Clinics in Orthopedic Surgery最新文献

{"title":"Treatment of Infantile Blount Disease with Double Osteotomy: Medial Hemielevation and Lateral Closing Wedge Single Stage with the Use of a Polyetheretherketone Cage: Case Series.","authors":"Elsayed Shaheen, Ahmed Said Mohamed, Nabil Al Moghazy, Khaled Zaghloul","doi":"10.4055/cios25350","DOIUrl":"10.4055/cios25350","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the effectiveness of polyetheretherketone (PEEK) cage grafting in achieving union at the medial tibial plateau hemielevation site, using intraoperative knee arthrography to assess the accuracy of correction. Advanced infantile Blount disease (Langenskiöld stages V and VI) poses considerable surgical challenges owing to its complex multiplanar deformities and elevated risk of recurrence. Several surgical strategies, including staged and single-stage corrections, have been described. This case series presents the outcomes of a single-stage approach that simultaneously addresses joint-level and proximal tibial deformities, combined with lateral epiphysiodesis to mitigate the risk of recurrence.</p><p><strong>Methods: </strong>Between 2015 and 2020, 13 patients (6 males, 7 females; aged 8-12 years) with stage V or VI infantile Blount disease underwent double osteotomy consisting of medial hemielevation and lateral closing wedge correction. Medial tibial plateau realignment was guided intraoperatively by arthrography, and the resulting gap was filled with a lumbar PEEK cage. A fibular osteotomy was performed in all patients. Fixation was achieved using a 4.5-mm T-plate that crossed the epiphyseal plate to facilitate lateral growth arrest. One patient had a history of prior surgical intervention.</p><p><strong>Results: </strong>The mean Pediatric Outcomes Data Collection Instrument score improved significantly from 47.9% preoperatively to 83.1% postoperatively (<i>p</i> < 0.001). All patients achieved a full range of knee motion without residual instability or varus thrust. Radiographic evaluation demonstrated correction of the mean tibiofemoral angle from 30° varus to 6° valgus, the medial proximal tibial angle from 60.0° to 87.1°, and the depressed medial plateau angle from 24.8° to 2.9° (all <i>p</i> < 0.001). No recurrence of deformity was observed, and the final limb-length discrepancy was < 1 cm in all patients.</p><p><strong>Conclusions: </strong>Single-stage double osteotomy with PEEK cage interposition, guided by intraoperative knee arthrography and stabilized with a lateral T-plate, provides effective correction of advanced tibial deformities in infantile Blount disease. This technique restores articular congruency, achieves mechanical alignment, and reduces the risk of recurrence.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"753-760"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680581","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":"Novel Coronoid Reconstruction Using a Patient-Specific 3-Dimensional Metal-Printed Prosthesis and Guide for Comminuted Coronoid Process Fractures.","authors":"Jun-Hyuk Lim, Sungmin Kim, Myung-Sun Kim","doi":"10.4055/cios25418","DOIUrl":"10.4055/cios25418","url":null,"abstract":"<p><strong>Background: </strong>The coronoid process is essential for elbow stability, and its severe comminuted fractures may require coronoid reconstruction. While coronoid reconstruction using autologous bone grafts has shown positive clinical outcomes, it has inherent limitations that create uncertainty in its outcomes. To our knowledge, while the potential for coronoid prostheses has emerged, there are currently no commercially available options, and clinical results remain insufficient. Thus, this study aimed to develop a new patient-specific coronoid prosthesis using 3-dimensional (3D) metal printing technology and to report clinical outcomes in patients with comminuted coronoid fractures where fixation was not feasible.</p><p><strong>Methods: </strong>We conducted a cadaveric validation to determine the optimal surgical approach and iteratively develop a patient-specific coronoid prosthesis and cutting guide. Bilateral 3D computed tomography was used to mirror and register the unaffected ulna to the injured side and define a cutting plane that removed only comminuted and nonviable bone while preserving key footprints such as the sublime tubercle. The patient-specific coronoid prosthesis was then applied in 2 patients with comminuted coronoid fractures not amenable to stable fixation. Evaluations comprised clinical and radiologic assessments. Clinical assessment included serial elbow range of motion (ROM), functional scoring, and documentation of the presence or absence of ulnar nerve symptoms. Radiologic assessment evaluated joint surface regularity, prosthesis-related complications, and evidence of bony integration at the titanium mesh interface.</p><p><strong>Results: </strong>We designed an integrated prosthesis and cutting guide that achieved favorable clinical outcomes with over 1 year of follow-up. Radiologic assessments of our patient-specific coronoid prosthesis demonstrated no irregularities on the joint surface, and no prosthesis-related complications were identified. Complete bony integration of the reconstructed area was confirmed approximately 6 months postoperatively, which can be attributed to the titanium mesh structure in the reconstruction area.</p><p><strong>Conclusions: </strong>Our patient-specific coronoid prosthesis, developed using 3D printing technology, achieved good clinical and radiologic outcomes with anatomical conformity. Our novel approach may improve recovery and function in patients with comminuted coronoid fractures for whom conventional fixation is difficult or unreliable, offering a promising alternative treatment option.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"695-707"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680524","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":"Prosthesis-Related Risk Factors for Trunnionosis: A Comprehensive Literature Review.","authors":"Young-Kyun Lee, Yonghan Cha, Won-Sik Choy, Kyung-Hoi Koo","doi":"10.4055/cios25364","DOIUrl":"10.4055/cios25364","url":null,"abstract":"<p><p>Trunnionosis has emerged as an increasingly recognized cause of failure in total hip arthroplasty (THA). Although multiple prosthesis-related factors have been proposed, the relative importance of these risk factors remains uncertain. A comprehensive literature review and case-based analysis were conducted using the PubMed database (up to June 15, 2025) to identify and validate prosthesis-related risk factors for trunnionosis. Device-specific data extracted from eligible case reports were aggregated to empirically confirm previously hypothesized mechanical and material risk factors. The most consistent prosthesis-related risk factors were cobalt-chromium femoral heads, stems composed of titanium-molybdenum-zirconium-iron (TMZF) alloy, large-diameter femoral heads (≥ 36 mm), increased head-neck offset, and short trunnion length. Adverse taper geometries-such as smaller diameters, shorter lengths, and specific taper angles-were associated with greater micromotion and fretting corrosion. Grooved or threaded trunnion surfaces and dual modular stem designs further amplified the risk. High body mass index, male sex, elevated activity levels, and prolonged implantation duration were recurrent patient-related contributors, whereas surgical factors such as inadequate impaction force, malalignment, and contamination during assembly also promoted early taper corrosion. Contemporary THA designs that favor large femoral heads and high-offset stems increase mechanical loading at the taper junction, inadvertently predisposing to trunnionosis. Preventive strategies should prioritize the use of ceramic heads, avoidance of TMZF stems, and careful consideration of trunnion geometry. Standardization of taper design, adherence to meticulous assembly techniques, and long-term postoperative surveillance are essential to minimize corrosion-related failures and improve implant longevity.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"585-599"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680586","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":"Targeted Fully-Threaded Screw Augmentation with the Femoral Neck System Reduces Neck Shortening and Posterior Tilt, Leading to Improved Function in Geriatric Garden I-II Femoral Neck Fractures: A Retrospective Comparative Study.","authors":"Oog-Jin Shon, Bum Jin Shim, Jae-Woo Cho, Whee Sung Son","doi":"10.4055/cios25342","DOIUrl":"10.4055/cios25342","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate whether targeted fully-threaded screw augmentation with the femoral neck system (FNS) reduces femoral neck shortening and posterior tilt, thereby improving functional outcomes in geriatric patients with Garden types I and II femoral neck fractures.</p><p><strong>Methods: </strong>We retrospectively reviewed the clinical and radiographic data of geriatric patients (> 60 years) with Garden type I or II femoral neck fractures who underwent FNS fixation and completed a 6-month follow-up. Of these, 32 patients received targeted fully-threaded screw augmentation with FNS (TFS-FNS group), while 24 underwent single FNS fixation (single FNS group). The 2 groups were compared in terms of femoral neck shortening, posterior or anterior tilt, bone union rate, Harris Hip Score (HHS), and complications, including those potentially associated with fully-threaded screw fixation. Additionally, we analyzed factors associated with functional outcomes. A subgroup analysis was performed to assess whether targeted fully-threaded screw augmentation could reduce re-shortening and recurrent posterior tilt following closed reduction.</p><p><strong>Results: </strong>There were no significant differences in demographic or clinical characteristics except for a higher prevalence of Pauwels type III fractures in the TFS-FNS group. All shortening-related outcomes were significantly lower in the TFS-FNS group (vertical: 1.46 ± 1.49 mm; horizontal: 0.87 ± 1.14 mm; total: 1.88 ± 1.70 mm) than in the single FNS group (vertical: 4.08 ± 2.83 mm; horizontal: 2.28 ± 2.42 mm; total: 5.31 ± 2.69 mm) (<i>p</i> < 0.001). The TFS-FNS group also showed reduced posterior or anterior tilt progression (1.49° ± 1.77° vs. 8.90° ± 8.82°; <i>p</i> < 0.001) and superior HHS (88.97 ± 8.13 vs. 79.04 ± 11.71; <i>p</i> = 0.001). Bone union rates and operation times were comparable, with no complications related to fully-threaded screw fixation in the TFS-FNS group. In multivariate analysis, age (<i>p</i> = 0.022) and femoral neck shortening (<i>p</i> = 0.048) were significantly associated with HHS. Subgroup analysis of patients who underwent closed reduction showed that the TFS-FNS group had significantly less re-shortening and recurrent posterior or anterior tilt (<i>p</i> < 0.001 and <i>p</i> = 0.002, respectively).</p><p><strong>Conclusions: </strong>Targeted fully-threaded screw augmentation combined with the FNS effectively reduced femoral neck shortening and posterior or anterior tilt in geriatric Garden types I and II femoral neck fractures, leading to improved functional outcomes without increasing complication rates.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"600-614"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680594","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":"Correction: Cortical Support in Unstable Intertrochanteric Fracture without Fixation of Posteromedial Fragment.","authors":"Ki-Tae Park, Dong-Hoon Lee, Kyung-Hoi Koo, Jung-Wee Park, Young-Kyun Lee","doi":"10.4055/cios25291corr","DOIUrl":"https://doi.org/10.4055/cios25291corr","url":null,"abstract":"<p><p>[This corrects the article on p. 413 in vol. 18, PMID: 42226786.].</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"776"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674405","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":"Complications of Total Hip Arthroplasty in Obese Patients: A Systematic Review.","authors":"Mahmoud Katanani, Ahmed Mohammed Belal, Ahmad Amer Mandil","doi":"10.4055/cios25168","DOIUrl":"10.4055/cios25168","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is a widely preferred surgical intervention for patients with severe hip osteoarthritis, as it significantly improves mobility and quality of life. The aim of this review is to evaluate the literature on the prevalence and frequency of common complications associated with THA in obese patients.</p><p><strong>Methods: </strong>This systematic review identified relevant studies through searches of electronic databases, including PubMed and the Cochrane Library. The search was conducted for studies published between 2005 and 2024, employing a combination of keywords such as \"arthroplasty,\" \"hip,\" \"osteoarthritis,\" \"complication,\" and \"obese.\" Boolean operators (\"OR\" and \"AND\") were utilized to refine and optimize the search strategy. The study endpoints included the complication rates and their common types in obese THA patients.</p><p><strong>Results: </strong>A total of 481 studies were initially identified, with 424 deemed relevant during the preliminary search. After screening titles and abstracts, 411 studies were excluded, leaving 13 eligible papers for inclusion and analysis. The total patient population across these studies was 1,676,926, of whom 241,920 were classified as obese. Approximately 340,328 were male and 437,652 were female, with a mean age of 60.6 years. Among the 241,920 obese patients, 32,556 complications were reported, corresponding to a prevalence of 13.5%. The most common complications included readmission (21.6%), revision surgery (14.2%), infections (11.4%), thrombosis/embolism (7.8%), dislocation (5.2%), nerve complications (2.2%), and fractures (0.02%). Additionally, 37.6% of the complications fell into the category of other or unspecified.</p><p><strong>Conclusions: </strong>This review demonstrates that the complication rate in THA is 13.5%, affirming that it remains a safe, effective, and viable treatment option for obese patients with hip joint pathology. However, the higher rates of readmissions, revision surgeries, and infections underscore the need for careful patient selection and tailored perioperative strategies. A multidisciplinary approach, combined with ongoing research, could optimize outcomes in this high-risk patient population.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"615-623"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674386","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":"Electrodiagnostic and Clinical Outcomes after Supercharged Anterior Interosseous Nerve Transfer in Advanced Cubital Tunnel Syndrome.","authors":"Tae Yeong Chang, Cho Rong Bae, Sung Bom Pyun, Jae Jun Nam, In Cheul Choi, Jong Woong Park","doi":"10.4055/cios25254","DOIUrl":"10.4055/cios25254","url":null,"abstract":"<p><strong>Background: </strong>In patients with advanced cubital tunnel syndrome (CuTS), conventional surgical outcomes are often suboptimal due to the long distance required for nerve regeneration. The supercharged end-to-side anterior interosseous nerve to ulnar motor nerve transfer (referred to as SETS transfer) has been proposed to enhance reinnervation and accelerate recovery. This study aimed to evaluate the electrodiagnostic and clinical outcomes of SETS transfer in patients with advanced CuTS and to determine the time course of functional recovery.</p><p><strong>Methods: </strong>This prospective study included 11 patients with severe, non-traumatic CuTS (modified McGowan grade IIB or III) who underwent ulnar nerve decompression, subcutaneous anterior transposition, and SETS transfer. Electrodiagnostic studies were performed preoperatively and at 3, 6, and 12 months postoperatively, assessing compound muscle action potentials (CMAPs) of the abductor digiti minimi (ADM) and first dorsal interosseous muscles, sensory nerve action potentials (SNAPs) of the ulnar and dorsal ulnar cutaneous (DUC) nerves, and detection of nascent motor unit action potentials (MUAPs). Grip and key-pinch strength and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed preoperatively and at 12 months.</p><p><strong>Results: </strong>The CMAP amplitude of the ADM significantly improved at the 12-month follow-up compared to the preoperative assessment (<i>p</i> = 0.004). Postoperative nascent MUAPs were observed in 8 patients, all of which appeared within 6 months. In contrast, among patients with no preoperative SNAP who had a postoperative response, most recorded their first SNAP at 12 months after surgery (5 of 6 for ulnar SNAP and 5 of 7 for DUC SNAP). Key-pinch strength and DASH scores improved significantly (<i>p</i> = 0.014 and <i>p</i> = 0.003, respectively), while grip strength showed no significant change (<i>p</i> = 0.142).</p><p><strong>Conclusions: </strong>SETS transfer may promote early reinnervation and improve intrinsic muscle function in patients with severe CuTS. Serial electrodiagnostic studies suggest that SETS transfer may contribute to motor recovery within the first 6 months postoperatively.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"727-737"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674385","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":"The Lego Block Technique: A Novel Method of Shaping Autogenous Bone Graft for Narrow Glenoids with Severe Bone Defects in Reverse Shoulder Arthroplasty.","authors":"Soo-Young Jeong, Il-Han Joo, Bong Gun Lee","doi":"10.4055/cios25233","DOIUrl":"10.4055/cios25233","url":null,"abstract":"<p><p>In cases with complex glenoid bone defects, bony increased-offset reverse shoulder arthroplasty can restore glenoid bone stock and improve stability using autografts harvested from the humeral head. However, conventional grafting methods may be insufficient when glenoid defects or deformities are complex. We present a novel bracket-shaped bone grafting technique applied in a patient with advanced rheumatoid arthritis and significant glenoid erosion. The graft was sculpted from the resected humeral head to match the glenoid defect in a Lego block-like fashion, resulting in stable fixation and favorable clinical outcomes.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"771-775"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674494","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":"Learning Curve of Robot-Assisted Total Hip Arthroplasty: Cumulative Sum Analysis.","authors":"Hyun-Min Lee, Seong-Jun Kim, Yong-Chan Ha","doi":"10.4055/cios26087","DOIUrl":"10.4055/cios26087","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted total hip arthroplasty (RA-THA) has been developed to enhance implant placement accuracy and minimize surgical variability. Although potential benefits have been demonstrated, adoption is accompanied by a learning curve. This study aimed to evaluate the learning curve associated with RA-THA using a single robotic platform.</p><p><strong>Methods: </strong>In this prospective design and retrospective review study, 40 consecutive RA-THA procedures were performed between March and April 2025, marking the initiation of a robotic hip program. All procedures utilized the MAKO robotic system (Stryker). Step-specific operative times, including pelvic array fixation, dissection and bone preparation, landmark registration, and acetabular reaming and impaction, were prospectively recorded by an independent observer. The learning curve was analyzed using cumulative sum (CUSUM) analysis.</p><p><strong>Results: </strong>CUSUM analysis identified 2 distinct phases: a learning phase (first 11 cases) followed by a proficiency phase. Significant reductions in operative times were observed for robotic-specific steps, particularly pelvic array fixation and landmark registration, during the proficiency phase (<i>p</i> < 0.05). There was no significant difference between the 2 phases in terms of acetabular cup positioning. The mean inclination angle was 38.9° ± 1.5° (range, 37-41), with all cases within the Lewinnek safe zone. Anteversion remained within 3° of the planned target, and combined anteversion was maintained within the safe range of 25°-50°.</p><p><strong>Conclusions: </strong>The learning curve for RA-THA using the MAKO system reached a plateau after 11 cases, with improved efficiency in robotic-specific steps. Accurate and reproducible cup positioning was maintained throughout the series, suggesting that the technical benefits of robotic assistance are realized early in the learning process.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"651-657"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680521","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":"Fixator-Assisted Plating and Nailing for Multiplanar Lower Limb Deformities in Adolescents: Indications, Technical Considerations, and Radiographic Outcomes.","authors":"Pilar Rovira Martí, Ana Méndez Gil, César Galo García Fontecha","doi":"10.4055/cios25434","DOIUrl":"10.4055/cios25434","url":null,"abstract":"<p><strong>Background: </strong>Uncorrected lower limb deformities in adolescents, particularly those with severe multiplanar deviations, can lead to early joint degeneration and functional impairment. When growth modulation is no longer feasible, corrective osteotomy becomes necessary. This study aims to demonstrate the efficacy of fixator-assisted techniques-fixator-assisted locked plating (FALP) and fixator-assisted nailing (FAN)-in achieving accurate correction of complex femoral and tibial deformities across the frontal, sagittal, and torsional planes.</p><p><strong>Methods: </strong>A prospective study was conducted involving 27 adolescent patients (31 surgeries) treated with FALP or FAN techniques between 2021 and 2024. Patients were divided into 3 groups: group A (FALP-distal femur), group B (FALP-tibia), and group C (FAN). Data collected included demographics, surgical parameters, preoperative and postoperative deformity measurements, time to weight-bearing, bone consolidation, return to daily activities, and complications. Statistical analysis was performed using IBM SPSS Statistics 29.0. The mean follow-up was 20.9 months.</p><p><strong>Results: </strong>Radiographic union was achieved in all cases, with a mean time to consolidation of 4 months. Mean mechanical axis deviation corrections reached 36.7 mm in valgus and 36.4 mm in varus deformities, achieving near-neutral postoperative alignment. Torsional corrections averaged 53.3° for internal femoral torsion and 36.3° for external tibial torsion. Sagittal corrections included 22° for femoral extension and 10° for tibial proximal flexion deformities. Patients treated with FAN achieved significantly earlier weight-bearing (mean 5.8 days). No clinically relevant secondary deformities, joint stiffness, or significant leg length discrepancies were identified during follow-up. Complications were rare and unrelated to the external fixator-assisted techniques. Implant removal was performed in 38.7% of cases.</p><p><strong>Conclusions: </strong>FALP and FAN techniques are safe and effective methods for the acute correction of severe multiplanar lower limb deformities in adolescents. They enable precise 3-dimensional correction with reliable bone healing and early return to activities and may represent a useful alternative to gradual correction methods in appropriately selected cases.</p>","PeriodicalId":47648,"journal":{"name":"Clinics in Orthopedic Surgery","volume":"18 4","pages":"761-770"},"PeriodicalIF":2.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680530","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}