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

{"title":"Intravenous Dexamethasone Transiently Elevates Blood Glucose Levels and Reduces Pain After TKA in Patients with Type-2 Diabetes Mellitus: A Randomized Controlled Study.","authors":"Hyung Jun Park, Moon Jong Chang, Tae Jung Kim, Tae Woo Kim, Man Ho Choi, Min Kyong Moon, Seung-Baik Kang","doi":"10.2106/JBJS.24.00984","DOIUrl":"10.2106/JBJS.24.00984","url":null,"abstract":"<p><strong>Background: </strong>Effective perioperative blood glucose control is crucial for reducing postoperative complications in patients with diabetes mellitus (DM) who are undergoing total knee arthroplasty (TKA). The aim of this study was to assess the impact of intravenous (IV) dexamethasone on blood glucose levels, insulin requirements, postoperative pain, and postoperative nausea and vomiting (PONV) in patients with well-controlled type-2 DM.</p><p><strong>Methods: </strong>A total of 83 Asian patients with well-controlled type-2 DM (defined as a preoperative glycated hemoglobin level of ≤7.0%) undergoing primary TKA were randomized to receive either IV dexamethasone or normal saline solution. Blood glucose and insulin requirements were monitored postoperatively up to day 5, and pain and PONV were assessed using a numeric rating scale.</p><p><strong>Results: </strong>Compared with the control, IV dexamethasone transiently elevated blood glucose levels on the day of surgery and on postoperative day 1, with the levels returning to baseline by day 3. Insulin requirements were higher in the intervention group on postoperative day 1 (p = 0.004). While IV dexamethasone did not significantly reduce PONV, it effectively alleviated postoperative pain up to day 3.</p><p><strong>Conclusions: </strong>In patients with DM who underwent TKA, IV dexamethasone administration transiently increased blood glucose on the day of surgery and on postoperative day 1 and elevated insulin requirements on postoperative day 1. Despite having no impact on PONV, IV dexamethasone provided clinical benefits by reducing early postoperative pain. These findings suggest the potential benefits of IV dexamethasone in enhancing perioperative management strategies for patients with DM who are undergoing TKA.</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":"1073-1081"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795574","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":"Molecular Evidence Supporting MEK Inhibitor Therapy in NF1 Pseudarthrosis.","authors":"Nandina Paria, Ila Oxendine, David Podeszwa, Meghan Wassell, Reuel Cornelia, Carol A Wise, Jonathan J Rios","doi":"10.2106/JBJS.24.01007","DOIUrl":"10.2106/JBJS.24.01007","url":null,"abstract":"<p><strong>Background: </strong>Neurofibromatosis type 1 (NF1) is a genetic condition predisposing children to fracture pseudarthroses. MEK inhibitors are U.S. Food and Drug Administration-approved or are under study for the treatment of malignant pathologies associated with NF1. However, their potential to treat pseudarthrosis is largely unknown.</p><p><strong>Methods: </strong>Primary cells cultured from control bone or fracture pseudarthroses from children with NF1 were treated with vehicle or with the MEK inhibitors trametinib or selumetinib. Gene expression was evaluated with use of transcriptome sequencing (RNAseq), and the activation of the downstream signaling pathway was evaluated with use of western blotting. Results were replicated in an independent cohort of patient fracture pseudarthrosis-derived primary cells.</p><p><strong>Results: </strong>Pseudarthrosis samples were reproducibly associated with the reduced expression of gene signatures implicated in osteoblast differentiation, skeletal development, and the formation of the extracellular matrix. The expression of these gene signatures was significantly rescued following treatment with MEK inhibitors and concomitant reduced MEK/ERK (MAPK) pathway activation.</p><p><strong>Conclusions: </strong>Our study identified molecular signatures associated with fracture pseudarthrosis that were rescued with MEK inhibitor treatment.</p><p><strong>Clinical relevance: </strong>MEK inhibitors may promote the healing of fracture pseudarthroses in children with NF1.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1098-1106"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763222","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":"Risk Factors for Amputation and Prolonged Hospitalization Among Children Who Received Traditional Bonesetting in Ethiopia.","authors":"Ephrem G Adem, Papa K Morgan-Asiedu, Mengistu G Mengesha, Mario Keko, Chen Mo, Sintayehu Bussa, Eden Alemu, Yishak Zerihun, Habtamu T Derilo, Mahamed Areis, Kaleab T Reda, Wubshet A Workneh, Bahru A Shiferaw, Moa C Jira, Habtamu B Gula, Mulugeta B Geneti, Claude Martin, Kiran J Agarwal-Harding, William J Harrison","doi":"10.2106/JBJS.24.00359","DOIUrl":"10.2106/JBJS.24.00359","url":null,"abstract":"<p><strong>Background: </strong>In Ethiopia, orthopaedic services are limited, and many injured children undergo traditional bonesetting (TBS) despite its association with limb- and life-threatening complications. We sought to identify the risk factors for amputation and a prolonged hospitalization of >7 days in children who presented to hospitals after undergoing TBS.</p><p><strong>Methods: </strong>Over a 15-month period, we prospectively enrolled children who presented to 8 Ethiopian hospitals after undergoing TBS. Separately for each outcome (amputation and prolonged hospitalization), we used multivariable logistic regression to evaluate associations between the outcome and 16 covariates, including demographic and injury characteristics, parent or guardian preference for TBS, and TBS topical treatments and immobilization methods.</p><p><strong>Results: </strong>We enrolled 460 children (mean age, 9.0 ± 4.0 years; 75% male) representing 8 Ethiopian regions and diverse demographic and socioeconomic backgrounds. Elbow injuries (194 patients; 42.2%) and closed fractures and/or dislocations (364 patients; 79.1%) were most common. TBS treatments included topical inorganic (190 patients; 41.3%) or organic (82 patients; 17.8%) material application and rigid (166 patients; 36.1%) or soft (182 patients; 39.6%) immobilization. Twenty-six children (5.7%) underwent an amputation, and 102 (22.2%) had a prolonged hospitalization. The odds of amputation were higher for children from rural communities (adjusted odds ratio [AOR], 6.71; 95% confidence interval [CI], 2.01 to 22.41) and for children with only non-osseous injuries (AOR, 5.76; 95% CI, 1.56 to 21.28). The odds of prolonged hospitalization were higher for children who were 11 to 17 years old (AOR, 2.77; 95% CI, 1.18 to 6.50) and for children with open fractures with a grade of ≥2 (AOR, 4.52; 95% CI, 1.33 to 15.28) but were lower for children from households with secondary education or higher (AOR, 0.40; 95% CI, 0.21 to 0.79). TBS with rigid immobilization increased the odds of amputation (AOR, 5.84; 95% CI, 1.74 to 19.60) and prolonged hospitalization (AOR, 2.20; 95% CI, 1.02 to 4.73). TBS organic topical treatment (with mud, leaves, or butter) increased the odds of amputation (AOR, 3.88; 95% CI, 1.40 to 10.73).</p><p><strong>Conclusions: </strong>For children who underwent TBS prior to hospital presentation, rigid splinting by bonesetters increased the odds of amputation and prolonged hospitalization. TBS organic topical treatments also increased the odds of amputation. Training bonesetters to avoid these dangerous practices may prevent devastating complications for children in Ethiopia.</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":"1050-1062"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390928","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":"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/m 2 , 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/m 2 , 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":"1082-1089"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","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":"Balancing Tumor Control and Cartilage Preservation for Patients with Giant Cell Tumor of Bone Around the Knee: A Clinical Report from a Single Institute.","authors":"Kuan-Lin Chen, Cheng-Fong Chen, Po-Kuei Wu, Pai-Han Wang, Tain-Hsiung Chen, Chao-Ming Chen, Wei-Ming Chen","doi":"10.2106/JBJS.23.01478","DOIUrl":"10.2106/JBJS.23.01478","url":null,"abstract":"<p><strong>Background: </strong>When managing aggressive giant cell tumor of bone (GCTB) around the knee joint, surgeons are often caught in a dilemma when determining whether to perform marginal excision or intralesional curettage. The purpose of this study was to report the long-term results of different treatment strategies in our institute.</p><p><strong>Methods: </strong>We retrospectively reviewed 64 eligible cases (34 female and 30 male) with a GCTB (37 in the distal femur, 27 in the proximal tibia) treated from 2002 to 2013. Forty patients received intralesional curettage (group A). Twenty-four received marginal excision of the tumor, with 18 of them undergoing reconstruction with unicondylar osteoarticular allograft (UOA) (group B) and 6 receiving arthroplasty reconstruction (group C). The minimum follow-up was 8 years, and the oncological status, clinical outcomes, and cartilage condition were analyzed.</p><p><strong>Results: </strong>Tumor recurrence was most common in group A (10 of 40, 25.0%), followed by group B (1 of 18, 5.6%) and group C (0 of 6). Eleven patients in group A (27.5%) and 6 in group B (33.3%) developed osteoarthritis (Kellgren-Lawrence grade 3 or 4). Five patients in group A (12.5%) and 3 patients in group B (16.7%) received total knee arthroplasty. Risk factors for the development of osteoarthritis in group A included a centrally located tumor, tumor length of >6 cm, a tumor-cartilage distance of ≤3 mm, and >50% subchondral bone involvement. In group B, osteoarthritis mostly resulted from postoperative complications. The mean Musculoskeletal Tumor Society (MSTS) score was 87.9 in group A, 84.8 in group B, and 93.3 in group C.</p><p><strong>Conclusions: </strong>Although intralesional curettage preserved cartilage and resulted in better function, it was associated with a higher tumor recurrence rate in our series. For advanced tumors close to the articular cartilage with significant subchondral bone involvement, marginal excision with UOA reconstruction might be a viable alternative. Arthroplasty should be reserved for patients who have bicondylar involvement with severe bone and cartilage loss making cartilage preservation impossible.</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":"e50"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573012","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":"Effects of Sustained Tensile Distraction on Vertebrae and Intervertebral Disc Growth: An in Vivo Study Using a Mouse Tail Model.","authors":"Pooria Salari, Garrett W D Easson, Kaitlyn S Broz, Michael P Kelly, Simon Y Tang","doi":"10.2106/JBJS.24.00224","DOIUrl":"10.2106/JBJS.24.00224","url":null,"abstract":"<p><strong>Background: </strong>Directed growth modulation is commonly utilized as a surgical treatment for early-onset scoliosis. Growing rods are instrumented on the spine and apply sustained tension on the immature spine for a substantial amount of time, with the clinical goal of accommodating axial expansion of the spine. Despite the use of growing rods in humans, the mechanobiology of the spinal tissues under tensile loading remains relatively unknown. To bridge this knowledge gap, we developed a preclinical mouse model that allows for mechanistic investigations of sustained tension on the spine.</p><p><strong>Methods: </strong>Using custom 3D-printed washers and tunable springs, we distracted across the seventh and ninth caudal vertebrae of adolescent and young adult C57BL/6 female mice with forces that were approximately 2 times the body mass of the animal. The springs were replaced weekly to maintain tension for the duration of the experiment. A set of 6-week-old animals were first instrumented for 10 weeks to evaluate the feasibility and tolerability. Subsequently, the 6- and 12-week-old experimental animals were instrumented until they were 20 weeks of age in order to evaluate the effects of tension until adulthood. The spines were monitored using digital radiography and micro-computed tomography (µCT), and the intervertebral discs (IVDs) were evaluated using mechanical testing and compositional assays.</p><p><strong>Results: </strong>The device was well tolerated and caused no notable complications. The tensile forces lengthened the vertebrae in the 6-week-old animals that were instrumented for 14 weeks and in the 12-week-old animals that were instrumented for 8 weeks. Increased IVD heights were observed in the 6-week-old animals but not in the 12-week-old animals. The porosity of the vertebral end plates increased following instrumentation in all groups but progressively recovered over time.</p><p><strong>Conclusions: </strong>Distraction accelerated the lengthening of the vertebrae and the heightening of the IVD, with no observable degeneration or decline in the mechanical performance of the IVDs for these distraction conditions.</p><p><strong>Clinical relevance: </strong>This model will be useful for investigating how spinal tissues adapt to directed growth modulation with maturation and aging.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1107-1115"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780219","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":"What's Important: When Humor Goes Wrong.","authors":"Christopher P Chiodo, Giovanna C Kalin, Emily B Parker, James D Kang","doi":"10.2106/JBJS.24.01192","DOIUrl":"10.2106/JBJS.24.01192","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1161-1162"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364891","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 New in Foot and Ankle Surgery.","authors":"Jared T Scott, Emily B Parker, Jorge Javier Del Vecchio, Andrew P Molloy, Christopher P Chiodo","doi":"10.2106/JBJS.25.00089","DOIUrl":"10.2106/JBJS.25.00089","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1043-1049"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772009","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":"Risk of Postoperative Nausea and Vomiting After Total Hip or Knee Arthroplasty Under Spinal Anesthesia: Randomized Trial Comparing Conventional Antiemetics with or without the EmeTerm Bracelet.","authors":"Yidan Yang, Chunping Wang, Guorui Cao, Hongjun Li, Lanbo Yang, Jianing Xi, Chaojun Sun, Huamei Lu, Youwen Liu, Jiayi Guo, Chen Yue","doi":"10.2106/JBJS.24.00773","DOIUrl":"10.2106/JBJS.24.00773","url":null,"abstract":"<p><strong>Background: </strong>Acupoint stimulation has been shown to reduce the risk of postoperative nausea and vomiting (PONV) after various types of surgeries involving general anesthesia, but whether the same is true after orthopaedic surgery involving spinal anesthesia is unclear. The purpose of this study was to compare PONV rates and the quality of recovery between patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) under spinal anesthesia receiving conventional antiemetics alone and those receiving antiemetics combined with use of a transcutaneous electrical acupoint stimulation bracelet (EmeTerm; WAT Medical Enterprise).</p><p><strong>Methods: </strong>Patients at moderate or high risk for PONV, including 195 patients undergoing THA and 153 patients undergoing TKA, were randomized to receive routine antiemetics (dexamethasone and ondansetron) alone or with use of the EmeTerm bracelet. The primary outcome was the PONV incidence within 24 hours postoperatively; secondary outcomes included the rates of severe PONV, antiemetic rescue, adverse events, and Quality of Recovery scores.</p><p><strong>Results: </strong>Combining antiemetics with the EmeTerm bracelet significantly reduced PONV (16.0% compared with 31.2%; p = 0.001), severe PONV (1.1% compared with 8.1%; p = 0.002), and antiemetic rescue (3.4% compared with 13.9%; p = 0.001). Use of the bracelet reduced the risk of PONV within 24 hours by 61% (adjusted hazard ratio, 0.39; 95% confidence interval [CI], 0.24 to 0.63), and its benefit became significant at 0 to 3 and 3 to 6-hour intervals after surgery. The complete response rate was higher for the bracelet + antiemetics group compared with the group with antiemetics alone (84.0% compared with 68.8%; p = 0.001), with better Quality of Recovery scores at 24 hours in the bracelet + antiemetics group.</p><p><strong>Conclusions: </strong>The EmeTerm bracelet enhanced the efficacy of antiemetics in reducing PONV after THA and TKA under spinal anesthesia and may improve short-term recovery.</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":"1063-1072"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736093","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":"Access to Orthopaedic Devices in Low and Middle-Income Countries: Challenges and Opportunities.","authors":"Myles Dworkin, Pierre Marie Woolley, Faseeh Shahab, McKenna C Noe, Rachid Barry, Dorcas Chomba, Emmanuel Makasa, Nabees Man Singh Pradhan, Jean Claude Byiringiro, Kiran J Agarwal-Harding","doi":"10.2106/JBJS.24.00997","DOIUrl":"10.2106/JBJS.24.00997","url":null,"abstract":"<p><p>➢ Musculoskeletal injuries constitute a substantial proportion of worldwide disease, with access limited to many due to the availability and cost of devices. A multifaceted approach is needed to improve system-level access to care.➢ Although a number of procurement policies are utilized, providers in low and middle-income countries often struggle with inconsistent supply chains, leading to delays in care or less desirable management strategies.➢ Partnerships between governments, academic institutions, and nongovernmental agencies are needed to improve access to devices by providing funds for patients and creating regulatory bodies to ensure product quality and availability.➢ There should be a focus on local and regional manufacturing as well as job creation within low and middle-income countries to achieve sustainable access to orthopaedic devices.➢ High-quality research initiatives are needed to provide evidence-based solutions. This includes a focus on outcomes-based studies to determine best management practices within the low and middle-income countries' context and operations research to optimize systems for device procurement.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"1154-1160"},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730192","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}