Journal of Orthopaedic Science最新文献

{"title":"The epidemiology of fifth metatarsal fracture surgeries in Japan using nationwide hospital claim database.","authors":"Takahisa Ogawa, Ryosuke Nishi, Hiroki Ukita, Yuto Nakamura, Hiroaki Omae, Kazuhiko Tsunoda, Jordanna Bergamasco, Kiyohide Fushimi, Toshitaka Yoshii, Atsushi Hasegawa, Naohiro Hio","doi":"10.1016/j.jos.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.jos.2025.01.005","url":null,"abstract":"<p><strong>Background: </strong>A fifth metatarsal fracture is a common condition with various causes. The epidemiology of this condition is well established in certain populations such as athletes, and people from Western countries, but not in Japan. We aimed to study the epidemiology of fifth metatarsal fracture surgeries in Japan among various age groups from school age to elderly and hypothesized that they are more common in older Japanese patients.</p><p><strong>Methods: </strong>Data was collected from the Japanese Diagnosis Procedure Combination inpatient database, which is a nationwide database containing discharge abstracts and administrative claims data from over 1500 hospitals in Japan. Patients hospitalized with a primary diagnosis of metatarsal fracture and who underwent open reduction and internal fixation between April 1, 2010, and March 31, 2021 were analyzed.</p><p><strong>Results: </strong>Overall, a total of 2044 participants, with an average age of 17.93 years and a BMI of 22.63, were included in the analysis. Males exhibited a unimodal distribution, with a peak occurring during their late teens, while females displayed a bimodal distribution, with a peak at the age of 50. Additionally, the incidence of these injuries among both males and females peaked during high school, particularly at the age of 17 years.</p><p><strong>Conclusions: </strong>The higher prevalence of fifth metatarsal fracture surgeries in elderly females and school age population was observed. This high prevalence may require fracture prevention and early screening. Further studies including patients who undergo conservative treatment are needed.</p><p><strong>Levels of evidence: </strong>III.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515926","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":"Intradiscal treatment with recombinant human MMP-7 for patients with lumbar disc herniation: A sham-controlled multicenter, single-blind, dose-escalation, single-dose, phase I/IIa study.","authors":"Hirotaka Haro, Tersuro Ohba, Kota Watanabe, Daisuke Nakashima, Satoshi Funayama, Hiroshi Yokomichi, Motohiro Kobayashi, Masaru Iwasaki, Hiromichi Komori, Masaya Nakamura","doi":"10.1016/j.jos.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.jos.2025.02.002","url":null,"abstract":"<p><strong>Background: </strong>This sham-controlled multicenter, single-blind, dose-escalation, single-dose, phase I/IIa study aimed to validate the safety and exploratory efficacy of intradiscal administration of recombinant human (rh) MMP-7 (KTP-001) for patients with lumbar disc herniation.</p><p><strong>Methods: </strong>The cohort consisted of three groups. Cohort 1 (C1): three patients in the Sham group, three patients in the KTP-001 X-μg group. Cohort 2 (C2): six patients in the KTP-001 2X-μg group. Cohort 3 (C3): six patients in the KTP-001 4X-μg group. Under X-ray guidance, KTP-001 was injected into center part of the intervertebral disc at the level of herniated disc. The patients between the ages of 20 and 60 years had a subligamentous extrusion type of lumbar disc herniation at the L3-L4, L4-L5, or L5-S1 level. Adverse events, vital signs, clinical tests, magnetic resonance imaging (MRI), X-ray images, and anti-KTP-001 antibodies were used as primary endpoints to evaluate the safety of the investigational drug. The secondary endpoints were low back and leg pain intensity, neurological findings, Oswestry Disability Index, serum keratan sulfate pharmacodynamics, and hernia size on MRI to evaluate exploratory efficacy. The observation period was up to 24 weeks after administration.</p><p><strong>Results: </strong>A total of 19 patients participated in the trial. No adverse events resulted in death or led to treatment discontinuation. Furthermore, CTCAE Grade 3 or higher adverse events did not occur. No changes were observed in the intervertebral discs or endplates that could be strongly attributed to drug administration based on MRI and X-ray radiographic. All the subjects remained negative for anti-KTP-001 antibody. Early after the treatment, we observed statistically significant improvements in neurological findings, SLR test results, and ODI results.</p><p><strong>Conclusions: </strong>Even if administered immediately after the onset of the disease and confirmation of the diagnosis, intradiscal treatment with KTP-001 may be safe and tolerable.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515922","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 single-leg stand-up test as a simple and effective tool for assessing motor function in children -KID locomo study.","authors":"Yusuke Kido, Masatoshi Teraguchi, Kanae Mure, Takahide Sasaki, Yoshiki Asai, Makiko Onishi, Takashi Shimoe, Nobuyuki Miyai, Hiroshi Hashizume, Hiroshi Yamada","doi":"10.1016/j.jos.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.jos.2025.01.004","url":null,"abstract":"<p><strong>Background: </strong>Early detection of motor function issues in children is crucial for timely interventions and prevention of long-term health problems. We evaluated the effectiveness of the Kodomo Locomo check and the Single-Leg Stand-Up Test (SLSUT) in assessing motor function in children, using the standardized New Physical Fitness Test as a reference measure.</p><p><strong>Methods: </strong>This cross-sectional study involved 871 children (436 boys, 435 girls) aged 6-15 years from rural Japan. Participants underwent the Kodomo Locomo check, the SLSUT, and the New Physical Fitness Test. We analyzed correlations between these assessments using Spearman's rank correlation coefficient and ordinal logistic regression.</p><p><strong>Results: </strong>The Kodomo Locomo check identified 26.4 % of participants as having potential motor function issues, with significant sex differences (33.7 % boys, 19.1 % girls, p < 0.001). The SLSUT demonstrated moderate correlations with New Physical Fitness Test grades (ρ = 0.48 for boys, ρ = 0.46 for girls, p < 0.001), and the Kodomo Locomo check showed weak correlations (ρ = 0.22 for boys, ρ = 0.28 for girls, p < 0.001). Ordinal logistic regression analysis revealed that for every 10 cm increase in SLSUT height, the odds of being in a lower grade category in the New Physical Fitness Test were approximately two times higher for both sexes (OR 2.08, 95 % CI: 1.82-2.38 for boys; OR 2.00, 95 % CI: 1.75-2.27 for girls, p < 0.001 for both).</p><p><strong>Conclusions: </strong>The SLSUT was shown to have a moderate correlation with overall physical fitness, suggesting its potential as a comprehensive tool for assessing motor function in children. The Kodomo Locomo check, while useful in initial screening, had significant sex-based discrepancies in rates of positivity, potentially causing bias in motor function assessments. Both tests are indicated to have potential in complementary roles in pediatric motor function assessment. Further research will seek to establish age- and sex-specific norms for the SLSUT and investigate the longitudinal predictive value.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515938","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":"Efficacy and safety of microendoscopic anterior cervical decompression and fusion. Compared with conventional open surgery.","authors":"Kotaro Oda, Keiji Nagata, Hiroshi Hashizume, Hiroshi Iwasaki, Shunji Tsutsui, Masanari Takami, Yuyu Ishimoto, Masatoshi Teraguchi, Ryuichiro Nakanishi, Hiroshi Yamada","doi":"10.1016/j.jos.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.jos.2025.02.003","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study of consecutive patients.</p><p><strong>Objective: </strong>This study aimed to (1) develop a new surgical procedure using microendoscopy in anterior cervical decompression and fusion (ACDF), (2) compare the complications and postoperative courses in patients with the new microendoscopic and conventional ACDFs, and (3) confirm the efficacy and safety of the microendoscopic ACDF.</p><p><strong>Summary of background data: </strong>ACDF is an excellent procedure that is minimally invasive to the muscle tissue and can improve alignment. However, it poses significant risks of complications such as postoperative acute airway obstruction. Retraction manipulation during surgery is considered the cause. Hence, we introduced microendoscopic surgery, which minimizes retraction manipulation. This study aimed to verify the safety and efficacy of microendoscopic ACDF.</p><p><strong>Methods: </strong>We compared the anteroposterior thickness of the prevertebral soft tissue on the radiographs preoperatively and 1, 2, and 7 days postoperatively in 15 patients who underwent conventional ACDF with 8 patients undergoing microendoscopic ACDF. Additionally, we assessed the perioperative complications and postoperative course.</p><p><strong>Results: </strong>Microendoscopic ACDF significantly reduced prevertebral soft tissue swelling 2 and 7 days postoperatively. No significant differences in surgical data, complications, or rates of symptom improvement were found between the two groups.</p><p><strong>Conclusions: </strong>Microendoscopic ACDF reduces postoperative prevertebral soft tissue swelling. Surgical data and efficacy are comparable to those of conventional techniques, indicating the safety and effectiveness of the procedure.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515918","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":"Association of cirrhosis severity with outcomes after hip fracture repairs: A propensity-score matched analysis using a large inpatient database.","authors":"Osamu Hamada, Takahiko Tsutsumi, Ayako Tsunemitsu, Noriko Sasaki, Susumu Kunisawa, Kiyohide Fushimi, Yuichi Imanaka","doi":"10.1016/j.jos.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.jos.2025.01.006","url":null,"abstract":"<p><strong>Background: </strong>Advanced cirrhosis is associated with increased mortality in certain surgeries, but the impact of cirrhosis severity on outcomes in patients with hip fractures remains unclear.</p><p><strong>Methods: </strong>In a large nationwide administrative database of hospitalized patients, we compared postoperative outcomes in patients with hip fractures across different Child-Pugh classes of cirrhosis in Japan. Using the Japanese Diagnosis Procedure Combination Database, we identified 833,648 eligible patients diagnosed with hip fractures and underwent surgery between July 2010 and March 2021. Three sets of 1:1 propensity-score matching were performed for four groups: non-cirrhosis cases and Child-Pugh classes A, B, and C. We compared in-hospital mortality, length of stay, hospitalization fees, readmission, and complications in non-cirrhosis cases vs. Child-Pugh class A, Child-Pugh class A vs. B, and Child-Pugh class B vs. C.</p><p><strong>Results: </strong>Propensity-score matching created 1065 pairs for non-cirrhosis vs. Child-Pugh class A, 1012 for Child-Pugh class A vs. B, and 489 for Child-Pugh class B vs. C. In-hospital mortality did not differ between non-cirrhosis cases and those with Child-Pugh class A. However, in-hospital mortality was significantly higher in patients with Child-Pugh class B than in those with class A (1.5 % vs. 5.9 %; RD 4.45 %; 95 % CI: 2.79%-6.10 %), and higher in patients with Child-Pugh class C compared with class B (6.3 % vs. 28.4 %; RD 22.09 %; 95 % CI: 17.54%-26.63 %). Patients in more severe Child-Pugh classes had longer hospital stays, higher hospitalization fees, and higher complication rates.</p><p><strong>Conclusion: </strong>Patients with hip fractures and cirrhosis who are at high risk of poor postoperative outcomes could be identified. This study highlights the significantly higher in-hospital mortality observed in patients with Child-Pugh class C cirrhosis undergoing hip fracture surgery compared to those with class B. These findings underscore the need for careful risk-benefit discussions, considering the severity of cirrhosis, surgical risks, and care goals for each patient.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468567","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":"Sound levels in the operating theatre resulting from hammering during cementless total hip arthroplasty.","authors":"Yasuhiro Homma, Tetsuro Wada, Masashi Unoki, Taiji Watari, Tomonori Baba, Atul F Kamath, Muneaki Ishijima","doi":"10.1016/j.jos.2024.12.007","DOIUrl":"https://doi.org/10.1016/j.jos.2024.12.007","url":null,"abstract":"<p><strong>Background: </strong>Although hearing loss in orthopaedic surgeons from exposure to hammering sounds have been previously reported, there are no reports on the noise environment during total hip arthroplasty (THA) in Japan. The aim of this study was to investigate the sound level generated by cementless THA in Japan, and to discuss the broader sound environment within this space.</p><p><strong>Methods: </strong>94 cementless THAs (94 patients with informed consent) performed by four surgeons were included. The equivalent continuous A-weighted sound levels (LAeq) in a series of 1086 continuous hammering maneuvers without pause and the maximum C-weighted sound levels (LCpeak) in 17,210 hammering sounds were investigated.</p><p><strong>Results: </strong>Among the hammering sounds analysed in terms of LAeq, the sound pressure level associated with some procedures did result in non-scrubbed personnel being exposed to the 8-h sound levels exceeding the LAeq threshold (85 dB), while most procedures exceeded this threshold for scrubbed personnel. For scrubbed personnel, the maximum number of operations that could be safely attended per day were 16.1 and 1.6 operations under average and worst-case scenario conditions, respectively. For LCpeak, no sound was found to be above the threshold (135 dB) for either non-scrubbed or scrubbed personnel.</p><p><strong>Conclusions: </strong>Although average sound levels in a standard operating theatre during cementless THA did not exceed recommended thresholds among non-scrubbed medical practitioners, our data are not sufficient to conclude that the sound environment is safe for scrubbed personnel close to the sound source. Further investigation is needed regarding sound exposure and the occurrence of hearing impairment in surgeons who perform total hip arthroplasties.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007323","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":"Risk factors influencing cage retropulsion following lumbar interbody fusion in treating degenerative lumbar diseases: A comprehensive systematic review and meta-analysis.","authors":"Yong Liu, Hongyu Chen, Xiaoming Hu, Xiaokun Wu, Xiangui Yu, Hai Chen, Wenxiong Zhang, Limin Du","doi":"10.1016/j.jos.2025.01.001","DOIUrl":"https://doi.org/10.1016/j.jos.2025.01.001","url":null,"abstract":"<p><strong>Background: </strong>Degenerative lumbar diseases (DLDs) often have significant impacts on patients' quality of life, particularly when cage retropulsion (CR) occurs following lumbar interbody fusion (LIF). In this study, we conducted a meta-analysis to assess the risk factors associated with CR after LIF.</p><p><strong>Methods: </strong>We retrieved literatures analyzing the risk factors associated with CR following LIF from seven databases. We examined baseline characteristics, diagnosis, comorbidity, fusion level, surgical status, imaging assessment, and cage status to identify potential risk factors.</p><p><strong>Results: </strong>Sixteen studies involving 8059 patients (251 in the CR group and 7808 in the Non-CR group) were included in the final analysis. The incidence of CR was 3.15 %. Results revealed that older age (mean difference [MD]: 2.35 [0.44, 4.26]), more fusion levels (MD: 0.64 [0.03, 1.25]), comorbidity-osteoarthritis (risk ratio [RR]: 2.02 [1.37, 2.98]), comorbidity-heart disease (RR: 2.95 [1.21, 7.21]), comorbidity-existing vertebral fracture (RR: 5.12 [2.52, 10.39]), endplate injury (RR: 2.93 [1.71, 5.02]), screw loosening (RR: 6.03 [1.90, 19.12]), pear-shaped disc (PSD, RR: 3.14 [1.46, 6.74]), greater mean disc height (MDH, MD: 1.65 [0.58, 2.72]), larger cobb angle (MD: 0.68 [0.10, 1.27] degrees), larger cage height (MD: 0.31 [0.01, 0.61]), and cage type-carbon (RR: 1.62 [1.16, 2.27]) were identified as risk factors for CR following LIF. The incidence of CR decreased with an increase in fusion level.</p><p><strong>Conclusions: </strong>Older age, endplate injury, PSD, and nine other factors are identified as risk factors for CR following LIF. Patients with these factors should undergo close monitoring during follow-up to prevent serious complications, such as significant cage displacement.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007305","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":"Hounsfield unit values are a better predictor than DXA T-score for adjacent vertebral fracture following balloon kyphoplasty.","authors":"Koji Matsumoto, Masahiro Hoshino, Hirokatsu Sawada, Sosuke Saito, Tomohiro Furutya, Yuya Miyanaga, Kazuyoshi Nakanishi","doi":"10.1016/j.jos.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.jos.2025.01.003","url":null,"abstract":"<p><strong>Background: </strong>Hounsfield unit values (HU) are known to correlate with dual-energy X-ray absorptiometry (DXA), and they are gaining attention as a new method for assessing Bone mineral density (BMD) that is not affected by the limitations of DXA, such as degeneration, scoliosis, and vascular calcification. The purpose of this study was to compare the efficacy of HU and DXA T-scores in predicting adjacent vertebral fractures (AVF) following balloon kyphoplasty (BKP) using the same computed tomography and DXA at one institution.</p><p><strong>Methods: </strong>The study included 84 cases (20 males, 64 females, mean age 79.3 ± 6.9) who underwent BKP for osteoporotic vertebral fractures. Cases were divided into two groups based on the presence or absence of AVF within 2 months postoperatively. BMD assessment included DXA T-scores (lumbar spine, hip, the lowest), HU of the fractured adjacent vertebra (adjacent-HU) and HU of the L1 vertebra (L1-HU). Logistic regression analysis was performed to identify risk factors for AVF, and the accuracy of AVF prediction was evaluated using the area under the receiver operating characteristics curve (AUC).</p><p><strong>Results: </strong>AVF occurred in 23 of the 84 cases (27.4 %) within 2 months postoperatively. In the logistic regression analysis, T-score was not identified as an independent risk factor, but L1-HU was identified as an independent risk factor for AVF (odds ratio: 0.982, P = 0.044∗). The AUC for predicting AVF was 0.515, 0.568, and 0.510 for T-score (lumbar spine, hip, the lowest), and 0.551 for adjacent-HU. The highest AUC was observed for L1-HU at 0.629 (95 % confidence interval 0.495-0.764).</p><p><strong>Conclusions: </strong>In the risk assessment of AVF, L1-HU was a better evaluation method than DXA T-score.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007297","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":"\"Does advanced imaging improve the reliability of 2018 AO/OTA classification for trochanteric femoral fractures?\"","authors":"Prajwal Gupta, Sumit Arora, Shahrukh Khan, Swati Gupta, Vineet Bajaj, Abhishek Kashyap","doi":"10.1016/j.jos.2024.12.009","DOIUrl":"https://doi.org/10.1016/j.jos.2024.12.009","url":null,"abstract":"<p><strong>Background: </strong>The influence of advanced imaging modalities on the reliability of 2018 AO/OTA classification and detection of features contributing to fracture instability have not been adequately studied in the literature.</p><p><strong>Methods: </strong>This prospective study was conducted to assess the reliability of 2018 AO/OTA classification for trochanteric femoral fractures, and features of instability in 50 patients using radiographs, multiplanar reformats (MPR), and 3D-reconstruction with fracture segmentation (3DR-FS) by 3 observers on 2 occasions at an interval of 4 weeks.</p><p><strong>Results: </strong>Mean inter-observer reliabilities on radiographs, MPR, 3DR-FS were 0.36, 0.39, 0.46 after first reading, and 0.35, 0.35, 0.44 after second reading respectively. The mean intra-observer reliabilities for radiographs, MPR, 3DR-FS were 0.36, 0.43, and 0.50 respectively. Inter-observer reliabilities on subgroup analysis were 0.35, 0.27, 0.40 for subgroup A1 and 0.19, 0.22, and 0.30 for subgroup A2 on radiographs, MPR and 3DR-FS respectively. All results were statistically significant (p-value <0.05). Posterior comminution was detected in 125(41 %), 247(82 %), and 255 (85 %) out of total 300 instances on radiographs, MPR and 3DR-FS respectively. Coronal split was detected in 113(37 %), 189(63 %), and 242 (80 %) out of total 300 instances on radiographs, MPR, and 3DR-FS respectively. Flexion of the proximal fragment was detected in 106(35 %), 163(54 %), and 180 (60 %) out of total 300 instances on radiographs, MPR, and 3DR-FS respectively. Lateral wall fracture was detected in 45(15 %), 80(26 %), and 138 (46 %) out of total 300 instances on radiographs, MPR, and 3DR-FS respectively. The banana fragment was detected in 5(1 %), 16(5 %), and 83 (27 %) out of a total of 300 instances on radiographs, MPR, and 3DR-FS respectively.</p><p><strong>Conclusions: </strong>2018 AO/OTA classification for trochanteric femoral fractures has 'fair' reliabilities on radiographs and MPR that improve to 'moderate' on adding 3DR-FS. We attribute it mostly to the difficulty in localizing innominate tubercle. Adding advanced imaging helps better detect fracture instabilities.</p><p><strong>Level of evidence: </strong>Level I, Diagnostic.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007259","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":"An alternative choice for overweight pediatric patient with femoral shaft fracture when rigid nail is contraindicated due to narrow intramedullary canal: Elastic stable intramedullary nail plus temporary external fixator.","authors":"Xin Tang, Jiaxin Liang, Baowen Zhang, Saroj Rai, Qingyi Hu, Yan Zou, Pan Hong","doi":"10.1016/j.jos.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.jos.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>Length unstable femoral shaft fractures in school-aged children usually demand surgical treatment, but the optimal choice remains controversial, especially in overweight adolescents. This study aimed to compare the clinical results of locking compression plates (LCP) and elastic stable intramedullary nails (ESIN) combined with temporary external fixator (TEF) in school-aged children weighing over 50 kg.</p><p><strong>Methods: </strong>Between January 2010 and January 2018, children over 50 kg with length unstable femoral shaft fracture treated with ESIN & EF in the authors' institute were included in this study. Adolescent patients with matched age, sex, body weight and fracture type receiving LCP were retrieved from hospital database. The Flynn Score System was used to evaluate the clinical outcomes of treatments at the last follow-up.</p><p><strong>Results: </strong>A total of 30 young children aged 10-14 years were included. Fifteen patients (9 male and 6 female) received ESIN & EF treatment, while the other fifteen (9 male and 6 female) received LCP treatment. All patients were followed up for more than 12 months post-surgery (14-26 months). In all, less operation time, less estimated blood loss and shortened hospital stay (P < 0.001), faster union time (P = 0.031) were observed in ESIN & EF group, compared with the Plating group. All surgeries in the ESIN & EF group were performed without exposing the fracture site. In contrast, 60 % (9/15) of the surgeries in the Plating group were performed with the fracture site exposed. Every patient scored satisfactory or excellent on the Flynn Score System without major complications demanding revision surgeries.</p><p><strong>Conclusions: </strong>ESIN plus EF produces satisfactory clinical outcome for overweight pediatric patients with femoral shaft fracture when rigid nail is contraindicated due to narrow medullary canal.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007260","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}