Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews最新文献

Injuries to the cardinal spine are quite uncommon in pediatric patients. Nonetheless, the second cervical vertebra are crucial for the human neck's extension and rotation. Surgery is the most typical treatment for patients who have a type II fracture of the cardinal vertebra's odontoid process along with a considerable displacement of the odontoid process. Nonetheless, surgical intervention is characterized by challenges and problems following surgery. For the first time, a youngster who had a type II fracture of the cardinal vertebra's odontoid process and substantial odontoid process displacement is described in this work. The child healed with conservative treatment. In addition to studying pertinent literature, the case history data, speciality and ancillary investigations, treatment approaches, and treatment outcomes are all thoroughly detailed.

Introduction: Proximal femoral fractures (PFFs) are a notable source of morbidity and mortality in elderly populations, with 1-year mortality rates ranging from 15% to 30% and projected incidence set to rise markedly. Interdisciplinary care models, including the integration of a nurse practitioner (NP), have shown the potential to improve outcomes in this vulnerable population.

Methods: We held a retrospective cohort study to evaluate the impact of adding a geriatric NP to the orthopedic department on mortality and hospitalization outcomes in patients with PFFs. A total of 2,065 patients were included: 1,300 from the preintervention period (2017 to 2020) and 765 from the NP-intervention period (2021 to 2024).

Results: Key outcomes revealed a notable reduction in in-hospital mortality from 5.6% to 2.4% (P = 0.0005) and an improvement in 1-year survival rates during the NP-intervention period. Kaplan-Meier analysis and Cox regression demonstrated a notable survival benefit with NP involvement, with average survival extending from 1.3 to 2.3 years (P < 0.001). The average length of stay decreased from 9.3 to 8.4 days (P = 0.003), and patient transfers to other departments were reduced by nearly one third.

Conclusion: These results highlight the positive effect of a geriatric NP on survival, hospital efficiency, and continuity of care for elderly PFF patients. The NP-led model, focusing on perioperative coordination, discharge planning, and comprehensive care, offers a promising approach to address the growing demand for geriatric fracture management, supporting its broader implementation to improve clinical and economic outcomes.

Implications for clinical practice: Our findings support the adoption of geriatric-focused, NP-led interventions in orthopedic settings to optimize the care of elderly fracture patients, aligning with current trends in interdisciplinary approaches to geriatric health care. Expanding this model may improve outcomes on a larger scale, addressing the growing needs of an aging population while promoting high-quality, cost-effective care in geriatric fracture management.

Background: Limited data exist on factors contributing to delayed repair of patellar tendon ruptures. This study describes the experience of a single surgeon managing acute and chronic patellar tendon tears, focusing on patient demographics, socioeconomic characteristics, and short-term surgical outcomes.

Methods: We conducted a retrospective cohort analysis of patellar tendon repairs performed at a single institution from January 2017 to January 2024. Patients were stratified into acute or chronic groups based on whether surgery occurred within 6 weeks of injury. Socioeconomic background was assessed using the area deprivation index, reported as national percentiles (1% to 100%) and state-normed deciles (1 to 10), with higher rankings indicating greater disadvantage. Mann-Whitney U and chi square tests were used for analysis.

Results: Of the 70 patients included, 45 underwent acute and 25 chronic repairs. Groups did not differ significantly in age, body mass index, race/ethnicity, comorbidities, insurance status, or area deprivation index scores. Surgical complications, infection, revision surgery rates, and postoperative range of motion scores were not statistically different. Functional outcomes such as strength and return to work were not measured.

Discussion: Within our predominantly minority, single-surgeon cohort, our analysis of socioeconomic characteristics revealed an average to moderate level of disadvantage with no notable demographic differences between the two groups. In addition, when appropriately managed, we found no statistically significant differences in surgical complications and postoperative range of motion values. These results reflect a specific practice setting and population. Broader studies incorporating functional outcomes and more diverse populations are needed to better understand delayed presentations and optimize care.

Introduction: Anatomic total shoulder arthroplasty (aTSA) is the preferred treatment for patients with glenohumeral osteoarthritis (GHOA) who have an intact rotator cuff experiencing limited range of motion (ROM) and/or pain unrelieved by nonsurgical care. This study evaluates the impact of socioeconomic status (SES) and social determinants of health (SDOH) on outcomes after aTSA.

Methods: This single-center retrospective study analyzed patients who underwent aTSA for GHOA between 2017 and 2021. Patients were grouped by zip code-based income and social deprivation using definitions from the Department of Housing and Urban Development (HUD), the Federal Reserve (FED), and the Social Deprivation Index (SDI). Demographics, complications, and 2-year American Shoulder and Elbow Surgeons (ASES) scores were collected. Analysis included ANOVA, Kruskal-Wallis, and chi-square tests.

Results: Of 105 patients, 86 (83%) had 2-year ASES scores. No differences were found in preoperative comorbidities. Differences in sex, race, and age were observed among FED and HUD groups, and in race and age among SDI groups. ASES scores differed among FED (P = 0.043) and HUD (P = 0.01) groups, as did active abduction among HUD groups (P = 0.03). No differences were found in ASES by SDI or in postoperative pain, other ROM measures, strength, or complications across groups.

Discussion: This study found differences in ASES scores by FED and HUD, but not by SDI. However, these differences may not be clinically significant. Worse active abduction in lower SES HUD groups was clinically significant. Despite institutional efforts to improve access, these disparities in outcomes highlight the need to reduce barriers to postoperative rehabilitation and recovery.

Aims: Reconstructing hips in moderate-to-severe developmental dysplasia of the hip (DDH) in adults, such as Hartofilakidis type B-C, presents a notable challenge. Despite various surgical procedures available, no approach has shown consistent long-term success. This observational study aimed to report the long-term survivorship and outcomes of a "selective osteotomy treatment algorithm," which involves selective osteotomy combined with anatomic hip restoration, for moderate-to-severe DDH.

Methods: We retrospectively reviewed 24 patients with Hartofilakidis type B (moderate) or C (severe) DDH who underwent total hip arthroplasty with selective osteotomy approach at Siriraj Hospital, Mahidol University, Thailand from 2001 to 2021. We employed a Kaplan-Meier curve to assess procedure survivorship, with revision surgery as the end point. Clinical, functional outcomes assessed with Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement score, complications, and radiological assessments during follow-up were recorded.

Results: The mean patient age was 56.8 ± 11.8 years (range 37 to 78 years), and mean height was 152.0 ± 11.7 cm (range 111 to 167 cm). The median surgical time was 84 minutes (range 50 to 300 minutes), with a median estimated blood loss of 450 mL (range 100 to 4000 mL). The median follow-up time was 7.8 years (range 4 to 21 years). The Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement score improved markedly from baseline, with a mean anchor-based increase of 23.70 ± 0.04 at 6 months postoperatively. Three cases encountered revision surgery due to osteotomy nonunion with stem fracture, early dislocation, and periprosthetic joint infection. The survival probability at 12 years was 83.7%. No sciatic nerve injuries were reported. No radiographic pathology was detected during follow-up.

Conclusion: Selective osteotomy combined with anatomic hip restoration is a feasible and effective approach for managing moderate-to-severe DDH, as it demonstrated favorable long-term outcomes. Our approach may serve as a treatment option for patients with similar challenging deformities.

Introduction: Musculoskeletal complications associated with end-stage renal disease (ESRD) are known to predispose patients to an increased risk of hip fractures. The aging population and the effects of treatments pose challenges to advancements in bone health management. This study is one of the largest to date, examining patient demographics and temporal trends among ESRDpatients with hip fractures.

Methods: A retrospective analysis of data from the United States Renal Data System, spanning 1977 to 2012, was conducted. Two cohorts of 115,386 sex-matched and age-matched patients with ESRD were studied: those with hip fractures and patients without hip fractures. Statistical significance was determined by a P value <0.05. Clinical significance was assessed using effect size (ES).

Results: The incidence of hip fractures among patients with ESRD increased by 3,369% between 1977 and 2007, followed by an 11% decrease from 2007 to 2012. ESRD patients with hip fractures were significantly more likely to be White (77.7% vs. 76.1%; P < 0.001, ES: 0.02) and older (71.6 vs. 71.2, P < 0.001; ES: 0.03). No difference in sex was observed between cohorts: male (47.0% vs. 47.0%) and female (53.0% vs. 53.0%).

Discussion: The temporal trend reflects current ESRD literature but contrasts with trends seen in the general population, partly because of the increased lifespan of these patients and thus longer dialysis, a known risk factor of fractures. Our data support current literature that White race is an independent risk factor of hip fractures, which may be due to genetic variations in vitamin D, FGF-23 metabolism, and bioavailability. The earlier onset of hip fractures in patients with ESRD may offset the effect of menopause-driven fractures observed in the general population.

Introduction: The Moberg volar advancement flap was classically described for covering thumb defects following traumatic fingertip amputations. However, its use in the lesser digits has been rarely reported. This study aims to evaluate the clinical outcomes of a modified volar advancement flap for fingertip amputations in lesser digits.

Methods: A single-center retrospective review was conducted on patients who underwent a modified volar advancement flap for fingertip amputation reconstruction of the lesser digits between 2015 and 2021. Patients who had flaps performed for the thumb, nontraumatic causes (eg, infection or gangrene), or who defaulted on postoperative rehabilitation and follow-up were excluded.

Results: Eighteen patients met the inclusion criteria for analysis, with a mean follow-up duration of 6 months. Protective sensation was achieved in 75% of patients, whereas 43.8% regained normal sensation. The mean QuickDASH score was 4.22 ± 5.97 (range 0 to 18.18). Common complications included hypersensitivity (61.1%), infection (11.1%), wound dehiscence (11.1%), and fixed flexion deformity of the distal interphalangeal joint (7.1%). No cases of flap necrosis or dorsal skin necrosis were observed.

Conclusion: The modified volar advancement flap remains a feasible option for reconstructing fingertip amputations, even in the lesser digits. This technique does not require microsurgical expertise and can be safely performed by general orthopaedic surgeons.

We report a case of a 9-year, 10-month-old female patient who ultimately required a revision vertebral column resection to manage a progressive congenital kyphoscoliosis complicated by postoperative surgical site infection, decubiti and implant exposure, proximal junctional kyphosis, and pseudarthrosis. Definitive surgery consisted of T4-L4 posterior spinal fusion and revision vertebral column resection with a pedicled rib vascular bone graft. At 3-year follow-up, the patient was fully recovered with return to full noncontact activities. The purpose of this case report is to describe the use of a rib vascular bone graft to increase the likelihood of arthrodesis for a complex pediatric spinal fusion patient with deficient posterior elements and multiple failed surgeries.

A number of children with abnormal tone are implanted with pumps that deliver baclofen to the intrathecal space through an attached catheter. These pumps contain a catheter access port that allows for withdrawal or introduction of fluids to the intrathecal space. Patients treated with baclofen pumps often also present with neuromuscular scoliosis or other conditions that require extensive surgery and perioperative analgesia. In this article, we describe cases in which intrathecal morphine (Duramorph) was delivered through implanted baclofen pumps to manage perioperative pain. We demonstrate that baclofen pumps can be used to deliver intrathecal morphine for effective perioperative analgesia with minimal risk of complications such as respiratory depression, pruritis, and nausea/vomiting. We also highlight steps which must be taken to ensure safety when using this technique.

Introduction: Interspinous process devices (IPDs) are a lesser invasive treatment option for lumbar spinal stenosis (LSS). The utility of IPDs has been debated, and no recent, large-scale representative database studies have examined utilization and revision surgery trends of IPDs.

Methods: Patients with LSS undergoing IPD placement were identified from the 2017-2022 M170Ortho PearlDiver Database and stratified by direct lumbar decompression usage and levels treated. Yearly IPD utilization of the study populations was tracked, and notable changes in usage were identified. Provider specialties placing IPDs were assessed. Kaplan-Meier survival analyses followed 3-year subsequent lumbar operation rates.

Results: A total of 10,422 patients with LSS undergoing IPD placements were identified, with a significant utilization increase from 2017 to 2020 (P = 0.027) and decrease from 2020 to 2022 (P = 0.039). These were done without direct decompression for 6183 (59.3%) and with direct decompression for 4239 (40.7%), with greater proportion performed without decompression over the years (P = 0.032). One-level procedures were 6,723 (64.5%) and two-level procedures were 3,699 (35.5%), with similar proportions over the years. Orthopaedic/neurologic surgeon utilization decreased, with pain specialists becoming the predominant providers using IPDs. Overall 3-year revision surgery rate was 12.0%, and no differences existed in revision surgery rates by decompression usage (P = 0.2) or levels treated (P = 0.3).

Discussion: This study is first to report on the notable IPD utilization decrease from 2020 to 2022 after strong adoption from 2017 to 2020. This aligned with an increasing proportion placed without decompression and by pain specialists, with no revision surgery rate differences. Although the reason for this change over time is unclear, this study reports shifting physician practices with IPDs.