International Orthopaedics最新文献

{"title":"Smartphone addiction, thumb-wrist symptoms, and first extensor compartment ultrasonographic findings in young adults: a multicentre prospective study with six-month follow-up.","authors":"Mehmet Ali Bozca, Malik Çelik, Yusuf Altuntaş, Enver İpek, Müjdat Bankaoğlu, Cemal Kural","doi":"10.1007/s00264-026-06950-9","DOIUrl":"10.1007/s00264-026-06950-9","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the relationship between smartphone addiction and thumb-wrist symptoms and first dorsal compartment ultrasonographic abnormalities in young adults, and to investigate whether addiction severity and usage patterns are associated with these findings.</p><p><strong>Methods: </strong>This multcentre prospective observational study included 477 university students aged 18-30 years. Smartphone addiction was assessed using the Smartphone Addiction Scale-Short Version (SAS-SV). Clinical evaluation included bilateral Finkelstein testing and pain assessment using the Visual Analog Scale (VAS). Standardized ultrasonographic examinations of the first dorsal extensor compartment were performed according to OMERACT recommendations. Tendon sheath thickening, fluid accumulation, retinacular thickening, and Doppler activity were recorded as positive findings. Participants classified as addicted at baseline were reassessed at six months and re-stratified according to their follow-up addiction status.</p><p><strong>Results: </strong>Smartphone addiction was significantly associated with female sex, symptom presence, higher pain scores, longer daily smartphone use, and increased ultrasonographic abnormalities on both dominant and non-dominant sides (all p < 0.001). Addicted participants demonstrated higher VAS scores and greater prevalence of bilateral ultrasonographic findings compared with non-addicted individuals. Dominant-side ultrasonographic abnormalities were associated with addiction status, symptom presence, and daily usage duration, whereas non-dominant-side findings were additionally associated with grip pattern. Among baseline-addicted participants reassessed at six months, those who no longer met the addiction threshold showed significant reductions in pain scores and regression of ultrasonographic findings, whereas those who remained addicted demonstrated persistence or progression of symptoms and structural findings despite partial reductions in screen time.</p><p><strong>Conclusion: </strong>Smartphone addiction is associated with increased thumb-wrist symptoms and first dorsal compartment ultrasonographic abnormalities in young adults. These findings suggest that excessive smartphone use may represent a relevant biomechanical exposure contributing to early tendon changes. Behavioral modification may facilitate partial recovery, whereas persistent abnormalities in addicted individuals highlight the importance of addressing usage behavior in prevention and management strategies. Further longitudinal studies with objective exposure measurements are warranted.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2505-2515"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarifying the interpretation of total hip arthroplasty free survival after intraosseous bone marrow concentrate for hip osteoarthritis.","authors":"Ziwen Jiang, Yumei Chen","doi":"10.1007/s00264-026-06992-z","DOIUrl":"10.1007/s00264-026-06992-z","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2763-2764"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aseptic glenoid baseplate loosening after reverse total shoulder arthroplasty with a lateralized convex baseplate: helical blade versus central peg fixation.","authors":"Aurélien Klein, Laurent Nové-Josserand, Philippe Collotte, Stanislas Gunst","doi":"10.1007/s00264-026-07006-8","DOIUrl":"10.1007/s00264-026-07006-8","url":null,"abstract":"<p><strong>Purpose: </strong>To compare aseptic glenoid baseplate loosening (AGBL) and AGBL-free survival after primary reverse total shoulder arthroplasty (RTSA) using a lateralised convex baseplate with either helical blade or central peg fixation.</p><p><strong>Methods: </strong>Multicentre retrospective analysis of 231 primary RTSAs with ≥ two years follow-up (helical blade, n = 127; central peg, n = 104), all with non-locking peripheral screws. AGBL was assessed radiographically; septic and post-traumatic loosenings were not classified as AGBL. AGBL rates and survival times were compared using Kaplan-Meier estimates and log-rank tests. Clinical outcomes were assessed in 219 unrevised shoulders.</p><p><strong>Results: </strong>Mean follow-up was 4.4 ± 1.8 years (range, 2 to 9.5 years). AGBL occurred in 9/231 cases (3.9%): in 7/127 cases (5.5%) in the helical blade group and 2/104 cases (1.9%) in the central peg group (p = 0.16). AGBL-free survival was similar in both groups (log-rank p = 0.38). Revisions were performed in 8/127 cases in the helical blade group (6.3%) and in 4/104 cases in the central peg group (3.8%; p = 0.40). Both groups had similar clinical improvement: the overall Constant score at last follow-up was 67.6 ± 15.0 and the mean subjective shoulder value was 80.3 ± 15.6. Complication rates did not differ significantly between the two groups.</p><p><strong>Conclusion: </strong>In these patients who underwent RTSA using a lateralised convex baseplate, AGBL rates and functional improvement at two years' follow-up did not differ significantly between helical blade and central peg fixation.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2643-2650"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neglected infected Charcot neuroarthropathy of the ankle: limb salvage using a one-stage reconstruction by distraction histogenesis principles.","authors":"Gamal Ahmed Hosny, NourEldin Elmesalamy, Ahmed Abdelnaser","doi":"10.1007/s00264-026-07016-6","DOIUrl":"10.1007/s00264-026-07016-6","url":null,"abstract":"<p><strong>Introduction: </strong>Neglected Infected Charcot neuroarthropathy (CN) of the ankle remains one of the most challenging problems in orthopaedic surgery. Traditionally, below-knee amputation (BKA) has been regarded as a common approach for these complex cases, reflecting the morbidity associated with prolonged and often unsuccessful reconstruction. However, advances in the principles of distraction histogenesis and circular external fixation offer a feasible option for limb salvage.</p><p><strong>Patients and methods: </strong>We report our experience with a specialized management protocol characterized by a one-stage procedure, the \"corticotomy-first\" technique, and non-radical debridement, applied in a series of 55 patients with Eichenholtz stage III Charcot neuroarthropathy of the ankle. Osteomyelitis was suspected clinically and radiographically in all patients, with active infection present in 45.5% of cases at the time of reconstruction and the remainder demonstrating chronic quiescent osteomyelitis.</p><p><strong>Results: </strong>By leveraging the angiogenic potential of distraction histogenesis principles, functional weight-bearing and limb preservation were achieved in the large majority of patients, including those with chronic ulceration, wheelchair dependency, and multi-drug resistant infection. Limb salvage was achieved in 52 of 55 patients (94.5%), radiographic union in 48 patients (87.3%), and independent ambulation in 50 patients (90.9%).</p><p><strong>Conclusion: </strong>We present our clinical rationale together with representative cases that illustrate this technique as an alternative reconstructive strategy for limb salvage in Neglected Infected Charcot neuroarthropathy of the ankle.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2621-2633"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the suitability of the Triathlon total knee replacement system as an alternative for former users of PFC; a single surgeon prospective cohort study.","authors":"Hannah Jones, Christopher Woodward, Peter Lewis","doi":"10.1007/s00264-026-06941-w","DOIUrl":"10.1007/s00264-026-06941-w","url":null,"abstract":"<p><strong>Introduction: </strong>Total Knee Replacement (TKR) implant selection is of paramount importance. The PFC TKR (DePuy Synthes), was a popular TKRs in the UK. As PFC has been phased out, surgeons have had to select a new implant. The replacement Attune system had some early concerns about loosening. Triathlon (Stryker), is another popular TKR in the UK. The aim of the project is to evaluate the Triathlon Knee system's introduction to an experienced PFC utilising team and asses whether PROMs and long term survival are comparable.</p><p><strong>Methods: </strong>We performed a prospective cohort study assessing 38 PFC and 45 Triathlon TKRs performed by a single surgical team form 2014-2015, at separate elective sites. Oxford Knee Score (OKS) at 4.5 months and one year were compared. Survival in terms of risk of revision was studied up to ten years.</p><p><strong>Results: </strong>83 TKRs were included; 38 PFC and 45 Triathlon. Mean age of both groups was 68, and mean ASA grade was 2.2 and 2 respectively. There was no statistical difference in group demographics. At 4 ½ months mean OKS of PFC was 31.9 compared to 28 for Triathlon. By one year this difference narrowed, with similar scores; 31.2 PFC, 31.1 Triathlon. At ten years only one (Triathlon) TKR was revised, due to infection. 11 patients underwent sequential bilateral total knee replacements with one side PFC and the other Triathlon. There was no significant difference in PROMS at 4 ½ months 17 vs 14.3 for PFC and Triathlon respectively (p value 0.49) or one year (p value 0.78), with OKS of 18.1 vs 19.6. for PFC and Triathlon.</p><p><strong>Discussion: </strong>Overall, our study should support surgeons in deciding on implant choice post PFC withdrawal. Amongst the alternative systems available, that may well be suitable implants to use, the Triathlon is a valid choice. While NJR data already demonstrates excellent survival of Triathlon, our study demonstrates a smooth transition of the lead surgeon and wider team, to using Triathlon, having been experienced in PFC.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2571-2576"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischial tuberculosis: MRI and mNGS enable early diagnosis in the largest reported case series of twenty two patients.","authors":"Yongchao Li, Jianfeng Li, Heng Wang, Jun Fan, Kai Tang, Guangxuan Yan, Weijie Dong, Tinglong Lan","doi":"10.1007/s00264-026-06939-4","DOIUrl":"10.1007/s00264-026-06939-4","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the clinical features, diagnosis, treatment, and prognosis of ischial tuberculosis (IT), and to evaluate the diagnostic value of MRI and mNGS in the largest reported case series to date.</p><p><strong>Methods: </strong>Data from 22 patients with confirmed IT treated between January 2013 and January 2023 were retrospectively reviewed. Diagnosis was based on histopathology, microbiology, and molecular tests.</p><p><strong>Results: </strong>The mean age was 31.6 years (11 to 67). Common symptoms included gluteal pain (100.0%), sitting-induced pain (81.8%), and local swelling (59.1%). Computed tomography (CT) revealed lesions in 86.4% of patients, while magnetic resonance imaging (MRI) showed abnormalities in all 18 patients examined. The ischial tuberosity was the most common site of involvement (63.6%). The T-cell spot test for tuberculosis infection (T-SPOT.TB), Xpert Mycobacterium tuberculosis/rifampicin resistance assay (Xpert MTB/RIF), and metagenomic next-generation sequencing (mNGS) showed positivity rates of 83.3%, 83.3%, and 100%, respectively. Histopathological granulomas were observed in 77.3%. Overall, 68.2% underwent surgical debridement. All patients achieved clinical cure with no recurrence at a mean follow-up of 34.7 months.</p><p><strong>Conclusion: </strong>IT has an insidious onset. MRI (100% sensitivity) is valuable for early diagnosis, and molecular tests, particularly mNGS (100% detection rate), enhance pathogen detection. Surgical debridement combined with standard chemotherapy achieved clinical cure in all patients, but comparative studies are needed to confirm its superiority over conservative treatment.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2533-2541"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral stem alignment and post-operative patient satisfaction: a retrospective analysis of total hip arthroplasty using computer-assisted equipment for placing cups.","authors":"Hiroki Kaneta, Takeshi Shoji, Shinichi Ueki, Hiroyuki Morita, Yosuke Kozuma, Naoto Nakayama, Shuhei Yamasaki, Nobuo Adachi","doi":"10.1007/s00264-026-06949-2","DOIUrl":"10.1007/s00264-026-06949-2","url":null,"abstract":"<p><strong>Purpose: </strong>Using computer-assisted equipment (CAE) in total hip arthroplasty (THA) has facilitated improved accuracy of acetabular cup placement, but the impact of aligning the femoral stem on post-operative patient satisfaction remains unclear. In this study, we evaluated the post-operative patient-reported outcome measures (PROMs) and identified factors related to femoral stem alignment associated with post-operative PROMs after THA.</p><p><strong>Methods: </strong>This retrospective study included 200 patients (205 hips; mean age, 67.3 ± 9.8 years) undergoing THA using CAE for acetabular cup placement at our hospital. Alignment parameters of the femoral stem, including stem anteversion, change in stem anteversion, femoral offset, and coronal and sagittal stem angles, were evaluated using computed tomography scans and radiographs. Patients were categorised into the normal and Low&High alignment groups based on predefined, clinically acceptable ranges and deviation from native femoral anatomy. Patient satisfaction was assessed using a visual analogue scale and clinical outcomes were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) at one year post-operatively.</p><p><strong>Results: </strong>Patients in the normal alignment group demonstrated significantly higher JHEQ total and movement scores than those in the Low&High group. Through multivariate logistic regression analysis, we identified change in stem anteversion as an independent factor associated with high post-operative patient satisfaction.</p><p><strong>Conclusion: </strong>Accurate femoral stem alignment, particularly minimizing deviations in stem anteversion from the native femoral anteversion, was significantly associated with improved post-operative PROMs after computer-assisted THA. These results highlight the importance of achieving accurate femoral stem alignment, even when acetabular cup placement is optimised using CAE.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2559-2569"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Historical contributions and future horizons of Japanese orthopaedic oncology: from surgical innovation to nationwide collaborations.","authors":"Akira Kawai, Keisuke Horiuchi, Koji Hiraoka, Toshifumi Ozaki, Kazuhiro Tanaka, Hirotaka Kawano","doi":"10.1007/s00264-026-06999-6","DOIUrl":"10.1007/s00264-026-06999-6","url":null,"abstract":"<p><strong>Purpose: </strong>Bone and soft tissue sarcomas are rare, heterogeneous malignancies presenting major diagnostic and therapeutic challenges. Over the past century, Japanese orthopaedic surgeons have occupied a unique position as both primary surgeons and comprehensive oncologists. On the occasion of the Centennial of the Japanese Orthopaedic Association (JOA), this review synthesizes the key historical milestones and future prospects of Japanese orthopaedic oncology.</p><p><strong>Methods: </strong>A narrative synthesis was structured across five consolidated domains: (1) Surgical Innovation; (2) Advanced Basic Research and Novel Therapeutics; (3) The Japan Bone and Soft Tissue Tumor Registry (JBSTTR); (4) Nationwide Collaborative Research Groups and Multidisciplinary Platforms; and (5) Onco-Orthopaedics and Future Musculoskeletal Care.</p><p><strong>Results: </strong>Japanese orthopaedic oncologists established quantitative surgical margin concepts, pioneered Total En Bloc Spondylectomy (TES) for spinal tumours, and developed recycled treated autografts (freezing, pasteurization, and irradiation). Translational research milestones encompass caffeine-potentiated chemotherapy, peptide-based immunotherapy, oncolytic viral therapies, Japan's first investigator-initiated clinical trial in oncology, and carbon-ion radiotherapy. Furthermore, a robust nationwide infrastructure has been forged through six decades of the JBSTTR alongside collaborative research engines-the Japanese Musculoskeletal Oncology Group (JMOG), the Japan Clinical Oncology Group Bone and Soft Tissue Tumor Study Group (JCOG-BSTTSG), and the Japan Ewing Sarcoma Study Group (JESS)-and the multidisciplinary platform Japanese Association of Sarcoma Treatment and Research (JSTAR). Expanding beyond primary sarcoma care, the conceptual framework of Onco-Orthopaedics has pioneered a holistic paradigm for managing locomotive syndrome in cancer patients \"Cancer Locomo\".</p><p><strong>Conclusion: </strong>The surgeon-led collaborative ecosystem in Japan bridges surgical precision, translational science, and nationwide multidisciplinary platforms, offering a sustainable model for advancing musculoskeletal oncology.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2729-2741"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the learning curve for anterolateral supine total hip arthroplasty: a retrospective analysis of six hundred and forty consecutive cases performed by a single surgeon.","authors":"Shigeru Murasawa, Yuki Asanuma","doi":"10.1007/s00264-026-07045-1","DOIUrl":"https://doi.org/10.1007/s00264-026-07045-1","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the learning curve for single-surgeon performed anterolateral supine (ALS)-total hip arthroplasty (THA).</p><p><strong>Methods: </strong>We analysed 640 consecutive primary ALS-THAs performed between April 2017 and August 2024, including procedures performed with supervised assistance during 2017-2019. Operative time (OT), blood loss (BL), and complication rate (CR) were evaluated. Temporal trends in OT and BL were assessed using cumulative sum (CUSUM) analysis, and a data-driven single change-point analysis was performed for CR using 100,000 Monte Carlo permutations. Firth's penalised logistic regression assessed the association between continuous case numbers and complications after adjustment for age, sex, and American Society of Anesthesiologists (ASA) physical status.</p><p><strong>Results: </strong>OT and BL CUSUM curves peaked at cases 411 and 437, respectively. Mean OT decreased from 74.8 to 66.3 min and BL from 251.6 to 184.6 mL between 2022-2023 (both Holm-adjusted P < 0.001). Nine cases (1.4%) experienced 11 complication events. The estimated CR change point was case 281, with pre- and post-point CRs of 2.8% and 0.3%, respectively, but the permutation test was not significant (P = 0.1021). Increasing experience was associated with lower early complication odds after adjustment (odds ratio 0.64 per 100-case increase, 95% confidence interval 0.40-0.94; P = 0.023).</p><p><strong>Conclusion: </strong>The ALS-THA learning curve varied by outcome, with operative efficiency improving after approximately 400 procedures. Increasing experience was associated with lower odds of early complications, supporting outcome-specific rather than single-threshold assessment.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of subtrochanteric varus osteotomy and shelf acetabuloplasty in fragmentation-stage (Waldenström stage II) Legg-Calvé-Perthes disease: a prospective randomized study.","authors":"Hazem Abd El-Hameed, Karim Ibrahim Okasha, Mohamed Mahmoud Hegazy, Hassan Magdy El-Barbary, Mohamed Youness Ali, Ahmed Morsy Ahmed","doi":"10.1007/s00264-026-06932-x","DOIUrl":"10.1007/s00264-026-06932-x","url":null,"abstract":"<p><strong>Purpose: </strong>Optimal containment in fragmentation stage (Waldenström stage II) of Legg-Calvé-Perthes disease (LCPD) remains controversial. This study compared the clinical and radiographic outcomes of subtrochanteric femoral varus osteotomy (STVO) versus shelf acetabuloplasty in children with fragmentation stage (Waldenström stage II) of LCPD.</p><p><strong>Methods: </strong>This prospective randomized clinical trial included 32 children (32 hips) with LCPD in fragmentation stage (Waldenström stage II), treated between April 2022 and June 2024. Patients were randomized into two groups: STVO (n = 16) and shelf acetabuloplasty (n = 16). The primary outcome was clinical outcome at final follow-up assessed using the modified Sundt criteria. Secondary outcomes included containment radiographic parameters, interim femoral head sphericity using the Stulberg classification, leg length discrepancy (LLD), and complications. Mean follow-up duration was 25.1 ± 1.8 months in the STVO group and 26.1 ± 2.0 months in the shelf acetabuloplasty group.</p><p><strong>Results: </strong>Both procedures resulted in significant clinical and radiographic improvement. Good clinical outcomes were achieved in 81.2% of hips in each group, with no poor outcomes. At final follow-up, the mean center-edge angle (CEA) increased significantly in both groups, reflecting improved lateral femoral head coverage. Sharp's angle decreased significantly in both groups, indicating improved acetabular morphology. Both groups demonstrated a significant reduction in the medial joint space ratio, indicating improved containment. After adjustment for baseline values using ANCOVA, no statistically significant between-group differences were identified. Among hips that had reached the remodeling stage, exploratory analysis suggested a higher proportion of favorable interim Stulberg outcomes (I-II) in the STVO group; however, interpretation is limited by the small subgroup size, differential progression to remodeling, and the use of a classification system originally intended for assessment at skeletal maturity. Clinically significant LLD (> 1.5 cm) occurred in 43.8% of STVO patients and in none of the shelf group. Complications were minor and comparable.</p><p><strong>Conclusion: </strong>STVO and shelf acetabuloplasty yield comparable short- to mid-term clinical outcomes in fragmentation stage (Waldenström stage II) of LCPD. However, STVO was associated with a substantially higher incidence of clinically significant leg length discrepancy, whereas shelf acetabuloplasty preserved limb length. Exploratory analyses suggested a possible advantage of STVO regarding interim femoral head sphericity. These findings should not be interpreted as evidence of superiority, and require confirmation at skeletal maturity.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"2543-2557"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}