Pub Date : 2026-01-28DOI: 10.1097/CORR.0000000000003840
Yafei Feng
{"title":"CORR Insights®: What Factors Were Associated With Implant Failure After Posterior Vertebral Column Resection for Severe Thoracolumbar Pott Deformity?","authors":"Yafei Feng","doi":"10.1097/CORR.0000000000003840","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003840","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146060512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1097/CORR.0000000000003819
Marisa Valentini, Martin Svehlik, Andreas Leithner, Marko Bergovec, Maria Anna Smolle
<p><strong>Background: </strong>Total femur replacements (TFRs) are rarely performed procedures in orthopaedic oncology and revision arthroplasty surgery. These procedures are associated with a high proportion of complications and revisions, most frequently because of infection. Revision risk and associated parameters in a high-risk population remain to be determined.</p><p><strong>Questions/purposes: </strong>(1) What is the cumulative incidence of implant revision and hip disarticulation after TFR at 2 and 5 years after the index procedure? (2) Which patient-related and procedure-related parameters associate with implant revision and hip disarticulation? (3) What are the overall mortality, oncologic outcome, minor complications, and reoperations in this study population?</p><p><strong>Methods: </strong>This was a retrospective, multicenter European Musculo-Skeletal Oncology Society (EMSOS) study reporting data from 14 international participating centers. The study included 143 patients who received a TFR between January 1, 1990, and March 31, 2024. The mean ± SD age at index operation was 44 ± 24 years, and 52% (74 of 143) of the participants were men. Most patients underwent TFR for oncologic indications (76% [108 of 143]; 12% [13 of 108] received extendable growth prostheses). Complications, revisions, amputations, as well as clinical and surgical data were documented. We investigated major complications and hip disarticulation in a competing risk framework with death as the competing event.</p><p><strong>Results: </strong>The cumulative incidence of implant revision at 2 and 5 years was 24% (95% confidence interval [CI] 16% to 31%) and 35% (95% CI 26% to 44%). The cumulative incidence of hip disarticulation at 2 and 5 years was 4% (95% CI 1% to 7%) and 10% (95% CI 4% to 16%). We found that advanced patient age was associated with an increased risk for major complications (subdistribution HR 1.01 [95% CI 0.98 to 1.02]; p = 0.17, cause-specific HR 1.01 [95% CI 1.00 to 1.03]; p = 0.023). Furthermore, advanced patient age (subdistribution HR 1.03 [95% CI 1.01 to 1.05]; p < 0.001, cause-specific HR 1.05 [95% CI 1.02 to 1.07]; p < 0.001) and no mesh graft (subdistribution HR 0.30 [95% CI 0.10 to 0.92]; p = 0.035, cause-specific HR 0.46 [95% CI 0.15 to 1.42]; p = 0.18) were associated with higher risk for hip disarticulations. No other risk factor was associated with altered risk for implant revision or hip disarticulation.</p><p><strong>Conclusion: </strong>Patients should be informed about the high incidence of revision associated with TFR and the secondary hip disarticulation risk. The identified risk factors may be considered upon patient counseling, as well as for surgical decision-making. Our findings confirm the beneficial effects of mesh grafts. As technical solutions for patients undergoing amputations advance, the indications for these complex reconstructions should be chosen carefully, especially in older patients.</p><p><strong>Level of
背景：全股骨置换术（TFRs）在骨科肿瘤学和翻修关节成形术中很少被采用。这些手术与高比例的并发症和翻修相关，最常见的原因是感染。高危人群的翻修风险和相关参数仍有待确定。问题/目的：(1)TFR术后2年和5年植入物翻修和髋关节脱臼的累积发生率是多少？(2)哪些与患者和手术相关的参数与假体翻修和髋关节脱臼相关？(3)该研究人群的总死亡率、肿瘤预后、轻微并发症和再手术情况如何？方法：这是一项回顾性的多中心欧洲肌肉骨骼肿瘤学会（EMSOS）研究，报告了来自14个国际参与中心的数据。该研究包括143名在1990年1月1日至2024年3月31日期间接受TFR的患者。指数手术时的平均±SD年龄为44±24岁，其中52%（143例中的74例）为男性。大多数患者因肿瘤适应症接受TFR（76%[108 / 143]； 12%[13 / 108]接受可扩展生长假体）。并发症，修复，截肢，以及临床和手术资料的记录。我们在以死亡为竞争事件的竞争风险框架中调查了主要并发症和髋关节脱臼。结果：2年和5年种植体翻修的累积发生率分别为24%（95%可信区间[CI] 16%至31%）和35% （95% CI 26%至44%）。2年和5年髋关节脱臼的累积发生率分别为4% （95% CI 1% ~ 7%）和10% （95% CI 4% ~ 16%）。我们发现，高龄患者发生主要并发症的风险增加相关（亚分布HR 1.01 [95% CI 0.98 ~ 1.02]; p = 0.17，病因特异性HR 1.01 [95% CI 1.00 ~ 1.03]; p = 0.023）。此外，高龄患者（亚分布危险度1.03 [95% CI 1.01 ~ 1.05]; p < 0.001，原因特异性危险度1.05 [95% CI 1.02 ~ 1.07]; p < 0.001）和无补片移植（亚分布危险度0.30 [95% CI 0.10 ~ 0.92]; p = 0.035，原因特异性危险度0.46 [95% CI 0.15 ~ 1.42]; p = 0.18）与髋关节脱臼的高风险相关。没有其他危险因素与假体翻修或髋关节脱臼的风险改变相关。结论：应告知患者与TFR相关的高发生率翻修和继发性髋关节脱臼风险。确定的风险因素可以在患者咨询时考虑，以及手术决策。我们的研究结果证实了网状移植物的有益作用。随着截肢患者技术解决方案的进步，这些复杂重建的适应症应该仔细选择，特别是在老年患者中。证据等级：III级，治疗性研究。
{"title":"Which Factors Associate With Implant Revision and Hip Disarticulation After Total Femur Replacement? A Retrospective Multicentric EMSOS Study.","authors":"Marisa Valentini, Martin Svehlik, Andreas Leithner, Marko Bergovec, Maria Anna Smolle","doi":"10.1097/CORR.0000000000003819","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003819","url":null,"abstract":"<p><strong>Background: </strong>Total femur replacements (TFRs) are rarely performed procedures in orthopaedic oncology and revision arthroplasty surgery. These procedures are associated with a high proportion of complications and revisions, most frequently because of infection. Revision risk and associated parameters in a high-risk population remain to be determined.</p><p><strong>Questions/purposes: </strong>(1) What is the cumulative incidence of implant revision and hip disarticulation after TFR at 2 and 5 years after the index procedure? (2) Which patient-related and procedure-related parameters associate with implant revision and hip disarticulation? (3) What are the overall mortality, oncologic outcome, minor complications, and reoperations in this study population?</p><p><strong>Methods: </strong>This was a retrospective, multicenter European Musculo-Skeletal Oncology Society (EMSOS) study reporting data from 14 international participating centers. The study included 143 patients who received a TFR between January 1, 1990, and March 31, 2024. The mean ± SD age at index operation was 44 ± 24 years, and 52% (74 of 143) of the participants were men. Most patients underwent TFR for oncologic indications (76% [108 of 143]; 12% [13 of 108] received extendable growth prostheses). Complications, revisions, amputations, as well as clinical and surgical data were documented. We investigated major complications and hip disarticulation in a competing risk framework with death as the competing event.</p><p><strong>Results: </strong>The cumulative incidence of implant revision at 2 and 5 years was 24% (95% confidence interval [CI] 16% to 31%) and 35% (95% CI 26% to 44%). The cumulative incidence of hip disarticulation at 2 and 5 years was 4% (95% CI 1% to 7%) and 10% (95% CI 4% to 16%). We found that advanced patient age was associated with an increased risk for major complications (subdistribution HR 1.01 [95% CI 0.98 to 1.02]; p = 0.17, cause-specific HR 1.01 [95% CI 1.00 to 1.03]; p = 0.023). Furthermore, advanced patient age (subdistribution HR 1.03 [95% CI 1.01 to 1.05]; p < 0.001, cause-specific HR 1.05 [95% CI 1.02 to 1.07]; p < 0.001) and no mesh graft (subdistribution HR 0.30 [95% CI 0.10 to 0.92]; p = 0.035, cause-specific HR 0.46 [95% CI 0.15 to 1.42]; p = 0.18) were associated with higher risk for hip disarticulations. No other risk factor was associated with altered risk for implant revision or hip disarticulation.</p><p><strong>Conclusion: </strong>Patients should be informed about the high incidence of revision associated with TFR and the secondary hip disarticulation risk. The identified risk factors may be considered upon patient counseling, as well as for surgical decision-making. Our findings confirm the beneficial effects of mesh grafts. As technical solutions for patients undergoing amputations advance, the indications for these complex reconstructions should be chosen carefully, especially in older patients.</p><p><strong>Level of","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1097/CORR.0000000000003827
Randall E Marcus, Alexander S Rascoe, Jordan Pasternack, Gregory P Guyton
<p><strong>Background: </strong>One goal of classifying fractures at the base of the fifth metatarsal is to reliably identify which fracture patterns have an increased risk of delayed union and nonunion and therefore merit consideration for operative fixation. The most common classification system of proximal fifth metatarsal fractures is the three-part Lawrence and Botte scheme, which has been shown to have poor interobserver and intraobserver reliability and can be ambiguous in terms of clinical treatment and prognosis. In particular, the assignment of the middle classification (Type II) has unclear implications for treatment and prognosis.</p><p><strong>Questions/purposes: </strong>We developed a two-part classification system based on prior anatomic and biomechanical studies that we performed, and we asked: (1) What is the interobserver and intraobserver reliability of the system? (2) What association does it have with the risk of delayed union or nonunion?</p><p><strong>Methods: </strong>This novel classification system was based on previous work on the effect of the peroneus brevis insertion on fracture stability. The fractures were divided into two categories, avulsion or indirect, based on their location with regard to the peroneus brevis footprint and with regard to the mechanism of injury. Fractures were considered avulsion if they occurred as the result of a direct avulsive force as ascertained by whether they were located within the peroneus brevis footprint. Fractures were considered indirect if they occurred as a result of a bending moment applied to the fifth metatarsal and were located outside of the peroneus brevis footprint. In that previous study, we used 10 cadaver specimens, and we simulated two loading conditions on the peroneus brevis tendon: (1) fractures within the peroneus brevis insertion (avulsion) were found to be stable and (2) fractures distal to the peroneus brevis footprint (indirect) were found to be unstable. The mean length of the peroneus brevis footprint on those specimens was 15 mm. This corresponded regardless of foot size to anatomic and radiographic features of the base of the fifth metatarsal. The most distal lateral extent of the avulsion fracture was 15 mm from the tuberosity. The most distal medial extent was proximal to the point where the curve of the articular surface of the base of the fifth metatarsal changes direction (inflection point). The most proximal lateral extent of the indirect fracture was distal to 15 mm from the tuberosity. The most proximal medial extent was distal to the inflection point of the curve of the base of the fifth metatarsal. To evaluate the reliability of this classification system, 30 sets of initial presentation radiographs composed of 10 fractures previously clinically diagnosed as representing each of the three zones in the Lawrence and Botte system were used. These radiographs represented a diverse pool of fractures chosen without knowledge of the patients' clinical
{"title":"A Novel Classification System for Fifth Metatarsal Base Fractures Is Reliable and Clinically Validated.","authors":"Randall E Marcus, Alexander S Rascoe, Jordan Pasternack, Gregory P Guyton","doi":"10.1097/CORR.0000000000003827","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003827","url":null,"abstract":"<p><strong>Background: </strong>One goal of classifying fractures at the base of the fifth metatarsal is to reliably identify which fracture patterns have an increased risk of delayed union and nonunion and therefore merit consideration for operative fixation. The most common classification system of proximal fifth metatarsal fractures is the three-part Lawrence and Botte scheme, which has been shown to have poor interobserver and intraobserver reliability and can be ambiguous in terms of clinical treatment and prognosis. In particular, the assignment of the middle classification (Type II) has unclear implications for treatment and prognosis.</p><p><strong>Questions/purposes: </strong>We developed a two-part classification system based on prior anatomic and biomechanical studies that we performed, and we asked: (1) What is the interobserver and intraobserver reliability of the system? (2) What association does it have with the risk of delayed union or nonunion?</p><p><strong>Methods: </strong>This novel classification system was based on previous work on the effect of the peroneus brevis insertion on fracture stability. The fractures were divided into two categories, avulsion or indirect, based on their location with regard to the peroneus brevis footprint and with regard to the mechanism of injury. Fractures were considered avulsion if they occurred as the result of a direct avulsive force as ascertained by whether they were located within the peroneus brevis footprint. Fractures were considered indirect if they occurred as a result of a bending moment applied to the fifth metatarsal and were located outside of the peroneus brevis footprint. In that previous study, we used 10 cadaver specimens, and we simulated two loading conditions on the peroneus brevis tendon: (1) fractures within the peroneus brevis insertion (avulsion) were found to be stable and (2) fractures distal to the peroneus brevis footprint (indirect) were found to be unstable. The mean length of the peroneus brevis footprint on those specimens was 15 mm. This corresponded regardless of foot size to anatomic and radiographic features of the base of the fifth metatarsal. The most distal lateral extent of the avulsion fracture was 15 mm from the tuberosity. The most distal medial extent was proximal to the point where the curve of the articular surface of the base of the fifth metatarsal changes direction (inflection point). The most proximal lateral extent of the indirect fracture was distal to 15 mm from the tuberosity. The most proximal medial extent was distal to the inflection point of the curve of the base of the fifth metatarsal. To evaluate the reliability of this classification system, 30 sets of initial presentation radiographs composed of 10 fractures previously clinically diagnosed as representing each of the three zones in the Lawrence and Botte system were used. These radiographs represented a diverse pool of fractures chosen without knowledge of the patients' clinical","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1097/CORR.0000000000003833
Adam M Pearson
{"title":"CORR Insights®: Can Posterior Intervertebral Release Enhance the Correction Efficiency of Severe and Rigid Adult Idiopathic Scoliosis? A Multicenter Study With a Minimum 2-year Follow-up.","authors":"Adam M Pearson","doi":"10.1097/CORR.0000000000003833","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003833","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1097/CORR.0000000000003831
B Sonny Bal
{"title":"Medicolegal Sidebar: What You Need to Know About Good Samaritan Laws.","authors":"B Sonny Bal","doi":"10.1097/CORR.0000000000003831","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003831","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21DOI: 10.1097/CORR.0000000000003798
Charles A C Villamin
{"title":"CORR Insights®: Periacetabular Resection for Bone Tumors: Is There Still a Role for Massive Allograft-prosthesis Composite Reconstructions?","authors":"Charles A C Villamin","doi":"10.1097/CORR.0000000000003798","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003798","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1097/corr.0000000000003829
Christoph A Schroen
{"title":"Letter to the Editor: What Is the Probability of Radial Nerve Recovery After Surgical Repair of Humerus Fractures Accounting for Time Since Injury?","authors":"Christoph A Schroen","doi":"10.1097/corr.0000000000003829","DOIUrl":"https://doi.org/10.1097/corr.0000000000003829","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"6 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1097/corr.0000000000003826
Robin T Higashi,Jessica Lee,Yadira Hernandez,Marisel Pontón,Joshua M Liao,Kyle C Cross,Jessica I Billig
BACKGROUNDTraumatic hand injuries can result in substantial harms to patients' functional abilities and financial health, disproportionately affecting individuals who are of working age, low income, and uninsured. However, little is known about how patients and their families cope with the functional limitations and economic consequences that follow, and how these injuries affect patients' mental and emotional health. Exploring clinician and staff perceptions about the impact of traumatic hand injuries on patients may provide insight into how to help address the various burdens patients face.QUESTIONS/PURPOSESIn this paper, we aimed to explore the following questions: (1) What is the impact of a traumatic hand injury on patients' financial health? (2) How does a traumatic hand injury affect patients' physical health and disability? (3) What kind of toll does a traumatic hand injury take on patients' emotional and mental health? (4) What health system challenges function as additional stressors after a traumatic hand injury?METHODSThis descriptive study consisted of surveys and semistructured interviews. We recruited patients from an outpatient hand surgery clinic at a safety-net hospital in a southern US city. Eligible patients were English- or Spanish-speaking, age 18 years or older, who presented to the clinic after a traumatic hand injury. Between January and April 2025, we invited patients to participate in three surveys that assessed financial burden and upper extremity disability: the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT), the DASH questionnaire, and the InCharge Financial Distress/Financial Well-Being Scale. Of 94 surveys offered, 88% (83) of surveys were completed. The mean ± SD patient age was 38 ± 13 years. Forty-five percent (37 of 83) of participants spoke English, 55% (46 of 83) spoke Spanish, 82% (68 of 83) identified as Hispanic or Latino (any race), 70% (58 of 83) were male, and 58% (48 of 83) relied on the safety-net institution's county charity program for coverage of medical expenses. We completed 26 interviews with patients and 10 interviews with clinicians and staff (three physicians, three clinical staff, one nonclinical staff, and three finance staff), each lasting a median (range) of 24 minutes (13 to 54), while 11 patients and four clinicians and staff declined to participate because of lack of time or interest. Among interview participants, the mean ± SD participant age was 39 ± 15 years. Fifty-four percent (14 of 26) spoke English, 58% (15 of 26) identified as Hispanic or Latino (any race), 65% (17 of 26) were male, and 42% (11 of 26) relied on the county charity program. All statistical analyses were performed using R, version 4.5.0, with p < 0.05. A convenience sample of clinic patients was invited to participate in semistructured interviews, as was a purposive sample of clinicians and staff. Eligible clinicians and staff were those who had been employ
{"title":"How Does Traumatic Hand Injury Impact Patients in a Safety-net Healthcare System? A Mixed Methods Study.","authors":"Robin T Higashi,Jessica Lee,Yadira Hernandez,Marisel Pontón,Joshua M Liao,Kyle C Cross,Jessica I Billig","doi":"10.1097/corr.0000000000003826","DOIUrl":"https://doi.org/10.1097/corr.0000000000003826","url":null,"abstract":"BACKGROUNDTraumatic hand injuries can result in substantial harms to patients' functional abilities and financial health, disproportionately affecting individuals who are of working age, low income, and uninsured. However, little is known about how patients and their families cope with the functional limitations and economic consequences that follow, and how these injuries affect patients' mental and emotional health. Exploring clinician and staff perceptions about the impact of traumatic hand injuries on patients may provide insight into how to help address the various burdens patients face.QUESTIONS/PURPOSESIn this paper, we aimed to explore the following questions: (1) What is the impact of a traumatic hand injury on patients' financial health? (2) How does a traumatic hand injury affect patients' physical health and disability? (3) What kind of toll does a traumatic hand injury take on patients' emotional and mental health? (4) What health system challenges function as additional stressors after a traumatic hand injury?METHODSThis descriptive study consisted of surveys and semistructured interviews. We recruited patients from an outpatient hand surgery clinic at a safety-net hospital in a southern US city. Eligible patients were English- or Spanish-speaking, age 18 years or older, who presented to the clinic after a traumatic hand injury. Between January and April 2025, we invited patients to participate in three surveys that assessed financial burden and upper extremity disability: the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT), the DASH questionnaire, and the InCharge Financial Distress/Financial Well-Being Scale. Of 94 surveys offered, 88% (83) of surveys were completed. The mean ± SD patient age was 38 ± 13 years. Forty-five percent (37 of 83) of participants spoke English, 55% (46 of 83) spoke Spanish, 82% (68 of 83) identified as Hispanic or Latino (any race), 70% (58 of 83) were male, and 58% (48 of 83) relied on the safety-net institution's county charity program for coverage of medical expenses. We completed 26 interviews with patients and 10 interviews with clinicians and staff (three physicians, three clinical staff, one nonclinical staff, and three finance staff), each lasting a median (range) of 24 minutes (13 to 54), while 11 patients and four clinicians and staff declined to participate because of lack of time or interest. Among interview participants, the mean ± SD participant age was 39 ± 15 years. Fifty-four percent (14 of 26) spoke English, 58% (15 of 26) identified as Hispanic or Latino (any race), 65% (17 of 26) were male, and 42% (11 of 26) relied on the county charity program. All statistical analyses were performed using R, version 4.5.0, with p < 0.05. A convenience sample of clinic patients was invited to participate in semistructured interviews, as was a purposive sample of clinicians and staff. Eligible clinicians and staff were those who had been employ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"52 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1097/corr.0000000000003824
Debra Zillmer
{"title":"The Intersection of Orthopaedic Culture and Gender: Too Confident.","authors":"Debra Zillmer","doi":"10.1097/corr.0000000000003824","DOIUrl":"https://doi.org/10.1097/corr.0000000000003824","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"95 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1097/corr.0000000000003828
Stijn R J Mennes,Sebastian Engbers,Bjarty L Garcia,Reinier W A Spek,Roelina Munnik-Hagewoud,Rutger G Zuurmond,Ruurd L Jaarsma,Job N Doornberg,Michel P J van den Bekerom,
BACKGROUNDProximal humerus fractures (PHFs) in patients ≥ 65 years of age are associated with increased risk of death in the months after injury. Controversy exists regarding the preferred treatment strategy in these patients, and operative treatment is associated with high complication and reoperation rates. Machine learning (ML)-driven probability calculators for mortality prediction therefore may be valuable during shared decision-making for surgeons and patients.QUESTIONS/PURPOSES(1) To develop ML algorithms to predict 1-year mortality in patients ≥ 65 years of age. (2) To externally validate all algorithms on a geographically distinct patient population. (3) To create an easy-to-use, online calculator that can be used by surgeons at the point of care to enable more informed decision-making.METHODSThis study identified 5114 potentially eligible patients age ≥ 65 years who presented to our two hospitals in Holland (one is a Level 1 trauma center and one is a Level 2 trauma center) between January 2016 and December 2023. Of those, we considered 3488 patients eligible because they were ≥ 65 years of age and had a first-time PHF. Based on that, 86% (2999) were included for the analysis. A further 10% (334) were excluded because of misdiagnosis, bilateral PHFs, or a history of previous PHFs. Finally, 4% (155) had an irretrievable mortality status or had incomplete data sets. Data on 24 potential factors associated with increased mortality after PHFs were collected. Surgical or nonoperative treatment were not included as the aim was to predict 1-year mortality at the moment a PHF was sustained, before a treatment choice had been made. Therefore, excluding treatment modalities does not limit the intended use as a pretreatment risk estimation model. Four ML algorithms were developed: logistic regression, extreme gradient boosting machine (XGBoost), random forest, and LightGBM. The ML algorithms were trained and internally validated on patients from the first hospital (59% [1768 of 2999]) and externally validated on a geographically distinct group of patients from the second hospital (41% [1231 of 2999]). The mean ± SD age in the training cohort was 77 ± 8 years, and it was 76 ± 8 years in the external validation set; 79% (2383 of 2999) of patients were female. The overall 1-year mortality rate was 11% (325 of 2999). Performance was assessed with discrimination and calibration curves, and overall performance was assessed using the Brier score. Discrimination was assessed with the c-statistic: the area under the receiver operating characteristic curve. The c-statistic ranges from 0.50 to 1.0, with 1.0 indicating perfect discriminating ability. Calibration was assessed by plotting the agreement between the observed outcome and predicted probability, and the intercept and slope were determined. The plot's intercept indicates whether predictions were too high (intercept < 0) or too low (intercept > 0). The slope reflects either overfitting (predictions to
背景：≥65岁的患者肱骨近端骨折（phf）与损伤后几个月内死亡风险增加相关。对于这些患者的首选治疗策略存在争议，手术治疗与高并发症和再手术率相关。因此，机器学习（ML）驱动的死亡率预测概率计算器在外科医生和患者共同决策时可能很有价值。(1)开发ML算法来预测≥65岁患者的1年死亡率。(2)在地理上不同的患者群体上对所有算法进行外部验证。(3)创建一个易于使用的在线计算器，供外科医生在护理点使用，以实现更明智的决策。方法：在2016年1月至2023年12月期间，在荷兰的两家医院（一家是一级创伤中心，一家是二级创伤中心）就诊的5114名年龄≥65岁的潜在符合条件的患者。其中，我们认为3488例患者符合条件，因为他们年龄≥65岁且首次发生PHF。在此基础上，86%（2999）被纳入分析。另有10%（334例）因误诊、双侧PHFs或既往PHFs病史而被排除。最后，4%（155例）的死亡率不可挽回或数据集不完整。收集了与phf后死亡率增加相关的24个潜在因素的数据。手术或非手术治疗不包括在内，因为其目的是在治疗选择之前预测PHF持续的1年死亡率。因此，排除治疗方式并不限制其作为预处理风险评估模型的预期用途。开发了四种机器学习算法：逻辑回归、极端梯度增强机（XGBoost）、随机森林和LightGBM。机器学习算法在第一家医院的患者身上进行了训练和内部验证（59%[2999的1768人]），在第二家医院的地理位置不同的患者组上进行了外部验证（41%[2999的1231人]）。训练组的平均±SD年龄为77±8岁，外部验证组的平均±SD年龄为76±8岁；2999例患者中女性占79%（2383例）。总的1年死亡率为11%（2999例中有325例）。用判别曲线和校准曲线评估其表现，用Brier评分评估其总体表现。用c统计量（即受者工作特征曲线下的面积）评价鉴别性。c统计量在0.50 ~ 1.0之间，1.0表示判别能力较好。通过绘制观测结果与预测概率之间的一致性来评估校准，并确定截距和斜率。图的截距表明预测是过高（截距< 0）还是过低（截距> 0）。斜率反映了过拟合（预测过于极端，斜率> 1）或欠拟合（预测不够极端，斜率< 1）。一个理想的预测模型具有截距为0，斜率为1的校准曲线。Brier分数反映了整体表现，是判别和校准的综合表现。0分代表完美预测，1分代表最差预测。阴性和阳性预测值也进行了评估。对于内部验证，执行五次交叉验证以防止数据泄漏，并使用1000次引导来确保稳健的结果并解释乐观主义。交叉验证需要将训练集划分为子集（五个），然后在四个集合上训练模型。第五，看不见的集合用于内部验证，防止高估模型性能。对于外部验证，仅使用1000倍的引导来评估性能，以确保稳健的结果和正确的乐观主义。结果算法与c-statistics（判别能力）相似，内部验证的范围为0.80 ~ 0.81(95%置信区间[CI] 0.72 ~ 0.86)，外部验证的范围为0.83 ~ 0.85 （95% CI 0.81 ~ 0.86）。c统计量超过0.80被认为是老年创伤人群死亡率预测模型的强大性能。在评估的模型中选择逻辑回归作为最佳模型，因为它具有足够的校准和可解释性。强校正确保模型不受过拟合或欠拟合的影响，也不会预测过高或过低。逻辑回归是可解释的，因为它需要较少的预测因子并提供可理解的系数。阴性预测值为0.91 (95% CI 0.90至0.92)，阳性预测值为0.66 (95% CI 0.54至0.81)，与死亡率相关性最强的因素是偏瘫、骨折前在医疗机构的居住和心力衰竭。 本研究开发并外部验证了一种机器学习驱动的预测模型，该模型可以准确地提供单个患者的1年死亡风险。医生可以在共同决策和患者咨询时使用这种预测预后的工具，因为它在考虑phf治疗方案时为患者和家属提供了现实的期望，从而增强了知情同意过程。预测工具被整合到一个免费的web应用程序中，可以通过https://bjarty.shinyapps.io/mortality_app/.LEVEL OF EVIDENCELevel III，治疗性研究访问。
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