Journal of Orthopaedic Science最新文献

{"title":"Retrieval-augmented generation enhances large language model performance on the Japanese orthopedic board examination.","authors":"Juntaro Maruyama, Satoshi Maki, Takeo Furuya, Yuki Nagashima, Kyota Kitagawa, Yasunori Toki, Shuhei Iwata, Megumi Yazaki, Takaki Kitamura, Sho Gushiken, Yuji Noguchi, Masataka Miura, Masahiro Inoue, Yasuhiro Shiga, Kazuhide Inage, Sumihisa Orita, Seiji Ohtori","doi":"10.1016/j.jos.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.003","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models (LLMs) have shown potential in medical applications. However, their effectiveness in specialized medical domains remains underexplored. The integration of Retrieval-Augmented Generation (RAG) has been proposed to improve these models by reducing hallucinations and enhancing domain-specific information access. Through this evaluation, we aim to assess whether RAG can effectively bridge the gap between LLMs' current capabilities and the accuracy needed for medical use by examining GPT-3.5 Turbo, GPT-4o, and o1-preview on the 2024 Japanese Orthopedic Specialist Examination.</p><p><strong>Methods: </strong>A specialized database was created using the \"Standard Textbook of Orthopedics\", and GPT-3.5 Turbo, GPT-4o, and o1-preview were evaluated with and without RAG. Models were tested on text-based and image-based questions exactly as presented in Japanese. An error analysis was conducted to identify key performance factors.</p><p><strong>Results: </strong>GPT-3.5 Turbo showed no substantial improvement with RAG, with its overall accuracy remaining at 28 %, compared to its baseline of 29 % without RAG. GPT-4o rose from 62 % to 72 %, while o1-preview increased from 67 % to 84 %. Error analysis indicated that GPT-3.5 Turbo primarily failed to apply retrieved data, whereas GPT-4o and o1-preview made errors when the database lacked relevant information or when dealing with image-based questions.</p><p><strong>Conclusions: </strong>The integration of RAG significantly boosted performance for GPT-4o and especially o1-preview. While both models surpassed the passing threshold, o1-preview demonstrated a level of proficiency relevant to clinical practice. However, RAG did not improve performance on GPT-3.5 Turbo because it lacks effective reasoning abilities.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of horizontal versus Akin Osteotomy of the proximal phalanx for hallux valgus.","authors":"Itaru Morohashi, Atsuhiko Mogami, So Kameda, Tomoji Matsuo, Takahisa Ogawa, Osamu Obayashi, Kazuo Kaneko, Muneaki Ishijima","doi":"10.1016/j.jos.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.006","url":null,"abstract":"<p><strong>Background: </strong>Currently, Akin osteotomy is widely used for hallux valgus. However, it is associated with several complications such as prolonged fusion, pseudarthrosis, overcorrection, and big toe shortening. To prevent such issues, a novel method can be used. In 2019, horizontal osteotomy of the proximal phalanx (HOPP) was established. The current study aimed to assess the outcomes of Akin osteotomy and HOPP for hallux valgus.</p><p><strong>Methods: </strong>Akin osteotomy was performed on 20 feet (Akin group) and HOPP on 14 feet (HOPP group).</p><p><strong>Results: </strong>One year after the surgery, the bone union rates of the Akin and HOPP groups were 95 % and 100 %, respectively. The average bone union period of the HOPP group (3.2 months, standard deviation: 0.80) was significantly shorter than that of the Akin group (5.8 months, standard deviation: 3.53) (P < 0.05). The 3-month bone union rate of the HOPP group was significantly higher than that of the Akin group (93 % vs. 45 %, P < 0.05). The mean shortening of the lateral proximal phalanx did not significantly differ between the Akin and HOPP groups (P = 0.46). However, the HOPP group had a significantly lesser medial shortening of the lateral proximal phalanx than the Akin group (P < 0.05). Moreover, the HOPP group had reduced shortening of the proximal phalanx. None of the patients in the HOPP group developed complications. However, some patients in the Akin group presented with complications such as osteotomy dissection, screw abduction, and protrusion.</p><p><strong>Conclusion: </strong>HOPP is an excellent option as it has a high bone union rate, can facilitate easy angle adjustment, and does not cause significant shortening of the lateral proximal phalanx.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative series.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing S1 nerve root block using three-dimensional computed tomography imaging: Identifying the ideal fluoroscopic angle and predicting S1 neural foramen position.","authors":"Noritaka Suzuki, Toshiaki Kotani, Shuhei Ohyama, Kotaro Sakashita, Shun Okuwaki, Shuhei Iwata, Yasushi Iijima, Masaya Mizutani, Tsuyoshi Sakuma, Sumihisa Orita, Kazuhide Inage, Yasuhiro Shiga, Masahiro Inoue, Shohei Minami, Seiji Ohtori","doi":"10.1016/j.jos.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.jos.2025.02.008","url":null,"abstract":"<p><strong>Background: </strong>S1 nerve root block (S1NRB) is frequently used to diagnose and treat lumbosacral and lower limb pain. However, the visibility of the S1 neural foramen can be obscured by factors including intestinal gas, increasing the procedure's technical difficulty. This study identified the optimal fluoroscopic angle for S1NRB and standardized the technique using three-dimensional (3D) computed tomography (CT) images.</p><p><strong>Methods: </strong>We analyzed 3D CT images of 101 patients with lumbar degenerative diseases (lumbar disc herniation and lumbar spinal canal stenosis). The reference position angle (RPA) was defined as the angle where the superior endplate of the sacrum appears straight, whereas the tunnel view angle (TVA) was defined as the angle where the anterior and posterior S1 neural foramina coincide. We evaluated the relationship between the RPA and TVA, measured the position of the S1 neural foramen at the RPA using the S1 spinous process and sacroiliac joint as landmarks, and analyzed correlations with sex and body size.</p><p><strong>Results: </strong>The mean RPA and TVA were 32.4 ± 6.4° and 34.0 ± 6.2°, respectively, with a mean difference of 1.5 ± 2.8° (r = 0.897, p < 0.0001). The horizontal distance from the S1 spinous process to the S1 neural foramen was 23.1 ± 2.1 mm, and to the sacroiliac joint was 52.0 ± 4.3 mm, with a ratio of 44.5 ± 3.4 %. The vertical distance from the S1 spinous process to the S1 neural foramen was -1.2 ± 1.7 mm caudally. In 84.2 % of the cases, the S1 neural foramen was located 0-4 mm caudal to the S1 spinous process and at 40-50 % of the horizontal distance between these landmarks. These parameters showed no significant differences based on sex or body size.</p><p><strong>Conclusions: </strong>RPA, using the superior endplate of the sacrum as a reference, closely approximates the TVA and is a useful indicator of the optimal fluoroscopic angle for S1NRB. The S1 neural foramen position can be predicted using anatomical landmarks, irrespective of patient characteristics.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel, easy-to-use scoring system for the diagnosis of extraforaminal stenosis of lumbosacral transition using X-ray and CT scan.","authors":"Kohei Takahashi, Myo Min Latt, Takumi Tsubakino, Manabu Suzuki, Takeshi Nakamura, Takeshi Hoshikawa, Tomowaki Nakagawa, Ko Hashimoto, Takahiro Onoki, Toshimi Aizawa, Yasuhisa Tanaka","doi":"10.1016/j.jos.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.001","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of extraforaminal stenosis of the lumbosacral transition (ESLT) using conventional two-dimensional (2D) magnetic resonance imaging (MRI) (2D-MRI) is challenging, with some overlooking of ESLT. It is desirable to have criteria for determining whether patients require additional three-dimensional MRI (3D-MRI). In this study, we created a simple scoring system to screen for ESLT using X-rays and computed tomography (CT).</p><p><strong>Methods: </strong>Ninety-two cases with unilateral L5 radiculopathy were recruited. We used 3D-MRI to determine the presence of ESLT. X-rays and CT were assessed by two examiners. X-rays were assessed for \"vertebral inclination\", \"lumbosacral overlap sign\", \"lordosis angle\", \"disc height\", and \"vacuum phenomenon\". Axial CT slices were assessed for \"transverse process drooping,\" \"nearthrosis\" between transverse process and sacral ala, \"osteosclerosis\" of L5 endplate, and \"osteophyte\". Correlation between ESLT and each radiological variable was assessed. Reproducible variables were defined as >0.6 for both intra- and interobserver agreement. Multivariate logistic regression analysis was performed using the radiological variables that were correlated with ESLT and judged to be reproducible. Finally, a score was assigned to each selected variable considering the odds ratio (OR), and a radiological index for screening the extraforaminal stenosis (RISE) score was established. The receiver operating characteristic (ROC) curve analysis was performed for external validation.</p><p><strong>Results: </strong>Vertebral inclination (>3°) (OR: 4.8, p = 0.003), nearthrosis (OR: 10.2, p < 0.001), and osteophyte (OR: 5.2, p = 0.002) were selected. Considering the OR, 1 point was assigned to vertebral inclination and osteophyte, and 2 points were assigned to nearthrosis, obtaining RISE score (0-4 points). The area under the ROC curve was 0.91.</p><p><strong>Conclusions: </strong>The RISE score accurately predicted the presence of ESLT, allowing aids in the selection of cases that require 3D-MRI.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body weight is associated with the ability to perform deep squats in school-aged Japanese children and adolescents: A retrospective cohort study.","authors":"Manato Horii, Kohei Takahashi, Seiji Kimura, Ryuichiro Akagi, Shotaro Watanabe, Satoshi Yamaguchi, Yoshihito Ozawa, Seiji Ohtori, Takahisa Sasho","doi":"10.1016/j.jos.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.004","url":null,"abstract":"<p><strong>Background: </strong>The ability to perform deep squats in children and adolescents is an essential component of lower extremity function. Especially for school-aged children and adolescents, the ability to perform deep squats is related to their daily life and school activities. Few reports have investigated the factors associated with deep squats ability in this population. This study aimed to identify the factors associated with deep squat ability in healthy Japanese children and adolescents.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted with children and adolescents aged 8-14 years in Japan from 2017 to 2019. Data on height, weight, ability to perform deep squats, general joint laxity, lower limb tightness, and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale score were collected at the beginning of each year. Participants who were able to squat during their musculoskeletal screening were divided into two groups: those who could deep squat the following year and those who could not. Logistic regression analysis with variable selection was performed to calculate the odds ratio for each predicted risk factor associated with the inability to perform a deep squat.</p><p><strong>Results: </strong>A total of 636 children and adolescents were included in the analysis, with 7.5 % of them being unable to perform deep squats the following year. The risk of being unable to deep squats significantly decreased with increasing age (odds ratio 0.66, 95 % confidence interval 0.50-0.87). In addition, higher weight (odds ratio 1.12, 95 % confidence interval 1.07-1.17) and higher Hospital for Special Surgery Pediatric Functional Activity Brief Scale score (odds ratio 1.05, 95 % confidence interval 1.01-1.10) were identified as risk factors associated with the inability to perform a deep squat. Other physical factors did not significantly contribute to the occurrence of deep squat abnormalities.</p><p><strong>Conclusions: </strong>Age, body weight, and physical activity levels were found to be associated with the ability to perform deep squats in healthy Japanese children and adolescents.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged wound closure using tension-reducing taping technique with negative pressure wound therapy in lower extremity open fractures: A retrospective review.","authors":"Yuta Izawa, Masahiro Nishida, Kentaro Futamura, Hiroko Murakami, Kazuo Sato, Yoshihiko Tsuchida","doi":"10.1016/j.jos.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.002","url":null,"abstract":"<p><strong>Background: </strong>In the treatment of lower extremity open fractures Gustilo-Anderson classification types IIIA/IIIB borderline cases, closing open wound under strong tension may lead to wound edge necrosis and the need for soft tissue reconstruction. The purpose of this study is to examine whether staged wound closure using tension-reducing taping with negative pressure wound therapy (NPWT) could prevent wound edge necrosis in borderline type lower extremity open fractures.</p><p><strong>Materials and methods: </strong>Patients with ⅢA/ⅢB borderline type lower extremity open fractures who were treated at our institution were included. The patients were divided into two groups: those who underwent conventional wound closure (Group 1) and those who underwent staged closure using tension-reducing taping (Group 2). Characteristics of patients and their injuries were compared between the two groups. In addition, the presence or absence of wound edge necrosis after wound closure, soft tissue reconstruction, and wound infection were compared between the two groups.</p><p><strong>Results: </strong>Twenty-six patients were included in Group 1 and 21 patients were included in Group 2. There were no significant differences in characteristics of patients and their injuries between the two groups. The rate of wound edge necrosis and the need for local flaps were significantly higher in Group 1 (p = 0.002, 0.027). There was no significant difference in infection rates between the two groups (p = 0.495).</p><p><strong>Conclusion: </strong>For ⅢA/ⅢB borderline type lower extremity open fractures, staged wound closure using tension-reducing taping technique with NPWT can reduce wound edge necrosis and prevent the transition to iatrogenic type ⅢB.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior capsule reconstruction using 8mm-thick fresh-frozen fascia lata graft for irreparable supraspinatus and infraspinatus tendon tears: A cadaveric biomechanical study.","authors":"Teruhisa Mihata, Christen E Chalmers, Joseph Carbone, Mauro Maniglio, Michael Künzler, Nilay A Patel, Michelle H McGarry, Thay Q Lee","doi":"10.1016/j.jos.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.jos.2025.02.007","url":null,"abstract":"<p><strong>Background: </strong>Superior capsule reconstruction (SCR) was developed to restore superior glenohumeral stability and function to shoulder joints with irreparable rotator cuff tears. Previous biomechanical studies have investigated the effects of SCR using dermal graft or freeze-dried fascia lata allograft. The objective of the current study was to investigate the effect of SCR using fresh-frozen fascia lata graft, which closely resembles the fresh fascia lata autograft used clinically, on shoulder biomechanics in irreparable rotator cuff tendon tear.</p><p><strong>Methods: </strong>Eight fresh-frozen cadaveric shoulders were tested by using a custom testing device. Subacromial peak contact pressure (pressure sensor), superior glenohumeral translation (three-dimensional digitizing system), and glenohumeral range of motion (goniometer) were compared under three conditions: (1) intact shoulder; (2) simulated irreparable rotator cuff (supraspinatus and infraspinatus) tear; and (3) SCR using fresh-frozen fascia lata graft. SCR was performed according to the technique for SCR using fascia lata autograft. The average graft thickness was 8.6 mm at the medial edge and 8.9 mm at the lateral edge.</p><p><strong>Results: </strong>Compared with the intact condition, creation of the irreparable rotator cuff tear increased superior translation and subacromial peak contact pressure at 0° (P < 0.01) and 30° (P < 0.001) of glenohumeral abduction. SCR using fresh-frozen fascia lata graft decreased superior translation and subacromial peak contact pressure to the intact level (P < 0.01 for both). SCR using fresh-frozen fascia lata graft did not decrease internal (P = 0.15 to 0.99), external (P = 0.90 to 0.99), or total (P = 0.35 to 0.98) rotation at 0°, 30°, or 60° of glenohumeral abduction, compared with the irreparable supraspinatus and infraspinatus tendon tear condition.</p><p><strong>Conclusion: </strong>For irreparable supraspinatus and infraspinatus tendon tear, SCR using 8 mm-thick fresh-frozen fascia lata graft restored superior glenohumeral stability to the intact level without any restriction of glenohumeral range of motion after surgery.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incidence and cause of reoperation for complications after volar locking plate fixation of distal radial fractures.","authors":"Ching-Chieh Hung, Chin-Hsien Wu, Ching-Hou Ma, I-Ming Jou, Yuan-Kun Tu","doi":"10.1016/j.jos.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.jos.2025.02.006","url":null,"abstract":"<p><strong>Background: </strong>Distal radial fractures are the most common upper extremity fractures. Volar locking plate fixation has become the standard surgical treatment, providing stable angular fixation, early rehabilitation, and effective support for comminuted and osteopenic bones. This study aimed to analyze the incidence and causes of major complications requiring secondary surgeries following volar plating for distal radial fractures and to investigate the correlation between demographic factors and postoperative outcomes, including major complications and reoperation.</p><p><strong>Methods: </strong>This retrospective study enrolled 1073 distal radial fracture cases from 1047 patients at a trauma medical center between January 2015 and June 2021. Patients under 18 years old and whose follow-up was less than 6 months or ended before the surgeon concluded their treatment were excluded. We also examined reasons for device removal, reoperation, and complications following volar plating, specifically identifying major complications requiring additional operations.</p><p><strong>Results: </strong>Among the 1073 distal radial fracture cases, 160 patients with 168 fractures underwent secondary orthopedic operations after volar plating. Ultimately, 33 cases required additional operations for major complications, resulting in a reoperation rate of 22 % and a major complication rate of 5.3 %. Major complications included: triangular fibrocartilage complex tear, deep infection, carpal tunnel syndrome, flexor pollicis longus injury and extensor pollicis longus injury, screw penetration or loosening, and complex regional pain syndrome. Logistic regression showed a higher reoperation incidence in males and patients under 65, although age and sex were not associated with major complications.</p><p><strong>Conclusions: </strong>This study outlined the incidence and causes of reoperation for complications following volar plating for distal radial fractures. Surgeons could benefit from preoperative counseling on potential complications and early identification and treatment. As age and sex were unrelated to postoperative complications, surgeons may consider factors like fracture patterns, functional demands, and baseline activity when determining treatment options with patients.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First ray mobility in hallux rigidus, hallux valgus, and normal feet based on weightbearing computed tomography and three-dimensional analysis: A case-control study","authors":"Tadashi Kimura ,&nbsp;Makoto Kubota ,&nbsp;Takumi Kihara ,&nbsp;Naoki Suzuki ,&nbsp;Asaki Hattori ,&nbsp;Mitsuru Saito","doi":"10.1016/j.jos.2024.04.002","DOIUrl":"10.1016/j.jos.2024.04.002","url":null,"abstract":"<div><h3>Background</h3><div><span>Hallux valgus and </span>hallux rigidus<span><span> are disorders affecting the first ray and are associated with hypermobility of this structure. This study aimed to investigate the three-dimensional mobility of each joint of the first ray between feet with hallux valgus or hallux rigidus and healthy feet using weightbearing and nonweightbearing </span>computed tomography (CT).</span></div></div><div><h3>Methods</h3><div><span>This case-control study analyzed 17 feet of 11 healthy volunteers (control group), 16 feet of 16 patients with hallux valgus (HV group), and 16 feet of 11 patients with hallux rigidus (HR group). First, nonweightbearing foot CT imaging was performed in the supine position on a loading device with no load applied, with the legs extended and the ankle in the neutral position. Next, a load equivalent to </span>body weight was applied for weightbearing CT imaging. Distal bone displacement relative to the proximal bone was quantified three-dimensionally under both conditions.</div></div><div><h3>Results</h3><div><span><span>In the HV group, the talonavicular joint showed significantly greater eversion (P = 00.011) compared with the control group and significantly greater dorsiflexion (P = 00.027) and eversion (P &lt; 00.01) compared with the HR group. In the medial cuneiform joint, the HV group showed significantly greater eversion (P &lt; 00.01) and abduction (P = 00.011) than the control group. For the first </span>tarsometatarsal joint, the HV group showed significantly greater dorsiflexion (P = 00.014), inversion (P = 00.028), and </span>adduction (P &lt; 00.01) than the control group, and greater inversion (P &lt; 00.01) and adduction (P &lt; 00.01) than the HR group. Dorsiflexion of the first tarsometatarsal joint was significantly greater in the HR group compared with the control group (P = 00.026).</div></div><div><h3>Conclusion</h3><div>Hypermobility of the first ray appears to be three-dimensional: in hallux valgus, it is centered at the first tarsometatarsal joint, while in hallux rigidus it is mainly in the sagittal plane at the first tarsometatarsal joint only. This difference may explain the different deformities ultimately observed in each condition.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 320-324"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative clinical outcomes and radiological images of clavicle hook plate versus Scorpion Plate® for unstable distal clavicle fractures","authors":"Naoki Takatori ,&nbsp;Yoshiyasu Uchiyama ,&nbsp;Eiji Shimpuku ,&nbsp;Takeshi Imai ,&nbsp;Masahiko Watanabe","doi":"10.1016/j.jos.2024.06.003","DOIUrl":"10.1016/j.jos.2024.06.003","url":null,"abstract":"<div><h3>Background</h3><div>Although various surgical methods<span><span> are available for unstable distal clavicle fractures<span>, consensus remains lacking on the optimal technique. Therefore, the present retrospective study aimed to compare the clavicle hook plate and Scorpion Plate® in terms of clinical outcomes and </span></span>radiological findings<span> for unstable distal clavicle fractures.</span></span></div></div><div><h3>Methods</h3><div><span>Fifty-seven patients with unstable distal clavicle fractures who underwent treatment using a clavicle hook plate (Group H; 28 patients) or Scorpion Plate® (Group S; 29 patients) were included in the present study. No patients received additional augmentation and all were followed-up for &gt;1 year (mean follow-up, 28 months). Clinical outcomes were operation time, bleeding volume, complications, range of motion (ROM) at 6 months after surgery and final follow-up, and clinical scores (Constant–Murley score and University of California, Los Angeles (UCLA) shoulder score). Radiological outcomes assessed were coracoclavicular distance (CCD), difference in CCD between affected and non-affected sides (ΔCCD), and acromioclavicular subluxation ratio (%ACS) from plain X-rays. The χ</span>² test and Mann–Whitney <em>U</em> test were used to compare each outcome.</div></div><div><h3>Results</h3><div>Complications were seen in 3 shoulders (10.7%) in Group H. ROM was significantly worse in Group H at 6 months postoperatively, but no significant differences between groups were evident at final follow-up. Moreover, no significant differences in clinical outcomes were seen between groups. In terms of radiological results, Group H showed greater improvement in CCD and ΔCCD than Group S. Further, %ACS was significantly worse in Group S.</div></div><div><h3>Conclusions</h3><div>The clavicle hook plate allows reconstruction of a more anatomical position than the Scorpion Plate®, but carries a greater risk of complications. Conversely, the Scorpion Plate® has a low risk of complications, but acromioclavicular subluxation remains. However, no significant differences in ROM or clinical outcomes were apparent at final follow-up.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"30 2","pages":"Pages 307-312"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}