Joint Dislocation

Researchers are studying the outcomes of two surgical methods for treating perilunate dislocations, a serious wrist injury. This research aims to compare the clinical and X-ray results between a new internal brace technique using a 4-anchor construct and the traditional Kirschner wire K-wire method. The study also seeks to identify the types and rates of complications associated with each technique, such as pain, numbness, weakness, and range of motion loss. Participants in this observational study have already undergone surgery for perilunate dislocations using either the standard K-wire fixation or the new internal bracing method. Researchers will follow these patients from enrollment through two years after their surgery, monitoring recovery and complications. The study does not involve additional treatments but focuses on collecting data about the surgical outcomes of the two fixation techniques. During the study, participants will undergo clinical functional assessments and complete the Quick DASH questionnaire to measure arm disability. Researchers will track specific complications and their frequency over the two-year follow-up period. The study is led by Bryan D Brown, MD, and aims to improve understanding of surgical options for perilunate dislocation recovery and long-term wrist function.

Musculoskeletal disorders and injuries cause significant disability worldwide, affecting people of all ages and leading to pain, limited mobility, and reduced quality of life. This ongoing open-label, single-arm phase IIIa study is evaluating the safety of a human allogeneic bone marrow-derived mesenchymal stromal cell product called StromaForte in patients with musculoskeletal injuries andor degeneration. The study aims to assess safety and changes in pain over one year after treatment with these stem cells. Participants receive 50 million StromaForte cells locally injected under ultrasound guidance at the injury or degeneration site, combined with or without 100 million cells given intravenously over about 30 minutes. If local injection is not possible, only the systemic intravenous treatment is given. Additional doses may be administered with specified minimum intervals between local and systemic doses. Four subgroups based on connective tissue injury or degeneration type are included. During the study, patients are monitored for adverse events up to one year after treatment. Researchers assess pain levels in each injured or degenerated area, quality of life measures using questionnaires, and changes in pain between treatment subgroups. Follow-up can be face-to-face or remote. This comprehensive evaluation will provide data on safety and patient-reported outcomes following StromaForte administration for musculoskeletal conditions.

Atlantoaxial dislocation is a condition involving instability or dislocation of the atlantoaxial joint in the spine. This research aims to update and improve the diagnosis and treatment strategies for atlantoaxial dislocation by collecting data from multiple medical centers. The study includes both retrospective and prospective parts to build a detailed clinical cohort and provide long-term safety and effectiveness information for surgical treatments. The study does not involve any new treatments but observes patients who have undergone surgery for atlantoaxial dislocation. It reviews different surgical approaches, such as anterior, posterior, or combined methods, based on a classification system developed from past cases. The research will analyze outcomes and complications over time to guide future surgical care for this condition. Participants will be followed for at least 12 months after surgery to monitor any adverse events that require special attention. Data collected will include clinical evaluations and long-term follow-up information to assess safety and effectiveness. This observational study spans several years and aims to create a recognized standard for diagnosing and treating atlantoaxial dislocation.

Researchers are evaluating whether accelerated flap coverage within 72 hours of injury reduces infection-related complications compared to standard flap coverage timing in patients with severe open fractures andor dislocations below the knee. This randomized controlled trial addresses an important uncertainty in care for these injuries, aiming to provide clear evidence to guide treatment timing and improve patient outcomes. The study includes adult patients 18 years and older who require acute flap coverage for their injury. Participants will be randomly assigned to receive either flap surgery within 72 hours of injury or flap surgery at the standard timing practiced at their medical center. The choice of flap type and management after surgery will be decided by the treating surgeons and recorded. Both groups will have their fracture or dislocation managed according to usual care. Follow-up visits are scheduled at 6 weeks, 3 months, 6 months, and 12 months after randomization to monitor progress. During the study, researchers will assess a combined primary outcome at 6 months that includes overall survival, limb amputation due to injury, re-operations for infection or flap issues, and days spent in acute hospital care. Secondary outcomes include these individual measures at 6 and 12 months, as well as patient-reported quality of life and satisfaction. Safety events will be reviewed regularly by a monitoring committee to ensure participant well-being throughout the trial.

Non-combat-related muscle, tendon, and bone injuries are common among military personnel, especially new recruits, affecting readiness and causing significant medical costs. This research investigates how hormonal changes, specifically sex hormones like testosterone and estrogen, influence muscle, tendon, and bone function as well as physical and psychological performance under stress. The study aims to improve military physical training and reduce injuries by understanding these hormonal effects. Participants will be assigned to different groups including a control group maintaining normal habits and a stress exposure group undergoing a 4-week military-style physical training program. Some men and women in the stress group will receive medications to suppress natural hormone production and then receive hormone replacement or a placebo. Treatments include a GnRH agonist injection and topical testosterone gels or estrogenprogesterone patches, with dosing varying by group and sex. Throughout the approximately 8-week study, participants will undergo measurements such as muscle and tendon imaging, body composition analysis, blood tests for hormone and biochemical markers, and physical and mental performance evaluations. Researchers will monitor changes in these outcomes over time to assess the effects of hormone suppression and replacement on musculoskeletal resilience and adaptation to stress.

This trial investigates whether a new rehabilitation approach called apprehension-based training leads to better recovery after shoulder dislocation compared to standard physical therapy among military personnel aged 18 to 39 years. The study aims to see if this training helps participants regain shoulder function, improves their shoulder-related quality of life, and reduces the risk of shoulder dislocations recurring. Participants have documented anterior shoulder dislocation confirmed by a medical professional and a positive anterior apprehension test. Participants are randomly assigned to one of two groups. The apprehension-based training involves a 3-phase exercise program progressing from static isometric exercises to dynamic exercises with added cognitive tasks, guided by a physical therapist over up to 8 one-on-one sessions, with daily home exercises. The standard physical therapy group receives individualized treatment by a licensed therapist, which may include various exercises, manual therapy, dry needling, or electrophysiological techniques, also up to 8 sessions with a home exercise program. Throughout the study, participants undergo assessments including shoulder function tests, strength measurements, and quality of life questionnaires at baseline, after 10 weeks of intervention, and up to one year later. Researchers monitor return to preinjury function, recurrence of dislocations, and shoulder instability signs. Additional measures such as muscle strength, pain-related fear, and heart rate variability are recorded. The study involves regular visits and exercises over a 10-week intervention period with follow-up evaluations extending to one year after treatment ends.

Researchers are evaluating two surgical methods for treating acute acromioclavicular joint injury ACJI, a common shoulder injury often caused by direct force to the shoulder. The study compares functional and radiologic outcomes between arthroscopic assisted coracoclavicular CC stabilization alone and the same procedure with additional K-wire fixation. The goal is to see if adding K-wire fixation changes recovery outcomes such as joint stability and shoulder function. Participants will be randomly assigned to one of two groups one receiving arthroscopic assisted CC stabilization with an extra K-wire device inserted from the acromion process to the distal clavicle, and the other receiving only the arthroscopic assisted CC stabilization without K-wire. This device is used as an additional fixation tool. The study will assess outcomes over a year to compare effectiveness. During the study, participants will have their shoulder function measured using scores like ACJI, Constant, DASH, and pain levels VAS at multiple time points including 3, 6, and 12 months after surgery. Radiologic outcomes such as coracoclavicular distance and gleno-acromio-clavicular angle will be monitored at specific intervals from day 1 post-surgery up to one year. These assessments help track the joint stability and recovery progress throughout the follow-up period.

Ankle sprains are common injuries that can lead to chronic ankle instability requiring surgery. This study compares two surgical methods for treating this condition the traditional open Brostrom-Gould technique and the newer arthroscopic Brostrom approach. The goal is to evaluate which method provides better pain relief and improved function. The trial is randomized, blinded, and conducted at multiple centers to provide reliable comparisons. Participants will be randomly assigned to receive either the open Brostrom repair or the arthroscopic Brostrom procedure. Both surgeries involve ligament repair with similar anesthesia and post-operative care including weight-bearing and motion exercises starting within weeks after surgery. Patients will be evaluated at 3, 6, 12, 24, and 48 weeks after surgery to monitor healing, complications, and functional outcomes. During the study, participants will complete questionnaires assessing ankle stability, pain, foot function, and overall health quality. Researchers will track major complications such as infections or nerve damage, along with minor issues like suture discomfort. The assessments will use validated tools including the Cumberland Ankle Instability Tool, American Orthopedic Foot and Ankle Society score, Visual Analogue Scale, Foot Function Index, and SF-36 survey. The total follow-up period is 48 weeks, allowing careful monitoring of recovery and surgical effects.

Researchers are evaluating whether artificial intelligence AI can help doctors detect broken bones, joint effusions, dislocations, and bone lesions more quickly and accurately in emergency room settings. This prospective, randomized, controlled trial compares traditional diagnostic methods to AI-assisted X-ray interpretation. The study also aims to see if AI can save time and reduce healthcare costs while improving clinical workflows in orthopedic emergency care. Participants will be assigned to one of two groups one using standard physician interpretation of X-rays without AI assistance, and the other using AI tools Aidoc or Gleamer BoneView integrated into the hospitals imaging system to highlight potential injuries in real time. Both groups will receive standard X-ray imaging of injured arms or legs. The AI serves as a diagnostic aid, with physicians making final diagnoses. The study includes around 4,800 patients presenting with isolated extremity injuries or joint complaints. During the study, participants will undergo routine X-ray imaging and have their images reviewed with or without AI support depending on group assignment. Researchers will collect baseline demographic and clinical data and assess diagnostic accuracy, time to diagnosis, physician confidence, and cost efficiency. Diagnoses will be independently reviewed by experts to ensure accuracy. The study adheres to ethical guidelines and requires informed consent from participants. Results may inform future use of AI in emergency care settings.

Researchers are conducting a prospective, observational cohort study to create a database of normal biomechanics in healthy athletes. The study focuses on measuring muscle strength, movement patterns, and biomechanics to better understand the risk of musculoskeletal injuries, especially anterior cruciate ligament ACL injuries. It aims to link these biomechanical factors with new injuries occurring over a 12-month period after initial testing. Athletes of various ages from middle school to university who participate in organized sports will be involved. The study uses advanced three-dimensional motion capture technology without markers to collect detailed biomechanical data. Participants will complete an injury risk screening as part of athletic camps, which includes muscle strength and movement assessments, as well as providing demographic and sports participation information. Follow-up surveys at six and twelve months will track any new injuries. Participants will be evaluated through biomechanical tests and injury risk screenings, with data collected on muscle strength, movement, and other risk factors like concussion history. The main measurement is the occurrence of new injuries within 12 months. This information will help improve care by providing clinicians with normative data to assess readiness for return to sport and guide treatment and prevention strategies for ACL injuries.