World Journal of Orthopedics最新文献

Pedicle screw fixation remains the gold standard for stabilizing unstable thoracolumbar fractures. However, ensuring long-term instrumentation stability continues to challenge both surgeons and implant designers. The study by Bokov et al contributes significantly to this discussion, identifying predictors of pedicle screw loosening such as low bone radiodensity, longer fixation constructs, and extensive decompression. Adjunctive strategies - auxiliary posterior fusion, anterior column reconstruction, and intermediate screw usage - support an individualized, biomechanically sound surgical plan. In this article, we explore the clinical relevance of these findings within spinal trauma care. We emphasize the role of preoperative bone quality assessment, including computed tomography-based Hounsfield unit analysis and magnetic resonance imaging-derived vertebral bone quality score, as modifiable predictors of long-term outcomes. We also discuss innovations in screw design, surface coatings, and patient-specific planning to reduce failure risk. Furthermore, emerging technologies such as finite element modeling and 3D-printed instrumentation may refine patient-specific strategies. By integrating biomechanical principles with personalized surgical planning, future approaches may enhance fixation durability. Ultimately, aligning mechanical stability with biological sustainability is critical to reducing implant failure in complex thoracolumbar trauma cases.

Background: In this aging population, lumbar spinal stenosis (LSS) reduces walking distance and impairs functionality. The definitive treatment is still controversial.

Aim: To assess the efficacy of physical therapy and surgery in improving function and reducing pain levels in patients with LSS, both in the short and long term.

Methods: This prospective study screened patients aged 50-80 years with LSS and divided them into two groups based on certain criteria: Surgical and conservative. The conservative group received a supervised physical therapy and exercise program for 45 minutes, five days a week, for one month. The surgery group underwent micro endoscopic decompression surgery based on their LSS levels. Assessments, conducted before treatment and at one-month and one-year intervals, included the participants' walking distance, pain level using the visual analog scale, functionality using the Istanbul low back pain disability index (ILBDI) and Swiss Spinal Stenosis Questionnaire (SSS) Scale, and activities of daily living level using the Nottingham Extended Activities of Daily Living.

Results: The study comprised 40 participants, equally divided into surgical and conservative treatment groups, with no significant demographic differences. After one year, both groups exhibited similar changes in walking distance and pain levels. However, the conservative group demonstrated significantly greater improvements in sub-parameters of functional activity and symptom severity of the SSS. After one year, the surgical group showed greater functionality, as assessed by ILBDI, and superior improvement in activities of daily living compared to the conservative group.

Conclusion: Both treatments showed comparable efficacy in core outcomes (pain, walking distance). However, complementary advantages were observed: Conservative management demonstrated superior improvement in SSS functional subscales, while surgery yielded greater gains in daily living activities and low-back-pain-related disability.

Background: Osteonecrosis of the femoral head (ONFH) is an ischaemic disorder often leading to collapse of the femoral head and severe hip dysfunction. Mesenchymal stem cells (MSCs) have a key role in bone repair, through their ability to differentiate into osteoblasts and their paracrine regulation of the bone microenvironment. While altered MSCs behaviour has been reported in some secondary forms of ONFH, the proliferative and differentiation programmes of MSCs in human idiopathic ONFH have not been previously characterized.

Aim: To compare the proliferative capacity, differentiation potential and nuclear factor kappa B (NF-κB) pathway activation of bone marrow MSCs (BM-MSCs) from idiopathic ONFH patients with those from osteoarthritis controls.

Methods: Femoral heads were collected during total hip replacement surgeries. Idiopathic ONFH was defined by imaging and histological criteria. Secondary causes were excluded. BM-MSCs were isolated from trabecular bone cylinders and expanded to passage 2 prior characterizations. Proliferation was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay at various seeding densities. Osteogenic potential was assessed by alkaline phosphatase activity, osteogenic gene expression (RUNX2, ALPL, COL1A1 and BGLAP) and Alizarin Red staining. Adipogenesis was quantified by Oil Red O staining. Expression of NF-κB target genes (IL6, NFKBIA, CCL2) was analyzed by quantitative polymerase chain reaction.

Results: Idiopathic ONFH MSCs exhibited significantly higher proliferation rates than osteoarthritis controls. However, they showed reduced alkaline phosphatase activity and osteogenic gene expression but paradoxically, increased mineralization, suggesting non-canonical mineral deposition mechanisms. These cells also display increased adipogenic differentiation. Importantly, ONFH-MSCs expressed higher, although non-significant levels of certain NF-κB target gene genes, consistent with an activated inflammatory state.

Conclusion: Human BM-MSCs from idiopathic ONFH display a paradoxical phenotype: Hyperproliferative yet osteogenically impaired with greater adipogenesis and activation of NF-κB signalling. This functional compromise and inflammatory bias may underline the failure of bone regeneration in ONFH, highlighting the need for therapies re-directing MSCs fate and modulating the bone marrow niche.

Background: Osteonecrosis of the femoral head (ONFH) is a prevalent clinical condition, and as the affected population becomes younger and more widespread, an increasing number of patients prefer to retain their own hip joints. In comparison to joint replacement and hip-preserving surgeries, conservative hip preservation treatment is gaining more recognition from both clinicians and patients.

Aim: To observe the clinical efficacy and influencing factors of conservative hip preservation treatment for patients with ONFH.

Methods: A total of 73 patients (119 hips) were included, and patients were grouped based on Association Research Circulation Osseous (ARCO) stage, Japanese Investigation Committee (JIC) classification, lesion size, and collapse degree. The clinical efficacy of conservative hip preservation treatment was evaluated from two aspects: Radiological progression and clinical functional scores [Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), international Hip Outcome Tool 12 (iHOT-12), and visual analogue scale (VAS)]. Analyzing the success rate of conservative hip preservation based on conversion to total hip arthroplasty or hip preservation surgery.

Results: In this retrospective cohort study, we retrospectively analyzed 73 patients (119 hips) with an average follow-up time of 53.58 ± 26.80 (18-129) months. The overall success rate of hip preservation is 90.76%. The success rates of hip preservation in ARCO I-II, IIIa, and IIIb were 97.67%, 91.53%, and 70.59%, respectively (P < 0.05). The success rates of hip preservation for JIC A-B, C1, and C2 were 93.37%, 92.59%, and 77.78%, respectively (P < 0.05). The success rates of hip preservation with collapse degree ≤ 2 mm and > 2 mm were 94.12% and 70.59%, respectively (P < 0.05). There was no significant difference in the success rate of hip preservation between different lesion sizes. In terms of clinical function, the Harris Hip Score, WOMAC, iHOT-12, and VAS scores at the last follow-up were significantly better than before treatment (P < 0.05). The VAS scores of ARCO IIIa and IIIb were significantly worse than those of ARCO I and II (P < 0.05). The iHOT-12, WOMAC, and VAS scores were significantly better with the lesion size < 15% (P < 0.05). In terms of radiological results, there was significant progress in ARCO staging and collapse degree after conservative hip preservation treatment, but there was no significant difference in JIC classification and lesion size.

Conclusion: Conservative hip preservation treatment can effectively treat ONFH, prevent the progression of the necrosis, and significantly improve the clinical function of patients. The radiological staging and lesion size at the initial visit may help determine the prognosis of conservative hip preservation treatment.

Background: Femur fractures are one of the most serious injuries that occur in the older population and are associated with severe pain and increased mortality. The primary objective of this study was to find if there was a significant difference in pain scores in patients treated with femoral nerve blocks (FNB) compared with patients treated with the standard analgesia protocol. The secondary objective was to find if there was a significant difference in morbidity between the two groups.

Aim: To evaluate the effectiveness of ultrasound (US)-guided FNB in managing preoperative pain and reducing morbidity in patients with neck femur fractures compared to the standard analgesia protocol. The study seeks to determine whether FNB offers superior outcomes in terms of pain control, rehospitalization rates, and mortality.

Methods: This retrospective cohort study included 1577 patients suffering from neck femur fractures. 387 patients were treated with a FNB for pain management upon arrival at the emergency department, the rest were treated with standard analgesia. Pain was assessed from electronic medical records using the visual analogue scale (VAS) pre surgery, 12- and 24-hour post-surgery. To determine morbidity and mortality during hospitalizations and 6 months after, it was collected from electronic medical records.

Results: In a cohort of 1577 patients, those receiving US-guided FNB had significantly lower preoperative VAS pain scores (1.46 ± 2.49 vs 1.82 ± 2.59, P = 0.001), reduced rehospitalization rates (0.99 ± 1.96 vs 1.46 ± 2.34, P < 0.001), and lower mortality (16% vs 32%, P < 0.001) compared to standard analgesia.

Conclusion: US guided FNB is more effective for pain management compared with standard analgesia. This method was also found to significantly reduce the risk of morbidity in those patients.

Platelet-rich plasma (PRP) therapy has gained prominence in orthopedics as a regenerative approach that utilizes autologous platelets enriched with growth factors to facilitate tissue healing. Innovations such as protein-enriched filtered PRP and the integration of PRP with biomaterials, including 3D-printed scaffolds and bioactive molecules like kartogenin, have been developed to enhance outcomes in cartilage and bone repair. Clinical studies have demonstrated the efficacy of PRP in managing conditions such as knee osteoarthritis, rotator cuff tendinopathy, and lateral epicondylitis, often showing superior long-term benefits compared with conventional treatments. Emerging therapies that combine PRP with mesenchymal stem cells and peptide-based treatments have shown synergistic effects, further enhancing tissue regeneration and functional recovery. Despite these promising developments, variability in PRP preparation methods and application protocols underscores the need for standardized guidelines and large-scale clinical trials to fully establish the role of PRP in orthopedic practice.

Patient-reported outcome measures (PROMs) are essential in orthopedic research and clinical practice, promoting standardized assessments of treatment efficacy and patient well-being. However, their validity across diverse populations depends on rigorous processes of translation, cultural adaptation, and validation. AlMousa et al successfully validated the Arabic version of the American Academy of Orthopedic Surgeons Foot and Ankle Outcomes Questionnaire, demonstrating strong reliability and clinical applicability for Arabic-speaking patients with traumatic foot and ankle injuries. This article highlights the vital role of culturally adapted PROMs in expanding the global scope of orthopedic research, enhancing patient-centered care, and promoting international collaboration. By addressing linguistic and cultural barriers, such adaptations support a more comprehensive and inclusive approach to evidence-based medicine. Future research should aim to optimize the integration of adapted PROMs into clinical practice, evaluate their influences on treatment decision-making, and investigate their functions in large-scale multicenter studies to further globally advance orthopedic research.

Bone defects represent a significant clinical challenge with diverse etiologies, including but not limited to tumors, trauma, necrosis, and congenital deformities, imposing substantial patient suffering and socioeconomic burdens. In recent years, novel approaches for bone defect repair have been continuously explored. Biodegradable synthetic materials, particularly those capable of gradual decomposition during tissue regeneration processes, are recognized as ideal candidates for bone repair implants. Natural or synthetic polymer-based materials have been extensively employed in osteochondral repair due to their favorable biocompatibility. Furthermore, biodegradable magnesium (Mg)-based metals constitute another crucial category of bone substitutes. Mg alloys demonstrate unique advantages, including tunable degradation rates, excellent biocompatibility, appropriate mechanical strength, and remarkable osteogenic potential, positioning Mg-containing implants as a pivotal direction in bone regenerative medicine. However, clinical applications of Mg alloys still face challenges such as rapid degradation kinetics and insufficient osteogenic performance. Further investigation into advanced application strategies for Mg alloys holds significant clinical implications for bone defect therapeutics.

Background: The anterior talofibular ligament (ATFL) is the most commonly injured ligament in ankle sprains. While most individuals recover with conservative management, some patients develop persistent pain and instability from chronic ATFL tears. Surgical repair is often required, and minimally invasive techniques are gaining popularity.

Aim: To evaluate the clinical outcomes of a novel, totally percutaneous (TP) modified Broström repair (MBR) for chronic ATFL insufficiency in a cohort of patients who failed conservative treatment.

Methods: This retrospective study analyzed 20 patients (14 males, 6 females; mean age, 28.7 years) who underwent TP-MBR between 2023 and 2024 at a tertiary trauma center. All patients had persistent pain and instability for at least 3 months despite conservative treatment. Diagnosis was confirmed by magnetic resonance imaging, arthroscopy, and stress testing. TP-MBR was performed using suture anchors and percutaneous ligament advancement. Functional outcomes were assessed using American Orthopaedic Foot and Ankle Society score and Karlsson score at a mean follow-up of 1.5 years.

Results: All procedures were completed successfully with no intraoperative complications. At a mean follow-up of 1.5 years, patients showed significant improvements in American Orthopaedic Foot and Ankle Society score (from 39.85 to 84.4; P < 0.001) and Karlsson scores (from 43.8 to 87.4; P < 0.001). All patients returned to pre-injury activity levels with resolution of instability. The technique resulted in minimal tissue trauma, reduced operative time, accelerated recovery, and excellent cosmetic outcomes. No recurrences or major complications occurred.

Conclusion: TP-MBR is a safe and effective alternative to open Broström repair for chronic ATFL tears. It offers the benefits of a minimally invasive approach, including less trauma and faster rehabilitation, making it a valuable option for appropriately selected patients.

Background: Accurate surgical fixation of intra-articular distal humerus fractures require olecranon osteotomy. Repair of osteotomy is achieved with a variety of techniques but no consensus has been achieved regarding the optimum technique for fixing the olecranon osteotomy. In this retrospective study, we compared the functional and radiological outcome of the two commonly used techniques of fixing olecranon osteotomy after fixing distal humerus intra-articular fractures. We hypothesized that olecranon osteotomy fixed with 6.5 mm cancellous intramedullary screw alone yielded better radiological and functional outcome than fixation with cerclage wire over cancellous screw applied in figure of eight as tension band wiring (TBW).

Aim: To determine the radiological and functional outcome of olecranon osteotomy fixation with cancellous screw alone vs cancellous screw combined with cerclage wiring applied as TBW.

Methods: This retrospective study was conducted in Lady Reading Hospital Peshawar Pakistan. Intra-articular distal humerus fractures fulfilling the inclusion criteria and operated during 2023 to 2025 were included. Olecranon osteotomy fixation with 6.5 mm cancellous screw alone was labelled as group A while cerclage wire over cancellous screw in figure of eight as TBW were labelled as group B. The demographics, radiological and functional outcome in both groups were compared at one year using Mayo Elbow Performance Score and Quick Disabilities of the Arm, Shoulder, and Hand Score.

Results: We included 32 patients in this study. The mean age of group A patients was 34 ± 5.5 years while group B had a mean age of 34 ± 6.2 years. Radiological union of olecranon osteotomy was achieved in all cases in both groups. Functional outcome however was significantly better in group A than in group B (P < 0.05). The Mayo Elbow Performance Score was excellent in 14 (87.5%) and good in 2 (12.5%) patients in group A while 7 (43.47%) patients had excellent outcome, 5 (31.25%) good and 4 (25%) had fair outcome in group B. The mean Quick Disabilities of the Arm, Shoulder, and Hand Score was 24.5 ± 2.1 and 78.1 ± 12.1 in group A and B respectively (P < 0.05).

Conclusion: Similar radiological union was achieved in all patients of olecranon osteotomy treated with intramedullary screw alone and intramedullary screw with TBW. Functional outcome however was significantly better in intramedullary screw alone than in intramedullary screw with TBW.