Orthopedic Reviews最新文献

Background: Femoral intramedullary screw fixation is widely performed to stabilize femoral fractures. Although uncommon, postoperative acute kidney injury (AKI) and dialysis are serious complications associated with increased morbidity and mortality. This study aimed to identify predictors of AKI and postoperative dialysis following femoral intramedullary screw fixation.

Methods: We utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patients undergoing femoral intramedullary screw fixation (CPT 27506) between 2018 and 2022. Predictors examined included demographic variables, comorbidities, preoperative laboratory values, ASA class, operative duration, and anesthesia type. Univariate analyses were performed, followed by multivariate logistic regression to determine independent risk factors for AKI and postoperative dialysis. Statistical significance was set at α = 0.05.

Results: A total of 63,734 patients were analyzed. Univariate predictors of AKI and postoperative dialysis included renal failure, elevated blood urea nitrogen, general anesthesia, hypertension, male sex, advanced age, decreased hematocrit, higher ASA class, diabetes, elevated BMI, and longer operative time. Multivariate logistic regression identified the following independent predictors: pre-existing renal insufficiency (p < 0.0001), elevated blood urea nitrogen (p < 0.0001), use of general anesthesia (p < 0.001), hypertension (p < 0.0001), male sex (p < 0.0001), older age (p < 0.001), decreased hematocrit (p < 0.001), ASA class III and IV (p = 0.0013, p = 0.0229), diabetes (p = 0.0038), and increased BMI (p = 0.0043).

Conclusion: This study identifies significant independent predictors of AKI and postoperative dialysis in patients undergoing femoral intramedullary screw fixation. Preoperative risk stratification incorporating these factors may improve perioperative planning and reduce adverse renal outcomes.

Lateral patellar dislocation (LPD) is a common knee joint sports injury in adolescents, with an incidence increasing year by year. Medial patellofemoral ligament reconstruction (MPFLR), as the mainstream surgical method for treating LPD, achieves favorable clinical efficacy and significantly reduces the redislocation rate. However, controversies remain regarding patients' return to sport (RTS) level, especially when combined with complex bony surgeries, where RTS outcomes are poorer. This review systematically evaluates the impact of different surgical strategies (isolated MPFLR and MPFLR combined with various bony surgeries) on RTS levels and explores the key role of psychological factors in RTS. It aims to provide references for optimizing clinical treatment strategies and formulating individualized RTS protocols.

Introduction: Busch-Hoffa fractures are rare, particularly in the pediatric population, with limited available literature. As it is an inherently unstable fracture and as the posterior femoral condyle is prone to non-union, correct and adequate treatment of the fracture is critical but challenging.

Objective: This study aims to (1) systematically review the literature on pediatric Busch-Hoffa fractures, and (2) present a rare case of a lateral Busch-Hoffa fracture with a bucket-handle lateral meniscus tear and popliteus tendon incarceration in a pediatric patient.

Methods: A systematic review was performed in February 2025 using PubMed/MEDLINE, identifying English-language articles on Busch-Hoffa fractures in patients aged ≤16 years. PRISMA guidelines and quality assessment tools were applied.

Results: A literature search identified 20 cases, predominantly occurring in males (66.7%) with an average age of 11.35 years. Falls and motor vehicle accidents were the most common mechanisms of injury. Open reduction and internal fixation was performed in 85% of cases, with generally favorable outcomes. Three cases presented with a concomitant osseous injury and two were associated with a soft tissue injury.

Conclusion: Although rare, pediatric Busch-Hoffa fractures must not be overlooked. Existing literature is sparse and consists primarily of case reports. Given the high risk of instability and non-union, surgical fixation remains the preferred treatment. Our case contributes to existing literature by presenting a unique combination of Busch-Hoffa fracture with significant soft tissue involvement, underscoring the role of arthroscopy in assessing and managing concomitant injuries.

With advancements in Left Ventricular Assist Devices (LVAD) technology, patients supported by LVAD are pursuing non-cardiac surgeries at a higher rate. This study is the largest retrospective case series to date to examine orthopedic surgery outcomes in this patient population. # Case Presentation From January 1, 2012, to December 31, 2022, there were 40 patients with LVAD who underwent 47 orthopedic surgeries at a Level II Trauma Center. The type of orthopedic procedure, time since LVAD implantation, length of hospital stays, blood loss, need for transfusion, postoperative thromboembolic events, and discharge destination were evaluated. # Management and Outcomes Orthopedic surgery in LVAD patients appears to have longer lengths of hospital stay, greater need for blood transfusion, higher emergency department visits, higher readmission rates, and a greater need for rehabilitation assistance. # Conclusion Orthopaedic surgery in patients with LVAD appears riskier, however, it is possible and may be necessary, optimization and collaborative inter-disciplinary care is paramount to success.

Aortic dissection is a life-threatening condition that deteriorates rapidly following onset. Factors such as uncontrolled hypertension, hyperlipidemia, and genetic factors contribute to the development of the condition. This case report covers the history, presentation, and treatment of a 66-year-old male with a Stanford Type A aortic dissection. This case highlights the urgency of the condition and the cruciality of teaching recognition and prompt treatment to maximize patient survival.

Chronic pain involving both the spine and visceral organs can present significant treatment challenges, especially in patients refractory to pharmacologic and interventional modalities. We report a case of a male in his late 50s with chronic axial lumbar pain due to degenerative disc disease and spondylosis, in combination with severe abdominal pain related to chronic pancreatitis. The patient failed multiple conservative treatments, including systemic medications and targeted nerve blocks. Ultimately, a spinal cord stimulator (SCS) was implanted with leads positioned at T5-T7 to capture both pain regions. The patient reported substantial improvement in both axial and abdominal pain, along with reduced opioid use. This case highlights the potential role of neuromodulation in managing complex, multifocal chronic pain syndromes.

Background: Post-traumatic elbow stiffness in adolescents is a complex challenge that requires individualized treatment approaches. While open arthrolysis remains the most commonly used technique, arthroscopic techniques have emerged as a promising alternative with potential advantages in this younger population. This narrative review aims to emphasize the advantages of arthroscopic arthrolysis over the open approach in the adolescent patient. In addition, we explore how differences in etiology, diagnostic evaluation, and treatment response between adolescents and adults influence decision-making and outcomes.

Methods: A narrative review of the current literature on post-traumatic elbow stiffness in adolescents was conducted. Clinical studies, previous reviews, and recent advancements were analyzed. Clinical examples from our center were also presented.

Results: Arthroscopic arthrolysis was associated with improved range of motion, faster recovery, and lower complication rates in selected patients. However, open arthrolysis remains superior in cases with severe deformity, heterotopic ossification, or prior surgical history. In our experience, the indications for arthroscopic arthrolysis can be expanded when performed by experienced surgeons.

Conclusion: Even though open arthrolysis remains the gold standard for complex elbow stiffness, arthroscopic approaches show promising outcomes in adolescents and could be used more widely in centers with sufficient expertise.

Background: Isolated radial head dislocation in children is a rare injury, often resulting from trauma or associated with complex elbow conditions like Monteggia fracture-dislocations. Its low incidence can lead to missed diagnoses, potentially causing long-term complications such as pain, stiffness, and functional impairment. Early recognition and intervention are essential.

Case presentation: A 7-year-old girl presented with persistent left elbow pain and limited motion three weeks after a fall on her outstretched hand. Initial treatment at a local facility misdiagnosed it as a soft-tissue injury. Radiographs revealed anterior radial head dislocation without fractures. Closed reduction failed, leading to open reduction and annular ligament reconstruction using a modified Bell-Tawse technique. Postoperative fixation and rehabilitation followed.

Conclusion: At 5-year follow-up, the patient achieved near-complete functional recovery with minimal pronation limitation. This case underscores the importance of thorough radiographic assessment in pediatric elbow trauma and demonstrates successful outcomes from surgical intervention in delayed presentations.

A comprehensive review of device-related complications from cylindrical lead spinal cord stimulator (SCS) implants was previously published. [1] Although SCS remains a minimally invasive treatment for neuropathic pain, hardware-related problems such as lead migration, lead fracture, lead disconnection, generator malfunction, loss of charge, generator flipping, pocket pain, and paresthesia intolerance are reported more often than biologic complications. [1,2] Understanding these issues, their clinical presentations, diagnostic evaluation, and management strategies is critical for long-term outcomes. This infographic was designed to present the key findings of the review in a clear and accessible visual format.

Background: Talus osteoarthritis (OA) is a disabling condition that negatively affects the lives of individuals in terms of pain, functional limitation. Hydrogels, due to their viscoelastic, bioactive, and biocompatible properties, have emerged as a promising therapeutic option in cartilage repair and OA management. Currently hydrogel applications in other joint OA such as knee are extensively studied, while their use in talocrural joint degeneration remains underexplored. This systematic review aims to analyze the uncertainty in the effectiveness and safety of hydrogel-based therapies in the treatment of talus OA.

Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Embase, Scopus, Web of Science, and the Cochrane Library from 2015 up to 2025. Eligible studies included case series, cohort and randomized clinical trials investigating hydrogel implementation for talus OA. Data extraction and risk of bias assessments were independently performed by two reviewers. Thematic synthesis was applied due to heterogeneity in study designs.

Results: Preliminary screening identified 5 relevant studies. Hydrogel types included hyaluronic acid derivatives. Outcomes assessed included pain scores, joint function and imaging-based structural changes.

Conclusion: Hydrogel-based therapies represent a promising joint-preserving option for talus osteoarthritis, offering potential cartilage support and symptom relief. However, current evidence remains limited. Larger, well-designed clinical trials with standardized outcome measures are essential to validate efficacy and refine formulations tailored to the unique biomechanics of the ankle joint.