{"title":"Cybersecurity is imperative in robotic arthroplasty.","authors":"Vaibhav Bagaria, Raju Vaishya, Abhishek Vaish, Sébastien Lustig","doi":"10.1051/sicotj/2026019","DOIUrl":"10.1051/sicotj/2026019","url":null,"abstract":"<p><p>Robotic platforms have revolutionized arthroplasty through precision and patient-specific planning, yet introduce cyber-physical vulnerabilities in interconnected surgical ecosystems. Recent incidents, including the 2026 cyber-attack, highlight operational risks despite low direct intraoperative threats. Proactive cybersecurity, via FDA-aligned secure design, institutional audits, and surgeon vigilance, is imperative to safeguard patient safety and trust in precision orthopedics.</p>","PeriodicalId":46378,"journal":{"name":"SICOT-J","volume":"12 ","pages":"E3"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844204","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}
SICOT-JPub Date : 2026-01-01Epub Date: 2026-05-25DOI: 10.1051/sicotj/2026021
Raju Vaishya, Brij Mohan Gupta, Mallikarjun Kappi, Abhishek Vaish, Andreas F Mavrogenis, Sébastien Lustig, Vikas Khanduja
{"title":"A decade of global orthopaedic research in SICOT-J (2015-2025): a scientometric analysis of publication trends, collaboration, and citation impact.","authors":"Raju Vaishya, Brij Mohan Gupta, Mallikarjun Kappi, Abhishek Vaish, Andreas F Mavrogenis, Sébastien Lustig, Vikas Khanduja","doi":"10.1051/sicotj/2026021","DOIUrl":"10.1051/sicotj/2026021","url":null,"abstract":"<p><strong>Background: </strong>The SICOT-J, an open-access orthopedic journal affiliated with the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT), has been a global orthopedic research platform since 2015. This study provides a scientometric analysis of SICOT-J publications from 2015 to 2025 to evaluate research productivity, citation impact, and collaboration patterns.</p><p><strong>Methods: </strong>542 documents published in SICOT-J and indexed in the Scopus database were analyzed using bibliometric indicators. Data on publication types, subject areas, authorship, institutional and geographic affiliations, funding disclosures, collaboration networks, and citation metrics were extracted. Microsoft Excel was used for data processing and analysis. Key indicators included citations per publication (CPP), relative citation index (RCI), and total link strength (TLS) for collaborative connections.</p><p><strong>Results: </strong>From January 1 2015, to June 30 2025, SICOT-J published 542 articles with an overall CPP of 10.29. Research articles comprised 78.6% of publications, while reviews - though fewer in number - had the highest CPP (23.38). The most frequent topics were arthroplasty (25.83%) and trauma/fractures (24.17%), with the hip and knee as the most studied anatomical regions. Only 5.17% of the articles reported external funding. Fifteen highly cited papers (≥50 citations) were mostly reviews and internationally co-authored.</p><p><strong>Conclusions: </strong>SICOT-J has demonstrated consistent publication growth and international participation, though with notable concentration in a few high-income countries. The high citation impact of reviews and collaborative works highlights the importance of strategic content development. Enhancing funding transparency, supporting underrepresented regions, and promoting emerging topics strengthen the journal's global impact.</p>","PeriodicalId":46378,"journal":{"name":"SICOT-J","volume":"12 ","pages":"32"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057490","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}
SICOT-JPub Date : 2026-01-01Epub Date: 2026-08-07DOI: 10.1051/sicotj/2026048
Jesper Fritz, Luke V Tollefson, Zakee Azmi, Sebastien Parratte, Robert F LaPrade
{"title":"Posterior tibial slope in the Emirati population: The slope is over 12 degrees.","authors":"Jesper Fritz, Luke V Tollefson, Zakee Azmi, Sebastien Parratte, Robert F LaPrade","doi":"10.1051/sicotj/2026048","DOIUrl":"10.1051/sicotj/2026048","url":null,"abstract":"<p><strong>Introduction: </strong>Posterior tibial slope (PTS) has been reported to be an important risk factor for anterior cruciate ligament (ACL) reconstruction (ACLR) failure. PTS varies between populations, and a mean value in the Emirati population has not been described. To evaluate PTS and to improve clinical decision-making regarding surgical thresholds for slope correcting osteotomy, a mean value for the Emirati population needs to be defined.</p><p><strong>Methods: </strong>This was an institutional review board-approved retrospective study of 213 consecutive Emirati patients with knee complaints visiting a single orthopedic center in 2025. Inclusion criteria were patients >18 years of age visiting the center for the first time with no previous surgery or fracture in the affected knee. Medial and lateral PTS were measured on long weight-bearing lateral tibial radiographs using the proximal and long anatomical tibial axis and mechanical tibial axis.</p><p><strong>Results: </strong>A total of 213 patients, 73 women and 140 men, were evaluated with a mean age of 46.0 years. The mean medial PTS was 12.8° ± 2.9° (range: 3.7-19.7°), and the mean lateral PTS was 11.9° ± 3.2° (range: 3.9-20.1°) using the proximal tibial axis. Using the long anatomical tibial axis, the mean medial PTS was 14.7° ± 3.3° (range: 4.8-25.5°), and the mean lateral PTS was 13.8° ± 3.7° (range: 5.1-24.8°). Using the mechanical tibial axis, the mean medial PTS was 12.7° ± 3.1° (range: 2.7-19.7°) and the mean lateral PTS was 12.2° ± 3.1° (range: 3.8-20.1°). Sex did not influence the PTS value (p > 0.05).</p><p><strong>Discussion: </strong>In this Emirati population, the mean medial PTS was 12.7-14.7° and the mean lateral PTS was 11.9-13.8° for the differing measurement techniques. These values are higher than other reported populations and can be used as a reference when evaluating knee injuries and contribute to surgical decision-making in ACL-deficient knees.</p>","PeriodicalId":46378,"journal":{"name":"SICOT-J","volume":"12 ","pages":"45"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686377","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}
SICOT-JPub Date : 2026-01-01Epub Date: 2026-02-26DOI: 10.1051/sicotj/2025071
Abdullah Addar, Abdullah I Alturki, Yazeed Alsanad, Turki Alotaibi, Fahad Alshayhan
{"title":"Early and late initiation of the Ponseti method yield comparable outcomes in congenital idiopathic clubfoot: a systematic review and meta-analysis.","authors":"Abdullah Addar, Abdullah I Alturki, Yazeed Alsanad, Turki Alotaibi, Fahad Alshayhan","doi":"10.1051/sicotj/2025071","DOIUrl":"10.1051/sicotj/2025071","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal timing to initiate the Ponseti method for congenital idiopathic clubfoot remains uncertain. This systematic review and meta-analysis aimed to evaluate whether starting treatment within the first four weeks of life improves outcomes compared to later initiation.</p><p><strong>Methods: </strong>Following PRISMA guidelines (PROSPERO ID: CRD42025650117), MEDLINE, Embase, Cochrane Library, and Google Scholar were searched for studies comparing early (≤4 weeks) versus late (>4 weeks) initiation of the Ponseti method. Outcomes included the number of casts, the relapse rate, and the need for tenotomy. Data were pooled using a random-effects model, and study quality was assessed using the MINORS tool.</p><p><strong>Results: </strong>Six studies involving 467 patients (689 feet) met the inclusion criteria. Early initiation was associated with a slightly higher mean number of casts (MD = 0.72, 95% CI [0.33-1.10], p = 0.0002), but this difference was not significant in the overall pooled analysis (MD = 0.06, 95% CI [-1.08-1.21], p = 0.91). Relapse (OR = 0.70, p = 0.68) and tenotomy rates (OR = 0.68, p = 0.41) were comparable between groups.</p><p><strong>Discussion: </strong>Although earlier treatment may require more casts, it does not reduce relapse or tenotomy rates. These findings suggest that initiating treatment after four weeks yields comparable outcomes, offering flexibility in clinical practice without compromising results. Variability across studies highlights the need for standardized treatment protocols and well-designed randomized controlled trials to confirm the optimal initiation age.</p>","PeriodicalId":46378,"journal":{"name":"SICOT-J","volume":"12 ","pages":"10"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12947636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311215","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}
SICOT-JPub Date : 2026-01-01Epub Date: 2026-05-13DOI: 10.1051/sicotj/2026022
Dominique F Gazielly, Marius M Scarlat
{"title":"The essential role of rehabilitation in operative and non-operative shoulder management: A 40-year experience (1985-2025).","authors":"Dominique F Gazielly, Marius M Scarlat","doi":"10.1051/sicotj/2026022","DOIUrl":"10.1051/sicotj/2026022","url":null,"abstract":"<p><strong>Introduction: </strong>As early as 1985, Charles S. Neer II and Peter Welsh emphasized that successful shoulder treatment - whether surgical or non-surgical - relies on structured rehabilitation based on simple exercises performed independently by the patient several times daily. The Sarah Jackins auto-rehabilitation program, developed with Frederick A. Matsen and Douglas T. Harryman in Seattle, further reinforced this concept and was widely implemented in clinical practice and training.</p><p><strong>Methods: </strong>This paper describes the application of four key rehabilitation principles in more than 24,000 patients treated for shoulder conditions, including over 8,000 surgical cases.</p><p><strong>Results and discussion: </strong>The protocol is based on (1) simple self-administered exercises performed three to five times daily, (2) supervision by a trained physiotherapist. The paper is well illustrated with examples of all the exercises performed. Type of paper: Descriptive, Level V of evidence, Expert Opinion.</p>","PeriodicalId":46378,"journal":{"name":"SICOT-J","volume":"12 ","pages":"28"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934386","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}
SICOT-JPub Date : 2026-01-01Epub Date: 2026-10-07DOI: 10.1051/sicotj/2026077
Raju Vaishya, Abhishek Vaish
{"title":"AI-induced deskilling in orthopedic surgery: Preserving judgment in the age of intelligent decision support.","authors":"Raju Vaishya, Abhishek Vaish","doi":"10.1051/sicotj/2026077","DOIUrl":"10.1051/sicotj/2026077","url":null,"abstract":"<p><p>Artificial intelligence (AI) is rapidly entering orthopedic practice, offering efficiency gains while risking cognitive deskilling, particularly among trainees who may shift from generating clinical judgments to passively verifying algorithmic recommendations. Drawing on foundational automation-bias literature, cognitive-load theory, deliberate-practice principles, and Miller's pyramid of competence, this editorial argues that orthopedic education must explicitly cultivate \"AI independence\" alongside AI fluency. We propose periodic AI-off assessments, a structured competency framework aligned with entrustable professional activities, and calibrated reliance modeled on aviation safety practices, so that future surgeons retain the capacity to reason, override, and remain accountable when intelligent systems are unavailable or incorrect.</p>","PeriodicalId":46378,"journal":{"name":"SICOT-J","volume":"12 ","pages":"E5"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128418","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}
SICOT-JPub Date : 2026-01-01Epub Date: 2026-05-19DOI: 10.1051/sicotj/2026012
Yuanzhuo Xu, Shengdong Yang, Fuqiang Gao, Sébastien Lustig, Weiguo Wang
{"title":"Global trends and hotspots in robotic-assisted arthroplasty from 1992 to 2025: a bibliometric and visualized analysis.","authors":"Yuanzhuo Xu, Shengdong Yang, Fuqiang Gao, Sébastien Lustig, Weiguo Wang","doi":"10.1051/sicotj/2026012","DOIUrl":"10.1051/sicotj/2026012","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted arthroplasty (RAA) is a rapidly advancing technology in orthopedic surgery. This study aims to conduct a comprehensive bibliometric analysis to map the global research landscape, identify hotspots, and trace the evolution of this field from 1992 to 2025.</p><p><strong>Methods: </strong>Literature was retrieved from the Science Citation Index Expanded (SCI-E) and Social Sciences Citation Index (SSCI) of Web of Science Core Collection. CiteSpace (6.3.R1) and VOSviewer (1.6.20) were employed to perform quantitative and visualized analyses of countries, institutions, authors, journals, co-citations, and keywords.</p><p><strong>Results: </strong>A total of 1373 publications were included. The annual publication output demonstrated exponential growth, particularly in the last five years. The USA led in productivity, while the United Kingdom had the highest average citation frequency. Mont, Michael A., Batailler, Cécile, and Lustig, Sébastien were identified as the most prolific authors. The Journal of Arthroplasty published the most papers. Keyword analysis revealed that research hotspots focused on total knee arthroplasty, alignment, accuracy, and functional alignment. Bursts and timeline analyses indicated a shift in frontiers from alignment accuracy and clinical outcomes to updates of robotic systems and new technologies.</p><p><strong>Conclusion: </strong>This bibliometric analysis maps the evolution of RAA, highlighting a shift from technical precision to patient-centered outcomes, and identifies future directions, including long-term benefit assessment and technology integration.</p>","PeriodicalId":46378,"journal":{"name":"SICOT-J","volume":"12 ","pages":"31"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13196294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989408","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}
SICOT-JPub Date : 2026-01-01Epub Date: 2026-09-22DOI: 10.1051/sicotj/2026060
Vaibhav Bagaria, Sachin Tapasvi, Anjali Tiwari
{"title":"Indian expert consensus on prophylactic incisional single-use negative pressure wound therapy in hip and knee arthroplasty: A modified Delphi study.","authors":"Vaibhav Bagaria, Sachin Tapasvi, Anjali Tiwari","doi":"10.1051/sicotj/2026060","DOIUrl":"10.1051/sicotj/2026060","url":null,"abstract":"<p><strong>Background: </strong>Surgical site complications remain an important cause of morbidity following total hip and knee arthroplasty. While international guidelines support the selective use of prophylactic single-use negative pressure wound therapy (sNPWT) in appropriately selected high-risk patients and surgical incisions, these recommendations are largely derived from studies performed in highly standardized healthcare environments. Differences in patient characteristics, healthcare delivery, perioperative pathways, resource utilization, and postoperative surveillance may influence their applicability across diverse healthcare systems. Consequently, pragmatic, context-specific recommendations are needed to translate the available evidence into routine clinical practice in India and other countries with similar healthcare settings.</p><p><strong>Methods: </strong>A modified Delphi process was conducted involving 10 experienced arthroplasty surgeons from across India. An exploratory meeting identified key clinical questions and developed candidate statements. Subsequently, nine experts independently evaluated 13 statements using anonymous four-point Likert-scale voting. Consensus was predefined as ≥75% agreement.</p><p><strong>Results: </strong>Twelve of the 13 candidate statements achieved consensus (agreement 77.8%-100%). The expert panel agreed that prophylactic sNPWT may be considered in selected high-risk situations, including revision arthroplasty involving implant removal, prolonged operative time (>120 min), morbid obesity (BMI > 40 kg/m<sup>2</sup>), uncontrolled diabetes (HbA1c > 8%), and high-tension wounds. Consensus was also achieved on key contraindications and practical application principles. These recommendations represent consensus-informed clinical guidance rather than definitive evidence-based recommendations.</p><p><strong>Conclusion: </strong>This modified Delphi consensus translates the available evidence and collective expert experience into practical recommendations for the selective use of prophylactic sNPWT following hip and knee arthroplasty. By providing a structured framework for patient selection and application, it aims to support consistent, evidence-informed decision-making in routine clinical practice, particularly in healthcare settings where context-specific implementation of international recommendations is required. Prospective clinical and health economic studies are needed to further validate these recommendations.</p>","PeriodicalId":46378,"journal":{"name":"SICOT-J","volume":"12 ","pages":"56"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026285","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}
SICOT-JPub Date : 2026-01-01Epub Date: 2026-10-13DOI: 10.1051/sicotj/2026055
Guillaume Auberger, Pierre-Alban Bouché, Thomas Aubert, Luc Lhotellier, Younes Kerroumi, Beate Heym, Valérie Zeller, Simon Marmor
{"title":"Unexpected positive intraoperative culture during supposed aseptic hip revision: Antibiotherapy is an effective and safe treatment. About 50 cases.","authors":"Guillaume Auberger, Pierre-Alban Bouché, Thomas Aubert, Luc Lhotellier, Younes Kerroumi, Beate Heym, Valérie Zeller, Simon Marmor","doi":"10.1051/sicotj/2026055","DOIUrl":"https://doi.org/10.1051/sicotj/2026055","url":null,"abstract":"<p><strong>Background: </strong>The management of periprosthetic joint infection (PJI) in revision total hip arthroplasty (rTHA) with unsuspected positive intraoperative cultures (UPC) is not well codified. There are conflicting results in the literature. No study reported the long-term outcomes between single or both component rTHA with UPC. The aim of this study was to compare the overall survival rate of single component revision to total in case of rTHA with UPC using an institutional registry database. The reinfection-free survival rate was assessed as secondary outcomes.</p><p><strong>Methods: </strong>Patients were selected from a PJI institutional registry of THA between March 2003 and May 2020. Fifty rTHA with UPC were finally included in the study: 26 in the both component revision group and 24 in the single component revision group. The mean age of the patients was 64.8 years (range: 30.6; 88.2), 36% (18/50) of the patients were women and with a mean body mass index (BMI) of 27.6 Kg/m2 (range: 19.6; 39.5). Kaplan-Meier analyses were performed to compare overall survival rate between groups.</p><p><strong>Results: </strong>The overall survival rate in our series of rTHA with UPC was 70.0% [56.1%-87.2%] at 10 years. Fourteen re-interventions were carried out during the follow-up period (28.0%, 14/50). There was no significant difference between groups (61.4% vs. 79.3% at 10 years, respectively in both and single rTHA, p = 0.76). At the last follow-up, three infections were observed (6%, 3/50): 1 relapse (33.4%) and 2 new infections (66.6%). There was no significant difference between groups (83.2% vs. 100.0% at 10 years, respectively in both and single component rTHA, p = 0.08).</p><p><strong>Conclusion: </strong>Antibiotic therapy alone for UPC in a single component revision of a presumed aseptic THA is a safe and effective treatment. Therapeutic study level of evidence, level III retrospective study.</p>","PeriodicalId":46378,"journal":{"name":"SICOT-J","volume":"12 ","pages":"69"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185256","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}
SICOT-JPub Date : 2026-01-01Epub Date: 2026-01-28DOI: 10.1051/sicotj/2025066
Fumiyoshi Kawashima, Ryuichi Nakamura, Akira Okano, Kaori Matsumoto, Jun Oike, Koji Kanzaki
{"title":"Direction of screw insertion for internal fixation plate in distal femoral osteotomy: Evaluation using axial computer tomography imaging.","authors":"Fumiyoshi Kawashima, Ryuichi Nakamura, Akira Okano, Kaori Matsumoto, Jun Oike, Koji Kanzaki","doi":"10.1051/sicotj/2025066","DOIUrl":"10.1051/sicotj/2025066","url":null,"abstract":"<p><strong>Purpose: </strong>In distal femoral osteotomy (DFO), using longer distal screws in fixation plates may improve stability. This study examined the insertion direction of three distal screws at the horizontal cross-section to determine if posterior angulation enables deeper placement.</p><p><strong>Methods: </strong>Forty-seven varus knees that underwent DFO were included (medial closed-wedge DFO [MCWDFO], 30 knees; lateral closed-wedge DFO [LCWDFO], 17 knees). Postoperative plain CT images were obtained from a plane parallel to the three distal screws, with the most distal screw designated as A, the anterior of the second distal row as B, and the posterior of the second distal row as C. For each case, a curve passing through the center of the bony cortex on the cross-section parallel to each screw and over its entire length was drawn, and the curve and the lower edge of the screw were projected onto a graph. The maximum angle at which the lower edge of each screw touches the intercondylar region without interfering with the intercondylar region was designated as (AnA), (AnB), and (AnC) for A-, B-, and C-screws, respectively. The angle between the line connecting the insertion points of the B- and C-screws on the plate and the tangent line to the medial and lateral bony cortex was designated as (AnP).</p><p><strong>Results: </strong>In the MCWDFO group, the mean values for each parameter were AnA, 10.9 ± 5.4; AnB, 27.0 ± 4.2; AnC, 9.2 ± 3.4; and AnP, -2.6 ± 6.9. In the LCWDFO group, the mean values for each parameter were AnA, 18.2 ± 6.9; AnB, 30.4 ± 7.1; AnC, 16.1 ± 7.2; AnP, -0.2 ± 6.1°.</p><p><strong>Conclusions: </strong>The medial surface is inclined compared to the epicondylar axis and posterior condyle, usually resulting in plate positioning that is parallel to the placement surface. The optimal screw insertion from the anterior to posterior was generally achieved; however, there was still room for posterior angulation margins of 9-11° for A- and C-screws and approximately 27° for the B-screw. In contrast, the lateral surface is flatter with less inclination, causing anterior plate placement and wider posterior angulation - approximately 16-18° for A- and C-screws and 30° for the B-screw - allowing a greater range of posterior swing than the medial side.</p>","PeriodicalId":46378,"journal":{"name":"SICOT-J","volume":"12 ","pages":"3"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12849697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146067721","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}