Orthopedic Reviews最新文献

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.

A pathologic fracture is characterized as a break in the bone in an area that has been previously weakened by diseases such as pre-existing pathological bone lesions, due to which even minor falls and trauma may lead to fractures. This paper details a case of an otherwise healthy eight-year-old boy who presented to the ED with an injury to the right lower extremity which was later determined to be a pathological fracture. Imaging revealed the presence of a non-aggressive multicystic bone lesion. This case emphasizes the significance of identification and prompt diagnosis of instances of pathologic fracture, as they may arise as a result of serious underlying conditions such as malignant bone tumors.

Introduction: Chronic knee pain has seen a significant rise over the past two decades, leading to increased functional limitations, mobility challenges, and decreased quality of life. Peripheral nerve stimulation (PNS) is an alternative management approach for chronic knee pain across various conditions. PNS involves implanting an electrode near a targeted nerve to deliver electrical stimulation, which interrupts pain signals, providing pain relief. This study evaluates the effectiveness of a 60-day PNS system in treating chronic knee pain and includes a comparison to a control group receiving conventional medical management (CMM).

Methods: This retrospective database and chart review study aimed at evaluating the effectiveness of a 60-day PNS system for managing chronic knee pain. Data were sourced from the device manufacturer's database, which included treatment records from two experienced interventional chronic pain physicians. The analysis focused on patients treated with the 60-day PNS therapy for chronic knee pain. The patient population consisted of individuals who received the PNS therapy specifically for knee pain under the care of the two experienced interventional chronic pain physicians, ensuring consistency in treatment application. Additionally, a chart review of 12 patients with similar pain complaints treated with CMM during the same time period was conducted to serve as a comparison group. Responder status was defined as achieving ≥ 50% pain relief.

Results: Eighteen patients were identified who underwent PNS-therapy, and 94.4% (17/18) of the patients achieved ≥ 50% pain relief (responders) following the 60-day percutaneous PNS therapy. The weighted average of relief among responders was determined to be 82.3%. In the CMM control group, only 33.3% (4/12) of patients met the responder threshold, with an average relief of 61.3% among responders.

Conclusions: The study findings suggest that a 60-day percutaneous PNS targeting lower extremity nerves can effectively manage chronic knee pain. Further research is needed to determine the long-term efficacy of this treatment for various pain conditions.

Background: Effective management of postoperative pain is essential for promoting recovery and improving overall patient outcomes after total knee arthroplasty (TKA). Intravenous corticosteroids, especially dexamethasone, have become increasingly popular due to their strong anti-inflammatory effects, which can enhance pain control while minimizing side effects. However, the optimal dosing strategy for dexamethasone remains unclear, as most studies have primarily focused on fixed high doses.

Objective: This retrospective case-matched study aimed to evaluate the effectiveness of weight-based low-dose intravenous dexamethasone (0.1 mg/kg) in managing postoperative pain following TKA.

Methods: Patients who underwent unilateral TKA for primary osteoarthritis were retrospectively analyzed and divided into two cohorts based on the timing of their surgery. The control group, consisting of patients who underwent TKA between March 2019 and November 2020, did not receive dexamethasone. In contrast, patients operated on between December 2020 and May 2022 received a preoperative weight-based dose of 0.1 mg/kg intravenous dexamethasone. Postoperative pain was assessed using the Verbal Numerical Rating Scale (VNRS), and fentanyl consumption was recorded over the first 72 hours postoperatively.

Results: The dexamethasone group demonstrated significantly lower pain scores at all measured intervals up to 60 hours postoperatively (p < 0.05) compared to the control group. Additionally, patients receiving dexamethasone required significantly less fentanyl in the first 24 hours and had lower cumulative fentanyl consumption over the entire 72-hour postoperative period (p < 0.001). There were no significant differences between the two groups in terms of hospital stay, deep infection rates, or other complications.

Conclusion: Weight-based low-dose dexamethasone (0.1 mg/kg) appears to be an effective strategy for reducing postoperative pain and opioid use following TKA.

Introduction: Interlaminar epidural steroid injections (ILESIs) using a parasagittal approach are frequently employed to manage lumbar radicular pain. The degree of contralateral symptom relief achieved with parasagittal ILESIs remains underexplored. This study aims to evaluate the short-term effectiveness of parasagittal ILESIs in providing ipsilateral and contralateral symptom relief in patients with bilateral lumbar radiculopathy and unilateral contrast spread.

Methods: A retrospective review was conducted on 12 patients with bilateral lumbar radicular symptoms who underwent parasagittal ILESIs under fluoroscopic guidance. Patient-reported symptom relief was assessed for both ipsilateral and contralateral sides at a two-week follow-up visit or phone call. Descriptive statistics were used to evaluate patterns in symptom relief across the cohort.

Results: All patients experienced significant relief on the ipsilateral side, with reported improvement ranging from 60% to 100% (mean: 84.6%). Contralateral relief was more variable, ranging from 0% to 90% (mean: 37.5%). No complications were reported.

Conclusion: Parasagittal ILESIs provide more consistent and substantial relief of ipsilateral lumbar radicular symptoms. Contralateral relief is less predictable and may be limited by needle placement and the spread of medication. These findings support the use of parasagittal ILESIs in cases of unilateral or dominant-side radicular pain. For patients with significant bilateral symptoms, midline ILESIs or bilateral transforaminal injections may be more effective. Further prospective studies are warranted to identify predictors of bilateral relief and optimize procedural technique.

There has been a recent trend towards outpatient arthroplasty since the Center for Medical Services removed the total knee and total hip arthroplasty from the inpatient only list. Arthroplasty in the ambulatory surgical center has been extensively studied, with research demonstrating better patient outcomes, better patient and surgeon satisfaction, and lower overall healthcare costs. Outpatient arthroplasty in the academic hospital setting has its own unique challenges associated with it. However there is a paucity of research pertaining to this particular setting. This review aims to evaluate the current literature and review of challenges particular to outpatient arthroplasty in the academic hospital setting. Throughout this review, evidence-based principles leading to the paradigm shift towards outpatient hip/knee arthroplasty within the hospital setting are elucidated. Additionally, practical methods for selecting appropriate candidates and optimizing perioperative care are discussed, as well as the implications of implementing outpatient arthroplasty within a university academic center.

Dislocations of the elbow are the second most common large joint dislocation, following shoulder dislocations. Most are closed reductions, especially posterior or posterolateral types, and do not require surgical intervention. When an elbow dislocation involves a vascular structure-usually the brachial artery-this injury becomes a rare and life-threatening emergency. Collateral circulation can maintain distal pulses, so these injuries can be underdiagnosed. Without rapid intervention, complications of limb ischemia, compartment syndrome, nerve injury, and even amputation can occur. This report describes a case of a 38-year-old female with complete transection of the brachial artery after elbow dislocation, emphasizing the importance of a thorough vascular assessment in the trauma setting. This case illustrates that a routine elbow injury can be catastrophic when there is a vascular injury. Given that the distal pulses can be maintained, an arterial injury should not be excluded based on pulse alone. Rapid surgery and a multidisciplinary approach were able to address the vascular repair and reduce the joint. This case also exemplifies the multiple complications that can occur with such injuries, including anterior interosseous nerve palsy. This case provides an example of a rare injury and treatment, which may aid in future patient care in the field of underrecognized and high-risk elbow trauma.