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Current Reviews in Musculoskeletal Medicine

Emily A Wagstrom, Jessica M Downes
PURPOSE OF REVIEW: To review literature published in the last 3 years related to minimally invasive approaches to calcaneal fracture fixation. RECENT FINDINGS: Numerous randomized control trials, cohort studies, and meta-analyses have been done in the last 3 years comparing surgical treatment of calcaneus fractures. These studies indicate minimally invasive procedures decrease wound complication rates and achieve similar radiographic and clinical outcomes to open reduction internal fixation...
July 11, 2018: Current Reviews in Musculoskeletal Medicine
Ahmad Badri, Guillem Gonzalez-Lomas, Laith Jazrawi
PURPOSE OF REVIEW: Accurate isolated PCL diagnosis continues to present a challenge. This article reviews the current literature regarding clinical and radiographic evaluation of PCL injuries. RECENT FINDINGS: A thorough history to understand the mechanism of injury should begin any evaluation. Several clinical tests have been shown to effectively assess PCL laxity, with the posterior drawer test possessing the highest sensitivity and specificity. Any thorough exam should compare the contralateral, uninjured leg...
July 10, 2018: Current Reviews in Musculoskeletal Medicine
Benjamin F Ricciardi, Gowrishankar Muthukrishnan, Elysia Masters, Mark Ninomiya, Charles C Lee, Edward M Schwarz
PURPOSE OF REVIEW: The incidence of complications from prosthetic joint infection (PJI) is increasing, and treatment failure remains high. We review the current literature with a focus on Staphylococcus aureus pathogenesis and biofilm, as well as treatment challenges, and novel therapeutic strategies. RECENT FINDINGS: S. aureus biofilm creates a favorable environment that increases antibiotic resistance, impairs host immunity, and increases tolerance to nutritional deprivation...
July 9, 2018: Current Reviews in Musculoskeletal Medicine
Z Deniz Olgun, Stephanie Maestre
PURPOSE OF REVIEW: Summarize classic and recent information regarding the unique subset of ankle fractures in children with open growth plates and share the authors' decision-making and surgical techniques. RECENT FINDINGS: Recent research on pediatric ankle fractures has centered on the accurate prediction and prevention of growth arrest following fractures of the distal tibia. Another source of discussion is the necessity and benefit of CT scanning in classification and treatment approach...
July 9, 2018: Current Reviews in Musculoskeletal Medicine
Fiachra E Rowan, Matthew J Donaldson, Jurek R Pietrzak, Fares S Haddad
PURPOSE OF REVIEW: In an era of increasing numbers of hip and knee replacements, strategies to manage prosthetic joint infection (PJI) that are effective at infection control with good patient-reported outcomes and cost containment for health systems are needed. Interest in single-stage exchange for PJI is rising and we assess evidence from the last 5 years related to this treatment strategy. RECENT FINDINGS: Only five series for total knee replacement and ten series for total hip replacement have been reported in the last five years...
July 9, 2018: Current Reviews in Musculoskeletal Medicine
Jeffrey M Manway, Cody D Blazek, Patrick R Burns
PURPOSE OF REVIEW: Ankle fractures and diabetes mellitus are both increasing in prevalence. Patients with both diabetes and an ankle fracture have been shown to have an increased rate of complications which can be catastrophic. The purposes of this review are to identify factors placing patients at an increased risk and offer guidance on the management of these injuries, in order to reduce potential complications. RECENT FINDINGS: Non-operative management of unstable ankle fractures in patients with diabetes results in an unacceptably high rate of complications...
July 5, 2018: Current Reviews in Musculoskeletal Medicine
Colin Whitaker, Blake Turvey, Emmanuel M Illical
PURPOSE OF THE REVIEW: Talar neck fractures are a rare but potentially devastating injury, which require a comprehensive understanding of the unique osteology, vasculature, and surrounding anatomy to recognize pathology and treat correctly. The purpose of this article is to describe both classic and current literature to better understand the evolution of talar neck fracture management. RECENT FINDINGS: Urgent reduction of displaced fractures and dislocations remains the standard of care to protect the soft tissue envelope and neurovascular structures...
July 4, 2018: Current Reviews in Musculoskeletal Medicine
Scott R Nodzo, Nicholas B Frisch
PURPOSE OF REVIEW: Organism identification and antibiotic selection remain a critical component of periprosthetic joint infection (PJI) treatment. Prior to organism identification and/or the availability of antibiotic sensitivities, empiric antibiotics are routinely started. A basic understanding of a region or institutions antibiogram is paramount for selection of an empiric treatment regimen. Evolving antibiogram results and regional antibiotic resistance are important to follow as this may change antibiotic selection in some patient populations...
July 3, 2018: Current Reviews in Musculoskeletal Medicine
K Keely Boyle, Stuart Wood, T David Tarity
PURPOSE OF REVIEW: The purpose of this manuscript is to provide a critical review of peer-reviewed literature over the last 5 years related to low virulent organisms associated with periprosthetic joint infection (PJI). We evaluated the most common organisms, the diagnostic challenges, and the novel tools available in the perioperative workup of PJI as well as the current understanding of how biofilm potentiates the indolent clinical presentation and explore a possible shift in the surgical management of these patients...
June 30, 2018: Current Reviews in Musculoskeletal Medicine
Linda I Suleiman, Daniel R Mesko, Denis Nam
PURPOSE OF REVIEW: Innovative measures have recently been proposed to prevent periprosthetic joint infection following total hip and knee arthroplasty. We sought to review these recent innovations to determine the reported reduction in periprosthetic joint infection. RECENT FINDINGS: The most recent literature demonstrates promising results in regard to hydrofiber dressings as an independent risk factor for primary prosthetic joint infection reduction, which in turn is also linked with cost savings...
June 23, 2018: Current Reviews in Musculoskeletal Medicine
Lorenzo Fagotti, Jakub Tatka, Mauro Jose Costa Salles, Marcelo C Queiroz
PURPOSE OF REVIEW: Although a two-stage exchange revision is reported to have a high success rate, this strategy may fail as a treatment for prosthetic joint infection (PJI). When it does, resection arthroplasty, arthrodesis, amputation, and chronic antibiotic suppression may play a role. The purpose of this review is to determine which are the main risk factors for a two-stage exchange failure and to analyze the indications and results of resection arthroplasty, arthrodesis, amputation, and antibiotic chronic suppression for PJI...
June 22, 2018: Current Reviews in Musculoskeletal Medicine
Mariam Taha, Hesham Abdelbary, F Patrick Ross, Alberto V Carli
PURPOSE OF REVIEW: Periprosthetic joint infection (PJI) is a devastating complication after total joint replacement. A main source for antibiotic tolerance and treatment failure is bacterial production of biofilm-a resilient barrier against antibiotics, immune system, and mechanical debridement. The purpose of this review is to explore some novel approaches to treat PJI and biofilm-related infections. RECENT FINDINGS: Innovative treatment strategies of bacterial and biofilm infections revolve around (a) augmenting current therapies, such as improving the delivery and efficiency of conventional antibiotics and enhancing the efficacy of antiseptics and (b) administrating completely new therapeutic modalities, such as using immunotherapy, nanoparticles, lytic bacteriophages, photodynamic therapy, novel antibiotics, and antimicrobial peptides...
June 20, 2018: Current Reviews in Musculoskeletal Medicine
Pierce Johnson, Sean M Mitchell, Simon Görtz
PURPOSE OF REVIEW: To highlight current and established concepts regarding PCL injury and reconstruction. RECENT FINDINGS: Recent biomechanical and clinical studies have brought attention to improved surgical techniques and clinical outcomes of PCL reconstruction. In contrast to anterior cruciate ligament (ACL) injuries, isolated posterior cruciate ligament (PCL) injuries occur much less frequently and have traditionally been treated non-operatively. Even when a PCL injury meets operative indications, outcomes of PCL reconstruction historically do not match the success rates of ACL reconstruction procedures...
June 16, 2018: Current Reviews in Musculoskeletal Medicine
K Keely Boyle, Sridhar Rachala, Scott R Nodzo
PURPOSE OF REVIEW: The associated patient morbidity and resource-intensive nature of managing surgical site infections (SSI) has focused attention toward not only improving treatment protocols but also enhancing preventative measures. The purpose of this review was to summarize the relevant updated CDC guidelines for the prevention of SSI that were released in 2017. The CDC recommends the integration of the guidelines for improvement in quality metrics, reportable outcomes, and patient safety...
June 16, 2018: Current Reviews in Musculoskeletal Medicine
Ryan S Charette, Christopher M Melnic
PURPOSE OF REVIEW: To review the diagnosis and treatment of prosthetic joint infection (PJI) with a focus on two-stage revision arthroplasty. The text will discuss different spacer constructs in total knee and total hip arthroplasty and will present clinical outcome data for these various options. RECENT FINDINGS: There is no appreciable difference in infection eradication between mobile and static antibiotic spacers. Mobile spacers have shown improved knee range of motion after second-stage re-implantation...
June 9, 2018: Current Reviews in Musculoskeletal Medicine
Douglas A Zaruta, Bowen Qiu, Andrew Y Liu, Benjamin F Ricciardi
PURPOSE OF REVIEW: Prosthetic joint infection is one the most common causes of revision surgery after hip or knee replacement. Debridement and implant retention (DAIR) is one method of treating these infections; however, significant controversy exists. The purpose of our review was to describe current knowledge about indications, intraoperative/postoperative patient management, and outcomes of DAIR. RECENT FINDINGS: Patient selection affects the success of DAIR...
June 5, 2018: Current Reviews in Musculoskeletal Medicine
Anna Katsman, Eric J Strauss, Kirk A Campbell, Michael J Alaia
PURPOSE OF REVIEW: The purposes of this review are to (1) discuss the epidemiology and workup of the rare posterior cruciate ligament (PCL) avulsion fracture, (2) review the indications for nonoperative and operative management of patients with PCL avulsion fractures, (3) examine surgical outcomes in this patient population, and (4) discuss the authors' preferred management algorithm and surgical approach. RECENT FINDINGS: In accordance with the rarity of these injuries, the literature is sparse regarding surgical outcomes...
June 4, 2018: Current Reviews in Musculoskeletal Medicine
Vignesh K Alamanda, Bryan D Springer
PURPOSE OF REVIEW: Periprosthetic joint infection (PJI) remains a complication that is associated with high morbidity as well as high healthcare expenses. The purpose of this review is to examine patient and perioperative modifiable risk factors that can be altered to help improve rates of PJI. RECENT FINDINGS: Evidence-based review of literature shows that improved control of post-operative glycemia, appropriate management of obesity, malnutrition, metabolic syndrome, preoperative anemia, and smoking cessation can help minimize risk of PJI...
June 4, 2018: Current Reviews in Musculoskeletal Medicine
Stephanie L Logterman, Frank B Wydra, Rachel M Frank
PURPOSE OF REVIEW: The purpose of this review is to present an in-depth look at the most recent literature regarding pertinent posterior cruciate ligament (PCL) anatomy and biomechanics. RECENT FINDINGS: The PCL is an important restraint of posterior tibial translation relative to the femur. In addition, the PCL acts as a secondary restraint to resist varus, valgus, and external rotation moments about the knee. While less common than ACL injuries, injuries to the PCL can occur from a posterior force directed on the tibia, most common with the knee in a flexed position...
May 31, 2018: Current Reviews in Musculoskeletal Medicine
Marvin K Smith, Brian C Werner, David R Diduch
PURPOSE OF REVIEW: To discuss the potentially significant complications associated with medial patellofemoral ligament (MPFL) reconstruction. Additionally, to review the most current and relevant literature with an emphasis on avoiding these potential complications. RECENT FINDINGS: Multiple cadaveric studies have characterized the anatomy of the MPFL and the related morphologic abnormalities that contribute to recurrent lateral patellar instability. Such abnormalities include patella alta, excessive tibial tubercle to trochlear grove (TT-TG) distance, trochlear dysplasia, and malalignment...
May 12, 2018: Current Reviews in Musculoskeletal Medicine
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