Current Orthopaedic Practice最新文献

{"title":"Surgical management of acetabular fractures associated with pelvic ring disruption, the time-dependent effect of delay","authors":"Islam Sameeh, Yamen Safwat, Mohammed Khalid Saleh","doi":"10.1097/bco.0000000000001242","DOIUrl":"https://doi.org/10.1097/bco.0000000000001242","url":null,"abstract":"Background: Associated fractures of the acetabulum and pelvic ring represent considerable percentage of polytrauma victims. These types of injuries are different from isolated acetabular or pelvic injuries regarding injury severity scores, haemodynamic status, blood transfusion requirements, and higher mortality rates up to 13%. Both Letournel and Matta have definitively shown that anatomic reduction of the fracture is the most influential factor predictive of clinical outcome. The ability of obtaining anatomical reduction is affected by age, fracture pattern, associated injuries, patient general condition, timing to surgery and complications. Design: Retrospective cohort study. Methods: It is a retrospective study among 24 patients performed in Zagazig university hospitals between May 2017 and February 2019. Matta scoring system was used to quantify the radiological outcome of both acetabular and pelvic components while, both Majeed and Merle d’Aubigné were used for clinical grading at the final follow up. Timing to surgery was found to affect the quality of reduction significantly. Results: We divided our cases into 2 groups; First group including the patients underwent operative management from day 0 to day 10 which include 18 cases and Second group including the patients underwent operative management from day 11 to day 21 which include 6 cases and we will observe if there is a correlation between the preoperative delay and Matta scoring for both acetabular and pelvic components. Among the operatively managed acetabular fracture There was significant association between preoperative delay and Matta scoring system for acetabular component ( P <0.05) Among the operatively managed pelvic ring injuries There was significant association between preoperative delay and Matta scoring system for pelvic component ( P <0.05). Conclusion: The quality of reduction can be controlled by controlling the time to surgery after optimization of the general condition of the patient and controlling the local complications. In our study the earlier to operate on both components within the first 10 days after initial trauma the better to get anatomical reduction.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"23 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reference suture of gluteus minimus muscle: a modification of the lateral approach in total hip arthroplasty","authors":"José María García López, Jorge Gómez Alcaraz, Juan Carlos García de la Blanca, Alexis D. Iliadis","doi":"10.1097/bco.0000000000001240","DOIUrl":"https://doi.org/10.1097/bco.0000000000001240","url":null,"abstract":"The lateral approach is one of the most frequently used surgical procedures in total hip arthroplasty, being its main disadvantage the postsurgical abductor muscle weakness that many patients present, which may lead to Trendelenburg gait in a high percent of cases. For this reason we propose a surgical variation which consists in using a suture reference for the gluteus minimus just before its tenotomy, that allows a better repair of the abductor musculature during the closure. It also facilities muscles mobilization during the dissection, reducing the risk of neurovascular damage if we place an additional retractor, and also protects the gluteus minimus and gluteus medium during the insertion of the prosthetic components. With these advantages, we aim to reduce the most frequent complication of the lateral approach as it is the abductor muscle weakness. This modification only consists in a new suture, so it does not implies additional complications in contrast with the classical approach. However, in some patients can be difficult to place the suture if they have a tendinous deterioration of the gluteus minimus or a chronic break.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"23 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Implications of Soft Tissue Depth in Primary Total Hip Arthroplasty","authors":"Blaine Oldham, Dustin Rinehart, Tyler Youngman, Michael Huo","doi":"10.1097/bco.0000000000001241","DOIUrl":"https://doi.org/10.1097/bco.0000000000001241","url":null,"abstract":"Background: Morbid obesity has been identified as a risk factor for complications in total hip arthroplasty (THA). However, the impact of the adipose tissue distribution near the surgical site has not been adequately studied. We aimed to characterize the complication rates associated with varying soft tissue depth around the operative hip as measured on plain films. Methods: We performed a retrospective review of primary THAs at our institution from 2009 to 2020. A total of 106 patients met inclusion criteria. Propensity score matching was used to match the patients that required reoperation (n=13) to a cohort of those that did not (n=33) based upon demographics, BMI, and age. Four standardized measurements were taken, and statistical analyses were performed to determine if complication differences existed between cohorts. Results: There was no statistical difference between the non-reoperation cohort or the reoperation cohort in age (65.0 vs. 65.4, P =0.462) or BMI (39.4 vs. 40.9, P =0.108). There was no significant difference between the two cohorts for all four measurements ( P =0.296, P =0.369, P =0.463, P =0.321). A subgroup analysis of patients with BMI ≥40 (n=23) demonstrated that individuals in the reoperation cohort had a higher value of measurements 3 and 4 (237.2 vs. 274.6, P =0.041; 236.5 vs. 284.1, P =0.015). Conclusions: A standardized measurement of thigh width on an AP pelvis plain film may help surgeons identify a subset of patients (BMI ≥40) at elevated risk for complication in primary THA.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135679340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generic orthopaedic trauma implants: implementation, outcomes, and cost savings","authors":"Rebekah Kleinsmith, Stephen A. Doxey, Fernando A. Huyke-Hernández, Nizar Mikhael, Brian P. Cunningham","doi":"10.1097/BCO.0000000000001237","DOIUrl":"https://doi.org/10.1097/BCO.0000000000001237","url":null,"abstract":"Background: As healthcare costs continue to rise, there has been increasing emphasis placed on providing value-based care. In orthopaedics, one way to influence cost is through the use of generic implants. The purpose of this study was to evaluate cost-savings and surgical outcomes with the implementation of generic orthopaedic trauma implant use. Methods: This was a retrospective case series of 154 primary orthopaedic trauma patients from April – December 2022 within a level II trauma center. Patients were included if treated solely with generic implants. Exclusion criteria consisted of revision procedures for any reason, and the use of conventional name brand implants. Eleven different primary orthopaedic trauma procedures in which generic implants were evaluated. Main outcome measurements included operative time, perioperative complications, reoperation rates, patient mortality, implant cost, cost-savings. Results: Cost-savings per procedure with the use of generic implants in eleven different primary orthopaedic trauma procedures ranged from 16% to 73%. The average cost-savings was 48.8% among the 11 procedures evaluated, with a yearly cost-savings of 56.0% when case volume is considered. Maintaining the 2021 case volume for one surgeon constant, an overall savings of $256,794 could be generated. Conclusions: This study demonstrated that generic implants can provide an opportunity for relatively good patient outcomes with minimal overall risk. Generic implants are a valid alternative to decrease costs while maintaining acceptable patient outcomes. Future studies should seek to provide patient-reported outcome measures for generic implants and compare them to conventional implant use.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"17 1","pages":"38 - 42"},"PeriodicalIF":0.3,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139317799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet rich plasma could replace tranexemic acid in total knee replacement? A comparative study between their postoperative- bleeding hemostatic effects","authors":"Mahmoud Fahmy, Ebeed Yasin","doi":"10.1097/bco.0000000000001238","DOIUrl":"https://doi.org/10.1097/bco.0000000000001238","url":null,"abstract":"Background: The aim of the study is to detect whether platelet rich plasma (PRP) is equal to tranexemic acid (TXA) in reducing blood loss and transfusion rates following total knee arthroplasty (TKA), and compare clinical outcomes, complications, and cost effectiveness between the two groups. This is one of the first randomized, controlled trials that compare both materials in elective knee arthroplasty. Methods: 120 patients were randomized. Postoperative blood loss was determined and compared by measuring the total drainage suction together with the hemoglobin level and blood transfusion rate. Thromboembolic complications and knee society score were recorded. Results: The mean total drain output was 469 mL in the TXA group compared with 698 mL in the PRP group, with statistical significance. There were significant differences in reduction of hemoglobin level (TXA: 1.21 vs. PRP: 2.08). The rate of deep vein thrombosis (DVT) in patients given TXA was higher than those given PRP, however, there were no significant differences. No transfusions were required in either group, and no significant differences were found in the length of hospital stay, pain assessment and knee society score. Conclusions: Though the blood loss was significantly bigger in the custom-made PRP group, no transfusions were required. Meanwhile, the rate of DVT in the PRP group tends to be lower than those in TXA group. We concluded that PRP was not superior to TXA in reducing perioperative blood loss, however further large-scale randomized trials are crucial to confirm these results to be added to the calling literature.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135092961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a simple angiocath instead of scorpion suture passer in transtibial pullout repair of the meniscal root tear","authors":"Mehdi Moghtadaei, Abolfazl Bagherifard, Hooman Yahyazadeh, Mehdi Mohammadpour, Khazar Adibmoradi Langroudi, Ali Mousapour","doi":"10.1097/bco.0000000000001235","DOIUrl":"https://doi.org/10.1097/bco.0000000000001235","url":null,"abstract":"Background: Suture pullout during arthroscopic transtibial pullout repair of the meniscal root tear is generally performed using a Scorpion. In this study, we introduce a suture passing technique using a simple angiocath and compare its results with that of a Scorpion. Patients and Methods: In a retrospective series, 28 patients for whom an angiocath was used to pass the suture and 28 group-matched patients for whom a Scorpion was used were included. The outcomes of the patients were evaluated radiologically by assessment of ghost sign, cleft sign, and meniscal extrusion in knee MRI, and clinically by the assessment of the International Knee Documentation Committee (IKDC) score, Lysholm scale, and VAS for pain, which were obtained in the last follow-up. Results: The baseline characteristics of the two groups were not significantly different. After the operation, no patient had a positive ghost or cleft sign. The change of meniscal extrusion was not statistically different between the two groups (P=0.24). At the last follow-up, the mean Lysholm scale was 84.7±7.3 in the case group and 83.7±7.4 in the control group (P=0.61). The mean IKDC score was 84.6±6.8 in the case group and 85.3±4.9 in the control group (P=0.33). The mean VAS for pain was 3.2±0.9 in the case group and 3.3±0.9 in the control group (P=0.44). Conclusion: Using an angiocath to pass the suture in transtibial pullout repair is a cost-effective and efficient substitute for the Scorpion suture passer and could be used alternatively. Level of evidence: Level IV.","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136095035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Time to Surgery for Distal Radius Fractures Impact Clinical and Radiographic Outcomes? A Systematic Literature Review.","authors":"Kaitlyn R Julian, Nicole M Truong, Chelsea Leversedge, Jeffrey W Kwong, Alexander Rosinski, Robin N Kamal, Lauren M Shapiro","doi":"10.1097/bco.0000000000001224","DOIUrl":"10.1097/bco.0000000000001224","url":null,"abstract":"<p><p>Distal radius fractures are one of the most common upper extremity fractures across all age groups. Although the American Academy of Orthopaedic Surgery (AAOS) Clinical Practice Guidelines have defined recommendations for the treatment of distal radius fractures, the optimal time to surgery was not included. There remains relatively little guidance or consensus regarding the optimal timing of surgical intervention for distal radius fractures and the impact of time to surgery on outcomes. As such, the purpose of this investigation is to systematically review clinical and radiographic outcomes associated with time to surgical management of distal radius fractures.</p>","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"34 1","pages":"229-235"},"PeriodicalIF":0.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10802167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44187324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing rates of clinic no-shows during and following the COVID-19 pandemic at an academic orthopaedic multispecialty group","authors":"Aaron K. Hoyt, Ryan C. LeDuc, H. Castillo, John R. Miller","doi":"10.1097/bco.0000000000001234","DOIUrl":"https://doi.org/10.1097/bco.0000000000001234","url":null,"abstract":"\u0000 \u0000 Clinic no-shows are common throughout all medical specialties and can be used as a potential surrogate marker for access to care and have a significant impact on patients and providers. While anecdotally, orthopaedic surgeons have noticed unprecedented changes in the delivery of care as a result of the COVID-19 pandemic, the effect on no-show rates has not been quantified.\u0000 \u0000 \u0000 \u0000 An analysis of the rates of outpatient clinic no-shows within a multispecialty, academic orthopaedic surgery practice was completed. Encounters were sub-classified into designated periods based on a “pre-COVID-19” period, a “COVID-19” period, and a “post-COVID-19” period. A univariate analysis was performed to comment on differences amongst insurance payer status. A multivariate regression was completed to assess which variables contributed to no-show rates among this orthopaedic practice.\u0000 \u0000 \u0000 \u0000 The overall no-show rate over the course of the study was 8.5%. These rates differed significantly between insurance groups, with the lowest no-show rate among Workers’ Compensation/Liability Insurance (WC/LI; 6.4%) and the highest among uninsured patients (21.4%). Additionally, no-show rates differed significantly by COVID period (pre-COVID=7.3%, COVID=8.6%, P<.0001). These rates further increased in the post-COVID period (9.6%, P<.0001) In response to the COVID-19 pandemic, medical practice habits have altered out of necessity.\u0000 \u0000 \u0000 \u0000 Despite a relaxation of social distancing guidelines, no-show rates have continued to increase at our institution. Our results suggest a disproportionate effect on those of lower socioeconomic status. The specific needs of the patient population should be considered when implementing strategies to improve clinic attendance.\u0000","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49288050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Median nerve compression by a reversed palmaris longus in the distal forearm: a case report","authors":"José María García López, D. Cecilia López, María Concepción Merino Sánchez","doi":"10.1097/bco.0000000000001236","DOIUrl":"https://doi.org/10.1097/bco.0000000000001236","url":null,"abstract":"","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41737812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning?: A retrospective cohort study: Erratum","authors":"","doi":"10.1097/bco.0000000000001226","DOIUrl":"https://doi.org/10.1097/bco.0000000000001226","url":null,"abstract":"","PeriodicalId":10732,"journal":{"name":"Current Orthopaedic Practice","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135286073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}