Orthopedic Reviews最新文献

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.

Objective: To investigate the clinical effects of Leukocyte-poor-Platelet-Rich-Plasma (LpPRP) injections to treat chronic facet joint syndrome.

Methods: 78 patients suffering from chronic facet joint syndrome at the Center for Molecular Orthopedics (CMO) agreed to participate to this prospective controlled study to receiving a series of CT-guided PAT-injections (periarticular therapy) to lumbar facet joints. The patients were free to decide to receive either injections based on Platelet-Rich-Plasma (PRP) or local anesthetics (LA/bupivacaine). In this study leucocyte-poor PRP (LpPRP) was used for all patients of the verum group, namely autologous conditioned plasma (Arthrex ACP® / Arthrex Inc., Naples, FL, USA) as the verum group. 59 patients were treated 3-5 times in at least two levels of facet joints in the PRP group, 19 patients decided to join the LA group receiving local anesthetics (LA group) each in a weekly interval. All patients agreed to answer an automated email questionnaire for up to one year starting at baseline before receiving the first injections. The follow up protocol was based on a pain scale, and the Oswestry disability score. Data analysis was evaluated using the Excel analysis tools.

Results: Data analysis revealed that both, PRP and local anesthetics had a pain reducing effect initially at week 2 after receiving the first PAT, but from week six on up to one year post injection, PRP infiltrations were superior with a significantly reduced pain score compared to baseline up to one year (p<0.001). Oswestry score showed similar results with a significant improvement to about one half compared to baseline (p<0.001) up to six months, still being significantly better at one year (p<0.01). The comparison of the PRP group to the LA group showed a better pain relief and better values at the Oswestry disability score between three and six months and one year.

Conclusions: We show that a CT-guided injection therapy (PAT) based on LpPRP addressing the facet joint mediated low back pain syndrome leads to a significant long term pain reduction, and to a significant improvement in the Oswestry disability score for at least one year.

Orthopedic injuries are a common challenge in sports, often associated with inadequate postural patterns.

Objective: The aim of this study was to investigate the relationship between postural biomechanics and the incidence of orthopedic injuries in athletes from different sports.

Method: An exploratory and descriptive literature review was carried out, with a qualitative approach, based on the analysis of studies published between 2020 and 2024 in the following databases: PubMed, SciELO and BVS.

Results: Deficits in postural control significantly increase the risk of injuries, especially in sports that involve rapid changes of direction and repetitive landings. In addition, postural correction training and continuous biomechanical monitoring have proven to be effective strategies for preventing injuries.

Conclusion: Postural biomechanics directly influence the vulnerability of athletes to musculoskeletal trauma, and that the implementation of preventive interventions, such as muscle strengthening and regular postural analysis, is essential. However, there is a need for broader and longitudinal studies to deepen knowledge about the effectiveness of these approaches in reducing sports injuries.

Introduction: Noise exposure in orthopedic operating rooms (ORs), particularly from power tools, poses potential risks to surgical staff and patients, including noise-induced hearing loss (NIHL). This scoping review quantifies noise exposure related to orthopedic instrument use and explores recommended guidelines.

Methods: Using Covidence, PubMed was systematically searched for studies published between January 1990 and December 2023. Of 1671 initial studies, 13 met inclusion criteria. Data extracted included decibel measurements, instrument types, measurement distances, and noise exposure recommendations.

Results: Unweighted decibel measurements for oscillating and reciprocating saws ranged from 81 dB to 131 dB, drilling systems from 78.3 dB to 97 dB, and hammering from 92 dB to 103.4 dB. A-weighted measurements for saws ranged from 53 dB(A) to 100 dB(A), drilling systems from 74.6 dB(A) to 97 dB(A), rasping systems from 87 dB(A) to 110 dB(A), and acetabular reaming at 87 dB(A). Action value set by the UK Control of Noise at Work Regulations, begin at 80 dB(A), requiring information, training, and hearing protection, while the upper exposure action value is 85 dB(A), mandating noise reduction measures and enforce hearing protection use. Of the included studies, 61.5% (8 of 13) provided explicit noise mitigation recommendations, 23.1% (3 of 13) presented mixed recommendations, and 15.4% (2 of 13) found no significant risk.

Conclusion: Significant variation exists in reported exposure levels and recommendations, highlighting the need for standardized evaluation methodologies. Future research should focus on standardizing measurement parameters and comprehensively evaluating current instrumentation to develop evidence-based noise mitigation protocols for orthopedic ORs.