Journal of Orthopaedic Surgery and Research最新文献

{"title":"Periprosthetic joint infection as the leading indication associated with in-hospital death after revision hip and knee arthroplasty: a ten-year single-centre retrospective cohort study of 103 in-hospital deaths among 2495 patients.","authors":"Annemarie Rusche, Andreas Roth, Christina Pempe","doi":"10.1186/s13018-026-07259-4","DOIUrl":"10.1186/s13018-026-07259-4","url":null,"abstract":"<p><strong>Objective: </strong>Revision arthroplasty procedures are associated with increased in-hospital morbidity and mortality. This study aimed to characterise in-hospital death after revision hip and knee arthroplasty, with particular focus on periprosthetic joint infection (PJI) as the leading indication among decedents.</p><p><strong>Methods: </strong>In this single-centre retrospective cohort study, all patients who died in hospital after revision hip or knee arthroplasty between 2014 and 2024 were identified among 2495 patients with revision surgery coded as OPS 5-821* and 5-823*. Primary procedures and patients younger than 18 years were excluded. Clinical and microbiological data of these 103 decedents were reviewed to characterise the circumstances, timing and causes of in-hospital death, including ICU admission, septic shock, and reoperation. Clinical characteristics, causes of death, and treatment strategies were described according to revision indication for periprosthetic joint infection (PJI), periprosthetic fracture (PF), and other indications.</p><p><strong>Results: </strong>Of 2495 patients undergoing revision surgery over the study period, 103 patients (4.1%) died in hospital. Decedents were predominantly elderly, with a median age of 80 years (IQR 70-85) and a higher proportion of women (58.3%) than men (41.7%). PJI was the indication for revision in the majority of decedents (n = 78/103, 75.7%), and sepsis was the leading cause of death overall (n = 69/103, 67.0%) and among patients with PJI (n = 64/78, 82.1%). Patients with PJI had elevated CRP-level, with median value of 260.0 mg/l (IQR 148.5-339.3) and nearly half showed polymicrobial joint infection (n = 36/78, 46.2%).</p><p><strong>Conclusion: </strong>PJI was the leading indication among patients who died in hospital after revision arthroplasty. Positive blood cultures, elevated preoperative CRP, and polymicrobial infection characterised this cohort of fatal cases and may reflect greater disease severity, although this descriptive analysis cannot establish them as independent risk factors. Comparative studies including surviving patients are needed to confirm which characteristics independently predict adverse outcomes and to inform perioperative risk stratification and surgical decision-making.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170069","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 treatment of complex scapular fractures: a single centre prospective observational study.","authors":"Sergio Ferraro, Andrea Pautasso, Riccardo Maria Lanzetti, Pipino Gennaro, Giai Via Alessio Davide Enrico, Fabio D'Angelo, Michele Francesco Surace, Filippo Migliorini, Nicola Maffulli","doi":"10.1186/s13018-026-07247-8","DOIUrl":"10.1186/s13018-026-07247-8","url":null,"abstract":"<p><strong>Background: </strong>Conservative management is traditionally preferred for scapular fractures, but recent studies suggest that surgical intervention may improve outcomes in selected patients. This study evaluates functional and imaging outcomes, complication rates, and under-reported factors, such as duration of surgery and time from injury to definitive fixation, in surgically treated patients.</p><p><strong>Methods: </strong>This prospective observational study included 12 patients who underwent surgery for scapular fractures between 2016 and 2022. Inclusion criteria were complex scapular fractures, defined as displaced fractures with articular extension or floating shoulder (i.e., with associated ipsilateral clavicle fractures), and good psychophysical condition for postoperative evaluation. Exclusion criteria included isolated intra-articular glenoid fractures, associated proximal humerus fractures, and patients who did not complete the 1-year follow-up. Functional outcomes were assessed using the Quick-DASH, Constant-Murley Score, and Simple Shoulder Test, with imaging outcomes evaluated through follow-up imaging. Statistical analysis included t-test and linear regression.</p><p><strong>Results: </strong>The mean age at the time of injury was 48.3 ± 15.9 years. At one year, the Quick-DASH score was 13.6 ± 10.5%, the Constant-Murley Score improved to 87.9 ± 5.3, and the Simple Shoulder Test increased to 11.7 ± 0.50. Range of motion improved significantly across all parameters, especially between 6 and 12 months (p < 0.05), without statistically significant differences compared with the contralateral side at 1 year. A significant association between age and external rotation values was evident at six months.</p><p><strong>Conclusion: </strong>Open reduction and internal fixation (ORIF) of complex scapular fractures yield excellent functional recovery and high patient satisfaction. Accurate fracture classification and tailored surgical approaches optimise outcomes. These findings support the role of ORIF and emphasise the importance of the trauma-to-surgery interval and operative time.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075105","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":"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":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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 &lt; 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&lt;sup&gt;2&lt;/sup&gt; = 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).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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":"Long-term clinical and radiographic outcomes of interlaminar coflex dynamic stabilization versus posterior lumbar interbody fusion for lumbar spinal stenosis: a comparative study with minimum 15-year follow-up.","authors":"Jie Wang, Zihao Ding, Yuzeng Liu, Yong Hai","doi":"10.1186/s13018-026-07174-8","DOIUrl":"10.1186/s13018-026-07174-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the clinical and radiographic outcomes of inter-laminar Coflex dynamic stabilization compared with posterior lumbar interbody fusion (PLIF) for the treatment of lumbar spinal stenosis (LSS) over a long-term follow-up period exceeding 15 years.</p><p><strong>Patients and methods: </strong>A retrospective cohort study was conducted on 78 patients (36 in the Coflex group and 42 in the PLIF group) treated between January 2007 and December 2009. Clinical outcomes were assessed using the visual analogue scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI). Radiographic evaluation included intervertebral foraminal height (IFH), intervertebral space height (ISH), and range of motion (ROM) at the operative and adjacent levels. Complications, symptomatic adjacent segment disease (ASD), and revision rates were documented.</p><p><strong>Results: </strong>At the final follow-up, the Coflex group demonstrated significantly lower low back VAS, leg VAS, and ODI scores compared to the PLIF group (P < 0.05). Coflex initially maintained higher IFH and ISH at 1 month postoperatively (P < 0.05), these parameters gradually decreased over time, becoming significantly lower than the PLIF group at the final follow-up (P < 0.05). The Coflex group successfully preserved ROM at the operative level. In contrast, the PLIF group exhibited significantly increased ROM at both proximal and distal adjacent segments at the final follow-up (P < 0.05). The incidence of symptomatic ASD (5.6% vs 16.7%) and the revision rate (2.8% vs 11.9%) were significantly lower in the Coflex group than in the PLIF group (P < 0.05).</p><p><strong>Conclusion: </strong>Inter-laminar Coflex dynamic stabilization provides superior long-term clinical relief and functional improvement compared to PLIF for LSS patients. The progressive reduction in IFH and ISH in the Coflex group represents a biomechanical adaptive change that does not compromise long-term pain relief. By preserving operative segment mobility and preventing compensatory hypermobility at adjacent levels, Coflex significantly reduces the long-term risk of symptomatic ASD and the need for revision surgery.</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/PMC13621667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081008","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":"Absorbable sutures reduce pain without compromising wound healing in open clinic hand surgery.","authors":"Mirjam Hägg, Cecilia Mellstrand Navarro, Johanna von Kieseritzky","doi":"10.1186/s13018-026-07159-7","DOIUrl":"10.1186/s13018-026-07159-7","url":null,"abstract":"<p><strong>Background: </strong>This prospective cohort study aimed to compare absorbable and non-absorbable sutures in the context of open clinic hand surgery, focusing on postoperative wound infection, dehiscence, patient-reported pain during dressing or suture removal, and healthcare time utilization during follow-up.</p><p><strong>Methods: </strong>A total of 270 adult patients undergoing minor hand procedures in an outpatient surgical setting were enrolled. Patients were alternately assigned, on a biweekly basis, to receive either 5-0 polyglactin 910 (Vicryl Rapid®, Ethicon®) or 5-0 monofilament nylon (Ethilon®, Ethicon®) for skin closure. Wounds were assessed at a standardized two-week postoperative follow-up by trained nursing staff. The presence of wound infection or dehiscence was documented. The time required for inspection and dressing, or suture removal was recorded in minutes. Pain during dressing or suture removal was evaluated by patients using a visual analog scale (VAS).</p><p><strong>Results: </strong>At follow-up, no significant difference was observed in infection rates between the two groups, with one case in each group requiring antibiotic treatment (p = 1.0). Superficial wound dehiscence occurred in 13 patients in the absorbable suture group and 11 in the non-absorbable group (p = 0.390), with no cases requiring reoperation. Median time spent on wound care during the follow-up visit was five minutes in both groups. However, patients in the absorbable suture group reported significantly lower pain scores on the VAS compared to those with non-absorbable sutures (p < 0.001).</p><p><strong>Conclusion: </strong>Absorbable sutures offer a safe alternative to non-absorbable sutures in outpatient hand surgery, providing equivalent outcomes in terms of wound healing while significantly reducing discomfort during follow-up care. These findings support the use of absorbable sutures as a patient-friendly option in ambulatory hand surgical practice. Trial registration number The study was pre-registered on ClinicalTrials.gov 2021-02-26. (identifier: NCT04812275).</p><p><strong>Level of evidence: </strong>II.</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/PMC13548472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900749","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":"Effects of hypochlorous acid, povidone-iodine, and Carrel-Dakin solution irrigation on open fracture healing: a rat femur model.","authors":"Hüseyin Emre Tepedelenlioğlu, Gökçe Nur Arık Erol, Kemal Şibar, Çiğdem Elmas, Aslı F Ceylan, Şefik Murat Arıkan, Çimen Karasu","doi":"10.1186/s13018-026-07189-1","DOIUrl":"10.1186/s13018-026-07189-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Open fractures require immediate irrigation and debridement to minimize the risk of contamination and support subsequent wound management. However, antiseptic irrigants may also exert local cytotoxic or osteogenesis-impairing effects. The objective of this study was to conduct a comparative analysis of the effects of hypochlorous acid (HOCl), povidone-iodine (PI), and boric acid-buffered Carrel-Dakin solution (CD) on fracture healing in a rat model of open femur fracture, compared to physiological saline (PS) solution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Thirty-two male Long-Evans rats underwent a standardized open femoral shaft fracture, followed by a 60-min contamination interval, intramedullary Kirschner-wire fixation, and irrigation with one of the following solutions: 0.9% PS, 0.5% PI, HOCl, or CD (n = 8/group). Animals received 10 mL of irrigant intraoperatively with a 4-min contact period before closure. Systemic antibiotics were intentionally omitted to isolate the local biological effects of the irrigants under standardized experimental conditions. Fracture healing was assessed using radiological, histopathological, immunohistochemical, and biomechanical methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Radiological healing scores were similar among groups on postoperative day 14 (p = 0.89) but differed on day 28 (H(3) = 17.63, p = 0.000525). The median radiological scores on day 28 were lowest in PI and highest in CD. Composite histological healing scores were lower in the PI than in PS, HOCl, and CD. SPARC (osteonectin) expression was strongest in PS and HOCl, whereas weak staining was observed in PI. HOCl showed the highest level of BSP/SPP1 (osteopontin) expression compared to other groups, showing positive reactions in the chondro-osseous junction, mineralized osteoid, and osteoblasts. Conversely, bone morphogenetic protein (BMP2, BMP4, BMP6, BMP7, and BMP8A) expressions were highest in the CD group. Serum IL-1 levels were ranked according to groups as PS &gt; PI&gt; HOCL &gt; CD. IL-12 and TNF-α levels were lowest in CD. Bone-specific-alkaline phosphatase (ALP) levels did not differ significantly among groups. The PI exhibited the highest lactate dehydrogenase (LDH) levels, indicating bone damage or metabolic changes. Collagen X and procollagen, the most sensitive biochemical turnover markers for bone matrix, were at the highest levels in PS. HOCl and CD exhibited a similar or better healing profile compared to PS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this rat open femur fracture model, single intraoperative irrigation with HOCl or CD did not show the delayed healing pattern observed after PI irrigation. These findings provide preliminary preclinical evidence that HOCl and CD were biologically better tolerated than PI under the tested concentrations and exposure duration. However, the results should not be interpreted as proof of antimicrobial efficacy or as a direct clinical recommendation. Further studies using infecte","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030941","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}