The Journal of Bone & Joint Surgery最新文献

{"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 <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 < 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 < 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}

{"title":"The T4-L1-Hip Axis Objectifies the Roussouly Classification Using Continuous Measures.","authors":"Jeffrey Hills,Camilo Molina,Lawrence G Lenke,Zeeshan M Sardar,Jean-Charles Le Huec,Kzuhiro Hasegawa,Hee-Kit Wong,Hwee Weng Dennis Hey,Bassel G Diebo,Nicholas A Pallotta,Michael P Kelly","doi":"10.2106/jbjs.24.01489","DOIUrl":"https://doi.org/10.2106/jbjs.24.01489","url":null,"abstract":"BACKGROUNDThe Roussouly classification is a popular system for the categorization of spinal alignment, although the categorization of continuous measures may compromise efforts toward a precision-medicine approach to sagittal alignment in spine surgery. Vertebral-pelvic angles provide continuous measures of sagittal alignment without the risk of misclassification.METHODSWe performed a cross-sectional study of asymptomatic adult volunteers with normal spines (no evidence of disc degeneration or scoliosis). Full-spine radiographs were obtained, and radiographic parameters were collected, including pelvic incidence (PI), sacral slope, lumbar lordosis, the apex of lordosis, the L1-pelvic angle (L1PA), and the T4-pelvic angle (T4PA). All spines were classified as Roussouly Type 1, 2, 3, or 4 on the basis of sacral slope and the apex of lumbar lordosis. Associations between the L1PA and PI, the L1PA and T4PA, and the T4-L1PA mismatch and PI were assessed for the whole cohort and when stratified by Roussouly type. A multinomial logistic regression model was fit to estimate Roussouly type based on PI, the L1PA, and the T4PA. Agreement (weighted κ), accuracy, and area under the receiver operating characteristic curve (1 type versus the rest) were computed. A subanalysis assessed potential variations in the relationships when Roussouly Type-3 spines were further classified as Type 3A (anteverted) versus Type 3.RESULTSThe 320 included volunteers had a median age of 37 years (interquartile range [IQR], 27 to 47 years), and 193 (60%) were female. By self-reported race or ethnicity, the highest percentage of patients were Caucasian (White, 38%) or East Asian (36%), followed by Arabo-Bèrbère (16%). Spines were classified as Roussouly Type 1 in 18 (6%) of the volunteers, as Type 2 in 63 (20%), as Type 3 in 161 (50%), and as Type 4 in 78 (24%). The L1PA was strongly associated with PI across Roussouly types (weakest in Roussouly Type-1 spines). A multinomial logistic regression model estimating Roussouly type by PI, the L1PA, and the T4PA showed strong agreement (weighted κ, 0.84), excellent discrimination, and overall accuracy of 0.82.CONCLUSIONSThe T4-L1-Hip axis is conceptually aligned with the description of spinal shapes in the Roussouly classification but with the advantage of utilizing continuous measures of spinal alignment. Goals of surgical realignment incorporating the T4-L1-Hip axis will be comparable with alignment planning using the Roussouly classification but with improved accuracy and precision.LEVEL OF EVIDENCEDiagnostic 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":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487915","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 Cost-Effectiveness of Continuous Pressure Measurement in the Diagnosis of Acute Compartment Syndrome.","authors":"Yasser Bouklouch,Milan Sen","doi":"10.2106/jbjs.24.00009","DOIUrl":"https://doi.org/10.2106/jbjs.24.00009","url":null,"abstract":"BACKGROUNDThe diagnosis of acute compartment syndrome (ACS) using a single-point pressure measurement device has demonstrated low specificity. Recently, sensors that allow for continuous monitoring of compartment pressure have been introduced, with improved specificity and sensitivity compared with single-point measurement. In this article, we present an economic model used to evaluate the cost-benefits of continuous pressure measurement in patients at risk for ACS.METHODSThe model used a decision-tree structure to estimate the treatment costs of ACS at 60 days and 1 year after admission and over the patient's lifetime. It assumed systematic use of the diagnostic devices for all tibial shaft and tibial plateau fractures and estimated the cost-effectiveness of continuous pressure measurement compared with noncontinuous pressure measurement by comparing costs, quality-adjusted life-years (QALYs), and length of stay (LOS).RESULTSThe improved specificity of continuous pressure measurement reduced unnecessary fasciotomies by 94%. The inflation-adjusted cost of an uncomplicated tibial fracture averaged $57,144; the performance of an unnecessary fasciotomy increased that cost by $27,790. The gain in QALYs was 0.004 per patient, with a net health benefit of 0.06 QALYs. Over a 60-day time horizon, the model showed an estimated decrease in LOS of 2.73 days, on average, per patient. The net monetary benefit was $2,789 (range, -$1,246 to $6,151) in favor of the continuous measurement, increasing to $4,085 (range, -$745 to $8,103) over the lifetime of the patient following the most conservative scenario of equal ACS grade distribution.CONCLUSIONSMost of the ACS economic burden lies in the lack of specificity of the current diagnostic methods. The low incidence of ACS and the high risk associated with prophylactic treatment indicate that improvement in health and economic outcomes should focus on reducing the rate of unnecessary fasciotomies.LEVEL OF EVIDENCEEconomic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487922","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}