Clinics in Orthopedic Surgery最新文献

{"title":"Arthroscopic Reduction and Fixation of Coronoid Fracture with Screws and Modified Pull Out Configuration.","authors":"Nicolas Moran, Nicolás López, Pablo Canales, Juan Pomés","doi":"10.4055/cios25025","DOIUrl":"https://doi.org/10.4055/cios25025","url":null,"abstract":"<p><p>The fracture of the coronoid process can compromise elbow stability. The surgical treatment aims to achieve adequate reduction and stability of the fragment. This article describes how arthroscopic assistance and the use of screws and sutures achieve fragment fixation. Our main objective is to describe the effectiveness of arthroscopy in obtaining reduction and fixation of isolated coronoid process fractures. This technique allows for optimal fragment stability and early rehabilitation.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 2","pages":"375-379"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624181","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":"Early Fracture Alignment Correction and Its Association with Neurologic Recovery in Pediatric Supracondylar Humeral Fractures.","authors":"Kang-San Lee, Jaehyub Kim, Young-Woo Kim, Kwang Hyun Park, Jong Pil Yoon","doi":"10.4055/cios25289","DOIUrl":"https://doi.org/10.4055/cios25289","url":null,"abstract":"<p><strong>Backgroud: </strong>Peripheral nerve injuries are a common complication of pediatric supracondylar humeral fractures. While most resolve spontaneously, the timeline for recovery remains unpredictable. This study investigated whether earlier correction of fracture alignment-regardless of timing of definitive surgical fixation-shortens the duration of neurologic recovery.</p><p><strong>Methods: </strong>We retrospectively reviewed pediatric patients (< 18 years) treated surgically for supracondylar humeral fractures between October 2008 and February 2025. Patients presenting with preoperative neurologic deficits were included. Timing of fracture alignment correction (via manipulation or surgery) and surgical fixation were recorded from the reported time of injury. The primary outcome was time to complete neurologic recovery, defined as full return of motor and/or sensory function. Statistical analyses included Pearson correlation, Mann-Whitney <i>U</i>-test at clinical time thresholds, and multivariate linear regression.</p><p><strong>Results: </strong>Among 341 cases, 35 patients (10.3%) presented with neurologic deficits, and 31 were included in the final analysis. Sensory deficits recovered significantly faster than motor or mixed-type injuries (mean, 13.4 vs. 91.4 days, <i>p</i> = 0.002). Among time-related variables, alignment correction within 4 hours of injury was significantly associated with faster neurologic recovery (23.9 vs. 93.5 days, <i>p</i> = 0.010), while surgical timing had no significant effect. This association remained marginally significant in multivariate analysis adjusting for injury type, nerve involvement, and fracture classification (<i>p</i> = 0.065).</p><p><strong>Conclusions: </strong>Early fracture alignment correction-especially within 4 hours-showed a trend toward faster neurologic recovery. This finding suggests that time-sensitive decompression may play an important role in promoting favorable neurologic recovery in pediatric supracondylar humeral fractures.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 2","pages":"312-320"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624298","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":"Revision Hip Arthroplasty with a Single-Taper Cementless Conical Revision Stem: Clinical and Radiographic Assessment of 57 Implants.","authors":"Stefano Lucchini, Andrea Burla, Andrea Poletto, Francesco Castagnini, Simone Gerardi, Francesco Traina","doi":"10.4055/cios25006","DOIUrl":"https://doi.org/10.4055/cios25006","url":null,"abstract":"<p><strong>Background: </strong>The optimal stem design for revision hip arthroplasties is still controversial. A retrospective cohort study of revision hip arthroplasties performed using a single-taper cementless conical stem was designed, aiming to assess clinical outcomes, complications and survival rates, and radiological osseointegration, at a minimum follow-up of 2 years.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted on 57 femoral revision arthroplasties performed between 2004 and 2018 using a cementless monoblock conical tapered stem, with a minimum 2-year follow-up. Clinical outcomes were assessed using the Harris Hip Score (HHS). Radiographic evaluations included stem alignment, bone stock remodeling across Gruen zones, and osseointegration graded using 2 systems: Global Radiographic Score (a 5-scale index combining bone quality and osseointegration) and the Engh criteria (fixation classified as bone ingrowth, stable fibrous fixation, or unstable fixation). Kaplan-Meier survival analysis was also performed.</p><p><strong>Results: </strong>At a mean follow-up of 6.0 ± 3.9 years, the mean HHS was 86.02 ± 9.73. The cumulative stem survival rate was 96.6% at 60 months and 120 months (implant survival: 96.6% and 89.7%, respectively). Bone stock improved across all Gruen zones, with significant increases in zones 1, 3, and 5. No radiolucent lines were found in 59.6% of proximal femurs and 93.0% of distal femurs. More than half of the stems (54.4%) achieved the maximum Global Radiographic Score (20 / 20), and 84.2% demonstrated bone ingrowth according to the Engh criteria.</p><p><strong>Conclusions: </strong>The single-taper conical revision stem provided good clinical outcomes and reliable survival rates (96.6%) at 6 and 10 years, with 93% of cases exhibiting very good stem stability.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 2","pages":"241-249"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624328","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":"Specifying the Entry Point for a Transiliac-Transsacral Screw in Posterior Pelvic Ring Fixation.","authors":"Guangping Liu, Junjun Tang, Jie He, Nazhi Zhan, Haoyu Liu, Zhengguo Zhu, Hua Chen","doi":"10.4055/cios25099","DOIUrl":"https://doi.org/10.4055/cios25099","url":null,"abstract":"<p><strong>Background: </strong>To stabilize posterior pelvic ring injuries with a transiliac-transsacral (TITS) screw percutaneously, it is crucial to determine the adequate entry point as an initial procedure. Here, we propose a universal method for specifying the entry point for the TITS screw under fluoroscopic guidance.</p><p><strong>Methods: </strong>Through analyzing 239 pelvic computed tomography (CT) images retrospectively, we determined the entry point for the TITS screw at the midpoint between the anterosuperior and posteroinferior corners of the respective vertebra in the strict mid-sagittal CT plane. Virtual surgical procedures were performed to verify the feasibility of using the midpoint as the entry point and to evaluate the accuracy of screw placement. Clinical surgical procedures with our proposed method of determining the entry point on the lateral fluoroscopic view were performed to validate the safety and accuracy of screw placement. Then, the efficacy of this method was evaluated compared to the previously applied method.</p><p><strong>Results: </strong>In the virtual surgical procedures, a total of 148 S1 TITS screws were securely placed in all pelvises with normal sacra, while 239 S2 TITS screws were securely placed in all pelvises regardless of dysmorphism. In clinical surgical procedures, 27 S1 screws and 15 S2 screws were securely placed in 41 pelvises, with 39 screws (92.9%) classified as grade 1 and 3 screws (7.1%) classified as grade 2. The rate of excellent or good functional outcomes was 100%. Compared to the previous method, our proposed method revealed superior efficacy regarding surgical duration (<i>p</i> < 0.001), fluoroscopic shots (<i>p</i> < 0.001), and guidewire attempts (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>On the lateral fluoroscopic view, the midpoint between the anterosuperior and posteroinferior corners of the respective vertebra can consistently serve as the entry point for the TITS screw, applicable to S1 and S2 screws in a normal sacrum, as well as to the S2 screw in a dysmorphic sacrum.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 2","pages":"218-227"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624408","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":"Complication Analysis of Conversion Hip Arthroplasty after Failed Intertrochanteric Fracture Fixation: A Meta-Analysis.","authors":"Naye Kang, Ki-Tae Park, Suyeon Park, Eunseo Joung, Nah Yon Kim, Byung-Ho Yoon","doi":"10.4055/cios25228","DOIUrl":"https://doi.org/10.4055/cios25228","url":null,"abstract":"<p><strong>Background: </strong>Although internal fixation (IF) techniques for intertrochanteric fractures have continuously advanced, the failure rate remains around 5%, often requiring secondary surgical intervention. This meta-analysis aimed to evaluate the clinical outcomes of conversion hip arthroplasty (CHA) following IF failure in intertrochanteric fracture patients.</p><p><strong>Methods: </strong>A total of 1,468 hips with CHA for failed IF of intertrochanteric fracture from 25 studies were included. The primary outcome was complication rate, including loosening, infection, dislocation, and periprosthetic fractures. The secondary outcomes were functional outcome measured by Harris Hip Score (HHS), operation time, and perioperative blood loss. A proportion meta-analysis using a random-effects model was performed to estimate the complications.</p><p><strong>Results: </strong>The mean follow-up period of the included studies was 51.08 months. The overall complication rate was 17%. Among specific complications, the loosening and infection rates were both 3%, while the dislocation rate was 5%. The pooled incidence of periprosthetic fractures including intraoperative and postoperative fractures was 9%. The mean HHS was 84.19. The mean operation time was 150.24 minutes, and the mean perioperative blood loss was 918.39 mL.</p><p><strong>Conclusions: </strong>CHA demonstrates an overall complication rate of 17%, which is slightly higher than that of primary hip arthroplasty, mainly reflecting the elevated risks of periprosthetic fractures and dislocation. Despite these concerns, CHA yields favorable functional recovery and represents an effective salvage strategy following failed IF, thereby supporting its continued role in clinical practice.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 2","pages":"228-240"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624317","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":"Type III Sugaya Classification after Rotator Cuff Repair: Preoperative Risk Factors and Progression to Retear.","authors":"Soo-Young Jeong, Ki Won Young, Tae Kang Lim","doi":"10.4055/cios25283","DOIUrl":"https://doi.org/10.4055/cios25283","url":null,"abstract":"<p><strong>Backgroud: </strong>The Sugaya classification is a widely used classification system to assess rotator cuff tendon integrity after repair. However, Sugaya type III has received less attention in the literature compared to types I/II or IV/V. Existing data on preoperative risk factors and long-term outcomes are limited, and for Sugaya type III, there remains inconsistency regarding whether it should be classified as a healed or retorn tendon. The purpose of this study was to evaluate preoperative risk factors for the development of Sugaya type III and its longitudinal outcomes after rotator cuff repair. We hypothesized that it would be associated with preoperative tear severity and have a higher risk of developing a retear compared to Sugaya types I/II.</p><p><strong>Methods: </strong>This retrospective study consisted of 124 consecutive patients who underwent arthroscopic rotator cuff repairs involving the supraspinatus/infraspinatus and/or subscapularis tendon. Repair integrity was examined by magnetic resonance imaging (MRI) according to the Sugaya classification at 6 months postoperatively and ultrasound (US) imaging at the final follow-up. We compared preoperative demographic data, clinical scores, and US results for Sugaya types I/II and type III.</p><p><strong>Results: </strong>The mean follow-up period was 28 months (range, 12-73 months). Based on MRIs at 6 months postoperatively, there were 76 (61%) Sugaya type I/II, 33 (27%) type III, and 15 (12%) type IV/V. On the final US evaluation, 5 patients with type I, II, or III had a newly developed retear, including 1 of 76 Sugaya type I/II patients (1.3%) and 4 of 33 Sugaya type III patients (12.1%). This difference in the late development of a retear between the early Sugaya type I/II and type III groups was statistically significant (<i>p</i> = 0.014). Our multivariate analysis showed that fatty infiltration of the infraspinatus was the only independent preoperative risk factor for the development of Sugaya type III (<i>p</i> = 0.005). The American Shoulder and Elbow Surgeons (ASES) score at the final follow-up was significantly lower in the retorn group than in the healed group (93.0 ± 7.6 and 96.4 ± 4.7, respectively; <i>p</i> = 0.036).</p><p><strong>Conclusions: </strong>Postoperative Sugaya type III repair status is associated with preoperative inferior muscle quality of the infraspinatus and can progress to a retear with a higher risk than Sugaya type I/II.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 2","pages":"303-311"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624396","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":"Research Trends on Perioperative Complications of Knee Replacement: A Bibliometric Analysis.","authors":"Wei Liang, Kai Zhang, Minghui Zhang, Mingwu Zhou","doi":"10.4055/cios25243","DOIUrl":"https://doi.org/10.4055/cios25243","url":null,"abstract":"<p><strong>Background: </strong>Knee replacement is a surgical procedure designed to alleviate severe knee pain and dysfunction by removing the damaged joint surface and replacing it with an artificial prosthesis, thereby restoring joint function and reducing pain. This study aims to identify and analyze research trends related to perioperative complications associated with knee replacement through a comprehensive bibliometric analysis.</p><p><strong>Methods: </strong>A systematic literature search was conducted using the Web of Science Core Collection (WoSCC) database. For bibliometric analysis, we utilized VOSviewer, CiteSpace, and the R package \"Bibliometrix\" to visualize collaboration networks, keyword co-occurrences, and emerging research trends.</p><p><strong>Results: </strong>A total of 5,751 articles published between 1973 and 2024 were included, contributed by 22,328 authors affiliated with 213 institutions across 47 countries. The United States (USA) led in publication volume with 2,403 articles and the highest citation count of 70,642. Parvizi Javad was identified as the most prolific author, contributing substantially with a high citation impact, while Harvard University emerged as the most productive institution. <i>The Journal of Arthroplasty</i> was a central publication venue, highlighted by its strong citation metrics. The most frequently occurring keywords were \"outcomes\" and \"risk factors,\" reflecting core research themes in perioperative complications associated with knee replacement. Keyword burst analysis indicated increased research focus on topics such as \"dislocation\" and \"enhanced recovery,\" underscoring key trends in the field.</p><p><strong>Conclusions: </strong>This bibliometric analysis highlights pivotal research trends in perioperative complications of knee replacement, with the USA and Harvard University as primary contributors. Future research is expected to focus on advancing Enhanced Recovery After Surgery protocols to further reduce complications and improve patient outcomes.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 2","pages":"250-262"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624351","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 Technique is the Optimal Option for the Treatment of Displaced Far-Lateral (Cho Type IIC) Distal Clavicle Fractures? A Comparative Analysis of Coracoclavicular Fixation Versus Anatomical Locking Plate Fixation.","authors":"Chul-Hyun Cho, Eun-Seok Son, Chang-Jin Yon, Du-Han Kim","doi":"10.4055/cios25318","DOIUrl":"https://doi.org/10.4055/cios25318","url":null,"abstract":"<p><strong>Background: </strong>As achieving stable fixation in unstable far-lateral distal clavicle fractures is challenging, the optimal surgical treatment remains controversial. The aim of this study was to compare the clinical and radiological results of coracoclavicular fixation (CCF) versus anatomical locking plate fixation (ALPF) in patients with Cho type IIC fractures.</p><p><strong>Methods: </strong>Thirty-eight patients who underwent surgical treatment for Cho type IIC fracture were included. Open CCF using a suture button device was performed in 25 patients and ALPF was performed in 13 patients. The mean follow-up period was 35.7 months (range, 12-132 months). Radiographic results were evaluated using serial plain radiographs. Clinical results were evaluated using the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, and Subjective Shoulder Value (SSV).</p><p><strong>Results: </strong>No significant differences were observed between the CCF and ALPF groups in terms of UCLA score (32.0 vs. 32.1), ASES score (90.6 vs. 91.0), and SSV (90.6% vs. 89.6%). Although significant differences between the 2 groups were observed in the mean coracoclavicular (CC) distance of the affected side at the immediate postoperative period (5.2 mm vs. 9.0 mm) and final follow-up (5.7 mm vs. 9.1 mm), the CC distances between the immediate postoperative period and final follow-up in each group were maintained without significant loss of reduction. In the CCF group, complications occurred in 4 of 25 cases (16.0%) including skin irritation caused by a superior button or knot in 2 cases, nonunion in 1 case, and shoulder stiffness in 1 case. In the ALPF group, complications occurred in 2 of 13 cases (15.4%) including screw pull-out in 1 case and shoulder stiffness in 1 case.</p><p><strong>Conclusions: </strong>Both CCF using a suture button device and ALPF without CC augmentation for type IIC fractures showed satisfactory clinical and radiological results. Both techniques can be recommended as the optimal option that can provide sufficient vertical stability for solid union.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 2","pages":"211-217"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624383","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":"An Anatomical Study to Ensure Precise Percutaneous Release of the Annular Pulley in the Trigger Finger.","authors":"Young-In So, Hyun-Il Lee, Wu-Chul Song, Yi-Suk Kim","doi":"10.4055/cios25123","DOIUrl":"https://doi.org/10.4055/cios25123","url":null,"abstract":"<p><strong>Background: </strong>The exact cause of trigger finger remains unknown; however, symptoms suggest that it occurs when the tendon becomes inflamed or thickened, leading to entrapment within the A1 pulley of the metacarpophalangeal joint. This study aims to establish an anatomical foundation for achieving successful outcomes in percutaneous A1 pulley release procedures.</p><p><strong>Methods: </strong>Specifically, easily identifiable skin creases were used as reference points to locate the A1 and A2 pulleys during surgery. A total of 156 fingers from 39 Korean adult cadavers were examined. Before dissection, surface landmarks such as the palmar crease (PC) and palmar digital crease (PDC) were identified, and the distances between nearby creases were measured. Following meticulous dissection, 9 distances, including the lengths of the A1 and A2 pulleys and the distance between the pulley edge and nearby crease, were recorded.</p><p><strong>Results: </strong>The results varied according to the fingers, with the A1 pulley averaging 7.2 mm (range, 6.9-7.4 mm) and the A2 pulley averaging 17.1 mm (range, 15.5-18.6 mm) in fingers 2 to 4. The gap between the A1 and A2 pulleys was relatively narrow (average, 3.4 mm). The A1 pulley was located distal to the PC in all cases. Additionally, the distance from the PC to the proximal margin of the A1 pulley averaged 4.2 mm (range, 3.1-4.9 mm). Furthermore, in some fingers, the entire A2 pulley was located proximal to the PDC, emphasizing anatomical variability.</p><p><strong>Conclusions: </strong>The findings of this study provide practical anatomical references for identifying the A1 and A2 pulleys using palmar skin creases, which may improve the safety and precision of percutaneous A1 pulley release while minimizing the risk of A2 pulley injury.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 2","pages":"329-336"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624210","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":"Clinical and Functional Outcomes Following Reverse Sural Flap of Lower Extremity Defects: A Comparative Retrospective Study.","authors":"Saleh Abualhaj, Mosleh M Abualhaj, Lina Alshadfan, Omar S Mansour, Eyad Alqarqaz, Mohd Said Dawod, Lamees A Arabiyat, Mohammad M Alshorman, Rami W Numeer, Osama Shattarah, Obadah Obeidat","doi":"10.4055/cios25223","DOIUrl":"https://doi.org/10.4055/cios25223","url":null,"abstract":"<p><strong>Background: </strong>The reverse sural artery flap (RSAF) is widely used for soft-tissue reconstruction of distal lower extremity defects. However, outcomes may vary based on the defect site. This study aimed to compare clinical, functional, and aesthetic outcomes of RSAF performed at the ankle, heel, and lower leg, and to identify predictors of postoperative complications.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 60 patients who underwent RSAF for soft-tissue reconstruction in the lower extremity. Patients were stratified by defect location: ankle, heel, or lower leg. Clinical data, complication rates, functional outcomes (Foot and Ankle Ability Measure [FAAM]), aesthetic outcomes (Vancouver Scar Scale), and predictors of complications were analyzed.</p><p><strong>Results: </strong>The heel group exhibited the highest complication rate (50%) compared to the ankle (33.3%) and lower leg (6.2%) (<i>p</i> = 0.019). Functional outcomes were poorest in the heel group, with a mean FAAM score of 76.8, while the lower leg group had the best outcomes (mean FAAM, 91.2). Aesthetic satisfaction was also lowest in heel reconstructions. Smoking, elevated body mass index (BMI), longer pedicle length, and heel defect location were significantly associated with higher complication rates in univariable analysis. However, in multivariable analysis, smoking (odds ratio [OR], 5.29; <i>p</i> < 0.001), increased BMI (OR, 1.653; <i>p</i> = 0.001), and pedicle length (OR, 1.241; <i>p</i> = 0.030) remained independent predictors, whereas the defect site did not reach statistical significance (<i>p</i> = 0.083, <i>p</i> = 0.155).</p><p><strong>Conclusions: </strong>While heel reconstructions demonstrated the highest raw complication rates and poorest functional outcomes, multivariable analysis suggests that patient factors-particularly smoking, obesity, and longer pedicle length-are stronger independent predictors of adverse outcomes than defect location itself. These findings underscore the importance of preoperative optimization and careful patient selection and highlight the need to interpret the influence of heel location with caution due to confounding factors such as the high prevalence of smoking in this subgroup.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 2","pages":"343-356"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624262","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}