Orthopedic Reviews最新文献

Background: Rotator cuff injuries are very common in the athletic population and both corticosteroid injections and platelets enriched plasma (PRP) are common management options used in clinical practice yet there aren't any recent systematic reviews that compare between the two, thus, this study aims to provide a high-quality systematic review of the clinical trials and the experimentation found in the literature as of yet to guide practitioners in choosing between these two management options.

Methods: This systematic review was conducted in accordance to PRISMA guidelines and was registered in PROSPERO (CRD4202461663). A comprehensive search was done in the following databases MEDLINE, Web of Science, Google Scholar. The included studies were comparing Platelet Rich-Plasma with Corticosteroid injections for rotator cuff injuries for Adult patients that struggled with the injury for more than three months. The measurements that were used to determine the outcomes were: pain (VAS score) and functional scores (e.g Constant-Murley, ASES, SST).

Results: Pain reduction (VAS score) PRP showed to be somewhat better in the short term but had similar scores to corticosteroids on the remaining time marks, with the difference between them being insignificant, also, PRP showed to be more effective than Corticosteroids in improving function, particularly as time went on, the difference became more apparent (at 3-6 weeks, the mean difference was -3.97, after 24 weeks, it became 9.85 Constant-Murley).

Conclusion: When comparing between corticosteroids and PRP, there is no significant difference between them regarding pain reduction, yet, PRP has proven its effectiveness over the long-term for functional improvement, and which means that it could see more clinical use provided that it is cost-effective, yet more research is required to reach a final judgment and thorough evaluation due to the heterogeneity found in the studies.

Introduction/background: Complex articular fractures around the knee in the elderly patient present an ongoing challenge regarding optimal treatment. While extensive research has evaluated immediate arthroplasty following fracture of the proximal femur, distal femur, proximal humerus, and elbow, relatively little focus has been given to immediate arthroplasty following complex tibia plateau fractures.

Methods: As seen with many other fractures, arthroplasty can shorten recovery and hospital stay and allow early weight-bearing with improved mobility while minimizing complications and possible future conversion arthroplasty cost. Notably, total knee arthroplasty (TKA) in the setting of post-traumatic arthritis has demonstrated worse outcomes when compared to TKA for osteoarthritis. Further, increased complication rates have been reported when TKA is performed following failed open reduction internal fixation compared to TKA for acute fracture.

Conclusion: Potential candidates for acute arthroplasty include the elderly patient with pre-existing degenerative joint disease, poor bone quality, complex articular fractures, inability to comply with weight-bearing restrictions, and cases where additional procedures may be poorly tolerated. When choosing arthroplasty, the principles of revision joint arthroplasty and implant selection remain critical. Meticulous preoperative planning, multidisciplinary perioperative management, and a well-executed technique are essential when performing arthroplasty for acute tibial plateau fractures in the elderly.

Sports-related musculoskeletal injuries are common and represent a significant public health concern, especially among physically active individuals. These injuries are typically managed through pharmacological methods such as pain medication or through rehabilitative approaches like physical therapy (PT). While both modalities are widely used, their comparative effectiveness in promoting long-term recovery, particularly from the perspective of those injured, remains a critical area for research. # Objectives The objective of this study is to evaluate the relative effectiveness of PT and pain medication in managing sports-related injuries. Specifically, it explores pain relief outcomes, long-term recovery perceptions, and treatment preferences among individuals with prior sports injuries, using a patient-reported survey approach. # Methods This cross-sectional survey-based study involved 200 participants who had experienced a sports-related injury. Inclusion criteria for the study included being at least 18 years of age, having sustained an injury related to physical activity, and having undergone treatment involving either pain medication, physical therapy (PT), or a combination of both. Participants provided information on injury types, pain intensity immediately following the injury (measured on a 5-point Likert scale), treatment approaches, treatment duration, and their perceptions of long-term effectiveness. Data analysis was performed using JMP Pro 15. # Results The participant population, totaling 200 individuals, consisted of 99 males (49.5%) and 101 females (50.5%), with a median age of 36.5 years (range 18-88). The most frequently reported injuries were sprains (33%) and muscle strains (20%). Regarding treatment, 50% of participants used a combination of pain medication and PT, 38% relied solely on pain medication, and 12% underwent only PT. A majority (59%) rated their initial pain as severe (≥4/5). Among those treated with pain medication, 65% experienced pain recurrence once the medication's effects subsided. In contrast, 73% of PT users agreed or strongly agreed that PT provided long-term injury resolution. Additionally, 68.2% of participants who utilized both treatments indicated that PT was more effective for sustained recovery.

The anterior cruciate ligament (ACL) of the knee is commonly injured and can lead to joint instability. ACL reconstruction (ACLR) is often required as endogenous healing is limited and the stability provided by dynamic stabilisers is insufficient for complete joint function. A graft, comprising either biological tissue or synthetic material, is used to replicate the biomechanical and structural properties of the native ACL to restore function. Autografts, particularly the quadruple semitendinosus/gracilis tendon (QSGT) and bone-patellar tendon-bone (BPTB), are commonly preferred. However, autograft harvesting can lead to donor site morbidity. Allografts and synthetic grafts avoid this issue but present other complications such as immune response and inflammation. Graft choice is one of several factors influencing ACLR outcomes; fixation method, physiotherapy, and patient-specific variables also play key roles. This review evaluates the current literature on ACLR graft types and highlights distinguishing features.

Background: Achilles tendon ruptures are common, particularly in active individuals, and significantly affect function. Controversy persists over whether conservative or surgical treatment offers superior outcomes.

Objective: To compare conservative and surgical treatments for Achilles tendon rupture regarding rerupture rates, functional recovery, and complication incidence.

Methods: A systematic review was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing conservative and surgical treatments published between 2015 and 2025 were selected using MEDLINE. Risk of bias was assessed using Cochrane RoB 2.0.

Results: Eight RCTs were included. Conservative treatment showed a higher rerupture rate but fewer complications. Surgical treatment, while reducing rerupture, increased risks of nerve injuries and infections. Long-term functional outcomes were generally comparable between groups.

Conclusion: Neither approach proved universally superior. Surgical repair may be preferred to prevent rerupture, but conservative treatment avoids operative complications. Clinical decisions should consider individual factors such as age, activity level, and patient preferences.

Periprosthetic joint infection (PJI) is a severe and challenging complication following joint replacement that significantly impacts patient outcomes and implant longevity. Various factors contribute to PJI onset, including patient-related comorbidities and surgical procedures. Preventive strategies are categorized into preoperative, perioperative, and postoperative measures. Preoperative risk factors can be classified as general or local. General ones include comorbidity management (metabolic disorder, rheumatic and inflammatory diseases), nutritional optimization, weight control, bacterial decolonization, and lifestyle modifications. Local factors involve avoiding intra-articular injections before surgery and assessing previous knee interventions, in addition to implementing preoperative physiotherapy and ensuring proper skin preparation. Preoperative patient optimization significantly improves outcomes following knee replacement by reducing PJI risk, as well as hospital stays and recovery times. Implementing standardized, evidence-based preoperative strategies can enhance surgical success and long-term implant survival. Multidisciplinary collaboration between surgeons, general practitioners, and healthcare providers is essential to minimize infection risks and improve patient outcomes following joint replacement. This paper focuses on preoperative optimization, highlighting evidence-based recommendations to minimize the risk of PJI in patients undergoing knee replacement.

Objective: Describe the clinical and paraclinical characteristics of the PIN syndrome and the result of the PIN entrapment release surgery. Subjects and methods: A case report.

Results: Posterior interosseous nerve entrapment is a rare condition. We report a case of an 18-year-old male patient with no records of medical history. Five months before being admitted to the hospital, the patient began to experience progressive weakness and paralysis in finger extension movements. The patient was diagnosed with posterior interosseous nerve entrapment syndrome and was indicated for nerve release surgery. During the surgery, we found that the patient's posterior interosseous nerve was compressed by the Leash of Henry and by the fibrous band of the supinator muscle at the Arcade of Frӧhse, where the interosseous nerve passes through the supinator. The posterior interosseous nerve was completely released at five most compressed sites, and the patient was discharged after one day with a follow-up appointment and scheduled rehabilitation sessions. After 4 months of surgery, the patient has partially regained the ability to extend their fingers.

Conclusions: Compression of the posterior interosseous nerve is a rare upper limb neurological condition with a very low incidence rate. The typical clinical feature of the disease is a gradual paralysis of fingers extension without loss of wrist extension. The disease is diagnosed through clinical examination and paraclinical. If the cause of compression is at the radial tunnel, the posterior interosseous nerve needs to be decompressed at five most compressed sites. Results of the surgery after 4 months have helped the patient partially regain the ability to extend their fingers, but further long-term monitoring is still needed.

Background: Frozen shoulder is a condition that causes pain, stiffness, and loss of range of motion. However, little is known regarding the need for intra-articular corticosteroid injections for this condition, as well as the association between known risk factors and the need for these injections.

Aim: To evaluate the relationship between known risk factors and the need for intra-articular corticosteroid injections in patients with adhesive capsulitis.

Methods: A retrospective cohort study was conducted to assess the association between risk factors for adhesive capsulitis and the use of intra-articular corticosteroid injections in patients treated between January and December 2022. All patients diagnosed with primary adhesive capsulitis were included. Comparative analysis between steroid users and non-users was performed using chi-square tests and linear model ANOVA variance, based on the data type and distribution. A binary logistic regression model was used to evaluate whether demographics and comorbidities predicted corticosteroid injection use.

Results: In total, 138 patients were diagnosed with primary adhesive capsulitis. Patients were divided into two groups according to the need for intra-articular corticosteroid injections. No statistically significant differences were found between the two groups regarding laterality, age, sex, hypothyroidism, hypertension, ischemic heart disease, diabetes mellitus, and other risk factors.

Consclusion: None of the investigated factors predicted the need for intra-articular corticosteroid injections. Further research is needed to explore other potential influences and improve treatment decision-making for adhesive capsulitis.

Background: Surgical training in the UK is under increasing pressure with a high demand for service provision. This raises concerns about the resultant negative impact this is having on training opportunities for surgical trainees in theatre due to a high demand for surgical procedures to be performed expediently by consultants. This is due to the assumption that trainee take significantly longer time to operate in theatre and thus result in a slow progress of theatre lists.

Objective: We evaluated the differences in operative time between orthopaedic trainees and orthopaedic consultants, as well as provided realistic timings for each stage encompassed within the entire duration a patient is in theatre.

Methods: From our trauma unit electronic theatre database, we retrospectively collected data for six Joint Committee of Surgical Training (JCST) mandatory procedures. Information collected included patients' ASA grading, total surgical time and grade of surgeons.

Results: A total of 956 procedures were reviewed, 71.8% hip procedures, 14.2% intramedullary nail fixations and 14.2% ankle fixations. 46.2% and 53.8% of the procedures were performed by consultants and trainees as first surgeon, respectively.

Conclusion: On average, consultants were found to be 13 minutes quicker in performing the hip procedures and this difference was found to be statistically significant (p < 0.05). However, trainees were found to be quicker in performing intramedullary femoral nailing and simple ankle fixations, but consultants were faster at performing intramedullary tibial nailing and complex ankle fixations. The differences were not found to be statistically significant (p > 0.05).

Introduction: Post-operative stroke following a total hip arthroplasty (THA) is relatively uncommon but remains a feared complication. This study completes both a univariate and multivariate analysis on independent conditions leading to postoperative stroke following THA.

Methods: The American College of Surgeons: National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for THA cases between 2017 to 2021 (CPT code 27130).Demographic, comorbid, diagnostic and preoperative laboratory values were investigated to decipher predictors of postoperative stroke. A statistical significance value of p<0.05 was used in evaluation.

Results: This analysis included 199,960 patients. In the initial univariate analysis for postoperative stroke, significant variables were age (p < 0.0001), and use of general anesthesia (p = 0.0249) and BMI (p = 0.0050). Diabetes (p = 0.7481), functional dependence (p = 0.8556), COPD (p = 0.6589), CHF (p = 0.9748), dialysis (p = 0.1136), and Frailty index (p = 0.8543) were not significant. The univariate variables age and general anesthesia remained significant in the multivariate analysis. However, upon removal of the frailty index due to its overlap with functional status, smoking status (p = 0.0210), and operation time (p = 0.0265) became statistically significant in the multivariate model.

Conclusion: This national cohort study found that the risk of postoperative stroke following total hip arthroplasty is associated with older age and having the procedure under general anesthesia in both univariate and multivariate analysis. When the frailty index was removed from analysis (due to its conceptual overlap with functional status), postoperative stroke after THA was also associated with smoking status and the duration of the operation.