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Journals Orthopedic Clinics of North Am...

Orthopedic Clinics of North America

https://read.qxmd.com/read/38782512/surgical-considerations-for-osteoporosis-osteopenia-and-vitamin-d-deficiency
#1
EDITORIAL
Frederick M Azar
No abstract text is available yet for this article.
July 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38782511/treatment-strategies-in-the-osteoporotic-spine
#2
REVIEW
Daniel Gelvez, Katherine Dong, Nathan Redlich, Jestin Williams, Amit Bhandutia, Berje Shamassian
This article reviews the appropriate assessment and management of osteoporotic compression fractures and discusses the implications of osteoporosis on initial patient evaluation, medical optimization for surgery, selection of instrumentation, and surgical technique. Adverse outcomes associated with osteoporosis are discussed. Failure to appropriately evaluate, optimize, and treat spine patients with osteoporotic bone can lead to disastrous complications. Weakened bone can lead to implant failure through cage subsidence and screw pullout, as well as, peri-implant fractures, failure of deformity correction, and proximal kyphosis...
July 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38782510/surgical-outcomes-in-charcot-arthropathy
#3
REVIEW
William C Skinner, Naveen Pattisapu, Jane Yeoh, Benjamin J Grear, David R Richardson, Garnett A Murphy, Clayton C Bettin
Treatment of Charcot neuroarthropathy (CN) of the foot and ankle remains challenging for both patients and surgeons. Nonoperative treatment with cast/orthosis immobilization has long been the mainstay of treatment, but surgical intervention has gained interest to improve poor long-term outcomes. A review of existing data on the operative management of CN demonstrates the potential benefits but also the continued risks associated with treatment. Additionally, a retrospective review of cohorts managed with limited surgical interventions (wound debridements, exostectomies, and other surgical procedures) compared to reconstructive procedures provides additional insight into the surgical management of CN...
July 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38782509/considerations-regarding-vitamin-d-in-foot-and-ankle-treatment-and-surgery
#4
REVIEW
James D Michelson
Although the impact that vitamin D has on bone healing is uncertain in foot and ankle (F&A) surgery, there is support for vitamin D supplementation (2000 IU/day) with calcium (1 g/day) to promote bone healing. Although orthopedic F&A surgeons are frequently the first provider to detect the harbingers of osteoporosis by the occurrence of fragility fractures, this should trigger referral to the appropriate specialist for assessment and treatment. There is circumstantial evidence suggesting a role of hypovitaminosis D in bone marrow edema syndrome and possibly osteochondritis dissecans...
July 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38782508/a-systematic-review-of-patient-selection-criteria-for-outpatient-total-shoulder-arthroplasty
#5
REVIEW
Kevin T Root, Keegan M Hones, Kevin A Hao, Tyler J Brolin, Jonathan O Wright, Joseph J King, Thomas W Wright, Bradley S Schoch
The utilization of total shoulder arthroplasty (TSA) is increasing, driving associated annual health care costs higher. Opting for outpatient over inpatient TSA may provide a solution by reducing costs. However, there is no single set of accepted patient selection criteria for outpatient TSA. Here, the authors identify and systematically review 14 articles to propose evidence-based criteria that merit postoperative admission. Together, the studies suggest that patients with limited ability to abmluate independently or a history of congestive heart failure may benefit from postoperative at least one night of hospital based monitoring and treatment...
July 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38782507/surgical-considerations-for-osteoporosis-osteopenia-and-vitamin-d-deficiency-in-upper-extremity-surgery
#6
REVIEW
Paul T Greenfield, Tori J Coble, Jared A Bell, James H Calandruccio, William J Weller
Fragility fractures as a result of osteoporosis, osteopenia, or vitamin D deficiency are some of the most common injuries encountered in orthopedics and require careful consideration when determining the appropriate management and treatment options. A thorough perioperative evaluation can identify causes of low bone mineral density allowing for initiation of appropriate therapy. Surgical treatment of these fractures can be difficult, and techniques should be employed to ensure stable fixation. It is important to understand the potential pitfalls associated with treatment of fragility fractures to prevent avoidable complications...
July 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38782506/perioperative-evaluation-and-management-of-children-with-osteoporosis-and-low-bone-mineral-density
#7
REVIEW
Jordan D Ross, Alicia Diaz-Thomas
As medical and surgical treatment options for children with osteoporosis expand, multidisciplinary strategies for bone health optimization become more important. Each patient's bone mineral density and fracture history should be interpreted in context. Off-label bisphosphonate use is a standard pharmacologic intervention for children with osteoporosis for optimal bone accrual. It is possible to continue this therapy perioperatively under certain circumstances. The rare side effects (osteonecrosis of the jaw and atypical femur fractures) seem less common in children...
July 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38782505/cementless-total-knee-arthroplasty-is-it-safe-in-demineralized-bone
#8
REVIEW
Christopher Deans, Bradford Zitsch, Beau J Kildow, Kevin L Garvin
There is concern for cementless total knee arthroplasty (TKA) in patients with decreased bone mineral density (BMD) due to the potential increase in complications, namely failed in-growth or future aseptic loosening. Some data suggest that advances in cementless prostheses mitigate these risks; however this is not yet born out in long-term registry data. It is crucial to expand our understanding of the prevalence and etiology of osteoporosis in TKA patients, survivorship of cementless implants in decreased BMD, role of bone-modifying agents, indications and technical considerations for cementless TKA in patients with decreased BMD...
July 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38782504/postoperative-vitamin-d-surveillance-and-supplementation-in-revision-total-knee-arthroplasty-patients-a-retrospective-cohort-analysis
#9
REVIEW
Jessica L Duggan, Wolfgang Fitz, Jeffrey K Lange, Vivek M Shah, Adam Olsen, Richard Iorio, Antonia F Chen
This study was a retrospective cohort analysis of 20 patients who underwent 23 revision total knee arthroplasty procedures in a single geographic region of the United States from January 2015 to February 2023. We analyzed their 25-OH vitamin D levels preoperatively and postoperatively at 1 month, 3 months, 6 months, 1 year, and 2 years. We categorized their supplementation regimens by dose: none, low dose (1000 IU and below), medium dose (1001-5000 IU), and high dose (>5000 IU). We found that there was a high incidence of vitamin D deficiency in this patient population...
July 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38782503/patients-with-osteoporosis-are-at-higher-risk-for-periprosthetic-femoral-fractures-and-aseptic-loosening-following-total-hip-arthroplasty
#10
REVIEW
James T Layson, Daniel Hameed, Jeremy A Dubin, Mallory C Moore, Michael Mont, Giles R Scuderi
This report provides an updated analysis for patients with osteoporosis following total hip arthroplasty (THA). The comorbidities of alcohol abuse, chronic kidney disease, cerebrovascular disease, obesity, and rheumatoid arthritis continue to be significant risk factors for periprosthetic femur fracture (PPFFx) and aseptic loosening in the population with osteoporosis. Patients with dual-energy x-ray absorptiometric (DEXA) scans were at risk for PPFFx regardless of femoral fixation method, and patients with DEXA scans with cementless fixation were at risk of aseptic loosening after THA...
July 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38403376/infections
#11
EDITORIAL
Frederick M Azar
No abstract text is available yet for this article.
April 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38403375/the-differentiation-between-infection-and-acute-charcot
#12
REVIEW
Ryan G Rogero, Samhita Swamy, Clayton C Bettin
The differentiation between acute Charcot neuroarthropathy and infection in the foot and ankle should be supported by multiple criteria. A detailed history and physical examination should always be completed. Plain radiographs should be performed, though advanced imaging, currently MRI, is more helpful in diagnosis. Scintigraphy and PET may become the standard imaging modalities once they are more clinically available due to their reported increased accuracy. Laboratory analysis can also act as a helpful diagnostic tool...
April 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38403374/diagnosis-and-management-of-infected-total-ankle-replacements
#13
REVIEW
Benjamin D Umbel, Brandon A Haghverdian, Karl M Schweitzer, Samuel B Adams
As the number of primary total ankle replacements increases for treatment of end-stage ankle arthritis, failures are also expected to rise. Periprosthetic joint infection is among the causes of failures and has been reported to be as high as 5%. Diagnosis is usually made by a combination of clinical examination findings, imaging, laboratory, and microbiological workup. Management is generally separated into limb salvage or amputation. Limb salvage can be challenging and may involve a single versus staged approach...
April 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38403373/management-of-the-septic-wrist-a-systematic-review-of-etiology-and-therapeutic-strategies
#14
REVIEW
Heather L Mercer, Diego Rodriguez, Rhiana Rivas, Elizabeth Rivenbark, Elizabeth Mikola, Deana Mercer
Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches...
April 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38403372/fingertip-infections
#15
REVIEW
James Barger, Reed W Hoyer
The fingertip is the interface between humans and the world, including the various thorns, dirty needles, and other hazards to be found there. It is unsurprising that this is the site where hand infections most frequently occur. Although commonly encountered by hand surgeons and other physicians, fingertip infections have several mimics, and diagnosis and management is not always straightforward. Early diagnosis and treatment are key to success. As with all infections, they are more common and are more aggressive in immunosuppressed patients...
April 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38403371/diagnostic-evaluation-of-prosthetic-joint-infections-of-the-shoulder-what-does-the-literature-say
#16
REVIEW
Jeffrey Klott, Tyler J Brolin
The total number of patients with a total shoulder arthroplasty (TSA) is increasing, and the number of patients experiencing a (TSA) prosthetic joint infection (PJI) also will increase. It is important that physicians know how to identify signs of infection, know the common pathogens, and know how to work up a shoulder PJI. This publication reviewed the current literature about presenting signs and symptoms, common shoulder pathogens and how they differ from total knee and hip pathogens, and what images, tests, and procedures can aid in identification of infection...
April 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38403370/the-septic-elbow-joint-treatment-approaches-for-improved-patient-outcomes
#17
REVIEW
Heather L Mercer, Diego Rodriguez, Elizabeth Mikola, Deana Mercer
Septic arthritis of the elbow is a serious problem requiring prompt, accurate diagnosis and urgent surgical intervention. Achieving successful patient outcomes depends heavily on early diagnosis and efficient streamlined surgical treatment. Essential tactics for treating the septic elbow joint include immediate joint irrigation and debridement in addition to administration of appropriate antibiotics. This comprehensive review delves into the cause of the septic elbow joint, identifies associated risk factors, and provides a comprehensive approach encompassing the diagnosis and treatment of the septic elbow...
April 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38403369/sequestration-and-involucrum-understanding-bone-necrosis-and-revascularization-in-pediatric-orthopedics
#18
REVIEW
Katherine S Hajdu, Courtney E Baker, Stephanie N Moore-Lotridge, Jonathan G Schoenecker
Sequestration, a condition where a section of bone becomes necrotic due to a loss of vascularity or thrombosis, can be a challenging complication of osteomyelitis. This review explores the pathophysiology of sequestration, highlighting the role of the periosteum in forming involucrum and creeping substitution which facilitate revascularization and bone formation. The authors also discuss the induced membrane technique, a two-stage surgical procedure for cases of failed healing of sequestration. Future directions include the potential use of prophylactic anticoagulation and novel drugs targeting immunocoagulopathy, as well as the development of advanced imaging techniques and single-stage surgical procedures...
April 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38403368/navigating-the-enigma-of-pediatric-musculoskeletal-infections-a-race-against-time
#19
REVIEW
Stephanie N Moore-Lotridge, Brian Q Hou, Katherine S Hajdu, Malini Anand, William Hefley, Jonathan G Schoenecker
Musculoskeletal infection (MSKI) in children is a critical condition in pediatric orthopedics due to the potential for serious adverse outcomes, including multiorgan dysfunction syndrome, which can lead to death. The diagnosis and treatment of MSKI continue to evolve with advancements in infectious organisms, diagnostic technologies, and pharmacologic treatments. It is imperative for pediatric orthopedic surgeons and medical teams to remain up to date with the latest MSKI practices.
April 2024: Orthopedic Clinics of North America
https://read.qxmd.com/read/38403367/the-state-of-local-antibiotic-use-in-orthopedic-trauma
#20
REVIEW
Carlo Eikani, Aaron Hoyt, Elizabeth Cho, Ashley E Levack
Fracture-related infections are a challenging complication in orthopedic trauma that often necessitates multiple surgeries. Early administration of systemic antibiotics and surgical intervention remains the gold standard of care, but despite these measures, treatment failures can be as high as 35%. For these reasons, the introduction of local antibiotics at the site of at-risk fractures has increased over the past decade. This review looks at the various measures being used clinically including local antibiotic powder, polymethylmethacrylate, biodegradable substances, antibiotic-coated implants, and novel methods such as hydrogels and nanoparticles that have the potential for use in the future...
April 2024: Orthopedic Clinics of North America
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