Bone & Joint Journal最新文献

{"title":"3D fracture assessment could be predictive of native hip survival after nonoperative treatment of acetabular fractures.","authors":"Neeltje M Trouwborst, Miriam G E Oldhoff, Kaj Ten Duis, Sven H van Helden, Erik Hermans, Ruurd L Jaarsma, Esther M M van Lieshout, Inge H F Reininga, Tjarda N Tromp, Michael H J Verhofstad, Jean-Paul P M de Vries, Mathieu M E Wijffels, Anne M L Meesters, Frank F A IJpma","doi":"10.1302/0301-620X.107B2.BJJ-2024-0390.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0390.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of the study was to apply 3D measurements for fracture displacement in minimally to moderately displaced acetabular fractures treated nonoperatively, and to evaluate whether this measurement can be used to estimate the likelihood of conversion to total hip arthroplasty (THA) at follow-up.</p><p><strong>Methods: </strong>A multicentre, cross-sectional study was performed on 144 patients who were treated nonoperatively for an acetabular fracture in four level 1 trauma centres between January 2000 and December 2020. For each patient, fracture displacement was measured on CT-based 3D models. The 3D gap area represents fracture displacement (mm²) between all fracture fragments. A receiver operating characteristic curve was generated to determine a 3D gap area threshold representing the optimal sensitivity and specificity to predict conversion to THA. Native hip survival was reported using Kaplan-Meier curves. Predictors of conversion to THA were determined using Cox regression analysis.</p><p><strong>Results: </strong>Of 144 patients, 18 (12%) received a THA. The median 3D gap area of the complete study cohort was 692 mm² (IQR 216 to 1,400). Native hip survival in patients with a gap area threshold ≤ 1,171 or > 1,171 mm² differed at one-year (98% vs 85%), two-year (96% vs 77%), and five-year follow-up (92% vs 73%). 3D gap area > 1,171 mm² (hazard ratio (HR) 4.3; 95% CI 1.7 to 11.0) and the presence of osteoarthritis grade 2 or higher (HR 3.1; 95% CI 1.2 to 7.8) independently predicted the likelihood of conversion to THA during follow-up.</p><p><strong>Conclusion: </strong>For nonoperatively treated acetabular fractures, introducing 3D gap area assessment to measure fracture displacement offers a promising approach for assessing the risk of conversion to THA. With the introduction of (semi-)automatic segmentation and measurement techniques, or their implementation into commercially available software, this 3D gap area measurement can serve as an addition to the Letournel classification and an alternative to traditional 2D gap and step-off measurements, improving accuracy, reproducibility, and applicability in clinical decision-making.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"204-212"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing pressure sores after hip fracture.","authors":"Matt L Costa, Clare Greenwood, Jane Nixon","doi":"10.1302/0301-620X.107B2.BJJ-2024-0635.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0635.R1","url":null,"abstract":"<p><p>Hip fractures commonly occur in older patients, with high levels of frailty and comorbidity. Many of these patients have limited mobility before their fracture, and even after surgery, their mobility may remain limited. It is therefore not surprising that they are at a high risk of developing pressure sores, particularly on their heels, and a variety of devices and interventions have been proposed to reduce this risk. Foam or air mattresses, designed to reduce contact pressure on the patient's whole body, are now routinely used in many healthcare systems. However, there is wide variation in their design. We developed the WHiTE 14;PRESSURE 3 trial to address the lack of evidence in this area. This is a three-arm multicentre randomized trial including health economic evaluation and recruiting patients from NHS hospitals in the UK. The trial compares standard strategies for the prevention of pressure sores with standard care plus a constant low-pressure device and with standard care plus a heel off-loading device. This annotation describes the development of this trial.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"135-138"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-based migration analysis of a tibial component compared to radiostereometric analysis : one-year results of a prospective single-group implant safety study.","authors":"Lars H W Engseth, Frank-David Øhrn, Anselm Schulz, Stephan M Röhrl","doi":"10.1302/0301-620X.107B2.BJJ-2024-0356.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0356.R2","url":null,"abstract":"<p><strong>Aims: </strong>Radiostereometric analysis (RSA) is considered the gold standard for in vivo migration analysis, but CT-based alternatives show comparable results in the shoulder and hip. We have previously validated a CT-based migration analysis method (CTMA) in a knee phantom compared to RSA. In this study, we validated the method in patients undergoing total knee arthroplasty (TKA). Our primary outcome measure was the difference in maximum total point motion (MTPM) between the differing methods.</p><p><strong>Methods: </strong>A total of 31 patients were prospectively studied having undergone an uncemented medial pivot knee TKA. Migrations were measured up to 12 months with marker-based and model-based RSA, and CT-RSA.</p><p><strong>Results: </strong>Mean precision data for MTPM were 0.27 mm (SD 0.09) for marker-based RSA, 0.37 mm (SD 0.26) for model-based RSA, and 0.25 mm (SD 0.11) for CTMA. CTMA was as precise as both RSA methods (p = 0.845 and p = 0.156). At three months, MTPM showed a mean of 0.66 mm (95% CI 0.52 to 0.81) for marker-based RSA, 0.79 (95% CI 0.64 to 0.94) for model-based RSA, and 0.59 (95% CI 0.47 to 0.72) for CTMA. There was no difference between CTMA and marker-based RSA (p = 0.400), but CTMA showed lower migration than model-based RSA (p = 0.019). At 12 months, MTPM was 1.03 (95% CI 0.79 to 1.26) for marker-based RSA, 1.02 (95% CI 0.79 to 1.25) for model-based RSA, and 0.71 (95% CI 0.48 to 0.94) for CTMA. MTPM for CTMA was lower than both RSA methods (p < 0.001). Differences between migration increased between the methods from three to 12 months. Mean effective radiation doses per examination were 0.016 mSv (RSA) and 0.069 mSv (CT). Imaging time for performing RSA radiographs was 17 minutes 26 seconds (SD 7 mins 9 sec) and 4 minutes 24 seconds (SD 2 mins 3 sec) for CT.</p><p><strong>Conclusion: </strong>No difference in precision was found between CTMA and marker- or model-based RSA, but CTMA shows lower migration values of the tibial component at 12 months. CTMA can be used with low effective radiation doses, and CT image acquisition is faster to perform than RSA methods and may be suitable for use in ordinary clinical settings.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"173-180"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late fracture-related infections in HIV-positive patients : a prospective cohort study.","authors":"Simon M Graham, Samuel Masterson, Maritz Laubscher, Nando Ferreira, William J Harrison, A Hamish R W Simpson, Sithombo Maqungo","doi":"10.1302/0301-620X.107B2.BJJ-2024-0660.R1","DOIUrl":"10.1302/0301-620X.107B2.BJJ-2024-0660.R1","url":null,"abstract":"<p><strong>Aims: </strong>HIV and musculoskeletal injuries both disproportionately affect individuals living in low- and middle-income countries (LMICs), leading to a significant number of fractures in HIV-positive patients. Despite this, little is known about the long-term outcomes for these patients. This prospective cohort study investigated whether HIV infection is associated with fracture-related infections (FRIs).</p><p><strong>Methods: </strong>All adult patients between September 2017 and December 2018 who received intramedullary nail fixation of lower limb fractures in two tertiary referral hospitals in Cape Town, South Africa, were deemed eligible. In total, 358 participants were recruited for this study, 33 of whom were lost to follow-up. Of the 325 participants, 37 (11.4%) developed a total of 39 FRIs over the study period; 25 were early FRIs (64.1%) and 14 were late FRIs (35.9%). Participants were followed up for a minimum of 24 months. Throughout follow-up, participants were monitored for FRIs. These were categorized as early FRIs (< 90 days) and late FRIs (> 90 days).</p><p><strong>Results: </strong>Overall, 71 participants (21.8%) were HIV-positive and 254 participants were HIV-negative (78.2%). In the HIV-positive population, 15 participants (21.1%) suffered 16 FRIs: seven early FRIs (9.9%) and nine late FRIs (7.0%). In the HIV-negative population, 22 participants (8.7%) experienced 23 FRIs, 18 were early FRIs (7.1%), and five participants experienced late FRIs (2.0%). On univariate and multivariate regression, being HIV-positive increased a participant's likelihood of suffering late FRIs, and FRIs overall. HIV status made no significant difference to early FRI rates.</p><p><strong>Conclusion: </strong>Contrary to recent evidence, this study demonstrates an association between HIV and an increased risk of a patient developing late FRIs. However, there was no significant difference in early FRI rates.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"221-228"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acetabular component position significantly influences the rebalancing of pelvic sagittal inclination following total hip arthroplasty in patients with Crowe type III/IV developmental dysplasia of the hip.","authors":"Han Du, Han Qiao, Zan-Jing Zhai, Jing-Wei Zhang, Hui-Wu Li, Yuan-Qing Mao, Zhen-An Zhu, Jie Zhao, De-Gang Yu, Chang-Qing Zhao","doi":"10.1302/0301-620X.107B2.BJJ-2024-0485.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0485.R1","url":null,"abstract":"<p><strong>Aims: </strong>Sagittal lumbar pelvic alignment alters with posterior pelvic tilt (PT) following total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The individual value of pelvic sagittal inclination (PSI) following rebalancing of lumbar-pelvic alignment is unknown. In different populations, PT regresses in a linear relationship with pelvic incidence (PI). PSI and PT have a direct relationship to each other via a fixed individual angle ∠γ. This study aimed to investigate whether the new PI created by acetabular component positioning during THA also has a linear regression relationship with PT/PSI when lumbar-pelvic alignment rebalances postoperatively in patients with Crowe type III/IV DDH.</p><p><strong>Methods: </strong>Using SPINEPARA software, we measured the pelvic sagittal parameters including PI, PT, and PSI in 61 patients with Crowe III/IV DDH. Both PSI and PT represent the pelvic tilt state, and the difference between their values is ∠γ (PT = PSI + ∠γ). The regression equation between PI and PT at one year after THA was established. By substituting ∠γ, the relationship between PI and PSI was also established. The Bland-Altman method was used to evaluate the consistency between the PSI calculated by the linear regression equation (ePSI) and the actual PSI (aPSI) measured one year postoperatively.</p><p><strong>Results: </strong>The mean PT and PSI changed from preoperative values of 7.0° (SD 6.5°) and -8.0° (SD 6.7°), respectively, to 8.4° (SD 5.5°) and -4.5° (SD 5.9°) at one year postoperatively. This change shows that the pelvis tilted posteriorly following THA. In addition, when lumbar-pelvic alignment rebalanced, the linear regression equation between PI and PT was PT = 0.45 × PI - 10.5°, and PSI could be expressed as PSI = 0.45 × PI - 10.5° - ∠γ. The absolute difference between ePSI and aPSI was less than 5° in 55 of 61 patients (90.16%).</p><p><strong>Conclusion: </strong>The new PI created by the positioning of the acetabular component significantly affects the PSI when lumbar-pelvic alignment changes and rebalances after THA in patients with Crowe III/IV DDH.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"149-156"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of complications in older adults after hip fracture surgery : a systematic review and meta-analysis.","authors":"En Lin Goh, Amulya Khatri, Alexander B Costa, Andrew Ting, Kat Steiner, May Ee Png, David Metcalfe, Jonathan A Cook, Matthew L Costa","doi":"10.1302/0301-620X.107B2.BJJ-2024-0251.R1","DOIUrl":"10.1302/0301-620X.107B2.BJJ-2024-0251.R1","url":null,"abstract":"<p><strong>Aims: </strong>Older adults with hip fractures are at high risk of experiencing complications after surgery, but estimates of the rate of specific complications vary by study design and follow-up period. The aim of this systematic review was to determine the prevalence of complications in older adults after hip fracture surgery.</p><p><strong>Methods: </strong>MEDLINE, Embase, CINAHL, and CENTRAL databases were searched from inception until 30 June 2023. Studies were included if they reported prevalence data of complications in an unselected, consecutive population of older adults (aged ≥ 60 years) undergoing hip fracture surgery.</p><p><strong>Results: </strong>A total of 95 studies representing 2,521,300 patients were included. For surgery-specific complications, the 30-day prevalence of reoperation was 2.31%, surgical site infection 1.69%, and deep surgical site infection 0.98%; the 365-day prevalence of prosthesis dislocation was 1.11%, fixation failure 1.77%, and periprosthetic or peri-implant fracture 2.23%. For general complications, the 30-day prevalence of acute kidney injury was 1.21%, blood transfusion 25.55%, cerebrovascular accident 0.79%, lower respiratory tract infection 4.08%, myocardial infarction 1.98%, urinary tract infection 7.01%, and venous thromboembolism 2.15%.</p><p><strong>Conclusion: </strong>Complications are prevalent in older adults who have had surgery for a hip fracture. Studies reporting complications after hip fracture surgery varied widely in terms of quality, and we advocate for the routine monitoring of complications in registries and clinical trials to improve the quality of evidence.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"139-148"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-stage revision for infection of oncological megaprostheses : a multicentre EMSOS study.","authors":"Andrea Sambri, Domenico A Campanacci, Elisa Pala, Maria A Smolle, Davide M Donati, Michiel A J van de Sande, Oleg Vyrva, Andreas Leithner, Lee Jeys, Pietro Ruggieri, Massimiliano De Paolis, Michele Fiore, Marta Bortoli, Alessandro Bruschi, Elisabetta Neri, Diogo Catelas, Vania Oliveira, Marko Bergovec, Korhan Özkan, Aykut Çelik, Erhan Okay, Luca Cevolani, Robert V der Wal, Richard Evenhuis, Minna Laitinen, Roman Malik, Andreas Krieg, Paul Jutte, Min Wook Joo, Tariq Azamgarhi, Craig Gerrand, Rob Pollock, Jasprit Kaur, Jonathan Stevenson, Hartej Sur, Guy Morris","doi":"10.1302/0301-620X.107B2.BJJ-2024-0562.R2","DOIUrl":"10.1302/0301-620X.107B2.BJJ-2024-0562.R2","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to assess the incidence of reinfection in patients after two-stage revision of an infected megaprosthesis (MPR) implanted after resection of a bone tumour.</p><p><strong>Methods: </strong>A retrospective study was carried out of 186 patients from 16 bone sarcoma centres treated between January 2010 and December 2020. The median age at the time of tumour diagnosis was 26 years (IQR 17 to 33); 69 (37.1%) patients were female, and 117 (62.9%) were male.</p><p><strong>Results: </strong>A total of 186 patients with chronic MPR infections were included. Median follow-up was 68 months (IQR 31 to 105). The most represented sites of MPR were distal femur in 93 cases (50.0%) and proximal tibia in 53 cases (28.5%). Polymicrobial infections were seen in 34 cases (18.3%). The most frequent isolated pathogens were staphylococci. Difficult-to-treat (DTT) pathogens were isolated in 50 cases (26.9%). The estimated infection recurrence (IR) rate was 39.1% at five years and 50.0% at ten years. A higher IR rate was found in DTT PJI compared to non-DTT infections (p = 0.019). Polymicrobial infections also showed a higher rate of infection recurrence (p = 0.046).</p><p><strong>Conclusion: </strong>This study suggests that an infected MPR treated by two-stage revision and ultimately reimplantation with a MPR can be successful, but the surgeon must be aware of a high recurrence rate compared to those seen with infected conventional implants.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"253-260"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning for automated hip fracture detection and classification : achieving superior accuracy.","authors":"Zhiqian Zheng, Byeong Y Ryu, Sung E Kim, Dae S Song, Seong H Kim, Jung-Wee Park, Du H Ro","doi":"10.1302/0301-620X.107B2.BJJ-2024-0791.R1","DOIUrl":"10.1302/0301-620X.107B2.BJJ-2024-0791.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to develop and evaluate a deep learning-based model for classification of hip fractures to enhance diagnostic accuracy.</p><p><strong>Methods: </strong>A retrospective study used 5,168 hip anteroposterior radiographs, with 4,493 radiographs from two institutes (internal dataset) for training and 675 radiographs from another institute for validation. A convolutional neural network (CNN)-based classification model was trained on four types of hip fractures (Displaced, Valgus-impacted, Stable, and Unstable), using DAMO-YOLO for data processing and augmentation. The model's accuracy, sensitivity, specificity, Intersection over Union (IoU), and Dice coefficient were evaluated. Orthopaedic surgeons' diagnoses served as the reference standard, with comparisons made before and after artificial intelligence assistance.</p><p><strong>Results: </strong>The accuracy, sensitivity, specificity, IoU, and Dice coefficients of the model for the four fracture categories in the internal dataset were as follows: Displaced (1.0, 0.79, 1.0, 0.70, 0.82), Valgus-impacted (1.0, 0.80, 1.0, 0.70, 0.82), Stable (0.99, 0.95, 0.99, 0.83, 0.89), and Unstable (1.0, 0.98, 0.99, 0.86, 0.92), respectively. For the external validation dataset, the sensitivity and specificity were as follows: Displaced (0.83, 0.94), Valgus-impacted (0.89, 0.90), Stable (0.88, 0.95), and Unstable (0.85, 0.99), respectively. The overall means (Micro AVG and Macro AVG) for the external dataset were Micro AVG (0.83 (SD 0.05), 0.96 (SD 0.01)) and Macro AVG (0.69 (SD 0.02), 0.95 (SD 0.02)), respectively.</p><p><strong>Conclusion: </strong>Compared to human diagnosis alone, our study demonstrates that the developed model significantly improves the accuracy of detecting and classifying hip fractures. Our model has shown great potential in assisting clinicians with the accurate diagnosis and classification of hip fractures.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"213-220"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Wrightington Classification System for elbow fracture-dislocations : an external reliability study.","authors":"Shannon Tse, An-Sofie Van de Kelft, Samuel K Simister, Danielle A Forster, Marcus Lee, Aditya Prinja, Kannan Rajesparan, Abbas Rashid","doi":"10.1302/0301-620X.107B2.BJJ-2024-0294.R1","DOIUrl":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0294.R1","url":null,"abstract":"<p><strong>Aims: </strong>Complex elbow fracture-dislocations often result in suboptimal outcomes and necessitate a thorough understanding of injury patterns to guide effective management and reduce adverse sequelae. The Wrightington Classification System (WCS) offers a comprehensive approach and considers both bony and soft-tissue disruption, providing clearer guidance for treatment. This is the first external study to assess the reliability of the WCS for elbow fracture-dislocations.</p><p><strong>Methods: </strong>A blinded study of patients with elbow fracture-dislocations at a single institution between December 2014 and December 2022 was conducted. Five assessors with a range of experience, including orthopaedic surgeons and radiologists, independently classified injuries using the WCS across three image methods: plain radiograph, 2D CT, and 2D and 3D CT reconstruction images, on two occasions with an eight-week interval. Interobserver and intraobserver reliability were evaluated using kappa statistics and the Landis and Koch criteria.</p><p><strong>Results: </strong>A total of 73 patients were included in the study. Interobserver reliability was moderate, with mean kappa values of 0.518 (95% CI 0.499 to 0.537), 0.557 (95% CI 0.537 to 0.577), and 0.582 (95% CI 0.562 to 0.601), for radiographs, 2D CT, and 2D and 3D CT reconstructions, respectively. Intraobserver agreement was substantial (mean kappa 0.695 (SE 0.067), 0.729 (SE 0.071), and 0.777 (SE 0.070) for radiographs, 2D CT, and 3D CT reconstructions, respectively).</p><p><strong>Conclusion: </strong>The WCS is a reliable and valuable tool for characterizing elbow fracture-dislocations and guiding surgical interventions. This study found moderate reliability in using the WCS, with higher reliability with combined 2D and 3D CT imaging. Further refinement within the WCS in differentiating between coronoid avulsions, basal, anteromedial, and/or anterolateral facet injuries may help improve reliability and reproducibility.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"188-192"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of combined intra-articular administration of vancomycin and ε-aminocaproic acid in total hip arthroplasty : a clinical study.","authors":"Mingwei Hu, Yifan Zhang, Cuicui Guo, Xue Yang, Hao Xu, Shuai Xiang","doi":"10.1302/0301-620X.107B2.BJJ-2024-0232.R2","DOIUrl":"https://doi.org/10.1302/0301-620X.107B2.BJJ-2024-0232.R2","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the concurrent use of vancomycin and ε-aminocaproic acid (EACA) in primary total hip arthroplasty (THA).</p><p><strong>Methods: </strong>In total, 120 patients undergoing unilateral primary THA were divided into three groups: Group VE received intra-articular vancomycin and EACA; Group V received only intra-articular vancomycin; and Group E received only intra-articular EACA. Blood and joint fluids were sampled postoperatively to measure the vancomycin levels using chromatography. Blood loss and kidney function were monitored.</p><p><strong>Results: </strong>Groups E and VE had equivalent blood loss, which was less than that in Group V. Intra-articular vancomycin levels were higher in Group VE at all intervals, with similar serum levels across the groups. Acute kidney injury, ototoxicity, and allergies were not observed, nor was a difference in rates of periprosthetic joint infection.</p><p><strong>Conclusion: </strong>Adding intra-articular EACA to vancomycin did not affect intra-articular vancomycin levels, and maintained EACA's antifibrinolytic effects.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 2","pages":"157-163"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}