Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Clinical applications of artificial intelligence in hand surgery: A systematic review and meta-analysis","authors":"J. Terrence Jose Jerome ,&nbsp;Vivaan Jain","doi":"10.1016/j.jcot.2026.103335","DOIUrl":"10.1016/j.jcot.2026.103335","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is increasingly applied in medicine, yet its clinical integration in hand surgery remains variable and incompletely validated. This systematic review and meta-analysis evaluated current AI applications in hand surgery and benchmarked performance against human comparators where available.</div></div><div><h3>Methods</h3><div>Following PRISMA 2020 guidelines, PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library were searched through October 2025. Eligible studies evaluated AI systems in hand or wrist surgery with reported performance metrics. Outcomes included diagnostic accuracy, prognostic discrimination, concordance with clinical recommendations, workflow impact, and user satisfaction. Meta-analysis using a bivariate random-effects model was performed when ≥3 comparable studies were available and was restricted to radiograph-based fracture detection (distal radius and scaphoid). All other applications were synthesized narratively due to heterogeneity. The protocol was registered with PROSPERO (CRD420251230505).</div></div><div><h3>Results</h3><div>Of 1228 screened records, 98 studies met inclusion criteria, most addressing diagnostic imaging. For distal radius fractures, pooled AI sensitivity and specificity were 92 % and 89 %, compared with 95 % and 94 % for human readers. For scaphoid fractures, AI demonstrated higher sensitivity (85 % vs. 71 %) but lower specificity (83 % vs. 93 %). Prognostic machine-learning models outperformed clinician estimates in selected retrospective cohorts (mean accuracy 78 % vs. 65 %), although calibration and external validation were inconsistently reported. Large language models demonstrated feasibility in simulated settings, achieving passing specialty-exam scores and generating high-quality documentation (mean satisfaction 4.6/5), while showing high sensitivity but variable specificity in treatment recommendations. Robotic and instrument-tracking applications remain experimental.</div></div><div><h3>Conclusions</h3><div>AI demonstrates promise in selected hand-surgery tasks, particularly fracture detection, outcome prediction, and documentation support. However, evidence is predominantly retrospective and single-center. Prospective multicenter validation and careful attention to bias, transparency, and ethical safeguards are required before routine clinical adoption. AI should augment—not replace—clinical expertise.</div></div><div><h3>Level of evidence</h3><div>II (systematic review/meta-analysis of predominantly Level II–III studies).</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103335"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928358","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}

{"title":"Reviewer Acknowledgment-2025","authors":"","doi":"10.1016/j.jcot.2025.103332","DOIUrl":"10.1016/j.jcot.2025.103332","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103332"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938791","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}

{"title":"A prospective randomized comparative study of surgeon administered adductor canal block with epidural analgesia in primary TKA","authors":"Gaurav Gupta ,&nbsp;Akshay Ramesh Gupta ,&nbsp;Vinit Kumar Singh","doi":"10.1016/j.jcot.2025.103320","DOIUrl":"10.1016/j.jcot.2025.103320","url":null,"abstract":"<div><h3>Background</h3><div>Total knee replacement stands as a reliable solution for patients experiencing severe knee osteoarthritis, yet persistent discomfort following the procedure can significantly impede the return to mobility and rehabilitation efforts. While epidural techniques have long supported pain control after surgery, they can cause issues like limited movement ability and urinary challenges. This investigation compared intraoperative surgeon-delivered adductor canal blockade with epidural analgesia in patients undergoing primary unilateral total knee replacement, focusing on early analgesia and rehabilitation.</div></div><div><h3>Methods</h3><div>A prospective analysis was performed in a tertiary orthopaedic hospital in northern India, involving 50 individuals undergoing lower limb joint replacement. Patients were divided equally into 2 groups one receiving adductor canal (25) or epidural (25) pain management approaches. All procedures were carried out under regional spinal anaesthetia. Postoperative discomfort was gauged using a Visual Analog Scale (VAS) at set intervals after surgery, and functional outcomes were captured with standardized knee scoring systems and joint movement measurements. Statistics were interpreted using appropriate tests, with significance assumed for values below 0.05.</div></div><div><h3>Results</h3><div>ACB patients reported significantly lower pain scores on postoperative days 0-1 compared to CEA patients (p = 0.0001). Measures of knee function and mobility at day three favoured the adductor canal approach, and a greater proportion of these patients achieved robust knee flexion early in their recovery. Additionally, hospital discharge was expedited, and the return of quadriceps strength was more prevalent among those managed with the adductor canal block.</div></div><div><h3>Conclusion</h3><div>In this small, pragmatic prospective randomized comparative study, surgeon-delivered adductor canal block was associated with lower early postoperative pain scores, reduced opioid consumption, faster functional recovery, and shorter hospital stay compared with continuous epidural analgesia within the first 72 h after total knee arthroplasty.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103320"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928360","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}

{"title":"Limb occlusion pressure versus standard tourniquet pressure in total: A prospective comparative study","authors":"Narendra Singh Kushwaha ,&nbsp;Ravi Kumar ,&nbsp;Ravindra Mohan ,&nbsp;Sujeet Kumar Chaudhary ,&nbsp;Rashmi Chandra ,&nbsp;Ashish Kumar","doi":"10.1016/j.jcot.2025.103331","DOIUrl":"10.1016/j.jcot.2025.103331","url":null,"abstract":"<div><h3>Background</h3><div>Tourniquet use during total knee arthroplasty (TKA) facilitates a bloodless surgical field but is associated with postoperative complications such as thigh pain, skin changes, and functional delays. Determining optimal tourniquet pressure individualized to each patient is crucial to minimize these adverse effects. Limb occlusion pressure (LOP) provides a physiologic basis for personalized tourniquet pressure settings.</div></div><div><h3>Methods</h3><div>This prospective randomized study enrolled 60 patients undergoing primary TKA, randomized equally into two groups. Group A had tourniquet pressure set using automated LOP measurement plus a safety margin, while Group B used a fixed standard pressure of 300 mmHg. Primary outcomes included tourniquet-site pain (VAS), wound complications (Southampton score), and functional recovery (Oxford Knee Score) at 6 weeks. Secondary measures included intraoperative blood loss and safety events.</div></div><div><h3>Results</h3><div>Group A had significantly lower tourniquet pressures (222.0 ± 28.6 mmHg vs. 300 mmHg, p &lt; 0.001) without increased blood loss (744.2 ± 256.4 ml vs. 709.8 ± 283.7 ml, p = 0.458). Postoperative pain was notably reduced in Group A, with 60 % scoring ≤2 on VAS compared to 20 % in Group B (p = 0.015). Wound healing was superior in Group A (60 % perfect healing vs. 20 %, p = 0.002), with fewer incidences of erythema, blistering, and bruising. Functional outcomes were better in Group A (Oxford Knee Score 35.9 ± 3.0 vs. 32.6 ± 1.7, p &lt; 0.001). No significant neurovascular or thromboembolic complications were reported.</div></div><div><h3>Conclusion</h3><div>LOP-guided individualized tourniquet pressure in TKA significantly reduces postoperative pain and wound complications while maintaining an effective bloodless field and comparable blood loss. Personalized pressure settings enhance early functional recovery and patient comfort, supporting routine LOP use for tourniquet management in orthopedic surgery.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103331"},"PeriodicalIF":0.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852498","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}

{"title":"Open vs. closed patella Fractures: Difference in incidence, treatment and outcomes","authors":"Ellen Lutnick ,&nbsp;Ryan Riley ,&nbsp;Emilie Harley ,&nbsp;Idem Essien ,&nbsp;Nicholas Frappa ,&nbsp;Christopher Mutty","doi":"10.1016/j.jcot.2025.103315","DOIUrl":"10.1016/j.jcot.2025.103315","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to describe the incidence and compare treatment and outcomes of open versus closed patella fractures at one institution.</div></div><div><h3>Methods</h3><div>Adult patients presenting to one American College of Surgeons Level 1 trauma hospital from 01/01/2001-12/31/2020 with patella fracture(s), screened by ICD codes were retrospectively reviewed. The primary outcome was the incidence of peri-injury or perioperative complications, including nonunion, superficial or deep infection, contracture/arthrofibrosis, deep venous thrombosis (DVT), hardware failure, patellar tendon rupture, painful hardware, wound healing complications, or return to the operating room (RTOR). Rates of postoperative complications were compared between fracture types (open vs closed) and treatment strategies (operative vs non-operative). All analyses were performed in R version 4.5.0. P-value &lt;0.05 was significant.</div></div><div><h3>Results</h3><div>Of 451 patients, (median age 52 years), 35.3 % were open fractures, and 62.3 % underwent operative treatment. Patients with open fractures were younger (mean age 38.84 ± 15.67 vs. 58.27 ± 19.45 years; p &lt; 0.001) and more commonly smokers (37.1 % vs. 27.4 %; p = 0.043). Open fractures had higher Injury Severity Scores (ISS) (12.81 ± 8.41 vs. 10.30 ± 8.28; p = 0.003) and were treated operatively more frequently than closed fractures (84.9 % vs. 50.0 %; p &lt; 0.001). Open fractures demonstrated a higher rate of any complication (38 [23.9 %] vs 42 [14.2 %], p = 0.014), as did patients treated operatively (78 [27.8 %] vs 2 [1.2 %], p &lt; 0.001). Patients who underwent RTOR were younger than those who did not (median 42.9 vs 53.7 years; p &lt; 0.001). Open fracture and postoperative complications were significantly associated with RTOR.</div></div><div><h3>Conclusion</h3><div>In this cohort, open patella fractures occurred at a higher rate than previously described in the literature at 35.3 %. Open fracture was significantly associated with increased risk of complications and unplanned RTOR.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103315"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839739","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}

{"title":"Geometric optimization of femoral rotational alignment in total knee arthroplasty using minimal surface theory versus anatomical reference axes: a computational simulation study","authors":"Horacio Rivarola ,&nbsp;Cristian Collazo ,&nbsp;Marcos Palanconi ,&nbsp;Marcos Meninato ,&nbsp;Gonzalo Arteaga ,&nbsp;Francisco Endara Urresta","doi":"10.1016/j.jcot.2025.103309","DOIUrl":"10.1016/j.jcot.2025.103309","url":null,"abstract":"<div><h3>Background</h3><div>Femoral rotational alignment is a critical determinant of contact mechanics, kinematics, and long-term survivorship in total knee arthroplasty (TKA). Traditional techniques rely on anatomical landmarks, which exhibit substantial inter-patient variability and may not reliably optimize tibiofemoral load distribution. This study introduces a geometric, anatomy-independent framework using minimal surface theory (MST) to identify an energy-minimizing femoral rotational alignment based on curvature equilibrium rather than fixed bony reference axes.</div></div><div><h3>Methods</h3><div>A three-dimensional finite element model of the tibiofemoral articulation was constructed from computed tomography–derived anatomy. Posterior-stabilized TKA components were virtually implanted, and femoral rotation was varied from 5° internal to 5° external relative to the surgical transepicondylar axis. Simulations were performed at 0°, 45°, and 90° of flexion under a 700-N axial load. Willmore surface energy, mean contact pressure, peak shear stress, and contact area were quantified for each alignment. Sensitivity analyses evaluated robustness to posterior tibial slope (±3°) and insert conformity.</div></div><div><h3>Results</h3><div>Across all flexion angles and model conditions, the MST-derived minimum energy state occurred consistently at <strong>2°–3° of external rotation</strong>. Compared with neutral alignment, this optimized orientation reduced Willmore energy by <strong>38.6 %</strong>, mean contact pressure by <strong>18.7 %</strong>, and peak shear stress by <strong>30.8 %</strong>, while increasing contact area by <strong>13.1 %</strong>. Internal malrotation resulted in abrupt curvature transitions, elevated stress concentrations, and reduced load-sharing capacity. Findings remained stable across sensitivity analyses, indicating that the energy-optimal configuration is reproducible and not dependent on specific anatomical landmarks.</div></div><div><h3>Conclusion</h3><div>Minimal surface theory identifies a narrow and consistent external rotational target that optimizes congruence and reduces mechanical stress in TKA. This framework provides a mathematically grounded, anatomy-independent alternative to conventional landmark-based alignment strategies and may support future computational or robotic applications for patient-specific rotational planning.</div></div><div><h3>Level of evidence</h3><div>Computational simulation study (Level V).</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103309"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839734","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}

{"title":"Impact of preoperative chronic pain diagnosis on unicompartmental knee arthroplasty surgery: Analysis of healthcare utilization and patient reported outcomes","authors":"Shujaa T. Khan,&nbsp;Dimitri Mabarak,&nbsp;Yuxuan Jin,&nbsp;Khaled A. Elmenawi,&nbsp;Nicolas S. Piuzzi","doi":"10.1016/j.jcot.2025.103305","DOIUrl":"10.1016/j.jcot.2025.103305","url":null,"abstract":"<div><h3>Background</h3><div>This study investigates (i) clinically relevant improvements in patient-reported outcome measures (PROMs), (ii) satisfaction rates at one-year post-unicompartmental knee arthroplasty (UKA), and (iii) patterns of healthcare utilization (HCU) in patients with and without preoperative chronic pain.</div></div><div><h3>Methods</h3><div>A total of 1275 patients who underwent primary elective unilateral UKAs at a large tertiary academic center in the United States between 2016 and 2022 were included in the cohort. Electronic medical record (EMR) was used to identify a preoperative diagnosis of chronic pain using ICD coding. The included PROMs were the KOOS Pain, PS, JR. Clinically relevant improvements were evaluated using established minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) threshold achievement.</div></div><div><h3>Results</h3><div>There were 234 (18.4 %) with a chronic pain diagnosis before their UKA. Chronic pain was not associated with failure to reach MCID improvement in any of the KOOS subscales. However, it was associated with failure to reach PASS in KOOS Pain, but not KOOS PS or KOOS JR. Chronic pain was not associated with dissatisfaction at 1-year after UKA (p = 0.112). There was no difference in discharge to home/home healthcare between chronic pain and non-chronic pain patients (p = 0.706). Similarly, there was no statistically significant difference in 90-day readmissions between the two groups (p = 0.38). After adjusting for possible confounding variables, patients with a preoperative chronic pain diagnosis were not associated with a prolonged LOS (p = 0.298).</div></div><div><h3>Conclusion</h3><div>Chronic pain patients reported similar 1-year satisfaction and self-perceived improvement in knee function and pain relief to their non-chronic pain counterparts. Surgeons may use these results to reassure and set optimistic expectations in these patients.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"73 ","pages":"Article 103305"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145928359","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}

{"title":"Comment on “Changes in sagittal spinopelvic parameters following S2-alar-iliac screw fixation in adult degenerative scoliosis: A one-year radiographic analysis of 80 patients”","authors":"Bhumesh Tyagi ,&nbsp;Aishwarya Biradar","doi":"10.1016/j.jcot.2025.103310","DOIUrl":"10.1016/j.jcot.2025.103310","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103310"},"PeriodicalIF":0.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839738","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}

{"title":"Single vs. dual plating for distal femur periprosthetic fractures post-total knee arthroplasty: A comparative analysis of functional and radiographic outcomes","authors":"Abhijit Das,&nbsp;Babaji Sitaram Thorat,&nbsp;Avtar Singh Kamboj,&nbsp;Arcot Reddy Vamsi Krishna,&nbsp;Kshitij Srivastav,&nbsp;Arshid H. Wani","doi":"10.1016/j.jcot.2025.103308","DOIUrl":"10.1016/j.jcot.2025.103308","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic distal femur fractures following total knee arthroplasty (TKA) are increasingly encountered and present considerable reconstructive challenges, with internal fixation remaining the mainstay of management. This retrospective comparative study examines the clinical and radiological outcomes of single locked plating versus dual plating in Rorabeck type I and II fractures.</div></div><div><h3>Methods</h3><div>A total of 45 patients treated between August 2017 and August 2024 were included (31 single plating; 14 dual plating). Functional outcome (Oxford Knee Score), union characteristics, weight-bearing timelines, and complications were compared.</div></div><div><h3>Results</h3><div>The study included 45 patients (30 females, 15 males), with a mean age of 67 ± 8.7 years. All fractures achieved union (100 % union rate) with a mean time to union of 4.4 ± 1.2 months. Dual plating achieved earlier fracture union (3.71 ± 1.35 months) and permitted earlier full weight-bearing (3.18 ± 1.22 months) compared with single plating (4.77 ± 0.85 months and 4.18 ± 0.84 months, respectively). Dual plating yielded significantly better functional outcomes than single plating, with progressively higher Oxford Knee Scores at 1, 3, and 6 months of follow-up (p &lt; 0.05). Complication rates were comparable between groups (superficial infection 3 cases; deep infection 1; delayed union 3; malunion 1).</div></div><div><h3>Conclusion</h3><div>Dual plating is better than single locked plating for such injuries, as it provides a stable construct, anatomical reduction, early fracture union, early mobilization, excellent outcomes, and minimal complications.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103308"},"PeriodicalIF":0.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839743","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}

{"title":"Radiation exposure in orthopaedic trauma surgery: A systematic review and meta-analysis","authors":"Wasif Kawsar Qadri,&nbsp;Altaf Ahmad Kawoosa,&nbsp;Junaid Ali,&nbsp;Ishtiyaq Ahmad Lone","doi":"10.1016/j.jcot.2025.103304","DOIUrl":"10.1016/j.jcot.2025.103304","url":null,"abstract":"<div><h3>Background</h3><div>Fluoroscopic imaging is a cornerstone of modern orthopaedic trauma surgery, providing real-time guidance for fracture reduction and implant positioning. However, repeated intraoperative exposure poses significant radiation risks to patients and operating room personnel. Despite its routine use, there is limited consolidated evidence quantifying radiation exposure in common orthopaedic trauma procedures, and standardized diagnostic reference levels (DRLs) have yet to be established.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, Web of Science, Scopus, and Ovid were performed up to May 2023. Studies reporting intraoperative radiation exposure using dose–area product (DAP, mGy·cm²) and/or fluoroscopy screening time (minutes:seconds) were included. Data were pooled using a random-effects model (DerSimonian–Laird). Study quality and risk of bias were assessed using the Joanna Briggs Institute (JBI) and ROBINS-I tools. The review could not be registered with PROSPERO, as retrospective registration is not permitted; however, the methodology fully adhered to PRISMA standards.</div></div><div><h3>Results</h3><div>Seven studies comprising 4159 patients met inclusion criteria. Proximal femoral nailing (PFN) showed the highest mean DAP (3168.8 ± 382.5 mGy cm²), followed by dynamic hip screw fixation (1606.5 ± 79 mGy cm²) and femoral intramedullary nailing (1251.6 ± 76.5 mGy cm²). The longest fluoroscopy times occurred during femoral and tibial nailing. Substantial heterogeneity (I² &gt; 99 %) reflected procedural and operator variability, with surgeon experience identified as a major determinant of exposure.</div></div><div><h3>Conclusion</h3><div>Femoral fixation procedures pose the highest radiation risk in orthopaedic trauma surgery. Structured radiation-safety education, adherence to ALARA principles, and establishment of standardized DRLs are essential. Future studies should report variance data and evaluate navigation-assisted and robotic techniques to minimize exposure.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103304"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839736","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}