Orthopaedic Surgery最新文献

{"title":"Modified Yoong Ultrasound-Guided Rotator Interval Injection for Adhesive Capsulitis: A 2-Year Follow-Up.","authors":"Azwan Aziz Mohamad, Norlelawati Mohamad, Muhammad Karbela Reza Ramlan, Nik Kamarul Arif, Badrul Akmal Hisham Md Yusoff","doi":"10.1111/os.70405","DOIUrl":"10.1111/os.70405","url":null,"abstract":"<p><strong>Objective: </strong>Adhesive capsulitis (AC) is characterized by progressive fibrosis of the glenohumeral capsule, with the rotator interval (RI) as a key pathological site. Ultrasound-guided hydrodilation of the RI (Yoong technique) is an established intervention, but traversal of a thickened coracohumeral ligament (CHL) can be technically challenging and painful. This study reports preliminary 2-year outcomes of a modified technique targeting the subacromial-subdeltoid (SASD) bursa at the RI, combined with immediate postinjection manipulation.</p><p><strong>Methods: </strong>A retrospective case series was conducted on 13 patients with AC in the frozen phase treated between January 2023 and September 2023 at a single sports medicine clinic. The modified technique involved ultrasound-guided SASD bursa injection (20 mL mixture: 4 mL 1% lidocaine, 15 mL 5% dextrose, 1 mL triamcinolone acetonide 40 mg) with mechanical fenestration of the CHL, followed by immediate shoulder manipulation. Outcomes included forward flexion, abduction, external rotation, Visual Analog Scale (VAS), and Quick DASH scores measured at baseline, 2, 12, 24, 52, and 104 weeks.</p><p><strong>Results: </strong>Mean age was 51.9 years (SD 7.52); 92.3% were female; 53.8% had diabetes. Significant improvements were observed across all outcomes (p < 0.001). Forward flexion improved from 76.6° (SD 6.3°) at baseline to 178.6° (SD 3.7°) at 104 weeks; abduction from 60.6° (SD 6.3°) to 178.8° (SD 2.7°); external rotation from 31.3° (SD 9.1°) to 78.0° (SD 3.6°). VAS decreased from 5.6 (SD 0.9) to 0 at 52 and 104 weeks. Quick DASH improved from 86.7 (SD 5.8) to 0.2 (SD 0.7) at 104 weeks. No complications were reported.</p><p><strong>Conclusion: </strong>This modified SASD-targeted injection technique, combined with immediate manipulation, was associated with sustained pain relief and functional improvement over 2 years in a small cohort of AC patients.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2217-2223"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674264","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":"Orthopedic Mechanophenotype: A Structured Narrative Review of Multiscale Biomechanics, Mechanotransduction, and Clinical Decision-Making.","authors":"Zihao Lan, Zhipeng Mu, Hongjian Li","doi":"10.1111/os.70421","DOIUrl":"10.1111/os.70421","url":null,"abstract":"<p><p>Orthopedic disorders are still classified mainly by anatomy or end-stage morphology, yet osteoporosis, osteoarthritis, fracture nonunion, spinal degeneration, and bone-implant interface failure share a common mechanobiological logic: external load is filtered by hierarchical tissue architecture, converted into cell-scale signals, and integrated with inflammation, metabolism, and repair capacity to determine whether adaptation or failure occurs. This structured narrative review synthesizes recent evidence on multiscale biomechanics, finite element analysis (FEA), mechanotransduction biology, tissue engineering, and emerging digital-twin approaches. Rather than introducing a separate disease entity, we define the orthopedic mechanophenotype as a clinically oriented integrative framework that describes the disease-relevant state generated by three interacting axes: load exposure, tissue susceptibility, and biological adaptability. We summarize how this three-axis state differs across bone, articular cartilage and the osteochondral unit, the intervertebral disc, fracture repair, and bone-implant interfaces. Particular emphasis is placed on evidence hierarchy, model assumptions, and persistent uncertainties, including timescale mismatch, idealized boundary conditions, incomplete cross-scale validation, and overinterpretation of cell-level causality from organ-level surrogates. We further illustrate how mechanophenotyping can be integrated with existing clinical pathways for osteoarthritis load redistribution, fracture fixation and rehabilitation, and spinal or implant-related planning. The central argument is that future progress will depend less on accumulating isolated mechanical variables and more on validated cross-scale markers that connect real-world loading, patient-specific structure, and stage-dependent biology to actionable orthopedic decisions.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2045-2059"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945392","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":"Optimizing Dual-Plate Fixation of Distal Femoral Periprosthetic Fractures Using a Distal Tibial Metaphyseal Plate.","authors":"Che Lin, Yueh-Ying Hsieh","doi":"10.1111/os.70420","DOIUrl":"10.1111/os.70420","url":null,"abstract":"<p><strong>Introduction: </strong>Distal femoral periprosthetic fractures following total knee arthroplasty (TKA) are complex and technically demanding injuries in orthopedic trauma surgery. With the increasing prevalence of TKA in an aging population, the incidence of these fractures has risen steadily. This study aims to share our experience of implant selection and surgical strategy, which provides an alternative and out-of-the-box thinking process for fracture fixation.</p><p><strong>Methods: </strong>Between 2022 and 2024, 10 consecutive patients with distal femoral periprosthetic fractures involving a well-fixed femoral component were treated using a dual-plate construct incorporating a distal tibial metaphyseal locking plate for medial augmentation and distal femoral plate. Clinical, radiographic, and functional outcomes were retrospectively collected and analyzed.</p><p><strong>Results: </strong>All patients were followed for a minimum of 12 months. Radiographic callus formation was observed at approximately 2 months postoperatively, and fracture union was achieved at a mean of 4 months. No cases of fixation failure, nonunion, or deep infection were observed during the follow-up period. Favorable functional outcomes were also noted at final follow-up.</p><p><strong>Conclusion: </strong>The use of a dual-plating construct that may provide enhanced mechanical stability was well established, allowing early mobilization and progression to weight-bearing. The distal tibial metaphyseal plate, which even though was not designed original for treating such kind of fracture, demonstrated good anatomical conformity to the medial distal femur and may serve as a practical option for medial augmentation. Orthopedic surgeons should not be constrained by the designation of a plate as an \"anatomical plate\"; rather, they should make judicious use of the implants available and apply them in the manner most appropriate for the specific fracture pattern. Using distal tibial metaphyseal plate as medial augmentation in dual-plate fixation appears to be a feasible and promising strategy for managing distal femoral periprosthetic fractures following TKA.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2238-2246"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866041","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":"Efficacy of a Disposable Skin-Stretch Closure Device Combined With Vacuum Sealing Drainage in the Treatment of Refractory Skin and Soft Tissue Defects: A Single-Arm Prospective Study.","authors":"Hao Guo, Zhengguo Zhu, Jinchang Wang, Zhonghe Wang, Yilin Wang, Jun Zhang, Wei Zhang, Guangping Liu, Zhiguang Chen, Shuangcheng Li, Xingxing Hu, Meijing Dou, Junjun Tang, Peifu Tang, Hua Chen","doi":"10.1111/os.70423","DOIUrl":"10.1111/os.70423","url":null,"abstract":"<p><strong>Objectives: </strong>The treatment of refractory skin and soft tissue defects (RSSTDs) has long posed a global challenge for surgeons. Traditional closure methods, such as skin grafting and flap repair, are often associated with significant trauma and a steep learning curve. Skin stretching, which enables the generation of \"extra skin,\" has emerged as a promising alternative. This study aims to evaluate the efficacy of a disposable skin-stretch closure (DSSC) device combined with vacuum sealing drainage (VSD) in the treatment of RSSTDs.</p><p><strong>Methods: </strong>A prospective single-arm clinical study was conducted to analyze the clinical data of 43 patients with RSSTDs who were treated with the DSSC device for wound repair at our hospital between July 2022 and December 2024. Among these patients, 30 were male and 13 were female, with ages ranging from 14 to 71 years (mean: 41.86 ± 16.02 years). The wound areas ranged from 4 to 90 cm² (mean: 18.56 ± 18.04 cm²). Wound conditions (including closure and healing) and the presence of complications were recorded. Wound closure was defined as the approximation of wound edges by manually compressing the bilateral skin to achieve tension-free or minimal-tension coaptation, allowing direct suturing. Closure time and closure rate (wound area/closure time) were recorded. Wound healing was defined as 100% re-epithelialization of the wound surface, confirmed during two consecutive follow-up assessments spaced 2 weeks apart, with no exudate, drainage, or dressing requirements. Healing time and healing grade (classified as Grade A, B, or C according to wound healing classification standards) were recorded.</p><p><strong>Results: </strong>All 43 patients were followed up, and all wounds achieved primary healing. No complications, including wound edge damage, necrosis, infection, dehiscence, or edema, were reported. Patients did not report pain or discomfort, and no significant scar formation was observed during the follow-up. The wound closure time ranged from 5 to 17 days (mean: 9.07 ± 2.93 days), which was comparable to the 7.8 ± 3.8 days reported in the literature. The wound closure rate ranged from 0.35 to 7.44 cm²/day (mean: 1.99 ± 1.63 cm²/day). The wound healing time ranged from 17 to 29 days (mean: 22.74 ± 2.80 days). The Visual Analog Scalescores ranged from 1 to 3 (mean: 2.02 ± 0.64), significantly lower than the 7.0 ± 1.0 reported in the literature. One patient experienced complete wound healing within 17 days without the need for suturing.</p><p><strong>Conclusion: </strong>The DSSC device was effective in treating RSSTDs, with short wound closure times, minimal complications, and a simple procedure.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2167-2175"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875580","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":"Kinematic Alignment in TKA Using the Contralateral Healthy Knee as Reference: A Combined Finite Element and Clinical Analysis.","authors":"Lingce Kong, Wei Lin, Huijun Kang, Muchen Yu, Ming Li, Chenyue Xu, Fei Wang","doi":"10.1111/os.70417","DOIUrl":"10.1111/os.70417","url":null,"abstract":"<p><strong>Objective: </strong>Mechanical alignment (MA) and kinematic alignment (KA) are common total knee arthroplasty (TKA) strategies. Patients with bilateral knee osteoarthritis lack a precise individualized alignment reference, whereas those with unilateral OA have a potential reference from the contralateral healthy knee. This study proposes a natural KA (NKA) strategy referencing the contralateral healthy knee and compares biomechanical and clinical outcomes of MA, KA, and NKA for TKA.</p><p><strong>Methods: </strong>Finite element models (neutral/mild/moderate varus) were established based on three selected patients with unilateral knee OA using bilateral CT data to simulate MA/KA/NKA implantation. This exploratory biomechanical analysis was designed to identify potential patterns. Stress distribution on the femoral component, polyethylene insert, and tibia, along with contact pressure, contact area, and implant displacement, was analyzed. Additionally, a retrospective clinical study included 101 patients who underwent TKA with a minimum 1-year follow-up. Patients were divided into MA, KA, and NKA groups based on postoperative radiographic alignment. Postoperative alignment parameters, range of motion (ROM), Knee Society Score (KSS), and Forgotten Joint Score (FJS) were compared.</p><p><strong>Results: </strong>Finite element analysis revealed that in the neutral and mild varus models, NKA resulted in a more balanced mediolateral biomechanical distribution, lower implant stress, and minimal component subsidence. In the moderate varus model, MA showed the most balanced mediolateral load distribution and the largest contact area. Clinical follow-up indicated that the MA group achieved lower limb alignment close to mechanical neutrality postoperatively, while the KA and NKA groups retained some physiological varus. No significant differences were observed in KSS among the three groups. However, FJS showed a statistically favorable trend in the KA and NKA groups compared with the MA group, although the clinical significance of this difference requires further investigation.</p><p><strong>Conclusion: </strong>The NKA strategy shows potential biomechanical advantages by optimizing stress distribution in selected neutral/mild varus models and is associated with better short-term patient-reported satisfaction than MA. NKA provides a feasible coronal alignment concept for precision TKA in patients with unilateral knee osteoarthritis without significant contralateral deformity. Long-term safety and generalizability require further validation.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2205-2216"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912782","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":"Distal Femoral Interlocking Screw Length Can be Estimated Using \"Anatomic Zones\" During Femoral Intramedullary Nailing.","authors":"Douglas Zhang, Hayden P Baker, Mary Kate Erdman, Anthony V Christiano, Jason Strelzow","doi":"10.1111/os.70401","DOIUrl":"10.1111/os.70401","url":null,"abstract":"<p><strong>Objective: </strong>Depth-gauge measurements can be time-consuming and prone to technical error. The aim of this study is to evaluate whether \"anatomic zones\" along the distal femur can be used to help estimate distal interlocking screw length during femoral intramedullary nailing.</p><p><strong>Methods: </strong>A retrospective \"anatomical control\" cohort was used to establish anatomic zones along the length of the distal femur and estimated screw length within each zone. Estimated screw lengths for each zone were based on mean cortex-to-cortex length at each zone as measured on computed tomography (CT). A validation cohort was prospectively enrolled to evaluate agreement between these estimated screw lengths and depth-gauge measurements for each zone. Agreement was evaluated using mean differences between estimated screw lengths and depth-gauge measurements, an intraclass correlation coefficient (ICC), and Bland-Altman analysis.</p><p><strong>Results: </strong>The retrospective cohort of 56 patients was used to establish eight anatomic zones. Screw length estimates derived from CT-based measurements ranged between 42.1 mm in the most proximal zone to 80.2 mm in the most distal zone. The validation cohort included 74 patients (126 screws), was 63.51% male (n = 47), with mean age 44.2 ± 24.7 years, mean height 173.2 ± 12.7 cm, and mean BMI 28.5 ± 10 kg/m². The mean absolute value difference between zone-estimated screw lengths and depth-gauge measurements was 3.9 mm ±2.9 mm, ranging 2.7 mm-5.6 mm depending on zone. The ICC was 0.94 (95% CI [0.91, 0.96], p < 0.01). Bland-Altman analysis revealed a bias of -0.86 mm with limits of agreement at +8.6 mm and -10.3 mm.</p><p><strong>Conclusion: </strong>Anatomic zone-based screw length estimates derived from CT data show strong agreement with depth-gauge measurements and are a potential adjunctive strategy to reduce operative time and errors in screw length selection without the need for additional equipment or technology.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2176-2182"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795703","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":"Headless Compression Screw Fixation Alone for Lunate Coronal Fractures in Kienböck Disease.","authors":"Jiangchao Zhang, Binzhi Zhao, Deshui Yu, Liping Xu, Ge Xiong","doi":"10.1111/os.70410","DOIUrl":"10.1111/os.70410","url":null,"abstract":"<p><strong>Objective: </strong>Lunate coronal fractures in Kienböck disease remain challenging to manage, and various reconstructive approaches have been described. The purpose of this study was to evaluate the outcomes of headless compression screw fixation alone in management of the lunate coronal fractures in Kienböck disease.</p><p><strong>Methods: </strong>Twelve patients (seven females and five males; mean age 36.9 years) with lunate coronal fractures who underwent headless compression screw fixation between 2017 and 2025 were included in this retrospective study. Clinical and radiographic assessments were performed preoperatively and at final follow-up. The clinical evaluations included visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Modified Mayo Wrist (MMW) score, active range of motion, and grip strength. Radiographic parameters included the radioscaphoid angle, Ståhl index, and Nattrass index. Comparisons between preoperative and final follow-up continuous variables were performed using the paired t-tests or Wilcoxon signed-rank tests, as appropriate.</p><p><strong>Results: </strong>The median clinical follow-up was 56.8 months (range: 12-101 months). Radiographic follow-up was available in 11 patients, and the median imaging follow-up was 50.9 months (range: 12-99 months). One patient declined further imaging examinations due to complete symptom resolution. Among patients with available imaging, all coronal fractures achieved union. The average time to bone union was 7.6 ± 1.2 months. Significant improvements in wrist pain, QuickDASH score, MMW score, range of motion, and grip strength were observed after surgery. However, changes in radioscaphoid angle, Ståhl index, and Nattrass index showed no significant difference at final follow-up.</p><p><strong>Conclusion: </strong>Headless compression screw fixation alone appears to be a reasonable treatment option for lunate coronal fractures in Kienböck disease in the absence of radiocarpal or midcarpal arthritis and without substantial lunate comminution.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2224-2229"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795714","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":"Time to Clinical Dryness and Wound Outcomes After Drainless DAA Total Hip Arthroplasty With Standardized Multilayer Symmetric PDS Plus Closure: Bikini Versus Longitudinal Incisions.","authors":"Tianchen Zhang, Xinyi Hou, Shanbin Zheng, Yuyang Zhai, Chao Zhang, Jiaqing Zhu, Yiguo Li, Tian Xiao, Yukun Li, Tianwei Xia, Xin Liu, Jirong Shen","doi":"10.1111/os.70414","DOIUrl":"10.1111/os.70414","url":null,"abstract":"<p><strong>Objective: </strong>In direct anterior approach total hip arthroplasty (DAA-THA), the inguinal incision is prone to superficial wound problems. This study evaluated the feasibility and short-term wound outcomes of standardized drainless multilayer closure using Symmetric PDS Plus for fascial and subcutaneous closure. Secondary aims were to compare longitudinal and bikini incisions and assess time to clinical dryness as a monitoring metric.</p><p><strong>Methods: </strong>This retrospective cohort included 168 primary unilateral DAA-THA patients treated between January 2023 and July 2025. All received continuous fascial and subcutaneous closure with Symmetric PDS Plus without routine drainage, including 115 longitudinal and 53 bikini incisions. Outcomes included wound complications within 3 months, Clavien-Dindo classification, deep closure time, time to clinical dryness, postoperative pain, Patient and Observer Scar Assessment Scale scores, Harris Hip Scores, and exploratory logistic regression for factors associated with wound complications. Propensity score overlap weighting was used as a sensitivity analysis.</p><p><strong>Results: </strong>Mean deep closure time was 12.2 ± 2.0 min. The bikini group had a statistically longer closure time than the longitudinal group (13.0 ± 1.6 vs. 11.8 ± 2.1 min, p < 0.001), but the absolute difference was small. Wound complications occurred in 17 patients (10.1%), mostly Clavien-Dindo grades I and II; three cases (1.8%) were grade IIIa. No deep infection, periprosthetic joint infection, or fascial dehiscence occurred. Complication rates were similar between incision groups (9.6% vs. 11.3%, p > 0.05). Mean time to clinical dryness was 1.7 ± 2.2 days and was longer in patients with delayed healing or complications than in those without complications (7.1 ± 3.7 days vs. 1.1 ± 0.2 days, p < 0.001). Pain scores and three-month Harris Hip Scores were comparable. Observer scar scores were similar, whereas the bikini group reported higher satisfaction with scar appearance and concealment. In exploratory multivariable analysis, rheumatic disease and diabetes were associated with increased odds of wound complications. Overlap weighting achieved covariate balance without materially altering the between-group results.</p><p><strong>Conclusions: </strong>This retrospective cohort suggests that standardized drainless multilayer Symmetric PDS Plus closure is feasible for DAA-THA wound management and was associated with early clinical dryness and mostly minor wound events. Because no conventional closure control group was included, superiority over other closure techniques cannot be inferred. Time to clinical dryness may serve as a simple monitoring marker, but its independent predictive value requires prospective validation. In patients with wound-healing risks, incision selection should prioritize wound safety over cosmetic preference.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2153-2166"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912902","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":"Mini-Open Versus Open Transforaminal Lumbar Interbody Fusion in Patients Aged ≥ 75 Years: Perioperative Surgical Burden and Clinical Outcomes.","authors":"Zhendong Huang, Kelv Shen, Fengxian Jiang, Fengyu Ma, Xiang Wang, Hui Wang, Zhengfeng Lu","doi":"10.1111/os.70398","DOIUrl":"10.1111/os.70398","url":null,"abstract":"<p><strong>Purpose: </strong>Patients aged ≥ 75 years are at increased risk of perioperative stress and delayed early recovery after lumbar fusion, making the choice of surgical approach clinically relevant. However, direct comparative data on mini-open transforaminal lumbar interbody fusion (MO-TLIF) and conventional open TLIF in this population remain limited. This study compared perioperative surgical burden, postoperative pain and functional recovery trajectories, and 12-month radiographic fusion and satisfaction between MO-TLIF and conventional open TLIF in patients aged ≥ 75 years.</p><p><strong>Methods: </strong>This prospective cohort study included 172 patients aged ≥ 75 years with degenerative lumbar disease who underwent MO-TLIF (n = 84) or open TLIF (n = 88). Eligible patients considered suitable for both procedures were alternately assigned to the MO-TLIF or open TLIF group according to the order of enrollment. Perioperative variables included operative time, blood loss, time to first ambulation, length of stay, and complications. Laboratory markers on postoperative day (POD) 3 were assessed to reflect muscle injury and inflammatory response. Patient-reported outcomes were assessed preoperatively and at POD 5, 1 month, 3 months, and 6 months using VAS (leg and back pain), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI). Radiographic fusion at 12 months was graded using the Bridwell classification, and satisfaction at 12 months was evaluated with the modified MacNab criteria.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. Compared with open TLIF, MO-TLIF was associated with shorter operative time (106.49 ± 21.69 vs. 129.40 ± 26.13 min; p < 0.001), less blood loss (104.00 ± 21.97 vs. 149.97 ± 37.12 mL; p < 0.001), earlier ambulation (2.18 ± 0.39 vs. 2.82 ± 0.56 days; p < 0.001), and shorter length of stay (9.27 ± 1.88 vs. 11.40 ± 2.31 days; p < 0.001). On POD 3, CK was lower after MO-TLIF (274.83 ± 119.09 vs. 363.50 ± 104.72 U/L; p < 0.001), while CRP and white blood cell count were similar (p > 0.05). PROMs improved over time in both groups; MO-TLIF showed faster early recovery, with significantly better pain and functional scores at POD 5 or 1 month (all p < 0.05), whereas between-group differences were not significant at 3 and 6 months (p > 0.05). At 12 months, Bridwell fusion grades and modified MacNab satisfaction were comparable between groups (p > 0.05).</p><p><strong>Conclusions: </strong>In patients aged ≥ 75 years, both MO-TLIF and open TLIF provided sustained pain relief and functional improvement. MO-TLIF reduced perioperative burden and was associated with faster early recovery while achieving similar 12-month radiographic fusion and patient satisfaction compared with open TLIF.</p><p><strong>Trail registration: </strong>Chinese Clinical Trial Registry: ChiCTR2500103261.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2090-2100"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819237","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":"Development and Validation of Daping Orthopedics Operative Risk Scoring System for Geriatric Hip Fracture (DOORS-GHF) for Predicting Postoperative Outcomes in Geriatric Hip Fracture Patients: A Multicenter Retrospective Comparative Study.","authors":"Zhiwei Gong, Yu Wang, Weiwen Zhu, Jing Zhong, Xiangdong Liu, Runze Jin, Zhaoyuan Zhang, Kesi Liu, Ziming Wang, Xingchen Lu, Yan Xiong","doi":"10.1111/os.70430","DOIUrl":"10.1111/os.70430","url":null,"abstract":"<p><strong>Objective: </strong>With China's accelerating population aging, geriatric hip fractures pose a growing clinical challenge. High comorbidity burden and diminished physiological reserve drive elevated postoperative complication and mortality risks in this population. However, most existing systems were developed decades ago, incompatible with modern perioperative advances, and are not tailored for geriatric hip fracture patients, resulting in unsatisfactory predictive specificity. To fill this gap, we developed the Daping Orthopedics Operative Risk Scoring System for Geriatric Hip Fracture (DOORS-GHF) and evaluated its predictive accuracy and clinical utility.</p><p><strong>Methods: </strong>We collected 4417 geriatric patients with hip fractures who underwent operative treatment at multicenter hospitals between 2012 and 2025. A total of 1599 patients were finally enrolled in this study. Of these, 1199 cases were included for the development of the scoring system. Using binary logistic regression with preoperative physiological score (PS) and operative severity score (OS) as independent variables, we constructed the DOORS-GHF model to predict 30-day postoperative complications and mortality. The remaining 400 cases formed the external validation cohort, in which we compared DOORS-GHF against the Daping Orthopedic Operative Risk Scoring System for Senile Patient version 3.0 (DORSSSP v3.0) and the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) using AUC, sensitivity, specificity, Hosmer-Lemeshow calibration, Brier score, and decision curve analysis (DCA).</p><p><strong>Results: </strong>The DOORS-GHF predictive equations were ln[R/(1 - R)] = -5.089 - 0.114 × OS + 0.226 × PS (complications) and ln[Z/(1 - Z)] = -10.308 + 0.655 × OS + 0.201 × PS (mortality). In the validation cohort (n = 400), 30-day mortality was 2.0% (8/400) and complication rate was 6.5% (26/400). DOORS-GHF outperformed both comparators across all metrics. For complication prediction, it achieved the highest AUC (0.878), acceptable calibration (HL χ² = 11.887, p = 0.156), and the lowest Brier score (0.0489). For mortality prediction, it achieved the highest AUC (0.968), good calibration (HL χ² = 6.259, p = 0.510), and the lowest Brier score (0.0140). DCA confirmed the broadest clinical net benefit for DOORS-GHF across threshold ranges of 0-0.65 (complications) and 0-0.40 (mortality).</p><p><strong>Conclusions: </strong>DOORS-GHF demonstrated superior discrimination, calibration, accuracy, and clinical utility over DORSSSP v3.0 and P-POSSUM in geriatric hip fracture patients. As a precise and practical system for assessing the risk of 30-day postoperative complications and mortality, it holds strong potential to improve perioperative decision-making and patient counseling in this vulnerable population.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069935","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}