Diagnosis and Management of Periprosthetic Joint Infections After Total Ankle Arthroplasty.

Periprosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a dreaded complication that may lead to catastrophic outcomes. Risk factors include a history of surgery on the operated ankle, low preoperative function scores, diabetes, extended surgical time, and postoperative wound-healing problems. Clinical presentation varies and may include increasing ankle pain and swelling, high temperature, local erythema, wound drainage, and dehiscence.

The Course of Tarsal Tunnel Syndrome after Ultrasound-Guided Injections.

Background: Local ultrasound (US)-guided injections of anesthetics with corticosteroids are commonly performed for the conservative treatment of tarsal tunnel syndrome (TTS).

Objective: This retrospective study aimed to investigate the outcomes of TTS after US-guided injections.

Methods: The study included patients who were diagnosed with TTS and received US-guided injections as part of their initial treatment.

Bisphosphonates and parathyroid hormone analogs for improving bone quality in spinal fusion: State of evidence.

Spinal fusion is among the most commonly performed surgical procedures for elderly patients with spinal disorders - including degenerative disc disease with spondylolisthesis, deformities, and trauma. With the large increase in the aging population and the prevalence of osteoporosis, the number of elderly osteoporotic patients needing spinal fusion has risen dramatically. Due to reduced bone quality, postoperative complications such as implant failures, fractures, post-junctional kyphosis, and pseudarthrosis are more commonly seen after spinal fusion in osteoporotic patients.

Current Strategies in Prevention of Postoperative Infections in Spine Surgery.

Study Design: Narrative review.

Objectives: Postoperative surgical site infections (SSIs) are among the most common acute complications in spine surgery and have a devastating impact on outcomes. They can lead to increased morbidity and mortality as well as greater economic burden.

Fate of Hardware in Spinal Infections.

Removal of hardware with irrigation and debridement in patients with surgical site infections (SSIs) is performed commonly. However, the removal of hardware from patients with SSIs after spinal procedures is controversial. Moreover, primary spinal infections such as spondylodiscitis may require instrumentation along with surgical debridement.

Advancing Simulation-Based Orthopaedic Surgical Skills Training: An Analysis of the Challenges to Implementation.

Simulation-based surgical skills training is recognized as a valuable method to improve trainees' performance and broadly perceived as essential for the establishment of a comprehensive curriculum in surgical education. However, there needs to be improvement in several areas for meaningful integration of simulation into surgical education. The purpose of this focused review is to summarize the obstacles to a comprehensive integration of simulation-based surgical skills training into surgical education and board certification and suggest potential solutions for those obstacles.

Prognostic Factors for Adjacent Segment Disease After L4-L5 Lumbar Fusion.

Background: Adjacent segment disease (ASD) is an important consideration during decision making for lumbar spinal fusion.

Objective: To identify risk factors for development of ASD after L4-L5 fusion and differences in incidence between rostral and caudal ASD.

Methods: We retrospectively reviewed all consecutive patients at a single institution who underwent first-time spinal fusion at the L4-L5 level for degenerative spinal disease over a 10-yr period, using posterolateral pedicular screw fixation with or without posterior interbody fusion.

Traumatic Lumbosacral Dislocation: Current Concepts in Diagnosis and Management.

Traumatic lumbosacral dislocation is a rare, high-energy mechanism injury characterized by displacement of the fifth lumbar vertebra in relation to the sacrum. Due to the violent trauma typically associated with this lesion, there are often severe, coexisting injuries. High-quality radiographic studies, in addition to appropriate utilization of CT scan and MRI, are essential for proper evaluation and diagnosis.

The Significance of Upper Extremity Neuromonitoring Changes During Thoracolumbar Spine Surgery.

Study Design: This is a retrospective matched-pair cohort study.

Objective: To investigate the significance of upper extremity (UE) neuromonitoring changes in patients undergoing thoracolumbar surgery in prone position.

Summary Of Background Data: Peripheral nerve injuries in the UEs due to the prone positioning during prolonged thoracolumbar spinal procedures can cause diminished postsurgical outcomes.

The effect of deep shoulder infections on patient outcomes after arthroscopic rotator cuff repair: a retrospective comparative study.

Introduction: The purpose of this study was to evaluate the effects of deep shoulder infections after RCR on patient outcomes.

Methods: A retrospective chart review was conducted involving all patients with deep shoulder infections after arthroscopic RCR (study group). Another group of patients who were matched with the study group by age, gender and rotator cuff tear size, and did not develop deep shoulder infections after arthroscopic RCR were randomly identified (control group).

Pathology and Treatment of Traumatic Cervical Spine Syndrome: Whiplash Injury.

Traumatic cervical syndrome comprises the various symptoms that occur as a result of external force such as that of a traffic accident. In 1995, the Quebec Task Force on whiplash-associated disorders (WAD) formulated the Quebec classification, with accompanying clinical practice guidelines. These guidelines were in accordance with the stated clinical isolated or combined symptoms of the syndrome: neck pain, headaches, dizziness, numbness of head or face, eye pain, vision loss, double vision, tinnitus, hearing loss, nausea, and numbness and/or weakness of extremities.

Posttraumatic Spinal Cord Injury without Radiographic Abnormality.

"Spinal Cord Injury without Radiographic Abnormality" (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too.

Measuring Surgical Skills in Simulation-based Training.

Simulation-based surgical skills training addresses several concerns associated with the traditional apprenticeship model, including patient safety, efficient acquisition of complex skills, and cost. The surgical specialties already recognize the advantages of surgical training using simulation, and simulation-based methods are appearing in surgical education and assessment for board certification. The necessity of simulation-based methods in surgical education along with valid, objective, standardized techniques for measuring learned skills using simulators has become apparent.

Postoperative deep shoulder infections following rotator cuff repair.

Rotator cuff repair (RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.

Orthopaedic education in the era of surgical simulation: Still at the crawling stage.

Surgical skills education is in the process of a crucial transformation from a master-apprenticeship model to simulation-based training. Orthopaedic surgery is one of the surgical specialties where simulation-based skills training needs to be integrated into the curriculum efficiently and urgently. The reason for this strong and pressing need is that orthopaedic surgery covers broad human anatomy and pathologies and requires learning enormously diverse surgical procedures including basic and advanced skills.

The Use of Endothelial Progenitor Cells for the Regeneration of Musculoskeletal and Neural Tissues.

Endothelial progenitor cells (EPCs) derived from bone marrow and blood can differentiate into endothelial cells and promote neovascularization. In addition, EPCs are a promising cell source for the repair of various types of vascularized tissues and have been used in animal experiments and clinical trials for tissue repair. In this review, we focused on the kinetics of endogenous EPCs during tissue repair and the application of EPCs or stem cell populations containing EPCs for tissue regeneration in musculoskeletal and neural tissues including the bone, skeletal muscle, ligaments, spinal cord, and peripheral nerves.

Retention of Skills After Simulation-based Training in Orthopaedic Surgery.

Simulation-based surgical skills training has become essential in orthopaedic practice because of concerns about patient safety and an increase in technically challenging procedures. Surgical skills training in specifically designed simulation laboratories allows practice of procedures in a risk-free environment before they are performed in the operating room. The transferability of acquired skills to performance with patients is the most effective measure of the predictive validity of simulation-based training.

Preoperative Planning in Orthopaedic Surgery. Current Practice and Evolving Applications.

Preoperative planning is an essential prerequisite for the success of orthopaedic procedures. Traditionally, the exercise has involved the written down, step by step "blueprint" of the surgical procedure. Preoperative planning of the technical aspects of the orthopaedic procedure has been performed on hardcopy radiographs using various methods such as copying the radiographic image on tracing papers to practice the planned interventions.

Stem cells in degenerative orthopaedic pathologies: effects of aging on therapeutic potential.

Purpose: The purpose of this study was to summarize the current evidence on the use of stem cells in the elderly population with degenerative orthopaedic pathologies and to highlight the pathophysiologic mechanisms behind today's therapeutic challenges in stem cell-based regeneration of destructed tissues in the elderly patients with osteoarthritis (OA), degenerative disc disease (DDD), and tendinopathies.

Methods: Clinical and basic science studies that report the use of stem cells in the elderly patients with OA, DDD, and tendinopathies were identified using a PubMed search. The studies published in English have been assessed, and the best and most recent evidence was included in the current study.

Multilayer scaffolds in orthopaedic tissue engineering.

Purpose: The purpose of this study was to summarize the recent developments in the field of tissue engineering as they relate to multilayer scaffold designs in musculoskeletal regeneration.

Methods: Clinical and basic research studies that highlight the current knowledge and potential future applications of the multilayer scaffolds in orthopaedic tissue engineering were evaluated and the best evidence collected. Studies were divided into three main categories based on tissue types and interfaces for which multilayer scaffolds were used to regenerate: bone, osteochondral junction and tendon-to-bone interfaces.

Augmentation of tendon-to-bone healing.

Tendon-to-bone healing is vital to the ultimate success of the various surgical procedures performed to repair injured tendons. Achieving tendon-to-bone healing that is functionally and biologically similar to native anatomy can be challenging because of the limited regeneration capacity of the tendon-bone interface. Orthopaedic basic-science research strategies aiming to augment tendon-to-bone healing include the use of osteoinductive growth factors, platelet-rich plasma, gene therapy, enveloping the grafts with periosteum, osteoconductive materials, cell-based therapies, biodegradable scaffolds, and biomimetic patches.

Arthroscopy-assisted reduction versus open reduction in the fixation of medial malleolar fractures.

Purpose: Purpose of this case-control study was to evaluate the feasibility and advantages of arthroscopically assisted reduction and internal fixation of isolated medial malleolar fractures and compare the outcomes with conventional open reduction and internal fixation.

Methods: Forty-seven patients with medial malleolar fractures were grouped into two: arthroscopy-assisted group, and conventional open reduction and internal fixation group. Arthroscopic treatment group consisted of 21 patients.