Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary Management of Carpal Tunnel Syndrome.","authors":"Lauren M Shapiro, Robin N Kamal","doi":"10.5435/JAAOS-D-24-01179","DOIUrl":"10.5435/JAAOS-D-24-01179","url":null,"abstract":"<p><p>Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies with regard to the diagnosis and treatment of carpal tunnel syndrome in adult patients (≥18 years of age). The scope of this guideline addresses the diagnosis and treatment of carpal tunnel syndrome and contains nine recommendations to assist orthopaedic surgeons and all qualified clinicians managing patients presenting with signs and symptoms which may be attributable to carpal tunnel syndrome based on the best current available evidence. It is also intended to serve as an information resource for professional healthcare practitioners, health services researchers, and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e356-e366"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786610","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":"Efficacy of Topical Antibiotic Powder Application in the Emergency Department on Reducing Deep Fracture-Related Infection in Type III Open Lower Extremity Fractures: A Multicenter Study.","authors":"Mir Ibrahim Sajid, Whisper Grayson, Mitchell P John, Shea Taylor, Bradley J Lauck, Zohair Zaidi, Alex Savage, Nicole Griffin, Mohamed Awad, Andrew T Chen, John Hwang, Nicholas Alfonso, Hassan R Mir","doi":"10.5435/JAAOS-D-24-00474","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00474","url":null,"abstract":"<p><strong>Objectives: </strong>Deep fracture-related infections (FRIs) are a common complication of type III open lower extremity fractures, resulting in notable patient morbidity. The purpose of this study was to determine whether topical application of antibiotic (ABX) powder to type III open lower extremity fracture wounds upon presentation to the emergency department (ED) reduces the rate of FRI.</p><p><strong>Methods: </strong>This is a retrospective review of ABX powder application compared with a historical cohort at 4 level 1 trauma centers. Patients with type III open lower extremity fractures from July 1, 2019, to October 1, 2022, who received topical ABX powder (1 g vancomycin and 1.2 g tobramycin) in the ED were compared with patients from a 4-year historical cohort who were treated through the same protocol without topical ABX powder. Outcomes include the development of FRI within 6 months of follow-up. Patient demographics, injury characteristics, and postoperative data were analyzed in addition to FRI.</p><p><strong>Results: </strong>One hundred fifteen patients received topical ABX powder in the ED and were compared with 135 patients who were treated without topical ABX powder. The rate of FRI in the intervention group was 8 of 115 (6.96%) vs. 22 of 135 (16.30%) in the control cohort (P = 0.024). Multivariate regression analysis demonstrated higher body mass index as a risk factor for the development of FRI (P = 0.003). When excluding those with intraoperative ABX powder use, there was still a markedly lower rate of FRI when ED ABX powder was used on regression analysis (P = 0.048).</p><p><strong>Conclusion: </strong>Antibiotic powder application to type III open fracture wounds in the ED markedly reduces the incidence of FRI in this multicenter study. Further large-scale studies are warranted.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781898","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":"Medicaid Insurance Is Associated With Increased Readmissions and Mortality After Surgery for Periprosthetic Joint Infection.","authors":"Mary K Richardson, Julian Wier, Dara Bruce, Kevin C Liu, Anna Cohen-Rosenblum, Jay R Lieberman, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-24-00165","DOIUrl":"10.5435/JAAOS-D-24-00165","url":null,"abstract":"<p><strong>Background: </strong>Patients with Medicaid insurance are at an increased risk of postoperative complications following total knee arthroplasty and total hip arthroplasty (TJA); however, their outcomes following revision TJA for periprosthetic joint infection (PJI) requires further study.</p><p><strong>Methods: </strong>A retrospective query was conducted for adult patients undergoing implant explantation and antibiotic spacer placement for TJA PJI from the Premier Healthcare Database between December 1, 2016, and December 31, 2021. Patients were then grouped by Medicaid or non-Medicaid insurance status and were age matched through exact caliper matching. Multivariable regression models addressed potential confounding. Adjusted risks of 90-day postoperative complications were reported.</p><p><strong>Results: </strong>Of the 40,346 patients identified, 2,711 Medicaid patients were matched to 10,844 non-Medicaid patients on age (56.1 vs. 56.1 years, P = 1.000). Patients with Medicaid experienced higher risk of sepsis (adjusted odds ratio [aOR] = 1.20, P = 0.010), readmission (aOR = 1.12, P = 0.022), being discharged to a skilled nursing facility (aOR = 1.13, P = 0.031), and had longer length of stay (9.48 vs. 6.67 days, P < 0.001), compared with patients with non-Medicaid. Medicaid patients had a higher rate of inpatient mortality (0.81% vs. 0.48%, P = 0.038); however, the risk was similar after accounting for differences in comorbidities.</p><p><strong>Conclusion: </strong>Following revision TJA for PJI, patients with Medicaid were at an increased risk for postoperative complication, including sepsis and readmission. They experienced a higher rate of inpatient mortality that may be driven by differences in comorbidities. Insurers and policy makers should consider this information to develop risk stratification-based payment strategies that take into account the healthcare burden of this high-risk patient population.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e391-e400"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787501","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":"Journey of International Medical Graduates Toward Orthopaedic Surgery Residency in the United States.","authors":"Pablo Sanchez-Urgelles, Suleiman Y Sudah, Joaquin Sanchez-Sotelo, Mariano E Menendez","doi":"10.5435/JAAOS-D-24-00761","DOIUrl":"10.5435/JAAOS-D-24-00761","url":null,"abstract":"<p><p>International medical graduates (IMGs) are integral to the US healthcare system but are scarce in orthopaedic residency classes. Positive contributions of IMGs to the field of orthopaedic surgery in the United States are well documented, but successfully matching into an orthopaedic residency position as an IMG remains very challenging. The purpose of this study was to review current processes, strategies, and potential barriers of IMGs applying for orthopaedic surgery residency in the United States as an IMG.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"327-335"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814862","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":"Shoulder Arthroplasty Patients Are Underscreened for Osteoporosis.","authors":"Alisa Malyavko, Amil R Agarwal, Jacob D Mikula, Matthew J Best, Uma Srikumaran","doi":"10.5435/JAAOS-D-23-00408","DOIUrl":"10.5435/JAAOS-D-23-00408","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporosis screening and subsequent treatment has been shown to be efficacious in decreasing the rates of fragility fractures and periprosthetic fractures (PPF). However, current screening and treatment rates are low. This study aims to determine (1) the prevalence of total shoulder arthroplasty (TSA) patients who meet criteria for osteoporosis screening, (2) the prevalence of those screened, and (3) the 5-year cumulative incidence of fragility fracture (FF) and periprosthetic fractures (PPF).</p><p><strong>Methods: </strong>The PearlDiver database was used to identify all patients older than 50 years who underwent TSA. Guidelines from the American Association of Clinical Endocrinologists were used to stratify patients into \"high risk\" and \"low risk\" of osteoporosis cohorts using International Classification of Disease codes for various risk factors. The prevalence of osteoporosis screening using dual-energy x-ray absorptiometry (DXA) scan was analyzed, and the 5-year cumulative incidence of FF and PPF was calculated between the \"low-risk\" and \"high-risk\" groups using Kaplan-Meier analysis.</p><p><strong>Results: </strong>In total, 66,140 (65.5%) who underwent TSA were considered \"high risk\" for osteoporosis. Of the \"high-risk\" patients, 11.7% patients received routine osteoporosis screening preoperatively. Within 5 years, \"high-risk\" TSA patients had markedly higher cumulative incidence for PPF (HR: 1.4; 95% CI: 1.0-1.9; P = 0.037) and FF (HR: 2.42; 95% CI: 2.1-2.8; P < 0.001) when compared with those at \"low risk\".</p><p><strong>Discussion: </strong>There is a high prevalence of osteoporosis among patients undergoing TSA but a low rate of routine osteoporosis screening in this cohort. Patients with osteoporosis who are categorized as \"high risk\" have an increased rate of fragility fractures and PPF. Therefore, there is an opportunity to increase appropriate osteoporosis screening and management in this cohort, which may affect future risk of FF and periprosthetic fracture.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"362-369"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787580","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":"Letter to the Editor: The Frailty of Fragility Index, Orthopaedic Paradigms and Practice.","authors":"Aleksi Reito, Teemu Karjalainen","doi":"10.5435/JAAOS-D-23-00862","DOIUrl":"10.5435/JAAOS-D-23-00862","url":null,"abstract":"","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e410-e411"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814899","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":"Contemporary Management of Proximal Humeral Fractures.","authors":"Erin Stockwell, Adil Ahmed, Hassan R Mir","doi":"10.5435/JAAOS-D-24-01073","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01073","url":null,"abstract":"<p><p>Proximal humerus fractures (PHFs) are common injuries managed by orthopaedic surgeons. Treatment for PHFs remains somewhat controversial. This review article discusses indications, techniques, and outcomes for several modes of contemporary management of PHFs including nonsurgical treatment, surgical fixation, and reverse shoulder arthroplasty.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781897","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":"Characterizing the Rotational Profile of the Distal Femur: A Roadmap for Distal Femoral Replacement Surgery.","authors":"Matthew S Chen, Kevin C Liu, Matthew C Gallo, Nicholas Kusnezov, Brian C Chung, Darryl Hwang, Alexander B Christ, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-24-00207","DOIUrl":"10.5435/JAAOS-D-24-00207","url":null,"abstract":"<p><strong>Introduction: </strong>Standard references for determining rotational alignment are often unavailable when performing distal femoral replacement (DFR) surgery. This study aimed to describe the rotational profile of the distal femoral osteology at common resection levels.</p><p><strong>Methods: </strong>Adults with CT scans of the bilateral legs were included. Exclusion criteria included fractures, congenital deformity, prior arthroplasty, or inadequate imaging. Referencing the transepicondylar axis, angles were measured in the axial plane using the following reference lines: anterior condylar axis or anterior femoral cortex axis (AFCA), posterior condylar axis or posterior femoral cortex axis (PFCA), lateral projection of the linea aspera (LAA), and Whiteside line (WL). These rotational measurements were assessed at 3, 5, 7, and 9 cm proximal of the joint line. External and internal rotation were denoted as positive and negative, respectively.</p><p><strong>Results: </strong>Fifty-one patients (102 femora) were included (mean age: 62.6 ± 13.4 years; mean body mass index: 26.0 ± 6.7 kg/m 2 ). Proximally, the anterior condylar axis/anterior femoral cortex axis became increasingly internally rotated (3-cm: -13.1 ± 3.5°, 9-cm: -21.2 ± 6.6°), whereas the posterior condylar axis/PFCA became increasingly externally rotated (3-cm: -6.7 ± 2.3°, 9-cm: 9.6 ± 6.1°). WL remained nearly perpendicular (3-cm: 88.8 ± 2.3°, 5-cm: 89.8 ± 3.7°) but was not reliably measured beyond 5 cm. The LAA was measurable proximal to 5 cm from the joint line and was internally rotated (5-cm: -58.5 ± 14.3°, 9-cm: -45.6 ± 13.4°).</p><p><strong>Conclusion: </strong>Distally, WL is a reliable anatomic landmark for femoral implant rotation. At more proximal resection levels, the posterior cortex may be a valuable landmark as referencing the linea aspera may lead to gross internal rotation of the femoral implant.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e401-e409"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814835","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":"Surgical Management of Hip Pain in Active Patients With Early Osteoarthritis: Navigating the Choice Between Hip Preservation and Arthroplasty.","authors":"Tyler R McCarroll, Benjamin D Kuhns, Benjamin G Domb","doi":"10.5435/JAAOS-D-24-00242","DOIUrl":"10.5435/JAAOS-D-24-00242","url":null,"abstract":"<p><p>Hip pain in active patients with early osteoarthritis can be quite debilitating, affecting mobility, quality of life, and overall well-being. Management of this patient population is challenging because arthroplasty implants inevitably have limited life expectancy while chondral damage can mitigate the benefits of arthroscopic or open hip preservation. A multifaceted, patient-specific approach to clinical decision making is crucial in this patient population, given their higher activity level and expectations compared with older cohorts. Several advances have been made to better stratify patients into the spectrum of management, which includes nonsurgical measures; injections, including orthobiologics; arthroscopic hip preservation; open hip preservation; hip resurfacing; and total hip arthroplasty.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"336-345"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029690","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":"Perioperative Nutritional Optimization in Spine Surgery.","authors":"Sapan Gandhi, Ikechukwu C Amakiri, Jason Pittman, Andrew White","doi":"10.5435/JAAOS-D-24-01101","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01101","url":null,"abstract":"<p><p>Although spine surgery has been shown to be an effective treatment for many spinal disorders, perioperative complications can increase patient morbidity and lead to poorer surgical outcomes. Nutritional status is a modifiable factor that affects spine surgery results. Malnutrition can negatively influence inflammatory pathways and can change circulating stress hormones. Perioperative nutrition status can be evaluated by both clinical and laboratory parameters, with nutritional indices allowing for determination of perioperative risk. Perioperative nutritional optimization has been attempted and has been associated with improved outcomes, for patients undergoing spine surgery. Additional investigation is needed to determine effective perioperative nutritional protocols.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773570","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}