Clinical Orthopaedics and Related Research®最新文献

{"title":"Letter to the Editor: Kinematic Alignment Does Not Result in Clinically Important Improvements After TKA Compared With Mechanical Alignment: A Meta-analysis of Randomized Trials.","authors":"Guiguan Wang","doi":"10.1097/CORR.0000000000003677","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003677","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991659","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: Do Patients With Dominant-side Distal Radius Fractures Have Greater Psychological Distress Than Those With Nondominant-side Fractures?","authors":"Xingwen Han,Ru Zhang","doi":"10.1097/corr.0000000000003667","DOIUrl":"https://doi.org/10.1097/corr.0000000000003667","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"63 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031830","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":"Should We Always Use a Metaphyseal Cone in Conjunction With Tibial Augments for Uncontained Defects? A Finite-element Biomechanical Analysis.","authors":"Fernando J Quevedo González,Andrew J Hughes,Marco Brenneis,Sebastian Braun,Peter K Sculco,Friedrich Boettner","doi":"10.1097/corr.0000000000003669","DOIUrl":"https://doi.org/10.1097/corr.0000000000003669","url":null,"abstract":"BACKGROUNDChoosing the appropriate implants for reconstruction in revision TKA is essential for long-term fixation. While cones and augments are routinely utilized to address tibial defects, the effect of augment location and size on the biomechanical stability of revision TKA constructs and the indications for the use of metaphyseal cones are not known.QUESTIONS/PURPOSESIs the risk of cement-implant debonding of revision TKA constructs impacted by the thickness and location (medial versus bicompartmental) of tibial augments and the presence of metaphyseal cones during (1) a demanding daily activity like stair ascent and (2) torsional loads?METHODSUnder institutional review board approval, we developed patient-specific finite-element models of revision TKA from four patients (three males and one female, ages 50 to 80 years, BMI 27 to 37 kg/m2) who underwent two-stage revision and had a CT scan with no metal artifact after first-stage implant removal. For each patient, we created 5-mm, 10-mm, and 15-mm-thick medial and bicompartmental uncontained defects. We considered two situations for the metaphysis: using a metaphyseal cementless cone into which the implant was cemented or using only cement to fill the metaphyseal cavity. To answer our first question, we conducted finite-element simulations of the immediate postoperative loading scenario representative of stair ascent, while to answer our second research question, we considered an idealized torsional test consisting of 100 N of axial load and twice the axial moment experienced at the same instant of stair ascent. We calculated the risk of cement-implant debonding from an interfacial failure function (calculated as a function of the normal and shear stresses at the cement-implant interface) wherein values of interfacial failure ≥ 1 indicate debonding. Our primary outcome was the cement-implant interface area with ≥ 10% risk of debonding, which we considered to be the interface area with greater than minimal risk of debonding.RESULTSDuring stair ascent, we computed a decrease of the cement-implant interface area with greater than minimal risk of debonding (that is, ≥ 10% risk of debonding) with medial uncontained defects (median [IQR] 2.6% [1.4% to 3.7%] with 15-mm augment) but not with bicompartmental defects (5.2% [3.7% to 5.3%]) compared with the scenario with no uncontained defect (5.2% [3.9% to 5.9%]). Compared with using a metaphyseal cone, using cement alone in the metaphysis increased the interfacial area with greater than minimal risk of debonding, reaching a median (IQR) of 13.8% (11.4% to 14.3%) with a 15-mm bicompartmental defect. Under the torsional load scenario, the increase in the area with greater than minimal risk of debonding was small for medial defects, from a median (IQR) of 4.3% (2.5% to 5.3%) to 4.9% (3.9% to 6.2%) when using a metaphyseal cone and from 7.0% (4.0% to 9.5%) to 7.2% (6.1% to 9.8%) when only using cement in the metaphysis. However, the area at risk of failur","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"116 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031827","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: Modic Changes Are Associated With Increased Pain Intensity, Greater Disability, and Reduced Quality Of Life In Low Back Pain: A Cross-Sectional Study.","authors":"Li Liu, Dazhi Li","doi":"10.1097/CORR.0000000000003673","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003673","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945287","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: What Is the Functional Spinopelvic Relationship in Three Dimensions? A CT and EOS Study.","authors":"Yi Song,Qingyu Xu,Lixin Bi,Zhi Ma","doi":"10.1097/corr.0000000000003671","DOIUrl":"https://doi.org/10.1097/corr.0000000000003671","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"33 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031826","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":"Can Simple Changes in Splinting Technique Reduce Posterior Heel Contact Pressure?","authors":"Erik R Nakken, Kempland C Walley, Carol A Janney, Davin C Gong, Vandan D Patel, David M Walton, Paul G Talusan, James R Holmes","doi":"10.1097/CORR.0000000000003662","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003662","url":null,"abstract":"<p><strong>Background: </strong>Lower extremity splints are commonly used for the treatment of foot and ankle injuries and carry the risk of posterior heel pressure injury. Assessing heel contact pressures in a splint may guide clinicians toward specific splint designs that are associated with lower contact pressures.</p><p><strong>Questions/purposes: </strong>This biomechanical study tested multiple splint characteristics to answer: (1) Which combination of heel position, padding thickness, and padding type (brand) minimizes posterior heel contact pressure? (2) Are there factors while making a splint that are associated with higher contact pressures?</p><p><strong>Methods: </strong>Twenty legs in 10 volunteer participants (mean ± SD age 30 ± 14 years) without current foot or ankle injury were recruited for this biomechanical study. Three of 10 volunteers were female. A pressure transducer was used over the posterior heel to measure contact pressure in a short leg splint. To answer our first research question about the effects of different splint characteristics, we measured contact pressures with 0, 2, 4, 6, 8, and 10 layers of two undercast padding brands, with both resting the heel down and floating the heel freely by placing the leg on a pillow to keep the splinted heel free of contact. Pressures were compared with a threshold of 32 mm Hg, the pressure of dermal arteriolar capillary collapse. To answer our second research question about factors associated with higher contact pressures, we recorded measurements of abnormal pressure spikes and observed the effect of improperly bunched or folded padding behind the heel.</p><p><strong>Results: </strong>Mean contact pressure remained above 32 mm Hg when resting the heel down, independent of padding thickness or brand. Floating the heel, by resting the leg on a pillow, with 6, 8, and 10 layers of thicker undercast padding or 8 and 10 layers of thinner padding reduced pressure below the threshold of 32 mm Hg. The mean contact pressure between 8 and 10 layers of padding was not different (10 layers reduced contact pressure by 4 mm Hg more than 8 layers [95% confidence interval -3 to 11]; p = 0.22). Improperly bunched undercast padding behind the heel increased mean contact pressure roughly threefold compared with evenly applied padding (median 270% increase [range 187% to 575%]).</p><p><strong>Conclusion: </strong>In this study, the best splint configuration consisted of 8 or 10 evenly applied layers of thicker undercast padding when floating the heel. Lower extremity positioning with the heel floating freely appears to be an important modifiable factor to reduce heel dermal pressures. We contend that attention to these details of splint application might reduce the likelihood of pressure ulcers in patients, but future clinical studies of patients with various injuries or other indications for splinting are warranted.</p><p><strong>Clinical relevance: </strong>These findings may be relevant to orthop","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945354","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":"Are Artificial Intelligence Models Reliable for Clinical Application in Pediatric Fracture Detection on Radiographs? A Systematic Review and Meta-analysis.","authors":"Gabriel Fontenele Ximenes,Átila Lobo Costa,Letícia Lima Leite,Lucas Lopes Costa,Matheus Oliveira Ribeiro,Paulo Giordano Baima Colares,Gilberto Santos Cerqueira","doi":"10.1097/corr.0000000000003660","DOIUrl":"https://doi.org/10.1097/corr.0000000000003660","url":null,"abstract":"BACKGROUNDArtificial intelligence (AI) applications for pediatric fracture diagnosis using radiographs have demonstrated growing potential in clinical settings. Despite this growing potential, existing studies are limited by small sample sizes, variability in their diagnostic metrics, and inconsistent use of external validation, which reduces confidence in their findings. These limitations hinder the assessment of real-world performance. A meta-analysis would help address these gaps by pooling data to generate more robust, generalizable estimates for clinical application and future guidance.QUESTIONS/PURPOSES(1) What is the pooled diagnostic performance of AI models, including sensitivity, specificity, and area under the curve (AUC), for detecting pediatric fractures on radiographs? (2) What is the clinical applicability of AI models, as determined by whether their diagnostic performance is sustained in studies that employed external validation? (3) How does anatomic coverage influence the diagnostic performance of AI models?METHODSThis meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered in PROSPERO (CRD42024628342). A systematic search of PubMed/MEDLINE, Embase, and the Cochrane Library was conducted from database inception through December 9, 2024. A total of 497 records were identified. Eligible studies included pediatric patients with suspected fractures evaluated by AI models on radiographs. Studies were excluded if they lacked sufficient data to calculate sensitivity, specificity, or AUC; if they combined adult and pediatric populations; or if they focused on rib fractures. Sixteen diagnostic accuracy studies were included, involving 10,203 pediatric patients with a mean age of 8.85 years, 54% of whom were male, and 21,789 radiographs, of which 5882 confirmed fractures. Data extraction followed the Population, Index test, Target condition (PIT) framework and was performed independently by two reviewers. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, which evaluates four domains (patient selection, index test, reference standard, and flow/timing) for low, high, or unclear risk. Most studies exhibited low to moderate risk of bias. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, which classifies evidence as high, moderate, low, or very low, and in this study demonstrated high certainty of evidence. Heterogeneity in the pooled estimates was moderate for sensitivity (I2 = 61%) and high for specificity (I2 = 90%). No evidence of publication bias was detected based on Egger test (p = 0.54) and funnel plot symmetry. Meta-analyses used logit transformation and bivariate modeling to estimate pooled sensitivity, specificity, and AUC.RESULTSThe pooled analysis demonstrated a sensitivity of 93% (95% confidence interval [CI] 92","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"29 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930109","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":"Value-based Healthcare: Subbing in Special Teams-The Case for Musculoskeletal Experts in the Emergency Department.","authors":"Philippe Dentino,Kevin J Bozic","doi":"10.1097/corr.0000000000003658","DOIUrl":"https://doi.org/10.1097/corr.0000000000003658","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"106 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930108","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®: Which Graft Is Associated With Better Outcomes in ACL Reconstruction? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.","authors":"Prashant Meshram","doi":"10.1097/CORR.0000000000003628","DOIUrl":"10.1097/CORR.0000000000003628","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945315","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: Is Prior Nonoperative or Operative Treatment of Dysplasia of the Hip Associated With Poorer Results of Periacetabular Osteotomy?","authors":"Yeyao Li,Xuejun Dai,Zhongxin Wang,Weiyu Duan,Xin Xin","doi":"10.1097/corr.0000000000003663","DOIUrl":"https://doi.org/10.1097/corr.0000000000003663","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":"18 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930116","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}