BMC Musculoskeletal Disorders最新文献

Background: Differentiating acute from chronic wedge-shaped thoracolumbar vertebral deformities on conventional lateral lumbar radiographs remains clinically challenging, especially when osteoporosis status also needs to be considered. This study aimed to develop and evaluate a You Only Look Once (YOLO)v8n framework for vertebral-level detection and classification of thoracolumbar fractures with osteoporosis-related stratification on lateral lumbar radiographs.

Methods: We retrospectively collected 1352 lateral lumbar radiographs from 1352 patients, with one radiograph per patient. A total of 1774 vertebral fracture segments were manually annotated. Lumbar magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DXA) were used as reference standards to stratify vertebral targets into three categories: acute fracture with osteoporosis, acute fracture without osteoporosis and chronic fracture with osteoporosis. The dataset was divided into training and validation subsets at the patient level. A YOLOv8n detector was trained as the primary model. To strengthen methodological rigor, additional baseline comparison experiments were conducted under the same patient-level training/validation split using YOLOv5n and Faster R-CNN. Detection performance was assessed using precision, recall, F1-score, mean average precision (mAP) 50 and mAP50-95.

Results: On the validation set, the YOLOv8n model achieved a precision of 0.495, recall of 0.482, F1-score of 0.490, mAP50 of 0.506, and mAP50-95 of 0.397. In comparative experiments, YOLOv5n achieved a precision of 0.451, recall of 0.549, F1-score of 0.495, mAP50 of 0.494, and mAP50-95 of 0.367, whereas Faster R-CNN achieved a precision of 0.273, recall of 0.814, F1-score of 0.409, mAP50 of 0.300, and mAP50-95 of 0.217. These findings indicate that YOLOv8n provided the most balanced overall detection performance in the present dataset.

Conclusion: The proposed YOLOv8n framework demonstrated preliminary feasibility for automated vertebral-level detection and classification of thoracolumbar fractures with osteoporosis-related stratification on lateral lumbar radiographs. However, given the moderate overall performance and lack of external validation, the current model should be regarded as an assistive screening tool rather than a standalone diagnostic system.

Background: Subtrochanteric femur fractures are challenging to treat due to complex anatomy and high mechanical stresses. Cephalomedullary nailing is the standard treatment, often performed with the patient supine on a traction table, but this can prolong setup and cause complications (pressure or nerve injuries). Lateral decubitus positioning without a traction table may facilitate reduction and reduce traction-related risks, yet comparative data in subtrochanteric fractures are limited. This study compared outcomes of lateral decubitus versus traction table positioning for subtrochanteric fracture nailing.

Methods: A retrospective cohort study included 68 patients with subtrochanteric femur fractures treated with cephalomedullary nails. Patients underwent surgery supine on a traction table (n = 37) or in lateral decubitus without a traction table (n = 31). Operative metrics (entry point determination time, operative time, fluoroscopy duration, and blood loss) and postoperative outcomes (transfusion requirements, time to mobilization, complications, and final Harris Hip Score) were compared between groups.

Results: Lateral decubitus positioning was associated with shorter entry-point determination time (median 2 vs. 7 min; p = 0.05), shorter operating-room time (80.3 ± 23.6 vs. 108.2 ± 23.2 min; p = 0.03), reduced fluoroscopy time (151.2 ± 19.2 vs. 178.2 ± 16.1 s; p = 0.03), and lower estimated blood loss (752 ± 346 vs. 1459 ± 611 mL; p = 0.01) compared with traction-table positioning. No statistically significant differences were observed in transfusion requirements, time to mobilization, final Harris Hip Score, or complication rates (all p > 0.05).

Conclusion: Compared with traction-table positioning, lateral decubitus cephalomedullary nailing was associated with better functional outcome, shorter operative and fluoroscopy times, and lower estimated blood loss, while union and complication rates were similar between groups. These findings suggest that lateral decubitus positioning is a viable alternative for subtrochanteric fracture fixation, particularly when traction-table setup may compromise operating-room efficiency. Given the observational design and potential confounding related to reduction techniques and surgeon factors, these findings should be interpreted as associations; prospective studies are warranted.

Background: Epidemiological data on injuries and fractures in children under two years of age is limited, thus, we aimed to explore the incidence, patterns and mechanisms.

Methods: Retrospective, population-based cross-sectional study including children under two, seen at the A&E department due to a trauma, or having a radiograph due to birth trauma. All radiographs were re-reviewed.

Results: Four hundred thirty children (49.8% female), mean age 14.7 months (SD 6.8), were included, of whom four had a high-energy trauma and 42 were birth-related. Of 388 children (50.3% female) (mean age 16.3 months, SD 5.1 months) with non-birth related injury, 163 (42.0%) had a fracture (annual incidence 4.3 per 1,000 children; 2.4 per 1,000 infants vs. 6.1 per 1,000 children aged 12 to 24 months of age. 47/163 (28.8%) fractures involved the forearm and 41 (25.2%) involved the leg. Fracture mechanisms 39.9% fall from more than own height/furniture; 17.2% fall from own height, 6.7% crush injury and 6.1% dropped by parent. In 12.9% of the traumas, no mechanism was provided. The number of fractures increased significantly by age group (p=0.027), and the distribution differed, with skull fractures predominating in 0-6-months-old (33.0%), clavicle fractures (33.0%) in 6-12-months-old and forearm fractures in the two older age groups (35.0% and 34.4%, respectively) (p < 0.001). No classic metaphyseal lesions were found in the entire cohort. Four children, all of whom had radiological "red flags", had inflicted injury. Forty-two children had birth-related injury, of whom 50.0% had a fracture (1.1 per 1,000 live births).

Conclusions: Fractures in infants are rare, in particular classic metaphyseal fractures. The occurrence of radiological "red flags" should raise suspicion of non-accidental injury and instigate further assessment.

Background: The surgical rate for distal radius fractures is steadily rising despite limited evidence of its benefits over non-surgical treatment. Using a natural experimental approach, we aimed to compare patient-reported outcomes following surgical versus non-surgical treatment of distal radius fractures.

Methods: Registered in the Swedish Fracture Register by 36 Swedish hospitals from 2013 to 2018, we included a cohort of 13,356 fractures on 13,031 patients aged 18 years or older with distal radius fractures Arbeitsgemeinschaft fur Osteosynthesefragen (AO) 23-A2.1-2, A3, and C1-C3. The observational study utilized differences in the frequency of surgical treatment across hospitals as a source of random treatment assignment and a natural experiment. We assumed that all hospitals encountered a similar range of fractures each year. Therefore, the annual frequency of surgery per hospital was used as a proxy for randomization between surgical and nonsurgical treatment, regardless of each patient's actual treatment. The outcome was the individual Patient Reported Outcome Measures (PROM) at 1 year, with the Arm and Hand Function Index from the Short Musculoskeletal Function Assessment (SMFA) as the primary measure.

Results: The surgical rate per hospital year ranged from 7 to 66%. Surgical treatment was associated with lower Arm and Hand Function Index scores in comminuted intraarticular fractures of type C2 (11.9 units, p = 0.004) and type C3 (19.4 units, p = 0.029). There was a tendency for a positive association with surgical treatment in dorsally angulated extraarticular fractures (23A2.2), but the difference of 5.1 units (p = 0.079) was below the Minimal Clinically Important Difference (MCID). In other extra-articular fractures (23-A2.1 and 23-A3) and simple intra-articular fractures (23-C1), the benefits of surgical treatment were small and also not statistically significant. Several sensitivity analyses were conducted to test the study design, and all supported the primary results.

Conclusions: In this comparison of surgical and non-surgical treatment for distal radius fractures across hospitals with varying surgical rates, comminuted intra-articular distal radius fractures (AO 23-C2/C3) treated surgically were associated with better one-year patient-reported outcomes than those treated non-surgically.

Background: Differentiating between spinal tuberculosis, pyogenic (bacterial) spondylitis and spinal metastasis remains a major diagnostic challenge because their radiological features often overlap. Delayed or incorrect diagnosis may lead to inappropriate treatment, permanent disability or death.

Objective: To develop and evaluate deep learning models for automated classification of spinal tuberculosis, pyogenic infection, and spinal metastasis using magnetic resonance imaging (MRI).

Methods: T2-weighted sagittal MRI scans from 120 patients (40 per disease group) with pathologically or microbiologically confirmed diagnoses between 2014 and 2019 were retrospectively analyzed. Lesion regions were manually annotated by radiologists, and data were split into 80% training and 20% testing sets at the patient level. Extensive data augmentation (rotation ± 5°, zoom 1.1-1.2×, shearing ± 5°, grid distortion 2 × 2) was applied to mitigate overfitting. Three models were trained and compared: (1) a single-layer perceptron baseline, (2) a custom dense neural network (2 × 1024 neurons), and (3) pre-trained convolutional neural networks (ResNet50, VGG16, InceptionV3). Model performance was evaluated using accuracy, precision, recall, and F1-score on both whole and segmented images.

Results: After augmentation, 1,000 synthetic samples were generated per class. The baseline model achieved 27-33% accuracy, whereas the dense and pre-trained models achieved 98-100% accuracy on the test set. Although pre-trained networks demonstrated marginally higher performance, the difference compared with the dense model was not statistically significant. Activation heatmaps revealed inconsistent localization of attention regions, suggesting potential overfitting and limitations in visualization interpretability.

Conclusion: Deep learning models demonstrated strong potential in distinguishing between spinal tuberculosis, bacterial spondylitis, and spinal metastasis on MRI. However, the near-perfect performance likely reflects dataset homogeneity and augmentation effects rather than full generalization. External, multi-center validation and improved interpretability methods (e.g., Grad-CAM) are warranted to confirm clinical applicability and ensure reliable decision support for radiologists.

Background: Chronic ankle conditions often lead to persistent functional limitations. Blood flow restriction (BFR) training is a potential adjunct to rehabilitation, but its specific efficacy for chronic ankle conditions remains to be synthesized.

Objective: To systematically evaluate the effects of BFR-assisted rehabilitation on primary outcomes (dynamic balance and patient-reported ankle stability) and secondary outcomes (ankle range of motion and muscle strength) in individuals with chronic ankle conditions (including chronic ankle instability, chronic ligamentous injury, and tendinopathy).

Methods: A systematic search of PubMed, Web of Science, Embase, CNKI, and Wanfang databases was conducted up to April 13, 2025. We included randomized controlled trials (RCTs) involving adults with chronic ankle instability (CAI) defined by a history of sprain and/or Cumberland Ankle Instability Tool (CAIT) score < 24. Grey literature was excluded. The protocol was registered on PROSPERO (CRD420251249207). Methodological quality was assessed using the Cochrane Risk of Bias (RoB) 1.0 tool. Data were pooled using random- or fixed-effects models.

Results: Seven RCTs (n = 204) were included. The overall risk of bias across the included studies was generally low to moderate. Meta-analysis of post-intervention values indicated that BFR-assisted rehabilitation significantly improved the primary outcome of dynamic balance (MD = 5.75; 95% CI [2.10, 9.40]; P < 0.01; I² = 34%, P = 0.22) compared with conventional rehabilitation. Significant improvements in the other primary outcome, CAIT scores were also observed (MD = 3.68; 95% CI [0.26, 7.11]; P = 0.05). However, secondary outcomes for dorsiflexion and plantarflexion range of motion exhibited high heterogeneity and unstable pooled estimates, showing no significant benefit. Muscle strength data were insufficient for meta-analysis.

Conclusions: BFR-assisted rehabilitation appears to enhance dynamic balance and perceived ankle stability in patients with chronic ankle conditions. However, evidence regarding its effect on joint range of motion remains inconclusive because of data instability. Current evidence supports BFR as a functional intervention, though standardized protocols are needed to further validate its clinical utility.

Background: Direct anterior approach total hip arthroplasty (DAA THA) has become increasingly popular due to its muscle-sparing nature, but it remains technically challenging due to patient-specific anatomical variability. A comprehensive classification system for assessing surgical difficulty in DAA THA is lacking. This study aimed to develop a simple radiograph-based hip anatomic classification to estimate the difficulty of DAA THA.

Methods: This retrospective cohort study analyzed primary, unilateral DAA THA performed by a single surgeon from January 2021 to December 2024. On preoperative radiographs, the horizontal offset distance (HOD) and the vertical offset distance (VOD) between the lateral-most iliac crest and the lateral-most greater trochanter were measured. Restricted cubic splines and receiver operating characteristic curves were used to determine HOD and VOD cutoffs for difficult DAA THA and defined four subtypes (Type A: low VOD/low HOD, Type B: low VOD/high HOD, Type C: high VOD/high HOD, Type D: high VOD/low HOD). Perioperative, radiographic, inflammatory, functional, and complication outcomes were compared using one-way analysis of variance, chi-square and other statistical methods. Subgroup analyses were performed to assess generalizability.

Results: HOD and VOD showed weak, nonlinear inverse associations with operative time. Four subtypes were defined using the optimal cutoffs (HOD = 6.25 mm; VOD = 126.95 mm). Type A had the longest operative time and a less favorable perioperative profile, whereas Type C had the shortest operative time, less total blood loss, more frequent cups within Lewinnek safe zones, and better early functional recovery.

Conclusions: This novel iliofemoral classification stratifies DAA THA technical difficulty and early outcomes and may support preoperative risk stratification and surgical planning.

Purpose: The purpose of the current study was to compare gait characteristics under cognitive dual-tasking and tandem walking in people with and without chronic neck pain.

Methods: Twenty-one adults with a history of non-specific neck pain and twenty-two matched control adults walked on a motorized treadmill under normal and tandem walking with and without a cognitive task. Gait spatiotemporal variables including cadence, stride length, and stride velocity were obtained using the motion analysis system.

Results: In cognitive dual-task condition, people with neck pain had significantly higher dual-task costs (DTC) of cadence (p <.01, ηp2=.45), stride length (p <.01, ηp2=.67), and stride velocity (p <.01, ηp2=.96) compared to controls. The pattern of change was not different between the two groups. All participants showed a shorter stride length, and lower stride length variability in dual-task walking (p <.01, ηp2>.10). Tandem walking resulted in lower cadence in the chronic neck pain group compared to controls (p=.02, ηp2=.11).

Conclusions: This study showed that people with neck pain rely more than healthy subjects on executive-attentional resources to control gait parameters; however, to better understand the dual-task-related gait changes in people with neck pain, further research is required to examine the dual-task gait in more challenging cognitive and walking tasks. Tandem walking should be considered in gait assessment and training of people with neck pain.

Purpose: To analyse the short-term effectiveness of soft bracing in the treatment of adolescent idiopathic scoliosis (AIS) patients in terms of the correction success rate, daily wear time and comfort levels and explore the sources of heterogeneity.

Methods: A literature search was performed using PubMed, EMBASE, Web Of Science, and Cochrane Library from the establishment of the literature database to April 2023. According to the evaluation criteria for the effectiveness of bracing from the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) and the evaluation indicators of the success rate in previous studies, the success rate was defined as a Cobb angle ≤ 5° curve progression at maturity and a terminal follow-up angle < 45°. The success rate of soft bracing was compared with that of observation and rigid bracing. The daily wear time and comfort levels of soft bracing were compared with those of rigid bracing. The data were analyzed using RevMan 5.4, Stata 15.0 and IBM SPSS 25.0.

Results: Twelve studies involving 510 patients were included in the meta-analysis. In the single-arm analysis of 12 studies, the success rate of soft braces was 70% [OR = 0.70, 95% CI (0.61, 0.77), P < 0.0001]. In the double-arm analysis, 4 studies reported that the success rate of soft bracing was lower than that of rigid bracing [RR = 0.66, 95% CI (0.53, 0.81), P < 0.0001]. Three studies reported that the success rate of soft bracing was higher than that of observation [RR = 2.02, 95% CI (1.41, 2.89), P = 0.0001]. According to the subgroup analysis, the success rate of the Cobb angle < 30° was 71% [OR = 0.71, 95% CI (0.63, 0.78), P < 0.00001], and the success rate of the prospective studies was 75% [OR = 0.75, 95% CI (0.70, 0.79), P < 0.00001]. The study types were heterogeneous source and the subgroup with a Cobb angle < 30° had a higher success rate and less heterogeneity. The wear time every day of the brace was 20.83 ± 2.08 h for the soft braces and 12.85 ± 2.08 h for the rigid braces, and there was a significant difference between the two groups (t = 10.39, p < 0.001).

Conclusions: Soft braces had short-term effectiveness for mild to moderate AIS patients compared with observation groups, and they had a lower success rate and higher daily wear time and comfort levels than rigid bracing. The subgroup of patients with a Cobb angle < 30° had a higher success rate and less heterogeneity in terms of soft bracing.

Purpose: To report the clinical and radiographic outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction in patients with recurrent or first-time traumatic patellar dislocation accompanied by multiple anatomical risk factors.

Methods: This retrospective study included 27 patients (27 knees) with a mean age of 22.70 ± 6.27 years (range, 14-35 years) who underwent isolated MPFL reconstruction between June 2019 and December 2023. All patients presented with severe trochlear dysplasia (Dejour types B-D), increased tibial tuberosity-trochlear groove (TT-TG) distance (>20 mm), patella alta (Caton-Deschamps index ≥ 1.2), and lower extremity torsion deformities (femoral anteversion ≥ 25° or external tibial rotation ≥ 30°). Clinical outcomes were evaluated using International Knee Documentation Committee (IKDC), Lysholm, Kujala, and Tegner scores. Radiographic parameters (patellar tilt angle (PTA) and lateral patellar displacement (LPD)) were measured on CT scans preoperatively and postoperatively. Return to sports, patient satisfaction (numeric rating scale 0-10 and categorical grades), redislocation rate, and complications were recorded at final follow-up.

Results: Mean follow-up was 3.14 ± 1.15 years (range, 1-4.42 years). The mean TT-TG distance was 22.22 ± 1.58 mm (range, 20.32-25.91 mm), the mean Caton-Deschamps index (CDI) was 1.41 ± 0.18 (range, 1.22-2.01), the mean femoral anteversion angle was 29.28° ± 3.88° (range, 25.26°-35.41°) and the mean external tibial rotation angle was 35.42° ± 4.54° (range, 30.62°-47.07°). All functional scores improved significantly (P < .001): Kujala (49.30 ± 9.36 to 87.85 ± 4.59), Lysholm (51.41 ± 9.61 to 88.63 ± 5.71), IKDC (44.46 ± 8.69 to 83.04 ± 3.86), and Tegner score (from 2.00 ± 1.03 to 3.67 ± 0.92). PTA decreased from 24.02 ± 7.07° to 7.31 ± 3.45° and LPD decreased from 10.55 ± 4.33 mm to 0.11 ± 6.28 mm (P < .001). One patient had postoperative subluxation and one experienced redislocation after direct trauma. Mean subjective satisfaction was 8.72.

Conclusions: Isolated MPFL reconstruction provides satisfactory short-term clinical outcomes with a low redislocation rate in patients with patellar instability and multiple severe anatomical risk factors.