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Spasticity: principles of orthopaedic management of upper and lower limb spasticity secondary to stroke 痉挛：中风继发的上肢和下肢痉挛的骨科治疗原则
Orthopaedics and Trauma Pub Date : 2026-08-01 Epub Date: 2026-07-09 DOI: 10.1016/j.mporth.2026.05.009
Rebecca Lewis, Sameera Abas, Catriona Heaver, Simon Hill, Simon Pickard
{"title":"Spasticity: principles of orthopaedic management of upper and lower limb spasticity secondary to stroke","authors":"Rebecca Lewis,&nbsp;Sameera Abas,&nbsp;Catriona Heaver,&nbsp;Simon Hill,&nbsp;Simon Pickard","doi":"10.1016/j.mporth.2026.05.009","DOIUrl":"10.1016/j.mporth.2026.05.009","url":null,"abstract":"<div><div>Stroke (cerebrovascular accident) is an extremely common disease with an estimated incidence of 100,000 per year in the UK. Up to 30% of patients will develop spasticity following stroke, the sequelae of which can have a significant impact on patients' abilities to carry out activities of daily living (ADLs), leading to a significant reduction in function and independence levels. Abnormal limb posture as a consequence of an upper motor neurone lesion affects patients' ability to ambulate and carry out simple hygiene; increases the risk of pressure sores, and can have a lasting impact on patients’ self-perception and image. In the upper limb there are multiple patterns of deformity whereas in the lower limb the predominant pattern is an equinovarus position of the foot and ankle. This article summarizes the principles of orthopaedic assessment and treatment for both upper and lower limb spasticity in stroke patients with a review of contemporary orthopaedic literature. Many of the principles described are also relevant to spasticity secondary to other upper motor neurone pathologies.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 4","pages":"Pages 242-250"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666856","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}
引用次数: 0
Biomechanics of the knee 膝关节的生物力学
Orthopaedics and Trauma Pub Date : 2026-08-01 Epub Date: 2026-07-10 DOI: 10.1016/j.mporth.2026.05.003
Dexter E. Zamora-Lagasca, Anthony M.J. Bull, Angela E. Kedgley
{"title":"Biomechanics of the knee","authors":"Dexter E. Zamora-Lagasca,&nbsp;Anthony M.J. Bull,&nbsp;Angela E. Kedgley","doi":"10.1016/j.mporth.2026.05.003","DOIUrl":"10.1016/j.mporth.2026.05.003","url":null,"abstract":"<div><div>The knee is a multifaceted joint complex that must sustain loading equivalent to multiple times an individual's bodyweight while maintaining stability and permitting the large range of motion required for daily activity. Normal knee function depends on the integrated interactions between the bones' articular geometry and the surrounding soft tissues in its tibiofemoral and patellofemoral joints. This article summarizes key principles of knee biomechanics, with an emphasis on functional anatomy, tibiofemoral and patellofemoral kinematics, soft-tissue contributions to stability, and load distribution. These principles highlight the coupled motions, passive and active restraints and joint loading that occur during knee flexion and extension. Their clinical relevance is illustrated through common knee pathologies that can be described as disruptions to these biomechanical functions. A clear understanding of knee biomechanics provides an important framework for interpreting common disorders and for informing their clinical management.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 4","pages":"Pages 195-203"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666810","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}
引用次数: 0
Management of ballistic trauma in the civilian population 平民弹道创伤的处理
Orthopaedics and Trauma Pub Date : 2026-08-01 Epub Date: 2026-07-10 DOI: 10.1016/j.mporth.2026.05.007
Stratton King, Benjamin Caesar
{"title":"Management of ballistic trauma in the civilian population","authors":"Stratton King,&nbsp;Benjamin Caesar","doi":"10.1016/j.mporth.2026.05.007","DOIUrl":"10.1016/j.mporth.2026.05.007","url":null,"abstract":"<div><div>Ballistic trauma presents challenges that differ markedly from other injury patterns, particularly in civilian practice, where such cases form only a small proportion of most departments’ workload. This review provides a region-based overview of common ballistic injuries and the key considerations that guide their assessment and management. While initial resuscitation is anchored in the Advanced Trauma Life Support (ATLS) framework, the article focuses on the decisions that arise once the patient leaves the resuscitation bay, where clinicians must interpret wound behaviour, anticipate evolving tissue injury, and plan appropriate operative or non-operative strategies. Current evidence on antibiotic use, wound management and the increasing role of selective non-operative approaches is summarized. This review also addresses common misconceptions in ballistic care and highlights how the growing prevalence of high energy weapons in civilian settings has altered expected wound patterns and management priorities. The aim is to provide a clear, practical guide that strengthens clinical reasoning and supports safe, contemporary management of civilian ballistic trauma.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 4","pages":"Pages 226-232"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666911","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}
引用次数: 0
Answers to the CME questions on The Shoulder 关于肩部的CME问题解答
Orthopaedics and Trauma Pub Date : 2026-08-01 Epub Date: 2026-07-08 DOI: 10.1016/j.mporth.2026.05.010
{"title":"Answers to the CME questions on The Shoulder","authors":"","doi":"10.1016/j.mporth.2026.05.010","DOIUrl":"10.1016/j.mporth.2026.05.010","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 4","pages":"Page 253"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666814","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}
引用次数: 0
CME questions on Principles of Orthopaedics 关于骨科原理的CME问题
Orthopaedics and Trauma Pub Date : 2026-08-01 Epub Date: 2026-07-08 DOI: 10.1016/j.mporth.2026.05.011
{"title":"CME questions on Principles of Orthopaedics","authors":"","doi":"10.1016/j.mporth.2026.05.011","DOIUrl":"10.1016/j.mporth.2026.05.011","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 4","pages":"Pages 251-252"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666857","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}
引用次数: 0
Bone and joint infection: clinical types, diagnostic approach and treatment 骨关节感染：临床类型、诊断方法和治疗
Orthopaedics and Trauma Pub Date : 2026-08-01 Epub Date: 2026-07-10 DOI: 10.1016/j.mporth.2026.05.005
Valeria Pintar, Benjamin Holmes, Athanasios I Tsirikos
{"title":"Bone and joint infection: clinical types, diagnostic approach and treatment","authors":"Valeria Pintar,&nbsp;Benjamin Holmes,&nbsp;Athanasios I Tsirikos","doi":"10.1016/j.mporth.2026.05.005","DOIUrl":"10.1016/j.mporth.2026.05.005","url":null,"abstract":"<div><div>The diagnosis and management of bone and joint infection, both in the context of the native skeleton and in the presence of prostheses, is one of the greatest tasks facing modern orthopaedic surgeons and patients. Anatomical, physiological, microbiological and mechanical factors render these infections especially complex. Successful eradication of infection with concomitant maintenance of a mechanically functional skeleton poses a unique challenge requiring complex surgical decision making and cohesive multidisciplinary collaboration. These infections, which cause significant patient morbidity, mortality, and elevated healthcare costs, are on the rise and are becoming an integral part of the orthopaedic workload. Although bone and joint infection is a rapidly evolving field, consensus has not been achieved on many clinical aspects. This review summarizes the presentation, diagnosis and current management strategies for native joint septic arthritis, osteomyelitis, spondylodiscitis, fracture-related infection and prosthetic joint infection in the adult patient population.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 4","pages":"Pages 211-218"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666812","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}
引用次数: 0
Sarcopenia: diagnosis, management and its relevance to orthopaedic practice 骨骼肌减少症：诊断、管理及其与骨科实践的相关性
Orthopaedics and Trauma Pub Date : 2026-08-01 Epub Date: 2026-07-10 DOI: 10.1016/j.mporth.2026.05.008
Brian Rigney, Paul McCarroll, Danilo Vukanic
{"title":"Sarcopenia: diagnosis, management and its relevance to orthopaedic practice","authors":"Brian Rigney,&nbsp;Paul McCarroll,&nbsp;Danilo Vukanic","doi":"10.1016/j.mporth.2026.05.008","DOIUrl":"10.1016/j.mporth.2026.05.008","url":null,"abstract":"<div><div>Sarcopenia is a progressive skeletal muscle disorder characterized by age-related loss of muscle mass, strength and function. It is independently associated with adverse clinical outcomes, including fractures, falls, disability and increased mortality. It represents a potentially modifiable surgical risk factor within the broader umbrella of frailty. Diagnosis is based on assessment of muscle strength and function, with or without quantitative measures of muscle mass. Current management strategies focus on resistance exercise and nutritional optimization, predominantly through increased protein intake and targeted amino acid supplementation. The relevance of sarcopenia to orthopaedic practice is increasingly recognized, particularly in patients sustaining fragility fractures and those undergoing elective joint replacement surgery. Orthopaedic surgeons are uniquely positioned to identify sarcopenia through functional assessment and to implement early interventions. Incorporating pre-operative screening and structured prehabilitation programmes may optimize functional reserve and improve post-operative outcomes in sarcopenic patients.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 4","pages":"Pages 233-241"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666855","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}
引用次数: 0
Recent advances in rheumatoid arthritis and other arthropathies 类风湿关节炎和其他关节病的最新进展
Orthopaedics and Trauma Pub Date : 2026-08-01 Epub Date: 2026-07-10 DOI: 10.1016/j.mporth.2026.05.002
Simon Paul
{"title":"Recent advances in rheumatoid arthritis and other arthropathies","authors":"Simon Paul","doi":"10.1016/j.mporth.2026.05.002","DOIUrl":"10.1016/j.mporth.2026.05.002","url":null,"abstract":"<div><div>Over the last 25 years, rheumatology has seen a huge expansion in agents available to treat inflammatory joint diseases, including rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis, as well as osteoarthritis and autoimmune rheumatic diseases such as systemic lupus erythematosus. These therapeutic advances have evolved through our deeper understanding of the pathogenesis of immune pathways and the interplay of omics, as well as realization of the heterogeneity within single phenotypes. We now have the real prospect of being able to offer patients remission, and in some, drug-free remission. This article discusses these advances and the challenges, in terms of disease interception, diagnosis and imaging, novel therapeutic approaches, the role of precision medicine, the influence of the menopause in rheumatic symptoms, managing comorbidities, as well as peri-operative issues for patients who require disease-modifying anti-rheumatic medications.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 4","pages":"Pages 182-194"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666809","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}
引用次数: 0
Peripheral nerve injuries, regeneration and repair 周围神经损伤，再生和修复
Orthopaedics and Trauma Pub Date : 2026-08-01 Epub Date: 2026-07-10 DOI: 10.1016/j.mporth.2026.05.001
David Okata, Karim Tokeisham, Princewill Chiemelu Okoye, Ashish Varughese Mammen
{"title":"Peripheral nerve injuries, regeneration and repair","authors":"David Okata,&nbsp;Karim Tokeisham,&nbsp;Princewill Chiemelu Okoye,&nbsp;Ashish Varughese Mammen","doi":"10.1016/j.mporth.2026.05.001","DOIUrl":"10.1016/j.mporth.2026.05.001","url":null,"abstract":"<div><div>Peripheral nerve injuries (PNIs) represent a significant clinical challenge, frequently affecting otherwise healthy individuals and leading to substantial motor, sensory and autonomic dysfunction. This article provides a comprehensive review of the fundamental aspects of PNIs, including the underlying anatomy, common aetiologies, and classifications of PNI using the Seddon and Sunderland systems. The pathophysiology of nerve injury is explored in detail describing the critical processes of Wallerian degeneration and the subsequent regenerative cascade, which are essential for determining the timing and approach to intervention. Clinical evaluation (combining detailed history, physical examination, electrodiagnostic studies, and advanced imaging such as MRI scans) is crucial for accurate localization and characterization of the injury. The current clinical management strategies, ranging from non-operative rehabilitation for low-grade injuries to surgical interventions for more severe injuries are also discussed in detail. Finally, we discuss emerging therapies designed to overcome the limitations of traditional repair. These therapies hold significant promise for enhancing axonal regeneration and functional recovery, though rigorous clinical trials are necessary to establish their efficacy and facilitate routine clinical adoption.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 4","pages":"Pages 176-181"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666848","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}
引用次数: 0
CME questions on Principles of Orthopaedics 关于骨科原理的CME问题
Orthopaedics and Trauma Pub Date : 2026-08-01 Epub Date: 2026-07-08 DOI: 10.1016/j.mporth.2026.05.011
{"title":"CME questions on Principles of Orthopaedics","authors":"","doi":"10.1016/j.mporth.2026.05.011","DOIUrl":"10.1016/j.mporth.2026.05.011","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 4","pages":"Pages 251-252"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666805","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}
引用次数: 0
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