Orthopedics最新文献_第4页

Clinical and Radiographic Outcomes With Minimum 2-Year Follow-up and Sub-Analysis of Navigation vs Non-Navigation for Hip Resurfacing. 髋关节置换术至少 2 年随访的临床和放射学结果，以及导航与非导航的子分析。

IF 1.1 4区医学

Orthopedics Pub Date : 2024-10-21 DOI: 10.3928/01477447-20241016-02

Roger Quesada-Jimenez, Ady H Kahana-Rojkind, Elizabeth G Walsh, Tyler R McCarroll, Mark F Schinsky, Benjamin G Domb

{"title":"Clinical and Radiographic Outcomes With Minimum 2-Year Follow-up and Sub-Analysis of Navigation vs Non-Navigation for Hip Resurfacing.","authors":"Roger Quesada-Jimenez, Ady H Kahana-Rojkind, Elizabeth G Walsh, Tyler R McCarroll, Mark F Schinsky, Benjamin G Domb","doi":"10.3928/01477447-20241016-02","DOIUrl":"10.3928/01477447-20241016-02","url":null,"abstract":"Background: The purpose of this study was to report the short-term clinical outcomes of hip resurfacing with navigation and the impact on accuracy of acetabular implant placement in both the frontal and sagittal planes.Materials and methods: Data were retrospectively analyzed for patients who received hip resurfacing between 2010 and 2021. Eligible patients had postoperative radiographs and completed a minimum 2-year follow-up questionnaire for the following patient-reported outcomes: modified Harris Hip Score (mHHS), Harris Hip Score (HHS), Forgotten Joint Score (FJS), visual analog scale (VAS) score, satisfaction, and Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR). Hips were propensity matched in a 1:1 ratio based on the use of navigation, age, and body mass index. The percentage of hips that met the minimal clinically important difference (MCID) for mHHS and VAS score was noted. Component placement analysis was conducted based on the safe zones defined by Lewinnek and Callanan and the Relative Acetabular Inclination Limit.Results: Seventy-six hips were matched, 38 per group. No differences were observed in patient-reported outcomes or the percentage of hips reaching MCID between the groups. The navigation group was 28.8 and 6.8 times more likely to be within the Callanan and Lewinnek safe zones, respectively. Based on the Relative Acetabular Inclination Limit, the navigation group was 3.1 and 6.4 times more likely to be within the 95% and 99% CI safe zones, respectively.Conclusion: Comparable improvements in patient-reported outcomes were observed in the two groups during a minimum 2-year follow-up. Navigation-assisted surgery enhances the accuracy of acetabular component positioning, with a higher likelihood of cup placement within the safe zones. [Orthopedics. 202x;4x(x):xx-xx.].","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"1-6"},"PeriodicalIF":1.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471752","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}

引用次数: 0

IF 1.1 4区医学

Orthopedics Pub Date : 2024-10-21 DOI: 10.3928/01477447-20241016-03

Guang Hua Li, Zenya Ito, Motohide Shibayama, Shu Nakamura, LiGuo Zhu, Fujio Ito

{"title":"Age-Related Association Between Unilateral Single-Channel and Double-Channel Surgery and Postoperative Multifidus Muscle Atrophy and Fat Infiltration.","authors":"Guang Hua Li, Zenya Ito, Motohide Shibayama, Shu Nakamura, LiGuo Zhu, Fujio Ito","doi":"10.3928/01477447-20241016-03","DOIUrl":"10.3928/01477447-20241016-03","url":null,"abstract":"Background: Unilateral biportal endoscopic laminotomy (UBE) and percutaneous endoscopic laminotomy (PEL) are minimally invasive spinal surgery (MISS) techniques used for unilateral and dual-channel endoscopic laminectomy. However, limited research has been conducted on lumbosacral multifidus muscle injuries in elderly individuals undergoing MISS for lumbar spinal canal stenosis. The objective of this study was to investigate the impact of single-channel and double-channel MISS on the multifidus muscle in elderly patients.Materials and methods: A total of 107 patients who underwent MISS were stratified into two cohorts: group A (<65 years) and group B (≥65 years). Preoperative imaging data, including magnetic resonance imaging, were gathered to classify the degree of stenosis based on the nerve root compression. The extent of multifidus muscle atrophy and fat infiltration was assessed by calculating the fat-free cross-sectional area (FCSA)/cross-sectional area (CSA) ratio before and after surgery through measurements of CSA and FCSA. Total cross-sectional area/FCSA were calculated using MRI cross-sectional T2WI.Results: The degree of atrophy and fat infiltration did not change between procedures in group A (P>.05), but changed significantly in group B (P<.05).Conclusion: Unilateral single-channel and double-channel surgery had no significant effect on the degree of multifidus muscle atrophy and fat infiltration in patients younger than 65 years. However, in patients 65 years and older, the degree of multifidus muscle atrophy and fat infiltration significantly increased with the increasing incidence of lateral recess stenosis, which was positively correlated with the duration of surgery. [Orthopedics. 202x;4x(x):xx-xx.].","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"1-8"},"PeriodicalIF":1.1,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471750","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}

引用次数: 0

The Minimum Patient Acceptable Symptom State for the ACL-Return to Sport after Injury Scale Among Patients Treated With Anterior Cruciate Ligament Reconstruction. 前交叉韧带损伤后恢复运动量表中患者可接受的最低症状状态。

IF 1.1 4区医学

Orthopedics Pub Date : 2024-09-23 DOI: 10.3928/01477447-20240918-04

Tim Dwyer, Prabjit Ajrawat, Darius Luke Lameire, Marcel Betsch, Daniel Whelan, Shahram Shahrokhi, John Theodoropoulos, Graeme Hoit, Jaskarndip Chahal

{"title":"The Minimum Patient Acceptable Symptom State for the ACL-Return to Sport after Injury Scale Among Patients Treated With Anterior Cruciate Ligament Reconstruction.","authors":"Tim Dwyer, Prabjit Ajrawat, Darius Luke Lameire, Marcel Betsch, Daniel Whelan, Shahram Shahrokhi, John Theodoropoulos, Graeme Hoit, Jaskarndip Chahal","doi":"10.3928/01477447-20240918-04","DOIUrl":"https://doi.org/10.3928/01477447-20240918-04","url":null,"abstract":"Background: Despite most patients reporting optimal knee function after anterior cruciate ligament reconstruction (ACLR), not all return to their pre-injury level of sport, often due to psychological factors. The ACL-Return to Sport after Injury Scale (ACL-RSI) was developed to measure the emotions, confidence in performance, and risk appraisal among athletes returning to sport. The purpose of this study was to determine the Patient Acceptable Symptom State (PASS) threshold for the ACL-RSI in patients undergoing ACLR.Materials and methods: Patients with an ACL injury that required surgical reconstruction were included in this prospective study. All patients underwent ACLR with a bone-patellar tendon-bone autograft and completed the ACL-RSI 12 months postoperatively. An anchor-based approach was used to generate a receiver operating characteristic curve and establish the PASS threshold. Multivariable regression analyses were used to evaluate the effect of age, sex, and baseline score on likelihood of achieving PASS.Results: A total of 113 patients (37% female) with a mean age of 28.1±8.2 years and a mean body mass index of 24.7±3.5 kg/m2 were included. At 12 months postoperatively, the threshold value for the PASS of the ACL-RSI was 40 (robust area under the curve: 0.89; sensitivity: 81%; specificity: 85%). Baseline score, sex, and age had no significant influence on achieving PASS at 12 months postoperatively.Conclusion: In a group of patients undergoing ACLR with bone-patellar tendon-bone autograft, the PASS threshold value was 40 for the ACL-RSI at 12 months postoperatively. The PASS value for the ACL-RSI established from this study can be useful for designing future clinical trials. [Orthopedics. 202x;4x(x):xx-xx.].","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"1-5"},"PeriodicalIF":1.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308262","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}

引用次数: 0

Peer-Reviewed Publications by Successfully Matched Orthopedic Surgery Residency Applicants in the 2022-2023 Match. 2022-2023 年配对成功的骨科住院医师申请人发表的同行评审论文。

IF 1.1 4区医学

Orthopedics Pub Date : 2024-09-19 DOI: 10.3928/01477447-20240913-01

Joseph Brenner,Braden Womack,Maverick Delp,David Yatsonsky,Maged Hanna,Christopher Sanford

{"title":"Peer-Reviewed Publications by Successfully Matched Orthopedic Surgery Residency Applicants in the 2022-2023 Match.","authors":"Joseph Brenner,Braden Womack,Maverick Delp,David Yatsonsky,Maged Hanna,Christopher Sanford","doi":"10.3928/01477447-20240913-01","DOIUrl":"https://doi.org/10.3928/01477447-20240913-01","url":null,"abstract":"BACKGROUNDThe Orthopaedic Surgery Match is highly competitive, with more applicants than residency spots. With the Step 1 Exam moving to a pass/fail result, residency programs and applicants have fewer objective data to determine applicants' relative competitiveness. Through this study, we sought to provide the mean number of accepted publications on PubMed a successfully matched orthopedic surgery applicant has by the time of submission of their application.MATERIALS AND METHODSOrthopedic surgery residency programs participating in the National Resident Matching Program were identified by their ranking on the Doximity Residency Navigator. Each program's intern class and their medical schools were identified. Their names were searched in PubMed and Scopus and articles with their name and affiliations were recorded.RESULTSIn total, 877 orthopedic surgery interns published a mean of 3.30±5.27 articles each on PubMed. They were first or second author on 1.44±2.58, and 1.96±3.89 publications were related to orthopedic surgery. There were no statistical differences between degree, sex, or residency program rank from the Doximity Residency Navigator. The mean number of publications from a successful applicant was approximately 3. There was a great range in the number of publications, and 27.3% of successful applicants did not have a single publication.CONCLUSIONFuture applicants and programs can use this number to gauge relative research output. [Orthopedics. 202x;4x(x):xx-xx.].","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"8 1","pages":"1-4"},"PeriodicalIF":1.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253052","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}

引用次数: 0

Ranking the Orthopedic Procedures With the Highest Morbidity and Mortality. 对发病率和死亡率最高的骨科手术进行排名。

IF 1.1 4区医学

Orthopedics Pub Date : 2024-09-19 DOI: 10.3928/01477447-20240913-02

Brady S Ernst,Nicholas R Kiritsis,Phillip B Wyatt,Charles R Reiter,Conor N O'Neill,James R Satalich,Alexander R Vap

{"title":"Ranking the Orthopedic Procedures With the Highest Morbidity and Mortality.","authors":"Brady S Ernst,Nicholas R Kiritsis,Phillip B Wyatt,Charles R Reiter,Conor N O'Neill,James R Satalich,Alexander R Vap","doi":"10.3928/01477447-20240913-02","DOIUrl":"https://doi.org/10.3928/01477447-20240913-02","url":null,"abstract":"BACKGROUNDMusculoskeletal conditions currently affect more than one-third of the US population and orthopedic procedures play a pivotal role in managing them. Like any invasive intervention, these carry a wide spectrum of risk, necessitating a comprehensive understanding of the associated morbidity and mortality. This study sought to provide a global perspective of the risks and complications associated with these procedures to establish an easy to understand risk stratification tool for both patients and providers.MATERIALS AND METHODSCurrent Procedural Terminology codes associated with orthopedic surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2018 to 2020. Each code was associated with its rate of 30-day mortality as well as any adverse event (AAE) and then ranked for descriptive analysis.RESULTSIn total, there were 698,549 patients who underwent orthopedic procedures associated with 94 CPT codes with at least 1 morbidity event and 144 CPT codes with at least 1 AAE. The CPT code associated with the highest mortality was 27590 or above knee amputation. The CPT code associated with the highest rate of AAE was 27507 or open treatment of femoral shaft fracture with plate and screws.CONCLUSIONThis is the first study to compare the rates of morbidity and mortality in all patients with orthopedic procedures. There was a strong bias toward increased risk associated with lower extremity surgery and surgery most often performed in the geriatric population. [Orthopedics. 202x;4x(x):xx-xx.].","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"31 1","pages":"1-5"},"PeriodicalIF":1.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253058","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}

引用次数: 0

Treatment of Kienböck's Disease Using Fourth and Fifth Extensor Compartmental Artery Vascularized Bone Grafts. 使用第四和第五伸肌室动脉血管化骨移植治疗基恩博克病

IF 1.1 4区医学

Orthopedics Pub Date : 2024-09-19 DOI: 10.3928/01477447-20240913-03

Byung Sung Kim,Joo Young Cha,Jaehyun Kim,Ki Jin Jung,Jae-Hwi Nho

{"title":"Treatment of Kienböck's Disease Using Fourth and Fifth Extensor Compartmental Artery Vascularized Bone Grafts.","authors":"Byung Sung Kim,Joo Young Cha,Jaehyun Kim,Ki Jin Jung,Jae-Hwi Nho","doi":"10.3928/01477447-20240913-03","DOIUrl":"https://doi.org/10.3928/01477447-20240913-03","url":null,"abstract":"BACKGROUNDThis study evaluated the radiological and clinical outcomes of bone grafts using fourth and fifth extensor compartmental arteries (4+5 ECAs) for the treatment of Kienböck's disease.MATERIALS AND METHODSIn total, 21 patients (12 men and 9 women; mean age, 41 years; range, 19-59 years) were followed for a mean of 33 months. Radiological images were analyzed for the Lichtman stage, carpal height ratio, radioscaphoid angle, and Stahl's index. Clinical evaluation included range of motion, visual analog scale (VAS) score, grip strength, modified Mayo wrist score (MMWS), Lichtman outcome score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. At the time of surgery, 6, 14, and 1 patients had Lichtman stages II, IIIA, and IIIB, respectively.RESULTSAt the final follow-up visit, grip strength had improved from 65.4% to 79.7%, wrist extension had improved from 43° to 57°, and flexion had improved from 42° to 50°. There were no significant changes in the carpal height ratio, Stahl's index, or radioscaphoid angle. The mean VAS score was 1.7, and the mean DASH score was 6.9. The mean MMWS was 87.9, with excellent and good outcomes in 6 and 11 patients, respectively. Satisfactory Lichtman outcome scores were observed in 81%. Body mass index had a strong correlation and age had a weak correlation with MMWS (coefficient=-0.534, P=.013, and coefficient=-0.393, P=.078, respectively).CONCLUSIONThe 4+5 ECA bone graft is effective for the treatment of Kienböck's disease in young patients with low body mass index. [Orthopedics. 202x;4x(x)xx-xx.].","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"15 1","pages":"1-5"},"PeriodicalIF":1.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253023","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}

引用次数: 0

Antiphospholipid Syndrome Increases Postoperative Complications After Total Hip and Knee Arthroplasty. 抗磷脂综合征会增加全髋关节和膝关节置换术后并发症。

IF 1.1 4区医学

Orthopedics Pub Date : 2024-09-01 Epub Date: 2024-06-27 DOI: 10.3928/01477447-20240619-03

Ankit Hirpara, Melissa Carpenter, Michael Dayton, Craig Hogan

{"title":"Antiphospholipid Syndrome Increases Postoperative Complications After Total Hip and Knee Arthroplasty.","authors":"Ankit Hirpara, Melissa Carpenter, Michael Dayton, Craig Hogan","doi":"10.3928/01477447-20240619-03","DOIUrl":"10.3928/01477447-20240619-03","url":null,"abstract":"Background: Antiphospholipid syndrome (APS) is a systemic autoimmune condition that predisposes patients to venous thromboembolism (VTE). Although many studies have explored risk factors for VTE after joint reconstructive procedures, the impact of APS is still unclear.Materials and methods: A retrospective cohort study was conducted using TriNetX, a health care database that includes 442,494 patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Ninety-day postoperative complications and 1- and 2-year surgical complications were compared between patients with and without preexisting APS. Patients underwent propensity score matching in a 1:1 ratio based on relevant comorbidities.Results: Patients undergoing THA or TKA with APS, compared with those without, had higher rates of deep venous thrombosis (hip: 9.2% vs 6.0%, odds ratio, 1.589, P=.022; knee: 10.5% vs 4.1%, odds ratio, 2.763, P<.001), pulmonary embolism (hip: 6.9% vs 3.6%, odds ratio, 1.992, P=.005; knee: 8.4% vs 3.0%, odds ratio, 2.989, P<.001), and anemia (hip: 24.8% vs 18.6%, odds ratio, 1.447, P=.004; knee: 18.5% vs 13.9%, odds ratio, 1.406, P=.007). Patients undergoing THA with APS also had higher rates of urinary tract infection (5.0% vs 2.8%, odds ratio, 1.842, P=.029) and pneumonia (3.7% vs 1.8%, odds ratio, 2.119, P=.025). APS did not impact rates of surgical complications or revision surgery.Conclusion: Overall, APS heightens patients' risk for complications after THA and TKA. Specific anticoagulation protocols and preoperative risk stratification should be implemented to reduce the risk of adverse events. [Orthopedics. 2024;47(5):301-307.].","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"301-307"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469871","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}

引用次数: 0

Opioid Use After Robotic-Assisted Versus Conventional Total Hip Arthroplasty: A National Database Analysis. 机器人辅助与传统全髋关节置换术后阿片类药物的使用：全国数据库分析。

IF 1.1 4区医学

Orthopedics Pub Date : 2024-09-01 Epub Date: 2024-07-08 DOI: 10.3928/01477447-20240702-03

Thompson Zhuang, Bill Young, Jessica Hooper, Derek F Amanatullah, Lauren Shapiro, Robin N Kamal

{"title":"Opioid Use After Robotic-Assisted Versus Conventional Total Hip Arthroplasty: A National Database Analysis.","authors":"Thompson Zhuang, Bill Young, Jessica Hooper, Derek F Amanatullah, Lauren Shapiro, Robin N Kamal","doi":"10.3928/01477447-20240702-03","DOIUrl":"10.3928/01477447-20240702-03","url":null,"abstract":"Background: In this study, we tested the null hypothesis that robotic-assisted total hip arthroplasty (THA) vs conventional THA was not associated with (1) the amount of postoperative opioid use and (2) the incidence of new, persistent opioid use.Materials and methods: We used a large, national administrative database to identify patients 50 years and older undergoing primary robotic or conventional THA. Patients with hip fractures or a history of malignancy, hip infection, or opioid use disorder were excluded. Patients who filled an opioid prescription within 1 year to 30 days preoperatively or who underwent a subsequent procedure within 1 year after THA were excluded. Outcomes included the morphine milligram equivalents (MMEs) filled within the THA perioperative period and the incidence of new, persistent opioid use. Multivariable logistic regression models were used to evaluate associations between robotic-assisted THA and new, persistent opioid use, adjusting for age, sex, insurance plan, region, location of surgery, and comorbidities.Results: In the postoperative period, robotic-assisted THA, compared with conventional THA, was associated with a lower mean total MMEs filled per patient (452.2 vs 517.1; P<.001) and a lower mean MMEs per patient per day (71.53 vs 74.64; P<.001). Patients undergoing robotic-assisted THA had decreased odds of developing new, persistent opioid use compared with patients undergoing conventional THA (adjusted odds ratio, 0.82 [95% CI, 0.74-0.90]).Conclusion: Robotic-assisted THA is associated with lower postoperative opioid use and a decreased odds of developing new, persistent opioid use compared with conventional THA. For the purposes of reducing opioid use, our results support the adoption of robotic-assisted THA. [Orthopedics. 2024;47(5):289-294.].","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"289-294"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559441","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}

引用次数: 0

Preventing Iatrogenic Fibula Fractures Using the Push-Pull Technique: A Biomechanical Comparison of Unicortical Versus Bicortical Post Screws. 使用推拉技术预防先天性腓骨骨折：单皮质后螺钉与双皮质后螺钉的生物力学比较。

IF 1.1 4区医学

Orthopedics Pub Date : 2024-09-01 Epub Date: 2024-07-08 DOI: 10.3928/01477447-20240702-02

Sheldon A McCown, Paul J Weatherby, Randal P Morris, Vinod K Panchbhavi, John C Hagedorn, William M Weiss, Jie Chen

{"title":"Preventing Iatrogenic Fibula Fractures Using the Push-Pull Technique: A Biomechanical Comparison of Unicortical Versus Bicortical Post Screws.","authors":"Sheldon A McCown, Paul J Weatherby, Randal P Morris, Vinod K Panchbhavi, John C Hagedorn, William M Weiss, Jie Chen","doi":"10.3928/01477447-20240702-02","DOIUrl":"10.3928/01477447-20240702-02","url":null,"abstract":"Background: Displaced diaphyseal fractures can be reduced using the push-pull technique, wherein a plate is affixed to the distal fragment of the fracture, a post screw is placed proximal to the plate, and a lamina spreader creates distraction. This study evaluated the load to failure and mechanism of failure of bicortical and unicortical post screws during reduction.Materials and methods: Four matched pairs of cadaver legs were subjected to a 2-cm oblique osteotomy simulating a displaced, oblique diaphyseal fracture. A 6-hole compression plate was affixed to the distal fragment with 2 unicortical locking screws, and a 12-mm unicortical or 20-mm bicortical screw was inserted as a post screw proximal to the plate. A lamina bone spreader was used to exert a distraction force between the plate and the post screw. A mechanical actuator simulated the distraction procedure until failure. Maximum applied load, displacement, and absorbed energy were recorded and compared across unicortical and bicortical groups by paired t tests.Results: At maximum load, we found statistically significant differences in displacement (P=.003) and energy absorbed (P=.022) between the two groups. All unicortical screws failed through screw toggle and bone cut-out. Bicortical screws failed through bending, with no visible damage to the bone at the screw site.Conclusion: When diaphyseal fractures are significantly shortened and require a greater distraction force to achieve reduction, bicortical screws demonstrate a higher mechanical load to failure and increased bone loss from the screw-removal site. A unicortical post screw may be used if minimal distraction is needed. [Orthopedics. 2024;47(5):308-312.].","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"308-312"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559442","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}

引用次数: 0

Tranexamic Acid Reduces the Amount of Blood Transfused in Revision Total Hip Arthroplasty for Vancouver B2/B3 Periprosthetic Femur Fractures. 氨甲环酸可减少温哥华B2/B3假体股骨骨折翻修全髋关节置换术的输血量。

IF 1.1 4区医学

Orthopedics Pub Date : 2024-09-01 Epub Date: 2024-07-29 DOI: 10.3928/01477447-20240718-05

John Patrick Connors, Robert James Magaldi, Sara Elaine Strecker, Robert James Carangelo, Dan Witmer

{"title":"Tranexamic Acid Reduces the Amount of Blood Transfused in Revision Total Hip Arthroplasty for Vancouver B2/B3 Periprosthetic Femur Fractures.","authors":"John Patrick Connors, Robert James Magaldi, Sara Elaine Strecker, Robert James Carangelo, Dan Witmer","doi":"10.3928/01477447-20240718-05","DOIUrl":"10.3928/01477447-20240718-05","url":null,"abstract":"Background: Periprosthetic fractures around total hip arthroplasty (THA) represent a significant source of morbidity and mortality. The use of tranexamic acid (TXA) in arthroplasty is well described, yet little literature supports its role in periprosthetic femur fractures (PFFs). This study investigated the effect of preoperative TXA administration on transfusion rate and volume, length of stay, and 90-day complication rates in patients undergoing revision THA for PFF.Materials and methods: All patients undergoing revision THA for PFF (Vancouver B2/B3) at our institution from August 2016 to June 2022 were identified. Routine TXA administration at surgical start was introduced in 2018. Patient demographics, operative time, blood product use, length of stay, and 90-day complications were collected. Patients were divided into those who received TXA preoperatively and those who did not.Results: A total of 56 patients were included. There was no difference in age, sex, anesthetic type, fracture classification, or preoperative blood values between cohorts. TXA significantly lowered the amount of blood product required (2.3 units vs 3.2 units, P=.023). Preoperative TXA did not independently reduce length of stay; however, blood transfusion was associated with increased length of stay (7 days vs 4.7 days, P=.003). There were no differences in 90-day complications.Conclusion: Among patients who underwent revision THA for Vancouver B2/B3 PFF, TXA did not affect transfusion rates but did result in the use of fewer blood products without an increase in complications. We support routine use of TXA in this patient population. Future studies should assess earlier administration of TXA in the emergency department or once patients' conditions have been medically optimized. [Orthopedics. 2024;47(5):e261-e267.].","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e261-e267"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788759","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}

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