Journal of Orthopaedic Science最新文献_第5页

Development and internal validation of a Cox proportional hazards model for predicting 1-year mortality in patients conservatively managed for hip fracture 用于预测髋部骨折保守治疗患者1年死亡率的Cox比例风险模型的建立和内部验证

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.06.002

Keisuke Nakamura , Yasushi Kurobe , Tomohiro Sasaki , Masayuki Shimizu

Background

Hip fractures in older adults are associated with high mortality and functional decline, particularly in conservatively managed patients. However, prognostic models specific to conservatively managed patients remain scarce. We aimed to develop and internally validate a Cox proportional hazards (PH) model to predict 1-year mortality based on admission data.

Methods

We conducted a retrospective cohort study at a community hospital in Japan, including 76 patients aged ≥65 years who sustained femoral neck or trochanteric fractures and received conservative treatment between April 2018 and April 2020. The primary outcome was 1-year all-cause mortality. Variables included demographics, comorbidities, cognitive function, fracture type, and nutritional status. Missing data were imputed using a random forest algorithm. Univariable and multivariable Cox PH models were used. Internal validation was performed with bootstrap resampling (1000 iterations). Model discrimination was assessed using Harrell's C-index, and calibration was assessed using calibration plots.

Results

The Cox PH regression analysis yielded: h (t∣age, body mass index [BMI], fracture type) = h₀(t) exp (0.005 × age − 0.274 × BMI − 1.870 × fracture type) (Fracture type: 0 = femoral neck, 1 = trochanteric). Lower BMI (hazard ratio [HR] = 0.760; 95 % confidence interval [CI]: 0.637–0.908; p = 0.002) and trochanteric fractures (HR = 0.154; 95 % CI: 0.058–0.411; p < 0.001) were significant predictors of increased mortality. The model demonstrated good discrimination (Harrell's C-index: 0.774; optimism-adjusted: 0.762). Calibration was poor at early timepoints (90–270 days); however, it improved at 365 days (slope = 1.03; C-statistic = 0.83). Decision curve analysis confirmed clinical utility at threshold probabilities above 10 %.

Conclusions

We developed a Cox PH regression model with good discrimination and acceptable calibration at 1 year to predict mortality in patients with conservatively managed hip fractures. This model may assist clinicians in early risk stratification and individualized care planning.

背景：老年人髋部骨折与高死亡率和功能下降有关，特别是在保守治疗的患者中。然而，针对保守治疗患者的预后模型仍然很少。我们的目的是建立并内部验证Cox比例风险（PH）模型，以根据入院数据预测1年死亡率。方法：我们在日本一家社区医院进行了一项回顾性队列研究，纳入了2018年4月至2020年4月期间76例年龄≥65岁的持续股骨颈或股骨粗隆骨折并接受保守治疗的患者。主要终点为1年全因死亡率。变量包括人口统计学、合并症、认知功能、骨折类型和营养状况。缺失数据的输入采用随机森林算法。采用单变量和多变量Cox PH模型。内部验证通过自举重采样（1000次迭代）进行。采用Harrell’sc指数评估模型判别，采用标定图评估模型标定。结果：Cox PH回归分析得出：h （t∣年龄，体重指数[BMI]，骨折类型）= h0(t) exp （0.005 ×年龄- 0.274 × BMI - 1.870 ×骨折类型）（骨折类型：0 =股骨颈，1 =粗隆）。较低的BMI(风险比[HR] = 0.760；95%置信区间[CI]: 0.637-0.908；p = 0.002)和转子骨折(HR = 0.154；95% ci: 0.058-0.411；P < 0.001)是死亡率增加的显著预测因子。模型具有良好的判别性(Harrell’s C-index: 0.774；optimism-adjusted: 0.762)。早期时间点（90-270天）的校准较差；但在365 d时有所改善(斜率= 1.03；C-statistic = 0.83)。决策曲线分析证实了阈值概率在10%以上的临床效用。结论：我们建立了一个Cox PH回归模型，该模型具有良好的判别性和可接受的1年校正，可预测保守治疗髋部骨折患者的死亡率。该模型可以帮助临床医生进行早期风险分层和个性化护理计划。

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引用次数: 0

Evaluation of skeletal muscle metabolism during walking in symptomatic and asymptomatic patients with osteoarthritis of the knee joint using positron emission tomography 使用正电子发射断层扫描评估有症状和无症状膝关节骨关节炎患者行走时骨骼肌代谢。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.001

Yusuke Yanatori , Takeshi Oshima , Yasushi Takata , Junichi Taki , Takuya Sengoku , Goro Sakurai , Seigo Kinuya , Satoru Demura , Junsuke Nakase

Background

This study aimed to evaluate skeletal muscle metabolism during walking in symptomatic and asymptomatic patients with knee osteoarthritis using positron emission tomography-computed tomography with 18F-fluorodeoxyglucose. We hypothesized that quadriceps muscle metabolism during walking would vary between the groups.

Methods

Twenty-two participants (11 males and 11 females) with knee osteoarthritis (Kellgren–Lawrence grade 2) were divided into symptomatic and asymptomatic groups. The participants performed two 10-min walks on a treadmill, received an intravenous injection of 18F-fluorodeoxyglucose between sets, and underwent positron emission tomography-computed tomography. Regions of interest were manually segmented into 35 skeletal muscles from the pelvis to the foot. The standardized uptake value was calculated to quantitatively examine 18F-fluorodeoxyglucose uptake by muscle tissue.

Results

The mean standardized uptake values of the hip abductor and external rotator muscles were lower in the symptomatic group than in the asymptomatic group and displayed a medium effect size (gluteus medius, P = 0.281; d = 0.482; gluteus minimus, P = 0.079; d = 0.793; piriformis, P = 0.184; d = 0.622). Although the vastus medialis demonstrated a medium effect size (P = 0.191; d = 0.597), the rectus femoris (P = 0.454; d = 0.299), vastus lateralis (P = 0.303; d = 0.392), and vastus intermedius (P = 0.300; d = 0.434) demonstrated no significant differences and only small effect sizes. Therefore, no overall difference in quadriceps muscle metabolism was observed between the groups.

Conclusion

A trend towards lower hip abductor and external rotator muscle metabolism was observed in patients with symptomatic knee osteoarthritis, suggesting that muscle metabolism may be associated with knee symptoms.

背景：本研究旨在利用正电子发射断层扫描- 18f -氟脱氧葡萄糖计算机断层扫描评估有症状和无症状膝骨关节炎患者行走时骨骼肌代谢。我们假设走路时的股四头肌代谢在两组之间会有所不同。方法：22例膝关节骨关节炎（Kellgren-Lawrence分级2级）患者（男11例，女11例）分为有症状组和无症状组。参与者在跑步机上进行两次10分钟的步行，在两组之间接受18f -氟脱氧葡萄糖静脉注射，并接受正电子发射断层扫描-计算机断层扫描。感兴趣的区域被人工分割成从骨盆到足部的35块骨骼肌。计算标准化摄取值，定量检测肌肉组织对18f -氟脱氧葡萄糖的摄取。结果：有症状组髋外展肌和外旋肌的平均标准化摄取值低于无症状组，并显示中等效应大小(臀中肌，P = 0.281；D = 0.482；臀小肌，P = 0.079；D = 0.793；梨状肌，P = 0.184；D = 0.622)。尽管股内侧肌表现出中等效应(P = 0.191；d = 0.597)，股直肌(P = 0.454；d = 0.299)，股外侧肌(P = 0.303；d = 0.392)，股中间肌(P = 0.300；D = 0.434)无显著差异，效应量较小。因此，各组之间没有观察到股四头肌代谢的总体差异。结论：在症状性膝骨关节炎患者中观察到下髋关节外展肌和外旋肌代谢的趋势，提示肌肉代谢可能与膝关节症状有关。

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引用次数: 0

Application effect of vacuum sealing drainage combined with nano-silver dressings in the treatment of non-healing wounds after surgery for open limb fractures 真空密封引流联合纳米银敷料在开放性肢体骨折术后未愈合伤口中的应用效果。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.012

Taihua Huang, Haiping Huang

Background

Non-healing wounds after open limb fracture surgery pose clinical challenges, requiring effective management; vacuum sealing drainage (VSD) promotes healing by removing exudate and stimulating granulation, while nano-silver dressings provide antimicrobial protection to reduce infection risk. We aimed to probe the application effect of VSD combined with nano-silver dressings in the treatment of non-healing wounds after surgery for Gustilo type III open limb fractures.

Methods

A total of 60 patients with non-healing wounds after surgery for Gustilo type III open limb fractures were randomly divided into two groups, with 30 cases in each group. The control group received conventional therapy, and the study group received VSD combined with nano-silver dressings. Before treatment and after 7 days of treatment, inflammatory cytokines (C-reactive protein (CRP) and procalcitonin (PCT)) in serum and growth factors (transforming growth factor beta1 (TGF-β1) and vascular endothelial growth factor (VEGF)) in wound exudate were measured using enzyme-linked immunosorbent assay. The pain level of the patients was measured by the Visual Analogue Scale (VAS). Patients' skin quality was assessed by the Vancouver Scar Scale (VSS), and the efficacy of trauma treatment was observed in both groups.

Results

After 7-day treatment, the study group performed lower levels of CRP and PCT, higher levels of TGF-β1 and VEGF, lower VAS scores and VSS scores, and better overall treatment rate compared to the control group (all P < 0.05).

Conclusion

VSD combined with nano-silver dressings has good therapeutic efficacy in non-healing wounds after surgery for open limb fractures and can inhibit inflammatory response and improve skin quality.

背景：开放性肢体骨折术后伤口未愈合是临床挑战，需要有效处理；真空密封引流（VSD）通过去除渗出液和刺激肉芽来促进愈合，而纳米银敷料提供抗菌保护以降低感染风险。我们旨在探讨VSD联合纳米银敷料在Gustilo III型开放性肢体骨折术后未愈合创面中的应用效果。方法：将60例gutilo III型开放性肢体骨折术后伤口未愈合患者随机分为两组，每组30例。对照组采用常规治疗，研究组采用VSD联合纳米银敷料治疗。治疗前和治疗7 d后，采用酶联免疫吸附法测定血清炎症因子（c反应蛋白（CRP）、降钙素原（PCT））和创面分泌物生长因子（转化生长因子β1 （TGF-β1）、血管内皮生长因子（VEGF））。采用视觉模拟评分法（Visual Analogue Scale， VAS）评定患者的疼痛程度。采用温哥华疤痕量表（Vancouver Scar Scale， VSS）评定患者皮肤质量，观察两组患者创伤治疗效果。结果：治疗7 d后，研究组CRP、PCT水平低于对照组，TGF-β1、VEGF水平高于对照组，VAS评分、VSS评分低于对照组，总治愈率优于对照组（均P < 0.05）。结论：VSD联合纳米银敷料对开放性肢体骨折术后未愈合创面具有良好的治疗效果，可抑制炎症反应，改善皮肤质量。

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引用次数: 0

Osteosynthesis using ultra-high molecular weight polyethylene fiber cables for periprosthetic femoral fracture 用超高分子量聚乙烯纤维电缆固定股骨假体周围骨折。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.06.018

Shohei Sogawa, Kenichi Oe, Tomohisa Nakamura, Yosuke Otsuki, Takashi Toyoda, Fumito Kobayashi, Hirokazu Iida, Takanori Saito

Background

An ultra-high molecular weight polyethylene (UHMWPE) fiber cable, formed into a soft flexible tape, offers excellent properties for use in osteosynthesis. The purpose of this study was to evaluate the outcomes of osteosynthesis using the UHMWPE fiber cable.

Methods

In this study, 23 patients who underwent osteosynthesis with the use of a UHMWPE fiber cable for periprosthetic fracture (PPF) following total or bipolar hip arthroplasty, at a total of 56 sites, were retrospectively evaluated. The procedures were performed between August 2010 and December 2022. The mean duration of clinical follow-up was 4.1 years (range, 1–10). The cable was used in two ways: direct cerclage around the femur at 38 sites and indirect cerclage around the femur through contact with a metal plate and/or strut grafts at 18 sites.

Results

No clinical complications were observed after the use of UHMWPE fiber cables. Fracture union was confirmed in all cases, with a mean duration of 7.6 months (range, 2–21). Local bone atrophy was observed in 27 % (15/56 sites), with a mean occurrence of 0.9 years (range, 0.1–2.9), but this atrophy did not progress. Significantly less bone atrophy was noted at the greater trochanter than at the femoral shaft (P = 0.009). The atrophy incidence rate was 39 % (15/38 sites) for direct cerclage and 0 % for indirect cerclage (P = 0.0009).

Conclusion

Osteosynthesis using a UHMWPE fiber cable for PPFs yielded successful results and was especially useful for reduction and fixation around the greater trochanter. However, for direct cerclage at the femoral shaft, particular attention to strategies that can prevent local bone atrophy is required.

背景：一种超高分子量聚乙烯（UHMWPE）纤维电缆，形成柔软的柔性带，为骨合成提供了优异的性能。本研究的目的是评估使用超高分子量聚乙烯纤维电缆进行骨固定的效果。方法：在本研究中，对23例在全髋关节置换术或双极髋关节置换术后56个部位使用超高分子量聚乙烯纤维电缆进行假体周围骨折（PPF）的患者进行回顾性评估。这些手术在2010年8月至2022年12月期间进行。平均临床随访时间为4.1年（范围1-10年）。该电缆有两种使用方式：在38个部位直接环绕股骨，在18个部位通过接触金属板和/或支架移植物间接环绕股骨。结果：UHMWPE纤维电缆使用后无临床并发症。所有病例均证实骨折愈合，平均持续时间7.6个月（范围2-21）。局部骨萎缩占27%（15/56个部位），平均发生时间为0.9年（范围0.1-2.9），但这种萎缩没有进展。股骨大转子处的骨萎缩明显小于股骨干处（P = 0.009）。直接环切术的萎缩发生率为39%（15/38个部位），间接环切术的萎缩发生率为0% （P = 0.0009）。结论：使用超高分子量聚乙烯纤维电缆固定PPFs取得了成功的结果，特别适用于大转子周围的复位和固定。然而，对于股骨干的直接环扎术，需要特别注意防止局部骨萎缩的策略。

{"title":"Osteosynthesis using ultra-high molecular weight polyethylene fiber cables for periprosthetic femoral fracture","authors":"Shohei Sogawa, Kenichi Oe, Tomohisa Nakamura, Yosuke Otsuki, Takashi Toyoda, Fumito Kobayashi, Hirokazu Iida, Takanori Saito","doi":"10.1016/j.jos.2025.06.018","DOIUrl":"10.1016/j.jos.2025.06.018","url":null,"abstract":"<div><h3>Background</h3><div>An ultra-high molecular weight polyethylene (UHMWPE) fiber cable, formed into a soft flexible tape, offers excellent properties for use in osteosynthesis. The purpose of this study was to evaluate the outcomes of osteosynthesis using the UHMWPE fiber cable.</div></div><div><h3>Methods</h3><div>In this study, 23 patients who underwent osteosynthesis with the use of a UHMWPE fiber cable for periprosthetic fracture (PPF) following total or bipolar hip arthroplasty, at a total of 56 sites, were retrospectively evaluated. The procedures were performed between August 2010 and December 2022. The mean duration of clinical follow-up was 4.1 years (range, 1–10). The cable was used in two ways: direct cerclage around the femur at 38 sites and indirect cerclage around the femur through contact with a metal plate and/or strut grafts at 18 sites.</div></div><div><h3>Results</h3><div>No clinical complications were observed after the use of UHMWPE fiber cables. Fracture union was confirmed in all cases, with a mean duration of 7.6 months (range, 2–21). Local bone atrophy was observed in 27 % (15/56 sites), with a mean occurrence of 0.9 years (range, 0.1–2.9), but this atrophy did not progress. Significantly less bone atrophy was noted at the greater trochanter than at the femoral shaft (<em>P</em> = 0.009). The atrophy incidence rate was 39 % (15/38 sites) for direct cerclage and 0 % for indirect cerclage (<em>P</em> = 0.0009).</div></div><div><h3>Conclusion</h3><div>Osteosynthesis using a UHMWPE fiber cable for PPFs yielded successful results and was especially useful for reduction and fixation around the greater trochanter. However, for direct cerclage at the femoral shaft, particular attention to strategies that can prevent local bone atrophy is required.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 200-206"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675047","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}

引用次数: 0

Is there a relationship between Buford complex and glenoid version? 布福德复合体和关节盂变形之间有关系吗？

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.002

Haluk Yaka , Mustafa Özer , Hasan Rüzgar , Yahaya Baako , Ulunay Kanatli

Background

This study aimed to investigate the relationship between the arthroscopically demonstrated Buford complex (BC) and scapular morphology in patients with anterior shoulder instability (ASI) and rotator cuff tears (RCT). We hypothesized that there may be a relationship between BC and scapular morphology.

Material and methods

1947 consecutive shoulder arthroscopy cases performed between 2015 and 2023 were retrospectively evaluated. 17 BC with ASI, 25 RCT with BC, 50 with RCT control group, 50 with ASI control group, and 60 with general control group were included in the study. Critical shoulder angle (CSA) on true anterior posterior radiographs, glenoid version (GV) and glenoid inclination (GI) values on magnetic resonance imaging were compared in all groups.

Results

The mean GV in the RCT with BC group was significantly lower than in the RCT control group (P < 0.001, -1º±3.3º vs 7.7º± 5.7º) and in the ASI with BC group than in the ASI control group (p < 0.001, −1.9º± 3.6º vs 3.35º± 4.8º). The mean GV in all patients with BC was significantly lower than the sum of the RCT, ASI control groups, and the general control group(P < 0.001,P < 0.001), with no difference between the groups in terms of GI and CSA.

Conclusion

In patients with RCT and ASI, the glenoid was more antevert in patients with the arthroscopically demonstrated BC. The BC may be a compensatory variation that develops against the tendency of the humeral head to shift anteriorly due to a reduced GV, and when the BC is diagnosed, it should be kept in mind that a more antevert glenoid may be encountered.

Level of evidence

Level III retrospective comparative study.

背景：本研究旨在探讨前肩不稳（ASI）和肩袖撕裂（RCT）患者关节镜下显示的Buford复合体（BC）与肩胛骨形态的关系。我们假设BC与肩胛骨形态之间可能存在关系。材料和方法：回顾性分析2015年至2023年期间进行肩关节镜检查的1947例患者。BC合并ASI患者17例，RCT合并BC患者25例，RCT对照组50例，ASI对照组50例，普通对照组60例。比较两组真实前后x线片上的临界肩关节角（CSA）、磁共振成像上的关节盂内径（GV）和关节盂内倾（GI）值。结果：RCT合并BC组的平均GV显著低于RCT对照组（P < 0.001, -1º±3.3ºvs . 7.7º±5.7º），ASI合并BC组的平均GV显著低于ASI对照组（P < 0.001, -1.9º±3.6ºvs . 3.35º±4.8º）。所有BC患者的平均GV均显著低于RCT、ASI对照组和普通对照组的总和（P < 0.001,P < 0.001）， GI和CSA在两组间无差异。结论：在RCT和ASI患者中，关节镜下显示的BC患者的关节盂更前倾。BC可能是一种代偿性变异，它与肱骨头因GV减小而前移的倾向相反，当诊断出BC时，应记住可能会遇到更前倾的肩关节。证据等级：III级回顾性比较研究。

{"title":"Is there a relationship between Buford complex and glenoid version?","authors":"Haluk Yaka , Mustafa Özer , Hasan Rüzgar , Yahaya Baako , Ulunay Kanatli","doi":"10.1016/j.jos.2025.05.002","DOIUrl":"10.1016/j.jos.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate the relationship between the arthroscopically demonstrated Buford complex (BC) and scapular morphology in patients with anterior shoulder instability (ASI) and rotator cuff tears (RCT). We hypothesized that there may be a relationship between BC and scapular morphology.</div></div><div><h3>Material and methods</h3><div>1947 consecutive shoulder arthroscopy cases performed between 2015 and 2023 were retrospectively evaluated. 17 BC with ASI, 25 RCT with BC, 50 with RCT control group, 50 with ASI control group, and 60 with general control group were included in the study. Critical shoulder angle (CSA) on true anterior posterior radiographs, glenoid version (GV) and glenoid inclination (GI) values on magnetic resonance imaging were compared in all groups.</div></div><div><h3>Results</h3><div>The mean GV in the RCT with BC group was significantly lower than in the RCT control group (P < 0.001, -1º±3.3º vs 7.7º± 5.7º) and in the ASI with BC group than in the ASI control group (p < 0.001, −1.9º± 3.6º vs 3.35º± 4.8º). The mean GV in all patients with BC was significantly lower than the sum of the RCT, ASI control groups, and the general control group(P < 0.001,P < 0.001), with no difference between the groups in terms of GI and CSA.</div></div><div><h3>Conclusion</h3><div>In patients with RCT and ASI, the glenoid was more antevert in patients with the arthroscopically demonstrated BC. The BC may be a compensatory variation that develops against the tendency of the humeral head to shift anteriorly due to a reduced GV, and when the BC is diagnosed, it should be kept in mind that a more antevert glenoid may be encountered.</div></div><div><h3>Level of evidence</h3><div>Level III retrospective comparative study.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 126-132"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187248","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}

引用次数: 0

Comparative results of uncalcined hydroxyapatite/poly-L-lactic acid composite screw fixation and titanium screw fixation in the Mitchell osteotomy for moderate hallux valgus deformity 未煅烧羟基磷灰石/聚l -乳酸复合螺钉固定与钛螺钉固定治疗中度拇外翻畸形Mitchell截骨术的比较结果。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.06.016

Kazuya Sugimoto , Shinji Isomoto , Tomohiro Matsui , Kimio Miura , Sayaka Wakiyama , Yusuke Kobayashi , Norihiro Samoto , Akira Taniguchi , Yasuhito Tanaka

Background

No study has reported on the use of bioabsorbable screws in modified Mitchell osteotomies. This study aimed to clarify the clinical and radiographic findings of modified Mitchell osteotomy using a bioabsorbable screw compared with the use of a titanium screw.

Methods

Fifty-one feet from 43 patients with hallux valgus angles (HVAs) > 20° and <40° were included in the study. The osteotomy was fixed using an unsintered hydroxyapatite/poly-l-lactic acid (u-HA/PLLA) screw in 29 feet from 23 patients (group A) and by a titanium headless screw in 22 feet from 20 patients (group B). Patient sex, age, and body mass index (BMI) at surgery, and preoperative and postoperative Japanese Society for Surgery of the Foot (JSSF) hallux scale scores of the two groups were compared. The HVA, intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were measured on weight-bearing radiographs preoperatively and 1 year postoperatively. Postoperative dorsal displacement of the 1st metatarsal head (DD1MH) was also assessed.

Results

No significant preoperative differences in these parameters were observed between the groups. The median JSSF scores improved from 75 to 95 in group A and from 64 to 95 in group B. Preoperatively and 1 year postoperatively, the HVAs were 27.5 and 11.0 in group A, 25.5 and 11.3 in group B; the IMAs were 14.3 and 9.4 in group A, 13.6 and 8.8 in group B; the DMAAs were 6.7 and −2.2 in group A, 7.9 and 4.5 in group B. The DD1MHs were 0.5 in group A and 0.0 in group B. No significant differences in the postoperative JSSF scale, HVA, IMA or DD1MH were noted between the groups.

Conclusions

The results of Mitchell osteotomy with u-HA/PLLA screws did not significantly differ from those with titanium screws in clinical outcomes, HVA, IMA and DD1MH at 1 year postoperatively.

Study design

Case control study; Level of evidence, 3.

背景：在改良Mitchell截骨术中使用生物可吸收螺钉尚无研究报道。本研究旨在澄清使用生物可吸收螺钉与使用钛螺钉的改良Mitchell截骨术的临床和影像学表现。方法：对43例拇外翻角度（HVAs）为bbb20°的51英尺患者进行分析。结果：术前各组间这些参数均无显著差异。A组JSSF评分中位数从75分提高到95分，B组从64分提高到95分。术前和术后1年，A组HVAs分别为27.5分和11.0分，B组为25.5分和11.3分；A组的ima分别为14.3、9.4，B组的ima分别为13.6、8.8；A组的DMAAs分别为6.7和-2.2，b组为7.9和4.5。A组的DD1MH分别为0.5和0.0。两组术后JSSF评分、HVA、IMA、DD1MH差异无统计学意义。结论：u-HA/PLLA螺钉Mitchell截骨术的临床结局、HVA、IMA和DD1MH与钛螺钉术后1年无显著差异。研究设计：病例对照研究；证据水平，3。

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引用次数: 0

Modified arthroscopic-assisted reduction and internal fixation for treatment of Ideberg type III scapular glenoid fracture associated with acromioclavicular joint injury 改良关节镜辅助复位内固定治疗Ideberg III型肩胛盂骨折伴肩锁关节损伤。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.05.011

Tongtong Li , Xuelei Wei , Guoyun Bu , Jianan Li , Haobo Jia , Jie Zhao , Chen Chen , Zengliang Wang

Objective

Ideberg type III scapular glenoid fracture associated with acromioclavicular joint injury is rare, as well as its therapeutic experience. The purpose of this study was to evaluate the effectiveness of modified arthroscopic-assisted treatment, and introduce our experience and surgical techniques.

Method

We retrospectively reviewed 11 patients with Ideberg type III scapular glenoid fracture associated with acromioclavicular joint injury. 6 males and 5 females were included with a mean of age 52.6 years. After the acromioclavicular joint was treated with clavicular hook plate, Ideberg type III scapular glenoid fracture experienced modified arthroscopic-assisted reduction and fixation, in which the 1:00 o'clock position of the glenoid was utilized as the starting point for screws to fix in multiple directions.

Results

The cases were followed up for 12–35 months, with an average of 18 months. The mean healing time of fracture was 3.4 months. The postoperative range of motion of the shoulders was well maintained. There were no complications of shoulder stiffness and muscle atrophy in the cases. The mean Constant score, UCLA score and ASES score were 95.1 points (range, 88–100 points), 34 points (range, 32–35 points) and 95.8 points (range, 90–100 points) respectively. The average VAS pain score was 0.4.

Conclusions

For patients with Ideberg type III scapular glenoid fracture associated with acromioclavicular joint injury, the modified arthroscopic-assisted reduction and internal fixation is a minimally invasive and effective treatment. The 1:00 o'clock position of the glenoid could be utilized as a safe starting point for screws to fix in multiple directions.

目的：探讨Ideberg III型肩胛盂骨折合并肩锁关节损伤的临床特点及治疗体会。本研究的目的是评估改良关节镜辅助治疗的有效性，并介绍我们的经验和手术技术。方法：对11例肩胛盂骨折合并肩锁关节损伤的患者进行回顾性分析。男性6例，女性5例，平均年龄52.6岁。肩锁关节经锁骨钩钢板治疗后，Ideberg型肩胛盂骨折在改良关节镜辅助下复位固定，以关节盂1:00点钟位置为起始点，螺钉多方向固定。结果：随访12 ~ 35个月，平均18个月。平均骨折愈合时间3.4个月。术后肩部活动范围保持良好。所有病例均未出现肩关节僵硬和肌肉萎缩等并发症。平均Constant评分为95.1分（范围88-100分），UCLA评分为34分（范围32-35分），ASES评分为95.8分（范围90-100分）。VAS疼痛评分平均为0.4分。结论：对于Ideberg型肩胛盂骨折合并肩锁关节损伤患者，改良关节镜辅助复位内固定是一种微创、有效的治疗方法。关节盂的1点钟位置可以作为螺钉在多个方向固定的安全起点。

{"title":"Modified arthroscopic-assisted reduction and internal fixation for treatment of Ideberg type III scapular glenoid fracture associated with acromioclavicular joint injury","authors":"Tongtong Li , Xuelei Wei , Guoyun Bu , Jianan Li , Haobo Jia , Jie Zhao , Chen Chen , Zengliang Wang","doi":"10.1016/j.jos.2025.05.011","DOIUrl":"10.1016/j.jos.2025.05.011","url":null,"abstract":"<div><h3>Objective</h3><div>Ideberg type III scapular glenoid fracture associated with acromioclavicular joint injury is rare, as well as its therapeutic experience. The purpose of this study was to evaluate the effectiveness of modified arthroscopic-assisted treatment, and introduce our experience and surgical techniques.</div></div><div><h3>Method</h3><div>We retrospectively reviewed 11 patients with Ideberg type III scapular glenoid fracture associated with acromioclavicular joint injury. 6 males and 5 females were included with a mean of age 52.6 years. After the acromioclavicular joint was treated with clavicular hook plate, Ideberg type III scapular glenoid fracture experienced modified arthroscopic-assisted reduction and fixation, in which the 1:00 o'clock position of the glenoid was utilized as the starting point for screws to fix in multiple directions.</div></div><div><h3>Results</h3><div>The cases were followed up for 12–35 months, with an average of 18 months. The mean healing time of fracture was 3.4 months. The postoperative range of motion of the shoulders was well maintained. There were no complications of shoulder stiffness and muscle atrophy in the cases. The mean Constant score, UCLA score and ASES score were 95.1 points (range, 88–100 points), 34 points (range, 32–35 points) and 95.8 points (range, 90–100 points) respectively. The average VAS pain score was 0.4.</div></div><div><h3>Conclusions</h3><div>For patients with Ideberg type III scapular glenoid fracture associated with acromioclavicular joint injury, the modified arthroscopic-assisted reduction and internal fixation is a minimally invasive and effective treatment. The 1:00 o'clock position of the glenoid could be utilized as a safe starting point for screws to fix in multiple directions.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 213-218"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369009","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}

引用次数: 0

Foot alignment characteristics in patients with Freiberg’s disease Freiberg病患者足部排列特征

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.06.007

Ryo Fukagawa , Ichiro Yoshimura , Tomonobu Hagio , Tetsuro Ishimatsu , Yuki Sugino , Seiya Tomonaga , Yoshimasa Taniguchi , Takuaki Yamamoto

Background

Freiberg’s disease is defined as aseptic necrosis of the metatarsal heads. It is more common in female patients and primarily affects adolescents aged 11–17 years. The second metatarsal is most frequently involved, accounting for approximately 68 % of cases. This study aimed to assess foot alignment in patients with Freiberg’s disease using a mapping system to evaluate radiographic images.

Methods

The study cohort included 13 patients (14 feet) diagnosed with Freiberg’s disease at our hospital between January 2010 and December 2022, with appropriate loading-position radiographs (Group F). The control group (Group C) comprised 14 patients with no abnormal foot alignment on the healthy side who had bilateral standing dorsoplantar images taken for other conditions. Foot alignment was evaluated using a mapping system.

Results

Mapping results on frontal radiographs showed medial deviation of the first metatarsal head and lateral deviation of the fifth metatarsal head and base in patients with Freiberg’s disease, with significant differences between Groups F and C (P < 0.05). Significant differences were also observed in the M1/M2, M3/M4, and M2/M4 angles (P < 0.05). No significant differences were found between the groups in Meary’s angle or calcaneal pitch on lateral radiographs.

Conclusion

This study demonstrated that patients with Freiberg’s disease exhibit specific radiographic abnormalities in foot alignment. These abnormalities may increase stress on the metatarsal head, potentially contributing to the development of the disease. Our findings offer a novel perspective on its etiology and progression. Further research is needed to determine whether these abnormalities reflect a congenital predisposition or result from ongoing pathological changes.

Level of evidence

Level Ⅲ, retrospective comparative study.

背景：Freiberg病被定义为跖骨头无菌性坏死。它在女性患者中更为常见，主要影响11-17岁的青少年。第二跖骨最常受累，约占病例的68%。本研究旨在利用制图系统评估影像学图像来评估Freiberg病患者的足部对齐。方法：研究队列包括2010年1月至2022年12月在我院诊断为Freiberg病的13例（14英尺）患者，并有适当的负荷位x线片（F组）。对照组（C组）包括14例健康侧无异常足对线的患者，他们在其他情况下拍摄了双侧站立背足底图像。使用制图系统评估足部对齐。结果：Freiberg病患者的正位片测图显示第一跖骨头内侧偏位，第五跖骨头和跖骨底外侧偏位，F组与C组比较差异有统计学意义（P < 0.05）。M1/M2、M3/M4、M2/M4角度差异均有统计学意义（P < 0.05）。在侧位x线片上，两组之间的Meary角或跟骨间距无显著差异。结论：本研究表明，Freiberg病患者在足线方面表现出特定的影像学异常。这些异常可能增加跖骨头的压力，可能导致疾病的发展。我们的发现为其病因和进展提供了一个新的视角。需要进一步的研究来确定这些异常是先天易感性还是持续病理改变的结果。证据等级：Ⅲ级，回顾性比较研究。

{"title":"Foot alignment characteristics in patients with Freiberg’s disease","authors":"Ryo Fukagawa , Ichiro Yoshimura , Tomonobu Hagio , Tetsuro Ishimatsu , Yuki Sugino , Seiya Tomonaga , Yoshimasa Taniguchi , Takuaki Yamamoto","doi":"10.1016/j.jos.2025.06.007","DOIUrl":"10.1016/j.jos.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Freiberg’s disease is defined as aseptic necrosis of the metatarsal heads. It is more common in female patients and primarily affects adolescents aged 11–17 years. The second metatarsal is most frequently involved, accounting for approximately 68 % of cases. This study aimed to assess foot alignment in patients with Freiberg’s disease using a mapping system to evaluate radiographic images.</div></div><div><h3>Methods</h3><div>The study cohort included 13 patients (14 feet) diagnosed with Freiberg’s disease at our hospital between January 2010 and December 2022, with appropriate loading-position radiographs (Group F). The control group (Group C) comprised 14 patients with no abnormal foot alignment on the healthy side who had bilateral standing dorsoplantar images taken for other conditions. Foot alignment was evaluated using a mapping system.</div></div><div><h3>Results</h3><div>Mapping results on frontal radiographs showed medial deviation of the first metatarsal head and lateral deviation of the fifth metatarsal head and base in patients with Freiberg’s disease, with significant differences between Groups F and C (<em>P</em> < 0.05). Significant differences were also observed in the M1/M2, M3/M4, and M2/M4 angles (<em>P</em> < 0.05). No significant differences were found between the groups in Meary’s angle or calcaneal pitch on lateral radiographs.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that patients with Freiberg’s disease exhibit specific radiographic abnormalities in foot alignment. These abnormalities may increase stress on the metatarsal head, potentially contributing to the development of the disease. Our findings offer a novel perspective on its etiology and progression. Further research is needed to determine whether these abnormalities reflect a congenital predisposition or result from ongoing pathological changes.</div></div><div><h3>Level of evidence</h3><div>Level Ⅲ, retrospective comparative study.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 154-160"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553845","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}

引用次数: 0

Comparison of symptomatic factors of os subfibulare using ultrasonography 腓骨下结节症状因素的超声比较。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.06.004

Tomohiro Matsui , Kenji Honda , Tsukasa Kumai , Takeshi Sugimoto , Yasushi Shinohara , Yasuhito Tanaka

Background

The os subfibulare is considered a fusion failure of the secondary ossification center or avulsion fracture at the lateral ankle ligament involving the anterior talofibular ligament alone or in combination with the calcaneofibular ligament. The os subfibulare causes symptomatic repetitive ankle sprains; however, asymptomatic forms exist. We aimed to identify the symptomatic factors of os subfibulare using ultrasonography (US).

Methods

Twenty-one feet of patients who underwent operative treatment for symptomatic os subfibulare and 24 feet of those with asymptomatic os subfibulare were examined. US images were retrospectively evaluated, and the size of the ossicle, distance from the lateral malleolus to the ossicle, and instability of the ossicle during the anterior drawer stress ultrasonography test were assessed.

Results

The size of the ossicle was mean 6.0 mm and 5.6 mm for the patient and control groups, respectively (p = 0.61). The distance in the rest position was mean 3.9 mm and 2.5 mm (p < 0.05) and median 1.4 mm and 0.0 mm during the stress test (p < 0.05) for the patient and control groups, respectively.

Conclusion

US is a useful examination tool for predicting os subfibulare prognosis. Additionally, the distance from the lateral malleolus in the rest position and dynamic instability were predictive factors for symptomatic os subfibulare.

Levels of evidence

Level Ⅲ, Case control study.

背景：腓骨下os被认为是继发性骨化中心融合失败或外侧踝关节韧带撕脱骨折，仅累及距腓骨前韧带或与跟腓骨韧带合并。腓骨下肌引起症状性重复性踝关节扭伤；然而，也存在无症状的形式。我们的目的是利用超声检查（US）来确定腓骨下骨的症状因素。方法：对有症状的腓骨下肌行手术治疗的21英尺和无症状的腓骨下肌行手术治疗的24英尺进行分析。回顾性评估超声图像，评估前抽屉应力超声检查时听骨的大小、外踝到听骨的距离以及听骨的不稳定性。结果：实验组和对照组听骨大小分别为6.0 mm和5.6 mm，差异有统计学意义（p = 0.61）。在压力测试中，患者组和对照组的休息位置距离分别为3.9 mm和2.5 mm (p < 0.05)，中位数分别为1.4 mm和0.0 mm （p < 0.05）。结论：超声是预测腓骨下骨预后的有效检查工具。此外，静止位置与外踝的距离和动力不稳定性是症状性腓骨下骨的预测因素。证据等级：Ⅲ级，病例对照研究。

{"title":"Comparison of symptomatic factors of os subfibulare using ultrasonography","authors":"Tomohiro Matsui , Kenji Honda , Tsukasa Kumai , Takeshi Sugimoto , Yasushi Shinohara , Yasuhito Tanaka","doi":"10.1016/j.jos.2025.06.004","DOIUrl":"10.1016/j.jos.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>The os subfibulare is considered a fusion failure of the secondary ossification center or avulsion fracture at the lateral ankle ligament involving the anterior talofibular ligament alone or in combination with the calcaneofibular ligament. The os subfibulare causes symptomatic repetitive ankle sprains; however, asymptomatic forms exist. We aimed to identify the symptomatic factors of os subfibulare using ultrasonography (US).</div></div><div><h3>Methods</h3><div>Twenty-one feet of patients who underwent operative treatment for symptomatic os subfibulare and 24 feet of those with asymptomatic os subfibulare were examined. US images were retrospectively evaluated, and the size of the ossicle, distance from the lateral malleolus to the ossicle, and instability of the ossicle during the anterior drawer stress ultrasonography test were assessed.</div></div><div><h3>Results</h3><div>The size of the ossicle was mean 6.0 mm and 5.6 mm for the patient and control groups, respectively (p = 0.61). The distance in the rest position was mean 3.9 mm and 2.5 mm (p < 0.05) and median 1.4 mm and 0.0 mm during the stress test (p < 0.05) for the patient and control groups, respectively.</div></div><div><h3>Conclusion</h3><div>US is a useful examination tool for predicting os subfibulare prognosis. Additionally, the distance from the lateral malleolus in the rest position and dynamic instability were predictive factors for symptomatic os subfibulare.</div></div><div><h3>Levels of evidence</h3><div>Level Ⅲ, Case control study.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 1","pages":"Pages 183-186"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560416","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}

引用次数: 0

Letter to the Editor regarding: Foot alignment characteristics in patients with Freiberg's disease 致编辑的信：弗莱伯格病患者的足部排列特征。

IF 1.4 4区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Science

Pub Date : 2026-01-01 DOI: 10.1016/j.jos.2025.08.015

Andreas Rehm, John E. Lawrence, Hatem Osman, Eve McMahon, Rebecca J. Worley, Elizabeth Ashby

引用次数: 0