Efort Open Reviews最新文献

The need of innovation and of preservation of well-established techniques in the era of MDR for improving outcomes. 在耐多药时代，需要创新和保存成熟的技术，以改善结果。

IF 4 2区医学

Efort Open Reviews Pub Date : 2026-05-01 DOI: 10.1530/EOR-2026-0055

Max Gordon, Olof Wolf, Viktor Mili-Schmidt

{"title":"The need of innovation and of preservation of well-established techniques in the era of MDR for improving outcomes.","authors":"Max Gordon, Olof Wolf, Viktor Mili-Schmidt","doi":"10.1530/EOR-2026-0055","DOIUrl":"10.1530/EOR-2026-0055","url":null,"abstract":"The European Union Medical Device Regulation (MDR 2017/745) has introduced stricter requirements for clinical evidence, limited reliance on equivalence and expanded post-market surveillance for orthopaedic implants. While designed to improve patient safety following high-profile device failures, MDR implementation has been associated with longer certification timelines, increased costs and withdrawal of established implants, particularly in lower-volume indications. The central regulatory challenge is proportionality: novel devices require robust prospective evidence, whereas long-established implants with extensive clinical track records may warrant risk-based recertification pathways. Uniform regulatory application risks unintended consequences for intermediate- and lower-volume indications that fall between orphan-device provisions and standard MDR requirements. Orthopaedic societies may play a key role in developing speciality-specific evidence guidance to support regulators and notified bodies, improving clarity while maintaining patient safety and sustainable innovation.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"366-371"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Imaging-based assessment of fracture stability does not reliably predict outcomes in patients with two-part proximal humeral fractures and may lead to unnecessary surgeries. 基于影像学的骨折稳定性评估不能可靠地预测肱骨近端两部分骨折患者的预后，并可能导致不必要的手术。

IF 4 2区医学

Efort Open Reviews Pub Date : 2026-05-01 DOI: 10.1530/EOR-2026-0043

Stig Brorson

引用次数: 0

Management and optimisation in the preoperative phase for patients with a fractured hip. 髋部骨折患者术前阶段的管理和优化。

IF 4 2区医学

Efort Open Reviews Pub Date : 2026-05-01 DOI: 10.1530/EOR-2026-0044

Geert Meermans, Jeroen C van Egmond

{"title":"Management and optimisation in the preoperative phase for patients with a fractured hip.","authors":"Geert Meermans, Jeroen C van Egmond","doi":"10.1530/EOR-2026-0044","DOIUrl":"10.1530/EOR-2026-0044","url":null,"abstract":"Hip fractures represent a time-critical, systemic condition in older adults, characterised by frailty, multimorbidity, inflammation, immobility, pain, and high risk of medical complications and mortality. While population ageing is expected to drive a continued rise in absolute hip fracture numbers, contemporary evidence demonstrates declining age-standardised incidence in many high-income countries, highlighting the importance of optimising perioperative care pathways to mitigate morbidity and mortality. Contemporary evidence consistently supports early surgical management, typically within 24-48 h, provided reversible medical issues are addressed in parallel rather than through prolonged preoperative workup. Orthogeriatric co-management and structured multidisciplinary pathways reduce time to surgery, delirium incidence, length of stay, and mortality while improving functional recovery. Key optimisation domains include multimodal opioid-sparing analgesia, delirium prevention bundles, targeted cardiovascular stabilisation, pragmatic management of anti-thrombotic therapy, anaemia, infection, and individualised anaesthetic strategies. Evidence supports protocol-driven, multicomponent care bundles over isolated interventions to enable safe early surgery, reduce complications, and improve functional recovery in this vulnerable population.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"390-403"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

'THA for DDH: replacement principles and techniques - femoral side'. 髋关节置换术治疗DDH：置换原则和技术-股侧。

IF 4 2区医学

Efort Open Reviews Pub Date : 2026-05-01 DOI: 10.1530/EOR-2026-0069

Konstantinos Konstantinidis, Dimitrios Grammatikopoulos, Eustathios Kenanidis, Alexander Maslaris, Pedro Dantas, Eleftherios Tsiridis

{"title":"'THA for DDH: replacement principles and techniques - femoral side'.","authors":"Konstantinos Konstantinidis, Dimitrios Grammatikopoulos, Eustathios Kenanidis, Alexander Maslaris, Pedro Dantas, Eleftherios Tsiridis","doi":"10.1530/EOR-2026-0069","DOIUrl":"10.1530/EOR-2026-0069","url":null,"abstract":"Developmental dysplasia of the hip (DDH) remains a leading cause of early hip osteoarthritis and poses considerable technical challenges during total hip arthroplasty. Existing classification systems focus on the abnormal relationship between the femoral head and the acetabulum without emphasising the femoral morphological variations, which are equally significant in surgical planning. Dysplastic femora often demonstrate excessive neck anteversion, variable neck-shaft angles, reduced offset, and metaphyseal-diaphyseal mismatch with narrow intramedullary canals. These anatomical variations often compromise the abductor mechanism and alter hip biomechanics. Thorough preoperative planning is crucial and should include the evaluation of leg-length discrepancy, reconstruction of the hip centre of rotation, assessment of femoral version and canal morphology, implant selection, and consideration of femoral shortening osteotomy. Computed tomography-based planning can enhance preoperative planning in complex cases. Both cemented and cementless stems align with positive findings in DDH patients. Cemented stems enable reliable version control, decrease intraoperative fracture risk, and may be beneficial for patients with poor bone quality. In mild cases, most uncemented stems are suitable. More severe deformities necessitate specialised implant designs with conical fluted stems, which provide strong fixation and excellent long-term survivorship. Modular and custom-made options also achieve favourable outcomes in high-grade deformities. Femoral shortening osteotomies are often needed to restore biomechanics, correct abnormal version, and prevent nerve injury during reduction. The subtrochanteric osteotomy has been linked with excellent results in treating severe DDH. High-quality research is essential to deepen our understanding of proximal femur morphological abnormalities and to enhance surgical results.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"404-414"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Indications and techniques of proximal femoral osteotomies in 2026. 股骨近端截骨术的适应症和技术。

IF 4 2区医学

Efort Open Reviews Pub Date : 2026-05-01 DOI: 10.1530/EOR-2026-0076

Samuel Friedrich Schaible, Paulo Rego, Simon Damian Steppacher, Sjard Simons, Moritz Tannast

引用次数: 0

Clinical application of mesenchymal stem cells in orthopaedics and traumatology in daily practice. 间充质干细胞在骨科和创伤学中的临床应用。

IF 4 2区医学

Efort Open Reviews Pub Date : 2026-05-01 DOI: 10.1530/EOR-2026-0056

Ismail Hadisoebroto Dilogo, Stephanie Gosal, Joshua Alward Herdiman, Alifaturrasyid Syafaatullah Ridwan

引用次数: 0

Dynamic wrist imaging using four-dimensional CT: current concepts, clinical applications, and future perspectives. 四维CT动态腕部成像：当前概念、临床应用和未来展望

IF 4 2区医学

Efort Open Reviews Pub Date : 2026-05-01 DOI: 10.1530/EOR-2026-0051

E P A van der Heijden, T Terng, M Haenen, H S Vries, S Hummelink, E H S Teule

{"title":"Dynamic wrist imaging using four-dimensional CT: current concepts, clinical applications, and future perspectives.","authors":"E P A van der Heijden, T Terng, M Haenen, H S Vries, S Hummelink, E H S Teule","doi":"10.1530/EOR-2026-0051","DOIUrl":"10.1530/EOR-2026-0051","url":null,"abstract":"Carpal instability is fundamentally a dynamic disorder that may not be detected using conventional static imaging modalities such as radiography, CT, and MRI. This diagnostic limitation may delay diagnosis and treatment, potentially leading to progressive instability and degenerative changes. Four-dimensional CT enables dynamic, in vivo visualisation and quantitative analysis of wrist kinematics by acquiring sequential volumetric datasets during active motion. This allows identification of abnormal motion patterns, including altered intercarpal coordination and subluxations, which cannot be detected using static imaging. Clinical applications include evaluation of scapholunate instability, distal radioulnar joint instability, midcarpal instability, and altered carpal kinematics in conditions such as Kienböck disease. Four-dimensional CT may also be valuable for preoperative planning and postoperative assessment by enabling objective evaluation of treatment-related changes in wrist motion. Comparison with the contralateral wrist provides an internal physiological reference and may improve diagnostic confidence by distinguishing pathological motion from normal anatomical variation. Four-dimensional CT complements conventional imaging and arthroscopy by providing functional information on wrist biomechanics. It should be used selectively when dynamic instability is suspected and conventional imaging is inconclusive. Ongoing advances in automated analysis, dose optimisation, and protocol standardisation are expected to further improve clinical applicability and support broader integration into clinical practice.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"381-389"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Multiligament-injured knee: what the general orthopedic surgeon should know. 膝关节多韧带损伤：普通骨科医生应该知道的事情。

IF 4 2区医学

Efort Open Reviews Pub Date : 2026-05-01 DOI: 10.1530/EOR-2026-0053

Michael Hantes, Vasileios Raoulis, Aristeidis Zibis, Nikolaos Metaxiotis, Artemis Hante, Nikolaos Stefanou, Vasileios S Akrivos

{"title":"Multiligament-injured knee: what the general orthopedic surgeon should know.","authors":"Michael Hantes, Vasileios Raoulis, Aristeidis Zibis, Nikolaos Metaxiotis, Artemis Hante, Nikolaos Stefanou, Vasileios S Akrivos","doi":"10.1530/EOR-2026-0053","DOIUrl":"10.1530/EOR-2026-0053","url":null,"abstract":"Multiligament knee injuries (MLKIs) are rare but severe injuries involving bicruciate or collateral ligament disruption, frequently associated with knee dislocation, fractures, and neurovascular compromise. Vascular injury occurs in a mean of approximately 18% of cases and may be present despite palpable pulses; an ankle-brachial index (ABI) < 0.9 demonstrates high sensitivity for arterial injury. Peroneal nerve injury occurs in approximately 10-40% of cases. Early recognition and structured evaluation are critical. Serial vascular examinations, selective CT angiography, and careful neurologic assessment are mandatory. General orthopedic surgeons often make the initial management decisions, and timely diagnosis, stabilization, and referral significantly influence limb salvage and long-term function. The Schenck KD classification remains standard, with recent consensus refinements to the KD V category and proposed modifiers such as '-EM' for extensor mechanism disruption. Associated meniscal, chondral, and rare entities, such as uniplanar coronal tibiofemoral subluxation, require high clinical suspicion. Knee-spanning external fixation is indicated in vascular injury, open or fracture-dislocations, soft-tissue compromise, or persistent instability, with reconstruction commonly performed later at 3-6 weeks. Current evidence shows no clear superiority of early versus delayed reconstruction in functional outcomes, although early surgery increases stiffness risk. Anatomic reconstruction is generally favored over repair for high-grade PLC and MCL injuries due to lower failure and complication rates. At 2 years, patients retain approximately 80-85% of knee function; however, a gradual functional decline over time is observed. Arthrofibrosis (≈10%) remains the most common complication.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"426-436"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is Kinesio taping an effective approach for acute ankle sprains? A systematic review and meta-analysis. 肌内修贴是治疗急性踝关节扭伤的有效方法吗？系统回顾和荟萃分析。

IF 4 2区医学

Efort Open Reviews Pub Date : 2026-04-07 DOI: 10.1530/EOR-2025-0034

Huiwu Zuo, Meng Zhang, Peng Chen, Ling Wang, Luyu Diao, Li Zhang

{"title":"Is Kinesio taping an effective approach for acute ankle sprains? A systematic review and meta-analysis.","authors":"Huiwu Zuo, Meng Zhang, Peng Chen, Ling Wang, Luyu Diao, Li Zhang","doi":"10.1530/EOR-2025-0034","DOIUrl":"10.1530/EOR-2025-0034","url":null,"abstract":"Purpose: To examine the effect of Kinesio taping (KT) on patients with acute ankle sprains (AAS).Methods: We searched MEDLINE (via PubMed), Cochrane Library, Embase, Web of Science, SPORTDiscus, CINAHL, and Google Scholar for all relevant publications from database inception to January 2025, without language restriction. Randomized controlled trials on KT for AAS were selected according to the participant, intervention, comparison, and outcome measures. A meta-analysis was conducted using R software. Heterogeneity investigation involved sensitivity, subgroup, and meta-regression analysis. Two independent reviewers assessed the quality of the literature using the Cochrane risk of bias tool 2, and the GRADE framework was applied to grade the certainty of the evidence.Results: Eight trials containing 582 participants were selected in this review. Moderate-certainty evidence indicated that KT was more effective than controls in relieving pain (standard mean difference (SMD) = -0.63; 95% CI: -1.25 to -0.01; I2 = 94.1%, P = 0.047) and improving function (SMD = 0.72; 95% CI: 0.10-1.34; I2 = 94.5%, P = 0.023). Low-certainty evidence was found for its effect on reducing swelling (SMD = -0.29; 95% CI: -0.48 to -0.10; I2 = 77.5%, P = 0.002). Subgroup analysis revealed that KT significantly improved pain, swelling, and function following 3-5 days of intervention. 'I'-shaped KT was found to significantly improve pain, swelling, and function.Conclusion: KT can significantly alleviate pain, reduce swelling, and improve function in patients with AAS. However, significant effects are only observed short-term, and the 'I'-shaped KT method may be the most effective recommendation for AAS.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"250-258"},"PeriodicalIF":4.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Methods of nerve mapping to prevent iatrogenic nerve injuries during ankle arthroscopy: scoping review. 踝关节镜检查中预防医源性神经损伤的神经定位方法：镜检综述。

IF 4 2区医学

Efort Open Reviews Pub Date : 2026-04-07 DOI: 10.1530/EOR-2024-0201

Philippe Beaudet, Kinga Michalewska, Floris van Rooij, Mo Saffarini, Alexis Nogier

{"title":"Methods of nerve mapping to prevent iatrogenic nerve injuries during ankle arthroscopy: scoping review.","authors":"Philippe Beaudet, Kinga Michalewska, Floris van Rooij, Mo Saffarini, Alexis Nogier","doi":"10.1530/EOR-2024-0201","DOIUrl":"10.1530/EOR-2024-0201","url":null,"abstract":"To synthesise the literature on pre- and intra-operative nerve mapping used to prevent iatrogenic nerve injuries during ankle arthroscopy. This scoping review followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was conducted using MEDLINE and Embase on 24 July 2024. Findings extracted from eligible studies were tabulated and synthesised. The search identified 270 articles, of which 9 met inclusion/exclusion criteria and were included in the review. Two studies described a mapping technique without reporting any outcomes, and three studies evaluated mapping techniques on cadavers and four on live patients. Four studies reported on visualisation and/or palpation, one study on arthroscopic transillumination, three on ultrasound and two on near-infrared light (NIR). There were only two comparative studies that showed that pre-operative ultrasound mapping places the nerves at safer distances from the portals and that ultrasound is more effective in the identification of the superficial peroneal nerve (SPN) than visualisation and/or palpation. Visualisation and/or palpation of the SPN is the most effective in ankle maximal plantar flexion and inversion and reduces the risk of nerve injury. There was no saphenous nerve injury with percutaneous screw insertion while using NIR. A reduction in nerve injuries during ankle arthroscopy might be achievable by using pre- or intra-operative nerve mapping with visualisation and/or palpation, ultrasound or (for nerves accompanied by the veins) NIR. The limited evidence suggests that pre-operative ultrasound might be potentially the most effective mapping method, but more comparative and prospective studies are needed to fully confirm these findings.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"243-249"},"PeriodicalIF":4.0,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0