Bulletin of the Hospital for Joint Disease (2013)最新文献

Objective: The purpose of this study was to describe our experience using superiorly applied low-profile locking plates for the operative fixation of displaced midshaft clavicle fractures (MCFs).

Study design: This was a retrospective analysis performed at an academic institution.

Results: Eighty-three patients who presented with displaced, shortened MCFs were treated operatively by a single surgeon at our institution over a 10-year period. All patients received a precontoured low-profile locking plate applied in the superior position. A displaced midshaft clavicle fracture was fixed operatively using a precountered low-profile 2.7/3.5 mm locking plate applied in the superior position. Data were analyzed to evaluate time to union, final shoulder range of motion, incidence of hardware removal, and rate of postoperative complications. The cohort was 66.2% male with an average age at initial injury of 36.5 ± 14.1 years. At a mean of 3.6 ± 1.9 months, 99% of patients had united their fracture. At an average of 7.37-month follow-up, mean range of motion was 174° forward elevation, 173° abduction, 82° external rotation, and internal rotation to T7. Using the short musculoskeletal functional assessment (SMFA), the mean functional outcome index score was 4.12, bothersome index was 1.94, activity index was 1.55, emotion index was 2.51, arm and hand index was 1.14, mobility index was 0.68, and total index was 1.56. Ninety-two percent of patients had retained their hardware. There was 1 incidence of each of the following complications: infection, nonunion, hardware failure, and deep vein thrombosis.

Conclusion: Superior clavicle plating using precontoured low-profile locking plates is an acceptable treatment modality for displaced MCF. This method yields excellent results regarding time to union, shoulder range of motion, incidence of hardware removal, and the rate of postoperative complications. Patients considering operative fixation of displaced MCF should be counseled accordingly.

Background: The purpose was to investigate whether pain, function, satisfaction, or return to play (RTP) differs between sexes postoperatively in those undergoing medial patellofemoral ligament (MPFL) reconstruction for patellar instability.

Methods: A review of patients who underwent an MPFL reconstruction for patellar instability was performed. Kujala score, visual analogue scale (VAS), patient satisfaction, willingness to undergo surgery again, revisions, RTP, and MPFL-return to sport after injury (MPFL-RSI) score were evaluated. Clinical outcomes were compared between sexes.

Results: Our study included 141 knees that underwent MPFL reconstruction, and the population was 69.5% female. Postoperatively, the mean VAS score at rest was 1.0 ± 1.7 in male patients and 1.6 ± 2.1 in female patients (P = .0963). The mean Kujala score was 88.8 ± 13.3 and 83.5 ± 16.1 for male and female patients, respectively (P = .1062). Overall, there was a significant difference in RTP, with male patients returning at higher rates (58.1 vs. 33.3%, P = .0479). The mean VAS score during activity was significantly lower in male patients at 1.8 compared with female patients at 3 (P = .016). The MPFL-RSI score was also significantly worse in female patients (69.5 vs. 55.6, P = .0098). Although female patients had slightly higher rates of recurrent subjective instability (14.3 vs. 11.7%) and re-dislocation (2 vs. 0%), the difference was not statistically significant (P > .05).

Conclusion: Female patients had worse clinical outcomes than male patients undergoing MPFL reconstruction for patellar instability, with significantly lower rates of RTP, VAS score during sport, and MPFL-RSI scores with a trend toward lower Kujala score and VAS score.

Abstract: The scapholunate ligament (SLL) is a critical stabilizer of the wrist joint. Disruption of the SLL leads to altered wrist kinematics, including scaphoid flexion, lunate extension, and increased stress on surrounding cartilage and ligaments, which can progress to dorsal intercalated segment instability and scapholunate advanced collapse. Despite predictable biomechanical changes, clinical outcomes vary widely because some patients develop significant functional limitations, whereas others remain asymptomatic. Nonoperative management, including immobilization, therapy, and bracing, remains the first-line treatment for partial tears or stable injuries. Surgical intervention, such as SLL repair with capsulodesis or reconstruction, is indicated for cases with persistent pain, instability, or functional deficits. Capsulodesis is a commonly used adjunct to SLL repair. Multiple surgical techniques exist for SLL repair in the acute setting and for reconstruction in the chronic setting when SLL is deemed irreparable. Although several surgical techniques are available for chronic injuries, a gold standard has not yet been established.

Background: The COVID-19 pandemic led to increased sedentary behavior and body mass index during 2020, which may decondition musculotendinous units and lead to increased risk for injury. As patients return to pre-COVID levels of activity, we hypothesize that there will be a resultant rebound increase in tendon ruptures.

Level of evidence: III, descriptive epidemiology study.

Methods: The electronic medical record was queried for current procedural terminology codes for tendon ruptures (Achilles, patella, quadriceps, hamstring, distal biceps, triceps, and pectoralis major) from January 2017 to December 2021 at a single academic urban center. Data were reviewed to ensure only acute tendon rupture repairs were included. The years 2017-2019 were used as a proxy for pre-COVID rates, 2020 as a proxy for the COVID quarantine, and 2021 as a proxy for "post-COVID" activity. Univariate analysis was performed for comparative data.

Results: A total of 1,879 patients (82.8% male, mean age 47.8 years) who sustained tendon injuries and underwent surgical repair were identified. There were 589 (31.3%) Achilles tendon repairs, 181 (9.6%) patella tendon repairs, 414 (22.0%) quadriceps tendon repairs, 100 (5.3%) hamstring tendon repairs, 397 (21.1%) distal biceps repairs, 105 (5.6%) triceps repairs, and 93 (4.9%) pectoralis tendon repairs. The total number of tendon injuries per year was 2017-357 (19.0%), 2018-380 (20.2%), 2019-380 (20.2%), 2020-308 (16.4%), and 2021-454 (24.2%). The rates in 2017, 2018, and 2019 were within 1% of each other, but there were a 3.8% decrease in rate of tendon injuries from 2019 to 2020 and a 7.8% increase in rate of tendon injuries from 2020 to 2021. When analyzed by quarter, a linear regression model demonstrated a statistically significant increase in case counts over the period from Q2 2020 to Q2 2021 (β = 21.20; 95% confidence interval = 13.62-28.78, P-value < .01).

Conclusions: A "COVID rebound" of tendon rupture repairs in 2021 from a prolonged period of inactivity during 2020 occurred at a single academic center. As patients return to pre-COVID levels of activity that may be unsuitable to their deconditioned state, healthcare providers should counsel patients appropriately on return to activity or sport following long periods of induced inactivity.

Abstract: As orthopedic surgeons navigate the complexities of selecting their first positions, or established surgeons seek changes in employment, understanding the evolving financial and structural landscape of surgical practices is crucial. The rising influence of private equity (PE) in health care has added another dimension to this decision, as investment firms increasingly acquire stakes in practices to drive consolidation and profitability. Between 2015 and 2022, PE transactions in health care surged dramatically, reflecting the growing trend of practice consolidation in response to declining reimbursements, rising operational costs, and regulatory burdens. PE firms use leveraged buyouts to acquire and restructure practices, often forming management services organizations to streamline operations. Although PE partnerships offer benefits, including access to capital and corporate expertise, they also raise concerns about reduced autonomy, increased procedural volumes, and potential impacts on care quality and costs. This article provides an overview of PE's role in orthopedic practices, including its history, investment strategies, and the anatomy of typical deals. It explores the implications of PE partnerships on financial and clinical outcomes and highlights the importance of physicians staying informed about these developments. By understanding the benefits and risks, orthopedic surgeons can make more informed decisions in the context of a rapidly changing health care environment.

Abstract: Given the progressive spread of medical misinformation, access to understandable educational content from trusted sources has become increasingly more crucial for patients. Online patient education materials, particularly from specialty organizations, have been criticized for being too complex for the average reader. It is advised that this information be at or below the 6th-grade reading level. This study is a 9-year follow-up to an analysis conducted in 2013 which evaluated the overall readability of educational articles from the American Academy of Orthopaedic Surgeons (AAOS) and American Society for Surgery of the Hand (ASSH) websites related to shoulder and elbow conditions. In the current investigation, 74 shoulder and elbow articles were assessed using the same methodology, which included analyzing the number of years since their last update, word count, percentage of passive sentences, Flesch Reading Ease score, Flesch-Kincaid grade level, Simple Measure of Gobbledygook (SMOG) grade, and New Dale-Chall grade level. No articles from either site were at or below the recommended 6th-grade reading level. Those from the AAOS were longer than those from the ASSH (P < .001). The articles had a mean Flesch Reading Ease score of 53.8 vs. 58 (P = .01), Flesch-Kincaid grade level of 9.6 vs. 9.4, SMOG grade of 8.9 vs. 8.6, and New Dale-Chall grade of 10.5 vs. 10.1 for the AAOS and ASSH sites, respectively. Although no significant differences in the readability measures were noted between the 2013 and current AAOS articles, the current ASSH content had a significantly higher Flesch Reading Ease score (P = .01) and significantly lower Flesch-Kincaid (P = .04), SMOG (P = .03), and New Dale-Chall (P = .03) grade levels, than their 2013 counterparts. Although improvements have been made in the shoulder and elbow articles from the ASSH, there remains a need to further improve the readability of AAOS and ASSH online materials to better ensure adequate patient education.

Abstract: Posterior shoulder instability (PSI) is a relatively rare but increasingly recognized condition that affects athletes and individuals engaged in overhead or high-impact sports. Historically underdiagnosed, PSI encompasses a spectrum of clinical presentations, including subluxations and dislocations, often leading to pain, mechanical symptoms, and loss of function. Over the past decade, we have gained a better understanding of this challenging disorder. This overview discusses the anatomy and pathophysiology underlying PSI, highlights key diagnostic modalities and imaging techniques, and emphasizes the importance of a personalized approach to diagnosis and management.

Abstract: The landscape of total shoulder arthroplasty (TSA) is rapidly evolving, with a significant shift toward outpatient procedures. This transition has been supported by enhanced recovery protocols and shorter hospital stays. Key factors for successful outpatient TSA include careful patient selection, focusing on individuals with minimal comorbidities, and preoperative optimization, such as patient education and mental health assessments. Intraoperative considerations like blood loss management, pain control, and surgical efficiency play a crucial role in ensuring positive outcomes. Although challenges remain, including patient selection bias and the need for standardized protocols, ongoing research, innovation in surgical practices, and integration of technology can further enhance the safety and effectiveness of outpatient TSA. Ultimately, with appropriate patient selection and optimization strategies, outpatient TSA can provide comparable outcomes to inpatient procedures, benefiting both patients and health care systems.

Abstract: Despite bone's robust regenerative capacity, complications such as delayed union and nonunion affect 5-10% of fractures, with significant clinical and economic burdens. The rising incidence of fractures, particularly in an aging population, highlights the importance of optimizing fracture healing strategies. This review explores current therapies aimed at enhancing bone regeneration, focusing on 2 main categories: local biologic therapies and mechanical therapies. Local biologic treatments, including concentrated bone marrow aspirate, platelet-rich plasma, bone morphogenetic proteins, and platelet-derived growth factor, aim to stimulate osteogenesis at the fracture site. Therapies, such as electrical stimulation, low-intensity pulsed ultrasound, and extracorporeal shockwave therapy, are theorized to modify the mechanical environment to promote healing. Although these therapies show promise, variability in clinical outcomes emphasizes the need for further research to standardize protocols and refine treatment strategies. Overall, advancing our understanding of bone healing mechanisms will continue to drive innovation in fracture management, improving patient outcomes and reducing health care costs.