2 Minute Medicine ® - Orthopedics

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...

1. Ketamine was non-inferior to morphine at analgesic pain reduction for out-of-hospital pain management. 2. There was, however, an increased number of adverse events in the ketamine group, though the majority of these were associated with emergence phenomenon and did not require intervention. Evidence Rating Level: 1 (Excellent) Pain is a common symptom experienced outside of the hospital, which is currently being researched to shore up inadequacies, especially for those experiencing traumatic pain. There is much discussion in this research over which analgesic is the best to prescribe for out-of-hospital pain...

1. This large retrospective cohort study found that female patients who underwent a hysterectomy with or without an adnexal surgical procedure had an increased osteoporosis risk compared with those without a hysterectomy. 2. Beyond 7 years, osteoporosis risk in the hysterectomy group without adnexal surgery was similar to the nonhysterectomy group, while the hysterectomy group with an adnexal procedure maintained an increased osteoporosis risk. 3. Despite the increased osteoporosis risk, hysterectomy with or without an adnexal surgical procedure was not associated with an increased fracture risk...

1. In this randomized controlled trial, topical testosterone was not superior to placebo in reducing the risk of fractures in men with clinical hypogonadism.  2. The rate of fractures was higher among men receiving testosterone therapy compared to placebo.  Evidence Rating Level: 1 (Excellent) Study Rundown: Hypogonadism in men, from pituitary and testicular causes, as well as an adverse effect of prostate cancer therapy, has been associated with an increased risk of fractures. Testosterone treatment has been shown to improve bone density and quality based on radiographic and computed tomography evidence...

1. In emergency patients with hip fracture and severe pain, patients randomize to receive early ultrasound-guided femoral nerve block (FNB) were observed with reduced preoperative opioid consumption without delaying time to optimal pain control, compared with standard care.  Evidence Rating Level : 1 (Excellent) Hip fractures are common painful injuries among elderly patients. 50 to 70% of patients experience severe pain, while 40% may receive sub-optimal pain management. While opioids are frequently employed for initial pain management, the prevalence of adverse effects associated with opioid use underscores the necessity for exploring alternative approaches...

1. In patients with distal femoral periprosthetic fractures (DFPF), patients treated with dual plating (DP) were more likely to be weight-bearing in the twelve-week postoperative period, compared with those treated with distal femoral locking plates (DFLP). 2. Compared with the DFLP group, the DP patients were more likely return to their baseline ambulatory status. Evidence Rating Level : 3 (Average) With an aging population and increasing rates of knee arthroplasty, the incidence of DFPF is expected to grow...

1. In this retrospective cohort study, patients who underwent total hip arthroplasty (THA) who had global mental health (GMH) scores in the lowest quartile had worse outcomes, including being less likely to be discharged home, than those with GMH scores in the top quartile. 2. However, patients in the lowest GMH quartile had greater improvements in GMH and global physical health (GPH) scores following the surgery compared to those in the top quartile. Evidence Rating Level: 3 (Average) Factors such as obesity and diabetes are known to influence clinical outcomes following total joint arthroplasty...

1. In this retrospective cohort study, postoperative mortality was similar regardless of gender concordance between patients and surgeons.  Evidence Rating Level: 2 (Good) Surgical outcomes are influenced by many factors, including patient comorbidities, disease characteristics, and the quality of perioperative care. Researchers aimed to determine whether there is an association between patient and surgeon gender concordance and mortality within 30 days of surgery. Patient, surgeon, and hospital characteristics were adjusted for as confounding variables...

1. In this randomized controlled trial, the combination of vancomycin with cefazolin was not superior to surgical antimicrobial prophylaxis with cefazolin alone in patients undergoing arthroplasty.  2. Prophylaxis with vancomycin and cefazolin was associated with an increased risk of hypersensitivity reactions and decreased risk of acute kidney injury (AKI) compared to cefazolin alone. Evidence Rating Level: 1 (Excellent) Study Rundown: The prevalence of knee and hip arthroplasty continues to increase in the United States...

1. In this randomized controlled trial of patients with patellofemoral pain (PFP), home-based exercise resulted in less pain, better function, and higher knee muscle strength compared with no exercise.  Evidence Rating Level : 1 (Excellent) PFP, a common knee disorder characterized by diffuse retropatellar pain, affects many aspects of daily life in both athletic and nonathletic populations. Exercise therapy, especially hip and knee-targeted programs, is beneficial in managing PFP. Home-based programs have gained significance, particularly during the COVID-19 pandemic...

1. The augmentation of usual intraoperative care with support from the Anesthesiology Control Tower (ACT) did not have an impact on the avoidance of postoperative hypothermia or hyperglycemia compared to the control group. 2. While there was no significant difference in other secondary or clinical outcomes, appropriate intraoperative glucose measurement was more common among patients with diabetes in the intervention group. Evidence Rating Level: 1 (Excellent) Study Rundown: Telemedicine—defined by the World Health Organization as using communication technologies for diagnosis and treatment—has seen significant growth over the past decade...

1. Total knee arthroplasty was found to decrease the incidence of depression among patients to 85% at 6 months follow-up. 2. Higher pre-operative Beck’s Depression Scale scores corresponded to worse knee function scores post-operatively. Evidence Rating Level : 2 (Good) Knee surgical procedures in relation to osteoarthritis are increasingly common due to rising life expectancy, but they entail complications, leading to higher financial burdens, reduced recovery time, and lower quality of life. Depression, with an estimated prevalence of 29...

1. The fracture reduction quality, functional outcomes, and overall patient satisfaction were comparable between patients in the wide-awake local anesthesia with no tourniquet (WALANT) and balanced anesthesia (BA) groups Evidence Rating Level : 2 (Good) DRF is a common injury that can require surgical intervention. As elderly patients with comorbidities increasingly opt for surgery to achieve quicker recovery and preserved functionality after injury, more suitable anesthetic options are being explored. WALANT offers various benefits including, cost-effectiveness, improved patient satisfaction, and reduced risks associated with systemic anesthesia...

1. In this longitudinal cohort study, neighborhood walkability and greenness were associated with decreased fracture risk.  Evidence rating level: 2 (Good) Neighborhood walkability and greenness are associated with health benefits, namely by promoting greater levels of physical activity, reducing exposure to pollution, increasing social connections, and reducing psychological stress. This longitudinal study aimed to examine whether walkability and greenness are associated with fracture risk. 23,940 participants were recruited for this cohort study in Ningbo, China between June 2015 and January 2018...

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...