Orthopedic Reviews最新文献

Background: Non-unions are one of the major challenges that orthopaedic surgeons must face. Vascularized bone transplants are widely used to treat these bony defects.

Objectives: The aim of this systematic review and meta-analysis was to investigate whether venous anastomosis in the bone-only graft increases the survival rate of the flap.

Methods: We conducted this review in accordance with the PRISMA guidelines. PubMed, Embase, and the Cochrane Library were systematically searched from the inception through January 2025. Studies reporting results about bone graft performed with microsurgical anastomosis of both vein and artery and studies reporting the results of bone graft with only arterial anastomosis were selected and compared. Data quality was assessed using the Newcastle-Ottawa Scale (NOS).

Results: The literature search yielded 1.140 papers, but only 26 papers were included in the systematic review. Heterogeneity was high, so a subgroup analysis was performed. Twenty papers dealt with only arterial anastomosis with a pooled failure rate at 4.5%. On the other side, six papers reported both vein and artery anastomosis with a pooled failure rate at 1.6%. The subgroup analysis of the papers in which venous anastomosis was made, however, did not allow to demonstrate that the venous anastomosis is truly protective (p = 0.3133).

Conclusion: Bone vascularized grafts are an indispensable therapeutic technique. The results of this review are not definitive about the role of the venous anastomosis, but it is not possible to exclude its protective role on the transplant survival. More targeted studies are essential to confirm it.

Introduction: Gluteus medius tendon (GMT) tears are a widely recognized source of lateral hip pain and weakness. While surgical repair often leads to symptom relief, outcomes are less favorable in cases involving chronic or high-grade tears. To improve healing, a variety of biologic augmentation strategies have been explored, including platelet-rich plasma (PRP), platelet-rich fibrin matrix (PRFM), collagen patches, dermal allografts, synthetic scaffolds, and bone marrow aspirate concentrate (BMAC). However, their effectiveness remains uncertain.

Objective: To systematically review published clinical outcomes associated with different biologic augmentation techniques used in GMT repair.

Methods: A systematic literature search was conducted through PubMed, Cochrane Library, and Embase for studies published between 2000 and 2025 reporting on the surgical repair of GMT tears with biologic augmentation. Data extracted included study design, type of biologic intervention, and postoperative clinical and imaging outcomes.

Results: A total of four studies comprising 123 hips were included, and all studies reported improvements in patient reported outcomes following surgical repair. However, the two available comparative studies found no significant differences in pain or function between augmented and unaugmented repairs. Case series of collagen patch augmentation demonstrated favorable structural healing in early clinical outcomes, while synthetic mesh combined with muscle transfer showed improvement in patients with irreparable tears.

Conclusion: While biologic augmentation in GMT repair appears safe and technically feasible, more data needs to be published relative to the results obtained with commonly used orthobiologic augmentation to determine if and under what circumstances such treatment provides consistent clinical advantage over standard repair.

Purpose: Revision surgery is widely recognized as the main performance index for Total Joint Arthroplasty (TJA). Whereas long-term revision rate is used for measuring implant durability, "early revision" is still not clearly defined, with timeframes ranging from 3 to 6 months until 2 or even 3 years used in the literature. Aim of this work is to review the current literature specifically related to "early" revisions, in order to provide an overview over reasons for early revision surgery.

Methods: Because of lack of definitions, a narrative review approach was chosen. Literature review of articles published within the last 10 years retrieved 254 articles. After applying exclusion and inclusion criteria, 55 publications were analysed. An accepted standard for narrative review was used.

Results: The analysed articles showed a marked heterogeneity in reported timeframes for early revision, but we found values labelled as "early" between 1 month and 5 years. 3-months revision rates ranged between 0.5% - 1.5% for total hip arthroplasty (THA), and were approximately 0.5% for total knee arthroplasty (TKA) for all causes. 5-year revision rates were between 2% - 4% for THA and between 3% - 5% for TKA for all causes. Furthermore, we found that the heterogeneity for the applied time definitions in early revisions do not allow a direct comparison for all-cause revision procedures.

Conclusions: Similarly to long term revision results, there is heterogeneity in short term revision results. It can be useful to take into account homogenous groups when comparing early revision outcomes, for example among same reason for revision. Moreover, several paper contributions suggested a significant dependence on modifiable patient characteristics at primary procedure.

Myxedema coma is a rare, life-threatening complication of severe, long-standing hypothyroidism, often precipitated by physiological stress such as infection, trauma, or surgery. Perioperative presentations of myxedema coma are especially uncommon. This case report describes a 71-year-old male with a history of poorly controlled hypothyroidism who underwent emergent surgical fixation of a traumatic left intertrochanteric femur fracture who developed intraoperative myxedema coma. Timely diagnosis and intervention-including intravenous thyroid hormone replacement, corticosteroids, hemodynamic support, and close anesthetic management were crucial to optimizing the patient's outcome. This report highlights the critical role of anesthetic management in myxedema coma cases, emphasizing the importance of endocrine and hemodynamic support. Furthermore, it promotes multidisciplinary coordination when managing endocrinological emergencies in high-risk surgical patients.

Acute Diabetic Charcot Arthropathy (ADCA) is a severe complication of diabetes mellitus in patients with peripheral neuropathy, often misdiagnosed due to its similarity to cellulitis or deep vein thrombosis. This review examines ADCA's pathophysiology, emphasizing early diagnosis to prevent progression. We explore the roles of inflammatory cytokines (TNF-α, IL-1β, IL-6) in bone loss and joint degeneration, and investigate potential biomarkers and therapeutic targets in Wnt and IL-17 signaling pathways. The impact of metabolic imbalances and comorbidities on ADCA development is also discussed. Our analysis reveals ADCA's complex, multifactorial nature, involving neuropathy, inflammatory responses, and metabolic dysregulation. A comprehensive management approach aimed at achieving a stable, ulcer-free foot is essential to improve patient mobility and quality of life. We conclude that early intervention is crucial, focusing on reducing stress on affected regions in inflammatory stages. This is achieved by highlighting and implementing the advances in clinical practice, integration of recent research, education of patients on the importance of early intervention alongside developing improvements to current treatments.

Introduction Ischial tuberosity apophyseal avulsion fractures (ITAFs) are rare injuries occurring primarily in adolescent males. ITAFs are typically caused by a strong eccentric hamstring contraction that avulses the ischial apophysis before it is fully fused. However, there is currently no consensus on its therapeutic paradigm. Case Presentation A 13-year-old male presented with posterior thigh pain after a twisting injury. On exam, he had ischial tenderness, limited hip flexion, and lower extremity paresthesias. Imaging revealed a proximally displaced ischial tuberosity apophyseal avulsion fracture. Management and Outcomes He underwent open reduction and hybrid fixation with suture anchors and a cannulated screw, and sciatic nerve neurolysis. Postoperatively, neurologic symptoms resolved, and he resumed full activity within five months. Conclusion This case demonstrates the successful and novel use of hybrid fixation for a displaced ITAF with neurologic symptoms. Hybrid fixation provides a stable repair, enabling a safe and timely return to sports for adolescents.

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.