Raveena Joshi,Surbhi Srinivas,Colin O'Neill,Atta Taseh,Abhinav Bhamidipati,Daniel Acevedo,Kevin Y Wang,Amgad A Haleem,Soheil Ashkani-Esfahani,John Y Kwon
BACKGROUNDPilon fractures result in substantial morbidity and are associated with a high rate of ankle arthritis. However, literature is scarce regarding the prevalence of posttraumatic subtalar arthritis. Tibiotalocalcaneal (TTC) arthrodesis, or hindfoot nailing, is increasingly used for comminuted pilon fractures, which often involve the subtalar joint. This study aimed to determine the prevalence and severity of posttraumatic subtalar arthritis, to better understand the implications of this surgical technique in these cases.METHODSPatients who sustained a pilon fracture and underwent open reduction and internal fixation were retrospectively identified. The patients were categorized into 4 groups on the basis of the time interval between the date of injury and the latest available radiographs: <12, 12 to 24, 25 to 48, and >forty-eight months. The Kellgren-Lawrence (K-L) and NSS (None, Some, Severe) grading systems were used to evaluate the radiographs. Postoperative computed tomography (CT) scans, when available, were similarly graded using the CT Ankle Osteoarthritis (CTAO) system. Pearson correlation, chi-square, Mann-Whitney U, and Welch t tests were used. P < 0.05 was considered significant.RESULTSThe study included 473 patients (mean age, 46.15 ± 7.50 years, 293 male and 180 female). The cohort was composed of 80.3% White and 15.8% non-White, with 3.9% missing data.(Patient age at the time of injury (p < 0.001) and at the time of imaging (p < 0.001), smoking status (p = 0.01), steroid use (p = 0.04), Charlson Comorbidity Index (CCI) (p = 0.003), AO/OTA classification (p = 0.03), and time from injury to final imaging (p = 0.004) were significantly correlated with the K-L grade. Group 3 was found to have a higher mean K-L grade than Group 1 (by 0.34, 95% confidence interval [CI]: 0.03 to 0.66; p = 0.04) and Group 2 (by 0.39, 95% CI: 0.05 to 0.73; p = 0.02). Group 4 had a higher K-L grade than Group 1 (by 0.37, 95% CI: 0.08 to 0.66; p = 0.01) and Group 2 (by 0.42, 95% CI: 0.11 to 0.73; p = 0.01). The CTAO score demonstrated meaningful correlation between subtalar arthritis and age at both the time of injury (p = 0.004) and the time of final CT (p = 0.01).CONCLUSIONSMultiple patient-based factors including age, smoking status, steroid use, CCI, AO/OTA classification, and the time interval since injury were significantly associated with the development of subtalar arthritis, as assessed using the K-L grade, after pilon fracture. This suggests that acute hindfoot nailing as an index treatment option for pilon fractures may have fewer clinical ramifications than has been anticipated on the basis of its violation of the subtalar joint.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"The Prevalence of Subtalar Arthritis Following Pilon Fractures.","authors":"Raveena Joshi,Surbhi Srinivas,Colin O'Neill,Atta Taseh,Abhinav Bhamidipati,Daniel Acevedo,Kevin Y Wang,Amgad A Haleem,Soheil Ashkani-Esfahani,John Y Kwon","doi":"10.2106/jbjs.25.00233","DOIUrl":"https://doi.org/10.2106/jbjs.25.00233","url":null,"abstract":"BACKGROUNDPilon fractures result in substantial morbidity and are associated with a high rate of ankle arthritis. However, literature is scarce regarding the prevalence of posttraumatic subtalar arthritis. Tibiotalocalcaneal (TTC) arthrodesis, or hindfoot nailing, is increasingly used for comminuted pilon fractures, which often involve the subtalar joint. This study aimed to determine the prevalence and severity of posttraumatic subtalar arthritis, to better understand the implications of this surgical technique in these cases.METHODSPatients who sustained a pilon fracture and underwent open reduction and internal fixation were retrospectively identified. The patients were categorized into 4 groups on the basis of the time interval between the date of injury and the latest available radiographs: <12, 12 to 24, 25 to 48, and >forty-eight months. The Kellgren-Lawrence (K-L) and NSS (None, Some, Severe) grading systems were used to evaluate the radiographs. Postoperative computed tomography (CT) scans, when available, were similarly graded using the CT Ankle Osteoarthritis (CTAO) system. Pearson correlation, chi-square, Mann-Whitney U, and Welch t tests were used. P < 0.05 was considered significant.RESULTSThe study included 473 patients (mean age, 46.15 ± 7.50 years, 293 male and 180 female). The cohort was composed of 80.3% White and 15.8% non-White, with 3.9% missing data.(Patient age at the time of injury (p < 0.001) and at the time of imaging (p < 0.001), smoking status (p = 0.01), steroid use (p = 0.04), Charlson Comorbidity Index (CCI) (p = 0.003), AO/OTA classification (p = 0.03), and time from injury to final imaging (p = 0.004) were significantly correlated with the K-L grade. Group 3 was found to have a higher mean K-L grade than Group 1 (by 0.34, 95% confidence interval [CI]: 0.03 to 0.66; p = 0.04) and Group 2 (by 0.39, 95% CI: 0.05 to 0.73; p = 0.02). Group 4 had a higher K-L grade than Group 1 (by 0.37, 95% CI: 0.08 to 0.66; p = 0.01) and Group 2 (by 0.42, 95% CI: 0.11 to 0.73; p = 0.01). The CTAO score demonstrated meaningful correlation between subtalar arthritis and age at both the time of injury (p = 0.004) and the time of final CT (p = 0.01).CONCLUSIONSMultiple patient-based factors including age, smoking status, steroid use, CCI, AO/OTA classification, and the time interval since injury were significantly associated with the development of subtalar arthritis, as assessed using the K-L grade, after pilon fracture. This suggests that acute hindfoot nailing as an index treatment option for pilon fractures may have fewer clinical ramifications than has been anticipated on the basis of its violation of the subtalar joint.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"167 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Majd Mzeihem,Luke Zabawa,Yeseop Park,Alexander Crespo,Yazdan Raji,Farid Amirouche
BACKGROUNDArticular depression, especially in central tibial plateau segments, is surgically challenging. According to the 10-segment classification, the anterolateral approach visualizes only 36.6% of the tibial plateau. The aim of this study was to compare biomechanical performance between fluoroscopy-guided fixation techniques with and without needle arthroscopy.METHODSThis cadaveric study used 16 knee specimens with standardized lateral tibial plateau fractures. Specimens were randomized to fluoroscopy-guided (FG) or fluoroscopy plus needle arthroscopy-guided (FNG) reduction performed via an anterolateral approach. Kirschner wires and proximal tibial plates were used for fixation. The primary outcome was load to failure. Secondary outcomes included stress, strain, stiffness, reduction quality, radiation exposure, and operative time.RESULTSSixteen cadaveric specimens (9 right knees; 12 males) were studied. The FG group had greater mean articular depression (1.77 versus 1.69 mm) and step-off (2.44 versus 2.26 mm) than the FNG group. The FNG group had a higher mean load to failure (1,784 versus 1,063 N), whereas the FG group had greater mean stiffness (170.34 versus 130.82 N/mm) and a longer mean operative time (1,662 versus 1,524 seconds). The FG group also demonstrated higher mean fluoroscopic doses and larger differences in condylar width and the medial tibial plateau angle than the FNG group.CONCLUSIONSFNG reduction improved articular congruity and load to failure in lateral tibial plateau fractures without increasing operative time, supporting needle arthroscopy as a valuable adjunct for managing complex articular fractures with less invasive exposure.CLINICAL RELEVANCEThis study is clinically relevant because it shows that incorporating needle arthroscopy during fixation of lateral tibial plateau fractures can improve reduction quality and stability without prolonging operative time.
{"title":"Fluoroscopy-Guided Lateral Tibial Plateau Fracture Fixation with and without Needle Arthroscopy: A Biomechanical and Reduction-Quality Comparison.","authors":"Majd Mzeihem,Luke Zabawa,Yeseop Park,Alexander Crespo,Yazdan Raji,Farid Amirouche","doi":"10.2106/jbjs.25.00793","DOIUrl":"https://doi.org/10.2106/jbjs.25.00793","url":null,"abstract":"BACKGROUNDArticular depression, especially in central tibial plateau segments, is surgically challenging. According to the 10-segment classification, the anterolateral approach visualizes only 36.6% of the tibial plateau. The aim of this study was to compare biomechanical performance between fluoroscopy-guided fixation techniques with and without needle arthroscopy.METHODSThis cadaveric study used 16 knee specimens with standardized lateral tibial plateau fractures. Specimens were randomized to fluoroscopy-guided (FG) or fluoroscopy plus needle arthroscopy-guided (FNG) reduction performed via an anterolateral approach. Kirschner wires and proximal tibial plates were used for fixation. The primary outcome was load to failure. Secondary outcomes included stress, strain, stiffness, reduction quality, radiation exposure, and operative time.RESULTSSixteen cadaveric specimens (9 right knees; 12 males) were studied. The FG group had greater mean articular depression (1.77 versus 1.69 mm) and step-off (2.44 versus 2.26 mm) than the FNG group. The FNG group had a higher mean load to failure (1,784 versus 1,063 N), whereas the FG group had greater mean stiffness (170.34 versus 130.82 N/mm) and a longer mean operative time (1,662 versus 1,524 seconds). The FG group also demonstrated higher mean fluoroscopic doses and larger differences in condylar width and the medial tibial plateau angle than the FNG group.CONCLUSIONSFNG reduction improved articular congruity and load to failure in lateral tibial plateau fractures without increasing operative time, supporting needle arthroscopy as a valuable adjunct for managing complex articular fractures with less invasive exposure.CLINICAL RELEVANCEThis study is clinically relevant because it shows that incorporating needle arthroscopy during fixation of lateral tibial plateau fractures can improve reduction quality and stability without prolonging operative time.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145785828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joon Young Lee,Jee Eun Park,Sung Eun Kim,Byung Sun Choi,Myung Chul Lee,Chong Bum Chang,Hyuk-Soo Han,Hye Youn Park,Du Hyun Ro
BACKGROUNDPostoperative delirium (POD) is a clinically important complication in elderly patients undergoing total knee arthroplasty (TKA) that is associated with prolonged hospitalization, increased morbidity, and higher health-care costs. Although cognitive impairment is a known risk factor for POD, the role of comprehensive cognitive and psychological evaluation remains underexplored in patients undergoing TKA. This study aimed to evaluate the correlation of preoperative cognitive and psychological factors with POD after TKA.METHODSThis prospective cohort study included 574 patients who were ≥60 years of age and underwent primary TKA at 1 of 2 major tertiary care hospitals. We assessed preoperative cognitive function using the Mini-Mental State Examination (MMSE), the full Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery, the Subjective Memory Complaints Questionnaire (SMCQ), and the Seoul Informant Report Questionnaire for Dementia (SIRQD). Psychological assessments were conducted with the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-15 (PHQ-15), and the Hospital Anxiety and Depression Scale (HADS). POD was evaluated daily from postoperative days 1 to 5 using the 4 A's Test (4AT) and the Confusion Assessment Method (CAM). A multivariable logistic regression analysis was performed to identify independent risk factors for POD.RESULTSPOD occurred in 24 (4.2%) of 574 patients. Univariate analysis revealed that POD was significantly correlated with lower MMSE (p < 0.001), higher PHQ-15 (p = 0.014), higher PSQI (p = 0.014), and higher Charlson Comorbidity Index (p = 0.010) scores; preoperative use of sedatives (p = 0.044) and antidepressants (p = 0.027); and lower mean noise levels in the patient's hospital room (p = 0.002). In the receiver operating characteristic curve analysis, the optimal cutoff value for predicting POD was an MMSE score of ≤25, with a sensitivity of 74.5% and a specificity of 78.3% (area under the curve, 0.834; p = 0.001). Multivariable logistic regression analysis identified lower MMSE scores (odds ratio [OR], 0.771; p = 0.002) and higher PHQ-15 scores (OR, 1.187; p = 0.028) as significant independent predictors of POD.CONCLUSIONSThis study comprehensively evaluated preoperative cognitive function and psychological symptoms in patients undergoing TKA. Even subclinical cognitive and somatic symptoms were linked to POD, emphasizing the need for preoperative identification of high-risk patients.LEVEL OF EVIDENCEPrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Low Cognitive Function and Somatic Psychological Symptoms Are Correlated with Greater Risk of Delirium After Total Knee Arthroplasty: A Prospective Cohort Study.","authors":"Joon Young Lee,Jee Eun Park,Sung Eun Kim,Byung Sun Choi,Myung Chul Lee,Chong Bum Chang,Hyuk-Soo Han,Hye Youn Park,Du Hyun Ro","doi":"10.2106/jbjs.25.00392","DOIUrl":"https://doi.org/10.2106/jbjs.25.00392","url":null,"abstract":"BACKGROUNDPostoperative delirium (POD) is a clinically important complication in elderly patients undergoing total knee arthroplasty (TKA) that is associated with prolonged hospitalization, increased morbidity, and higher health-care costs. Although cognitive impairment is a known risk factor for POD, the role of comprehensive cognitive and psychological evaluation remains underexplored in patients undergoing TKA. This study aimed to evaluate the correlation of preoperative cognitive and psychological factors with POD after TKA.METHODSThis prospective cohort study included 574 patients who were ≥60 years of age and underwent primary TKA at 1 of 2 major tertiary care hospitals. We assessed preoperative cognitive function using the Mini-Mental State Examination (MMSE), the full Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery, the Subjective Memory Complaints Questionnaire (SMCQ), and the Seoul Informant Report Questionnaire for Dementia (SIRQD). Psychological assessments were conducted with the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-15 (PHQ-15), and the Hospital Anxiety and Depression Scale (HADS). POD was evaluated daily from postoperative days 1 to 5 using the 4 A's Test (4AT) and the Confusion Assessment Method (CAM). A multivariable logistic regression analysis was performed to identify independent risk factors for POD.RESULTSPOD occurred in 24 (4.2%) of 574 patients. Univariate analysis revealed that POD was significantly correlated with lower MMSE (p < 0.001), higher PHQ-15 (p = 0.014), higher PSQI (p = 0.014), and higher Charlson Comorbidity Index (p = 0.010) scores; preoperative use of sedatives (p = 0.044) and antidepressants (p = 0.027); and lower mean noise levels in the patient's hospital room (p = 0.002). In the receiver operating characteristic curve analysis, the optimal cutoff value for predicting POD was an MMSE score of ≤25, with a sensitivity of 74.5% and a specificity of 78.3% (area under the curve, 0.834; p = 0.001). Multivariable logistic regression analysis identified lower MMSE scores (odds ratio [OR], 0.771; p = 0.002) and higher PHQ-15 scores (OR, 1.187; p = 0.028) as significant independent predictors of POD.CONCLUSIONSThis study comprehensively evaluated preoperative cognitive function and psychological symptoms in patients undergoing TKA. Even subclinical cognitive and somatic symptoms were linked to POD, emphasizing the need for preoperative identification of high-risk patients.LEVEL OF EVIDENCEPrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145785827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDLarge language models are increasingly being used in scientific writing, but their use in orthopaedic literature remains unclear.METHODSWe analyzed 196 articles published in March 2025 in 10 leading orthopaedic journals. GPTZero quantified artificial intelligence (AI)-generated text by article section. Composite AI scores were calculated and tested for associations with the h5-index, study design, level of evidence, authorship characteristics, and geographic region with use of nonparametric and both Pearson and Spearman correlation analyses.RESULTSAI-generated content was detected in 89.8% of articles. The mean AI score was 18.1% (median, 14.9%). Scores differed by section (p < 0.001) and were the highest in the Results. AI use correlated with the proportion of non-MD authors (ρ = 0.22) and with the total author count (ρ = 0.19), but not with the h5-index. No association with study design or level of evidence was found. Differences by geographic region were modest and not significant after correction.CONCLUSIONSAI-generated content appears to be widespread, particularly in Results sections. Its use varies by authorship characteristics and geography but not by study design or journal prestige. Clear disclosure standards are essential to guide responsible AI use in scientific writing.CLINICAL RELEVANCEThis study is clinically relevant because transparency in scientific writing supports accurate interpretation of the evidence used in patient care. Identifying the prevalence of AI-generated text helps to protect the integrity of the orthopaedic literature.
{"title":"AI-Generated Text in Orthopaedic Articles: A Cross-Sectional Analysis.","authors":"Paxton Sweeney,Matthew R Yuro,Wayne S Berberian","doi":"10.2106/jbjs.25.00971","DOIUrl":"https://doi.org/10.2106/jbjs.25.00971","url":null,"abstract":"BACKGROUNDLarge language models are increasingly being used in scientific writing, but their use in orthopaedic literature remains unclear.METHODSWe analyzed 196 articles published in March 2025 in 10 leading orthopaedic journals. GPTZero quantified artificial intelligence (AI)-generated text by article section. Composite AI scores were calculated and tested for associations with the h5-index, study design, level of evidence, authorship characteristics, and geographic region with use of nonparametric and both Pearson and Spearman correlation analyses.RESULTSAI-generated content was detected in 89.8% of articles. The mean AI score was 18.1% (median, 14.9%). Scores differed by section (p < 0.001) and were the highest in the Results. AI use correlated with the proportion of non-MD authors (ρ = 0.22) and with the total author count (ρ = 0.19), but not with the h5-index. No association with study design or level of evidence was found. Differences by geographic region were modest and not significant after correction.CONCLUSIONSAI-generated content appears to be widespread, particularly in Results sections. Its use varies by authorship characteristics and geography but not by study design or journal prestige. Clear disclosure standards are essential to guide responsible AI use in scientific writing.CLINICAL RELEVANCEThis study is clinically relevant because transparency in scientific writing supports accurate interpretation of the evidence used in patient care. Identifying the prevalence of AI-generated text helps to protect the integrity of the orthopaedic literature.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145785826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Good judgment remains fundamental to clinical decision-making, and yet it is increasingly augmented by data and artificial intelligence (AI). Although AI holds promise for real-time clinical-decision support, its impact on patient care has been modest. The principal limitation is not algorithmic capability but the quality, structure, and completeness of the data available for training and deployment. Most AI systems rely on electronic medical records (EMRs), which were designed primarily for billing rather than clinical insight. Consequently, important clinical information is fragmented, inconsistently documented, or absent altogether. Natural language processing and large language models (LLMs) improve data extraction, and yet they remain constrained by the underlying data quality and important privacy concerns. A critical gap persists in the acquisition of quantitative physiological data, particularly for the musculoskeletal system, where current practice relies on qualitative or semiquantitative assessments collected at single time points. In contrast, other industries-such as the autonomous vehicle industry-have advanced further by integrating continuous, multimodal sensor data to inform real-time decisions. Emerging multimodal wearable technologies offer a pathway toward similarly rich physiological data sets in medicine. Meaningful progress in AI-enabled health care will require such a transformation in data acquisition, enabling more accurate, continuous, and clinically relevant decision support.
{"title":"AI-Based Medical Decision Support: Exploring the Data Gap.","authors":"Joseph H Schwab","doi":"10.2106/jbjs.25.01387","DOIUrl":"https://doi.org/10.2106/jbjs.25.01387","url":null,"abstract":"Good judgment remains fundamental to clinical decision-making, and yet it is increasingly augmented by data and artificial intelligence (AI). Although AI holds promise for real-time clinical-decision support, its impact on patient care has been modest. The principal limitation is not algorithmic capability but the quality, structure, and completeness of the data available for training and deployment. Most AI systems rely on electronic medical records (EMRs), which were designed primarily for billing rather than clinical insight. Consequently, important clinical information is fragmented, inconsistently documented, or absent altogether. Natural language processing and large language models (LLMs) improve data extraction, and yet they remain constrained by the underlying data quality and important privacy concerns. A critical gap persists in the acquisition of quantitative physiological data, particularly for the musculoskeletal system, where current practice relies on qualitative or semiquantitative assessments collected at single time points. In contrast, other industries-such as the autonomous vehicle industry-have advanced further by integrating continuous, multimodal sensor data to inform real-time decisions. Emerging multimodal wearable technologies offer a pathway toward similarly rich physiological data sets in medicine. Meaningful progress in AI-enabled health care will require such a transformation in data acquisition, enabling more accurate, continuous, and clinically relevant decision support.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Importance of Phase-2 Clinical Research: Commentary on an article by Weishi Li, MD, PhD, et al.: \"Bezeotermin Alfa (rhBMP-6) Administration in Lumbar Interbody Fusion Surgery Using a Posterior Approach. A Randomized, Double-Blinded, Placebo-Controlled Phase-2 Study\".","authors":"Sheila Sprague","doi":"10.2106/jbjs.25.01078","DOIUrl":"https://doi.org/10.2106/jbjs.25.01078","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"20 1","pages":"2686-2687"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical Treatment of Osteochondritis Dissecans Leading to Normal Bone Density: Commentary on an article by Satoshi Miyamura, MD, PhD, et al.: \"Normalization of Subchondral Bone Density Patterns After Surgical Treatment for Capitellar Osteochondritis Dissecans. A Quantitative Analysis\".","authors":"John D Lubahn","doi":"10.2106/jbjs.25.01136","DOIUrl":"https://doi.org/10.2106/jbjs.25.01136","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"246 1","pages":"2688"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Win Ratio: Enhancing Outcomes Assessment in Orthopaedic RCTs: Commentary on an article by Sofia Bzovsky, MSc, et al.: \"A New Angle on Outcomes: Introducing the Win Ratio to Orthopaedic Research\".","authors":"Michelle Ghert","doi":"10.2106/jbjs.25.00940","DOIUrl":"https://doi.org/10.2106/jbjs.25.00940","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"29 1","pages":"2682-2683"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Malpractice Litigation in Orthopaedic Surgery: Considerations Regarding Subspecialty and Training Level: Commentary on an article by Peter Boufadel, MD, et al.: \"Medical Malpractice Litigation in Orthopaedic Surgery in the United States. Risk Factors, Outcomes, and Strategies for Navigating Lawsuits, Prevention, and Reform\".","authors":"Zoe H Dailiana","doi":"10.2106/jbjs.25.01372","DOIUrl":"https://doi.org/10.2106/jbjs.25.01372","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"29 1","pages":"2684-2685"},"PeriodicalIF":0.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amer Sebaaly,Mohammad Daher,Joseph E Nassar,Gaby Kreichati,Khalil Kharrat,Alan H Daniels
Spine surgery in limited-resource environments is challenging due to the complexity of the procedures, which can involve often-costly implants and imaging or navigation tools that may not be available in all regions and markets. Orthopaedic and neurological surgery residents in low to middle-income countries (LMICs) are faced with limited case exposure, faculty shortages, and a lack of simulation tools, resulting in incomplete spine surgery training. International fellowships, telesurgery integration, and global collaboration can help to address these gaps. The high costs of implants, restricted use of intraoperative neuromonitoring, and limited access to advanced technologies such as robotics and endoscopy may hinder optimal surgical care. These challenges could be mediated by the implementation of cost-effective practices, the establishment of clinical guidelines, and the publication of cost-effectiveness data. LMIC contributions to spine research are limited due to a lack of funding, poor research infrastructure, and publication bias. Building research capacity through mentorship, international partnerships, and regional academic platforms is needed to advance global spine care.
{"title":"Obstacles to Spine Surgery in Limited-Resource Environments.","authors":"Amer Sebaaly,Mohammad Daher,Joseph E Nassar,Gaby Kreichati,Khalil Kharrat,Alan H Daniels","doi":"10.2106/jbjs.25.01208","DOIUrl":"https://doi.org/10.2106/jbjs.25.01208","url":null,"abstract":"Spine surgery in limited-resource environments is challenging due to the complexity of the procedures, which can involve often-costly implants and imaging or navigation tools that may not be available in all regions and markets. Orthopaedic and neurological surgery residents in low to middle-income countries (LMICs) are faced with limited case exposure, faculty shortages, and a lack of simulation tools, resulting in incomplete spine surgery training. International fellowships, telesurgery integration, and global collaboration can help to address these gaps. The high costs of implants, restricted use of intraoperative neuromonitoring, and limited access to advanced technologies such as robotics and endoscopy may hinder optimal surgical care. These challenges could be mediated by the implementation of cost-effective practices, the establishment of clinical guidelines, and the publication of cost-effectiveness data. LMIC contributions to spine research are limited due to a lack of funding, poor research infrastructure, and publication bias. Building research capacity through mentorship, international partnerships, and regional academic platforms is needed to advance global spine care.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145760039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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