Orthopaedic Surgery最新文献

{"title":"An Unnoticed Femoral Condyle Deformity in Transverse Plane Is Associated With Knee Valgus in Patients With Unilateral Developmental Dysplasia of the Hip.","authors":"Yijian Huang, Mingfeng Li, Cheng Wang, Fangxin Zhao, Jiafeng Yi, Wei Chai, Xiangpeng Kong","doi":"10.1111/os.70094","DOIUrl":"10.1111/os.70094","url":null,"abstract":"<p><strong>Objective: </strong>Patients with developmental dysplasia of the hip (DDH) are usually accompanied by knee valgus, and the previous studies mainly focused on the deformity of the knee in the coronal plane that led to knee valgus. In the transverse plane, the deformity of the femoral condyle had never been considered. This study aimed to analyze the transverse morphology of the femoral condyle in patients with unilateral DDH and explore the correlation between the morphology of the femoral condyle and lower limb alignment.</p><p><strong>Methods: </strong>Sixty-seven patients (10 male and 57 female) with unilateral DDH in our center between May 2019 and March 2024 were retrospectively analyzed. Then, the lengths of each part of the femoral condyle were collected from CT, and the ratios of anterolateral condyle to anteromedial condyle (ALC/AMC), posterolateral condyle to posteromedial condyle (PLC/PMC), lateral condyle to medial condyle (LC/MC), anterolateral condyle to posterolateral condyle (ALC/PLC) and anteromedial condyle to posteromedial condyle (AMC/PMC) were calculated. Then, the patients were grouped by Crowe classification to further analyze the morphology of the distal femur condyle. The mechanical axis deviation (MAD) of the lower limbs was evaluated. The Pearson correlation coefficient was used to explore the correlation between knee valgus and the morphology of the femur condyle.</p><p><strong>Result: </strong>Compared with the contralateral side, the ratio of ALC/PLC (p < 0.001) and the ratio of AMC/PMC (p = 0.031) in the ipsilateral side were significantly greater. Grouped by Crowe classification, the greater ratio of ALC/PLC (p < 0.001) in the ipsilateral side could be found in patients with Crowe III and IV DDH. The greater ratio of AMC/PMC (p = 0.003) was only found in patients with Crowe IV DDH. When the four Crowe type sides are compared with each other, the ratio of ALC/PLC in patients with Crowe III and IV DDH is greater than that of patients with Crowe I and II DDH (p = 0.005). The ratio of AMC/PMC in patients with Crowe IV DDH is greater than that of other Crowe type patients(p = 0.003). Besides, as the severity of DDH increases, the MAD increased, which was correlated with the ratio of the ALC/PLC (r = 0.609, p < 0.001) and the ratio of AMC/PMC (r = 0.229, p = 0.031).</p><p><strong>Conclusion: </strong>Patients with unilateral high-riding DDH could present with an increased ratio of anterolateral condyle and posterolateral condyle on the ipsilateral side, which may be associated with the occurrence of knee valgus. Level III, prognostic study.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2835-2843"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041012","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":"Comparison of Artificial Intelligence and Traditional Methods in Preoperative Planning for Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Di Xue, Kaiyong Wang, Huan He, Liru Wang, Yupei Dai, Guohang Shen, Yang Chen, Jia Chen, Yiqiang Yang, Zhirong Chen, Xiaoyuan Wang, Chen Zhang, Yajing Su, Xue Lin","doi":"10.1111/os.70156","DOIUrl":"10.1111/os.70156","url":null,"abstract":"<p><p>Although the application of artificial intelligence in orthopedics is becoming increasingly widespread, and initial progress has been made particularly in total hip arthroplasty (THA), its use in preoperative planning remains in the exploratory stage. Most existing studies are small-scale observational studies with inconsistent results, making it difficult to establish a unified clinical consensus. Therefore, our study aims to explore the latest research developments and potential unique advantages of artificial intelligence in preoperative planning for THA. We conducted a comprehensive literature search in PubMed, Embase, Web of Science, and the Cochrane Library, covering all publications up to April 23, 2025. To evaluate study quality, we applied the revised Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale (NOS) for non-randomized studies. For the statistical analysis, odds ratios (OR) were used to assess categorical variables, while mean differences (MD) were calculated for continuous outcomes. Depending on the level of heterogeneity, a random-effects model was adopted when substantial heterogeneity was detected (I² > 50%); otherwise, a fixed-effects model was applied. Through this process, a total of 518 studies were initially identified, of which 16 met the predefined inclusion criteria. The pooled analysis demonstrated that, in comparison to traditional methods, artificial intelligence achieved significantly superior outcomes in several key areas: acetabular-side matching accuracy (OR = 0.24), femoral-side matching accuracy (OR = 0.24), postoperative leg length discrepancy (MD = -1.02), operative time (MD = -12.18 min), intraoperative blood loss (MD = -50.82 mL), and postoperative Harris hip score (MD = 1.42). Notably, the overall methodological quality of the included studies was generally high. The final results of the study indicate that, compared to traditional preoperative planning, artificial intelligence in preoperative planning for THA can provide more precise surgical guidance, reduce surgical risks, and improve the overall success rate of the procedure. Trial Registration: PROSPERO registration number: CRD42024619714.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2823-2834"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963749","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":"Multivariate Analysis of Risk Factors for Atlantoaxial Osteoarthritis: A Retrospective Cohort Study on Ligament Ossification, Joint Degeneration, and Muscle Fatty Infiltration.","authors":"Shuqing Jin, Shuhao Zhang, Yuxiao Zhu, Yan Chen, Yiting Tu, Yurui Wu, Siyu Hu, Chen Xiang, Xiangyang Wang","doi":"10.1111/os.70125","DOIUrl":"10.1111/os.70125","url":null,"abstract":"<p><strong>Objective: </strong>Atlantoaxial osteoarthritis (AAOA) cause occipitocervical and retroauricular pain and cervical rotation disorder. Few studies have focused on the relationship between cervical spine structure and the prevalence of AAOA in China. This study aimed to investigate whether the inter-atlanto-occipital ligament ossification, uncovertebral joint degeneration and fat infiltration (FI) in the obliquus capitis inferior (OCI) muscles are associated with atlantoaxial arthritis, and to explore other potential risk factors in a clinical cohort from Eastern China.</p><p><strong>Methods: </strong>We analyzed CT images of the upper cervical spine from 1021 adult trauma patients scanned at our hospital between January 1, 2014, and July 1, 2024. Atlantoaxial osteoarthritis and uncovertebral joint degeneration were categorized as none-to-mild (no osteoarthritis) or moderate-to-severe (osteoarthritis present). Ossification of the inter-atlanto-occipital ligament was graded 0-3 based on its extent. Risk factors for atlantoaxial osteoarthritis were identified using univariate and multivariable logistic regression analyses. Among these patients, 381 underwent cervical MRI, and we assessed fat infiltration (FI) in the inferior oblique muscles, classifying it into quartiles: mild (8.51%-18.49%), moderate (18.67%-31.56%), and severe (31.88%-46.22%). Multivariate regression analysis was then performed to explore the relationship between FI severity and the incidence of AAOA.</p><p><strong>Results: </strong>The study group consisted of 59.4% men, with a mean age of 50.18 ± 17.23 years, and an AAOA prevalence of 11.6%. In the primary multivariable logistic regression analysis, the following factors were independently associated with AAOA: age ≥ 50 years (OR 30.48, p < 0.001), inter-atlanto-occipital ligament ossification (OR 1.59, p = 0.033), female sex (OR 2.54, p < 0.001), and uncovertebral joint degeneration in the lower cervical spine (OR 2.38, p < 0.001). In a separate multivariate logistic regression analysis that specifically included the degree of fatty infiltration in the inferior oblique muscles, it was found that greater fatty infiltration was also significantly associated with an increased risk of AAOA (OR 3.52, p < 0.001).</p><p><strong>Conclusions: </strong>Age over 50 years, inter-atlanto-occipital ligament ossification, female sex, and uncovertebral joint degeneration are significant factors associated with atlantoaxial osteoarthritis. Severe fatty infiltration of the inferior oblique muscles may also be a potential risk factor. Delayed diagnosis and treatment may be prevented by prioritizing these risk factors.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2851-2861"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963760","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":"Coalition Resection and Extra-Osseous Talotarsal Stabilization for Talocalcaneal Coalition With Pes Planus Deformity: A Retrospective Study.","authors":"Wenqi Gu, Xianchao Xu, Shaoling Fu, Guoxun Song, Zhongmin Shi, Hongtao Zhang","doi":"10.1111/os.70151","DOIUrl":"10.1111/os.70151","url":null,"abstract":"<p><strong>Objective: </strong>The treatment of talocalcaneal coalition (TCC) with pes planus deformity in adolescent patients still presents challenges. With the pes planus deformity untreated, the final clinical outcome would be compromised. Therefore, simultaneous correction of pes planus deformity seems to be of great importance. This study aimed to retrospectively evaluate the clinical efficacy of coalition resection combined with extra-osseous talotarsal stabilization (EOTTS) treatment for adolescent TCC with pes planus deformity.</p><p><strong>Methods: </strong>Data was reviewed for patients of TCC and pes planus deformity treated by coalition resection and EOTTS from January 2018 to January 2024. Meary's angle and talar-1st metatarsal angle (T1MA) were measured to assess the alignment improvement (paired sample t-test). Visual analog scale (VAS) for pain (Wilcoxon signed rank test) and American Orthopedic Foot & Ankle Society ankle-hindfoot score (AOFAS-AHS) (paired sample t-test) were evaluated for the overall clinical outcomes. Time to return to sports activity and complications were also recorded.</p><p><strong>Results: </strong>No early wound or soft tissue complications occurred. At 1-year follow-up, Meary's angle and T1MA improved from 13.4° ± 5.2° to 5.1° ± 3.4°, and from 14.7° ± 3.7° to 6.4° ± 2.5°, respectively. The median VAS score decreased from 5 to 0, while the AOFAS-AHS increased from 51.1 ± 8.9 to 90.1 ± 9.3 (all p < 0.05). Fifteen patients returned to sports at a median of 3 months (range: 2-4 months). One patient experienced sinus tarsi pain, which was resolved after implant removal at 14th month postoperatively.</p><p><strong>Conclusion: </strong>Simultaneous coalition resection and EOTTS for adolescent TCC with pes planus deformity achieves satisfactory clinical outcomes with minimal complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2879-2886"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963840","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":"Superior Primary Stability of a Knotless Double-Row Construct Compared to Mason-Allen Repair for Anatomical Refixation of Gluteal Tendons-Biomechanical Human Cadaver Study.","authors":"Vanessa Twardy, Daniela Warnecke, Peter M Prodinger, Norbert Harrasser, Christian Scheele, Rüdiger von Eisenhart-Rothe, Martina Roth, Ingo J Banke","doi":"10.1111/os.70153","DOIUrl":"10.1111/os.70153","url":null,"abstract":"<p><strong>Objectives: </strong>Hip abductor tendon tears remain an underrecognized diagnosis, initially classified under Greater Trochanteric Pain Syndrome. This often results in ineffective conservative treatment, providing only temporary pain relief. While certain surgical approaches, particularly knotless double-row repair techniques (Hip Bridge) have shown promising clinical outcomes, comprehensive biomechanical data remain insufficient. Therefore, this study aimed to biomechanically compare Hip Bridge (HB) repair with the standard Mason-Allen (MA) technique using a human cadaver model.</p><p><strong>Methods: </strong>Gluteus minimus and medius were released in 12 fresh-frozen human cadaveric specimens and reattached to their anatomical footprints either with transosseous MA or knotless double-row HB technique. HB consisted of two proximal PEEK (polyetheretherketone) anchors, each preloaded with double-V shaped tapes, crossed, and distally fixated with two additional anchors. Femurs were fixated in a custom-made sample holder while gluteal muscles were clamped using a cryo-jaw. The construct underwent a cyclic loading test between 10 and 125 N for 150 cycles at 2.5 Hz (preload 10 N), followed by a pull-to-failure test. Failure mode and elongation were determined, the latter by a 3D optical measurement system. Statistical analysis was performed using t-test.</p><p><strong>Results: </strong>HB repair resulted in significantly higher ultimate failure loads (339.1 ± 144.4 N) compared to the MA technique (209.6 ± 62.1 N, p = 0.0381). HB failed exclusively due to tendon failure, whereas MA exhibited different failure modes: tendon failure (1/6), bone cutting (4/6), and muscle rupture (1/6). During cyclic loading, the calculated final plastic elongation was 4.4 ± 0.5 mm for MA and 3.4 ± 1.4 mm for HB (p = 0.0731). During pull-to-failure testing, stiffness of 59.7 ± 12.5 N/mm (MA) and 66.8 ± 18.4 N/mm (HB) was observed (p = 0.247).</p><p><strong>Conclusion: </strong>The HipBridge technique provides superior biomechanical stability compared to the standard Mason-Allen repair, showing significantly higher ultimate failure load and reduced failure variability. This advantage may be attributed to greater contact restoration of the anatomical footprint, which is particularly beneficial for treating weakened tendons and bones in elderly patients.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2973-2981"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144848229","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":"Targeting Ferroptosis With Ginsenoside Rg3 Alleviates Intervertebral Disc Degeneration.","authors":"Weiran Xu, Fei Geng, Kaihui Zhang, Yinhuan Wang","doi":"10.1111/os.70150","DOIUrl":"10.1111/os.70150","url":null,"abstract":"<p><strong>Objective: </strong>Intervertebral disc degeneration (IVDD) has been closely associated with ferroptosis in nucleus pulposus cells (NPCs), the underlying regulatory mechanisms and therapeutic strategies remain poorly defined. This study aims to delineate how ginsenoside Rg3 mitigates IVDD progression through ferroptosis suppression, providing a basis for clinical translation.</p><p><strong>Method: </strong>An erastin-induced nucleus pulposus cell ferroptosis model was established. Suitable Erastin concentrations (0-20 μM) were screened via CCK-8, qRT-PCR, and Western blotting based on viability, extracellular matrix (COL2A1/ACAN/ADAMTS5/MMP3) and ferroptosis markers (GPX4/FTH-1/ACSL4), followed by determination of optimal Rg3 concentrations (0-150 μM) using identical methods. Key targets of Rg3 were predicted through network pharmacology and verified by qRT-PCR and Western blotting. After establishing a rat tail puncture-induced IVDD model, local injection of Rg3 was administered. Therapeutic efficacy was evaluated by MRI assessment of nucleus pulposus status and disc height, alongside histological and immunohistochemical analyses of Rg3's role in delaying disc degeneration.</p><p><strong>Result: </strong>5 μM Erastin effectively induced ferroptosis in nucleus pulposus cells, reducing cell viability, suppressing expression of extracellular matrix anabolic proteins (COL2A1, ACAN), while promoting catabolic factors (MMP3, ADAMTS5) and downregulating ferroptosis inhibitors (GPX4, FTH-1). These alterations were significantly reversed by 100 μM Rg3. Integrated network pharmacology and molecular biological validation identified PRKAA2 as the key target mediating Rg3's anti-degenerative effects. In vivo rat experiments demonstrated that Rg3 treatment preserved disc height and attenuated disc degeneration, with histological and immunohistochemical analyses further confirming its therapeutic efficacy and PRKAA2-targeted regulation.</p><p><strong>Conclusion: </strong>This study elucidates the therapeutic mechanism of Rg3 in delaying IVDD progression via PRKAA2-mediated ferroptosis inhibition, providing substantial experimental evidence for its clinical translation as a potential disease-modifying agent.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2960-2972"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963822","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":"Research Trends in Immunomodulatory Therapy for Postmenopausal Osteoporosis: A Bibliometric Analysis.","authors":"Shenghui Yi, Janguo Liu, Huiming Chen, Zhijian Deng, Yongxia Zhang, Yang Luo, Yuehua Li, Wen Tang","doi":"10.1111/os.70145","DOIUrl":"10.1111/os.70145","url":null,"abstract":"<p><p>This bibliometric analysis investigates the research trends in immunomodulatory therapies for postmenopausal osteoporosis from 2000 to 2024. Utilizing 950 articles retrieved from the Web of Science Core Collection, we employed CiteSpace, VOSviewer, and R-based Bibliometrix to analyze publication dynamics, collaborative networks, and thematic evolution. Key findings include: (1) a steady rise in annual publications, peaking at 82 articles in 2024, with China (265 articles) and the United States (173 articles) as leading contributors. (2) Research hotspots centered on the RANKL/RANK/OPG pathway, T-cell-mediated inflammation (e.g., Th17/IL-17 axis), and emerging topics such as gut microbiota-bone axis and mesenchymal stem cell differentiation. (3) Clinical strategies prioritized denosumab (anti-RANKL) and IL-17 inhibitors, though long-term safety requires validation. (4) Institutional collaboration spanned continents, with Emory University, Harvard University, and Sichuan University as pivotal hubs. Keyword bursts revealed a shift from foundational mechanisms (e.g., TNF-α/IL-6 signaling) to translational topics like gene editing and precision medicine. Limitations include database bias (exclusive reliance on Web of Science) and undifferentiated clinical versus preclinical studies analysis. This study underscores the transformative potential of immunotherapies in osteoporosis management while advocating for multidisciplinary integration, expanded data sources, and rigorous clinical validation to address existing gaps.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2809-2822"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835978","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":"Equilibrium Mechanics in Fracture Reduction of Tibial Plateau.","authors":"Kaixuan Zhang, Xinrui Zhu, Wei Chen, Jing Na, Ningning Miao, Yuan Gao, Zhongzheng Wang, Yanbin Zhu, Shuang Yang, Yingze Zhang","doi":"10.1111/os.70133","DOIUrl":"10.1111/os.70133","url":null,"abstract":"<p><strong>Background: </strong>Tibial plateau fracture is one of the common fractures in the lower limb, mostly caused by high-energy injuries, which may be accompanied by different degrees of compression and displacement of the joint surface, affecting the knee joint alignment, stability, and sports function, and improper treatment may cause various complications, which are a more difficult problem in the clinic. The objective of this study was to investigate the biomechanical mechanisms underlying effective closed reduction in the treatment of tibial plateau fractures, particularly focusing on the performance of the homeopathic double reverse traction repositor compared to traditional traction table methods.</p><p><strong>Methods: </strong>We developed a biomechanical model to analyze the equilibrium mechanics during tibial plateau fracture reduction. A quantitative analysis was performed to evaluate the mechanical forces involved in both the traditional traction table method and the double reverse traction repositor.</p><p><strong>Results: </strong>Our analysis revealed that the use of a traction table generates an additional bending moment at the tibial plateau, resulting in medial over-distraction and lateral compression. This mechanical imbalance can obstruct fracture reduction and irritate surrounding soft tissues. In contrast, the double reverse traction repositor avoids these adverse forces, reducing soft tissue irritation and improving reduction efficiency by utilizing equilibrium mechanics.</p><p><strong>Conclusion: </strong>The double reverse traction repositor offers a biomechanical advantage in the reduction of tibial plateau fractures by creating a more balanced mechanical environment. This study enhances the understanding of fracture reduction mechanics and supports the repositor's use not only for tibial plateau fractures but also for other fracture types, such as intertrochanteric, extremity long bone, and comminuted fractures.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2935-2942"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874337","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":"Trans-Ulnar Single Incision Fasciotomy for Decompression of Forearm Compartment Syndrome: A Cadaveric Study.","authors":"Summer M Drees, Cade R McGarvey, Noah Miller, Sahil Kapur, Anderson Lee, Martin Skie, Ahmed Suparno Bahar Moni","doi":"10.1111/os.70157","DOIUrl":"10.1111/os.70157","url":null,"abstract":"<p><strong>Objectives: </strong>Acute compartment syndrome (ACS) is a medical emergency that requires timely intervention, and delays in treatment can lead to severe complications such as nerve injury, muscle necrosis, amputation, and even death. Definitive treatment of ACS requires a fasciotomy. Currently, there is no consensus on the best approach for a forearm fasciotomy; compartment release is most commonly done through volar or combined volar and dorsal incisions. A trans-ulnar single incision approach has been demonstrated to be effective in a case report. This study investigates if a trans-ulnar single incision decompresses both deep volar and dorsal forearm compartments to less than 30 mmHg in a cadaveric model of ACS.</p><p><strong>Methods: </strong>Ten fresh, frozen cadaveric upper extremities were injected with egg whites and compartment pressures were measured to determine successful simulation of ACS. A single trans-ulnar incision was made between the Flexor Carpi Ulnaris (FCU) and Extensor Carpi Ulnaris (ECU), extending from 4 to 5 cm (2″) proximal to the ulnar styloid to 6 to 8 cm (3″) distal to the olecranon. After blunt dissection to release the compartments, pressures were measured to confirm decompression.</p><p><strong>Results: </strong>ACS was successfully simulated in all upper extremities to above 30 mmHg. The mean volume of saline injected to simulate local anesthetic was 38.0 ± 4.2 mL. The mean operative time was 10.1 min. The mean compartment readings 1-min post-fasciotomy were 7.1 ± 3.0 mmHg for the deep volar compartment and 9.4 ± 5.6 mmHg for the dorsal compartment. All fasciotomies reduced deep volar and dorsal compartment pressures below the clinical threshold of 30 mmHg, with significant differences between pre- and post-fasciotomy pressures.</p><p><strong>Conclusions: </strong>All 10 fasciotomies successfully reduced deep volar and dorsal compartment pressures to below the clinical threshold of 30 mmHg, demonstrating the success of the trans-ulnar single incision fasciotomy to decompress compartment syndrome in cadaveric forearms.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2982-2991"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874338","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":"Comparison of the Clinical Efficacy of the Anterolateral and Regular Approaches for Hip Joint Puncture: A Randomized Cross-Over Trial.","authors":"Jiamu Liu, Jingjie Huang, Yiling Tan, Chunmei Liu, Jing Li, Wen Sui, Xing Hua, Tiao Su, Guangxing Chen","doi":"10.1111/os.70155","DOIUrl":"10.1111/os.70155","url":null,"abstract":"<p><strong>Objective: </strong>Given the limitations of conventional anterior and lateral approaches, such as variable success rates and risks of neurovascular injury, there is a critical need to evaluate alternative techniques that enhance procedural safety and efficiency. This study aimed to investigate the safety and precision of the anterolateral approach for hip joint puncture and compare its clinical efficacy with those of the anterior and lateral approaches.</p><p><strong>Methods: </strong>A single-center, prospective, randomized Williams crossover trial was conducted from March 2023 to June 2023 involving 30 patients with hip pain. Each patient underwent three hip joint punctures within 3 weeks, all conducted using anatomical landmark-guided blind puncture. The punctures were administered in different sequences of anterior, anterolateral, and lateral approaches, with one-week intervals between punctures. Thirty patients were randomly assigned to six groups (n = 5), following different sequences of the three approaches. The primary outcomes were the success rate and accuracy, and the secondary outcomes were post-puncture pain assessed using the Visual Analogue Scale (VAS), procedure time, puncture depth, and complications.</p><p><strong>Results: </strong>The anterolateral approach achieved a higher success rate (96.7%) compared to the anterior (86.7%) and lateral (83.3%) approaches; although statistical significance was not reached (p = 0.328). Besides, it significantly shortened procedure duration (72.87 s, SD 9.66) compared to anterior (87.20 s, SD 20.57) and lateral (92.80 s, SD 39.02) approaches (p = 0.006). The puncture path length was shorter with the anterolateral approach (57.77 mm, SD 1.295) than with the lateral approach (63.33 mm, SD 1.295) (p = 0.004). The anterolateral approach achieved lower VAS pain scores (1.77, SD 0.94) compared to the lateral approach (2.90, SD 2.17). During the anterior approach injection, one patient experienced numbness in the lateral thigh of the surgical side.</p><p><strong>Conclusion: </strong>This preliminary randomized crossover trial demonstrates that the anterolateral approach offers significant advantages in procedural efficiency (reduced time, shorter path length) and suggests a trend toward higher success rates compared to standard anterior and lateral approaches for hip joint puncture. These findings, particularly the improvements in efficiency and patient comfort (lower VAS), support the anterolateral approach as an effective technique.</p><p><strong>Level of evidence: </strong>I, Randomized controlled trial.</p><p><strong>Trial registration: </strong>chictr.org.cn: ChiCTR2300074174.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2903-2913"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12497558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963809","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}