Orthopaedics and Trauma最新文献

{"title":"Management of the spine in the polytrauma victim","authors":"M Zaki B Choudhury,&nbsp;Athanasios I Tsirikos","doi":"10.1016/j.mporth.2025.01.002","DOIUrl":"10.1016/j.mporth.2025.01.002","url":null,"abstract":"<div><div>Major trauma is a common occurrence globally and a leading cause of death in younger patients. Its definition and epidemiology is described in depth elsewhere in the symposium. In the UK there are approximately 22,000 cases presenting per year. Overall management strategy dictates that major trauma is directed to centres experienced in its management. It is, however, important that all clinicians recognize and are aware of it, with implications for resource utilization. The spine can be injured through a variety of mechanisms but importantly in major trauma it is unusual for the spine to be injured in isolation, unless a direct impact is sustained. Conversely, it is critical to be aware of the possibility of vertebral and spinal cord injury which may be masked by distracting injury. Strategies and guidelines for the management of the spine in major trauma will be discussed, and some case examples will be shown in order to demonstrate key concepts and pitfalls.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 2","pages":"Pages 95-104"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791582","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":"CME questions on Major Trauma","authors":"","doi":"10.1016/j.mporth.2025.01.008","DOIUrl":"10.1016/j.mporth.2025.01.008","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 2","pages":"Pages 133-134"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791745","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":"Special considerations for major trauma in pregnancy and childhood","authors":"Marwan Ibrahim,&nbsp;Marjan Raad,&nbsp;Alastair Robertson","doi":"10.1016/j.mporth.2025.01.003","DOIUrl":"10.1016/j.mporth.2025.01.003","url":null,"abstract":"<div><div>Managing trauma in pregnant women and children is challenging due to their unique anatomical and physiological features. This paper aims to explore the special considerations needed for trauma management in these vulnerable populations, emphasizing the need for patient-centred approaches. Trauma in pregnancy involves a balance between maternal and fetal well-being, requiring adjustment to resuscitation protocols, to tailor for the maternal physiological changes during pregnancy, and continuous fetal monitoring with the collaborative help of neonatologists and obstetricians. The challenges in paediatric trauma are focused on avoiding long-term developmental defects, especially after growth plate injuries that may lead to limb discrepancies, or complete growth arrests. This requires age-specific interventions and a robust rehabilitation strategy to minimize long-term complications following trauma. This paper also highlights the importance of simulation-based learning and medico-legal understanding for orthopaedic trainees. Future studies should focus on optimizing maternal and fetal health following trauma, with a focus on delivery methods, and creating innovative strategies to minimize long-term outcomes in paediatric patients. Understanding the unique nature of these vulnerable populations allows the clinician to respond effectively, optimizing the outcomes and trauma care.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 2","pages":"Pages 105-110"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791846","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":"Answers to the CME questions on Knee Arthroplasty","authors":"","doi":"10.1016/j.mporth.2025.01.007","DOIUrl":"10.1016/j.mporth.2025.01.007","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 2","pages":"Page 135"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791746","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-energy distal femur fractures: an update","authors":"Henry C Chandler","doi":"10.1016/j.mporth.2025.01.004","DOIUrl":"10.1016/j.mporth.2025.01.004","url":null,"abstract":"<div><div>Distal femur fractures follow a typical bimodal distribution between higher energy fractures affecting a younger population and lower energy fractures affecting a more elderly population. This article focuses on the former and the unique challenges they pose to the treating orthopaedic surgeon. Starting with initial assessment and early management there is discussion regarding appropriate investigation and classification of these injuries before moving on to discuss different techniques in their surgical management. These are complex injuries with potential for significant lifelong morbidity and as such the definitive management should be meticulously planned with appropriate input from experienced clinicians as well as other specialties and disciplines. There will and should be differences of opinion regarding ‘the best’ surgical technique for fixing these fractures, but the aim should be to restore pain-free function to the patient and limit the long-term sequelae of their injury.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 2","pages":"Pages 111-117"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791847","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 overview of open fracture management","authors":"Anthony Rayner,&nbsp;Arthur Chen Wun Tan,&nbsp;Enis Guryel,&nbsp;Alastair Robertson","doi":"10.1016/j.mporth.2025.01.001","DOIUrl":"10.1016/j.mporth.2025.01.001","url":null,"abstract":"<div><div>Open fractures are complex and potentially limb-threatening injuries. Early, systematic and thorough treatment of all fractures can reduce the risk of life-changing consequences, regardless of injury severity. In the UK, national guidelines have been established to standardize care and improve outcomes. The recent adoption of the multidisciplinary orthoplastics approach focuses on the key management principles of reducing infection risk, skeletal stabilization and timely soft tissue coverage. These principles encompass multiple aspects of care, starting from standardized trauma care at the time of injury, to the complex management of potential critical-sized bone defects. These injuries and their consequences can also lead to significant psychological distress. Therefore, recognizing and addressing this is vital in providing holistic care for the patient. This review aims to summarize the current management of open fractures and explore the evidence surrounding these aspects of care.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 2","pages":"Pages 86-94"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791659","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":"At the peak: a review of current diagnostic and therapeutic concepts surrounding tibial plateau fractures","authors":"Babajide Simon Taiwo,&nbsp;Adeife Benjamin Erinfolami,&nbsp;Chido Donald Nwankwo,&nbsp;Effie Menyah,&nbsp;Princewill Chiemelu Okoye,&nbsp;Alastair Robertson","doi":"10.1016/j.mporth.2025.01.005","DOIUrl":"10.1016/j.mporth.2025.01.005","url":null,"abstract":"<div><div>Tibial plateau fractures are complex injuries commonly resulting from high-energy trauma in younger patients or low-energy falls in the elderly. They significantly impair knee function and overall quality of life, often leading to complications such as post-traumatic osteoarthritis and knee stiffness. This review looks at current diagnostic modalities, epidemiological data, anatomical considerations, and therapeutic strategies for managing tibial plateau fractures, highlighting advancements in treatment and outcomes. The well-established Schatzker and AO/OTA systems of classification have evolved alongside emerging frameworks like the three-column classification and ten-segment concepts that utilize three-dimensional imaging technologies. Tibial plateau fractures have an estimated incidence of 10.3 per 100,000 people, with males affected more frequently than females. The incidence increases with age, particularly among women in their seventh decade. The management of tibial plateau fractures can involve either non-operative or operative interventions. While minimally displaced fractures may be treated conservatively, more complex cases typically require surgical procedures such as open reduction and internal fixation or arthroscopically assisted techniques. Recent improvements in rehabilitation protocols and surgical techniques aim to enhance recovery and minimize complications. Long-term assessments indicate that functional deficits and complications persist in many patients following tibial plateau fractures. Factors such as age, fracture type, and soft tissue integrity significantly influence recovery trajectories. Effective management of tibial plateau fractures requires a multi-faceted approach that utilizes imaging techniques, judicious surgical intervention, and patient-tailored rehabilitation. Further research is needed to refine treatment protocols and establish standardized methods for evaluating functional outcomes.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 2","pages":"Pages 118-124"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791848","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":"Tibial shaft fractures: current concepts","authors":"Arthur Chen Wun Tan,&nbsp;Anthony Rayner,&nbsp;Alastair Robertson","doi":"10.1016/j.mporth.2025.01.006","DOIUrl":"10.1016/j.mporth.2025.01.006","url":null,"abstract":"<div><div>In the adult population, tibial shaft fractures make up a significant portion of both closed and open long bone fractures. These injuries are often associated with high-energy trauma and have considerable financial impact on healthcare resources. Hence, it is crucial that these injuries are appropriately managed to provide optimal patient outcomes. The OTA/AO classification is frequently used to describe these fractures and are used in conjunction with the Gustilo–Anderson classification when open fractures are present. Along with conventional radiographs, modern imaging techniques such as computed tomography should be considered given their associations with intra-articular fractures. Primary treatment strategies aim to minimize further insult to soft tissues surrounding the fracture, prevent and/or recognize compartment syndrome, re-establish limb alignment and allow for early mobilization. Closed fractures may be treated conservatively or surgically, while open fractures require surgical intervention, sometimes in multiple stages. Postoperative care, including rehabilitation and weight-bearing guidelines, depends on injury severity and fracture type. Although scoring systems for fracture healing exist, specific validated functional outcome measures for tibial fractures are lacking. This review is aims to re-visit basic concepts and provide updates in the management of tibial shaft fractures.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 2","pages":"Pages 125-132"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791744","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":"Prehabilitation and rehabilitation for total knee replacement surgery: physiotherapy interventions in personalized medicine and charting a course towards optimal outcomes","authors":"Nicholas C Clark","doi":"10.1016/j.mporth.2024.12.012","DOIUrl":"10.1016/j.mporth.2024.12.012","url":null,"abstract":"<div><div>Physiotherapy is a critical component in the multidisciplinary team approach to supporting patients to achieve optimal outcomes after the onset of knee osteoarthritis and progression to total knee replacement (TKR) surgery. Physiotherapists possess a wide range of scientifically-informed and evidence-based intervention techniques that can be combined to differing degrees and integrated in differing contexts for the multi-modal, personalized and holistic rehabilitation of patients after TKR surgery. The purpose of this paper is to offer the reader advice and instruction on specific considerations in physiotherapy practice for people preparing for and recovering from TKR surgery. Emphasis is placed on a clinically-reasoned and rational approach with a solid foundation in science and pragmatic clinical practice. Specific comments and recommendations are made regarding defining optimal outcomes after TKR surgery, framing optimal outcomes relative to models of clinical reasoning, the association between impairments (e.g. quadriceps muscle weakness) and physical activity limitations (e.g. inability to walk), physiotherapy intervention techniques in personalized medicine, physiotherapy intervention techniques in prehabilitation and rehabilitation, physiotherapy effectiveness after TKR surgery, and physiotherapy rehabilitation session design and progression. The ideal approach to physiotherapy practice for people preparing for and recovering from TKR surgery is also considered, along with the contribution of outpatient physiotherapy to post-surgery patient satisfaction. Collaboration between the general practitioner, surgeon, physiotherapist, other allied health professionals and the patient is necessary to best influence the probability for optimal outcomes after TKR surgery.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 1","pages":"Pages 65-73"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142943","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":"Technical challenges in revision total knee arthroplasty","authors":"Alexander Maslaris,&nbsp;Abtin Alvand","doi":"10.1016/j.mporth.2024.12.007","DOIUrl":"10.1016/j.mporth.2024.12.007","url":null,"abstract":"<div><div>The number of revision total knee arthroplasty procedures is on the increase, and the modern-day arthroplasty surgeon must be equipped to deal with this growing challenge. Every revision can differ, in terms of the technical challenges encountered. These can include issues with exposure, joint line reconstruction, as well as bone loss and ligament deficiency. A standardized approach to these problems is required to optimize the outcome of surgery. This review aims to provide a simple yet comprehensive approach to dealing with the technical challenges encountered during revision knee arthroplasty.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"39 1","pages":"Pages 55-64"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142944","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}