Clinical Orthopaedics and Related Research®最新文献

{"title":"Equity360: Gender, Race, and Ethnicity-CMS TEAM and the Elusive Goal of Health Equity.","authors":"Matt Reiter, Mary I O'Connor","doi":"10.1097/CORR.0000000000003335","DOIUrl":"10.1097/CORR.0000000000003335","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"208-210"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766838","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":"Are There Differences in Performance Among Femoral Stem Brands Utilized in Cementless Hemiarthroplasty for Treatment of Geriatric Femoral Neck Fractures?","authors":"Ishan Shah, Heather A Prentice, Kanu Okike, Ronald A Navarro, Brian H Fasig, Elizabeth W Paxton, Christopher D Grimsrud","doi":"10.1097/CORR.0000000000003222","DOIUrl":"10.1097/CORR.0000000000003222","url":null,"abstract":"<p><strong>Background: </strong>For the vast majority of displaced femoral neck fractures in older patients, cemented femoral fixation is indicated because it is associated with a lower risk of periprosthetic fracture than cementless fixation. Nevertheless, cementless fixation continues to be utilized with high frequency for hip fractures in the United States. It is therefore helpful to understand the performance of individual cementless brands and models. Although prior studies have compared femoral stems by design type or stem geometry, there may still be a difference in revision risk according to femoral stem brand given the potential differences within design groupings with regard to manufacturing, implantation systems, and implant design nuances among vendors.</p><p><strong>Questions/purposes: </strong>(1) Is there a difference in aseptic revision risk among femoral stem brands in patients ≥ 60 years of age who have displaced femoral neck fractures treated with cementless hemiarthroplasty? (2) Is there a difference in revision for periprosthetic fracture among femoral stem brands in patients ≥ 60 years of age with displaced femoral neck fractures treated with cementless hemiarthroplasty?</p><p><strong>Methods: </strong>A retrospective, comparative, large-database cohort study was conducted using data from Kaiser Permanente's Hip Fracture Registry. This integrated healthcare system covers more than 12 million members throughout eight regions in the United States; membership has been found to be representative of the general population in the areas served. The Hip Fracture Registry collects details on all patients who undergo hip fracture repair within the organization. These patients are then longitudinally monitored for outcomes after their repair, and all identified outcomes are manually validated through chart review. Patients ages ≥ 60 years who underwent unilateral hemiarthroplasty treatment of a displaced femoral neck fracture from 2009 to 2021 were identified (n = 22,248). Hemiarthroplasties for polytrauma, pathologic or open fractures, or patients who had additional surgeries at other body sites during the same stay, as well as those with prior procedures in the same hip, were excluded (21.4% [4768]). Cemented procedures and those with missing or inconsistent implant information (for example, cement used but cementless implant recorded) were further excluded (47.1% [10,485]). To allow for enough events for evaluation, the study sample was restricted to seven stems for which there were at least 300 hemiarthroplasties performed, including four models from DePuy Synthes (Corail®, Summit®, Summit Basic, and Tri-Lock®) and three from Zimmer Biomet (Medial-Lateral [M/L] Taper®, Trabecular Metal®, and Versys® Low Demand Fracture [LD/FX]). The final sample included 5676 cementless hemiarthroplasties: 653 Corail, 402 M/L Taper, 1699 Summit, 1590 Summit Basic, 384 Tri-Lock, 637 Trabecular Metal, and 311 Versys LD/FX. Procedures were performed b","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"253-264"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999510","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":"Do Patients With Dominant-side Distal Radius Fractures Have Greater Psychological Distress Than Those With Nondominant-side Fractures?","authors":"Hayati Kart, Erdoğdu Akça","doi":"10.1097/CORR.0000000000003244","DOIUrl":"10.1097/CORR.0000000000003244","url":null,"abstract":"<p><strong>Background: </strong>Distal radius fractures have a psychological impact on patients, with the pain and disability caused by these injuries potentially leading to psychological distress. It is not known whether dominant-side and nondominant-side distal radius fractures cause more psychological distress in patients.</p><p><strong>Questions/purposes: </strong>(1) Compared with patients who have distal radius fractures on the nondominant side, do patients with dominant-side fractures experience greater pain? (2) Do patients with dominant-side distal radius fractures have greater disability? (3) Do patients with dominant-side distal radius fractures have worse psychological adjustment? (4) What factors are associated with a worse quality of life mental component measure?</p><p><strong>Methods: </strong>This retrospective study was conducted by the departments of orthopaedics-traumatology and psychiatry in a multidisciplinary manner at our university hospital, which is a public hospital. The study included 172 patients with distal radius fractures who were treated nonoperatively. We excluded 2% (3 of 172) of patients who underwent surgery because of loss of reduction, 1% (2 of 172) of patients with bilateral distal radius fractures, and 9% (16 of 172) of patients who did not consent to participate in the study. After the exclusion of 12% (21 of 172) of ineligible patients, the study continued with 88% (151 of 172) of patients. Forty-six percent (70 of 151) of patients had dominant distal radius fractures and 54% (81 of 151) of patients had nondominant distal radius fractures. The evaluation was carried out face-to-face at the end of the sixth week of treatment in the orthopaedic outpatient clinic. The VAS score was used to assess pain (this score ranges from 0 to 10, where 0 represents no pain and 10 represents the worst pain, with a minimum clinically important difference [MCID] of 2), the QuickDASH was used to assess disability (ranges from 0 to 100, representing best to worst, with an MCID of 15.9), the Brief Adjustment Scale-6 (BASE-6) was used to assess psychological adjustment (ranges from 6 to 42, lower scores indicate better outcomes), and the SF-12 was used to assess quality of life (ranges from 0 to 100, representing worst to best, with an MCID of 5).</p><p><strong>Results: </strong>At cast removal, patients with dominant-side distal radius fractures had higher levels of pain (dominant VAS median [IQR] 4 [4], nondominant VAS median 2 [3], median difference 2; p = 0.005), but the difference was not clinically important. There were no differences in disability (dominant QuickDASH median 63.6 [21], nondominant Quick DASH median 59.1 [25], median difference 4.5; p = 0.20). Psychological adjustment was worse in patients with dominant-side fractures (dominant BASE-6 median 22.5 [24.3], nondominant BASE-6 median 15 [23.5], median difference 7.5; p = 0.004). After accounting for variables such as age, occupation, and gender, a better qual","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"279-285"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139506","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":"Does Cannabis-based Medicine Improve Pain and Sleep Quality in Patients With Traumatic Brachial Plexus Injuries? A Triple-blind, Crossover, Randomized Controlled Trial.","authors":"Piyabuth Kittithamvongs, Pattraluck Anantasinkul, Sopinun Siripoonyothai, Navapong Anantavorasakul, Kanchai Malungpaishrope, Chairoj Uerpairojkit, Somsak Leechavengvongs","doi":"10.1097/CORR.0000000000003221","DOIUrl":"10.1097/CORR.0000000000003221","url":null,"abstract":"<p><strong>Background: </strong>After traumatic brachial plexus injuries, despite treatment with appropriate medications, some patients experience uncontrollable pain, which can be devastating. Cannabis-based medicine is considered to have pain-relieving benefits in this situation, but the evidence is limited.</p><p><strong>Questions/purposes: </strong>Is cannabis-based medicine effective compared with the placebo in (1) reducing pain (measured by the VAS for pain) and neuropathic pain (measured by the DN4 questionnaire), and (2) improving sleep quality (measured by the VAS for sleep quality) in patients with traumatic brachial plexus injury?</p><p><strong>Methods: </strong>This prospective, triple-blinded (the researcher administering the substance, the patients, and the evaluator were all blinded to the substance used), two-period crossover, placebo-controlled, randomized controlled trial was conducted at a single center. Between January 2020 and January 2022, we treated 147 patients for neuropathic pain related to a traumatic brachial plexus injury. Our inclusion criteria were age between 20 and 60 years and moderate-to-severe pain (VAS for pain equal to or greater than 4 of 10 for more than 6 months), even with the use of appropriate medications. Based on these criteria, 20% (30) of patients were eligible. They were randomly allocated to receive either cannabis-based medicine followed by the placebo or vice versa. Fifteen patients received cannabis-based medicine first, and 15 patients received the placebo first. The groups did not differ at baseline in terms of demographic parameters. Participants received both the cannabis-based medicine and the placebo; they started with 10 days of the initial intervention, followed by a 14-day washout period, and then a 10-day period with the second intervention. The dosage regimen adhered strictly to the protocol. The outcomes were the (1) VAS for pain, which ranges from 0 to 10 and where 0 represents no pain and 10 signifies the worst pain; (2) the DN4 questionnaire which ranges from 1 to 10 and where a score of 4 or higher indicates a positive result for neuropathic pain; and (3) VAS for sleep quality, from 0 (worst) to 10 (best). The minimum clinically important difference of VAS for pain was defined as a 2-point improvement. After enrollment, 7% (2 of 30) of patients (one patient received the cannabis-based medicine first and another received the placebo first) were lost before the minimum study follow-up, leaving 93% (28 of 30) for analysis. With 28 patients in each group, the study was powered a priori at 90% to detect a clinically important difference of 2 points in the VAS for pain. No carryover or period effects were observed in the study. Four patients experienced mild dizziness during the cannabis-based medicine period but were able to continue the intervention.</p><p><strong>Results: </strong>When comparing the use of cannabis-based medicine alongside pain control medications with the combina","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"228-234"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901142","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®: Taper Junction Subsidence Occurs in Modular Tumor Endoprostheses: How Concerned Should We Be?","authors":"Magdalena Maria Gilg","doi":"10.1097/CORR.0000000000003246","DOIUrl":"10.1097/CORR.0000000000003246","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"303-305"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153291","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":"Value-based Healthcare: The Impact of Consolidation in Healthcare on the Field of Orthopaedic Surgery.","authors":"Victor C Agbafe, David N Bernstein, Kevin J Bozic","doi":"10.1097/CORR.0000000000003360","DOIUrl":"10.1097/CORR.0000000000003360","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"211-213"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913909","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":"Not the Last Word: Joint Replacement for Patients With Obesity is About Opinions and Incentives.","authors":"Joseph Bernstein","doi":"10.1097/CORR.0000000000003361","DOIUrl":"10.1097/CORR.0000000000003361","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"194-198"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926544","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":"Do Surgeons Experience Moral Dissonance When There Is Misalignment Between Evidence and Action? A Survey and Scenario-based Study.","authors":"Bandele Okelana, Amin Razi, David Ring, Sina Ramtin","doi":"10.1097/CORR.0000000000003220","DOIUrl":"10.1097/CORR.0000000000003220","url":null,"abstract":"<p><strong>Background: </strong>Moral dissonance is the psychological discomfort associated with a mismatch between our moral values and potentially immoral actions. For instance, to limit moral dissonance, surgeons must develop a rationale that the potential for benefit from performing surgery is meaningfully greater than the inherent harm of surgery. Moral dissonance can also occur when a patient or one's surgeon peers encourage surgery for a given problem, even when the evidence suggests limited or no benefit over other options. Clinicians may not realize the degree to which moral dissonance can be a source of diminished joy in practice. Uncovering potential sources of moral dissonance can help inform efforts to help clinicians enjoy their work.</p><p><strong>Questions/purposes: </strong>In a scenario-based experiment performed in an online survey format, we exposed musculoskeletal specialists to various types of patient and practice stressors to measure their association with moral dissonance and asked: (1) What factors are associated with the level of pressure surgeons feel to act contrary to the best evidence? (2) What factors are associated with the likelihood of offering surgery?</p><p><strong>Methods: </strong>We performed a scenario-based experiment by inviting members of the Science of Variation Group (SOVG; an international collaborative of musculoskeletal surgeons that studies variation in care) to complete an online survey with randomized elements. The use of experimental techniques such as randomization to measure factors associated with specific ratings makes participation rate less important than diversity of opinion within the sample. A total of 114 SOVG musculoskeletal surgeons participated, which represents the typical number of participants from a total of about 200 who tend to participate in at least one experiment per year. Among the 114 participants, 94% (107) were men, 49% (56) practiced in the United States, and 82% (94) supervised trainees. Participants viewed 12 scenarios of upper extremity fractures for which surgery is optional (discretionary) based on consensus and current best evidence. In addition to a representative age, the scenario included randomized patient and practice factors that we posit could be sources of moral distress based on author consensus. Patient factors included potential sources of pressure (such as \"The patient is convinced they want a specific treatment and will go to a different surgeon if they don't get it\") or experiences of collaboration (such as \"The patient is collaborative and involved in decisions\"). Practice factors included circumstances of financial or reputational pressure (such as \"The practice is putting pressure on you to generate more revenue\") and factors of limited pressure (such as \"Your income is not tied to revenue\"). For each scenario, the participant was asked to rate both of the following statements on a scale from 0 to 100 anchored with \"I don't feel it at all\" at 0,","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"217-224"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901141","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":"Reply to the Letter to the Editor: Contralateral Neck-shaft Angle Lower Than 130° Is Associated With Clinical Failure in Nongeriatric Individuals: Analysis of the National Femoral Neck Fracture Database of 1066 Patients.","authors":"Dajun Jiang, Jiaqing Cao, Weitao Jia","doi":"10.1097/CORR.0000000000003376","DOIUrl":"10.1097/CORR.0000000000003376","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"364-365"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022456","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":"Letter to the Editor: Contralateral Neck-shaft Angle Lower Than 130° Is Associated With Clinical Failure in Nongeriatric Individuals: Analysis of the National Femoral Neck Fracture Database of 1066 Patients.","authors":"Yi-Yen Tsai, Zhi-Hong Zheng","doi":"10.1097/CORR.0000000000003333","DOIUrl":"10.1097/CORR.0000000000003333","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":"363"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766848","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}