Orthopedic Research and Reviews最新文献

{"title":"Optimal Management of Partial Thickness Rotator Cuff Tears: Clinical Considerations and Practical Management","authors":"T. Thangarajah, I. Lo","doi":"10.2147/ORR.S348726","DOIUrl":"https://doi.org/10.2147/ORR.S348726","url":null,"abstract":"Abstract Partial thickness rotator cuff tears have been diagnosed with increased frequency due to heightened awareness and an improvement in diagnostic modalities. When >50% of the tendon thickness has ruptured, intra-tendinous strain of the residual tendon increases. Surgery is generally confined to patients who have failed non-operative measures and have persistent symptoms. The rationale for repairing partial thickness tears lies in their limited self-healing capacity, and propensity to enlarge over time and progress to a full thickness defect. Although tear debridement and acromioplasty can improve pain and function, tear progression can occur, in addition to worse results being noted in bursal-sided defects. Several surgical strategies have been recommended but there is a lack of evidence to advocate one form of treatment over another. The aim of this narrative review is to discuss the treatment options for partial thickness tears of the rotator cuff.","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"14 1","pages":"59 - 70"},"PeriodicalIF":2.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47663461","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":"Postoperative Fluid Collections in Total Joint Arthroplasty: A Narrative Review","authors":"Dylan Smith, G. Berdis, Vishavpreet Singh, Alexander Caughran, Matthew W. Bullock","doi":"10.2147/ORR.S348919","DOIUrl":"https://doi.org/10.2147/ORR.S348919","url":null,"abstract":"Abstract A post-operative fluid collection (POFC) represents a common finding in both primary and revision total joint arthroplasty (TJA). Fortunately, most resolve on their own, but in instances where they become symptomatic, prompt identification and management are paramount, especially when they occur adjacent to a joint arthroplasty because of the increased the risk of developing a periprosthetic joint infection. A strong clinical suspicion with appropriate clinical exam is required along with select imaging modalities to arrive at a diagnosis. Meticulous surgical technique is crucial to prevent POFC, but new emerging treatments continue to evolve. This article presents an updated overview of incidence, pathophysiology, diagnosis, and management of POFC in the setting of TJA. We review the role of select imaging modalities as well as summarize current literature regarding new treatments such as sclerotherapy agents, acellular dermal matrices, and negative pressure wound therapy. Future studies are necessary to explore the interplay of inflammatory mediators in POFC formation and to define their role in fluid collection resolution.","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"14 1","pages":"43 - 57"},"PeriodicalIF":2.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42564252","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":"Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets.","authors":"Gracie R Baum,&nbsp;Jaxon T Baum,&nbsp;Dan Hayward,&nbsp;Brendan J MacKay","doi":"10.2147/ORR.S378278","DOIUrl":"https://doi.org/10.2147/ORR.S378278","url":null,"abstract":"<p><p>As the epidemic of gunshot injuries and firearm fatalities continues to proliferate in the United States, knowledge regarding gunshot wound (GSW) injury and management is increasingly relevant to health-care providers. Unfortunately, existing guidelines are largely outdated, written in a time that high-velocity weapons and deforming bullets were chiefly restricted to military use. Advances in firearm technology and increased accessibility of military grade firearms to civilians has exacerbated the nature of domestic GSW injury and complicated clinical decision-making, as these weapons are associated with increased tissue damage and often result in retained bullets. Currently, there is a lack of literature addressing recent advances in the field of projectile-related trauma, specifically injuries with retained bullets. This review aims to aggregate the available yet dispersed findings regarding ballistics, GSW etiology, and treatment, particularly for cases involving retained projectiles.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"14 ","pages":"293-317"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/18/ff/orr-14-293.PMC9462949.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10642034","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":"Management of Syndesmosis Injury: A Narrative Review.","authors":"Jiayong Liu,&nbsp;Daniel Valentine,&nbsp;Nabil A Ebraheim","doi":"10.2147/ORR.S340533","DOIUrl":"https://doi.org/10.2147/ORR.S340533","url":null,"abstract":"<p><p>The syndesmosis is an important fibrous joint that plays a crucial role in normal ankle weight-bearing and movements. Syndesmosis injuries include disruption of one or more of the ligaments comprising the distal tibiofibular syndesmosis and are commonly associated with ankle fractures. The treatment of grade 1 syndesmosis injury should be conservative, such as immobilization for one to three weeks followed by gradual return to activity. For the treatment of grade 2 syndesmosis injury, if it was stable enough, the patients still could be managed with conservative therapies. But majority of them strongly favor surgical treatment. For the treatment of grade 3 syndesmosis injury, it should treat with surgical reconstruction. If syndesmosis injury is associated with ankle fractures, surgical reduction, fixation, and reconstruction are usually required. Common surgical treatment methods include syndesmosis screws, composed of either metallic or bioabsorbable material; fibula intramedullary nails; and dynamic button-suture fixation, TightRope or ZipTight. Each method has advantages and disadvantages which must be considered while determining which treatment will provide the best outcomes depending on the patient's needs. Continued exploration of new materials, devices, and methods for surgical fixation is necessary for advancement in this field.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"14 ","pages":"471-475"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/61/43/orr-14-471.PMC9749496.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10748699","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":"Radiation in Adolescent Idiopathic Scoliosis Management: Estimated Cumulative Pre-Operative, Intra-Operative, and Post-Operative Exposure.","authors":"Alexander Duke,&nbsp;Richard Marchese,&nbsp;David E Komatsu,&nbsp;James Barsi","doi":"10.2147/ORR.S387369","DOIUrl":"https://doi.org/10.2147/ORR.S387369","url":null,"abstract":"<p><strong>Background: </strong>Adolescent Idiopathic Scoliosis (AIS) is the most common type of scoliosis affecting adolescents, with approximately 2-4% of children being diagnosed. Crucial to the diagnosis and management are radiographic imaging, which allow physicians to assess and treat - from initial visits through surgical planning and post-operative management. While initial stages require low levels of exposure to radiation, via x-rays, as patients progress in disease severity exposure becomes larger with pre-operative, intra-operative and post-operative CT scans. While many studies have evaluated exposure during AIS treatment, few have assessed the cumulative radiation exposure adolescents receive during their evaluation. The purpose of our study is to complete a comprehensive review on cumulative radiation exposure and determine what stages in AIS treatment expose patients to the highest level of radiation over a duration of 2 years.</p><p><strong>Methods: </strong>A retrospective chart review of 109 AIS cases (29M, 80F), mean age 14.9 ± 2.3 years was completed to assess and quantify each imaging modality used. Employing a radiation detector, each imaging modality was then assessed, and estimated radiation exposures were determined. Statistical analysis was completed utilizing averaged patient exposures during each selected period in AIS management.</p><p><strong>Results: </strong>Mean estimated radiation doses (StDev) were 60.94 mrem (±0.609 mrem) for two x-rays (full-length AP and lateral radiograph of the entire spine), 12.92 mrem (±1.292 mrem) for each fluoroscopy exposure, and 1340.60 mrem (±13.406 mrem) per CT scan. Based on these values, estimated subject exposures were calculated. The total estimated radiation exposure over a 2-year period was 5572.74 mrem (±1428.88 merm) or 2786.37 mrem (±714.43 mrem) per year.</p><p><strong>Conclusion: </strong>The two-year cumulative radiation exposure is below the recommended exposure by Nuclear Regulatory Commission and OSHA. As expected, CT exposure presents the largest radiation exposure to patients with AIS throughout their operative management.</p><p><strong>Level of evidence: </strong>III, retrospective study.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"14 ","pages":"487-493"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/77/36/orr-14-487.PMC9809375.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10860569","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":"Lower Back Pain Caused by the Impact of COVID-19 Quarantine on Physical Activity and Daily Sitting Among Adult Saudi Arabian Populations in Jeddah: A Cross-Sectional Study.","authors":"Lutf Ahmed Abumunaser,&nbsp;Kawther Ali Alfaraj,&nbsp;Lujain Khalid Kamal,&nbsp;Renad Abdullah Alzahrani,&nbsp;Maram Misfer Alzahrani,&nbsp;Alzahraa Bader AlAhmed","doi":"10.2147/ORR.S386995","DOIUrl":"https://doi.org/10.2147/ORR.S386995","url":null,"abstract":"<p><strong>Purpose: </strong>During the COVID-19 quarantine period, most outdoor activities and events were banned, resulting in a decrease in physical activity (PA) and prolonged sitting (PS) time, which are significant factors in the development of lower back pain (LBP). The aim of this study was to evaluate the association between physical inactivity and daily sitting time during quarantine with LBP among the Saudi Arabian population.</p><p><strong>Patients and methods: </strong>In this cross-sectional study conducted at King Abdulaziz University Hospital, 288 participants were recruited using an online, self-administered questionnaire in Arabic. It consisted of 21 questions assessing back pain, PA, and daily sitting time before and during quarantine. The main outcome measures included demographics, low back pain levels, daily sitting time, and PA level.</p><p><strong>Results: </strong>The participants consisted of 236 women and 52 men aged 18-65 years. During quarantine, 74% of participants sat most of the time and did not exercise or performed less exercise. Furthermore, almost half of the participants did not engage in PA both before and during the quarantine. There was an increase in the prevalence of LBP, with only 44.8% of participants presenting with LBP before quarantine and 59.4% having it during quarantine. A statistically significant association was found between daily sitting time and LBP (P=0.007) and PA and LBP (P=0.045) during quarantine. However, there was no significant association between age and painkiller use for LBP (P=0.251).</p><p><strong>Conclusion: </strong>Our study highlights the relationship of physical inactivity and PS during quarantine with an increase in the prevalence and intensity of LBP. The limitations of the study include the use of self-reports, a small sample size, and unequal survey distribution. A well-distributed survey with a larger sample size is necessary to obtain an adequate representation of the entire Saudi population.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"14 ","pages":"477-485"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/be/6d/orr-14-477.PMC9759024.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10461857","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":"A New Test for the Advanced Diagnosis of Lateral Elbow Tendinopathy with Concomitant Intrasubstance Tear: Failure to Resist Extension Effort (the Free Test).","authors":"Cristóbal Greene,&nbsp;Guillermo Droppelmann,&nbsp;Nicolás García,&nbsp;Carlos Jorquera,&nbsp;Arturo Verdugo","doi":"10.2147/ORR.S364050","DOIUrl":"https://doi.org/10.2147/ORR.S364050","url":null,"abstract":"<p><strong>Background: </strong>Lateral elbow tendinopathy (LET) is one of the most common causes of musculoskeletal pain. The diagnosis is based on the clinical history and different physical maneuvers. Ultrasound (US) is a complementary diagnostic method to detect degenerative tendon changes and intrasubstance tears (IST). To date, there is no available physical maneuver to identify an IST in patients with LET.</p><p><strong>Aim: </strong>To evaluate the diagnostic accuracy of an index test to detect an IST confirmed by ultrasound in patients with LET.</p><p><strong>Methods: </strong>A diagnostic retrospective study was performed. Patients who presented medical records with LET were recruited. Two orthopaedic surgeons developed the physical maneuver. The index test was considered positive when the position failed to resist the wrist extension maximum effort. Clinical findings were associated with confirmation of IST by US. Data were calculated using diagnostic accuracy, sensitivity, and specificity with 95% confidence intervals.</p><p><strong>Results: </strong>Thirty-nine patients (39 elbows) were analyzed, 25 (64%) women and 14 (36%) men, with an average age of 47.7 years. The index test's sensitivity was 0.86 (95% CI, 0.67-0.96). Accuracy was 0.79 (95% CI, 0.64-0.91), and the specificity was 0.64 (95% CI, 0.31-0.89).</p><p><strong>Conclusion: </strong>The index test presented very good sensitivity and good accuracy in patients with LET with US diagnostic confirmation of IST.</p><p><strong>Level of evidence: </strong>Diagnostic study, Level III.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"14 ","pages":"495-503"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e2/c5/orr-14-495.PMC9809378.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10857051","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":"Improving the Management of Patients with Osteoporosis Undergoing Spinal Fusion: The Need for a Bone Mineral Density-Matched Interbody Cage.","authors":"Steven M Falowski,&nbsp;Sebastian F Koga,&nbsp;Trent Northcutt,&nbsp;Laszlo Garamszegi,&nbsp;Jeremi Leasure,&nbsp;Jon E Block","doi":"10.2147/ORR.S339222","DOIUrl":"https://doi.org/10.2147/ORR.S339222","url":null,"abstract":"<p><p>With an increasingly aging population globally, a confluence has emerged between the rising prevalence of degenerative spinal disease and osteoporosis. Fusion of the anterior spinal column remains the mainstay surgical intervention for many spinal degenerative disorders. However, decreased vertebral bone mineral density (BMD), quantitatively measured by dual x-ray absorptiometry (DXA), complicates treatment with surgical interbody fusion as weak underlying bone stock increases the risk of post-operative implant-related adverse events, including cage subsidence. There is a necessity for developing cages with advanced structural designs that incorporate bioengineering and architectural principles to tailor the interbody fusion device directly to the patient's BMD status. Specifically, lattice-designed cages that mimic the web-like structure of native cancellous bone have demonstrated excellent resistance to post-operative subsidence. This article provides an introductory profile of a spinal interbody implant designed intentionally to simulate the lattice structure of human cancellous bone, with a similar modulus of elasticity, and specialized to match a patient's bone status across the BMD continuum. The implant incorporates an open pore design where the degree of pore compactness directly corresponds to the patient's DXA-defined BMD status, including patients with osteoporosis.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"13 ","pages":"281-288"},"PeriodicalIF":2.0,"publicationDate":"2021-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/f1/orr-13-281.PMC8684416.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39745150","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":"Effectiveness of Kyphosis Reduction Using Cantilever Method in Thoracolumbar Spondylitis Tuberculosis: A Short-Term Follow-Up.","authors":"Didik Librianto,&nbsp;Ismail Hadisoebroto Dilogo,&nbsp;Achmad Fauzi Kamal,&nbsp;Ifran Saleh,&nbsp;Fachrisal Ipang,&nbsp;Dina Aprilya","doi":"10.2147/ORR.S342365","DOIUrl":"https://doi.org/10.2147/ORR.S342365","url":null,"abstract":"<p><strong>Background: </strong>Kyphosis in spondylitis tuberculosis (STb) is more than just a cosmetic issue. It has a potentially detrimental effect on both spine-associated structures and cardiopulmonary function. It can be corrected in any stage of STb; however, the corrective surgery is challenging, especially in the late case, in which the additional stiffness of the spine can come into consideration. To date, the cantilever technique is still a gold standard for sagittal plane deformity correction. However, no study to date has explored its effectiveness for thoracolumbar kyphotic deformity, especially that caused by spondylitis tuberculosis.</p><p><strong>Methods: </strong>This is a retrospective study of 16 consecutive cases of spondylitis tuberculosis with thoracolumbar kyphosis that underwent corrective surgery in our center in the period of 2020-2021. We aim to evaluate the effectiveness of the cantilever technique that we use for kyphotic correction in thoracolumbar STb patients.</p><p><strong>Results: </strong>At the 3-months follow-up, the mean Cobb angle was 14.6°±10.27°, with the mean gain of 20.90°±12.00° and positively correlate with the thoracolumbar kyphosis (TLK) correction (68.69%, r = 0.654, p = 0.001). The mean thoracic kyphosis, lumbar lordosis, and sagittal vertebral axis were 30.6°±13.08°, 39.4°±16.02°, and 1.4±4.09 cm, respectively, with sagittal Cobb difference of 12.70±9.85.</p><p><strong>Conclusion: </strong>The kyphotic Cobb angle reduction by cantilever technique in the thoracolumbar area significantly improved the thoracolumbar kyphosis and realign the spinal sagittal axis. Thus, the cantilever technique remains the gold standard for sagittal plane deformity correction which can be applied for kyphotic deformity correction in thoracolumbar STb cases.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"13 ","pages":"275-280"},"PeriodicalIF":2.0,"publicationDate":"2021-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/2e/orr-13-275.PMC8651210.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39711067","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":"Modified Ponseti Technique in an Eleven-Year-Old with Bilateral Untreated Clubfoot: A Case Report.","authors":"Maria Wong,&nbsp;Mazelan Ali,&nbsp;Aik Saw","doi":"10.2147/ORR.S342738","DOIUrl":"https://doi.org/10.2147/ORR.S342738","url":null,"abstract":"<p><p>We report the case of an eleven-year-old girl with untreated bilateral clubfoot. She had a total of nine long leg castings changed weekly, Achilles tendon Z-lengthening and posterior ankle release followed by another six weeks of long leg cast immobilization post-operatively. We encouraged using night-time foot abduction brace for twelve months. Independent walking was achieved six months post-treatment. No recurrence was noted at eighteen months following treatment. The modified Ponseti weekly casting method was successful up to adolescent age; however, more cast changes, longer stretching before each cast application and posterior ankle release will be needed to achieve functional correction.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"13 ","pages":"247-254"},"PeriodicalIF":2.0,"publicationDate":"2021-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/16/orr-13-247.PMC8648273.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39703837","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}