The Iowa orthopaedic journal最新文献

{"title":"Blood Flow Restriction Therapy in the Shoulder: A Review.","authors":"Sean Munroe, Catherine Harding, Hannah P Gibbs, Christian Cruz, Justin J Ernat, Daniel J Song","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Blood flow restriction therapy (BFRT) describes the application of an occlusive device to an extremity to occlude arterial flow while maintaining venous return. BFRT has been shown to increase strength gains and muscle hypertrophy at lower weight loads than traditionally required. It is increasing in interest among orthopaedic surgeons, as demonstrated by the number of recent studies on BFRT. There is abundant evidence of the effects distal to the occlusive cuff, but limited research on the effects proximally. Therefore, we have explored current literature regarding BFRT in the shoulder, specifically reviewing proposed mechanisms of action, applications in healthy adults, and its use for non-operative and post-operative shoulder pain. Future research opportunities are also discussed. <b>Level of Evidence:</b> VI.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"127-134"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13359498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148440617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct Clinical Presentations of Trunnionosis with and Without Gross Trunnion Failure Following Mechanically Assisted Crevice Corrosion in Total Hip Arthroplasty.","authors":"Marisa Brito, Ashish R Chowdary, Daniel Sanz, Omar Syed, Nigam Sheth, James R Roberson, Ajay Premkumar, Jacob M Wilson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Mechanically assisted crevice corrosion (MACC) is a rare but serious complication of total hip arthroplasty (THA). This study evaluated differences in symptoms and clinical presentation of trunnionosis with and without gross trunnion failure (GTF) in patients revised for MACC involving the Accolade I titanium-molybdenumzirconium-iron (TMZF) femoral stem paired with a cobalt-chromium (CoCr) low-friction ion treatment (LFIT) femoral head.</p><p><strong>Methods: </strong>This retrospective chart review included 73 patients (82 hips) who underwent revision THA due to MACC from the Accolade I femoral stem and LFIT CoCr femoral head. Patients were categorized into groups-trunnionosis alone (trun-nionosis group) and trunnionosis with GTF (GTF group)-based on radiographic and intraoperative findings. Baseline patient demographics, implant characteristics, intraoperative findings, and postoperative outcomes were compared. Continuous variables were analyzed using Mann-Whitney U tests, and categorical variables were compared using chi-square or Fisher's exact tests. Qualitative data was collected from clinic and operative notes.</p><p><strong>Results: </strong>Overall, patients with GTF were more frequently male (77% vs. 44%), taller (177.2 vs. 171.0 cm), and had a longer interval from primary to revision surgery (10.0 vs. 7.2 years). They reported markedly shorter symptom duration (3.1 vs. 8.9 months) and were far less likely to experience chronic pain (38% vs. 97%), with several presenting as asymptomatic until catastrophic failure. Patients with trunnionosis typically described months of aching or radiating pain, whereas patients with GTF characterized their symptoms as sharp or deep when present at all, reflecting sudden mechanical failure. Despite differing presentations, postoperative patient reported outcomes and metal ion levels improved similarly in both groups.</p><p><strong>Conclusion: </strong>These findings demonstrate that trunnionosis and GTF have distinct clinical presentations. Trunnionosis tends to present earlier with persistent, radiating pain and prolonged symptoms, while GTF tends to occur later, with minimal or no pain, and an increased risk of sudden mechanical failure. Recognizing these contrasting presentations is critical for early diagnosis and prevention of MACC events through timely surveillance and intervention.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"21-29"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Descriptive Analysis and Postoperative Surgical Complications of Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis Patients at a Midwest Tertiary Referral Center.","authors":"Aaron Blom, Elisabeth M Martin, Yumeng Gao, Akar Jani, Reagan Grieser-Yoder, Catherine Olinger","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are at increased risk for spinal pathology and frequently require orthopedic surgical intervention. However, region-specific data describing the demographic characteristics, socioeconomic factors, operative patterns, and short-term postoperative complications in these populations remain limited. This study aims to characterize these features among AS and DISH patients treated at a Midwest tertiary referral center.</p><p><strong>Methods: </strong>We performed a retrospective, crosssectional descriptive study of patients with ICD-documented AS or DISH treated between 2008 and 2023 at a single Midwest tertiary referral center. Demographic characteristics, comorbidities, substance use, area demographics, Area Deprivation Index (ADI), orthopedic procedures, and 90-days postoperative complications were obtained from the electronic health record.</p><p><strong>Results: </strong>Among 989 patients (AS: 776; DISH: 213), most were white and male, with median age 46 years for AS and 65 years for DISH. Insurance coverage was common in both groups. Median BMI was 27.7 kg/m² and 32.9 kg/m², respectively. Most patients lived in urban areas and in nationally disadvantaged regions, though they were relatively more advantaged within their state. Current tobacco use was reported in 21.0% of AS patients and 13.2% of DISH patients, and alcohol use was reported in approximately half of each cohort. HLA-B27 positivity was documented in 37.4% of AS patients and 1.9% of DISH patients. Among 699 patients with available data, the median number of comorbidities was three per patient; cardiovascular disease, chronic pulmonary disorders, and hypertension were common in both groups, with osteoporosis more prevalent in AS patients and diabetes more common in DISH patients. 220 patients underwent 573 orthopedic procedures, most commonly spine surgeries, particularly fusions. The median hospital length of stay was one day for AS patients and two days for DISH patients. Postoperative complications within 90 days were infrequent.</p><p><strong>Conclusion: </strong>At this center, AS and DISH patients demonstrated demographic and comorbidity profiles consistent with prior reports and experienced low short-term complication rates following orthopedic surgery. These findings provide a regional benchmark that may inform future studies evaluating long-term outcomes and healthcare disparities in these populations.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"151-158"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional Pitchers with Higher Combined Joint and Segment Velocities Irrespective of Sequence Order Demonstrate Faster Ball Velocity At The Cost of Increased Throwing Arm Kinetics.","authors":"Joseph Manzi, Brittany Dowling, Zhaorui Wang, Suleiman Y Sudah, Omar Rahman, Stephen J Nicholas, Michael A Zacchilli, Etan Sugarman, Joshua S Dines","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Observe how summative maximum joint and segment velocities, dependent and independent of sequence order, may impact ball velocity and throwing arm kinetics in professional pitchers.</p><p><strong>Methods: </strong>Professional (n=338) pitchers threw 8-12 fastball pitches while evaluated with 3Dmotion capture (480 Hz). Pitches (independent and dependent of sequence order) were classified as 'Overall Fast* or 'Overall Slow' with kinematic and kinetic parameters compared between groups. A regression model for ball velocity dependent on maximum joint and segment velocities was also calculated.</p><p><strong>Results: </strong>In-sequence pitches with 'Overall Fasf velocity consisted of smaller mass (p<0.001, d=0.9) pitchers that achieved faster ball velocity by on average, 1.6m/s or 3.6 mi/hr (p<0.001, d=1.1). When comparing throwing arm kinetics, the 'Overall Fast' pitches had significantly higher absolute shoulder internal rotation torque (p<0.001, d=1.1), shoulder distractive force (p<0.001, d=1.4), elbow medial force (p=0.014, d=0.7), and elbow flexion torque (p<0.001, d=0.7). A multi-regression prediction model for ball velocity based on maximum joint and segment velocities achieved a R²=0.132. Maximum lead knee extension velocity (B: 0.004 0:0.263 p<0.001) and maximum trunk rotation velocity (B: 0.003 0: 0.223 p=0.045) achieved the highest standardized regression coefficients. For every one standard deviation increase in maximum lead knee extension velocity (125 °/sec), ball velocity increased by 0.5 m/s (1.1 MPH).</p><p><strong>Conclusion: </strong>Professional pitchers with increasing summative maximum joint and segment velocities demonstrated faster ball velocity at the cost of increased throwing arm kinetics, irrespective of sequence order.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"203-212"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Postoperative Weightbearing on Intracapsular Femoral Neck Fractures Treated with The Femoral Neck System: A Comparative Cohort Study.","authors":"Brendan P Mitchell, Seth A Tarrant, Zane D Littell, Nada L Jibbe, Rosalee E Zackula, Randall L Lais, Bradley R Dart","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Postoperative weightbearing management of patients surgically treated for femoral neck fractures is controversial. This study aimed to compare the outcomes of patients treated with a fixed-angle implant, the Femoral Neck System (FNS), as a function of their postoperative weightbearing protocol.</p><p><strong>Methods: </strong>A comparative cohort study of patients with intracapsular femoral neck fractures who underwent fixation with the FNS at a Level I trauma center from 2019 to 2023 was conducted. Patients were assigned to either the weightbearing as tolerated (WBAT) group or the toe-touch weightbearing (TTWB) group based on surgeon preference after each procedure. Primary outcome measures were postoperative complications and the need for revision surgery. Secondary outcomes included visual analog scale (VAS) pain score, SF-12 score, and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score.</p><p><strong>Results: </strong>There were 25 patients in the WBAT group and 19 in the TTWB group. Ten of 25 (40%) fracture union complications occurred in the WBAT cohort compared with 6 of 19 (32%) in the TTWB group (p = 0.565). Revision surgeries were required in 7 of 25 cases (28%) in the WBAT cohort compared with 3 of 19 (16%) in the TTWB group (p = 0.339). No statistically significant differences in VAS pain scores, SF-12 scores, or WOMAC scores between the groups were found.</p><p><strong>Conclusion: </strong>There were no statistically significant differences in radiographic complications, reoperations, or functional outcome scores between the two postoperative weightbearing protocols. Our findings suggest that WBAT may be permitted in this patient cohort, thereby simplifying postoperative care for patients and surgeons.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"255-260"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeat Mri Within 90 Days in Patients with Spine Infections Does Not Lead to a Change in Patient Management: A Retrospective Study.","authors":"Erin Choi, Yumeng Gao, Natalie Glass, Catherine Olinger","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Spine infections are associated with significant morbidity and mortality. Despite Infectious Diseases Society of America (IDSA) guidelines recommending treatment be assessed through clinical examination and inflammatory markers rather than routine magnetic resonance imaging (MRI), repeat MRIs are frequently obtained. The clinical utility and consequences of repeat MRI in this setting remain unclear.</p><p><strong>Methods: </strong>We performed a retrospective singleinstitution study of adult patients with infectious spine pathology who underwent repeat MRI between January 2019 and December 2023. Patients were stratified by timing of repeat MRI (≤90 days vs >90 days from index MRI). The primary outcome was surgical intervention prompted by repeat MRI findings. Secondary outcomes included changes in physical examination prior to repeat MRI, need for fast-acting anxiolytic medication, and acute kidney injury.</p><p><strong>Results: </strong>A total of 222 repeat MRIs were identified in 141 patients. Of these, 163 (73%) were performed ≤90 days and 59 (27%) were performed >90 days from the index MRI. Patients undergoing repeat MRI >90 days were significantly more likely to undergo spine surgery (p=0.04) and to have a documented change in physical examination prior to imaging (p<0.001). Repeat MRI ≤90 days was not associated with increased surgical intervention. Overall, 30% of repeat MRIs required pre-procedure anxiolytic medication, with higher rates in the ≤90-day cohort (p=0.04). AKI occurred after 9/164 (5%) repeat MRIs, with no difference between groups.</p><p><strong>Conclusion: </strong>Repeat MRI within 90 days in patients with spine infections rarely alters surgical management and is often obtained in the absence of clinical deterioration. Clinical examination appears to be a more reliable indicator of treatment response. These findings support IDSA guidelines recommending selective use of repeat MRI and highlight potential patient-centered consequences of unnecessary imaging.<b>Level of Evidence:</b> III.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"55-59"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Far Cortical Locking Screws in Locking Plates Lead to Earlier and Increased Medial Callus in Distal Femur Fractures Comparing to Standard Locking Screws?","authors":"Yanin Plumarom, Brandon G Wilkinson, Natalie Glass, Michael C Willey, J Lawrence Marsh, Matthew D Karam","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Locking plates (LP) are commonly used to treat distal femur fracture. Far cortical locking (FCL) screws are designed to increase axial motion at the fracture site resulting in more callus formation in animal study. In our previous study, progress to healing was assessed. There were statistically significant differences in modified RUST score postoperatively with higher scores in the FCL group. However, the amount of callus formed was not quantitatively measured. The purpose of this study is to quantitatively assess the medial callus area (mm²) and changes in callus area over time in radiographs of distal femur fractures treated with FCL as compared to traditional locking plate constructs.</p><p><strong>Methods: </strong>A retrospective review of medical records conducted to identify patients with distal femur fractures. Medial callus area from AP radiographs was quantified from 6-, 12- and 24-week postop radiographs using OrthoRead software. Medial callus areas were compared between FCL construct fixation and traditional LP.</p><p><strong>Results: </strong>After applying inclusion and exclusion criteria, 69 patients with 70 total fractures were included for analysis. There were no significant differences between FCL (n=42) and LP (n=28) in demographic data or rates of complications (18%), fixation failures (10%), union (90%), or revision (10%) (all p>0.05). Medial callus areas did not significantly differ after adjustment for multiple comparisons between FCL vs. LP at 6 (195.2 mm² (0.0-2007.1) vs. 200.7 mm² (0.0-1137.0), p=0.982) or 12 (372.1 mm² (0.0-2241.9) vs. 298.1 mm² (0.0-1959.9), p=0.727) weeks postop. While between group differences were significant at 24 weeks postop (FCL:455.7 mm² (30.4-2388.2) vs. LP:287.8 mm² (0.0-1514.7), p=0.023) statistically significant differences were not sustained following adjustment for multiple comparisons (p=0.069). Larger medial callus was formed as duration from surgery increased to 24 weeks in the FCL as compared to the LP group in analyses limited to titanium implants ((FCL:455.7 mm² (30.4-2388.2) vs. LP: 259.25 mm² (0.001514.70), p=0.039).</p><p><strong>Conclusion: </strong>In this study, there is increased callus generated in FCL vs LP constructs at 24 weeks postoperatively (p=0.02). This is in accordance with previous animal models. However clinical advantages of this increased callus were not identified in the study. Because of the study limitations and potential confounders, prospective studies are necessary to further assess whether there is a clinically relevant healing advantage of FCL over standard LP constructs.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"247-254"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact Stress Elevations Following Acetabular Fracture Fixation are Associated With Radiographic Osteoarthritis At Minimum Two-Year Follow-Up.","authors":"Holly D Aitken, Michael C Willey, Natalie A Glass, Kevin N Dibbern, Tai C Holland, Tyler CarlLee, J Lawrence Marsh, Jessica E Goetz, Donald D Anderson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Despite improvements in fixation strategies over the past few decades, post-traumatic osteoarthritis (PTOA) rates following acetabular fracture have remained relatively constant. Chronic exposure to elevated contact stresses has been shown to result in both radiographic evidence of osteoarthritis and articular cartilage degeneration, but no association between contact mechanics and PTOA risk in reduced acetabular fractures has been established. The objective of this study was to determine if elevated contact stresses after acetabular fracture fixation are associated with future radiographically apparent PTOA.</p><p><strong>Methods: </strong>Sixteen adult patients treated for acetabular fractures with operative fixation between January 1, 2004 and December 31, 2016 who had (1) minimum two-year radiographic follow-up or conversion to hip arthroplasty and (2) an immediate post-operative pelvis CT scan for contact stress assessment met inclusion criteria for this study. Follow-up radiographs were graded using the modified Tonnis scale, and PTOA was considered present for grades >2 or if converted to hip arthroplasty. Discrete element analysis (DEA) was used to compute patient-specific contact mechanics for hips with acetabular fractures and intact contralateral hips.</p><p><strong>Results: </strong>Eleven of sixteen patients developed PTOA by Tonnis grading at a mean follow-up of 43.3 months. There were no differences in demographics or lengths of follow-up between patients who developed PTOA and those who did not. Acetabular fractures that developed PTOA had significantly different (p<0.024) contact mechanics than contralateral intact hips, while no significant differences (p>0.438) in contact mechanics metrics were found between intact and fractured sides in patients that did not develop PTOA. Only peak contact stress was significantly (p=0.027) higher in acetabular fractures that developed PTOA than those that did not. All contact stress metrics demonstrated significant, yet moderate, correlations with Tonnis grade across all hips.</p><p><strong>Conclusion: </strong>Development of radiographically apparent PTOA after acetabular fracture fixation is associated with persistently elevated contact stresses. Further, returning contact mechanics after surgical treatment of these fractures to levels similar enough to native intact hips may successfully help prevent PTOA.</p><p><strong>Clinical relevance: </strong>These findings confirm the importance of anatomical articular fracture reduction during fixation of acetabular fractures to reduce elevated contact stresses and prevent future joint failure.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"231-240"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13403717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiologic Trends in Common Injury Mechanisms and Associated Consumer Products in Pediatric Radial Head Subluxation Cases.","authors":"Karissa Gawronski, Zaina Khoury, Andrew Peace, Belal Tarakji, Elise Atkinson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Nursemaid's elbow injuries occur in young children, with axial traction on the arm as a commonly-described mechanism. Prior demographic studies have noted a significant increase in this injury over the last three decades. We sought to examine incidence of nursemaid's elbow over time and assess the impact of COVID-19 on injury frequency. Additionally, certain household products and female gender have been frequently seen in cases presenting to emergency departments. The present study aims to further investigate injury scenarios to better understand the difference in injury rates and mechanisms.</p><p><strong>Methods: </strong>Using the National Electronic Injury Surveillance System database, this study analyzed 4,075 cases of nursemaid's injuries presenting to emergency departments from 2019-2023 in children from birth to six-years-old. The events' narrative case descriptions were searched for keywords to identify terms used to describe the injury. Cases were examined in groups by age, gender, location of the injury event, mechanism of injury (\"fall\" versus \"pull\"), and product involved.</p><p><strong>Results: </strong>There was no significant change in rate of cases during the time period, although there was a non-significant drop in 2020. Females had a higher incidence of injury. Two-year-olds represented the largest affected age group. Common injury mechanisms were \"falls\" (44% of events) and \"pulls\" (29%), with twisting motions rarely described. The most common household products involved in injuries were beds and bed frames (21% of cases). The higher incidence in females compared to males persisted across age groups, mechanisms, and most products involved, with the exception of more daywear-related \"fall\" injuries in males.</p><p><strong>Conclusion: </strong>Unlike previous studies, incidence of nursemaid's elbow did not statistically increase during the pandemic. Females continued to account for most injuries, a trend that remained largely stable when data were subdivided by product, age, and mechanism. This could be due to a possible anatomic difference in young female elbows compared to those of males, which represents an area for future investigation. Educating caretakers about nursemaid's elbow and implementing household safeguards may help prevent injury.<b>Level of Evidence:</b> III.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"87-94"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Outcomes of Oxidized Regenerated Cellulose (ORC) in Total Joint Arthroplasty (TJA): A Systematic Review and Meta-Analysis.","authors":"Jenna Chrabolowski, Troy B Puga, Abanoub Attalah, Kyle P O'Connor, McKenna W Box, Ashley Stovall, Michael Muncy, John T Riehl","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Novel hemostatic agents, such as oxidized regenerated cellulose (ORC) have grown in popularity. The aim of this systematic review and meta-analysis is to evaluate the efficacy of ORC for intraoperative and postoperative blood loss in total joint arthroplasty (TJA).</p><p><strong>Methods: </strong>A search was conducted across seven databases. Titles and abstracts were screened for eligibility for inclusion criteria. Full texts were screened and included if they met eligibility criteria. Demographics and results of the studies were extracted. Meta-analysis was conducted to evaluate outcomes.</p><p><strong>Results: </strong>Eleven studies met inclusion criteria. One case report study did report a hypersensitivity reaction, however, the remaining studies showed no additional complications from the use of ORC. Five studies reported equivalent rates of blood transfusion, with one study finding that ORC led to lower rates of blood transfusions. Nine studies were included for meta-analysis. Total blood loss (Cohen's d: -0.42, CI: -0.66-0.19, p<0.001) and intraoperative blood loss (Cohen's d: -0.33, CI: -0.51-0.14, p<0.001) were significantly lower in the ORC cohort compared to using no ORC. The ORC cohort also had significantly lower hemoglobin drop on postoperative day 1, however, publication bias was present in association with this finding. There was no significant difference between the ORC cohort and the no ORC cohort for postoperative day 7 hemoglobin (Cohen's d: 1.13, CI: -0.15- 2.42, p=0.08), postoperative day 1 C-Reactive Protein (CRP) (Cohen's d: 0.09, CI: -0.10- 0.29, p=0.36), and postoperative day 7 CRP (Cohen's d: 0.04, CI: -0.50- 0.58, p=0.88)..</p><p><strong>Conclusion: </strong>ORC may help to reduce total blood loss and intraoperative blood loss in TJA, however, it does not appear to have sustained effects over the following week, nor does it appear to lower transfusion rates with the current available evidence. ORC has been shown to be safe, with CRP levels remaining constant postoperatively, and only one case report showing a self-limited hypersensitivity reaction (local rash). ORC may be a useful adjunct to help reduce blood loss for TJA, however, it is not currently clear if its usage leads to significant improvements in clinical outcomes.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":94233,"journal":{"name":"The Iowa orthopaedic journal","volume":"46 1","pages":"31-42"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}