JBJS Open Access最新文献

{"title":"Marked Increase in Anterior Ulnar Nerve Displacement at ≥90° of Elbow Flexion in Healthy Children.","authors":"Tomoo Nakagawa, Youichi Yasui, Kenichi Kawabata, Jun Sasahara, Takahiro Inui, Masashi Nei, Yoichiro Konno, Hirotaka Kawano, Wataru Miyamoto","doi":"10.2106/JBJS.OA.26.00115","DOIUrl":"10.2106/JBJS.OA.26.00115","url":null,"abstract":"<p><strong>Background: </strong>Iatrogenic ulnar nerve (UN) injury is a serious complication of percutaneous medial pinning for pediatric supracondylar humeral fractures, particularly when deep elbow flexion is required for reduction. However, the flexion angle at which the nerve becomes unstable and patient characteristics predisposing to displacement remain unclear. This study aimed to determine the elbow flexion angle at which UN instability occurs in healthy children and to identify independent risk factors for anterior displacement.</p><p><strong>Methods: </strong>A cross-sectional study of 74 healthy, asymptomatic children (144 elbows) aged 7 to 12 years was conducted. Dynamic ultrasonography was performed at 5 static flexion angles (0°, 30°, 60°, 90°, and 120°), with nerve position classified as normal, subluxated, or dislocated relative to the medial epicondyle. Multivariate logistic regression analysis identified independent predictors of instability (subluxation or dislocation) at deep flexion (≥90°), evaluating age, sex, body mass index, handedness, and generalized joint laxity.</p><p><strong>Results: </strong>UN instability increased progressively with elbow flexion. At 0° and 30°, the nerve remained stable in >97% of elbows. A marked increase in instability was observed at ≥90°: 60.4% demonstrated instability (50.0% subluxation, 10.4% dislocation) at 90°, rising to 94.4% (54.2% subluxation, 40.3% dislocation) at 120°. Multivariate analysis identified female sex (odds ratio 3.61; 95% confidence interval 1.50-8.67) and generalized joint laxity (odds ratio 2.61; 95% confidence interval, 1.03-6.61) as independent risk factors. Age, body mass index, and handedness were not significantly associated with displacement.</p><p><strong>Conclusions: </strong>In healthy children, the UN demonstrated a pronounced angle-dependent pattern, with marked anterior displacement at ≥90° of flexion. Female sex and generalized joint laxity were associated with higher odds of sonographic instability. These findings characterize the anatomical behavior of the UN during elbow flexion and provide context for future investigation in surgical populations.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13259555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Mecobalamin on the Prevention of Complex Regional Pain Syndrome Type 1 Following Foot Ankle Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial.","authors":"Marut Arunakul, Chakkris Leesakul, Pheemaphol Samornpitakul, Prapasri Kulalert, Adinun Apivatgaroon, Preeyaphan Arunakul","doi":"10.2106/JBJS.OA.26.00104","DOIUrl":"10.2106/JBJS.OA.26.00104","url":null,"abstract":"<p><strong>Background: </strong>Mecobalamin has been proposed to improve the outcomes of Foot and Ankle patients with complex regional pain syndrome type 1 (CRPS-1). The primary outcome was to evaluate the effects of mecobalamin on the event rate of CRPS-1 after foot ankle surgery. The secondary outcomes were to compare the visual analog scale (VAS) and functional outcomes of both groups.</p><p><strong>Methods: </strong>The study recruited 440 patients. Operative foot and ankle patients were randomized into control (220 patients) and Mecobalamin groups (220 patients). Patients were assessed for CRPS-1 using the Budapest criteria for a follow-up period of 12 months. Preoperative and postoperative foot and ankle ability measure, Short Form 36, and VAS were compared.</p><p><strong>Results: </strong>Analysis included 432 patients. CRPS-1 occurred in 4 patients (1.8%) in the mecobalamin group compared with 20 patients (9.3%) in the placebo group. After adjustment using multivariable regression, mecobalamin was associated with a significantly lower risk of CRPS-1, with the risk difference of -8.1% (95% confidence interval: -12.4 to -3.8; p < 0.001) compared with placebo. Postoperative pain and functional outcomes also favored mecobalamin. The reduction in VAS score from preoperation to postoperation was significantly greater in the mecobalamin group, with an adjusted mean difference of -0.49 (95% confidence interval: -0.8 to -0.2; p = 0.001) at the 1-year follow-up.</p><p><strong>Conclusion: </strong>Prophylactic mecobalamin significantly lowered the occurrence of CRPS-1 in foot ankle surgery.</p><p><strong>Level of evidence: </strong>Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13259568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender Disparities in Financial Relationships Between Industry and Orthopaedic Surgeons Are Improving But Still Persist.","authors":"David N Bernstein, Gabrielle S Ray, Emily B Parker, Cat N Johnson, Tamara D Rozental, A Holly Johnson","doi":"10.2106/JBJS.OA.26.00109","DOIUrl":"10.2106/JBJS.OA.26.00109","url":null,"abstract":"<p><strong>Background: </strong>Prior research has revealed gender disparities in the financial relationships between industry and orthopaedic surgeons. Despite attempts to level the playing field, it remains unclear whether these efforts have reduced or eliminated gender disparities in financial relationships between industry and orthopaedic surgeons.</p><p><strong>Methods: </strong>The Centers for Medicare and Medicaid Services (CMS) Open Payments database was queried from January 1, 2024, to December 31, 2024 for orthopaedic surgeons receiving \"consulting fee\" or \"royalty or license\" payments of $1,000 or more. Surgeon characteristics were recorded from the CMS database and public sources. Total payment amounts and number of payments were calculated. Characteristics were compared by gender between those receiving any industry payment, consulting payment, and royalty payment. Multivariable linear regression analyses were used to identify factors associated with payment amount and number of payments. Results were compared with a study using similar data from 2016 to 2017.</p><p><strong>Results: </strong>A total of 3,714 surgeons received industry payments, with 3,514 (95%) being men. Of those receiving royalty payments (n = 1,374), 1.5% (n = 21) were women. Of those receiving consulting payments (n = 3,122), 6.2% (n = 194) were women. Men (β = 1.57 [95% confidence interval [CI]: 0.41-2.73, p = 0.008), years of experience (β = 0.09 [95% CI: 0.07-0.12], p < 0.001), and adult reconstruction (β = 1.77 [95% CI: 0.76-2.79], p = 0.001) were associated with a greater total number of payments. Hand surgery (β = -2.57 [95% CI: 3.97 to -1.17], p < 0.001), pediatrics (β = -2.62 [95% CI: 4.60 to -0.64], p = 0.01), and sports (β = -1.12 [95% CI: 2.08 to -0.16], p = 0.02) were associated with the fewer total number of payments. Men (β = 0.34 [95% CI: 0.10-0.57], p = 0.004), years of experience (β = 0.051 [95% CI: 0.046-0.056], p < 0.001), and adult reconstruction (β = 0.47 [95% CI: 0.27-0.68], p < 0.001) were associated with greater payment amounts, while hand (β = -0.96 [95% CI: 1.24 to -0.68], p < 0.001) and pediatrics (β = -0.79 [95% CI: 1.18 to -0.39], p < 0.001) were associated with lower payment amounts. When examining trends over time, men received 1.57 (2024) vs. 5.17 (2016-2017) additional payments and 40% (2024) vs. 197% (2016-2017) larger payments compared with women.</p><p><strong>Conclusions: </strong>Gender disparities in financial relationships (i.e., number of payments and payment amounts) between industry and orthopaedic surgeons persist, though are improved compared with prior research from about a decade ago.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic Assessment of Spinopelvic Parameters in Asymptomatic Ethiopian Adults: A Cross-Sectional Study.","authors":"Fentahun Bantigegn Seyoum, Alazar Menbere Haile, Eskinder Kebede Tadesse, Kaleab Tesfaye Reda, Tofike Aman Kersema, Semehal Berihun Demewez, Amanuel Berhaneselassie Stephano, Michael Mamusha Shenkute, Biruk Lambisso Wamisho","doi":"10.2106/JBJS.OA.26.00028","DOIUrl":"10.2106/JBJS.OA.26.00028","url":null,"abstract":"<p><strong>Background: </strong>Spinopelvic alignment is central to spinal biomechanics and surgical planning. Normative spinopelvic parameters vary by geography and ethnicity, and reference data for Ethiopia have not previously been reported.</p><p><strong>Objectives: </strong>This study aimed to determine normative spinopelvic parameters in healthy Ethiopian adults and examine their variation based on age and sex.</p><p><strong>Methods: </strong>An observational cross-sectional study was conducted at Tikur Anbessa Specialized Hospital between August and December 2025. The study included 117 healthy adults (60 men, 57 women). Standardized standing lateral lumbosacral radiographs were obtained. Two spine surgeons independently measured pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and lumbar lordosis (LL).</p><p><strong>Results: </strong>The median age was 40 years. The mean values were PI 52.6° ± 8.9°, SS 39.8° ± 7.4°, PT 12.9° ± 7.0°, and LL 60.1° ± 8.5° (measured from the inflection point to S1). LL exceeded values reported in Asian and North American cohorts but was comparable with African and European populations. Women demonstrated higher values across all parameters. Multivariable regression identified PI (β = 0.83, p < 0.001), PT (β = -0.76, p < 0.001), and female sex (β = 3.05, p = 0.008) as independent predictors of LL (R² = 0.64).</p><p><strong>Conclusions: </strong>This study establishes the first normative spinopelvic reference values for asymptomatic Ethiopian adults, providing a foundation for population-specific alignment assessment and future outcome studies.</p><p><strong>Level of evidence: </strong>Level IV Diagnostic. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Neurography Within a Multimodal Framework for Predicting C5 Root Graftability in Traumatic Brachial Plexus Injury.","authors":"Ying-Hsuan Lee, Yenpo Lin, Yu-Ching Lin, Tommy Nai-Jen Chang, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu","doi":"10.2106/JBJS.OA.26.00123","DOIUrl":"10.2106/JBJS.OA.26.00123","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative assessment of C5 nerve root graftability is crucial for surgical planning in brachial plexus injuries. This study evaluates the diagnostic accuracy of magnetic resonance neurography (MRN) compared with clinical examination and electrodiagnostic studies in predicting C5 graftability.</p><p><strong>Methods: </strong>This retrospective cohort study included 402 adult traumatic brachial plexus injuries patients undergoing nerve reconstruction at a single tertiary center between September 2008 and November 2024. Patients were categorized into panplexus (C5-T1, n = 166) and non-panplexus (n = 236) injuries. Diagnostic modalities included physical examination (deafferentation pain, Tinel's sign, rhomboid, and levator scapulae muscle power [MP]), electromyography of C5 paraspinal and rhomboid muscles, and high-resolution MRN with avulsion severity scoring. Intraoperative surgical inspection served as the reference standard. Multivariate logistic regression and receiver operating characteristic curve analysis evaluated diagnostic performance.</p><p><strong>Results: </strong>Intraoperative exploration revealed graftable C5 roots in 195 patients (48.5%). MRN demonstrated the highest predictive value (odds ratio 9.171, p < 0.001). Optimal diagnostic models varied by injury pattern: Panplexus injuries showed optimal prediction with MRN plus Tinel's sign (area under the receiver operating characteristic curve 0.828), while non-panplexus injuries required MRN, Tinel's sign, and levator scapulae MP (area under the receiver operating characteristic curve 0.766). Electromyography showed limited diagnostic value.</p><p><strong>Conclusions: </strong>MRN is a valuable tool for assessing C5 nerve root graftability, demonstrating the highest predictive performance among evaluated modalities. When combined with clinical examination, it supports structured preoperative decision making in brachial plexus reconstruction.</p><p><strong>Level of evidence: </strong>Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generative Artificial Intelligence Chatbots for Parental Guidance in Pediatric Orthopaedics: A Pilot Feasibility Study.","authors":"Wayne Yong Xiang Foo, Kenneth Pak Leung Wong, Arjandas Mahadev, Mohammad Ashik Bin Zainuddin, Andrew Chia Chen Chou","doi":"10.2106/JBJS.OA.26.00078","DOIUrl":"10.2106/JBJS.OA.26.00078","url":null,"abstract":"<p><strong>Background: </strong>Parents of children with pediatric orthopaedic conditions frequently have questions after their clinic visit, and a reliable postconsultation resource to address these enquiries is lacking. Online resources are variable in quality, and general purpose artificial intelligence (AI) models have demonstrated safety limitations, including unprompted treatment recommendations and citation inaccuracies. A purpose-built, supervised generative AI solution may offer a safer and more reliable alternative.</p><p><strong>Methods: </strong>A generative AI chatbot was developed using retrieval-augmented generation and trained on OrthoKids educational materials covering 5 common pediatric orthopaedic conditions: in-toeing, flatfoot, scoliosis, bow legs, and knock knees. After iterative refinement by 2 fellowship-trained pediatric orthopaedic surgeons, the chatbot was evaluated by 18 multidisciplinary clinicians using a structured 12-item 5-point Likert scale survey assessing accuracy, safety, usability, and clinical acceptability.</p><p><strong>Results: </strong>Mean scores exceeded 4.0 of 5.0 on 11 of 12 domains. Clarity of explanation achieved unanimous positive endorsement (100%), while protocol alignment received the highest mean score (4.50 ± 0.62). Citation accuracy was the lowest-rated domain (4.00 ± 0.77). No hallucinations were identified, and 88.9% of evaluators confirmed the absence of unprompted treatment recommendations. The reverse-scored safety item (Q8) demonstrated the greatest inter-rater variability (mean 3.11 ± 1.57), with orthopaedic specialists rating perceived harm substantially lower (mean 1.33) than nurses (mean 4.40).</p><p><strong>Conclusion: </strong>A purpose-built gen AI chatbot demonstrated high clinical accuracy and acceptability among multidisciplinary evaluators, with effective avoidance of unprompted treatment recommendations. These pilot findings support feasibility for use as a parental education adjunct in pediatric orthopaedic practice.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strain-Dependent Effects of Controlled Micromotion on Fracture Healing: Rethinking the Strain Threshold.","authors":"Weichen Qi, Jiaxin Lv, Xiaoreng Feng, Bin Chen, Frankie Ka Li Leung","doi":"10.2106/JBJS.OA.26.00108","DOIUrl":"10.2106/JBJS.OA.26.00108","url":null,"abstract":"<p><strong>Background: </strong>The strain required to optimize controlled micromotion in indirect (callus-mediated) fracture healing remains uncertain. Although the classic 2% to 10% strain range proposed by Perren is widely cited, several animal and clinical studies have reported healing at higher strain levels. This study evaluated the strain-healing relationship in a controlled micromotion model. We hypothesized that the strain threshold that supports healing exceeds 10%.</p><p><strong>Materials and methods: </strong>A standardized 2-mm transverse osteotomy was created in Sprague-Dawley rats and stabilized with an external fixator capable of delivering precise micromotion. Five strain levels (0%, 10%, 20%, 30%, 40%) were applied once daily at 0.5 Hz for 30 minutes beginning 2 weeks after surgery and continued for 2 weeks. Healing was assessed by radiographs, micro-computed tomography, mechanical testing, histology, and immunohistochemistry.</p><p><strong>Results: </strong>A strain level of 20% was associated with the most favorable overall healing profile across radiographic, structural, and mechanical assessments, with no cases of nonunion. Lower strains demonstrated limited callus formation, while higher strains produced abundant early cartilage but delayed conversion to bone and reduced mineralization. Moderate strain was accompanied by balanced expression of IL-6, IL-1β, and RANKL/OPG, whereas excessive strain showed patterns consistent with impaired remodeling.</p><p><strong>Conclusions: </strong>Under stable fixation and before the fracture gap transitions to stiffer cartilaginous tissue, the functional upper limit of beneficial strain appears to exceed the traditional 10% threshold. Approximately 20% of compressive strain, applied between day 14 and 21 postosteotomy, provided the most balanced combination of early repair and subsequent remodeling in this model.</p><p><strong>Clinical relevance: </strong>These findings suggest that controlled micromotion with 20% interfragmentary strain may be most relevant to fractures managed under relative stability and healing through callus formation. However, faster callus-mediated healing is not inherently clinically advantageous, and its value depends on fracture type, anatomical site, and fixation strategy.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Social Media Utilization Among Members of the Musculoskeletal Tumor Society: Implications in Practice.","authors":"Mark P Youssef, Andrew F Ibrahim, Alexandria Giese, Jake A Fiore, Paul G Guirguis, Mina Botros, Susan McDowell","doi":"10.2106/JBJS.OA.25.00088","DOIUrl":"10.2106/JBJS.OA.25.00088","url":null,"abstract":"<p><strong>Background: </strong>Social media plays an increasing role in healthcare, influencing patient education, provider selection, and physician marketing. Previous studies show mixed results on its impact on physician review scores, and limited data exist within orthopedic oncology. The purpose of this study was to quantify social media utilization among Musculoskeletal Tumor Society (MSTS) members as well as identify any differences by physician sex or practice type.</p><p><strong>Methods: </strong>All active MSTS members were searched for common social media accounts. Account activity and engagement data were acquired. Publicly available ratings from popular physician review websites were compiled. Data were collected on each member's demographic details including sex, geographical location, type of practice, and h-index. The association between social media activity and online review scores was analyzed using chi-square tests for categorical data and t-tests for continuous variables.</p><p><strong>Results: </strong>A total of 247 MSTS members, comprising 199 academic and 48 private surgeons, revealed significant differences in orthopedic surgeon social media engagement and online presence. At least 1 social media account was used by 178 (72.1%) of MSTS members with LinkedIn most used (57.9%) followed by ResearchGate (39.7%). Surgeons with 3 or more active social media accounts demonstrated significantly higher ratings on practice-affiliated scoring sites compared with those without any social media presence (4.88 ± 0.10 vs. 4.82 ± 0.13, p = 0.017), and a significant difference was observed in practice-affiliated scoring, with higher h-index surgeons receiving better ratings (4.84 ± 0.10 vs. 4.79 ± 0.11, p = 0.009).</p><p><strong>Conclusions: </strong>Most MSTS members do not have professional social media accounts geared toward the patient population (i.e. Instagram, TikTok). Although social media demonstrates benefits of patient engagement, education, and recruitment, there was only significant difference in ratings on practice-affiliated scoring sites with over 3 social media accounts compared with surgeons without any accounts.</p><p><strong>Level of evidence: </strong>Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound Screening for Developmental Hip Dysplasia: A Markov Cost-Utility Analysis Comparing 6 Variations of Ultrasound Hip Screening to No Screening Modeled Across the Lifespan.","authors":"Joshua T Bram, Drake G Lebrun, Bridget K Ellsworth, Olivia C Tracey, Pari L Palandjian, Peter Cirrincione, Erikson Nichols, Ernest L Sink, Emily R Dodwell","doi":"10.2106/JBJS.OA.26.00068","DOIUrl":"10.2106/JBJS.OA.26.00068","url":null,"abstract":"<p><strong>Background: </strong>Developmental hip dysplasia (DDH) is now considered the primary cause of early hip arthritis. Complications of missed or delayed DDH may be minimized with early diagnosis and effective nonoperative interventions. The standard of care in the United States for detecting DDH is selective screening whereby ultrasound is only performed in infants with an abnormal physical examination or risk factors. A cost-effectiveness analysis, considering health utilities and lifespan costs, is warranted.</p><p><strong>Methods: </strong>A Markov model was designed comparing 7 DDH screening strategies: Universal ultrasound screening at birth 2 weeks (USB); selective ultrasound screening at birth/2 weeks (SSB); universal ultrasound screening at 6 weeks (US6); selective ultrasound at 6 weeks (SS6); universal hybrid screening with ultrasound birth 2 weeks for positive examination and at 6 weeks for all others (UHS); a German national model with ultrasound at birth/2 weeks for instability or risk factors and all others at 6 weeks; and a no ultrasound screening. A literature review captured relevant probabilities, costs, and incidences. Society and payer perspectives were analyzed. Deterministic and probabilistic sensitivity analyses were used.</p><p><strong>Results: </strong>From a societal perspective, US6 was more effective (77.08 vs. 77.06 quality-adjusted life years (QALYs)) yet minimally more costly ($5,629.68 vs. $5,471.50) than SS6. Using a willingness-to-pay threshold of <$100,000/QALY, US6 was more cost-effective than SS6 (incremental cost effectiveness ratio [ICER] = $7,833.45/QALY). From the payer perspective, US6 was again cost-effective relative to SS6 (ICER = $8,224.57/QALY). US6 was overall cost-effective (<$100,000/QALY) in 50.4% of 10,000 probabilistic sensitivity analysis iterations assessing societal costs (vs. 20.8% UHS, 13.2% SS6, 12.6% German, 2.6% USB, and 0.5% SSB) and 50.7% of payer iterations (vs. 21.0% UHS, 13.4% SS6, 12.3% German, 2.3% USB, and 0.4% SSB). UHS was the second most cost-effective (77.06 QALYs, societal = $5,668.58, payer = $4,351.63). Differences in mean costs and QALYs among leading strategies were small.</p><p><strong>Conclusion: </strong>US6 was the most cost-effective strategy in the base case from both societal and payer perspectives. Given small differences in mean costs and QALYs among leading strategies, implementation feasibility and outcome distribution may be important policy considerations in the US context. A UHS strategy may represent a pragmatic pathway for adoption while preserving broader detection benefits.</p><p><strong>Level of evidence: </strong>III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Sectional and Radiologic Imaging as an Adjunct Teaching Modality in Musculoskeletal Anatomy Education.","authors":"Ameen Suhrawardy, Dylan Moran, Muhammad Waheed, Sayf Al-Katib, Rahul Vaidya, Malli Barremkala, Drew D Moore","doi":"10.2106/JBJS.OA.25.00255","DOIUrl":"10.2106/JBJS.OA.25.00255","url":null,"abstract":"<p><strong>Background: </strong>Exposure to musculoskeletal (MSK) imaging is limited in medical education. Radiology integration and module-based learning have been previously shown to improve learning when integrated with anatomy education. This project aims to create, implement, and assess self-directed, image-based modules to enhance visuospatial understanding of MSK anatomy among undergraduate medical students. We hypothesize that students using this resource will show greater anatomical understanding and higher end-of-course examination scores.</p><p><strong>Methods: </strong>Two modules incorporating interactive interfaces and cross-sectional imaging with MSK anatomy were integrated into the preclinical MSK course at a single U.S. M.D. program. Data on student engagement with the module were compared with performance on the end-of-course written examination and practical examination. Subjective data on the perceived efficacy of the educational resource were collected.</p><p><strong>Results: </strong>Between the academic years of 2022 and 2025, 114 (23.5%) and 165 (33.8%) second-year medical students completed the optional spine and upper extremity modules, respectively, from 488 total enrolled in the MSK course. Those who completed the spine module and the upper extremity module had a mean 3.5% increase (p < 0.0001) and 3.3% increase (p = 0.00025) in final practical anatomy examination scores compared with those who did not use the modules. Usage of the module did not result in a statistically significant increase in final written examination scores. 98.0% of respondents on the postmodule survey reported that the modules improved their understanding of MSK anatomy.</p><p><strong>Conclusion: </strong>The results from the collected data show utilization of interactive modules incorporating imaging alongside MSK anatomy specifically improved performance on practical anatomy assessments. Integration of cross-sectional and radiologic imaging in MSK anatomy instruction can improve visuospatial understanding of anatomy among medical trainees and can be an effective method to prepare them for clinical application.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148158209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}