Journal of Orthopaedic Surgery and Research最新文献

{"title":"The preoperative BUN-to-albumin ratio predicts early mortality after geriatric intertrochanteric fracture surgery: a retrospective cohort study.","authors":"Bahri Bozgeyik, İlkan Kişi, Ramazan Erol, Emre Kırkgöz, Nevzat Gönder, Erman Öğümsöğütlü","doi":"10.1186/s13018-026-06868-3","DOIUrl":"https://doi.org/10.1186/s13018-026-06868-3","url":null,"abstract":"<p><strong>Background: </strong>Early postoperative mortality remains a major challenge in elderly patients with intertrochanteric hip fractures. Identifying simple and reliable preoperative biomarkers is essential for short-term risk stratification. The blood urea nitrogen-to-albumin ratio (BAR) integrates metabolic stress, renal perfusion, and nutritional status; however, its prognostic value in orthopedic trauma has not been fully clarified.</p><p><strong>Methods: </strong>This retrospective cohort study included 514 patients aged ≥ 65 years who underwent surgical treatment for intertrochanteric femur fractures. Preoperative BAR and other inflammatory biomarkers-including CRP-to-albumin ratio (CAR), fibrinogen-to-albumin ratio (FAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR)-were analyzed. Thirty-day mortality was evaluated using receiver operating characteristic (ROC) analysis and multivariable logistic regression.</p><p><strong>Results: </strong>Thirty-day mortality occurred in 54 patients (10.5%). Non-survivors had significantly higher inflammatory and metabolic biomarker levels and lower albumin levels compared with survivors (all p < 0.05). BAR demonstrated the highest discriminative ability for predicting 30-day mortality (AUC = 0.82), with an optimal cut-off value of 9.0 (sensitivity 79%, specificity 72%). In multivariable analysis, BAR ≥ 9.0 remained the only independent predictor of mortality (adjusted OR 2.68; 95% CI 1.34-5.34; p = 0.006).</p><p><strong>Conclusions: </strong>Preoperative BAR is an independent biomarker for predicting early mortality in elderly patients with intertrochanteric hip fractures. Its simplicity and routine clinical availability support its potential use in preoperative risk stratification. Prospective multicenter studies are needed to confirm these findings.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774352","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":"Optimizing surgical strategy in Lenke 5 C AIS patients with poor thoracic compensatory ability: is there a role of coronal imbalance?","authors":"Chunxiao Chen, Qiang Liu, Yinyu Fang, Jie Li, Xiaodong Qin, Benlong Shi, Saihu Mao, Yong Qiu, Zezhang Zhu, Zhen Liu","doi":"10.1186/s13018-026-06874-5","DOIUrl":"https://doi.org/10.1186/s13018-026-06874-5","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the effect of preoperative coronal balance patterns on the clinical outcome of Lenke 5 C patients with poor thoracic curve compensation ability following different fusion strategies.</p><p><strong>Methods: </strong>Poor thoracic compensatory ability was defined as a thoracic cobb angle between 15° and 25° on supine bending films. Coronal balance patterns were classified as Type A (coronal balance distance (CBD)<20 mm), Type B (CBD > 20 mm and C7 plumbline (C7PL) shifted to concave side of main curve), and Type C (CBD > 20 mm and C7PL shifted to convex side of main curve), based on CBD and position of C7PL relative to main curve. Patients with preoperative Type C were classified into the Group Type C1(underwent selective fusion) and the Group Type C2(underwent non-selective fusion), and patients with preoperative Type A all underwent selective fusion surgery. Quality of life in preoperative Type C patients following different fusion strategies was assessed using the SRS-22 scale.</p><p><strong>Results: </strong>Patients with preoperative Type C coronal pattern and poor thoracic compensatory ability showed a higher likelihood of thoracic curve progression after selective fusion surgery compared to Type A patients (48.7% vs. 20.9%, P = 0.007). In the Type A group, only 4.65% experienced thoracic curve progression exceeding 10°, while in the Type C1 group, this percentage was 21.95%. Additionally, at the last follow-up, 93.1% of Type A patients maintained good coronal balance, whereas 17.1% of Type C1 patients still had coronal imbalance. Type C2 patients who underwent non-selective fusion showed improved thoracic curvature from 34.86 ± 4.64° to 11.14 ± 4.30°, which was well maintained during follow-up. At the last follow-up, only 1 of 35 (2.8%) patients retained the Type C coronal pattern. The SRS-22 questionnaire showed that in Lenke 5 C AIS patients with preoperative Type C, the Type C2 group had significantly higher pain (4.33±0.51 vs. 3.87±0.55, P = 0.003) and self-image scores (4.88±0.10 vs. 4.55±0.50, P = 0.020) compared to the Type C1 group.</p><p><strong>Conclusion: </strong>For Lenke 5 C AIS patients exhibiting poor thoracic compensatory ability and preoperative Type C coronal imbalance, selective fusion demonstrated higher risks of proximal thoracic curve progression compared and inferior coronal balance restoration during follow-up. These findings suggest cautious consideration for preoperative coronal pattern and poor thoracic compensatory ability in Lenke 5 C AIS patients when planning surgery strategies.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774300","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":"Decreased kinesiophobia with virtual embodiment for post-surgical knee rehabilitation: a randomized controlled trial.","authors":"Tony Donegan, Beñat Amestoy-Alonso, Bernhard Spanlang, Sergi Sastre, Andrés Combalia, Maria V Sanchez-Vives","doi":"10.1186/s13018-026-06865-6","DOIUrl":"https://doi.org/10.1186/s13018-026-06865-6","url":null,"abstract":"<p><p>Anterior cruciate ligament (ACL) ruptures are prevalent, particularly among young athletes. Although ligament reconstruction is the gold standard treatment, the rehabilitation process is extensive and has high reinjury rates. Recovery is often hindered by muscle inhibition and psychological factors like kinesiophobia and associated fear of reinjury. Emerging evidence suggests that motor imagery and action observation could enhance rehabilitation outcomes. Immersive virtual reality (VR) offers a novel way to integrate these techniques, potentially accelerating recovery. In this parallel randomized controlled trial, patients undergoing ACL reconstruction were randomly assigned to receive either conventional rehabilitation alone or conventional rehabilitation plus VR training. Our VR content incorporated several novel elements, including embodiment in a virtual body, first-person perspective, and the performance of virtual exercises guided by a virtual physiotherapist. Another innovative feature was that patients conducted the daily VR training independently at home using a standalone head-mounted display. The VR group performed a 20-min daily VR rehabilitation program for 4 weeks post-surgery, visualizing, planning, and executing movements using an embodied virtual avatar. Self-reported disability (International Knee Documentation Committee score, IKDC), quadriceps strength limb symmetry, active knee extension range of motion (ROM) limb symmetry, and kinesiophobia (Tampa Scale of Kinesiophobia-short form, TSK-11) were measured at baseline, 4, 12, and 36 weeks. Forty-seven participants were randomized, with 44 completing treatment. IKDC scores were not statistically significantly different between groups, despite moderate effect sizes at 4 and 36 weeks (Cohen's d = 0.559, and d = 0.722, respectively). The VR intervention group showed significantly lower kinesiophobia at 4 weeks post-surgery compared to controls (27.00 ± 6.58 vs. 33.35 ± 5.07, Cohen's d = - 0.971, p = 0.045). Both groups demonstrated significant improvements in all outcomes over time (p < 0.001). No significant differences were found for range of motion or quadriceps strength limb symmetry. No adverse events were reported related to the intervention. Reducing kinesiophobia is crucial for timely and effective rehabilitation and return to sport, and for reducing reinjury risk. To our knowledge, this is the first clinical study to investigate the independent use of therapeutic VR at home during post-orthopedic surgery rehabilitation. Future research should explore different VR interventions, including more active exercises and personalized programs, to enhance adherence and optimize recovery. The study was pre-registered with the National Library of Medicine (NCT05080894; first registered 09/20/2021).</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774322","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":"Diagnostic accuracy of magnetic resonance imaging for subscapularis tendon tears: a comparison with intraoperative arthroscopic findings.","authors":"Gokhan Karademir, Sabri Kerem Diril, Onur Tunali, Yasemin Begum Topkarci, Ata Can Atalar","doi":"10.1186/s13018-026-06834-z","DOIUrl":"https://doi.org/10.1186/s13018-026-06834-z","url":null,"abstract":"<p><strong>Background: </strong>Subscapularis tendon (SSt) tears are frequently underdiagnosed by non-shoulder specialists. Delayed diagnosis may result in tendon retraction, muscle atrophy, and fatty degeneration, negatively affecting surgical outcomes. Magnetic resonance imaging (MRI) is widely used for preoperative evaluation, but its diagnostic accuracy for SSt tears remains controversial. This study aimed to evaluate the diagnostic performance of MRI in detecting SSt tears by comparing preoperative MRI findings with intraoperative arthroscopic findings.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients who underwent shoulder arthroscopy for rotator cuff pathology between January 2014 and December 2023. Preoperative MRI evaluations were performed by an experienced musculoskeletal radiologist, while intraoperative assessment was conducted by an orthopedic surgeon specialized in shoulder surgery and served as the reference standard. The sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, prevalence, positive likelihood ratio, and negative likelihood ratio of MRI for detecting SSt tears were calculated with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 128 patients were included, with a mean age of 65.4 years. Intraoperatively, SSt tears were identified and repaired in 77 patients, while 51 patients had an intact tendon. MRI reports identified SSt tears in 48 patients and reported an intact tendon in 80 patients. The sensitivity and specificity of MRI for detecting SSt tears were 45.5% (95% CI 0.346-0.567) and 74.5% (95% CI 0.610-0.848), respectively. The positive predictive value was 72.9% (95% CI 0.587-0.837), and the negative predictive value was 47.5% (95% CI 0.368-0.585). The overall accuracy was 57.0% (95% CI 0.483-0.654). The prevalence of SSt tears was 60.2% (95% CI 0.514-0.684). The positive likelihood ratio was 1.78 and the negative likelihood ratio was 0.73. Among 77 arthroscopically confirmed tears, 70 were partial thickness tears and 7 were full thickness tears. All 42 false negatives occurred in partial-thickness tears.</p><p><strong>Conclusions: </strong>MRI demonstrated limited sensitivity in detecting SSt tears despite moderate specificity. These findings indicate that MRI alone may be insufficient for establishing a reliable diagnosis. Clinical examination findings should be integrated with imaging results in the assessment of patients with shoulder pain.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774274","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":"Is genicular nerve radio frequency ablation the key to improving patients' satisfaction after total knee arthroplasty? a randomised controlled trial.","authors":"Assem M M Ahmed, Ahmed Sayed Kotb, Amr Khairy, Ibrahim El Ganzoury, Haytham Abdelazim, Ahmed Mohamed Mohasseb","doi":"10.1186/s13018-026-06855-8","DOIUrl":"10.1186/s13018-026-06855-8","url":null,"abstract":"<p><strong>Background: </strong>Some studies regarding patients complaining of residual pain after total knee arthroplasty (TKA) showed pain scores improvement using genicular nerve radiofrequency ablation (GNRFA). This prompted the hypothesis that combining GNRFA with TKA intraoperatively might improve early postoperative pain control and functional outcomes.</p><p><strong>Methods: </strong>Seventy patients were randomly assigned into two groups, one group underwent total knee arthroplasty combined with genicular nerve radiofrequency ablation (TKA-GNRFA), and the other group underwent total knee arthroplasty (TKA) alone. A parallel-group trial with 1:1 allocation using a superiority framework, Visual Analog Scale (VAS), and functional outcome using the Oxford Knee Score (OKS) were evaluated. Assessments were conducted during the first six months following surgery.</p><p><strong>Results: </strong>There were no significant differences in pain score or functional outcome between the two groups in the first six months postoperative follow-up period.</p><p><strong>Conclusion: </strong>At Six months postoperatively, Combining Genicular Nerve radiofrequency ablation with total knee arthroplasty (TKA-GNRFA) showed no significant advantage regarding pain scores and functional outcome over performing TKA alone. Further randomized controlled trials with larger sample sizes are recommended to provide higher-level evidence and validate these findings. Trial Registration Retrospectively registered under Trial Registration Number NCT07381062 on 24-01-2026.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774303","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":"Modified bone-disc-bone osteotomy (MBDBO) for the treatment of spinal kyphotic deformity secondary to old thoracolumbar vertebral fracture: a retrospective study with 2-year follow-up.","authors":"Xu Zhai, Da Wei Wang, You Chen Ye, Ke Feng Zhao, Hong Pan, Jie Zheng","doi":"10.1186/s13018-026-06867-4","DOIUrl":"https://doi.org/10.1186/s13018-026-06867-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the clinical efficacy and safety of modified bone-disc-bone osteotomy (BDBO) in the treatment of kyphosis caused by old thoracolumbar vertebral fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was performed on 22 consecutive patients (mean age 65.1 ± 5.9 years) who underwent posterior-only modified BDBO combined with internal fixation and fusion between September 2020 and December 2023. Radiological parameters, including global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), were measured on standing full-spine lateral X-rays. Clinical outcomes were evaluated using the Scoliosis Research Society-22 (SRS-22) questionnaire. All indicators were assessed preoperatively, on the 5th postoperative day, and at the final follow-up (minimum 24 months, mean 25.45 ± 2.24 months). Surgical data and complications were also recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Modified BDBO significantly corrected global kyphosis. For GK, the preoperative mean value was 45.32 ± 10.76°, which decreased to 10.51 ± 4.08° on the 5th postoperative day (significant difference, t = 15.82, p &lt; 0.001) and 11.15 ± 4.25° at the final follow-up (compared with preoperative: t = 15.4, p &lt; 0.001; compared with 5th postoperative day: t = - 10.88, p = 0.031). For TK, the preoperative mean value of 40.21 ± 11.24° significantly decreased to 24.5 ± 2.17° on the 5th postoperative day (t = 8.1, p &lt; 0.001) and 24.82 ± 2.31° at the final follow-up (t = 8.01, p &lt; 0.001), with a slight difference between the 5th postoperative day and final follow-up (t = - 6.25, p = 0.049). For LL, it decreased from 47.62 ± 14.74° preoperatively to 42.73 ± 6.58° on the 5th postoperative day (t = 2.79, p = 0.011) and 39.59 ± 7.18° at the final follow-up (t = 4.92, p = 0.006), with continuous adjustment between the 5th postoperative day and final follow-up (t = 23.1, p = 0.010). For SVA (a marker of spinal balance), the preoperative mean value of 37.95 ± 8.02 mm drastically decreased to 12.11 ± 3.92 mm on the 5th postoperative day (t = 29.06, p &lt; 0.001) and 13.39 ± 4.07 mm at the final follow-up (t = 28.36, p &lt; 0.001), with no significant drift. PI, PT, and SS also showed significant improvements and remained stable. No major neurological injury occurred. One patient had a superficial wound infection cured before discharge, and one had a pulmonary infection resolved with anti-infection treatment. All patients achieved solid fusion without internal fixation failure or pseudarthrosis. SRS-22 scores in Function (3.0 ± 0.3 vs. 3.8 ± 0.2, p &lt; 0.001), Appearance (2.8 ± 0.2 vs. 4.0 ± 0.2, p&lt; 0.001), and Pain (2.8 ± 0.2 vs. 3.6 ± 0.1, p &lt; 0.001) domains improved significantly, with a mean satisfaction score of 4.1 ± 0.23.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Modified BDBO is an effective and relatively safe surgical technique for kyphosis secondary to old th","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774288","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":"Kirschner wire-assisted positioning technique reduces operative time and fluoroscopy exposure in proximal humeral PHILOS plate placement: a retrospective comparative study.","authors":"Wutang Que, Xuezhao Tu, Jianhong Xie, Wenhui Fu, Zhilong Hu, Weibin Lan","doi":"10.1186/s13018-026-06869-2","DOIUrl":"https://doi.org/10.1186/s13018-026-06869-2","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy of K-wire-assisted positioning versus conventional freehand palpation in improving intraoperative efficiency (fluoroscopy frequency, operative time, and blood loss) for PHILOS plate placement in elderly patients with proximal humeral fractures.</p><p><strong>Methods: </strong>This retrospective study included 44 patients aged > 60 years with Neer three- or four-part proximal humeral fractures treated with PHILOS plate fixation via deltopectoral approach (January 2021-June 2024). Patients were divided into freehand palpation (n = 21) and K-wire-assisted (n = 23) groups based on intraoperative technique. Primary outcomes included number of intraoperative fluoroscopies, operative time, and blood loss. Secondary outcomes were postoperative complications and Constant-Murley Score (CMS) at 6 months.</p><p><strong>Results: </strong>Follow-up was completed in 37 patients (84.1%). The K-wire group required significantly fewer fluoroscopies (10.00 ± 1.41 vs. 14.61 ± 4.74 times, p = 0.001), shorter operative time (97.55 ± 7.89 vs. 112.25 ± 7.40 min, p = 0.036), and less blood loss (218.26 ± 40.75 vs. 288.33 ± 46.19 mL, p = 0.001) than the freehand group. No significant differences were found in complication rates (10.5% vs. 27.8%, p = 0.181) or 6-month CMS (76.95 ± 7.98 vs. 76.44 ± 8.68, p = 0.855).</p><p><strong>Conclusion: </strong>K-wire-assisted positioning improves intraoperative efficiency by reducing radiation exposure, operative time, and blood loss without compromising functional outcomes or increasing complications. This technique may be particularly valuable for less-experienced surgeons.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774324","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":"Percutaneous spinal endoscopic surgery for thoracic ossification of the posterior longitudinal ligament: a noval bilateral crossover decompression technique.","authors":"Xingchen Li, Luyang Wang, Yiping Zheng, Xizhong Zhu, Yusheng Xu, Haiyang Wu","doi":"10.1186/s13018-026-06870-9","DOIUrl":"https://doi.org/10.1186/s13018-026-06870-9","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the feasibility and clinical efficacy of bilateral crossover decompression technique under percutaneous spinal endoscopic surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 18 patients with T-OPLL who underwent bilateral crossover percutaneous spinal endoscopic surgery between January 2020 and December 2023. There were 10 males and 8 females, with a mean age of 54.8 years. Surgical levels included T_6/7 (4 cases), T_7/8 (3 cases), T_8/9 (4 cases), T_9/10 (2 cases), T_10/11 (2 cases), T_11/12 (1 cases), and T_12/L₁ (2 cases). Total operative time, intraoperative blood loss, length of hospital stay, and complications were recorded. Neurological function was evaluated using the modified Japanese Orthopaedic Association (mJOA) score and the Oswestry Disability Index (ODI) preoperatively, at 3 days and 6 months postoperatively, and at the final follow-up. Clinical efficacy at the last follow-up was assessed using the modified MacNab criteria, and the excellent-to-good rate was calculated. Sagittal canal diameter and canal area were measured to evaluate spinal cord decompression.</p><p><strong>Results: </strong>The mean total operative time was 102.39 min (range: 90-130 min), intraoperative blood loss was 40.61 ml (range: 30-55 ml), and mean hospital stay was 10.22 days (range: 8-14 days). All patients were followed up for a mean duration of 16.78 months (range: 12-24 months). Compared with the preoperative period, mJOA scores significantly improved at 3 days, 6 months, and at the final follow-up (p < 0.05), with further improvement observed at the final follow-up compared with 3 days and 6 months postoperatively (p < 0.05). Similarly, ODI scores were significantly reduced at 3 days, 6 months, and at the final follow-up compared with preoperative scores (p < 0.05). According to the modified MacNab criteria at the final follow-up, 9 cases were rated as excellent, 7 as good, and 2 as fair, yielding an excellent-to-good rate of 88.89%. Compared with preoperative measurements, both the sagittal canal diameter and canal area were significantly increased at 3 days, 6 months, and at the final follow-up (p < 0.05). Complications included intercostal neuralgia in 2 patients, dural tear in 2 patients, and transient postoperative muscle weakness in 1 patient; no cases of epidural hematoma, neck pain, or iatrogenic neurological injury were observed.</p><p><strong>Conclusion: </strong>Bilateral crossover decompression percutaneous spinal endoscopic surgery is a safe and effective minimally invasive technique for the treatment of T-OPLL, with satisfactory short-term clinical outcomes.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774331","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":"Impact of intraoperative lateral hinge fracture on early clinical and radiological outcomes following open wedge high-tibial osteotomy.","authors":"Rahmatolah Jokar, Hoda Shirafkan, Yasin Sharifzadeh","doi":"10.1186/s13018-026-06806-3","DOIUrl":"https://doi.org/10.1186/s13018-026-06806-3","url":null,"abstract":"<p><strong>Background: </strong>Medial opening-wedge high tibial osteotomy (MOWHTO) is a primary intervention for varus knee malalignment. However, the specific impact of lateral hinge fracture (LHF) on early functional recovery and unintended radiological deviations remains previously unresolved. we aimed to investigate the influence of LHF on short-term patient-reported outcomes, weight-bearing progression, and sagittal alignment.</p><p><strong>Methods: </strong>This retrospective cohort study (n = 154) compared outcomes between patients sustaining intraoperative LHF (n = 12) and those with preserved hinges. Clinical recovery was assessed via Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale (VAS), while CT scans evaluated posterior tibial slope (PTS) and joint line convergence angle (JLCA).</p><p><strong>Results: </strong>Intraoperative LHF revealed a profound delay in functional progression; 0% of LHF patients achieved independent weight-bearing by 24 weeks compared to a median of 17.0 weeks in the non-LHF group (p < 0.001). Multivariable regression demonstrated that LHF was the most substantial negative predictor of 6-month KOOS (β = - 0.493, p < 0.001) and significantly drove increased pain (β = 0.328, p < 0.001). Furthermore, LHF cases exhibited an unprecedented increase in PTS compared to controls (13.17 ± 1.37 vs. 8.95 ± 2.09, p < 0.001).</p><p><strong>Conclusions: </strong>Lateral hinge fractures significantly impair early rehabilitation and induce unintended sagittal alignment changes, which provides a new framework for prioritizing surgical precision and hinge-protective strategies.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774254","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":"Arthroscopic transglenoid dynamic subscapular sling achieves short-term clinical outcomes in patients with recurrent shoulder dislocation.","authors":"Shiyou Ren, Yiyong Tang, Wei Xiang, Ri Zhou, Mengjun Ma, Wentao Zhang","doi":"10.1186/s13018-026-06843-y","DOIUrl":"https://doi.org/10.1186/s13018-026-06843-y","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated short-term outcomes of arthroscopic transglenoid dynamic subscapular sling (ATDSS) for recurrent anterior shoulder instability (RASI) with < 20% glenoid bone loss (GBL).</p><p><strong>Methods: </strong>A retrospective series of 25 patients (mean age 36.4 ± 17.3 years) undergoing ATDSS using an adjustable-length loop cortical suspensory fixation device with a tendon graft (semitendinosus autograft, palmaris longus autograft, or tibialis anterior allograft) around the upper subscapularis tendon was analyzed. Outcomes included Oxford Shoulder Instability Score (OSIS), visual analogue scale (VAS), Rowe score, American Shoulder and Elbow Surgeons (ASES) score, recurrence, sports activity, and range of motion at ≥ 12-month follow-up.</p><p><strong>Results: </strong>At mean 20.6 ± 4.9 months, significant improvements were observed: Rowe score (31.2 ± 16.7 vs. 83.0 ± 15.6, P < 0.001; Hedges' g = 3.21), OSIS (33.4 ± 8.0 vs. 20.2 ± 7.9, P < 0.001), ASES (81.6 ± 2.2 vs. 94.3 ± 4.5, P < 0.001), and VAS pain (1.2 ± 0.6 vs. 0.5 ± 0.6, P < 0.001). External rotation decreased (65.6° ± 6.8° vs. 56.5° ± 8.0°, P < 0.001), but only 24% exceeded the 10° minimal clinically important difference. Forward flexion remained unchanged (160.9° ± 15.1° vs. 160.1° ± 14.5°, P = 0.329). Recurrence occurred in 1 patient (4%), with no infections or complications. Sports activity improved (P < 0.001): 48% (12/25) achieved full premorbid activity (Grade I) versus 4% preoperatively.</p><p><strong>Conclusion: </strong>ATDSS using an adjustable-loop cortical suspensory device effectively stabilizes RASI with < 20% GBL, yielding low recurrence (4%), significant functional gains (Rowe, ASES, OSIS), and pain reduction. Minor external rotation loss did not impair function. The technique minimizes subscapularis dissection, avoids hardware complications, and preserves anatomy, offering a minimally invasive solution for subcritical GBL.</p><p><strong>Level of evidence: </strong>Level IV; Case Series; retrospective study.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774317","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}