Journal of Orthopaedic Surgery最新文献

BackgroundTo investigate the clinical utility of shear wave elastography (SWE) in the diagnosis and prognostic evaluation of acute anterior talofibular ligament (ATFL) injuries.MethodsThis prospective cohort study enrolled 46 patients with unilateral acute ATFL injuries and 32 age and gender-matched healthy volunteers. All patients underwent B-mode ultrasonography and SWE within 48 h post-injury and at 3 month post-rehabilitation. Quantitative assessments included ATFL thickness, Young's modulus, shear wave velocity (SWV), vascular perfusion, and echotextural characteristics.ResultsDuring the acute phase (≤48 h), injured ATFLs exhibited significantly greater thickness compared to contralateral and healthy control ligaments (3.54 ± 0.68 mm vs 2.15 ± 0.22 mm and 2.31 ± 0.16 mm, respectively; p < .05), alongside markedly reduced Young's modulus and SWV. Biomechanical parameters were consistently elevated in plantarflexion-inversion versus neutral positioning. At 3-month follow-up, elastic parameters normalized substantially, with restoration of ligamentous thickness and vascular perfusion eliminating intergroup differences. The dynamic trajectory of SWE metrics paralleled structural recovery patterns.ConclusionSWE quantitatively evaluates biomechanical integrity and recovery progression in acute ATFL injuries. Combined with B-mode ultrasonography, SWE provides a robust imaging framework for diagnosis, longitudinal monitoring, and prognostic stratification, demonstrating significant clinical value in musculoskeletal trauma management.

ObjectiveThis study assesses the clinical efficacy and safety of combining traditional Chinese medicine (TCM) external therapy (Xiaozhong Zhitong ointment) with volar locking plate (VLP) fixation for treating complex AO-C2/3 distal radius fractures.MethodsSixty patients with complex AO-C2/3 distal radius fractures were randomly assigned into two groups (n = 30 each). The control group received standard VLP fixation alone, while the study group additionally received external application of Xiaozhong Zhitong ointment postoperatively. Clinical endpoints included Visual Analogue Scale (VAS) score, swelling condition, Cooney scores, Generic Quality of Life Inventory-74 (GQOL-74) score, radiographic parameters (palmar tilt, ulnar variance, radial height, joint surface displacement), wrist joint mobility (flexion, extension, pronation, supination, radial and ulnar inclination), and incidence of complications.ResultsCompared to the control group, at 2- and 4-weeks postoperatively, the study group showed lower VAS scores and swelling levels (p < 0.05). The study group also exhibited higher Cooney scores at 4 weeks and 6 months postoperatively and excellent-good rate of Cooney scores at 6 months postoperatively. Additionally, the study group demonstrated better GQOL-74 scores across all dimensions at 6 months postoperatively, along with improved imaging parameters (palmar tilt, ulnar deviation, joint surface displacement) and greater wrist flexion range of motion at 12 months postoperatively (all p < 0.05). There was no significant difference in complication rates between the two groups (p > 0.05).ConclusionCombining Xiaozhong Zhitong ointment with VLP fixation improves outcomes for complex distal radius fractures, reducing pain and swelling, enhancing quality of life and wrist function, with no added complication risk, making it a potential adjunct to standard care.

ObjectiveTo investigate the clinical efficacy of selective versus dual-segment fusion in the treatment of bi-segmental lumbar spinal stenosis with segmental instability using spinal endoscopy.MethodsA retrospective analysis was conducted on 49 patients with bi-segmental degenerative lumbar disease who underwent endoscopic spinal surgery at our institution between October 2022 and June 2025. In the selective fusion group (n = 27), fusion was performed on the unstable segment and decompression was performed on the other segment. Both segments underwent fusion in the dual-segment fusion group (n = 22). Surgical time, intraoperative blood loss, hospital stay, Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) fusion rate, and functional improvement were compared.ResultsThe selective fusion group had a significantly shorter operative time and lesser blood loss than the dual-fusion group (p < 0.05). Postoperative hospital stay did not differ significantly between groups. Both groups demonstrated significant postoperative improvements in VAS and ODI scores (p < 0.001), with no intergroup differences. At 12 months, Bridwell Grade I-II fusion rates were comparable between the two groups (93.3% vs 90.9%, p > 0.05). The fusion rates and functional outcomes were comparable.ConclusionIn patients with bi-segmental lumbar stenosis and single-segment instability, Selective fusion under endoscopic guidance provides comparable clinical and radiological outcomes to dual-segment fusion, with reduced operative trauma and faster recovery. This minimally invasive strategy effectively balances surgical stability with functional preservation and warrants broader clinical application.

PurposeOlecranon fractures and osteotomies worldwide are commonly stabilized using tension band wiring (TBW), traditionally tightened with two knots to achieve optimal compression. However, soft tissue irritation and technical issues have led to the adoption of a simplified single-knot technique. This study aimed to compare compression forces at the medial, lateral, and ventral osteotomy surface between single- (SKO) and double-knot osteosynthesis (DKO) using ultra-thin custom pressure sensors.MethodsStandardized V-shaped olecranon osteotomies were performed on composite ulnas and fixed with TBW using either SKO or DKO, each performed 10 times. Three pre-calibrated pressure sensors were placed medially (PM), laterally (PL), and ventrally (PV) on each specimen. A 1.25 mm cerclage wire was tightened using a 0.45 Nm torque limiter. Compression forces were compared between SKO and DKO using t-tests, and intra-group differences assessed compression symmetry.ResultsNo significant differences in PM, PL, or PV were found between SKO and DKO (p = .62, .89, .20). In both groups, ventral pressure was significantly lower than medial and lateral (p < .001), and lateral pressure exceeded medial in both SKO (p = .003) and DKO (p = .004).ConclusionSingle-knot TBW provides comparable compression to the traditional double-knot technique, challenging the standard approach. Given its simplicity and similar biomechanical performance, SKO may offer a viable alternative, warranting further clinical evaluation regarding outcomes and complication rates.

BackgroundThis study aimed to investigate the effect of topical administration of TXA on blood loss and hematologic parameters following RSA.MethodsThis retrospective study included 111 patients who underwent RSA mainly for cuff tear arthropathy and massive rotator cuff tears between November 2014 and September 2021, excluding patients with proximal humerus fractures, of whom 52 received TXA (TXA group) and 59 did not receive TXA (non-TXA group). In the TXA group, 1 g of TXA was administrated topically in the subacromial space after skin closure. Hematological parameters were assessed preoperatively and at postoperative days 3, 7, and 14. Intraoperative blood loss, surgical drain volume, calculated total blood loss, blood transfusion, and venous thromboembolic events were compared.ResultsThere was no significant difference in intraoperative blood loss between the groups. Calculated blood loss and total surgical drain volume were significantly lower in the TXA group than the non-TXA group (843 ± 334 mL vs 1051 ± 391 mL and 213 ± 142 mL vs 389 ± 164 mL,p < 0.01 and p < 0.01, respectively). In the non-TXA group, hemoglobin (Hb) and hematocrit (Hct) values decreased until postoperative day 7 before increasing at postoperative day 14; in the TXA group, these values decreased at postoperative day 3 and then increased up to postoperative day 14. No thromboembolic event occurred in either group.ConclusionsThe present results showed that topical administration of TXA in RSA reduced blood loss without adverse events and promoted the early recovery of hematologic parameters.

BackgroundIn many countries, disposable high-value consumables are sterilized and reused for economic reasons. We aimed to study the feasibility and ways to reduce potential risks of reusing these consumables in shoulder arthroscopy.MethodsWe reported cases with complications potentially related to reusing high-value consumables. We evaluated the outflow water temperature from new and reused radiofrequency (RF) devices of different brands and under varying surgical practices. We also conducted fatigue tests on suture-passing needles from different brands subjected to various disinfection methods.ResultsReused RF devices from MECHAN demonstrated significantly higher peak temperature (PT) (68.3 ± 2.3°C vs 63.9 ± 3.0°C, P < 0.001) and peak sustaining temperature (PST) (62.6 ± 2.3°C vs 58.5 ± 3.1°C, P < 0.001) compared to new devices. The mean flow rate of MECHAN devices was higher than that of DePuy (63.2 ± 8.2 ml/min vs 42.0 ± 11.1 ml/min, P < 0.001). Ethylene oxide disinfection did not significantly affect the excitation times before fatigue fracture of Arthrex (291.6 ± 76.9 vs 305.1 ± 86.6, P = 0.717) and DePuy (173.3 ± 26.8 vs 174.6 ± 31.7, P = 0.922) suture-passing needles. High-pressure steam disinfection also did not markedly affect the fatigue time of Arthrex (291.6 ± 76.9 vs 292.0 ± 65.7, P = 0.990) and DePuy (173.3 ± 26.8 vs 168.8 ± 36.1, P = 0.755) suture-passing needles.ConclusionsFor both RF devices and suture-passing needles, being reused after ethylene oxide disinfection for appropriate times can be feasible and safe if surgeons and disinfection suppliers exercise caution.

Level of EvidenceLevel III - Retrospective Cohort Study.BackgroundMusculoskeletal lesions commonly present as pain, masses, or incidental imaging findings. Accurate diagnosis is critical for treatment planning. Although open biopsy was historically considered the gold standard, core needle biopsy (CNB) has emerged as a minimally invasive and reliable diagnostic method with a favorable safety profile. The primary objective was to determine the diagnostic accuracy of image-guided core needle biopsy (CNB) for musculoskeletal lesions.MethodsWe conducted a retrospective analysis of 426 patients who underwent image-guided CNB for musculoskeletal lesions at a single tertiary referral center between January 2014 and December 2020. Patient demographics, biopsy characteristics, and diagnostic outcomes were analyzed. Diagnostic performance was evaluated using sensitivity, specificity, predictive values, and area under the ROC curve (AUC).ResultsMost patients were adults (82.4%) and male (56.6%). The lower limb was the most common biopsy region (43.2%), with the trunk (26.3%), upper limb (15.5%), and pelvis (14.3%) following in order of frequency. CNB demonstrated a sensitivity of 98.8%, specificity of 72.3%, negative predictive value of 99.0%, and overall accuracy of 82.3% (AUC = 0.855).ConclusionImage-guided CNB provides high diagnostic sensitivity and excellent negative predictive value for musculoskeletal lesions, with a very low complication rate. While it is effective as a first-line diagnostic tool, limitations remain in specificity and tumor subtype confirmation, particularly in heterogeneous or necrotic lesions. Standardized protocols and multidisciplinary interpretation are essential to optimize accuracy.

IntroductionProximal tibia osteotomy has advanced with various techniques, such as dome and modified oblique osteotomies, to correct angular deformities and redistribute knee stress, thereby slowing arthritic progression. Despite advancements, a gap remains in understanding the biomechanical strengths of these techniques, especially concerning correction angles. The study aims to compare the stability of the construct for different degrees of osteotomy.Materials and methodsEighteen synthetic tibias were osteotomised based on the dome and modified oblique osteotomy technique. For dome osteotomy, the osteotomy site was fixed with two Kirschner wires 2.0 mm for different degrees of osteotomy, which were 10^o, 20^o, and 30^o. Three samples from each construct were tested for rotational force. For modified osteotomy, two screws 3.5 mm were used to fix the osteotomy site and tested for rotational forces.ResultsThe constructs were stiffest at ten degrees for rotational force, both in dome and modified oblique osteotomy (0.39 Nmm and 0.4 Nmm). The stiffness of dome osteotomy in correction angles of 10° and 20° is almost similar (p > 0.95), and it reduces significantly at 30°(p < 0.001). There were significant differences in stiffness of the oblique osteotomy construct when comparing 10° with 20° (p = 0.003), 10° with 30°(p < 0.001) and 20° with 30° (p < 0.001) correction angles. This is further proved by comparing the means of stiffness between the two methods, where dome osteotomy did better compared to modified oblique osteotomy at 20° and similar at 10°.ConclusionIn performing proximal tibia osteotomy, we recommend limiting the acute angle of correction to 20°, and we suggest that for a larger correction angle, dome osteotomy exhibits better biomechanical stiffness. An angle exceeding 30^o will predispose to higher rate of non-union or malunion as the stiffness of the surgical construct drops significantly, making it less resistant to rotational forces.