Journal of surgical orthopaedic advances最新文献

Rural patients have poorer health indicators, including higher risk of developing osteoarthritis. The objective of this study is to compare rural patients undergoing primary total joint arthroplasty (TJA) at rural hospitals with those undergoing primary TJA at urban hospitals with regards to demographics, comorbidities, and complications and to determine the preferred location of care for rural patients. Data from the Healthcare Cost and Utilization Project National Inpatient Sample between 2016 and 2018 were analyzed. Demographics, comorbidities, inpatient complications, hospital length of stay, inpatient mortality, and discharge disposition were compared between rural patients who underwent TJA at rural hospitals and urban hospitals. Rural patients undergoing primary TJA in rural hospitals were more likely to be women, to be treated in the South, to have Medicaid payer status, to have dementia, diabetes mellitus, lung disease, and postoperative pulmonary complications, and to have a longer hospital length of stay. Those patients were also less likely to have baseline obesity, heart disease, kidney disease, liver disease, cancer, postoperative infection, and cardiovascular complications, and were less likely to be discharged home. Rural patients undergoing primary TJA tend to pursue surgery in their rural hospital when their comorbidity profile is manageable. These patients get their surgery performed in an urban setting when they have the means for travel and cost, and when their comorbidity profile is more complicated, requiring more specialized care, Rural patients are choosing to undergo their primary TJA in urban hospitals as opposed to their local rural hospitals. (Journal of Surgical Orthopaedic Advances 33(2):061-067, 2024).

The diagnosis of septic arthritis requires a reliance on ancillary tests, including synovial fluid white blood cell count (jWBC), percentage of polymorphonuclear leukocytes (%PMN), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). This study evaluated these tests to determine their diagnostic utility in suspected septic arthritis. A retrospective chart review was performed on patients admitted to an urban hospital who underwent arthrocentesis. The authors evaluated the jWBC, %PMN, ESR, and CRP with receiver operating characteristic (ROC) curve analyses. Two hundred sixty-five patients met inclusion criteria. Sixty-three had a culture-positive aspirate. ROC curve analysis resulted in an area under the curve (AUC) of 0.80 for jWBC with cutoff point of 22,563 cells/mm3 and an AUC of 0.71 for %PMN with cutoff point of 90.5%. CRP and ESR had AUC values of 0.62 and 0.61, respectively. The culture-positive cohort had higher elevations in all assessed diagnostic tests. However, AUC data for ESR and CRP showed little diagnostic utility. Additionally, sensitivities and specificities of jWBC and %PMN were too low. Associated cutoff points would result in excessive unnecessary operative intervention. Further studies should incorporate synovial fluid biomarkers into the workup of a suspected septic joint. (Journal of Surgical Orthopaedic Advances 33(2):108-111, 2024).

Lateral plating alone has been postulated as an alternative for fixation of bicondylar tibial plateau fractures in attempts to limit morbidity associated with dual plating. Characterization of fracture patterns that may facilitate lateral plating alone for bicondylar tibial plateau fractures is not well established. The authors analyzed radiographic and clinical outcomes of isolated lateral plating in patients with at least 6 months of follow-up. Of 56 patients identified, 37 (66%) had 41 AO Foundation (AO)/Orthopaedic Trauma Association (OTA) C1/C2 fractures with 19 (34%) presenting with 41 C3 fractures. Mean posteromedial articular fracture angle (PMAFA) was 69.9 degrees, with an average of 1.3 medial articular fragments. Only 16 patients (28%) had a PMAFA under 45 degrees. There were no cases of nonunion, and five patients (8.9%) developed wound infection during follow-up. Four patients (7.1%) experienced malreduction over three degrees, and eight patients (14.3%) experienced change in alignment over the follow-up duration, indicating some risk of inadequate fixation with this technique. (Journal of Surgical Orthopaedic Advances 33(2):088-092, 2024).

The purpose of this study was to assess the rate and pattern of intraarticular extension of ballistic distal femur fractures. The authors examined all ballistic distal femur fractures that presented to their hospital between 2015 and 2019. The authors excluded direct condylar injuries and patients of whom a computed tomography (CT) scan was not obtained. The authors classified the rate of intraarticular extension and the pattern of that extension. Sixty-three fractures met inclusion in this study. Of these, 19 (30%) extended intraarticular, whereas the remaining 44 did not. Ninety-five percent of the fractures in the intraarticular group contained a sagittal fracture, whereas only 26% contained a fracture in the coronal plane. Ballistic distal femur fractures have a lower rate of intraarticular extension than blunt fractures. There are predictable patterns of joint involvement with ballistic injuries that warrant different treatment strategies. The authors propose a new classification system to further classify these unique fractures. (Journal of Surgical Orthopaedic Advances 33(3):178-180, 2024).

The objective of this study was to determine if preoperative patient characteristics have an effect on pain and function after primary arthroscopic rotator cuff repair. Seventy-five arthroscopic primary rotator cuff repairs with at least 2 years of follow-up were identified. Studied variables were preoperative tobacco, opioid, and alcohol use; obesity; mood disorders; disability claim; and Workers' Compensation status. Outcome measures included visual analog pain scores, American Shoulder and Elbow Surgeons (ASES) scores, Single Assessment Numeric Evaluation (SANE) scores, range of motion, and strength. Preoperative smoking was significantly associated with worse pain (p = 0.009), ASES (p = 0.004), and SANE (p = 0.011) scores. Opioid use showed no statistically significant difference in pain or functional scores. Alcohol use did predict improved ASES scores at long-term follow-up (p = 0.046). The other variables were not associated with inferior outcomes. Smoking and preoperative opioid use represent modifiable risk factors that can be corrected before surgery to optimize outcomes. (Journal of Surgical Orthopaedic Advances 33(1):005-009, 2024).

This is a retrospective case series of patients with distal radius fractures treated with an indirect coronal reduction technique previously described by the senior author using volar locking plates. Seventeen distal radius fractures underwent treatment at a Level I Trauma Center and were retrospectively reviewed for anatomic alignment, surgical complications, and wrist range of motion in the global period. Near-anatomic restoration was achieved with the average radial inclination, radial height, and volar tilt measured as 23.2 ± 3.9 degrees, 11.8 ± 2.1 degrees, and 8.5 ± 5.4 degrees, respectively. Average coronal translation was 2.8 ± 2.7 mm. Postoperative wrist motion on average was within the normal ranges for pronation, supination, wrist flexion, and wrist extension at an average of 36 weeks follow-up. There were no complications related to surgical technique or implant. This case series demonstrates the reliability for coronal reduction with a volar locking plate technique without complications. (Journal of Surgical Orthopaedic Advances 33(1):037-040, 2024).

The purpose of this study was to compare two sources of nerve graft for brachial plexus reconstruction: the denervated superficial branch of the radial nerve (SBRN) and the sural nerve. Ninety-seven patients who underwent brachial plexus reconstruction with denervated SBRN nerve (24 patients with 24 grafts) or with sural nerve grafting (73 patients with 83 nerve grafts) were included. The two groups were compared with respect to postoperative muscle reinnervation, disabilities of the arm, shoulder, and hand (DASH) scores. In the SBRN group, only four (17%) of the nerve grafts provided grade III or higher muscle function. In the sural nerve group, 31 (37%) of the nerve grafts provided grade III or higher muscle function. Smoking had a negative impact on muscle recovery. Denervated SBRN grafts are associated with inferior outcomes when compared with sural nerve grafts in the treatment of traumatic adult brachial plexus injuries. (Journal of Surgical Orthopaedic Advances 33(2):080-083, 2024).

The purpose of this study is to evaluate trends in distal clavicle excision (DCE) in association with arthroscopic rotator cuff repair (RCR) from 2010 to 2019. The National Surgical Quality Improvement Program database was queried to identify all patients who underwent arthroscopic RCR from January 1, 2010 to December 31, 2019, and was further subdivided into procedure type: (1) isolated RCR; and (2) RCR with arthroscopic or open DCE. The proportion of each surgery type, by year and within groups, was calculated. The Cochran-Armitage test for trend was used to analyze yearly proportions of RCR with concomitant DCE. In a sample size of 19,163 patients, the proportion of RCR with DCE decreased from 51.2% to 40.8% (r = -0.830; p = 0.003). Although the results of this study suggest that surgeons are performing fewer DCEs in the setting of RCR, many DCEs are still being done. (Journal of Surgical Orthopaedic Advances 33(2):077-079, 2024).

Common fibular nerve (CFN) injury due to ankle fracture is an underreported complication. The authors have proposed that torsional injury to the ankle can be translated along the interosseous membrane (IOM), producing tension on the CFN at the fibular neck. A 23-year-old woman presented to our clinic for left foot drop. Three months prior, the patient sustained a fall with left ankle inversion injury while running. She was diagnosed with a minor ankle fracture and placed in an orthopaedic boot. Unfortunately, her swelling worsened and one week later the patient was diagnosed with foot drop, which was further corroborated with EMG studies showing severe CFN injury localizing to the fibular neck. Because of the lack of recovery, she underwent decompression of the CFN. She experienced immediate symptomatic relief. High resolution imaging in this case supports our previous mechanism for indirect trauma to the ankle resulting in CFN injury. (Journal of Surgical Orthopaedic Advances 33(1):053-055, 2024).

Total knee arthroplasty (TKA) in obese patients (body mass index [BMI] > 30) is associated with increased complications. There is a renewed interest in cementless fixation in obese patients. However, the ideal method of TKA fixation in obese patients remains unclear. The literature was systematically reviewed to evaluate survivorship and functional outcomes of cemented versus cementless TKAs performed in obese patients. Complications, revision rates, and patient-reported functional outcomes were examined in studies comparing cemented and cementless fixation methods. Five articles met inclusion criteria to be included in the review. The cementless cohort had lower revision rates in two included studies but no difference in the three other studies examined. Functional outcomes were inconsistently reported. Overlap of patient cohorts and heterogeneity in reporting of functional outcomes precluded a pooled metaanalysis. Cementless TKA may have lower revision rates and better functional outcomes in obese patients, but paucity of data and inconsistency in reporting of functional outcomes prevents definitive conclusions. (Journal of Surgical Orthopaedic Advances 33(3):189-195, 2024).