Orthopaedics and Trauma最新文献

英文中文

Minding the gap: management of bone defects after trauma 注意缝隙：创伤后骨缺损的处理

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-10-01 DOI: 10.1016/j.mporth.2025.08.005

Babajide Simon Taiwo, Princewill Chiemelu Okoye, Anthony Rayner, Enis Guryel, Alastair Robertson

Bone defects which constitute a major orthopaedic challenge can arise from various causes, including trauma, infection, tumours, or surgical resections. These defects can lead to significant functional impairment and disability, particularly when they are classified as critical-sized defects. Treatment modalities for bone defects are influenced by factors such as defect size, the condition of adjacent soft tissue, and patient-specific considerations including age and co-morbidities. Therapeutic options include bone grafting techniques, distraction osteogenesis, and the Masquelet technique, each with its advantages and limitations. Recent advancements have improved surgical techniques and biomaterials, facilitating limb salvage and functional restoration. Emerging trends highlight the combination of treatment methods like the induced membrane technique and the use of titanium mesh cages, which enhance healing outcomes by providing stability and promoting vascular ingrowth. Innovative approaches in bone tissue engineering also offer promise in optimizing treatment for orthopaedic trauma patients with critical-sized defects. Future directions in research must focus on tailoring treatment options to individual patient needs while integrating advanced bone tissue engineering techniques to improve healing and restore functionality.

骨缺损是骨科面临的一个重大挑战，它可以由各种原因引起，包括创伤、感染、肿瘤或手术切除。这些缺陷可以导致显著的功能损伤和残疾，特别是当它们被归类为临界大小的缺陷时。骨缺损的治疗方式受多种因素的影响，如缺损的大小、邻近软组织的状况以及患者的具体考虑因素，包括年龄和合并症。治疗选择包括植骨技术、牵张成骨和Masquelet技术，每种技术都有其优点和局限性。最近的进展已经改进了手术技术和生物材料，促进了肢体的保留和功能恢复。新兴趋势突出了治疗方法的结合，如诱导膜技术和钛网笼的使用，通过提供稳定性和促进血管长入来提高愈合效果。骨组织工程的创新方法也为具有临界尺寸缺陷的骨科创伤患者提供了优化治疗的希望。未来的研究方向必须集中在定制治疗方案，以满足个体患者的需求，同时整合先进的骨组织工程技术，以提高愈合和恢复功能。

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引用次数: 0

Complications of distal radius fractures in the skeletally mature patient 骨成熟患者桡骨远端骨折的并发症

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-07-14 DOI: 10.1016/j.mporth.2025.06.001

Madeleine Bickley, Hannah James, Michael David

Distal radius fractures (DRFs) are some of the most common fractures seen in the emergency department, accounting for up to one in six of all fractures seen. Given the high prevalence of this injury, complications following DRF are a significant concern, regardless of how they are managed. A robust understanding of these, and how they can be avoided, is essential to any orthopaedic practitioner. This paper sets out the complications associated with DRFs, stratified into six broad categories relating to healing and biomechanics, infection, neurovascular structures, tendon injury, pain, and psychological factors. We will outline associated risk factors, treatment strategies and tips to avoid each complication.

桡骨远端骨折（DRFs）是急诊科最常见的骨折之一，占所有骨折的六分之一。鉴于这种损伤的高发生率，无论如何处理，DRF后的并发症都是一个值得关注的问题。一个强有力的了解这些，以及如何避免他们，是必不可少的任何骨科医生。本文列出了与DRFs相关的并发症，分为六大类，涉及愈合和生物力学、感染、神经血管结构、肌腱损伤、疼痛和心理因素。我们将概述相关的危险因素、治疗策略和避免每种并发症的提示。

引用次数: 0

Wrist denervation: surgical decision-making and technical considerations 腕部去神经支配：手术决策和技术考虑

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-07-14 DOI: 10.1016/j.mporth.2025.06.003

Suzanne E Thomson, Chrishan Mariathas, Robert Farnell

Wrist pain, secondary to trauma or degeneration, impacts an increasing number of individuals, resulting in reduced function, psychosocial impact and an associated socioeconomic cost. Wrist denervation is a motion-preserving surgical option in the management of chronic wrist pain. It relies on an understanding of wrist anatomy to selectively disconnect distal radio-ulnar and carpal articular branches of the median, radial and, or without, ulnar nerves. Several surgical variations have been described and the reasons for our preferred method is outlined here. Surgical indications include following scaphoid trauma, Kienbock's disease, inflammatory arthritis, ulnocarpal abutment and occupation-associated vibration hand syndrome. Appropriate patient selection relies on a detailed history and evaluation. Preoperative local anaesthetic may be administered in clinic to simulate and predict surgical outcomes. Both partial and total denervation results in improvement of objectively measured grip strength and pain scales, and this is reflected by the high return to work rate postoperatively. The duration of relief is variable and the surgery does not influence disease progression, so patients should be counselled that further, function limiting surgeries may be required. Postoperative complications include recurrence, scar tenderness and rarely neuroma. Partial neurectomy can be performed alongside other motion-preserving surgical interventions and it may delay or obviate the need for function-reducing surgeries. As such it is a key tool in the wrist surgeon's armamentarium.

继发于创伤或退行性变的手腕疼痛影响到越来越多的个体，导致功能下降、社会心理影响和相关的社会经济成本。腕部去神经支配是治疗慢性腕部疼痛的一种保持运动的手术选择。它依赖于对腕部解剖学的理解，选择性地断开正中神经、桡骨神经和尺神经或没有尺神经的远端桡尺和腕关节分支。已经描述了几种不同的手术方法，这里概述了我们首选方法的原因。手术指征包括：舟状骨创伤、Kienbock病、炎症性关节炎、尺腕基台和职业相关振动手综合征。适当的患者选择依赖于详细的病史和评估。术前局部麻醉可用于临床模拟和预测手术结果。部分和全部去神经都能改善客观测量的握力和疼痛量表，这反映在术后高的工作恢复率上。缓解的持续时间是可变的，手术不影响疾病进展，因此应告知患者，可能需要进一步的功能限制手术。术后并发症包括复发、瘢痕压痛和少见的神经瘤。部分神经切除术可以与其他保持运动的手术干预一起进行，它可以延迟或避免功能降低手术的需要。因此，它是腕部外科医生装备中的关键工具。

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引用次数: 0

Unravelling ulna-sided wrist pain 解开尺骨侧手腕疼痛

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-07-14 DOI: 10.1016/j.mporth.2025.06.002

Alastair Faulkner, Daniel Brown

Ulna-sided wrist pain is a common presenting condition, however the unique and complex anatomy of that area presents wide-ranging diagnostic challenges. Ulnar-sided wrist pain can be due to: bony, cartilaginous or ligamentous injury; joint instability in the carpus or distal radioulnar joint; bony impingement; nerve compression; tendon dysfunction or arthritis. The aim of this review article is to detail the important relevant anatomy and the associated pathoanatomy in order to understand the conditions; and to highlight relevant history, examination findings, and investigations that can help decipher the problem and make a correct diagnosis.

尺骨侧腕关节疼痛是一种常见的症状，然而该区域独特而复杂的解剖结构给诊断带来了广泛的挑战。尺侧腕关节疼痛可由以下原因引起：骨质、软骨或韧带损伤；腕骨或尺桡关节远端关节不稳；骨撞击;神经压迫;肌腱功能障碍或关节炎。这篇综述文章的目的是详细介绍重要的相关解剖和相关病理解剖，以便了解病情；并强调相关的历史，检查结果，和调查，可以帮助破译问题，并作出正确的诊断。

引用次数: 0

Wrist arthroscopy: indications, portal anatomy and therapeutic advances 腕部关节镜：指征、门静脉解剖及治疗进展

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-07-14 DOI: 10.1016/j.mporth.2025.06.004

Philip Mathew, Fabio Andres Tandioy-Delgado

Wrist arthroscopy has revolutionized the management of wrist pathology in recent years. This article aims to provide the reader with an overview of the procedure, its indications, set-up, and its applications, both diagnostic and therapeutic. A good knowledge of anatomy is a pre-requisite to performing safe arthroscopic surgery and thus decrease iatrogenic complications. Advances in technology and techniques have allowed the safe utilization of wrist arthroscopy with good outcomes for a wider range of indications.

近年来，腕部关节镜检查彻底改变了腕部病理的处理。本文旨在为读者提供一个概述的程序，它的适应症，设置，和它的应用，诊断和治疗。良好的解剖学知识是进行安全关节镜手术的先决条件，从而减少医源性并发症。技术和技术的进步使腕关节镜手术在更广泛的适应症中得到了安全的应用和良好的结果。

引用次数: 0

Anatomy and approaches of the wrist 腕部解剖与入路

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-07-14 DOI: 10.1016/j.mporth.2025.06.005

Joseph Alsousou, Vijay Bhalaik

A thorough knowledge of the anatomy of the wrist is key to performing successful approaches to the complex tendon, ligament, neural and articular structures of the wrist. Several approaches have been described in the literature employing a range of anatomical planes. These approaches can be categorized into dorsal, volar and specialized approaches. Eight surgical approaches within the three categories are described in this article. The relevant anatomy for each approach is described, including details of vascular, neural, osseous, articular and ligamentous relations. This is followed by description of the surgical approaches to the distal radius, distal radio-ulnar joint, carpal tunnel, Guyon’s canal, volar distal radius, volar scaphoid, dorsal scaphoid and de Quervain’s release.

全面了解腕部解剖结构是成功治疗腕部复杂肌腱、韧带、神经和关节结构的关键。文献中描述了几种采用一系列解剖平面的方法。这些入路可分为背侧入路、掌侧入路和专门入路。在这篇文章中描述了三类中的八种手术入路。描述了每个入路的相关解剖，包括血管、神经、骨、关节和韧带关系的细节。接下来介绍桡骨远端、桡尺关节远端、腕管、guy’s管、掌侧桡骨远端、掌侧舟状骨、舟状骨背侧和de Quervain松解术的手术入路。

引用次数: 0

Radiology of the wrist 腕部放射学

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-07-12 DOI: 10.1016/j.mporth.2025.06.009

Priam Heire, David Temperley, Raj Murali

The anatomy and biomechanics of the wrist are complex and the joint can be affected by a wide range of pathology. Here, we explain the radiological anatomy of the wrist joint with respect to various imaging modalities. Trauma is a major cause of wrist pain and disability and can involve fractures, ligamentous and other soft tissue injuries. Fractures of the scaphoid can lead to avascular necrosis, non-union and accelerated osteoarthritis. Injuries of the intrinsic ligaments can disrupt the normal biomechanical relationship of the scaphoid and trapezium and cause instability and scapholunate advanced collapse. Carpal dislocations are severe injuries and include lunate dislocation, where the lunate dislocates in a volar direction, or perilunate dislocation, where there is dislocation of the carpus relative to the lunate. Tears of the triangular fibrocartilage can be traumatic or degenerate and are best imaged with MR arthrography. Diagnosis of distal radioulnar joint instability can be problematic but there are various methods which can be employed, including the Mino, epicentre and congruency techniques. The wrist joint can be involved in all types of arthropathy, most commonly osteoarthritis which is commonly seen at the base of the thumb. Rheumatoid arthritis is an inflammatory condition and ultrasound is a very sensitive examination for assessment of active synovitis, tenosynovitis or tendon rupture.

手腕的解剖和生物力学是复杂的，关节可以受到各种病理的影响。在这里，我们解释了腕关节的放射解剖学与各种成像方式。创伤是手腕疼痛和残疾的主要原因，可能包括骨折、韧带和其他软组织损伤。舟状骨骨折可导致无血管坏死、骨不愈合和加速骨关节炎。固有韧带损伤会破坏舟状骨和斜方骨的正常生物力学关系，导致不稳定和舟月骨晚期塌陷。腕关节脱位是一种严重的损伤，包括月骨脱位，即月骨在掌侧方向脱位，或月骨周围脱位，即腕骨相对于月骨脱位。三角纤维软骨的撕裂可能是外伤性的或退行性的，MR关节摄影是最好的成像方法。远端尺桡关节不稳定的诊断可能是有问题的，但有各种方法可以采用，包括米诺，震中和一致性技术。腕关节可涉及所有类型的关节病，最常见的骨关节炎常见于拇指基部。类风湿关节炎是一种炎症性疾病，超声是评估活动性滑膜炎、腱鞘炎或肌腱断裂的一种非常敏感的检查。

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引用次数: 0

Answers to the CME questions on Orthopaedic Oncology 关于骨科肿瘤的CME问题解答

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-07-11 DOI: 10.1016/j.mporth.2025.06.007

引用次数: 0

CME questions on The Wrist 关于The Wrist的CME问题

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-07-11 DOI: 10.1016/j.mporth.2025.06.008

引用次数: 0

Clinical examination of the wrist 腕关节的临床检查

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-07-11 DOI: 10.1016/j.mporth.2025.06.006

Hassaan Sheikh, Dan Morell

A well-rehearsed and slick clinical examination of the wrist is key to a successful outcome in the FRCS exam as well as ascertaining accurate diagnosis of a patient’s symptoms. Precise localization of the pathology from a focused history and thorough examination is crucial prior to requesting appropriate investigations. Although localization of offending pathology can be difficult due to multiple anatomical structures in close proximity, a systematic examination will avoid missed pathology. It is useful to compartmentalize wrist symptoms as being radial sided, central or ulnar sided whilst taking the history as this will direct the examiner to focus their examination accordingly. This article will detail a routine of wrist examination with subsequent focus on specific tests and findings present in common subacute and elective conditions. As with any musculoskeletal examination, the key to accurate diagnosis is working knowledge of underlying anatomy and its relevance to functions of the wrist and hand. Whilst the scope of this article limits discussion of anatomy, it is highly recommended to be well versed with this.

精心排练和熟练的手腕临床检查是FRCS检查成功结果的关键，也是确定患者症状的准确诊断的关键。在要求适当的调查之前，从集中的病史和彻底的检查中精确定位病理是至关重要的。虽然由于多个解剖结构接近，很难定位病变，但系统的检查将避免遗漏的病理。在记录病史的同时，将腕关节症状划分为桡侧、中央侧或尺侧是很有用的，因为这将指导检查者相应地集中检查。本文将详细介绍常规手腕检查，随后重点介绍常见亚急性和选择性疾病的具体检查结果。与任何肌肉骨骼检查一样，准确诊断的关键是基础解剖学知识及其与手腕和手的功能的相关性。虽然本文的范围限制了对解剖学的讨论，但强烈建议您精通解剖学。

引用次数: 0

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