The Journal of Bone & Joint Surgery最新文献

{"title":"Incidence and Prediction of Postoperative Urinary Retention Following Lumbar Decompression.","authors":"Cole Kwas,Eric Kim,Joshua Zhang,Kasra Araghi,Avani S Vaishnav,Olivia Tuma,Austin Kaidi,Eric Mai,Tejas Subramanian,Tomoyuki Asada,Annika Heuer,Nishtha Singh,Chad Simon,Maximilian Korsun,Myles Allen,Ellen Soffin,Evan Sheha,James Dowdell,Russel Huang,Sheeraz Qureshi,Sravisht Iyer","doi":"10.2106/jbjs.24.01030","DOIUrl":"https://doi.org/10.2106/jbjs.24.01030","url":null,"abstract":"BACKGROUNDPostoperative urinary retention (POUR), a common complication after spine surgery, can contribute to longer hospital stays, urinary tract infection, pain, and morbidity. This study aimed to determine the incidence of POUR in patients who underwent lumbar decompression and to construct a predictive model for preoperatively identifying high-risk patients.METHODSThis was a retrospective review of patients undergoing primary lumbar decompression from 2017 to 2023. Demographic characteristics, comorbidities, and perioperative data were collected. Factors associated with POUR were assessed, and multivariable logistic regressions were performed to identify independent predictors of the development of POUR. A nomogram to predict the development of POUR was developed within a training subset, based on a multivariable logistic regression model of preoperative variables, followed by the internal validation of the model in a validation subset and assessment of its performance.RESULTSOf the 1,938 patients included in this study, 133 (6.9%) developed POUR. Following multivariable analysis, the following risk factors for POUR were identified: a history of urinary retention (odds ratio [OR], 4.956 [95% confidence interval (CI), 2.157 to 11.383]; p < 0.001), insurance that was not commercial (private) (OR, 2.256 [95% CI, 1.298 to 3.922]; p = 0.004), intraoperative Foley catheter use (OR, 5.967 [95% CI, 3.506 to 10.156]; p < 0.001), inpatient opioid consumption of >93 morphine milligram equivalents (OR, 1.898 [95% CI, 1.220 to 2.952]; p = 0.004), and anticholinergic medication use during hospitalization (OR, 3.450 [95% CI, 2.313 to 5.148]; p < 0.001). The nomogram, which included the preoperative variables of male sex, age of >65 years, history of urinary retention, history of benign prostatic hyperplasia, not having commercial insurance, and American Society of Anesthesiologists (ASA) classification of >2, demonstrated good discrimination in the training subset (area under the curve [AUC], 0.725 [95% CI, 0.673 to 0.776]) and the validation subset (AUC, 0.709 [95% CI, 0.599 to 0.819]). The Hosmer-Lemeshow goodness-of-fit test demonstrated that the model fit the data well (chi-square test = 9.063; p = 0.170).CONCLUSIONSThe incidence of POUR after lumbar decompression surgery was found to be 6.9%. A history of urinary retention, not having commercial (private) insurance, intraoperative Foley catheter usage, inpatient opioid consumption of >93 morphine milligram equivalents, and the administration of anticholinergic medication during hospitalization increased the risk of developing POUR. Furthermore, we constructed a preoperative predictive model with good performance metrics to help clinicians to identify patients at elevated risk for developing POUR.LEVEL OF EVIDENCEPrognostic 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":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586693","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":"An Institutional Large Language Model for Musculoskeletal MRI Improves Protocol Adherence and Accuracy.","authors":"James Thomas Patrick Decourcy Hallinan,Naomi Wenxin Leow,Yi Xian Low,Aric Lee,Wilson Ong,Matthew Ding Zhou Chan,Ganakirthana Kalpenya Devi,Stephanie Shengjie He,Daniel De-Liang Loh,Desmond Shi Wei Lim,Xi Zhen Low,Ee Chin Teo,Shaheryar Mohammad Furqan,Wilson Wei Yang Tham,Jiong Hao Tan,Naresh Kumar,Andrew Makmur,Ting Yonghan","doi":"10.2106/jbjs.24.01429","DOIUrl":"https://doi.org/10.2106/jbjs.24.01429","url":null,"abstract":"BACKGROUNDPrivacy-preserving large language models (PP-LLMs) hold potential for assisting clinicians with documentation. We evaluated a PP-LLM to improve the clinical information on radiology request forms for musculoskeletal magnetic resonance imaging (MRI) and to automate protocoling, which ensures that the most appropriate imaging is performed.METHODSThe present retrospective study included musculoskeletal MRI radiology request forms that had been randomly collected from June to December 2023. Studies without electronic medical record (EMR) entries were excluded. An institutional PP-LLM (Claude Sonnet 3.5) augmented the original radiology request forms by mining EMRs, and, in combination with rule-based processing of the LLM outputs, suggested appropriate protocols using institutional guidelines. Clinical information on the original and PP-LLM radiology request forms were compared with use of the RI-RADS (Reason for exam Imaging Reporting and Data System) grading by 2 musculoskeletal (MSK) radiologists independently (MSK1, with 13 years of experience, and MSK2, with 11 years of experience). These radiologists established a consensus reference standard for protocoling, against which the PP-LLM and of 2 second-year board-certified radiologists (RAD1 and RAD2) were compared. Inter-rater reliability was assessed with use of the Gwet AC1, and the percentage agreement with the reference standard was calculated.RESULTSOverall, 500 musculoskeletal MRI radiology request forms were analyzed for 407 patients (202 women and 205 men with a mean age [and standard deviation] of 50.3 ± 19.5 years) across a range of anatomical regions, including the spine/pelvis (143 MRI scans; 28.6%), upper extremity (169 scans; 33.8%) and lower extremity (188 scans; 37.6%). Two hundred and twenty-two (44.4%) of the 500 MRI scans required contrast. The clinical information provided in the PP-LLM-augmented radiology request forms was rated as superior to that in the original requests. Only 0.4% to 0.6% of PP-LLM radiology request forms were rated as limited/deficient, compared with 12.4% to 22.6% of the original requests (p &lt; 0.001). Almost-perfect inter-rater reliability was observed for LLM-enhanced requests (AC1 = 0.99; 95% confidence interval [CI], 0.99 to 1.0), compared with substantial agreement for the original forms (AC1 = 0.62; 95% CI, 0.56 to 0.67). For protocoling, MSK1 and MSK2 showed almost-perfect agreement on the region/coverage (AC1 = 0.96; 95% CI, 0.95 to 0.98) and contrast requirement (AC1 = 0.98; 95% CI, 0.97 to 0.99). Compared with the consensus reference standard, protocoling accuracy for the PP-LLM was 95.8% (95% CI, 94.0% to 97.6%), which was significantly higher than that for both RAD1 (88.6%; 95% CI, 85.8% to 91.4%) and RAD2 (88.2%; 95% CI, 85.4% to 91.0%) (p &lt; 0.001 for both).CONCLUSIONSMusculoskeletal MRI request form augmentation with an institutional LLM provided superior clinical information and improved protocoling accuracy compared with clinicia","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586679","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":"Intraoperative Direct Sonication Improves Accuracy and Reduces Time to Culture Growth: Commentary on an article by Yicheng Li, PhD, et al.: \"Intraoperative Direct Sonication Versus Conventional Sonication in the Diagnosis of Periprosthetic Joint Infection. Comparison of Diagnostic Accuracy and Time to Positivity of Fluid Culture\".","authors":"Brett R Levine","doi":"10.2106/jbjs.25.00170","DOIUrl":"https://doi.org/10.2106/jbjs.25.00170","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"32 1","pages":"e71"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533348","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":"Complication Rates and Functional Outcomes After TAA in Patients with Rheumatoid Arthritis Are Less Defined Than for Patients with Osteoarthritis: Commentary on an article by Colleen M. Wixted, MD, MBA, et al.: \"Complication Rates and Functional Outcomes After Total Ankle Arthroplasty in Patients with Rheumatoid Arthritis\".","authors":"Johnny T C Lau","doi":"10.2106/jbjs.25.00400","DOIUrl":"https://doi.org/10.2106/jbjs.25.00400","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"11 1","pages":"e74"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533574","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":"Should Optimization for Elective Surgery Include Mental Health Optimization?: Commentary on an article by Roger Quesada-Jimenez, MD, et al.: \"Effects of Depression and/or Anxiety on the Outcomes of Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears. A Minimum 5-Year Follow-up Study\".","authors":"Randy M Cohn","doi":"10.2106/jbjs.25.00113","DOIUrl":"https://doi.org/10.2106/jbjs.25.00113","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"189 1","pages":"e72"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533569","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":"High-Quality Evidence That a Postoperative Protocol of Immediate Weight-Bearing Is Superior to Non-Weight-Bearing and Cast Use After Operatively Treated Malleolar Ankle Fractures: Commentary on an article by Ramy Khojaly, et al.: \"Intermediate Weight-Bearing Compared with Non-Weight-Bearing After Operative Ankle Fracture Fixation. Results of the INWN Pragmatic, Randomized, Multicenter Trial\".","authors":"Stephen Matthew Quinnan","doi":"10.2106/jbjs.25.00088","DOIUrl":"https://doi.org/10.2106/jbjs.25.00088","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"11 1","pages":"e70"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533570","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":"Clinical Guideline Necessary to Manage Obese Patients Undergoing Total Joint Arthroplasty: Commentary on an article by Christiaan H. Righolt, MD, et al.: \"Primary Total Knee Arthroplasty in Patients with BMI of ≥50 kg/m2. A Cohort Study with Long-Term Follow-up\".","authors":"Alparslan Uzun,Ibrahim Azboy","doi":"10.2106/jbjs.25.00154","DOIUrl":"https://doi.org/10.2106/jbjs.25.00154","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"9 17 1","pages":"e73"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533572","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":"What's Important: Beyond the Incision: The Power of Patient Narratives in Surgery.","authors":"Sonal Kumar,Shelley S Noland","doi":"10.2106/jbjs.25.00152","DOIUrl":"https://doi.org/10.2106/jbjs.25.00152","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521492","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":"A Prospective, Randomized Comparison of Functional Bracing and Spica Casting for Femoral Fractures Showed Equivalent Early Outcomes.","authors":"Lindsay M Andras,Julia S Sanders,Tiffany N Phan,Sarah R Purtell,Jasmine Gasca,Tishya A L Wren,Andrew T Sim,David Skaggs,Andrea Kramer,Michelle Chavez,Robert Kay","doi":"10.2106/jbjs.24.01081","DOIUrl":"https://doi.org/10.2106/jbjs.24.01081","url":null,"abstract":"BACKGROUNDAAOS Clinical Practice Guidelines recommend spica casting for the treatment of most femoral fractures in children 6 months to 5 years of age. The purpose of the present study was to compare the outcomes of treatment with prefabricated braces with those of spica casting.METHODSWe performed a randomized prospective study of patients 6 months to 5 years of age who were managed with functional bracing or spica casting for the treatment of diaphyseal femoral fractures at 2 pediatric trauma centers. Patients with polytrauma, medical comorbidities impacting fracture-healing, or &lt;6 weeks of follow-up were excluded. Spica casts were placed in the operating room with the patient under anesthesia. Functional braces were placed at bedside.RESULTSEighty patients (40 in the spica casting group and 40 in the functional bracing group) met the inclusion criteria and were analyzed. The mean age was 2.0 years in the casting group and 2.3 years in the bracing group (p = 0.15). Radiographs demonstrated similar shortening (9.0 ± 7.6 mm in the casting group and 6.8 ± 8.2 mm in the bracing group; p = 0.21), varus angulation (9.0º ± 11.9º in the casting group and 5.6º ± 9.4º in the bracing group; p = 0.19), and procurvatum (9.4º ± 12.9º in the casting group and 6.7º ± 8.4º in the bracing group; p = 0.31). At 6 weeks, there were no differences in shortening (13.1 ± 9.4 mm in the casting group and 11.0 ± 10.0 mm in the bracing group; p = 0.35), varus angulation (2.4º ± 7.3º in the casting group and 5.3º ± 6.3º in the bracing group, p = 0.06), or procurvatum (12.3º ± 9.8º in the casting group and 9.1º ± 8.1º in the bracing group; p = 0.11). Fifty-one patients (24 in the casting group and 27 in the bracing group) had 1 year of follow-up. There were no differences between the groups in terms of shortening (4.9 ± 5.4 mm in the casting group and 3.0 ± 6.9 mm in the bracing group; p = 0.23) or varus angulation (1.8º ± 3.5º in the casting group and 1.2º ± 4.1º in the bracing group; p = 0.56), but there was a slight difference in procurvatum (11.7º ± 8.3º in the casting group and 5.1º ± 5.8º in the bracing group; p &lt; 0.01). More superficial skin issues were observed in the bracing group than in the casting group (9 compared with 1; p = 0.02), but all skin issues resolved with local wound care. Patients in the casting group had more difficulty moving independently (median score, 8 of 10 in the casting group and 5 of 10 in the bracing group; p = 0.05). Patients in the bracing group were more likely to fit into their car seat (40% in the casting group versus 86% in the bracing group; p &lt; 0.01).CONCLUSIONSIn this prospective randomized trial, patients who were treated with functional bracing had equivalent outcomes to those who were treated with spica casting. Prefabricated functional braces provided a viable alternative, avoiding the cost and anesthesia associated with cast placement.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete descripti","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504558","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":"AOA Critical Issues Symposium: How Are Orthopaedic Leaders Chosen? Competency Versus Kingmaker.","authors":"Kristy Weber,Mary Lauria,Lilly Marks","doi":"10.2106/jbjs.24.01554","DOIUrl":"https://doi.org/10.2106/jbjs.24.01554","url":null,"abstract":"Leadership selection in the field of orthopaedic surgery takes place in many settings, including national, regional, and local associations; academic departments; and private practice groups. In general, there is neither a consistent method of competency-based leadership selection nor a codified set of criteria by which to identify a successful leader in national organizations. This can potentially lead to leadership based on personality rather than process. Polling results among the orthopaedic leaders who were present at the 2024 American Orthopaedic Association (AOA) Annual Meeting Symposium revealed that 80% think that the selection process for board leadership for national orthopaedic organizations needs to improve, and 75% think that the selection process for academic department chairs also needs to improve. This summary of the 2024 AOA Symposium provides a strategy for consistent, competency-based leadership selection in orthopaedic organizations, identifies potential key selection criteria that are necessary to identify talent, and enumerates steps that can be used by nominating or search committees. Although the focus of this work is directed toward the process that is used to identify leaders for national orthopaedic organizations, features of academic medical leadership and corporate talent selection will be highlighted for consideration and translation to the orthopaedic community.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504611","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}