Journal of Bone and Joint Surgery, American Volume最新文献

{"title":"Advances in the Management of Sternoclavicular Joint Injuries.","authors":"Colby Nielsen, Niloofar Dehghan, Michael D McKee","doi":"10.2106/JBJS.25.01025","DOIUrl":"https://doi.org/10.2106/JBJS.25.01025","url":null,"abstract":"<p><p>➢ The sternoclavicular joint (SCJ) serves as the only osseous connection between the axial skeleton and the upper limb and is a synovial, saddle-like joint with robust posterior ligamentous stabilizers and a fibrocartilaginous disc.➢ The brachiocephalic veins and other mediastinal structures are at risk from injury or surgery about the SCJ.➢ SCJ injuries are best imaged with computed tomography (CT). CT angiography is warranted when a vascular injury is suspected, and magnetic resonance imaging (MRI) is useful to define soft-tissue injuries.➢ Acute posterior SCJ dislocations in active, healthy individuals can result in considerable disability if unreduced and an aggressive treatment approach is warranted.➢ Chronic locked posterior dislocations are more challenging to treat, making prompt recognition and referral (if appropriate) important.➢ Reliable surgical techniques including ligament reconstruction and open reduction and internal fixation for SCJ injuries have been well supported in the current orthopaedic literature.➢ Vascular injury is a rare but catastrophic concern when dealing with SCJ pathology and should be considered when determining the venue for planned intervention, as should collaboration with a thoracic or vascular surgeon.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Dedicated Trauma Operating Room for Hand Surgery Reduces After-Hours Cases and Costs without Affecting Wait Times: A Retrospective Single-Center Cohort Study.","authors":"Chloe R Wong, Mauz Asghar, David R Urbach, Heather L Baltzer","doi":"10.2106/JBJS.25.00025","DOIUrl":"10.2106/JBJS.25.00025","url":null,"abstract":"<p><strong>Background: </strong>After-hours hand trauma care is associated with surgeon fatigue, a higher risk of complications, and increased staffing costs. Dedicated trauma operating rooms (DTORs) have been established in orthopaedic and trauma surgery to improve access to care and patient outcomes. The purpose of this study was to measure the impact of a DTOR for hand surgery on the proportion of after-hours cases and wait times from consultation to surgery at a Canadian urban tertiary-care center.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients undergoing hand trauma surgery during 2 periods: before DTOR implementation, from August 1, 2018, to January 31, 2020 (n = 599), and after DTOR implementation, from August 1, 2022, to January 31, 2024 (n = 541). The main outcomes were the proportion of emergency cases performed after hours and the wait times from consultation to surgery. A post hoc analysis examined total hospital costs. Multivariable logistic regression was used to estimate associations with binary outcomes, and multivariable negative binomial regression was used to estimate associations with continuous outcomes. Other outcomes, including caseload, surgical complications, and revision surgeries, were assessed using univariate analysis.</p><p><strong>Results: </strong>After DTOR implementation, after-hours cases decreased from 18% (109 of 599) to 8% (45 of 541). Adjusting for covariates, DTOR implementation was associated with fewer emergency hand surgeries being performed after hours (odds ratio, 0.47 [95% confidence interval (CI), 0.23 to 0.95]; p = 0.03). The median wait times were similar before and after DTOR implementation: 6 days before implementation and 8 days after it (rate ratio, 1.03 [95% CI, 0.91 to 1.16]; p = 0.64). DTOR implementation was associated with a 19% adjusted reduction in total hospital costs: in Canadian dollars, $2,578.66 before DTOR implementation and $2,220.98 after it (rate ratio, 0.81 [95% CI, 0.78 to 0.84]; p < 0.001). The hand trauma caseload was similar (p = 0.09) before and after DTOR implementation. Complications became less frequent after DTOR implementation (reduced from 5% to 2%; p = 0.03), whereas revision rates did not change (10% and 11%; p = 0.70).</p><p><strong>Conclusions: </strong>DTOR implementation was associated with fewer after-hours surgeries, lower complication rates, and meaningful hospital cost savings, without increasing wait times or revision rates. These findings support integrating DTORs to improve operational efficiency and patient outcomes in hand trauma care.</p><p><strong>Level of evidence: </strong>Economic and Decision Analysis Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"658-663"},"PeriodicalIF":4.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145856494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Examining Cross-Linking: Commentary on an article by Young-Hoo Kim, MD, et al.: \"Comparison of Highly Cross-Linked and Conventional Polyethylene During Simultaneous Bilateral Cruciate-Retaining Total Knee Arthroplasties. Results at a Minimum Follow-up of 15 Years\".","authors":"Elizabeth G Lieberman","doi":"10.2106/JBJS.25.01320","DOIUrl":"https://doi.org/10.2106/JBJS.25.01320","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"108 9","pages":"615"},"PeriodicalIF":4.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Podagra.","authors":"Kiana C Allen","doi":"10.2106/JBJS.25.01513","DOIUrl":"10.2106/JBJS.25.01513","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"621"},"PeriodicalIF":4.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sterile But Not Clean: Managing Retained PMMA in Autoclaved Surgical Trays: Commentary on an article by Andrew L. Thomson, BS, et al.: \"Autoclaving Effectively Sterilizes Contaminated Retained Cement in Orthopaedic Surgical Trays\".","authors":"Koki Abe, Hyonmin Choe, Yutaka Inaba","doi":"10.2106/JBJS.25.01520","DOIUrl":"https://doi.org/10.2106/JBJS.25.01520","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"108 9","pages":"616-617"},"PeriodicalIF":4.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI-Based Synthetic CT Shows Promise as a Radiation-Free Alternative to Conventional CT in Orthopaedics.","authors":"Henry Stewart, Aidan Watkins, Shivani Ahlawat, Laura M Fayad, David L Skaggs, Paul D Sponseller","doi":"10.2106/JBJS.25.00976","DOIUrl":"10.2106/JBJS.25.00976","url":null,"abstract":"<p><p>➢ Computed tomography (CT) remains the gold standard for bone imaging, but radiation risks, especially in children, are driving interest in alternatives. ➢ Magnetic resonance imaging (MRI)-based techniques are emerging as a radiation-free alternative to CT, using sequences such as zero echo time, ultrashort echo time, and 3-dimensional (3D) gradient recalled echo, along with deep learning-based synthetic CT. ➢ Zero echo time MRI stands out for its high-resolution and silent imaging, whereas 3D gradient recalled echo offers widespread availability and minimal requirements for implementation. ➢ Early studies have shown high agreement of all modalities with CT across multiple anatomical sites, supporting broader clinical use, especially in pediatrics, surgical planning, and cost-reduction efforts. ➢ Deep learning-based synthetic CT demonstrates strong potential given its ability to improve over time and to generate highly accurate CT-like images, although current applications are limited by existing training data.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"629-638"},"PeriodicalIF":4.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All Boats Rise: A Dedicated Hand Trauma Operating Room Improves Patient Care, Decreases Costs, and Can Improve Physician Wellness: Commentary on an article by Chloe R. Wong, MD, et al.: \"A Dedicated Trauma Operating Room for Hand Surgery Reduces After-Hours Cases and Costs without Affecting Wait Times. A Retrospective Single-Center Cohort Study\".","authors":"Sonya P Agnew","doi":"10.2106/JBJS.25.01358","DOIUrl":"https://doi.org/10.2106/JBJS.25.01358","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"108 9","pages":"613-614"},"PeriodicalIF":4.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Highly Cross-Linked and Conventional Polyethylene During Simultaneous Bilateral Cruciate-Retaining Total Knee Arthroplasties: Results at a Minimum Follow-up of 15 Years.","authors":"Young-Hoo Kim, Jang-Won Park, Young-Soo Jang, Eun-Jung Kim","doi":"10.2106/JBJS.25.00621","DOIUrl":"10.2106/JBJS.25.00621","url":null,"abstract":"<p><strong>Background: </strong>There have been no long-term studies comparing the revision rates of a highly cross-linked polyethylene (HXLPE) bearing with those of a conventional polyethylene (CP) bearing among cruciate-retaining (CR) total knee arthroplasties (TKAs). The aim of the current long-term study was to compare CR TKAs with HXLPE and CP bearings in terms of clinical, radiographic, and computed tomographic (CT) scan results; prevalence of osteolysis; revision rate; and implant survivorship.</p><p><strong>Methods: </strong>This study enrolled a consecutive series of 410 Korean patients (mean age, 62.6 ± 8 years) who underwent simultaneous bilateral TKAs during the same anesthetic session. This study included 164 men and 246 women. Each patient underwent a posterior CR high-flexion TKA (NexGen CR-Flex TKA; Zimmer Biomet) with an HXLPE bearing on 1 side and a NexGen CR-Flex TKA with a CP bearing on the opposite side. The mean follow-up period was 17.5 years (range, 15 to 19 years).</p><p><strong>Results: </strong>At the latest follow-up, there were no significant differences between the HXLPE and CP groups with regard to the Knee Society score (94 compared with 93 points), Western Ontario and McMaster Universities Osteoarthritis Index (19.2 points for both groups), range of motion (125° compared with 126°), radiographic and CT results, or revision rate (2.0% compared with 2.2%). No knee showed osteolysis in either group. The estimated survival rate at 17.5 years, using revision or aseptic loosening as the end point, was 98.0% (95% confidence interval, 92% to 100%) for the group with the CR-Flex TKA with an HXLPE bearing and 97.8% (95% confidence interval, 92% to 100%) for the group with the CR-Flex TKA with a CP bearing.</p><p><strong>Conclusions: </strong>The findings of this long-term study (minimum follow-up of 15 years) indicate that CR-Flex TKAs with HXLPE and CP bearings both yielded excellent clinical outcomes and implant survivorship. However, no significant clinical advantage was observed for HXLPE over CP bearings in this patient population.</p><p><strong>Level of evidence: </strong>Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"664-670"},"PeriodicalIF":4.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145856524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cost-Effectiveness of Enoxaparin Compared with Aspirin for Thromboprophylaxis in Patients with Orthopaedic Trauma.","authors":"Joseph F Levy, Robert V O'Toole, Deborah M Stein, Elliott R Haut, Katherine P Frey, Renan C Castillo, Nathan N O'Hara","doi":"10.2106/JBJS.25.00681","DOIUrl":"10.2106/JBJS.25.00681","url":null,"abstract":"<p><strong>Background: </strong>Although clinical guidelines endorse enoxaparin for the prevention of venous thromboembolism in patients with orthopaedic trauma, recent evidence from a large clinical trial has demonstrated that aspirin provides comparable protection against death and pulmonary embolism. This study evaluated the cost-effectiveness of thromboprophylaxis with enoxaparin compared with that with aspirin in patients with orthopaedic trauma from the perspective of the U.S. health-care system.</p><p><strong>Methods: </strong>The study modeled a hypothetical cohort of adult patients with an operatively treated extremity, pelvic, or acetabular fracture based on data from a recent clinical trial and national databases. We used a decision analysis model to compare 30 mg of enoxaparin with 81 mg of aspirin, administered twice daily in-hospital and prescribed for 21 days after discharge. Health-care costs and quality-adjusted life-years (QALYs) within 1 year after the injury derived from published research and publicly available cost data were based on potential disease states, including death or a combination of pulmonary embolism, proximal deep vein thrombosis, distal deep vein thrombosis, or a bleeding complication. We assessed cost-effectiveness compared with a willingness-to-pay threshold of $150,000 per QALY.</p><p><strong>Results: </strong>Our model estimated that the 1-year health-care costs among patients prescribed enoxaparin were $35,301, producing 0.6705 QALYs. Aspirin was associated with $35,067 in 1-year health-care costs and 0.6701 QALYs. The overall health-care costs were $234 higher with enoxaparin but yielded only a 0.0004 improvement in QALYs, for an incremental cost-effectiveness ratio for enoxaparin of $635,340 per QALY, indicating that enoxaparin is not cost-effective compared with aspirin. In a sensitivity analysis, the probability of enoxaparin thromboprophylaxis being cost-effective compared with aspirin was 9.8% in 10,000 iterations.</p><p><strong>Conclusions: </strong>The findings suggest that enoxaparin is not cost-effective relative to aspirin for thromboprophylaxis in patients with orthopaedic trauma. The results support consideration of aspirin as a preferred agent in future guidelines, especially given the consistent patient preference for its oral administration.</p><p><strong>Level of evidence: </strong>Economic and Decision Analysis Level I . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"e9"},"PeriodicalIF":4.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prevalence of Pediatric Septic Arthritis of the Hip with Concomitant Osteomyelitis: A Retrospective Study of 58 Consecutive Cases Investigated Using MRI.","authors":"Ahmer Ahmad Khan, Elio Paris, Viola Sbampato, Giacomo De Marco, Anne Tabard-Fougère, Oscar Vazquez, Christina Steiger, Romain Dayer, Dimitri Ceroni","doi":"10.2106/JBJS.25.01422","DOIUrl":"https://doi.org/10.2106/JBJS.25.01422","url":null,"abstract":"<p><strong>Background: </strong>This observational study systematically used magnetic resonance imaging (MRI) to determine the prevalence of concomitant osteomyelitis and its influence on clinical outcomes in cases of pediatric septic arthritis (SA) of the hip.</p><p><strong>Methods: </strong>We retrospectively analyzed the demographic, clinical, microbiological, and radiographic data of 58 children treated for SA of the hip who underwent systematic MRI between 2000 and 2025. Patients were categorized into 2 groups: isolated septic arthritis and septic arthritis with concomitant osteomyelitis. The clinical and laboratory parameters, causative pathogens, and treatments were compared between the groups.</p><p><strong>Results: </strong>Concomitant osteomyelitis was identified with MRI in 43% (25) of the 58 patients, while radiographs detected it in only 16%. Demographic, clinical, and inflammatory parameters were statistically similar between the groups. Kingella kingae was the most commonly identified pathogen (37.9%), and Staphylococcus aureus and Streptococcus spp. were more frequently associated with repeat surgery. No significant differences in complication rates, treatment duration, or outcomes were found between the groups.</p><p><strong>Conclusions: </strong>The systematic use of MRI revealed concomitant osteomyelitis in >40% of cases of pediatric SA. However, the presence of osteomyelitis was not associated with worse outcomes, suggesting that factors related to the microorganism profile or virulence must contribute substantially to disease severity. Nonetheless, MRI should be considered early in any diagnostic work-up of pediatric SA of the hip.</p><p><strong>Level of evidence: </strong>Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}