Orthopedics (all articles)
Geriatric odontoid fractures: treatment algorithms based on expert consensus and a systematic review
25 Apr, 2023 | 14:08h | UTC
RCT | Stereotactic radiosurgery vs. conventional radiotherapy for localized vertebral metastases of the spine
24 Apr, 2023 | 13:37h | UTCStereotactic Radiosurgery vs Conventional Radiotherapy for Localized Vertebral Metastases of the Spine: Phase 3 Results of NRG Oncology/RTOG 0631 Randomized Clinical Trial – JAMA Oncology (link to abstract – $ for full-text)
Audio interview: Radiosurgery of Spine Metastasis—NRG/RTOG 0631 RCT Final Results – JAMA
Commentary on Twitter
Phase 3 rand trial of spinal radiosurgery vs. conventional external beam radiation therapy for pts w/spinal metastases showed radiosurgery did not significantly improve pain response at 3mo but showed feasibility that makes it widely used today. https://t.co/LvZY1nbUpS #RadOnc
— JAMA Oncology (@JAMAOnc) April 20, 2023
Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review
12 Apr, 2023 | 13:17h | UTC
Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews
11 Apr, 2023 | 14:39h | UTCRelated:
SR | Nonopioid pharmacological management of acute low back pain
M-A | Limited evidence for analgesic effectiveness in acute low back pain treatment
M-A: Effectiveness of treatments for acute and subacute mechanical non-specific low back pain
Guideline Interventions for the management of acute and chronic low back pain.
M-A: Little benefit from muscle relaxants for adults with non-specific low back pain.
RCT | Effectiveness of nail bed repair in children with vs. without replacing the fingernail
4 Apr, 2023 | 13:33h | UTCNews Release: New approach to nail bed injury surgery could significantly cut NHS costs – University of Oxford
SR | Nonopioid pharmacological management of acute low back pain
31 Mar, 2023 | 13:27h | UTC
RCT | Drain usage may increase the length of hospital stay following lumbar arthrodesis
31 Mar, 2023 | 13:18h | UTCCommentary: Wound drains increase hospital los after lumbar surgery? – Orthopedics This Week
SR | Extracutaneous features and complications of the Ehlers-Danlos syndromes
30 Mar, 2023 | 13:41h | UTC
M-A | Limited evidence for analgesic effectiveness in acute low back pain treatment
29 Mar, 2023 | 13:32h | UTCSummary: The objective of this systematic review and network meta-analysis was to assess the effectiveness and safety of various analgesic medicines for treating acute non-specific low back pain. After examining 98 randomized controlled trials with over 15,000 participants, the study found that the quality of evidence for the effectiveness and safety of these medications is low or very low.
Some analgesic medicines showed potential in reducing pain intensity, but the evidence was limited due to trial risk of bias and imprecision in effect estimates. Furthermore, certain medications might increase the risk of adverse events during treatment, with evidence ranging from moderate to very low confidence.
Given the lack of high-quality evidence, clinicians and patients are advised to be cautious when using analgesic medicines for acute non-specific low back pain. More robust head-to-head comparison trials are needed to provide clearer guidance on the best course of treatment.
News Release: Study finds “considerable uncertainty” around effectiveness and safety of analgesics for low back pain – BMJ Newsroom
Commentary from the author on Twitter (thread – click for more)
Out today in @bmj_latest.
We found “considerable uncertainty” around the effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain.
Available at https://t.co/PeOmEOeJyJ
Thread 🧵 pic.twitter.com/T8YDNGhhME
— Michael Wewege, PhD (@mawewege) March 22, 2023
SR | Local corticosteroid injection versus placebo for carpal tunnel syndrome
29 Mar, 2023 | 13:00h | UTCLocal corticosteroid injection versus placebo for carpal tunnel syndrome – Cochrane Library
Summary: Local steroid injection for carpal tunnel syndrome – Cochrane Library
Commentary on Twitter
https://twitter.com/CochraneUK/status/1621853332003344385
Plasma D-Dimer may be useful in the diagnosis of periprosthetic joint infection
29 Mar, 2023 | 12:33h | UTCPlasma D-Dimer Is Noninferior to Serum C-Reactive Protein in the Diagnosis of Periprosthetic Joint Infection – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)
News Release: D-dimer blood test shows value in detecting prosthetic joint infections – Wolters Kluwer
Study reveals high rates of nonadherence to antimicrobial prophylaxis guidelines, often due to unnecessary vancomycin use
23 Mar, 2023 | 13:13h | UTCSummary: The study evaluated adherence to surgical antimicrobial prophylaxis guidelines in 825 US hospitals for elective surgeries from 2019-2020. The study found that 41% of surgical prophylaxis regimens were nonadherent to the American Society of Health-System Pharmacists guidelines.
Unnecessary vancomycin use was the most common reason for nonadherence to surgical antimicrobial prophylaxis guidelines, accounting for 77% of nonadherent regimens and occurring in 31% of all surgeries. It’s noteworthy that when vancomycin was used, it was often unnecessarily combined with cefazolin, and patients who received this combination had a 19% higher risk of acute kidney injury compared to those who received cefazolin alone.
The authors suggest that quality-improvement efforts aimed at reducing unnecessary vancomycin use and potential guideline revisions may offer impactful strategies for improving the risk-benefit profile of antimicrobial prophylaxis.
RCT | Short-term indwelling foley catheters do not reduce the risk of postoperative urinary retention in THA and TKA
22 Mar, 2023 | 13:14h | UTCShort-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA: A Randomized Controlled Trial – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)
RCT | Intermittent IV ibuprofen reduces morphine consumption and provides pain relief after surgery
20 Mar, 2023 | 13:39h | UTCSummary: The article describes a randomized, placebo-controlled, double-blind clinical trial to evaluate the efficacy and safety of different doses of intravenous ibuprofen (IVIB) in treating acute postoperative pain. The trial involved patients who underwent abdominal or orthopedic surgery and were randomized to placebo, IVIB 400 mg, or IVIB 800 mg. The first dose was given intravenously 30 minutes before surgery ended, followed by IV administration every 6 hours for a total of 8 doses.
The study found that IV administration of ibuprofen 400 mg or 800 mg significantly reduced morphine consumption and relieved pain without increasing the incidence of adverse events.
The study’s strengths were its multicenter, randomized, controlled, and prospective design. However, the extensive list of exclusion criteria suggests that the study was made in a relatively healthy population, making it difficult to extrapolate the safety results for more fragile patients.
M-A | Artificial intelligence for hip fracture detection and outcome prediction
20 Mar, 2023 | 13:13h | UTC
Consensus Paper | The management of developmental dysplasia of the hip in children aged under three months
17 Mar, 2023 | 13:07h | UTCRelated Guideline: Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants Up to Six Months of Age – American Academy of Orthopaedic Surgeons
Review | Evidence-based informed consent form for total knee arthroplasty
17 Mar, 2023 | 12:58h | UTC
SR | Splinting for carpal tunnel syndrome
17 Mar, 2023 | 12:57h | UTCSplinting for carpal tunnel syndrome – Cochrane Library
Summary: Splinting for carpal tunnel syndrome – Cochrane Library
Global validation of the AO Spine Upper Cervical Injury Classification
16 Mar, 2023 | 12:58h | UTCGlobal Validation of the AO Spine Upper Cervical Injury Classification – Spine
RCT | Intra-articular 10 mg triamcinolone acetonide non-inferior to 40 mg for knee osteoarthritis pain relief
16 Mar, 2023 | 12:55h | UTC
Review | MRI image features with an evident relation to low back pain
15 Mar, 2023 | 15:01h | UTC
RCT | The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures
10 Mar, 2023 | 14:24h | UTC
Consensus Recommendations | Spinal tumors
9 Mar, 2023 | 14:15h | UTC
SR | Spinal cord stimulation for low back pain provides no sustained clinical benefits compared to placebo
9 Mar, 2023 | 14:12h | UTCSummary: Spinal cord stimulation (SCS) is a surgical procedure used to treat persistent low back pain by sending electrical signals via implanted electrodes into the spinal cord. The review included 13 studies (randomized controlled trials and cross‐over trials) with 699 participants.
Most of the studies were focused on short-term effects (less than one month), but the review found it is uncertain whether spinal cord stimulation can improve outcomes in the immediate term compared with placebo. At six months, SCS probably does not improve back or leg pain, function, or quality of life compared with placebo, with moderate certainty of evidence. Adverse events were also reported, including infections, neurological damage, and lead migration requiring repeated surgery.
The review concluded that the data does not support the use of SCS to manage low back pain outside a clinical trial. Current evidence suggests SCS probably does not have sustained clinical benefits that would outweigh the costs and risks of this surgical intervention.
Article: Spinal cord stimulation for low back pain – Cochrane Library
Summary: Spinal cord stimulation for low back pain – Cochrane Library
Commentary from the author on Twitter
Our Cochrane review on spinal cord stimulators for #backpain out today.
Bottom line:
-Mod certainty evidence of no benefit vs placebo in medium term
-Uncertain if benefit on pain in immediate term
-Adverse events (infection, re-operation) commonhttps://t.co/lNJQeN96Zs— Adrian Traeger (@adrian_traeger) March 7, 2023
E-Scooter users more likely to suffer serious trauma compared to bicycle users: a nationwide study in England and Wales
8 Mar, 2023 | 14:13h | UTCSummary:
The study aimed to determine the incidence, demographics, and injury patterns involved in E-Scooter-related hospital admissions due to significant trauma compared with bicycle-related trauma within England and Wales. The retrospective cohort study was based on data submitted to the UK Trauma Audit and Research Network (TARN) registry between 1 January 2021 to 31 December 2021.
The study found that E-Scooter users were more likely to be admitted to a major trauma center or a critical care unit than bicycle users. Serious head and limb trauma occurred more frequently among E-Scooter users, while serious chest and pelvic trauma were greater among bicycle users. Over one-third of E-Scooter injuries were incurred outside the current legislation by patients who were intoxicated by alcohol and drugs or under the age of 17.
The study suggests a greater relative incidence of serious trauma and an alternative pattern of injury among E-Scooter users compared with bicycle users. The study concludes that further legislation and tighter regulation of E-Scooter rental are required to reduce the already significant burden of injury associated with this mode of transport.
Article: Major trauma among E-Scooter and bicycle users: a nationwide cohort study – Injury Prevention
News Release: Crashing an e-scooter likely to lead to more serious injuries than crashing a bike – British Medical Journal
Commentary: E-scooter riders more likely than cyclists to sustain serious injuries – BBC