The Journal of Bone & Joint Surgery最新文献

{"title":"Is There a Difference in Postoperative Outcomes Between Kyphoplasty and Vertebroplasty in the Management of Vertebral Compression Fractures?: A Meta-Analysis of Randomized Controlled Trials.","authors":"Mohammad Daher,Marven Aoun,Andrew Xu,Alan H Daniels,Amer Sebaaly","doi":"10.2106/jbjs.24.01191","DOIUrl":"https://doi.org/10.2106/jbjs.24.01191","url":null,"abstract":"BACKGROUNDCement augmentation using vertebroplasty (VP) or kyphoplasty (KP) can be employed to manage vertebral compression fractures (VCFs). Randomized controlled trials (RCTs) have disagreed about the superiority of one technique over the other. Therefore, a meta-analysis of RCTs is warranted.METHODSPubMed, Cochrane, Embase, and Google Scholar were searched for articles from database inception to July 15, 2024. The inclusion criteria consisted of English and non-English-language RCTs comparing KP to VP in the management of VCFs. The studied outcomes were the risks of cement leakage and adjacent vertebral fractures (AVFs), operative time, the postoperative local kyphotic angle, and postoperative back pain.RESULTSA total of 11 RCTs were included, comprising 1,190 patients, of whom 600 (50.4%) underwent KP and 590 (49.6%) underwent VP. We found no difference in the risk of cement leakage (risk ratio [RR], 1.07; 95% confidence interval [CI], 0.68 to 1.69; p = 0.78) or AVFs (RR, 0.60; 95% CI, 0.29 to 1.23; p = 0.16) between the 2 groups. With the inclusion of additional trials, the KP group had a lower risk of AVFs (RR, 0.58; 95% CI, 0.34 to 0.98; p = 0.04). We found no difference in operative time (mean difference, 4.75 minutes; 95% CI, -7.34 to 16.84; p = 0.44) or postoperative pain (mean difference, -0.48; 95% CI, -1.91 to 0.95; p = 0.51) between the 2 groups. A lower postoperative kyphotic angle was observed in the KP group (standardized mean difference, -2.97; 95% CI, -5.62 to -0.32; p = 0.03).CONCLUSIONSThis meta-analysis revealed that KP was associated with a better postoperative local kyphotic angle and a lower risk of AVFs, with no difference in postoperative pain or cement leakage, compared with VP.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677965","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":"Erratum: Effects of Sustained Tensile Distraction on Vertebrae and Intervertebral Disc Growth.","authors":"Pooria Salari,Garrett W D Easson,Kaitlyn S Broz,Michael P Kelly,Simon Y Tang","doi":"10.2106/jbjs.er.24.00224","DOIUrl":"https://doi.org/10.2106/jbjs.er.24.00224","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"63 1","pages":"e78"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640188","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":"Insights from 300 Periprosthetic Tibial Fractures: Where Do We Go from Here?: Commentary on an article by Evan M. Dugdale, MD, et al.: \"Three Hundred Periprosthetic Tibial Fractures Around a Total Knee Replacement. Classification and Outcomes from a Single Institution\".","authors":"Noah M Hodson,Phillip C McKegg,Michael A Charters","doi":"10.2106/jbjs.25.00234","DOIUrl":"https://doi.org/10.2106/jbjs.25.00234","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"2 1","pages":"e76"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640194","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":"CARE Trial: Patient Education Reduces Opioid Use After ACL Reconstruction: Commentary on an article by Jonathan D. Packer, MD, et al.: \"Perioperative Opioid Counseling for Patients Undergoing Anterior Cruciate Ligament Reconstruction. A Randomized Controlled Trial\".","authors":"Bashir Ahmed Zikria,Jean Fleuriscar","doi":"10.2106/jbjs.25.00221","DOIUrl":"https://doi.org/10.2106/jbjs.25.00221","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"13 1","pages":"e75"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640175","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":"Adequately Reduced Distal Radial Fractures in Elderly Patients: How Long Should We Immobilize?: Commentary on an article by A. Sala-Pujals, MD, et al.: \"Immobilization Time for Conservative Treatment of Distal Radial Fractures in Elderly Patients. A Randomized Controlled Trial\".","authors":"Dafang Zhang","doi":"10.2106/jbjs.25.00333","DOIUrl":"https://doi.org/10.2106/jbjs.25.00333","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"4 1","pages":"e77"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640189","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":"Tension Band Wiring Versus Precontoured Plate Fixation for 2-Part and Multifragmented Olecranon Fractures: A Prospective Randomized Trial.","authors":"Kaare Sourin Midtgaard,Gunnar Birkeland Flugsrud,Kenneth B Jonsson,Greta Snellman,Marius Coucheron,Ane Djuv,Dag Grundel,Lars Gunnar Johnsen,Espen Laudal,Knut Erik Mjaaland,Tor Nicolaysen,Jan Erik Madsen,Frede Frihagen, ","doi":"10.2106/jbjs.24.01461","DOIUrl":"https://doi.org/10.2106/jbjs.24.01461","url":null,"abstract":"BACKGROUNDWe conducted a randomized controlled trial to compare the outcomes of tension band wiring and precontoured plate fixation for the treatment of 2-part and multifragmented isolated, displaced olecranon fractures.METHODSWe recruited 200 patients, 18 to 75 years of age, who had isolated, displaced olecranon fractures and randomly allocated them to tension band wiring (n = 100) or plate fixation (n = 100). The patients were followed at 6 weeks, 12 weeks, 12 months, and 24 months. The study was designed as a noninferiority trial. The primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 12 months.RESULTSMore patients in the tension band wiring group were classified as ASA (American Society of Anesthesiologists) grade I; otherwise, the randomization groups were similar. Two patients in the tension band wiring group and 3 in the plate fixation group did not receive the allocated treatment. The duration of the surgical procedure was 64 and 88 minutes in the tension band wiring and plate fixation groups, respectively (p < 0.01). After 12 months, the median QuickDASH score was 5 for both groups, and the median of the differences was 0 (95% 1-sided confidence interval [CI], 2.3). There were no clinically relevant differences between the groups at any time point. In addition, there were no differences in outcomes in subgroup analyses of 2-part and multifragmented olecranon fractures. Complications and secondary surgical procedures were analyzed on the basis of the treatment received (tension band wiring = 101 patients, plate fixation = 99 patients). Sixty-four complications were recorded in 52 patients (tension band wiring, 30 patients; plate fixation, 22 patients; relative risk [RR], 1.20 [95% CI, 0.88 to 1.58]; p = 0.23). In the tension band wiring and plate fixation groups, 49 and 34 patients (RR, 1.33 [95% CI, 1.01 to 1.74]; p = 0.04) required at least 1 additional surgical procedure, respectively. Hardware-related irritation was the most reported indication of secondary surgery.CONCLUSIONSWhen treating isolated, displaced 2-part and multifragmented olecranon fractures, tension band wiring was noninferior compared with plate fixation. The surgical procedure was quicker for tension band wiring, but the frequency of secondary surgical procedures was higher. The majority of secondary surgical procedures were removal of symptomatic hardware.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144611520","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":"The Utility of a Prediction Model Using Neurological Examination Findings for Diagnosing Degenerative Cervical Myelopathy.","authors":"Masahiro Funaba,Hiroaki Nakashima,Lindsay Tetreault,Hidenori Suzuki,Yasutsugu Yukawa,Norihiro Nishida,Kazuhiro Fujimoto,Kiyoshi Ichihara,Sadayuki Ito,Naoki Segi,Jun Ouchida,Shiro Imagama,Takashi Sakai","doi":"10.2106/jbjs.24.00098","DOIUrl":"https://doi.org/10.2106/jbjs.24.00098","url":null,"abstract":"BACKGROUNDThe diagnostic accuracy of neurological examination findings for identifying degenerative cervical myelopathy (DCM) is not apparent, given the paucity of studies with appropriate control groups. In order to address this knowledge gap, we conducted a community cervical spine screening project and examined subjects without DCM or evidence of myelopathy on cervical magnetic resonance imaging (MRI).METHODSThis study included a total of 229 patients diagnosed with DCM, based on MRI evidence of spinal cord compression and improvement after surgery, and 807 controls without DCM (40 to 79 years of age) enrolled in the screening project. Neurological examination was performed on each subject, including the assessment of deep tendon reflexes at the biceps, triceps, patella, and Achilles tendon and the Hoffmann reflex, Babinski sign, sensory disturbance, and 10-second grip-and-release test. Multiple logistic regression analysis was performed to build a diagnostic model for DCM based on the neurological examination findings.RESULTSUsing a stepwise multiple logistic regression analysis method, an almost perfect diagnostic model was designed that comprised sex, age, 10-second grip-and-release test, patellar tendon reflex, Hoffmann reflex, Babinski sign, and sensory disturbance (area under the curve [AUC] in the receiver operating characteristic curve analysis, 0.994). However, given that the last 2 parameters are less commonly evaluated in routine practice, an alternative reduced model was developed for practical use and consisted of sex, age, Hoffmann reflex, patellar tendon reflex, and 10-second grip-and-release test. The reduced model yielded a nearly equivalent AUC of 0.956.CONCLUSIONSBoth diagnostic prediction models demonstrated excellent accuracy in distinguishing patients with DCM from subjects without DCM, highlighting the importance of combining specific neurological signs and performance measures when evaluating patients with suspected DCM.LEVEL OF EVIDENCEPrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603857","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":"GLP-1 Receptor Agonists in Orthopaedic Surgery: Implications for Perioperative and Outcomes: An Orthopaedic Surgeon's Perspective.","authors":"Rahul Ramanathan,Joon Y Lee,Jonathan F Dalton,Ryan T Lin,Isaac Lee,Christopher Gonzalez,Jeremy D Shaw,Gregory D Schroeder,Christopher K Kepler,Michael Spitnale,Alexander R Vaccaro,Alexandra S Gabrielli,Richard A Wawrose","doi":"10.2106/jbjs.24.01287","DOIUrl":"https://doi.org/10.2106/jbjs.24.01287","url":null,"abstract":"➢ Glucagon-like peptide-1 (GLP-1) receptor agonists are a promising tool for preoperative weight loss in the patient who is undergoing orthopaedic surgery and has concomitant obesity and type-2 diabetes mellitus.➢ With regard to the perioperative management of GLP-1 receptor agonists for the orthopaedic surgeon, the American Society of Anesthesiologists (ASA) recommends withholding daily-dose GLP-1 therapy on the day of the elective surgical procedure and withholding weekly-dose therapy for the week prior to the procedure.➢ The ASA recommends postponing surgery or proceeding with \"full stomach precautions\" if the patient undergoing an orthopaedic procedure and taking GLP-1 therapy exhibits gastrointestinal symptoms on the day of the elective procedure.➢ In the trauma setting, patients taking GLP-1 therapy should proceed with the surgical procedure at the discretion of the surgeon with full stomach precautions or a preoperative point-of-care gastric ultrasound.➢ GLP-1 receptor agonists show the potential for disease modification in osteoarthritis and osteoporosis.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603852","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":"Of Mice and Men: Temporal Comparison of Femoral Shaft Fracture Healing After Intramedullary Nailing: Retrospective Observational Study of Modified Radiographic Union Scores for Tibia.","authors":"Yohan Jang,Luke A Lopas,David P Foley,Todd O McKinley,Brian H Mullis,Christopher D Collier,Ziyue Liu,Melissa A Kacena,Roman M Natoli","doi":"10.2106/jbjs.24.01304","DOIUrl":"https://doi.org/10.2106/jbjs.24.01304","url":null,"abstract":"BACKGROUNDResearchers employ murine fracture models to study bone healing, but the temporal relationship between mouse and human fracture healing is poorly understood. The hypothesis of this study was that it was possible to quantify specific post-fracture time frames corresponding to the stages of endochondral ossification in both mice and humans.METHODSRadiographs of mice and human femoral fractures treated with intramedullary stabilization were reviewed. The study included 330 human femoral fractures (OTA/AO 32A, B, or C injuries) that ultimately healed without complications in patients aged 18 to 55 years and 309 surgically created midshaft femoral fractures in 3-month-old C57BL6/J mice. Multiple orthopaedic surgeons assessed the radiographs using the Modified Radiographic Union Score for Tibia (mRUST). A 4-parameter log-logistic curve was fit to describe fracture healing over time, with 3 parameters allowed to vary: Y∞ (mRUST score at time = ∞), k (healing rate in [1/log(time)]), and X0.5 (time to half-healing).RESULTSThe values (and 95% confidence interval) for the mice were Y∞ = 14.70 (14.54 to 14.87), k = 4.54/log(days) (4.30 to 4.77), and X0.5 = 11.77 days (11.56 to 11.98). For the humans, the values were Y∞ = 16.78 (16.21 to 17.36), k = 1.37/log(days) (1.28 to 1.45), and X0.5 = 91 days (83 to 99). All parameters differed significantly between the mice and humans (p < 0.05).CONCLUSIONSUsing mRUST scoring and mathematical modeling, we were able to quantify and compare the temporal progression of fracture healing in mice and humans.CLINICAL RELEVANCEThese data are relevant for designing and/or interpreting fracture healing studies of mice and humans to promote rational translation of fracture research between species.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"706 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603854","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":"The Timing of Direct Oral Anticoagulant Usage Did Not Impact Outcomes Following Hip Arthroplasty for Femoral Neck Fractures.","authors":"Xiao T Chen,Bryan D Springer,Shalmali Borkar,Aaron Spaulding,Linjun Yang,Cody C Wyles,Steven B Porter,Joshua S Bingham,Benjamin K Wilke","doi":"10.2106/jbjs.24.01293","DOIUrl":"https://doi.org/10.2106/jbjs.24.01293","url":null,"abstract":"BACKGROUNDOrthopaedic surgeons routinely delay surgical management of femoral neck fractures in patients taking direct oral anticoagulants (DOACs) to decrease perioperative bleeding and associated complications. However, this practice contradicts the principles of hip fracture management, as early surgery is associated with morbidity and mortality benefits. The purpose of this study was to quantify the association of DOAC use and perioperative outcomes in patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for femoral neck fractures. We hypothesized that early surgical intervention on a patient taking a DOAC medication would not lead to worse perioperative outcomes.METHODSA retrospective cohort study was conducted on 2,833 patients who underwent primary THA or HA for femoral neck fractures between December 31, 2017, and January 29, 2024, across our hospital system. The patients taking a DOAC were divided into 3 groups based on the time since the last DOAC intake: 1 day, 2 days, and ≥3 days. Propensity matching was performed 1:1, accounting for age, sex, Elixhauser Comorbidity Index, preoperative chronic kidney disease stage, preoperative hemoglobin, body mass index, and hospital type. Subanalyses utilizing linear and conditional logistic regression models were performed to assess differences in outcomes between the groups that had a DOAC withheld and the control groups.RESULTSThe mean age of all patients was 81 ± 10 years, 1,805 patients (64%) were women, and 207 patients (7%) were taking a DOAC prior to surgery. Despite comparable preoperative and postoperative hemoglobin levels between the groups that had a DOAC withheld and the control groups (all p > 0.05), the patients who had a DOAC withheld for 1 day were more likely to receive a postoperative blood transfusion (23.1% compared with 0%; p = 0.002). This difference in transfusion rate was not observed in other cohorts. There were no differences in medical complications, reoperation, discharge disposition, or mortality between the groups that had a DOAC withheld and the matched controls at any time point.CONCLUSIONSDelaying surgical management due to DOAC medications may be unnecessary in patients undergoing arthroplasty for femoral neck fractures. Consideration should be given to adjusting transfusion triggers to reduce unwarranted blood transfusions in patients taking a DOAC.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603856","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}