2 Minute Medicine ® - Orthopedics

1. Patients with a new diagnosis of osteoporotic vertebral compression fracture (OVCF) are at higher risk of mortality compared to their sex- and age-matched controls. 2. Factors that increase the risk of mortality amongst OVCF patients include: Male sex, older age, low-income, high Charlson Comorbidity Index, and medical comorbidities such as CHF, cancer, and stroke. Evidence Rating Level: 2 (Good) Osteoporotic vertebral compression fractures (OVCF) are one of the most common osteoporotic fractures. OVCFs can cause tremendous pain and instability, further increasing risk of falls...

1. Following total knee replacement (TKR) for osteoarthritis, patients randomized to a combined digital intervention experienced less pain, less disability, and increased physical activity at 12 months follow-up, compared to care usual. Evidence Rating Level: 1 (Excellent) Patients who undergo total knee replacement (TKR) for osteoarthritis (OA) may continue to have ongoing pain and limited function, with some reports showing that 10% of patients are dissatisfied at 2 years of follow-up. Digital interventions are one strategy shown to improve pain and increase activity after TKR...

 1.  In a prospective cohort study, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin (PCT) were elevated in pediatric patients with a musculoskeletal infection. 2. WBC count, ANC, CRP, ESR, and PCT were distinguished musculoskeletal infections from Lyme arthritis and other types of inflammatory arthritis. Evidence Rating Level: 2 (Good) Study Rundown: Bacterial musculoskeletal infections (MSKI) are serious conditions that require rapid recognition and treatment...

1. In this systematic review, there was limited data to support the use of combined hormonal contraceptives (CHC) to prevent musculoskeletal conditions and injuries. 2. There was also low-certainty evidence to suggest that CHC use was associated with higher risks of future fracture and total knee arthroplasty. Evidence Rating Level: 1 (Excellent) It is known that women typically experience more musculoskeletal (MSK) pain and chronic MSK conditions compared to men. Some have postulated that these sex differences may be related to their menstrual status...

1. Deep surgical site infection at 90 days was 1.7% in the single-antibiotic group versus 1.2% in the dual-antibiotic loaded cement group, with no significant differences between groups. 2. Quality of life, mobility, and mortality at 120 days were comparable between both groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Hip fracture is a common injury in the elderly that necessitates hospital, and often operative, management. Although surgical site infections are common, mixed evidence exists regarding the use of antibiotic-loaded bone cement in hemiarthroplasty...

1. In this randomized controlled trial, there was no difference in pediatric forearm fracture functional outcomes between those assessed with ultrasonography versus radiography. 2. Ultrasonography was associated with higher caregiver satisfaction compared to radiography. Evidence Rating Level: 1 (Excellent) Study Rundown: Due to the biomechanical properties of developing bones, distal forearm fractures are a common presentation among children in the emergency department. Within higher-income countries, radiography is regularly performed, given its availability and utility in ruling out fractures...

1. In this prospective randomized controlled study, pain scores for the topical tranexamic acid (TXA) group on the first day after total hip arthroplasty (THA) were significantly lower than the intravenous (IV) group. 2. Those enlisted to receive topical TXA were additionally observed to use lesser amounts of tramadol on days 1 and 2 postoperatively. 3. There was no significant difference in total blood loss or adverse events between the two groups. Evidence Rating Level: 1 (Excellent) The possibility of opioid dependence post-operatively should always be a consideration for healthcare providers...

1. In this systematic review, musculoskeletal injury (MSK) in adult athletes was associated with worsened scores across multiple domains of mental health. 2. Furthermore, involuntary retirement from sport due to MSK injury was commonly associated with worsened mental health. Evidence Rating Level: 1 (Excellent) Mental health disorders such as anxiety and depression may be prevalent in athletic populations due to an intertwining of their identity with their sport. Studies have shown that injured athletes tend to experience poorer mental health...

1. Anatomic alteration of the carpal tunnel in conservatively managed distal radius fractures (DRF), particularly diminished radio capitate distance (RCD), volar prominence height (VPH), and volar tilt (VT), is significantly associated with delayed carpal tunnel syndrome (DCTS) development. Evidence Rating Level : 3 (Average) Carpal tunnel syndrome (CTS) is a common complication following DRF. CTS development after DRF may present acutely (at the time of injury) or in a delayed fashion (after several weeks)...

1. Among patients undergoing shoulder arthroscopy, the use of dexmedetomidine as an adjuvant to an erector spinae plane block reduced intraoperative and postoperative opioid requirements. Evidence Rating Level: 1 (Excellent) Shoulder arthroscopy continues to be one of the most frequently performed orthopedic surgery. As postoperative pain is a significant consequence of this surgery, good pain management is key to optimal surgical results and recovery following surgery. Currently, several analgesic strategies such as regional nerve blocks, local anesthetic, non-steroidal anti-inflammatory drugs, intravenous opioids, and patient-controlled analgesia are commonly used modalities...

Clinical outcomes of pediatric osteomyelitis : https://read.qxmd.com/read/36732705 1. Pediatric patients under 18 years with chronic osteomyelitis were more likely to have long-term orthopedic follow-up, pathologic fractures, and require multiple surgeries, compared to patients with acute osteomyelitis. 2. There were no differences in rates of limb length discrepancies, readmission rates, or fatality, between acute and chronic osteomyelitis pediatric patients. 3. Limb length discrepancies, pathologic fractures, and fatality were rare sequelae amongst all pediatric osteomyelitis patients...

1. In this randomized control trial of knee osteoarthritis patients, there was no significant difference between high-dose and low-dose exercise therapy for Knee injury and Osteoarthritis Outcome Scores (KOOS).  2. No significant difference between groups was found in patient experience of pain intensity or quality of life. Evidence Rating Level: 1 (Excellent) Study Rundown: Knee osteoarthritis can significantly impact patient quality of life through chronic joint pain, knee stiffness, and decreased functioning...

1. In this randomized clinical trial, there were no differences in mortality, pulmonary embolism, or safety between thromboprophylaxis with aspirin versus low-molecular-weight heparin in patients with fractures. 2. Incidence of deep vein thrombosis was higher with aspirin use compared to low-molecular-weight heparin use. Evidence Rating Level: 1 (Excellent) Study Rundown: Thromboprophylaxis therapy is currently recommended to reduce death and complications associated with venous thromboembolism after fractures...

1. For patients with type 2 diabetes mellitus (T2DM), metformin use was associated with a significant reduction in risk of total knee replacement (TKR) and total hip replacement (THR).  Evidence Rating Level: 2 (Good) Study Rundown: Osteoarthritis (OA) is one of the primary causes of chronic pain and disability, leading to high volumes of total knee replacement (TKR) and total hip replacement (THR) surgeries worldwide. While obesity is a risk factor for OA, diabetes mellitus is also a risk factor independent of obesity, with insulin resistance cited as a contributing factor...

1. Anterior knee pain (AKP) is a potential complication of ACL Reconstruction (ACLR) with hamstring tendon (HT) autograft. 2. Patients with AKP following ACLR with HT autograft have decreased isokinetic strength and functional pain 4 months post-operatively, but not at 7 months, compared to patients without AKP.  Evidence Rating Level: 2 (Good) Anterior knee pain (AKP) following anterior cruciate ligament reconstruction (ACLR) is a common complaint, with an estimated prevalence of 2.7 to 20%, more often seen in patellar tendon (PT) autografts than hamstring tendon (HT)...

1. In this randomized controlled trial, community-based diet and exercise education led to improvement in osteoarthritis associated pain score. 2. Community-based diet and exercise regimen was more effective in lowering mean body weight and mean waist circumstance compared to attention control group.   Evidence Rating Level: 1 (Excellent) Osteoarthritis (OA) is the most common cause of mobility and disability amongst the elderly. Since patients with OA live with symptoms for an average of 26.1 years, optimizing treatment of OA can have a significant impact on quality of life for this population...

1. In this retrospective observational study, there were significant between-hospital and within-hospital variations of cemented implant use in Nova Scotia in patients who suffered a femoral neck fracture and who underwent hip arthroplasty. Evidence Rating Level: 2 (Good) Femoral neck fractures are a high priority area for policymakers in Canada due to high prevalence and high mortality rates. Arthroplasty is a common method of treatment, but there is a lack of consensus for the use of cemented versus uncemented implants...

1. In this retrospective, cohort, control-matched study, a diagnosis of juvenile idiopathic diabetes was associated with an increased risk of developing obstructive sleep apnea. 2. Additionally, the association between sleep apnea and juvenile idiopathic arthritis was strongest in those aged 18-30 and in males. Evidence Rating Level: 2 (Good) Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition that affects the temporomandibular joint. JIA can lead to deformities in the joint that can cause upper airway collapse and difficulty breathing, increasing the risk of obstructive sleep apnoea (OSA)...

1. In patients with end-stage ankle osteoarthritis, no differences were seen in outcomes between total ankle replacement (TAR) and ankle fusion (AF) surgeries. 2. There were no significant differences in the rate of adverse events in patients who received TAR as compared to AF surgeries.   Evidence Rating Level: 1 (Excellent) Study Rundown: Surgical procedures are indicated for patients with severe ankle osteoarthritis that have failed six months of nonoperative management. TAR and AF are the main surgical treatments for ankle osteoarthritis...

1. In this systematic review and meta-analysis, moderate certainty evidence suggested that damage to various structures of the knee may increase the odds of symptomatic osteoarthritis (OA). 2. Furthermore, modifiable risk factors for OA remain more established than modifiable risk factors for post-traumatic OA. Evidence Rating Level: 1 (Excellent) OA is the most common joint condition affects millions of people worldwide. Post-traumatic OA represents at least 12% of these cases. Unlike the availability of high-level evidence to guide prevention of post-traumatic knee OA, there is a gap that remains in how to delay or prevent the development of OA after a traumatic injury...