Journal of Orthopaedic Surgery最新文献

BackgroundFemoral neck shortening following internal fixation of unstable femoral neck fractures can compromise functional recovery, particularly in young, active patients. This study aimed to evaluate the efficacy of a length-stable dynamic hip screw (LSD) construct in minimizing postoperative shortening compared to the femoral neck system (FNS).MethodsA retrospective review was conducted on 65 patients with high-grade unstable femoral neck fractures treated between February 2016 and February 2023 at a single institution. Patients underwent either FNS (n = 31) or LSD (n = 34) fixation. Femoral neck shortening was quantified using vector-based analysis derived from contralateral femoral comparison at final follow-up. Functional outcomes were assessed using the Hip Disability and Osteoarthritis Outcome Score (HOOS).ResultsThe LSD group demonstrated significantly less femoral neck shortening compared to the FNS group (5.0 ± 4.6 mm vs 10.4 ± 6.7 mm, p = 0.001). Final HOOS scores were significantly higher in the LSD group in the symptom (88.1 vs 75.8, p = 0.049) and stiffness subdomains. Union was achieved in 31 of 34 patients (91.2%) in the LSD group and 26 of 31 (83.9%) in the FNS group (p = 0.605). Other complications were more frequent in the FNS group but did not reach statistical significance.ConclusionLength-stable fixation using the LSD construct significantly reduced postoperative femoral neck shortening in high-grade unstable fractures, without compromising union rates or functional recovery. Our results support the role of length-stable constructs as a reliable option for maintaining anatomic integrity in unstable femoral neck fractures.

BackgroundDorsal wrist ganglia (DWGs) are common, yet the contribution of carpal morphology to their formation is underexplored. We investigated whether scapholunate joint, lunate, and capitate morphology differ between DWG wrists and controls.MethodsRetrospective MRI case-control study of adults aged 18-60 years, comprising 70 DWG wrists and 70 controls. Categorical variables were lunate type (medial hamatolunate facet present or absent), scapholunate joint morphology (parallel, inverted-Y, point-like parallel), and capitate head shape (flat, round, V-shaped). Quantitative measures included capitate-triquetral distance, mid-joint scapholunate gap, and medial hamatolunate facet length, recorded only when a facet was present.ResultsInterobserver agreement was generally good across both categorical and quantitative measures (categorical κ range: 0.50-0.88; quantitative ICC range: 0.72-0.95). Capitate morphology differed between groups: round heads were more frequent in DWG (71.4%) than in controls (44.3%) (p < 0.05). The scapholunate gap was larger in DWG (mean 1.8 mm) than in controls (1.5 mm) (p < 0.05). No between-group differences were observed for lunate type (Type II: 51.4% vs 38.6%; p = 0.107), scapholunate joint type (p = 0.787), capitate-triquetral distance (p = 0.223), or medial hamatolunate facet length (p = 0.395).ConclusionDWG wrists more often exhibit a round capitate head and a larger scapholunate gap than matched controls, whereas lunate type, scapholunate joint configuration, capitate-triquetral distance, and medial hamatolunate facet length are similar. Capitate head shape may be associated with DWG; however, given the lower agreement for this parameter, this finding should be considered exploratory and requires further validation before any recommendation for routine reporting can be made. The scapholunate gap can be considered supportive context alongside clinical findings. Prospective multicenter studies with multiplanar/loaded MRI or arthroscopic correlation are warranted.

PurposeTo assess whether the preoperative triglyceride-glucose (TyG) index is associated with 30-day surgical site infection (SSI) after instrumented posterior lumbar fusion (PLF) and to examine its predictive performance.MethodsWe retrospectively reviewed consecutive adults who underwent elective one- or two-level instrumented PLF between 2017 and 2024 at a tertiary center. Patients with active infection, revision surgery, tumor, trauma, or incomplete 30-day follow-up were excluded. Preoperative fasting triglycerides and glucose were used to calculate the TyG index as ln[(triglycerides × glucose)/2]. The primary outcome was 30-day SSI defined by Centers for Disease Control and Prevention criteria. Multivariable logistic regression evaluated the association between TyG and SSI, and receiver operating characteristic analysis assessed discrimination and identified an optimal cut-off. Incremental predictive value was examined by comparing a clinical model with and without TyG using AUC, likelihood ratio testing, reclassification metrics, calibration, Brier score, and decision curve analysis with bootstrap internal validation.ResultsAmong 438 patients, 29 (6.6%) developed SSI (24 superficial, 2 deep, 3 organ/space). Patients with SSI had higher TyG values than non-SSI patients (9.1 ± 0.5 vs 8.6 ± 0.6; p < 0.001). Each 1-unit increase in TyG was independently associated with higher odds of SSI (adjusted odds ratio 3.65; 95% confidence interval 1.62-8.24; p = 0.002). TyG alone yielded an area under the curve of 0.73, and a cut-off of 8.80 identified a high-risk group with an SSI rate of 11.8% versus 2.5% in the low-TyG group. Beyond standard clinical factors, adding TyG improved model fit (LRT χ² = 10.98; p = 0.001) and improved reclassification.ConclusionA higher preoperative TyG index is independently associated with 30-day SSI after PLF and provides moderate discriminative ability as a simple predictor. Incorporating TyG into preoperative risk assessment may help refine perioperative optimization and infection surveillance strategies in lumbar fusion surgery.

PurposeDespite systemic antibiotics and topical vancomycin powder, deep surgical-site infections (SSIs) remain a devastating complication of major posterior spine surgery, driving morbidity, costs, and antimicrobial resistance. In this study, we aimed to compare deep surgical-site infection (SSI) incidence following major posterior spine surgery between patients receiving intraoperative hypochlorous acid (HOCl) lavage and a historical control group receiving intrawound vancomycin powder.MethodsIn this retrospective comparative study, 161 patients undergoing major posterior spinal surgery received ≥2L of topical HOCl lavage, while 88 historical controls received intra-wound vancomycin powder. The primary endpoint was deep SSI incidence within 12 months. Demographics, operative variables, and microbiological data were analyzed with rigorous statistical methods.ResultsDeep SSI rates were nearly identical: 3.1% (5/161) with HOCl versus 3.4% (3/88) with vancomycin (p = 0.999), with no HOCl-related adverse effects. Pathogen profiles (including MRSA, S. epidermidis, and E. coli) were comparable between groups, underscoring HOCl's broad-spectrum efficacy.ConclusionHOCl lavage showed similar deep SSI rates to intrawound vancomycin powder in this retrospective cohort; prospective multicenter studies are warranted to validate these findings and define optimal protocols.

PurposeTo determine whether the restoration of greater sigmoid notch (GSN) congruity differs between osteotomized and simple fractured olecranon treated with tension-band wiring (TBW) using arc center distance (ACD) as a quantitative radiographic indicator.MethodsWe retrospectively evaluated 45 patients who underwent TBW with ring pins, including 23 who underwent olecranon osteotomy and 22 with Mayo type 2A olecranon fractures. Postoperative sagittal computed tomography images were analysed to measure ACD, articular gap, step-off, interfragmentary distance (IFD), and osteotomy angle. GSN was considered congruent when ACD was <2 mm. Subgroup analysis evaluated the association between osteotomy angle and GSN restoration using receiver operating characteristic (ROC) analysis.ResultsCongruent GSN was achieved less frequently in the osteotomy group than in the fracture group (60.9% vs 90.9%, p = 0.019). The osteotomy group showed a higher ACD (1.2 ± 1.1 mm vs 0.5 ± 0.8 mm); however, there were no differences in articular gap, step-off, IFD, and bone mineral density between the groups. In the osteotomy group, the mean osteotomy angle was significantly smaller in the incongruent subgroup than in the congruent subgroup (12.2 ± 3.6° vs 20.7 ± 4.4°). ROC analysis identified a 19.0° cutoff (area under the curve = 0.948) for predicting congruent restoration, with 100% sensitivity and 78.6% specificity.ConclusionGSN restoration after TBW was less accurate in olecranon osteotomies than in simple olecranon fractures. A more transverse osteotomy angle (<19°) was associated with incongruent restoration. Maintaining an osteotomy obliquity of approximately 20° may help preserve articular congruity.

PurposeThis study aimed to investigate changes in sarcopenia status and physical function after total knee arthroplasty (TKA) in patients with knee osteoarthritis (KOA).MethodsThis prospective observational study was conducted at a single general hospital. Seventy-one patients with KOA undergoing first TKA were classified into sarcopenia (n = 12) and non-sarcopenia (n = 59) groups based on the 2019 Asian Working Group for Sarcopenia criteria. Outcomes including walking speed, grip strength, skeletal muscle mass index (SMI), Knee Injury and Osteoarthritis Outcome Score (KOOS), knee joint muscle strength, and performance-based tests were evaluated preoperatively and at 6 and 12 months postoperatively. Analysis of covariance (ANCOVA) with age and sex as covariates was used to examine differences in improvement at 6 and 12 months. Clinical equivalence was evaluated using 90% confidence intervals and minimum clinically important differences.ResultsOf the 12 patients with preoperative sarcopenia, 10 (83.3%) improved at 12 months postoperatively. ANCOVA showed significant adjusted mean difference (aMD) of 0.31 for SMI at 12 months. No significant differences were found in grip strength (aMD: 0.60), KOOS pain (aMD: 0.01), or 40-m fast-paced walk test (aMD: -0.03). Clinical equivalence was observed for SMI, grip strength, KOOS pain, and 40-m fast-paced walk test, but not other outcomes.ConclusionsIn patients with KOA and sarcopenia, TKA combined with postoperative rehabilitation was associated with improvements in sarcopenia-related measures. Improvements in gait ability, grip strength, and appendicular skeletal muscle mass were comparable to those observed in non-sarcopenic patients.

Periprosthetic Joint Infection (PJI) represents a significant complication following joint arthroplasty, highlighting the necessity for accurate diagnostic strategies to guide clinical decision-making. This review highlights advancements in PJI diagnostic techniques, including pathogen identification, biomarker profiling, imaging, and molecular biology techniques. Diagnostic accuracy in culture-based pathogen identification is influenced by factors such as sampling method, antibiotic administration, specimen type, incubation period, and type of culture media. Methods such as ultrasonic agitation and chemical dissolution (e.g., dithiothreitol, DTT) have demonstrated potential in improving pathogen identification in biofilms. Moreover, commonly employed biomarkers include C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), α-defensin, D-dimer, and interleukin-6 (IL-6), though each exhibits variable specificity and sensitivity. Imaging techniques such as X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) offer diverse diagnostic capabilities, with PET/CT demonstrating high sensitivity and specificity despite higher costs. Furthermore, molecular biology methods such as Polymerase Chain Reaction (PCR) and next-generation sequencing (NGS) provide rapid and sensitive detection, which is especially valuable in culture-negative and polymicrobial infections. However, financial constraints limit their routine clinical use. Future research should focus on further optimizing diagnostic modality, exploring novel diagnostic techniques (such as machine learning, (ML) analysis and point-of-care, (POC) diagnostics), while integrating multimodal strategies to enhance the accuracy and efficiency of PJI identification.

PurposeThis study aimed to evaluate the clinical and radiological outcomes of lunate excision scaphocapitate fusion (LESCF) using a single headless cannulated compression screw in patients with advanced Kienböck disease (Lichtman IIIb-IV). The hypothesis was that this technique would provide significant pain relief, functional improvement, and comparable union rates to multi-screw methods while reducing implant-related morbidity.MethodsA retrospective single-center case series included 24 patients (8 males, 16 females; mean age 37.3 ± 8.5 years) who underwent LESCF between June 2021 and June 2023. Minimum follow-up was 24 months (mean 33.6 ± 4.1). Clinical evaluation included pain (VAS), wrist function (Modified Mayo Wrist Score), grip strength, and range of motion. Radiological assessment involved union rate and time, radioscaphoid angle (RSA), carpal height ratio (CHR), Modified Carpal Ulnar Distance Ratio (modified-CUDR) and ulnar variance.ResultsRadiographic union was achieved in all cases (100%) at a mean of 3.5 ± 1.2 months. Mean VAS score decreased from 7.2 ± 1.1 to 2.1 ± 1.0 (p < 0.001), and Modified Mayo Wrist Score improved from 47 ± 12 to 74 ± 10 (p < 0.001). Grip strength increased from 55 ± 15% to 75 ± 18% of the contralateral hand (p < 0.01). Flexion-extension arc slightly decreased (81° ± 10 to 76° ± 9; p < 0.05), while radioulnar deviation changes were minimal. RSA improved from 48° ± 7 to 41° ± 6 (p < 0.01), with no significant change in CHR or ulnar variance. Modified CUDR values were found to be 0.834 ± 0.104 in the preoperative period and 0.804 ± 0.116 in the postoperative period. One patient (4.2%) reported mild screw irritation without surgical intervention; no other complications occurred.ConclusionSingle-screw scapho-capitate fusion and lunate excision can be considered a suitable treatment option for advanced Kienböck's disease, offering pain reduction, positive effects on functional recovery, acceptable healing rates, and a low risk of complications. However, larger, prospective studies are needed to demonstrate the long-term results of this method and its comparative effectiveness with other surgical techniques.

BackgroundIntegrating large language models (LLMs) into decision-making and education has shown promise across various healthcare disciplines. The study aimed to evaluate the performance of leading LLMs-ChatGPT-5, Gemini 2, Grok 3, and DeepSeek R1-in accurately responding to structured multiple-choice and open-ended queries about complex case scenarios in hand surgery.MethodsA prospective cross-sectional analysis used 50 clinically relevant, guideline-based case scenarios developed for hand surgery. Each scenario consisted of four open-ended and two multiple-choice questions, totaling 300 points per LLM. Responses were independently assessed by blinded expert reviewers using a standardized six-point Likert scale evaluating accuracy, completeness, and adherence to international surgical guidelines.ResultsIn multiple-choice queries, Gemini (5.9 ± 0.2) and Grok (5.9 ± 0.1) outperformed ChatGPT (5.7 ± 0.3; p = 0.031 and p = 0.009, respectively) and DeepSeek (5.6 ± 0.4; p = 0.004 and p = 0.001, respectively). In open-ended queries, Gemini (5.6 ± 0.3 accuracy) and Grok (5.5 ± 0.4 accuracy) demonstrated superior results across all measured dimensions-accuracy, completeness, and guideline adherence-markedly surpassing ChatGPT (5.1 ± 0.5 accuracy, p < 0.001) and DeepSeek (4.9 ± 0.6 accuracy; p < 0.001). Notably, Gemini and Grok demonstrated consistently high performance with minimal variability, while ChatGPT, particularly DeepSeek, exhibited considerable inconsistency in complex clinical judgments.ConclusionGemini 2 and Grok 3 showed reliable and clinically relevant performance, positioning them as promising adjunctive tools for decision-making and education in hand surgery. The limitations in ChatGPT-5 and the significant shortcomings of DeepSeek underscore the necessity for cautious deployment and continued refinement.

AimsThis study aims to evaluate the long-term durability of a unicompartmental knee arthroplasty (UKA) implant using a fixed-bearing all-polyethylene tibial tray with a Cobalt-Chromium (Co-Cr) femoral condyle, stratified by patient age. It also aims to compare implant survivorship between inlay and onlay tibial implantation techniques.MethodsData from the New Zealand Joint Registry (NZJR) was used to evaluate survival of Smith & Nephew Genesis II^® UKA performed between February 2000 and December 2011 in which two different tibial implant techniques (inlay and onlay) were used. The primary endpoint was revision surgery.ResultsAt a minimum follow-up of 10 years, 57 revisions were performed at an average of 6.6 years from index surgery. The revision rate per 100 component years was 1.29 (CI: 0.97 - 1.66), with a significant difference between the over-75 years cohort compared with the under-65 cohort, in favour of the older cohort (p < 0.05). There was a significant difference in survival between inlay and onlay techniques, in favour of the inlay technique (p < 0.05).ConclusionFixed-bearing all-polyethylene tibial UKA show acceptable outcomes at an average 12-year follow-up, especially in elderly patients and use of inlay tibial tray implantation technique.