Clinical Orthopaedics and Related Research®最新文献

{"title":"Letter to the Editor: Virtue Ethics in a Value-driven World: It Is What It Is.","authors":"James D Michelson","doi":"10.1097/corr.0000000000003713","DOIUrl":"https://doi.org/10.1097/corr.0000000000003713","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"83 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Should We Always Use a Metaphyseal Cone in Conjunction With Tibial Augments for Uncontained Defects? A Finite-element Biomechanical Analysis.","authors":"Bernardo Innocenti","doi":"10.1097/CORR.0000000000003710","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003710","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the Letter to the Editor: Is Prior Nonoperative or Operative Treatment of Dysplasia of the Hip Associated With Poorer Results of Periacetabular Osteotomy?","authors":"Zhendong Zhang, Dianzhong Luo, Hong Zhang","doi":"10.1097/CORR.0000000000003704","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003704","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bias or Best Fit? A Comparative Analysis of the SEER and NCDB Data Sets in Single-model Machine Learning for Predicting Osteosarcoma Survival Outcomes.","authors":"Andrew G Girgis,Bishoy M Galoaa,Megan H Goh,Marcos R Gonzalez,Santiago A Lozano-Calderón","doi":"10.1097/corr.0000000000003701","DOIUrl":"https://doi.org/10.1097/corr.0000000000003701","url":null,"abstract":"BACKGROUNDMachine-learning models are increasingly used in orthopaedic oncology to predict survival outcomes for patients with osteosarcoma. Typically, these models are trained on a single data set, such as the Surveillance, Epidemiology, and End Results (SEER) or the National Cancer Database (NCDB). However, because any single database, even if it is large, may emphasize different data points and may include errors, models trained on single data sets may learn database-specific patterns rather than generalizable clinical relationships, limiting their clinical utility when applied to different patient populations.QUESTIONS/PURPOSESWe developed separate machine-learning models using SEER and NCDB databases and (1) compared the accuracy of SEER- and NCDB-trained models in estimating 2- and 5-year overall survival when validated on their respective databases, (2) assessed which database produced a more generalizable machine-learning model (defined as one that maintains high performance when applied to unseen external data) by using the model trained on one database to externally validate the other, and (3) identified key factors contributing to prediction accuracy.METHODSFrom 2000 to 2018 (SEER) and 2004 to 2018 (NCDB), we identified 15,241 SEER patients and 11,643 NCDB patients with osteosarcoma. After excluding patients with tumors outside the extremities/pelvis, including unconfirmed osteosarcoma histology results (52% [7989] SEER, 22% [2537] NCDB) and those with missing metastasis, treatment, or prognosis data (20% [2974] SEER, 43% [5057] NCDB), we included 4049 patients from NCDB and 4278 patients from SEER, all with confirmed osteosarcoma. SEER provides population-based coverage with detailed staging but limited treatment information, while NCDB offers hospital-based data with comprehensive treatment details. We developed separate models for each data set, randomly splitting each into training (80%) and validation (20%) sets. This separation was crucial because it allowed us to test how well our models performed on completely new, unseen data-to test whether a model will work in real-world clinical practice. Primary outcomes included accuracy (proportion of correct predictions), area under the receiver operating characteristic curve (AUC) (discriminative ability between survival outcomes, with values > 0.8 indicating good performance), Brier score (probabilistic prediction accuracy, with values < 0.25 indicating useful models), precision (proportion of positive predictions that were correct), recall (sensitivity for identifying actual outcomes), and F1 score (harmonic mean of precision and recall). The median patient age was 22 years in the NCDB versus 17 years in SEER (p = 0.005), with similar sex distributions (56% male in NCDB, 56% male in SEER) but different racial compositions and overall survival rates (72% and 52% at 2 and 5 years, respectively, for NCDB versus 65% and 43% for SEER).RESULTSInternal validation showed excellent performanc","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"97 8 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Factors Are Associated With Acute Compartment Syndrome After Gunshot Injuries to the Upper Extremity?","authors":"Julia Nascimben,Charles Liu,George Jacob Wolf,Jennifer Moriatis Wolf,Jeffrey Stepan,Jason Strelzow","doi":"10.1097/corr.0000000000003697","DOIUrl":"https://doi.org/10.1097/corr.0000000000003697","url":null,"abstract":"BACKGROUNDFirearm-related injuries are a growing cause of morbidity and mortality in the United States, with varying odds of acute compartment syndrome (ACS) and other complications reported in the research. ACS is associated with higher complications after injury, including infection, need for repeat surgery, and functional loss, with the forearm being one of the most common sites for ACS. Although ACS in gunshot-related injuries has been studied, existing research documents wildly variable odds of developing ACS, with much of these data derived from military sources with high-energy weapons or inclusive of upper and lower extremity injuries.QUESTIONS/PURPOSES(1) What proportion of patients with upper extremity gunshot wounds (GSWs) experienced ACS? (2) Which patient- or injury-related factors, such as vascular injury, are associated with the development of ACS? (3) What postoperative complications are associated with ACS after gunshot injuries?METHODSBetween May 2018 and January 2023, we treated 1740 patients with GSWs presenting to a single, urban Level 1 trauma center. After excluding lower limb and torso injuries, 773 patients with upper extremity injuries were identified, of which 42 left hospital care prior to assessment and therefore had no data for analysis, leaving 731 for inclusion. As part of our institutional standard, GSWs are trauma activations with a recommended 12 to 24 hours of observation followed by discharge with strict and specific return precautions and education on the signs and symptoms of compartment syndrome. Patient demographics, injury characteristics, and outcomes were collected through reviews of the electronic medical record (EMR) and a longitudinally maintained trauma database, which reflects a combination of 60% blunt and 40% ballistic injuries. Institutionally, the population with GSWs is predominantly male (90%), with a mean age of 32 years and injuries to the torso, pelvis and acetabulum, and the long bones, as well as periarticular fractures. Identification of patients with ACS was performed using the institutional trauma database followed by a search of the EMR for relevant Current Procedural Terminology codes and clinical documentation of gunshot injury and compartment syndrome, followed by manual chart review that specifically included patients without signs of ACS to capture those at risk, even if they did not go on to surgery. Univariate analysis was conducted to identify associations with ACS.RESULTSIn patients with gunshot injuries to the upper extremity, we found that 2% (12 of 731) developed ACS, with all subsequent surgically treated patients undergoing forearm fasciotomy. Vascular injury was the only factor associated with the development of ACS OR 47 [95% confidence interval (CI) 12 to 181]; p < 0.001). Other variables, including fracture location and polytrauma, were not associated with the development of ACS. Patients who developed ACS had a high risk of persistent postoperative neurologic defic","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"64 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Editorial: Coming Back to Work After a Wrong-site Surgical Procedure.","authors":"Ethan Lichtblau","doi":"10.1097/corr.0000000000003702","DOIUrl":"https://doi.org/10.1097/corr.0000000000003702","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"106 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145241024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cochrane in CORR®: Direct Factor Xa Inhibitors Versus Low Molecular Weight Heparins or Vitamin K Antagonists for Prevention of Venous Thromboembolism in Elective Primary Hip or Knee Replacement or Hip Fracture Repair.","authors":"Kim Madden","doi":"10.1097/CORR.0000000000003692","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003692","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spine Stiffness Leads to High Pelvic Mobility: Uncoupling Native Mechanics and Explaining Why Patients With Stiff Spines Have Increased Dislocation Risk.","authors":"Jeroen C F Verhaegen,Moritz M Innmann,Christian Merle,Nuno A Batista,Philippe Phan,George Grammatopoulos","doi":"10.1097/corr.0000000000003691","DOIUrl":"https://doi.org/10.1097/corr.0000000000003691","url":null,"abstract":"BACKGROUNDPatients with stiff spines are at increased risk of instability after THA because of pelvic stiffness. Comprehensive study of patients with a stiff spine without hip arthritis could provide insight into native compensatory mechanisms and provide guidance on the mechanics to account for after arthroplasty.QUESTIONS/PURPOSESThe primary aim of this study was to characterize static and dynamic compensatory mechanics that occur in the presence of either a stiff hip or stiff spine. The secondary study aims were to assess which spinopelvic imaging modalities would best uncouple compensation mechanisms and to test the effect of length of spinal fusion (that is, number of fused segments) on the existing compensatory mechanics.METHODSThis was a prospective, case-control study performed at two academic tertiary referral centers. The cohort studied included three groups: (1) the control group of asymptomatic volunteers without signs of hip osteoarthritis or history of spinal surgery (n = 52); (2) the hip group of patients with osteoarthritis treated with THA between 2018 and 2019 (n = 512), excluding those with age < 18 years (n = 2), BMI > 40 kg/m2 (n = 9), different diagnosis than osteoarthritis (n = 117), history of spinal or lower limb disease or surgery (n = 206), neurologic comorbidities (n = 17), absence of study consent (n = 20), or without spinopelvic radiographs (n = 17), in which the included patients (n = 124) were matched for age, sex, and BMI to the control group, resulting in the final hip group of 52 patients; and (3) the spine group were patients seen in clinic between 2023 and 2024 (n = 121), 1 year after spinal fusion, excluding those with BMI > 40 kg/m2 (n = 10), hip osteoarthritis or surgery (n = 16), neuromuscular disease (n = 1), spinal fusion not including lumbar spine (n = 1), or without spinopelvic radiographs (n = 41), leaving 52 patients. The whole cohort comprised 60% (93 of 156) females, and the mean ± SD age was 64 ± 11 years. All underwent standing, relaxed-, and deep-seated radiographs to determine static characteristics: lumbar lordosis, pelvic tilt, pelvic-femoral angle, and pelvic incidence. Dynamic characteristics included difference in pelvic tilt, lumbar lordosis, and pelvic-femoral angles between standing and relaxed- or deep-seated positions, thereby determining which imaging modality best uncoupled compensatory mechanisms. Correlation between the number of fused segments and spinopelvic parameters was assessed using Spearman correlation coefficient.RESULTSWhen standing, the spine group had a higher mean ± SD pelvic-femoral angle than the control (197° ± 7° versus 186° ± 10°, mean difference -11° [95% confidence interval (CI) -14° to -7°]; p < 0.001) and hip group (197° ± 7° versus 183° ± 11°, mean difference -14° [95% CI -18° to -10°]; p < 0.001) and a higher pelvic tilt compared with the control (20° ± 9° versus 15° ± 8°, mean difference -5° [95% CI -8° to -2°]; p = 0.003) and hip group (20° ± 9° versus 15","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"41 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: All-inside ACL Reconstruction Offers No Advantage in Clinical Outcomes, Graft Healing, or Tunnel Widening Compared With the Complete Tibial Tunnel Technique: A Prospective Randomized Trial.","authors":"Robert A Teitge","doi":"10.1097/CORR.0000000000003698","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003698","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Are the Complications, Functional Outcomes, and Health-related Quality of Life of Bone-anchored Prostheses in Transfemoral Amputees? A Comparison of Single- and Two-stage Surgery Over Time.","authors":"David Reetz,Zadakiel-Kyrillos M Saleib,Esther M M Van Lieshout,Michael J R Edwards,Michiel H J Verhofstad,Mark G Van Vledder,Oscar J F Van Waes,Jan Paul M Frölke,Ruud A Leijendekkers","doi":"10.1097/corr.0000000000003652","DOIUrl":"https://doi.org/10.1097/corr.0000000000003652","url":null,"abstract":"BACKGROUNDThe insertion of an osseointegration implant providing direct skeletal attachment to an external prosthesis, creating a bone-anchored prosthesis (BAP), is an alternative for patients who have a lower limb socket-suspended prosthesis with socket-related problems. Historically, the osseointegrated implant was inserted in a two-stage procedure for safety reasons; however, the single-stage procedure is being performed and reported on as well. Because there are no studies comparing these two treatment strategies, we conducted this study to investigate complication rates, functional outcomes, and health-related quality of life (HRQoL).QUESTIONS/PURPOSESDid patients who underwent single-stage surgery, compared with two-stage surgery, (1) have a lower frequency of adverse events, (2) have faster rehabilitation times and fewer sessions needed for completing the rehabilitation program, (3) perform better on the Timed Up and Go (TUG) test and 6-Minute Walk Test (6MWT), and (4) have superior HRQoL and prosthesis wearing time?METHODSBetween May 2009 and October 2019, Radboud UMC treated 238 patients with BAP, and between September 2017 and December 2019 treated 180 patients, of which 34% (62) had transfemoral amputation and an indication for the standard BAP in a two-stage surgery. Erasmus MC treated 57 patients, of which 51% (29) had transfemoral amputation and an indication for the standard BAP in a single-stage surgery. All patients were considered potentially eligible if they could provide written informed consent. Based on that, all patients were eligible, and of those from Radboud UMC, all were included; a further 3% (2 of 62) were lost at 2-year follow-up because of emigration. For patients from Erasmus MC, a further 10% (3 of 29) were excluded because 7% (2 of 29) did not provide informed consent and 3% (1 of 29) died of nontreatment-related causes. A total of 88 patients remained, with 86 patients remaining at 2-year follow-up. We performed a double-center, retrospective study of patients ages 18 years and older with 2 years of follow-up who were fitted with unilateral osseointegrated implants for a BAP through either single-stage (Erasmus MC, Rotterdam) or two-stage (Radboud UMC, Nijmegen) surgery between December 2014 and November 2019. Both hospitals are Level 1 trauma centers in The Netherlands. Surgeons at Radboud UMC began performing two-stage surgery in 2009 and eventually transitioned to single-stage surgery. Erasmus MC started in 2017 with BAP and exclusively performed single-stage surgery. Patients were eligible for osseointegrated implant surgery if they had demonstrated failure of previous treatments with socket prostheses. The respective clinical teams at each center conducted baseline assessments and postoperative follow-up at 6 months, 1 year, and 2 years as part of routine clinical care, independent of this study. The only differences in patient characteristics were that patients in the two-stage group were younger (mean ± S","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"18 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}