JBJS Open Access最新文献

{"title":"Effective Compression and a Minimally Invasive Rail Plate to Optimize Bone Transport in Distraction Osteogenesis: New Concepts.","authors":"E López-Carreño, E P López Avendaño, L Padilla Rojas, A Y Martínez-Castellanos, I Arámbula Rodríguez, C García López, H Campos Huerta, L Flores Huerta","doi":"10.2106/JBJS.OA.23.00144","DOIUrl":"10.2106/JBJS.OA.23.00144","url":null,"abstract":"<p><strong>Background: </strong>Bone transport in distraction osteogenesis is an effective, well-known procedure. However, bone compression is an aspect of this technique for which there is no objective information. The lack of direct bone compression measurements may result in a lack of uniformity in the bone transport process, which can result in its ineffective application and may be contributing to its underutilization. This study describes the results of applying objectively measured compressions to achieve a distraction regeneration zone and docking site consolidation during bone transport in distraction osteogenesis.</p><p><strong>Methods: </strong>This prospective study describes the results of a single cohort of 32 patients who underwent distraction osteogenesis with bone transport utilizing a combination of a minimally invasive rail plate and monolateral external fixation. The patients were categorized into 2 groups: (1) those with hypertrophic, atrophic, or infectious pseudarthrosis-nonunion (the pseudarthrosis-nonunion group), and (2) those with bone loss due to trauma or osteomyelitis (the bone loss group). The initial bone compression was measured during the latency phase, and the final compression was measured during the distraction phase. The healing index, external fixation index, healing time, consolidation time, and docking time were calculated for each patient. The Mann-Whitney U and Kruskal-Wallis tests were used for comparisons between and within groups.</p><p><strong>Results: </strong>In this study, 28 (88%) of the patients were male. The mean patient age was 44.93 ± 16.21 years. The median values were 3.2 Nm for the initial compression and 3.4 Nm for the final compression, with no significant difference between or within groups of patients. The osseous results were excellent in 29 patients (91%), and the functional results were good or excellent in 31 patients (97%).</p><p><strong>Conclusions: </strong>This study is the first to objectively measure compression in the bone transport process. Our findings showed that all patients who had an initial compression of ≥3.2 Nm achieved 100% consolidation of the distraction regeneration zone, and those who had a final compression of ≥2.9 Nm achieved complete docking site consolidation without complications. These 2 values thus represent effective compression and highlight the role of bone compression in bone transport.</p><p><strong>Level of evidence: </strong>Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773239","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":"Transfemoral Osseointegration for Amputees with Well-Managed Diabetes Mellitus.","authors":"Jason S Hoellwarth, Shakib Al-Jawazneh, Atiya Oomatia, Kevin Tetsworth, Munjed Al Muderis","doi":"10.2106/JBJS.OA.23.00168","DOIUrl":"https://doi.org/10.2106/JBJS.OA.23.00168","url":null,"abstract":"<p><strong>Background: </strong>The most common reason for lower-extremity amputations remains the management of complications of diabetes mellitus (DM) and/or peripheral vascular disease. Traditional socket prostheses remain the rehabilitation standard, although transcutaneous osseointegration for amputees (TOFA) is proving a viable alternative. Limited studies of TOFA for vascular amputees have been published, but no study has focused on TOFA for patients with DM, neglecting this important patient population. The primary aim of the present study exploring this potential care option was to report the frequencies and types of adverse events following TOFA for patients with well-controlled DM. The secondary aims were to report their mobility and quality-of-life changes.</p><p><strong>Methods: </strong>A retrospective review was performed of 17 consecutive patients with well-controlled DM who had undergone unilateral transfemoral TOFA from 2013 to 2019 and had been followed for at least 2 years. Outcomes were perioperative complications, additional surgery (soft-tissue refashioning, debridement, implant removal, periprosthetic fracture treatment), mobility (daily prosthesis wear hours, K-level, Timed Up and Go Test, 6-Minute Walk Test), and patient-reported outcomes (Questionnaire for Persons with a Transfemoral Amputation, Short Form-36).</p><p><strong>Results: </strong>There were no perioperative systemic complications, deaths, or proximal amputations. Two patients (12%) sustained a periprosthetic fracture following a fall, managed by internal fixation with implant retention, and regained independent ambulation. Eight patients (47%) had additional surgery or surgeries for non-traumatic complications: 4 (24%) had soft-tissue refashioning, 3 (18%) had debridement, and 3 others had implant removal with subsequent revision osseointegration for aseptic loosening (1) or infection (2). The proportion of patients wearing their prosthesis at least 8 hours daily improved from 5 (36%) to 11 (79%) of 14 (p = 0.054). The proportion of patients who achieved at least K-level 2 improved from 6% to 94% (p < 0.001). Other changes were not significant.</p><p><strong>Conclusions: </strong>Contraindicating TOFA for all patients with DM seems draconian. Patients with well-controlled DM experienced significant mobility improvements, although additional surgery was somewhat common. Improvements in selection criteria or surgical technique to reduce risks are needed so that TOFA can be routinely considered for amputees with well-controlled DM.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773254","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":"Comparing Treatment Outcomes of Eligible Patients Consenting to or Declining Randomization in a Randomized Clinical Trial: A Secondary Analysis of the FISH Trial on Humeral Shaft Fractures.","authors":"Thomas Ibounig, Cyrill Suter, Bakir O Sumrein, Antti P Launonen, Tomasz Czuba, Teppo L N Järvinen, Simo Taimela, Mika Paavola, Lasse Rämö","doi":"10.2106/JBJS.OA.24.00018","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00018","url":null,"abstract":"<p><strong>Background: </strong>The Finnish Shaft of the Humerus (FISH) trial compared open reduction and internal plate fixation (ORIF) with functional bracing in adult patients with displaced, closed humeral shaft fractures. Here, we compare the results of the patients in the randomized clinical trial (RCT [the randomized cohort]) with those of the cohort of patients who were also eligible but declined randomization (the nonrandomized cohort) to investigate if patients' treatment preference was associated with the outcomes during a 2-year follow-up.</p><p><strong>Methods: </strong>A total of 321 patients were treated at 2 university hospitals in Finland between November 2012 and January 2018. Of the 140 eligible patients, 82 were randomized to ORIF or functional bracing. Of the 58 patients declining randomization, 42 consented to participate in a nonrandomized cohort in which the patients were able to choose the treatment method. The primary outcome of this study was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Patients in the randomized cohort and the nonrandomized cohort were analyzed separately in 3 groups: those who had (1) initial surgery, (2) successful functional bracing, and (3) late surgery due to failed functional bracing. We used mixed-model, repeated-measures analysis of variance to compare the treatment effect among the 3 groups.</p><p><strong>Results: </strong>In the randomized cohort, 38 patients had an initial surgical procedure. Of the 44 patients randomized to functional bracing, 30 (68%) healed successfully and 14 (32%) underwent a late surgical procedure. In the nonrandomized cohort, 9 patients preferred an initial surgical procedure. Of the 33 patients preferring functional bracing, 26 (79%) healed successfully and 7 (21%) underwent late surgery. The DASH scores in the randomized cohort and the nonrandomized cohort were 6.8 (95% confidence interval [CI], 2.3 to 11.4) and 12.3 (95% CI, 0.3 to 24.3) for the initial surgery groups, 6.0 (95% CI, 1.0 to 11.0) and 3.4 (95% CI, 0 to 9.3) for the bracing groups, and 17.5 (95% CI, 10.5 to 24.5) and 20.5 (95% CI, 9.4 to 31.6) for the late surgery groups at 2 years.</p><p><strong>Conclusions: </strong>The results of the randomized cohort and the nonrandomized cohort were comparable and suggest that patients' treatment preferences are not associated with the treatment outcomes of these injuries.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773233","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":"Disparities in Access to and Utilization of Surgical Care for Patients with Closed Unstable AO/OTA 44B2 Ankle Fractures and Medicaid.","authors":"Joseph T Patterson, Akhil S Reddy, Jacob A Becerra, R Kiran Alluri, Fergui Hernandez, Andrew M Duong, Ryan C Ross","doi":"10.2106/JBJS.OA.23.00152","DOIUrl":"https://doi.org/10.2106/JBJS.OA.23.00152","url":null,"abstract":"<p><strong>Background: </strong>Closed, unstable AO/OTA 44B2 ankle fractures are common injuries with similar distributions by age, sex, and race. The purpose of this study was to identify disparities in access to and utilization of surgical care for these injuries.</p><p><strong>Methods: </strong>Ambulatory patients ≥18 years of age with capitated Medicaid health insurance who presented from January 2016 to February 2020 with an isolated, closed AO/OTA 44B2 ankle fracture with radiographic evidence of instability were retrospectively identified at 1 Level-I safety-net trauma center. Associations between patient characteristics (age, sex, preferred language, race, ethnicity, housing status, employment, and substance use) and measures of access to and utilization of ankle fracture surgery (days from injury to evaluation, being offered surgery, undergoing surgery, and days from evaluation to surgery) were investigated on bivariable and multivariable analysis.</p><p><strong>Results: </strong>Of the 1,116 patients who were screened, 323 met the inclusion criteria. The included patients had a median age of 41 years; 207 patients (64%) were male and 255 (79%) were Hispanic. Patients presented at a mean of 4.6 ± 7.0 days from injury. Delayed presentation was associated with self-identification as Hispanic (rate ratio [RR], 1.93; 95% confidence interval [CI]: 1.17, 3.12]) and with marijuana use (RR, 1.59; 95% CI: 1.08, 2.36), whereas significantly earlier presentation was associated with a non-English language preference (RR, 0.64; 95% CI: 0.46, 0.89), alcohol abuse (RR, 0.74; 95% CI: 0.55, 0.99), and illicit drug use (RR, 0.30; 95% CI: 0.14, 0.67). Ankle fracture surgery was offered to 274 patients (85%). Experiencing homelessness was associated with a decreased likelihood of being offered surgery (odds ratio [OR], 0.15; 95% CI: 0.03, 0.69). Of patients who were offered surgery, 216 (79%) underwent surgery. Black patients underwent surgery significantly less frequently than patients who identified as White (OR, 0.14; 95% CI: 0.01, 0.77). The median time from evaluation to surgery was 11 days (interquartile range, 7 to 14 days). Patients who used illicit drugs experienced a mean delay to surgery of 6.0 days relative to those who did not use illicit drugs (mean time to surgery, 16.8 ± 7.1 and 10.8 ± 5.1 days, respectively).</p><p><strong>Conclusions: </strong>We identified disparities in access to and utilization of surgical care for unstable AO/OTA 44B2 ankle fractures that negatively affected patients with Medicaid insurance who identified as Hispanic or Black, were experiencing homelessness, or used illicit drugs. These disparities may negatively affect outcomes for patients receiving care in similar environments, such as capitated health-care networks and public safety-net health systems.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773236","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":"Both-Bone Forearm Shaft Fractures Treated with Compression Plate Fixation in Adults: A Systematic Review on Adverse Events and Outcomes.","authors":"Henri Vasara, Antti Stenroos, Samuli Aspinen, Jussi Kosola, Turkka Anttila, Panu H Nordback","doi":"10.2106/JBJS.OA.24.00129","DOIUrl":"10.2106/JBJS.OA.24.00129","url":null,"abstract":"<p><strong>Background: </strong>Both-bone forearm shaft fractures (BBFFs) in adults carry a significant risk of adverse events (AEs). Based on the current literature, there is considerable variance in AE incidence reporting. We aimed to systematically review the literature on BBFFs in adults treated with compression plate fixation, assessing AEs and long-term outcomes.</p><p><strong>Methods: </strong>We performed a systematic review based on the PubMed database on the current literature on adult BBFFs treated with open reduction and internal fixation with compression plates. Two authors independently collected the data, and a third author resolved disagreements between the 2 reviewers. The primary outcome measure was postoperative AEs, whereas the secondary outcome was to review the long-term outcomes. We evaluated the methodological quality of the studies with a modified version of the Coleman Methodology Score.</p><p><strong>Results: </strong>Fifteen studies (12 retrospective case series and 3 randomized controlled trials) met the set inclusion criteria. In total, there were 944 patients, of whom 24% (n = 224) experienced some AEs, and 14% had major AEs requiring secondary operations or remaining persistent. The most common AEs were postoperative nerve injuries (incidence 7%, n = 64/944) and fracture nonunion (incidence 5%, n = 45/944). Disabilities of the Arm, Shoulder, and Hand scores were available for 135 patients (5 studies), with a mean score of 12.5 (range 0-61). According to the modified Coleman Methodology Scores, there were 2 good-, 1 fair-, and 12 poor-quality studies among the included studies.</p><p><strong>Conclusion: </strong>BBFF compression plate fixation in adults poses a relatively high AE risk (24%). According to available patient-reported outcomes and range of motion measurements, the average postoperative outcomes are good, although a minor disability typically persists to some extent. There is a need for high-quality prospective trials assessing the treatment and outcomes of BBFFs in adults to improve forearm fracture treatment.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733280","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":"Exploring the Performance of ChatGPT in an Orthopaedic Setting and Its Potential Use as an Educational Tool.","authors":"Arthur Drouaud, Carolina Stocchi, Justin Tang, Grant Gonsalves, Zoe Cheung, Jan Szatkowski, David Forsh","doi":"10.2106/JBJS.OA.24.00081","DOIUrl":"10.2106/JBJS.OA.24.00081","url":null,"abstract":"<p><strong>Introduction: </strong>We assessed ChatGPT-4 vision (GPT-4V)'s performance for image interpretation, diagnosis formulation, and patient management capabilities. We aim to shed light on its potential as an educational tool addressing real-life cases for medical students.</p><p><strong>Methods: </strong>Ten of the most popular orthopaedic trauma cases from OrthoBullets were selected. GPT-4V interpreted medical imaging and patient information, providing diagnoses, and guiding responses to OrthoBullets questions. Four fellowship-trained orthopaedic trauma surgeons rated GPT-4V responses using a 5-point Likert scale (strongly disagree to strongly agree). Each of GPT-4V's answers was assessed for alignment with current medical knowledge (accuracy), rationale and whether it is logical (rationale), relevancy to the specific case (relevance), and whether surgeons would trust the answers (trustworthiness). Mean scores from surgeon ratings were calculated.</p><p><strong>Results: </strong>In total, 10 clinical cases, comprising 97 questions, were analyzed (10 imaging, 35 management, and 52 treatment). The surgeons assigned a mean overall rating of 3.46/5.00 to GPT-4V's imaging response (accuracy 3.28, rationale 3.68, relevance 3.75, and trustworthiness 3.15). Management questions received an overall score of 3.76 (accuracy 3.61, rationale 3.84, relevance 4.01, and trustworthiness 3.58), while treatment questions had an average overall score of 4.04 (accuracy 3.99, rationale 4.08, relevance 4.15, and trustworthiness 3.93).</p><p><strong>Conclusion: </strong>This is the first study evaluating GPT-4V's imaging interpretation, personalized management, and treatment approaches as a medical educational tool. Surgeon ratings indicate overall fair agreement in GPT-4V reasoning behind decision-making. GPT-4V performed less favorably in imaging interpretation compared with its management and treatment approach performance. The performance of GPT-4V falls below our fellowship-trained orthopaedic trauma surgeon's standards as a standalone tool for medical education.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733281","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":"Nonoperative Care Versus Surgery for Degenerative Cervical Myelopathy: An Application of a Health Economic Technique to Simulate Head-to-Head Comparisons.","authors":"Markian Pahuta, Mohamed Sarraj, Jason Busse, Daipayan Guha, Mohit Bhandari","doi":"10.2106/JBJS.OA.23.00166","DOIUrl":"10.2106/JBJS.OA.23.00166","url":null,"abstract":"<p><strong>Background: </strong>Degenerative cervical myelopathy (DCM) occurs when spondylotic changes compress the spinal cord and cause neurologic dysfunction. Because of a lack of comparative data on nonoperative care versus surgery for DCM, it has been difficult to support patients through the shared decision-making process regarding treatment options. Our objective was to synthesize the best available data in a manner that helps clinicians and patients to weigh the differences between nonoperative care and surgery at different ages and disease severity. The 2 patient-centered questions we sought to answer were (1) \"am I more likely to experience worsening myelopathy with nonoperative care, or need more surgery if I have my myelopathy treated operatively?\" and (2) \"how much better will my quality of life be with nonoperative care versus surgery?\"</p><p><strong>Methods: </strong>We used a health economic technique, microsimulation, to model head-to-head comparisons of nonoperative care versus surgery for DCM. We incorporated the best available data, modeled patients over a lifetime horizon, used direct comparators, and incorporated uncertainty in both natural history and treatment effect.</p><p><strong>Results: </strong>Patients with mild DCM at baseline who were ≥75 years of age were less likely to neurologically decline under nonoperative care than to undergo a second surgery if the index surgery was an anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (ADR), or posterior cervical decompression and instrumented fusion (PDIF). Using quality-adjusted life-years (QALYs), our results suggest that surgery for DCM may be superior to nonoperative care. However, for all patients except those with severe DCM who are of middle age or younger (depending on the procedure, ≤50 to ≤60 years of age), the lower bound of the 95% confidence interval for the estimated difference in QALYs was <0.</p><p><strong>Conclusions: </strong>In most patient groups, neurologic progression with nonoperative management is more likely than the need for additional cervical surgery following operative management, with the exception of patients 75 to 80 years of age and older with mild DCM. Furthermore, on average, surgery for DCM tends to improve quality of life. However, patients with DCM who are older than middle age should be aware that the estimates of the quality-of-life benefit are highly uncertain, with a lower bound of <0.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689002","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":"Reoperation Rate After Posterior Spinal Fusion Varies Significantly by Lenke Type.","authors":"Peter Boufadel, Daniel Badin, Amer F Samdani, Paul D Sponseller","doi":"10.2106/JBJS.OA.23.00179","DOIUrl":"10.2106/JBJS.OA.23.00179","url":null,"abstract":"<p><strong>Background: </strong>Lenke curve types can vary in their response to treatment. We explored potential differences in reoperation rates, causes, and risk factors among patients with different Lenke types who underwent posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>We studied a multicenter database of patients with AIS who underwent index PSF at ≤21 years of age and had a minimum 2-year follow-up. Baseline and surgical characteristics were collected. Reoperation rates, causes, and risk factors were analyzed by Lenke type.</p><p><strong>Results: </strong>A total of 3,165 patients were included. The mean age was 14.6 years, and most patients were female (81%) and Caucasian (68%). The mean follow-up period was 4.4 years. A total of 138 patients (4.4%) underwent reoperation. The reoperation rate varied by Lenke type (p = 0.02): patients with type-5 curves had the highest reoperation rate (7.2%), and those with type-1 curves had the lowest (3.0%). The most common cause of reoperation was an instrumentation complication. The rate of reoperation due to an instrumentation complication varied by Lenke type (p < 0.01). Compared with patients with type-1 curves, those with type-5 curves had significantly higher rates of reoperation due to implant prominence (odds ratio [OR], 11.7; p = 0.03), loss of fixation (OR, 3.9; p = 0.01), or a broken rod (OR, 7.8; p = 0.02) and those with type-3 curves had a significantly higher rate of reoperation due to loss of fixation (OR, 4.37; p = 0.01). Independent risk factors for reoperation were a major curve magnitude of ≥60° in patients with type-5 curves (adjusted OR [aOR], 4.18; p = 0.04), a major curve correction of ≥40° in patients with type-5 curves (aOR, 3.6; p = 0.04), and a lowest instrumented vertebra (LIV) at or above L1 in patients with type-1 curves (aOR, 2.8; p = 0.02).</p><p><strong>Conclusions: </strong>The reoperation rate for patients with AIS who underwent PSF varied by Lenke type. Patients with type-5 curves had the highest reoperation rate, whereas patients with type-1 curves had the lowest. Patients with Lenke type-5 curves had a higher rate of reoperation due to instrumentation complications.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683009","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":"Collagenase <i>Clostridium histolyticum</i> Versus Needle Fasciotomy for Primary Metacarpophalangeal Dupuytren Contracture: Five-Year Results from a Randomized Controlled Trial.","authors":"Ingi Thor Hauksson, Morten Beier Havdal, Jūratė Šaltytė Benth, Sigurd E Hoelsbrekken, Per-Henrik Randsborg","doi":"10.2106/JBJS.OA.24.00038","DOIUrl":"10.2106/JBJS.OA.24.00038","url":null,"abstract":"<p><strong>Background: </strong>Collagenase <i>Clostridium histolyticum</i> (CCH) and percutaneous needle fasciotomy (PNF) are 2 treatment options for Dupuytren disease. The purpose of this study was to compare these 2 methods in terms of clinical and patient-reported outcomes.</p><p><strong>Methods: </strong>Eighty patients (median age, 72 years; 83% male) with a single-digit primary metacarpophalangeal (MCP) joint contracture of ≥30° were randomized to either CCH or PNF and followed for 5 years. The primary outcome was the difference in flexion-contracture reduction at the MCP joint from baseline to 2 years, with additional analysis examining the effect of the primary endpoint variable up to 5 years. Secondary outcomes included complications, grip strength, scores on the visual analogue scale (VAS) for pain, the shortened version of the Disabilities of the Arm, Shoulder and Hand, the brief Michigan Hand Questionnaire, Unité Rhumatologique des Affections de la Main, and a VAS for treatment satisfaction as well as recurrence and retreatments.</p><p><strong>Results: </strong>The mean MCP joint contracture was 48° at baseline and 2° at 5 years in the CCH group, and 50° at baseline and 7° at 5 years in the PNF group. The reduction in MCP contracture at 2 years was larger in the CCH group than in the PNF group, with a mean difference between the groups of 12° (95% confidence interval [CI], 1.5° to 22.3°; p = 0.026). At 5 years, this mean difference was reduced to 6° (-1.5° to 12.8°; p = 0.1). There was no difference between the groups in any patient-reported outcome scores or grip strength beyond 4 weeks, with the exception of the brief Michigan Hand Questionnaire at 5 years. Ten (25%) of the patients in the PNF group compared with no patient in the CCH group had recurrence (contracture of ≥30°) at the MCP joint at 2 years. At 5 years, 17 (42.5%) of 40 patients in the PNF group had been retreated compared with 4 (10%) of 40 in the CCH group (p < 0.001). The CCH group experienced more transient complications (stiffness and hematoma) during the first week and were more satisfied (VAS satisfaction) from 1 year to the 5-year follow-up.</p><p><strong>Conclusions: </strong>The main finding of this study is that CCH and PNF were equally effective in reducing MCP flexion contracture, but the correction of contracture lasted longer in the CCH group.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683008","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 Dedicated Research Rotation Increases Orthopaedic Residency Scholarly Activity.","authors":"Nathan Angerett, Christopher Ferguson, Matthew Kelly, Timothy Ackerman","doi":"10.2106/JBJS.OA.24.00075","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00075","url":null,"abstract":"<p><strong>Introduction: </strong>Although clinical research has traditionally been a part of orthopaedic residency, there are now certain core requirements created by the Accreditation Council for Graduate Medical Education (ACGME), which outline the type of research activities to be completed during residency. However, there are no specific details included in the ACGME guidelines regarding how these milestones are to be met. Nor is there specificity regarding expectations of scholarly activity to be completed by the time of graduation. There is a paucity of literature demonstrating the effectiveness of implementing a dedicated research block in an orthopaedic surgical residency, especially in the community setting where limited research-related resources are available.</p><p><strong>Methods: </strong>We implemented a dedicated research rotation along with a set of research milestones and guidelines at our single orthopaedic surgery community residency program. A search was performed through PubMed using residents' and faculty members' names to find publications included a 7-year period from 2015 to 2022 to determine number of publications by residents and faculty. Scholarly activity of faculty was analyzed and quantified using self-reported annual surveys.</p><p><strong>Results: </strong>The average annual number of resident publications (by all 25 residents) increased from 2 to 26 after implementation of a dedicated research rotation. Faculty's scholarly activity, as measured by the following criteria, increased as well: number of publications (from 22 to 55), conference presentations (from 51 to 83), and other presentations (from 43 to 72).</p><p><strong>Conclusion: </strong>Implementation of a dedicated research rotation in a community orthopaedic residency program is associated with an increased publication rate in major academic journals among residents and faculty. There is also an observed association with implementation of a dedicated resident research rotation and an increase in faculty scholarly activity satisfying ACGME faculty requirements.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629512","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}