Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Tuberculous osteomyelitis masquerading as tumors and tumor-like lesions: A clinico-radiological study of 20 patients","authors":"Zile Singh Kundu ,&nbsp;Kunika Kundu ,&nbsp;Parveen Rana ,&nbsp;Pankaj Kumar Sharma ,&nbsp;Lakshmana Das ,&nbsp;Jyoti Sharma","doi":"10.1016/j.jcot.2025.102973","DOIUrl":"10.1016/j.jcot.2025.102973","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculous osteomyelitis is uncommon and may present with varied clinical and radiological presentations. This study aimed to elaborate on how these lesions mimicked different tumors or tumor-like lesions and their successful outcome with antitubercular therapy (ATT).</div></div><div><h3>Methods</h3><div>A retrospective review of 20 patients with tuberculous osteomyelitis who presented as tumors or tumor-like lesions of bone in the last 10 years. All these were histopathologically proven lesions. Eleven cases with sequestrations required curettage for the extensive lesions. All twenty received ATT for 12 months.</div></div><div><h3>Results</h3><div>There were 12 males and eight females, with ages ranging from 3 to 61 years (an average of 22.15). Eight cases presented like bone cysts in the metaphyseal area of the long bones, with one cystic lesion in the body of the talus. 2 mimicked chondroblastoma and one patient each, like giant cell tumors and osteoid osteomas, respectively. One patient had multifocal lytic lesions resembling metastasis or multiple myeloma. One patient had two lesions involving the clavicle and the proximal phalanx of the little finger). One lesion in the metatarsal and five in the phalanges of the hand mimicked chondromas. All resolved well, with no residual disability after receiving ATT.</div></div><div><h3>Conclusions</h3><div>In endemic countries, tuberculosis should always be considered one of the differential diagnoses for lytic bone lesions. Histopathological confirmation is the gold standard for the diagnosis. These can be effectively treated with anti-tubercular medication.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102973"},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection after shoulder replacement: A literature review and strategies on diagnosis, management, and clinical outcomes","authors":"Saheed Olanrewaju Akinola ,&nbsp;Hariharan Mohan ,&nbsp;Zaid Ali ,&nbsp;Siddhartha Murhekar ,&nbsp;Bijayendra Singh","doi":"10.1016/j.jcot.2025.102968","DOIUrl":"10.1016/j.jcot.2025.102968","url":null,"abstract":"<div><div>Infection following shoulder arthroplasty is on the rise as recent data have shown, potentially due to the increase in the number of shoulder arthroplasties being performed. Despite this increase, infective complications in lower limb procedure still exceed those of the upper limb. Infection in the shoulder usually occurs as a low-grade infection due to the most common causative pathogen (Propionibacterium acnes) and can be easily missed. Therefore, a high index of suspicion is needed to make the diagnosis. Furthermore, the use of MSIS criteria can greatly enhance the diagnosis of Periprosthetic Joint Infection (PJI) if appropriately utilised. There are a number of options in the treatment of PJIs; with the 2-stage procedure appearing to be the most commonly utilised, however, the 1-stage has been shown to have similar outcomes, if not superior. The choice of antibiotics should be determined by the antimicrobial susceptibility test and in conjunction with local guidelines and microbiology support. This is usually done as part of the preoperative work up from the pre-surgical aspirate/specimen cultures.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102968"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing complications during acetabular fracture surgery, a review","authors":"Rahul Vaidya ,&nbsp;Sasha Stine ,&nbsp;Kayo Medeiros ,&nbsp;Alyxandra Camello ,&nbsp;Kevin Blue ,&nbsp;Kodi Kojima ,&nbsp;Detroit Medical Center Trauma Clinic","doi":"10.1016/j.jcot.2025.102957","DOIUrl":"10.1016/j.jcot.2025.102957","url":null,"abstract":"<div><div>Complications after acetabular fracture surgery include: hemorrhage, nerve injury, infection, malreduction, heterotopic ossification, post-traumatic arthritis, and medical complications may reach an incidence of 30–50 %. Total hip arthroplasty can salvage a poor reduction or post-traumatic arthritis but has higher complication rates then a primary replacement and in many cases may have to last 50 years. Sciatic nerve palsy, which is often caused by the injury, and infection/osteomyelitis, which is often caused by the surgical intervention, result in universally poor outcomes and every effort should be aimed at avoiding these. Methods of avoiding complications and treatment once they occur are discussed.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102957"},"PeriodicalIF":0.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closed avulsion of flexor digitorum profundus of the ring finger: Does the surgical technique really change the outcome?","authors":"Andrea Poggetti,&nbsp;Chiara Suardi,&nbsp;Irene Felici,&nbsp;Sandra Pfanner","doi":"10.1016/j.jcot.2025.102956","DOIUrl":"10.1016/j.jcot.2025.102956","url":null,"abstract":"<div><h3>Background/aims</h3><div>Flexor digitorum profundus avulsion injuries occurs mainly in sport injuries, also known as “jersey fingers”. Is important to surgically approach those lesions with correct timing. Different surgical procedures exist. Complications can occur, but there is no consensus of which type of surgical technique can be superior to others. The aim of this study was to observe three different groups affected by a Type II sec. Leddy and Packer avulsion, managed by three different methods of fixation: pull-out suture through the fingertip without passing the nail bed, bone anchor, and a combination of those. The objective was to analyse whether one of these methods was superior to the others in terms of final TAM and whether one of them was more suitable than the others for the use of the early rehabilitation protocol.</div></div><div><h3>Methods</h3><div>66 patients affected by FDP type II closed avulsion were surgically managed by the three different ways and the controlled active motion protocol. TAM, time of recovery and complications were addressed for each group.</div></div><div><h3>Results</h3><div>The three procedures adopted were similar at the final outcome.</div></div><div><h3>Conclusion</h3><div>These data showed a comparable the strength of suture techniques used with good clinical outcomes in terms of TAM recovery after surgery.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"65 ","pages":"Article 102956"},"PeriodicalIF":0.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injury patterns and treatment outcomes in sports-related knee and shoulder injuries in athletes from India's Olympic state, Haryana","authors":"Amit Mor ,&nbsp;Ashish Devgan ,&nbsp;Anurag Bhakhar ,&nbsp;Umesh Yadav ,&nbsp;Nirvin Paul ,&nbsp;Arvind Yadav","doi":"10.1016/j.jcot.2025.102958","DOIUrl":"10.1016/j.jcot.2025.102958","url":null,"abstract":"<div><h3>Background</h3><div>Our study aims to investigate injury patterns and treatment results in sports-related knee and shoulder injuries among athletes from Haryana, the most prominent state in the contribution of Olympic medals for India.</div></div><div><h3>Material and methods</h3><div>A cross-sectional prospective observational study was conducted in a tertiary referral centre. Over five years, from May 2018 to June 2023, 920 participants were included in our study.</div></div><div><h3>Result</h3><div>Most injuries (59.90 %) occurred between the ages of 16 and 20. Men (62.60 %) outnumbered women (37.40 %). On average, the individuals weighed 68.57 ± 13.65 kg, stood 1.57 ± 0.11 m tall, and had a BMI of 25.75 ± 4.81 kg/m2. Kabaddi players, most commonly injured athletes (42.60 %), followed by wrestling (31.30 %). Most athletes were professional, with 35.43 % competing at the national level, while 33.26 % competed at the state level. The average delay in presentation was 14.28 ± 8.12 months. Most injuries occurred during competitive matches (61.30 %), rest during practice. Contact injuries accounted for 31.41 % of cases, while non-contact injuries accounted for 54.02 % of all injuries. Only knee and shoulder injuries were considered, accounting for 77.28 % and 22.72 % of all injuries. Most observed injuries were ACL rupture (60.76 %), followed by meniscal tears (54.45 %) and collateral ligament injuries (26.96 %). 424 patients treated conservatively, whereas 53.9 % cases underwent arthroscopic/open surgical procedures. 74.13 % of athletes returned to competitive sports after their injury of which 38.71 % returned to the previous level of activity. The duration of time lost to injury ranged from 4 to 60 months (average 10.58 ± 4.74). Return to sports was significantly affected by the athletes’ gender, BMI, level of competitiveness, and management modality (p-value &lt;0.01 each).</div></div><div><h3>Conclusion</h3><div>Limiting the frequency, severity, and amount of time missed in sports while enabling athletes to return virtually to their pre-injury activity level should continue to be the primary goal of injury prevention.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102958"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nail plate combination technique for periprosthetic supracondylar femur fractures: How far have we come?","authors":"Jaclyn M. Jankowski,&nbsp;Christian G. Zapf,&nbsp;Ian S. Hong,&nbsp;Joseph G. Miceli,&nbsp;Richard S. Yoon,&nbsp;Frank A. Liporace","doi":"10.1016/j.jcot.2025.102969","DOIUrl":"10.1016/j.jcot.2025.102969","url":null,"abstract":"<div><div>Open reduction and internal fixation for periprosthetic supracondylar femur fractures (PPFx) around a stable total knee arthroplasty (TKA) remains the gold standard, with the nail plate combination (NPC) technique offering increased biomechanical stability and high union rates. Advances in implant technology, particularly the introduction of the novel lateral locking attachment washer (LAW), have increased the availability of NPC options in the treatment of these technically demanding and complex cases. In this technical paper, we discuss two cases: Case 1 – describing the traditional NPC technique utilizing a retrograde intramedullary nail and lateral distal femoral locking plate; Case 2 – describing the NPC technique utilizing a retrograde nail and a novel LAW implant, which is now the authors’ more commonly utilized technique. Managing PPFx around a TKA implant remain a challenge, however, the integration of the LAW and newer generation of retrograde intramedullary nails have marked significant progress in treating these complex fractures.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102969"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of adductor ratio in the Indian population: Is it a reliable indicator for recreating joint line of the knee?","authors":"Yuvarajan Palanisamy,&nbsp;Abhijit Jawali,&nbsp;Arjun R. Prasad,&nbsp;David V. Rajan","doi":"10.1016/j.jcot.2025.102970","DOIUrl":"10.1016/j.jcot.2025.102970","url":null,"abstract":"<div><h3>Background</h3><div>Accurate restoration of the joint line is critical in revision total knee arthroplasty (r-TKA) to ensure proper ligament tension and optimize functional outcomes.</div></div><div><h3>Objective</h3><div>To determine the adductor ratio in the Indian population and assess its reliability for restoring the joint line in primary total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>The study consisted of two parts. In the first part, 93 young, non-arthritic individuals were evaluated radiologically to estimate the adductor ratio. In the second part, 47 patients with grade IV osteoarthritis undergoing primary TKA were included. Pre-operative radiographic and intraoperative calliper measurements of the adductor tubercle to joint line distance (ATJL) and femoral width (FW) were taken. Pearson correlation was estimated between FW and ATJL, and Bland-Altman analysis was used to assess the agreement between pre-operative and intra-operative measurements. The error in using a standard adductor ratio was estimated.</div></div><div><h3>Results</h3><div>The mean adductor ratio in the non-arthritic population was 0.542, with a strong correlation between ATJL and FW (r = 0.81, p &lt; 0.001). In the second part, the mean adductor ratio was consistent pre-operatively (0.53) and intra-operatively (0.54), with a bias of 0.001 and 95 % limits of agreement from −0.062 to 0.065. The estimated ATJL was within 5 mm of the actual measurement in 95 % of cases.</div></div><div><h3>Conclusion</h3><div>The adductor ratio of 0.54 is a reliable indicator for joint line restoration in the Indian population. Documentation of ATJL and FW during primary TKA is recommended for enhancing accuracy in joint line reconstruction in revision scenarios.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102970"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey of management of ankle fracture blisters in Yorkshire among orthopaedic surgeons","authors":"Praise Kess Briggs ,&nbsp;Jeevith Shetty Sowkoor ,&nbsp;Adnan Abdulmajeed Faraj","doi":"10.1016/j.jcot.2025.102955","DOIUrl":"10.1016/j.jcot.2025.102955","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of ankle fracture blisters is contentious. This study aims to evaluate the management of ankle fracture blisters among orthopedic surgeons in Yorkshire and establish a consensus.</div></div><div><h3>Methods</h3><div>A questionnaire was distributed among Orthopaedic Surgeons in Yorkshire, United Kingdom, to gain insight into their management of ankle fracture blisters. Responses were processed in Excel spreadsheet, chi-squared analysis was done, comparing the responses of foot and ankle surgeons with other orthopaedic surgeons.</div></div><div><h3>Results</h3><div>There were 69 respondents (58 % of whom were consultants, 7 % associate specialists and 35 % registrars) out of 125 surgeons invited to participate (55.2 % response rate). 17 were foot and ankle surgeons. For most respondents, the type of blister (haemorrhagic or serosanguinous) does not affect decision around timing of surgery. 76 % say that blister location affects the placement of skin incision. 19 % would make their skin incisions irrespective of blister location and 5 % had variable responses to this. 43 surgeons would defer the surgical fixation of the fracture if the blister were at the incision site, while 22 (32 %) would defer surgery if blister is extensive, but not as incision site. If surgery is deferred because of the blister, 52 % will wait till skin creases return while others would wait a variable period. While waiting, 67 % would immobilize with a plaster cast if appropriate, 56 % would use an external fixator. 65 % think that blisters increase the risk of infection, however, 97 % will not prescribe any systemic antibiotics for ankle fracture blisters. The most preferred dressing for blisters is Inadine and Mepitel.</div></div><div><h3>Conclusion</h3><div>Majority of Orthopaedic Surgeons in Yorkshire consider ankle fracture blisters to be significant in determining the management of patients with ankle fractures; however significantly more foot and ankle surgeons opine that blisters should not cause delay in definitive fixation of ankle fractures.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102955"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing agreement in classification and surgical approach selection for tibial plateau fractures: The role of identifying metaphyseal fracture exit. - A Cross-sectional study","authors":"Jaime A. Leal ,&nbsp;Natalia Rodríguez ,&nbsp;Stephanie Renza ,&nbsp;Georgina González ,&nbsp;Carlos A. Sanchéz","doi":"10.1016/j.jcot.2025.102954","DOIUrl":"10.1016/j.jcot.2025.102954","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine if identifying the metaphyseal exit can enhance intra- and inter-observer agreement in utilizing the Kfuri and Schatzker anatomical classification and selecting the appropriate surgical approach for tibial plateau fractures.</div></div><div><h3>Methods</h3><div>Design: Cross-sectional observational study.</div><div>Setting: Academic hospital with access to advanced imaging technologies.</div><div>Patient Selection Criteria: Tibial plateau fracture cases from January 2019 to March 2021 with complete image sets (AP and lateral knee radiographs, CT scans). Exclusion criteria included periprosthetic, neglected, or pathological fractures.</div><div>Outcome Measures and Comparisons: Primary outcome measures were intra- and inter-observer agreement in fracture classification and surgical approach selection, quantified using Cohen's and Fleiss Kappa coefficients.</div></div><div><h3>Results</h3><div>The study analyzed 63 cases. Intra-observer agreement improved from moderate to 'very good,' especially in the third evaluation phase when the metaphyseal exit was identified alongside 3D CT imaging. Inter-observer agreement was generally low but improved when comprehensive image sets were available. Notably, the most experienced evaluator demonstrated significantly higher agreement in both fracture classification and surgical approach selection.</div></div><div><h3>Conclusions</h3><div>The identification of metaphyseal exit points significantly enhances agreement in fracture classification and surgical approach selection, addressing limitations of traditional systems. While surgeon experience and imaging availability remain critical, incorporating the metaphyseal exit into the Kfuri and Schatzker classification offers a reproducible framework for guiding treatment decisions.</div></div><div><h3>Level of evidence</h3><div>III Diagnostic Study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102954"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bibliometric studies: Essential navigational tools in today's academic landscape","authors":"Raju Vaishya (Senior Consultant Orthopaedics),&nbsp;Brij Mohan Gupta (Retired Scientist)","doi":"10.1016/j.jcot.2025.102952","DOIUrl":"10.1016/j.jcot.2025.102952","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102952"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}