Journal of Orthopaedic Science最新文献

{"title":"Assessing subscapularis tears: Relationship between special tests and pain & tear severity.","authors":"İnci Hazal Ayas, Baran Sarıkaya, Mustafa Özer, Mehmet Ali Tokgöz, Zeynep Hazar, Almasbek Akhmetov, Dilek Yapar, Ulunay Kanatlı","doi":"10.1016/j.jos.2024.09.010","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.010","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study is to examine the association between special tests for subscapularis tears and both pain and tear severity.</p><p><strong>Methods: </strong>Nine hundred and two patients (145 with isolated lesions and 757 with combined lesions) diagnosed with arthroscopically confirmed subscapularis tears between 2010 and 2022. Subscapularis tear severity was classified according to Lafosse classification type I, II, III and IV. Preoperative Visual Analogue Scale (VAS) pain score at rest of the patients, flexion and abduction range of motion (ROM) of the shoulder and the results of the Lift-off test (LOT), Belly Press test (BPT), Bear Hug test (BHT), and Empty Can test (ECT) were documented.</p><p><strong>Results: </strong>The sensitivity of LOT in isolated and combined tears was 70.3 % and 69.5 %, 45.6 % and 41.2 % of BPT, 72.1 % and 72.6 % of BHT, 81.2 % and 84.1 % of ECT, respectively. There was no association between the severity of the subscapularis tear and the sensitivity in all special tests (p > 0.05). Only the ECT was observed to be associated with pain in the multivariate logistic regression analysis (OR = 33.1, p < 0.001).</p><p><strong>Conclusions: </strong>The special tests used to evaluate subscapularis tears are neither sensitive to the severity of the tear nor to pain except for ECT. BHT is the most successful test to detect any subscapularis tear in both isolated and combined tears. Pain severity was related to the presence of a rotator cuff lesion accompanying subscapularis lesion, but not with the severity of subscapularis or remaining rotator cuff tear.</p><p><strong>Study design: </strong>Levels of Evidence III, cross-sectional archive study.</p><p><strong>Clinical trial registration number: </strong>Since the study was a retrospective archive study, there was no clinical trial registration.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of orthopedic surgery-related incidents in operating rooms using a nationwide incident reporting database.","authors":"Shiho Nakano, Toshiaki Kotani, Arata Nakajima, Masato Sonobe, Kayo Inakuma, Seiji Ohtori, Koichi Nakagawa","doi":"10.1016/j.jos.2024.09.008","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.008","url":null,"abstract":"<p><strong>Background: </strong>Patient safety is crucial in high-risk specialties such as orthopedic surgery due to the significant incidence of preventable adverse events. Analyzing extensive databases of orthopedic surgery-related incidents in operating rooms is vital for enhancing medical safety and identifying targeted interventions. This study analyzed orthopedic surgery-related incidents in operating rooms using a nationwide incident reporting database in Japan to identify risk factors associated with severe harm.</p><p><strong>Methods: </strong>We extracted orthopedic surgery-related incidents in the operating room from the Japan Council for Quality Health Care's database, which contained 127,207 near-miss and adverse event reports recorded between January 1, 2010 and September 30, 2022. We analyzed 882 incident cases, focusing on patient demographics, incident timing, surgical site, incident causes, and severity levels.</p><p><strong>Results: </strong>The most incidents involved surgeons (93.3 %) with an average of 16.0 ± 8.5 years of experience. The frequent causes were \"failure to check\" (48.0 %) and \"misjudgment\" (24.0 %), which were non-technical errors. \"Errors in methods/procedures\" accounted for 37.1 % of incidents, possibly due to a wide variety of surgical approaches and implants used in orthopedic surgeries. Regarding severity, 86 % were critical incidents that threatened patients' livelihoods or lives. Surgeries involving surgeons had a significantly higher risk of severe harm than those involving healthcare professionals other than surgeons (odds ratio: 3.311, 95 % confidence interval: 1.858-5.901).</p><p><strong>Conclusions: </strong>This study revealed that most of orthopedic surgery-related incidents in operating rooms involved experienced surgeons and resulted in severe patient harm. The frequent causes were failure to check, misjudgment, and errors in methods/procedures. These highlight the crucial role of orthopedic surgeons in actively contributing to medical safety databases and fostering a culture of reporting within their field.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural adaptation and validation of the kinesiophobia causes scale: A descriptive survey have undergone total knee arthroplasty in China.","authors":"Yuru Guo, Yanjin Liu, Yuan Zheng, Libai Cai, Min Ren, Yaya Zhai","doi":"10.1016/j.jos.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.006","url":null,"abstract":"<p><strong>Objective: </strong>The objectives of this study were to revise the Kinesiophobia Causes Scale (KCS) to make it suitable for Chinese cultural context and to verify its applicability in Chinese Total knee arthroplasty (TKA) patients.</p><p><strong>Methods: </strong>TKA patients in Henan Province, China (N = 418, average age ≥64 years). Exploratory and confirmatory factor analysis was performed on two samples randomly selected from the population (each N = 208). Psychometric properties, including the content, construct, predictive and concurrent validity was evaluated for KCS.</p><p><strong>Results: </strong>The KCS scale showed desirable internal consistency (Cronbach's alpha: 0.927), test-retest reliability (0.936), and content validity (0.958). A seven-factor structure was revealed and confirmed using exploratory and confirmatory factor analysis. The area under the curve was 0.852. The optimal cut-off score for KCS was 3.68.</p><p><strong>Conclusions: </strong>The developed Chinese version of KCS is both reliable and valid when applied in Chinese setting of TKA patients.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latissimus dorsi tendon transfer versus open complete repair for symptomatic massive rotator cuff tear.","authors":"Emre Kaya, Mehmet Kapıcıoglu, Koray Sahin, Tolga Kececi, Kerem Bilsel","doi":"10.1016/j.jos.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.001","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic massive rotator cuff tear (MRCT) treatment is challenging, and there is no clear treatment strategy. In our study, we aimed to compare latissimus dorsi tendon transfer (LDTT) and open complete repair (OCR) surgical techniques for the treatment of MRCT.</p><p><strong>Methods: </strong>Cases of symptomatic MRCT treated surgically with LDTT and OCR techniques between 2014 and 2021 were included in the study. The study was conducted in two centers: 1) one surgeon performed LDTT in first center and 2) the other surgeon performed OCR in second center. This study included 18 cases of LDTT and 15 cases of OCR. The patients were evaluated preoperatively and postoperatively in terms of demographic, radiological and functional scores. The American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley (CM) score, and visual analog scale (VAS) were used for functional evaluation. Symptom duration was defined as less than 6 months after onset, longer than 6 months and less than one year (<1Y)after onset, and longer than one year (>1Y) after onset.</p><p><strong>Results: </strong>The functional scores and range of motion improved significantly in both groups. No statistically significant differences were found between the symptom duration subgroups in the LDTT group. However, there was a significant difference in functional scores between <1Y and >1Y (P < 0.001) in the OCR group. Re-tear was seen in 5 (33.3 %) cases in the OCR group, and failure was seen in 3 (16.6 %) cases in the LDDT group. The failure rate was significantly higher in the OCR group than in the LDTT group (P < 0.05).</p><p><strong>Conclusions: </strong>LDTT technique is good option in the treatment of MRCT. However, in acute-subacute MRCT cases, open complete repair is a simpler, successful and safe technique. In chronic cases of >1Y, re-tear rates with OCR were high, and functional outcomes were low. We recommend that LDTT treatment for chronic cases (>1Y).</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing an optimal central sensitization inventory cut-off value affecting postoperative outcomes of osteotomy around the knee.","authors":"Shoichi Hasegawa, Hideyuki Koga, Yusuke Nakagawa, Hao Ding, Aritoshi Yoshihara, Masaki Amemiya, Takashi Hoshino, Mai Katakura, Nobutake Ozeki, Tomomasa Nakamura, Hiroki Katagiri","doi":"10.1016/j.jos.2024.09.009","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.009","url":null,"abstract":"<p><strong>Background: </strong>Central sensitization has a significant effect on pain after osteotomy around the knee (OAK). The central sensitization inventory (CSI) score is considered disease specific, and the appropriate cut-off values for OAK are unclear. The purpose of this study was to establish the optimal CSI cut-off value affecting the postoperative outcomes of OAK based on the postoperative knee injury and osteoarthritis outcome score (KOOS).</p><p><strong>Methods: </strong>Patients who underwent OAK for medial compartment knee osteoarthritis were included. The postoperative KOOS symptoms, pain, and activities of daily living (ADL) were categorized into two groups (score ≥80 each for symptoms, pain, and ADL, and score <80 for any of the three) and were used as factors to calculate receiver operating characteristic curves and the area under the curve with the CSI score. Cut-off values were calculated using the Youden index and the threshold value closest to the upper left corner. Subsequently, logistic multivariate analysis was performed using the KOOS and the obtained CSI cut-off values and other variables.</p><p><strong>Results: </strong>A total of 173 patients were included in this study. The area under the curve of the model was 0.801 (95 % confidence interval, 0.74-0.87), and a CSI score of 12 was determined as the cut-off value. Logistic multivariate analysis based on the cut-off value showed that only the CSI score (odds ratio, 9.79; 95 % CI, 4.47-21.4; P < 0.01) was significant.</p><p><strong>Conclusions: </strong>The optimal CSI cut-off value affecting the postoperative outcomes of OAK calculated using the postoperative KOOS was 12, which was supported by multivariate analysis results. Central sensitization assessment with an appropriate cut-off value would allow a more personalized treatment approach and may contribute to a better postoperative outcome.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative responsiveness of the PROMIS-29 and SF-36 instruments in individuals with chronic musculoskeletal pain.","authors":"Wannisa Kumban, Rotsalai Kanlayanaphotporn, Kornkanok Khutok","doi":"10.1016/j.jos.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.004","url":null,"abstract":"<p><strong>Background: </strong>Chronic musculoskeletal pain (CMP) impacts Health-Related Quality of Life (HRQoL). Several questionnaires are widely used for evaluating the HRQoL, such as Patient Reported Outcomes Measurement Information System 29-item Health Profile (PROMIS-29) and 36-Item Short Form Health Survey (SF-36). This study aimed to assess and compare the responsiveness of PROMIS-29 and SF-36 in individuals with CMP.</p><p><strong>Methods: </strong>The prospective study collected data from 215 patients with CMP. The participants completed both questionnaires at baseline and a 4-week follow-up with the global perceived effect (GPE) scale. The internal and external responsiveness methods evaluated the responsiveness of the instruments. The effect size (ES) and standardized response mean (SRM) assessed the internal responsiveness. External responsiveness was measured by Spearman's correlation coefficients (r) and area under the receiver operating curve (AUC). The responsiveness of the PROMIS-29 and SF-36 were compared in similar constructs.</p><p><strong>Results: </strong>The PROMIS-29 demonstrated responsiveness as moderate in fatigue (ES = -0.79, SRM = -0.64), moderate to large in pain interference (ES = -0.94, SRM = -0.64), and large effect in pain intensity subscale (ES = -1.25, SRM = -1.16). The SF-36 bodily pain exhibited moderate responsiveness (ES = 0.73, SRM = 0.60). Spearman's correlation showed moderate between GPE and change scores of PROMIS-29 physical function (r = 0.31), fatigue (r = -0.36), pain intensity (r = 0.45), and weak between GPE and changes score of SF-36 (r = 0.15-0.26). Besides, the AUC of the PROMIS-29 fatigue, and pain intensity scale were 0.701 and 0.725, respectively, indicating superior discriminative ability.</p><p><strong>Conclusions: </strong>The PROMIS-29 and SF-36 were the most responsive in assessing the pain domain for physical health and PROMIS-29 fatigue domain for mental health among individuals with CMP. The PROMIS-29 demonstrated superior results compared to the SF-36. Other domains related to HRQoL could be considered in other assessment instruments.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of adipose-derived stem cells in preventing peripheral nerve adhesion and promoting nerve regeneration: A laboratory investigation in a rat model.","authors":"Yuta Nakamura, Kaoru Tada, Mika Akahane, Tsuyoshi Hattori, Masashi Matsuta, Atsuro Murai, Soichiro Honda, Osamu Hori, Satoru Demura","doi":"10.1016/j.jos.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.005","url":null,"abstract":"<p><strong>Background: </strong>Neurolysis alone or administration of anti-adhesion products after neurolysis is performed to treat peripheral nerve adhesion; however, the recovery of nerve function is poor. This study aimed to investigate the efficacy of adipose-derived stem cells (ADSCs) for peripheral nerve adhesion in a rat model.</p><p><strong>Methods: </strong>As a nerve adhesion procedure, the neural bed was coagulated, and the epineurium of the sciatic nerve was sutured to the coagulated neural bed using nylon. Neurolysis was performed 6 weeks after the nerve adhesion procedure, and saline (control group) or ADSCs (ADSC group) were administered around the nerve where neurolysis was performed. Evaluations were performed 6 weeks after the administration.</p><p><strong>Results: </strong>The wet weight ratio of the tibialis anterior muscle and nerve conduction velocity, which are indicators of nerve regeneration, were significantly better, while tensile strength, which is an indicator of the severity of nerve adhesion, was significantly lower in the ADSC group than in the control group. In the nerve, the expression of interleukin-10 and transforming growth factor-β in the nerve was significantly higher and that of tumor necrosis factor-α was significantly lower in the ADSC group than in the control group. Furthermore, significantly fewer M1 macrophages and significantly more M2 macrophages were observed in the ADSC group than in the control group. In the perineural scar, significantly fewer perineural collagen fibers and significantly more vascularization were observed in the ADSC group than in the control group.</p><p><strong>Conclusions: </strong>ADSCs prevented peripheral nerve adhesion by reducing perineural scarring and enhancing vascularization. Additionally, ADSCs promoted nerve regeneration by decreasing inflammatory cytokine levels and increasing anti-inflammatory cytokine levels, as ADSCs regulated macrophage polarization from M1 to M2 macrophages. These findings hold promise for using ADSCs to treat nerve adhesion.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of retrograde intramedullary multiple pinning for proximal humeral fractures using a modified palm tree technique.","authors":"Takayuki Oishi, Atsushi Tasaki, Yutaka Inaba, Nobuto Kitamura","doi":"10.1016/j.jos.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.007","url":null,"abstract":"<p><strong>Background: </strong>Retrograde intramedullary multiple pinning using a modified palm tree technique for proximal humeral fractures has attracted interest from surgeons because of its minimal invasiveness into the soft tissue around the shoulder joints. We aimed to evaluate the clinical and radiological outcomes of this procedure.</p><p><strong>Methods: </strong>This retrospective study included 21 patients who underwent surgery using a modified palm tree technique for proximal humeral fractures between March 2010 and March 2022. Patients with two- and three-part proximal humeral fractures that could be reduced by closed manipulation under general anesthesia were included in this study. All patients were clinically evaluated using the Japanese Orthopaedic Association (JOA) and University of California at Los Angeles (UCLA) shoulder scores. Postoperative radiographic findings, including fracture healing and signs of pinning-related complications, were evaluated.</p><p><strong>Results: </strong>Twenty-one shoulders in 21 patients (9 men and 12 women) with mean age at surgery of 66.3 ± 19.3 years were evaluated. The mean period until bone union was 2.6 ± 0.7 months. The mean JOA and UCLA shoulder scores at the final follow-up were 84.8 ± 12.1 and 27.5 ± 5.4, respectively. Perforation of the humeral head by Kirschner (K) wires was observed in 9 of the 21 (42.9 %) shoulders. The JOA and UCLA shoulder scores at the final follow-up were not significantly different between the groups with and without perforations (p = 0.41 and 0.27, respectively). The oblique or Y-view detected significantly more wires with perforation of the humeral head than did the anteroposterior view (6 vs. 15 wires, p < 0.01).</p><p><strong>Conclusions: </strong>The modified palm tree technique for proximal humeral fractures demonstrated good postoperative clinical outcomes and early fracture healing. However, modifications in postoperative management and surgical techniques should be considered to reduce the high rate of perforation of the humeral head by K-wires.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elderly trochanteric fracture outcomes: Unveiling the risks of excessive postoperative sliding - A retrospective multicenter (TRON group) investigation.","authors":"Makoto Suzuki, Yasuhiko Takegami, Katsuhiro Tokutake, Hiroaki Nakasima, Kenichi Mishima, Hiroaki Kumagai, Shiro Imagama","doi":"10.1016/j.jos.2024.09.003","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.003","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary nailing (IMN) for femoral trochanteric fractures (FTF) is the primary surgical intervention. Excessive lag screw sliding (ES) of the femoral neck screw sometimes occurs. This multicenter investigation sought to 1) determine the prevalence of ES, 2) evaluate the relationship between ES and postoperative complications, and 3) identify the factors of ES in elderly patients with FTF undergoing IMN.</p><p><strong>Methods: </strong>From 2016 to 2020, 1448 patients with FTF were treated using a short IMN across 11 institutions (TRON group). Upon applying exclusion criteria, 519 patients (127 men, 392 women; mean age, 84.4 years) were included. The postoperative sliding distance was measured immediately after surgery and at final follow-up. A sliding distance of ≥8 mm categorized patients as having ES. We identify the factors contributing to ES using the logistic regression analysis, with a p < 0.05 as statistical significance.</p><p><strong>Results: </strong>ES was observed in 116 patients (22.4 %). Patients with ES had a higher incidence of postoperative cut-out and peri-implant fracture. Logistic regression analysis showed that achieving optimal reduction in both AP and lateral views (odds ratio (OR) 0.48, p = 0.0012) and the use of a double screw system or twin screws with integrated locking mechanism significantly reduced the risk of ES (OR 0.27, 0.17; p = 0.0027, <0.001).</p><p><strong>Conclusions: </strong>The incidence rate of ES was 22.4 %. ES was associated with a higher risk of postoperative complications. The surgeons should aim for optimal reduction and use a double screw or twin screws with an integrated interlocking mechanism as the implant of choice.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of treatment outcomes for severe extremity trauma in an independent orthopedic trauma center: A case series.","authors":"Yuta Izawa, Hiroko Murakami, Kazuo Sato, Mizuki Minegishi, Yoshihiko Tsuchida","doi":"10.1016/j.jos.2024.09.011","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.011","url":null,"abstract":"<p><strong>Background: </strong>Severe extremity trauma is one of the most challenging injuries to treat. Limb salvage after severe extremity trauma requires rapid revascularization, accurate and appropriate bone and soft tissue reconstruction, and appropriate management to address critical complications. The purpose of this study was to report the treatment outcomes for severe extremity trauma injuries at our independent orthopedic trauma center.</p><p><strong>Methods: </strong>This study included patients with severe extremity trauma who underwent major vascular repair or soft tissue reconstruction. Bone reconstruction method, presence or absence of revascularization, and flap type were investigated. Complications were investigated, including revascularization failure, flap failure, infection, and ultimately, whether amputation was required. Additionally, we investigated the number of surgeries performed on each patient at the time of initial hospitalization.</p><p><strong>Results: </strong>Thirty-five patients who underwent revascularization or soft tissue reconstruction were included in this study. Plate fixation was performed in 18 patients, intramedullary nail fixation in 8, screw fixation in 1, pinning in 4, and without implant fixation in 4. Revascularization was performed in six patients, and no vascular complications occurred. Pedicled and free flaps were used in 17 and 16 patients, respectively. Partial flap necrosis occurred in four patients, and arterial occlusion occurred in one. Infection occurred in 10 patients who were treated with frequent irrigation and high-concentration antibiotics local infusion therapy. None of the 35 patients required limb amputation. Mean number of surgeries was 12.5.</p><p><strong>Conclusions: </strong>The limb of all the 35 patients with severe extremity trauma treated at our independent orthopedic trauma center were salvaged.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}