Efort Open Reviews最新文献

Fracture-related infection (FRI) after tibial plateau open reduction and fixation is a common complication that leads to catastrophic sequelae and substantial economic costs, making prevention paramount. To facilitate an appropriate approach, it is useful to classify risk factors based on patient-related factors, injury-related factors, and management-related factors. Patient-related factors like smoking have a great amount of evidence establishing their relation with FRI. Diabetes and obesity might be associated, but evidence is somewhat conflicting. Nevertheless, smoking cessation and a multidisciplinary approach for these pathologies are essential to prevent FRI. Injury-related factors like high-energy fractures and acute compartment syndrome have compelling evidence relating them to FRI and must be acknowledged as inherent factors. While the exposure of the fracture has been associated with infection, open fractures are yet to be confirmed as directly related to FRI in tibial plateau fractures. Likewise, early antibiotic prophylaxis and surgical debridement are mandatory. As for management-related factors, increased surgical time emerges as a strong predictor for FRI. Evidence regarding the number of surgical approaches and plates shows a trend toward an increase in FRI prevalence. With respect to external fixator installation and removal, pin-plate overlapping is yet to be confirmed or ruled out as risk factors.

Fibrodysplasia ossificans progressiva and progressive osseous heteroplasia are genetic forms of heterotopic ossification (HO). Fibrodysplasia ossificans progressiva is caused by ACVR1 gene mutations, while progressive osseous heteroplasia is caused by GNAS gene mutations. Nongenetic HO typically occurs after trauma or surgery, with an occurrence rate of 20-60%. It can also be observed in conditions such as diffuse idiopathic skeletal hyperostosis, spinal ligament ossification, ankylosing spondylitis, and skeletal fluorosis. The exact cause of nongenetic HO is not entirely clear. More than 100 types of miRNAs have been identified as being linked to the development of HO. Some miRNAs are promising potential biomarkers for traumatic HO and ossification of the posterior longitudinal ligament. These findings further emphasize the significant role miRNAs play in the pathogenesis and progression of bone disorders. Repeated investigations into the function of a specific miRNA are infrequent and yield inconsistent results, possibly because of variable experimental conditions. It is hypothesized that miRNAs can enhance osteogenesis for the management of fractures and bone defects. However, further research is required to validate this hypothesis.

Purpose: To identify, synthesise, and critically appraise findings of systematic reviews and/or meta-analyses on hip preservation surgeries for borderline and/or frank dysplasia with or without concomitant femoroacetabular impingement (FAI).

Methods: A search, following the PRISMA guidelines, was conducted using Medline and Embase on 19/04/2023. Findings extracted from eligible studies were tabulated and synthesised.

Results: The search identified 477 references. Nineteen were eligible for data extraction: nine reported on arthroscopy, five reported on periacetabular osteotomy (PAO), one reported on shelf acetabuloplasty, and one reported on Chiari osteotomy, while two compared arthroscopy versus PAO, and one compared PAO versus rotational acetabular osteotomy (RAO) versus eccentric acetabular osteotomy (ERAO). The nomenclature and lateral centre edge angle (LCEA) thresholds to define hip dysplasia varied widely across included studies. All hip preservation surgeries provided good outcomes, with the Harris hip score (HHS) being the most commonly reported clinical score. Using the AMSTAR checklist for risk of bias, no systematic reviews were rated as high quality; ten were rated as moderate quality; six were rated as low quality; and three were rated as critically low quality.

Conclusions: Most published systematic reviews on hip preservation surgery are of moderate or low quality, and there is high heterogeneity among them regarding outcomes reported, follow-up periods, and definitions of dysplasia. The authors recommend the following thresholds and nomenclature for dysplasia: LCEA < 20° for frank dysplasia, 20°-25° for borderline dysplasia, and >25° for no dysplasia. Although all hip preservation surgeries can provide good outcomes, it is challenging to conclude which surgery provides the best outcomes and to determine if treatment options are dependent on LCEA.

Purpose: Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty, resulting in high morbidity and mortality. The neutrophil-to-lymphocyte ratio (NLR) and albumin-to-globulin ratio (AGR) are novel diagnostic markers for PJI; however, their diagnostic value remains inconsistent.

Methods: This meta-analysis was conducted using the PubMed, Embase, and MEDLINE databases to determine the diagnostic accuracy of NLR and AGR for PJI in the knee or hip. Data extraction and quality assessment were independently completed by two reviewers. The pooled sensitivity and specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic curve (sROC), and area under the sROC curve (AUC) were assessed using the univariate meta-analysis framework.

Results: Nineteen eligible studies were included in the quantitative analysis. The pooled sensitivity and specificity of NLR for the diagnosis of PJI were 0.73 (95% CI: 0.68-0.77) and 0.72 (95% CI: 0.66-0.77), respectively. Its pooled DOR was 6.89 (95% CI: 5.03-9.43), and AUC was 0.79 (95% CI: 0.75-0.82). The pooled sensitivity and specificity of AGR for the diagnosis of PJI were 0.80 (95% CI: 0.70-0.88) and 0.83 (95% CI: 0.79-0.87), respectively. Its DOR was 17.69 (95% CI: 10.76-29.07), and AUC was 0.88 (95% CI: 0.85-0.91).

Conclusion: NLR and AGR can be individually used as reliable serum biomarkers for the detection of PJI. Future research is warranted to determine the diagnostic value of these markers in combination with C-reactive protein levels and erythrocyte sedimentation rates to improve diagnostic accuracy for PJI in clinical practice.

Conventional repair of rotator cuff tears bears a variable but significant risk of incomplete healing. Biological therapies that accompany surgical rotator cuff repair include platelet-rich plasma, stem cells of different origins, and biological scaffolds. Biological therapies facilitate the regeneration of the correct microarchitecture of the tendon attachment to the bone and reduce failures after surgical rotator cuff repair.

Systemic antibiotic prophylaxis (SAP) is well-established in arthroplasty to prevent periprosthetic joint infection. However, the optimal duration and dosing of SAP remain a matter of debate, as evidenced by ongoing discordance between recommendations and clinical practice, reflected in the heterogeneity and imprecision of national and societal guidelines. The evidence currently available regarding the duration of SAP is summarised and discussed, specifically the postoperative repeated administration of antimicrobials within the first 24 h. The evidence available suffers from limitations, specifically deficiencies in outcome assessments in the available randomised controlled trials. Observational studies suggest that a short postoperative prolongation (<24 h) of SAP in arthroplasty may result in superior long-term outcomes compared to a single dose, and that an optimal dosing strategy, which warrants further prospective evaluation, may involve 'stacked dosing' in the early postoperative period, with re-administration every two half-lives when using commonly recommended beta-lactam antibiotics, instead of repetition at usual dosing intervals over 24 h. A stacked approach would also cover recognised indications for repetition, such as major blood loss and increased duration of operation, potentially simplifying prescribing protocols. Pharmacokinetic simulations are provided to illustrate the distinct concentration-time profiles associated with different prophylaxis regimens. Prolonging SAP beyond 24 h is not recommended. This review concludes by providing recommendations for further research, particularly a call to document SAP regimens with sufficient detail (choice of drug, dose regimen, and duration of administration) into established national arthroplasty registries, which should rapidly enable a significantly more nuanced understanding of these critical issues than permitted by the current literature.

Purpose: The association of adipose tissue-derived injectable products with platelet-rich plasma (PRP) has been promoted for osteoarthritis (OA) treatment. The aim of this study was to investigate the preclinical and clinical evidence supporting the potential of this combined approach to treat OA.

Methods: A systematic review was performed in January 2024 on five databases (PubMed, Embase, Scopus, Cochrane, and Web-of-Science) to identify preclinical in vivo and clinical studies. Safety, OA biomarker changes, and outcomes in terms of clinical and imaging results were analyzed. The quality of studies was assessed with the SYRCLE's tool for preclinical studies and the Downs and Black checklist for clinical studies.

Results: Ten preclinical studies (223 animals) and 14 clinical studies (594 patients) were included. Preclinical results documented improvements at the cartilage histological and immunohistochemical evaluation and at the biomarkers level. Clinical studies confirmed the procedure's safety, and the case series suggested satisfactory results in different joints in terms of symptoms and function improvement, with positive findings at the biomarker level. However, the randomized controlled trials did not document any clinical benefit, nor any changes in the imaging analysis. A large heterogeneity and overall poor quality were documented in both preclinical and clinical studies.

Conclusions: There is an increasing interest in the use of adipose tissue-derived injectable products associated with PRP for the treatment of OA joints, with preclinical studies showing promising results with this combined approach. However, clinical studies did not confirm the benefits offered by PRP augmentation to adipose tissue-derived injectable products in patients affected by OA.

Purpose: To assess whether distal radius fracture (DRF) malunion is associated with greater patient-reported disability.

Methods: We searched PubMed, EMBASE, and Cochrane databases up to 21 May 2023. Two reviewers independently screened retrieved titles/abstracts and assessed the full text of potentially eligible articles to identify cohort studies and randomized controlled trials reporting outcomes of DRF in adults at least 12 months after fracture, confirmed radiologically 3 months or longer after fracture. We excluded studies not reporting patient-reported outcomes according to malunion and studies judged to have a high risk of bias, as assessed independently by two reviewers using the Quality In Prognosis Studies tool. To express the overall effect of malunion on patient-reported disability, we calculated the standardized mean difference (SMD) with a 95% CI.

Results: Six studies with 898 patients (77% women) were included; five involved adults of all ages, and one restricted to patients aged 65 years and older. In the meta-analysis including the five studies with adults of all ages (1047 observations), the SMD was 0.58 (95% CI: 0.42-0.74; P < 0.001), favoring no malunion, with no statistically significant heterogeneity or publication bias. In the meta-analysis including all six studies (1193 observations), the SMD was 0.51 (95% CI: 0.35-0.67; P < 0.001), favoring no malunion, with moderate but significant heterogeneity.

Conclusion: Malunion of distal radius fracture is associated with significantly greater patient-reported disability with a moderate magnitude in terms of clinical importance. The study does not address the possible influence of age or treatment methods.

Background: Over the past two decades, modern spine surgery has become increasingly intellectualized and minimally invasive. However, whether using robots in spine surgery results in more accurate pedicle screw placement remains a topic of debate. This study aimed to evaluate the certainty and quality of the available evidence on the efficacy of robot-assisted pedicle screw placement.

Methods: We performed an overview of reviews including systematic reviews (SRs) and meta-analyses (MAs) regarding the accuracy of robot-assisted pedicle screw placement. Regarding the SRs/MAs, five electronic databases were searched from inception to 28 April 2023. There were no restrictions on the language or population. The quality and certainty of the evidence were evaluated with PRISMA, AMSTAR-2, ROBIS, Veritas plot, and GRADE tools.

Results: Fifteen SRs/MAs were analyzed. The findings indicated that the accuracy of pedicle screw placement in the robot-assisted group was not superior to that in the freehand group. All the SRs/MAs were of low or critically low quality. The main reasons for this include missing data, lack of transparency, lack of sensitivity analysis, and measurement of heterogeneity in the included studies, registration of reporting protocols, and deficiencies in the study inclusion methods and selection criteria.

Conclusions: While there is potential for robot-assisted pedicle screw placement to offer superior accuracy compared to conventional surgery, the current evidence is limited by methodological shortcomings. The quality of the studies analyzed was insufficient to provide a robust basis for developing clinical guidelines. Further high-quality research is necessary to confirm the benefits and establish clearer recommendations.

The pathogenesis of steroid-induced osteonecrosis of the femoral head (SONFH) remains unclear; however, emerging evidence suggests that mitochondrial injury plays a significant role. This review aims to elucidate the involvement of mitochondrial dysfunction in SONFH and explore potential therapeutic targets. A comprehensive literature search was conducted in PubMed, Web of Science, and Elsevier ScienceDirect, focusing on mitochondrial homeostasis, including mitophagy, mitochondrial biogenesis, mitochondrial dynamics, and oxidative stress in SONFH. Ultimately, we included and analyzed a total of 16 studies. Glucocorticoids initially promote but later inhibit mitochondrial biogenesis in osteoblasts, leading to excessive ROS production and mitochondrial dysfunction. This dysfunction impairs osteoblast survival and bone formation, contributing to SONFH progression. Key proteins such as mitochondrial transcription factor A (TFAM) and peroxisome proliferator-activated receptor γ coactivator 1-α (PGC1α) are potential therapeutic targets for promoting mitochondrial biogenesis and reducing ROS-induced damage. Enhancing mitochondrial function and reducing oxidative stress in osteoblasts may prevent or slow the progression of SONFH. Future research should focus on developing these strategies.