Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Refined Techniques in Tibial Nailing.","authors":"Cory A Collinge, Mariel M Rickert, Phillip M Mitchell, Robert H Boyce","doi":"10.5435/JAAOS-D-24-00238","DOIUrl":"10.5435/JAAOS-D-24-00238","url":null,"abstract":"<p><p>Intramedullary nail fixation of unstable tibial diaphyseal fractures is commonly used with excellent clinical results. Indications for nailing have rapidly expanded over recent years, allowing for more difficult fractures to be addressed with \"extreme nailing.\" Despite its widespread use, evolution of newer nailing systems and varying techniques for insertion bring new difficulties with tibial fracture reduction, and malalignment occurs with relative frequency. This highlights the need for a methodical approach for efficient and predictable tibial nailing. An algorithmic approach is essential, beginning with identifying challenging patterns in proximal and distal fractures and addressing any intra-articular elements initially. A semiextended approach is helpful to neutralize deforming forces. Optimizing the starting point and confirming lateral termination of the guidewire mitigate fracture malreduction after nail placement. Fracture reduction is facilitated with clamps, fibular or tibial plating, blocking screws or wires, external fixation, universal distractor, or manual manipulation to optimize outcomes and avoid pitfalls in an effective tibial nailing.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e291-e300"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781916","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":"A Comprehensive Review of Injury Causation Analysis Methodology for the Assessment of Workers' Compensation and Motor Vehicle Collision Injuries.","authors":"Erick M Santos, Richard A Watson, Alexis E Dixon, Peter G Whang","doi":"10.5435/JAAOS-D-24-00112","DOIUrl":"10.5435/JAAOS-D-24-00112","url":null,"abstract":"<p><p>Orthopaedic surgeons are frequently involved in treating patients with conditions resulting from occupational injuries or trauma from motor vehicle collisions. These circumstances may lead to disputes that are subject to litigation or medicolegal determinations by state agencies. As musculoskeletal experts, orthopaedic surgeons are frequently asked to opine on the causation and extent of injury in these patients. This comprehensive review details the methodology for injury causation analysis, which has been developed and validated in the peer-reviewed literature. These approaches evolved from the Hill criteria to encompass protocols used by the American Medical Association and taught at the American Academy of Orthopaedic Surgeons instructional courses. The various methodologies are defined in the context of their use for workers' compensation cases and motor vehicle collisions with the assistance of an illustrative case.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"212-220"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11812656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015459","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":"Managing and Preserving Tattoos During Orthopaedic Surgery.","authors":"Shafic Sraj, Brendan Farley, Acara Turner, Kerri Woodberry","doi":"10.5435/JAAOS-D-24-00596","DOIUrl":"10.5435/JAAOS-D-24-00596","url":null,"abstract":"<p><p>Orthopaedic surgeons encounter tattoos in surgical fields with an increasing frequency and have the choice of avoiding, disregarding, bordering, or incorporating them into the surgical incisions. This article describes the history and the personal, social, and artistic value of tattoos; the physiology of tattoos and wound healing; the principles of incision planning for optimal cosmesis; and specific considerations when encountering tattoos in the surgical field. It subsequently describes cosmetic outcomes and tattoo-specific complications after surgery and provides a decision tree to help surgeons and patients decide the best approach for individual situations.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"221-230"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015533","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":"Vitamin D Supplementation May Prevent or Treat Deficiency After Total Knee Arthroplasty: A Retrospective Cohort Analysis.","authors":"Jessica L Duggan, Matthew P Jamison, Wolfgang Fitz, Jeffrey K Lange, Meryl S LeBoff, Antonia F Chen","doi":"10.5435/JAAOS-D-24-00005","DOIUrl":"10.5435/JAAOS-D-24-00005","url":null,"abstract":"<p><strong>Background: </strong>Vitamin D deficiency is associated with poorer functional outcomes and increased complication rates after total knee arthroplasty (TKA). Yet, there is no longer term study evaluating vitamin D levels and supplementation after TKA. Our study aimed to compare quantitative vitamin D levels and supplementation regimens after TKA stratified by patient sex and race.</p><p><strong>Methods: </strong>A retrospective cohort study of primary TKA patients at a single hospital from 2015 to 2022 was conducted. We analyzed vitamin D preoperatively and postoperatively up to 2 years. Vitamin D deficiency was defined as <30 ng/mL. A subgroup analysis was conducted in patients with vitamin D <21 ng/mL. Supplementation categories included none, low (<1,001 IU), medium (1,001 to 5,000 IU), and high (>5,000 IU).</p><p><strong>Results: </strong>A total of 400 (66.0% female) patients who underwent 430 primary TKA procedures were included, and 65.3% received supplementation. Patients who were vitamin D sufficient preoperatively demonstrated higher vitamin D levels and ability to maintain sufficiency postoperatively using low-dose supplementation compared with no supplementation ( P = 0.004). Those who were vitamin D deficient preoperatively demonstrated higher vitamin D levels postoperatively using medium to high doses ( P = 0.02). For patients who became deficient postoperatively, supplementation was associated with achieving repletion at an average of 10.2 months ( P < 0.001). Black patients demonstrated 2.8 times higher odds of having a vitamin D level less than 30 ng/mL ( P = 0.03).</p><p><strong>Conclusion: </strong>Our study demonstrated that low-dose vitamin D supplementation (<1,001 IU) was beneficial for vitamin D-sufficient TKA patients to achieve higher levels and maintain vitamin D sufficiency. Vitamin D-deficient TKA patients benefitted from medium-to-high dose supplementation (1,001 to 5,000+), but only 33.7% achieved vitamin D repletion. This work highlights the need to continue vitamin D surveillance postoperatively and the need to continue vitamin D repletion.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e301-e311"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728263","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":"Comparison of Time and Rate of Achieving Minimal Clinically Important Difference: Robotic Versus Manual Unicompartmental Knee Arthroplasty.","authors":"Perry L Lim, Zain Sayeed, Marcos R Gonzalez, Christopher M Melnic, Hany S Bedair","doi":"10.5435/JAAOS-D-24-00380","DOIUrl":"10.5435/JAAOS-D-24-00380","url":null,"abstract":"<p><strong>Background: </strong>Robotics in unicompartmental knee arthroplasty (UKA) continues to increase with the ever-growing demand to use technology in the surgical setting. However, no studies have used minimal clinically important difference (MCID) to compare patient-reported outcome measures (PROMs) between robotic UKA (rUKA) and manual UKA (mUKA). This study aimed to compare the rate of achieving MCID for improvement (MCID-I) and worsening (MCID-W) and the time to achieving MCID.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of robotic and manual UKAs performed between 2016 and 2022. Preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, PROMIS Physical Function Short-Form 10a (PF-10a), and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-Form (KOOS-PS) scores were collected. Patients were stratified on reaching MCID-I, MCID-W, or \"no notable change\" (score between MCID-W and MCID-I). Survival curves with and without interval censoring were used to assess the time to achieving the MCID. Log-rank and weighted log-rank tests were used to compare groups.</p><p><strong>Results: </strong>A total of 256 UKAs (64 robotic and 192 manual) were analyzed. No differences were observed in the proportion of patients achieving MCID-I or MCID-W across all three PROMs. Similarly, median time to achieving MCID showed no significant differences between rUKA and mUKA for PROMIS Global Physical (3.3 versus 4.9 months, P = 0.44), PROMIS PF-10a (7.7 versus 8.3 months, P = 0.93), and KOOS-PS (3.0 versus 6.0 months, P = 0.055) scores, both with and without interval censoring.</p><p><strong>Discussion: </strong>This study indicates that rUKA and mUKA exhibit comparable rates of achieving MCID-I and MCID-W, along with similar median time to reach MCID. These findings offer valuable patient-centric insights into the effectiveness of rUKA. Additional studies evaluating the long-term outcomes of rUKA are needed to determine its long-term advantages.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"231-241"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861590","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":"Intraoperative Cardiac Arrest in Orthopaedic Surgery: A Case Series of 42 Patients.","authors":"Aleksander P Mika, Robert B Ponce, Sean P Wrenn, Joshua M Lawrenz, Daniel J Stinner, Phillip M Mitchell","doi":"10.5435/JAAOS-D-24-00359","DOIUrl":"10.5435/JAAOS-D-24-00359","url":null,"abstract":"<p><strong>Introduction: </strong>Intraoperative cardiac arrest (IOCA) is a rare event during orthopaedic surgery. Although infrequent, it has a notable effect, with mortality as high as 35%. Little is known about the outcomes of IOCA in orthopaedic surgery, and this study aims to fill that knowledge gap to improve patient counseling and treatment decisions.</p><p><strong>Methods: </strong>A retrospective review of a single health system over a 20-year period identified 42 patients who experienced IOCA during orthopaedic surgery. Patient characteristics, procedure details, cardiac event specifics, and postoperative complications with an emphasis on morbidity and mortality were collected.</p><p><strong>Results: </strong>Return of spontaneous circulation (ROSC) was achieved in 88% (37 of 42) of patients. In-hospital death following successful resuscitation occurred in 22% (8 of 37) of patients. In those who survived their hospitalization (29 of 42, 69%), 59% (17 of 29) required additional treatment for medical complications acquired secondary to their arrest. IOCA occurred most often during spinal surgery, intramedullary nailing, and cemented endoprosthetic reconstruction, accounting for one-half of cases. Pulmonary embolism was the most common cause of IOCA. In patients requiring case abortion with rapid closure and a delayed return to the operating room for case completion, the infection rate was 40%.</p><p><strong>Conclusion: </strong>The majority of orthopaedic surgery patients achieve ROSC following IOCA. For patients who achieve ROSC, two-thirds had either subsequent in-hospital death or a long-term medical complication secondary to their arrest. These findings suggest that a cautious prognosis is indicated even after a successful resuscitation.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"261-265"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830278","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":"Industry Payments to Orthopaedic Surgeons: A Geospatial Analysis of the Open Payments Database.","authors":"Daniel Farivar, Nolan B Condron, Nicholas J Peterman, Kenneth D Illingworth, David L Skaggs","doi":"10.5435/JAAOS-D-23-00395","DOIUrl":"10.5435/JAAOS-D-23-00395","url":null,"abstract":"<p><strong>Introduction: </strong>There has been an increasing demand for transparency between industry and physicians. Several studies have evaluated the distribution of payment value and types to orthopaedic surgeons, but little is known about the spending patterns from an industry-centric perspective. The purpose of this study was to describe the payment patterns of top medical device companies in orthopaedics while presenting a geospatial analysis of these trends.</p><p><strong>Methods: </strong>The Open Payments database was assessed for all records of industry financial relationships with orthopaedic surgeons from 2015 to 2021. Value of financial relationships was expressed on a per orthopaedic surgeon basis, with the numerator representing total value of payments and denominator representing number of orthopaedic surgeons, and was geographically analyzed according to United States Census Divisions.</p><p><strong>Results: </strong>Based on averages during the study period, the top 10 paying companies were (1) DePuy, (2) Zimmer Biomet, (3) Stryker Corporation, (4) Arthrex, (5) SpineFrontier, (6) Medtronic, (7) Smith and Nephew, (8) Renovis Surgical Technologies, (9) NuVasive, and (10) Paragon 28. Payments in the South Atlantic ($6,854 ± $1,265) Division were significantly greater than all other eight divisions ( P < 0.001), with the next leading division being the Pacific Division ($4,114 ± $643). Five companies strongly favored one particular division, directing more than double the amount of payments to this division compared with the next leading division (SpineFrontier, 99% South Atlantic; Renovis Surgical Technologies, 81% Pacific; Paragon 28, 59% South Atlantic; NuVasive, 43% West North Central; DePuy, 35% South Atlantic). Only 3 of 10 companies were headquartered in the same division where most payments were made.</p><p><strong>Conclusion: </strong>From 2015 to 2021, companies preferentially supported surgeons in certain geographic regions, irrespective of where they were headquartered in. Surgeons in the South Atlantic Division received significantly more payments than any other division by a wide margin.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"266-273"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787291","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":"Your Academy, Your Meeting, Your Journal.","authors":"Peter S Rose, Jeffrey S Fischgrund, Gwo-Chin Lee","doi":"10.5435/JAAOS-D-25-00002","DOIUrl":"10.5435/JAAOS-D-25-00002","url":null,"abstract":"","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"211"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392443","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":"The Biomechanical Stability of a Single Headless Compression Screw Construct to Fix Scaphoid Waist Fractures.","authors":"Stephanie A Kwan, Tiffany N Bridges, Levi Buchan, Ashkan Sedigh, Justin M Kistler, Rick Tosti, Amir R Kachooei, Michael Rivlin","doi":"10.5435/JAAOS-D-24-00348","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00348","url":null,"abstract":"<p><strong>Background: </strong>Scaphoid fracture fixation using a single headless compression screw (HCS) may permit unacceptable rotation at the fracture site. This study aimed to assess the biomechanical stability of a single HCS construct to fix scaphoid waist fractures.</p><p><strong>Questions/purposes: </strong>(1) Does a single HCS provide rotational stability? (2) What degree of rotation is found at the central axis of a scaphoid without fixation?</p><p><strong>Methods: </strong>In eight fresh frozen cadavers, two parallel K-wires were placed in the scaphoid to mark rotation and an osteotomy was created at the scaphoid waist. To determine whether rotation was present between the proximal and distal poles, radiographs of the wrist at terminal range of motion (ROM) were reviewed for relative change in wire position. The fracture was then reduced, and an HCS was then advanced across the fracture; rotation was again evaluated. Rotation was quantified in the group without fixation using a sensor that measured angular rotation.</p><p><strong>Results: </strong>Before screw fixation, interfragmentary rotation was found to average 22.5° during flexion/extension, 19.0° during pronation/supination, and 34.0° during radial/ulnar deviation around the central axis. The radiographs after osteotomy demonstrated rotation in all specimens. After fixation with an HCS, radiographs demonstrated relative rotation of the two halves of the scaphoid in all ROMs for all specimens, except flexion for one specimen.</p><p><strong>Discussion: </strong>Internal angular tension was observed within the scaphoid, and rotation of 20° to 30° was noted around the central axis during simulated ROM mimicking nonsurgical treatment. A single HCS failed to prevent fragment-relative rotation at the fracture site.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525058","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":"Introduction to Spine Injuries in the Pickleball Athlete.","authors":"Jalen Dansby, Paal Nilssen, Alfonso Ocampo, Nakul Narendran, Cameron Murphy, David L Skaggs, Terrence T Kim","doi":"10.5435/JAAOS-D-24-01234","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01234","url":null,"abstract":"<p><strong>Introduction: </strong>Pickleball is one of the fastest growing sports in the United States. Despite its popularity, there is limited research on pickleball-related orthopaedic injuries, particularly in the spine. This study aims to provide a deeper understanding of spinal injuries in pickleball players and offers insights into injury patterns and risk factors.</p><p><strong>Methods: </strong>A retrospective review from our urban tertiary medical center's electronic medical record from 2013 to 2023 was done using OpenAI's Generative Pretrained Transformer-4 model to identify pickleball-related orthopaedic injuries. After artificial intelligence-driven identification, a manual review of medical records identified injuries related to the spine. The resulting medical records were manually reviewed for variables such as injury year, age, sex, spinal region affected, and treatment. Artificial intelligence did not generate any data, participate in writing, or assist with statistical analysis. Statistical analyses were done using Stata software, with significance set at P < 0.05.</p><p><strong>Results: </strong>Among 1,527 pickleball-related orthopaedic injuries, 135 (8.8%) involved the spine (77% women, median age: 62 ± 12.4 years). Pickleball-related spinal injuries increased 56-fold from 2013 to 2023. Most injuries involved the lumbar spine (84%), followed by the cervical spine (15%) and thoracic spine (1%). The most common complaint was lumbar radicular symptoms (63%). Forty-six percent of patients had a body mass index over 25, and this was associated with lumbar radiculopathy and acute disk herniation (P < 0.05). Most patients sought outpatient care (98%) and 10% required surgical intervention, primarily spinal decompression.</p><p><strong>Conclusion: </strong>Pickleball-related spine injuries are relatively uncommon but increasing as the sport grows in popularity, with the lumbar spine being the most frequently affected region. Elevated body mass index emerged as an important modifiable potential risk factor, and the study found a relatively high rate of surgical intervention at 10%. These findings can help guide counseling and treatment for pickleball athletes, although further research is needed to better understand risk factors, treatment options, prognosis, and return-to-play guidelines.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574613","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}