Journal of orthopaedics最新文献

{"title":"What is the multifactorial efficacy of day-zero ambulation post-total hip replacement surgery: A systematic review","authors":"Christopher Efford ,&nbsp;Catherine Holdsworth ,&nbsp;Margaret Donovan-Hall ,&nbsp;Dinesh Samuel","doi":"10.1016/j.jor.2024.08.003","DOIUrl":"10.1016/j.jor.2024.08.003","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the multi-factorial efficacy of day-zero ambulation following primary total hip arthroplasty.</div></div><div><h3>Data sources</h3><div>MEDLINE, CINAHL, AMED, EMBASE and APA PsychInfo in accordance with PRISMA guidelines.</div></div><div><h3>Review methods</h3><div>Studies were classified for study design and ranked in a hierarchy of evidence. Studies ranked excellent or good who followed a treatment pathway inclusive of day-zero ambulation were appraised using the appropriate content checklist (PRISMA, CONSORT, STROBE), CASP checklist and where possible for risk of bias using the appropriate tool (RoB 2.0, ROBINS-1). Results were produced using a narrative synthesis.</div></div><div><h3>Results</h3><div>A total of 8 studies met inclusion criteria. Studies reported a consensus of a reduced length of hospital stay in pathways where day-zero ambulation was included, but with varying effect sizes. Findings suggested that day-zero ambulation may speed up return to function following THR. There was not enough evidence to provide synthesised results on financial efficiency, post-operative pain, or safety of day-zero ambulation via post-operative complications.</div></div><div><h3>Conclusions</h3><div>This systematic review reveals limitations within the literature base on day zero-ambulation. There are problems of concomitant interventions, methodological heterogeneity, and an abundance of research low in the evidence hierarchy. Day zero-ambulation shows promise in reducing length of hospital stay and there is suggestion that it accelerates functional recovery. However, to establish this with rigor, there is further need for high quality, prospective studies such as RCTs to examine the multi-factorial effect of day-zero ambulation, challenge existing theories and contribute to confident synthesised findings more useful to clinical decision makers.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320075","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":"Impact of tranexamic acid use in total hip replacement patients: A systematic review and meta-analysis","authors":"Hsuan-Wei Liu ,&nbsp;Shin-Da Lee","doi":"10.1016/j.jor.2024.08.004","DOIUrl":"10.1016/j.jor.2024.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Tranexamic acid (TXA) dose in the context of primary complete hip replacements (THA) is still a hot debate about the best way to administer TXA. The need to select the most efficient and secure TXA dosing regimen, taking into account elements like perioperative bleeding, postoperative complications, and patient outcomes, has been emphasized by numerous studies. Improving clinical procedures and the general efficacy and safety of employing TXA in THA surgeries requires addressing this ongoing debate.</div></div><div><h3>Methods</h3><div>For this systematic review, We looked at the safety and efficacy of administering TXA intravenously (iTXA) and topically (tTXA) during THA. A thorough search turned up ten randomized controlled trials with 1295 individuals. Parameters evaluated included blood loss, Hb level on the day following surgery, transfusion rates, and drainage volume.</div></div><div><h3>Results</h3><div>Strategies had comparable impacts on deep vein thrombosis occurrences and wound complications. iTXA produced considerably less intraoperative blood loss (WMD = −12.687), concealed blood loss (WMD = 14.276), and the greatest hemoglobin drop (WMD = −0.400) when compared to tTXA.</div></div><div><h3>Conclusion</h3><div>Both administration techniques were secure and efficient in primary THA, although iTXA showed superior results in lowering blood loss and Hb decline.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356707","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":"Fracture related infection – Evolving concepts, definitions, treatment options and healthcare costs","authors":"Raju Ahluwalia ,&nbsp;Hemant Sharma","doi":"10.1016/j.jor.2024.08.006","DOIUrl":"10.1016/j.jor.2024.08.006","url":null,"abstract":"","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552712","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":"An evaluation of the diagnostic performance of the triphasic bone scintigraphy in patients suspected of aseptic total knee arthroplasty loosening","authors":"George S. Buijs ,&nbsp;Arthur J. Kievit ,&nbsp;Matthias U. Schafroth ,&nbsp;Leendert Blankevoort","doi":"10.1016/j.jor.2024.08.007","DOIUrl":"10.1016/j.jor.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><p>Total Knee Arthroplasty (TKA) is a widely conducted and successful orthopedic procedure. However, aseptic loosening, a common cause of TKA failure, necessitates revision surgery. Diagnostic accuracy of triphasic bone scintigraphy, a common imaging modality for aseptic loosening detection, remains controversial. This study investigated the diagnostic accuracy of bone scintigraphy when separately evaluated by a nuclear physicist and an orthopedic surgeon, and the interrater reliability between the two.</p></div><div><h3>Methods</h3><p>Patients undergoing knee revision surgery due to suspected aseptic loosening at three medical centers from 2006 to 2023 were included. Relevant demographic, clinical, and procedural data were extracted from the records. The bone scintigraphy results as noted by the nuclear physicist and orthopedic surgeon were used as index test and intraoperative findings of loosening were used as reference tests. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and kappa's agreement was assessed.</p></div><div><h3>Results</h3><p>Out of 611 revision TKAs, 59 cases were analyzed. The nuclear physicist's evaluation of bone scintigraphy had a sensitivity of 73 %, specificity of 0 %, positive predictive value of 93 %, negative predictive value of 0 %, and diagnostic accuracy of 69 %. The orthopedic surgeon's evaluation showed higher sensitivity, specificity, positive and negative predictive values, and an accuracy of 84 %. Agreement levels were moderate (kappa = 0.46) between the nuclear physicist's and orthopedic surgeons evaluation.</p></div><div><h3>Interpretation</h3><p>The diagnostic accuracy of bone scintigraphy for aseptic loosening is 84 % when evaluated by the orthopedic surgeon compared to 69 % for the nuclear physicist's evaluation. Kappa's agreement between the two was moderate.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972978X24002952/pdfft?md5=a118b756a26178a8c05386e5875eea88&pid=1-s2.0-S0972978X24002952-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273905","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":"Mitigating calcar fracture risk with automated impaction during total hip arthroplasty","authors":"Dan Gordon ,&nbsp;Justin M. Cardenas ,&nbsp;David Fawley ,&nbsp;Kurt J. Kitziger ,&nbsp;Brian P. Gladnick","doi":"10.1016/j.jor.2024.08.002","DOIUrl":"10.1016/j.jor.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><p>Automated broaching has recently been introduced for total hip arthroplasty (THA), with the goal of improving surgical efficiency and reducing surgeon workload. While studies have suggested that this technique may improve femoral sizing and alignment, little has been published regarding its safety, particularly with regard to calcar fractures. The purpose of our study was to evaluate the risk of calcar fracture during automated broaching, and to determine if this risk can be mitigated.</p></div><div><h3>Methods</h3><p>We queried our prospective institutional database and identified 1596 unilateral THAs performed by the senior author using automated impaction between 2019 and 2023. We identified the incidence of calcar fracture with automated impaction, and whether the fracture occurred during broaching or stem insertion. We additionally determined calcar fracture incidence within two consecutive subgroups of patients using different stem insertion techniques; subgroup (1): automated broaching with automated stem insertion for all patients; versus subgroup (2): automated broaching with automated stem insertion ONLY if a cushion of cancellous bone separated the broach from the calcar, otherwise the stem was placed manually. Continuous and categorical variables were analyzed with Student's t-test and Fisher's exact test, respectively.</p></div><div><h3>Results</h3><p>Seventeen calcar fractures occurred intraoperatively (1.1 %). Only two fractures occurred during automated broaching (0.1 %), while fifteen occurred during final stem impaction (0.9 %) (p = 0.007). Four calcar fractures (1.4 %) occurred in subgroup 1, compared to two in subgroup 2 (0.6 %) (p = 0.28).</p></div><div><h3>Conclusions</h3><p>Our study found a calcar fracture incidence of 1.1 % using automated impaction, consistent with historically reported rates of 0.4–3.7 %. We found that calcar fractures are more likely to occur during stem insertion than during femoral broaching. We recommend that if any part of the final broach is in direct contact with the calcar, the final stem should be impacted manually to minimize fracture risk.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972978X24002903/pdfft?md5=e35f0247e7cdda1e88b8bbf65030d0e6&pid=1-s2.0-S0972978X24002903-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274155","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":"Short-term outcomes with routine use of size ≥40 femoral heads in THA: A retrospective cohort study","authors":"Steven Ralles,&nbsp;Michael P. Murphy,&nbsp;Hassan Farooq,&nbsp;Whisper Grayson,&nbsp;William J. Hopkinson,&nbsp;Nicholas M. Brown","doi":"10.1016/j.jor.2024.08.001","DOIUrl":"10.1016/j.jor.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><p>Using larger femoral heads during total hip arthroplasty (THA) may result in a more stable hip. Greater volumetric wear and frictional torque, however, may result in increased postoperative complications. The purpose of this study was to compare outcomes of patients with femoral head size ≥40 mm compared to those with femoral head size &lt;40 mm.</p></div><div><h3>Materials and methods</h3><p>A retrospective chart review of 504 THAs performed by a single surgeon at a single institution from 2009 to 2016 was conducted. Following exclusions, 131 THAs were identified with femoral heads ≥40 mm and 348 THAs were identified with femoral heads &lt;40 mm. In addition to demographic data, all postoperative complications were recorded. Plain radiographs were used to rule out/in periprosthetic osteolysis and/or acetabular loosening. Chi-square tests and Student's t-tests were used to compare categorical and continuous variables, respectively.</p></div><div><h3>Results</h3><p>Mean follow-up period for the entire cohort was 5.5 years. Complications with ≥40 mm femoral heads included 1 superficial infection and 1 deep periprosthetic joint infection (PJI). There were no cases of dislocation, osteolysis, acetabular loosening, or trunnionosis. In contrast, complications with &lt;40 mm femoral heads included 9 dislocations and 7 PJIs.</p></div><div><h3>Conclusion</h3><p>The routine use of large femoral heads (≥40-mm) during THA appears to be a safe option for patients at short-term clinical follow-up. Notably, 0 patients had a clinical course complicated by dislocation, osteolysis, acetabular loosening, or trunnionosis.</p></div><div><h3>Level of evidence</h3><p>Level III Retrospective Cohort Study.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972978X24002897/pdfft?md5=f494c6d0b5d1f55b19d40d195ba4d00c&pid=1-s2.0-S0972978X24002897-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274058","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":"Feasibility of prehabilitation for patients awaiting total knee arthroplasty; a pilot study","authors":"Louisa T.M.A. Mulder ,&nbsp;Danielle D.P. Berghmans ,&nbsp;Peter Z. Feczko ,&nbsp;Rob A. de Bie ,&nbsp;Antoine F. Lenssen","doi":"10.1016/j.jor.2024.07.019","DOIUrl":"10.1016/j.jor.2024.07.019","url":null,"abstract":"<div><h3>Objective</h3><p>To examine the feasibility of conducting a preoperative home-based prehabilitation program for total knee arthroplasty patients at risk for delayed in-hospital recovery, and to explore the pre- and postoperative impact of this program.</p></div><div><h3>Design</h3><p>A retrospective cohort study with matched controls, enabling subgroup analyses.</p></div><div><h3>Setting</h3><p>Home-based.</p></div><div><h3>Subjects</h3><p>Patients awaiting primary unilateral total knee arthroplasty between 2019 and 2020, were compared with matched historic cases from 2016 to 2017. Matching criteria were scoring ≤17 points on the De Morton Mobility Index and &gt;12.5 s on the timed-up-and-go test.</p></div><div><h3>Intervention</h3><p>Supervised home-based prehabilitation program versus no prehabilitation.</p></div><div><h3>Outcomes</h3><p>Feasibility, determined by recruitment rate, adherence, and safety of the program. Preoperative impact, assessed for the intervention group by differences in mean values for aerobic capacity, muscle strength and functional mobility between the first and last sessions. Postoperative impact was defined as the time needed to achieve in-hospital independence of physical function and was measured by the differences in mean values between the intervention and control groups.</p></div><div><h3>Results</h3><p>Recruitment rate was 71 %; adherence and drop-out rates were 88 % and 12 % respectively. No adverse events were reported. Preoperatively, the intervention group showed significant improvements in aerobic capacity on the 2-min walking test (84.29 m–98.06 m; p = 0.007) and 2-min step test (40.35 steps to 52.95 steps; p = 0.014), muscle strength on the 30 s chair stand test (7.3 stands to 10.1 stands; p = 0.002), and functional mobility as seen in the timed-up-and-go-test (19.52 s–15.85 s; p = 0.031). Postoperatively, the intervention group achieved in-hospital independence of physical function earlier (mean rank 16.11) than the control group (mean rank 24.89; p=&lt;0.01).</p></div><div><h3>Conclusions</h3><p>It is feasible to conduct a prehabilitation program 4–6 weeks preoperatively, for high-risk patients awaiting total knee arthroplasty. Additionally, the program appears to have a positive impact on physical fitness both pre- and postoperatively.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972978X24002885/pdfft?md5=493f06159ba8439deeeddcc5b1045f40&pid=1-s2.0-S0972978X24002885-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273961","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":"Trendelenburg gait after total hip arthroplasty due to reduced muscle contraction of the hip abductors and extensors","authors":"Tsutomu Fujita ,&nbsp;Satoshi Hamai ,&nbsp;Daisuke Hara ,&nbsp;Shinya Kawahara ,&nbsp;Ryosuke Yamaguchi ,&nbsp;Satoshi Ikemura ,&nbsp;Goro Motomura ,&nbsp;Kenichi Kawaguchi ,&nbsp;Yasuharu Nakashima","doi":"10.1016/j.jor.2024.07.020","DOIUrl":"10.1016/j.jor.2024.07.020","url":null,"abstract":"<div><h3>Background</h3><p>Despite experiencing pain relief and improved activities of daily living after total hip arthroplasty (THA) for osteoarthritis of the hip, a Trendelenburg gait may be observed in some patients. The concentric and eccentric contraction patterns of hip muscles in a Trendelenburg gait are not well understood.</p></div><div><h3>Methods</h3><p>This study included 89 patients (28 males and 61 females, mean age 66.5 ± 8.4 years, mean postoperative period 1.3 ± 0.4 years) after unilateral THA without functional impairment on the contralateral side. Gait analysis utilized a three-dimensional motion capture system to assess pelvis and hip angles, hip moment, and hip power. A Trendelenburg gait was defined as positive when nonoperative pelvic descent occurred at 30 % of the gait cycle, equivalent to mid-stance. Patients were classified into Trendelenburg gait-positive and -negative groups for statistical analysis. Unpaired <em>t</em>-test and chi-square test were used to compare the two groups. Multiple regression analysis was conducted to identify factors associated with the presence of a Trendelenburg gait.</p></div><div><h3>Results</h3><p>A Trendelenburg gait was observed in 24 patients (27 %). Multiple regression analysis indicated that abduction (p &lt; 0.01) and extension (p = 0.03) of hip joint power were significant determining of a Trendelenburg gait. Patients with a Trendelenburg gait exhibited reduced eccentric contraction of the hip abductor muscles and decreased concentric contraction of hip extensor muscles during early to mid-stance of their gait.</p></div><div><h3>Conclusion</h3><p>Centrifugal contraction of hip abductor muscles and diminished eccentric contractility of hip extensor muscles appear crucial for hip stabilization mechanisms during gait after THA.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972978X24002873/pdfft?md5=e082ddf993eaf6734c01f10cb069fc76&pid=1-s2.0-S0972978X24002873-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273962","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":"Independent volumetric internal fixation reduces posterior column acetabular fracture site motion as compared to plate/screw construct: A biomechanical analysis","authors":"Helyn G. Fraser ,&nbsp;M. Wesley Honeycutt ,&nbsp;Daniel Thompson ,&nbsp;Nina Suh ,&nbsp;Huai Ming Phen ,&nbsp;William S. Godfrey ,&nbsp;Adam R. Boissoneault ,&nbsp;Michael A. Maceroli","doi":"10.1016/j.jor.2024.07.007","DOIUrl":"10.1016/j.jor.2024.07.007","url":null,"abstract":"<div><h3>Aims &amp; objectives</h3><p>To establish whether a suprapectineal pelvic reconstruction plate and posterior column screw (P&amp;S) construct or a single 6.5-mm cannulated posterior column screw (PCS) construct demonstrates greater mechanical stability for fixation of acetabulum fractures involving the posterior column (PC). We hypothesized that the PCS construct would result in less fracture site motion.</p></div><div><h3>Materials &amp; methods</h3><p>Twelve fourth-generation composite hemipelvi were utilized, 6 for each construct. The P&amp;S construct consisted of a suprapectineal pelvic reconstruction plate with two 3.5-mm posterior column screws crossing the fracture site in lag-by-technique fashion and two screws anchoring the plate to the sciatic buttress. The PCS construct consisted of a single 6.5-mm partially threaded cannulated screw placed in an antegrade fashion. Both fixation models were cyclically loaded at 0.5 cycles/second at 400N and 800N, first in a sit-to-stand position that is expected during recovery, and subsequently in a squat-to-stand position to test overload conditions.</p></div><div><h3>Results</h3><p>Under sit-to-stand loading, the PCS construct resulted in less motion at the fracture site than the P&amp;S construct (0.06 ± 0.02 mm vs 0.1 ± 0.02 mm at 400N, p = 0.02; 0.13 ± 0.03 mm vs 0.19 ± 0.04 mm at 800N, p = 0.03). The PCS construct also demonstrated less fracture site motion under squat-to-stand loading (0.22 ± 0.13 mm vs 1.9 ± 0.5 mm at 400N, p = &lt; 0.001; 1.48 ± 0.44 mm vs 4.77 ± 0.3 mm at 800N, p = &lt; 0.001). At 800 N, half of the repairs failed during squat-to-stand loading (2 PCS, 4 P&amp;S).</p></div><div><h3>Conclusion</h3><p>Fixation of the posterior column of the acetabulum with a 6.5-mm cannulated screw demonstrated comparable fracture motion upon loading compared to the plate and screw construct.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972978X24002757/pdfft?md5=8d9e29a2596ed2784a85d8e7f88af515&pid=1-s2.0-S0972978X24002757-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274057","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":"Bone grafting augmentation choices in complex proximal humerus fractures: A systematic review","authors":"Ali Etemad-Rezaie ,&nbsp;Serena Dienes ,&nbsp;Chetan Gohal ,&nbsp;Valerie Politis-Barber ,&nbsp;Stephanie Searle ,&nbsp;Diane Nam ,&nbsp;Ujash Sheth","doi":"10.1016/j.jor.2024.07.017","DOIUrl":"10.1016/j.jor.2024.07.017","url":null,"abstract":"<div><h3>Objective</h3><p>To systematically identify and evaluate different bone graft augmentation techniques in the operative treatment of complex proximal humerus fractures.</p></div><div><h3>Methods</h3><p>Four databases were searched from 1970 to February 2023 for Level I to IV English studies that investigated outcomes of different bone augments in the primary surgical fixation of proximal humerus fractures. The JBI critical appraisal checklist, methodological index for non-randomized studies and cochrane risk of bias tool were used to assess study quality. Descriptive statistics including weighted means are presented where applicable.</p></div><div><h3>Methods</h3><p>Thirty-three articles including 964 patients met the inclusion. Seven bone augments were identified, including fibular strut allograft (693 patients across 21 studies), femoral head allograft (84 patients across 4 studies), iliac crest allograft (54 patients across 3 studies), iliac crest autograft (94 patients across 5 studies), humeral endosteal allograft (6 patients in 1 single study), unspecified cancellous allograft (28 patients in 1 single study) and distal clavicle autograft (3 patients in 1 single study). Mean patient age was 67.1 years, with female patients comprising 65.2 %. Fracture union rates were similar between groups, with an average of 99.6 %. The average Constant Murley Score (CMS) was not reported in the humeral endosteal allograft or the distal clavicle autograft group but was 81.8 (fibular strut allograft), 79.1 (femoral head allograft), 76.8 (iliac crest allograft), 77.7 (iliac crest autograft), and 81.5 (unspecified cancellous allograft) in the remaining groups. Revision surgery was required in 16.7 % of patients receiving humeral endosteal allograft, 7 % of patients with femoral head allograft, 2 % of iliac crest autografts and 1.9 % in the fibular allograft group. Reported complications included avascular necrosis, hardware complications and loss of reduction.</p></div><div><h3>Conclusion</h3><p>Bone graft augmentation is an effective adjunct to open reduction internal fixation of complex proximal humerus fractures. Fibular strut allograft is the most common bone graft augment used. Majority of patients treated with bone graft augmentation achieved bony union (83%–100 %) and average CMS scores at final follow-up were similar between graft types (76–82). However, no conclusive data suggests superiority of one bone graft type over another. Future studies should aim to compare the outcomes amongst graft types.</p></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972978X2400285X/pdfft?md5=77cd5cd9af380e0ca06fc4d0b0a8d249&pid=1-s2.0-S0972978X2400285X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853627","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}