Journal of Orthopaedic Surgery and Research最新文献

{"title":"Clinical efficacy and radiological changes of proximal fibular osteotomy for medial compartment knee osteoarthritis: a systematic review and meta-analysis.","authors":"Yu Jiang, Jingyuan Li, Liang Zhang, Xiaodong Jia, Tianrui Wang, Xia Zhao, Jinli Chen, Kuishuai Xu","doi":"10.1186/s13018-025-06052-z","DOIUrl":"10.1186/s13018-025-06052-z","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to analyze the clinical efficacy, safety, and radiological changes of proximal fibular osteotomy (PFO) for medial compartment knee osteoarthritis (MKOA).</p><p><strong>Methods: </strong>Since the establishment of the databases, we searched all studies involving proximal fibular osteotomy in PubMed, Proquest, Scopus, and Web of Science. The outcomes of interest were visual analog scale (VAS), knee function scores, radiological results, and complication rates. Case-control studies were assessed using the Newcastle-Ottawa scale, and randomized controlled trials were independently evaluated using the Cochrane Collaboration's assessment tool. Heterogeneity was tested using I², and a fixed or random-effects model was selected for meta-analysis based on the heterogeneity results. Of the 21 studies included, 17 were case-control studies and 4 were RCTs.</p><p><strong>Results: </strong>A total of 21 studies, including 1006 knees, were included in the meta-analysis. PFO can effectively alleviate the most troubling pain for patients (VAS: mean difference MD = -4.25 [-5.51; -3.00]) and significantly improve postoperative knee function (Hedges' g = 2.41 [1.35-3.47]). Moreover, due to the minimal surgical trauma, the incidence of postoperative complications is low, with sensory abnormalities of the common peroneal nerve being the most common adverse event (5.93%; 95% CI: 2.15-11.25%), followed by common peroneal nerve palsy (2.25%; 95% CI: 0.14-6.14%), fracture (0.56%; 95% CI: 0-1.74%), and only two cases of infection were reported in all included studies, both of which recovered within half a year. In addition, PFO can effectively improve the radiological outcomes, with an increase in HKA (MD = 1.73 [0.33; 3.13]), a decrease in FTA (MD = -3.83 [-4.05; -3.62]), an increase in knee joint space (MD = 2.66 mm[2.38; 2.94]), and an increase in the ratio of medial to lateral knee joint space (MD = 0.16 [0.15; 0.18]).</p><p><strong>Conclusion: </strong>In the field of MKOA treatment, PFO has shown a promising prospect. The clinical function scores and radiological assessments improved after PFO in this meta-analysis, indicating that this surgical method can significantly improve patients' symptoms, correct the varus deformity of the lower limb alignment, and is safe. However, it must be pointed out that the quality of evidence supporting this conclusion is still low, and radiological studies are relatively few. Therefore, future studies need to be conducted in more diverse patient populations, incorporating more radiological indicators and providing higher-quality clinical evidence.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"672"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659480","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":"Quantitative computed tomography analysis of bone microarchitecture is associated with rotator cuff healing.","authors":"Heyong Yin, Yufei Ding, Ziyang Feng, Zexing Yan, Ai Guo","doi":"10.1186/s13018-025-06102-6","DOIUrl":"10.1186/s13018-025-06102-6","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff repair in patients with osteoporosis (OP) is often hindered by poor tendon-to-bone healing and a high rate of retears, largely due to compromised bone remodeling at the repair site. However, few studies have investigated the relationship between computed tomography (CT)-based quantitative analysis of bone microarchitecture and the prognosis of rotator cuff healing.</p><p><strong>Methods: </strong>An OP rat model was established via bilateral ovariectomy combined with dexamethasone administration. A full-thickness supraspinatus tear was surgically induced, followed by an 8-week intervention with either alendronate (ALN) or saline. Non-osteoporotic rats served as control group. Histological analysis and biomechanical testing were performed to evaluate tendon-to-bone healing. Additionally, quantitative micro-CT analysis of the humeral greater tuberosity was conducted, and correlations with tendon healing outcomes were assessed.</p><p><strong>Results: </strong>Histological analysis at 8 weeks revealed disorganized structure and poor fibrovascular tissue in the OP group, while the OP + ALN group exhibited improved tendon-bone healing with better collagen fiber alignment and higher histological scores. A decreased RANKL/OPG ratio suggested that ALN treatment modulated regional bone metabolism in the humeral greater tuberosity. The Young's modulus was reduced in both osteoporotic groups compared to the Control group. Although the difference between the OP and OP + ALN groups was not statistically significant, a trend was observed: 50% of specimens in the OP group failed at the tendon-bone interface, compared to 33.3% in the OP + ALN group. CT analysis demonstrated that ALN treatment improved bone microarchitecture. Notably, bone microarchitectural parameters significantly correlated with histological scores of tendon healing.</p><p><strong>Conclusion: </strong>Tendon-bone healing is impaired in the presence of OP but can be partially restored by ALN treatment. Furthermore, CT-based quantitative analysis of bone microarchitecture at the humeral greater tuberosity shows a significant correlation with rotator cuff healing. These results imply that such analysis might serve as a potential indicator of postoperative prognosis.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"670"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659483","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":"Optimizing blood management in arthroplasty: a meta-analysis of carbazochrome sodium sulfonate and Tranexamic acid combination.","authors":"Mohamed A Alsaied, Omnia Samy El-Sayed, Shahd Alqato, Abdelrahman M Elettreby, Ahmed A Abo Elnaga","doi":"10.1186/s13018-025-06038-x","DOIUrl":"10.1186/s13018-025-06038-x","url":null,"abstract":"<p><strong>Background: </strong>Persistent bleeding and inflammation during and after surgery are frequent problems in hip and knee surgeries that lead to high blood transfusion needs and slow recovery. Tranexamic acid (TXA) is a popular agent used to control bleeding, but its efficacy may be improved when combined with Carbazochrome sodium sulfate (CSS), capillary hemostatic agent that stabilizes microvascular integrity and reduces capillary bleeding. This meta-analysis compares the efficacy and safety of CSS plus TXA and TXA alone in controlling bleeding during surgery, inflammation, and postoperative outcomes.</p><p><strong>Methods: </strong>A thorough literature search was performed across multiple databases until January 2025 to identify pertinent randomized controlled trials comparing the efficacy and safety of the combination of Carbazochrome sodium sulfate and Tranexamic acid against Tranexamic acid alone for the reduction of blood loss. The study's primary outcomes were total blood loss, hidden blood loss, intraoperative blood loss, and maintenance of hemoglobin levels. The quality of the studies included was evaluated utilizing the RoB 2 tool. Subsequent to data extraction, a meta-analysis was conducted utilizing RevMan 5 software with a random effects model.</p><p><strong>Results: </strong>This systematic review identified six studies (n = 800 patients) fulfilling research criteria. The meta-analysis has shown that there was a robust reduction in total blood loss (MD = -230.92 mL, 95% CI [-271.69 to -190.14], P < 0.00001) and hidden blood loss (MD = -220.52 mL, 95% CI [-263.78 to -177.27], P < 0.00001) when comparing the intervention group with TXA alone with topical administration providing less blood loss than Intravenous. In addition to the above measure, hemoglobin preservation was also improved (MD = -0.59 g/dL, 95% CI [-0.73 to -0.46], P < 0.00001). Furthermore, compared to TXA alone, the combination group had much lower requirements for blood transfusion (RR = 0.13, 95% CI [0.04 to 0.38], P = 0.0003) while there was no increase in complication with wounds or venous thromboembolism.</p><p><strong>Conclusion: </strong>The use of carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) proves to be more effective at controlling bleeding, hemoglobin loss, postoperative inflammation, and pain after hip and knee arthroplasty than using TXA alone. There was also increased efficacy from topical application, as well as increased safety and decreased transfusion use. Combination therapy had good results; however, its relative inefficacy on operative duration and duration of hospital admissions indicates that more work needs to be done on this issue.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"668"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659482","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":"Impact of mental fatigue on lower limb biomechanics and non-contact anterior cruciate ligament injury risk in basketball players during the stop-jump task: a self-controlled trial.","authors":"Zeyang Zhang, Bosong Zheng, Zeyi Zhang, Jianghui Kang, Mengjie Li, Youping Sun","doi":"10.1186/s13018-025-05905-x","DOIUrl":"10.1186/s13018-025-05905-x","url":null,"abstract":"<p><strong>Background: </strong>Non-contact anterior cruciate ligament (ACL) injuries are prevalent among basketball players, particularly during abrupt stop-jump actions. Most existing studies have focused primarily on the impact of physical fatigue on athletic performance, often overlooking the critical role of mental fatigue (MF). The MF experienced in high-intensity game scenarios may further increase the risk of non-contact ACL injuries by altering lower limb biomechanical characteristics; however, the underlying mechanisms remain unclear. This study aimed to investigate the effects of mental fatigue on lower limb biomechanics during stop-jump tasks in basketball players and evaluate its potential contribution to ACL injury risk factors.</p><p><strong>Methods: </strong>A total of 38 basketball players were recruited via a self-controlled study design. MF was induced through a 45-minute Stroop task, with fatigue levels assessed via the visual analogue scale (VAS). Infrared motion capture systems, force platforms, and surface electromyography (EMG) devices were used to measure changes in kinematic, kinetic, and surface EMG data before and after MF intervention. The Wilcoxon signed-rank test was applied to analyse the effects of MF on lower limb biomechanical characteristics.</p><p><strong>Results: </strong>Following the induction of MF, significant decreases were observed in the knee flexion angle (z = -2.211, P = 0.02), internal rotation angle (z = -2.228, P = 0.02), internal rotation moment (z = -2.178, P = 0.02), and median frequency (MDF) of the rectus femoris (z = -3.009, P < 0.01), biceps femoris (z = -3.285, P < 0.01), tibialis anterior (z = -3.053, P < 0.01), and gastrocnemius (z = -2.110, P = 0.03). Conversely, significant increases were noted in the peak vertical ground reaction force (z = -2.015, P = 0.04) and knee extension moment (z = -2.162, P = 0.03).</p><p><strong>Conclusions: </strong>MF negatively impacts the biomechanics of the lower extremities during abrupt stop jumps in basketball players, potentially increasing the risk of non-contact ACL injury.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"671"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659481","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":"Timing optimization of teriparatide dosing for postmenopausal osteoporosis: a randomized controlled trial.","authors":"Huan Wang, Liyuan Tao, Dongyang Liu, Xiaoyan Yan, Haiyan Li, Chunli Song","doi":"10.1186/s13018-025-06083-6","DOIUrl":"10.1186/s13018-025-06083-6","url":null,"abstract":"<p><strong>Background: </strong>Accumulating evidence highlights the critical role of circadian rhythms in regulating bone turnover. Bone turnover markers, including parathyroid hormone, C-terminal telopeptide of type I collagen, and N-terminal propeptide of type I procollagen, all exhibit distinct diurnal variations. Teriparatide, a recombinant parathyroid hormone analog, demonstrates time-dependent efficacy influenced by these endogenous rhythms. However, the impact of administration timing on bone metabolism remains underexplored.</p><p><strong>Objective: </strong>This randomized, open-label, exploratory trial investigates the impact of teriparatide administration timing by comparing subcutaneous injection at 08:00 versus 20:00 on bone turnover markers in postmenopausal women with osteoporosis.</p><p><strong>Methods: </strong>Twenty-eight participants (aged 60-70 years, lumbar spine T-score ≤ -3.0) will be randomized in a 1:1 ratio to receive 20 µg/day of teriparatide via subcutaneous injection at either 08:00 or 20:00 for 12 weeks. All participants will receive standardized calcium (1000-1500 mg/day) and cholecalciferol (800-1200 IU/day) supplementation throughout the study period. The primary outcomes are the between-group differences in serum parathyroid hormone, C-terminal telopeptide of type I collagen, and N-terminal propeptide of type I procollagen profiles, which will be assessed at baseline, 4 weeks, and 12 weeks. Secondary outcomes will evaluate the safety profile during the trial.</p><p><strong>Discussion: </strong>This trial is expected to provide crucial insights into optimizing teriparatide administration timing, potentially guiding personalized dosing strategies to enhance bone formation and reduce fracture risk in osteoporosis. The findings may inform future research on circadian rhythm-aligned therapies.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov ID NCT06951776.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"669"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659484","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":"Correlations between insertional Achilles tendinopathy and haglund's deformity: MRI and radiographic findings.","authors":"Shih-Chieh Tang, Han-Ting Shih, Yu-Hsien Wu, Shun-Ping Wang","doi":"10.1186/s13018-025-06036-z","DOIUrl":"10.1186/s13018-025-06036-z","url":null,"abstract":"<p><strong>Background: </strong>The relationship between insertional Achilles tendinopathy (IAT) and Haglund's deformity has not been fully elucidated. This study aimed to determine the optimal cutoff value of MRI-based Achilles thickness and intratendinous degeneration for IAT and further explored the correlations of IAT and Haglund's deformity.</p><p><strong>Materials and methods: </strong>Thirty heels with symptomatic IAT (IAT group) underwent surgeries and 38 healthy participants without heel pain (control group) were enrolled. Five different radiographic parameters for diagnosing Haglund's deformity were measured. The IAT changes including tendon thickness and intratendinous degenerative ratio (ITD ratio) were obtained on MRI. The correlations of IAT and different radiographic parameters of Haglund's deformity were evaluated.</p><p><strong>Results: </strong>A total of 68 feet were enrolled. The optimal thresholds of Achilles tendon thickness and ITD ratio were 6.1 mm and 48.8%, respectively. Both tendon thickness and ITD ratio were positively correlated with bump height and bump-calcaneus ratio (p < 0.001), but Fowler-Phillip angle, Heneghan-Pavlov parallel pitch lines and X-Y ratio were not.</p><p><strong>Conclusion: </strong>Achilles tendon thickness of more than 6.1 mm and intratendinous abnormality of over 48.8% were confirmed to be diagnostic cutoff values for IAT. Haglund's deformity was determined as a risk factor of IAT requiring surgery. Both radiographic parameters of Haglund's deformity using the bump height and the bump-calcaneus ratio were useful in predicting the presence of IAT on MRI.</p><p><strong>Level of clinical evidence: </strong>Level III, Retrospective cohort study.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"666"},"PeriodicalIF":2.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649710","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":"Intramedullary nailing versus minimally invasive plate osteosynthesis (MIPO) for proximal tibial fracture: a systematic review and meta-analysis.","authors":"Heng Xu, Peng Chen, Yu Zhang, He Huang, Xiaodong Xie, Zhongming Ren","doi":"10.1186/s13018-025-06094-3","DOIUrl":"10.1186/s13018-025-06094-3","url":null,"abstract":"<p><strong>Purpose: </strong>To compare intramedullary nailing (IMN; suprapatellar, infrapatellar, or parapatellar) with minimally invasive plate osteosynthesis (MIPO) for proximal tibial fractures by systematically evaluating clinical outcomes.</p><p><strong>Materials and methods: </strong>We included English-language randomized controlled trials (RCTs) and comparative studies evaluating adult proximal tibial fractures (AO/OTA 41-A2/A3, 41-C1/C2) treated with IMN or MIPO. Databases including PubMed, Embase, Cochrane, and Scopus were searched until June 9, 2025. Study selection, data extraction, and quality assessment were independently performed by two reviewers. Statistical analyses were conducted using STATA version 18.0. Dichotomous outcomes were expressed as risk ratios (RR) or odds ratios (OR), and continuous outcomes as weighted mean differences (WMD) or standardized mean differences (SMD), each with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistic and Cochran's Q test, applying a random-effects model if I² >50% or p < 0.1. Publication bias was evaluated via funnel plots and Egger's regression test.</p><p><strong>Results: </strong>Eleven studies comprising 829 patients (409 IMN; 420 MIPO) met the inclusion criteria. The IMN group demonstrated a significantly lower infection rate compared with the MIPO group (RR = 0.55; 95% CI, 0.33-0.91; p = 0.019). Conversely, traditional (infrapatellar and parapatellar) IMN approaches showed significantly increased anterior knee pain incidence compared to MIPO (RR = 6.27; 95% CI, 0.92-20.55; p = 0.002). Suprapatellar IMN studies did not report anterior knee pain outcomes. No significant differences were identified between IMN and MIPO in nonunion rates (RR = 1.04; 95% CI, 0.61-1.77; p = 0.88), malalignment incidence (RR = 1.29; 95% CI, 0.88-1.89; p = 0.19), knee range of motion (WMD = 0.08; 95% CI, -2.22-2.37; p = 0.95), or implant removal rates (RR = 0.69; 95% CI, 0.41-1.15; p = 0.16).</p><p><strong>Conclusion: </strong>IMN fixation for proximal tibial fractures significantly reduces infection risk compared with MIPO surgery, but traditional IMN approaches (infrapatellar/parapatellar) carry a greater risk of anterior knee pain. No differences were observed in nonunion rates, malalignment, knee range of motion, or implant removal rates between the two treatments. Further high-quality studies evaluating suprapatellar IMN approaches are warranted.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"663"},"PeriodicalIF":2.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649711","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":"C - reactive protein predicts proximal femur osteomyelitis in suppurative hip arthritis.","authors":"Haiting Jia, Tao Liu, Jiazhi Yu, Mingzhu Lu","doi":"10.1186/s13018-025-06096-1","DOIUrl":"10.1186/s13018-025-06096-1","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound is capable of detecting hip joint effusion and guiding puncture procedures, which is cheap and convenient, but can not identify osteomyelitis. Magnetic resonance imaging (MRI) has high sensitivity and specificity for diagnosing osteomyelitis, but it is time-consuming and expensive. The purpose of this study was to find out certain indicators to identify suppurative hip arthritis with proximal femur osteomyelitis in order to optimize MRI.</p><p><strong>Methods: </strong>Data of 48 children with acute suppurative arthritis of the hip diagnosed and treated from March 2018 to September 2024 were retrospectively analyzed. According to the results of MRI, 28 children with simple suppurative arthritis of the hip were included in the suppurative arthritis group, and 20 children with suppurative arthritis of the hip accompanied by osteomyelitis of the proximal femur were included in the osteomyelitis group. Age, sex, duration of onset, maximum body temperature at onset, and inflammatory indicators detected after admission were compared and analyzed between the two groups. The effectiveness of each index in diagnosing proximal femoral osteomyelitis was evaluated according to receiver operating characteristic (ROC). Logistic regression analysis was used to determine independent risk factors for proximal femoral osteomyelitis.</p><p><strong>Results: </strong>There were no significant differences in age, sex, duration of onset, maximum body temperature, white blood cell count, neutrophil count and erythrocyte sedimentation rate between the two groups (P > 0.05). The median C-reactive protein was 31.58 mg/L and 76.69 mg/L in suppurative arthritis and osteomyelitis group, respectively, and the difference was statistically significant (P < 0.05). The sensitivity, specificity and area under the ROC curve of C-reactive protein were 80.0%, 67.9% and 0.770, respectively. Logistic regression analysis showed that C-reactive protein > 47.04 mg/L (OR = 8.444, 95%CI: 2.184-32.658) was an independent risk factor for predicting proximal femoral osteomyelitis (P < 0.05).</p><p><strong>Conclusions: </strong>Compared with simple suppurative arthritis of the hip, C-reactive protein was higher in suppurative hip arthritis with osteomyelitis of the proximal femur. C-reactive protein > 47.04 mg /L can predict the possibility of suppurative hip arthritis accompanied by proximal femur osteomyelitis, and it is recommended that such children should undergo MRI in time.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"664"},"PeriodicalIF":2.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649753","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":"Short-term anabolic agent and sequential therapy to improve bone mineral density and bone turnover markers in patients with osteoporotic hip fractures.","authors":"Jun Young Park, Jun-Young Lim, Tae Kang Kim, Byung Woo Cho, Hyuck Min Kwon, Kwan Kyu Park, Woo-Suk Lee","doi":"10.1186/s13018-025-06084-5","DOIUrl":"10.1186/s13018-025-06084-5","url":null,"abstract":"<p><strong>Background: </strong>Therapy using anabolic and antiresorptive agents in sequence is reportedly effective for severe osteoporosis management. However, evidence for this approach in osteoporotic hip fracture patients remains limited. This study aimed to evaluate the effectiveness of sequential therapy using short-term anabolic agents followed by antiresorptive treatment on bone mineral density (BMD) and bone turnover markers (BTMs) in patients with osteoporotic hip fractures.</p><p><strong>Methods: </strong>We retrospectively reviewed 330 patients with osteoporotic hip fractures between February 2022 and December 2023 and selected 113 patients. The patients were categorized into a sequential group (n = 68), who received an anabolic agent (teriparatide or romosozumab) for three to six months, followed by two doses of denosumab administered at six-month intervals, and a non-sequential group (n = 45), who received anabolic agent monotherapy. The primary outcome was mean change in BMD at the lumbar spine (LS), femoral neck (FN), and total hip (TH) at one-year postoperatively. Secondary outcomes were the osteoporosis medication profile and mean change of 25-hydroxyvitamin D₃ (25(OH)D₃) and BTMs including C-terminal telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP).</p><p><strong>Results: </strong>The sequential group showed significant increases in LS-, FN-, and TH-BMD at one-year follow-up (3.6 ± 3.7%, 4.4 ± 7.9%, and 1.9 ± 4.1%, respectively; p < 0.001 for all). In contrast, the non-sequential group showed non-significant changes in BMD at all sites. In the sequential group, CTX levels decreased significantly (0.57 ± 0.39 to 0.32 ± 0.30 ng/ml, p < 0.001), whereas the non-sequential group showed a non-significant increase in CTX levels (0.73 ± 0.47 to 0.90 ± 0.56 ng/ml, p = 0.44). P1NP levels decreased significantly in the sequential group (88.2 ± 65.7 to 66.2 ± 62.8 µg/L, p < 0.001). The 25(OH)D₃ levels improved in both groups but were higher in the sequential group (20.7 ± 11.1 to 37.2 ± 13.6 ng/mL).</p><p><strong>Conclusion: </strong>Sequential therapy with short-term anabolic agents followed by antiresorptive therapy significantly improved BMD and normalized BTMs in patients with osteoporotic hip fractures. This treatment approach may be an effective strategy to enhance bone health and potentially reduce subsequent fracture risk in this high-risk population.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"662"},"PeriodicalIF":2.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649713","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":"Biomechanical evaluation of In-Out-In pedicle screws for atlantoaxial posterior fixation in the presence of high-riding vertebral artery and narrow C2 pedicles: a finite element analysis.","authors":"Xiong-Han Lian, Wen He, Wen-Jia Sun, Xu-Chao Lin, Huo-Huo Xue, Zhi-Feng Zeng, Yu-Fan Chen, Ming-di Chen, Feng-Guang Wei, Zhi-Qiang Wang, Hong-Liang Ruan, Zi-Qi Luo, Xiang-Ting Chen, Xin Chen, Jing-Lai Xue","doi":"10.1186/s13018-025-06095-2","DOIUrl":"10.1186/s13018-025-06095-2","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with high-riding vertebral artery (HRVA) and narrow pedicles, placement of C2 pedicle screws carries a significant risk of vertebral artery injury. The in-out-in pedicle screws (IOIPS) technique offers an alternative posterior fixation strategy. However, the biomechanical performance remains unclear.</p><p><strong>Methods: </strong>A finite element model of the upper cervical spine (C0-C2) was developed to simulate HRVA and narrow pedicles. All posterior fixation constructs utilized C1 pedicle screws, while four different techniques were applied to C2: IOIPS, pedicle screws, pars screws, and translaminar screws. A vertical load of 50 N and a torque of 1.5 Nm were applied at C0 to assess and compare the range of motion (ROM) and stress distribution.</p><p><strong>Results: </strong>All four fixation techniques effectively reduced ROMs at the atlantoaxial, with IOIPS demonstrating the lowest ROMs and translaminar screws showing the highest. Pedicle and pars screws exhibited higher von Mises stresses within the implants, while IOIPS achieved a more uniform stress distribution. Translaminar screws had the lowest implant stresses but provided the least stability.</p><p><strong>Conclusion: </strong>For patients with HRVA and narrow C2 pedicles, IOIPS offers superior stability along with relatively low and evenly distributed implant stress, suggesting it is a biomechanically viable fixation technique. However, its application should be reserved for carefully selected cases rather than adopted as a routine surgical strategy.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"667"},"PeriodicalIF":2.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649752","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}