Orthopedic Reviews最新文献

Background: There is relatively little literature into the cost of treating diaphyseal femur fractures in paediatric population. This study aims to determine the cost of managing paediatric diaphyseal femur fractures in a South African Academic Hospital.

Objective and methods: We conducted a retrospective study using prospectively collected data on paediatric diaphyseal femoral fracture treatment at our public academic hospital over a four-month duration. The study included patients who were between 2 years and 14 years of age and excluded those with femur fractures caused by pathological or atypical factors. The following costs were reviewed: emergency department, inpatient admission, anaesthesia and theatre, allied department, and radiology department.

Results: Data from 31 patients (80.6% males) with diaphyseal femoral fractures were included in the study; falls accounted for 64.5% of the injuries. The patients who underwent surgery had a mean hospital stay of 7.4 days (range:3 to 22 days), while the group that did not have surgery had a mean hospital stay of 24.1 days (range:17 to 34 days). The factors that had a greater impact on cost were the duration of the hospital stay, the cost of the implant, and the cost of the theatre. There was no statistically significant variation in the cost of emergency unit services among this group.

Conclusion: The data showed that orthopaedic surgeons need to be cognizant of the cost of treating paediatric diaphyseal femoral fractures in the current state of the economy.

Purpose: To systematically evaluate the effects of Tai Chi on bone mineral density (BMD) in lumbar spine, femoral greater trochanter, Ward's triangle, femoral neck, and calcaneus among middle-aged and older adults through a meta-analysis.

Methods: A comprehensive literature search was conducted across multiple databases, including CNKI, PubMed, Embase, Web of Science, and Cochrane Library, to identify randomized controlled trials (RCTs) investigating the impact of Tai Chi on BMD in middle-aged and older populations. The literature search covered the period from the establishment of each database to February 25, 2025. EndNote 20 was employed for literature management. The methodological quality of included studies was evaluated using the PEDro (Physiotherapy Evidence Database) scale. Heterogeneity analysis, bias assessment, and sensitivity analysis were performed on extracted data using RevMan 5.4 and Stata SE 15.0 software.

Results: 1. Seventeen randomized controlled trials (RCTs) with a total sample size of 1,253 participants (intervention group: n=675; control group: n=578) were included in the final analysis. The methodological quality of the included studies, as assessed by standardized evaluation criteria, demonstrated overall high robustness. The meta-analysis revealed statistically significant improvements in bone mineral density (BMD) at multiple skeletal sites following Tai Chi intervention: lumbar spine (WMD = 0.07, 95% CI: 0.04-0.11, p < 0.00001), greater trochanter (WMD = 0.04, 95% CI: 0.02-0.06, p < 0.00001), Ward's triangle (WMD = 0.03, 95% CI: 0.01-0.05, p = 0.007), femoral neck (WMD = 0.03, 95% CI: 0.02-0.05, p < 0.0001), and calcaneus (WMD = 5.52, 95% CI: 3.87-7.27, p < 0.00001).

Conclusion: Regular Tai Chi practice demonstrates significant improvements in bone mineral density (BMD) among middle-aged and older adults, particularly at the lumbar spine. Our meta-analysis suggests Tai Chi may serve as a viable non-pharmacological intervention for mitigating osteoporosis in aging populations. Notably, individuals aged ≥60 years exhibit more pronounced BMD enhancements when adhering to a structured regimen of ≥3 sessions/week over ≥6 months. However, rigorously designed randomized controlled trials (RCTs) are required to validate these observed benefits and systematically explore optimal Tai Chi exercise regimens for skeletal health promotion.

Background: The Latarjet technique is the gold standard for treatment of anterior shoulder instability with glenoid bone loss or hyperlaxity. Since its initial description by Latarjet in 1954, the procedure has undergone significant evolution. While existing literature describes each of the various advances and alterations in technique, there is no existing literature that describes the complete history of the Latarjet procedure.

Questions/purposes: The purpose of this study is to provide a comprehensive review of the evolution of the Latarjet procedure, while highlighting the underlying biomechanical principles of the technique.

Methods: This study was performed as a systematic review of literature aimed at characterizing the history and rationale of the open Latarjet procedure as well as its initial outcomes and its subsequent evolution of technique.

Results: Long-term studies of the open Latarjet procedure have consistently demonstrated low rates of recurrent instability, high patient satisfaction, and high rates of return to sport. Though a reliable procedure, complication rates have been reported between 7-35%. The arthroscopic Latarjet was first described in 2007 and combined the benefits of minimally invasive arthroscopic surgery with the reliability of the open procedure, though with an initial learning curve. Finally, Boileau et al described the utilization of low-profile cortical buttons for fixation in place of the traditional screws. Subsequent analysis has demonstrated no significant biomechanical differences in the two techniques with proposed benefits of improved graft union and positioning as well as decreased rates of neurologic injury.

Conclusion: The Latarjet procedure has remained a reliable technique to address anterior shoulder instability. The initial technique has undergone several iterations in an effort to improve outcomes, minimize complications, and capitalize on the benefits of minimally invasive techniques. As technology and techniques improve, we anticipate that the all-arthroscopic Latarjet will become more commonly performed to address anterior shoulder instability.

Background: This study aimed to evaluate the early outcomes of full-endoscopic decompression using the outside-in technique via the interlaminar approach for treating lumbar spinal stenosis in Vietnamese patients.

Methods: A retrospective review was conducted on 25 consecutive patients with lumbar spinal stenosis (16 men and 9 women; mean age ± SD: 65.80 ± 8.41 years) who underwent full-endoscopic decompression. Clinical outcomes were analyzed using the Visual Analog Scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) preoperatively, immediately postoperatively, and at a three-month follow-up. The final outcome was evaluated using the MacNab criteria.

Results: Among the 25 patients, the L4-L5 level was the most common site of stenosis (17 patients, 68%), with central canal stenosis observed in 10 patients (40%). The primary causes of stenosis were hypertrophy of the facet joints combined with ligamentum flavum thickening (9 patients, 36%) and disc herniation (11 patients, 44%). Unilateral decompression was performed in 20 patients (80%), while bilateral decompression was required in 5 patients (20%). The mean operative time was 50.96 ± 16.20 minutes, and the average hospital stay was 2.13 ± 0.52 days, with no reported complications. VAS scores for back pain decreased from 7.60 preoperatively to 1.80 at 6 months, and leg pain scores from 7.20 to 1.76. The ODI improved from 76.35 preoperatively to 10.34 at 6 months. MRI results showed a significant increase in the canal cross-sectional area, from 75.78 mm² to 155.2 mm². Based on Mac-Nab criteria, 80% of patients achieved excellent results, 16% good, and 4% fair at 6 months.

Conclusions: Full-endoscopic decompression of lumbar canal stenosis demonstrates promising early outcomes. Advances in endoscopic surgical instruments facilitate decompression procedures that can be performed as effectively, if not more so, than traditional open decompression surgery.

The widespread condition Subacromial impingement syndrome (SAIS) appears among the leading causes of shoulder pain, which restrict people in their daily routine activities and diminish their quality of life. The condition specifically relates to subacromial space reduction that leads to rotator cuff damage. # Objective The study aims to determine whether particular acromion shapes and different stages of AC joint degeneration significantly contribute to the risk of developing SAIS. # Methods The retrospective study was conducted on 608 patients who underwent shoulder MRI between the period of 2017 to 2020. The Acromion type and AC joint degeneration severity were evaluated by using T1- or T2/PD-weighted MRI sequences obtained from sagittal and coronal oblique planes. # Results Type III acromion and mild AC joint degeneration were more frequently observed in SAIS patients, but these findings were not statistically significant (P-value =0.38). Results showed that supraspinatus and infraspinatus tendon pathologies together with reduced acromiohumeral distance were strongly linked to SAIS development. # Conclusion Acromion shape together with AC joint degeneration did not produce significant effects on increasing the risk of developing SAIS. However, the rotator cuff pathologies combined with reduced subacromial space act as primary causes of SAIS, additional studies are needed further for better diagnostics and treatment strategies.

Periprosthetic femoral fractures (PFFs) are an increasingly common complication following total hip arthroplasty, especially in aging populations. This retrospective study analyzes a five-year experience at the National Scientific Center of Traumatology and Orthopedics in Astana, Kazakhstan, using a domestically developed anatomically contoured locking plate for surgical fixation. Thirty-eight patients were included, with the majority being elderly females. The most common fracture locations were the femoral shaft and distal femur. All patients underwent open reduction and internal fixation with the national plate system. No in-hospital complications, reoperations, or mortality were recorded. Clinical improvement at discharge was observed in all cases. ICU admission decreased over time, and the average hospital stay was significantly longer in patients aged ≥70 years. The plate's design enabled bicortical fixation around existing femoral stems, and the system demonstrated excellent short-term outcomes. This study supports the use of localized implant strategies in low- and middle-income countries and highlights the role of centralized surgical expertise. Further multicenter studies with long-term follow-up are recommended. Periprosthetic femoral fractures (PFFs) represent a serious complication following total hip arthroplasty (THA), particularly in elderly and osteoporotic patients. Their incidence is increasing in parallel with the global growth of primary arthroplasty procedures. In resource-limited settings, access to modular revision systems is often constrained, necessitating cost-effective and anatomically appropriate alternatives. This study aimed to evaluate the clinical characteristics, management strategies, and early outcomes of patients with PFFs treated using a domestically produced anatomically contoured locking plate at a national trauma center in Kazakhstan.

The diagnosis and treatment of long bone nonunion remains a historical challenge in the field of orthopedics. Bone nonunion management encompasses surgical and non-surgical options. This review discusses the potential use of untraditional methods in their treatment such as orthobiologics. The cornerstone of local biological therapies lies in their ability to directly stimulate the biological processes essential for bone repair. This precision targeting ensures that bone healing pathways are activated specifically where needed, enhancing both the rate and quality of union. It particularly addresses the use of biologic agents and the possibility of their combination with biomaterials to enhance their stability, delivery, and osteoconductive properties. The aim of this review is to obtain an updated point of view regarding the management of nonunion of the bone as well as expanding on the latest innovations aiming to create a shift from passive biologic supplementation to active regenerative engineering.

[This corrects the article DOI: 10.52965/001c.88396.].

Despite advancements in surgical techniques and implant designs, Periprosthetic joint infection (PJI) continues to be one of the commonest and most devastating causes of failure in total joint arthroplasty. PJIs are associated with significant morbidity and mortality, placing a multifactorial burden on patients, caregivers, surgeons, hospitals, health systems, and economies. The incidence of PJI ranges from 0.5% to 2.3% based on current literature. Mortality rates in PJI subsequent to a primary total hip arthroplasty (THA) range from 4% to 8% after one year. The common treatment for PJI is a two-stage revision THA, which itself is associated with significant morbidity and mortality. The economic burden of PJI is substantial, with treatment costs 3 to 5.6 times higher than primary THA. Patients with PJI experience inferior hip function, lower health-related quality of life scores, and higher odds of developing new onset depression. PJI's negatively impacts on a patient's capacity to work and conduct everyday activities. Orthopaedic surgeons also face significant psychological stress due to the challenges in managing PJI, including feelings of incompetence, insecurity, and frustration. Continued research and innovation are essential to optimize THA outcomes and reduce the need for revision surgeries. Improved prevention strategies, multidisciplinary cooperation, and comprehensive care and support for both patients and surgeons are crucial. It is paramount that every orthopaedic surgeon remains cognisant of this complication to institute better prevention strategies, promote better multi-disciplinary cooperation and enhance patient pre-operative care.

Introduction: Since 1972 Title IX legislation there has been an increase in female sports participation, and with that there has been an increase in female related injuries. For example, the female athlete has a two to eight times more frequency of injuring her ACL compared to males. This has led to additional research focusing on why female athletes have a higher disposition for ACL injuries. The aim of this study is to quantitatively assess the literature for authorship relationships, general publication trends, and keyword occurrences through conducting a bibliometric review.

Methods: The data used in this analysis was collected from PubMed. A MeSH search was conducted with the following parameters: (women or female[MeSH Terms]) AND (ACL injury[MeSH Terms])) NOT (male[MeSH Terms])) NOT (men[MeSH Terms])) NOT (man[MeSH Terms]) on February 11th 2025.

Results: The bibliometric analysis resulted in 435 publications from the year 2000 to 2025. There was a steady increase in the number of publications over the observed study period. The top keywords included: "ACL injury" and "female", and common sports related ACL injuries like soccer and basketball. Additional noteworthy findings included soccer, basketball, quadriceps, and biomechanics. There was linkage between numerous authors associated with the Norwegian School of Sport Sciences and the Oslo Sports Trauma Research Center.

Conclusion: The paper provides an analysis on current female ACL injury trends. It is important to discuss injury related disparities between female and male athletes, so prevention programs can be put into place.