Pub Date : 2026-02-01DOI: 10.1016/j.jcot.2026.103340
Shuang Feng , Yichen Du , Siu Wai Choi, Kelvin Sin Chi Cheung, Jason Pui Yin Cheung, Zezhou Su
Early onset scoliosis (EOS), a spinal deformity that occurs before 10 years of age, imposes significant morbidity due to its rapid Cobb angle progression, three-dimensional spinal curvature, and potential respiratory compromise from thoracic cage distortion. This condition, classified into idiopathic, congenital, neuromuscular, and syndromic subtypes, exhibits high phenotypic heterogeneity and multisystem involvement. Current treatments like bracing and surgery focus on modulating curve progression and preserving growth, but the genetic and molecular overview is not clear. This review delineates both the genetic basis and the pathogenic mechanisms of EOS. We summarize 79 genes implicated in EOS subtypes and discuss the underlying pathogenetic mechanisms, including somitogenesis defects, abnormal vertebral development, and neuromuscular disorders. We also highlight emerging therapeutic strategies and discuss future directions. By integrating genetic discoveries with molecular pathophysiology, this review provides a foundation for advancing precision medicine in EOS and highlights critical future research directions in the field.
{"title":"The role of genetics and molecular mechanisms in early onset scoliosis","authors":"Shuang Feng , Yichen Du , Siu Wai Choi, Kelvin Sin Chi Cheung, Jason Pui Yin Cheung, Zezhou Su","doi":"10.1016/j.jcot.2026.103340","DOIUrl":"10.1016/j.jcot.2026.103340","url":null,"abstract":"<div><div>Early onset scoliosis (EOS), a spinal deformity that occurs before 10 years of age, imposes significant morbidity due to its rapid Cobb angle progression, three-dimensional spinal curvature, and potential respiratory compromise from thoracic cage distortion. This condition, classified into idiopathic, congenital, neuromuscular, and syndromic subtypes, exhibits high phenotypic heterogeneity and multisystem involvement. Current treatments like bracing and surgery focus on modulating curve progression and preserving growth, but the genetic and molecular overview is not clear. This review delineates both the genetic basis and the pathogenic mechanisms of EOS. We summarize 79 genes implicated in EOS subtypes and discuss the underlying pathogenetic mechanisms, including somitogenesis defects, abnormal vertebral development, and neuromuscular disorders. We also highlight emerging therapeutic strategies and discuss future directions. By integrating genetic discoveries with molecular pathophysiology, this review provides a foundation for advancing precision medicine in EOS and highlights critical future research directions in the field.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103340"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078153","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}
Pub Date : 2026-02-01DOI: 10.1016/j.jcot.2026.103353
Cesare Meschini , Mattia Chirico , Matteo Innocenti , Giovanni Valentini , Paolo Salari , Andrea Baldini
Background
As the number of total hip arthroplasties (THA) performed in elderly patients continues to rise, the optimal fixation strategy for individuals over 75 years remains debated. Hybrid constructs, combining a cemented femoral stem with an uncemented acetabular component, may offer a balance between immediate mechanical stability and durable biological fixation. This study aimed to evaluate clinical outcomes, complications, implant survivorship, and patient-reported satisfaction following hybrid THA in patients aged >75 years.
Methods
A retrospective multicenter study was conducted including patients ≥75 years who underwent primary hybrid THA between 2017 and 2023, with a minimum follow-up of 12 months. All procedures were performed using a mini-posterolateral approach within a standardized fast-track perioperative protocol. Patients were further stratified into two subgroups based on acetabular articulation: Group A, treated with a dual-mobility construct, and Group B, treated with a fixed-bearing liner. Outcomes included the Oxford Hip Score (OHS), patient satisfaction, complications, and Kaplan–Meier survivorship analyses using best- and worst-case scenarios.
Results
A total of 642 patients were included (mean age 80.0 ± 4.0 years; 72.6 % female), with a mean follow-up of 39.9 ± 19.4 months. The OHS improved from 22.4 ± 3.3 preoperatively to 42.1 ± 2.8 at final follow-up. Overall satisfaction was high, with 93.5 % of patients reporting a score of 3 or 4 on a 5-point scale. Complication rates were low, including dislocation (1.2 %), periprosthetic fracture (0.5 %), infection (0.2 %), aseptic loosening (0.2 %), and reoperation (1.2 %). Thirty-day readmission was 0.8 %. Overall mortality during follow-up was 6.4 %, with no procedure-related deaths. Implant survivorship was 98.6 % in the best-case and 84.1 % in the worst-case scenario.
Conclusion
Hybrid THA in patients over 75 years provides excellent functional recovery, high satisfaction, and low complication rates, supporting its safety and effectiveness in the elderly population. Further long-term prospective studies are warranted.
{"title":"Hybrid total hip arthroplasty in patients aged over 75: Patient-reported outcomes and complication rates","authors":"Cesare Meschini , Mattia Chirico , Matteo Innocenti , Giovanni Valentini , Paolo Salari , Andrea Baldini","doi":"10.1016/j.jcot.2026.103353","DOIUrl":"10.1016/j.jcot.2026.103353","url":null,"abstract":"<div><h3>Background</h3><div>As the number of total hip arthroplasties (THA) performed in elderly patients continues to rise, the optimal fixation strategy for individuals over 75 years remains debated. Hybrid constructs, combining a cemented femoral stem with an uncemented acetabular component, may offer a balance between immediate mechanical stability and durable biological fixation. This study aimed to evaluate clinical outcomes, complications, implant survivorship, and patient-reported satisfaction following hybrid THA in patients aged >75 years.</div></div><div><h3>Methods</h3><div>A retrospective multicenter study was conducted including patients ≥75 years who underwent primary hybrid THA between 2017 and 2023, with a minimum follow-up of 12 months. All procedures were performed using a mini-posterolateral approach within a standardized fast-track perioperative protocol. Patients were further stratified into two subgroups based on acetabular articulation: Group A, treated with a dual-mobility construct, and Group B, treated with a fixed-bearing liner. Outcomes included the Oxford Hip Score (OHS), patient satisfaction, complications, and Kaplan–Meier survivorship analyses using best- and worst-case scenarios.</div></div><div><h3>Results</h3><div>A total of 642 patients were included (mean age 80.0 ± 4.0 years; 72.6 % female), with a mean follow-up of 39.9 ± 19.4 months. The OHS improved from 22.4 ± 3.3 preoperatively to 42.1 ± 2.8 at final follow-up. Overall satisfaction was high, with 93.5 % of patients reporting a score of 3 or 4 on a 5-point scale. Complication rates were low, including dislocation (1.2 %), periprosthetic fracture (0.5 %), infection (0.2 %), aseptic loosening (0.2 %), and reoperation (1.2 %). Thirty-day readmission was 0.8 %. Overall mortality during follow-up was 6.4 %, with no procedure-related deaths. Implant survivorship was 98.6 % in the best-case and 84.1 % in the worst-case scenario.</div></div><div><h3>Conclusion</h3><div>Hybrid THA in patients over 75 years provides excellent functional recovery, high satisfaction, and low complication rates, supporting its safety and effectiveness in the elderly population. Further long-term prospective studies are warranted.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103353"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078152","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}
Pub Date : 2026-02-01DOI: 10.1016/j.jcot.2025.103334
Niam Patel , Thor S. Stead , Eric Yang , Latha Ganti
Background
Femoral fractures are common, high-energy injuries associated with substantial morbidity. Although surgical fixation remains the mainstay of treatment, outcomes vary widely, and predictors of adverse events are not fully defined. This study aimed to identify clinical and perioperative factors associated with 30-day mortality, readmission, and re-operation after femoral fracture fixation.
Methods
We performed a retrospective cohort analysis of adult patients undergoing femoral fracture fixation between 2018 and 2022 using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Outcomes included 30-day mortality, unplanned readmission, and re-operation. Predictors assessed included demographic, clinical, and perioperative variables such as age, ASA class, albumin, operative time, comorbidities, and laboratory values. Univariate associations were examined, followed by multivariate logistic regression to identify independent predictors. Odds ratios with 95 % confidence intervals and receiver operating characteristic (ROC) curves were reported.
Results
Among 63,734 patients, 9499 experienced an adverse event. Thirty-day mortality occurred in 3543 patients (5.6 %), most strongly associated with advanced age, higher ASA class, lower preoperative albumin, cancer, COPD, CHF, renal failure, and male sex. Readmission (n = 4776) was predicted by low albumin, ASA class, COPD, cancer, CHF, diabetes, steroid use, and general anesthesia. Re-operation (n = 1180) was primarily associated with hypoalbuminemia and prolonged operative time. Multivariate modeling demonstrated that preoperative albumin, ASA class, and operative duration were the most consistent predictors across outcomes. Model performance was strongest for mortality (AUC 0.77) and more modest for readmission and re-operation (AUC ∼0.61).
Conclusion
This large, national study highlights preoperative albumin, ASA class, and operative duration as central markers of postoperative mortality, readmission, and re-operation after femoral fracture fixation. These findings underscore the importance of optimizing nutritional status, recognizing physiologic reserve, and streamlining perioperative processes to mitigate risk and improve outcomes.
{"title":"Association of albumin, ASA class, and time with mortality, Re-admission, and Re-operation after proximal femoral fracture fixation","authors":"Niam Patel , Thor S. Stead , Eric Yang , Latha Ganti","doi":"10.1016/j.jcot.2025.103334","DOIUrl":"10.1016/j.jcot.2025.103334","url":null,"abstract":"<div><h3>Background</h3><div>Femoral fractures are common, high-energy injuries associated with substantial morbidity. Although surgical fixation remains the mainstay of treatment, outcomes vary widely, and predictors of adverse events are not fully defined. This study aimed to identify clinical and perioperative factors associated with 30-day mortality, readmission, and re-operation after femoral fracture fixation.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort analysis of adult patients undergoing femoral fracture fixation between 2018 and 2022 using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Outcomes included 30-day mortality, unplanned readmission, and re-operation. Predictors assessed included demographic, clinical, and perioperative variables such as age, ASA class, albumin, operative time, comorbidities, and laboratory values. Univariate associations were examined, followed by multivariate logistic regression to identify independent predictors. Odds ratios with 95 % confidence intervals and receiver operating characteristic (ROC) curves were reported.</div></div><div><h3>Results</h3><div>Among 63,734 patients, 9499 experienced an adverse event. Thirty-day mortality occurred in 3543 patients (5.6 %), most strongly associated with advanced age, higher ASA class, lower preoperative albumin, cancer, COPD, CHF, renal failure, and male sex. Readmission (n = 4776) was predicted by low albumin, ASA class, COPD, cancer, CHF, diabetes, steroid use, and general anesthesia. Re-operation (n = 1180) was primarily associated with hypoalbuminemia and prolonged operative time. Multivariate modeling demonstrated that preoperative albumin, ASA class, and operative duration were the most consistent predictors across outcomes. Model performance was strongest for mortality (AUC 0.77) and more modest for readmission and re-operation (AUC ∼0.61).</div></div><div><h3>Conclusion</h3><div>This large, national study highlights preoperative albumin, ASA class, and operative duration as central markers of postoperative mortality, readmission, and re-operation after femoral fracture fixation. These findings underscore the importance of optimizing nutritional status, recognizing physiologic reserve, and streamlining perioperative processes to mitigate risk and improve outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103334"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078150","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}
Pub Date : 2026-02-01DOI: 10.1016/j.jcot.2026.103345
Aaron J. Wey, Alexander J. Schüpper, Travis S. CreveCoeur, Amer F. Samdani
Children with neuromuscular and syndromic disorders are among the most medically fragile patients in pediatric spine care. Conditions such as cerebral palsy, myelomeningocele, spinal muscular atrophy, neurofibromatosis type 1, Marfan syndrome, and Prader–Willi syndrome carry a high risk of early-onset scoliosis during critical periods of thoracic and pulmonary development. In these populations, scoliosis is rarely an isolated problem; it reflects the cumulative burden of neurologic impairment, connective tissue fragility, cardiopulmonary compromise, nutritional deficiency, and systemic disease. This review highlights the clinical and surgical challenges unique to each condition while emphasizing the central role of multidisciplinary care. In cerebral palsy, scoliosis risk correlates with motor severity and is compounded by respiratory and nutritional compromise. In myelomeningocele, neurosurgical and urologic coordination is essential given the prevalence of shunt dependence, Chiari malformation, tethered cord, and neurogenic bladder. In spinal muscular atrophy, perioperative pathways center on airway clearance, noninvasive ventilation, and nutritional optimization. Neurofibromatosis type 1 is distinguished by dystrophic scoliosis and dural ectasia, requiring advanced imaging and tailored instrumentation, while families often seek broader clinic support from genetics, oncology, and ophthalmology. In Marfan syndrome, connective tissue fragility complicates fixation, and combined management with cardiology and chest wall specialists is often required. For Prader–Willi syndrome, obesity, endocrine dysfunction, and severe sleep apnea demand careful optimization. Evidence demonstrates that standardized multidisciplinary pathways shorten hospitalizations, reduce pulmonary and infectious complications, and improve consistency of care. Beyond measurable outcomes, families report greater trust and satisfaction when diverse specialties are integrated. Together, these findings reinforce that optimal management of neuromuscular and syndromic scoliosis depends not only on surgical expertise, but also on coordinated, comprehensive, and lifelong care.
{"title":"Early onset scoliosis in syndromic and neuromuscular disorders: A multidisciplinary approach","authors":"Aaron J. Wey, Alexander J. Schüpper, Travis S. CreveCoeur, Amer F. Samdani","doi":"10.1016/j.jcot.2026.103345","DOIUrl":"10.1016/j.jcot.2026.103345","url":null,"abstract":"<div><div>Children with neuromuscular and syndromic disorders are among the most medically fragile patients in pediatric spine care. Conditions such as cerebral palsy, myelomeningocele, spinal muscular atrophy, neurofibromatosis type 1, Marfan syndrome, and Prader–Willi syndrome carry a high risk of early-onset scoliosis during critical periods of thoracic and pulmonary development. In these populations, scoliosis is rarely an isolated problem; it reflects the cumulative burden of neurologic impairment, connective tissue fragility, cardiopulmonary compromise, nutritional deficiency, and systemic disease. This review highlights the clinical and surgical challenges unique to each condition while emphasizing the central role of multidisciplinary care. In cerebral palsy, scoliosis risk correlates with motor severity and is compounded by respiratory and nutritional compromise. In myelomeningocele, neurosurgical and urologic coordination is essential given the prevalence of shunt dependence, Chiari malformation, tethered cord, and neurogenic bladder. In spinal muscular atrophy, perioperative pathways center on airway clearance, noninvasive ventilation, and nutritional optimization. Neurofibromatosis type 1 is distinguished by dystrophic scoliosis and dural ectasia, requiring advanced imaging and tailored instrumentation, while families often seek broader clinic support from genetics, oncology, and ophthalmology. In Marfan syndrome, connective tissue fragility complicates fixation, and combined management with cardiology and chest wall specialists is often required. For Prader–Willi syndrome, obesity, endocrine dysfunction, and severe sleep apnea demand careful optimization. Evidence demonstrates that standardized multidisciplinary pathways shorten hospitalizations, reduce pulmonary and infectious complications, and improve consistency of care. Beyond measurable outcomes, families report greater trust and satisfaction when diverse specialties are integrated. Together, these findings reinforce that optimal management of neuromuscular and syndromic scoliosis depends not only on surgical expertise, but also on coordinated, comprehensive, and lifelong care.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103345"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078149","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}
Pub Date : 2026-02-01DOI: 10.1016/j.jcot.2026.103349
Ratko Yurac , Andrei Joaquim , Sebastian Bigdon , Mohamed M. Aly , Ignacio Cirillo , Gaurav Dhakal , Klaus Schnake , Richard Bransford , Gregory Schroeder , Mohammad El-Sharkawi , Philipp Schleicher , AO Spine Knowledge Forum Trauma & Infection
This narrative review examines floating lateral mass (F3) fractures of the subaxial cervical spine, uncommon but clinically relevant injuries that are frequently under-recognized. A comprehensive literature search was conducted in PubMed, Embase, LILACS, and the Cochrane Library to identify studies published between 1990 and May 2025. These fractures result from combined pedicle and lamina disruption, separating the articular processes and creating a “floating” lateral mass. Despite advances in imaging, assessment of mechanical instability remains controversial, particularly in minimally displaced injuries.
Magnetic resonance imaging is essential for identifying associated intervertebral disc and posterior ligamentous complex injuries, which are strongly associated with failure of non-operative treatment. Surgical management is commonly indicated when instability or neurological compromise is present, with anterior cervical discectomy and fusion being the most frequently reported approach. However, the optimal strategy, including anterior, posterior, or combined fixation and the number of stabilized levels, remains debated and is guided by fracture morphology, reducibility, and disco-ligamentous involvement. Dynamic radiographs and computed tomography angiography may provide complementary information in selected cases.
Overall, these fractures should be considered potentially unstable. Surgical stabilization is appropriate in most patients, whereas conservative management may succeed in carefully selected stable cases with close clinical and radiographic follow-up.
{"title":"Controversies in management of floating lateral mass fractures of subaxial cervical spine: a narrative review","authors":"Ratko Yurac , Andrei Joaquim , Sebastian Bigdon , Mohamed M. Aly , Ignacio Cirillo , Gaurav Dhakal , Klaus Schnake , Richard Bransford , Gregory Schroeder , Mohammad El-Sharkawi , Philipp Schleicher , AO Spine Knowledge Forum Trauma & Infection","doi":"10.1016/j.jcot.2026.103349","DOIUrl":"10.1016/j.jcot.2026.103349","url":null,"abstract":"<div><div>This narrative review examines floating lateral mass (F3) fractures of the subaxial cervical spine, uncommon but clinically relevant injuries that are frequently under-recognized. A comprehensive literature search was conducted in PubMed, Embase, LILACS, and the Cochrane Library to identify studies published between 1990 and May 2025. These fractures result from combined pedicle and lamina disruption, separating the articular processes and creating a “floating” lateral mass. Despite advances in imaging, assessment of mechanical instability remains controversial, particularly in minimally displaced injuries.</div><div>Magnetic resonance imaging is essential for identifying associated intervertebral disc and posterior ligamentous complex injuries, which are strongly associated with failure of non-operative treatment. Surgical management is commonly indicated when instability or neurological compromise is present, with anterior cervical discectomy and fusion being the most frequently reported approach. However, the optimal strategy, including anterior, posterior, or combined fixation and the number of stabilized levels, remains debated and is guided by fracture morphology, reducibility, and disco-ligamentous involvement. Dynamic radiographs and computed tomography angiography may provide complementary information in selected cases.</div><div>Overall, these fractures should be considered potentially unstable. Surgical stabilization is appropriate in most patients, whereas conservative management may succeed in carefully selected stable cases with close clinical and radiographic follow-up.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103349"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078151","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}
Access to complex, resource-intensive procedures such as spine surgery is often limited for economically disadvantaged populations due to high out-of-pocket expenditure. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched to mitigate these costs, yet data on its specific impact on spine surgery remains limited. This study aims to analyse the impact of PM-JAY on access to spine surgery at a tertiary care centre in North India.
Methods
A retrospective, single-centre observational study was conducted analysing all spine surgeries performed from January 2023 to December 2024. Data regarding patient demographics, clinical diagnosis, surgical procedure, and mode of financing were extracted from institutional records. Financing modes were categorised as PM-JAY, self-paid, and other government schemes. Comparative analysis of financing patterns across the study years was performed using the chi-square test.
Results
A total of 410 patients underwent spine surgery during the study period (mean age 49.3 ± 4.1 years). Degenerative spinal disorders (46.1 %) and traumatic injuries (33.4 %) constituted the majority of cases. Overall, 276 procedures (67.3 %) were funded under PM-JAY, while 110 (26.8 %) were self-financed. A significant temporal shift was observed: PM-JAY utilisation increased from 58.7 % (101/172) in 2023 to 73.5 % (175/238) in 2024. Correspondingly, self-financed procedures declined from 37.8 % in 2023 to 18.9 % in 2024 (p < 0.001).
Conclusion
This study demonstrates a substantial and statistically significant increase in the utilisation of PM-JAY for spine surgery, with a concurrent decline in self-financed procedures. The findings suggest that publicly funded insurance is effectively improving financial access to implant-intensive spine care across a broad spectrum of pathologies. However, robust clinical governance remains essential to ensure equitable implementation and prevent overutilisation.
{"title":"Impact of Ayushman Bharat (PM-JAY) on access to spine surgery at a tertiary care centre in North India: A retrospective analysis","authors":"Vishal Kumar , Tharun Teja Aduri , Aditya Gupta , Sarvdeep Singh Dhatt","doi":"10.1016/j.jcot.2026.103352","DOIUrl":"10.1016/j.jcot.2026.103352","url":null,"abstract":"<div><h3>Background</h3><div>Access to complex, resource-intensive procedures such as spine surgery is often limited for economically disadvantaged populations due to high out-of-pocket expenditure. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) was launched to mitigate these costs, yet data on its specific impact on spine surgery remains limited. This study aims to analyse the impact of PM-JAY on access to spine surgery at a tertiary care centre in North India.</div></div><div><h3>Methods</h3><div>A retrospective, single-centre observational study was conducted analysing all spine surgeries performed from January 2023 to December 2024. Data regarding patient demographics, clinical diagnosis, surgical procedure, and mode of financing were extracted from institutional records. Financing modes were categorised as PM-JAY, self-paid, and other government schemes. Comparative analysis of financing patterns across the study years was performed using the chi-square test.</div></div><div><h3>Results</h3><div>A total of 410 patients underwent spine surgery during the study period (mean age 49.3 ± 4.1 years). Degenerative spinal disorders (46.1 %) and traumatic injuries (33.4 %) constituted the majority of cases. Overall, 276 procedures (67.3 %) were funded under PM-JAY, while 110 (26.8 %) were self-financed. A significant temporal shift was observed: PM-JAY utilisation increased from 58.7 % (101/172) in 2023 to 73.5 % (175/238) in 2024. Correspondingly, self-financed procedures declined from 37.8 % in 2023 to 18.9 % in 2024 (p < 0.001).</div></div><div><h3>Conclusion</h3><div>This study demonstrates a substantial and statistically significant increase in the utilisation of PM-JAY for spine surgery, with a concurrent decline in self-financed procedures. The findings suggest that publicly funded insurance is effectively improving financial access to implant-intensive spine care across a broad spectrum of pathologies. However, robust clinical governance remains essential to ensure equitable implementation and prevent overutilisation.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103352"},"PeriodicalIF":0.0,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038348","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}
Pub Date : 2026-01-13DOI: 10.1016/j.jcot.2026.103344
Ammar Ghabi , Thibault Druel , Jean-Baptiste Odent , Hugues Pascal-Moussellard , Bernard de Geofroy , Laurent Mathieu
Background
Gunshot-related limb injuries are increasingly seen in civilian settings. Surgical management may follow either Damage Control Orthopaedics (DCO) or Early Total Care (ETC) principles.
Methods
We retrospectively analyzed 222 civilian patients with gunshot-related limb injuries treated between 2012 and 2023 across five French trauma centers. Patients were grouped according to initial surgical strategy: DCO or ETC. The primary outcome was bone healing; secondary outcomes included infection rates and reoperations.
Results
ETC patients showed significantly higher union rates (88 % vs. 76 %) and lower infection and reoperation rates. However, the DCO group presented significantly higher Injury Severity Scores and more frequent vascular and nerve injuries, reflecting greater injury severity.
Conclusion
ETC may be associated with improved outcomes in selected civilian patients with gunshot limb injuries. However, significant selection bias limits the interpretation of comparative results. Further prospective studies are needed to validate these findings.
背景：与枪击有关的肢体伤害越来越多地出现在民用环境中。手术处理可遵循损伤控制骨科（DCO）或早期全面护理（ETC）原则。方法回顾性分析2012年至2023年间法国5家创伤中心收治的222例平民枪伤相关肢体损伤患者。患者根据初始手术策略进行分组：DCO或ETC。主要结局是骨愈合；次要结局包括感染率和再手术。结果setc患者愈合率（88% vs. 76%）明显高于对照组，感染和再手术率明显低于对照组。然而，DCO组的损伤严重程度评分明显更高，血管和神经损伤更频繁，反映了更严重的损伤程度。结论etc可能与部分平民肢体枪伤患者预后的改善有关。然而，显著的选择偏差限制了对比较结果的解释。需要进一步的前瞻性研究来验证这些发现。
{"title":"Management of civilian gunshot limb injuries: A comparison of Early Total Care and Damage Control Orthopedics","authors":"Ammar Ghabi , Thibault Druel , Jean-Baptiste Odent , Hugues Pascal-Moussellard , Bernard de Geofroy , Laurent Mathieu","doi":"10.1016/j.jcot.2026.103344","DOIUrl":"10.1016/j.jcot.2026.103344","url":null,"abstract":"<div><h3>Background</h3><div>Gunshot-related limb injuries are increasingly seen in civilian settings. Surgical management may follow either Damage Control Orthopaedics (DCO) or Early Total Care (ETC) principles.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 222 civilian patients with gunshot-related limb injuries treated between 2012 and 2023 across five French trauma centers. Patients were grouped according to initial surgical strategy: DCO or ETC. The primary outcome was bone healing; secondary outcomes included infection rates and reoperations.</div></div><div><h3>Results</h3><div>ETC patients showed significantly higher union rates (88 % vs. 76 %) and lower infection and reoperation rates. However, the DCO group presented significantly higher Injury Severity Scores and more frequent vascular and nerve injuries, reflecting greater injury severity.</div></div><div><h3>Conclusion</h3><div>ETC may be associated with improved outcomes in selected civilian patients with gunshot limb injuries. However, significant selection bias limits the interpretation of comparative results. Further prospective studies are needed to validate these findings.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103344"},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038343","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}
Pub Date : 2026-01-12DOI: 10.1016/j.jcot.2026.103346
Linnea Fischer , Erika Ratcliff , David N. Hackney , Emily Hamburg-Shields
Background
To determine the risk of venous thromboembolism (VTE) and the clinical practice pattern for VTE prophylaxis after orthopedic fracture in pregnant and postpartum patients. This review was registered in PROSPERO (ID CRD42024499753).
Methods
Literature searches of PubMed, Embase, Web of Science, and Clinicaltrials.gov were performed using key words relating to orthopedic fracture in pregnancy and VTE prophylaxis. Of 640 studies screened, 17 articles were eligible for inclusion. The primary outcome was whether VTE prophylaxis was administered and the medication, dose, and duration. Secondary outcomes included clinical characteristics of the pregnancy and fracture and the occurrence of complications including VTE. Data were analyzed by descriptive statistics and narrative synthesis, as the lack of controlled studies precluded meta-analysis.
Results
The 17 eligible studies were all case reports or small case series. 26 cases were reported in which a fracture occurred during the prenatal period. Of the 26 patients, 23 received pharmacologic VTE prophylaxis. The majority received low molecular weight heparin (LMWH) or unfractionated heparin (UFH). Duration of prophylaxis ranged from 6 days to 20 weeks (the remainder of the pregnancy). Only one patient in the eligible reports had a VTE event; this patient had not received VTE prophylaxis. No complications of VTE prophylaxis were reported.
Conclusion
Pharmacologic VTE prophylaxis is typically recommended in the general population after major orthopedic surgery and major traumatic injuries. Pregnant patients may be at additionally elevated risk of VTE after orthopedic injury compared to non-pregnant patients. The degree of benefit of VTE prophylaxis and the appropriate duration of therapy is not known due to lack of controlled studies in this population.
研究背景：探讨妊娠和产后骨科骨折患者发生静脉血栓栓塞（VTE）的风险及预防VTE的临床实践模式。本综述已在PROSPERO注册（ID CRD42024499753）。方法通过PubMed、Embase、Web of Science、Clinicaltrials.gov等网站对妊娠骨科骨折、静脉血栓栓塞预防相关关键词进行文献检索。在筛选的640项研究中，有17篇文章符合纳入条件。主要结局是静脉血栓栓塞预防是否实施以及药物、剂量和持续时间。次要结局包括妊娠和骨折的临床特征及静脉血栓栓塞等并发症的发生情况。由于缺乏对照研究，无法进行meta分析，因此采用描述性统计和叙述性综合来分析数据。结果17项入选研究均为病例报告或小病例系列。本文报道了产前发生骨折26例。在26例患者中，23例接受静脉血栓栓塞药物预防。大多数患者接受低分子肝素（LMWH）或未分级肝素（UFH）治疗。预防的持续时间从6天到20周（剩余的妊娠期）。在符合条件的报告中，只有1例患者发生静脉血栓栓塞事件；该患者未接受静脉血栓栓塞预防治疗。静脉血栓栓塞预防无并发症报道。结论药物预防静脉血栓栓塞是一般人群在骨科大手术和重大外伤后的首选方法。与非妊娠患者相比，妊娠患者在骨科损伤后发生静脉血栓栓塞的风险可能更高。由于缺乏对这一人群的对照研究，静脉血栓栓塞预防的获益程度和适当的治疗时间尚不清楚。
{"title":"Venous thromboembolism prophylaxis in obstetric patients after orthopedic injury: a systematic review","authors":"Linnea Fischer , Erika Ratcliff , David N. Hackney , Emily Hamburg-Shields","doi":"10.1016/j.jcot.2026.103346","DOIUrl":"10.1016/j.jcot.2026.103346","url":null,"abstract":"<div><h3>Background</h3><div>To determine the risk of venous thromboembolism (VTE) and the clinical practice pattern for VTE prophylaxis after orthopedic fracture in pregnant and postpartum patients. This review was registered in PROSPERO (ID CRD42024499753).</div></div><div><h3>Methods</h3><div>Literature searches of PubMed, Embase, Web of Science, and <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> were performed using key words relating to orthopedic fracture in pregnancy and VTE prophylaxis. Of 640 studies screened, 17 articles were eligible for inclusion. The primary outcome was whether VTE prophylaxis was administered and the medication, dose, and duration. Secondary outcomes included clinical characteristics of the pregnancy and fracture and the occurrence of complications including VTE. Data were analyzed by descriptive statistics and narrative synthesis, as the lack of controlled studies precluded meta-analysis.</div></div><div><h3>Results</h3><div>The 17 eligible studies were all case reports or small case series. 26 cases were reported in which a fracture occurred during the prenatal period. Of the 26 patients, 23 received pharmacologic VTE prophylaxis. The majority received low molecular weight heparin (LMWH) or unfractionated heparin (UFH). Duration of prophylaxis ranged from 6 days to 20 weeks (the remainder of the pregnancy). Only one patient in the eligible reports had a VTE event; this patient had not received VTE prophylaxis. No complications of VTE prophylaxis were reported.</div></div><div><h3>Conclusion</h3><div>Pharmacologic VTE prophylaxis is typically recommended in the general population after major orthopedic surgery and major traumatic injuries. Pregnant patients may be at additionally elevated risk of VTE after orthopedic injury compared to non-pregnant patients. The degree of benefit of VTE prophylaxis and the appropriate duration of therapy is not known due to lack of controlled studies in this population.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103346"},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978608","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}
Artificial intelligence (AI) has emerged as a transformative tool in orthopaedics, with its various applications. Despite increasing interest, the global research landscape, collaborative networks, and trends in AI-based orthopaedic research remain incompletely characterized. This research aims to perform a comprehensive bibliometric analysis of AI research in orthopaedics, mapping annual publication trends, document types, leading journals, authors, institutions, countries, funding agencies, and citation impact from 2015 to 2025.
Methods
A Scopus-based search was conducted for published documents in AI in Orthoapedics between 2015 and 2025. Bibliographic information including publication year, document type, journal, author names, affiliations, country, funding, and citations was extracted. Descriptive statistics summarized trends, while VOSviewer (v1.6.20) visualized co-authorship, bibliographic coupling, and collaboration networks at author, institution, and country levels.
Results
A total of 1629 documents were identified. Publications increased steeply after 2022, peaking in 2025 (n = 544), with original research articles (55.9 %) and reviews (20.7 %) dominating. The United States (34.8 %), China (14.1 %), and India (8.6 %) were the most productive countries. Co-authorship and bibliographic coupling analyses revealed expanding yet fragmented collaborative networks. The National Natural Science Foundation of China and the U.S. National Institutes of Health were the top funding agencies. The dataset accumulated 17,429 citations, with an h-index of 59.
Conclusions
AI in orthopaedics has experienced exponential growth over the past decade, driven by high-impact institutions and collaborative networks, yet its clinical translation remains limited, highlighting the need for globally coordinated, methodologically rigorous research to fully realize its transformative potential.
{"title":"Global research landscape of artificial intelligence in orthopaedics: A decade of trends from a Scopus-based bibliometric analysis (2015–2025)","authors":"Anil Regmi , Vivaan Jain , Surakshya Baral , Bishwa Bandhu Niraula","doi":"10.1016/j.jcot.2026.103342","DOIUrl":"10.1016/j.jcot.2026.103342","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) has emerged as a transformative tool in orthopaedics, with its various applications. Despite increasing interest, the global research landscape, collaborative networks, and trends in AI-based orthopaedic research remain incompletely characterized. This research aims to perform a comprehensive bibliometric analysis of AI research in orthopaedics, mapping annual publication trends, document types, leading journals, authors, institutions, countries, funding agencies, and citation impact from 2015 to 2025.</div></div><div><h3>Methods</h3><div>A Scopus-based search was conducted for published documents in AI in Orthoapedics between 2015 and 2025. Bibliographic information including publication year, document type, journal, author names, affiliations, country, funding, and citations was extracted. Descriptive statistics summarized trends, while VOSviewer (v1.6.20) visualized co-authorship, bibliographic coupling, and collaboration networks at author, institution, and country levels.</div></div><div><h3>Results</h3><div>A total of 1629 documents were identified. Publications increased steeply after 2022, peaking in 2025 (n = 544), with original research articles (55.9 %) and reviews (20.7 %) dominating. The United States (34.8 %), China (14.1 %), and India (8.6 %) were the most productive countries. Co-authorship and bibliographic coupling analyses revealed expanding yet fragmented collaborative networks. The National Natural Science Foundation of China and the U.S. National Institutes of Health were the top funding agencies. The dataset accumulated 17,429 citations, with an h-index of 59.</div></div><div><h3>Conclusions</h3><div>AI in orthopaedics has experienced exponential growth over the past decade, driven by high-impact institutions and collaborative networks, yet its clinical translation remains limited, highlighting the need for globally coordinated, methodologically rigorous research to fully realize its transformative potential.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103342"},"PeriodicalIF":0.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978610","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}
Pub Date : 2026-01-07DOI: 10.1016/j.jcot.2026.103338
Zachariah Gene Wing Ow , Edmund Jia Xi Zhang , Keng Lin Wong
Background
Accurate assessment of knee function is essential for diagnosis, monitoring, and rehabilitation of musculoskeletal injuries. Patient-reported outcome measures (PROMs) such as the International Knee Documentation Committee (IKDC) score, although validated, are limited by subjectivity and ceiling effects. This study aimed to validate a novel wearable device, the GATOR system, which integrates inertial measurement units (IMUs) and ultrasound to produce an objective composite knee function score, PRIME.
Methods
In a prospective cohort of 90 participants (180 knees), PRIME scores were obtained for healthy, injured, and contralateral knees, with concurrent IKDC scores. Descriptive statistics and non-parametric tests compared groups. Spearman correlation and univariate linear regression assessed the relationship between PRIME and IKDC, with the primary correlation analysis restricted to injured knees. Receiver operating characteristic (ROC) analysis evaluated the ability of PRIME to discriminate injured from healthy knees, and the optimal PRIME cut-off was derived using the Youden index. The minimal detectable change (MDC) of PRIME was estimated from the variability in healthy knees.
Results
PRIME scores were highest in healthy knees, intermediate in contralateral knees, and lowest in injured knees, with statistically significant differences between all groups (p < 0.001). In injured knees, PRIME showed a moderate-to-strong correlation with IKDC (ρ = 0.54, p < 0.001), whereas no significant correlation was observed in healthy knees, likely reflecting ceiling effects. ROC analysis yielded an AUC of 0.846. A PRIME cut-off of 71.2 points optimally discriminated injured from healthy knees (sensitivity 74.5 %, specificity 82.1 %). The MDC for PRIME was 39.1 points, suggesting that changes exceeding this threshold likely represent true change beyond measurement error.
Conclusion
PRIME appears to be a valid, objective measure of knee function that correlates with patient-reported outcomes in pathological knees and demonstrates good discriminatory performance for detecting knee injury.
背景：准确评估膝关节功能对于肌肉骨骼损伤的诊断、监测和康复至关重要。患者报告的结果测量（PROMs），如国际膝关节文献委员会（IKDC）评分，虽然经过验证，但受主观性和天花板效应的限制。本研究旨在验证一种新型可穿戴设备GATOR系统，该系统集成了惯性测量单元（imu）和超声波，以产生客观的复合膝关节功能评分PRIME。方法在90名参与者（180个膝关节）的前瞻性队列中，获得健康、受伤和对侧膝关节的PRIME评分，并同时获得IKDC评分。描述性统计和非参数检验比较各组。Spearman相关和单变量线性回归评估了PRIME和IKDC之间的关系，主要的相关分析仅限于受伤的膝盖。受试者工作特征（ROC）分析评估了PRIME区分损伤膝关节和健康膝关节的能力，并利用约登指数（Youden index）得出最佳PRIME截止值。从健康膝关节的可变性中估计PRIME的最小可检测变化（MDC）。结果健康双膝评分最高，对侧双膝评分中等，损伤双膝评分最低，两组间差异有统计学意义（p < 0.001）。在受伤的膝关节中，PRIME与IKDC表现出中等到强的相关性（ρ = 0.54, p < 0.001），而在健康的膝关节中没有观察到显著的相关性，可能反映了天花板效应。ROC分析的AUC为0.846。PRIME临界值为71.2分，最佳地区分了损伤的膝盖和健康的膝盖（敏感性74.5%，特异性82.1%）。争取民主变革运动为PRIME赢得了39.1分，这表明超过这个阈值的变化可能代表了超越测量误差的真正变化。结论prime似乎是一种有效的、客观的膝关节功能测量方法，与病理性膝关节患者报告的结果相关，并且在检测膝关节损伤方面表现出良好的歧视性。
{"title":"Validation of a novel knee harness inertial-cum-ultrasound wearable device as a quantitative measure of knee function","authors":"Zachariah Gene Wing Ow , Edmund Jia Xi Zhang , Keng Lin Wong","doi":"10.1016/j.jcot.2026.103338","DOIUrl":"10.1016/j.jcot.2026.103338","url":null,"abstract":"<div><h3>Background</h3><div>Accurate assessment of knee function is essential for diagnosis, monitoring, and rehabilitation of musculoskeletal injuries. Patient-reported outcome measures (PROMs) such as the International Knee Documentation Committee (IKDC) score, although validated, are limited by subjectivity and ceiling effects. This study aimed to validate a novel wearable device, the GATOR system, which integrates inertial measurement units (IMUs) and ultrasound to produce an objective composite knee function score, PRIME.</div></div><div><h3>Methods</h3><div>In a prospective cohort of 90 participants (180 knees), PRIME scores were obtained for healthy, injured, and contralateral knees, with concurrent IKDC scores. Descriptive statistics and non-parametric tests compared groups. Spearman correlation and univariate linear regression assessed the relationship between PRIME and IKDC, with the primary correlation analysis restricted to injured knees. Receiver operating characteristic (ROC) analysis evaluated the ability of PRIME to discriminate injured from healthy knees, and the optimal PRIME cut-off was derived using the Youden index. The minimal detectable change (MDC) of PRIME was estimated from the variability in healthy knees.</div></div><div><h3>Results</h3><div>PRIME scores were highest in healthy knees, intermediate in contralateral knees, and lowest in injured knees, with statistically significant differences between all groups (p < 0.001). In injured knees, PRIME showed a moderate-to-strong correlation with IKDC (ρ = 0.54, p < 0.001), whereas no significant correlation was observed in healthy knees, likely reflecting ceiling effects. ROC analysis yielded an AUC of 0.846. A PRIME cut-off of 71.2 points optimally discriminated injured from healthy knees (sensitivity 74.5 %, specificity 82.1 %). The MDC for PRIME was 39.1 points, suggesting that changes exceeding this threshold likely represent true change beyond measurement error.</div></div><div><h3>Conclusion</h3><div>PRIME appears to be a valid, objective measure of knee function that correlates with patient-reported outcomes in pathological knees and demonstrates good discriminatory performance for detecting knee injury.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103338"},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978609","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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