Orthopedics最新文献

{"title":"Outcomes and Risks Associated With Subsequent Contralateral Hip Fractures.","authors":"Paige N Chapman, Gregory M Georgiadis, Sara Seegert, Benjamin Russell, Kristin O'Mara-Gardner, Jeffrey M Bair, Jason C Tank","doi":"10.3928/01477447-20240520-05","DOIUrl":"10.3928/01477447-20240520-05","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures constitute a major public health problem for older individuals. They are associated with functional deterioration, limited mobility, and increased mortality, while contributing to economic and social hardships that are compounded by a second hip fracture. With the aging US population and increasing rates of hip fractures, it is essential to understand factors surrounding subsequent contralateral hip fractures.</p><p><strong>Materials and methods: </strong>This descriptive study was a retrospective review of patients 60 years and older who were identified in the institutional geriatric hip fracture database as having had an initial and subsequent contralateral hip fracture, with the second treated at our tertiary referral center.</p><p><strong>Results: </strong>The incidence of subsequent hip fracture was 13.2%. The mean time to second hip fracture was 3.5 years after the initial injury. The first fracture tended to be a femoral neck fracture, whereas the second injury was more likely to have an intertrochanteric pattern. There was a higher complication rate after a subsequent hip fracture. Patients taking osteoporosis and adjuvant medication prior to admission for the second fracture tended to have a lower 90-day mortality rate. Patients with a history of any fracture prior to the first hip fracture, with cancer, and with osteopenia had shorter intervals to the subsequent event.</p><p><strong>Conclusion: </strong>Subsequent hip fractures carry high morbidity and mortality rates. Steps should be taken after the initial injury to optimize outcomes in the case of a subsequent event. Patients discharged after initial hip fracture should be maintained with osteoporosis medication. [<i>Orthopedics</i>. 2024;47(5):264-269.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"264-269"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176067","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":"Re-revision Extensor Mechanism Reconstruction Because of Nonunion and Tendon Failure After Total Knee Arthroplasty.","authors":"Brandi Krieg, Michael Dayton, Nicholas Alfonso","doi":"10.3928/01477447-20240809-14","DOIUrl":"10.3928/01477447-20240809-14","url":null,"abstract":"<p><p>Extensor mechanism (EM) disruption after total knee arthroplasty (TKA) is devastating, especially in cases of re-rupture. A 67-year-old man with diabetes had patellar tendon rupture after revision TKA and then had migration of the bone block after Achilles tendon allograft with bone block (ATBB) augmentation with cerclage. A third reconstruction was performed with open reduction and internal fixation and high-strength braided suture augmentation. Five months postoperatively, the patient had regained full range of motion with intact EM and hardware. The risk of re-rupture is high in ATBB, and the primary issues in this case were nonunion and tendinous compromise. A construct that encompasses compression and buttressing of the bone block with tendon augmentation potentially addresses the risks of recurrent EM rupture in more complex cases. [<i>Orthopedics.</i> 2024;47(5):e273-e276.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e273-e276"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009112","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":"Therapeutic Interventions for Prevention of Musculoskeletal Pain Among Orthopedic Surgeons.","authors":"Chenée Armando, Morgan Voulo, Dean Plafcan, Paul Herickhoff","doi":"10.3928/01477447-20240609-02","DOIUrl":"https://doi.org/10.3928/01477447-20240609-02","url":null,"abstract":"<p><p>Orthopedic surgery is a physically demanding specialty. The factors contributing to musculoskeletal injury among surgeons often stem from positioning the patient, using non-ergonomic instruments, maintaining static postures, and performing repetitive movements. This article focuses on exercise techniques intended to combat the most common problematic static postures held during procedures. Each exercise explained in this article is organized into \"preop,\" \"intraop,\" and \"postop\" components. Preop includes strengthening movements, intraop provides postural recommendations, and postop focuses on mobilization and recovery. This article aims for efficient body conditioning, targeting the muscular posterior chain and supporting elements. [<i>Orthopedics</i>. 2024;47(4):e214-e216.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"47 4","pages":"e214-e216"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748822","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":"<i>Cutibacterium acnes</i> Infection as a Cause of Nonunion After Ulnar-Shortening Osteotomy.","authors":"Logan M Hansen, Alex C Lindahl, Erik B Eller, Charles S Day","doi":"10.3928/01477447-20240609-01","DOIUrl":"10.3928/01477447-20240609-01","url":null,"abstract":"<p><p>Ulnar-shortening osteotomy is a reliable solution to treat ulnar impaction syndrome, but it has a significant rate of nonunion as a known complication. Generally nonunion after the procedure is attributed to noninfectious causes. When infections happen, they follow the microbiological trends of nonunions elsewhere in the body. We present a case of ulnar-shortening osteotomy using an oblique-cut osteotomy system that resulted in septic nonunion. At the time of revision surgery, <i>Cutibacterium acnes</i> and <i>Staphylococcus hominis</i> were isolated from the osteotomy site. The patient was successfully treated using intravenous antibiotics and the two-stage Masquelet technique and eventually went on to bony union. As <i>C acnes</i> is rarely encountered in this context, this report highlights the need to consider all possible pathogens in the workup of a potentially septic nonunion. Surgeons should consider bacteria such as <i>C acnes</i> that require prolonged incubation for isolation from cultures, which may not be part of many institutions' usual protocol. [<i>Orthopedics</i>. 2024;47(4):e211-e213.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"47 4","pages":"e211-e213"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748821","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":"The Morbidity of Greater Trochanteric Pain Syndrome Versus That of Patients Awaiting Total Hip Replacement.","authors":"Sonia Wadekar, John M Gaddis, Emily Middleton, Yin Xi, Ed Mulligan, Ryan Bialaszewski, Bretton Laboret, Joel Wells","doi":"10.3928/01477447-20240520-03","DOIUrl":"10.3928/01477447-20240520-03","url":null,"abstract":"<p><strong>Background: </strong>Greater trochanteric pain syndrome (GTPS) is a commonly diagnosed medical issue, yet there are little data assessing the relative morbidity of GTPS. We sought to characterize the morbidity on presentation of GTPS and compare it to that of patients with end-stage hip osteoarthritis awaiting total hip arthroplasty. We hypothesized that patients with GTPS would have morbidity similar to or worse than that of patients with osteoarthritis.</p><p><strong>Materials and methods: </strong>This retrospective case-control study examined patient-reported outcome measures of 156 patients with GTPS (193 hips) and 300 patients with hip osteoarthritis before total hip arthroplasty (326 hips). Patients with secondary hip conditions or previous hip surgeries were excluded from the study. Patient-reported outcome measures were analyzed using an equivalence test and two one-sided <i>t</i> tests.</p><p><strong>Results: </strong>Equivalence in mean visual analog scale pain scores between GTPS and osteoarthritis was established with a tolerance margin of ±10. The difference in mean visual analog scale pain scores was 0.35 (95% CI, -0.86 to 0.16; <i>P</i>=.02). The Hip disability and Osteoarthritis Outcome Score Quality of Life was much worse for patients with GTPS, placed well outside of the ±10 tolerance margin, and the difference in mean scores was 1.72 (95% Cl, -2.17 to -1.26; <i>P</i>=.99). Equivalence in mean UCLA Activity scores between GTPS and osteoarthritis was established with a tolerance margin of ±5. The difference in mean UCLA Activity scores was 0.002 (95% CI, -0.45 to 0.43; <i>P</i><.01).</p><p><strong>Conclusion: </strong>The morbidity and functional limitations of patients with GTPS were similar to those of patients undergoing total hip arthroplasty. GTPS remains a functional problem for patients, and clinicians and researchers should consider GTPS as seriously as hip osteoarthritis. [<i>Orthopedics</i>. 2024;47(4):205-210.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"205-210"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176120","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":"Pain Self-Efficacy Can Improve During a Visit With an Orthopedic Surgeon.","authors":"Jacie L Lemos, Giselle I Gomez, Pariswi Tewari, Derek F Amanatullah, Loretta Chou, Michael J Gardner, Serena Hu, Marc Safran, Robin N Kamal","doi":"10.3928/01477447-20240605-01","DOIUrl":"10.3928/01477447-20240605-01","url":null,"abstract":"<p><strong>Background: </strong>Greater pain self-efficacy (PSE) is associated with reduced pain, fewer limitations, and increased quality of life after treatment for orthopedic conditions. The aims of this study were to (1) assess if PSE improves during a visit with an orthopedic surgeon and (2) identify modifiable visit factors that are associated with an increase in PSE.</p><p><strong>Materials and methods: </strong>We performed a prospective observational study of orthopedic clinic visits at a multispecialty clinic from February to May 2022. New patients who presented to one of six orthopedic surgeons were approached for the study. Patients who provided consent completed a pre-visit questionnaire including the Pain Self-Efficacy Questionnaire (PSEQ) and demographic questions. A trained research member recorded the five-item Observing Patient Involvement in Decision Making Instrument (OPTION-5) score, number of questions asked, and visit duration. Immediately after the visit, patients completed a post-visit questionnaire consisting of the PSEQ and Perceived Involvement in Care Scale (PICS).</p><p><strong>Results: </strong>Of 132 patients enrolled, 61 (46%) had improved PSE after the orthopedic visit, with 38 (29%) having improvement above a clinically significant threshold. There were no significant differences between patients with increased PSE and those without increased PSE when comparing the PICS, OPTION-5, questions asked, or visit duration.</p><p><strong>Conclusion: </strong>Almost half of the patients had improvement in PSE during an orthopedic visit. The causal pathway to how to improve PSE and the durability of the improved PSE have implications in strategies to improve patient outcomes in orthopedic surgery, such as communication methods and shared decision-making. Future research can focus on studying different interventions that facilitate improving PSE. [<i>Orthopedics</i>. 2024;47(4):e197-e203.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e197-e203"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306521","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":"Evaluation of the Safety of Uninterrupted Warfarin Anticoagulation With Tranexamic Acid in Total Joint Arthroplasty.","authors":"Michael G Johnston, Matthew A Porter, Kade E Eppich, Celeste G Gray, David F Scott","doi":"10.3928/01477447-20240304-04","DOIUrl":"10.3928/01477447-20240304-04","url":null,"abstract":"<p><strong>Background: </strong>The continuation of long-term warfarin therapy is gaining acceptance in minor surgeries but maintaining therapeutic international normalized ratio (INR) values among patients during major orthopedic procedures raises concern. While bridging therapy with low-molecular-weight heparin is currently recommended for patients receiving anticoagulation, few studies have evaluated the safety of continuing warfarin during total joint arthroplasty. This study evaluated the safety and efficacy of continuous warfarin anticoagulation through total joint arthroplasty with and without prophylactic tranexamic acid (TXA).</p><p><strong>Materials and methods: </strong>We conducted a retrospective, matched-pair analysis of two experimental groups of patients who underwent primary total hip arthroplasty or total knee arthroplasty performed by a single surgeon. Our first experimental group, warfarin plus TXA (warfarin+TXA), consisted of 21 patients who underwent arthroplasty while receiving therapeutic anticoagulation with warfarin (INR, 2.0-3.0) and who received prophylactic TXA. Our second experimental group, warfarin without TXA (warfarin-TXA), consisted of 40 patients who underwent arthroplasty while receiving therapeutic anticoagulation with warfarin (INR, 2.0-3.0) without prophylactic TXA.</p><p><strong>Results: </strong>The percent change in hemoglobin value after surgery, red blood cells transfused, surgical site infections, bleeding complications, and thrombotic complications were similar between both experimental and control groups. When comparing the historical group with the warfarin+TXA group, the addition of TXA resulted in a statistical decrease in mean red blood cells transfused and estimated blood loss, with no statistically significant increase in complications.</p><p><strong>Conclusion: </strong>Many factors must be considered when choosing perioperative thromboembolic prophylaxis for arthroplasty candidates with medical comorbidities requiring long-term anticoagulation. This study presents data indicating that it could be safe and effective to continue therapeutic warfarin while using prophylactic TXA. [<i>Orthopedics</i>. 2024;47(4):211-216.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"211-216"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102089","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":"Risk Factors for the Development of Arthrofibrosis After Anterior Cruciate Ligament Reconstruction in Children and Adolescents.","authors":"Jordan Murphy, Caleb LaVigne, Alec Rush, Albert Pendleton","doi":"10.3928/01477447-20240520-04","DOIUrl":"10.3928/01477447-20240520-04","url":null,"abstract":"<p><strong>Background: </strong>Arthrofibrosis is a fibrotic joint disorder resulting in restricted joint motion and pain. Risk factors associated with the development of postoperative arthrofibrosis include female sex, type of graft, and quicker time to reconstruction. These patients have typically benefitted from manipulation under anesthesia or arthroscopic lysis of adhesions. The purpose of this study was to retrospectively review the rate of arthrofibrosis in children and adolescents who previously underwent anterior cruciate ligament (ACL) reconstruction.</p><p><strong>Materials and methods: </strong>This was a retrospective chart review examining patients 18 years or younger who underwent ACL reconstruction between 2013 and 2023. Data collected included age, body mass index, reconstruction technique, concomitant meniscal or ligamentous pathology, and need for revision surgery for arthroscopic lysis of adhesions vs manipulation under anesthesia.</p><p><strong>Results: </strong>A total of 461 patients 18 years or younger who underwent ACL reconstruction were included in this study. Eighteen (3.90%) patients required reoperation for the development of arthrofibrosis. Skeletally immature patients were found to have a statistically significant lower rate of arthrofibrosis compared with skeletally mature patients (0% vs 4.80%; <i>P</i>=.0184). Patients with a higher weight and body mass index had an increased rate of arthrofibrosis (<i>P</i>=.0485 and <i>P</i>=.0410, respectively). Graft type did not have a significant impact on arthrofibrosis rates. There were no significant findings in terms of concomitant injuries and rate of arthrofibrosis.</p><p><strong>Conclusion: </strong>Arthrofibrosis developed in 3.90% of patients after ACL reconstruction. Skeletal immaturity may be protective against the development of arthrofibrosis. No association was found between graft type or concomitant knee pathology and arthrofibrosis. [<i>Orthopedics</i>. 2024;47(4):e161-e166.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e161-e166"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176071","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":"Limited Health Literacy Among Patients With Orthopedic Injuries: A Cross-sectional Survey of Patients Who Underwent Orthopedic Trauma Surgery in a County Hospital Setting.","authors":"Stephan Aynaszyan, Geordie C Lonza, Tanmaya D Sambare, Sung Jun Son, Isabel Alvarez, Grace Tomasek, Jason Bryman, Stephen J Shymon, John P Andrawis","doi":"10.3928/01477447-20240520-01","DOIUrl":"10.3928/01477447-20240520-01","url":null,"abstract":"<p><strong>Background: </strong>Patients with limited health literacy have difficulty understanding their injuries and postoperative treatment, which can negatively affect their outcomes.</p><p><strong>Materials and methods: </strong>This cross-sectional questionnaire-based study of 103 adult patients sought to quantify patients' health literacy at a single county hospital's orthopedic trauma clinic and to examine their ability to understand injuries and treatment plans. Demographics, Newest Vital Sign (NVS) health literacy assessment, and knowledge scores were used to assess patients' comprehension of their injuries and treatment plan. Patients were grouped by NVS score (NVS <4: limited health literacy). Fisher's exact tests and <i>t</i> tests were used to compare demographic and comprehension scores. Multivariate logistic regression analysis was used to examine the association among low health literacy, sociodemographic variables, and knowledge scores.</p><p><strong>Results: </strong>Of the 103 patients, 75% were determined to have limited health literacy. Patients younger than 30 years were more likely to have adequate literacy (50% vs 23%, <i>P</i>=.01). Patients who spoke Spanish as their primary language were 8.77 times more likely to have limited health literacy with respect to sociodemographic factors (odds ratio, 8.77; 95% CI, 1.03-76.92; <i>P</i>=.04). Low health literacy was 3.52 and 4.14 times more likely to predict discordance in answers to specific bone fractures and the narcotics prescribed (<i>P</i>=.04 and <i>P</i>=.02, respectively).</p><p><strong>Conclusion: </strong>Spanish-speaking patients have demonstrated limited health literacy and difficulty understanding their injuries and postoperative treatment plans compared with English-speaking patients. Patients with low health literacy are more likely to be unsure regarding which bone they fractured or their prescribed opiates. [<i>Orthopedics</i>. 2024;47(4):249-255.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"249-255"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176102","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":"Impact of COVID-19 on Pulmonary Embolism Rates in Patients Undergoing Total Joint Arthroplasty.","authors":"Trevor Barronian, Amira Y E Scaramella, Danielle Y Ponzio, Zachary D Post, Alvin C Ong","doi":"10.3928/01477447-20240520-02","DOIUrl":"10.3928/01477447-20240520-02","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to evaluate the incidence and severity of pulmonary embolism (PE) in patients undergoing total hip and knee arthroplasties after the onset of the coronavirus disease 2019 (COVID-19) pandemic.</p><p><strong>Materials and methods: </strong>Patients who underwent a total hip arthroplasty or a total knee arthroplasty between 2017 and 2022 and had a PE within 90 days postoperatively were included. Demographics, medical history, procedural information, and PE outcomes were collected and evaluated.</p><p><strong>Results: </strong>There were 5933 procedures and 17 PE events (0.27%) before COVID-19 compared with 3273 procedures and 16 PE events (0.49%) after COVID-19 (<i>P</i>=.12). There was an increase in intensive care unit admission after COVID-19 (44% vs 0%, <i>P</i><.05).</p><p><strong>Conclusion: </strong>This study showed a trend toward an increased incidence of PE events in the post-COVID-19 cohort and a statistically significant increase in the severity. [<i>Orthopedics</i>. 2024;47(4):233-237.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"233-237"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176097","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}