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

{"title":"Sport Participation Is Associated with Superior 10-Year Patient Acceptable Symptom State Achievement Following Contemporary Hip Arthroscopy for Femoroacetabular Impingement.","authors":"Ron Gilat, Michael J Vogel, Omair Kazi, Alexander B Alvero, Shane J Nho","doi":"10.2106/JBJS.24.00324","DOIUrl":"10.2106/JBJS.24.00324","url":null,"abstract":"<p><strong>Background: </strong>Sport participation has been associated with favorable outcomes following hip arthroscopy (HA) for femoroacetabular impingement (FAI) at short- and mid-term follow-up; however, few studies have evaluated the 10-year outcomes in this population. The purpose of this study was to compare patient-reported outcome measures (PROMs), the achievement of clinically significant outcomes, and reoperation-free survivorship between patients with and without regular preoperative sport participation who underwent HA for FAI and had a minimum of 10 years of follow-up.</p><p><strong>Methods: </strong>Data were prospectively collected for patients who underwent primary HA for FAI between January 2012 and September 2013. Patients who participated in weekly sport participation at the time of surgery (\"athletes\") were matched 1:1 to patients who denied sport participation (\"nonathletes\"), controlling for age, sex, and body mass index (BMI). Preoperative and 10-year postoperative PROMs were collected, including the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports (HOS-Sports) subscales, the modified Harris hip score (mHHS), and the visual analog scale for pain (VAS Pain) and satisfaction (VAS Satisfaction). Patient acceptable symptom state (PASS) achievement and reoperation-free survivorship were compared between the groups.</p><p><strong>Results: </strong>Sixty-four athletes were matched to 64 nonathletes of similar age, sex, and BMI (p ≥ 0.411). In the athlete group, 85.9% were recreational-level athletes. The groups had similar preoperative PROMs, except for the HOS-ADL subscale, where the athlete group demonstrated a higher preoperative score (67.8 ± 16.7 versus 59.9 ± 21.1, p = 0.029). Both groups demonstrated a significant improvement in all PROMs (p < 0.001) at the minimum 10-year follow-up10.3 ± 0.4 years). At the time of the final follow-up, the athlete group demonstrated significantly higher scores across all of the measured PROMs (p ≤ 0.036). Athletes showed a higher cumulative PASS achievement compared with nonathletes for the HOS-ADL subscale (73% versus 50%, p = 0.033), the HOS-Sports subscale (85% versus 61%, p = 0.010), the mHHS (69% versus 43%, p = 0.013), and the VAS Pain (78% versus 51%, p = 0.006). Reoperation-free survivorship frequencies were 87.5% and 82.8%, respectively (p = 0.504).</p><p><strong>Conclusions: </strong>Athletes who underwent contemporary HA for FAI showed superior PROMs and PASS achievement compared with nonathletes at the 10-year follow-up. Athletes and nonathletes showed reoperation-free survivorship frequencies of 87.5% and 82.8%, respectively.</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":"858-867"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441032","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 Adductor Canal Block Before Versus After Total Knee Arthroplasty in Terms of Pain, Stress, and Functional Outcomes: A Double-Blinded Randomized Controlled Trial.","authors":"Qiuru Wang, Jian Hu, Changjun Chen, Ting Ma, Jing Yang, Pengde Kang","doi":"10.2106/JBJS.24.00679","DOIUrl":"10.2106/JBJS.24.00679","url":null,"abstract":"<p><strong>Background: </strong>Whether an adductor canal block (ACB) is more effective when administered before or after total knee arthroplasty (TKA) is unclear. This study compared pain, stress, and functional outcomes between patients who received the block before surgery and those who received the block after surgery.</p><p><strong>Methods: </strong>In this double-blinded trial, 100 patients at our hospital were randomized to receive an ACB at either 30 minutes before general anesthesia or postoperatively in the post-anesthesia care unit (PACU). All patients received periarticular local infiltration analgesia during surgery. The 2 groups were compared with respect to the primary outcome, the postoperative consumption of morphine as rescue analgesia, and in terms of the secondary outcomes, including the time from the end of surgery to the first rescue analgesia or discharge, intraoperative and postoperative stress, postoperative pain, functional recovery, the incidence of chronic pain, and complications.</p><p><strong>Results: </strong>All included patients were Asian (Chinese) in race/ethnicity. The 2 groups had similar demographic information. Compared with the postoperative ACB, the preoperative ACB was associated with significantly lower morphine consumption within the first 24 hours postoperatively and lower total morphine consumption. It was also associated with a longer time until the first rescue analgesia, lower intraoperative consumption of opioids and inhaled anesthetic, fewer episodes of hypertension during surgery, a lower rate of rescue analgesia in the PACU, lower levels of cortisol and adrenocorticotropic hormone in serum on the morning of postoperative day 1, lower pain on a visual analog scale while at rest or during motion within 12 hours postoperatively, better range of knee motion on postoperative day 1, and a lower incidence of chronic pain at 3 months postoperatively. The 2 groups did not differ significantly with respect to postoperative ambulation distance, time until discharge, or complication rates.</p><p><strong>Conclusions: </strong>Administering an ACB before rather than after TKA may lead to lower opioid consumption during hospitalization, lower intraoperative and postoperative stress responses, better pain relief during hospitalization, and a lower incidence of chronic pain at 3 months postoperatively.</p><p><strong>Level of evidence: </strong>Therapeutic 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":"796-804"},"PeriodicalIF":4.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070762","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":"Ratio of Weight-to-Tibial Baseplate Surface Area in Predicting Aseptic Tibial Loosening in TKA and the Protective Effect of Tibial Stem Extensions.","authors":"Nathan A Huebschmann, Jonathan L Katzman, Joseph X Robin, Morteza Meftah, Joshua C Rozell, Ran Schwarzkopf","doi":"10.2106/JBJS.24.01226","DOIUrl":"10.2106/JBJS.24.01226","url":null,"abstract":"<p><strong>Background: </strong>High body mass index (BMI) is a risk factor for tibial baseplate loosening following total knee arthroplasty (TKA) but may not adequately correlate with stresses at the tibial baseplate. In this study, we aimed to determine an optimal cutoff of a weight-to-tibial baseplate surface-area ratio (weight/SA) for predicting aseptic tibial baseplate loosening. We further examined whether tibial stem extensions have a protective effect.</p><p><strong>Methods: </strong>We identified 16,368 patients who underwent primary, elective TKA from June 2011 to March 2023. Patient demographics, including age, sex, and race, implants used, and revision surgeries were extracted. Revisions were manually reviewed to confirm revision indications. The exact surface areas of tibial baseplates were obtained from manufacturers. Receiver operating characteristic (ROC) analysis of patients without tibial stem extensions was utilized to examine the utility of BMI and weight/SA for predicting aseptic tibial baseplate loosening. Optimal weight/SA and BMI cutoffs for predicting loosening were determined. The effect of tibial stem extensions on loosening was then examined in patients at or above (n = 7,698; 3.7% with stem extension) and below (n = 8,670; 1.3% with stem extension) the determined weight/SA cutoff.</p><p><strong>Results: </strong>There were 16,368 patients in the final sample (median age, 67 years; 68.9% female; 54.1% White). Weight/SA (area under the curve [AUC] = 0.653; p < 0.001) was a better predictor of aseptic tibial baseplate loosening requiring revision compared with patient BMI (AUC = 0.624; p < 0.001). The optimal weight/SA cutoff for predicting loosening was 0.0162 kg/mm 2 (sensitivity = 0.747, specificity = 0.537). Multivariable logistic regression demonstrated that being at or above the weight/SA cutoff (odds ratio [OR] = 3.17; p < 0.001) but not the BMI cutoff (p = 0.911) was a significant predictor of revision for tibial baseplate loosening in patients without stem extensions. No cases of revision for aseptic tibial baseplate loosening in patients with stem extensions occurred either at or above or below the cutoff. The rate of revision for aseptic tibial baseplate loosening in patients without stem extensions was 0.3% for patients below and 1.0% for patients at or above the weight/SA cutoff.</p><p><strong>Conclusions: </strong>The ratio of weight-to-tibial baseplate surface area was more predictive of revision for aseptic tibial baseplate loosening following TKA compared with BMI alone. For patients with obesity with small tibial baseplate sizes, utilization of a tibial stem extension may protect against tibial loosening.</p><p><strong>Level of evidence: </strong>Prognostic 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":"1362-1370"},"PeriodicalIF":4.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784370","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":"Universal Clinical DDH Screening Complemented with Targeted Ultrasound Is Effective in Finland.","authors":"Emma-Sofia Luoto, Jenni Jalkanen, Ilari Kuitunen, Reijo Sund, Yrjänä Nietosvaara","doi":"10.2106/JBJS.24.00313","DOIUrl":"10.2106/JBJS.24.00313","url":null,"abstract":"<p><strong>Background: </strong>The late diagnosis rate of developmental dysplasia of the hip (DDH) with universal ultrasound screening is 0.2 per 1,000 children according to a recent meta-analysis, which is the same as in Japan where selective ultrasound screening is used. We hypothesized that Finland's current program of universal clinical screening complemented with targeted ultrasound is noninferior to universal and selective ultrasound screening programs.</p><p><strong>Methods: </strong>For this retrospective cohort study, we collected the number of children <15 years of age who were diagnosed with DDH (International Classification of Diseases, Tenth Revision [ICD-10] codes Q65.0-Q65.6 and Ninth Revision [ICD-9] code 7543) as their primary diagnosis after ≥3 visits to a physician. These data were obtained from the Finnish Care Register for Health Care, which collects the ICD-10 and ICD-9 codes from every medical appointment. We calculated the annual incidence of DDH diagnoses per 1,000 newborns between 2002 and 2021. Late diagnosis of DDH was defined as a finding of DDH in children aged 6 months through <15 years at the initial diagnosis who had undergone treatment under anesthesia (closed reduction and casting or surgery). We also registered the geographic, age, and sex distributions of the DDH diagnoses.</p><p><strong>Results: </strong>During the 20-year study period, 1,103,269 babies were born (median per year, 57,214 babies; range per year, 45,346 to 60,694 babies). A total of 6,421 children had a diagnosis of DDH (mean per year, 321 children; range per year, 193 to 405 children), with a mean calculated incidence of 5.8 per 1,000 newborns (95% confidence interval [CI], 5.7 to 6.0). Altogether, 120 children aged 6 months through <15 years were treated for DDH, with little annual variation (median, 6.5 children; range, 2 to 9 children). The mean national incidence of late-diagnosed cases was 0.11 per 1,000 newborns (95% CI, 0.09 to 0.13).</p><p><strong>Conclusions: </strong>Finland's current DDH screening program, which includes universal clinical screening with targeted ultrasound, is noninferior when compared with other screening programs.</p><p><strong>Level of evidence: </strong>Prognostic 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":"e26"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nerve Recovery in Pediatric Supracondylar Humeral Fractures: Assessing the Impact of Time to Surgery.","authors":"Akbar N Syed, David Isaacs, Leta Ashebo, Divya Talwar, Jason B Anari, J Todd R Lawrence","doi":"10.2106/JBJS.24.00371","DOIUrl":"10.2106/JBJS.24.00371","url":null,"abstract":"<p><strong>Background: </strong>Nerve injuries in pediatric supracondylar humeral (SCH) fractures occur in 2% to 35% of patients. Previous research has suggested that isolated anterior interosseous nerve injuries are not influenced by the time to surgery; however, little is known about other nerve injuries or mixed, motor, and sensory injuries. With this study, we aimed to examine the impact of time to surgery on nerve recovery in patients with traumatic nerve injuries associated with SCH fractures.</p><p><strong>Methods: </strong>Patients <18 years of age with SCH fractures stabilized using percutaneous pins during the period of January 2009 to June 2022 were retrospectively reviewed. Patients presenting with any traumatic nerve injury noted preoperatively were included, while those with iatrogenic or postoperative nerve injuries and incomplete documentation were excluded. Demographic data, injury characteristics, time to surgery, and number of days to nerve recovery were collected. Comparisons of nerve recovery time by anatomic distribution and functional deficit using an 8-hour time-to-surgery cutoff were made in bivariate and multivariate analyses.</p><p><strong>Results: </strong>A total of 2,753 patients with SCH fractures were identified, with 214 of the patients having an associated nerve injury. Documentation of nerve recovery was available for 197 patients (180 patients with complete recovery) with an overall mean age of 6.8 ± 2.1 years. Time to recovery differed significantly when comparing the motor, sensory, and mixed-deficit cohorts (p < 0.001). Early surgery (≤8 hours from injury to surgery) was significantly associated with shorter overall time to nerve recovery (p = 0.002), recovery of multiple nerve distributions (p = 0.011), and recovery of mixed motor and sensory deficits (p = 0.007). On multivariable analysis, mixed nerve deficits (hazard ratio [HR], 0.537 [95% CI, 0.396 to 0.728]; p < 0.001) and time from injury to treatment of >8 hours (HR, 0.542 [95% CI, 0.373 to 0.786]; p = 0.001) were significantly associated with delayed nerve recovery.</p><p><strong>Conclusions: </strong>Surgical timing impacts the time to recovery of complex nerve injuries. Early surgical management of patients with mixed motor-sensory deficits may help to reduce the time to complete nerve recovery.</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":"687-693"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468045","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 Direction of the Future: Opioid-Free Protocols: Commentary on an article by Robby Turk, MD, MBA, et al.: \"An Opioid-Free Perioperative Pain Protocol Is Noninferior to Opioid-Containing Management. A Randomized Controlled Trial\".","authors":"Suzanne Novak","doi":"10.2106/JBJS.24.01171","DOIUrl":"10.2106/JBJS.24.01171","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"107 7","pages":"e28"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763460","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":"An Opioid-Free Perioperative Pain Protocol Is Noninferior to Opioid-Containing Management: A Randomized Controlled Trial.","authors":"Robby Turk, Benjamin Averkamp, Kayla Hietpas, Caleb Michalek, Daniel Leas, Susan M Odum, Nady Hamid","doi":"10.2106/JBJS.24.00460","DOIUrl":"10.2106/JBJS.24.00460","url":null,"abstract":"<p><strong>Background: </strong>In recent years, orthopaedic surgeons have attempted to decrease opioid consumption through multimodal pain management. However, a limited effort has been made to eliminate opioids entirely in the perioperative period. The purpose of this study was to compare the efficacy and safety of a novel opioid-free pain management pathway with that of an opioid-containing pathway across 5 common orthopaedic subspecialty surgical procedures.</p><p><strong>Methods: </strong>In a 1:1, unblinded fashion, 315 patients were randomized to a perioperative pain management pathway that was either opioid-free (n = 157) or opioid-containing (n = 158). Pain was measured with a numeric rating scale (NRS) for pain of 0 to 10 at 6 hours, 12 hours, 24 hours (the primary outcome assessing noninferiority), 2 weeks, 6 weeks, and 1 year after the surgical procedure. Data on patient characteristics, deviations from the pain management pathway, morphine milligram equivalents (MME), readmissions, adverse events, and patient-reported outcomes were collected.</p><p><strong>Results: </strong>There were 315 patients in the final group, with a mean age of 63.6 years. Of the patients in the study, 59.7% were female, 85.7% were White, 12.4% were Black/African-American, 1.0% were Hispanic/Latino, 0.6% were American Indian, and 0.3% were unknown. At 24 hours, the median NRS for pain in the opioid-free group (2 [interquartile range (IQR), 0 to 4]) was statistically noninferior (p < 0.0001) to the opioid-containing group (4 [IQR, 2 to 6]). Pain levels were significantly lower in the opioid-free group than in the opioid-containing group at 12 hours (p = 0.0173) and 2 weeks (p = 0.0003). Pain scores at 6 hours, 6 weeks, and 1 year were similar. Patients in the opioid-free group reported significantly greater comfort at 24 hours (p = 0.0392) and higher satisfaction with pain control (p = 0.0355) at 6 weeks. There were no reported adverse events or unplanned readmissions. Demographic characteristics were similar between the 2 groups.</p><p><strong>Conclusions: </strong>Across 5 common orthopaedic subspecialty procedures, an opioid-free pain management pathway was safe and effective and provided noninferior pain control at 24 hours compared with the opioid-containing pathway.</p><p><strong>Level of evidence: </strong>Therapeutic 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":"665-677"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390922","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":"Thessaly Graft Index: An Artificial Intelligence-Based Index for the Assessment of Graft Integrity in ACL-Reconstructed Knees.","authors":"Georgios Chalatsis, Athanasios Siouras, Vasileios Mitrousias, Ilias Chantes, Serafeim Moustakidis, Dimitris Tsaopoulos, Marianna Vlychou, Sotiris Tasoulis, Michael Hantes","doi":"10.2106/JBJS.24.00427","DOIUrl":"10.2106/JBJS.24.00427","url":null,"abstract":"<p><strong>Background: </strong>Magnetic resonance imaging (MRI) has proven to be a valuable noninvasive tool to evaluate graft integrity after anterior cruciate ligament (ACL) reconstruction. However, MRI protocols and interpretation methodologies are quite diverse, preventing comparisons of signal intensity across subsequent scans and independent investigations. The purpose of this study was to create an artificial intelligence (AI)-based index (Thessaly Graft Index [TGI]) for the evaluation of graft integrity following ACL reconstruction.</p><p><strong>Methods: </strong>The cohort study included 24 patients with an isolated ACL injury that had been treated with a hamstring tendon autograft and followed for 1 year. MRI was performed preoperatively and 1 year postoperatively. The clinical and functional evaluations were performed with use of the KT-1000 and with the following patient-reported outcome measures (PROMs): the Knee Injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Subjective Knee Function form (IKDC), the Lysholm score, and the Tegner Activity Scale (TAS). An AI model, based on the YOLOv5 Nano version, was designed to compute the probability of accurately detecting, in the sagittal plane, a healthy ACL (on a percentage scale) and was trained on healthy and injured knees from the KneeMRI dataset. The model was used to assess the integrity of ACL grafts, with a maximum score of 100. The results were compared with the MRI assessment from an independent radiologist and were correlated with PROMs and KT-1000 laxity.</p><p><strong>Results: </strong>The mean preoperative and postoperative TGI scores were 64.21 ± 8.96 and 82.37 ± 3.53, respectively. A mean increase of 15% in the TGI scores was observed between preoperative and postoperative images. The minimum threshold for TGI to categorize a graft as healthy on the postoperative MRI was 79.21%. Twenty-two grafts were characterized as intact and 2 as reruptured, with postoperative TGI scores of 71% and 42%. The radiologist's assessment was in total agreement with the TGI scores. The correlation of the TGI ranged from moderate to good with the TAS (0.668), IKDC (0.516), Lysholm (0.521), KOOS total (0.594), and KT-1000 (0.561).</p><p><strong>Conclusions: </strong>The TGI is an AI tool that is able to accurately recognize an ACL graft rupture. Moreover, the TGI correlated with the KT-1000 postoperative values and PROM scores.</p><p><strong>Level of evidence: </strong>Diagnostic Level IV . 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":"733-740"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370739","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":"Can We Improve the Results of Internal Fixation?: Commentary on an article by Boris C. Wagner, BMedSci(Hons), MBChB, et al.: \"Outcomes for Younger Patients with Femoral Neck Fractures\".","authors":"Gerard Slobogean","doi":"10.2106/JBJS.25.00033","DOIUrl":"10.2106/JBJS.25.00033","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"107 7","pages":"e29"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763417","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":"Properties of Tungsten Carbide Rings When Compressed to Failure or Cut with a Diamond Grinding Bit: A Biomechanical Study.","authors":"Ernesto S Quinto, Nathan P Reyes, Joshua P Steimel, JuEun Lee, John M Dowbak","doi":"10.2106/JBJS.24.00582","DOIUrl":"10.2106/JBJS.24.00582","url":null,"abstract":"<p><strong>Background: </strong>Tungsten carbide rings are increasingly popular modern jewelry items. Tungsten carbide is an extremely dense, hard metal. Previously described methods to remove tungsten carbide rings include using locking pliers to compress the ring or cutting the ring with a high-speed dental drill.</p><p><strong>Methods: </strong>A universal mechanical testing system (MTS) machine was used to diametrically compress tungsten carbide rings 9 mm in length and 2.4 mm in thickness with a 23.4-mm outer diameter and a 21.0-mm inner diameter while measuring the force required to fracture the rings. A computer numerical control (CNC) machine was used to cut tungsten carbide rings with a diamond grinding bit with and without a flow of normal saline solution. An infrared thermal camera was used to record the temperature at the site of contact between the ring and the grinding bit and at a site one-quarter of the circumference along the ring.</p><p><strong>Results: </strong>A mean force with 95% confidence interval of 3.7 ± 1.2 kN was required to fracture the tungsten carbide rings via diametral compression (p = 0.05). The rings failed at a mean displacement with 95% confidence interval of 0.32 ± 0.13 mm (p = 0.05). The maximum temperature observed at the site of contact between the ring and grinding bit averaged 160.2°C including cases with and without coolant. The time to reach maximum temperature and the duration of maximum temperature differed significantly between the cases with and without coolant (p = 0.0007 and p = 0.0108, respectively).</p><p><strong>Conclusions: </strong>Tungsten carbide rings fractured with minimal displacement using a small amount of force via diametral compression. The brittle fracture pattern of the rings produced minimal comminution. Tungsten carbide rings reached extreme temperatures when cut with a high-speed diamond grinding bit despite cooling with normal saline solution.</p><p><strong>Clinical relevance: </strong>Previously documented methods to remove a tungsten carbide ring include breaking the ring by compressing it with pliers or cutting it off with a high-speed dental drill. Clinicians should be aware of potential complications of current methods to remove tungsten carbide rings.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"e27"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}