Orthopedic Reviews最新文献

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.

The distinction between prolonged bone healing and nonunion in long bone fracture remains a historical challenge in the field of orthopedics. Despite numerous proposed definitions and scoring systems, a consensus remains elusive, thereby complicating both diagnosis and treatment. An accurate diagnosis is necessary, facilitated by a range of imaging modalities. Bone nonunion management encompasses surgical and non-surgical options, including external or internal fixation, and bone grafting, tailored to the nonunion type. This review discusses the pathophysiology of nonunion, risk factors, diagnosis and treatment. It particularly addresses early detection and the impacts of nonunion on the patient. The aim of this review is to obtain a global and updated point of view regarding nonunion of the bone as well as to reflect on the potential use of untraditional methods in their treatment such as orthobiologics, along with emerging and non-invasive technologies including shockwave therapy, gene therapy, tissue engineering, regenerative medicine and 3D printing.

Background: Adequate treatment of proximal humeral fractures (PHF) is essential for restoring shoulder function and expediting return-to-work (RTW). This study aims to assess the impact of conservative and operative treatments on RTW and PHF recovery.

Objective & methods: In a retrospective case-control study, 858 patients (aged 18-68) treated for PHF between 2018 and 2021 were included. Questionnaires were sent to 342 operatively treated patients (Operative group (OG)) and 191 conservatively treated matched controls (Conservative group (CG)). Assessments covered RTW, functional outcomes (DASH, ASES), and quality of life (EQ-5D). A Kaplan-Meier analysis explored RTW in weeks.

Results: With a 61% response rate, 73 eligible participants (40 OG, 33 CG) contributed. Of respondents, 67.1% were female, and 60% were employed pre-trauma. Almost 70% of employed patients RTW, with no significant difference between groups (log rank, p=0.36). Among those returning to work, OG tended to resume 4 weeks later than CG (OG 10.5, IQR 22 vs. CG 6.00, IQR 8 weeks, p=0.07). DASH, ASES, and quality of life VAS scores showed no statistical difference between groups (p=0.542, p=0.257, p=0.530, respectively).

Conclusion: The RTW proportion did not differ between operatively and conservatively treated PHF patients, though the former tended to return 4 weeks later. Functional outcomes demonstrated no significant differences. Further adequately powered studies are necessary to establish a standardized aftercare protocol for PHF, enhancing patient care and minimizing work disability.

Headaches are among the most prevalent medical complaints globally. Occipital neuralgia is a chronic headache disorder characterized by unilateral or bilateral severe pain originating in the neck or skull base and radiating up along the occipital nerve distribution. Effective treatment options for occipital neuralgia can be challenging and some patients may prove to be refractory to conventional medical and interventional therapies. We present a case report on a patient with severe occipital neuralgia that was refectory to conventional therapies that responded to percutaneous peripheral nerve stimulation.

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.