Journal of orthopaedics最新文献

Clinical impact of acetabular defect severity on hip center of rotation restoration in revision total hip arthroplasty 髋臼缺损严重程度对改良全髋关节置换术中髋关节旋转中心恢复的影响

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-01-29 DOI: 10.1016/j.jor.2026.01.015

Victor Rafael Casas Gállego , Miguel Angel Ortega Núñez , Basilio José de la Torre Escuredo

Background

Acetabular revision is a challenging procedure, especially in patients with large defects. This study aimed to evaluate how the severity of acetabular bone loss influences reconstruction of the center of rotation (COR) and how the COR influences clinical outcomes and patient-reported outcome measures (PROMs).

Methods

Patients who underwent acetabular revision at a tertiary hospital from January 2013 to December 2018 were included. Patients were grouped according to the Paprosky and Saleh classifications. To determine the COR, we applied the method described by Fessy. The Harris Hip Score (HHS), Western Ontario McMaster Arthritis Index (WOMAC) and Short Form 12 (SF-12) were used to determine clinical outcomes and PROMs at a median of 41 months of follow-up. A total of 117 acetabular revisions were performed. The Paprosky classification was I for 54 acetabular defects (46.15 %); II for 36 acetabular defects (30.76 %); and III for 27 acetabular defects (23.07 %). The Saleh classification was as follows: I for 54 (46.15 %); II for 26 (22.22 %); III for 19 (16.23 %); IV for 16 (13.67 %) and V for 2 (1,7 %) acetabular defects.

Results

The percentage of patients who achieved an appropriate COR was 60.1 % according to the Fessy method. This method showed a statistically significant association between the severity of the acetabular defect and the ability to accurately reconstruct the center of rotation. Similarly, no differences were observed in patients’ functional outcomes (HHS, WOMAC, and SF-12 scores) based on whether the hip center of rotation was restored. Likewise, no differences were found in complication rates regardless of COR restoration or the degree of bone loss

Conclusion

These findings suggest that, in complex acetabular revisions, prioritizing stable fixation and bone preservation rather than perfect anatomic restoration of the center of rotation does not adversely affect functional outcomes.

背景：髋臼翻修是一项具有挑战性的手术，特别是对于有较大缺损的患者。本研究旨在评估髋臼骨丢失的严重程度如何影响旋转中心（COR）的重建，以及COR如何影响临床结果和患者报告的结果测量（PROMs）。方法纳入2013年1月至2018年12月在某三级医院行髋臼翻修术的患者。患者按照papprosky和Saleh分类进行分组。为了确定COR，我们采用了Fessy描述的方法。Harris髋关节评分（HHS）、Western Ontario McMaster Arthritis Index （WOMAC）和Short Form 12 （SF-12）用于确定临床结果和PROMs，随访时间中位数为41个月。共进行了117例髋臼翻修。54例（46.15%）髋臼缺损，Paprosky分级为I级；髋臼缺损36例（30.76%）；髋臼缺损27例（23.07%）。Saleh分类如下：I为54例（46.15%）；II为26例（22.22%）；III为19例（16.23%）；IV型16例（13.67%），V型2例（1.7%）。结果采用Fessy法获得合适的COR的患者比例为60.1%。该方法显示髋臼缺损的严重程度与准确重建旋转中心的能力之间有统计学意义的关联。同样，基于髋关节旋转中心是否恢复，患者的功能结局（HHS、WOMAC和SF-12评分）也没有观察到差异。同样，无论COR修复或骨质流失程度如何，并发症发生率也没有差异。结论这些发现表明，在复杂的髋臼翻修中，优先考虑稳定固定和骨保存而不是旋转中心的完美解剖修复不会对功能结果产生不利影响。

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引用次数: 0

Spring ligament repair with and without augmentation demonstrates favorable outcomes in progressive collapsing flatfoot disorder: A systematic review 弹簧韧带修复有和没有增强显示有利的结果进行性塌陷扁平足疾病：系统回顾

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-01-22 DOI: 10.1016/j.jor.2026.01.014

Jared Rubin , Alexander Tham , Reed Macey , Nathaniel Mattera , Michael Allen , Samuel R. Montgomery Jr. , Megan Donnelly , Jay Zaifman , John G. Kennedy

Background

Spring ligament disruption is a primary contributor to the development of progressive collapsing flatfoot deformity (PCFD). The purpose of this systematic review is to evaluate the radiographic findings, clinical outcomes, complications, and failures following spring ligament repair with and without augmentation.

Methods

During December 2025, the PubMed, Cochrane, and EMBASE library databases were systematically searched to identify studies examining radiographic findings, clinical outcomes, complications, and failures in patients who underwent spring ligament repair with and without augmentation.

Results

Nine studies including 209 patients (212 feet) with spring ligament injuries were analyzed. Patients who underwent spring ligament repair with and without augmentation were evaluated. Both treatment approaches were associated with clinically meaningful improvements in radiographic alignment, with mean talo-first metatarsal angle (TFMA) correction of 12.9° following isolated repair and 11.0° following repair with augmentation. Clinical outcomes also improved, with mean increases in American Orthopaedic Foot and Ankle Society (AOFAS) scores of 24.1 and 29.8 points for isolated repair and repair with augmentation, respectively. Complication rates were low for both isolated repair (4.5 %) and repair with augmentation (6.7 %), with corresponding failure rates of 1.3 % and 3.3 %, respectively.

Conclusion

Spring ligament repair with and without augmentation is associated with meaningful improvements in radiographic alignment and clinical outcomes in patients with PCFD. Across the included studies, both treatment approaches also demonstrated low complication and failure rates. While suture augmentation may provide additional mechanical support in select patients, the available evidence precludes direct comparative conclusions regarding the superiority of the technique over isolated spring ligament repair. Further high-quality, comparative studies are warranted to definitively establish the optimal surgical method for managing spring ligament injuries.

Level of evidence

IV

背景：弹簧韧带断裂是导致进行性塌陷扁平足畸形（PCFD）的主要原因。本系统综述的目的是评估带和不带增强术的弹簧韧带修复后的影像学表现、临床结果、并发症和失败。方法：在2025年12月，系统地检索PubMed、Cochrane和EMBASE数据库，以确定接受弹簧韧带修复的患者的影像学表现、临床结果、并发症和失败的研究。结果分析了9项研究，包括209例（212英尺）弹性韧带损伤患者。对接受弹簧韧带修复术的患者进行评估。两种治疗方法在影像学上均有临床意义的改善，单独修复后的平均距第一跖骨角（TFMA）矫正为12.9°，增强修复后的平均距第一跖骨角矫正为11.0°。临床结果也有所改善，美国骨科足踝协会（AOFAS）孤立修复和增强修复的平均评分分别提高了24.1分和29.8分。单独修复（4.5%）和增强修复（6.7%）的并发症发生率均较低，相应的失败率分别为1.3%和3.3%。结论弹簧韧带修复有或没有增强与PCFD患者的x线对准和临床结果有意义的改善相关。在纳入的研究中，两种治疗方法也显示出较低的并发症和失败率。虽然缝线增强术可以为特定患者提供额外的机械支持，但现有的证据排除了关于该技术优于孤立弹簧韧带修复的直接比较结论。进一步的高质量的比较研究是有必要的，以明确地建立治疗弹簧韧带损伤的最佳手术方法。证据水平

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引用次数: 0

The impact of subject weight and activity level on over-inserted cemented acetabular cups after Total HIP Arthroplasty (THA) 体重和活动量对全髋关节置换术后过度置入骨水泥髋臼杯的影响

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-01-22 DOI: 10.1016/j.jor.2026.01.012

Teresa Alonso-Rasgado , Jose F. Del-Valle-Mojica , Israel Miguel-Andres , Colin G. Bailey , Tim N. Board

In cemented Total Hip Arthroplasty (THA), several risk factors have been identified with the failure of the acetabular component, including body mass index (BMI), exercise, femoral head size, cup placement, and cement mantle integrity. Elevated BMI and larger femoral heads increase bone and cement stresses, accelerating wear and predisposing to aseptic loosening. This study evaluates the effect of over-inserted acetabular cups on cement mantle interfaces and pelvic bone stresses using two femoral head sizes (28 mm and 36 mm), four body weights (normal, overweight, obese, and morbidly obese), and three activities (one-leg stand, stair descent, and stumbling). Results show that von Mises stresses rise with increasing body weight, activity intensity, and femoral head size, with the highest values observed in the superior periacetabular region of the pelvic bone for the morbidly obese subject during stumbling with the 36 mm head. Stresses at the bone-cement interface exceeded those at the cement-cup interface, particularly in the superior quadrant of over-inserted cups. Our findings suggest that morbidly obese subjects are at a higher risk of aseptic loosening due to the stresses induced in the bone-cement interface during physical activities, resulting in higher peak hip reaction forces. This risk is increased in the case of over-insertion of the acetabular cup, leading to a thinner cement layer. These findings highlight the combined influence of implant design, patient characteristics, and surgical technique on long-term THA performance.

在骨水泥全髋关节置换术（THA）中，有几个与髋臼假体失败相关的危险因素，包括身体质量指数（BMI）、运动、股骨头大小、髋臼杯放置和骨水泥套完整性。BMI升高和股骨头变大会增加骨和骨水泥的压力，加速磨损，易发生无菌性松动。本研究通过两种股骨头尺寸（28mm和36mm）、四种体重（正常、超重、肥胖和病态肥胖）和三种活动（单腿站立、下楼梯和绊倒）评估过插入髋臼杯对水泥套界面和骨盆骨应力的影响。结果表明，von Mises应力随体重、活动强度和股骨头大小的增加而增加，在36 mm头绊倒时，病态肥胖受试者骨盆骨的髋臼周围区域的应力值最高。骨水泥界面处的应力大于水泥杯界面处的应力，特别是在过插入杯的上象限。我们的研究结果表明，病态肥胖受试者在体育活动中由于骨水泥界面的应力引起无菌性松动的风险更高，导致髋关节反作用力峰值更高。在髋臼杯过度插入的情况下，这种风险增加，导致水泥层变薄。这些发现强调了种植体设计、患者特征和手术技术对THA长期疗效的综合影响。

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引用次数: 0

Global research trends, evolution, and future directions on platelet-rich plasma in surgery: A bibliometric analysis 外科手术中富血小板血浆的全球研究趋势、演变和未来方向：文献计量学分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-01-22 DOI: 10.1016/j.jor.2026.01.011

Ai-Jia Guan , Hong-Chen He

Aims & objectives

The study aimed to examine the international research landscape of PRP in surgery, identify influential contributors, and explore emerging research trends up to 2024.

Materials and methods

Publications related to PRP in surgery were included from inception to 2024. Data were retrieved from the Web of Science Core Collection and analyzed via the Bibliometrix tool to assess publication growth, author influence, affiliations' output, countries’ contribution, and keyword occurrence.

Results

A total of 1898 articles were retrieved, demonstrating a consistent upward trajectory in publication output with an approximate annual growth rate of 14 %. Leading contributors include Pietro Gentile, Giuseppe Filardo, Valerio Cervelli and David M. Dohan Ehrenfest. Prominent institutions such as KU Leuven, Universidade Estadual Paulista, and the Egyptian Knowledge Bank, together with leading countries including China, the United States, and Italy, collectively constitute the core driving forces shaping this research domain. Keywords with high frequency revealed two dominant research clusters: PRP for musculoskeletal regeneration and PRF for oral surgery and wound healing. PRP research is expanding beyond established fields to new indications such as lumbar intervertebral disc protrusion and cardiac surgery, while advancing toward integration with engineering biomaterials.

Conclusion

Global PRP research in surgery has demonstrated sustained growth and increasing interdisciplinary integration. Future progress depends on enhancing cross-continental collaboration, protocol standardization, mechanistic elucidation, and large-scale randomized controlled trials. PRP has evolved from experimental research to clinical application as a key component of regenerative surgical strategies, contributing to the advancement of enhanced recovery after surgery.

本研究旨在研究外科PRP的国际研究现状，确定有影响力的贡献者，并探索到2024年的新兴研究趋势。材料和方法纳入从成立到2024年与外科PRP相关的出版物。数据从Web of Science核心馆藏中检索，并通过Bibliometrix工具进行分析，以评估出版物增长、作者影响力、附属机构产出、国家贡献和关键字出现情况。结果共检索到1898篇文章，显示出出版产出持续上升的轨迹，年增长率约为14%。主要贡献者包括Pietro Gentile， Giuseppe Filardo， Valerio Cervelli和David M. Dohan Ehrenfest。鲁汶大学、圣保罗大学和埃及知识银行等知名机构，以及包括中国、美国和意大利在内的主要国家，共同构成了塑造这一研究领域的核心驱动力。高频关键词显示了两个主要的研究集群：PRP用于肌肉骨骼再生和PRF用于口腔手术和伤口愈合。PRP研究正在从现有领域扩展到新的适应症，如腰椎间盘突出症和心脏外科，同时向工程生物材料的整合迈进。结论全球外科PRP研究呈现持续增长和跨学科融合的趋势。未来的进展取决于加强跨洲合作、方案标准化、机制阐明和大规模随机对照试验。PRP已经从实验研究发展到临床应用，作为再生手术策略的关键组成部分，有助于提高手术后的恢复。

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引用次数: 0

Interobserver reliability of the AO/OTA and Luo three-column classification systems for tibial plateau fractures and their impact on surgical approach selection AO/OTA和Luo三柱分类系统对胫骨平台骨折的观察者间可靠性及其对手术入路选择的影响

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-01-22 DOI: 10.1016/j.jor.2026.01.013

Maximilian Appel , Axel Jubel , Moritz Antoni

Purpose

This study aims to compare the interobserver reliability of the traditional two-dimensional AO/OTA classification with the more recent three-dimensional Luo three-column classification for tibial plateau fractures. Furthermore, it evaluates the impact of both systems on the surgical approach selection, particularly examining Luo et al.'s hypothesis that the three-column classification encourages increased consideration of the posterior column during preoperative planning. However, this hypothesis has not been evaluated yet, leaving a research gap regarding its influence in practice on surgical approach selection.

Methods

Fifteen cases of tibial plateau fractures were retrospectively analyzed by nine trauma surgeons using radiographs and CT scans. Fractures were classified according to the AO/OTA and Luo classifications, and preferred surgical approaches for definitive fixation were determined. Interobserver reliability was assessed using Fleiss' kappa and interpreted according to the categorical rating by Landis and Koch. Additionally, a chi-square test was performed to evaluate statistical significance in the surgical approach selection.

Results

Both classification systems showed overall substantial reliability (k_AO = 0.63; k_Luo = 0.67). The difference in agreement for surgical approach groups between the two classifications was 0.11 (k_{AO_approach} = 0.37; k_{Luo_approach} = 0.48). The posterior approach group was not selected significantly more often using the Luo three-column classification compared to the AO/OTA classification (p = 0.543).

Conclusion

No significant difference in interobserver reliability or in the choice of surgical approach was observed between the AO/OTA and Luo classifications.

本研究旨在比较传统的二维AO/OTA分类与最新的三维Luo三柱分类对胫骨平台骨折的观察者间可靠性。此外，它评估了两种系统对手术入路选择的影响，特别是检验了Luo等人的假设，即三柱分类鼓励在术前计划中更多地考虑后柱。然而，这一假设尚未得到评估，其在实践中对手术入路选择的影响尚存在研究空白。方法回顾性分析9位创伤外科医生15例胫骨平台骨折患者的x线及CT表现。根据AO/OTA和Luo分类对骨折进行分类，并确定确定固定的首选手术入路。观察者间信度采用Fleiss的kappa进行评估，并根据Landis和Koch的分类评级进行解释。此外，采用卡方检验评估手术入路选择的统计学意义。结果两种分类系统均具有总体可靠度（kAO = 0.63, kLuo = 0.67）。两种分类手术入路组的一致性差为0.11 （kAO_approach = 0.37； k珞_approach = 0.48）。与AO/OTA分类相比，后路入路组使用Luo三柱分类的次数没有明显增加（p = 0.543）。结论AO/OTA与Luo分类在观察者间信度及手术入路选择上无显著差异。

{"title":"Interobserver reliability of the AO/OTA and Luo three-column classification systems for tibial plateau fractures and their impact on surgical approach selection","authors":"Maximilian Appel , Axel Jubel , Moritz Antoni","doi":"10.1016/j.jor.2026.01.013","DOIUrl":"10.1016/j.jor.2026.01.013","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to compare the interobserver reliability of the traditional two-dimensional AO/OTA classification with the more recent three-dimensional Luo three-column classification for tibial plateau fractures. Furthermore, it evaluates the impact of both systems on the surgical approach selection, particularly examining Luo et al.'s hypothesis that the three-column classification encourages increased consideration of the posterior column during preoperative planning. However, this hypothesis has not been evaluated yet, leaving a research gap regarding its influence in practice on surgical approach selection.</div></div><div><h3>Methods</h3><div>Fifteen cases of tibial plateau fractures were retrospectively analyzed by nine trauma surgeons using radiographs and CT scans. Fractures were classified according to the AO/OTA and Luo classifications, and preferred surgical approaches for definitive fixation were determined. Interobserver reliability was assessed using Fleiss' kappa and interpreted according to the categorical rating by Landis and Koch. Additionally, a chi-square test was performed to evaluate statistical significance in the surgical approach selection.</div></div><div><h3>Results</h3><div>Both classification systems showed overall substantial reliability (k<sub>AO</sub> = 0.63; k<sub>Luo</sub> = 0.67). The difference in agreement for surgical approach groups between the two classifications was 0.11 (k<sub>AO_approach</sub> = 0.37; k<sub>Luo_approach</sub> = 0.48). The posterior approach group was not selected significantly more often using the Luo three-column classification compared to the AO/OTA classification (p = 0.543).</div></div><div><h3>Conclusion</h3><div>No significant difference in interobserver reliability or in the choice of surgical approach was observed between the AO/OTA and Luo classifications.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 234-238"},"PeriodicalIF":1.5,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Femoral neck system: A comparable fixation technique for femoral neck fractures in young adults 股骨颈系统：一种可比较的年轻成人股骨颈骨折固定技术

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-01-21 DOI: 10.1016/j.jor.2026.01.010

Brittany McPhee , Doriann M. Alcaide , Monica Guirgus , Brandon Richmond , Vahe Yacoubian , Joey P. Johnson , Rebecca Rajfer

Objective

To examine outcomes of femoral neck fractures (FNFs) in non-geriatric adults treated with the Femoral Neck System (FNS; DePuy Synthes, Warsaw, IN) compared to three other fixation techniques.

Methods

This was a retrospective study in two Level I Trauma Centers (2019–2024) in adults 18–50 years old with FNFs (AO/OTA 31) that underwent surgical fixation. Patients were classified by fixation method: femoral neck system (FNS), dynamic hip screw (DHS), cephalomedullary nail (CMN) device and cannulated screws (CS). Outcomes compared between groups included: rates of reoperation, union, hardware failure, avascular necrosis (AVN), conversion to total hip arthroplasty (THA), operative time, intraoperative radiation exposure, surgical site infection (SSI) and length of stay (LOS).

Results

A total of 95 patients were included (FNS n = 27; DHS n = 15; CMN n = 15; CS n = 38). The majority of the patients were male (64.2 %), with an average age of 32.5 years and follow up time of 363 days. While being used predominantly for displaced fractures (66.7 %, p = 0.001), the FNS had significantly lower rates of hardware failure (74.1 %; p = 0.046), AVN (0 %, p = 0.034) and THA conversion (0 %, p = 0.029). CS had the highest union rates (89.5 %; p = 0.046), lowest reoperation rates (13.2 %; p = 0.030) and were used primarily for non-displaced fractures (63.2 %, p = 0.001). There were no differences among groups in surgical time (p = 0.191), or LOS (p = 0.592). A sub-analysis comparing reoperation rates after closed reduction showed that successful closed reduction was associated with not requiring reoperation (40.5 % vs 14.3 %; p = 0.026).

Conclusion

Fixation of FNFs in young adults with the FNS has lower rates of AVN, hardware failure and THA conversion compared to other fixation methods. Fixation with screws has the highest union rate and lowest reoperation rate in this demographic. Fixation of FNFs with the FNS has similar if not better outcomes when compared to other fixation methods. However, surgical factors such as fracture displacement and closed reduction may have influenced outcomes and require further study.

Level of evidence

III

目的比较股骨颈系统（FNS; DePuy Synthes, Warsaw, in）与其他三种固定技术治疗非老年成人股骨颈骨折（FNFs）的疗效。方法：本研究是一项回顾性研究，在两个一级创伤中心（2019-2024）对18-50岁接受手术固定的成年fnf （AO/OTA 31）进行研究。采用股骨颈系统（FNS）、动力髋螺钉（DHS）、头髓钉（CMN）装置和空心螺钉（CS）固定。两组间比较的结果包括：再手术率、愈合率、硬体失效率、缺血性坏死率（AVN）、转全髋关节置换术率（THA）、手术时间、术中放射暴露、手术部位感染（SSI）和住院时间（LOS）。结果共纳入95例患者（FNS 27例，DHS 15例，CMN 15例，CS 38例）。患者以男性居多（64.2%），平均年龄32.5岁，随访363天。虽然FNS主要用于移位骨折（66.7%,p = 0.001），但其硬体失败率（74.1%,p = 0.046）、AVN （0%, p = 0.034）和THA转换率（0%,p = 0.029）明显较低。CS愈合率最高（89.5%,p = 0.046），再手术率最低（13.2%,p = 0.030），主要用于非移位性骨折（63.2%,p = 0.001）。两组间手术时间（p = 0.191）和LOS （p = 0.592）差异无统计学意义。一项比较闭合复位后再手术率的子分析显示闭合复位成功与不需要再手术相关（40.5% vs 14.3%; p = 0.026）。结论与其他固定方法相比，FNS固定青壮年fnf具有较低的AVN、硬体失效和THA转换率。在这一人群中，螺钉内固定愈合率最高，再手术率最低。与其他固定方法相比，FNS固定fnf的效果即使不是更好，也是相似的。然而，骨折移位和闭合复位等手术因素可能会影响结果，需要进一步研究。证据水平ii

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引用次数: 0

Robotic S2Alar iliac screw placement: Comparing conventional and robot assisted minimally invasive techniques 机器人s2ar髂骨螺钉置入：比较传统和机器人辅助微创技术

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-01-13 DOI: 10.1016/j.jor.2026.01.009

Balamurugan Thirugnanam , Vidyadhara Srinivasa , Abhishek Soni , R. Dinesh Iyer , Madhava Pai Kanhangad

Objectives

To evaluate the clinical, imaging, and peri-operative results of robotic-guided conventional versus robot assisted minimally invasive techniques for S2 Alar-Iliac (S2AI) screw placement during spinopelvic fixation.

Methods

A prospective comparative study comparing the clinicoradiological parameters of patients undergoing conventional robotic assisted S2AI screw insertion and those who underwent Robotic minimally invasive percutaneous screw insertion between November 2023 and June 2025 was done. Data collected included demographics, operative time, intraoperative blood loss, postoperative pain, hospital stay, radiographic angles, radiation dose, screw accuracy, and complications.

Results

A total of 102 patients underwent spinopelvic fixation during the study period - 56 patients (116 screws) underwent conventional robotic assisted S2AI screw insertion and 46 patients (92 screws) underwent robot assisted percutaneous S2AI screw insertion. Both groups showed accurate screw placement without any intraoperative adverse events. The robot assisted percutaneous group had markedly reduced postoperative VAS scores (3.2 ± 1.1 vs. 5.8 ± 1.5, p < 0.0001) and reduced length of stay (3.1 ± 0.9 vs. 5.0 ± 1.3 days, p < 0.0001). Intraoperative blood loss,wound complications and operative time were also lesser in the robot assisted group but was not statistically significant. All other radiographic parameters and radiation dose were comparable across groups.

Conclusion

Robot assisted minimally invasive S2AI screw placement is a safe and efficient alternative to the conventional open technique. It offers comparable radiographic accuracy and biomechanical stability, with the added benefits of reduced postoperative pain and shorter hospital stay.

目的评价机器人引导的传统微创技术与机器人辅助的微创技术在脊柱-骨盆固定术中放置S2翼髂螺钉（S2AI）的临床、影像学和围术期结果。方法前瞻性对比研究2023年11月至2025年6月间，接受常规机器人辅助S2AI螺钉置入与机器人微创经皮螺钉置入患者的临床放射学参数。收集的数据包括人口统计学、手术时间、术中出血量、术后疼痛、住院时间、放射角度、放射剂量、螺钉精度和并发症。结果102例患者在研究期间接受了脊柱盆腔内固定，其中56例（116颗螺钉）采用传统机器人辅助S2AI螺钉置入，46例（92颗螺钉）采用机器人辅助经皮S2AI螺钉置入。两组均显示螺钉置入准确，无术中不良事件发生。机器人辅助经皮组术后VAS评分明显降低（3.2±1.1比5.8±1.5,p < 0.0001），住院时间明显缩短（3.1±0.9比5.0±1.3天，p < 0.0001）。机器人辅助组术中出血量、伤口并发症和手术时间也较少，但无统计学意义。所有其他放射学参数和辐射剂量在各组间具有可比性。结论机器人辅助微创S2AI螺钉置入是一种安全、有效的替代传统开放技术的方法。它提供了相当的放射学准确性和生物力学稳定性，并增加了减少术后疼痛和缩短住院时间的好处。

{"title":"Robotic S2Alar iliac screw placement: Comparing conventional and robot assisted minimally invasive techniques","authors":"Balamurugan Thirugnanam , Vidyadhara Srinivasa , Abhishek Soni , R. Dinesh Iyer , Madhava Pai Kanhangad","doi":"10.1016/j.jor.2026.01.009","DOIUrl":"10.1016/j.jor.2026.01.009","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the clinical, imaging, and peri-operative results of robotic-guided conventional versus robot assisted minimally invasive techniques for S2 Alar-Iliac (S2AI) screw placement during spinopelvic fixation.</div></div><div><h3>Methods</h3><div>A prospective comparative study comparing the clinicoradiological parameters of patients undergoing conventional robotic assisted S2AI screw insertion and those who underwent Robotic minimally invasive percutaneous screw insertion between November 2023 and June 2025 was done. Data collected included demographics, operative time, intraoperative blood loss, postoperative pain, hospital stay, radiographic angles, radiation dose, screw accuracy, and complications.</div></div><div><h3>Results</h3><div>A total of 102 patients underwent spinopelvic fixation during the study period - 56 patients (116 screws) underwent conventional robotic assisted S2AI screw insertion and 46 patients (92 screws) underwent robot assisted percutaneous S2AI screw insertion. Both groups showed accurate screw placement without any intraoperative adverse events. The robot assisted percutaneous group had markedly reduced postoperative VAS scores (3.2 ± 1.1 vs. 5.8 ± 1.5, p < 0.0001) and reduced length of stay (3.1 ± 0.9 vs. 5.0 ± 1.3 days, p < 0.0001). Intraoperative blood loss,wound complications and operative time were also lesser in the robot assisted group but was not statistically significant. All other radiographic parameters and radiation dose were comparable across groups.</div></div><div><h3>Conclusion</h3><div>Robot assisted minimally invasive S2AI screw placement is a safe and efficient alternative to the conventional open technique. It offers comparable radiographic accuracy and biomechanical stability, with the added benefits of reduced postoperative pain and shorter hospital stay.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 214-219"},"PeriodicalIF":1.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Relationship between social determinants of health and hip fracture in the American population: a cross-sectional NHANES study 美国人群健康的社会决定因素与髋部骨折之间的关系：一项横断面NHANES研究

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-01-12 DOI: 10.1016/j.jor.2026.01.008

Fangfang Deng, Huali Guo, Li Song, Bo Chen

Background

This article aims to investigate the link between social determinants of health (SDoH) and the occurrence of hip fractures, and to analyze the potential underlying mechanisms of influence.

Methods

This paper conducted a deep analysis among the general sample population from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. Within each survey period, self-reported data covering eight domains of SDoH were collected, including employment status, poverty-to-income ratio (PIR), food security, educational level, health insurance coverage, type of health insurance, homeownership, and marital status. Concurrently, a history of hip fractures among participants was learned through self-reporting. Correlation analysis, Lasso regression analysis, and the Boruta algorithm were employed to explore the link between SDoH and hip fractures.

Results

This study comprehensively analyzed 11,254 adult participants. The findings indicated a notable link between eight sub-items of SDoH and the risk of hip fracture. Specifically, the cumulative number of adverse SDoH was positively linked with the risk of hip fracture. Especially as 4-7 adverse factors were accumulated, the incidence of hip fractures climbed greatly.

Conclusion

This paper suggests a marked link between adverse SDoH and the occurrence of hip fractures, particularly when these adverse factors accumulate to a certain number (4–7). A profound probe into the interactions among these SDoH and their mechanisms of influence on fracture risk may offer crucial evidence for the prevention and intervention of hip fractures.

本文旨在探讨健康的社会决定因素（SDoH）与髋部骨折发生之间的联系，并分析其潜在的影响机制。方法对1999-2018年国家健康与营养检查调查（NHANES）的一般样本人群进行深入分析。在每个调查期间，收集了包括就业状况、贫困收入比（PIR）、粮食安全、教育水平、医疗保险覆盖率、医疗保险类型、住房所有权和婚姻状况在内的八个领域的自我报告数据。同时，参与者通过自我报告了解髋部骨折史。采用相关分析、Lasso回归分析和Boruta算法探讨SDoH与髋部骨折的关系。结果本研究综合分析了11254名成年参与者。研究结果表明，SDoH的8个分项与髋部骨折风险之间存在显著联系。具体而言，不良SDoH累积次数与髋部骨折风险呈正相关。特别是随着4-7个不良因素的累积，髋部骨折的发生率急剧攀升。结论本文认为不良SDoH与髋部骨折的发生有明显的联系，特别是当这些不良因素累积到一定数量时（4-7）。深入探讨这些SDoH之间的相互作用及其对骨折风险的影响机制，将为髋部骨折的预防和干预提供重要依据。

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引用次数: 0

Mid-term outcomes of the Latarjet procedure for shoulder instability: A retrospective study of 187 shoulders with an eight-year follow-up Latarjet手术治疗肩部不稳定的中期结果：一项对187个肩部进行8年随访的回顾性研究

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-01-10 DOI: 10.1016/j.jor.2026.01.006

Asghar Elmi, Aran Nikpay, Sharareh Mirzazadeh Maryan, Alireza Rouhani

Purpose

While the Latarjet procedure is a recognized intervention for glenohumeral instability, mid-term outcomes data, particularly regarding recurrence and complication rates, remain uncharacterized within the specified national context. This study aimed to retrospectively evaluate the mid-term clinical and functional results of the open Latarjet procedure for the management of recurrent anterior shoulder instability.

Methods

A retrospective, descriptive cohort study was conducted on patients undergoing the open Latarjet procedure for shoulder instability between 2009 and 2017 at a single academic medical center. A total of 186 patients (187 shoulders) were included via census sampling. Primary outcome measures included postoperative pain assessed via a Visual Analog Scale (VAS) and functional stability evaluated using the Rowe and Duplay-Walch scoring systems. Radiographic assessment for osteoarthritis and documentation of complications were performed.

Results

The mean follow-up period was [If available, insert mean ± SD years]. The mean postoperative Duplay-Walch score was 84 ± 19.4. A statistically significant improvement was observed in the mean Rowe score, from 13.9 ± 19 preoperatively to 93.6 ± 14 postoperatively (P < 0.001). The rate of recurrent dislocation was 3.2 % (n = 6). Postoperative complications included the development of grade I osteoarthritis in 9.6 % (n = 18) and grade II in 2.1 % (n = 4) of shoulders, and musculocutaneous nerve neuropraxia in 1.1 % (n = 2) of cases. No instances of axillary nerve injury were recorded.

Conclusion

The findings indicate that the open Latarjet procedure is an effective and reliable intervention for recurrent anterior shoulder instability, providing excellent mid-term stability with a low recurrence rate. The procedure was associated with predictable complication profiles, including a low risk of nerve injury and progressive glenohumeral arthritis, with minimal functional restriction in external rotation.

Level of evidence

Level IV (Therapeutic Study, Case Series).

目的：虽然Latarjet手术是公认的肩关节不稳定的干预措施，但中期结果数据，特别是关于复发率和并发症发生率，在特定的国家背景下仍未确定。本研究旨在回顾性评估开放式Latarjet手术治疗复发性前肩不稳的中期临床和功能结果。方法对2009年至2017年在单一学术医疗中心接受开放性Latarjet手术治疗肩关节不稳的患者进行回顾性、描述性队列研究。通过普查抽样共纳入186例患者（187例肩部）。主要结果测量包括术后疼痛通过视觉模拟量表（VAS）评估和功能稳定性使用Rowe和Duplay-Walch评分系统评估。进行骨关节炎的影像学评估和并发症的记录。结果平均随访时间为[如有，插入平均±SD年]。术后平均Duplay-Walch评分为84±19.4。平均Rowe评分从术前的13.9±19分提高到术后的93.6±14分，差异有统计学意义（P < 0.001）。脱位复发率为3.2% （n = 6）。术后并发症包括9.6%（18例）发生I级骨关节炎，2.1%（4例）发生II级骨关节炎，1.1%（2例）发生肌皮神经失用症。无腋窝神经损伤病例。结论开放性Latarjet手术是治疗复发性肩前路不稳的有效且可靠的干预措施，具有良好的中期稳定性和低复发率。该手术与可预测的并发症相关，包括神经损伤和进行性肩关节关节炎的风险较低，外旋功能限制最小。证据水平：IV级（治疗性研究，病例系列）。

{"title":"Mid-term outcomes of the Latarjet procedure for shoulder instability: A retrospective study of 187 shoulders with an eight-year follow-up","authors":"Asghar Elmi, Aran Nikpay, Sharareh Mirzazadeh Maryan, Alireza Rouhani","doi":"10.1016/j.jor.2026.01.006","DOIUrl":"10.1016/j.jor.2026.01.006","url":null,"abstract":"<div><h3>Purpose</h3><div>While the Latarjet procedure is a recognized intervention for glenohumeral instability, mid-term outcomes data, particularly regarding recurrence and complication rates, remain uncharacterized within the specified national context. This study aimed to retrospectively evaluate the mid-term clinical and functional results of the open Latarjet procedure for the management of recurrent anterior shoulder instability.</div></div><div><h3>Methods</h3><div>A retrospective, descriptive cohort study was conducted on patients undergoing the open Latarjet procedure for shoulder instability between 2009 and 2017 at a single academic medical center. A total of 186 patients (187 shoulders) were included via census sampling. Primary outcome measures included postoperative pain assessed via a Visual Analog Scale (VAS) and functional stability evaluated using the Rowe and Duplay-Walch scoring systems. Radiographic assessment for osteoarthritis and documentation of complications were performed.</div></div><div><h3>Results</h3><div>The mean follow-up period was [If available, insert mean ± SD years]. The mean postoperative Duplay-Walch score was 84 ± 19.4. A statistically significant improvement was observed in the mean Rowe score, from 13.9 ± 19 preoperatively to 93.6 ± 14 postoperatively (P < 0.001). The rate of recurrent dislocation was 3.2 % (n = 6). Postoperative complications included the development of grade I osteoarthritis in 9.6 % (n = 18) and grade II in 2.1 % (n = 4) of shoulders, and musculocutaneous nerve neuropraxia in 1.1 % (n = 2) of cases. No instances of axillary nerve injury were recorded.</div></div><div><h3>Conclusion</h3><div>The findings indicate that the open Latarjet procedure is an effective and reliable intervention for recurrent anterior shoulder instability, providing excellent mid-term stability with a low recurrence rate. The procedure was associated with predictable complication profiles, including a low risk of nerve injury and progressive glenohumeral arthritis, with minimal functional restriction in external rotation.</div></div><div><h3>Level of evidence</h3><div>Level IV (Therapeutic Study, Case Series).</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 220-225"},"PeriodicalIF":1.5,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nonoperative management of sacral chordomas: A systematic review of the literature 骶脊索瘤的非手术治疗：文献的系统回顾

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics

Pub Date : 2026-01-08 DOI: 10.1016/j.jor.2026.01.007

Sean Bae , Mark Ehioghae , Jonathan P. Japa , Ala Alshomali , Aaron Phung , Linus Lee , Justin Hyde , Jamie Lee , Kevin Yoon , Addisu Mesfin

Background

Sacral chordomas are rare malignant tumors arising from notochordal remnants that can be identified incidentally or present with sacral pain. Although surgical resection is the accepted standard treatment, some patients forgo surgery due to associated morbidity and complications. Nonoperative alternatives, including radiotherapies, have emerged, but literature on their outcomes remains scarce. The purpose of this study was to evaluate the outcomes of nonoperative management of sacral chordomas.

Methods

We conducted a systematic review of the literature utilizing PubMed. Search keywords included “nonoperative treatment,” “sacral chordomas,” “radiotherapy,” and “functional outcomes.” Studies involving sacral chordoma patients who underwent nonoperative treatment were included; patients with surgical treatment and hybrid therapies that included surgery were excluded from the analysis.

Results

Eleven clinical studies on nonoperative management of sacral chordomas with 52 patients aged between 35 and 85 years (mean = 62.8) were identified. Males were affected at higher rates than females (73.1 % vs 26.9 %). S1 (15.4 %) and S2 (25 %) were the most affected spinal segments. CT-guided biopsy was the most common method of tumor diagnosis (82.7 %). Carbon ion radiotherapy (CIRT) and proton beam therapy were the most common treatment methods, with 57.7 % of patients reporting recurrence-free survival at a mean follow-up of 24 months.

Conclusion

Nonoperative management of sacral chordomas shows promising outcomes for patients who are not candidates for surgery. Although recurrence remains a risk, nonoperative management may offer meaningful functional preservation and local disease control.

背景：骶脊索瘤是一种罕见的恶性肿瘤，起源于脊索残余，可偶然发现或伴有骶痛。虽然手术切除是公认的标准治疗方法，但由于相关的发病率和并发症，一些患者放弃手术。包括放射治疗在内的非手术替代疗法已经出现，但关于其结果的文献仍然很少。本研究的目的是评估非手术治疗骶脊索瘤的结果。方法利用PubMed对相关文献进行系统综述。搜索关键词包括“非手术治疗”、“骶脊索瘤”、“放疗”和“功能结果”。包括接受非手术治疗的骶脊索瘤患者的研究；手术治疗和混合治疗包括手术的患者被排除在分析之外。结果对52例35 ~ 85岁的骶脊索瘤患者进行非手术治疗的临床研究，平均62.8岁。男性受影响的比例高于女性（73.1% vs 26.9%）。S1（15.4%）和S2（25%）是受影响最大的脊柱节段。ct引导下活检是最常见的肿瘤诊断方法（82.7%）。碳离子放射治疗（CIRT）和质子束治疗是最常见的治疗方法，平均随访24个月，57.7%的患者报告无复发生存。结论非手术治疗骶脊索瘤对不需要手术治疗的患者有较好的疗效。虽然复发仍有风险，但非手术治疗可能提供有意义的功能保留和局部疾病控制。

{"title":"Nonoperative management of sacral chordomas: A systematic review of the literature","authors":"Sean Bae , Mark Ehioghae , Jonathan P. Japa , Ala Alshomali , Aaron Phung , Linus Lee , Justin Hyde , Jamie Lee , Kevin Yoon , Addisu Mesfin","doi":"10.1016/j.jor.2026.01.007","DOIUrl":"10.1016/j.jor.2026.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Sacral chordomas are rare malignant tumors arising from notochordal remnants that can be identified incidentally or present with sacral pain. Although surgical resection is the accepted standard treatment, some patients forgo surgery due to associated morbidity and complications. Nonoperative alternatives, including radiotherapies, have emerged, but literature on their outcomes remains scarce. The purpose of this study was to evaluate the outcomes of nonoperative management of sacral chordomas.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of the literature utilizing PubMed. Search keywords included “nonoperative treatment,” “sacral chordomas,” “radiotherapy,” and “functional outcomes.” Studies involving sacral chordoma patients who underwent nonoperative treatment were included; patients with surgical treatment and hybrid therapies that included surgery were excluded from the analysis.</div></div><div><h3>Results</h3><div>Eleven clinical studies on nonoperative management of sacral chordomas with 52 patients aged between 35 and 85 years (mean = 62.8) were identified. Males were affected at higher rates than females (73.1 % vs 26.9 %). S1 (15.4 %) and S2 (25 %) were the most affected spinal segments. CT-guided biopsy was the most common method of tumor diagnosis (82.7 %). Carbon ion radiotherapy (CIRT) and proton beam therapy were the most common treatment methods, with 57.7 % of patients reporting recurrence-free survival at a mean follow-up of 24 months.</div></div><div><h3>Conclusion</h3><div>Nonoperative management of sacral chordomas shows promising outcomes for patients who are not candidates for surgery. Although recurrence remains a risk, nonoperative management may offer meaningful functional preservation and local disease control.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"74 ","pages":"Pages 186-194"},"PeriodicalIF":1.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0