Pub Date : 2024-03-05eCollection Date: 2024-03-01DOI: 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.
{"title":"Magnetic Resonance Imaging in Pediatric Acetabulum Fractures with Open Triradiate Cartilage-A Report of 3 Cases.","authors":"Shaan Sadhwani, Brian Omslaer, Jonathan Dalton, Brendan Sweeney, Z Deniz Olgun","doi":"10.5435/JAAOSGlobal-D-23-00233","DOIUrl":"10.5435/JAAOSGlobal-D-23-00233","url":null,"abstract":"<p><p>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.</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":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10914233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029141","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}
Pub Date : 2024-03-05eCollection Date: 2024-03-01DOI: 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.
{"title":"A Novel Surgical Indication for Scheuermann's Kyphosis.","authors":"Jason J Haselhuhn, Kari Odland, Paul Brian O Soriano, Kristen E Jones, David W Polly","doi":"10.5435/JAAOSGlobal-D-23-00187","DOIUrl":"10.5435/JAAOSGlobal-D-23-00187","url":null,"abstract":"<p><p>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.</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":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10914238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029138","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}
Pub Date : 2024-03-05eCollection Date: 2024-03-01DOI: 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.
{"title":"Outcomes of Name-brand Versus Generic Cephalomedullary Nail Fixation for Intertrochanteric and Subtrochanteric Fractures: A Matched Cohort Study.","authors":"Rebekah M Kleinsmith, Stephen A Doxey, Fernando A Huyke, Brian P Cunningham","doi":"10.5435/JAAOSGlobal-D-23-00186","DOIUrl":"10.5435/JAAOSGlobal-D-23-00186","url":null,"abstract":"<p><p>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.</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":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10917135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040625","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}
Pub Date : 2024-03-01DOI: 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.
{"title":"Racial Disparities in 30-day Readmission After Orthopaedic Surgery: A 5-year National Surgical Quality Improvement Program Database Analysis.","authors":"Victoria E Bergstein, Lucy R O'Sullivan, Kenneth H Levy, Ettore Vulcano, Amiethab A Aiyer","doi":"10.5435/JAAOSGlobal-D-24-00013","DOIUrl":"10.5435/JAAOSGlobal-D-24-00013","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</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/PMC10906581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029142","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}
Pub Date : 2024-03-01DOI: 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.
{"title":"An Analysis of Participant Preferences Regarding Virtual Versus In-person Format of Orthopaedic Surgery Educational Materials in Low- and Middle-Income Countries.","authors":"Michael J Flores, Kelsey E Brown, Madeline C MacKechnie, Jamieson M O'Marr, Patricia Rodarte, David W Shearer","doi":"10.5435/JAAOSGlobal-D-23-00134","DOIUrl":"10.5435/JAAOSGlobal-D-23-00134","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>Survey data were collected via e-mail after each SMART course using RedCap or Qualtrics. Statistical analyses were conducted using Stata.</p><p><strong>Results: </strong>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%).</p><p><strong>Discussion: </strong>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.</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/PMC10906641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029139","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}
Pub Date : 2024-03-01DOI: 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.
{"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}
Pub Date : 2024-02-29eCollection Date: 2024-03-01DOI: 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}
Pub Date : 2024-02-29eCollection Date: 2024-03-01DOI: 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}
Pub Date : 2024-02-22eCollection Date: 2024-02-01DOI: 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.
{"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}
Pub Date : 2024-02-22eCollection Date: 2024-02-01DOI: 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.
{"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}