David E. Komatsu

Introduction: Osteoporosis is a debilitating bone disease that affects a large segment of the population. Currently, pharmacological treatment options for osteoporosis, including antiresorptive drugs and those that prevent bone loss, are limited. Multiple studies have shown that the endocannabinoid system and cannabis may play a significant role in bone remodeling. As both the use of cannabis and high-quality research on its effects continue to grow, novel medicinal uses of selected components, such as tetrahydrocannabinol (THC), are being investigated. The present study examined the potential effect of chronic THC inhalation during early adulthood on an ovariectomized rodent model of post-menopausal osteoporosis. Materials and Methods: Young (26-week-old) adult female rats received daily either THC or air inhalation for 8 weeks. The rats then underwent an ovariectomy (OVX) or sham surgery (Sx) when they were 34 weeks old. They were then euthanized 4 weeks post-OVX, and skeletal tissues were collected for analysis. Results: MicroCT analysis of femora showed that THC + OVX rats showed a significant decrease (45%) in trabecular bone volume compared to Air + Sham Sx rats. As expected, the Air + OVX rats also showed a 17% reduction in trabecular bone volume. Discussion: Overall, early adulthood THC exposure increased susceptibility to osteoporosis following ovariectomy-induced menopause. This suggests that THC exerts long-lasting effects on bone health, which may exacerbate post-menopausal bone loss.

Background: Osteoporosis, a debilitating bone disease characterized by low bone mineral density, poses a large burden on the population. Current pharmacological treatment options are limited, with antiresorptive drugs being the current first-line option. Recent research has shown that the endocannabinoid system, modulated by endocannabinoids and phytocannabinoids, may influence bone remodeling. As the prevalence of cannabis use and research into its medicinal potential continues to increase, its therapeutic potential has emerged. Objective: To investigate the role of Δ9-tetrahydrocannabinol (THC) inhalation in treating osteoporosis in a rodent model. Methods: Adult female Sprague–Dawley rats underwent ovariectomy (OVX) to induce osteoporosis. Four weeks post-OVX, rats received either THC or Air treatment via inhalation for 8 weeks. A control group of age-matched rats received sham surgery. Rats were then euthanized at 38 weeks old, and hindlimb samples were collected for caliper, microCT, and biomechanical analyses. Results: OVX Air-treated rats showed significantly decreased trabecular bone volume, trabecular bone volume fraction, trabecular separation, trabecular tissue mineral density, trabecular number, and connective density compared to sham surgery controls. Compared with Air controls, OVX rats treated with THC showed increased endosteal volume (20%; p < 0.05). THC-treated rats also showed decreased trabecular bone mineral density (2%; p < 0.005) and trabecular thickness (14%; p < 0.05). Conclusions: Chronic inhaled THC worsened key aspects of trabecular bone microarchitecture. Results do not support use of THC vapor as a therapeutic agent for osteoporosis and suggest THC may adversely affect bone quality in estrogen-deficient states. Further research is needed to evaluate dose-dependent effects and to distinguish the skeletal impacts of different cannabinoid components.

Background: Preoperative pain is routinely reported in the clinical literature and is benchmarked against numerous clinical parameters, necessitating that baseline preoperative pain is precisely defined and exhibits minimal variability. The goal of this study was to determine whether there is variability in pain scores obtained on the day of surgery (DOS) compared to preoperative clinic visits. Methods: We conducted a retrospective analysis of total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal fusion (SF). Self-reported 0-10 numeric rating scale (NRS) pain scores were compared between clinic visits and DOS in 1,567 patients. The primary intent was to determine if there were differences between clinical and DOS NRS scores. Secondary analyses were performed by stratifying the results by procedure, gender, and time of clinic visit. Additionally, we performed a qualitative literature review to assess how the timing of preoperative pain assessments is reported. Results: Our primary analysis found patients undergoing painful procedures reported significantly greater pain in the clinic compared to DOS, with a median difference of 3 and an interquartile range (IQR) of 6 (p < 0.0001). For our secondary analyses, similar differences between clinic and DOS were found for TKA (3; IQR 7; p < 0.0001), THA (3; IQR 7; p < 0.0001), and SF (2; IQR 5; p < 0.0001). Stratification by gender revealed comparable reductions (p = 0.6985). Finally, these discrepancies were consistent across preoperative clinic visits ranging from 1-90 days prior to surgery compared to DOS (p = 0.1944). Our qualitative literature review revealed that the timing of preoperative pain acquisition is rarely reported. Conclusions: Our results indicate that the degree of patient-reported pain differs drastically between clinic visits and DOS and identify a potential source of interstudy variability, highlighting the importance of defining the timing and setting of preoperative pain assessments.

Purpose Distal radius fractures (DRFs) are a common orthopaedic injury with a bimodal age and gender distribution, comprising male children after high-energy trauma and older women after low-energy falls. Complications like malunion, ligament ruptures, and nerve injuries can significantly impact recovery. This study aimed to address the gap in population-based data by analyzing the prevalence and risk factors for peripheral nerve injuries associated with DRFs. Methods The National Inpatient Sample database was used to analyze DRFs patients with associated ulnar, median, or radial nerve injuries. Patient demographics, comorbidities, and fracture characteristics were analyzed using chi-square tests and binary logistic regression to determine independent risk factors. Finally, independent sample t-tests assessed differences in average lengths of stay and total hospitalization charges between patients with and without ulnar, median, or radial nerve injuries. Results Between 2015 and 2020, 175,040 patients with DRFs were admitted to U.S. hospitals, with 0.24% experiencing ulnar nerve injury, 0.49% median nerve injury, and 0.08% radial nerve injury. Age, race, fracture morphology, and several comorbidities were identified as significant predictors of nerve injury. Open fractures notably increased the odds for all three nerve injuries. Protective factors included older age, intra-articular fractures, and comorbidities like diabetes and obesity. Peripheral nerve injuries were associated with longer hospital stays and increased total hospitalization costs. Conclusions Peripheral nerve injuries related to DRFs are rare but can significantly complicate treatment and recovery. This study investigated the prevalence of nerve injuries associated with DRFs and identified open fractures as the strongest predictor of ulnar, median, and radial nerve injuries at the wrist. Older age and intra-articular fractures were linked to a reduced risk of nerve involvement. These findings can help orthopaedic surgeons assess the risk of concurrent nerve injuries by considering key demographic and fracture morphology factors, allowing for more targeted evaluation and management. Level of evidence Level IV, Differential Diagnosis / Symptom Prevalence Study.

Purpose This study aimed to explore potential complications and risk factors associated with arthroscopic rotator cuff repair (aRCR) in patients with congestive heart failure (CHF). Methods This study examined all individuals who underwent aRCR from 2015 to 2021, sourced from the American College of Surgeons National Surgical Quality Improvement database. The analysis encompassed patient demographics, comorbidities, and 30-day postoperative complications. Logistic regression was employed to analyze the postoperative complications linked to patients with CHF. Results Compared to patients without CHF, patients with CHF undergoing aRCR were independently associated with a significantly greater likelihood of experiencing any complication (OR 3.21, 95% CI 1.89–5.48; P < .001), sepsis (OR 13.04, 95% CI 2.45–69.31; P = .003), cardiac event (OR 7.76, 95% CI 1.59–37.97; P = .011), readmission (OR 3.61, 95% CI 1.78–7.35; P < .001), and nonhome discharge (OR 5.43, 95% CI 2.27–13.02; P < .001). Conclusion CHF was identified as an independent risk factor for experiencing any complication, sepsis, cardiac event, readmission, and nonhome discharge in patients undergoing aRCR. The increased risk of postoperative complications in CHF patients after aRCR highlights the need for diligent preoperative management of these patients to reduce the risk of severe complications and enhance surgical outcomes. Level of evidence Level III; Retrospective Cohort Comparison Using Large Database; Prognosis Study.

Purpose Diabetes mellitus (DM) is a well-established risk factor for postoperative complications. Distal radius fractures (DRFs) are a common orthopedic injury and often require open reduction and internal fixation (ORIF). The rise of ORIF utilization warrants investigation into factors that may expose patients to postoperative complications following DRF ORIF. Methods We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for cases of DRF ORIF between 2015 and 2021. Cases were stratified into cohorts based on diabetes mellitus (DM) status. The DM cohort was further stratified into non-insulin-dependent DM (NIDDM) and insulin-dependent DM (IDDM) groups. Bivariate logistic regression was performed to compare patient demographics, comorbidities, and 30-day postoperative complications. Multivariate logistic regressions were performed to identify associations between diabetes mellitus status and postoperative complications. Results A total of 27,761 cases of DRF ORIF were identified from 2015 to 2021. After exclusion criteria were applied, 25,971 cases remained, of which 2169 (8.4%) cases had DM and 23,802 (91.6%) cases were free of DM. Within the DM cohort, there were 1392 cases in the NIDDM subgroup and 777 cases in the IDDM subgroup. Relative to the cohort without diabetes, the IDDM cohort was independently associated with sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off mechanical ventilation, readmission, and nonhome discharge. Conclusion Having IDDM was independently associated with higher rates of postoperative sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off ventilation, readmission, and nonhome discharge when compared to the cohort without diabetes following DRF ORIF. Level of evidence Level III; Retrospective cohort comparison; Prognosis study.