Central sensitization (CS), which is characterized by amplified nociceptive processing within the central nervous system, is a key mechanism underlying chronic pain disorders. Chronic pain is a significant global health issue; however, the relationship between CS and pain distribution in the general population remains unclear. This study aimed to investigate the association between CS and the number of locations of body pain in a representative sample of the general population.
Methods
This cross-sectional study included 739 participants (340 men, 399 women) from the Wakayama Health Promotion Study. CS was assessed using the Japanese version of the Central Sensitization Inventory (CSI-J), with scores of ≥30 indicating CS. Participants reported pain at 13 locations. Statistical analyses, including chi-square tests, Student's t-tests, and multiple regression analyses, were performed to determine the associations between Central Sensitization Inventory (CSI) scores and pain locations.
Results
Among the participants, 9.5 % were diagnosed with CS. Females had significantly higher CSI scores than males. Lower back pain (20.6 %) and shoulder pain (15.0 %) were most common in men, whereas shoulder pain (20.6 %), knee pain (20.1 %), and lower back pain (19.5 %) were most common in women. Multivariate analysis revealed that sex, headache, neck pain, shoulder pain, arm pain, lower back pain, hip pain, thigh pain, and knee pain were significantly associated with CSI scores. Participants with ≥3 locations were 14.4 times more likely to have CS.
Conclusions
This study highlights the significant prevalence of CS in the general population, with a higher prevalence in females. Specific locations of pain, particularly those close to the trunk, are strongly associated with CS. These findings underscore the importance of assessing CS in individuals with multisite pain for targeted management and treatment strategies.
{"title":"Association between central sensitization and multisite pain in the general population: A cross-sectional analysis of The Wakayama Health Promotion Study","authors":"Shingo Inoue , Hiroshi Hashizume , Shizumasa Murata , Hiroyuki Oka , Takuhei Kozaki , Kunihiko Minakata , Ryo Taiji , Masatoshi Teraguchi , Hiroshi Iwasaki , Shunji Tsutsui , Masanari Takami , Kanae Mure , Yukihiro Nakagawa , Nobuyuki Miyai , Hiroshi Yamada","doi":"10.1016/j.jos.2025.02.001","DOIUrl":"10.1016/j.jos.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div><span>Central sensitization (CS), which is characterized by amplified nociceptive processing within the central nervous system, is a key mechanism underlying chronic </span>pain disorders. Chronic pain is a significant global health issue; however, the relationship between CS and pain distribution in the general population remains unclear. This study aimed to investigate the association between CS and the number of locations of body pain in a representative sample of the general population.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 739 participants (340 men, 399 women) from the Wakayama Health Promotion Study. CS was assessed using the Japanese version of the Central Sensitization Inventory (CSI-J), with scores of ≥30 indicating CS. Participants reported pain at 13 locations. Statistical analyses, including chi-square tests, Student's t-tests, and multiple regression analyses, were performed to determine the associations between Central Sensitization Inventory (CSI) scores and pain locations.</div></div><div><h3>Results</h3><div>Among the participants, 9.5 % were diagnosed with CS. Females had significantly higher CSI scores than males. Lower back pain (20.6 %) and shoulder pain (15.0 %) were most common in men, whereas shoulder pain (20.6 %), knee pain (20.1 %), and lower back pain (19.5 %) were most common in women. Multivariate analysis<span> revealed that sex, headache, neck pain, shoulder pain, arm pain, lower back pain, hip pain, thigh pain, and knee pain were significantly associated with CSI scores. Participants with ≥3 locations were 14.4 times more likely to have CS.</span></div></div><div><h3>Conclusions</h3><div>This study highlights the significant prevalence of CS in the general population, with a higher prevalence in females. Specific locations of pain, particularly those close to the trunk, are strongly associated with CS. These findings underscore the importance of assessing CS in individuals with multisite pain for targeted management and treatment strategies.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1186-1192"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537310","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}
Bone metastases are the main cause of locomotive syndrome in cancer patients (Cancer Locomo). They should be appropriately managed to improve patients' activities of daily living and quality of life, especially in designated cancer care hospitals (DCCHs). Still, the actual involvement of orthopedic surgeons in managing bone metastases was uncertain.
Materials and methods
In 2018, an online questionnaire of 38 questions was used to conduct a nationwide survey among orthopaedic training facilities. Eleven questions were used to clarify whether orthopaedic surgeons were actively involved in bone metastasis treatment, whether bone metastases were operated equally and actively, and whether there were any barriers to decision-making in bone metastasis treatment.
Results
As much as 36.4 % of the DCCHs answered that they were not actively involved in bone metastasis treatment and would never be. 4,783 surgeries were performed in 1,423 facilities. 316 DCCHs did 2,833 surgeries. The mean ± standard deviation of the number of bone metastasis surgeries at each DCCH was 9.0 ± 7.6, whereas that per 1,000 registered cancer patients was 5.2 ± 3.9. Basic surgical procedures, such as biopsy and internal fixation, were unavailable in approximately 15 % of the DCCHs. The most common barrier to decision-making in bone metastasis treatment was cancers of unknown primary. DCCHs having >6 certified orthopaedic surgeons and ≥1 specialist(s) in bone and soft tissue tumors did more surgeries of a wider variety with fewer concerns.
Conclusion
Overall, orthopaedic surgeons were not actively involved in bone metastasis treatment. Bone metastases were not operated on equally or actively. Various factors, including the burden to handle cancers of unknown primary, disturbed decision-making in bone metastasis treatment. Increasing awareness of the importance of Cancer Locomo management and aligning with in-hospital other departments or outside specialists in bone and soft tissue tumors may improve this situation.
{"title":"Institutional disparities in the treatment of bone metastases by orthopaedic surgeons at training facilities designated by the Japanese orthopaedic association–A nationwide survey","authors":"Jungo Imanishi , Hideo Morioka , Masahiro Hirahata , Takahiro Inui , Yusuke Shinoda , Tatsuya Takagi , Yoshitada Sakai , Satoru Iwase , Kazuya Oshima , Naoshi Ogata , Takashi Ohe , Kozo Nakamura , Hirotaka Kawano","doi":"10.1016/j.jos.2025.04.002","DOIUrl":"10.1016/j.jos.2025.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Bone metastases are the main cause of locomotive syndrome in cancer patients (<em>Cancer Locomo</em>). They should be appropriately managed to improve patients' activities of daily living and quality of life, especially in designated cancer care hospitals (DCCHs). Still, the actual involvement of orthopedic surgeons in managing bone metastases was uncertain.</div></div><div><h3>Materials and methods</h3><div>In 2018, an online questionnaire of 38 questions was used to conduct a nationwide survey among orthopaedic training facilities. Eleven questions were used to clarify whether orthopaedic surgeons were actively involved in bone metastasis treatment, whether bone metastases were operated equally and actively, and whether there were any barriers to decision-making in bone metastasis treatment.</div></div><div><h3>Results</h3><div>As much as 36.4 % of the DCCHs answered that they were not actively involved in bone metastasis treatment and would never be. 4,783 surgeries were performed in 1,423 facilities. 316 DCCHs did 2,833 surgeries. The mean ± standard deviation of the number of bone metastasis surgeries at each DCCH was 9.0 ± 7.6, whereas that per 1,000 registered cancer patients was 5.2 ± 3.9. Basic surgical procedures, such as biopsy and internal fixation, were unavailable in approximately 15 % of the DCCHs. The most common barrier to decision-making in bone metastasis treatment was cancers of unknown primary. DCCHs having >6 certified orthopaedic surgeons and ≥1 specialist(s) in bone and soft tissue tumors did more surgeries of a wider variety with fewer concerns.</div></div><div><h3>Conclusion</h3><div>Overall, orthopaedic surgeons were not actively involved in bone metastasis treatment. Bone metastases were not operated on equally or actively. Various factors, including the burden to handle cancers of unknown primary, disturbed decision-making in bone metastasis treatment. Increasing awareness of the importance of Cancer Locomo management and aligning with in-hospital other departments or outside specialists in bone and soft tissue tumors may improve this situation.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1158-1164"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016653","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 : 2025-11-01DOI: 10.1016/j.jos.2025.04.010
João Pedro Oliveira , José Carlos Noronha , António Completo
Background
All-inside, one of the most popular techniques for anterior cruciate ligament reconstruction in which suspensory cortical devices for graft fixation are mandatory, has a technical concern during intra-articular passage of the fixation device. This can be overpass using a Nice knot tied over a button after the intra-articular passage of the graft avoiding, by this, any possible debris that can lock its progression and compromise final fixation. This study aimed to test the hypothesis that a Nice knot tied over a button has similar biomechanical performance to that of the currently available cortical fixation devices on the market and is suitable for anterior cruciate ligament graft fixation.
Methods
This controlled laboratory study was performed using two different validated cortical fixation devices for comparison: Endobutton, as a fixed loop, and Ultrabutton, as an adjustable loop. The devices were preconditioned; a cyclic loading of 50–250 N was applied for 1000 cycles and finally pulled to failure at 50 mm/min. Biomechanical properties of the devices were tested in terms of elongation, ultimate strength, and stiffness.
Results
The ultimate strength and displacement differences between the Nice knot and Endobutton were significant (p < 0.05). No significant differences in displacement and stiffness were found between the Nice knot and Ultrabutton; however, the ultimate failure load was significantly higher (p < 0.05) for Ultrabutton than for the Nice knot.
Conclusions
The performance of the Nice knot tied over a button exhibits similar displacement and stiffness characteristics to the Ultrabutton. However, its maximum ultimate strength (838 ± 28 N) is significantly lower than both tested devices. Despite this, it remains superior to the physiological forces experienced by patients during the initial phases of ACL rehabilitation.
{"title":"Biomechanical study of the Nice knot as an alternative fixation for anterior cruciate ligament reconstruction","authors":"João Pedro Oliveira , José Carlos Noronha , António Completo","doi":"10.1016/j.jos.2025.04.010","DOIUrl":"10.1016/j.jos.2025.04.010","url":null,"abstract":"<div><h3>Background</h3><div>All-inside, one of the most popular techniques for anterior cruciate ligament reconstruction<span> in which suspensory cortical devices for graft fixation are mandatory, has a technical concern during intra-articular passage of the fixation device. This can be overpass using a Nice knot tied over a button after the intra-articular passage of the graft avoiding, by this, any possible debris that can lock its progression and compromise final fixation. This study aimed to test the hypothesis that a Nice knot tied over a button has similar biomechanical performance to that of the currently available cortical fixation devices on the market and is suitable for anterior cruciate ligament graft fixation.</span></div></div><div><h3>Methods</h3><div>This controlled laboratory study was performed using two different validated cortical fixation devices for comparison: Endobutton, as a fixed loop, and Ultrabutton, as an adjustable loop. The devices were preconditioned; a cyclic loading of 50–250 N was applied for 1000 cycles and finally pulled to failure at 50 mm/min. Biomechanical properties of the devices were tested in terms of elongation, ultimate strength, and stiffness.</div></div><div><h3>Results</h3><div>The ultimate strength and displacement differences between the Nice knot and Endobutton were significant (p < 0.05). No significant differences in displacement and stiffness were found between the Nice knot and Ultrabutton; however, the ultimate failure load was significantly higher (p < 0.05) for Ultrabutton than for the Nice knot.</div></div><div><h3>Conclusions</h3><div>The performance of the Nice knot tied over a button exhibits similar displacement and stiffness characteristics to the Ultrabutton. However, its maximum ultimate strength (838 ± 28 N) is significantly lower than both tested devices. Despite this, it remains superior to the physiological forces experienced by patients during the initial phases of ACL rehabilitation.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1145-1149"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015703","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 : 2025-11-01DOI: 10.1016/j.jos.2025.04.006
Hui Li, Xiang Tong, Xiao Long, Yihe Hu, Bin Chen
Background
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a severe clinical illness. Cancer patients exhibit a VTE risk substantially increased, ranging from four to seven times that of non-cancer patients. Our study aimed to ascertain the occurrence and risk determinants of VTE in spinal metastasis patients undergoing operation, as well as to formulate a predictive model.
Methods
Examining 166 cancer patients treated surgically for spinal metastases and 100 non-cancer patients treated surgically for spinal diseases between 2022 and 2025 at our institution in this study. Data on patient characteristics and clinical parameters were collected for comparison between VTE and non-VTE cases in cancer populations to identify risk factors. Subsequently, an independent risk factor-driven nomogram was constructed, and its predictive performance was assessed.
Results
The authors identified 166 cancer patients, 43 (27.20 %) were diagnosed with a DVT postoperatively, 2 (1.20 %) were diagnosed with PE. Among the 100 non-cancer patients, only 2 (2 %) were diagnosed with DVT postoperatively. In the multivariate logistic regression model, nine independent risk factors for VTE in cancer patients were identified. These included preoperative albumin level (OR = 0.889, 95 % CI 0.823–0.962, P = 0.003) and one-day postoperatively (OR = 1.261, 95 % CI 1.062–1.498, P = 0.008), the preoperative D-dimer level (OR = 1, 95 % CI 1.00–1.00, P = 0.032) and three-day postoperatively (OR = 1, 95 % CI 1.00–1.001, P = 0.005), the PLT level one-day postoperatively (OR = 1.016, 95 % CI 1.005–1.027, P = 0.004) and three-day postoperatively (OR = 0.989, 95 % CI 0.980–0.999, P = 0.023), the preoperative hemoglobin level (OR = 1.050, 95 % CI 1.001–1.102, P = 0.044) and one-day postoperatively (OR = 0.901, 95 % CI 0.833–0.974, P = 0.009), the fibrinogen level three-day postoperatively (OR = 2.011, 95 % CI 1.125–3.595, P = 0.018). The constructed Nomogram model exhibited high accuracy in predicting VTE in spinal metastasis patients undergoing operation, with external validation confirming its predictive performance. Based on the receiver operating characteristic (ROC) curves, the nomogram showed the areas under the curves (AUCs) of the model were 0.819.
Conclusion
Following oncological spine surgery, this study confirmed the relevance of nine biomarkers in predicting VTE in cancer patients. The model devised by our team exhibits significant potential to support clinicians in clinical decision-making and patient risk assessment. Validating these biomarkers is crucial for future research.
背景：静脉血栓栓塞（VTE），包括深静脉血栓形成（DVT）和肺栓塞（PE），是一种严重的临床疾病。癌症患者的静脉血栓栓塞风险显著增加，是非癌症患者的4到7倍。本研究旨在探讨脊柱转移手术患者静脉血栓栓塞的发生及危险因素，并建立预测模型。方法：对我院2022 - 2025年间166例脊柱转移手术治疗的癌症患者和100例脊柱疾病手术治疗的非癌症患者进行研究。收集患者特征和临床参数数据，比较癌症人群中静脉血栓栓塞和非静脉血栓栓塞病例，以确定危险因素。随后，构建了独立风险因素驱动的nomogram，并对其预测性能进行了评价。结果：166例肿瘤患者中43例（27.20%）术后诊断为DVT， 2例（1.20%）术后诊断为PE。在100例非癌症患者中，只有2例（2%）被诊断为术后DVT。在多元logistic回归模型中，确定了癌症患者静脉血栓栓塞的9个独立危险因素。其中包括术前白蛋白水平(或= 0.889,95% CI 0.823 - -0.962, P = 0.003),术后一天(或= 1.261,95% CI 1.062 - -1.498, P = 0.008),术前肺动脉栓塞水平(或= 1,95%可信区间1.00 - -1.00,P = 0.032),术后三天(或= 1,95%可信区间1.00 - -1.001,P = 0.005), PLT水平术后一天(或= 1.016,95% CI 1.005 - -1.027, P = 0.004),术后三天(OR = 0.989, 95% CI 0.980 - -0.999, P = 0.023),术前血红蛋白水平（OR = 1.050, 95% CI 1.001 ~ 1.102, P = 0.044）、术后1天（OR = 0.901, 95% CI 0.833 ~ 0.974, P = 0.009）、术后3天纤维蛋白原水平（OR = 2.011, 95% CI 1.125 ~ 3.595, P = 0.018）。所构建的Nomogram模型对脊柱转移手术患者的静脉血栓栓塞（VTE）预测具有较高的准确性，并得到了外部验证。根据受试者工作特征（ROC）曲线，nomogram显示模型的曲线下面积（auc）为0.819。结论：在脊柱肿瘤手术后，本研究证实了九种生物标志物在预测癌症患者静脉血栓栓塞中的相关性。我们的团队设计的模型显示出支持临床医生在临床决策和患者风险评估方面的巨大潜力。验证这些生物标志物对未来的研究至关重要。
{"title":"A new nomogram for predicting the postoperative venous thromboembolism in patients with spinal metastasis undergoing operation: A retrospective study","authors":"Hui Li, Xiang Tong, Xiao Long, Yihe Hu, Bin Chen","doi":"10.1016/j.jos.2025.04.006","DOIUrl":"10.1016/j.jos.2025.04.006","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Venous thromboembolism (VTE), including </span>deep vein thrombosis<span> (DVT) and pulmonary embolism (PE), represents a severe clinical illness. Cancer patients exhibit a VTE risk substantially increased, ranging from four to seven times that of non-cancer patients. Our study aimed to ascertain the occurrence and risk determinants of VTE in </span></span>spinal metastasis patients undergoing operation, as well as to formulate a predictive model.</div></div><div><h3>Methods</h3><div>Examining 166 cancer patients treated surgically for spinal metastases and 100 non-cancer patients treated surgically for spinal diseases between 2022 and 2025 at our institution in this study. Data on patient characteristics and clinical parameters were collected for comparison between VTE and non-VTE cases in cancer populations to identify risk factors. Subsequently, an independent risk factor-driven nomogram was constructed, and its predictive performance was assessed.</div></div><div><h3>Results</h3><div><span>The authors identified 166 cancer patients, 43 (27.20 %) were diagnosed with a DVT postoperatively, 2 (1.20 %) were diagnosed with PE. Among the 100 non-cancer patients, only 2 (2 %) were diagnosed with DVT postoperatively. In the multivariate logistic regression model, nine independent risk factors for VTE in cancer patients were identified. These included preoperative albumin level (OR = 0.889, 95 % CI 0.823–0.962, </span><em>P</em> = 0.003) and one-day postoperatively (OR = 1.261, 95 % CI 1.062–1.498, <em>P</em> = 0.008), the preoperative D-dimer level (OR = 1, 95 % CI 1.00–1.00, <em>P</em> = 0.032) and three-day postoperatively (OR = 1, 95 % CI 1.00–1.001, <em>P</em> = 0.005), the PLT level one-day postoperatively (OR = 1.016, 95 % CI 1.005–1.027, <em>P</em> = 0.004) and three-day postoperatively (OR = 0.989, 95 % CI 0.980–0.999, <em>P</em> = 0.023), the preoperative hemoglobin level (OR = 1.050, 95 % CI 1.001–1.102, <em>P</em> = 0.044) and one-day postoperatively (OR = 0.901, 95 % CI 0.833–0.974, <em>P</em><span> = 0.009), the fibrinogen level three-day postoperatively (OR = 2.011, 95 % CI 1.125–3.595, </span><em>P</em><span> = 0.018). The constructed Nomogram model exhibited high accuracy in predicting VTE in spinal metastasis patients undergoing operation, with external validation confirming its predictive performance. Based on the receiver operating characteristic (ROC) curves, the nomogram showed the areas under the curves (AUCs) of the model were 0.819.</span></div></div><div><h3>Conclusion</h3><div>Following oncological spine surgery, this study confirmed the relevance of nine biomarkers in predicting VTE in cancer patients. The model devised by our team exhibits significant potential to support clinicians in clinical decision-making and patient risk assessment. Validating these biomarkers is crucial for future research.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1026-1034"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285035","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 : 2025-11-01DOI: 10.1016/j.jos.2025.02.006
Ching-Chieh Hung , Chin-Hsien Wu , Ching-Hou Ma , I-Ming Jou , Yuan-Kun Tu
Background
Distal radial fractures are the most common upper extremity fractures. Volar locking plate fixation has become the standard surgical treatment, providing stable angular fixation, early rehabilitation, and effective support for comminuted and osteopenic bones. This study aimed to analyze the incidence and causes of major complications requiring secondary surgeries following volar plating for distal radial fractures and to investigate the correlation between demographic factors and postoperative outcomes, including major complications and reoperation.
Methods
This retrospective study enrolled 1073 distal radial fracture cases from 1047 patients at a trauma medical center between January 2015 and June 2021. Patients under 18 years old and whose follow-up was less than 6 months or ended before the surgeon concluded their treatment were excluded. We also examined reasons for device removal, reoperation, and complications following volar plating, specifically identifying major complications requiring additional operations.
Results
Among the 1073 distal radial fracture cases, 160 patients with 168 fractures underwent secondary orthopedic operations after volar plating. Ultimately, 33 cases required additional operations for major complications, resulting in a reoperation rate of 22 % and a major complication rate of 5.3 %. Major complications included: triangular fibrocartilage complex tear, deep infection, carpal tunnel syndrome, flexor pollicis longus injury and extensor pollicis longus injury, screw penetration or loosening, and complex regional pain syndrome. Logistic regression showed a higher reoperation incidence in males and patients under 65, although age and sex were not associated with major complications.
Conclusions
This study outlined the incidence and causes of reoperation for complications following volar plating for distal radial fractures. Surgeons could benefit from preoperative counseling on potential complications and early identification and treatment. As age and sex were unrelated to postoperative complications, surgeons may consider factors like fracture patterns, functional demands, and baseline activity when determining treatment options with patients.
{"title":"The incidence and cause of reoperation for complications after volar locking plate fixation of distal radial fractures","authors":"Ching-Chieh Hung , Chin-Hsien Wu , Ching-Hou Ma , I-Ming Jou , Yuan-Kun Tu","doi":"10.1016/j.jos.2025.02.006","DOIUrl":"10.1016/j.jos.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div><span><span><span>Distal radial fractures are the most common upper </span>extremity fractures. </span>Volar locking plate fixation has become the standard surgical treatment, providing stable angular fixation, early rehabilitation, and effective support for comminuted and osteopenic bones. This study aimed to analyze the incidence and causes of major complications requiring secondary surgeries following volar plating for distal radial fractures and to investigate the correlation between demographic factors and postoperative outcomes, including major complications and </span>reoperation.</div></div><div><h3>Methods</h3><div>This retrospective study enrolled 1073 distal radial fracture cases from 1047 patients at a trauma medical center between January 2015 and June 2021. Patients under 18 years old and whose follow-up was less than 6 months or ended before the surgeon concluded their treatment were excluded. We also examined reasons for device removal, reoperation, and complications following volar plating, specifically identifying major complications requiring additional operations.</div></div><div><h3>Results</h3><div>Among the 1073 distal radial fracture cases, 160 patients with 168 fractures underwent secondary orthopedic operations after volar plating. Ultimately, 33 cases required additional operations for major complications, resulting in a reoperation rate of 22 % and a major complication rate of 5.3 %. Major complications included: triangular fibrocartilage<span><span> complex tear, deep infection, carpal tunnel syndrome<span>, flexor pollicis longus injury and extensor pollicis longus injury, screw penetration or loosening, and complex regional pain syndrome. </span></span>Logistic regression showed a higher reoperation incidence in males and patients under 65, although age and sex were not associated with major complications.</span></div></div><div><h3>Conclusions</h3><div>This study outlined the incidence and causes of reoperation for complications following volar plating for distal radial fractures. Surgeons could benefit from preoperative counseling on potential complications and early identification and treatment. As age and sex were unrelated to postoperative complications, surgeons may consider factors like fracture patterns, functional demands, and baseline activity when determining treatment options with patients.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1041-1046"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615573","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}
S1 nerve root block (S1NRB) is frequently used to diagnose and treat lumbosacral and lower limb pain. However, the visibility of the S1 neural foramen can be obscured by factors including intestinal gas, increasing the procedure's technical difficulty. This study identified the optimal fluoroscopic angle for S1NRB and standardized the technique using three-dimensional (3D) computed tomography (CT) images.
Methods
We analyzed 3D CT images of 101 patients with lumbar degenerative diseases (lumbar disc herniation and lumbar spinal canal stenosis). The reference position angle (RPA) was defined as the angle where the superior endplate of the sacrum appears straight, whereas the tunnel view angle (TVA) was defined as the angle where the anterior and posterior S1 neural foramina coincide. We evaluated the relationship between the RPA and TVA, measured the position of the S1 neural foramen at the RPA using the S1 spinous process and sacroiliac joint as landmarks, and analyzed correlations with sex and body size.
Results
The mean RPA and TVA were 32.4 ± 6.4° and 34.0 ± 6.2°, respectively, with a mean difference of 1.5 ± 2.8° (r = 0.897, p < 0.0001). The horizontal distance from the S1 spinous process to the S1 neural foramen was 23.1 ± 2.1 mm, and to the sacroiliac joint was 52.0 ± 4.3 mm, with a ratio of 44.5 ± 3.4 %. The vertical distance from the S1 spinous process to the S1 neural foramen was −1.2 ± 1.7 mm caudally. In 84.2 % of the cases, the S1 neural foramen was located 0–4 mm caudal to the S1 spinous process and at 40–50 % of the horizontal distance between these landmarks. These parameters showed no significant differences based on sex or body size.
Conclusions
RPA, using the superior endplate of the sacrum as a reference, closely approximates the TVA and is a useful indicator of the optimal fluoroscopic angle for S1NRB. The S1 neural foramen position can be predicted using anatomical landmarks, irrespective of patient characteristics.
{"title":"Optimizing S1 nerve root block using three-dimensional computed tomography imaging: Identifying the ideal fluoroscopic angle and predicting S1 neural foramen position","authors":"Noritaka Suzuki , Toshiaki Kotani , Shuhei Ohyama , Kotaro Sakashita , Shun Okuwaki , Shuhei Iwata , Yasushi Iijima , Masaya Mizutani , Tsuyoshi Sakuma , Sumihisa Orita , Kazuhide Inage , Yasuhiro Shiga , Masahiro Inoue , Shohei Minami , Seiji Ohtori","doi":"10.1016/j.jos.2025.02.008","DOIUrl":"10.1016/j.jos.2025.02.008","url":null,"abstract":"<div><h3>Background</h3><div>S1 nerve root block (S1NRB) is frequently used to diagnose and treat lumbosacral and lower limb pain<span>. However, the visibility of the S1 neural foramen can be obscured by factors including intestinal gas, increasing the procedure's technical difficulty. This study identified the optimal fluoroscopic angle for S1NRB and standardized the technique using three-dimensional (3D) computed tomography (CT) images.</span></div></div><div><h3>Methods</h3><div><span>We analyzed 3D CT images of 101 patients with lumbar degenerative diseases<span> (lumbar disc herniation and lumbar spinal canal stenosis). The reference position angle (RPA) was defined as the angle where the superior endplate of the sacrum appears straight, whereas the tunnel view angle (TVA) was defined as the angle where the anterior and posterior S1 neural foramina coincide. We evaluated the relationship between the RPA and TVA, measured the position of the S1 neural foramen at the RPA using the S1 </span></span>spinous process<span> and sacroiliac joint as landmarks, and analyzed correlations with sex and body size.</span></div></div><div><h3>Results</h3><div>The mean RPA and TVA were 32.4 ± 6.4° and 34.0 ± 6.2°, respectively, with a mean difference of 1.5 ± 2.8° (r = 0.897, p < 0.0001). The horizontal distance from the S1 spinous process to the S1 neural foramen was 23.1 ± 2.1 mm, and to the sacroiliac joint was 52.0 ± 4.3 mm, with a ratio of 44.5 ± 3.4 %. The vertical distance from the S1 spinous process to the S1 neural foramen was −1.2 ± 1.7 mm caudally. In 84.2 % of the cases, the S1 neural foramen was located 0–4 mm caudal to the S1 spinous process and at 40–50 % of the horizontal distance between these landmarks. These parameters showed no significant differences based on sex or body size.</div></div><div><h3>Conclusions</h3><div>RPA, using the superior endplate of the sacrum as a reference, closely approximates the TVA and is a useful indicator of the optimal fluoroscopic angle for S1NRB. The S1 neural foramen position can be predicted using anatomical landmarks, irrespective of patient characteristics.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1005-1012"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719900","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}
The management of elective surgeries during the COVID-19 pandemic was controversial, and the impact on lumbar spinal stenosis (LSS) surgery outcomes remains unclear. This study aimed to retrospectively analyze older adults who underwent LSS surgery during the pandemic and compare cases from its early and late phases.
Methods
Medical records of patients aged 65 and older who underwent LSS surgery between April 2020 and April 2023 were reviewed. The Zurich Claudication Questionnaire and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were administered preoperatively and at 6 months and 1 year postoperatively.
Results
The period from April 2020 to September 2021 was classified as the early phase, while October 2021 to April 2023 was classified as the late phase. This study evaluated a total of 267 older patients with LSS, with 138 undergoing surgery during the early phase and 129 during the late phase. There was one case of COVID-19 infection during hospitalization in the early phase and none in the late phase. Significant differences were found between the early and late phases in the distribution of American Society of Anesthesiologists physical status (ASA) and frequency of degenerative lumbar scoliosis (DLS). When the association between the COVID-19 pandemic phase and effective case of surgery treatment on JOABPEQ was examined, the multivariable adjusted relative risks of effective case in social life domain for the late-stage group were 0.7 (95 % CI = 0.5–0.9) at both 6 months and 1 year postoperatively using the early-phase group as the reference. No significant differences were found in the other four domains at either 6 months or 1 year postoperatively.
Conclusions
Poorer social life outcomes in the late-phase patients with LSS surgery may be attributed to worse preoperative ASA scores and changes in social life during different pandemic phases.
背景：COVID-19大流行期间择期手术的管理存在争议，对腰椎管狭窄（LSS）手术结果的影响尚不清楚。本研究旨在回顾性分析大流行期间接受LSS手术的老年人，并比较其早期和晚期的病例。方法：回顾2020年4月至2023年4月期间65岁及以上LSS手术患者的医疗记录。术前、术后6个月和1年分别进行苏黎世跛行问卷和日本骨科协会背痛评估问卷（JOABPEQ）。结果：2020年4月至2021年9月为前期，2021年10月至2023年4月为后期。本研究共评估了267例老年LSS患者，其中138例在早期接受手术，129例在晚期接受手术。早期住院期间感染1例，晚期无感染。美国麻醉医师协会生理状态（ASA）的分布和退行性腰椎侧凸（DLS）的频率在早期和晚期之间存在显著差异。当检验COVID-19大流行阶段与JOABPEQ手术治疗有效病例之间的相关性时，以早期组为参照，晚期组在术后6个月和1年的社会生活领域有效病例的多变量调整相对风险为0.7 （95% CI = 0.5-0.9）。术后6个月或1年，其他4个领域无明显差异。结论：晚期LSS手术患者较差的社会生活结果可能归因于术前ASA评分较差和不同流行阶段社会生活的变化。
{"title":"A look back at lumbar spinal stenosis cases in older adults during the COVID-19 pandemic","authors":"Yuki Akaike , Soya Kawabata , Takehiro Michikawa , Takaya Imai , Hiroki Takeda , Kei Ito , Sota Nagai , Daiki Ikeda , Shinjiro Kaneko , Nobuyuki Fujita","doi":"10.1016/j.jos.2025.04.007","DOIUrl":"10.1016/j.jos.2025.04.007","url":null,"abstract":"<div><h3>Background</h3><div><span>The management of elective surgeries during the COVID-19 pandemic was controversial, and the impact on </span>lumbar spinal stenosis (LSS) surgery outcomes remains unclear. This study aimed to retrospectively analyze older adults who underwent LSS surgery during the pandemic and compare cases from its early and late phases.</div></div><div><h3>Methods</h3><div><span><span>Medical records of patients aged 65 and older who underwent LSS surgery between April 2020 and April 2023 were reviewed. The Zurich </span>Claudication Questionnaire and Japanese </span>Orthopaedic<span> Association Back Pain Evaluation Questionnaire (JOABPEQ) were administered preoperatively and at 6 months and 1 year postoperatively.</span></div></div><div><h3>Results</h3><div>The period from April 2020 to September 2021 was classified as the early phase, while October 2021 to April 2023 was classified as the late phase. This study evaluated a total of 267 older patients with LSS, with 138 undergoing surgery during the early phase and 129 during the late phase. There was one case of COVID-19 infection during hospitalization in the early phase and none in the late phase. Significant differences were found between the early and late phases in the distribution of American Society of Anesthesiologists physical status (ASA) and frequency of degenerative lumbar scoliosis (DLS). When the association between the COVID-19 pandemic phase and effective case of surgery treatment on JOABPEQ was examined, the multivariable adjusted relative risks of effective case in social life domain for the late-stage group were 0.7 (95 % CI = 0.5–0.9) at both 6 months and 1 year postoperatively using the early-phase group as the reference. No significant differences were found in the other four domains at either 6 months or 1 year postoperatively.</div></div><div><h3>Conclusions</h3><div>Poorer social life outcomes in the late-phase patients with LSS surgery may be attributed to worse preoperative ASA scores and changes in social life during different pandemic phases.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1035-1040"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020700","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 : 2025-11-01DOI: 10.1016/j.jos.2025.04.003
Eric Pasqualotto , Rafael Oliva Morgado Ferreira , Leonardo Salvatore Migliardi , Pedro Henrique Felisbino Silva , Tales Pasqualotto , Joyce Cristina Campos , Julia de Lira Kaszubowski , Sabrina da Silva , Serafim Barros , Luis Fernando Z. Funchal
Purpose
To compare home-based remote rehabilitation with usual rehabilitation care for knee osteoarthritis (OA).
Methods
PubMed, Cochrane, and Embase databases were searched for randomized controlled trials (RCTs) comparing home-based remote rehabilitation (telephone calls, video calls, apps, or websites) with usual in-person rehabilitation in patients with knee OA. Mean differences (MDs) or standardized mean differences (SMDs) were calculated for continuous outcomes and risk ratios (RRs) for binary outcomes, with 95 % confidence intervals (CIs). Statistical analyses were performed using R Software, version 4.4.1.
Results
A total of 9 RCTs were included, comprising 974 patients with knee OA, of whom 483 (49.6 %) were randomized to home-based remote rehabilitation. Compared with usual rehabilitation, home-based remote rehabilitation significantly reduced pain severity (SMD -0.34; 95 % CI -0.67 to −0.02) and significantly improved physical activity levels (SMD -0.45; 95 % CI -0.85 to −0.05). Furthermore, the home-based remote rehabilitation group showed a significant reduction in pain assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (MD -0.95 points; 95 % CI -1.84 to −0.06), an improvement in functionality assessed with the Timed Up and Go test (MD -0.83 s; 95 % CI -1.64 to −0.02), and a greater patient satisfaction (RR 2.01; 95 % CI 1.46 to 2.76).
Conclusion
The results demonstrated that home-based remote rehabilitation reduced pain and increased patient satisfaction, however, there is insufficient evidence to state that remote rehabilitation significantly improved physical activity and functionality. Home-based remote rehabilitation appears to be a viable and effective alternative for patients with knee OA.
目的：比较家庭远程康复与常规康复治疗对膝骨关节炎（OA）的影响。方法：检索PubMed、Cochrane和Embase数据库，比较基于家庭的远程康复（电话、视频通话、应用程序或网站）与膝关节OA患者通常的面对面康复的随机对照试验（rct）。计算连续结局的平均差异（md）或标准化平均差异（SMDs），以及二元结局的风险比（rr），置信区间为95% （ci）。采用R软件4.4.1版本进行统计分析。结果：共纳入9项随机对照试验，共纳入974例膝关节OA患者，其中483例（49.6%）随机接受家庭远程康复治疗。与常规康复相比，居家远程康复显著降低疼痛严重程度(SMD -0.34；95% CI -0.67至-0.02)和显著改善的身体活动水平(SMD -0.45；95% CI -0.85 ~ -0.05)。此外，根据西安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评估，以家庭为基础的远程康复组疼痛显著减轻(MD -0.95分；95% CI -1.84至-0.06)，通过Timed Up and Go测试评估的功能改善(MD -0.83 s；95% CI -1.64 ~ -0.02)，患者满意度更高(RR 2.01；95% CI 1.46 - 2.76)。结论：结果表明，以家庭为基础的远程康复减轻了疼痛，提高了患者满意度，然而，没有足够的证据表明远程康复显著改善了身体活动和功能。以家庭为基础的远程康复似乎是一个可行的和有效的替代膝关节OA患者。
{"title":"The efficacy of home-based remote rehabilitation versus usual rehabilitation for patients with knee osteoarthritis: A systematic review and meta-analysis","authors":"Eric Pasqualotto , Rafael Oliva Morgado Ferreira , Leonardo Salvatore Migliardi , Pedro Henrique Felisbino Silva , Tales Pasqualotto , Joyce Cristina Campos , Julia de Lira Kaszubowski , Sabrina da Silva , Serafim Barros , Luis Fernando Z. Funchal","doi":"10.1016/j.jos.2025.04.003","DOIUrl":"10.1016/j.jos.2025.04.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare home-based remote rehabilitation<span> with usual rehabilitation care for knee osteoarthritis (OA).</span></div></div><div><h3>Methods</h3><div><span>PubMed, Cochrane, and Embase databases were searched for </span>randomized controlled trials<span> (RCTs) comparing home-based remote rehabilitation (telephone calls, video calls, apps, or websites) with usual in-person rehabilitation in patients with knee OA. Mean differences (MDs) or standardized mean differences (SMDs) were calculated for continuous outcomes and risk ratios (RRs) for binary outcomes, with 95 % confidence intervals (CIs). Statistical analyses were performed using R Software, version 4.4.1.</span></div></div><div><h3>Results</h3><div><span><span>A total of 9 RCTs were included, comprising 974 patients with knee OA, of whom 483 (49.6 %) were randomized to home-based remote rehabilitation. Compared with usual rehabilitation, home-based remote rehabilitation significantly reduced pain severity (SMD -0.34; 95 % CI -0.67 to −0.02) and significantly improved </span>physical activity levels (SMD -0.45; 95 % CI -0.85 to −0.05). Furthermore, the home-based remote rehabilitation group showed a significant reduction in pain assessed with the </span>Western Ontario and McMaster Universities Osteoarthritis Index<span> (WOMAC) (MD -0.95 points; 95 % CI -1.84 to −0.06), an improvement in functionality assessed with the Timed Up and Go test (MD -0.83 s; 95 % CI -1.64 to −0.02), and a greater patient satisfaction (RR 2.01; 95 % CI 1.46 to 2.76).</span></div></div><div><h3>Conclusion</h3><div>The results demonstrated that home-based remote rehabilitation reduced pain and increased patient satisfaction, however, there is insufficient evidence to state that remote rehabilitation significantly improved physical activity and functionality. Home-based remote rehabilitation appears to be a viable and effective alternative for patients with knee OA.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1073-1080"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016656","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}
The ability to perform deep squats in children and adolescents is an essential component of lower extremity function. Especially for school-aged children and adolescents, the ability to perform deep squats is related to their daily life and school activities. Few reports have investigated the factors associated with deep squats ability in this population. This study aimed to identify the factors associated with deep squat ability in healthy Japanese children and adolescents.
Methods
A retrospective cohort study was conducted with children and adolescents aged 8–14 years in Japan from 2017 to 2019. Data on height, weight, ability to perform deep squats, general joint laxity, lower limb tightness, and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale score were collected at the beginning of each year. Participants who were able to squat during their musculoskeletal screening were divided into two groups: those who could deep squat the following year and those who could not. Logistic regression analysis with variable selection was performed to calculate the odds ratio for each predicted risk factor associated with the inability to perform a deep squat.
Results
A total of 636 children and adolescents were included in the analysis, with 7.5 % of them being unable to perform deep squats the following year. The risk of being unable to deep squats significantly decreased with increasing age (odds ratio 0.66, 95 % confidence interval 0.50–0.87). In addition, higher weight (odds ratio 1.12, 95 % confidence interval 1.07–1.17) and higher Hospital for Special Surgery Pediatric Functional Activity Brief Scale score (odds ratio 1.05, 95 % confidence interval 1.01–1.10) were identified as risk factors associated with the inability to perform a deep squat. Other physical factors did not significantly contribute to the occurrence of deep squat abnormalities.
Conclusions
Age, body weight, and physical activity levels were found to be associated with the ability to perform deep squats in healthy Japanese children and adolescents.
{"title":"Body weight is associated with the ability to perform deep squats in school-aged Japanese children and adolescents: A retrospective cohort study","authors":"Manato Horii , Kohei Takahashi , Seiji Kimura , Ryuichiro Akagi , Shotaro Watanabe , Satoshi Yamaguchi , Yoshihito Ozawa , Seiji Ohtori , Takahisa Sasho","doi":"10.1016/j.jos.2025.03.004","DOIUrl":"10.1016/j.jos.2025.03.004","url":null,"abstract":"<div><h3>Background</h3><div>The ability to perform deep squats in children and adolescents is an essential component of lower extremity function. Especially for school-aged children and adolescents, the ability to perform deep squats is related to their daily life and school activities. Few reports have investigated the factors associated with deep squats ability in this population. This study aimed to identify the factors associated with deep squat ability in healthy Japanese children and adolescents.</div></div><div><h3>Methods</h3><div><span>A retrospective cohort study was conducted with children and adolescents aged 8–14 years in Japan from 2017 to 2019. Data on height, weight, ability to perform deep squats, general </span>joint laxity<span><span>, lower limb tightness, and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale score were collected at the beginning of each year. Participants who were able to squat during their musculoskeletal screening were divided into two groups: those who could deep squat the following year and those who could not. Logistic regression analysis with variable selection was performed to calculate the odds ratio for each predicted </span>risk factor associated with the inability to perform a deep squat.</span></div></div><div><h3>Results</h3><div>A total of 636 children and adolescents were included in the analysis, with 7.5 % of them being unable to perform deep squats the following year. The risk of being unable to deep squats significantly decreased with increasing age (odds ratio 0.66, 95 % confidence interval 0.50–0.87). In addition, higher weight (odds ratio 1.12, 95 % confidence interval 1.07–1.17) and higher Hospital for Special Surgery Pediatric Functional Activity Brief Scale score (odds ratio 1.05, 95 % confidence interval 1.01–1.10) were identified as risk factors associated with the inability to perform a deep squat. Other physical factors did not significantly contribute to the occurrence of deep squat abnormalities.</div></div><div><h3>Conclusions</h3><div>Age, body weight<span>, and physical activity levels were found to be associated with the ability to perform deep squats in healthy Japanese children and adolescents.</span></div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1137-1144"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692398","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}
This study compared the biomechanical properties of three cannulated screws (3-CSs) and a fixed angle device (FAD) for treating undisplaced femoral neck fracture (FNF) Pauwels types I and III, using finite element analysis (FEA) models created with nonlinear material properties; accurately reflecting the bone quality of osteoporotic patients.
Materials and methods
FEA involved three patients with a history of undisplaced FNF. Mesh generation was performed using the preoperative CT data. Two internal fixation models:3-CSs and FAD were created for Pauwels type I and III models with a fracture angle of 30° and 70°, respectively. Compression force and relative displacement of the fracture site, and von Mises stress (VMS) of the implants were evaluated. Data analysis involved paired t-test at p < 0.05 statistical level of significance.
Results
No significant difference was seen in the compression force between the two implants for Pauwels 30° and 70°models. There was no significant difference in the relative displacement and VMS between the two implants for Pauwels 30° model. However, both relative displacement and VMS were significantly higher in 3-CSs than in FAD for Pauwels 70° model.
Conclusion
Results indicate the need for FAD when treating Pawels Type III FNF with osteoporosis, since FAD fixation exhibited superior mechanical stability compared to 3-CSs. However, for the Pauwels Type I FNF, both fixation methods provided comparable stability. When considering the implant's simple and minimally invasive features, the clinical use of 3-CSs may be applicable. These findings highlight the importance of evaluating the Pauwels angle when determining the optimal fixation method for undisplaced FNF.
{"title":"Biomechanical study of internal fixation methods for undisplaced femoral neck fractures with osteoporosis based on the Pauwels angle: Fixed angle device versus three cannulated screws","authors":"Sakura Kuniyoshi, Satoshi Nakasone, Mika Takaesu, Takahiro Igei, Fumiyuki Washizaki, Kotaro Nishida","doi":"10.1016/j.jos.2025.04.001","DOIUrl":"10.1016/j.jos.2025.04.001","url":null,"abstract":"<div><h3>Background</h3><div>This study compared the biomechanical properties of three cannulated screws (3-CSs) and a fixed angle device (FAD) for treating undisplaced femoral neck fracture (FNF) Pauwels types I and III, using finite element analysis (FEA) models created with nonlinear material properties; accurately reflecting the bone quality of osteoporotic patients.</div></div><div><h3>Materials and methods</h3><div>FEA involved three patients with a history of undisplaced FNF. Mesh generation was performed using the preoperative CT data. Two internal fixation models:3-CSs and FAD were created for Pauwels type I and III models with a fracture angle of 30° and 70°, respectively. Compression force and relative displacement of the fracture site, and von Mises stress (VMS) of the implants were evaluated. Data analysis involved paired <em>t</em>-test at p < 0.05 statistical level of significance.</div></div><div><h3>Results</h3><div>No significant difference was seen in the compression force between the two implants for Pauwels 30° and 70°models. There was no significant difference in the relative displacement and VMS between the two implants for Pauwels 30° model. However, both relative displacement and VMS were significantly higher in 3-CSs than in FAD for Pauwels 70° model.</div></div><div><h3>Conclusion</h3><div>Results indicate the need for FAD when treating Pawels Type III FNF with osteoporosis, since FAD fixation exhibited superior mechanical stability compared to 3-CSs. However, for the Pauwels Type I FNF, both fixation methods provided comparable stability. When considering the implant's simple and minimally invasive features, the clinical use of 3-CSs may be applicable. These findings highlight the importance of evaluating the Pauwels angle when determining the optimal fixation method for undisplaced FNF.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 6","pages":"Pages 1126-1132"},"PeriodicalIF":1.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027355","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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