Journal of surgical orthopaedic advances最新文献

In cases of cervical facet dislocations, traction is typically delivered in the acute setting with tongs attached to the skull via two pins. Although the pins are recommended to be inserted symmetrically in a neutral loading position, erroneous asymmetric pin placement has been documented in case reports, but its biomechanical implications are unknown. The current study utilized a human surrogate to evaluate the influence of asymmetrically placed pins in the axial or frontal planes. In addition, asymmetry of the cable that delivers the traction force to the tongs was also investigated. In the majority of the pin configuration experiments, pin asymmetry did not significantly affect cervical spine loading. One exception was if one pin was placed 1 cm anterior to neutral and the contralateral was in the neutral position. This configuration resulted in a significant increase in the cervical extension moment, which should typically be avoided because it can hinder reduction. (Journal of Surgical Orthopaedic Advances 33(4):233-239, 2024).

Distal femoral skeletal traction is a common procedure for the stabilization of fractures of the pelvis, acetabulum, and femur following trauma. Femoral traction pins are traditionally inserted via medial-to-lateral (MTL) entry to accurately direct the pin away from the medial neurovascular bundle. Alternatively, cadaveric studies have demonstrated low risk to the neurovascular bundle using a lateral-to-medial (LTM) approach. The purpose of this study was to compare the incidence of complications of LTM and MTL femoral traction pin placement at a single institution. This was a retrospective review of patients from the orthopaedic consult registry at a academic Level I Trauma Center. We identified 233 LTM femoral traction pin procedures in 231 patients and 29 MTL pin procedures in 29 patients. The two pin placement techniques were compared with respect to complications, specifically the incidence of neurovascular injury, cellulitis, septic arthritis, osteomyelitis, and heterotopic ossification after femoral traction pin placement. Two complications were reported. One patient developed heterotopic ossification along the pin tract after LTM traction pin placement. Another patient developed septic arthritis after LTM pin placement, likely attributable to retrograde intramedullary nailing of his open femur fracture rather than his traction pin. There were no reports of neurovascular injury, cellulitis, or osteomyelitis associated with pin placement. The complication rate was 0.9% for LTM group and 0.0% for MTL group (p = 0.616). LTM femoral traction pin placement is a safe procedure with a similarly low complication rate compared with traditional MTL placement when the limb is positioned in neutral alignment. (Journal of Surgical Orthopaedic Advances 32(4):259-262, 2023).

Heterotopic ossification (HO) following acetabular fracture surgery is relatively common. The purpose of this study was to perform a systematic review of the literature regarding HO rates following acetabular surgery and the effectiveness of the various prophylactic measures taken to prevent its occurrence. A search of PubMed, MEDLINE, and Cochrane Database of Systematic Reviews was performed using the search terms ("Acetabular" OR "Acetabulum") AND ("Heterotopic Ossification" OR "HO" OR "Ectopic Ossification"). Inclusion criteria included articles published in English reporting on HO in acetabular fracture surgery. Descriptive statistics were calculated with categorical data presented as frequency with percentages and continuous data as means. Standard weighted means were calculated for all parameters. Sixty-six articles were included in this study with a total of 5,028 patients. HO was identified in 1,511 (30%) of fractures. Indomethacin (27%) and radiation therapy (24%) demonstrated decreased rates of HO formation versus no prophylaxis (36%). In particular, rates of severe HO formation were substantially decreased with radiation therapy (3%) and indomethacin (7%) compared to no prophylaxis (18%). Indomethacin and radiation therapy both appear to decrease HO formation and severity without substantially increasing surgical morbidity. (Journal of Surgical Orthopaedic Advances 32(4):217-224, 2023).

Tibial plateau fractures are a common injury treated by orthopaedic trauma surgeons. Depression of the articular surface of the tibial plateau is often an associated injury pattern. The methods used to address depressed tibial plateau fractures can vary, as it has yet to be determined if the type of bone void filler utilized affects the long-term functional outcomes of patients with tibial plateau fractures. A 28-question survey was created to better elucidate the current practices used by orthopaedic surgeons and the factors influencing the selection of bone void fillers for treatment of these injuries. The survey was distributed online to Orthopaedic Trauma Association (OTA) members. There were 106 orthopaedic surgeons that completed the survey with a wide range of responses. The survey determined the current practice of orthopaedic surgeons varies widely when selecting bone void fillers in the treatment of depressed tibial plateau fractures. (Journal of Surgical Orthopaedic Advances 32(3):156-159, 2023).

High tibial osteotomy (HTO) is a surgical procedure that can be used as a primary or as an adjunctive treatment for a variety of knee pathologies, most commonly isolated medial compartment arthrosis in a knee with varus alignment. More recently, indications for HTO have been expanded to include its use in combination with cartilage preserving techniques, to offload the effected compartment, and in conjunction with ligamentous reconstruction. HTO also has utility in delaying total knee arthroplasty (TKA) in select patients with favorable literature on future TKA outcomes. Numerous techniques for HTO have been published, however, medial opening wedge and lateral closing wedge osteotomies remain the most common. The purpose of this article is to summarize HTO patient selection and indications, surgical techniques, common complications, and review outcomes from recent literature. (Journal of Surgical Orthopaedic Advances 32(3):148-155, 2023).

The objective of this study was to determine if physicians are compensated equally for the treatment of femoral neck fractures based on fixation method in a propensity score matched cohort of patients. The American College of Surgeons' National Surgical Quality Improvement Project (ACS NSQIP) database was queried for patients undergoing open reduction internal fixation (ORIF), hemiarthroplasty (HA), and total hip arthroplasty (THA) for femoral neck fractures. Exact matching was used to account for differences in patient-specific variables and underlying medical comorbidities. Total relative value units (RVU), operative time, RVU/minute, and reimbursement/minute were compared between the three procedures after exact matching to assess relative valuation. Propensity score matching resulted in a total of 4,581 patients eligible for final data analysis (1,527 patients in each treatment group). The groups were very well matched for age, sex, BMI, comorbidities, and American Society of Anesthesiologists (ASA) class (p > 0.99 for all). When dividing compensation by case duration, ORIF generated the most RVUs per minute (0.31 ± 0.19 or $11.01 ± 7.02) followed by THA (0.27 ± 0.14 or $9.86 ± 5.15) and HA (0.25 ± 0.1 or $8.99 ± 3.75; p<0.001 for all). This study shows that orthopaedic surgeons are compensated the most for ORIF followed by THA and HA for fixation of femoral neck fractures. (Journal of Surgical Orthopaedic Advances 32(3):164-168, 2023).

Outcomes of the Surgical Implant Generation Network (SIGN) nail have been reported for femur and tibial fractures, but its use in tibiotalocalcaneal arthrodesis (TTCA) is not well studied. Radiographic and clinical outcomes of TTCA using the SIGN database in patients with > 6 months of radiographic follow up were analyzed. Rates of tibiotalar (TT) fusion and subtalar (ST) fusion at final follow up were assessed by two independent reviewers. Of the 62 patients identified, use of the SIGN nail for TCCA resulted in 53% rate of fusion in the TT joint and 20% in the ST joint. Thirty-seven patients (60%) demonstrated painless weight bearing at final follow up. There were no differences in incidence of painless weight bearing between consensus fused and not fused cohorts for TT and ST joints (p > 0.05). There were five implant failures, no cases of infection, and seven cases of reoperation. (Journal of Surgical Orthopaedic Advances 32(3):187-192, 2023).

To review the literature on iliac wing fractures to assess outcomes of operative and nonoperative treatment. A search of PubMed, MEDLINE, and Cochrane Database of Systematic Reviews was performed. Articles reporting on iliac wing fractures without pelvic ring destabilization or intraarticular extension were included. Study information and patient data were collected, and a Methodological Index for Non-randomized Studies (MINORS) score was assigned to each article. In total, 19,363 articles were identified with 32 qualifying for inclusion. The articles included 131 patients with 133 fractures. The mean age was 43.6, and mean follow-up time was 41.9 months. Forty-eight (36%) fractures were treated operatively, and 85 (64%) were treated nonoperatively. Associated injuries included bowel injuries, other pelvic fractures, gunshot wounds, and arterial injuries. There is an absence of comparative studies between operative and nonoperative management of iliac wing fractures. Indications for operative management appear to depend on comminution, open fractures, and associated injuries. (Journal of Surgical Orthopaedic Advances 32(3):139-147, 2023).

Outpatient shoulder arthroplasty presents potential clinical benefits but also risk without perioperative optimization. Length of stay depends largely on surgeon preferences, and a large single-surgeon cohort may provide insight into optimal strategies and costs for outpatient shoulder arthroplasty. A single-surgeon cohort of 472 anatomic and reverse shoulder arthroplasties performed between 2017 and 2020 was retrospectively reviewed. Cases were stratified by those who did or did not undergo same-day discharge. The 90-day readmission, discharge to post-acute care, cost, and 45 patient/case factors were examined. Two hundred fifty (53%) underwent same-day discharge, with the proportion of outpatient cases increasing over time to nearly 80%, with no significant difference in 90-day readmissions. Revision cases often underwent same-day discharge, whereas fractures were typically admitted. The cost was significantly higher for inpatients, with implants accounting for 52%. Surgeons may safely transition a substantial proportion of shoulder arthroplasties to same-day discharge with some reassurance regarding cost savings and 90-day readmissions. (Journal of Surgical Orthopaedic Advances 32(4):263-269, 2023).

Acute compartment syndrome (ACS) represents a surgical emergency requiring effective, complete fasciotomy. The purpose of this study is to evaluate cadaver-based training on the ability of practicing general surgeons to effectively perform upper extremity, thigh, and leg fasciotomies. One hundred seventeen general surgeons underwent a 2-day, cadaver-based course with formative and summative assessments based on validated scoring tools. Overall performance and critical item scores were recorded and compared utilizing analysis of variance with repeated measures and eta-squared values to evaluate effect size. For all three procedures, post-training scores were significantly improved when compared with pre-training scores (p < 0.001). Mean pre-training score for lower leg fasciotomy met the standard for competent performance of the procedure (total score > 80), whereas neither thigh nor upper extremity performance scores met this standard before training. This 2-day, cadaver-based course improves the ability of practicing general surgeons to effectively and independently perform upper extremity, thigh, and lower leg fasciotomies. (Journal of Surgical Orthopaedic Advances 32(4):238-241, 2023).