Journal of Orthopaedic Surgery and Research最新文献

{"title":"Duloxetine for postoperative pain management in total hip and knee arthroplasty: a systematic review and meta-analysis.","authors":"Abdelrahman Ibrahim, Mohamed Abdelnabi, Reda Ali Sheta","doi":"10.1186/s13018-026-07176-6","DOIUrl":"10.1186/s13018-026-07176-6","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain following total hip arthroplasty (THA) and total knee arthroplasty (TKA) drives opioid dependence. Perioperative duloxetine is an option as a multimodal analgesic adjunct, yet its efficacy and safety in this population are not fully defined.</p><p><strong>Methods: </strong>This systematic review and meta-analysis compared perioperative duloxetine to placebo in THA and TKA patients, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420261294277). The search strategy spanned PubMed, Web of Science, and Scopus. The Cochrane Library was also queried from inception to March 2, 2026. The primary outcomes were Visual Analog Scale (VAS) pain scores at rest and during ambulation; secondary outcomes included postoperative opioid consumption and the incidence of adverse effects. VAS and Numeric Rating Scale (NRS) pain scores were converted to a common 0-100 mm scale for pooling and expressed as mean differences (MD) with 95% confidence intervals (CI); opioid consumption was standardized to morphine milligram equivalents (MME) and expressed as MD in MME. Dichotomous data were expressed as risk ratios (RR).</p><p><strong>Results: </strong>Thirteen randomized controlled trials (RCTs) (n = 1176) were included. Duloxetine significantly reduced pain at rest (MD - 5.09 mm, 95% CI - 8.76 to - 1.43, P = 0.006) and during ambulation (MD - 4.55 mm, 95% CI - 8.71 to -0.40, P = 0.03) at 24 h. Analgesic benefits persisted at 2 weeks (rest pain: MD - 6.48 mm, 95% CI - 11.14 to - 1.82, P = 0.006; ambulatory pain: MD - 8.93 mm, 95% CI - 13.16 to - 4.69, P < 0.0001) and ≥3 months (rest pain: MD - 2.79 mm, 95% CI - 4.93 to - 0.64, P = 0.01; ambulatory pain: MD - 3.76 mm, 95% CI - 6.62 to - 0.89, P = 0.01). After standardization to morphine milligram equivalents (MME), statistically significant opioid-sparing effects were observed at 48 h (MD - 22.74 MME, 95% CI - 44.17 to - 1.31, P = 0.04, I<sup>2</sup> = 100%) and 72 h (MD - 10.58 MME, 95% CI - 18.67 to - 2.49, P = 0.01); both estimates were subject to extreme heterogeneity, and the 48-h estimate in particular should be interpreted with substantial caution given its very wide interval. Duloxetine significantly reduced the risk of nausea/vomiting (RR 0.73, 95% CI 0.55-0.97, P = 0.03); a borderline reduction in fatigue was also observed (RR 0.87, 95% CI 0.76-0.996, P = 0.04). Duloxetine increased the risk of drowsiness/somnolence (RR 1.88, P = 0.001).</p><p><strong>Conclusions: </strong>Perioperative duloxetine produces statistically significant, though sub-threshold, analgesic effects across all assessed timepoints and a selective opioid-sparing effect spanning 48 to 72 h postoperatively when incorporated into multimodal analgesia for THA and TKA. All findings are subject to substantial heterogeneity and should be interpreted with ","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880846","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":"Reconstruction of chronic Achilles tendon ruptures using a doubled peroneus longus tendon free graft and interference screw fixation: a technical note.","authors":"Nicola Maffulli, Cristiano Benelli, Niccolò Cacciuni, Vito Caiolo, Filippo Migliorini, Federico Morelli","doi":"10.1186/s13018-026-07162-y","DOIUrl":"10.1186/s13018-026-07162-y","url":null,"abstract":"<p><strong>Background: </strong>The surgical management of chronic Achilles tendon ruptures (CATR) with significant tissue defects (Myerson Type II/III) presents a clinical challenge. Traditional reconstructive methods relying on free hamstring autografts or flexor hallucis longus transfers are often limited by donor-site morbidity, infection risks, or are unavailable in patients with a history of anterior cruciate ligament (ACL) reconstruction. This technical note describes a refined, tissue-preserving surgical technique utilising a doubled free autologous peroneus longus (PL) tendon graft.</p><p><strong>Methods: </strong>Under regional anaesthesia and thigh tourniquet control, a targeted 4 cm mini-open lateral incision is performed. The PL tendon is identified, harvested proximally using a tendon stripper, and a concomitant distal side-to-side tenodesis of the PL to the PB is performed to minimise eversion weakness. On the back table, the free PL autograft is doubled to achieve a 10 mm diameter construct. A calcaneal tunnel is drilled using progressive reaming. The free graft is routed through the proximal Achilles stump, passed subcutaneously, and drawn through the calcaneus. Final rigid stabilisation is secured with a 10 × 30 mm Bio-Interference Screw (Arthrex®) with the ankle held in maximum forced equinus to ensure optimal tensioning. Postoperatively, a 4-phase accelerated protocol begins with 3 weeks in a short-leg fibreglass cast under protected weight-bearing.</p><p><strong>Results/technical advantages: </strong>This technique achieves reliable primary mechanical stability, allowing for early protected loading while minimising soft-tissue stripping in the hypovascular distal Achilles watershed area. The free PL autograft provides an adequate structural match, and complements the translational framework of the Soft Tissue Healing Diamond (ST-Diamond) concept. Furthermore, this approach serves as a potential alternative for middle-aged patients who have a history of prior ACL reconstruction using hamstring autografts, avoiding contralateral donor-site morbidity or the use of allografts.</p><p><strong>Conclusion: </strong>The described mini-open free peroneus longus autograft reconstruction with interference screw fixation represents a cautious, reproducible, and biologically sound salvage option for large chronic Achilles tendon defects, balancing mechanical stability with minimal surgical morbidity.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874515","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":"A biomechanical comparison of closed-reduction osteosynthesis techniques for fractures of the ulnar styloid.","authors":"Jonas Eck, Inska Onken, Julian P Maier, Kilian Reising, Nikos Karvouniaris, Jörg Bayer, Hagen Schmal, Ferdinand C Wagner","doi":"10.1186/s13018-026-07188-2","DOIUrl":"10.1186/s13018-026-07188-2","url":null,"abstract":"<p><strong>Background: </strong>Ulnar styloid fractures (USF) are frequently underestimated and can contribute to clinically relevant wrist instability and impaired functional outcomes. Several osteosynthesis techniques are available for the treatment of unstable USF. This study aims to compare the biomechanical stability of fixation methods applicable to closed reduction - specifically K-wire and headless compression screw fixation - to support clinical decision-making.</p><p><strong>Methods: </strong>This biomechanical in vitro study was conducted using 30 specimens of artificial ulnae. USF were simulated through a standardized osteotomy at the base. Three groups of ten specimens each were created to compare three methods of osteosynthesis: One 1.4 mm (mm) Kirschner-wire (K-wire) (Group 1KW), two 1.0 K-wires (Group 2KW) or one 2.0 cannulated headless screw (Group CHS). Each construct underwent 1,000 load cycles up to 50 newtons (N) followed by load-to-failure testing, which was defined as displacement ≥ 2 mm. Displacement [mm], stiffness [N/mm] and load to failure [N] were recorded and compared among the groups.</p><p><strong>Results: </strong>The mean fracture displacement after 1,000 cycles was 0.58 mm (SD 0.37) in the 1KW group, 0.23 mm (SD 0.09) in the 2KW group and 0.09 mm (SD 0.03) in the CHS group. Significant group differences could be shown between CHS and 1KW (p < 0.01) as well as between CHS and 2KW (p = 0.017). The mean construct stiffness was 269.95 (SD 45.72) N/mm in the 1KW group, 484.08 (SD 207.60) N/mm in the 2KW group and 730.95 (SD 241.42) N/mm in the CHS group. Significant group differences could be shown between CHS and 1KW (p < 0.01). The mean load-to-failure was 136.82 (SD 68.86) N in the 1KW group, 181.60 (SD 28.09) N in the 2KW group and 204.17 (SD 63.10) N in the CHS group. Significant group differences could be shown between CHS and 1KW (p = 0.013).</p><p><strong>Conclusion: </strong>Ulnar styloid refixation with a headless compression screw provides superior axial stability compared to single or double K-wire fixation. This should be considered in the treatment of unstable USF.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840405","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":"Surgical anatomy, biomechanics and clinical outcomes of latissimus dorsi transfer for irreparable rotator cuff tears: a review.","authors":"Jean Michel Hovsepian, Marco A Cartaya, Johannes Glaser, Nicola Oehler, Igor Solovyov, Charbel Abi Mansour, Julio Carruyo Avila, Stephan Vogt","doi":"10.1186/s13018-026-07200-9","DOIUrl":"10.1186/s13018-026-07200-9","url":null,"abstract":"<p><strong>Background: </strong>Latissimus dorsi transfer is a well-established joint-preserving option for irreparable rotator cuff tears in young, active patients without glenohumeral arthritis. Originally described by Gerber in 1988 for posterosuperior tears, indications now also include anterosuperior reconstruction, either as isolated transfer to the lesser tuberosity or in combination with the teres major. No recent review has integrated surgical anatomy, biomechanics, fixation strategies, clinical outcomes and patient selection in a single resource.</p><p><strong>Main text: </strong>We reviewed the anatomy, biomechanics, surgical technique, outcomes, and patient selection for latissimus dorsi transfer, drawing on the PubMed/MEDLINE literature through January 2026. For posterosuperior tears, the transfer reduces pain and improves external rotation, with sustained gains at follow-up beyond ten years. Patients with pseudoparesis show the largest functional gains. Subscapularis insufficiency, Goutallier 3-4 fatty infiltration of the teres minor, and prior failed repair predict poor outcome. For anterosuperior tears, anterior latissimus dorsi transfer or combined latissimus dorsi and teres major transfer restores internal rotation and reduces anterior subluxation, with outcomes comparable to pectoralis major transfer and a line of pull that better matches the subscapularis. Arthroscopic and open techniques produce comparable functional outcomes in published series.</p><p><strong>Conclusions: </strong>Latissimus dorsi transfer is the most biomechanically rational joint-preserving option for irreparable rotator cuff tears in younger, active patients without glenohumeral arthritis. Reverse shoulder arthroplasty remains the salvage option when arthritis is present or in older patients. Patient selection is the most important determinant of outcome.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840389","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":"Decoding resistance: a comprehensive study on pathogens and antibiotic efficacy in periprosthetic joint infections.","authors":"Niklas Hahn, Marcus Jäger, Alexander Wegner, Tobias Ludger Schulte, André Busch","doi":"10.1186/s13018-026-07165-9","DOIUrl":"10.1186/s13018-026-07165-9","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) continues to be a severe complication following total joint arthroplasty (TJA). Identifying the causative pathogens and their antibiotic resistance profiles is essential for the effective eradication.</p><p><strong>Materials and methods: </strong>In this retrospective study, 825 antibiograms and demographic data of patients with confirmed PJIs from 2005 to 2021 were evaluated. The resistance profile evaluation focused on the antibiotics ampicillin/sulbactam, clindamycin, gentamicin, vancomycin, ciprofloxacin and rifampicin.</p><p><strong>Results: </strong>Methicillin-sensitive staphylococcus aureus (MSSA) was the most prevalent pathogen (20.8%) followed by methicillin-resistant staphylococcus epidermidis (MRSE, 16.1%) and methicillin-sensitive staphylococcus epidermidis (MSSE, 10.8%). Polymicrobial (PM) PJI (15.9%) was also high with MSSA (21.2%) as the most frequent pathogen followed by gram-negative (GN) pathogens (20.2%) and MRSE (18.3%). The overall resistance rate against ampicillin/sulbactam and clindamycin was 42.3% and 40%, respectively. Vancomycin showed low resistance rates of nearly 1% with higher rates in enterococci (4%). MSSA and MRSA exhibit high sensitivity rates against gentamicin (97.4% and 89.5%). Gentamicin resistance was high in staphylococcus epidermidis (43%) and particularly in MRSE (64.6%). Ciprofloxacin resistance was especially high among MRSA (81.3%) and MRSE (84.0%) isolates, whereas sensitivity was most common in GN (78.5%) and MSSE (85.0%) groups. This study reveals high rates of MRSE, SE and GN pathogens causing PJI. GN and MRSE rates were also increased in PM PJI. The high overall resistance rates against ampicillin/sulbactam raise doubts as first line empiric oral antibiotic in PJI. The nearly 20% ciprofloxacin resistant GN pathogens should be alarming due to limited choice of biofilm-penetrating antibiotics in GN PJI.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794435","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":"Correction: circ_0044235 exacerbates neuroinflammation and apoptosis following spinal cord injury by targeting miR-338-5p.","authors":"Mianlong Lin, Lina Huang, Bin Zhang, Yue Wang, Xingyu Zhu, Wencong Zeng","doi":"10.1186/s13018-026-07193-5","DOIUrl":"https://doi.org/10.1186/s13018-026-07193-5","url":null,"abstract":"","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794465","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":"Correction: Clinical and radiographic outcomes of double-triangle locking compression plate (DT-LCP) versus T-shaped locking compression plate (T-LCP) in medial open-wedge high tibial osteotomy: a follow-up study of over 5 years.","authors":"Yu Jiang, Xiaodong Jia, Haifeng Li, Huiying Zhou, Cui Wang, Liang Zhang, Tianrui Wang, Xia Zhao, Ning Yu, Yingze Zhang, Kuishuai Xu, Jinli Chen","doi":"10.1186/s13018-026-07139-x","DOIUrl":"10.1186/s13018-026-07139-x","url":null,"abstract":"","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706904","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":"Severe medial tibial plateau fractures: feasibility and functional and radiographic results of an extended approach with medial femoral epicondyle osteotomy.","authors":"Hannah Gablac, Christian Arras, Peter Behrendt, Hendrik Fahlbusch, Clemens Galavics, Michael Hoffmann, Karl-Heinz Frosch, Matthias Krause","doi":"10.1186/s13018-026-07100-y","DOIUrl":"10.1186/s13018-026-07100-y","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the clinical and radiological outcomes of tibial plateau fractures involving the medial plateau by comparing an extended medial approach with medial femoral epicondyle osteotomy (med ECO) to a conventional approach without epicondyle osteotomy (non-ECO).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at two level one trauma-centers. All fractures of the medial tibial plateau (OA/OTA Type B or C) treated with med ECO were classified according to the AO/OTA and 10-segment classification using pre-operative CT scans. A comparative cohort study was performed against non-ECO patients based on age, sex, body mass index (BMI), injury mechanism, and fracture patterns. The quality of fracture reduction was determined by post-operative CT scans. Functional outcomes and postoperative complications were assessed over a minimum follow-up of 2 years.</p><p><strong>Results: </strong>Twenty-nine patients (mean age: 50.2 ± 10.2 years, mean follow-up 71.65 ± 18.9 months) were analyzed. Both groups consisted of patients with severe tibial plateau fractures, knee dislocations, high-velocity trauma and polytrauma and concomitant injuries requiring an average hospital stay of 24.9 ± 12.4 days. Radiological outcomes showed a medial fracture step > 2 mm in 10 cases (med ECO n = 5, non-ECO n = 5) and a gap > 5 mm in 8 cases (med ECO n = 3, non-ECO n = 5). The mean radiological Rasmussen score was 13.8 ± 2.8 (med ECO 14.1 ± 2.8 vs. non-ECO 13.4 ± 3.0, p > 0.05). The mean Knee Injury and Osteoarthritis Outcome Score (KOOS) was 60.4 ± 16.9 (med ECO 61.3 ± 12.7 vs. non-ECO 59.5 + 16.2, p > 0.05) and the International Knee Documentation Committee score (IKDC score) was 56.6 ± 16.9 (med ECO 58.8 ± 19.0 vs. non-ECO 52.6 ± 14.4, p > 0.05).</p><p><strong>Conclusion: </strong>Both med ECO and non-ECO demonstrated good radiological results. No significant differences were observed in clinical and radiological outcomes during follow-up. However, severe medial tibial plateau fractures are devastating knee injuries, being a challenge to the functional outcome of patients due to multiple concomitant injuries. Thus, medial epicondyle osteotomy should be reserved for specific fractures, considering the added morbidity and invasiveness associated with the procedure.</p><p><strong>Level of evidence: </strong>Retrospective Cohort Study, Level of Evidence = III.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697664","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":"Multi-parametric quantitative MRI for characterizing of lumbar intervertebral disc high-intensity zones in patients with chronic low back pain.","authors":"Linlin Meng, Xiaojing Liu, Ke Jiang, Ling Huang, Gaochao Ma, Mingming Sheng, Wentao Zhao, Hai Zhong","doi":"10.1186/s13018-026-07129-z","DOIUrl":"10.1186/s13018-026-07129-z","url":null,"abstract":"<p><strong>Background: </strong>A high-intensity zone (HIZ) in the posterior annulus fibrosus is a critical radiological marker frequently associated with discogenic low back pain (LBP) and annular tears. Conventional MRI evaluation is inherently subjective, while quantitative MRI provides objective insights into biochemical changes within the intervertebral disc. Therefore, this cross-sectional study aimed to identify independent factors associated with HIZs and develop an integrated multivariable model combining quantitative parameters and morphological features.</p><p><strong>Methods: </strong>Patients with chronic LBP underwent conventional lumbar MRI and multi-parametric quantitative MRI mapping. Pfirrmann grade, disc level, and structural status (normal, bulging, or herniation) were independently assessed for each intervertebral disc from L1/L2 to L5/S1. Quantitative T1, T2, and proton density (PD) values were measured in the nucleus pulposus, anterior annulus fibrosus, and posterior annulus fibrosus. Univariable and multivariable analyses based on generalized estimating equations (GEE) were performed to identify independent factors associated with HIZ. The model's discriminative performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC) and variable importance analysis.</p><p><strong>Results: </strong>A total of 385 intervertebral discs from 77 patients were evaluated, of which 53 (13.8%) discs were HIZ positive. Disc herniation (OR = 4.39, P = 0.010), lower disc level (L4/L5-L5/S1) (OR = 3.60, P = 0.043), and T2 values in the nucleus pulposus (T2_NP) (OR = 2.46 per 10-ms decrease, P = 0.002) were identified as independent associated factors for HIZ. The integrated multivariable model yielded excellent discrimination (AUC = 0.904, 95% CI 0.871-0.935), which was confirmed by internal validation with 1000 bootstrap resamples (AUC = 0.899, 95% CI 0.889-0.905). T2_NP alone also demonstrated favorable diagnostic efficacy (AUC: 0.832, 95% CI 0.789-0.874, DeLong's test P = 0.008), with a cut-off value of ≤ 60.25 ms. Variable importance analysis showed that T2_NP dominated the model, accounting for 72.3% of the discriminative weight.</p><p><strong>Conclusion: </strong>Disc herniation, lower disc levels, and T2_NP were independent associated factors for HIZs. T2_NP was the predominant quantitative biomarker associated with HIZs in patients with chronic LBP, suggesting that it may reflect underlying biochemical changes more sensitively than macroscopic morphological features.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887778","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":"The impact of self-efficacy and sense of coherence on hand disability during the first year after distal radius fracture surgery-a prospective cohort study.","authors":"S Svärding, C Mellstrand Navarro, O Sköldenberg, M Björk, N Brodin","doi":"10.1186/s13018-026-07114-6","DOIUrl":"10.1186/s13018-026-07114-6","url":null,"abstract":"<p><strong>Background: </strong>Distal radius fractures are among the most common surgically treated fractures in adults. While many patients recover well after surgery, a substantial number continue to experience pain, stiffness, and limitations in hand function that affect daily life and well-being. These difficulties are not always explained by physical healing alone. Psychological responses such as worry, low motivation, or reduced confidence in recovery are often observed in clinical encounters. Two psychological constructs, sense of coherence and self-efficacy, have been associated with outcomes in musculoskeletal rehabilitation. However, their contribution to recovery after distal radius fracture has not been fully established. This study aimed to explore how sense of coherence and self-efficacy are associated with hand disability during the first year after surgical treatment.</p><p><strong>Methods: </strong>This prospective cohort study included adults (18-74 years) with surgically treated distal radius fractures. Data were collected at cast removal and at three months, six months, and one year post-surgery. Outcome measures included hand disability (DASH), sense of coherence (SOC-13), task-specific self-efficacy, pain, grip strength, and range of motion. Nonparametric statistics were used. Group differences were analyzed with Mann-Whitney U and chi-squared tests. Logistic regression explored associations between psychological factors and disability.</p><p><strong>Results: </strong>74 patients completed the three-month follow-up, and 61 remained at one year. Sense of coherence scores were stable and not associated with disability at any time point. Self-efficacy was generally high. At six months, higher self-efficacy for goal fulfilment was associated with lower disability, but no associations were found at three months or one year. Median DASH scores improved from 12 at three months to 2 at one year. Pain at rest was normalized by one year, while pain during activity remained. Grip strength and volar flexion had not fully recovered at 12 months. Supination, pronation, and radial/ulnar deviation returned to near normal by six months.</p><p><strong>Conclusion: </strong>Neither sense of coherence nor self-efficacy consistently predicted outcomes after a surgically treated distal radius fracture across all time points. However, our exploratory results contribute to the overall understanding of the multifactorial nature of recovery in this patient population.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630722","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}