Bone & Joint Open最新文献

{"title":"The role of diagnostic wrist arthroscopy in suspected scapholunate ligament injury : a cohort study of 324 patients.","authors":"Lyse van Wijk, Brigitte van der Heijden, J S Souer, Steven E R Hovius, Joost W Colaris","doi":"10.1302/2633-1462.63.BJO-2024-0237.R1","DOIUrl":"10.1302/2633-1462.63.BJO-2024-0237.R1","url":null,"abstract":"<p><strong>Aims: </strong>Diagnostic wrist arthroscopy is considered the gold standard for evaluating wrist joint complaints. Although this tool is often used to diagnose and stage scapholunate ligament (SLL) lesions, reports about the possible findings and their clinical relevance are scarce. Therefore, this study describes the patient characteristics, arthroscopic findings, and treatment of patients who underwent diagnostic arthroscopy for suspected SLL injury.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients who underwent diagnostic wrist arthroscopy due to suspicion of a SLL lesion based on medical history, physical examination, and imaging. We systematically gathered arthroscopic findings and complications.</p><p><strong>Results: </strong>This study included 324 patients, predominantly male (55%), with a median age of 44 years (IQR 29 to 54) and symptom duration of ten months (IQR 5 to 24). The indication of SLL injury was arthroscopically confirmed in 253 patients (78%). Isolated SLL injuries were found in 92 patients (28%) (Geissler I/II: 32%; III: 37%; IV: 32%). SLL lesions and SLL-associated cartilage damage were discovered in 31 patients (10%). Additional findings were found in 181 patients (56%), such as triangular fibrocartilage complex lesions (36%), lunotriquetral ligament lesions (7%), and radioscaphocapitate ligament lesions (11%). No pathology was found in 20 patients (6%). In 27 patients (8%), complications occurred due to wrist arthroscopy. The most common follow-up surgeries were 3LT (40%), salvage procedures (9%), and ulnar shortening osteotomy (6%).</p><p><strong>Conclusion: </strong>While diagnostic wrist arthroscopy commonly confirms the suspected SLL lesions and their severity, it often reveals additional pathologies (un)related to the suspected pathology. It is essential to perform the procedure thoroughly to establish all possible pathologies. Determining the appropriate treatment for these additional findings is not always straightforward and needs further investigation.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 3","pages":"312-320"},"PeriodicalIF":2.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The health-economic burden of hip and knee periprosthetic joint infections in Europe : a comprehensive analysis following primary arthroplasty.","authors":"Volker Alt, Dominik Szymski, Markus Rupp, Andreas Fontalis, Danguole Vaznaisiene, Leonard C Marais, Christof Wagner, Nike Walter, Volker Alt, Martin Clauss, Matteo Carlo Ferrari, Efthymia Giannitsioti, Mathias Glehr, André Grenho, Tomislav Madjarevic, Dirk J Moojen, Kaisa Huotari, Bedri Karaismailoglu, Rik Osinga, Jeroen Neyt, Imre Sallai, Andrea Sambri, Pablo Sanz-Ruiz, Ricardo Sousa, Anna Stefansdottir, Rihard Trebse, Danguole Vaznaisiene, Marianne Westberg, Christof Wagner","doi":"10.1302/2633-1462.63.BJO-2024-0225.R1","DOIUrl":"10.1302/2633-1462.63.BJO-2024-0225.R1","url":null,"abstract":"<p><strong>Aims: </strong>Periprosthetic joint infections (PJIs) pose significant challenges to patients and healthcare systems worldwide. The aim of this study was to estimate the health-economic burden of reimbursement payment in Europe for PJIs following primary hip and knee arthroplasty.</p><p><strong>Methods: </strong>The calculation was based on health-economic modelling using data on primary hip and knee arthroplasties for the year 2019 from the Statistical Office of the European Union (Eurostat) and published infection rates to estimate the total number of hip and knee PJIs in 30 European countries. Revision procedures were stratified into: 1) debridement, antibiotics, and implant retention (DAIR); 2) one-stage exchange; and 3) two-stage revision procedures. The cases were then multiplied by the respective healthcare system reimbursement payments. Payment data were acquired from a survey of 13 countries (Austria, Croatia, France, Germany, Italy, Lithuania, Netherlands, Norway, Portugal, Slovenia, Switzerland, Turkey, and the UK) and extrapolated for the remaining countries.</p><p><strong>Results: </strong>In 2019, a total of 2,048,778 primary total joint replacements were performed (total hip arthroplasty (THA) = 1,147,316 and total knee arthroplasty (TKA) = 901,462), with an estimated 20,416 cases of PJIs (11,131 hip and 9,285 knee) in Europe. This results in an estimated total reimbursement burden of €346,262,026 for European healthcare systems. The breakdown for hip PJI reimbursement was €197,230,953 (€9,751,962 for DAIR procedures, €45,135,894 for one-stage revisions, and €142,343,097 for two-stage revisions). For knee PJIs, the analysis yielded a total reimbursement of €149,031,073 (€9,335,075 for DAIR procedures, €48,058,479 for one-stage revisions, and €91,637,518 for two-stage revisions).</p><p><strong>Conclusion: </strong>This is the first study to evaluate the health-economic burden of PJIs in Europe, revealing a substantial impact on healthcare systems with an estimated case load of 20,414 cases and overall reimbursement of €346,262,026 for primary THAs and TKAs performed in 2019.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 3","pages":"298-311"},"PeriodicalIF":2.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proposed practice parameters for the performance of radiofrequency echographic multispectrometry (REMS) evaluations.","authors":"Kimberly Zambito, Yevgeniya Kushchayeva, Andrew Bush, Paola Pisani, Sergiy Kushchayeva, Mary Peters, Nick Birch","doi":"10.1302/2633-1462.63.BJO-2024-0107.R1","DOIUrl":"10.1302/2633-1462.63.BJO-2024-0107.R1","url":null,"abstract":"<p><strong>Aims: </strong>Assessment of bone health is a multifaceted clinical process, incorporating biochemical and diagnostic tests that should be accurate and reproducible. Dual-energy X-ray absorptiometry (DXA) is the reference standard for evaluation of bone mineral density, but has known limitations. Alternatives include quantitative CT (q-CT), MRI, and peripheral quantitative ultrasound (QUS). Radiofrequency echographic multispectrometry (REMS) is a new generation of ultrasound technology used for the assessment of bone mineral density (BMD) at axial sites that is as accurate as quality-assured DXA scans. It also provides an assessment of the quality of bone architecture. This will be of direct value and significance to orthopaedic surgeons when planning surgical procedures, including fracture fixation and surgery of the hip and spine, since BMD alone is a poor predictor of fracture risk.</p><p><strong>Methods: </strong>The various other fixed-site technologies such as high-resolution peripheral q-CT (HR-pQCT) and MRI offer no further significant prognostic advantages in terms of assessing bone structure and BMD to predict fracture risk. QUS was the only widely adopted non-fixed imaging option for bone health assessment, but it is not considered adequately accurate to provide a quantitative assessment of BMD or provide a prediction of fracture risk. In contrast, REMS has a robust evidence base that demonstrates its equivalence to DXA in determining BMD at axial sites. Fracture prediction using REMS, combining the output of fragility information and BMD, has been established as more accurate than when using BMD alone.</p><p><strong>Conclusion: </strong>The practice parameters described in this protocol provide a framework for clinicians who provide REMS services that will, to the greatest possible extent, ensure the most accurate assessment possible from this diagnostic technology.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 3","pages":"291-297"},"PeriodicalIF":2.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which performance indicators are used globally for evaluating healthcare in patients with a hip fracture? : a mixed methods systematic review.","authors":"Veena Mazarello Paes, Andrew Ting, James Masters, Mahalia V I Paes, Elizabeth Tutton, Simon M Graham, Matthew L Costa","doi":"10.1302/2633-1462.63.BJO-2024-0104.R1","DOIUrl":"10.1302/2633-1462.63.BJO-2024-0104.R1","url":null,"abstract":"<p><strong>Aims: </strong>Performance indicators are increasingly used to evaluate the quality of healthcare provided to patients with a hip fracture. The aim of this review was to map the variety of performance indicators used around the world and how they are defined.</p><p><strong>Methods: </strong>We present a mixed methods systematic review of literature on the use of performance indicators in hip fracture care. Evidence was searched through 12 electronic databases and other sources. A Mixed Methods Appraisal Tool was used to assess methodological quality of studies meeting the inclusion criteria. A protocol for a suite of related systematic reviews was registered at PROSPERO (CRD42023417515).</p><p><strong>Results: </strong>A total 24,634 articles were reviewed, of which 171 met the criteria of the review. Included studies were heterogenous in design and came from varied healthcare systems in 34 different countries. Most studies were conducted in high-income countries in Europe (n = 118), followed by North America (n = 33), Asia (n = 21), Australia (n = 10), and South America (n = 2). The highest number of studies in one country came from the UK (n = 45). Only seven of the 171 studies (< 2,000 participants) were conducted across ten low- and middle-income countries (LMICs). There was variation in the performance indicators reported from different healthcare systems, and indicators were often undefined or ambiguously defined. For example, there were multiple definitions of 'early' in terms of surgery, different or missing definitions of 'mobilization', and variety in what was included in an 'orthogeriatric assessment' in hip fracture care. However, several performance indicators appeared commonly, including time to surgery (n = 142/171; 83%), orthogeriatric review (n = 30; 17%), early mobilization after surgery (n = 58; 34%), and bone health assessment (n = 41; 24%). Qualitative studies (n = 18), mainly from high-income countries and India, provided evidence on the experiences of 192 patients and 138 healthcare professionals with regard to the use of performance indicators in clinical care and rehabilitation pathways. Themes included the importance of education and training in parallel with the introduction of performance indicators, clarity of roles with the clinical team, and the need for restructuring or integration of care pathways.</p><p><strong>Conclusion: </strong>This review identified a large number of performance indicators related to the delivery of healthcare for patients with a hip fracture. However, their definitions and thresholds varied across studies and countries. Evidence from LMICs is sparse. Both qualitative and quantitative evidence indicates that there remains a pressing need for further research into the use and standardization of performance indicators in hip fracture care and their influence on patient outcomes and economic costs.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 3","pages":"275-290"},"PeriodicalIF":2.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of natural language processing applications in Trauma & Orthopaedics.","authors":"Luke Farrow, Arslan Raja, Mingjun Zhong, Lesley Anderson","doi":"10.1302/2633-1462.63.BJO-2024-0081.R1","DOIUrl":"10.1302/2633-1462.63.BJO-2024-0081.R1","url":null,"abstract":"<p><strong>Aims: </strong>Prevalence of artificial intelligence (AI) algorithms within the Trauma & Orthopaedics (T&O) literature has greatly increased over the last ten years. One increasingly explored aspect of AI is the automated interpretation of free-text data often prevalent in electronic medical records (known as natural language processing (NLP)). We set out to review the current evidence for applications of NLP methodology in T&O, including assessment of study design and reporting.</p><p><strong>Methods: </strong>MEDLINE, Allied and Complementary Medicine (AMED), Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) were screened for studies pertaining to NLP in T&O from database inception to 31 December 2023. An additional grey literature search was performed. NLP quality assessment followed the criteria outlined by Farrow et al in 2021 with two independent reviewers (classification as absent, incomplete, or complete). Reporting was performed according to the Synthesis-Without Meta-Analysis (SWiM) guidelines. The review protocol was registered on the Prospective Register of Systematic Reviews (PROSPERO; registration no. CRD42022291714).</p><p><strong>Results: </strong>The final review included 31 articles (published between 2012 and 2021). The most common subspeciality areas included trauma, arthroplasty, and spine; 13% (4/31) related to online reviews/social media, 42% (13/31) to clinical notes/operation notes, 42% (13/31) to radiology reports, and 3% (1/31) to systematic review. According to the reporting criteria, 16% (5/31) were considered good quality, 74% (23/31) average quality, and 6% (2/31) poor quality. The most commonly absent reporting criteria were evaluation of missing data (26/31), sample size calculation (31/31), and external validation of the study results (29/31 papers). Code and data availability were also poorly documented in most studies.</p><p><strong>Conclusion: </strong>Application of NLP is becoming increasingly common in T&O; however, published article quality is mixed, with few high-quality studies. There are key consistent deficiencies in published work relating to NLP which ultimately influence the potential for clinical application. Open science is an important part of research transparency that should be encouraged in NLP algorithm development and reporting.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 3","pages":"264-274"},"PeriodicalIF":2.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Number, treatment, and mortality of paediatric pelvic ring fractures in two level 1 trauma centres in the Netherlands : a multicentre retrospective cohort study.","authors":"Anna H M Mennen, Esther M M Van Lieshout, Frank W Bloemers, Abby E Geerlings, Meike E Van Haeringen, Justus R De Jong, Michael H J Verhofstad, Mark G Van Vledder, Daphne Van Embden","doi":"10.1302/2633-1462.63.BJO-2024-0242","DOIUrl":"10.1302/2633-1462.63.BJO-2024-0242","url":null,"abstract":"<p><strong>Aims: </strong>Paediatric pelvic ring fractures are rare but severe injuries, presenting significant treatment challenges. This study aimed to analyze patient characteristics and explore trends in incidence, treatment methods, and mortality associated with these injuries.</p><p><strong>Methods: </strong>This multicentre, retrospective cohort study analyzed paediatric patients (aged ≤ 18 years) with pelvic ring fractures treated between 2001 and 2021 at two level 1 trauma centres. Data on patient demographics, injury characteristics, treatment approaches, and outcomes were collected, and visual trend analysis was conducted to identify patterns.</p><p><strong>Results: </strong>A total of 157 patients with pelvic ring fractures were included. The median age was 15 years (IQR 12 to 17), with 52% (n = 81) being female. Traffic accidents were the leading cause of injury, accounting for 68% of cases (n = 106). Concomitant injuries were observed in 83% of patients (n = 131). The one-year mortality rate was 11.5%, with 76% of deaths occurring within 48 hours of admission, primarily due to traumatic brain injury (53%). Most patients (60%) were treated nonoperatively, while 48% of surgically treated patients underwent internal fixation without prior external fixation. Visual trend analysis revealed an increase in the absolute number of paediatric pelvic ring fractures over time, though no significant shift towards surgical treatment was observed. Among surgically treated patients, there was a trend towards open reduction and internal fixation rather than external fixation as definitive treatment. Nonoperative treatment was more common in children (69%) than in adolescents (55%). For surgical cases, external fixation was preferred in children (44%), while ORIF was more common in adolescents (53%).</p><p><strong>Conclusion: </strong>The incidence of paediatric pelvic ring fractures has increased over time, with a high mortality rate largely attributable to severe neurotrauma. There has been a shift towards surgical treatment without prior external fixation, with differences noted in the treatment approaches between children and adolescents, particularly in surgical fixation methods.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 3","pages":"254-263"},"PeriodicalIF":2.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic characteristics and reliability of radiological methods used in the assessment of scaphoid fracture union : a systematic review.","authors":"Gemma Smith, Wai H Teng, Nicholas D Riley, Christopher Little, Edward Sellon, Neal Thurley, Joe Dias, Benjamin J F Dean","doi":"10.1302/2633-1462.63.BJO-2024-0211.R1","DOIUrl":"10.1302/2633-1462.63.BJO-2024-0211.R1","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the diagnostic characteristics and reliability of radiological methods used to assess scaphoid fracture union through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>MEDLINE, Embase, and the Cochrane Library were searched from inception to June 2022. Any study reporting data on the diagnostic characteristics and/or the reliability of radiological methods assessing scaphoid union was included. Data were extracted and checked for accuracy and completeness by pairs of reviewers. Methodological quality was assessed using the QUADAS-2 tool.</p><p><strong>Results: </strong>A total of 13 studies were included, which were three assessed radiographs alone, six CT alone, and four radiographs + CT. Diagnostic sensitivity was assessed by CT in three studies (0.78, 0.78, and 0.73) and by radiographs in two studies (0.65, 0.75). Diagnostic specificity was assessed by CT in three studies (0.96, 0.8, 0.4) and by radiographs in two studies (0.67, 0.4). Interobserver reliability was assessed for radiographs by seven studies (two fair, four moderate, and one substantial) and for CT in nine studies (one fair, one moderate, six substantial, and one almost perfect).</p><p><strong>Conclusion: </strong>There is evidence to support both the use of CT and radiographs in assessing scaphoid fracture union. Although CT appears superior in terms of both its diagnostic characteristics and reliability, further research is necessary to better define the optimal clinical pathways for patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 3","pages":"246-253"},"PeriodicalIF":2.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic knee pain while awaiting arthroplasty is associated with worsening joint-specific function, health-related quality of life and personal wellbeing, and increased use of opioid analgesia.","authors":"Nick D Clement, Ruth A Duthie, Deborah J MacDonald, Liam Z Yapp, Chloe E H Scott","doi":"10.1302/2633-1462.63.BJO-2024-0210.R1","DOIUrl":"10.1302/2633-1462.63.BJO-2024-0210.R1","url":null,"abstract":"<p><strong>Aims: </strong>To assess whether chronic knee pain (CKP) influenced health-related quality of life (HRQoL), knee-specific health, wellbeing, and use of opioid analgesia, and identify variables associated with CKP in patients awaiting knee arthroplasty.</p><p><strong>Methods: </strong>This study included 217 patients (mean age 69.7 years (SD 8.7), 116 female (53%)) who completed questionnaires that included the EuroQol five-dimension questionnaire (EQ-5D) and EuroQol-visual analogue scale (EQ-VAS), Oxford Knee Score (OKS), and wellbeing assessments at six and 12 months after being listed for surgery. Analgesia use at 12 months was also recorded. CKP was defined using the OKS pain score (PS) of ≤ 14 points at 12 months.</p><p><strong>Results: </strong>At 12 months, 169 patients (77.9%) had CKP. Compared with those without CKP, those with CKP had clinically meaningfully worse HRQoL and knee-specific health at 12 months and were more likely to have a health state worse than death (odds ratio (OR) 29.7, 95% CI 4.0 to 220.2; p < 0.001). The CKP group were more likely to use weak (OR 3.03, 95% CI 1.65 to 7.96; p = 0.001) and strong (OR 11.8, 95% CI 1.58 to 88.88; p = 0.001) opioids for analgesia. The CKP group had worse overall wellbeing with significantly (p < 0.001) lower satisfaction with life, life being worthwhile and happiness, and increased anxiety. The CKP group had a significant (p < 0.001) deterioration in their OKS, OKS-PS, EQ-5D, and EQ-VAS from six to 12 months, which was not observed in the group without CKP. A worse OKS-PS at six months was independently associated with an increased risk of CKP, and a threshold value of < 13 (sensitivity 91.7%, specificity 94.7%) was an excellent discriminator (area under the curve 96.9, 95% CI 94.2 to 99.6; p < 0.001).</p><p><strong>Conclusion: </strong>Four in five patients had CKP after waiting 12 months, which was associated with deteriorations in HRQoL and knee health, worse wellbeing, and increased opioid analgesia use. The OKS-PS at six months could be used to identify patients at risk of CKP after 12 months of waiting.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 3","pages":"237-245"},"PeriodicalIF":2.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported outcomes three months after treatment of metacarpal and phalangeal fractures or dislocations : a multicentre snapshot study.","authors":"Louise E M de Haas, Veronique A P van de Lücht, Bastiaan T van Hoorn, Dorien A Salentijn, Rolf H H Groenwold, Niels W L Schep, Mark van Heijl, Elke Arts, Said Bachiri, Reinier Beks, Leonie Blom, Doeke Boersma, Jan T Bosch, Floor Ter Brugge, Niels Bruggeman, Brigitte van der Heijden, Priscilla Jawahier, Pieter Joosse, Siegrid de Meer, Amanda Nijhuis, Jan Siert Reinders, Luke van Rossenberg, Friso Schonk, David Tas, Michiel Teijgeler, Tim Timmers, Ruben van Veen, Detlef van der Velde, Stephanie Zielinski","doi":"10.1302/2633-1462.62.BJO-2024-0146.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0146.R1","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate patient-reported outcomes three months after treatment of metacarpal and phalangeal fractures or dislocations, and to identify factors that are associated with worse patient-reported outcomes.</p><p><strong>Methods: </strong>This cross-sectional, multicentre snapshot study included all adult patients with metacarpal and phalangeal fractures or dislocations during a three-month period between August and October 2020. The primary outcome was the Michigan Hand Outcomes Questionnaire (MHQ) three months after injury. The MHQ scores were compared to normative MHQ scores of 90 points of the affected hand of patients who sustained unilateral trauma derived from a previous study. Subgroup analyses were performed for the most common injury types. Multivariable linear regression was used to study associations between patient characteristics and worse MHQ scores.</p><p><strong>Results: </strong>The MHQ scores of 512 patients were analyzed. The median MHQ score was 80 (IQR 65 to 91) for nonoperatively treated patients (n = 398) and 78 (IQR 66 to 85) for operatively treated patients (n = 114). After nonoperative treatment, 104/398 patients (26%) reached a MHQ score equal to or better than the normative MHQ score, ranging between 11% (1/9) and 42% (13/31) among the nine most common injury types. After operative treatment, this was 11% (13/114), ranging between 10% (3/29) and 31% (5/16) among the three most common injury types. No significant differences in MHQ scores were found between common injury types. Older age, the presence of hand comorbidities, and referral to hand therapy were associated with a worse MHQ score after nonoperative treatment.</p><p><strong>Conclusion: </strong>These results suggest that most patients have not returned to a normal hand function within three months following metacarpal and phalangeal fractures or dislocations. Older age, the presence of hand comorbidities, and referral for hand therapy were associated with worse hand functioning after nonoperative treatment. The findings are relevant for clinicians to evaluate recovery and for patients to manage their expectations.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"227-236"},"PeriodicalIF":2.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does composite bone resection for soft-tissue sarcoma with cortical contact result in better local control and survival compared to sub-periosteal dissection? : a comparative retrospective cohort study.","authors":"Hao Qu, Keyi Wang, Cangyi Shi, Hengyuan Li, Xiumao Li, Peng Lin, Nong Lin, Zhaoming Ye","doi":"10.1302/2633-1462.62.BJO-2024-0057.R2","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0057.R2","url":null,"abstract":"<p><strong>Aims: </strong>Osseous invasion exhibited in soft-tissue sarcoma (STS) is recognized as a prognostic risk factor. Achieving a wide margin is the default surgical approach for local control. However, for STSs where the tumour is in contact with the adjacent cortex but without clear evidence of osseous invasion, such as medullary invasion, the question of whether bone resection can provide better local control or survival than more conservative sub-periosteal excision remains controversial. The aim of this study was to assess whether bone resection for thigh STS with cortical contact of the adjacent bone results in better local control and survival compared to sub-periosteal dissection, and to investigate the prognostic factors for clinical outcomes in STS.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 142 patients with thigh STS exhibiting cortical contact but without medullary invasion, from May 2000 to May 2020. Patients underwent either composite bone resection or sub-periosteal excision. Demographics, clinical outcomes, and functional outcomes were compared between the two groups. Additionally, Cox regression analysis was used to analyze risk factors for local recurrence.</p><p><strong>Results: </strong>The five-year overall survival, local recurrence-free survival, and metastasis-free survival among patients with bone resection was 74.0%, 65.9%, and 74.1%, respectively, compared to 72.9%, 68.3%, and 72.0%, respectively, among patients with sub-periosteal excision. The cumulative incidence of recurrence was 33.1% for patients who underwent bone and 36.4% for those with sub-periosteal excision (p = 0.681). In multivariate analysis, STS with high Fédération Nationale des Centres de Lutte Contre Le Cancer (FNCLCC) grade, invasion involving posterior intermuscular septum, medial intermuscular septum, and adductor brevis were found to be associated with poorer prognosis. The mean Musculoskeletal Tumor Society (MSTS) score in the bone resection group was 24.7, significantly lower than the 28.3 in the sub-periosteal group (p < 0.001).</p><p><strong>Conclusion: </strong>Routine bone resection failed to improve local control or survival in STS patients with cortical bone contact, but resulted in significantly impaired postoperative function. A more conservative sub-periosteal excision approach may be preferable for these cases.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"215-226"},"PeriodicalIF":2.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}