Orthopedic Reviews最新文献

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.

Platelet-rich plasma (PRP) therapy has emerged as a biologically based approach to enhance tendon healing and functional recovery in hand and other musculoskeletal injuries. PRP is an autologous concentrate of platelets and growth factors, including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), insulin-like growth factor (IGF), and vascular endothelial growth factor (VEGF), which modulate inflammation, stimulate tenocyte proliferation, promote collagen synthesis, and support angiogenesis. Preclinical studies demonstrate that PRP improves extracellular matrix remodeling, collagen fiber alignment, and biomechanical strength in injured tendons, with effects influenced by PRP formulation, leukocyte content, activation method, and timing of application. Clinical evidence in hand tendon injuries-particularly flexor tendon repair, chronic tendinopathies, and stenosing tenosynovitis-suggests that PRP is generally safe and may enhance tendon morphology, range of motion, pain relief, and return to function. However, results are heterogeneous, with some randomized trials showing limited short-term functional improvements compared to conventional treatments such as corticosteroids, hyaluronic acid, or percutaneous needle tenotomy. The variability in outcomes reflects differences in PRP preparation, injection protocols, injury chronicity, and study design. Beyond the hand, PRP has been applied to rotator cuff, lateral epicondylitis, plantar fasciitis, ligament injuries, and spinal surgery, with mixed results and some evidence of tissue-specific limitations. Current challenges include standardizing PRP formulations, optimizing dosing and delivery, and identifying patient- and injury-specific factors influencing response. Future research should prioritize multicenter, well-powered randomized trials with uniform outcome measures, long-term follow-up, robust safety monitoring, and exploration of combination therapies to clarify the therapeutic role of PRP and support evidence-based integration into clinical practice.

Purpose: Hip arthroscopy is a minimally invasive procedure which has been increasingly used among athletes for several hip joint related pathologies as it allows for a faster recovery. However, objective return to sport criteria have not been described previously among this population.

Objective: To systematically review the literature to evaluate and describe the objective return-to-sport (RTS) criteria to release patients back to sport following hip arthroscopy.

Methods: We conducted a comprehensive literature search according to the PRISMA guidelines. Studies were included in the review if patients underwent a hip arthroscopy procedure and the study described criteria for their patients to RTS. Two independent reviewers selected studies for inclusion and extracted study characteristics and objective RTS criteria.

Results: Of the 306 that were a part of our original search, 6 studies fit our inclusion criteria. There were 250 athletes (average age: 26.1) and 263 hips which underwent hip arthroscopy surgery. Of these athletes, the cohort was on average 46.5% female and an average of 91.2% of athletes returned to sport about 6 months following surgery. The primary sports these athletes participated in were soccer, swimming, skiing/snowboarding, and hockey. The objective RTS measures that were generally described included sport specific tests, range-of-motion, hip strength, and performance-based criteria.

Conclusion: There are minimal studies who described objective RTS criteria to release patients back to sport following hip arthroscopy procedures. Sports specific tests, hip strength, and performance-based criteria were mentioned as objective criteria to release patients back to sport.

Background: Venous thromboembolism (VTE) remains a major source of morbidity after femoral fracture repair. We evaluated perioperative risk factors for 30-day deep vein thrombosis (DVT) and pulmonary embolism (PE) using a national clinical registry.

Methods: We conducted a retrospective cohort study of adults undergoing femoral fracture repair in the American College of Surgeons National Surgical Quality Improvement Program. Outcomes were 30-day DVT and PE. Candidate predictors included demographics, comorbidities, functional status, preoperative laboratory values, American Society of Anesthesiologists (ASA) class, and operative time. Multivariable logistic regression models were fit separately for DVT and PE. Model performance was assessed with area under the receiver operating characteristic curve (AUC).

Results: Disseminated cancer and longer operative time were independent predictors of postoperative DVT. Disseminated cancer conferred higher odds of DVT (adjusted odds ratio [aOR] 1.65, 95% CI 1.15-2.36, p=0.0065), and each additional operative minute increased DVT odds by 0.32% (aOR 1.0032, 95% CI 1.0017-1.0047, p<0.001), approximating 19% higher odds per 60 minutes. Body mass index (BMI) showed a borderline association (aOR 1.014 per kg/m², 95% CI 0.999-1.027, p=0.056), while age, sex, diabetes, smoking, functional status, preoperative creatinine, platelets, dialysis, heart failure, and preoperative INR were not significant. The DVT model demonstrated modest discrimination (AUC 0.57).For PE, disseminated cancer (aOR 2.77, 95% CI 1.92-4.00, p<0.001), longer operative time (aOR 1.0025 per minute, 95% CI 1.0006-1.0044, p=0.012), and higher BMI (aOR 1.018 per kg/m², 95% CI 1.002-1.035, p=0.031) were independent risk factors, whereas higher preoperative INR was protective (aOR 0.43 per unit, 95% CI 0.23-0.80, p=0.008). The PE model AUC was 0.61.

Conclusions: Within 30 days of femoral fracture repair, disseminated cancer and prolonged operative time consistently increased VTE risk; BMI contributed modestly, and higher preoperative INR reduced PE risk. These findings support targeted prophylaxis and heightened surveillance in high-risk subgroups and highlight the need for enhanced, multifactorial prediction tools.

Background: Femoral intramedullary screw fixation is widely performed to stabilize femoral fractures. Although uncommon, postoperative acute kidney injury (AKI) and dialysis are serious complications associated with increased morbidity and mortality. This study aimed to identify predictors of AKI and postoperative dialysis following femoral intramedullary screw fixation.

Methods: We utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patients undergoing femoral intramedullary screw fixation (CPT 27506) between 2018 and 2022. Predictors examined included demographic variables, comorbidities, preoperative laboratory values, ASA class, operative duration, and anesthesia type. Univariate analyses were performed, followed by multivariate logistic regression to determine independent risk factors for AKI and postoperative dialysis. Statistical significance was set at α = 0.05.

Results: A total of 63,734 patients were analyzed. Univariate predictors of AKI and postoperative dialysis included renal failure, elevated blood urea nitrogen, general anesthesia, hypertension, male sex, advanced age, decreased hematocrit, higher ASA class, diabetes, elevated BMI, and longer operative time. Multivariate logistic regression identified the following independent predictors: pre-existing renal insufficiency (p < 0.0001), elevated blood urea nitrogen (p < 0.0001), use of general anesthesia (p < 0.001), hypertension (p < 0.0001), male sex (p < 0.0001), older age (p < 0.001), decreased hematocrit (p < 0.001), ASA class III and IV (p = 0.0013, p = 0.0229), diabetes (p = 0.0038), and increased BMI (p = 0.0043).

Conclusion: This study identifies significant independent predictors of AKI and postoperative dialysis in patients undergoing femoral intramedullary screw fixation. Preoperative risk stratification incorporating these factors may improve perioperative planning and reduce adverse renal outcomes.