Orthopedic Reviews最新文献

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.

Background: Sacroiliac joint (SIJ) dysfunction is a frequently underdiagnosed contributor to chronic low back pain. Although fluoroscopic-guided SIJ injections remain the gold standard for both diagnostic and therapeutic purposes, their availability may be limited by insurance barriers or logistical constraints. In such cases, alternative approaches such as ultrasound-guided or landmark-based injections may offer practical, rapid solutions in outpatient settings. This case series aims to compare outcomes between landmark-based and fluoroscopic-guided SIJ injections in patients presenting with clinical findings suggestive of SIJ-related pain.

Methods: Ten patients with suspected SIJ-related pain were identified based on a positive Fortin's Finger Test and FABERs examination. Five patients underwent landmark-based SIJ injections, performed by palpating the posterior superior iliac spine (PSIS) and directing the needle slightly inferior to this landmark. The remaining five patients received fluoroscopic-guided SIJ injections using standard imaging protocols. All injections consisted of 2 mL of 0.25% bupivacaine combined with 40 mg of triamcinolone. Pain relief was assessed at a 2-week follow-up using patient-reported percentage improvement.

Results: Among patients who underwent landmark-based injections, reported pain relief at two weeks was 50%, 40%, 50%, 90%, and 50%, with an average relief of 56%. In contrast, patients receiving fluoroscopic-guided injections reported pain relief of 80%, 50%, 75%, 100%, and 75%, with an average relief of 76%. No procedural complications were reported in either group.

Discussion: Fluoroscopic-guided SIJ injections were associated with greater and more consistent pain relief at short-term follow-up. However, landmark-based injections provided meaningful clinical benefit in the majority of patients and may serve as a practical option when immediate intervention is needed, particularly when imaging resources are unavailable or delayed due to insurance approval. The absence of complications in either group supports the relative safety of both approaches when performed by trained interventionalists. Notably, we maintain that fluoroscopic-guided injections remain the gold standard and should be utilized to confirm sacroiliac joint pain or when assessing patients for potential advanced interventions.

Conclusion: While fluoroscopic guidance offers superior accuracy and therapeutic efficacy for SIJ injections, landmark-based techniques can be a viable solution in specific clinical scenarios. Fluoroscopic-guided injections remain the gold standard and should be utilized to confirm sacroiliac joint pain or when assessing patients for potential advanced interventions.

Pancoast tumors are a rare form of non-small cell lung cancers located in the lung apex invading thoracic inlet structures and surrounding tissues. This case focuses on a 71-year-old male smoker who presented with chronic neck pain and weakness in his right arm. Imaging revealed a mass in the right lung apex that had spread to the ribs, vertebrae, and brachial plexus. A biopsy confirmed squamous cell carcinoma. Initial treatment includes chemoradiation, especially in cases where surgical resection is not recommended due to invasion of critical structures. Early recognition is crucial to avoid disease progression and to initiate appropriate oncologic management. This case emphasizes the need to consider Pancoast tumors in patients with ongoing neck and upper limb neurological symptoms, even if they do not have respiratory issues, to ensure quick diagnosis and treatment.

Background: Although less common of a procedure than knee or hip arthroplasties, shoulder arthroplasties are an important procedure. As with all arthroplasties, shoulder arthroplasties are associated with complications The present research aimed to investigate subject characteristics and complications in shoulder arthroplasty research using a bibliometric approach. # Methods Publications related to shoulder arthroplasty and complications in the last 20 years from 2006 to 2025 were searched in the Web of Science database. VOSviewer, a free visualization software, was used to analyze the results. # Results Bibliometric analysis revealed 3735 records. The United States contributed the highest number of publications, followed by France and Germany. The most relevant institutions were the Mayo Clinic in Rochester. Minnesota and the Hospital for Special Surgery in New York City. The most productive journal was the Journal of Arthroplasty. The top keywords include "complications" with 753 occurrences, "arthroplasty" with 526 occurrences, "outcomes" with 463 occurrences, and "prosthesis" with 385 occurrences.

Conclusion: The current study observed an increasing trend of research papers in shoulder arthroplasty complications. Institutions from the United States were found to dominate the field. An increase in clinical research and information about rehabilitation strategies following shoulder arthroplasties will prove to be advantageous for trainers, physicians, and orthopaedic surgeons alike.

Objective: The authors investigate predictors of morbidity and mortality in patients after fall-related Traumatic Brain Injury (TBI) in a retrospective cohort study of patients presenting to a single emergency department.

Methods: This study analyzed the predictors of a subset of patients who come to the emergency department (ED) of a Level 1 trauma center who sustained a TBI after a fall. The study also examines the utility of head Computed Tomography (CT) scan as a predictor in determining outcomes such as hospital admission, in-hospital death, and Intensive Care Unit (ICU) admission. Demographic variables such as age, sex, race, and marital status, as well as symptoms associated with the TBI injury such as seizures, vomiting, loss of consciousness (LOC), post-trauma amnesia (PTA), alteration of consciousness (AOC), were all variables included in the multivariate model. Statistical analysis was conducted in JMP Pro 17 for the Macintosh.

Results: The cohort was composed of 1439 patients, of which 833 (57%) patients were male. The median Glasgow Coma Scale (GCS) score for the cohort was 15, and 87% of the patients experienced mild TBI. Statistically significant predictors of in-hospital death, both in the presence and absence of abnormal head CT in the multivariate model, were age in years, loss of consciousness, and diastolic blood pressure. Predictors that were statistically significant for hospital admission both in the presence and absence of abnormal head CT in the multivariate model were loss of consciousness, age in years, and patient diastolic blood pressure. Finally, predictors for ICU admission that were significant in the presence and absence of abnormal head CT in the multivariate model were GCS score and loss of consciousness.

Conclusion: The presence of an abnormal head CT increased the R2 value in all 3 of the outcomes of in-hospital death, hospital admission, and ICU admission. This suggests that a head CT of the patient plays an important role in predicting various health outcomes, emphasizing the importance of early interventions.