Clinical Orthopaedics and Related Research®最新文献

{"title":"ArtiFacts: Cyborg.","authors":"Alan J Hawk","doi":"10.1097/CORR.0000000000003454","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003454","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"483 5","pages":"800-802"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Is the Accuracy of 16S PCR Followed by Sanger Sequencing or Next-generation Sequencing in Native Vertebral Osteomyelitis? A Systematic Review and Meta-analysis.","authors":"Omar K Mahmoud, Francesco Petri, Said El Zein, Madiha Fida, Felix E Diehn, Jared T Verdoorn, Audrey N Schuetz, M Hassan Murad, Ahmad Nassr, Elie F Berbari","doi":"10.1097/CORR.0000000000003314","DOIUrl":"10.1097/CORR.0000000000003314","url":null,"abstract":"<p><strong>Background: </strong>Identifying a microorganism in patients with native vertebral osteomyelitis presents diagnostic challenges. Microorganism identification through culture-based methods is constrained by prolonged processing times and sensitivity limitations. Despite the availability of molecular diagnostic techniques for identifying microorganisms in native vertebral osteomyelitis, there is considerable variability in reported sensitivity and specificity across studies, leading to uncertainty in their clinical utility.</p><p><strong>Questions/purposes: </strong>What are the sensitivity, specificity, and diagnostic odds ratios for 16S broad-range PCR followed by Sanger sequencing (16S) and metagenomic next-generation sequencing (NGS) for detecting bacteria in native vertebral osteomyelitis?</p><p><strong>Methods: </strong>On June 29, 2023, we searched Cochrane, Embase, Medline, and Scopus for results from January 1970 to June 2023. Included studies involved adult patients with suspected native vertebral osteomyelitis undergoing molecular diagnostics-16S bacterial broad-range PCR followed by Sanger sequencing and shotgun or targeted metagenomic NGS-for bacteria detection. Studies involving nonnative vertebral osteomyelitis and cases of brucellar, tubercular, or fungal etiology were excluded. The reference standard for the diagnosis of native vertebral osteomyelitis was a composite clinical- and investigator-defined native vertebral osteomyelitis diagnosis. Diagnostic performance was assessed using a bivariate random-effects model. Risk of bias and diagnostic applicability were evaluated using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. After a manual screening of 3403 studies, 10 studies (5 on 16S, 5 on NGS) were included in the present analysis, from which 391 patients were included from a total of 958 patients overall. Quality assessment via QUADAS-2 criteria showed moderate risk of bias and good applicability.</p><p><strong>Results: </strong>16S showed 78% (95% confidence interval [CI] 95% CI 31% to 96%) sensitivity and 94% (95% CI 73% to 99%) specificity, whereas NGS demonstrated 82% (95% CI 63% to 93%) sensitivity and 71% (95% CI 37% to 91%) specificity. In addition, the diagnostic ORs were 59 (95% CI 9 to 388) and 11 (95% CI 4 to 35) for 16S and NGS, respectively. Summary receiver operating characteristic curves showed high test performance for 16S (area under the curve for 16S 95% [95% CI 93% to 97%] and for NGS 89% [95% CI 86% to 92%]). Certainty in estimates was moderate because of sample size limitations.</p><p><strong>Conclusion: </strong>This meta-analysis found moderate-to-high diagnostic performance of molecular methods on direct patient specimens for the diagnosis of native vertebral osteomyelitis. When used as a complementary test to microbiological analyses, a positive 16S result rules in the diagnosis of native vertebral osteomyelitis, while further studies are needed to understand ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"930-938"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Is Preoperative Opioid Use Associated With Readmissions and Outcomes in Lower Extremity Trauma?","authors":"Heather Peluso, Sthefano Araya, Heli Patel, Daniel Najafali, Bhavana Thota, Lindsay Talemal, Madison Hackley, Civanni Moss, Sameer A Patel, Adam Walchak","doi":"10.1097/CORR.0000000000003346","DOIUrl":"10.1097/CORR.0000000000003346","url":null,"abstract":"<p><strong>Background: </strong>Opioid use disorder (OUD) has been implicated as a potential risk factor for adverse outcomes and readmissions in various surgical procedures. Patients admitted with an open fracture of the lower extremity often have multifarious pain needs, require surgical procedures, and have prolonged rehabilitation; previous OUD complicates this process. Our goal was to describe at a national level how OUD is associated with readmission, complications, and healthcare expenditure for patients admitted with open lower extremity fractures.</p><p><strong>Questions/purposes: </strong>(1) Do patients with OUD who were treated for open lower extremity fractures have higher odds of readmission compared with patients without OUD? (2) Do patients with OUD who were treated for open lower extremity fractures have higher healthcare utilization (specifically, length of stay and hospitalization charges and costs)?</p><p><strong>Methods: </strong>This was a retrospective, comparative study using the Nationwide Readmissions Database, which is the largest nationally representative readmissions database in the United States. Patients were included if they had an ICD-10-CM principal diagnosis of open lower extremity fracture. Between January 1, 2019, and September 30, 2019, a total of 17,811 patients were admitted for open lower extremity fractures and entered in the National Readmissions Database. Of the 17,811 patients, 2.3% (410) had a secondary diagnosis of OUD and 97.7% (17,401) did not. The mean age was 46 years for both groups. The most common operative procedure was debridement, and 1.5% of patients received a flap for reconstruction. Opioid disorders were identified using ICD-10-CM codes. Ninety-day complications and readmissions were characterized for the calendar year. Patients undergoing flap-based reconstructions were identified with ICD-10-PR codes. Confounders (patient demographic and hospital characteristics) were adjusted for using multivariable regression analysis models.</p><p><strong>Results: </strong>After controlling for potentially confounding variables such as primary payer, Charlson comorbidity index, Gustillo type, and bone density, we found that patients with OUD had greater odds of readmission after open lower extremity fractures (adjusted OR 1.45 [95% confidence interval (CI) 1.0 to 2.0]; p = 0.03). The 90-day infection occurrence was higher in patients with OUD (adjusted OR 1.96 [95% CI 1.0 to 3.8]; p = 0.049) and was the primary reason for readmission in both groups. Moreover, 11% (11 of 103) of patients with OUD were readmitted with opioid-induced complications, which was exclusively observed in this cohort. Patients with OUD also had longer hospital stays (adjusted mean difference 2.2 days [95% CI 0.5 to 3.8]; p = 0.01) and higher hospitalization charges (adjusted mean difference in USD 34,000 [95% CI 1000 to 66,000]; p = 0.04) and costs (adjusted mean difference in USD 7000 [95% CI 2000 to 13,000]; p = 0.007) tha","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"918-927"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Does Merit-based Incentive Payment System Performance Differ Based on Orthopaedic Surgeon Gender?","authors":"Wakenda K Tyler","doi":"10.1097/CORR.0000000000003412","DOIUrl":"10.1097/CORR.0000000000003412","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"829-831"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Fracture of the Anteromedial Facet of the Coronoid Is More Common Than Previously Thought in Combined Fractures of the Coronoid and Radial Head.","authors":"Mihir Sheth","doi":"10.1097/CORR.0000000000003371","DOIUrl":"10.1097/CORR.0000000000003371","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"889-891"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: How Do Individuals Perceive Diagnostic Labels and Explanations for Hip Pain? A Qualitative Study Among Adults With Persistent Hip Pain.","authors":"Troy Amen","doi":"10.1097/CORR.0000000000003528","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003528","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behind the Mask: My New Best Friend.","authors":"Steven E Zhang","doi":"10.1097/CORR.0000000000003447","DOIUrl":"10.1097/CORR.0000000000003447","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"798-799"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leptin Enhances M1 Macrophage Polarization and Impairs Tendon-Bone Healing in Rotator Cuff Repair: A Rat Model.","authors":"Yinghao Li, Lei Yao, Yizhou Huang, Long Pang, Chunsen Zhang, Tao Li, Duan Wang, Kai Zhou, Jian Li, Xin Tang","doi":"10.1097/CORR.0000000000003428","DOIUrl":"10.1097/CORR.0000000000003428","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff tears are common, affecting more than 60% of individuals older than 80 years, and they have been implicated in 70% of patients with shoulder pain. M1 polarization-related inflammation has been reported to be associated with poor healing outcomes of rotator cuff injury, and leptin, an adipokine, has been reported to be a potential activator of inflammation. However, whether leptin affects rotator cuff repair remains unknown.</p><p><strong>Questions/purposes: </strong>Using in vitro cell experiments and an in vivo rat rotator cuff tear model, we therefore asked: (1) Does leptin promote the M1 polarization of macrophages in vitro and in vivo? (2) Does leptin impair biomechanical strength, the histologic structure of the tendon-bone interface, bone mineral density (BMD), or gait in the rotator cuff tear scenario? (3) Does leptin promote M1 polarization by upregulating the tumor necrosis factor (TNF) pathway?</p><p><strong>Methods: </strong>The impact of leptin on M1 macrophage polarization in vitro was determined by reverse transcription-polymerase chain reaction (RT-PCR), the Western blot test, and immunofluorescence staining. The effect of leptin on tendon-bone healing was assessed in an in vivo rat rotator cuff tear model by comparing a leptin group with a suture group in terms of gait, biomechanical tensile strength, the histologic structure of the tendon-bone interface, and BMD. In the in vivo experiments, 8-week-old male Sprague Dawley rats were used, adapting a previously developed rat rotator cuff tear model. The supraspinatus tendon was resected from the greater tuberosity bilaterally, and then the tendon was secured to its anatomical footprint using the transosseous single-row technique. In total, 30 rats were randomized into two groups (suture, leptin) by drawing lots (15 rats in each group). They were assessed at 2, 4, and 8 weeks after the surgery. In the suture group, 100 µL of normal saline was injected into the subacromial space after the deltoid muscle was restitched to the original position. In the leptin group, 100 µL of leptin solution (200 ng/mL) was injected into the subacromial space after the deltoid muscle was restitched to the original position. Biomechanical properties including maximal failure load, stiffness, and tensile failure stress were determined to assess the biomechanical strength at 4 and 8 weeks after the surgery. Histologic staining was conducted to compare the structure of the tendon-bone interface between treatment groups. Micro-MRI and micro-CT assessments were conducted to compare the overall healing outcome and BMD between treatment groups. Gait analysis was conducted to compare the stride length and strength between treatment groups. M1 macrophage polarization in vivo at the tendon-bone interface was assessed by immunofluorescence staining. Finally, to explore the underlying mechanism of the effects of leptin, Necrostatin-1 (Nec-1) was used to block the TNF sign","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"939-951"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Hip-Spine Relationship in Femoroacetabular Impingement: Does Hip Arthroscopy Affect Pelvic Mobility?","authors":"George Grammatopoulos","doi":"10.1097/CORR.0000000000003389","DOIUrl":"10.1097/CORR.0000000000003389","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"853-856"},"PeriodicalIF":4.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12014106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On Patient Safety: Managing the Risks of Telehealth Prescribing.","authors":"James Rickert","doi":"10.1097/corr.0000000000003522","DOIUrl":"https://doi.org/10.1097/corr.0000000000003522","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"25 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}