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A Lateral Fracture Line Affects Femoral Trochanteric Fracture Instability and Swing Motion of the Intramedullary Nail: A Biomechanical Study. 侧骨折线影响股骨转子骨折的不稳定性和髓内钉的摆动:生物力学研究。
Q2 ORTHOPEDICS Pub Date : 2024-02-13 eCollection Date: 2024-01-01 DOI: 10.2106/JBJS.OA.23.00118
Takuya Usami, Naoya Takada, Weerachai Kosuwon, Permsak Paholpak, Masami Tokunaga, Hidetoshi Iwata, Yusuke Hattori, Yuko Nagaya, Hideki Murakami, Gen Kuroyanagi

Background: An unstable trochanteric femoral fracture is a serious injury, with a 1-year mortality rate of 5.4% to 24.9%, for which there is currently no standard treatment method. The lag screw insertion site is one of the primary contact areas between the cortical bone and an intramedullary nail. We hypothesized that a posterolateral fracture causes intramedullary nail instability when the posterolateral fracture line interferes with lag screw insertion. The purpose of the present study was to investigate the effect of posterolateral fracture line morphology on intramedullary nail stability by simulating unstable trochanteric femoral fractures with a posterolateral fracture fragment.

Methods: Eighteen custom-made synthetic osteoporotic bone samples were used in the present study. Nine samples had a posterolateral fracture line interfering with the lag screw insertion hole (Fracture A), and the other 9 had a fracture line 10 mm away from the hole (Fracture B). Cyclic loading (750 N) was applied to the femoral head 1,500 times. Movement of the end cap attached to the intramedullary nail was recorded. The amplitudes of motion in the coronal plane (coronal swing motion), sagittal plane (sagittal swing motion), and axial plane (total swing motion) were evaluated. The change in the neck-shaft angle was evaluated on photographs that were made before and after the test. Medial cortical displacement was measured before and after the test.

Results: Two Fracture-A samples were excluded because the amplitude of sagittal swing motion was too large. The mean values for coronal, sagittal, and total swing motion were 1.13 ± 0.28 mm and 0.51 ± 0.09 mm (p < 0.001), 0.50 ± 0.12 mm and 0.46 ± 0.09 mm (p = 0.46), and 1.24 ± 0.24 mm and 0.69 ± 0.11 mm (p < 0.001) for Fractures A and B, respectively. The mean neck-shaft angle change was -8.29° ± 2.69° and -3.56° ± 2.35° for Fractures A and B, respectively (p = 0.002). The mean displacement of the medial cortex was 0.38 ± 1.12 mm and 0.12 ± 0.37 mm for Fractures A and B, respectively (p = 0.57).

Conclusions: This study showed that an unstable trochanteric femoral fracture with a posterolateral fracture line that interferes with the lag screw insertion holes is a risk factor for increased intramedullary nail instability.

背景:不稳定股骨转子骨折是一种严重损伤,1 年死亡率为 5.4% 至 24.9%,目前尚无标准治疗方法。滞后螺钉插入部位是皮质骨与髓内钉的主要接触区域之一。我们假设,当后外侧骨折线干扰髓内螺钉插入时,后外侧骨折会导致髓内钉不稳定。本研究的目的是通过模拟不稳定的股骨转子后侧骨折与后外侧骨折片,研究后外侧骨折线形态对髓内钉稳定性的影响:本研究使用了 18 个定制的合成骨质疏松骨样本。其中 9 个样本的后外侧骨折线与滞后螺钉插入孔相邻(骨折 A),另外 9 个样本的骨折线与插入孔相距 10 毫米(骨折 B)。对股骨头施加循环负荷(750 牛顿)1500 次。记录与髓内钉相连的端盖的运动情况。评估了冠状面(冠状摆动运动)、矢状面(矢状摆动运动)和轴向面(总摆动运动)的运动幅度。颈轴角的变化通过测试前后的照片进行评估。在测试前后测量了内侧皮质位移:由于矢状摆动幅度过大,两个骨折 A 样本被排除在外。骨折 A 和 B 的冠状、矢状和总摆动运动的平均值分别为 1.13 ± 0.28 毫米和 0.51 ± 0.09 毫米(p < 0.001)、0.50 ± 0.12 毫米和 0.46 ± 0.09 毫米(p = 0.46)以及 1.24 ± 0.24 毫米和 0.69 ± 0.11 毫米(p < 0.001)。骨折 A 和 B 的平均颈轴角变化分别为 -8.29° ± 2.69° 和 -3.56° ± 2.35°(p = 0.002)。骨折 A 和 B 的内侧皮质平均移位分别为 0.38 ± 1.12 mm 和 0.12 ± 0.37 mm(p = 0.57):本研究表明,不稳定的股骨转子骨折后外侧骨折线与滞后螺钉插入孔干扰,是增加髓内钉不稳定性的危险因素。
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引用次数: 0
The Rising Quality of Randomized Controlled Trials in The Journal of Bone & Joint Surgery: An Updated Analysis from 2014 to 2022. 骨与关节外科杂志》上随机对照试验的质量不断提高:2014年至2022年的最新分析。
Q2 ORTHOPEDICS Pub Date : 2024-02-12 eCollection Date: 2024-01-01 DOI: 10.2106/JBJS.OA.23.00079
Nareena Imam, Suleiman Y Sudah, Siraj Z Shaikh, Ashley A Bonney, Allen D Nicholson, Surena Namdari, Mariano E Menendez
<p><strong>Background: </strong>Previous reports found that 40% of randomized controlled trials (RCTs) published in <i>The Journal of Bone & Joint Surgery (JBJS)</i> from 1988 to 2000 and 47% of those published from 2001 to 2013 were of high quality. The purpose of this study was to assess the quality of RCTs published from 2014 to 2022 in <i>JBJS</i> and to compare these findings with those of prior analyses in order to identify trends over time and areas for continued improvement.</p><p><strong>Methods: </strong>PubMed was searched for the term "randomized controlled trial" to identify studies published in <i>JBJS</i> from 2014 to 2022. Each included RCT was evaluated with use of the Detsky score and a risk-of-bias assessment modified from the Cochrane tool. These evaluations were then compared with previous evaluations of RCTs from the 1988 to 2000 and 2001 to 2013 periods with use of independent-sample t tests. A transformed Detsky score of >75% and a modified risk-of-bias score of ≥8 were defined as being indicative of high quality.</p><p><strong>Results: </strong>A total of 218 RCTs were published in <i>JBJS</i> from 2014 to 2022. An a priori sample size was calculated in 183 studies (83.9%). A total of 152 (83.1%) of the 183 studies enrolled the calculated number of patients, of which 126 (82.9%) maintained an adequate number at the time of final follow-up. Most RCTs were conducted at a single center (146 of 218; 67%), evaluated a surgical intervention (162 of 218; 74%), and reported positive results (142 of 218; 65%). The mean transformed Detsky score was 85% ± 10% (95% confidence interval, 83.7% to 86.3%), with 82% of trials (179 of 218) scored as high quality. The mean transformed Detsky score from 2014 to 2022 was higher than that from 1988 to 2000 and that from 2001 to 2013 (85% versus 76% and 68%, respectively; p < 0.001). The mean modified risk-of-bias score was 7 ± 1, with 42% of trials (92 of 218) scored as high quality. RCTs published from 2014 to 2022 had a higher mean modified risk-of-bias score than those published from 2001 to 2013 (7 ± 1 versus 6 ± 1; p < 0.001). Compared with the 2001 to 2013 and 2014 to 2022 periods, the 1988 to 2000 period had a greater proportion of trials that reported positive results (51% and 65% versus 82%, respectively; p < 0.001) and that included data from multiple centers (31% and 33% versus 67%; p < 0.001).</p><p><strong>Conclusions: </strong>The quality of RCTs published in <i>JBJS</i> from 2014 to 2022 has improved from that reported previously, as demonstrated by the increases in the modified risk-of-bias score and transformed Detsky score from prior periods. This may be the result of journal policies such as the requirements of CONSORT adherence and prospective trial registration. Investigators should focus on improving the clarity of reporting, limiting attrition bias, and making efforts to blind support staff in order to increase the quality of future RCTs.</p><p><strong>Clinical relevance
背景:以前的报告发现,1988年至2000年期间在《骨与关节外科杂志》(JBJS)上发表的随机对照试验(RCT)中有40%的质量较高,2001年至2013年期间发表的随机对照试验中有47%的质量较高。本研究的目的是评估2014年至2022年发表在《骨与关节外科杂志》上的RCT的质量,并将这些结果与之前的分析结果进行比较,以确定随时间推移的趋势和需要继续改进的领域:以 "随机对照试验 "为关键词在PubMed上进行检索,以确定2014年至2022年发表在JBJS上的研究。使用 Detsky 评分和根据 Cochrane 工具修改的偏倚风险评估对纳入的每项随机对照试验进行评估。然后使用独立样本 t 检验将这些评估结果与 1988 年至 2000 年和 2001 年至 2013 年期间的 RCT 评估结果进行比较。转换后的 Detsky 得分>75%,修改后的偏倚风险得分≥8 分,则被定义为高质量的标志:从2014年到2022年,JBJS上共发表了218篇研究论文。183项研究(83.9%)计算了先验样本量。在183项研究中,共有152项(83.1%)入选了计算出的患者人数,其中126项(82.9%)在最终随访时保持了足够的患者人数。大多数研究都是在单个中心进行的(218 项研究中的 146 项,占 67%),对手术干预进行了评估(218 项研究中的 162 项,占 74%),并报告了积极的结果(218 项研究中的 142 项,占 65%)。转化后的 Detsky 评分均值为 85% ± 10%(95% 置信区间为 83.7% 至 86.3%),82% 的试验(218 项中的 179 项)被评为高质量。2014年至2022年的平均转化Detsky评分高于1988年至2000年和2001年至2013年的平均转化Detsky评分(分别为85%对76%和68%;P < 0.001)。修改后的偏倚风险平均得分为 7 ± 1,42% 的试验(218 项中的 92 项)被评为高质量。与2001年至2013年发表的研究相比,2014年至2022年发表的研究的平均修正偏倚风险得分更高(7±1分对6±1分;P <0.001)。与2001年至2013年和2014年至2022年期间相比,1988年至2000年期间报告阳性结果的试验比例更高(分别为51%和65%对82%;P<0.001),且包含来自多个中心的数据(分别为31%和33%对67%;P<0.001):从2014年到2022年,JBJS上发表的RCT质量比之前的报告有所提高,这体现在修改后的偏倚风险评分和转换后的Detsky评分比之前有所提高。这可能是期刊政策的结果,如遵守 CONSORT 和前瞻性试验注册的要求。研究者应集中精力提高报告的清晰度,限制自然减员偏倚,并努力使支持人员盲目,以提高未来 RCT 的质量:鉴于 RCT 有可能影响当前的临床实践,因此提高 RCT 的质量至关重要。
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引用次数: 0
High Research Productivity During Orthopaedic Surgery Residency May Be Predicted by Number of Publications as a Medical Student. 医学生发表论文数量可预测矫形外科住院医师培训期间的高科研生产力。
IF 2.3 Q2 ORTHOPEDICS Pub Date : 2024-01-30 eCollection Date: 2024-01-01 DOI: 10.2106/JBJS.OA.23.00105
Connor Donley, Matthew McCrosson, Sri Prahad, Collier Campbell, Fei Zhao, Narcy Amireddy, Michael Johnson

Introduction: Orthopaedic applicants have increased the average number of publications on their residency application to compete with the growing competitiveness of the field. The purpose of this study was to assess whether research productivity before orthopaedic residency and caliber of one's institution is correlated with academic productivity during residency.

Methods: Scopus was used to extract publication metrics. Quantity and quality (how often the publications were cited) were analyzed at 2 different time periods: before and during residency. All subjects in the study had graduated an ACGME-accredited orthopaedic surgery residency in 2021. Military residents, international medical graduates, and residents not listed on their department's website were excluded. Residents were categorized as both high (≥2 publications) or low (<2 publications) publishers according to their pre-residency publications. They were also categorized based on their program's Jones et al. research productivity ranking.

Results: For the 758 residents, the median number of publications was 0 (Interquartile Range [IQR]: 0-2) and 3 (IQR: 1-6) before and during residency, respectively. High publishing medical students had more publications during training than low publishers (6 [IQR: 3-14] and 2 [IQR: 1-4], p < 0.001). Residents at higher ranked programs also had more publications (4 [IQR: 2-9] and 2 [IQR: 0-4], p < 0.001). High publishing students now training at lower ranked institutions had more publications during residency than low publishers who trained at more productive institutions (4 [IQR: 1-9] and 3 [IQR: 1-6], p < 0.001).

Conclusion: Having 2 or more publications before residency is correlated with an increased number of publications during residency. While attending a higher academically productive program is associated with increased resident publications, a high publishing medical student would be expected to have more publications during residency than a low publishing student, regardless of program rank. Notably, most matched applicants continue to have zero publications before matriculation.

简介:骨科申请者在住院实习申请中增加了发表论文的平均数量,以应对该领域日益激烈的竞争。本研究的目的是评估骨科住院医师培训前的研究效率和个人所在机构的水平是否与住院医师培训期间的学术效率相关:方法:使用 Scopus 提取发表论文的指标。方法:使用 Scopus 提取发表论文的指标,分析两个不同时期的数量和质量(论文被引用的频率):住院实习前和住院实习期间。所有研究对象都在2021年毕业于ACGME认可的骨科住院医师培训。军事住院医师、国际医学毕业生和未在其所在科室网站上列出的住院医师不在研究范围内。住院医师被分为高水平(≥2 篇论文)和低水平(结果:758名住院医师在住院实习前和实习期间发表论文的中位数分别为0(四分位距[IQR]:0-2)和3(四分位距[IQR]:1-6)。发表论文多的医学生在培训期间发表的论文数量多于发表论文少的学生(6 [IQR:3-14] 和 2 [IQR:1-4],P < 0.001)。排名较高的项目的住院医师发表的论文也更多(4 [IQR:2-9] 和 2 [IQR:0-4],p < 0.001)。目前在排名较低的机构接受培训的高发表率学生在住院医师培训期间发表的论文多于在排名较高的机构接受培训的低发表率学生(4 [IQR:1-9] 和 3 [IQR:1-6],P < 0.001):结论:住院实习前发表 2 篇或更多论文与住院实习期间发表论文数量的增加有关。虽然就读于学术成果较高的专业与住院医师发表论文数量的增加有关,但无论专业排名如何,发表论文多的医学生在住院医师培训期间发表的论文数量预计会多于发表论文少的学生。值得注意的是,大多数匹配的申请者在入学前发表的论文数量仍然为零。
{"title":"High Research Productivity During Orthopaedic Surgery Residency May Be Predicted by Number of Publications as a Medical Student.","authors":"Connor Donley, Matthew McCrosson, Sri Prahad, Collier Campbell, Fei Zhao, Narcy Amireddy, Michael Johnson","doi":"10.2106/JBJS.OA.23.00105","DOIUrl":"10.2106/JBJS.OA.23.00105","url":null,"abstract":"<p><strong>Introduction: </strong>Orthopaedic applicants have increased the average number of publications on their residency application to compete with the growing competitiveness of the field. The purpose of this study was to assess whether research productivity before orthopaedic residency and caliber of one's institution is correlated with academic productivity during residency.</p><p><strong>Methods: </strong>Scopus was used to extract publication metrics. Quantity and quality (how often the publications were cited) were analyzed at 2 different time periods: before and during residency. All subjects in the study had graduated an ACGME-accredited orthopaedic surgery residency in 2021. Military residents, international medical graduates, and residents not listed on their department's website were excluded. Residents were categorized as both high (≥2 publications) or low (<2 publications) publishers according to their pre-residency publications. They were also categorized based on their program's Jones et al. research productivity ranking.</p><p><strong>Results: </strong>For the 758 residents, the median number of publications was 0 (Interquartile Range [IQR]: 0-2) and 3 (IQR: 1-6) before and during residency, respectively. High publishing medical students had more publications during training than low publishers (6 [IQR: 3-14] and 2 [IQR: 1-4], p < 0.001). Residents at higher ranked programs also had more publications (4 [IQR: 2-9] and 2 [IQR: 0-4], p < 0.001). High publishing students now training at lower ranked institutions had more publications during residency than low publishers who trained at more productive institutions (4 [IQR: 1-9] and 3 [IQR: 1-6], p < 0.001).</p><p><strong>Conclusion: </strong>Having 2 or more publications before residency is correlated with an increased number of publications during residency. While attending a higher academically productive program is associated with increased resident publications, a high publishing medical student would be expected to have more publications during residency than a low publishing student, regardless of program rank. Notably, most matched applicants continue to have zero publications before matriculation.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10817159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139643081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Use of Social Media in Orthopaedic Surgery Training and Practice: A Systematic Review. 在矫形外科培训和实践中使用社交媒体:系统性综述。
Q2 ORTHOPEDICS Pub Date : 2024-01-16 eCollection Date: 2024-01-01 DOI: 10.2106/JBJS.OA.23.00098
Aliya G Feroe, Arthur J Only, Jerome C Murray, Lynsey R Malin, Nizar Mikhael, Ryan S Selley, Ryan R Fader, Mahad M Hassan

Background: Social media use has grown across healthcare delivery and practice, with dramatic changes occurring in response to the coronavirus (COVID-19) pandemic. The purpose of this study was to conduct a comprehensive systematic review to determine the current landscape of social media use by (1) orthopaedic surgery residencies/fellowship training programs and (2) individual orthopaedic surgeons and the change in use over time.

Methods: We searched 3 electronic databases (PubMed, MEDLINE, and Embase) from their inception to April 2022 for all studies that analyzed the use of social media in orthopaedic surgery. Two reviewers independently determined study eligibility, rated study quality, and extracted data. Methodology was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Twenty-eight studies were included, of which 11 analyzed social media use by orthopaedic surgery residency and fellowship training programs and 17 examined its use by individual orthopaedic surgeons. Among residency and fellowship programs, Instagram was identified as the most common platform used, with 42% to 88% of programs reporting program-specific Instagram accounts, followed by Twitter/X (20%-52%) and Facebook (10%-38%). Social media was most commonly used by programs for recruitment and information dissemination to prospective residency applicants (82% and 73% of included studies, respectively). After the start of the COVID-19 pandemic, there was a 620% and 177% increase in the number of training programs with Instagram and Twitter/X accounts, respectively. Individual use of social media ranged from 1.7% to 76% (Twitter/X), 10% to 73% (Facebook), 0% to 61% (Instagram), 22% to 61% (LinkedIn), and 6.5% to 56% (YouTube).

Conclusions: Instagram, Twitter/X, and Facebook are the premier platforms that patients, residency applicants, and institutions frequent. With the continued growth of social media use anticipated, it will be critical for institutions and individuals to create and abide by guidelines outlining respectful and professional integration of social media into practice.

Level of evidence: Level IV.

背景:社交媒体的使用在医疗保健服务和实践中不断增长,在冠状病毒(COVID-19)大流行时发生了巨大的变化。本研究旨在开展一项全面的系统性综述,以确定(1)骨科外科住院医师/研究员培训项目和(2)骨科外科医生个人目前使用社交媒体的情况,以及随着时间推移使用社交媒体的变化情况:我们检索了 3 个电子数据库(PubMed、MEDLINE 和 Embase)中从开始到 2022 年 4 月分析骨科手术中社交媒体使用情况的所有研究。两名审稿人独立确定研究资格、评定研究质量并提取数据。研究方法符合《系统综述和元分析首选报告项目》指南:共纳入了 28 项研究,其中 11 项研究分析了骨科手术住院医师和研究员培训项目对社交媒体的使用情况,17 项研究考察了骨科医生个人对社交媒体的使用情况。在住院医师和研究员培训项目中,Instagram 被认为是最常用的平台,42% 到 88% 的项目报告了项目专用的 Instagram 账户,其次是 Twitter/X(20%-52%)和 Facebook(10%-38%)。社交媒体最常用于项目招募和向潜在住院医师申请者发布信息(分别占纳入研究的 82% 和 73%)。COVID-19 大流行开始后,拥有 Instagram 和 Twitter/X 账户的培训项目数量分别增加了 620% 和 177%。个人使用社交媒体的比例从 1.7% 到 76%(Twitter/X)、10% 到 73%(Facebook)、0% 到 61%(Instagram)、22% 到 61%(LinkedIn)以及 6.5% 到 56%(YouTube)不等:Instagram、Twitter/X 和 Facebook 是患者、住院医师申请者和医疗机构经常使用的主要平台。随着社交媒体使用的持续增长,机构和个人必须制定并遵守相关准则,以尊重和专业的方式将社交媒体融入实践中:证据等级:IV 级。
{"title":"Use of Social Media in Orthopaedic Surgery Training and Practice: A Systematic Review.","authors":"Aliya G Feroe, Arthur J Only, Jerome C Murray, Lynsey R Malin, Nizar Mikhael, Ryan S Selley, Ryan R Fader, Mahad M Hassan","doi":"10.2106/JBJS.OA.23.00098","DOIUrl":"10.2106/JBJS.OA.23.00098","url":null,"abstract":"<p><strong>Background: </strong>Social media use has grown across healthcare delivery and practice, with dramatic changes occurring in response to the coronavirus (COVID-19) pandemic. The purpose of this study was to conduct a comprehensive systematic review to determine the current landscape of social media use by (1) orthopaedic surgery residencies/fellowship training programs and (2) individual orthopaedic surgeons and the change in use over time.</p><p><strong>Methods: </strong>We searched 3 electronic databases (PubMed, MEDLINE, and Embase) from their inception to April 2022 for all studies that analyzed the use of social media in orthopaedic surgery. Two reviewers independently determined study eligibility, rated study quality, and extracted data. Methodology was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.</p><p><strong>Results: </strong>Twenty-eight studies were included, of which 11 analyzed social media use by orthopaedic surgery residency and fellowship training programs and 17 examined its use by individual orthopaedic surgeons. Among residency and fellowship programs, Instagram was identified as the most common platform used, with 42% to 88% of programs reporting program-specific Instagram accounts, followed by Twitter/X (20%-52%) and Facebook (10%-38%). Social media was most commonly used by programs for recruitment and information dissemination to prospective residency applicants (82% and 73% of included studies, respectively). After the start of the COVID-19 pandemic, there was a 620% and 177% increase in the number of training programs with Instagram and Twitter/X accounts, respectively. Individual use of social media ranged from 1.7% to 76% (Twitter/X), 10% to 73% (Facebook), 0% to 61% (Instagram), 22% to 61% (LinkedIn), and 6.5% to 56% (YouTube).</p><p><strong>Conclusions: </strong>Instagram, Twitter/X, and Facebook are the premier platforms that patients, residency applicants, and institutions frequent. With the continued growth of social media use anticipated, it will be critical for institutions and individuals to create and abide by guidelines outlining respectful and professional integration of social media into practice.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10786589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Age-Based Incidence of Dens Fracture Has Unimodal Distribution Rather Than Commonly Claimed Bimodal Distribution. 以年龄为基础的颅骨骨折发病率呈单峰分布,而非通常所说的双峰分布。
Q2 ORTHOPEDICS Pub Date : 2024-01-11 eCollection Date: 2024-01-01 DOI: 10.2106/JBJS.OA.23.00059
Rita Somogyi, Spencer Smith, Jonathan Kark, Won Hyung A Ryu, Jung Yoo

Background: Type-II dens fractures have long been described in the literature as occurring in a bimodal distribution, peaking in young adulthood as well as in older adulthood; however, the origin of this claim is unclear. The primary goal of this study was to examine the incidence of type-II dens fractures and assess for bimodality.

Methods: This is a retrospective cross-sectional review of the National Trauma Data Bank (NTDB) records on traumatic type-II dens fractures between October 2015 and December 2016. Rates were obtained from the NTDB, and the incidence per 100,000 was ascertained by utilizing U.S. Census data from 2016. Subgroupings by gender and Black or White race were also examined.

Results: Dens fractures occur unimodally, peaking around 89 years of age overall, skewed left by high rates in older White adults. The Black subgroup demonstrated trimodality, with the fracture incidence peaking at 25, 62, and 82 years of age. Rates among Black and White patients were similar until age 65, after which dens fractures occurred disproportionately in White patients. Fractures prior to age 75 occurred predominantly in men.

Conclusions: The evidence derived in this study challenges the common belief that type-II dens fractures occur bimodally across the entire population. However, there remains utility in considering younger and older patients as distinct groups for the purposes of management.

背景:长期以来,文献中描述 II 型颅骨畸形骨折呈双峰分布,在青年期和老年期达到高峰;然而,这种说法的起源尚不清楚。本研究的主要目的是检查 II 型颅骨穹隆骨折的发生率,并评估其双峰性:这是一项对美国国家创伤数据库(NTDB)2015年10月至2016年12月期间创伤性II型颅骨穹窿骨折记录的回顾性横断面回顾。发病率来自 NTDB,每十万人的发病率通过 2016 年的美国人口普查数据确定。此外,还研究了按性别和黑人或白人种族划分的分组情况:颅骨骨折呈单侧发生,在89岁左右达到高峰,白人老年人的发病率较高。黑人亚组显示出三态性,骨折发生率在 25 岁、62 岁和 82 岁达到高峰。黑人和白人患者在 65 岁之前的骨折发生率相似,65 岁之后,白人患者的椎体骨折发生率更高。75岁之前的骨折主要发生在男性身上:本研究得出的证据对人们普遍认为 II 型椎体骨骺骨折在整个人群中呈双峰分布的观点提出了质疑。然而,将年轻患者和老年患者视为不同的群体进行管理仍然是有用的。
{"title":"Age-Based Incidence of Dens Fracture Has Unimodal Distribution Rather Than Commonly Claimed Bimodal Distribution.","authors":"Rita Somogyi, Spencer Smith, Jonathan Kark, Won Hyung A Ryu, Jung Yoo","doi":"10.2106/JBJS.OA.23.00059","DOIUrl":"10.2106/JBJS.OA.23.00059","url":null,"abstract":"<p><strong>Background: </strong>Type-II dens fractures have long been described in the literature as occurring in a bimodal distribution, peaking in young adulthood as well as in older adulthood; however, the origin of this claim is unclear. The primary goal of this study was to examine the incidence of type-II dens fractures and assess for bimodality.</p><p><strong>Methods: </strong>This is a retrospective cross-sectional review of the National Trauma Data Bank (NTDB) records on traumatic type-II dens fractures between October 2015 and December 2016. Rates were obtained from the NTDB, and the incidence per 100,000 was ascertained by utilizing U.S. Census data from 2016. Subgroupings by gender and Black or White race were also examined.</p><p><strong>Results: </strong>Dens fractures occur unimodally, peaking around 89 years of age overall, skewed left by high rates in older White adults. The Black subgroup demonstrated trimodality, with the fracture incidence peaking at 25, 62, and 82 years of age. Rates among Black and White patients were similar until age 65, after which dens fractures occurred disproportionately in White patients. Fractures prior to age 75 occurred predominantly in men.</p><p><strong>Conclusions: </strong>The evidence derived in this study challenges the common belief that type-II dens fractures occur bimodally across the entire population. However, there remains utility in considering younger and older patients as distinct groups for the purposes of management.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fatty Degeneration of the Rotator Cuff Muscles Improves in Shoulders with Successful Arthroscopic Rotator Cuff Repair: A Prospective Study Using Quantitative T2 Mapping Techniques, with 2-Year Follow-up. 成功进行关节镜下肩袖修复术的肩袖肌肉脂肪变性有所改善:使用定量 T2 映像学技术的前瞻性研究及 2 年随访。
Q2 ORTHOPEDICS Pub Date : 2024-01-11 eCollection Date: 2024-01-01 DOI: 10.2106/JBJS.OA.23.00083
Keisuke Matsuki, Hiroyuki Sugaya, Norimasa Takahashi, Morihito Tokai, Shota Hoshika, Yusuke Ueda

Background: There remain arguments regarding whether fatty degeneration of the rotator cuff muscles improves following rotator cuff repair. The purpose of this study was to prospectively investigate changes in fatty degeneration of the rotator cuff muscles, quantitatively measured on magnetic resonance imaging (MRI) with use of transverse relaxation time (T2) mapping techniques, and to assess the relationship between these changes and clinical outcomes.

Methods: Patients were included if they were scheduled for arthroscopic rotator cuff repair using the suture-bridge technique between June 2014 and December 2015, underwent preoperative MRI including the T2 mapping sequence, and consented to participate in the study. Exclusion criteria consisted of trauma within 2 months before preoperative MRI, isolated subscapularis tears, patch augmentation, neuromuscular disease, and a follow-up duration of <2 years. MRI scans were acquired preoperatively and at 2 years postoperatively, and T2 values of the supraspinatus and infraspinatus muscles were measured, with smaller T2 values indicating less fat content. Shoulders were evaluated on the basis of active range of motion (ROM), Constant and University of California Los Angeles Shoulder Rating Scale scores, shoulder external rotation strength with the arm at the side, and rotator cuff integrity on postoperative MRI.

Results: A total of 103 patients (103 shoulders) with a mean age of 65 ± 9 years (range, 42 to 83 years) were included, of whom 52 were male and 51 were female. There were 13 partial, 18 small, 35 medium, 33 large, and 4 massive tears. Concomitant subscapularis tears were observed in 35 shoulders. Overall, ROM, clinical scores, and external rotation strength significantly improved postoperatively. Retears were found in 27 shoulders (26%). External rotation strength significantly improved postoperatively only in shoulders without a retear. Among shoulders without a retear, the postoperative T2 values of the supraspinatus and infraspinatus were significantly smaller than the preoperative values (p < 0.001 for both); however, no improvement was seen in shoulders with a retear.

Conclusions: Shoulders with successful repair demonstrated significantly smaller T2 values postoperatively as well as significantly improved external rotation strength. Fatty degeneration of the cuff muscles can be reversed, at least in part, and muscle strength improves in shoulders with successful repair.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

背景:关于肩袖肌肉的脂肪变性是否会在肩袖修复后得到改善,目前仍存在争议。本研究旨在前瞻性地调查利用横向弛豫时间(T2)映射技术在磁共振成像(MRI)上定量测量的肩袖肌肉脂肪变性的变化,并评估这些变化与临床结果之间的关系:2014年6月至2015年12月期间计划使用缝合桥技术进行关节镜下肩袖修复术、术前接受了包括T2映射序列在内的磁共振成像检查并同意参与研究的患者均被纳入研究范围。排除标准包括术前 2 个月内接受过磁共振成像检查的外伤、孤立的肩胛下肌撕裂、补片增量、神经肌肉疾病以及随访时间超过《结果》:共纳入 103 例患者(103 肩),平均年龄为 65 ± 9 岁(42 至 83 岁),其中男性 52 例,女性 51 例。其中部分撕裂 13 例,小撕裂 18 例,中撕裂 35 例,大撕裂 33 例,大面积撕裂 4 例。35例肩胛下肌同时撕裂。总体而言,术后关节活动度、临床评分和外旋力量均有明显改善。27个肩部(26%)发现了再撕裂。只有没有再撕裂的肩关节在术后外旋力量才有明显改善。在未发生再撕裂的肩部中,冈上肌和冈下肌的术后T2值明显小于术前(P均小于0.001);但在发生再撕裂的肩部中未见改善:结论:成功修复的肩关节术后 T2 值明显变小,外旋力量明显提高。肩袖肌肉的脂肪变性可以逆转,至少是部分逆转,成功修复的肩部肌肉力量也有所改善:证据等级:治疗四级。有关证据级别的完整描述,请参阅 "作者须知"。
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引用次数: 0
Functional and Radiographic Outcomes of Open Proximal Femoral Fractures Caused by Gunshot Wounds in Yemen: A Prospective Cohort Study. 也门枪伤所致开放性股骨近端骨折的功能和影像学结果:前瞻性队列研究
Q2 ORTHOPEDICS Pub Date : 2024-01-11 eCollection Date: 2024-01-01 DOI: 10.2106/JBJS.OA.23.00085
Mohammad Hutaif, Abdullah Al-Moaish, Anwar Al-Fadliy

Background: Open proximal femoral fractures caused by gunshot wounds are rare but devastating injuries that pose considerable challenges for prognosis and management. The aim of this study was to evaluate the functional and radiographic outcomes of patients with open proximal femoral fractures caused by gunshot wounds treated at 3 Level-I trauma centers in Yemen and to identify the factors that influence them.

Methods: We prospectively enrolled 174 patients with open proximal femoral fractures caused by gunshot wounds. The fractures were classified according to the Gustilo-Anderson and OTA/AO systems. The primary outcome measures were fracture union, infection, and functional outcomes. The secondary outcome measures were the Harris hip score (HHS) and the Short Form-36 (SF-36) health survey score. We performed multivariable logistic regression modeling to identify the predictors of complications and poor functional outcomes.

Results: The overall rate of fracture union was 87%. The complication rates were 18% for infection, 13% for nonunion, 23% for reoperation, 12% for delayed union, 4% for osteonecrosis, 6% for heterotopic ossification, and 2% for amputation. The mean HHS at the final follow-up was 78.4, and the mean SF-36 score was 67.3.

Conclusions: Open proximal femoral fractures caused by gunshot wounds are associated with high rates of complications and poor functional outcomes in Yemen. Early debridement, appropriate fixation, infection control, and adequate soft-tissue coverage are essential for achieving satisfactory results. The type of wound, the type of fracture, and the type of definitive fixation are significant predictors of the outcomes. Future studies should compare different fixation methods and evaluate the long-term outcomes and complications of these injuries.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

背景:枪伤导致的开放性股骨近端骨折是一种罕见的破坏性损伤,给预后和治疗带来了巨大挑战。本研究旨在评估也门 3 家一级创伤中心收治的枪伤所致开放性股骨近端骨折患者的功能和影像学预后,并确定影响预后的因素:我们对174名因枪伤导致的开放性股骨近端骨折患者进行了前瞻性登记。这些骨折根据古斯蒂洛-安德森(Gustilo-Anderson)和OTA/AO系统进行分类。主要结果指标为骨折愈合、感染和功能性结果。次要结果指标为哈里斯髋关节评分(HHS)和短表格-36(SF-36)健康调查评分。我们进行了多变量逻辑回归建模,以确定并发症和不良功能预后的预测因素:结果:总体骨折愈合率为87%。并发症发生率为:感染 18%、不愈合 13%、再次手术 23%、延迟愈合 12%、骨坏死 4%、异位骨化 6%、截肢 2%。最终随访的平均 HHS 为 78.4,平均 SF-36 评分为 67.3:在也门,枪伤导致的开放性股骨近端骨折并发症发生率高,功能预后差。早期清创、适当固定、感染控制和充分的软组织覆盖对取得满意的疗效至关重要。伤口类型、骨折类型和最终固定的类型是预测疗效的重要因素。未来的研究应比较不同的固定方法,并评估这些损伤的长期疗效和并发症:证据级别:治疗 II 级。有关证据级别的完整描述,请参阅 "作者须知"。
{"title":"Functional and Radiographic Outcomes of Open Proximal Femoral Fractures Caused by Gunshot Wounds in Yemen: A Prospective Cohort Study.","authors":"Mohammad Hutaif, Abdullah Al-Moaish, Anwar Al-Fadliy","doi":"10.2106/JBJS.OA.23.00085","DOIUrl":"10.2106/JBJS.OA.23.00085","url":null,"abstract":"<p><strong>Background: </strong>Open proximal femoral fractures caused by gunshot wounds are rare but devastating injuries that pose considerable challenges for prognosis and management. The aim of this study was to evaluate the functional and radiographic outcomes of patients with open proximal femoral fractures caused by gunshot wounds treated at 3 Level-I trauma centers in Yemen and to identify the factors that influence them.</p><p><strong>Methods: </strong>We prospectively enrolled 174 patients with open proximal femoral fractures caused by gunshot wounds. The fractures were classified according to the Gustilo-Anderson and OTA/AO systems. The primary outcome measures were fracture union, infection, and functional outcomes. The secondary outcome measures were the Harris hip score (HHS) and the Short Form-36 (SF-36) health survey score. We performed multivariable logistic regression modeling to identify the predictors of complications and poor functional outcomes.</p><p><strong>Results: </strong>The overall rate of fracture union was 87%. The complication rates were 18% for infection, 13% for nonunion, 23% for reoperation, 12% for delayed union, 4% for osteonecrosis, 6% for heterotopic ossification, and 2% for amputation. The mean HHS at the final follow-up was 78.4, and the mean SF-36 score was 67.3.</p><p><strong>Conclusions: </strong>Open proximal femoral fractures caused by gunshot wounds are associated with high rates of complications and poor functional outcomes in Yemen. Early debridement, appropriate fixation, infection control, and adequate soft-tissue coverage are essential for achieving satisfactory results. The type of wound, the type of fracture, and the type of definitive fixation are significant predictors of the outcomes. Future studies should compare different fixation methods and evaluate the long-term outcomes and complications of these injuries.</p><p><strong>Level of evidence: </strong>Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
External Rotation Strength After TSA in Osteoarthritic Shoulders with Eccentric Deformity Is Not Impacted by Posterior Rotator Cuff Deficiency. 具有偏心畸形的骨关节炎肩关节 TSA 后的外旋强度不受肩袖后部缺损的影响。
Q2 ORTHOPEDICS Pub Date : 2024-01-09 eCollection Date: 2024-01-01 DOI: 10.2106/JBJS.OA.23.00053
Margaret S Coats-Thomas, Guido Marra, Daniel Ludvig, Ankur Garg, Eric J Perreault, Amee L Seitz

Background: Patients with persistent glenohumeral osteoarthritis symptoms despite nonoperative management may pursue anatomic total shoulder arthroplasty (TSA). TSA revision rates are higher in patients with preoperative eccentric (asymmetric posterior erosion) compared with concentric (symmetric) glenoid deformity. If posterior rotator cuff deficiency demonstrated preoperatively in patients with eccentric deformity persists after TSA, it may manifest as relative weakness in external compared with internal rotation secondary to deficient activity of the shoulder external rotator muscles. Persistent posterior rotator cuff deficiency is hypothesized to contribute to TSA failures. However, it remains unknown whether rotational strength is impaired after TSA in patients with eccentric deformity. Our goal was to determine if patients with eccentric deformity exhibit relative external rotation weakness that may be explained by posterior rotator cuff deficiency after TSA.

Methods: Patients who were >1 year after TSA for primary glenohumeral osteoarthritis and had had preoperative eccentric or concentric deformity were prospectively recruited. Torque was measured and electromyography was performed during maximal isometric contractions in 26 three-dimensional direction combinations. Relative strength in opposing directions (strength balance) and muscle activity of 6 shoulder rotators were compared between groups.

Results: The internal (+) and external (-) rotation component of strength balance did not differ in patients with eccentric (mean internal-external rotation component of strength balance: -7.6% ± 7.4%) compared with concentric deformity (-10.3% ± 6.8%) (mean difference: 2.7% [95% confidence interval (CI), -1.3% to 6.7%]; p = 0.59), suggesting no relative external rotation weakness. Infraspinatus activity was reduced in patients with eccentric (43.9% ± 10.4% of maximum voluntary contraction [MVC]) compared with concentric (51.3% ± 10.4% of MVC) deformity (mean difference: -7.4% [95% CI, -13.4% to -1.4%] of MVC; p = 0.04).

Conclusions: A relative external rotation strength deficit following TSA was not found, despite evidence of reduced infraspinatus activity, in the eccentric-deformity group. Reduced infraspinatus activity suggests that posterior rotator cuff deficiencies may persist following TSA in patients with eccentric deformities. Longitudinal study is necessary to evaluate muscle imbalance as a contributor to higher TSA failure rates.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

背景:非手术治疗后仍有持续性盂肱骨关节炎症状的患者可寻求解剖性全肩关节置换术(TSA)。与同心(对称)盂成形术相比,术前存在偏心(不对称后方侵蚀)盂畸形的患者TSA翻修率更高。如果偏心畸形患者术前表现出的后肩袖缺损在TSA术后持续存在,则可能表现为外旋相对于内旋无力,这是因为肩关节外旋肌活动不足所致。据推测,肩袖后部的持续缺损是导致 TSA 失败的原因之一。然而,偏心畸形患者在进行 TSA 后旋转力量是否会受损仍是未知数。我们的目标是确定偏心畸形患者是否表现出相对的外旋无力,而这可能是TSA术后肩袖后部缺损造成的:方法:前瞻性地招募了因原发性盂肱骨关节炎而接受TSA术后1年以上的患者,这些患者术前存在偏心或同心畸形。在 26 个三维方向组合的最大等长收缩过程中测量扭矩并进行肌电图检查。比较了不同组间对立方向的相对力量(力量平衡)和 6 个肩关节旋转肌的肌肉活动:结果:与同心畸形患者(-10.3% ± 6.8%)相比,偏心畸形患者的力量平衡的内旋(+)和外旋(-)部分没有差异(力量平衡的平均内旋-外旋部分:-7.6% ± 7.4%)(平均差异:2.7% [95% 置信区间 (CI),-1.3% 至 6.7%];p = 0.59),表明没有相对的外旋无力。与同心畸形(最大自主收缩[MVC]的 51.3% ± 10.4%)相比,偏心畸形(最大自主收缩[MVC]的 43.9% ± 10.4%)患者的冈下肌活动减少(平均差异:最大自主收缩[MVC]的-7.4% [95% CI, -13.4%至-1.4%];P = 0.04):结论:尽管有证据表明偏心畸形组冈下肌活动减少,但并未发现 TSA 后出现相对外旋力量不足。冈下活动的降低表明,偏心畸形患者在进行TSA后,肩袖后部的缺陷可能会持续存在。有必要进行纵向研究,以评估肌肉失衡是否是导致TSA失败率较高的因素:预后III级。有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
Clinical and Patient-Reported Outcomes After Total Wrist Arthroplasty and Total Wrist Fusion: A Prospective Cohort Study with 2-Year Follow-up. 全腕关节置换术和全腕关节融合术后的临床和患者报告结果:一项为期两年的前瞻性队列研究。
Q2 ORTHOPEDICS Pub Date : 2024-01-09 eCollection Date: 2024-01-01 DOI: 10.2106/JBJS.OA.23.00081
Martin Clementson, Sara Larsson, Antonio Abramo, Elisabeth Brogren

Background: The functional benefits of total wrist arthroplasty (TWA) over total wrist fusion (TWF) are unknown. The purpose of this prospective cohort study was to compare TWA and TWF with respect to functional outcomes and activity limitations at up to 2 years postoperatively.

Methods: Between 2015 and 2020, we enrolled all adult patients undergoing TWA or TWF for the management of symptomatic end-stage wrist arthritis at 1 hand surgery department. The primary outcome was the Patient-Rated Wrist Evaluation (PRWE). The secondary outcomes were the visual analog scale (VAS) for pain at rest, on motion, and on loading; grip strength; Disabilities of the Arm, Shoulder and Hand (DASH); and range of motion. Patients completed questionnaires and were examined by the same physiotherapist at baseline and at 3, 6, 12, and 24 months postoperatively. Mixed-model analyses adjusting for age, diagnosis, the preoperative value of the dependent variable, and time since surgery were performed to compare differences in PRWE scores, VAS pain scores, and grip strength between TWA and TWF.

Results: Of the 51 patients who had been included at baseline, 47 (18 in the TWA group and 29 in the TWF group) responded to questionnaires and underwent examinations at up to 2 years postoperatively. At baseline, the 2 groups did not differ in terms of age, sex, diagnosis (inflammatory or noninflammatory arthritis), PRWE score, VAS pain score, grip strength, DASH score, or range of motion. No differences between the groups were found for the PRWE (β, -0.1; 95% confidence interval [CI], -14 to 13; p = 0.99), VAS pain at rest (β, -3.3; 95% CI, -15 to 9; p = 0.58), VAS pain on loading (β, -5.3; 95% CI, -22 to 11; p = 0.52), or grip strength (β, -0.02; 95% CI, -0.18 to 0.14; p = 0.80) on the adjusted mixed-model analyses.

Conclusions: Among patients with symptomatic end-stage wrist arthritis, those who underwent TWA did not demonstrate short-term outcomes, including patient-reported disability, pain, and grip strength, superior to those of patients who underwent TWF. These findings call into question the widespread use of TWA.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

背景:与全腕关节融合术(TWF)相比,全腕关节置换术(TWA)的功能优势尚不清楚。这项前瞻性队列研究的目的是比较 TWA 和 TWF 在术后长达 2 年的功能结果和活动限制:方法:2015 年至 2020 年期间,我们在 1 个手外科部门招募了所有接受 TWA 或 TWF 治疗无症状终末期腕关节炎的成年患者。主要结果为患者腕部评分(Patient-Rated Wrist Evaluation,PRWE)。次要结果包括静息时、运动时和负重时疼痛的视觉模拟量表(VAS);握力;手臂、肩部和手部残疾(DASH);以及运动范围。患者在基线期、术后 3、6、12 和 24 个月时填写调查问卷,并由同一位理疗师进行检查。在对年龄、诊断、因变量的术前值和术后时间进行调整后,进行了混合模型分析,以比较TWA和TWF在PRWE评分、VAS疼痛评分和握力方面的差异:在基线时纳入的 51 名患者中,有 47 人(TWA 组 18 人,TWF 组 29 人)回答了调查问卷,并在术后最长 2 年接受了检查。基线时,两组患者在年龄、性别、诊断(炎症性或非炎症性关节炎)、PRWE 评分、VAS 疼痛评分、握力、DASH 评分或活动范围方面没有差异。在 PRWE(β,-0.1;95% 置信区间 [CI],-14 至 13;P = 0.99)、静息时 VAS 疼痛(β,-3.3;95% 置信区间 [CI],-15 至 9;P = 0.58)、负重时的 VAS 疼痛(β,-5.3;95% CI,-22 至 11;p = 0.52)或握力(β,-0.02;95% CI,-0.18 至 0.14;p = 0.80):结论:在有症状的终末期腕关节炎患者中,接受TWA治疗的患者在短期疗效(包括患者报告的残疾、疼痛和握力)上并不优于接受TWF治疗的患者。这些研究结果对TWA的广泛使用提出了质疑:证据级别:治疗 II 级。有关证据等级的完整描述,请参阅 "作者须知"。
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引用次数: 0
Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes. 骨折后深部手术部位感染对功能预后影响深远
Q2 ORTHOPEDICS Pub Date : 2024-01-09 eCollection Date: 2024-01-01 DOI: 10.2106/JBJS.OA.23.00042
Ida Leah Gitajn, Paul M Werth, Anthony R Carlini, Michael J Bosse, Joshua L Gary, Reza Firoozabadi, William Obremskey, Todd O McKinley, Renan C Castillo, Robert V O'Toole

Background: Fracture-related infection is one of the most challenging complications in orthopaedic trauma surgery. However, the effect of infection on functional and pain-related outcomes has not been well established. The aims of this study were to evaluate functional recovery for patients with fracture and a deep surgical site infection compared with patients with fracture without infection and to evaluate whether pain severity, social support, and preinjury mental health have a moderating effect on the magnitude and direction of the relationship between deep surgical site infection and functional recovery.

Methods: This is a secondary retrospective cohort study using prospectively collected data from the VANCO trial (Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection) and the OXYGEN (Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High Energy Fracture Surgery) trial. In this study, 2,116 patients with tibial plateau, pilon, or calcaneal fractures at high risk for infection were included. Patients were divided into cohorts of patients who experienced a deep surgical site infection and those who did not. The primary outcome measure was the functional outcome using the Veterans RAND 12-Item Health Survey (VR-12).

Results: After controlling for covariates, deep surgical site infection was independently associated with functional outcome, with a 3.3-point reduction in the VR-12 Physical Component Score, and pain severity was independently associated with functional outcome, with a 2.5-point reduction in the VR-12 Physical Component Score. Furthermore, the Brief Pain Inventory pain severity demonstrated an important moderating effect on the relationship between infection and functional outcome. In patients with lower pain scores, infection had a large negative impact on functional outcome, whereas, in patients with higher pain scores, infection had no significant impact on functional outcome. Furthermore, the functional outcome in the entire cohort remains at only 61% of baseline.

Conclusions: This study documents the negative impact of postoperative infection on functional recovery after injury, as well as the novel finding of pain severity as an important moderating factor. This study emphasizes not only the importance of developing effective interventions designed to reduce postoperative infection, but also the role that factors that moderate pain severity plays in limiting recovery of physical function.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

背景:骨折相关感染是创伤骨科手术中最具挑战性的并发症之一。然而,感染对功能和疼痛相关结果的影响尚未得到很好的证实。本研究旨在评估骨折合并深部手术部位感染患者与无感染的骨折患者相比的功能恢复情况,并评估疼痛严重程度、社会支持和受伤前心理健康是否对深部手术部位感染与功能恢复之间关系的程度和方向有调节作用:这是一项二次回顾性队列研究,使用了从 VANCO 试验(局部抗生素疗法减少感染高风险骨折术后感染)和 OXYGEN(围术期补充氧气减少高能骨折术后手术部位感染)试验中收集的前瞻性数据。在这项研究中,共纳入了 2,116 名胫骨平台、皮隆或小关节骨折的高感染风险患者。患者被分为发生深度手术部位感染和未发生感染两组。主要结果是使用退伍军人兰德12项健康调查(VR-12)来衡量功能结果:结果:在控制了协变量后,深部手术部位感染与功能预后独立相关,VR-12 物理成分得分降低了 3.3 分;疼痛严重程度与功能预后独立相关,VR-12 物理成分得分降低了 2.5 分。此外,简明疼痛量表的疼痛严重程度对感染与功能预后之间的关系有重要的调节作用。在疼痛评分较低的患者中,感染对功能预后有很大的负面影响,而在疼痛评分较高的患者中,感染对功能预后没有显著影响。此外,整个组群的功能结果仅为基线的 61%:本研究记录了术后感染对伤后功能恢复的负面影响,以及疼痛严重程度作为重要调节因素的新发现。这项研究不仅强调了制定有效干预措施以减少术后感染的重要性,还强调了疼痛严重程度的调节因素对身体功能恢复的限制作用:预后III级。有关证据级别的完整描述,请参阅 "作者须知"。
{"title":"Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes.","authors":"Ida Leah Gitajn, Paul M Werth, Anthony R Carlini, Michael J Bosse, Joshua L Gary, Reza Firoozabadi, William Obremskey, Todd O McKinley, Renan C Castillo, Robert V O'Toole","doi":"10.2106/JBJS.OA.23.00042","DOIUrl":"10.2106/JBJS.OA.23.00042","url":null,"abstract":"<p><strong>Background: </strong>Fracture-related infection is one of the most challenging complications in orthopaedic trauma surgery. However, the effect of infection on functional and pain-related outcomes has not been well established. The aims of this study were to evaluate functional recovery for patients with fracture and a deep surgical site infection compared with patients with fracture without infection and to evaluate whether pain severity, social support, and preinjury mental health have a moderating effect on the magnitude and direction of the relationship between deep surgical site infection and functional recovery.</p><p><strong>Methods: </strong>This is a secondary retrospective cohort study using prospectively collected data from the VANCO trial (Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection) and the OXYGEN (Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High Energy Fracture Surgery) trial. In this study, 2,116 patients with tibial plateau, pilon, or calcaneal fractures at high risk for infection were included. Patients were divided into cohorts of patients who experienced a deep surgical site infection and those who did not. The primary outcome measure was the functional outcome using the Veterans RAND 12-Item Health Survey (VR-12).</p><p><strong>Results: </strong>After controlling for covariates, deep surgical site infection was independently associated with functional outcome, with a 3.3-point reduction in the VR-12 Physical Component Score, and pain severity was independently associated with functional outcome, with a 2.5-point reduction in the VR-12 Physical Component Score. Furthermore, the Brief Pain Inventory pain severity demonstrated an important moderating effect on the relationship between infection and functional outcome. In patients with lower pain scores, infection had a large negative impact on functional outcome, whereas, in patients with higher pain scores, infection had no significant impact on functional outcome. Furthermore, the functional outcome in the entire cohort remains at only 61% of baseline.</p><p><strong>Conclusions: </strong>This study documents the negative impact of postoperative infection on functional recovery after injury, as well as the novel finding of pain severity as an important moderating factor. This study emphasizes not only the importance of developing effective interventions designed to reduce postoperative infection, but also the role that factors that moderate pain severity plays in limiting recovery of physical function.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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JBJS Open Access
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