Journal of Orthopaedic Surgery and Research最新文献

{"title":"Correction: Application of a rapid and accurate safe-margin volume generation method in computer-assisted bone tumor resection surgery.","authors":"Yu Zhang, Daming Pang, Zhuoyu Li, Yang Sun, Weifeng Liu, Qing Zhang","doi":"10.1186/s13018-026-07078-7","DOIUrl":"10.1186/s13018-026-07078-7","url":null,"abstract":"","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447708","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 retrospective comparative study of intraoperative fluoroscopy and postoperative radiography for measuring mounting parameters of the taylor spatial frame in tibial fractures.","authors":"Zhiming Zhao, Chengkuo Cai, Guoqi Ji, Weiguo Xu","doi":"10.1186/s13018-026-07112-8","DOIUrl":"10.1186/s13018-026-07112-8","url":null,"abstract":"<p><strong>Objective: </strong>Reliable measurement of mounting parameters (MP) is crucial for effective deformity correction using the Taylor Spatial Frame (TSF). Intraoperative fluoroscopy (IF) allows real-time parameter acquisition but is technically demanding, requiring precise projection angles; otherwise, projection distortion may occur. In contrast, postoperative radiographic measurement is simpler but prone to parallax errors inherent to two-dimensional imaging. The consistency between these two methods and their respective effects on correction efficiency remains unclear. Therefore, this study aims to compare the consistency of IF with postoperative radiography (PR) for measuring the MP of TSFs and to evaluate their clinical impact.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 86 patients aged 20-60 years with tibial fractures who underwent TSF treatment between May 2021 and May 2024. Based on the measurement method for MP, the patients were divided into two groups: an IF group (n = 41, measured via IF) and a PR group [n = 45, measured via postoperative standard anteroposterior (AP) and lateral (LAT) radiographs]. Primary outcome measures included measurement of operation time, surgical time, number of electronic prescriptions, and fracture reduction time (interval from the execution of the first prescription to imaging-confirmed satisfactory reduction). Secondary outcome measures included final radiological outcomes (AP and LAT angulation and translation), fracture healing time, and Johner-Wruhs functional scores at the study endpoint. The intraclass correlation coefficient (ICC) was used to evaluate the inter-observer consistency of parameters between two independent observers, and the satisfactory reduction rate of the initial prescription was compared between the two groups.</p><p><strong>Results: </strong>All 86 patients completed the follow-up, with a mean follow-up of 28.1 months. The two groups were comparable at baseline for age, sex, injury mechanism, AO/OTA classification, and Gustilo-Anderson classification (all P > 0.05). Regarding consistency, the inter-observer consistency in the IF group appeared higher than that in the PR group based on descriptive comparison of 95% CIs (ICC: 0.92 vs. 0.81), and parallax errors caused by suboptimal radiographic positioning were the primary reason for measurement inconsistency in the PR group. In terms of intraoperative workflow, the software-based measurement time in the PR group was shorter than that in the IF group (11.8 ± 2.4 min vs. 18.4 ± 2.1 min). Because the measurement process was shifted to the postoperative period, the total surgical time was significantly shorter than that in the IF group (73.7 ± 6.2 min vs. 92.1 ± 7.2 min), with both differences being statistically significant (P < 0.001). Regarding reliability and reduction efficiency, the IF group required fewer electronic prescriptions (median [IQR]: 1 [1, 2] vs. 2 [1, 2], P = 0.00","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13464878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447715","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":"Functional and radiographic outcomes after operative and nonoperative treatment of pediatric Lisfranc injuries.","authors":"Nezih Ziroglu, Ali Can Koluman, Basar Burak Cakmur, Altug Duramaz, Cemal Kural, Emre Baca","doi":"10.1186/s13018-026-07048-z","DOIUrl":"10.1186/s13018-026-07048-z","url":null,"abstract":"<p><strong>Background: </strong>Pediatric Lisfranc injuries are rare and frequently misdiagnosed, potentially resulting in delayed treatment and long-term morbidity. Evidence guiding surgical versus nonoperative management in children remains limited.</p><p><strong>Methods: </strong>This retrospective cohort study included 21 pediatric patients with radiographically confirmed Lisfranc injuries treated surgically (n = 8) or nonoperatively (n = 13). Functional outcomes were assessed at final follow-up using the American Orthopaedic Foot & Ankle Society-Midfoot Function Score (AOFAS-MFS), Pediatric Quality of Life Inventory (PedsQL), and visual analog scale (VAS). Radiographic alignment parameters were measured on weight-bearing radiographs. Between-group differences were analyzed using nonparametric tests. Effect sizes (Hedges g) and 95% bootstrap confidence intervals (CI) were reported. Multivariable regression models adjusted for injury severity (Nunley-Vertullo grade), age, and time to presentation.</p><p><strong>Results: </strong>Injury severity differed between groups (p = 0.013). Nonoperative treatment was associated with higher AOFAS scores (mean difference 15.65; 95% CI 8.83-22.65; g = 2.14; p = 0.0006) and lower VAS scores (mean difference - 2.80; 95% CI - 3.88 to - 1.69; g = - 2.31; p = 0.0005). PedsQL scores were also higher following nonoperative treatment (mean difference 17.06; 95% CI 3.78-32.44; g = 1.17; p = 0.0176). After adjustment, surgical treatment remained independently associated with lower AOFAS and higher VAS scores. In the predefined exploratory Grade 2 subgroup, patients treated nonoperatively demonstrated higher functional scores, whereas radiographic parameters were comparable between groups.</p><p><strong>Conclusion: </strong>In this retrospective cohort, patients treated nonoperatively demonstrated higher functional scores and lower pain at mid-term follow-up, including within the exploratory Grade 2 subgroup. However, these findings should not be interpreted as evidence of treatment superiority because of the observational design, severity-based treatment allocation, and limited sample size. Nonoperative treatment may be considered in carefully selected pediatric patients without clear instability, but prospective multicenter studies are needed to define pediatric-specific treatment thresholds.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436955","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 high-molecular-weight hyaluronic acid on inflammatory and matrix-associated responses in a chondrocyte-osteoclast co-culture model.","authors":"Adam Eid, Kavitha Raja, Dineshwary Suresh, Surendra Singh Rawat, Ivan James Prithishkumar, Thomas Nau, Nerissa Naidoo","doi":"10.1186/s13018-026-07024-7","DOIUrl":"10.1186/s13018-026-07024-7","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis (OA) is a degenerative joint disorder marked by chronic inflammation, extracellular matrix (ECM) breakdown, and subchondral bone remodeling, ultimately leading to loss of cartilage integrity and joint function. Hyaluronic acid (HA), a key component of synovial fluid, contributes to joint lubrication and has been implicated in the regulation of inflammatory and anabolic processes. High-molecular-weight (HMW) HA (> 1 MDa) is reported to exert anti-inflammatory and matrix-preserving effects; however, its role in multicellular systems remains incompletely understood. In this study, we investigated the effects of HMW HA using an in vitro chondrocyte-osteoclast co-culture model designed to reflect key features of the osteoarthritic microenvironment.</p><p><strong>Methods: </strong>Bone marrow-derived mesenchymal stem cells were differentiated into chondrocytes, while RAW 264.7 macrophages were induced into osteoclast-like cells using M-CSF and RANKL. Cells were co-cultured at a 1:1 ratio and stimulated with lipopolysaccharide (LPS; 1 µg/mL) to induce inflammatory stress, followed by HA treatment (50-500 µg/mL) for 24-48 h. Cell viability, morphology, and TRAP staining were assessed. Expression of inflammatory and matrix-associated markers was analysed by Western blot, qPCR, and ELISA. Cell-cycle distribution and DNA integrity were evaluated using flow cytometry and agarose gel electrophoresis.</p><p><strong>Results: </strong>LPS exposure reduced metabolic activity, altered morphology, and was associated with increased expression of NF-κB-related inflammatory markers and elevated expression of IL-1β, TNF-α, MMP-13, and ADAMTS-5, alongside reduced COL2A1 and ACAN levels. HA treatment improved metabolic activity and preserved cellular morphology in a concentration-dependent manner, with the most pronounced effects observed at 200-500 µg/mL. HA-treated cultures showed lower levels of inflammatory and catabolic markers together with increased expression of ECM-associated genes. In addition, HA treatment was associated with a more balanced cell-cycle profile and reduced DNA fragmentation.</p><p><strong>Conclusion: </strong>HMW HA was associated with coordinated modulation of inflammatory and matrix-related markers in an LPS-induced co-culture system. These findings suggest that HA may contribute to maintaining cellular homeostasis under inflammatory conditions in vitro. Further studies are needed to clarify the underlying mechanisms and translational relevance.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436880","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":"Feasibility of shoulder joint visualization using the 0° Arthrex Nanoscope: a cadaveric study on twenty specimens.","authors":"Jędrzej Lesman, Błażej Wójtowicz, Łukasz Gołek, Michał Szufnara, Marcin Domżalski","doi":"10.1186/s13018-026-07061-2","DOIUrl":"10.1186/s13018-026-07061-2","url":null,"abstract":"<p><strong>Purpose: </strong>Nanoscopic technology is increasingly employed in minimally invasive orthopedic procedures, offering enhanced access to tight compartments with reduced soft-tissue disruption. This study assessed the feasibility of visualizing key anatomical structures of the shoulder joint using a 0° nanoscope in cadaveric specimens.</p><p><strong>Methods: </strong>Twenty fresh-frozen human cadaveric shoulders (10 left, 10 right) were examined by two orthopedic surgeons with different experience levels using a 1.9 mm 0° nanoscope. Standard posterior, anterior, and lateral portals were used to assess glenohumeral and subacromial compartments. Predefined landmarks were graded on a 5-point Likert scale. The primary outcome was feasibility of identifying each structure; secondary outcomes included mean visibility scores and inter-observer variability.</p><p><strong>Results: </strong>All predefined landmarks were identified in all 20 specimens. The senior surgeon reported an overall mean visibility score of 4.45 (SD ± 0.18), and the resident 4.18 (SD ± 0.21). Highest scores were observed for the long head of the biceps tendon and superior labrum. Lower scores occurred in the subacromial space, particularly in bursal-side rotator cuff assessment, reflecting challenges inherent to the 0° field of view. Inter-observer agreement was good (mean differences ≤ 0.3).</p><p><strong>Conclusion: </strong>Nanoscopic visualization of the shoulder using a 0° device is feasible and yields high visibility scores for most landmarks. Surgeon experience may influence interpretation in anatomically complex regions such as the subacromial space. These findings support a potential diagnostic and adjunctive therapeutic role for shoulder nanoscopy.</p><p><strong>Level of evidence vi: </strong>Descriptive laboratory study.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436962","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":"Albumin as a predictor of periprosthetic joint infection in patients undergoing total hip arthroplasty and total knee arthroplasty: a retrospective study.","authors":"Lingtian Min, Shiqi Ren, Cheng Chen","doi":"10.1186/s13018-026-07081-y","DOIUrl":"10.1186/s13018-026-07081-y","url":null,"abstract":"<p><strong>Background: </strong>Nutritional assessment and diagnosis of the periprosthetic joint infection (PJI) following arthroplasty are critical for effective management of patients undergoing joint replacement surgery and their subsequent health outcomes. The present study aimed to investigate the potential relationship between postoperative nutritional status and inflammatory response in postoperative patients.</p><p><strong>Methods: </strong>Albumin (ALB) serves as a key indicator for nutritional assessment. Peripheral blood levels of C-reactive protein (CRP), erythrocyte sedimentation rates (ESR), white blood cell (WBC), neutrophilic granulate percentage (NEU), D-Dimer, and ALB were measured in patients prior to surgery and for six consecutive days following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Further analysis was conducted to explore the correlation between ALB and the aforementioned inflammatory indicators.</p><p><strong>Results: </strong>The results demonstrated that ALB levels decreased significantly subsequent to both THA and TKA, indicating potential differences between the THA and TKA groups. Furthermore, ALB levels were closely associated with the progression of postoperative inflammation.</p><p><strong>Conclusions: </strong>Simultaneous detection of ALB and other inflammatory indicators can more accurately and sensitively reflect the inflammatory status and infection risk in patients following THA and TKA.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430755","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":"Quadriceps recovery after subvastus total knee arthroplasty in valgus deformity: a systematic review and pooled descriptive analysis.","authors":"Hifza Babar, Yu Zhang, Qiangqiang Li, Dongyang Chen, Zezhang Zhu","doi":"10.1186/s13018-026-07012-x","DOIUrl":"10.1186/s13018-026-07012-x","url":null,"abstract":"<p><strong>Background: </strong>The subvastus approach preserves the extensor mechanism, but its efficacy in total knee arthroplasty (TKA) for valgus deformity remains unclear. This systematic review synthesizes available evidence on quadriceps recovery and clinical outcomes after subvastus TKA specifically in patients with valgus deformity.</p><p><strong>Methods: </strong>A systematic search of PubMed, Cochrane Library, and Embase (2000-2025) was performed. Studies reporting outcomes of the subvastus approach in valgus TKA were included. The primary outcome was time to straight leg raise (SLR). Secondary outcomes included functional scores, range of motion (ROM), pain (VAS), and complications. Due to single-arm designs and high heterogeneity, a formal meta-analysis was not appropriate; results are presented descriptively with pooled means for illustrative purposes only.</p><p><strong>Results: </strong>Three retrospective studies (286 valgus knees) were included. Time to SLR ranged from 0.92 to 2.0 days across studies (pooled descriptive mean: 1.35 days; I² = 99%). Functional scores improved substantially (e.g., American Knee Society Score: 39 to 91; Hospital for Special Surgery Score: 35 to 93). Postoperative ROM gains ranged from 9° to 27° across studies, with final flexion exceeding 109° in all cohorts. Postoperative rest pain scores ranged from 2.3 to 4.6; walking pain was reported as 5.2 in one study. Complication rates were low, with two revisions (0.7%) and one transient nerve palsy (0.3%) among 286 knees. No approach-related major complications were reported.</p><p><strong>Conclusion: </strong>The subvastus approach appears viable for selected valgus knees, associated with rapid quadriceps recovery, functional improvement, and low complications within the available evidence. However, these findings derive from only three retrospective, single-arm studies with substantial heterogeneity. High-quality prospective comparative studies are required.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436953","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 repair of radial meniscus tears yields favorable healing rates: a systematic review.","authors":"Felipe Moreira Borim, Cindy Zeng, Jan Rechsteiner, Timothy Lording","doi":"10.1186/s13018-026-07080-z","DOIUrl":"10.1186/s13018-026-07080-z","url":null,"abstract":"<p><strong>Purpose: </strong>To report on current surgical techniques, patient-reported outcome measures (PROMs), and quantify healing rates following repair of radial meniscus tears.</p><p><strong>Methods: </strong>A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed, Cochrane Library, Embase and Scopus databases up to November 15, 2025. Studies included reported ≥ 6-month mean follow-up on radial meniscus tear repair, were published in English (or translated) after January 1, 1990. Technical reports and biomechanical or cadaveric research were excluded. Search terms included MeSH and keywords for \"meniscal/meniscus AND radial/vertical tears\" and repair concepts. Quality was assessed using both the Methodological Index for Non-Randomized Studies (MINORS) and the Modified Coleman Methodology Score (MCMS).</p><p><strong>Results: </strong>Eighteen studies (316 patients, 321 radial repairs) met criteria. Mean follow-up was 36.1 ± 6.4 months (range 6.2-71). Lateral tears predominated (n = 279, 87%). Inside-out and all-inside techniques were most common. Postoperative PROMs demonstrated statistically significant improvement from pre- to postoperative assessments (p < 0.01 for Lysholm, IKDC, Tegner scores), generally indicating good to excellent functional outcomes and activity levels. Satisfactory healing (complete or partial) was reported in 82.5% of assessed tears, with a low complication rate (3.7%). Quality assessment indicated predominantly medium risk of bias according to MINORS criteria, and moderate quality based on MCMS scores (mean 55 ± 8.7).</p><p><strong>Conclusions: </strong>Despite variations in repair techniques, postoperative subjective outcomes indicated significant patient improvement following radial tear repair, with high reported healing rates.</p><p><strong>Clinical relevance: </strong>As concern for post-meniscectomy osteoarthritis grows, meniscal preservation via radial tear repair offers a promising approach to improve clinical outcomes.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level III and IV studies.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421736","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 diagnostic accuracy of artificial intelligence in detecting foot and ankle fractures: a systematic review and meta-analysis of diagnostic test accuracy.","authors":"Gregorius Thomas Prasetiyo, Jeremiah Hilkiah Wijaya","doi":"10.1186/s13018-026-07108-4","DOIUrl":"10.1186/s13018-026-07108-4","url":null,"abstract":"<p><strong>Introduction: </strong>Foot and ankle fractures, including radiographically subtle or occult injuries, present a diagnostic challenge in emergency settings, with missed diagnoses causing severe complications. Artificial intelligence (AI), specifically deep learning, offers a promising adjunct for radiographic interpretation. This systematic review and meta-analysis evaluates the diagnostic test accuracy of AI in detecting foot and ankle fractures and appraises the available evidence for occult fracture detection where reported.</p><p><strong>Method: </strong>Adhering to PRISMA-DTA guidelines, a systematic search was conducted across PubMed, Embase, and Scopus from inception to 10 May 2026. Studies evaluating AI algorithms for identifying foot and ankle fractures on radiographs or CT were included, with occult-fracture data extracted separately when available. Extracted data populated 2 × 2 contingency tables. We utilized a bivariate random-effects model to calculate pooled sensitivity, specificity, and the summary receiver operating characteristic (SROC) curve. Quality was assessed via QUADAS-2.</p><p><strong>Results: </strong>Sixteen studies encompassing over 37,000 radiographs or images were included. Pooled sensitivity was 92.4% (95% CrI 82.5-96.1%) and pooled specificity was 95.1% (95% CrI 83.3-98.3%). The diagnostic odds ratio was 236.64 (95% CrI 33.56-1087.11). At a 25% pre-test probability, a positive AI result increased post-test probability to 86%, while a negative result reduced it to 3%. Substantial between-study heterogeneity was observed. Only two studies explicitly reported occult fracture cases; therefore, the pooled estimates primarily reflect AI performance for overall foot and ankle fracture detection rather than occult fractures alone.</p><p><strong>Conclusion: </strong>AI algorithms demonstrate high diagnostic accuracy for foot and ankle fracture detection and show meaningful clinical utility as adjunctive tools. However, current evidence is insufficient to support robust occult-fracture-specific conclusions, and all included studies were retrospective. Prospective validation, standardized reporting of occult fracture subgroups, and real-world impact studies are needed before widespread clinical implementation.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421718","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":"Clinical and functional outcomes of upper extremity 3D-printed immobilization devices compared to traditional methods: a systematic review with limited meta-analysis.","authors":"Alexis Watson, Samuel Hauke, Kyle DeRoma, Royal Shrestha, Anuj Vimawala, Michael Lohse, Asiya Falak, Wen Chao, Al Smith, Thomas Murphy, Rand Kittani","doi":"10.1186/s13018-026-07109-3","DOIUrl":"10.1186/s13018-026-07109-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Fractures are a common cause of emergency department visits, and immobilization choice affects not only fracture healing but also comfort, hygiene, mobility, and quality of life. Conventional casting remains standard but is associated with limitations, including bulk, discomfort, and poor water tolerance. 3-Dimensional (3D)-printed, patient-specific immobilization may improve ventilation and functional tolerance while maintaining stability, but clinical evidence is still emerging and heterogeneous. This systematic review aims to evaluate the current clinical evidence on 3D-printed immobilization technologies versus traditional standard methods for fracture management in both pediatric and adult patients with respect to fracture healing, stability, pain, and functional recovery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive search of PubMed, Scopus, and Web of Science databases was performed from database inception until November 2025 on the topic of evaluating 3D-printed technology to create casts, splints, or orthoses for upper-extremity fracture immobilization. Due to heterogeneity in design, interventions, and outcome reporting, results were synthesized narratively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 828 articles retrieved from the initial search, 581 studies were included for screening after removing duplicate articles, and underwent title and abstract screening, with 32 full-text studies assessed for eligibility. Thirteen studies met full inclusion criteria, while 19 studies were excluded. Twelve (n = 456) were included in the result analysis as they all focused on upper-extremity fractures, all of which had a moderate-to-high risk of bias. Fracture union was reported at or near 100% across studies. Patient satisfaction generally favored 3D-printed immobilization (10/11 studies), with a non-significant large, pooled effect (Hedges' g = 0.83; 95% CI = 0.21-1.88; p = 0.085; I&lt;sup&gt;2&lt;/sup&gt; = 77.5%). Pain showed a non-significant small-to-moderate benefit (g = 0.36; 95% CI = 1.94-2.66), and functional outcomes were similar between groups (g = 0.13; 95% CI = 1.02-1.28). Skin-related outcomes more often favored 3D-printed devices (7/9 studies), with reduced irritation and hygiene burden, while device weight was consistently lower, but cost and production time were higher.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;3D-printed immobilization devices show comparable fracture healing and improved patient satisfaction and skin tolerability compared with conventional casting, with early functional advantages that are not consistently sustained long term. However, the evidence is limited by small sample sizes, short follow-up, moderate-to-high risk of bias, and substantial heterogeneity, resulting in low-to-moderate certainty. Larger, high-quality randomized trials with longer follow-up are needed to confirm these findings and inform clinical recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;Protocol registered prospect","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421771","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}