Archives of Bone and Joint Surgery-ABJS最新文献

Objectives: Metatarsal fractures account for 5-6% of all fractures presenting to emergency care centers with 68% being fifth metatarsal (5MT) fractures. While most heal uneventfully, non-union is one of the most common complications regardless of treatment modality. Predicting the risk for non-union would potentially change treatment decisions thus lowering burden on patients and the healthcare system. The aim of this study was to identify factors associated with non-union in 5MT fractures.

Methods: In this retrospective case-control study, 731 patients met inclusion criteria. Radiographs and clinical documentation were utilized to determine fracture characteristics and final healing status. 547 were assigned to the union group and 184 to the non-union group. Patients' data were gathered and analyzed using machine learning methods, as well as Mann-Whitney U, Pearson R chi-square test, and multivariable logistic regression analysis. P<0.05 was considered statistically significant.

Results: The overall radiographic non-union rate was 25.2%. The highest incidence of non-union was observed for Zone 3 fractures (31.2%). Fracture displacement (P=0.03) was found to have an independent correlation with healing. Several chronic conditions such as osteoporosis (P=0.03), irritable bowel syndrome (P=0.01), cardiovascular disease (P=0.01) and sleep apnea (P=0.03), were found to have an independent correlation with healing. Beta-blockers (P=0.047) and topical steroids (P=0.04) were also found to be associated with 5MT non-union.

Conclusion: In this study, we identified several non-traditional factors associated with 5MT fracture non-union that warrant further consideration and may assist clinicians during the decision-making process. The relationship between non-fracture related factors with non-union needs to be further examined via larger clinical studies before causality can be determined and designation of those variables as risk factors.

Objectives: This study aimed to evaluate the safety and efficacy of aspirin as a standalone thromboprophylaxis (TP) treatment following elective total hip arthroplasty (THA). Additionally, it compares the primary and secondary outcomes related to efficacy and safety, respectively, between aspirin and enoxaparin.

Methods: A retrospective review was conducted of 2,107 patients who underwent primary or revision total hip arthroplasty (THA) between 2011 and 2017. Low-risk patients received aspirin (325 mg twice daily for 4 weeks), while high-risk patients were administered enoxaparin (4,000 units once daily for 2 weeks). The outcomes assessed included symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE), hematoma, bleeding, infection, and 90-day mortality.

Results: The incidence of symptomatic deep vein thrombosis (DVT) requiring treatment in the aspirin group was 0.10% (2/1,905), whereas no cases were observed in the enoxaparin group. The rate of fatal pulmonary embolism (PE) was 0.05% (1/1,905) in the aspirin group, compared to 0.49% (1/202) in the enoxaparin group. Gastrointestinal (GI) bleeding occurred in 0.05% (1/1,905) of the aspirin group and 0.49% (1/202) of the enoxaparin group. The incidence of periprosthetic joint infection (PJI) was 0.15% (3/1,905) in the aspirin group, compared to 0.49% (1/202) in the enoxaparin group.

Conclusion: As a standalone TP agent, aspirin is at least as effective as potent anticoagulants for patients undergoing elective THA, with comparable safety and efficacy profiles.

Objectives: This study evaluated the diagnostic performance of the apparent diffusion coefficient (ADC) in distinguishing osteomyelitis from reactive bone marrow edema (RBME).

Methods: This cross-sectional study included three groups of consecutive patients with diabetic foot ulcers (DFU) presenting with osteomyelitis, RBME, or healthy bone. All patients had DFU and were referred for magnetic resonance imaging (MRI). Patients with a history of foot surgery or biopsy before MRI, those who received antibiotic therapy for three or more days before imaging, and those with contraindications to MRI were excluded from the study. Osteomyelitis was confirmed by tissue biopsy, whereas RBME was diagnosed by exclusion. All participants underwent diffusion-weighted imaging (DWI), and ADC values were measured independently by two radiologists who were blinded to the clinical diagnosis. The diagnostic performance of ADC was then assessed.

Results: A total of 45 patients with diabetic foot ulcers (DFU) were recruited, of whom 18 (40.0%) had osteomyelitis, 16 (35.6%) had reactive bone marrow edema (RBME), and 11 (24.4%) had healthy bone tissue. Osteomyelitis demonstrated significantly higher ADC values compared to normal bone (P < 0.001) and significantly lower ADC values compared to RBME (P < 0.001). Using a cut-off value of 1478.0 × 10⁻⁶ mm²/s, ADC differentiated osteomyelitis from RBME with an accuracy of 88.2%, sensitivity of 94.4%, specificity of 81.2%, and an area under the curve (AUC) of 0.958.

Conclusion: These findings support the applicability of diffusion-weighted imaging (DWI) as a non-invasive and accurate diagnostic tool for differentiating osteomyelitis from reactive bone marrow edema.

Objectives: Non-repairable scaphoid proximal pole nonunion remains a major challenge. Various reconstructive surgical approaches have been introduced, but each one has some limitations, including microvascular anastomosis, donor site morbidities, and the risk of compromising the scapholunate ligament.

Methods: This prospective interventional case series was performed on five patients. The patients underwent reconstructive surgery using proximal hamate arthroplasty by a single surgeon and were followed up for at least 12 months.

Results: All patients were male and the median age was 28, and the median follow-up time was 24 months. The median Mayo score was 70, and the DASH score was 0 (no disability) in 3 patients and 15 in two patients. The median of postoperative grip strength in the operated hands was 37.3 kg (Range 36.1-39) and in the opposite hands was 42.5 kg (Range 40-45.9). However, there were significant differences between grip strength between operated and opposite hands (P value= 0.008). A reduction of 11.1% and 15% was shown in postoperative flexion and extension compared with preoperative flexion and extension (P value = 0.194, P value = 0.102).

Conclusion: Hamate arthroplasty for nonunion of the scaphoid proximal pole appears to be a viable surgical option with favorable outcomes in terms of union rates, functional recovery, and patient satisfaction.

Objectives: The composition of department leadership, notably the Department Chair and Program Director, plays a pivotal role in "Match" decision making and further residency training. This study aims to examine the current landscape of subspecialties and other demographic characteristics of the Department Chairs and Program Directors of orthopaedic surgery residency programs across the United States.

Methods: A list of Department Chairs and Program Directors of all 201 ACGME orthopaedic surgery residency programs was generated from the Orthopaedic Residency Information Network (ORIN) website. Demographic information, years of practice, research productivity (H-Index), and subspecialty for both Chairpersons and Program Directors were gathered. Information was available on 163/201 department chairs and 199/201 program directors.

Results: Among the 163 Department Chairs, Sports (24.5%), Adult Reconstruction (16.6%), and Trauma (13.5%) emerged as the most prevalent subspecialties, while Shoulder and Elbow (5.5%), Pediatrics (3.7%), and General Orthopedics (1.8%) were the least represented. Among the 199 Program Directors, Trauma (22.1%), Sports (17.1%), and Hand and Upper Extremity (14.1%) were the most common, while Shoulder and Elbow (6.0%), Foot and Ankle (5.5%), and General Orthopedics (1.0%) were the least represented. Chairpersons exhibited notably higher mean years of practice, mean H-index, and were more commonly male compared to Program Directors. However, in the multivariable regression model predicting leadership position, only years of practice and H-index were found to be significant predictors.

Conclusion: Sports, trauma, joint reconstruction, and hand were the most common subspecialities among those in positions of leadership explained by their higher prevalence among American-board orthopedic surgeons. Furthermore, H-index and years of practice were both predictors of being a chairperson.

Objectives: To introduce a ligament in the posterior distal extent of the forearm interosseous membrane (IOM).

Methods: Ten cadavers were dissected in which the ligament was consistently present extending obliquely from the distal radius metaphysis to the distal radioulnar joint capsule. The ligament was also explored in a patient during posterior interosseous nerve (PIN) excision.

Results: The posterior oblique ligament (POL) is found consistently in all cadavers via a dorsal approach.

Conclusion: This discovery highlights the complexity of forearm ligamentous structures and their role in the proximal, middle, and distal radio-ulnar stabilization.

The use of cementless total knee arthorplasty (TKA) has increased in recent years to the detriment of the use of cemented TKA. However, there is still no agreement on when to cement and in whom. A recent meta-analysis has shown that the cumulative survival at 12 years was 97% for the cementless implants and 89% for the cemented implants. Besides, no differences between the cemented and cementless TKAs were found in patient-reported results and revision rates. Another study showed noninferiority to cemented TKA. Its authors stated that cementles TKA can be utilized as an alternative mode of fixation in individuals opting for primary TKA. However, it was mentioned that additional long-run follow-up was required to confirm if cementless TKA can exhibit improved survivorship over cemented TKA. In individuals > 70 years of age, cementless TKA accomplished clinical scores equivalent to those of younger individuals at 2-year follow-up. Cementless TKA seemed to be a safe alternative for older individuals. Another meta-analysis has shown a substantial reduction in all-cause revisions and revisions for aseptic loosening when utilizing cementless fixation in high body mass index individuals when compared to the usage of cemented implants. In conclusion, clinical practice guidelines are required to ensure safe and efficacious usage of cementless fixation.

Artificial Intelligence (AI) is rapidly transforming healthcare, particularly in orthopedics, by enhancing diagnostic accuracy, surgical planning, and personalized treatment. This review explores current applications of AI in orthopedics, focusing on its contributions to diagnostics and surgical procedures. Key methodologies such as artificial neural networks (ANNs), convolutional neural networks (CNNs), support vector machines (SVMs), and ensemble learning have significantly improved diagnostic precision and patient care. For instance, CNN-based models excel in tasks like fracture detection and osteoarthritis grading, achieving high sensitivity and specificity. In surgical contexts, AI enhances procedures through robotic assistance and optimized preoperative planning, aiding in prosthetic sizing and minimizing complications. Additionally, predictive analytics during postoperative care enable tailored rehabilitation programs that improve recovery times. Despite these advancements, challenges such as data standardization and algorithm transparency hinder widespread adoption. Addressing these issues is crucial for maximizing AI's potential in orthopedic practice. This review emphasizes the synergistic relationship between AI and clinical expertise, highlighting opportunities to enhance diagnostics and streamline surgical procedures, ultimately driving patient-centric care.

Objectives: More than 20% of patients experience chronic lateral ligamentous instability of the ankle (CLLIOTA) following the appropriate management of an ankle sprain. The modified Broström-Gould (MBG) procedure has become the standard treatment for the anatomic repair of symptomatic CLLIOTA.

Methods: This retrospective, single-group study included all patients with CLLIOTA who underwent surgery using the MBG technique in Shahid Kamyab Hospital, Mashhad, Iran, between July 2015 and August 2020. The American Orthopedic Foot and Ankle Score (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ), and Pain Visual Analog Scale (VAS) were used to evaluate the outcome. The correlation between patient-related factors and each outcome measure was also analyzed.

Results: In total, 38 patients underwent the MBG procedure. The mean follow-up was 40.1 (18-67) months. Overall, 15 patients (39.47%) had a history of sports-related ankle sprains, and 15 (39.47%) had ankle osteochondral lesions. The AOFAS score improved significantly (51.23±13.49 to 91.92±12.077, P<0.001), while MOXFQ and VAS scores decreased significantly in the follow-up evaluation (50.28±9.33 to 27.5±13.35, P<0.001, and 6.2±1.47 to 2.18±1.86, P<0.001, respectively). No significant correlation was found between pre-operative ankle osteoarthritis, talus osteochondral lesion, duration of the follow-up, ankle sprain etiology (sports vs. non-sports), age, body mass index, gender, and the interval between the first sprain and surgery on the one hand, and post-operative outcomes, on the other hand. The more time passed after the surgery, the less painful the ankle of the patient was (P=0.038). No failure was observed among the patients.

Conclusion: This study showed that the open MBG technique for CLLIOTA can improve clinical outcomes with no major complications following surgery in the Iranian population.