BMC Musculoskeletal Disorders最新文献

Background: Pediatric septic arthritis requires immediate recognition, as delayed diagnosis can cause severe joint damage and long-term dysfunction. In the absence of guideline-based cut-off values for laboratory markers, surgical decisions are often made on a case-by-case basis. Due to the scarcity of evidence specific to the pediatric population, treatment strategies are often based on adult data, highlighting the need for targeted research in this population. To address this gap, we developed a diagnostic algorithm that incorporated reliable predictive factors.

Methods: Of 443 joint aspirations performed in our clinic (2014-2024), 132 (29.8%) were for suspected septic arthritis. After applying exclusion criteria, 80 cases were included. Clinical (fever, pain with movement, comorbidities), laboratory parameters at the time of joint aspiration (serum CRP, synovial white blood cell count [syWBC], serum white blood cell count [seWBC], synovial neutrophil perventage [syN%] and radiological data (radiographs, CT and MRI if available) were collected. Septic arthritis was defined by detection of pathogens in joint aspirate via culture or PCR.

Results: A pathogen was identified in 25% (20/80) of cases, with Kingella kingae (30%) being the most frequently detected organism, followed by Staphylococcus aureus (25%). Regression analysis revealed CRP (p < 0.01), syWBC (p = 0.04), but not syN% (p = 0.51) as predictors. ROC analysis yielded optimal cutoff values for CRP (69 mg/L; AUC = 0.82; 95% CI 0.71-0.93) and syWBC (65,000 cells/µL; AUC = 0.79; 95% CI 0.66-0.92). A diagnostic algorithm using CRP > 69 mg/L alone, or CRP < 69 mg/L combined with syWBC > 110,000 cells/µL, predicted septic arthritis with a sensitivity of 85% (95% CI 0.62-0.97; p < 0.01) and a specificity of 90% (95% CI 0.79-0.96; p < 0.01).

Conclusion: CRP was slightly more accurate than syWBC in predicting septic arthritis. When combined in an recursive partitioning model, these parameters demonstrated strong diagnostic performance. In cases where CRP measurements may be unreliable, an elevated syWBC count represents a CRP-independent alternative, although with reduced specificity.

Level of evidence: Level III: a retrospective case-control study.

Background: Low back pain (LBP) is a leading cause of disability worldwide. Impaired lumbopelvic control contributes to chronic and recurrent LBP, often presenting as aberrant movement patterns. This study aimed to investigate whether inertial measurement units (IMUs) can classify individuals with no LBP (NoLBP), chronic LBP (CLBP), and a history of LBP (HxLBP) based on lumbopelvic kinematics.

Methods: A total of 141 participants (47 per group) performed ten standardized lumbopelvic movement control tests while wearing IMU sensors. Kinematic parameters, including mean velocity (MV), peak-to-peak amplitude (P2P), and area under the curve (AUC) of acceleration, were extracted. One-way ANOVA was used to compare kinematic differences across groups, and binary logistic regression models were developed to identify predictors for classification. Robustness analyses using 10-fold cross-validation with the least absolute shrinkage and selection operator (LASSO) were also performed.

Results: Significant group differences were found in MV, P2P, and AUC across multiple movement tests (P < 0.05). The most pronounced differences were observed between NoLBP and CLBP: individuals with CLBP were characterized by slower trunk flexion (odds ratio [OR] = 0.94, 95% CI: 0.90-0.98), greater AUC during prone hip rotation (OR = 2.78, 95% CI: 1.45-5.34), and greater P2P during trunk rotation (OR = 1.32, 95% CI: 1.12-1.55). Robustness analyses confirmed the robustness and stability of the classification models.

Conclusion: IMU-derived kinematic parameters provide objective measures of impaired movement control and may support clinical identification of individuals at risk for chronic or recurrent LBP.

Background: Rotator cuff injuries, a leading cause of shoulder pain and dysfunction, present significant diagnostic challenges. While MRI is the diagnostic gold standard, ultrasonography (US) offers a cost-effective alternative but lacks standardization. This study addresses this gap by developing and validating a novel multiparameter ultrasonic scoring system to increase the diagnostic accuracy and clinical applicability of shoulder ultrasonography for rotator cuff pathology.

Methods: A retrospective diagnostic accuracy study of 252 patients with suspected rotator cuff injury was analyzed. Independent predictors identified through multivariable logistic regression included tear width, tendon swelling, synovial effusion, and vascular score, which were integrated into a weighted composite scoring system. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: The scoring system demonstrated excellent discriminative ability, with an area under the ROC curve (AUC) of 0.92. An optimal diagnostic threshold of > 4 points yielded a sensitivity of 82.2% and a specificity of 94.0%. This system enabled risk stratification into three tiers. Multivariate analysis confirmed tear width, degree of tendon swelling, synovial effusion, and vascular score as key diagnostic indicators.

Conclusion: This ultrasonic scoring system introduces a standardized, quantitative approach to rotator cuff diagnostics, designed to reduce interobserver variability and enhance diagnostic reliability. By stratifying patients into risk categories, it facilitates personalized treatment planning. However, as this represents the initial development and internal validation phase, further prospective and external validation studies are warranted to confirm its broader applicability.

Background: Giant cell tumor of bone (GCTB) is a locally aggressive neoplasm with variable biological behavior. Programmed death-ligand 1 (PD-L1) has been implicated in tumor progression across multiple malignancies, but its relationship to growth kinetics in GCTB remains unclear. This study investigated whether PD-L1 mRNA expression correlates with tumor growth rate in extremity GCTB.

Methods: This single-institution retrospective cohort study included 36 patients with GCTB treated surgically between January 2020 and December 2024. Of these, 18 provided consent for research use of tissue; four were excluded due to lack of serial MRI data, yielding a final cohort of 14 patients. PD-L1 mRNA levels were quantified using real-time PCR. Tumor volumes were segmented from MRI using 3D Slicer, and growth rate (cc/month) was calculated. Patients were stratified into high- and low-PD-L1 groups using the cohort median fold change (2.62) as an exploratory cutoff. Group comparisons used Mann-Whitney U and Fisher's exact tests, and Spearman's rank correlation analysis and exploratory linear regressions were performed adjusting for age, sex, tumor site, and preoperative denosumab use.

Results: Median age was 32 years; 57% were male. Tumors with high PD-L1 expression showed faster growth than those with low expression (5.0 [1.3-7.1] vs. 0.8 [0.2-2.1] cc/month; p = 0.038). This relationship was further supported by a significant positive correlation between PD-L1 mRNA levels and tumor growth rate (ρ = 0.6, p = 0.026). The association remained significant in exploratory multivariable and robust regression analyses adjusting for covariates.

Conclusions: Higher PD-L1 mRNA expression correlated with accelerated tumor growth in extremity GCTB. These exploratory findings suggest PD-L1 may serve as a potential biomarker of tumor aggressiveness, warranting validation in larger cohorts.

Purpose: Early clinical recognition of postmenopausal osteoporosis (PMOP) can be challenging. With the advancement of machine learning, several prediction models for PMOP have been developed. This study assessed their performance by carrying out a systematic review and meta-analysis.

Methods: The PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang database and China Science and Technology Journal Database (VIP) were systematically searched. Studies with a sample size of at least 100 and involving postmenopausal women were included Included models were descriptively summarized, and meta-analyses were conducted to derive discrimination estimates. Homogeneous results from different studies were pooled using MedCalc software.

Results: Out of 37,115 identified studies, 21 were included. Most of the models were developed using data from cross-sectional studies and the sample size of included models ranged from 103 to 12,175, totaling 45,383 participants with 16,008 positive events. Several models contained some similar predictors, including age, prior fractures, and body mass index (BMI). We also conducted a meta-analysis that included 22 models with reported AUC and its 95% confidence interval (95% CI), which demonstrated that the prediction models have good discriminative performance. The most frequently observed predictive variables include age, weight, body mass index (BMI), menopause status, height, fracture history, lower limb cramps, fatigue, waist circumference，diabetes mellitus，hyperlipidemia and glucocorticoids.

Conclusions: We found that the PMOP prediction models demonstrated promising performance. However, this review also highlights several potential limitations of current approaches, including a high risk of bias and limited external validation. Future research should aim to refine these models using larger and more diverse populations, as well as by incorporating additional risk factors to improve their clinical applicability.

Background: The Tip-Apex Distance (TAD) is known to affect outcomes of traditional implants such as sliding hip screws (SHS). However, it is unclear if the TAD has the same effect on the Femoral Neck System (FNS). This study aimed to assess if the TAD is a predictor of FNS failure and report outcomes of FNS at our institution.

Methods: This retrospective, single-centre study included 46 patients who underwent FNS for femoral neck fractures (FNF) between 2017 and 2022. Radiographic and clinical factors were analysed. Outcomes reported include intra-operative duration, length of hospitalization and failure rate. Failure was defined as the presence of complications like cut-out, breakage, avascular necrosis (AVN) or neck shortening. Scale data were analysed with Unpaired Student T-test and Mann-Whitney U test. Categorical data were assessed with Pearson χ2 or Fischer's exact test where appropriate. Binary logistic regression was performed for risk factors.

Results: Mean age was 69.6 years old. Mean follow-up was 20.4 months. Median operation duration was 53.5 minutes. Median length of stay was 9 days. Failure rate was 15.2% (n = 7), consisting of two cut-outs, three AVN, one neck shortening and one distal screw breakage. Re-operation rate was 8.7% (n = 4). Mean TAD was 16.8 mm and 18.1 mm in the failure and non-failure groups respectively (P = 0.431) and was not a significant risk factor for failure on logistic regression testing (p = 0.444). Osteoporotic BMD value was more prevalent in the failure group (71.4%) but was not a significant risk factor for failure on logistic regression (P = 0.056). Quality of reduction, age, body mass index (BMI) and pre-operative Garden's score were also insignificant on logistic regression. (P > 0.05) CONCLUSION: The TAD is not a reliable predictor of FNS implant failure for treatment of FNFs. Overall, the FNS is a reliable device with a low failure rate, a short operative time, and a short length of stay comparable to that reported in the literature and with traditional implants.

Objectives: Intraosseous hemangioma (IH) is a rare benign vascular tumor of bone, infrequently observed in tubular bones. The imaging characteristics of IH in these locations remain poorly defined. This study aimed to characterize the imaging features and clinical management of IH in tubular bones.

Methods: This retrospective analysis reviewed the imaging and clinical data of 10 patients with histopathologically confirmed IH of tubular bones.

Results: Of the 10 patients, seven were female (70%) and three were male (30%), with ages ranging from 10 to 75 years (mean ± SD, 40.1 ± 22.8 years). Nine patients (90%) presented with localized pain and swelling. Radiographic findings included six purely osteolytic lesions (60%), three with a soap-bubble appearance (30%), and one lesion (10%) was heavily calcified with a lobulated morphology. Among intramedullary cases, three showed cortical destruction, two had pathological fractures. Two lesions (20%) were confined to the cortex, demonstrated cortical thickening, sclerosis, and internal lytic changes. MRI revealed iso- or hypointense on T1WI and hyperintense on T2WI/STIR in three patients (30%). One patient (10%) displayed patchy hyperintensity on both T1WI and T2WI, with partial hypointensity on T2-STIR. Flow voids corresponding to low-signal blood vessels were seen in four patients (40%), while one (10%) exhibited a hypervascular lesion. Among the four patients who underwent contrast-enhanced CT or MRI, all marked heterogeneous enhancement. Nine patients (90%) were treated with curettage of the lesion, while one patient (10%) underwent complete lesion excision. In one hypervascular case, preoperative DSA embolization was performed.

Conclusion: Intraosseous hemangioma of tubular bones predominantly present as osteolytic lesions with characteristic soap-bubble morphology on radiographs. Recognition of intralesional vascular structures is critical for diagnosis. Imaging modalities, particularly CT and MRI, enable precise lesion characterization and assist in surgical planning. In hypervascular cases, preoperative embolization guided by vascular imaging can effectively minimize intraoperative bleeding risk.

Purpose: Thoracic hyperkyphosis (THK) is a prevalent spinal deformity in adolescents, which can impair respiratory function by affecting diaphragm morphology and thoracic mechanics. This study investigates the relationship between THK and diaphragmatic thickness using ultrasonography (USG) to explore its diagnostic and therapeutic implications.

Methods: This prospective study included 25 adolescents with THK and 29 healthy controls. Diaphragmatic thickness was measured using ultrasonography at the end of inspiration and expiration, and spirometry was conducted to assess respiratory function. Thoracic hyperkyphosis was diagnosed based on Cobb angle measurements. Statistical analysis included regression and ROC analyses to determine predictors of THK and evaluate diagnostic accuracy. The study was approved by the local Ethics Committee of the University of Healthy Science, Gaziosmanpasa Training and Research Hospital (IRB number: 109, date: 16 August 2023). The study protocol was registered to the clinicaltrial.gov.tr (NCT06418334 and initial release date: 01/11/2024).

Results: Adolescents with THK exhibited significantly higher Cobb angles (59.3 ± 7.9°) compared to controls (34.6 ± 3.7°, p < 0.001). Diaphragmatic thickness during inspiration (2.5 mm vs. 3.1 mm, p = 0.125) and expiration (1.50 mm vs. 1.56 mm, p = 0.965) was lower in the THK group, with significant reductions in thickening ratio (1.76 ± 0.29 vs. 1.98 ± 0.30, p = 0.008) and thickening fraction (DTf) (75.4% vs. 97.6%, p = 0.008). A negative correlation was observed between Cobb angle and diaphragmatic thickening (r=-0.378, p = 0.005). ROC analysis indicated that USG parameters, particularly thickening fraction (AUC = 0.72, p = 0.002), are reliable predictors of THK.

Conclusion: Adolescents with THK demonstrate reduced diaphragmatic thickness and impaired respiratory function. Ultrasonography emerges as a valuable, non-invasive tool for early diagnosis and monitoring of THK, offering potential for timely intervention to mitigate respiratory complications.