Anterior cruciate ligament (ACL) injuries are common among young adults, often resulting in knee instability and impacting quality of life. Despite advances in surgical techniques and rehabilitation, patients experience persistent quadriceps weakness, altered gait patterns, and increased risk of osteoarthritis.
Methods
This 1-year prospective cohort study investigated knee joint stability and gait patterns in 45 patients within one-year post-ACL reconstruction. Gait analysis was performed using a six-infrared camera system and two force plates. Lysholm knee scoring scale was used to evaluate knee function.
Results
The study's results showed that among 45 ACL reconstruction patients, majority were males (97.78 %) aged 25–29 (33.33 %), with high knee function (average Lysholm score: 95.33 ± 3.47). Gait analysis revealed altered patterns with reduced trunk movement, deviations from normal stride parameters in both limbs. Trunk obliquity and tilt were lower than normal, knee valgus-varus alignment was lower in both limbs, with the operated limb having slightly higher alignment. Knee flexion-extension was lower in the operated limb. The study highlighted altered gait patterns and reduced trunk movement in ACL reconstruction patients.
Conclusion
This study emphasizes the importance of comprehensive rehabilitation programs for ACL reconstruction patients, focusing on hip strengthening exercises to restore optimal gait patterns. Tailored rehabilitation plans with hip physiotherapy can improve hip muscle strength and symmetry, enhancing patient care and long-term success. By integrating these insights, healthcare professionals can provide more effective care, improving patients' quality of life and functional abilities.
{"title":"Revisiting the ACL reconstruction rehabilitation algorithm: A gait analysis study","authors":"Champak Roy, Vineet Kumar, Devashish Chhutani, Prabhat Kumar, Pankaj Aggarwal, Mohd Ammar Aslam","doi":"10.1016/j.jcot.2025.103291","DOIUrl":"10.1016/j.jcot.2025.103291","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cruciate ligament (ACL) injuries are common among young adults, often resulting in knee instability and impacting quality of life. Despite advances in surgical techniques and rehabilitation, patients experience persistent quadriceps weakness, altered gait patterns, and increased risk of osteoarthritis.</div></div><div><h3>Methods</h3><div>This 1-year prospective cohort study investigated knee joint stability and gait patterns in 45 patients within one-year post-ACL reconstruction. Gait analysis was performed using a six-infrared camera system and two force plates. Lysholm knee scoring scale was used to evaluate knee function.</div></div><div><h3>Results</h3><div>The study's results showed that among 45 ACL reconstruction patients, majority were males (97.78 %) aged 25–29 (33.33 %), with high knee function (average Lysholm score: 95.33 ± 3.47). Gait analysis revealed altered patterns with reduced trunk movement, deviations from normal stride parameters in both limbs. Trunk obliquity and tilt were lower than normal, knee valgus-varus alignment was lower in both limbs, with the operated limb having slightly higher alignment. Knee flexion-extension was lower in the operated limb. The study highlighted altered gait patterns and reduced trunk movement in ACL reconstruction patients.</div></div><div><h3>Conclusion</h3><div>This study emphasizes the importance of comprehensive rehabilitation programs for ACL reconstruction patients, focusing on hip strengthening exercises to restore optimal gait patterns. Tailored rehabilitation plans with hip physiotherapy can improve hip muscle strength and symmetry, enhancing patient care and long-term success. By integrating these insights, healthcare professionals can provide more effective care, improving patients' quality of life and functional abilities.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103291"},"PeriodicalIF":0.0,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839741","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 : 2025-11-30DOI: 10.1016/j.jcot.2025.103292
Cole R. Johnson, Khaled A. Elmenawi, Ahmed K. Emara, Benjamin E. Jevnikar, Matthew E. Deren, Nicolas S. Piuzzi
Background
Arthroscopic meniscectomy (AM) is a common procedure in middle-aged adults with degenerative meniscal tears. As many of these patients eventually require total knee arthroplasty (TKA), concerns have emerged regarding the potential impact of prior AM on TKA outcomes. This study evaluated whether a history of ipsilateral AM is associated with increased short- and mid-term complications following TKA.
Methods
Using the PearlDiver national database, adult patients who underwent primary TKA for osteoarthritis between 2016 and 2022 with 1-year of follow-up and laterality available were identified (n = 1,152,444). Patients with prior ipsilateral AM were matched 1:1 to controls without prior AM based on age, sex, comorbidities, and year of surgery (n = 40,341 per group). Multivariate logistic regression was used to evaluate 90-day healthcare utilization (emergency department visits, reoperations, and readmissions) and 1- and 2-year revision risks (all-cause, septic, and aseptic).
Results
Approximately 3.5 % of TKA patients had prior AM. Patients with prior AM had significantly higher rates of 90-day emergency department visits (OR, 1.23; 95 % CI, 1.18–1.29), reoperations (OR, 2.10; 95 % CI, 1.95–2.27), and readmissions (OR, 1.43; 95 % CI, 1.32–1.55) (all p < 0.001). At 1-year post-TKA, these patients had increased odds of all-cause revision (OR, 2.47), revision for PJI (OR, 2.15), and aseptic revision (OR, 2.62). These risks remained elevated at 2 years: all-cause revision (OR, 2.83), revision for PJI (OR, 2.33), and aseptic revision (OR, 3.06) (all p < 0.001).
Conclusions
Prior ipsilateral AM is associated with significantly increased risks of short- and mid-term complications following primary TKA, including reoperations, readmissions, and both septic and aseptic revisions. These findings highlight the need for careful patient counseling and surgical planning in patients with a history of meniscectomy.
{"title":"Meniscectomy before total knee arthroplasty increases the risk of all-cause revision and revision for infection: A national database analysis","authors":"Cole R. Johnson, Khaled A. Elmenawi, Ahmed K. Emara, Benjamin E. Jevnikar, Matthew E. Deren, Nicolas S. Piuzzi","doi":"10.1016/j.jcot.2025.103292","DOIUrl":"10.1016/j.jcot.2025.103292","url":null,"abstract":"<div><h3>Background</h3><div>Arthroscopic meniscectomy (AM) is a common procedure in middle-aged adults with degenerative meniscal tears. As many of these patients eventually require total knee arthroplasty (TKA), concerns have emerged regarding the potential impact of prior AM on TKA outcomes. This study evaluated whether a history of ipsilateral AM is associated with increased short- and mid-term complications following TKA.</div></div><div><h3>Methods</h3><div>Using the PearlDiver national database, adult patients who underwent primary TKA for osteoarthritis between 2016 and 2022 with 1-year of follow-up and laterality available were identified (n = 1,152,444). Patients with prior ipsilateral AM were matched 1:1 to controls without prior AM based on age, sex, comorbidities, and year of surgery (n = 40,341 per group). Multivariate logistic regression was used to evaluate 90-day healthcare utilization (emergency department visits, reoperations, and readmissions) and 1- and 2-year revision risks (all-cause, septic, and aseptic).</div></div><div><h3>Results</h3><div>Approximately 3.5 % of TKA patients had prior AM. Patients with prior AM had significantly higher rates of 90-day emergency department visits (OR, 1.23; 95 % CI, 1.18–1.29), reoperations (OR, 2.10; 95 % CI, 1.95–2.27), and readmissions (OR, 1.43; 95 % CI, 1.32–1.55) (all p < 0.001). At 1-year post-TKA, these patients had increased odds of all-cause revision (OR, 2.47), revision for PJI (OR, 2.15), and aseptic revision (OR, 2.62). These risks remained elevated at 2 years: all-cause revision (OR, 2.83), revision for PJI (OR, 2.33), and aseptic revision (OR, 3.06) (all p < 0.001).</div></div><div><h3>Conclusions</h3><div>Prior ipsilateral AM is associated with significantly increased risks of short- and mid-term complications following primary TKA, including reoperations, readmissions, and both septic and aseptic revisions. These findings highlight the need for careful patient counseling and surgical planning in patients with a history of meniscectomy.</div></div><div><h3>Level of evidence</h3><div>Level III; Retrospective cohort study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103292"},"PeriodicalIF":0.0,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797114","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}
Proximal tibial malunions resulting from inappropriate reduction or neglected traumatic sequelae can significantly alter knee biomechanics and predispose the patients to pain, instability, and early post traumatic osteoarthritis (PTOA). Their management requires a detailed analysis of the fracture fragments, location of deformity and status of soft tissue. Accurate preoperative assessment including clinical evaluation, standing radiographs, long-leg scanogram, and 2D/3D CT scans are critical for identifying coronal, sagittal, rotational, and multiplanar deformities. Deformity analysis using malalignment tests and marking of the centre of rotation of angulation (CORA) guides surgical planning. Surgical management focus on correction of limb alignment, restoration of articular congruity and stable fixation. Intra-articular osteotomy is preferred for depression or split-depression injuries, while extra-articular osteotomies address coronal or sagittal plane malalignment. Bicondylar and combined deformities may require dual approaches, and a tibial tubercle (TT) osteotomy might be needed to access and correct deformities, when CORA is close to TT. The biological potential of the osteotomy site, soft tissue condition, and bone quality must be considered when planning fixation. Internal fixation devices including bone graft is only suitable in cases with good soft tissue cover. A circular external fixator is preferred when gradual correction is required and particularly in cases where soft tissues are unsuitable for internal fixation. Mechanical axis should be restored as soon as it is safe to do so to prevent or slow the progression of PTOA. In this article we discuss classification and management strategies for proximal tibial malunions, emphasizing meticulous preoperative planning, surgical approach selection, surgical strategies to optimise functional outcomes and preserve the native joint.
{"title":"Intra-articular and extra-articular malunion of proximal tibia: Assessment and management","authors":"Srinivas Kasha , Ranjith Kumar Yalamanchili , Rohit GPRK , Susmith Koneru , Anurag Gurram , Venkat Ravi Weera Athili","doi":"10.1016/j.jcot.2025.103279","DOIUrl":"10.1016/j.jcot.2025.103279","url":null,"abstract":"<div><div>Proximal tibial malunions resulting from inappropriate reduction or neglected traumatic sequelae can significantly alter knee biomechanics and predispose the patients to pain, instability, and early post traumatic osteoarthritis (PTOA). Their management requires a detailed analysis of the fracture fragments, location of deformity and status of soft tissue. Accurate preoperative assessment including clinical evaluation, standing radiographs, long-leg scanogram, and 2D/3D CT scans are critical for identifying coronal, sagittal, rotational, and multiplanar deformities. Deformity analysis using malalignment tests and marking of the centre of rotation of angulation (CORA) guides surgical planning. Surgical management focus on correction of limb alignment, restoration of articular congruity and stable fixation. Intra-articular osteotomy is preferred for depression or split-depression injuries, while extra-articular osteotomies address coronal or sagittal plane malalignment. Bicondylar and combined deformities may require dual approaches, and a tibial tubercle (TT) osteotomy might be needed to access and correct deformities, when CORA is close to TT. The biological potential of the osteotomy site, soft tissue condition, and bone quality must be considered when planning fixation. Internal fixation devices including bone graft is only suitable in cases with good soft tissue cover. A circular external fixator is preferred when gradual correction is required and particularly in cases where soft tissues are unsuitable for internal fixation. Mechanical axis should be restored as soon as it is safe to do so to prevent or slow the progression of PTOA. In this article we discuss classification and management strategies for proximal tibial malunions, emphasizing meticulous preoperative planning, surgical approach selection, surgical strategies to optimise functional outcomes and preserve the native joint.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103279"},"PeriodicalIF":0.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694037","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 : 2025-11-21DOI: 10.1016/j.jcot.2025.103275
Stephen C. Moye , Austin T. Gregg , Thirushan Wignakumar , Adam N. Musick , Antonia F. Chen , Nishant Suneja
Background
Displaced femoral neck fractures in older adults are commonly treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA), with the choice influenced by patient characteristics, surgeon training, and logistical factors. Prior international studies suggest THA is more often performed on weekdays and by arthroplasty-trained surgeons, but it is unclear whether similar patterns exist in the United States. This study examines whether weekend surgery affects the choice between HA and THA after adjusting for patient and surgeon-specific factors.
Methods
Design: Retrospective cohort.
Setting: Two Level 1 Trauma Centers.
Patient Selection Criteria: Adult patients with displaced femoral neck fractures (2001–2023) treated with HA or THA.
Outcome Measures and Comparisons: The primary outcome was the relative proportion of HA versus THA performed on weekends versus weekdays. Secondary outcomes included perioperative factors associated with weekend surgery.
Results
Among 1947 cases, propensity matching yielded two well-balanced cohorts of 497 cases. Before matching, HA patients were older (80.4 vs. 70.9 years, p < 0.0001), had lower BMI (24.6 vs. 25.4 kg/m2, p = 0.002), and had a higher Elixhauser Comorbidity Index (25.5 vs. 15.3, p < 0.0001). Surgeon subspecialty training differed between the cohorts and more experienced surgeons were more likely to choose THA (15.1 years vs. 13.0 years, p = 0.0004). After matching, weekend surgery was associated with higher HA rates (24.7 % vs. 18.7 %, p = 0.021), despite appropriately balanced patient and surgeon characteristics.
Conclusions
Weekend surgery is associated with higher rates of HA over THA in displaced FNFs, independent of patient and surgeon characteristics. These findings suggest potential system-level factors influencing surgical decision-making and highlight the need for further investigation into resource allocation, cognitive biases, and perioperative workflows.
Mesh terms
Arthroplasty, Replacement, Hip; Hip Fractures; Practice Patterns, Physician's; Propensity Score.
Level of evidence
Therapeutic Level IV.
背景：老年人移位性股骨颈骨折通常采用半髋关节置换术（HA）或全髋关节置换术（THA）治疗，其选择受患者特点、外科医生培训和后勤因素的影响。先前的国际研究表明，人工髋关节置换术更常在工作日由接受过关节置换术培训的外科医生进行，但尚不清楚在美国是否存在类似的模式。本研究考察了在调整患者和外科医生的特定因素后，周末手术是否会影响HA和THA之间的选择。方法设计：回顾性队列研究。环境：两个一级创伤中心。患者选择标准：接受HA或THA治疗的成年移位型股骨颈骨折患者（2001-2023）。结果测量和比较：主要结果是在周末和工作日进行HA和THA的相对比例。次要结局包括与周末手术相关的围手术期因素。结果在1947例病例中，倾向匹配得到两组均衡的497例病例。配对前，HA患者年龄较大（80.4 vs. 70.9岁，p <； 0.0001），BMI较低（24.6 vs. 25.4 kg/m2, p = 0.002），Elixhauser共病指数较高（25.5 vs. 15.3, p <； 0.0001）。外科医生亚专科培训在队列之间存在差异，经验丰富的外科医生更有可能选择THA（15.1年vs 13.0年，p = 0.0004）。匹配后，周末手术与更高的HA率相关（24.7 % vs. 18.7 %,p = 0.021），尽管适当平衡了患者和外科医生的特征。结论：与患者和外科医生的特点无关，周末手术与移位的fnf中HA的发生率高于THA相关。这些发现提示了影响手术决策的潜在系统层面因素，并强调了对资源分配、认知偏差和围手术期工作流程进行进一步调查的必要性。补片术语：髋关节置换；髋部骨折;医师执业模式；倾向分数。证据水平：治疗性四级。
{"title":"Weekend surgery is associated with increased use of hemiarthroplasty for displaced femoral neck fractures: A propensity-matched study","authors":"Stephen C. Moye , Austin T. Gregg , Thirushan Wignakumar , Adam N. Musick , Antonia F. Chen , Nishant Suneja","doi":"10.1016/j.jcot.2025.103275","DOIUrl":"10.1016/j.jcot.2025.103275","url":null,"abstract":"<div><h3>Background</h3><div>Displaced femoral neck fractures in older adults are commonly treated with either hemiarthroplasty (HA) or total hip arthroplasty (THA), with the choice influenced by patient characteristics, surgeon training, and logistical factors. Prior international studies suggest THA is more often performed on weekdays and by arthroplasty-trained surgeons, but it is unclear whether similar patterns exist in the United States. This study examines whether weekend surgery affects the choice between HA and THA after adjusting for patient and surgeon-specific factors.</div></div><div><h3>Methods</h3><div><strong><em>Design</em></strong>: Retrospective cohort.</div><div><strong><em>Setting</em></strong>: Two Level 1 Trauma Centers.</div><div><strong><em>Patient Selection Criteria</em></strong>: Adult patients with displaced femoral neck fractures (2001–2023) treated with HA or THA.</div><div><strong><em>Outcome Measures and Comparisons</em></strong>: The primary outcome was the relative proportion of HA versus THA performed on weekends versus weekdays. Secondary outcomes included perioperative factors associated with weekend surgery.</div></div><div><h3>Results</h3><div>Among 1947 cases, propensity matching yielded two well-balanced cohorts of 497 cases. Before matching, HA patients were older (80.4 vs. 70.9 years, p < 0.0001), had lower BMI (24.6 vs. 25.4 kg/m<sup>2</sup>, p = 0.002), and had a higher Elixhauser Comorbidity Index (25.5 vs. 15.3, p < 0.0001). Surgeon subspecialty training differed between the cohorts and more experienced surgeons were more likely to choose THA (15.1 years vs. 13.0 years, p = 0.0004). After matching, weekend surgery was associated with higher HA rates (24.7 % vs. 18.7 %, p = 0.021), despite appropriately balanced patient and surgeon characteristics.</div></div><div><h3>Conclusions</h3><div>Weekend surgery is associated with higher rates of HA over THA in displaced FNFs, independent of patient and surgeon characteristics. These findings suggest potential system-level factors influencing surgical decision-making and highlight the need for further investigation into resource allocation, cognitive biases, and perioperative workflows.</div></div><div><h3>Mesh terms</h3><div>Arthroplasty, Replacement, Hip; Hip Fractures; Practice Patterns, Physician's; Propensity Score.</div></div><div><h3>Level of evidence</h3><div>Therapeutic Level IV.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103275"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624598","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 : 2025-11-20DOI: 10.1016/j.jcot.2025.103277
Nitish Jagdish Jyoti , Pon Aravindhan, Ritvik Janardhanan, Dyuti Deepta Rano, Love Kapoor, Shah Alam Khan
Background
Fibrous dysplasia (FD) is characterised by structurally weak bone due to disorganized fibro-osseous matrix, leading to pain, deformities and pathological fractures. While traditional treatments like curettage and bone grafting are ineffective due to graft resorption and lesion persistence, intramedullary fixation is currently preferred method to prevent recurrent deformities and fractures. This study aimed to evaluate the clinical and functional outcomes of neo-adjuvant zoledronic acid (ZA) therapy combined with valgus osteotomy in proximal femoral FD, and to assess changes in neck-shaft angle (NSA) and limb length discrepancy (LLD).
Methods
This single centre, retrospective study included eight patients with proximal femoral monostotic/polyostotic FD treated between January 2021 and December 2023. All patients received three doses of intravenous ZA at 4-week intervals, followed by valgus osteotomy performed 8 weeks after the final ZA dose. Pre- and post-operative NSA and LLD were recorded and compared. Functional outcomes were assessed using the modified Guille criteria.
Results
The mean age was 21.8 ± 6.68 years. Three patients had monostotic and 5 had polyostotic FD. Mean follow-up was 24.5 ± 6.4 months. All patients experienced pain relief post-ZA without serious adverse events, although only 2 showed radiological improvement. The mean modified Guille score improved from 3.5 ± 1.51 to 8.25 ± 1.48 (p = 0.01). The mean NSA improved from 100.75 ± 17.05° to 125.75 ± 8.31° (p = 0.044) and LLD reduced from 1.93 ± 0.72 cm to 0.93 ± 0.49 cm (p < 0.001). Union was achieved in all cases with a mean healing time of 6.25 ± 1.66 months.
Conclusion
Combining neo-adjuvant ZA therapy and valgus osteotomy offers significant functional improvement and deformity correction in proximal femoral FD. While ZA offers consistent pain relief, its radiological impact remains variable. Valgus osteotomy, stabilized with intra- or extramedullary fixation remains a valuable technique for managing FD-associated deformities. Further prospective studies are warranted to refine treatment protocols and validate long-term outcomes.
{"title":"Clinical and functional outcomes of neo-adjuvant zoledronic acid therapy and valgus osteotomy in proximal femoral fibrous dysplasia","authors":"Nitish Jagdish Jyoti , Pon Aravindhan, Ritvik Janardhanan, Dyuti Deepta Rano, Love Kapoor, Shah Alam Khan","doi":"10.1016/j.jcot.2025.103277","DOIUrl":"10.1016/j.jcot.2025.103277","url":null,"abstract":"<div><h3>Background</h3><div>Fibrous dysplasia (FD) is characterised by structurally weak bone due to disorganized fibro-osseous matrix, leading to pain, deformities and pathological fractures. While traditional treatments like curettage and bone grafting are ineffective due to graft resorption and lesion persistence, intramedullary fixation is currently preferred method to prevent recurrent deformities and fractures. This study aimed to evaluate the clinical and functional outcomes of neo-adjuvant zoledronic acid (ZA) therapy combined with valgus osteotomy in proximal femoral FD, and to assess changes in neck-shaft angle (NSA) and limb length discrepancy (LLD).</div></div><div><h3>Methods</h3><div>This single centre, retrospective study included eight patients with proximal femoral monostotic/polyostotic FD treated between January 2021 and December 2023. All patients received three doses of intravenous ZA at 4-week intervals, followed by valgus osteotomy performed 8 weeks after the final ZA dose. Pre- and post-operative NSA and LLD were recorded and compared. Functional outcomes were assessed using the modified Guille criteria.</div></div><div><h3>Results</h3><div>The mean age was 21.8 ± 6.68 years. Three patients had monostotic and 5 had polyostotic FD. Mean follow-up was 24.5 ± 6.4 months. All patients experienced pain relief post-ZA without serious adverse events, although only 2 showed radiological improvement. The mean modified Guille score improved from 3.5 ± 1.51 to 8.25 ± 1.48 (p = 0.01). The mean NSA improved from 100.75 ± 17.05° to 125.75 ± 8.31° (p = 0.044) and LLD reduced from 1.93 ± 0.72 cm to 0.93 ± 0.49 cm (p < 0.001). Union was achieved in all cases with a mean healing time of 6.25 ± 1.66 months.</div></div><div><h3>Conclusion</h3><div>Combining neo-adjuvant ZA therapy and valgus osteotomy offers significant functional improvement and deformity correction in proximal femoral FD. While ZA offers consistent pain relief, its radiological impact remains variable. Valgus osteotomy, stabilized with intra- or extramedullary fixation remains a valuable technique for managing FD-associated deformities. Further prospective studies are warranted to refine treatment protocols and validate long-term outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103277"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624596","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}
In a prior investigation, we demonstrated that the Mitsuzawa classification for dislocated and severely displaced proximal humeral fractures (PHFs) provided substantially higher reliability than the Neer or AO/OTA systems when applied to plain radiographs. The present study builds on that work by determining whether computed tomography (CT) alters classification outcomes or improves observer agreement.
Methods
Four independent reviewers—two shoulder specialists and two orthopedic residents—classified 70 PHFs according to the Neer, AO/OTA, and Mitsuzawa systems. Each fracture fulfilled criteria for dislocation or severe displacement requiring arthroplasty. Evaluations were performed at two separate timepoints: first with radiographs and then with CT scans, including three-dimensional reconstructions. Changes between modalities were recorded. Intraobserver consistency was assessed with the Cohen κ statistic, while interobserver reliability was evaluated with the Fleiss κ statistic.
Results
The incidence of axillary artery injury was 7.1 %. After CT review, classification changes occurred in 31 % of Neer, 29 % of AO/OTA, and 11 % of Mitsuzawa assessments. With radiographs alone, intraobserver reliability was moderate for Neer (κ = 0.52), substantial for AO/OTA (κ = 0.63), and substantial for Mitsuzawa (κ = 0.73). With CT imaging, the corresponding values were 0.55, 0.59, and 0.73. Interobserver agreement ranged from 0.43 to 0.45 (Neer), 0.49–0.52 (AO/OTA), and 0.68–0.68 (Mitsuzawa) with radiographs, and from 0.47 to 0.50, 0.57–0.57, and 0.67–0.69, respectively, after CT. Significant pairwise differences (p < 0.05) in interobserver agreement were observed among all combinations of the three systems for both modalities.
Conclusions
The Mitsuzawa classification was minimally influenced by imaging modality and consistently provided substantial agreement. For dislocated and displaced PHFs, CT appears to have only a minor influence on Mitsuzawa-based categorization, indicating that well-performed radiographs remain sufficient for reproducible classification. These findings have direct implications for clinical decision-making, imaging selection, and anticipating risks such as neurovascular compromise.
{"title":"Computed tomography versus plain radiography in the Mitsuzawa classification for severe proximal humeral fractures: Comparative agreement analysis and clinical implications","authors":"Sadaki Mitsuzawa , Hisataka Takeuchi , Tadashi Yasuda , Shuichi Matsuda","doi":"10.1016/j.jcot.2025.103276","DOIUrl":"10.1016/j.jcot.2025.103276","url":null,"abstract":"<div><h3>Background</h3><div>In a prior investigation, we demonstrated that the Mitsuzawa classification for dislocated and severely displaced proximal humeral fractures (PHFs) provided substantially higher reliability than the Neer or AO/OTA systems when applied to plain radiographs. The present study builds on that work by determining whether computed tomography (CT) alters classification outcomes or improves observer agreement.</div></div><div><h3>Methods</h3><div>Four independent reviewers—two shoulder specialists and two orthopedic residents—classified 70 PHFs according to the Neer, AO/OTA, and Mitsuzawa systems. Each fracture fulfilled criteria for dislocation or severe displacement requiring arthroplasty. Evaluations were performed at two separate timepoints: first with radiographs and then with CT scans, including three-dimensional reconstructions. Changes between modalities were recorded. Intraobserver consistency was assessed with the Cohen κ statistic, while interobserver reliability was evaluated with the Fleiss κ statistic.</div></div><div><h3>Results</h3><div>The incidence of axillary artery injury was 7.1 %. After CT review, classification changes occurred in 31 % of Neer, 29 % of AO/OTA, and 11 % of Mitsuzawa assessments. With radiographs alone, intraobserver reliability was moderate for Neer (κ = 0.52), substantial for AO/OTA (κ = 0.63), and substantial for Mitsuzawa (κ = 0.73). With CT imaging, the corresponding values were 0.55, 0.59, and 0.73. Interobserver agreement ranged from 0.43 to 0.45 (Neer), 0.49–0.52 (AO/OTA), and 0.68–0.68 (Mitsuzawa) with radiographs, and from 0.47 to 0.50, 0.57–0.57, and 0.67–0.69, respectively, after CT. Significant pairwise differences (<em>p</em> < 0.05) in interobserver agreement were observed among all combinations of the three systems for both modalities.</div></div><div><h3>Conclusions</h3><div>The Mitsuzawa classification was minimally influenced by imaging modality and consistently provided substantial agreement. For dislocated and displaced PHFs, CT appears to have only a minor influence on Mitsuzawa-based categorization, indicating that well-performed radiographs remain sufficient for reproducible classification. These findings have direct implications for clinical decision-making, imaging selection, and anticipating risks such as neurovascular compromise.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103276"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624597","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 : 2025-11-20DOI: 10.1016/j.jcot.2025.103278
Abhishek Soni , Vaibhav Sinha , Vidyadhara S , Balamurugan T
Background
S2-alar-iliac (S2AI) screws are widely used for spinopelvic fixation due to their biomechanical advantages. Although pelvic incidence (PI) is traditionally considered fixed after skeletal maturity, emerging evidence suggests that surgical procedures involving the sacroiliac joint may alter pelvic parameters. This study aimed to evaluate the effect of S2AI screw fixation on spinopelvic parameters and analyse variations based on preoperative PI values.
Methods
A retrospective review was conducted of 80 consecutive patients (160 screws) who underwent spinopelvic fusion for adult degenerative scoliosis between January 2020 and December 2023. Standing radiographs obtained preoperatively and at one-year follow-up were analysed for PI, pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL). Patients were classified by preoperative PI as low (<40°), normal (40°–60°), or high (>60°). Changes >6° were considered clinically significant. Statistical analyses used paired t-tests and chi-squared tests (p < 0.05).
Results
PI significantly decreased from 50.45° ± 11.42°–46.18° ± 10.81° (p < 0.001), and PT decreased from 21.46° ± 10.45°–16.50° ± 9.19° (p < 0.001), while SS remained unchanged (p = 0.403). PI–LL mismatch improved from 18.26° ± 11.30°–8.07° ± 5.88° (p < 0.001). Clinically significant PI reduction (>6°) occurred in 40 % of patients, most frequently in those with high preoperative PI (64.7 % vs. 36.5 % normal, 18.2 % low; p = 0.043). ODI scores improved from 77.2 ± 12.1 to 33.9 ± 15.0 (p < 0.001), representing a 56 % reduction in disability, with all patients achieving the minimal clinically important difference. Hardware failure occurred in four screws (2.5 %) without related symptoms or need for revision, and alignment was maintained.
Conclusion
S2AI screw fixation significantly modifies spinopelvic parameters, challenging the concept of fixed PI after skeletal maturity. Greater PI reduction in patients with high preoperative PI highlights its relevance for surgical planning in adult spinal deformity correction.
{"title":"Changes in sagittal spinopelvic parameters following S2-alar-iliac screw fixation in adult degenerative scoliosis: A one-year radiographic analysis of 80 patients","authors":"Abhishek Soni , Vaibhav Sinha , Vidyadhara S , Balamurugan T","doi":"10.1016/j.jcot.2025.103278","DOIUrl":"10.1016/j.jcot.2025.103278","url":null,"abstract":"<div><h3>Background</h3><div>S2-alar-iliac (S2AI) screws are widely used for spinopelvic fixation due to their biomechanical advantages. Although pelvic incidence (PI) is traditionally considered fixed after skeletal maturity, emerging evidence suggests that surgical procedures involving the sacroiliac joint may alter pelvic parameters. This study aimed to evaluate the effect of S2AI screw fixation on spinopelvic parameters and analyse variations based on preoperative PI values.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of 80 consecutive patients (160 screws) who underwent spinopelvic fusion for adult degenerative scoliosis between January 2020 and December 2023. Standing radiographs obtained preoperatively and at one-year follow-up were analysed for PI, pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL). Patients were classified by preoperative PI as low (<40°), normal (40°–60°), or high (>60°). Changes >6° were considered clinically significant. Statistical analyses used paired t-tests and chi-squared tests (p < 0.05).</div></div><div><h3>Results</h3><div>PI significantly decreased from 50.45° ± 11.42°–46.18° ± 10.81° (p < 0.001), and PT decreased from 21.46° ± 10.45°–16.50° ± 9.19° (p < 0.001), while SS remained unchanged (p = 0.403). PI–LL mismatch improved from 18.26° ± 11.30°–8.07° ± 5.88° (p < 0.001). Clinically significant PI reduction (>6°) occurred in 40 % of patients, most frequently in those with high preoperative PI (64.7 % vs. 36.5 % normal, 18.2 % low; p = 0.043). ODI scores improved from 77.2 ± 12.1 to 33.9 ± 15.0 (p < 0.001), representing a 56 % reduction in disability, with all patients achieving the minimal clinically important difference. Hardware failure occurred in four screws (2.5 %) without related symptoms or need for revision, and alignment was maintained.</div></div><div><h3>Conclusion</h3><div>S2AI screw fixation significantly modifies spinopelvic parameters, challenging the concept of fixed PI after skeletal maturity. Greater PI reduction in patients with high preoperative PI highlights its relevance for surgical planning in adult spinal deformity correction.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103278"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624497","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}
This study aimed to evaluate the change in foot and ankle functional outcome scores and the CT fusion ratio after Posterior Arthroscopic Subtalar Arthrodesis (PASTA) in patients with isolated subtalar arthritis.
Methods
A prospective observational study was conducted from March 2021 to March 2023, enrolling 20 patients (12 males, 8 females) with posttraumatic or degenerative isolated subtalar arthritis. Functional outcomes were assessed at 6 weeks, 3 months, and 6 months postoperatively using AOFAS, FADI, FAOS, and VAS scores. Fusion was assessed via CT scan at 6 months to calculate the CT fusion ratio.
Results
Functional outcomes significantly improved over time. The mean AOFAS score increased from 48.0 ± 8.53 preoperatively to 83.8 ± 9.73 at 6 months. The mean FADI and FAOS scores improved from 42.85 ± 7.11 and 43.35 ± 8.78 preoperatively to 86.5 ± 11.38 and 86.75 ± 11.15, respectively, at 6 months. The VAS score decreased from a mean of 4.9 ± 0.89 at 6 weeks to 1.6 at 6 months. The mean CT fusion ratio at 6 months was 65.39 % ± 13.98 %. Only one patient showed a fusion ratio below 33 % and later required ankle arthrodesis. A significant positive correlation was observed between CT fusion ratio and AOFAS (ρ = 0.64, p = 0.002), FADI (ρ = 0.55, p = 0.010), and FAOS (ρ = 0.45, p = 0.043). Most patients rated satisfaction as “excellent” at final follow-up. Minor complications such as transient pain and swelling were observed but resolved over time.
Conclusion
Arthroscopic subtalar arthrodesis significantly improved functional outcomes and demonstrated a high CT fusion rate with minimal complications in patients with isolated subtalar arthritis.
Level of evidence
Level III.
本研究旨在评估孤立性距下关节炎患者后路关节镜距下关节融合术（PASTA）后足部和踝关节功能评分和CT融合率的变化。方法前瞻性观察研究于2021年3月至2023年3月进行，纳入20例创伤后或退行性孤立距下关节炎患者（男性12例，女性8例）。分别在术后6周、3个月和6个月使用AOFAS、FADI、FAOS和VAS评分评估功能结局。6个月时通过CT扫描评估融合情况，计算CT融合率。结果：随着时间的推移，功能预后显著改善。平均AOFAS评分由术前的48.0±8.53分上升至6个月时的83.8±9.73分。6个月时，FADI和FAOS平均评分分别从术前的42.85±7.11和43.35±8.78提高到86.5±11.38和86.75±11.15。VAS评分从6周时的平均4.9±0.89降至6个月时的1.6。6个月平均CT融合率为65.39%±13.98%。只有1例患者融合率低于33%，随后需要进行踝关节融合术。CT融合率与AOFAS （ρ = 0.64, p = 0.002）、FADI （ρ = 0.55, p = 0.010）、FAOS （ρ = 0.45, p = 0.043）呈正相关。在最后的随访中，大多数患者的满意度为“优秀”。观察到轻微的并发症，如短暂的疼痛和肿胀，但随着时间的推移而消退。结论关节镜下距下关节融合术可显著改善孤立性距下关节炎患者的功能预后，CT融合率高，并发症少。证据等级：III级。
{"title":"Determining the change in functional outcome score and CT fusion ratio following arthroscopic subtalar arthrodesis: A prospective observational study","authors":"Bishwa Bandhu Niraula , Anil Regmi , Shivam Bansal , Saptarshi Barman , Rohan Gowda , Pradeep Kumar Meena","doi":"10.1016/j.jcot.2025.103280","DOIUrl":"10.1016/j.jcot.2025.103280","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the change in foot and ankle functional outcome scores and the CT fusion ratio after Posterior Arthroscopic Subtalar Arthrodesis (PASTA) in patients with isolated subtalar arthritis.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted from March 2021 to March 2023, enrolling 20 patients (12 males, 8 females) with posttraumatic or degenerative isolated subtalar arthritis. Functional outcomes were assessed at 6 weeks, 3 months, and 6 months postoperatively using AOFAS, FADI, FAOS, and VAS scores. Fusion was assessed via CT scan at 6 months to calculate the CT fusion ratio.</div></div><div><h3>Results</h3><div>Functional outcomes significantly improved over time. The mean AOFAS score increased from 48.0 ± 8.53 preoperatively to 83.8 ± 9.73 at 6 months. The mean FADI and FAOS scores improved from 42.85 ± 7.11 and 43.35 ± 8.78 preoperatively to 86.5 ± 11.38 and 86.75 ± 11.15, respectively, at 6 months. The VAS score decreased from a mean of 4.9 ± 0.89 at 6 weeks to 1.6 at 6 months. The mean CT fusion ratio at 6 months was 65.39 % ± 13.98 %. Only one patient showed a fusion ratio below 33 % and later required ankle arthrodesis. A significant positive correlation was observed between CT fusion ratio and AOFAS (ρ = 0.64, p = 0.002), FADI (ρ = 0.55, p = 0.010), and FAOS (ρ = 0.45, p = 0.043). Most patients rated satisfaction as “excellent” at final follow-up. Minor complications such as transient pain and swelling were observed but resolved over time.</div></div><div><h3>Conclusion</h3><div>Arthroscopic subtalar arthrodesis significantly improved functional outcomes and demonstrated a high CT fusion rate with minimal complications in patients with isolated subtalar arthritis.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103280"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839740","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 : 2025-11-15DOI: 10.1016/j.jcot.2025.103265
Bradley A. Lezak , Meghan Maseda , Alexander J. Egol , Nathaniel P. Mercer , Kenneth A. Egol
Surgical repair of extracapsular hip fractures is associated with a higher rate of successful healing compared to intracapsular fractures; however, a small subset of patients may still experience complications or treatment failure. Potential modes of failure include nonunion, peri-implant fracture, malalignment, cortical impingement or perforation and hardware failure with or without lag screw cutout. Factors determining salvage method include physiologic age, functionality, bone quality, and fracture stability. In this review, potential complications of extracapsular hip fracture repair are described with proposed solutions and supporting literature, when available.
{"title":"Salvage options following failed surgical hip fracture repair: Part II, extracapsular proximal femoral fractures","authors":"Bradley A. Lezak , Meghan Maseda , Alexander J. Egol , Nathaniel P. Mercer , Kenneth A. Egol","doi":"10.1016/j.jcot.2025.103265","DOIUrl":"10.1016/j.jcot.2025.103265","url":null,"abstract":"<div><div>Surgical repair of extracapsular hip fractures is associated with a higher rate of successful healing compared to intracapsular fractures; however, a small subset of patients may still experience complications or treatment failure. Potential modes of failure include nonunion, peri-implant fracture, malalignment, cortical impingement or perforation and hardware failure with or without lag screw cutout. Factors determining salvage method include physiologic age, functionality, bone quality, and fracture stability. In this review, potential complications of extracapsular hip fracture repair are described with proposed solutions and supporting literature, when available.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103265"},"PeriodicalIF":0.0,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580506","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 : 2025-11-13DOI: 10.1016/j.jcot.2025.103263
José Andreu Castelo , Juan Francisco Londoño , Jacobo Triviño-Arias , Gilberto Antonio Herrera , Paulo José Llinás , Juan Pablo Martinez-Cano
Background
Patella alta is a known risk factor in recurrent patellofemoral dislocation. It is recommended to add a tibial tubercle distalization osteotomy for managing patella alta. Medial patellofemoral ligament reconstruction (MPFLr) could alter patellar height. The aim of this study is to quantify the possible decreasing effect of the MPFLr on patellar height in patients with patellofemoral instability treated with two different techniques: the anatomical (Schoettle's point) technique and the adductor's tendon sling technique, in three different indexes.
Methods
Retrospective observational study in patients with recurrent patellofemoral dislocation who underwent medial patellofemoral ligament reconstruction with an anatomical technique and an adductor's tendon sling technique between 2011 and 2020, comparing the preoperative and postoperative patellar height.
Results
A total of 15 knees and 14 patients were included, with a mean age of 19.2 ± 4.84 years. Eight patients (53.33 %) were treated with the adductor tendon technique and seven (46.67 %) with the anatomic technique. The change between preoperative and postoperative patellar height showed a statistically significant decrease in the three indexes measured, Caton-Deschamps (CD) (p = 0.0017), modified Insall-Salvati (IS) (p = 0.0022), and Blackburne-Peel (BP) (p = 0.0067). No statistically significant difference was found when comparing the delta of patellar descent between anatomic and adductor tendon groups. The mean decrease for the three measurements was 9 %, equivalent to 0.12 for CD, 0.17 for modified IS, and 0.11 for BP.
Conclusion
MPFL reconstruction contributes to a mild decrease in patellar height. This effect should be considered in surgical planning. Selected cases of patients with subtle patella alta could avoid the need for additional distalization procedures. Both techniques showed to decrease patellar height, and no differences could be demonstrated between them.
{"title":"Medial patellofemoral ligament reconstruction descends the patella: results from an observational retrospective study with two different surgical techniques","authors":"José Andreu Castelo , Juan Francisco Londoño , Jacobo Triviño-Arias , Gilberto Antonio Herrera , Paulo José Llinás , Juan Pablo Martinez-Cano","doi":"10.1016/j.jcot.2025.103263","DOIUrl":"10.1016/j.jcot.2025.103263","url":null,"abstract":"<div><h3>Background</h3><div>Patella alta is a known risk factor in recurrent patellofemoral dislocation. It is recommended to add a tibial tubercle distalization osteotomy for managing patella alta. Medial patellofemoral ligament reconstruction (MPFLr) could alter patellar height. The aim of this study is to quantify the possible decreasing effect of the MPFLr on patellar height in patients with patellofemoral instability treated with two different techniques: the anatomical (Schoettle's point) technique and the adductor's tendon sling technique, in three different indexes.</div></div><div><h3>Methods</h3><div>Retrospective observational study in patients with recurrent patellofemoral dislocation who underwent medial patellofemoral ligament reconstruction with an anatomical technique and an adductor's tendon sling technique between 2011 and 2020, comparing the preoperative and postoperative patellar height.</div></div><div><h3>Results</h3><div>A total of 15 knees and 14 patients were included, with a mean age of 19.2 ± 4.84 years. Eight patients (53.33 %) were treated with the adductor tendon technique and seven (46.67 %) with the anatomic technique. The change between preoperative and postoperative patellar height showed a statistically significant decrease in the three indexes measured, Caton-Deschamps (CD) (p = 0.0017), modified Insall-Salvati (IS) (p = 0.0022), and Blackburne-Peel (BP) (p = 0.0067). No statistically significant difference was found when comparing the delta of patellar descent between anatomic and adductor tendon groups. The mean decrease for the three measurements was 9 %, equivalent to 0.12 for CD, 0.17 for modified IS, and 0.11 for BP.</div></div><div><h3>Conclusion</h3><div>MPFL reconstruction contributes to a mild decrease in patellar height. This effect should be considered in surgical planning. Selected cases of patients with subtle patella alta could avoid the need for additional distalization procedures. Both techniques showed to decrease patellar height, and no differences could be demonstrated between them.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103263"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145529106","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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