Purpose: This review provides guidance and ideas for researchers through a comprehensive and comparative analysis of the present state, trends, and hotspots in the epiphyseal injury literature in the last 2 decades.
Methods: We searched the Web of Science core database to explore the epiphyseal injury literature from January 1, 2003 to December 31, 2022. (1) Search parameters: #1.TS = "epiphysis" or "epiphyseal" or "growth plate"; #2.TS = "injury" or "trauma". (2) Document types: "Article" and "Review"; (3) Time: January 1, 2003-December 31, 2022; (4) Languages: "English". We used Citespace 6.2.R3 software to explore the country/region distribution, institutions, journals, keyword analysis, and co-cited references of the literature.
Results: A total of 2138 relevant literature were obtained, with the number of publications increasing annually. The country with the highest number of publications is the United States. The highest-producing institution was Harvard University. The most cited journal was the Journal of Bone and Joint Surgery-American Volume. The first tag for keyword clustering was the anterior cruciate ligament (ACL). Keyword bursts were found in the recent attention to the words: outcome, physeal fractures, risk factors, fixation, risk, transplantation, and osteoarthritis. The analysis of the literature co-citation found that the topic of ACL and regeneration of epiphysis is a trend in research and high-quality literature in this field.
Conclusions: We can quickly get a sense of the focus and changing trends in epiphyseal injuries through keywords and co-citation reference bursts. The treatment of ACL injuries is a major area of interest for researchers. The most common concerns are MRI assessment of ACL injury reconstruction, comparison of different treatment methods, such as avoiding damage in epiphyseal reconstruction surgery, and associated complications. The analysis of the keywords and the co-citation references revealed that managing risk factors, treatment modalities, and complications related to epiphyseal injury after epiphyseal fracture will be a trend in future research.
Uncontrolled hemorrhage is a leading cause of mortality in trauma. It is considered the most significant preventable cause of death in trauma patients. Junctional hemorrhages are responsible for approximately 20% of this possibly preventable mortality. At this time, the options for controlling such hemorrhages are either by manual pressure points or the use of junctional tourniquets, which, although they have been proven to be effective, are cumbersome and not readily available to the medical team in the field. The objective of this study was to evaluate the effectiveness and feasibility of a new junctional tourniquet (Life Saving Tourniquet, T-W-Medical ltd.) that is simpler to use and can perform both as a regular tourniquet and a junctional one.
Purpose: The objective of the study was to determine the causal interrelationships between sociodemography, clinic, and injury characteristics, and to access to rehabilitation services that generate disability in road traffic injury survivors in 2 regions of Southwest Colombia during the 2018-2021 period.
Methods: An ambispective cohort study included 261 survivors from road traffic in 2 regions of Southwest Colombia (Cauca and Valle del Cauca) between April 19, 2021 and June 03, 2022. These survivors accepted treatment in 3 high-level comprehensive health institutions in Cali, Colombia, which are regional referral centers for trauma in the region. Patients (1) with hospitalization time ≥12 h, (2) aged ≥18 years, and (3) having the ability to understand the research questionnaires by themselves or their legal representatives, were included. Those with a history of deficiency before the road traffic injury were excluded. A structural equation model of causal pathways of disability was established to estimate exposure variables that are sociodemography, clinic, and access to rehabilitation services. The main outcome variable was disability, estimated by the World Health Organization Disability Assessment Schedule 2.0. Exposure variables related to clinical characteristics were measured through medical record review. The variables of access to rehabilitation services and disability were measured through a telephone-based survey. Structural equation analysis was performed, estimating the mediating effects of disability. The analyses were conducted in the software R Studio® y Mplus®.
Results: The study found a significant gender difference in disability, with women presenting a significantly higher disability than men (β: 6.21; p = 0.041). Disability was also associated with clinical conditions, such as injury severity score (β: 0.67; p < 0.001) and length of hospitalization (β: 0.28; p < 0.001). Regarding access to health services, the risk of disability was higher among those who were readmitted to the health institution (β: 4.96; p < 0.001).
Conclusions: Disability caused by road traffic injuries must be conceived as a complex phenomenon to be studied, involving the non-linear interaction between the individual's deficiencies and contextual factors.
Purpose: Anterior cruciate ligament (ACL) injuries significantly impact athletes' careers and quality of life, necessitating ACL reconstruction to restore knee functionality. Platelet-rich plasma (PRP) has been investigated as an adjunct therapy for enhancing recovery post-ACL reconstruction due to its potential pro-regenerative properties. However, the empirical evidence on PRP's efficacy in ACL reconstruction outcomes remains mixed. This study aims to evaluate the effectiveness and safety of PRP vs. control treatments in patients undergoing ACL reconstruction, focusing on pain management and knee function recovery.
Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials comparing PRP with control interventions post-ACL reconstruction. Comprehensive searches were performed across PubMed, Scopus, Web of Science, and Cochrane Library databases up to July 2024. We used "platelet-rich plasma", "controls", and "anterior cruciate ligament reconstruction surgery" as keywords. Statistical analysis was conducted using RevMan 5.3, employing the inverse variance method under a random effects model. We reported outcomes as mean difference (MD) or standardized with confidence intervals (CI). A p < 0.05 was considered statistically significant.
Results: The analysis incorporated data from 18 studies involving 1082 patients. KT-1000 measurements indicated improved knee stability (MD: -0.57 mm, 95% CI: -0.94 to -0.20, p = 0.002). However, no significant improvements were observed in the Lysholm score (MD: 0.68, 95% CI: =1.24 to 2.26, p = 0.484), visual analog scale pain score (MD: -0.34, 95% CI: -0.68 to -0.01, p = 0.057), International Knee Documentation Committee score (MD: 1.08, 95% CI: -1.05 to 3.42, p = 0.298), Tegner score (MD: 0.13, 95% CI: -0.32 to 0.57, p = 0.575), and femoral and tibial tunnel diameters (femoral MD: -0.07 mm, 95% CI: -0.46 to 0.32, p = 0.726; tibial MD: 0.08 mm, 95% CI: -0.60 to 0.75, p = 0.818).
Conclusion: Our findings provide moderate evidence that PRP can significantly enhance knee stability post-ACL reconstruction. However, further high-quality randomized controlled trials are needed to clarify PRP's overall effectiveness and optimal use in ACL reconstruction rehabilitation protocols.
Purpose: Infection after ankle fracture fixation is a serious complication, leading to a prolonged healing period and dysfunction in a long-term follow-up. Identifying risk factors for ankle fracture-related infection (FRI) is beneficial in preventing complications and reducing the risk of treatment. The study aims to retrospectively analyze clinical risk factors for ankle FRI.
Methods: A cross-sectional retrospective study of operatively treated ankle fractures was conducted at 2 medical centers from March 2020 to March 2023. Patients with open or pathological conditions were excluded, and 298 patients who underwent surgical treatment for ankle fractures were included. Risk factors of the patients who were diagnosed of FRI were analyzed using univariate analysis and binary logistic regression. Regression coefficients were used to calculate statistical probabilities of FRI.
Result: Of the 298 patients, 21 (7.1%) were diagnosed infection. On univariate analysis, soft tissue bloody blisters (p=0.002) and ankle dislocation (p=0.001) were associated with a significantly higher incidence of infection. On binary logistic multifactorial regression analysis, the risk factors for FRI were ankle dislocation (p<0.001, odd ratio (OR)=11.799, 95% confidence interval (CI): 3.307-42.135), soft tissue bloody blisters (p=0.045, OR=8.004, 95%CI: 1.045-61.340), Langer-Hans typing pronation-abduction (p=0.033, OR=1.746, 95%CI: 1.183-27.766), and smoking (p=0.037, OR=4.94, 95%CI: 1.105-22.162).
Conclusion: The risk factors of FRI were soft tissue conditions including bloody blisters and ankle dislocation, when dealing with ankle fractures. The results of this study will help surgeons to inform patients of the risk of FRI and prevent it accordingly before ankle fracture surgery.
Purpose: Proximal fractures of the tibia (i.e., shin bone) are often treated using proximal tibia fracture plates (PTFPs) that are not always biomechanically optimal. This is a review of biomechanical papers that studied the effect of modifying PTFP plate and screw variables.
Methods: PubMed, Scopus, and Web of Science databases were searched for English-language papers published before February 2024 using the terms "biomechanics" plus "proximal or plateau" plus "tibia" plus "fracture or "plate." Eligibility criteria were applied: (1) biomechanical studies only; (2) optimization studies that systematically permutated plate or screw variables; (3) plate-and-screw fixation only; (4) intra-articular or extra-articular fractures. The papers were examined for implant variables such as plate geometry, plate material, screw number, etc., while papers were also examined for outcome metrics like interfragmentary motion, plate stress, overall stiffness, etc. RESULTS: The 52 eligible PTFP papers considered the biomechanical effect of plate geometry, material, hole type, number, and position, while screw variables included geometry, number, and angle. Outcome metrics were interfragmentary motion (0-22.53 mm or 0-60.1°), bone stress (1-1170 MPa), plate stress (3-586 MPa), and screw stress (3-1613 MPa), bone stress under the plate (2-11 MPa), number of loading cycles to failure (11,500-1,000,000), overall stiffness (22-24,869 N/mm or 0.4-63.8 Nm/degree), and failure strength (259-14,387 N). Reviewed papers showed that a PTFP's biomechanical stability could be maximized by using 1 or 2 plates that were contoured, larger, locking, metal, and/or placed on the largest surface of the bone fragment(s), while head, kickstand, and/or shaft screws should be longer, thicker, solid, metal, and/or angled. But more future work could be done on the biomechanical effect of plate design (e.g., alternative materials), bone quality (e.g., normal vs. osteoporotic), loading mode (i.e., axial, bending, torsion), etc. CONCLUSIONS: PTFPs should have their plate and screw variables optimized to provide the best biomechanical performance and clinical outcomes, but more work is required to determine the optimal conditions. Engineers and surgeons may find this review beneficial for designing, analyzing, or utilizing PTFPs.
Purpose: This study aimed to evaluate the treatment of scaphoid nonunion with dual screw fixation in preventing postoperative humpback deformity.
Methods: This retrospective study is from December 2010 to December 2021, 18 patients with scaphoid nonunion were treated with dual screw fixation through the dorsal approach. This study included patients aged 16-60 years with scaphoid nonunion (>6 months) classified as Mack-Lichtman types I-III (mild arthritis), while excluding those with immature osteogenesis (<16 years), osteoporosis (>60 years), prior wrist surgery or fractures, avascular necrosis, advanced degenerative changes (types IV-V), small fragment fixation difficulty, or loss to follow-up. Scaphoid length and angles were assessed on X-rays. Wrist function was assessed based on the Mayo wrist score.
Results: The average age of the participants was 27 (range 17-49) years. The mean time from injury to surgery was 13 (range 6-48) months. There were types I (n=5), II (n=11), and III (n=2) nonunions based on the Mack-Lichtman classification. Nonunion sites included proximal 1/3 (n=4), waist (n=8), and distal 1/3 (n=6). All nonunions healed at a mean of 15 (range 10-28) weeks. The preoperative scaphoid length was 20 (range 17-23) mm, and the data at bone union was 23 (range 21-26) mm. The preoperative scapholunate angle was 46° (range 18°-72°), and the data at bone union was 39° (range 30°-48°). The preoperative radiolunate angle was 24° (range 5°-51°), and the data at bone union was 18° (range 8°-29°). Follow-up lasted for a mean of 52 (range 24-119) months. Mayo wrist score improved from 47 (range 13-64) to 95 (range 78-100). There were 15 excellent, 2 good, and 1 satisfactory results.
Conclusion: In the treatment of scaphoid nonunion, dual screw fixation through the dorsal approach can successfully prevent postoperative humpback deformity. Reduction is maintained to bone union without complications. The technique can be an alternative for the treatment of scaphoid nonunion.
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