Orthopedic Reviews最新文献

Introduction: Intertrochanteric fractures are very common injuries in the elderly population and are typically managed with cephalomedullary nailing. Even though this approach generally has successful outcomes, complications like implant failure or peri-implant fractures could still occur, especially in osteoporotic patients.

Case presentation: An 87-year-old female with a previously operated intertrochanteric femoral fracture presented with a subcapital femoral neck fracture combined with breakage of the cephalic lag screw. Imaging showed no signs of non-union or malalignment in the pertrochanteric region.

Management: The patient underwent cemented dual mobility total hip arthroplasty after removal of the broken lag screw and cephalomedullary nail. Intraoperatively, a distal femoral spiral fracture occurred. This was stabilized with lag screws and a locking plate. The patient recovered uneventfully and returned to full weight-bearing 3 months postoperatively.

Conclusion: This case highlights a rare complication and presents a therapeutic approach in the context of contemporary literature.

This study leveraged the robust, multicenter ACS NSQIP database to evaluate risk factors associated with the development of pulmonary embolism (PE) following total knee arthroplasty (TKA). Our findings demonstrate that advanced age, elevated body mass index (BMI), chronic obstructive pulmonary disease (COPD), preoperative thrombocytosis or thrombocytopenia, congestive heart failure (CHF), and prolonged operative time are independently associated with increased odds of postoperative PE. These results underscore the importance of comprehensive preoperative risk stratification and individualized perioperative management strategies aimed at minimizing thromboembolic complications in this patient population.

Introduction: Ankle arthrodesis is a key surgical option for end-stage ankle arthritis when total ankle replacement is not feasible. Despite advancements, challenges like non-union and infection persist. While bibliometric analysis has been applied in other orthopaedic fields, no study has focused on ankle arthrodesis.

Methods: This study analysed the 50 most-cited articles to assess their impact and guide future research and clinical practice. A Web of Science search using the terms (("Ankle*" OR "Tibiotalar") AND ("Arthrodesis" OR "Fusion")) identified 533 articles published up to October 2024, including only English-language, peer-reviewed studies on human subjects, while excluding non-peer-reviewed, non-English, or unrelated studies. After screening and data extraction, bibliometric techniques assessed publication trends, citation impact, and key research contributors.

Results: The 50 analysed articles, published between 1948 and 2017, accumulated 12,674 citations (average 678.8 per year), with Ankle Arthrodesis: Long-Term Follow-Up with Gait Analysis by Mazur et al. (1979) as the most cited. The Journal of Bone and Joint Surgery published the most articles (N=26), with the USA leading in research output (N=31). Research activity increased in the 1990s and 2000s, with most studies being observational (92%) and Level IV evidence (34%) prevailing.

Conclusion: This analysis highlights influential studies and research gaps, emphasizing the need for high-quality clinical trials to refine surgical techniques and improve patient outcomes in ankle arthrodesis. Future research should focus on robust methodologies and long-term functional outcomes to advance ankle arthrodesis practice.

Background: Osteogenesis Imperfecta (OI) is a rare genetic bone disorder that has attracted increasing scientific attention. Bibliometric analysis offers insights into the intellectual structure and evolution of this field. This study aimed to identify and evaluate the most highly cited articles on OI to highlight influential contributors, leading journals, and major research trends.

Methods: A bibliometric search was conducted in the Web of Science Core Collection using the terms "Osteogenesis Imperfecta" and "Brittle Bone Disease." The search was restricted to English- language original and review articles published between 2000 and 2024. The 50 most cited articles were selected and analyzed based on citation metrics, journal impact factors, author contributions, institutional affiliations, and collaboration patterns. Statistical analyses were performed using SPSS version 25.0.

Results: The United States produced the highest number of publications, followed by the United Kingdom and Germany. The most cited article, published by Rauch et al. (2004), received 950 citations. The Journal of Bone and Mineral Research and The American Journal of Human Genetics were the most prolific journals in this domain. Observational studies and genetic investigations dominated the top-cited works. Collaboration networks revealed strong interconnections among North American and European institutions, while keyword analysis highlighted growing research interest in gene therapy, molecular diagnostics, and precision medicine.

Conclusion: This bibliometric analysis identified the most influential contributions in OI research, underscoring the role of key authors, journals, and international collaborations. It also revealed major trends in genetic and clinical studies while highlighting emerging areas such as gene therapy and precision medicine as promising directions for future research.

Background: Anterior cruciate ligament (ACL) injuries often require surgical intervention. The use of the peroneus longus tendon in ACL reconstruction has been reported to offer significant potential benefits, such as preserving the hamstring tendons. However, its effects on the ankle must be considered prior to surgery.

Methods: This was a cross-sectional study evaluating ankle morbidity using the American Orthopedic Foot and Ankle Society (AOFAS) score, plantarflexion and eversion strength, and Clarke's angle on both extremities. Data were collected from patients who underwent ACL reconstruction using the peroneus longus tendon as an autograft. Statistical analysis was performed using the Mann-Whitney test with SPSS v.26.

Results: A total of 64 patients were included, with the mean AOFAS scores of 58.88 (donor side) and 70.12 (contralateral side). Mann-Whitney test results showed no significant difference in AOFAS scores between the two sides (p=0.085). The mean plantarflexion strength values were 62.23 (donor) and 66.77 (contralateral), with no significant difference (p=0.489). Additionally, the mean Clarke's angle values were 59.10 (donor) and 69.90 (contralateral), with no significant difference (p=0.099).

Conclusion: There was no statistically significant difference in ankle function in patients who used the peroneus longus tendon as an autograft in ACL reconstruction.

Background/objectives: Femoral and tibial shaft fractures are among the most common long bone fractures. This study aims to assess and compare the economic impact of these two approaches by evaluating: direct costs (implant pricing, instrumentation and operating room expenses) and indirect costs (complication rates and reoperation expenses).

Methods: This study is a comparative cost-analysis study aimed at evaluating the financial burden of stocking an orthopaedic theatre with IM nails versus locking rods used for the treatment of femoral and tibial shaft fractures. The analysis will focus on the costs associated with the procurement; storage and utilization of these implant systems, using publicly available data, manufacturer pricing and relevant industry reports.

Results: In this comparison, IM nailing is slightly more expensive than treating the same fractures by universal locking rod systems with the cost difference ranging between $3,473and$ 5,846. The main contributors to the cost difference include the slightly higher surgical time for IM nailing, as well as higher staffing and operating room costs in addition to higher complication rates reported.

Conclusions: While universal locking rods may have a higher upfront cost, they can reduce hospital inventory needs through their innovative designs which can potentially lead to long term cost savings, as one system can accommodate a bigger range of fractures.

Osteoarthritis (OA) is a degenerative joint disease characterized by cartilage erosion, synovial inflammation and pain. Accumulating evidence demonstrates that deubiquitinating enzymes (DUBs) are critical regulators of OA pathogenesis through their ability to rescue key proteins from proteasomal degradation. Among them, USP7 stabilizes NOX4 to amplify ROS-NLRP3-dependent pyroptosis and cartilage catabolism; USP15 deubiquitinates ERK2 and SMAD2 to enhance TGF-β signaling and chondrocyte anabolism; USP13 sustains PTEN and IL-1R8/Sigirr to restrain PI3K/AKT/NF-κB-mediated inflammation and oxidative stress; USP3 and USP49 block TRAF6 ubiquitination and Wnt/β-catenin signaling to attenuate chondrocyte senescence and apoptosis; USP5 and USP14 promote NF-κB activation by stabilizing TRAF6 or deubiquitinating IκBα, driving chondrocyte dedifferentiation and matrix metalloproteinase expression. Pre-clinically, small-molecule USP7 inhibitors (P22077), USP14 inhibitors (IU1) and genetic silencing of USP15 or USP49 have all been shown to reduce cartilage loss and inflammatory pain in mouse OA models. Collectively, these findings establish DUBs as druggable nodes in OA and underscore the need for selective inhibitors that can safely modulate ubiquitin-dependent protein turnover in human joints.However, DUB research remains nascent, requiring further validation of their clinical efficacy and safety. This review elucidates DUB-mediated mechanisms in OA and discusses challenges in developing selective DUB inhibitors for future therapies.

This article documents the influence of treatment history on the success of hip arthroplasty. To prove this, we present the results of a study of a hip endoprosthesis that failed unusually. Intensive damage of the endoprosthesis head made of cobalt alloy was observed, which resulted in advanced metallosis of the tissues surrounding the implant. Macroscopic and microscopic studies combined with EDS analysis were carried out. An X-ray analysis of the endoprosthesis acetabulum was performed using computed tomography and a 3D scan of the endoprosthesis head. The tests showed that the primary wear mechanism of the endoprosthesis head was the abrasive wear caused by the hard particles of porous alumina bioceramics, which were embedded in the polyethylene acetabulum due to the forces acting on the joint. In our examined situation, the particles were immovably affixed to the polyethylene insert, escalating headwear. Alumina bioceramics were used as a tissue engineering element in the patient's previous treatment. The presented results have great practical significance, as they indicate that great care should be taken when using polyethylene components, especially in cases where previous surgeries involved using porous bioceramics to fill damaged bone fragments. This study's findings can potentially improve the long-term success of hip arthroplasty.

Purpose: The purpose of this systematic review is to explore strategies for preventing phantom limb pain in amputated patients. Given the complex mechanisms of peripheral and central sensitization underlying phantom limb pain and the limited effectiveness of current pharmacological and non-pharmacological treatments, prevention is critical to reducing its impact on patients' quality of life and treatment burden.

Methods: Through a comprehensive search from four databases about the prevention of phantom limb pain, 1781 articles published between 2014 and 2024 were identified. Human studies that measured the association between preventive methods for phantom limb pain were considered eligible. The inclusion criteria of the literature were (1) prevention/ prophylactic treatment of phantom limb pain among amputees, (2) publication within the last 10 years, (3) randomized controlled trial or cohort, and (4) study written in English. Animal studies were excluded from this analysis.

Results: Four randomized controlled trials and one cohort were included in this study. To prevent phantom limb pain, various approaches can be taken, both operative and non-operative. Surgery involving a combination of peripheral nerve coaptation, collagen nerve wrapping, and submuscular transposition, when compared to neurectomy alone, has demonstrated satisfactory results. In the non-surgical method, the administration of dexmedetomidine and calcitonin as an epidural injection, oral gabapentin, and mirror therapy gave good results.

Conclusions: A preventive approach to phantom limb pain, in terms of surgical and non-surgical methods, might reduce the incidence of phantom limb pain and increase the quality of life among amputees.

Anterior cruciate ligament (ACL) avulsion fracture is an uncommon injury in the pediatric population, typically involving a bony avulsion at the tibial insertion of the ligament. Diagnosis is usually established on plain radiographs, particularly in the lateral view, and further characterized by magnetic resonance imaging (MRI). Treatment may be conservative or surgical, depending on the degree of displacement and rotation of the bony fragment according to the Meyers and McKeever (MM) classification, as well as the presence of associated soft-tissue injuries. However, the optimal management of Type II fractures remains debated, making individual case reports valuable to guide clinical decision-making. We report the case of a five-year-old child with a Type II MM ACL avulsion fracture managed successfully with conservative treatment. The patient was immobilized in extension with a long leg cast for 30 days, and follow-up imaging demonstrated complete healing without complications. At two-year follow-up, clinical examination confirmed full recovery with a stable knee and no residual laxity. This case emphasizes that, in the absence of concomitant intra-articular lesions on MRI, conservative management can represent a safe and effective option for Type II ACL avulsion fractures in very young patients.