Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Different treatment modalities and their impact on outcomes in severe rigid scoliosis: a systematic review and pooled data meta-analysis","authors":"Syed Ifthekar ,&nbsp;Deepankar Satapathy ,&nbsp;Kaustubh Ahuja ,&nbsp;Samarth Mittal ,&nbsp;Siddharth Sekhar Sethy ,&nbsp;Pankaj Kandwal","doi":"10.1016/j.jcot.2025.103295","DOIUrl":"10.1016/j.jcot.2025.103295","url":null,"abstract":"<div><h3>Background</h3><div>Severe rigid scoliosis is a stiff and complex three-dimensional deformity. The children presenting with severe scoliosis need to be timely treated to prevent further deterioration of the curves and physiological function. The goals of treatment include to stop the progression of the curve, restore the spinal alignment, prevent neurological deterioration or improve the neurology if it is already deteriorated, improvement of pulmonary function and improve cosmetic outcomes. The various surgical options are one stage correction with osteotomies, posterior only approach, staged anterior release and posterior approach, pre-operative optimization by halo traction followed by posterior fusion and temporary internal distraction.</div></div><div><h3>Method</h3><div>The study protocol was published in PROSPERO with the ID CRD420251046131.Studies with participants diagnosed with severe rigid scoliosis who were operated and reporting the baseline values and correction of the scoliosis at follow-up were included. Studies mentioning the type of procedure and complications associated with the procedure were also included. Studies dealing with exclusive kyphosis, infective deformities, porcine models, adult degenerative lumbar scoliosis and those that did not give details about the scoliosis correction were excluded.</div></div><div><h3>Results</h3><div>A total of Seventy-Five studies were included with 2314 patients. Both neurological and non-neurological complications were significantly more likely in osteotomy compared to halo traction followed by definitive surgery. The difference was very significant in neurological complications (RR∼3.76, 95 % CI = 2.52–5.60).</div></div><div><h3>Conclusion</h3><div>Among the various strategies employed to treat severe rigid scoliosis, Spinal Osteotomy techniques had the highest rates of neurological and non-neurological complications. All the techniques described like halo traction, osteotomy and staged procedures gave a good curve correction in severe rigid scoliosis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103295"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797115","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":"Surgical techniques for the management of severe rigid scoliosis","authors":"Stephane Owusu-Sarpong ,&nbsp;Tejas Subramanian ,&nbsp;Han Jo Kim","doi":"10.1016/j.jcot.2025.103293","DOIUrl":"10.1016/j.jcot.2025.103293","url":null,"abstract":"<div><div>Severe rigid scoliosis presents some unique challenges with respect to surgical techniques and complications. Anterior and posterior techniques, as well as combined approaches, can be employed for the surgical management of this condition. The purpose of this article is to describe severe rigid scoliosis as an entity and to delve into the surgical tools that may be utilized for the treatment of this complex condition. Specific techniques are presented in detail, including preoperative halo-gravity/halo-pelvic traction, as well as correction maneuvers such as anterior release, thoracoplasty, concave rib osteotomy, and posterior vertebral column resection. Preoperative halo traction improves curve flexibility and pulmonary status, anterior release and concave rib osteotomy enhance mobilization, thoracoplasty addresses rib prominence, and posterior vertebral column resection provides powerful single-stage correction. Collectively, these techniques expand surgical options and mitigate neurologic and cardiopulmonary risks in severe rigid scoliosis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103293"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839735","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 posterior tibial slope on functional outcomes after mobile-bearing total knee arthroplasty","authors":"Tarun Jayakumar,&nbsp;Kushal Hippalgaonkar,&nbsp;Albin Savio,&nbsp;Chiranjeevi Thayi,&nbsp;AV.Gurava Reddy","doi":"10.1016/j.jcot.2025.103296","DOIUrl":"10.1016/j.jcot.2025.103296","url":null,"abstract":"<div><h3>Background</h3><div>Posterior tibial slope (PTS) is believed to influence range of motion (ROM) and functional outcomes after total knee arthroplasty (TKA), particularly in cruciate-retaining and posterior-stabilized designs. However, limited data exist on its impact in mobile-bearing systems. This study evaluated whether variations in PTS affect ROM and patient-reported outcome measures (PROMs) following mobile-bearing TKA using the Buechel-Pappas design.</div></div><div><h3>Methods</h3><div>This was a retrospective, single center cohort study on 359 patients who underwent cemented mobile-bearing TKA between 2018 and 2022, with a minimum follow-up of 2 years. Patients were stratified into three PTS categories: &lt;4°, 4–7°, and &gt;7° and analyzed. Functional outcomes were assessed using the Oxford Knee Score (OKS), Forgotten Joint Score (FJS), maximal knee ROM, and complications.</div></div><div><h3>Results</h3><div>Patient had a mean follow-up of 2.8 years (SD = 0.9) with a mean age was 61.3 (SD = 7.7) years. Baseline demographic characteristics were comparable between the 3 cohorts. Mean postoperative ROM improved significantly from 75.2° to 95.3°, and mean OKS from 16.2 to 34.5 (p &lt; 0.001). However, no significant differences in ROM, OKS, or FJS were observed between PTS groups (p &gt; 0.05). Analysis of change in PTS between pre-operative to post-operative showed no significant difference. ROC analyses and logistic regression demonstrated poor predictive ability of PTS for functional outcomes.</div></div><div><h3>Conclusion</h3><div>Variations in posterior tibial slope within typical clinical ranges (&lt;4°, 4–7°, &gt;7°), as well as the degree of change in slope achieved from preoperative to postoperative alignment, did not significantly affect postoperative range of motion or patient-reported outcomes following mobile-bearing total knee arthroplasty.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103296"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797000","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":"Revisiting the ACL reconstruction rehabilitation algorithm: A gait analysis study","authors":"Champak Roy,&nbsp;Vineet Kumar,&nbsp;Devashish Chhutani,&nbsp;Prabhat Kumar,&nbsp;Pankaj Aggarwal,&nbsp;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}

{"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,&nbsp;Khaled A. Elmenawi,&nbsp;Ahmed K. Emara,&nbsp;Benjamin E. Jevnikar,&nbsp;Matthew E. Deren,&nbsp;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 &lt; 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 &lt; 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}

{"title":"Intra-articular and extra-articular malunion of proximal tibia: Assessment and management","authors":"Srinivas Kasha ,&nbsp;Ranjith Kumar Yalamanchili ,&nbsp;Rohit GPRK ,&nbsp;Susmith Koneru ,&nbsp;Anurag Gurram ,&nbsp;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}

{"title":"Weekend surgery is associated with increased use of hemiarthroplasty for displaced femoral neck fractures: A propensity-matched study","authors":"Stephen C. Moye ,&nbsp;Austin T. Gregg ,&nbsp;Thirushan Wignakumar ,&nbsp;Adam N. Musick ,&nbsp;Antonia F. Chen ,&nbsp;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 &lt; 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 &lt; 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}

{"title":"Clinical and functional outcomes of neo-adjuvant zoledronic acid therapy and valgus osteotomy in proximal femoral fibrous dysplasia","authors":"Nitish Jagdish Jyoti ,&nbsp;Pon Aravindhan,&nbsp;Ritvik Janardhanan,&nbsp;Dyuti Deepta Rano,&nbsp;Love Kapoor,&nbsp;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 &lt; 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}

{"title":"Computed tomography versus plain radiography in the Mitsuzawa classification for severe proximal humeral fractures: Comparative agreement analysis and clinical implications","authors":"Sadaki Mitsuzawa ,&nbsp;Hisataka Takeuchi ,&nbsp;Tadashi Yasuda ,&nbsp;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> &lt; 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}

{"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 ,&nbsp;Vaibhav Sinha ,&nbsp;Vidyadhara S ,&nbsp;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 (&lt;40°), normal (40°–60°), or high (&gt;60°). Changes &gt;6° were considered clinically significant. Statistical analyses used paired t-tests and chi-squared tests (p &lt; 0.05).</div></div><div><h3>Results</h3><div>PI significantly decreased from 50.45° ± 11.42°–46.18° ± 10.81° (p &lt; 0.001), and PT decreased from 21.46° ± 10.45°–16.50° ± 9.19° (p &lt; 0.001), while SS remained unchanged (p = 0.403). PI–LL mismatch improved from 18.26° ± 11.30°–8.07° ± 5.88° (p &lt; 0.001). Clinically significant PI reduction (&gt;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 &lt; 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}