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How to distinguish a benign from a malignant tumour in children and when should a biopsy be done and by whom. 如何区分儿童良性肿瘤和恶性肿瘤，以及何时和由谁进行活组织检查。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0031
Marta Salom, Inês Balacó
{"title":"How to distinguish a benign from a malignant tumour in children and when should a biopsy be done and by whom.","authors":"Marta Salom, Inês Balacó","doi":"10.1530/EOR-24-0031","DOIUrl":"10.1530/EOR-24-0031","url":null,"abstract":"<p><p>Bone tumours are frequent in children but most of them are benign. Moreover, the incidence and type of tumours differ from those of adults. As an orthopaedic surgeon, we will likely encounter a bone lesion in a child and we must be able to distinguish if it is a benign lesion or has malignant characteristics and it is necessary to refer it to a centre specialized in tumours. We will discuss the key points we would have to ask in the medical history, look at the physical examination and the radiological characteristics that will allow us to distinguish between a benign and a malignant bone lesion in a child. When there are doubts about the malignancy of a bone lesion or if the diagnosis is not clear, a biopsy should be performed following certain rules in a specialized centre.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"9 5","pages":"393-402"},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899892","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
WALANT surgery of the hand: state of the art. 手部 WALANT 手术：最新技术。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0033
Ilse Degreef, Donald H Lalonde
{"title":"WALANT surgery of the hand: state of the art.","authors":"Ilse Degreef, Donald H Lalonde","doi":"10.1530/EOR-24-0033","DOIUrl":"10.1530/EOR-24-0033","url":null,"abstract":"<p><p>Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25-1% lidocaine, with 1:100 000-1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"9 5","pages":"349-356"},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899950","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
Advancing spine care through AI and machine learning: overview and applications. 通过人工智能和机器学习推进脊柱护理：概述与应用。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0019
Andrea Cina, Fabio Galbusera
{"title":"Advancing spine care through AI and machine learning: overview and applications.","authors":"Andrea Cina, Fabio Galbusera","doi":"10.1530/EOR-24-0019","DOIUrl":"10.1530/EOR-24-0019","url":null,"abstract":"<p><p>Machine learning (ML), a subset of artificial intelligence, is crucial for spine care and research due to its ability to improve treatment selection and outcomes, leveraging the vast amounts of data generated in health care for more accurate diagnoses and decision support. ML's potential in spine care is particularly notable in radiological image analysis, including the localization and labeling of anatomical structures, detection and classification of radiological findings, and prediction of clinical outcomes, thereby paving the way for personalized medicine. The manuscript discusses ML's application in spine care, detailing supervised and unsupervised learning, regression, classification, and clustering, and highlights the importance of both internal and external validation in assessing ML model performance. Several ML algorithms such as linear models, support vector machines, decision trees, neural networks, and deep convolutional neural networks, can be used in the spine domain to analyze diverse data types (visual, tabular, omics, and multimodal).</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"9 5","pages":"422-433"},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899848","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
Modern treatment of unicameral and aneurysmatic bone cysts. 单腔骨囊肿和动脉瘤性骨囊肿的现代治疗方法。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0027
Elisa Pala, Giulia Trovarelli, Andrea Angelini, Maria Chiara Cerchiaro, Pietro Ruggieri
{"title":"Modern treatment of unicameral and aneurysmatic bone cysts.","authors":"Elisa Pala, Giulia Trovarelli, Andrea Angelini, Maria Chiara Cerchiaro, Pietro Ruggieri","doi":"10.1530/EOR-24-0027","DOIUrl":"10.1530/EOR-24-0027","url":null,"abstract":"<p><p>The best treatment of unicameral bone cyst and aneurismatic bone cyst (ABC) is debated in the literature. For simple bone cysts, multiple treatments were proposed from observation only to open curettage. The historical treatment with intraosseous injection of methylprednisolone acetate into the bone cysts nowadays is reduced due to the morbidity of multiple injections and the risk of multiple pathologic fractures until the healing. Different types of treatments for ABC are reported, including surgery, percutaneous treatments, and medical treatments; however, there is currently no consensus on the best approach. The association of curettage, bone graft, and elastic stable intramedullary nail (ESIN) had a success rate of over 85%. Decompressing the cyst wall is more critical for increasing the healing rate than the type of graft used to fill the cavity. In ABC, sclerotherapy offers the advantages of lower invasiveness and morbidity, associated with better functional scores and faster return to full weight-bearing. Moreover, they can be used in challenging locations. Selective arterial embolization is a complex procedure and often requires association with other treatments. Further studies are needed to confirm the effectiveness of denosumab and its side effects on skeletally immature patients. Curettage with adjuvants and autogenous bone grafting still shows promising results and can be used in larger, aggressive defects or superficial lesions. For simple bone cysts, the combination of curettage, bone graft, and ESIN showed the best results. Sclerotherapy for ABC also shows promising results.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"9 5","pages":"387-392"},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899945","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
How to manage a native stiff knee. 如何处理原发性膝关节僵硬
IF 4.3 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0034
Francesco Pirato, Federica Rosso, Federico Dettoni, Davide Edoardo Bonasia, Matteo Bruzzone, Roberto Rossi
{"title":"How to manage a native stiff knee.","authors":"Francesco Pirato, Federica Rosso, Federico Dettoni, Davide Edoardo Bonasia, Matteo Bruzzone, Roberto Rossi","doi":"10.1530/EOR-24-0034","DOIUrl":"10.1530/EOR-24-0034","url":null,"abstract":"<p><p>Knee stiffness is a widely known and worrying condition in several postoperative knees. Less is known about native stiff knee. The aim of this manuscript is to summarize the available literature on native stiff knee epidemiology, classification and treatment. In 1989 stiff knee was defined as a knee with less than 50° of total range of motion. If range of motion is <30°, it is defined as an ankylosed knee. Knee stiffness can be divided into three main types: flexion contractures, extension contractures, and combined contractures. Different risk factors have been associated to native stiff knee and grouped into modifiable or not modifiable. Furthermore, risk factors can be divided into patients' related no patients'-related. Different treatment modalities can be indicated to treat knee stiffness, including manipulation under anesthesia (MUA), arthroscopic and open surgical release. When stiffness is associated with articular disruption TKA represent an option. TKA in native stiff knee can be challenging for the surgeon. Implant's choice and knee exposure are the first steps. In some cases, additional release and extensive can be considered. A stepwise approach and careful preoperative planning are mandatory to obtain long-term satisfactory outcomes. Native stiff knee is a rare but invalidating condition. Different treatment modalities have been proposed as treatment. However, considering that it is frequently associated to sever arthritis, TKA can be an option in painful stiff knees. Nature of knee stiffness necessitates a customized approach to ensure successful management and achieve satisfying outcomes.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"9 5","pages":"363-374"},"PeriodicalIF":4.3,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899896","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
Diagnosis and treatment of posterior shoulder instability based on the ABC classification. 根据 ABC 分类法诊断和治疗肩关节后方不稳。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0025
Alp Paksoy, Doruk Akgün, Sebastian Lappen, Philipp Moroder
{"title":"Diagnosis and treatment of posterior shoulder instability based on the ABC classification.","authors":"Alp Paksoy, Doruk Akgün, Sebastian Lappen, Philipp Moroder","doi":"10.1530/EOR-24-0025","DOIUrl":"10.1530/EOR-24-0025","url":null,"abstract":"<p><p>Posterior shoulder instability (PSI) is less common than anterior shoulder instability, accounting for 2-12% of total shoulder instability cases. However, a much higher frequency of PSI has been recently indicated, suggesting that PSI accounts for up to 24% of all young and active patients who are surgically treated for shoulder instability. This differentiation might be explained due to the frequent misinterpretation of vague symptoms, as PSI does not necessarily present as a recurrent posterior instability event, but often also as mere shoulder pain during exertion, limited range of motion, or even as yet asymptomatic concomitant finding. In order to optimize current treatment, it is crucial to identify the various clinical presentations and often unspecific symptoms of PSI, ascertain the causal instability mechanism, and accurately diagnose the subgroup of PSI. This review should guide the reader to correctly identify PSI, providing diagnostic criteria and treatment strategies.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"9 5","pages":"403-412"},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899864","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
Immediate management of a stable patient with unstable pelvis. 立即处理骨盆不稳定的稳定型患者。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-05-10 DOI: 10.1530/EOR-24-0055
Juan Ramón Cano, José Manuel Bogallo, Alicia Ramirez, Enrique Guerado
{"title":"Immediate management of a stable patient with unstable pelvis.","authors":"Juan Ramón Cano, José Manuel Bogallo, Alicia Ramirez, Enrique Guerado","doi":"10.1530/EOR-24-0055","DOIUrl":"10.1530/EOR-24-0055","url":null,"abstract":"<p><p>The diagnosis of a traumatic unstable pelvis in a stable patient is a temporary concept depending on when we see the patient, as all patients presenting with hemorrhagic shock have hemodynamic stability until they become unstable. As a rule, the more unstable the pelvic fracture is, the higher the risk of bleeding and hemodynamic instability it has. Therefore, in unstable pelvic fractures, hemodynamic stability should be a diagnosis by exclusion. For bleeding detection in stable patients, an immediate one-stage contrast-enhanced CT scan is the appropriate diagnosis test; however, since CT scan radiation is always an issue, X-rays should be considered in those cases of hemodynamically stable patients in whom there is a reasonable suspicion that no unsafe bleeding is going on. Pelvic fracture classification is essential as usually there is an association between the injury mechanism, the fracture displacement, and the hemodynamic stability. Anteroposterior and, particularly, vertical traumatisms have much more proclivity to provoke major pelvic displacement and bleeding. The use of a pelvic binder, as early as possible including pre-hospital management, should be standard in high-impact blunt trauma patients independently of the trauma mechanisms. External fixation is the preferred method of stabilization in case of open fractures, and, in closed ones, when the schedule for definite osteosynthesis prolongs because of the patient's general condition. If possible, immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produce excellent results even in open fractures.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"9 5","pages":"434-447"},"PeriodicalIF":3.4,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140899899","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
Outcomes of total hip arthroplasty using collared versus collarless uncemented HA-coated stems: a meta-analysis. 使用有髋环与无髋环非骨水泥 HA 涂层髋关节柄进行全髋关节置换术的结果：一项荟萃分析。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-04-04 DOI: 10.1530/eor-22-0091
Tarik Ait-Si-Selmi, Jean-Pierre Vidalain, Sonia Ramos-Pascual, Thomas Kuratle, Mo Saffarini, Edouard Dejour, Michel P Bonnin
{"title":"Outcomes of total hip arthroplasty using collared versus collarless uncemented HA-coated stems: a meta-analysis.","authors":"Tarik Ait-Si-Selmi, Jean-Pierre Vidalain, Sonia Ramos-Pascual, Thomas Kuratle, Mo Saffarini, Edouard Dejour, Michel P Bonnin","doi":"10.1530/eor-22-0091","DOIUrl":"https://doi.org/10.1530/eor-22-0091","url":null,"abstract":"to systematically review comparative studies reporting revision rates, clinical outcomes, or radiographic outcomes of total hip arthroplasty (THA) using collared versus collarless conventional-length uncemented hydroxyapatite (HA)-coated stems.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"58 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593665","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}
引用次数: 0
The role of kyphoplasty and expandable intravertebral implants in the acute treatment of traumatic thoracolumbar vertebral compression fractures: a systematic review. 椎体成形术和可膨胀椎体内植入物在创伤性胸腰椎压缩性骨折急性期治疗中的作用：系统性综述。
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-04-04 DOI: 10.1530/eor-23-0190
Diogo Lino Moura
{"title":"The role of kyphoplasty and expandable intravertebral implants in the acute treatment of traumatic thoracolumbar vertebral compression fractures: a systematic review.","authors":"Diogo Lino Moura","doi":"10.1530/eor-23-0190","DOIUrl":"https://doi.org/10.1530/eor-23-0190","url":null,"abstract":"The aim of the study was to assess the role of kyphoplasty and expandable intravertebral implants in the treatment of traumatic vertebral compression fractures.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"29 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593570","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}
引用次数: 0
Brachymetatarsia. Brachymetatarsia.
IF 3.4 2区 医学
Efort Open Reviews Pub Date : 2024-04-04 DOI: 10.1530/eor-23-0011
Matías Sepulveda, Gabriel Orellana, Francisco Sanchez, Estefania Birrer
{"title":"Brachymetatarsia.","authors":"Matías Sepulveda, Gabriel Orellana, Francisco Sanchez, Estefania Birrer","doi":"10.1530/eor-23-0011","DOIUrl":"https://doi.org/10.1530/eor-23-0011","url":null,"abstract":"Brachymetatarsia involves a reduction in length of one or more metatarsals. The affected metatarsal is shortened by 5 mm or more, altering the normal metatarsal parabola. In addition to being an aesthetic deformity, it can present with pain due to transfer metatarsalgia. A possible association with genetic disorders needs to be investigated during clinical evaluation. Surgical treatment may involve a one-stage lengthening procedure or progressive distraction, each having its advantages and limitations.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"30 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140593575","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}
引用次数: 0
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