JBJS Reviews最新文献

{"title":"Differences in Talar Morphology Between Patients With Clubfoot and Nonclubfoot Patients from Fetus to Adulthood: A Systematic Review.","authors":"Manon Pigeolet, Adam Nasreddine, Sion Yu Jang, Louise Atadja, Daniel Guss, Collin J May","doi":"10.2106/JBJS.RVW.25.00028","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00028","url":null,"abstract":"<p><strong>Background: </strong>The talus plays a central role in understanding the pathophysiology and natural history of clubfoot deformity. The morphology, severity, natural history, and functional implications of talar dysplasia in patients with clubfoot are poorly understood. Flat-top talus is a common finding in patients with a history of clubfoot that can lead to limited ankle dorsiflexion and painful anterior ankle impingement. The aim of this review was to assess the morphological differences between clubfoot and non-clubfoot tali.</p><p><strong>Methods: </strong>We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE/PubMed, Embase, and Scopus for articles reporting on talar morphology in patients with clubfoot. Our primary outcomes collected were demographic data of included patients and variables describing talar morphology.</p><p><strong>Results: </strong>The clubfoot talus is dysplastic in multiple dimensions. The prevalence of talar flattening appears to increase in early life and stabilizes during childhood. Differences in talar length and transverse talar neck angle between clubfoot and nonclubfoot tali virtually disappear by adolescence. The current literature suggests that differences in talar morphology in patients with clubfoot are both of an innate and an acquired nature. Despite the lack of longitudinal studies, some studies show a potential correlation between the presence or development of a flat-top talus and increased clubfoot severity.</p><p><strong>Conclusion: </strong>Talar dysplasia in patients with clubfoot, including flat-top talus, remains poorly understood, and further studies are necessary to inform treatment guidelines for flat-top talus.</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":"13 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276260","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":"Congenital Pseudarthrosis of the Tibia: A Comprehensive Literature Review.","authors":"Akram Al Ramlawi, Stephen W Chenard, Munir Sidani, John E Herzenberg, Jonathan G Schoenecker, Philip K McClure","doi":"10.2106/JBJS.RVW.25.00035","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00035","url":null,"abstract":"<p><p>» NF1 Link and Pathophysiology: Congenital pseudarthrosis of the tibia (CPT) is strongly associated with neurofibromatosis type 1 (NF1), where loss of normal NF1 gene function impairs bone formation and promotes fibrous hamartoma, resulting in recurrent tibial nonunion.» Classifications and Diagnostics: Multiple radiographic classifications (Andersen, Crawford, Boyd, Paley, etc.) guide clinical decision making, while newer imaging (magnetic resonance imaging, quantitative ultrasound) refines diagnosis and helps tailor interventions.» Treatment Modalities: Strategies range from nonoperative bracing (prefracture) to surgical approaches such as intramedullary rods (standard or telescopic), free vascularized fibular grafts, ring fixators (Ilizarov), and \"cross-union\" procedures-often combined with pharmacologic agents such as bone morphogenetic proteins (BMPs) or bisphosphonates.» Mixed Results With Pharmacologics: While rhBMP and bisphosphonates address bone catabolism and anabolism, neither agent alone has consistently succeeded in NF1-related CPT; combination regimens may offer better outcomes but require more robust research.» Future Directions: Ongoing studies explore early surgery (vs. waiting until age 2-3) and guided growth to address tibial bowing, molecular therapies (e.g., MAPK kinase and Src homology 2 containing protein tyrosine phosphatase 2 inhibitors), and refined fixation techniques. The management of CPT continues to evolve as genetic and cellular mechanisms become clearer.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235538","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":"Ulnar Collateral Ligament Injuries in Pediatric and Adolescent Throwing Athletes.","authors":"Patrick Saunders, Abhay Mathur, Jordan Frausto, Carlos Ramirez, Adam Lindsay, Viraj Deshpande, Evan Simpson, Hafiz F Kassam","doi":"10.2106/JBJS.RVW.25.00060","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00060","url":null,"abstract":"<p><p>» There has been an alarming increase in the incidence of ulnar collateral ligament (UCL) injuries among youth patients.» Preventative programs are effective in reducing the risk of UCL injuries in youth patients.» Further research on UCL injury in this particular population would be beneficial given the increasing incidence of pathology and unique considerations apart from adult patients.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162911","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":"Institution-Based Quality and Safety Improvement Initiatives in Spine Surgery: A Scoping Review.","authors":"Zonglin He, Meiru An, Dong Chen, Huili Peng, Huiren Tao, Kenneth M C Cheung","doi":"10.2106/JBJS.RVW.24.00195","DOIUrl":"10.2106/JBJS.RVW.24.00195","url":null,"abstract":"<p><strong>Background: </strong>Improving patient safety and healthcare quality is necessary to advance value-based health care. Spine surgery is complex, entailing joint efforts between different disciplines. This scoping review aimed to map the research on establishing and implementing institution-based quality improvement (QI) initiatives in spine surgery.</p><p><strong>Methods: </strong>Studies were identified in electronic searches of PubMed, Web of Science, and Scopus databases. Qualitative or quantitative studies that report the implementation of QI programs that occurred in or covered spine surgery were included; studies that did not describe the establishment, implementations, impacts, barriers, and facilitators of QI initiatives were excluded. Three reviewers independently screened the retrieved studies, and 2 reviewers extracted data and conducted a quality assessment of full-text articles. Studies were categorized according to dimensions of quality (timely, effective, patient-centered, efficient, equitable, and safe), and quality appraisal was conducted using the Standards for Quality Improvement Reporting Excellence reporting guidelines.</p><p><strong>Results: </strong>The search from the 3 databases yielded 2,876 returns; after removing duplicates, there were 1,274 in total. After screening, 228 records were entered into a full-text review, resulting in 133 records included in the review. Specifically, 88 addressed aspects of efficiency, 74 on safety, 32 on improving effectiveness, 23 on patient-centeredness, 7 on timeliness, and 1 on equity. Of the studies included, 71 rely on retrospective audits, 19 are prospective, and only 8 are interventional trials. Only 67 QI initiatives leveraged the advantages of multidisciplinary teams or the rigor of evidence-based protocols. Study gaps include limited follow-up, small sample sizes, and lack of comprehensive assessment using both objective measures and patient-reported outcomes.</p><p><strong>Conclusions: </strong>This scoping review maps the current research on developing and implementing institution-based QI initiatives in spine surgery. Although most of the initiatives reported show improvement in the quality of health care and patient safety from multiple aspects, the sustainability of these initiatives remains unknown, and further studies are needed to trace the long-term effects and generalizability of these initiatives.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162909","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":"Thoracic Deformity in Fibrodysplasia Ossificans Progressiva.","authors":"Frederick S Kaplan, Paul D Sponseller, Robert J Pignolo","doi":"10.2106/JBJS.RVW.25.00042","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00042","url":null,"abstract":"<p><p>» Fibrodysplasia ossificans progressiva (FOP), the most severe form of heterotopic ossification (HO) in humans, may lead to severe thoracic deformity (TD) and thoracic insufficiency syndrome (TIS), the most common cause of mortality in individuals with FOP.» In this study, we examine the multiple causes of TD in FOP and propose a dynamic model for the development and evolution of TD that can be used to guide clinical care. This model posits that multiple factors, all originating from the causative gain-of-function mutation in activin receptor A, type 1, lead to TD in FOP.» Factors that lead to TD in FOP include early developmental costovertebral and facet joint arthropathy and joint ankylosis, progressive episodic flare-ups (both trauma induced or spontaneous) and subsequent HO, dysregulated soft tissue sensitivity to mechanical stimuli, growth plate dysregulation, and congenital rib fusions. These factors contribute to TD in FOP through a combination of intra-articular and extra-articular mechanisms, all amplified by growth.» Although FOP is a rare condition, it is illustrative of how a mutation in a critical receptor in the bone morphogenetic protein signaling pathway can cause a litany of musculoskeletal dysfunction that can lead to life-threatening consequences. Clinicians caring for individuals who have FOP must be aware of the occurrence, evolution, and implications of progressive TD and resultant TIS so that appropriate preventive measures such as avoidance of pulmonary infections, incentive spirometry, and diaphragmatic strengthening can be instituted.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129101","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":"Foot Drop in Orthopaedic Surgery: Anatomy, Etiology, Differential Diagnosis, and Treatment.","authors":"Katherine Dong, Justin L Reyes, Michael A Mastroianni, Josephine R Coury, Riley Sevensky, Fthimnir M Hassan, Joseph M Lombardi, Charles A Popkin, Bonnie Y Chien, Lawrence G Lenke, Zeeshan M Sardar","doi":"10.2106/JBJS.RVW.24.00170","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.24.00170","url":null,"abstract":"<p><p>» Foot drop is a problem encountered by orthopaedic surgeons from various subspecialties. The etiology can vary from the lower extremity to the spine and can be managed conservatively depending on functional limitations. Common nonsurgical interventions include ankle-foot orthoses, physical therapy, electrical nerve stimulation, and activity modification. Surgical options vary between nerve decompression and lower extremity tendon transfers. The purpose of this review was to provide an overview of the anatomy, etiology, diagnoses, and treatment options of foot drop.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129096","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 Epidemiology of Slipped Capital Femoral Epiphysis in Children and Adolescents: A Systematic Review of Risk Factors and Incidence Across Populations.","authors":"Marc Daniel Bouchard, Bianca G Vescio, Mehnaz Munir, Justin Gilbert, Russell J de Souza, Jeffrey Kay, Darren de Sa, Gita Wahi","doi":"10.2106/JBJS.RVW.25.00052","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00052","url":null,"abstract":"<p><strong>Background: </strong>Childhood obesity is a growing global health crisis with significant health and orthopedic complications such as slipped capital femoral epiphysis (SCFE), a hip disorder characterized by the displacement of the metaphysis relative to the epiphysis. SCFE always requires surgical intervention to prevent severe outcomes such as avascular necrosis, gait abnormalities, and lifelong disability and deformity. Obesity is a well-established risk factor for SCFE; however, emerging evidence suggests that elevated leptin levels may independently contribute to the development of SCFE, regardless of obesity status. This systematic review synthesizes geographic, socioeconomic, age, and sex-related trends in SCFE incidence among children with obesity.</p><p><strong>Methods: </strong>Searches of Embase, OVID Medline, and Emcare databases were performed from inception through October 1, 2024. Observational studies reporting the incidence of SCFE in children and adolescents with obesity (aged ≤18 years) across various geographic populations were included. Studies involving children with other chronic health conditions or animal studies on the physis were excluded. Study quality was evaluated using the methodological index for nonrandomized studies scoring system. Descriptive statistics were presented as absolute frequencies with percentages or as weighted means with corresponding measures of variance where applicable.</p><p><strong>Results: </strong>Fifteen studies (5,467 patients) from North America, Europe, Asia, and Oceania met inclusion criteria. SCFE patient samples ranged from 55 to 1,630, with some larger cohorts monitoring multiple medical conditions. The mean age was 12.0 years (SD = 0.4), and male-to-female ratios ranged from 1.43:1 to 3.12:1. SCFE incidence varied by region, from 50.5 per 100,000 (Sweden) to 0.33 per 100,000 (South Korea), with a pooled incidence of 9.62 per 100,000. Overweight prevalence was highest in Sweden (66%) and South Korea (67.6%) and lowest in Japan (11.8%). Unilateral SCFE predominated (68.4% to 90.6%). In situ screw fixation was the most common treatment, with 1 study reporting intertrochanteric osteotomy.</p><p><strong>Conclusion: </strong>Geographic variation in SCFE incidence suggests multifactorial influences beyond obesity, including socioeconomic factors, healthcare access, and genetic predisposition. Limited high-quality comparative studies and inconsistent BMI criteria highlight the need for further research to clarify SCFE risk factors.</p><p><strong>Level of evidence: </strong>Level IV, systematic review. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129098","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":"Timing and Selection of Lower Extremity Arthroplasty Procedures: Which to Perform First and When to Consider Simultaneous Bilateral Procedures.","authors":"Nicole D Quinlan, Todd M Miner, Jason M Jennings, Douglas A Dennis","doi":"10.2106/JBJS.RVW.25.00010","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00010","url":null,"abstract":"<p><p>» For patients with both lumbar spine pathology, hip and knee degenerative joint disease, it is important to consider the implications of surgically addressing each anatomic region first.» Performing total hip arthroplasty before lumbar spine fusion may decrease the risk of dislocation and revision surgery; however, if spinal fusion is performed first, it may be protective to wait 1 to 2 years to lower the risk of complications.» In all patients with concurrent hip and low back symptoms, it is recommended that an evaluation of both areas is performed before proceeding with either surgical intervention.» If arthroplasty procedures are to occur in a staged fashion, adverse events in high-risk patients may be mitigated by waiting for more than 1 year between procedures. Staged procedures performed less than 30 days apart are at increased risk of medical and surgical complications.» Simultaneous bilateral total joint arthroplasty procedures should likely be avoided in more elderly patients, those with higher body mass index and those with a greater burden of medical comorbidities due to the increased risks of postoperative complications.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102460","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":"Anterior Sternoclavicular Joint Dislocation Classification and Management: A Review of the Literature.","authors":"Anas El Zouhbi, Ahmad Hammad, Mahmoud Hammad, Mohamad Nassereddine","doi":"10.2106/JBJS.RVW.25.00011","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00011","url":null,"abstract":"<p><p>» Closed reduction and physical therapy are the primary approaches for most acute anterior sternoclavicular joint (SCJ) dislocations, with acceptable outcomes for low-demand patients. However, these treatments have a high rate of recurrent instability, albeit with minimal functional impact.» Persistently symptomatic recurrent dislocations typically warrant surgical intervention. The choice of technique-ranging from nonabsorbable sutures to tendon autografts and plating-is based on individualized care by considering patient-specific factors such as activity level, bone quality, and health.» High-demand patients, such as athletes, benefit from robust techniques like suture repair with an internal brace or hamstring tendon autografts. These methods provide durable stability and reduce recurrence risks.» Patients with poor bone quality, such as those with osteoporosis, may require plating techniques (e.g., locking plates or SCJ-specific plates) to ensure rigid fixation, albeit with potential hardware-related complications.» Owing to the rarity of the condition and limited studies, no standardized treatment protocol exists. Tailored approaches based on clinical and functional needs yield optimal outcomes, and further research is needed to identify the best practices.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015387","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":"Clinical Recommendations for the Perioperative Management of Biologic Medications for Nonrheumatologic Diseases in Total Joint Arthroplasty.","authors":"Andrew R Moya, Pooya Tehrany, Kassem Ghayyad, Ramakanth Yakkanti, Andrew Pepper","doi":"10.2106/JBJS.RVW.25.00004","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.25.00004","url":null,"abstract":"<p><p>» Managing biologic therapies in nonrheumatologic patients undergoing total joint arthroplasty (TJA) poses unique risks, such as infection, and wound healing issues, yet guidelines are limited.» Some agents may be continued during the perioperative period, while others may need to be temporarily withheld before surgery.» The absence of clear perioperative guidelines for patients on biologics underscores the need for evidence-based protocols to support optimal surgical outcomes.» A deeper understanding of biologic pharmacodynamics in the perioperative period can help manage risks, particularly as the demand for TJAs in biologic-treated patients grows.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"13 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001346","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}