Journal of Orthopaedics and Traumatology最新文献

Background: Hemiarthroplasty (HA) is a salvage option in revision shoulder arthroplasty when reimplantation (aTSA/rTSA) or secure glenoid fixation is not feasible. This systematic review evaluates indications, clinical outcomes, and complications after conversion to HA using an indication- and implant-stratified synthesis.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), PubMed/MEDLINE, Embase/Scopus, and Web of Science were queried to 15 March 2024. Studies reporting revision of any shoulder arthroplasty to HA with ≥ 12-month follow-up were included. Owing to heterogeneity in measures and implant types, a descriptive analysis stratified by initial implant × indication was performed; primary endpoints were postoperative functional scores, with complications and reoperations as secondary endpoints.

Results: Of 580 identified studies, 20 met inclusion criteria, totaling 268 patients. Glenoid component loosening was the most frequent indication (≈59%), followed by soft-tissue insufficiency (≈11%) and infection (≈9%). Postoperative function varied: ASES 48.2-66, constant 22-37, SANE 54-70. Complications occurred in 29%, and 15.7% underwent reoperation. Outcomes were indication-dependent: the highest scores were observed after humeral loosening (small subgroup), whereas glenoid loosening after aTSA or rTSA showed moderate, clinically meaningful improvements, particularly when bone loss could be reconstructed (e.g., grafting). Instability yielded modest gains, and infection was associated with the poorest results. Preoperative values were inconsistently reported, limiting Δ estimates.

Conclusions: HA remains a salvage solution with indication-dependent effectiveness: best after humeral/glenoid loosening when reconstruction is feasible, modest in instability, and poor in infection. While HA can relieve pain and provide moderate functional improvement, it does not restore normal function. Selection should be deliberate and indication-specific, and future studies should adopt standardized reporting and prospective, indication-stratified designs.

Purpose: This study was to evaluate the efficacy of soft tissue reconstruction using synthetic mesh and a medial gastrocnemius flap in patients who underwent proximal tibial hemiarthroplasty after resection of proximal tibial bone sarcomas.

Methods: A retrospective cohort study was conducted on 102 skeletally immature children (58 males, 44 females) who underwent proximal tibial Hemiarthroplasty between January 2005 and December 2023. The most common diagnoses were osteosarcoma (95%), Ewing's sarcoma (4%), and chondrosarcoma (1%). The mean age was 11 years (7-14 years) and the mean follow-up was 85 months (12-233 months). We reported complications according to the modified Henderson classification. The functional outcomes were evaluated by Musculoskeletal Tumour Society Score (MSTS-93) and the Toronto Extremity Salvage Score (TESS).

Results: Patients in the combined reconstruction group had higher MSTS-93 and TESS scores (MSTS-93, 83% versus 72%, p = 0.023; TESS, 85% versus 74%, p = 0.041). The mean 2-year postoperative Insall-Salvati ratio (ISR), the Blackburne-Peel index (BPI), and the Caton-Deschamps index (CDI) for patients who underwent combined reconstruction were 1.18 ± 0.32, 0.98 ± 0.22, and 1.21 ± 0.28, respectively. While, The mean 2-year postoperative ISR, BPI, and CDI of patients without combined reconstruction were 1.42 ± 0.39, 1.25 ± 0.29, and 1.61 ± 0.41, respectively (p < 0.05). The combined reconstruction group had a lower mean extensor lag (4.3° versus 11.3°, p < 0.001). In total, 33 patients had at least one complication and 27 patients underwent surgical revision, including 13 infections, 8 local recurrences, 3 soft tissue failures, 2 aseptic loosening, and 1 implant failure. The combined reconstruction group had a lower rate of knee dislocation (2.7% versus 21.4%, p = 0.002).

Conclusions: Soft tissue reconstruction of the proximal tibia using synthetic mesh combined with a medial gastrocnemius flap improves the postoperative efficacy of tumor-related proximal hemiarthroplasty and is expected to reduce the incidence of postoperative knee dislocation and periprosthetic infection.

Level of evidence: Level III case control study.

Background: Rheumatoid arthritis (RA) affects ankle joints in up to one half of patients with established disease, causing inflammation and damage. Arthroscopic synovectomy removes inflamed tissue to improve joint function, but long-term outcomes and the potential role of adjunctive therapies are limited.

Materials and methods: A total of 176 patients who had a preoperative diagnosis of RA according to the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria, radiographic Larsen grade ≤ 3, and who underwent arthroscopic synovectomy from May 2013 to May 2019 were prospectively enrolled. Weight-bearing anteroposterior and lateral plain radiographs of the ankle were performed annually after initial surgery. The Larsen grade was used to evaluate the progression of ankle joint damage in RA, and patient-reported outcomes (American Orthopaedic Foot and Ankle Society [AOFAS] Ankle-Hindfoot Scale and the Foot and Ankle Outcome Score [FAOS]) were collected annually. The primary outcome measure was 5-year AOFAS score. Baseline characteristics, including age, body mass index (BMI), duration of symptoms before surgery, Larsen grade before surgery, and other potentially related factors, including number of platelet-rich plasma (PRP) injections and change in BMI from baseline, were recorded.

Results: There were 138 patients included, all with minimum 5-year follow-up data. The overall reoperation rate was 13% (95% confidence interval [CI] 6.8-18.9%; 18 of 138). According to multivariable analysis, 5-year AOFAS scores were associated with number of PRP injections (correlation coefficient = 2.09 [95% CI 1.47-2.71]; P < 0.001), duration of symptoms before surgery (correlation coefficient = 0.42 [95% CI 0.14-0.70]; P = 0.01), Larsen grade before surgery (correlation coefficient = 0.28 [95% CI 0.06-0.49]; P = 0.034), and mean BMI change from baseline (correlation coefficient = -1.23 [95% CI -1.57 to -0.89]; P < 0.001). When comparing the number of PRP injections (0, 1-2, or ≥ 3), patients who had serial PRP injections (≥ 3) had diminished functional and radiographic deterioration over time.

Conclusions: Arthroscopic synovectomy improves symptoms for ankle RA and appears to slow-but not halt-radiographic deterioration over 5 years. Serial PRP injections and reduction in BMI from baseline could be associated with better clinical outcomes and slower joint degeneration, which needs to be verified by randomized controlled trials.

Level of evidence: Level II, prospective cohort study. Trial registration Research Registry, researchregistry10878. Registered 24 November 2024-retrospectively registered, http://researchregistry.knack.com/researchregistry10878.

Background: The purpose of this study was to assess the methodological quality of meta-analyses (MAs) and resolve evidence inconsistencies by quantifying overlap in primary studies, thereby providing enhanced evidence on the efficacy of extracorporeal shockwave therapy (ESWT) versus placebo, ultrasound therapy, and corticosteroid injections for lateral epicondylitis.

Methods: We conducted searches in four databases: PubMed, Embase, Cochrane Library, and Web of Science, until August 2024. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) graded the quality and reliability of the MAs, and the quality of outcomes was graded by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Graphical Representation of Overlap for OVErviews (GROOVE) was applied to analyze overlap and classified the resulting evidence into four categories (I-IV) on the basis of evidence classification criteria.

Results: A total of nine MAs were included for analysis: five had a high AMSTAR 2 rating, three had a moderate AMSTAR 2 rating, and one had a low AMSTAR 2 rating. GROOVE analysis revealed substantial overlap, informing evidence classification. ESWT can effectively reduce the pain assessed by the visual analogue scale (VAS) compared with placebo (MD = -0.68; 95% CI -1.06, -0.3; P = 0.0004; I² = 75%). Compared with ultrasound therapy, ESWT has a significantly large reduction in the level of pain after the treatment at 1-month follow-up (MD = -1.42; 95% CI -2.14, -0.7; P = 0.0001; I² = 92%) and 3-month follow-up (MD = -1.65; 95% CI -1.81, -1.49; P < 0.00001; I² = 98%). ESWT is better than corticosteroid injection when calculating the pooled effect size of VAS (SMD = 1.13, 95% Cl 0.72, 1.55; P < 0.00001; I² = 0). ESWT also has a significant difference in the rate of 50% reduction in pain (RR = 1.38; 95% CI 1.09, 1.75; P = 0.008; I² = 41%). However, compared with placebo, it has no clinically important difference of grip strength (MD = 3.33; 95% CI 0.93, 5.73; P = 0.007; I² = 30%), and the pain score of Thomsen test (MD = -3.22; 95% CI -14.06, 7.62; P = 0.56; I² = 69%).

Conclusions: ESWT has a significant difference in reducing pain evaluation and relief of pain symptoms, and the effect is better than ultrasound therapy and corticosteroid injections.

Level of evidence i:

This protocol has been registered in the prospero database: CRD42024586419.

Objective: This study aimed to evaluate the performance of five machine learning algorithms in predicting tibial intramedullary nail length using patient demographic data (gender, height, age, and weight), with the goal of developing a clinically relevant and accurate predictive model.

Methods: Retrospective data from 155 patients who underwent tibial intramedullary nailing at the Affiliated Jiangyin Hospital of Nantong University were analyzed. After data cleaning, outlier handling, and gender encoding, the dataset was divided into an 80% training set and 20% testing set. Models were trained and evaluated using root mean squared error (RMSE), mean absolute error (MAE), coefficient of determination (R²), and correlation analysis. Key variables included height (cm), weight (kg), age (years), and gender.

Results: The XGBoost model demonstrated superior clinical precision, achieving the lowest testing RMSE (9.15 mm) and MAE (7.56 mm), with an R² of 0.871, explaining 87.1% of variance in nail length. While the random forest model had the highest R² (0.874) and correlation coefficient (r = 0.935), XGBoost outperformed all models in error metrics, critical for minimizing surgical complications. Variable importance analysis identified height as the most influential factor, followed by weight and age. All models achieved acceptable accuracy (≥ 86.21%) within a ± 15 mm error margin, compatible with intraoperative adjustments.

Conclusions: Machine learning, particularly XGBoost, significantly improves preoperative prediction of tibial intramedullary nail length compared with traditional methods.

Level of evidence iv:

Background: Limited research exists on young patients with femoral head subchondral stress fractures (SSF), especially regarding how hip anatomy may contribute to this condition. Few studies have explored the potential correlation between its pathogenesis and developmental dysplasia of the hip (DDH). We aimed to determine hip morphology in patients with femoral head SSF and analyze the distribution of various parameters reflecting hip coverage and stability.

Materials and methods: Radiographic data of all patients with femoral head SSF who met the inclusion criteria between January 2019 and November 2023 were retrospectively reviewed. These data included the lateral center-edge angle (LCEA), Tönnis angle, anterior center-edge angle (ACEA), femoral head extrusion index, acetabular arc, femoral head lateralization, upsloping lateral sourcil, cliff sign, crossover sign, posterior wall sign, and ischial spine sign. We determined the proportion of borderline DDH (BDDH) and the distribution of each parameter on the affected side. Additionally, we compared differences between patients with LCEA < 25° and LCEA > 25°.

Results: In affected hips, 15 cases (57.7%) had BDDH, 3 cases (11.5%) had DDH, and only 8 cases (30.8%) had a normal LCEA. On the contralateral side, 8 cases (30.8%) had BDDH, 4 cases (15.4%) had DDH, and 14 cases (53.8%) had normal LCEA. Abnormalities were prominent in the extrusion index (50.0%), acetabular arc (65.4%), femoral head lateralization (46.2%), cliff sign (42.3%), and posterior wall sign (65.4%). Among patients with affected-side LCEA < 25°, more than 50% exhibited abnormalities in ACEA, extrusion index, acetabular arc, cliff sign, or posterior wall sign. Among patients with normal LCEA on the affected side, most had acetabular retroversion, with 75.0% showing a positive crossover sign and 75.0% showing a positive ischial spine sign.

Conclusions: This study revealed a notably high prevalence of BDDH in young patients with femoral head SSF. The various abnormalities observed in parameters reflecting coverage and stability in BDDH may explain the potential association between BDDH and femoral head SSF.

Level of evidence iv: Retrospective case series.

Background: The reverse sural artery flap (RSAF) has emerged as a versatile option for soft tissue reconstruction in the distal lower extremity, particularly when microsurgical expertise or resources are limited. Despite its increasing use, comprehensive multicenter data on its survival outcomes and anatomical site-specific performance remain limited.

Methods: This retrospective multicenter case series included all patients who underwent RSAF for distal lower extremity defects between 2015 and 2024 across military, governmental, private, and academic institutions. Data on patient demographics, defect characteristics, surgical technique, and postoperative outcomes were collected and analyzed using Jamovi. Kaplan-Meier survival analysis was used to assess flap survival over time, with subgroup comparisons based on defect site.

Results: A total of 60 patients were included. The overall flap survival rate was 96.7%, with a mean wound healing time of 21.5 days. Venous congestion occurred in 83.3% of cases. Persistent venous congestion occurred in 10% of cases, leading to partial flap necrosis. Flap width, pedicle length, prolonged operative time, and patient-specific factors such as body mass index (BMI) and smoking status were significantly associated with adverse outcomes. Site-specific analysis revealed that RSAFs used for ankle and lower leg defects had a 100% survival rate at 60 months, while heel-based flaps showed a decline in survival to 70.8% at 60 months.

Conclusions: RSAF is a highly successful and reliable option for lower extremity reconstruction, especially in resource-variable settings. However, anatomical site, flap design parameters, and modifiable patient risk factors significantly impact outcomes. Long-term surveillance highlights excellent durability in ankle and lower leg reconstructions, while heel-based reconstructions require closer follow-up. Level of Evidence Level III (Retrospective Comparative Study).

This editorial aims to guide prospective authors in effectively preparing and structuring a manuscript for submission to JOOT. Despite the increasing scientific quality of many submissions, the Editorial Board frequently receives manuscripts that fail to meet fundamental standards in structure, style or adherence to journal requirements, which may compromise their chances of acceptance. Scientific writing is a crucial skill, and tailoring a manuscript to the expectations and guidelines of the target journal is vital for successful publication. This article offers practical recommendations to enhance manuscript preparation, improve clarity and align submissions with the editorial standards of JOOT.

Introduction: Minimally invasive plate osteosynthesis (MIPO) has been reported to be superior to open reduction and internal fixation (ORIF) for the treatment of different long bone fractures. This retrospective study aimed to compare MIPO with the mini-open technique versus conventional ORIF for the treatment of displaced midshaft clavicular fractures. We hypothesized that this technique would improve supraclavicular nerve (SCN) injury-related numbness, decrease surgical incision, blood loss, thick scar, and overall patient satisfaction.

Methods: We retrospectively reviewed 45 cases of displaced midclavicular fractures that were treated surgically at our hospital between December 2020 and June 2022. There were 20 (44.4%) patients using mini-open with MIPO and 25 (55.6%) patients using conventional ORIF treated with anatomical locking plate guided by C-arm X-ray machine. Comparison of surgical indices (operative time, blood loss, incision length, and fluoroscopy exposure times) and postoperative complications (anterior chest wall numbness, area of numbness, superficial infection, hardware irritation, and scar satisfaction) were compared between the two groups. In addition, Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Score (CMS), and overall surgical satisfaction were compared between the two groups.

Results: The mini-open MIPO group had statistically significant benefits on the basis of surgical length, blood loss, visual analog scale (VAS) score on the first and third postoperative days, and length of hospital stay. Major complications, such as SCN-related numbness, area of numbness, and thick scarring, were greatly reduced. The cosmetic and overall surgical satisfaction was greater in MIPO. Conversely, hardware irritation, surgical infection, and numbness were more frequent in the ORIF group. There were no significant differences in DASH and CMS scores between the groups at the 12-month follow-up.

Conclusions: MIPO is a more effective and safer modern surgical method than ORIF for displaced midclavicle fractures. Improvements in operative indices, postoperative numbness owing to SCN injury, surgical incision, and cosmesis satisfaction were achieved.

Level of evidence: Level III, retrospective case-control study.