Journal of Orthopaedic Surgery and Research最新文献

{"title":"Association between vertebral endplate defects and low back pain: an integrative omics study revealing the role of lipotoxicity-induced EGFR/COX-2 signalling.","authors":"Liqun Duan, Jiang Jiang, Yuyang Chen, Tianci Yu, Yijun Dong, Wenzhi Zhang, Xi Chen","doi":"10.1186/s13018-026-07111-9","DOIUrl":"https://doi.org/10.1186/s13018-026-07111-9","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To investigate the association between endplate defects and patient-reported outcomes and to further clarify the role of lipotoxicity-induced EGFR/COX-2 signalling in the pathogenesis of low back pain. As the hub of intervertebral discs, the metabolic status of the endplate remains poorly characterized. Investigating metabolic stress conditions and downstream biological events in the endplate may provide insights into the pathological mechanisms of endplate defects and their association with patient-reported outcomes.</p><p><strong>Methods: </strong>Patients were classified into defect and non-defect groups based on radiographic evidence of endplate defects. Endplate cells were analyzed using lipidomics, transcriptomics, and functional assays. Outcome measures were compared between groups. Pearson's correlation was used to assess relationships among symptoms, immune-positive cells, and lipid content. Multivariate linear analysis evaluated the contribution of different variables to patient-reported symptoms.</p><p><strong>Results: </strong>Preoperative VAS-Back scores (6.6 vs. 4.9, p < 0.01) and ODI scores (61.8 vs. 49.7%, p < 0.05) were significantly higher in the defect group compared to the non-defect group. Integrated analysis revealed that the defect group was characterized by lipid droplets accumulation in endplate cells and activation of the EGFR/COX2 signalling. In vivo animal studies confirmed that lipotoxicity induces endplate defects and activates EGFR/COX2 signalling. Preoperative VAS-Back and ODI scores showed positive correlations with EGFR expression (r = 0.403, p < 0.01; r = 0.466, p < 0.01) and relative lipid content (r = 0.432, p < 0.01; r = 0.358, p < 0.001) in the endplate cells. Multivariate linear analysis identified EGFR-positive cells (p = 0.010), relative triglyceride content (p = 0.049), and the presence of endplate defects (p = 0.046) as significant factors influencing preoperative VAS-Back pain.</p><p><strong>Conclusions: </strong>Patients with endplate defects reported severe symptoms and exhibited upregulation of the lipid droplet-EGFR/COX-2 pathway in endplate cells. Lipotoxicity-associated inflammatory factors significantly contribute to chronic low back pain and influence patient-reported outcomes.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internal brace augmentation versus modified brostrom-gould procedure for chronic lateral ankle instability: a systematic review and meta-analysis of functional and radiographic outcomes.","authors":"Xiuzhi Li, Zhuoqi Wei, Yuan Cao, Zengzhen Cui, Xiaoyu Norman Pan, Gao Si, Yang Lv","doi":"10.1186/s13018-026-07113-7","DOIUrl":"https://doi.org/10.1186/s13018-026-07113-7","url":null,"abstract":"<p><strong>Purpose: </strong>To compare functional, radiographic, and safety outcomes between internal brace (IB) augmentation and modified Broström-Gould (MBG) repair for chronic lateral ankle instability (CLAI), and to determine whether IB provides clinically relevant advantages over conventional anatomic repair.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and prospectively registered in PROSPERO. PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus were searched from inception to January 2026. Randomized controlled trials and observational studies comparing IB augmentation with MBG repair for CLAI were included. The primary outcome was the Foot and Ankle Ability Measure (FAAM) Sports score. Secondary outcomes included Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) score, return-to-sport time and rate, complications, recurrence, talar tilt angle (TTA), anterior talar translation (ATT), and operative time. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analyses were performed.</p><p><strong>Results: </strong>Thirteen comparative studies involving 1,015 patients (472 IB, 543 MBG) were included. IB was associated with a significant improvement in FAAM Sports score versus MBG (mean difference [MD] + 4.59; 95% confidence interval [CI] + 1.35 to + 7.82; I²=67.1%). After exclusion of a young female-specific cohort, the effect increased (MD + 6.06; 95% CI + 4.26 to + 7.86; I²=0%). Descriptively, IB patients returned to sport 4-8 weeks earlier than MBG patients across two studies; formal meta-analysis was not performed owing to the limited number of studies (k = 2). No significant between-group differences were observed for FAOS, AOFAS, return-to-sport rate, complications, recurrence, TTA, ATT, or operative time.</p><p><strong>Conclusion: </strong>IB augmentation was associated with better sports-specific function and earlier return to sport than MBG repair in patients with CLAI, without evidence of inferior radiographic or safety outcomes. These findings support IB as a useful surgical option, particularly for active patients in whom recovery trajectory and return to sport are important clinical priorities.</p><p><strong>Registration: </strong>This systematic review and meta-analysis was prospectively registered in PROSPERO (Registration No. CRD420261355719; registration date: 30 March 2026).</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of perifracture site injections for pain control following distal radius and ankle fracture surgery: a meta-analysis of randomized controlled trials.","authors":"Byung-Ho Yoon, Minsub Kim, Young Hak Roh","doi":"10.1186/s13018-026-07072-z","DOIUrl":"https://doi.org/10.1186/s13018-026-07072-z","url":null,"abstract":"<p><strong>Background: </strong>Surgical site analgesic injections are used as part of multimodal analgesia in elective orthopedic surgery, but their effectiveness in orthopedic trauma surgery, particularly for distal extremity fractures, remains controversial. This meta-analysis aimed to assess the efficacy of peri-fracture site local analgesic injections on postoperative pain and opioid consumption after distal radius and ankle fracture surgery.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, the Cochrane Library, and EMBASE was performed to identify randomized controlled trials assessing the efficacy of perifracture site injections for pain control after distal extremity fracture surgery. Pooled analyses compared postoperative pain intensity and total opioid consumption between the injection and control groups.</p><p><strong>Results: </strong>Five randomized controlled trials comprising 390 participants were included. The pooled analysis showed that the injection group had significantly lower pain scores at 4 h postoperatively (SMD - 0.34; 95% CI - 0.56 to - 0.12; I² = 37%). However, no significant differences in pain scores were observed between 8 and 48 h, with substantial heterogeneity at 8 and 24 h (8 h: SMD - 0.18; 95% CI - 0.78 to 0.42, I² = 86%; 24 h: SMD - 0.23; 95% CI - 0.81 to 0.35, I² = 85%). Total opioid consumption was significantly lower in the injection group (SMD - 0.29; 95% CI - 0.52 to - 0.07; I² = 6%).</p><p><strong>Conclusions: </strong>Peri-fracture site injection for distal radius and ankle fractures provided significant analgesic efficacy confined to the early postoperative period, along with an overall reduction in opioid consumption. Further investigations are needed to establish optimal injection protocols and to determine whether this approach can provide more sustained postoperative pain relief. Registry number: CRD420251185330.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D bioprinted bilayer GelMA/HAp hydrogel scaffold functionalized with miR-140-5p-modified MSCs for enhanced osteochondral regeneration.","authors":"Yingjie Xu, Junhui Xing, Ziyu Zhang, Minghui Li, Jing Qu, Hongtao Zhang","doi":"10.1186/s13018-026-07060-3","DOIUrl":"https://doi.org/10.1186/s13018-026-07060-3","url":null,"abstract":"<p><strong>Background: </strong>Osteochondral defects remain a major clinical challenge due to the limited intrinsic healing capacity of articular cartilage and the complex structural integration required between cartilage and subchondral bone. Tissue-engineered scaffolds offer a promising strategy for improving repair outcomes.</p><p><strong>Methods: </strong>We developed a 3D bioprinted bilayer GelMA/hydroxyapatite (HAp) hydrogel scaffold incorporating miR-140-5p-modified mesenchymal stem cells (MSCs). The upper chondral-oriented layer consisted of 5% GelMA60, while the lower relatively stiffer HAp-containing layer comprised 5% GelMA90 with 1% HAp. Mechanical properties, cell viability, migration, and differentiation were evaluated in vitro. Osteochondral repair efficacy was further assessed in a rabbit femoral condyle defect model using macroscopic scoring, Micro-CT, and histological analysis.</p><p><strong>Results: </strong>The bilayer scaffold demonstrated enhanced compressive strength and maintained favorable swelling characteristics. MSC viability remained high in both scaffold groups and exceeded 90% by day 5 after bioprinting. miR-140-5p modification significantly promoted MSC migration and upregulated chondrogenic markers. In vivo, the functionalized scaffold markedly improved cartilage surface integrity, subchondral bone reconstruction, and ICRS scores compared with controls.</p><p><strong>Conclusion: </strong>The 3D bioprinted bilayer GelMA/HAp scaffold combined with miR-140-5p-modified MSCs significantly enhances osteochondral repair in a rabbit model and represents a promising strategy for clinical translation.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of acromial periosteal flap technique for enhanced reconstruction of acromioclavicular joint dislocations: a cadaveric study.","authors":"Ole Somberg, Eckart Förster, Thomas Rosteius, Maria Bernstorff, Thomas Schildhauer, Matthias Königshausen","doi":"10.1186/s13018-026-07110-w","DOIUrl":"10.1186/s13018-026-07110-w","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to test the feasibility of mobilizing an acromial periosteal flap (APF) and to evaluate its potential to provide locally available, additional biological autologous augmentation for acute and chronic acromioclavicular joint (ACJ) injuries.</p><p><strong>Methods: </strong>Ten cadaveric upper extremities (5 right, 5 left; 3 female, 7 male) with an average age of 82 ± 3.7 years were used. A direct surgical approach to the ACJ was performed, and the APF was mobilized from three sides of the acromion, leaving the side closest to the clavicle intact. The flap was folded over onto the clavicle and secured with a transosseous suture. Measurements of flap length, width, and clavicular overlap were recorded.</p><p><strong>Results: </strong>Mobilization of the APF was successfully achieved in all specimens. The flaps appeared clinically stable and tear-resistant, with an average length of 2.3 ± 0.5 cm, width of 1.75 ± 0.5 cm, and clavicular overlap of 1.29 ± 0.6 cm.</p><p><strong>Conclusion: </strong>Our study demonstrated the anatomical feasibility of preparing an acromial periosteal flap (APF). This anatomical proof of concept may provide the basis for potential future clinical applications as an additional option for biological augmentation in ACJ reconstruction. However, further biomechanical investigations and clinical studies are necessary to evaluate whether this technique can translate into improved stability and functional outcomes.</p><p><strong>Level of evidence: </strong>V.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456180","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":"Radiographic findings after radial head replacement.","authors":"Gopal R Lalchandani, Matthew Cherches, Ryan T Halvorson, Akshara B Vykunta, Lisa L Lattanza, Nicolas H Lee, Utku Kandemir","doi":"10.1186/s13018-026-07103-9","DOIUrl":"https://doi.org/10.1186/s13018-026-07103-9","url":null,"abstract":"<p><strong>Background: </strong>Radial head arthroplasty (RHA) has become the preferred treatment for displaced radial head and neck fractures that cannot be fixed. While good short-term results are reported, mid- to long-term radiographic findings such as loosening, stress shielding, and radiocapitellar arthritis are not uncommon. The aim of this study was to analyze and quantify radiographic findings after primary RHA. We hypothesized high rates of radiographic changes could be appreciated at mid-term follow-up.</p><p><strong>Methods: </strong>Patients at a single institution who underwent RHA between 2006 and 2019 with at least six months of radiographic follow-up were included. Associated injuries, fracture pattern, implant design, radiolucency, stress shielding, radiocapitellar arthritis, and heterotopic ossification were evaluated. Radiographic reviews were performed independently by two fellowship-trained orthopedic surgeons. Regression analysis was used to assess the relationship between demographics, clinical characteristics, and radiographic findings and reoperation.</p><p><strong>Results: </strong>Sixty-three elbows amongst 62 patients with a mean age of 47 (range 15-83) met inclusion criteria, with an average follow-up of 748.8 days (range 230-4554 days). At mid-term follow-up, 82.5% of patients had at least one radiographic finding, most of which were mild; stress shielding was present in 58.7% and radiolucency in 27.0%. In regression analysis, implant type was not associated with an increased odds for radial head specific reoperation. Age, follow-up duration, fracture pattern, and associated ligamentous injuries were not associated with SS, arthritis, HO, or radiolucency. Male gender was associated with a lower degree of radiocapitellar arthritis (estimate - 0.40; 95% CI - 0.72 to - 0.08), as was the use of bipolar implants (estimate - 0.6; 95% CI - 1.11 to - 0.09).</p><p><strong>Conclusion: </strong>Radiographic changes are frequently observed by mid-term follow-up after RHA, although most are mild and do not necessarily indicate clinical failure. Male gender and the use of bipolar implants may be protective against radiographic radiocapitellar arthritis. However, the clinical implications of these radiographic findings remain to be determined.</p><p><strong>Level of evidence: </strong>III.</p><p><strong>Type of study: </strong>Prognostic.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vibration assessment of transfemoral implant stability: a longitudinal case series.","authors":"Mostafa Mohamed, Eric Beaudry, Ahmed Shehata, Dylan Brenneis, Lindsey Westover, Jacqueline Hebert","doi":"10.1186/s13018-026-07056-z","DOIUrl":"https://doi.org/10.1186/s13018-026-07056-z","url":null,"abstract":"<p><strong>Background: </strong>The success of osseointegrated implants (OI) for individuals with transfemoral amputation (TFA) depends on the quality of the bone-implant interface (BII), which is difficult to track clinically. Vibration methods assess the biomechanical properties of the BII non-invasively and quantitatively. This study implements a vibration-based approach that quantifies BII stiffness ([Formula: see text]) for press-fit transfemoral osseointegrated implants . The primary objective is to assess the initial validity of using k to determine BII condition as individuals progress through rehabilitation and and after transition to unaided prosthesis use.</p><p><strong>Methods: </strong>Implant stability measurements of four participants with TFA were longitudinally collected prospectively over a 2-year follow-up period. The measurements covered post-operative rehabilitation from static loading up to and including unaided prosthesis walking. Vibration signals were analyzed using a custom-developed application that estimates [Formula: see text] by comparing the clinically acquired vibration signal to a one-dimensional finite element model of the bone-implant system. The longitudinal changes in k were tracked, and the Mann Whitney U-test was used within each participant to compare the Early (after completion of static loading), Intermediate and Late (post-year 1) osseointegration phases. Complications and X-rays were tracked as per clinical standard.</p><p><strong>Results: </strong>Longitudinal [Formula: see text] measurements demonstrated high repeatability and sensitivity. Within participants, maximum to minimum [Formula: see text] ratio ranged from 2.8 to 88 times, indicating high sensitivity to potential BII changes (such as mechanical properties and/or bone-implant contact ratio) during rehabilitation. Observed patterns, such as reduced [Formula: see text] during loading followed by higher readings and plateaus later in rehabilitation, align with expectations of BII healing. At the individual level, Early and Late healing showed a significant difference [Formula: see text], with higher [Formula: see text] in the Late phase, indicating greater implant stability and sensitivity towards clinically meaningful healing.</p><p><strong>Conclusions: </strong>The proposed measurement method shows promising potential for non-invasively tracking implant stability for individuals with TFA. The changes in [Formula: see text] were aligned with: expected bone-implant healing timelines, previously reported vibration assessments for other OI systems, implant survival and rehabilitation stages. The small sample size limits population level inference and generalizability of findings. Larger clinical cohorts are needed to enable population level comparisons and establish clinically relevant predictive [Formula: see text] stability/instability thresholds.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biologics or surgery for moderate knee osteoarthritis? a patient-centered framework for short-term relief and long-term outcomes.","authors":"Muhammad Adil Malik, Song Wu, Wenxiu Zhang, Junjie Huang, Xu Cao","doi":"10.1186/s13018-026-07062-1","DOIUrl":"https://doi.org/10.1186/s13018-026-07062-1","url":null,"abstract":"<p><strong>Purpose: </strong>To provide a narrative synthesis comparing clinical outcomes, durability, and patient-specific suitability of autologous biologic therapies (platelet-rich plasma [PRP], bone marrow aspirate concentrate [BMAC]) versus non-TKA surgical strategies (high tibial osteotomy [HTO], unicompartmental knee arthroplasty [UKA]) in patients with moderate knee osteoarthritis (Kellgren-Lawrence grade 2-3).</p><p><strong>Methods: </strong>A structured literature search was conducted in PubMed, Scopus, and Web of Science (January 2010-March 2024). Priority was given to prospective cohort studies, randomized controlled trials, and comparative studies involving KL grade 2-3 patients. Evidence was synthesized qualitatively, focusing on pain, function, durability, complications, and cost-effectiveness.</p><p><strong>Results: </strong>Biologic therapies provide rapid pain relief within 3-6 months (mean VAS/WOMAC reduction: -2.6 to - 5.8 points) but show attenuation beyond 18-24 months, particularly in KL3 disease. BMAC demonstrates superior short-term outcomes compared to PRP (WOMAC mean difference - 5.8, p = 0.03). Surgical interventions exhibit slower initial improvement but superior durability, with 5-year survivorship of 92% for UKA and 85% for HTO. Complication rates are low for biologics (< 1% major) but higher for surgery (HTO 5.2%, UKA 3.8%). Cost-effectiveness remains favorable for all interventions (<$50,000/QALY). KL2 patients respond well to biologics, while KL3 patients with malalignment derive greater benefit from surgery.</p><p><strong>Conclusions: </strong>Management of moderate knee OA is best guided by a severity-stratified, patient-centered framework. Biologic therapies may be suitable for earlier-stage disease or for patients seeking minimally invasive, short-term symptom relief, while surgical interventions represent more durable options for patients with advanced degeneration or biomechanical imbalance. Treatment decisions should prioritize patient characteristics, disease stage, values, and expectations rather than implying a hierarchical superiority of one modality over another.</p><p><strong>Level of evidence: </strong>Narrative Review - Level V.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes of percutaneous pedicle screw fixation for unstable traumatic thoracolumbar fractures: a meta-analysis focused on randomized controlled trials from the past 15 years.","authors":"Jianfeng Zhao","doi":"10.1186/s13018-026-07094-7","DOIUrl":"https://doi.org/10.1186/s13018-026-07094-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Previous meta-analyses often lacked explicit time and included heterogeneous case types and surgical strategies. This led to substantial heterogeneity and limited the clinical applicability of these meta-analyses. This study focuses on evidence from the past 15 years, systematically comparing percutaneous pedicle screw fixation (PPSF) with open pedicle screw fixation (OPSF) for unstable traumatic thoracolumbar fractures (TTF). We aim to evaluate perioperative outcomes and radiographic correction based on contemporary practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Randomized controlled trials (RCTs) published in English between January 2011 and January 2026 were retrieved from PubMed, Embase, the Cochrane Library, and the Web of Science Core Collection. Studies were screened using predefined inclusion and exclusion criteria. Six RCTs involving 305 patients were included, with 151 patients in the experimental group and 154 in the control group. Meta-analysis was performed using Review Manager 5.4. Mean difference (MD) was used as the effect size. Heterogeneity was assessed with the I&lt;sup&gt;2&lt;/sup&gt; statistic. Sensitivity analysis was used to identify the main source of heterogeneity. Publication bias was evaluated using Egger's test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The random-effects meta-analysis showed that the experimental group had significantly less intraoperative blood loss (MD = - 32.51 mL, 95% CI - 57.52 to - 7.51, P = 0.01), shorter postoperative hospital stay (MD = - 2.09 d, 95% CI - 3.89 to - 0.29, P = 0.02), and smaller postoperative Cobb angle (MD = - 1.06°, 95% CI - 1.67 to - 0.46, P &lt; 0.001). There was no significant difference in operative time (MD = - 10.15 min, 95% CI - 28.75 to 8.46, P = 0.29) or postoperative vertebral wedging angle (MD = 0.25°, 95% CI - 1.73 to 2.24, P = 0.80) between groups. Sensitivity analyses identified the study by Yang et al. as the main source of heterogeneity for operative time. After excluding this study, the fixed-effects model showed a shorter operative time in the experimental group (MD = - 8.85 min, 95% CI - 12.74 to - 4.95, P &lt; 0.001). Perioperative outcomes showed high heterogeneity, whereas radiographic outcomes showed low to moderate heterogeneity. Egger's test indicated no significant publication bias. Risk-of-bias assessment classified four RCTs as having a low risk of bias and two as having some concerns; no study was judged to have a high risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;PPSF may offer perioperative advantages over OPSF in selected unstable traumatic thoracolumbar fractures, mainly by reducing visible intraoperative blood loss and shortening postoperative hospital stay. PPSF was also associated with a modestly smaller postoperative segmental Cobb angle, although its clinical relevance and long-term durability remain uncertain. The operative-time finding should be interpreted cautiously because it became significant only in exploratory sensitivity analy","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone marrow edema as an independent imaging predictor of dedifferentiated chondrosarcoma.","authors":"Caleb Cummings, Joseph Redding, Chloe Chose, Sarah C Tepper, David M Joyce, Odion T Binitie, Jamie T Caracciolo, Alexander L Lazarides","doi":"10.1186/s13018-026-07093-8","DOIUrl":"https://doi.org/10.1186/s13018-026-07093-8","url":null,"abstract":"<p><strong>Background: </strong>Dedifferentiated chondrosarcoma is the most aggressive subtype of chondrosarcoma; however, imaging features that independently distinguish it from other subtypes remain unclear. The purpose of this study was to identify independent imaging predictors of long bone dedifferentiated chondrosarcoma to signal for expedited biopsy and treatment.</p><p><strong>Methods: </strong>This retrospective study incorporated consecutive patients undergoing resection at a tertiary center for primary intramedullary long bone chondrosarcoma between February 2001 and January 2024. Inclusion required preoperative MRI and postoperative pathological confirmation. Seven imaging features were analyzed. Multivariate regression investigated independent predictors of dedifferentiated versus non-dedifferentiated chondrosarcoma.</p><p><strong>Results: </strong>Sixty-seven patients were included. Of these, 23 (34%) patients presented with dedifferentiated chondrosarcoma, while 43 (64%) had conventional chondrosarcoma (21 grade 1, 18 grade 2, 4 grade 3) and one (1.5%) had grade 3 mesenchymal chondrosarcoma. On multivariate analysis, bone marrow edema was the only independent predictor of dedifferentiated status (p = 0.0091). This association persisted after controlling for age, sex, and tumor size (p = 0.0057). Bone marrow edema achieved a sensitivity and specificity of 87% and 68%, respectively, and the greatest area under the ROC curve among individual imaging features (AUC = 0.78, p = 0.0027), while the overall combined model achieved even greater discrimination (AUC = 0.87, p < 0.001).</p><p><strong>Conclusions: </strong>Marrow edema was the only imaging feature that independently predicted dedifferentiated chondrosarcoma in multivariable analysis. Although incorporation of additional imaging findings provides the highest overall diagnostic accuracy, marrow edema alone demonstrates high sensitivity and is a readily identifiable marker that may prompt expedited biopsy when identified on routine preoperative MRI.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}