Journal of orthopaedics最新文献

{"title":"Mid-term failure rates, timing, and mechanisms for osteochondral allograft transplantation in the knee: Characterizing risk factors and identifying modifiable variables","authors":"James L. Cook ,&nbsp;Kylee Rucinski ,&nbsp;Cory R. Crecelius ,&nbsp;Clayton W. Nuelle ,&nbsp;James P. Stannard","doi":"10.1016/j.jor.2025.03.040","DOIUrl":"10.1016/j.jor.2025.03.040","url":null,"abstract":"<div><h3>Background</h3><div>Knee osteochondral allograft transplantation (OCAT) is consistently successful, however, higher failure rates for multisurface and bipolar OCATs persist. Failure mechanisms have involved OCA erosion, delamination, degeneration, fracture, and/or fragmentation, and progression of joint disease, associated with older patient age, higher BMI, male sex, nicotine use, comorbidities, low chondrocyte viability, larger OCA volume, and bipolar OCAT.</div></div><div><h3>Methods</h3><div>Patient outcomes were prospectively followed after primary knee OCAT and analyzed for failure mechanisms categorized as OCA Cartilage, OCA Bone, Meniscus Allograft, Joint Disease Progression, or Unknown. Cases were included when OCAT was performed &gt;5 years prior; all failure cases were included regardless of final follow-up (FFU) time. Failure and non-failure cohorts, and failure mechanism subcohorts, were compared based on patient sex, age, BMI, nicotine use, concurrent procedures, OCAT surgery type, and adherence.</div></div><div><h3>Results</h3><div>There were 186 cases in 184 patients (n = 112 males; mean age = 37.1 years; mean BMI = 28.5 kg/m²; mean FFU = 79 months). Initial failure rate was 23.1% (n = 43) with mechanisms attributed to OCA Bone (n = 15; 34.9%), Meniscus (n = 13; 30.2%), Joint Disease Progress (n = 11; 25.6%), OCA Cartilage (n = 2; 4.7%), or Unknown (n = 2; 4.7%). Risk factors included concurrent ligament reconstruction, ipsilateral osteotomy, and tibiofemoral bipolar + OCAT. However, older age and higher BMI, as well as potential barriers for post-operative adherence should be considered during patient selection.</div></div><div><h3>Conclusions</h3><div>Recent advances have mitigated key risk factors, such that reductions in knee OCAT failure rates with improvements in function, mental health, and quality of life have been more consistently realized.</div></div><div><h3>Level of evidence</h3><div>2, prospective cohort study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 88-94"},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143705291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High variability in pelvic orientation in the lateral decubitus position negatively affects acetabular component placement","authors":"Daniel J. Sherwood ,&nbsp;Hemant Reddy ,&nbsp;Xiuyi A. Yang ,&nbsp;Yoav Zvi ,&nbsp;Zeynep Seref-Ferlengez ,&nbsp;Yonatan Schwartz ,&nbsp;Anna Tarasova ,&nbsp;Eli Kamara","doi":"10.1016/j.jor.2025.03.041","DOIUrl":"10.1016/j.jor.2025.03.041","url":null,"abstract":"<div><h3>Purpose</h3><div>Determine factors that impart increased risk of acetabular component malposition in the lateral decubitus position.</div></div><div><h3>Methods</h3><div>A retrospective review of 813 X-rays from posterior THA procedures at a single institution. Pelvic tilt and rotation were measured on preoperative standing AP-pelvis and intraoperative cross-table x-rays. Proper intraoperative pelvic orientation (PPO) was defined as vertical tilt and axial rotation within ± 15° of the preoperative standing pelvis orientation. Acetabular abduction was measured on standing postoperative x-rays with Goal abduction (GA) of 30–50°.</div></div><div><h3>Results</h3><div>PPO was obtained in 284/413 cases (69 %). Patient sex, weight, BMI, and operative laterality were not significantly associated with PPO. Patients with PPO were shorter (1.68m vs 1.72m, p &lt; 0.01). PPO occurred in 168/221 patients (76 %) with the Capello or Wixson hip positioner, compared to 116/192 (60 %) with the De Mayo positioner (p &lt; 0.01). GA was obtained in 249/284 (88 %) of patients with PPO, as compared to 103/129 (80 %) patients without PPO.</div></div><div><h3>Conclusion</h3><div>The risk of pelvic malpositioning significantly increases with the use of certain hip positioning systems, and taller patients. Acetabular component abduction is negatively affected by an improperly positioned pelvis.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 48-53"},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significant Prevalence of nerve injuries associated with extremity civilian low-energy gunshot wounds with limited recovery of functional deficits","authors":"Shefali R. Bijwadia ,&nbsp;Ilexa R. Flagstad ,&nbsp;Micah Christenson ,&nbsp;Samuel T. Davidson ,&nbsp;Sandy Vang ,&nbsp;Mai P. Nguyen","doi":"10.1016/j.jor.2025.03.038","DOIUrl":"10.1016/j.jor.2025.03.038","url":null,"abstract":"<div><div>This study aimed to quantify rates of nerve involvement, management strategies, and return of functional impairment in patients with civilian extremity gunshot wounds. We performed a retrospective review of 34 patients presenting with extremity gunshot wounds with nerve injury to our level 1 trauma center between January 2019 and October 2021. The incidence of nerve involvement and functional deficits after extremity GSW and rate of return of function after operative or non-operative management were reported. Nerve involvement was found in 34 (34 %) patients in the cohort with 23 (68 %) involving the upper extremities and 11 (32 %) involving lower extremities. Among patients with nerve injuries, 81 % had concomitant fractures. 59 % of patients reporting sensory only, 34 % sensory and motor, and 6 % motor only deficits. 31 % of nerve injuries underwent a surgical procedure targeting their nerve injury with the remaining 69 % managed nonoperatively. Complete resolution of nerve functional deficits in the 29 patients with at least 90 days of follow-up or full return of function was reported in 22 % and 32 % of patients who were treated operatively and nonoperatively, respectively (p = 0.62). Nerve injuries were found in approximately one-third of the extremity gunshot wounds at our trauma center. These injuries carried poor prognosis with low recovery rate with either operative or non-non operative treatment.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 29-32"},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical behavior of fibula fracture fixation using the Stryker VariAx 2 system: A finite element analysis of lower limb load distribution","authors":"V. Filardi","doi":"10.1016/j.jor.2025.03.039","DOIUrl":"10.1016/j.jor.2025.03.039","url":null,"abstract":"<div><h3>Aims</h3><div>In this study, we used finite element analysis to evaluate the mechanical behavior of the lower extremity under three conditions: an intact fibula, a fractured fibula without fixation, and a fractured fibula stabilized using the Stryker VariAx 2 One-Third Tubular Plating System.</div></div><div><h3>Methods</h3><div>Three-dimensional solid models incorporating detailed representations of bones, ligaments, and tendons were developed from CT and MRI data. Loading conditions were imposed simulating an axial compressive load of 700 N applied to the upper extremity of the resected femur and a torsional load of 6000 Nmm applied to the proximal femur, and a fixed constraint was imposed on the foot, simulating physiological conditions encountered during gait.</div></div><div><h3>Results</h3><div>indicated that the absence of the fibula leads to significant increases in stress and angular displacement across key anatomical regions, including the tibia, femur, patella, and foot, underscoring the fibula's role in load sharing. Although reintroducing a fibular implant partially ameliorates these effects, the implant itself exhibits elevated stress compared to a natural fibula.</div></div><div><h3>Conclusion</h3><div>These findings highlight the need for careful preoperative planning and individualized treatment strategies in fibula fracture management, while also informing future improvements in implant design.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 53-60"},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive 10-year clinical outcomes of a total hip arthroplasty system with a unique femoral stem design","authors":"Alexander Nielsen ,&nbsp;Jesua Law ,&nbsp;Matthew Parkin ,&nbsp;Aaron Hofmann","doi":"10.1016/j.jor.2025.03.042","DOIUrl":"10.1016/j.jor.2025.03.042","url":null,"abstract":"<div><h3>Problem considered</h3><div>Earlier versions of cementless femoral stems used in total hip arthroplasty were frequently associated with thigh pain, stress shielding, and challenging revision procedures. A modern design cementless femoral stem was examined in this study with the goal of mitigating these problems.</div></div><div><h3>Methods</h3><div>This retrospective analysis examined the 10-year follow-up results from an original cohort of 100 patients that had a cementless total hip arthroplasty using a unique femoral design between 2013 and 2014 in a single surgeon study. Comprehensive physical examinations and radiographic analyses were conducted and documented.</div></div><div><h3>Results</h3><div>Harris Hip Scores (HHS) were recorded at the final follow-up visit, averaging 90.1 ± 8.7. Gruen zone analysis demonstrated good bone maintenance adjacent to the femoral stem with the absence of distal stress shielding, subsidence, and thigh pain. Charnley zones were reviewed as well and revealed minimal osteolytic changes with maintenance of cup position.</div></div><div><h3>Conclusions</h3><div>The overall findings indicated minimal complication rates unrelated to the femoral stem or cup design, with 10-year cup survivorship of 99 % and stem survivorship of 100 %. This system showed outstanding HHS, low revision rates, optimal bone response, and no instances of thigh pain associated with its design.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 9-12"},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative depression screening using PHQ-2 is associated with worse outcomes after ACL reconstruction","authors":"Joshua P. Castle ,&nbsp;Michael A. Gaudiani ,&nbsp;Muhammad J. Abbas ,&nbsp;Eleftherios L. Halkias ,&nbsp;Brittaney A Pratt ,&nbsp;Matthew A. Gasparro ,&nbsp;Susan G. Wager ,&nbsp;Vasilios Moutzouros ,&nbsp;Eric C. Makhni","doi":"10.1016/j.jor.2025.03.006","DOIUrl":"10.1016/j.jor.2025.03.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine how screening positive for depression preoperatively can affect patient reported outcomes after anterior cruciate ligament reconstruction (ACLR).</div></div><div><h3>Methods</h3><div>Primary ACLR patients between May 2020–September 2022 with a PHQ-2 score prior to their surgery were retrospectively reviewed. Patients older than 13 years of age and with minimum 6-months of follow-up were included for analysis. Patients were categorized as PHQ(+) (PHQ-2 ≥2) or PHQ2(−) (PHQ-2 &lt; 2). Demographics, preoperative and postoperative Patient Reported Outcome Information System (PROMIS) -Physical Function (PF) and Pain Interference (PI) scores, Patient Acceptable Symptomatic State (PASS), surgical clinical outcomes, and complications were collected and compared. Chi-square tests and independent t-tests were used for categorical and continuous variables, respectively.</div></div><div><h3>Results</h3><div>A total of 127 patients were analyzed, with 32 PHQ2(+) and 95 PHQ2(−). The PHQ2(+) group had a lower proportion responding “yes” to PASS preoperatively (6.5 % vs. 25.3 %, p = 0.03), at 9 months (47.4 % vs. 72.4 %, p = 0.05), and 12 months postoperatively (42.9 % vs 79.5 %, p = 0.009). PHQ2(+) reported worse PROMIS-PI scores preoperatively, at 6 months, and at 9 months. The PHQ2(+) group reported worse PROMIS-PF preoperatively, at 6 months, at and 12 months. The PHQ2(+) group had worse IKDC scores preoperatively at 9 months and at 12 months. Those screening positive for depression also demonstrated a higher incidence of postoperative complications (34.4 % vs. 9.5 %, p = 0.001) and reoperation rates (21.9 % vs. 4.2 %; p = 0.002).</div></div><div><h3>Conclusion</h3><div>A brief preoperative survey, such as the PHQ-2, can provide prognostic value for patient outcomes after ACLR.</div></div><div><h3>Level of evidence</h3><div>III-Retrospective cohort study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 63-69"},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and complications of shoulder arthroplasty in patients with rheumatoid arthritis: A large insurance claims matched cohort analysis","authors":"Catherine Hand,&nbsp;Camden Bohn,&nbsp;Chase Gornbein,&nbsp;Daanish Khazi-Syed,&nbsp;Josh Chang,&nbsp;Andrew Savoia,&nbsp;Brian Forsythe","doi":"10.1016/j.jor.2025.03.032","DOIUrl":"10.1016/j.jor.2025.03.032","url":null,"abstract":"<div><h3>Introduction</h3><div>Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation, pain, and stiffness, often progressing to joint erosion and deformity. Shoulder arthroplasty is a reliable treatment for alleviating severe arthritic pain in RA patients. This study examines the outcomes and complications of shoulder arthroplasty in individuals with RA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study using the PearlDiver national insurance claims database identified patients over 18 who underwent primary shoulder arthroplasty, including anatomic, reverse, and hemiarthroplasty, between 2010 and 2020. Patients with preoperative RA were matched 1:2 with healthy controls by age and gender. Primary outcomes included revision arthroplasty and rotator cuff repair (RCR), while 90-day complications such as infections, wound disruption, and medical conditions were secondary outcomes. Statistical significance was assessed using multivariate and Chi-square analyses.</div></div><div><h3>Results</h3><div>Of 33,282 patients, 11,431 (34.3 %) had preoperative RA. The RA group exhibited significantly higher rates of 90-day complications, including infections (OR 4.4, p &lt; 0.001), ED visits (OR 3.0, p &lt; 0.001), cardiac arrhythmias (OR 3.0, p = 0.015), deep vein thrombosis (OR 1.3, p = 0.045), and pulmonary embolism (OR 4.2, p &lt; 0.001). However, no significant differences were observed in revision or RCR rates between groups.</div></div><div><h3>Conclusion</h3><div>Patients with RA undergoing shoulder arthroplasty face increased risks of postoperative complications compared to controls, highlighting the need for tailored perioperative strategies to optimize outcomes in this high-risk population.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 96-100"},"PeriodicalIF":1.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported factors determining long-term follow-up after total knee arthroplasty in individuals with knee osteoarthritis visiting a tertiary care hospital","authors":"Saidan Shetty ,&nbsp;Sandeep Vijayan ,&nbsp;G Arun Maiya ,&nbsp;Mohandas Rao Kg ,&nbsp;Bincy M. George","doi":"10.1016/j.jor.2025.03.011","DOIUrl":"10.1016/j.jor.2025.03.011","url":null,"abstract":"<div><h3>Purpose</h3><div>Postoperative follow-up after total knee arthroplasty (TKA) in individuals with knee osteoarthritis (OA) is essential for patients, surgeons, and rehabilitation specialists to monitor patient prognosis. Loss to follow-up is a common problem noted following surgery, and many factors influence follow-up.</div></div><div><h3>Objective</h3><div>The objective of this study was to report patient-reported factors determining long-term follow-up after TKA in individuals with knee OA visiting a tertiary care hospital.</div></div><div><h3>Methods</h3><div>Patients who underwent TKA from January 2021 to December 2022 at a tertiary care hospital in South India were contacted via telephone. Demographic details, follow-up history, reasons for loss to follow-up to the hospital, patient satisfaction, pain, patient-reported function, and quality of life (QoL) were noted.</div></div><div><h3>Results</h3><div>Among the patients, 26.8 % returned for long-term follow-up, whereas 73.2 % were lost to follow-up after TKA. A list of patient-reported factors determining long-term follow-up following TKA was noted. Overall, 81.8 % of patients reported satisfaction following surgery, whereas 18.2 % expressed dissatisfaction. The mean postoperative scores on the numerical pain rating scale (NPRS), lower extremity functional scale (LEFS) score, knee injury and osteoarthritis outcome score (KOOS), and short form-36 (SF-36) health survey questionnaire were noted.</div></div><div><h3>Conclusion</h3><div>A range of patient-reported factors, such as the absence of symptoms, longer wait times in the hospital, increased travel distance to the hospital, the absence of caregivers, financial constraints, the COVID-19 pandemic, and other unspecified reasons were noted as reasons, for loss to follow-up following TKA.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 124-129"},"PeriodicalIF":1.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic variables are rarely included in femoral neck fracture randomized controlled trials: A systematic review","authors":"Avanish Yendluri,&nbsp;Jennifer Yu,&nbsp;Carolina Stocchi,&nbsp;Mark Kurapatti,&nbsp;Nikan K. Namiri,&nbsp;Junho Song,&nbsp;John J. Corvi,&nbsp;John K. Cordero,&nbsp;Steven Yacovelli,&nbsp;Brett L. Hayden,&nbsp;David A. Forsh","doi":"10.1016/j.jor.2025.03.023","DOIUrl":"10.1016/j.jor.2025.03.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Sociodemographic factors may affect outcomes after surgery for patients with femoral neck fractures. The purpose of this study was to assess the inclusion of sociodemographic variables in high-impact randomized controlled trials (RCTs) related to femoral neck fracture operative management.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Medline were queried from January 1, 2017 to March 31, 2024 for RCTs pertaining to operative treatment of femoral neck fracture patients in high impact journals were included. The journal of publication, year of publication, and interventions assessed by the RCTs were extracted. Each RCT was assessed for inclusion of the following sociodemographic variables: age, sex/gender, body mass index (BMI)/weight, race/ethnicity, education level, insurance, smoking/tobacco use, socioeconomic status, marital status, alcohol use, English proficiency, geographic measures (i.e. proximity to hospital), employment status, and prefracture residence status. Temporal reporting trends were analyzed using Chi-square test.</div></div><div><h3>Results</h3><div>Of 1038 RCTs identified, 37 were included for analysis. All 37 studies reported age and sex/gender. BMI/weight was reported in 22 studies (59.5 %). Patients’ prefracture residence status was reported in 11 studies (29.7 %). Smoking/tobacco use was reported in 9 studies (24.3 %). Race/ethnicity was reported in only 5 studies (13.5 %). Socioeconomic status, English proficiency, geographic measures, marital status, education level, insurance, and employment variables were all reported in less than 10 % of the analyzed RCTs. Furthermore, there was no significant difference in the proportion of studies reporting at least one sociodemographic variable (excluding age, sex/gender, and BMI/weight) in 2017–2020 (10/22) versus 2021–2024 (8/15; <em>p</em> = 0.743).</div></div><div><h3>Conclusion</h3><div>Our analysis of high-impact RCTs revealed a large gap in the reporting of sociodemographic variables. RCTs relating to femoral neck fracture management should consistently report key sociodemographic variables to ensure generalizability of study findings.</div></div><div><h3>Level of evidence</h3><div>1</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"69 ","pages":"Pages 79-85"},"PeriodicalIF":1.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radial sensory nerve to anterior interosseous nerve transfer for symptomatic neuromas- clinical outcomes and a transfer classification system","authors":"Alexander D. Jeffs ,&nbsp;Margaret M. Fisher ,&nbsp;Patricia K. Wellborn ,&nbsp;Andrew D. Allen ,&nbsp;Bradley J. Lauck ,&nbsp;Charles A. Baumann ,&nbsp;G. Aman Luther","doi":"10.1016/j.jor.2025.03.034","DOIUrl":"10.1016/j.jor.2025.03.034","url":null,"abstract":"<div><h3>Background</h3><div>Radial sensory nerve (RSN) injuries occur during common surgical procedures or injuries to the wrist and often result in the formation of painful neuromas. Management strategies of primary repair or secondary reconstruction are limited by poor patient satisfaction. We present a targeted muscle reinnervation (TMR) technique, its clinical outcomes, and a novel classification system for the treatment of recalcitrant RSN neuromas with transfer of the RSN to the anterior interosseous nerve (AIN).</div></div><div><h3>Methods</h3><div>Cadaveric specimens were used to devise a classification system for the transfer. RSN to AIN transfer was performed after simulated injury at three levels: proximal, at, and distal to the bifurcation. The transfer was performed in five patients with symptomatic recalcitrant RSN neuromas. Clinical and patient-reported outcomes were prospectively collected for one year.</div></div><div><h3>Results</h3><div>A cadaveric classification system was devised to guide nerve transfer. Five patients underwent RSN to AIN transfer for symptomatic recalcitrant RSN neuromas. There was one Zone 1 injury, two Zone 2 injuries, and three Zone 3 injuries. The mean visual analog scale (VAS) pain score significantly improved by 6 ± 2 points. The mean Quick Disabilities of Arm, Shoulder, &amp; Hand (DASH) scores significantly improved by 37 ± 11 points (p &lt; 0.05). The wrist flexion/extension arc significantly improved by 30 ± 14°, and the radial/ulnar deviation arc significantly improved by 10 ± 3° (p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Our classification system can guide intraoperative decision-making for RSN to AIN transfer based on the zone of RSN injury. RSN to AIN transfer resulted in significant improvement in QuickDASH and VAS Pain scores that exceeded the established thresholds for substantial clinical benefit.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"70 ","pages":"Pages 20-24"},"PeriodicalIF":1.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}