World Journal of Orthopedics最新文献

Nanofiber scaffold has built a bionic microenvironment for bone marrow mesenchymal stem cells by highly simulating the topological structure of natural extracellular matrix. Its ordered fiber network effectively guides the directional migration and spatial arrangement of cells through the mechanical signal transduction mediated by integrin. Surface functionalization can synergistically activate the osteogenic transcription network and significantly enhance the osteogenic differentiation potential of cells. The precise design of scaffold stiffness affects the cell fate choice by regulating the nuclear translocation of mechanical sensitive factors. This triple cooperative strategy of "physical topology-biochemical signal-mechanical microenvironment" effectively overcomes the biological inertia of traditional scaffolds and provides a dynamic and adjustable platform for bone defect repair. Looking forward to the future, breaking through the bottleneck of clinical transformation such as long-term intelligent slow release of functional factors and in situ efficient construction of vascular network is the key to promoting nanofiber scaffolds from basic research to precise bone regeneration treatment.

The surgical treatment of severe scoliosis and kyphoscoliosis in the pediatric population is complicated and has high morbidity and mortality risks. Severe scoliosis has traditionally been defined by a coronal Cobb angle of greater than 90° or 100°. The usual corrective methods for these patients have been anterior or posterior release and osteotomies using a combined anterior-posterior or posterior-only approach. Many of these patients have pre-existing pulmonary compromise; therefore, an anterior approach is often not reasonable or possible. Acute correction of a deformity may also cause neurologic injury. Halo gravity traction (HGT) allows for progressive, gradual, and sustained correction of the spinal deformity in the coronal, sagittal, and axial planes, leading to a decrease in the amount of correction needed at definitive posterior fusion. This relates to decreased postoperative neurologic deficit and improved pulmonary function. Preoperative HGT has evolved to be the surgical adjunct in the treatment of severe spinal deformity. Indications for HGT, best protocols of application, and optimal duration of traction still lack uniformity; thus, a review of the literature remains relevant and necessary. This review summarizes the existing literature on HGT, including its indications, applications, duration of traction, and associated complications.

Background: Inferior intra-articular patella dislocation is rare and comprises horizontal (type 1) and the more common vertical (type 2) dislocations in young and elderly patients respectively. In this case report, we describe a case of an elderly patient who presented with a type 2 dislocation after a fall. The mechanisms of inferior patella dislocation, their classification, key imaging features and treatment options are discussed.

Case summary: A 75-year-old woman presented with a right knee fixed flexion deformity after a fall. Preoperative imaging confirmed a vertical intra-articular patella dislocation with a femoral trochlear osteochondral defect and lax though grossly intact patella tendon. Closed reduction was performed under general anaesthesia. Knee arthroscopy confirmed the presence of a femoral trochlear osteochondral defect whose edges were subsequently smoothed and there was debridement of scant debris with thorough irrigation of the joint. Postoperative imaging demonstrated anatomical alignment, however, there was a new nondisplaced medial femoral trochlear. The patient however was able to mobilise well in a range of motion brace set at 0-30 degrees and was discharged 1-day post operatively.

Conclusion: Inferior patella dislocation is rare and this article highlights its types and imaging features which determine the most appropriate management.

Osteoarthritis (OA) is a chronic joint disease characterized by cartilage degradation, synovial inflammation, and subchondral bone remodelling. Despite its increasing prevalence, effective diagnostic, disease-limiting, and therapeutic strategies remain unattainable. Recent studies have recognized the involvement of microRNA-155 (miR-155) in the pathogenesis of OA and most of its risk factors while also identifying the antidiabetic drug metformin as a potential modulator of disease progression. MiR-155, a key endogenous regulator of the immune system, mechano-transduction, and multiple genetic pathways, interacts with OA targets of cellular energetic and circadian homeostasis, promoting systemic and local articular inflammation, cartilage matrix degradation, and chondrocyte apoptosis. Metformin, widely used for type 2 diabetes, has demonstrated anti-inflammatory, anti-oxidative, and chondroprotective properties in OA, mainly through its activation of adenosine monophosphate-activated protein kinase and inhibition of nuclear factor kappa-B signalling. Enthrallingly, metformin targets the same cellular pathways as miR-155 with emerging evidence also suggesting miR-155 expression modulation, indicating synergistic, potentially disease-modifying effects in OA. This review highlights the central role of miR-155 in OA pathophysiology and its potential as a biomarker for disease diagnosis and progression. MiR-155 targeting - through microRNA therapeutics (mimics/antagomiRs) and/or metformin - could pave the way for innovative treatments, including novel articular delivery systems and cell-based therapies.

Background: Wound management is an essential part of emergency medicine practice. A good suture technique should deal a complex irregular traumatic wound without any complications of dehiscence/gaping, infection, delayed wound healing, frequent dressings and further stay in hospital. There is no ideal technique of suturing for any wound. In pursuit of the new techniques, we have introduced a new suturing technique called combined oblique and vertical everting running (COVER) stitch which has showed good healing with less complications.

Aim: To compare the outcomes between the COVER stitch and conventional suturing group.

Methods: In this study, we included 40 cases which were divided into two groups. Group 1 patients were managed by COVER stitch, and group 2 patients underwent conventional suturing for their wounds. The outcomes were measured in terms of scar quality, suturing duration and length of suture material used, suturing related complications and suture removal time which were compared by t-test using χ ² test.

Results: Better results were seen in COVER stitch than the conventional suturing. COVER group had significantly better results in terms of time taken for suture, amount suture material used and time taken for suture removal compared to the conventional group. No wound related complications were seen in this group. Moreover, scar formed was also better in COVER group.

Conclusion: COVER stitch is another new technique which can be used to deal simple to complex wounds and it is an emerging idea with good healthy scars with less complications.

Background: Low back pain is a major cause of disability worldwide, with intervertebral disc degeneration contributing to nearly 40% of cases. Conventional treatments focus on symptom relief without addressing the underlying degeneration. Platelet-rich plasma (PRP), a regenerative therapy rich in growth factors, offers potential therapeutic benefits through growth factor-mediated mechanisms, though clinical evidence is limited.

Aim: To evaluate the efficacy of intradiscal autologous PRP injection in reducing pain and improving function in patients with chronic lumbar disc prolapse.

Methods: This pilot quasi-experimental study was conducted in tertiary care centre between July 2022 and June 2024. The study involved comparing the outcomes between group A (n = 17) who failed to respond to conservative treatment measures and received intradiscal PRP injection with group B (n = 22) who responded to conservative treatment. Visual Analogue Scale (VAS) and Functional Rating Index (FRI) scores were recorded at baseline, 3 weeks, and 6 weeks for both the groups.

Results: Forty patients were enrolled in the study. The PRP group demonstrated significant improvement in VAS and FRI scores compared to baseline. While both groups improved from their respective baselines, direct between-group comparisons are limited by baseline differences in symptom severity. Patients who failed conservative trial showed significant improvement following PRP intervention, with outcomes approaching those observed in physiotherapy responders.

Conclusion: Intradiscal PRP injection significantly improved pain and function in patients with lumbar disc disease, with clinical improvements that approached the level observed in physiotherapy responders, despite baseline differences in symptom severity. PRP shows promise as an effective treatment for lumbar disc pathology; however, these preliminary findings are limited by the small sample size and short follow-up, warranting larger trials with long-term evaluation.

Background: Minimally invasive lumbar interbody fusion (LIF) procedures have evolved rapidly in recent years, with robot-assisted (RA) techniques increasingly integrated into clinical practice. However, questions remain regarding the relative advantages of RA over traditional fluoroscopy-guided and navigation-assisted methods in terms of perioperative, radiographic, and clinical outcomes. This systematic review synthesizes current evidence on these comparisons, focusing on the accuracy of screw placement, perioperative efficiency, radiographic and clinical outcomes, and complications.

Aim: To investigate the comparative effectiveness of RA vs conventional LIF techniques.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and Cochrane guidelines. Databases searched included PubMed, EMBASE, Web of Science, Scopus, and the Cochrane Library (through May 2025). Eligible studies were randomized controlled trials and observational studies comparing RA with fluoroscopy - or navigation-guided LIF (transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, oblique lumbar interbody fusion) in adults. Two reviewers independently extracted data and assessed risk of bias. The Grading of Recommendations Assessment, Development and Evaluation framework was used to evaluate certainty of evidence. Meta-analyses were performed where data were sufficiently homogeneous.

Results: Twenty-two studies were included, encompassing a total of 2313 patients - 1046 who underwent RA-guided procedures and 1267 who received comparator techniques. Meta-analyses showed that RA significantly improved perfect pedicle screw placement [pooled odds ratio = 2.93; 95% confidence interval (CI): 1.40-6.14; I ² = 78.2%] and reduced intraoperative blood loss (pooled standardized mean difference = -0.28; 95%CI: -0.47 to -0.08; I ² = 0%). Operative time did not significantly differ between groups (pooled standardized mean difference = 0.01; 95%CI: -0.30 to 0.31; I ² = 66%). Radiation dose could not be synthesized quantitatively due to heterogeneous definitions and measurement units. Narratively, RA demonstrated consistent advantages in reducing surgical exposure and adjacent segment degeneration. Clinical and radiographic outcomes, fusion success, and complication rates were generally comparable across groups.

Conclusion: RA LIF improves pedicle screw placement accuracy and reduces blood loss and surgeon radiation exposure while maintaining similar clinical outcomes and safety profiles to conventional techniques. These findings support the integration of RA into spine surgery but highlight the need for high-quality multicenter randomized controlled trials and cost-effectiveness studies to guide broader implementation.

Prophylactic fixation (ProFix) of the proximal femur in elderly patients with osteoporosis presents a forward-thinking approach to preventing debilitating fractures and their associated complications. By addressing fracture risk before an injury occurs, ProFix has the potential to enhance patient outcomes, promote long-term mobility, and reduce healthcare costs. Early intervention in individuals at high risk can significantly lower hospital admissions, shorten recovery periods, and preserve independence, mitigating challenges such as chronic pain and reduced life expectancy. Given the high prevalence of undiagnosed osteoporosis, prioritising early risk assessment and targeted prevention is essential. Advancements in minimally invasive surgical techniques and safer anaesthesia methods further support ProFix as a feasible and effective strategy to decrease fracture-related morbidity, improve overall patient well-being, and optimise the use of healthcare resources. This opinion review details the evidence supporting this concept, its efficacy, the challenges in its implementation, and a strategic plan for future implementation.

Ankle snapping occurs when tendons or retinacular structures abruptly move or slip over adjacent anatomical structures, often due to anatomical variations, pathological conditions, or acute injury. This phenomenon can cause pain and discomfort, ranging from mild irritation to debilitating symptoms that potentially disrupt daily activities and athletic pursuits. Considering the anatomy of the ankle, these snapping phenomena can be categorized into four regional groups: (1) Lateral; (2) Medial; (3) Anterior; and (4) Posterior. Lateral ankle snapping, a common occurrence, typically results from peroneal tendon subluxation due to compromise of the superior and inferior peroneal retinacula, or from intrasheath subluxation, characterized by abnormal tendon motion within an otherwise intact retromalleolar groove and retinaculum. Medial ankle snapping primarily affects the posterior tibial tendon and can involve the flexor digitorum longus tendon. Anterior ankle snapping results from abnormal gliding of the tibialis anterior tendon, extensor digitorum longus tendon, peroneus tertius tendon, and inferior extensor retinaculum. Posterior ankle snapping typically involves the plantaris tendon and flexor hallucis longus (hallux saltans). This mini-review comprehensively explores these snapping phenomena and their related pathologies in the foot and ankle, emphasizing the crucial roles of anatomical knowledge, thorough clinical assessment, and appropriate diagnostic and treatment approaches.

In this article, we make a comment on the recent article by Sun et al, focusing on the advances of neutrophil extracellular traps (NETs) formation in common osteoarticular diseases. Neutrophils are the first line to eliminate invading pathogens including fungal and bacterial infections via releasing hydrolytic enzymes and reactive oxygen species. Besides, neutrophils will accumulate at the inflammatory site and release NETs, which are composed of histones, DNA and granular proteins. Traumatic heterotopic ossification (THO) was generally believed to develop through four stages: Inflammation, chondrogenesis, osteogenesis, and bone maturation. Thus, it can be seen that THO was related to inflammation and bone formation. Apart from immune and infectious diseases, recent studies have also shown that NETs play a significant role in the pathogenesis of THO. This article focuses on elaborating the role of NETs in the onset of THO, discussing the existing problems in the current research and outlining future directions.