Orthopedic Reviews最新文献

Introduction: Craniofacial hyperplasia is a disorder where the face and head do not fully develop. This leads to difficulties in airway management in those undergoing general anesthesia (GA), requiring consideration in anesthetic planning with GA and intubation versus approaches with regional/spinal anesthesia.

Case presentation: A 54-year-old male (45 kg, 172.7 cm) presented for a penile implant insertion for severe erectile dysfunction following radical prostatectomy. He was classified as ASA physical status class III.

Management and outcomes: Pertinent medical history included craniofacial hypoplasia from childhood surgical interventions and radiation for sinus cancer (rhabdomyosarcoma), moderate mitral regurgitation, mild tricuspid regurgitation, pulmonary hypertension, recurrent esophageal strictures, and anemia. Spinal anesthesia was selected over GA. Airway complications were avoided, and cardiopulmonary stability was preserved while maintaining adequate analgesic coverage.

Conclusion: Craniofacial hypoplasia patients require individualized anesthesia planning that anticipates complications. Spinal anesthesia can be used in these patients to avoid airway and hemodynamic complications.

Purpose: Open Reduction and Internal Fixation of the Femur (ORIF) is a surgical procedure which carries risk for complications including wound dehiscence and postoperative surgical site infections. This study aims to identify significant predictors of wound dehiscence, deep wound surgical site infection, organ/space surgical site infection within 30 days of ORIF for femoral shaft and subtrochanteric fractures.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data registry was used to collect data on significant independent risk factors associated with the complications of interest within 30 days of operation. The ACS NSQIP was filtered to examine the outcome of dehiscence, superficial space, deep space, and organ space infections following ORIF. The following variables were tested for significance: Age, Sex, BMI, ASA classification, total operating time, anesthesia type, diabetes, preoperative steroid use, functional status, dialysis, cancer, hypertension requiring medication, preoperative albumin, preoperative platelets, and preoperative WBC.

Results: The 30-day odds of wound dehiscence were significantly associated with higher BMI (p=0.004) and chronic steroid use (p=0.011). Significant predictors of deep incisional SSI included operative time (p<0.001), low preoperative albumin (p<0.001), high body mass index (p=0.026), general vs. neuraxial anesthesia (p=0.033), and preexisting renal dysfunction (p=0.04). Significant Predictors of organ/space infections included longer operative time (p<0.001) and lower preoperative albumin (p=0.016).

Conclusions: Elevated body mass index and prolonged operating time most consistently predicted the incidence of wound dehiscence and deep incisional, and organ space surgical site infections within 30 postoperative days of ORIF for femoral shaft and subtrochanteric fractures.

The six-week mark is a widely recognized benchmark in orthopedic practice, guiding fracture management, rehabilitation, and postoperative care. Though often viewed as conventional, this timeframe reflects biological healing, clinical observations, and practical considerations. Historically, uncomplicated fractures were noted to achieve sufficient stability by six weeks, enabling cast removal, mobilization, and weight-bearing. Advances in bone biology confirmed that, around this time, soft cartilaginous callus transitions to mineralized woven bone, providing measurable structural integrity. Radiographs often demonstrate bridging callus, correlating with clinical readiness for progressive loading. Clinically, six weeks frequently marks the shift from immobilization to motion and load-bearing. In upper-limb fractures, studies support early mobilization when fixation is stable, with six weeks serving as a common rehabilitation reference. In lower-limb fractures, randomized trials show safe progression to full weight-bearing by this point under radiographic guidance. The same interval is relevant in venous thromboembolism prevention, with guidelines recommending extended prophylaxis for up to 35 days after major orthopedic surgery. Beyond biology and safety, the six-week milestone offers practical benefits: it standardizes follow-up, facilitates complication detection, and streamlines patient communication. Telemedicine has further validated this timeframe for remote monitoring. Nevertheless, variability in healing exists, influenced by age, comorbidities, smoking, and bone quality. Emerging tools-biomarkers, wearables, and artificial intelligence-may enable individualized recovery timelines. In conclusion, the six-week interval represents a convergence of biological healing and clinical pragmatism. While reliable for most patients, its future lies in refinement into a personalized standard of care.

Knee osteoarthritis (KOA) is a chronic degenerative joint disease that lead to cartilage loss, inflammation, and disability. Intra-articular hyaluronic acid (HA) is widely used for its viscoelastic, anti-inflammatory, and chondroprotective properties; however clinical outcomes remain inconsistent. Recent studies have explored combining HA with biologic or pharmacologic agents, such as platelet-rich plasma (PRP), corticosteroids (CS), fibrinogen, botulinum toxin A, polydeoxyribonucleotide (PDRN), and stem cells, to enhance efficacy through multimodal mechanisms. Despite this, the comparative benefits and safety profiles of these emerging strategies remain unclear. This review aims to evaluate the clinical efficacy of intra-articular HA, used either alone or in combination with adjunctive agents, for the management of KOA. A comprehensive literature search was conducted across PubMed, Embase, the Cochrane Library, and Web of Science, covering the period from January 2010 to April 2025. A total of 70 studies were included, comprising 50 randomized controlled trials (RCTs) and 20 meta-analyses. High-quality evidence supports the modest yet clinically significant efficacy of HA monotherapy, especially in the early to moderate stages of KOA. Outcomes appear to be affected by factors such as molecular weight, crosslinking, and injection protocols. Among combination strategies, the combination of HA and PRP demonstrates the most consistent synergistic benefits across various outcome domains. Short-term improvements are also observed with the combination of HA and CS. Emerging combinations involving fibrinogen, botulinum toxin A, peripheral blood stem cells and polydeoxyribonucleotide show early promise but remain under investigation.

Introduction: Research on the Female Athlete Triad and Relative Energy Deficiency in Sport (RED-S) has expanded considerably over the past decade as awareness of low energy availability and its multisystem consequences has grown. Bibliometric evaluation provides insight into global research trends, collaboration networks, and emerging areas of scholarly focus. This study aimed to analyze publication patterns, influential contributors, institutional productivity, and global collaboration within the literature on the Female Athlete Triad and RED-S.

Methods: A bibliometric analysis was conducted using publications indexed in the Web of Science Core Collection and PubMed databases. Search terms included "Female Athlete Triad," "relative energy deficiency in sport," and related keywords. Bibliographic data were exported and analyzed using Microsoft Excel and VOSviewer to evaluate authorship patterns, institutional affiliations, funding sources, journals, countries of origin, and collaboration networks. Co-authorship and institutional mapping were visualized through network analysis.

Results: The analysis demonstrated a sustained increase in publications over time, particularly after 2015, reflecting growing recognition of RED-S as a multisystem condition. China and the United States emerged as leading contributors, with research output concentrated among a limited number of academic institutions and investigators. Prominent collaboration clusters centered around established leaders in sports endocrinology and exercise physiology. English-language publications dominated the literature, and government agencies represented the primary funding sources. Network visualization revealed dense collaboration among central authors alongside emerging peripheral research groups.

Conclusion: Research on the Female Athlete Triad and RED-S continues to expand globally but remains concentrated within specific geographic regions and academic networks. Future research should prioritize broader international collaboration, interdisciplinary approaches, and clinically oriented investigations to enhance translation of research findings into athlete care and prevention strategies.

Ewing sarcoma is an atypical and aggressive bone malignancy, most commonly observed in the pediatric population. Looking at epidemiological data shows that individuals of Caucasian descent are most susceptible to the disease, which additionally show a slight male predominance. We present the case of a 46-year-old male of South Asian descent who came into an outpatient clinic complaining of ongoing pain in the left posterior flank. The clinical picture initially raised suspicion for recurrent Nephrolithiasis because of the patient's previous medical history. The patient was advised to get a CT scan when imaging revealed a 7cm unidentified mass in the left retroperitoneum. The mass appeared to be developing under the sub aorta and was partially encasing it. Due to the conclusive findings, the patient proceeded to get sampling done by a pathologist. Pathologic examination identified small round blue cells, a key identifier and comparable biologic characteristics of Ewing's Sarcoma. This case emphasizes the diagnostic and clinical significance of encountering a destructive malignancy, specifically Extraskeletal Ewing's Sarcoma; such as anatomical site, patient age group, proximity to vital body structures, and ethnic group. Factors that challenge the traditional scope of Ewing's Sarcoma and the importance of widening diagnostic perspective.

Hand surgery has undergone remarkable evolution over the past decade, driven by advances in microsurgery, biologics, imaging, and digital technologies. Key areas of progress include high-resolution imaging, minimally invasive surgery, wide-awake local anesthesia (WALANT), and biologic therapies such as platelet-rich plasma and stem cells. Reconstructive strategies have advanced with vascularized bone and nerve grafts, tendon repair techniques, and the integration of biologics with scaffolds and 3D printing. Technological innovations-artificial intelligence, virtual and augmented reality, robotics, and telemedicine-are redefining surgical education, intraoperative navigation, and rehabilitation. Despite rapid growth, challenges remain regarding validation, equity of access, and ethical considerations. This review highlights transformative developments, focusing on innovations that have reshaped diagnostic accuracy, surgical precision, and patient-centered outcomes.

Peripheral nerve injuries pose significant challenges due to limited regenerative capacity and functional recovery, especially in large or complex defects. Traditional repair methods using non-vascularized autologous nerve grafts often result in suboptimal outcomes due to ischemia-induced central necrosis and delayed axonal regeneration. Vascularized nerve grafts (VNGs), which provide an intrinsic blood supply, have emerged as a promising alternative to enhance nerve repair by improving graft survival, supporting Schwann cell viability, and promoting early neovascularization. This review on vascularized nerve grafting examines its advantages, challenges, and emerging experimental approaches. VNGs demonstrate superior functional outcomes compared to non-vascularized grafts, with improved motor and sensory recovery, and higher axonal density, particularly in long-gap and delayed repairs. Although the use of vascularized nerve grafts is limited by technical complexity, increased operative time, and donor site morbidity. In this study we aim to provide a comprehensive overview of the rationale, outcomes, and challenges associated with vascularized nerve grafts, while highlighting emerging experimental strategies poised to overcome current limitations in peripheral nerve repair.