Journal of Orthopaedic Science最新文献

{"title":"Prognostic factors in patients with bone metastasis of renal cell carcinoma in the era of immune checkpoint inhibitors.","authors":"Yuki Ishibashi, Hiroshi Kobayashi, Koichi Okajima, Takahiro Oki, Yusuke Tsuda, Yusuke Shinoda, Ryoko Sawada, Sakae Tanaka","doi":"10.1016/j.jos.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.008","url":null,"abstract":"<p><strong>Background: </strong>Patients with clear cell renal cell carcinoma (ccRCC) have a higher incidence of bone metastasis; however, the availability of immune checkpoint inhibitors (ICIs) is expected to improve their overall survival (OS). Hence, accurate data on the prognosis and survival of patients with bone metastases are necessary to recommend appropriate treatments. Therefore, we investigated the prognosis and prognostic factors of patients with ccRCC bone metastasis in the era of ICIs.</p><p><strong>Methods: </strong>This retrospective cohort study included 33 patients with ccRCC who were treated for bone metastases between 2016 and 2022. We evaluated the association between OS and clinical parameters, including serum biochemical concentrations, and blood cell count, using Kaplan-Meier curves and Cox proportional hazards models.</p><p><strong>Results: </strong>The median OS was 28 months (95 % confidence interval (CI): 8 months - not censored), and the 1-year survival rate was 64 %. Twenty-one patients were treated with ICIs after bone metastasis diagnosis. The multivariate analysis revealed that the use of ICIs after bone metastasis diagnosis was a good prognostic factor (hazard ratio, 0.32; 95 % CI: 0.11-0.89, p = 0.029). Patients in the Katagiri score 5-7 points group using ICIs had a significantly longer survival (p = 0.012) but similar OS compared to the 2-4 points group (p = 0.34).</p><p><strong>Conclusions: </strong>ICI use after the diagnosis of bone metastasis may be a favorable prognostic factor in patients with bone metastases due to ccRCC. The predictive power of the current scoring system could underestimate the prognoses in patients with ccRCC and bone metastasis not treated with ICIs, highlighting the need for a better predictive scoring system in the era of ICIs.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560428","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":"Early surgery within 48 h for post-injury hip fractures improved clinical outcomes.","authors":"Tsunemasa Kita, Taro Funamoto, Haruki Mori, Hiroshi Ikejiri, Takuya Tajima, Etsuo Chosa, Naosuke Kamei","doi":"10.1016/j.jos.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.jos.2025.05.008","url":null,"abstract":"<p><strong>Background: </strong>A medical fee incentive based on a 48-h target time for hip fracture surgery has been implemented in Japan since 2022. This study aimed to evaluate the clinical outcomes of early surgery within 48 h after hip fracture.</p><p><strong>Methods: </strong>This study was a retrospective, single-center study. Patients >60 years of age who underwent hip fracture surgery between 2021 and 2022 were eligible. They were divided into 2 groups: 2021 (before implementation of the system) and 2022 (after implementation of the system). The primary outcome was the surgical waiting time after injury. The secondary outcomes were clinical outcomes such as postoperative complication rate, mortality rate at 1 and 6 months after surgery, and length of stay in our institution. To assess the influence of early surgery on these outcomes, an additional analysis was performed in 2 groups: the early group (surgery within 48 h) and the delayed group (surgery beyond 48 h).</p><p><strong>Results: </strong>In total, 365 patients were included in this study. The surgical waiting time was significantly shortened after the implementation of the system (64.5 h in 2021 vs. 42.8 h in 2022, p < 0.001). There were significant differences between the 2021 and 2022 groups in the complication rate (17 % vs. 9 %, p = 0.03) and length of hospital stay (15 days vs. 13 days, p < 0.001). A multivariate analysis between the early and delayed group showed that early surgery was associated with a lower complication rate and shorter length of stay (p < 0.05).</p><p><strong>Conclusion: </strong>Efforts to perform early surgery within 48 h of injury following the new reimbursement scheme have contributed to improved clinical outcomes, including lower complication rates and shorter hospital stay in our institution.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564923","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":"Medial meniscus tears in early-stage medial knee osteoarthritis: Prevalence and type in a Japanese cohort.","authors":"Ichiro Sekiya, Hisako Katano, Hideyuki Koga, Noriya Okanouchi, Makoto Tomita, Jun Masumoto, Nobutake Ozeki","doi":"10.1016/j.jos.2025.06.010","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.010","url":null,"abstract":"<p><strong>Background: </strong>Medial meniscus (MM) tears are closely associated with medial knee osteoarthritis (OA); however, their relationship in early-stage OA remains poorly understood. The purpose of this study was to elucidate the prevalence and types of MM tears in relation to age, gender, Kellgren-Lawrence (KL) grade, and MM extrusion among participants in the Kanagawa Knee Study, with the aim of potentially capturing the transition from healthy knees to early-stage medial knee OA.</p><p><strong>Methods: </strong>The study analyzed 469 subjects (227 women, 242 men) aged 30-79 years. MM morphology was classified into six types using 3 T magnetic resonance imaging (3 T MRI): signal, horizontal tear, longitudinal tear, radial tear, complex tear, and root tear. The KL grades were automatically evaluated using KOALA software. The MM extrusion was measured on coronal MRI images.</p><p><strong>Results: </strong>MM tears were present in 18.2 % of the subjects, with complex (7.9 %) and horizontal (7.7 %) tears being the most common. The prevalence of MM tears increased with age, with women in their sixties and seventies showing a significant increase compared to younger age groups. A marked gender difference was observed in patients in their sixties, with women showing a 45 % prevalence of MM tears compared to 19 % in men. The prevalence of MM tears increased with KL grade: 7 % in KL0, 14 % in KL1, 51 % in KL2, and 100 % in KL3-4. The prevalence was significantly higher in knees with MM extrusion ≥3 mm (90 %) than in those with MM extrusion <3 mm (11 %).</p><p><strong>Conclusions: </strong>MM tears become more prevalent with advancing age, higher KL grade, and increased MM extrusion. The risk of MM tears appears to be considerably higher in women in their sixties than in men of the same age group.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564924","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":"Development and internal validation of a Cox proportional hazards model for predicting 1-year mortality in patients conservatively managed for hip fracture.","authors":"Keisuke Nakamura, Yasushi Kurobe, Tomohiro Sasaki, Masayuki Shimizu","doi":"10.1016/j.jos.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.002","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures in older adults are associated with high mortality and functional decline, particularly in conservatively managed patients. However, prognostic models specific to conservatively managed patients remain scarce. We aimed to develop and internally validate a Cox proportional hazards (PH) model to predict 1-year mortality based on admission data.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a community hospital in Japan, including 76 patients aged ≥65 years who sustained femoral neck or trochanteric fractures and received conservative treatment between April 2018 and April 2020. The primary outcome was 1-year all-cause mortality. Variables included demographics, comorbidities, cognitive function, fracture type, and nutritional status. Missing data were imputed using a random forest algorithm. Univariable and multivariable Cox PH models were used. Internal validation was performed with bootstrap resampling (1000 iterations). Model discrimination was assessed using Harrell's C-index, and calibration was assessed using calibration plots.</p><p><strong>Results: </strong>The Cox PH regression analysis yielded: h (t∣age, body mass index [BMI], fracture type) = h₀(t) exp (0.005 × age - 0.274 × BMI - 1.870 × fracture type) (Fracture type: 0 = femoral neck, 1 = trochanteric). Lower BMI (hazard ratio [HR] = 0.760; 95 % confidence interval [CI]: 0.637-0.908; p = 0.002) and trochanteric fractures (HR = 0.154; 95 % CI: 0.058-0.411; p < 0.001) were significant predictors of increased mortality. The model demonstrated good discrimination (Harrell's C-index: 0.774; optimism-adjusted: 0.762). Calibration was poor at early timepoints (90-270 days); however, it improved at 365 days (slope = 1.03; C-statistic = 0.83). Decision curve analysis confirmed clinical utility at threshold probabilities above 10 %.</p><p><strong>Conclusions: </strong>We developed a Cox PH regression model with good discrimination and acceptable calibration at 1 year to predict mortality in patients with conservatively managed hip fractures. This model may assist clinicians in early risk stratification and individualized care planning.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560427","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 results of uncalcined hydroxyapatite/poly-L-lactic acid composite screw fixation and titanium screw fixation in the Mitchell osteotomy for moderate hallux valgus deformity.","authors":"Kazuya Sugimoto, Shinji Isomoto, Tomohiro Matsui, Kimio Miura, Sayaka Wakiyama, Yusuke Kobayashi, Norihiro Samoto, Akira Taniguchi, Yasuhito Tanaka","doi":"10.1016/j.jos.2025.06.016","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.016","url":null,"abstract":"<p><strong>Background: </strong>No study has reported on the use of bioabsorbable screws in modified Mitchell osteotomies. This study aimed to clarify the clinical and radiographic findings of modified Mitchell osteotomy using a bioabsorbable screw compared with the use of a titanium screw.</p><p><strong>Methods: </strong>Fifty-one feet from 43 patients with hallux valgus angles (HVAs) > 20° and <40° were included in the study. The osteotomy was fixed using an unsintered hydroxyapatite/poly-l-lactic acid (u-HA/PLLA) screw in 29 feet from 23 patients (group A) and by a titanium headless screw in 22 feet from 20 patients (group B). Patient sex, age, and body mass index (BMI) at surgery, and preoperative and postoperative Japanese Society for Surgery of the Foot (JSSF) hallux scale scores of the two groups were compared. The HVA, intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were measured on weight-bearing radiographs preoperatively and 1 year postoperatively. Postoperative dorsal displacement of the 1st metatarsal head (DD1MH) was also assessed.</p><p><strong>Results: </strong>No significant preoperative differences in these parameters were observed between the groups. The median JSSF scores improved from 75 to 95 in group A and from 64 to 95 in group B. Preoperatively and 1 year postoperatively, the HVAs were 27.5 and 11.0 in group A, 25.5 and 11.3 in group B; the IMAs were 14.3 and 9.4 in group A, 13.6 and 8.8 in group B; the DMAAs were 6.7 and -2.2 in group A, 7.9 and 4.5 in group B. The DD1MHs were 0.5 in group A and 0.0 in group B. No significant differences in the postoperative JSSF scale, HVA, IMA or DD1MH were noted between the groups.</p><p><strong>Conclusions: </strong>The results of Mitchell osteotomy with u-HA/PLLA screws did not significantly differ from those with titanium screws in clinical outcomes, HVA, IMA and DD1MH at 1 year postoperatively.</p><p><strong>Study design: </strong>Case control study; Level of evidence, 3.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564922","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":"Comparison of symptomatic factors of os subfibulare using ultrasonography.","authors":"Tomohiro Matsui, Kenji Honda, Tsukasa Kumai, Takeshi Sugimoto, Yasushi Shinohara, Yasuhito Tanaka","doi":"10.1016/j.jos.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.004","url":null,"abstract":"<p><strong>Background: </strong>The os subfibulare is considered a fusion failure of the secondary ossification center or avulsion fracture at the lateral ankle ligament involving the anterior talofibular ligament alone or in combination with the calcaneofibular ligament. The os subfibulare causes symptomatic repetitive ankle sprains; however, asymptomatic forms exist. We aimed to identify the symptomatic factors of os subfibulare using ultrasonography (US).</p><p><strong>Methods: </strong>Twenty-one feet of patients who underwent operative treatment for symptomatic os subfibulare and 24 feet of those with asymptomatic os subfibulare were examined. US images were retrospectively evaluated, and the size of the ossicle, distance from the lateral malleolus to the ossicle, and instability of the ossicle during the anterior drawer stress ultrasonography test were assessed.</p><p><strong>Results: </strong>The size of the ossicle was mean 6.0 mm and 5.6 mm for the patient and control groups, respectively (p = 0.61). The distance in the rest position was mean 3.9 mm and 2.5 mm (p < 0.05) and median 1.4 mm and 0.0 mm during the stress test (p < 0.05) for the patient and control groups, respectively.</p><p><strong>Conclusion: </strong>US is a useful examination tool for predicting os subfibulare prognosis. Additionally, the distance from the lateral malleolus in the rest position and dynamic instability were predictive factors for symptomatic os subfibulare.</p><p><strong>Levels of evidence: </strong>Level Ⅲ, Case control study.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560416","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":"Development of a machine-learning model for patient satisfaction prediction in lumbar spinal stenosis surgery: A multicenter study with ZCQ and JOABPEQ scores.","authors":"Soya Kawabata, Gen Miura, Yuki Akaike, Sota Nagai, Kurenai Hachiya, Takaya Imai, Hiroki Takeda, Atsushi Yoshioka, Shinjiro Kaneko, Yudo Hachiya, Nobuyuki Fujita, Takayuki Kannon, Junichiro Yoshimoto","doi":"10.1016/j.jos.2025.06.014","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.014","url":null,"abstract":"<p><strong>Background: </strong>Patient satisfaction is an essential metric for evaluating treatment outcomes for LSS, both for patients and for their primary physicians. However, the Zurich Claudication Questionnaire (ZCQ) is the only representative patient-reported outcome measure that evaluates satisfaction. To develop a model using machine learning to predict postoperative satisfaction among older patients with lumbar spinal stenosis (LSS) based on preoperative and postoperative scores of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ).</p><p><strong>Methods: </strong>The training dataset was composed of time-course data of ZCQ and JOABPEQ scores from patients aged ≥65 years who underwent LSS surgery at a university hospital. The validation dataset included data from patients with LSS treated at a private orthopedic clinic. A linear support vector machine classifier was trained to predict achievement of a \"Satisfied\" state from preoperative and postoperative JOABPEQ scores. Internal validation was carried out via leave-one-out cross-validation, and external validation using a separate dataset to assess the accuracy, sensitivity, specificity, F1 score, and area under the receiver operating characteristics curve (AUROC). Variable importance was analyzed using model class reliance.</p><p><strong>Results: </strong>A total of 232 and 66 individuals were included in the training and validation datasets, respectively. The machine-learning model exhibited an accuracy of 0.72, sensitivity of 0.75, specificity of 0.69, and AUROC of 0.82. Psychological disorder and walking ability were identified through permutation importance analysis as key factors for satisfaction. External validation on an independent dataset demonstrated comparable accuracy (0.76), sensitivity (0.83), and AUROC (0.75), although the specificity decreased (0.42).</p><p><strong>Conclusions: </strong>The machine learning model presented here can predict the postoperative satisfaction score on the ZCQ from preoperative and postoperative JOABPEQ scores, highlighting its potential for broader application in clinical settings.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553844","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":"Acute traumatic patellar dislocation with periarticular injuries in children: A retrospective study of 137 patients.","authors":"Fuchao Wang, Shixia Chen, Yan Zhang, Yue Shen, Yuqi Wang, Xi Zhang","doi":"10.1016/j.jos.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.005","url":null,"abstract":"<p><strong>Objective: </strong>We endeavor to investigate the incidence and treatment of acute traumatic patellar dislocation (PD) in conjunction with various knee joint injuries in children.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 137 patients diagnosed with acute traumatic PD and associated periarticular injuries. Patient imaging examinations, medical histories, and treatment records were collected and analyzed to assess the occurrence of PD in combination with injuries to the surrounding knee joint tissues, and to explore effective treatment strategies.</p><p><strong>Results: </strong>Among the patients studied: 1 had a quadriceps injury, 6 had peripheral ligament injuries, 31 had avulsion fractures of the medial border of the patella, 7 had fractures of the lateral femoral condyle, 2 had fractures of the medial femoral condyle,5 had tibial tubercle fractures, 43 had cartilage injuries. Several patients presented with multiple injuries. In cases where only medial patellofemoral ligament (MPFL) injury occurred: 13 patients underwent MPFL reconstruction, none of whom experienced re-dislocation post-surgery. 29 patients underwent non-surgical treatment, with 12 experiencing at least one re-dislocation afterward. Overall: 92 patients received non-surgical treatment, with 30 patients experiencing re-dislocation post-surgery, resulting in a re-dislocation rate of 32.61 %. 45 patients underwent surgical treatment, with only 1 patient experiencing re-dislocation post-surgery, yielding a recurrence rate of 2.22 %.</p><p><strong>Conclusion: </strong>Traumatic PD in children often involves significant soft tissue and bone damage. Surgical intervention is particularly beneficial when combined with extensor mechanism injuries, cartilage damage, or large fractures, as it effectively reduces the recurrence rate of postoperative dislocations.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540601","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":"Foot alignment characteristics in patients with Freiberg's disease.","authors":"Ryo Fukagawa, Ichiro Yoshimura, Tomonobu Hagio, Tetsuro Ishimatsu, Yuki Sugino, Seiya Tomonaga, Yoshimasa Taniguchi, Takuaki Yamamoto","doi":"10.1016/j.jos.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.007","url":null,"abstract":"<p><strong>Background: </strong>Freiberg's disease is defined as aseptic necrosis of the metatarsal heads. It is more common in female patients and primarily affects adolescents aged 11-17 years. The second metatarsal is most frequently involved, accounting for approximately 68 % of cases. This study aimed to assess foot alignment in patients with Freiberg's disease using a mapping system to evaluate radiographic images.</p><p><strong>Methods: </strong>The study cohort included 13 patients (14 feet) diagnosed with Freiberg's disease at our hospital between January 2010 and December 2022, with appropriate loading-position radiographs (Group F). The control group (Group C) comprised 14 patients with no abnormal foot alignment on the healthy side who had bilateral standing dorsoplantar images taken for other conditions. Foot alignment was evaluated using a mapping system.</p><p><strong>Results: </strong>Mapping results on frontal radiographs showed medial deviation of the first metatarsal head and lateral deviation of the fifth metatarsal head and base in patients with Freiberg's disease, with significant differences between Groups F and C (P < 0.05). Significant differences were also observed in the M1/M2, M3/M4, and M2/M4 angles (P < 0.05). No significant differences were found between the groups in Meary's angle or calcaneal pitch on lateral radiographs.</p><p><strong>Conclusion: </strong>This study demonstrated that patients with Freiberg's disease exhibit specific radiographic abnormalities in foot alignment. These abnormalities may increase stress on the metatarsal head, potentially contributing to the development of the disease. Our findings offer a novel perspective on its etiology and progression. Further research is needed to determine whether these abnormalities reflect a congenital predisposition or result from ongoing pathological changes.</p><p><strong>Level of evidence: </strong>Level Ⅲ, retrospective comparative study.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553845","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":"Current status of patients with hip fracture in Japan: A nationwide survey.","authors":"Kazuhide Inage, Naoki Kondo, Satoshi Komatsubara, Yukio Nakamura, Nobukazu Okimoto, Junichi Takada, Naohisa Miyakoshi, Takeshi Miyamoto, Satoshi Mori, Hiroshi Ozawa, Satoshi Ikeda","doi":"10.1016/j.jos.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.jos.2025.05.014","url":null,"abstract":"<p><strong>Background: </strong>Although surgical treatment is the standard of care for most hip fractures, the post-fracture management of osteoporosis remains challenging. This study aimed to elucidate the status of osteoporosis treatment, subsequent fracture rates, mortality rates, and changes in residential status and care levels among hip fracture patients in Japan, and to explore strategies for fracture prevention and extension of healthy life expectancy.</p><p><strong>Methods: </strong>This study included patients with hip fractures treated at approximately 3000 orthopaedic facilities nationwide during July 2020. Data was collected via web-based surveys at the time of injury and 6 and 12 months post-injury.</p><p><strong>Results: </strong>A total of 6705 patients were registered from 1309 facilities (mean age: 82.9 ± 0.7 years; 86.4 % were female). The surgery rate was 94.8 %, with 62.1 % undergoing osteosynthesis and 37.9 % receiving hemiarthroplasty or total hip arthroplasty. Osteoporosis treatment rates gradually increased from 23.0 % at the time of injury to 44.8 % at 6 months and 47.3 % at 12 months, although the rates remained suboptimal. Active vitamin D3-based medications were the most commonly used medications, accounting for approximately 60 % of cases. The cumulative 12-month mortality rate was 10.0 %, and the incidence of new fractures was 11.0 %. The main fracture sites were the contralateral proximal femur, vertebral, and proximal humerus. The most common reason for non-treatment was \"patient's decision.\" Among patients who were not enrolled in long-term care insurance at the time of injury, 66.1 % had newly obtained care level certification by 12 months after injury. The proportion of patients who returned home among those living at home at the time of injury was 80.7 % at 6 months and 96.8 % at 12 months, respectively.</p><p><strong>Conclusions: </strong>Osteoporosis treatment rates after hip fractures remain low, indicating the need for more proactive intervention, including secondary fracture prevention. This study also highlights the importance of early rehabilitation and continuous support.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540602","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}