Efort Open Reviews最新文献

{"title":"Analgesic effects of dexmedetomidine combined with shoulder nerve blocks before arthroscopy: a meta-analysis of randomized-controlled trials.","authors":"Wenhao Lu, Djandan Tadum Arthur Vithran, Bubacarr Jallow, Shide Jiang, Yusheng Li, Licheng Wei, Wenfeng Xiao","doi":"10.1530/EOR-2024-0069","DOIUrl":"10.1530/EOR-2024-0069","url":null,"abstract":"<p><strong>Purpose: </strong>Dexmedetomidine is a widely employed adjunct in nerve block anesthesia for shoulder arthroscopy. This study aimed to assess the analgesic efficacy of dexmedetomidine as a nerve block adjuvant in patients undergoing shoulder arthroscopy.</p><p><strong>Methods: </strong>A thorough search of PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library databases was conducted to identify randomized-controlled trials comparing the effects of dexmedetomidine-enhanced shoulder arthroscopy nerve blocks against those without dexmedetomidine. This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane-recommended risk of bias tool was employed for quality and bias assessment. Statistical analysis, utilizing Review Manager 5.4 with a significance level of P < 0.05, focused on primary outcomes: duration of analgesia and postoperative 24 h morphine consumption, and secondary outcomes: motor and sensory block duration, visual analog scale pain scores and adverse events.</p><p><strong>Results: </strong>Out of 307 articles retrieved, ten randomized-controlled trials involving 672 patients were included. Dexmedetomidine supplementation significantly prolonged the duration of analgesia (MD = 3.58, 95% CI: 2.53- 4.63, P < 0.00001, I 2 = 77%) and decreased postoperative morphine consumption (MD = -11.88, 95% CI: -17.25 to -6.52, P < 0.0001, I 2 = 41%). In addition, the dexmedetomidine group exhibited lower VAS pain scores at 1, 12 and 24 h postoperatively. No significant differences were observed in motor block duration, bradycardia (P = 0.18), hypotension (P = 0.50) and nausea and vomiting (P = 0.76). Sensitivity analyses validated the robustness of these findings.</p><p><strong>Conclusions: </strong>This meta-analysis supports dexmedetomidine as an effective adjuvant in nerve blocks for shoulder arthroscopy. It enhances postoperative analgesia without increasing adverse events such as bradycardia, hypotension and nausea and vomiting.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"510-519"},"PeriodicalIF":4.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545688","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}

{"title":"Does rigid intramedullary nailing through open growth plates cause harm? A scoping review.","authors":"Maria Tirta, Søren Kold, Ali Yalcinkaya, Jan Duedal Rölfing, Ole Rahbek","doi":"10.1530/EOR-2024-0189","DOIUrl":"https://doi.org/10.1530/EOR-2024-0189","url":null,"abstract":"<p><strong>Purpose: </strong>This scoping review aimed to map the literature on the effects of growth plate violation with intramedullary locking nail (IMN) at the knee in skeletally immature patients. It focused on assessing clinical and experimental outcomes, with particular attention to complications such as growth arrest and deformities.</p><p><strong>Methods: </strong>This scoping review followed the PRISMA extension for scoping reviews, with registered protocol at the Open Science Framework. A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus was performed for studies involving pediatric patients with open growth plates treated with IMNs at the knee and animal studies assessing physeal violations.</p><p><strong>Results: </strong>Ten studies were included, comprising six clinical, three animal studies, and one review. The clinical studies included 89 pediatric patients treated either with retrograde femoral or antegrade tibial nailing. The youngest patient was a 7-years-old female, and there were no reported cases of growth arrest following IMN. Animal studies demonstrated that up to 7% of physeal violation did not result in significant growth disturbances, but exceeding this threshold led to growth inhibition. In addition, implant removal showed mixed results, with early bone bridge formation noted in few cases.</p><p><strong>Conclusions: </strong>Limited physeal violations by IMN may not cause significant growth disturbances, while exceeding certain thresholds could result in adverse outcomes. The current evidence is insufficient to make recommendations on the use of IMN at the knee in skeletally immature patients, particularly to make recommendations regarding age, femur/tibia and sex. Further research is needed to establish long-term outcomes and optimal guidelines for safe physeal instrumentation.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"487-495"},"PeriodicalIF":4.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Misconduct in science and medicine.","authors":"Alain Charles Masquelet","doi":"10.1530/EOR-2025-0126","DOIUrl":"10.1530/EOR-2025-0126","url":null,"abstract":"","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"439-444"},"PeriodicalIF":4.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545673","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}

{"title":"Application of hyperbaric oxygen therapy in femoral head necrosis: a systematic review and meta-analysis.","authors":"Yangbin Cao, Peiyuan Tang, Han Tan, Wenbo Ma, Hua Chai, Bin Lin, Ying Zhu, Wenfeng Xiao, Ting Wen, Jun Zhang, Yusheng Li, Shuguang Liu","doi":"10.1530/EOR-2024-0167","DOIUrl":"10.1530/EOR-2024-0167","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness of hyperbaric oxygen therapy (HBOT) in the treatment of osteonecrosis of the femoral head (ONFH).</p><p><strong>Methods: </strong>Search for term systems related to ONFH and HBOT in PubMed, Cochrane Library, Embase and Web of Science databases. The risk ratio (RR) was used as the effective index for dichotomous variables while mean difference (MD) and 95% confidence interval (CI) were used as the effective index for continuous variables, with a two-sided P < 0.05 considered statistically significant. I2 statistic and Q test were used to evaluate the statistical heterogeneity of the included studies.</p><p><strong>Results: </strong>Ten studies were included, involving 568 participants. Pre-post meta-analyses to show the visual analog scale after HBOT (MD = -2.94, 95% CI: -4.27, -1.60, P < 0.0001), short form 12 physical component summary scale (SF12 PCS) (MD = 17.28, 95% CI: 8.26, 26.31, P = 0.0002), short form 12 mental component summary scale (SF12 MCS) (MD = 4.26, 95% CI: 2.56, 5.95, P < 0.00001), Harris hip score (HHS) (MD = 26.91, 95% CI: 0.35, 53.46, P = 0.05), modified Harris hip score (mHHS) (MD = 44.31, 95% CI: 13.75, 74.87, P = 0.004) were significantly different from those before treatment. The results of SF12 PCS (MD = -0.39, 95% CI: -7.85, 7.06, P = 0.92) and SF12 MCS (MD = 0.76, 95% CI: -7.02, 8.52, P = 0.85), patients' improved events (RR = 1.83, 95% CI: 0.37, 9.09, P = 0.46) showed no significant difference between the HBO and non-HBO groups.</p><p><strong>Conclusion: </strong>The results of this study indicate that HBOT cannot be regarded as an effective measure for the treatment of early-stage necrosis of the femoral head and more large-scale randomized controlled trials are needed for further verification.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"466-474"},"PeriodicalIF":4.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545666","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}

{"title":"Selection of experimental animals and modeling methods in developmental dysplasia of the hip research.","authors":"Yu Rao, Gonzalo Saiz-Gonzalo, Prateeksha Prateeksha, Anmin Wang, Hongxin Shi, Weiguo Wang, Chuan Li","doi":"10.1530/EOR-2025-0006","DOIUrl":"10.1530/EOR-2025-0006","url":null,"abstract":"<p><p>Developmental dysplasia of the hip (DDH) is a common neonatal musculoskeletal condition characterized by hip instability and inadequate acetabular coverage. If untreated, it can lead to osteoarthritis, chronic pain, and eventual hip replacement. Animal models, including dogs, pigs, sheep, rabbits, rodents, and chickens, are essential tools for studying DDH pathogenesis and testing therapeutic strategies. Larger species closely resemble human anatomy, while smaller species facilitate cost-effective, high-throughput studies and advanced genetic manipulation. Key modeling strategies include surgical interventions (e.g. joint dislocation, femoral or pelvic osteotomy), external fixation, and genetic modifications (e.g. gene knockout or lentiviral transduction) to simulate various aspects of DDH and reflect its multifactorial etiology. Evaluation techniques such as radiography, microcomputed tomography, MRI, and ultrasound are employed to image bony and cartilaginous structures. Histological and immunohistochemical analyses provide insights into cellular and extracellular matrix changes, while gait assessments evaluate functional deficits and pain-related behaviors. Selecting an appropriate animal model requires careful consideration of research objectives, ethical standards, and translational potential. Advances in gene editing technologies (e.g. CRISPR), three-dimensional-printed implants, and in vivo imaging are enhancing model fidelity and accelerating the discovery of novel therapies. Ongoing innovations in DDH research are expected to bridge gaps in understanding the disease's etiology and improve long-term outcomes for affected patients through optimized therapeutic interventions.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"496-509"},"PeriodicalIF":4.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545675","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}

{"title":"Towards a comprehensive digital wearable tracking system of the patient recovery journey after extremity trauma: a narrative review.","authors":"Benedikt J Braun, Maximilian M Menger, Tina Histing, Meir T Marmor, Bernd Grimm, Felix Fischer, Conrad Harrison, Alexander Joeris, Simon Lambert","doi":"10.1530/EOR-2024-0154","DOIUrl":"10.1530/EOR-2024-0154","url":null,"abstract":"<p><p>Enabling our patients to recover back to their pre-injury state or beyond is at the core of every treatment in orthopedic trauma surgery. Current methods of assessing functional recovery after extremity trauma largely focus on individual segments of complex, compound activities, or are created for a specific purpose and for specific populations. Such assessment instruments cannot readily account for the effect of limitations in adjacent segments. Equally, the segment-specific instruments use limited domains to assess complex actions and aptitudes. Most traditional functional assessment tools do not accommodate the individual nature of function and only assess function in larger increments during follow-up clinic visits. Recent developments of both commercial and medical-grade wearable systems and associated digital technologies can overcome most of the challenges associated with traditional outcome measures. In this review, we introduce the main technologies and their potential to track patient functional recovery in relation to the treatment phase, both before and after an injury.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"445-453"},"PeriodicalIF":4.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545677","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}

{"title":"Magnetic resonance imaging of cruciate ligament disorders: current updates.","authors":"Tanda Yang, Yexin Li, Longtao Yang, Qian Liu","doi":"10.1530/EOR-2024-0093","DOIUrl":"10.1530/EOR-2024-0093","url":null,"abstract":"<p><p>While conventional structural magnetic resonance imaging (MRI) can detect cruciate ligament anatomy and injuries, it has inherent limitations. Recently, novel MRI technologies such as quantitative MRI and artificial intelligence (AI) have emerged to mitigate these shortcomings, providing critical quantitative insights beyond gross morphological imaging and poised to expand current knowledge in assessing cruciate ligament injuries and to facilitate clinical decision making. Quantitative MRI serves as a noninvasive histological and quantification tool, which significantly improves the evaluation of degeneration and repair processes. AI plays a crucial role in automating radiological estimations and enabling data-driven predictions of future events. Despite the transformative impact of advanced MRI techniques on the analytical and diagnostic algorithms related to cruciate ligament disorders, future efforts are warranted to address challenges such as economic burdens and ethical considerations.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"475-486"},"PeriodicalIF":4.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545672","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}

{"title":"Topical tranexamic acid in hip and knee surgery: a meta-analysis of randomized-controlled trials.","authors":"Saran Tantavisut, Sanzhar Artykbay, Pasawiss Tangwiwat, Paweena Susantitaphong","doi":"10.1530/EOR-2024-0152","DOIUrl":"10.1530/EOR-2024-0152","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the efficacy and safety of topical tranexamic acid (TXA) to systemic administration (intravenous and oral) and placebo in hip and knee surgeries.</p><p><strong>Methods: </strong>This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was conducted in PubMed and Scopus to compare the bleeding, hospitality, and morbidity between topical tranexamic acid with systemic administration of TXA and placebo. Random-effect models and meta-regressions were used to generate pooled estimates and assess heterogeneity.</p><p><strong>Results: </strong>Eighty RCTs with 13,969 patients were identified reporting on the outcomes of using topical tranexamic acid in hip fracture surgery, hip arthroplasty and knee arthroplasty compared with intravenous, oral, and placebo. Overall, topical TXA acid decreased total blood loss (-353 mL (95% CI: -395, -311), P < 0.001), drainage volume (-239.802 mL (95% CI: -298.744, -180.859), P < 0.001), intraoperative blood loss (-14.994 mL (95% CI: -34.370, 4.382), P < 0.001), hidden blood loss (-123.711 mL (95% CI: -153.703, -93.719), P < 0.001), total hemoglobin loss (-0.970 gr/dL (95% CI: -1.289, -0.651), P < 0.001), total hematocrit loss (-0.937 (95% CI: -1.289, -0.584), P < 0.001), and blood transfusion rate (RR diff.: 0.480 (95% CI: 0.386, 0.597), P < 0.001) compared to placebo. No significant differences were observed between topical TXA and systemic routes (intravenous or oral) in total blood loss, transfusion rates, and hemoglobin levels.</p><p><strong>Conclusion: </strong>Topical TXA (intra-articular, peri-articular, or wound irrigation) significantly reduced blood loss, drain volume, hemoglobin loss, and transfusion need compared to placebo. Subgroup analysis showed that topical TXA outperformed placebo and was similar to intravenous and oral routes.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"454-465"},"PeriodicalIF":4.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545676","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}

{"title":"Incidence and complications of orthopaedic screw protrusion.","authors":"Rasi Mizori, Mueed Ijaz, Mohamed Hashem, Ruben Doyle, Yasser Al Omran, Omar Musbahi","doi":"10.1530/EOR-2024-0147","DOIUrl":"10.1530/EOR-2024-0147","url":null,"abstract":"<p><strong>Purpose: </strong>This scoping review examines the epidemiology and incidence of complications associated with incorrect screw length in orthopaedic trauma surgeries, aiming to underscore its impact on clinical outcomes and healthcare costs.</p><p><strong>Methods: </strong>Guided by Arksey and O'Malley's framework and PRISMA guidelines, a thorough search was conducted across PubMed, Web of Science, Cochrane, and Google Scholar up to April 2024. Studies included must be human-based orthopaedic procedures involving screw length, published in peer-reviewed journals with full text available, and report complications from incorrect screw length; studies excluded were systematic reviews/meta-analyses. Paper characteristics and data on incident rates of complications due to screw protrusion were extracted and presented in a supplementary table using Microsoft Excel.</p><p><strong>Results: </strong>Of 2,285 studies identified, 31 met the inclusion criteria. Incorrect screw length led to severe complications, including neurovascular damage (7 studies), avascular necrosis (4 studies), delayed union or pseudoarthrosis (9), tendinitis/tendon rupture (12 studies), and pain (10 studies). Notably, improperly sized screws increased neurovascular and avascular necrosis complications, especially in weight-bearing joints. In addition, incorrect screw length was linked to higher hardware removal rates, contributing to increased healthcare costs. Limitations include the inability of some studies to definitively attribute complications to screw protrusion and the exclusion of cases involving joint collapse or solely mechanical complications.</p><p><strong>Conclusion: </strong>This review underscores the importance of precise screw length selection to prevent complications and improve surgical outcomes. It calls for further research on the medico-legal and economic impacts of screw length errors and the need for better surgical practices.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"562-569"},"PeriodicalIF":4.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545670","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}

{"title":"Imaging and classifications of atlantoaxial dislocation: a narrative review.","authors":"Guangzhou Li, Hao Zhang, Qing Wang","doi":"10.1530/EOR-2024-0061","DOIUrl":"10.1530/EOR-2024-0061","url":null,"abstract":"<p><p>Radiography is of importance in the diagnosis of atlantoaxial dislocation (AAD), and it is the basic imaging technique. However, it should not be the sole diagnostic modality, especially in complex or unclear cases. Conventional X-ray includes an open-mouth odontoid view and a cross-table lateral view, and careful study of radiological findings is crucial to give an early diagnosis of AAD. Lateral flexion-extension dynamic views are only used as an additional supplement in some special cases. Although X-ray images are enough to diagnose AAD in most cases, some patients suspected with AAD should be evaluated with the readily available and quick CT scan. If patients with AAD have symptoms of spinal cord and medullary compression, apart from conventional radiographs, a combination of high-quality CT and MRI of cervical spine are necessary for the diagnosis and choice of treatment. For patients with AAD, both the thin slice CT scanning with coronal, sagittal and three-dimensional reconstruction images and MRI of cervical spine are fundamental to surgical planning. Clinical classifications of AAD associated with imaging are useful in determining treatment strategies. The present study reviews publications on imaging and clinical classification of AAD to aid the clinician in the evaluation and management of these dislocations.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"551-561"},"PeriodicalIF":4.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545669","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}