Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: This study aims to identify potential risk factors and assess postoperative outcomes associated with requiring emergency abdominal surgery (EAS) within 30 days following total hip arthroplasty (THA) and total knee arthroplasty (TKA). We hypothesized that patients requiring EAS would carry a higher morbidity and mortality rates compared to patients that underwent the index operation alone.

Methods: We conducted a retrospective analysis using TriNetX, examining data from 2016-2024 from patients over 18 years old who underwent THA/TKA and required EAS within 30 days. Postoperative outcomes, including mortality and hospital readmission, were compared between patients requiring EAS and those who did not. Statistical analyses included measures of association and chi-squared tests. Patient demographic data, including age, sex, and comorbidities were analyzed.

Results: Patients requiring EAS within 30 days of a joint arthroplasty were significantly more likely to be older, overweight or obese, and to be diagnosed with comorbidities including diverticular disease, cholelithiasis, alcohol use disorders, and tobacco use. These patients had significantly higher mortality rates within 60 days of joint arthroplasty compared to patients without EAS, suggesting that the second operation contributed significantly to the increase in adverse outcomes.

Conclusion: This study emphasizes the importance of recognizing key risk factors for severe GI complications that require EAS. These findings highlight the need for careful patient selection, pre-operative evaluation of risk, and vigilant post-operative management, especially in those with many risk factors. Improved identification and management of high-risk patients may help reduce the likelihood of EAS and its associated mortality.

Objectives: This scoping review aims to evaluate the safety and efficacy of orthobiologics in the treatment of Greater Trochanteric Pain Syndrome (GTPS), with a focus on pain relief, functional improvement, and quality of life.

Methods: We conducted a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, Scopus, Google Scholar, and CINAHL for studies published from January 1, 2000, to March 20, 2024. Eligible studies included case series, cohort studies, case-control studies, and randomized controlled trials (RCTs) that investigated the use of orthobiologics for GTPS. The primary outcomes assessed were pain, function, and quality of life. The quality of the studies was evaluated using the JADAD scale, the Cochrane Risk of Bias Tool, and the MINORS score.

Results: The review included 19 studies involving a total of 811 participants. Platelet-rich plasma (PRP) was found to significantly reduce pain, as measured by the VAS scores, and to improve functional outcomes including the modified Harris Hip Score (mHHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. These findings suggest that PRP may be an effective treatment for GTPS. The studies reported minimal side effects that were generally mild and transient.

Conclusion: PRP and other orthobiologic treatments show promise in managing GTPS, showing good safety profiles and potential benefits. However, further high-quality RCTs are necessary to confirm long-term efficacy and to establish standardized treatment protocols.

Objectives: The purpose of this study is to evaluate the outcomes of a polyaxial locking plate utilizing locking-cap fixation for treatment of patients with displaced olecranon fractures.

Methods: A retrospective review was performed for all consecutive patients at two institutions with displaced olecranon fractures treated with a polyaxial locking plate. Patients were required to have at least 1-year follow up. Clinical outcomes including the Disabilities of the Arm, Shoulder, and Hand (DASH) score, Single Assessment Numeric Evaluation (SANE), along with a Likert-scaled satisfaction survey ranging between 1-5 (1= very unsatisfied and 5= very satisfied) were collected.

Results: The plate osteosynthesis was performed on 24 patients with displaced olecranon fractures. Functional outcome scores were collected on 19 (79.2%) patients. The mean age at the time of surgery was 57.9 years (range, 23 to 78) and mean clinical follow-up was 21.0 ± 6.6 months (range, 12-34 months). All patients achieved osseous union in an acceptable position. Four (16.7%) patients complained of plate related pain and 6 (25%) patients complained of postoperative stiffness. Complications were found in 3 (12.5 %) patients, which included two neuropathies and one hardware failure in which a patient presented following a fall with a broken screw. No patients required revision surgery nor removal of hardware. A total of 16 (84%) patients were somewhat to very satisfied. The mean SANE score was 87.8 ± 14.6 (range: 45-100) and the mean DASH score was 13.8 + 17.5 (range: 0-55.8). Seventeen (89%) patients rated their elbows as 75% or better on SANE assessment and 16 (84%) patients achieved DASH scores of less than 30.

Conclusion: Polyaxial plate fixation utilizing locking-cap technology resulted in excellent short-term functional outcomes in patients with displaced olecranon fractures. Further follow-up is needed to determine the long-term outcomes of locking-cap constructs for olecranon fractures.

Objectives: Heparin-induced thrombocytopenia (HIT) represents a serious adverse reaction triggered by antibodies (anti-PF4/H) in heparin regimens. It is not clear if different low-molecular weight heparins (LMWHs) prompt distinct immunogenic responses in anti-PF4/H production and if these antibodies correlate with thrombocytopenia, thrombotic events, and early postoperative mortality. This pilot prospective study investigates the early output of anti-PF4/ H in elderly patients undergoing proximal femoral nailing for an intertrochanteric hip fracture surgery.

Methods: A total of 100 consecutive patients (72 females) with surgically treated intertrochanteric hip fractures were prospectively included. Ninety-four patients were available for the final follow-up. Twenty-seven patients received bemiparin, 42 enoxaparin and 25 tinzaparin. The levels of anti-PF4/H using the semi-quantitative latex-enhanced immunoassay; HemosIL® HIT-Ab(PF4-H) and platelets (PLT) levels were measured on the admission day and on day 5 following LMWH administration. Patients were followed up for at least 3 months for major thrombotic events and all-cause mortality.

Results: No patient developed clinically evident HIT, while 6 (6.4%) experienced thrombotic complications, and 22 (23.4%) passed away within 3 months after surgery. None of the patients with thrombotic complications tested positive for anti-PF4/H. Upon evaluating patients' seroconversion by day 5, six out of 94 (6.4%) patients tested positive for anti-PF4/H. Among them, three patients received bemiparin, two tinzaparin, and one enoxaparin. No statistically significant variance was observed in anti-PF4/H seroconversion between different types of LMWHs (p-value = 0.545) or in PLT count deviations (p-value = 0.990).

Conclusion: This pilot prospective study investigated anti-PF4/H production in older patients with hip fractures receiving different LMWHs. Preliminary results suggest that all tested anticoagulants have similar immunogenicity profiles in terms of PF4/H sensitization. These findings highlight the overall safety of LMWHs in elderly hip fracture patients. Moreover, the presence of anti-PF4/H appears unrelated to PLT fluctuations, subsequent VTE events and early postoperative mortality.

Objectives: This study aimed to clarify the debate on anterior cruciate ligament (ACL) injury management and the selection of patients for surgical or nonsurgical treatment.

Methods: A retrospective, citation-based approach was employed to search for English literature that assessed management options and mechanisms for ACL injuries.

Results: A variety of mechanical and neurocognitive mechanisms are involved in ACL injuries that could be used to develop practical prevention strategies. More precise preoperative clinical, and paraclinical assessments, as well as clarification of available treatment options for patients, would lead to individualized decisions on injury management, and thus to objective and subjective satisfaction. Prioritization of attentive physical therapy rehabilitation plans will also improve treatment outcomes.

Conclusion: A better understanding of the ACL injury/patient characteristics will help to achieve optimal treatment outcomes for each individual and develop targeted and practical prevention strategies.

Objectives: Fixing a broken limb has been a concern of humans for thousands of years. They have used different methods, devices, and combinations to do this. This study deals with the two hypotheses of the ancient use of the delayed splint method and the use of Plaster of Paris material in Persian Medicine.

Methods: This narrative-analytical review is based on the documentation of authentic books of Persian Medicine, such as Liber Continents and the Canon of Medicine, data from databases such as PubMed and Scopus, and search engines such as Google Scholar, to find information from other civilizations as well as Persian Medicine.

Results: The documentation reveals a global exchange of medical knowledge, with the fixation of broken limbs starting in Egypt and spreading to India, China, and Greece. In the 7th century AD, this knowledge reached Iran, where medical scholars, in their keen observation, extracted techniques from this wealth of knowledge. The renowned delayed splint technique, credited to Rhazes (865-925 AD), and the use of Plaster of Paris, as evidenced in the writings of Hakim Abu Mansour Movafagh Heravi (10th century AD), are just a few examples of the innovative methods developed in this medical school.

Conclusion: A careful study of ancient books will sometimes reveal traces of the use of today's techniques in the past. Although their report is focused on contemporary centuries and a new method has been introduced, their use has been recorded in past centuries. For instance, the delayed splint technique, named after George Keynes (1892-1979), and the application of Plaster of Paris, named after Antonius Mathijsen in 1852, was introduced in orthopedic science. This makes it necessary to search and analyze past medical books in various branches of modern medical knowledge to correctly teach the older ones and preserve the identity of medical schools.

Objectives: This study aimed to translate, culturally adapt, and validate the Patient and Observer Scar Assessment Scale (POSAS) for Persian-speaking populations, ensuring its applicability and reliability in both clinical and research settings in Iran.

Methods: The cross-cultural adaptation process involved forward and backward translations, expert panel reviews, and pre-testing. A total of 60 post-surgical patients participated in the study. Psychometric evaluations included content validity, internal consistency, and test-retest reliability. Content Validity Ratios (CVRs) and Content Validity Indices (CVIs) were calculated, with thresholds set at 0.51 and 0.79, respectively. Reliability was assessed using Cronbach's alpha coefficients (≥0.7) and test-retest stability over a two-week interval.

Results: The Persian POSAS demonstrated robust psychometric properties. All items exceeded the CVI threshold, achieving strong expert consensus (CVR ≥0.51). Cronbach's alpha coefficients were 0.88 and 0.81 for the Observer Scar Assessment Scale (OSAS) and Patient Scar Assessment Scale (PSAS), respectively, indicating high internal consistency. Test-retest reliability confirmed stability over time. These results were consistent with previous adaptations in other languages, including Arabic and Italian.

Conclusion: The Persian adaptation of POSAS is a valid and reliable tool for scar assessment, filling a critical gap in patient-centered care for Persian-speaking populations. This tool enables standardized evaluation of scars and supports clinical research. Future studies should explore its responsiveness to therapeutic interventions and its applicability across diverse patient demographics.

Objectives: Post-operative wound complications are relatively common. The development of an optimal protocol for the frequency of wound dressing change that results in minimal complications seems crucial. The current study aims to compare two different protocols of single and intermittent dressing change for patients undergoing carpal tunnel release (CTR) in terms of: 1) wound healing indicators and 2) complications.

Methods: In this two-arm parallel randomized clinical trial study, 60 patients who were planned to undergo CTR were enrolled. The participants were randomly assigned to two groups: group A) receiving a single dressing, and group B) receiving intermittent dressing changes every other day. After two weeks, all patients were evaluated for epithelialization, exudate amount, localized pain, localized erythema, localized edema, delayed healing, necrosis, fibrosis, final overall wound condition, final skin condition as indicators of wound healing, and signs of infection. We also employed the Visual Analogue Scale (VAS) to evaluate the pain intensity.

Results: There was no difference between the two groups in terms of basic demographic variables. The results revealed no significant difference in any of the measured wound healing indicators and complications except for the epithelialization rate which was higher in the single-dressing group (8 patients in the single group vs. 0 in the intermittent group; P-value < 0.001).

Conclusion: Overall, the findings suggest that use of the intermittent dressing change protocol for CTR surgery wounds does not improve wound healing or mitigate complications, in comparison to the single dressing protocol, which is more cost-beneficial.