Journal of Orthopaedic Surgery最新文献

BackgroundExternal fixation for geriatric C-type distal radius fractures (DRF) often restricts early wrist motion. This study compares a strategy of early mobilization after 3-4 weeks of external fixation with lightweight support against the conventional approach of 6-7 weeks of continuous external fixation.MethodsA total of 174 patients aged 60 or older with C-type DRF were included. They were assigned to either an early mobilization group (n = 86), where external fixation was replaced with a lightweight support at 3-4 weeks, or a control group (n = 88) with conventional 6-7 weeks of external fixation. Outcomes included radiographic measures, functional scores (Gartland-Werley and Quick DASH), and satisfaction.ResultsAt week 7, no significant difference in radiographic data was observed between groups (all P > 0.05). At month 12, the control group showed better radiographic outcomes (P = 0.03). The early mobilization group had better functional scores at week 7 for both Gartland-Werley (P = 0.01) and Quick DASH (P = 0.02) compared to the control group. At 6 and 12 months, no significant differences were found between groups in either score (all P > 0.05). Patient satisfaction was significantly higher in the early mobilization group (P < 0.001). There were no significant differences in complication rates (P = 0.13).ConclusionTransitioning to early mobilization after 3-4 weeks of external fixation facilitates earlier functional recovery and improves patient satisfaction compared to prolonged immobilization, despite a slight increase in ulnar variance that did not impact functional outcomes.

BackgroundThis study aims to compare the performance of two artificial intelligence (AI) models, ChatGPT-4.0 and DeepSeek-R1, in addressing clinical questions related to degenerative lumbar spinal stenosis (DLSS) using the North American Spine Society (NASS) guidelines as the benchmark.Methods15 clinical questions spanning five domains (diagnostic criteria, non-surgical management, surgical indications, perioperative care, and emerging controversies) were designed based on the 2013 NASS evidence-based clinical guidelines for the diagnosis and management of DLSS. Responses from both models were independently evaluated by two board-certified spine surgeons across four metrics: accuracy, completeness, supplementality, and misinformation. Inter-rater reliability was assessed using Cohen's κ coefficient, while Mann-Whitney U and Chi-square tests were employed to analyze statistical differences between models.ResultsDeepSeek-R1 demonstrated superior performance over ChatGPT-4.0 in accuracy (median score: 3 vs 2, P = 0.009), completeness (2 vs 1, P = 0.010), and supplementality (2 vs 1, P = 0.018). Both models exhibited comparable performance in avoiding misinformation (P = 0.671). DeepSeek-R1 achieved higher inter-rater agreement in accuracy (κ = 0.727 vs 0.615), whereas ChatGPT-4.0 showed stronger consistency in ssupplementality (κ = 0.792 vs 0.762).ConclusionsWhile both AI models demonstrate potential for clinical decision support, DeepSeek-R1 aligns more closely with NASS guidelines. ChatGPT-4.0 excels in providing supplementary insights but exhibits variability in accuracy. These findings underscore the need for domain-specific optimization of AI models to enhance reliability in medical applications.

PurposeThe proximal femur is a region frequently affected by pathological fractures due to metastases. Partial head megaprostheses are among the surgical options that can be preferred for treating pathological fractures in this area. The aim of this study is to evaluate the impact of various factors on the functional outcomes and mortality of patients with actual proximal femoral fractures treated with a megaprosthesis.MethodsThe study included 28 patients. None of these patients had impending fractures; all of them had actual pathological fractures. Functional outcomes were assessed using VAS improvement, MSTS, and KPS scores, in relation to factors including age, cancer diagnosis before fracture, additional fracture, bone metastasis, visceral metastases, postoperative oncological treatment, preservation of the trochanter major, and type of cancer. These same factors were also considered in the survival analysis. The impact of knowing the cancer diagnosis prior to the fracture on time to surgery was also evaluated.ResultsPatients showed a mean VAS improvement of 5.8 ± 1.3, with median postoperative MSTS and KPS scores of 18 (range:12-23) and 65 (range:40-80), respectively. Younger patients had significantly better functional outcomes (p < 0.05). Other clinical factors had no significant effect on functions. Visceral metastases negatively impacted survival (p = 0.044), while younger age (p = 0.029), favorable cancer type (p < 0.001), and receiving postoperative oncological treatment improved survival (p = 0.049). Time to surgery was longer in patients without a prior cancer diagnosis (p < 0.001), though this did not affect survival (p = 0.888).ConclusionMegaprostheses in the treatment of actual metastatic fractures of the proximal femur provide excellent pain relief and satisfactory functional improvement. Functional outcomes were associated with age, while survival was influenced by age, cancer type, presence of visceral metastases, and whether postoperative oncological treatment was received. Although the preoperative time to surgery was longer in patients without a prior cancer diagnosis, survival was not affected by whether the diagnosis was known before the fracture.Level of EvidenceIV.

PurposeTo provide preliminary evidence of the effectiveness of a novel surgical technique using patient-specific 3D-printed titanium prosthesis/autograft composite (3D-PAC) in reconstruction of a large osteoarticular metacarpal defect.Material and methodsSeven patients (4 women, 3 men; mean age, 30 years; mean follow-up duration, 37.4 months (range, 12-73 months)) with large osteoarticular metacarpal defect who were treated with 3D-PAC reconstruction between January 2018 and November 2024 were included in the study. The etiologies were bone tumors in 4 patients, and open fracture in 3 patients.ResultsAt the final follow-up, mean metacarpophalangeal (MCP) extension was 2.1° (range, 0°-10°), and flexion was 52.9° (range, 30°-90°). Mean total active motion of the involved digit was 185.7 (range, 110°-270°) with 3 excellent cases, 3 good cases, and 1 fair case. Mean grip strength was 71.3 % (range, 40%-91%), and key pinch strength was 84.7% (range, 50%-128%) of the contralateral side. Mean visual analog scale score was 0.6 (range, 0-2), Michigan Hand Outcomes Questionnaire score was 70.3 (range, 52.4-83.1), and Disabilities of the Arm, Shoulder and Hand score was 12.9 (range, 4.2-21.7). One patient developed persistent periprosthetic joint infection which required prosthetic removal and converted to arthrodesis. No mechanical complications including aseptic loosening, and implant breakage was revealed. All were satisfied with the function and cosmesis of reconstructive hands.ConclusionPatient-specific 3D-printed titanium prosthesis/autograft composite reconstruction appears to be effective in treatment of large osteoarticular defect of metacarpal in a pilot study. Although suboptimal MCP flexion and decreased hand strength were revealed, such joint motion-sparing procedure was useful to achieve satisfactory hand function and cosmesis. Further studies with a larger sample size compared with the conventional treatments are required to validate the benefits of 3D-PAC reconstruction.

Background and AimInsertional Achilles tendinopathy (IAT) is a degenerative disorder characterized by pain and functional limitation at the tendon's calcaneal insertion. Surgical intervention is indicated when nonoperative management fails. This study aimed to compare clinical outcomes of calcaneal osteotomy with and without Achilles tendon reinsertion in patients with IAT.MethodsIn this double-blind randomized clinical trial, 42 patients (mean age: 52.25 ± 6.72 years; 69.0% male) with IAT were allocated equally to osteotomy with reinsertion (n = 21) or without reinsertion (n = 21). Functional status and pain were assessed preoperatively and at 3, 6, and 9 months postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and the Visual Analogue Scale (VAS) for pain at rest and during activity. Complication rates were also recorded.ResultsIn the reinsertion group, mean AOFAS scores improved from 51.00 ± 14.81 preoperatively to 66.33 ± 12.59 (3 months), 68.81 ± 20.54 (6 months), and 68.81 ± 20.54 (9 months). In the non-reinsertion group, scores improved from 55.10 ± 12.84 to 63.67 ± 14.22, 70.38 ± 13.14, and 70.38 ± 13.14, respectively. VAS scores for pain during activity and rest decreased progressively in both groups, approaching near-zero levels by 9 months. No statistically significant between-group differences were observed for AOFAS or VAS improvements (p > 0.05). Complication rates were low and comparable between groups.ConclusionBoth surgical techniques provided significant and sustained pain reduction and functional improvement over 9 months. Achilles tendon reinsertion did not confer measurable short-term advantages when a substantial portion of the native insertion was preserved, although potential long-term biomechanical benefits needs further investigation.

BackgroundThe autologous peroneus longus tendon (PLT), which is a common graft in sports medicine. However, superior fulcrum reconstruction (SFR) using autologous PLT for irreparable massive rotator cuff tears (IMRCT) have not been reported. The objective of this study is to histologically evaluate the effect of the SFR using autologous PLT on tendon-to-bone healing.Methods30 mature New Zealand white rabbits were used in this study, and were used to build the model of irreparable massive rotator cuff tears, which were randomly divided into two groups of 15 rabbits in each group, with superior fulcrum reconstruction (SFR group) and superior capsule reconstruction (SCR group). Five rabbits in each group were sacrificed at 4, 8 and 12 weeks postoperatively for histological assessment.ResultsIn the histological analysis, there was no significant difference in the modified tendon maturation scoring system and semiquantitative evaluation of the cartilage staining area at 4 weeks. For 8 weeks and 12 weeks, SFR group confirmed a higher scoring level than SCR group. In the Immunohistochemical evaluation, the SFR group showed better angiogenesis and higher expression of collagen I compared to the SCR group at 8 weeks and 12 weeks.ConclusionThe superior fulcrum reconstruction using autologous PLT can promote a better biological healing process. It could be used as a clinical option for irreparable massive rotator cuff tears.

BackgroundOsteochondral fracture (OCF) often occurs in patellar dislocation and has various treatment methods. The purpose of this study is to ascertain the clinical efficacy of using absorbable cartilage screws to fix OCF.MethodsWe conducted a retrospective analysis of 455 patients who underwent medial patellofemoral ligament reconstruction (MPFLR) from 2020 to 2024, with the aim of identifying patients who underwent simultaneous OCF fixation with bioabsorbable screws. The preoperative and postoperative joint functions were evaluated by ROM (range of motion), VAS (visual analogue scale) score of patellofemoral joint pain during knee deep flexion, Kujala score, Lysholm score, IKDC (international knee documentation committee) score and Tegner score. The MRI was used to evaluate the fracture healing.ResultsThere were a total of 31 patients who underwent both MPFLR and OCF fixation simultaneously. The average age was 18.21 years (12.08-36 years) [16.00, 20.41]. The average follow-up time was 33.71 months (10-60 months) [27.54, 39.88]. The ROM (120.81 ± 7.30), VAS score (1.35 ± 0.49), Kujala score (87.00 ± 7.32), Lysholm score (86.32 ± 8.92), IKDC score (85.26 ± 4.49) and Tegner score (5.81 ± 0.75) at the latest follow-up were significantly improved comparing with the preoperative ROM (87.32 ± 8.83), VAS score (8.35 ± 0.55), Kujala score (56.16 ± 18.43), Lysholm score (48.61 ± 10.16), IKDC score (43.58 ± 6.00) and Tegner score (3.52 ± 0.51), the differences were statistically significant (t = -16.273, 53.048, 8.660, 15.535, -30.959, -14.088, respectively. all p < 0.001). MRI showed good healing of OCF. All patients recovered well after surgery.ConclusionThis study confirms the satisfactory clinical outcomes of using absorbable cartilage screws to fix OCF caused by patellar dislocation.

PurposeTo compare the clinical and radiological results of two double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) techniques. DB ACLR and anterolateral ligament reconstruction (ALLR) with internal brace (IB), and outside-in (OI) DB ACLR.HypothesisWe hypothesized that DB ACLR and ALLR with IB wound yield less femoral tunnel, especially femoral posterolateral bundle tunnel complications, than OI DB ACLR without ALLR because of better rotational control. Both techniques could provide good postoperative clinical outcomes.MethodsPatients who received DB ACLR and ALLR (ALLR group) and who received outside-in DB ACLR (non-ALLR group) were enrolled. Age, BMI, follow-up duration, meniscus repair, laterality, and knee range of motion (ROM) were collected. Lysholm, Tegner scale, and radiological results were compared.ResultsThirty-four and 33 patients were enrolled in the ALLR and non-ALLR groups. Patient demographics were similar between groups. Both groups showed postoperative improvements in Lysholm (ALLR group, 62.5 ± 6.8 preoperatively and 85.1 ± 5.7 postoperatively (p < 0.01); non-ALLR group, 63.5 ± 6.0 preoperatively and 82.9 ± 5.2 postoperatively (p < 0.01)) and Tegner Scale (ALLR group, 4.97 ± 0.52 preoperatively and 7.79 ± 0.41 postoperatively (p < 0.01); non-ALLR group, 4.91 ± 0.58 preoperatively and 7.7 ± 0.47 postoperatively (p < 0.01)) at final follow-up. There were no significant differences between groups preoperatively (Lysholm, p = 0.324, Tegner, p = 0.649) and postoperatively (Lysholm, p = 0.679, Tegner, p = 0.369). The ALLR group exhibited significantly lower percentages of femoral posterolateral bundle tunnel widening (p = 0.021) and a more femoral divergent angle (p < 0.001) than the non-ALLR group. Furthermore, no femoral tunnel coalescence was observed in the ALLR group, while 3% of the non-ALLR group showed coalescence.ConclusionsDB ACLR with ALLR yielded less femoral posterolateral bundle tunnel widening, no femoral tunnel coalescence, and more femoral divergent angle than OI DB ACLR. Both techniques provided good postoperative outcomes. Incorporating ALLR and IB may benefit patients undergoing DB ACLR.Level of evidenceLevel III, Retrospective comparative therapeutic trial.Clinical relevanceDB ACLR with ALLR and IB provides less femoral PL tunnel widening, no femoral tunnel coalescence, and more divergent angles between the two femoral tunnels compared with traditional OI DB ACLR. DB ACLR with ALLR and IB technique provides more flexibility during femoral tunnel preparation.