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Magnetic Resonance Imaging in Pediatric Acetabulum Fractures with Open Triradiate Cartilage-A Report of 3 Cases. 小儿髋臼骨折伴开放性三叉软骨的磁共振成像--3 个病例的报告。
IF 1.5 Q3 Medicine Pub Date : 2024-03-05 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-23-00233
Shaan Sadhwani, Brian Omslaer, Jonathan Dalton, Brendan Sweeney, Z Deniz Olgun

We present three cases of posterior wall acetabulum fractures occurring in pediatric patients with open triradiate cartilage for whom preoperative magnetic resonance imaging was obtained and open reduction and internal fixation was done. All patients had excellent outcomes at an average of 68-week follow-up. Failure to adequately recognize the severity of pediatric acetabulum fractures can lead to detrimental long-term sequelae in acetabular development when treated nonsurgically. Management of this rare injury is not well reported in the literature. We highlight the utility of MRI in evaluating potential nonosseous injury and examining the articular surface to guide surgical management.

我们介绍了三例儿童髋臼后壁骨折病例,这些患者均为开放性三软骨骨折,术前均已获得磁共振成像,并进行了切开复位和内固定术。所有患者在平均 68 周的随访中均取得了良好的疗效。如果不能充分认识到小儿髋臼骨折的严重性,非手术治疗可能会导致髋臼发育方面的长期后遗症。关于这种罕见损伤的处理方法,文献报道不多。我们强调核磁共振成像在评估潜在的非骨性损伤和检查关节面以指导手术治疗方面的作用。
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引用次数: 0
A Novel Surgical Indication for Scheuermann's Kyphosis. Scheuermann's Kyphosis 的新手术适应症。
IF 1.5 Q3 Medicine Pub Date : 2024-03-05 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-23-00187
Jason J Haselhuhn, Kari Odland, Paul Brian O Soriano, Kristen E Jones, David W Polly

Scheuermann kyphosis can be treated surgically to restore proper sagittal alignment. Thoracic curves >70° are typically indicated for surgical intervention. However, patients who have reached their natural limit of compensatory lumbar hyperlordosis are at risk of accelerated degeneration. This can be determined by comparing lumbar lordosis on standing neutral radiographs and supine extension radiographs. Minimal additional lordosis in extension compared with neutral, abutment of the spinous processes, or greater lumbar lordosis standing than with attempted extension suggest the patient is maximally compensated. We present a case of an adolescent boy with Scheuermann kyphosis who had reached the limit of his hyperlordosis compensation reserve. He subsequently underwent a T4 to L2 posterior spinal fusion with T7 to T11 Ponte Smith-Petersen grade two osteotomies. He tolerated the procedure well with no intraoperative complications or neuromonitoring changes. The patient has continued to do well and progressed to normal activity at 5-month follow-up.

Scheuermann 脊柱弯曲可以通过手术治疗来恢复正常的矢状排列。胸椎弯曲度大于 70° 的患者通常需要进行手术治疗。然而,已达到腰椎过度前凸代偿自然极限的患者有加速退化的风险。这可以通过比较站立中立位X光片和仰卧位伸展位X光片上的腰椎前凸来确定。与中立位相比,患者在伸展时的腰椎前凸最小,脊柱棘突突出,或站立时的腰椎前凸大于尝试伸展时的腰椎前凸,这表明患者的腰椎代偿已达到最大程度。我们介绍了一例患有谢尔曼椎体后凸的青少年男孩,他的过度前凸代偿储备已达到极限。随后,他接受了 T4 至 L2 后路脊柱融合术和 T7 至 T11 Ponte Smith-Petersen 二级截骨术。他对手术的耐受性良好,术中未出现并发症或神经监测变化。随访5个月后,患者的情况一直很好,可以正常活动。
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引用次数: 0
Outcomes of Name-brand Versus Generic Cephalomedullary Nail Fixation for Intertrochanteric and Subtrochanteric Fractures: A Matched Cohort Study. 转子间和转子下骨折的名牌与普通头髓内钉固定术的疗效:一项匹配队列研究
IF 1.5 Q3 Medicine Pub Date : 2024-03-05 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-23-00186
Rebekah M Kleinsmith, Stephen A Doxey, Fernando A Huyke, Brian P Cunningham

This study aims to compare 90-day and 6-month outcomes and implant costs of intertrochanteric and subtrochanteric fracture fixation using cephalomedullary nails (CMNs) from a single name-brand company to fixation using generic CMNs. This was a retrospective matched cohort study. All CMN procedures for a single surgeon in a single US metropolitan institution from 2021 to 2022 were identified using current procedural terminology codes. Nearest neighbor 1:1 matching was conducted between the name-brand and generic cohorts controlling for (1) age, (2) American Society of Anesthesiologists score, and (3) Charlson Comorbidity Index. A total of 50 patients were successfully matched (25 namebrand versus 25 generic). The average implant cost per case for the name-brand group was $3,587 versus $1,615 for the generic group. Cost of disposables averaged $109 for the generic implant sets versus $916 for the name-brand (P < 0.001). Overall, a cost savings of 61% could be generated per case with the use of generic implants and disposables. Fixation of intertrochanteric and subtrochanteric fractures using generic CMNs produces similar outcomes compared with using name-brand CMNs for approximately half the implant cost.

本研究旨在比较使用单一名牌公司生产的头髓内钉(CMN)与使用普通CMN进行转子间和转子下骨折固定的90天和6个月疗效以及植入成本。这是一项回顾性匹配队列研究。研究人员使用当前的手术术语代码识别了 2021 年至 2022 年期间美国大都市中一家医疗机构的一名外科医生进行的所有 CMN 手术。在名牌组和非名牌组之间进行最近邻 1:1 匹配,并控制 (1) 年龄、(2) 美国麻醉医师协会评分和 (3) Charlson 合并症指数。共有 50 名患者成功配对(25 名名牌患者与 25 名普通患者)。名牌组每个病例的平均植入成本为 3,587 美元,而普通组为 1,615 美元。非专利植入物组的一次性用品平均成本为 109 美元,而名牌植入物组为 916 美元(P < 0.001)。总体而言,使用普通植入物和一次性耗材可为每个病例节省 61% 的成本。使用非专利 CMN 固定转子间骨折和转子下骨折的疗效与使用名牌 CMN 相似,而植入成本仅为其一半左右。
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引用次数: 0
Racial Disparities in 30-day Readmission After Orthopaedic Surgery: A 5-year National Surgical Quality Improvement Program Database Analysis. 骨科手术后 30 天再入院的种族差异:为期 5 年的国家外科质量改进计划数据库分析》(National Surgical Quality Improvement Program Database Analysis)。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-24-00013
Victoria E Bergstein, Lucy R O'Sullivan, Kenneth H Levy, Ettore Vulcano, Amiethab A Aiyer

Background: Readmission rate after surgery is an important outcome measure in revealing disparities. This study aimed to examine how 30-day readmission rates and causes of readmission differ by race and specific injury areas within orthopaedic surgery.

Methods: The American College of Surgeon-National Surgical Quality Improvement Program database was queried for orthopaedic procedures from 2015 to 2019. Patients were stratified by self-reported race. Procedures were stratified using current procedural terminology codes corresponding to given injury areas. Multiple logistic regression was done to evaluate associations between race and all-cause readmission risk, and risk of readmission due to specific causes.

Results: Of 780,043 orthopaedic patients, the overall 30-day readmission rate was 4.18%. Black and Asian patients were at greater (OR = 1.18, P < 0.01) and lesser (OR = 0.76, P < 0.01) risk for readmission than White patients, respectively. Black patients were more likely to be readmitted for deep surgical site infection (OR = 1.25, P = 0.03), PE (OR = 1.64, P < 0.01), or wound disruption (OR = 1.45, P < 0.01). For all races, all-cause readmission was highest after spine procedures and lowest after hand/wrist procedures.

Conclusions: Black patients were at greater risk for overall, spine, shoulder/elbow, hand/wrist, and hip/knee all-cause readmission. Asian patients were at lower risk for overall, spine, hand/wrist, and hip/knee surgery all-cause readmission. Our findings can identify complications that should be more carefully monitored in certain patient populations.

背景:术后再入院率是揭示差异的重要结果指标。本研究旨在探讨骨科手术中不同种族和特定损伤部位的 30 天再入院率和再入院原因有何不同:对美国外科医生学会-国家外科质量改进计划数据库中 2015 年至 2019 年的骨科手术进行了查询。根据自我报告的种族对患者进行分层。使用与特定损伤部位相对应的当前手术术语代码对手术进行分层。多元逻辑回归评估了种族与全因再入院风险以及特定原因导致的再入院风险之间的关联:在 780,043 名骨科患者中,30 天再入院的总体比例为 4.18%。与白人患者相比,黑人和亚裔患者的再入院风险分别更高(OR = 1.18,P < 0.01)和更低(OR = 0.76,P < 0.01)。黑人患者更有可能因深部手术部位感染(OR = 1.25,P = 0.03)、PE(OR = 1.64,P < 0.01)或伤口破坏(OR = 1.45,P < 0.01)而再次入院。在所有种族中,脊柱手术后全因再入院率最高,手/腕部手术后最低:结论:黑人患者在总体、脊柱、肩/肘、手/腕和髋/膝关节全因再入院风险较高。亚裔患者在整体、脊柱、手/腕和髋/膝手术中因各种原因再入院的风险较低。我们的研究结果可以确定在某些患者群体中应更仔细监测的并发症。
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引用次数: 0
An Analysis of Participant Preferences Regarding Virtual Versus In-person Format of Orthopaedic Surgery Educational Materials in Low- and Middle-Income Countries. 分析中低收入国家参与者对骨科手术教育材料的虚拟形式和现场形式的偏好。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-23-00134
Michael J Flores, Kelsey E Brown, Madeline C MacKechnie, Jamieson M O'Marr, Patricia Rodarte, David W Shearer

Introduction: The University of California, San Francisco Institute for Global Orthopaedics and Traumatology Surgical Management and Reconstructive Training (SMART) course has instructed orthopaedic surgeons from low-resource countries on soft-tissue reconstruction. Before the COVID-19 pandemic, the course was conducted in-person; however, it was transitioned to a virtual format during the pandemic. The aim of this study was to determine participant preferences regarding a virtual or in-person SMART course format.

Methods: Survey data were collected via e-mail after each SMART course using RedCap or Qualtrics. Statistical analyses were conducted using Stata.

Results: There were 247 survey respondents from 44 countries representing all world regions, with Africa (125, 51%) the most represented. Of those who attended both an in-person and virtual course, most (82%) preferred the in-person format. In addition, all measured course outcomes were significantly better for participants attending the in-person course. The most common reason for not attending an in-person course was the cost of travel (38, 51%).

Discussion: This study demonstrated a preference toward in-person learning for the SMART course. In addition, those surgeons participating in the in-person course endorsed increased positive outcomes from the course. Increased emphasis should be placed on in-person surgical skills training for low-resource surgeons.

导言:加利福尼亚大学旧金山分校全球骨科与创伤研究所的外科管理与重建培训(SMART)课程为来自资源匮乏国家的骨科医生提供了软组织重建方面的指导。在 COVID-19 大流行之前,该课程以面授形式进行;但在大流行期间,该课程转为虚拟形式。本研究旨在确定学员对虚拟或面对面 SMART 课程形式的偏好:每次 SMART 课程结束后,我们都会使用 RedCap 或 Qualtrics 通过电子邮件收集调查数据。使用 Stata 进行统计分析:来自 44 个国家的 247 名调查对象代表了世界所有地区,其中非洲最多(125 人,占 51%)。在同时参加面授和虚拟课程的受访者中,大多数(82%)更喜欢面授形式。此外,对于参加面授课程的学员来说,所有测评的课程结果都明显更好。不参加面授课程的最常见原因是旅行费用(38 人,51%):讨论:本研究表明,参加 SMART 课程的人员更倾向于现场学习。此外,参加面授课程的外科医生对课程的积极成果表示认可。应更加重视为资源匮乏的外科医生提供面对面的外科技能培训。
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引用次数: 0
Femoral Head Core Decompressions: Characterization of Subsequent Conversion to Total Hip Arthroplasty and Related Complications. 股骨头核心凹陷:随后转为全髋关节置换术及相关并发症的特征。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-24-00024
Will Jiang, Joshua Sanchez, Meera M Dhodapkar, Mengnai Li, Daniel Wiznia, Jonathan N Grauer

Background: Core decompression is a minimally invasive joint-preserving approach for early-stage osteonecrosis. The rate at which core decompression patients require total hip arthroplasty (THA) and rates of perioperative adverse outcomes have not been well-characterized.

Methods: Adult patients undergoing core decompression and/or THA with osteonecrosis of the femoral head were identified from the 2015 to 2021 Q3 PearlDiver M157 database. Those undergoing THA without or with antecedent core decompression were identified and matched 4:1 on age, sex, and Elixhauser Comorbidity Index. Postoperative 90-day adverse events were compared with multivariable analysis. Five-year rates of revision, dislocation, and periprosthetic fracture were compared by the Kaplan-Meier curve and log-rank tests.

Results: Core decompressions were identified for 3,025 patients of whom 387 (12.8%) went on to THA within 5 years (64% within the first year). The median time from initial core decompression to THA was 252 days. For THA, 26,209 adults were identified and 387 had prior core decompression. After matching, there were 1,320 without core decompression and 339 with core decompression. No statistically significant differences were observed in 90-day postoperative adverse events or 5-year rates of revision, dislocation, or periprosthetic fracture.

Conclusion: Core decompression may be an option for patients with osteonecrosis and does not seem to affect THA outcomes if required later.

背景:核心减压术是治疗早期骨坏死的一种微创关节保留方法。核心减压术患者需要进行全髋关节置换术(THA)的比例以及围手术期不良结局的发生率尚未得到很好的描述:从 2015 年至 2021 年 Q3 PearlDiver M157 数据库中确定了接受核心减压术和/或 THA 且股骨头坏死的成人患者。对未接受或先接受核心减压术的 THA 患者进行识别,并按年龄、性别和 Elixhauser 合并指数进行 4:1 匹配。通过多变量分析比较了术后 90 天的不良事件。通过 Kaplan-Meier 曲线和对数秩检验比较了五年内翻修、脱位和假体周围骨折的发生率:3,025名患者进行了核心减压,其中387人(12.8%)在5年内继续接受THA手术(64%在第一年内)。从首次核心减压到 THA 的中位时间为 252 天。就 THA 而言,26,209 名成人被确认为曾接受过核心减压术,其中 387 人曾接受过核心减压术。经过匹配后,1320 人未进行过核心减压,339 人进行过核心减压。在术后90天不良事件或5年翻修、脱位或假体周围骨折发生率方面,未观察到有统计学意义的差异:结论:骨坏死患者可以选择核心减压,如果以后需要,核心减压似乎不会影响THA的疗效。
{"title":"Femoral Head Core Decompressions: Characterization of Subsequent Conversion to Total Hip Arthroplasty and Related Complications.","authors":"Will Jiang, Joshua Sanchez, Meera M Dhodapkar, Mengnai Li, Daniel Wiznia, Jonathan N Grauer","doi":"10.5435/JAAOSGlobal-D-24-00024","DOIUrl":"10.5435/JAAOSGlobal-D-24-00024","url":null,"abstract":"<p><strong>Background: </strong>Core decompression is a minimally invasive joint-preserving approach for early-stage osteonecrosis. The rate at which core decompression patients require total hip arthroplasty (THA) and rates of perioperative adverse outcomes have not been well-characterized.</p><p><strong>Methods: </strong>Adult patients undergoing core decompression and/or THA with osteonecrosis of the femoral head were identified from the 2015 to 2021 Q3 PearlDiver M157 database. Those undergoing THA without or with antecedent core decompression were identified and matched 4:1 on age, sex, and Elixhauser Comorbidity Index. Postoperative 90-day adverse events were compared with multivariable analysis. Five-year rates of revision, dislocation, and periprosthetic fracture were compared by the Kaplan-Meier curve and log-rank tests.</p><p><strong>Results: </strong>Core decompressions were identified for 3,025 patients of whom 387 (12.8%) went on to THA within 5 years (64% within the first year). The median time from initial core decompression to THA was 252 days. For THA, 26,209 adults were identified and 387 had prior core decompression. After matching, there were 1,320 without core decompression and 339 with core decompression. No statistically significant differences were observed in 90-day postoperative adverse events or 5-year rates of revision, dislocation, or periprosthetic fracture.</p><p><strong>Conclusion: </strong>Core decompression may be an option for patients with osteonecrosis and does not seem to affect THA outcomes if required later.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10906578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029140","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
The Top 100 Classical and Contemporary Papers on Elbow Surgery: A Trend Analysis of Elbow Surgery Literature. 关于肘关节外科的 100 篇经典和当代论文:肘部手术文献趋势分析。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-02-29 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-23-00287
Jacob A Worden, Andrew M Gabig, Hayden L Cooke, Michael B Gottschalk, Eric R Wagner

Introduction: Bibliometric analyses provide an aggregate of the most frequently cited literature in a given field. The purpose of this study was to analyze the top 100 most-cited classical and contemporary papers relating to elbow surgery to serve as a reference for surgeons and trainees for educational and research purposes.

Methods: A search was conducted for all papers containing the term "elbow" in the categories Orthopedics, Surgery, and Sports Science in the Clarivate Web of Science. Classical papers were those published from 1980 to 2009, and contemporary papers were those published from 2010 to 2019. Articles were assessed by country of origin, authors and their credentials, parent journal, level of evidence, and topic.

Results: Citation frequency ranged from 86 to 867. Among the classical group, there were more level IV papers compared with level I papers; however, the opposite was true in the contemporary group. The most common topic in the classical group was elbow anatomy and function, and the most common topic in the contemporary group was lateral epicondylitis and medial epicondylitis and associated therapies.

Discussion: This bibliometric analysis serves to help guide surgeons and trainees on the highly cited articles and important topics in elbow surgery, demonstrating a shift to prospective randomized controlled trials in recent years.

Level of evidence: Level V (Systematic Review with Level V as Lowest LOE).

简介文献计量学分析提供了特定领域中最常被引用文献的总和。本研究的目的是分析与肘部手术相关的经典和现代论文中被引用次数最多的前 100 篇,为外科医生和受训人员的教育和研究提供参考:方法:在Clarivate Web of Science中搜索了所有包含 "肘部 "一词的论文,分类为骨科、外科和运动科学。经典论文指 1980 年至 2009 年发表的论文,当代论文指 2010 年至 2019 年发表的论文。文章按照来源国、作者及其资历、母刊、证据级别和主题进行评估:引用频率从86次到867次不等。在经典组中,IV 级论文多于 I 级论文;但在当代组中,情况恰恰相反。经典组中最常见的主题是肘部解剖和功能,而当代组中最常见的主题是外侧上髁炎和内侧上髁炎及相关疗法:该文献计量学分析有助于指导外科医生和受训人员了解肘关节手术中的高引用率文章和重要主题,显示了近年来向前瞻性随机对照试验的转变:五级(系统综述,五级为最低LOE)。
{"title":"The Top 100 Classical and Contemporary Papers on Elbow Surgery: A Trend Analysis of Elbow Surgery Literature.","authors":"Jacob A Worden, Andrew M Gabig, Hayden L Cooke, Michael B Gottschalk, Eric R Wagner","doi":"10.5435/JAAOSGlobal-D-23-00287","DOIUrl":"10.5435/JAAOSGlobal-D-23-00287","url":null,"abstract":"<p><strong>Introduction: </strong>Bibliometric analyses provide an aggregate of the most frequently cited literature in a given field. The purpose of this study was to analyze the top 100 most-cited classical and contemporary papers relating to elbow surgery to serve as a reference for surgeons and trainees for educational and research purposes.</p><p><strong>Methods: </strong>A search was conducted for all papers containing the term \"elbow\" in the categories Orthopedics, Surgery, and Sports Science in the Clarivate Web of Science. Classical papers were those published from 1980 to 2009, and contemporary papers were those published from 2010 to 2019. Articles were assessed by country of origin, authors and their credentials, parent journal, level of evidence, and topic.</p><p><strong>Results: </strong>Citation frequency ranged from 86 to 867. Among the classical group, there were more level IV papers compared with level I papers; however, the opposite was true in the contemporary group. The most common topic in the classical group was elbow anatomy and function, and the most common topic in the contemporary group was lateral epicondylitis and medial epicondylitis and associated therapies.</p><p><strong>Discussion: </strong>This bibliometric analysis serves to help guide surgeons and trainees on the highly cited articles and important topics in elbow surgery, demonstrating a shift to prospective randomized controlled trials in recent years.</p><p><strong>Level of evidence: </strong>Level V (Systematic Review with Level V as Lowest LOE).</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10906574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991460","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
A Systematic Review of the Orthoplastic Approach in Adult Lower Extremity Soft Tissue Sarcoma Flap Reconstruction. 成人下肢软组织肉瘤皮瓣重建整形方法的系统性回顾。
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-02-29 eCollection Date: 2024-03-01 DOI: 10.5435/JAAOSGlobal-D-23-00290
Myles N LaValley, David Dugue, Sarah E Diaddigo, Kevin G Kuonqui, Wakenda K Tyler, Jarrod T Bogue

Background: The orthoplastic approach to patient care has changed the way patients with a wide variety of lower extremity pathology are treated. Through a systematic review, we aim to analyze outcomes in adult patients with lower extremity soft tissue sarcomas who undergo an orthoplastic flap management approach to their care.

Methods: A systematic review of adult lower extremity soft tissue sarcoma excision with plastic surgery flap reconstruction was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines searching the Pubmed, Embase, and Web of Science databases from inception to April 2023.

Results: After removal of duplicates, title and abstract screening, and full-text review, 26 articles were accepted for inclusion. The total mean follow-up duration was 32.0 ± 24.3 months. Reconstruction used microvascular free flaps in 65.5% (487/743), while 34.5% (256/743) were local flaps. 85.8% (307/358) of patients ambulated postoperatively. Revision surgery was required in 21% of patients during their respective follow-up periods. The limb salvage rate was 93.4% (958/1,026). Among pooled surgical outcomes, 22.2% (225/1,012) of patients experienced a perioperative complication.

Discussion: Our study demonstrates that although complication rates in lower extremity soft tissue sarcoma reconstruction may be further optimized, a multidisciplinary flap reconstructive approach provides high rates of limb salvage and functional postoperative ambulation.

背景:矫形方法改变了治疗各种下肢病变患者的方式。通过系统回顾,我们旨在分析下肢软组织肉瘤成人患者接受整形皮瓣管理方法治疗后的疗效:根据《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)指南,我们在Pubmed、Embase和Web of Science数据库中搜索了从开始到2023年4月的成人下肢软组织肉瘤切除术与整形外科皮瓣重建术:结果:在去除重复文章、筛选标题和摘要以及全文审阅后,26 篇文章被接受纳入。总平均随访时间为(32.0 ± 24.3)个月。65.5%(487/743)的重建使用了微血管游离皮瓣,34.5%(256/743)使用了局部皮瓣。85.8%(307/358)的患者术后可以行走。21%的患者在随访期间需要进行翻修手术。肢体挽救率为93.4%(958/1,026)。在汇总的手术结果中,22.2%(225/1,012)的患者经历了围手术期并发症:讨论:我们的研究表明,虽然下肢软组织肉瘤重建术的并发症发生率有待进一步优化,但多学科皮瓣重建方法的肢体挽救率和术后功能活动率都很高。
{"title":"A Systematic Review of the Orthoplastic Approach in Adult Lower Extremity Soft Tissue Sarcoma Flap Reconstruction.","authors":"Myles N LaValley, David Dugue, Sarah E Diaddigo, Kevin G Kuonqui, Wakenda K Tyler, Jarrod T Bogue","doi":"10.5435/JAAOSGlobal-D-23-00290","DOIUrl":"10.5435/JAAOSGlobal-D-23-00290","url":null,"abstract":"<p><strong>Background: </strong>The orthoplastic approach to patient care has changed the way patients with a wide variety of lower extremity pathology are treated. Through a systematic review, we aim to analyze outcomes in adult patients with lower extremity soft tissue sarcomas who undergo an orthoplastic flap management approach to their care.</p><p><strong>Methods: </strong>A systematic review of adult lower extremity soft tissue sarcoma excision with plastic surgery flap reconstruction was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines searching the Pubmed, Embase, and Web of Science databases from inception to April 2023.</p><p><strong>Results: </strong>After removal of duplicates, title and abstract screening, and full-text review, 26 articles were accepted for inclusion. The total mean follow-up duration was 32.0 ± 24.3 months. Reconstruction used microvascular free flaps in 65.5% (487/743), while 34.5% (256/743) were local flaps. 85.8% (307/358) of patients ambulated postoperatively. Revision surgery was required in 21% of patients during their respective follow-up periods. The limb salvage rate was 93.4% (958/1,026). Among pooled surgical outcomes, 22.2% (225/1,012) of patients experienced a perioperative complication.</p><p><strong>Discussion: </strong>Our study demonstrates that although complication rates in lower extremity soft tissue sarcoma reconstruction may be further optimized, a multidisciplinary flap reconstructive approach provides high rates of limb salvage and functional postoperative ambulation.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10906598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991459","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
In-Office Needle Arthroscopy: Indications, Surgical Techniques, Tips, and Tricks. 诊室内针关节镜手术:适应症、手术技巧、窍门和诀窍。
IF 1.5 Q3 Medicine Pub Date : 2024-02-22 eCollection Date: 2024-02-01 DOI: 10.5435/JAAOSGlobal-D-23-00124
Arianna L Gianakos, John G Kennedy

In-office needle arthroscopy (IONA) has gained increased attention as a minimally invasive alternative to standard arthroscopy performed in the operating room (OR) setting. IONA uses instrumentation that is markedly smaller in size and diameter making arthroscopy less invasive. Less OR equipment and less OR staff are required resulting in procedures that may be more accessible and less expensive. IONA is typically performed using local intra-articular blocks, thereby reducing the need for regional anesthesia or general anesthesia along with its associated risks. Using a clinic setting rather than an OR reduces the cost and increases the efficiency of the procedure. This article will present the indications for IONA in upper and lower extremity injuries and will describe the best practice office setup. Technical pearls and pitfalls will also be discussed.

诊室内针关节镜(IONA)作为在手术室(OR)环境下进行的标准关节镜检查的微创替代方法,受到越来越多的关注。IONA 使用的器械尺寸和直径明显更小,因此关节镜手术的创伤更小。所需的手术室设备和手术室工作人员更少,从而使手术更方便,费用更低。IONA 通常使用局部关节内阻滞进行,从而减少了区域麻醉或全身麻醉及其相关风险。使用诊所环境而非手术室可降低成本并提高手术效率。本文将介绍 IONA 在上肢和下肢损伤中的适应症,并介绍最佳实践的诊室设置。还将讨论技术要点和陷阱。
{"title":"In-Office Needle Arthroscopy: Indications, Surgical Techniques, Tips, and Tricks.","authors":"Arianna L Gianakos, John G Kennedy","doi":"10.5435/JAAOSGlobal-D-23-00124","DOIUrl":"10.5435/JAAOSGlobal-D-23-00124","url":null,"abstract":"<p><p>In-office needle arthroscopy (IONA) has gained increased attention as a minimally invasive alternative to standard arthroscopy performed in the operating room (OR) setting. IONA uses instrumentation that is markedly smaller in size and diameter making arthroscopy less invasive. Less OR equipment and less OR staff are required resulting in procedures that may be more accessible and less expensive. IONA is typically performed using local intra-articular blocks, thereby reducing the need for regional anesthesia or general anesthesia along with its associated risks. Using a clinic setting rather than an OR reduces the cost and increases the efficiency of the procedure. This article will present the indications for IONA in upper and lower extremity injuries and will describe the best practice office setup. Technical pearls and pitfalls will also be discussed.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10883628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933459","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
Effect of Antibiotic Spacer Dosing on Treatment Success in Two-Stage Exchange for Periprosthetic Joint Infection. 抗生素间隔剂量对两阶段交换治疗假体周围关节感染成功率的影响
IF 1.5 Q3 Medicine Pub Date : 2024-02-22 eCollection Date: 2024-02-01 DOI: 10.5435/JAAOSGlobal-D-23-00103
Hunter S Warwick, Timothy L Tan, Khuzaima Rangwalla, David N Shau, Jeffrey J Barry, Erik N Hansen

Introduction: In two-stage exchange for periprosthetic joint infection (PJI), adding antibiotics to cement spacers is the standard of care; however, little is known about optimal dosage. There is emphasis on using >3.6 g of total antibiotic, including ≥2.0 g of vancomycin, per 40 g of cement, but these recommendations lack clinical evidence. We examined whether recommended antibiotic spacer doses affect treatment success.

Methods: This was a retrospective review of 202 patients who underwent two-stage exchange for PJI from 2004 to 2020 with at least 1-year follow-up. Patients were separated into high (>3.6 g of total antibiotic per 40 g of cement) and low-dose spacer groups. Primary outcomes were overall and infectious failure.

Results: High-dose spacers were used in 80% (162/202) of patients. High-dose spacers had a reduced risk of overall (OR, 0.37; P = 0.024) and infectious (OR, 0.35; P = 0.020) failure for infected primary arthroplasties, but not revisions. In multivariate analysis, vancomycin dose ≥2.0 g decreased the risk of infectious failure (OR, 0.31; P = 0.016), although not overall failure (OR, 0.51; P = 0.147).

Conclusion: During two-stage exchange for PJI, spacers with greater than 3.6 g of total antibiotic may reduce overall and infectious failure for infected primary arthroplasties. Furthermore, using at least 2.0 g of vancomycin could independently decrease the risk of infectious failure.

简介:在两阶段置换治疗假体周围关节感染(PJI)的过程中,在骨水泥垫片中添加抗生素是标准的治疗方法;然而,人们对最佳用量知之甚少。人们强调每 40 克骨水泥中应使用大于 3.6 克的抗生素总量,其中包括≥2.0 克万古霉素,但这些建议缺乏临床证据。我们研究了推荐的抗生素垫片剂量是否会影响治疗成功率:这是一项回顾性研究,研究对象是 2004 年至 2020 年期间因 PJI 接受两阶段置换术且随访至少 1 年的 202 例患者。患者被分为高剂量组(每 40 克骨水泥中抗生素总量大于 3.6 克)和低剂量垫片组。主要结果为总体和感染性失败:80%的患者(162/202)使用了高剂量间隔器。高剂量间隔器降低了感染性初次关节置换术的总体失败风险(OR,0.37;P = 0.024)和感染性失败风险(OR,0.35;P = 0.020),但没有降低翻修风险。在多变量分析中,万古霉素剂量≥2.0 g可降低感染性失败的风险(OR,0.31;P = 0.016),但不能降低总体失败的风险(OR,0.51;P = 0.147):结论:在两阶段置换治疗 PJI 期间,抗生素总量大于 3.6 克的间隔器可降低感染性初级关节置换术的总体失败率和感染性失败率。此外,使用至少 2.0 克万古霉素可独立降低感染失败的风险。
{"title":"Effect of Antibiotic Spacer Dosing on Treatment Success in Two-Stage Exchange for Periprosthetic Joint Infection.","authors":"Hunter S Warwick, Timothy L Tan, Khuzaima Rangwalla, David N Shau, Jeffrey J Barry, Erik N Hansen","doi":"10.5435/JAAOSGlobal-D-23-00103","DOIUrl":"10.5435/JAAOSGlobal-D-23-00103","url":null,"abstract":"<p><strong>Introduction: </strong>In two-stage exchange for periprosthetic joint infection (PJI), adding antibiotics to cement spacers is the standard of care; however, little is known about optimal dosage. There is emphasis on using >3.6 g of total antibiotic, including ≥2.0 g of vancomycin, per 40 g of cement, but these recommendations lack clinical evidence. We examined whether recommended antibiotic spacer doses affect treatment success.</p><p><strong>Methods: </strong>This was a retrospective review of 202 patients who underwent two-stage exchange for PJI from 2004 to 2020 with at least 1-year follow-up. Patients were separated into high (>3.6 g of total antibiotic per 40 g of cement) and low-dose spacer groups. Primary outcomes were overall and infectious failure.</p><p><strong>Results: </strong>High-dose spacers were used in 80% (162/202) of patients. High-dose spacers had a reduced risk of overall (OR, 0.37; P = 0.024) and infectious (OR, 0.35; P = 0.020) failure for infected primary arthroplasties, but not revisions. In multivariate analysis, vancomycin dose ≥2.0 g decreased the risk of infectious failure (OR, 0.31; P = 0.016), although not overall failure (OR, 0.51; P = 0.147).</p><p><strong>Conclusion: </strong>During two-stage exchange for PJI, spacers with greater than 3.6 g of total antibiotic may reduce overall and infectious failure for infected primary arthroplasties. Furthermore, using at least 2.0 g of vancomycin could independently decrease the risk of infectious failure.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10883627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933458","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
期刊
Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
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