Clinics in Orthopedic Surgery最新文献

{"title":"Comparative Study of 3-Dimensional-Printed Poly-L-Lactic Acid/Bone Morphogenetic Protein (BMP)/Collagen Bone Substitute and Commercial Hydroxyapatite/BMP for Bone Regeneration Efficacy Using a Mouse Calvarial Model.","authors":"Tae Ho Kim, Yu Ri Hong, Jeong Ok Lim, Chang-Wug Oh","doi":"10.4055/cios24323","DOIUrl":"10.4055/cios24323","url":null,"abstract":"<p><strong>Background: </strong>Bone substitutes such as hydroxyapatite (HA) ceramic and recombinant bone morphogenetic protein-2 (BMP-2) are essential in treating bone defects. However, the challenges of controlled and localized BMP-2 delivery necessitate the development of advanced bone graft substitutes. This study introduces and evaluates an innovative, ready-to-use bone substitute employing 3-dimensional-printed poly-L-lactic acid (PLLA) scaffolds combined with BMP-2 to enhance bone regeneration efficiency.</p><p><strong>Methods: </strong>We conducted a comparative study using C57BL/6 mice to evaluate the efficacy of rhBMP-2-coated PLLA scaffolds against traditional HA-based bone graft materials. The PLLA scaffolds were coated with varying concentrations of BMP-2 using an alginate-catechol method. Bone regeneration was assessed through micro-computed tomography (CT) imaging and histological analysis 4 weeks after implantation. The statistical significance of bone mass and formation differences across groups was determined using Student <i>t</i>-test and analysis of variance.</p><p><strong>Results: </strong>Micro-CT analysis revealed substantial bone formation in the group with PLLA scaffolds containing 0.1% BMP-2, exhibiting a bone volume ratio of 11.1% ± 2.8%, significantly higher than all other groups (<i>p</i> = 0.008). Histological analysis corroborated these findings, showing dense collagen deposition and active osteoblast presence in this group, indicating enhanced bone regeneration.</p><p><strong>Conclusions: </strong>The novel PLLA scaffold with alginate-catechol-coated BMP-2 significantly enhances bone regeneration compared to traditional bone graft materials. This innovative approach holds promising potential for clinical applications in orthopedics, particularly for treating bone defects.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"340-345"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765421","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":"Outcomes of Tibiotalocalcaneal Arthrodesis in Hindfoot Charcot Neuroarthropathy According to Coronal-Plane Deformity and Talar Osteolysis.","authors":"Sunghoo Kim, Ho-Seong Lee, Youngrak Choi","doi":"10.4055/cios24319","DOIUrl":"10.4055/cios24319","url":null,"abstract":"<p><strong>Background: </strong>Patients with severe hindfoot Charcot neuroarthropathy may experience various complications following tibiotalocalcaneal arthrodesis. Therefore, it is crucial to establish appropriate treatment plans to prevent potential complications and predict prognosis before surgery. This study aimed to investigate the impact of the degree of preoperative deformity in hindfoot Charcot neuroarthropathy on the outcomes of tibiotalocalcaneal arthrodesis.</p><p><strong>Methods: </strong>Twenty patients who underwent tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy were grouped by the severity of their deformities into a mild deformity group (tibiotalar angle between 80° and 100° with minimal or no talar osteolysis) and a severe deformity group (tibiotalar angle < 80° or > 100°, or severe talar osteolysis precluding tibiotalocalcaneal arthrodesis and necessitating tibiocalcaneal arthrodesis). Their demographics, comorbidities, and various surgical outcomes were compared between the 2 groups. Additional analyses were conducted to determine the factors associated with poor clinical outcome, defined as the inability to achieve independent ambulation or the need for below-knee amputation.</p><p><strong>Results: </strong>There were no significant differences in demographics and comorbidities between the 2 groups. Postoperative clinical outcomes, including the rate of postoperative infection and poor clinical outcome (inability to walk independently or having undergone below-knee amputation), showed no significant differences between the 2 groups. In terms of radiological outcomes, the bony union rates were 66.7% in the mild deformity group and 54.5% in the severe deformity group, with no significant difference. Similarly, other radiological outcomes, such as postoperative malalignment and time to union, did not vary significantly between the 2 groups. Factors associated with poor clinical outcome were the presence of preoperative infected wound and postoperative infection.</p><p><strong>Conclusions: </strong>The severity of preoperative coronal deformity or talar osteolysis was not associated with clinical or radiological outcomes of tibiotalocalcaneal arthrodesis for hindfoot Charcot neuroarthropathy. However, preoperative infected wound and postoperative infection were associated with poor clinical outcomes. Therefore, instead of early amputation in cases of severe coronal deformity or insufficient talar bone stock, limb salvage with tibiotalocalcaneal arthrodesis may be a viable alternative, with particular attention to patients with preoperative infected wound and postoperative infection.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"331-339"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765387","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":"Distal Biceps Brachii Rupture.","authors":"Ahmad Almigdad, Saharish Saleem, Amar Malhas","doi":"10.4055/cios24185","DOIUrl":"10.4055/cios24185","url":null,"abstract":"<p><strong>Backgroud: </strong>Distal biceps tendon ruptures are rare injuries that predominantly affect active men between the fourth and sixth decades, with a higher incidence in weightlifters and bodybuilders. This study aimed to comprehensively review cases involving distal biceps tendon ruptures, focusing on sociodemographic factors (such as sex, age, occupation, and smoking status), injury mechanisms, postoperative outcomes, and recorded complications.</p><p><strong>Methods: </strong>This retrospective review examines distal biceps injuries at Royal Berkshire Foundation Trust NHS Hospital from 2017 to 2023. Analyzed data encompasses demographic information, injury mechanisms, clinical findings, and complications. Outcomes were assessed using the range of movement and Elbow Oxford Score.</p><p><strong>Results: </strong>The average age of 73 patients (72 men and 1 woman) was 45.6 ± 9.4 years, with 75.3% falling between 36 and 55 years. Manual workers represented 46.6%, and 9.6% reported comorbidities and 6.8% steroid use. Lifting heavy objects and sports injuries were the predominant causes, constituting 43.8% and 13.7%, respectively. Most injuries (91.8%) involved complete tears, and most underwent acute surgery within the initial 4 weeks (84.9%). The most common complications were heterotopic ossification (23.3%) and neurological injury (16.4%). Ongoing weakness and fatigue were reported by 6.8%. At final follow-up, 75.7% of patients demonstrated a range of movement comparable to the contralateral side. However, 13.7% had a limited pronation-supination arch with a mean loss of 20° ± 14°, 11% had an extension lag with a mean of 15° ± 7°, and 2.7% showed a 10° flexion loss compared to the contralateral side.</p><p><strong>Conclusions: </strong>Distal biceps injuries are rare but lead to substantial functional loss without operative treatment. Surgical repair yields positive functional outcomes. Our study aligns with existing literature, emphasizing a predominance of middle-aged men and manual workers. It underscores the impact of corticosteroids and smoking, highlights surgical efficacy, and advocates for increased research in distal biceps injury prevention and treatment understanding.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"267-273"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765427","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":"Does Hip Abduction during Intramedullary Nail Fixation Help Correct Residual Varus Alignment in Subtrochanteric Fractures? A Retrospective Cohort Study.","authors":"Incheol Kook, Young Woon Gil, Kyu Tae Hwang","doi":"10.4055/cios24271","DOIUrl":"10.4055/cios24271","url":null,"abstract":"<p><strong>Background: </strong>Varus malalignment is a risk factor for nonunion and mechanical complications in subtrochanteric femoral fractures (SFFs). Although various reduction techniques have been reported to avoid varus malalignment in SFFs, achieving anatomic reduction remains challenging, often resulting in residual varus alignment (RVA) after reduction. This study aimed to investigate the radiographic and clinical outcomes of a novel method resolving RVA by abducting the ipsilateral hip after cephalomedullary fixation with an intramedullary nail and subsequently inserting distal interlocking screws.</p><p><strong>Methods: </strong>This retrospective study, conducted between March 2016 and March 2022, included patients who underwent hip abduction during intramedullary nailing due to RVA. Demographics and fracture patterns (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association [AO/OTA]) and types (typical or atypical) were analyzed. Radiographic outcomes included Baumgaertner reduction quality criteria (BRQC), tip-apex distance (TAD), neck-shaft angle (NSA), lateral cortex residual gap, union, and time to union. Clinical outcomes included ambulatory level using the Palmer-Parker Mobility Score (PPM), complications, and reoperation.</p><p><strong>Results: </strong>This study included 45 patients (mean age, 65.8 years; mean follow-up period, 18.4 months). The most common fracture pattern was 32A2 in 15 patients and 29 were typical and 16 were atypical fractures. The BRQC was good in 36 patients, and TAD was < 25 mm in 43 patients. Pre-abduction NSA (126.0° ± 3.8°) was significantly smaller than post-abduction NSA (129.9° ± 3.4°, <i>p</i> < 0.001). Post-abduction NSA was comparable to contralateral NSA of 128.9° ± 2.8° (<i>p</i> = 0.155). Residual gap was significantly reduced from 6.1 ± 2.9 mm pre-abduction to 1.7 ± 1.0 mm post-abduction (<i>p</i> < 0.001). Union was achieved in 44 patients (97.8%; mean duration, 5.9 months). PPM decreased from 7.8 ± 2.0 pre-injury to 7.0 ± 2.1 1-year postoperatively. One nonunion case required reoperation. Radiographic outcomes did not significantly differ by fracture pattern (<i>p</i> = 0.470 for NSA and <i>p</i> = 0.334 for residual gap).</p><p><strong>Conclusions: </strong>Hip abduction during intramedullary nailing corrects alignment and reduces the gap in SFFs with residual varus alignment. This method can be applied to various fracture patterns in a straightforward manner and considered valuable for managing SFFs.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"194-203"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765428","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":"Comparison of Analgesic Efficiency between Local Infiltration of a Long-Acting Analgesic and Regional Nerve Block among Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction: Meta-Analysis of Randomized Controlled Trials.","authors":"Carlo F Fernandez, Byron S Angeles","doi":"10.4055/cios23149","DOIUrl":"10.4055/cios23149","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopic anterior cruciate ligament (ACL) reconstruction is gaining popularity. Different kinds of anesthetic techniques are used; however, regional nerve block (RNB) such as femoral nerve block is considered the most popular choice. The purpose of this study was to compare the effectiveness of long-acting local anesthesia infiltration (LAI) versus RNB used to control pain and reduce opioid consumption in patients undergoing arthroscopic ACL reconstruction.</p><p><strong>Methods: </strong>We conducted a meta-analysis using a comprehensive literature search of Google Scholar, PubMed, Medline, and Cochrane Library. All randomized trials comparing the use of infiltration anesthesia versus RNB in patients undergoing arthroscopic ACL reconstruction were included. Methodological quality, risk of bias, and grade of the eligible studies were assessed by 3 independent reviewers. The risk of bias was analyzed using contour-enhanced funnel plots.</p><p><strong>Results: </strong>The search yielded 671 records. Eight studies were included in the systematic review. The study focused on the assessment of immediate, 24-hour, and 48-hour postoperative pain scores and total opioid consumption. There was no significant difference between the use of LAI and RNB with regard to the immediate (<i>p</i> = 0.962), 24-hour (<i>p</i> = 0.156), and 48-hour postoperative pain scores (<i>p</i> = 0.216). The results suggested that LAI could lead to a similar level of opioid consumption as RNB (<i>p</i> = 0.304). However, there was considerable heterogeneity in the opioid consumption outcome due to the different anesthetic techniques used in the included studies.</p><p><strong>Conclusions: </strong>Regarding postoperative pain control, LAI showed similar clinical effects when compared to the conventional RNB, while maintaining a similar level of opioid consumption postoperatively, decreasing the risk of any adverse effects of morphine. In summary, LAI offers a simpler method of achieving pain relief without the motor weakness associated with RNB. It also allows surgeons to perform ACL reconstruction in institutions without specialized anesthesia for RNB.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"228-237"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765424","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":"Could the Type of Allograft Used for Anterior Cervical Discectomy and Fusion Affect Surgical Outcome? A Comparison Between Cortical Ring Allograft and Cortico-Cancellous Allograft.","authors":"Gumin Jeong, Hyun Wook Gwak, Sehan Park, Chang Ju Hwang, Jae Hwan Cho, Dong-Ho Lee","doi":"10.4055/cios24108","DOIUrl":"10.4055/cios24108","url":null,"abstract":"<p><strong>Backgroud: </strong>Allograft is predominantly used interbody spacers for anterior cervical discectomy and fusion (ACDF). The cortico-cancellous allograft has weaker mechanical strength as it is an artificial composite of the cancellous and cortical parts. Additionally, whether utilizing a firmer allograft, such as the cortical ring, leads to better outcomes is unclear. Therefore, we aimed to compare the surgical outcomes of cortical ring and cortico-cancellous allografts in ACDF.</p><p><strong>Methods: </strong>Patients who underwent ACDF using allograft and were followed up for > 1 year were retrospectively reviewed. Patient characteristics, including fusion rates (assessed by interspinous motion [ISM], intra-graft bone bridging, and extra-graft bone bridging), subsidence, allograft complications (e.g., allograft fracture and resorption), and patient-reported outcome measures (neck pain visual analog scale [VAS], arm pain VAS, and neck disability index), were assessed. Patients were divided into 2 groups based on the allograft used: cortical ring and cortico-cancellous allograft groups. Subgroup analysis was subsequently conducted in single- and multi-level operation groups.</p><p><strong>Results: </strong>A total of 227 patients were included. Of them, 134 (59.0%) and 93 (41.0%) underwent ACDF using cortical ring and cortico-cancellous allograft, respectively. In single-level operations, the cortico-cancellous allograft significantly frequented allograft resorption (24 / 66, 36.4%) than the cortical ring allograft (1 / 28, 3.7%) (<i>p</i> = 0.001). The cortico-cancellous allograft group demonstrated significantly greater subsidence. However, the fusion rates did not significantly differ between the 2 groups. In multi-level operations, the cortico-cancellous allograft (5 / 27, 18.5%) resulted in a significantly higher fracture rate than the cortical ring allograft (5 / 105, 4.7%) (<i>p</i> = 0.030). The fusion rate at 1-year postoperative assessed using ISM (63.2% vs. 55.5%) and intra-graft bone bridging (66.7% vs. 40.7%) was higher in the cortical ring group; however, the difference was not significant. The patient-reported outcomes at 1-year postoperative did not demonstrate significant intergroup differences both in single- and multi-level operations.</p><p><strong>Conclusions: </strong>Allograft resorption or fracture occurs more frequently with cortico-cancellous than cortical ring allografts. Despite the frequent occurrence of allograft-related complications with cortico-cancellous allografts, the fusion rate was not significantly affected. Due to the higher rate of allograft resorption or fractures and greater subsidence with cortico-cancellous allografts, cortical ring allografts might yield more stable results in ACDF.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"238-249"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765426","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":"Comments on the Article \"Three-Dimensional Morphological Analysis of the Suprascapular Notch in Patients with Arthroscopic Rotator Cuff Repair\": To the Editor.","authors":"George Triantafyllou, George Tsakotos, Maria Piagkou","doi":"10.4055/cios24321","DOIUrl":"10.4055/cios24321","url":null,"abstract":"","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"354-357"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765419","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":"Stiffness-Related Disability Following Surgical Correction for Adolescent Idiopathic Scoliosis: A Comparative Analysis According to the Lowest Instrumented Vertebra Level.","authors":"Se-Jun Park, Chong-Suh Lee, Dong-Ho Kang, Jin-Sung Park","doi":"10.4055/cios24248","DOIUrl":"10.4055/cios24248","url":null,"abstract":"<p><strong>Background: </strong>Extensive spinal fusion inevitably results in loss of mobility, which may induce stiffness-related disability (SRD) during activities of daily living. Few studies have examined SRD after surgical correction for adolescent idiopathic scoliosis (AIS). This study aimed to investigate SRD following surgical treatment in AIS patients particularly with respect to the lowest instrumented vertebra (LIV).</p><p><strong>Methods: </strong>Patients who underwent surgical correction for AIS between 2014 and 2021 and were followed up for 2 years were included. The degree of SRD was evaluated using the Stiffness-Related Disability Index (SRDI), which consists of 4 categories, each containing 3 questions, giving a total of 12 components of the questionnaire. The SRDI scores were compared according to the LIV level. Correlation analysis was performed to examine the relationship between the SRDI and legacy health-related quality of life (HRQOL) measurements.</p><p><strong>Results: </strong>This study included 174 patients (47 men and 127 women) with a mean age of 13.8 years. Among the 12 items of the SRDI, the scores of 9 items showed a significant increase after surgery. The total sum of the SRDI scores also significantly increased after surgery. Pearson correlation analysis showed that the SRDI scores were significantly correlated with Oswestry disability index, nearly all domains, and the total sum of Scoliosis Research Society-22 questionnaire, and 36-Item Short Form Survey. No differences in the SRDI score were found among cases with the LIV between T12 and L3. However, the SRDI scores of patients with LIV at L4 were significantly higher than those of patients with other LIV levels.</p><p><strong>Conclusions: </strong>Various degrees of SRD occurred after spinal fusion for AIS. The SRDI was significantly correlated with the HRQOL measurements. The SRDI score was highest in patients with the LIV at L4 when compared to those with other LIV levels. Fusion can be safely extended to L3 without significantly increasing SRD.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"258-266"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765389","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":"Additional Screw Added to the Femoral Neck System Could Enhance the Stability of Pauwel Type III Femoral Neck Fractures: a Finite Element Analysis.","authors":"Yonghan Cha, Sunghoon Park, Chang-Ho Jung, Jin-Woo Kim, Jun-Il Yoo, Jung-Taek Kim, Yongho Jeon, Kyeong Jin Han","doi":"10.4055/cios24194","DOIUrl":"10.4055/cios24194","url":null,"abstract":"<p><strong>Backgroud: </strong>This study explores effective fixation methods for Pauwel type III femoral neck fractures by evaluating the biomechanical benefits of adding a screw to the Femoral Neck System (FNS).</p><p><strong>Methods: </strong>Computed tomography (CT) scans of an 82-year-old female patient with an intertrochanteric fracture were used to establish a finite element femur model with heterogeneous material properties. Finite element models of Pauwel type III fractures were created with and without an additional screw. The central and inferior trajectories of the FNS bolt were examined separately and combined with an additional screw for virtual fixation. Walking and stair-climbing loads were applied.</p><p><strong>Results: </strong>With the addition of a screw, both peak maximum and minimum principal strains consistently stayed comparable or decreased in models with both central and inferior bolt trajectories, while the volume of elements with principal strain exceeding 1% decreased by more than half. The peak von Mises stress observed in the implants ranged from 215.7 to 359.3 MPa, remaining below the titanium alloy's yield strength of 800 MPa. For normal walking, the addition of a screw to the central bolt trajectory model decreased the fracture gap by 50.6% and reduced sliding distance by 8.6%. For the inferior bolt trajectory, the gap was reduced by 57.9% and sliding distance by 25.0%. Under stair-climbing conditions, these improvements were also evident; the central trajectory model saw a halved fracture gap and a 7.9% decrease in sliding distance, while the inferior trajectory model experienced a 55.7% gap reduction and a 27.2% decrease in sliding distance. The additional screw increased the area ratio of the fracture site experiencing interfragmentary compression 34%-39%, while the additional screw alleviated peak interfragmentary compression by 12%-18% under both normal walking and stair-climbing conditions.</p><p><strong>Conclusions: </strong>The addition of a screw reduced the fracture gap, sliding distance, and peak interfragmentary compression, while increasing the area ratio of interfragmentary compression under both walking and stair-climbing loads, regardless of the FNS bolt trajectory, suggesting a better mechanical environment for fracture healing.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"204-215"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765418","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":"Comparative Analysis of Ultrasound and Surgical Findings in Anatomical Variations of de Quervain's Disease.","authors":"Young Seok Lee, Wan-Sun Choi, Seung Hun Baek, Hyunwoo Kang, Chang-Hun Lee","doi":"10.4055/cios24127","DOIUrl":"10.4055/cios24127","url":null,"abstract":"<p><strong>Background: </strong>This study compares ultrasound and surgical findings of anatomical variations in de Quervain's disease.</p><p><strong>Methods: </strong>Seventy-four wrists from patients with unilateral de Quervain's disease were examined through ultrasonography and surgery. Presence of intracompartment septum, abductor pollicis longus (APL) slips, and selective stenosis were verified by both methods. Two orthopedic surgeons assessed ultrasound findings for intra- and interobserver reliability.</p><p><strong>Results: </strong>Amongst 74 participants (43 women and 31 men), 60.8% had a complete septum, 31.1% had an incomplete septum, and 8.1% had no septum; 70.3% had multi-slip APL and 66.2% had extensor pollicis brevis stenosis. Surgical and ultrasonographic findings displayed a high level of sensitivity and specificity. Intraobserver reliability was high, and interobserver reliability was substantial.</p><p><strong>Conclusions: </strong>The study confirms ultrasonography's reliability in identifying anatomical variations in de Quervain's disease, with high sensitivity, specificity, and substantial intra- and interobserver reliability, emphasizing its usefulness in preoperative assessment and planning.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"17 2","pages":"308-316"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765420","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}