Orthopaedic Surgery最新文献

{"title":"Risk Factors of Subtalar Arthroereisis for Progressive Collapsing Foot Deformity: A Retrospective Analysis of 236 Cases.","authors":"Shaoling Fu, Jiazheng Wang, Cheng Wang, Chenglin Wu, Shutao Zhang, Zhongmin Shi","doi":"10.1111/os.70148","DOIUrl":"10.1111/os.70148","url":null,"abstract":"<p><strong>Purpose: </strong>Although subtalar arthroereisis (SA) with HyProCure is increasingly utilized for progressive collapsing foot deformity (PCFD), evidence regarding risk factors for complications remains limited. This study aimed to analyze the influencing factors and correlations of sinus tarsi pain and implant removal in PCFD patients after SA utilizing the HyProCure device.</p><p><strong>Methods: </strong>A retrospective study was conducted involving 223 patients (236 ft) diagnosed with PCFD who underwent SA from June 2015 to June 2023. General data and surgical data such as patient gender, age, body mass index (BMI), surgical side, any adjunctive surgeries, length of stay, HyProCure size, and HyProCure depth were collected. Complications were also recorded. Statistical analysis included normality assessment, inter-group comparisons (t-tests for normal quantitative data, Mann-Whitney U for non-normal data, and chi-square for categorical variables). Spearman correlation analyzed factors associated with sinus tarsi pain and implant removal. Binary logistic regression identified risk factors.</p><p><strong>Results: </strong>From 2015 to 2023, a total of 60 cases with sinus tarsi pain, with an incidence rate of 25.42%. Spearman correlation analysis showed that sinus tarsi pain was positively correlated with BMI (r = 0.159, p = 0.014), length of stay (r = 0.165, p = 0.011), and HyProCure depth (r = 0.501, p < 0.01). HyProCure removal was positively correlated with HyProCure depth (r = 0.521, p < 0.01) and sinus tarsi pain (r = 0.700, p < 0.01). In the analysis of sinus tarsi pain, the primary risk factor in patients with PCFD was identified as length of stay (OR = 1.456, 95% CI 1.113-1.904) and HyProCure depth (OR = 2.156, 95% CI 1.690-2.750), both of which were statistically significant (p < 0.05). Among the cases of sinus tarsi pain, 36 patients underwent HyProCure removal, leading to an incidence rate of 15.25%. Regarding the removal of HyProCure, the primary risk factor identified was HyProCure depth (OR = 2.531, 95% CI 1.849-3.463), which was statistically significant (p < 0.05). In particular, no significant correlation was observed between HyProCure size and sinus tarsi pain or implant removal (p > 0.05).</p><p><strong>Conclusion: </strong>In patients with PCFD, length of stay was correlated with the incidence of sinus tarsi pain. Additionally, HyProCure depth was linked to both the incidence of sinus tarsi pain and HyProCure removal. Our research suggests that the prognosis is better for PCFD patients with a shorter length of stay and a reduced HyProCure depth.</p><p><strong>Level of evidence: </strong>Level III, Retrospective Comparative Study.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2662-2669"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799692","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":"A Retrospective Study on the Relationship Between Calcar Femorale Injury and Postoperative Complications of Femoral Neck Fracture in Young and Middle-Aged Patients Treated With Three Cannulated Screws.","authors":"Qi Liu, Kaijun Zhang, Bin Zhao, Haoyuan Du, Teng Zhang, Wei Han, Junqiang Wang","doi":"10.1111/os.70147","DOIUrl":"10.1111/os.70147","url":null,"abstract":"<p><strong>Objectives: </strong>Given the critical biomechanical role of the calcar femorale in load transmission and fracture stability, understanding its relationship with postoperative complications is essential for optimizing surgical outcomes. Therefore, this study aimed to explore the relationship between calcar femorale injury and postoperative complications of femoral neck fracture in young and middle-aged patients.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 350 femoral neck fracture patients (aged 18-65 years) treated with closed reduction and three cannulated screws fixation at a single institution from 2015 to 2020. Evaluate the clinical and imaging information of patients such as sex, age, body mass index, Garden classification, calcar femorale injury situation, computed tomography Hounsfield units (CT HUs), comorbidities (e.g., diabetes, hypertension etc.) and complications (femoral neck shortening, nonunion, and femoral head necrosis). CT-based 3D reconstruction was used to analyze calcar femorale morphology. Statistical analyses included univariate and multivariate logistic regression to identify independent risk factors.</p><p><strong>Results: </strong>A total of 284 patients were included for analysis according to the inclusion and exclusion criteria. The results showed that Garden classification with displaced type (p < 0.001, OR = 4.615, 95% CI: 2.479-8.593), calcar femorale injury (p = 0.026, OR = 1.990, 95% CI: 1.087-3.645) and lower CT HUs (p = 0.002, OR = 0.989, 95% CI: 0.982-0.996) were independent risk factors for femoral neck shortening. Whether the patient has diabetes (p = 0.005, OR = 10.069, 95% CI: 2.043-49.628) was an independent risk factor for femoral neck nonunion. BMI (p = 0.030, OR = 1.154, 95% CI: 1.014-1.313) and Garden classification with displaced type (p < 0.001, OR = 10.000, 95% CI: 2.950-33.903) were independent risk factors for femoral head necrosis.</p><p><strong>Conclusion: </strong>This study found that older patients with displaced type femoral neck fractures with calcar femorale injury are more likely to experience femoral neck shortening. Clinicians should pay close attention to the above risk factors to reduce the incidence of postoperative complications in young and middle-aged patients with femoral neck fractures.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2653-2661"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144848227","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 Analysis of Arthroscopic Treatment of Synovial Chondromatosis of the Knee: A Retrospective Study of More Than Five Years.","authors":"Yang Xu, Tao Li, Wenjing Ma, Lei Yao, Jian Li","doi":"10.1111/os.70132","DOIUrl":"10.1111/os.70132","url":null,"abstract":"<p><strong>Objective: </strong>The synovial chondromatosis is an exceptionally rare benign condition, predominantly found in the knee joint, and can result in pain, restricted mobility, and potential irreversible damage to the joint and cartilage. Despite the utilization of arthroscopic techniques in the surgical management of synovial chondromatosis, there remains a paucity of long-term assessment regarding its efficacy. The main objectives of this study include: (i) investigating the long-term efficacy of arthroscopic surgery in patients with knee synovial chondromatosis;(ii) identifying factors influencing functional improvement in patients post-surgery function.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of all patients with synovial chondromatosis of the knee who underwent arthroscopic synovectomy and loose body removal at our institution between June 2009 and January 2020. The follow-up period for all cases exceeded 5 years. Data collection included demographic details, clinical efficacy indicators(VAS, KOOS, WOMAC, etc.), imaging findings, and subjective satisfaction of patients with surgical outcomes. Data analysis selected t-tests, ANOVA, non-parametric tests, and correlation methods based on normality test results.</p><p><strong>Results: </strong>We enrolled a total of 13 patients, including 4 men and 9 women, with a mean follow-up of 113.15 ± 30.45 months (range 61-145). There were no postoperative complications, recurrence, or malignant transformation in all patients, and the VAS scores, KOOS scores, WOMAC scores, and Lysholm scores of all patients were significantly improved at 3 months, 6 months, 1 year, 5 years, and the last follow-up (p < 0.05). However, one patient experienced osteoarthritis progression, necessitating arthroplasty.</p><p><strong>Conclusion: </strong>This retrospective study demonstrated that arthroscopic treatment for knee synovial chondromatosis is effective and safe. It leads to immediate post-intervention improvement in symptoms and function, with sustained long-term benefits.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2608-2616"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682868","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":"Perioperative Enhanced Recovery After Surgery (ERAS) Clinical Pathway for Unilateral Biportal Endoscopy with Unilateral Laminotomy for Bilateral Decompression.","authors":"Zhiwu Zhang, Jiashen Shao, Shuning Liu, Hai Meng, Zihan Fan, Jisheng Lin, Xiang Li, Qi Fei","doi":"10.1111/os.70117","DOIUrl":"10.1111/os.70117","url":null,"abstract":"<p><strong>Objective: </strong>Unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression (UBE-ULBD) is a widely utilized minimally invasive surgical technique for treating lumbar spinal stenosis (LSS). This study aimed to evaluate the effectiveness of the enhanced recovery after surgery (ERAS) clinical pathway in improving perioperative and short-term clinical outcomes for patients undergoing UBE-ULBD for LSS.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on the clinical data of patients who underwent UBE-ULBD surgery for LSS from May 2022 to April 2024. Since the implementation of the ERAS clinical pathway in our department in May 2023, all eligible patients were divided into the ERAS group (May 2023-April 2024) and the traditional group (May 2022-April 2023). The two groups were analyzed for Visual Analog Scale (VAS) scores for lower extremities at preoperative, 6, 24, and 48 h postoperatively and on the day of discharge. In addition, the Oswestry Disability Index (ODI) and walking distances were assessed preoperatively, at 3 months postoperatively, and at 6 months postoperatively. Other parameters evaluated included the time to first ambulation after surgery, total length of hospital stay (LOS), postoperative LOS, perioperative opioid consumption, postoperative rehydration volume, and the incidence of postoperative complications.</p><p><strong>Result: </strong>Compared to the traditional group, patients in the ERAS group demonstrated significantly lower pain scores at 6 and 24 h postoperatively, earlier ambulation, shorter total LOS and postoperative LOS, reduced postoperative rehydration volume, and perioperative opioid application (p < 0.05). No statistically significant differences were observed between the two groups in terms of lower extremities VAS scores before surgery, at 48 h postoperatively, and on the day of discharge. No statistically significant differences were observed in ODI scores before surgery, at 3 months postoperatively, and at 6 months postoperatively, as well as walking distances (p > 0.05). Furthermore, the incidence of complications was comparable between the two groups (p > 0.05).</p><p><strong>Conclusion: </strong>The UBE-ULBD surgery under the guidance of the ERAS program, through multidisciplinary collaboration and comprehensive measures, can significantly optimize perioperative management, improve postoperative recovery quality, and achieve satisfactory perioperative and short-term clinical outcomes.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2699-2707"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Physiologic Radiolucent Lines Under the Tibial Base Plate After Osteoarthritis With Primary Computer-Assisted Navigation TKA-A Nested Case-Control Study.","authors":"Hao Tian, Yang Ma, Jinrui Zhang, Enbo Liu, Zhuo Zhang, Jianlin Zuo","doi":"10.1111/os.70134","DOIUrl":"10.1111/os.70134","url":null,"abstract":"<p><strong>Background: </strong>Osteoarthritis (OA) is the most prevalent joint disease in the elderly population, and primary computer-assisted navigation total knee arthroplasty (CA-TKA) remains a critical therapeutic intervention for OA. The presence of physiologic radiolucent lines (RLLs) beneath the tibial base plate following CA-TKA carries significant long-term clinical implications and is regarded as a potential indicator of prosthetic loosening. However, the specific risk factors for RLL development in CA-TKA, despite its theoretical precision advantages, remain poorly understood. This study aimed to characterize the clinical features of physiologic RLLs and identify associated risk factors.</p><p><strong>Methods: </strong>A retrospective nested case-control study was conducted using a cohort of OA patients who underwent primary CA-TKA between January 2021 and September 2024. Physiologic RLLs were diagnosed according to the 1989 Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Patients with physiologic RLLs under the tibial base plate at follow-up were assigned to the RLLs group, while controls were matched 1:1 from the cohort based on follow-up time (±14 days). Covariates included age, gender, body mass index, smoking, alcohol consumption, hypertension, diabetes, surgical side, hospital stay duration, operative time, anesthesia type, continuous passive motion use, periprosthetic joint infection, total perioperative blood loss, preoperative/postoperative hip-knee-ankle angle (HKA), tibial cement mantle quality, cement penetration, and perioperative medial proximal tibial angle. Univariate and multivariate analyses were performed to identify risk factors.</p><p><strong>Results: </strong>The cohort comprised 407 patients, of whom 113 developed physiologic RLLs under the tibial base plate. Univariate analysis identified age, preoperative HKA, tibial cement mantle defects, and cement penetration as statistically significant risk factors (all p < 0.05). Multivariate logistic regression analysis revealed that preoperative HKA (OR = 0.919, 95% CI = 0.876-0.963, p < 0.001), tibial cement mantle defects (OR = 2.638, 95% CI = 1.043-6.668, p = 0.040), and cement penetration (OR = 0.205, 95% CI = 0.126-0.332, p < 0.001) were independent risk factors for physiologic RLLs under the tibial base plate after primary CA-TKA in OA patients. Age was not an independent risk factor.</p><p><strong>Conclusions: </strong>The overall incidence and clinical characteristics of physiologic RLLs under the tibial base plate after primary CA-TKA were comparable to those reported for conventional TKA techniques. This nested case-control study identified preoperative HKA, tibial cement mantle defects, and cement penetration as independent risk factors for physiologic RLLs, whereas age was not.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2717-2725"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799691","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":"A New Nanotechnology for Imaging the Juxta-Articular Intraosseous Vasculature-Canal Complex and Related Clinical Pilot Studies.","authors":"Mengmeng Dou, Jinfeng Yang, Jiaoran Li, Jianmin Li, Zhenzhong Li, Xianhao Shao, Xia Su, Jing Li, Guanghui Wang, Kun Cheng","doi":"10.1111/os.70149","DOIUrl":"10.1111/os.70149","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to achieve distinct visualization of juxta-articular intraosseous microvessels, a novel nanoimaging methodology in which superparamagnetic iron oxide nanoparticles and meglumine diatrizoate (MD) are used cooperatively was implemented.</p><p><strong>Methods: </strong>A newly created composite of MD and Fe₃O₄ nanoparticles (MD-Fe₃O₄ NPs) was prepared as a contrast agent to achieve efficacious imaging of the juxta-articular intraosseous vasculature-canal complex (JIVCC). Scanning electron microscopy (SEM) and energy dispersive spectrum (EDS) were employed to observe the structural characteristics and binding stability of the MD-Fe₃O₄ NPs. In 20 rabbits that received an injection of MD-Fe₃O₄ NPs, 1-mm-thick computed tomography (CT) scanning was performed for radiographic assessment. Hematoxylin-eosin- and potassium ferrocyanide-stained sections from 10 sacrificed rabbits were used to observe the histological characteristics of JIVCC with MD-Fe₃O₄ NPs, and the remaining 10 rabbits were utilized for a systemic safety evaluation. After a healthy volunteer received an MD-Fe₃O₄ NP injection, we also performed CT scanning and related safety evaluations.</p><p><strong>Results: </strong>When the MD nanoparticles and amino-Fe₃O₄ nanoparticles were mixed together, they aggregated into a stable compound structure according to microscopic observations and SEM-EDS verification. In 20 rabbits receiving MD-Fe₃O₄ injections, 1-mm slice CT imaging demonstrated significantly enhanced visualization of the JIVCCs in magnet-placed knees compared to contralateral limbs (tibial JIVCC: p < 0.001; femoral JIVCC: p < 0.001), confirming MD-Fe₃O₄ NPs as the efficacious magnetic contrast enhancer. The histological characteristics of MD-Fe₃O₄ NPs in JIVCC were revealed. The levels of serum iron before and 4 and 72 h after MD-Fe₃O₄ NP injection were 23.9 ± 2.13 μmol/L, 26.2 ± 2.30 μmol/L, and 24.9 ± 2.33 μmol/L, respectively, indicating that there was no significant difference in safety (p = 0.092). After a volunteer received MD-Fe₃O₄ NPs via intravenous administration, the JIVCC was clearly visualized, laboratory tests of serum iron levels were normal, and no injection-related complications occurred.</p><p><strong>Conclusions: </strong>A novel compound nanoparticle, which achieved satisfactory overall outcomes, was implemented as an appropriate alternative for the discernible visualization of juxta-articular intraosseous microvessels. The nanotechnology utilized in this study may augment the clinical imaging methodology for the osseous vascular system.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2744-2755"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817190","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 Analysis of Magnetic Resonance Imaging on the Intra- and Extra-Osseous Blood Supply After Scaphoid Fractures.","authors":"Wei Zheng, Ge Xiong, Zhe Guo, Wei Zhang, Zongxuan Zhao, Jiangchao Zhang","doi":"10.1111/os.70136","DOIUrl":"10.1111/os.70136","url":null,"abstract":"<p><strong>Objectives: </strong>Scaphoid fractures are the most common carpal fractures with a relatively high incidence of nonunion and avascular necrosis. Previous autopsy studies have shown that proximal ischemia after a fracture is related to the fracture site and retrograde blood supply within the scaphoid, but actual changes in blood flow after fractures have not been thoroughly studied. The purpose of this study was to analyze the influencing factors of blood supply after scaphoid fractures.</p><p><strong>Methods: </strong>This was a prospective study. Between 2022 and 2023, contrast-enhanced magnetic resonance angiography and gadolinium-enhanced magnetic resonance imaging were performed in 32 patients (28 males and 4 females) with scaphoid fractures. The average age was 35 years (ranges: 15-74 years). We observed the accumulation and filling time of contrast media, and measured the diameters of extraosseous arteries as well as the signal intensity of intraosseous perfusion. The Mann-Whitney U-test, student's t-test, and Friedman test were used, respectively.</p><p><strong>Results: </strong>31 of 32 patients showed contrast media accumulation in the wrist joints on the affected sides. The filling time of contrast media on the affected sides was 5.6 (6.05-1) s quicker than on the healthy sides. The diameters of the radial arteries on the affected side increased by 12.8% (SD, 18.4%) compared to those on the healthy side (p = 0.002). All the patients had visible scaphoid nutrient arteries originating from the radial arteries on the affected side. The number of visible arteries on the healthy side was lower. Blood supply to the scaphoid was not related to the patient's sex, injury side, or fracture site. The increase in blood supply at the proximal fragment in older patients was less than that in young individuals (p = 0.015). Blood supply to the proximal and distal fragments of the scaphoid increased after fracture (p < 0.05). Within 1 month after the fracture, the increase in blood supply at the proximal fragment was less than that at the distal fragment, and it increased significantly after 1 month (p = 0.014). However, long-term nonunion (more than 4 years) leads to a decrease in proximal blood supply.</p><p><strong>Conclusions: </strong>The unique blood supply pattern of the scaphoid and fracture sites might not be the cause of ischemia after a fracture. This could be due to prolonged nonhealing, which leads to proximal ischemia.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2617-2628"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753953","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":"Design of a Novel Artificial Atlanto-Odontoid Joint and Its Anatomical and Radiological Studies Following Transoral Pharyngeal Approach Arthroplasty.","authors":"Shengguang Lei, Lingyong Jing, Xijiong Chen, Zhiwei Gan, Jianbin Zhong, Liming Yu, Yong Hu","doi":"10.1111/os.70088","DOIUrl":"10.1111/os.70088","url":null,"abstract":"<p><strong>Objective: </strong>For atlantoaxial joint disorders, traditional surgical approaches often presented challenges such as significant trauma and prolonged recovery. Therefore, it was crucial to explore safer and more effective surgical alternatives. The primary aim of this study was to investigate the anatomical safety and feasibility of artificial atlanto-odontoid joint (AAOJ) replacement via a transoral pharyngeal approach, through simulated surgical procedures and postoperative anatomical and radiological studies.</p><p><strong>Methods: </strong>The novel AAOJ replacement surgery was simulated on 18 fresh adult cadaveric head and neck specimens, and relevant anatomical parameters were measured. Postoperatively, the specimens underwent X-ray and CT scans, and software was used to measure the relevant parameters of the fixation screws. The spatial relationships between the atlantoaxial components, fixation screws, and critical anatomical structures were also examined. The comparison of parameters between the left and right sides was conducted using paired-sample t-tests.</p><p><strong>Results: </strong>The transoral pharyngeal approach provided adequate exposure, clear surgical visualization, and sufficient working space. Anatomical measurements showed that the width of the anterior arch bone window of the atlas was (13.8 ± 0.7) mm; the width of the vertebral body bone window of the axis was (11.0 ± 0.4) mm; the distance between the insertion points for the atlas screws was (28.2 ± 4.0) mm; the distance from the atlas insertion points to the lateral joint edge of the atlanto-axial joint was (5.2 ± 0.9) mm; the distance between the insertion points for the axis screws was (16.8 ± 1.6) mm; and the distance from the axis insertion points to the lateral joint edge of the atlanto-axial joint was (7.7 ± 0.9) mm. Radiological measurements showed that the screw trajectory length of the lateral mass screw in the atlas was (21.5 ± 2.8) mm, the outward insertion angle was (13.2 ± 2.5)°, and the caudal insertion angle was (3.5 ± 1.1)°; for the pedicle screw of the axis, the screw trajectory length was (29.8 ± 2.8) mm, the outward insertion angle was (20.7 ± 2.8)°, and the caudal insertion angle was (16.6 ± 2.7)°. The prosthesis was precisely fitted to the upper cervical spine, with adequate safety distances between the atlantoaxial components, fixation screws, and critical anatomical structures such as the foramen transversarium, vertebral artery groove, and spinal canal.</p><p><strong>Conclusions: </strong>The transoral pharyngeal approach for novel AAOJ replacement is anatomically safe and feasible.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2670-2679"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Poor Matching of Intervertebral Fusion Devices After Posterior Vertebral Column Resection in Patients With Kyphosis or Kyphoscoliosis.","authors":"Xin Xin, Jiajun Ni, Shi Yan, Lei Yuan, Zhongqiang Chen, Yan Zeng","doi":"10.1111/os.70116","DOIUrl":"10.1111/os.70116","url":null,"abstract":"<p><strong>Objectives: </strong>Numerous studies have reported the manifestations and influencing factors of poor matching of intervertebral fusion devices (IFDs) in patients with cervical and lumbar degenerative diseases. However, there is currently no research addressing the use of IFDs matching in posterior vertebral column resection (PVCR) procedures. The purpose of this retrospective radiographic study was to analyze the risk factors associated with poor matching of IFDs following PVCR.</p><p><strong>Methods: </strong>Data from 92 patients using IFDs following PVCR between June 2006 and July 2024 were reviewed. IFDs implantation failure, adjacent vertebral fractures, subsidence greater than 5 mm, angle formation exceeding 10°, and malposition (defined as one-third of the IFDs exceeding the outer edge of the matching interface) were used as screening indicators to divide patients into poor matching and matching groups. Potential risk factors of poor matching were assessed through univariate and multivariate logistic regression analysis. The multiple regression model was evaluated by the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Among the 92 patients, 37 (40.2%) experienced poor matching. Univariate logistic regression analysis revealed that the preoperative and postoperative sagittal Cobb angles, the angle between osteotomy surfaces, total instrumented vertebrae, the number of vertebrae resected, the height of IFDs, and the use of titanium mesh or artificial vertebral bodies were potential risk factors for poor matching. Backward stepwise multivariate logistic regression analysis indicated that the preoperative sagittal Cobb angle (OR = 1.053, p = 0.001), the angle between osteotomy surfaces (OR = 1.152, p = 0.003), and the height of IFDs (OR = 1.058, p = 0.033) were independent risk factors for poor matching. The overall predictive performance of this multiple regression model (AUC = 0.872) for poor matching was deemed satisfactory.</p><p><strong>Conclusion: </strong>The use of IFDs in PVCR was associated with a high rate of immediate poor matching. The preoperative sagittal Cobb angle, the angle between osteotomy surfaces, and the height of IFDs are independent risk factors for poor matching.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2579-2587"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682887","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":"Establishment of Subtrochanteric Fracture in Pre-Clinical Animal Model.","authors":"Poornima Palanisamy, Simon Kwoon-Ho Chow, Shuai Li, Michelle Meng-Chen Li, Wing-Hoi Cheung, Ling Qin, Yong-Ping Zheng","doi":"10.1111/os.70137","DOIUrl":"10.1111/os.70137","url":null,"abstract":"<p><strong>Objective: </strong>About 7%-34% of the femur fracture contributes to subtrochanteric fracture, and only very little research is available about these fractures when compared to common hip fractures. Hence, the aim of this study was to develop a clinically relevant and reproducible open fracture model in rabbits at the subtrochanteric region to understand the fracture healing mechanism at this site and to explore treatment effects of biophysical intervention in future studies.</p><p><strong>Methods: </strong>An open osteotomy was created in 32 adult New Zealand white rabbits at the subtrochanteric region, followed by customized titanium internal fixations. The internal fixator consists of a 3D printed titanium compression plate with cortical screws for locking. The fracture healing was monitored for 6 weeks, and the corresponding radiography, MicroCT, and histomorphometry analysis were performed at regular intervals.</p><p><strong>Results: </strong>Four rabbits were excluded due to complications (4/32), including bone dislocation one week post-surgery (3/32). Fracture healing progression was observed in radiographic images. MicroCT analysis showed increased callus volume after 42 days. Histomorphometry revealed remodeled bone area with a higher number of osteocyte cells.</p><p><strong>Conclusion: </strong>The rabbit fracture model of an open femoral osteotomy at the subtrochanteric region has been successfully established, with the facilitation of an internal fixator consisting of a 3D printed titanium compression plate with cortical screws for locking. Applications of this model are being investigated, including different biophysical stimulation methods for accelerating fracture healing.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2726-2734"},"PeriodicalIF":2.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760721","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}