Pub Date : 2026-01-01DOI: 10.1016/j.jos.2025.06.005
Fuchao Wang , Shixia Chen , Yan Zhang , Yue Shen , Yuqi Wang , Xi Zhang
Objective
We endeavor to investigate the incidence and treatment of acute traumatic patellar dislocation (PD) in conjunction with various knee joint injuries in children.
Methods
A retrospective analysis was conducted on 137 patients diagnosed with acute traumatic PD and associated periarticular injuries. Patient imaging examinations, medical histories, and treatment records were collected and analyzed to assess the occurrence of PD in combination with injuries to the surrounding knee joint tissues, and to explore effective treatment strategies.
Results
Among the patients studied: 1 had a quadriceps injury, 6 had peripheral ligament injuries, 31 had avulsion fractures of the medial border of the patella, 7 had fractures of the lateral femoral condyle, 2 had fractures of the medial femoral condyle,5 had tibial tubercle fractures, 43 had cartilage injuries. Several patients presented with multiple injuries. In cases where only medial patellofemoral ligament (MPFL) injury occurred: 13 patients underwent MPFL reconstruction, none of whom experienced re-dislocation post-surgery. 29 patients underwent non-surgical treatment, with 12 experiencing at least one re-dislocation afterward. Overall: 92 patients received non-surgical treatment, with 30 patients experiencing re-dislocation post-surgery, resulting in a re-dislocation rate of 32.61 %. 45 patients underwent surgical treatment, with only 1 patient experiencing re-dislocation post-surgery, yielding a recurrence rate of 2.22 %.
Conclusion
Traumatic PD in children often involves significant soft tissue and bone damage. Surgical intervention is particularly beneficial when combined with extensor mechanism injuries, cartilage damage, or large fractures, as it effectively reduces the recurrence rate of postoperative dislocations.
{"title":"Acute traumatic patellar dislocation with periarticular injuries in children: A retrospective study of 137 patients","authors":"Fuchao Wang , Shixia Chen , Yan Zhang , Yue Shen , Yuqi Wang , Xi Zhang","doi":"10.1016/j.jos.2025.06.005","DOIUrl":"10.1016/j.jos.2025.06.005","url":null,"abstract":"<div><h3>Objective</h3><div>We endeavor to investigate the incidence and treatment of acute traumatic patellar dislocation (PD) in conjunction with various knee joint injuries in children.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 137 patients diagnosed with acute traumatic PD and associated periarticular injuries. Patient imaging examinations, medical histories, and treatment records were collected and analyzed to assess the occurrence of PD in combination with injuries to the surrounding knee joint tissues, and to explore effective treatment strategies.</div></div><div><h3>Results</h3><div>Among the patients studied: 1 had a quadriceps injury, 6 had peripheral ligament injuries, 31 had avulsion fractures of the medial border of the patella, 7 had fractures of the lateral femoral condyle, 2 had fractures of the medial femoral condyle,5 had tibial tubercle fractures, 43 had cartilage injuries. Several patients presented with multiple injuries. In cases where only medial patellofemoral ligament (MPFL) injury occurred: 13 patients underwent MPFL reconstruction, none of whom experienced re-dislocation post-surgery. 29 patients underwent non-surgical treatment, with 12 experiencing at least one re-dislocation afterward. Overall: 92 patients received non-surgical treatment, with 30 patients experiencing re-dislocation post-surgery, resulting in a re-dislocation rate of 32.61 %. 45 patients underwent surgical treatment, with only 1 patient experiencing re-dislocation post-surgery, yielding a recurrence rate of 2.22 %.</div></div><div><h3>Conclusion</h3><div>Traumatic PD in children often involves significant soft tissue and bone damage. Surgical intervention is particularly beneficial when combined with extensor mechanism injuries, cartilage damage, or large fractures, as it effectively reduces the recurrence rate of postoperative dislocations.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 255-261"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with clear cell renal cell carcinoma (ccRCC) have a higher incidence of bone metastasis; however, the availability of immune checkpoint inhibitors (ICIs) is expected to improve their overall survival (OS). Hence, accurate data on the prognosis and survival of patients with bone metastases are necessary to recommend appropriate treatments. Therefore, we investigated the prognosis and prognostic factors of patients with ccRCC bone metastasis in the era of ICIs.
Methods
This retrospective cohort study included 33 patients with ccRCC who were treated for bone metastases between 2016 and 2022. We evaluated the association between OS and clinical parameters, including serum biochemical concentrations, and blood cell count, using Kaplan–Meier curves and Cox proportional hazards models.
Results
The median OS was 28 months (95 % confidence interval (CI): 8 months - not censored), and the 1-year survival rate was 64 %. Twenty-one patients were treated with ICIs after bone metastasis diagnosis. The multivariate analysis revealed that the use of ICIs after bone metastasis diagnosis was a good prognostic factor (hazard ratio, 0.32; 95 % CI: 0.11–0.89, p = 0.029). Patients in the Katagiri score 5–7 points group using ICIs had a significantly longer survival (p = 0.012) but similar OS compared to the 2–4 points group (p = 0.34).
Conclusions
ICI use after the diagnosis of bone metastasis may be a favorable prognostic factor in patients with bone metastases due to ccRCC. The predictive power of the current scoring system could underestimate the prognoses in patients with ccRCC and bone metastasis not treated with ICIs, highlighting the need for a better predictive scoring system in the era of ICIs.
{"title":"Prognostic factors in patients with bone metastasis of renal cell carcinoma in the era of immune checkpoint inhibitors","authors":"Yuki Ishibashi , Hiroshi Kobayashi , Koichi Okajima , Takahiro Oki , Yusuke Tsuda , Yusuke Shinoda , Ryoko Sawada , Sakae Tanaka","doi":"10.1016/j.jos.2025.06.008","DOIUrl":"10.1016/j.jos.2025.06.008","url":null,"abstract":"<div><h3>Background</h3><div>Patients with clear cell renal cell carcinoma (ccRCC) have a higher incidence of bone metastasis; however, the availability of immune checkpoint inhibitors (ICIs) is expected to improve their overall survival (OS). Hence, accurate data on the prognosis and survival of patients with bone metastases are necessary to recommend appropriate treatments. Therefore, we investigated the prognosis and prognostic factors of patients with ccRCC bone metastasis in the era of ICIs.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 33 patients with ccRCC who were treated for bone metastases between 2016 and 2022. We evaluated the association between OS and clinical parameters, including serum biochemical concentrations, and blood cell count, using Kaplan–Meier curves and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>The median OS was 28 months (95 % confidence interval (CI): 8 months - not censored), and the 1-year survival rate was 64 %. Twenty-one patients were treated with ICIs after bone metastasis diagnosis. The multivariate analysis revealed that the use of ICIs after bone metastasis diagnosis was a good prognostic factor (hazard ratio, 0.32; 95 % CI: 0.11–0.89, p = 0.029). Patients in the Katagiri score 5–7 points group using ICIs had a significantly longer survival (p = 0.012) but similar OS compared to the 2–4 points group (p = 0.34).</div></div><div><h3>Conclusions</h3><div>ICI use after the diagnosis of bone metastasis may be a favorable prognostic factor in patients with bone metastases due to ccRCC. The predictive power of the current scoring system could underestimate the prognoses in patients with ccRCC and bone metastasis not treated with ICIs, highlighting the need for a better predictive scoring system in the era of ICIs.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 262-267"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Epidemiological characteristics of Hip osteoarthritis (OA) continue to change due to population aging and emerging disease concepts, such as femoroacetabular impingement (FAI) and subchondral insufficiency fracture of the femoral head (SIF). This study aimed to analyze the current etiologies of hip OA in Japan and identify characteristics associated with each etiology.
Methods
A multicenter cross-sectional study was conducted in 2022 at 12 major Japanese hospitals, including 1197 patients (1515 hips) newly diagnosed with hip OA. Etiologies were classified into nine categories based on patient background and imaging findings: hip dysplasia, primary OA, FAI, SIF, rapidly destructive coxopathy (RDC), trauma, Legg-Calvé-Perthes disease (LCPD), slipped capital femoral epiphysis (SCFE), and skeletal dysplasia.
Results
The etiologies included hip dysplasia (74.4 %), primary OA (13.4 %), FAI (4.8 %), SIF (3.4 %), RDC (1.3 %), trauma (1.3 %), LCPD (0.9 %), SCFE (0.1 %), and skeletal dysplasia (0.1 %). Patients in their 70s comprised the largest group, with a predominance of female patients across all ages. The proportion of hip dysplasia decreased in the elderly patients, whereas primary OA and SIF increased. Hip dysplasia was more common in female than male (78.2 % vs. 55.2 %), whereas FAI was more frequent in male (17.9 % vs. 2.2 %). The Japanese Orthopaedic Association hip scores were highest for FAI and lowest for SIF. Kellgren-Lawrence (KL) grade ≥3 was more common in primary OA (82.0 %) and hip dysplasia (76.7 %) than in FAI (57.7 %) and SIF (66.7 %).
Conclusions
Hip dysplasia remains the predominant cause of hip OA in Japan. Age-specific analyses revealed that FAI was more common in younger patients, while primary OA and SIF were prevalent in older patients. Patients with hip dysplasia and primary OA often presented with advanced KL grades, while SIF was associated with the poorest clinical scores. These findings may inform diagnostic and treatment approaches based on predominant etiologies.
{"title":"Etiology and clinical trends in hip osteoarthritis in Japan: Insights from a multicenter cross-sectional study","authors":"Taishi Sato , Ryosuke Yamaguchi , Takeshi Utsunomiya , Yutaka Inaba , Hiroyuki Ike , Koichi Kinoshita , Kenichiro Doi , Tsutomu Kawano , Kyohei Shiomoto , Toshihiko Hara , Kazuhiko Sonoda , Ayumi Kaneuji , Eiji Takahashi , Tomohiro Shimizu , Daisuke Takahashi , Yusuke Kohno , Tamon Kabata , Daisuke Inoue , Shuichi Matsuda , Koji Goto , Yasuharu Nakashima","doi":"10.1016/j.jos.2025.06.006","DOIUrl":"10.1016/j.jos.2025.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Epidemiological characteristics of Hip osteoarthritis (OA) continue to change due to population aging and emerging disease concepts, such as femoroacetabular impingement (FAI) and subchondral insufficiency fracture of the femoral head (SIF). This study aimed to analyze the current etiologies of hip OA in Japan and identify characteristics associated with each etiology.</div></div><div><h3>Methods</h3><div>A multicenter cross-sectional study was conducted in 2022 at 12 major Japanese hospitals, including 1197 patients (1515 hips) newly diagnosed with hip OA. Etiologies were classified into nine categories based on patient background and imaging findings: hip dysplasia, primary OA, FAI, SIF, rapidly destructive coxopathy (RDC), trauma, Legg-Calvé-Perthes disease (LCPD), slipped capital femoral epiphysis (SCFE), and skeletal dysplasia.</div></div><div><h3>Results</h3><div>The etiologies included hip dysplasia (74.4 %), primary OA (13.4 %), FAI (4.8 %), SIF (3.4 %), RDC (1.3 %), trauma (1.3 %), LCPD (0.9 %), SCFE (0.1 %), and skeletal dysplasia (0.1 %). Patients in their 70s comprised the largest group, with a predominance of female patients across all ages. The proportion of hip dysplasia decreased in the elderly patients, whereas primary OA and SIF increased. Hip dysplasia was more common in female than male (78.2 % vs. 55.2 %), whereas FAI was more frequent in male (17.9 % vs. 2.2 %). The Japanese Orthopaedic Association hip scores were highest for FAI and lowest for SIF. Kellgren-Lawrence (KL) grade ≥3 was more common in primary OA (82.0 %) and hip dysplasia (76.7 %) than in FAI (57.7 %) and SIF (66.7 %).</div></div><div><h3>Conclusions</h3><div>Hip dysplasia remains the predominant cause of hip OA in Japan. Age-specific analyses revealed that FAI was more common in younger patients, while primary OA and SIF were prevalent in older patients. Patients with hip dysplasia and primary OA often presented with advanced KL grades, while SIF was associated with the poorest clinical scores. These findings may inform diagnostic and treatment approaches based on predominant etiologies.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 187-193"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jos.2025.05.008
Tsunemasa Kita , Taro Funamoto , Haruki Mori , Hiroshi Ikejiri , Takuya Tajima , Etsuo Chosa , Naosuke Kamei
Background
A medical fee incentive based on a 48-h target time for hip fracture surgery has been implemented in Japan since 2022. This study aimed to evaluate the clinical outcomes of early surgery within 48 h after hip fracture.
Methods
This study was a retrospective, single-center study. Patients >60 years of age who underwent hip fracture surgery between 2021 and 2022 were eligible. They were divided into 2 groups: 2021 (before implementation of the system) and 2022 (after implementation of the system). The primary outcome was the surgical waiting time after injury. The secondary outcomes were clinical outcomes such as postoperative complication rate, mortality rate at 1 and 6 months after surgery, and length of stay in our institution. To assess the influence of early surgery on these outcomes, an additional analysis was performed in 2 groups: the early group (surgery within 48 h) and the delayed group (surgery beyond 48 h).
Results
In total, 365 patients were included in this study. The surgical waiting time was significantly shortened after the implementation of the system (64.5 h in 2021 vs. 42.8 h in 2022, p < 0.001). There were significant differences between the 2021 and 2022 groups in the complication rate (17 % vs. 9 %, p = 0.03) and length of hospital stay (15 days vs. 13 days, p < 0.001). A multivariate analysis between the early and delayed group showed that early surgery was associated with a lower complication rate and shorter length of stay (p < 0.05).
Conclusion
Efforts to perform early surgery within 48 h of injury following the new reimbursement scheme have contributed to improved clinical outcomes, including lower complication rates and shorter hospital stay in our institution.
{"title":"Early surgery within 48 h for post-injury hip fractures improved clinical outcomes","authors":"Tsunemasa Kita , Taro Funamoto , Haruki Mori , Hiroshi Ikejiri , Takuya Tajima , Etsuo Chosa , Naosuke Kamei","doi":"10.1016/j.jos.2025.05.008","DOIUrl":"10.1016/j.jos.2025.05.008","url":null,"abstract":"<div><h3>Background</h3><div>A medical fee incentive based on a 48-h target time for hip fracture surgery has been implemented in Japan since 2022. This study aimed to evaluate the clinical outcomes of early surgery within 48 h after hip fracture.</div></div><div><h3>Methods</h3><div>This study was a retrospective, single-center study. Patients >60 years of age who underwent hip fracture surgery between 2021 and 2022 were eligible. They were divided into 2 groups: 2021 (before implementation of the system) and 2022 (after implementation of the system). The primary outcome was the surgical waiting time after injury. The secondary outcomes were clinical outcomes such as postoperative complication rate, mortality rate at 1 and 6 months after surgery, and length of stay in our institution. To assess the influence of early surgery on these outcomes, an additional analysis was performed in 2 groups: the early group (surgery within 48 h) and the delayed group (surgery beyond 48 h).</div></div><div><h3>Results</h3><div>In total, 365 patients were included in this study. The surgical waiting time was significantly shortened after the implementation of the system (64.5 h in 2021 vs. 42.8 h in 2022, p < 0.001). There were significant differences between the 2021 and 2022 groups in the complication rate (17 % vs. 9 %, p = 0.03) and length of hospital stay (15 days vs. 13 days, p < 0.001). A multivariate analysis between the early and delayed group showed that early surgery was associated with a lower complication rate and shorter length of stay (p < 0.05).</div></div><div><h3>Conclusion</h3><div>Efforts to perform early surgery within 48 h of injury following the new reimbursement scheme have contributed to improved clinical outcomes, including lower complication rates and shorter hospital stay in our institution.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 219-225"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jos.2025.06.011
Mehmet Fevzi Cakmak , Serkan Bayram , Levent Horoz , Hicabi Sezgin , Burak Akan
Background
This study aimed to compare the clinical and radiological outcomes of patients who underwent autograft application following standard transverse osteotomy supported by two cobalt-chrome cables with those who did not use autografts to support the osteotomy line in Crowe type IV Developmental Dysplasia of the Hip (DDH).
Methods
Sixty-nine patients (78 hips) with Crowe type IV DDH underwent a transverse subtrochanteric shortening osteotomy. In Group 1, 42 hips had their osteotomy site supported with an autograft harvested from the shortening osteotomy. Conversely, Group 2 consisted of 36 hips in which graft application was not performed, and fixation of the osteotomy site was solely achieved by employing the femoral stem. Clinical outcome measures included limb length discrepancy, pain (visual analog score), and functional Harris Hip Score (HHS). For radiological evaluation, bone healing of the femoral osteotomy site was assessed using the radiographic union score for tibial (mRUST) classification, and stabilization of components was evaluated according to the Engh classification.
Results
There were no significant differences in age, body mass index, follow-up duration, preoperative and postoperative LLD, VAS score, and HHS values. No statistically significant difference was identified between the Engh classification. Significant differences between the groups were detected in the mRUST classification (p = 0.020). The mean value of the group not utilizing autograft (11,89 ± 1,83) was higher than that of the group using autografts (10,95 ± 1,59). There was no statistically significant relationship between complications between the groups (p = 0.981).
Conclusion
Performing of THA in Crowe type IV DDH, the press-fit application of the femoral component, without additional implantation or grafting, have shown comparable and satisfactory outcomes.
{"title":"Intercalary autograft not mandatory for shortening in total hip arthroplasty: A retrospective study","authors":"Mehmet Fevzi Cakmak , Serkan Bayram , Levent Horoz , Hicabi Sezgin , Burak Akan","doi":"10.1016/j.jos.2025.06.011","DOIUrl":"10.1016/j.jos.2025.06.011","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to compare the clinical and radiological outcomes of patients who underwent autograft application following standard transverse osteotomy supported by two cobalt-chrome cables with those who did not use autografts to support the osteotomy line in Crowe type IV Developmental Dysplasia of the Hip (DDH).</div></div><div><h3>Methods</h3><div>Sixty-nine patients (78 hips) with Crowe type IV DDH underwent a transverse subtrochanteric shortening osteotomy. In Group 1, 42 hips had their osteotomy site supported with an autograft harvested from the shortening osteotomy. Conversely, Group 2 consisted of 36 hips in which graft application was not performed, and fixation of the osteotomy site was solely achieved by employing the femoral stem. Clinical outcome measures included limb length discrepancy, pain (visual analog score), and functional <strong>Harris Hip Score (HHS).</strong> For radiological evaluation, bone healing of the femoral osteotomy site was assessed using <strong>the radiographic union score for tibial (mRUST)</strong> classification, and stabilization of components was evaluated according to the Engh classification.</div></div><div><h3>Results</h3><div>There were no significant differences in age, body mass index, follow-up duration, preoperative and postoperative LLD, VAS score, and HHS values. No statistically significant difference was identified between the Engh classification. Significant differences between the groups were detected in the mRUST classification (p = 0.020). The mean value of the group not utilizing autograft (11,89 ± 1,83) was higher than that of the group using autografts (10,95 ± 1,59). There was no statistically significant relationship between complications between the groups (p = 0.981).</div></div><div><h3>Conclusion</h3><div>Performing of THA in Crowe type IV DDH, the press-fit application of the femoral component, without additional implantation or grafting, have shown comparable and satisfactory outcomes.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 170-176"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jos.2025.06.015
Younguk Park, DaeHyun Han, Myungsub Lee, Young Wook Seo
Background
With significant advancements in arthroscopic surgical techniques, the frequency of arthroscopic lateral ankle ligament repair procedures has increased. However, anchor positioning accuracy remains uncertain, with studies suggesting a higher probability of the anchor being fixed in non-anatomical positions, such as insertion proximal to the fibular obscure tubercle (FOT). Using ultrasound guidance, anchors can be positioned more anatomically. This study aimed to analyze anchor position in arthroscopic all-inside lateral ligament repair using ultrasound.
Methods
Thirty-three patients with chronic ankle instability were prospectively enrolled and underwent ultrasound-guided, arthroscopic all-inside lateral ankle ligament repair, termed Arthroscopic Ultrasound-Assisted All-Inside Repair of the Lateral Ankle Ligament (AURA). Postoperative computed tomography (CT) scans were taken to analyze anchor positions, with the FOT as the reference point. Subsequently, the anchor positions were classified as anatomic, sub-anatomic, and nonanatomic based on the relationship between the fibular anterior tubercle and the FOT.
Results
The mean distance between anchor position and the fibular obscure tubercle (FOT) was 2.08 mm (range, 0–12 mm). Based on postoperative CT analysis, anchor placements were classified relative to the FOT: 28 of 33 cases (84.8 %) were within 25 % of the fibular length distal to the FOT (anatomic zone), 4 cases (12.2 %) were positioned between 25–50 % (sub-anatomic zone), and 1 case (3.0 %) was beyond 50 % (non-anatomic zone).
Conclusion
The ultrasound-assisted technique demonstrated high anatomical accuracy in anchor placement, as confirmed by postoperative 3D-CT evaluation.
{"title":"Enhanced anatomical accuracy in arthroscopic all-inside lateral ligament repair using ultrasound-guided anchor placement","authors":"Younguk Park, DaeHyun Han, Myungsub Lee, Young Wook Seo","doi":"10.1016/j.jos.2025.06.015","DOIUrl":"10.1016/j.jos.2025.06.015","url":null,"abstract":"<div><h3>Background</h3><div>With significant advancements in arthroscopic surgical techniques, the frequency of arthroscopic lateral ankle ligament repair procedures has increased. However, anchor positioning accuracy remains uncertain, with studies suggesting a higher probability of the anchor being fixed in non-anatomical positions, such as insertion proximal to the fibular obscure tubercle (FOT). Using ultrasound guidance, anchors can be positioned more anatomically. This study aimed to analyze anchor position in arthroscopic all-inside lateral ligament repair using ultrasound.</div></div><div><h3>Methods</h3><div>Thirty-three patients with chronic ankle instability were prospectively enrolled and underwent ultrasound-guided, arthroscopic all-inside lateral ankle ligament repair, termed Arthroscopic Ultrasound-Assisted All-Inside Repair of the Lateral Ankle Ligament (AURA). Postoperative computed tomography (CT) scans were taken to analyze anchor positions, with the FOT as the reference point. Subsequently, the anchor positions were classified as anatomic, sub-anatomic, and nonanatomic based on the relationship between the fibular anterior tubercle and the FOT.</div></div><div><h3>Results</h3><div>The mean distance between anchor position and the fibular obscure tubercle (FOT) was 2.08 mm (range, 0–12 mm). Based on postoperative CT analysis, anchor placements were classified relative to the FOT: 28 of 33 cases (84.8 %) were within 25 % of the fibular length distal to the FOT (anatomic zone), 4 cases (12.2 %) were positioned between 25–50 % (sub-anatomic zone), and 1 case (3.0 %) was beyond 50 % (non-anatomic zone).</div></div><div><h3>Conclusion</h3><div>The ultrasound-assisted technique demonstrated high anatomical accuracy in anchor placement, as confirmed by postoperative 3D-CT evaluation.</div></div><div><h3>Level of Evidence</h3><div>IV, case study.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 177-182"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Intramedullary headless screw fixation has become significant in the treatment of phalangeal fractures. While intramedullary headless screw fixation is a simple and rigid approach, common techniques for guide wire insertion, including retrograde, antegrade-intra-articular, and trans-articular techniques, damage the articular cartilage and extensor tendon, particularly the central slip. To mitigate these risks, we applied a new method by percutaneously inserting the screw obliquely from the radial or ulnar base of the proximal or middle phalanges. This study aimed to assess the clinical outcomes of intramedullary headless screw fixation using the oblique technique in the treatment of proximal and middle phalangeal fractures.
Methods
Between April 2022 and August 2023, we retrospectively collected data on consecutive unstable proximal or middle phalangeal fractures treated with percutaneous intramedullary headless screw fixation using the oblique technique. The clinical outcomes were the active range of motion of each phalangeal joint and the grip strength ratio. Surgical time, fracture union, and complications were also evaluated.
Results
Sixteen patients (6 middle and 10 proximal phalanx fractures) were included in this study. The mean operative time was 34.2 min, while the median fracture union time was 7.2 weeks. The mean values of the active range of motion (ROM) of extension and flexion of the proximal interphalangeal joint were -1.3° and 98.5°, respectively, in middle phalanx fractures and -9.2° and 83.7° in proximal phalanx fractures. No complications were observed.
Conclusions
This study demonstrated the good clinical outcome of percutaneous intramedullary headless screw fixation using the oblique technique for proximal and middle phalangeal fractures. This simple technique reduces the damage risk to the articular cartilage and extensor tendons.
{"title":"Clinical outcomes of percutaneous intramedullary headless screw fixation with an oblique technique for the treatment of proximal and middle phalanx fractures","authors":"Hiroki Yokoyama , Kenichi Asano , Hidemasa Yoneda , Katsuyuki Iwatsuki , Marie Mabuchi , Michiro Yamamoto","doi":"10.1016/j.jos.2025.06.017","DOIUrl":"10.1016/j.jos.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Intramedullary headless screw fixation has become significant in the treatment of phalangeal fractures. While intramedullary headless screw fixation is a simple and rigid approach, common techniques for guide wire insertion, including retrograde, antegrade-intra-articular, and <em>trans</em>-articular techniques, damage the articular cartilage and extensor tendon, particularly the central slip. To mitigate these risks, we applied a new method by percutaneously inserting the screw obliquely from the radial or ulnar base of the proximal or middle phalanges. This study aimed to assess the clinical outcomes of intramedullary headless screw fixation using the oblique technique in the treatment of proximal and middle phalangeal fractures.</div></div><div><h3>Methods</h3><div>Between April 2022 and August 2023, we retrospectively collected data on consecutive unstable proximal or middle phalangeal fractures treated with percutaneous intramedullary headless screw fixation using the oblique technique. The clinical outcomes were the active range of motion of each phalangeal joint and the grip strength ratio. Surgical time, fracture union, and complications were also evaluated.</div></div><div><h3>Results</h3><div>Sixteen patients (6 middle and 10 proximal phalanx fractures) were included in this study. The mean operative time was 34.2 min, while the median fracture union time was 7.2 weeks. The mean values of the active range of motion (ROM) of extension and flexion of the proximal interphalangeal joint were -1.3° and 98.5°, respectively, in middle phalanx fractures and -9.2° and 83.7° in proximal phalanx fractures. No complications were observed.</div></div><div><h3>Conclusions</h3><div>This study demonstrated the good clinical outcome of percutaneous intramedullary headless screw fixation using the oblique technique for proximal and middle phalangeal fractures. This simple technique reduces the damage risk to the articular cartilage and extensor tendons.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 119-125"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pyogenic vertebral osteomyelitis (PVO) is a rare but serious disease that presents diagnostic and therapeutic challenges. Although recent studies provide limited insights into its management trends, data on antibiotic regimens and surgical procedures remain scarce. This study aimed to assess real-world treatment trends for PVO in Japan.
Methods
We conducted a descriptive study using a hospital administrative database from 2015 to 2023. We included 1524 adult patients hospitalized for PVO in 50 hospitals that continuously contributed data during this period. We assessed antibiotic regimens (duration, trends in specific agents, and combination therapy), surgical procedures, and in-hospital mortality. We used the Cochran–Armitage trend test to evaluate annual changes, and examined factors associated with in-hospital mortality using univariable modified Poisson regression.
Results
The median duration of antibiotic therapy was 54 days. Although the proportion of patients receiving cefazolin (slightly over half) remained unchanged, there was a marked increase in the use of broad-spectrum antibiotics such as ceftriaxone, vancomycin, and piperacillin-tazobactam. During the oral phase, minocycline (33.5 %) and levofloxacin (24.8 %) were the most commonly prescribed. Approximately 30 % of patients received combination therapy, and this proportion did not change substantially over time. Surgical interventions increased during the study period, primarily because of rising posterior fixation procedures. In-hospital mortality was 5.2 %. Older age, heart failure, hemodialysis, and a higher Charlson Comorbidity Index were strongly associated with increased in-hospital mortality.
Conclusions
Our findings suggest that the treatment duration of PVO tended to be longer than guideline recommendations, whereas the selection of oral agents was consistent with them. The growing trend in posterior fixation surgeries may reflect the adoption of minimally invasive techniques such as percutaneous pedicle screw fixation. Older patients with heart and kidney failure require particular caution in treatment.
{"title":"Treatment trends and outcomes of pyogenic vertebral osteomyelitis in Japan, 2015–2023: A descriptive epidemiological study","authors":"Takaki Yoshiyama , Toshiki Fukasawa , Soichiro Masuda , Bungo Otsuki , Koichi Murata , Takayoshi Shimizu , Takashi Sono , Shintaro Honda , Koichiro Shima , Masaki Sakamoto , Ryohei Saito , Shuichi Matsuda , Koji Kawakami","doi":"10.1016/j.jos.2025.06.003","DOIUrl":"10.1016/j.jos.2025.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Pyogenic vertebral osteomyelitis (PVO) is a rare but serious disease that presents diagnostic and therapeutic challenges. Although recent studies provide limited insights into its management trends, data on antibiotic regimens and surgical procedures remain scarce. This study aimed to assess real-world treatment trends for PVO in Japan.</div></div><div><h3>Methods</h3><div>We conducted a descriptive study using a hospital administrative database from 2015 to 2023. We included 1524 adult patients hospitalized for PVO in 50 hospitals that continuously contributed data during this period. We assessed antibiotic regimens (duration, trends in specific agents, and combination therapy), surgical procedures, and in-hospital mortality. We used the Cochran–Armitage trend test to evaluate annual changes, and examined factors associated with in-hospital mortality using univariable modified Poisson regression.</div></div><div><h3>Results</h3><div>The median duration of antibiotic therapy was 54 days. Although the proportion of patients receiving cefazolin (slightly over half) remained unchanged, there was a marked increase in the use of broad-spectrum antibiotics such as ceftriaxone, vancomycin, and piperacillin-tazobactam. During the oral phase, minocycline (33.5 %) and levofloxacin (24.8 %) were the most commonly prescribed. Approximately 30 % of patients received combination therapy, and this proportion did not change substantially over time. Surgical interventions increased during the study period, primarily because of rising posterior fixation procedures. In-hospital mortality was 5.2 %. Older age, heart failure, hemodialysis, and a higher Charlson Comorbidity Index were strongly associated with increased in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that the treatment duration of PVO tended to be longer than guideline recommendations, whereas the selection of oral agents was consistent with them. The growing trend in posterior fixation surgeries may reflect the adoption of minimally invasive techniques such as percutaneous pedicle screw fixation. Older patients with heart and kidney failure require particular caution in treatment.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 102-108"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.jos.2025.06.009
Masaki Ikejiri , Hideki Shigematsu , Sachiko Kawasaki , Yuma Suga , Takahiro Mui , Yasuhito Tanaka
Background
Lower instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) corrective surgery is selected using the center sacral vertical line on supine side-bending radiographs. However, a horizontal line reference is not possible on supine radiographs. Therefore, we aimed to determine the pelvic reference line that best reflects the horizontal line, which can be used in determining the LIV on supine side-bending radiograph in patients with AIS.
Methods
Patients with AIS (n = 258) were evaluated. On whole-spine standing anteroposterior radiographs, three lines were selected (the upper sacral line [USL], sacroiliac joint line [SIL], and upper iliac line [UIL]) and compared with the horizontal line to investigate tilt angles. Patients were allocated into thoracic (T; n = 90), lumbar (L; n = 61), and double (D; n = 107) curve groups based on thoracic and lumbar Cobb angles.
Results
The mean USL; SIL; and UIL tilts were 2.3°, 4.7°, and 3.8°; 1.6°, 2.0°, and 2.0°; and 1.4°, 2.2°, and 1.8° in the T, L, and D groups, respectively. The USL was significantly tilted in all groups, without significant difference between the SIL and UIL tilts. The USL tilted significantly more from the horizontal line in the L and D groups than in the T group; the UIL tilted more in the L group compared with the T group. The SIL tilt was comparable between the groups. The Cobb angle on the thoracolumbar or lumbar curve significantly, albeit weakly, correlated with the USL and UIL tilt.
Conclusions
On whole-spine standing anteroposterior radiographs, the USL had the greatest tilt (mean: 3.5°), whereas the SIL had the smallest tilt (mean: 1.8°) without significant variation across scoliosis types. Independent of Cobb angle and scoliosis type, the SIL was the most stable and reliable reference line for horizontal alignment, making it the preferred reference to LIV selection in patients undergoing AIS corrective surgery.
{"title":"Does the upper line of the sacral ala approximate a horizontal line on pelvic radiographs of idiopathic scoliosis?","authors":"Masaki Ikejiri , Hideki Shigematsu , Sachiko Kawasaki , Yuma Suga , Takahiro Mui , Yasuhito Tanaka","doi":"10.1016/j.jos.2025.06.009","DOIUrl":"10.1016/j.jos.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Lower instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) corrective surgery is selected using the center sacral vertical line on supine side-bending radiographs. However, a horizontal line reference is not possible on supine radiographs. Therefore, we aimed to determine the pelvic reference line that best reflects the horizontal line, which can be used in determining the LIV on supine side-bending radiograph in patients with AIS.</div></div><div><h3>Methods</h3><div>Patients with AIS (n = 258) were evaluated. On whole-spine standing anteroposterior radiographs, three lines were selected (the upper sacral line [USL], sacroiliac joint line [SIL], and upper iliac line [UIL]) and compared with the horizontal line to investigate tilt angles. Patients were allocated into thoracic (T; n = 90), lumbar (L; n = 61), and double (D; n = 107) curve groups based on thoracic and lumbar Cobb angles.</div></div><div><h3>Results</h3><div>The mean USL; SIL; and UIL tilts were 2.3°, 4.7°, and 3.8°; 1.6°, 2.0°, and 2.0°; and 1.4°, 2.2°, and 1.8° in the T, L, and D groups, respectively. The USL was significantly tilted in all groups, without significant difference between the SIL and UIL tilts. The USL tilted significantly more from the horizontal line in the L and D groups than in the T group; the UIL tilted more in the L group compared with the T group. The SIL tilt was comparable between the groups. The Cobb angle on the thoracolumbar or lumbar curve significantly, albeit weakly, correlated with the USL and UIL tilt.</div></div><div><h3>Conclusions</h3><div>On whole-spine standing anteroposterior radiographs, the USL had the greatest tilt (mean: 3.5°), whereas the SIL had the smallest tilt (mean: 1.8°) without significant variation across scoliosis types. Independent of Cobb angle and scoliosis type, the SIL was the most stable and reliable reference line for horizontal alignment, making it the preferred reference to LIV selection in patients undergoing AIS corrective surgery.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 87-95"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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