Journal of orthopaedics最新文献

{"title":"Effectiveness of intra-articular vancomycin in preventing prosthetic joint infections in hip and knee arthroplasty: A systematic review and meta-analysis of RCT's","authors":"Vinícius Furtado da Cruz ,&nbsp;Elcio Machinski ,&nbsp;André Richard da Silva Oliveira Filho ,&nbsp;Rodrigo Arruda Conde ,&nbsp;Bruno Butturi Varone ,&nbsp;Riccardo Gomes Gobbi ,&nbsp;Camilo Partezani Helito ,&nbsp;Daniel Peixoto Leal","doi":"10.1016/j.jor.2024.12.025","DOIUrl":"10.1016/j.jor.2024.12.025","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate the effectiveness and safety of intra-articular vancomycin powder in reducing prosthetic joint infections (PJIs) in primary hip and knee arthroplasty through a meta-analysis of randomized controlled trials (RCTs).</div></div><div><h3>Methods</h3><div>A research in Pubmed, Embase and Cochrane databases was performed to identify randomized clinical trials comparing intra-articular vancomycin use to conventional antibiotic prophylaxis in total hip or knee arthroplasty patients, assessing postoperative infection rates, adverse drug reactions, and venous thrombotic events. Statistical analysis was performed using R (RStudio 2024.04.2), and heterogeneity was assessed with the I² test.</div></div><div><h3>Results</h3><div>A total of 1485 patients from five randomized clinical trials were included, with 737 receiving intra-articular vancomycin. The infection rate was 0.54 % in the intervention group and 1.73 % in the control group (RR 0.37; 95 % CI 0.02–8.95; p = 0.369; I² = 49 %), showing no statistically significant difference between the groups. Adverse reactions to the glycopeptide were reported in six cases (0.8 %) in the intervention group compared to four cases (0.5 %) in the control group (RR 1.50; 95 % CI 1.50–150; p = 0.001; I² = 0 %). Regarding thrombotic events, there was one case in 647 patients in the intervention group and three cases in 660 patients in the control group (RR 0.45; 95 % CI 0.03–7.02; p = 0.169; I² = 0 %).</div></div><div><h3>Conclusion</h3><div>Although no significant difference was found, the intervention group showed a trend toward lower infection rates. Additional RCTs with larger sample sizes are required to confirm these findings<strong>.</strong></div></div><div><h3>Trial registration</h3><div>The prospective registration of the meta-analysis was conducted on PROSPERO in July 2024 with the protocol number 565988.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 25-33"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052839","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}

{"title":"Periacetabular metastases: Proposed extension of the Harrington classification","authors":"Javier Gutierrez-Pereira ,&nbsp;Juan Luis Cebrian-Parra ,&nbsp;Roberto Garcia-Maroto ,&nbsp;Sergio Llanos ,&nbsp;Antonio Garcia-Lopez","doi":"10.1016/j.jor.2025.01.003","DOIUrl":"10.1016/j.jor.2025.01.003","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the functional outcomes, complications, and reconstruction types in patients with periacetabular metastases and to propose an extension of the Harrington classification.</div></div><div><h3>Methods</h3><div>Twenty-eight patients (13 males, 15 females) with a mean age of 63.8 ± 15.5 years presented with periacetabular metastases from January 2010 to December 2021. The periacetabular metastases were graded according to Harrington's classification, with four additional categories introduced: A) joint involvement, B) Enneking zone 1 involvement, C) pathological acetabular fracture, and X) none of the above. All patients underwent surgery at a single national referral center.</div></div><div><h3>Results</h3><div>Based on the Harrington classification, the acetabular destruction results were as follows: Class 1, two cases (7 %); Class 2, eight cases (29 %); Class 3, 17 cases (61 %); and Class 4, one case (3 %). The results for the additional categories were: A, five cases (18 %); B, five cases (18 %); C, seven cases (25 %); and X, 11 cases (39 %). The most frequent type of reconstruction was total hip prosthesis with a reinforcement ring. Four patients (14 %) required reintervention. After a mean follow-up of 43 ± 45 months (range 2–144), seven patients (25 %) could walk unaided, 16 (57 %) required assistance, and five (18 %) could not walk. Three patients (11 %) died before the third postoperative month.</div></div><div><h3>Conclusion</h3><div>Most patients in this study achieved functional outcomes that allowed ambulation. The type of reconstruction was determined by the classification of the bone defect. We propose extending Harrington's classification to include the four additional categories introduced in this study.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 34-42"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management and outcomes of pure sacroiliac joint dislocations: A systematic review","authors":"Salvatore Pantè ,&nbsp;Marco Bufalo ,&nbsp;Alessandro Aprato ,&nbsp;Michele Nardi ,&nbsp;Riccardo Giai Via ,&nbsp;Francesco Bosco ,&nbsp;Luca Rollero ,&nbsp;Alessandro Massè","doi":"10.1016/j.jor.2025.01.005","DOIUrl":"10.1016/j.jor.2025.01.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Sacroiliac joint (SIJ) dislocations, particularly pure SIJ dislocations without associated fractures, represent a rare and complex subset of pelvic ring injuries. Given the intricate pelvic anatomy and the need to achieve both stability and functional recovery, the optimal surgical management for these injuries remains a topic of debate. This systematic review aims to evaluate the various surgical techniques employed in treating this rare and challenging injury and assess associated clinical outcomes and complications.</div></div><div><h3>Materials and methods</h3><div>A systematic review was conducted adhering to the PRISMA guidelines. Relevant studies were searched in four databases: Pubmed, Scopus, Embase, and Medline. The selected articles were evaluated according to the criteria of levels of evidence. The included studies were analyzed using the Methodological index for non-randomized studies (MINORS) criteria for quality assessment. This paper was registered in the International Prospective Registry of Systematic Reviews (PROSPERO).</div></div><div><h3>Results</h3><div>The review identified four studies. The surgical techniques varied across studies, with percutaneous fixation, open reduction and internal fixation (ORIF), and combined approaches being the most reported methods. Clinical outcomes generally indicated satisfactory pain relief and functional recovery (Majeed score 57–90), though the rates of complications, including hardware failure (4–17 %) and infection (17–32 %), were notable. The results also highlighted that anatomical reduction and stable fixation are crucial for optimizing outcomes and minimizing complications. However, the heterogeneity of the data, especially the timing of surgery and surgical technique, precluded a formal meta-analysis.</div></div><div><h3>Conclusions</h3><div>Surgical management of pure SIJ dislocations presents significant challenges due to the complex biomechanics of the pelvic ring. While various surgical techniques have been employed with generally positive outcomes, the lack of high-quality, large-scale studies limits the ability to establish definitive guidelines. Early definitive treatment of these injuries and anatomical reduction of the SIJ are the main factors to improve clinical outcomes and reduce complication rates.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 14-20"},"PeriodicalIF":1.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance imaging evaluation of the distance to the popliteal artery in arthroscopic popliteus tendon versus posterior cruciate ligament reconstruction","authors":"Steven Heylen ,&nbsp;Peter Verdonk ,&nbsp;Matthias Krause ,&nbsp;Jozef Michielsen","doi":"10.1016/j.jor.2025.01.007","DOIUrl":"10.1016/j.jor.2025.01.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Wide acceptance of arthroscopically treating posterolateral corner injuries has not occurred. There remains a fear of neurovascular (NV) injury while arthroscopically performing these reconstructions. The study's aim is to compare on Magnetic Resonance Scans the distance of the tibial tunnel in an arthroscopic popliteus tendon reconstruction (APB) and arthroscopic posterior cruciate ligament (PCL) reconstruction (APC) to the popliteal neurosvascular bundle.</div></div><div><h3>Methods</h3><div>MRI scans of 93 patients were evaluated. The tibial tunnel exit point of an APB and an APC reconstruction was marked. The smallest distance of the center of the exit point of these tunnels to the NV bundle was assessed. Mean variances and distances were assessed. A Welch's unpaired <em>t</em>-test was calculated. The difference in variances was also assessed.</div></div><div><h3>Results</h3><div>Mean distance to NV bundle from the tibial tunnel in an APB procedure was 15.9 mm. The mean distance to the NV bundle from an APC tibial tunnel was 11.2 mm. The Welch's unpaired <em>t</em>-test p-value was &lt;0.0001. The p-value of the test for equality of variances was 0.0002.</div></div><div><h3>Conclusion</h3><div>The distance to the NV bundle from the tibial tunnel of an APB is significantly higher than the distance to the NV bundle from the tibial tunnel of a APC. However, there is a significantly larger variance in distance to the NV bundle in an APB. Drilling a tibial tunnel during an APB should therefore not be considered more dangerous than drilling the tibial tunnel during an APC.</div><div>Level 4 LOE.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 21-24"},"PeriodicalIF":1.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052843","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}

{"title":"Arthroscopic-assisted reduction for developmental dysplasia of the hip in children: A systematic review","authors":"Ahmed Elzeiny ,&nbsp;Riccardo Giai Via ,&nbsp;Alessandra Cipolla ,&nbsp;Andrea Audisio ,&nbsp;Stephan Erdmenger ,&nbsp;Matteo Giachino ,&nbsp;Alessandro Massè ,&nbsp;Alessandro Aprato","doi":"10.1016/j.jor.2025.01.004","DOIUrl":"10.1016/j.jor.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Developmental dysplasia of the hip (DDH) is a pediatric orthopedic condition characterized by abnormal hip joint formation, leading to subluxation or dislocation of the femoral head from the acetabulum. Early diagnosis and treatment are essential to prevent long-term disability. Conservative treatments are effective if diagnosed early, but late diagnosis often requires more invasive interventions, such as closed or open reduction. Open reduction, although practical, carries significant risks, including avascular necrosis (AVN). Arthroscopic reduction has emerged as a less invasive alternative with potential benefits.</div></div><div><h3>Material and Methods</h3><div>This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including a thorough search of five main databases: PubMed, Scopus, Embase, Medline, and Cochrane. Eligible articles were evaluated according to predefined criteria for levels of evidence (LoE), with retrospective studies assessed using the Coleman Methodology Score (mCMS). This systematic review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO).</div></div><div><h3>Results</h3><div>The review included 11 studies involving 169 patients with 195 hips treated arthroscopically for DDH. The majority of the patients were female (136, 80.5%). The ages of the patients ranged from 3 months to 3.4 years. The follow-up period ranged from 9 months to 9 years after treatment. Success rates of arthroscopic reduction ranged from 70% to 100%, with a median AVN rate of 10.2%. Complications included AVN (11.3%), redislocation (8.2%) and the need for secondary procedures (29.7%). Most of the studies used sub-adductor and anterolateral portals.</div></div><div><h3>Conclusions</h3><div>Arthroscopic-assisted reduction for DDH is a viable and less invasive treatment method that offers good clinical and radiological results. This technique can be particularly beneficial for pediatric patients when performed by experienced surgeons. This study's findings contribute to the growing body of evidence supporting the use of arthroscopic reduction as a possible alternative to open reduction in treating DDH. However, further high-quality research is needed to confirm these results and improve the validity of the data.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 34-40"},"PeriodicalIF":1.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153739","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}

{"title":"Global trends in proximal femoral trabecular research: A bibliometric and visualized analysis","authors":"Peng Jia ,&nbsp;Yi Yang ,&nbsp;Xin Tang","doi":"10.1016/j.jor.2025.01.009","DOIUrl":"10.1016/j.jor.2025.01.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Hip disease is a global public health issue, associated with high morbidity, mortality, and healthcare costs. Although research on proximal femoral trabeculae has been conducted for over a century, no bibliometric analysis has been carried out. The purpose of this study is to evaluate the existing research landscape, identify emerging trends, and offer insights for future studies.</div></div><div><h3>Method</h3><div>The scientific output related to the trabeculae within the human proximal femur from 2004 to 2023 was sourced from the Web of Science Core Collection. Moreover, both the annual publications and cumulative totals over this period were summarized in Excel. The VOS viewer was utilized to analyze co-authorship and co-citation relationship between authors, institutions, countries, references and journals. CiteSpace was used to cluster the keywords and research frontiers in this field.</div></div><div><h3>Results</h3><div>A total of 365 publications were extracted, with the USA emerging as the primary contributor to this field, accounting for 133 publications with 5807 total citations, averaging 43.7 citations per publication. The Journal of Bone and Mineral Research has been identified as the most co-cited journal with a total of 1742 citations. The journals can be categorized into 5 distinct clusters, including medical imaging, orthopedic clinical research, research on endocrine and metabolic related diseases, human evolution and anatomy related research, biomechanics and modeling. The keyword with the highest co-occurrence frequency is “bone mineral density”. The keywords were stratified into six clusters, including DXA, bone remodeling, diagnosis, titanium alloy bionic cannulated screws, individual trabecula segmentation, and QCT. More recently, the focus has expanded to three-dimensional modeling, falls, microarchitecture, and avascular necrosis.</div></div><div><h3>Conclusions</h3><div>Evaluation of proximal femoral strength can be improved by combining structural parameters with bone mineral density by DXA or QCT. Three-dimensional analysis, microarchitecture, and bionic implants are emerging as significant areas of focus and trends for future research.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 84-91"},"PeriodicalIF":1.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080422","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}

{"title":"Accuracy and learning curve of imageless robotic-assisted total knee arthroplasty","authors":"Francesco Bosco ,&nbsp;Giuseppe Rovere ,&nbsp;Carmelo Burgio ,&nbsp;Giorgia Lo Bue ,&nbsp;Claudio Domenico Cobisi ,&nbsp;Riccardo Giai Via ,&nbsp;Ludovico Lucenti ,&nbsp;Lawrence Camarda","doi":"10.1016/j.jor.2024.12.029","DOIUrl":"10.1016/j.jor.2024.12.029","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) is widely used to manage severe knee osteoarthritis. However, conventional TKA (C-TKA) often leaves patients dissatisfied due to suboptimal alignment and soft-tissue balance. Robotic-assisted TKA (RA-TKA), particularly with imageless systems like the NAVIO Surgical System, promises enhanced accuracy and improved outcomes. This study aims to validate the accuracy of RA-TKA in achieving functional alignment (FA) and to explore the learning curve associated with this technique.</div></div><div><h3>Materials and methods</h3><div>A retrospective analysis included 101 patients undergoing RA-TKA with the NAVIO system from July 2021 to April 2024. Data on alignment angles, gap balance, and surgical times were analyzed. Patients were categorized by preoperative coronal alignment (valgus, neutral, and varus), with subgroups within the varus category. Accuracy was defined as deviations ≤3° for alignment and ≤1 mm for gap balance. Learning curve trends were analyzed using segmented regression.</div></div><div><h3>Results</h3><div>The study demonstrated a mean alignment error of 1.18° (±1.21) and a gap balance accuracy of 84 %, with no significant differences across knee morphologies. The RA-TKA system achieved an overall implant alignment accuracy rate of 95 %. Varus knees with greater deformities (&gt;6°) showed comparable or superior accuracy to less severe cases. Surgical time averaged 72.3 min (±5.6), with significant reductions observed after the first 11 cases, reflecting procedural efficiency improvements without compromising accuracy.</div></div><div><h3>Conclusion</h3><div>The RA-TKA reliably achieves precise FA across diverse knee morphologies with a rapid learning curve. Future studies should evaluate long-term outcomes and implant survivorship to confirm these promising findings.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 77-83"},"PeriodicalIF":1.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11779652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip hemiarthroplasty versus closed reduction percutaneous pinning: A matched cohort analysis of 18,242 patients","authors":"Anubhav Thapaliya ,&nbsp;Paul Gudmundsson ,&nbsp;Benjamin Montanez ,&nbsp;Varatharaj Mounasamy ,&nbsp;Senthil Sambandam","doi":"10.1016/j.jor.2024.12.043","DOIUrl":"10.1016/j.jor.2024.12.043","url":null,"abstract":"<div><h3>Background</h3><div>Closed reduction and percutaneous pinning (CRPP) and hemiarthroplasty are two common surgical treatments for hip fracture management, with different risks and benefits. This study compares short- and long-term outcomes in patients treated with CRPP versus hemiarthroplasty to emphasize the need for strategic surgical selection.</div></div><div><h3>Methods</h3><div>This retrospective cohort study extracted de-identified patient data using relevant ICD-9, ICD-10, and CPT codes from the TriNetX Research Network. Two cohorts were generated: 10,179 patients receiving hemiarthroplasty and 12,436 patients receiving CRPP. Propensity score matching adjusted for age, sex, obesity status, and tobacco use, producing matched groups of 9121 patients each. Statistical significance was set at P &lt; 0.01.</div></div><div><h3>Conclusion</h3><div>CRPP patients had lower rates of transfusion, infection, and periprosthetic complications compared to hemiarthroplasty in matched cohorts. These findings highlight the need for careful surgical selection, particularly in vulnerable patients with increased risk of complications – such as patients on dialysis treatment. Further research is needed to refine patient selection criteria to optimize hip fracture outcomes and mitigate mortality risk.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 119-126"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144979","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}

{"title":"Tibiotalocalcaneal nailing as a treatment for ankle fractures in the elderly population: A systematic review","authors":"Christian Harter,&nbsp;Thomas Cho,&nbsp;Jiayong Liu","doi":"10.1016/j.jor.2024.12.047","DOIUrl":"10.1016/j.jor.2024.12.047","url":null,"abstract":"<div><div>This study evaluated patient outcomes of tibiotalocalcaneal (TTC) nailing for ankle fractures in an elderly population. A systematic literature search of PubMed and Google Scholar identified 24 studies involving 657 patients aged over 65. Key outcome measures included union rates, healing time, functional scores, and complications. The average union rate for TTC nail patients was 88.36 % (±12 %), with a healing time of 17.8 weeks (±4.68). Post-operatively, 77.16 % (±17 %) of patients returned to or exceeded their baseline ambulatory function. Pre-injury Olerud-Molander Ankle Scores averaged 63.1 (±5.00), compared to 50.43 (±8.59) post-surgery. Infection rates were reported in 10.51 % (±0.07) of patients (60/571), with superficial and deep infection rates of 6.83 % (±8 %) and 3.68 % (±6 %), respectively. Nail failure occurred in 4.7 % (12/255) of cases, and the average revision rate was 13.36 % (±7 %). In conclusion, TTC nailing is a viable treatment for elderly patients with ankle fractures. It offers satisfactory functional outcomes and an acceptable complication risk. It is particularly beneficial for those unable to undergo multiple surgeries or with significant comorbidities, providing a quick and effective means to restore mobility.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"67 ","pages":"Pages 1-6"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052887","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}

{"title":"Large language models in orthopedics: An exploratory research trend analysis and machine learning classification","authors":"Ausberto Velasquez Garcia ,&nbsp;Masataka Minami ,&nbsp;Manuel Mejia-Rodríguez ,&nbsp;Jorge Rolando Ortíz-Morales ,&nbsp;Fernando Radice","doi":"10.1016/j.jor.2024.12.039","DOIUrl":"10.1016/j.jor.2024.12.039","url":null,"abstract":"<div><h3>Background</h3><div>Large Language Models (LLMs) are set to transform orthopedic practice with promising applications and a growing body of research. This exploratory study analyzed research trends in orthopedic LLMs and validated a machine learning classifier for categorizing publications into predefined domains. We hypothesized that LLM-related research would exhibit distinct thematic trends, and that a machine learning classifier would be able to accurately categorize research domains.</div></div><div><h3>Methods</h3><div>A bibliometric analysis of 140 Scopus-indexed publications (2019–2024) was performed using keyword co-occurrence and thematic clustering. Articles were categorized into five areas: Patient Education, Research and Ethics, Surgeon Education, Clinical Support, and Diagnostics and Radiology Interpretation. Machine learning classifiers were trained on TF-IDF vectorized text and evaluated using precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC-ROC). Exploratory projections using linear regression assessed the volume and growth trends within the five research areas.</div></div><div><h3>Results</h3><div>The exploratory analysis revealed a substantial increase in LLM publications increased significantly from 28 in 2023 to 108 articles in 2024. The support vector machine (SVM) model outperformed others, achieving 82 % accuracy (AUC-ROC: 0.97), with high precision for categorizing research in Clinical Assistance Tools and strong recall for Diagnosis and Radiology Interpretation. Subgroup analysis showed that Patient Education achieved balanced performance (precision: 88 %, recall: 78 %, F1-score: 82 %), but overlapping terminology caused misclassifications between research and education domains. Temporal analysis predicted continued growth in these research domains, with Patient Education (+26 %) and Research and Ethics (+57 %) leading the way through 2027.</div></div><div><h3>Conclusion</h3><div>LLMs are exploring advancements in patient engagement, surgeon training, and orthopedic research, but challenges in reliability and ethics require careful implementation. Future work should focus on real-world validation, specialty-specific applications, and integrating multimodal AI systems. The SVM classifier demonstrated robust capabilities, providing a valuable tool for navigating the growing body of literature.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"66 ","pages":"Pages 110-118"},"PeriodicalIF":1.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143144978","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}