JBJS Reviews最新文献

{"title":"Fracture Management and Care in Pregnancy.","authors":"Kiran Sharma, Zina Smadi, Mohammad Munir Zaitoun, Fahad Nadeem, Abdullah Ghali, Toufic R Jildeh","doi":"10.2106/JBJS.RVW.25.00275","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00275","url":null,"abstract":"<p><p>» Pregnancy alters calcium balance, hormone regulation, and mechanical loading, which together lowers bone mineral density and increases risk of fractures. » Trauma during pregnancy carries significant maternal and fetal risk as low-mechanism injuries can trigger placental abruption, preterm labor, and fetal loss. » Imaging, anesthesia, and surgery require coordinated teams to provide care safely and optimize maternal and fetal outcomes. » Providers must verify pregnancy safety stratifications before medication selection.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718275","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":"Management of Pyogenic Flexor Tenosynovitis.","authors":"George M Anderson, Joshua D Proal, Christopher S Crowe, Stephen A Kennedy","doi":"10.2106/JBJS.RVW.26.00015","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.26.00015","url":null,"abstract":"<p><p>» Pyogenic flexor tenosynovitis (PFT) is an uncommon closed-space infection of the hand that can result in severe stiffness and other sequela. » When PFT is recognized and treated with antibiotics before advanced disease, surgery is often unnecessary to achieve a cure. » Physical examination features are helpful in differentiating PFT from other finger infections, particularly when considered together in aggregate. » Laboratory values such as systemic inflammatory markers are usually normal in early cases of PFT and are more likely to be elevated in other diagnoses like cellulitis. » Imaging findings such as x-ray, ultrasound, and computed tomography scan remain investigational and are not routinely used to make the diagnosis. » Stiffness and contracture are the most common sequela and benefit from early motion and hand therapy.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718375","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":"Treatment of Distal Clavicle Fractures in Adults: Evidence-Based Strategies for Treatment.","authors":"Dennis A DeBernardis, Tej Joshi, Swara R Kalva, Dario Fucich, Mandeep S Virk","doi":"10.2106/JBJS.RVW.25.00260","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00260","url":null,"abstract":"<p><p>» Distal clavicle fractures are less common, accounting for 10% to 30% of all clavicle fractures. » The presence of radiographic nonunion does not correlate with symptomatic nonunion, with a variable percentage of patients necessitating subsequent surgical intervention (20%). » Fracture displacement is associated with a higher risk of nonunion (31%-37%), particularly in Neer type II and V fracture patterns. » Nondisplaced distal clavicle fractures can be treated with nonoperative management (Neer types I, III, and IV). » Surgical treatment is indicated for displaced Neer type II and V fractures. Increased radiographic coracoclavicular (CC) distance in type II and V fractures is an indication for CC stabilization. However, there is no consensus on ideal fixation techniques for fracture fixation and CC stabilization. » Surgical treatment may require secondary implant removal, regardless of the fixation construct used (28%-55%) but especially common with hook plate fixation.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718390","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":"Revisiting Intranasal Salmon Calcitonin: Historical Osteoporosis Evidence and a Potential Role in Acute Orthopaedic Pain Management.","authors":"Areeb Ahmad, Kassem Ghayyad, Elisabeth Davis, Daniel Goltz, G Russell Huffman, Olamide Oshikoya","doi":"10.2106/JBJS.RVW.26.00021","DOIUrl":"10.2106/JBJS.RVW.26.00021","url":null,"abstract":"<p><p>» Intranasal salmon calcitonin (IN-CAL) is a well-tolerated, noninvasive antiresorptive agent with reproducible pharmacodynamic activity, despite lower systemic bioavailability than parenteral formulations. » In preosteoporotic postmenopausal women, IN-CAL provides small, spine-limited preservation of bone mass, with minimal hip or forearm benefit; treatment response depends more on baseline bone turnover than on dose escalation. » In established postmenopausal osteoporosis, IN-CAL produces early biochemical suppression (1-3 months) and small but consistent lumbar spine bone mineral density (BMD) gains with sustained therapy (≥6-12 months). » IN-CAL is less effective than bisphosphonates and modern anabolic agents for increasing BMD and reducing fracture risk; accordingly, its use is best reserved for patients who cannot take first-line therapies due to contraindications, intolerance, or personal preference. » IN-CAL provides short-term pain relief for vertebral fractures in osteoporosis and offers a similarly time-limited analgesic benefit in acute orthopaedic settings, with pain reduction often within days and biochemical or skeletal effects evolving over subsequent weeks.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13048325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634828","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":"Treatment Outcomes for Distal Radius Fractures: A Meta-Analysis.","authors":"Ki Woong Yoon, Jiayong Liu, Martin Skie","doi":"10.2106/JBJS.RVW.25.00254","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00254","url":null,"abstract":"<p><strong>Background: </strong>Distal radius fractures (DRFs) are among the most prevalent in upper-extremity injuries, particularly in older adults and individuals with osteoporosis. The common treatment options include surgical interventions such as volar locking plate (VLP) fixation and percutaneous pinning, as well as conservative strategies like splinting and bracing. However, the comparative effectiveness of these modalities remains unclear. This study aims to compare the functional outcomes and complication rates associated with VLP, percutaneous pinning, bracing, and splinting in the treatment of DRFs.</p><p><strong>Methods: </strong>A systematic search of PubMed, Google Scholar, and the Cochrane Library (September 2001-February 2025) identified randomized controlled trials, prospective cohort studies, and retrospective cohort studies comparing DRF treatments. Functional outcomes and complication rates (superficial infection, malunion, nonunion, delayed union) were analyzed. Data were analyzed using Review Manager Web with significance set at p ≤ 0.05.</p><p><strong>Results: </strong>Twenty-seven studies involving 3,200 patients met inclusion criteria: VLP fixation (n = 896), percutaneous pinning (n = 666), splinting (n = 718), and bracing (n = 903). No significant differences were observed between VLP and splinting or between bracing and splinting for Disabilities of the Arm, Shoulder, and Hand (DASH); Patient-Rated Wrist Evaluation (PRWE); or grip strength. Compared with VLP, percutaneous pinning demonstrated better PRWE scores but a higher infection rate. Compared with bracing, percutaneous pinning showed significantly better DASH, PRWE, and grip strength outcomes, although with substantial heterogeneity. Compared with bracing, VLP fixation yielded significantly better DASH, PRWE, and grip strength outcomes and a lower malunion rate.</p><p><strong>Conclusion: </strong>All 4 treatments achieved acceptable outcomes, but with key trade-offs: Percutaneous Pinning had the best functional results but a higher infection risk. VLP provided better function and lower malunion rates than bracing. Splinting and bracing were effective conservative options, often yielding results similar to VLP, but were inferior in some specific measures. The findings suggest that a perfect anatomic repair is not always necessary for a good recovery. Ultimately, the choice of treatment must be individualized, weighing the functional benefits against the risks of complications, while considering patient health factors and preferences.</p><p><strong>Level of evidence: </strong>Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634887","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":"Evaluation and Surgical Management of Adult Spastic Hip and Knee Deformities.","authors":"Kitty Y Wu, Emmanouil Grigoriou, Peter C Rhee","doi":"10.2106/JBJS.RVW.25.00227","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00227","url":null,"abstract":"<p><p>» Thorough patient presurgical counseling should emphasize individual patient goals, which may include improving ambulation, reducing reliance on orthoses, alleviating pain, or facilitating caregiver support.» Careful physical examination is essential to differentiate whether the primary cause of dysfunction is weakness, spasticity, or both.» Diagnostic adjuncts including botulinum toxin, short-acting blocks, instrumented gait analysis, and dynamic electromyography provide valuable insight and guide operative decisions.» Surgical treatment must be individualized, with nerve-based procedures indicated for pure spasticity and tendon lengthening, tenotomy, or joint procedures being required to treat soft tissue and joint contractures.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Femoral Component Flexion in Total Knee Arthroplasty.","authors":"Matthew J Wood, Jessica A Armitage, Yusuf Omran Hasan","doi":"10.2106/JBJS.RVW.25.00266","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00266","url":null,"abstract":"<p><p>» Whilst it is widely accepted that extension of the femoral component is suboptimal, there is currently no clear consensus on the optimal degree of femoral component flexion in the sagittal plane or if optimizing component flexion translates to any clinical benefit.» Flexing the femoral total knee arthroplasty (TKA) component by 0° to 3° relative to the distal anatomic axis of the femur has been demonstrated to improve restoration of posterior condylar offset, maximal knee flexion, and patellofemoral biomechanics and aid in gap balancing by reducing excessive flexion gap.» Excessive flexion of the femoral component has been associated with worse implant survival, worse patient-reported outcomes, and fixed flexion contracture.» Early evidence suggests that using robotic-assisted TKA to align the femoral component relative to each patient's individual distal anatomic axis of the femur can reduce the rate of femoral component extension and improve the proportion of patients with optimally flexed femoral components.» Robust clinical studies are needed to establish whether 0° to 3° of femoral component flexion confers any significant clinical benefit, particularly examining the role of individualized robotic-assisted TKA in achieving reproducible component positioning.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391250","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":"Arthroscopic Meniscectomy for the Degenerative Meniscus with Mild to Moderate Osteoarthritis: A Contemporary Analysis.","authors":"Amr Kaadan, John Pietro, Roy K Aaron","doi":"10.2106/JBJS.RVW.25.00258","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00258","url":null,"abstract":"<p><p>» Arthroscopic partial meniscectomy (APM) for the treatment of degenerative meniscal tears has been controversial, and quantification of its benefits has been limited by methodological problems and varying clinical definitions.» Among the problems with APM are patients crossing over from the treatment arm to which they have been randomized to another treatment and analyzed by the randomized treatment, whether they received that treatment or not.» Aggregated information suggests that a program of structured exercise is a reasonable initial treatment for degenerative meniscal tears with APM reserved for patients who fail nonsurgical therapy.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Traditional Healers in Musculoskeletal Care for Hispanic and Latino/a Americans: A Systematic Review.","authors":"Isabel Gippo, Samiya Manocha, Maria Gabriela Pino Paez, Julie Johnson, Neeraj Patel","doi":"10.2106/JBJS.RVW.25.00257","DOIUrl":"10.2106/JBJS.RVW.25.00257","url":null,"abstract":"<p><strong>Background: </strong>Hispanic and Latino/a Americans face barriers to musculoskeletal (MSK) care. Given disparities in trust in and access to mainstream care, traditional healers (THs) may provide an alternative option. Little is known about how this population uses THs for MSK care. We aimed to describe the types of conditions treated, treatments employed, and reasons for using THs for this type of care.</p><p><strong>Methods: </strong>For this systematic review, we queried PubMed, Scopus, EMBASE, the Cochrane Library, and Web of Science for the literature published between 2000 and 2025. We included studies focused on MSK care provided by THs in Hispanic or Latino/a communities in the United States. Search terms included various TH types. We collected data on study design, participants, types of THs, diagnostic and treatment practices, and reasons for using THs. Descriptive statistics were calculated and are reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.</p><p><strong>Results: </strong>Our search yielded 4,837 articles of which 19 met inclusion criteria (21.1% quantitative, 78.9% qualitative or mixed methods). The majority focused on TH use for MSK care in adults (89.5%) and dual allopathic and TH use (73.7%). Curandero/a/x (78.9% of all articles), sobadores (52.6%), and yerberos/herbalists (36.8%) were the most frequently studied THs. The most frequently mentioned MSK conditions were atraumatic/general MSK pain (57.9% of articles), back pain (42.1%), and acute limb/joint injury (36.8%). Palpation (26.3%) and observation (21.0%) were common diagnostic practices, while physical manipulation/massage (57.9%) was the most common treatment. Dissatisfaction with allopathic medical care (57.9%), accessibility (31.6%), and affordability (26.3%) were the most frequently reported reasons for using THs.</p><p><strong>Conclusion: </strong>THs treat a variety of MSK conditions and are used by Hispanic and Latino/a American patients due to accessibility, affordability, and dissatisfaction with allopathic care. Understanding the role of THs allows allopathic clinicians to provide more culturally insightful care and consider opportunities for engagement, collaboration, and integration. This may result in more holistic, equitable orthopaedic care.</p><p><strong>Level of evidence: </strong>Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391248","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":"Limited Clinical Benefit of the Subacromial Balloon Spacer in Massive Irreparable Rotator Cuff Tears: A Comprehensive Review of Clinical Outcomes and Cost-Effectiveness.","authors":"Waleed Albishi, Mishari Alanezi, Noura Alnasser, Khalid Murrad, Emad Elansary, Abdulrahman Alaseem","doi":"10.2106/JBJS.RVW.25.00231","DOIUrl":"10.2106/JBJS.RVW.25.00231","url":null,"abstract":"<p><p>» Subacromial balloon spacer (SBS) implantation has been proposed as a minimally invasive treatment for massive irreparable rotator cuff tears (MIRCTs), particularly in elderly patients with preserved glenohumeral articulation and limited functional demands.» Across observational studies, SBS has been associated with short to midterm improvements in pain and shoulder function, reflected by increases in ASES and Constant-Murley scores.» Evidence from randomized controlled trials is mixed; the SPACE trial showed SBS is noninferior to partial repair, while the START:REACTS trial found it less effective than debridement alone.» Complications are uncommon and primarily include balloon migration, synovitis, and rare infections, supporting SBS's safety profile when patient selection is appropriate.» Based on current high-level evidence, SBS is not recommended for routine treatment of MIRCT. Its use should be restricted to carefully selected elderly patients with chronic, nonarthritic MIRCT who are poor candidates for other reconstructive procedures.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"14 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147291352","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}