Journal of Orthopaedic Science最新文献

{"title":"Diagnosis and assessment of subtle Lisfranc injuries: Comparison of computed tomography and weight-bearing radiography.","authors":"Hiroki Ukita, Masanori Taki, Naohiro Hio, Nao Ito, Kazunari Oshima","doi":"10.1016/j.jos.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.jos.2025.04.004","url":null,"abstract":"<p><strong>Background: </strong>Subtle Lisfranc injuries cause instability around the Lisfranc joint, leading to loss of foot function without appropriate treatment. The diagnostic accuracy of the commonly used Nunley classification, which is based on weight-bearing radiographs, is controversial. We compared the Nunley classification and computed tomography (CT) findings for subtle Lisfranc injury severity.</p><p><strong>Methods: </strong>Fifty-one patients diagnosed with subtle Lisfranc injury were retrospectively enrolled. After excluding those without weight-bearing radiography or CT images, the medical histories, weight-bearing radiographs, and CT images of 33 patients were reviewed. We measured the distance between the proximal first and second metatarsals from the anteroposterior radiographs and that between the plantar aspect of the first cuneiform and plantar aspect of the fifth metatarsals from the lateral view and then classified the cases according to the Nunley classification. CT images were evaluated for avulsion fragments at the Lisfranc ligament complex attachment sites.</p><p><strong>Results: </strong>According to the Nunley classification, seven patients were stage I, 23 were stage II, and three were stage III. Based on weight-bearing radiographs, the C1-M5 distance was 1.29 ± 0.40 cm/1.01 ± 0.36 cm (injured feet/contralateral feet; p < 0.05) overall. On CT images, the avulsion bone fragment location revealed one case of interosseous Lisfranc ligament and five cases of plantar capsular Lisfranc ligament complex in Nunley stage I. In Nunley stage II, three patients had a dorsal capsular Lisfranc ligament complex, 15 had an interosseous Lisfranc ligament, and 18 had a plantar capsular Lisfranc ligament complex. In Nunley stage III, two patients had interosseous Lisfranc ligaments, and three patients had a plantar capsular Lisfranc ligament complex.</p><p><strong>Conclusions: </strong>Patients in the acute phase of subtle Lisfranc injury did not place weight on their injured foot. In 93.9 % of subtle Lisfranc injury cases, avulsion fragments were present at the ligament attachment site, and severity was different from weight-bearing radiographs.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086435","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 efficacy of home-based remote rehabilitation versus usual rehabilitation for patients with knee osteoarthritis: A systematic review and meta-analysis.","authors":"Eric Pasqualotto, Rafael Oliva Morgado Ferreira, Leonardo Salvatore Migliardi, Pedro Henrique Felisbino Silva, Tales Pasqualotto, Joyce Cristina Campos, Julia de Lira Kaszubowski, Sabrina da Silva, Serafim Barros, Luis Fernando Z Funchal","doi":"10.1016/j.jos.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.jos.2025.04.003","url":null,"abstract":"<p><strong>Purpose: </strong>To compare home-based remote rehabilitation with usual rehabilitation care for knee osteoarthritis (OA).</p><p><strong>Methods: </strong>PubMed, Cochrane, and Embase databases were searched for randomized controlled trials (RCTs) comparing home-based remote rehabilitation (telephone calls, video calls, apps, or websites) with usual in-person rehabilitation in patients with knee OA. Mean differences (MDs) or standardized mean differences (SMDs) were calculated for continuous outcomes and risk ratios (RRs) for binary outcomes, with 95 % confidence intervals (CIs). Statistical analyses were performed using R Software, version 4.4.1.</p><p><strong>Results: </strong>A total of 9 RCTs were included, comprising 974 patients with knee OA, of whom 483 (49.6 %) were randomized to home-based remote rehabilitation. Compared with usual rehabilitation, home-based remote rehabilitation significantly reduced pain severity (SMD -0.34; 95 % CI -0.67 to -0.02) and significantly improved physical activity levels (SMD -0.45; 95 % CI -0.85 to -0.05). Furthermore, the home-based remote rehabilitation group showed a significant reduction in pain assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (MD -0.95 points; 95 % CI -1.84 to -0.06), an improvement in functionality assessed with the Timed Up and Go test (MD -0.83 s; 95 % CI -1.64 to -0.02), and a greater patient satisfaction (RR 2.01; 95 % CI 1.46 to 2.76).</p><p><strong>Conclusion: </strong>The results demonstrated that home-based remote rehabilitation reduced pain and increased patient satisfaction, however, there is insufficient evidence to state that remote rehabilitation significantly improved physical activity and functionality. Home-based remote rehabilitation appears to be a viable and effective alternative for patients with knee OA.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016656","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":"Increasing utilization of total ankle arthroplasty in Japan: Trends and regional variations over 12 Years from a national database.","authors":"Takumi Matsumoto, Masaki Hatano, Ryutaro Takeda, Yuichiro Matsuo, Sakae Tanaka, Hideo Yasunaga","doi":"10.1016/j.jos.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.jos.2025.04.009","url":null,"abstract":"<p><strong>Background: </strong>Ankle arthritis significantly impacts a patient's quality of life, often necessitating surgical treatment in advanced cases. While ankle arthrodesis has been the standard procedure for decades, total ankle arthroplasty (TAA) has gained acceptance as a motion-preserving alternative. Although TAA adoption has expanded globally, data on trends and regional variations in Japan are limited. This study aimed to analyze the utilization and regional disparities in TAA and ankle arthrodesis over a 12-year period using a national database.</p><p><strong>Methods: </strong>Data were retrospectively extracted from the Diagnosis Procedure Combination database, which includes over 50 % of inpatient admissions in Japan. Patients who underwent primary TAA or ankle arthrodesis for osteoarthritis or rheumatoid arthritis between 2010 and 2022 were included. Procedure counts, patient demographics, and regional variations were analyzed. Statistical methods included linear regression for trend analyses and exploration of factors influencing regional disparities, such as hospital volume and the number of members of the Japanese Society for Surgery of the Foot.</p><p><strong>Results: </strong>From 2010 to 2022, 2461 TAA and 9415 ankle arthrodesis procedures were performed. TAA utilization increased 3.8-fold compared with a 1.4-fold increase in ankle arthrodesis. The proportion of TAA among ankle surgeries increased from 13.4 % to 30.2 %. TAA was performed more frequently in older patients and those with rheumatoid arthritis than ankle arthrodesis. Over the study period, the average age of TAA patients significantly increased, whereas the proportion of patients with rheumatoid arthritis decreased, reflecting a shift toward treating patients with osteoarthritis. Significant regional variations in TAA utilization were observed, primarily influenced by the availability of high-volume hospitals.</p><p><strong>Conclusions: </strong>TAA utilization has grown significantly in Japan, underscoring its acceptance as an alternative to ankle arthrodesis. However, access disparities persist, driven by the limited availability of high-volume hospitals. These findings highlight the need for improved access to TAA and the standardization of surgical practices to ensure equal treatment opportunities for patients with ankle arthritis.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030564","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":"Motor-evoked potential analysis of peroneal nerve status during lateral closed wedge high tibial osteotomy.","authors":"Tetsuro Ishimatsu, Akira Maeyama, Taiki Matsunaga, Takuaki Yamamoto","doi":"10.1016/j.jos.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.jos.2025.04.008","url":null,"abstract":"<p><strong>Introduction: </strong>Common peroneal nerve (CPN) palsy has been reported as an intraoperative complication during lateral closed wedge high tibial osteotomy (CWHTO). However, various intraoperative iatrogenic causes have been reported, the specific cause of CPN palsy has not been clearly established. The present study aimed to clarify the effects of retractors on CPN status in CWHTO.</p><p><strong>Materials and methods: </strong>23 knees of 18 patients underwent CWHTO with transcranial motor-evoked potential (MEP) analysis. The CPN integrity was tested at four time-points: preoperatively as a control (first period); just after retractor placement on the fibula for fibular osteotomy in the middle portion (second period); just after retractor placement on the posterior tibia to pull the tibialis anterior muscle (third period); and after the procedure (fourth period). Postoperative CPN damage was evaluated by the presence of paralysis and a manual muscle test (MMT) for strength of ankle dorsiflexion.</p><p><strong>Results: </strong>There was no significant difference in the mean amplitude of the CPN between the first (100 %) and 92.6 % (range, 64-100 %) in the second periods (p = 0.53); however, the amplitude was significantly reduced from the second period to 59.0 % (range, 15-100 %) in the third period (p < 0.01), and then significantly improved to 77.4 % (range, 20-100 %) in the fourth period (p < 0.01). In 20 knees (87.0 %), the amplitude of the CPN in the third period was reduced. All 18 patients had postoperative MMT grade of 5 without paralysis of the CPN.</p><p><strong>Conclusion: </strong>20 of 23 knees (87.0 %) revealed a significant reduction of the CPN amplitude by the retractor on the posterior tibia. Therefore, the posterior retractor should be carefully placed on the common peroneal nerve in CWHTO.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000170","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 surgical instrument and implant utilization in orthopedic procedures: A lean methodology approach to cost reduction and efficiency improvement.","authors":"Kota Watanabe, Takuji Iwamoto, Robert Nakayama, Shu Kobayashi, Akihito Oya, Morio Matsumoto, Masaya Nakamura","doi":"10.1016/j.jos.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.jos.2025.04.011","url":null,"abstract":"<p><strong>Background: </strong>Operating rooms (ORs) are among the most resource-intensive areas in hospitals, and optimizing surgical efficiency is crucial for cost reduction. A key contributor to inefficiency is the overstocking of surgical instrument trays and implants, leading to increased sterilization costs, longer processing times, and workflow inefficiencies. Despite its impact, instrument tray optimization has received limited attention in orthopedic surgery.</p><p><strong>Methods: </strong>This single-center prospective observational study analyzed the utilization rates of surgical instruments and implants in total knee arthroplasty (TKA), total hip arthroplasty (THA), anterior cruciate ligament (ACL) reconstruction, and posterior spinal fusion (PSF) surgeries. Using Lean methodology, unnecessary instruments and implants were identified and removed from standard trays. The effectiveness of this optimization was assessed through comparisons of instrument utilization rates, sterilization costs, and OR preparation times before and after implementation.</p><p><strong>Results: </strong>A total of 162 procedures were analyzed. Prior to optimization, mean instrument tray utilization rates were low across all procedures (58-65 %), and implant utilization was particularly poor (5-11 %). Post-optimization, significant reductions were observed in the mean number of instrument trays and implants brought into the OR, leading to improved utilization rates (PSF: 67 %, THA: 75 %, ACL: 67 %) and cost savings of up to 1374 JPY per case. The mean intraoperative times unchanged after optimization, while in THA, a notable decrease in intraoperative time was observed (p = 0.022).</p><p><strong>Conclusion: </strong>Lean-based surgical instrument tray optimization effectively reduces unnecessary material use, lowers sterilization costs up to 1374 JPY per case, without compromising intraoperative times. The estimated annual cost savings for the hospital amounted to 729,575 JPY. Further research on long-term impact is warranted to maximize cost savings and enhance standardization in orthopedic surgeries.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005962","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":"Extra-articular coronal protrusion of volar locking plate and screw cutout in the treatment of distal radius fracture in coronal plane: Classification, clinical outcomes and how to prevent.","authors":"Emre Kaya, Tolga Keçeci","doi":"10.1016/j.jos.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.jos.2025.04.013","url":null,"abstract":"<p><strong>Background: </strong>Complications related to implant placement can occur during the surgical treatment of displaced distal radius fractures (DRF) with a volar locking plate(VLP). The literature has often focused on implant placement in the sagittal plane, whereas the coronal plane has been neglected. The purpose of this study was to evaluate the effect of VLP protrusions in the coronal plane in the surgical treatment of DRF.</p><p><strong>Material and method: </strong>Between 2015 and 2022, 302 patients who underwent DRF surgery with VLP between 2015 and 2022 were included in the study. Patients were divided into group 1(anatomically located VLP) and group 2 (protruding VLP and/or screw cutout in the coronal plane), and statistically compared. Patients with radiocarpal intra-articular and sagittal plane protrusions, neurological problems, preoperative DRUJ injury, previous fracture or surgery in the ipsilateral upper extremity, malunion, or incomplete data were excluded. Patients with at least two years of follow-up were included in the study. The Fernandez classification was used for fracture classification. Group 2 patients were classified into subgroups according to the anatomical location of the protrusions: group A (metaphyseal radial styloid side), group B (ulnar metaphyseal side), and group C (diaphyseal side). Functional outcomes were statistically compared between subgroups in terms of the amount of protrusion (≥2 mm and <2 mm), brachioradialis (BR) and abductor pollicis longus (APL) tenosynovitis, distal radioulnar joint (DRUJ) irritation, and necessity for plate removal surgery. QuickDash and PRWE scores were used to assess functional outcomes.</p><p><strong>Results: </strong>PRWE, QuickDash scores, and plate removal rates were higher in group 2 (p < 0.05).The demographic and radiological parameters were similar between the groups (P > 0.05).Within group 2, functional scores, BR and/or APL tendinitis, and plate removal were higher in group A cases with protrusion ≥2 mm and in group B cases with screw prominence in the DRUJ, whereas no difference was found between group A cases with protrusion <2 mm, group B caseswith pure protrusion of the VLP without screw, and all group C cases. All cases requiring plate removal were in group A ≥2 mm and had BR and/or APL tenosynovitis, and in group B with screws penetrating the DRUJ. Functional scores improved significantly after plate removal in all patients requiring plate removal (p < 0.05).</p><p><strong>Conclusion: </strong>≥2 mm protrusion in group A and group B cases with screw cutout to the DRUJ, the results are unsatisfactory and implant removal is required in these cases. If the screw hole was left empty in the protruded VLP in group B and in all group C cases, clinical outcomes were not significantly affected.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998104","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":"Biomechanical study of the Nice knot as an alternative fixation for anterior cruciate ligament reconstruction.","authors":"João Pedro Oliveira, José Carlos Noronha, António Completo","doi":"10.1016/j.jos.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.jos.2025.04.010","url":null,"abstract":"<p><strong>Background: </strong>All-inside, one of the most popular techniques for anterior cruciate ligament reconstruction in which suspensory cortical devices for graft fixation are mandatory, has a technical concern during intra-articular passage of the fixation device. This can be overpass using a Nice knot tied over a button after the intra-articular passage of the graft avoiding, by this, any possible debris that can lock its progression and compromise final fixation. This study aimed to test the hypothesis that a Nice knot tied over a button has similar biomechanical performance to that of the currently available cortical fixation devices on the market and is suitable for anterior cruciate ligament graft fixation.</p><p><strong>Methods: </strong>This controlled laboratory study was performed using two different validated cortical fixation devices for comparison: Endobutton, as a fixed loop, and Ultrabutton, as an adjustable loop. The devices were preconditioned; a cyclic loading of 50-250 N was applied for 1000 cycles and finally pulled to failure at 50 mm/min. Biomechanical properties of the devices were tested in terms of elongation, ultimate strength, and stiffness.</p><p><strong>Results: </strong>The ultimate strength and displacement differences between the Nice knot and Endobutton were significant (p < 0.05). No significant differences in displacement and stiffness were found between the Nice knot and Ultrabutton; however, the ultimate failure load was significantly higher (p < 0.05) for Ultrabutton than for the Nice knot.</p><p><strong>Conclusions: </strong>The performance of the Nice knot tied over a button exhibits similar displacement and stiffness characteristics to the Ultrabutton. However, its maximum ultimate strength (838 ± 28 N) is significantly lower than both tested devices. Despite this, it remains superior to the physiological forces experienced by patients during the initial phases of ACL rehabilitation.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015703","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":"Prediction of postoperative SSIs and causative organisms in the spine by measuring trophic factors using preoperative serum markers.","authors":"Hiroki Katayama, Hyonmin Choe, Yohei Ito, Hiroyuki Ike, Ken Kumagai, Naomi Kobayashi, Yutaka Inaba","doi":"10.1016/j.jos.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.jos.2025.03.012","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection (SSI) following spinal surgery, although rare, is a serious complication that affects patient outcomes. Identifying risk factors such as patient background, preoperative serum markers, and surgical factors is essential for effective screening and prevention measures. Therefore, this study aimed to verify whether preoperative patient conditions serve as predictors of post-spinal surgery infections and to determine the association between preoperative serum markers and infecting pathogen species.</p><p><strong>Methods: </strong>This single center retrospective study analyzed 427 patients who underwent spinal surgery at our hospital between November 2019 and September 2022. Data on patient demographics, comorbidities, preoperative blood tests, surgical factors, SSI occurrence, and causative organisms were collected. Logistic regression analysis was performed to identify independent predictors of SSI, and a subgroup analysis compared preoperative serum markers between superficial and intra-abdominal bacterial infections.</p><p><strong>Results: </strong>SSI occurred in 33 patients (7.7 %). Several factors showed significant differences between the SSI and non-SSI groups, including albumin (ALB), Albumin-Globulin Ratio (AGR), Prognostic Nutritional Index (PNI), C-Reactive Protein (CRP), CAR, D-dimer, and blood loss. Logistic regression analysis identified ALB as the only independent predictor of SSI (OR = 0.23, 95 % CI: 0.11-0.48, P < 0.001), with a cutoff value of <4.0 g/dL. Among SSI cases with identified pathogens, 17 were caused by skin commensal bacteria, while 7 were attributed to intra-abdominal comm-ensal bacteria. Subgroup analysis revealed that AGR and Lympocyte to Monocyte Ratio (LMR) were significantly higher in the intra-abdominal infection group than in the superficial infection group (P = 0.028 and P = 0.045, respectively).</p><p><strong>Conclusion: </strong>Preoperative ALB levels serve as a crucial predictor of postoperative SSI in spinal surgery, with a cutoff value of <4.0 g/dL. Additionally, the type of bacterial infection (superficial vs. intra-abdominal) may be influenced by preoperative patient factors.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998540","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":"Institutional disparities in the treatment of bone metastases by orthopaedic surgeons at training facilities designated by the Japanese orthopaedic association-A nationwide survey.","authors":"Jungo Imanishi, Hideo Morioka, Masahiro Hirahata, Takahiro Inui, Yusuke Shinoda, Tatsuya Takagi, Yoshitada Sakai, Satoru Iwase, Kazuya Oshima, Naoshi Ogata, Takashi Ohe, Kozo Nakamura, Hirotaka Kawano","doi":"10.1016/j.jos.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.jos.2025.04.002","url":null,"abstract":"<p><strong>Background: </strong>Bone metastases are the main cause of locomotive syndrome in cancer patients (Cancer Locomo). They should be appropriately managed to improve patients' activities of daily living and quality of life, especially in designated cancer care hospitals (DCCHs). Still, the actual involvement of orthopedic surgeons in managing bone metastases was uncertain.</p><p><strong>Materials and methods: </strong>In 2018, an online questionnaire of 38 questions was used to conduct a nationwide survey among orthopaedic training facilities. Eleven questions were used to clarify whether orthopaedic surgeons were actively involved in bone metastasis treatment, whether bone metastases were operated equally and actively, and whether there were any barriers to decision-making in bone metastasis treatment.</p><p><strong>Results: </strong>As much as 36.4 % of the DCCHs answered that they were not actively involved in bone metastasis treatment and would never be. 4,783 surgeries were performed in 1,423 facilities. 316 DCCHs did 2,833 surgeries. The mean ± standard deviation of the number of bone metastasis surgeries at each DCCH was 9.0 ± 7.6, whereas that per 1,000 registered cancer patients was 5.2 ± 3.9. Basic surgical procedures, such as biopsy and internal fixation, were unavailable in approximately 15 % of the DCCHs. The most common barrier to decision-making in bone metastasis treatment was cancers of unknown primary. DCCHs having >6 certified orthopaedic surgeons and ≥1 specialist(s) in bone and soft tissue tumors did more surgeries of a wider variety with fewer concerns.</p><p><strong>Conclusion: </strong>Overall, orthopaedic surgeons were not actively involved in bone metastasis treatment. Bone metastases were not operated on equally or actively. Various factors, including the burden to handle cancers of unknown primary, disturbed decision-making in bone metastasis treatment. Increasing awareness of the importance of Cancer Locomo management and aligning with in-hospital other departments or outside specialists in bone and soft tissue tumors may improve this situation.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016653","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":"Biomechanical study of internal fixation methods for undisplaced femoral neck fractures with osteoporosis based on the Pauwels angle: Fixed angle device versus three cannulated screws.","authors":"Sakura Kuniyoshi, Satoshi Nakasone, Mika Takaesu, Takahiro Igei, Fumiyuki Washizaki, Kotaro Nishida","doi":"10.1016/j.jos.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.jos.2025.04.001","url":null,"abstract":"<p><strong>Background: </strong>This study compared the biomechanical properties of three cannulated screws (3-CSs) and a fixed angle device (FAD) for treating undisplaced femoral neck fracture (FNF) Pauwels types I and III, using finite element analysis (FEA) models created with nonlinear material properties; accurately reflecting the bone quality of osteoporotic patients.</p><p><strong>Materials and methods: </strong>FEA involved three patients with a history of undisplaced FNF. Mesh generation was performed using the preoperative CT data. Two internal fixation models:3-CSs and FAD were created for Pauwels type I and III models with a fracture angle of 30° and 70°, respectively. Compression force and relative displacement of the fracture site, and von Mises stress (VMS) of the implants were evaluated. Data analysis involved paired t-test at p < 0.05 statistical level of significance.</p><p><strong>Results: </strong>No significant difference was seen in the compression force between the two implants for Pauwels 30° and 70°models. There was no significant difference in the relative displacement and VMS between the two implants for Pauwels 30° model. However, both relative displacement and VMS were significantly higher in 3-CSs than in FAD for Pauwels 70° model.</p><p><strong>Conclusion: </strong>Results indicate the need for FAD when treating Pawels Type III FNF with osteoporosis, since FAD fixation exhibited superior mechanical stability compared to 3-CSs. However, for the Pauwels Type I FNF, both fixation methods provided comparable stability. When considering the implant's simple and minimally invasive features, the clinical use of 3-CSs may be applicable. These findings highlight the importance of evaluating the Pauwels angle when determining the optimal fixation method for undisplaced FNF.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027355","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}