2 Minute Medicine ® - Orthopedics

1. Walking significantly reduced low-back pain recurrence compared to the control group. 2. Patients in the walking group saved approximately AU $7802 per quality-adjusted life-years gained. Evidence Rating Level: 1 (Excellent) Study Rundown: Low back pain recurrence is common, contributing significantly to both the disease burden and economic costs associated with this condition. While exercise is recommended to prevent recurrence, the effectiveness and cost-efficiency of simple, low-cost interventions such as walking remain unclear...

1. Low-volume local anesthetic with intravenous dexamethasone reduced the incidence of diaphragmatic paresis and provided equivalent analgesic duration compared to the conventional volume of local anesthetic in arthroscopic shoulder surgery Evidence Rating Level: 1 (Excellent) Severe postoperative pain is common in patients undergoing arthroscopic shoulder surgery. Therefore, appropriate analgesia and rehabilitation are key for recovery. Interscalene brachial plexus block provides effective analgesia after arthroscopic shoulder surgery but carries a high risk of diaphragmatic paresis...

1. Patients in the early weight-bearing group showed better recovery than those in the delayed weight-bearing group at 4 months post-randomization. 2. Early weight-bearing was more cost-effective with comparable adverse outcomes. Evidence Rating Level: 1 (Excellent) Study Rundown: Patients recovering from ankle surgery have traditionally been advised to avoid walking for 6 weeks, a strategy known as delayed weight-bearing. An alternative approach, early weight-bearing, allows walking 2 weeks post-surgery and may offer better rehabilitation outcomes...

1. Tumor response rate at 25 weeks was significantly greater in vimseltinib than placebo. 2. Most adverse events were mild-to-moderate with no treatment-related fatalities. Evidence Rating Level: 1 (Excellent) Study Rundown: Tenosynovial giant cell tumour (TGCT) is an aggressive neoplasm of the tendon sheath with limited treatment options. Vimseltinib, an oral CSF1R inhibitor, has shown promise for symptomatic TGCT patients, although further research is needed. This randomized controlled trial aimed to assess the safety and efficacy of vimseltinib compared to placebo among patients with TGCT not amenable to surgery...

1. Femoral neck bone mineral density (FNBMD) alone discriminated 5-year hip fracture risk at least as well as FRAX and Garvan tools incorporating FNBMD. 2. Fracture Risk Assessment Tool (FRAX) modestly underpredicted observed hip fracture probability in intermediate-risk individuals and Garvan greatly overpredicted observed hip fracture probability in high-risk individuals. Evidence Rating Level: 2 (Good) Adults 80 years and older make up 70% of hip fractures in the United States. Tools to estimate absolute risk of hip fracture include the Fracture Risk Assessment Tool (FRAX) and Garvan fracture risk calculator...

1. Total knee arthroplasty (TKA) using a MAKO robot improves short-term efficacy and can assist in planning while maintaining high safety.  Evidence Rating Level: 3 (Average) Traditional total knee arthroplasties (TKA) are done using cutting guides for osteotomy. The precision of osteotomy and soft tissue balancing can significantly affect the postoperative alignment and prosthetic positioning. The MAKO surgical robot can help plan correction and balance ligament tension during surgery. This study aimed to compare the efficacy of TKA assisted by the MAKO robot and conventional TKA through retrospective analysis...

1. In this randomized controlled trial, progressive resistance training (PRT) was not superior to neuromuscular exercise (NEMEX) in improving functional performance in patients with hip osteoarthritis (OA). 2. PRT was not superior to NEMEX in improving patients’ hip pain or hip-related quality of life. Evidence Rating Level: 1 (Excellent) Study Rundown: OA is a degenerative joint disease characterized by the breakdown of cartilage between bones, which results in pain, decreased range of motion, and impaired quality of life...

1. In a cohort of older adults, the use of corticosteroid injections (CSIs) was not associated with increased fracture risk, regardless of osteoporosis status. 2. The cumulative dose of CSI used over four years was also not a predictor of fracture risk. Evidence Rating Level: 2 (Good) Corticosteroid injections (CSI) are commonly used in the management of musculoskeletal (MSK) pain, particularly in older adults. While they are formulated to prolong their presence locally at the injection site, there is some systemic absorption of CSIs...

1. Neutral version and 30° retroversion humeral components in reverse total shoulder arthroplasty had no significant difference in range of motion, muscle strength, or patient-reported outcomes.  Evidence Rating Level: 1 (Excellent)   Reverse total shoulder arthroplasty (rTSA) for patients with rotator cuff tear arthropathy improves forward elevation, pain, and function but can result in limited internal and external rotation. The goal of this randomized control trial was to determine if internal and external rotation are affected by the positioning of the humeral component (neutral or 30° of retroversion)...

1. At 12 months, patients with anterior cruciate ligament reconstruction randomized to receive postoperative intra-articular platelet-rich plasma injection were not found to have improved knee function compared to no postoperative injection. Evidence Rating Level: 1 (Excellent) Platelet-rich plasma (PRP), a product derived from autologous blood and rich in growth factors, has been viewed as a promising therapeutic option for various musculoskeletal disorders. However, there has been conflicting evidence for the efficacy of PRP use in patients undergoing anterior cruciate ligament reconstruction (ACLR), with recent studies showing that intraoperative injection was not associated with long term improvements...

1. Increased incidence of radiographic knee osteoarthritis was associated with high amounts of weight-bearing activity only in those with a low lower-limb muscle mass index (LMI). 2. There was no association identified between symptomatic knee osteoarthritis and weight-bearing activity, total physical activity, or non-weight-bearing activity.  Evidence Rating Level: 1 (Excellent)  Osteoarthritis is an inflammatory joint disease involving the degeneration of joints along with chronic pain and limited mobility...

  1. Reverse total shoulder replacement (RTSR) was examined as a potential treatment for end-stage shoulder arthritis. 2. After analysing the risk factors, RTSR was shown as a potential alternative treatment to total shoulder replacement for those with an intact rotator cuff. Evidence Rating Level: 1 (Excellent) One treatment for end-stage shoulder arthritis that is increasingly popular is shoulder replacement therapy. Reverse total shoulder replacement (RTSR) has previously been used for rotator cuff arthropathy but has expanded its use for other indications despite a lack of supporting evidence...

1. The 3-month symptomatic venous thromboembolism rate was 0.7% in patients with TRiP(cast) score < 7 and not receiving anticoagulation. 2. There was no significant difference between the control and intervention phases regarding secondary outcomes. Evidence Rating Level: 1 (Excellent) Study Rundown : Venous thromboembolism (VTE) is a well-recognized potential complication resulting from orthopedic trauma and periods of prolonged immobilization. However, there exists a lack of consensus around prophylactic anticoagulation among patients with lower limb trauma requiring immobilization...

1. This retrospective cohort study found that immediate weight-bearing following clavicle fracture fixation in patients with concurrent lower extremity trauma does not impact rates of hardware failure (HWF) or fracture union, compared with non-weight bearing (NWB) patients with isolated clavicular fractures.  Evidence Rating Level : 2 (Good) Clavicle fractures are increasingly treated with open reduction internal fixation (ORIF). Postoperative care often involves 6 weeks of NWB, but in polytrauma cases with lower extremity injuries, NWB is challenging...

1. This retrospective cohort study found that in one surgeon’s practice, administration of vancomycin/tobramycin local antibiotic powder (LAP) after open treatment of fractures resulted in an 8.3% reduction in deep surgical site infections (SSIs) compared with no LAP procedures. Evidence Rating Level : 2 (Good) Conflicting data exist regarding LAP effectiveness in reducing SSIs in orthopedic surgery. While the VANCO trial showed no significant reduction in deep SSIs with vancomycin LAP, post hoc analysis suggested a decrease in gram-positive infections offset by gram-negative ones...

1. In a cohort of patients with traumatic brain injury, early fixation of extremity fractures within 24 hours of injury was not associated with greater rates of unfavourable functional outcomes at 6 months.  Evidence Rating: 2 (Good)  While extremity fractures are commonly seen in conjunction with traumatic brain injury (TBI), the ideal timing of fixation and definitive treatment of these fractures remain controversial. On one hand, there are those who argue in favour of earlier fixation to promote a shorter recovery course and decreased complication rates...

1. Long-term adherence to a plant-based diet was not associated with an increased risk of hip fractures in a cohort of US adult women. 2. Consumption of healthier plant-based options (whole fruits, vegetables) was associated with a 21% lower risk of fracture. 3. Consumption of more unhealthy plant-based options (fruit juices, processed foods, refined grains) was associated with a 28% higher risk of fracture. Evidence Rating Level: 1 (Excellent) As the aging process ensues, fractures become a public health concern as older adults have decreasing bone mass, especially postmenopausal women...

1. In this nationwide, population-based retrospective cohort study, dental procedures did not increase the risk of periprosthetic joint infections (PJI) in patients who have undergone primary and revision total knee arthroplasty (TKA). 2. Prophylactic antibiotics in these patients did not reduce the PJI risk, while posttraumatic arthritis was associated with PJI. Evidence Rating Level : 2 (Good) The efficacy of prophylactic antibiotics before dental procedures to prevent PJI post-total joint arthroplasty (TJA) remains uncertain despite multiple guideline revisions...

1. In geriatric patients with hip fractures on direct oral anticoagulants (DOACs), surgical treatment within 48 hours of their last preoperative DOAC dose had comparable complication rates and 1-year mortality compared with patients with surgery delayed past 48 hours. 2. Patients who underwent surgical management within 48 hours required fewer transfusions and had decreased length of stay, compared with those who underwent surgery beyond 48 hours.  Evidence Rating Level : 2 (Good) Geriatric hip fractures are associated with 1-year mortality rates as high as 33%...

Incidence and influence factors of venous thromboembolism in traumatic rib fracture patient: a multicenter study : https://read.qxmd.com/read/38395963 1. In patients with traumatic rib fractures, the number of rib fractures was an independent risk factor for venous thromboembolism (VTE). 2. Surgical fixation of isolated rib fractures involving ≥3 ribs reduced the incidence of VTE compared with conservative treatment. Evidence Rating Level :1 (Excellent) Traumatic rib fractures increase VTE risk due to reduced mobility, trauma impact, and treatment interventions...