Archives of Bone and Joint Surgery-ABJS最新文献

Ulnar nerve compression is commonly seen at the elbow at the cubital tunnel and the wrist at the Guyon canal but is rarely seen in the hand. This case report describes an 18-year-old male presenting with seven months of atraumatic hand weakness and atrophy associated with heavy weightlifting. Exam demonstrated isolated interosseous muscle atrophy mostly sparing the abductor digiti minimi with intact sensation and negative nerve compression tests including Tinel at carpal and ulnar tunnels, Froment sign, Wartenberg test, cross finger test, and Spurling test. Electromyography and nerve conduction studies demonstrated prolonged distal latency, low amplitude potential, and large amplitude fibrillations with severely reduced motor unit firing in the first dorsal interosseous muscle consistent with ulnar nerve deep motor branch compromise. Magnetic resonance imaging revealed a ganglion cyst between the third metacarpal shaft and the flexor profundus tendon. Given the progressive symptoms, ganglion cyst excision and ulnar motor nerve branch neurolysis were performed.

Objectives: This study aims to evaluate whether using a novel antiseptic irrigant solution combined with vancomycin powder can effectively reduce the incidence of surgical site infections (SSIs) in orthopedic trauma patients. Specifically, we seek to determine if this combined approach significantly decreases SSI rates compared to using vancomycin powder alone. The study also aims to assess the safety and efficacy of the phosphate buffer solution, particularly its ability to reduce biofilm formation on surgical implants without causing cytotoxic effects. Ultimately, our goal is to provide insights into potential clinical practice changes that can enhance infection prevention strategies in orthopedic trauma surgeries.

Methods: This retrospective study analyzed 450 orthopedic trauma surgeries for lower extremity fractures at a Level Two hospital in Oregon, USA, between January 2021 and October 2023. Patients were stratified based on intraoperative irrigation with either vancomycin alone or vancomycin combined with a phosphate buffer irrigation solution. Data analysis included demographic characteristics, operative details, and occurrences of SSIs within 90 days postoperatively.

Results: Among the 450 surgeries analyzed, 18 (8.1%) SSIs occurred in the vancomycin cohort compared to 3 (1.3%) in the vancomycin and Phosphate buffer cohort. Adjusted logistic regression revealed an 89% reduction in the odds of SSIs in the vancomycin and Phosphate buffer cohort (OR: 0.11, 95% CI 0.02-0.35, P=0.001), adjusting for age, tobacco use, operative time, and procedure type.

Conclusion: This study underscores the promising role of combined vancomycin and Phosphate buffer irrigation in reducing SSI rates in orthopedic trauma surgeries. Further prospective studies are warranted to validate these findings and explore optimal infection prevention strategies in diverse surgical settings.

Objectives: Lower limb alignment (LLA) measurements are vital for pre-operative assessments and surgical planning in orthopedics. Artificial intelligence (AI) can enhance the precision and consistency of these measurements. This systematic review and meta-analysis evaluates the accuracy and reliability of AI-based approaches in detecting anatomical landmarks and measuring LLA angles, highlighting both their strengths and limitations.

Methods: Adhering to PRISMA guidelines, we searched PubMed, Scopus, Embase, and Web of Science on July 2024 and included observational studies validating AI-driven LLA measurements. Pooled intraclass correlation coefficients (ICCs) were computed to assess inter-rater reliability between AI and manual measurements. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess study quality.

Results: We reviewed 28 studies with 47,200 patients and 61,253 images; AI demonstrated high reliability in measuring 15 lower limb angles, with pooled ICCs ranging from 0.9811 to 1.0597. Angles like the hip-knee-ankle (HKA; ICC = 0.9987, 95% CI: 0.9975-0.9998) and the mechanical tibiofemoral angle (mTFA; ICC = 1.0001, 95% CI: 1.0001-1.0001) showed near-perfect agreement. In contrast, the joint line convergence angle (JLCA) and femoral anatomical-mechanical angle (FAMA) exhibited lower reliability and significant publication bias. Heterogeneity was substantial across most angles (I² = 63%-100%). These findings highlight the potential of AI for clinical applications while also identifying areas that require refinement and standardization.

Conclusion: AI exhibits high reliability and accuracy in measuring key LLA angles, often outperforming manual techniques in both speed and consistency. It holds significant promise as a clinical tool, though challenges with less reliable angles warrant further refinement. Future studies should focus on standardizing landmark definitions and addressing implementation barriers to maximize AI's potential in orthopedic practice.

Objectives: To evaluate inter- and intraindividual differences in mean platelet volume (MPV) between blood and platelet-rich plasma (PRP), and to assess the influence of demographic factors (sex, age, body mass index (BMI)).

Methods: A retrospective analysis of 877 patients treated with PRP for musculoskeletal conditions (Nov 2021-Dec 2024). MPV values in blood and PRP were compared. Intrasubject variability was analyzed in a subgroup of 298 patients who received at least three PRP doses.

Results: MPV was significantly lower in PRP compared to blood (p < 0.001). Age, sex, and BMI had no significant effect on MPV. The coefficient of variation (CV) was low in both blood (2.78%) and PRP (3.87%), with the variation in PRP being significantly greater than that in blood (p < 0.001). Intrasubject MPV variability was low (coefficient of variation (CV): 2.78% in blood, 3.87% in PRP; p < 0.001), while intersubject variability was greater in PRP.

Conclusion: Centrifugation significantly reduces MPV in PRP compared to whole blood, indicating that the preparation process alters platelet characteristics. While demographic factors such as age, sex, and BMI do not appear to influence platelet size, the greater intersubject variability-compared to low intrasubject variability-suggests that centrifugation protocols play a key role in determining PRP composition. These findings support the reliability of the single-step PRP preparation method used in this study and highlight the importance of protocol standardization to ensure consistent biological quality, which may ultimately impact the therapeutic effectiveness of PRP in musculoskeletal treatments.

Objectives: Osteosarcoma, the most common high-grade malignant bone tumor, has experienced only limited progress in therapeutic options, highlighting the urgent need for more effective treatments. This review examines bibliometric trends and clinical developments in osteosarcoma research from 2015 to 2024, with a particular focus on precision medicine and personalized therapy.

Methods: A search in the Web of Science Core Collection identified 17,476 osteosarcoma-related publications for bibliometric analysis. Key metrics, including publication trends, international collaborations, and emerging research topics, were evaluated using the Bibliometrix R package. Additionally, a clinical review examined recent innovations in diagnostic imaging, prognostic biomarkers, chemotherapy resistance, targeted therapies, immunotherapies, and surgical techniques.

Results: Research publications on osteosarcoma steadily increased, peaking at 2,009 in 2021, with significant contributions from China, the United States, Japan, India, and Italy. Key research themes encompassed apoptosis, metastasis, chemotherapy resistance, and immunotherapy. Advances in imaging techniques, such as dynamic MRI and PET/CT, have significantly enhanced tumor staging and prediction of treatment response. Emerging biomarkers, including genetic alterations (TP53, RB1, MYC) and inflammatory markers, have become important prognostic tools. Surgical innovations, including patient-specific instrumentation and limb-sparing techniques, have improved patient outcomes. Furthermore, targeted therapies (kinase inhibitors, antibody-drug conjugates) and immunotherapies (CAR T-cell therapy, immune checkpoint inhibitors) have demonstrated promising results in clinical trials.

Conclusion: Integrating bibliometric insights with clinical advancements underscores the importance of personalized approaches in osteosarcoma management. Predictive imaging biomarkers and precision-targeted therapies play a crucial role, and future research should focus on their clinical validation to enhance patient outcomes.

A rare case of severe prolonged persistent Teriparatide-induced hypercalcemia (14.3mg/dL on admission) in an osteoporotic patient after ceasing the Teriparatide is reported. This 67-year-old female was admitted with polyuria, xerostomia, constipation, progressive weakness, and a history of Triparatide use due to a previous osteoporotic fracture. Her serum calcium, PTH, and vitamin D levels had been normal before starting Teriparatide. Ninety six hours after ceasing the Teriparatide along with rehydration and Calcitonin treatment, the patient's serum calcium levels returned to normal. Severe Teriparatide-induced hypercalcemia does not follow any defined pattern and may persist for days and can usually be controlled through ceasing the Teriparatide, rehydration, and close monitoring of the serum calcium level and symptoms.

The aim of this article is to perform a review of the literature on the current status of shoulder arthroplasty in people with hemophilia (PWH). A search was conducted in PubMed on December 8, 2024, using the keywords "hemophilia" and "shoulder arthroplasty." To date only 4 articles (84 shoulder arthroplasties) in PWH have been published. A recent study with level 3 of evidence has found that five-year implant survival was similar in PWH (97.3%) than in matched controls (95.2%) suggesting that total shoulder arthroplasty (TSA) survivorship endures lasting and might be proposed to PWH. However, the high risks of both 90-day bleeding complication and venous thromboembolism (VTE) in PWH stressed the special dares of scrupulously weighing factor replacement and VTE prophylaxis pre-, intra-, and postoperatively on an individual patient basis with cautious hematologist coordination.

Periarticular multimodal drug injection (PMDI) is better than FNB (femoral nerve block) in pain relief after total knee arthroplasty (TKA). PMDI of bupivacaine [20 mL 0.5% bupivacaine hydrochloride - HCl (100 mg) following implantation plus incisional injection of 10 mL 0.5% bupivacaine HCl (50 mg) before wound closure] is more efficacious than PMDI after implantation. PMDI leads to less postoperative pain than IAI (intraarticular injection) and IAI + PMDI. PMDI of magnesium sulfate and sodium bicarbonate added to a conventional PMDI (ropivacaine, epinephrine, and dexamethasone) prolongs analgesia. No differences exist between gonyautoxin (GTX)2/3 (40 µg GTX 2/3 diluted in 30 mL of sodium chloride 0.9%) and a combination of 300 mg of levobupivacaine, 1 mg of epinephrine, and 60 mg ketorolac diluted in 150 mL of sodium chloride 0.9%.

Objectives: The survey conducted at the 2024 biennial meeting of the Iranian Society of Knee Surgery, Arthroscopy, and Sports Traumatology (ISKAST) aimed to assess practice trends among ISKAST members in primary total knee arthroplasty (TKA), thereby providing a benchmark for future studies.

Methods: The session moderator presented multiple-choice questions via an audience response system to 94 registered ISKAST members. Responses were collected centrally and subsequently displayed to the audience after a brief interval.

Results: The survey revealed that most ISKAST surgeons, reflecting their high level of expertise, work in diverse settings, with more than half performing over 100 TKAs annually. Regarding perioperative management, the majority of respondents utilize spinal anesthesia and tranexamic acid, with a significant number applying tourniquets during surgery. The median parapatellar approach and posterior cruciate-substituting designs are commonly preferred for routine TKA procedures. Additionally, pain management is primarily achieved through patient-controlled analgesia, while low-molecular-weight heparin, combined with mechanical measures, is the most common method for venous thromboembolism prophylaxis. Although follow-up practices vary, the majority of surgeons schedule annual postoperative visits.

Conclusion: The survey results provide valuable insights into the approaches of knee surgeons in Iran toward TKA, highlighting both common practices and variations in treatment methods. While these findings reflect current practices, they may not represent the most optimal techniques. This underscores the need for further research to validate these results and explore their applicability to a broader patient population.