Orthopedic Reviews最新文献

Splints have been used since ancient times. With knowledge and technology, they have continually advanced. This manuscript summarizes the history of splints to elucidate how and why they have changed over time. With this knowledge, readers will be able to value the contributions of previous innovators and imagine future possibilities, and the world of orthopedics continues to evolve.

Background: Cervical epidural steroid injections (CESIs) are frequently utilized for the treatment of cervical radiculopathy and axial neck pain. Given the anatomical complexity of the cervical spine, techniques that enhance precision while maintaining safety are essential. This case series evaluates the safety of a catheter-based approach for CESI, allowing targeted medication delivery to the affected spinal level.

Methods: A retrospective review was conducted of 9 patients who underwent cervical ESIs using a catheter-based technique. Under fluoroscopic guidance, the epidural space was accessed with a touhy needle, and a flexible catheter was advanced to the level of pathology for medication administration. All patients were monitored during and after the procedure for any complications.

Results: All 9 procedures were successfully completed without any reported complications. There were no cases of dural puncture, neurological injury, or other adverse events associated with the procedure.

Conclusion: This case series supports the safety and feasibility of catheter-based cervical epidural steroid injections. The technique allowed for accurate targeting of pathology without any observed complications. These preliminary findings warrant further investigation in larger, controlled studies to confirm safety and efficacy.

Objective: The objective of this study is to demographically identify and describe the local pediatric population that presented to the Emergency Department for TBI and their associated outcomes.

Methods: This was an observational cohort study of consecutive Emergency Department patients aged 0-4 years diagnosed as having a TBI as one of their discharge diagnoses, in a level 1 trauma center in Southeastern United States. Main outcome measures included predictors of abnormal head CT scan and hospital admission. Additionally, demographic characteristics, injury patterns and mechanisms of injury are described.

Results: Predictors of abnormal head CT in this pediatric population include younger age, lower pediatric Glasgow Coma Scale (PGCS), mechanism of traffic accident, and the presence of vomiting. Hospital admission was predicted by the presence of an abnormal CT finding or loss of consciousness in this population. In this single center study, younger children (0-2) were less likely to be symptomatic but more likely to have significant abnormal CT findings.

Conclusion: This paper highlights the burden of TBI in infants and toddlers presenting to the emergency department and highlights the differences in presentation of this common complaint. Better understanding of this population will help to form better strategies or to amend current management practices in order to provide more effective treatment to such patients, especially in hospitals lacking the sophisticated pediatric emergency departments.

Purpose: The effectiveness of exercise therapy for moderate adolescent idiopathic scoliosis and its potential benefits when combined with other treatments require further investigation. This systematic review and meta-analysis evaluated the efficacy of exercise therapy as a conservative management strategy for AIS.

Methods: Following PRISMA guidelines, we searched PubMed, Cochrane Library, Embase, and Web of Science up to June 4, 2024, for RCTs. Eligible studies included AIS patients (10-18 years, Cobb angle 20°-45°) undergoing various exercise therapies, such as scoliosis-specific exercises and core stabilization training. Primary outcomes included Cobb angle, ATR, trunk appearance, QoL, and respiratory function. Data extraction and risk-of-bias assessment followed Cochrane guidelines, and study quality was evaluated using the 11-item PEDro scale. Meta-analyses were conducted based on standardized mean differences.

Results: Eight RCTs with nine intervention groups were analyzed. At six months, exercise alone showed no significant advantage over bracing in improving Cobb angle, ATR, QoL, or trunk appearance (p < 0.05). However, exercise combined with other therapies significantly improved Cobb angle (MD = -6.11, 95% CI: -9.21 to -3.02), QoL (SMD = 0.89, 95% CI: 0.27 to 1.51), and lung function (SMD = 0.46, 95% CI: 0.13 to 0.80) at three months. These effects persisted for Cobb angle at six months (MD = -4.87, 95% CI: -8.77 to -0.98).

Conclusions: Low to moderate evidence suggests exercise alone is comparable to bracing for AIS, while exercise combined with other therapies offers short-term benefits for Cobb angle, QoL, and lung function.

Objective: To determine the predictors of traumatic head injury (TBI) severity in adult patients involved in motor vehicle collisions or accidents, and to report on the outcomes of hospital admission, in-hospital death, and return to the Ed within 72 hours of discharge.

Methods: This is an observational cohort of adult patients (≥18 years) who sustained a TBI through involvement in motor vehicle collisions (MVC). Demographic, pre-hospital and clinical data were collected from medical records of patients.

Results: In our cohort, patients who had loss of consciousness, alteration of consciousness, or post-traumatic amnesia were individual predictors of more severe traumatic brain injury. TBI severity was categorized by using GCS scores on emergency department arrival. Similarly, male patients, those who did not wear seat belts, and those with alcohol consumption were more likely to have severe TBI. When controlling for sex, loss of consciousness, no seat belt use, and alcohol consumption prior to injury were still statistically significant predictors of having more serious traumatic brain injury.

Conclusion: Lack of seat belt use, alcohol consumption before injury, and loss of consciousness because of injury are significant predictors of having more severe head injury. These data support a call for action to implement more widespread injury prevention, seat belt use education and advocacy.

Objectives: To evaluate the outcomes of arthroscopic surgery for patients with shoulder impingement syndrome (SIS).

Methods: A systematic search was conducted in PubMed, Web of Science, SCOPUS, and Science Direct for studies on the outcomes of arthroscopic surgery for SIS. Screening, data extraction, and quality appraisal were performed independently.

Results: Eleven studies with a total of 782 patients were included. Arthroscopic subacromial decompression (ASAD) showed reduced pain and improved function regardless of age or chronicity, with high satisfaction rates and a low complication rate of 0-19.4%. Arthroscopic acromioplasty provided good short-term outcomes for refractory SIS and superior long-term outcomes compared to open surgery.

Conclusion: ASAD is more effective than open or conservative treatment for recalcitrant SIS, though similar results can be attained with well-structured exercise therapy. Low complication rates associated with arthroscopy underscore its safety.

Background: Spinal fusion surgeries remain a successful treatment for degenerative disc disease. While autograft is considered the gold standard bone graft, synthetic bone void fillers are increasingly used to limit donor site morbidity while giving sufficient graft volume.

Methods: This retrospective clinical study evaluates MagnetOs Easypack Putty^TM as a standalone graft without autograft in interbody fusion. An independent radiologist blinded to the clinical status provided evaluation of computed tomography (CT) images obtained at 12 months and graded each treated level based on the Brantigan-Steffee-Fraser (BSF) Classification. Twenty subjects were enrolled in the study. A total of 36 spinal levels were treated with an average of 1.8 levels per subject (L2-L3 to L5-S1).

Results: The primary endpoint of CT-based fusion was 94.4% (34/36 levels) based on the presence of bridging bone or locked pseudoarthrosis at 12 months. The high fusion rate was accompanied by consistent improvement in pain scores. Visual analogue scale (VAS) pain scores decreased an average of 25% from 5.3/10 pre-operatively to 2.8/10 at 12 months post-operative, and all subjects who reported pre-operative back or leg pain reported improved pain post-operatively. Although the patient population included risk factors and comorbidities, the fusion rate remained high, and no device-related adverse events (AEs) were observed.

Conclusions: The high fusion rate and favorable safety profile support the performance of MagnetOs Easypack Putty for standalone use without autograft in interbody fusion procedures.

Purpose: Proper management of simple elbow dislocations is mandatory to avoid elbow stiffness, chronic instability, heterotopic ossification, or deformity of the elbow. The aim of the present study was to perform a systematic review of the current treatments of simple elbow dislocations to identify the best non-surgical and surgical management for patients with simple elbow dislocations (SED).

Methods: A review of the literature was performed according to the PRISMA guidelines. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases was performed using the following keywords: "elbow dislocation", "simple elbow dislocation", "traumatic elbow dislocation", "treatment", "management", "reduction", "rehabilitation", "functional outcome", "range of motion", "complications", "recovery time" over the years 1976-2024.

Results: The literature search and cross-referencing resulted in a total of 345 references, of which 283 were rejected due to off-topic abstract and/or failure to fulfil the inclusion criteria. After reading the remaining full-text articles, we included 60 studies, investigating non-surgical management or surgical management of simple elbow dislocations.

Conclusion: The SMDA-SEC consensus panel provided recommendations to improve the management of patients with SED in clinical practice. Early mobilization is recommended for all cases of simple elbow dislocations. The CMA-EC panel was unable to advise or against the short-period (1-3-wk) immobilization, prolonged (3-wk) immobilization or operative treatment due to insufficient or conflicting evidence.

Background: Caudal epidural steroid injections (ESIs) are commonly used to manage lumbosacral radicular pain and axial low back pain. While they are generally considered safe, real-world data on complication rates and patient-reported outcomes remain limited. This study aimed to evaluate the safety profile and short-term effectiveness of caudal ESIs by reviewing a series of randomly selected cases performed over a six-month period.

Methods: A retrospective chart review was conducted on 40 randomly selected caudal ESI procedures performed between July 1, 2024, and December 31, 2024. All procedures were performed under fluoroscopic guidance using a corticosteroid mixed with local anesthetic and preservative-free normal saline. Charts were reviewed for procedural complications, including dural puncture, neurological injury, and infection. Outcome data, including starting and post-injection pain scores and patient-reported percent relief, were analyzed in patients with complete follow-up at two weeks or by post-procedure phone call.

Results: There were no documented dural puncture, infection, or permanent neurological injury among the 40 cases. Of the 27 patients with complete follow-up data, the average pain score decreased from 8.6 to 2.9 on the numerical rating scale. The average patient-reported percent relief was 67.4%. A total of 24 patients (88.9%) reported at least 50% relief, 3 patients (11.1%) reported complete (100%) relief, and only 1 patient reported no relief (0%).

Conclusion: Caudal ESIs demonstrated a favorable safety profile and were associated with meaningful short-term pain relief in most patients. These findings support the continued use of caudal ESIs as a safe and effective interventional option for appropriately selected patients with lumbosacral pain.

Cartilage microfracturation is a surgical technique specifically designed to address chondral defects, which are injuries to the cartilage that covers the ends of bones in joints. These defects can result from traumatic injuries, degenerative conditions such as osteoarthritis, or congenital abnormalities. The primary objective of microfracture surgery is to promote the regeneration of functional cartilage tissue, thereby restoring joint function, alleviating pain, and enhancing mobility. The procedure involves creating small, controlled perforations, or microfractures, in the subchondral bone plate beneath the damaged cartilage. This process, performed with precision to minimize damage to surrounding healthy tissue, penetrates the subchondral bone to reach the bone marrow, which is rich in mesenchymal stem cells (MSCs).