Journal of Orthopaedic Surgery最新文献

PurposeThis study aimed to evaluate the efficacy and safety of an elastic constriction ring compared to traditional pneumatic tourniquets in patients undergoing surgery for closed distal radius fractures.MethodsA total of 60 participants were enrolled, with 30 in the experimental group (elastic constriction ring) and 30 in the control group (traditional tourniquet). Key indicators assessed included preoperative exsanguination time, intraoperative blood loss, tourniquet-related complications, and so on.ResultsThe experimental group demonstrated a significantly shorter average exsanguination time (8.36 ± 2.72 s vs 55.98 ± 3.61 s) and lower intraoperative blood loss (12.07 ± 6.54 mL vs 17.07 ± 8.29 mL). No significant differences were observed in tourniquet time or operation time between the groups. Besides, adverse events related to the device are minimal in two groups.ConclusionsThe elastic constriction ring is an effective alternative to traditional pneumatic tourniquets, offering significant advantages in reducing exsanguination time and intraoperative blood loss without increasing complication rates.

ObjectivesThis study compared outcomes of primary repair and palmaris longus tendon reconstruction in patients with lateral ulnar collateral ligament (LUCL) injuries.Material and MethodA retrospective comparative cohort study was conducted between 2017 and 2023, including 40 patients who underwent surgery for elbow dislocation or fracture-dislocation with intraoperatively confirmed LUCL injury. Surgical choice was made intraoperatively: repair was performed if the ligament could be reattached without tension, while reconstruction was selected if the tissue was shortened, retracted, or degenerative. Patients were divided into a repair group (n = 17) and a reconstruction group (n = 23). Clinical outcomes included Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Mayo Elbow Performance Score (MEPS), range of motion (ROM), fracture healing, and complications, with a mean follow-up of 26.4 months.ResultsThe repair group showed mean VAS 16.2, QuickDASH 9.7, MEPS 89.9, and ROM 137.2°, while the reconstruction group had VAS 17.2, QuickDASH 8.4, MEPS 89.0, and ROM 133.6°. There were no significant differences in VAS, QuickDASH, or MEPS, though the repair group demonstrated superior ROM (p = 0.029). The absolute ROM difference (∼3-4°) was not considered clinically meaningful. In isolated LUCL cases (n = 15), no significant differences were observed between groups. All associated fractures achieved union without non-union or malunion. Complications included heterotopic ossification in seven patients (three repairs, four reconstructions) and two superficial infections, all successfully managed without reoperation. No patient developed recurrent instability, nerve deficits, or clinically significant stiffness.ConclusionBoth primary repair and palmaris longus tendon reconstruction provided satisfactory outcomes and durable stability. Although the repair group showed slightly greater ROM, this difference was not clinically relevant and disappeared when patients with concomitant fractures were excluded. Injury complexity, rather than surgical technique, appears to be the main determinant of long-term function.

ObjectiveTo evaluate and compare pain management, complication patterns, and functional outcomes between cannulated screw and Kirschner wire fixation for treating pediatric medial epicondylar fractures.MethodA retrospective cohort study was conducted at a tertiary hospital from 2013 to 2023, involving 31 pediatric patients with displaced medial epicondylar fractures (Watson-Jones Types III and IV). Patients were divided into two groups: 16 received cannulated screw fixation, while 15 underwent Kirschner wire fixation. Clinical outcomes, including operation time, fracture healing, pain levels, and complications, were assessed.ResultsBoth groups demonstrated similar long-term functional outcomes, with no significant difference in Mayo Elbow Performance Scores (p > 0.05). The cannulated screw group experienced significantly lower pain on the third postoperative day compared to the Kirschner wire group (p < 0.001). The Kirschner wire group had a higher rate of pin-track infections (13.3%) and delayed union (6.7%), whereas the cannulated screw group had fewer complications, with one case of superficial wound infection. Hardware removal occurred significantly earlier in the Kirschner wire group (p < 0.001).ConclusionBoth fixation methods offer effective treatment for pediatric medial epicondylar fractures, with cannulated screws providing better pain control and fewer complications but requiring longer retention. Kirschner wires allow for earlier removal but carry a higher risk of infection and delayed healing. Treatment decisions should be individualized, considering factors such as pain sensitivity, family preferences, and medical resources.

ObjectiveThe feasibility of placing longer, larger diameter double-threaded screws into the pedicle for good fixation in osteoporotic patients with lumbar spondylolisthesis was investigated via robot-assisted optimal access planning.MethodA total of 80 patients with degenerative lumbar spondylolisthesis needed posterior incision decompression and bone grafting combined with pedicle screw fixation due to spondylolisthesis. The patients were equally and randomly assigned to a robot-assisted group and a bone cement-strengthened group. The operative time, intraoperative blood loss, and intraoperative radiation dose were recorded. X-ray and CT scans were routinely reviewed after the surgery. The ratio of screw diameter to pedicle width (SD/PW) was calculated. The pedicle position was graded. The Bub score assessed proximal facet joint invasion. Visual analogue pain scale (VAS) was recorded before surgery and 3 days after surgery. The Oswestry Disability Index (ODI) and health Survey Summary Form (SF-36 to assess patients' quality of life) were performed before surgery and 6 months after surgery. The rate of screw loosening, removal, complications and revision were evaluated by X-ray and CT 12 months after operation.ResultsVAS score on day 3 after surgery was significantly better in the robot-assisted group than in the bone cement-strengthened group. (p = 0.027). The operative time and intraoperative radiation dose of the robot-assisted group were lower than those of the bone cement-strengthened group (p < 0.001). The ratios of screw length, screw diameter, and SD/PW in both groups were significantly better in the robot-assisted group than in the bone cement-strengthened group (p < 0.001). The incidence of screw small joint invasion was 10.2% in the robot-assisted group and 19.1% in the bone cement-strengthened group, with a statistically significant difference between the two (p = 0.020). The Oswestry Disability Index (ODI) and Health Survey Summary Form (SF-36) at 6 months after surgery were significantly improved in both groups.ConclusionPatients with osteoporotic lumbar spondylolisthesis who use robot assistance to implant longer, thicker-diameter double-threaded screws achieved a similar fixation effect as those of bone cement-reinforced screws. Meanwhile, the operation time was shorter, the radiation damage was less, and the difficulty of later revision surgery was reduced. Thus, the proposed surgical protocol can be applied as a new option for patients with osteoporotic lumbar spondylolisthesis.

BackgroundGamification has emerged as a novel approach in rehabilitation. This systematic review and meta-analysis aimed to evaluate the effectiveness of gamification-based exercises on foot posture in children and adolescents with flatfoot.MethodsA systematic review and meta-analysis were conducted in accordance with PRISMA guidelines, utilizing the PubMed, Scopus, Web of Science, and Google Scholar databases to search for original and peer-reviewed articles with selected keywords from inception to July 2025. The quality of the included studies was assessed using the Joanna Briggs Institute checklist. Statistical analysis was conducted with Comprehensive Meta-Analysis software version 3. To evaluate data heterogeneity, the Q-test and I² statistic were applied. Egger's test was used to assess publication bias.ResultsAfter searching the mentioned databases, 2160 articles were found. Finally, seven articles were included in the current review. It was shown that gamification-based exercise had a significant effect, leading to a reduction in navicular drop (95% CI = -1.796 to -0.516, p = 0.000) and an increase in balance scores (95% CI = -1.647 to -0.462, p = 0.000), compared to the passive control groups that did not receive any intervention. However, no significant differences were seen in the Staheli index (95% CI = -3.298 to 0.023, p = 0.053). High heterogeneity was noted in the navicular drop test (95% CI = -2.412 to -0.603, p = 0.001). Egger's test indicated no statistically significant publication bias for either navicular drop (p = 0.080) or Staheli index (p = 0.210).ConclusionThe results showed that exercise with gamification may be effective in improving foot alignment in children and adolescents. Specifically, positive effects were evident when using the navicular drop test, whereas no significant changes were detected with the Staheli index. However, interpretation should be made cautiously due to the limited number of studies and lack of age or gender stratification.

Study designA retrospective study.ObjectivesThis study aimed to evaluate the clinical and radiological outcomes of pedicle subtraction osteotomy (PSO) at L2 and L3 levels in ankylosing spondylitis (AS) patients with similar kyphotic deformities. The primary focus was to compare these levels in terms of spinal alignment, sagittal balance, and functional improvements.MethodsA retrospective analysis was conducted on 28 AS patients who underwent L2 or L3 level PSO between 2010 and 2021. Patients were divided into two groups based on osteotomy levels (14 in each group) and matched for similar kyphosis angles and deformity patterns. Radiological parameters, including pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), global kyphosis (GK), spinosacral angle (SSA), sagittal vertical axis (SVA), osteotomized vertebral angle (OVA) were measured preoperatively, immediately postoperatively, and at final follow-up using SURGIMAP. Functional outcomes were assessed using VAS, ODI, and BASFI scores.ResultsBoth groups showed significant improvements in sagittal alignment parameters such as PT, LL, and SVA postoperatively (p < 0.01). The L3 group demonstrated better sagittal balance, achieving the recommended SVA value (<47 mm) at follow-up, while the L2 group did not. There was no significant difference in radiological parameters between the groups (p > 0.05). Functional outcomes, including VAS, ODI, and BASFI scores, improved significantly in both groups (p < 0.001), with no significant differences between them.ConclusionsL2 and L3 PSO levels yielded comparable radiological and functional outcomes in AS patients with similar curve patterns. Both levels can be effectively utilized for correcting rigid kyphotic deformities, with L3 providing slightly better sagittal balance.

PurposeKnee joint fibrosis after anterior cruciate ligament (ACL) reconstruction causes dysfunction and requires precise quantification. Magnetic resonance imaging (MRI) is the primary method but has limitations like high cost and long scan times. Computed tomography (CT) offers better accessibility and speed, but its reliability remains unverified. This study compares CT and MRI for quantifying fibrosis volume post-ACL reconstruction.Methods18 fibrosis patients underwent same-day CT (1.0-mm and resliced 3.5-mm) and MRI (3.5-mm). Two observers measured fibrotic volume via three-dimensional (3D) reconstruction. Standardized regions of interest (ROI) were delineated to measure total and regional fibrotic volumes across three imaging modalities: 1.0-mm CT, 3.5-mm CT, and 3.5-mm MRI. Statistical analyses included intraclass correlation coefficient (ICC), Pearson's correlation coefficient, Bland-Altman analysis, one-way ANOVA, and paired-sample t-tests.ResultsBoth Pearson correlation coefficients and ICC values between the two observers exceeded 0.9, indicating excellent correlation and agreement. Bland-Altman analysis showed low mean inter-observer differences (-1.29% to 2.78%). For comparisons between imaging modalities with identical slice thickness (3.5-mm CT vs 3.5-mm MRI), the mean differences were minimal (-3.02% to 1.06%) with Pearson correlation coefficients >0.9. ANOVA analysis revealed no significant differences, demonstrating excellent agreement between CT and MRI. Although 1.0-mm CT did not show statistically significant differences in ANOVA analysis compared to the other two modalities, its thinner slice thickness provided more detailed visualization, resulting in significantly higher volume measurements in Bland-Altman analysis. Nevertheless, it maintained excellent correlation (Pearson's > 0.9) with both 3.5-mm CT and MRI.ConclusionThis study provides a method to quantify anterior knee fibrosis. CT is a feasible tool with performance comparable to MRI. Further studies are needed for multi-regional assessment and integration with other imaging or functional parameters.

BackgroundGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for obesity and type 2 diabetes mellitus (T2DM). While their metabolic benefits are well-established, their impact on postoperative outcomes following total joint arthroplasty (TJA) remains controversial. This study aimed to systematically evaluate the association between GLP-1 RA use and postoperative outcomes in patients undergoing total hip (THA), knee (TKA), or shoulder arthroplasty (TSA).MethodsWe conducted a PRISMA-compliant systematic review and meta-analysis across PubMed, Embase, Web of Science, and Scopus through April 24, 2025. Eligible retrospective cohort studies compared adults undergoing TJA with and without preoperative GLP-1 RA exposure. Primary outcomes were 90-day readmission and all-cause revision. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were calculated under random-effects models. Subgroup analysis based on the type of arthroplasty was conducted where applicable.ResultsFourteen studies (total sample size of 365,154; including 62,117 (17.01%) GLP-1 consumers, and 303,037 (82.98%) control cases) met the inclusion criteria (All studies included primary TJA cases). GLP-1 RA use was associated with lower 90-day readmission (OR = 0.86, 95% CI: 0.74-0.99, p = 0.033) and reduced sepsis incidence (OR = 0.63, 95% CI: 0.46-0.88, p = 0.006). No significant differences were observed for all-cause revision, thromboembolic events, and other medical and surgical complications. Length of stay was marginally shorter in GLP-1 users (SMD = -0.09, p = 0.048). Subgroup analyses showed the strongest sepsis reduction in TSA.ConclusionGLP-1 RA use before TJA is associated with reduced readmission and sepsis risk without increasing surgical or thromboembolic complications. These findings support the potential perioperative benefits of GLP-1 RAs, warranting prospective trials to confirm causality and define optimal perioperative strategies for high-risk arthroplasty patients.

ObjectivesPlantar calcaneal spur (PCS) is a bony outgrowth of the calcaneal tuberosity frequently associated with chronic heel pain. Although its precise etiology remains uncertain, mechanical stress and repetitive traction forces are frequently implicated. Haglund's deformity, defined as a bony enlargement on the posterosuperior calcaneus, results in retrocalcaneal impingement of the Achilles tendon. While both conditions involve stress-related alterations of the calcaneus, their potential association has not been clearly established. This study aimed to evaluate the relationship between PCS and Haglund's deformity by determining the incidence of Haglund's deformity in symptomatic PCS patients and investigating associated factors.MethodsIn this retrospective case-control study, 377 patients aged ≥18 years who underwent weight-bearing lateral foot radiographs between March 2023 and March 2024 were included. The case group (n = 94) consisted of patients with symptomatic PCS, and the control group (n = 283) comprised patients without PCS. Haglund's deformity was assessed radiographically using the BRINK angle, with values >20° considered diagnostic. Demographic characteristics and comorbidities were analyzed.ResultsHaglund's deformity was significantly more prevalent in the PCS group (62/94; 66.0%) compared with controls (53/283; 18.7%) (p = 0.001). Diabetes mellitus showed a significant association with Haglund's deformity (p = 0.01). No significant differences were observed in age, sex, body mass index, or other comorbidities.ConclusionOur findings demonstrate a strong radiological association between PCS and Haglund's deformity, suggesting shared biomechanical stress pathways involving the plantar fascia and Achilles tendon. Prospective studies incorporating biomechanical evaluation are warranted to clarify underlying mechanisms and clinical implications.

PurposeThis study investigates the efficacy of antibiotic-loaded bone cement followed by autogenous iliac bone grafting in managing subacute/chronic phalangeal osteomyelitis (OM), focusing on infection eradication, reconstruction of bone defects, and functional restoration.MethodsWe conducted retrospective analysis involving 14 patients treated between September 2007 and November 2023, with a mean follow-up duration of 18.21 months. The treatment protocol involved staged procedures, beginning with debridement and bone cement insertion, followed by cement extraction and autogenous bone grafting.ResultsComplete infection resolution was achieved for all patients, and radiological evidence of bone union was observed within an average of 46.93 days. Bone defects measured between 10 and 30 mm; most patients received cancellous bone grafts, although cortico-cancellous grafts were utilized in four cases. Functional outcomes, evaluated through the Quick disabilities of the arm, shoulder, and hand questionnaire, demonstrated marked improvement (49.78→10.33). The mean total active motion of the affected digits was 82.14%, with a majority attaining functional use. No cases of recurrent infection were identified, and the staged surgical method demonstrated effectiveness for digit preservation, including those with bone loss exceeding 10 mm.ConclusionThe authors suggest antibiotic-loaded bone cement insertion followed by autogenous iliac bone grafting can be a highly reliable and reproducible intervention for subacute/chronic phalangeal OM. We advocate this approach as a treatment option for phalangeal OM.