Orthopaedic Surgery最新文献

{"title":"Bone Cement Augmentation for Cervical Vertebrae-Ossification of the Posterior Longitudinal Ligament Complex Contributes to Anterior Controllable Antedisplacement and Fusion in Patients With Osteoporosis.","authors":"Qilin Lu, Xugui Li, Bin Zhang, Jiangang Shi, Jingchuan Sun","doi":"10.1111/os.70093","DOIUrl":"10.1111/os.70093","url":null,"abstract":"<p><strong>Objective: </strong>Anterior controllable antedisplacement and fusion (ACAF) is an effective strategy in treating cervical ossification of the posterior longitudinal ligament (C-OPLL). The controllable antedisplacement of the vertebrae-OPLL complex (VOC) through screws is both the most critical and technically challenging procedure, especially in osteoporosis (OP) condition. This study aims to introduce a modified method to significantly improve the procedure of VOC antedisplacement in ACAF.</p><p><strong>Methods: </strong>The modified ACAF was used to treat 22 patients both with C-OPLL and OP from January 2020 to January 2023. The cohort comprised 17 females and 5 males, with an age of 60.68 ± 1.2 years (50-71 years). During this modified ACAF, bone cement was injected into the VOC, and the corresponding steps of grooving were improved. Japanese Orthopedic Association (JOA) score, complications, and fusion conditions were documented. A paired t-test was used to compare the changes before and after surgery.</p><p><strong>Results: </strong>Twenty-two C-OPLL patients were successfully treated by the modified ACAF. The operation time was 270.5 ± 14.8 min, and the intraoperative blood loss volume was 303.6 ± 13.0 mL. All patients were followed up for 26.55 months on average. The JOA score with 12.18 ± 1.68 at the last follow-up was significantly improved (vs. 8.59 ± 1.89 of presurgery, p < 0.05). No cement leakage was found during the augmentation, and 0.4 mL of bone cement was injected in each VOC, which obviously enhanced screws anchorage. All VOCs were successfully hoisted after the augmentation without screw loosening. Twenty-two C-OPLL patients achieved satisfactory fusion at the last visit.</p><p><strong>Conclusions: </strong>Bone cement augmentation with modified steps of grooving can effectively assist the VOC antedisplacement in ACAF for OP group and has potential instantaneous revision ability for the intraoperative screw loosening for no-OP group.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2479-2485"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249024","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":"Factors Associated With Complications in 176 Crowe IV Hips Treated With Total Hip Arthroplasty.","authors":"Cheng-Qi Jia, Yu-Jie Wu","doi":"10.1111/os.70120","DOIUrl":"10.1111/os.70120","url":null,"abstract":"<p><strong>Objective: </strong>Total hip arthroplasty (THA) in Crowe IV hip was a challenge for surgeons, along with some complications. Currently, most evaluations focused on the surgical techniques and radiographs, which were indirectly measured parameters and easily affected by the operators. Objective factors were not considered. This study aimed to investigate objective factors to predict the complications.</p><p><strong>Methods: </strong>We retrospectively reviewed a series of Crowe IV patients who received THA between July 2010 and December 2019 in our hospital. Demographics and surgical parameters were collected: gender, age, height, weight, sides of preoperative knee valgus, limb length discrepancy, hip surgical history, osteotomy length, acetabular prosthesis position, acetabular prosthesis sizes, femoral prosthesis, femoral head sizes, femoral prosthesis distal sizes, and acetabular liner. The complications periprosthetic fractures, periprosthetic infection, polyethylene lining wear, postoperative dislocation, limited flexion, limp, knee valgus, knee pain, thigh pain (distal femoral prosthesis), and hip abnormal noise were recorded. Univariable and multivariable logistic regression analyses were used to identify the predictors of complications.</p><p><strong>Results: </strong>A total of 136 Crowe IV patients (176 hips) were included in this study. The mean follow-up time was 8.87 ± 2.60 (5-14) years. The mean limb length discrepancy was 2.73 ± 2.05 cm. Thirty-two hips had a surgical history. One hundred and three hips underwent intraoperative osteotomy, and the mean osteotomy length was 3.42 ± 1.22 (1-7) cm. Complications occurred in 45% (79/176) Crowe IV hips. The height (odds ratio [OR]: 0.00; 95% confidence interval [CI]: 0.00-0.26), and preoperative left knee valgus (OR: 0.37; 95% CI: 0.16-0.88) were identified as independent significant factors for complications in Crowe IV hips. A residual limp was observed in 34.09%, knee valgus was 23.3%, hip abnormal noise was 7.39%, knee pain was 1.7%, thigh pain (distal femoral prosthesis) was 1.14%, and limited flexion was 0.57%. The incidence of polyethylene lining wear was 6.3%, periprosthetic fractures was 1.7%, postoperative dislocation was 1.14%, and periprosthetic infection was 0.57%.</p><p><strong>Conclusion: </strong>Our model provided a framework to guide decision-making in Crowe IV hips for surgeons. A tall Crowe IV patient with preoperative left knee valgus was found to have a lower rate of complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2397-2404"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659742","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":"Risk Factors of Aseptic Loosening After Total Hip Arthroplasty With Collum Femoris Preserving Stem: A Long-Term Follow-Up Study.","authors":"Yongbo Ma, Yansong Liu, Zeming Liu, Jiangqi Chang, Mengnan Li, Tao Wu","doi":"10.1111/os.70099","DOIUrl":"10.1111/os.70099","url":null,"abstract":"<p><strong>Objective: </strong>The Collum Femoris Preserving (CFP) stem offers biomechanical advantages in total hip arthroplasty (THA). However, aseptic loosening remains the most common cause of failure and other severe complications, with specific risk factors associated with the CFP stem remaining inadequately defined. This study aims to investigate the possible factors associated with aseptic loosening.</p><p><strong>Methods: </strong>This study retrospectively analyzed patients who underwent primary THA with the CFP stem from January 2004 to December 2009 in our institution. Patients were divided into two groups based on whether there was aseptic loosening. Demographic and imaging parameters were collected from medical records and the hospital's Picture Archiving and Communication System (PACS). Comparative analyses were conducted, and variables with significant differences were subjected to Cox regression to identify independent risk factors of aseptic loosening.</p><p><strong>Results: </strong>A total of 469 hips were included, with 52 hips (11.1%) of aseptic loosening identified. Seven independent risk (protective) factors were found, including ceramic-on-polyethylene (COP) bearing surfaces (Hazard Ratio = 2.084, 95% Confidence Interval: 1.043-4.166, p = 0.038), history of steroid therapy (HR = 2.393, 95% CI: 1.056-5.425, p = 0.037), neck resorption ratio (NRR) (HR = 1.019, 95% CI: 1.005-1.033, p = 0.008), bone mineral density (BMD) (HR = 0.933, 95% CI: 0.891-0.976, p = 0.003), canal fill ratio (CFR) (HR = 0.951, 95% CI: 0.923-0.980, p = 0.001), cortical index (HR = 0.933, 95% CI: 0.891-0.976, p = 0.003), and varus/valgus angle between 3° and 6° (HR = 4.427, 95% CI: 2.303-8.509, p < 0.001), varus/valgus angles > 6° (HR = 8.854, 95% CI: 3.704-21.165, p < 0.001).</p><p><strong>Conclusion: </strong>This study identifies key risk factors contributing to aseptic loosening, including COP bearing surfaces, steroid therapy history, excessive femoral neck resorption, and significant varus/valgus malalignment. Conversely, higher BMD, improved cortical index, and favorable CFR were protective against loosening. These findings underscore the need for careful preoperative assessment and precise intraoperative positioning to optimize long-term implant stability.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2321-2330"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507333","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 Prevalence and Risk Factors of Residual Back Pain After Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.","authors":"Wenlong Li, Bing Zhang, Chencheng Mei, Hui Li, Ruizheng Zhu, Hao Lin, Jianmin Wen, Yang Wu, Xianzhi Ma","doi":"10.1111/os.70095","DOIUrl":"10.1111/os.70095","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic vertebral compression fractures (OVCFs) are prevalent among the elderly. Percutaneous vertebroplasty (PVA) is a commonly adopted minimally invasive treatment, yet many patients endure residual back pain (RBP) posttreatment, affecting their recovery and quality of life. Given the inconsistent prevalence of RBP across studies and the multitude of influencing factors, a systematic review and meta-analysis is necessary to determine its prevalence and identify risk factors.</p><p><strong>Methods: </strong>English (PubMed, Embase, Web of Science, Ovid, Cochrane Library) and Chinese (CNKI, WanFang Data, VIP, CBM) literature databases were systematically searched until December 31, 2023. A random-effects meta-analysis was used to pool prevalence rates from individual studies. The associations between the identified risk factors and RBP were also analyzed. Sensitivity and subgroup analyzes were performed to identify the source of heterogeneity and to compare the prevalence estimates across the groups. The Joanna Briggs Institute's (JBIs) quality assessment checklist was used to evaluate the quality of the included studies. The I² tests were used to assess heterogeneity among the studies.</p><p><strong>Results: </strong>A total of 5146 articles were collected. Finally, 26 articles involving 9703 participants were included. Among them, 1245 experienced RBP. The prevalence of RBP in individual studies ranged from 4.56% to 50.00%, with a median of 14.90%. The pooled prevalence was 16.3% (95% CI: 13.5%-19.1%). The prevalence was higher among females [16.1% (95% CI: 13.1%-19.1%)] than males [15.9% (95% CI: 12.5%-19.2%)]. Subgroup analysis based on evaluation time showed that the prevalence was higher at 3 months or more after surgery [total: 17.3% (95% CI: 13.2%-21.4%) vs. 15.7% (95% CI: 12.1%-19.2%), males: 16.5% (95% CI: 12.3%-20.6%) vs. 15.3% (95% CI: 11.0%-19.6%), females: 16.9% (95% CI: 12.6%-21.1%) vs. 15.5% (95% CI: 11.6%-19.5%)]. Regarding the risk factors, several factors demonstrated significant associations with RBP. Patients with low pre-bone mineral density were more likely to experience RBP compared to those with higher density. Moreover, thoracolumbar fascia injury, unsatisfactory cement distribution, multiple vertebral fractures, and postoperative vertebral body height recovery rate were also identified as risk factors increasing the likelihood of RBP.</p><p><strong>Conclusion: </strong>RBP is common after PVA, indicating the imperative of intervention strategies to alleviate the suffering and reduce negative ramifications. Moreover, various risk factors should be comprehensively considered to accurately assess patients' conditions and formulate targeted treatment and rehabilitation plans to alleviate patients' RBP symptoms.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2266-2280"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507335","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":"Impact of Warmed Irrigation Fluid During Shoulder Arthroscopy on Patient Temperature, Recovery, and Cognitive Function: A Prospective Analysis of Influencing Factors.","authors":"Jingfeng Liu, Xiaohong Huang, Xiaowei Xu, Yanyan Song, Jie Chen, Pei Yu, Tingjun Ye, Yin Zhang, Dahang Zhao, Gen Li, Lei Wang, Ying Wang, Zhenjin Ju, Chengyu Zhuang","doi":"10.1111/os.70123","DOIUrl":"10.1111/os.70123","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effects of warmed irrigation fluid during shoulder arthroscopy on patient temperature regulation, recovery outcomes, and cognitive function.</p><p><strong>Methods: </strong>A randomized single-blind prospective study (Level II) and a total of 85 patients who underwent shoulder arthroscopy at our hospital from February 2022 to April 2023 were selected, all of whom signed informed consent, which was randomly divided into two groups (warmed irrigation fluid group and room temperature fluid group). Among them, there were 29 males (34.1%) and 56 females (65.9%) (male:female ratio = 1:2), with an average age of 60.80 ± 11.70 years (ranging from 19 to 79 years). There were 50 patients (58.8%) aged over 60 and 35 patients (41.2%) aged under 60. All patients were diagnosed with rotator cuff injuries. We recorded primary patient data, anesthesia duration, anesthesia method, surgery duration, intraoperative temperature protection measures, irrigation volume, intraoperative nasopharyngeal and rectal temperatures, and preoperative and postoperative Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. Statistical analysis was performed to evaluate the impact of warmed irrigation fluid on patient temperature, recovery, and cognitive status.</p><p><strong>Results: </strong>Analysis of the data from the 85 shoulder arthroscopy patients indicated that warming the irrigation fluid effectively prevented a decrease in core body temperature (nasopharyngeal and rectal temperatures), with significant differences observed at 120 min (nasopharyngeal temperature) and 105 min (rectal temperature). Patients with warmed irrigation fluid had a shorter average anesthesia recovery time than those without warming, although this difference was not statistically significant. Analysis of MMSE and MOCA scores revealed that the areas of cognitive decline post-surgery mainly involved cumulative memory and attention, while orientation was not affected. Education level was identified as a factor influencing cognitive decline.</p><p><strong>Conclusion: </strong>The administration of warmed irrigation fluid during shoulder arthroscopy has effectively preserved patients' core body temperature. This practice may contribute to a reduction in recovery time and complications associated with the procedure. Furthermore, minimally invasive techniques such as arthroscopy have been associated with a decreased incidence of postoperative cognitive impairment.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2371-2384"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643101","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":"Is Collum Femoris Preserving Stem (CFP) an Epiphyseal-Stabilized Prosthesis? A Long-Term Single-Center Series Follow Up of 705 Cases.","authors":"Yansong Liu, Yongbo Ma, Xuzhuang Ding, Jiangqi Chang, Mengnan Li, Tao Wu","doi":"10.1111/os.70109","DOIUrl":"10.1111/os.70109","url":null,"abstract":"<p><strong>Background: </strong>The global increase in total hip arthroplasty (THA) has led to widespread use of cementless femoral stems. The Collum Femoris Preserving (CFP) stem, initially designed as an epiphyseal-stabilized prosthesis, aims to preserve proximal bone and reduce stress shielding. However, long-term observations have revealed unexpected proximal bone resorption and distal sclerosis, challenging this classification. This study aims to reassess the fixation pattern and long-term complications of CFP stems to inform clinical decision-making.</p><p><strong>Methods: </strong>Between 2006 and 2012, 497 patients (705 hips) were included. The primary outcomes included prosthesis survival, periprosthetic bone remodeling, and clinical outcomes, assessed using the Harris Hip Score (HHS). Kaplan-Meier survival analysis was performed, with endpoints of prosthesis loosening and reoperation. Radiographic data were analyzed to evaluate periprosthetic bone remodeling.</p><p><strong>Results: </strong>A total of 497 patients (705 hips) with a mean follow-up of 10.4 years were included. The long-term survival rate of the CFP stem was 95.32%, with a 97.2% survival rate for aseptic loosening and 95.5% for reoperation. Complications included 2.84% aseptic loosening, 0.99% infection, 0.99% periprosthetic fractures, 0.57% dislocation, and 1.42% heterotopic ossification. The CFP stem, which has not shown signs of aseptic loosening, exhibits radiographic features characteristic of a distal-stabilized prosthesis.</p><p><strong>Conclusion: </strong>The long-term survival rate of the CFP prosthesis was 95.32%. Radiographic findings indicate that the CFP prosthesis should be considered a distal-stabilized prosthesis rather than the traditionally regarded epiphyseal-stabilized prosthesis.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2385-2396"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659743","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":"Quantitative Evaluation and Preoperative Planning Using Three-Dimensional CT Profiles Improves the Accuracy of Bony Correction Under Primary Hip Arthroscopy and Clinical Outcomes in the Setting of Cam-Type Femoroacetabular Impingement Syndrome.","authors":"Feng Zheng, Wang Daofeng, Song Guanyang, Li Yue, Wang Xuesong","doi":"10.1111/os.70102","DOIUrl":"10.1111/os.70102","url":null,"abstract":"<p><strong>Objective: </strong>Residual cam deformity is the main cause of revision hip arthroscopy, and the precise correction of cam lesions is a crucial clinical problem. This study aimed to propose a novel quantitative evaluation and preoperative planning method based on 3D-CT profile analysis applied in primary hip arthroscopy for the treatment of cam-type femoroacetabular impingement syndrome (FAIS) and to evaluate the effect of this method.</p><p><strong>Methods: </strong>Consecutive patients who underwent primary hip arthroscopy for cam-type FAIS between April 2018 and August 2022 were enrolled in this study. According to the method assisting cam resection, the included patients were divided into the planning group and the control group. Patients' demographic characteristics, preoperative radiographic measurements, and intraoperative procedures were collected. Preoperative and postoperative anterior α angle (Aα) and lateral α angle (Lα) were measured on 3D-CT profiles, and the residual rates of anterior cam lesion (Ac) and lateral cam lesion (Lc) were calculated. Moreover, the 2-year postoperative clinical outcomes, including clinical scores and achieving rates of clinically significant outcomes, were compared between groups.</p><p><strong>Results: </strong>Eventually, the planning group included 68 patients and the control group included 57 cases. There were no significant differences in demographic characteristics, preoperative radiographic measurements, and intraoperative procedures between groups (p > 0.05). Postoperatively, the mean postoperative Lα in the planning group was significantly smaller than that in the control group (43.4° ± 9.5° vs. 60.8° ± 20.8°, p < 0.001). Correspondingly, patients in the planning group had a significantly lower rate of residual Lc (9.4% vs. 62.5%, p < 0.001) and overall residual cam lesion (14.7% vs. 54.4%, p < 0.001) compared to cases in the control group. At 2-year follow-up postoperatively, patients in the planning group reported significantly superior scores of mHHS (91.0 ± 6.0 vs. 86.3 ± 8.5, p = 0.001), iHOT-12 (89.9 ± 7.2 vs. 82.7 ± 11.1, p < 0.001), and VAS for pain (1.2 ± 0.8 vs. 1.6 ± 1.1, p = 0.018) compared to patients in the control group. Moreover, the percentage of cases achieving patient acceptable symptom state (PASS) for mHHS in the planning group was significantly higher than that in the control group (97.1% vs. 84.2%, p = 0.012).</p><p><strong>Conclusions: </strong>Quantitative analysis using 3D-CT profiles is a reliable method for the evaluation of femoral morphology in patients with cam-type FAIS. Additionally, preoperative planning based on 3D-CT profiles can reduce the residual rate of cam lesions and improve short-term clinical outcomes in these patients who underwent primary hip arthroscopy.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2422-2434"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476224","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":"\"Virtual Lateral Wall\" Technique to Overcome Nail Entry Pathway Errors and Optimize Success of Intramedullary Nailing in Pertrochanteric Fractures.","authors":"Qiang Guo, Yifu Tang, Ling Luo","doi":"10.1111/os.70122","DOIUrl":"10.1111/os.70122","url":null,"abstract":"<p><strong>Objective: </strong>The use of intramedullary implants for the treatment of pertrochanteric fractures is well-established. Nail entry pathway error is a common intraoperative challenge, particularly in pertrochanteric fractures with unstable greater trochanter fragment. This study introduces our innovative virtual lateral wall technique, which allows \"lateral wall fracture\" simplification from unstable to stable and effectively guides the reamer to create an accurate entry pathway for nail insertion in the treatment of pertrochanteric fractures.</p><p><strong>Methods: </strong>A retrospective study was conducted on 12 consecutive cases of pertrochanteric fractures in our department between September 2022 and January 2024. The study population included three men and nine women, aged 68-90 years. Fractures were classified according to the AO/OTA system: one case of AO/OTA 1.3, one case of AO/OTA 2.2, and 10 cases of AO/OTA 2.3. All patients underwent surgical treatment with the proximal femoral nail anti-rotation (PFNA) implant. The surgical technique involved creating a \"virtual lateral wall\" using two 2.5-mm K-wires inserted into the greater trochanter from anterolateral to posteromedial to stabilize the unstable greater trochanter fragment and guide the nail entry. Intraoperative fluoroscopy was used to confirm the correct nail entry point and pathway. Surgical outcomes, including operative time, fluoroscopic exposure time, tip-to-apex distance (TAD), femoral neck-shaft angle, lag screw placement, and reduction quality based on the modified Baumgaertner criteria, were analyzed to evaluate the feasibility and efficacy of the technique. Complications were also recorded.</p><p><strong>Results: </strong>The mean operative time was 33.3 ± 10.1 min, with an average blood loss of 58.3 ± 20.8 mL. Intraoperative fluoroscopy was used 13.8 ± 5.4 times, and the surgical incision length was 6.2 ± 0.7 cm. Postoperative radiographic evaluation revealed a femoral neck-shaft angle of 129.4° ± 5.5° and a tip-to-apex distance of 23.3 ± 4.4 mm. The lag screw was consistently positioned inferiorly within the femoral head. All cases achieved good reduction quality according to the modified Baumgaertner criteria. No severe complications, such as neurological or vascular damage, were observed during or after surgery.</p><p><strong>Conclusions: </strong>The virtual lateral wall technique has demonstrated remarkable efficacy in preventing nail insertion complications in patients undergoing proximal femoral nail treatment for pertrochanteric fractures, particularly those characterized by an unstable lateral wall. This technique provides a reliable method for achieving accurate nail position, making it a valuable addition to the surgical management of complex pertrochanteric fractures with unstable greater trochanter fragment.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2486-2494"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659740","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":"Total Hip Arthroplasty Stems and Femur Strain During Implant Insertion: A Biomechanical Study of Single Taper, Double Taper, and Collared Monolithic Stems.","authors":"Barrett Bruno Torre, Jordan Andre Bauer, Ian Wellington, Tannaz Sedghi, Dillon Neumann, Adam Lindsay, Olga Solovyova","doi":"10.1111/os.70110","DOIUrl":"10.1111/os.70110","url":null,"abstract":"<p><strong>Objective: </strong>In total hip arthroplasty (THA), intraoperative periprosthetic femoral fracture (IOPFF) is a significant concern, often occurring during femoral canal instrumentation and stem implantation due to proximal femur strain. However, the impact of different stem designs on this strain remains unclear. This study conducted a biomechanical analysis comparing strain patterns on the proximal femur during the implantation of three stem types: single taper, double taper, and collared stems. This study aims to explore if there is a difference in strain patterns placed on the proximal femur during the implantation of three different stem types: single taper, double taper, and collared stems?</p><p><strong>Methods: </strong>There were 24 cadaveric femurs randomly assigned to three groups based on implant geometry: Smith and Nephew anthology (single taper), synergy (double taper), and polar (collared) stems. Strain gauges were placed on the proximal femur to measure strain during implantation in both horizontal and vertical directions. Peak strain, the difference between maximum strain at final impaction and baseline, was recorded. The Kruskal-Wallis test compared peak strain between stem designs.</p><p><strong>Results: </strong>At the medial proximal femur, collared stems produced compressive strain (-276) in the horizontal vector, differing significantly from the tensile strain generated by single (41, p = 0.009) and double taper stems (218.5, p = 0.003). No significant strain difference existed between single and double taper stems at the medial proximal femur. At the lateral proximal femur, double taper stem impaction resulted in compressive strain (-69), significantly differing from the tensile strain produced by single taper (221, p = 0.024) and collared stem impaction (462, p = 0.009). No strain differences were observed in other tested areas.</p><p><strong>Conclusion: </strong>This study highlights distinct strain patterns at the medial and lateral proximal femur depending on the stem type. Collared stems induce compressive strain at the medial proximal femur, while double taper stems result in compressive strain at the lateral proximal femur. Understanding these differences may help reduce IOPFF risk in THA procedures. Based on these findings, the use of collard stems would be preferable over single or double taper stems in elderly patients with suboptimal bone quality, as it reduces strain on the medial cortex and improves immediate stability.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2445-2453"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575980","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":"Noninvasive Compartmental Pressure Assessment With iCare in Healthy Individuals of Different Ages.","authors":"Jialiang Guo, Jianfeng Zhang, Kezheng Du, Bo Shi, Weichong Dong, Yingze Zhang, Zhiyong Hou","doi":"10.1111/os.70078","DOIUrl":"10.1111/os.70078","url":null,"abstract":"<p><strong>Objective: </strong>Acute compartment syndrome is a major orthopedic emergency due to elevated pressure in the closed muscle compartment, and prompt evaluation and fasciotomy are always needed. However, the gold standard indicator of fasciotomy is still under debate. To date, few studies have investigated the variations in compartmental pressure at different locations in people of different ages. The aim of the research was to compare compartmental pressure among different age groups and measurement locations.</p><p><strong>Methods: </strong>A total of 154 healthy individuals including 106 males and 48 females over 18 years (46.8 ± 14.0 years) were enrolled between January 2020 and December 2021, and classified into five age groups: Group I = 18-30 years; Group II = 31-40 years; Group III = 41-50 years; Group IV = 51-60 years; and Group V ≥ 61 years. Six measurement locations (lower, middle, and upper points, 6 points) were selected to assess pressure variations in the anterior compartment and posterior superficial compartment with the iCare device, which calculates biomechanical properties based on the tissue's inherent response. Differences in pressure among the five age groups and six measurement locations (three for anterior compartment, three for posterior superficial compartment) were examined. One-way ANOVA and LST tests were used to conduct comparisons among five independent age groups.</p><p><strong>Results: </strong>In the same measurement location, the compartmental pressure in Group V at the upper anterior (anterior fascial compartment) measurement location was increased compared with that in Groups I, III, and IV. However, the compartmental pressures at the middle anterior and posterior measurement locations were almost comparable among the five different age groups. In the same age group, the compartmental pressure was more inclined to be lower at the upper anterior measurement location in Groups I-IV. However, no significant differences were observed for other measurement locations.</p><p><strong>Conclusions: </strong>The measurement results demonstrated comparable compartmental pressure in the fascial compartment at most measurement locations. The fascia, which forms the limb compartment, may play a role in pressure release or redistribution after injury or fracture due to its function and unique or interconnected structure.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2413-2421"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302624","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}