Hasil untuk "Orthopedic surgery"

Hoon-Sang Sohn, Jong-Keon Oh

BackgroundAutogenous bone graft is the gold standard bone graft material. However, due to limitations of supply and morbidity associated with autograft harvest, various bone substitutes have been considered. This article aims to review the properties of the bone graft and various bone substitutes currently available in orthopedic surgery.Main bodySynthetic bone substitutes consist of hydroxyapatite, tricalcium phosphate, calcium sulfate, or a combination of these minerals. Synthetic porous substitutes share several advantages over allografts, including unlimited supply, easy sterilization, and storage. However, they also have some disadvantages, such as brittle properties, variable rates of resorption, and poor performance in some clinical conditions. Recently, attention has been drawn to osteoinductive materials, such as demineralized bone matrix and bone morphogenetic proteins.ConclusionDespite tremendous efforts toward developing autograft alternatives, a single ideal bone graft substitute has not been developed. The surgeon should understand the properties of each bone graft substitute to facilitate appropriate selection in each specific clinical situation.

I. Panayotov, Valérie Orti, F. Cuisinier et al.

F. Doglietto, M. Vezzoli, F. Gheza et al.

Importance There are limited data on mortality and complications rates in patients with coronavirus disease 2019 (COVID-19) who undergo surgery. Objective To evaluate early surgical outcomes of patients with COVID-19 in different subspecialties. Design, Setting, and Participants This matched cohort study conducted in the general, vascular and thoracic surgery, orthopedic, and neurosurgery units of Spedali Civili Hospital (Brescia, Italy) included patients who underwent surgical treatment from February 23 to April 1, 2020, and had positive test results for COVID-19 either before or within 1 week after surgery. Gynecological and minor surgical procedures were excluded. Patients with COVID-19 were matched with patients without COVID-19 with a 1:2 ratio for sex, age group, American Society of Anesthesiologists score, and comorbidities recorded in the surgical risk calculator of the American College of Surgeons National Surgical Quality Improvement Program. Patients older than 65 years were also matched for the Clinical Frailty Scale score. Exposures Patients with positive results for COVID-19 and undergoing surgery vs matched surgical patients without infection. Screening for COVID-19 was performed with reverse transcriptase-polymerase chain reaction assay in nasopharyngeal swabs, chest radiography, and/or computed tomography. Diagnosis of COVID-19 was based on positivity of at least 1 of these investigations. Main Outcomes and Measures The primary end point was early surgical mortality and complications in patients with COVID-19; secondary end points were the modeling of complications to determine the importance of COVID-19 compared with other surgical risk factors. Results Of 41 patients (of 333 who underwent operation during the same period) who underwent mainly urgent surgery, 33 (80.5%) had positive results for COVID-19 preoperatively and 8 (19.5%) had positive results within 5 days from surgery. Of the 123 patients of the combined cohorts (78 women [63.4%]; mean [SD] age, 76.6 [14.4] years), 30-day mortality was significantly higher for those with COVID-19 compared with control patients without COVID-19 (odds ratio [OR], 9.5; 95% CI, 1.77-96.53). Complications were also significantly higher (OR, 4.98; 95% CI, 1.81-16.07); pulmonary complications were the most common (OR, 35.62; 95% CI, 9.34-205.55), but thrombotic complications were also significantly associated with COVID-19 (OR, 13.2; 95% CI, 1.48-∞). Different models (cumulative link model and classification tree) identified COVID-19 as the main variable associated with complications. Conclusions and Relevance In this matched cohort study, surgical mortality and complications were higher in patients with COVID-19 compared with patients without COVID-19. These data suggest that, whenever possible, surgery should be postponed in patients with COVID-19.

Liam T. Kane, Taolin Fang, Matthew S. Galetta et al.

Propensity score matching (PSM) is a commonly used statistical method in orthopedic surgery research that accomplishes the removal of confounding bias from observational cohorts where the benefit of randomization is not possible. An alternative to multiple regression analysis, PSM attempts to reduce the effects of confounders by matching already treated subjects with control subjects who exhibit a similar propensity for treatment based on preexisting covariates that influence treatment selection. It, therefore, establishes a new control group by discarding outlier control subjects. This new control group reduces the unwanted influences of covariates, allowing for proper measurement of the intended variable. An example from orthopedic spine literature is discussed to illustrate how PSM may be applied in practice. PSM is uniquely valuable in its utility and simplicity, but it is limited in that it requires the removal of data and works primarily on binary treatments. In addition to matching, the propensity score can be used for stratification, covariate adjustments, and inverse probability of treatment weighting, but these topics are outside the scope of this paper. Personnel in the orthopedic field would benefit from learning about the function and application of this method given its common use in the orthopedic literature.

Thomas Ibounig, Olof Wolf, William M Oliver et al.

This educational review outlines the core principles of humeral shaft fracture (HSF) management and is designed for orthopedic trainees, general orthopedic surgeons, emergency physicians, and allied health professionals who participate in the acute or postoperative care of patients with HSFs. The content integrates the authors’ expert opinion with the current evidence. Humeral shaft fractures account for 1–3% of adult fractures, most often resulting from low-energy falls in older adults or high-energy trauma in younger patients. Although open fractures and neurovascular injuries are rare, primary radial nerve palsy (RNP) occurs in about 10% of cases. Diagnosis relies primarily on clinical evaluation and standard radiographs, with CT or MRI reserved for complex or pathological cases. Functional bracing has traditionally been the mainstay of nonsurgical treatment, achieving good long-term results but with nonunion rates up to 25%. Surgical fixation methods—including open reduction and internal fixation, minimally invasive plate osteosynthesis, and intramedullary nailing—allow earlier mobilization and more predictable fracture union but carry risks of iatrogenic RNP and infection. Management of primary RNP remains largely nonsurgical, with over 90% recovering spontaneously. Nonunion is frequently symptomatic and managed most often with compression plating. Surgery offers faster early recovery and lower nonunion rates, although long-term outcomes converge with successful bracing. Cost-effectiveness analyses suggest surgery may be more economical when productivity loss is considered, particularly for working-age patients. Optimal treatment selection depends on patient age, activity level, fracture characteristics, and patient preference, emphasizing shared decision-making.

Charlotte Brookes, Alice Rose, Moatisim Qayyum-Bin-Asim et al.

Aims: The decision to proceed to planned lower limb amputation in the context of previous trauma is a complex one. Much of the existing literature with regard to decision for amputation, and outcomes, focuses on a different patient demographic (older patients with diabetes or vascular disease) and therefore is unlikely to be applicable to young patients. In this study, we aim to identify the reasons for proceeding to a planned lower limb amputation in patients with previous lower limb trauma. We report on postoperative amputation complication rates, including reoperation, infection, phantom limb pain, and neuroma. The data were derived from one of the largest amputee multidisciplinary rehabilitation units in the UK. Methods: A retrospective analysis was undertaken of a prospectively collected database of all lower limb amputations secondary to trauma from a regional multidisciplinary amputee service in London. Clinical records were consulted for date and mechanism of injury of index trauma, date of amputation, evidence of reoperation, infection (superficial or deep), phantom limb pain, and neuroma. Amputations were deemed planned if occurring > six weeks post-traumatic injury. Results: A total of 69 amputations in 66 patients were analyzed. Mean age at index trauma was 38 years (10 to 77), and mean age at time of amputation was 45 years (12 to 80). The most prevalent mechanism of injury was road traffic accident (41%), followed by fall from a height (28%). Mean time from index trauma to amputation was 77 months (3 to 508). Chronic pain and infection were the leading causes in proceeding to a planned amputation (32% and 29%, respectively); nonunion accounted for 23%. Post-amputation rates of phantom limb pain, reoperation, and neuroma were 52.17%, 18.84%, and 8.70%, respectively. Infection was reported at a rate of 33%. Mean follow-up from time of amputation was 128 months. Conclusion: Chronic pain and infection are the most common reasons for proceeding to planned amputation of a previously traumatized lower limb. The rates of reoperation, neuroma, and phantom limb pain following planned amputation due to trauma are in keeping with those published for amputations secondary to diabetes or vascular disease. However, we report a higher rate of infection, likely attributable to chronic infection as a leading cause for planned amputation. Our data can assist clinicians and patients in making the complex, informed decision of whether to proceed to amputation. This is the first study describing the incidence of complications in patients with planned lower limb amputations due to trauma in the UK. Cite this article: Bone Jt Open 2026;7(3):448–454.

Dani Kiyasseh

Mapping surgery is fundamental to developing operative guidelines and enabling autonomous robotic surgery. Recent advances in artificial intelligence (AI) have shown promise in mapping the behaviour of surgeons from videos, yet current models remain narrow in scope, capturing limited behavioural components within single procedures, and offer limited translational value, as they remain inaccessible to practising surgeons. Here we introduce Halsted, a vision-language model trained on the Halsted Surgical Atlas (HSA), one of the most comprehensive annotated video libraries grown through an iterative self-labelling framework and encompassing over 650,000 videos across eight surgical specialties. To facilitate benchmarking, we publicly release HSA-27k, a subset of the Halsted Surgical Atlas. Halsted surpasses previous state-of-the-art models in mapping surgical activity while offering greater comprehensiveness and computational efficiency. To bridge the longstanding translational gap of surgical AI, we develop the Halsted web platform (https://halstedhealth.ai/) to provide surgeons anywhere in the world with the previously-unavailable capability of automatically mapping their own procedures within minutes. By standardizing unstructured surgical video data and making these capabilities directly accessible to surgeons, our work brings surgical AI closer to clinical deployment and helps pave the way toward autonomous robotic surgery.

M. Nuwer, E. Dawson, L. G. Carlson et al.

Lizabeth A. O’Connor, DMSc, MPH, PA-C, Curtis C. Quinn, MD, FACS, Bryan Houseman, DO

Phantom limb pain is the experience of painful sensations in an amputated limb. It is highly prevalent with unclear etiology. There is no consensus regarding the ideal prevention and treatment of this condition. We report a case of a 58-year-old female who underwent a right below-knee amputation with concomitant application of cryo nerve block to the tibial, deep, and superficial peroneal nerves. The patient denied phantom limb pain at 1 year following surgery. This case highlights the potential benefits of cryo nerve block for postoperative pain reduction and prevention of phantom limb pain.

Sean P. Moroze, MD, Miguel A. Diaz, MS, William Baione, MD et al.

Background: Tibial defects in total knee arthroplasty require appropriate fixation for stability. Smaller defects are treated with cement or a screw and cement construct (rebar technique), while larger defects may require augments. Prior studies validate screws and cement for small defects but caution against use beyond 5 mm. This study compares the stiffness and subsidence of cement-only vs rebar techniques in larger contained and uncontained defects. Methods: Thirty-two proximal tibial composite bone analogs were divided into 2 groups: (1) Cemented and (2) Rebar, with subgroups for contained and uncontained defects (8 each). Tibial defects mimicked Anderson Orthopaedic Research Institute Bone Defect Classification T1 and T2A classifications. Tibial baseplates were implanted using either cement alone or with a rebar technique (2 6.5 mm cancellous screws). Samples were mounted to a testing fixture simulating heel strike and underwent 10,000 cycles at 1 Hz. Tracking points were placed on each sample to measure displacement. Load and displacement data from the test frame were also collected. Results: In the contained defect subgroup, rebar showed higher stiffness than cement alone, but the difference was not statistically significant (P = .349) and both groups had similar micromotion (P = .989). In uncontained defects, cement-only showed slightly higher stiffness than rebar (P = .655), with no statistical difference in micromotion (P = .893). Uncontained defects exhibited significantly more micromotion than contained defects (P = .0018, P = .0055). Conclusions: Rebar and cement-only techniques demonstrated similar biomechanical performance in tibial defects up to 1 cm. The cement and screw technique remains a viable option but may not be necessary in primary and revision total knee arthroplasty.

Mircea Stoian, Leonard Azamfirei, Sergio Rares Bandila et al.

Sepsis is a major medical emergency, characterized by a dysfunctional immune response to infection, which often progresses to multiple organ failure and death. Early diagnosis and prognostic evaluation present significant challenges due to limitations in the specificity and sensitivity of traditional biomarkers. This narrative review summarizes recent evidence on the potential of circulating microRNAs (<i>miRNAs</i>) such as <i>miR-150</i>, <i>miR-146a</i>, <i>miR-223</i>, <i>miR-155</i>, <i>miR-122</i>, and <i>miR-4772-5p</i> and plasma gelsolin (pGSN) as diagnostic and prognostic markers in sepsis. We discuss mechanisms involved and their potential for integration with artificial intelligence (AI) in personalized medicine. PubMed, Embase, and Web of Science databases were searched for relevant literature. Original research, systematic reviews, and meta-analyses focused on the diagnostic or prognostic value of circulating <i>miRNAs</i> or pGSN in sepsis were included; opinion papers and case reports were excluded. Altered expression of certain circulating microRNAs correlates with disease severity and mortality. Among circulating microRNAs (<i>miRNAs</i>), miR-122 and miR-150 have become the most consistently validated biomarkers in clinical studies, associated with sepsis severity and death rates. Additionally, other <i>miRNAs</i> such as <i>miR-146a</i>, <i>miR-155</i>, and <i>miR-223</i> play roles in modulating immune and endothelial responses, highlighting the complex regulation of sepsis pathophysiology. Low pGSN concentrations at admission are associated with severe sepsis and acute respiratory distress syndrome, and serve as an independent predictor of mortality. Preclinical studies suggest that supplementation with exogenous pGSN could increase survival. AI algorithms show promising results for early sepsis detection and optimization of therapeutic decisions. However, combining circulating <i>miRNAs</i> and plasma gelsolin (pGSN) into AI-based models is still an exploratory idea that needs prospective validation, assay standardization, and multicenter studies before it can be used clinically.

Melanie Schaller, Sergej Hloch, Akash Nag et al.

This study investigates a pulsating fluid jet as a novel precise, minimally invasive and cold technique for bone cement removal. We utilize the pulsating fluid jet device to remove bone cement from samples designed to mimic clinical conditions. The effectiveness of long nozzles was tested to enable minimally invasive procedures. Audio signal monitoring, complemented by the State Space Model (SSM) S4D-Bio, was employed to optimize the fluid jet parameters dynamically, addressing challenges like visibility obstruction from splashing. Within our experiments, we generate a comprehensive dataset correlating various process parameters and their equivalent audio signals to material erosion. The use of SSMs yields precise control over the predictive erosion process, achieving 98.93 \% accuracy. The study demonstrates on the one hand, that the pulsating fluid jet device, coupled with advanced audio monitoring techniques, is a highly effective tool for precise bone cement removal. On the other hand, this study presents the first application of SSMs in biomedical surgery technology, marking a significant advancement in the application. This research significantly advances biomedical engineering by integrating machine learning combined with pulsating fluid jet as surgical technology, offering a novel, minimally invasive, cold and adaptive approach for bone cement removal in orthopedic applications.

Zhongtao Wu, Jingling Yang

We establish a $d$-invariant surgery formula for $L$-space knots that provides an effective tool for studying surgeries between lens spaces. Using this formula, we classify distance one surgeries between lens spaces of the form $L(n,1)$. This classification has direct applications to band surgeries between torus links $T(2,n)$, with connections to DNA topology. In particular, we show that chirally cosmetic banding of torus links can possibly occur only when $n=1,5,9$ or $10$.

Pedro Guicardi, Mrunmay Jagadale

The $\hat{Z}$ invariants of three-manifolds introduced by Gukov-Pei-Putrov-Vafa have influenced many areas of mathematics and physics. However, their TQFT structure remains poorly understood. In this work, we develop a framework of decorated $\mathrm{Spin}$-TQFTs and construct one based on Atiyah-Segal-like axioms that computes the $\hat{Z}$ invariants. Central to our approach is a novel quantization of $SL(2,\mathbb{C})$ Chern-Simons theory and a $\mathbb{Q}$-extension of the algebra of observables on the torus, from which we obtain the torus state space of the $\hat{Z}$-TQFT. Using the torus state space and topological invariance, we uniquely determine the $\hat{Z}$ invariants for negative-definite plumbed manifolds. Within this TQFT framework, we establish gluing, rational surgery, partial surgery, satellite, and cabling formulas, as well as explicit closed-form expressions for Seifert manifolds and torus link complements. We also generalize these constructions to higher-rank gauge groups.

Shunyu Wan, Hugo Zhou

We prove that for any pair of Legendrian representatives of the Chekanov-Eliashberg twist knots with different LOSS invariants, any negative rational contact $r$-surgery with $r\neq -1$ always gives rise to different contact 3-manifolds distinguished by their contact invariants. This gives the first examples of pairs of Legendrian knots with the same classical invariants but distinct contact $r$-surgeries for all negative rational number $r$. We also generalize the statement from the twist knots to a certain families of two-bridge knots.

Marina Martinelli, André Tosi Furtado

This paper is a comprehensive exploring of technology capability in 5G/6G TIS, explicitly focusing on the potential of remote surgery globally and in Germany. The paper's main contribution is its ability to anticipate new debates on the interplay between TIS and contexts, with particular emphasis on the national and international levels. Our findings, derived from a Bibliometrics study of industry-academic relationships, highlight crucial collaborations in Germany, positioning the country as a strategic actor in international TIS and, by extension, in applying 5G/6G technological systems to remote surgery due to its knowledge production capability. We propose policies that can stimulate interaction between smaller suppliers and larger companies, which can act as intermediaries and provide access to international markets.

Enneng Yang, Li Shen, Zhenyi Wang et al.

Model merging-based multitask learning (MTL) offers a promising approach for performing MTL by merging multiple expert models without requiring access to raw training data. However, in this paper, we examine the merged model's representation distribution and uncover a critical issue of "representation bias". This bias arises from a significant distribution gap between the representations of the merged and expert models, leading to the suboptimal performance of the merged MTL model. To address this challenge, we first propose a representation surgery solution called Surgery. Surgery is a lightweight, task-specific module that aligns the final layer representations of the merged model with those of the expert models, effectively alleviating bias and improving the merged model's performance. Despite these improvements, a performance gap remains compared to the traditional MTL method. Further analysis reveals that representation bias phenomena exist at each layer of the merged model, and aligning representations only in the last layer is insufficient for fully reducing systemic bias because biases introduced at each layer can accumulate and interact in complex ways. To tackle this, we then propose a more comprehensive solution, deep representation surgery (also called SurgeryV2), which mitigates representation bias across all layers, and thus bridges the performance gap between model merging-based MTL and traditional MTL. Finally, we design an unsupervised optimization objective to optimize both the Surgery and SurgeryV2 modules. Our experimental results show that incorporating these modules into state-of-the-art (SOTA) model merging schemes leads to significant performance gains. Notably, our SurgeryV2 scheme reaches almost the same level as individual expert models or the traditional MTL model. The code is available at \url{https://github.com/EnnengYang/SurgeryV2}.

A. F. Pull ter Gunne, D. B. Cohen

Min Zou, Xin Duan, Mufan Li et al.

Abstract Background Treating lateral compression type 1 (LC1) pelvic ring injuries in older patients is controversial. This study evaluated surgical treatments combined with ERAS for treating LC1 pelvic fractures in the elderly. Methods In this retrospective study, patients who underwent surgery with INFIX (supra-acetabular spinal pedicle screws, and a subcutaneous connecting rod; the experimental group) or superior pubic ramus cannulated screw (the control group) fixation of LC1 pelvic fracture from January 2019 to January 2022 were reviewed. Injury radiography and computed tomography were performed to determine the Young–Burgess classification. All patients performed standardized early rehabilitation exercises after surgery and were followed up for > 12 months. After surgery, the Matta score and the visual analog scale (VAS) were evaluated, and the postoperative weight-bearing time and the length of stay (LOS) were recorded. The Barthel index and the Majeed score were evaluated at 4 months after surgery and at the last follow-up. Results Fifty-three patients were included. Thirty-two patients included in the experimental group had a mean age of 75.0 ± 6.2 (range, 66–86) years, and the other 21 patients in the control group had a mean age of 74.6 ± 4.6 (range, 68–83) years. The mean follow-up time was 13.1 ± 1.6 (range, 12–18) months in the experimental group and 13.4 ± 1.3 (range, 12–16) months in the control group. There were no significant differences in follow-up time between the groups (P > 0.05). The mean VAS score, time to weight-bearing, and LOS were 2.0 ± 0.7 (range, 1–3), 1.1 ± 0.3 (range, 1–2) d, and 5.8 ± 0.9 (range, 4–7) d in the experimental group and 2.3 ± 1.2 (range, 1–5), 2.5 ± 1.6 (range, 1–7) d, and 6.1 ± 1.6 (range, 5–11) d in the control group, respectively. Between the two groups, there was a significant difference in the postoperative time to weight-bearing (P < 0.05), while there was no significant difference in the LOS (P > 0.05). No bedrest-related complications occurred in either group. The Matta score was 90.6% in the experimental group and 90.4% in the control group (P > 0.05). At the 4-months follow-up, the experimental group had a better Barthel index and Majeed score compared with the control group, which were 86.1 ± 6.2 (range, 70–95) vs. 81.2 ± 4.1 (range, 75–90) and 86.3 ± 3.3 (range, 78–91) vs. 80.3 ± 3.9 (range, 76–86), respectively. The experimental group had better early rehabilitation effect than the control group. There was no significant difference in Barthel index and Majeed score between the two groups at the last follow-up (P > 0.05). Conclusion Both INFIX and intramedullary superior pubic ramus cannulated screws can successfully treat LC1 pelvic fractures and reduce bed rest complications among older patients.

Reiko Yamaura, Hideko Kasahara, Satoshi Iimuro et al.

ABSTRACT This study aimed to investigate the association between daily sleep duration of <7 hours and lower bone mineral density (BMD) using data from annual health check‐ups conducted in Japan between 2020 and 2022. Multivariate regression models were used, where BMD was the objective variable and daily sleep duration (<5 hours, 5 to <7 hours, 7 to <9 hours [reference], ≥9 hours) was the exposure variable adjusted for age, body mass index, physical activity, smoking status, and alcohol intake for men and women and further adjusted for menopausal status for women. The association between insomnia and BMD was also investigated. BMD was determined using calcaneal quantitative ultrasound and expressed as a percentage of the young adult mean (%YAM). In total, 896 men and 821 women were included. Median age was 54 years (interquartile range [IQR]: 46 to 64) for men and 55 years (IQR: 46 to 64) for women). Median BMD for men and women was 79%YAM (IQR: 71 to 89) and 75%YAM (IQR: 68 to 84), respectively. Approximately 80% of men and women slept <7 hours daily. Multivariate regression showed no association between sleep duration and BMD in men. However, women who slept 5 to <7 hours daily had significantly higher BMD by 3.9% compared with those who slept 7 to<9 hours (p = 0.004). No association between insomnia and BMD was found. Overall, a daily sleep duration of <7 hours was not independently associated with lower BMD compared to those who slept 7 to <9 hours in men and women. However, as there is evidence of both shorter and longer sleep durations being associated with an increased risk of adverse events, including cardiovascular events, our result needs to be interpreted with caution. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.