Hss Journal最新文献

Background: Primary spine/pelvic tumors are aggressive, and en bloc resection is often essential. While stereotactic navigation is increasingly used for instrumentation in spine surgery, its specific role in tumor resection remains incompletely defined.

Purpose: We sought to describe (1) reported rates of achieving negative margins, (2) local recurrence, (3) complications attributed to navigation, and (4) comparative outcomes from studies involving nonnavigated controls.

Methods: We conducted a systematic review according to preferred reporting items for systematic reviews and meta-analysis guidelines. Databases were queried for studies investigating the use of stereotactic navigation in primary spine/pelvic tumor surgery. Outcomes including surgical margin status, local recurrence, and complications were extracted and qualitatively synthesized using a best-evidence approach.

Results: Twenty-one studies with 240 patients were included. The mean patient age was 46 years with follow-up of 33.4 months. Tumors were most often located in the sacrum/pelvis (81.3%), followed by the thoracic (8.3%), cervical (5.8%), and lumbar spine (4.6%). Chordoma (31.7%) and chondrosarcoma (27.1%) were the most frequently reported types. Negative surgical margins were achieved in 88.3% of cases. Local recurrence was reported in 16% of patients, with the highest observed in chondrosarcoma (32.4%). Complications occurred in 30.3% of patients; however, only 1% (2 cases) were attributed to navigation use. Two comparative studies examining navigated versus nonnavigated cohorts suggested improved bony margins and lower recurrence risk with navigation.

Conclusion: Early studies suggest that stereotactic navigation may be a feasible and safe adjunct for the resection of primary spine/pelvic tumors, particularly in achieving adequate bony margins. However, the current evidence is limited to small retrospective studies with heterogeneity in methodology, tumor type, and follow-up.

Level of evidence: Level IV: Systematic review of level-III and level-IV studies.

[This corrects the article DOI: 10.1177/15563316251340983.].

Background: Patella alta is common in children with cerebral palsy (CP), often resulting from quadriceps spasticity and tendon elongation. In typically developing children, patella alta is linked to trochlear dysplasia and instability. Whether these associations exist in CP, and how they vary with age and functional ability, has not been established.

Purpose: We sought to determine whether patella alta is associated with alterations in trochlear morphology in ambulatory children with CP and to evaluate the influence of age and functional severity.

Methods: We conducted a retrospective study of pediatric patients under the age of 18 diagnosed with hemiplegic or diplegic CP. We included patients classified as Gross Motor Function Classification System levels I to III to ensure relative ambulatory function and minimize confounding due to severe joint contractures. Inclusion criteria included patients who had had a lateral radiograph of the knee and axial computed tomography scans of the distal femur and proximal tibia showing the anterior tibial tuberosity. Eligible patients were identified through a comprehensive search of the institutional electronic medical record system between 2016 and 2024.

Results: Of the 164 patients identified, 31 were included based on available imaging suitable for the assessment of both patellar height and trochlear morphology; 6 of these patients were excluded due to poor image quality, resulting in a final cohort of 25 patients and 48 limbs. Patella alta was identified in 17 knees (35.4%). No differences in trochlear morphology were observed between groups or across functional levels. In both groups, older age correlated with features of physiologic trochlear development, including increased trochlear groove depth and narrower sulcus angle. in patients with patella alta, age also correlated with greater tibial tubercle to trochlear groove (TT-TG) distance.

Conclusion: Patella alta was not associated with trochlear dysplasia in ambulatory children with CP. However, its persistent presence may alter patellofemoral alignment through age-related increases in TT-TG distance, contributing to pain or instability, highlighting the need for longitudinal studies and early recognition in clinical care.

Level of evidence: Level IV, Retrospective Prognostic Study.

Background: "Rice body" describes the gross appearance of hyperplastic synovial villi that develop into rice-like fibrinous loose bodies. Rice bodies have historically been associated with tuberculosis and inflammatory arthritis, but no retrospective studies have correlated their magnetic resonance imaging (MRI) appearances to histology or to the underlying diagnoses.

Purpose: We sought to correlate the appearance on MRI of rice body-like particles with histology and describe the associated diagnoses.

Methods: We conducted a retrospective cross-sectional study of MRI reports in our institutional imaging database in which a radiologist described "rice bodies." The search was performed by a keyword search for "rice," ultimately yielding a total of 100 patients between June 1992 and July 2022. Patients were excluded if their MRI was not available for retrospective review or if there was insufficient follow-up to establish a clear underlying diagnosis. Cases were included if the MRI finding of rice bodies was confirmed by retrospective review of the images and there was clinical follow-up or surgery with histology establishing the underlying diagnosis.

Results: Of the 52 patients who met inclusion criteria and were enrolled in our retrospective study, 37% (19/52) had prior surgery, 73% (14/19) being arthroplasty. Diagnoses associated with rice body-like particles on MRI were inflammatory arthritis (52%; 27/52), infection (25%; 13/52), synovial chondromatosis (8%; 4/52), osteoarthritis (6%; 3/52), bursitis (6%; 3/52), and adverse local tissue reaction (4%; 2/52). Among 13 infections, only 1 was mycobacterial while 46% (6/13) were staphylococcal and 31% (4/13) were culture-negative. In the presence of arthroplasty, rice body-like particles were associated with infection in 71% (10/14), followed by adverse local tissue reaction (14%; 2/14), 46% (24/52) underwent surgery after MRI, and 45% (10/22) had rice bodies confirmed on histology.

Conclusion: Our retrospective findings suggest that rice body-like synovial particles on MRI are not specific to tuberculosis and inflammatory arthritis. Other diagnoses may also be considered, particularly nonmycobacterial infection when there is an arthroplasty.

Level of evidence: Level IV: retrospective cross-sectional study.

Background: Evaluating physical activity in children is crucial for determining functional limitations and promoting healthy growth. The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) is a valid, concise tool that assesses activity levels of children and adolescents participating in sports. There is currently no validated Turkish version.

Purpose: We sought to (1) translate and cross-culturally adapt the HSS Pedi-FABS into Turkish and (2) evaluate the scale's psychometric properties in a Turkish pediatric and adolescent population.

Methods: The HSS Pedi-FABS was translated and culturally adapted following established guidelines. Physically active, healthy, and Turkish-speaking children and adolescents aged 8 to 17 years were included in the study. The exclusion criteria were as follows: (1) orthopedic/neurological conditions limiting functional activity, (2) language difficulties that could limit comprehension, (3) cognitive impairments, (4) illiteracy, (5) major organ failure, (6) malignancy, and (7) refusal to participate. Psychometric evaluation included internal consistency (Cronbach's α), test-retest (t1-t2) reliability (intraclass correlation coefficient), construct validity (correlation with existing physical activity questionnaires), and floor/ceiling effects.

Results: Fifty-five participants were included in the study. The Turkish version of the HSS Pedi-FABS (Turkish HSS Pedi-FABS) showed good internal and excellent test-retest reliability. Construct validity was demonstrated with strong correlations between the Turkish questionnaire and comparator instruments. No floor or ceiling effects were found as the minimum score was observed in <15% of participants (5.5% at t1) and the maximum score was not observed.

Conclusion: The Turkish HSS Pedi-FABS is a valid and reliable instrument for assessing physical activity in healthy children and adolescents. It can be used for both clinical and research purposes.

Level of evidence: Level II: validation study.

Background: Avascular necrosis (AVN) of the bone may result in severe pain, and patients with AVN and their families may seek out information about the condition. With the rise of ChatGPT, AVN patients and families may turn to this chatbot with questions.

Purpose: We sought to explore expert clinicians' perceptions of the quality of ChatGPT's responses to frequently asked parent questions about AVN in children. Secondary aims of this study were to assess provider perceptions of ChatGPT and AVN parental education and to evaluate the readability of ChatGPT responses.

Methods: We conducted a cross-sectional survey study of 9 pediatric orthopedic surgeons, oncologists, and advanced practice providers with expertise in the clinical management of AVN. Fifteen common questions parents ask about AVN were posed to ChatGPT, preceded by the following prompt: "Please answer the following parent question relating to avascular necrosis. Please give me a response at or below a sixth-grade reading level: [Question]." The answers were evaluated by participants using a 4-point Likert scale. ChatGPT responses were also assessed using the following readability scores: Flesch-Kincaid Grade Level, Gunning Fog index, and Flesch Reading Ease. In addition, the survey included 4 questions developed to gather overall provider perceptions.

Results: Providers deemed answers to all 15 questions as at least satisfactory, requiring minimal clarification on average. Yet only 3 ChatGPT responses (20%) were at or below a sixth-grade reading level, as prompted. The average Flesch-Kincaid Grade Level was 6.94, and the average Gunning Fog Index was 9.22, suggesting the responses reflect a reading level between approximately seventh grade and early high school. A majority of providers agreed that these responses would be sufficient for most parents (56%) and that the information was at the appropriate reading level (100%).

Conclusion: The findings of this small survey study suggest that ChatGPT's responses to common parent questions about AVN were satisfactory, requiring minimal clarification. ChatGPT has the potential to serve as a resource for orthopedic patients and family education, though concerns remain.

Background: Large language models (LLMs), an artificial intelligence tool, have become widely available and used by patients and members of the general public to answer health care questions.

Purpose: We sought to understand whether currently available LLMs can recommend an appropriate total knee arthroplasty (TKA) surgeon when prompted.

Methods: We used 3 widely available LLMs (ChatGPT, Gemini, and DeepSeek) to conduct searches for a TKA surgeon, with 1 of 4 home cities specified (Lynchburg, VA; Trumbull, CT; Chicago, IL; and New York, NY). The first prompt posed was (1) "I was told by my primary care provider that I need a knee replacement, I live in (city, state), who would you recommend that I see?" Once the list of surgeons was elicited, the LLM was prompted: (2) "Why did you recommend this (these) surgeon(s)?"; (3) "Where did you get your information about this (these) surgeon(s)?"; and (4) "How do I get in contact with this (these) surgeon(s)?" Recommendations were considered appropriate if the surgeon routinely performed TKA and was actively practicing in the area. Descriptive statistics and Fisher's exact tests were used to summarize findings.

Results: Across the 3 LLMs, 49 of the 74 (66%) recommendations were deemed appropriate, although this varied by model: Gemini (26/30, 87%), ChatGPT (14/19, 74%), and DeepSeek (9/25, 36%). Of the inappropriate responses, 6 of the surgeons were out of area, 13 were not performing TKA, and 6 were hallucinated names. When asked for rationales for the recommendations, LLMs most commonly cited hospital and practice Web sites and patient reviews, which tended to favor surgeons with longer local practice tenure. Of the 74 contact details provided, only 17 (23%) were accurate, with significant variation among models: ChatGPT (13/19, 79%), DeepSeek (2/25, 8%), and Gemini (2/30, 7%).

Conclusion: While LLMs show potential in identifying TKA surgeons, the 3 LLMs we tested varied in their ability to validate surgeon expertise and provide reliable contact information. Further research may be necessary to elucidate the criteria by which LLMs recommend surgeons.

Background: Acute compartment syndrome (ACS) is a limb-threatening complication of pediatric tibial tubercle fractures. Despite its severity, the incidence of ACS in pediatric cases has been largely unexplored.

Purpose: We sought to examine the incidence and risk factors of ACS and associated fasciotomies in pediatric patients with tibial tubercle fractures.

Methods: We conducted a retrospective cohort study using data from the Pediatric Health Information System, a comprehensive inpatient and outpatient nationwide database. Inclusion criteria specified patients 18 years of age or younger with tibial tubercle fracture (International Classification of Disease, 10th Revision (ICD-10) diagnosis code, S82.151-156) between October 1, 2015, and June 30, 2023. Exclusion criteria were patients with a positive hematologic or immunologic flag and patients with a positive congenital or genetic defect flag. Patients with tibial tubercle fractures were stratified into 3 categories: (1) patients with a diagnosis code for ACS and/or a fasciotomy procedure code; (2) patients with a diagnosis code for ACS and a fasciotomy code; and (3) patients exclusively with a fasciotomy procedure code.

Results: Of the 6830 included patients with tibial tubercle fractures, 4% had a code for ACS and/or fasciotomy, 1% had a code for ACS and a procedure code for fasciotomy, and 2.9% had a code for fasciotomy only. Univariate analysis revealed that older and male patients had higher rates of ACS and fasciotomies without any corresponding diagnosis of ACS, compared to their counterparts; White patients had higher rates of ACS than patients of other races. Multivariate analysis showed that age was the only significant predictor of ACS across all groups.

Conclusion: This retrospective database study suggests that ACS is a rare complication of pediatric tibial tubercle fractures and that fasciotomies without any evidence of ACS-interpreted as prophylactic fasciotomies-occur at a higher rate than formally diagnosed ACS.

Level of evidence: Level IV: Retrospective Cohort Study.