Orthopaedic Surgery最新文献

{"title":"A Comparative CT Study on Anatomical Characteristics of Pediatric Habitual Patellar Dislocation in Extension and Flexion.","authors":"Qin Zhang, Zhen-Zhen Dai, Han Zhou, Han-Xiao Yu, Hai Li, Lin Sha","doi":"10.1111/os.70165","DOIUrl":"https://doi.org/10.1111/os.70165","url":null,"abstract":"<p><strong>Objective: </strong>Habitual patellar dislocation (HDP) in children and adolescents is divided into dislocation in flexion and dislocation in extension, but their pathogenesis remains unclear. Our purpose is to focus on investigating the anatomical difference between the extended dislocation and the flexed dislocation of HDP.</p><p><strong>Methods: </strong>We retrospectively observed all patients diagnosed as HDP who underwent surgery at our institution from May 2016 to August 2023. Patients were categorized into two subgroups according to \"J sign\": the extension group and the flexion group. We measured and compared the various anatomical parameters on CT images, including patellar dysplasia, trochlear dysplasia, alignment of the patellofemoral joint, and torsional deformity of the knee joint. Continuous data were analyzed using the t-test, while categorical data were analyzed using Fisher exact test and Mann-Whitney U test.</p><p><strong>Results: </strong>We enrolled 20 patients (average age of 9 years old, ranging from 6 to 15; 14 patients in the extension group and 6 patients in the flexion group) with 30 knees. The extension group exhibited significantly greater Wiberg index (0.62 ± 0.09 vs. 0.56 ± 0.05, p = 0.030), lateral patellar angle (17.83 ± 4.5 vs. 12.24 ± 5.7, p = 0.009), PT/FT ratio (1.45 ± 0.1 vs. 1.31 ± 0.1, p = 0.005), and Caton-Deschamps index (1.46 ± 0.3 vs. 1.17 ± 0.1, p = 0.015) than those in the flexion group. Meanwhile, the flexion group demonstrated greater patellar lateralization distance (24.03 ± 11.5 vs. 16.26 ± 7.3, p = 0.036), patellar inclination angle (50.75 ± 13.1 vs. 29.98 ± 14.5, p = 0.001), lateral patellofemoral angle (38.49 ± 13.5 vs. 18.32 ± 8.2, p = 0.000) and congruence angle (57.57 ± 23.3 vs. 28.15 ± 16.7, p = 0.001) when knees were extending but a smaller lateral trochlear inclination angle (18.84 ± 6.9 vs. 12.49 ± 5.2, p = 0.026) than those in the extension group. Additionally, the knees in the flexion group predominated the femoral trochlea of Dejour type C and D (100%) while only half of the extension group had Dejour type C and D (51%). The duration of symptoms before surgery was significantly longer in the extension group compared to the flexion group (25.93 ± 25.8 months vs. 9.33 ± 4.18 months, p = 0.034). Parameters related to torsional abnormality of the lower extremity showed no significant difference between the two groups.</p><p><strong>Conclusions: </strong>Patients with HDP in extension had patella alta, more severe patellar dysplasia, while those with HDP in flexion had a more inclined patella, laterally positioned patella when knees extended, and a more dysplastic femoral trochlea. These differences provide reasonable references for doctors to better understand the mechanisms of dislocation and the design of optimal surgical strategies.</p><p><strong>Clinical relevance: </strong>Improved understanding of anatomical features of HDP is critical to informing clinical treatment decis","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Hip Arthroplasty for Intertrochanteric Fractures Under the Treatment Concept of Periprosthetic Fractures.","authors":"Wei-Qiang Zhao, Xu-Song Li, Ke-Qin Yu, Rong-Zhen Xie, Jiang Hua, Jie-Feng Huang","doi":"10.1111/os.70164","DOIUrl":"https://doi.org/10.1111/os.70164","url":null,"abstract":"<p><strong>Objective: </strong>Intertrochanteric fractures (IF) in the elderly are often complicated by osteoporosis and high rates of fixation failure. Current treatment options have limitations in providing both stable fixation and early mobilization in this fragile population. This study aimed to introduce and evaluate a novel approach, the periprosthetic femoral fracture treatment concept (PFFtc), as a surgical strategy to guide hip arthroplasty in elderly IF patients.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 209 elderly patients (mean age: 81.6 years; range: 70-93) with IF who underwent hip arthroplasty using the PFFtc protocol between March 2014 and August 2021, comprising 133 females and 76 males. All patients underwent treatment with the \"PFFtc\" and were subsequently followed up at intervals of 1 month, 3 months, 6 months, 1 year, 2 years, and annually thereafter. Clinical parameters such as ASA anesthesia grading, Visual Analogue Scale (VAS) scores, Harris Hip Scores (HHS), and Short-Form 36 (SF-36) outcomes were meticulously recorded. The subsidence of the femoral stem was assessed using Pelligrini's method, while mortality rates, postoperative complications, and patient's survival status post-discharge were systematically documented. Multivariate logistic regression analysis was performed to identify independent risk factors for postoperative complications.</p><p><strong>Results: </strong>Over a mean follow-up of 38.5 ± 6.0 months, prosthesis subsidence averaged 2.2 mm and stabilized. No deaths occurred within 30 days postoperatively. The 1- and 2-year cumulative mortality rates were 4.3% and 11%, respectively. The most common complications included DVT and urinary tract infections. Logistic regression identified hypoproteinemia (OR = 2.38, p = 0.032) and heart disease (OR = 2.74, p = 0.012) as independent risk factors for postoperative complications. At final follow-up, the mean VAS was 1.1 ± 1.0, HHS was 89.4 ± 3.9, PCS was 53.2 ± 8.5, and MCS was 50.5 ± 6.7. Among surviving patients, 63.0% lived independently at home.</p><p><strong>Conclusion: </strong>The PFFtc-guided arthroplasty approach appears to be a safe and effective option for managing IF in elderly patients. It provides stable fixation and functional recovery of prostheses and muscles and offers a promising alternative to traditional fixation strategies.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain Phenotype in Knee Osteoarthritis: Implications for Mechanism-Based Therapy.","authors":"Chenchang He, Qiyao Li, Rui Huang, Xiang Gao, Li Li, Pei Fan","doi":"10.1111/os.70161","DOIUrl":"https://doi.org/10.1111/os.70161","url":null,"abstract":"<p><p>Pain is the main symptom of knee osteoarthritis (KOA) and the main cause for patients to seek medical treatment. Despite the development of various therapies to address pain, its efficacy often remains uncertain. According to the new classification of the International Association for the Study of Pain, pain is classified as nociceptive pain, neuropathic pain and nociplastic pain. This review sought to outline potential mechanisms and clinical manifestations within this new classification framework and provided tailored treatment recommendations for each type of pain. Moreover, we further divided nociceptive pain into three subgroups including Inflammatory Pain, Mechanical Pain, and BMLs-related Pain. We suggest: (1) For inflammatory pain, the use of anti-inflammatory medications such as NSAIDs and corticosteroids is recommended. (2) For mechanical pain, weight loss, adjustments to mechanical alignment of the lower limb, and rehabilitation training may significantly alleviate symptoms. (3) For BMLs-related pain, patients might benefit from treatment, such as reducing weight-bearing and implementing antiosteoporosis drugs. (4) For neuropathic pain, management may involve tricyclic antidepressants or anticonvulsants. (5) For nociplastic pain, we give priority to nonpharmacological therapies, with an emphasis on the biopsychosocial model, and encourage patients to adopt positive lifestyle changes, including physical activity, weight management, sleep hygiene, and self-management, as well as involvement in psychotherapy and intervention. In clinical practice, it is essential to recognize that many patients may present with a combination of these pain types. Thus, it becomes imperative to identify the primary pain type and craft precise and individual treatment strategies tailored to their specific needs.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing an Optimized Perioperative Strategy for Percutaneous Vertebroplasty: Clinical Application and Outcome Evaluation.","authors":"Zhiwu Zhang, Shuning Liu, Jiashen Shao, Hai Meng, Jisheng Lin, Qi Fei","doi":"10.1111/os.70160","DOIUrl":"https://doi.org/10.1111/os.70160","url":null,"abstract":"<p><strong>Objective: </strong>Percutaneous vertebroplasty (PVP) is a widely used minimally invasive procedure for the treatment of osteoporotic vertebral compression fracture (OVCF), yet accelerating postoperative recovery and reducing complications remain critical clinical challenges that require urgent resolution. This study aimed to evaluate the clinical effectiveness of an optimized perioperative management strategy based on the Enhanced Recovery After Surgery (ERAS) concept in patients undergoing PVP.</p><p><strong>Methods: </strong>From May 2022 to April 2024, a total of 301 patients with OVCF who underwent PVP were retrospectively enrolled in the retrospective cohort study. Using May 2023 as the implementation time point for the optimized perioperative management strategy in our department, all subjects were divided into the traditional group (155 cases) and the optimized strategy (ERAS) group (146 cases). The two groups were analyzed for visual analog scale (VAS) scores for low back pain at various time points before and after surgery, Oswestry Disability Index (ODI) at preoperative and 3 months postoperatively, postoperative first ambulation time, total length of hospital stay (LOS), postoperative LOS, postoperative rehydration volume, and postoperative complications. Group comparisons of continuous variables were performed using independent samples t-tests or Mann-Whitney U tests, while categorical variables were compared using χ² tests or Fisher's exact tests. p-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>Compared to the traditional group, patients in the ERAS group exhibited significantly lower VAS pain scores at 2 and 4 h postoperatively, earlier postoperative first ambulation time, shorter total and postoperative LOS, and reduced postoperative intravenous rehydration volume (p < 0.05). However, no statistically significant differences were observed between the two groups in preoperative VAS scores, VAS scores at 24 h postoperatively and on the day of discharge, as well as in ODI scores both preoperatively and at 3 months postoperatively (p > 0.05). Additionally, the complication rates were similar between the two groups (p > 0.05).</p><p><strong>Conclusion: </strong>For patients with OVCF, performing PVP under the optimized perioperative management strategy facilitates early pain relief, reduces the average LOS, shortens the postoperative first ambulation time, and significantly improves perioperative clinical outcomes.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Femoral Neck-Shaft Offset: A Key Element in the Reconstruction of Intertrochanteric Fracture.","authors":"Kun Wang, Ming Hao, Junsong Wang, Gang Zhang, Shaobo Nie, Peifu Tang, Licheng Zhang","doi":"10.1111/os.70163","DOIUrl":"https://doi.org/10.1111/os.70163","url":null,"abstract":"<p><strong>Background: </strong>Anteromedial cortex reduction and accurate placement of the cephalomedullary nail is the key point to confront implant failure of intertrochanteric fractures. Existing intramedullary nails cannot compensate for femoral neck-shaft offset (FNSO), potentially undermining surgical outcome. This study aimed to investigate the effect of FNSO on anteromedial cortex reduction and accurate placement of the cephalomedullary nail for intertrochanteric fractures.</p><p><strong>Methods: </strong>This retrospective study included patients with intertrochanteric fractures treated with short intramedullary nails at our institution from January 2014 to December 2016, who were divided into acceptable and unacceptable groups according to the anteromedial cortex reduction quality. We measured the femoral neck-shaft offset (FNSO) and offset angle (FNSOA) on the uninjured femur CT. Postoperative CT of the fractured femur was used to measure the offset between the femoral neck axis and the cephalic nail axis (FNCO) and the corresponding angular offset (FNCOA). Cephalic nail insertion alignment was classified into three types (oblique-forward/rear, coincident, and oblique-backward/front) based on FNCO/FNCOA values. Group differences were analyzed, and logistic regression identified predictors of poor reduction.</p><p><strong>Results: </strong>Fifty-seven patients (mean age 78.10 ± 13.47 years; 74% women) were included. The median FNSO and FNSOA of unaffected femurs were 4.31 (IQR 1.50) mm and 4.85° (IQR 2.01). 42.1% of cases had acceptable anteromedial reduction, while 57.9% were unacceptable. Cephalic nail insertion types were: 43.9% oblique-backward/front, 28.1% coincident, and 28.1% oblique-forward/rear. The unacceptable reduction group had significantly different FNCO (-2.32 vs. 2.14 mm) and FNCOA (-3.5° vs. 0°) compared to the acceptable group (both p < 0.001), despite similar fracture types and devices. Cephalic nail insertion type differed between groups (p < 0.001): oblique-backward/front and coincident insertions were more common in poor reductions. Logistic regression showed that oblique-backward/front insertion (OR = 51.33, 95% CI 7.60-346.85) and coincident insertion (OR = 9.00, 95% CI 1.52-53.40) were strong independent predictors of unacceptable reduction (both p < 0.001). Among insertion types, oblique-forward/rear had the lowest median FNCO (3.59 mm) and FNCOA (0.69°) and only 12.5% unacceptable reductions, versus coincident (0 mm, 0°, 56.3%) and oblique-backward/front (-3.06 mm, -5.84°, 88.0%) (p < 0.001).</p><p><strong>Conclusions: </strong>It is difficult for existing intramedullary nails to achieve both the reduction of the anterior medial cortex and the accurate implantation of intramedullary nails due to the presence of FNSO. Optimizing intramedullary nailing design and surgical strategy according to FNSO may improve the treatment outcome of intertrochanteric fractures.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Application of 3D-Printed Custom Hemipelvic Prostheses With Re-Entrant Chiral Structure in Reconstruction After Pelvic Tumor Resection.","authors":"Linyun Tan, Ye Li, Xin Hu, Yitian Wang, Xiaolu Zhang, Xiaoyan Liu, Yi Luo, Yong Zhou, Chongqi Tu, Xiao Yang, Li Min","doi":"10.1111/os.70159","DOIUrl":"https://doi.org/10.1111/os.70159","url":null,"abstract":"<p><strong>Objectives: </strong>Pelvic reconstruction with conventional 3D-printed prostheses faces a critical trade-off, where achieving sufficient porosity for optimal bone ingrowth often compromises essential mechanical stability. To address this challenge, this study evaluates the clinical outcomes of 3D-printed hemipelvic prostheses incorporating re-entrant chiral structure (RCS), a novel negative Poisson's ratio design, in patients undergoing pelvic reconstruction following tumor resection.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 15 patients (eight females and seven males; mean age: 39.3 ± 11.7 years) with pelvic malignancies who underwent reconstruction using 3D-printed hemipelvic prostheses incorporating RCS between March 2018 and June 2023. The diagnoses included osteosarcoma (n = 8), Ewing's sarcoma (n = 3), chondrosarcoma (n = 2), and high-grade soft tissue sarcoma (n = 2). All patients were staged as IIB according to the Enneking system, except for one case of Ewing's sarcoma (stage III). Neoadjuvant chemotherapy (four cycles) was administered to six osteosarcoma patients, and one Ewing's sarcoma patient received six cycles, while other patients proceeded directly to surgery. Patient outcomes were systematically evaluated through oncological status, functional performance (MSTS-93 score), pain assessment (VAS score), surgical parameters, complications, and radiographic analysis using Tomosynthesis Shimadzu Metal Artifact Reduction Technology (T-SMART).</p><p><strong>Results: </strong>At the latest follow-up (44.5 ± 9.4 months), 13 patients (86.7%) remained disease-free; one patient (6.7%) experienced local recurrence requiring revision surgery, and one patient (6.7%) died of metastatic complications at 32 months post-surgery. Functional outcomes showed significant improvement, with mean MSTS-93 scores increasing from 14.5 ± 1.1 preoperatively to 25.8 ± 1.3 at final follow-up (p < 0.001). Pain control was satisfactory, with VAS scores decreasing from 5.5 ± 0.6 to 1.5 ± 0.5 (p < 0.001). The mean surgical duration was 289.3 ± 30.4 min, with an average intraoperative blood loss of 3540 ± 621.5 mL. Early complications included delayed wound healing in three cases (20%), successfully managed with wound care protocols and VAC therapy. One patient (6.7%) developed deep prosthetic infection at 14 months post-surgery, necessitating a two-stage revision procedure. No mechanical failures, aseptic loosening, or prosthesis fractures were observed during the follow-up period. Radiographic analysis demonstrated progressive bone ingrowth into the RCS porous regions in all cases, with no signs of osteolysis or implant migration in the remaining prostheses.</p><p><strong>Conclusion: </strong>D-printed custom hemipelvic prostheses with RCS offer an effective solution for pelvic reconstruction by achieving an optimal balance between mechanical stability and biological integration, leading to promising clinical outcomes.</","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Enhanced Biomechanical Stability in Proximal Humeral Fractures: Finite Element Analysis of a Novel Endosteal Anatomical Support Nail for Improved Fixation in Elderly Patients\".","authors":"","doi":"10.1111/os.70106","DOIUrl":"10.1111/os.70106","url":null,"abstract":"","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2495"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317557","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":"Exploring Appropriate Positioning of the Spiral Blade in Treatment of Subtrochanteric Fractures of the Femur Using Proximal Femoral Nail Antirotation.","authors":"Qingyan Zhang, Xiaogang Wang, Longhui Su, Qiang Xu","doi":"10.1111/os.70051","DOIUrl":"10.1111/os.70051","url":null,"abstract":"<p><strong>Objectives: </strong>Subtrochanteric fractures have anatomic characteristics distinct from intertrochanteric fractures that may affect the positioning of the spiral blade during surgical treatment. Tip-apex distance (TAD) and calcar-referenced tip-apex distance (Cal-TAD) were measured to determine if these measures are reliable indicators to assist in the accurate placement of intramedullary nails and minimize postoperative complications.</p><p><strong>Methods: </strong>For patients treated with proximal femoral nail antirotation (PFNA) internal fixation between 2016 and 2020, we analyzed the TAD, Cal-TAD, and postoperative complications. Fracture healing was assessed radiographically at 6-week intervals until union. The incidences of axial cut-off, cephalad cut-off, and non-union were also examined. Analysis of variance and Fisher's exact test were performed to evaluate differences in complications between the TAD and Cal-TAD groups.</p><p><strong>Results: </strong>Data from 104 patients (58 males, 46 females) with a mean age of 56.9 years were analyzed. Fracture healing was observed in 90 (86.5%) patients at an average time of 14.92 ± 1.81 weeks. The healing rate was significantly higher when the TAD and Cal-TAD were controlled within the 20-25 mm range (p < 0.05). Postoperative complications occurred in 14 (13.5%) cases [cephalad cut-off, n = 5 (4.8%); axial cut-off, n = 4 (3.8%); non-union, n = 5 (4.8%)]. Five (4.8%) complications occurred without internal fixation failure. The fracture healing time and incidence of complications differed among groups defined by TAD and Cal-TAD measurements, and were shortest and lowest, respectively, in the 20 mm < TAD/Cal-TAD < 25 mm group.</p><p><strong>Conclusions: </strong>In our cohort, use of PFNA internal fixation for treatment of unstable femoral subtrochanteric fractures and placement of the spiral blade in the middle or lower 1/3 of the femoral neck did not increase the incidence of complications. Therefore, we propose that the TAD rule of 20-30 mm should not apply to subtrochanteric fractures, and TAD and Cal-TAD should be controlled within the range of 20-25 mm to reduce the incidence of complications.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2291-2301"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317558","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":"Predicting the Nonunion of the Acute Osteoporotic Vertebral Compression Fracture Following Low-Energy Injuries by Quantifying Vertebral Marrow Fat Fraction on T₂-Weighted Dixon Sequences.","authors":"Pengguo Gou, Rui Wang, Zhihui Zhao, Yunguo Wang, Yuan Xue","doi":"10.1111/os.70098","DOIUrl":"10.1111/os.70098","url":null,"abstract":"<p><strong>Objective: </strong>Increased marrow fat fraction (MFF) of vertebrae was detected in patients with osteoporosis. However, MFF of the fractured vertebrae decreased significantly following the fracture. The aim of this study was to assess the predictive value of fractured vertebrae MFF quantified on T₂-weighted Dixon sequences for the prediction of nonunion risk of acute OVCF.</p><p><strong>Materials and methods: </strong>Medical records of 39 patients with OVCF, including a total of 60 fractured vertebrae, were reviewed retrospectively. Fractured vertebrae in the acute phase were grouped into the nonunion group (20 vertebrae) and the union group (40 vertebrae), based on the OVCF prognosis confirmed by computer tomography (CT). MFF of the fractured vertebrae was quantitatively assessed with the software Matlab on T₂-weighted Dixon sequences. Interclass correlation coefficients (ICC) were analyzed to assess the repeatability of MFF measurement. Binary logistic regression analysis was performed to determine the relative contribution of the MFF for predicting the prognosis of OVCF. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic performance of MFF.</p><p><strong>Results: </strong>The ICC indicated that the repeatability of MFF measurement was excellent (all p < 0.001). The MFF (42.25% ± 26.61%) decreased significantly compared to the value before OVCF (79.84% ± 9.65%) (p < 0.001). The MFF of the fractured vertebrae was lower in the nonunion group (16.40% ± 15.65%) than in the union group (55.18% ± 20.93%) (p < 0.001). Binary logistic regression analysis indicated that MFF of fractured vertebrae could independently predict the prognosis of acute OVCF (p < 0.001). ROC analysis indicated the area under the curve was 0.928 (95% CI, 0.831-0.979, p < 0.0001).</p><p><strong>Conclusions: </strong>The MFF quantified on T₂-weighted Dixon sequences was a useful marker for assessing the nonunion risk of acute OVCF. The fractured vertebra with low MFF should be carefully monitored for nonunion.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2405-2412"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333643","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":"Which Factors Affect Functional Outcomes and Survival in Metastatic Humeral Fractures Treated With Nails?","authors":"Ebubekir Eravsar, Ali Gulec, Sadettin Ciftci, Numan Mercan, Selim Safali, Bahattin Kerem Aydin","doi":"10.1111/os.70101","DOIUrl":"10.1111/os.70101","url":null,"abstract":"<p><strong>Objective: </strong>Intramedullary nailing is a treatment method for metastatic humerus fractures that stabilizes a large area while minimizing damage to the surrounding soft tissues. However, the results of this treatment may vary depending on certain factors. This study aimed to investigate the factors influencing functional outcomes and survival in patients with pathological humeral fractures treated using humeral nails.</p><p><strong>Methods: </strong>This retrospective study included 41 patients who underwent humeral nailing for metastatic pathological humerus fractures between 2009 and 2024. Functional outcomes were compared based on factors such as gender, age, cancer type, another pathological fracture surgery, visceral metastases, cancer diagnosis prior to fracture, fracture type and location, and cement use, using VAS improvement, MSTS, KPS scores, and ROM measurement. Survival analysis was performed considering these same factors. Statistical analyses included the Mann-Whitney U test, Kruskal-Wallis test, Chi-square test, and Kaplan-Meier survival curves. Cox regression analyses were used to identify factors associated with mortality.</p><p><strong>Results: </strong>In younger patients, better VAS improvement(p = 0.001), MSTS(p = 0.038), KPS(p = 0.028), and ROM(p = 0.045) were observed compared to those 65 and older. Cancer type and visceral metastases negatively impacted MSTS(p = 0.007, p = 0.049) and KPS(p = 0.002, p = 0.022). Actual fractures showed greater VAS improvement than impending fractures(p = 0.002), and shaft fractures had greater VAS improvement than proximal fractures(p = 0.037). Unknown cancer diagnosis prior to fracture led to better VAS improvement(p = 0.008), MSTS(p = 0.018), KPS(p = 0.023), and ROM(p = 0.006). Rapid growth tumor(p < 0.001) and visceral metastasis(p = 0.007) were independently associated with poor survival. No significant effects were seen for gender or cement use on functional outcomes and mortality.</p><p><strong>Conclusion: </strong>Although intramedullary nails are feasible implants for humeral pathological fractures, there are significant factors that affect their functional outcomes and survival. Actual fractures and shaft fractures showed better pain relief. Patients with a known cancer diagnosis prior to fracture and older patients had poor functional outcomes. Rapid cancer type and visceral metastasis negatively affect both functional outcomes and survival. Although cement use carries a risk of thrombosis, no significant changes in mortality and functional outcomes were observed with cement use.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":19566,"journal":{"name":"Orthopaedic Surgery","volume":" ","pages":"2342-2349"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12318681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529120","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}