World Journal of Orthopedics最新文献

Background: Orthopedic training, one of the most useful but under-represented specialties in undergraduate medical curricula, has some difficulties in clinical teaching.

Aim: To determine if simulation-based learning (SBL) was effective in enhancing procedural accuracy, skill confidence, and knowledge recall in final-year medical students.

Methods: This was a cross-sectional observational study performed in the Department of Orthopaedics in a tertiary care teaching hospital with simulation training facilities. The trial was conducted over 2 months (January 2025-February 2025) and was designed to determine the effect of SBL on procedural skills, knowledge retention, and self-perceived confidence in a group of final-year medical students. The inclusion criterion was undergraduate medical students in their final year who had clinical postings in orthopedics. Convenience sampling was used to recruit 106 students. The sample size was estimated to achieve a post-training 50% improvement ratio in procedural accuracy, a confidence interval of 95%, and an absolute precision of 10%. The simulation sessions included exercises with synthetic bone models, cast equipment, and procedural packs [orthopedic skills: (1) Closed fracture reduction; (2) Application of plaster; and (3) Traction]. Each session consisted of an instructor-led demonstration, practice under supervision, and immediate feedback.

Results: In our study involving 106 final-year medical students, SBL significantly improved procedural accuracy with scores rising from 62.5% to 84.9% (P < 0.001). Knowledge retention also improved markedly with post-test scores increasing from 63.4% to 78.2% (P < 0.001). Self-reported confidence levels showed a substantial gain, increasing from 4.6 to 8.2 on a 10-point scale. Prior simulation exposure and academic performance ≥ 75% were significantly associated with higher post-training accuracy. Gender had no significant influence on outcomes.

Conclusion: The current study attested to the value of SBL in the enhancement of procedural skills, knowledge retention, and self-confidence of final-year medical students in orthopedics.

Sickle cell disease (SCD) is a genetic disorder characterized by chronic hemolysis and vaso-occlusive crises (VOCs), leading to musculoskeletal complications that significantly affect quality of life. Among these, shoulder complications are a concern, with humeral head avascular necrosis (AVN) being the second most common site of involvement after the femoral head. Other shoulder pathologies, including osteomyelitis and septic arthritis, further contribute to morbidity. However, these conditions remain underdiagnosed and understudied, often due to overlapping symptoms with VOC-related bone infarctions. Imaging, particularly magnetic resonance imaging, is crucial for early diagnosis and accurate differentiation. Management strategies range from conservative pain control to surgical interventions, including core decompression for early-stage AVN and arthroplasty for advanced joint destruction. Surgical outcomes in SCD, however, remain inconsistent due to higher complication rates and a lack of standardized guidelines. Despite advancements in diagnosis and treatment, shoulder pathology in SCD remains an area of limited research. This review highlights the need for larger, long-term studies with a homogeneous etiology to support and refine current treatment strategies and improve patient outcomes.

Background: Sleeve fracture of the patella is an unusual fracture, almost unique to children. The majority of sleeve fractures involve the inferior patellar pole. However, sleeve fractures of the superior pole of the patella are extremely rare in adults.

Case summary: An 18-year-old male patient fell while running in the morning. The patient had tenderness to palpation at the superior pole of the patella, with a palpable gap over the upper part of the patella in both knees. We applied two 4.5-mm suture anchors with the Krackow stitch to repair the sleeve fracture, augmented by autogenous gracilis through performing the figure-of-eight technique. The patient regained approximately the full range of motion of the knee joint without any quadriceps weakness and a normal gait 6 weeks after surgery.

Conclusion: Sleeve fractures of the superior pole of the patella are extremely rare in adults, especially bilateral sleeve fractures. Suture anchors, augmented by autogenous gracilis, provided secure fixation and achieved excellent results in this rare injury.

Osteoarthritis (OA) is an extremely prevalent degenerative joint disease which commonly occurs in the knee. In severe cases of knee OA, total knee arthroplasty (TKA) is often indicated to relieve pain and restore limb alignment. While studies have shown how TKA improves knee symptoms, the relationship between the operated knee with the hip and ankle remains understudied. A prospective study by Buterin et al showed a significant relationship between reduced ankle symptoms and better TKA recovery. The objective of this paper is to explore ways to expand the completed study to make it more widely applicable. These include sampling patients from multiple surgical centers in different cultural backgrounds, including different etiologies of OA, extending the study time points, and evaluating the contralateral limb. Together, the study by Buterin et al combined with future work can elucidate new TKA rehabilitation techniques which focus on the entire lower extremity.

Background: Osteoarthritis (OA) is a common degenerative joint disease that considerably affects the quality of life (QoL) of individuals, especially the elderly. The Kellgren-Lawrence (KL) grading system assesses the severity of OA through radiographic evaluation, whereas the Knee Injury and Osteoarthritis Outcome Score (KOOS) measures clinical symptoms and functional status.

Aim: To analyze the relationship between KL grades and KOOS to elucidate the association between radiographic severity and clinical manifestations of knee OA.

Methods: A cross-sectional study was performed at King Fahd Hospital of the University, involving 164 adult patients diagnosed with knee OA. Patients were evaluated using the KL system, based on standing knee X-rays performed within the last six months. The KOOS questionnaire was utilised for clinical assessment, evaluating five domains: (1) Pain; (2) Symptoms; (3) Activities of daily living; (4) Sport and recreation function; and (5) Knee-related QoL. Analysis of variance was utilised to examine variations in KOOS domain scores among different patient variables. The correlations between KOOS domains were determined using Pearson's correlation.

Results: KOOS scores demonstrated a significant decline in patients with elevated KL grades, with Grade 4 exhibiting the lowest scores and grade 1 the highest (P < 0.001). The correlation between pain and activities of daily living was strong (r = 0.871, P < 0.001), as was the correlation with knee-related QoL (r = 0.754, P < 0.001). Notable age-related disparities were observed, as older patients (≥ 60 years) indicated poorer pain and functional outcomes. Gender differences were noted exclusively in symptoms, with females exhibiting lower scores than males (P = 0.022).

Conclusion: The association between radiographic severity and clinical impact is shown by the substantial correlation between KL grading and KOOS results, especially in later stages of OA. The results highlight the necessity for thorough assessments that integrate radiographic and clinical evaluations for individualized therapy choices for OA patients.

Background: Comminuted calcaneal fractures present significant treatment challenges. Open reduction and internal fixation carries risks such as infection and skin necrosis, while minimally invasive techniques may compromise reduction stability. Conservative management is generally limited to minimally displaced fractures. Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction. It offers distinct advantages including lower cost, minimal soft tissue trauma, and the avoidance of expensive reduction equipment or internal fixation materials.

Case summary: A 60-year-old female presented with left foot pain and limited mobility following a fall. Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°. A standardized, stepwise Traditional Chinese manual bone-setting was initially performed, followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy. The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3. The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months, indicating rapid functional recovery and high patient satisfaction. At 7 months postoperatively, the American Orthopaedic Foot and Ankle Society score reached 95, prompting removal of internal fixation. At the 6-year follow-up, reduction remained well maintained, with the Böhler angle preserved at 22°.

Conclusion: The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.

The mini-review explores the potential use of alginates produced biotechnologically by bacteria for the development of various implantable biomaterials intended for bone and cartilage tissue regeneration in orthopedics: the recent studies on the use of algal alginate-based biomaterials in the form of hydrogels, scaffolds, and microparticles for medical applications are considered as a potential opportunity to use bacterial alginate for these applications, taking into account the advantages of biotechnological production of a polymer with desired properties. The methods of producing different alginate-based biomaterials, the manufacturing of implantable medical devices using them, and the surgical techniques for bone and cartilage tissue regeneration using these materials for orthopedic purposes are discussed.

Early diagnosis of rapidly progressive osteoarthritis of the hip (RPOH) remains clinically challenging due to the lack of unified guidelines and standardized diagnostic criteria. Current diagnostic criteria (chondrolysis > 2 mm/year) require follow-up for at least 12 months. This review characterizes two types of early-stage RPOH progression: Chondrolysis with or without subsequent femoral head destruction within 12 months of onset. Based on their association with early disease progression in RPOH, elevated serum matrix metalloproteinase-3 levels and spinopelvic malalignment may serve as predictive factors for subsequent bone destruction when only joint space narrowing is observed. This review also proposes potential mechanisms of pathogenesis and intervention strategies for RPOH at its initial stage. Cartilage matrix fragments generated by stress concentrations on the hip joint, resulting from spinopelvic malalignment, may trigger inflammatory pathways involving proinflammatory cytokines and inflammasome activation, ultimately leading to joint destruction in the initial phase of RPOH. Suppression of these early pathological events may prevent joint destruction caused by RPOH. However, further elucidation of the cellular and molecular pathways involved in rapid joint destruction is necessary to identify specific biomarkers for early diagnosis and to facilitate the development of targeted therapies in the initial phase of RPOH.

Background: Surgical site infection (SSI) is a major concern in orthopaedic surgery procedures as they can have devastating consequences for patients and their outcomes. Many infection prevention measures are routinely taken in order to prevent infection during surgery, the main one being surgical skin preparation prior to any incision.

Aim: To investigate the efficacy of different perioperative surgical skin preparation products commonly used in orthopaedic surgery.

Methods: Seven databases were searched from inception to January 25, 2025, using a combination of keywords and medical subject headings terms, specifically for studies comparing any two surgical skin preparation products used at any point prior to skin incision for orthopaedic procedures. Titles and abstracts were screened and full texts reviewed based on inclusion criteria. Data was extracted on study design, interventions, and outcomes from studies that met inclusion criteria. Meta-analysis was not completed due to heterogeneity.

Results: Thirty-two studies met the inclusion criteria in this systematic review. In extremity fracture surgery, evidence was mixed on whether iodine or chlorhexidine-based solutions are more effective at preventing SSI. No significant difference was found between iodine and chlorhexidine-based solutions in total joint arthroplasty, spine surgery, foot and ankle surgery, or upper extremity surgery. No tested preparation method was superior in reducing positive Cutibacterium acnes culture rates in upper extremity (shoulder) surgery. Adding adjuncts to iodine and chlorhexidine methods, such as isopropyl alcohol, hydrogen peroxide, or benzoyl peroxide showed no significant changes to SSI or bacterial cultures.

Conclusion: Current literature shows no significant difference between chlorhexidine-based and iodine-based skin preparation solutions in orthopaedic extremity or spine surgery regarding SSI prevention or culture results. Likewise, adding other antiseptic agents provided no clear benefit. While skin antisepsis is important, many different factors contribute to SSI risk outside of the skin preparation solution.

Background: Supracondylar humeral fractures are among the most common paediatric injuries. Displacement and consequent need for reduction impose operative treatment. Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb. Stable K-wire fixation can be succeeded either by closed or open reduction method.

Aim: To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.

Methods: We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department. All patients underwent clinical and radiological examination recording elbow range of motion, function and deformity.

Results: The standard lateral approach was carried out in all patients while in 47 cases (35.9%) additional medial approach was used. Average follow-up time was 5.4 years (1-14 years). Fracture healing was completed at 4-6 weeks. The average operative time was 50 min (range: 37-75 minutes, SD: 11.307) and the average duration of radiation exposure based on image intensifier usage time was 20 seconds (range: 7-45 seconds, SD: 9.864). No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion, Patient-Reported Outcome Measures (Disabilities of the Arm, Shoulder, and Hand questionnaire, Mayo Elbow Performance Scores) at 2-year follow-up was satisfying.

Conclusion: Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden. Moreover, the risk of neurovascular injuries due to manipulations of closed reduction, is minimized while complications related to surgical approaches are insignificant provided there is expertise.