Background: To determine whether an integrated dual-lag-screw (IDLS) cephalomedullary nail (CMN) confers superior clinical and mechanical outcomes compared with single-lag-screw (SLS) designs in the fixation of intertrochanteric femoral fractures.
Methods: Seven databases (MEDLINE, Embase, Cochrane CENTRAL, Web of Science, Google Scholar, ClinicalTrials.gov) were searched from inception through 20 January 2025 following PRISMA guidelines. Randomized trials and comparative observational studies of adult intertrochanteric or subtrochanteric extension fractures treated with IDLS versus SLS nailing and ≥ 6 months follow-up were eligible. Twenty-nine studies met all criteria. Three reviewers independently screened studies, extracted data, and graded quality (ROB-2 for randomized controlled trials, MINORS for non-randomized studies). Random-effects meta-analysis produced pooled odds ratios (OR) for binary outcomes; heterogeneity was assessed with I². Publication bias was explored with funnel plots, trim-and-fill, and Egger's test.
Results: The 29 studies encompassed over 20,000 fractures. Compared with SLS nails, IDLS fixation was associated with significantly fewer implant-related complications (OR 0.55, P = .01), instances of lag-screw cut-out (OR 0.44, P = .016), and cases of lateral hip or thigh pain (OR 0.50, P < .01). In the unstable-fracture subgroup, IDLS nails similarly showed lower odds of implant-related complications (OR 0.38, P < .001), revision surgeries (OR 0.37, P = .005), mechanical failure (OR = 0.19, P < .001), cut-out (OR = 0.19, P < .001) and post-operative hip/thigh pain (OR = 0.47, P < .006) compared to SLS nails. No significant evidence of publication bias was detected. Operative time, blood loss, union rate, and 1-year Harris Hip Score were comparable between constructs.
Conclusions: IDLS CMNs demonstrated markedly lower rates of mechanical failure, revision surgery, and lateral hip/thigh pain, especially in unstable intertrochanteric fracture patterns. These findings support preferential use of IDLS implants in geriatric fragility hip fractures.
Level of evidence: Level IV Therapeutic.
Objective: This study aimed to quantify and compare the learning curves of percutaneous endoscopic interlaminar discectomy (PEID) and unilateral biportal endoscopic discectomy (UBED) for lumbar disc herniation (LDH), using operative time and clinical outcomes as primary metrics.
Methods: This study retrospectively reviewed 158 consecutive patients with lumbar disc herniation (LDH) who underwent endoscopic lumbar discectomy from 2022 to 2024. The patients were categorized into two groups: PEID group (n = 93) and UBED group (n = 65). The learning curve for each technique was evaluated using cumulative sum (CUSUM) analysis. Surgical failure was defined as the occurrence of either complications or a lack of symptom relief. Patient and surgical variables were then compared across the distinct phases of the learning curve.
Results: CUSUM analysis demonstrated distinct learning curves for PEID and UBED, with identified cut-off points at 45 and 31 cases, respectively. Upon reaching the mastery phase, the mean operative time decreased significantly by approximately 17 min for PEID and 18 min for UBED. The surgical failure rate did not differ significantly between the initial and mastery phases in either group. Notably, both techniques resulted in significant postoperative improvements in clinical outcomes, as evidenced by the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores at the final follow-up compared to preoperative baselines.
Conclusion: Both PEID and UBED demonstrated comparable effectiveness and low complication rates in the treatment of LDH. Notably, the learning curve analysis revealed that achieving procedural proficiency required 45 cases for PEID, compared to 31 cases for UBED.
Purpose: This study aimed to identify radiographic and demographic predictors influencing the intraoperative decision for cemented versus cementless humeral fixation in patients ≤ 80 years undergoing short-stem reverse shoulder arthroplasty (RSA).
Methods: A retrospective analysis was conducted on RSA cases between 02/2019 and 10/2024. Patients ≤ 80 years were stratified into Group A (cementless fixation; n = 209) or Group B (cemented fixation; n = 58) based on intraoperative assessment of trial stem stability and bone quality. Preoperative variables included age, sex, body mass index (BMI), American Society of Anesthesiologists score (ASA), diagnosis, and radiographic parameters such as cortical bone thickness gauge (CBTg), average cortical thickness (CBTavg), acromiohumeral distance (AHD), and Hamada and Walch classifications. Multivariate logistic regression including age, sex, CBTavg, CBTg, and diagnosis was performed to identify independent predictors of cemented fixation.
Results: Patients in the cemented group were significantly older (74.0 ± 4.2 vs. 70.0 ± 6.1 years; p < 0.05) and more often female (81% vs. 61%; p < 0.05). Cortical bone measurements were significantly lower in the cemented group (CBTg: 0.25 ± 0.06 vs. 0.27 ± 0.06; CBTavg: 5.15 mm ± 1.23 mm vs. 6.42 mm ± 1.43 mm; both p < 0.05). Multivariate analysis identified increasing age (OR: 1.1; p < 0.05), female sex (OR: 2.8; p < 0.05), and reduced CBTavg (OR: 0.6; p < 0.05) as independent predictors of cemented fixation. Other variables such as BMI, ASA score, AHD, and CBTg did not show significant associations with fixation type.
Conclusion: Among all evaluated factors, lower CBTavg was the strongest independent predictor for the use of cemented humeral fixation in short-stem RSA. Its integration into preoperative planning may assist surgical decision-making and improve consistency in fixation strategy.
Study design: Level IV; retrospective case series.
Background: Marijuana use is rising in the United States, yet its impact on perioperative outcomes remains poorly understood, particularly in orthopaedic trauma where cessation is often not feasible. This study evaluates the risks associated with cannabis and nicotine use in patients undergoing fixation of upper extremity fractures.
Methods: We performed a retrospective analysis of adult trauma patients with upper extremity fractures (2015-2023) identified using CPT codes for surgical fixation in the TriNetX database. Four cohorts were defined: cannabis-only users (n = 801), nicotine-only users (n = 14,310), concurrent users (n = 901), and non-users matched 1:1 to each exposure cohort. Propensity score matching was applied to each pairwise comparison. Primary outcomes were surgical and medical complications; secondary outcomes included new postoperative psychosocial diagnoses (anxiety, depression, opioid use disorder, and chronic pain) and coagulation parameters. Binary outcomes were compared using absolute risk differences, risk ratios, odds ratios, and 95% confidence intervals; continuous outcomes with independent t-tests, all assessed within 1 year following surgery.
Results: Cannabis-only users had significantly higher rates of implant-related infection, reoperation, readmission, depression, and anxiety compared with non-users (p < 0.05). Nicotine-only users demonstrated higher odds ratios in most overlapping outcomes and showed significantly elevated rates across a broader range of complications, including superficial and deep infection, nonunion or malunion, wound dehiscence, pneumonia, chronic pain, mortality, and psychosocial complications. Concurrent users did not demonstrate additive risk compared with cannabis-only users.
Conclusion: Cannabis and nicotine use were independently associated with increased postoperative complications following fixation of upper extremity fractures compared with matched non-user controls. The absence of statistically significant additive effects may reflect limited power to detect modest interactions, overlapping biological mechanisms, or a true absence of synergy. These findings support standardized screening, risk stratification, and targeted perioperative strategies, including extended antibiotic prophylaxis and integrated psychosocial support, to reduce complications in this at-risk population.
Objective: To evaluate the mid- to long-term clinical outcomes of all inside arthroscopic suture lateral meniscal allograft transplantation (MAT) combined with different cartilage repair techniques, microfracture (MF) or osteochondral autograft transplantation systems (OATS), in the treatment of lateral meniscal deficiency with concomitant lateral compartmental chondral lesions of the knee.
Methods: A retrospective study was conducted on 22 patients who underwent arthroscopic lateral MAT combined with cartilage repair between June 2013 and December 2020 in the First Affiliated Hospital of Chongqing Medical University. All patients were diagnosed preoperatively by MRI and confirmed via arthroscopy to have lateral meniscal deficiency with local cartilage lesions of the lateral femoral condyle. The cartilage defects were less than 2 cm2 in size and classified as ICRS grade III-IV. Based on lesion characteristics, patient age, and activity level, either MF or OAT was performed in combination with lateral MAT. Postoperative assessments included knee function (Lysholm and Tegner scores), pain levels (VAS score), and MRI evaluation of meniscal graft integrity and cartilage repair status.
Results: All patients completed the follow-up. Lysholm, Tegner, and VAS scores improved significantly at 6 months, 1 year, 2 years, and 5 years postoperatively compared to preoperative values (P < 0.05), with sustained improvement observed through the final follow-up. MRI showed intact meniscal grafts in 20 cases (90.9%), while graft failure due to tear was identified in 2 cases. The overall rate of excellent or good cartilage repair (ICRS grading) was 59.1% (13/22). No major complications such as infection or common peroneal nerve injury were observed.
Conclusion: Lateral meniscal allograft transplantation combined with microfracture or osteochondral autograft transplantation with all inside arthroscopic suture is a safe and effective treatment for patients with lateral meniscal deficiency and small-to-moderate local cartilage lesions, yielding sustained improvement in knee function, pain relief, and cartilage repair outcomes in the mid- to long-term.
Background: The unique vulnerability of the neonatal joint to septic arthritis poses a substantial risk for lifelong musculoskeletal disability. Precise estimates of long-term functional outcomes are crucial for prognostication and clinical decision-making, yet robust pooled data remain scarce. This systematic review and meta-analysis was therefore conducted to determine the aggregate rate of favorable prognosis in neonates following septic arthritis.
Methods: We queried four major databases (PubMed, Embase, Cochrane Library, and Web of Science) from inception until September 2025 to identify studies reporting Prognostic outcomes of neonatal septic arthritis. The primary outcome was the pooled rate of favorable prognosis, defined as normal/near-normal joint function, synthesized under a random-effects model. Heterogeneity was quantified (I2 statistic), and we explored its sources via pre-specified subgroup analyses and sensitivity analyses.
Results: Thirteen studies (258 patients) were included. The pooled rate of favorable prognosis was 69.7% (95% CI: 60.5-77.7). Significant heterogeneity (I2 = 40.9%) was observed. Subgroup analyses identified longer follow-up (> 2 years), non-hip joint involvement, and prompt intervention (≤ 7 days) as significant positive predictors of outcome.
Conclusion: Approximately one-third of infants with neonatal septic arthritis experience adverse sequelae. Prognosis is significantly influenced by follow-up duration, anatomic site of involvement (particularly the hip), and the timeliness of intervention. These findings highlight the paramount importance of early diagnosis and urgent treatment, providing crucial evidence for family counseling and structuring long-term follow-up protocols.
Background: The selection of graft remains a subject of ongoing debate in anterior cruciate ligament (ACL) reconstruction, with distinct maturation processes having been observed among different graft types. A thorough understanding of these differences in graft maturation is crucial for optimizing rehabilitation protocols and ensuring a safe return to sports. This study aimed to systematically review the differences in graft maturation among different graft types following ACL reconstruction.
Methods: A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included only if they compared intra-articular ACL graft maturity across different graft types.
Results: Twenty-one studies met the inclusion criteria. Graft maturity was assessed using magnetic resonance imaging (MRI) in 15 studies, second-look arthroscopy in 4 studies, and histological biopsy in 1 study; one additional study utilized both MRI and second-look arthroscopy. Hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts showed similar maturity, as assessed by MRI signal intensity (SI) and histological findings, after ACL reconstruction. However, results from second-look arthroscopy were inconclusive. HT autografts exhibited MRI SI comparable to soft-tissue allografts within the first postoperative year, but demonstrated superior maturity and graft appearances at approximately 2 years postoperatively. Quadriceps tendon (QT) autografts, both with and without a patellar bone block, revealed lower MRI SI compared to HT autografts, suggesting better graft maturity. HT autografts with preserved tibial insertion maintained relatively lower SI during the early maturation phase (6 and 12 months) than free HT autografts, though no significant differences were observed at later stages (24 and 60 months).
Conclusion: MRI, second-look arthroscopy, and histological biopsy analysis indicated distinct graft maturation levels following ACL reconstruction. No conclusive evidence established whether HT or BPTB autografts are superior in terms of graft maturity. Compared to free HT autografts and soft-tissue allografts, QT autografts and HT autografts with preserved tibial insertion may mature earlier, which may allow for consideration of an earlier return to sports in clinical decision-making. These grafts may therefore represent viable alternatives to HT and BPTB grafts, particularly in young and active patients.
Level of evidence: III, systematic review of level Ⅰ-Ⅲ investigation.
Background: This study evaluated the long-term clinical and radiological outcomes of operatively treated scapular fractures using the tissue-sparing posterior Brodsky approach. We hypothesized that osteosynthesis using this approach would yield favorable functional outcomes.
Methods: This retrospective study included patients with acute scapular fractures treated operatively using the posterior Brodsky approach from January 2015 to December 2019. Radiologic evaluation included fracture classification and fracture union. Functional outcomes were assessed using the Constant-Murley Score (CMS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Shoulder Pain and Disability Index (SPADI), Visual Analogue Scale (VAS), and range of motion. Postoperative complications were documented.
Results: A total of 16 patients with a mean follow-up of 6.3 years were included. The cohort included both extra-articular and intra-articular fracture patterns, with associated injuries such as coracoid fractures. All fractures achieved radiographic union. The mean Constant-Murley Score was 75 ± 14 points, the SPADI score was 85 ± 15, the DASH score was 15 ± 15, and the mean VAS score was 2 ± 1. Shoulder motion was largely preserved, with a mean external rotation of 70° ± 12°. Postoperative complications were observed in one patient due to incorrect screw placement during coracoid fracture fixation. Five patients required a staged surgical procedure due to associated coracoid fractures.
Conclusions: Operative treatment of scapular fractures using a tissue-sparing posterior approach was associated with favorable long-term functional outcomes, preserved shoulder motion, low pain levels, and reliable fracture union, with a low complication rate, even in cases requiring staged procedures due to associated injuries.
This study aimed to determine whether patient-specific 3D-printed guide plates enhance femoral tunnel placement accuracy, reduce operative time, and promote faster functional and kinematic recovery in medial patellofemoral ligament (MPFL) reconstruction compared to conventional techniques. Prospective, randomized controlled trial. Single academic tertiary care hospital. Sixty patients diagnosed with recurrent patellar dislocation were enrolled and randomly assigned to either a 3D-printed guide plate group (n = 30) or a conventional fluoroscopy-guided group (n = 30). Patients in the intervention group underwent MPFL reconstruction assisted by customized 3D-printed guide plates for femoral tunnel placement. The control group received conventional fluoroscopy-assisted MPFL reconstruction. Both groups followed an identical rehabilitation protocol postoperatively. Primary outcomes included operative time, femoral tunnel placement accuracy (distance from the Schöttle point), knee function scores (Lysholm, Kujala, Tegner, IKDC), and 3D gait kinematics using the Opti-Knee system. Knee function scores were assessed preoperatively at 3, 6, and 12 months, and 3D gait kinematics were tested preoperatively at 3, 6, 9, and 12 months. The 3D-printed group had significantly shorter operative times (68 ± 12 min) than the conventional group (85 ± 16 min; p < 0.05). Femoral tunnel deviation was lower in the 3D group (5.42 ± 2.29 mm) compared to controls (7.65 ± 2.47 mm; p < 0.001). Functional scores were higher in the 3D group at 3 and 6 months (p < 0.05), and flexion-extension kinematics normalized by 6 months in the 3D group compared to 12 months in controls. 3D-printed guide plates improve femoral tunnel accuracy and reduce surgical time, accelerating early functional recovery. These findings support their clinical utility as a superior alternative to conventional guidance methods.
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