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

{"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}

{"title":"Functional Outcomes After Modern External Ring Fixation or Internal Fixation for Severe Open Tibial Shaft Fractures.","authors":"Justin Solarczyk, Natasha M Simske, Austin R Thompson, Lisa Reider, Eben A Carroll, Joshua L Gary, Renan Castillo, Stephen M Quinnan, William Obremskey, Robert V O'Toole, Heather A Vallier, Saam Morshed","doi":"10.2106/JBJS.24.00888","DOIUrl":"10.2106/JBJS.24.00888","url":null,"abstract":"<p><strong>Background: </strong>This study compared the functional outcomes of patients with open tibial shaft fractures who were randomized to either modern external ring fixation (EF) or internal fixation (IF). We hypothesized that there would be differences in patient-reported function between the treatment groups.</p><p><strong>Methods: </strong>This preplanned analysis of secondary outcomes from the FIXIT study, a multicenter randomized clinical trial, included patients 18 to 64 years of age with a Gustilo-Anderson Type-IIIB or severe-Type IIIA diaphyseal or metaphyseal tibial fracture who were randomly assigned to either IF (n = 132) or EF (n = 122). Follow-up visits occurred at 6 weeks and 3, 6, and 12 months after randomization. Outcomes included Short Musculoskeletal Function Assessment (SMFA) scores, the Veterans RAND 12-Item Health Survey (VR-12) physical component score (PCS), use of ambulatory assistive devices, and ability to ambulate.</p><p><strong>Results: </strong>The mean VR-12 PCS was slightly higher (better) for IF (24.8) than for EF (22.6) at 3 months (mean difference, 2.2 [95% confidence interval (CI): 0.2, 4.3]; p = 0.03) and trended higher for IF (27.0) compared with EF (25.3) at 6 months (mean difference, 1.8 [95% CI: -0.9, 4.4]; p = 0.19). However, there was no difference between the groups at 12 months. There were no clinically important or significant differences in SMFA Dysfunction and Bother scores between the treatment groups at any time point. EF was associated with a higher risk of using any ambulatory assistive device at 6 months (relative risk, 1.5 [95% CI: 1.21, 1.82]; p < 0.0001). The absolute percentage of patients using any ambulatory device was 37.6% for IF and 45.4% for EF at 1 year. There was no difference in ambulatory status between the treatment groups at any time point.</p><p><strong>Conclusions: </strong>We found no difference in physical function between patients with severe tibial fractures treated with IF versus EF. There was a high rate of impairment overall. Assistive devices for walking were more often utilized in the EF group at 6 months, and both treatment groups demonstrated similar overall impairment.</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":"694-701"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468001","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":"Similar Functional Results in Patients Outside the Classical Criteria for Medial Unicompartmental Knee Arthroplasty.","authors":"Fernando Vanoli, Corentin Pangaud, Pauline Chabas, Sylvain Guy, Henri Peuchot, Matthieu Ollivier, Jean-Noël Argenson, Christophe Jacquet","doi":"10.2106/JBJS.24.01087","DOIUrl":"https://doi.org/10.2106/JBJS.24.01087","url":null,"abstract":"<p><strong>Background: </strong>The indications for unicompartmental knee arthroplasty (UKA) are restricted by multiple criteria. The aim of this study was to explore the functional results of UKA in a population of patients outside the classical criteria.</p><p><strong>Methods: </strong>This study included a population of 197 patients who underwent UKA for medial osteoarthritis between 2017 and 2020. Two groups of patients were compared: those meeting the classical criteria and those presenting with ≥1 contraindication (e.g., age of ≥75 years, body mass index [BMI] of ≥30 kg/m2, or coronal limb deformity of >8°). The implant that was used was a modern fixed-bearing primary medial UKA component. The minimal follow-up was 3 years. The primary outcome was the functional results, including the Knee Society Score (KSS), and the secondary outcomes were the complication and revision rates.</p><p><strong>Results: </strong>There were 100 patients in the indication group and 97 in the off-indication group. No significant differences were observed between the 2 groups for height, sex ratio, operated side, or osteoarthritis stage (p > 0.05). There was no significant difference in the KSS between the 2 groups (p = 0.96). At 3 years of follow-up, the survival rate without revision was 100% in the indication group and 95.38% in the off-indication group (p = 0.57). The rate of complications was 12.9% in the indication group and 8.96% in the off-indication group (p = 0.47).</p><p><strong>Conclusions: </strong>UKA for medial osteoarthritis yielded the same functional results for patients presenting with ≥1 theoretical contraindication, including a BMI of ≥30 kg/m2, age of ≥75 years, and coronal limb deformity of >8°, without altering the complication or revision rates at 3 years of follow-up.</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":""},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772575","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 2024 American Orthopaedic Association-Japanese Orthopaedic Association Traveling Fellowship.","authors":"Lucas S McDonald, Kelly K Hynes, Joshua A Parry, Byron F Stephens, Joseph H Schwab","doi":"10.2106/JBJS.24.01011","DOIUrl":"10.2106/JBJS.24.01011","url":null,"abstract":"<p><strong>Abstract: </strong>In 1992, the American Orthopaedic Association-Japanese Orthopaedic Association (AOA-JOA) Traveling Fellowship was created to develop and enhance collaboration between the Japanese and American orthopaedic communities. The fellowship is geared to early-career surgeons and fosters clinical and cultural exchange between members of the 2 countries. In 2024, the fellows hailed from around the United States: Kelly K. Hynes, Lucas S. McDonald, Joshua A. Parry, Joseph H. Schwab, and Byron F. Stephens all participated in the program. During the 3-week fellowship, the fellows visited 8 academic centers across Japan and attended the JOA Annual Meeting in Fukuoka. This experience was incredibly rewarding, both clinically and professionally, and all the fellows returned home with novel ideas for their clinical practices.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"782-787"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739549","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":"What's Important (Arts & Humanities): My Personal Journey from the Oil Field to Orthopaedics: Trading Drills.","authors":"Dustin L Richter","doi":"10.2106/JBJS.24.00780","DOIUrl":"10.2106/JBJS.24.00780","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"780-781"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854288","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":"What's Important: The Rationale for a Comprehensive and Fully Transparent Database.","authors":"Jesse B Jupiter, Pietro Regazzoni, Wen-Chih Liu, Alberto Fernandez Dell'Oca","doi":"10.2106/JBJS.24.01028","DOIUrl":"10.2106/JBJS.24.01028","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"778-779"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854295","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":"Health-Care Costs for Patients with a Lower-Extremity Fracture Have Increased Disproportionately Over the Past 10 Years: A Medical Expenditure Panel Survey Analysis of Total Expenditure and Out-of-Pocket Costs.","authors":"J H Raats, Y Chang, D T Brameier, N Ponds, M J Weaver","doi":"10.2106/JBJS.24.00544","DOIUrl":"10.2106/JBJS.24.00544","url":null,"abstract":"<p><strong>Background: </strong>Increasing U.S. health-care costs raise concerns regarding the sustainability of the U.S. health-care system, with the potential for negative effects on the mental and physical health of patients. Orthopaedic injuries often impose considerable financial burdens on patients and hospitals, but the trends in, and drivers of, costs remain unclear. This study evaluated the total expenditure and out-of-pocket (OOP) costs of patients with a lower-extremity (LE) fracture in the non-institutionalized U.S. population from 2010 to 2021.</p><p><strong>Methods: </strong>A total of 3,016 participants with an LE fracture from the Medical Expenditure Panel Survey (MEPS) were propensity score matched with 15,080 MEPS participants with no LE fracture. Patients with an LE fracture were predominantly between 40 and 64 years old (43.2%), female (66.0%), and White (78.8%). Total expenditure and OOP costs were compared between the groups. A multivariable regression analysis was performed to identify factors that were associated with costs. Outcomes were adjusted on the basis of the 2022 Consumer Price Index.</p><p><strong>Results: </strong>Patients with an LE fracture had greater total expenses than the control group ($20,230 [95% confidence interval (CI), $18,916 to $21,543] versus $10,678 [95% CI, $10,302 to $11,053]; p < 0.001) as well as greater OOP costs ($1,634 [95% CI, $1,516 to $1,753] versus $1,089 [95% CI, $1,050 to $1,128]; p < 0.001). Between 2010 and 2021, total expenses increased more for patients with an LE fracture than for the control group (101.2% versus 51.4%; p < 0.001), whereas OOP costs increased to a lesser degree in both groups (61.1% versus 44.5%; p = 0.17). In the LE fracture group, total expenditure was driven by inpatient care, office-based visits, and prescription costs, whereas OOP costs were driven by office-based visits, prescription costs, and \"other\" sources. Femoral fracture, hospitalization, and certain comorbidities were associated with higher total expenses. Hospitalization, uninsured status, and a higher income level were associated with increased OOP costs, whereas African American or Hispanic background and a lower educational level were associated with lower OOP costs.</p><p><strong>Conclusions: </strong>An LE fracture was associated with considerable total expenditure and OOP costs, which increased disproportionately compared with general health-care costs over the past decade. Post-hospitalization care was the biggest driver of both total expenses and OOP costs. Due to limitations inherent to the MEPS database, the impact of financial burden on not only payers but also individuals and their medical decision-making remains unclear and requires further investigation.</p><p><strong>Level of evidence: </strong>Economic 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":"717-724"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458154","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":"Incidence of and Risk Factors for Ileus Following Spine Surgery.","authors":"Yusef J Jordan, Gregory S Kazarian, Kyle W Morse, Jung Kee Mok, Izzet Akosman, Harvinder S Sandhu, Andrew A Sama","doi":"10.2106/JBJS.24.00044","DOIUrl":"10.2106/JBJS.24.00044","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to determine the incidence of postoperative ileus (POI) after spine surgery and to identify risk factors for its development.</p><p><strong>Methods: </strong>A retrospective database study was performed between 2019 and 2021. A database of all patients who underwent spine surgery was searched, and patients who developed clinical and radiographic evidence of POI were identified. Demographic characteristics, perioperative data including opioid consumption, ambulation through postoperative day 1, surgical positioning, medical history, and surgical history were obtained and compared to examine risk factors for developing POI.</p><p><strong>Results: </strong>A total of 10,666 consecutive patients were identified who underwent cervical, thoracic, thoracolumbar, lumbar, or lumbosacral surgery with or without fusion. No patients were excluded from this study. The overall incidence of POI after spine surgery was 1.63%. POI was associated with a significantly greater mean length of stay of 7.6 ± 5.0 days compared with 2.9 ± 2.9 days in the overall cohort (p < 0.001). A history of ileus (odds ratio [OR], 21.13; p < 0.001) and a history of constipation (OR, 33.19; p < 0.001) were also associated with an increased rate of POI compared with patients without these conditions. Postoperatively, patients who developed POI had decreased early ambulation distance through postoperative day 1 at 14.8 m compared with patients who did not develop POI at 31.4 m (p < 0.001). Total postoperative opioid consumption was significantly higher (p < 0.001) in the POI group (330.3 morphine equivalent dose [MED]) than in the group without POI (174.5 MED). Lastly, patients who underwent fusion (p < 0.001), were positioned in a supine or lateral position (p = 0.03) (indicators of anterior or lateral approaches), had thoracolumbar or lumbar surgery (p = 0.01), or had multiple positions during the surgical procedure (p < 0.001) had a significantly higher risk of POI than those who did not.</p><p><strong>Conclusions: </strong>The overall incidence of POI after all spine surgery is low. Several nonmodifiable predictors of POI include prior ileus, constipation, hepatitis, and prostatectomy. Multiple surgical factors increased the risk of POI, including supine positioning, surgery with the patient in multiple positions, and fusion. POI was associated with decreased early ambulation and increased opioid usage. Strategies should be implemented to maximize early ambulation and decrease opioid usage perioperatively.</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":"749-754"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468027","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":"Optimizing Outcomes in Pediatric Supracondylar Humeral Fractures with Nerve Palsy: The Case for Standardized Assessments and Early Intervention: Commentary on an article by Akbar N. Syed, MD, et al.: \"Nerve Recovery in Pediatric Supracondylar Humeral Fractures: Assessing the Impact of Time to Surgery\".","authors":"Pablo Castañeda","doi":"10.2106/JBJS.24.01369","DOIUrl":"https://doi.org/10.2106/JBJS.24.01369","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"107 7","pages":"e30"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763424","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 Impact of Adolescent Idiopathic Scoliosis on Pregnancy.","authors":"Karolina A Serhan, Vivek M Abraham, Eric D Shirley","doi":"10.2106/JBJS.24.00850","DOIUrl":"https://doi.org/10.2106/JBJS.24.00850","url":null,"abstract":"<p><p>➢ Physiologic changes during pregnancy alter the biomechanics of the spine, including increased ligamentous laxity, lumbar lordosis, and pelvic tilt.➢ Patients with adolescent idiopathic scoliosis treated with a fusion construct with the lowest instrumented vertebra of L3 and below have an increased risk of developing low back pain during pregnancy.➢ There is a low risk of curve progression during pregnancy for patients with adolescent idiopathic scoliosis treated with spinal fusion.➢ Although neuraxial anesthesia is possible in patients who had previously undergone spinal fusion for adolescent idiopathic scoliosis, successful placement may require a more experienced provider and more attempts to place the epidural.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"107 7","pages":"771-777"},"PeriodicalIF":4.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763503","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}