Orthopaedic Surgery最新文献

{"title":"Biomechanical Characteristics of First Coronal Reverse Vertebrae in Lenke Type V Adolescent Idiopathic Scoliosis: A Study Using Finite Element Analysis.","authors":"Zhenguo Shang, Zhiyong Hou, Wei Chen, Hengrui Chang, Jiaxin Xu, Di Zhang, Hui Wang","doi":"10.1111/os.14294","DOIUrl":"10.1111/os.14294","url":null,"abstract":"<p><strong>Objective: </strong>Whether first coronal reverse vertebrae (FCRV) can directly cause biomechanical changes in adjacent segments remains unclear. The objective of this study was to explore the biomechanical changes in adjacent discs of the FCRV to better understand the stress distribution of adolescent idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>According to the plain CT scan data of T8-T10 segment of an AIS patient, T9 was the FCRV, and a three-dimensional FE model was established accurately. The T8-T9 segment disc was defined as the adjacent upper disc (UD), axial section as half of the upper disc (HUD). Similarly, T9-T10 segment disc was the adjacent lower disc (LD), axial section as half of the lower disc (HLD). The biomechanical changes in adjacent discs of the FCRV under different loads were assessed.</p><p><strong>Results: </strong>The maximum Von-Mises stress values of the LD were greater under various loads than those of the HLD, UD, and HUD. The average stress on the LD was greater than that of the other discs under the left lateral bending (LLB) or right lateral bending (RLB) load. It was noted that the concave side of the LD was subjected to greater stress under the neutral standing or LLB load compared with convex side. Additionally, the concave side of the LD was subjected to greater stress under the LLB or RLB load compared with that of other discs. Interestingly, the same trends were observed for the convex side of the LD.</p><p><strong>Conclusions: </strong>FCRV caused LD to take on greater stress magnitudes. The stress showed a trend of local concentration, which was in the concave side of the scoliosis. These findings could contribute to further treatment planning for the patient and aid physicians' management decision-making.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"563-574"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801616","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":"Biomechanical Analysis and Solution Suggestions of Screw Replacement Scenarios in Femoral Neck Fracture Surgeries: Finite Element Method.","authors":"Yılmaz Güvercin, Murat Yaylacı, Ayberk Dizdar, Mehmet Emin Özdemir, Sevil Ay, Ecren Uzun Yaylacı, Umitcan Karahasanoğlu, Hüseyin Uygun, Gökhan Peker","doi":"10.1111/os.14337","DOIUrl":"10.1111/os.14337","url":null,"abstract":"<p><strong>Objective: </strong>Despite several surgical options, there has yet to be a consensus on the best treatment for femoral neck fracture (FNF) due to higher complication rates compared to other bone fractures. This study aims to examine the possible consequences and solution suggestions of changing screws during surgery for various reasons in FNF surgical treatment from a biomechanical perspective.</p><p><strong>Method: </strong>FNF and treatment materials were analyzed biomechanically using a package program based on the finite element method (FEM). This study created a solid model with images of femur bone tomography. Dynamic hip screws (DHS), cannulated screws (CCS), and medial buttress plates (MBP) were obtained by making three-dimensional designs. The required elements for the models were assigned, and the material properties of the elements were defined. The solutions were obtained as crack distance and deformation results after defining the boundary conditions and applying the necessary loading.</p><p><strong>Results: </strong>The strain and crack distance values created by six models on the fracture line under different parameters were obtained, and the numerical results were evaluated. The DHS and CCS models produced the highest crack distance and deformation values when all screws were loose. The lowest values were obtained in the intact-85 model when all CCS were tight. When the results are evaluated, it is seen that the MBP has a decreasing effect on the results. Mechanical evaluation of six different options used in femoral neck fractures was performed. 85 mm CCS applied to our standard model gave the best results, while the use of 80 mm CCS in the same model showed promising results compared to other models. It is understood that CCS have the best stability even in loosening models with the medial support plate. Different models are from intact-85 mm DHS+1CS+MBP to DHS+1CS, which was worked with LSR+USR-2, according to decreasing stability.</p><p><strong>Conclusion: </strong>This study offers various biomechanical solutions to possible intraoperative problems in FNF treatment. The following results were obtained from the study data. When the CCS needs to be lengthened or replaced, it is appropriate to use the CCS with the MBP. A single anti-rotation screw is sufficient for lag screw extensions of the DHS plate, and the MBP may be a savior procedure in surgery.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":"17 2","pages":"614-623"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080714","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":"Sagittal Inclination Angle of the Graft Affects Graft Maturity and Knee Stability After Anterior Cruciate Ligament Reconstruction.","authors":"Ming Li, Fangang Meng, Dianbo Long, Dorje Wencheng, Yanlin Zhong, Yan Kang, Peihui Wu, Aishan He","doi":"10.1111/os.14305","DOIUrl":"10.1111/os.14305","url":null,"abstract":"<p><strong>Objective: </strong>The influence of the graft sagittal inclination angle (SIA) on knee stability, biomechanics, and graft maturity has been elucidated. However, no study has comprehensively described the effects of SIA on the aforementioned postoperative prognostic indicators. So, we aimed to determine whether the sagittal inclination angle (SIA) of a graft is associated with postoperative graft maturity, joint stability, and joint function after anterior cruciate ligament (ACL) reconstruction.</p><p><strong>Methods: </strong>Patients who had undergone ACL reconstruction between April 2019 and February 2022 and those with intact ACL were eligible. Using magnetic resonance imaging, graft maturity was evaluated as the mean signal-to-noise quotient (SNQ) measured in three regions. Anterior tibial translation (ATT) was used to evaluate knee stability. Correlation analysis was conducted for the SIA, ATT, and clinical outcome scores. Multivariate stepwise regression analysis was used on the SIA and potential risk factors to determine their association with the graft SNQ. The SIA threshold of knee instability was calculated by receiver-operating characteristic curves.</p><p><strong>Results: </strong>Sixty-three postoperative patients were enrolled. The SIA was significantly negatively associated with graft SNQ value. A multivariate stepwise regression analysis showed that SIA and body mass index were significant influencing factors associated with the graft SNQ. Correlations between the SIA and medial and lateral ATT were statistically significant. A larger SIA resulted in a decreased probability of medial and lateral ATT ≥ 5 mm. The SIA threshold of an increased risk of lateral ATT ≥ 5 mm was < 44.4°. A positive correlation was observed between SIA and subjective symptom subscales in the KOOS.</p><p><strong>Conclusions: </strong>A low SIA is not conducive to graft maturation after ACL reconstruction. A larger graft SIA was correlated with better postoperative knee stability. However, the effect of the SIA on joint function was only significant in terms of symptoms. Therefore, these new findings provide new ideas for preoperative assessment and intraoperative determination of the ideal graft inclination.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"427-436"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770976","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":"Anterior Controllable Antedisplacement and Fusion (ACAF) for Cervical Stenosis Patients With Hyperextension Injury: A Retrospective Study.","authors":"Shuangxi Sun, Yingying Miao, Tao Xu, Kaiqiang Sun, Yijuan Lu, Jingchuan Sun, Jiuyi Sun, Jiangang Shi","doi":"10.1111/os.14319","DOIUrl":"10.1111/os.14319","url":null,"abstract":"<p><strong>Objective: </strong>Central cord syndrome (CCS) is an incomplete spinal cord injury (SCI) causing severe motor weakness, and timely decompression via surgical intervention facilitates better recovery. Anterior controllable antedisplacement and fusion (ACAF) is a novel decompression technique and achieved satisfactory outcomes in treating cervical degenerated diseases. However, the clinical effects of ACAF on CCS remains unknown. This present study aimed to investigate the clinical outcomes of ACAF for cervical stenosis patients with CCS due to hyperextension injury.</p><p><strong>Methods: </strong>This is a retrospective study, and patients who underwent ACAF due to CCS in our institution from July 2021 to December 2022 were enrolled based on the inclusion and exclusion criteria. All patients underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) before and after surgery. The duration of follow-up was at least 12 months. The radiological parameters included associated pathologies, prevertebral hyperintensity (HI), intramedullary signal intensity (ISI), and Torg-Pavlov ratio (TPR). The cervical stability was also evaluated. Neurological function was assessed using the American Spinal Injury Association (ASIA) grading system and Japanese Orthopaedic Association (JOA) score. The Mann-Whitney U test was used to compare the clinical outcomes preoperatively and postoperatively.</p><p><strong>Results: </strong>Finally, 13 patients (7 male and 6 female) with the minimum of 12-month follow-up were finally enrolled in this study, with the mean age of 56.6 ± 12.5 years (range, 39-74 years). There were eight patients suffered CCS due to fall, three due to vehicle accident, and two due to diving injuries. The average delay from injury to surgery was 2.23 days (range, 1-4 days), and the mean duration of follow-up was 16.1 ± 3.5 months. In terms of prevertebral HI and ISI, C4-C6 were the most affected region. In addition, 76.9% (10 of 13) patients were observed to have cervical stenosis indicated by TPR. Associated pathologies were herniated nucleus pulposus (HNP) in five patients, OPLL in three cases, and HNP-osteophyte complexes (HNP-OC) in six patients. At the final follow-up, 13 patients were improved to E. The mean JOA score improved to 15.4 ± 1.0, with the recovery rate of 77.0% ± 12.0%. Two patients experienced postoperative dysphagia, two patients had hoarseness, and one patient suffered postoperative hematoma.</p><p><strong>Conclusions: </strong>ACAF can be a good option for treating CCS patients due to hyperextension injury with underlying cervical spondylosis and stenosis.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"500-512"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818722","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":"Effect of Decellularized Amniotic Membrane on the Tendon-Bone Integration in Rotator Cuff Repair: A Comparative Rat Model Study.","authors":"Jiangtao Wang, Chunbao Li, Jiating Zhang, Mingyang An, Gang Zhao, Samuel D Stark, Yujie Liu","doi":"10.1111/os.14316","DOIUrl":"10.1111/os.14316","url":null,"abstract":"<p><strong>Objective: </strong>Rotator cuff retear after arthroscopy repair is a difficult complication that is often due to poor tendon-bone healing. Decellularized amniotic membrane (DAM) has a variety of bioactive substances which have great potential to enhance tendon-bone healing. However, DAM has three layers, of which the middle basement layer is dense and thick. Whether DAM will hinder tendon-bone healing of rotator cuff after surgical repair is unclear. Our study aims to investigate the effect of DAM on tendon-bone healing of the rotator cuff after surgical repair.</p><p><strong>Methods: </strong>Thirty-three Sprague-Dawley (SD) rats were selected to establish unilateral supraspinatus (ST) tear models and were randomly treated with only suturing repair (OSR group, n = 11), and suturing repair with DAM placed between the ST and bone (DAM group, n = 11). In the normal control group (NCT group, n = 11), the supraspinatus was only exposed but not detached or repaired. After 4 weeks the rats were sacrificed. The assessment of specimens was conducted by micro-CT analysis, histopathological evaluation, and biomechanical testing.</p><p><strong>Results: </strong>The DAM group had a significantly higher ultimate load to failure, new bone volume, and histological evaluation at 4 weeks after surgery than the OSR group. When comparing the DAM group to the NCT group, the DAM group performed slightly worse in biomechanical testing, micro-CT analysis, and histological evaluation.</p><p><strong>Conclusion: </strong>When placed between tendon and bone at the rotator cuff footprint, DAM, despite its dense and thick basement layer, does not impede tendon-bone healing after surgical repair for rotator cuff injury, but rather promotes increased healing quality and biomechanical properties. However, the healing quality and biomechanical properties are still lower than that of the normal rotator cuff, and further improvement should be made to the application strategy of a DAM.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"575-582"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807692","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 Health-Related Quality of Life for Cemented Versus Uncemented Hemiarthroplasty in Elderly Patients With Femoral Neck Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Mohanad Samaheen, Maen Mohammad, Mikhail Salzmann, Nikolai Ramadanov","doi":"10.1111/os.14339","DOIUrl":"10.1111/os.14339","url":null,"abstract":"<p><strong>Objective: </strong>Femoral neck fractures in the elderly are a global health issue, with the choice between cemented and uncemented hemiarthroplasty remaining a topic of debate. This systematic review and meta-analysis aims to compare the effects of the two surgical options on health-related quality of life (HRQoL), mortality, and functional outcomes.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing cemented with uncemented hemiarthroplasty in patients aged 50 years and older with femoral neck fractures. The primary outcome of interest was HRQoL as measured by the European Quality of Life 5-Dimension Questionnaire (EQ-5D) score. Secondary outcomes included mortality, surgical, general, and local complications.</p><p><strong>Results: </strong>We included 20 RCTs with a total of 3680 patients with femoral neck fractures, of whom 1871 (50.5%) underwent cemented and 1809 (49.5%) uncemented hemiarthroplasty. The follow-up ranged from 1 to 6 years. The early (after 3-4 months) EQ-5D utility score (MD 0.07; 95% CI 0.03-0.12; p = 0.003; I ² = 22%) and the 12-month EQ-5D utility score (MD 0.08; 95% CI 0.00-0.16; p = 0.04; I ² = 67%) suggested an improved HRQoL in the cemented hemiarthroplasty group. The outcomes of 1-year mortality, requirement for additional surgeries, surgery duration, risk of pulmonary embolism, pressure sores or ulcers, intraoperative fractures, and periprosthetic or postoperative fractures demonstrated significant differences between the two groups.</p><p><strong>Conclusions: </strong>The use of cemented hemiarthroplasty in patients with femoral neck fractures presented better results when compared to uncemented hemiarthroplasty in terms of HRQoL during the first year after surgery and greater mortality reduction at 1 year follow-up and reduced the need for further surgery. Therefore, the use of cemented hemiarthroplasty may be preferred for the treatment of femoral neck fractures in elderly patients.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"361-372"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896534","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":"Management of Bone Defects and Complications After Bone Tumor Resection Using Ilizarov Method.","authors":"Kai Zheng, Xiu-Chun Yu, Jinfang Cai, Ming Xu, Haocheng Cui, Qian Chen, Jing-Yu Zhang","doi":"10.1111/os.14318","DOIUrl":"10.1111/os.14318","url":null,"abstract":"<p><strong>Objective: </strong>Ilizarov technology is highly effective in addressing complex orthopedic challenges. This study aims to describe our experience with distraction osteogenesis in managing bone tumors in the lower extremity, focusing on composite bone defects and associated complications.</p><p><strong>Methods: </strong>A retrospective clinical study was conducted to analyze patients with primary bone tumors who underwent distraction osteogenesis using the Ilizarov method from 2010 to 2020. Some young children received epiphyseal distraction and bone transport as part of their sarcoma surgical treatment. Additionally, external fixation, bone transport, or limb lengthening were employed to address complex postoperative complications associated with bone tumors. The clinical outcomes assessed included the patient's general information, the location of bone defects, the length of bone repair, the status of bone healing, and limb function.</p><p><strong>Results: </strong>Eleven patients were followed up for an average of 66 months (range, 24-132 months). The average length of repaired bone defects was 13 cm (range, 2.5-32 cm). The cohort comprised three females and eight males, with ages at presentation ranging from 6 to 42 years (mean, 18 years). The sites of involvement included the distal femur (n = 4), femoral diaphysis (n = 3), proximal tibia (n = 2), and the distal tibia (n = 2). Nine patients were diagnosed with osteosarcoma, while one presented with Ewing's sarcoma and another with a giant cell tumor of bone. Three young children were successfully treated with epiphyseal stretching; however, one patient experienced treatment failure. Additionally, seven patients underwent external fixation to address complex postoperative complications, including infection, bone defects, and limb shortening. At the last follow-up, with the exception of one failure, the average Musculoskeletal Tumor Society (MSTS) limb function scores for the remaining 10 patients were 25 (range, 21-30). Three months post-fixator removal, the Asociación Latinoamericana de Oncología (ASAMI) bone score was rated as excellent in 63.6% (7/11) of patients, whereas the ASAMI function score was excellent in 36.4% (4/11) and good in 54.5% (6/11) of cases.</p><p><strong>Conclusion: </strong>The Ilizarov method demonstrates some clinical value in the resection and reconstruction of bone tumors, as well as in the management of postoperative complications associated with such tumors.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"492-499"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818726","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":"Augmented Reality Navigation System Enhances the Accuracy of Spinal Surgery Pedicle Screw Placement: A Randomized, Multicenter, Parallel-Controlled Clinical Trial.","authors":"Yichao Ma, Jiangpeng Wu, Yanlong Dong, Hongmei Tang, Xiaojun Ma","doi":"10.1111/os.14295","DOIUrl":"10.1111/os.14295","url":null,"abstract":"<p><strong>Objective: </strong>The pedicle screw insertion technique has evolved significantly, and despite the challenges of precise placement, advancements like AR-based surgical navigation systems now offer enhanced accuracy and safety in spinal surgery by integrating real-time, high-resolution imaging with virtual models to aid surgeons. This study aims to evaluate the differences in accuracy between novel AR-guided pedicle screw insertion and conventional surgery techniques.</p><p><strong>Methods: </strong>A randomized controlled trial was conducted from March 2019 to December 2023 to compare the efficacy of AR-guided pedicle screw fixation with conventional freehand surgery using CT guidance. The study included 150 patients, aged 18-75, with 75 patients in each group. The total number of pedicle screws planned for the clinical trial placement was 351 and 348 in the experimental and control groups. The safety and efficacy of the procedures were evaluated by assessing screw placement accuracy and complication rates.</p><p><strong>Results: </strong>In the full analysis set (FAS) analysis, the difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 6.3% [3.0%-9.8%], with a p value of 0.0003 for the superiority test. In the FAS sensitivity analysis, the success rate was 98.0% (344 out of 351) in the experimental group and 91.7% (319 out of 348) in the control group, with a difference and 95% confidence interval of 6.3% [2.9% and 9.8%, respectively]. In the per-protocol set (PPS) analysis, the difference in the excellent and good rates of screw placement between the experimental and control groups, and the 95% confidence interval was 6.4% [3.3%-9.5%], with a p value of 0.0001 for the superiority test. In the actual treatment set (ATS) analysis, the excellent and good rates of screw placement were 99.1% in the experimental group and 91.7% in the control group. The difference in the excellent and good rates of screw placement (experimental group - control group) and 95% confidence interval was 7.3% [4.1%-10.6%], with a p value of < 0.0001 for the superiority test.</p><p><strong>Conclusions: </strong>The AR surgical navigation system can improve the accuracy of pedicle screw implantation and provide precise guidance for surgeons during pedicle screw insertion.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"631-643"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009238","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":"Measured Resection as Gap Balance Method in Mobile-Bearing Medial Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial.","authors":"Qian Liu, Jianhua Ren, Wenhui Zhang, Tangzhao Liang, Zhe Wang, Siwei Xie, Yuhang Li, Jianfeng Hou, Kun Wang, Ronghan He","doi":"10.1111/os.14346","DOIUrl":"10.1111/os.14346","url":null,"abstract":"<p><strong>Objective: </strong>Gap balancing is a vital process during mobile-bearing unicompartmental knee arthroplasty (MB-UKA). However, this process commonly depends on the surgeon's experience and lacks specific unified standards. This study aimed to propose and evaluate a novel \"measured resection\" method for gap balance in MB-UKA.</p><p><strong>Methods: </strong>This prospective study included 49 consecutive patients (52 knees) who underwent MB-UKA from February 1, 2023, to September 1, 2023. Gap balance was achieved by the traditional \"two-finger\" method (Group 1, 26 knees) or the measured resection method (Group 2, 26 knees). The novel \"measured resection\" method was performed by measuring the thickness of the resected posterior femoral condyle and resected medial posterior tibial plateau to assess proper meniscal bearing thickness. Data were collected at baseline and the 6-month follow-up. Prosthetic angles, range of motion (ROM), visual analog scale (VAS) score, Oxford knee score (OKS), and Global Perceived Scale (GPE) were used to evaluate clinical outcomes. Independent samples t-test and Mann-Whitney U test were used to compare the differences.</p><p><strong>Results: </strong>There were significant improvements in all measured outcomes at the 6-month follow-up from baseline in both groups (p < 0.01). Patients using measured resection method showed better ROM (130° vs. 120°, p = 0.007), VAS score (1 vs. 2, p = 0.013), and OKS scores (39.9 vs. 38.1, p = 0.013) at 6-month follow-up than the traditional \"two-finger\" method group. The prosthetic angles, ROM improvement, and GPE showed no significant difference between the groups (p > 0.05).</p><p><strong>Conclusions: </strong>The measured resection method is a reliable method for assisting surgeons in choosing the ideal meniscal bearing thickness in MB-UKA to achieve proper gap balance and gain better clinical outcomes.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT03815448).</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"603-613"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932581","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":"Enhanced Biomechanical Stability in Proximal Humeral Fractures: Finite Element Analysis of a Novel Endosteal Anatomical Support Nail for Improved Fixation in Elderly Patients.","authors":"Jiawen Chen, Zhonghe Wang, Changda Li, Peiyu He, Zhongxuan Chen, Lijun Sun, Xiaoyan Cao, Na Tian, Xiang Dong, Peifu Tang, Hua Chen","doi":"10.1111/os.14297","DOIUrl":"10.1111/os.14297","url":null,"abstract":"<p><strong>Objectives: </strong>Intramedullary nailing is preferred for treating elderly proximal humeral fractures, but secondary reductions are common, particularly in elderly and osteoporotic patients. This occurs due to the intramedullary nail fixation's insufficient anti-varus and anti-rotational capacities and high stress at the bone-implant interface. We aim to enhance the anti-varus and anti-rotational stability of the fixation structure while reducing the stresses on the bone and internal fixation through structural design.</p><p><strong>Materials and methods: </strong>We developed a novel endosteal anatomical support nail (EASN) that integrates an endosteal torus construct into the proximal portion of the angle-stable proximal humerus nail. The endosteal torus construct includes endosteal anatomical support (EAS) with a flat plane that allows direct fixation of the humeral head fragments and is shaped to conform to the medial side of the medullary cavity of the proximal humerus. We conducted finite element analysis to assess the biomechanical stability of four constructs: EAS with a calcar screw (CS), EAS without CS, non-EAS with CS, and non-EAS without CS. This analysis determined the contribution of the EAS to the mechanical stability of the proximal humerus in two-part PHF with medial column disruption. Specimens were subjected to loads simulating partial-weight-bearing (as in rising from a chair or using crutches) and full-weight-bearing (as in rising from bed). We evaluated the stiffness of the construct, displacement at the fracture site, von Mises stress, and stress distribution.</p><p><strong>Results: </strong>Under compressive or rotational loads, the EAS construct, with or without CS, was significantly stiffer than the non-EAS construct. Displacement at the fracture site was significantly less with the EAS fixation than with the non-EAS fixation. However, the stiffness and displacement at the fracture site of the EAS fixation without CS were comparable to those of the non-EAS construct with CS. The EAS construct reduced the load on the nail and decreased the risk of implant failure. Both von Mises stress and stress distribution were significantly lower following fixation with the EAS constructs.</p><p><strong>Conclusions: </strong>This study introduces a novel EAS concept to enhance the anti-varus and anti-rotational capabilities of the humeral head and distribute stress at the bone-implant interface in treating elderly PHFs. This strategy shows promise based on our limited analysis.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"551-562"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731522","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}