Efort Open Reviews最新文献

{"title":"The most common bone tumors of the upper extremity in childhood and adolescence and their treatment: a review of the current literature.","authors":"Dong Yu, Alexandre Kaempfen, Maximilian Burger, Kira Barlow, Andreas H Krieg","doi":"10.1530/EOR-2025-0149","DOIUrl":"10.1530/EOR-2025-0149","url":null,"abstract":"<p><p>In upper extremity bone tumors, osteochondromas and solitary bone cysts represent the predominant benign entities, with osteosarcoma accounting for the majority of malignant presentations. The proximal humeral metaphysis emerges as the most prevalent anatomical site across both tumor entities. Upper, one-sided extremity pain in children and adolescents should be followed up and diagnosed, since 'growing pain' in the upper extremities is not a common finding. Osteochondromas should be surgically addressed early if they impose a risk of development of a deformity, such as those located on the forearm and the distal tibia, where they can cause growth disorders and thus functional impairments. Reconstructions for pediatric malignant bone tumors of the upper arm or forearm should allow the spatial placement of the hand. Given the longevity of sarcoma survivors, the longevity of the reconstruction is an important planning consideration. Biological reconstructions combining autologous/vascularized bone with tendon repair and transfers appear to be the most appropriate and preferable to prosthesis whenever possible. Multidisciplinary collaboration involving plastic surgeons with hand reconstruction expertise constitutes a critical component in orthopedic oncology treatment planning.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"317-327"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634935","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":"Congenital lumbar spinal stenosis: current perspectives on diagnosis, imaging, and treatment.","authors":"Bechara El Khoury, Ahmad Assi, Mohamad Farhat, Marc Boutros, Amer Sebaaly","doi":"10.1530/EOR-2025-0159","DOIUrl":"10.1530/EOR-2025-0159","url":null,"abstract":"<p><p>Congenital lumbar stenosis (CLS) is an uncommon disorder marked by a congenitally small spinal canal, which frequently results in early-onset neurogenic symptoms. Sarpyener originally characterized CLS in 1947, and Verbiest later offered a clinical description of lumbar spinal stenosis that did not recognize the congenital nature of the condition. The frequency of absolute CLS is believed to be 2.6%; however, data are lacking. This narrative review will outline current knowledge on CLS, including its prevalence, clinical presentation, genetic implications, aspects in diagnostic imaging for the condition, and treatment options. CLS has similar clinical characteristics to acquired lumbar stenosis; however, individuals with CLS report more severe leg and back pain. Genetic factors may contribute to CLS occurrence; however, research on this aspect is scarce. CLS is usually related to cervical and thoracic stenosis, as well as diseases such disk herniation and spondylolisthesis. The diagnosis is based on imaging criteria, which are continually being refined. The treatment options vary from conservative care to surgical treatments, such as laminoplasty and stability-preserving decompression, although long-term outcome data are limited. CLS poses distinct diagnostic and treatment challenges given its early onset. Further study is needed to provide uniform diagnostic criteria, evaluate long-term treatment results, and identify specific genetic factors that contribute to CLS.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"359-365"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634863","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":"Minimally invasive plate fixation of paediatric lower limb long bone fractures: a review on when and how.","authors":"Alberto Daniel Navarro Vergara, Jamil Soni, Weverley Rubele Valenza, Estefanía Birrer, Heloisa Zimmmermann Faggion","doi":"10.1530/EOR-2025-0122","DOIUrl":"10.1530/EOR-2025-0122","url":null,"abstract":"<p><p>Fractures of the lower limbs represent a common cause of hospital admission. Surgical intervention is increasingly indicated in paediatric patients. The gold standard for treating long bone fractures in the immature skeleton is intramedullary fixation with titanium elastic nails. Minimally invasive plating is considered a suitable option when elastic nailing is not feasible. The use of a plate provides adequate mechanical stability for weight-bearing and limb mobility while preserving biological bone integrity and resulting in limited scarring, generally well accepted by patients and families, although it requires a more extensive incision than intramedullary fixation. Potential drawbacks of this technique include a more extensive surgical approach, possible delay in weight-bearing, and the potential need for implant removal.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"299-306"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634882","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":"A narrative review of our developing knowledge about paediatric spondylodiscitis based on existing literature.","authors":"Ahmer Ahmad Khan, Aikaterini Doubovina, Giacomo De Marco, Christina Steiger, Romain Dayer, Dimitri Ceroni","doi":"10.1530/EOR-2025-0224","DOIUrl":"10.1530/EOR-2025-0224","url":null,"abstract":"<p><p>Paediatric spondylodiscitis (SD) is an infection involving the vertebral bodies and adjacent intervertebral discs in populations below 16 years old. It is rarely confined to a single compartment; more often, it spreads to other areas in the spinal column and may cause other infections, such as epidural abscesses, subdural abscesses, septic arthritis of the facet joints, paravertebral abscesses and even meningitis. SD predominantly affects children from 6 to 48 months old, and the lumbar spine seems to be most at risk; no specific markers are currently available for a biological diagnosis of SD. Blood cultures are often negative, and even disc or bone biopsies show limited yields. However, recent advances in nucleic acid amplification tests have laid the foundations for developing and implementing more efficient methods of identifying pathogens in samples. Microbiologically, Kingella kingae dominates in children from 6 to 48 months old, while Staphylococcus aureus is more common in infants under 6 months and in older children. High-throughput sequencing performed on plasma samples (recognised as liquid biopsy) is a promising multi-purpose tool that can detect not only pathogens circulating in the bloodstream but also those emanating from focal infections, something particularly interesting in cases of paediatric SD, where disc sampling is strongly discouraged. Paediatric SD treatments are mainly medical; surgery is rarely indicated, except for abscess drainage, emergency neurological decompression or spinal stabilisation.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"307-316"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634745","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":"Muscle edema of the rotator cuff: a systematic review of characteristics and associated pathologies from the LaTour group.","authors":"Jeanni Zbinden, Kinga Michalewska, Sean Wl Ho, Marko Nabergoj, Mohamed Ibrahim, Joe Chih-Hao Chiu, Xue Ling Chong, Brigitte Von Rechenberg, Alexandre Lädermann","doi":"10.1530/EOR-2025-0096","DOIUrl":"10.1530/EOR-2025-0096","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review the characteristics, diagnostic methods, and etiologies of rotator cuff (RC) muscle edema.</p><p><strong>Methods: </strong>A PRISMA-compliant review of clinical and laboratory studies from PubMed and Embase (PROSPERO ID: 626276); data on edema location, imaging features, and associated pathologies were qualitatively synthesized.</p><p><strong>Results: </strong>MRI is the most consistent tool for detecting muscle edema, typically showing T2 hyperintensity with variable patterns depending on etiology (traumatic, neurogenic, exertional, myopathic, or iatrogenic). Traumatic edema is associated with tendon retraction, bursal effusion, and fatty infiltration; neurogenic edema is diffuse and symmetric with atrophy; exertional edema appears 'fluffy' or 'feather-like'; myopathic and iatrogenic forms show peripheral or localized changes.</p><p><strong>Conclusion: </strong>The imaging appearance, location, and timing of RC muscle edema provide valuable diagnostic clues and should be considered in the context of the underlying pathology.</p><p><strong>Level of evidence: </strong>Systematic review, level 4.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"338-348"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634801","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":"Tactical use of irrigants in open orthopaedic procedures: 'what to use & when'.","authors":"Madhav Chowdhry, Abdul Qayyum Khan, Christopher Hamad, Nicholas M Bernthal, Edward J McPherson","doi":"10.1530/EOR-2025-0136","DOIUrl":"10.1530/EOR-2025-0136","url":null,"abstract":"<p><p>Musculoskeletal infections (MSIs) pose formidable challenges to healthcare resources. Surgical wound irrigation is a crucial step in reducing microbial bioburden in open orthopaedic procedures, yet there remains ambiguity regarding optimal use of lavage agents. For tactical selection of irrigants, orthopaedic wounds can be classified into three major categories (aseptic, acute septic and chronic septic) based upon microbial bioload and presence or absence of biofilm upon implanted hardware and/or musculoskeletal tissues. Irrigant products can be stratified based upon their modes of action: single modal (dilutional), dual modal (dilutional and chemical) and multi-modal (dilutional with multiple mechanisms). Host toxicity is commensurate with increased complexity of an irrigant product. A tailored, stepwise strategy of irrigant selection aligned with wound type is recommended, escalating from simple low toxicity dilutional lavage for low microbial bioloads to potent multi-modal chemical agents for biofilm-laden chronic infections. The method of irrigant delivery and selected volume are integral to wound lavage. The difference between methods is the impact pressure to host tissues and the depth of fluid penetration. Higher impact pressures clear adherent bacteria and foreign debris albeit the cost of host tissue damage.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 3","pages":"145-155"},"PeriodicalIF":4.6,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327846","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":"CT protocols for lower limb arthroplasty: the Stanmore hip and knee protocols.","authors":"Angelika Ramesh, Anna Di Laura, Jennifer Gibson, Alister Hart, Johann Henckel","doi":"10.1530/EOR-2025-0001","DOIUrl":"10.1530/EOR-2025-0001","url":null,"abstract":"<p><p>Computed tomography (CT) enables 3D surgical planning for implant size and position, patient-specific instruments, and robotic-assisted lower limb joint replacement. Orthopaedic companies provide CT protocols tailored to specific implant systems and designs, including off-the-shelf and custom-made implants, leading to substantial variability in imaging guidelines for centres and hospitals. This study aims to consolidate CT imaging workflows through harmonised protocols that minimise ambiguity and enhance clarity, clinical practice and patient safety. A multidisciplinary team critically reviewed all 17 hip and 12 knee CT protocols that were available. Imaging elements were assessed, highlighting deficiencies and inconsistencies. These protocols informed the recommendation of five harmonised CT protocols through informal consensus: i) primary hip, ii) revision hip, iii) primary knee, iv) revision knee and v) total femoral replacement. Significant variability was found among company guidelines regarding scan volume, X-ray tube current, voltage and other parameters, resulting in inconsistent image quality and radiation exposure. Lack of harmonisation can lead to scan rejections and repeat imaging. The harmonised protocols prioritise high-resolution imaging with optimal parameters, reduced scan volume and minimal metal artefacts. Designed to be clear, concise, consistent and comprehensive, these user-friendly protocols effectively capture key anatomical structures, landmarks and alignment details crucial for planning and monitoring lower limb arthroplasty. The protocols are sufficiently flexible to accommodate both standard and customised implant planning requirements. These protocols streamline the imaging process, fostering alignment across companies by consolidating existing protocols; they reduce duplication and eliminate inconsistencies, without redefining the content or intent of the original protocols.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 3","pages":"156-166"},"PeriodicalIF":4.6,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327446","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":"The approach to hip instability in children with cerebral palsy: an umbrella review.","authors":"Ana Paula Tedesco, Alessandro Melanda, Davi Moshe, Epitácio Rolim Filho, Francesco Camara Blumetti, Leonardo Cury Abrahão, Mauro César de Morais Filho, Patricia Moreno Grangeiro","doi":"10.1530/EOR-2025-0114","DOIUrl":"10.1530/EOR-2025-0114","url":null,"abstract":"<p><strong>Purpose: </strong>Children with cerebral palsy (CP) are at a high risk of progressive hip displacement, defined as lateral migration of the femoral head measured by the Reimers migration percentage. This condition may impair quality of life, highlighting the need for improved hip care. This umbrella review assessed current evidence on the evaluation, prevention, and treatment of hip displacement in children with CP by synthesizing systematic reviews.</p><p><strong>Methods: </strong>Systematic reviews published in English between 2004 and 2024 were included, focusing on children with CP aged 0-18 years. Searches were conducted in nine databases: PubMed, MEDLINE, Web of Science, Scopus, BVS, CINAHL, Cochrane Library, PEDro, LILACS, and EMBASE. Methodological quality was assessed using AMSTAR 2 for interventional studies and JBI criteria for non-interventional studies. This review has been registered at PROSPERO (registration number: CRD42024618645).</p><p><strong>Results: </strong>In total, 25 systematic reviews addressed key aspects of hip management, including hip surveillance; tone management; preventive, reconstructive, and salvage procedures; and antifibrinolytic use. Hip surveillance reduced hip dislocation rates and the need for salvage surgery, whereas postural and tone management showed no consistent preventive effect. Combined pelvic and femoral osteotomies achieved better outcomes than isolated procedures, while soft-tissue surgeries had high recurrence rates. Proximal femoral hemiepiphysiodesis improved radiographic outcomes but frequently required revision. Salvage procedures such as valgus osteotomy and femoral head resection relieved pain, whereas hip arthrodesis showed poor outcomes. Total hip arthroplasty improved pain and function but was associated with high complication rates.</p><p><strong>Conclusions: </strong>This umbrella review highlights evidence-based practices and important knowledge gaps in the management of hip instability in children with CP, supporting future research and improved clinical care.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 3","pages":"208-223"},"PeriodicalIF":4.6,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327875","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":"The routine use of skin traction in patients with femoral neck fractures awaiting arthroplasty: a narrative review.","authors":"Ismail Ravat, Allan Roy Sekeitto, Laine Alexander, Nkhodiseni Sikhauli, Lipalo Mokete, Jurek R T Pietrzak","doi":"10.1530/EOR-2024-0149","DOIUrl":"10.1530/EOR-2024-0149","url":null,"abstract":"<p><p>Femoral neck fractures remain a significant challenge in orthopaedic surgery, particularly among elderly patients. This review synthesizes the current peer-reviewed literature on initial management strategies, with a particular emphasis on the use of skin traction. Skin traction, which involves the application of adhesive tape, a crepe bandage, and a calibrated pulley system with precise weights, is analysed in terms of its efficacy in clinical practice. The review discusses the benefits and drawbacks of skin traction, drawing on recent studies to assess its role in fracture management. The goal is to provide nuanced scientific insights into the ongoing discourse surrounding the management of femoral neck fractures.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 3","pages":"183-190"},"PeriodicalIF":4.6,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327826","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":"Femoral head fractures: anatomy, diagnosis and management.","authors":"Olivia Ann Dunseath, Ibrahem Al-Obaidi, Luca Ignatius, Branavan Rudran, Chris Jordan","doi":"10.1530/EOR-2025-0026","DOIUrl":"10.1530/EOR-2025-0026","url":null,"abstract":"<p><p>Femoral head fractures are complex and severe injuries, usually associated with hip dislocation. They typically result from high-energy trauma. Therefore, a low index of suspicion is required for diagnosis in these contexts. Initial presentation can vary depending on coexisting injuries but is typically an emergency and requires immediate reduction of the joint. Delays result in worse outcomes for patients. Pelvic radiographs are recommended before and after joint reduction, with Judet, inlet and outlet views to identify any associated acetabular fracture and pelvic ring injury. Computed tomography helps determine the fracture configuration and classification, commonly using the Pipkin classification. Definitive fracture management depends on patient demographics, fracture pattern and associated injuries. Pipkin type I and II fractures with minimal displacement and an anatomically congruent hip joint may be treated conservatively. Otherwise, surgical open reduction internal fixation via the anterior approach is recommended. Young patients with Pipkin type III injuries usually require open reduction internal fixation via the anterior or posterior approach, while elderly patients may need total hip arthroplasty. Pipkin type IV fractures may require a combination of open reduction internal fixation approaches with or without trochanteric flip osteotomy. Femoral head fractures often have poor outcomes, with type III and IV fractures having worse outcomes than types I and II. Early complications include infection and sciatic nerve palsy. Late complications include avascular necrosis, heterotopic ossification and post-traumatic arthritis. This article considers the anatomy, diagnosis and evidence-based management strategies for femoral head fractures.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 3","pages":"175-182"},"PeriodicalIF":4.6,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327534","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}