Journal of Orthopaedic Surgery最新文献

{"title":"Surgical management of lateral ulnar collateral ligament injuries in elbow dislocations and fracture-dislocations: Comparative outcomes of primary repair and palmaris longus tendon reconstruction.","authors":"Eralp Erdogan, Zafer Gunes","doi":"10.1177/10225536251387310","DOIUrl":"https://doi.org/10.1177/10225536251387310","url":null,"abstract":"<p><p>ObjectivesThis study compared outcomes of primary repair and palmaris longus tendon reconstruction in patients with lateral ulnar collateral ligament (LUCL) injuries.Material and MethodA retrospective comparative cohort study was conducted between 2017 and 2023, including 40 patients who underwent surgery for elbow dislocation or fracture-dislocation with intraoperatively confirmed LUCL injury. Surgical choice was made intraoperatively: repair was performed if the ligament could be reattached without tension, while reconstruction was selected if the tissue was shortened, retracted, or degenerative. Patients were divided into a repair group (n = 17) and a reconstruction group (n = 23). Clinical outcomes included Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Mayo Elbow Performance Score (MEPS), range of motion (ROM), fracture healing, and complications, with a mean follow-up of 26.4 months.ResultsThe repair group showed mean VAS 16.2, QuickDASH 9.7, MEPS 89.9, and ROM 137.2°, while the reconstruction group had VAS 17.2, QuickDASH 8.4, MEPS 89.0, and ROM 133.6°. There were no significant differences in VAS, QuickDASH, or MEPS, though the repair group demonstrated superior ROM (p = 0.029). The absolute ROM difference (∼3-4°) was not considered clinically meaningful. In isolated LUCL cases (n = 15), no significant differences were observed between groups. All associated fractures achieved union without non-union or malunion. Complications included heterotopic ossification in seven patients (three repairs, four reconstructions) and two superficial infections, all successfully managed without reoperation. No patient developed recurrent instability, nerve deficits, or clinically significant stiffness.ConclusionBoth primary repair and palmaris longus tendon reconstruction provided satisfactory outcomes and durable stability. Although the repair group showed slightly greater ROM, this difference was not clinically relevant and disappeared when patients with concomitant fractures were excluded. Injury complexity, rather than surgical technique, appears to be the main determinant of long-term function.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251387310"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiological association between Haglund's deformity and plantar calcaneal spur: A retrospective case-control study.","authors":"Volkan Özel, Ibrahim Halil Demir, Nevzat Gönder, Fatih Günaydın","doi":"10.1177/10225536251386154","DOIUrl":"https://doi.org/10.1177/10225536251386154","url":null,"abstract":"<p><p>ObjectivesPlantar calcaneal spur (PCS) is a bony outgrowth of the calcaneal tuberosity frequently associated with chronic heel pain. Although its precise etiology remains uncertain, mechanical stress and repetitive traction forces are frequently implicated. Haglund's deformity, defined as a bony enlargement on the posterosuperior calcaneus, results in retrocalcaneal impingement of the Achilles tendon. While both conditions involve stress-related alterations of the calcaneus, their potential association has not been clearly established. This study aimed to evaluate the relationship between PCS and Haglund's deformity by determining the incidence of Haglund's deformity in symptomatic PCS patients and investigating associated factors.MethodsIn this retrospective case-control study, 377 patients aged ≥18 years who underwent weight-bearing lateral foot radiographs between March 2023 and March 2024 were included. The case group (<i>n</i> = 94) consisted of patients with symptomatic PCS, and the control group (<i>n</i> = 283) comprised patients without PCS. Haglund's deformity was assessed radiographically using the BRINK angle, with values >20° considered diagnostic. Demographic characteristics and comorbidities were analyzed.ResultsHaglund's deformity was significantly more prevalent in the PCS group (62/94; 66.0%) compared with controls (53/283; 18.7%) (<i>p</i> = 0.001). Diabetes mellitus showed a significant association with Haglund's deformity (<i>p</i> = 0.01). No significant differences were observed in age, sex, body mass index, or other comorbidities.ConclusionOur findings demonstrate a strong radiological association between PCS and Haglund's deformity, suggesting shared biomechanical stress pathways involving the plantar fascia and Achilles tendon. Prospective studies incorporating biomechanical evaluation are warranted to clarify underlying mechanisms and clinical implications.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251386154"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of different distraction gaps in open wedge high tibial osteotomy on the mechanical distribution around the knee joint: A finite element analysis and clinical validation.","authors":"Jing Han, Wenqian Xu, Jinsong Liu, Jianlin Zhao, Xiaoyu Wan, Zengrui Zhang, Zhiguang Chen, Tixiong Xia, Weibo Liao, Yingxing Xu","doi":"10.1177/10225536251383123","DOIUrl":"https://doi.org/10.1177/10225536251383123","url":null,"abstract":"<p><p>ObjectiveThe study aimed to investigate the mechanical distribution around knee joint after open wedge high tibial osteotomy (OWHTO) in different osteotomy distraction gaps (ODG) and confirm the safe ranges of correction after OWHTO.MethodsA three-dimensional finite element analysis (FEA) was performed to observe the max stress distribution for three compartments of knee joint in each OWHTO model under the different ODG (1, 1.5, 2, 2.5, 3 cm), and measure the joint line height (JLH), Blackburne Peel Index (BPI), Insall-Salvati index (ISI), and joint line convergence angle (JLCA). Moreover, a retrospective clinical study involving 50 patients underwent OWHTO (7 males with 8 knees and 40 females with 42 knees; aged from 42 to 67 years old, BMI ranged from 18.80 to 32.17 kg/m², duration from 12 to 38 months) was implemented to further reveal the role of different ODG on the clinical outcomes of patients after OWHTO.ResultsIn the FEA, the ODG after OWHTO were positively correlated with the JLH (R² = 0.980), negatively correlated with the BPI (R² = 0.995) and the JLCA (R² = 0.989), and not correlated with the ISI. Additionally, the turning point for the stress alterations of the three compartments of the knee joint was found when the ODG ranged from 2 to 2.5 cm. In the clinical study, a significant correlation was investigated between the two classifications (Kellgren-Lawrence and Iwano grading) and correction angle (r = 0.447, <i>p</i> < .001; r = 0.592, <i>p</i> < .001). A lower grading was observed in the correction angle within the range of 9-12°, compared with that in other ranges (χ² = 31.733, <i>p</i> < .001; χ² = 34.899, <i>p</i> < .001).ConclusionsThe ODG could affect the stress distribution of three compartments of the knee joint by altering the JLH, JLCA and BPI. As result of this, limited correction angle should be fully considered in the preoperative planning to avoid overcorrection and patellofemoral joint disorders.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251383123"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 0-degree and 30-degree endoscopes in unilateral biportal endoscopic decompression for lumbar spinal stenosis: Which preserves the facet joint better?","authors":"Abdullah Merter, Mustafa Özyıldıran","doi":"10.1177/10225536251386150","DOIUrl":"https://doi.org/10.1177/10225536251386150","url":null,"abstract":"<p><p>PurposeThis study aimed to compare the radiological and clinical outcomes of unilateral biportal endoscopic lumbar decompression (UBELD) performed with 0-degree and 30-degree endoscopes.MethodsPatients with single-level lumbar spinal stenosis without instability were included in this single-center retrospective study. The patients were categorized into two groups on the basis of the angle of the endoscope used by the surgeon. Clinical outcome measures included JOA scores, Oswestry Disability Index (ODI), and VAS scores for low back and leg pain, assessed preoperatively and at 12 months postoperatively. Ipsilateral and contralateral osteotomy angles, overhang distance, and ipsilateral inferior articular process (IAP) area were measured.ResultsAmong the 81 patients who met the inclusion criteria, a 30-degree endoscope was used in 51 patients, while a 0-degree endoscope was used in 30 patients. The JOA score, VAS-leg score, VAS-low back pain score, and ODI significantly improved in both groups at the final follow-up period (<i>p</i> < 0.001). Postoperative VAS-low back pain score in the 30-degree endoscope group was significantly lower than that in the 0-degree endoscope group (1.4 vs 2.9, <i>p</i> < 0.001). Significant differences were also observed in the ipsilateral osteotomy angle (77.8° vs 87.8°, <i>p</i> < 0.001), overhang distance (-1.16 mm vs -4.39 mm, <i>p</i> < 0.001), and the postop/preop ratio of ipsilateral IAP area (0.74 vs 0.69, <i>p</i> = 0.006). Radiological parameters for facet preservation were better in the 30-degree endoscope group.ConclusionSuccessful clinical improvements were achieved with both endoscope angles. However, facet preservation parameters were more favorable in the 30-degree endoscope group compared to the 0-degree endoscope group.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251386150"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional outcomes and mortality in patients with actual pathological proximal femoral fractures treated with megaprosthesis.","authors":"Ebubekir Eravsar, Ali Güleç, Fatih Durgut, Serkan Yildirim, Bahattin Kerem Aydin","doi":"10.1177/10225536251380326","DOIUrl":"10.1177/10225536251380326","url":null,"abstract":"<p><p>PurposeThe proximal femur is a region frequently affected by pathological fractures due to metastases. Partial head megaprostheses are among the surgical options that can be preferred for treating pathological fractures in this area. The aim of this study is to evaluate the impact of various factors on the functional outcomes and mortality of patients with actual proximal femoral fractures treated with a megaprosthesis.MethodsThe study included 28 patients. None of these patients had impending fractures; all of them had actual pathological fractures. Functional outcomes were assessed using VAS improvement, MSTS, and KPS scores, in relation to factors including age, cancer diagnosis before fracture, additional fracture, bone metastasis, visceral metastases, postoperative oncological treatment, preservation of the trochanter major, and type of cancer. These same factors were also considered in the survival analysis. The impact of knowing the cancer diagnosis prior to the fracture on time to surgery was also evaluated.ResultsPatients showed a mean VAS improvement of 5.8 ± 1.3, with median postoperative MSTS and KPS scores of 18 (range:12-23) and 65 (range:40-80), respectively. Younger patients had significantly better functional outcomes (<i>p</i> < 0.05). Other clinical factors had no significant effect on functions. Visceral metastases negatively impacted survival (<i>p</i> = 0.044), while younger age (<i>p</i> = 0.029), favorable cancer type (<i>p</i> < 0.001), and receiving postoperative oncological treatment improved survival (<i>p</i> = 0.049). Time to surgery was longer in patients without a prior cancer diagnosis (<i>p</i> < 0.001), though this did not affect survival (<i>p</i> = 0.888).ConclusionMegaprostheses in the treatment of actual metastatic fractures of the proximal femur provide excellent pain relief and satisfactory functional improvement. Functional outcomes were associated with age, while survival was influenced by age, cancer type, presence of visceral metastases, and whether postoperative oncological treatment was received. Although the preoperative time to surgery was longer in patients without a prior cancer diagnosis, survival was not affected by whether the diagnosis was known before the fracture.Level of EvidenceIV.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251380326"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-bundle ACL and ALL reconstruction results in less femoral posterolateral bundle tunnel widening than outside-in double-bundle ACL reconstruction.","authors":"Joe Chih-Hao Chiu, Chih-Li Wang, Poyu Chen, Lei Hsia, Cheng-Pang Yang, Huan Sheu","doi":"10.1177/10225536251376590","DOIUrl":"https://doi.org/10.1177/10225536251376590","url":null,"abstract":"<p><p>PurposeTo compare the clinical and radiological results of two double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) techniques. DB ACLR and anterolateral ligament reconstruction (ALLR) with internal brace (IB), and outside-in (OI) DB ACLR.HypothesisWe hypothesized that DB ACLR and ALLR with IB wound yield less femoral tunnel, especially femoral posterolateral bundle tunnel complications, than OI DB ACLR without ALLR because of better rotational control. Both techniques could provide good postoperative clinical outcomes.MethodsPatients who received DB ACLR and ALLR (ALLR group) and who received outside-in DB ACLR (non-ALLR group) were enrolled. Age, BMI, follow-up duration, meniscus repair, laterality, and knee range of motion (ROM) were collected. Lysholm, Tegner scale, and radiological results were compared.ResultsThirty-four and 33 patients were enrolled in the ALLR and non-ALLR groups. Patient demographics were similar between groups. Both groups showed postoperative improvements in Lysholm (ALLR group, 62.5 ± 6.8 preoperatively and 85.1 ± 5.7 postoperatively (<i>p</i> < 0.01); non-ALLR group, 63.5 ± 6.0 preoperatively and 82.9 ± 5.2 postoperatively (<i>p</i> < 0.01)) and Tegner Scale (ALLR group, 4.97 ± 0.52 preoperatively and 7.79 ± 0.41 postoperatively (<i>p</i> < 0.01); non-ALLR group, 4.91 ± 0.58 preoperatively and 7.7 ± 0.47 postoperatively (<i>p</i> < 0.01)) at final follow-up. There were no significant differences between groups preoperatively (Lysholm, <i>p</i> = 0.324, Tegner, <i>p</i> = 0.649) and postoperatively (Lysholm, <i>p</i> = 0.679, Tegner, <i>p</i> = 0.369). The ALLR group exhibited significantly lower percentages of femoral posterolateral bundle tunnel widening (<i>p</i> = 0.021) and a more femoral divergent angle (<i>p</i> < 0.001) than the non-ALLR group. Furthermore, no femoral tunnel coalescence was observed in the ALLR group, while 3% of the non-ALLR group showed coalescence.ConclusionsDB ACLR with ALLR yielded less femoral posterolateral bundle tunnel widening, no femoral tunnel coalescence, and more femoral divergent angle than OI DB ACLR. Both techniques provided good postoperative outcomes. Incorporating ALLR and IB may benefit patients undergoing DB ACLR.Level of evidenceLevel III, Retrospective comparative therapeutic trial.Clinical relevanceDB ACLR with ALLR and IB provides less femoral PL tunnel widening, no femoral tunnel coalescence, and more divergent angles between the two femoral tunnels compared with traditional OI DB ACLR. DB ACLR with ALLR and IB technique provides more flexibility during femoral tunnel preparation.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251376590"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of shear wave elastography in diagnosis and prognostic assessment of acute anterior talofibular ligament injuries.","authors":"Lin Yang, Xue Xu, Jing Liu","doi":"10.1177/10225536251376589","DOIUrl":"https://doi.org/10.1177/10225536251376589","url":null,"abstract":"<p><p>BackgroundTo investigate the clinical utility of shear wave elastography (SWE) in the diagnosis and prognostic evaluation of acute anterior talofibular ligament (ATFL) injuries.MethodsThis prospective cohort study enrolled 46 patients with unilateral acute ATFL injuries and 32 age and gender-matched healthy volunteers. All patients underwent B-mode ultrasonography and SWE within 48 h post-injury and at 3 month post-rehabilitation. Quantitative assessments included ATFL thickness, Young's modulus, shear wave velocity (SWV), vascular perfusion, and echotextural characteristics.ResultsDuring the acute phase (≤48 h), injured ATFLs exhibited significantly greater thickness compared to contralateral and healthy control ligaments (3.54 ± 0.68 mm vs 2.15 ± 0.22 mm and 2.31 ± 0.16 mm, respectively; <i>p</i> < .05), alongside markedly reduced Young's modulus and SWV. Biomechanical parameters were consistently elevated in plantarflexion-inversion versus neutral positioning. At 3-month follow-up, elastic parameters normalized substantially, with restoration of ligamentous thickness and vascular perfusion eliminating intergroup differences. The dynamic trajectory of SWE metrics paralleled structural recovery patterns.ConclusionSWE quantitatively evaluates biomechanical integrity and recovery progression in acute ATFL injuries. Combined with B-mode ultrasonography, SWE provides a robust imaging framework for diagnosis, longitudinal monitoring, and prognostic stratification, demonstrating significant clinical value in musculoskeletal trauma management.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251376589"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of topical tranexamic acid administration on postoperative blood loss and hematologic parameters after reverse shoulder arthroplasty.","authors":"Yuji Yamaguchi, Atsushi Urita, Yuki Matsui, Kazuo Tomizawa, Norimasa Iwasaki, Hiroshi Taneichi","doi":"10.1177/10225536251387473","DOIUrl":"https://doi.org/10.1177/10225536251387473","url":null,"abstract":"<p><p>BackgroundThis study aimed to investigate the effect of topical administration of TXA on blood loss and hematologic parameters following RSA.MethodsThis retrospective study included 111 patients who underwent RSA mainly for cuff tear arthropathy and massive rotator cuff tears between November 2014 and September 2021, excluding patients with proximal humerus fractures, of whom 52 received TXA (TXA group) and 59 did not receive TXA (non-TXA group). In the TXA group, 1 g of TXA was administrated topically in the subacromial space after skin closure. Hematological parameters were assessed preoperatively and at postoperative days 3, 7, and 14. Intraoperative blood loss, surgical drain volume, calculated total blood loss, blood transfusion, and venous thromboembolic events were compared.ResultsThere was no significant difference in intraoperative blood loss between the groups. Calculated blood loss and total surgical drain volume were significantly lower in the TXA group than the non-TXA group (843 ± 334 mL vs 1051 ± 391 mL and 213 ± 142 mL vs 389 ± 164 mL,<i>p</i> < 0.01 and <i>p</i> < 0.01, respectively). In the non-TXA group, hemoglobin (Hb) and hematocrit (Hct) values decreased until postoperative day 7 before increasing at postoperative day 14; in the TXA group, these values decreased at postoperative day 3 and then increased up to postoperative day 14. No thromboembolic event occurred in either group.ConclusionsThe present results showed that topical administration of TXA in RSA reduced blood loss without adverse events and promoted the early recovery of hematologic parameters.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251387473"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal tibia osteotomy: Biomechanics study of two techniques.","authors":"Nik Ahmad Fauzan Nik Wan, Nik Alyani Nik Abdul Adel, Ardilla Hanim Abdul Razak, Mohd Shukrimi Awang, Ahmad Syahrizan Sulaiman","doi":"10.1177/10225536251369145","DOIUrl":"https://doi.org/10.1177/10225536251369145","url":null,"abstract":"<p><p>IntroductionProximal tibia osteotomy has advanced with various techniques, such as dome and modified oblique osteotomies, to correct angular deformities and redistribute knee stress, thereby slowing arthritic progression. Despite advancements, a gap remains in understanding the biomechanical strengths of these techniques, especially concerning correction angles. The study aims to compare the stability of the construct for different degrees of osteotomy.Materials and methodsEighteen synthetic tibias were osteotomised based on the dome and modified oblique osteotomy technique. For dome osteotomy, the osteotomy site was fixed with two Kirschner wires 2.0 mm for different degrees of osteotomy, which were 10^o, 20^o, and 30^o. Three samples from each construct were tested for rotational force. For modified osteotomy, two screws 3.5 mm were used to fix the osteotomy site and tested for rotational forces.ResultsThe constructs were stiffest at ten degrees for rotational force, both in dome and modified oblique osteotomy (0.39 Nmm and 0.4 Nmm). The stiffness of dome osteotomy in correction angles of 10° and 20° is almost similar (<i>p</i> > 0.95), and it reduces significantly at 30°(<i>p</i> < 0.001). There were significant differences in stiffness of the oblique osteotomy construct when comparing 10° with 20° (<i>p</i> = 0.003), 10° with 30°(<i>p</i> < 0.001) and 20° with 30° (<i>p</i> < 0.001) correction angles. This is further proved by comparing the means of stiffness between the two methods, where dome osteotomy did better compared to modified oblique osteotomy at 20° and similar at 10°.ConclusionIn performing proximal tibia osteotomy, we recommend limiting the acute angle of correction to 20°, and we suggest that for a larger correction angle, dome osteotomy exhibits better biomechanical stiffness. An angle exceeding 30^o will predispose to higher rate of non-union or malunion as the stiffness of the surgical construct drops significantly, making it less resistant to rotational forces.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251369145"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of ultrasonic bone scalpel in posterior cervical expansive open-door laminoplasty for cervical degenerative diseases: A prospective randomized controlled trial.","authors":"Hongzi Wu, Pin Feng, Yongqi Li, Yi Liao, Shaobo Wang","doi":"10.1177/10225536251364200","DOIUrl":"10.1177/10225536251364200","url":null,"abstract":"<p><p>BackgroundKey instruments used in posterior cervical expansive open-door laminoplasty (CEOL), such as the high-speed drill (HSD) and the ultrasonic bone scalpel (UBS), are selected based on surgeon preference. However, skepticism remains among some surgeons regarding the superiority of the HSD over the widely used UBS, necessitating a scientific evaluation of its practical utility.ObjectiveTo evaluate the efficacy and safety of the ultrasonic bone scalpel compared to the high-speed drill in cervical expansive open-door laminoplasty using a posterior cervical approach in a prospective randomized controlled trial.MethodsThis prospective study, conducted after obtaining prior informed consent, involved 40 patients diagnosed with cervical degenerative diseases who underwent cervical expansive open-door laminoplasty between July 2018 and June 2021. The patients were randomly divided into two groups: the ultrasonic bone scalpel group (<i>n</i> = 20) and the high-speed drill group (<i>n</i> = 20). Surgeons could not be blinded due to the nature of the intervention, but outcome assessors were blinded to group allocation where feasible. Surgical time, open-door time, intraoperative blood loss, postoperative drainage loss, post-operative complications, and functional outcomes were compared between the two groups.ResultsNo statistically significant difference was observed between the two groups in terms of intraoperative blood loss, post-operative complications, screw migration, plate fracture, or spinal cord expansion. However, the ultrasonic bone scalpel group demonstrated significantly shorter surgical time, open-door time, and reduced postoperative drainage loss compared to the high-speed drill group (<i>p</i> < .05). The reduced drainage volume may be attributed to thermal sealing of small vessels by the UBS rather than solely reduced tissue trauma. No significant differences were observed in the Visual Analog Scale (VAS) scores, bony union at the hinge, or Japanese Orthopedic Association (JOA) score improvement rates between the two groups at 1 week, 3 months, and 1 year postoperatively. While the UBS group showed numerical reductions in complication rates (e.g., dural tear: 0% vs 5%, <i>p</i> = .311), these differences did not reach statistical significance, likely due to the limited sample size.ConclusionsThe study concluded that USB significantly reduces operation time, open-door time, and postoperative drainage loss. However, the study's limited sample size may have been insufficient to detect differences in complication rates between groups.</p>","PeriodicalId":16608,"journal":{"name":"Journal of Orthopaedic Surgery","volume":"33 3","pages":"10225536251364200"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}