Joint diseases and related surgery最新文献

Although fractures of the trapezium are extremely rare, the bone plays a crucial role in grip and pinch movements of the hand. These fractures may be associated with a concomitant fracture of the first metacarpal base and dislocation of the carpometacarpal joint. A 19-year-old male presented with bilateral hand and wrist pain following a motorcycle accident. Imaging revealed a comminuted Walker type V trapezium fracture and a second metacarpal base fracture on the right side and a non-displaced Walker type IV trapezium fracture with second, third, and fourth metacarpal base fractures on the left. The left trapezium fracture was managed conservatively, while metacarpal fractures were treated with percutaneous Kirschner wire (K-wire) fixation. On the right, closed reduction and percutaneous K-wire fixation were applied for the comminuted trapezium and associated metacarpal base fractures. The patient achieved complete bone union at one-year follow-up with no range of motion limitation. However, hand grip and key pinch strength were below normative values bilaterally, likely due to trauma, with slightly better results on the nonoperatively treated side. In conclusion, this case emphasizes the importance of high clinical suspicion and advanced imaging in the diagnosis of trapezium fractures, particularly in high-energy trauma. Individualized treatment strategies based on fracture type and displacement can result in satisfactory radiological and functional outcomes even in complex bilateral cases.

Objectives: This study aims to evaluate the incidence and clinical predictors of postoperative urinary retention (POUR) following total joint arthroplasty (TJA) and to evaluate whether preoperative bladder voiding efficiency (BVE) can independently predict POUR.

Patients and methods: Between September 2023 and May 2024, a total of 200 patients (66 males, 134 females; median age: 69 years; range, 32 to 90 years) scheduled for primary total hip or knee arthroplasty were prospectively analyzed. Patients were classified into POUR (n=33) and non-POUR (n=167) groups. Demographic characteristics, urological history, operative variables, the International Prostate Symptom Scores (IPSS), and bladder scanner measurements were collected and compared.

Results: The overall incidence of POUR was 16.5% (33/200). Compared to the non-POUR group, the POUR group exhibited significantly higher IPSS (p<0.001) and lower BVE (p=0.0016). Higher body mass index (p<0.001), hypertension (p<0.001), and diabetes mellitus (p<0.001) were significantly associated with POUR development.

Conclusion: Higher preoperative IPSS and lower BVE seem to be independently associated with POUR following TJA. Notably, BVE emerges as a novel and clinically meaningful predictor. Routine preoperative assessment of BVE and IPSS may aid in the early identification of high-risk patients, enabling the implementation of targeted strategies to prevent POUR and its associated complications.

Objectives: This study aims to evaluate the diagnostic performance of large language models (LLMs) in musculoskeletal radiological anatomy and to compare their accuracy with radiologists of varying experience levels.

Patients and methods: Between May 16, 2025 and June 12, 2025, a total of 175 multiple-choice questions (82 image-based, 93 text-only) were retrieved from Radiopaedia's open-access database. Questions were classified by anatomical region and imaging modality. Three LLMs, ChatGPT-4o (OpenAI), Claude 3.7 Sonnet (Anthropic), and Grok 3 (×AI), were assessed in a zero-shot setting. Their responses were compared to those of an attending musculoskeletal radiologist and two residents (senior and junior). Accuracy rates were calculated and statistically compared.

Results: The attending radiologist achieved the highest overall accuracy (79.4%), followed by the senior (72.6%) and junior resident (66.9%). Among LLMs, ChatGPT-4o performed best overall (69.7%), particularly in text-based questions (88.2%). All LLMs outperformed radiologists in text-based questions but underperformed in image-based ones. The attending radiologist significantly outperformed all LLMs in image interpretation (p<0.001). Variations in performance were also noted across anatomical regions and imaging modalities, with some LLMs exceeding radiologists in specific domains such as spinal or shoulder anatomy.

Conclusion: While LLMs, particularly ChatGPT-4o, show strong performance in text-based anatomical questions, their accuracy in image-based musculoskeletal radiology remains limited compared to human radiologists. These findings suggest that LLMs can serve as supplementary tools in education but require further optimization, particularly for visual interpretation tasks, before clinical implementation.

Objectives: This study aims to examine whether genetically predicted immunoglobulin G (IgG) N-glycosylation patterns (IGPs) affect osteoporosis risk using a two-sample Mendelian randomization (MR) method.

Materials and methods: In a collaborative effort involving the Medical Research Council (MRC) Human Genetics Unit and the FinnGen consortium, we conducted genome-wide association studies (GWAS) to explore the relationship between 77 IGPs (8,090 samples) and osteoporosis (438,872 samples). Utilizing the inverse-variance weighted (IVW) method as our primary analytical tool, we delved into these complex genetic associations. To further substantiate our findings, we employed additional complementary methods such as MR-Egger, weighted median, and weighted mode. Sensitivity analyses, including MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO), MR-Egger, Cochran's Q, and leave-one-out methods, were used to test the core MR assumptions and validate the robustness of the results. This multi-faceted approach allowed us to detect underlying causal relationships with greater confidence.

Results: The IGP4 exhibited a protective effect against osteoporosis with an odds ratio (OR) of 0.77 (95% confidence interval [CI]: 0.63-0.95, p=0.012). In contrast, IGP45 demonstrated a modest risk increase with an OR of 1.10 (95% CI: 1.01-1.19, p=0.021). Similarly, the results of the present MR study suggest that IGP56 also showed a protective trend, with an OR of 0.86 (95% CI: 0.78-0.96, p=0.006). To confirm our findings, we conducted rigorous sensitivity analyses utilizing MR-PRESSO, MR-Egger, Cochran's Q, and leave-one-out methods. These analyses revealed no evidence of heterogeneity or horizontal pleiotropy, thereby reinforcing the robustness and reliability of our findings.

Conclusion: Our study results indicate that IgG45 contributes positively to osteoporosis, whereas IgG4 and IgG56 exhibit a negative correlation. Nonetheless, additional research is crucial to understand their mechanisms and devise broader preventive strategies for osteoporosis.

High-pressure injection injuries to the upper extremities are uncommon yet serious, particularly when they involve substances such as concrete. These injuries, frequently occurring in industrial environments, can lead to substantial tissue damage and functional impairment. A 24-year-old male patient who incurred a high-pressure concrete injection injury to his left hand and forearm while employed at a construction site was admitted. The injury, originally seeming minor, involved concrete penetration into the thenar region and extended through the forearm, resulting in significant damage to muscles, tendons, and nerves. The immediate medical care comprised immersion of the injured arm in warm water, administration of intravenous antibiotics, and tetanus prophylaxis, succeeded by rapid debridement in the operating room. Through a series of surgeries, comprising sequential debridements and reconstructive interventions, hand function of the patient was acceptable regarding the occupational return. Radiographic imaging was essential in evaluating the severity of injury and informing surgical choices. Preoperative radiological clarification of the extension of the upper extremity to the anatomical regions with high pressure is of utmost importance in determining the location and size of the surgical incision to remove the vital initial debridement and cement from the anatomical regions as much as possible. This case highlights the significance of prompt identification, assertive treatment, and sequential surgical procedures in high-pressure injection injuries. The necessity for proactive workplace safety protocols and heightened awareness of the potential severity of these injuries is underscored. We believe that this case report enhances the comprehension of the difficulties and problems associated with treating high-pressure concrete injection injuries to the upper extremities.

Objectives: This study aims to evaluate hidden blood loss (HBL) in patients undergoing anterior cervical surgery for two-level cervical spondylotic myelopathy (CSM) and to compare the HBL between anterior cervical discectomy and fusion (ACDF) and single-level anterior cervical corpectomy and fusion (ACCF) with adjacent discectomy.

Patients and methods: Between January 2019 and December 2023, a total of 100 patients (55 males, 45 females; mean age: 49.4±11.4 years; range, 43 to 84 years) who underwent anterior cervical surgeries were retrospectively analyzed. Data collection encompassed demographic information, laboratory findings, and clinical records. Patients treated with ACDF were classified as Group A, while those receiving ACCF were assigned to Group B. Total blood loss (TBL) was calculated using the Gross formula, and HBL was determined based on TBL, postoperative drainage volume, and intraoperative blood loss.

Results: The most frequently affected segments were C3/4 and C4/5. The mean operative time was 135.5±13.4 min in Group A versus 139.5±12.8 min in Group B, indicating no statistically significant difference (p=0.130). The mean intraoperative blood loss and HBL were 42.5±9.2 mL and 231.5±55.0 mL in Group A, respectively, compared to 53.4±9.02 mL and 262.8±53.3 mL in Group B. Both parameters showed statistically significant intergroup differences (intraoperative blood loss: TBL: p<0.001; HBL: p=0.005). Hemoglobin (Hb) loss was significantly lower in Group A than in Group B, demonstrating a statistically significant difference (p<0.001).

Conclusion: In the perioperative period of anterior cervical surgery for two-level CSM (primarily C3/4-C4/5), HBL represents a clinically significant factor which should not be overlooked. Compared to ACDF, greater attention should be paid to postoperative anemia and HBL in patients undergoing ACCF.

Objectives: The aim of this meta-analysis was to compare the clinical efficacy of robot-assisted total hip arthroplasty (R-THA) versus conventional total hip arthroplasty (C-THA) for the treatment of developmental dysplasia of the hip (DDH).

Materials and methods: Eligible articles published until May 2025 were searched from the Cochrane Library, Web of Science, PubMed, Embase, ScienceDirect, and Springer. Search terms included "robot-assisted", "developmental dysplasia of the hip", "total hip arthroplasty", using mean differences (MDs) and risk differences (RDs) as combined variables, and selecting 95% as the confidence interval (CI).

Results: Seven clinical studies with a total of 876 patients were finally included in this study. There were no significant differences between the two groups in terms of cup inclination (MD=0.07; 95% CI: -0.95 ~ 1.10; p=0.89), cup anteversion (MD=-4.02; 95% CI: -9.59 ~ 1.55; p=0.16), intraoperative bleeding (MD=11.25; 95% CI: -56.02 ~ 78.52; p=0.74), operative time (MD=3.03; 95% CI: -15.66 ~ 21.72; p=0.75), postoperative complications (dislocation [RD=-0.01; 95% CI: -0.03 ~ 0.01; p=0.26], deep infection [RD=0.01; 95% CI: -0.01 ~ 0.02; p=0.37] and nerve injury [RD=0.01; 95% CI: -0.01 ~ 0.03; p=0.56], revision/reoperation [RD=-0.00; 95% CI: -0.03 ~ 0.03; p=1.00], and absolute vertical distance of center of rotation [COR] [MD=-0.50; 95% CI: -1.07 ~ 0.06; p=0.08]). However, compared to the C-THA group, the R-THA group showed significantly higher Harris Hip Score (HHS) (MD=2.17, 95% CI: 0.11 ~ 4.22, p=0.04) and more accurate placement of the horizontal COR (MD=-0.77; 95% CI: -1.21 ~ -0.32; p=0.0008).

Conclusion: In the R-THA group, the accuracy of horizontal placement of the COR was moderately improved, and the postoperative HHS was higher than that in the C-THA group, although such differences might not be obviously perceived by patients. Additionally, no significant differences were found between the two groups in other surgery-related parameters and safety.

Objectives: This study aims to quantitatively compare the biomechanical effects of proximal fibular osteotomy (PFO), total knee arthroplasty (TKA), and combined TKA+PFO on load distribution in the human knee under physiological axial loading.

Materials and methods: Four finite element models were constructed from high resolution computer-aided design (CAD) geometries: intact knee, PFO, TKA (cobalt chromium femoral/tibial components with polyethylene insert), and TKA+PFO. Linear elastic, isotropic material properties were assigned to bone, menisci, and implant components. Each model was meshed with 10 node tetrahedral elements (1-mm element size) in ANSYS workbench 2022 R2. A static axial load of 750 N was applied to the femur; distal tibia and fibula surfaces were fully constrained. Total deformation and von Mises stress were extracted for anterior (A), posterior (P), medial (M), lateral (L), and global maximum (Max) regions, and percentage deviations (Δ) were computed relative to the intact model.

Results: The PFO increased regional deformations by 68 to 74% and redistributed stress posteriorly (+104% in P), with modest stress reductions anteriorly (-11%) and medially (-17%). TKA alone increased deformations by 39 to 46%, while reducing stress by >95% anteriorly, medially, and posteriorly, and ~65% laterally. Both TKA+PFO produced the greatest compliance increase (Δ>114%) and deepest stress off-loading (global Δ ≈-84%). The combined approach synergistically minimized peak stresses (~5.6 MPa) at the expense of maximal deformation (~6.0 mm).

Conclusion: Our study results suggest that PFO and TKA exert distinct biomechanical modifications and their combination offers more satisfactory stress reduction, but markedly increases compliance. We believe that these findings can be used to tailor surgical planning and implant design and to optimize joint mechanics.

Objectives: This study aims to investigate the current status of discharge readiness in elderly osteoporotic vertebral compression fractures (OVCFs) patients and to analyze the factors influencing it, providing a basis for the development of personalized discharge plans and interventions.

Patients and methods: Between January 2025 and April 2025, a total of 356 elderly OVCF patients (141 males, 215 females; mean age: 72.9±8.4 years; range, 60 to 98 years) were included. The following data were collected: general information, the Readiness for Hospital Discharge Scale (RHDS), and the Quality of Discharge Teaching Scale (QDTS). Univariate and multivariate linear regression analyses were employed to further analyze factors related to discharge readiness and the correlation between discharge readiness and the quality of discharge guidance.

Results: The mean total score of discharge readiness of elderly OVCF patients was 87.53±16.90, and the mean score of each item was 7.30±1.41. The quality of discharge guidance was 166.16±25.95 and the mean score of each item was 6.92±1.08. Discharge readiness of elderly OVCF patients was positively correlated with the quality of discharge guidance (r=0.354, p<0.001). Multiple linear regression showed that sex, age, length of stay in hospital, marital status, comorbidities, admission mode, and quality of discharge guidance were independent factors of discharge readiness in elderly OVCF patients (p<0.05).

Conclusion: The readiness for discharge and the quality of discharge guidance of elderly OVCF patients need further improvement. Healthcare professionals should strengthen the patients' readiness for discharge as early as possible after admission according to the patient's actual conditions, to help them smoothly achieve the transition from hospital to home.

Objectives: This study aims to evaluate the impact of tetracalcium phosphate (TTCP) applied directly to the fracture line in a rat femur fracture model.

Materials and methods: Thirty-three male Sprague-Dawley rats weighing 350 to 400 g were randomly and equally divided into three groups: normal control (NC), fracture control (PC), and TTCP treatment group. Standardized femur fractures were created in the PC and TTCP groups and fixed using intramedullary Kirschner wires. In the TTCP group, TTCP dissolved in distilled water was applied directly to the fracture line. All rats were sacrificed on postoperative Day 28. Radiological, histopathological, and biochemical analyses were performed to assess fracture healing.

Results: Radiological scoring revealed significantly higher fracture healing in the TTCP group compared to the PC group on Days 14 and 28 (p<0.05). Histopathological analyses showed reduced inflammation and fibrosis, and increased chondrocyte activity and neovascularization in the TTCP group. On Day 28, serum tumor necrosis factor-alpha (TNF-α) levels were significantly higher in the PC group compared to TTCP and NC, while TTCP values were comparable to NC. No adverse tissue reactions were observed in any group.

Conclusion: The TTCP enhances fracture healing when applied directly to the fracture line, without causing soft tissue irritation or histologically detectable adverse reactions. Its biological activity and ease of application suggest that TTCP may be a promising adjunct in the treatment of complex fractures.