Orthopaedic Surgery最新文献

{"title":"Comparison of Modified Oblique Lateral Interbody Fusion and Posterior-Only Approach in the Treatment of Degenerative Lumbar Scoliosis.","authors":"Xiang Zhang, Yongqiang Wang, Yilin Lu, Junyu Li, Zhuoran Sun, Yan Zeng, Weishi Li, Miao Yu","doi":"10.1111/os.70038","DOIUrl":"https://doi.org/10.1111/os.70038","url":null,"abstract":"<p><strong>Objective: </strong>Degenerative lumbar scoliosis (DLS) often requires surgical intervention, but traditional posterior-only approaches, despite their effectiveness, result in significant muscle damage and high complication rates. Minimally invasive techniques like oblique lumbar interbody fusion (OLIF) and the Wiltse approach are preferred for preserving posterior structures. However, the lack of controlled studies comparing combined approaches to traditional methods limits their efficacy evaluation. The purpose of this study is to explore the clinical and radiological outcomes of OLIF with posterior fixation through Wiltse approach versus a posterior-only approach in treating DLS.</p><p><strong>Methods: </strong>This retrospective study included 88 DLS patients underwent surgery from January 2019 to September 2021. The patients were divided into the OLIF group (n = 32) and the posterior group (n = 56). Comprehensive evaluations of clinical and radiological outcomes, including Cobb angle, coronal balance distance (CBD), sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were conducted, with a subsequent subgrouping of OLIF group based on preoperative sagittal vertical axis (SVA) into Subgroup A (SVA ≤ 50 mm) and Subgroup B (SVA > 50 mm) for further analysis. The t-test or Wilcoxon's rank sum test is used to compare continuous variables, and the chi-square test is used to compare categorical variables.</p><p><strong>Results: </strong>The OLIF group had fewer fixation levels (4.25 ± 1.08 vs. 5.56 ± 2.04, p < 0.001) and shorter hospitalization (5.22 ± 2.25 d vs. 6.66 ± 2.16 d, p < 0.001), fewer drainage volume (371.94 mL vs. 1065.25 mL, p < 0.001), but longer surgical time. Postoperatively, the OLIF group showed better clinical outcomes. In both groups, Cobb angle, coronal balance distance, and sagittal spinal pelvic parameters improved significantly. The OLIF group achieved a lower SVA (23.84 mm ± 36.70 mm vs. 42.84 mm ± 36.25 mm, p = 0.027), which was not maintained at the final follow-up. Subgroup A maintained sagittal balance (34.55 mm ± 24.99 mm vs. 83.73 mm ± 61.90 mm, p = 0.029). Moreover, the OLIF group had fewer complications.</p><p><strong>Conclusion: </strong>Minimally invasive multi-level OLIF with posterior fixation through Wiltse approach, as compared to the conventional posterior approach, has fewer fixation segments, offers comparable radiographic outcomes and, more importantly, superior clinical results. In addition, patients with a preoperative SVA > 50 mm could benefit from more fixation levels to maintain sagittal balance.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dural Tears and Cerebrospinal Fluid Leak in Osteotomy Surgery for Ankylosing Spondylitis: Incidence, Risk Factors.","authors":"Yue Huang, Fuze Liu, Yifei Li, Qi Zhu, Hai Wang, Jianguo Zhang","doi":"10.1111/os.70036","DOIUrl":"https://doi.org/10.1111/os.70036","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The osteotomy surgery for ankylosing spondylitis (AS) presents a higher risk of dural injury and cerebrospinal fluid leakage compared to conventional spinal surgical procedures. However, there is currently a lack of systematic summaries in this field. This study aims to present the incidence and risk factors associated with dural tears and cerebrospinal fluid (CSF) leakage during corrective osteotomy procedures for AS with kyphotic deformity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was conducted on patients diagnosed with AS in our hospital between June 2014 and May 2024 who presented with kyphotic deformity and underwent corrective osteotomy, specifically pedicle subtraction osteotomy (PSO) or Smith-Petersen osteotomy (SPO). A total of 110 patients were included in this investigation. Among them, 98 patients underwent PSO (69 received single-segment PSO; 29 received double-segment PSO), while 12 patients underwent SPO. The mean age of the participants at the time of surgery was 36.25 years (ranging from 21 to 59 years). Of the total cohort, intraoperative dural tears occurred in 37 patients. Radiological parameters-including sagittal vertical axis (SVA), total kyphosis angle, posterior epidural space thickness at the PSO segment, sagittal alignment of the vertebral canal at the PSO segment, Andersson lesions, and dural ossification-were assessed using spine radiographs or computed tomography (CT) scans analyzed via Surgimap software. The continuous variables mentioned above were primarily compared between groups using independent samples t test, while categorical variables were mainly analyzed through the chi-square test or Fisher's exact test for intergroup comparisons. Additionally, binary logistic regression was employed to further validate the risk factors associated with cerebrospinal fluid leakage in patients undergoing PSO osteotomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The overall incidence of dural tears was found to be 33.6%. Specifically, the incidence during PSO procedures was recorded at 36.4%, whereas it was only 9.1% for SPO procedures. The upper lumbar PSO is the surgical segment with the highest probability of dural tears during PSO procedures. This study summarizes the imaging characteristics of patients undergoing PSO, revealing that those who experience dural tears and CSF leakage typically present with a smaller thickness of the epidural space at the osteotomy site and a higher prevalence of Andersson lesions and dural ossification. A multiple linear regression model indicates that reduced thickness of the epidural space at the osteotomy site, along with Andersson lesions and dural ossification, are significant risk factors for dural tears and CSF leakage following PSO surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The total accidental dural tears rate in osteotomy surgery for AS is 33.6%. PSO presents a higher risk compared to SPO procedures. Factors such as the thickness of the poste","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Neural Network Model for Intelligent Classification of Distal Radius Fractures Using Statistical Shape Model Extraction Features.","authors":"Xing-Bo Cai, Ze-Hui Lu, Zhi Peng, Yong-Qing Xu, Jun-Shen Huang, Hao-Tian Luo, Yu Zhao, Zhong-Qi Lou, Zi-Qi Shen, Zhang-Cong Chen, Xiong-Gang Yang, Ying Wu, Sheng Lu","doi":"10.1111/os.70034","DOIUrl":"https://doi.org/10.1111/os.70034","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Distal radius fractures account for 12%-17% of all fractures, with accurate classification being crucial for proper treatment planning. Studies have shown that in emergency settings, the misdiagnosis rate of hand/wrist fractures can reach up to 29%, particularly among non-specialist physicians due to a high workload and limited experience. While existing AI methods can detect fractures, they typically require large training datasets and are limited to fracture detection without type classification. Therefore, there is an urgent need for an efficient and accurate method that can both detect and classify different types of distal radius fractures. To develop and validate an intelligent classifier for distal radius fractures by combining a statistical shape model (SSM) with a neural network (NN) based on CT imaging data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;From August 2022 to May 2023, a total of 80 CT scans were collected, including 43 normal radial bones and 37 distal radius fractures (17 Colles', 12 Barton's, and 8 Smith's fractures). We established the distal radius SSM by combining mean values with PCA (Principal Component Analysis) features and proposed six morphological indicators across four groups. The intelligent classifier (SSM + NN) was trained using SSM features as input data and different fracture types as output data. Four-fold cross-validations were performed to verify the classifier's robustness. The SSMs for both normal and fractured distal radius were successfully established based on CT data. Analysis of variance revealed significant differences in all six morphological indicators among groups (p &lt; 0.001). The intelligent classifier achieved optimal performance when using the first 15 PCA-extracted features, with a cumulative variance contribution rate exceeding 75%. The classifier demonstrated excellent discrimination capability with a mean area under the curve (AUC) of 0.95 in four-fold cross-validation, and achieved an overall classification accuracy of 97.5% in the test set. The optimal prediction threshold range was determined to be 0.2-0.4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The SSMs for both normal and fractured distal radius were successfully established based on CT data. Analysis of variance revealed significant differences in all six morphological indicators among groups (p &lt; 0.001). The intelligent classifier achieved optimal performance when using the first 15 PCA-extracted features, with a cumulative variance contribution rate exceeding 75%. The classifier demonstrated excellent discrimination capability with a mean AUC of 0.95 in four-fold cross-validation and achieved an overall classification accuracy of 97.5% in the test set. The optimal prediction threshold range was determined to be 0.2-0.4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The CT-based SSM + NN intelligent classifier demonstrated excellent performance in identifying and classifying different types of distal radius fractures. This nove","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Denosumab Treatment on Pain and Function Beyond Bone Density in Patients With Postmenopausal Osteoporosis: A Prospective Study.","authors":"Miao Zheng, Xiong-Yi Wang, Ke-Yu Zhu, Si-Min Yun, Yi-Ke Wang, Cheng-Wei Weng, Dong-Zhang, Qi Wei, You-Jia Xu","doi":"10.1111/os.70032","DOIUrl":"https://doi.org/10.1111/os.70032","url":null,"abstract":"<p><strong>Objective: </strong>Postmenopausal osteoporosis (PMOP) leads to bone loss, fragility, and fractures, causing pain and reduced function. Effective treatment should improve bone mineral density (BMD), prevent fractures, and enhance quality of life. Denosumab is FDA-approved for osteoporosis, but its effects on pain and function in Chinese patients with PMOP remain underexplored. This study investigates the impact and influencing factors of denosumab treatment on pain and function to support a broader evaluation of osteoporosis treatment.</p><p><strong>Methods: </strong>This prospective study included 200 patients with PMOP, treated at the hospital, between September 2022 and September 2023. Subjects received 60 mg of denosumab subcutaneously, and calcium and vitamin D supplements. Pain (Numerical Rating Scale, NRS), function (Oswestry Disability Index, ODI), bone metabolic markers, and BMD were assessed at baseline, 6, and 12 months posttreatment. Correlations between NRS, ODI, and BMD, and the influencing factors of efficacy differences were analyzed.</p><p><strong>Results: </strong>(1) Posttreatment, NRS scores and ODI significantly decreased. (2) Posttreatment, bone metabolic markers were significantly lower; BMD of the hip, femoral neck, and lumbar spine significantly increased from baseline but was most significant in the lumbar spine. (3) Changes in NRS and ODI positively correlated with the increase in lumbar spine BMD but not with changes in femoral neck or total hip BMD. ODI reduction was positively correlated with increases in all three sites' BMD. (4) Factors influencing NRS, ODI, and BMD of treatment include the following: patients with prior fragility fractures (mainly vertebral fractures) had greater improvements in NRS, ODI, and lumbar spine BMD than those without a history of fragility fractures; those without previous antiosteoporosis medication had a more significant increase in lumbar spine BMD than those with a history of antiosteoporosis medication use (mainly antiresorptive drugs).</p><p><strong>Conclusion: </strong>Following 12 months of denosumab treatment in patients with PMOP and increasing BMD, there was a significant improvement in pain and functional disability. The improvement in pain was closely related to the increase in lumbar spine BMD, while functional enhancement was strongly associated with BMD gains in the total hip, femoral neck, and lumbar spine. Age, weight, and osteoporosis severity do not affect treatment response. Patients with prior fragility fractures (mainly vertebral fractures) experienced more significant improvements in pain symptoms and functional outcomes. Denosumab resulted in a more significant increase in BMD in patients with a history of fragility fractures (mainly vertebral fractures) and those without a history of antiosteoporosis medication use.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Three Vertebral Screw Placement Directions in Anterior Thoracolumbar Fracture Surgery: A Finite Element Study.","authors":"Xuehai Jia, Yanjun Xie, Yi Yang, Yi Deng, Kerui Zhang, Changyong Shen, Ya Li, Litai Ma","doi":"10.1111/os.70017","DOIUrl":"https://doi.org/10.1111/os.70017","url":null,"abstract":"<p><strong>Background: </strong>Thoracolumbar fractures, especially burst fractures, are common severe spinal injuries requiring surgery. The main goals are to restore spinal stability and normal curvature, relieve nerve compression, and prevent further neurological damage. Minimally invasive techniques are increasingly used in spinal surgery. This study aims to use finite element analysis to compare two new thoracolumbar anterior fixation systems: Hybrid cross-thoracolumbar fixation system and new hybrid cross-thoracolumbar fixation system (HXTL and NHXTL) with Medtronic's ANTERIOR system, providing a theoretical reference for surgeries.</p><p><strong>Method: </strong>A finite element model of the T12-L2 vertebrae of a 27-year-old healthy male was built based on CT images. The model was processed, optimized, meshed, and analyzed using software. In vitro biomechanical tests were compared with the finite element model results to verify the model's validity. A 500 N compressive load and a 10 N m bending moment were applied to the upper surface of T12. The stress and displacement of the vertebral body and the stress state of the support body of the two models under various conditions like forward flexion and backward extension were observed and analyzed.</p><p><strong>Results: </strong>The study compared the biomechanical performance of the HXTL, NHXTL, and ANTERIOR systems under six physiological conditions. The vertebral body displacement of the three systems was maximum under forward flexion. During right flexion, the HXTL displacement was significantly greater than that of the ANTERIOR and NHXTL systems, while during extension, the HXTL and NHXTL displacements were significantly less than those of the ANTERIOR system. Under other motion conditions, the displacements were relatively small. In terms of vertebral body stress, the ANTERIOR model had the maximum stress during left flexion, significantly greater than that of the other two. In terms of titanium mesh stress, the HXTL system had significantly higher stress during extension and left rotation compared to the other two systems. In terms of nail-rod stress, the ANTERIOR system had higher stress in all directions than the HXTL and NHXTL systems.</p><p><strong>Conclusion: </strong>Compared with the ANTERIOR system, the HXTL system reduces the surgical incision through oblique nail placement, can reduce the risk of nail-rod failure, and increase the stability of the titanium mesh between vertebral bodies, but it also brings a higher risk of subsidence. The NHXTL model not only reduces the surgical incision and the risk of accidental injury to contralateral blood vessels but also reduces the risk of nail-rod failure and does not increase the risk of titanium mesh subsidence. It is a more optimized choice.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LRP1 Mediates Endocytosis Activity and Is a Potential Therapeutic Target in Osteoarthritis.","authors":"Yuangang Wu, Kaibo Sun, Mingyang Li, Yang Yang, Yuan Liu, Limin Wu, Yang Ding, Yi Zeng, Bin Shen","doi":"10.1111/os.70035","DOIUrl":"https://doi.org/10.1111/os.70035","url":null,"abstract":"<p><p>Osteoarthritis (OA) is a degenerative disease characterized by cartilage abrasion and pain, affecting millions globally. However, current treatments focus on symptom management rather than modifying disease development. Recent studies have indicated that low-density lipoprotein receptor-related protein 1 (LRP1) is associated with maintaining cartilage homeostasis through its involvement in endocytosis and signaling pathways. LRP1 facilitates the removal of extracellular matrix (ECM)-degrading enzymes, including a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTSs) and matrix metalloproteinases (MMPs), thereby protecting against excessive cartilage breakdown. However, OA cartilage shows increased shedding of LRP1, leading to reduced endocytic capacity and elevated levels of these enzymes, contributing to accelerated ECM breakdown. LRP1 is also involved in key signaling pathways, such as Wnt/β-catenin, transforming growth factor-beta (TGF-β), and nuclear factor-kappa B (NF-κB), which regulate processes like chondrocyte proliferation, apoptosis, differentiation, and autophagy. Dysregulation of these pathways, combined with impaired LRP1-mediated endocytosis, fosters a catabolic environment in osteoarthritic cartilage. Emerging therapies targeting LRP1, such as gene interventions, exosome-based therapies, and small-molecule modulators, show potential in restoring LRP1 function, reducing cartilage degradation, and promoting joint repair. This review emphasizes the significance of LRP1 in the development of OA and explores its potential as a therapeutic target for creating disease-modifying strategies to maintain joint integrity and enhance patient well-being.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Dual-Plane Puncture Percutaneous Vertebroplasty Reduces Re-Collapse in Osteoporotic Vertebral Compression Fractures by Advancing Cement Delivery.","authors":"Huo-Liang Zheng, Chang-Hai Liu, Lei-Sheng Jiang, Xin-Feng Zheng, Sheng-Dan Jiang","doi":"10.1111/os.70004","DOIUrl":"https://doi.org/10.1111/os.70004","url":null,"abstract":"<p><strong>Purpose: </strong>Evaluate the efficacy of a novel unilateral dual-plane puncture technique in improving bone cement distribution and reducing vertebral re-collapse following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). By introducing the novel unilateral dual-plane puncture technique, this study aims to improve cement distribution, reduce the incidence of re-collapse, and enhance long-term clinical outcomes for patients suffering from OVCFs.</p><p><strong>Methods: </strong>This is a randomized trial conducted from April 2021 to December 2022, enrolling 145 patients diagnosed with OVCFs. Patients were allocated into either traditional or unilateral dual-plane puncture groups. Bone cement distribution, vertebral height, and segmental kyphotic angle were measured through postoperative x-ray, while clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Statistical analysis was performed using the Mann-Whitney U test and independent samples t test for continuous variables, and chi-square or Fisher's exact test for categorical variables.</p><p><strong>Results: </strong>The unilateral dual-plane puncture technique notably augmented bone cement contact with both superior and inferior endplates compared to conventional methods, achieving rates of 64.86% versus 40.85% (p < 0.001). This contributed to a significant reduction in the incidence of vertebral re-collapse within the first year post-operation: 18.92% in the unilateral dual-plane group as opposed to 42.25% in the traditional group (p < 0.001). Furthermore, the unilateral dual-plane group exhibited markedly superior long-term efficacy, evidenced by mean VAS and ODI scores of 1.26 and 28.58, respectively, in comparison to 2.03 and 32.45 in the traditional group.</p><p><strong>Conclusions: </strong>The unilateral dual-plane puncture technique advances bone cement distribution within the vertebra, thereby reducing the risk of vertebral re-collapse following PVP surgery and improving long-term clinical outcomes for patients with OVCFs.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Femoral Neck Fractures in Adults With Improved Biplane Double-Supported Screw Fixation and Femoral Neck System: Complications and Surgical Techniques.","authors":"Xiaolong Zhang, Xiwen Feng, Lingfei Ouyang, Shan Shu, Lebin Zhuang, Weichao Gui, Sheng Zhang, Zilong Yao, Gang Wang, Hua Liao, Jijie Hu","doi":"10.1111/os.14353","DOIUrl":"10.1111/os.14353","url":null,"abstract":"<p><strong>Objectives: </strong>Treating femoral neck fractures remains a significant challenge for orthopedic surgeons and imposes a substantial economic burden on developing regions. Current novel internal fixation methods demonstrate excellent biomechanical performance. However, these new internal fixation methods are still associated with various complications. This study aimed to report the clinical complications of femoral neck system (FNS) and biplane double-supported screw fixation (BDSF) treatments for femoral neck fractures at our institution and provide directions for selecting cost-effective internal fixation methods.</p><p><strong>Methods: </strong>A retrospective case-control study of adult patients with femoral neck fractures treated with BDSF or FNS was conducted at Nanfang Hospital from April 2019 to April 2022. General medical records were collected both preoperatively and intraoperatively. Primary complication measures included osteonecrosis of the femoral head, nonunion, screw-out, and subtrochanteric fractures, along with femoral neck shortening. The primary functional measure evaluated was the Harris hip score. This study employed t-test, Wilcoxon rank-sum test, and chi-square test to statistically analyze the data.</p><p><strong>Results: </strong>Statistically significant differences were observed between the BDSF and FNS groups in terms of surgery duration (60.8 ± 12.6 min vs. 71.0 ± 12.0 min), incision length (5.5 ± 1.2 cm vs. 9.1 ± 1.6 cm) and hospitalization costs (39563.8 ± 9086.4 RMB vs. 24960.4 ± 10154.4 RMB). No statistically significant differences between the BDSF and FNS groups were found in the baseline data, blood loss or hospital stay. Moderate femoral neck shortening was significantly less common in the BDSF group than in the FNS group (27.1% vs. 61.5%, p = 0.016). Postoperatively, no statistically significant differences in complication rates, such as femoral head necrosis, nonunion, subtrochanteric fractures or screw-out, were observed between the BDSF and FNS groups.</p><p><strong>Conclusions: </strong>This study revealed no significant difference in the incidence of postoperative complications such as femoral head necrosis, nonunion or screw cut-out between BDSF and FNS. Although BDSF has drawbacks, such as a long learning curve and the potential to cause subtrochanteric fractures, it is cost-effective and better maintains the length of the femoral neck. The modified BDSF technique may be more suitable for developing regions with limited health care budgets.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1057-1066"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Degenerative Hip Osteoarthritis in Unilateral Knee Osteoarthritis Patients: A Correlation Analysis.","authors":"Juncheng Li, Wenrun Zhu, Jun Yang, Xinhao Niu, Han Tang, Lu Cao, Changan Guo","doi":"10.1111/os.14372","DOIUrl":"10.1111/os.14372","url":null,"abstract":"<p><strong>Objective: </strong>Hip and knee OA often occur successively. However, little is known about the relationship between hip and knee OA in unilateral knee OA patients. The aim of the study was to explore the correlation between unilateral knee OA and bilateral hip degeneration to determine the impact unilateral knee OA has on the severity of hip degeneration.</p><p><strong>Methods: </strong>This retrospective case-control study enrolled 162 patients who were presented with unilateral knee osteoarthritis and hospitalized in Zhongshan hospital, Fudan University, from January 2016 to December 2018. The severity of affected knee joint and bilateral hip joint was evaluated by using the Kellgren-Lawrence (KL) score. Variates, such as gender, age, body mass index (BMI) and Knee Society Score (KSS) at admission, were also recorded. Differences in the severity of OA between ipsilateral, contralateral hip joints and affected knee joints were accessed with chi-square tests. Single-factor and multi-factor logistic regression were applied to determine the risk factors for hip OA in patients with unilateral knee OA.</p><p><strong>Results: </strong>Gender have no impact on KSS, the length of disease, and BMI of patients. In contralateral hip joints, there was significant difference in the proportion of patients with severe hip degeneration (KL score ≥ 2) compared to those with mild hip degeneration (KL score < 2) when considering length of disease (p < 0.001), KSS symptom score < 70 (p = 0.001) or KSS function score (p < 0.001). The risk factors for contralateral hip degeneration of patients with unilateral knee OA include that long disease course (> 5 years) (OR 3.030 [95% CI 1.476 to 6.220]; p < 0.001), and high KSS function score (≥ 70 year) (OR 0.921 [95% CI 0.878 to 0.967]; p < 0.001), increased risk of contralateral hip degeneration of patients with unilateral knee OA.</p><p><strong>Conclusions: </strong>The correlation between unilateral knee OA and contralateral hip degeneration was stronger than that between unilateral knee OA and ipsilateral hip degeneration. For knee OA patients with longer course and lower KSS functional score, more attention should be paid to the degeneration process of the contralateral hip joint.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1201-1208"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 3D-Printed Customized Femoral Short Stem Offers Improved Anatomical Parameters Restoration, Fitness and Biomechanical Performance Compared With Traditional Femoral Stem.","authors":"Ziang Jiang, Rongshan Cheng, Dimitris Dimitriou, Yangyang Yang, Tsung-Yuan Tsai, Liao Wang","doi":"10.1111/os.70000","DOIUrl":"10.1111/os.70000","url":null,"abstract":"<p><strong>Objective: </strong>The traditional femoral stem is unsuitable for patients with severe proximal femoral bone defects or deformities. However, 3D-printed customized designs offer improved proximal femoral canal contact and enhance the initial stability of the femoral prosthesis. Therefore, this study aims to compare the anatomical parameters, contact parameters, and performance of the 3D-printed customized femoral short (CFS) stem with those of the traditional femoral stem following total hip arthroplasty (THA).</p><p><strong>Methods: </strong>An in vitro study simulating THA was performed using artificial femur models, with a 3D-printed CFS stem as the experimental group and a Trilock stem as the control group. Anatomical parameters, fitness, filling, micro-motion, and strain distribution were evaluated using artificial femoral models. Micro-motion and strain were recorded under different simulated bodyweight loading using a 3D digital image correlation measurement system.</p><p><strong>Results: </strong>The neck-shaft angles (NSA) and coronal femoral horizontal offset (CFHO) of the 3D-printed CFS stem (NSA: 125.22°, CFHO: 41.03 mm) were closer to those of the intact femur (NSA: 127.37°, CFHO: 43.27 mm) compare with the Trilock stem (NSA: 132.61°, CFHO: 32.98 mm). In addition, the 3D-printed CFS stem showed improved fitness at cross-sections (The top of the lesser trochanter: 6.31%, the middle of the lesser trochanter: 23.42%, the bottom of the lesser trochanter: 26.61%) and reduced micro-motion under different simulated bodyweight loads (1000: 0.043, 1375: 0.056, 2060 N: 0.061 mm).</p><p><strong>Conclusions: </strong>The 3D-printed CFS stem provides improved restoration of anatomical parameters, enhanced fitness, and superior biomechanical performance compared with the Trilock stem.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"1220-1229"},"PeriodicalIF":1.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}