but are not limited to, irreducible shoulder dislocations, acute traumatic rotator cuff tears, posterior sternoclavicular joint dislocations, high grade acromioclavicular joint dislocations, pectoralis major tendon ruptures, distal biceps tendon ruptures, and triceps tendon ruptures. The purpose of this manuscript is to review the sports medicine injuries of the upper extremity which require acute/urgent management to facilitate optimal treatment.

Skeletal fractures are traumatic injuries that are widely accepted as requiring acute treatment to avoid long-term disability and dysfunction. There are a number of soft-tissue injuries or non-traditional fractures, frequently treated by sports medicine surgeons, which additionally require treatment in an expedited fashion in order to optimize healing and function. Sports medicine injuries of the lower extremity requiring acute treatment include, but are not limited to, multiligamentous knee injuries, proximal hamstring ruptures, quadriceps tendon ruptures, patellar sleeve avulsions, patellar tendon ruptures, tibial spine avulsions, posterior cruciate ligament avulsions, bucket handle meniscus tears, and achilles tendon ruptures. The purpose of this manuscript is to review the sports medicine injuries of the lower extremity which require acute/urgent management to facilitate optimal treatment.

Cervical radicular pain following anterior cervical discectomy and fusion (ACDF) is a challenging condition, particularly in the presence of hardware complications. This case report discusses the successful use of a cervical interlaminar steroid injection to alleviate radicular pain in a patient who presented with a fractured screw following C6/7 ACDF. The patient's symptoms, treatment plan, and outcome are reviewed, highlighting the success of an interlaminar steroid injection in managing radicular pain until the patient could receive corrective surgery.

Background: Memorizing mounds of facts without having an effective conceptual framework to store them is often an unsuccessful learning style because memory frequently fails without understanding. To accomplish this goal, we offer a framework of ideas called "concept maps". Of the many strategies for metacognition (that is, thinking about thinking), concept mapping is proven to improve meaningful and independent learning. We used this approach to guide understanding of common orthopaedic infections. This paper is not meant to serve as an approach on how to treat, but rather as a storage system with the ability to assist in understanding orthopaedic infections.

Methods: Concept maps are constructed using information from over 30 sources of orthopaedic or infectious disease literature. The sequential levels of each concept map are referred to as levels of hierarchy. Boxes of each level of hierarchy are designed to be a point of differentiation between a similar concept. Branches form lower levels of hierarchy to further divide specific concepts.

Results: 5 concept maps were constructed. One map is an overview of all concepts, and the key concept for each of the following map are as follows: osteomyelitis, synovial infection, myositis, and foreign material infection.

Conclusion: A conceptual approach is a way of learning material in a manner that allows effective storage and retrieval. This approach will ultimately lead to a better understanding of orthopaedic infections.

Chronic knee pain from osteoarthritis (OA) is a leading cause of disability, with limited treatment options for patients who fail conservative management and intra-articular (IA) injections. Genicular nerve blocks (GNBs) have emerged as a promising treatment for chronic knee pain, especially in patients who are not candidates for total knee replacement (TKR). This case series discusses six patients with chronic knee pain from OA who failed conventional treatments, including IA injections, and found significant relief with GNBs.

Patellofemoral or anterior knee pain is a common cause of medical evaluation around the globe. It affects one in four individuals and is more frequent in females. It is considered a multifactorial disease in which conservative management must focus on the alterations found in the physical exam and radiologic images. Recurrence is high, as 39-40% of the patients continue with symptoms in one year of follow-up. Surgical management should be considered when symptoms persist after six months of conservative measures and when evident malalignments are identified. This article aims to establish and summarize the possible causes, involve the importance of the physical examination and the radiologic images suggested, as to consider the different treatment options that may be used to treat such a frequent and irregular pathology.